EMT Questions to Ask
EMT questions to ask patients on scene: 66 of them, grouped the way an assessment runs. The opening questions come first, then pain in OPQRST order, other symptoms, medical history following SAMPLE, the extra questions for chest pain, breathing trouble, stroke, diabetes and labor, the questions to ask an injured person after a fall, a collision, a cut or a burn, and what to ask witnesses and settle before you leave. The note under each one says what the answer tells you and what to follow it with. Written for EMT students, new crew and other first responders to practice with; your training and local protocols come first.
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The questions
Each question, and why to ask it
Opening
What happened?
Why ask it
An open question gets you the mechanism in the patient's own words, and those words belong in your report. If the story does not fit what you can see, such as injuries too severe for the height of the fall, ask again once things are calmer and mention the mismatch when you hand over.
What is bothering you most right now?
Why ask it
This is the chief complaint, and it is worth asking even when the call was dispatched as something else. A fall call where the patient answers 'my chest feels tight' has just become a different assessment, so write the answer down in their words.
Are you having trouble breathing?
Why ask it
Judge this on how they answer as much as what they answer. Short phrases, a pause mid-sentence, or having to sit forward to speak tell you more than a denial does.
Are you having any pain?
Why ask it
A no does not clear the patient. One obvious injury, alcohol, a head injury or shock can each hide pain somewhere else, so pair the question with your own hands-on check.
When did this start?
Why ask it
The hospital will make time-sensitive decisions on this answer, so press for an anchor: a TV show, a meal, a phone call. If the patient cannot pin it down, ask when they last felt completely normal and record that time instead.
Can you tell me your name and date of birth?
Why ask it
This does two jobs, identification and a recall check, and the date is the harder half. Watch for hesitation rather than error, since a slow correct answer is still a finding.
Do you know where you are and what day it is?
Why ask it
Orientation questions are only useful if you note the exact answer and repeat them later. A patient who improves between checks is a different situation from one who is drifting.
Have you been awake the whole time?
Why ask it
Any period of lost consciousness changes the assessment, and the patient is the least reliable source on it. Ask bystanders the same question and record both accounts separately.
Is it all right if I check you over and take a few readings?
Why ask it
Asking first is consent as well as courtesy, and it tells a frightened patient what the next two minutes hold. A no is information too: find out what they are afraid of before you reach for the cuff.
Pain
Where does it hurt?
Why ask it
Have them point with one finger instead of naming a region, since people describe anatomy loosely. Pain felt away from the obvious problem, in the tip of the shoulder, the jaw or between the shoulder blades, is worth pointing out at handover.
What were you doing when it started?
Why ask it
Rest, exertion, a meal, a cough, getting out of bed: the activity at onset is one of the first things the emergency department will ask you. It also catches the patient who was woken by the pain, which deserves its own line in the report.
Did it come on suddenly, or build up slowly?
Why ask it
Sudden means seconds, so offer a comparison: like a light switch, or like a dimmer. People say 'suddenly' about pain that grew over an hour, and those are two different stories to the team you hand over to.
Does anything make it better or worse?
Why ask it
Go through position, a deep breath, movement and pressing on the spot, one at a time. Whatever eases it is often the position to transport them in, where your protocol allows, and that is a kindness as well as a finding.
What does it feel like, in your own words?
Why ask it
Offer no adjectives until they have tried their own. If they are stuck, give several at once, sharp, dull, burning, pressure, so that no single word is planted.
Does the pain go anywhere else?
Why ask it
Have them trace the path with a finger and note where it ends. A patient who says it goes into the arm may mean the shoulder, the elbow or the fingertips, and the handover is better for knowing which.
On a scale of 1 to 10, how bad is it?
Why ask it
The number varies too much from person to person to compare one patient with another, so its value is the trend. Ask again after movement, splinting or pain relief, and record both readings with the times.
Has it been constant, or does it come and go?
Why ask it
For pain that arrives in waves, ask how long each one lasts and how long the gaps are, then time one yourself if it happens in front of you. Your measured interval is better evidence than their estimate.
Have you ever had this pain before?
Why ask it
A yes gives you a comparison, so ask what it turned out to be last time and whether today matches. People with a long-standing condition know their own pattern, and a remark that this is not the usual should reach the hospital word for word.
Have you taken anything for it, and did it help?
Why ask it
Get the name, the amount and the time, including pills borrowed from a relative or bought over the counter. It prevents a second dose landing on top of the first, and it is what your protocol will want settled before you assist with any medicine.
Symptoms
Do you have any pain, pressure or tightness in your chest?
Why ask it
Offer all three words, because plenty of people with a heavy or tight chest will say no to pain. If they hesitate, ask them to show you with a hand where the feeling sits.
Is this your normal breathing, or is it worse than usual?
Why ask it
Someone with a long-term lung or heart condition has a baseline of their own, and your readings only mean something against it. Ask how far they can usually walk and how many pillows they sleep on, then compare with today.
Are you feeling dizzy or lightheaded?
Why ask it
One word covers two complaints, so find out which: the room spinning, or the feeling of being about to faint. Check whether it comes on when they stand, and whether it started before the fall or after it, because dizziness first changes the whole story.
Do you feel nauseated, or have you thrown up?
Why ask it
Count the episodes and find out what it looked like, since vomit that is bloody or dark like coffee grounds should be reported as soon as you hear it. Vomiting more than once after a head injury is something to pass up the chain, not only to write down.
Are you bleeding anywhere, or have you been?
Why ask it
Patients report the wound they can see. Ask about blood in urine or stool, and check the surfaces they have been lying on, since blood loss into clothing and furniture is easy to underestimate.
Did you hit your head?
Why ask it
Find out what the head struck, then look for yourself whatever the answer, since hair hides a good deal. Blood thinners raise the stakes on this one, so tie it to the medication list when you reach it.
What is the last thing you remember before this?
Why ask it
A clear memory right up to the fall points one way and a gap before it points another. Come back to it ten minutes later, and make a note if the patient keeps asking you the same thing.
Does your neck or back hurt?
Why ask it
This one comes before you move them, and they should answer in words and keep their head still while they do. What follows is set by your local spinal protocol; the question is there so that decision is made on purpose.
Can you move your arms and legs, and does it feel normal?
Why ask it
Movement alone is not enough, since a change in feeling can show up before weakness does. Check for tingling, numbness and whether both sides feel the same, and note anything they say has changed since the event.
Do you have a headache, or has your vision changed?
Why ask it
The follow-ups that count are how fast it came on and whether it resembles their ordinary headaches. Sudden, severe and unlike anything before is a description to hand over exactly as it was given to you.
Have you felt sick or had a fever over the past few days?
Why ask it
Today's call often began earlier in the week. A cough, a urinary infection, a poor appetite or a new pill in the days before can explain a fall or a confused relative better than anything you find on scene.
History
Do you have any allergies?
Why ask it
Follow a yes with what happens when they are exposed. To the patient a rash and a swollen throat are both an allergy, and the difference matters to what you and the hospital can give. Name latex and foods as well as medicines.
What medications are you taking?
Why ask it
Ask to see the bottles or a written list instead of relying on memory, and bring them along. Blood thinners, beta blockers and insulin each change what you expect to find, so say those names out loud if the patient is vague.
Have you missed any doses, or started anything new lately?
Why ask it
A new prescription, a changed dose or pills that ran out last week can explain today, and patients seldom think to mention them. Go back two weeks, and name patches, inhalers and injections, which many people do not count as medication.
Do you have any medical conditions we should know about?
Why ask it
Patients often name only the condition they think is relevant. Follow up with which doctors they see regularly and what for, then run through heart, lungs, diabetes, seizures and stroke by name, since a yes or no is easier than recalling a list.
Do you have a pacemaker, home oxygen or any other medical device?
Why ask it
Devices point to conditions the patient forgot to list. Ask what the usual oxygen setting is, and bring the device card or paperwork with you if one exists.
Have you been in the hospital or had surgery recently?
Why ask it
A recent operation or hospital stay raises the possibility of bleeding, infection or a clot, and it explains dressings and lines you find. Get what it was for and the date, and whether today feels connected to it.
When did you last eat or drink anything?
Why ask it
The hospital will want it if surgery or sedation is likely, and it matters straight away for a diabetic patient who has taken insulin and skipped a meal. Ask about fluids separately, since people forget they have had nothing to drink.
Have you had any alcohol or taken anything else today?
Why ask it
Say why you are asking: you are not the police, and the answer changes what is safe to give. Put flatly, in the same voice as the allergy question, it draws a truer reply than it does with a raised eyebrow.
Is there any chance you are pregnant?
Why ask it
Ask privately where the scene allows, since a family member in the room changes the answer. If it is a yes or a maybe, find out how many weeks, because that bears on positioning, medication and where you take her.
Specific calls
Have you had heart trouble before, and does this feel the same?
Why ask it
A patient who has had a heart attack and says this is the same feeling should be believed, and so should the one who says it is nothing like it. Ask whether they carry their own heart medication and whether they have used it today, then work from your chest pain protocol.
Do you have asthma or COPD, and have you used your inhaler today?
Why ask it
Get the count: how many puffs, at what time, and whether it helped as much as it normally does. A rescue inhaler that usually settles things and has not today belongs near the top of your radio report, and your protocol will want the count before you assist with more.
Can you smile for me and hold both arms out in front of you?
Why ask it
The start of a stroke check, finished with a sentence for them to repeat. Use the stroke scale your service trains, record what you saw and the clock time, and bear in mind that the patient often cannot tell one side is lagging.
Do you have diabetes, and when did you last check your sugar?
Why ask it
Worth asking on any call with confusion, sweating or odd behavior, whatever the dispatch said. Ask what the reading was and what they have eaten since their last dose, and take your own reading if that is within your scope.
Did you trip over something, or did you feel faint first?
Why ask it
A rug or a curb makes it an injury to assess. A blackout, or legs that simply gave way, makes it a medical call with an injury attached. How long they were on the floor is the next thing to find out.
Where were you sitting, and were you wearing a seatbelt?
Why ask it
Add the speed if they know it, whether the airbags fired and whether they got out unaided. Then look at the vehicle yourself, because the damage often tells the story more accurately than a shaken driver can.
How far did you fall, and what did you land on?
Why ask it
Get the height in something countable, such as stairs, rungs or floors, since a guess in feet is rarely right. Concrete, carpet and water are three different landings, and which part of the body arrived first tells you where else to look.
Did you hear or feel a snap, a pop or something give way?
Why ask it
People tend to remember the sound long after the details of the pain have blurred. Report it as they said it, and let it settle how carefully the limb is supported before anyone moves it, within your splinting training.
Can you put weight on it, or use it the way you normally would?
Why ask it
Find out what they have already done before inviting them to try: walking to the phone on a hurt ankle is a finding in itself. If they do test it, they set the limit, and you stop at the first wince.
Were you wearing a helmet or any other protective gear?
Why ask it
Have a look at the helmet, because a crack or a scuff marks where the blow landed even when the scalp looks fine. Whether it stayed on through the crash is the follow-up, and some services want the helmet sent in with the patient, so check what yours expects.
What cut or burned you, and has anything been put on it?
Why ask it
A clean blade, a rusty nail, hot oil and a drain cleaner are four different wounds, so name the object or the substance at handover. Butter, ointment or a tight home bandage changes what you see, and for a chemical the container is worth bringing along if it is safe to carry.
Have you been stung or eaten anything new, and do you carry an auto-injector?
Why ask it
Find the injector and check whether it has been used and at what time, since your protocol's next step depends on it. Whether a reaction has ever put them in the hospital before is worth one more question, and worth passing on.
What did you take, how much, and when?
Why ask it
Three questions, best asked one at a time despite how they are printed here. On a poisoning or overdose call, gather every bottle, box and blister strip you can find and bring them, since a label is more reliable than anyone's memory.
How far apart are the contractions, and do you feel the need to push?
Why ask it
Time two contractions with your own watch instead of taking the estimate. The need to push is the answer your childbirth protocol turns on, so say it to your partner out loud, then find out whether this is a first baby and whether her water has broken.
Witnesses and transport
Did you see what happened?
Why ask it
Speak to each witness separately if you can, starting with whoever was closest. You are after the sequence, not a diagnosis: what they saw first, what the patient did next, and whether anyone has moved them.
Is this how he normally is?
Why ask it
The baseline question, and for a confused, very old or very young patient it may be the most useful one on the scene. Ask what he could do yesterday that he cannot do now: walk to the kitchen, hold a conversation, recognize the family.
When did you last see her well?
Why ask it
On a suspected stroke this is the time that counts, and it is not the same as the time she was found. Get a clock time, the name of whoever saw her and a phone number for them, because the hospital may want to ask again.
Did he shake or go stiff, and how long did it last?
Why ask it
Witnesses badly overestimate duration, so ask what they did in the meantime: made a call, ran next door, went to get a neighbor. Ask as well what the first minutes afterwards looked like, since drowsy and confused is a different picture from wide awake.
Does she have a medication list, a care plan or any paperwork about her wishes?
Why ask it
One question that covers the pharmacy printout, the nursing home packet and any do-not-resuscitate order. Which documents a crew can act on depends on where you work, so know your local rule and bring the paperwork with the patient.
Is anyone else here hurt or feeling sick?
Why ask it
Easy to forget once you are fixed on one patient. Two people ill in the same house is a reason to stop and think about the house itself, gas, fumes, a shared meal, before you carry on.
Is there anyone at home who depends on you?
Why ask it
Children due back from school, a husband with dementia, a dog shut in the kitchen. Worries like these keep people from agreeing to go, and many of them can be settled with one phone call.
Which hospital do you usually go to?
Why ask it
Where the records and the specialists are is worth knowing even when the destination is not the patient's to choose. Tell them plainly where you are going and why, and pass the name of the usual hospital on when you arrive.
Is there someone we should call for you?
Why ask it
Ask early rather than at the door, while the patient can still answer clearly. Get the relationship and the number, and tell the patient what you will say, which is often what they are actually worried about.
Do you have your keys, phone, glasses and hearing aids?
Why ask it
Thirty seconds here saves hours later. A patient without hearing aids can get written up as confused, and one without keys or a phone has no easy way home if discharged in the middle of the night.
Has anything changed since we got here?
Why ask it
The reassessment question, for the ride in. Pair it with a fresh set of vital signs and hold both against your first, so the handover describes a direction and not a snapshot.
Do you understand what we think is happening and where we are taking you?
Why ask it
Have them say it back in their own words instead of settling for a nod. If they are leaning toward staying home, this is where you learn whether the risk has been understood, which your refusal procedure will expect you to document.
Is there anything else you think I should know?
Why ask it
Save it for the end, once they have had time to trust you, and then wait through the silence. The fall last week, the pills they stopped, the thing they would not say in front of family: this is where those surface.
Asking Well Under Pressure
Practical guidance for the conversation itself
On scene
Use the groups, not the whole list
Nobody asks every question here on one call. Opening and History apply almost every time. Pain, Symptoms and Specific calls are picked to fit what the patient told you first, and Witnesses and transport covers the people around the patient and the minutes before you leave.
One question at a time
Stacked questions get one answer, usually to the last part. This matters most with breathless, elderly or frightened patients, who will otherwise agree with whatever you finished on.
Use the patient's own words in the handover
Record how they described it, not your translation of it. Crushing, tearing and heavy are three different descriptions, and a paraphrase loses the detail the emergency department will ask you for.
Avoid leading the answer
Asking whether the pain goes into their left arm invites a yes. Asking whether the pain goes anywhere else gets the real distribution.
Ask the people around them
Family and bystanders hold the timeline, the baseline and the medication list. For a confused or unconscious patient they are the history, and their account of what normal looks like is worth more than your first impression.
Look as well as ask
Pill bottles, a pharmacy printout on the fridge, an alert bracelet, dialysis access, a nebulizer by the chair. These fill in the history a distressed patient cannot give you.
First responder questions before the ambulance arrives
A police officer, firefighter or community responder who reaches the patient first does not need the whole list. What happened, what is bothering them most, allergies, medications and the time it started are what the ambulance crew will want from you, so write the answers down with the clock time beside them.
The standard prompts, in plain words
- SAMPLE covers signs and symptoms, allergies, medications, past history, last oral intake, and the events leading up to the call.
- The History group follows the middle of SAMPLE: allergies, then medications, then past history, then last intake. Signs, symptoms and events are covered by Opening and Symptoms.
- OPQRST covers onset, what provokes or eases it, quality, whether it radiates, severity, and timing. After 'Where does it hurt?', the Pain group asks them in that order.
- For orientation, note the actual answers given instead of recording only that the patient was oriented.
- AVPU grades responsiveness: alert, responds to voice, responds to pain, unresponsive. Record which one, and the time.
- For a fall, find out which came first: the trip, or the feeling of going down. That order separates a mechanical fall from a medical one.
- The witness questions are written with he or she. On a call, use the patient's name.
Common pitfalls
Accepting fine as an answer
Patients play things down, particularly in front of family and particularly if they do not want to go to the hospital. Ask something specific instead: whether they can take a full breath, whether they can put weight on the leg.
Finishing the history before starting treatment
For a critically ill patient the questions come alongside treatment and transport, not before them. If you get nothing else, get allergies, medications and the time it started.
Asking sensitive questions in front of the wrong audience
Pregnancy, alcohol and drug use, and anything about how an injury happened may get a different answer with a partner or parent in the room. Make a moment of privacy if the scene allows it.
Losing the answers
Write down times, doses and exact quotes as you get them. Detail recalled at the hospital doors is already unreliable.
Treating the list as the protocol
These are prompts for taking a history. What you may give, when a patient can stay at home and where you transport are set by your training, your service and your medical direction, and those come first.