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Principles of Patient Assessment
in EMS

Chapter 5 – Making a Priority
Decision
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

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.

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.

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

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.”

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

A Close Up on One System
C U P S
 Acronym that stands for:
 critical
 unstable
 potentially unstable
 stable
 First introduced in the BTLS course
 Adapted in many states

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

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

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

Examples of “Potentially Unstable
Patients”
 Cardiorespiratory instability
 MOI indicating a possible hidden injury
 Major isolated injury
 General medical illness
 An uncomplicated childbirth

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

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

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

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

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

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

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.”

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

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)

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)

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?

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.

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Principles of assessment for ems chapter 05

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