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Everyday EMS
by Greg Friese

4 patient assessment scenarios that are actually useful

Consider adding these often-encountered patients to your class's patient assessment drills or high-fidelity patient simulations

By Greg Friese

I was reviewing a set of case studies for a high-fidelity patient simulation program. They were well-prepared and factual, and the signs and symptoms logically changed if the treatment progression was accurate.

Like many patient assessment drills or simulations, these were scenarios for infrequently encountered traumatic injuries. Tension pneumothorax, femur fracture and abdominal evisceration will probably be only a tiny fraction of the calls EMTs or paramedics run in their careers.

A large percentage of patients don't easily conform to a National Registry skill sheet or instructor throwaway lines like "load and go" or "stay and play." Consider adding these often-encountered patients to your class's patient assessment drills or high-fidelity patient simulation to prepare your students for what they are more likely to encounter on the streets:

1. Elderly patient fell. Spouse is unable to lift patient back into bed, and assistance is needed. Patient denies injury and refuses treatment. Spouse would like the patient transported. Practice the lift assist and injury assessment. Discuss the conversation to encourage transport, but respect the wishes of the patient and the spouse, and document that transport was declined against medical advice.

2. Middle aged patient reported as "intoxicated for days." Patient is incontinent of urine, has not eaten for several days and is only aware of person and place. Patient requests transport to most distant receiving facility for alcohol abuse treatment. Practice assessment of incoherent and poor historian and identifying other possible causes of altered mental status. Discuss risks of transporting to closest receiving facility versus the patient's preferred hospital.

3. Elderly patient frequently calls 911 because she is weak and "shaky." Her vital signs are within normal limits, and she has no obvious injuries. During the history portion of the assessment she begins to quietly cry and confides that she is "terribly lonely." Discuss alternative community and social services for this patient. Also discuss soft-skills approaches to treating this patient's emotional emergency.

4. Caregiver reports that a feeding tube "has fallen out" of a patient who was paralyzed from a motorcycle accident. Patient needs transport to physician's office for tube replacement. Discuss different types of permanent and semi-permanent tubes and catheters patients may have. Talk about assessment of patient as well as the tube placement location. Practice patient transfers from bed to cot or wheelchair to cot to avoid displacing tubes and catheters.

How do you make your patient assessment scenarios and simulations real and reflective of actual calls students are likely to encounter? 

About the author

Greg Friese is Editor-in-Chief of He is an educator, author, paramedic, and marathon runner. Ask questions or submit tip ideas to Greg by e-mailing him at
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Susan Yurek Susan Yurek Thursday, September 04, 2014 6:31:32 PM These scenarios are great! You could have a variety of aspects of scenario 1: Multiple falls over a few days, fall with hip injury, went back to bed now three hours later can't put weight on a leg or sit up (pelvic fx). I've also decided after several months of "FTOing" multiple students, that we need to practice what we do in the ambulance. Run a scenario, get the patient to the ambulance, then reassess and do the call in. Many students are great at assessments but seem lost once they get the patient in the ambulance. Our transports can be 15 to 45 minutes. Thanks for the great suggestions.

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