The PEAT Scale: An EMS Tool

EMS has a unique perspective on patient injury and illness: We get to see the environment in which the patient is found. Documenting the mechanism of injury on a trauma call is a very important part of our job. We are good at that. But when it comes to the patient's home environment, as a group, we aren't as focused or trained in relaying that information to the hospital.

Most EMTs and paramedics will report any home situation that is unacceptable, but until now there has been no standardized way to measure and record the quality of a patient's home environment. The PEAT scale (Physical Environment Assessment Tool) is designed for that purpose.

The PEAT scale uses four categories to measure the quality and safety of a patient's home environment and assigns a number score. Whether the patient lives in an apartment, condo or cardboard box, anyone familiar with the scale can interpret the patient's score and its significance at a glance.

For years, firefighters have extended the focus of their primary purpose to include fire prevention, public education and fire code laws. Perhaps EMS could do more for our patients and create awareness and prevention for a host of health issues. Once a patient enters the hospital system, there are many services that can be activated, if needed. Who better than EMS to document their living conditions?

Goals of the PEAT Scale

• To encourage EMS to more actively observe the patient's home environment and be aware of its impact on patient health.
• To make awareness and assessment of abuse a higher priority.
• To encourage providers to seek out hazards to the patient.
• To facilitate standardized communication about a patient's home environment between medical and social services professionals.
• To prompt EMS to contact social services directly, conduct follow-up home visits, or participate in proactive illness and injury prevention.

The Categories

Dwelling

Dwelling assesses whether the patient is protected from the weather. This is defined as wherever the patient is living at the time of your assessment, even if it is not in a house. It could be a car, nursing home bed, homeless shelter, park bench or someplace else.

• Enclosed shelter: Any enclosed shelter that keeps the patient dry, such as a house, apartment, car, RV, tent, hut, wickiup, bunker, barn, igloo or other.
• Electricity: Does the patient have electricity? This is primarily important for the safe storage of food, but is also needed for cooking, cleaning and grooming.
• Running water means the patient has potable water in the home suitable for hydration, cleaning and bathing.
• Temperature-safe: The temperature in the patient's home is appropriately warm or cool. Most homes have heat and/or air conditioning, but that is not required. Some people live in climates that don't need heat or AC. Any heat source is acceptable, as long as it provides sufficient heat for healthy temperatures.

Cleanliness

Cleanliness relates to how neat or clean the patient's living environment is.

• Immaculate is completely clean with no clutter. All objects are in their place.
• Clutter would be clothes, books, toys or other nonbiodegradable items scattered about.
• Small biodegradable waste: Small amounts of biodegradable materials like dirty dishes, spoiled food or trash.
• Large biodegradable waste: Large or unacceptable amounts of biodegradable materials such as rotting food, vomit, garbage or feces.

Social Structure

This assesses the patient's social environment. This is significant because emotional and social health are closely tied to physical health. Abuse is also part of this assessment. Abuse may sometimes be difficult to assess, but it is necessary to ask patients if they are safe. They are the best source of this information.