The ABCs may be the essential bedrock of first aid, but there's another simple tool that's often overlooked. Will Legon makes the case for the humble but useful casualty card.
On the floor lying on his back, still tied into his harness, rope lying slack about his body, was a climber who had evidently taken a lead fall from Regent Street, a classic E2 at Millstone Edge in the Peak District. His mate's anxious call had alerted me when I had been walking by. As a first aider I was happy to offer help. The casualty was conscious and talking to me. Dazed and confused, the last thing he remembered was climbing several metres above his gear. His mate was clearly worried, and panicked, and by now calling the ambulance service.
I checked the fallen climber for any potential injury: I could feel swelling under the jeans of his right thigh. Continuously I was mentally checking through my list of ABCs – A – Airway open, B – Breathing (he's talking), C – Circulation – possibly internal bleeding from a broken femur? Though his breathing was quickened it was not fast nor was it shallow plus his skin colour was pink and he felt warm to the touch. For now at least the only action I would take as a first aider would be to call the emergency services again – specifically for mountain rescue. Additionally as a first aider my role now was to reassure the casualty and his mate too that all was going to be OK.
Thinking back over the years about the various incidents that I have dealt with on the hill or at the crag and thinking about how many first aid courses I have sat through, I realise that strikingly there is one lesson rarely taught well: the importance of the casualty card.
A casualty card is essentially a record of what has happened to whom, and when. Further, it is a record of how the vital signs (pulse, breathing rate, colour, temperature and alertness) are changing with time. It could just be a piece of note-paper, but better is a pre-printed form on waterproof paper.
There are four good reasons you should carry and use one of these
1. As a medical record
You are potentially the first on the scene. Hence you are best placed to record what has happened. For me on that day in the Peak District my casualty was conscious – it might have been the case that by the time the medics turned up he'd lose consciousness. Hence I was well placed to record how he felt, where the pain was, who his next of kin were, if he was on medication and so much more … All potentially useful information for people further down the line.
2. It can inform your decisions
One aspect of using the casualty card is that you use it to monitor and record the casualty's vital signs: pulse, breathing, colour, temperature, and state of alertness. In turn it keeps you focused on how the casualty's condition may be changing. That day at Millstone Edge with my fallen climber I waited 20 minutes before the professionals turned up. By monitoring his vital signs I was able to reap information – in particular I was looking for signs of shock and thinking about what I could do if he went into shock.
3. It is of use for the medics who take over
Checking the vital signs and recording them every five minutes meant that when the medics arrived they had an idea of how this casualty was doing. Four sets of readings gave them a trend and a base line which in turn could help with their decisions.
4. It can massively reassure the casualty you know what you are doing
And this is the best reason, in my experience, for using a casualty card – it makes you, a humble first aider, look incredibly professional and this is hugely reassuring to the casualty and to anyone with them. On that day last August, with the aid of my casualty card it gave me something to do and helped me achieve my aim of reassuring my casualty and his mate that they would both be ok.
A casualty card costs practically nothing, it weighs practically nothing but this one piece of first aid kit is enormously beneficial. So if you don't already carry one in your first aid kit then now's the time to get online and to print a few off.
As for my casualty that day in the Peak District? He was flown out by air ambulance. For the little I had done, he and his mate were incredibly grateful, and I was just so happy that I'd been equipped to help as best as I could.
Will Legon of Will4Adventure.com works professionally in the outdoors leading groups walking and instructing single pitch rock climbing. Since 2009 Will has been delivering first aid training specialising in outdoor first aid courses. He is an ITC (Immediate Temporary Care) trainer, offering a range of courses accredited by Ofqual and the SQA. In a former life, Will was a maths teacher and an infantry officer in the Territorial Army.
Will4Adventure are specialists in outdoor first aid, running regular courses every month.