This is the process of receiving an individual into a healthcare facility after they have been involved in an accident, to provide necessary medical assessment and care.

Initial Reception and Triage
This means quickly assessing how urgently the individual needs care upon arrival at the facility.

• Rapidly identify any immediate life-threatening conditions.

• Prioritize care based on the severity of injury (e.g., breathing difficulty, severe bleeding, altered consciousness are high priority).

• Assign the individual to the appropriate care area (e.g., resuscitation bay for critical injuries, treatment room for less severe ones).

Primary Survey (ABCDE Approach)
A rapid, systematic assessment to identify and immediately manage life-threatening injuries.

• Airway: Check if the airway is open and clear. Use airway opening maneuvers (e.g., jaw thrust if neck injury suspected) or adjuncts if needed. Maintain cervical spine protection if head or neck injury is suspected.

• Breathing: Assess respiratory rate, effort, chest movements, listen for breath sounds, check oxygen saturation. Provide oxygen as needed. Identify and manage conditions like tension pneumothorax.

• Circulation: Check heart rate, blood pressure, capillary refill time, skin color, and temperature. Control any obvious external bleeding with direct pressure. Establish intravenous (IV) access for fluids or medications.

• Disability: Assess level of consciousness (e.g., using AVPU: Alert, responds to Voice, responds to Pain, Unresponsive; or Glasgow Coma Scale – GCS). Check pupil size, equality, and reaction to light. Check blood glucose level.

• Exposure / Environment: Fully undress the individual to allow for a thorough examination for all injuries. Prevent hypothermia by using warm blankets, warmed IV fluids, and keeping the environment warm.

Vital Signs Monitoring
This means regularly checking key physiological measurements to assess the individual’s status.

• Obtain baseline temperature, pulse rate, respiration rate, blood pressure, and oxygen saturation.

• Assess pain using an appropriate pain scale.

• Continue frequent monitoring, especially if the individual is unstable or their condition is changing.

History Taking (Focused on the Accident)
Gathering essential information about the accident event and the individual’s relevant health background.

• Mechanism of Injury: How did the accident happen? (e.g., type of fall, speed of vehicle in a car crash, type of burn agent). This helps predict potential injuries.

• Injuries Sustained: What injuries are apparent or suspected by those at the scene or by the individual?

• Signs and Symptoms: What is the individual currently experiencing (e.g., pain location and severity, difficulty breathing, dizziness)?

• Treatment Given: Any first aid or medical treatment provided before arrival at the facility?

• Use AMPLE history when possible and appropriate:

  • Allergies (to medications, food, etc.).

  • Medications (current prescriptions, over-the-counter, including immunisation status).

  • Past medical history (any significant illnesses, previous surgeries, or injuries).

  • Last meal or drink (time and type – important if surgery might be needed).

  • Events leading up to the injury / Environment related to the injury.

Secondary Survey
A more detailed, systematic head-to-toe examination to identify all other injuries, performed once immediate life-threats from the primary survey are addressed and the individual is relatively stable.

• Examine the head, face, neck (maintaining spinal precautions if indicated), chest, abdomen, pelvis, all four limbs, and back.

• Look for deformities, contusions (bruises), abrasions, punctures/penetrations, burns, tenderness, lacerations, swelling (DCAP-BTLS).

• If spinal injury is suspected, log-roll the individual with assistance to inspect the back and spine, maintaining alignment.

Documentation
This means accurately and comprehensively recording all findings, interventions, and the individual’s responses to treatment.

• Document time of arrival, triage category, all assessment findings (primary and secondary surveys, vital signs, history), treatments given (medications, procedures), and any changes in condition.

• Use clear, concise, and objective language. This is a legal record of care.

Initiation of Diagnostic Tests
Ordering appropriate tests to help identify the nature and extent of injuries.

• Based on assessment findings and suspected injuries (e.g., X-rays for suspected fractures, CT scans for head or internal injuries, ultrasound for abdominal trauma, blood tests for baseline hemoglobin, electrolytes, etc.).

Pain Management
This involves assessing pain and providing appropriate relief.

• Use an age-appropriate pain assessment tool.

• Administer analgesia (pain relief medication) as ordered and appropriate for the individual’s condition and type of injury (e.g., oral, intravenous).

• Consider non-pharmacological methods of pain relief (e.g., distraction, comfort positioning, application of cold packs to specific injuries if appropriate).

Communication with Family/Caregivers
Keeping the family or caregivers informed and providing necessary support during a stressful time.

• Explain findings, planned investigations, and treatments in understandable terms.

• Provide regular updates on the individual’s condition.

• Offer emotional support and address their concerns and questions.

• Obtain informed consent for procedures as required by facility policy.

Consideration of Non-Accidental Injury (NAI)
This means being alert to the possibility that the injury may not have been accidental, especially if the explanation of the accident does not seem to match the type or severity of the injuries.

• Observe the interaction between the individual and accompanying adults.

• Note any unusual patterns of injury, multiple injuries in different stages of healing, or significant delay in seeking care.

• If NAI is suspected, follow facility protocols for further assessment and reporting to appropriate child protection services. This is a crucial safeguarding responsibility.

Preparation for Further Care or Disposition
This could involve admission to a ward, transfer to an operating room for surgery, transfer to a specialized unit (e.g., intensive care unit), or discharge home if injuries are minor.

• Ensure the individual is as stable as possible before transfer.

• Complete all necessary documentation.

• Provide a thorough and accurate handover of care to the receiving team, unit, or facility, outlining the history, injuries, treatments given, and current status.