The measurement of subjectiveness

As all first aiders know, there are many observations we need to take when treating a casualty - pulse, breathing, pupils, temperature, blood pressure - and what is common with all of these is that they are objective. It is accepted that one person taking a pulse may get a slightly different reading to the next person taking the same pulse but, allowing for a margin of error, they should be the same.

The latest observation we are now advised to check is pain, and this is particularly the case should there be the requirement for someone qualified to administer pain relief.

The way to ‘measure’ pain, rather than using any hi-tech instruments or conducting any physical assessment, is quite simply to ask the casualty about the type and extent of the pain. A helpful mnemonic to use when assessing this is PQRST.

• P: Provocation – what causes the pain to get better or worse, e.g. movement?
• Q: Quality - what is the casualty’s description of the pain, e.g. sharp or dull, constant or throbbing?
• R: Region and Radiation – where is the pain on the body and does it extend out from that point?
• S: Severity – how much pain is the casualty in on a score of 0 to 10. 0 being no pain and 10 being the worst pain they have ever had?
• T: Time – how long has the casualty had the pain, has it changed at all and have they had it before?

Measuring pain, particularly the pain score, is entirely subjective and based on what the casualty feels at that moment. What is painful to one person may not be as painful to another. Two people suffering the same ‘level’ of pain may have experienced different levels of pain in the past so provide different scores. It will always be the casualty, rather than the first aider, who is the greatest authority on how much pain they are in, hence the reason for such a method. Everyone has a different pain threshold and if a casualty expresses severe pain then this needs to be managed appropriately.

It is important to note that should pain relief be administered then it is essential to keep assessing the pain, along with the other observations, to determine whether it is being successful. That said, even when pain relief is not administered, periodic observations should be taken anyway until the casualty is out of the first aider’s care.