Sick/Not Sick

1. Sick/Not Sick Rapid Assessment of a Patient with Traumatic Injury

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3. The Concept of Sick/Not Sick • This concept has been around for years and is based off similar principles used during Mass Casualty Incidents • It’s a method of rapid patient assessment that allows you to make good treatment decisions based on proven clinical indicators • Facilitates good coordination and communication in the field and results in better patient care Truama Sick/Not Sick

4. Purpose of Sick/Not Sick • To help you quickly and accurately decide who is critically injured and who is not • Assure a rapid initial assessment and transport to appropriate facility • Prevent delays in patient care Truama Sick/Not Sick

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6. Objectives • Understanding Terms • The clinical picture • Who is “Sick” • Who is “Not Sick” • Making a decision • Treatment • Transport Truama Sick/Not Sick

7. Terms While In Route • Index of Suspicion – The anticipation that certain types of accidents will result in certain types of injuries • Mechanism of Injury – The forces of injury and how they were applied to the body Truama Sick/Not Sick

8. Terms Involving Exam • Perfusion – The flow of blood through the organs and tissue of the body • RPM – An acronym that stands for respirations, pulse and mentation • Skin Signs – Observable indications of circulation including skin color, temperature and moisture Truama Sick/Not Sick

9. Terms of Decision • Sick – Someone who appears physiologically unstable as indicated by clinical indicators • Critical / Urgent / Unstable • Not Sick – Someone who appears physiologically as indicated by adequate respiration, pulse, mental status, skin color and an appropriate body position • Non-critical / Non-urgent / Stable Truama Sick/Not Sick

10. The “Sick” Patient • Appears to be unstable as indicated by clinical signs • Has life-threatening injuries that need to be treated aggressively by both BLS and ALS crews • This patient can die quickly unless you initiate immediate treatment and rapid transport to an appropriate facility Truama Sick/Not Sick

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12. Recognizing the Sick Patient It may only take one of these to convince you! • Index of Suspicion • Mechanism of Injury • Respirations • Pulse • Mental Status • Skin Signs • Body Position Truama Sick/Not Sick

13. The “Not Sick” Patient • Appears to be stable as indicated by clinical signs • This patient still has injuries at this time the condition is not life threatening • Even though this patient has no life threatening injuries they still need and deserve treatment and transport to the appropriate facility Truama Sick/Not Sick

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15. Gathering The Information • Pre Plan While In Route • Index of suspicion/Mechanism of injury • Differential Diagnosis X 3 • View the Clinical Picture Upon Arrival • Chief complaint • Respirations • Pulse • Mental status • Skin color/signs • Body position Truama Sick/Not Sick

16. Making The Decision • What does the clinical picture tell you? • Chief Complaint – Focus on injury • Mechanism of Injury (MOI) – How significant was the mechanism and is there obvious trauma • Respirations – What is the rate or character • Pulse – Can it be palpated and what is its rate and character • Mental Status – Is the patient anxious, combative, drowsy, lethargic or unconscious • Skin Signs – What is the color, temperature and moister • Body Position – meeting you at the door, tripod to breath, unable to support weight • Is the patient likely to survive without immediate and aggressive action? Truama Sick/Not Sick

17. The Decision Made • The clinical picture has been formed • All information has been gathered quickly • Sick/Not Sick • Having a plan • Taking action based on the decision • Sick – ALS & rapid transport • Not Sick – Thorough on-scene exam with appropriate treatment Truama Sick/Not Sick

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19. Changing The Decision • It’s OK to switch from Not Sick to the Sick decision • Things may change in the patients status • You may discover more information during a thorough exam • You may have a “Gut Feeling” • Don’t get caught • Failing to respond to new information • Having tunnel vision • Not having a clear well thought out plan Truama Sick/Not Sick

20. Treatment/Transport • Formulate a plan based on the clinical decision • Make a decision early in the call • Take action quickly, add additional recourses early and treat the patient aggressively • Transport the patient to an appropriate destination and inform them that you are coming Truama Sick/Not Sick

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22. Summary • Speed up the delivery of care to critical patients by determining Sick/Not Sick early • Create a plan while en-route based on information from dispatch and other units on-scene • Treat Sick patients aggressively with both BLS and ALS crews • Understand the clinical signs and how they are used to determine if a patient is Sick or Not Sick Truama Sick/Not Sick

23. Summary The sick patient appears unstable as indicated by inadequacies in: • Respirations • Pulse • Mental Status • Skin Signs • Body Position • Evidence of Significant Mechanism of Injury Truama Sick/Not Sick

24. Questions? Truama Sick/Not Sick