Is SAMPLE only used by EMTs, or does it apply at every level?

It's used across every certification level — the framework doesn't change, though what you do with the information (treatment options, medications) expands as scope of practice increases.

Do I need to ask SAMPLE and OPQRST as two separate conversations?

No — in practice they blend together naturally. OPQRST typically comes up while exploring the "Signs & Symptoms" portion of SAMPLE, not as a separate rigid script.

What if I can't complete the full history because the patient is unstable?

The primary survey and immediate life threats always come first. A full SAMPLE/OPQRST history is not the priority on an unstable patient — get what you can from bystanders or family while you manage the emergency.

Primary & Secondary Assessment: The Frameworks Worth Knowing Cold

This page covers assessment structure only — not medication dosing, protocols, or treatment decisions. Always follow your agency's current protocols and medical direction for anything beyond assessment.

Good assessment isn't about knowing more facts than the next provider — it's about not missing anything, in order, under pressure. That's what these frameworks are actually for. They're not trivia to memorize for an exam and forget; they're the structure that keeps you from skipping something critical when a scene is loud, a patient is scared, and you've got thirty seconds to form a plan.

The short version: the primary survey finds and fixes what kills first. The secondary survey and SAMPLE/OPQRST build the fuller picture once immediate threats are addressed. Skipping the order — not skipping the content — is what actually gets people in trouble.

Primary Survey: Find What Kills First

The primary survey exists to catch immediately life-threatening problems before anything else — before history-taking, before a detailed exam, before treatment decisions that aren't urgent. The exact acronym taught varies a little by curriculum, but the sequence is consistent: airway, breathing, circulation, and a rapid disability/exposure check, addressing each life threat as you find it rather than finishing the survey and circling back.

The discipline here is resisting the pull toward an interesting-but-not-urgent finding before the primary survey is complete. A dramatic-looking injury that isn't actively killing the patient still comes after you've confirmed the airway is open and they're breathing and perfusing adequately.

SAMPLE History

Once immediate threats are addressed, SAMPLE structures the history-taking so nothing important gets missed in the adrenaline of the moment:

Signs & SymptomsWhat's actually wrong, in the patient's or bystanders' words and what you observe

AllergiesMedication, food, and environmental allergies

MedicationsCurrent prescriptions, OTC drugs, and supplements

Pertinent Past HistoryRelevant medical history, prior episodes of the same problem, recent procedures

Last Oral IntakeTiming and content of last food/drink — relevant for surgical and airway considerations

Events Leading UpWhat the patient was doing right before symptoms started

OPQRST for Pain and Symptom History

Where SAMPLE covers the whole patient, OPQRST drills into a specific complaint — most commonly pain, but it adapts to other symptoms too:

OnsetSudden or gradual, and what the patient was doing when it started

Provocation/PalliationWhat makes it better or worse

QualityHow the patient describes it in their own words — sharp, dull, crushing, tearing

Region/RadiationWhere it is, and whether it moves or spreads elsewhere

SeverityUsually a 0–10 scale, and whether it's changed since onset

TimeHow long it's been going on, and whether it's constant or comes and goes

Secondary Survey: Building the Full Picture

Once life threats are managed and history is gathered, the secondary survey is a systematic head-to-toe (or focused, depending on the call) physical exam — looking, listening, and feeling for what the history alone won't reveal. This is where a lot of new providers rush, especially on calls that feel routine. The point of doing it the same way every time isn't ritual for its own sake — it's what keeps you from missing the quiet finding on the call that turns out not to be routine after all.

Why the Order Matters More Than the Details

New providers often over-focus on memorizing every possible finding under each letter and under-focus on the sequence itself. In practice, the sequence is what protects the patient: primary survey before history, history before detailed exam, life threats addressed the moment they're found rather than queued up for later. Get the order right and the frameworks do the remembering for you under pressure — that's the actual point of having them.

FAQ

Is SAMPLE only used by EMTs, or does it apply at every level?: It's used across every certification level — the framework doesn't change, though what you do with the information (treatment options, medications) expands as scope of practice increases.
Do I need to ask SAMPLE and OPQRST as two separate conversations?: No — in practice they blend together naturally. OPQRST typically comes up while exploring the "Signs & Symptoms" portion of SAMPLE, not as a separate rigid script.
What if I can't complete the full history because the patient is unstable?: The primary survey and immediate life threats always come first. A full SAMPLE/OPQRST history is not the priority on an unstable patient — get what you can from bystanders or family while you manage the emergency.