5 primary assessment tips for EMS providers
You are on scene with a patient who was choking on food; is your primary assessment as efficient as possible?
The primary assessment as taught to EMS students generally involves some combination of the ABC’s, level of
5 primary assessment tips for EMS providers
You are on scene with a patient who was choking on food; is your primary assessment as efficient as possible?
The primary assessment as taught to EMS students generally involves some combination of the ABC’s, level of consciousness, a general impression of the patient’s condition and a definition of treatment priorities for the call. This assessment still plays an important role in determining the flow of a call from start to finish.
The stepwise method taught in school is a great way to remember each phase of the assessment, but can take too long to complete on critical patients. While the primary assessment is taught — and tested — in a linear fashion, there are several ways that a provider can streamline the process. While in school you are required to perform many skills on your own, but practicing medicine as an EMS professional means that you have one or more additional providers at your disposal and you can expedite the process.
1. Multi-task ABC assessments
One reason why EMS students are required to perform each step of a task independently is that instructors and evaluators need a way to ensure that the student actually knows each of the steps involved. Once practicing on her own, however, an EMT or paramedic can find ways to combine steps to speed up the process.
Take the ABC’s for example: when assessing a patient’s airway, breathing and circulatory status you could certainly perform each evaluation one at a time. Consider, however, walking up, gently taking the patient’s wrist to check for a pulse and asking his name. As soon as the patient speaks, you know he has a patent airway since air cannot effectively move past the vocal cords through an occluded airway.
The number of words spoken in a single breath and how the patient’s voice sounds can give you some insight into his respiratory status. A patient wheezing and speaking two to three words per breath is struggling while a patient with a clear voice and speaking eight to 10 words per breath is breathing adequately. Also, you should have a general sense for presence and quality of pulse by now. Instead of taking the time to perform each step of the ABC’s, you’ve completed them all at once.
2. Prioritize and delegate
Delegate certain assessment tasks to other EMS providers on scene. In the case of the choking patient, the primary provider may ask his partner to obtain a set of vital signs while she assesses the patient’s ABC’s. It isn’t uncommon to see five or six EMS personnel standing around with only one actually performing any assessment or patient care. As with most decisions in EMS, pick the task that is most important to complete and assign that task first. In my experience, fire department first responders are often great recipients of task delegation because of their experience with chain of command on the fireground.
3. Correct and move one
Often taught alongside the ABC’s is the idea that there are certain treatment interventions that should be performed during the primary assessment; generally limited to treatments which are considered lifesaving. While the goal is to complete the primary assessment quickly, it is important for the new EMS provider not to lose sight of the treatments which can and should occur during the primary assessment.
For instance, a patient without a patent airway should have that condition corrected immediately. Start with the least invasive approach or, better yet, delegate that activity and move on to your next assessment step. As a general rule, you should not move on to the