Principles of Patient Assessment in EMS

Focused History & Physical Exam Trauma Patient

Introduction In U.S. trauma is the leading cause of death (ages 1 to 44) In U.S. trauma is the leading cause of death (ages 1 to 44) Many MOI have predictable patterns Many MOI have predictable patterns Evaluation of MOI is essential. Top MOIs: Evaluation of MOI is essential. Top MOIs: Motor vehicle crashes Motor vehicle crashes Falls Falls Poisoning Poisoning Burns Burns Drownings Drownings

Reconsider MOI Early evaluation of the MOI should guide the EMS provider to suspect certain injury patterns Early evaluation of the MOI should guide the EMS provider to suspect certain injury patterns “Index of suspicion” – injury patterns help the EMS provider anticipate the potential for shock or other problems “Index of suspicion” – injury patterns help the EMS provider anticipate the potential for shock or other problems © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Reconsider MOI (continued) 2 major factors for injuries are: 2 major factors for injuries are: The amount of energy exchanged with the body The amount of energy exchanged with the body The anatomical structures involved The anatomical structures involved Inappropriate identification of MOI may result in incorrect treatment and high mortality rates Inappropriate identification of MOI may result in incorrect treatment and high mortality rates © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Reconsider MOI (continued) “Index of suspicion” for a spinal injury: “Index of suspicion” for a spinal injury: Cracked windshield Cracked windshield Bent steering wheel Bent steering wheel Dented dashboard Dented dashboard Side door intrusion into motor vehicle Side door intrusion into motor vehicle © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Evaluating the MOI The presence of a significant MOI is a key decision point in the assessment algorithm The presence of a significant MOI is a key decision point in the assessment algorithm This key decision point can make a significant impact on the life or death of a critical trauma patient This key decision point can make a significant impact on the life or death of a critical trauma patient © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Evaluating the MOI (continued) Key decisions regarding the MOI should help the EMS provider: Key decisions regarding the MOI should help the EMS provider: Minimize scene time Minimize scene time Quickly perform a rapid trauma assessment Quickly perform a rapid trauma assessment Perform life-saving procedures Perform life-saving procedures Transport to the appropriate facility Transport to the appropriate facility © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Evaluating the MOI (continued) Consider the following questions: Consider the following questions: How long ago did this happen? How long ago did this happen? How fast or what velocity was involved? How fast or what velocity was involved? How hard was the impact or surface impacted upon? How hard was the impact or surface impacted upon? How high did the patient fall from? How high did the patient fall from? How far did the patient travel before stopping? How far did the patient travel before stopping? © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Evaluating the MOI (continued) Distracting injuries can keep more serious injuries from being discovered quickly Distracting injuries can keep more serious injuries from being discovered quickly Scene management can also cause delays: Scene management can also cause delays: Multiple patients Multiple patients Relatives Relatives Bystanders Bystanders Other rescuers Other rescuers Minor trauma can appear serious at first Minor trauma can appear serious at first © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Significant Trauma Detailed observation is key to managing the patient with significant trauma Detailed observation is key to managing the patient with significant trauma Don’t be distracted by less serious injuries Don’t be distracted by less serious injuries © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Golden Hour Time is a critical factor for the patient with a significant MOI Time is a critical factor for the patient with a significant MOI Barring the need for extrication, the rule of the “Golden hour” and the “Platinum 10 minutes” will apply Barring the need for extrication, the rule of the “Golden hour” and the “Platinum 10 minutes” will apply © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Platinum Ten Minutes The maximum time EMS providers stay on the scene for a critical trauma patient The maximum time EMS providers stay on the scene for a critical trauma patient © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Rapid Trauma Assessment (RTA) Quick and systematic exam of these body sections: Quick and systematic exam of these body sections: Head Head Chest Chest Abdomen Abdomen Pelvis Pelvis Extremities Extremities Back/buttocks Back/buttocks © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Rapid Trauma Assessment (RTA) After the RTA obtain baseline VS and a SAMPLE history After the RTA obtain baseline VS and a SAMPLE history When the patient is unresponsive obtain the information from bystanders, relatives, or other first responders When the patient is unresponsive obtain the information from bystanders, relatives, or other first responders Do not extend the scene time to obtain info Do not extend the scene time to obtain info © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Rapid Trauma Assessment (RTA) Perform a detailed physical exam enroute Perform a detailed physical exam enroute Transportation destination depends on the needs of the patient and capabilities of a trauma center as well as your local protocols Transportation destination depends on the needs of the patient and capabilities of a trauma center as well as your local protocols © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Rapid Trauma Assessment (RTA) All your efforts on the scene and enroute may be for naught when a critical trauma patient is transported to an inappropriate facility All your efforts on the scene and enroute may be for naught when a critical trauma patient is transported to an inappropriate facility © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Ongoing Assessment (OA) Repeat IA, reassess VS, and interventions Repeat IA, reassess VS, and interventions Repeat OA every 5 minutes on critical trauma patients Repeat OA every 5 minutes on critical trauma patients In cases of short manpower or short transport time – performing the OA takes priority over the DPE In cases of short manpower or short transport time – performing the OA takes priority over the DPE © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Minor Trauma Examples: Examples: Isolated extremity injury Isolated extremity injury Minor burns Minor burns Small lacerations or abrasions Small lacerations or abrasions An exception would be a minor injury with an altered mental status or intoxication An exception would be a minor injury with an altered mental status or intoxication © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Focused Physical Exam: Assess D – deformity D – deformity C – contusions C – contusions A – abrasions A – abrasions P – punctures/penetrations P – punctures/penetrations B – burns B – burns T – tenderness T – tenderness L – lacerations L – lacerations S – swelling S – swelling © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Focused Physical Exam: Assess Range of motion (ROM) Range of motion (ROM) Pulse, motor, and sensation (PMS) Pulse, motor, and sensation (PMS) Skin color, temp. and condition (CTC) Skin color, temp. and condition (CTC) © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Additional Steps in Minor Trauma Patient Assessment Develop a treatment plan Develop a treatment plan Perform interventions(s) Perform interventions(s) Obtain baseline VS Obtain baseline VS Obtain SAMPLE history Obtain SAMPLE history Perform OA every 15 minutes Perform OA every 15 minutes © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Conclusion EMS providers can make a significant impact on the life or death of a critical trauma patient by: EMS providers can make a significant impact on the life or death of a critical trauma patient by: Minimizing scene time Minimizing scene time Performing a RTA Performing a RTA Performing life-saving interventions Performing life-saving interventions Transporting to an appropriate facility Transporting to an appropriate facility © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Conclusion The decision point as to the presence of a significant MOI will predicate the extent of exam, speed, priority of transport, and destination The decision point as to the presence of a significant MOI will predicate the extent of exam, speed, priority of transport, and destination © 2003 Delmar Learning, a Division of Thomson Learning, Inc.