EMS patient interview techniques


CarolinaFireJournal - David Hesselmeyer
David Hesselmeyer
08/01/2012 -

How many times have you gone on EMS runs and had to play detective? Most of us would say just about every time we have responded to a call. We normally do not walk up to a patient and hear them state their problem such as “I am having an acute asthma attack brought on by my inability to pay for my medications and my exposure to the trigger mechanism.” If they did it would make our job a lot easier.

We gather information from the patients by being a good detective. One tool in the detective’s box is good interviewing techniques. We have all been taught these. However, it is a combination of education and experience that can make you good at it.

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My Method

Let me start by saying that my method is not perfect; nor is it absolute. There are different styles and manners of doing this. This method has allowed me the best opportunities to gain valuable information from my patients for me.

So first, I introduce myself and give the patient an open minute or so to describe what is going on with them. This would likely sound something to the effect of “Hi, my name is David and I am a paramedic. So, what is going on today?” This generally allows the patient to feel at ease with me as well as to feel open to discuss what is happening to them.

Secondly, I follow the standard OPQRST pneumonic. But do not let the pneumonic run your interviewing questions. I do not simply ask what the onset of the problem was. I might ask a question such as “Did this problem wake you up?” Questions posed in this manner are likely to solicit more information from the patient than simply asking what was the onset. Form your questions to where they fit your suspicion of the underlying cause of their illness and let them provide the details.

One caveat though is to not question the patient again about what they have already told you, unless it is to confirm their information. So if you remember them telling you that this woke them up but are not sure about the time they stated then do not ask them if it woke them up again; simply ask what time it woke them up.

I follow this with information concerning their medical condition. This line of questioning of course pertains to their medical history, allergies and medications.

When I ask about their medical history I also try to ask questions concerning their family medical history — especially if their illness concerns medical problems that could be genetic. Also do not forget to ask questions concerning their lifestyle when it is pertinent to the case. Such questions would be about smoking, drinking, recreational drug use and seatbelt use. This is also a good educational opportunity. They could want to quit smoking or drinking but have no manner to get help and you just may be that opportunity.

Allergies should not just be concerning medications. Remember that some medications have contraindications if they are allergic to some foods. Also attempt to get a full list of medications that the patient is taking. I like to take their meds to the hospital so that I do not waste time on-scene writing them down. This also helps the Emergency Department to record what dosages they are taking as well.

By this time you are likely to have a general suspicion of the cause of their illness. However, if you do not or if you still want to further confirm, ask follow on questions. Always make sure these and your other questions are not leading. Let your patient be the storyteller but ensure you have control of the interview.

Points to Ponder

There are several common themes for interviews/interviewees:

  • Do not lead your patient. Let them tell the story.
  • Find a method that works for you. Learn from partners and build a system that works for you.
  • Be thorough. Missing one piece of information can lead you down a different path altogether.
  • Be an educator. Remind them about the dangers of any habits but do so in a caring way. You may be surprised at who needs the help.
  • Allow the patient to be open. Sometimes the patient may fear the information getting into the wrong hands such as their parents or friends. Let them know (including by showing it) that they can trust you.

Conclusion

Interview techniques can be helpful or a hindrance when attempting to find the cause of an illness. We must be vigilant in our search and be that good medical detective. We are medical professionals and our patients, no matter how serious their illness or perceived illness is, should be given our utmost care and attention.

Good luck out there and be safe!

David Hesselmeyer has over 11 years experience in fire and EMS. Hesselmeyer works for the Public Health Regional Surveillance (PHRST) Team 3 out of Cumberland County as a Regional Emergency Management Planner. He can be reached at [email protected].
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