AIM: To detect and correct life threatening illness or injury.

Danger

Position the ambulance appropriately, taking into consideration patient access and egress.

• Don appropriate PPE.
• Approach scene cautiously.
• Assess for dangers to self, partner, bystanders and patient. Look, listen and smell to identify potential or existing hazards present. Evaluate risks and negate danger if safe to do so.
• Consider need for other emergency services required to ensure scene safety (WA Police, DFES, SES).
  • If the patient is in immediate danger and they can be moved safely, do so at this stage, regardless of injury.
• Do not enter scene until deemed safe.
• If multi-casualty incident is evident, refer to the Emergency Management Guidelines

Response

• Perform a brief neurological assessment to establish patient’s conscious state (AVPU).
  
  • Alert = Describes a patient who is spontaneously awake and aware of their surroundings.
  • Verbal = Describes a patient who responds to verbal stimuli i.e. when spoken to in a loud voice.
  • Pain = Describes a patient who responds to touch or a painful stimuli (trapezius squeeze only)
  • Unresponsive = Describes a patient who does not respond to verbal or painful stimuli.

Send for Help

• Establish need for emergency services back-up:
  
  • Consider how many patients there are at the scene, and their condition
  • Are additional ambulances required?
  • Are the Police and/or Fire/Rescue services required to help manage scene safety?
• Establish need for Clinical Support to assist with patient management: 
  • Clinical Paramedic: Contactable 24/7 in State Ambulance Operations Centre – referred to as CSPSOC.

Airway

• Open mouth using cross-finger technique.
  
• Inspect oral cavity for any obstruction and/or fluid.
• Clear airway with lateral position to assist drainage, finger sweeps, and/or suction.
• Open the airway by performing an appropriate airway manoeuvre:
  • Triple – non injured adult patient
  • Double – spinal injured adult patient
  • Neutral alignment – Paediatric patient
• Maintain: Consider Oropharyngeal Airway (OPA) or Nasopharyngeal Airway (NPA) if unresponsive/appropriate.
• Place in lateral position if unconscious, once signs of life have been confirmed.

Note: Consideration of c-spine injury should take place during airway assessment and management. If injury is suspected, positioning and immobilising of the head in neutral alignment is indicated, but not at the expense of the airway.

Breathing

• Assess breathing for adequacy. Look, listen and feel for 5-10 seconds:
  
  Look:
  • Equal rise and fall of chest wall
  • Rate, regularity and effort of breathing
  • Accessory muscle use
  • Cyanosis (Blue tinge, commonly seen at the finger nails and lips)
  • Tripod positioning
  • Recessive breathing in paediatrics (sucking-in of chest wall)
  Listen:
  • Abnormal noises associated with breathing (wheezes, crackles)
  • Ability to talk in full sentences
  Feel:
  • Rise and fall of chest
  • Breath on cheek (unconscious patients only)
• Apply SpO₂ monitoring if trained and authorised.
  
• Record dyspnoea score
• Correct any breathing problems encountered according to relevant CPGs or Skills (e.g. Ventilation).
• If patient is not breathing/not breathing normally, commence resuscitation.

Circulation

• Assess for bleeding and control any life threatening haemorrhage according to relevant skill/CPG.
• Palpate a pulse for 5 seconds. Note characteristics such as speed, regularity and strength.
  Common pulse sites and situations include:
  • Carotid (unconscious patients, or conscious patients where radial pulse is difficult to locate)
  • Brachial (infants)
  • Radial (conscious adult patients)
  • Apical (newborns)
• Assess capillary refill.
• Assess skin temperature and colour (useful in identifying shocked patients).
• Correct any life threatening circulatory problems according to relevant CPG.
• Where CPR is indicated and chest compression initiated, attach defibrillator as soon as possible to assist with restoration of circulation as per cardiac arrest CPG.

Disability

• Rapid assessment of brain function:
  • Assess conscious level (AVPU/GCS)
  • Assess pupil reaction to light (PERL)
  • Assess neurological limb function (sensation, movement and strength)
  • Perform BGL where patient is not fully alert and orientated to time, place and person
  • Perform FAST test where stroke is suspected.
    • If FAST positive, complete RACE evaluation
  • Consider temperature where suspected of causing reduced conscious level
  • Correct life threatening disability problems according to relevant CPG

Exposure & Evaluation

• Perform brief systematic head to toe evaluation:
Expose:
• Potential injury/illness sites, manage according to relevant CPG
• Consider exposure to the elements, don’t leave exposed unnecessarily.
Evaluate:
• Treatment/interventions provided
• Time critical status

Note: Any patient exhibiting significant primary survey problems is deemed time critical and requires urgent transportation to the nearest receiving hospital under Priority 1 conditions. Constant reassessment, life-saving interventions and a pre-alert/notification should be carried out en-route.