tskstorm Posted May 5, 2009 Posted May 5, 2009 (FYI, the FDNY EMS Command has the Dispatcher at EMD advise the hospital of the "note" from the ambulance crews. The crews rarely, if at all, have direct contact with the ER/ED crews while enroute.) Side comment, If you work for a facility and want to give a direct notification you can, and the phone numbers to all the ER's are available, but as said seldom used. I have directly notified the facility I was working for twice and have gotten better response and more attention as the ER was able to ask questions and better prepare themselves.
CBEMT Posted May 5, 2009 Posted May 5, 2009 (edited) "Hi doc, this is CBEMT from _____________. Doc I have an 18 year old male with a history of seizures, he had a witnessed grand-mal seizure of approximately 30 seconds per the witnesses. He's still postictal at this time, kind of in and out in terms of lucidity, says he hasn't taken his seizure meds in two weeks. BP is 150/90, pulse 120, respirations about 28, and he weighs about 200 pounds. We have him on O2, IV is in. Doc if you don't mind, I'd like an order for Versed in case he starts seizing again." *order received and confirmed, spelling of Dr's name requested and confirmed* "Ok Doc thanks, we'll be there in about 5." "Hi Doc, this is CBEMT from ___________. Doc I have a 13 year old female with a dislocated right knee, this has happened to her before, she had surgery for it about a year ago at ________ Hospital, however we're going to be coming to you. Right now she is in a LOT of pain Doc, she's seated at a school desk, between that and the fact that this school doesn't have an elevator I'd like to get her some pain relief before moving her. Vitals right now.... BP 120/70, pulse 100, respirations 24, she weighs about 110." *order received and confirmed." "Ok great Doc, but before I let you go can I get a follow-up dose order now? We're going to have about a 20 minute ride and it can get pretty bumpy." *order received and confirmed, spelling of Dr's name requested and confirmed* *Comm Center answers* "Hi, _________ Rescue coming in." *hold, then triage answers* "Hey there, ___________ Rescue coming in, 40 year old male, fell about 30 feet off a roof to the ground, positive loss of consciousness of about a minute according to his coworkers. The only obvious trauma we've noticed is some abrasions on his head and right arm. Right now he's alert and oriented, vitals OK with the exception of his blood pressure, last one was 203/150, no history of that. We have a board and collar, IV's in, normal sinus, we'll be there in about 10." (Yeah, I know, not fantastic report on the last one, but it gets the point across to triage nurses who pretty much only want to know if we need a trauma room and if so how bad it is. The more detailed report will be given at least twice on arrival.) Edited May 5, 2009 by CBEMT
FireMedic65 Posted May 5, 2009 Posted May 5, 2009 Personally, I think scripting radio reports is not the best of ideas. Sure, in the perfect world we will all give the best reports and receive the best reports. Sadly though, more often than not, providers give horrible reports. They leave out info, give you wrong info from them doing a bad assessment, or you just can't understand them. I am not saying everyone is like this, and it sucks there some are. They are out there though!
Dustdevil Posted May 5, 2009 Posted May 5, 2009 Doc, this is Medic 28. I have a 31 year old white male who was unrestrained driver of a four-door sedan, travelling at a high rate of speed. He lost control and collided sideways with a steel sign post, which ripped the car in half. The car is in two pieces, about thirty metres apart. Everything from the dashboard forward is in one half, and from the drivers seat back in the other. The patient was found ambulatory on the scene. He is alert and fully oriented. He is atraumatic to inspection and palpation. There are no signs of ETOH or other intoxication. Vitals: BP 144/90, Pulse 118, Respirations 16. He denies LOC, has no complaints of pain or injury, and is refusing care or transportation.
CBEMT Posted May 5, 2009 Posted May 5, 2009 "Approved, as long as he buys a lottery ticket on the way home!"
AnthonyM83 Posted May 5, 2009 Posted May 5, 2009 Well, LA with the mother may I system that it is tends to give very long reports for each and every call. So maybe as an example of something that's too long...would be same length for any c/c: -Rampart base, this is Squad 51 with a medical run, how do you copy? -Sequence number AB 123456. We have a 45 year old male, with c/c of Sz. Pt found lying supine in living room, post-ictal. Family reports a clonic-tonic sz lasting 4-5 minutes. Pos oral trauma, pos incontinence to urine, neg other trauma. Airway is patent. Respirations are 12 a minute, good tidal volume. Lung are clear bilaterally. Pulse is 100, strong and regular. Skins are cool, pale, and moist. Pupils are PEARL. He is a 4-6-4 (we do E-M-V) on the GCS. His BP is 150/80. Pulse Ox 100%. Shows sinus tach on the monitor. Blood sugar is 108. Pt has a history of sz and high cholesterol. No allergies. Patient takes Dilantin and is compliant. We have this patient in full c-spine precautions, O2 at 15LPM via non-rebreather, and attempting to start a line of normal saline TKO at this time. At this time, you are our closest facility being 10 minutes out with USC being our 2nd closest facility at 15 minutes. How do you copy? -Squad 51, copy, O2, IV, and valium 2-10 prn. Squad 51, feels comfortable breaking down at this point. -Copy Squad 51, out. Aaaaggh. Same thing for a broken wrist. Oh, as far as the radio reports where they need to ask for information, you might consider either doing some live training (one guy on a cell phone and the class listening on speaker phone) to elicit information during critical calls. -Rescue 1! -Rescue 1, go ahead. -Rescue 1, coming in with 2 year old cardiac arrest. Umm, we're doing CPR, came in as a difficulty breathing, degraded en-route...umm two minutes out, uhh, what do you need base? Or a few episodes like that where medic is a bit discombabulated because of circumstances and operator needs to get bare minimum info without asking too much and distracting medics (history, allergies, meds?) You can do the whole panicky voice on the phone, too
FireMedic65 Posted May 5, 2009 Posted May 5, 2009 Well, LA with the mother may I system that it is tends to give very long reports for each and every call. So maybe as an example of something that's too long...would be same length for any c/c: -Rampart base, this is Squad 51 with a medical run, how do you copy? -Sequence number AB 123456. We have a 45 year old male, with c/c of Sz. Pt found lying supine in living room, post-ictal. Family reports a clonic-tonic sz lasting 4-5 minutes. Pos oral trauma, pos incontinence to urine, neg other trauma. Airway is patent. Respirations are 12 a minute, good tidal volume. Lung are clear bilaterally. Pulse is 100, strong and regular. Skins are cool, pale, and moist. Pupils are PEARL. He is a 4-6-4 (we do E-M-V) on the GCS. His BP is 150/80. Pulse Ox 100%. Shows sinus tach on the monitor. Blood sugar is 108. Pt has a history of sz and high cholesterol. No allergies. Patient takes Dilantin and is compliant. We have this patient in full c-spine precautions, O2 at 15LPM via non-rebreather, and attempting to start a line of normal saline TKO at this time. At this time, you are our closest facility being 10 minutes out with USC being our 2nd closest facility at 15 minutes. How do you copy? -Squad 51, copy, O2, IV, and valium 2-10 prn. Squad 51, feels comfortable breaking down at this point. -Copy Squad 51, out. Aaaaggh. Same thing for a broken wrist. Oh, as far as the radio reports where they need to ask for information, you might consider either doing some live training (one guy on a cell phone and the class listening on speaker phone) to elicit information during critical calls. -Rescue 1! -Rescue 1, go ahead. -Rescue 1, coming in with 2 year old cardiac arrest. Umm, we're doing CPR, came in as a difficulty breathing, degraded en-route...umm two minutes out, uhh, what do you need base? Or a few episodes like that where medic is a bit discombabulated because of circumstances and operator needs to get bare minimum info without asking too much and distracting medics (history, allergies, meds?) You can do the whole panicky voice on the phone, too wow... that would drive me nuts! taking away from patient care to dictate a novel over the radio. I hate the mother may I system
Doczilla Posted May 5, 2009 Author Posted May 5, 2009 You guys are frakkin' awesome. This is exactly what I need. 'zilla Personally, I think scripting radio reports is not the best of ideas. Sure, in the perfect world we will all give the best reports and receive the best reports. Sadly though, more often than not, providers give horrible reports. They leave out info, give you wrong info from them doing a bad assessment, or you just can't understand them. I am not saying everyone is like this, and it sucks there some are. They are out there though! We're using the scripts as a starting point for the training. As you've noticed from the examples here, there are different styles to radio reports. With the number of EMS systems that transport to our facility, we see great variability, even within those systems. I'm trying to train the residents to listen for that which is truly relevant to us in the report. What do we need to know in order to approve an order? What do we need in a notification that makes a difference? Is there something buried in the report that makes this a CAT 1 trauma instead of a CAT 2? I'm going to modify the scripts to snip some information (maybe important info) so they will have to ask for it. So I'm going to make some of these into crappy reports. The reason we're using scripts is that we need it to be interactive. If there is a piece missing, the residents need to know to ask for it. If an order is requested, the residents need to know how to give it. This will require a live person on the other end. 'zilla
Richard B the EMT Posted May 6, 2009 Posted May 6, 2009 Just hope you never get this one: Crew: Unit to hospital. OLMC: Go unit. Crew: We're inbound with a 60 year old female in cardiac arrest, CPR in progress, ETA 6 minutes. OLMC: What are the vitals? Unit:? OLMC: Unit, what are the patient's vitals? Unit: I say again, the patient is in arrest, CPR in progress! (Off mic) What's with them? OLMC: I need the patient's vitals. Unit; (off mic) they gotta be kidding. (On mic) Zero over zero, pulse rate zero, resps zero. ETA 5. OLMC: We're setting up for you. Although through the dispatcher, this is pretty much how one call I was involved with happened, with names left out to protect both innocent and guilty
Dustdevil Posted May 6, 2009 Posted May 6, 2009 Yeah, I had a similar one once. Had to relay through dispatch, because the receiving hospital's radio was down. Told them we had a male who had been assaulted. Witnesses say he was knocked down, had a seizure, and now he presents post ictal. The dispatcher replied, "Whoa, whoa whoa! Wait a minute... first of all, was there any loss of consciousness?" My partner gave me a dumbfounded and annoyed look, then replied, "Well... he had a SEIZURE, so yeah... I'd call that a loss of consciousness."
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