Patient Patient AssessmentAssessment

EMT/Paramedic

Refresher Training

Elements of A Patient AssessmentElements of A Patient Assessment

• Scene Size Up Scene Size Up

• Initial AssessmentInitial Assessment

• Vitals Signs and Patient HistoryVitals Signs and Patient History

• Focused History and Detailed ExamFocused History and Detailed Exam• Trauma Patient Assessment Trauma Patient Assessment • Medical Patient AssessmentMedical Patient Assessment

• Ongoing ExamOngoing Exam

Elements of A Patient AssessmentElements of A Patient AssessmentSCENE SIZE-UP

INITIAL ASSESSMENT

FOCUSED HISTORY &

PHYSICAL EXAM

FOCUSED HISTORY &

PHYSICAL EXAM

DETAILED

PHYSICAL EXAM

MEDICALMEDICALPATIENTPATIENT

TRAUMATRAUMAPATIENTPATIENT

DETAILED

PHYSICAL EXAM

ON-GOING ASSESSMENT

Scene Scene Size-upSize-up

What do we know about What do we know about this scene?this scene?

What do we What do we know about know about this scene?this scene?

Scene Size UpScene Size Up• Scene Size-upScene Size-up• Steps taken by a responding crew when Steps taken by a responding crew when

approaching the scene of an emergency call.approaching the scene of an emergency call.• Checking Scene SafetyChecking Scene Safety• Taking Body Substance Isolation (BSI) Taking Body Substance Isolation (BSI)

precautionsprecautions• Noting the Mechanism of Injury or Nature of Noting the Mechanism of Injury or Nature of

IllnessIllness• Determining the # of patientsDetermining the # of patients• Deciding if additional resources are needed.Deciding if additional resources are needed.

YOU should continue to Size-up your scene throughout the call!

Scene Size UpScene Size Up• Begins with receipt of callBegins with receipt of call

• LocationLocation• IncidentIncident• Injured/InjuriesInjured/Injuries

Scene Size UpScene Size Up• Observe the scene while you approach and as you Observe the scene while you approach and as you

exit the vehicle.exit the vehicle.• Listen for other approaching Emergency Units Listen for other approaching Emergency Units

from other directions. from other directions. • Look for down wires, smoke, or other hazards.Look for down wires, smoke, or other hazards.• Observe the traffic flow.Observe the traffic flow.• Look for victims on or near the roadway.Look for victims on or near the roadway.• Be alert for onlookers.Be alert for onlookers.• Watch for signals from police officers or other Watch for signals from police officers or other

emergency personnel.emergency personnel.• Sniff for odors.Sniff for odors.

The Scene Size-up begins before the ambulance ever comes to a STOP!

Scene Size UpScene Size Up• Establishing the DANGER Zone.Establishing the DANGER Zone.

• A Danger Zone exist around the wreckage of every vehicle A Danger Zone exist around the wreckage of every vehicle collision, within which special precautions must be taken.collision, within which special precautions must be taken.• No apparent hazards – the Danger Zone should be No apparent hazards – the Danger Zone should be

extended at least 50ft in all directions.extended at least 50ft in all directions.• If fuel has been spilled or a vehicle is on fire – the Danger If fuel has been spilled or a vehicle is on fire – the Danger

Zone should extend a minimum of 100 ft in all directions. Zone should extend a minimum of 100 ft in all directions. Park Upwind. Also if fuel has spilled, park uphill if Park Upwind. Also if fuel has spilled, park uphill if possible.possible.

• If wires are down – consider the danger zone the area in If wires are down – consider the danger zone the area in which people or vehicles might be contacted by the wires if which people or vehicles might be contacted by the wires if they pivoted around their attachments. they pivoted around their attachments.

• When a hazardous material is involved – check the When a hazardous material is involved – check the Emergency Response Guidebook.Emergency Response Guidebook.

An Ambulance should never be parked inside the DANGER ZONE!

Scene Size UpScene Size Up• Crime Scene and Acts of ViolenceCrime Scene and Acts of Violence• Observe for these potential signs of violence in Observe for these potential signs of violence in

you Scene Size-upyou Scene Size-up• Fighting or Loud VoicesFighting or Loud Voices• Weapons Visible or In UseWeapons Visible or In Use• Signs of Alcohol or Other Drug UseSigns of Alcohol or Other Drug Use• Unusual SilenceUnusual Silence• Knowledge of Prior ViolenceKnowledge of Prior Violence

If a hazard is present, RETREAT!!! Return only when the scene is secured by law enforcement.

Scene Size UpScene Size Up

Once your scene survey is complete, Once your scene survey is complete, determine the determine the nature of the callnature of the call by by identifying theidentifying the mechanism of injury mechanism of injury or theor the nature of illness. nature of illness.

Scene Size UpScene Size Up

• Mechanism of injury – Mechanism of injury – a force or forces that a force or forces that may have caused injury.may have caused injury.

• certain injuries are considered common certain injuries are considered common to a given situation.to a given situation.

• even though you can’t determine the even though you can’t determine the exact injury a patient may have exact injury a patient may have sustained, knowing the mechanism of sustained, knowing the mechanism of injury may allow you to predict injury injury may allow you to predict injury patternspatterns

Scene Size UpScene Size Up

• Identifying the Identifying the mechanism of injurymechanism of injury is very is very • important when dealing with motor vehicle collisions.important when dealing with motor vehicle collisions.• There are actually three collisions involved in each There are actually three collisions involved in each

motor vehicle crash.motor vehicle crash.• 1-The force of the vehicle as it strikes an object.1-The force of the vehicle as it strikes an object.• 2-The force of the patient’s body as it strikes 2-The force of the patient’s body as it strikes

the vehicles interiorthe vehicles interior• 3-The force of the patient’s organs as they 3-The force of the patient’s organs as they

strike surfaces within the body.strike surfaces within the body.

Remember The Law of Inertia: a body in motion will remain in motion unless acted upon by an outside force.

Scene Size UpScene Size Up

• Nature of Illness – What is medically Nature of Illness – What is medically wrong with the patient.wrong with the patient.

• The Nature of Illness may be obtained The Nature of Illness may be obtained from the following sources:from the following sources:• 1- The Patient1- The Patient• 2- Family Members or Bystanders2- Family Members or Bystanders• 3- The Scene3- The Scene

Scene Size UpScene Size Up

• Determine the number of patients and the Determine the number of patients and the adequacy of resourcesadequacy of resources• Call for assistanceCall for assistance• Other EMS UnitsOther EMS Units• Law EnforcementLaw Enforcement• Fire DepartmentFire Department• HazMatHazMat• Negotiating TeamNegotiating Team• etc.etc.

Initial Initial AssessmentAssessment

The Initial AssessmentThe Initial Assessment

• PurposePurpose• To rapidly identify & correct life threatsTo rapidly identify & correct life threats• To identify those patients who need rapid To identify those patients who need rapid

evacuationevacuation• Minimum Time on scene - Maximum Minimum Time on scene - Maximum

Care En RouteCare En Route

The Initial AssessmentThe Initial Assessment

• General ImpressionGeneral Impression• Using the facts gathered to this point, what Using the facts gathered to this point, what

is your first impression of the patient’s is your first impression of the patient’s condition?condition?

• Are there any immediate life threats?Are there any immediate life threats?

• Chief ComplaintChief Complaint• The reason EMS was called, usually in the The reason EMS was called, usually in the

patients own words.patients own words.

The Initial AssessmentThe Initial Assessment

• Mental Status (Level Mental Status (Level • of Consciousness)of Consciousness)• A - AlertA - Alert• V - VerbalV - Verbal• P - PainfulP - Painful• U - UnresponsiveU - Unresponsive

The Initial AssessmentThe Initial Assessment• Identify & Treat Life ThreatsIdentify & Treat Life Threats

AAirwayirway• Control C-spine (If trauma suspected)Control C-spine (If trauma suspected)• Open-Clear-MaintainOpen-Clear-Maintain

BBreathingreathing• Look, Listen, FeelLook, Listen, Feel• Oxygenate and ventilate as indicated.Oxygenate and ventilate as indicated.• Bare chest.Bare chest.

CCirculation irculation • Pulse (Rapid/Slow : Weak/Bounding)Pulse (Rapid/Slow : Weak/Bounding)• Skin ColorSkin Color• TempTemp• Major BleedingMajor Bleeding

The Initial AssessmentThe Initial Assessment• Determine PriorityDetermine Priority

• Immediate Priority Immediate Priority (Load-&-Go)(Load-&-Go)

VS.VS.

• Further On-Scene Assessment and Further On-Scene Assessment and Care (Stay-&-Play)Care (Stay-&-Play)

TraumaTraumaAssessmentAssessment

Trauma AssessmentTrauma Assessment• Focused History and Physical Exam for the Trauma Focused History and Physical Exam for the Trauma

PatientPatient• PurposePurpose• Obtain Chief ComplaintObtain Chief Complaint• What happened to the patient?What happened to the patient?

• Evaluate Chief ComplaintEvaluate Chief Complaint• What circumstances surround this incident?What circumstances surround this incident?• Is the Mechanism of Injury a high risk for Is the Mechanism of Injury a high risk for

injury?injury?• Conduct Physical ExamConduct Physical Exam• Obtain Baseline Vital SignsObtain Baseline Vital Signs

Trauma AssessmentTrauma Assessment

• Re-evaluate Mechanism of Injury (MOI)Re-evaluate Mechanism of Injury (MOI)• Significant MOI? Yes/NoSignificant MOI? Yes/No• Is patient unresponsive or disoriented? Is patient unresponsive or disoriented? • Can they participate in examination?Can they participate in examination?

• Is the patient under the influence of drugs Is the patient under the influence of drugs or alcohol? or alcohol? • Can they participate in examination?Can they participate in examination?

Trauma AssessmentTrauma Assessment

In Patients with NO significant mechanism In Patients with NO significant mechanism of injury…of injury…

• Reconsider the Mechanism of InjuryReconsider the Mechanism of Injury• Determine Chief ComplaintDetermine Chief Complaint• SAMPLESAMPLE History History • Baseline VitalsBaseline Vitals• Focused AssessmentFocused Assessment

Trauma AssessmentTrauma Assessment

Patients without significant MOIPatients without significant MOI • Focused Physical ExamFocused Physical Exam– DCAP-BTLSDCAP-BTLS• D - DeformitiesD - Deformities• C - ContusionsC - Contusions• A - AbrasionsA - Abrasions• P - Punctures/PenetrationsP - Punctures/Penetrations• B - BurnsB - Burns• T - TendernessT - Tenderness• L - LacerationsL - Lacerations• S - SwellingS - Swelling

Trauma AssessmentTrauma Assessment

Patients with significant Patients with significant MOIMOI … …

• Assess Reconsider the Assess Reconsider the MOIMOI

• Continue manual Continue manual stabilization of the stabilization of the head and neck.head and neck.

• Consider requesting Consider requesting advanced life support.advanced life support.

• Reconsider the Reconsider the transport decision.transport decision.

• Reassess mental status.Reassess mental status.• Perform Rapid Perform Rapid

Trauma Trauma • Baseline VitalsBaseline Vitals• SAMPLE HistorySAMPLE History

Trauma AssessmentTrauma Assessment

Patients with significant Patients with significant MOIMOI … …

• RAPID TRAUMA RAPID TRAUMA ASSESSMENTASSESSMENT– Head-to-Toe Physical Head-to-Toe Physical

ExamExam– PalpationPalpation– AuscultationAuscultation– Other SensesOther Senses

Trauma AssessmentTrauma Assessment

Patients with significant MOIPatients with significant MOI • RAPID TRAUMA ASSESSMENTRAPID TRAUMA ASSESSMENT– DCAP-BTLSDCAP-BTLS• D - DeformitiesD - Deformities• C - ContusionsC - Contusions• A - AbrasionsA - Abrasions• P - Punctures/PenetrationsP - Punctures/Penetrations• B - BurnsB - Burns• T - TendernessT - Tenderness• L - LacerationsL - Lacerations• S - SwellingS - Swelling

Trauma AssessmentTrauma Assessment

• Baseline Vital SignsBaseline Vital Signs• More than one setMore than one set• Look for “trending”Look for “trending”

• History History • S-A-M-P-L-ES-A-M-P-L-E

MedicalMedicalAssessmentAssessment

Medical AssessmentMedical Assessment

• Patient Responsive? Yes/NoPatient Responsive? Yes/No• AVPUAVPU

AA - Alert - AlertVV - Verbal - VerbalPP - Painful - PainfulUU -Unresponsive -Unresponsive

Medical AssessmentMedical AssessmentThe Responsive Patient…The Responsive Patient…• Assess Chief ComplaintAssess Chief Complaint• Signs & SymptomsSigns & Symptoms

OO - Onset - OnsetPP – Provokes – ProvokesQQ - Quality - QualityRR - Region/Radiation - Region/RadiationS S - Severity- SeverityTT - Time - Time

Medical AssessmentMedical AssessmentThe Responsive Patient…The Responsive Patient…

• SAMPLESAMPLE History History• Focused Medical AssessmentFocused Medical Assessment• Baseline Vital SignsBaseline Vital Signs• Transport DecisionTransport Decision• Detailed Physical ExamDetailed Physical Exam• Ongoing AssessmentOngoing Assessment

Medical AssessmentMedical AssessmentThe Unresponsive Patient…The Unresponsive Patient…

• Rapid Physical AssessmentRapid Physical Assessment• Baseline Vital SignsBaseline Vital Signs• SAMPLESAMPLE History History • Family, co-workers, bystandersFamily, co-workers, bystanders

• TransportTransport• Ongoing assessmentOngoing assessment

Detailed Detailed Physical ExamPhysical Exam

Detailed Physical ExamDetailed Physical Exam• More detailed Head-to-Toe More detailed Head-to-Toe

examinationexamination• Time sensitiveTime sensitive• Usually performed en-routeUsually performed en-route

• Required for any unresponsive Required for any unresponsive patientpatient

• Required for any multi-trauma Required for any multi-trauma patientpatient

• Required for any Patient with Required for any Patient with significant mechanism of injurysignificant mechanism of injury– If the mechanism of injury If the mechanism of injury couldcould

have caused serious injuries, you have caused serious injuries, you must actively assess for additional must actively assess for additional injuriesinjuries

Ongoing Ongoing AssessmentAssessment

Ongoing AssessmentOngoing Assessment• Purpose - Purpose - – Determine if there are any changes in the patient’s Determine if there are any changes in the patient’s

conditioncondition– Identify any missed injuries or conditionsIdentify any missed injuries or conditions– Assess the effectiveness of treatment given and Assess the effectiveness of treatment given and

adjust if necessaryadjust if necessary

• Performed on both the trauma or medical patient Performed on both the trauma or medical patient • ProcedureProcedure– Repeat Initial AssessmentRepeat Initial Assessment– Reassess Vital SignsReassess Vital Signs– Repeat Focused AssessmentRepeat Focused Assessment– Check InterventionsCheck Interventions

QUESTIONSQUESTIONS

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