1. Sick/Not Sick Rapid Assessment of a Patient with Traumatic Injury

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3. 3 The Concept of Sick/Not Sick This concept has been around for years and is based off similar principles used during Mass Casualty Incidents This concept has been around for years and is based off similar principles used during Mass Casualty Incidents It’s a method of rapid patient assessment that allows you to make good treatment decisions based on proven clinical indicators It’s a method of rapid patient assessment that allows you to make good treatment decisions based on proven clinical indicators Facilitates good coordination and communication in the field and results in better patient care Facilitates good coordination and communication in the field and results in better patient care

4. Truama Sick/Not Sick4 Purpose of Sick/Not Sick To help you quickly and accurately decide who is critically injured and who is not To help you quickly and accurately decide who is critically injured and who is not Assure a rapid initial assessment and transport to appropriate facility Assure a rapid initial assessment and transport to appropriate facility Prevent delays in patient care Prevent delays in patient care

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6. 6 Objectives Understanding Terms Understanding Terms The clinical picture The clinical picture Who is “Sick” Who is “Sick” Who is “Not Sick” Who is “Not Sick” Making a decision Making a decision Treatment Treatment Transport Transport

7. Truama Sick/Not Sick7 Terms While In Route Index of Suspicion – The anticipation that certain types of accidents will result in certain types of injuries Index of Suspicion – The anticipation that certain types of accidents will result in certain types of injuries Mechanism of Injury – The forces of injury and how they were applied to the body Mechanism of Injury – The forces of injury and how they were applied to the body

8. Truama Sick/Not Sick8 Terms Involving Exam Perfusion – The flow of blood through the organs and tissue of the body Perfusion – The flow of blood through the organs and tissue of the body RPM – An acronym that stands for respirations, pulse and mentation RPM – An acronym that stands for respirations, pulse and mentation Skin Signs – Observable indications of circulation including skin color, temperature and moisture Skin Signs – Observable indications of circulation including skin color, temperature and moisture

9. Truama Sick/Not Sick9 Terms of Decision Sick – Someone who appears physiologically unstable as indicated by clinical indicators Sick – Someone who appears physiologically unstable as indicated by clinical indicators Critical / Urgent / Unstable Critical / Urgent / Unstable Not Sick – Someone who appears physiologically as indicated by adequate respiration, pulse, mental status, skin color and an appropriate body position Not Sick – Someone who appears physiologically as indicated by adequate respiration, pulse, mental status, skin color and an appropriate body position Non-critical / Non-urgent / Stable Non-critical / Non-urgent / Stable

10. Truama Sick/Not Sick10 The “Sick” Patient Appears to be unstable as indicated by clinical signs Appears to be unstable as indicated by clinical signs Has life-threatening injuries that need to be treated aggressively by both BLS and ALS crews Has life-threatening injuries that need to be treated aggressively by both BLS and ALS crews This patient can die quickly unless you initiate immediate treatment and rapid transport to an appropriate facility This patient can die quickly unless you initiate immediate treatment and rapid transport to an appropriate facility

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12. Truama Sick/Not Sick12 Recognizing the Sick Patient It may only take one of these to convince you! Index of Suspicion Index of Suspicion Mechanism of Injury Mechanism of Injury Respirations Respirations Pulse Pulse Mental Status Mental Status Skin Signs Skin Signs Body Position Body Position

13. Truama Sick/Not Sick13 The “Not Sick” Patient Appears to be stable as indicated by clinical signs Appears to be stable as indicated by clinical signs This patient still has injuries at this time the condition is not life threatening This patient still has injuries at this time the condition is not life threatening Even though this patient has no life threatening injuries they still need and deserve treatment and transport to the appropriate facility Even though this patient has no life threatening injuries they still need and deserve treatment and transport to the appropriate facility

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15. Truama Sick/Not Sick15 Gathering The Information Pre Plan While In Route Pre Plan While In Route Index of suspicion/Mechanism of injury Index of suspicion/Mechanism of injury Differential Diagnosis X 3 Differential Diagnosis X 3 View the Clinical Picture Upon Arrival View the Clinical Picture Upon Arrival Chief complaint Chief complaint Respirations Respirations Pulse Pulse Mental status Mental status Skin color/signs Skin color/signs Body position Body position

16. Truama Sick/Not Sick16 Making The Decision What does the clinical picture tell you? What does the clinical picture tell you? Chief Complaint – Focus on injury Chief Complaint – Focus on injury Mechanism of Injury (MOI) – How significant was the mechanism and is there obvious trauma Mechanism of Injury (MOI) – How significant was the mechanism and is there obvious trauma Respirations – What is the rate or character Respirations – What is the rate or character Pulse – Can it be palpated and what is its rate and character Pulse – Can it be palpated and what is its rate and character Mental Status – Is the patient anxious, combative, drowsy, lethargic or unconscious Mental Status – Is the patient anxious, combative, drowsy, lethargic or unconscious Skin Signs – What is the color, temperature and moister Skin Signs – What is the color, temperature and moister Body Position – meeting you at the door, tripod to breath, unable to support weight Body Position – meeting you at the door, tripod to breath, unable to support weight Is the patient likely to survive without immediate and aggressive action? Is the patient likely to survive without immediate and aggressive action?

17. Truama Sick/Not Sick17 The Decision Made The clinical picture has been formed The clinical picture has been formed All information has been gathered quickly All information has been gathered quickly Sick/Not Sick Sick/Not Sick Having a plan Having a plan Taking action based on the decision Taking action based on the decision Sick – ALS & rapid transport Sick – ALS & rapid transport Not Sick – Thorough on-scene exam with appropriate treatment Not Sick – Thorough on-scene exam with appropriate treatment

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19. Truama Sick/Not Sick19 Changing The Decision It’s OK to switch from Not Sick to the Sick decision It’s OK to switch from Not Sick to the Sick decision Things may change in the patients status Things may change in the patients status You may discover more information during a thorough exam You may discover more information during a thorough exam You may have a “Gut Feeling” You may have a “Gut Feeling” Don’t get caught Don’t get caught Failing to respond to new information Failing to respond to new information Having tunnel vision Having tunnel vision Not having a clear well thought out plan Not having a clear well thought out plan

20. Truama Sick/Not Sick20 Treatment/Transport Formulate a plan based on the clinical decision Formulate a plan based on the clinical decision Make a decision early in the call Make a decision early in the call Take action quickly, add additional recourses early and treat the patient aggressively Take action quickly, add additional recourses early and treat the patient aggressively Transport the patient to an appropriate destination and inform them that you are coming Transport the patient to an appropriate destination and inform them that you are coming

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22. Truama Sick/Not Sick22 Summary Speed up the delivery of care to critical patients by determining Sick/Not Sick early Speed up the delivery of care to critical patients by determining Sick/Not Sick early Create a plan while en-route based on information from dispatch and other units on- scene Create a plan while en-route based on information from dispatch and other units on- scene Treat Sick patients aggressively with both BLS and ALS crews Treat Sick patients aggressively with both BLS and ALS crews Understand the clinical signs and how they are used to determine if a patient is Sick or Not Sick Understand the clinical signs and how they are used to determine if a patient is Sick or Not Sick

23. Truama Sick/Not Sick23 Summary Respirations Respirations Pulse Pulse Mental Status Mental Status Skin Signs Skin Signs Body Position Body Position Evidence of Significant Mechanism of Injury Evidence of Significant Mechanism of Injury The sick patient appears unstable as indicated by inadequacies in:

24. Truama Sick/Not Sick24 Questions?