Scene Assessment in the Real World

By: Astrid de Jager

A man sits on a rock at the side of a dirt road in a small residential area. Laying in the dirt in front of him is his bicycle. He wears a helmet and gloves. Blood is dripping from both elbows and forms a small puddle on the ground underneath. His face is bloodstained. Cars are stopping and people are coming out of their houses, forming a circle around the man. An ambulance is called. One of the drivers takes the first-aid kit from the trunk, asks the neighbors for water and starts assessing the man, assigning tasks to the bystanders as she goes. 

Realistic Emergency Scene Assessment 

Everyone who’s done a first-aid class has heard of them: Scene assessments. Usually they come with cool mnemonics, like SAFE or the famous Five Steps which are designed to help you remember the vital steps in scene assessment. But they might feel a little unrealistic. Who takes the time to Stop and think, consciously Assess the scene, Find the necessary items (like phone, first-aid kit, AED) and don Exposure protection, all before even approaching the possible victims? That is nonsense, right? People might be dying! 

Scene Safety and Assessment

Accident scenes can be chaotic, even when there’s just one victim. It’s easy to react rather than act, and even easier to get overwhelmed and lose track of what needs to be done. Therefore, while learning or teaching first response classes, we take time for a scene assessment drill. We go through the motions and learn the different steps to take. There are several ways to go about this. But there are a few steps that you will always need to cover, and covering them in the same order will prevent you from skipping a step in a real emergency:

1. Take a breath. Think. This does not take long. But it might save you time later, because thinking before you act may prevent you from forgetting something crucial.
2. Assess the situation from a distance. Remember that your safety is paramount. If you get hurt, you cannot help. Do what you can to make the scene safe for you, the victim, and the bystanders. This may include parking your car in a way that blocks traffic, turning on warning signs, flipping the main electricity breaker or opening a window. It might even involve doing nothing and waiting for the fire brigade.
3. Think about what you have and what you need. If you don’t have what you need, think about the quickest way to get it. Do you have a first-aid kit in your car? Bring it. Do you have gloves? Wear them. If you don’t, do you have hand sanitizer? Water? Soap? Tissues?
4. Here’s where you put bystanders to work. If there’s something you don’t have, let them get it. Let them call an ambulance or warn the victim’s family if applicable. Let them handle incoming traffic or show the first responders where to go. You may be the only person that knows what needs to be done. But that doesn’t make you the only person that can do it.
5. Does your scene have multiple victims or victims with multiple injuries? Try to assess the most immediately life-threatening injuries that you can help with, and start with those. Again, use bystanders wherever possible.
6. Assess the victim’s health.
   1. Introduce yourself and start a conversation. Who are they? How do they feel? What happened? Were they alone? Who’s waiting for them? Do they have a phone or phone number to call their family?
   2. If the victim is not responding to questions, what is their level of responsiveness? Do they open their eyes when spoken to? Do they respond to pain? Or are they completely unresponsive?
   3. Check breathing and pulse. If the victim is unresponsive and breathing and pulse are undetectable, start CPR. But if they are talking, it’s safe to assume they have a pulse.
   4. What’s the skin color? Is it (relatively) normal, or exceptionally pale? Look at the extremities: are they pale or bluish? What about their lips?
   5. If warranted, check for bleeding and bruising – as far as you can do this without moving the victim.

Real World Emergency Scene Scenarios 

Now let’s try to apply this to some real-world scenarios:

On a narrow road, a man in a pickup truck tried to pass an old van and a smaller sedan, right before a sharp left turn. Right after the turn a small herd of donkeys decides to cross the road. The driver of the truck swerves to avoid them, pushing the sedan next to him off the road. The woman loses control and her car lands two meters down in the bushes, nose first into a large tree. The toddler who had been standing in between the front seats has disappeared from sight. The old man driving the van responds too late and hits the left back of the first car full speed, pushing it across the road. The impact causes his head to collide with the steering wheel, rendering him unresponsive. As other cars approach, the driver of the pickup is stumbling out of his car. A small amount of fluid is leaking from under it.

 Imagine approaching this scene with your car. What do you do? What can you do? Where do you start? Again, a quick but systematic assessment could save you a lot of trouble. So:

• Take a breath. Think! And last but not least: call emergency services.
• How can we improve safety? Can you block the road and warn incoming traffic on both sides? Can you safely approach the accident? What about the fluid leaking from the pickup truck? Is it condensation from the AC or could it be oil or gasoline? If so, is there any open fire or sparks that could cause a major problem?
• Find first-aid materials.
• Find anything that might help. Bush trimmers? Blankets? Water? Anyone that might help?
• Triage:
  • The guy stepping out of his truck: Does he respond to questions? Any visible injuries? Anything that points toward head injury? If not, make him follow you or leave him under supervision of a bystander.
  • The old guy in the van: Is he breathing? Does he have a heartbeat? Visible and extensive bleeding? If all of the above, treat the bleeding, leave him under supervision of the truck driver or a bystander and move on.
  • Get to the sedan: Can you open the door? If so, did the airbags fire? If not, approach from behind. Check the injuries, treat the ones you can and leave the rest for emergency services. Do not move the victims, unless not moving them poses more of a danger than moving them.

A regular day at the office. Or so it seems. One of your colleagues, a male in his fifties, looks a little pale. He makes it back to his desk, but pretty much collapses onto his chair. He starts sweating, and complains of feeling dizzy and nauseous.

How would a scene assessment be relevant in this case? Well, let’s start at the beginning.

• Stop, breath and think: Did your brain immediately go to ‘heart attack’? You might be right. But your colleague might be suffering from something as innocent as food poisoning, or even a panic attack. How can you find out quickly?
• Assess: In this case, the scene will probably not pose any dangers to you. The chances of gas or hot electricity wires in an office building are slim. But what about your colleague? If he collapses behind his desk, can you still get to him? Is he going to hurt himself by hitting anything on the way down? Can you move him now and prevent future problems?
• Find: Call for assistance, make sure you have someone with a phone ready, and send someone to grab the first-aid kit and AED, just in case.
• Extras: Get people that can help. Clear out anyone that can’t. And get some materials that might help you in this specific case, depending on your skillset, like:
  • A bag or bucket in case of vomiting
  • A pen and piece of paper, so you can write down your observations
  • A watch or clock that can measure seconds, so you can measure the heart rate and breathing
  • Blood pressure cuff and / or pulse oxygen meter if available and you know how to work them
  • Medical history and / or a list of medications he’s taking, if this is available.
  • Contact information for next of kin.
• Assess your colleague, starting with the events, his consciousness, pulse and – if you can – blood pressure. Go over anything else that could cause a problem, like allergies, medications, and pre-existing medical conditions. If any of these is alarming or if you’re not entirely sure: call an ambulance. Just make sure he didn’t just run up seven flights of stairs, or aeat a suspicious oyster.

Incidents and accidents can be chaotic and overwhelming. However, knowing a way to start can help to get you moving in an efficient way, while preventing worse from happening to you or the victim(s). Teaching yourself some of the motions, no matter how artificial they look during class, might save a life one day. It might even save yours.