First most important question to ask

[armywifeemt]

What is the single most important question to ask in the SAMPLE history?

There are a few ways of looking at this, but I am going to go off of the literal meaning of the OPs initial question. He asked about SAMPLE specifically.. yes, it is a tool, a guide, and not something you will rely on for every call, especially as you gain experience... but if it weren't useful, we wouldn't learn it. As far as the most useful question, I personally think in most hypothetical situations it would be Medications... It seems to me that you could probably get answers to a lot of the other questions in SAMPLE just by asking about medications, especially if you know your pharmacology. You have a very good chance of finding out about allergies and pertinent medical history from medications... and depending on what you were dispatched for and how much information you got from dispatch, it might give you a strong indication as to what is going on. For instance... dispatched for a patient who is "acting funny" at work, and the coworkers told dispatch that their consciousness had been slowly deteriorating all day... you get there, have a barely conscious patient (situation such as what I quoted from mycrofft below) and ask them if they take any meds... say they're taking insulin... Good indication that it might be time to get a BS read and give them some glucose.


The only problem with this whole question, especially mycroffts rephrasing of it is that the majority of the real calls we get will give us different contextual hints. So many clues on scene guide the questions you ask... and even the nature of the call. I mean responding to an MVA you're usually going to be automatically suspecting shock... possibly inebriation, especially between midnight and 5 AM... responding to a patients house, you may have medication bottles laying all over the place, or alcohol, or even drug paraphernalia. It is hard to really determine one important question.. some patients you might not even get to ask questions.. So, yeah, hypothetically you may be able to come up with an answer to this question, but in reality, there really is no one right answer.

Allowing for time for the increasingly obtunded pt to think then reply, NOW tell us what the most important question(s) is/are.
Honest answers to these could be a real psychological test.

 

[Needles17]

Did you really spend time searching online which is important? Signs and symtoms are mostly what you observe before you even speak to the pt. SOB, Diaphresis, Skin Color, feeling a pulse...fast or slow...etc... I wouldn't really consider that a question. They are all important for a complete assessment. You should be able to get on a track withing 60 secs after pt contact. Sure some people blab on with every question, but just looking at your pt will usually tell you what is going on. Maybe spend time online searching how to assess like a rock star...lol

 

[eveningsky339]

*strolls up to apneic, pulseless, cyanotic patient*

Hello, I'm eveningsky from the ambulance. Why did you request an ambulance?

...

May I ask your name?

...

You having a some chest pain today?

...



*ahem* Anyway, to address the OP, it depends on what type of service you are with. If you are with a rural EMS agency, the first most important questions are as follows:

How much did you drink?

What brings us here today?

*after patient response*

Sweet Gravy, you did what with what?

 

[EMSLaw]

While it's not a question per se, I'm interested in the whole introduction thing. I've run with a few EMTs who don't introduce themselves, while I almost always do (well, not to the unconscious...)

So, I usually start out with, "Hi, I'm EMSLaw, I'm an EMT with Slow Boat to the ED Ambulance. What's your name, sir/ma'am?" "Okay, Mr./Ms. Soandso, what seems to be the problem/what brings us here tonight/how'd you get that bloody stump, and where is the rest of your leg?"

Besides, asking the patient's name is one of the first indicators I have that they're oriented. Except when the hovering family members jump in and start answering all my questions before the patient can.

Department of Health regulations require that paid-service EMTs wear identification with their name and level of training - though interestingly, an EMT patch is optional. Volunteers don't have that requirement, so I prefer to let them know who I am and what my qualifications are (not that most people know what being an EMT means, other than that I'm in the big ambulance and came to help.)

 

[MrBrown]

I always introduce myself and ask (unless screamingly obvious) "whats going on today".

Although our uniforms say Technician, Paramedic or Intensive Care (as of Q1 2010) it is not common for people to use thier practice level title here.

On the name topic, some people here cover up thier surname on thier name badge if they have an old one before the option of having first name only was introduced.

Mine has both my surname and forename.

 

[alyssa_]

This is entirely speculation, since I'm only an EMT student with 24 hours of ridealongs under my belt, but if there's more than one person on scene... "Who called 911?" sounds like a good question, if it's not glaringly obvious.

It might be a little embarrassing to start treating the wrong person. :blush:

 

[firetender]

Kojak's (remember Telly Savalas, the bald detective on TV?) first words to a guy who had been threatening to jump off a bridge for an hour, virtually holding a city at bay, were "Where do you want us to send your body?"

 

[girlyEMT26]

If its a cardiac patient, dont for get to ask if they have taken any sexual enhancing drugs, a little embarrassing but very important.

 

[girlyEMT26]

I was always taught to ask the patient there name and ask permission to treat. those are important.

 

[EMSLaw]

This is entirely speculation, since I'm only an EMT student with 24 hours of ridealongs under my belt, but if there's more than one person on scene... "Who called 911?" sounds like a good question, if it's not glaringly obvious.

It might be a little embarrassing to start treating the wrong person. :blush:

This /can/ be an issue, but most of the time, especially if you respond to a private residence, it's not difficult to find the patient. They'll be the one that looks like crap, or is standing by the door with a suitcase in hand.

Now, when you get called to a "skilled nursing facility", it is sometimes an adventure to figure out why you're there, who your patient is, and what the patient's chief complaint may be. "I'm sorry, so... Ms. Oldperson fell, and got back up and danced the tango, and doesn't want our help, but since she fell, your unit nurse said you /had/ to call 9-1-1? Okay. We'll take it from here, thanks."