Canoe Excursion

Carrying canoes down at Amla Bay. Photo:Private

The 23rd to the 25th of August we went out on a canoe excursion from Amla bay close to Kaupanger and out to Holm and the nearby area. We had a short brief on first aid and rescue before jumping in to the 16 degree ocean trying it out. I am going to introduce a tool to an organized response to any situation. This will help you find and describe the problems occurring and what to do with them. To remain order in a difficult and chaotic situation the system is based on a problem list and a plan. The tool consists of three important steps which are; gathering information, creating a problem list, and planning treatment and evacuation. The information can be organized in a format abbreviated as SOAP, Subjective, Objective, Assessment and Plan.

The Three Steps of the Patient Assessment System

Scene Size-Up

Keeps you alive and functioning while stabilizing the scene. Take a moment to identify hazards to yourself, partner, others and patient. As next step stabilize the scene by moving the danger or the patient from the danger. Evaluate the mechanism of injury and determine the number of injured peoples or at risk and rescuers (Isaac & Johnson, 2008;13-14).

Initial Assessment at Holm. Photo: Knut Myking

Initial Assessment

Quick-check the status of the Circulatory, Respiratory and Nervous systems. Stabilize in the order of most critical problem first. Look for sufficient respiration and clear airways. Check pulse and determine if it is fast, slow or normal. Execute a quick exam for severe bleeding while doing this keep the patients spine stable and assess the level of consciousness (Isaac & Johnson, 2008;14).

Focused History and Physical Exam

Complete then treat. First step is to perform a physical exam from where it makes sense to start and complete a head to toe check list. Then complete a survey with vital signs and a detailed physical exam to discover abnormalities as tenderness, discolouration, swelling and deformity. Vital signs are important to observe a decay or improvement in health. An complete list of vital signs include pulse. Reading for 15 seconds times 4 works well, write down rate and regular/irregular rhythm. Watch respiratory rate and speed; slow, normal or fast. If a blood pressure cuff is available, measure the systolic and diastolic pressure. Temperature of body core is most accurate in rectum, but oral temperatures is more convenient and readings are usually 1 degree lower. In field cool or warm is. Reduced skin perfusion may indicate compensation for loss of blood volume. Warm, dry and pink is normal. Cool and pale could be an injury or a response to cold weather. Dark skinned patients can be measured in palms and soles. Consciousness and mental status is a measure of brain function. We measure mental status by the words abbreviated to AVPU, Awake/alert, Verbal, Pain and Unresponsive. All vital signs should be measured at regular intervals to observe change (Isaac & Johnson, 2008;14-17).

SAMPLE History

The SAMPLE history can be gathered before or after, but not during the Physical exam to get correct information (Isaac & Johnson, 2008;17). SAMPLE is another shortening of words which are:

Symptoms: onset and progression, what makes it better or worse

Allergies: to medications, food, environmental allergens. Note type and severity of previous reactions

Medications: prescription, over-the-counter, homeopathic

Pertinent History: previous similar symptoms or problems, contributing factors

Last ins and outs: food, fluides:time and quantity, urine and bowel, normal or abnormal

Events: leading up to the accident or illness, consider mixed mechanisms

Creating the Problem List SOAP

CPR at Holm. Photo: Knut Myking

Subjective is the story, description of the scene, the mechanism of injury, symptoms patient is complaining about and relevant SAMPLE history.

Objective is the exam findings, what you see, hear, smell and feel during the examination and vital signs of the patient.
Assessment is the list of both objective and subjective problems, also anticipated(A') problems.

Plan is the treatment of existing problems, monitoring the anticipated problems and evaluate if a evacuation is necessary. When radioing for assistance the information needed is location, situation and scene, plan and assistance needed, patient and the problem list (Isaac & Johnson, 2008;17-20).

The SOAP format helps to paint the whole picture in the situation and keep you on track of whats need to be done right now and other problems which have to be dealt with in the near future. These rules need to be crammed and used in scenarios to make them stick when the shit hits the fan in a real situation. I like this approach because it gives you control of the entire situation, helps you solve the problems fronted step by step and it feels harder to miss problems that can be fatal later with this system. Radioing information about the situation to get an evacuation is easy using this approach too since the complete situation is written down in front of you.

References:

Isaac J.E & Johnson D.E. (2008). Wilderness and Rescue Medicine - A Practical Guide For the Basic and Advanced Practitioner. WMA, Scarborough USA.