1. Patient Assessment EMT/Paramedic Refresher Training

2. Elements of A Patient Assessment Scene Size UpScene Size Up Initial AssessmentInitial Assessment Vitals Signs and Patient HistoryVitals Signs and Patient History Focused History and Detailed Exam Focused History and Detailed Exam Trauma Patient AssessmentTrauma Patient Assessment Medical Patient AssessmentMedical Patient Assessment Ongoing ExamOngoing Exam

3. Elements of A Patient Assessment SCENE SIZE-UP INITIAL ASSESSMENT FOCUSED HISTORY & PHYSICAL EXAM FOCUSED HISTORY & PHYSICAL EXAM DETAILED PHYSICAL EXAM MEDICALPATIENTTRAUMAPATIENT DETAILED PHYSICAL EXAM ON-GOING ASSESSMENT

4. Scene Size-up

5. What do we know about this scene?

7. Scene Size Up Scene Size-upScene Size-up Steps taken by a responding crew when approaching the scene of an emergency call.Steps taken by a responding crew when approaching the scene of an emergency call. Checking Scene SafetyChecking Scene Safety Taking Body Substance Isolation (BSI) precautionsTaking Body Substance Isolation (BSI) precautions Noting the Mechanism of Injury or Nature of IllnessNoting the Mechanism of Injury or Nature of Illness Determining the # of patientsDetermining the # of patients Deciding if additional resources are needed.Deciding if additional resources are needed. YOU should continue to Size-up your scene throughout the call!

8. Scene Size Up Begins with receipt of callBegins with receipt of call LocationLocation IncidentIncident Injured/InjuriesInjured/Injuries

9. Scene Size Up Observe the scene while you approach and as you exit the vehicle.Observe the scene while you approach and as you exit the vehicle. Listen for other approaching Emergency Units from other directions.Listen for other approaching Emergency Units from other directions. Look for down wires, smoke, or other hazards.Look for down wires, smoke, or other hazards. Observe the traffic flow.Observe the traffic flow. Look for victims on or near the roadway.Look for victims on or near the roadway. Be alert for onlookers.Be alert for onlookers. Watch for signals from police officers or other emergency personnel.Watch for signals from police officers or other emergency personnel. Sniff for odors.Sniff for odors. The Scene Size-up begins before the ambulance ever comes to a STOP!

10. Scene Size Up Establishing the DANGER Zone.Establishing the DANGER Zone. A Danger Zone exist around the wreckage of every vehicle collision, within which special precautions must be taken.A Danger Zone exist around the wreckage of every vehicle collision, within which special precautions must be taken. No apparent hazards – the Danger Zone should be extended at least 50ft in all directions.No apparent hazards – the Danger Zone should be extended at least 50ft in all directions. If fuel has been spilled or a vehicle is on fire – the Danger Zone should extend a minimum of 100 ft in all directions. Park Upwind. Also if fuel has spilled, park uphill if possible.If fuel has been spilled or a vehicle is on fire – the Danger Zone should extend a minimum of 100 ft in all directions. Park Upwind. Also if fuel has spilled, park uphill if possible. If wires are down – consider the danger zone the area in which people or vehicles might be contacted by the wires if they pivoted around their attachments.If wires are down – consider the danger zone the area in which people or vehicles might be contacted by the wires if they pivoted around their attachments. When a hazardous material is involved – check the Emergency Response Guidebook.When a hazardous material is involved – check the Emergency Response Guidebook. An Ambulance should never be parked inside the DANGER ZONE!

11. Scene Size Up Crime Scene and Acts of ViolenceCrime Scene and Acts of Violence Observe for these potential signs of violence in you Scene Size-upObserve for these potential signs of violence in you Scene Size-up Fighting or Loud VoicesFighting or Loud Voices Weapons Visible or In UseWeapons Visible or In Use Signs of Alcohol or Other Drug UseSigns of Alcohol or Other Drug Use Unusual SilenceUnusual Silence Knowledge of Prior ViolenceKnowledge of Prior Violence If a hazard is present, RETREAT!!! Return only when the scene is secured by law enforcement.

12. Scene Size Up Once your scene survey is complete, determine the nature of the call by identifying the mechanism of injury or the nature of illness.

13. Scene Size Up Mechanism of injury – a force or forces that may have caused injury.Mechanism of injury – a force or forces that may have caused injury. certain injuries are considered common to a given situation.certain injuries are considered common to a given situation. even though you can’t determine the exact injury a patient may have sustained, knowing the mechanism of injury may allow you to predict injury patternseven though you can’t determine the exact injury a patient may have sustained, knowing the mechanism of injury may allow you to predict injury patterns

14. Scene Size Up Identifying the mechanism of injury is veryIdentifying the mechanism of injury is very important when dealing with motor vehicle collisions.important when dealing with motor vehicle collisions. There are actually three collisions involved in each motor vehicle crash.There are actually three collisions involved in each motor vehicle crash. 1-The force of the vehicle as it strikes an object.1-The force of the vehicle as it strikes an object. 2-The force of the patient’s body as it strikes the vehicles interior2-The force of the patient’s body as it strikes the vehicles interior 3-The force of the patient’s organs as they strike surfaces within the body.3-The force of the patient’s organs as they strike surfaces within the body. Remember The Law of Inertia: a body in motion will remain in motion unless acted upon by an outside force.

15. Scene Size Up Nature of Illness – What is medically wrong with the patient.Nature of Illness – What is medically wrong with the patient. The Nature of Illness may be obtained from the following sources:The Nature of Illness may be obtained from the following sources: 1- The Patient1- The Patient 2- Family Members or Bystanders2- Family Members or Bystanders 3- The Scene3- The Scene

16. Scene Size Up Determine the number of patients and the adequacy of resourcesDetermine the number of patients and the adequacy of resources Call for assistanceCall for assistance Other EMS UnitsOther EMS Units Law EnforcementLaw Enforcement Fire DepartmentFire Department HazMatHazMat Negotiating TeamNegotiating Team etc.etc.

17. Initial Assessment

18. The Initial Assessment PurposePurpose To rapidly identify & correct life threatsTo rapidly identify & correct life threats To identify those patients who need rapid evacuationTo identify those patients who need rapid evacuation Minimum Time on scene - Maximum Care En RouteMinimum Time on scene - Maximum Care En Route

19. The Initial Assessment General ImpressionGeneral Impression Using the facts gathered to this point, what is your first impression of the patient’s condition?Using the facts gathered to this point, what is your first impression of the patient’s condition? Are there any immediate life threats?Are there any immediate life threats? Chief ComplaintChief Complaint The reason EMS was called, usually in the patients own words.The reason EMS was called, usually in the patients own words.

20. The Initial Assessment Mental Status (LevelMental Status (Level of Consciousness)of Consciousness) A - AlertA - Alert V - VerbalV - Verbal P - PainfulP - Painful U - UnresponsiveU - Unresponsive

21. The Initial Assessment Identify & Treat Life ThreatsIdentify & Treat Life Threats A irway Control C-spine (If trauma suspected)Control C-spine (If trauma suspected) Open-Clear-MaintainOpen-Clear-Maintain B reathing Look, Listen, FeelLook, Listen, Feel Oxygenate and ventilate as indicated.Oxygenate and ventilate as indicated. Bare chest.Bare chest. C irculation Pulse (Rapid/Slow : Weak/Bounding)Pulse (Rapid/Slow : Weak/Bounding) Skin ColorSkin Color TempTemp Major BleedingMajor Bleeding

22. The Initial Assessment Determine PriorityDetermine Priority Immediate PriorityImmediate Priority (Load-&-Go) (Load-&-Go) VS. VS. Further On-Scene Assessment and Care (Stay-&-Play)Further On-Scene Assessment and Care (Stay-&-Play)

23. Trauma Assessment

24. Focused History and Physical Exam for the Trauma PatientFocused History and Physical Exam for the Trauma Patient PurposePurpose Obtain Chief ComplaintObtain Chief Complaint What happened to the patient?What happened to the patient? Evaluate Chief ComplaintEvaluate Chief Complaint What circumstances surround this incident?What circumstances surround this incident? Is the Mechanism of Injury a high risk for injury?Is the Mechanism of Injury a high risk for injury? Conduct Physical ExamConduct Physical Exam Obtain Baseline Vital SignsObtain Baseline Vital Signs

25. Trauma Assessment Re-evaluate Mechanism of Injury (MOI)Re-evaluate Mechanism of Injury (MOI) Significant MOI? Yes/NoSignificant MOI? Yes/No Is patient unresponsive or disoriented?Is patient unresponsive or disoriented? Can they participate in examination?Can they participate in examination? Is the patient under the influence of drugs or alcohol?Is the patient under the influence of drugs or alcohol? Can they participate in examination?Can they participate in examination?

26. Trauma Assessment In Patients with NO significant mechanism of injury… Reconsider the Mechanism of InjuryReconsider the Mechanism of Injury Determine Chief ComplaintDetermine Chief Complaint SAMPLE HistorySAMPLE History Baseline VitalsBaseline Vitals Focused AssessmentFocused Assessment

27. Trauma Assessment Patients without significant MOI Focused Physical ExamFocused Physical Exam –DCAP-BTLS D - DeformitiesD - Deformities C - ContusionsC - Contusions A - AbrasionsA - Abrasions P - Punctures/PenetrationsP - Punctures/Penetrations B - BurnsB - Burns T - TendernessT - Tenderness L - LacerationsL - Lacerations S - SwellingS - Swelling

28. Trauma Assessment Patients with significant MOI … Assess Reconsider the MOIAssess Reconsider the MOI Continue manual stabilization of the head and neck.Continue manual stabilization of the head and neck. Consider requesting advanced life support.Consider requesting advanced life support. Reconsider the transport decision.Reconsider the transport decision. Reassess mental status.Reassess mental status. Perform Rapid TraumaPerform Rapid Trauma Baseline VitalsBaseline Vitals SAMPLE HistorySAMPLE History

29. Trauma Assessment Patients with significant MOI … RAPID TRAUMA ASSESSMENTRAPID TRAUMA ASSESSMENT –Head-to-Toe Physical Exam –Palpation –Auscultation –Other Senses

30. Trauma Assessment Patients with significant MOI RAPID TRAUMA ASSESSMENTRAPID TRAUMA ASSESSMENT –DCAP-BTLS D - DeformitiesD - Deformities C - ContusionsC - Contusions A - AbrasionsA - Abrasions P - Punctures/PenetrationsP - Punctures/Penetrations B - BurnsB - Burns T - TendernessT - Tenderness L - LacerationsL - Lacerations S - SwellingS - Swelling

31. Trauma Assessment Baseline Vital SignsBaseline Vital Signs More than one setMore than one set Look for “trending”Look for “trending” HistoryHistory S-A-M-P-L-E S-A-M-P-L-E

32. Medical Assessment

33. Patient Responsive? Yes/NoPatient Responsive? Yes/No AVPUAVPU A - Alert V - Verbal P - Painful U -Unresponsive

34. Medical Assessment The Responsive Patient… Assess Chief Complaint Assess Chief Complaint Signs & SymptomsSigns & Symptoms O - Onset P – Provokes Q - Quality R - Region/Radiation S - Severity T - Time

35. Medical Assessment The Responsive Patient… SAMPLE HistorySAMPLE History Focused Medical AssessmentFocused Medical Assessment Baseline Vital SignsBaseline Vital Signs Transport DecisionTransport Decision Detailed Physical ExamDetailed Physical Exam Ongoing AssessmentOngoing Assessment

36. Medical Assessment The Unresponsive Patient… Rapid Physical AssessmentRapid Physical Assessment Baseline Vital SignsBaseline Vital Signs SAMPLE HistorySAMPLE History Family, co-workers, bystandersFamily, co-workers, bystanders TransportTransport Ongoing assessmentOngoing assessment

37. Detailed Physical Exam

38. More detailed Head-to-Toe examinationMore detailed Head-to-Toe examination Time sensitiveTime sensitive Usually performed en-routeUsually performed en-route Required for any unresponsive patientRequired for any unresponsive patient Required for any multi-trauma patientRequired for any multi-trauma patient Required for any Patient with significant mechanism of injuryRequired for any Patient with significant mechanism of injury –If the mechanism of injury could have caused serious injuries, you must actively assess for additional injuries

39. Ongoing Assessment

40. Purpose -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 Performed on both the trauma or medical patientPerformed on both the trauma or medical patient ProcedureProcedure –Repeat Initial Assessment –Reassess Vital Signs –Repeat Focused Assessment –Check Interventions