Onset
When did it begin? Was it sudden or gradual? What was the patient doing at the time?
How → Why → Practice
Describe pain clearly, recognize red flags, and document what the patient actually reports.
OPQRST organizes symptom questions without replacing the primary assessment or treatment of immediate life threats.
0 of 3 lessons complete
Lesson 1
HOW: Perform an OPQRST assessment
Ask open questions first, then clarify the patient's own words. Reassess after movement or treatment.
Provocation/Palliation
What makes it better or worse—movement, breathing, position, eating, palpation, or rest?
Quality
Ask the patient to describe it: pressure, sharp, tearing, burning, cramping, aching, or another term.
Region/Radiation
Where is it? Does it travel to the arm, jaw, back, shoulder, groin, or another location?
Severity
Use an age-appropriate scale. Record the patient's number and observe how the pain affects function.
Time
Is it constant or intermittent? Has it changed? Has the patient had anything similar before?
Pain is subjective—but documentation must be objective
Record the patient's quoted description, location, radiation, score, timing, associated findings, and response to care. Do not document “severe” only because the score is high.
Also assess
- Associated shortness of breath, nausea, diaphoresis, weakness, or neurologic symptoms
- Mechanism of injury and visible findings
- Vital signs and changes over time
- Relevant SAMPLE history
- Pain before and after intervention
Common mistakes
- Leading the patient toward a description
- Skipping sudden-onset or radiation questions
- Using only the 0–10 score
- Ignoring pain-free but serious presentations
- Failing to reassess and document changes
Lesson 2
WHY: Connect pain features to risk
No single pain description proves a diagnosis. Patterns help determine urgency, additional assessment, and transport decisions.
Sudden onset matters
Abrupt maximal pain may increase concern for vascular, neurologic, pulmonary, or other time-sensitive causes.
Provocation adds clues
Pain with movement, palpation, breathing, exertion, meals, or position can help focus the assessment without ruling disease in or out.
Radiation changes concern
Discomfort traveling to the jaw, arm, back, shoulder, or groin may indicate referred pain and requires context.
Reassessment shows trend
Changes in pain, vitals, mental status, or associated symptoms may be more important than the first score.
FindingExampleConcern
Sudden maximal onset“Worst headache instantly”Time-sensitive neurologic or vascular cause
Exertional pressureSubsternal pressure with diaphoresisPotential cardiac ischemia
Tearing to backChest pain radiating between shoulder bladesPotential major vascular emergency
Pleuritic painSharp pain worse with breathingPulmonary, chest wall, or other cause
Pain with instabilityPelvic pain after major traumaPossible significant internal injury
Knowledge check
Full scenario mode: complete this assessment for the active patient. Teaching sections and patient changes are locked until you leave the scenario.
Lesson 3
PRACTICE: Interview, interpret, and document
Reveal a randomized OPQRST interview, decide whether it contains a concerning pattern, select the best next EMT action, and write a PCR-ready pain description.
Randomized patient
Patient encounter
Patient's answers
0/4
Coaching feedback
Your OPQRST assessment
Example PCR documentation