PATIENT ASSESSMENT/MANAGEMENT -- MEDICAL

This station is designed to test your ability to perform a patient assessment of a victim with a chief complaint of a medical nature and voice-treat all conditions and injuries discovered. You must conduct your assessment as you would in the field, including communicating with your patient. As you conduct your assessment, you should state everything you are assessing. Clinical information not obtainable by visual or physical inspection, for example, blood pressure, will be given to you after you demonstrate how you would normally gain that information. You may assume that you have two EMTs working with you and that they are correctly carrying out the verbal treatments you indicate.

You have (10) ten minutes to complete this skill station. Do you have any questions?

Takes or verbalizes body substance isolation precautions

SCENE SIZE-UP

Determines the scene is safe
Determines the mechanism of injury/nature of illness
Determines the number of patients
Requests additional help if necessary
Considers stabilization of spine

INITIAL ASSESSMENT

Verbalizes general impression of patient
Determines responsiveness/level of consciousness
Determines chief complaint/apparent life threats

Assesses airway and breathing
Assessment
Initiates appropriate oxygen therapy
Assures adequate ventilation

Assesses Circulation
Assesses/controls major bleeding
Assesses pulse
Assesses skin (color, temperature and condition)

Identities priority patients/makes transport decision

FOCUSED HISTORY AND PHYSICAL EXAM/RAPID ASSESSMENT

Signs and symptoms (assess history of present illness)

Respiratory - opqrst

Cardiac - opqrst

AMS - Description of episode, onset, duration, associated
symptoms, evidence of trauma, interventions, seizures, fever

Allergic Reaction - History of Allergies, What were you exposed to,
How were you exposed, Effects, Progression, Interventions

Poisoning/overdose - Substance, When did you ingest/ become
exposed, How much did you ingest, Over what time period,
Interventions, Estimated weight, effects

Environmental Emergency - Source, Environment, Duration,
Loss of consciousness, effects - general or local

Obstetrics - Are you pregnant, How long have you been pregnant,
Pain or contractions, Bleeding or discharge,
Do you feel the need to push, Last menstrual period, Crowning

Behavioral - How do you feel, Determine suicidal tendencies,
Is the patient a threat to self or others, Is there a medical
problem, Interventions

Allergies
Medications
Past medical history
Last Meal
Events leading to present illness (rule out trauma)

Performs focused physical examination - Assesses affected body part/system or, if indicated, completes rapid assessment

Vitals (obtain baseline vitals)

Interventions -obtains medical direction or verbalizes standing order for medication intervention and verbalizes proper additional intervention/treatment
Transport - reevaluates transport decision
Verbalizes the consideration for completing a detailed physical exam

ONGOING ASSESSMENT (verbalized)

Repeats initial assessment
Repeats vital signs
Repeats focused assessment regarding patient complaint or injuries
Checks interventions

CRITICAL CRITERIA

Did not take or verbalize body substance isolation precautions
Did not determine scene safety
Did not "obtain medical direction or verbalize standing orders for medication interventions
Did not provide high concentration of oxygen
Did not evaluate and find conditions of airway, breathing, circulation
Did not find or manage problems associated with airway, breathing, hemorrhage or shock (hypoperfusion)
Did not differentiate patient's needing transportation versus continued assessment at the scene
Does detailed or focused history/physical examination before assessing airway, breathing and circulation
Did not ask questions about the present illness
Administered a dangerous or inappropriate intervention

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