Eight Ways you can Ace your Patient Assessment – EMS

The patient assessment is probably the most important skill every EMS person should master in order to be a truly exceptional EMT. No matter the call, no matter the patient, the EMS provider needs to be able to rapidly zero in on a complaint, make a working diagnosis, and provide adequate treatment for the patient’s condition. This skill is more important than any other simply because if you don’t know what is going on with the patient, you can’t know how to treat them.

Patient assessment has been taught many ways over the years by different versions of the EMT curriculum. I was taught that each patient gets three different types of assessment during the course of an encounter with EMS. These are: The Primary Assessment, the Secondary Assessment, and the Ongoing Assessment. Each of these three types of assessments is valuable to the EMT or Paramedic in determining what is really wrong with the patient. They’re designed to function in concert, each giving more information to the EMS provider that they can use in formulating an effective treatment plan. The more detailed they are, the better treatment decisions they allow and the better the patient’s overall progression through the healthcare system will be. Every patient should get all three of these assessments. EVERY PATIENT, EVERY CALL, EVERY TIME. Whether the call is a 911 emergency fall off of a cliff or a simple discharge back to a nursing home, every patient you come into contact with in your entire career should get your best assessment. It’s something you just can’t skip.

Take a look at the three general types of assessments:

  • The PRIMARY ASSESSMENT: The quickest assessment in the EMS toolkit, it is the first impression you make of your patient. It is intended to rapidly identify life-threatening conditions and facilitate immediate stabilizing treatment. In this assessment you should check for Airway Patency (openness), Breathing (Rate, quality, presence), and Circulation (Pulse, blood pressure, and Skin perfusion – Color, temperature, and moisture). You should also check for gross deformity, major trauma and/or blood loss, or anything else that may cause the patient to crash. If found, you should act immediately to provide stabilizing treatment. This is also where you should determine the chief complaint, the need for spinal immobilization, and form your general impression of the overall patient condition.

 

 

  • The Ongoing Assessment: The previous two assessments are useful in determining your patient’s baseline presentation and making your working field diagnosis. However, your assessment doesn’t stop there. The Ongoing Assessment is used to monitor changes in the patient’s condition and to get a trend of their progression, good or bad. You can measure the effectiveness of your treatments and see how their condition is progressing. This could be as simple as asking a patient “Do you feel any better or worse?” and rechecking their vital signs, or as in-depth as redoing your entire secondary assessment. Monitor every patient closely for changes. Recheck vitals every 5-10 minutes for compromised patients, and every 10-15 for stable ones.

Here are some tricks you can use to nail your assessment:

  1. Just Do It! – Remember, you can’t over-assess your patient. The more information you get the better. Every patient gets a full assessment, every time. Even if you can’t act on the information you gather, the information could prove invaluable to healthcare providers further down the road. They need good information on the acute phase of the patient’s illness. Remember, the EMT is “the eyes and ears of the physician in the field.” You’d never see a physician diagnose a patient without a thorough exam, don’t skip it either.

 

  1. Standardize! – Develop a standard assessment that covers at least all of the stuff I talked about above, and do it every time. Start at the head and work your way down. Think up a set of questions you want to know the answers to about your patient, and answer them every time. Not only will practicing the assessment get it down to a science, you’ll also get very quick at it. This also can help you with your narrative report writing. You can put the answers to all of your questions in your patient care report, and that’s a great way to write a narrative.

                                                    

  1. Start your assessment the second you arrive on scene – Start gathering information about the patient immediately. Note the ambient temperature. Note the condition of the patient’s living space and where you found them. If the patient is at home, look for adequate food and water. Check for disease vectors such as filth. You may want to ask the patient about their living conditions later, such as asking them if they’ve been sleeping upright in a chair when checking for CHF. Any information you gather is useful.

 

  1. Check THESE THREE THINGS when you first encounter the patient – Always introduce yourself to the patient using your name and while you’re doing this, feel their radial pulse with your fingers. This tells you three immediately important things that will drive the rest of your care: The status of their Airway, Breathing, and Circulation. You’ll feel the rate and quality of their pulse; feel their skin temperature, moisture, and condition; and be able to assess their work of breathing when they answer you back from your introduction. If any of these things are compromised… the patient is probably sick and in need of intervention.

 

  1. Try to determine the patient’s ultimate diagnosis – What, you’re scared of making a diagnosis because you’ve heard that medics don’t diagnose? That’s BS. We diagnose all the time, we just don’t make the final diagnosis. Call it a “Field Diagnosis” if you want, but I say you should try to piece together the symptoms your patient is having and try to diagnose the cause. If you don’t know the answer, fire up the Google and do some research. You’ll be surprised at what you can learn that way. Also, talk to the receiving physicians and nurses at the ER. You’ll learn a vast amount of information that will make you a better provider overall.

 

  1. Be as thorough as time will allow – Certainly, there are times where an EMT will be focused on immediately stabilizing treatment, such as airway management or hemorrhage control and won’t be able to hit all of the possible nooks and crannies of a patient assessment. However, most patients aren’t that severe and you’ll have time to gather all of the information you can. The more you assess the better information you can collect and pass on. Check for such things as: Pulsus paradoxus; a difference in blood pressure between the arms; the Babinski Sign; hidden trauma; Cushing’s Triad; and many other interesting things. You’ll learn a lot, and might just catch a few zebras.

 

  1. Don’t afraid to touch the patient – You’re a medical person. Medical people touch other people. Sometimes they see them naked. Sometimes it’s uncomfortable and sometimes you have to touch them in a way that wouldn’t otherwise be socially acceptable. Of course, don’t do anything wrong, illegal, or immoral… but when you’re checking for a broken leg you have to touch the leg. Actually Look at, Listen to, and Feel your patients. Be a professional.

 

  1. Know what “normal” is, and look for things that aren’t – Eventually, once you master the art of determining what a normal presentation is, the things that are abnormal will jump out at you. Once you’ve practiced and honed your assessment skills, you’ll be able to see any abnormalities with relative ease. It takes practice, but developing the skill is well worth the effort.

Employ these tricks and you’ll be well on your way to mastering the art of the assessment. Always learn and strive to improve your craft. Keep your eyes open and absorb new information. Pretty soon you’ll be amazing your colleagues with what you know and what you can tell them about your patients.

——————————–

Want more information on the patient assessment?

Read – Assessing Greatness: Catching the stuff you’re supposed to

Or – Ten (or so) Things You Should Try to do with Every Patient

Also, Check out TheEMTspot.com’s “Mastering the Head to Toe Assessment”

  • http://emtmedicalstudent.wordpress.com/ Joe Paczkowski

    One thing I would add is try to do a review of systems (ROS) for every patient, but especially medical patients. The ROS is the safety net of questions, so to speak, starting from general questions, then moving from head to toe. It’s things like, does the patient have fevers, chills, dizziness, weight loss, weight gain (general), vision or hearing changes, stiff neck, palpitations, shortness of breath, coughing, nausea, vomiting, diarrhea, and so on.

  • http://twitter.com/Smurfe Steve Murphy

    Assessment in not “PROBABLY” the most important skill, it “IS” the most important skill. This article nails verbatim my philosophy when I precept EMT students of all levels. I especially drill the paramedic students with this. I tell them I don’t really care about any ALS skill they have learned or think they can do until I see a solid BLS assessment. Once you nail the BLS assessment skill, being a paramedic is easy. What’s sad is in today’s advanced EMS society not many basic EMT’s get the chance to practice that skill while working with a paramedic partner.

  • http://twitter.com/EMS_Geek EMS_Geek

    Excellent post! I am relatively new on the job. (just over 2yrs) and I am still working towards perfection. Thanks for the wonderful advice!

  • Pingback: Call PAPPA for Chest Pain – A helpful Mnemonic for Paramedics and EMTs | Life Under the Lights

background image Blogger Img

Chris Kaiser aka "Ckemtp"

I am a paramedic trying to advance the idea that the Emergency Medical Services can be made into the profession that we all want it, need it, and know it deserves to be.

JEMS Talk: Google Hangout

Categories
  • 2009 (2)
  • 911 (4)
  • 911 fail (20)
  • accident (4)
  • ACLS (3)
  • Administration & Leadership (86)
  • aed (2)
  • AHA (3)
  • Als (9)
  • ALS Intercept (14)
  • Ambulance (92)
  • Ambulance cleaning (4)
  • Ambulance Driver (6)
  • ambulance humor (20)
  • Ambulance maintenance (5)
  • ambulance report (3)
  • American Heart Association (3)
  • amulance (1)
  • appreciation (13)
  • attack (2)
  • bad calls (6)
  • Bed pan (1)
  • Bed pans (1)
  • bedpan (1)
  • bernoulli (1)
  • blog (5)
  • blogger (4)
  • blogosphere (3)
  • boy scouts (1)
  • camaraderie (2)
  • Case law (2)
  • cat puke (1)
  • cats (1)
  • CCC (5)
  • CCR (7)
  • CDC (1)
  • change (21)
  • chart (1)
  • CISD (3)
  • ckemtp (14)
  • ckemtp rants (29)
  • cnn fail (1)
  • code-3 (2)
  • comfort (1)
  • Command & Leadership (54)
  • cool pics of thunderstorm (1)
  • courtesy (2)
  • cpr (10)
  • cpr fail (4)
  • cpr save (4)
  • crisis (6)
  • dave barry (2)
  • dextrocardia (1)
  • disaster (2)
  • disinfection (4)
  • Dispatch & Communications (2)
  • DNR (5)
  • Do Not Resuscitate Order (5)
  • domestic violence (1)
  • Dr. Bledsoe (1)
  • drive fast (2)
  • duty boots (2)
  • Economics (17)
  • edemse (28)
  • EKG (10)
  • Emergency Communications (5)
  • Emergency Medical Services (191)
  • Emergency Nurse (11)
  • Emergency room (11)
  • Emergency Room Nurse (5)
  • emotions (17)
  • EMS (252)
  • ems 2.0 (68)
  • EMS Blog (19)
  • EMS Blog Carnival (3)
  • EMS blogosphere (11)
  • ems boots (1)
  • EMS Conference (4)
  • EMS Dispatch (3)
  • ems education (54)
  • EMS ethics (54)
  • ems garage (2)
  • EMS Health & Safety (69)
  • EMS Humor (41)
  • EMS Management (52)
  • EMS Motivation (22)
  • EMS motivational posters (1)
  • ems narrative (7)
  • EMS narrative report (6)
  • ems pants (1)
  • EMS paramedics (25)
  • ems patient care report (6)
  • EMS pay sucks (7)
  • ems pcr (1)
  • EMS pep talk (21)
  • EMS practice (8)
  • EMS protocol project (1)
  • EMS protocols (12)
  • EMS rant (27)
  • ems report (3)
  • EMS safety (10)
  • ems salary (8)
  • ems scenario (9)
  • ems scenario based education (12)
  • EMS system (9)
  • EMS Topics (239)
  • EMS training (58)
  • ems uniforms (1)
  • EMS week (10)
  • EMS Week 2009 (2)
  • ems week 2010 (8)
  • EMT (73)
  • emt narrative (3)
  • EMT-Intermediate (6)
  • EMT-Paramedic Specialist (5)
  • ER (8)
  • ET Intubation (3)
  • Ethics (27)
  • everyday ems ethics (29)
  • explosion video (1)
  • extrication (1)
  • ez-io (2)
  • FEMA (2)
  • fire (13)
  • fire boots (2)
  • Fire department (38)
  • fire department taser training (1)
  • Fire Dispatch (1)
  • Fire Prevention & Education (4)
  • Fire Rescue Topics (97)
  • fire truck (1)
  • Firefighter (21)
  • Firefighter Safety & Health (20)
  • firefighter Tazed (1)
  • Firefighting Operations (4)
  • Fires (2)
  • first call (1)
  • first day of school (1)
  • first responder (3)
  • friendly (1)
  • Funding & Staffing (15)
  • funny (8)
  • grumblemedics (6)
  • Happy Medic (2)
  • harry reid (1)
  • HazMat (1)
  • hospital (5)
  • humor (14)
  • hurricane (1)
  • idph (3)
  • illinois (4)
  • In the Line of Duty (13)
  • infection control (5)
  • information (1)
  • inside the mind of a paramedic (16)
  • intraosseous (3)
  • Introduction (1)
  • intubation (3)
  • IO (3)
  • Iowa (4)
  • Iowa EMS (4)
  • ireland (1)
  • Irish EMS (1)
  • IV (3)
  • jaws of life (1)
  • kindergarten (1)
  • kneeling (1)
  • las vegas review journal (1)
  • Letter (2)
  • letter to the editor (4)
  • lights and sirens (2)
  • Line of Duty (12)
  • link (3)
  • MABAS (1)
  • Magnum boots (2)
  • magnum elite equipment (2)
  • mainstream media sucks (3)
  • Major Incidents (3)
  • Management (10)
  • Mass Casualty Incident (1)
  • medical ethics (19)
  • medicblog999 (7)
  • mental illness (2)
  • mental imagery (6)
  • Mission Lifeline (1)
  • Music (1)
  • narrative (4)
  • narrative report (3)
  • new perspective (16)
  • News (23)
  • newspaper (3)
  • NOAA (1)
  • northern illinois (3)
  • nursing home (2)
  • obama (1)
  • odansetron (2)
  • Paramedic (196)
  • paramedic education (74)
  • paramedic narrative (7)
  • paramedic pants (1)
  • paramedic salary (11)
  • Patient Assessment (7)
  • patient care (38)
  • Patient Handovers (3)
  • Patient Management (78)
  • pcr (2)
  • pediatric cardiology (2)
  • physician (10)
  • politics (36)
  • potential (14)
  • PR (5)
  • pride (15)
  • profession (27)
  • professionalism (32)
  • Protocol development (5)
  • psychology (6)
  • Public relations (14)
  • puke (2)
  • rant (7)
  • relationships (2)
  • renaisance (1)
  • rescue (1)
  • rescuing providence (1)
  • RN (3)
  • Rockford (1)
  • roll-over (1)
  • run sheet (2)
  • rural ems (3)
  • sadness (6)
  • safety (4)
  • salary (7)
  • sanitize (3)
  • save (3)
  • scenario (13)
  • scenario based training (15)
  • school bus (1)
  • Scope of Practice (4)
  • severe storm pictures (2)
  • sherman frederick (1)
  • shift length (2)
  • show tunes (1)
  • SitRep (1)
  • Skilled Nursing Facility (2)
  • SMG (7)
  • SMO (7)
  • soap (4)
  • soap charting (3)
  • socialized medicine (4)
  • southern wisconsin (4)
  • Special Operations (1)
  • STEMI (8)
  • stories (12)
  • swine flu (2)
  • Taser (1)
  • tattoo (1)
  • tattoo humor (1)
  • Technology & Communications (9)
  • technology-communications-ems-topics (10)
  • thank you (3)
  • The EMT Spot (2)
  • The Handover (3)
  • The Shine Factor (2)
  • thom dick (1)
  • thunderstorm (1)
  • train derailment (1)
  • train explosion (1)
  • Training (16)
  • Training & Development (49)
  • training-fire-rescue-topics (19)
  • Transfer of Care (1)
  • UK Child custody (1)
  • UK medic attacked (1)
  • UK paramedics (5)
  • Uncategorized (233)
  • united kingdom (4)
  • universal healthcare (5)
  • us (2)
  • US economy (11)
  • Vehicle Operation & Ambulances (3)
  • Vehicle Operations & Apparatus (1)
  • Videos (3)
  • volunteer fire department (9)
  • volunteer firefighter (6)
  • wall cloud (1)
  • Week (1)
  • whattaya do (4)
  • when god made paramedics (1)
  • wisconsin (3)
  • wolf parkinson white (1)
  • wpw (1)
  • wpw syndrome (1)
  • Your Happy Medic (5)
  • zofran (1)
  • Comments
    Ckemtp
    I Got Attacked – A Paramedic Speaks About Public Trust
    I somewhat agree, though I assure you I didn't set out to waste your time. I probably should have broken this down into two separate points as the second point was the one I most wanted to emphasize. My bad on this one, I'll do better next time. Thanks for the feedback. If you'd like,…
    2014-12-16 20:25:00
    hawk4080
    I Got Attacked – A Paramedic Speaks About Public Trust
    Wow. That was a total waste to read.
    2014-12-16 19:20:00
    retired ems medic
    I Got Attacked – A Paramedic Speaks About Public Trust
    The radios should have had a trouble button to eliminate the need to key the Mike and talk. Maybe the dispatchers need to be rotated out to the streets to get out of the mode of just getting the calls out and only half listening to the radio.
    2014-12-16 14:50:00
    HybridMedic
    I Got Attacked – A Paramedic Speaks About Public Trust
    We use "Signal C" as a code to relay a crew in distress. Takes a second for the dispatchers to confirm it, but it sends the nearest engine, battalion chief, fire investigator (who are sworn LEO's) and makes an officer in distress call to Memphis Police. The arrival of all those resources is quite... Dramatic.
    2014-12-15 14:29:00
    exmedic
    Welcome to the Club
    Not me anymore
    2014-12-15 09:17:00

    Care to Search the Blog?

    FireEMS Blogs eNewsletter

    Sign-up to receive our free monthly eNewsletter

    LATEST EMS NEWS

    HOT FORUM DISCUSSIONS