ASSESSMENT

After initial stabilization, every casualty requires regular head-to-toe reassessments. Regular assessments allow providers to gain an understanding of the casualty’s baseline, changes to that baseline, and help to dictate treatment and the plan of care.

Non-medical Responders

- Reassess all interventions completed previously during the MARCH-PAWS assessment at the responder’s level of training.
- Become familiar with the PCC Flowsheet (Appendix A).
- Assist the medical responder as needed.

Medical Responders

- Minimum:
  - If appropriate, receive verbal reports from TCCC non-medical or other medical personnel on all interventions completed on the casualty.
  - Briefly review any casualty documentation provided( verbal or handwritten and note method conveyed).
  - Assess any interventions for appropriateness and effectiveness using the MARCH-PAWS sequence in accordance with PCC Guidelines:
    - Massive Hemorrhage - Assess all interventions for continued hemorrhage control.
    - Airway - Assess the airway for patency and check any adjuncts for proper placement and securement.
    - Respiration - Assess any interventions for tension pneumothorax, assess breathing for rate and depth, and check pulse oximetry if available.
    - Circulation - Assess pelvic compression device, if present. Check tourniquets, if present, and determine if conversion is indicated, check all dressings for effectiveness, and check pulses.
    - Hypothermia/Head Injury – Assess any interventions for hypothermia for ongoing necessity and effectiveness. Assess reported head injury for change in casualty’s status.
    - Pain - Reassess pain control - note the last time pain medications were administered and determine based on pain score if the casualty needs to be redosed.
    - Antibiotics - Reassess the need for antibiotics, either initial or repeat doses.
    - Wounds - Reassess and treat additional wounds.
    - Splints - Check any splints for proper fit and assess pulses distal to the splint.
- Better: Perform periodic re-assessment rounds. Include the following observations in ongoing clinical decision-making:
  - Is the casualty sick or not sick? (acutely ill, decompensating, or experiencing a serious medical/surgical condition requiring ongoing management?)
  - Is the casualty stable or unstable?
  - Is the casualty getting better or getting worse?
  - How is that assessment different from the last assessment?
- Best: Complete head-to-toe primary and secondary assessment. Perform comprehensive physical exam and detailed history with problem list and care plan. As soon as it is feasible, perform teleconsultation.