PATIENT ASSESSMENT

INTRODUCTION
 Process of identifying injuries, illnesses, or medical emergencies, allowing to provide appropriate and timely care or
determine the need for further medical intervention.

 It involves a systematic evaluation of a patient's condition, including gathering information, performing physical exams,
and using various tools to determine the nature and severity of an illness or injury.

It involves different techniques such as observation, palpation, percussion and auscultation

Most assessment tests are done by a nurse, but emergency medical crew members, physicians or other qualified
medical personnel also perform these assessments.
MEDICAL VS TRAUMA
Medical and trauma are two primary categories that help categorize patient conditions and events encountered in
healthcare settings
Medical : These refer to illnesses, diseases, or health issues that are non-traumatic in nature, often stemming from
internal factors or chronic conditions. Medical conditions are usually not caused by external forces or injuries.
•Example: Heart disease, diabetes, asthma, pneumonia, stroke, seizures, and gastrointestinal disorders are all
medical conditions. These often arise from internal factors such as genetic predisposition, lifestyle choices,
infections, or other systemic issues
Trauma: specifically refers to injuries or health issues resulting from external forces or accidents. These injuries can be
caused by various incidents such as falls, motor vehicle accidents, assaults, sports injuries, or other physical impacts.
•Example: Fractures, burns, lacerations, head injuries, and spinal cord injuries are all examples of trauma. These
conditions result from sudden external forces impacting the body, leading to physical damage or injury
Remember that medical events can cause trauma
•For e.g a person with diabetes who takes insulin may forget to eat breakfast; the patient;s glucose levlel then drops and,
as a result, the patient falls down the steps.
 By comparison traumatic events can produce medical problems
•A person with asthma might be involved in MVC, and the the stress of the event then result in asthma attack.
 A medical patient refers to someone seeking medical care or treatment for an illness, disease, or condition. This category
encompasses a wide range of health issues, from chronic diseases like diabetes or hypertension to acute infections such as
pneumonia.
 A trauma patient is someone who has suffered physical injuries resulting from an accident, violence, or any sudden event
causing bodily harm. Examples of trauma patients include individuals involved in car accidents, victims of assault, or those
with injuries from falls.

INJURY VS ILLNESS
 An illness refers to a health condition that affects the body's normal functioning, often characterized by specific symptoms.
For instance, the flu is an illness marked by symptoms like fever, cough, and fatigue.

 An injury refers to physical harm or damage to the body caused by an external force. An example could be a sprained ankle
from twisting it while running

SIGN VS SYMPTOMS

 Signs: These are objective findings that a healthcare provider can observe or measure. They are visible or measurable
indications of an illness or a medical condition. Examples include a rash, high blood pressure readings, fever, swelling, or
abnormal heart sounds detected during a physical examination.
 Symptoms: These are subjective experiences or feelings reported by the patient that indicate an illness or abnormality.
Symptoms are felt or experienced by the individual but may not be visible to others. Examples include pain, nausea, fatigue,
headache, dizziness, or shortness of breath
 For instance, a rash (sign) visible on the skin could indicate an allergic reaction, while a patient reporting feelings of fatigue
(symptom) could suggest various underlying health issues.
 SICK VS NOT SICK

 The most important skills that paramedic needs to acquire is to be able to quickly determine whether the patient is SICK OR NOT SICK
 An important assessment skill is determining whether the patient is sick or not sick based on:
 Medical patients:
a. The chief complaint
b. Respirations
c. Pulse
d. Mental status
e. Skin signs and color
 Trauma patient :
a Mechanism of injury
b. Obvious signs of trauma

 All these assessment together reflect the over-all performance of the patient’s respiratory system ,CVS and neurological system and can
quickly help for determining whether a patient is in stable or unstable condition.

 If the patient is sick, the next step is to determine how sick.

a. Minor illness versus life-threatening event

 Every time you assess a patient you have to:

a. Qualify whether your patient is sick or not sick
b. Quantify how sick the patient is

 Assessing whether a patient is sick or not sick is important because it helps the healthcare provider to decide whether Patient’s care
needs to be provided at the scene, in the ambulance or en-route to the hospital
 ESTABLISHING FIELD IMPRESSION
 A process of determining the patient’s current problem based on the patient history and the chief complaint
 Establishing a strong field impression during patient assessment involves
1. Observation: Take in the environment, noting any potential hazards or clues about the patient's condition.
2. Approach: Introduce yourself, assess the situation calmly, and maintain professionalism to instill confidence in the
patient.
3. Assessment: Conduct a systematic evaluation of the patient, focusing on vital signs, symptoms, and pertinent
information to form an initial impression of their condition.
4. Communication: Communicate effectively with the patient, asking questions, and actively listening to gather essential
information.
5. Documentation: Document your findings accurately and thoroughly to convey the field impression to other
healthcare providers.
SIGNIFICANT CHALLENGES OF ESTABLISHING A FIELD IMPRESSION
 Differing educational, cultural and ethnic back grounds
 Patients with various levels of cognitive ability
 Patient impaired by alcohol or drugs
PATIENT ASSESSMENT FLOW CHART

SCENE SIZE-UP

• Ensure Scene safety

• Determine mechanism of injury/nature of illness
• Take standard precautions
• Determine number of patients
• Consider additional /specialized resources
 SCENE SIZE-UP
 Refers to the assessment of the scene to ensure scene safety for the paramedic crew, patient(s), and by-standers; a quick assessment
to determine the resources needed to manage the scene adequately
 The purpose of the assessment is to determine what resources are needed to safely manage the event. Scene size-up is a continuous
evaluation of the scene that begins when the call is received .It requires quickly gathering facts about the situation, analyzing the
problems and potential problems, and determining the appropriate response.
 When a call is received for an emergency response, the paramedic should obtain as much information from the dispatcher as possible.
Information from the dispatch center that will help in scene size-up includes:
 Exact location
 Type of occupancy (e.g., manufacturing, roadway ,residence)
 Number of patients
 Type of situation (e.g., medical, trauma, vehicle collision)
 Hazards on the scene
 Unique issues (e.g.,key boxes , known medical or access problems)
 Obtaining this information and regular updates from the dispatch center will help the paramedic determine the need for additional
resources. These resources may include additional ambulances, fire-rescue services, mutual aid, utility services (e.g., electrical power
lines and gas lines), law enforcement, air-medical services and hazardous materials (Hazmat) teams.
 Other Resources to Safely Manage a Scene:
 Special Equipment For Extrication And Fire Suppressive On Additional Medical Supplies And Equipment Helicopter Rescue
 Special Rescue Teams
 Hazmat Decontamination
 Traffic And Crowd Control Public Safety
 Animal Control
 Additional lighting
 Hospital availability and personnel
 Public heat resources
 SCENE SAFETY
 Scene safety involves assessing the environment for any potential hazards, such as downed power lines, spilled chemicals,
violent patients, or unstable structures that could threaten the safety of the provider or the patient
 There are many factors that can affect scene safety in an emergency response. Examples include environmental hazards, the
presence of hazardous substances, violence, and rescue-related hazards

• Environmental hazards Inclement

– weather Extremes in temperatures
– Slick or icy conditions
– Poor or inadequate lighting
• Hazardous substances
– Chemical
– Biological Nuclear
– Explosive
• Violence
– Patient
– Bystanders
– Animal
– Crime scenes
• Rescue- related hazards
– Extrication
– Road operation dangers
– Specialized rescue situations
 ENVIRONMENTAL HAZARDS
 Dealing with the environment is a unique aspect of pre-hospital care. Hot weather conditions can expose the patient to
thermal injury. An example is thermal burns from placing a patient on a spine board that is left uncovered on hot asphalt.
Likewise, heat-related illness (hyperthermia) can quickly escalate if the EMS crew does not take immediate measures to
remove the patient from the hot environment. All patients who are at risk for hyperthermia should be moved to a cooler
environment to begin care.

 Cold weather poses many challenges as well. An ill or injured patient is less able to regulate body temperature, allowing
hypothermia to develop quickly. Patients who are at risk for hypothermia should be immediately sheltered from the wind
and moved to a warm environment. Wet clothing should be quickly removed and the patient should be covered with warm,
dry blankets. Warming measures may need to be initiated

 Caring for patients in a thunderstorm can be dangerous to everyone on the scene. Patients should be quickly moved to a
location that is protected from lightning and other storm hazards. The paramedic should assume that wires downed from
high winds are charged and dangerous until trained personnel verify their safety.

 Many environmental hazards will warrant specialized rescue teams and additional resources. An example is rescue of a
patient in water or on ice. Low light conditions can make patient assessment difficult and can easily contribute to personal
injury. Portable light should be available to properly assess for hazards. Large rescue scenes should be properly lighted by
requesting additional resources.
 HAZARDOUS SUBSTANCES
 Chemical, biological, radiological, and explosive hazards may be encountered from industrial accidents or terrorist incidents.
Paramedics should be alert to dispatch in formation that indicates the potential for any of these hazards. Reports of large
numbers of patients with similar signs or symptoms should signal the potential for one of these incidents.
 Assessment of a scene with a possible hazardous materials spill should be carefully planned. Scene assessment should begin
at a distance using binoculars to look for the presence of indicators of hazardous materials. Indicators include container
shape, smoke or vapor clouds and identifying Hazmat placards. These scenes should not be entered until they have been
secured and made safe by specialized teams, which may include law enforcement personnel, hazardous materials teams, or
public health specialists.
 VIOLENCE

 Many factors can contribute to a violent scene. An example is verbal aggression toward the EMS crew out
of concern for the safety and well-being of a love done. Drugs or behavioral illness can also alter a
patient’s behavior and create a dangerous situation. When patients or others on the scene display
aggressive or violent behavior, the EMS crew should retreat from the scene until it has been secured by
law enforcement personnel.

 Paramedics should be alert for the presence of weapons at any scene. Traditional weapons include knives
or guns. Other objects within reach of the patient also can be used as a weapon. Examples include tools,
kitchen appliances, and household chemicals. In some states, concealed weapons are legal. All patients
should be asked if they are carrying a knife, gun, or other weapon. If so, safely removing and securing the
weapon during transport should be dictated by department policy.

 Dogs or other pets can be a hazard to rescuers, particularly if they perceive their owner may be harmed. If
dangerous animals are unsecured, the patient or a family member should be asked to contain them.I f that
is not possible, local animal control specialists should be summoned.

 When responding to a known violent crime scene, the EMS crew should remain at a safe distance. This
staging position should be maintained until law enforcement personnel have secured the area. Many
crime scenes are not completely safe, even when law enforcement personnel are present. The paramedic
should stay alert for clues that a dangerous situation can ensue or escalate.
 Rescue-Related Hazards
 Scenes involving rescue can be very dangerous. Common motor vehicle collisions often involve patient extrication, sharp
metal, broken glass, unstable vehicles, and leaking fluids that increase the risk of fire. If it is safe to approach a vehicle
involved in a collision, the paramedic should put the patient’s vehicle in park and turn off the ignition before beginning
patient care. The extrication itself may create additional hazards related to the powerful cutting and spreading tools; a
shifting vehicle; or the possibility that an air bag will violently deploy. Paramedics should not remain in the vehicle during
extrication unless properly trained and wearing appropriate protective equipment.

 Each time a paramedic enters a roadway to provide care, there is a risk of being struck by on coming traffic. Measures to
reduce this risk should be taken on all roadway calls, regardless of the roadway speed limit. The ambulance should be
positioned in a safe location. Other emergency vehicles and response personnel should park their units in a manner that
shields the ambulance and the affected vehicles from on coming traffic. Appropriate ANSI Class II vests (traffic vests) and
other protective gear should be worn as outlined in departmental policies. A safety officer should monitor the scene at all
times . Egress from the roadway should be made as quickly as possible
SCENE SAFETY ALGORITHM
 EVALUATION OF THE SCENE
 When evaluating the scene, the paramedic must always ask “Is the scene safe?” If the scene is not safe and cannot be made
safe, the scene should not be entered. Rather, the EMS crew should remain in a safe holding area and request additional
resources.
 Only when the scene has been secured should the area be entered by EMS personnel. If no safety hazards exist, the
paramedic should establish patient contact and proceed with patient assessment .
 Sometimes it may be possible to quickly make a scene safe to enter. For example, if the incident is on a busy roadway,
emergency vehicles can be quickly positioned to provide protection for emergency personnel. Another way to make a scene
safer to enter is to wear reflective vests and clothing to improve rescuer visibility
 However, it must be stressed that making a scene safe to enter should only be considered when it can be done without
accepting significant risk to the paramedic or the patient.
 SCENE MANAGEMENT

 Successful management of an emergency scene requires many considerations, these include:

 Impact of the environment on patient care
 Addressing scene hazards
 Violent scenes
 Need for additional/specialized resources
 Standard precautions
 Multiple patient situations

 Impact of the Environment on Patient Care

– A quick, visual survey of the scene should be made on all emergency calls. For medical calls, the paramedic should
first determine the nature of the illness. This includes being observant of the patient’s surroundings for possible clues
to the nature of the emergency . For example, are there empty pill bottles or drug paraphernalia nearby ? Is the
patient wearing a medical alert necklace or bracelet? Are there any unusual odors ? Are there any hazards at the
scene that could suddenly make the scene unsafe?
– For trauma calls, it is important to quickly determine the mechanism of injury. Visual clues can be significant in
directing patient care and in anticipating patient care that may be needed while at the scene and during transport. For
example, was a steering wheel, dashboard, or windshield damaged in a motor vehicle collision? Were the occupants
in the car wearing personal restraints ?Was the patient wearing a helmet when she crashed her motorcycle ? What is
the length of the knife that was used to stab the victim ? Are there any hazards at the scene that could suddenly make
the scene unsafe?
 ADDRESSING HAZARDS
– As stated previously, all emergency scenes should be assessed for any environmental
conditions or hazards. To ensure scene safety , any hazard must be addressed.
Environmental conditions and hazards that could affect patient care or the safety of
patients, by-standers, or emergency personnel include:
• Weather or extreme temperatures
• Toxins and gases
• Secondary collapses and falls
• Unstable conditions
– After making the scene safe for the paramedic, the safety of the patient becomes the next priority.
The paramedic should attempt to correct any hazards that might threaten the health or safety of the
patient. If a hazard cannot be alleviated, the patient should be moved to a safer environment.
Likewise, any condition that poses a threat to bystanders should be minimized. They too should be
moved to a safer area
– Additional and specialized resources may be needed to address hazards at the scene. These resources should be
requested as soon as possible. The need for additional resources should be anticipated quickly when the scene is
initially scanned for mechanism of injury or nature of illness. For example, if there are multiple patients, additional
ambulances will be needed. Fire service will be needed if there are fire or electrical hazards, chemical spills, biological
threats, unsafe structures, and rescue or extrication requirements. Utility services may be required to manage
downed power lines or to secure natural gas lines. Law enforcement personnel maybe needed to control traffic, to
manage by-standers, and to contain any violence at the scene
STANDARD PRECAUTION
 The use of standard precautions should be part of any EMS response. To review, standard precautions are based on the principle that
all blood, body fluids, secretions, excretions (except sweat), non intact skin, and mucous membranes may contain transmissible
infectious agents.
 Standard precautions include a group of infection prevention strategies. These strategies apply to all patients, regardless of suspected
or confirmed infection status. They also apply to any healthcare delivery setting where patient care activities take place . The extent of
precautions used is determined by the anticipated likelihood of exposure to blood, body fluids, or pathogens. Standard precautions are
implemented by thorough hand-washing and by wearing:
– Gloves
– Protective eyewear
– Masks
– Gowns
PERSONAL PROTECTIVE EQUIPMENT
 Personal protective equipment (PPE) includes any clothing or specialized equipment that provides
some protection to the wearer . PPE protects the paramedic and other emergency personnel from
substances that may pose a health or safety risk. PPE should be appropriate for the potential
hazard. Examples of PPE include:
– Steel-toe-boots
– Helmets
– Turn out gear
– Heat-resistant outer wear
– Reflective clothing
– Bullet-proof vests in high crime areas
– Safety glasses
– Hearing protection
– Self-contained breathing apparatus(SCBA)
– Leather gloves
MULTIPLE PATIENT SITUATIONS
 When responding to an incident where there are multiple patients , the paramedic should anticipate the need for additional
support. Often times, the dispatch center has made this determination and requested assistance before EMS arrives at the
scene . As stated earlier , additional and specialized resources that may be needed are based on the nature of the incident.
These may include :
 additional ambulances and/or air medical service
 additional manpower to sort and care for the injured
 additional medical supplies, special equipment for extrication and fire suppression specialized rescue teams
 Hazmat decontamination and traffic and crowd control.

 The goals of managing an event with multiple patients are to ensure scene safety, protect the patients, and protect the
bystanders. Bystanders will need to be removed from the patient care area and isolated from the scene. Barricades may
sometimes need to be erected and manned by law enforcement personnel to ensure the goals of managing the event.
Large-scale scenes or major incidents will likely require a command structure to safely manage the scene. These command
structures are known as Incident Command System (ICS) or Incident Management System (IMS).
 These systems organize inter-agency functions and responsibilities of emergency personnel and public service agencies at
the scene. Command structures play a vital role in scene management whenever available resources are insufficient to
manage the number of casualties or the type of emergency . Examples of major incidents are listed below:
 Highway crashes
 Air crashes
 Major fires
 Train derailments
 Building collapse
 Acts of violence or terrorism
 Search and rescue operations
 Hazardous materials releases
 Natural disasters