JPINFV

Ah, missed that. However patients in cardiac arrest shouldn't be transported anyways.

Do you transport infants who are in arrest in a car-seat ? NO.

Considering that the first company I worked for had a contract for a local children's hospital, all the time (unless it was an incubator transfer). Granted, we'd go back to the base to retrieve a car seat before being sent on a transfer, but we'd still put the car seat onto the stretcher (and I'd always reposition the straps to mimic a traditional 3 point restraint system).

Additionally, a car seat option is becoming a standard feature of the captain's chair on new ambulances.

I told my boss I would do the transfer if I could remove the stretcher brackets and she refused. I called her 3 times about it BEFORE I refused transport.

I appreciate the input.

See, I wouldn't have even asked if that was the make or break point. Horns come out, horns go back in, supervisor doesn't need to know if the supervisor isn't even there.

I'm going to bet that if there was a significant delay for reasons that could impact patient care, it would matter. Besides, it is very much documented how the patient arrived at the hospital, which could easily be argued that it doesn't matter if EMS brought a patient in or they walked in themselves.

How about, "Unit XYZ dispatched to _____ for ____. Responded ____ [note: I very much consider response/transport status to be an intervention to be based on what information is known to the crew/dispatch]. Delayed at rail road crossing for 5 minutes.

On arrival, pt is a... [insert rest of HPI here].

As far as electronic vs paper PCRs, I'm not sure. I'm only experienced with paper PCRs, and never used dispatch times when documenting. There needs to be one time source for all times documented, be it dispatch times or what time vitals are taken, or what time specific interventions are being administered. Unless you're going to ask dispatch for the time every time you take a set of vital signs, then why would you use dispatch's clock for your various movement times (i.e. alert, en route, arrival, etc)?

More importantly, if movement times aren't clinically important, why document them at all?

So, all the people who are refusing transport, what's the alternative, oh professionals of transport medicine?

Dear Hospital,

Stop taking large patients, regardless of why they're large. You'll never be able to get rid of them. Sucks to be you.

Sincerely,

Your local ambulance service.

Dear Patient:

Don't be large, what ever the reason. Maybe the local ranch with a flatbed used to haul livestock can swing around and transport you.

Sincerely,

Your local ambulance service.

When you're delayed 10 minutes at a rail road crossing, I imagine it's kinda of important.

Hey all,

As an FTO, I frequently have to teach a new employees and paramedic preceptees how to do EMS Documentation. I have a number of recources, documents, etc as well as war stories of documentation gone bad. I wont torture you with all of it.

That said, as I hit the 21 year mark, I am stil a huge fan of SOAP in one form or another. For me it is the gold standard by wich I measure al naritives regardlessof format.

One of my first PO's (probationary employee...AKA a preceptee in an FTEP program) had a lot of difficulty in charting. She took copious notes on our informal discussions and then added it to a little EMS website she ran at the time (long defunct now as she passed away from cancer several years ago).

I have since copied, adapted and otherwise used what she wrote and turned it into one of the first handouts I give my new PO's. It wrks as a good starting point for discussions and teaching on charting.

The documet is attached to this post. I hope this helps.

SOAP Report Guidelines for EMS.doc

My only complaint with a classic SOAP note for EMS is that it overlooks the need to document response and prearrivial information. I don't think that response to treatment really belongs in a "plan" area, and treatments that may be given, but not needed, should be included in the plan section (for example, even if pain medication isn't given, I think there's value in documenting "morphine PRN for pain" in the plan section). The plan section could also be used to document why certain interventions weren't provided ("Immobilization not indicated per NEXUS").

Similarly, what happens if something delays arrival, for example being stuck at an at grade rail road crossing? Those two issues was why I coined the term "Pre-SOAPeD" (Pre= pre-arrival and D=Delta=Change) for my 5 (6 when I get around to the wrap up post) blog posts on documenting.

Towel? What's that for besides being a hoopy frood?

When it came to the company linen, we only had one blanket and it was only to be used over the disposable sheets. That said, a few quick comments. If a patient coming from a facility needed a blanket, we used the facility blanket (I've always taken linen as something that works out to be near zero sum), in general blankets aren't needed most of the time in So. Cal, and we never dilly dallied around outside anyways.

I've worked in a prosecutor's office and the law enforcement reports all have two things in common -- they are written almost strictly chronologically and they describe just the facts.

However, unlike police, health care professionals needs to include their interpretation of what's going on. It isn't simply enough to list vital signs and exam findings. Those have to mean something as a whole, and diseases are not nearly as clearly defined or as straight forward as the penal code. Those interpretations needs to be justified in facts, but they also need to be documented.

As for reporting formats, I prefer straight chronological. Those reports are the easiest to read and follow.

Yet that is not the standard used by physicians. Why is that? Simply because chronological order isn't nearly as important as it's made out to be. Unlike the police where certain facts have to be established in a specific order (in order to do things like justifying a search or arrest, or use of force), it doesn't matter if I ask allergies before medications, or look at the abdomen before listening to lung sounds. The order of treatments provided, and the ensuing response, is the only thing that's chronologically important in terms of the care provided.

On a similar note, I've also always considered SOAP note style H&Ps to be fairly straight forward and easy when they were available on a discharge or transfer.

Personally, I'd want to make it as easy as possible for them to understand what you did and why you did it.

That's why you take the stand. I'd rather have to dumb down my testimony than look like the 2 Michael Jackson paramedics who just testified.

As an aside, I do hate it when the stretcher fetchers come in and grab arm loads of linens though. They are a for profit company. Therefore should be supplying their own linens. The hospital provides them for EMS and the Critical care folks. It is a costly venture but one they deem important.

Is this under contract that the hospital will supply you with linens, or is it a case where the staff simply doesn't say anything? Similarly, how often are linens circulated from facility to facility? After all, the patient who goes from nursing home to the hospital with facility sheets isn't going to go from the hospital to the facility with the original set of sheets.

I think we would be lying if we said we had never done it. You should not do it though,but u don't know that might have been there last sheet and they were planning on changing it before the next call.

Nope. Never done it, even to much chagrin to some partners (especially at the slow service where it was almost guaranteed that the next transport would be a return trip for the patient we just brought to dialysis). I think this is one of the biggest benefits of disposable sheets. Regardless of whether the patient laid on the sheets or was draw sheeted over on facility sheets, the disposable sheet covering the gurney would be destroyed all the same, thus necessitating replacement.

Just as important, is it really that hard to simply do your (generic "you") job properly? It takes, what, 30 seconds to replace sheets?

Change the sheets, every patient, every time, even if I end up transporting a patient on the facility's sheets.

To stop and help or not? To stop to keep idiots from making a situation worse or not? It all depends. To counter a "Stop to stop idiots from moving a patient" argument with a situation where no spinal precaution would be taken due to an imminent environmental threat is a straw man argument.

As with everything, the ultimate answer is "it depends." Stopping at an accident in the middle of Los Angeles is a different decision than stopping at an accident on the 15 in the middle of the Mojave Desert on the way to Vegas. Similarly, there's a difference between making your way halfway through a stadium and walking 3 rows back. Similarly, there's a difference between treating a patient without BSI who's a bloody mess and checking a pulse on a patient who collapsed and starting compressions (and that 3-4 minutes for the ambulance to be notified and respond is important). To further make a comment on the BSI front, I swear, EMS providers makes themselves sound like they all have a case of SCID and live in a bubble.

To treat all situations the same is the height of stupidity.

If it comes down to leaving him under a burning car or holding c-spine, get him out from under the car. C-spine injuries are not nearly as common as they are made out to be in EMT class. Most people do not end up with broken necks.

You mean the spinal column isn't weaker than a piece of uncooked spaghetti?

And of course there is the EMT Oath and Code from National Registry:

http://www.naemt.org...us/emtoath.aspx

I never took an oath when I became certified and licensed as an EMT. Furthermore, oaths are more like guidelines, or else things like surgery or palliative care would be off the table (taking the Hippocratic Oath's requirement to 'do no harm' to stupid extreme).

RIP.

Those Paramedics are absolute fucking retards, demonstrate piss poor medical knowledge and generally embarass themselves.

...and here I was trying to be somewhat polite about it.

I find it inappropriate that the court would focus on a scribbled note instead of the PCR. Is a scribbled note now a legal document that can override the validity of the PCR?

What will they use next, vital signs off the back of a soiled glove?

Was the scribbled note the information written on the teletype printout?

I didn't watch all of it, and to be honest got to the point where I wanted to throw something at my computer because of issues I'm probably being over sensitive about. Like not being able to define "BVM" (No, the definition is not "ambu bag"), calling asystole "flatline" (really, you're not the general public, you don't get to use lay terminology), and other similar word choice that is entirely inappropriate for a professional giving testimony in a courthouse.

Incredible! I'd love to see a version with PCP in place of EMT and ACP in place of Paramedic so I can share it with Canadian paramedic friends who don't frequent US-based EMS forums.

Easy enough to do...

http://emtmedicalstudent.files.wordpress.com/2011/10/ems-matrix-canadian.jpg

Is this guy better?

Actually, I should have used either of these two guys...

Ok, technically Rory is a nurse, but who's counting?

http://emtmedicalstudent.wordpress.com/2011/08/11/how-ems-providers-view-each-other/

If I started working on an ambulance now, I'd use a modified SOAP format while maintaining the classic SOAP formatting (i.e. not shove it all into one continuous paragraph).

http://emtmedicalstu...ing-pre-soaped/

As healthcare professionals in the hospital we are expected to identify ourselves to our patients. Ethically it is part of a provider-patient relationship. Why should EMS be any different, especially if they want to be viewed as healthcare professionals? Patients and families threaten hospital staff all of the time, why would it be any different in the field?

...because, as a whole, EMS providers generally want the respect of being a healthcare professional without the actual work. There are too many (and I don't view EMS forums as representative of the average EMS population) providers who don't want the education, liability (oh, we'll just call medical control and make them liable for our (in)action), or ethical responsibilities that comes with being an actual professional.

Someone translate the alphabet soup of EMTATA?

EMTALA: Emergency Medical Treatment and Active Labor Act. The gist is that every patient who presents to the ED requesting assistance must receive a medical screening exam, and if a life threatening condition or active labor is present, the patient must be stabilized to the best of the hospital's ability, and if specialty care is needed beyond the scope of the hospital, only then can the patient be transferred. This is all without regard to the patient's ability to pay.

If someone, especially the patient, wants access to your name, they're going to get it. Is it on the patient care report?

Would you go to a physician who wouldn't let you know what their last name was? If you had a complaint about a nurse in a hospital, would you not expect to know what their name was? How much of this is public record anyways, with varying amounts of difficulty to obtain? The fact is, if I really wanted to know the name of someone who showed up on scene, there are more than enough ways to find out. Hence, hiding a surname is really more of a false sense of security.

I agree that it's highly unlikely that Congress or State legislatures are going to submit amendments that change any of the Bill of Rights amendments. However, it's still an option and constitutional amendments overrule the SCOTUS. Similarly, Heller and McDonald decisions are extremely narrow rulings. However, just because it's unlikely doesn't mean he can't call for it. Should the people who gather at one of the local intersections protesting Iraq and Afghanistan simply leave because it's highly unlikely that Congress or Obama is going to pull the troops out?

Since you seem to have such a huge problem with the U.S. constitution and it's Bill of Rights, may I suggest that you locate your nearest national borders and then use your freedom of choice to step across one of them?

I hate this line of reasoning. What if he wants to avail himself to Article 5 of the constitution?

I know in NYS, all firearms must be stored in a locked safe and unloaded. Having it under the pillow is a fine in NYS... Glad to see everyone is alright... Of course this is all conjecture...

Source? Because I'm not finding the "by law, guns must be locked up" bit in the NYS penal code.

http://ypdcrime.com/penal.law/article265.htm

http://www.click2houston.com/news/24092915/detail.html

I guess this 15 and 12 year old should have just called the police and prayed to God that the burglars didn't want to do anything to them, right? After all, who in their right mind would teach their children to safely operate an evil black rifle?