MED-02 — Lesson 2 of 6

SAMPLE: Building a Baseline Before Crisis

Proactive medical documentation for preparedness groups

The SAMPLE Mnemonic

SAMPLE stands for Signs and Symptoms, Allergies, Medications, Past Medical History, Last Oral Intake, and Events Leading Up to the Incident. In standard emergency medicine, it is collected reactively after something goes wrong. In preparedness, you collect it proactively — before anything happens.

S — Signs and Symptoms

Signs and Symptoms — What is abnormal now — and what is normal for this person?

Signs are objective findings you can observe: swelling, pallor, abnormal breathing rate, deformity, skin color changes. Symptoms are what the patient reports: pain, nausea, dizziness, weakness.

The most important preparedness insight: baseline matters. A resting heart rate of 95 might be alarming in one person and completely normal for another. Documenting what is normal for each person allows you to recognize what is abnormal early.

Questions to ask proactively

• Do you have any chronic pain conditions?
• What is your typical resting heart rate and blood pressure, if you know it?
• Do you experience recurring symptoms (headaches, shortness of breath, dizziness)?
• What is your normal exercise tolerance?

A — Allergies

Allergies — What substances trigger reactions — and what do those reactions look like?

In austere settings, a single medication choice may be all you have. Allergies directly shape what is safe to administer. An unrecognized medication allergy in an environment without epinephrine can be fatal.

Document these specifically

• Medication allergies (including over-the-counter drugs like aspirin, ibuprofen, sulfa drugs)
• Food allergies (particularly relevant when rations change from normal diet)
• Insect and environmental reactions (bee stings, plant oils like poison ivy)
• What does the reaction look like? (Rash? Anaphylaxis? Hives? GI symptoms?)
• Has the person been prescribed an epinephrine auto-injector (EpiPen)?

M — Medications

Medications — What they take, when they last took it, and what happens if they miss doses

Medications are both a resource to manage and a critical piece of clinical information. What someone is taking tells you what conditions they have. When they last took it tells you where they are in their treatment cycle. What happens if they miss it tells you your margin for error.

High-risk medications to identify immediately

• Insulin — Diabetes management. Temperature-sensitive. Life-threatening if interrupted.
• Cardiac medications — Beta-blockers, ACE inhibitors, antiarrhythmics. Missing doses can cause rapid decompensation.
• Seizure medications — Missed doses significantly lower seizure threshold. A seizure in a hazardous environment can be fatal.
• Blood thinners — Warfarin, rivaroxaban, apixaban. Minor trauma becomes high risk. Drug-drug interactions become lethal.
• Mental health medications — SSRIs, antipsychotics, mood stabilizers. Abrupt discontinuation causes withdrawal symptoms that can degrade group function and decision-making.
• Steroid-dependent conditions — Cannot tolerate physiologic stress without supplemental steroids.

Document for each medication

• Drug name and dose
• Dosing schedule
• What is the current supply? How many days remain?
• What symptoms appear if doses are missed?
• Does the drug require refrigeration?

P — Past Medical History

Past Medical History — Conditions that change survival timelines, risk tolerances, and work assignments

Past medical history does not just describe what someone has had — it predicts what they are likely to struggle with. Conditions that are well-managed under normal circumstances can become destabilizing under the physical and psychological stress of a prolonged emergency.

Focus on conditions that change operational decisions

• Cardiac disease — Limits heavy exertion, changes evacuation urgency if chest symptoms develop, increases risk under heat and stress.
• Diabetes — Changes nutritional requirements, exertion limits, and monitoring frequency. Disrupted meals can cause rapid deterioration.
• Respiratory disease — Asthma, COPD. Changes exposure limits for smoke, dust, cold. Determines inhaler supply priority.
• Seizure disorders — Changes work assignments (no operating vehicles, no heights), increases monitoring needs, makes sleep and hydration non-negotiable.
• Kidney disease — Limits medication options, changes hydration requirements, reduces tolerance for fluid loss.
• Immune compromise — Cancer treatment, HIV, autoimmune disease, steroid therapy. Infection risk is dramatically elevated; wound care priorities increase.

Also document

• Prior surgeries (particularly abdominal — affects diagnostic possibilities for abdominal pain)
• Prior hospitalizations and reasons
• Similar episodes to any current complaint (“Have you felt like this before?”)

L — Last Oral Intake

Last Oral Intake — Food, water, alcohol, caffeine — timing, quantity, and patterns

Last intake is critical for two reasons: it directly affects current physiological status, and it links complaints to potential causes. Nausea that began one hour after eating from a shared pot is very different from nausea that developed spontaneously.

Ask about

• Last solid food — what and when
• Last fluid intake — how much and when
• Any alcohol in the past 24 hours
• Caffeine dependence (withdrawal headaches within hours of missing morning coffee)
• For female patients: last menstrual period (relevant for multiple differential diagnoses including ectopic pregnancy)

E — Events Leading Up

Events Leading Up — What happened before this — physical, environmental, and situational triggers

Events leading up to the complaint often contain the mechanism or trigger that explains everything else. This is also where you discover whether the complaint is isolated or part of a pattern.

Explore

• What was the person doing when this started?
• Any recent exertion, heavy lifting, or unusual physical activity?
• Any trauma — even minor falls or impacts the person might minimize?
• Environmental exposures — heat, cold, altitude change, smoke, chemicals?
• Recent insect bites or plant exposures?
• Sleep — how much in the last 48 hours?
• Stress level — any significant emotional or situational stressors?
• Has anyone else in the group had similar symptoms?

Building a Proactive SAMPLE Profile

The most powerful use of SAMPLE is collecting it before anyone gets sick or injured. For every member of your preparedness group or household, build a simple SAMPLE profile and keep it accessible — in a go-bag, a sealed pouch in a first aid kit, or a printed card in the group medical cache.

This profile should be updated annually, after any major medical change, and whenever a new person joins the group.