First Aid Patient Assessment: Finding Out What Is Wrong

When a worker goes down on a job site, the first question is not “what is the right treatment?” It is “what is actually happening?” Every first aid intervention, from calling 911 to applying direct pressure to performing CPR, depends on correctly identifying what is wrong before acting. Skipping or rushing the assessment step is one of the most common failure points in workplace first aid response.

This article covers the structured approach to patient assessment in workplace first aid: scene safety, the primary survey using the DRABC framework, the secondary survey, and the SAMPLE history. It is grounded in the 2024 American Heart Association and American Red Cross First Aid Guidelines, which identify the primary survey and SAMPLE history as essential components for rapidly detecting life-threatening conditions.

Why Structured Assessment Matters

The instinct in an emergency is to act immediately. That instinct causes problems when the action is wrong because the situation was misread. A worker slumped in a chair could be having a cardiac event, a diabetic emergency, a stroke, a heat illness, or a seizure. The initial presentation can look similar across these conditions, and the correct first aid response differs significantly between them.

A structured assessment does not slow down the response. It takes 30 to 60 seconds and prevents the kind of errors that waste critical minutes: treating an unconscious diabetic as a drunk worker, attempting to move someone with a suspected spinal injury, or starting CPR on a person who is breathing normally but unconscious.

2024 AHA/Red Cross guidance: The primary survey, physical examination, and SAMPLE history are essential components of first aid assessment, structured to rapidly detect life-threatening conditions. The guidelines explicitly state that skipping these components may result in delays in detecting and resolving life-threatening conditions.

Step 1: Scene Safety

Before approaching any person who appears injured or ill, the first aid responder must evaluate whether it is safe to do so. This is not a bureaucratic formality. A responder who enters an unsafe scene becomes a second casualty, which worsens the outcome for everyone.

Scene safety checklist before approaching

►Electrical hazards: A worker who contacted live electrical equipment cannot be touched until power is confirmed off. Approach from a position that lets you assess without touching.

►Atmospheric hazards: An unconscious worker in a confined space may have been overcome by a hazardous atmosphere. Entry requires atmospheric testing and appropriate rescue equipment, not an untrained rush to help.

►Fall or structural hazard: Check that the area is stable before approaching a worker who fell. Unstable scaffolding or a trench wall that partially collapsed can collapse further.

►Traffic and moving equipment: Establish a safety perimeter before approaching a worker struck by a vehicle or near active equipment. Redirect traffic or signal equipment to stop before entering the area.

Critical: If the scene is not safe and cannot be made safe without specialist resources (confined space rescue team, electrical isolation, structural stabilization), call 911 and keep bystanders clear. Do not enter an unsafe scene without appropriate training and equipment. This is not a failure to help; it is correct first aid practice.

Step 2: The Primary Survey (DRABC)

The primary survey is the rapid, systematic check used to identify and address life-threatening conditions in order of priority. The DRABC framework, used consistently in US and international first aid training, structures the assessment into five sequential steps.

DRABC: Primary Survey

Danger

Confirm the scene is safe before approaching. Look for electrical hazards, moving vehicles, unstable structures, and atmospheric or chemical hazards. If danger exists and cannot be controlled, do not approach.

Response

Tap the person’s shoulders firmly and ask loudly “Are you okay?” and “Can you open your eyes?” If they respond in any way (eye opening, verbal response, purposeful movement), they are responsive. If there is no response to stimulation, they are unresponsive. Unresponsiveness triggers immediate action: call 911, check airway and breathing.

Note: life-threatening bleeding discovered at this point takes priority. If a large, gushing wound is visible, apply direct pressure or a tourniquet before proceeding with the rest of the survey.

Airway

For an unresponsive person, open the airway using the head-tilt, chin-lift method: place one hand on the forehead and gently tilt the head back while lifting the chin with two fingers. This moves the tongue away from the back of the throat. If a spinal injury is suspected (fall from height, vehicle impact, diving injury), use the jaw-thrust technique without head tilt.

Breathing

Look, listen, and feel for breathing for no more than 10 seconds. Look for chest rise, listen for breath sounds, and feel for air movement near the mouth and nose. Normal breathing in an adult is 12 to 20 breaths per minute. Gasping, very slow breathing, or no breathing at all is not normal and requires CPR. If breathing is present and the person is unresponsive, place them in the recovery position unless a spinal injury is suspected.

Circulation

Check for signs of circulation, including visible heartbeat, normal breathing, movement, and signs of severe bleeding. For trained first aiders checking for a pulse, check the carotid artery (side of the neck) for adults. A pulse check should take no more than 10 seconds. Absence of a pulse in an unresponsive, non-breathing person means begin CPR immediately.

On gasping: Agonal breathing (occasional gasping breaths) after cardiac arrest is not normal breathing and should not delay CPR. If an unresponsive person is taking infrequent, shallow, or gasping breaths, treat it as not breathing and start CPR.

Calling for Help During the Primary Survey

Call 911 as early in the assessment as possible. If a second person is present, assign them to call while you continue the assessment. If alone with an unresponsive adult, call 911 before beginning CPR unless the person is clearly a child, in which case give 2 minutes of CPR first.

When calling 911, be ready to provide:

What to tell the 911 dispatcher

1Your specific location: building name or number, floor, unit, nearest entrance or landmark

2What has happened: “Worker unresponsive, not breathing” or “Worker with severe bleeding from a laceration”

3What is being done: “I am starting CPR now” or “Direct pressure is applied to the wound”

4Stay on the line: the dispatcher can provide real-time guidance and will update EMS with information as you provide it

Step 3: The Secondary Survey

The secondary survey is conducted after the primary survey is complete and any immediate life threats have been addressed. Its purpose is to identify additional injuries or conditions that may not be immediately obvious and to gather the information EMS will need to treat the patient effectively.

The secondary survey has two components: the SAMPLE history and the head-to-toe examination.

SAMPLE History

SAMPLE is the standard mnemonic for gathering patient history from a conscious, communicative person. The questions should be asked conversationally, and the answers should be relayed to EMS when they arrive.

SAMPLE: Patient history questions

Letter

Stands for

What to ask

Signs and Symptoms

“What are you feeling? Where does it hurt? On a scale of 1 to 10, how bad is the pain?”

Allergies

“Do you have any allergies to medications, food, or anything else I should know about?”

Medications

“Are you taking any medications, including prescription drugs, over-the-counter medicines, or supplements?”

Past Medical History

“Do you have any medical conditions I should know about? Diabetes, heart problems, epilepsy?”

Last Oral Intake

“When did you last eat or drink anything?” (Critical for diabetic emergencies and for anesthesia risk if surgery is needed.)

Events

“What were you doing when this happened? Did you feel anything before you fell or passed out?”

Why the Events question matters in a workplace context: A worker who says “I was welding and then felt dizzy” suggests possible fume inhalation. One who says “I was fine and then my chest felt tight” suggests a cardiac or respiratory event. One who says “I tripped on the edge of the mat” suggests a fall mechanism. The event description determines whether additional hazards (atmospheric, chemical) may still be present, and what injuries are most likely.

Head-to-Toe Examination

For a conscious worker with a mechanism of injury that could have caused hidden trauma, a brief head-to-toe check identifies injuries that may not be immediately visible or reported: a construction worker who fell from a ladder may have a visible wrist fracture but also a head injury they are not aware of.

Head-to-toe: what to check

Head and neck: Look for cuts, swelling, bruising, or deformity of the skull. Check the ears and nose for blood or clear fluid (can indicate a skull fracture). Check the neck for deformity or tenderness along the spine. If neck tenderness is present, do not move the person.

Chest: Look for visible wounds, asymmetric breathing, or paradoxical movement. Gently press both sides of the chest. Unequal chest rise or pain on compression can indicate rib fractures or pneumothorax.

Abdomen: Look for bruising, distension, or rigidity. Ask if pressure on the abdomen causes pain. Internal bleeding in the abdomen can be severe without obvious external signs.

Arms and legs: Check each limb for deformity, swelling, bruising, and the ability to move. Compare injured and uninjured sides. Check distal pulse in each limb (wrist for arms, ankle for legs) to confirm circulation is intact.

Skin condition: Pale, cool, clammy skin suggests shock or poor circulation. Hot, dry skin suggests heat stroke or high fever. Bluish discoloration (cyanosis) of the lips or fingernails indicates oxygen deprivation.

When the Person Is Unconscious

If the worker cannot answer SAMPLE questions, gather information from bystanders who witnessed what happened, and look for:

Medical alert jewelry

Bracelets or neck tags that list conditions such as diabetes, epilepsy, blood thinners, or allergy to specific medications. Check the wrists and neck as part of the assessment.

Witness accounts

Ask any bystanders: “Did you see what happened?” “Did they say anything before they collapsed?” “Did they have any complaints earlier in the shift?” These accounts become the E (events) component of the SAMPLE history.

Environmental clues

A worker found near an exhaust source may have carbon monoxide exposure. A worker found near chemical containers may have had a toxic exposure. What is in the immediate area tells part of the story the worker cannot tell.

Common Assessment Errors in Workplace Emergencies

Entering an unsafe scene to reach a victim faster

A second casualty does not help the first. Scene safety is the first step for a reason. In confined spaces, near electrical hazards, or in chemical release scenarios, entering without protection creates additional victims.

Treating gasping as normal breathing and not starting CPR

Agonal gasping is a reflex, not breathing. An unresponsive person who is gasping is in cardiac arrest and needs CPR immediately. The visual of a gasping person can delay CPR by creating the impression that they are alive and breathing.

Moving an unconscious worker without assessing for spinal injury

A fall from height, a vehicle collision, or any mechanism that could have caused a head or neck injury requires spinal precautions. Moving the person without considering this can convert a survivable injury into permanent paralysis.

Assuming a known medical condition explains the presentation

A worker known to have epilepsy who is found unresponsive may be having a seizure, or may have a completely unrelated cardiac event, head injury, or toxic exposure. Past history informs the assessment; it does not replace it.

Not relaying SAMPLE information to EMS on arrival

The information gathered during the secondary survey is the handoff data for EMS. A SAMPLE history written on a notepad or phone during the assessment gives paramedics a head start on diagnosis that saves critical treatment time.

Putting It All Together: Assessment Sequence Summary

First aid assessment: the full sequence

1Scene safety: Is it safe to approach? Identify hazards; control or avoid them before entering.

2Response (DRABC): Check responsiveness. Call for help. Direct someone specific to call 911.

3Airway and Breathing: Open the airway; assess for normal breathing. Start CPR if not breathing normally.

4Circulation: Check for pulse; check for severe bleeding and control it. Retrieve AED.

5Secondary survey: SAMPLE history if conscious; head-to-toe examination; check for medical alert jewelry if unconscious.

6Handoff to EMS: Report what you found in the primary and secondary surveys. Provide written SAMPLE notes if possible. Stay with the worker until EMS assumes care.

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