Patient assessment workshop by young doctors.

What would I do if a person walking in front of me suddenly collapses? He's holding his stomach and seems to be suffering from some kind of severe pain...

Much has been talked about basic life support (BLS), but that algorithm basically only applies to cases where the patient's heart has stopped. Well, then what do we do if a person's heart still seems to be working but he's unconscious and seems to be hurt in some way, is the question here. This is called advanced medical life support (AMLS) or international trauma life support (ITLS), and it's about assessing the condition of the patient in an emergency.

The algorithm consists of three major steps, and the first is called "Scene Size-Up", where the checklist assesses five points: body substance isolation (BSI), scene safety, number of patients, nature of the illness or the mechanism of the injury, and the resources that you have at that moment. The main purposes of this step is to provide safety not only for the patient but also for yourself, and collect information that can be gathered in a glance.

"Initial Assessment" is the second step, which is also the most important of the three. We assess five things here too: general impression of the patient, mental status, airway, breathing, and circulation. Does the patient seem severe? What's the level of consciousness? (AVPU - Alert, reacting to Verbal stimulation, reacting to Pain stimulation, or Unconscious?) Is there anything obstructing the airway? Is the patient breathing? What's the heart rate and condition of the peripheral circulation? Is the patient bleeding? Appropriate assessment in this step is vital, as the third step depends on the condition of the patient.

If the heart is not moving, we move on to BLS or advanced cardiac life support (ACLS). But if that's not the case, we first evaluate whether it's a trauma case or not. If it is, then we see if it's a single trauma or multiple. If it's single, we do a focused rapid examination of the injured area and ask the patient SAMPLE (Sign/symptom, Allergy, Medication, Past medical history, Event prior to the symptom) questions, while if it's multiple, we need to do a rapid thorough trauma survey of the entire body before asking the same set of questions. All of this is done before handing the patient over to the hospital.

Now, if the case is not a trauma, then we first see whether the patient is responsive or unresponsive. In the latter case, we must go through a rapid medical assessment of the entire body and check the vital signs (circulation and blood data). Gathering the medical history of the patient comes last, since one cannot speak at this moment. If the patient can respond to you, you gather this information first and then move on to rapid medical assessment and checking vital signs. Again, this is done outside or in the ambulance, before it reaches a hospital.

Of course, there's more detail and thinking to this, but the important thing about this type of learning right now is for us to do simulations with our fellow peers over and over to memorize the algorithm with your body, instead of the just the brain. Then we can move on to the details and the thinking of case-by-case scenarios. What's amazing about this workshop was that it was planned and carried out by a group of only first and second-year doctors and students. It really motivates you. :-)