Comparison of 4 patient assessment systems (first aid in remote areas)

Firstly, this text does not represent the views of the Red Cross, nor of any other first aid organizations. It is a personal written exercise.

This resource is not a substitute for first aid training provided by a recognized training provider.

Training providers use very similar techniques; there's no reinventing the wheel. However, there are more pronounced differences in approach, and that's what interests me for this text.

I was curious to compare the different patient assessment systems (PSS) and I am sharing my results with you here.

I compare the SEPs of the following 4 entities:

• Red Cross

• Wilderness Medical Associates International

• SIRIUSMEDx

• CNESST (this is not first aid in isolated regions, but still relevant in this context).

Red Cross

The Red Cross protocol is the one I am familiar with and I can tell you that it has become much simpler over the years.

Check

1. Check the premises

2. Verify the person (primary examination)

• State of consciousness

• ABC Points

A: Respiratory tract (Airway)

B: Breathing

C: Circulation

3. Recovery position (if unconscious or in an altered state of consciousness)

Secondary Examination (SOAP)

1. S: Subjective (SAMPLE)

2. O: Objective (vital signs + physical examination (targeted or contact examination))

3. A: Overview (record your results)

4. P: Action plan (treatment/transport/extended care)

• SHOCK (at all times, be attentive to signs of a life-threatening condition)

Wilderness Medical Associates International

1. Scene evaluation

• Risk (personal, public, patient)

• Mechanism of injury (trauma, medical, environmental)

• Numbers (patients, rescuers, resources)

2. Primary assessment

• Circulatory (pulse, bleeding)

• Respiratory (airways, breathing)

• Nervous system (AVPU, spine)

3. Secondary assessment

• Physical examination (checking range of motion, checking CSM, head-to-toe, inspection, palpation, listening)

• SAMPLE (symptoms, allergies, medications, relevant history, recent events, admissions and discharges)

• Vital signs (AVPU, pulse, respirations, skin, temperature, blood pressure, oxygen saturation)

SIRIUS

1. Site inspection

• Security

• Injury mechanism

• Number of people

• Universal precautions

Extreme bleeding

2. Primary Examination (The ABCs)

L': State of consciousness

A: Air routes

B: Good breathing

C: Circulation

3. Protect the victim (DE)

D: Disorder/dysfunction

E: Environment

4. Assessment

Objective (physical examination)

Subjective (questionnaire)

5. Analysis and planning

6. Data logging.

7. Long-term care

8. Evacuation and transfer to the emergency medical service (EMS)

CNESST

Less relevant in the context of an isolated region, but I thought it appropriate to add it anyway.

1. Assess the situation (security?)

• Estimate the number of people

• Request the necessary specialized resources

• Ensuring its protection

• Assess the nature of the need

2. (The) Checking the state of consciousness

3. Call emergency medical services if necessary.

4. Check the ABCs (medical or traumatic)

A: Open the airway (tilt the head)

B: Check breathing

C: Check traffic

5. Check all the problems found in the ABC

6. Perform a secondary assessment (look for signs and symptoms)

7. Apply the appropriate protocols

6. Double-check the ABCs

Consignment

All (except the CNESST) have a similar version of the SOAP note. It's a logical and effective format for documenting and communicating patient assessments and treatments.

Conclusion

They all have a more or less detailed version of:

1. Premises check (Is it safe? What happened?)

2. Primary Examination (ABC)

3. Secondary examination (in-depth analysis)

4. Management and support

Red Cross : a simplified approach, adapted for rapid and effective intervention.

Wilderness Medical Associates International : A more complex and detailed, but still intuitive, approach.

Sirius : Unique concepts with the X (extreme bleeding) and the DE of L'-ABCDE to protect the victim. Progressive approach with the pyramid, but more complex.

CNESST : Very simple. Less relevant in a remote environment.

The Red Cross and CNESST are comparable in their simplicity, with systems that are quick to implement.

Sirius and Wilderness have slightly more complex and detailed approaches.

Sources

Canadian Red Cross Society . Wilderness and Remote First Aid, Pocket Guide . Canadian Red Cross Society, 2020. ISBN: 978-1-55104-860-4.

Wilderness Medical Associates International . Field Guide of Wilderness & Rescue Medicine . 10th edition, Wilderness Medical Associates, 2023. ISBN: 979-8-9850021-5-7.

Les Publications du Québec . Workplace First Aid . 6th edition, Government of Quebec, 2022. ISBN: 978-2-551-26771-2 (print), 978-2-551-26778-1 (PDF).

SIRIUSMEDx . First aid in isolated regions, Field manual , Sainte-Adèle, Quebec, 2023. ISBN: 978-2-9821419-0-2.

Same same but different!!

Alex