Assessment Considerations in Disasters and Conflicts

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Introduction

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Database

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Subjective Assessment

History of Presenting Condition

Past Medical History

Drug History

Social History

Objective Assessment

Observation

Observation of your patient should include behaviour including level of distress, posture, patterns of movement including gait and involuntary movements if applicable, oedema, pressure sores, deformities, any external fixation, surgical sites or wounds and dressings and document injuries and observations on a body chart if available as part of your record.

Try to coincide rehabilitation with dressing checks to allow for surgical site or wound assessment to monitor for any signs of infection. Do not undress a wound yourself unless you are trained to redress it or a colleague is available to do so.

NOTE: Signs of Wound or Surgical Site Infections

• Redness,
• Warmth
• Swelling
• Purulent discharge
• Delayed healing
• New or Increasing Pain
• Malodour

Consciousness

It is also essential to establish what level of consciousness the individual has before commencing assessment and to monitor for any changes in levels of consciousness. Consciousness can be measured with either the AVPU (Alert, Verbally Responsive, Pain Responsive or Unresponsive) or the more detailed Glasgow Coma Scale. The Glasgow Coma Scale Aid is available to download in a wide range of languages from here.

Vital Signs

Vital signs including heart rate, blood pressure, respiratory rate (including work of breathing), oxygen saturation levels and temperature should only be checked and interpreted if you are trained to do so as part of your role. These can also be checked from the medical records available to see trends in vital signs over the previous hours and days which can provide an early sign of complications and determine wether the patient is suitable for participation in rehabilitation, and guide treatment options.

NOTE: Signs of Sepsis (Blood Infection):

• A fever above 101°F (38°C) or a temperature below 96.8°F (36°C)
• Resting heart rate higher than 90 beats per minute,
• Breathing rate higher than 20 breaths per minute.

Table 1. Normal Vital Signs

Age	Heart Rate	Respiratory Rate	Systolic BP	Diastolic BP
Preterm	120-200	40-80	38-80	25-57
Full Term	100 - 200	30-60	60-90	30-60
1 Year	100-180	25-40	70-130	45-90
3 Years	90-150	20-30	90-140	50-80
10 Years	70-120	16-24	90-140	50-80
Adolescent	60-100	12-18	90-140	60-80
Adult	60-100	12-18	90-140	60-80

Cognition

Cognition is the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses. While in some cases like in those with a suspected acquired brain injury may require a more detailed assessment of cognition, for most patients you just need to complete a quick check of orientation, including orientation to

• Person - Whats your name?

• Place - Do you know where you are?
• Time - Do you know what day, month, year or season it is?
• Situation - Do you know what happened to you?

Respiratory

Respiratory conditions can affect breathing either through damage to the lungs or excess secretions. To ensure that the correct treatment is implemented if you are competent to carry out and interpret it, a thorough respiratory assessment should include both a comprehensive subjective and objective component to get a complete understanding of the patient's function and baselineAt a minimum chest x-ray review, auscultation and palpation should be undertaken. You can read about a complete respiratory assessment here.

Pain

Pain is common with the type of injuries seen in disaster and conflict settings and gaining an understanding of the type of distribution of pain can be useful, to help identify the cause of pain and whether it is improving or worsening. A good pneumonic PQRST offers support to remember the elements of a pain assessment;

P	Provokes	What provoked the pain? What makes it worse? What makes it better?
Q	Quality	sharp, dull, squeezing, pressure, pounding, burning, stabbing, stinging or aching pain
R	Radiates	Does the pain move anywhere? Ask the patient to point to anywhere they feel pain.
S	Severity	Ask the patient to rate the pain on a scale - There are a wide range of pain assessment scales available including the visual analogue scale, numeric pain rating scale
T	Time	When did it start? Was the onset slow or sudden? How long has it lasted? Is it a constant or intermittent ? Have you had the pain previously? Is it the same as previously or is it different from last time?

Range of Movement

Muscle Strength

Muscle Tone

Function

Psychological Status

Tissue Viability Status

Nutritional Status

Resources

References 

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