The Assessment Sequence
Patient assessment follows a systematic sequence: scene size-up, primary assessment, history taking, secondary assessment, and reassessment. This sequence ensures that life-threatening conditions are identified and treated first, and that no important findings are missed. The NREMT heavily tests your ability to follow this sequence and prioritize appropriately.
Primary Assessment
The primary assessment identifies and treats immediate life threats. Follow the XABCDE approach: eXsanguinating hemorrhage (control life-threatening external bleeding), Airway (open and maintain the airway), Breathing (assess and support ventilation), Circulation (assess pulse, skin signs, and perfusion), Disability (assess mental status using AVPU: Alert, responds to Verbal stimuli, responds to Painful stimuli, Unresponsive), and Exposure (expose the patient as needed to identify injuries). Form a general impression and determine the transport priority.
SAMPLE History
SAMPLE is a mnemonic for obtaining a patient history: Signs and Symptoms (what is the chief complaint?), Allergies (medications, foods, environmental), Medications (prescription, over-the-counter, supplements), Past medical history (relevant medical conditions and surgeries), Last oral intake (when and what the patient last ate or drank), and Events leading up to the current situation. Obtain the SAMPLE history from the patient if possible, or from family, bystanders, or medical alert devices.
OPQRST for Pain Assessment
OPQRST is used to evaluate pain or discomfort: Onset (when did it start? what were you doing?), Provocation/Palliation (what makes it worse or better?), Quality (describe the pain: sharp, dull, burning, pressure), Region/Radiation (where is the pain? does it spread?), Severity (on a scale of 1 to 10), and Time (how long has it lasted? is it constant or intermittent?). OPQRST provides critical information for differential diagnosis and communication with the receiving facility.
Secondary Assessment and Reassessment
The secondary assessment is a systematic, head-to-toe physical examination. It is more detailed than the primary assessment and includes vital signs, auscultation, and palpation of all body regions. For trauma patients, perform a rapid trauma assessment focusing on DCAP-BTLS (Deformities, Contusions, Abrasions, Punctures/Penetrations, Burns, Tenderness, Lacerations, Swelling). Reassess the patient every 5 minutes for unstable patients and every 15 minutes for stable patients. Document and communicate any changes in condition.