Patient Assessment

1Why it matters

Patient assessment is the core EMT skill. Splinting, oxygen, bleeding control — none of it matters if you never figure out what's wrong. The NREMT tests assessment on nearly every question, and every skill station starts with it, because in the field the assessment is the call.

The framework has five phases, always in the same order:

1. Scene size-up — is it safe, what happened, how many patients, what do I need?
2. Primary assessment — find and fix anything that kills in minutes.
3. History taking — SAMPLE and OPQRST: what's the story?
4. Secondary assessment — a head-to-toe or focused exam, plus baseline vitals.
5. Reassessment — repeat, trend, and catch the patient who's getting worse.

2Scene size-up

Size-up starts before you leave the rig and covers five things, every call, no exceptions:

• Standard precautions (BSI/PPE). Gloves at minimum, every patient. Add eye protection, mask, or gown when blood, airway procedures, or respiratory illness are in play. Decide before contact, not after.
• Scene safety. Traffic, fire, downed lines, unstable vehicles, hostile bystanders, dogs. If the scene isn't safe, you don't enter — a hurt EMT is one more patient and one less rescuer.
• MOI / NOI. Trauma calls have a mechanism of injury (what forces hit the body); medical calls have a nature of illness (why EMS was called). Read the scene: starred windshield, pill bottles, space heater. It shapes everything that follows.
• Number of patients. Count before you commit to anyone. If patients outnumber your resources, you're in a mass-casualty incident — declare it, request resources, and shift to triage (see the START Triage guide).
• Additional resources & c-spine. Do you need ALS, fire, extrication, law enforcement, more ambulances? And based on the MOI, does this patient need spinal motion restriction? Decide now — resources take time to arrive.

3Primary assessment

The primary assessment answers one question in about 60 seconds: is anything killing this patient right now? It starts the moment you see them.

Form a general impression — age, position, work of breathing, skin color, obvious blood. Then check responsiveness with AVPU: is the patient Alert, responsive to Verbal stimulus, responsive to Painful stimulus, or Unresponsive? Anything below Alert raises your concern immediately.

Then work the ABCs:

4History: SAMPLE & OPQRST

Once nothing is actively killing the patient, get the story. Most of what you'll ever know about a medical patient comes from two mnemonics — ask them the same way every time and you'll never leave a hole in your report.

SAMPLE — the baseline history for every patient

S — Signs & symptoms

What you can see or measure (signs) and what the patient tells you they feel (symptoms).

A — Allergies

Medications, foods, environmental. Also ask what the reaction looks like.

M — Medications

Prescriptions, over-the-counter, herbal, recreational. Meds are a map of the medical history.

P — Pertinent past history

Medical conditions, surgeries, hospitalizations relevant to today's complaint.

L — Last oral intake

When and what they last ate or drank — matters for diabetics, surgery candidates, and airway risk.

E — Events leading up

What was the patient doing when this started? Often the most revealing answer of the six.

OPQRST — digging into pain or a chief complaint

O — Onset

What were you doing when it started? Sudden or gradual?

P — Provocation / Palliation

What makes it worse? What makes it better? Movement, breathing, rest, position?

Q — Quality

Describe it in the patient's own words — sharp, dull, crushing, tearing, burning.

R — Region / Radiation

Where is it? Does it move anywhere — arm, jaw, back?

S — Severity

On a scale of 0 to 10. The number matters less than how it changes over time.

T — Time

When did it start? Constant or intermittent? Ever had it before?

5Secondary assessment

The secondary assessment is a physical exam plus baseline vital signs. Which exam you run depends on the patient in front of you:

Whichever exam you run, you're looking and feeling for the same findings. That's DCAP-BTLS:

Round out the secondary with a full set of baseline vitals — respirations, pulse, blood pressure, skin, pupils, and pulse oximetry. These numbers are the anchor every later reading gets compared against; know what normal looks like in the Vital Signs guide.

6Reassessment

Assessment doesn't end — it loops. Reassessment repeats until you transfer care at the hospital, on a schedule set by how sick the patient is:

• Unstable or priority patients: every 5 minutes.
• Stable patients: every 15 minutes.

Each cycle, you re-check four things:

1. The primary assessment — airway, breathing, circulation, mental status. Killers can develop en route.
2. Vital signs — a fresh full set, compared against your baseline.
3. The chief complaint — better, worse, or different? New complaints count.
4. Your interventions — is the oxygen still flowing, the bleeding still controlled, the splint still doing its job?

7Self-check

Answer before you expand. If you miss one, re-read that section — then go drill it for real.