Two Assessment Pathways
The NREMT expects EMTs to adapt their assessment approach based on whether the patient presents with a medical complaint or a traumatic injury. While the primary assessment (XABCDE) is the same for both, the secondary assessment differs significantly. Understanding when and how to apply each approach is frequently tested.
Medical Patient Assessment
Medical patients present with illness-related complaints: chest pain, difficulty breathing, abdominal pain, altered mental status, or other symptoms without a traumatic mechanism.
History First
For responsive medical patients, obtain the history before the physical exam. The history guides your physical assessment. Use OPQRST for the chief complaint:
- O - Onset: What were you doing when it started?
- P - Provocation/Palliation: What makes it better or worse?
- Q - Quality: Describe the feeling (sharp, dull, pressure, tearing)
- R - Radiation: Does it go anywhere else?
- S - Severity: On a scale of 1 to 10?
- T - Time: When did it start? Constant or intermittent?
Obtain a SAMPLE history:
- S - Signs/Symptoms: What are you feeling?
- A - Allergies: Any medication or food allergies?
- M - Medications: What medications do you take?
- P - Past medical history: Any medical conditions?
- L - Last oral intake: When did you last eat or drink?
- E - Events: What were you doing when this started?
Focused Physical Exam
After obtaining the history, perform a focused physical exam directed by the chief complaint. For chest pain, focus on the cardiovascular and respiratory systems. For abdominal pain, focus on the abdomen. Auscultate lung and heart sounds, palpate for tenderness, and assess vital signs including pulse oximetry.
Trauma Patient Assessment
Trauma patients present with injuries from a known or suspected mechanism. The assessment approach prioritizes finding and treating life threats quickly.
Physical Exam First
For trauma patients, the physical exam takes priority over the history. Injured patients may have injuries they are not aware of, and the physical exam reveals conditions the history cannot.
Rapid Trauma Assessment vs. Focused Exam
Use a rapid head-to-toe trauma assessment for patients with significant mechanism of injury, altered mental status, or multiple injuries. This involves systematically palpating and inspecting the head, neck, chest, abdomen, pelvis, and extremities in 60 to 90 seconds.
Use a focused trauma exam for patients with isolated, non-significant injuries (for example, a twisted ankle with no other complaints). Assess only the injured area and obtain vital signs.
Reassessment
Reassess unstable patients every 5 minutes and stable patients every 15 minutes. Reassessment includes repeating the primary assessment, checking vital signs, evaluating interventions, and monitoring for changes in condition. Document any changes and adjust your treatment plan accordingly.