Principles of Patient Assessment in EMS

Overview to Patient Assessment

Introduction The latest versions of the national standard curricula are “assessment based” and place more emphasis on the assessment process in training EMS providers. The latest versions of the national standard curricula are “assessment based” and place more emphasis on the assessment process in training EMS providers.

Importance of a Standardized Approach The EMS provider’s approach to patient assessment and physical examination must be similar for all new patients. The EMS provider’s approach to patient assessment and physical examination must be similar for all new patients. Four key factors must be considered: environment, severity, medical versus trauma, and level of care available. Four key factors must be considered: environment, severity, medical versus trauma, and level of care available.

Is The Environment Safe?

What’s the Patient’s Severity? Stable or Unstable P-1, P-2, P-3, “high” or “low”?

Medical or Trauma? MOI MOI Significant Significant Non-significant Non-significant NOI NOI Responsive Responsive Not responsive Not responsive

Level of Care First Responder First Responder EMT-Basic EMT-Basic EMT-Intermediate EMT-Intermediate EMT-Paramedic EMT-Paramedic Aeromedical Evacuation Aeromedical Evacuation

Components of Assessment Scene size-up Scene size-up Initial assessment Initial assessment Focused history & physical exam: trauma Focused history & physical exam: trauma Focused history & physical exam: medical Focused history & physical exam: medical Detailed physical exam Detailed physical exam Ongoing assessment Ongoing assessment

Scene Size-up Scene safe for you and crew Scene safe for you and crew Body substance isolation precautions needed Body substance isolation precautions needed Is additional help needed Is additional help needed

Initial Assessment Orderly and sequential exam with correction of life-threats Orderly and sequential exam with correction of life-threats MS-ABC Priority Plan MS-ABC Priority Plan General impression General impression Chief complaint (MOI/NOI) Chief complaint (MOI/NOI) Assess mental status Assess mental status Assess airway, breathing, and circulation Assess airway, breathing, and circulation Determine priority and need for ALS Determine priority and need for ALS

Focused History & Physical Exam: Trauma Significant MOI Significant MOI Rapid Trauma Exam Rapid Trauma Exam Baseline Vital Signs Baseline Vital Signs SAMPLE History SAMPLE History Transport (if not already doing so) Transport (if not already doing so) Non-significant MOI Non-significant MOI Focused Exam Focused Exam Baseline Vital Signs Baseline Vital Signs SAMPLE History SAMPLE History Transport as needed Transport as needed

SAMPLE History S – signs and symptoms S – signs and symptoms A – allergies A – allergies M – medications M – medications P – pertinent past medical history P – pertinent past medical history L – last oral intake L – last oral intake E – events leading up to E – events leading up to

Focused History & Physical Exam: Medical Not Responsive Not Responsive Rapid Physical Exam Rapid Physical Exam Baseline Vital Signs Baseline Vital Signs SAMPLE History SAMPLE History Transport (if not already doing so) Transport (if not already doing so) Responsive Responsive History of present event (OPQRST) History of present event (OPQRST) SAMPLE History SAMPLE History Baseline Vital Signs Baseline Vital Signs Focused physical exam Focused physical exam Transport Transport

OPQRST Elaborate on the Chief Complaint O – onset O – onset P – provocation P – provocation Q – quality Q – quality R – radiation, region, referral R – radiation, region, referral S – severity S – severity T - time T - time

Detailed Physical Exam Trauma with significant MOI Trauma with significant MOI Enroute to the hospital Enroute to the hospital Assess the head, face, eyes, nose, mouth, neck, chest, abdomen, pelvis, extremities, back and buttocks Assess the head, face, eyes, nose, mouth, neck, chest, abdomen, pelvis, extremities, back and buttocks

Ongoing Assessment Conducted enroute to the hospital Conducted enroute to the hospital Reassess the vital signs Reassess the vital signs Reassess initial assessment Reassess initial assessment Reassess interventions Reassess interventions

Conclusion Assessment is a dynamic process Assessment is a dynamic process Use a standardized approach Use a standardized approach Continually reassess Continually reassess Be flexible and reprioritize as needed Be flexible and reprioritize as needed Follow the assessment algorithm Follow the assessment algorithm © 2003 Delmar Learning, a Division of Thomson Learning, Inc.