Step - step in the assessment of patients
a. Situation Assessment
b. Early Assessment
c. Physical examination
d. Patient History
e. Periodic examination or Continue
f. Handover and reporting

State assessment
Situation assessment undertaken to ensure the situation faced in a relief effort. As a rescuer we must ensure that what we actually face, whether there is danger of aftershocks or anything that may harm a rescuer. Remember always that one or more persons have become victims, not compounded by rescuers who become victims. Safety is number one helper.

d. Respiratory rate (Breathing)
Check whether there is breath in the street can see, hear and feel, the value for 3 - 5 seconds.
Breathing is good enough
• Chest rise and fall in full
• Breathe easily and smoothly
• The quality of the normal breathing
(<8 x / min adults, <10 x / min children - son, 20 x / min infants)
Respiratory unfavorable
• Chest does not rise or fall in full
• There is difficulty breathing
• Cyanosis (blue / gray skin, lips, or nails)
• Quality of abnormal breathing

e. Assess circulation and stop the heavy bleeding
Make sure your heart rate is good enough Make sure that no life-threatening bleeding that can not be seen. Wearing thick blood can be collected in sufficient quantity lots.

f. Contact support
Ask for assistance to another person or other trained personnel. The message conveyed must be brief, clear and complete.

Early assessment must be completed and all life-threatening condition must be rectified before continuing physical examination.

Physical examination
The physical examination should be done with a detailed and systematic starting from head to toe.
Three methods of physical examination:
1. Sight (Inspection)
2. Tactile (Palpation)
3. Hearing (Auscultation)

Do not waste a lot of time to conduct a detailed examination. Do it fast but make sure nothing is missed. Physical examination to ensure that nothing is missed.

Some things that can be searched at the time to examine the victim:
D - (deformities) compared with the healthy side of pain
O - (Open Injuries) are usually apparent and the blood
T - (Tenderness) regions of the injured soft when pressed
S - (Swelling) experienced swelling of the injured area

Some signs of injury may be clearly seen, many of which are not visible and potentially save a serious injury.

Listen to the patient. By listening to show concern and lets get the information.

Physical examination (Head to Toe)
Observe and touch (using both hands and with pressure), cf (symmetric), the unusual smell and hear (the sound of breath or creaking limbs), in the following order:
1. Head
• Scalp and Skull
• Ear and Nose
• Pupil Eyes
• Mouth
2. Neck
3. Chest
• Check for changes in shape, open wounds, or change in hardness
• Feel the change in the form of a rib to spine
• Do palpability on bone
4. Abdomen
• Check the rigidity (hardness)
• Check for injuries and potential infection
• There may be no visible injury, do the palpability
• Check for swelling
5. Back
• Check for changes in the form of a rib
• Check the shape changes along the spine
6. Pelvis
7. Tool motion over
8. Under the motion tool

Checking vital signs
1. Pulse, including pulse quality, strong or weak, irregular or no
2. Breathing frequency, as well as whether the process occurs breathe easily, or no effort to breathe, is there any signs of shortness of breath.
3. Blood pressure, not inspected by the basic KSR
4. Temperature, examined the relative temperature on the forehead of the patient. Also check the skin condition: dry, sweating, redness, discoloration, and others.

Normal Pulse:
Infants: 120 - 150 x / min
Child: 80 - 150 x / min
Adults: 60 - 90 x / min

Normal Breathing Frequency:
Infants: 25 - 50 x / min
Child: 15 - 30 x / min
Adults: 12 - 20 x / min

Patient History
In addition to the examination, if possible to do an interview to obtain additional data. The interview is very important if you find the victim with the disease.

Given the interviews conducted can grow very large, to help the used acronyms: MDFIEI
M = Main Complaint (symptoms and Signs)
something very patient complained
D = Drugs taken.
Treatment of patients who currently lived or had just taken a drug or medicine that should be drunk but in fact, not drunk.
F = Food / beverage last
This event may be the basis of loss of response in patients. Additionally this data is also important to know if it is the patient will have surgery later in hospital.
I = illnesses suffered by
History of illness or have suffered that may be related to the circumstances experienced by patients at this time, such as shortness of breath with a history of complaints of heart trouble 3 years ago.
E = Experienced allergic.
Necessary to find whether the cause of abnormalities in these patients may be a form of allergy, usually patients or their families already know about it
I = Incident.
Incidents experienced by victims, before the accident or before the onset of symptoms and signs of illness at this time.

These interviews can be conducted while checking the victim, no need to wait until the investigation is completed.

Investigation Continuing
After completion of the inspection and actions, then do periodic checks, according to the severity of cases that confront us.
In cases that are considered heavy, regular inspection is conducted every 5 minutes, while in mild cases can be done once every 15 minutes.
Some things can be done at periodic inspection is:
1. State response
2. Return value and improve the airway if necessary
3. Value re-breathing, frequency and quality
4. Recheck the pulse of the patient and if necessary to do in detail when the time is available.
5. Return value of skin conditions: temperature, humidity and condition Check back from head to toe, there may be missing parts or require a more thorough examination.
6. Check again carefully there may be a part that has not been checked or deliberately bypassed for checking focus.
7. Value re-treatment patients, whether good or still need to have other actions. Check back all of the dressing, fitting splint is still quite strong, whether the bleeding has to be overcome, there are parts that have not been maintained.
8. Maintain communication with the patient to maintain a safe and comfortable

Reporting and handover
Get used to create a written report. This report is useful as you note, the PMI and medical evidence.
Things that should be reported are:
• Age and sex of patients
• Main Complaint
• Level of response
• Condition of the airway
• Breathing
• Circulation
• Physical Examination important
• MDFIEI important
• Treatment
• Other developments that are considered important

If there are forms to include this report form to the officer who took over the victims of your hand.

The handover can be done on site, which is when teams come to your aid, or those of you who come to health facilities.




By: Subchan (PMI Cab Sidoarjo)