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Patient assessment, patient history, primary examination, secondary examination.
To facilitate the appropriate initial assessment and management of any patient requiring EMS and to refer to the appropriate recommendations dictated by the findings contained in the General Rules of Care guideline.
All patients in need of EMS.
None of the above.
1. Safety of the scene:
2. Apply appropriate personal protective equipment.
3. Wear high quality, reflective clothing if deemed necessary (e.g., activities at night or in the dark, on/near roads).
4. Remember to brace your cervical spine and/or treat back injuries.
5. Initial examination: ABC (Airway, Breathing, Circulation are listed below; although there are also cases where the status of circulation, airway, breathing may indicate cardiac arrest or massive arterial bleeding).
5.1. Airway (assess airway patency/restore airway patency):
a) the patient cannot maintain airway patency on their own – restore airway patency by
b) in the presence of airway obstruction, laryngectomy, tracheostomy, see the guideline “Airway Management”.
5.2. Breathing:
a) Assess the respiratory rate, sounds, involvement of accessory respiratory muscles, chest retraction, and position of the patient;
b) administer oxygen appropriately to achieve 94-98% saturation in patients in the most acute condition;
c) in the presence of apnea (lack of breathing), see the guideline “Airway management”.
5.3 Circulation:
a) Control any major external bleeding – see the Limb Injury/Control of External Bleeding guideline;
b) assess the pulse:
c) assess perfusion – skin color, temperature, capillary refill time.
5.4. The state of neurological function:
a) assess neurological status – use the AVPU scale;
b) assess general motor and sensory function in each limb;
c) measure blood glucose levels in patients with impaired consciousness;
d) in the case of suspected stroke, see the guideline Suspected Stroke/Transient Ischemic Attack.
5.5. Open the patient according to the complaint:
a) remember to respect the patient’s shyness;
b) keep the patient warm.
6. 6. Secondary review.
The secondary examination should not delay the transportation of patients in critical condition. The secondary examination has the following sequence:
a) head:
b) neck:
c) chest:
d) abdomen/back:
e) extremities:
f) neurology:
7. Collection of information on vital signs (pulse, blood pressure, respiratory rate, assessment of neurological status).
7.1. Assessment of neurological status (see Appendix 3) involves establishing the baseline condition and then the tendency to any change in the patient’s neurological condition.
The Glasgow Coma Scale (see Appendix 3) is one of the most popular methods of assessing the state of consciousness, but errors often occur during the assessment and scoring. Given the difficulties of scoring and evaluation, and in the absence of experience in its use, it is recommended to use a simpler method of assessment, namely the AVPU scale or to assess only motor function using the GCS scale.
7.2. Patients with respiratory and cardiovascular system problems:
a) pulse oximetry;
б) 12-lead ECG;
c) continuous monitoring of ECG results (if possible);
d) capnography (a mandatory examination method when working with patients who require invasive manipulations to control airway interventions) or digital captometry.
7.3. Patients with impaired consciousness:
a) check glucose levels;
b) consider capnography (important in patients requiring invasive airway management) or digital capnometry.
7.4. For patients in stable condition, vital signs should be assessed twice. Ideally, one vital sign assessment should be performed just prior to arrival at the hospital, and the second vital sign assessment should be performed immediately prior to hospital admission.
7.5. Patients in critical condition require continuous monitoring of vital signs.
8. Take a history using the OPQRST chart.
8.1. Onset of symptoms.
8.2. Any factors that alleviate or worsen the patient’s condition.
8.3. Quality of pain.
8.4. Localization of areas in which pain is present.
8.5. Severity of symptoms – on the pain scale.
8.6. Time since the onset of symptoms and causes of their occurrence.
9. Anamnesis using the “SAMPLE” scheme.
9.1. Symptoms.
9.2. Medications taken by the patient as prescribed, over-the-counter; bring containers to the EMS, if possible.
9.3. Previous medical history (history of illness):
a) interview or examine the patient for medical warning bracelets, medical records, or other findings that may provide information about illness;
b) question or examine the patient for medical devices/implants (the most common are dialysis shunts, insulin pens, pacemakers, central venous catheters, tracheal tubes, gastric tubes, urinary catheters).
9.4. Last meal and fluids.
9.5. Events preceding the call to the EMS.
In case of loss of consciousness, cardiac arrest, deterioration of consciousness or acute stroke, consider inviting witnesses to the hospital or obtaining their phone numbers for the EMS team.
1. Provide oxygen therapy and maintain an oxygenation rate of 94-98%.
2. Apply appropriate vital signs monitoring tools as appropriate:
a) continuous pulse oximetry;
b) heart rate monitoring;
c) capnography or digital capnometry;
d) carbon monoxide assessment.
3. Provide venous access if indicated or in patients at risk of deterioration.
If IV access is to be used in conscious patients, consider administering 0.5 mg/kg lidocaine 0.1 mg/mL slowly via an IV needle to a maximum of 40 mg to relieve pain from IV administration.
4. Monitor for the manifestation of pain.
5. Reassess the patient’s condition.
1. The use of special signals (headlights and warning lights) does not guarantee complete patient safety during transportation.
2. Even if you use special signals, keep to the permissible driving speed to ensure the safety of the patient and also pay attention to the road conditions.
3. Remember to respect the patient and their rights, as this may affect the course of care (e.g., patients with special needs or children with special medical needs).
4. Be aware of the possible need to adjust the care algorithm based on the patient’s age and disease, as well as the dosage of medications.
5. The maximum dose per body weight of medicinal products administered to children should not exceed the maximum dose for adult patients, unless required by the instructions for use.
6. Communication with the medical management should be established clearly according to the regulations or when necessary.
7. Remember to use air transport, if available, to transport patients in critical condition if the time of transportation by land is longer than 45 minutes.
1. Pediatric patients: Use weight and height-based patient assessment tools (height tape or other systems) to measure the patient’s weight and height.
Patients are generally considered children if they weigh less than 40 kg or are under 14 years of age.
Remember to use the pediatric assessment triangle (appearance, respiration, circulation) when first encountering a child.
2. Geriatrics: Although the definition of the elderly varies from state to state, the generally accepted definition of the elderly is generally defined as being 65 years of age or older.
This patient population, as well as all adult patients, may require lower doses of medications in the event of kidney problems (dialysis or acute renal failure) or liver disease (cirrhosis or end-stage liver cancer).
3. Comorbidities: it may be necessary to use lower doses of medicinal products in case of kidney problems (in case of dialysis or acute renal failure) or liver problems (cirrhosis or end-stage liver cancer).
4. Vital signs:
a) Oxygen:
b) normal vital signs (listed in Table 1 below):
c) abnormal hypertension can be expected in many patients:
5. Secondary inspection: may not be carried out if there are critical problems at the stage of primary inspection.
6. Patients in critical condition: continuous monitoring of the patient should be performed in parallel with the assessment.
6.1. Ideally, one professional should be designated solely to monitor and facilitate patient care.
6.2. Treatment and interventions should be initiated as soon as possible, but should not impede evacuation or delay transportation to care.
7. Air medical transport: Air transport of trauma patients should be reserved for patients in acute states due to trauma, when there is a significant time reduction compared to ground transport, when the appropriate destination is not accessible by land due to system or logistical problems, and for patients who meet the criteria of anatomical, physiological and situational CDCs.
This guideline is too large to describe all possible data.
1. A minimum of 2 vital signs should be documented for each patient.
2. All interventions performed must be documented.
1. Pathological vital signs require treatment and subsequent reassessment.
2. Response to therapy should be documented, including reassessment of pain (if necessary).
3. Limit the time patients in critical condition spend at the scene unless clinically indicated.
4. Proper utilization of air medical transport resources.
5. Take glucose readings as indicated.
Table 1: Normal vital signs