Mastering The Head-To-Toe Assessment

You probably practiced your head-to-toe assessment a bunch in your EMT class. Maybe more than any other skill in the EMT curriculum. If your class was or is anything like mine (as a student or a teacher) you performed the head-to-toe assessment again and again.

As much as we practice this skill in EMT class, I often wonder why so many EMT’s have such bad head-to-toe skills out on the street. It seems that, once we get out on the street, the systematic, thorough head-to-toe assessment falls out of favor and quickly gets replaced with the faster, more direct focused assessment.

That works just fine most of the time. If it didn’t, I figure it probably wouldn’t be such a universal phenomenon. (For the record, have you ever worked somewhere where this wasn’t the case? Neither have I.) The downside is that when the patient arrives who really needs a, honest-to-goodness, rapid, complete head-to-toe, we’re not up to the task.

I happen to believe that patient assessment skills are one of the defining qualities of a talented EMT. Here are seven tips to keep your head-to-toe in top form.

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The S.O.A.P. Reporting Break Through

SOAP is another one of those EMS acronyms that has endured through the years. I was taught the SOAP format in my EMT class 20 years ago and I’m still teaching it to my EMT students today.

SOAP reporting has a bunch of things going for it. It’s simple, it’s universal, it easily adapts to a multitude of situations and its feels familiar, because it’s the order your brain naturally recalls a memory of something that happened.

If there is one major limiting factor to SOAP it has nothing to do with its design and everything to do with its use. When you were in EMT school we drilled you on the importance of accurate and complete documentation. We frightened you with ideas about the legality, confidentiality and permanence of your medical reports. We worked hard to impress upon you the importance of your reporting and, like most, you probably took these lessons to heart. All of these scare tactics might have given you the idea that your medical report is a serious and formal necessity. Serious yes. Formal … no, not always. In fact, in the case of verbal hand-off reports and even standard report narratives (to a lesser degree), I’d argue that rigid formality works against you.

If you want your reports to shine, especially your SOAP format reports, you need to drop the rigid, robot-like formality. What I want you to get from this unconventional review of how to use SOAP is this: you can adapt the format. You can mix it up. You can play with it. SOAP is our tool. We can use it or disregard it in the ways that we see fit.

From now on, I want you to think of soap as your way of answering these four questions:

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The Normalization of Deviance

In the span of a generation, NASA has lost two spacecraft and 14 pilots in the collective disasters of the space shuttles Challenger and Columbia. Can you tell me why? Trust me, it’s worth exploring.

The space buffs in the crowed might recall that faulty O-rings in the Challenger’s solid rocket boosters failed and allowed supper heated gasses to escape. The result was a catastrophic explosion and a sullen announcement from my school principal in the middle of sophomore science class. In his quiet monotone, we learned that the mighty Challenger, moments before, had been destroyed and the crew was lost.

Our teacher didn’t know quite what to say, and in the silence that followed, my sixteen year old world got a little smaller.

More of you might recall that Challenger’s sister ship, Columbia, burned up on reentry returning from a mission in 2003. The Columbia’s heat tiles were damaged when a piece of foam insulation dislodged during takeoff and struck the tiles on the wing. Those tiles later failed under the heat of reentry and the craft burned up over the mid-west. Interesting right? But what does all this have to do with EMS? Follow me on this next part.

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