FAR - First Aid Responder - initial response

FAR - First Aid Responder


Primary Survey:

  • Controlling haemorrhage and identifying life threatening injuries

Secondary Survey:

  • Vital signs, re-assessment, identify other injuries (head to toe check)


Primary survey is done at the beginning and quickly (after scene safety)


Scene safety:

  • Assess all pre-arrival info

  • Identify hazards, standard infection precautions (gloves)

  • Mechanism of injury / nature of illness (identify)

  • # of patients, additional resources required

  • Fire brigade 

  • Gardaí

  • ESB - electrical

  • Coast guard

  • Gas networks 

  • Mountain rescue



Primary Survey:

  • Form a general impression of the patient (gender, age, responsiveness)

  • Introduce yourself, consent, level of consciousness 


C catastrophic haemorrhage

A airway

C maintain c-spine if needed (fall - spinal injury)

B breathing

C circulation

D disability (AVPU)

E expose and examine



Secondary Survey:

  • Breathing

  • Pulse

  • Skin condition

  • Capillary refill

  • AVPU

Breathing:

  • Normal adult - between 12 and 20 breaths per minute

  • Rate can be rapid, shallow or slow

  • Quality can be deep, wheezing, gasping, panting, snoring, noisy, or laboured

  • Infant - 30-60 bpm

  • Toddler - 24-40 bpm

  • Pre-school - 22-34

  • School age - 18-30

  • 1 inhale and exhale = 1 breath

  • Observe without informing patient 

Pulse:

  • Caused by wave of pressure originated from the heart which indicates speed and force of heartbeat

  • Normal adult pulse rate - between 60 and 100 beats per minute

  • Note rate, rhythm, and strength

Skin condition:

  • Colour - dark/light, blue, yellow, white

  • Temperature - hot/cold

Capillary refill:

  • Ability of circulatory system to return blood to the capillaries after blood is squeezed out

  • Normal cap refill should occur within 2 seconds

  • Delayed / absent: 

  • Loss of a lot of blood

  • In shock

  • Blood vessels to limb are damaged


Re-assessment:

  Focused medical history

  • Attempt to gather important facts

  • Ask clear questions - direct, closed, systematic

  • SAMPLE

  • Reassure patient:

  • Have you ever been to the hospital?

  • Have you seen your doctor for any issues lately?

  • Have you ever had an operation?


Conducting a physical examination:

  • Check patient from head to toe

  • Identify illness / injury

  • Additional medical info - bracelets / pacemakers etc


Head to toe:

  • Beware of sharp objects in clothing

  • Have colleague with you to witness removal of items from pockets

  • Document findings

  • Ensure security of the patient’s personal belongings

  • Look for: medications, identification, etc


CSMs:

  • Circulation - pulse / cap refill

  • Sensation - check if patient can feel stimulus and feels normal

  • Movement - patient can move limb easily


Patient consent:

  • Permission

  • What is a competent adult? - a competent patient can refuse consent to assessment / treatment

  • Consent should be obtained for every intervention / medication

  • Patient has right to refuse care - note what they refuse