Principles of Patient Assessment in EMS

1. Principles of Patient Assessment in EMS By: Bob Elling, MPA, EMT-P & Kirsten Elling, BS, EMT-P

2. Chapter 7 – Focused History & Physical Exam Trauma Patient © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

3. Objectives • Explain how the EMS provider’s assessment of the MOI is critical to the management of the trauma patient. • Explain how the EMS provider’s “index of suspicion” relates to the MOI. • Describe the two major factors affecting injuries to the body. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

4. Objectives (continued) • Describe how the “golden hour” and the “platinum 10 minutes” pertain to the critical trauma patient. • Explain why the SAMPLE history is important to the management of the critical trauma patient. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

5. Objectives (continued) • Explain why the EMS provider should complete a full assessment on the minor trauma patient who appears to be intoxicated or has an altered mental status. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

6. Introduction • In U.S. trauma is the leading cause of death (ages 1 to 44) • Many MOI have predictable patterns • Evaluation of MOI is essential. Top MOIs: • Motor vehicle crashes • Falls • Poisoning • Burns • Drownings © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

7. Reconsider MOI • Early evaluation of the MOI should guide the EMS provider to suspect certain injury patterns • “Index of suspicion” – injury patterns help the EMS provider anticipate the potential for shock or other problems © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

8. Reconsider MOI (continued) • 2 major factors for injuries are: • The amount of energy exchanged with the body • The anatomical structures involved • Inappropriate identification of MOI may result in incorrect treatment and high mortality rates © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

9. Reconsider MOI (continued) • “Index of suspicion” for a spinal injury: • Cracked windshield • Bent steering wheel • Dented dashboard • Side door intrusion into motor vehicle © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

10. Evaluating the MOI • The presence of a significant MOI is a key decision point in the assessment algorithm • This key decision point can make a significant impact on the life or death of a critical trauma patient © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

11. Evaluating the MOI (continued) • Key decisions regarding the MOI should help the EMS provider: • Minimize scene time • Quickly perform a rapid trauma assessment • Perform life-saving procedures • Transport to the appropriate facility © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

12. Evaluating the MOI (continued) • Consider the following questions: • How long ago did this happen? • How fast or what velocity was involved? • How hard was the impact or surface impacted upon? • How high did the patient fall from? • How far did the patient travel before stopping? © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

13. Evaluating the MOI (continued) • Distracting injuries can keep more serious injuries from being discovered quickly • Scene management can also cause delays: • Multiple patients • Relatives • Bystanders • Other rescuers • Minor trauma can appear serious at first © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

14. Significant Trauma • Detailed observation is key to managing the patient with significant trauma • Don’t be distracted by less serious injuries © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

15. Golden Hour • Time is a critical factor for the patient with a significant MOI • Barring the need for extrication, the rule of the “Golden hour” and the “Platinum 10 minutes” will apply © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

16. Platinum Ten Minutes • The maximum time EMS providers stay on the scene for a critical trauma patient © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

17. Rapid Trauma Assessment (RTA) • Quick and systematic exam of these body sections: • Head • Chest • Abdomen • Pelvis • Extremities • Back/buttocks © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

18. Rapid Trauma Assessment (RTA) • After the RTA obtain baseline VS and a SAMPLE history • When the patient is unresponsive obtain the information from bystanders, relatives, or other first responders • Do not extend the scene time to obtain info © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

19. Rapid Trauma Assessment (RTA) • Perform a detailed physical exam enroute • Transportation destination depends on the needs of the patient and capabilities of a trauma center as well as your local protocols © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

20. Rapid Trauma Assessment (RTA) • All your efforts on the scene and enroute may be for naught when a critical trauma patient is transported to an inappropriate facility © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

21. Ongoing Assessment (OA) • Repeat IA, reassess VS, and interventions • Repeat OA every 5 minutes on critical trauma patients • In cases of short manpower or short transport time – performing the OA takes priority over the DPE © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

22. Minor Trauma • Examples: • Isolated extremity injury • Minor burns • Small lacerations or abrasions • An exception would be a minor injury with an altered mental status or intoxication © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

23. Focused Physical Exam: Assess • D – deformity • C – contusions • A – abrasions • P – punctures/penetrations • B – burns • T – tenderness • L – lacerations • S – swelling © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

24. Focused Physical Exam: Assess • Range of motion (ROM) • Pulse, motor, and sensation (PMS) • Skin color, temp. and condition (CTC) © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

25. Additional Steps in Minor Trauma Patient Assessment • Develop a treatment plan • Perform interventions(s) • Obtain baseline VS • Obtain SAMPLE history • Perform OA every 15 minutes © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

26. Conclusion • EMS providers can make a significant impact on the life or death of a critical trauma patient by: • Minimizing scene time • Performing a RTA • Performing life-saving interventions • Transporting to an appropriate facility © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

27. Conclusion • The decision point as to the presence of a significant MOI will predicate the extent of exam, speed, priority of transport, and destination © 2003 Delmar Learning, a Division of Thomson Learning, Inc.