Priorities of treatment

Imagine a scene whereby you have several casualties at once:

  • Who do you treat first?

  • What injuries do you treat first?

Another question for you:

  • Would you give CPR to a casualty with broken ribs?

This section is going to help you answer these questions and many others you may have when asking who and what? 

First Aid Treatment Prioritisation

When you assess your casualty you must first ascertain what conditions they have starting with your primary survey DRSABCD.

They may have several injuries and the list below will help you identify which injury you treat first. 

BREATHING

- Priority 1

A casualty who is not breathing (or not breathing normally) are either dying or dead therefore this is your number one priority. 

BLEEDING

- Priority 2

Severe bleeding can be life threatening and blood loss of only 40% can lead to death

BONES / BURNS

- Priority 3

Bones and burns are not deemed as life threatening however can lead to shock so would become a number 2 priority as shock is deemed as bleeding due to a circulatory issue.

ALL OTHER INJURIES

- Priority 4

Any other injuries would be classed as a priority 4. Conditions do deteriorate so could quickly turn into a priority 1. 

How does it all work?

Assess your casualty/ casualties to identify what injuries they have then treat them in the order as stated above.

Now to answer the above question: "Would you give CPR to a person with broken ribs?" 

The general worry is that you will start to puncture internal organs when pushing the ribs down. However using the priority list above:

Broken ribs:      Priority 3

Not breathing: Priority 1

If you are having to do CPR it is because they are not breathing (priority 1) therefore what are the consequences of not conducting CPR due to the fear of puncturing internal organs? They are dead! 

Because breathing is a higher priority (1) then the secondary priority (3) ribs is to take second place and treat the breathing first. Let's be honest you can't make their condition any worse. 

MONITOR YOUR CASUALTY:

Just because you have assessed and treated your casualty do not take your eye of them, an example would be a casualty with a broken arm is classed as a number 3 priority, if you do not monitor them they could go into shock which is a number 2 priority which could then lead to a number 1 priority. 

There is only one time when these priorities will change. 

A casualty who is not breathing (priority 1) will require CPR how ever if they have a substantial bleed (priority 2)  then you will need to deal with the bleed first. 

If the bleeding is not stopped then every time you pump the heart during CPR the wound will simply pump out more blood placing the casualty in a position less likely to recover. Therefore in these circumstances bleeding will become the number 1 priority and is to be dealt with first but quickly. 

1. Breathing

2. Bleeding