Principles of Patient Assessment
in EMS
By:
Bob Elling, MPA, EMT-P
&
Kirsten Elling, BS, EMT-P
Chapter 9 – Focused History and
Physical Exam of the Medical
Patient
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Objectives
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Describe the approach for obtaining a
focused history from a responsive medical
patient.
Explain how the EMS provider might
obtain a focused history from an
unresponsive patient.
Provide examples of positive findings and
pertinent negatives for a medical patient.
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Objectives
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(continued)
Describe how the two acronyms OPQRST
and SAMPLE are used to obtain essential
medical history information.
List the components of the focused
physical exam (PE) for the medical
patient.
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Objectives

(continued)
Describe how the approach to the PE of a
responsive medical patient differs from the
approach to the unresponsive patient.
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Introduction
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In the absence of trauma it is most likely a
medical complaint
Determine the chief complaint
Responsive patients – begin SAMPLE &
FH, get the history of present illness
Positive findings
Pertinent negatives
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
FH & PE Medical Patient
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Determine if the patient is responsive
Reasonable response
Can interview patient if they are
responsive
Establish rapport and obtain consent
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
The Responsive Medical Patient
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CC
OPQRST
SAMPLE
Focus PE on specific body system:
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Respiratory or cardiac
Neurological or behavioral
Abdominal or obstetrical
Geriatric or pediatric
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Questions to Ask
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CC – Why was EMS called?
O – When did symptoms/ CC begin?
P – What seems to provoke it (ie: exercise,
fever)?
Q – How do you describe the sensation (ie:
crushing, stabbing, pressure…)?
R – Where is the pain & where does it go? Does
anything relieve it?
S – How would you rate this experience on a
scale of 1 to 10?
T – When did it start?
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Responsive Medical Patient:
SAMPLE Examples
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S – nausea, vomiting, blurred vision
A – drugs, insects, plants, environmental
M – lasix, potassium, insulin, penicillin
P – recent surgery, CABG, pacemaker,
diabetes
L – meal, drinks, meds
E – stress or emotional event
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Responsive Medical Patient:
Additional Steps
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Focused PE (guided by the CC):
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Respiratory
Cardiac
Neurological
Behavioral
Abdominal
Geriatric
Pediatric
Multiple body systems evaluated as
needed (skin, muscles, circulatory, GI…)
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
The Unresponsive Medical Patient
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Begin with the PE, then talk
Perform a rapid physical exam (RPE)
Get baseline VS
Consider other tests:
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EtCO2
Pulse oximetry
Temperature
ECG
Blood sugar
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Speak to The Family & Bystanders
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Ask about SAMPLE history
Ask about patient’s
general health status
Ask for list of meds
Ask about advanced
directives
Take one family member
along to the hospital
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Look for Clues!
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Vial of Life
Medic alert bracelet, necklace, or anklet
Global Med-Net service
Look in the refrigerator for meds
Have the police look for a wallet card
Look for meds and check them in your
pocket reference
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Conclusion
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The FH & PE follows one of two pathways
depending if the patient is responsive or
not responsive.
The order of steps in the FH & PE of the
medical patient depends on the patients
responsiveness.
The exam is either rapid, in the patient
who is not responsive, or focused in the
responsive patient.
© 2003 Delmar Learning, a Division of Thomson Learning, Inc.