What do you look for in EMS run reports?

[MadMack]

This might be somewhat off topic, but I figured this thread might be the right place to ask.

What do you look for in run reports from Paramedics? Do you look for comprehensive patient assessments covering head to toe, or do you look for complaint specific information, or both?

There seems to be a wide variance between different medics as to what we should provide in our reports. One school of thought is say as little as possible to avoid liability, and the other is to, if time allows, assess and record as comprehensively as possible to help ensure that the ER staff can get the same picture EMS had when arriving on scene.

I'm a Paramedic student myself, so any information provided would be appreciated greatly.

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[igcgnerd]

Most people I work with never even look at the PCR except for the PT's name. The bullet is much more important. The people who give crappy bullets, dump and run make enemies fast especially when a history can't be gathered from the PT.

 

[GeneralVeers]

Your best bet as a paramedic is to be as concise as possible. I don't care about a head to toe survey.

The things I think paramedics should relay to the physician:

1. Patient name
2. Age
3. Where from (home, nursing home etc.)
4. Why they were brought here (i.e. chest pain)
5. Pertinent medical history (i.e. CABG, diabetes, etc)
6. Med list (if patient can't give history)
7. Vitals (if patient obtunded)
8. DNR DNR DNR on old patients!

I can't tell you the number of times paramedics can't tell me if the patient is DNR and we begin resuscitation only to find out later that there is a valid DNR order. If you're at the nursing home to pick the patient up, do us all a favour and ask this question!

 

[docB]

I agree with Veers. Simple, concise assessments are best. I do look at the run reports. I'm liable for what's in them so not looking at them (or nurses notes for that matter) is dangerous.

I do ask that EMTs limit their assessment R/O list though. When someone has a headache and the assessment is "Headache" it leaves me lots more room than when the assessment is "R/O SAH, meningitis or other neurologic catastrophy." Then I can get cornered into doing a huge work up or explaining in leaglese detail why the EMT was off base.

 

[BADMD]

What do you look for in run reports from Paramedics? Do you look for comprehensive patient assessments...

When I look at a run sheet, I'm only looking for a few things. I'm going to assess the patient, so I'm really not interested in a comprehensive review of your thoughts. I'm really not interested in reading your physical exam, with the exception of pertinent abnormals. A run report full of "normals"
with musing on whether this is CHF versus asthma is going to get ignored.

What I do want to know: The 5Ws. You are the closest thing I have to eyes when it comes to the scene. I want to know the story of what happened in significant detail and what things looked like. Good details are better. If someone is unconscious, I want to know how EMS was called. Medical history and meds are plus (heck, toss everything in a bag). If you have had previous encounters with the patient, that is good to know too. Much of that is going to be in the oral transfer report, but make sure that important hisotrical elements get into the run report for future reference.

Keep in mind that your report is going to be viewed by the admitting team, who won't be able to talk to you. Having a clear, concise story, well documented times, and a few abnormals can be very helpful to them.

Also, remember that (at least in my system) I'm looking at the 3rd copy of a triplicate form. Push hard. Write on a hard surface. Use a cheap ballpoint pen that makes you work to write. That way I'll actually be able to read your report.

 

[beanbean]

Honestly, right now I am happy to see a run report at all. With the change to electronic records in EMS many of the services are dropping off the patient with a quick report to triage and then are out the door with a "promise" to fax the run form. I don't know where these faxes end up or if they ever even arrive at all. I do know I miss having the information that EMS provides. So besides actually leaving a run form with the patient, I agree with the above posters. Short and concise; paint me a picture of the pertinent info on scene. It can be invaluable.

 

[docB]

I don't know where these faxes end up or if they ever even arrive at all.

Well that's just because your hospital has poor processes. At my shining tower on the hill all of the PCRs are quickly and effeciently faxed to a broken fax machine with no paper housed in a closent in dietary somewhere. Periodically any PCRs that do make it are gathered up and thrown into the alley behind the cafeteria (after all HIPPA sensitive info is removed of course).

It is kind of funny. AMR is using this really cool WiFi fax system from their laptop/hardbooks and no one knows where they are faxing them.

 

[emtcsmith]

I know for a fact that the county I did my paramedic school field time had a rather good system to make sure EMS charts made it to the hospital records. The paramedic service was hospital based so after they did the chart it was given to medical records and they attached it to the chart. When I did time in Peds, Burns, etc the flight services charts were attached so its clear there records made it to the hospital as well.

I know work PRN for a different service in that county and I'm told they pay to be apart of a computer system that all charts can be pulled from a central database of some nature. Who knows how things work from one place to another in America but I'm under the impression that its a JACHO has some pull in making sure EMS charts make it to hospital records.
_______________________

When it comes to an initial report when transferring a patient it varies slightly on standard medical vs. trauma patient. I try and give a good run down of everything, Hx, any treatment, medication, etc. In the case of a trauma patient what I consider our true stage with lights and all that dramatic effect. I'm obviously much louder spoken, typically direct it to one of the doc's and RN's and once thats over will try and hang in the room for a bit and answer any residual questions from the team/rn/etc.

_____________________

The written PCR narrative has a head to toe based on body system, vitals (with aprox time), treatment, and dispo..I try and avoid using abbreviation as well.

 

[docB]

I know for a fact that the county I did my paramedic school field time had a rather good system to make sure EMS charts made it to the hospital records. The paramedic service was hospital based so after they did the chart it was given to medical records and they attached it to the chart. When I did time in Peds, Burns, etc the flight services charts were attached so its clear there records made it to the hospital as well.

I know work PRN for a different service in that county and I'm told they pay to be apart of a computer system that all charts can be pulled from a central database of some nature. Who knows how things work from one place to another in America but I'm under the impression that its a JACHO has some pull in making sure EMS charts make it to hospital records.

I would argue that any system that gets the PCR to the patient's chart that bypasses the ED visit is medicolegally dangerous. If PCRs are being routed to and placed in the patient chart by med records they won't be available to the clinicians until days after the patient is gone or admitted. Then if EMS picked up something important that everyone else missed it's there and everyone is liable for it but it was hidden and inaccessible.

 

[docB]

Also, remember that (at least in my system) I'm looking at the 3rd copy of a triplicate form. Push hard. Write on a hard surface. Use a cheap ballpoint pen that makes you work to write. That way I'll actually be able to read your report.

I second this.

We have a box on our T Sheets where we check for "EMS run sheet reviewed" I frequently write "unavailable" or "illegible" and I use the illegible note more often for poorly transferred carbon than for handwriting.

 

[deleted65604]

I have rarely looked at a run report in 3 years of residency. I've tried several times, but usually can't find them. The nurse at the ED that heard the report, or the nurse from the facility they were transferred from has always given me enough information. If they are actively dying, usually, we are told that someone is coming in "lights and sirens" and are able to ask any relevant information in person.

The more complicated patients such as nursing home patients are often straight-forward, and all but scream "admit me for urosepsis (or dehydration, pneumonia, fall with hip fracture, stroke or whatever emergent diagnosis that you can think of). The only time when details really matter are when the patient looks fine and you can't figure out why the patient was sent there from the nursing home in the first place. In that rare case, I'd rather have it first hand from the nurse at the nursing home they were sent from, rather than a second hand report from the paramedics.

If the patient is not a demented nursing home patient, then they can give me a history themselves, and the paramedics version of events is rarely relevant.

I hope I'm not demeaning your documentation. You guys peform a vital function and can really make a difference in people's lives. Our documentation is similar in that 99 % of the time, nobody will ever read the details, (except for lawyers, or M and M committees, or the billers).

 

[roja]

VS
Story
any abnormal PE findings
Meds

 

[anonymousEM]

Regarding the RN at the NH,

By the time I've dealt with acute emergencies and get around to calling the NH inevitably the RN who knew the patient is long gone and the next shift nurse only knows "they went to the hospital....they're not coming back tonight are they????"

Agree with the 3rd triplicate as well....way more often an issue than handwriting. And the fax runsheets also an enigma at our place that uses them.

 

[leviathan]

My general approach is something like this:

-Name
-Age
-Presenting complaint,
-Medical hx I think is relevant to their presenting complaint
-Relevant vitals (if stable, then I just say 'stable vitals')
-Medications or other treatments already given
-If relevant, how the patient was found, circumstances they called for help under, etc.

Most seem to be pretty receptive to it.

 

[emtcsmith]

I can't imagine people are still doing paper PCR's?! Join the 21st century of the computer, let alone tablet and or MDT based charting software that allows you to do the chart in a mobile setting and not be required to be at the station to do it.

If I can expand on the thread....I know that when a 12 Lead is taken in the ED its taken to the doc and signed. I had a medical director suggest we bring that idea to our practice. There is a lot of programs dedicated to 12 lead transmission to ED, cath lab, etc but if medics routinely presented you a 12 lead and you had maybe a 10 second conversation over it in addition to the verbal report is that something you would support?

 

[leviathan]

I can't imagine people are still doing paper PCR's?! Join the 21st century of the computer, let alone tablet and or MDT based charting software that allows you to do the chart in a mobile setting and not be required to be at the station to do it.

If I can expand on the thread....I know that when a 12 Lead is taken in the ED its taken to the doc and signed. I had a medical director suggest we bring that idea to our practice. There is a lot of programs dedicated to 12 lead transmission to ED, cath lab, etc but if medics routinely presented you a 12 lead and you had maybe a 10 second conversation over it in addition to the verbal report is that something you would support?

We still use paper forms, then scan them at the station and shred the physical copy.

 

[emtcsmith]

A word from the street...

I arrive on scene to find a 38 (aprox 90 kg) year old Caucasian male sitting upright in bed, in his apartment. He says he was woke sweaty and with a full body 'burning' sensation. History: NIDDM, Stent, HTN, Abdominal Aneurysm the apartment and scene seem in order. The patient seems tired and can't give me any solid complaint and 20 hours into the shift at around 2300 at night I want to call this the flu but find the patient boarder line hypotensive 100/p , denies vomiting, some nausea and neck stiffness, no CP, no SOB.

We assist him to the ambulance, and he is boarder line Sinus Bradycardia with no changes on the 12 lead, and a b/g of 122. The patient seems tired and en route his pressure drops into the 90's despite NSS flowing wide open and appears to have moments where he brady's down to the 30's and 40's although you could blame the moniter and an occasional PVC.

I call for notification and ask to speak to the command doctor, to me it seems the patient is continuing to get sicker and I want to get his opinon on 1mg of atropine. We don't have to call for orders for atropine but to me the patient seems to be getting sicker, I can't put a good reason to any of it but the presentation is boarder line and he asks to hold off as I'm in the driveway of the ED

...............

On the topic of reports, if your on the other end of the phone call what are your thoughts of those boarder line calls? Your medics not really looking for orders and while we can try and sell you on orders he is really looking for that second person to comment on the patient/situation at hand. Maybe these types of calls are rare and more common from a new medic like me but like I'm sure you all know sometimes the patient just can't make sense of a patient epically within the first half hour.

 

[DeLaughterDO]

I would like for one to actually be present. By the time they are done and we could possibly get our hands on one (wherever they are faxed), the patient is already back by ambulance for a REPEAT visit for their hang-nail....

 

[emtcsmith]

I would like for one to actually be present. By the time they are done and we could possibly get our hands on one (wherever they are faxed), the patient is already back by ambulance for a REPEAT visit for their hang-nail....

I thought the special was toe pain this week!

 

[leviathan]

A word from the street...

I arrive on scene to find a 38 (aprox 90 kg) year old Caucasian male sitting upright in bed, in his apartment. He says he was woke sweaty and with a full body 'burning' sensation. History: NIDDM, Stent, HTN, Abdominal Aneurysm the apartment and scene seem in order. The patient seems tired and can't give me any solid complaint and 20 hours into the shift at around 2300 at night I want to call this the flu but find the patient boarder line hypotensive 100/p , denies vomiting, some nausea and neck stiffness, no CP, no SOB.

We assist him to the ambulance, and he is boarder line Sinus Bradycardia with no changes on the 12 lead, and a b/g of 122. The patient seems tired and en route his pressure drops into the 90's despite NSS flowing wide open and appears to have moments where he brady's down to the 30's and 40's although you could blame the moniter and an occasional PVC.

I call for notification and ask to speak to the command doctor, to me it seems the patient is continuing to get sicker and I want to get his opinon on 1mg of atropine. We don't have to call for orders for atropine but to me the patient seems to be getting sicker, I can't put a good reason to any of it but the presentation is boarder line and he asks to hold off as I'm in the driveway of the ED

...............

On the topic of reports, if your on the other end of the phone call what are your thoughts of those boarder line calls? Your medics not really looking for orders and while we can try and sell you on orders he is really looking for that second person to comment on the patient/situation at hand. Maybe these types of calls are rare and more common from a new medic like me but like I'm sure you all know sometimes the patient just can't make sense of a patient epically within the first half hour.

Hmm, I agree and sometimes feel like calling for medical advice which is hard to give over the phone.

I heard on another forum about a call for a guy with sudden onset abd. pain radiating to the back, and also complaining that he felt like he needed to void his bowels. No other signs of a retroperitoneal bleed and his vitals are all normal with an exception of BP at about 200. Do you transport fast and head to a hospital with a vascular surgeon (thinking AAA), or think it is renal colic and head slow to the nearest hospital?

 

[emtcsmith]

I think my biggest fear would be the medic that is know for 'crying wolf' to often and looking for that conversation with the doctor when its not really needed. EMS, in specific paramedic care has come a long way in its short life and we pride ourselves now on being able to generally operate without medical direction.

In the case of the last patient mentioned, feel free to transport "hot" or "RLS." I would present the patient at the hospital with the chance that this is a AAA, but typically diversion protocals don't exsist for something like this. Trauma, Cath Lab/Stroke, and sometimes Psych care yes but otherwise "closest most apropriate hospital" is the rule.

 

[sphincter tone]

Your best bet as a paramedic is to be as concise as possible. I don't care about a head to toe survey.

The things I think paramedics should relay to the physician:

1. Patient name
2. Age
3. Where from (home, nursing home etc.)
4. Why they were brought here (i.e. chest pain)
5. Pertinent medical history (i.e. CABG, diabetes, etc)
6. Med list (if patient can't give history)
7. Vitals (if patient obtunded)
8. DNR DNR DNR on old patients!

I can't tell you the number of times paramedics can't tell me if the patient is DNR and we begin resuscitation only to find out later that there is a valid DNR order. If you're at the nursing home to pick the patient up, do us all a favour and ask this question![/QUOTE]

Absolutely!

Problem is, most of the nursing homes around here have no clue what the patient's code status is

I've definitely intubated patients that the NH staff swore up and down was full code only to have the family tear me a new one at the ER

What I've been told must be included in hospital copies (and this may have been made up by my service or be a state thing) is:

Demographics
Chief complaint
History
Allergies
Meds
1 set of vitals
Interventions performed

seems to work pretty well