Every job a paramedic enters, the risk of getting injured is always prominent; But with the correct approach, that risk is minimised. Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. After checking for dangers, the paramedic will need to check the patient’s level of consciousness using the AVPU scale. The paramedic then checks the airway, breathing and circulation of the patient, using a triple airway maneuver. Finally, the secondary survey will be discussed with the commencement of the patient’s history, pain assessment, head to toe physical examination and vital sign check.
“Ten Australian paramedics were seriously injured each year as a result of an assault,” so efficient procedure of risk management, is mandatory for every scenario a paramedic arrives to (Maguire et al, 2014).) When responding to a scene as a paramedic, checking for danger as part of your primary survey, is vital to protect yourself, your partner, bystanders and the patient. The Queensland Ambulance Service (QAS) clinical manual states that the primary and secondary survey epitomize the major and consecutive process of patient assessment (QAS, 2016). Looking for dangers and a POP (person, object and place) assessment is essential for every single patient a paramedic gets dispatched too. If there is a danger prominent at a scene, it is “Important to control the danger if it is safe to do so, requesting assistance from another agency such as police, and/or removing yourself from the scene completely until it’s safe to reenter the scene” (Halliwell et al, 2011). When assessing the person aspect of POP, you are dealing with the person’s age, height, build, gender and their body language. (Davies, 2016). These dangers involving a person could be heightened when someone is under the influence of alcohol or drugs, or someone who is mentally ill. In relation to objects at a scene, a lot of household items can hold an accountable danger, as it can be used as a weapon. Objects to look out for are knives, large furniture, machinery, vehicles etc. and other objects that could pose a severe risk of being used as a weapon (Queensland Police Service, 2014). Lastly, there could be some dangers in the place you are responding too, such as the height of the job, remote areas, blocked doorways, and where there could be working machinery present (Queensland Police Service, 2014). In relation to Sarah’s scenario, the paramedic is not in any obvious danger and can move onto the AVPU scale. Therefore, the risk towards a paramedic is always going to appear in jobs, but with the correct procedure of checking for dangers and the POP assessment, the threat is minimised, allowing the paramedic to further go on to his primary survey, and moving into response and the ABC/CAB method.
After checking for dangers, the paramedic will need to check the patient’s level of consciousness using the AVPU scale. Using the AVPU scale, is the patient alert and cognitive? Is the patient responding to verbal stimulus? Responding to pain? Or are unresponsive? (QAS,2016). If the patient is fully awake (they do not need to be orientated), then they are considered to be alert. If the patient has a response to yours, partners or bystanders voice, that means that they are triggered by a vocal stimulus. This response could be as little as a groan, scream or even a slight movement of limb or eyes if it is triggered by voice (Harmony Event Medicine, 2019). If the patient responds to a pain stimulus, such as the paramedic rubbing the breastbone or pinching their fingernails, then they respond to pain. “The person assessing should always exercise care when performing pain stimulus as a method of assessing levels of consciousness,” and should not further create injuries or profusely make the injuries worse (Fairley et al, 2005). Back to the case scenario, Sarah is turning blue, with her conscious level unknown from the caller, but could be assumed that she is unconscious due to her appearance. When the AVPU scale is completed and the patient is given a score, the paramedic can then go onto ABC/CAB.
After checking the patient’s level of consciousness, the paramedics will then check the airway, breathing and circulation, commonly known as ABC. “The evidence supporting the systematic ABC approach to critically ill or injured patients is expert consensus,” and is widely encouraged for everyone to know the basics of the approach (Thim et al, 2012). If the patient is unresponsive, you will have to check the circulation first, and breathing will then follow. If the patient is awake and alert, talking and breathing normally, their airway is clear. If the person is not responding and is unconscious, you will need to check the airway for any obstruction using the triple airway maneuver, or a modified airway maneuver if there is a spinal injury present. You will open the airway by tilting the patients head back towards the neck and thrusting the jaw open, supporting the patient’s neck (Queensland Health,2017). To check for breathing, you will look for the rise and fall of the patient’s chest, while putting your ear near their mouth and nose for any sign of respiration. You can also feel for breathing, by putting your hand on the lower extremities of the chest and abdomen, for a sign of movement (Victoria Government, 2014). Finally, checking for circulation requires examining the patient’s pulses, and to count the rate, rhythm and strength of the pulse (QAS,2016). To check the pulse, “place an index finger on the underside of the patient’s wrist, below the base of the thumb,” or the side of neck, where the corroded artery is” (American College of Cardiology, 2015). The circulation can also be assessed by the colour of the patient’s skin, sweating or a decreased level of consciousness or any signs of drop-in perfusion (Thim et al, 2012). In the case, you will do CAB, as Sarah is unconscious and is turning blue. Therefore, the systematic ABC method is required to check for any airway obstruction, patient not breathing or the commencement of CPR.
After the following steps, a secondary survey is commenced after the patient is stable and any immediate life threats are handled. The secondary survey consists of the patient’s history, pain assessment, head to toe physical examination and vital sign survey (QAS, 2016). Taking an adequate patient history is vital for the understanding of the extent of injuries present, and any other injuries that may be present. The use of the SAMPLE acronym is used to gathering the patient’s history properly (Victorian Department of Health, 2019). For example, the paramedic will ask for the current medication the patient is taking, and of the patient has any allergies, including medications or environmental (QAS,2016). Performing a head and toe examination required the paramedic to go down the patient’s body, head to toes, to see if there are any other injuries that might be present. For example, you would look in the ears “for bleeding or a suggestive base of skull fracture” (Royal Children Hospital Melbourne, 2019). As well, vital signs are conducted including “pulse, respiration, skin signs, pupils, temperature, blood pressure and glucose level etc.” (United States Department of Health, 2017). The secondary survey is required to further go on to treat the patient and stabilise the patient’s injuries to transport to the hospital.
The effective uses of a primary and secondary survey on a patient are crucial for the stabilisation for the patient and safety for all parties at a scene. Danger will always be adherent to a paramedic, but with the correct systematic approach of POP and identifying these dangers, the risks will not be as high. The AVPU scale and ABC method are used together to establish the conscious levelness of a patient and to correctly perform the measures of checking for a clear airway, normal breath sounds and respiratory rhythm. Lastly, the secondary survey is needed to check the patient’s history, and to check for any other existing injuries, making sure to check for abnormalities using the head to toe, or their vital signs. It can be shown, that the correct systematic approach of the elements we discussed, Sarah will be given the appropriate care, while leaving the paramedics safe.