Principles of assessment for ems chapter 07

Principles of Patient Assessment
in EMS

Chapter 7 – Focused History &
Physical Exam Trauma Patient
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

Objectives
 Explain how the EMS provider’s
assessment of the MOI is critical to the
management of the trauma patient.
 Explain how the EMS provider’s “index of
suspicion” relates to the MOI.
 Describe the two major factors affecting
injuries to the body.

Objectives (continued)
 Describe how the “golden hour” and the
“platinum 10 minutes” pertain to the
critical trauma patient.
 Explain why the SAMPLE history is
important to the management of the
critical trauma patient.

Objectives (continued)
 Explain why the EMS provider should
complete a full assessment on the minor
trauma patient who appears to be
intoxicated or has an altered mental
status.

Introduction
 In U.S. trauma is the leading cause of
death (ages 1 to 44)
 Many MOI have predictable patterns
 Evaluation of MOI is essential. Top MOIs:
 Motor vehicle crashes
 Falls
 Poisoning
 Burns
 Drownings

Reconsider MOI
 Early evaluation of the MOI should guide
the EMS provider to suspect certain injury
patterns
 “Index of suspicion” – injury patterns help
the EMS provider anticipate the potential
for shock or other problems

Reconsider MOI (continued)
 2 major factors for injuries are:
 The amount of energy exchanged with the
body
 The anatomical structures involved
 Inappropriate identification of MOI may
result in incorrect treatment and high
mortality rates

Reconsider MOI (continued)
 “Index of suspicion” for a spinal injury:
 Cracked windshield
 Bent steering wheel
 Dented dashboard
 Side door intrusion into motor vehicle

Evaluating the MOI
 The presence of a
significant MOI is a
key decision point in
the assessment
algorithm
 This key decision
point can make a
significant impact on
the life or death of a
critical trauma patient

Evaluating the MOI (continued)
 Key decisions regarding the MOI should
help the EMS provider:
 Minimize scene time
 Quickly perform a rapid trauma assessment
 Perform life-saving procedures
 Transport to the appropriate facility

 Consider the following questions:
 How long ago did this happen?
 How fast or what velocity was involved?
 How hard was the impact or surface impacted
upon?
 How high did the patient fall from?
 How far did the patient travel before
stopping?

 Distracting injuries can keep more serious
injuries from being discovered quickly
 Scene management can also cause delays:
 Multiple patients
 Relatives
 Bystanders
 Other rescuers
 Minor trauma can appear serious at first

Significant Trauma
 Detailed observation is key to managing
the patient with significant trauma
 Don’t be distracted by less serious injuries

Golden Hour
 Time is a critical factor
for the patient with a
significant MOI
 Barring the need for
extrication, the rule of
the “Golden hour” and
the “Platinum 10
minutes” will apply

Platinum Ten Minutes
 The maximum time EMS
providers stay on the
scene for a critical
trauma patient

Rapid Trauma Assessment (RTA)
 Quick and systematic exam of these body
sections:
 Head
 Chest
 Abdomen
 Pelvis
 Extremities
 Back/buttocks

 After the RTA obtain baseline VS and a
SAMPLE history
 When the patient is unresponsive obtain
the information from bystanders, relatives,
or other first responders
 Do not extend the scene time to obtain
info

 Perform a detailed physical exam enroute
 Transportation destination depends on the
needs of the patient and capabilities of a
trauma center as well as your local
protocols

 All your efforts on the scene and enroute
may be for naught when a critical trauma
patient is transported to an inappropriate
facility

Ongoing Assessment (OA)
 Repeat IA, reassess VS, and interventions
 Repeat OA every 5 minutes on critical
trauma patients
 In cases of short manpower or short
transport time – performing the OA takes
priority over the DPE

Minor Trauma
 Examples:
 Isolated extremity injury
 Minor burns
 Small lacerations or abrasions
 An exception would be a minor injury with
an altered mental status or intoxication

Focused Physical Exam: Assess
 D – deformity
 C – contusions
 A – abrasions
 P – punctures/penetrations
 B – burns
 T – tenderness
 L – lacerations
 S – swelling

Focused Physical Exam: Assess
 Range of motion (ROM)
 Pulse, motor, and sensation (PMS)
 Skin color, temp. and condition (CTC)

Additional Steps in Minor Trauma
Patient Assessment
 Develop a treatment plan
 Perform interventions(s)
 Obtain baseline VS
 Obtain SAMPLE history
 Perform OA every 15 minutes

Conclusion
 EMS providers can make a significant
impact on the life or death of a critical
trauma patient by:
 Minimizing scene time
 Performing a RTA
 Performing life-saving interventions
 Transporting to an appropriate facility

Conclusion
 The decision point as to the presence of a
significant MOI will predicate the extent of
exam, speed, priority of transport, and
destination

Principles of assessment for ems chapter 07

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