• Patient Assessment• VS• Communication• Documentation• The older folks• The younger folks• Block III written and practical

Scene-Size-up –Initial Assessment –Focused history and physical exam-Detailed Physical Exam-On-Going Assessment-

BSIBSI BSI

BSI BSI

BSI BSIBSI

Scene Size-up – Initial Assessment – Focused Hx. & PE – Detailed Assessment – On-going assessment

Scene Size-up

Initial evaluation of the scene• Continues throughout the scene

Part I SCENE SIZE-UPDefined:

Begins with dispatchInitial evaluation of the scene

Goals:Ensure scene safety

To determine if patient is medical or traumaDetermine total number of patients

• Scene Size-upBegins with Dispatch

demographics: residence - Pull to curbside in front of house

Always remember, scene safety is a component of Scene Size-up

Nature of illness:Number of patients: Considers stabilization

of spineRequests additional help if necessary: ALS

Personal protection• Always perform your own size-up• Observe as you approach and before getting out

of the truck

Nature of Illness• Information can be obtained from

The patientFamily members or bystandersScene

• Mechanism of injury

• Number of patients• Call for additional help if needed

ALS

Collision Scene• Look and listen• Check for power outages• Observe traffic flow• Check for smoke

As you approach:• Look for clues to escape hazourdous

materials• Look for patients on or near the road• Look for smoke not seen at a distance• Look for broken utility poles and downed

lines• Be on the look-out for bystanders• Watch for signals of police officers or other

agency personnel

Danger Zone• No apparent hazard-at least 50ft in all directons• Fuel spill-at least 100 ft. in all directions

uphill and downwindavoid gutter, gullies, ditchesdo not use flares

• Vehicle fire-at least 100 ft. in all directions• Downed wires-area in which contact can be made• Hazardous Materials

Emergency Response Guide BookChemtrec

Crimes Scenes and Acts of ViolenceSignals of violence:• Fighting or loud voices• Visible weapons• Signs of alcohol or other drug use• Unusual silence• Knowledge of prior violence

Nature of call• Illness• Injury

• Part II INITIAL ASSESSMENT• Defined:• Discovering and treating life-threatening conditions• Goals:• Determine if the patient is ill or injured• Triage• Components:• General Impression

• Illness or injury• Mechanism of injury/Nature of illness• Age, sex, race• Identify life-threatening problems

• Mental Status• A lert V erbal Response P ainful Response U

nresponsive• Assess Breathing• Assess Breathing• Triage

• Part III Focused History and Physical Exam• Defined:• To identify additional serious or potentially life-threatening injuries or conditions• Components, Trauma• Reconsider Mechanism of injury

• Index of suspicion• Rapid Trauma Assessment

• Head to toe physical exam quickly conducted• Base-line Vital Signs• Assess S A M P L E history• Components Medical• History of present illness

• O – P – Q – R – S – T• S A M P L E• Rapid Assessment• Base-line Vital Signs• Treat

• IF UNRESPONSIVE:• Rapid Assessment• Base-line Vital Signs• Assess S A M P L E• Care

Focused History and Physical Exam• Onset?• Provokes?• Quality?• Radiates?• Severity?• Time?• Interventions?

S A M P L E history• Signs/Symptoms• Allergies• Medications• PMHx.• Last oral intake• Events leading to the illness/injury

General Impression• Illness or injury• Mechanism of injury/Nature of illness• Age, sex, race• Identify life-threatening problems

Vital Signs• Pulse

Apical• Respirations• Skin color, temp, condition• Pupils• Blood Pressure

AuscultationPalpation

• Mental Status

Communicating with your patient• Position yourself close to the patient• Identify and yourself and reassure• Speak in a normal voice• Learn your patient’s name• Learn your patient’s age

• Part IV Detailed Physical Exam• Defined• Head to toe physical exam that is

performed slower and in a more thorough manner that the rapid assessment

• Components• Head to Toe exam• Reassess vital signs• Continue care

• Part V On-Going Assessment• Defined:• To detect any changes in the patient’s condition• To detect any missed injuries or conditions• To adjust care as needed• Goal:• The initial assessment is repeated• Vital signs are repeated and recorded• Focused assessment repeated for additional complaints• Components:• Repeat Initial Assessment• Repeat focused assessment• Check interventions• Note trends in patient condition

On-going Assessment• Repeats initial assessment• Repeats vital signs:• Repeats focused assessment regarding patient

complaint or injuries:

Scene Size-up – Initial Assessment – Focused Hx. & PE – Detailed Assessment – On-going assessment

Responsive• Four parts

History of present illnessFocused physical exam

OPQRSTSAMPLE

Baseline VS• Prior history• DCAPBTLS

Unresponsive• Patient history from family, bystanders etc.• Rapid assessment

Abd: distension, firmness, rigidityPelvis: Incontinence of urine, feces

• ID bracelets• Baseline VS• Consider need for ALS• History of present illness and SAMPLE

History of present illness and SAMPLE• Patient’s name• What happened

what did family/bystander see• Did patient complain of anything prior• Know illness• Medications