Notes on Advanced Level Psychomotor Examination for EMTs

Introduction

• Focus on patient assessment
• Includes verbalizing appropriate PPE precautions
• Seam size-up and safety determination
• Mechanism of injury/nature of illness evaluation
• Assessment and treatment priorities

Scene Size-Up

• Evaluate scene situation safety
• Determine mechanism of injury/nature of illness
• Assess number of patients
• Request additional help if needed
• Consider spine stabilization

Primary Survey

• General impression of the patient
• Determine responsiveness/level of consciousness
• Identify chief complaint/apparent life threats
• Assess airway and breathing:
  • Ensure adequate ventilation
  • Initiate appropriate oxygen therapy
• Circulation assessment:
  • Control major bleeding
  • Assess skin color, temperature, condition
  • Assess pulse
• Identify priority patient and make transport decision

History Taking and Secondary Assessment

• History of present illness:
  • Onset, severity, provocation, time, quality, associated signs
  • Symptoms related to OPQRST
• Past medical history:
  • Allergies, past pertinent history, events leading to current situation
  • Medications, last oral intake
• Secondary assessment:
  • Affected body part/system assessment
  • Rapid assessment completion
  • Systems include cardiovascular, neurological, reproductive, pulmonary, musculoskeletal, GI/GU, psychological/social

Vital Signs & Diagnostics

• Vital signs:
  • Pulse, respiratory rate and quality, blood pressure, AVPU
• Diagnostics:
  • Blood glucose test, pulse oximetry, ETCO2 if needed

Patient Management

• State field impression of patient
• Verbalize treatment plan and call for interventions
• Transport decision and re-evaluation
• Reassessment:
  • Repeat primary survey
  • Repeat vital signs
  • Evaluate treatment responses
  • Repeat secondary assessment concerning patient complaints or injuries

Critical Fail Criteria

• Failure to initiate or call for transport within 15-minute limit
• Inadequate PPE precautions
• Scene safety not determined before patient approach
• Inadequate oxygen therapy or ventilation
• Failure in managing airway, breathing, and circulation threats
• Failure in immediate transportation vs. on-scene assessment determination
• Detailed history or exam before airway and circulation threat assessment
• Failure to identify primary patient problem
• Ordering dangerous/inappropriate interventions
• Failure to provide spinal protection when indicated