Acronyms In First Aid
A lot of my students in the past always had the same complaint, why so many acronyms in first aid and Emergency medicine? Well, there’s a lot of information that a first responder needs to remember during times of stress and acronyms help fill in the blanks during assessments and priorities. The ABCs of Airway, Breathing, and Circulation have now been stretched to the ABCD and E. In a traumatic bleeding injury, ABCs are modified to CAB, so bleeding(circulation) takes priority over the airway and breathing. The wilderness environment adds a level of difficulty to patient care thus the addition to the ABCs & D for deformity and E for the environment. The deformity is the type of injury and how rescuers are going to remove the patient for definitive care. The type of specialized equipment used to move a person with a spinal injury is a lot different and requires more personnel than an ankle sprain or a dislocated shoulder. The environment adds to the seriousness of the emergency when faced with extreme cold and hot temperatures. The longer the person stays in the environment waiting to get removed, the person providing aid must manage the victim’s body temperature until definitive care is reached. Managing hyper or hypothermia can drastically change the patient’s outcome and recovery. The environment around the patient and rescuer can also be dangerous such as wildfires, avalanches, or wild animals, and must be moved to safety before care can be initiated.
After the ABCE and Ds are covered, AVPU stands for Alert, Verbal, Painful, and Unresponsive when assessing the person’s level of alertness. When a person walks up to you your gaze should look up and make eye contact as if you recognize something in your space making the patient Alert to normal human behavior. If the person is staring past you or away without any recognition of your presence they are not alert and move to V for verbal response. A loud shout of the person’s name or “hey you” with recognition makes the responsive to verbal (unless hearing impaired, or injury to the ears) If there is no response go to P for Painful. A pinch to the trapezius or back of the arm will make a person move away from the pain or place focus on you. Let’s not go to the extremes of pain to not leave a bruise or get an assault charge. If there is no response to pain, you document U for Unresponsive.
MOI- Mechanism of Injury and NOI- nature of illness are used to help describe the person's chief complaint. In a traumatic injury mechanism of injury or MOI is used to describe how the person injured themselves, for example, fall from a height of 20ft or more, blunt force from an object, stab wound or penetrating injury or impalement. The nature of illness or NOI is for medical emergencies such as chest pain or difficulty breathing. In some instances, MOI and NOI may crossover in cases when a person passes out from exhaustion/ dehydration first and then falls down a hillside or strikes their head on the ground suffering injuries. The report would go, a head injury from a fall was secondary to passing out from exhaustion.
SAMPLE- is used to gather information about the patient for definitive care and treatment. S for signs and symptoms of the illness like headache, pain, or shortness of breath. A-for allergies to medications or to foods and bees. Often found on a wallet card or bracelets/necklaces if unresponsive ask family member/bystander. M-medications taken whether prescription or non-prescription to help with obtaining medical history or possible overdose. P for Pertinent medical history meaning relevant to the person’s current condition. L= last oral intake whether its liquid or solid food. Last one, E -events leading up to the current patient’s condition. *Pro-tip, when you have somebody getting in the way of your assessment by acting hysterical or verbally abusive, send them to gather this information.
DOTS – is used to help find injuries on the head-to-toe assessment. D- is for deformities to the body that indicate a broken bone or internal injury. O – open wounds are obvious breaks in the skin for a route of infection or blood loss. T- tenderness when you physically touch the area or palpate with a complaint from the patient. S- swelling in an area or extremities can identify injury below the surface of the skin.
To help our students at The Woodsrunner School LLC., during the wilderness first aid class we provide a quick reference laminated card to every student to reinforce assessment skills during the class and help with future emergencies if encountered after the class.
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Jeff Goalen, NRP
"The Woodsrunner Medic"
Wilderness Medicine Instructor
Woodsrunner School, LLC