Emergency First Aid Training - Chest Pain
June 4, 2015

How Do You Assess Chest Pain in a First Aid Emergency?

As a good first aider, I am sure that you are familiar with using mnemonics to help remember first aid procedures. Sometimes it can be difficult to recall every step involved in helping someone during an emergency, which is why memory aids can be incredibly useful.

In the ambulance world, mnemonics are used regularly, and because healthcare professionals frequently refresh their skills, these tools become second nature. Today, I’ll walk you through a simple and effective way to assess a patient experiencing chest pain using a well-known mnemonic.

Patient assessment and history taking are essential skills in first aid and pre-hospital care.

What Should You Do First When Someone Complains of Chest Pain?

Let’s paint a picture.

It’s 11:15 am, and you’re in the office at work. Jerry, a 60-year-old colleague, approaches you looking pale, sweaty, and generally unwell. He says he feels sick.

At this point, Jerry could be suffering from a range of conditions, so where do you start?

Getting him to sit down is a good first step, but what we’re really looking at is how to ask the right questions to quickly identify what might be happening.

As first aiders, we don’t have access to the diagnostic tools used by paramedics or doctors, so effective questioning becomes extremely important.

A simple question such as:

“Jerry, you don’t look well. What’s happening?”

is often enough to start the conversation. From there, Jerry may tell you that he is experiencing pain in his chest or a nearby area.

What Questions Should You Ask About Chest Pain?

Now that we know Jerry has chest pain, what else do we need to find out?

One of the most effective ways to assess pain is by using the PQRST pain assessment mnemonic.

While some ambulance services use other methods such as DOLOR, PQRST remains a popular and easy-to-remember approach for first aiders.

Let’s break it down.

What Does P Stand for in the PQRST Pain Assessment?

P = Provoking Factors

Question: “Jerry, what were you doing when the pain started?”

Understanding what the patient was doing when the pain began can provide important clues.

Was Jerry:

  • Sitting quietly?
  • Walking or exercising?
  • Lifting or carrying something?
  • Experiencing stress or anxiety?

We’re trying to identify possible causes while treating the situation as potentially cardiac-related until proven otherwise.

How Can the Quality of Pain Help Identify the Cause?

Q = Quality

Question: “Jerry, what does the pain feel like?”

This helps determine the nature of the pain.

The patient may describe it as:

  • Heavy
  • Tight
  • Squeezing
  • Burning
  • Sharp
  • Dull

The way pain is described can provide valuable information about its possible origin.

Where Is the Pain Located and Does It Radiate?

R = Region and Radiation

Question: “Where is the pain?”

Followed by:

“Does the pain travel anywhere else?”

It’s important to identify both the location and whether the pain spreads to other areas of the body.

Let’s assume Jerry tells us that the pain:

  • Started in the centre of his chest
  • Feels heavy
  • Travels into his left arm and jaw

At this point, many first aiders would be considering the possibility of cardiac chest pain.

How Severe Is the Chest Pain?

S = Severity

Question: “On a scale of 0 to 10, how bad is the pain?”

Where:

  • 0 = No pain
  • 10 = The worst pain imaginable

Pain is subjective, so everyone’s pain tolerance is different. However, a pain score is still useful because it helps monitor changes over time.

For example:

  • Is the pain getting worse?
  • Is treatment helping?
  • Is the patient deteriorating?

Tracking pain levels allows first aiders and emergency responders to identify trends and make informed decisions.

Why Is Knowing the Time of Onset Important?

T = Time of Onset

Question: “What time did the pain start?”

Knowing when symptoms began can be critical information for healthcare professionals.

Jerry may tell you:

  • The pain started suddenly.
  • The pain has been present for several days but recently worsened.
  • The discomfort comes and goes.

Documenting the timing of symptoms helps build a clearer picture of what may be happening.

What Information Have We Gathered So Far?

Based on our assessment, we now know:

  • Jerry is a 60-year-old male.
  • He was sitting at his desk when the pain started.
  • The pain began around 11:00 am.
  • He rates the pain as 6 out of 10.
  • The pain is heavy and central in the chest.
  • It radiates into his left arm and jaw.

This information strongly suggests the possibility of cardiac chest pain and should be treated as a medical emergency.

What Else Should a First Aider Check for During a Chest Pain Emergency?

While waiting for emergency services, there are additional questions and observations that may help.

Ask whether Jerry normally takes any medications.

You might also ask him to take a deep breath.

This simple action can provide two important clues:

Is the Patient Short of Breath?

If Jerry struggles to take a deep breath, this may indicate respiratory distress or another serious issue.

Does Breathing Change the Pain?

If taking a deep breath causes a sharp pain that Jerry can point to with one finger, the cause may be more likely related to the respiratory system or musculoskeletal structures rather than the heart.

While this isn’t a definitive diagnosis, it can help guide your assessment.

Why Is the PQRST Method Important for First Aiders?

The PQRST pain assessment mnemonic is a simple but effective tool for evaluating chest pain and gathering important information before emergency services arrive.

By asking structured questions, first aiders can:

  • Assess the severity of the situation
  • Provide accurate information to paramedics
  • Monitor changes in the patient’s condition
  • Improve overall patient care

When it comes to chest pain, remembering PQRST can make a significant difference in helping identify potentially life-threatening conditions and ensuring the patient receives prompt medical attention.

Can the PQRST Method Improve Your First Aid Assessment Skills?

Absolutely.

The more comfortable you become with structured patient assessment techniques such as PQRST, the more confident you’ll be in responding to emergencies.

While there are many other assessment tools and techniques available, PQRST remains one of the easiest and most effective mnemonics for first aiders assessing chest pain.