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Principles of Patient Assessment in EMS Overview to Patient Assessment Introduction The latest versions of the national standard curricula are “assessment based” and place more emphasis on the assessment process in training EMS providers. 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. Is The Environment Safe? What’s the Patient’s Severity? Stable or Unstable P-1, P-2, P-3, “high” or “low”? Medical or Trauma? MOI Significant Non-significant NOI Responsive Not responsive Level of Care First Responder EMT-Basic EMT-Intermediate EMT-Paramedic Aeromedical Evacuation Components of Assessment Scene size-up Initial assessment Focused history & physical exam: trauma Focused history & physical exam: medical Detailed physical exam Ongoing assessment Scene Size-up Scene safe for you and crew Body substance isolation precautions needed Is additional help needed 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 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 SAMPLE History S – signs and symptoms A – allergies M – medications P – pertinent past medical history L – last oral intake E – events leading up to 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 OPQRST Elaborate on the Chief Complaint O – onset P – provocation Q – quality R – radiation, region, referral S – severity T - time 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 Ongoing Assessment Conducted enroute to the hospital Reassess the vital signs Reassess initial assessment Reassess interventions 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.