A Prospective Evaluation of Prehospital Patient Assessment by Direct In-field Observation: Failure of ALS Personnel to Measure Vital Signs

We prospectively evaluated the frequency with which advanced life support (ALS) personnel fail to attempt to measure blood pressure (BP) and/or puke (P) during prehospital patient assessment. A single in-field observer rode on ALS rescue vehicles from 20 Emergency Medical Services (EMS) agencies throughout Arizona during a one-year study (1/89–12/89). Data were collected from urban, suburban, and rural systems. Statistical evaluation was performed by Chi Square analysis with p «0.05 considered significant. Among 227 patient encounters, BP and/or P measurements were omitted in 84 cases (37.0%). BP and/or P were omitted in 50.0% of children (age «18 years) compared to 26.5% of adults (p=0.023). Among patients who were transported to a hospital, 19.4% had BP omitted compared to 49.1 % of those not transported (p=0.00003). Seven of 58 patients in whom IVs were attempted (12.1 %) had BP omitted compared to 54 of 169 patients without IV attempts (32.0%, p=0.0055). Blood Pressure was omitted in 21.9% of patients transported Code 3 and in 24.2% of patients with Glasgow Coma Scale «13. Omission of BP occurred more frequently in non-urban agencies (33.9%) than in urban ones (20.0%), p=0.027). In a statewide evaluation of prehospital patient assessment, failure to measure vital signs (VS) occurred on a frequent basis. Our data indicate that a concerning lack of attention to the most basic detaih of patient assessment is common. It is possible that failure to measure VS might even happen more frequently during routine patient encounters without an observer present. Medical control physicians must emphasize to EMS personnel the paramount importance of careful assessment to ensure optimal patient care.