SECTION 2 - PATIENT ASSESSMENT

4/5/6.2.1

Primary Survey Medical Adult

Primary Survey Medical - Adult

PATIENT ASSESSMENT

05/08

AP
Take standard infection control precautions

Consider pre-arrival information

Scene safety
Scene survey
Scene situation

Assess responsiveness

S2

Go to
FBAO
CPG

Head tilt/chin lift

Suction
OPA
NPA

Airway
obstructed

Yes

No

Yes

Airway patent

Maintain

No

Give 2 initial
Ventilations

No

Breathing

Consider

Yes

Oxygen therapy

Oxygen therapy

Pulse

Go to
Basic Life
Support
CPG

No

Yes

AVPU assessment

Go to
appropriate
CPG

Request
ALS

Life
threatening

Clinical status decision

Non serious
or life threat

Serious not
life threat

Consider
ALS

20

EMT

Go to
Secondary
Survey
CPG

PHECC Clinical Practice Guidelines - Emergency Medical Technician

SECTION 2 - PATIENT ASSESSMENT

4/5/6.2.2

Primary Survey Trauma Adult

EMT
AP

Take standard infection control precautions

Consider pre-arrival information

Mechanism of
injury suggestive
of spinal injury

No

C-spine
control

Yes

Assess responsiveness

P
Go to
FBAO
CPG

Jaw thrust
(Head tilt/chin lift)
Suction
OPA
NPA

Airway
obstructed

Yes

Yes

No

Airway patent

No

Breathing

Yes

Pulse

No

Maintain

PATIENT ASSESSMENT

Scene safety
Scene survey
Scene situation

Primary Survey Trauma - Adult

05/08

S2

No

Give 2 initial
Ventilations

Consider
Oxygen therapy

Oxygen therapy
Go to
traumatic
cardiac
arrest
CPG

Yes
Arrest major external haemorrhage

AVPU assessment

Expose & check obvious injuries

Treat life threatening injuries only
at this point
Go to
appropriate
CPG

Request
ALS

Life
threatening

Clinical status decision

Non serious
or life threat

Serious not
life threat

Consider
ALS

Go to
Secondary
Survey
CPG

PHECC Clinical Practice Guidelines - Emergency Medical Technician

21

Secondary Survey Medical - Adult

PATIENT ASSESSMENT

SECTION 2 - PATIENT ASSESSMENT

S2

4.2.4

EMT

Secondary Survey Medical Adult

05/08

Primary
Survey

Record vital signs

Patient acutely
unwell

Markers identifying acutely unwell

Cardiac chest pain
MEWS Score of 5
Acute pain > 5

Yes

No
Focused medical
history of presenting
complaint
Go to
appropriate
CPG

Request
ALS

Identify positive findings

and initiate care
management

SAMPLE history

Check for medications

carried or medical
alert jewellery

Consider
Paramedic

Modified Early Warning Score (MEWS)

Score
Resp Rate
Heart Rate
Sys BP
Temp
AVPU

<9
< 71

< 41

41 - 50

71 - 80

81 - 89

< 35

9 - 14

15 - 20

21 - 29

> 29

51 - 100

101 - 110

111 - 129

> 129

90 - 159

160 - 169

170 - 199

35 38.4
Alert

> 199

> 38.4
Voice

Pain

Unresponsive

A score of 5 or more is a marker for immediate transport

Reference: Sanders, M. 2001, Paramedic Textbook 2nd Edition, Mosby

Gleadle, J. 2003, History and Examination at a glance, Blackwell Science
Rees, JE, 2003, Early Warning Scores, World Anaesthesia Issue 17, Article 10

22

PHECC Clinical Practice

PHECC Clinical
Guidelines
Practice
- Emergency
Guidelines
Medical Technician

Secondary Survey Trauma Adult

4.2.5

EMT

05/08

Primary
Survey

Yes

No
Examination of
obvious injuries

Record vital signs

Go to
appropriate
CPG

Identify positive findings

and initiate care
management

SAMPLE history

Complete a head to toe

survey as history dictates

Request
ALS

PATIENT ASSESSMENT

Markers for multisystem trauma

present

Secondary Survey Trauma - Adult

SECTION 2 - PATIENT ASSESSMENT

S2

Check for medications

carried or medical
alert jewellery

Consider
Paramedic

Markers for multi-system trauma

Systolic BP < 90
Respiratory rate < 10 or > 29
Heart rate > 120
AVPU = V, P or U on scale
Mechanism of Injury

Reference: McSwain, N. et al, 2003, PHTLS Basic and advanced prehospital trauma life support, 5th Edition, Mosby

PHECC Clinical Practice Guidelines - Emergency Medical Technician

23

SECTION 2 - PATIENT ASSESSMENT

4/5/6.2.6

Pain Management Adult

05/08

EMT

Pain Management - Adult

Pain

PATIENT ASSESSMENT

P
AP

Pain assessment

Nitrous Oxide & Oxygen, inhalation

Yes

Adequate relief
of pain

No

Analogue Pain Scale

0 = no pain..10 = unbearable
5 on pain
scale severe

No
3 to 4 on
pain scale moderate

Paracetamol 1 g PO
And / or

S2

Ibuprofen 400 mg PO

< 5 on pain
scale

No

Request
ALS

Yes
Morphine 2 mg IV

Consider

Repeat Morphine at
not < 2 min intervals
if indicated.
Max 10 mg

Ondansetron 4 mg IV slowly
Or
Cycilizine 50 mg IV slowly

Go back
to
originating
CPG

Decisions to give analgesia must

be based on clinical assessment
and not directly on a linear scale

Special Authorisation:
Advanced Paramedics are authorised to administer Morphine
10 mg IM if IV not accessible, the patient is cardio-vascularly
stable and no cardiac chest pain present

AP

EMT
P

Special Authorisation:
Registered Medical Practitioners may authorise the
use of IM Morphine by Paramedic or EMT practitioners
for a specific patient in an inaccessible location

Reference: World Health Organization, Pain Ladder

24

PHECC Clinical Practice Guidelines - Emergency Medical Technician