How do Paramedics know what steps to take to save a life?

In a way: Para-medicine is almost a game. No 2 calls will ever be exactly the same and that among other things is what I LOVE about this field of work. I say that Para-medicine is like a game because we are called to a scene and then expected to figure out what is wrong with a patient ("A Differential Pre-hospital Diagnosis") and then to treat our findings accordingly but how does one go about figuring all of this out? Growing up I had seen several accidents and incidents in which Paramedics were called to the scene to help someone in need and I used to always wonder how they knew exactly what steps to take and questions to ask to find out someones problems. The answer lies in the very basics.

At the beginning of both EMT and Paramedic school we are given a "Skeleton" that will lead us into what we need to know. These skeletons are the National Registry Standard for EMT and Paramedic certification. Starting with a medical patient who calls 9-11 because something is bothering them such as difficulty breathing, Chest pain, or any other variety of medical calls, We as Paramedics use these skeletons to direct our way of critical thinking and can then ask questions accordingly.

Within the "Skeletons" I mentioned before are lots of Pneumonics that help us to remember the steps we should take to come to a differential field diagnosis of the problem so that we can treat it while getting you or your loved on to the hospital. A few of the most common Mnemonics include: ENAMES, GRC, ABC, OPQRST, and SAMPLE. I will follow the acronyms with very basic questions that sometimes get asked; These questions and mnemonics are used only to lead us where we need to go and then more detailed questions are asked of the responsive patient.

ENAMES: ENAMES are the questions we ask of ourselves before we consider entering a scene and providing any treatment. E: Environment, Is it safe? N: Number of Patients we have: A: Additional resources, Do we need any? M: Mechonism of injury, or Nature of illness, What is it? E: Extrication: Do we need to remove this patient from their current environment? S: Spinal Precautions, Do we need to take any spinal precautions? (SP's would be taken in any case of major trauma, or falls)

GRC: G: General impression of my patient, How do they look? R: Responsiveness, Can they answer my questions? C: Chief Complaint: What is the reason they called 9-11?

ABC: In any situation, The first thing we will assess is the A: Airway, We need to make sure that any patient has an open and patent airway, this is often established when a patient is able to speak to us and tell us how their feeling, If the airway is not established, The first thing we will worry about before we advance to any other treatments is opening the airway and making sure that our patient has adequate ventilation's. If an open airway is the only thing that can be accomplished then that's all we would treat. B: Breathing, A normal adult breathes anywhere between 12 and 20 times per minute, The 2nd thing we assess is a patients breathing pattern and respiration's. C: Circulation, We check for a pulse, with it's accompanying rate and rhythm. Often times Paramedics may choose to get a set of Vital Signs (Pulse, Blood Pressure, Temp, Respirations, etc. during ABC)

OPQRST: This Mnemonic is used primarily to determine someone's pain and to help us understand what might be causing their pain. O: Onset, How long ago did this start? P: Provocation, Does anything make this pain feel worse or better? Q: Quality, Describe your pain for me. R: Radiation, Does your pain radiate anywhere?
S: Severity, On a scale of 1-10 1 being low 10 being the worst pain ever where do you rate your pain? T: Time, Has this happened at any other time in your life? These simple questions will tell us a-lot about what kind of pain our patient is having and what additional questions we will need to ask to figure out their problems.

SAMPLE: S: Signs and Symptoms, These are both what we can see and what the patient is complaining of. A: Allergies, Are you allergic to any medications? M: Medications, Are you currently taking any medications? P: Past Pertinant Medical History, Are you now or have you recently been seeing a Dr. for anything? L: Last Oral Intake, When was the last time you had anything to eat? E: Events Leading Up To, What were you doing before and when this happened?.. SAMPLE is the most commonly used mnemonic in a medical patient scenario because it helps us to understand the patients history.

Don't be surprised if a Paramedic asks you if he can assess your body from head to toe during, before or after asking a few of these questions. In many cases we will do a head to toe assessment just to see if perhaps anything else is bothering you. As I stated before these are just the very basics of the Paramedic skeleton that we use when assessing a patient during a medical call, There is so much more to a patient assessment that I couldn't even try to cover it all here. The answers to the pieces of the puzzle lie within this skeleton and can lead us into proper treatment. If you call 9-11 because you believe something is wrong, Chances are you will hear a Paramedic asking you questions that lead off of this skeleton. What you probably won't hear is the questions stated in such a basic way as each paramedic eventually develops their own "Groove" and style for a patient assessment, However, You'd better believe that we all know this skeleton inside out and backwards because we all fall back on it from time to time and using these steps is how we are going to figure out what is wrong with you.

Trauma calls aren't much different from Medical calls, We follow a very similar skeleton of steps and mnemonics however with trauma we will start with a head to toe assessment and control any major bleeding or life-threatening injuries that we see.

I was caught by our lead instructor with my butt on my desk and my feet in my chair chatting away during our lunch break and as a result I was able to run a scenario in front of everyone. I was dispatched to a 21 year old female who was losing blood through a very abnormal and heavy flow, because I was a male, she didn't want to talk to me and was very reluctant to answer any of my questions. This scenario challenged my way of critical thinking and ultimately forced me to fall back on the skeleton and thoroughly think through how I was phrasing my questions and what I needed to have her do to help me understand what was wrong with her while still attempting to maintain a somewhat decent level of comfortability for my patient.

EMS Pocket Guide Pack: Patient Assessment Handbook / Pocket Reference for the EMT-B And First Responder 2e / Drug Guide for ParamedicsThe Paramedic Learning Series: Patient Assessment