EMT-Basic Exam: The Basics of Patient Assessment

One of the most challenging parts of assessing and managing patients at the scene of an emergency is remembering to verbalize your actions, thoughts, and needs. This will help your fellow EMT-Basics understand what you need. Verbalizing the steps you are taking can also help to reassure scared or anxious patients. Communication is vital to an EMT-Basic’s success in the field. Questions on the EMT-Basic exam will test your knowledge of sizing up the scene, assessing the patient, physically examining the patient, documenting your work, and communicating with the appropriate personnel.

Although caring for the patient is a high priority, you already know that the first thing an EMT-Basic must do is survey the scene of an emergency. This process is called scene size-up. The safety of the scene is important to the well-being of the victims, bystanders, witnesses, and emergency responders. The status of the scene will affect the way you respond to and care for the victims, possibly complicating or easing the process. EMT-Basics must observe the entire scene—every sight, sound, or smell could affect the safety of everyone at the scene. When on the scene, you will have to perform many duties quickly to ensure everyone’s safety before assessing the patient.

1. Body Substance Isolation (BSI)
Before approaching a patient, you should take all necessary body substance isolation (BSI) precautions. As you may recall from “Preparatory,” this includes wearing the appropriate gear to protect you from contagious diseases. This gear includes gloves, masks, gowns, and goggles. You may choose not to wear a gown because your uniform will protect most of your body, but you should always keep a spare gown or uniform nearby in case contamination occurs. Taking BSI precautions will not only protect you and your fellow emergency responders, but also your patients. Always remember to change your gloves when moving from one patient to the next to prevent cross-contamination.

Body substance isolation (BSI) gear.

2. Scene Safety
As previously mentioned, safety at the scene is vital for the well-being of everyone present, including you. To ensure your safety, you should survey the entire environment before assessing the patient. Communication is another important component of safety on the scene. Talk yourself and your partner through the actions you’re performing. This will ensure that your partner is up to date on the tasks you have completed and what you’ve found. Your partner will also be on the lookout for anything you may have overlooked.
Your personal roles and responsibilities will vary in different situations, but your personal safety should always be a top priority, especially in unusual emergencies. Wear personal protective equipment (PPE) that is appropriate for potentially dangerous situations, such as hazardous materials emergencies, rescue missions, and violent situations. This specialized equipment may include hazardous materials suits, puncture-proof gloves or pants, and helmets with ear protection. EMT-Basics are needed for a variety of emergencies, from car accidents to crime scenes. Although you will receive extensive training, there is no way to prepare for every possible emergency. This is why it is always important to assess the situation before attending to the patient.
As soon you determine that the scene is safe, you are responsible for the safety of the patient. This does not necessarily mean you should assess or treat patients at this time, but you must protect them from further injury. At a car accident, this might mean keeping them safe from glass or metal fragments, flames, or sparks. In the outdoors, you may need to protect the patient from snow, sleet, rain, extreme winds, heat, or cold.
Typically, police on the scene are responsible for bystander safety, but if EMT-Basics are first to arrive, you may need to ask the bystanders to move out of harm’s way. Often, EMT-Basics will ask bystanders to assist them in basic tasks, such as moving patients from the ground onto stretchers. If you ask bystanders for help, provide detailed instructions on what needs to be done. If they are not fit to help, ask them to step away from the scene.

Tip: Always be aware of your environment, especially the area that surrounds your patient.

3. Mechanism of Injury (MOI)
EMT-Basics typically note mechanisms of injury (MOIs) when working with unresponsive trauma patients. An MOI is the incident that led to the patient’s injury. Sometimes the MOI is determined before EMT-Basics arrive on the scene, but most of the time the EMT-Basics must discover what caused the injury. Although some cases exist where an MOI is uncertain, you should always attempt to determine the MOI before leaving the scene.
Many times, a quick look at your surroundings will lead you to an MOI. A steep set of stairs may cause a fall, or ice on the road may lead to a car crash. The best way to figure out what happened is to question the patient. If the patient is unconscious or unresponsive, you should talk to friends, family members, or bystanders who witnessed the event.
Don’t immediately trust the first MOI that comes to mind. Try to avoid making assumptions without proof. For example, even though the road was icy, a car accident could be the result of the driver suffering a seizure. A near-fatal fall down a flight of stairs could have been an accident, or it may have been attempted murder. Determining the right answer isn’t always easy, so be sure to ask the witnesses and the police direct questions about the incident.

4. Number of Patients and the Need for Additional Help
As you survey the scene, count the number of patients you’ll have to assess and treat. Medical calls often involve one patient, but trauma calls may include multiple patients with various injuries. Sometimes, it is difficult to locate a patient when you arrive on the scene. If you’re called to a car accident, for example, the patient may have fled the scene for fear of getting in trouble, or the patient may have been thrown from the car. Look for possessions such as purses, wallets, or toys that may indicate the presence of other patients. If there are too many patients for your unit to handle responsibly, call for help. If you manage to gain control of the situation before help arrives, that’s okay—it’s better to have more people than not enough.

Related Topics You Should Review:
- How to use BSI precautions
- Types of PPE for every situation
- Nature of illnesses and chief complaints
- Labeling a patient as unresponsive
- Asking questions to determine MOI
- Working with other agencies and units