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emtcsmith

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I'm going to try and direct this at anyone who normally takes or has taken calls for incomming patients. Mabye a little of the calls for orders, etc but mostly when an EMS unit be it BLS or ALS calls and give you a report of an incomming patient.

What do you want to hear?
What do you NOT want to hear?
How long is to long, how short is to short?

I've tried to narrow done much of my reports to hospitals based on the state of the patient and amount of info I've come to see ED's actually care to hear. Just like how we all view the patient "sick, critically sick, or not sick" is how I expect you would be looking to hear, and mabye this thread can be some what of a bridge betwen EMS and ED.
 

Apollyon

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I did a PowerPoint on this because Durham EMS sucked that badly.

In summary?

Call the hospital and identify yourself (as in, "Hospital X, this is Unit Y" - NOT "Unit Y calling hospital X").

Age/sex, chief complaint/tight elements of trauma, vital signs (NOT "stable"), pertinent PE findings, what you've done, ETA.

Things NOT to say: "enroute to your facility" - wasting airtime - would you call to say you WEREN'T coming?

"Do you have any more?" - if I want information, I'll ask for it - you don't have to prod/remind me.

Such as, "Hospital X, this is Unit Y"
"Go ahead, Y"
"64, male, chest pain, states it feels like his last MI, pain 8/10, now resolved, SOB, v/s HR 105, BP 160/90, RR 26, Sinus tach on monitor, lungs clear, IV established, NTG SL x3 with relief, Morphine 2mg, ASA 81mg x4, ETA 5 minutes.

Or
Approx 25 male passenger belted T-bone driver's side, rollover, 5 minute extrication, conscious, alert, pain in bilat femur, R arm, v/s HR 120, BP (+) radial bilat, rr 16, obvious fx bilat femur, R humerus, splinted, immobilized, IV x2, Morphine 2mg, ETA 3 minutes.

Tight.

Also, if the patient has a specific need (trauma team, Ob, Haz-Mat/isolation), this is the time you drop that word in.
 

waterski232002

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I expect to hear the following.... and in this rough order (of course it doesn't have to be just like this, but some organization helps).

ambulance number
pt age + sex
cheif complaint
Brief 1-2 sentence description
Major medical problems (DM, CHF, Asthma, Dementia)
vitals, dexi if pertinent (sz or AMS)
Brief physical (mental status, eyes, lungs, skin)
Interventions, including IV
Destination + ETA

Example....
Ambulance 76 in route with a 60 yo F c/o CP. It began 30 min ago, and feels like an old MI. Pain is 8/10. PMH is significant for MI x 2, CHF, DM. BP 160/90, HR 110, RR 20, O2 100% on 2L NC. She is currently A+Ox3, Lungs are clear, skin parameters normal, pupils are PERRL. An IV is established and running TKO, we've given ASA, and 2 SL Nitro... pain level is currently 4/10, repeat BP going.... We're heading to St Josephs, ETA 5 min.

Most of our EMS guys are excellent at this... I rarely have questions.
 
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waterski232002

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true... all ours say it out of habit... the only time I really care is with AMS or Sz.
 

emtcsmith

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I think everyone has issues with it starting off but like most things I think it comes with an understanding of each situation. For example giving a notification for a BLS fall from a nursing home 4 days ago should require less then a trauma activation, or other ALS call. I like the comment about losing useless wording which isn't uncommon on the radio. Sometimes wording like "enroute" come as part of a sentence but I could see where you would find it excessive.

Does anyone often find reports that leave you asking more questions then before the report? I think many times in urgent situations giving "level one trauma, stabbing to the right lower chest, x b/p, IV in progress, eta 5min" should paint enough of a picture to call the trauma and be ready. Or do you feel all reports should be the same in content and length.
 

Apollyon

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I think everyone has issues with it starting off but like most things I think it comes with an understanding of each situation. For example giving a notification for a BLS fall from a nursing home 4 days ago should require less then a trauma activation, or other ALS call. I like the comment about losing useless wording which isn't uncommon on the radio. Sometimes wording like "enroute" come as part of a sentence but I could see where you would find it excessive.

Does anyone often find reports that leave you asking more questions then before the report? I think many times in urgent situations giving "level one trauma, stabbing to the right lower chest, x b/p, IV in progress, eta 5min" should paint enough of a picture to call the trauma and be ready. Or do you feel all reports should be the same in content and length.

No, you're on the right track. I mean, what else do you have to add to "Multiple GSW to chest, tubed, CPR, ETA 3 minutes"?

Our problem is EMS not knowing what level the patient is, and leveling incorrectly. Another thing is the ETA - even the flight medics SUCK at it - and it's embarassing to us when we have the trauma attending, chief resident, resident, ortho resident(s), and +/- neurosurgery standing around for >15 or even 20 minutes.
 

edinOH

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I want to hear this.

This is medic so and so...

We are inbound with bull****.

or...

We are inbound with a sick mother****er who needs some serious attention when we get there.

It would help to know trauma vs medical, arrest vs not quite there yet.

I honestly don't care about the rest.
 

Febrifuge

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One of our local ambulance companies is notorious for screwing up the ETA. It's not uncommon for them to call and say ETA 9 minutes, and then the clerk, knowing better, will wait five and then say "ETA 7 minutes" over the loudspeaker.

Even so, after 8 minutes of standing around in the bay, somebody will usually say, "so is this a regular 7 minutes, or a [name of company] 7 minutes?

Then we laugh, for two more minutes, and then the patient rolls in.
 

greytmedic

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Things NOT to say: "enroute to your facility" - wasting airtime - would you call to say you WEREN'T coming?
Hi everyone. I am applying to medical school right now but have many years EMS experience. I occasionally wander into this forum just to look around and see what I can learn. I did notice this and just wanted to say that in many systems refusals have to be called in. So, you do call to say you aren't coming. I preface these reports with "Ambulance X with a pt refusal." This lets the listener know that it is a refusal so they can stop paying attention if they want to.
 

Apollyon

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Hi everyone. I am applying to medical school right now but have many years EMS experience. I occasionally wander into this forum just to look around and see what I can learn. I did notice this and just wanted to say that in many systems refusals have to be called in. So, you do call to say you aren't coming. I preface these reports with "Ambulance X with a pt refusal." This lets the listener know that it is a refusal so they can stop paying attention if they want to.

I had 10 years of EMS before becoming a doc. What you are saying is system-dependent. Many don't have to call in refusals/PRAs/Code 4's/whatever. Others use a cell phone to call the doc on a closed line.

"Ambulance X with a pt refusal" =/= "enroute to your facility". The first is germane; the second is wasting airtime with a redundancy/generality.

And, if your policy to call in a refusal means the listener can "stop paying attention if they want to", your system is in dire need of repair. Refusals should be the BEST documented calls, and, if you are required to call me, believe me, I'm listening.
 
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Don't call and "request order to give drug X according to protocol." If you have a protocol for it, use it. I don't need to hear a five minute story about your patient who has a history of CHF, feels like CHF, and sounds like CHF, and you want to give lasix. Just give the drug. Thanks.
 

greytmedic

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To start with, I was not trying to point out you were wrong or attacking your post in any way. It just struck me as funny that your exact quote was, "would you call to say you WEREN'T coming?" This was funny because that is exactly what happens when a refusal is called, that made me chuckle. Secondly, I know that on-line medical control of refusals is system dependent, that is why I stated "many systems" not all systems.
Finally, it is not the EMS system in need of repair, it is the nurses that take report that need to be reminded of the importance of on-line medical control. I am not attacking nurses, let me be blatant about that so there is no misinterpretation. The nurses are so over-worked, under-staffed, and under-paid that listening to a radio report about someone that won't be impacting the operation of patient care in the ED is low on their priority list, and I don't blame them.
Pt refusal reports get the same amount of energy and detail as other pt reports from me, I believe that all pt reports should be the BEST documented calls.
So, if I struck a nerve by quoting you and responding to something that seemed ironic to me I apologize, it was not my intention. And if I am mis-interpreting your response I also apologize, it is hard to judge emotions on the internet when tone, inflection, and non-verbal queues are absent. Just don't get me wrong, I am not the average over-confident, cocky paramedic who was trying to call you out on a mistake. It just seemed ironic to me thay you asked if you would call to say you weren't coming when I call refusals to say I am not coming. This seemed funny to me and I was pointing out to others so they could also see the comedy of this.
 

Jeff698

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What do you want to hear?
What do you NOT want to hear?
How long is to long, how short is to short?


Keep in mind that I say this after being a paramedic for 18 years (ie, I say it with nothing but love):

I don't want to hear from you at all unless you really need an MD to authorize something or give MD level advice. Otherwise tell the nurse. No offense, but instead of talking to you, I could be seeing patients or charting.

I'll be happy to talk with you in person when you get here. Just not on the radio when I could be doing other things.

Also, keep in mind that YMMV. I can almost promise you, even in my ED, the next doc you speak to on the radio will want something different. So, the bottom line is you just can't win. :D

Take care,
Jeff
 

Dr. Wexler

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Young, female, belly pain, 5 min.

Should patient with this (lack of) actuity be called ahead? In one system I am familiar with the only patients the hospital was notified for was trauma and unstable patients. One way system. If a situation arose in which the medic needed to talk to a doc(rare), he called on a phone.

In another system, while all patients were called ahead on a 2 way radio, it was the nurse, not the doc, who talked to EMS. (Really just said "OK we'll be expecting you".)

As a physician, do you care that a young female with belly pain is coming in? (I can see where the charge nurse would care so she can find a spot for the pt.) Maybe the problem is not only that the reports you are getting are too long, but also that you are getting too many reports.
 

blotto geltaco

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We never used to call in the pts. who really needed a really expensive taxicab. Just drop them off at triage or show them the waiting room. I used to walk pts. in the ED all the time.
 

emtcsmith

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I've probaby scene the spectrum of ways reports are taken to. One had a one way system where the city dispatcher relayed the report over the intercom and the whole ED heard it. Others I've seen get the calls fowarded to there phone they carry and they are the ones that take the calls. Then others closer to home where you will be luky if a nurse answers and its not the ER tech. Don't get me wrong I get a kick taking to a friend on the other end but isn't it called the "medical command" notification/line for a reason?
 

hyperbaric

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I've probaby scene the spectrum of ways reports are taken to. One had a one way system where the city dispatcher relayed the report over the intercom and the whole ED heard it. Others I've seen get the calls fowarded to there phone they carry and they are the ones that take the calls. Then others closer to home where you will be luky if a nurse answers and its not the ER tech. Don't get me wrong I get a kick taking to a friend on the other end but isn't it called the "medical command" notification/line for a reason?

As an ER tech I answered the line once - all the nurses were slammed with multiple critical patients. You better believe the first thing out of my mouth was "hyperbaric, ER tech, all the nurses are in codes". Lucky for me I knew the medic - he laughed and said, "don't worry. all you need to know is LOL c/o roach in L ear."
 
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hyperbaric

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One time I checked en route to the big house with 1 patient, one roach, both 3 priority.

At the time that was my first thought. But this little old lady was REAL old and couldn't get anyone to bring her in the middle of the night. Never experienced a roach in the ear, but it appears to be painful particularly when the roach is scratching on the tympanic membrane.
 
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My perfect report involves
"Was enroute to your facility, patient stable now, wishes to go to facility X[not mine]"
 

docB

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Should patient with this (lack of) actuity be called ahead? In one system I am familiar with the only patients the hospital was notified for was trauma and unstable patients. One way system. If a situation arose in which the medic needed to talk to a doc(rare), he called on a phone.

In another system, while all patients were called ahead on a 2 way radio, it was the nurse, not the doc, who talked to EMS. (Really just said "OK we'll be expecting you".)

As a physician, do you care that a young female with belly pain is coming in? (I can see where the charge nurse would care so she can find a spot for the pt.) Maybe the problem is not only that the reports you are getting are too long, but also that you are getting too many reports.

There's some kind of rule about doing call ins around here. So they have to call in the silly stuff. I don't field many of the calls, just a few. I do wind up listening to lots of them because the radio is near my desk.
 

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Age, complaint, sick vs. not sick, ETA. Maybe less.
Examples:
Young, female, belly pain, 5 min.
Old, cardiac arrest, already tubed, 3.
Baby, fever, seizure, looks good now, 10.

No offense to Appolyon, but I think that is way too much info for an EMS report. I don't need to hear about 81mg of ASA, or how much morphine they've gotten or what they're pain is now etc...

all of that pertinant info will be answered on arrival by medics with report and given to us in the form of a run report. getting all of that during biocom is kind of redundant in my opinion.

I need age, complaint, vitals and if they have IV access or are tubed.

that's about it.

At my facility fortunately our reports are just like DocB's which are GREAT!!

30y/o pregnant, vag bleeding, vitals stable, IV, ETA 5 minutes. Any questions?

almost always no questions are asked.

I think vitals are stable is perfectly acceptable and think it's kind of goofy that people say."what do you mean? stable?"

Everyone knows that if you say something is stable in reference to vitals it means that they're fine. It also takes up less air time than rattling the vitals off to me.

if they have bad vitals they tell us. Otherwise, stable means they're normal.

just my thoughts from years as a medic and now being on the other end.

later
 

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No offense to Appolyon, but I think that is way too much info for an EMS report. I don't need to hear about 81mg of ASA, or how much morphine they've gotten or what they're pain is now etc...

all of that pertinant info will be answered on arrival by medics with report and given to us in the form of a run report. getting all of that during biocom is kind of redundant in my opinion.

I need age, complaint, vitals and if they have IV access or are tubed.

that's about it.

At my facility fortunately our reports are just like DocB's which are GREAT!!

30y/o pregnant, vag bleeding, vitals stable, IV, ETA 5 minutes. Any questions?

almost always no questions are asked.

I think vitals are stable is perfectly acceptable and think it's kind of goofy that people say."what do you mean? stable?"

Everyone knows that if you say something is stable in reference to vitals it means that they're fine. It also takes up less air time than rattling the vitals off to me.

if they have bad vitals they tell us. Otherwise, stable means they're normal.

just my thoughts from years as a medic and now being on the other end.

later
Personally I never say "stable", preferring to use "within normal limits". The last thing I want is to get my butt handed to me in court with some lawyer going "You thought the patient was stable eh? Blah, blah, blah, blah!"
 

12R34Y

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Personally I never say "stable", preferring to use "within normal limits". The last thing I want is to get my butt handed to me in court with some lawyer going "You thought the patient was stable eh? Blah, blah, blah, blah!"

Again.....I think this is a ridiculous argument in semantics. When people say the patient's vitals are stable they of course mean they are fine.

This term is most frequently used especially in the non-emergent non-sick reports.

guy stubs his toe, tooth pain and out of pain meds, vitals are stable, ETA 5minutes.

Everyone knows that that means his vitals are fine.

later
 

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For a code:
age/ sex
trauma/ medical reason for code if known
current rythm
following acls protocols
drugs given/ times defibrilated
down time
questions or orders
 

Apollyon

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No offense to Appolyon, but I think that is way too much info for an EMS report. I don't need to hear about 81mg of ASA, or how much morphine they've gotten or what they're pain is now etc...

It's a dynamic thing - depending on where you're at and/or how busy you are (and how much trust the ED has with EMS), and system policy, you can get by with less, or not call. I mean, if you're good, "chest pain, resolved" can work, but, if you then roll in with a precarious patient, we wonder what other basics you DIDN'T do. Likewise, if you gave the aspirin, but don't tell us, and don't have the information available to me in good time (where I was a resident, they had 7 days to turn in the ambulance run report), that doesn't help me, and doesn't help the patient.

Likewise, "vital signs are stable" - literally, HR 130 and RR 28 is "stable", because it's not changing. Once again, if you say that, and you come in with a pt with a BP of 80 systolic - but it's "stable" because it's been that and not changing, you're wrong - and now I wonder what else you don't know. (That is not a theoretical example - I've seen it, many times.)

Of course, "12y/o, obvious fx R forearm, neurovascular intact, splinted, immobilized, iced, 5 minutes" is FINE.

And, as I say, it's dynamic - it's "garbage in, garbage out" - there were places that would ALWAYS have someone on the radio asking for minutiae over the air - because the "log" had a space for it. That's why asking if there are "any questions" is redundant. If I do, I will ask.
 

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What do you want to hear?

If you're coming to me without lights and siren and do not want orders, then nothing. Don't call in. It's a waste of resources, and it ends up you having to repeat the story yet again when you get to the triage nurses.

If you need orders, then brief chief complaint, past medical history relative to the complaint, current meds, allergies, VITAL SIGNS, physical exam, and what you are requesting. As Apollyon said, clearly identify yourself by last name and unit.

If you're coming with a stat return, then chief complaint, PERTINENT vital signs (i.e., if they're significantly abnormal: heart rate of 20 or 160, hypotensive, etc.), any pertinent physical exam findings/EKG findings, what you've done, when you're gonna be here.
 

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"A good call-in is like a skirt, long enough to cover the essentials, but short enough to hold our attention. Yours is more like a Wonder Bra. Eye-catching but mostly built on false pretenses." :smuggrin:
 

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Our patches are way too long and unnecessary. AMR patches for routine transports, then repeats the story to the triage nurses, and then tells the story again to the resident/nurses when they roll the patient to a room.

Where I used to work, we didn't patch routine transports. Stat returns got patched (Medic 5, 5 minutes out with an anterior MI. IV, nitro, morphine, aspirin, O's (for O2), labs drawn, and metoprolol given. See you in 5.)
 

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I think everyone has different preferences for what they want in an EMS report. I work for a service that covers a lot of dirt and transports to about 20 different ERs.

Hospital A literally wants "urgent patient, stick a central line kit in room two and call RT for a vent" only.

Hospital B wants to know what size the IV is, it's location, childhood illnesses, step-mother's maiden name etc.

Hospital C usually only sees a BLS only service and tells you (over the radio) to make sure to apply the AED to a patient in cardiac arrest.

Working with the ER staff to figure out what info they want is the way to go
 
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