1 Scene Assessment and Emergency Priorities

Make the scene as safe as possible

Scene assessment is a rapid, repeated process: make the scene as safe as possible, identify immediate threats to life, intervene within training and protocol, and reassess. A patient who appears stable can deteriorate, and new findings can change priorities.

Before approaching, look for moving traffic, fire or smoke, violence, unstable structures, electrical hazards, and unknown chemicals or other dangerous materials. Use appropriate personal protective equipment, keep an exit route in mind, and request specialized help when needed. Do not enter a scene that remains unsafe; wait for appropriate hazard control or responders.

Once it is safe to approach, note the number of patients, what may have happened, and whether additional resources are needed. These observations help anticipate hazards and guide the assessment.

Rapidly assess urgent functions

Form a quick general impression while checking responsiveness and looking for obvious distress. Then rapidly assess the patient’s most urgent functions using the ABCDE framework, following the service’s sequence because protocols can vary.

• Airway: Determine whether the airway is open and maintainable. Look and listen for obstruction or abnormal sounds.

• Breathing: Determine whether breathing is present and effective. Look for severe effort, very slow or absent breathing, or other signs of respiratory failure.

• Circulation: Look for life-threatening bleeding and signs of poor circulation, such as pale, cool, clammy skin or a weak pulse.

• Disability: Check responsiveness and major changes in mental status.

• Exposure: Look for significant injuries while protecting the patient from unnecessary heat loss and exposure.

In trauma, immediately obvious catastrophic bleeding may need control before or alongside the airway check, according to local protocol. Assess, intervene, and reassess rather than completing a long examination before treating an evident life threat.

Act on immediate threats

Prioritize patients with a present or suspected threat to airway, breathing, circulation, or consciousness. Warning findings include:

• An obstructed or unprotected airway, or inability to speak normally.

• Absent, inadequate, or severely labored breathing; blue or gray color; or rapidly worsening respiratory distress.

• Severe external bleeding, signs of shock, or a rapidly weakening condition.

• Unresponsiveness, markedly altered mental status, or sudden deterioration.

Provide appropriate immediate care, such as positioning or maintaining the airway, supporting breathing, controlling severe bleeding, or beginning resuscitation when indicated. These actions must remain within your training, scope of practice, and current local protocols. Activate additional resources early when the patient’s needs exceed those available on scene.

Prioritize among patients

When several patients are present, quickly identify who has an immediate life threat and who can safely wait for reassessment. Compare patients by the severity of their threats, not by who speaks loudest: a conscious person calling for help may be less urgent than a quiet, unresponsive person with abnormal breathing.

Follow incident triage procedures when there are multiple patients. Routine single-patient assessment priorities should not replace local mass-casualty triage rules.

At a collision scene, first confirm that traffic hazards are controlled. If one patient is talking comfortably and another is unresponsive with abnormal breathing, the second patient has the more urgent life threat and needs immediate assessment and intervention. Recheck both as resources allow.

Reassess and communicate

After each intervention, check whether the patient’s condition improved, stayed the same, or worsened. Repeat the initial assessment if the patient changes; new findings can alter who needs attention first.

Communicate the main threats, findings, actions taken, and the patient’s response to incoming clinicians. Continue reassessing as resources allow.

• Scene safety