Patient Assessment Trauma 1

Step by Step Patient Assessment Procedure

Patient Assessment is, without a doubt, The most important skill that you will learn during your experience as an EMT student.  Without "assessment" ability, the EMT will never 'know' when it's appropriate to apply a Kendrick's Extrication Device (KED,) or IF helping the patient self-administer an "EPI-pen" is indicated, or "how much" oxygen the patient "really" needs.  It IS the basis from which ALL other decisions will be made. Actually the 'Entire Scope' of the "skill" goes well beyond the patient.  The properly "honed" skill will include an 'assessment' of the patient, that's true, but it will also include an 'assessment' of the environment (the scene,) as well as a 'pre-assessment' of the "call," so that, when you arrive at the scene, you will 'grab' the proper equipment (stretcher type, 'treatment' adjuncts, personal protective equipment, etc.)  to better prepare yourself to deal with the patient.

The "first step" in the entire process actually begins before your involvement, with a properly trained dispatcher.  The dispatcher, who takes the initial call for help, should 'collect' as much pertinent information as is available, so that the "dispatch" is a complete one.  Knowing "where" you are going, a familiarity with the "location," and an understanding of the "problem," are all 'pieces' of information that will help you make a proper "pre-assessment."  While responding to the scene, 'armed' with the information supplied by the dispatcher and associating that information with your available equipment, your knowledge of the area, and your 'ability' to deal with the upcoming anticipated problems, will better prepare you (mentally and emotionally) to deal with this patient.  That "preparation" will also serve to present an 'organized' group of rescuers to onlookers, family members, and the patient, when your ambulance arrives at the scene, adding to the degree of "professionalism" perceived by the 'public.'

Once at the scene, a proper "patient assessment" begins with an 'assessment' of that scene.  As a matter of fact, the entire process of "patient assessment" is one that starts out very "general" and as the process continues, the focus becomes more and more specific.

Here you can download the Patient Assessment Drill Sheet

NREMT Patient Assessment Sheet

The process includes four basic "steps."

·         Scene Size-Up

·         Initial Assessment

·         Focused History (Hx) and Physical Exam (PE):

Trauma [Emts] or Medical [Emt-P]

(This may include a "Rapid Trauma Assessment" or a "Detailed Physical Exam" depending on the outcome of the "Hx and/or PE")

·         Ongoing

Scene Size-Up

As mentioned above, your 'evaluation' of the scene should begin during the dispatch process, assuming that the dispatch was 'complete.'  But any 'scene' is a dynamic entity, changing from minute to minute, and an "up-to-the-minute" evaluation of this scene will actually begin as you arrive.  When approaching the scene, park the ambulance a reasonable distance from the scene, but DO NOT enter the 'scene' with your emergency vehicle.  At most scenes, law enforcement personnel will, most likely, have arrived first, and should have already defined the 'borders' of this scene. 

The "steps" involved in this "scene size-up" include"

• Body Substance Isolation  (BSI) Always Preventions
• Scene Safety for the Crew?
• Mechanism of Injury         (MOI)
  Nature of Ilness                (NOI)
• Number of Patients? MCI?=over 6 pts? is Crew Enough to Handle the Job? 
• Need for Additional Help? PD, FD, BLS, ALS, PC? 
• Consider In-Line Immobilization of the C-Spine

With no intent to insult your propriety, please consider the two words, spoken more often by the majority of Emergency Service Providers when arriving at the scene of any major incident..."Oh Shit!" - 'Mother F ck" - "F cks" -"Big F ck Balloon". etc. 

We offer these words as a quote, understanding that they are NOT within the acceptable limits of conventional conversation.  They do, however, express the reaction that many who arrive at this scene initially formulate (whether spoken or unspoken.)  This "initial" reaction can lead to a sense that some immediate engagement in this scene is, not only appropriate, but expected by those already on the scene.  DO NOT GIVE IN TO THIS SENSE OF URGENCY.  As a matter of fact, your first action is NOT to run into this scene (as an Emergency Service Provider, you should not RUN anywhere,) but to stop.  Take a nice deep breath (be careful not to get 'run over' by the other providers running to the scene) and look around.  

Tunnel Vision: Those providers running to the scene are concentrating on the "problem" expressed in the scene.  They may be unaware of the 'cause' of the "problem," and under such circumstances are more likely to become part of the "problem."  They may very likely be experiencing a phenomenon called "Tunnel Vision," and the 'experience' can be deadly.  While "looking around" as suggested above, be aware of several things:
Any additional Emergency Services traffic approaching the scene
Any "civilian" pedestrian and/or vehicular traffic attracted by the scene
(People 'traffic' will MOST LIKELY be experiencing "Tunnel Vision" and they are not looking 'for' you or 'at' you.  The probability of injury to you, as a result of their Tunnel Vision is VERY HIGH.) Any environmental problems (heat, extreme cold, mud, ice, unstable ground, darkness, other conditions that limit your vision or ability to safely navigate the terrain, etc.) The presence of any hazardous materials, or POSSIBLE presence of such materials (spilled gasoline, leaking gas, airborne powders, unmarked "containers" of unknown substances, etc.) [As an 'aside,' please be aware that the company charged with the 'responsibility' for moving the greatest amounts of hazardous materials over the public highways (in most of the world) is United Parcel Service (UPS.)  They accept and manage that responsibility very well, and although the number of vehicular accidents involving UPS trucks is not unusually high, the likelihood that a UPS truck is carrying some hazardous substance is information that should be noted at any such accident.]

• Broken glass
• Jagged metal
  Downed electrical lines
• Crime Scene -The possible presence of "evidence."

All of this "input" is intended to provide YOU with a 'platform' from which to make a SMART DECISION: "Do I enter the scene, or not?  And, if so, what Personal Protective Equipment (PPE) will I bring with me?"

If the scene is found to be 'unsafe,' DO NOT ENTER IT, unless you can render it 'safe,' or until it has been made 'safe' by others.i.e. Fireman, PD, Bomb Squad.

Web index:

http://www.emtb.com

www.EmergencyMedicalEd.com
http://www.health.state.ny.us/nysdoh/emshttp://www.emt-national-training.com/medical-assessment.php

or you can download as a PDF at:http://www.health.state.ny.us/nysdoh/ems/pdf/srgpadefinitions.pdf#search='patient%20assessment'