By: Mr. Mike Greene FRCS FFAEM, Consultant Accident & Emergency Medicine
A — Assess
Assess the accident site.
Assess the safety of the casualty, other party members and yourself.
Assess the cause of the accident – it will provide clues to the injuries sustained.
A — Approach with care
Do not cause a second accident.
A — Airway
Ask the patient a question. A casualty who can talk has an open airway. If they are not responsive an airway problem can be anticipated. LOOK, LISTEN & FEEL for air movement at the mouth.
If this is not present remove any obvious vomit or foreign material from the mouth using a finger. The tongue can be lifted from the back of the mouth using a jaw lift or thrust manoeuvre. Avoid moving the neck of an unconscious injured climber. The cervical spine should be held still by another helper and then immobilised before they are transported to prevent injury to the spinal cord.
B — Breathing
LOOK & FEEL for movements of the chest wall.
The chest should move symmetrically and the normal rate of breathing is 12 – 16 breaths per minute. Fast or slow rates should alert you to a potentially serious problem that will prompt a high degree of urgency for rescue.
C — Circulation
Blood loss may be obvious from a wound or open fracture. In general applying direct pressure and elevating the limb if this is possible should control external bleeding. Internal bleeding into the chest or abdomen maybe expected from the mechanism of accident and the casualty’s physical condition. Look for signs of severe blood loss – a fast pulse > 100 per minuet, rapid breathing, pallor, sweaty skin and anxiety or loss of consciousness. These signs require a high degree of urgency in rescue.
D — Disability
This really means conscious level. Is the casualty Alert and can answer all your questions, only responds to Verbal commands, worse only to Pain or are they Unresponsive ? ( A.V.P.U. score) This information will be helpful to the rescue team in assessing the urgency of the situation. Reassess the conscious level of a casualty with a head injury at regular intervals and report changes to the team.
E — Exposure to the elements
Any mountain casualty is at risk of rapid cooling and hypothermia as are the accompanying party and rescuers.
Arrange shelter and insulation from the ground as soon as possible to prevent the condition from becoming worse.
F — Fractures
LOOK & FEEL for fractures. These are common in mountaineering accidents. Look in particular for suspected fractures of the spine were inappropriate movement may cause further damage, rib fractures which may have injured the lungs and pelvic fractures which can bleed heavily. Immobilise and splint a fractured limb. Provide suitable pain relief if possible.
G & H — Get Help
If you use a cell phone stay where you are and DO NOT TURN IT OFF – the rescue team will want to talk to you for more information after you have dialed 999 and spoken to the police. The number of casualties and an assessment of injuries.
I – I hope you never have to use this information!