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has stopped breathing or his heart has stopped;
suffers severe chest pains or has trouble breathing (possible cardiac ar-
rest);
is bleeding severely;
is unconscious;
has had a serious head injury;
has a severe burn;
has a severe allergic reaction;
suffers numbness down one side (possible stroke);
cannot understand what is said to them;
has suspected broken bone or dislocation;
experiences severe stomach pains which do not go away when treated
by over-the counter medicines;
has overdosed or poisoned themselves.
There are established procedures for dealing with casualties of
major incidents such as terrorism attacks, large fires, and multiple
road traffic accidents. One of the first things is to determine who is a
priority and needs to be treated immediately, and who can wait. One
method is to colour code patients like this:
– blue (patients who are severely injured and will die)
– red (patients who need immediate surgery or other life-saving ac-
tion)
– yellow (patients who are stable but who will need hospital care)
– green (patients who will need to see a doctor, but not immediately)
– white (patients who only require first aid and home care).
Legally, anything that is not recorded has not been done, so the
training of A&E staff emphasizes the importance of accurate and full
record keeping. This is not just because clear communication is essen-
tial for efficiency, but also as a defence against complaints. A&E staff
are frequently sued and accurate note keeping helps to protect them
against legal action. Accusations of neglect are one of the most fre-
quent reasons for legal action. In many countries, medical records can
be used as evidence in courts. A&E staff therefore learn the im-
portance of disciplined record keeping and they are instructed to
record relevant positive and negative results,
never write derogatory remarks,
document the results of all investigations in the correct terminology,
outline procedures performed,