introduction

1. Principles of Patient Assessment
in EMS

2. Chapter 1 – Overview to Patient
Assessment
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

3. 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.
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

4. Introduction
 The latest versions of the national
standard curricula are “assessment based”
and place more emphasis on the
assessment process in training EMS
providers.
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

5. 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.
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

6. Is The Environment Safe?
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7. What’s the Patient’s Severity?
Stable or Unstable
P-1, P-2, P-3, “high” or “low”?
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8. Medical or Trauma?
 MOI
 Significant
 Non-significant
 NOI
 Responsive
 Not responsive
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

9. Level of Care
 First Responder
 EMT-Basic
 EMT-Intermediate
 EMT-Paramedic
 Aeromedical
Evacuation
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

10. Components of Assessment
 Scene size-up
 Initial assessment
 Focused history & physical exam: trauma
 Focused history & physical exam: medical
 Detailed physical exam
 Ongoing assessment
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

11. A
l
g
o
r
I
t
h
m
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12. Scene Size-up
 Scene safe for you
and crew
 Body substance
isolation precautions
needed
 Is additional help
needed
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13. 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
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

14. 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
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

15. SAMPLE History
 S – signs and symptoms
 A – allergies
 M – medications
 P – pertinent past medical history
 L – last oral intake
 E – events leading up to
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

16. 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
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

17. OPQRST
Elaborate on the Chief Complaint
 O – onset
 P – provocation
 Q – quality
 R – radiation, region, referral
 S – severity
 T - time
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18. 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
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

19. Ongoing Assessment
 Conducted enroute to the hospital
 Reassess the vital signs
 Reassess initial assessment
 Reassess interventions
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

20. Conclusion
 Assessment is a dynamic process
 Use a standardized approach
 Continually reassess
 Be flexible and reprioritize as needed
 Follow the assessment algorithm
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit