5 EMT Secondary Assessment Tips

When it comes to secondary assessments in emergency medical services (EMS), the goal is to conduct a thorough and systematic evaluation of the patient’s condition to identify any potential life-threatening issues that may not have been apparent during the initial primary assessment. A secondary assessment is typically performed after the patient’s airway, breathing, and circulation (ABCs) have been stabilized and is designed to gather more detailed information about the patient’s condition. Here are five EMT secondary assessment tips to help you improve your skills:

1. Use a Systematic Approach

A systematic approach to the secondary assessment is crucial for ensuring that nothing is missed. This typically involves evaluating the patient from head to toe, checking for any signs of injury or illness. The mnemonic “HEAD TO TOE” can be helpful in remembering the order of assessment: - Head and face: Check for lacerations, hematoma, or other signs of trauma. - Eyes, ears, nose, and throat: Look for signs of injury or infection. - And neck: Check for mobility, tenderness, or swelling. - Deitalize if necessary (e.g., log-roll the patient to assess the back). - Torso: Front and back, checking for signs of trauma or medical conditions affecting the chest and abdomen. - Organ systems (also consider checking limbs for injury or neurological deficits). - The patient’s back (if not already done). - Organize your findings to communicate effectively with other healthcare providers. - Everything else (include a review of the patient’s vital signs and medical history).

2. Focus on the Patient’s History

The patient’s medical history, including allergies, previous illnesses, and current medications, can provide critical clues about their condition. Always ask about the patient’s last meal if considering anesthesia or sedation, the onset of symptoms, and any recent travel or exposures. Use the mnemonic “SAMPLE” to guide your questioning: - S - Signs and symptoms: What symptoms is the patient experiencing? - A - Allergies: Are there any known allergies, especially to medications? - M - Medications: What medications is the patient currently taking? - P - Past medical history: Are there any significant previous medical conditions? - L - Last oral intake: When did the patient last eat or drink? - E - Events leading up to the illness or injury: What happened before the emergency?

3. Don’t Forget Vital Signs

Vital signs are a crucial part of the secondary assessment. They provide quantifiable data that can indicate the severity of the patient’s condition and help in monitoring changes over time. Ensure you document: - Respiratory rate and depth - Pulse rate and rhythm - Blood pressure - Oxygen saturation - Level of consciousness (using scales like AVPU or GCS) - Pain level (using a pain scale)

4. Use Your Senses

During the secondary assessment, use all your senses to gather information. - Look for signs of injury, such as lacerations, burns, or deformities. - Listen to the patient’s chest with a stethoscope to assess lung sounds and heart rhythm. - Feel for abnormalities, such as tenderness, swelling, or changes in skin temperature. - Smell for any unusual odors that might indicate a medical condition (e.g., diabetic ketoacidosis can cause a sweet odor). - Sometimes, even taste can be relevant, although this is less common in EMS assessments.

5. Communicate Effectively

Clear and concise communication is vital, both with the patient and with other healthcare professionals. Ensure that your report includes all relevant information gathered during the secondary assessment. Use a standardized format, such as the ICS (Identification, Chief Complaint, History, Assessment, and Plan) or the SOAP (Subjective, Objective, Assessment, and Plan) note, to organize your findings. Effective communication helps in ensuring continuity of care and can significantly impact patient outcomes.

In conclusion, a thorough secondary assessment is a cornerstone of EMS care, providing critical information that guides treatment decisions and improves patient outcomes. By following these tips and staying focused on providing compassionate and high-quality care, EMTs can make a significant difference in the lives of their patients.

By mastering the skills involved in a secondary assessment and staying up-to-date with the latest practices and guidelines, EMTs can enhance the quality of care they provide, ultimately leading to better outcomes for their patients.