EMT Primary Assessment Explained (39-43% of the NREMT Exam)

Nearly half the EMT exam is one skill. Here is that skill, from zero. Primary assessment is thirty-nine to forty-three percent of the National Registry exam. No other area is close.

And it is not a body of knowledge, it is a sequence you run every single call. Here is what it actually is. The first sixty to ninety seconds with a patient, where you are answering exactly one question: is anything about to kill this person right now? And this is the rule people miss.

You fix life threats as you find them. You do not finish the survey and then go back. If you find an airway problem at step three, you stop and fix the airway. The exam tests that constantly.

Step one happens before you touch anybody. Scene size-up. Is the scene safe, do you have gloves and eye protection on, what happened, how many patients are there, and do you need more help. If the scene is not safe, you do not have a patient yet.

You have two. Then a general impression, from across the room. Sick or not sick. And then level of consciousness, which you grade with four letters: AVPU.

A is alert. V means they respond only when you speak to them. P means they respond only to pain. U is unresponsive, no reaction at all.

That single letter changes everything that follows, because a U patient cannot protect their own airway. Then airway, breathing, circulation, in that order. Is the airway open. Is the breathing adequate, and that means rate and depth, not just whether they are breathing.

And circulation: do they have a pulse, are they bleeding badly, what does their skin tell you. Let us work one. A fifty-eight-year-old is unresponsive, making snoring sounds, breathing eight times a minute with shallow chest rise. No trauma.

What do you do immediately? Insert a nasal airway and transport. Put on a non-rebreather mask at fifteen liters. Head-tilt chin-lift and start bag valve mask ventilation.

Or place them in the recovery position and monitor. Snoring means the tongue is blocking the airway, so the airway is the problem, and it comes first. Eight shallow breaths a minute is not adequate breathing, so they need you to breathe for them. That rules out the mask, which only helps someone already moving air.

And it rules out watching and waiting. Open the airway, then ventilate. Now the fork that catches people. How you open an airway depends on one thing: do you suspect a spine injury?

Second question. A patient is unresponsive with an obstructed airway after a diving accident, so you suspect a cervical spine injury. Which maneuver first? Jaw thrust.

Log roll into the recovery position. Head-tilt chin-lift. Or immediate nasal airway insertion. Jaw thrust.

It opens the airway without extending the neck. Head-tilt chin-lift moves the neck, which is exactly what you are trying to avoid, so it is reserved for patients with no suspected trauma. Same goal, different tool, and the trauma history is what picks the tool. One exception you have to know, because it inverts the order.

If the patient is unresponsive with no pulse and not breathing, that is cardiac arrest, and you start compressions first. Compressions, airway, breathing. CAB, not ABC. Circulation moves to the front only in confirmed arrest.

So try one. An adult is unresponsive, has no pulse, and is not breathing. What do you do first? Give two rescue breaths, begin chest compressions, open the airway, or check for an obstruction.

Pause if you want to decide. Begin chest compressions. This is the one time circulation outranks airway, because nothing you put into the lungs matters if it is not being pumped anywhere. So, to recap.

Primary assessment is nearly half your exam. Scene safety before you touch anyone. AVPU for level of consciousness. Then airway, breathing, circulation, fixing each threat as you find it.

Jaw thrust if you suspect a spine injury, head-tilt chin-lift if you do not. And compressions first in cardiac arrest. Practice these with real EMT questions, free at quibank.com/en/emt.