# What do you say in a patch to the hospital?



## sbp7993 (Jun 16, 2010)

Everybody has a different way of patching to the hospital. What do you include in your patch, and in what order?


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## Stephanie. (Jun 16, 2010)

I usually tell them something along the lines of the following:


Who I am.
Ask them if they can read me.
Pt age and gender
Pt chief complaint and any pertinent medical history, including vitals.
My treatments.
ETA
If they have any questions.


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## lightsandsirens5 (Jun 16, 2010)

Here is a patch from a recent call:

"Mt Carmel hospital this is 805."

_Wait for reply_

"Good afternoon Mt. Carmel. 805 is currently inbound ten out with a 21 year old male c/o nausea and vomiting for the past few hours. He is complaining of dizzyness when standing and almost passed out when we assisted him to stand. Pt stated he has not eaten in the past few days and has drunk almost no water in the past two.

Current vitals are a B/P of 150/96, pulse of 120, respirations about 14-16, Spo2 is 100 on 4 liters by a cannula, bgl is 155, we have the pt on a 3 lead showing a sinus tach, IV with bloods drawn, running fluid (I dont remeber what kind)

Any questions?"

_If no questions ER clears air_

"805 clear."


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## firecoins (Jun 16, 2010)

I ususally patch the hospital with cement.  Fills the holes up quickly.


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## MSDeltaFlt (Jun 16, 2010)

One thing about radio reports, brevity is key. You really give 2 reports on 911 call. 

1. Radio report. Short, sweet, and to the point.
2. Bedside report. Detailed.

Dont confuse the two. Remember that when you're transmitting on the radio, you are the ONLY one who is able to talk on that frequency at that particular time. Translation, if somebody else has a real critical pt, they have to wait until you are finished in order to give their report as well. Get on. Get off. It's that simple.

-On your salutation, state to whom you are calling then who you are. In that order. It's etiquette.
-Ask if they are ready for a report.
-When they are, give them your ETA.
-Age, gender of pt.
-Chief complaint. (keep it brief)
-Assesment findings (keep it brief)
-What you did to the pt (keep it brief)
-If you're still working on stuff, tell them that as well. They may need to prepare in case you don't get it.
-Ask if they need any further info.
-If none needed, state you're finished and get off the radio.

Here's an example of how I do it.

"So and so medical center, this is Delta18"
"Go ahead"
"Yes ma'am(sir) 15 mins out with 18 yo male unrestrained driver of head on MVC with heavy front end damage. No airbag deployment. Chief complaint: chest pain, shortness of breath.  No loss of consciousness.
Trachea midline. breath sounds clear.
150/80, sinus at 112 (Saying "tach" is futile. They know it's fast. Plus by saying it's sinus they know you have him on the monitor), 24 and unlabored (They know it's RR because you said "unlabored"), 88 on room air, 96 on nonrebreather. (Liter flow is moot)
Full C-spine restrictions (I say "pt's packaged")
Got one line, working on a 2nd. (They don't need to know how big or what flavor, where, or even how fast. You'll show them at the bedside)
No further. (Saying "no further" is saying I'm done talking so someone else can talk)

That's one way. There are several others.

If you give a med that requires an IV normally, it's usually a foregone conclusion with my care that I started an IV then gave the med.

If they're hypotensive and I give them a bolus, they know I had to give it through an IV.

Tranfers are even more brief.
"So and so medical center, unit 31"
"Go ahead"
"20 min out with a transfer from yonder county hospital of 57 yo male pt with this Dx. You aware of this pt?"
"Yes we are"
"No change in pt condition (if there is no change). See you in 20"

Most ER's start ignoring long and detailed radio reports, from my experience. Also, those who try to sound important often don't.


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## NomadicMedic (Jun 16, 2010)

How long and detailed the patch is depends on where I'm going and what I'm bringing.

Some hospitals only want a 15 second down and dirty. Others want to know EVERYTHING!

Ask the charge nurse what he or she would like in a radio report. Also, many of the EDs have a form they fill out when they answer the radio. Grab a copy of that and give your report in that order. The Charge at one hospital liked that I did it that way and she asked if I could have some of the other crews follow that format. 

Find out how they want it at YOUR local hospitals.


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## SD_EMT (Jun 16, 2010)

Hail the ER, then..

age
sex
C/C

Hx of C/C
Medical Hx
Alergies
Meds

Depending on trauma, or medical, your vitals in the form of

P    B
R    R
O    I
B    M
E    C
L    A
L    C
S    B/P
      Pulse 

Secondary assessment
Rx
ETA


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## JPINFV (Jun 16, 2010)

Radio entry report:

Age, sex CC, *immediately pertinent* information (history, exam findings, etc), ETA. 

Pertinent would be something like pain scale of a chest or abd pain patient. Grossly abnormal V/S (yes, a BP of 140/80 is hypertensive. No, not to the level of radio report importance).

Here's an thread with comments from the people taking the report:

http://forums.studentdoctor.net/showthread.php?t=323003


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## EMT012 (Jun 16, 2010)

Here's our general rundown:


Medic # to Hospital
Enroute with a ____ yo M/F 
Chief Complaint
Vitals
What you did for Pt
ETA
Questions?

Course it depends on two things 1. Your companies protocals for reporting, 2. Your Hospitals requirements from EMS for reporting while enroute.


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## trevor1189 (Jun 16, 2010)

Hospital X this is trevor1189 on BLS ambulance 1 with a patient a report...

go ahead...

Currently enroute to your facility with a class two 50 year old female complaining of vomitting. Blood pressure is 92/50, otherwise vitals are withing normal limits. We are about 8-10 minutes out.

Short and sweet. Giving allergies, medications, past medical history really doesn't change anything they are going to do before I get there so there is no point in telling that over the phone (med radios really don't get used where I live).


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## medicRob (Jun 17, 2010)

I just say "Haaaaaaaay!".

j/k

I usually call in to receiving hospital with pretty much the same info EMT012 posted. 

Medic # here, to Receiving Hospital

[Receiving hospital: Medic #, Go ahead]
We are en route with [age] [sex] 
complaining of: [chief complaint]

Pertinent Vitals (I usually only give BP over the radio if WNL)
Pertinent Interventions (I tell them the big stuff such as did we intubate, meds given, etc... also, I give them any pertinent responses to those treatments, such as pt still experiencing chest pain after 3 sprays nitro, etc). 

We are ____ minutes out.     

over.


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## Akulahawk (Jun 17, 2010)

I typically do what MSDeltaFlt does (pretty similar) or I'll follow whatever the County EMS Agency mandates for a radio report. I do keep it pretty brief. One thing I usually put in there is what protocol I'm following, if I'm short on time and much to do. That way they at least have an idea about what I'm doing and what might yet need to be done. If I'm not in a time crunch, I'll put in what I've done so far. 

I try to be off the air in 30 seconds or less, if I can. They don't need the full story, they need to know basically what's coming in and how soon so that they can assign an appropriate bed/room. As has been said before, the bedside report is MUCH more detailed...


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## Aidey (Jun 17, 2010)

I third what MSDeltaFlt and AKulahawk said. 

A typical radio report is like this 



> Me: St Mary's Hospital, Unit 123 code 1 traffic. (1 is stable, 3 is critical)
> 
> St M: This is St Mary's, go ahead 123
> 
> ...



I try and stick with one word descriptions of things, like on a cardiac I may say "IV, O2, Aspirin, Zofran, nitro x 3 with no change". Nitro is really the only medication I routinely say the dose on the air, the only other time I give doses is if the dose is significantly outside of normal, like "Seizure activity stopped after 10 of Ativan and 5 of Versed". 

Like was said above, I don't generally give the route of medication administration because they know how the meds are given and I will cover that in my bedside report. 

On more complicated patients, like strokes or MIs the patches are longer, but that is generally because they need the extra info to determine if they need to activate the stroke/MI team or not. 

Where I work there are multiple hospitals and one radio channel, if you hog the channel with a 2 minute patch you are liable to get your neck wrung by both the charge nurse and your co-workers.


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## MrBrown (Jun 17, 2010)

Our template is 

"This is ___ from Ambulance with a ___ m/d/y old M/F, ___ (chief complaint), ___ (pertinant findings, vital signs (BP/HR/RR/SPO2/GCS/ECG as appropriate), ___ (significant interventions), patient is status 1/2/3 and will be with you in ___ minutes"

- Describe findings and vital signs pertinant for chief compaint only
- Routine treatment e.g. oxygen, IV access, cervical collaring, bleeding control and splinting is not to included.

Eg "this is Brown from Ambulance, five year old male, simple fracture of the right humerus as a result of a fall approx 1 metre, no neurological signs, not knocked out, GCS 15, status three ETA 5 minutes"

... or more appropriately "Yes good morning it's Brown speaking, I am one of the helicopter emergency medical service Doctors, listen mate we're about ten minutes away from you with ....."


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## johnrsemt (Jun 17, 2010)

Indianapolis where I used to work most of the hospitals didn't want anything.  they didn't even care if we were coming.   they always told us to surprise them.   Unless major trauma or CPR in progress or they needed emergent cath.
  Utah where I work now  (and Colorado, where I am TDY for 2 months) every hospital wants to know everything.      in fact on one run, the nurse kept me on the phone for over 23 minutes asking every set of vitals (on a 2 hour transport, with 2 patients).        crazy


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## ceej (Jun 17, 2010)

Short and sweet, our system uses a pretty standardized format for radio reports:

"__ General, __ General Medic 2176 on IHERN"

::Here's the part where maybe they answer you in a timely fashion::

"Good morning/afternoon/evening ___ General this is Medic 2176, we're en route to your location ALS non-emergent with a 21 y/o female c/o abdominal pain x 2 hours pt states diffuse in RLQ. Tenderness noted on palpation, PE otherwise unremarkable. We do have an 18g established in the R AC at a keep open rate with labs drawn and a BGL of 101. Current set of vitals are as follows: BP 108/80, HR 96, RR 20, SP02 99% on 2LPM. Showing sinus on the monitor. We're about 5 minutes out are you requesting anything further?"

::Acknowledge::

"Medic 2176 clear."


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## Akulahawk (Jun 18, 2010)

I've worked in systems with one channel and multiple hospitals and systems that have a trunked radio system with individual talkgroups assigned to each hospital. With the former, you pretty much always have an idea how busy an individual hospital is from the radio reports going to them. You have to listen for your turn though. With the TRS, I never had to wait for my turn, just to wait for the radio to beep...


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## medicdan (Jun 18, 2010)

I have no problem with trauma or arrest notifications, in fact they are quite easy for me "Good Morning BMC, 10 out with 94 y/o BLS arrest, pulseless, apneic, CPR in progress, 2 shocks." or " "Good Morning BMC, 5 out with 36 y/o MVC, struck several times at 40 mph, head, chest, leg injuries, conscious, (-) LOC, 116/80, 104, 22. Packaged, bandaged and on O2. 5 min out, questions?"

What I dislike is hospitals that request a patch for every single patient coming through the door, including direct admits just walking through the ER. These facilities tend to then then ask for details on the report that seem utterly unnecessary. Example, "Good MBH this is BMS BLS 2, coming in with 78 year old female, from SNF with bilateral leg swelling x2 weeks. Vitals stable, 5 min out. Questions?". We are inevitably asked what the patient's respirations are, shoe size and last menstrual cycle.

...Perhaps I bring it on, because I ask for questions...?


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## Stephanie. (Jun 18, 2010)

emt.dan said:


> We are inevitably asked what the patient's respirations are, shoe size and last menstrual cycle.
> 
> ...Perhaps I bring it on, because I ask for questions...?


Would you like fries with that?


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## thegreypilgrim (Jun 18, 2010)

Usually either one of these two general formats:

"St. Nowhere this is XYZ Ambulance en route to shovel more bull**** through your doors."

"Oh God!! There's so much _*blood!!*_" *gunfire*sirens*screaming*silence*

OK actually where I work, the radio reporting is a nightmarish process. We have actual radio systems (which almost no one uses) and we have cell phones (which everyone else uses) to call the hospital so there's really not much of a "patch-in" element to it.

With LA County being the Mother-May-I? system that it is, the hospitals generally want to know _*everything*_ about the patient - sometimes I wonder if I'm going to get questions about the patient's shoe size, whether he/she is right or left handed, results of most current report card, etc. Essentially our radio reports are equivalent to the bedside report...which is incredibly redundant.

Part of the problem, though, is the fact that we have things here called "base hospitals" and every ALS unit in the county is assigned to one of them. So, regardless of where you're geographically located (although the assignments do tend to be based of geography), whoever your assigned base is, that's who you call (unless you've got a trauma patient, in that case you call the trauma center you're going to). You, therefore, may or may not be transporting to your base hospital; and, when you don't the base then calls the receiving facility and gives them the report you just gave the base...kind of dizzying. The major reason for it, however, is the paramedics here tend to be of poor quality, and if the MICN (in California, paramedics talk to nurses for radio reports and medical direction, not physicians) didn't question every last detail of patient care then there's a good chance most of that crap wouldn't get done. Also, you have to really paint a thorough picture of your situation if you want to get cleared for the med orders you want/need because, again, the MICNs like to keep the medics here on a short leash. 

Anyway, our report format goes something like this:

Unit ID
Sequence Number (on the PCR)
Age, Sex, Weight (include Broselow tape measurement for kids)
Chief Complaint
Level of Distress (none, mild, moderate, severe)
GCS (for every patient...:glare
LOC (which is somehow different from GCS to LA hospitals - LA is still hung up on the whole "AOx3" thing though, and if you have someone who's AOx2 I guess they feel knowing whether the pt is disoriented to name, place, or time is somehow significant)
Assessment Findings (detail!)
Vital Signs (BP, P, RR, SpO2%, Pain level, Skins, Pupils, Breath Sounds, ECG)
Field Treatments (you have to _*say*_ "02 at 15 lpm non-rebreather" can't just say "on 02" for example)
Patient Response to Field Treatments
Request(s) for Additional Orders if necessary
Transport Decision
ETA
Clear.

That whole mess is complicated by the fact that 911 EMS is handled by fire departments here, so they're typically the only ones calling in. Meanwhile, there are many private ambulance companies who do ALS IFTs (like where I work), who almost never need to call unless something terrible happened en route. It seems like most MICNs have no idea how the ALS IFT thing works either (and to be fair, I still don't really know how it works) so every time I have to call in I have to explain myself as to why I can't just get standing orders from the sending doc, who the hell I even am, why I'm calling _*them*_ in particular, etc. It's really just a nightmare.


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## ah2388 (Jun 18, 2010)

Im still a student but this is how I give mine...we use cell phones for the most part for example:

Me:Hi this is Adam on medic 8 for a patient report.

Physician:Go ahead

Me:We are coming to you guys with a 57 yo male who called us today for chest pain.  Patient presented sitting upright in a chair with mild DB.  Pt has hx of MI, and received a double bypass 2 years ago.  Pt VS are.....hes on 4L NC, weve given 4x Baby Aspirin, 3x NTG spray, 2mg MS and have an IV established.  12 lead shows elevation in leads xxxxxx without a BBB, weve faxed it to you all.  We are approx 12 minutes out, and we arent requesting anything at this time.  Any Questions?

Physician: xxxxx

Me: Clear


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## Akulahawk (Jun 19, 2010)

thegreypilgrim said:


> That whole mess is complicated by the fact that 911 EMS is handled by fire departments here, so they're typically the only ones calling in. Meanwhile, there are many private ambulance companies who do ALS IFTs (like where I work), who almost never need to call unless something terrible happened en route. It seems like most MICNs have no idea how the ALS IFT thing works either (and to be fair, I still don't really know how it works) so every time I have to call in I have to explain myself as to why I can't just get standing orders from the sending doc, who the hell I even am, why I'm calling _*them*_ in particular, etc. It's really just a nightmare.


About the ALS-IFT thing, here in Sacramento, if an ambulance entity can enter into an agreement with the EMS agency to go to entirely off-line medical direction for non-911/scene calls. What does that mean operationally? The protocol book has delineated points where a medic MUST call a base hospital for the OK to proceed beyond that certain point in a given protocol. Thus, you have "on-line" medical control, and there's a couple different versions of how/where you can have OLMC. Off-line means you don't have to contact any medical control, and the entire manual is open to the paramedic to use.


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## 1badassEMT-I (Jun 20, 2010)

Amazing pretty much everybody is the same.

WV we report to Regional Commands Centers not directly to the hospital RC report us coming in to the hospital. They also give us our orders from the MCP which is the ER doctor if we request orders to administer a med that a MCP must approve. Here is how I give my report:

Regional Command General 643

Wait for response from RC

I always ask how copy?

I give my Name and Cert number what hospital we are in route to and ETA.

Pt. age and CC 
History meds and allergies
Pt condition at this time VITALS, my treatments (IV, O2, Monitor, and meds  I have already administer per protocol)
Ask for meds if I need additional meds the are MCP approved
Update time to hospital.
Clear the radio.


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## 1badassEMT-I (Jun 20, 2010)

Akulahawk said:


> About the ALS-IFT thing, here in Sacramento, if an ambulance entity can enter into an agreement with the EMS agency to go to entirely off-line medical direction for non-911/scene calls. What does that mean operationally? The protocol book has delineated points where a medic MUST call a base hospital for the OK to proceed beyond that certain point in a given protocol. Thus, you have "on-line" medical control, and there's a couple different versions of how/where you can have OLMC. Off-line means you don't have to contact any medical control, and the entire manual is open to the paramedic to use.



You should look at our protocols......in WV.....I can give morephine but am not allowed to push Zofran.....I get give you something for the pain but cant give you something to keep from getting sick from it....GO figure that!


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## Akulahawk (Jun 20, 2010)

1badassEMT-I said:


> You should look at our protocols......in WV.....I can give morphine but am not allowed to push Zofran.....I get give you something for the pain but cant give you something to keep from getting sick from it....GO figure that!


Sometimes, they just don't make much sense unless you've been around a long time. Then things often _really_ don't make sense.  Perhaps they've not had much experience with I's giving anti-emetics or perhaps they've seen a couple goofs with it so they want some positive control over the process.

At least you _have_ the option of anti-emetics... The best I could do is Benadry... if I can get an order for it. :wacko:


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## 1badassEMT-I (Jun 21, 2010)

Akulahawk said:


> Sometimes, they just don't make much sense unless you've been around a long time. Then things often _really_ don't make sense.  Perhaps they've not had much experience with I's giving anti-emetics or perhaps they've seen a couple goofs with it so they want some positive control over the process.
> 
> At least you _have_ the option of anti-emetics... The best I could do is Benadry... if I can get an order for it. :wacko:



I been in this for 22 years several states but WV makes no sense when it comes to protocols of this nature....


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