1. Seven Chapter Scene Size-Up, Initial Assessment, Baseline Vitals, and SAMPLE History

3. O VERALL ASSESSMENT SCHEME Scene Size-Up Initial Assessment Trauma Medical Physical Exam Vital Signs & SAMPLE History SAMPLE History Physical Exam & Vital Signs Detailed Physical Exam Ongoing Assessment HOSP

4. Scene Size-up An assessment to ensure the well-being of the EMT-Basic K EY TERM

6. S CENE SAFETY TECHNIQUES

8. Crash or Rescue Scenes Toxic Substances or Hazmat

9. Crime Scenes & Violence Unstable Surfaces: Slopes, Ice, Water

13. BSI Review: Gloves Mask and Eye Protection (Continued)

14. BSI Review: Gown

15. Mechanism of Injury The physical event that caused an injury (fall, motor vehicle accident, etc.) K EY TERM

18. Mechanism of Injury: Motor Vehicle Collision - Head On (Continued)

19. Mechanism of Injury: Motor Vehicle Collision - Rear Impact (Continued)

20. Mechanism of Injury: Motor Vehicle Collision - Side Impact (Continued)

21. Mechanism of Injury: Motor Vehicle Collision - Rollover (Continued)

24. Mechanism of Injury: Vehicle Interior

26. Mechanism of Injury: Penetrating Trauma

30. Scene Size-Up Initial Assessment Trauma Medical Physical Exam Vital Signs & SAMPLE History SAMPLE History Physical Exam & Vital Signs Detailed Physical Exam Ongoing Assessment HOSP O VERALL ASSESSMENT SCHEME

33. P RECEPTOR P EARL Many EMT-Bs, especially at the beginning of their careers, are reluctant to apply a painful stimulus. Out of shyness or a reluctance to harm the patient, they apply only a mild stimulus that is not sufficient to rouse the patient. The EMT then notifies the ED that the patient is unresponsive to verbal and painful stimuli. But on arrival at the ED, the staff is easily able to elicit a response with a brisk sternal rub or a pinch of the trapezius. Watch for this tendency with new or inexperienced EMT-Bs, and give them the benefit of your experience.

34. Assess the airway.

37. Assess breathing.

39. P RECEPTOR P EARL New EMT-Bs, in their desire to explain to the patient everything that is going on, may say something like, “I’m going to count your breaths right now, so just relax.” Of course, the patient who knows someone is counting his or her breathing rate will think about it and probably breathe either faster or slower as a result. If you hear new EMT-Bs using this approach, remind them that counting a respiratory rate should be done without bringing the patient’s attention to it.

40. Circulation: Pulse, bleeding, skin

42. Infants: Check brachial pulse.

43. Look for and control severe bleeding.

45. Infants/children: Capillary refill

48. Focused history and physical exam (medical) or Focused history and physical exam (trauma) Determine Next Assessment Step

49. Scene Size-Up Initial Assessment Trauma Medical Physical Exam Vital Signs & SAMPLE History SAMPLE History Physical Exam & Vital Signs Detailed Physical Exam Ongoing Assessment HOSP O VERALL ASSESSMENT SCHEME

51. Respirations

54. If you cannot feel a radial pulse, check the carotid pulse.

55. Check skin color, temperature, and condition.

59. Pupils

60. Abnormal Pupil Conditions

61. Palpation Auscultation Measuring Blood Pressure

66. Pertinent past history should include medical, surgical, and trauma factors.

67. 1. What are the components of a scene size-up? 2. List the steps in the initial assessment of a patient. 3. Give examples of patients who should be handled as a “high priority.” 4. What does the acronym SAMPLE stand for? 5. What is the range of normal vital signs? R EVIEW QUESTIONS