The Role of Assessment in Wilderness Medicine

Look, listen, and feel. 

If you’ve been around wilderness medicine long enough, you may remember when this was the standard teaching for determining breathing status. You place your hand on the injured party’s stomach (feel), your ear to their mouth (listen), and watch (look) to see whether their chest is rising and falling.  

This method remains a foundation for assessing breathing, and its application has been expanded to cover a wider range of injuries and illnesses common in wilderness scenarios.

Look, listen, and feel is still a great way to remember that much of the assessment process (arguably the most important) comes in the form of look (visually inspect), listen (auscultate), and feel (palpate). These three actions are like the bumps on a key that align with tumblers to open a lock. In the context of emergency medicine, they form the key that unlocks the door to assessing the patient’s condition and developing treatment and evacuation plans.

NCOAE’s Patient Assessment Process

“Assessment” is the process of determining the nature, quality, or ability of something. In the context of medical assessment, it refers to determining the realities of the patient’s condition and environment factors in order to provide appropriate care and make well-informed evacuation decisions. 

In order to most accurately determine these realities, it is important to use a system of assessment that is easy to remember yet sophisticated enough to avoid overlooking vital data.

While assessment varies depending on the patient’s condition, environmental factors, and the wilderness medicine provider’s level of training and experience, The National Center for Outdoor & Adventure Education (NCOAE) patient assessment process is a wonderful example of a systematic approach that progresses from basic evaluation to a more detailed analysis for optimizing patient outcomes and evacuation decisions.

The process starts with sizing up the scene to develop a rational understanding of and insight into what is often a chaotic situation — the type of situation that is characteristic of wilderness medicine (see our previous post, “What Is Wilderness Medicine?”). As a first responder, figuring out “what happened” can provide valuable insight into the condition of the injured party along with guidance on next steps to take.

The scene size-up includes evaluating how the injury occurred (the mechanism of injury) to estimate the nature and severity of the injury. Additionally, responders must take an inventory of resources that are available and needed, and then come up with a plan to incorporate resources in the most useful fashion and request additional resources, if necessary. 

After quickly sizing up the scene, responders conduct their primary assessment to determine immediate life threats and address them. A life-threat scan may include a blood sweep to find and correct any sources of massive bleeding. The first five letters of the alphabet are a great way to remember the assessments of key life sustaining systems:

• A: Airway
• B: Breathing
• C: Circulation
• D: Disability
• E: Environment

After the primary assessment, responders move on to develop their evacuation plan. 

Evacuation and Continued Assessment

In most wilderness medicine contexts, the evacuation plan is not implemented immediately or quickly. Because of this, responders typically have time to move further in the assessment process at the scene of the incident.

This path involves conducting a secondary medical or trauma assessment:

• The purpose of the medical assessment is to gather information relevant to the current problem. It involves questioning the patient about the situation and exploring information about their past that may help in the current situation.
• A trauma assessment is a physical examination conducted to identify any signs of traumatic injury.

Both benefit through examining vital signs such as pulse, breathing, and mental status.

After completing the secondary medical or trauma assessments, it is time to implement a treatment plan and conduct appropriate reassessments. This is often done during the evacuation.

Developing an Effective Assessment Methodology

Developing an effective assessment methodology is like cutting a blank key into the proper shape to unlock the door leading to an accurate diagnosis and a well-planned evacuation. Having the right key grants access to a more positive outcome for both patients and responders.

For further information and training experience related to wilderness medicine patient assessment, attend a future NCOAE wilderness medicine course. For a list and description of courses, visit our Wilderness Medicine page. 

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About the Author: Todd Mullenix is the Director of Wilderness Medicine Education at The National Center for Outdoor & Adventure Education in Wilmington, North Carolina.

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