A focused check, often termed a focused assessment, is a targeted examination used by a first responder to gain a deeper understanding of a patient’s condition. This systematic process is reserved for individuals who are conscious, stable, and capable of communicating their primary complaint. Its main purpose is to determine the nature of a specific illness or injury after immediate life threats have been addressed. By concentrating the examination on the area of concern, the first aider gathers precise details to inform care decisions and relay information to professional medical responders.
Placement in the Patient Assessment Sequence
The focused check follows the Primary Survey, the initial rapid assessment designed to identify and manage life-threatening conditions (e.g., blocked airway, inadequate breathing, severe bleeding, or lack of circulation). The first responder proceeds to the focused assessment only once the patient is determined to be stable and is not exhibiting immediate life-threatening signs. This ensures that examining a specific complaint does not delay treatment for a more serious, systemic problem.
The criteria for initiating this check center on the patient’s stability and responsiveness. The patient must be conscious, able to interact, and clearly identify the chief complaint, such as pain in a specific limb or an isolated symptom. If a patient is unconscious, unresponsive, or has sustained a severe mechanism of injury, the first aider bypasses the focused check entirely. They perform a comprehensive Head-to-Toe assessment to search for hidden injuries, as the focused check is deliberately limited to the area of reported concern.
Executing the Physical Examination
The physical portion of the focused check is highly localized to the area the patient identifies as being injured or ill. If the patient reports a painful knee, the assessment focuses solely on that lower extremity. The first aider starts with an uninjured area and gradually moves toward the painful site, allowing for a direct comparison with the corresponding uninjured side.
The first aider employs a method of observation and interaction, commonly summarized by the acronym DOTS: Deformities, Open wounds, Tenderness, and Swelling. Deformities indicate an abnormal shape, often suggesting a fracture or dislocation, and are assessed by sight and comparison with the opposite limb. The first aider looks for Open wounds, including lacerations, abrasions, or puncture sites that could lead to infection or further blood loss.
The first responder gently palpates the area to check for Tenderness, which is pain elicited upon touch, indicating an underlying injury that may not yet be visible. Tenderness can be a precursor to other signs like bruising or swelling. Finally, the check includes an assessment for Swelling, a build-up of fluid in the tissues that commonly accompanies soft tissue injuries. For medical complaints, such as difficulty breathing, the physical exam shifts to focused observation of chest rise and fall, skin condition, and the work of breathing, rather than a hands-on search for DOTS.
Gathering Patient History (SAMPLE)
The physical examination is paired with a verbal information-gathering process, systematically organized using the SAMPLE history acronym. This structured inquiry provides context for the physical findings and helps determine the root cause of the patient’s distress. The “S” stands for Signs and Symptoms, which involves asking the patient to describe what they observe (signs) and what they feel (symptoms).
The “A” is for Allergies, identifying known sensitivities to medications, food, or environmental triggers, which helps prevent adverse reactions during care. “M” represents Medications, and the first aider asks about any prescription, over-the-counter drugs, or supplements the patient is currently taking, as these can influence the patient’s condition. “P” is for Past Pertinent History, covering any relevant medical conditions, chronic illnesses, or previous surgeries related to the current situation.
The “L” addresses Last Oral Intake, asking when the patient last ate or drank, which is relevant in cases of potential low blood sugar or if the patient may require surgery. The final letter, “E,” stands for Events Leading Up To the incident, prompting the patient to describe the timeline and circumstances immediately preceding the symptoms or injury. Collecting the SAMPLE history provides a comprehensive narrative that, when combined with the focused physical check, allows the first aider to form a complete picture of the patient’s overall health status.