SAMPLE history taking by itself is a valuable tool in any medical provider's toolbox, but while these six questions are good at obtaining vital information, they often fail to give the provider the full picture. For this reason, we ask other questions such as OPQRST and PASTE to attempt to gather a more complete history of the patient's chief complaint and medical history. This page is dedicated to follow-up questions (and their rationales) specific to the patient's SAMPLE history that can potentially give the provider a more complete set of information to make treatment decisions. Keep in mind, these follow-up questions are not the only ones; there exists an almost infinite number of questions that can be used to elicit a complete history from your patient, only time and experience will allow you to pick the best questions for the situation.
Signs and Symptoms[edit | edit source]
General assessment[edit | edit source]
Look at the patient for the signs. Symptoms are the complaints described by the patient.
Further assessment[edit | edit source]
Question: "Do you have any Nausea, Vomiting, Diarrhea, Lightheadedness, Dizziness, Chest Pain, Shortness of Breath, Abdominal Pain, Headache, Numbness or Tingling, Changes to Vision or Hearing, Recent Trauma or Illness, or Weakness?"
Rationale: All of these symptoms are either rule-outs for life threatening conditions (CP, SOB, HA, etc.) or are common symptoms that people may not regularly disclose that could clue the provider in to a different pathology.
Allergies[edit | edit source]
General assessment[edit | edit source]
"Do you have any allergies to food, medicine, etc.?"
Further assessment[edit | edit source]
Question: "Have you eaten/come into contact with your allergen recently?"
Rationale: Knowing that the patient is allergic to penicillin is great, but knowing that your patient was just given an unknown antibiotic that could be penicillin is better. Additionally, some allergens such as bee venom are finite (i.e. there is only as much venom as the stinger can inject; remove the stinger and you remove the potential for more venom) while others are longer lasting (these are the ingested ones such as nuts, where the allergen can continue to cause a reaction for the duration of digestion).
Question: "How do you react to each allergen?"
Rationale: Not every allergic reaction is life threatening, nor does every allergic reaction involve the respiratory system. There is a whole spectrum of severity and presentation of allergic reactions that can involve symptoms from itchiness to nausea and vomiting.
Question: "Do you carry an EpiPen for any of your allergies?"
Rationale: This is related to the previous question but is more targeted to the life threatening allergies. If your patient needs an EpiPen, their allergy is severe enough to warrant transport to the hospital for continued evaluation.
Medications[edit | edit source]
General assessment[edit | edit source]
"What medications do you take?"
Further assessment[edit | edit source]
Question: "Are you taking your medications as prescribed?"
Rationale: Many patients do not take their medications as they should, leading to issues like uncontrolled hypertension, seizures, or suicidal ideation, for example. Patients do not take medications for a variety of reasons that can, and does, include access to medications, cost of medications, and a wish to avoid unpleasant side effects from medications.
Question: "Do you take any un-prescribed medications or recreational drugs?"
Rationale: Un-prescribed medications like acetaminophen or ibuprofen are commonly used over the counter without any needed prescriptions. Asking if a patient has used OTC medications may allow the provider to obtain critical information about what the patient was feeling prior to the call (e.g. why they took the medication). An example of this would be a septic patient found without a fever because they had just been given Tylenol. Recreational drug use is helpful to know about as it may explain abnormal findings like tachycardia, respiratory depression, or chest pain.
Question: "Have you had any recent changes or additions/removals to your medications?"
Rationale: Occasionally patients will have additions, removals, or changes to their medications, all of which can cause potential problems. For example, a patient who just received an increased dose of metoprolol (a beta blocker whose side effects include reduced blood pressure and slowed heart rate) and experienced a syncopal episode (fainting) upon standing.
Question: "Do you administer your medications, or does someone else give them to you?"
Rationale: This is an especially useful question for older patients or patients who reside with caregivers or in assisted-living spaces. If the patient self-administers medications, there is the possibility of double-dosing accidentally (Dementia/Alzheimer's patients especially). If there are multiple caregivers who do not keep reliable medication dosing records, mis-dosing or double-dosing may also occur after shift change.
Past Medical History[edit | edit source]
General assessment[edit | edit source]
"What medical history do you have?"/ "What do you see a doctor for?".
Further assessment[edit | edit source]
Question: "Have you had any recent surgeries? How about surgeries in general?"
Rationale: Recent surgeries increase the likelihood of internal bleeding, venous thrombosis, and pulmonary embolism among other issues. Additionally, many elective surgeries require discontinuation of anticoagulant medications prior to surgery; if your patient is normally on an anticoagulant and has not restarted it following a surgery, coagulopathy may occur. General surgeries are useful to know about as they may give valuable insight into the patient's medical history (e.g. lower right sided abdominal pain with history of appendectomy means that it is most likely not appendicitis).
Question: "Has anything like this ever happened before? If so, was it better, worse, or the same as this time?"
Rationale: If the patient has had history of similar events, what course of action did they take in the past? Did they go to the ER, make a doctor's appointment, or stay home and monitor? Did they receive a diagnosis or new medications that may have helped control the issue up until this point? All of these are important questions to ask about the course of your patient's illness. Asking if this instance is better or worse than last time will provide a metric as to the severity of this incident (e.g. an asthmatic who states that their asthma is normally well controlled but is now in significant distress should be treated aggressively as their current exacerbation is likely severe).
Question: "When was the last time you had a checkup with your doctor?" or "When was the last time you saw your [specialist]?"
Rationale: Many patients do not regularly see the doctor due to dislike of medical professionals, fear, or worries about increased costs. These patients are likely to have incomplete medical records and knowledge of their conditions as well as poorly managed health in general. Specialists visits are of interest to EMS personnel specifically if they relate to the reason for the 911 call. Chest pain 8/10 at rest with no provocation or palliation? When you last saw your cardiologist, did they say there was anything to watch out for or foods to avoid? Did they find any abnormalities on their last exam?
Last Oral Intake[edit | edit source]
General assessment[edit | edit source]
"When was the last time you had something to eat or drink ---- What was it?"
Further assessment[edit | edit source]
Question: "Have you been eating and drinking normally? If so, do you normally eat/drink a lot, a little, or a normal amount compared to other people?"
Rationale: Many conditions such as orthostatic hypotension, hypoglycemia, and generalized weakness may be precipitated by incorrect nutrition. This question is especially useful when assessing transient patients (homeless) or dementia patients (ask the caregivers). For example, patients with a UTI or hyperglycemia may exhibit polydipsia (increased thirst).
Question: "Are there any foods that your doctor said you shouldn't eat? If so, have you eaten any of them recently?"
Rationale: This question is targeted for primarily cardiac patients who may be on a restricted salt intake diet but is also in the general assessment of normal patients. Salt is not the only dietary restriction, some patients are directed away from high fat diets (because they can aggravate cholecystitis) or specific foods like grapefruit (because they interfere with antimicrobials, statins, anxiolytics, and other medications).
Events Leading to Complaint/Call[edit | edit source]
General assessment[edit | edit source]
"What happened?"
Further assessment[edit | edit source]
Question: "Can you walk me through before and after the event as well?"
Rationale: In addition to gaining a more comprehensive history of the event, this question serves to test the patient's recall of the event. This is especially important for patients who experienced a loss of consciousness from a motor vehicle accident or fall, for example. The events immediately preceding and following the event may help clue the provider into the cause of the LOC, i.e. was the LOC caused by the crash (traumatic etiology) or by dizziness, lightheadedness, and a syncopal event that caused the crash (medical etiology).
Question: "Did someone else see this happen?"
Rationale: While the patient is oftentimes a good historian, if the patient is unable to recall the event or it was a traumatic event, bystander testimony can serve an important, generally impartial role in determining what, exactly, happened to cause 911 to be called.