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Principles of Patient Assessment
in EMS

Chapter 4 – The Initial
Assessment
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

Objectives
 Describe the importance of obtaining the
chief complaint in the patient’s own words
and list examples of chief complaints.
 Define AVPU and discuss how it is used to
assess a patient’s mental status.
 List the three key questions the EMS
provider needs to ask when assessing the
airway of any patient.

Objectives (continued)
 Describe how to assess a patient’s breathing.
 List three key questions the EMS provider must
keep in mind when assessing circulatory status.
 Describe how to assess a patient’s skin and list
several abnormal skin conditions.
 Describe the last step of the initial assessment
and how it is used to make a transportation
decision.

Introduction
 Purpose is to rapidly identify and manage
the life-threats.
 Every patient should receive an initial
assessment.
 Treat any life-threats immediately.
 Most patients do not have life-threatening
problems.

Your General Impression
 The environment (ie: bottom of stairs, out
in the cold, tripod position, pool of blood)
 Patient’s MOI/NOI
 Patient’s age and sex
 Patient’s degree of distress
 Listen for the chief complaint
 Keep the priority of care in focus

Mental Status
 Are they conscious or unconscious? (if
unconscious do CPR quick-check)
 Introduce yourself
 What’s your name? (oriented to person)
 Do you know where you are? (oriented to place)
 What day of the week is it? (oriented to day)
 How can I help you today? (chief complaint)

A V P U
 Alert – oriented to person, place, and day
(“big three”)
 Verbal – cannot answer the “big three”
correctly
 Painful – either appropriate, inappropriate,
or posturing (decorticate/decerebrate)
 Unresponsive

Airway Status
 The 3 key questions:
 Is the airway open?
 Will the airway stay open?
 Does anything endanger the airway?

Airway Status
 Factors to consider:
 Unconsciousness
 Suspected spinal injury
 Obstruction

Airway Status
 Complex airway problems:
 Impaled object(s)
 Significant MOI (i.e.: gunshot)
 Burns
 Crushed or fractured larynx

Breathing
 The 6 key questions:
 Is the patient breathing?
 What’s the respiratory rate?
 Is the rate adequate?
 Does anything endanger breathing?
 Can the patient take a deep breath?
 Is the patient having trouble breathing?

Breathing
 Adequacy
 Dyspnea
 Chest wall stability

Circulatory Status
 Ask the 3 key questions:
 Does the patient have a pulse?
 What is the quality of the pulse?
 Is there any major bleeding that needs to be
controlled?

Assess the Pulse
 Distal vs. proximal
 Infant and child pulses
 External hemorrhage
 Skin signs (CTC):
 Color
 Temperature
 Condition
 Capillary refill (in children)

Make a Priority Decision!
 High or low priority
 Transportation decision
 Is ALS needed (consider an intercept)

Conclusion
 Quickly assess for life-threats!
 Remember the key steps of the initial
assessment (MS-ABC).
 Make a priority and transport decision!

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