As we all know, agency, local and personal first responder patient assessment protocols can vary across organizations and geographies. As a study aide, it is often helpful to view & study such protocols from other groups.

Thus the purpose of this blog is to hold a collection of Patient Assessment Protocols used by emergency care first responders across the U.S. and world.

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Sunday, January 4, 2015

Assessment Protocol 1


Sub-steps
General




The scene is safe. I’m crossing my skis uphill.
I see one patient, no witnesses.
The scene shows that … may be the MOI.
I have BSI on.


Size-Up Scene



“Hi, my name is Piotr, I’m with Ski Patrol, may I help you?”
Introduction & Permission
First Contact

“Please don’t move your head”
Qualitative assessment of:
Pulse is… (strong and steady)
Skin is… (warm, dry, and pink)

2 Pt Landing

“Tell me what happened. Tell me what hurts”

"Does it feel like it’s bleeding?" [Go to skin]

>>“Please don’t move your head. Just answer me verbally".
     (If they move their head)
>>“Can you point to where it hurts?”
    (If they can't clearly identify injury)

Chief Complaint



Patient is speaking and has Airway
A
ABCs
(<5 min to death)
Patient is Breathing
B
Patient has pulse and is not bleeding - Circulation
C
"I have my ABCs"




LOC Questions:
 “What is your name?”
“Where are you?”
“What day is it?”
“What happened just before the accident?”

>> Patroller will note: "Patient is A&O by 3, not responsive to time".

D1/ Mental Status

(LOR/LOA) PPTE
Four D’s & Decision
(<1 hr to death)
(Pause to) Review for signs of shock:

Head – (LOC) - from above LOC questions
Heart – Pulse is… (pulse & type) - from 2-point landing check
Lungs – Respiration is… (respiration & type) - from 2 point landing check
Skin – Skin is… (color, temp, wet) - from 2 point landing check

D2/ Shock Signs

(Head, Heart, Lungs, Skin)
Always Questions:
Did you hit your head?”
“Did you hit your back?”
“Does your neck hurt?”
“Does your back hurt?”
“Did you ever lose consciousness?

D3/ Always Questions

Important Medical Issues Questions:
“Do you have any medical issues that I should be aware of,
such as Heart Disease, Hemophilia, Epilepsy, Asthma, Allergies or Diabetes?”

D4/ Medical Issues HHEADD
>>Is the situation urgent and thus requires Emergency Transport?
Decision




“I’m going to do a body survey”
Checking head
Checking cervical spine
Checking anterior neck and trachea
Checking clavicles and shoulders
Checking chest
Checking abdominal quadrants
Checking pelvis by squeezing not pressing
Checking legs (including CSM & pedal test)
Checking arms (including CSM & squeeze test)
Roll patient over & check back & palpate spine

Head
C-Spine
Neck
Clavicles / Shoulders
Chest / Sternum
Abdominal Quadrants
Pelvis Squeeze
Legs
Arms
Back
Spine
Rapid Survey
 (>1 hr to death)
Check CSM (can/usually is done during arm & leg test above)
“Does this feel numb or tingly?”
“Can you tell me which finger/toe I’m holding?”
“Can you move your… “

C – circulation
S – sensation
M – motion
For medical chief complaints or if you reason to believe a sign/symptom may be medical:
 “When did this start?”
“Does anything make it worse?  Does anything make it better?”
“Can you describe the pain?”
“Does the pain radiate anywhere?”
“On a scale from 1 to 10, 10 being the worst pain in your life, how much pain are you feeling?”
“Is it getting better? Is it getting worse?”

O – onset
P – provoke
Q – quality
R – radiate
S – severity
T – time

*for medical issue not trauma



"Pulse is X Respiration rate is Y"
15 pulse x 4
15 breathing x4
*after every body survey and in severe situations on regular basis
Vitals




“Dispatch, I have a…

male,

25 years old,

with a shoulder injury with compromised CMS.

Patient is A&O by 3.

We are skiers right on Big Dipper near tower 10.

I need a sled and sled bag

Requesting emergency transportation.”

S – sex
A – age
I – injury

L – LOC & location
E – equipment needed
R – resources
Radio Call



 “Do you have any allergies?”
“Do take medications - prescription, recreational, OTC ?"
“Prior medical conditions/seeing a doctor for anything?”
“When was the last time you ate or drank anything?  What was it?"
"One more time, tell me what happened"
A – allergies
M – medication
P – prior medical cond.
L – last oral intake
E – events
SAMPLE



MOI – Mechanism of Injury
BSI – Body Safe Isolation
DO: Tell the patient that “We are getting you the best help we can”
DON’T: Tell the patient that “Everything is going to be alright.”
15 second count x2 x2
* final count divisible by  4


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