When an emergency happens, the immediate actions taken by a bystander can make a profound difference in the outcome for the patient. Patient assessment in this context is not a formal medical diagnosis but a rapid, organized process designed to identify and address immediate life threats. The goal is to stabilize the person enough to survive until professional medical help arrives and to gather accurate information to relay to the emergency responders. Understanding this systematic approach helps a layperson move past panic, focusing efforts where they can have the greatest impact on preserving life and ensuring effective communication with the incoming team.
Immediate Safety and Responsiveness Checks
The very first action in any emergency situation is to ensure the environment is safe for both the patient and the rescuer. Before approaching, quickly check for ongoing hazards, such as traffic, fire, falling debris, or downed power lines, often referred to as scene safety. If the scene poses a danger, the priority shifts to moving the patient to a safer location, if possible, or calling for specialized rescue assistance.
Once the scene is deemed safe, the next step is to determine the patient’s level of consciousness using the AVPU scale. This straightforward assessment checks whether the patient is Alert, responds to Voice, responds only to Pain, or is completely Unresponsive. Begin by speaking to the person, asking a simple question like, “Are you okay?” to gauge if they are alert or respond to voice commands.
If there is no response to voice, apply a gentle but firm painful stimulus, such as a squeeze of the trapezius muscle or pressure on the nail bed. A patient who only reacts to this stimulus is classified as “Painfully Responsive.” If the patient fails to respond to any checks, they are considered “Unresponsive,” indicating severe neurological impairment and demanding immediate medical attention. This rapid check determines the urgency and informs the rescuer’s next steps.
Primary Assessment: Checking Vital Functions
After establishing responsiveness, the primary assessment focuses on immediate life threats, commonly remembered through the ABC mnemonic: Airway, Breathing, and Circulation. The assessment sequence begins with the Airway to determine if air can pass freely. If the patient is unconscious, the tongue can obstruct the upper airway, requiring a manual maneuver like the head-tilt/chin-lift to correct. If a neck or spinal injury is suspected, use a jaw-thrust maneuver instead to minimize potential cervical spine movement.
Next, assess Breathing immediately after ensuring a clear airway. The rescuer should look for the rise and fall of the chest, listen for air movement, and feel for breath against their cheek for no more than 10 seconds. If the patient is not breathing normally or is only gasping, treat it as a respiratory or cardiac arrest, and immediately shift focus to intervention.
The Circulation check focuses on identifying severe, life-threatening external bleeding, which can lead to rapid shock. Uncontrolled external hemorrhage must be stopped immediately by applying direct, continuous pressure to the wound with a clean cloth. If the patient is unresponsive and not breathing, bypass a pulse check—as laypersons often have difficulty locating a pulse—and immediately begin chest compressions. Chest compressions, delivered at a rate of 100 to 120 per minute, maintain minimal blood flow until professional help arrives.
Gathering Contextual Information (Patient History)
Once immediate life threats are addressed, or if the patient is conscious and stable, the focus shifts to gathering relevant background information. This verbal data collection is structured using the SAMPLE history acronym, which provides a framework to collect details for medical providers. For a patient unable to communicate, this information can sometimes be found on medical alert bracelets, wallet cards, or emergency medical identification stored on a mobile phone. The systematic use of the SAMPLE history provides a comprehensive narrative to the responding emergency medical team.
The SAMPLE Acronym
- Signs and Symptoms: Signs are objective observations (e.g., pale skin or swelling), and symptoms are the subjective feelings the patient describes (e.g., pain or nausea).
- Allergies: Covers allergies to medications, food, or environmental factors.
- Medications: Addresses all current medications, including prescriptions, over-the-counter drugs, and supplements.
- Past medical history: Involves asking about pre-existing conditions, recent surgeries, or chronic illnesses that might relate to the current emergency.
- Last oral intake: Refers to the last time the patient ate or drank anything, which is relevant for subsequent medical procedures.
- Events leading up to the incident: Asks the patient or witnesses to describe what they were doing just before the emergency occurred.
Observing and Documenting Specific Findings
The final stage involves a detailed, systematic observation of the patient’s body for injuries and symptoms that were not immediately life-threatening. This secondary observation includes looking for obvious deformities, localized swelling, or unusual skin coloration, such as paleness, flushing, or a bluish tint indicating poor oxygenation. The rescuer should also check for changes in skin temperature and moisture, noting if the skin feels cool and clammy or hot and dry.
A primary component of this phase is documenting and communicating these findings effectively to professional responders. The rescuer should clearly note the exact time the injury occurred or the symptoms began, and the specific location of any pain or deformity. It is also important to record any changes in the patient’s condition, particularly their level of consciousness, throughout the assessment process. This detailed, objective report allows emergency medical services to transition seamlessly into advanced care.