If at some point before or during a first aid secondary survey / secondary assessment
you had reason to suspect a head injury,
or if the person can tell you their name, but doesn’t know what happened to them,
you could ask ‘levels of consciousness’ (LOC) questions.
A person who is oriented to their surroundings and situation should be able to tell you
their name,
where they are,
what time it is (not to the exact hour but at least is it morning or evening),
and what happened to them.
Sometimes as people go in and out of consciousness they tend to lose ability to answer the levels of consciousness (LOC) questions in the order person, place, time and event, with their name being the last thing they remember. They might know who they are, where they are, what time of the day it is, but they do not know what just happened to them (how they they sustained their injury).
They can be fully awake, (as in, not asleep) but not fully conscious or fully unconscious.
Later they might remember what had happened, or it could get worse and they know their name, but not place, time, event. The EMT / Paramedic who responds and the emergency room doctor needs to know what their levels of consciousness were at what times.
It is common for people hit by or nearly hit by lightning to lose short term memory for a few days, or at east suffer “mild confusion, memory slowness or mental clouding”.
Many people refer to being unconscious as being “passed out,” “conked out,” or “blacked out.” For students in the De Anza first aid class, it is suggested the you start using the word unconscious instead of using the phrase passed out.
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Some also refer to this as Mental Status (“the patient’s level of awareness and interaction with the environment” or “the patient is alert and oriented to person, place, and time with normal speech”)
and a doctor they see might only observe the person, place, time portions. But in an emergency, right after an accident, if you have reason to suspect a concussion, or the person seems out-of-it, it can be crucial to find out if the person knows what just happened to them.
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The Glasgow Trauma (or COMA) Scale, used by medical personnel, labels a person who can answer all these questions ‘oriented.’
If they can’t give accurate responses, but they can take part in a conversation of sorts the label is ‘confused.’
They are given a score for these and ‘inappropriate words,’ ‘incomprehensible sounds,’ or ‘no verbal response’ as well.
A person who is not ‘oriented’ or has slurred speech needs professional help and should not be allowed to leave the scene until seen by an EMT/ Paramedic.
Remember, even if they are not oriented, and may not respond to you properly, they often can understand everything you are saying so be positive without lying.
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Some sources ask for,
(and you might find yourself with a test question in an different class that the answer is),
person, place, date, and situation.
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Boy Scouts are often trained in their first aid classes
to say something like
“Please do not move until I know more about you.
Can you tell me who you are and what happened?”
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A question on the final exam for HLTH57A is:
7) As people lose consciousness they sometimes remember some things, but not others. A person who is fully oriented to their surroundings and situation will know about all four of the following, but they can lose awareness, and always in the same order. List the four words.
P_______________ P______________ T______________ and E___________.
Take a moment to see if you can answer the question. Then scroll down past these photos to find the correct answers.
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Answers to the question are:
7) As people lose consciousness they sometimes remember some things, but not others. A person who is fully oriented to their surroundings and situation will know about all four of the following, but they can lose awareness, and always in the same order. List the four words.
Person, Place, Time and Event
Most people find it easier to memorize things they need to if they say them out loud. For many, it helps to write them down and if you handwrite a flash card, with the question on one side and the answer on the other, you can also use it to quiz yourself.
In answer to a question, the birds above are a
Sandhill Crane,
Peregrine Falcon
Magpie,
Bald Eagle,
Osprey
all of which people have seen on the De Anza Outdoor Club between summer quarter and fall quarter trip to Grand Teton National Park in Wyoming.
And many of us have been lucky enough, especially when out padding,
to see a Bald Eagle (or Osprey) dive down and snatch a fish out of the water.
