1. Get Organized! Organizing Your Initial Assessment Ed Ludwig EMS Education Coordinator Morris Hospital & Healthcare Centers

4. Scene Size-Up Begins when you report to shift! o Weather o Crew o Equipment Readiness Consists of 3 core components o Safety o Number of Resources Needed o Mechanism of Injury Sets the stage for the rest of your incident!

5. Scene Size-Up Safety o Is your crew safe to be where you are? o May need law enforcement to secure scene o Consider moving patient to safety before providing care o Proper PPE required? o If treating on or along a roadway is traffic controlled or proper blocking provided? o Keep your head on a swivel! Number of Resources Needed o Do you need additional units? “Call them early & often” o How many patients do you have? o Quick triage and prioritize the patients o Aeromedical transport considerations

6. Scene Size-Up Mechanism of Injury (MOI) o Traumatic, Medical or Environmental? Or a Mix? o “If it looks bad, it probably is bad” o Pay close attention to any clues that may lead you to suspect the type of injuries your patient may have sustained. o Front end collision, side impact or rear impact collisions all have different injury patterns. o Height of a fall and what did they land on? o What about the environment (extreme hot or cold)? o Always have a high index of suspicion! o A good EMS provider always prepares for the worst and hopes for the best! o Remember having a high index of suspicion and reading the MOI will help you perform proactive medicine rather than reactive medicine.

8. General Impression

9. Once the patient is in view begin forming your general impression. A general impression is your opinion on how severe the patient’s condition is. You should conclude your general impressions with “Sick or Not Sick” (sick also means injured) The general impression focuses on three main areas o Appearance- Mental Status? Muscle Tone? Conscious or Unconscious? o Work of Breathing- Visible movement? Rate? Effort? Body Position? Audible sounds? o Circulation- Skin Color?

11. Primary Survey

12. Introduce yourself and establish a rapport with patient and family. (This may be inappropriate if the patient’s condition needs immediate intervention) The Primary Survey is your opportunity to quickly identify immediate life threats and “Fix as you go” The Primary Survey consists of 5 main components o Airway o Breathing o Circulation o Disability (Mental Status) o Expose At the end of your Primary Survey you need to make a transport decision- “Load and Go” or “Stay and Play”?

13. Primary Survey Airway o Patent? Head tilt chin lift or jaw thrust needed? Think about C-spine control if indicated? Is the airway positional? Breathing o Rate? Too fast or too slow? Regularity? Is it adequate? If not adequate, do something about it! Circulation o Take a pulse not a heart rate! Taking a pulse involves touching and feeling your patient. A heart rate is just a number on a machine. You can have a heart rate without a pulse! (think about it). o Is the PULSE present? Too Fast? Too Slow? Weak? Strong? Perfusion? Pulse Location? o Don’t worry about heart rate, just check the pulse for the above criteria. You can get the heart rate later when you get your vital signs.

14. Primary Survey Disability (Mental Status) o Mini-Neuro Exam o AVPU? GCS? (A=15, V=12, P=8, U=3) Expose o Are you missing anything? o Adequately exposing your patient based upon MOI can save their lives! Transport Decision o “Load & Go”? o “Stay and Play”? o If you decide “Load & Go” you should put yourself on a 5 minute internal clock to transport. This means you need to fix the immediate life threats, package the patient, load them into ambulance and begin transport within 5 minutes. o All other procedures should be performed while enroute.

16. Secondary Survey

17. Choose a Physical Exam to perform o Medical o Rapid Trauma- Multi-system (MVC’s) o Focused Trauma- Single Issue (Isolated Extremity Injury) During your Physical Exam o OPQRST? o DCAPBTLS-TIC? o PMS? SAMPLE History o Allergies? Medications? History? Oral Intake? Events leading up? Vital Signs o Heart Rate? Pulse? Blood Pressure? Respirations? Mental Status? Temp? Skin Vitals? SpO2? ETCO2?

19. Develop a Treatment Plan & Implement

20. Now take everything you learned from your Initial Assessment and come up with a plan on how you are going to stabilize, treat and ultimately make your patient better! What SMO are you going to be working or is it multiple SMO’s? Make sure you inform your patient and crew of your plan. Delegate your plan to the crew, you can’t do everything! Constantly “Read” your patient and make sure your plan is working. If not adjust accordingly.

22. Reassessment

23. Reassessment Make sure you take vitals signs every 5 or 15 minutes depending on how critical your patient is. Vitals signs are NOT just for documentation purposes! They are your opportunity to “Read” your patient and make adjustments to your care plan. Trending and tracking vital signs is important to stay ahead of your care plan and become more proactive than reactive. Is your plan working? If not, adjust it!

24. Summary Practice makes perfect! An organized patient assessment is a skill that needs to be trained on. Keep your crew informed of your plan. If you don’t they will develop their own! Include your patient throughout your assessment and care when possible. An organized patient assessment WILL make a difference in patient care. Remember you are the professional and people count on your decision making capabilities, skills and most importantly attitude.

25. Thank You! Any Questions or Comments? Ed Ludwig EMS Education Coordinator Morris Hospital & Healthcare Centers 815-705-7180 eludwig@morrishospital.org