“How long has your stomach been hurting? You’re feeling dizzy in the heat — how much water did you drink today? Is that rash itchy or painful? Can you walk on that ankle?”

Innocuous questions can have an outsized impact on the health and safety of the people around you. But knowing which questions to ask is one of the biggest challenges in any medical situation. A situation needs to be assessed using a systematic approach to correctly identify potential threats to someone’s life when seconds matter. But in a less critical situation, having a systematic approach enables you to elicit subtle symptoms and recognize less obvious problems, which can mean the difference between a save and a bad outcome. 

The Scene Survey

“Look both ways before crossing a street" is a life lesson we have all encountered (and usually shared). This age-old adage of looking around to survey the scene before stepping into it yourself drives home a fundamental truth about approaching any situation: if you as a first responder are injured, you’re now another victim, rather than a helpful hand. 

The Primary Assessment

Seconds matter. A primary assessment is designed to quickly assess and rectify any life-threatening injuries. It can be completed very rapidly in any traumatic situation. 

The main life-threatening injuries in a trauma patient are:

• massive hemorrhage
• airway obstruction
• respiratory failure
• spinal cord or brain injuries

Certain traumatic situations place people at high risk for a cervical spine injury, so it is important to take proper precautions to ensure spinal immobilization and alignment while assessing the injured person. By knowing what to do and how to do it, you can be your own first responder and save a life. 

The Secondary Assessment

As the medical advisor for a university outdoor education program, I heard about a group of students who were camping in the Sierra Nevada. One evening, they were hoisting a bear bin up a tree branch to hang at their campsite. The branch broke and it fell down and hit a camper on the head. They were concerned about the head injury and possible spinal injury, so the next morning the trip leaders made the decision to evacuate and hiked out to seek medical advice. Was this necessary? Once evaluation of any life-threatening injuries is complete, the secondary assessment of an injured person is performed in a thorough head-to-toe examination. This systematic approach to injury evaluation should provide specific indicators to either alleviate or increase the caregiver’s concerns.

Obtaining pertinent data about the nature of the injury, understanding the mechanism of the injury, and eliciting associated signs and symptoms is helpful to both prioritize evaluation and ongoing management. There are mnemonics to help remember the type of questions to ask (ie., FAR COLDER: Frequency, Associated symptoms, Radiation, Character, Onset, Location, Duration, Exacerbation, Relief) that may, or may not, help delineate the appropriate level of concern. The problem with mnemonics is they’re great for multiple choice test questions, but often do not match the exact need in a clinical situation. 

Regarding that head injury, appropriate questions to ask would have included:

• Does the person seem confused or are they repeating questions?
• Was there a brief loss of consciousness?
• When the decision was made to evacuate, were there worsening headache symptoms, persistent nausea, midline neck pain, extremity weakness or numbness, or blurred vision? 

Asking the right questions and knowing what to look out for can allow you to continue your fun times outdoors, or know when to get out and get medical attention. 

Scenarios with Overlapping Symptoms

Some of the biggest challenges we face in outdoor health situations are when the scenario is unclear and the presenting symptoms overlap with various medical conditions. This is called a differential diagnosis, and without diagnostic testing at your disposal, getting to the right answer is predicated on asking the correct questions. 

For example, a common problem is encountering someone feeling dizzy on a hot day. With heat-related illness on all of our minds as summers get hotter, asking the right questions can prevent a potential tragedy. Has the person been drinking water, and, if so, how much? Over-hydrating and dilution of the body’s salt concentration (called hyponatremia) can present similar symptoms as heat illness. 

Is the person acting confused in the heat? Are they warm to touch? The presence (or absence) of sweating should not be used to differentiate heat exhaustion from heat stroke. Rather, it is the presence of confusion or other altered mental status changes that should raise the red flag to initiate prompt cooling interventions. 

What about that strange rash? Does it itch? Is there an associated fever? Is the redness spreading and painful? Does the rash fade (blanch) when palpated? Having the step-by-step direction of which questions to ask, check, and then recheck not only provides peace of mind, but keeps kids out in the field. 

Musculoskeletal injuries are the most common cause of visits to the infirmary at summer camps. That painful elbow can be a sprain, a strain, a broken bone, or even a dislocation. Can the extremity bend normally? Is there evidence of intact circulation, nerves, and muscle function? Or is the pain simply unbearable? Without a handy X-ray technician, asking a few pointed questions and eliciting several directed movements can make the difference between stay and play versus a timely and costly visit to the nearest emergency department.

Best Practice

Any outdoor situation can quickly become an emergency. But having prompt and correct assessment is a necessary step to mitigate risk for both the person in harm’s way and the first responder. Having a readily accessible tool, such as GOES, as a pocket guide promotes a best practice approach to outdoor illnesses and injuries. The guidance provided in GOES is written and curated from scientific literature by emergency medicine physicians fellowship trained in wilderness medicine. Having a tool at your disposal, online and offline, can walk you through a step-by-step approach to the primary and secondary assessments you might encounter, then prompt you to ask the necessary questions when and where you are. 

It is important to stay up to date on key assessment and care activities. Medical handbooks may have incomplete information or lack the specific tools needed to evaluate the situation.

There have been numerous clinical trials that evaluate health decisions around whether a particular test is needed, a trip to the hospital is indicated, or help define the likelihood for the presence or absence of a particular disease or condition. These decision tools are based on tens of thousands of patients, validated through the peer review process, and published in the highest impact clinical journals. Having ready access to this expert information in real time, offline, in an easily digestible format to help ask the correct questions is not just ideal, it is both optimal and now deliverable through a platform called GOES Health. 

Asking the right questions will get you the correct answer. 

Have fun. Stay safe. 

Dr. Grant Lipman
CMO, GOES Health

This blog was sponsored by GOES Health.

Periodically, the American Camp Association (ACA) makes timely and relevant information about products and services available to its members so they can make informed decisions for their camps. However, the ACA does not endorse products, services, or companies.