International Examination and Synthesis of the Primary and Secondary Surveys in Paramedicine

Abstract

<p class="Pa2"><strong>Background</strong></p><p class="Pa2">To guide their care paramedics routinely rely upon two assessment and treatment algorithms, known as the primary survey and the secondary survey. No clear consensus of the concepts (assessments and interventions) that are, or should be, included in these algorithms exist internationally. </p><p class="Pa2"><strong>Methods </strong></p><p class="Pa2">This paper evaluated Australasian paramedic clinical practice guidelines (CPGs), as well as six other international paramedic CPGs (USA, Ireland, UK, South Africa, Qatar, and the United Arab Emirates) in order to identify which concepts are currently described in best-practice recommendations for paramedics. The authors also contributed concepts that they felt were important additions based on their experience as veteran paramedics and paramedic educators.</p><p class="Pa2"><strong>Results </strong></p><p class="Pa2">The resulting amalgamation of concepts identified in each term was then formed into two mnemonics which, together sequentially list approximately 100 specific clinical concepts that paramedics routinely consider in their care of patients. We describe these as the “International Paramedic Primary and Secondary Surveys”.</p><p class="Pa2"><strong>Conclusion </strong></p><p class="Pa2">The primary and secondary surveys presented in this paper represent an evidence-based guide to the best practice in conducting a primary and secondary survey in the paramedic context. Findings will be of use to paramedics, paramedic students, and other clinicians working in remote or isolated practices.</p>

What do community paramedics assess? An environmental scan and content analysis of patient assessment in community paramedicine

“…General health assessment practices have evolved to consider multiple disease processes across multiple care settings with the ability to integrate with other care providers 38 all criteria that should guide assessment practices in community paramedicine because patient assessment is foundational to managing care plans, collaborating with other care providers, and providing interventions. [39][40][41] The importance of assessment has been demonstrated in traditional paramedic practice 41 and often underlies program delivery in community paramedicine. 3,4,13,18 Future work regarding the minimum threshold for intake assessments in community paramedicine home visit programs should engage stakeholders to determine the appropriateness of the assessment areas that have been summarized here.…”

Examining consensus for a standardised patient assessment in community paramedicine home visits: a RAND/UCLA-modified Delphi Study

“…The high level of agreement was achieved in-spite of differences in backgrounds of panel members, designs of community paramedicine programme that they were familiar with or areas of assessment expertise. Although paramedic training and education (and subsequent certification) varies between jurisdictions, their assessment practices in emergency settings are very similar 15 30. Community paramedicine programme represent a new context for assessment that apply paramedic assessment skills outside of traditional emergency settings and care paradigms.…”

“…However, pain is a very complex condition that can affect different patients in different ways. Community paramedics might be expected to follow the same style of pain mnemonic adapted from emergency practice,30 but the detail involved in determining intensity, duration, frequency and severity of pain was not explicitly described in the questionnaire provided. Similar exploration of depth and detail could be ascribed to nearly all of the assessment domains included in the questionnaire.…”

“…Yet, standardised assessment instruments are used across multiple healthcare settings as a valuable tool for promoting information continuity across the continuum of care 16 23 25 27–29. Other studies have investigated assessment domains in traditional emergency paramedic settings to inform clinical guidelines for paramedics 30. Without further investigation of the viability for community paramedicine assessment practices, it is difficult to determine whether or not pertinent assessment domains are being included in the community paramedic decision making processes for interventions and care planning in different community paramedicine home visit programme.…”

“…We sought to investigate the level of consensus that could be achieved for standardised assessment content in community paramedicine home visit programme by an international panel of relevant experts. We expected that consensus could be achieved on the relevance of some assessment domains in the community paramedicine setting despite assumed differences in programme design between settings because common assessment domains in emergency settings were identified from an international sample of paramedic assessments 30. Should such a consensus be achieved, it would provide an opportunity for future testing of a standardised assessment instrument in community paramedicine.…”