OBJECTIVES
1. List component of patient assessment.
2. Explain scene safety.
3. Determine mechanism of injury (MOI ) / nature of
illness.
4. List BSI precautions (body substance isolation).
5. Determining the number of patients.
6. Identifying any additional resources needed
• The patient assessment process is divided into five
main parts:
1. Scene size- up.
2. Primary assessment.
3. History taking.
4. Secondary assessment.
5. Reassessment.
Scene size - up
Primary assessment
History taking
Medical Assessment
Trauma Assessment
Scene Size-up
1. Ensure Scene safety.
2. Determine mechanism of injury (MOI ) / nature
of illness.
3. Taking BSI precautions (body substance
isolation).
4. Determining the number of patients.
5. Identifying any additional resources needed
Scene Safety
1) Personal protection.
2) Protection of the
patient.
3) Protection of
bystanders.
If the scene is not safe,
DO NOT ENTER.
Scene safety
• Involves evaluating the overall safety and stability
of the scene:1. Safe and secure access into the scene.
2. Ready egress out of the scene.
3. Specialty resources needed.
• Ensure the safety and well-being of your EMS team.
1. If the scene is not safe, do what is necessary to
make it safe.
2. Requires fixed reassessment.
Mechanism of Injury or Nature of Illness
1. Mechanism of injury (MOI):The body has been exposed to some Force or
energy that has result in a temporary injury.
2. Nature of illness (NOI): EMS attention because of illnesses Not caused by
out side force.
 You must examine the general type of illness.
Standard Precautions
1. BSI precautions ( Body
Substance Isolation)
1. Wear properly sized gloves.
2. Wear eye protection.
3. Wear mask.
4. Wear gown.
5. Wash your hands after
removing gloves.
Standard Precautions
2. Personal Protective Equipment (PPE)
– Clothing or equipment that provides protection from
substances that affect a health /safety risk.
1. Steel-toe boots.
2. Helmets.
3. Heat-resistant outerwear.
4. Self-contained breathing apparatus.
5. Leather gloves.
Standard Precautions
• Be wary of toxic
substances and toxic
environments.
–Proper body and
respiratory
protection is a must.
Determining the number of patients
As part of the scene size up, its essential you
identify number of patient.
When there are multiple patients you should use the
incident command system.
Call for additional units, and begin triage.
Once all patient have been triage, you can begin to
establish treatment and transport priorities.
Some trauma and medical situation may require more
ambulances.
Some patient may have need for specialized resources
as basic life support (BLS).
Ask some questions as:1. How many patients are there?
2. What is the nature of their condition?
3. Who contacted EMS?
4. Does the scene threat to you, your patient, or others?
Identifying any Additional Resources
• Multiple patients or obese patient may need to
additional resources.
1. Multiple patients must be triaged.
2. Be familiar with specialized resources.
3. Assess the need for spinal motion
restriction.
Medical Versus Trauma
1. Medical patients:Identify chief complaint through
medical history.
2. Trauma patients:-
Medical history may have less impact.
Requires a modified approach.
Establishing the Field Impression
1. A determination of what you
think is the patient’s current
problem.
 You must be able to
communicate and ask the
right questions.
2. The process must be organized
and systematic but still flexible.
 Know when to expand your
questioning.
 Know when to focus your
questioning.
Scene size up
• Potential crime scenes
1. Law enforcement should
enter first.
2. Formulate an escape plan.
3. Be aware of violence
from bystanders.
4. Patients who abuse can be
a large threat.
Scene Size up
• Risks related to the
environment include:
I. Unstable surfaces
II. Snow and ice
III. Rain
• Consider the stability of
the structures around you.
Scene Size up
 Ensure safety of the patient and bystanders next.
 When the environment is unfriendly perform assessment,
address threats, and move the patient as quickly as
possible.
What does the patient need?
1. Safety.
2. Identify the need for resuscitation/correction of a
primary assessment problem.
3. Identify the need for other immediate action.
4. Identify life threatening conditions.
5. Symptom relief.
6. Patient service.