Identify Lethal Dangers | Size Up the Scene
Scan for immediate threats to life and use an alphabet cue—the letters A, B, C, D, and E—to focus and prioritize.
>> Check Look for obstructions. If the victim is conscious and breathing, have him empty his mouth.
>> Treat If he’s not conscious or breathing, open his airway. If you’re not worried about possible spine damage (see “Decide about the spine,” below), open the airway with the head tilt/chin lift (A): Place one hand on the patient’s forehead and the other under his chin. Press and lift, extending the head and raising the chin. If you suspect a spinal injury, use the jaw thrust (B): Kneel behind the patient with your hands on both sides of his head. With your thumbs on the cheekbones and fingers gripping the jaw bone, lift the jaw forward and up. Both moves should lift the tongue (the most common obstruction) off the back of an unconscious person’s throat.
>> Check Look, listen, and feel for a patient’s breath for 10 seconds. Position your cheek near the patient’s mouth and look down the midline of the chest.
>> Treat If there’s no breath and the airway is open, begin rescue breathing: 1. With one hand, hold the patient’s forehead and pinch his nose closed. 2. With the other hand, hold his mouth open and tilt the head (as above). Take a deep breath and seal your open mouth over the victim’s.* 3. Deliver a pair of two-second breaths into the lungs, watching the chest rise and fall. Deliver 10 to 12 breaths per minute.
>> Check If a patient is breathing, blood is circulating. If you’re rescue breathing, check for the patient’s brachial pulse on his wrist, below the thumb. If you can’t find a pulse there, feel for the carotid (neck) pulse. Also, check under the body for signs of major blood loss; on porous ground, a lot of blood can drain without pooling.
>> Treat Stop any fast, high-volume bleeding, regardless of pulse; apply pressure to the wound or pressure points. No significant bleeding but still no pulse? Begin CPR. Find tips on CPR and locating pressure points at backpacker.com/firstaidcenter.
Decide about the spine
>> Check Evaluate the patient’s mechanism of injury (MOI)—ask him or look for clues to how he got hurt. There’s a possibility of spinal trauma if he fell from higher than two times head height; landed with a bend, twist, or arch in his spine; or rapidly decelerated from high speed. Take pulses in each hand and foot to check for circulation. If the victim is conscious, ask him to wiggle digits in each extremity.
>> Treat If MOI hints at a spinal injury, immobilize the patient’s head and neck until you can do a focused spine assessment. Have a helper hold the head still, or if you’re alone, brace the head in place with padded rocks or weighted packs.
>> Check Expose injuries: Check all injuries at skin level to eliminate the possibility of a life-threatening bleed. Environment: Look for hazards (like rising water or lightning) that may intensify over time.
>> Treat Expose injuries: Stop major bleeds, and plug a sucking chest wound with an airtight dressing. Environment: If imminent hazards exist, roll the patient onto a tarp and drag him to safety; or, if you have five or more rescuers, BEAM him (an acronym for body elevate and move). Use multiple hands to stabilize and carry the patient’s body.
*Pros pack a seven-ounce CPR mask to protect themselves from contamination.