BLS report requirements on ALS calls

[Ridryder 911]

In my EMS both are required to sign for the run report. You have a primary and secondar medic, no matter what the level you are. Yes, whomever was the primary does the paperwork, of additonal coments can be made.

R/R 911

[nsmedic393]

We have what we call continuation forms. The patient info is entered at the top and most of the page is just blank lines. If I think someone has something to add. Or I have something to add to someone elses call, we fill out a continuation.

[Ace844]

now, should medics be doing charts for patients they let their Basic take?

This is even more important than when it happens the other way...The litigous risks & responsibility die to training, ed, and scope are much larger..as always CYA!!!!

[SingleLovingLife]

As an EMT with a VFD I may or may not arrive on scence prior to ALS. We are required to document what we find and what we do. Our PCR's ask for outcome of the patient - did we turn care over to another service - if so who, where did they transport to, etc. If we are first on scene, we document as if we are in charge of the scene - because until ALS arrives we are. If we arrive on scene AFTER ALS, then we document what we found and what we did, if anything. If a member of the ALS team asks me to check a BGL while they start an IV, then I document that I did the BGL and what the results were. Since I'm not starting the IV, I do not attempt to document specifics of it, except to say ALS started an IV. If I assist the ALS crew by riding to the hospital with them, then I document what I did during the ride (CPR, BVM, monitoring of vitals, etc.) By its very definition, BLS documentation may not be as extensive, because we are not performing as many skills as ALS. As long as your documentation is accurate and you state at what point you turned care over to ALS - that should suffice.

[strippel]

It has always been state law here, each vehicle (and crew) on scene has to write a PCR. Back in the old days, BLS was volunteer, and ALS was hospital based. Each wrote their own PCR. Obviously, the BLS providers did not write any ALS skills, only documented something like "ALS care provided by Medic 2", then wrote what they found, and their care provided..

There are sometimes we have an ALS unit, BLS unit, and a fire department (state licensed) "quick response unit". In that case, 3 different PCRs are generated, one for each service.

There was one volunteer service that decided to start their own ALS. Due to still having volunteers, the medic was given an SUV, both responded to ALS dispatched calls. The volunteers did not like writing PCRs, so they decided not to, since THEIR medic had to write one anyway. So they didn't. First, the billing company got upset, and tried explaining that they needed to produce 2 PCRs. One for the ALS services provided (different vehicle, additional crew member), and one for the BLS transporting volunteer ambulance. The volunteers did not like this, so many boycotted writing PCRs. "That is why we have the paid medic", they argued.

After a while, the billing service convinced the manager that 2 PCRs were needed. So the manager convinced the volunteers to write a PCR. BLS PCR consisted of times, patient name and demographics, and "see ALS chart". Billing company was still upset, but... Finally, the regional council saw "missing" PCRs, and way to many with "see ALS chart". A nasty letter was sent, and now a PCR is written for each.

Bottom line, unless your ALS provider belongs to your ambulance association, fire department, or rescue squad, you need to create your own PCR. If you bill, or not. If your ALS provider is your own, check with the DOH.

[ebemt]

Ok now i've learned this through experience that BLS should not write up ALS procedures. I accidentally stated the pt received 1 nitro on a call report when they really were given 2 by ALS. In New Jersey, or at least the two squads i'm on we simply write " Medic work-up" in the narrative. We leave it at that just to keep things clear and cover our asses.