What does DOTS stand for in first aid?

DOTS is an acronym used to remember what to look for when conducting a physical assessment of a casualty (ie, looking for injuries).

DOTS stands for:

  • Deformities
  • Open wounds
  • Tenderness
  • Swelling

These four signs are common indications of an injury to a body part.


A deformity is used to describe an abnormal shape of a body part. Common causes of deformities are fractures or dislocations as they disrupt the skeleton.

The best way to check for a deformity is to compare sides. For example, comparing both wrists to look for a deformity associated with a wrist fracture.

The photo shows an example of an obvious deformity to the wrist.Deformity

Open wounds

Searching for open wounds is an important part of the assessment of a casualty, especially if the person is unresponsive. It is important to find and stop any bleeding in order to prevent the casualty deteriorating.

Wounds can be hidden and not immediately obvious so you may have to go searching! Always remember to protect yourself from any bodily by wearing gloves.


Pressing on an area may cause pain, this is known as tenderness and may indicate an underlying injury. Tenderness will occur before other more visible signs (for example bruising). 

In an unresponsive patient who is unable to communicate you should always look at the face when assessing for tenderness. You may see a pain response if you press over an injury. 


Swelling occurs mainly with soft tissue injuries and fractures. Swelling does not occur immediately after an injury so may not be obvious during your initial assessment. 

John Furst

JOHN FURST is an experienced emergency medical technician and qualified first aid and CPR instructor. John is passionate about first aid and believes everyone should have the skills and confidence to take action in an emergency situation.

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