Patient assessment is an essential EMS provider skill that improves with experience and education, but are you wearing blinders? I believe that all EMS providers can improve this process and efficiency by using all bodily senses: sight, hearing, touch, smell and taste. Realizing the importance of this ability will help improve patient outcome and even safety. A provider can tell what’s wrong with a patient and determine how severe they are before you speak to or question the patient, family, friends or bystanders. Doing a complete assessment helps you define a possible diagnosis followed by an appropriate treatment modality.
Some get this concept quickly while others take time to master this ability. It is an essential proficiency that an EMS provider must develop and understand. It will save your patient’s life and maybe even yours, too.
The five senses
Most emergency care providers limit themselves by not using all their senses. They miss subtle signs/symptoms, which could affect one’s findings, leading to an incorrect diagnosis and treatment plan. Tunnel vision can develop due to the horrific nature of an incident or grotesque injury one may encounter. More than 50 percent of your sensory input, sight may pull you in the wrong direction during your assessment process. For example, general systemic cyanosis could make you believe your patient is experiencing severe respiratory compromise, but indeed can be a sign of something different, such as extreme hypothermia or even blood loss.
Hearing what the patient and others tell you is just as important as any visual clues. If your patient describes that they felt and heard something break during a traumatic event, I’ll bet you’ll find a fracture or dislocation. If they tell you they feel like they are going to die, you need to listen and believe them, because it might happen. If a family member or bystander describes to you something other than what you are seeing, you may want to revisit and look again at the not-so-obvious things. Listening to deferential sounds may also help your assessment skills. Careful assessment of breath sounds is a perfect example. Hearing rales, rhonchi, wheezes, or other sounds can distinguish different airway and respiratory diseases or compromise.
Touch is also an important finding and observation. Using protective equipment such as medical gloves can make this process more difficult. Using the back of your arm to feel your patient’s skin to determine their body temperature and the presence or lack of moisture can help you distinguish between several medical issues. Palpating your patient’s body looking for unusual findings or causing them pain can assist in your overall assessment results and conclusions.
A smell can be an essential finding that may save your life or your patient’s. You must remember that just because you smell something once and not detect it again doesn’t mean it is not present. Many chemicals can cause olfactory fatigue or deaden your sense of smell. Others, such as carbon monoxide, don’t give off an odor and can asphyxiate and kill you.
Taste is not a common practice in the medical world, and I’m not suggesting you start making it one. But if you perceive a taste, good or bad, it should be noted and its causes determined. Once again, not doing this can be a safety issue that may need mitigation.
Application
Let’s evaluate the following scenarios:
- You knock on the door of a residence to gain access. You find an elderly female sitting in the corner of the room having a casual conversation. There are several other people in the room watching a football game.
- Approaching a residence, people are outside waving you down. As you exit your ambulance, everyone seems concerned, telling you to hurry. You are directed to an elderly female slumped over in a chair. The TV is on, but no one is watching. The patient is unconscious and appears ashen gray. While you observe a used syringe and uneaten food on a table, you notice an odd odor in the room.
These are different cases where your observations alone will inform you long before you verify through questioning.
Don’t become a practitioner who does routine patient assessments and misses out on other vital clues. Look beyond tunnel vision by using all your senses to evaluate the incident and patient(s). If you believe something is wrong, then you should treat it. If something doesn’t feel right, looks or feels suspicious, smells or tastes funny, re-evaluate. Being an excellent patient advocate will help you assess and correctly treat a patient.
