Patient assessment, triage and casualty transport
Patient assessment, triage, and transport test whether you can find life threats fast, sort multiple casualties correctly, and move each patient to the right destination without making things worse.
Core rules
- The primary survey in trauma follows catastrophic bleeding control first, then airway, breathing, circulation, disability, and exposure with hypothermia prevention (MARCH or ABCDE depending on your service).
- Assess level of consciousness with AVPU or GCS, then respiratory rate, pulse, blood pressure, oxygen saturation, skin colour and temperature, pupils, and blood glucose.
- Take a history once life threats are managed: SAMPLE, and OPQRST for pain.
- Triage sorts patients by urgency of treatment and transport, not by who is loudest. START uses rapid checks: can the patient walk; is the respiratory rate above 30 per minute; is capillary refill over 2 seconds or the radial pulse absent; and can the patient follow simple commands. JumpSTART adapts this for children.
- Categories are immediate, delayed, minor, and deceased or expectant, according to local protocol.
- Transport decisions weigh priority, distance, hospital capability, and the patient's position. Package and secure the patient, monitor en route, and give a structured handover.
Worked example
A minibus leaves the road with four casualties. One is walking and talking; one has a respiratory rate of 34; one is unresponsive and breathing after chin lift; one has no pulse and obvious mortal injuries. Applying START: the walking casualty is minor; the one at 34 breaths per minute is immediate; the unresponsive but breathing casualty is immediate; the deceased is not transported. Transport the two immediate casualties first, with the minor casualty last, and notify the receiving hospital of numbers and severities.
Traps
- Spending ten minutes on a full assessment in an unsafe or multi-casualty scene.
- Triaging by how dramatic an injury looks rather than by physiology.
- Transporting the walking wounded first because they are easy to move.
- Failing to reassess after triage; patients deteriorate quietly.
- Omitting the mechanism of injury and the time of injury from the handover.