The Basics

The interview is always the same and follows a set pattern of questions. Questions that occur to the ambulance crew after this conversation would be referred to as a follow up question.

• Subjective – This is the patient’s chief complaint as defined in terms of onset, provocation, quality, radiation, severity, and time. The patient says they have chest pain, then the medics ask about OPQRST (onset, provocation, quality, radiation, severity, and time).
• Allergies – The patient is probably allergic to a medication. Having a drug allergy means that when the patient takes the medication they have an allergic reaction. Many patients will confuse a medications side effect with an allergy. Not a problem for the ambulance crew. Simply write down the allergy and what happens when they take the medication.
• Medications – Patients are prescribed numerous medications. The EMS crew should write down each medication, the dosage for each mediation, and how many times they take the medication per day. Having a good list of medications is important to the rest of the health care team.
• Previous medical history – Inquire about the patient’s medical history. What medical conditions are they being treated for? What surgeries have they had? Is the patient undergoing some sort of holistic health treatment such as exercising, special diet, or fasting?
• Last meal or oral intake – What was the last thing the patient ate. It doesn’t make that big of a deal most of the time, but if the patient needs surgery, the anesthesiologists are definitely going to want to know.
• Events preceding the complaint – What was the patient doing before they started experiencing the pain that led them to call 911?

Any question formulated after having this conversation would be referred to as a follow up question. Examples of follow up questions could be:

• Do you have any plans to kill yourself?
• Did you go back to the same doctor after the incident?
• Have you ever eaten octopus before?

OPQRST Is How We Define The Chief Complaint

When a patient tells the medics that something is wrong, the medics need more information. It’s not enough to just have chest pain, there is more detail to be gleaned from the patient. The questions don’t have to asked in any order and some of the questions won’t make sense for the pateint’s complaint (like radiation for shortness of breath). Assuming the the patient is complaining of chest pain, the following are questions that would lead the medics to a greater understanding of the patient’s complaint.

• Onset – Did the complaint get worse over time or did it start at the level it is now.
• Provocation – What makes the complaint hurt worse or makes it better
• Quality – Describe the pain, either as sharp, dull, or burning
• Radiation – Does the pain move anywhere
• Severity – Rate the pain, generally on a 1 to 10 scale
• Time – When did the pain start

The following is a dialogue that should demonstrate the use of this pneumonic and that it is most useful when asked out of the OPQRST order:

Medic - So, why am I here?
Patient - I am having chest pain.
Medic - Ok, can you describe the pain?
Patient - The pain is dull
Medic - On a scale of 1 to 10, how would you rate the pain? 
Patient - The pain is a 10
Medic - Oh, my.  Did it start out as a 10?
Patient - Yes, it started out as a 10
Medic - What makes it worse?
Patient - Moving my left arm
Medic - Does the pain move from your chest to another area of your body?
Patient - No

You can see from the example above that all the questions were asked, but more in an order that is organic to a conversation. The OPQRST pneumonic is intended to help medics remember to ask the questions rather than be a format for a conversation.