The document discusses the principles of ongoing patient assessment in EMS. It defines ongoing assessment as the phase of care provided while transporting a patient to the hospital. The key steps of ongoing assessment are repeating the initial assessment, re-evaluating priorities, reassessing vital signs, repeating the focused exam, and checking interventions. Trending vital signs and exam findings is important to determine if a patient's condition is improving, worsening or unchanged. Communication with medical control and documentation of assessment findings is also emphasized.

1. Principles of Patient Assessment
in EMS

2. Chapter 20 – The Ongoing
Assessment
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

3. Objectives
 List the steps of the ongoing assessment.
 List three objectives of the OA.
 Define trending and describe why trending
is an important tool in patient care.
 Provide two examples of trending.
 Describe the typical information included
in a “radio report.”
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

4.  Discuss appropriate use of a patient
assessment card.
 Explain why it is not appropriate to
complete the PCR enroute to the hospital
or facility.
 Explain how to document statements
made by the patient while under your
care.
Objectives
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

5. Introduction
 Ongoing assessment (OA) – the phase of
care provided to the patient while enroute
to the hospital.
 The steps of the OA include:
 Repeating the IA
 Re-evaluating the patient’s priority
 Reassessing and recording the VS
 Repeating the focused assessment
 Checking interventions
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

6. Settling In
 Once in the ambulance assure that:
 The patient is properly secured (belted)
 The compartment temperature is appropriate
 IV is secure/patent
 Equipment is fastened down
 Oxygen is switched to the onboard
 Monitors are secured and visible
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

7. Settling In (continued)
 Once you are “settled in” maintain a
continuous concerned conversation with
the patient.
 Explain or answer questions to keep the
patient informed and alleviate anxiety.
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

8. Repeat the IA
 Manage any potential life-threats.
 Re-evaluate patient priorities.
 Observe and note “trends.”
 Communicate with medical control or the
receiving facility.
 Document assessment finding and care
rendered.
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

9. Trending
 The process of obtaining a baseline
assessment, followed by serial
assessments to determine if patient is
getting better, worse, or has no change.
 An important tool in patient care.
 Examples of trending info are VS or noting
MS changes.
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

10. Communicating Enroute
 In most EMS systems a radio report to
Medical Control or the receiving hospital is
done enroute.
 This is also done with other methods (cell
phone, computer, or fax).
 Local protocols may have you consult or
obtain permission for various treatments.
 Information obtained in the OA is a
significant part of the radio report.
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

11. Documentation
 Important to document assessment
findings and patient management.
 Assessment cards are helpful for taking
notes prior to writing a complete
prehospital care report (PCR).
 Take notes on:
 Scene size-up
 IA and Vital signs
 FH and PE
 OA
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

12.  Some EMS providers utilize a PDA for
taking notes or to quickly reference
information.
 The PCR:
 NOT designed to be completed enroute
 Report needs to be neat, complete, accurate,
and well thought out
Documentation (continued)
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

13. Documentation (continued)
 The PCR continued:
 Use objective language and avoid subjective
judgments
 Be exact about what you see, hear, feel, or smell
 Avoid interpretations about patient behavior
 Include pre- and post- assessment findings around
treatment modalities (i.e. splinting, med
administration, etc)
 Document pertinent patient quotes such as “I drank 2
beers”
 Use only abbreviations that are standardized and
commonly understood by other health care
professionals
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

14. Repeat the Focused Physical Exam
 In a medical patient focus on the specific
complaint (i.e. respiratory, cardiac, etc).
 In a trauma patient with no significant
MOI, focus on the isolated injury.
Reassess distal PMS and splinting.
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

15. Checking Interventions
 Anything that the EMS provider does to a patient
that is expected to change the patient’s
condition should be reassessed.
 Determine if the intervention had an effect:
 Positive - desired improvement
 Negative - undesired deterioration
 No observed effect
 Reassess vital signs every 5 minutes for unstable
patients and every 15 minutes for the stable
patients.
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

16. Conclusion
 The OA is done on every call when the
patient is transported to a receiving
facility.
 The steps involve reassessment of the IA,
obtaining serial VS and observing for
trending in the patient’s condition.
 Make notes for trending, radio report and
documentation.
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit