A structured approach to care when seconds matter and help may be delayed or unavailable.
In austere, wilderness, disaster, or grid-down environments, good outcomes depend less on equipment and more on clear assessment, disciplined decision-making, and accurate reporting.
This page provides a high-level overview of the core assessment and reporting frameworks used across emergency medicine, tactical care, and disaster response. Each section serves as a jump point to more detailed guides, job aids, and printable forms.
Why Structured Assessment Matters
Under stress, the human brain skips steps.
Structured assessment systems exist to:
- Prioritize life-threatening problems first
- Reduce missed injuries
- Create a shared mental model among caregivers
- Enable clear handoff and documentation
These tools are modular. You do not need all of them at once — but you should know when and why to use each.
Primary & Immediate Life-Threat Assessment
MARCH-PAWS
Purpose: Identify and treat immediate causes of preventable death.
Used when: Trauma, violence, blast injuries, major accidents, or any situation with uncontrolled bleeding or airway compromise.
Framework:
- Massive hemorrhage
- Airway
- Respiration
- Circulation
- Head injury / Hypothermia
- Pain
- Antibiotics
- Wounds
- Splinting
Why it matters: MARCH-PAWS enforces a do-the-most-critical-first mindset before moving on to detailed assessment.
➡️ Jump to: MARCH-PAWS step-by-step guide
Rapid Trauma Survey
DCAP-BTLS
Purpose: Systematic head-to-toe trauma identification.
Used when: After immediate life threats are controlled.
Framework:
- Deformities
- Contusions
- Abrasions
- Punctures / Penetrations
- Burns
- Tenderness
- Lacerations
- Swelling
Why it matters: DCAP-BTLS prevents fixation on obvious injuries while missing hidden ones.
➡️ Jump to: DCAP-BTLS body-region checklist
Patient History & Symptom Assessment
SAMPLE + OPQRST
Purpose: Capture medical history and clarify the patient’s complaint.
Used when: Medical emergencies, illness, or trauma once the patient is stable enough to answer questions.
SAMPLE:
- Signs & symptoms
- Allergies
- Medications
- Past medical history
- Last oral intake
- Events leading up
OPQRST (for pain or symptoms):
- Onset
- Provocation / Palliation
- Quality
- Region / Radiation
- Severity
- Time
Why it matters: These frameworks turn vague complaints into actionable information.
➡️ Jump to: SAMPLE + OPQRST interview guide
Mass Casualty Prioritization
START Triage
Purpose: Rapidly prioritize multiple patients when resources are limited.
Used when: Mass casualty incidents, disasters, or overwhelmed care situations.
Categories:
- Immediate (Red)
- Delayed (Yellow)
- Minor (Green)
- Deceased / Expectant (Black)
Why it matters: START triage accepts hard realities — it focuses resources where they will save the most lives.
➡️ Jump to: START triage flowchart & drills
Reporting & Documentation
CASREP (Casualty Report)
Purpose: Rapid situation reporting to higher authority or support elements.
Used when: Communicating patient status during disasters, tactical operations, or remote incidents.
Typical elements include:
- Location
- Number of casualties
- Severity
- Immediate needs
- Evacuation requirements
Why it matters: Clear reports prevent delays, duplication, and misallocation of resources.
➡️ Jump to: Patient Assessment – Documentation
TCCC Card (DD Form 1380)
Purpose: Continuity of care during tactical or austere evacuation chains.
Used when: Trauma care, especially where patients may change hands.
Why it matters: The TCCC card travels with the patient and preserves critical treatment data under chaotic conditions.
➡️ Jump to: How to properly fill out a TCCC card
Patient Care Report (PCR)
Purpose: Detailed clinical documentation of assessment, treatment, and response.
Used when: Extended care, delayed evacuation, or post-incident review.
Why it matters: PCRs support continuity of care, legal protection, training review, and after-action analysis.
➡️ Jump to: Long-form PCR template & guidance
The Hard Decision: Stay or Move
In wilderness, disaster, or grid-down environments, evacuation is not always possible — or safe.
Factors to Consider
Patient factors:
- Airway stability
- Bleeding control
- Spinal injury suspicion
- Shock
- Ability to move or self-assist
Environmental factors:
- Weather and terrain
- Distance to help
- Time to deterioration
- Security risks
Resource factors:
- Manpower
- Equipment
- Communications
- Shelter and sustainment
Key principle:
Do not create a second patient by forcing movement.
Sometimes the correct decision is to treat, stabilize, and shelter in place.
➡️ Jump to: Stay vs Move decision framework
How to Use This Material
You do not memorize these systems.
You practice them.
- Use one framework at a time
- Build muscle memory
- Layer complexity as skills increase
This overview page is your map. Each linked page provides depth, drills, and printable tools.