Brady is pleased to share with you a preview of our forthcoming EMS Transition Series. Our first offering is for the EMT level. Transition Series: Topics for the EMT by Joseph Mistovich and Daniel Limmer provides both an overview of new information contained within the Education Standards at the EMT level and a source of continuing education for practicing EMTs. Intended for a new generation of EMTs, the text integrates new “topics” that were not contained in the U.S. DOT 1994 EMT-Basic National Standard Curriculum and existing “topics” at a much greater depth and breadth than what was contained in the typical EMT-Basic education program. Visit www.bradybooks.com for more information.
Standard: Patient Assessment
Competency: Applies scene information and patient assessment findings (scene size-up, primary and secondary assessment, patient history, reassessment) to guide emergency management
- Importance for the EMT to assess a medical patient with a body system approach, rather than with a complaint-based approach
- Comparison of the 1994 EMT-Basic curriculum and the National EMS Educational Standards regarding terminology used during the assessment of a medical patient
- Reinforcement of the critical thinking and differential diagnosis processes for the EMT while completing a medical assessment and developing a patient care plan
- Illustration of body systems the EMT should assess when confronted with a patient with one of several common complaints
- Important questions to ask the patient when assessing a certain body system given the patient’s complaint(s)
Medical emergencies can be looked at as a mystery that must be solved. To solve the mystery, you will gather facts in your assessment.
The assessment of the medical patient is focused on the patient history. As mentioned in the article in the February issue, Assessment of the Trauma Patient, trauma patient assessment centers around the hands-on exam. The opposite is true here. You will gain a majority of your information about the medical patient from the history. This is not to say that the physical examination is unimportant, just that experience has demonstrated the importance of this history.
Again, as with trauma assessment, the EMS Education Standards have done away with a detailed, step-by-step process. Instead, you will perform examinations on body systems. For example, if a patient has chest pain or discomfort, you will assess the cardiac and respiratory systems. A patient with an altered mental status will require the examination of several systems to determine the potential cause and choose the correct interventions.
This is a dramatic departure from the old curriculum, which called for treating a patient simply based on the patient’s complaint without the level of clinical reasoning now required. During your class and subsequent field experience, you have likely picked up much of this knowledge.
Assessment of the Medical Patient
The processes used when assessing the medical patient are similar to the steps in trauma patient assessment (see Table I), but within each of the examinations are some differences.
The scene size-up remains a foundational part of the assessment. You will ensure scene safety and determine what Standard Precautions are necessary. You will determine how many patients are present and what resources are necessary. There are rarely multiple medical patients (although it can happen), and the resources you need often center around lifting assistance for bariatric patients or advanced life support for critical patients.
You will also determine the nature of illness (NOI). This takes the place of mechanism of injury in the trauma patient. The NOI is your first impression of the kind of medical problem your patient has. You will determine this from a variety of sources. Dispatch will begin this process with the information it relays to you. You may also get information from family members or bystanders as you approach. Finally, as you approach the patient and arrive at his side, you will get this information and bridge into the primary assessment.