Presentation on theme: "“BASICS” OF BASIC SCENE ASSESSMENT"— Presentation transcript:
1“BASICS” OF BASIC SCENE ASSESSMENT Amy Gutman MD ~ EMS Medical Director
2OBJECTIVES Systematic method of scene & patient assessment Look at cool photos…see how your eyes & gut lead to assessment & management strategies
3BACK TO BASICSThe majority of patients seen daily require competent performance of basic interventionsAlthough it’s not “sexy”, the most basic AND most difficult skill is patient assessment
4NREMT EMT SKILL REQUIREMENTS AssessmentOperationalScene size-up, initial assessment, reducE patient anxietyFocused history for trauma, medical, geriatric, pediatric & special population patientsDetailed physical exams & ongoing assessmentCommunication & documentationAmbulance operationsInfection control proceduresScene safety, access, extrication & hazardous materials emergenciesMultiple casualty incidents, START triage & weapons of mass destruction
5ASSESSMENT STARTS WITH DISPATCH Emergency dispatch designed so crew receives information to appropriately manage the sceneTrauma vs medicalLife-threatening conditionsMultiple patients / vehiclesSpecial hazards (Fire, haz mat, water, weather, traffic)Requires special personnel or equipmentReported violencePre-arrival instructions
6SIZING UP THE SCENE Scene safe? Police / Haz Mat required?Establish “Danger Zone”, Access & EgressMedical, Trauma, Both?A family all with "flu“MVC with unconscious pt w/o obvious injury?MVCPDOF & speed of vehiclesRestraintsPosition in CarOther injuries
14TUNNEL VISION Avoid urge to rush onto scene Tunnel vision may cause you to overlook safety precautions & require rescue yourselfAsk Yourself:PPD?MOI? / Nature of illness?Number & type of patients ?Need for additional help ?Triage & Incident Command ?
15WARNING SIGNS Fighting or loud voices Weapons used / visible Signs of drug useUnusual silenceKnowledge of prior violencePanicRemember your inner voice
16SCENE CONTROL Establish control immediately, access & egress Key is the confidence with which you interact with patient, family & prehospital personnelWork with police to establish control / preserve evidenceKnow when the scene is “out-of-control”Too many confoundersToo many patients
18SPECIAL CIRCUMSTANCES Recognize early to rapidly request additional resourcesToxinsCrash scenesCrime scenesMCIWater / Weather
19MASS CASUALTY / DISASTERS Any event overwhelming available resourcesMCIs often trigger a health crisisDisasters often compounded by poor planning, disjointed communications costing time, resources, & lives
20MCIs Early recognition of personnel & equipment needs 1st on scene calls “Code Black”Most experienced on scene is ICTriage maximizes outcomes by effective resource allocation & patient sortingKnow local / regional resources for appropriate back-up
21PROVIDERS’ ROLES Data collection Data analysis Data application Rapid assessmentData analysisDifferential diagnosesData applicationTreatment plan
28DATA COLLECTION: CRITICAL THINKING 911 call to transfer of careConstantly evolving“Unconsciously Conscious” thought process“Fundamental” knowledgeData organizationComparison to similar situationsConstruction of data-driven plan
30DATA ANALYSIS Use what you “see” & what you “know” Differential Diagnoses:Absolutely “No”PossiblyAbsolutely “Yes”Decide what is going to kill patient first & start interveningYou will never fix what you do not consider
31WHEN DATA DOESN’T MAKE SENSE, ASK A DIFFERENT QUESTION
37HPI: SAMPLE Ideally obtained from patient Bystander “Rule of Indirect Uselessness”Runs of “Tachylawdys” & “Paroxysmal Sweet Jesuses”Assessments must be situational, systematic & performed the same way every timeSigns & SymptomsAllergiesMedicationsPertinent PMH / PSHLast MealEvents leading to CC
41BLS vs ALS If the patient is mentating, they are circulating ALS? Gut responseUnresponsive or altered mental statusAirway compromise or respiratory distressInadequate perfusion / ShockCardiac arrest / Chest PainUncontrolled bleedingBetter to over-triage than under-triage
48SERIAL ASSESSMENTSAssessment is a continuous process throughout entire patient encounterReassess every time you deliver or change an interventionRepeat & record vital signsRepeat focused exam prnO2 delivery adequate?Bleeding controlled?Splint too tight?
49PCR DOCUMENTATION Leave a copy for ED (yes…some of us read it) Complete, legible documentation keeps you out of trouble more than good patient careNever written, never doneErrors occurWhen they do, document what happened & what steps were taken to correct itNever attempt to cover up errorsNarrative must have pertinent positives & negatives
50DOCUMENTATION PET PEEVES I can’t figure out what happenedToo much / not enough infoIllegible anythingMade-up acronyms“DMF”“TSTL”Concrete statements“Entry wound”Sloppy charting = sloppy care
51SUMMARY: DON’T OVERLOOK THE OBVIOUS Is the scene safe?Is the patient sick?What does your gut say?Standard: A, B, C, D, E, but Don’t forget the “F, G, H” ~“F_ _king Get to the Hospital”!
52Thanks For Your Attention! email@example.com