When performing an assessment of your patient, you should first prioritize scene safety

September 27, 2025 •

4 min read

In emergency situations, it is a foundational principle of care that a responder must first ensure the safety of the environment before approaching a patient. This critical initial step is the ultimate priority, determining the course of action and ensuring the well-being of all involved when performing an assessment of your patient, you should first.

Quick Summary

Prioritizing scene safety and assessing for immediate life-threatening conditions is the absolute first step in any patient assessment. Without ensuring safety, both the patient and rescuer are at risk, and effective care cannot be delivered. This initial triage guides all subsequent actions.

Key Points

Prioritize Scene Safety: The absolute first step is to ensure the environment is safe for both the patient and the rescuer before beginning any assessment.
Start with the ABCs in Emergencies: After confirming safety, perform a rapid primary survey focusing on Airway, Breathing, and Circulation to identify immediate life threats.
Build Patient Rapport Immediately: Establishing trust through a friendly introduction and clear communication from the start is critical for a successful and comprehensive assessment.
Gather Subjective and Objective Data: A thorough assessment involves collecting the patient's story (subjective data) and performing a physical exam (objective data) to inform a diagnosis.
Follow a Systematic Approach: Whether it's the rapid primary survey in an emergency or the methodical head-to-toe in a non-emergency, a systematic process ensures no critical information is missed.
Document Accurately: All findings from the assessment must be accurately and thoroughly documented to ensure continuity of care and effective communication among the healthcare team.

The Foundational Principle: Ensuring Scene Safety

Before initiating any physical or verbal interaction, the paramount concern is scene safety. In any medical scenario, from a routine clinic visit to a traumatic event, a healthcare professional must assess for potential dangers. This is a non-negotiable step that protects both the patient and the rescuer from harm. Dangers could include environmental hazards, aggressive individuals, fire, or other unseen threats. The protocol is clear: if the scene is not safe, it must be made safe before proceeding with the assessment. This action prevents a single patient incident from becoming a multiple-victim tragedy.

The Rapid Assessment: Primary Survey and ABCs

Once the scene is deemed safe, a primary survey, also known as the ABCs (Airway, Breathing, and Circulation), is the next critical step, especially in an emergency setting. The goal is to quickly identify and address any immediate life-threatening issues. This assessment is rapid and focused.

Airway: Is the patient's airway open and clear? Listen for stridor, gurgling, or snoring. Look for chest movement. A simple question like, “Can you tell me your name?” can quickly assess the airway's patency.
Breathing: Is the patient breathing adequately? Observe the respiratory rate, rhythm, and effort. Note any cyanosis, retractions, or abnormal breath sounds. Listen for breath sounds with a stethoscope if available.
Circulation: Is the patient's circulatory system functioning? Check a pulse, assess skin color and temperature, and check for major bleeding. Poor circulation can be indicated by pale, cool, or clammy skin.

Assessing Responsiveness: The AVPU Scale

Simultaneously with the ABCs, the healthcare provider assesses the patient's level of consciousness (LOC) using a scale like AVPU.

A - Alert: The patient is fully awake, responsive, and aware of their surroundings.
V - Voice: The patient responds to verbal stimuli but may be confused or drowsy.
P - Pain: The patient responds only to painful stimuli.
U - Unresponsive: The patient does not respond to any stimuli.

The Non-Emergency Assessment Process

In a non-urgent setting, the assessment process is more deliberate and comprehensive. After establishing rapport and ensuring a safe environment, the process typically proceeds with collecting subjective data, followed by objective data.

Gathering Subjective Data: The Patient's Story

This involves taking a thorough patient history, often beginning with the Chief Complaint (CC)—the main reason for the visit. This is followed by the History of Present Illness (HPI), which is best guided by the OLDCARTS mnemonic.

Onset: When did the symptoms begin?
Location: Where is the problem located?
Duration: How long does the symptom last?
Characteristics: How would the patient describe the symptom?
Aggravating Factors: What makes the symptom worse?
Relieving Factors: What makes the symptom better?
Temporal Factors: What is the pattern of the symptoms?
Severity: How bad is the symptom on a scale of 0 to 10?

This detailed history also includes the patient's past medical and surgical history, family history, and social history.

Collecting Objective Data: The Physical Examination

This hands-on part of the assessment uses specific techniques to gather objective data.

Inspection: Visually observe the patient's general appearance, posture, and any visible abnormalities.
Palpation: Use touch to assess for temperature, texture, moisture, lumps, and tenderness.
Percussion: Tapping on the body surface to evaluate underlying structures and determine organ size and density.
Auscultation: Listening to body sounds, such as heart, lung, and bowel sounds, using a stethoscope.

Crucial objective data also includes taking vital signs, which serve as a baseline for the patient's health status. The four main vital signs are temperature, pulse rate, respiratory rate, and blood pressure.

Emergency vs. Routine Assessment: A Comparison


Aspect	Emergency Assessment	Non-Emergency/Routine Assessment
Priority	Immediate life threats (ABCs)	Comprehensive, holistic data collection
Pace	Rapid, often simultaneous steps	Systematic, methodical sequence
Key First Steps	Scene safety, primary survey (ABCs)	Build rapport, collect subjective data (history)
Focus	Stabilize patient, identify immediate needs	Gather baseline data, identify problem, plan care
Goal	Prevent further deterioration	Develop an accurate diagnosis and care plan
Data Type	Focus on objective, observable signs	Both subjective and objective data collection

The Art of Building Rapport

Beyond the technical steps, building a relationship of trust with the patient is an essential component that starts from the very beginning of the assessment. A friendly introduction, explaining each step, and maintaining eye contact can significantly reduce a patient's anxiety and encourage them to provide accurate and complete information. Effective communication ensures the patient feels respected and heard, which is critical for a patient-centered care approach. By actively listening and using clear, simple language, you ensure the patient is a full partner in their care. The College of Nurses of Ontario emphasizes the importance of building rapport through timely and comprehensive assessments to ensure client safety and inform care decisions.

Documentation and Analysis

Following the assessment, accurate and thorough documentation is vital. This record includes the chief complaint, history, physical findings, and a plan of care. This record ensures continuity of care, allowing other healthcare professionals to understand the patient's condition and the interventions that have been performed. Analysis of all the collected data—both subjective and objective—is used to form a diagnosis and guide further treatment decisions. This circular process of assessment, diagnosis, planning, and evaluation continues throughout the patient's care.

Frequently Asked Questions

The very first consideration is scene safety. You must ensure that the environment is free of hazards for both yourself and the patient. Never put yourself in a position of harm, as you cannot help others if you are injured.

The primary survey focuses on the ABCs (Airway, Breathing, and Circulation) and is performed in emergency situations immediately after ensuring scene safety. Its purpose is to rapidly identify and treat any immediate, life-threatening conditions.

Building rapport helps establish trust and reduces patient anxiety. A patient who feels comfortable and respected is more likely to provide accurate and complete information about their symptoms and history, which is crucial for an effective assessment.

Subjective data is information reported by the patient, such as their symptoms or feelings. Objective data is information that can be observed or measured by the healthcare provider, like vital signs, physical exam findings, and lab results.

In an emergency, the focus is on a rapid primary survey (ABCs) to stabilize the patient. In a non-emergency, the assessment is a more detailed, systematic process that includes a thorough history and comprehensive physical examination.

The AVPU scale is a quick and simple method used to assess a patient's level of consciousness. It checks if the patient is Alert, responsive to Voice, responsive only to Pain, or Unresponsive.

Following the initial assessment (primary survey), a secondary assessment is performed. This includes a more detailed head-to-toe examination, a thorough medical history, and obtaining vital signs to gather more comprehensive data.