Ems Radio Report Pearls & Format

EMS RADIO REPORT PEARLS & FORMAT (References: EMS1.com, Mosby, Bates, Life Under The Lights, JEMS)

 There is no “perfect” report for every patient, but good reports tell a short story explaining circumstances of the call, decisions made & why, and the outcome of those decisions.  When you call into the ED, make sure you have a person listening to your transmission. Nothing is more wasteful than giving a report to find out that your connection was interrupted causing you to repeat information or delay care.  While you document much more in your written narrative, your verbal report is a brief snapshot letting the ED know if your patient is “Sick”, “Not Sick” or “Oh Dear Freaking G-d Sick”  Ask yourself…what would you want to hear if you were in the ED getting that report? Your short attention span is similar to the ED staff taking that report. We ALL have ADHD (a job requirement of emergency services personnel).  Spend some time in the ED listening to reports – many of them will make you laugh or cringe. Try never to be the person greeted by the ED staff laughing or growling.  Practice makes perfect. Tape yourself giving mock reports & then listen. Do you sound disorganized? Are all pertinent components present & easily understood? If not, try, try again!  Plan ahead. Consider a written SOAP-format template to reference to be orderly & concise with details (and also to reference for your written report).  If you are spending more than one minute on the radio, you are spending too much time talking & not enough on patient care. The flip-side is if you have a significant change in the patient’s condition, the ED absolutely wants to hear more information.  Emphasize important positives & negatives; i.e. why you gave aspirin (chest pain protocol) but no nitroglycerin (patient took Viagra that morning).  The difference between Objective & Subjective information is the difference between “I’m having a heart attack” & an EKG showing a STEMI.  Avoid irrelevant details.  Be accurate, honest and objective. If you can’t tell a STEMI from Afib, let the ED doc know.  If the patient is under arrest, requires restraints, or combative, let the ED know!  If you did something & the patient got better or worse, let the ED know!  If you need something right now (i.e. CPAP), have an uncontrolled airway, an unstable patient, a STEMI, Stroke or otherwise critical patient, let the ED know!  If given an order, repeat the order back to Medical Control to confirm & obtain the name of the MD.  If the order given to you by Medical Control is contradictory to EMS Protocols, ask the doctor to repeat the order. If the order is still wrong (i.e. medication dosage), gently correct Med Control – they are human beings, and may make mistakes (or not be familiar with current guidelines). NEVER follow an order that violates your scope of practice or State Protocol, and explain to the physician that you will discuss it with them “off-line”.  Vitals are never “normal”, “unremarkable” or “good”; take 5 seconds & give the ED a set of vitals.  Be professional, and never curse or use “inappropriate” terminology (i.e. “POS”, “Frequent Flyer”, “A-Hole”)– ALL reports are recorded and may be used in court. You also don’t want to hear your own report in M&M rounds (or get a letter from your Medical Director)!  For high risk refusals, if the patient absolutely refuses to be transported, try and get the Medical Control physician on-line to speak with the patient. This may be a great “save” from the liability standpoint, and adds credence to the fact that you tried to do the right thing for the patient.  Medical Control is your friend (honestly). The physicians are there to answer questions, provide clarifications & help triage your patients to the correct facility. Do not hesitate to call with questions. SAMPLE SOAP FORMAT Identifiers / Subjective o Agency / Unit o Ask for confirmation of the patch o Patient Age, Gender o Chief Complaint & Priority o History of Present Illness (with Pertinent Positives / Negatives) o Pertinent Associated Symptoms o Pertinent Past Medical History/ Past Surgical History / Past Intubation History (if respiratory patient) o Pertinent Medications / Allergies

Objective o Vital Signs o Presentation/Appearance (includes scene if pertinent, i.e. CO exposure) o Level of Consciousness (ABCs, GCS) o Pertinent Exam Positives & Negatives o Testing as Pertinent to Presentation (i.e. ECG / 12 Lead ECG, Glucose, Stroke Scale) o Inclusions/Exclusions (i.e. TPA, STEMI or Trauma Diversions)

Assessment / Plan / Interventions / Other o All Interventions (i.e. IV, O2, Advanced Airway, CPAP, Spinal Precautions) o Medications (Dose/Route) o Estimated Time of Arrival o Immediate needs upon arrival (i.e. security, CPAP, resuscitation, lifting assistance) o Orders requested o ETA / Sign off

EXAMPLES OF GOOD RADIO REPORTS Medical ~ Chest Pain / Respiratory Distress “This is EMS 51 with a Priority 2 transport, 70 year old male with chest pain requesting med control…do you copy? Patient’s substernal pain is a 10/10, awoke him from sleep 30 minutes ago. Took a baby aspirin at home with improvement to 6/10. Complaining of shortness of breath and sweatiness. Has an allergy to nitroglycerin. Took all other BP meds last night. Had a “negative” stress test 2 weeks ago. Current vitals are BP 140/92, HR regular in the 120s, Sat 84% on room air, labored breathing. Patient is A&Ox3. Reproducible substernal CP, crackles at BL bases, diaphoretic & ashen, pitting edema in legs. Monitor showing sinus tach, no ischemia on the 12 lead. IV established, patient given 50mcgs of fentanyl, one Duoneb & placed on CPAP with improvement of CP to 2/10, sats to 99% & BP stable at 120 systolic. We are calling for a 2nd dose of fentanyl with an ETA of 10 minutes. Do you copy Med Control?” Medical ~ Respiratory Distress “Tobey, this is Medic 51, do you copy? We are transporting a 36-year-old male complaining of shortness of breath and non-radiating, sharp chest pain on expiration. Symptoms began 1 hour ago after exercising. He attempted to use his inhaler without relief. He has a history of asthma. Patient initially with moderate difficulty breathing but awake, appropriate and cooperative. On exam we find lung sounds with wheezes in upper lobes bilaterally and quiet lower lobes. Vitals BP 162/94, pulse 124, respirations 36 and labored, pulse ox 92% on 15 liters non-rebreather. ECG sinus tach without ischemia. Patient given 4 baby aspirins, and a duoneb plus oxygen with wheezes decreasing and sats in the 90s. Our ETA is 7 minutes. Do you have any questions?” Trauma ~ Major Trauma with Trauma Triage Diversion Request “This is Medic 51…We need a physician on-line for a Trauma Diversion. We have a 50 yo male with a fall from a tree approximately 20 feet, landing on his back and left side. He is A&Ox3, but has repetitive questioning. His initial vitals are BP 88/62, respiratory rate 20 and unlabored, heart rate in low 100s. No neck tenderness, positive bruising to the left side of his head, lungs clear to auscultation all fields with some bruising to the left side. He has an obvious left femur deformity, with a pelvis that is unstable to rocking and compression. We have applied a traction splint and a pelvic binder with good distal pulses. IV established and after 250 cc, his BP is 120. Glucose 210. Patient maintaining his airway, and in full spinal precautions. We gave 50 of fentanyl, 4 of zofran and are going to bypass you to go to the trauma center but wanted permission to give a second dose of fentanyl 50mcg due to pain from the fracture”

Medical ~ Patient Refusal “This is Medic 51 requesting a physician-on-line for a refusal. We are on scene with a 35 yo female with a long history of diabetes. We were called today by her husband who found her snoring in the living room with a blood sugar of 36. IV started and patient given an amp of D50. She immediately became more oriented, and a repeat glucose 15 minutes after the IV meds was 150. Pt is only on insulin, no orals, and is drinking orange juice. Her husband will be with her for the rest of the night. We have 2 sets of vitals within normal range except initially tachy at 110, now with a heart rate of 82. She is A&Ox4, and states that she will follow-up with her primary doc in the morning, and her husband will call 911 if she has any worsening problems. She understands the risks of not being transported including dying . Do you want to speak with the patient doc?” (the medical control physician declined to speak to the patient). “OK doc…we will note that the patient is refusing and that you agree, and will have the patient sign her refusal with her husband witnessing. This is Medic 51, out”.

Medical ~ Chest Pain “Tobey ED, this is BLS Unit One 5 minutes out with a 62 year old male complaining of sudden onset of crushing chest pain and shortness of breath. Pain is 8 out of 10 and radiates to his neck. He has a history of angioplasty 2 months ago, and took a full aspirin prior to our arrival. We called for ALS twice, with no units available for at least 15 minutes so we are coming to you rather than wait on scene. Vitals show BP 150/92, HR 120s and irregular, respiratory rate in the 20s with a sat of 92% on a non-rebreather. Patient’s pain is still 8/10. Do you have any questions or orders? (physician at this point asked why the EMTs didn’t have an EKG, start an IV or give nitro) Med Control…we copy you but we are only a Basic Unit, and have no medic capability. We will be at your door in 3 minutes”.

Medical ~ Field Pronouncement “CMED we are requesting Medical Control to call a code” (CMED provides the patch to the paramedics, and the physician gets online). “Hi Doc this is Medic Gage from Rampart calling for permission to terminate a code. We are on scene with a 80 year old female, long standing cardiac and stroke history whose family called when they found her unresponsive. Unknown down time, but the patient was still warm. They did not start CPR. Police arrived, and AED indicated no shock. They started CPR. We arrived 3 minutes later and continued CPR, intubated the patient and found that she was still in asystole. We have given 3 rounds of epi and 1 atropine, and after 10 minutes, the patient is still asystolic, pupils fixed and dilated with a glucose of 128. The son and daughter are requesting that we stop CPR and not transport. We are calling for permission to discontinue and leave the patient on-scene with the police.” (physician gets on-line, agrees with the paramedics and asks if the family wishes to speak with her). “Thanks Doc, the family says that they will talk to their own doctor but appreciates you asking. We will call the time of death at 0345 if that’s still OK with you. Medic Gage out”.

Medical ~ Active Labor “Good Morning…this is Medic 51 inbound with a 22 year old female in active labor. Patient states she is 8 months pregnant with her first baby having contractions every 30 seconds. She states that this has been a normal pregnancy and her OB is at your hospital. Her water broke about 3 hours ago. She is diaphoretic and in “a million out of ten” pain (patient audibly screaming obscenities in the background). Current vitals are 160/82, sinus tach in the 130s, respiratory rate 30, HR 126 sinus tach on the monitor, RR 22, SPO2 100% on high-flow oxygen. Patient will not let us establish an IV, but we were able to look and we see a head crowning. We are 2 minutes out and requesting physician and nursing staff to meet us in the ambulance bay for a possible emergency delivery”.

Medical ~ STEMI Alert with Cath Lab Activation “Rampart…This is Medic 51 inbound with an ETA of 10 minutes with a STEMI-Alert, I repeat a STEMI-Alert with request to activate the cath lab. 65 year old female with history of prior MI last year and 2 stents who has been off her plavix for 1 month, presents with acute onset chest pain, dizziness and nausea without vomiting. She states this is how she felt with her last heart attack. Patient is pale and diaphoretic. 12-lead shows an inferior wall STEMI with obvious ST elevation in 2, 3, and F without reciprocal changes. Current vitals are BP 90/60, HR 54 sinus bradycardia without blocks, respirations 28 and somewhat labored, sat 100% on high- flow O2. We have an IV established, saline at KVO after a 250cc bolus, and a second saline lock. We gave 4 babies (aspirin) and zofran 4 IV. No nitro given because of inferior changes and hypotension. Pressure holding stable in the high 90s. If you have no further questions or orders, we’ll see you in about 8 minutes and give you an update with any changes.”

Trauma~ Pediatric MVC “This is BLS Unit 15 with a pediatric Priority 3 MVC ETA 10 minutes. We are enroute with a en route to your facility with a 10 yo male, restrained front seat passenger in a low-speed MVC in which his car rear-ended another vehicle that had stopped short while merging at a rate of approximately 25 mph. Patient complaining of mild midline neck pain and some chest pain from the seat belt. No other injuries reported in the vehicle, but mom wants the child transported for evaluation. Patient ambulatory on-scene with minimal damage to the car, no intrusion but air-bags did deploy. Vitals are BP 102/60, HR 118, respirations clear all fields and 99% on room air. Patient boarded and collared, neurovascularly intact, moving all extremities with distal pulses intact. No focal findings on examination. He is A&Ox3, and mom will be riding with us on the way to the hospital. Do you copy?”

Trauma ~ Low Back Pain “Dispatch, this is Medic 51 on scene with a 42 year old male with a long history of back pain who called for acute worsening of his pain after moving furniture tonight. Patient’s vitals stable, but he is refusing to be moved to the stretcher without getting pain medication. On exam, he has distal pulses intact in all extremities, and can move all extremities with equal grips bilaterally but will not allow us to touch his right lower back due to 10/10 pain. We have established an IV KVO normal saline, and requesting an order for fentanyl 50mcgs. Patient states allergy to toradol, no other significant past medical history. Not sure that we can board and collar this guy, but will transport in position of comfort.”

Medical ~ Abdominal Pain, Nausea / Vomiting "Medic 51 to Tobey, we are bringing you a Priority Two 23 year old male complaining of abdominal pain for the past day after drinking ‘a few beers’. Pain is in the right lower quadrant, is 8/10, does not radiate. Patient states he has vomited 10-20 times over the past day, and also has diarrhea. Vitals are BP 145/34, heart rate 130, sat 100% on room air. IV established, we gave zofran and morphine 4 and 4. Our ETA is about 15 minutes. Patient is well known to us and you, and we will give you more details upon our arrival in about 10 minutes. Do you have any questions?” Medical ~ Cardiac Arrest “Tobey, This is Medic 51 calling with a Priority 1 drowning with ROSC, requesting physician on-line…I'm at the Y with a female in her 40s who had was found face-down in the hot-tub. She was last seen 10 minutes prior by a bystander who was also in the locker room. Bystander called for help and she and the Y staff got the patient out of the tub and started CPR. They couldn’t apply the AED pads because the patient was too wet. At out arrival, the patient was in fine Vfib, and was shocked once. There was no response, so compressions continued, and patient was shocked again while we established an IV and gave a milligram of epi. After the second shock the patient converted into a sinus rhythm. Patient intubated with ETCO 2 in the 40s. She has no spontaneous movement at this time, but remains in a sinus rhythm with a BP in the 80s with pupils filed and dilated. I don’t have a glucose. We have an ETA of 10-12 minutes” (Medical control asks for the medics to start dopamine at 5, amiodarone 150 IV bolus, start cooling the patient if possible and perform an EKG). “Tobey, this is Medic 51…we don’t have ice to cool. Patient is sinus on the monitor without an obvious STEMI. I’ll start dopamine with a fluid bolus and try to get that amiodarone in before we get to you as well as a sugar. Medic 51 out”.

Trauma ~ Gunshot Patient Priority 1 “Tobey, requesting physician on-line for a Priority 1, I repeat a Priority 1 GSW to the abdomen. Patient was shot approx 30 minutes prior to our arrival with a delay on scene due to securing the area. Initial vitals were BP 80 over palp, pulse of 130 weak and thready, respirations gurgling and shallow at 10 with sats in the 80s, now assisted by BVM. Appears to have one wound to upper abdomen / lower chest without an obvious exit wound. Significant bleeding noted on patient and on the ground, with pressure dressing applied and bleeding controlled. We’ve established 2 large bore IVs and bloused 250 cc, pressure now in 90s. Pt has no, I repeat no breath sounds on the right side, but fighting us…we cannot needle his chest. GCS about 8, patient moaning, moving all extremities and fighting us so we can’t intubate at this time. Our ETA is 5 minutes, coming in hot…do you have any orders?”