2National EMS Education Standard Competencies (1 of 5) AssessmentUse scene information and simple patient assessment findings to identify and manage immediate life threats and injuries within the scope and practice of the emergency medical responder (EMR).
3National EMS Education Standard Competencies (2 of 5) Scene Size-UpScene safetyScene managementImpact of the environment on patient careAddressing hazardsViolenceNeed for additional or specialized resourcesStandard precautions
4National EMS Education Standard Competencies (3 of 5) Primary AssessmentPrimary assessment for all patient situationsLevel of consciousnessABCsIdentifying life threatsAssessment of vital functionsBegin interventions needed to preserve life
5National EMS Education Standard Competencies (4 of 5) History TakingDetermine the chief complaintMechanism of injury/nature of illnessAssociated signs and symptoms
6National EMS Education Standard Competencies (5 of 5) Secondary AssessmentPerforming a rapid full-body scanFocused assessment of painAssessment of vital signsReassessmentHow and when to reassess patients
7Introduction (1 of 2)EMRs are the first trained EMS providers at many emergency scenes.Patient assessment sequencePerform a scene size-up.Perform a primary assessment.Obtain the patient’s medical history.Perform a secondary assessment.Perform a reassessment.
8Introduction (2 of 2)The skills and knowledge presented in this chapter follow an assessment-based care model.The treatment rendered is based on the patient’s symptoms.Assessment-based care requires you to conduct a careful and thorough evaluation.
9Patient Assessment Sequence The patient assessment sequence provides a framework so that you can:Safely approach an emergency sceneDetermine the need for additional helpExamine the patient to determine if injuries or illnesses are presentObtain the patient’s medical historyReport the results to other EMS personnel
10Scene Size-Up (1 of 9)General overview of the incident and its surroundingsReview dispatch information.Location of the incidentMain problem or type of incidentNumber of people involvedSafety level of the scene
11Scene Size-Up (2 of 9) Review dispatch information. (cont’d) Other factors can affect your actions:Time of dayDay of the weekWeather conditionsMentally prepare for other situations you may find when you arrive on the scene.If you come across a medical emergency, contact dispatch using your two-way radio.
13Scene Size-Up (4 of 9) Ensure scene safety. (cont’d) Visible hazards include:Crash or crime sceneFallen electrical wiresTrafficSpilled gasolineUnstable buildings or surfacesWeatherCrowds
14Scene Size-Up (5 of 9) Ensure scene safety. (cont’d) Invisible hazards include:ElectricityBiologic hazardsHazardous materialsPoisonous fumesIf a scene is unsafe, keep people away until specially trained teams arrive.
15Scene Size-Up (6 of 9)Determine the mechanism of injury or nature of illness.Look for clues that may indicate how the accident happened.Ask the patient, family members, or bystanders for additional information.Do not rule out any injury without conducting a full-body physical assessment.
16Scene Size-Up (7 of 9) Take standard precautions. Always have gloves readily available.Consider whether the use of additional protection may be necessary.Wash your hands thoroughly after contact with a patient or contaminated materials.
17Scene Size-Up (8 of 9) Determine the number of patients. Call for additional assistance if you think you will need help.It may be necessary to perform triage.Consider additional resources, including:Law enforcement personnelFire department unitsUtility company personnelWrecker operators
19Primary Assessment (1 of 10) The purpose of the primary assessment is to identify life threats to the patient.Form a general impression.Note the patient’s sex and approximate age.Determine whether the patient has experienced trauma or illness.Determine the patient’s level of consciousness.
20Primary Assessment (2 of 10) Assess the level of responsiveness.Introduce yourself to establish:Your reason for being at the sceneThe fact that you will be helping the patientThe patient’s level of consciousnessIntroduce yourself even if the patient appears to be unconscious.
21Primary Assessment (3 of 10) Assess the level of responsiveness. (cont’d)Use the AVPU scale.AlertVerbalPainUnresponsive
22Primary Assessment (4 of 10) Perform a rapid scan.Assess the airway.If the patient is alert and able to answer questions, the airway is open.In an unconscious patient, you must open the airway.Inspect the airway for foreign bodies or secretions.Clear the airway as needed.You may need to insert an airway adjunct.
23Primary Assessment (5 of 10) Perform a rapid scan. (cont’d)Assess breathing.Assess the rate and quality of breathing.If the patient is unconscious, use the look, listen, and feel approach.Check for foreign objects and remove them.If the patient is not breathing, open the airway and perform rescue breathing.
24Primary Assessment (6 of 10) Perform a rapid scan. (cont’d)Assess circulation.If the patient is unconscious, check a carotid pulse.If the patient is conscious, assess the radial pulse.Check the patient for severe external bleeding.Assess the patient’s skin color and temperature.
26Primary Assessment (8 of 10) Perform a rapid scan. (cont’d)Descriptions of skin color:Pale—whitish, indicating decreased circulation to that part of the body or to all of the bodyFlushed—reddish, indicating excess circulation to that part of the bodyBlue—cyanotic, indicating lack of oxygen and possible airway problemsYellow—indicating liver problemsNormal
28Primary Assessment (10 of 10) Update responding EMS units.Elements of the report:Age and sex of the patientChief complaintLevel of responsivenessStatus of airway, breathing, and circulationTry to perform all four steps of the primary assessment quickly as you make contact with the patient.
29History Taking (1 of 4) Investigate the chief complaint. Do not allow a conscious patient’s comments to distract you.The purpose of obtaining a history is to:Gather a systematic account of past medical conditions, illnesses, and injuries.Determine the events leading up to the present medical situation.Determine the signs and symptoms of the current condition.
30History Taking (2 of 4) Investigate the chief complaint. (cont’d) Question the patient in a clear and systematic manner.Learn the relevant facts, including:Serious injuries, illnesses, or surgeriesPrescriptive medicinesOver-the-counter medicines and herbal medicinesAllergies to any medicines, foods, or seasonal allergens
31History Taking (3 of 4) Obtain a SAMPLE history. Provides a framework to ask further questions of the patientAsk the patient one question at a time.Listen carefully and use good eye contact.If the patient is unconscious or senile, a family member or friend may be able to help.Communicate this information to other EMS personnel.
33Secondary Assessment (1 of 13) The secondary assessment is done to assess non–life-threatening conditions.The physical examination helps you locate and begin initial management of signs and symptoms of illness or injury.A sign is something about the patient you can see or feel for yourself.A symptom is something the patient tells you about his or her condition.
34Secondary Assessment (2 of 13) Systematically assess the patient.Look and feel for signs of injury:DeformitiesOpen injuriesTendernessSwellingFull-body assessmentCan be done whether the patient is conscious or unconscious
35Secondary Assessment (3 of 13) Full-body assessment (cont’d)Assume that all unconscious, injured patients have spinal injuries.Stabilize the head and spine to minimize movement during the patient examination.Follow the steps in Skill Drill 8-1 to perform a full-body assessment.
36Secondary Assessment (4 of 13) Focused assessmentPerformed on patients who have sustained nonsignificant MOIs or on responsive medical patientsBased on the chief complaintFocuses your attention on the immediate problem
37Secondary Assessment (5 of 13) Assess vital signs.RespirationThe normal adult resting respiratory rate is 12 to 20 breaths per minute.Count the patient’s breath for 1 minute.Check the breathing rate and quality.PulseIndicates the speed and force of the heartbeatTake the radial pulse of a conscious patient.
38Secondary Assessment (6 of 13) Assess vital signs. (cont’d)Pulse (cont’d)Take the carotid pulse of an unconscious patient.When examining an infant, use the brachial pulse.In a normal adult, the resting pulse rate is 60 to 100 beats per minute.Determine the rhythm and the quality.Capillary refillAbility of the circulatory system to return blood to the capillary vessels
39Secondary Assessment (7 of 13) Assess vital signs. (cont’d)Capillary refill (cont’d)Squeeze the patient’s nail bed firmly between your thumb and forefinger until the nail bed looks pale.Release the pressure and count 2 seconds.The patient’s nail bed should return to pink in this time, indicating a normal capillary refill.
41Secondary Assessment (9 of 13) Assess vital signs. (cont’d)Blood pressureSystolic pressure is the force exerted on the walls of the arteries as the heart contracts.Diastolic pressure is the arterial pressure during the relaxation phase of the heart.Hypertension exists when the blood pressure remains greater than 140/90 mm Hg.Check blood pressure by palpation (feeling) or auscultation (listening).
42Secondary Assessment (10 of 13) Assess vital signs. (cont’d)Skin conditionCheck for skin color, temperature, and moisture.Normal body temperature is 98.6°F (37°C).Normal skin conditions are described as warm, pink, and dry.Pupil size and reactivityExamine each eye to detect signs of head injury, stroke, or drug overdose.
43Secondary Assessment (11 of 13) Assess vital signs. (cont’d)Pupil size and reactivity (cont’d)Determine whether the pupils are of equal size and whether both react when light is shone into them.
44Secondary Assessment (12 of 13) Assess vital signs. (cont’d)Pupil size and reactivity (cont’d)Pupils of unequal size can indicate a stroke or injury to the brain.Pupils may remain constricted in a person who is taking narcotics.Dilated pupils indicate a relaxed or unconscious state.
45Secondary Assessment (13 of 13) Assess vital signs. (cont’d)Level of responsivenessObserve and note any changes that occur between the time of your arrival and the time you turn over the patient’s care to higher-level personnel.Use the AVPU scale.
46Reassessment (1 of 5)If you need to continue to care for the patient, some parts of the patient assessment need to be repeated.Repeat the primary assessment.Recheck the patient’s level of responsiveness and ABCs.Continue to maintain an open airway and to monitor breathing and pulse for rate and quality.
47Reassessment (2 of 5) Reassess vital signs. Observe the patient’s skin color and temperature.Reassess the patient’s blood pressure.Reassess the chief complaint.Recheck the effectiveness of treatment.If the patient’s status changes, determine whether you need to alter your care.
48Reassessment (3 of 5)Identify and treat changes in the patient’s condition.Reassess the patient.Reassess a stable patient every 15 minutes.If the patient is unstable, repeat the reassessment every 5 minutes.
49Reassessment (4 of 5) Provide a hand-off report, including the: Age and sex of the patientHistory of the incidentPatient’s chief complaintPatient’s level of responsivenessStatus of the vital signsResults of the secondary patient assessment
50Reassessment (5 of 5) Provide a hand-off report, including: (cont’d) Any pertinent medical conditions (using the SAMPLE format)Any interventions provided
51A Word About Medical and Trauma Patients (1 of 2) Patients can generally be classified into two main categories:Those who have a sudden illnessThose who sustain traumaThe patient assessment sequence can be used to examine patients who have experienced illnesses, trauma, or both.
52A Word About Medical and Trauma Patients (2 of 2) When examining medical patients, follow the basic assessment sequence.When caring for a trauma patient, perform the secondary assessment before taking the medical history.Always avoid jumping to conclusions.
53Summary (1 of 4)A complete patient assessment consists of five steps: perform a scene size-up, perform a primary assessment, obtain a patient’s medical history, perform a secondary assessment, and provide reassessment.The scene size-up is a general overview of the incident and its surroundings.
54Summary (2 of 4)During the primary assessment, determine and correct any life-threatening conditions. The steps of the primary assessment are to form a general impression of the patient, assess responsiveness, and perform a rapid scan that consists of checking and correcting problems with the patient’s airway, breathing, and circulation. Finally, update responding EMS units.
55Summary (3 of 4)A medical history provides a systematic account of the patient’s past medical conditions, illnesses, and injuries to determine the signs and symptoms of the current condition.The secondary assessment of the patient consists of a full-body assessment used to assess non-life-threatening conditions.
56Summary (4 of 4)If the patient is stable, repeat the vital signs every 15 minutes. If the patient is unstable, repeat the vital signs every 5 minutes.Provide a concise and accurate hand-off report to EMS personnel.
57ReviewWhich of the following steps might be performed during the scene size-up?assessing vital signs using appropriate monitoring devicesforming a general impression of the patientnotifying dispatch to send fire personnelperforming a full-body scan
58ReviewAnswer:C. notifying dispatch to send fire personnel
59Review The goal of the primary assessment is to: quickly diagnose the patient’s condition.determine the need to perform a full-body assessment.determine the number of patients.identify and treat life threats.
60ReviewAnswer:D. identify and treat life threats.
61ReviewAfter performing a primary assessment and treating any immediate life threats, you should next:determine the priority of patient care and transport.reassess the patient.recheck your interventions.promptly transport the patient to the closest hospital.
62ReviewAnswer:A. determine the priority of patient care and transport.