Initial Assessment

The initial assessment has a single, critical, all important goal: to identify and initiate treatment of immediate or potential life threats. Information concerning life-threatening conditions can be obtained from the visual appearance of the patient, how the patient’s complaints relate to the currecnt MOI or NOI, and obvious problems with the patient’s airway, breathing, and circulation (ABCs). 

Consider Mechanism of Injury/Nature of Illness (MOI/NOI) - Pg. 267-268

The dispatched complaint will guide you in the direction of the the patient’s problem. It could be either a traumatic problem that involves a mechanism of injury (MOI) or a medical problem based on the nature of illness (NOI).

Mechanism of Injury (MOI)

As an EMT-B, you will be called to motor vehicle crashes or other situations in which patients may have sustained life-threatening traumatic injuries. To care for these patients properly, you must understand how traumatic injuries occur, or the mechanism of injury (MOI). With a traumatic injury, the body has been exposed to some force or energy that has resulted in a temporary injury,permanent damage, or even death.

The net result of this information is that you can use the mechanism of injury as a kind of guide to predict the potential for a serious injury by evaluating three factors:  First, the amount of force applied to the body, Second the length of time the force was applied, and Third the areas of the body that are involved. You will commonly hear the terms “blunt trauma” and “penetrating trauma.”

Blunt Trauma is when the force of the injury occurs over a borad area, and the skin is usually not broken. However, the tissues and organs below the area of impact may be damaged.

Penetrating Trama the force of the injury occurs at a small point of contact between the kin and the object. The object pierces the skin and creates an open wound that carries a high potential for infection.

Nature of Illness (NOI)

As an EMT-B you must examine the nature of the illness (NOI). You may need to search for clues in making an effort to determine the general type of illness, which is often best described by the patient’schief complaint: The reason EMS was called.

In figuring out the nature of illness always be cautions of the clues that could be given. By doing so talk to the patient, bystanders, and  family members about the problem. Also look for other examples such as; open medications containers, poisonous substances, or unsanitary living conditions.

The Importance of MOI and NOI

Considering the MOI or NOI early can be of value in preparing to care for your patient. During your prehospital assessment you may be tempted to categorize your patient immediately as a trauma or Medical Patient. Remember, the fundamentals of a good patient assessment are the same despite the unique aspects of trauma and medical care.

For Example: If an unconscious patient is found at the bottom of a ladder, did he fall off the ladder, strike his head, and become unconsciousness or did he climb down the ladder and then lose consciousness?

Early in the assessment, it can be difficult to identify with absolute certainty whether the problem is a traumatic or medical origin. Although further assessment is needed to come to a conclusion, considering MOI or NOI early will help you prepare for the rest of your assessment.

Performance (MOI/NOI)	Procedures
Mechanism of Injury  or Nature of Illness (Determine whether MOI or NOI)	Trama – Assess mechanism of Injury (MOI) Medical – Assess Nature of Illness (NOI)

 Consider C-Spine Immobilization - Pg. 269

If an injury is suspected, consider early spinal immobilization. This is an important step, as moving such a patient  without proper spinal immobilization can have serious implications such as lifelong paralysis. When you are uncertain whether spinal immobilization is necessary, err on the side of caution and immobilize the patient.

Performance (Spinal Immobilization)	Procedures
Consider Spinal Immobilization	Consider Spinal Immobilization

Form General Impression - Pg. 271

The general impression includes noting things such as the person’s age, gender, race, level of distress, and overall appearance.  You may anticipate different problems depending on the patient’s age, gender, or race.  As you approach the patient, make sure that they see you coming to avoid surprising the patient or causing the patient to turn to see you, possibly making any injuries worse. Note the patient’s position and whether the patient is moving or still.

When you reach your patient, place yourself at a lower position, if possible, to show respect for the patient and help the patient feel comfortable and less threatened as you begin your assessment.

Performance (General Impression)	Procedures
Form General Impression	Determine age, gender, and race Evaluate the patients overall appearance and the environment

Introduce Yourself and Ask Permission to Treat - Pg. 271

Introduce yourself to the patient and others by telling them who you are and what you are doing. For example, “Hello, my name is John Smith, I’m an EMT with AnyTown EMS. I’m here to help you.” After introducing yourself, ask the patient his or her name to address the patient as he or she wishes.

Obtain Consent to Care for the Patient – Pg. 75-77, 272

 Conscious patients may allow you to care for them without you needing to ask specifically if you can help them. Other times, you may want to formally ask, “May I look at your arm? It seems to be injured.” This communication establishes a formal relationship between you and the patient and may reduce anxiety and gain cooperation when caring for younger patients.

Treatment for unresponsive patients is based on implied consent, assuming that, if they were conscious, they would consent to emergency care. If the patient wakes up, however, you must explain who you are, what you are doing, and why you are doing it.

 Determine Chief Complaint – Pg. 147-48, 272

Once the introductions are over and you have the patient’s permission to help, you should determine the Chief Complaint. This may be done by simply asking, “What happened?” or “How may I help you?” The chief complaint is the most serious thing that the patient is concerned about and is usually expressed in the patients own words (symptoms); however, it may be something observable by the EMT (signs). In unresponsive patients, their chief complaint is often expressed as being “unresponsive.”

Keep in mind the chief complaint expressed by the patient may not be the most serious thing that is wrong; however, it is a good place to start.  For example, a patient with difficulty breathing from a chronic lung condition may complain about leg problems from poor perfusion. Your responsibility is to determine what is more important-the leg problem or the difficulty breathing. The chief complaint gives you a reference point to begin with during your assessment process.

Performance (Identify Self)	Procedures
Identify Self, Obtain Consent to Treat. Determine Chief Complaint	Identify yourself and ask if you can help Inquire: “What is the problem?”

Level of Consciousness (LOC) – Pg. 160-62