Principles of Patient Assessment in EMS

1. Principles of Patient Assessment in EMS By: Bob Elling, MPA, EMT-P & Kirsten Elling, BS, EMT-P

2. Chapter 5 – Making a Priority Decision © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

3. Objectives • Describe how the priority decision impacts the care of the patient. • Define up triaging and how it applies to patient care. • List four types of systems the EMS provider can use to make a priority decision • List the three common classifications of burn severity and describe examples of each. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

4. Objectives (continued) • Define START system and describe how EMS providers can use this system in a MCI. • Describe how EMS providers utilize triage tags during an MCI. • Describe the four levels of trauma centers and how a hospital or facility is designated into one of these levels. • Provide examples of the type of patient that would be transported to a level I trauma center. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

5. Introduction • Priority decisions are made to set the tone for patient care and management. • Perform the initial assessment first. • When more than one patient is present you must triage (to sort): • Triage use in prehospital and hospital • Many triage systems available © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

6. The Priority Decision • Priority decision making is an essential skill for EMS providers. • Failure to make a priority decision may have serious life-threatening implications. • Consider the “golden hour” and the “Platinum ten minutes.” • Stable vs. Unstable • When two priority choices are possible “up triage.” © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

7. Systems of Prioritizing • Become familiar with the system used in your area: • Hot / cold • Red / yellow / green • High / Low • Minor / Moderate / Severe • P-1, P-2, P-3 • C U P S © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

8. A Close Up on One SystemC U P S • Acronym that stands for: • critical • unstable • potentially unstable • stable • First introduced in the BTLS course • Adapted in many states © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

9. Examples of “Critical Patients” • Actual or impending cardiorespiratory arrest • Respiratory failure • Decompensated shock (hypoperfusion) • Rising intracranial pressure • Severe upper airway difficulties © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

10. Examples of “Unstable Patients” • Cardiorespiratory instability • Respiratory distress • Compensated shock (hypoperfusion) • Two or more long bone fractures • Trauma with associated burns • Amputation proximal to wrist or ankle • Penetrating injury to: head, neck, chest, abdomen, pelvis © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

11. Examples of “Unstable Patients” (continued) • Uncontrollable external bleeding • Chest pain with a systolic BP < 100 • Severe pain • Poor general impression • Unresponsive patients • Responsive patients who do not follow commands © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

12. Examples of “Potentially Unstable Patients” • Cardiorespiratory instability • MOI indicating a possible hidden injury • Major isolated injury • General medical illness • An uncomplicated childbirth © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

13. Examples of “Stable Patients” • Patients with a low potential for cardiorespiratory instability • Low grade fever • Minor illness • Minor isolated injury • An uncomplicated extremity injury © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

14. Tools to Determine Priority • Developed to logically examine, evaluate, and rate severity of a patient using a numbering system • Developed initially for trauma patients yet also used on medical patients • Glasgow Coma Score • The Trauma Score © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

15. Glasgow Coma Score (GCS) • Measures: • Eye opening • Verbal response • Motor response • The best responses are given a numerical score © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

16. Trauma Score (TS) • Developed in 1980 as a triage tool • Used to predict patient outcomes • Numerical grading system combining GCS and the following: • Respiratory rate • Respiratory expansion • Systolic BP • Capillary refill • Conversion scale for GCS © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

17. Triaging and Prioritizing Burn Patients • Burn severity determined by: • Source type • Body surface area (BSA) • Rule of nines used to calculate BSA • Classifications of burns include: • Mild -sunburn • Moderate – uncomplicated partial thickness < 30% BSA • Severe – inhalation injuries or electrical burns © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

18. Triage to Aeromedical Transport • Refer to established regional protocols • Weather conditions – visibility and wind • Medical considerations • Injury factors – MOI, length of extrication, distance to trauma center © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

19. Triage in MCIs • Triage is needed when there are multiple patients and limited resources. • Triage helps to ensure the most serious are treated and transported first. • Designate a “triage officer” and use “triage tags.” © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

20. The START System • Acronym - simple triage and rapid treatment • Developed in the 1980’s, separating patients into: • Minor • Delayed • Immediate • Deceased • Few responders can triage many rapidly. • Assessing: • Respiratory status • Hemodynamic status • Mental status © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

21. Triage Tags • Used in MCIs • Several types available • Eliminates need to reassess each patient over and over • Most tags have 4 priorities: • P-1 (immediate or red) • P-2 (delayed or yellow) • P-3 (hold, “walking wounded,” or green) • P-0 (deceased, no priority or black) © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

22. Trauma Centers • Hospitals capable of caring for the acutely injured patient • Must meet strict criteria to use this designation • Classified into 4 levels • Some hospitals also specialize in specific care (burns, peds) © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

23. Trauma Centers (continued) • Each community has different needs and resources • Criteria for a regional structure is often found in local protocols • What is the trauma center in your region? © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

24. Conclusion • Important care and transport decisions are based on the priority decision! • Practice is needed to gain proficiency. • Be familiar with the tools in your system or region. • Patient conditions are dynamic and can quickly change the priority. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.