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Patient Handling Tip

From the Editor
by Greg Friese, Editor-in-Chief

Patient assessments: How to avoid free-for-alls

Updated July 20, 2015

Is your patient assessment like a gift-giving free-for-all or officiated like mom in a Santa hat?

On Christmas morning, our kids raced into the living room, prepared to thrash their way through the pile of gifts as rapidly as possible.

Substantial cajoling and adult guidance from mom in a Santa hat was required to initiate an orderly process of taking turns, appreciating a gift after it was opened, and taking occasional pauses for a meal or to welcome additional relatives.

I also know some families that have just the opposite process; a gift-opening free-for-all.

Kids scrape through the pile for the presents with their name on the label and tear into them as rapidly as possible. In a matter of minutes, the area around the Christmas tree is covered with wrapping paper, box debris, and toy parts.

In tiered response systems, a patient can be quickly surrounded by three or four medical first responders from a fire company, a two- or three-person ambulance crew, and even a police officer.

Sometimes this leads to a patient assessment free-for-all. A bewildered patient, roughed up like a new toy in the hands of a 3-year-old, is peppered with questions and poked and prodded by responders coming at them from three different directions.

Work with your on-scene crew to determine a process where each patient assessment question or assessment is treated like a gift.

Follow an orderly process to open the gifts, pause to appreciate the importance of each gift, and make sure really significant gifts, like hypotension in a chest pain patient or low blood sugar, are announced to the whole group before the next gift opening begins.

Continue the conversation in the comments. How do you keep the patient assessment process smooth and orderly?

About the author

Greg Friese, MS, NRP, 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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Steve Whitehead Steve Whitehead Wednesday, January 04, 2012 2:25:43 PM If I'm at the head of the patient, I'll often end up dominating the subjective portion of the assessment and covering the C-spine and LOC portion of the assessment. If I'm part of the rabble, I think I get a pretty quick jist of whether or not patient assessment priorities are being covered. If they are, I back off and support the crew. If they aren't, I tend to wait for the appropriate moment and launch a head-to-toe. I start by saying, "Jim, I'm goig to start at your head and go all the way to your feet making sure we're not missing anything." In that way I let everyone know that I'm planning on doing the whole shebang. Also, my assessment behavior is very different depending on if I'm the attending paramedic or not. Great question. I hope we get a bunch of comments on this one. I'd like to hear more.
Brandon Oto Brandon Oto Thursday, January 05, 2012 9:15:59 AM This is part of the reason why I think it's extremely important in most cases to have ONE person who runs the scene. There may be ten of you there, poking and prodding, beginning interventions or performing assessments, but there should be a single person through whom all information is flowing, who is making the decisions that need to be made, and (in my opinion) who is actually communicating with the patient. There's nothing more obnoxious to the patient AND more calculated to throw off my diagnostic "patter" than people jumping in with questions out of left field or derailing remarks. There can be discussion or input, but in the end one person should be asking the questions and making the calls. I know of very few crews that can significantly mess with this process and still make things work.
Wayne 'Smitty' Smith Wayne 'Smitty' Smith Friday, January 06, 2012 7:50:11 PM Once the lead medical crew is on scene, they should give everyone else responsibilities, eg, boiling water and getting clean towels for the childbirth. If they're busy with a task, they can less likely get in the way!
Jayeson Vance Jayeson Vance Saturday, January 07, 2012 10:36:56 AM Brandon's right, let the IC take charge and the whole issue is avoidable.
Joe Barlow Joe Barlow Sunday, January 08, 2012 9:51:36 AM I love the comments. Great article.
Greg Friese Greg Friese Tuesday, January 10, 2012 6:15:16 AM Thanks for the compliments and comments. The pit crew concept is being taught for cardiac arrest calls and gives each crew member a specific assignment. Should the pit crew concept be applied to all calls?
Daniel Scanlon Daniel Scanlon Wednesday, February 13, 2013 5:25:05 AM Having 5 children this is a great way to look at this.we see it a lot in the assessement of our older population who are at a greater disadvantage due to hearing and the feeling they have little say in there own care in an emergency.This is the reason why I think it's extremely important in most cases to have ONE person who runs the scene.And informs the patient of what's going on.