How to Deal with the Casualty

The first few seconds of your approach and initial contact sets the scene and starts to restore order to the chaos of the accident.
A calm, controlled voice gives the injured person confidence that you will help, and positive eye contact will hold their attention.
Initial physical contact is always a shock for an injured person, and needs to be positive, but not excessive, reassuring them that you are a competent and experienced rescuer.
Please take time to LISTEN to the injured person.  If you ask a question, give them time to answer, and then confirm back to them what they have said.
This way they know that you have recognised their pain and anxiety, and will give you a better picture of where they hurt and what is distressing them.
Look as well as feel during your examination.  Often the position of the injured person will tell you where and what their injuries are likely to be.
Carry out this survey quickly, but in a planned and careful sequence.
Explain why you are doing the survey and initial observations (e.g. pulse), using simple language, which will be understood by an ordinary person.
Recognise the pain of the injured person, and be responsive to it.
Remember that the injured person is in a vulnerable frame of mind, and unfamiliar with things which happen to them in these situations.
You need to tell them what you are doing, and why.   
Check areas where the injured person is hurt carefully. Although you will need to get down to skin level in some areas, remember only expose them as much as you need in order to examine the injuries, and then cover them up, so that they are not exposed to the public gaze, or to the elements.
Firm, gentle and systematic examination with the fingers (not the finger tips) will stop them from feeling prodded and pinched.
Identify areas of pain/discomfort, and check them regularly to make sure they are not getting worse.
If the injured person has pain in the neck, they are unlikely to be able to hold it up properly, so will need you to hold it for them in a comfortable, but correct position.
Keep them focussed on something, so that they do not try to turn their head to see things, or to talk to you.
Keep them informed about what is happening, so that they are less likely to flinch or turn at sudden noises or movements.
The injured person needs to be protected from the elements, as well as noise, debris and unnecessary movement. However, they do need to feel that they can breathe easily, and see some daylight, so be careful with your selection of soft protection.
Although the injured person does not need to see or feel the cutting equipment even when it is close to them, they do need to be reassured that you have taken all the safety precautions you can to protect them from further injury.  
If you fit a cervical collar, do it carefully and competently so that the head of the injured person does not move as you are doing it.  Keep up the manual stabilisation once it is fitted, so that they remain completely still and protected.
If you apply a mask, remember that they may be afraid of it, so explain how it will help them.  If you are using oxygen, remember to keep the flow on while you are cutting glass. If you offer them a dust mask, ask them first if they have any allergies.
Take care where you put your equipment – BP cuffs, oxygen tubes can get damaged or kinked, and the oxygen bottle placed on top of a pair of broken legs during the extrication will not improve the injured person’s condition.
Talk TO the injured person, not AT them.  Tell them what is happening around them.  Sudden, unexpected noises such as breaking glass, cutting, vibration, unexpected pops and bangs all frighten people who are hurt, and it undermines your reassurance.  These noises can raise blood pressure, increase pain, deepen shock and may increase blood loss.  They make people jump, and affect their position.
Talk about what is happening to the injured person here and now, so that they know that you are concerned about THEM.
As a rescuer you know that there are occasions during the rescue when our concept of time changes, sometimes it seems to stretch interminably, sometimes it is just too short.  This is also true of the person being rescued, but often the perception of the rescuer differs from that of the patient.  A rescuer who is a good communicator will recognise this, and will talk, or use silence sensitively.  They will also be careful about discussing personal issues (such as friends, family, or the injured person lack of them), will not ask intrusive questions about their private life or use inappropriate humour (such as making jokes about having a convertible car).
One of the injured person’s greatest anxieties is that they will not be rescued, and will die at the scene. This is greatly emphasised if at any time they are left alone, and will undermine any reassurance, which you have given them.
Do not talk over them or about them without their permission.  Have just one person talking to them, so they do not get confused and even more anxious by having to keep repeating things.
Remember they will be feeling very insecure and out of control of their life, so do not get irritated by their need for constant reassurance.
Do not tell them that you are going to do something right now (such as get them out or protect them from falling debris), and then go off to do something else, or fail to do it at all.
Do not tell them untruths.  “Reassurance” such as “you are fine” or “you will be up and about tomorrow” when you both know they have 2 broken legs, just doesn’t work.  If you have to cause them pain, for instance when you move them, let them know and help them to bear it. In more difficult circumstances, find a balance, which will not compromise either of you.
In short, you need to be: