Introduction to systems of care for

patient assessment and

management

401067 Paramedic Practice 1

Week 3

For most diagnoses all that is

needed is an ounce of knowledge,
an ounce of intelligence, and a
pound of thoroughness
Anon.

Patient
assessment
Physical
examination

History
taking

Patient assessment must be

Systematic
Structured
Reproducible
Consistent

REGARDLESS OF PERCEIVED ACUITY

Dont be lulled into apathy or shortcuts just because:

1.

What you have been called to sounds benign or non-urgent

2.

The patient presents on initial visual assessment to be well

LOW ACUITY CASES MAY BE HIGH IN COMPLEXITY

Traditional paramedical approach to patient assessment

Biomedical model of patient assessment

Biological /
physiological

Bio-psycho-social model

Physiological

Patient

Social /
personal

Psychological

Where does patient assessment and care start?

MPDS problem categories

Chief Complaint

Metro. Ops

Reg. Ops

Total

Falls

4,581

2,697

7,278

Sick person (non-specific

4,206

2,437

6,643

Chest pain (non-traumatic)

4,010

2,175

6,185

Breathing problems

3,639

1,919

5,558

Unconscious/Fainting (near)

3,212

1,605

4,817

Psychiatric/Abnormal

2,005

1,068

3,073

Abdominal pain/problems

1,960

977

2,937

Traffic/transportation incident

1,540

709

2,249

Traumatic injuries (specific)

1,337

869

2,206

Overdose/poisoning (ingestion)

1,571

607

2,178

Haemorrhage/laceration

1,251

746

1,997

Convulsions/seizures

1,237

721

1,958

Assault/sexual assault

1,054

512

1,556

Stroke (CVA)

861

490

1,351

Heart problems/AICD

792

316

1,108

Unknown problem (man down)

652

387

1,039

Back pain (non-traumatic or non-

625

378

1,003

Other complaints

4,053

2,260

6,313

Chief complaints (total)

38,586

20,873

59,459

diagnosis

behaviour/Suicide attempt

recent trauma)

Response priorities

NSW Ambulance, 2013

Scene assessment = patient assessment

(`mechanism of injury)

Scene assessment

Then you find your patient

Systematic approach to patient care

Patient care algorithm

Wardrope at al 2008

Wardrope et al 2008;
NSW Ambulance 2014

A systematic approach to patient assessment

S.O.A.P.E.D.D.
S subjective information
O objective information
A analyse findings
P plan you actions
E explain treatment, options and risks to patient
D determine capacity and competency
D decide on most appropriate disposition

Considerations when taking a history

Emotional
intelligence

Rapport

Relevance

Nonjudgemental

Explanation

Patient
privacy

Empathy
Active
listening

Sensitivity

Key components of history taking

Chief
complaint /
presenting
symptom

Hx of chief
complaint /
presenting
symptom

Social Hx

Allergies

Sexual Hx

Medications

Menstrual
Hx

Previous
illnesses /
treatments

Family Hx

Geriatric
Hx

Paediatric
Hx

Systems review
Neurological

Cardiovascular

Musculoskeletal

Systems
review

Gastrointestinal
/ urinary

Respiratory

A systematic approach for standard history taking

C.H.A.M.P.S.S

C chief complaint
H history/nature of chief complaint
A allergies
M medications
P previous medical history
S social/personal history
S systems review

Assessing the chief complaint or symptom

S.O.C.R.A.T.E.S
S site
O onset
C character
R radiation
A alleviating factors
T timing
E exacerbating factors
S severity

Lecture summary

History taking is critical to establishing a provisional diagnosis

History taking must be structured and systematic

History taking should be combined with objective assessment (patient examination) prior to determining a course
of treatment or formulating a provisional diagnosis

You, as the paramedic must control the history taking process dont let the patient lead you away from your
structured routine

Ask follow up question to clarify or get more information dont be happy with just any old answer

History taking requires great communication and interviewing skills , both verbal and non-verbal

Write it down or you will forget a glove is not sufficient. A notepad is essential

Double-lecture week
The face to face lecture is still on, so see you
there!