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Principles of Patient Assessment in EMS By: Bob Elling, MPA, EMT-P & Kirsten Elling, BS, EMT-P Chapter 1 – Overview to Patient Assessment © 2003 Delmar Learning, a Division of Thomson Learning, Inc. Objectives Describe significant changes to the approach to assessment in the past two decades. Discuss the importance of a standardized approach to patient assessment. List and describe four key factors to the assessment approach. List and describe six components of the standardized approach to patient assessment. © 2003 Delmar Learning, a Division of Thomson Learning, Inc. Introduction The latest versions of the national standard curricula are “assessment based” and place more emphasis on the assessment process in training EMS providers. © 2003 Delmar Learning, a Division of Thomson Learning, Inc. Importance of a Standardized Approach The EMS provider’s approach to patient assessment and physical examination must be similar for all new patients. Four key factors must be considered: environment, severity, medical versus trauma, and level of care available. © 2003 Delmar Learning, a Division of Thomson Learning, Inc. Is The Environment Safe? © 2003 Delmar Learning, a Division of Thomson Learning, Inc. What’s the Patient’s Severity? Stable or Unstable P-1, P-2, P-3, “high” or “low”? © 2003 Delmar Learning, a Division of Thomson Learning, Inc. Medical or Trauma? MOI Significant Non-significant NOI Responsive Not responsive © 2003 Delmar Learning, a Division of Thomson Learning, Inc. Level of Care First Responder EMT-Basic EMT-Intermediate EMT-Paramedic Aeromedical Evacuation © 2003 Delmar Learning, a Division of Thomson Learning, Inc. Components of Assessment Scene size-up Initial assessment Focused history & physical exam: trauma Focused history & physical exam: medical Detailed physical exam Ongoing assessment © 2003 Delmar Learning, a Division of Thomson Learning, Inc. A l g o r I t h m © 2003 Delmar Learning, a Division of Thomson Learning, Inc. Scene Size-up Scene safe for you and crew Body substance isolation precautions needed Is additional help needed © 2003 Delmar Learning, a Division of Thomson Learning, Inc. Initial Assessment Orderly and sequential exam with correction of life-threats MS-ABC Priority Plan General impression Chief complaint (MOI/NOI) Assess mental status Assess airway, breathing, and circulation Determine priority and need for ALS © 2003 Delmar Learning, a Division of Thomson Learning, Inc. Focused History & Physical Exam: Trauma Significant MOI Rapid Trauma Exam Baseline Vital Signs SAMPLE History Transport (if not already doing so) Non-significant MOI Focused Exam Baseline Vital Signs SAMPLE History Transport as needed © 2003 Delmar Learning, a Division of Thomson Learning, Inc. SAMPLE History S – signs and symptoms A – allergies M – medications P – pertinent past medical history L – last oral intake E – events leading up to © 2003 Delmar Learning, a Division of Thomson Learning, Inc. Focused History & Physical Exam: Medical Not Responsive Rapid Physical Exam Baseline Vital Signs SAMPLE History Transport (if not already doing so) Responsive History of present event (OPQRST) SAMPLE History Baseline Vital Signs Focused physical exam Transport © 2003 Delmar Learning, a Division of Thomson Learning, Inc. OPQRST Elaborate on the Chief Complaint O – onset P – provocation Q – quality R – radiation, region, referral S – severity T - time © 2003 Delmar Learning, a Division of Thomson Learning, Inc. Detailed Physical Exam Trauma with significant MOI Enroute to the hospital Assess the head, face, eyes, nose, mouth, neck, chest, abdomen, pelvis, extremities, back and buttocks © 2003 Delmar Learning, a Division of Thomson Learning, Inc. Ongoing Assessment Conducted enroute to the hospital Reassess the vital signs Reassess initial assessment Reassess interventions © 2003 Delmar Learning, a Division of Thomson Learning, Inc. Conclusion Assessment is a dynamic process Use a standardized approach Continually reassess Be flexible and reprioritize as needed Follow the assessment algorithm © 2003 Delmar Learning, a Division of Thomson Learning, Inc.