Acronym Drill

Keep yourself, your partner and your patient safe. It starts at dispatch, continues as you approach, and never stops.

H

Hazards

Any danger to you, your partner, the patient or bystanders: fire, traffic, weapons.

E

Environment

Surroundings and conditions: weather, lighting, confined space, indoors or out.

M

MOI / NOI

Mechanism of Injury (trauma) or Nature of Illness (medical): it steers the whole assessment.

P

Patient count

How many? It changes triage, resources and transport plans.

P

PPE

Gloves, mask, eye protection, gown: chosen for the risk in front of you.

A

Assistance / backup

Decide EARLY: fire, police, more medics, helicopter, hazmat, extrication.

The rapid patient scan you do from the doorway: sick or not sick, before you touch anyone.

P

Position

Supine, tripod, fetal, slumped? Posture gives instant clues about distress, pain and LOC.

A

Age & gender

Narrows the differential: elderly with stroke signs, teen with OD risk, middle-aged chest pain.

C

Chief complaint (apparent)

What are they saying, or what do you see? Gasping, clutching the chest, or simply not right.

E

Eye tracking / alertness

Tracking = awareness. Staring = altered LOC. Darting = anxious or hypoxic. Closed = GCS time.

R

Respiratory distress

SOB, stridor, gurgling, accessory muscles, one-word answers: tells you if airway, BVM or O₂ is needed NOW.

S

Skin signs

Colour, moisture, temperature. Pale, cool, diaphoretic, flushed, cyanotic: your first perfusion metric.

The decisions to make before you roll, while the scene is still yours.

H

History from others

Family, bystanders, coworkers, fire, police: your verbal ECG. What happened? How were they before? Any meds, drugs, history?

E

Early oxygen / oximetry

If PACERS showed SOB, stridor, altered LOC or abnormal work of breathing, delegate O₂ now. Do not wait for vitals.

I

Interventions: SMR, deadly bleeds

If the mechanism suggests spinal risk, start or delegate spinal motion restriction right away. Control any deadly bleed now. Do not delay either to get set up.

S

Scene distance / time

Minutes or miles from help? Long transport, remote scene, GPS and route: time is risk.

T

Transport urgency / stability

Stable = full assessment, control the scene. Unstable = load and go, reassess en route.

The patient's story, in the order that stops you forgetting a piece of it.

S

Story, signs, symptoms

What happened, and what you can see and they can feel.

A

Allergies

Medications, foods, environmental.

M

Medications

Prescribed, over the counter, recreational.

P

Past medical history

Conditions, surgeries, previous episodes.

L

Last meal, menstrual period, BM, urine

Last oral intake, last menstrual period, last bowel movement, last urination.

E

Events prior

What led up to the chief complaint.

How to interrogate pain so the answer is usable, and repeat it after treating.

O

Onset

When it started, and what they were doing.

P

Provokes

What makes it worse.

Q

Quality

Describe the feeling, in their words.

R

Region / radiation

Where is it, and where does it travel.

S

Severity

1–10 scale.

T

Time

Intermittent or constant, and how long.

A

Alleviation

What makes it better.

What you are looking and feeling for at every region, on a trauma patient.

D

Deformities

C

Contusions

A

Abrasions

P

Punctures

P

Penetrations

B

Burns

L

Lacerations

S

Swelling

T

Tenderness

I

Instability

C

Crepitus

D

Distention

Abdomen.

R

Rigidity

Abdomen.

T

Tenderness

Abdomen.

Checked before every medication, every time.

D

Documentation

Recorded: what, when, how much, by whom.

R

Right to refuse

The patient's, always.

T

Time

The right time, and the right interval since the last dose.

R

Route

Oral, sublingual, inhaled, IM, IN.

A

Amount

The right dose for this patient.

M

Medication

The right drug: read the label.

P

Patient

The right person, and it is prescribed to them.

What you physically check on the package before it goes anywhere near a patient.

C

Colour

Does it look the way it should?

C

Clarity

Clear, not cloudy or particulate.

C

Concentration

The strength on the label matches the dose you intend.

C

Contraindications

Checked against this patient, now.

E

Expiry date

In date.

If the patient has CDCPAIN, they should not get gas. The owner's own phrasing.

C

Comply

Unable to follow instructions.

D

Decompression sickness

Or a recent dive.

C

Consciousness altered

Head injury or intoxication.

P

Pneumothorax

Suspected or known.

A

Air embolism

Suspected or known.

I

Inhalation injury

Smoke, chemical, thermal.

N

Nitroglycerin usage

Recent.

How you hand the patient over, and how the written record is structured.

I

Introduction

Your name, your training, the patient's demographics.

C

Chief complaint

What you and the patient are concerned about.

H

History

Past medical history: the SAMPLE you took.

A

Assessment

What you found on your physical exam.

T

Treatments

What you have done, and deliberately not done.

The first, fastest read of how responsive a patient is, before a GCS.

A

Alert

Eyes open, aware of you, answering.

V

Verbal

Responds only when spoken to.

P

Pain

Responds only to a painful stimulus.

U

Unresponsive

No response to voice or pain.

The four questions that show an alert patient is also oriented.

P

Person

Do they know who they are?

P

Place

Do they know where they are?

T

Time

Do they know roughly the day and time?

E

Event

Do they know what happened?

What a normal pair of pupils looks like, so an abnormal pair stands out.

P

Pupils

Both of them, compared with each other.

E

Equal

The same size.

A

And

R

Reactive

Constrict when light reaches them.

L

to Light

Checked with a light, one eye at a time.

Checked below an injury or a splint, before and after you do anything to the limb.

C

Circulation

Pulse, colour, warmth and capillary refill below the injury.

S

Sensation

Can they feel you touch their fingers or toes?

M

Movement

Can they wiggle their fingers or toes?

The short version of the trauma check, region by region.

D

Deformities

O

Open wounds

T

Tenderness

S

Swelling

The order the life threats are found in, and the order they are fixed in.

A

Airway

Open, clear, and protected if the patient cannot protect it.

B

Breathing

Rate, depth, effort and oxygen.

C

Circulation

Pulse, skin and major bleeding.

D

Disability

Level of responsiveness and pupils.

E

Exposure

Look at what you need to see, then keep them warm.

The quick stroke screen, and the reminder that the clock is running.

F

Face

Ask them to smile. Does one side droop?

A

Arms

Ask them to raise both arms. Does one drift down?

S

Speech

Ask them to repeat a sentence. Is it slurred or wrong?

T

Time

Note when they were last seen normal, and go.

The list to run through when a patient is not themselves and nobody can say why.

A

Alcohol

E

Epilepsy

A seizure, or the period after one.

I

Insulin

Low or high blood sugar.

O

Overdose

Also oxygen: not enough of it.

U

Uremia

Kidney failure and the toxins it leaves behind.

T

Trauma

Also temperature: too hot or too cold.

I

Infection

P

Psychiatric

Also poisoning.

S

Stroke

Also shock.

What to do for a sprain or strain once a fracture is not suspected.

R

Rest

Stop using it.

I

Ice

Cold, wrapped, never straight on the skin.

C

Compression

A snug bandage, checking CSM below it.

E

Elevation

Above the level of the heart where you can.

The signs that a limb is in trouble below an injury, a cast or a splint.

P

Pain

Out of proportion to what you can see, worse on stretching.

P

Pallor

Pale skin below the injury.

P

Paresthesia

Pins and needles or numbness.

P

Pulselessness

A late sign. Do not wait for it.

P

Paralysis

Cannot move it. Also late.

P

Poikilothermia

The limb is cold, taking the temperature of the room.

What an organophosphate or nerve agent exposure looks like: everything wet.

S

Salivation

L

Lacrimation

Tears.

U

Urination

D

Defecation

G

Gastric upset

Cramping and pain.

E

Emesis

Vomiting.

M

Miosis

Pinpoint pupils.

The order of care when bleeding, not the airway, is the thing most likely to kill first.

M

Massive hemorrhage

Tourniquet or packing before anything else.

A

Airway

R

Respiration

Breathing and the chest.

C

Circulation

The bleeding you did not see first, and shock.

H

Hypothermia

Also head injury. Keep them warm.

One way to structure a patient care report so nothing is left out.

S

Subjective

What the patient and bystanders told you.

O

Objective

What you found: vital signs, exam, observations.

A

Assessment

Your impression of what is going on.

P

Plan

What you did and what happens next.

The other common report structure, in the order a reader expects.

C

Chief complaint

H

History

SAMPLE and OPQRSTA.

A

Assessment

Your findings.

R

Rx, treatment

What you did.

T

Transport

How they left, and in what condition.

The name of the triage system most responders are taught first.

S

Simple

T

Triage

A

And

R

Rapid

T

Treatment

Thirty seconds a patient: walking, breathing, perfusion, mental status.

The first radio report from a big scene, in the order the people coming need it.

M

Major incident

Declared, or standing by.

E

Exact location

T

Type of incident

H

Hazards

Present and potential.

A

Access

The best way in, and out.

N

Number of casualties

And how badly hurt.

E

Emergency services

On scene, and what you need.

Scored at one minute and five minutes after birth, each letter out of two.

A

Appearance

Colour.

P

Pulse

Heart rate.

G

Grimace

Response to stimulation.

A

Activity

Muscle tone.

R

Respiration

Breathing effort.

The first corner of the pediatric assessment: is this child's brain getting what it needs?

T

Tone

Moving, resisting, or limp?

I

Interactiveness

Interested in you and the room?

C

Consolability

Can a caregiver settle them?

L

Look or gaze

Tracking you, or staring through you?

S

Speech or cry

Strong, or weak and strange?

The current term for what used to be called spinal immobilization.

S

Spinal

M

Motion

R

Restriction

What AVPU and the GCS measure.

L

Level

O

of

R

Responsiveness

For trauma. Its partner for medical calls is NOI, the nature of illness.

M

Mechanism

O

of

I

Injury

The moment in a resuscitation when a pulse comes back.

R

Return

O

of

S

Spontaneous

C

Circulation

The ventilation device a crew uses for a patient who is not breathing enough.

B

Bag

V

Valve

M

Mask

The two basic airway adjuncts. The first letter is the route.

O

Oropharyngeal airway

Through the mouth. Only for a patient with no gag reflex.

N

Nasopharyngeal airway

Through the nose. Tolerated by a patient who still has a gag.