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Reassessment

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

Overview

Reassessment is the ongoing monitoring phase of patient care — the loop that runs continuously from the end of secondary-assessment through patient handoff. The purpose is to detect changes in patient condition, verify that interventions are working, and catch deterioration early. It is not optional; patient condition can change rapidly in the back of an ambulance.

Key Points

  • Repeat primary assessment: Re-check LOC (AVPU), airway, breathing, and circulation at each reassessment cycle. A patient who was "V" on AVPU fifteen minutes ago may now be "P" — that is a critical change.
  • Vital sign frequency:
  • Critical / priority patient: every 5 minutes
  • Stable / non-priority patient: every 15 minutes
  • Reassess interventions: Is the oxygen mask still on? Is the tourniquet still occlusive? Is the splint still in position? Did the oral-glucose improve mental status? Did the epinephrine-auto-injector reduce anaphylaxis symptoms?
  • Re-evaluate transport priority: A non-priority patient who develops signs of shock has become a priority patient. Communicate with the driver; increase urgency if needed.
  • Re-check chief complaint: Has the pain changed in quality, location, or severity? Has a new complaint emerged?

Assessment Relevance

Reassessment closes the loop on all previous steps. Findings here feed back into primary-assessment (is there still an airway threat?) and inform what you report to the receiving facility. Trending vital signs — comparing each set against the baseline from secondary-assessment — is the primary tool for detecting developing shock, improving perfusion after interventions, or deterioration from internal bleeding.

Key trending patterns: - Rising HR + falling BP + worsening skin signs → developing or worsening shock - Improving HR, BP stabilizing, improved skin signs → response to treatment - Altered LOC improving → medication or intervention is working - New altered LOC → significant change; upgrade priority and notify medical control

Procedures

At each reassessment cycle: 1. Repeat LOC (AVPU) — compare to baseline. 2. Reassess airway patency and breathing rate/quality. 3. Reassess pulse rate and quality; check skin signs. 4. Obtain full vital signs set; document time. 5. Inspect all interventions (O2 delivery, tourniquet, splints, C-collar). 6. Re-ask about chief complaint; note any change. 7. Re-evaluate transport priority. 8. Document all findings and times.

NM Protocol Notes

  • NM EMS documentation (PCR) requires vitals be documented with timestamps. Minimum: one set on scene, one set en route for stable patients; continuous for critical.
  • If patient deteriorates en route, notify receiving hospital via radio or phone. San Juan Regional Medical Center (Farmington) requires advance notification for priority patients.
  • Medication reassessment: oral-glucose — reassess in 15 minutes. epinephrine-auto-injector — reassess within 5 minutes; may repeat per protocol if no improvement.

NREMT Relevance

Reassessment is listed as the final component on both the Trauma and Medical patient assessment/management skill stations. Examiners look for: - Verbalization of repeat primary assessment - Verbalization of vital sign frequency (5 min critical, 15 min stable) - Verbalization of reassessing interventions - Recognition of any scenario changes the examiner introduces during this phase

Common miss: students end the assessment at secondary and forget to verbalize reassessment. Even if the scenario doesn't require physical reassessment, you must verbalize the plan.

Sources

  • raw/supplemental/patient-assessment-sequence.md — Section 5: Reassessment
  • raw/nremt/psychomotor-skills.md — Patient Assessment/Management (Trauma and Medical)