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Taking a SAMPLE History and OPQRST Pain Assessment


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SAMPLE History

The SAMPLE history is a mnemonic that Emergency Medical Technicians (EMT) use to elicit a patient’s history during the early phases of the patient assessment. It’s common for emergency medical service (EMS) personnel to use mnemonics and acronyms as simple memory cues. These help EMS remember the order of medical assessments and treatments.

 

For some more mnemonic examples, check out our Medical Acronyms page. The emergency medical technician can use the SAMPLE history to begin a conversation about the patient’s chief complaint.

 

The SAMPLE history can be used by the EMT during any patient assessment.  It will usually begin after the ABC’s and Primary Survey is complete. So, if the primary survey indicates any life threats, those need to be treated before performing the SAMPLE history.

 

For example, any airway, breathing, circulation, or severe bleeding issues need to be treated before attempting to elicit answers to SAMPLE history questions. Check out our post on the Primary Survey to learn more.

 

What does SAMPLE stand for?

 

S → Signs & Symptoms

A → Allergies

M → Medications

P → Pertinent Medical History

L → Last Oral Intake

E → Events Leading To Present Illness

 

OPQRST

When the patient has pain as the chief complaint, EMTs can use OPQRST as a memory tool for continuing the patient assessment. The OPQRST pain assessment is usually done after the primary assessment and before the SAMPLE history is completed.

 

During the National Registry of EMT (NREMT) Patient Assessment Medical Exam the candidate will complete the OPQRST pain assessment, including clarifying questions related to the chief complaint and the OPQRST pain assessment in order to get full points. For information on the NREMT physical exam go here.

 

The mnemonic OPQRST stands for:

 

O → Onset

P → Provocation

Q → Quality

R → Radiation

S → Severity

T → Time

 

opqrst Pain Assessment

 

OPQRST Pain Assessment

The OPQRST pain assessment should be a conversation between the EMT and the patient. You want to ask the patient a lot of questions without it feeling like an interrogation. It’s important to give the patient time to respond to your questions and to actually listen to the patient’s response.

 

Ask questions based on the answers they give that make sense for the situation. Don’t list off a memorized set of questions like a robot without listening and understanding the patient’s responses.

 

O → Onset: During this part of the pain assessment the EMT will determine what the patient was doing when the pain began. This is especially important for cardiac patients with angina symptoms.

 

Some questions the EMT could ask during the onset portion of the OPQRST pain assessment are:

 

“What was going on when the pain started?”

“Did it start suddenly?”

“What were you doing when the pain started?”

 

P → Provocation: The EMT will determine if anything affects the pain during this portion of the pain assessment.

 

Some good questions to ask the patient are:

 

“Does anything make the pain worse?”

“Does anything make the pain better?”

“Does the pain change with movement or rest?”

 

OPQRST Pain patient

 

Q → Quality: During this part of the pain assessment it’s important to have the patient report in their own words how they would describe the pain. The EMT should ask open-ended questions and try not to lead the patient by giving them words to describe the pain.

 

The EMT can ask questions like:

 

“What does your pain feel like?”

“Can you tell me how the pain feels?”

“Can you describe your pain for me?”

“Has the pain changed since it began?”

 

Some common words patients will use to describe pain is sharp, throbbing, achy, dull, pounding, crushing, pressure, and burning.

 

R → Radiation: The EMT will determine if there is any referred pain during this part of the pain assessment. Some questions to ask are:

 

“Where is the pain now and does it travel anywhere else?”

“Can you feel the pain anywhere else?”

“Does the pain go up your arm or jaw at all?”

 

S → Severity: Everyone has a different pain tolerance so the EMT can determine how bad the pain is for this patient and also get a baseline to compare to future pain assessments. This will help the EMT know if the patient’s pain gets worse or improves while the patient is in their care.

 

The commonly accepted way to do the pain assessment, both in and out of the hospital, is using the pain scale from 0 – 10. The best way to question the patient is by asking them questions like:

 

“How bad is the pain on a scale of zero to ten, with ten being the worst pain in your life?”

“How would you rate the pain on a scale from 0 – 10, with ten being the worst pain in your entire life?”

“How bad is the pain right now on a scale of 0 – 10?”

 

T → Time: During this part of the pain assessment the EMT will determine what time the pain started or about how long the patient has been in pain. Some questions to ask are:

 

“When did you start feeling this way?”

“When did the pain start?”

“How long have you been in pain?”

“Does the pain come and go or is it constant?”

 

Another important question the EMT should get in the habit of asking is whether the patient has ever had this pain before. Often this will help the patient remember pertinent medical history that they otherwise would forget to mention.

 

OPQRST Pain Assessment-Infographic

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Purpose of Sample History

The SAMPLE history allows EMTs to gather information related to the chief complaint in a quick efficient matter which is not only beneficial to the EMT, but also to the hospital staff once the patient is dropped off.

 

Sick Nature of Illness EMTThe SAMPLE history is used during the patient assessment to identify what happened that caused the patient to call for help.

 

In a trauma this is the mechanism of injury (MOI) and in a medical patient it’s the nature of illness (NOI).

 

Taking a good SAMPLE history can help you find out whether the patient became unconscious due to a fall or fell due to losing consciousness. It can help you determine the cause of the patient’s complaints and anticipate possible complications in the near future.

 

Remember EMTs document all the information taken during the SAMPLE history and then verbally report important details to the staff at receiving facilities.

 

This means taking an accurate SAMPLE history can make the patient experience go more smoothly.

 

NREMT Test Requirements

Below is a step by step guide to completing the SAMPLE history in a prehospital setting along with the OPQRST patient assessment.

 

During the NREMT psychomotor examination candidates will need to address the SAMPLE history on both the Patient Assessment: Trauma and the Patient Assessment: Medical exams.

 

However, during the NREMT trauma assessment you can just send your partner to take the SAMPLE history for you. The NREMT medical assessment exam will require candidates to perform the SAMPLE history portion of the patient assessment themselves.

 

When taking a SAMPLE history after completing the OPQRST assessment, the EMT should already have determined the signs and symptoms relating to the history of present illness.

 

In fact, the NREMT medical assessment awards two points for asking clarifying questions about the associated signs and symptoms related to OPQRST. Because of this, the patient assessment following OPQRST becomes the AMPLE mnemonic instead of SAMPLE.

 

Basically this means during the NREMT medical assessment if you have a patient with chest pain, you will do OPQRST and then move on to the AMPLE mnemonic.

 

However in the field, patients without pain complaints will need the full SAMPLE history done.

 

SAMPLE Assessment

Signs & Symptoms: During this portion of the SAMPLE history assessment, the EMT will try to determine exactly what the current patient complaint is. Sometimes patients will verbalize one complaint, but their real issue is something different.

 

For example the patient or bystanders may say the patient has slurred speech and erratic behavior, but the EMT will need to figure out if it’s from alcohol intoxication or if it’s caused by a neurological issue like a stroke.

SAMPLE History - Sign vomitingA SIGN is a measurable or observable finding that the EMT can witness. Some examples of signs are bruising, vomiting, hives, pale skin, blood pressure, heart rate and respiratory rate.

 

A SYMPTOM is the patients experience of their illness or injury and can’t be measured by the EMT. Symptoms are subjective descriptions from the patient to the EMT and include nausea, fatigue, numbness and light-headedness.

 

It’s important to ask the patient questions like:

 

Why did you call today?” or “What’s wrong?” rather than “What are your signs and symptoms?

 

Allergies: The goal of this portion of the SAMPLE history is to determine whether the patient has any allergies.

 

The EMT will ask questions like:

 

“Do you have any allergies?”

“Are you allergic to any foods, medications, contrast, or anything else?”

“Do you have any allergies we should know about?”

 

It’s also a good idea to find out whether the patient has a local or system allergic reaction to the allergen. You can do this by asking them:

 

“What happens when you are exposed to the allergen?”

 

Medications: During this part of the SAMPLE history assessment the EMT will find out if the patient is taking any medications.

 

SAMPLE History MedicationsUnfortunately, asking the patient “Are you taking any medications?” won’t always get the EMT a complete answer.

 

Therefore, asking: Are you prescribed any other medications?” and “Have you taken any medications today?” can help you get more accurate information during the patient assessment.

 

Patients often forget medications or get distracted while answering, so continue asking about medications until you have them all.

 

Following up with “What other medications do you take?” is always good for your patient assessment until you record them all. This also give patients a moment to think of anything else they may have forgotten.

 

Past Pertinent History: The EMT will use this part of the SAMPLE history to figure out the patient’s past medical history and decide if there are any conditions effecting the patient’s chief complaint.




This part of the SAMPLE history can be a little tricky. The EMT has a limited medical knowledge which means they can’t always decide what past issues are pertinent to the current complaint. For this reason, it’s better to record more of the patient’s history than less if you aren’t sure.

 

Fortunately, some of this information will already be recorded during the allergies and medications portion of the SAMPLE patient assessment. After all, if your patient is taking a blood pressure medication you’ll ask them if it’s for high blood pressure.

 

Here are some examples of questions the EMT can ask during the P portion of the SAMPLE history:

 

“Do you have any medical conditions I should know about?”

“Have you ever had this happen before?”

“Have you ever been admitted to the hospital or had any surgeries?”

“Have you had any illness or infection recently?”

 

Last Oral Intake: During this part of the SAMPLE history the EMT will try to determine if the patient’s intake and output is the cause of or is being affected by the chief complaint.

 

This is done by finding out when and what the patient last ate and drank. Asking about the patients eating and drinking history may not sound very important. However, if you get in the habit of doing it you’ll notice that it reveals a lot about your patient.

 

The L portion of the SAMPLE history can give the EMT a clear picture of the patient’s lifestyle for the last 24 – 48 hours.

 

This is important because some patients are poor historians. For example a patient may tell you he began feeling ill 2 hours ago. Then during the oral intake questioning say he hasn’t eaten much for the last 2 days because he has been too nauseous.

 

Last oral intake becomes especially important for patients with diabetes and gastrointestinal (GI) complaints. In fact, for GI patients the EMT should include questions about the patients output, including bowel movements and urine.

 

Some common questions the EMT can ask during the L portion of the SAMPLE history are:

 

“Have you been eating and drinking like normal?”

“What has stopped you from eating normally, and for how long?”

“When did you last have something to eat or drink?”

“What was it?”

 

Events Leading to Present Illness or Injury: The last part of the SAMPLE history is meant to determine what was going on when the patient began experiencing their current medical illness or injury.

 

The EMT can hear the patient explain what was going on at the time of the incident or illness. At this point, the EMT should be able to determine whether the events leading up to the current illness or injury were sudden or gradual.

 

Knowing what led up to the event can help provide the EMT with clues for what caused the illness and therefore, what treatment is needed.

 

Some questions the EMT can ask during the final part of the Sample history are:

 

“What happened?”

“What were you doing when this happened?”

“How did you get hurt?”

 

SAMPLE History Infographic EMT 

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EMS SAMPLE History

The SAMPLE history taking is a proven technique for EMS workers. Practice and experience can help you master the SAMPLE history and learn to elicit the information you need from the patient in the comfortable tone of a conversation.

 

Remember that while you are taking a SAMPLE history in the field you can also be performing patient assessment skills like taking blood pressure, heart rate, etc.

 

Outside of the testing environment you can find your groove and learn how to get the patient’s history while simultaneously checking for peripheral pulses, abdominal tenderness, or whatever else is relevant to your specific patient.

 

When documenting and giving verbal report it’s a good idea to use the patients own words to describe their complaints. This is good for accuracy and makes sure that future healthcare workers know exactly why the patient made a call for help that day.

 

Sample history events Child bike accident

 

Interested in more EMT topics? Check out:

Pediatric Vitals Signs Guide

Prehospital Care of Electrocution Burns

Top 10 Best EMS Pants 

 

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