Patient assessment is a very important skill every EMS professional will use. The National EMS Education Standards, Emergency Medical Technician instructional guidelines devote a significant amount of class time to teaching students the knowledge and skills needed to perform patient assessment.
Patient assessment is broken down into three steps.
Primary Assessment: This is the quick, first impression an EMT makes of the patient. It helps set the general impression of overall patient condition. An EMT or paramedic checks the ABCS – Airway, Breathing, Circulation, and Skin, and begins to stabilize and treat the patient.
Secondary Assessment: Otherwise known as the “Head to Toe assessment,” it is a detailed physical assessment, literally head to toe. The caregiver assesses diagnostic criteria such as pupil and eye condition, condition of the neck and trachea, chest rise and fall, and examines the extremities, among other things. The EMT looks for hidden injuries and things that don’t appear normal.
Ongoing Assessment: The Ongoing Assessment monitors changes in the patient’s condition and reveals the trend in their progression, good or bad. Ongoing assessment includes checking and re-checking vital signs as well as re-doing a head-to-toe check to see if they are improving. With a responsive patient, an EMT can even simply ask, “Are you feeling better or worse?”
Classroom education in EMS spends a lot of time on teaching assessment skills to EMS providers. However, field experience will build and strengthen patient assessment skills in different ways. As you develop proficiency in the field, here are tips that can help.
8 Tips to Patient Assessment
1. Start the assessment as soon as you arrive on scene. Take in the patient’s immediate environment, and look for signs that can be impacting their health, such as poor air flow or a dirty or cluttered room.
2. Check the radial pulse. Introduce yourself to the patient, and check his/her radial pulse. A radial pulse can tell you three things very quickly: the status of a patient’s airway, breathing, and circulation. You can also feel the temperature and moisture of the patient’s skin; and if they are able to respond verbally to your introduction, you can assess their alertness and breathing.
3. Develop your own patient assessment routine. Textbooks and lectures can teach you the steps of patient assessment, but as you enter field work, you will want to develop a routine that works for you. Developing muscle memory starts in simulation training, and will improve with experience.
4. First impressions are important. As you start to work with real patients, learn to trust your instincts. You will start to recognize what a normal presentation is, and abnormal things will jump out at you. Don’t be afraid to expedite treatment and transportation when you feel it’s appropriate.
5. Take a thorough history. When a patient is conscious and responsive, this is a simple interviewing process between you and the patient. In the case of an unconscious or unresponsive patient, a family member or bystander can answer questions as a physical assessment is performed. Sometimes, though, all you have are the patient surroundings and the physical assessment. You will have to look for on-scene clues to give you insight into the current problem.
6. The AVPU scale is part of the ongoing assessment. “Alert, Voice, Pain, Unconscious” (AVPU) provides a lot of information upfront, but be sure to continue to ask questions to make sure a patient is staying alert and oriented.
7. Go ahead and diagnose. An EMT’s or paramedic’s initial diagnosis is not the final say, but assessing a patient accurately and forming an initial diagnosis will help you learn. After a call, doing some research into symptoms and talking to ER personnel will increase your knowledge and help you be a better provider.
8. Learn to adapt. Be smart and stay flexible on a call. Not everything is going to go according to the book! Thinking critically, developing a routine, and adapting to the situation will serve your patients best. Patient assessment is a baseline, critical skill for EMS providers; it informs treatment decisions. You’ll always be learning, so stay open to the process.
Hands-on simulation training is used to help students develop assessment skills, but something that may be lacking is the actual environment assessment and treatment. Virtual Reality (VR) simulation can help bridge this gap.
Pocket Nurse has teamed up with Virtual Education Systems (VES) to distribute VRPatients, a VR system that is immersive and helps students learn patient assessment with real-time feedback.
Amy Hallstein is a Major Account Manager at Pocket Nurse.
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