EMT-Basic Exam: The Basics of Patient Assessment - Ongoing Assessment

Ongoing assessment occurs on the way to the medical facility and includes further examination of and careful attention to the patient. During this time, you should also check on the success or failure of any interventions, such as the use of high-flow nonrebreather masks. Pay close attention to the patient’s mental status, vital signs, and blood pressure as you approach the hospital. If the patient becomes unstable, address the situation accordingly and report any changes to the professionals who will take over the care of your patient. Questions about ongoing assessment on exams like the EMT-Basic will appear similar to those about the initial assessment and the physical exam, as the steps are repeated during this process.

1. Components of an Ongoing Assessment
A stable patient is one who has endured a simple or specific injury. The condition of these patients remains steady and does not worsen upon further assessment. These patients most likely did not receive a full physical exam, but they should receive ongoing assessment once every 15 minutes. An unstable patient is either a medical patient in extreme distress or a trauma patient with a significant MOI. Unstable patients should receive ongoing assessment once every 5 minutes. The components of ongoing assessment include the following steps:

1. Repeat the initial assessment.

2. Determine mental status.

3. Assess airway, breathing rate, and pulse rate.

4. Assess skin color, condition, perfusion, and temperature.

5. Identify priority patients.

6. Record all vital signs.

7. Repeat focused assessments.

8. Check on all interventions.

Although the ideal location to perform an ongoing assessment is on the way to the hospital, sometimes EMS units don’t have the ability to transport patients. If you’re waiting for transportation, perform the ongoing assessment while you wait.

2. Repeat Initial Assessment
Keep interaction and communication with the patient constant during, or while waiting for, transport. Constant interaction will make reassessing the patient’s mental status an easy task and will allow you to take notice of any changes that may occur. Check on the patient’s airway and ensure that it is open. Evaluate the patient’s breathing and pulse rate using the radial or carotid arteries. Observe the patient’s skin color as you interact with him or her. Check on any major bleeding that you attempted to control on the scene while inspecting interventions. If an intervention fails, correct it immediately. If the patient’s condition deteriorates, he or she becomes a high-priority patient. In this case, turn on the sirens and lights and maintain a quick, but safe, speed.

3. Repeat Vital Signs and Focused Assessment
You will need to record vital signs for your patient’s skin, pupils, blood pressure, circulation, and breathing every 5 to 15 minutes, depending on your patient’s stability. Document all vital sign assessments so professionals at the hospital can see how the patient’s condition has altered over time. Be sure to complete a focused assessment as often as you check the patient’s vital signs. For patients with specific or simple injuries, inspect the site of the injury thoroughly, noting any alterations. If a patient has a life-threatening injury or condition, work with your partner to keep the airway clear and the patient breathing. In these situations, the patient’s breathing is your first priority; a formal ongoing assessment may be delayed.

Related Topics You Should Review:
- Airway, breathing, and pulse assessment
- Emergency intervention plans
- Riding in a moving transport vehicle