How to obtain a medical history from an altered patient
You are on scene with a patient who was found lying on the sidewalk with an altered level of consciousness; how can you obtain a history for a patient who cannot provide it himself?
The mnemonic SAMPLE is frequently taught as a tool to collect the medical history of a patient encountered by EMS personnel.
SAMPLE stands for:
- Past medical history
- Last oral intake
- Events leading to the incident
Memory tools like SAMPLE are certainly helpful prompts to keep providers from forgetting pieces of the assessment, but they work best when a patient (or family member/caregiver) can answer questions about their medical history and condition of.
When a patient is unresponsive or altered, collecting a history using SAMPLE becomes more difficult. Here are five tools to assist you in obtaining a medical history even when a patient cannot provide you answers.
1. Medical alert tags
A patient’s medical history may be located on a variety of tags and jewelry. Most common are Medical Alert bracelets or pendants worn by diabetic and seizure patients. These items generally contain information about the patient’s history, prescription medications or medical allergies. When assessing an unresponsive patient, be sure to look for medical alert tags, particularly if there is some suspicion for common causes of unresponsiveness.
While the traditional medical alert tag simply has a listing of medical information, there are other products on the market which provide additional information for EMS. Road ID, for example, is increasingly popular with recreational athletes like runners and cyclists. The ID’s may be found on wrist bands or activity trackers, but some versions also have 24/7 call center support where patients can maintain a medical profile which is available to first responders should the patient be unable to interact.
Additionally, several companies offer USB memory sticks preloaded with a patient’s medical history. With the proliferation of computer-based EMS charting, most providers have a computer available on scene to review these documents. Though, EMS having the time or resources to gather extensive information on a computer or from a call center may not be feasible in a life-threatening situation.
2. The bathroom
One sure way to develop a picture of a patient’s medical history is to have a medication list available. Most EMS students are required to demonstrate knowledge of classes of medications. Knowing common medications of a certain class and what those drugs are used for can provide insight into a patient’s history.
While some patients carry around a list of medications, others do not. Also, written lists may not be kept up to date.
Instead, consider locating a patient’s medication bottles. Often these bottles are in the bathroom though patients may keep them elsewhere. With a patient who is unable to speak, ask them to point to where they keep their medications. Periodically, neighbors or friends may know where a patient keeps his or her medications even if they know nothing about the patient’s history.
There are a few pitfalls with this approach to keep in mind. Patients may have old bottles of medication so you may be assuming the presence of a condition for which the patient is no longer treated. Additionally, patients who take multiple medications at different times of day may have a pill organizer. Often these are unlabeled and the patient may have disposed of the empty bottles leaving little clue to the contents of the organizer. Several medical reference apps for smartphones include a pill identifier function based on pill size, shape, color and imprint.
While not entirely reliable, don’t discount the knowledge of bystanders on the scene, even if they are not related to the patient. Patients often speak with friends and co-workers about their medical history, but even if they don’t, bystanders may know a patient’s regular habits:
- Are they normally active?
- Is EMS called to the house often?
- Is there family available in the area?
In the interest of maintaining patient confidentiality, ask questions about what bystanders may know about the patient without disclosing findings of your assessment.
4. The freezer
The Vial of Life is a non-profit program available throughout the United States. In areas which have implemented the program, potential patients fill out an information form with pertinent medical history, prescription medication names and doses and allergies as well as other items, including test results or recent ECGs. This information is put into a resealable plastic bag and placed in the freezer. Patients then put a sticker on their front door to identify that they participate in the Vial of Life program. This prompts responders to look for the labeled bag in the freezer should the patient be unable to provide medical history.
A top feature of the Vial of Life program is that the front door decals are provided free to individuals through the program’s website. Larger groups can order decals and are only asked to cover shipping and handling costs by donating. The program can be an easy way to connect with your community and ensure that important information is available to responders in a patient’s time of need.
5. The patient’s smartphone
The latest operating systems for Apple and Android phones include a feature that allows the user to enter demographic information, medical history and emergency contacts. Information is available from the lock screen on the phone even without the patient’s pin code or thumbprint. If a patient has entered information into their smartphone, responders should be able to access it even if the patient is unresponsive and unable to interact. Since many people are rarely without their smartphone, this is a simple, free option for taking information on-the-go.
While performing your secondary assessment, you do not find any medical identification on Peter’s wrists or around his neck. The bystanders on scene can all identify Peter, but don’t know much about his medical history other than the fact that he is active and appears to be an avid runner and cyclist. One of the firefighters on scene notices that Peter has his phone with him. Opening the Medical ID application reveals that Peter has a history of hypertension and takes metorpolol, a beta-blocker. The app also has a contact number for Peter’s wife. After speaking with her you determine that Peter is training for a marathon and was out for a 16-mile run today. He also just recently started taking the beta-blocker. You know that hypoglycemia is a possible side effect of beta-blockers and do not find any food in Peter’s pocket or anywhere with him.
A blood glucose measurement reads "Low" and after two tubes of oral glucose, Peter’s mental status has begun to improve. Eventually, he can confirm that he was most of the way through his run when he began feeling weak. He did not eat anything during his run. Peter’s wife arrives with some food and after eating Peter refuses transport and is released with his wife.
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