1. Principles of Patient Assessment in EMS

2. Making a Priority Decision

3. Introduction
Priority decisions are made to set the tone for patient care and management.
Perform the initial assessment first.
When more than one patient is present you must triage (to sort):
Triage use in pre-hospital and hospital
Many triage systems available

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The Priority Decision
Priority decision making is an essential skill for EMS providers.
Failure to make a priority decision may have serious life-threatening implications.
Consider the “golden hour” and the “Platinum ten minutes.”
Stable vs. Unstable
When two priority choices are possible “up triage.”
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5. Systems of Prioritizing
Become familiar with the system used in your area:
Hot / cold
Red / yellow / green
High / Low
Minor / Moderate / Severe
P-1, P-2, P-3
C U P S
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6. A Close Up on One System C U P S
Acronym that stands for:
critical
unstable
potentially unstable
stable
First introduced in the BTLS course
Adapted in many states
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7. Examples of “Critical Patients”
Actual or impending cardiorespiratory arrest
Respiratory failure
Decompensated shock (hypoperfusion)
Rising intracranial pressure
Severe upper airway difficulties
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8. Examples of “Unstable Patients”
Cardiorespiratory instability
Respiratory distress
Compensated shock (hypoperfusion)
Two or more long bone fractures
Trauma with associated burns
Amputation proximal to wrist or ankle
Penetrating injury to: head, neck, chest, abdomen, pelvis
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9. Examples of “Unstable Patients” (continued)
Uncontrollable external bleeding
Chest pain with a systolic BP < 100
Severe pain
Poor general impression
Unresponsive patients
Responsive patients who do not follow commands
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10. Examples of “Potentially Unstable Patients”
Cardiorespiratory instability
MOI indicating a possible hidden injury
Major isolated injury
General medical illness
An uncomplicated childbirth
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11. Examples of “Stable Patients”
Patients with a low potential for cardio-respiratory instability
Low grade fever
Minor illness
Minor isolated injury
An uncomplicated extremity injury
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12. Tools to Determine Priority
Developed to logically examine, evaluate, and rate severity of a patient using a numbering system
Developed initially for trauma patients yet also used on medical patients
Glasgow Coma Score
The Trauma Score
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13. Glasgow Coma Score (GCS)
Measures:
Eye opening
Verbal response
Motor response
The best responses are given a numerical score
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Trauma Score (TS)
Developed in 1980 as a triage tool
Used to predict patient outcomes
Numerical grading system combining GCS and the following:
Respiratory rate
Respiratory expansion
Systolic BP
Capillary refill
Conversion scale for GCS
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15. Triaging and Prioritizing Burn Patients
Burn severity determined by:
Source type
Body surface area (BSA)
Rule of nines used to calculate BSA
Classifications of burns include:
Mild -sunburn
Moderate – uncomplicated partial thickness < 30% BSA
Severe – inhalation injuries or electrical burns
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16. Triage to Aeromedical Transport
Refer to established regional protocols
Weather conditions – visibility and wind
Medical considerations
Injury factors – MOI, length of extrication, distance to trauma center
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Triage in MCI’s
Triage is needed when there are multiple patients and limited resources.
Triage helps to ensure the most serious are treated and transported first.
Designate a “triage officer” and use “triage tags.”
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The START System
Acronym - simple triage and rapid treatment
Developed in the 1980’s, separating patients into:
Minor
Delayed
Immediate
Deceased
Few responders can triage many rapidly.
Assessing:
Respiratory status
Hemodynamic status
Mental status
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Triage Tags
Used in MCI’s
Several types available
Eliminates need to reassess each patient over and over
Most tags have 4 priorities:
P-1 (immediate or red)
P-2 (delayed or yellow)
P-3 (hold, “walking wounded,” or green)
P-0 (deceased, no priority or black)
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Trauma Centers
Hospitals capable of caring for the acutely injured patient
Must meet strict criteria to use this designation
Classified into 4 levels
Some hospitals also specialize in specific care (burns, peds)
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21. Trauma Centers (continued)
Each community has different needs and resources
Criteria for a regional structure is often found in local protocols
What is the trauma center in your region?
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Conclusion
Important care and transport decisions are based on the priority decision!
Practice is needed to gain proficiency.
Be familiar with the tools in your system or region.
Patient conditions are dynamic and can quickly change the priority.
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.