Overview
Patient assessment is the core skill of emergency care. A good assessment is systematic: it moves from the big picture to the details and always deals with the most dangerous problems first. This lesson presents the standard sequence — scene safety, a general impression, the primary survey for life threats, and the secondary survey for a full history and examination.
Important: This is educational content, not a substitute for certified hands-on training. In a real emergency, call your local emergency number immediately, and do not assume that reading about assessment qualifies you to manage a patient.
Starting Point: Scene Safety and General Impression
Assessment begins the moment you approach, and it always starts with confirming the scene is safe (covered in Lesson 1). As you reach the patient, you form a general impression — an instant read on how sick or hurt the person appears. Are they walking and talking, or slumped and pale? This gut-level judgment sets the urgency for everything that follows and helps you identify the chief complaint, the main problem in the patient’s own words.
Level of Consciousness: AVPU
Next, quickly gauge the patient’s level of consciousness with the AVPU scale:
| Letter | Meaning |
|---|---|
| A | Alert — awake and aware of surroundings |
| V | Responds to Voice — reacts when spoken to |
| P | Responds to Pain — reacts only to a painful stimulus |
| U | Unresponsive — no response at all |
A declining AVPU level is a warning sign of a serious airway, breathing, or brain problem.
The Primary Survey: Finding Life Threats
The primary survey is a rapid check for anything that could kill the patient in minutes. It follows the ABC order, and each problem is treated the moment it is found before moving on.
- Airway — Is the airway open and clear? In an unresponsive patient, the tongue may block it, and vomit or blood must be cleared.
- Breathing — Is the patient breathing adequately? Look, listen, and feel for the rate and effort of breathing. Inadequate breathing needs support.
- Circulation — Is blood circulating? Check for a pulse and for severe bleeding, and note the skin’s color, temperature, and moisture.
Some systems add D (disability/neurologic status) and E (exposure to examine injuries). If the patient is in cardiac arrest, the priority shifts to compressions and defibrillation (see Lesson 5). The key idea is simple: fix the biggest threat first.
The Secondary Survey: History and Detailed Exam
Once life threats are controlled, the secondary survey gathers the full story and examines the patient more thoroughly. Two mnemonics organize this.
SAMPLE History
| Letter | Question |
|---|---|
| S | Signs and symptoms — what is the patient feeling and what do you observe? |
| A | Allergies — to medications, foods, or the environment |
| M | Medications — what does the patient take? |
| P | Past medical history — relevant illnesses or surgeries |
| L | Last oral intake — when did they last eat or drink? |
| E | Events — what led up to the problem? |
OPQRST for Pain
When a patient has pain or a specific symptom, OPQRST explores it in detail:
- Onset — what were you doing when it started?
- Provocation/Palliation — what makes it better or worse?
- Quality — sharp, dull, crushing, burning?
- Region/Radiation — where is it, and does it spread?
- Severity — rate it, often 0 to 10.
- Time — when did it start and how has it changed?
The detailed exam may include a head-to-toe check for injuries and a full set of vital signs (see Lesson 3). Reassessment then repeats key checks over time to catch changes.
Clinical Relevance
Consider a patient found sitting on the curb after a fall, holding their chest. A structured assessment protects against tunnel vision: the responder confirms scene safety, forms a general impression (pale, anxious), checks AVPU (alert), and completes ABCs, finding an open airway and adequate breathing but a rapid pulse and cool skin. Only then does the secondary survey — SAMPLE reveals heart medication, OPQRST reveals crushing chest pain radiating to the arm — point toward a possible heart attack. Because the primary survey came first, no immediate life threat was missed while gathering that history. This disciplined order, life threats before details, is what makes assessment reliable under pressure.