Keep It Simple: Patient Assessment in EMS


By:  The Musing Medic (@TheMusingMedic)


These Two Ideas Keep Me Out Of Trouble

Whenever I take on a new paramedic student as a preceptor, I have two pieces of advice:


  1. There is no good treatment without a good assessment
  2. Occam’s Razor: With all things being equal, the simplest explanation is usually the right one


The question is how do you utilize these two tidbits of knowledge?


Keep It Simple.


In the pre-hospital setting, the paramedic is thrown into the unknown. We are expected to walk into an unfamiliar environment where we will assess, diagnose, and treat a complete stranger.  Our training prepares us to recognize and manage numerous pathologies of differing presentations. Everything from medical to trauma, pediatric to geriatric, walking wounded to circling the drain.  Just like our more well trained EM physician colleagues, we are expected to manage whatever comes through the door. Doing this requires the ability to perform a proper assessment of the patient and situation.  So how should a proper assessment in the pre-hospital environment go?


During my patient encounters, I focus on looking and listening.  Look at the patient for signs and symptoms of disease processes. Additionally, look at the patient in the context of their past medical history and current medications.  It is also wise to view the patient with regard to their environment, living situations, etc.  Most important though is to listen to the patient.  I don’t mean lung sounds or cardiac auscultation only.  Listen to their story closely, paying attention to the details.  The patient will tell you what is wrong with them. Then connect the dots between looking and listening.  Doing this, a very simple plan of attack, will always lead to a good assessment.


What about the common pitfall of misdiagnosis?  How can paramedics avoid misdiagnosing a common condition as a more obscure medical issue?


When You Hear Hoofbeats, Think Horses Not Zebras.


Zebras is common term in medical lingo.  They are rare, esoteric conditions or diagnoses that are infrequently encountered.  We learn about these conditions during didactics and may even encounter them at some point in the course of our career.  But if we see one hundred patients with similar signs and symptoms, the likelihood that one or more has the rare condition is between slim and none.  So keep it simple. Focus on the most likely cause.  Let the looking and listening skills mentioned previously guide you to the most likely medical issue.


If you keep these two thoughts in mind during your patient encounter, the best care will ultimately be provided.  It will also help avoid both overreacting and under reacting.  An even keel is the way to go.


Till next time


The Musing Medic