PATIENT ASSESSMENT IN THE FIELD

LEARNING OBJECTIVE: Recognize the assessment sequence for emergency medical care in the field, and identify initial equipment and supply needs.

Patient assessment is the process of gathering information needed to help determine what wrong with the patient is. Assessments that you conduct in the field (at the emergency scene) or during transport are known as a field assessments. Field assessments are normally performed in a systematic manner. The formal processes are known as the primary survey and the secondary survey. The primary survey is a rapid initial assessment to detect and treat life-threatening conditions that require immediate care, followed by a status decision about the patients stability and priority for immediate transport to a medical facility. The secondary survey is a complete and detailed assessment consisting of a subjective interview and an objective examination, including vital signs and head-to-toe survey. (Both types of surveys will be discussed in more detail later in this chapter.) BEFORE ARRIVAL AT THE SCENE Before or during transit to an emergency scne, you may learn about the patients illness or injury. Although this information could later prove to be erroneous, you should use this time to consider what equipment you may need and what special procedures you should use immediately upon arrival. ARRIVAL AT THE SCENE When you arrive at an emergency scene, you need to start gathering information immediately. First, make sure the scene is safe for you, then for the patient or patients. Do not let information you received before your arrival form your complete conclusion concerning the patient's condition. Consider all related factors before you decide what is wrong with the patient and what course of emergency care you will take. You can quickly gain valuable information as to what may be wrong with the patient. Observe and listen as you proceed to your patient. Do not delay the detection of life-threatening problems. Be alert to clues that are obvious or provided to you by others. Some immediate sources of information may come from the following: The scene Is it safe or hazardous? Does thepatient have to be moved? Is the weather severe? The patient Is the patient conscious, trying totell you something, or pointing to a part of his body? Bystander Are they trying to tell yousomething? Listen. They may have witnessedwhat happened to the patient or have pertinentmedical history of the patient (for example, priorheart attacks).

Medical identification device Is the patient wearing a medical identification device (necklaceor bracelet)? Medical identification devices can provide you with crucial information on medical disorders, such as diabetes. Mechanism of injury Was there a fire? Did the patient fall or has something fallen on the patient? Is the windshield of vehicle cracked or the steering wheel bent? Deformities or injuries Is the patient lying in a strange position? Are there burns, crushed limbs, or other obvious wounds? Signs What do you see, hear, or smell? Is there blood around the patient? Has the patient vomited? Is the patient having convulsions? Are the patients clothes torn?