I knew and worked with some great paramedics. I learned a lot from partners and others over the years and they helped me improve my ability to assess and treat patients.

The truth is that you can’t effectively treat patients if you don’t know  what is wrong with them. I also worked with some “throw everything in your drug box” medics who often didn’t know exactly what they thought they were treating. They were like automobile technicians that used the so called “parts cannon” to try to fix a problem without diagnosing the issue.

By the way, paramedics diagnose. The doctors unions don’t like that and for the most part medics use other terms, but it’s still a diagnosis. The best of the several medical directors I worked for over the years once said “Of course paramedics diagnose. How else do you know what you’re treating?”

There are several steps to making a diagnosis. Sometimes those steps happen almost simultaneously as you walk in the door and look at the patient. From ten feet away you can tell the patient is sick and from his appearance you can even figure out what the problem is. It’s still important to do a proper assessment, but it’s confirmatory, not discovery.

The paramedic school I went to had an Anatomy and Physiology course built in. It was a college level program as the same university also had a well regarded nursing program and the same instructor taught our program.

Some of my fellow students asked him when we were going to get to abnormal A&P and all these years later I remember his answer. “Once you know normal A&P, you will know abnormal A&P when you see it.

Part of assessment is knowing what’s normal and what isn’t. For example normal breath sounds are quiet, almost silent. So, anything that is noisy is abnormal and we are left to figure out what is causing that and then apply our protocols. I’m often surprised how often paramedics default to giving a bronchodilator when the problem is fluid in the patient’s lungs. That’s a lack of understanding both anatomy and physiology.

That’s a lot of writing to get to the point of this post.

EMS1 has a pretty good article on using OPQRST as part of the assessment.

Go ahead and read it,

How to use OPQRST as an effective patient pain assessment tool

The description of what each component is very good, but I do have a quibble with the pain scale. I’ve never used the 1-10 scale because it tries to quantify what is clearly subjective. My 10, is your 5, and the guy down the roads 2. Then there is always the person who says it’s an 11. Maybe they are fans of Spinal Tap, but often it’s an exaggeration.

I once asked a patient if his chest pain was like an elephant sitting on his chest. He replied “No, it’s more like a German Shepard sitting on my chest.” That gave me an approximate idea of how severe his pain was and I was able to proceed from there.

I have only one problem with OPQRST. I can’t remember it. This presented a problem as I’d miss something in my assessment because I forgot one of the questions.

I mentioned this one day to one of my fellow paramedics. She was a very good paramedic, if a bit rough around the edges and I learned quite a bit about patient care by working with her.

She told me she used to have the same problem until someone gave her a different mnemonic. It worked so well that I still use it when reviewing PCRs.

Here it is. LOCDIT.  Compare it to OPQRST and you’ll see it’s just a different way to approach the same issue.

Location. Where is the pain and does it radiate anywhere?

Onset.  Did it come on suddenly or over a period of time?

Character. Is the pain sharp or dull? Alternatively you can ask the patient to describe it using their own words. This might not work well if the patient can’t give concise answers and sort of rambles on.

Duration. When did it start? Is it constant or intermittent?

Intensity. As mentioned, I’ve never been a fan of the 1-10 scale and even less so the “Smiley Face” pictogram. Use the initial pain level, however you determined it as your baseline for treatment. After each treatment, ask again if the pain has changed at all.

Treatment. Did the patient do anything to treat the pain? Did it help or make it worse?

That’s it. LOCDIT. You might find that it helps you better organize your assessment of patient complaints. While it’s geared to pain it can also be adapted to a complaint of Dyspnea.