What should be done first when beginning to provide patient care?

September 22, 2025 •

4 min read

Globally, up to 4 in 10 patients experience safety issues in primary and ambulatory care settings. To combat this, a systematic and safety-focused process is essential. Knowing what should be done first when beginning to provide patient care is the critical foundation for all subsequent actions, ensuring the well-being of both the patient and the provider.

Quick Summary

Before direct patient contact, the very first steps involve ensuring scene safety for both the provider and the patient and performing initial hand hygiene. Following these safety precautions, a rapid primary assessment is conducted to prioritize and address any immediate, life-threatening conditions related to the patient's airway, breathing, and circulation.

Key Points

Scene Safety is First: Always assess the environment for hazards and ensure personal protective equipment (PPE) is in place before making contact with a patient.
ABCs for Life Threats: After securing the scene, immediately perform a primary assessment (ABCDE) to identify and address any life-threatening issues with the patient's airway, breathing, and circulation.
Identify and Introduce: For all patient encounters, properly confirm the patient's identity using two identifiers and introduce yourself and your role to build trust.
Systematic Assessment: A secondary assessment, which includes taking a detailed patient history and performing a focused physical exam, follows the primary assessment to gather comprehensive information.
Communication is Key: Use clear and empathetic communication techniques, like the AIDET framework, to inform the patient and set expectations.
It's a Continuous Process: Patient care involves constant reassessment, not just a single initial check. Conditions can change, and providers must remain vigilant to adjust care accordingly.

Establishing a Safe Environment: Scene Safety and BSI

Before taking any action toward a patient, the single most important step is to assess and secure the scene. This initial evaluation, known as scene size-up, protects the provider, the patient, and any bystanders. This is especially critical in emergency and pre-hospital settings but applies to all care environments.

Assess for Environmental Hazards

Scan the area for potential dangers, which can vary widely depending on the situation:

Traffic: For roadside incidents, ensure vehicles are safely positioned and traffic is controlled.
Fire or Explosions: Identify any fire risks or other volatile materials.
Hazardous Materials: Look for spills or leaks of chemicals, gases, or other dangerous substances.
Violence: Evaluate for potential violence from the patient or bystanders. If a threat exists, retreat to a safe location and call for law enforcement.
Unstable Structures: In a collapsed building or similar situation, assess the stability of the surroundings before entry.

Implement Personal Protective Measures

Once the scene is deemed safe, your personal safety is next. This involves using Body Substance Isolation (BSI) precautions to protect against infectious diseases. The type of Personal Protective Equipment (PPE) needed depends on the specific situation, but hand hygiene is universally required.

Wash your hands or use an alcohol-based hand sanitizer immediately before patient contact.
Don appropriate PPE, which may include gloves, masks, gowns, and eye protection.
Remember that PPE is not a substitute for proper hand hygiene.

The Primary Assessment: Addressing Life Threats (ABCDE)

After ensuring safety, the next step is the rapid primary assessment, an algorithmic approach to identify and manage immediate, life-threatening conditions. For emergency care providers, this is the core of their initial evaluation.

A: Airway

Assess: Is the patient's airway open and unobstructed? Can they speak clearly?
Intervene: If obstructed, open it using a head-tilt chin-lift maneuver (unless a spinal injury is suspected, in which case use a jaw-thrust maneuver) and clear any obstructions.

B: Breathing

Assess: Is the patient breathing adequately? Check the rate, rhythm, and quality of their breathing.
Intervene: If breathing is inadequate, provide supplemental oxygen or assist with ventilation.

C: Circulation

Assess: Check for a pulse, assess skin color and temperature, and look for signs of significant external bleeding.
Intervene: Control any major hemorrhage immediately with direct pressure. Initiate CPR if there is no pulse.

D: Disability

Assess: Evaluate the patient's neurological status and level of consciousness using methods like AVPU (Alert, Verbal, Pain, Unresponsive).

E: Exposure

Assess: Expose the patient to perform a full physical examination, but be mindful of their dignity and the need to prevent heat loss.

Initiating Interaction and Patient Identification

In non-emergency or in-patient settings, the initial steps also focus on safety and establishing a therapeutic relationship. This involves proper identification, an essential step to prevent medical errors.

The AIDET Communication Framework

Acknowledge: Greet the patient by their name and make eye contact.
Introduce: Clearly state your name and your role.
Duration: Provide an estimated timeframe for the tasks you will perform.
Explanation: Explain what you are about to do in simple terms.
Thank You: Thank the patient for their time and cooperation.

Two-Identifier Protocol

Before any procedure, use at least two patient identifiers to confirm you are with the correct person. These typically include the patient's name and date of birth.

The Secondary Assessment: Gathering Comprehensive Information

Once the primary assessment is complete and any life threats are managed, a more detailed secondary assessment can be performed. This involves gathering a more thorough patient history and conducting a focused physical exam based on the patient's chief complaint.

The SOAP Note Format

Healthcare providers often use the SOAP note format for organizing this information:

Subjective: Information from the patient's point of view, including their chief complaint and any symptoms.
Objective: Measurable, factual data observed by the provider, such as vital signs, physical exam findings, and lab results.
Assessment: The provider's analysis and diagnosis based on the subjective and objective data.
Plan: The proposed course of action, including treatments, medications, and follow-up care.

Comparison of Emergency vs. Non-Emergency Initial Steps


Initial Step	Emergency Situation (e.g., Trauma)	Non-Emergency Situation (e.g., Clinic Visit)
Priority	Immediately address life threats (ABCDE) after scene safety.	Establish rapport, verify patient identity, and gather thorough history.
First Action	Scene size-up, then perform a rapid primary assessment.	Hand hygiene, introduce yourself, and confirm patient identity with two identifiers.
Focus	Rapid assessment for immediate threats.	Comprehensive assessment, gathering detailed information.
Communication	Focused, direct questions to assess mentation and airway patency.	Empathetic communication to build trust and gather a full history using frameworks like AIDET.
Documentation	Use standardized mnemonics and focus on critical findings.	Use a structured format like SOAP for detailed record-keeping.

The Continuous Process of Assessment and Care

Providing patient care is a continuous process, not a one-time event. Even after the initial steps, a provider must remain vigilant. The patient's condition can change rapidly, and continuous reassessment is necessary. The initial assessment establishes a baseline, but subsequent focused and time-lapsed assessments are crucial for monitoring progress and adjusting care plans as needed. This integrated approach ensures that patient needs are prioritized effectively, from the most basic physiological needs to long-term health goals, aligning with principles like Maslow's Hierarchy of Needs. For more foundational information on patient safety, visit the World Health Organization's page.

Conclusion: Building a Foundation of Safe and Effective Care

Mastering the initial steps of patient care, from scene safety and primary assessment to clear communication and proper identification, is the cornerstone of effective healthcare. Whether in a high-pressure emergency or a routine clinical setting, following a systematic protocol minimizes harm, builds trust, and lays the groundwork for high-quality care. By prioritizing safety and thoroughness from the very beginning, providers can ensure the best possible outcomes for their patients.

Frequently Asked Questions

Scene safety is the first priority because a provider cannot help a patient if they become a victim themselves. Assessing and mitigating environmental hazards protects everyone involved and is the foundation for all subsequent care.

In a primary assessment, ABCDE stands for Airway, Breathing, Circulation, Disability, and Exposure. It is a mnemonic used to systematically assess and address immediate life-threatening problems in order of priority.

When beginning to provide patient care, a provider should introduce themselves by name and state their role clearly. Many facilities use the AIDET framework, which includes acknowledging the patient, introducing yourself, stating the duration of the task, explaining the procedure, and thanking the patient.

The two-identifier protocol requires providers to use at least two distinct pieces of information, such as the patient's name and date of birth, to confirm their identity. This is a critical safety measure to prevent medical errors and ensure care is provided to the correct individual.

Subjective data is information the patient tells you from their perspective (e.g., "my stomach hurts"), while objective data is factual, measurable information gathered by the provider (e.g., vital signs, physical exam findings). Both are crucial parts of the patient assessment.

Maslow's Hierarchy provides a framework for prioritizing patient needs, starting with the most basic physiological and safety needs at the bottom of the pyramid. This aligns with the ABCDE approach, which addresses life-threatening issues (physiological needs) before moving on to less urgent concerns.

The SOAP format (Subjective, Objective, Assessment, Plan) is a structured method for documenting a patient encounter. It is used by a variety of healthcare providers, including doctors, nurses, and physician assistants, to organize and communicate patient information effectively.

Following the initial assessment, the next steps involve implementing the care plan, which may include further diagnostic tests, administering medication, or preparing for a procedure. Continuous reassessment is also required to monitor the patient's condition and evaluate the effectiveness of the interventions.