Great work making it this far in the module. We've covered a lot of technical material that will require regular practice to master. But, we believe in you and you can do it. In the final videos in this module, we will shift gears from calculating vital signs and assessing skin signs to gathering a patient history upon your interaction. There is good news, no calculations are necessary. However, history taking will also require practice to master. We will discuss some tips and guides to organizing your history taking, but learning a natural conversational approach will lead to the most substantive patient interactions. Let's get going. What do I mean by patient history taking? This can be a very broad topic, so it is up to you to narrow or widen the focus as you see necessary to gather the right information at the right time. History taking is essentially gathering information about what led to a call for emergency medical services and then, additional background information that might help you, the EMT, establish your differential diagnosis. Your differential diagnoses are a set of possible causes to your patient's problem. First and foremost, you must make sure that you're seen as safe at the time of starting your patient history gathering and remember to ensure scene safety through out the entire process. If at anytime you or your patient safety is endanger, reposition, retreat, call for additional resources, and get to safety immediately. Secondly, is whether you have the time for history taking or not. In some instances, like a mass casualty incident or MCI, you'll have to make rapid brief assessment without asking many or if any questions at all. So, your scene is safe, you have one patient to assess, you are ready to proceed. The next step is easy, introduce yourself. Remember what they say about first impressions, here's your opportunity to make it a good one. Find a balance between casual and robotic. Say you are professional, but warm and convey confidence and trust to your patient. I would start with your name, your title, and your agency, and ask how you may be of service to them. This is your opportunity to ascertain your patient's chief complaint. Why don't you pause to practice this. "Hi, my name is Arthur. I'm a paramedic with Denver Health and how can I help you out today?" Remember, it's all in your delivery, tone and body language. Try to sound empathetic, encouraging, and supportive. You may try other methods of ascertaining a chief complaints such as, "What seems to be wrong?" or "What's going on?" If their response is vague or non-specific, you could attempt to focus their answering by saying, "Why exactly did you call 9-1-1 today?" Some patients require very specific questions to get the answer that you're looking for and others may share way more information than you were looking for. It is your job to hone in the history taking as you find pertinent. Try and start with an open ended question, but narrow it down as you see fit. Once you have learned their symptoms and/or chief complaint, it's time to begin your assessment. You'll want to make sure that it's okay to begin touching your patient before you actually do. Try, "I'm sorry to hear that you're not feeling well, may I go ahead and evaluate you? I'm going to take your arm and take your vital signs right now." This allows the patient to consent to assessment and being touched by you. Some patients may want you to explain each step of the process you're about to do, whereas others will understand what you're doing with an umbrella phrase like, "I'm going to take your vital signs." Try to fulfill the needs of each of your individual patients. While you are performing your initial assessment of your patient's chief complaint, the position of where you stand is important. Remember how I said that scene safety is an ongoing concern? Well, make sure that you are in a position to retreat or take cover should your patients attitude change to combative or agitated. Furthermore, be prepared to retreat if an unwanted bystander arrives like an angry partner or the suspect of a crime. Body language is also important in your communication. Shaking a patient's hand or a family member's hand is a professional way to greet yourself especially if you are entering a private residence. For patients who are sitting down or who are showing reluctance to in communicating with you, it is helpful to kneel so that you are at or below their eye level. Be aware that while kneeling, that you are still able to retreat if the scene becomes dangerous. If too many people including bystanders, extra first responders, family or friends are surrounding the patient, it is crucial to break up the crowd. Too much presence around the patient can intimidate the patient, exacerbate medical conditions, and lead to a breakdown in information gathering. It may be helpful to bring the patient into the ambulance to complete the assessment, so their privacy is insured. If the scene is hectic or emergent, you'll have to do your best to assess what you can, where you find the patient. Your competence and control of the scene will lead to a better patient interaction. We have a general idea now of the setup to taking a history. Let's now go further into the details of history taking.
