Understanding The Patient Assessment System

Disclaimer: This article is meant to be a study guide and refresher for people that are interested in wilderness medicine. Although it contains life-saving information, it shouldn’t take the place of proper training and certification from an accredited company.

To provide proper care to a patient that’s suffering from a traumatic injury or medical condition, it’s important to use the patient assessment system first. This procedure should be followed closely since many signs and symptoms don’t readily present themselves.

Sizing-Up The Scene

Whenever you encounter a medical situation, the first priority is making sure that you are calm, collected, and cool-headed. Also remember that during an emergency, the most important person to keep safe is yourself. Therefore, it’s crucial to first look for any environmental factors that may present dangers to you, the patient, or anybody else in the vicinity. And don’t forget to take a quick stock of any resources that might be useful.

Be observant: are there multiple patients or just one? Ask the patient or others if you’re unsure. Quickly try to determine what the the patient’s Mechanism Of Injury (MOI) is by observing them and perhaps asking, “what happened to you?” If there are multiple patients, treat whomever is in the most urgent need of care (it will likely not be the person screaming and making the most noise). Also take note of how sick or hurt the patient is.

Once you’re sure that you’re in no immediate danger, establish Body Substance Isolation (BSI) by utilizing the following Personal Protective Equipment (PPE):

  • Gloves or another impermeable barrier for you hands
  • A mask or handkerchief to protect your face and mouth
  • Glasses or goggles to protect the eyes
  • A jacket to protect your skin

Completing the Initial Assessment

Once the scene is sized-up and you’ve got your PPE on, it’s time to approach the patient. Try to determine if they’re dead or alive though not only observation, but also vocalization. Tell them your name and that you have medical training before asking for consent and control for treatment. Getting consent is important, and remember that unconsciousness is implied consent to treat. If the patient refuses treatment, you must respect their wishes for not only ethical, but also personal safety concerns.

If there is an MOI for spinal injury, make sure that you keep their spine protected until you complete a Focused Spinal Assessment (FSA). If the patient needs CPR, remember CAB: do Compressions first before checking their Airway and then Breathing. Otherwise, follow the ABCDE protocol:

  • Airway: open the patient’s mouth and look for any obstructions before removing them. Be careful of vomit or other fluids that might come out of their mouth.
  • Breathing: Check for heavy or labored breathing, and look for chest wounds or anything that could hinder breathing.
  • Circulation: Take the patient’s pulse and look for any signs of bleeding. Also do a blood sweep to check for unregistered bleeding.
  • Decision: If death is not imminent, make a quick determination about what to do next. This can include a brief conversation with the patient or others. If there is a spinal injury, maintain stabilization.
  • Expose: Remove any gear, clothes, or debris to expose and treat life threatening injuries.

Completing the Secondary Assessment

Once the patient is protected from immediate danger, it’s time to further evaluate their condition. If the patient is suffering from a traumatic injury, you’ll want to do the secondary assessment in the order listed here. If the patient is suffering from a medical emergency, do it in reverse order (History, Vitals, Head-To-Toe). Gather their history first before taking their vital signs because if they need medication, for example, you’ll want to find out where it is to administer it immediately.

Physical Exam

Before a head-to-toe examination, tell the patient what you’re doing and make sure that they’re comfortable. Have others move away and perhaps establish a barrier for privacy, but don’t move the patient until the FSA is complete. Use tight “mitten hands” to avoid touching the patient in a way might be uncomfortable, and try to have someone take notes for you. When doing the head-to-toe exam, remember to look, ask, feel, and listen to the patient.

Vital Signs

When taking vital signs, write them down or have someone else take notes for you. Remember that taking vital signs includes checking the patient’s:

  • Level Of Responsiveness (LOR)
  • Heart Rate (HR)
  • Respiratory Rate (RR)
  • Skin Color, Temperature, and Moisture (SCTM)
  • Blood Pressure (BP)
  • Pupils (P)
  • Temperature (T)

Patient History

If the patient can communicate, ask them what their age is and also determine their sex. After that, investigate their Chief Complaint (CC) by asking about signs and symptoms, and remember to follow OPQRST. Also think about the MOI and/or the History of the Present Illness (HPI) before collecting the SAMPLE history. Remember to be professional yet friendly during the interview, and be sure to ask as many open-ended questions as possible.

Post Assessment Procedures

If the MOI suggests a spinal injury, you can do a Focused Spinal Assessment at this point. If the FSA suggests any injury to the spine, keep the patient immobilized with their neck manually kept strait. Otherwise, they may be able to sit up at this point and move into a more comfortable position–but remember to use discretion if movement will aggravate their condition.

Once any life threatening concerns are taken care of and you have all the information that you need, it’s time to look over your notes to plan and make a list of priorities. If there are multiple injuries and/or conditions, list them by severity with the most urgent and in need of treatment at the top. Make a SOAP note and prepare for any anticipated problems, such as changing weather conditions or rising flood waters.

At this point, decide if you will be evacuating the patient or if they will need to be carried out. Either way, make a plan and begin whatever treatments are required. Don’t forget to monitor the patient’s vitals as frequently as their condition needs. If the patient is in shock or experiencing another emergency condition, take vital signs at least every 15 minutes. Otherwise, monitor their vitals every hour to look for a deteriorating condition.

Conclusion

The first thing that first responders must do is follow the patient assessment system. This procedure ensures that the patient gets the care they need while securing everyone’s safety. The best way to make the PAS second nature is with scenario training, so sign up for a wilderness medicine course or recertify today.

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