Takes or verbalizes body substance isolation precautions

"BSI"

Determines the scene is safe

"Is the scene safe?"

Determines the mechanism of injury/nature of illness

"What is the mechanism of injury or nature of illness?"

Determines the number of patients

"Is this my only patient?"

Requests additional help if necessary

"Are there any special considerations that might need more help"?

Considers stabilization of spine

"Is there any trauma involved in this call"? If yes or in any doubt designate someone to begin manual c-spine stabilization and get a collar on after assessing the life threats section

Verbalizes general impression of patient

Your general impression is based on what you are told and see

Determines responsiveness/level of consciousness

Use the AVPU scale. Combine this with patient’s chief complaint

Determines chief complaint/apparent life threats (see next)

The chief complaint is the reason EMS was called, in the patients own words. "Why did you call EMS today"? From your response you can make a conclusion of the patient’s responsiveness/level of consciousness – no response drops you down to check for "Painful", or "Unresponsive". A spontaneous response – "the patient is alert, with a chief complaint of chest pain"

ASSESS AIRWAY AND BREATHING

Assessment

You need to find out the RATE, DEPTH AND QUALITY

"How is the patient breathing? How fast is he breathing?"

"Do I have equal breath sounds? What is the quality?"

Indicates appropriate oxygen therapy

Based on your findings select a non-rebreather at 15 liters/min

OR have someone else bag the patient with a BVM 15 lpm

above or below 12-20, with poor chest rise or bad sounds bag.

Assures adequate ventilation

Since you have performed an intervention you have to reassess.

"Does the oxygen seem to be helping? Is the patient responding

to the oxygen?" Based on response upgrade or downgrade.

ASSESS CIRCULATION

Assess/control major bleeding

Scan your patient for bleeding. Control any MAJOR bleed.

Check with the evaluator: "is there any major bleeding" for

bleeding which may not be easily seen. Defer minor bleeding to

later – "I’ll have my assistant put a dressing on that minor leg

laceration when he gets a chance"

Assess pulse

Use this to multi-task. Take the wrist: "how fast is the pulse?

IDENTIFY PRIORITY PATIENTS/MAKES TRANSPORT DECISION

Based on your findings make your patient "high" or "low" priority.

Declare whether you will transport now or continue assessment.

High priority conditions: poor general impression, unresponsive, not

If you have found your patient to be unstable conduct a rapid assessment first, then do you interrogatories. If your patient is stable do your interrogatories then your exam.

PERFORM OPQRST or questions specific to the complaint class

Onset – "what were you doing when it started?"

Provokes – "Can you think of anything that might have caused it? Does

anything you do make it better or make it worse?"

Quality- "can you describe it to me?"

Radiation- "Where is the pain? Does the pain go anywhere else?"

Severity – "How bad is the pain? On a scale of 1 to 10 where zero was no

pain and 10 was the worst pain you can imagine what number would

you assign to the pain"?

Time – "when did the pain start – has it changed at all since it started?"

These questions will vary if the complaint is AMS, Poisoning, Environmental, Obstetric or Behavioral.

PERFORM SAMPLE

Signs and symptoms: "What’s wrong"?

Allergies: are you allergic to any medications, foods, or environmental"?

Medications: "what medications are you currently taking?"

Pertinent Past History: "Have you been having any medical problems"?

Last Oral intake: "When and what did you last eat or drink? "

Events Leading: "what sequence of events led up to today’s problem?"

PERFORM APPROPRIATE PHYSICAL EXAM

For the responsive medical patient usually a focused medical exam is done.

Examine only specifics associated with the complaint.

For the unresponsive medical patient perform a rapid physical exam before

the interrogatories.

RAPIDLY ASSESS: head, neck, chest, abdomen, pelvis, extremities and

Posterior. Check for DCAP-BTLS. Also check for:

JVD, medical alert tags, = breath sounds,abd

Distension firmness or rigidity, incontinence, PMS

OBTAIN BASELINE VITALS

Mental Status, Pulse, Blood Pressure, Respiratory Rate, Pupillary response

INTERVENTIONS ACCORDING TO THE COMPLAINT AND PATIENT CONDITION

Contact medical control and request glucose, nitroglycerin, inhaler,

activated charcoal, or epi-pen as pertinent and if conditions for

administration are met

TRANSPORT re-evaluate your transport decision to stay or go and priority

Verbalize consideration for detailed physical exam

Indicate why or why not you will be performing a detailed exam.

You may choose not to do a detailed exam due to:

Condition is isolated

Patient is unstable and requires attention to life threats

Insufficient time

ONGOING ASSESSMENT

Repeat the initial assessment – general impression, level of consciousness

Life threats, ABC’s

Repeat vital signs

Repeat or do focused exam based on earlier findings

CRITICAL CRITERIA

Did not take or verbalize BSI

Did not determine scene safety

Did not obtain med control or verbalize standing orders on interventions

Did not provide high concentration oxygen

Did not find or manage problems associated with airway, breathing,

Hemorrhage or shock

Did not differentiate patient’s need for transportation versus continued

Assessment on scene

Did detailed or focused history/physical exam prior to assessing ABC’s

Did not ask questions about the present illness

Administered a dangerous or inappropriate intervention