# ACOx3/ACOx4



## JWalters (Oct 2, 2014)

There is really no mention of it in my book, and my instructor seems to use them interchangeably which I see as a problem because if you are using recollection of recent events as criteria and the patient is NOT alert to that you would then have to document a ACOx3...which could be misleading because someone else would interpret that as the ACO assessment being wnl.

I've googled a bit and (tried to) reference some other textbooks and still haven't found a good explanation as to when you would use a fourth criteria is assessing. Is this just a standard that is determined by an individual service's protocol? Or am I missing something?


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## OnceAnEMT (Oct 2, 2014)

From what I work by, ANOx4 means alert to Person, Place, Time, and Event. 

Person - What is your name? "Bob"
Place - Where are we Bob? "In an ambulance"
Time - What day/month/year is it Bob? "Thursday/October/2014"
Event - Why were you where you were, what happened, what are the colors of the American flag, who is the president, etc. 

I have seen some folks start using ANOx3/3 or ANOx3/4 to indicate the scale, but like I said, the protocols of the systems I work with or around indicate a x4 scale.


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## medichopeful (Oct 2, 2014)

I generally see A+Ox4 in the EMS environment, and A+Ox3 in the hospital.


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## Jim37F (Oct 2, 2014)

medichopeful said:


> I generally see A+Ox4 in the EMS environment, and A+Ox3 in the hospital.


For me it was reversed. In EMT school it was always x3 but when I first started working IFTs the nurses would tell me (or it'd be in the chart as) A&Ox4

Nowadays when giving reports at the ED I report using x4, and if the patient is only 3 I'll specify A&Ox3 out of 4, can't recall xx..


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## Handsome Robb (Oct 3, 2014)

I've never heard it called "ACO". I've heard AAO (awake, alert and oriented), CAO (conscious, alert and oriented) and A&O (alert and oriented), never ACO though (I'm guessing alert, conscious and oriented). I've never understood CAO or AAO. If they're alert and oriented it's implied that they're awake or conscious.

For us A&Ox3 is oriented - Person, place and time. A&Ox4 is person, place, time and event. I'm too tired to look for it but it's been shown that recollection of the event is not required for someone to be oriented. Also being A&Ox3 or 4 does not equal competent. Competency is much more complex than that. 

It comes down to agency SOPs/Protocols. It's clearly defined in ours. 

It's not totally uncommon to get a report from a co-responding agency on scene or a nurse at a sending facility where all they say is "They're A&O" meaning "They're awake and oriented". If they're altered I want to know what they're alert to, but if they're completely oriented I don't need to be told x3 or x4. I generally don't straight up ask people the questions they teach you, I gather that information during my assessment, "Hi, I'm Handsome Robb, what is your name?" "What happened today?" "About what time did this start?" Although with time you generally have to ask but I'm not going to say they're altered if they can't tell me the exact time, "what day is it" or "about what time is it" or "what month is it" all work fine, especially in the middle of the night. Hell I can't usually tell you the exact time without looking at my phone or my watch.


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## JWalters (Oct 3, 2014)

Handsome Robb said:


> I've never heard it called "ACO". I've heard AAO (awake, alert and oriented), CAO (conscious, alert and oriented) and A&O (alert and oriented), never ACO though (I'm guessing alert, conscious and oriented). I've never understood CAO or AAO. If they're alert and oriented it's implied that they're awake or conscious.



I hadn't either, but that what she calls it. As we are just in a classroom setting it doesn't matter much to me.

There have been some helpful responses. Thanks everyone!


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