Transcript Principles of Assessment for EMS by: Bob & Kirsten Elling

Principles of Patient Assessment
in EMS
By:
Bob Elling, MPA, EMT-P
&
Kirsten Elling, BS, EMT-P
Chapter 1 – Overview to Patient
Assessment
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Objectives
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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.
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Introduction
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The latest versions of the national
standard curricula are “assessment based”
and place more emphasis on the
assessment process in training EMS
providers.
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Importance of a
Standardized Approach
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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.
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Is The Environment Safe?
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
What’s the Patient’s Severity?
Stable or Unstable
P-1, P-2, P-3, “high” or “low”?
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Medical or Trauma?
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MOI
Significant
Non-significant
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NOI
Responsive
Not responsive
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Level of Care
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First Responder
EMT-Basic
EMT-Intermediate
EMT-Paramedic
Aeromedical
Evacuation
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Components of Assessment
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Scene size-up
Initial assessment
Focused history & physical exam: trauma
Focused history & physical exam: medical
Detailed physical exam
Ongoing assessment
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© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Scene Size-up
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Scene safe for you
and crew
Body substance
isolation precautions
needed
Is additional help
needed
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Initial Assessment
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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
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Focused History & Physical Exam:
Trauma
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Significant MOI
Rapid Trauma Exam
Baseline Vital Signs
SAMPLE History
Transport (if not
already doing so)
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Non-significant MOI
Focused Exam
Baseline Vital Signs
SAMPLE History
Transport as needed
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
SAMPLE History
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S – signs and symptoms
A – allergies
M – medications
P – pertinent past medical history
L – last oral intake
E – events leading up to
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Focused History & Physical Exam:
Medical
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Not Responsive
Rapid Physical Exam
Baseline Vital Signs
SAMPLE History
Transport (if not
already doing so)
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Responsive
History of present
event (OPQRST)
SAMPLE History
Baseline Vital Signs
Focused physical
exam
Transport
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
OPQRST
Elaborate on the Chief Complaint
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O – onset
P – provocation
Q – quality
R – radiation, region, referral
S – severity
T - time
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Detailed Physical Exam
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Trauma with
significant MOI
Enroute to the
hospital
Assess the head, face,
eyes, nose, mouth,
neck, chest,
abdomen, pelvis,
extremities, back and
buttocks
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Ongoing Assessment
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Conducted enroute to the hospital
Reassess the vital signs
Reassess initial assessment
Reassess interventions
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Conclusion
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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.