Paramedic Assessment Study Notes

Scene and Assessment Framework

  • Purpose of assessments in paramedic practice: structure and prioritize patient care from scene arrival through transport.

  • Key outcomes:

    • Continue with understanding the Paramedic Call Response.

    • Determine what assessments are required for various patient presentations.

    • Select the most appropriate assessment given different patient presentations.

RECAP – Scene Assessment (Environmental Scan)

  • Also known as: Environmental Scan; EMCA-P.

  • Definition: Assessment of safety and resources as paramedics approach the scene and before patient contact.

  • Questions to answer at this stage:

    • Do I have all the appropriate resources I need to manage this call?

  • Purpose: Ensure safety and readiness prior to interacting with the patient.

RECAP – Preliminary Assessment

  • Purpose: Determine the acuity of the patient presentation before hands-on assessment.

  • Functions:

    • Inform the patient of your arrival and presence while assessing for response.

    • Begin spinal immobilization until the physical assessment can determine the need.

RECAP – Primary Assessment

  • Timing: Completed once the scene is deemed safe to proceed.

  • Why it matters:

    • Identify priority patients.

    • Identify patients with threats to airway, breathing, and/or circulation.

    • Identify immediate management requirements based on threat to airway, breathing, and/or circulation.

  • How it’s conducted:

    • Methodical assessment of LOC, airway, breathing, and circulation (the ABCs).

  • Location of scope: First line assessment focused on life threats and immediate needs.

What if’s? (Non-standard LOC/A/B/C approaches)

  • Recognize that differing circumstances may require assessing a patient outside the strict LOC, A, B, C approach.

  • Be prepared for alternative assessment thought processes based on scene and presentation.

Primary Assessment – Key completions

  • After primary assessment, the paramedic should have:

    • Assessed and managed ABC compromises.

    • Determined the need for spinal motion restriction (SMR).

    • Determined the need for load-and-go transport if the patient is critical and requires immediate hospital transfer.

Spinal Motion Restriction (SMR) – Lab note

  • Important context for this course:

    • SMR standard requirements/theory have not yet been presented in class or lab.

  • End-of-primary expectations (lab intent):

    • Ask the patient about recent falls, trauma, or head injury.

    • If the patient says “no,” partners are cleared from holding the head/neck.

    • Emphasis on establishing muscle memory for the Primary Assessment.

AFTER THE PRIMARY – Trauma vs Medical pathways

Trauma Patients

  • Actions to consider after the primary:

    • Ensure a RAPID TRAUMA ASSESSMENT if necessary.

    • Complete a FOCUSED ASSESSMENT based on MOI for minor trauma.

    • Complete baseline VITAL SIGNS and SAMPLE History.

Medical Patients

  • Actions to consider after the primary:

    • Ensure a Rapid Medical Assessment.

    • Complete a baseline set of VITAL SIGNS and obtain a FOCUSED HISTORY.

    • Complete a FOCUSED MEDICAL ASSESSMENT based on the patient’s chief complaint.

Page 10: Flow Diagram – Trauma vs Medical (from the resource)

  • Trauma Patients – Focused History and Physical Examination:

    • Reconsider Mechanism of Injury (MOI)

    • Significant MOI

    • Rapid Trauma Assessment

    • Baseline Vital Signs

    • SAMPLE History

    • Reevaluate Transport Decision

    • If No Significant MOI: Focused Trauma Assessment based on Chief Complaint; Baseline Vital Signs; SAMPLE History; Reevaluate Transport Decision

  • Medical Patients – Focused History and Physical Examination:

    • Responsive

    • History of Illness

    • SAMPLE History

    • Evaluate Responsiveness

    • Focused Medical Assessment based on Chief Complaint

    • Baseline Vital Signs

    • Reevaluate Transport Decision

  • Unresponsive Medical Patients:

    • Rapid Medical Assessment

    • Baseline Vital Signs

    • SAMPLE History

    • Reevaluate Transport Decision

    • Initiate Immediate Transport

FOCUSED HISTORY and EXAM – Medical

  • Objectives:

    • Obtain information from the patient to determine the chief complaint.

    • Explore details of history as it relates to the chief complaint.

    • Focus on a system-based assessment (e.g., GI, gynecological, etc.).

    • Explore differential diagnoses.

    • Determine a working diagnosis.

History of Illness – Example Prompt

  • Scenario: A 72-year-old female with abdominal pain at a residence.

  • Question prompting: What questions would you ask?

  • Purpose: Illustrate how to elicit relevant history for abdominal pain in an elderly patient.

FOCUSED HISTORY AND EXAM – Medical Signs and Symptoms Acronym

  • Use the acronym to structure history and exam:

    • Onset, Provoking, Quality, Radiation/Region/Referral, Severity, Time

  • The acronym assists in organizing the clinical picture around the chief complaint.

Focused HISTORY AND EXAM – Medical – Other Core Areas

  • Current health status

  • Dietary habits

  • Current medications

  • Allergies

  • Exercise

  • Alcohol or tobacco use

  • Recreational drug use

  • Sleep patterns and disorders

  • Immunizations

Focused HISTORY AND EXAM – Medical – Additional Info

  • Obtain information regarding:

    • Signs and symptoms of the chief complaint

    • Signs (objective) vs Symptoms (subjective)

    • Allergies

    • Medications

    • Previous medical history

    • Last meal

    • Events leading up to the activation of 911

FOCUSED HISTORY AND EXAM – Medical: Unresponsive Patients

  • Challenges:

    • Unresponsive patients cannot provide history reliably.

    • Most reliable information may come from family or friends.

  • AEIOU TIPS in unresponsive patients (as a mnemonic):

    • Alcohol, Epilepsy, Insulin, Overdose, Uremia (metabolic), Trauma, Infection, Psychiatric, Stroke/sepsis

    • Reference: BLSPCS 2011

FOCUSED HISTORY AND EXAM – Trauma

  • Focused history and physical examination for trauma:

    • Distinguishes isolated injuries from multisystem trauma.

    • Be aware of a “high visibility factor” on scene.

The FOCUSED HISTORY AND EXAM – Trauma: Lack of serious injuries

  • Indicators:

    • Lack of serious critical injuries

    • Lack of signs of significant MOI

    • No systemic involvement signs

Secondary Assessment

  • Trigger: Performed after the primary assessment and rapid trauma/medical assessment.

  • Key components:

    • Focused history (SAMPLE)

    • Vital Signs

    • Head-to-Toe Physical Exam

    • Glasgow Coma Scale (GCS)

    • Pain assessment

    • Environment and social factors

  • Documentation: If any part of this assessment is not completed, documentation must reflect that.

The Ongoing Assessment

  • Reassessment scope:

    • Mental status and the ABCs

    • Repeat primary assessment

    • Reassess vital signs and breath sounds

    • Repeat focused assessments

    • Continuously evaluate and reevaluate status and treatments

    • Track trends in the patient’s condition

The Ongoing Assessment – Care Plan and Transport

  • Reassessment questions:

    • Have you addressed all life threats?

    • Do you need to revise your priority list?

    • Reassess the transport plan

The Ongoing Assessment – Vital Signs and Trends

  • Approach:

    • Compare current vital signs with expected outcomes from therapies

    • Look for trends or patterns

    • Revisit patient complaints to determine what has improved, resolved, or remains unresolved

Resources (References)

  • Nancy Caroline. Emergency Care in The Streets (8th CDN). Jones and Bartlett.

  • Ministry of Health and Long-Term Care. Basic Life Support Patient Care Standards (2023). Ontario. Emergency Health Services Branch.