EMT Questions to Ask
Twenty short questions for on-scene patient assessment, in roughly the order you would use them: what happened, where it hurts and how badly, breathing, allergies, medications, medical history, orientation, and who to contact. Phrased plainly enough to use under pressure.
The questions
Open any question for the note
What happened?
Why ask it
Open framing gets the mechanism, and the patient's own words are what belongs in the handover. If the account does not fit the damage you can see, a fall with injuries too severe for the height, treat it as a reason to look for a cause behind the event.
Are you having any pain?
Why ask it
A no does not clear the patient. Distraction from one obvious injury, intoxication, head injury and shock all suppress the report, so pair the question with your own palpation rather than accepting the answer alone.
Where does it hurt?
Why ask it
Ask them to point rather than name a region, since patients describe anatomy loosely. Pain that moves or sits away from the injury, shoulder tip, jaw, between the shoulder blades, is worth flagging specifically.
On a scale of 1 to 10, how bad is it?
Why ask it
The absolute number varies too much between people to compare, so its value is the trend. Ask again after movement, splinting or analgesia, and record both readings with the times.
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.
When did this start?
Why ask it
Onset time drives time-critical decisions, so press for an anchor: a television programme, a meal, a phone call. When the patient cannot be exact, ask instead when they were last known to be well.
Do you have any allergies?
Why ask it
Ask what happens, not only to what. A rash and an airway reaction sit in the same answer otherwise, and the distinction changes what you and the receiving unit can give.
What medications are you taking?
Why ask it
Ask to see the packets or the list rather than relying on recall, and bring them along. Anticoagulants, beta blockers and insulin each change what you expect to see, and a dose missed today can be the whole explanation.
Do you have any medical conditions we should know about?
Why ask it
Patients often name only the condition they think is relevant. Following up with whether they see a specialist, or have been in hospital in the past year, surfaces the history they left out.
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.
Can you move your arms and legs, and does it feel normal?
Why ask it
Movement alone is not enough, since sensory change can precede weakness. Ask about tingling, numbness and whether both sides feel the same, and note anything they say has changed since the event.
Are you feeling dizzy or lightheaded?
Why ask it
Ask whether it happens only on standing or also lying down, which separates a postural cause from a central one. Dizziness that started before a fall changes the whole story.
Do you feel sick, or have you been sick?
Why ask it
Note the number of episodes and the appearance, since coffee-ground or blood-streaked vomit is significant. Repeated vomiting after a head injury needs escalating rather than recording.
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.
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.
Is there any chance you are pregnant?
Why ask it
Ask privately where the scene allows, since a family member's presence changes the answer. It affects positioning, drug choices and which unit the patient should go to.
When did you last eat or drink anything?
Why ask it
Relevant if surgery or sedation is likely, and directly relevant in 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 been in hospital or had surgery recently?
Why ask it
Recent procedures raise the odds of bleeding, infection and clots, and they also explain devices and dressings you find. Ask which hospital, since that is where the records are.
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.
Asking Well Under Pressure
Practical guidance for the conversation itself
On scene
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 clinically different, and a paraphrase loses the detail the receiving clinician needs.
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
Medication packets, a repeat prescription list, an alert bracelet, dialysis access, a nebuliser by the chair. These fill in the history a distressed patient cannot give you.
The standard prompts, in plain words
- SAMPLE covers signs and symptoms, allergies, medications, past history, last intake, and the events leading up to it.
- OPQRST covers onset, what provokes or eases it, quality, whether it radiates, severity, and timing.
- For orientation, note the actual answers given rather than recording that the patient was oriented.
- For a fall, ask what happened first: the trip, or the feeling of going down. That order separates mechanical from medical.
- For chest pain, ask what they were doing when it began and whether it has happened before.
Common pitfalls
Accepting fine as an answer
Patients minimise, particularly in front of family and particularly if they do not want to go to hospital. Ask a specific question instead: whether they can take a full breath, whether they can weight bear.
Finishing the history before starting treatment
For a critically unwell patient the questions come alongside intervention and transport, not before them. Allergies, medications and onset time are the ones you cannot skip.
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 present. Create 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.