Important Aspects of History

AMPLE

If you receive a patient that is unstable, after paramedic handover (I MIST-AMBO) an AMPLE history should be retaken in the first instance (if possible)

Allergies

Medications (especially anticoagulants/platelet inhibitors, betablockers)

Past medical history

Last ate (when)

Events leading to trauma

Mechanism of injury

When time allows, more information regarding the mechanism of injury can provide insight into the forces applied and potential injuries sustained.

Photographs from the scene can sometimes provide valuable insight.

Road traffic crashes

• Number of vehicles involved
• Patient’s position in the car
• Estimate of speed (of all vehicles involved) – did either party brake before impact?
• Direction of impact (eg: T boned, head on, rear ended)
• Damage sustained to the car
  • amount of intrusion where patient was sitting
  • windshield shatter pattern from head impact?
  • often the paramedics take a photo of the damage at the scene
• Seatbelt worn?
• Airbags deployed?
• Why did crash occur? ie: driver error vs medical event
• Rollover?
• Ejection from vehicle
• Other deaths in the vehicle or in the accident
• Did patient self extricate? Mobilise at scene?
• If entrapped – how long for and how released

Pedestrian vs vehicle

• speed of vehicle at impact
• type of vehicle
• where on body patient was initially impacted, did they hit the bonnet as well?
• patient run over or dragged?
• how far patient thrown

Motorcyclist (or quadbike)

• Wearing helmet?
• Leathers or other body protection worn?
• Estimate speed at impact
• Thrown from motorcycle or skidded off
• Secondary impact eg: car, tree
• Handlebar impact to body?
• Patient crushed by bike?

Cyclist

• Wearing helmet?
• Estimate of cyclist’s speed at impact
• If hit by another vehicle – what type, speed at impact, run over?
• If thrown, how far

Horses

• Wearing helmet?
• Body protection worn?
• Size of horse
• Estimate speed of horse at time of fall
• Stomped on, kicked or crushed by horse?
• If thrown, how far

Falls

• Distance (eg: height, number of steps)
• Fall broken by anything (eg: an awning)
• If witnessed, how did patient land

Stab wounds

• Type of weapon
• Diameter and length
• Estimate of depth
• Trajectory

Gun shot wounds

• type of gun (eg: pistol, semi-automatic, shotgun, sawn-off shotgun)
• calibre of weapon/bullet
• distance shot from

Other pre-hospital considerations

• Estimation of blood loss at scene (notoriously quite inaccurate)
• Initial vital signs and trends
• Pre-hospital treatment administered
  • medications
  • IV fluids or blood
  • reduction of fractures or dislocations