Principles of Patient Assessment in EMS

Making a Priority Decision

Introduction Priority decisions are made to set the tone for patient care and management. Perform the initial assessment first. When more than one patient is present you must triage (to sort): Triage use in pre-hospital and hospital Many triage systems available

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. The Priority Decision Priority decision making is an essential skill for EMS providers. Failure to make a priority decision may have serious life-threatening implications. Consider the “golden hour” and the “Platinum ten minutes.” Stable vs. Unstable When two priority choices are possible “up triage.” © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Systems of Prioritizing Become familiar with the system used in your area: Hot / cold Red / yellow / green High / Low Minor / Moderate / Severe P-1, P-2, P-3 C U P S © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

A Close Up on One System C U P S Acronym that stands for: critical unstable potentially unstable stable First introduced in the BTLS course Adapted in many states © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Examples of “Critical Patients” Actual or impending cardiorespiratory arrest Respiratory failure Decompensated shock (hypoperfusion) Rising intracranial pressure Severe upper airway difficulties © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Examples of “Unstable Patients” Cardiorespiratory instability Respiratory distress Compensated shock (hypoperfusion) Two or more long bone fractures Trauma with associated burns Amputation proximal to wrist or ankle Penetrating injury to: head, neck, chest, abdomen, pelvis © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Examples of “Unstable Patients” (continued) Uncontrollable external bleeding Chest pain with a systolic BP < 100 Severe pain Poor general impression Unresponsive patients Responsive patients who do not follow commands © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Examples of “Potentially Unstable Patients” Cardiorespiratory instability MOI indicating a possible hidden injury Major isolated injury General medical illness An uncomplicated childbirth © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Examples of “Stable Patients” Patients with a low potential for cardio-respiratory instability Low grade fever Minor illness Minor isolated injury An uncomplicated extremity injury © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Tools to Determine Priority Developed to logically examine, evaluate, and rate severity of a patient using a numbering system Developed initially for trauma patients yet also used on medical patients Glasgow Coma Score The Trauma Score © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Glasgow Coma Score (GCS) Measures: Eye opening Verbal response Motor response The best responses are given a numerical score © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. Trauma Score (TS) Developed in 1980 as a triage tool Used to predict patient outcomes Numerical grading system combining GCS and the following: Respiratory rate Respiratory expansion Systolic BP Capillary refill Conversion scale for GCS © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Triaging and Prioritizing Burn Patients Burn severity determined by: Source type Body surface area (BSA) Rule of nines used to calculate BSA Classifications of burns include: Mild -sunburn Moderate – uncomplicated partial thickness < 30% BSA Severe – inhalation injuries or electrical burns © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Triage to Aeromedical Transport Refer to established regional protocols Weather conditions – visibility and wind Medical considerations Injury factors – MOI, length of extrication, distance to trauma center © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. Triage in MCI’s Triage is needed when there are multiple patients and limited resources. Triage helps to ensure the most serious are treated and transported first. Designate a “triage officer” and use “triage tags.” © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. The START System Acronym - simple triage and rapid treatment Developed in the 1980’s, separating patients into: Minor Delayed Immediate Deceased Few responders can triage many rapidly. Assessing: Respiratory status Hemodynamic status Mental status © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. Triage Tags Used in MCI’s Several types available Eliminates need to reassess each patient over and over Most tags have 4 priorities: P-1 (immediate or red) P-2 (delayed or yellow) P-3 (hold, “walking wounded,” or green) P-0 (deceased, no priority or black) © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. Trauma Centers Hospitals capable of caring for the acutely injured patient Must meet strict criteria to use this designation Classified into 4 levels Some hospitals also specialize in specific care (burns, peds) © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Trauma Centers (continued) Each community has different needs and resources Criteria for a regional structure is often found in local protocols What is the trauma center in your region? © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. Conclusion Important care and transport decisions are based on the priority decision! Practice is needed to gain proficiency. Be familiar with the tools in your system or region. Patient conditions are dynamic and can quickly change the priority. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.