Standard

Revised: 4/18/07 / Posted 06/07/07

EMS 127 - Patient Assessment

Course Description

Introduces the fundamental principles and skills involved in assessing the pre-hospital patient. Emphasis is on the systematic approach to patient assessment, with adaptations for the medical versus the trauma patient. Topics include: therapeutic communications, history taking, techniques of physical exam, patient assessment, clinical decision-making, EMS communications, and documentation. This course provides instruction on topics in Division 1, Section 9 and Division 3, Sections 1-9 of the USDOT/NHTSA Paramedic National Standard Curriculum.

Competency Areas	Hours
Therapeutic Communications	Class	3
History Taking	D. Lab	2
Techniques of Physical Exam	P. Lab/O.B.I.	0
Patient Assessment	Credit	4
Clinical Decision-Making
EMS Communications
Documentation

Prerequisite:	Program Admission
Corequisites:	AHS 101

Course Guide

Competency	After completing this section, the student will:	Hours
		Class	D.Lab	P.Lab/ O.B.I.
THERAPEUTIC COMMUNICATIONS		3	2	0
	Restate the strategies for developing patient rapport.
	Provide examples of open-ended and closed or direct questions.
	Discuss common errors made by paramedics when interviewing patients.
	Identify the nonverbal skills that are used in patient interviewing.
	Restate the strategies to obtain information from the patient.
	Summarize the methods to assess mental status based on interview techniques.
	Discuss the strategies for interviewing a patient who is unmotivated to talk.
	Differentiate the strategies a paramedic uses when interviewing a patient who is hostile compared to one who is cooperative.
	Restate unique interviewing techniques necessary to employ with patients who have special needs.
	Discuss interviewing considerations used by paramedics in cross-cultural communications.
	Serve as a model for an effective communication process.
	Advocate the importance of external factors of communication.
	Promote proper responses to patient communication.
	Exhibit professional non-verbal behaviors.
	Advocate development of proper patient rapport.
	Value strategies to obtain patient information.
	Exhibit professional behaviors in communicating with patients in special situations.
HISTORY TAKING		3	2	0
	Describe the techniques of history taking.
	Discuss the importance of using open-ended questions.
	Describe the use of facilitation, reflection, clarification, empathetic responses, confrontation, and interpretation.
	Differentiate between facilitation, reflection, clarification, sympathetic responses, confrontation, and interpretation.
	Describe the structure and purpose of a health history.
	Describe how to obtain a comprehensive health history.
TECHNIQUES OF PHYSICAL EXAM		9	6	0
	Define the terms inspection, palpation, percussion, and auscultation.
	Describe the techniques of inspection, palpation, percussion, and auscultation.
	Describe the evaluation of mental status.
	Evaluate the importance of a general survey.
	Describe the examination of skin, hair and nails.
	Differentiate normal and abnormal findings of the assessment of the skin.
	Distinguish the importance of abnormal findings of the assessment of the skin.
	Describe the examination of the head and neck.
	Differentiate normal and abnormal findings of the scalp examination.
	Describe the normal and abnormal assessment findings of the skull.
	Describe the assessment of visual acuity.
	Explain the rationale for the use of an ophthalmoscope.
	Describe the examination of the eyes.
	Explain the rationale for the use of an otoscope.
	Describe the examination of the ears.
	Differentiate normal and abnormal assessment findings of the ears.
	Describe the examination of the nose.
	Differentiate normal and abnormal assessment findings of the nose
	Describe the examination of the mouth and pharynx.
	Differentiate normal and abnormal assessment findings of the mouth and pharynx.
	Describe the examination of the neck.
	Differentiate normal and abnormal assessment findings in the neck
	Describe the survey of the thorax and respiration.
	Describe the examination of the posterior chest.
	Describe percussion of the chest.
	Differentiate the percussion notes and their characteristics.
	Differentiate the characteristics of breath sounds.
	Describe the examination of the anterior chest.
	Differentiate normal and abnormal assessment findings of the chest examination.
	Describe special examination techniques related to the assessment of the chest.
	Describe the examination of the arterial pulse including rate, rhythm, and amplitude.
	Distinguish normal and abnormal findings of arterial pulse.
	Describe the assessment of jugular venous pressure and pulsations.
	Distinguish normal and abnormal examination findings of jugular venous pressure and pulsations.
	Describe the examination of the heart and blood vessels.
	Differentiate normal and abnormal assessment findings of the heart and blood vessels.
	Describe the auscultation of the heart.
	Differentiate the characteristics of normal and abnormal findings associated with the auscultation of the heart.
	Describe special examination techniques of the cardiovascular examination.
	Describe the examination of the abdomen.
	Differentiate normal and abnormal assessment findings of the abdomen.
	Describe auscultation of the abdomen.
	Distinguish normal and abnormal findings of the auscultation of the abdomen.
	Describe the examination of the female genitalia.
	Differentiate normal and abnormal assessment findings of the female genitalia.
	Describe the examination of the male genitalia.
	Differentiate normal and abnormal findings of the male genitalia.
	Describe the examination of the anus and rectum.
	Distinguish between normal and abnormal findings of the anus and rectum.
	Describe the examination of the peripheral vascular system.
	Differentiate normal and abnormal findings of the peripheral vascular system.
	Describe the examination of the musculoskeletal system.
	Differentiate normal and abnormal findings of the musculoskeletal system.
	Describe the examination of the nervous system.
	Differentiate normal and abnormal findings of the nervous system.
	Describe the assessment of the cranial nerves.
	Differentiate normal and abnormal findings of the cranial nerves.
	Describe the general guidelines of recording examination information.
	Discuss the considerations of examination of an infant or child.
	Demonstrate a caring attitude when performing physical examination skills.
	Discuss the importance of a professional appearance and demeanor when performing physical examination skills.
	Appreciate the limitations of conducting a physical exam in the out-of-hospital environment.
	Demonstrate the examination of skin, hair and nails.
	Demonstrate the examination of the head and neck.
	Demonstrate the examination of the eyes.
	Demonstrate the examination of the ears.
	Demonstrate the assessment of visual acuity.
	Demonstrate the examination of the nose.
	Demonstrate the examination of the mouth and pharynx.
	Demonstrate the examination of the neck.
	Demonstrate the examination of the thorax and ventilation.
	Demonstrate the examination of the posterior chest.
	Demonstrate auscultation of the chest.
	Demonstrate percussion of the chest.
	Demonstrate the examination of the anterior chest.
	Demonstrate special examination techniques related to the assessment of the chest.
	Demonstrate the examination of the arterial pulse including location, rate, rhythm, and amplitude.
	Demonstrate the assessment of jugular venous pressure and pulsations.
	Demonstrate the examination of the heart and blood vessels.
	Demonstrate special examination techniques of the cardiovascular examination.
	Demonstrate the examination of the abdomen.
	Demonstrate auscultation of the abdomen.
	Demonstrate the external visual examination of the female genitalia.
	Demonstrate the examination of the male genitalia.
	Demonstrate the examination of the peripheral vascular system.
	Demonstrate the examination of the musculoskeletal system.
	Demonstrate the examination of the nervous system.
	List the components of a comprehensive history of an adult patient.
	Demonstrate the importance of empathy when obtaining a health history.
	Demonstrate the importance of confidentiality when obtaining a health history.
PATIENT ASSESSMENT		9	6	0
	At the end of this unit, the paramedic student will be able to integrate the principles of history taking and techniques of physical exam to perform a patient assessment.
	Recognize hazards/potential hazards.
	Describe common hazards found at the scene of a trauma and a medical patient.
	Determine hazards found at the scene of a medical or trauma patient.
	Differentiate safe from unsafe scenes.
	Describe methods to making an unsafe scene safe.
	Discuss common mechanisms of injury/nature of illness.
	Predict patterns of injury based on mechanism of injury.
	Discuss the reason for identifying the total number of patients at the scene.
	Organize the management of a scene following size-up.
	Explain the reasons for identifying the need for additional help or assistance.
	Summarize the reasons for forming a general impression of the patient.
	Discuss methods of assessing mental status.
	Categorize levels of consciousness in the adult, infant and child.
	Differentiate between assessing the altered mental status in the adult, child and infant patient.
	Discuss methods of assessing the airway in the adult, child and infant patient.
	State reasons for management of the cervical spine once the patient has been determined to be a trauma patient.
	Analyze a scene to determine if spinal precautions are required.
	Describe methods used for assessing if a patient is breathing.
	Differentiate between a patient with adequate and inadequate minute ventilation.
	Distinguish between methods of assessing breathing in the adult, child and infant patient.
	Compare the methods of providing airway care to the adult, child and infant patient.
	Describe the methods used to locate and assess a pulse.
	Differentiate between locating and assessing a pulse in an adult, child and infant patient.
	Discuss the need for assessing the patient for external bleeding.
	Describe normal and abnormal findings when assessing skin color.
	Describe normal and abnormal findings when assessing skin temperature.
	Describe normal and abnormal findings when assessing skin condition.
	Explain the reason for prioritizing a patient for care and transport.
	Identify patients who require expeditious transport.
	Describe the evaluation of patient’s perfusion status based on findings in the initial assessment.
	Describe orthostatic vital signs and evaluate their usefulness in assessing a patient in shock.
	Apply the techniques of physical examination to the medical patient.
	Differentiate between the assessment that is performed for a patient who is unresponsive or has an altered mental status and other medical patients requiring assessment.
	Discuss the reasons for reconsidering the mechanism of injury.
	State the reasons for performing a rapid trauma assessment.
	Recite examples and explain why patients should receive a rapid trauma assessment.
	Apply the techniques of physical examination to the trauma patient.
	Describe the areas included in the rapid trauma assessment and discuss what should be evaluated.
	Differentiate cases when the rapid assessment may be altered in order to provide patient care.
	Discuss the reason for performing a focused history and physical exam.
	Describe when and why a detailed physical examination is necessary.
	Discuss the components of the detailed physical exam in relation to the techniques of examination.
	State the areas of the body that are evaluated during the detailed physical exam.
	Explain what additional care should be provided while performing the detailed physical exam.
	Distinguish between the detailed physical exam that is performed on a trauma patient and that of the medical patient.
	Describe the components of the on-going assessment.
	Differentiate patients requiring a detailed physical exam from those who do not.
	Discuss the reasons for repeating the initial assessment as part of the on-going assessment.
	Describe trending of assessment components.
	Discuss medical identification devices/systems.
	Explain the rationale for crew members to evaluate scene safety prior to entering.
	Serve as a model for others explaining how patient situations affect your evaluation of mechanism of injury or illness.
	Explain the importance of forming a general impression of the patient.
	Explain the value of performing an initial assessment.
	Demonstrate a caring attitude when performing an initial assessment.
	Attend to the feelings that patients with medical conditions might be experiencing.
	Value the need for maintaining a professional caring attitude when performing a focused history and physical examination.
	Explain the rationale for the feelings that these patients might be experiencing.
	Demonstrate a caring attitude when performing a detailed physical examination.
	Explain the value of performing an on-going assessment.
	Recognize and respect the feelings that patients might experience during assessment.
	Explain the value of trending assessment components to other health professionals who assume care of the patient.
	Observe various scenarios and identify potential hazards.
	Demonstrate the scene-size-up.
	Demonstrate the techniques for assessing mental status.
	Demonstrate the techniques for assessing the airway.
	Demonstrate the techniques for assessing if the patient is breathing.
	Demonstrate the techniques for assessing if the patient has a pulse.
	Demonstrate the techniques for assessing the patient for external bleeding.
	Demonstrate the techniques for assessing the patient's skin color, temperature, and condition.
	Demonstrate the ability to prioritize patients.
	Using the techniques of examination, demonstrate the assessment of a medical patient.
	Demonstrate the patient care skills that should be used to assist with a patient who is responsive with no known history.
	Demonstrate the patient care skills that should be used to assist with a patient who is unresponsive or has an altered mental status.
	Perform a rapid medical assessment.
	Perform a focused history and physical exam of the medical patient.
	Using the techniques of physical examination, demonstrate the assessment of a trauma patient.
	Demonstrate the rapid trauma assessment used to assess a patient based on mechanism of injury.
	Perform a focused history and physical exam on a non-critically injured patient.
	Perform a detailed physical examination.
	Perform a focused history and physical exam on a patient with life-threatening injuries.
	Demonstrate the skills involved in performing the on-going assessment.
CLINICAL DECISION-MAKING		3	2	0
	At the end of this unit, the paramedic student will be able to apply a process of clinical decision making to use the assessment findings to help form a field impression.
	Compare the factors influencing medical care in the out-of-hospital environment to other medical settings.
	Differentiate between critical life-threatening, potentially life-threatening, and non life-threatening patient presentations.
	Evaluate the benefits and shortfalls of protocols, standing orders and patient care algorithms.
	Define the components, stages and sequences of the critical thinking process for paramedics.
	Apply the fundamental elements of critical thinking for paramedics.
	Describe the effects of the “fight or flight” response and the positive and negative effects on a paramedic’s decision making.
	Summarize the “six Rs” of putting it all together: Read the patient, Read the scene, React, Reevaluate, Revise the management plan, Review performance.
	Defend the position that clinical decision making is the cornerstone of effective paramedic practice.
	Practice facilitating behaviors when thinking under pressure.
EMS COMMUNICATIONS		1.5	1	0
	Identify the importance of communications when providing EMS.
	Identify the role of verbal, written, and electronic communications in the provision of EMS.
	Describe the phases of communications necessary to complete a typical EMS event.
	Identify the importance of proper terminology when communicating during an EMS event.
	Identify the importance of proper verbal communications during an EMS event.
	List factors that impede effective verbal communications.
	List factors which enhance verbal communications.
	Identify the importance of proper written communications during an EMS event.
	List factors which impede effective written communications.
	List factors which enhance written communications.
	Recognize the legal status of written communications related to an EMS event.
	State the importance of data collection during an EMS event.
	Identify technology used to collect and exchange patient and/or scene information electronically.
	Recognize the legal status of patient medical information exchanged electronically.
	Identify the components of the local EMS communications system and describe their function and use.
	Identify the components of the local dispatch communications system and describe their function and use.
	Describe the functions and responsibilities of the Federal Communications Commission.
	Identify and differentiate among the following communications systems: a. Simplex b. Multiplex c. Duplex d. Trunked e. Digital communications f. Cellular telephone g. Facsimile h. Computer
	Describe how an EMS dispatcher functions as an integral part of the EMS team.
	List appropriate information to be gathered by the Emergency Medical Dispatcher.
	Identify the role of Emergency Medical Dispatch in a typical EMS event.
	Identify the importance of pre-arrival instructions in a typical EMS event.
	Describe the purpose of verbal communication of patient information to the hospital.
	Describe information that should be included in patient assessment information verbally reported to medical direction.
	Diagram a basic model of communications.
	Organize a list of patient assessment information in the correct order for electronic transmission to medical direction according to the format used locally.
	Show appreciation for proper terminology when describing a patient or patient condition.
	Demonstrate the ability to use the local dispatch communications system.
	Demonstrate the ability to use a radio.
	Demonstrate the ability to use the biotelemetry equipment used locally.
DOCUMENTATION		1.5	1	0
	At the completion of this unit, the paramedic student will be able to effectively document the essential elements of patient assessment, care and transport.
	Identify the general principles regarding the importance of EMS documentation and ways in which documents are used.
	Identify and use medical terminology correctly.
	Recite appropriate and accurate medical abbreviations and acronyms.
	Record all pertinent administrative information.
	Explain the role of documentation in agency reimbursement.
	Analyze the documentation for accuracy and completeness, including spelling.
	Identify and eliminate extraneous or nonprofessional information.
	Describe the differences between subjective and objective elements of documentation.
	Evaluate a finished document for errors and omissions.
	Evaluate a finished document for proper use and spelling of abbreviations and acronyms.
	Evaluate the confidential nature of an EMS report.
	Describe the potential consequences of illegible, incomplete, or inaccurate documentation.
	Describe the special considerations concerning patient refusal of transport.
	Record pertinent information using a consistent narrative format.
	Explain how to properly record direct patient or bystander comments.
	Describe the special considerations concerning mass casualty incident documentation.
	Apply the principles of documentation to computer charting, as access to this technology becomes available.
	Identify and record the pertinent, reportable clinical data of each patient interaction.
	Note and record “pertinent negative” clinical findings.
	Correct errors and omissions, using proper procedures as defined under local protocol.
	Revise documents, when necessary, using locally-approved procedures.
	Assume responsibility for self-assessment of all documentation.
	Demonstrate proper completion of an EMS event record used locally.
	Advocate among peers the relevance and importance of properly completed documentation.
	Resolve the common negative attitudes toward the task of documentation.

Suggested Resources

Bledsoe, et al; Essentials of Paramedic Care 1^st ed., 2003; Brady Prentice Hall Publishing, Upper Saddle River, NJ 07458; ISBN: 0-13-098792-1

Sanders, et al; Mosby’s Paramedic Textbook 2^nd ed., 2002; Mosby Publishing, Philadelphia, PA 19106; ISBN: 032301416X

Bledsoe, et al; Paramedic Care: Principles & Practice- Vol. 2-Patient Assessment 1^st ed.; 2000; Brady-Prentice Hall Publishing, Upper Saddle River, NJ 07458; ISBN: 0-13021597X

Elling; Principles of Patient Assessment in EMS; 1^st ed; 2003; Delmar Learning/Thomson Learning, Inc. Clifton Park, NY 12065; ISBN: 0-7668-3899-4

Jarvis; Physical Examination & Health Assessment 3^rd ed.; 2001; W. B. Saunders Company; Philadelphia, PA 19106; ISBN: 072169769-0

Stanford; EMS Report Writing: A Pocket Reference 1^st ed.; 1992; Prentice Hall Publishing, Upper Saddle River, NJ 07458; ISBN: 0893038237