Safety First: Estimate LOAs


Study Notes:

  1. 1.Awareness is a description of how well someone responds to changes in their environment.

  2. 2.We report this by using the statement “The patient is responding to (this sort of stimulus) __________ by (doing this) _____________.

  3. 3.Normally we use the simple AVPU scale.

  4. 4.A stands for alert and means that the patient responds to normal stimuli (although how they respond may be abnormal)

  5. 5.V stands for verbal and means that the patient somehow responds to verbal stimuli.  You should always specify whether it is ‘normal verbal’, or ‘loud verbal’ that they are responding to.

  6. 6.P stands for pain and means that the patient somehow responds to painful stimuli.

  7. 7.Always use a nail-bed-press on an extended arm (if safe) to administer pain.

  8. 8.Record the patients response to pain as one of the following:
    • they awake and follow commands
    • they reach toward the pain (called localizing)
    • they withdraw away from the pain
    • decorticate posturing, (toward the midline - indicates problems with the coritcospinal tracts)
    • decerebrate posturing, (away from the midline - indicates problems with their cerebrum i.e. their brains are damaged).

  9. 9.U stands for unresponsive and means that the patient does not respond to verbal or painful stimuli at all.

  10. 10.Orientation, Memory and GCS are assessed later in the call.

  11. 11.At this point, we are just performing a very quick estimate

“E is for Estimate LOAs”


“Safety First” ... Table of Contents

Safety    Use your BSI - Biological Safety

              F is for Fire - Scene Safety

I                 I is for Incident: MOI/NOI          

R                Determine the numbeR of patients

S                Send for help

T                Trauma to the C-spine?

G                General impression of the patient

E                Estimate LOAs

T                Threats to you or your patient?

1°A             1° Airway

1°B             1° Breathing

1°C             1° Circulation

1°D             1° Decision

2°A             2° Airway

2°B             2° Breathing

2°C             2° Circulation

2°D             2° Decision

“Hello ... anybody home”?

Up until now we haven’t really been interacting with the patient at all. Instead we’ve been examining the environment, and maybe telling them not to move their heads, but we haven’t really been talking or interacting with them.

Now it’s time to introduce ourselves and start actually interacting with them for the first time.  Initially, we want to assess their levels of awareness (or LOAs).

However, at this point it really is a ‘down-and-dirty’ estimate.  Remember, we haven’t even done the ABC’s, so we don’t want to be wasting time.

Basically we're trying to figure out how well the patient is reacting to changes in their environment.  How much stimulus does it take for them to be aware that something around them has changed.

Although that sounds like it might be tricky to determine, If you figure out and then fill in the blanks for this sentence, you’ll be able to quickly communicate their LOA:

“The patient is responding to _________ (fill in stimulus) by _________ (fill in their response)”.

So, for example, we might say that the patient is responding to loud noises by moving.

However, to make this even easier, medical professionals use a four point scale, called the 'AVPU' scale.  You need to learn this scale (so check this out).

Estimating the patient’s LOAs is the E in ‘Safety F.I.R.S.T. G.E.T. 1° &  2° ABCDs’.   To end this mnemonic, we’re going to go back to where we started and look for ...