May 18, 2013

Who’s Up?

Overheard in the station after returning from a call:

Sean: “You guys ever been to Europe?”

Other Crew: “Ummm….No. Why?”

Sean: “Cause…..Yer’ Up”

Determining what crew is up for call can be a very simple or complicated process. In my years in EMS, I have seen call rotation rules that were extremely straight-forward and simple and some that rivaled the federal tax code in complexity. Anybody that has experienced station life with more than one ambulance on-duty knows exactly what I’m talking about.

For the most part, the call rotation rules I have seen were made in-house by the crews assigned to the shifts / stations. As long as the calls were made within the allotted time, nobody in management cared. Likewise, the crews involved knew that it was in their best interest that management not care or get involved. Most people have the understanding that once management gets involved, rules get made that nobody likes.

A wise man once told me that “sometimes you eat the bear, and sometimes the bear eats you”. This is especially true in EMS and I’m a firm believer that no set of rules can change that. I always get a laugh out of crews that come up with complicated call rotations in an attempt to make things “fair”. For example, here is a set of rules I had to follow at one point in time:

You are up for call until you:

  • Transport a patient to the hospital.
  • Run 2 dry-runs.
  • Make it past a specific location (railroad tracks, intersection, road marker, etc)
  • Fly a patient out.
  • Complete 2 post moves.

Not to mention that being “first up” was contingent on whether or not it was an even or odd day.

I’m fairly certain there were more rules, I just can’t think of them all. Below is what I go by now:

You are up for call until you:

  • Turn the wheels on your ambulance.

Personally, I prefer the simpler of the 2. Sure, sometimes you kinda get screwed, but it’s consistent. If the crews watch each other’s back and aren’t asses about the rotation, it can be a really fair system. For example, if my counterparts have been running like crazy, and I have had nothing but dry runs or canceled calls, I’ll volunteer to take 1 or 2 to allow them to eat, do paperwork, etc. Even we choose to take the completely selfish route, it still evens out in the end.

I’m curious to here other stories about call rotations. What are some crazy rules that you have had to follow?

 

 

The CPR Saga Continues

CPRAs more details have come out regarding the “nurse” who refused to perform CPR on a resident at an independent living center, so have the mixed opinions on how the situation should have been handled. I wasn’t all that surprised to see a large amount of people – healthcare professionals included – come out in support of the decision not to initiate CPR. The truth is, elderly people often do sustain serious injuries from CPR and rarely have positive outcomes, but is it really our job to make that end-of-life determination for the patient?

Dr. Peter Boling, a professor of geriatric and internal medicine at the Virginia Commonwealth University School of Medicine, said deciding not to perform CPR on a frail, elderly person, especially those with advanced conditions, may be the kindest and most appropriate response possible.
Source: http://www.bakersfieldcalifornian.com/health/x738927148/Decision-not-to-perform-CPR-may-sometimes-be-most-humane

The problem with that statement, is that we don’t get to make that choice. As healthcare providers, we have a duty to act. I agree that CPR in the elderly and chronically ill is traumatic and rarely effective, but that needs to be discussed with the patient and family BEFORE their heart stops. Regardless of our personal beliefs, we can’t just decide on our own whether or not somebody will have any quality of life as a result of our actions.

All the talks about whether or not CPR would have beneficial in this case are irrelevant. The issue at hand here is that the person who identified herself as a nurse to 911 dispatchers refused to perform CPR because she believed it would be a violation of her company’s policies and procedures. While such a policy wouldn’t have stopped me personally from initiating CPR, I can’t really blame her for interpreting the policy the way she did. After all, her boss came out on national TV and defended her actions and stated she followed their protocols appropriately. Kinda hard to hold her accountable when her own boss doesn’t even understand the policy. If you ask me, he should be the one on voluntary leave.

The family of an elderly woman whose death ignited a wave of anger after a nurse at her senior living community refused to give CPR released a statement Tuesday saying they have no plans to sue.

Lorraine Bayless’ family said she “personally selected” Glenwood Gardens independent living facility in Bakersfield knowing there were not “trained medical staff” and that she wanted to “die naturally…without any kind of life-prolonging intervention.”
Source: “http://www.bakersfieldcalifornian.com/health/x837006764/Family-We-dont-intend-to-sue-Glenwood-Gardens

I’m putting this one back on the family. If this is how they felt, they should have signed a DNR. A simple piece of paper would have saved all the controversy and drama. They bear a large part of the responsibility for this event.

I hope this story helps to make people realize the importance of making these decisions with their loved ones before these traumatic events happen. End of life decisions need to be made with the family, not the healthcare provider.

Those Pesky Ambulance Chasers

….and not the kind you are imagining.

If you don’t read the Motor Cop Blog, you should. MC has a great column called “Ask MC” where he takes questions from readers about anything related to law enforcement. I can appreciate this column as I have been the recipient of his advice on more than one occasion. Thanks again, MC!

Anyway, on to the story.

MC had a reader submit a question about family members following ambulances at a dangerously close distance during emergency transports. Rather than try and re-create the reader’s scenario, I will paste the question here:

I recently assisted in transporting a baby to a city hospital after he was brought to our ER after an arrest. It was a roll of the dice as to whether he’d make it there, we had 4 adults in the back keeping eyes on him and praying. Stressful, to say the least. Before we left the family was told NOT to try to keep up with the ambulance, and the last thing anyone needed was a car wreck on the way. Every family has been told this, on every transport I’ve been on, and to date none have listened. This morning we were trying to part traffic in the city during rush hour, and the family car was on our butts all the way. About 1 foot off the bumper, in spite of getting floodlighted from the ambulance and the doc making “Get away!!” gestures from the back window.

Do you have any suggestions…our hospital frowns on firing warning shots out the back window. What could be more convincing, and within the law as far as instructions before the transport, and what are officers able to do to help. Obviously we went through several towns fairly fast, and a police chase after a speeding ambulance is darned disruptive and dangerous, so I was at a loss at the time.

MC had a great response to the reader’s question. Do yourself a favor and read the article to see his response before continuing on.

http://motorcopblog.com/2012/01/14/ask-mc-follow-that-ambulance-or-dont/

He really hit the nail on the head when he said that you can’t control other people’s actions. This is especially true during a state of panic. What you CAN control, is your actions.

All of us in EMS have experienced situations like this, probably on a fairly regular basis. I personally have been rear-ended twice by following family during a transport. On both occasions, we had to stop and wait for another ambulance to show up and continue patient care and transport. It’s a bad situation for everybody.

Now, back to controlling the things that we can control, like our actions. MC pointed out that we should communicate with the family and explain what’s going on and explain why following the ambulance is a bad idea. I can’t agree more. Keeping family in the loop is key. I have made a practice of taking down family member’s phone numbers before leaving, so that I can call them once we arrive at the ER to either update them on the situation, or allow the hospital staff to contact them. I have found that taking the time to make sure they know what’s going on goes a long way towards bringing them down off their state of panic.

There will be occasions where nothing you say or do works. A wise man once said that “you can’t fix stupid”. Well, Mr. White couldn’t be more correct, and in these cases you just have to do what’s right for yourself and the patient. On some occasions I have elected to discontinue a code-3 (lights and sirens) transport and continue in “cold” due to a vehicle following too close. Every time I have done this the family got upset and complained, and management has always backed me. You have a responsibility to protect yourself and those around you. If a following vehicle is compromising your safety during a code-3 transport, then you have to do whatever it takes to be safe.

One of the best quotes of MC’s response:

One of the great things about an ambulance is the medic in the back.  While you are headed to the hospital, you are receiving the appropriate medical care you need.  There is less need to drive with imprudence…at least theoretically.

Took the words right out of my mouth. We are no longer “gurney jockeys”. The scoop-and-run mentality is slowly dying and we are starting to be looked at more like a mobile ER, as we should. There are only a few scenarios where rapid transport is warranted, much less beneficial. I’m sure a bunch of people disagree with me, but trust me when I say that we will never advance in our field if we keep hauling ass to the ER’s instead of actually treating our patients.

Now back to the topic on hand……(see EMS and ADD)

The bottom line is, don’t compromise your safety. Driving an ambulance is a lot like riding a motorcycle. Everybody is either aiming for you or ignoring you. As professional drivers, we have to do our jobs and everyone else’s as well. Be aware of your surroundings. Try to avoid putting yourself in these positions by communicating with the family. If all else fails, drive slow.

 

He’s Right, Nothing is Absolute

I’ve burned the rulebook/protocols, both physically and metaphorically, probably more times than I can count. There were times when what I did was right, and there were times when what I did was wrong. Either way I learned from the experience, and right or wrong I always owned it and did it knowing there would be repercussions.

Reading the article “Nothing being absolute except death….. and taxes” from The Social Medic brought back some unfortunate memories of when doing the right thing, wasn’t the right thing. His article was sparked by some debate over a story of firefighters that transported a pediatric patient on their fire engine, rather than waiting for the ambulance. I’m not going to come out and say whether or not what they did was “right”. Instead, I’m going to share my own story of “right vs wrong”. I’m pretty sure it will give you a good idea of how I would react if I was in their shoes.

We were dispatched to a doctors office for a younger female that had suffered a pneumothorax as a result of a medical procedure that had gone bad. Her doctor had requested that we transport to a hospital that his group contracts with. At the time, that hospital was on ED closure. I informed him of said closure only to be informed that he had contacted the receiving physician and that he had accepted this patient.

This is something that I have encountered MANY times. Every other time, I would have just transport to the hospital and call them en route to inform them of the situation. NO BIG DEAL…..right?

We loaded the patient without delay and did what me or any other paramedic in our system would have done. We started towards the ER of choice. When I called in report, I was instructed to divert. I called them on a land-line to speak with the charge nurse to inform him of why I was continuing to their facility. He still refused the patient. The accepting physician had already gone home and they were not going to accept this patient.

This was a first for me. I informed the patient of the hospital’s refusal and was immediately met with a demand to stop the ambulance and let her out. She was adamant that she would not receive care at any other hospital and was willing to take her chances with death.

Sure, I had informed her of the risks and she COULD have signed AMA and walked off to die somewhere, but I’m not OK with letting someone go, knowing what’s about to happen. I re-contacted the hospital and explained that the patient was attempting to sign AMA and go home. They didn’t care. Their suggestion was to allow her to do so.

I instructed my partner to divert to another hospital while I attempted to convince our patient to allow another hospital to treat her. We finally had no choice but to pull over before getting to any hospital and call someone to pick her up. I couldn’ legally keep her any more. I called my supervisor for help and he showed up to ultimately receive the same resistance. She was stubborn and she knew her rights. By now her work of breathing had increased and I had to increase her oxygen to maintain a decent Sp02. Not a good time to sign AMA.

Being that transporting was out of the question, we were able to convince her to let her family drive her to the original ER of choice. I told her that we would follow her to make sure she made it OK. She agreed.

My supervisor called the ER one more time to inform them that she was going to be arriving via private vehicle. He asked them to do the right thing and just accept the patient so she didn’t have to resort to such measures. They finally agreed and accepted the patient. We arrived at the ER and the patient was transferred over with no issues.

Later that night – 10 minutes after clearing that hospital, to be exact – the charge nurse filed a formal complaint with our governing EMS agency. I was investigated and found to be in violation of the county’s transport destination policy. I had an infraction placed against my paramedic license and it remains until this day. The EMSA director said obtaining the AMA would have been the right thing to do.

If I had it to do over again, I would do the exact same thing, in the exact same way I did it. I don’t care how stubborn that patient was, it was my responsibility to make sure she received the care she needed.

Sometimes we get confused about what’s right, but I know for sure it’s not always what’s on paper.

Kids and needle-sticks

Working in a children’s hospital has certainly given me a new perspective on many aspects of pediatric care, both in the emergency and non-urgent settings. One of the biggest changes to my approach with kids is pain management, but not quite in the way that you might be thinking.

A good majority of the patients that walk through our doors are going to get some form of needle-stick, and no matter what, they aren’t going to like it. This can be one of the biggest challenges for us being that kids typically don’t tolerate pain as well as adults. Throw bad parenting into the mix and the problem only multiplies.

For the longest time, my solution to “sticking” pediatric patients was some form of restraint. Sometimes “burrito rolling” the kids in a blanket worked, other times the swat-team probably wouldn’t have been sufficient to keep them still long enough to start an IV. This all changed when I started my training in the ER.

There are 3 steps that we take to perform needle-sticks without our kids putting up a fight:

  1. Explanation.
  2. Distraction.
  3. Pain Management.

Explanation

Before we do anything, we talk to the kids and tell them exactly what we are going to be doing in terms that can understand. The big key here is talking to them and the parents using the same words. If you talk to the kids using “kid-friendly” words, and then turn to the parents and re-explain what you just said using medical terms, the kids will view that as “code-talk” and you will lose their trust.

The other big trick is avoid words like “needle” or “poke”. Using less-threatening words will keep the anxiety level down and will help you get through the procedure without having to fight with them.

Here are some ideas for words that you can use to explain what you are about to do without scaring your patient:

  • Straw = IV (Show them the catheter – minus the needle – and explain that it goes in their vein so you can give medicine to make them feel better.)
  • Rubber band = Tourniquet (Tell you need to put a rubber band on their arm to see how big their muscles are.)
  • Soap = Alcohol Swab (Explain that you need to use some soap to clean their skin “real good”)

Unless you have a form of pain management for invasive procedures like cold-spray or buffered-Lidocaine, you will have to explain that it’s going to hurt. The element of surprise isn’t going to do you any good in this situation. They will pull their arm away and immediately start to fight if you surprise them with a needle-stick. Try asking them if they have ever had anyone pinch them before, and explain that what you are going to do might “pinch for a little bit”. This may sound crazy, but I have personally found that making them promise that they will “let you know if it hurts”, has worked wonders.

A big part of this is also making sure you don’t attempt a needle-stick unless you are certain that you have an acceptable vein. You want to be done with the procedure as fast as you possibly can.

Distraction

This is one of those things that works great, but nobody really thinks to do. Kids have the ability to build up high amounts of anxiety and stress, but they are also easily distracted. Carrying a few tools in your bag to grab their attention can pay off when it comes time to gain IV access on a sick kid.

This can be something like a game on your phone, a book, a toy, or some kind of activity for them to do while you do the dirty work. Obviously, having a second set of hands present will help with this step, but it’s not impossible to do by yourself.

One of my favorites is the i-spy books. They are big, which makes blocking the view of what you are doing easy. They require all of their attention as they have to find small objects on a big piece of paper, and best of all, they are cheap. If you have a second person available, have them hold the book up and search for the objects with them. If not, try propping it up or have them hold it with their “good arm”. You can always tell them to look for a specific object before you start the procedure.

If you are a high-tech, geeky, kinda medic like I am, then you can always get out your tablet, smart-phone, etc and let them play a game or watch a video. Of course, do this at your own risk. All of my devices have protective cases to help prevent damage from dropping.

Pain Management

This is one of those things that you may or may not have available at your service or hospital. I was recently introduced to the wonder of buffered-Lidocaine, and I’m not sure how I ever got by without it before.

I kid you not, using buffered-lidocaine through a J-Tip injector will eliminate any pain that would they would normally experience with a needle-stick. The J-Tip is a neat little device that forces the medication inside the syringe (in our case, Lidocaine) into the subcutaneous tissue around the vein by using a c02 cartridge. I have had it done to me, and I can honestly say that I didn’t feel a thing. The Lidocaine numbs the area good enough that the patients don’t even feel the needle-stick. I usually tell the kids that I’m going to give them “magic medicine” so they wont hurt.

The video below demonstrates the J-Tip injector. It’s pretty dry and boring, but if you fast-forward towards the end, you can actually see it being used on someone’s hand.


Chances are, you probably don’t have this available, but there are other options out there like cold-spray or topical anesthetics. If you don’t have access to any of these options, just remember to follow the first 2 steps. You will find that your pediatric patients will be much more cooperative and will be much easier to manage during your course of treatment.

If you have any methods to needle-sticks in pediatrics, please feel free to share below.

Using Google Calendars to Create a Shift Calendar

I have said many times before that Google pretty much controls my life. Between search features, Google Voice, Gmail, Android, Google Reader, and Google Calendar, it’s pretty much safe to say that they are quite an asset in my life. Forget Skynet, if any form of software is going to take over the world, it will be Google.

Well, world domination may be a project for the distant future, but Google recently did take over one more task in my work life: The shift calendar.

Anyone working long-hour shifts can understand how difficult planning future events can be. Up until recently, if you were to ask me if I wanted to pick up a shift, go on trip, play a gig, etc, I wouldn’t be able to give a definite answer without digging out the almighty shift calendar. Sure, I COULD carry it everywhere with me, but I prefer to only deal with one schedule for all of my needs (i.e. Google Calendars). Plus, I’m just a technology-loving, geeky kinda guy.

I was recently asked if it was possible to create a “never-ending” shift calendar on-line. Without even firing up my computer, I already knew that this would be possible using Google Calendars. I just couldn’t figure out why I hadn’t thought of this before. Using this method literally only takes a couple minutes and you will have yourself a shift calendar that continues for as long as you want. As long as your shift schedule is some sort of repeating rotation (Kelly schedule, 24on / 48 off, etc) then this method will work for you.

The video below takes you through all the steps on creating your “never ending” shift calendar and saying goodbye to paper schedules once and for all!


Download | YouTube MP3 Converter

Conclusion: 23-year-old with chest pain

I received some really good responses both on this blog and on Twitter / Facebook. This call wasn’t as simple as treating any other cardiac arrhythmia as it was being caused by a mechanical failure of an implanted device that we had no control over. As it turned out, one of the leads had come loose and was rubbing against the heart. This was causing large amounts of artifact that was being interpreted by the defibrillator as v-fib.

As mentioned in the scenario, the patient had no device to disable her defibrillator, but she did have a card with a phone number to the manufacture. After making base contact, the manufacturer was contacted and they sent a field representative to the hospital to disable the device.

Treatment for this patient was tricky as the defibrillator was the root of the problem. After the defibrillator shocked the patient for the 3rd time, the patient’s rhythm converted to v-tac. The defibrillator recognized this and shocked her again and converted her back to sinus rhythm. Shortly after that, it shocked her again while she was in a sinus rhythm. That once again converted her back to v-tach only to be shocked again by the defibrillator. This cycle continued during a 12 minute transport and shocked the patient for a total of 9 times.

Luckily the patient never went into cardiac arrest. Lidocaine was administered to this patient while en route to the ER to help suppress the multiple episodes of v-tach. After the medication was administered, no further episodes of v-tach occurred, however the patient was shocked 1 more time by her internal defibrillator. The representative from the manufacturer arrived at the ER and was able to disable the defibrillator remotely from a computer. An ECG log was pulled up and revealed the artifact that caused the device to shock the patient.

The patient had congenital heart defects since birth and had the pacemaker / defibrillator in place for several years prior to this incident. This was truly one of those times where the best thing you could do was just get to the hospital.

If anyone else has any similar stories, I would love to hear them!

Case Review: 23-year-old with chest pain

Here’s an interesting case to wrap your head around:

EMS is dispatched to a residence code-3 for chest pain. On arrival, the crew finds a distraught young man waving them inside the residence. He stated that he and his 23-year-old girlfriend were arguing when she suddenly started to complain of severe chest pain. The girlfriend is in the fetal position on the ground crying and grabbing her chest. It is difficult to obtain any information out of her as she is hysterical and won’t answer any questions. The paramedic on the ambulance kneels down to try and calm the patient and get her to talk, while the EMT partner questions the boyfriend.

The patient starts to calm down and tells the paramedic that her chest hurts and is interrupted by the EMT who yells from across the room that the patient has an internal defibrillator. The paramedic turns to his partner who explains that the boyfriend just said that the patient was grabbing her chest saying that her defibrillator shocked her. The patient tells the paramedic that her defibrillator shocked her “a bunch of times”. He instructs his partner to place her on oxygen while he places her on the ECG monitor. Before he can get all of the leads on her, she screams in pain and says “it shocked me again”.

The ECG monitor is applied and shows sinus tachycardia a rate of 112. The crew places her on the gurney and obtains a quick set of vitals. NIBP = 142/72, Sp02 = 99%, HR = 112. Just as the crew prepares to leave the house, her internal defibrillator shocks her again while the paramedic was watching the monitor. The paramedic now suspects that the defibrillator is malfunctioning as she still had a narrow complex rhythm when it shocked her. He asks her if she has a magnetic device to disable the defibrillator. She states that she lost it a long time ago.

The crew loads the patient into the ambulance and begins towards the nearest cardiac facility code-3. While en route, the defibrillator shocks the patient again, only now the patient’s rhythm converts to ventricular tachycardia.

Have you ever run into a scenario like this? What would you do for this patient?

Stay tuned for a follow up post.

Clear to Enter

Dispatch: “Respond priority 3 to stage for an overdose”

Crew: “Show us en route”

Dispatch: “Your now clear to enter, the RP is advising that the patient is unconscious”

Crew: “Can you confirm if law enforcement or fire is on scene?”

Dispatch: “Negative on both, the patient isn’t violent, you are clear to enter”

Crew: “Copy, we will be staging until law enforcement arrives”

If there is one thing that is more important that anything else in this job, it’s going home safely after your shift. One of the biggest problems with the above scenario is the fact that dispatch relies on the reporting party to give enough information to determine whether or not the scene is safe to enter.

On most calls like this, the patient who overdosed is not the one you need to worry about, it’s the people surrounding them. Whether this patient unintentionally overdosed on street drugs, or intentionally overdosed on prescription drugs, one thing is for sure. They aren’t thinking rationally, and the people they associate with are probably not thinking rationally either. And when you go into a scene expecting irrational people to act rationally, you are setting yourself up to get hurt.

Obviously this doesn’t just apply to just overdoses. Stabbings, shootings, assaults and psychiatric patients are all prime examples of calls where we should be staging until law enforcement arrives. You can call me scared, paranoid, or even accuse me of trying to dodge calls, but I’m going home every night and that’s all that matters. I’m sorry, but after having a good friend of mine get beat unconscious on a “clear to enter” call, and another coworker wind up with a gun pointed at his stomach, I’m done with taking risks.

Your safety doesn’t stop with a law enforcement presence either. When dealing with these types of calls, or any calls for that matter, there are certain steps (and easy ones) you should take to help ensure you, your partner’s and your patient’s safety.

  • Always look around you and try to avoid having your back to anyone. Logistically, this isn’t always possible for you to do, but there is no reason your partner or other responders on scene can’t keep a watch on what’s going on. This simple task could be your saving grace in the event that  someone tried to harm you.
  • Scan the area for items that may be used to harm you. A quick scan of the area that the patient has immediate access to only takes seconds and can help identify any threats. Don’t just rely on law enforcement personnel to do this.
  • When dealing with altered or unconscious overdose patients, pat them down for weapons. This is a habit I developed after learning the hard way and having to wrestle a knife out of someone’s hand that woke up after I administered Narcan. Trust me when I say this pays off.
  • When you do find yourself in a position where you need to administer Narcan to an unconscious patient, try to do so on scene or in an environment where you have extra hands in the event that the patient becomes violent. Soft restraints are nice, but they aren’t perfect.

Unfortunately there are bad people out there and no matter how careful we are, there is no way to protect ourselves from 100% of the dangers out there. However, this doesn’t mean that we should let our guard down. There have been plenty of line-of-duty injuries and deaths that could have been easily avoided had the responders taken precautions. Don’t become a statistic. If your not sure the scene is safe, don’t enter. And if the scene becomes unsafe, leave. Remember, at the end of the day, the only thing that matters is going home.

 

A Guide to Radio Reports

Radio reports or “call ins” can be a bit of an art. Finding that happy-medium between too much and too little information can be difficult. People starting out in EMS often have trouble adapting to formal lines of communication like radio systems as getting the most information out with the least amount of words is an acquired skill. If you have never worked in a setting that utilizes formal radio traffic then naturally, you want to speak just like you would in any other conversation. But in the name of formality and time savings, you have to learn to kick proper English to the curb. In this article, I will go over some tricks that I have learned over my years in EMS and hopefully break the barrier that many of us have when it comes to giving reports over the air.

Time

Different systems may require different amounts of information, but the expectation that your report will be short and thorough typically remains the same. A good rule of thumb for a desired length is less than 30 seconds. If done correctly, that should be ample time to deliver a good report.

Minimizing the amount of time your report takes helps to ensure that you aren’t tying up the base-station radio for other crews that may need orders or have a critical patient to call in. It also frees up time for patient care and you don’t lose the attention of the staff on the radio. As silly as it may seem, try practicing reports with a timer. You will find that it doesn’t take long to improve your technique and shorten your reports.

Content

You are the eyes and ears of the ER staff until you arrive at the hospital, so it is your job to paint the best picture you can of the patient’s current condition. Now this doesn’t mean that you have to tell a long winded story of what led up to this event. All that does is lose the attention of the ER staff. Remember, all of that information can be relayed once you arrive at the hospital. The staff is pretty much looking to either give orders or assign a priority to your patient, so you really only need to give them the information necessary to achieve those tasks.

Here is a list of essential information that should be included in your report:

  • Age
  • Sex
  • GCS
  • Chief Complaint
  • Pertinent Positives or Negatives
    -Example: Shortness of breath associated with chest pain.
  • OPQRST (if applicable)
    -Example: This can be used to clearly paint a picture of chest pain being cardiac vs non-cardiac, or to paint the picture of a patient with abdominal pain having probable appendicitis.
  • Vital signs (including skin color and lung sounds)
  • History, Allergies or Medications (if pertinent to the chief complaint)
  • Any treatment or interventions along with response.
  • Any other information that may help paint a clear picture of the patient’s condition.

There are always exceptions to these guidelines. You may be required to provide certain information in order to activate a STEMI, Trauma Code, or Stroke protocol. I typically prefer to add this information to the end of my report under “other information”. Do what works best for you.

Gathering Information

In order to provide an adequate amount of information, you must first gather that information. In order to do this, I find it best to maintain an organized system of writing down information that I will use during my call-ins. Some people write on their gloves, some people carry a notepad and some people are talented enough to go completely off memory.

When you are going through your questioning, assessment, etc, try writing down your findings in the order that you give your radio report. For example, if you are writing on a notepad, write the age, sex, GCS on the top line, the chief complaint on the second line and so-forth. This way you can essentially read right off your notepad from top to bottom when you do your call-in. This helps to avoid long pauses, repeating yourself or leaving out information.

To help facilitate gathering information in an organized fashion, I created a simple document that you can print on any 3×5 card. I typically clip a bunch of these together and carry them in my shirt pocket. When I call in my reports, I read from left to right, top to bottom. This way my reports are consistent and I minimize the chance of leaving anything out.

Below is a blank view of my 3×5 report card:

When I use this format, I fill in all of the pertinent information prior to making my call-in. Any information that I don’t plan to pass along over the radio is skipped over. For example; A patient complaining of chest pain would most likely require every field to be completed while a complaint of general weakness would not require the OPQRST.

The medical history, allergies and current medications are generally skipped over during the call-in, but written down to reference for documentation and the formal report given at the bedside.

The “TX/Other” section is utilized for treatment, response to treatment, mechanism of injury (for trauma calls) and anything else that might be needed to paint a clear picture.

This card is available for free download on this site.

Calling in the Report:

This is the part that requires some time and repetition to get right. This is where you need to learn to minimize the amount of words that you use in an effort to keep your report brief and formal. Remember, it should only take 30 seconds or less to deliver a brief but thorough report.

When reporting a chief complaint, stick to only the necessary information. Rambling on about things like the patient’s last doctors visit will eat up that 30 seconds and lose the attention of the staff on the other end of the radio. Here is an common example of “rambling” on the chief complaint:

County Hospital, Medic 325, Paramedic Eddy en route to your facility with a 57 year-old male with a GCS of 15. The patient states that he started complaining of chest pain this afternoon. He also states that he is short of breath and nauseous. He was seen at Dr. Smith’s office today and is now being transported at the request of the physician to rule out a possible MI.

In the above example, I told the hospital that the patient is being transported from a physician’s office with a complaint of chest pain with associated shortness of breath and nausea. While this does help to paint the picture of a cardiac event, it can be done in much less time with fewer words. The following example delivers the same message with less than half of the words:

County Hospital, Medic 325, Paramedic Eddy en route to your facility from Dr. Smith’s office with a 57 year-old male complaining of chest pain, shortness of breath and nausea. Physician on scene requesting transport to rule out MI.

On a chest pain call like this, it would be wise to include the OPQRST, as that information can be useful to the base facility to differentiate between cardiac and non-cardiac chest pain. Here is an example of how you can deliver that information in a brief and effective manner:

County Hospital, Medic 325, Paramedic Eddy en route to your facility from Dr. Smith’s office with a 57 year-old male complaining of chest pain, shortness of breath and nausea. Physician on scene requesting transport to rule out MI. Patient’s pain is with a gradual onset, non-provoked, dull in nature, non-radiating, 7/10, times 2 hours.

In the above example, we have told the base hospital everything they need to know about the chief complaint and we can now move on to the vital signs. Any other information in regards to the complaint itself can be relayed once we arrive at the hospital. At this point we are about half way done with our report and have probably only taken up about 10-13 seconds. All that’s left to cover is the vital signs, treatment and ETA. Here is an example of the complete report:

County Hospital, Medic 325, Paramedic Eddy en route to your facility from Dr. Smith’s office with a 57 year-old male complaining of chest pain, shortness of breath and nausea. Physician on scene requesting transport to rule out MI. Patient’s pain is with a gradual onset, non-provoked, dull in nature, non-radiating, 7/10, times 2 hours. Blood Pressure is 146/82 with a strong radial pulse of 90, non-labored respirations of 16, sating 98% on 2 liters, and sinus on the monitor with no ectopy. Skins signs pink, warm and dry, lung sounds clear. History, allergies and meds on arrival. Pt has received 1 aspirin and 2 nitros with no relief. IV is established and our ETA is 10 minutes. Any questions or orders?

This example is actually on the longer end of the spectrum as far as radio reports go. For calls that don’t involve pain, you can skip past the OPQRST and probably come in around 20 seconds for the entire report. Chest pain, vehicle collisions, and others that require special protocols (STEMI, Stroke) are going to be the longer reports, while most other medical complaints will be rather short.

When it comes to radio reports just remember; short, sweet and to the point.

Examples:

Here are a few examples of some radio reports for different types of calls:

Trauma

County Hospital, Medic 325, Paramedic Eddy en route with a 25 year-old male involved in a 2 vehicle collision. Pt was a restrained driver of a small-sized sedan traveling approximately 30mph when striking another vehicle from behind. No LOC, passenger space intrusion, or airbag deployment noted. Pt complains of lower back pain with no obvious deformities. Blood pressure is 126/74 with a strong radial pulse of 80 and non-labored respirations of 18. Skin signs pink, warm and dry. Lung sounds clear. History, allergies, meds on arrival. Pt is in c-spine and we are utilizing BLS interventions only. ETA is 5 minutes. Any questions or orders?

-Note: Trauma is the only time that I skip straight to MOI prior to the chief complaint. I know of several paramedics that prefer to leave it at the end. Do what works best for you.

Respiratory

County hospital, Medic 325, Paramedic Eddy en route with a 36 year-old female GCS of 15 complaining of difficulty breathing x 2 hours. Pt presents with labored respirations, retractions and speaks in 1-2 word sentences. Blood pressure is 146/82 with a strong radial pulse of 120, labored respirations of 26, sating 93% on 15 liters and is sinus tach on the monitor. Skin signs pink, warm and dry. Lung sounds reveal wheezing in all fields. History of Asthma, further history, allergies and meds on arrival. Pt has significant breathing improvement post 2 Albuterol treatments and .3mg sub-q Epi. IV is established and our ETA is 8 minutes. Any questions or orders?

Cardiac Arrest

County hospital, Medic 325, Paramedic Eddy en route with a 58 year old male GCS of 3. Pt found pulseless and apenic, downtime of approximately 5 minutes prior to EMS arrival. Pt has sustained asystole post 3 rounds of Epi and Atropine. Pt is intubated and an IV is established. Continuing ACLS protocol en route. ETA is 10 minutes. Any questions or orders?

-Note: The hospital will be busy getting a bed ready for your arrival. The faster you get the report done, the faster you can get back to working and the hospital can start working.

Conclusion

These guidelines have worked well for me during my career as a paramedic. These guidelines are meant to be flexible and should work on pretty much any type of call. If you have a format that works well for you, I would love to hear from you and try it out.

Feel free to e-mail me with any questions, comments or suggestions.