EMS history taking

[musicislife]

So we did a drill today. The scenario was a 42 year old male hypoglycemic in an MVC.

I was assigned to take history, pt assessment, and vitals. My partner had the history sheet.

He started asking him the SAMPLE questions while i was doing a rapid trauma assessment.

Should i have done all of the asking, while having my partner write the info down?

[Arctickat]

Yes. Try to keep the communication line between you and your client. Having both of you rapid firing questions at him would tend to cause confusion and something will get missed. You will also be distracted from doing your assessment because you're trying to hear the SAMPLE history. You may also want to develop short term memory skills that will help you to remember your client's history in case your partner isn't writing it down for you. He may be off talking to bystanders and getting a history from them, etc.

To control the scene you need to have that rapport with your patient, your partner shouldn't confuse the issue.

I am assuming that you were following the ITLS standard assessment when doing this scenario. At what point is the SAMPLE history taken?

Edited September 15, 2012 by Arctickat

[musicislife]

well, my partner tried to simultaneously ask while I was asking different questions.

but, normally i think they should be asked after the physical assessment/rapid trauma assessment, before vitals

[DwayneEMTP]

It's not your best goal, depending on where you are in your training maybe, to decide the best place to place your SAMPLE history in relation to your physical exam specifically.

What was the scenario specifically? A hypoglycemic that was altered enough to crash his car, yet still lucid enough to give a relevant history? Pretty unlikely. Or an accident caused by other means where the patient just happened to be having a hypoglycemic episode? Something else?

Diagnosis IS history taking. Truly. But what order that that history/assessment comes in depends on the the patient.

Let's say that instead of this patient that you have an MVC, minor fender bender, pt unrestrained, complaining of crushing chest pain, diaphoretic, diff breathing. Would you want to extricate the patient and do a full physical examination before focusing on the chest pain and previous medical history, particualrly cardiac? No, right?

I'm truly not trying to bust your chops, but instead warning of many if not most students desire to have a structure to follow for every/most patients, and that's not really a good idea in most cases, in my opinion.

On every case you're trying to solve a puzzle. The puzzle involves the patient presentation, physiological/anatomical markers, previous pertinent medical history, history of current incident, etc. Which one of these things should be examined first? Would you choose to ignore the big sunflower in the middle, for which you can find all the pieces quickly, and instead build the edges of the puzzle because that's just the way that you always do it? Hopefully not in medicine...

I certainly can't say that you're incorrect in your thinking, but I do worry that you force yourself down certain paths when you try and decide which thing is "right" to do first...Highest probability for mortality/morbidity first, then work your way down the list backwards...

[MikeEMT]

There is no structure or order to History taking. I ask the SAMPLE / OPQRST questions in the order that I need the information for the situation. SAMPLE is not the order that must be followed, rather it is there for you to REMEMBER what questions to ask. Don't get hung up on the order.

As far as who asks, ideally the EMT who is treating the patient should be asking the questions as part of the assessment. However, sometimes the partner will need to ask if you are busy with something else (i.e. dressing a wound).

Regardless of who asks, you need to make sure you are getting the information. The patient is going to be bombarded by questions as it is from nurses and doctors, last thing you want is for them to repeat themselves when they just told your partner.

Good communication is key, both with the patient and with your partner.

[Bernhard]

Good drill scenario.

Despite the other things all others have said, I see another misconception in your assessment: where's the treatment? You can perfectly do diagnosis and starting treatment parallel

.

Even diagnosis could be done by two providers, but only one should ask questions. So the other meanwhile could place pulsoxymeter and measure RR, silent, just reading the measurings out loud. Then start preparing obvious things like O2, i.v., stretcher, ...

Another thing: Arctickat already mentioned the single/focused communication line - try to stay with that. Don't change providers talking to the patient from first assessment to handing over to next level of care. That's not always possible but would be the most calming for the patient (and the scene in general). Nothing worse than multiple providers running by and asking the same questions and doing some random things...especially in a multi casualty scenario.

In reality that's not always possible, but it should be the target. Sometimes it's needed to have another medic get into the communication line, especially when things are complicated to diagnose, but this should be done in the most unconfusing way possible.