principles of patient assessment in ems. overview to patient assessment

Principles of Patient Principles of Patient Assessment in EMS Assessment in EMS

Overview to Patient Overview to Patient Assessment Assessment

IntroductionIntroduction

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

Importance of a Importance of a Standardized ApproachStandardized Approach

The EMS provider’s approach to The EMS provider’s approach to patient assessment and physical patient assessment and physical examination must be similar for all examination must be similar for all new patients.new patients.

Four key factors must be considered: Four key factors must be considered: environment, severity, medical environment, severity, medical versus trauma, and level of care versus trauma, and level of care available.available.

Is The Environment Safe?Is The Environment Safe?

What’s the Patient’s Severity?What’s the Patient’s Severity?Stable or UnstableStable or Unstable

P-1, P-2, P-3, “high” or “low”?P-1, P-2, P-3, “high” or “low”?

Medical or Trauma?Medical or Trauma?

MOIMOI SignificantSignificant Non-significantNon-significant

NOINOI ResponsiveResponsive Not responsiveNot responsive

Level of CareLevel of Care

First ResponderFirst Responder EMT-BasicEMT-Basic EMT-IntermediateEMT-Intermediate EMT-ParamedicEMT-Paramedic Aeromedical Aeromedical

EvacuationEvacuation

Components of AssessmentComponents of Assessment

Scene size-upScene size-up Initial assessmentInitial assessment Focused history & physical exam: Focused history & physical exam:

traumatrauma Focused history & physical exam: Focused history & physical exam:

medicalmedical Detailed physical examDetailed physical exam Ongoing assessmentOngoing assessment

Scene Size-upScene Size-up

Scene safe for you Scene safe for you and crewand crew

Body substance Body substance isolation isolation precautions precautions neededneeded

Is additional help Is additional help neededneeded

Initial AssessmentInitial Assessment

Orderly and sequential exam with Orderly and sequential exam with correction of life-threatscorrection of life-threats

MS-ABC Priority PlanMS-ABC Priority Plan General impressionGeneral impression Chief complaint (MOI/NOI)Chief complaint (MOI/NOI) Assess mental statusAssess mental status Assess airway, breathing, and circulationAssess airway, breathing, and circulation Determine priority and need for ALSDetermine priority and need for ALS

Focused History & Physical Focused History & Physical Exam: TraumaExam: Trauma

Significant MOISignificant MOI Rapid Trauma Rapid Trauma

ExamExam Baseline Vital SignsBaseline Vital Signs SAMPLE HistorySAMPLE History Transport (if not Transport (if not

already doing so)already doing so)

Non-significant MOINon-significant MOI Focused ExamFocused Exam Baseline Vital SignsBaseline Vital Signs SAMPLE HistorySAMPLE History Transport as Transport as

neededneeded

SAMPLE HistorySAMPLE History

S – signs and symptomsS – signs and symptoms A – allergiesA – allergies M – medicationsM – medications P – pertinent past medical historyP – pertinent past medical history L – last oral intakeL – last oral intake E – events leading up toE – events leading up to

Focused History & Physical Focused History & Physical Exam: MedicalExam: Medical

Not ResponsiveNot Responsive Rapid Physical Rapid Physical

ExamExam Baseline Vital SignsBaseline Vital Signs SAMPLE HistorySAMPLE History Transport (if not Transport (if not

already doing so)already doing so)

ResponsiveResponsive History of present History of present

event (OPQRST)event (OPQRST) SAMPLE HistorySAMPLE History Baseline Vital SignsBaseline Vital Signs Focused physical Focused physical

examexam Transport Transport

OPQRSTOPQRSTElaborate on the Chief Elaborate on the Chief

ComplaintComplaint O – onsetO – onset P – provocationP – provocation Q – qualityQ – quality R – radiation, region, referralR – radiation, region, referral S – severityS – severity T - timeT - time

Detailed Physical ExamDetailed Physical Exam

Trauma with Trauma with significant MOIsignificant MOI

Enroute to the Enroute to the hospitalhospital

Assess the head, Assess the head, face, eyes, nose, face, eyes, nose, mouth, neck, mouth, neck, chest, abdomen, chest, abdomen, pelvis, extremities, pelvis, extremities, back and buttocksback and buttocks

Ongoing AssessmentOngoing Assessment

Conducted enroute to the hospitalConducted enroute to the hospital Reassess the vital signsReassess the vital signs Reassess initial assessmentReassess initial assessment Reassess interventionsReassess interventions

ConclusionConclusion

Assessment is a dynamic processAssessment is a dynamic process Use a standardized approachUse a standardized approach Continually reassessContinually reassess Be flexible and reprioritize as neededBe flexible and reprioritize as needed Follow the assessment algorithmFollow the assessment algorithm

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.