1. PATIENT ASSESSMENT Gathering detailed information to paint a picture for others!

2. EMT Patient Assessment2 Objectives What is Patient Assessment? Why is Patient Assessment important?

3. EMT Patient Assessment3 Objectives Why is the order of Patient Assessment important? Why is it necessary to develop a method of assessment and use that method on all patients?

4. EMT Patient Assessment4 Introduction What are the phases of patient assessment? –Review of Dispatch Information –Scene Survey –Initial Assessment –Focused History and Physical Exam –Detailed Physical Exam –Ongoing Assessment –Communication –Documentation

5. EMT Patient Assessment5 Differential Diagnosis Begin with receipt of call from dispatch –Location –Incident –Illness/Injury

6. EMT Patient Assessment6 Updated Information While en-route –Further info from dispatcher –Info from units on scene Smoke? Fire? High line wires? Railroads? Water? Industry? Other Public Safety units?

7. EMT Patient Assessment7 Upon Arrival Scene Size Up –Look around don’t rush in! Scene Safety Overall scene Location of victim(s) Possible Mechanisms of Injury

8. EMT Patient Assessment8 Scene Size Up Upon Arrival –What do you see? Hazards –Crowds –Haz-Mat –Electricity –Gas –Fire –Glass –Stability of environment –Traffic

9. EMT Patient Assessment9 Scene Safety –Ensure Safety Yourself Partner Other rescuers/Bystanders Patient

10. EMT Patient Assessment10 What Might You Need –Call for assistance early Medic Units Additional BLS Units Fire Suppression Heavy Rescue Technical Rescue Water Rescue Haz-Mat Unit Law Enforcement Negotiating Team

11. EMT Patient Assessment11 Scene Safety Personal & Crew Protection Body Substance Isolation –Gloves & eye protection (Always) –Mask & gown –SCBA? –Hand washing

12. EMT Patient Assessment12 Scene Safety PPE Protective Clothing –Cold weather clothing Dress in layers –Turnout gear Provides head-to-toe protection –Gloves Use proper gloves for job being performed

13. EMT Patient Assessment13 Scene Safety PPE Protective Clothing (Cont.) –Helmets Must be worn in any fall zone –Boots Should protect your feet, fit well, be flexible

14. EMT Patient Assessment14 Scene Safety PPE Protective Clothing (Cont.) –Eye & ear protection Should be used on rescue operations –Sun protection Use sun block when working outdoors

15. EMT Patient Assessment15 Scene Safety Personal & Crew Protection Violent Situation –Civil disturbances –Domestic disputes –Crime scenes –Large gatherings

16. EMT Patient Assessment16 Scene Safety Personal & Crew Protection Behavioral Emergencies –Determinants of violence Past History Posture Vocal Activity Physical activity

17. EMT Patient Assessment17 Scene Safety Personal Protection Immunizations –Tetanus-Diphtheria –Measles vaccine –Rubella Vaccine –Mumps Vaccine –Flu Vaccine –Hepatitis Vaccine

18. EMT Patient Assessment18 Protest Yourself to Protect Others Your personal safety is of the utmost importance. You must understand the risks of each environment you enter! If you are hurt or disabled you have not helped the situation, you have made it worse When you expose yourself, you expose your family

19. EMT Patient Assessment19 Initial Assessment Purpose –To rapidly identify & correct life threats –To identify those patients who need rapid evacuation Minimum Time on scene - Maximum Care En Route

20. EMT Patient Assessment20 Initial Assessment General Impression –Using the facts gathered as you responded to the scene and what you see as you approach the patient. –What is your first impression of the patient’s condition? Sick/Not Sick Chief Complaint

21. EMT Patient Assessment21 Initial Assessment Mental Status (Level of Consciousness) –A - Alert –V - Verbal –P - Painful –U - Unresponsive

22. EMT Patient Assessment22 Initial Assessment Identify Life Threats –Airway Control C-spine (If trauma suspected) Open-Clear-Maintain

23. EMT Patient Assessment23 Initial Assessment –Breathing Look Listen Feel Bare chest if respiratory distress apparent

24. EMT Patient Assessment24 Initial Assessment –Circulation Major Bleeding Pulse (Rapid/Slow : Weak/Bounding) –Radial >80 systolic –Femoral >70 systolic –Carotid >60 systolic

25. EMT Patient Assessment25 Initial Assessment –Circulation (cont.) Capillary Refill Skin Color –Pale –Ashen –Cyanotic –Mottled –Red

26. EMT Patient Assessment26 Initial Assessment –Circulation (cont.) Skin Temperature –Hot (warm) –Cool Skin Condition –Moist –Dry –Skin Turgor

27. EMT Patient Assessment27 Initial Assessment –Disability –Expose Head/Neck Chest Abdomen

28. EMT Patient Assessment28 Initial Assessment Rapid Evacuation –Consider ALS intercept –If, during the Initial Assessment, you encounter a life-threatening condition that your intervention cannot alleviate, you should rapidly evacuate to someone who can.

29. EMT Patient Assessment29 Criteria for Rapid Evacuation –Poor General Impression –Unresponsive - no gag or cough reflex –Responsive - unable to follow commands –Cannot establish / maintain patent airway –Difficulty breathing / Resp. distress

30. EMT Patient Assessment30 Criteria for Rapid Evacuation –Poor perfusion –Uncontrolled bleeding –Severe pain in any part of the body –Severe chest pain –Inability to move any part of body

31. EMT Patient Assessment31 Criteria for Rapid Evacuation –Complicated childbirth –High body temp (above 104° F) –Signs of generalized hypothermia –Severe allergic reaction (anaphylaxsis) –Poisoning or overdose of unknown nature

32. EMT Patient Assessment32 Focused History & Physical Exam - Trauma Purpose –Obtain Chief Complaint What happened to the patient? –Evaluate Chief Complaint What circumstances surround this incident? Is the Mechanism of Injury a high risk for injury? –Conduct Physical Exam –Obtain Baseline Vital Signs

33. EMT Patient Assessment33 Focused History & Physical Exam - Trauma Re-evaluate Mechanism of Injury (MOI) –Significant MOI? Yes/No –Is patient unresponsive or disoriented? Can they participate in examination? –Is the patient under the influence of drugs or alcohol? Can they participate in examination?

34. EMT Patient Assessment34 Patients with Significant MOI RAPID TRAUMA ASSESSMENT –Head-to-Toe Physical Exam –Palpation –Auscultation –Other Senses

35. EMT Patient Assessment35 Patients with Significant MOI RAPID TRAUMA ASSESSMENT –DCAP-BTLS D - Deformities C - Contusions A - Abrasions P - Punctures/Penetrations B - Burns T - Tenderness L - Lacerations S - Swelling

36. EMT Patient Assessment36 Patients with Significant MOI Quickly Obtain Baseline Vital Signs –More than one set –Look for “trending”

37. EMT Patient Assessment37 Patients with Significant MOI S-A-M-P-L-E History –S - Signs & Symptoms –A - Allergies Medications Foods Environment

38. EMT Patient Assessment38 Patients with Significant MOI –M - Medications Are you taking any? When did you last take your medication? What are they? What are they for? May I see them?

39. EMT Patient Assessment39 Patients with Significant MOI –P - Previous Medical History Pertinent Related to this complaint Complicating factor

40. EMT Patient Assessment40 Patients with Significant MOI –L - Last Oral Intake Food and/or Drink? What? When?

41. EMT Patient Assessment41 Patients with Significant MOI –E - Events leading up to the incident What happened? When?

42. EMT Patient Assessment42 Patients with NO Significant MOI Assess Chief Complaint Focused Assessment Baseline Vitals SAMPLE History

43. EMT Patient Assessment43 Focused History & Physical Exam - Medical Patient Responsive? Yes/No AVPU –A - Alert –V - Verbal –P - Painful –U -Unresponsive

44. EMT Patient Assessment44 Responsive Patients - Medical Assess Chief Complaint Signs & Symptoms –O - Onset When & How did the symptom begin? –P - Provokes What makes the symptom worse?

45. EMT Patient Assessment45 Responsive Patients - Medical Signs & Symptoms (cont.) –Q - Quality How would you describe the pain?/What does the pain feel like? DO NOT lead the patient –R - Region/Radiation Where is the pain? Does the pain travel anywhere else?

46. EMT Patient Assessment46 Responsive Patients - Medical Signs & Symptoms (cont.) –S - Severity How bad is the pain? –T - Time How long have you had the symptom? Document actual time it started

47. EMT Patient Assessment47 Responsive Patients - Medical SAMPLE History Focused Medical Assessment Baseline Vital Signs Transport Decision Detailed Physical Exam Ongoing Assessment

48. EMT Patient Assessment48 Unresponsive Patients - Medical Rapid Medical Assessment Baseline Vital Signs SAMPLE History –Family, co-workers, bystanders Transport Ongoing assessment

49. EMT Patient Assessment49 Detailed Physical Exam More detailed Head-to-Toe examination Time sensitive –Usually performed en-route

50. EMT Patient Assessment50 Detailed Physical Exam Required for any unresponsive patient –If the patient cannot communicate what is wrong, you must seek out the problem(s) Required for any multi-trauma patient –Victims of multiple trauma must be assessed for less obvious or “masked” injuries

51. EMT Patient Assessment51 Detailed Physical Exam Required for any Patient with significant mechanism of injury –If the mechanism of injury could have caused serious injuries, the EMT must actively assess for additional injuries

52. EMT Patient Assessment52 On-Going Assessment Purpose - –Determine if there are any changes in the patient’s condition –Identify any missed injuries or conditions –Assess the effectiveness of treatment given and adjust if necessary

53. EMT Patient Assessment53 On-Going Assessment Performed on both the trauma or medical patient Procedure –Repeat Initial Assessment –Reassess Vital Signs –Repeat Focused Assessment –Check Interventions

54. EMT Patient Assessment54 Go Big or Go Home Error on the side of caution Always work with the patients best interest in mind Any Questions?