As an Emergency Medical Responder, you must look quickly at the entire scene before approaching the patient. You must size up the scene to find out if there are any threats that may cause injury to you, other rescuers, or bystanders or that may cause additional injury to the patient.
Scene size-up is the first phase of patient assessment and is made up of five parts:
Body substance isolation (BSI) precautions
Evaluation of scene safety
Determining the mechanism of injury or the nature of the patient's illness
Determining the total number of patients
Determining the need for additional resources
You must take appropriate BSI precautions on every call. Consider the need for BSI precautions before you approach the patient. Put on appropriate personal protective equipment based on the information the dispatcher gives you and your initial survey of the scene. This equipment includes gloves, eye protection, mask, and gown, if necessary.
Scene safety is an assessment of the entire scene and surroundings to ensure your well-being and that of other rescuers, the patient(s), and bystanders.
During the scene size-up, try to determine the mechanism of injury or the nature of the illness.
The mechanism of injury (MOI) is the way in which an injury occurs, as well as the forces involved in producing the injury. A trauma patient is one who has experienced an injury from an external force. In trauma situations, look for the mechanism of injury. Traumatic situations include motor vehicle crashes, motor vehicle-pedestrian crashes, falls, bicycle crashes, motorcycle crashes, and penetrating traumas.
A medical patient is one whose condition is caused by an illness. The nature of the illness (NOI) describes the medical condition that resulted in the patient's call to 9-1-1. Examples are fever, difficulty breathing, chest pain, headache, and vomiting. You should try to find out the nature of the illness by talking to the patient, family, coworkers, and bystanders.
The ability to assess a patient properly is one of the most important skills you can master. As an Emergency Medical Responder, you must learn to work quickly and efficiently in all types of situations. You must approach patient assessment systematically. Patient assessment consists of the following components:
Scene size-up
Initial assessment
You must provide emergency medical care based on the patient's signs and symptoms. A sign is a medical or trauma condition of the patient that can be seen, heard, smelled, measured, or felt. Examples are unusual chest movement, bleeding, swelling, pale skin, and a fast pulse. A symptom is a condition described by the patient. Shortness of breath, nausea, abdominal pain, chills, chest pain, and dizziness are examples of symptoms.
Using the AVPU scale, you must evaluate the patient's level of responsiveness (mental status):
A = Alert
V = Responds to Verbal stimuli
P = Responds to Painful stimuli
U = Unresponsive
After assessing the patient's level of responsiveness, you should note the need for spinal precautions. You would then assess the patient's ABCs (airway, breathing, and circulation).
Focused history and physical examination
After the initial assessment, you should obtain a SAMPLE history, complete a physical exam, and obtain baseline vital signs (an initial set of vital sign measurements against which later measurements are compared).
SAMPLE is an aid to remind you of the information you should get from the patient:
Signs and symptoms
Allergies
Medications
(Pertinent) Past medical history
Last oral intake
Events leading to the injury or illness
DOTS can help you remember what to look and feel for during physical exam:
Deformities
Open injuries
Tenderness
Swelling
Detailed physical examination
The term physical exam implies a head-to-toe assessment of the patient's entire body. A focused physical examination is an assessment of specific body areas that relate solely to the patient's illness or injury.
Before examining the head of a trauma patient, have someone stabilize the patient's head and neck to keep the patient from moving (if this has not already been done).
A quick head-to-toe assessment of a trauma patient with a significant mechanism of injury is called a rapid trauma assessment. Seriously injured or unresponsive trauma patients require this type of physical exam in order to find out if they have life-threatening injuries. Less seriously injured trauma patients do not require a head-to-toe physical exam.
Begin the physical exam by checking the patient's head. Then examine the neck, chest, abdomen, pelvis, lower extremities, upper extremities, and the back. Compare one side of the body with the other. If an injury or a medical condition involves one side of the body, use the uninjured or uninvolved side as the normal finding for comparison.
Vital signs are assessments of breathing, pulse, temperature, pupils, and blood pressure. Measuring vital signs is an important part of patient assessment. Vital signs are measured to
Detect changes in normal body function
Recognize life-threatening situations
Determine a patient's response to treatment
Ongoing assessment
While waiting for additional EMS resources, continue to assess the patient. Repeat the initial assessment every 15 minutes for a stable patient and every 5 minutes for an unstable patient. Reassess the patient's mental status and maintain an open airway. Monitor the patient's breathing, pulse, skin color, temperature, and condition. Repeat the physical exam as needed. Check the treatments you provide to be sure that they are effective. Continue to calm and reassure the patient.
When EMS personnel arrive, provide a hand-off report. Your report should include the following patient information:
