SAMPLE History in EMS: What Each Letter Asks and Why

A SAMPLE history is the structured patient history used across EMS. SAMPLE stands for Signs and symptoms, Allergies, Medications, Past pertinent history, Last oral intake, and Events leading up to the illness or injury. It takes a couple of minutes, it works on medical and trauma patients alike, and it is a part of the assessment receiving staff commonly ask to hear again.

Why a mnemonic at all

Under pressure, people skip things. Many history errors are not wrong answers but missing questions: nobody asked about allergies, nobody found out the patient takes a blood thinner, nobody knows when they last ate. SAMPLE is a short list that makes those omissions harder. It is not a script, and a good history sounds like a conversation, but the letters are what you check against before you hand the patient over.

Each letter, and what to ask

S: Signs and symptoms

Symptoms are what the patient reports: pain, nausea, shortness of breath, dizziness. Signs are what you observe: pale skin, a wheeze, a limp. Start with the chief complaint in the patient's own words, then ask about associated symptoms. This is where OPQRST usually lives, because it is the structured way to describe a symptom.

• "What is bothering you most right now?"
• "Anything else going on? Nausea, sweating, shortness of breath, dizziness?"

A: Allergies

Ask about medications first, then foods, latex and environmental allergies. Then ask what the reaction was. "Allergic to penicillin" can mean anything from a stomach upset to anaphylaxis, and the difference matters to whoever gives the next drug. Check for a medical alert bracelet or wallet card on a patient who cannot answer.

M: Medications

Ask what the patient takes, including what they took today and whether they have missed doses. Patients reliably leave out the same things, so ask about them directly:

• Over-the-counter medications, vitamins and supplements.
• Inhalers, patches, eye drops and injections, which many people do not think of as medications.
• Blood thinners, which change how you think about any fall or bleed.
• Recent changes: a new prescription, a stopped one, a changed dose.
• Recreational drugs and alcohol, asked plainly and without judgment.

If there is a list, a pill organizer or a bag of bottles, bring it or photograph it according to your service's practice. A list in hand is more reliable than a list from memory, especially from a patient who is unwell.

P: Past pertinent history

The word that matters is pertinent. A complete medical history is not the goal; the history that relates to today's complaint is. Ask about major conditions such as heart disease, lung disease, diabetes, seizures and stroke, recent surgeries or hospital stays, and whether anything like this has happened before. A patient who says "this is exactly like my last heart attack" has told you something important.

L: Last oral intake

When did the patient last eat or drink, and what? It matters for a diabetic patient whose glucose may be off, for a patient with abdominal complaints, and for anyone who may need sedation or surgery at the hospital. Some programs add variants. One is last output: urination, bowel movements, vomiting. Another, for patients of childbearing age, is last menstrual period. Ask what your program expects.

E: Events leading up

What happened before the complaint started? For a medical patient, what were they doing and did anything unusual happen in the hours before. For a trauma patient, this is the mechanism of injury, and it may be more reliably told by a bystander than by the patient. Ask about anything that came first: a dizzy spell before the fall, chest pain before the crash.

SAMPLE and OPQRST together

SAMPLE describes the patient; OPQRST describes the complaint. The two overlap at S, where OPQRST is how you work through a symptom, and at M, where you ask what the patient took for it. Use them together, follow the conversation rather than the order of the letters, and make sure every letter of both is covered before you report.

When the patient cannot answer

An unresponsive, confused or very young patient still has a SAMPLE history; you just get it from somewhere else. Family members, caregivers, bystanders, medication bottles, medical alert jewelry, care facility paperwork and the scene itself all carry history. Record where each piece came from, because a history from a bystander who met the patient ten minutes ago is not the same as one from a spouse.

With a child, ask the caregiver and also ask the child, at a level they can answer. Children old enough to talk can often tell you where it hurts and what happened better than an adult who was in the next room.

Common mistakes

• Asking allergies without asking the reaction.
• Accepting "no medications" without asking about inhalers, supplements and over-the-counter drugs.
• Taking a full medical history instead of a pertinent one, and running out of time before the questions that mattered.
• Skipping last oral intake because it feels irrelevant. It is easy to leave out of a handoff.
• Forgetting to record the source of the history on a patient who could not give it.

Practice turning a SAMPLE history into a structured handoff

The short version

• Signs and symptoms, Allergies, Medications, Past pertinent history, Last oral intake, Events leading up.
• For allergies, ask what the reaction was.
• For medications, ask directly about over-the-counter drugs, inhalers, blood thinners and recent changes.
• Past history means pertinent history.
• SAMPLE describes the patient; OPQRST describes the complaint.
• An unresponsive patient still has a history. Find it, and record the source.