Wilderness First Aid — Field Assessment Reference
Page 1 of 21 · Scene size-up — before you approach (you are priority #1)
- Hazards: rockfall, water, traffic, weather, animals. What hurt them can hurt you. Don't become patient #2.
- Gloves on (Standard Precautions): treat all blood and body fluids as infectious.
- How many patients? Loudest is rarely sickest, so check the quiet ones early. Severe bleeding still goes first (X), screaming or not.
- Mechanism of injury: high energy = suspect hidden injury. Vehicle, diving, or a fall of more than about 10 feet (roughly one story, or about twice their height), lower for older adults or anyone who lands on their head. Unsure? Treat it as high energy.
- Consent: ask a responsive adult; unresponsive = implied consent.
2 · First look — 10-second general impression
AppearanceAlert? Interacting? Posture normal?
BreathingEffort? Noise? Position to breathe?
SkinPink? Pale, mottled, blue?
Any side abnormal → treat as sick and go straight to the primary survey.
AVPU — level of responsiveness
AAlert — awake, oriented
VResponds to Voice
PResponds to Pain only
UUnresponsive
V, P, U, or any decline is a red flag. Recheck often and watch the trend.
3 · XABCDE primary survey — find and fix life threats, in order
XExsanguinating hemorrhage — severe bleeding first. Spurting, pooling, or soaking-through limb bleeding: tourniquet now, high and tight, no pressure trial; note the time. Other bleeding, and groin/armpit wounds a tourniquet can't reach: firm direct pressure, pack the wound.
AAirway — open and clear it (jaw thrust if spine concern). Talking = open airway. Snoring or gurgling = blocked, so reposition. Unresponsive but breathing, no spine concern → recovery position (on their side). With spine concern, hold the head and jaw-thrust if you can stay; if you must leave, can't hold the airway, or they vomit, roll them onto their side, head and body in line. Airway wins.
BBreathing — look, listen, feel. Unresponsive and not breathing (or only gasping) → start CPR now, no pulse check: 100–120/min, 30:2. Drowning or lightning: 2 rescue breaths first.
CCirculation — pulse rate and quality, skin color/temp/moisture, treat for shock (flat, insulate underneath, keep warm).
DDisability — AVPU, pupils, protect the spine if the mechanism suggests injury.
EExpose / Environment — expose to examine injuries, then protect from heat/cold. Hypothermia worsens everything.
Don't-miss treatments — the ones that change the outcome
- Life-threatening limb bleed: tourniquet right away, high and tight; note the time.
- Unresponsive, not breathing (or only gasping): CPR now, 30:2, no pulse check. Drowning: breaths first.
- Anaphylaxis: epi first and early (adult auto-injector 0.3 mg); second dose at 5–15 min if not improving.
- Heat + altered mental status: heat stroke. Cool first with whatever you have, right where you are, then evacuate.
- Hypothermia: insulate underneath, wrap torso and legs, cover the head, handle gently.
- Confused known diabetic who can swallow: sugar, recheck in ~15 min. Unresponsive: nothing by mouth.
- Crushing chest pain: stop all exertion, sit them down, aspirin (chewed) if no allergy; call early.
- Snakebite: mark the swelling edge + time, immobilize, evacuate. No cut, no suck, no tourniquet, no ice.
SAMPLE — history
SSigns & symptoms
AAllergies
MMedications
PPast history
LLast oral intake
EEvents leading up
OPQRST — pain / complaint
OOnset — sudden or slow?
PProvokes — better/worse?
QQuality — sharp, dull?
RRadiates — where to?
SSeverity — 0–10 vs. before
TTime — when did it start?
Head-to-toe exam — DCAP-BTLS, feel for:
Deformity · Contusions · Abrasions · Punctures · Burns · Tenderness · Lacerations · Swelling
Compare side to side. Check CSM (circulation, sensation, motion) beyond every injured limb, before and after splinting.
Normal adult vitals
| Pulse | 60–100/min (count 15 s × 4) |
|---|---|
| Breathing | 12–20/min (60 s) · >20 fast · <10 or >30 red flag |
| Skin | Pink, warm, dry · cap refill < 2 s |
| Recheck | Stable q15 min · unstable q5 min |
Evacuation urgency — judge the trend, not just the snapshot
- EMERGENT (fastest possible): a life threat now or likely soon: uncontrolled or suspected internal bleeding · shock · declining or altered mental status that doesn't reverse · anaphylaxis, even after epi (it can rebound) · heat stroke · severe hypothermia · chest pain · stroke · breathing trouble that isn't resolving · spine injury with deficits. Call for rescue now (helicopter if available).
- URGENT (hospital within hours, not minutes): open fracture · closed long-bone fracture · ankle fracture they can't bear weight on · spine mechanism with an unreliable exam, no deficits · dislocation · infected wound that's spreading · any snakebite: evacuate now (emergent if symptoms). Move steadily; don't take big risks.
- NON-URGENT: can walk out or finish the day with a plan: ankle sprain they can walk on · minor wounds. Know the red flags.
Wilderness First Aid — free online course · openwfa.com
Educational use only — not a substitute for hands-on training or professional care.
Patient SOAP Note — Field Form
Page 2 of 2S · Subjective — chief complaint, SAMPLE, OPQRST
Allergies askedMeds askedPast historyLast intakeEvents
O · Objective — serial vital signs (stable q15 min · unstable q5 min)
| Time | AVPU | Pulse | Breaths | Skin (color/temp/moist) | Pain 0–10 / notes |
|---|---|---|---|---|---|
Exam findings (head-to-toe, DCAP-BTLS, CSM):
A · Assessment — what do you think is going on?
P · Plan — treatment + evacuation
EmergentUrgentNon-urgent
Calling for help — MIST report
Also give: your location · party size · terrain/weather · resources on scene. Helicopter needs ~100 × 100 ft clear, level area.
Hand this form to rescuers or medical providers when you transfer care.
Wilderness First Aid — free online course
← Back to the course · Full detail lives in Lesson 2: Patient Assessment and Lesson 13: Evacuation. The course syllabus lists every lesson.