Chest Pain Assessment

What Is Chest Pain Assessment?

A prehospital chest pain assessment is built around OPQRST (Onset, Provocation/Palliation, Quality, Radiation, Severity, Time) for the pain itself and SAMPLE (Signs/Symptoms, Allergies, Medications, Past history, Last oral intake, Events leading up) for context, paired with a 12-lead ECG as early as possible, since STEMI recognition time directly affects cath lab activation and outcome. The differential in the field spans cardiac (ACS, pericarditis), vascular (aortic dissection, which classically presents as tearing pain radiating to the back), pulmonary (PE, pneumothorax), and non-emergent causes (GERD, costochondritis, anxiety), and prehospital providers are trained to treat toward the most dangerous possibility first rather than wait for a definitive diagnosis. Cardiac biomarkers like troponin are a hospital lab test, not a field tool; the 12-lead ECG and clinical presentation are what EMS actually has to work with on scene.

Why Chest Pain Assessment Matters on the Fireground

A clean-looking initial ECG doesn't rule out ACS, since early ischemic changes can be subtle or evolve over time, which is why serial ECGs and treating the clinical picture (not just one strip) matter. Nitroglycerin, one of the most common chest pain interventions, has hard contraindications, hypotension, right-sided/inferior MI with RV involvement, and recent PDE5 inhibitor use (sildenafil, tadalafil), that can cause a dangerous BP crash if missed during the SAMPLE history.

Relevant NFPA Standards

• NFPA 455: Standard for Emergency Medical Services (EMS)
• AHA ACLS Guidelines: American Heart Association Advanced Cardiovascular Life Support Guidelines

Field Procedures & Tactical Steps

1. Obtain a 12-lead ECG as early as possible and transmit or relay findings to the receiving facility if STEMI criteria are met.
2. Complete OPQRST for the pain and SAMPLE for history, specifically screening for PDE5 inhibitor use before considering nitroglycerin.
3. Monitor and trend vital signs (BP, HR, SpO2) throughout transport rather than relying on a single set of readings.
4. Reassess and repeat the 12-lead ECG if pain changes or initial findings are non-diagnostic, since ischemic changes can evolve.

Common Context & Application

Performed on any chest pain complaint from dispatch to patient contact, prioritized ahead of a full physical exam so a 12-lead ECG can be obtained and transmitted early if a STEMI is suspected.

Frequently Asked Questions about Chest Pain Assessment