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Primary Assessment

Category: Patient Assessment Sources: raw/supplemental/patient-assessment-sequence.md, raw/nremt/psychomotor-skills.md Last updated: 2026-04-03

Overview

The primary assessment identifies and immediately treats life threats. It is conducted on every patient, every time, directly after scene-size-up. The goal is simple: find and fix anything that will kill the patient in the next few minutes. Airway, breathing, circulation — in that order.

Key Points

  • General impression: Form immediately on approach. Age, sex, apparent distress, is anything obviously life-threatening? This informs your urgency before you even speak to the patient.
  • AVPU scale for level of consciousness:
  • A — Alert (oriented to person, place, time, event)
  • V — Responds to Verbal stimuli
  • P — Responds to Painful stimuli
  • U — Unresponsive
  • Airway: Is it patent (open)? Maintainable? Not maintainable?
  • Trauma: jaw thrust (no head extension); no-trauma: head-tilt/chin-lift
  • Suction secretions, blood, or vomit if present
  • Insert OPA (unresponsive, no gag reflex) or NPA (conscious or intact gag) if needed
  • Breathing: Present? Rate? Depth? Quality?
  • Normal adult rate: 12–20 breaths/min; child: 15–30; infant: 25–50
  • Distressed but breathing: apply oxygen via non-rebreather mask at 10–15 LPM
  • Inadequate or absent breathing: bvm-ventilation immediately
  • Circulation: Pulse present? Rate and quality? Skin color/temperature/moisture (CTM)? Major bleeding?
  • Control major bleeding immediately — direct pressure, tourniquet if needed (see bleeding-control-shock)
  • Poor perfusion (pale, cool, diaphoretic skin; weak rapid pulse) → treat for shock
  • Transport decision: Priority (load and go) or non-priority?

Assessment Relevance

The primary assessment is the most critical component of patient care. Any life threat found here must be addressed before moving on — do not proceed to history or secondary assessment if the airway is not secured or major bleeding is not controlled. Transport decision made here determines whether the rest of the assessment happens on scene or en route.

Priority indicators (load and go): - Poor general impression - Unresponsive or altered LOC - Difficulty breathing - Signs of shock (poor perfusion) - Uncontrolled bleeding - Complicated childbirth - Chest pain with SBP <100 - Severe pain

Procedures

  1. Form general impression on approach.
  2. Assess LOC using AVPU.
  3. Open airway using appropriate technique; insert adjunct if needed.
  4. Assess breathing — rate, depth, quality; intervene if inadequate.
  5. Assess circulation — pulse, skin signs, major bleeding.
  6. Control major bleeding immediately if found.
  7. Make transport decision (priority vs non-priority).

NM Protocol Notes

  • NM protocols authorize EMT-B to apply OPA, NPA, and suction as airway adjuncts.
  • BVM ventilation is within EMT-B scope; two-rescuer technique is preferred when crew is available.
  • Oxygen administration is authorized; device selection based on patient condition (NRB for distress, NC for mild hypoxia, BVM for inadequate breathing).
  • Transport priority in San Juan County may be affected by long transport times to regional trauma centers (Farmington, Albuquerque) — early load-and-go decisions are critical.

NREMT Relevance

Primary assessment is tested on both Trauma and Medical patient assessment/management skills sheets. Examiners look for: - Verbalizing general impression - Correctly applying AVPU - Demonstrating appropriate airway management - Assessing breathing rate and depth - Assessing circulation including skin signs and pulse quality - Controlling major bleeding when present - Making and verbalizing a transport decision

Critical failure: not recognizing and treating an inadequate airway or absent breathing.

Sources

  • raw/supplemental/patient-assessment-sequence.md — Section 2: Primary Assessment
  • raw/nremt/psychomotor-skills.md — Patient Assessment/Management (Trauma and Medical)