The Three Second Medical Assessment
New medics often learn a comprehensive head-to-toe method of assessment that covers just about every conceivable condition or presentation, but can take as much as two or three minutes to perform. That’s way too much time in many situations so here is the Seven Second Assessment.
In no way is it suggested that you can or should half-ass your assessment of a casualty if you don’t have to. This method is offered as a quick and dirty way of ascertaining casualties Massive Hemorrhage, Airway, Respiration, Circulation and progression towards irreversible shock in as short a time as possible, in the event you need to be focusing on other things.
It is just a method to allow you to get a quick idea of whether or not this person needs immediate intervention to save their life, or if you can wait a few minutes to deal with them.
There are two basic components, and should be performed in this order:
1: Look: Often referred to as the ‘Look Test’. The first thing you should be doing when approaching a casualty is looking them over head to toe. This is just a quick once-over, and you’re really only looking for three things.
1a/ Is the person awake and looking back at you as you approach?
1b/ Can you see any obvious, major injuries?
1c/ What is their skin like?
If the casualty is awake and looking at you as you approach you’ve confirmed one critical element – they’re conscious and alert. This means their central nervous system is intact and functioning, and they’re getting oxygenated blood to their brain. If they look asleep or unconscious, this person is critical until proven otherwise.
Next, you’re looking for any major and obvious injuries. We’re talking about exposed organs, missing or severely mangled limbs, bright red spurting blood or large pools of blood. Don’t be fooled into thinking that just because someone looks like a bloody mess they’re automatically seriously injured – many minor lacerations bleed like crazy (scalp lacerations in particular), and even a relatively minor amount of blood can look horrific if its spread all over a person.
Thirdly, take a look at the condition of their skin. What you’re looking for is pale, bluish skin (called cyanosis) or people drenched in sweat, which are both warning signs of shock.
These three elements need to be brought together to give you an idea of how badly off the casualty is. Someone who is awake and looking at you, doesn’t have any obvious major injuries and who has a normal skin tone and condition is doing well at this point. A casualty who isn’t alert, has obvious major injuries or is pale and sweaty is someone you need to be worried about.
Your next step is to start talking, and you only need one question to get all the information you need at this point.
“Are you okay?”
What the response is isn’t as important as how they say it. What you’re hoping for is a clear, coherent response given without a lot of effort. A person who responds with something like “I’ve been shot!!!,” has given you three bits of critical information:
2a/ Intact Airway – He can get air through his trachea. This is very good.
2b/ Level of Awareness – He understood your question, and formed a situation-appropriate response, meaning his brain is getting enough oxygen to function, at least for the moment. This is also good.
2c/ Respiratory Effort – He is moving air well enough to be able to speak, meaning his lungs are working reasonably well. This is good.
By contrast, a person who moans incoherently while gasping for air with blood bubbling out of his mouth also gives you three critical facts:
2a/ Airway Compromised – Blood in his trachea. This is extremely bad.
2b/ Possibly not Aware – His brain may not be getting enough oxygen. This is also very bad.
2c/ Insufficient Respiratory Effort – His lungs are compromised or not working well enough to move air. Again, very bad.
And that’s pretty much it. With practice, this entire process can be carried out in about three seconds. What you choose to do with the information you acquire is entirely dependant on the context of the situation at hand. Again, all you’re hoping to achieve with this is getting a quick-and-dirty picture of how badly injured a casualty is – if, for example, you’re in a situation where you need to decide if a team member or family member needs to be evacuated now, or can wait a few minutes while a potential threat is dealt with, or other personnel or family in other areas are checked out.
It cannot be overstated the fact that this method is not intended to be a replacement for a proper, thorough assessment. Use this method if you need to know someone’s medical status and you need to know it fast.