1. Principles of Patient Assessment in EMS By: Bob Elling, MPA, EMT-P & Kirsten Elling, BS, EMT-P

2. Chapter 20 – The Ongoing Assessment © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

3. Objectives List the steps of the ongoing assessment. List the steps of the ongoing assessment. List three objectives of the OA. List three objectives of the OA. Define trending and describe why trending is an important tool in patient care. Define trending and describe why trending is an important tool in patient care. Provide two examples of trending. Provide two examples of trending. Describe the typical information included in a “radio report.” Describe the typical information included in a “radio report.” © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

4. Discuss appropriate use of a patient assessment card. Discuss appropriate use of a patient assessment card. Explain why it is not appropriate to complete the PCR enroute to the hospital or facility. Explain why it is not appropriate to complete the PCR enroute to the hospital or facility. Explain how to document statements made by the patient while under your care. Explain how to document statements made by the patient while under your care. Objectives © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

5. Introduction Ongoing assessment (OA) – the phase of care provided to the patient while enroute to the hospital. Ongoing assessment (OA) – the phase of care provided to the patient while enroute to the hospital. The steps of the OA include: The steps of the OA include: Repeating the IA Repeating the IA Re-evaluating the patient’s priority Re-evaluating the patient’s priority Reassessing and recording the VS Reassessing and recording the VS Repeating the focused assessment Repeating the focused assessment Checking interventions Checking interventions © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

6. Settling In Once in the ambulance assure that: Once in the ambulance assure that: The patient is properly secured (belted) The patient is properly secured (belted) The compartment temperature is appropriate The compartment temperature is appropriate IV is secure/patent IV is secure/patent Equipment is fastened down Equipment is fastened down Oxygen is switched to the onboard Oxygen is switched to the onboard Monitors are secured and visible Monitors are secured and visible © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

7. Settling In (continued) Once you are “settled in” maintain a continuous concerned conversation with the patient. Once you are “settled in” maintain a continuous concerned conversation with the patient. Explain or answer questions to keep the patient informed and alleviate anxiety. Explain or answer questions to keep the patient informed and alleviate anxiety. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

8. Repeat the IA Manage any potential life-threats. Manage any potential life-threats. Re-evaluate patient priorities. Re-evaluate patient priorities. Observe and note “trends.” Observe and note “trends.” Communicate with medical control or the receiving facility. Communicate with medical control or the receiving facility. Document assessment finding and care rendered. Document assessment finding and care rendered. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

9. Trending The process of obtaining a baseline assessment, followed by serial assessments to determine if patient is getting better, worse, or has no change. The process of obtaining a baseline assessment, followed by serial assessments to determine if patient is getting better, worse, or has no change. An important tool in patient care. An important tool in patient care. Examples of trending info are VS or noting MS changes. Examples of trending info are VS or noting MS changes. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

10. Communicating Enroute In most EMS systems a radio report to Medical Control or the receiving hospital is done enroute. In most EMS systems a radio report to Medical Control or the receiving hospital is done enroute. This is also done with other methods (cell phone, computer, or fax). This is also done with other methods (cell phone, computer, or fax). Local protocols may have you consult or obtain permission for various treatments. Local protocols may have you consult or obtain permission for various treatments. Information obtained in the OA is a significant part of the radio report. Information obtained in the OA is a significant part of the radio report. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

11. Documentation Important to document assessment findings and patient management. Important to document assessment findings and patient management. Assessment cards are helpful for taking notes prior to writing a complete prehospital care report (PCR). Assessment cards are helpful for taking notes prior to writing a complete prehospital care report (PCR). Take notes on: Take notes on: Scene size-up Scene size-up IA and Vital signs IA and Vital signs FH and PE FH and PE OA OA © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

12. Some EMS providers utilize a PDA for taking notes or to quickly reference information. Some EMS providers utilize a PDA for taking notes or to quickly reference information. The PCR: The PCR: NOT designed to be completed enroute NOT designed to be completed enroute Report needs to be neat, complete, accurate, and well thought out Report needs to be neat, complete, accurate, and well thought out Documentation (continued) © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

13. Documentation (continued) The PCR continued: The PCR continued: Use objective language and avoid subjective judgments Use objective language and avoid subjective judgments Be exact about what you see, hear, feel, or smell Be exact about what you see, hear, feel, or smell Avoid interpretations about patient behavior Avoid interpretations about patient behavior Include pre- and post- assessment findings around treatment modalities (i.e. splinting, med administration, etc) Include pre- and post- assessment findings around treatment modalities (i.e. splinting, med administration, etc) Document pertinent patient quotes such as “I drank 2 beers” Document pertinent patient quotes such as “I drank 2 beers” Use only abbreviations that are standardized and commonly understood by other health care professionals Use only abbreviations that are standardized and commonly understood by other health care professionals © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

14. Repeat the Focused Physical Exam In a medical patient focus on the specific complaint (i.e. respiratory, cardiac, etc). In a medical patient focus on the specific complaint (i.e. respiratory, cardiac, etc). In a trauma patient with no significant MOI, focus on the isolated injury. Reassess distal PMS and splinting. In a trauma patient with no significant MOI, focus on the isolated injury. Reassess distal PMS and splinting. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

15. Checking Interventions Anything that the EMS provider does to a patient that is expected to change the patient’s condition should be reassessed. Anything that the EMS provider does to a patient that is expected to change the patient’s condition should be reassessed. Determine if the intervention had an effect: Determine if the intervention had an effect: Positive - desired improvement Positive - desired improvement Negative - undesired deterioration Negative - undesired deterioration No observed effect No observed effect Reassess vital signs every 5 minutes for unstable patients and every 15 minutes for the stable patients. Reassess vital signs every 5 minutes for unstable patients and every 15 minutes for the stable patients. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

16. Conclusion The OA is done on every call when the patient is transported to a receiving facility. The OA is done on every call when the patient is transported to a receiving facility. The steps involve reassessment of the IA, obtaining serial VS and observing for trending in the patient’s condition. The steps involve reassessment of the IA, obtaining serial VS and observing for trending in the patient’s condition. Make notes for trending, radio report and documentation. Make notes for trending, radio report and documentation. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.