One-Pager
EMS Patient Assessment
Scene to handoff for EMT and paramedic: XABCDE, history, GCS, reassessment, reports
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Scene size-up and primary assessment
- PPE, then scene safety; recheck it all call
- Mechanism of injury (MOI) or nature of illness; number of patients
- Call for resources early: ALS, fire, police
- Consider spinal motion restriction
Primary: general impression, AVPU, chief complaint and life threats, then XABCDE. Fix problems as you find them.
| Step | Check | Act now |
|---|---|---|
| X | Spurting or pooling blood | Tourniquet, packing, direct pressure |
| A | Open? Snoring, gurgling, fluids | Position (jaw thrust if trauma), suction, adjunct |
| B | Rate, effort, chest rise, SpO₂ | Oxygen, BVM if inadequate, seal chest wound |
| C | Pulse, skin, capillary refill | Position, keep warm, IV/IO (paramedic) |
| D | AVPU or GCS, pupils, glucose if altered | Treat low glucose per protocol; note deficits |
| E | Expose to find injuries | Re-cover; prevent hypothermia |
End the primary with a priority and transport decision: unstable or potentially unstable means go now.
History: SAMPLE and OPQRST
| SAMPLE | OPQRST |
|---|---|
| Signs and symptoms | Onset: sudden or gradual? |
| Allergies | Provokes/palliates: worse or better? |
| Medications | Quality: patient's own words |
| Pertinent past history | Radiation: does it spread? |
| Last oral intake | Severity: 0–10 |
| Events leading up | Time: how long? Changing? |
Pertinent negatives: expected findings that are absent (chest pain without shortness of breath). Record and report them.
Secondary assessment: medical vs trauma
| Patient | Exam focus |
|---|---|
| Trauma, significant MOI or altered mental status | Rapid head-to-toe |
| Trauma, minor isolated injury | Focused exam of the injury |
| Medical, responsive | History, then focused exam |
| Medical, unresponsive | Rapid full-body exam; history from others |
- Rapid exam: head, neck (trachea, neck veins), chest (breath sounds), abdomen, pelvis, limbs (pulse, motor, sensation), back and buttocks
- DCAP-BTLS: deformities, contusions, abrasions, punctures, burns, tenderness, lacerations, swelling
- Paramedic: a differential diagnosis steers the exam
Mental status: AVPU and GCS
AVPU: Alert (note orientation: person, place, time, event), Verbal, Pain, Unresponsive. GCS adds detail; score the best response.
| Score | Eye | Verbal | Motor |
|---|---|---|---|
| 6 | — | — | Obeys commands |
| 5 | — | Oriented | Localizes |
| 4 | Spontaneous | Confused | Normal flexion (withdraws) |
| 3 | To sound | Words (inappropriate) | Abnormal flexion (decorticate) |
| 2 | To pressure (pain) | Sounds (incomprehensible) | Extension (decerebrate) |
| 1 | None | None | None |
- Score after ABCs are managed, before sedation or paralytics
- TBI airway: GCS under 9 (or 9 and falling), airway not maintained, or SpO₂ under 90% despite oxygen; best means in your scope
- Preverbal child: pediatric GCS; standard GCS over age 2
Vital signs and reassessment
Baseline: BP, pulse, respirations; add SpO₂, skin, pupils, glucose if altered. Trend every set.
| Patient | Reassess |
|---|---|
| Unstable | Every 5 min, or more often |
| Stable | At least every 15 min |
| After any intervention | Right away: did it work? |
| Head injury | GCS each check; at least every 30 min |
| Age | Field triage red flags |
|---|---|
| Any | Motor GCS <6; RR <10 or >29; respiratory distress or support needed; room-air SpO₂ <90% |
| 10–64 | SBP <90 or HR > SBP |
| 65+ | SBP <110 or HR > SBP |
Reports and documentation
Radio report: under 1 minute, no names. One common order; follow your system's:
- Unit and provider level
- Age, sex, chief complaint, field impression
- Key history, mental status, findings
- Treatment and response
- Latest vitals
- ETA; any questions?
Handoff: a structured verbal report; for trauma, MIST (Mechanism, Injuries, Signs, Treatment).
- The PCR is a legal record: objective facts, standard abbreviations, no opinions or radio codes
- Record pertinent negatives and why a treatment was skipped (aspirin already taken)
- Paper error: one line, initial, correct; never erase
- Electronic: dated, signed addendum; never alter records to hide errors
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Calculators for this topic
Sources
- National Registry of EMTs. Patient Assessment/Management – Trauma, EMT Psychomotor Examination skill sheet (e201/10-16), 2016. Link
- National Registry of EMTs. Patient Assessment/Management – Medical, EMT Psychomotor Examination skill sheet (e202/10-16), 2016. Link
- National Registry of EMTs. Cardiac Arrest Management/AED, EMT Psychomotor Examination skill sheet (e215/07-17), 2017. Link
- National Registry of EMTs. National Registry Emergency Medical Technician Examination Specifications (2023 BLS Practice Analysis; administered from spring 2025). Link
- National Registry of EMTs. The Updated EMR and EMT Certification Examinations (launch April 7, 2025). Link
- National Registry of EMTs. National Registry Paramedic Examination Specifications (administered from July 1, 2024). Link
- NHTSA Office of EMS. National EMS Education Standards, 2021. Link
- NHTSA. National EMS Education Standards Instructional Guidelines (2009), Assessment section (Alabama Department of Public Health copy). Link
- NHTSA. National EMS Education Standards Instructional Guidelines (2009), Trauma section (Alabama Department of Public Health copy). Link
- NAEMT. PHTLS: Prehospital Trauma Life Support, 9th ed. Jones & Bartlett Learning, ©2020 (ISBN 9781284171471); publisher description via Fire-Police-EMS. Link
- NAEMT. Prehospital Trauma Life Support (PHTLS) course page. Link
- American College of Surgeons. ATLS 11 (launched July 2025). Link
- American College of Surgeons. Trauma Care Gets Major Upgrade with Launch of ATLS 11. ACS Brief, September 16, 2025. Link
- Institute of Neurological Sciences, NHS Greater Glasgow and Clyde. Glasgow Coma Scale: Do it this way (assessment aid). Link
- Glasgow Coma Scale. What is GCS? Link
- Glasgow Coma Scale. Frequently Asked Questions. Link
- Merck Manual Professional Version. Glasgow Coma Scale (table, adapted from Teasdale G, Jennett B. Lancet 1974). Link
- Hawryluk GWJ, Lulla A, Bell R, et al. Guidelines for Prehospital Management of Traumatic Brain Injury, 3rd Edition: Executive Summary. Neurosurgery. 2023;93(6):e159-e169. Link
- National Expert Panel on Field Triage. National Guideline for the Field Triage of Injured Patients, 2021 (ACS algorithm). Link
- Hamper C, Curtz C, Edwins HA, Kennel J. Oregon EMS Psychomotor Skills Lab Manual: Calling in HEAR Reports. Open Oregon, 2023 (CC BY-NC-SA 4.0). Link
- Hamper C, et al. Oregon EMS Psychomotor Skills Lab Manual: Trauma Assessment MARCH. Open Oregon, 2023. Link
- Hamper C, et al. Oregon EMS Psychomotor Skills Lab Manual: Medical Assessment. Open Oregon, 2023. Link
- Mistovich J, Limmer D. Transition Series: Topics for the EMT, Medical Assessment. EMS World, April 2011. Link
- Ehlers P, et al. Prospective Observational Multisite Study of Handover in the Emergency Department: Theory versus Practice. West J Emerg Med. 2021. Link
- NEMSIS Technical Assistance Center. NEMSIS Data Dictionary, NHTSA v3.5.1, Build 251001 Critical Patch 2 (October 1, 2025). Link
- Page, Wolfberg & Wirth for NEMSIS TAC. PCR Data QuickGuide: FAQs on Owning, Amending, Retaining and Sharing Patient Care Report Data, 2023. Link
- Fried D. If You Didn't Write It, You Didn't Do It. FireEMS, January 2004 (El Dorado County EMS Agency required reading, Article 2). Link