Carry out structured assessment and treatment

Control Measure Knowledge

By adopting a systematic approach to casualty care, for example <C> Ac B C D E, any life-threatening conditions can be rapidly identified and managed. Structured assessment and treatment using <C> Ac B C D E aims to prioritise the needs of the casualty and focus activity towards those injuries or conditions that may do more harm to the casualty, or may cause death.

If a casualty is unresponsive, medical alert tags, bracelets or cards may provide information about pre-existing medical conditions. Prescribed medical equipment may also be an indicator of a pre-existing medical condition.

A structured assessment of the casualty should be carried out by a competent person, with the necessary equipment and using the following approach:

  • <C> Control of catastrophic external compressible bleeding
    • The use of tourniquets, by trained personnel, forms part of the Faculty of Pre-Hospital Care (FPHC) position statement.
    • If there is a concern that a major bleed may occur on the casualty’s release, tourniquet(s) may be applied loose, prior to extrication. These can then be quickly tightened if required – this action should only be undertaken by trained personnel.
  • Airway
    • A simple ‘airway ladder’ approach to airway care should be promoted
    • Assessment and monitoring of the airway should be continuous
    • Suction should be available to clear the airway


Figure: Diagram showing the airway ladder approach to airway care

  • Cervical spine (c-spine)
    • If possible, self-extrication of the casualty is encouraged, following the guidelines promoted in the Faculty of Pre-Hospital Care (FPHC) Spinal immobilisation consensus statement
    • Manual in-line stabilisation is an acceptable method of stabilising the c-spine
    • A long board is used for extrication only and the casualty is placed onto a spinal stabilising device. Ideally a vacuum mattress or split device (for example a scoop stretcher) should be used to transport the casualty to definitive care
    • If extrication cannot be effected quickly, a request for advanced medical support to deliver advanced medical care (doctor or immediate care practitioner) should be considered at the earliest opportunity
  • Breathing
    • Assessment of breathing / ventilation and the chest should be structured
    • Suggest RV-FLAPS WET:
      • Rate and Volume of breathing
      • Feel the chest
      • Look at the chest
      • Armpits clear of injury
      • Press the chest wall
      • Search the back and side/shoulders
      • Wounds on the neck
      • Emphysema felt in the neck
      • Trachea central in the sternal notch
    • Assessment and monitoring of breathing should be continuous
      • Minimum (rate and volume)
      • The means to support a casualty who has stopped breathing should be available – pocket mask and/or bag valve mask (BVM)
    • Self-ventilating patients will receive high-flow oxygen via a non-rebreather mask
    • Sucking chest wounds should be covered with either a gloved hand or appropriate chest seal dressing with one-way air release valve

Figure: Diagram showing the bleeding ladder approach

  • Circulation
    • All bleeding should be stopped or controlled
    • Stopping bleeding is a priority and should be achieved using the ‘bleeding ladder’ approach:
    • Pelvic fractures should be treated in line with the Faculty of Pre-Hospital Care (FPHC) consensus statement; pre-hospital providers must ensure that their employees do not apply pelvic binders unless they are appropriately trained with clinical governance structures in place
    • Assessment of circulation through methods such as checking capillary refill
    • Shock is a life-threatening condition that occurs when the body is not getting enough flow of blood; if there is no evidence of external blood loss, there is likely to be internal bleeding
  • Disability
    • The casualty’s level of consciousness is measured using AVPU:
      • Alert
      • Voice
      • Pain
      • Unresponsive
    • AVPU assessment should be recorded every 3 to 5 minutes
    • Casualties should have a pain score recorded
    • The irritable or uncooperative casualty will require early specialist medical assessment and treatment
    • If the casualty is presenting with a psychiatric illness or personality disorder the police should be involved early
  • Exposure, Extrication and Evacuation
    • Casualties should be protected from the elements
    • Active rewarming is encouraged
    • Casualties may require stripping to skin to enable assessment
    • The dignity of the casualty should be maintained
    • If trapped, extrication should be, where possible, swift but controlled
    • Casualty handling principles should be adopted as per Faculty of Pre-Hospital Care (FPHC) consensus statement

Strategic Actions

Tactical Actions