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Somehow I've become the go-to site for information on the EMS Narrative Report. I'm very much OK with that. I believe that the Narrative Report and the EMS Report is the most important information-sharing tool for the Paramedic or EMT.
Here are some of the things I've written concerning the EMS Narrative Report, and for EMS Charting general.
Soapy Pictures – The EMS Narrative Report
This article is about the evolution of my narrative style, and shows how I went from just writing something into actually charting about the patient in the best way that I can. It shows how I fuse the "Chronological Narrative" reporting style with "SOAP Charting" (using the SOAP method to write the EMS narrative) – There's a lot of tips in here.
More on EMS narrative reporting
This article is a more in-depth "nuts and bolts" how-to guide for the paramedic or EMT to use in designing their narrative reporting style. I emphasize how to properly place information and how to share it with the user of the information. Emphasis is placed on using the SOAP charting method.
Six Tricks You Can Use Today to Improve your EMS Narrative Report
Don't have time to read due to your call volume? Use these tips and tricks as a quick tutorial and begin writing professional EMS narrative Reports today. Whether you're a paramedic or an EMT, these tips will have you writing your ambulance run sheet like a pro.
For more information, please read the above information on the EMS narrative report, SOAP charting, EMS Charting, and EMS Patient Care Reports.
I found a site that caught my eye the other day and signed up for it. It’s called EMSLive.com, and no, they’re not paying me to write about it. I posted some articles there and I think that I’ll post anything that I’m particularly proud of on that site so it gets more exposure. I posted The Shine Factor there today. Let’s see if anyone reads it. Oh, and THIS LINK RIGHT HERE may be my favorite comic strip ever. Thanks to Dave Barry and the Miami Herald, and of course, Calvin and Hobbes.
Tonight I would like to take a few moments to hit on what is one of my top-ten all-time use-a-lot-of-dashes-in-between pet-peeves in EMS and probably in health care in general. It’s the “DNT” or “Do not Treat” order. It might just as well be called the “DNC” or “Do Not Care” order, or “Do Not Comfort”, or “Do Not Be Humane”, “DNBH” Order. Yes, I’m talking about DNRs here. They’re “Do Not Resuscitate” orders and if you’ve been in EMS for longer than a minute or two you’ve heard about them. DNRs serve a good, humane purpose in a lot of cases. We all know that even though we’re improving (GO CCR!!) CPR and ACLS are largely rituals that we perform for the dead in our society. They rarely bring people back if they happened to be sick enough to die in the first place. They’re also very traumatic things to do to a body. DNR Orders are a humane way for patients and families to say “Enough. When God or whom/whatever I may or may not believe in says it is my time, it is indeed my time”. I can respect that. I happen to be a Christian and I believe that we go to a better place once God decides that it’s time to punch our clocks. If I had a hopelessly terminal disease I would probably be pretty ticked off if some young kid with a shiny new EMT card brought me back to face more of the disease progression with a couple of broken ribs for the trouble. I get it. What I don’t get, and what just drives me crazy is people who treat DNR orders like they’re “DO NOT TREAT THIS PATIENT BECAUSE THEY’RE JUST A DNR” Orders. I know that I will hear this again, and probably tomorrow because I heard it three times today and I’m on a 48hr shift here, but I think that I might say something unkind to the next person that says, “well.. They’re a DNR” when I ask them why they’ve let their patient suffer in agony for hours before they decided to send them to the ER. Yes, I um… occasionally go to “Skilled Nursing Facilities”, can you tell? Here’s what a DNR order does NOT mean:
Don’t think that I’m just picking on the nursing homes here.
I once had a transport where I took a young infant with a horrible medical condition from a small ER to a tertiary Childrens’ Hospital. (A different one from the one in a previous post). This poor little baby was now living with a set of very nice foster parents but just didn’t seem to have much chance in the world due to his/her terrible start in life. The child was on oxygen, needed regular suctioning, and was being sent to this tertiary facility to replace his/her feeding tube, which had become dislodged. Because of that, the patient was having some increased breathing difficulty and was actually pretty challenging to take care of for the hour long transport. The foster mother had brought the baby into the pediatrician’s office for this condition, and the pediatrician had set up the direct admit to the tertiary facility after sending the kid to the ER close to his office.
The foster mother was a very nice lady who seemed genuinely concerned and caring about the kid. I asked her why if the kid was in that bad of shape did she not call 911. Her answer? “I thought I couldn’t call 911 because he has a DNR order”. Someone, and I don’t know whom… but someone had told this wonderful foster mother that this child was NOT WORTH EMERGENCY CARE because he had a DNR order! Yea, not in so many words I don’t think… but that’s the general idea she had. I corrected it. Told her to call 911 whenever she felt she needed to and let her know that the ambulance crew where she lived would love to come visit her to learn about and help take care of the child. I cannot believe that someone would lead a person to believe that… I just can’t.
Oh, and yes, today I had a SNF patient that fit my whole DNR/DNT pet peeve thing… and yes, an ER staff person may or may not have given the “Just a DNR” comment. In fact the whole healthcare system may have failed someone today that chose to have a DNR order and neither he/she nor his/her family knew about it. But I did, and I fixed it.
And I just ranted about it.
Someday soon I may turn this blog post into a coherent article, got any rants you’d like to post? I like comments. As always: ProEMS1@yahoo.com
Some time ago I was working a shift in a clinic on a particularly busy day when I had a few moments to sit down, have a cup of coffee, and talk with my coworkers. It was the usual stuff, talk about the day, tidbits about personal lives, and since most of the people I was working with were women, talk about things that I didn’t really need to hear about. After a few minutes we all had to get back up and head back onto the floor to keep up with the constant tide of flu-season sniffles.
It was all pretty mundane for me until the doc that we were working with who hadn’t been there much before, made a statement. As we were walking out, he said “Man, I really hate this! This isn’t my love, it’s not my passion!” I was taken aback. I asked him what he meant. He went on to say that he really wanted to be a concert pianist and that he only did medicine now because he didn’t know how to do anything else.
Now, I’m not you… but even though this guy was a pretty good Doctor, I immediately felt sorry for all of the patients that day. I mean, would you want this guy to be your doctor? Who in their right mind would want someone who hated taking care of you taking care of you?
It did, however, get me to thinking… Is that where we are in EMS today? I mean our profession. The profession of EMS, our careers and our industry. Are we made up of people like this doctor? Now during the day that I worked with him, he never made any egregious errors in patient care, nor did I see him do anything illegal, immoral, or fattening. However, if providers aren’t *in* to providing to care, would you want to have them providing care to you or your family? What about your service? Sure, we all know providers who love EMS, love their patients, and can’t wait to take care of any patient that calls for their help, but while I would hope that they are the majority… are they?
EMS is a profession in its infancy, we’ve only been around since sideburns were popular, but in that time we’ve gone from dedicated but untrained people rocketing around in hearses to professional providers practicing curbside critical care. It’s a great profession to be in and I’m proud to be a part of it. As a group we’re a pretty dynamic fast paced lot. I would like to ask our group though, do we have the love of providing care to the breadth of society who call us when they think that the life or health of their themselves or their loved ones are in danger? Or have we fallen short of the lofty goals set forth by Johnny and Roy?
Yep, I’m asking a lot of questions here. I just would like to open up a dialogue among the EMS professionals out there. Ask yourselves if the EMS providers in your area are advancing the profession of EMS to the place where you think it should be heading. Ask yourselves if you work with people who have the love of the profession enough so that if they were strangers and you were a patient would you want them making decisions about your life? I think that it’s high time that EMS is taken over by EMS professionals who care about advancing our profession into the future, not by people who don’t care enough to understand the vast array of issues that face our industry today. I would like EMS people to take ownership and drive our industry where we believe it should go. It’s our profession, and our responsibility to strengthen our service to meet the challenges that are facing our communities. And that responsibility starts with you, the individual EMS provider.
You, as a caring EMS professional actually have the tools to do this. First off, realize that EMS is a profession all its own, truly a dynamic industry that has earned a place in the very fabric of country. Think about it, our generation and the generations to come have grown up with the notion of 911. They know that when the unthinkable happens, all they have to do is call the magic three numbers and someone will come and help them. It’s a powerful piece of the American psyche that people rarely give second thought to… but they all know what they’re going to do the next time they find Grandpa unresponsive. I think that if EMS ceased to exist (and contrary to what it may look like from the dashboard of your ambulance some days, it’s not all that likely) our society would look a lot different than it does now. People need to have the notion of EMS. And make no mistake, we’re darn privileged to have the role in society that we do. It is, however, up to us to awaken the public to what it is that we do, to educate ourselves to our own potential, and to show the medical establishment what we’re capable of. Ask yourself, really ask, if you want some other group to decide where we’re going for us, oh… say like the nurses’ lobby, or the IAFF, or the DOT, or the (insert non-EMS acronym here). You are sitting right now in an industry on the cusp of a watershed change, and it’s up to you to take ownership and steer EMS where you want it to go.
Here’s what I’m doing, and what I would like to suggest to you all. First, recognize that EMS is indeed a profession; and a good one at that. Second, evangelize EMS to all you meet. You can’t complain about the system abusers (or worse, the people who truly need us and yet don’t call us) if you aren’t out there educating them about what we’re here for. Third, realize that “PR Saves lives” and make sure that the information out there about EMS in your community is projecting the message that you think it should, and if it isn’t, write something up and get the word out to change that. Talk with everyone you can and let them know just what it is that we do, who we are, and what we’re capable of. Take ownership of EMS, because if we don’t, someone else out there will.
As always, post publicly if you want public discussion, or contact me at: ProEMS1@yahoo.com
So the other day I was taking this cute little 9 month old to a tertiary specialty childrens’ hospital. It was a nice place, big, clean, bright, state of the art equipment, people scurrying about looking busy, cute nurses, etc.. It was a class act. The patient was stable and quite pleasant actually. We had been playing in the back for the last hour to the extent that a 9 month old can play while in a papoose restraint. Yes, he was papoosed, but only because he had a fractured femur and needed the tight immobilization. I happen to like kids thankyouverymuch.
What got me about this is that when I got the patient into the ER room, a bunch of slightly older kids walked in wearing scrubs. My first thought was that they had a new crop of ED techs that were in training… however, much to my horror they identified themselves as surgical residents. Oops. Looks like the last ten years or so that I spent driving fast and breaking things could have been spent in a cramped room looking at books and developing my student loan debt. It got me to thinking that if new doctors were starting to look young, and if I was starting to feel grandfatherly in the ambulance, maybe I should consider advancing my career.
The problem with this is that I’m an EMS addict. Really. No I don’t have 25 warning lights in my personal vehicle and my physique is free from star-of-life tattoos… But I just have always liked getting up every morning and being plum lucky enough to be a paramedic. I can’t imagine doing anything else for a living. It has struck me that whenever I hear coworkers talk about career advancement it usually involves leaving the streets and taking time away from patient care. If you’re on the fire side, you can become a lieutenant or captain and get off the “box” away from the “gomers”, or if you’re not you can become a nurse and increase your income while diminishing your clinical decision making skills (Yes, I pick on most nurses here). However, I’ve been thinking about what I could do to “advance” my career while feeding my addiction to making sick people feel better in the way that only medics can.
So here it is, after a shift or two of kicking it around, I have decided to decrease the amount of my time that I used to spend sitting around on duty watching Internet videos of people hurting themselves and looking up pictures of cats with funny captions (Yes, I’m more of a man because I love my fluffy-wuffy lil’ Kitty-Witty) and spend some time writing useful tidbits of ambulance crap that I have garnered through the last ten years or so of riding under the lights and being smacked around by what the streets have served me up. What follows on this blog is one of my first pieces for the enjoyment of a wide audience. If you like it, I’d love feedback here or at: proems1@yahoo.com.
Oh, and for the web crawlers: Paramedic, Firefighter, EMT, Boobies, ambulance, fire, medic, EMS.
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