-

1. Patient AssessmentPatient Assessment
Model (PAM)Model (PAM)
NCDCCNCDCC

2. Learning ObjectiveLearning Objective
The cadets will be able to understand:The cadets will be able to understand:
 The basic principles of a singleThe basic principles of a single
casualtycasualty
 The procedure of Rapid Body SurveyThe procedure of Rapid Body Survey
 Decide the situation of the casualtyDecide the situation of the casualty

3. ScopeScope
 IntroductionIntroduction
 Rescue Scene EvaluationRescue Scene Evaluation
 Primary surveyPrimary survey
 Decision pointDecision point
 EvaluationEvaluation
 ConclusionConclusion

4. RSERSE
Rescue Scene EvaluationRescue Scene Evaluation
 What is the environment?What is the environment?
 Is there any hazard?Is there any hazard?
 What is the mechanism of InjuryWhat is the mechanism of Injury

5. Primary SurveyPrimary Survey
AimAim :: To discover and treat life or limb - threateningTo discover and treat life or limb - threatening
conditionsconditions
 LOC (Level of consciousness – using AVPU)LOC (Level of consciousness – using AVPU)
 Delicate SpineDelicate Spine
 Airway (Head tilt Chin lift)Airway (Head tilt Chin lift)
 Breathing (Look Listen and feel)Breathing (Look Listen and feel)
 Circulation (check for radial & carotid pulse)Circulation (check for radial & carotid pulse)
 RAPID BODY SURVEY (no more than 30s)RAPID BODY SURVEY (no more than 30s)
 Look for life & limb threatening injuriesLook for life & limb threatening injuries
 SkinSkin

6. Primary SurveyPrimary Survey
LOC - Level ofLOC - Level of
Consciousness (AVPU)Consciousness (AVPU)
AwakeAwake –– the patient respond to you,the patient respond to you,
able to maintain his or her own airway.able to maintain his or her own airway.
VerbalVerbal –– the patient respond to speech.the patient respond to speech.
PainPain –– the person make some kind ofthe person make some kind of
response to a painful stimulus.response to a painful stimulus.
UnresponsiveUnresponsive –– there is no responsethere is no response
to verbal and painful stimuli.to verbal and painful stimuli.

7. Primary surveyPrimary survey
DD -- Delicate spineDelicate spine
- Immediately stabilize the head and- Immediately stabilize the head and
neck if you cannot rule out theneck if you cannot rule out the
possibility of spinal injurypossibility of spinal injury

8. Primary SurveyPrimary Survey
AA –– AirwayAirway
 Check for Obstructed AirwayCheck for Obstructed Airway
-- push chin down (No Spinal Injuries)push chin down (No Spinal Injuries)
- modified jaw thrust (Spinal Injuries)- modified jaw thrust (Spinal Injuries)

9. Primary SurveyPrimary Survey
BB -- BreathingBreathing
Determine casualty’s breathing using the 3Determine casualty’s breathing using the 3
senses: LOOK, LISTEN AND FEELsenses: LOOK, LISTEN AND FEEL
 LOOKLOOK the rise and fall of the chestthe rise and fall of the chest
 LISTENLISTEN place ear over the casualty’splace ear over the casualty’s
mouth then listen/feel on cheeksmouth then listen/feel on cheeks
 FEELFEEL feel the breathing from thefeel the breathing from the
nose/mouthnose/mouth

10. NO BREATHINGNO BREATHING
 GIVE 2 BREATHS THEN CHECK FORGIVE 2 BREATHS THEN CHECK FOR
PULSE.PULSE.
 IF PULSE PRESENT GIVE RESCUEIF PULSE PRESENT GIVE RESCUE
BREATHING (12 TIMES PER MINUTE).BREATHING (12 TIMES PER MINUTE).
 IF PULSE ABSENT. STARTIF PULSE ABSENT. START CPRCPR
Primary SurveyPrimary Survey

11. Primary SurveyPrimary Survey
CIRCULATIONCIRCULATION
CPR No CPR
•30:2 = 1 cycle
•5 cycles
•Control haemorrhage
•Control haemorrhage
•Perform RBS
Note: - check for rate and characteristic
- NO radial pulse, check carotid pulse
- NO carotid pulse, perform CPR

12. Primary SurveyPrimary Survey
RBSRBS -- Rapid Body Survey (max. 30secs)Rapid Body Survey (max. 30secs)
 check for external bleeding and deformitiescheck for external bleeding and deformities
 expose and examine injury siteexpose and examine injury site
 provide appropriate emergency treatmentprovide appropriate emergency treatment
 PracticalPractical

13. Primary SurveyPrimary Survey
SkinSkin
- check for colour and condition to- check for colour and condition to
project any sign of shock.project any sign of shock.
TreatmentTreatment
 Cut & expose woundCut & expose wound
 Arresting HaemorrhageArresting Haemorrhage
 Immobilise FractureImmobilise Fracture

14. Primary SurveyPrimary Survey
Decision pointDecision point
-- UNSTABLEUNSTABLE
> transport> transport IMMEDIATELYIMMEDIATELY
-- STABLESTABLE
> provide necessary treatment before> provide necessary treatment before
transportationtransportation

15. Secondary SurveySecondary Survey
(optional to teach)(optional to teach)
AIM : To identify problems that do not pose
an immediate threat to survival. However,
it may threaten survival if undetected
Consists of
o History
o Vital Signs
o Head to Toe Examination

16.  HistoryHistory
chief complaintchief complaint
history of chief complainthistory of chief complaint
medical history - past andmedical history - past and
presentpresent
medicationsmedications
allergiesallergies
identifying dataidentifying data
PAM1-10PAM1-10

17.  Vital SignsVital Signs
level of consciousnesslevel of consciousness
pulse, respiration (30sec*2)pulse, respiration (30sec*2)
skin color & conditionskin color & condition
temperature (if appropriate)temperature (if appropriate)
NOTE : ifNOTE : if UNSTABLEUNSTABLE transporttransport
IMMEDIATELYIMMEDIATELY
( Complete secondary survey enroute( Complete secondary survey enroute
to hospital )to hospital )
PAM1-11PAM1-11

18. Rapid Body SurveyRapid Body Survey
(Practical)(Practical)

19. HeadHead
EyesEyes
EarEar
NoseNose
MouthMouth
SkinSkin
SpineSpine
PAM1-12PAM1-12
Head to Toe Examination
(inspection & palpation)
ChestChest
ShoulderShoulder
Upper ExtremitiesUpper Extremities
AbdomenAbdomen
PelvisPelvis
Lower ExtremitiesLower Extremities

20. Head to Toe ExaminationHead to Toe Examination
1.1. HeadHead
 Run your hands carefully over the scalpRun your hands carefully over the scalp
to feel for bleeding, swelling orto feel for bleeding, swelling or
depression, which may indicate adepression, which may indicate a
possible fracturepossible fracture
note:note: Be careful not to move the casualty ifBe careful not to move the casualty if
you suspect that she may have injured heryou suspect that she may have injured her
neckneck

21. Head to Toe ExaminationHead to Toe Examination
2.2. EarEar
 Look for blood or clear fluid (or both)Look for blood or clear fluid (or both)
coming from either ear. Thesecoming from either ear. These
discharges may be signs of damagedischarges may be signs of damage
inside the skullinside the skull

22. Head to Toe ExaminationHead to Toe Examination
3.3. EyesEyes
Examine both eyesExamine both eyes
 Note whether the eyes are openNote whether the eyes are open
 Check the size of the pupils, whether theCheck the size of the pupils, whether the
pupils are equal in sizepupils are equal in size (as they should be)(as they should be)
 whether they react to light (the pupils shouldwhether they react to light (the pupils should
shrink when light falls on them)shrink when light falls on them)
 Look for any foreign object, blood, orLook for any foreign object, blood, or
bruising in the whites of the eyesbruising in the whites of the eyes

23. Head to Toe ExaminationHead to Toe Examination
4.4. NoseNose
 Check the nose for discharges as youCheck the nose for discharges as you
did for the earsdid for the ears
 Look for the blood or clear fluidLook for the blood or clear fluid
(or a mixture of both) coming from either(or a mixture of both) coming from either
nostrilnostril
Note: Any of these discharges might indicate damagesNote: Any of these discharges might indicate damages
inside the skullinside the skull

24. Head to Toe ExaminationHead to Toe Examination
5.5. MouthMouth
 Note the rate, depth, and nature (easy orNote the rate, depth, and nature (easy or
difficult, noisy or quiet) of the breathingdifficult, noisy or quiet) of the breathing
 Note any odor on the breathNote any odor on the breath
 Look for anything that might obstruct theLook for anything that might obstruct the
airway.airway.
 If the denture is firm and in place, leave themIf the denture is firm and in place, leave them
alonealone
 Look for any wound in the mouth or irregularityLook for any wound in the mouth or irregularity
in the line of the teethin the line of the teeth
 Check the lips for burnsCheck the lips for burns

25. Head to Toe ExaminationHead to Toe Examination
6.6. SkinSkin
Note the colour, temperature, and state of theNote the colour, temperature, and state of the
skin:skin:
 Is it pale, flushed, or grey-blueIs it pale, flushed, or grey-blue
(cyanosis)(cyanosis)
 Is it hot or cold, dry or damp?Is it hot or cold, dry or damp?
 E.g. pale, cold, sweaty skin suggest shockE.g. pale, cold, sweaty skin suggest shock
 A flushed, hot face suggests fever orA flushed, hot face suggests fever or
heat strokeheat stroke
 A blue tinge indicates lack of oxygen;A blue tinge indicates lack of oxygen;
 Look for the sign especially in the lips,Look for the sign especially in the lips,
ears, and faceears, and face

26. Head to Toe ExaminationHead to Toe Examination
7.7. SpineSpine
 Run your fingers gently along the spineRun your fingers gently along the spine
from the base of the skull downwards asfrom the base of the skull downwards as
far as possible, without disturbing thefar as possible, without disturbing the
casualty’s position;casualty’s position;
 Check for any irregularity, swelling, orCheck for any irregularity, swelling, or
tendernesstenderness``
Note: Loosen clothing around the neck, andNote: Loosen clothing around the neck, and
look for signs such as a medical warninglook for signs such as a medical warning
medallion or a hole (stoma) in themedallion or a hole (stoma) in the
windpipe left by surgical operationwindpipe left by surgical operation

27. Head to Toe ExaminationHead to Toe Examination
8.8. ChestChest
 Ask the casualty to breathe deeply, and noteAsk the casualty to breathe deeply, and note
whether the chest expands evenly, easily, andwhether the chest expands evenly, easily, and
equal on both sidesequal on both sides
 Feel the ribcage to check for deformities,Feel the ribcage to check for deformities,
irregularity, or tendernessirregularity, or tenderness
 listen for unusual sounds when the victim islisten for unusual sounds when the victim is
breathingbreathing
 Observe whether breathing causes any painObserve whether breathing causes any pain
 Look for bleedingLook for bleeding

28. Head to Toe ExaminationHead to Toe Examination
9.9. ShouldersShoulders
Gently feel for any deformity, irregularityGently feel for any deformity, irregularity
or tenderness on:or tenderness on:
 Collar bonesCollar bones
 ShouldersShoulders

29. Head to Toe ExaminationHead to Toe Examination
10.10. Upper extremitiesUpper extremities
 Check the movement of the elbows,Check the movement of the elbows,
wrists, and fingers by asking thewrists, and fingers by asking the
casualty to bend and straighten thecasualty to bend and straighten the
arm and hand at each of the jointsarm and hand at each of the joints
 Check that the casualty can feelCheck that the casualty can feel
normally with her fingers and thatnormally with her fingers and that
there are no abnormal sensations inthere are no abnormal sensations in
the limbsthe limbs

30. Head to Toe ExaminationHead to Toe Examination
10.10. Upper extremitiesUpper extremities
 Note the colour in the fingers: if theNote the colour in the fingers: if the
fingertips are pale or grey-blue, this mayfingertips are pale or grey-blue, this may
indicate a problem with the circulationindicate a problem with the circulation
 Look for any marks on the forearm, andLook for any marks on the forearm, and
for a medical warning braceletfor a medical warning bracelet
 Take the pulse at the wrist or neckTake the pulse at the wrist or neck

31. Head to Toe ExaminationHead to Toe Examination
10.10. Upper extremitiesUpper extremities
Note:Note:
 Do not move the casualty to examine theDo not move the casualty to examine the
spine when you notice any impairment orspine when you notice any impairment or
loss of movement, these signs suggestloss of movement, these signs suggest
spine injuryspine injury
 Otherwise, gently pass your hand underOtherwise, gently pass your hand under
the hollow of the back and feel along thethe hollow of the back and feel along the
spine, checking for swelling andspine, checking for swelling and
tendernesstenderness

32. Head to Toe ExaminationHead to Toe Examination
12.12. AbdomenAbdomen
 Gently feel the casualty’s abdomen toGently feel the casualty’s abdomen to
detect any evidence of bleedingdetect any evidence of bleeding
 Identify any rigidity or tenderness of theIdentify any rigidity or tenderness of the
abdomen’s muscular wallabdomen’s muscular wall

33. Head to Toe ExaminationHead to Toe Examination
13.13. PelvisPelvis
 Feel both sides of the hips, and gentlyFeel both sides of the hips, and gently
move the pelvis to look for signs ofmove the pelvis to look for signs of
fracturefracture
 Check the clothing for any evidence ofCheck the clothing for any evidence of
incontinence or bleeding from orificesincontinence or bleeding from orifices

34. Head to Toe ExaminationHead to Toe Examination
14.14. Lower ExtremitiesLower Extremities
 Ask the casualty to raise each leg in turn,Ask the casualty to raise each leg in turn,
and to move his/her ankles and kneesand to move his/her ankles and knees
 Look and feel for bleeding, swelling,Look and feel for bleeding, swelling,
deformity, or tendernessdeformity, or tenderness
 Check the movement and feeling in theCheck the movement and feeling in the
toestoes
 Look at their skin colour: grey-blue skinLook at their skin colour: grey-blue skin
indicate a circulatory disorder or injuries dueindicate a circulatory disorder or injuries due
to coldto cold

35. PROTOCOLS OF PAMPROTOCOLS OF PAM
LOC
D
A
B
C
RBS
SKIN
DECISION POINT
TREATMENT
LOAD & TRANSPORT
RECORD & REPORT
RSE
HISTORY VITAL SIGNS HEAD TO TOE
Stable
Primarysurvey
Unstable
Transport Immediately
Second
Protocol

36. ConclusionConclusion
 What are the 3 information that you need
to find out for RSE
 What are the aims in Primary Survey
 What are the aims of Secondary Survey
 What should you do if the casualty is
unstable
 What should you do if the casualty is stable