LEARNING OBJECTIVE: Recognize the assessment sequence for emergency medical care in the field, and identify initial equipment and supply needs.

Patient assessment is the process of gathering information needed to help determine what is wrong with the patient. Assessments that you conduct in the field (at the emergency scene) or during transport are known as a field assessments.

Field assessments are normally performed in a systematic manner. The formal processes are known as the primary survey and the secondary survey. The primary survey is a rapid initial assessment to detect and treat life-threatening conditions that require immediate care, followed by a status decision about the patient's stability and priority for immediate transport to a medical facility. The secondary survey is a complete and detailed assessment consisting of a subjective interview and an objective examination, including vital signs and head-to-toe survey. (Both types of surveys will be discussed in more detail later in this chapter.)

BEFORE ARRIVAL AT THE SCENE
Before or during transit to an emergency scene, you may learn about the patient's illness or injury.

Although this information could later prove to be erroneous, you should use this time to consider what equipment you may need and what special procedures you should use immediately upon arrival.

ARRIVAL AT THE SCENE
When you arrive at an emergency scene, you need to start gathering information immediately. First, make sure the scene is safe for yourself, then for the patient or patients. Donot let information you received before your arrival form your complete conclusion concerning the patient's condition. Consider all related factors before you decide what is wrong with the patient and what course of emergency care you will take.

You can quickly gain valuable information as to what may be wrong with the patient. Observe and listen as you proceed to your patient. Do not delay the detection of life-threatening problems. Be alert to clues that are obvious or provided to you by others. Some immediate sources of information may come from the following:

* The scene 3/4 Is it safe or hazardous? Does the patient have to be moved? Is the weather severe?

* The patient 3/4 Is the patient conscious, trying to tell you something, or pointing to a part of his body?
* Bystanders 3/4 Are they trying to tell you something? Listen. They may have witnessed what happened to the patient or have pertinent medical history of the patient (for example, prior heart attacks).

* Medical identification device 3/4 Is the patient wearing a medical identification device (necklace or bracelet)? Medical identification devices can provide you with crucial information on medical disorders, such as diabetes.

Mechanism of injury 3/4 Was there a fire? Did the patient fall or has something fallen on the patient? Is the windshield of vehicle cracked or the steering wheel bent?

* Deformities or injuries 3/4 Is the patient lying in a strange position? Are there burns, crushed limbs, or other obvious wounds?
* Signs 3/4 What do you see, hear, or smell? Is there blood around the patient? Has the patient vomited? Is the patient having convulsions? Are the patient's clothes torn?

PRIMARY SURVEY
As stated earlier, the primary survey is a process carried out to detect and treat life-threatening conditions. As these conditions are detected, lifesaving measures are taken immediately, and early transport may be initiated. The information acquired before and upon your arrival on the scene provides you with a starting point for the primary survey. The primary survey is a "treat-as-you-go" process. As each major problem is detected, it is treated immediately, before moving on to the next.

During the primary survey, you should be concerned with what are referred to as the ABCDEs of emergency care: airway, breathing, circulation, disability, and expose.

A = Airway. An obstructed airway may quickly lead to respiratory arrest and death. Assess responsiveness and, if necessary, open the airway.

B=Breathing. Respiratory arrest will quickly lead to cardiac arrest. Assess breathing, and, if necessary, provide rescue breathing. Look for and treat conditions that may compromise breathing, such as penetrating trauma to the chest.

C=Circulation. If the patient's heart has stopped, blood and oxygen are not being sent to the brain. Irreversible changes will begin to occur in the brain in 4 to 6 minutes; cell death will usually occur within 10 minutes. Assess circulation, and, if necessary, provide cardiopulmonary resuscita-tion (CPR). Also check for profuse bleeding that can be controlled. Assess and begin treatment for severe shock or the potential for severe shock.

D=Disability. Serious central nervous system injuries can lead to death. Assess the patient's level of consciousness and, if you suspect a head or neck injury, apply a rigid neck collar. Observe the neck before you cover it up. Also do a quick assessment of the style="mso-spacerun: yes"> patient's ability to move all extremities.

E=Expose. You cannot treat conditions you have not discovered. Remove clothing- especially if the patient is not alert or communicating with you- to see if you missed any life-threatening injuries. Protect the patient's privacy, and keep the patient warm with a blanket if necessary.

As soon as the ABCDEprocess is completed, you will need to make what is referred to as a status decision of the patient's condition. Astatus decision is a judgment about the severity of the patient's condition and whether the patient requires immediate transport to a medical facility without a secondary survey at the scene. Ideally, the ABCDE steps, status, and transport decision should be completed within 10 minutes of your arrival on the scene.