SAMPLE HISTORY

S – Signs & Symptoms of the episode

A – Allergies: Is the patient allergic to any medication, food or other substances? What reactions
did the patient have to any of them?

M – Medications: What medications was the patient prescribed? What dosage was prescribed?
How often is the patient supposed to take the medication? What prescription, OTC medications
and herbal medications has the patient taken in the last 12 hours? How much was taken?

P – Pertinent past history: Does the patient have any history of medical, surgical or trauma
occurrences? Has the patient had a recent illness or injury, fall or blow to the head?

L – Last oral intate: When did the patient last eat or drink? What did the patient eat or drink and
how much was consumed? Did the patient take any drugs or drink any alcohol? Has there been
any oral intake in the last 4 hours?

E – Events leading to the injury or illness: What are the key events that lead up to the incident?
What occurred between the onset of the incident and your arrival? What was the patient doing
when this illness started? What was the patient doing when this injury happened?
 CINCINNATI STROKE SCALE

TEST NORMAL ABNORMAL

Facial Drop Both sides of face move One side of face does not move
equally well as well as other
Ask patient to show teeth or
smile

Arm Drift
Ask patient to close eyes and
hold both arms out with palms
up
Speech
Ask patient to say,”The sky is
blue in Cincinnati”
Both arms move the same or One arm does not move, or one
both arms do not move arm drifts down compared with
the other side
Patient uses correct words with Patient slurs words, uses
no slurring inappropriate words, or is
unable to speak
O Onset, that is, when did the problem begin and what caused it?

P Provocation or Palliation, that is, does anything make it feel better? Worse?

Q Quality, that is, what is the pain like? Sharp, dull, crushing, tearing?

R Region/Radiation, that is, where does it hurt? Does the pain move anywhere?

S Severity, that is, on a scale of 1 to 10, 10 being the worst and 1 being none, how
would you rate your pain?

T Timing, that is, has the pain been constant, or does it come and go? How long
have you had the pain (often answered under ”O”, onset)
 SCENE SIZE-UP
BSI / SCENE SAFETY

CONSIDER MECHANISM OF INJURY / NATURE OF ILLNESS

DETERMINE NUMBER OF PATIENTS

CONSIDER ADDITIONAL RESOURCES

CONSIDER C-SPINE

INITIAL ASSESSMENT
APPROACH AND FORM GENERAL IMPRESSION

ASSESS MENTAL STATUS

ASSESS AIRWAY

ASSESS BREATHING

ASSESS CIRCULATION

INDENTIFY PRIORTY PATIENTS AND MAKE TRANSPORT

DECISION