One hour after injury is the key to life and death decisions, assessment refers to the life-threatening and non-life-threatening in the short term to separate the wounded, according to the first re-light, the first principle to focus on the life-saving rescue diagnosis requires a unique emergency personnel awareness, critical thinking, assessing classification quickly and accurately.

1.1 Early assessment and airway and ventilation is the first one, and then must determine the nature of the patient's respiratory, circulatory perfusion and control bleeding, and then to determine the possible damage to the limbs. Whether the patient is breathing shallow promotion, wheezing, difficulty, respiratory depression; assessment of skin, oral mucosa, nail bed color to determine whether there is sufficient oxygenation, to check whether the oral throat vomit, blood, or foreign body obstruction.

1.2 by DRABC checks:

D (danger) refers to the risk that the presence of risk factors, such as the intestine to leak out, the wound continued bleeding, airway obstruction, cervical fracture, which requires immediate action.

R (reaction) refers to the reaction, i.e., check the casualty response to stimuli.

A (airway) refers to the respiratory tract, airway patency check that, when oral secretions, and immediately sucked out, keep the airway patency.

B (breath) refers to breathe, that is to observe the movement of the thorax or wounded feeling ventilation conditions for the wounded. Three conditions are most commonly affected ventilation tension pneumothorax, open pneumothorax, massive pulmonary contusion and flail chest. Visible contradiction breathing, can and

Crepitus, with rib fractures and bone fricative. Auscultation voiced showing pleural effusion, pleural drum sound shows a lot of product gas.

C (circulation) refers to the cycle, that touches judgment carotid or femoral artery circulation situation. Wounded in critical condition for a long time, can only be assessed in blood pressure if they can reach the radial artery, femoral artery, internal carotid artery pulse when systolic blood pressure of at least 10.7,9.3 and 8.0Kpa. There are three shock accident site assessment very practical ways: First, the estimated blood pressure monitor pulse evaluate cardiac output. Mild shock, pulse 100 to 120 beats / min, systolic blood pressure 12 ~ 13.3Kpa estimated reduction in cardiac output. Moderate shock pulse> 120 to 140 beats / min, 8-12Kpa estimated systolic cardiac output decreased. Severe shock, pulse hard hit or> 140 beats / min, estimated systolic 5.3 ~ 8Kpa. Second, capillary refill test (the wounded hand gently press the nail or nail bed ends to slide gently press their oral mucosa, if the time from red to white in the 2s as normal, if> 2s speed is slow capillary refill) , filling speed is slow tissue hypoperfusion one of the earliest indications. The third is to assess the state of consciousness, in the absence of brain trauma cases, the level of consciousness is a reliable indication of cerebral hypoperfusion. If significant changes in level of consciousness, can be considered to have severe tissue hypoperfusion and hypoxemia.

1.3 Pay special attention to non-response capability wounded.

Shock due to various reasons, has not been corrected by; bleeding, failure to effectively stop bleeding; airway obstruction, respiratory dysfunction, extreme difficulty breathing; blood pneumothorax, open pneumothorax, tension pneumothorax, flail chest; hypertensive crisis like, acute cerebrovascular accident, deep coma with brain injury, intracranial pressure, such as the focus of treatment given. Trauma associated with heart and lung function deterioration may have different causes, treatment should be carried out for each cause, the underlying cause heart and lung function deterioration causes include: ① severe central nervous system damage associated with cardiovascular events; ② central nervous system damage, airway obstruction, chest open airway collapse or fracture caused by respiratory disorders, and hypoxia; ⑧ direct damage to vital organs such as the heart, aorta, lungs; ④ potential iatrogenic or otherwise cause damage, such as electrical injury or driving members of sudden ventricular fibrillation; ⑤ tension pneumothorax or pericardial tamponade lead to reduced cardiac output; ⑥ cause hemorrhagic hypovolemia decreased oxygen carrying capacity so; ⑦ secondary severe hypothermia caused by cold environment.

1.4 Classification of the wounded to mark the striking card said. Usually red, yellow, green, black four-color system to identify the disease priorities.