Many years ago Patient Assessment was a much simpler process, at least in terms of our final practical skills - it was only ONE station and not A or B. Understanding the difference between a Trauma Assessment and a Medical Assessment could be crucial to your treatment and the patient outcome. The specific steps in our practical exams may not always be the specific steps in the field, BUT THEY STILL PROVIDE THE MOST RELIABLE GUIDELINE and should definitely be remembered and practiced often.
The first step to ANY patient contact is scene safety and appropriate precautions (BSI). If you or one of your crew members becomes injured or ill because of a danger, apparent or not, then it will only complicate the scene, increasing the number of victims in direct proportion to decreasing the number of active responders.
As you approach your patient, determine if this is a medical or trauma emergency as well as the mechanism of injury or nature of illness; defining injury or illness will help you decide how to treat (ie: spinal immobilization) and where to transport and can make a major difference in your patient’s outcome. Your dispatcher transmitted information to you that he may have received from a frantic caller and may not be entirely accurate. Your crew chief should be comfortable communicating with the crew and able to delegate tasks to improve assessment and treatment time.
Your initial assessment will be checking for life-threatening injuries or conditions; remember ABCDE—airway, breathing, circulation, disability and expose. For all patients verbalize your general impressions, check the patient’s level of consciousness (AVPU, alert, voice, pain, unresponsive), determine the chief complaint (WHY were you called), check airway and breathing, check circulation, look for and control life-threatening bleeding, check for pulses, and assess the skin color, temperature and quality. When you check for pulses you should note whether it’s radial, brachial, or carotid; the closer to the heart you have to go the more likely the blood pressure is low. Priority patients should be transported as soon as possible.
In a medical emergency you need to obtain the history of the illness, or the OPQRSTI questions (onset, provocation, quality, radiates, severity, time and interventions) and then SAMPLE (signs/symptoms, allergies, medications, past pertinent history, last oral intake, and events leading to present illness). Perform a focused exam of inspection, palpation and listening - this is hands-on and may include exposing, so keep the patient’s privacy in mind (in the back of the rig). Get baseline vitals noting rate and quality. Take appropriate interventions as necessary.
On a trauma patient go directly from the initial assessment to obtaining baseline vitals and SAMPLE. Start a physical head-to-toe exam palpating, inspecting and assessing the head, eyes, face, neck, chest, abdomen, pelvis, extremities and posterior. The hands-on assessment focuses on anatomical regions. When palpating start with a gentle touch to minimize patient discomfort. Make sure you’ve checked motor, sensory, and distal circulation in all four extremities. Manage any secondary wounds and injuries. You can palpate or assess with diagnostic equipment based on your initial findings, such as using a stethoscope for breathing difficulties or palpating a flail chest.
Repeat initial and focused assessments and monitor vital signs on all patients during transport. Helpful conditions to note include jugular distention, edema, wheezing, and deformities. Be sure to report all significant findings and any changes to the hospital receiving staff.