Casualty Card

Fallen climber

On the floor lying on his back, still tied into his harness, and a 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.

Casualty monitoring - posed picture of a fallen climber
First things first – the ABCs

As a first aider I was happy to offer my help. The casualty was conscious and talking to me (so I knew he had an A – airway, and was B – Breathing). A bit dazed and confused, the last thing he remembered was climbing above his gear 5m or so further up the rock face. His mate was clearly worried and panicked and by now calling the ambulance service.

I checked the fallen climber for any potential injury: his right thigh felt swollen and hard to the touch. I couldn’t pinch up any denim like I could with his left leg.

Was this guy in (hypovolaemic) shock?

Mentally I continued checking through my ABCs of first aid – A – Airway open, B – Breathing (he’s talking), C – Circulation – could he possibly have an internal bleed from a broken femur, I asked myself? Should I raise his legs I wondered, or leave him still?

In order to make a decision, I needed information

More to the point, the emergency services would want information too in order to best prioritise this callout. In order to get that information, as a first-aider, I needed to use my casualty monitoring card.

Using the card I was prompted to check his vital signs … The vital signs associated with shock can be cold, white clammy skin, fast shallow breathing, and a fast weak pulse. 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 keep the emergency services updated – specifically the local mountain rescue team.

Reassurance

Additionally as a first aider my role now was to reassure the casualty and his partner too that they were in good hands. So there I am, with just a pair of blue nitrile gloves on my hands, with me checking through the casualty’s vital signs and this simple act was a huge boost for the casualty and his mate too.

The casualty card

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 had to sit 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 and when, to whom. 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 or, for me a pre-printed form on waterproof paper.

Four GREAT reasons to use a casualty card …

There are four good reasons why 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
    Recording 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 hugely important 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, 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. It 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 – 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.

Print off your own casualty card from here

Will Legon (of Will4Adventure.com) works professionally in the outdoors leading groups walking, climbing and mountain biking. (He has also been known to go running in the hills and is a keen cyclist, MTB, gravel and bike-packing). 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.

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