Giving BLS reports to ALS

[AnthonyM83]

I'd like to hear from the medics out there how they best like their reports from EMTs who have been on-scene first. At my service, FD Medics and Private EMTs usually arrive 1-2 minutes apart. When we're first on-scene, I'd like to have something to say, even if we just got there.

I've started doing:

Hey guys, this is Jane Doe, 31, alert and oriented times three, skin signs normal, warm, and dry with a radial pulse of 96, strong and regular. Her chief complaint is chest pain. *stop*

Then continue with whatever details of the complaint, history, allergies, and meds (while partner concurrently obtains BP).

Also, after obtaining a chief complaint, such as chest pain, do you guys find it more useful to go into OPQRST (or whatever non-acronym method you use for details) or in history/allergies/meds which often also ends up yielding background to her complaint?

[AZCEP]

Give me a good history of the present complaint, and past medical history, and I'll worry about the rest.

You can mention your vitals, but unless there is a pattern to them they won't mean anything once I leave the scene.

[AnthonyM83]

I try to throw out the ABC's first, because I'm often cut off when giving reports to ask what the vitals are, I think to know if patient is big sick or little sick. I don't know if that's a medic thing or so captain can fill out the PCR.

Perhaps, I'll start with name, age, chief complaint, mini-history, and then ABCs (thing is I usually check ABCs first on-scene, so that's what I have to report). Also, a lot of medics will cut you off as soon as they arrive, so if you start getting into history with patient (which often goes around in circles to get patients to answer the questions you need) you end up with nothing substantial to report other than "chest discomfort" and they wonder what you've been doing that minute you've been on-scene.

[stcommodore]

Mini report via radio to incomming medic

"15 year old female possible syncopal after marching band show, vitals 110/80, hr of 90, we'll be at the entrance to the stadium"

they'll get more if they want it when they arrive. This specific one was followed by

"cancel the medic, mother refusing for the patient"

[Timmy]

“Hey guys, nice day isn’t it….” *Tears pink copy from PRF then hands to paramedics* Everything you’ll ever need to know is on this form.

[AnthonyM83]

I hate when they do that to US! We show up second, "hey guys, here you go" riiiip "So and so Hospital". I rush to read to through, then ask him a couple questions and learn it's ALS criteria per protocol, look back up to say something, but there's only dust trails. Dammnit, had again!

[Dustdevil]

Yeah, I agree that sucks. But, of course, them dumping on you is a very different situation from you turning an ALS patient over to them. As I understand it, you are still going to be going to the hospital with them anyhow, so it's not like you're bailing.

Their disinterest, and the fact that you will still be there throughout transport to answer any further questions, combine to validate what AZCEP suggests. KISS. Chief Complaint and any immediately significant findings. "Chest pain for two hours. One MI 2 years ago. Took two nitro. Blood pressure good." **STOP** If I want or need anything else, I'll ask. But, as a professional practitioner, I want to start ONLY with the nature of the problem and any immediately significant history or findings. Now, of course, I realise that LA County firemedics are not normal medics, and I may be silly to assume that they would operate like normal medics would, but *normally*, that's all that most normal medics would want or need. The rest, we are going to find out for ourselves through our own assessment anyhow, because we are medically and legally liable for the assessment being accurate, and not second hand. Therefore, the above is really all I need from BLS unless I ask for other specifics.

You're wasting your breath with the "alert and oriented" stuff, as that information is self-evident to the medic without your report. Same with the skin condition and other first-impression items.

Unfortunately, in a system that big, you really can't come up with a style that is going to please everybody, or even the majority. Probably half of them blow you off completely, no matter what you have to say. And then the educated ones who are there for the medicine will treat you like trash for not going into detail for them. Or for just not being a firemonkey, which we all know makes you less than human in Kalifornia EMS. But, I digress. Probably the best compromise is to give what AZCEP and I recommend, but stay right there by their side and ready to continue the conversation if they ask for more. The ones that really want or need more will immediately ask for it. When you are ready to give them intelligent answers, you will redeem yourself for any doubts they may have had about your assessment. And again, if they don't ask, they aren't interested anyhow. The ones who just shoot you that look like, "Is that all you got?" are, of course, just being arseholes anyhow, so screw them.

Either way, you end up feeling like a second-class citizen in that system. You really can't win. At least if you keep it short and simple, you significantly lessen your chances of being ignored and/or shoved, which is probably the most important thing for your long term sanity.

[fiznat]

What I really look for is the basic information. Chief complaint, pertinent positive findings, and relevant history. Like dust said, don't waste your time with things that you found that are normal, or unrelated history. I'm interested in the "story," but hopefully a condensed version: without the rambling BS that the patient probably told you.

Also, don't be offended that I will probably reassess and re-ask the questions you just had answered. It isn't an insult, but I need to be sure and sometimes starting at the beginning of the path helps me find where I am going to end up.

[Doug]

Oh boy, a topic near and dear to me...

In addition to being a paramedic with an ALS service i am a volenteer with the FD in my town. We don't have our own ambulance we rely on mutual aide from next town over which is ALS.

I got a taste of what it's like to turn care over to an A**hole medic..lol. I took full hx of a man with an obvious dislocation of his shoulder appeared to be isolated injury...5-6/10 for pain SITTING still..no meds no allergies etc. If it was my pt (considering the long dirt driveway and approx 15 minute ride to hosp. over crappy roads) i would have offered pain control...well, medic showed up i gave a quick report and said "I think he would benefit from some pain control..." pause...have you ever gotten a look that said "You know what, just because you suggested it i ain't gonna do it..." yeah i got that look.. she walked the guy to the truck...had him step up in...didn't even talk to the pt. and turned it over to the BLS provider. Then apparently bad mouthed me to several people...so i can sympathize with the BLS providers who get a real jerk...i am happy to say after dealing with THAT i have asked many BLS providers (and had others ask for me to make sure that they weren't intimidated) if i ever acted like that and am happy to say that apparently i don't. If i do smack me...

[AnthonyM83]

Thanks for the advice.

I realize how LACounty'ed I'm becoming by including name and age right away in the reports. I used to hate wasting time on it instead of going into chief complaint, first, other than maybe first name, but it's the first thing on the runsheet they're filling out on-scene, so they always stop me to ask. Name, age, Hx,Alrgy,Meds, BP, Pulse, (not even for diagnostic purposes, but for fill in the box purposes, it seems).

Also, part of wanting to give good reports, is simply practice in verbalizing findings and practice in making sure I go through a good assessment. Hopefully that helps me in medic school, even if I do it in a different fashion, it helps me get used to verbalizing under pressure instead of just babbling out, skins signs normal when patient electrodes won't even stick to the patient. Make it easier on myself during medic internship.

Again thanks for advice guys. YOU are my FTO's, seriously.