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Principles of Patient Assessment in EMS . By: Bob Elling, MPA, EMT-P & Kirsten Elling, BS, EMT-P. Chapter 5 – Making a Priority Decision. © 2003 Delmar Learning, a Division of Thomson Learning, Inc. . Objectives. Describe how the priority decision impacts the care of the patient.

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principles of patient assessment in ems

Principles of Patient Assessment in EMS

By:

Bob Elling, MPA, EMT-P

&

Kirsten Elling, BS, EMT-P

chapter 5 making a priority decision

Chapter 5 – Making a Priority Decision

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

objectives
Objectives
  • Describe how the priority decision impacts the care of the patient.
  • Define up triaging and how it applies to patient care.
  • List four types of systems the EMS provider can use to make a priority decision
  • List the three common classifications of burn severity and describe examples of each.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

objectives continued
Objectives (continued)
  • Define START system and describe how EMS providers can use this system in a MCI.
  • Describe how EMS providers utilize triage tags during an MCI.
  • Describe the four levels of trauma centers and how a hospital or facility is designated into one of these levels.
  • Provide examples of the type of patient that would be transported to a level I trauma center.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

introduction
Introduction
  • Priority decisions are made to set the tone for patient care and management.
  • Perform the initial assessment first.
  • When more than one patient is present you must triage (to sort):
    • Triage use in prehospital and hospital
    • Many triage systems available

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

the priority decision
The Priority Decision
  • Priority decision making is an essential skill for EMS providers.
  • Failure to make a priority decision may have serious life-threatening implications.
  • Consider the “golden hour” and the “Platinum ten minutes.”
  • Stable vs. Unstable
  • When two priority choices are possible “up triage.”

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

systems of prioritizing
Systems of Prioritizing
  • Become familiar with the system used in your area:
    • Hot / cold
    • Red / yellow / green
    • High / Low
    • Minor / Moderate / Severe
    • P-1, P-2, P-3
    • C U P S

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

a close up on one system c u p s
A Close Up on One SystemC U P S
  • Acronym that stands for:
    • critical
    • unstable
    • potentially unstable
    • stable
  • First introduced in the BTLS course
  • Adapted in many states

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

examples of critical patients
Examples of “Critical Patients”
  • Actual or impending cardiorespiratory arrest
  • Respiratory failure
  • Decompensated shock (hypoperfusion)
  • Rising intracranial pressure
  • Severe upper airway difficulties

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

examples of unstable patients
Examples of “Unstable Patients”
  • Cardiorespiratory instability
  • Respiratory distress
  • Compensated shock (hypoperfusion)
  • Two or more long bone fractures
  • Trauma with associated burns
  • Amputation proximal to wrist or ankle
  • Penetrating injury to: head, neck, chest, abdomen, pelvis

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

examples of unstable patients continued
Examples of “Unstable Patients” (continued)
  • Uncontrollable external bleeding
  • Chest pain with a systolic BP < 100
  • Severe pain
  • Poor general impression
  • Unresponsive patients
  • Responsive patients who do not follow commands

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

examples of potentially unstable patients
Examples of “Potentially Unstable Patients”
  • Cardiorespiratory instability
  • MOI indicating a possible hidden injury
  • Major isolated injury
  • General medical illness
  • An uncomplicated childbirth

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

examples of stable patients
Examples of “Stable Patients”
  • Patients with a low potential for cardiorespiratory instability
  • Low grade fever
  • Minor illness
  • Minor isolated injury
  • An uncomplicated extremity injury

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

tools to determine priority
Tools to Determine Priority
  • Developed to logically examine, evaluate, and rate severity of a patient using a numbering system
  • Developed initially for trauma patients yet also used on medical patients
  • Glasgow Coma Score
  • The Trauma Score

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

glasgow coma score gcs
Glasgow Coma Score (GCS)
  • Measures:
    • Eye opening
    • Verbal response
    • Motor response
  • The best responses are given a numerical score

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

trauma score ts
Trauma Score (TS)
  • Developed in 1980 as a triage tool
  • Used to predict patient outcomes
  • Numerical grading system combining GCS and the following:
    • Respiratory rate
    • Respiratory expansion
    • Systolic BP
    • Capillary refill
    • Conversion scale for GCS

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

triaging and prioritizing burn patients
Triaging and Prioritizing Burn Patients
  • Burn severity determined by:
    • Source type
    • Body surface area (BSA)
  • Rule of nines used to calculate BSA
  • Classifications of burns include:
    • Mild -sunburn
    • Moderate – uncomplicated partial thickness < 30% BSA
    • Severe – inhalation injuries or electrical burns

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

triage to aeromedical transport
Triage to Aeromedical Transport
  • Refer to established regional protocols
  • Weather conditions – visibility and wind
  • Medical considerations
  • Injury factors – MOI, length of extrication, distance to trauma center

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

triage in mcis
Triage in MCIs
  • Triage is needed when there are multiple patients and limited resources.
  • Triage helps to ensure the most serious are treated and transported first.
  • Designate a “triage officer” and use “triage tags.”

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

the start system
The START System
  • Acronym - simple triage and rapid treatment
  • Developed in the 1980’s, separating patients into:
    • Minor
    • Delayed
    • Immediate
    • Deceased
  • Few responders can triage many rapidly.
  • Assessing:
    • Respiratory status
    • Hemodynamic status
    • Mental status

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

triage tags
Triage Tags
  • Used in MCIs
  • Several types available
  • Eliminates need to reassess each patient over and over
  • Most tags have 4 priorities:
    • P-1 (immediate or red)
    • P-2 (delayed or yellow)
    • P-3 (hold, “walking wounded,” or green)
    • P-0 (deceased, no priority or black)

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

trauma centers
Trauma Centers
  • Hospitals capable of caring for the acutely injured patient
  • Must meet strict criteria to use this designation
  • Classified into 4 levels
  • Some hospitals also specialize in specific care (burns, peds)

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

trauma centers continued
Trauma Centers (continued)
  • Each community has different needs and resources
  • Criteria for a regional structure is often found in local protocols
  • What is the trauma center in your region?

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

conclusion
Conclusion
  • Important care and transport decisions are based on the priority decision!
  • Practice is needed to gain proficiency.
  • Be familiar with the tools in your system or region.
  • Patient conditions are dynamic and can quickly change the priority.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc.

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