Scene assessment is the critical first step in any emergency response situation. It involves quickly evaluating the environment and circumstances surrounding an emergency before approaching or treating any victims. This systematic evaluation ensures the safety of both the first aid provider and the victim while determining the best course of action.
Why Scene Assessment is Important
1. Safety First
- Protects rescuers from becoming additional victims
- Prevents further harm to existing victims
- Ensures a safe working environment for providing care
2. Situational Awareness
- Helps understand what caused the emergency
- Identifies potential ongoing threats
- Determines the scope and severity of the situation
3. Resource Planning
- Assesses the number of victims needing help
- Determines what type of help is needed
- Identifies available resources and bystanders
Remember
Never rush into a scene without proper assessment. A few seconds of evaluation can prevent you from becoming part of the problem rather than the solution.
How to do a Scene Assessment ?
Mentally Prepare
- Stop: Pause for 1–2 seconds before moving in.
- Observe: Use all your senses — look, listen, smell — before you approach.
- Think: Base on what you have sensed, try thinking in methodically way to analyze the possibilities.
- Plan: Decide your approach, where you’ll stand, and how you’ll exit.
Remember
Keep your breathing slow and steady, approach with care. A calm rescuer makes better, safer decisions.
Identifing Hazards and Potential Dangers
Look for specific dangers and decide how you’ll control or avoid them:
- Traffic and moving machinery: oncoming cars, bikes, forklifts, etc.
- Fire/heat/smoke/explosion risk: flames, burning smell, popping sounds, gas cans. Keep distance; don’t enter smoke-filled or fire areas.
- Electrical: downed wires, damaged outlets, water near power.
- Gas/chemicals/odors: fuel, solvents, chlorine/ammonia smells, hissing from cylinders. Otherwise back out and call EMS/fire.
- Water and environment: deep/fast water, ice, flooding, extreme heat/cold, lightning.
- Structural instability: collapsed roofs/walls, falling debris, unstable vehicles, ladders, broken glass.
- Violence/security: weapons, aggressive persons, fights.
- Animals/insects: any animals that may harm you or victim; wasps, snakes, bear, wolf, etc.
Call for help
If you not sure what to do, what you can do or the environment will put you in danger, you should always call EMS or other bystanders for help.
Is it safe to enter?
Ask yourself:
- Can I reach the victim without putting myself at significant risk?
- Can I keep a clear exit path the whole time?
- Do I have the PPE and help I need?
If any answer is “no,” keep your distance, secure the area, and call EMS. Your safety comes first.
Survey the scene for the mechanism of injury
Use what you see to predict injuries and priorities:
- Trauma clues: vehicle damage, broken glass, skid marks, height of a fall, sharp/blunt objects, helmet damage, furniture/wall impact, blood patterns.
- Medical clues: medication bottles/inhalers/insulin, glucose meters, medical alert bracelets, oxygen equipment, recent illness, environmental stress (heat/cold).
Mechanism of injury informs you the injuries is a result from external factors or medical illness or disorder.
Spinal injury clues
- A fall from height
- Head, neck or back injury that caused by a external force.
- Clear injury at head, neck or back.
Recognize, Assess, Act
Continually monitor for change
Scenes change. Stay alert at all tiem and reassess every period or after any new event:
- Worsening fire/smoke, raising water level, shifting traffic, changing weather/light.
- Crowd or aggressor behavior changes.
- New odors, sounds (hissing, cracking), or structural movement.
- Patient condition changes.
If the risk increases, move yourself to safety first, then direct the patient/bystanders if possible. Always maintain an exit route.
Primary Assessment - ABC Approach
- A – Airway: Is the victim's airway open and clear?
- B – Breathing: Is the victim breathing normally?
- C – Circulation: Check for signs of circulation, such as movement or normal skin color.
- LOC – Level of Consciousness: Is the person awake or not responding?
Step 1 - Level of Consciousness
- Approach, identify yourself, and get consent if possible.
- Tap and shout: "Are you okay?", squeeze or pinch gently if applicable.
- If unresponsive: call EMS. Put cellphone on speaker if you’re alone.
AVPU Assessment for Level of Consciousness
Alert: Open eyes and follow instructions
Voice: Does not open eyes and only responds to voice
Pain: Only react to painful touch
Unresponsive: No respond to verbal or painful touch
Note
If the victim is able to talk with you normally, you can also assume they have breathing and circulation in most cases.
Step 2 - Airway
- In the event of airwya obstruction or unresponsive victim, open the airway with a head-tilt, chin-lift.
- If you suspect head/neck/spine injury, use a jaw-thrust technique.
- Remove objects if any that blocking the airway if possible and safe.
- Turn victim to their side if find difficult in removing it with fingers. It is recommend to turn them towards you so you can see it clearly.
Step 3 - Breathing
- Look, listen, and feel for breathing for 5 seconds.
- Keep victim's airway open.
- Watch the chest and abdomen for rise and fall; listen and feel for air at the mouth and nose.
Step 4 - Circulation
- If victim is NOT breathing, start CPR immediately.
- If victim is breathing, check for severe bleeding, a quick visual and physical head-to-toe examination.
Quick head-to-toe check
By gently running your hands from the casualty’s head to their feet (including under bulky clothing), you can quickly identify severe bleeding, possible internal bleeding, and obvious fractures.
- Wear gloves if available, and frequently check them for signs of blood.
- Move carefully to avoid causing additional injury.
- Watch the casualty’s facial expressions to detect pain or reactions while you assess.
Why we need to do a check for severe bleeding ?
Rapidly identifying and controlling severe, life-threatening bleeding is necessary to prevent the patient from going into shock and to address immediate life threats.
Why there is no pulse check ?
The pulse check was removed from the primary assessment for lay rescuers in the American Heart Association (AHA) and European Resuscitation Council (ERC) guidelines due to its inaccuracy and the significant time delay it caused in starting CPR.
First aid provider can assume cardiac arrest for a unresponsive non-breathing victim.
Decision Flowchart
%%{init: {'theme': 'neutral'}}%%
flowchart TB
S@{ shape: circle, label: "Start" } --> A{{Is Hazards Present?}}
A{{Is Hazards Present?}} -- Yes --> B{{Can be removed?}}
A{{Is Hazards Present?}} -- No --> C{{Is Spinal?}}
B{{Can be removed ?}} -- Yes --> D[Remove it]
D[Remove it] --> C{{Is Spinal}}
B{{Can be removed ?}} -- No --> E[Contact EMS]
C{{Is Spinal?}} -- Yes --> F[Prevent Movement]
C{{Is Spinal?}} -- No --> G{{Is Conscious?}}
F[Prevent Movement] --> G{{Is Conscious?}}
G{{Is Conscious?}} -- Yes --> H{{Distress?}}
G{{Is Conscious?}} -- No --> I[Contact EMS]
H{{Distress?}} -- Yes --> L[Treatment]
L[Treatment] --> M[Check for severe bleeding]
H{{Distress?}} -- No --> M[Check for severe bleeding]
I[Contact EMS] --> J{{Breathing?}}
J{{Breathing?}} -- Yes --> M[Check for severe bleeding]
J{{Breathing?}} -- No --> K[CPR]
M[Check for severe bleeding] --> N[Treat for shock]
N[Treat for shock] --> O[Secondary Assessment]
O[Secondary Assessment] --> Z@{ shape: circle, label: "End" }
Multiple Victim Situation
In a multiple-victim incident, do a very quick primary survey on each person to identify who has treatable life-threatening problems. In situations with severely limited or not enough resource, prioritize and treat the victims with severe, life-threatening injuries who have a high probability of survival.
The main priority categories in resource-limited situations are often color-coded (Developed by Hoag Hospital and Newport Beach Fire Department):
- Red (Immediate): Victims with severe, life-threatening injuries who have a high probability of survival with immediate intervention and transport (e.g., airway obstruction, massive bleeding). These are treated first to save the maximum number of lives.
- Yellow (Delayed): Victims with serious but not immediately life-threatening injuries whose transport can be delayed for a few hours without significant risk of deterioration (e.g., stable fractures, some burns).
- Green (Minor/Walking Wounded): Victims with minor injuries who are stable and can often assist in their own care or wait for treatment until the more critical patients are managed.
- Black (Expectant/Deceased): Victims who are unlikely to survive given the severity of their injuries and the limited available resources. Palliative care and pain relief are provided, but life-saving resources are allocated to those with a higher chance of survival.
Secondary Assessment
A first aid secondary assessment is a systematic examination that follows after the primary assessment and treatments. It is to identify any potential injuries and gather information for medical help.
Brief medical history - SAMPLE
- S = Sign & Symptoms - How is the victim currently feeling and issues? Look for things like bruising, swelling, pain, bleeding, weakness, etc.
- A = Allergies - Does the victim has any allergies?
- M = Medications - What medications is the patient currently taking or in the past 24 hours? Is there any doses they have missed?
- P = Past Medical History - Does the victim has any past medical conditions or any history of similar experience?
- L = Last Oral Intake - When did the victim last eat or drink?
- E = Events Leading to the Incident - How does this happen? What events happened just before the incident?
Head-to-Toe Check
Head-to-Toe check in secondary assessment is a more detailed examination on the victim. Ask victim for consent and explain what you’re doing if the person is conscious. Move systematically so nothing is missed. Wear gloves and check your gloves for blood frequently.
1. Head and Face
- Check scalp, forehead, ears, eyes, nose, mouth.
- Look for bleeding, deformity, fluid from ears/nose (possible skull injury), unequal pupils, bruising.
- Ask about headache, vision issues.
2. Neck
- Check for pain, swelling, or deformity.
- Be cautious of possible spinal injury.
3. Arms (Shoulders to Hands)
- Check upper arms, elbows, forearms, wrists, hands.
- Look for deformities, warmth, swelling.
- Check pulse at wrist if possible.
4. Chest and under
- Press gently on collarbones and chest.
- Look for bruising or instability (flail chest).
- Ask if breathing is painful.
5. Abdomen and under
- Gently press all four quadrants.
- Look for tenderness, swelling, hardness (rigidity may suggest internal bleeding).
6. Pelvis & Hips
- Gently press hips inward and downward.
- Ask about pain before moving legs.
- Be cautious—don’t force movement if pain is present.
7. Legs (Upper to Lower)
- Check thighs, knees, shins, ankles, feet.
- Look for deformity, bleeding, swelling.
- Compare both sides, feel temperature.
- Ask about sensation and movement.
Vital Signs Check
Keep checking victim's vital signs for every 5-10 minutes. There are 5 vital signs to check on:
- Level of consciousness
- Breathing
- Pulse
- Pupils
- Skin: color, temperature, texture
Documentation
After completing the secondary assessment, document everything you observed as clearly and accurately as you can. This information will be useful for medical professionals who continue treating the injured person.
In workplace emergencies, proper documentation is also important because it may be reviewed during an investigation. All details of the incident and the first aid provided should be written on standard reporting forms and kept according to provincial laws and regulations for future reference by investigators.