# X3 or X4



## MedicPrincess (Jun 21, 2006)

So which is it?  Are is it A&Ox3 or X4?  I thought it was X4...person, place, time, events....but fire around here always says X3, and I keep wondering we have a patient with a potential decreased LOC...

So does it matter or is it six of one half dozen of another?


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## DT4EMS (Jun 21, 2006)

EMTPrincess said:
			
		

> So which is it?  Are is it A&Ox3 or X4?  I thought it was X4...person, place, time, events....but fire around here always says X3, and I keep wondering we have a patient with a potential decreased LOC...
> 
> So does it matter or is it six of one half dozen of another?



Doesn't really matter. Just depends on how a person was taught. X4 may help if it was a trauma to check for event amnesia. It isn't uncommon for a person who was rendered unconscious to not be able to recall the event.

The events usually get covered in SAMPLE under the "E" for events prior.


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## Jon (Jun 21, 2006)

I do x4... if I specify anything else, I note it as CAOx3 (Person, place, time, not oriented to event).


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## rescuecpt (Jun 21, 2006)

Both, depending.    Either works just as well... if they only have 2/3 or 2/4, either way, they're not necessarily A&O...

And, what does the "A" stand for?  In some places it's Alert.... others it's Awake...


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## MMiz (Jun 21, 2006)

What is fourth assessment on AOx4?


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## MedicPrincess (Jun 21, 2006)

Person, Place, Time, and Events...


I was asking b/c my partner has kind of a "Form Narrative" for our reports she wants me to use.  She has CAOX4 in there.  On of the FD's yesterday had A&O3 on their pt info sheet they give us.  

But when I was with the FD, in our First Responder course, we learned X3....dunno....dang firefighters....always messing me up!


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## gradygirl (Jun 21, 2006)

We always evaluate CAOx4 to person, place, time, and event.

When the ambulances arrive, the medics typically ask the pts. all sorts of other questions such as phone #, SSN, name of the president (I've heard some incredible responses to this question), etc.


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## DT4EMS (Jun 21, 2006)

If we want to get technical, attorneys have argued about using things like AAOX3 and MAEX4. It can be argued...."Did he move one extremity four tiimes?" or "Did you ask him the same question 3 times?" etc.

It is always better to avoid abbreviations in any report. It is all good until you have to go to court.


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## MMiz (Jun 23, 2006)

DT4EMS said:
			
		

> If we want to get technical, attorneys have argued about using things like AAOX3 and MAEX4. It can be argued...."Did he move one extremity four tiimes?" or "Did you ask him the same question 3 times?" etc.
> 
> It is always better to avoid abbreviations in any report. It is all good until you have to go to court.


I think half of the reports would be practically blank then.  I'd hate to go to court.  I don't remember most of my patients or calls.  They all seem to blend together.  I can't leave my paperwork for the end of the shift as I tend to forget a lot of stuff.  They always say "If it isn't written down then you didn't do it," which would especially be the case for me.


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## bowhkr (Jun 23, 2006)

I do C/A/Ox4 Person, Place, Date, Event


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## Flight-LP (Jun 23, 2006)

DT4EMS said:
			
		

> If we want to get technical, attorneys have argued about using things like AAOX3 and MAEX4. It can be argued...."Did he move one extremity four tiimes?" or "Did you ask him the same question 3 times?" etc.
> 
> It is always better to avoid abbreviations in any report. It is all good until you have to go to court.



You beat me to it. Do not abbreviate, write it out. Believe me, it will bite you in the *** eventually..............


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## DT4EMS (Jun 25, 2006)

Flight-LP said:
			
		

> You beat me to it. Do not abbreviate, write it out. Believe me, it will bite you in the *** eventually..............




Finally Lady Luck has smiled on me!!


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## Guardian (Jun 25, 2006)

DT4EMS said:
			
		

> If we want to get technical, attorneys have argued about using things like AAOX3 and MAEX4. It can be argued...."Did he move one extremity four tiimes?" or "Did you ask him the same question 3 times?" etc.
> 
> It is always better to avoid abbreviations in any report. It is all good until you have to go to court.




My reports would be way to long without these abbreviations.  If some attorney asked me about the extremity moving four times or same question 3 times, i would say, no sir, if you look in any paramedic textbook or various other medical sources, you would find that AAOX3 simply meant awake and oriented to person, place and time.  And if he could some how twist that around against me, then god help our legal system.


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## DT4EMS (Jun 25, 2006)

Guardian said:
			
		

> My reports would be way to long without these abbreviations.  If some attorney asked me about the extremity moving four times or same question 3 times, i would say, no sir, if you look in any paramedic textbook or various other medical sources, you would find that AAOX3 simply meant awake and oriented to person, place and time.  And if he could some how twist that around against me, then god help our legal system.



Good luck.


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## Guardian (Jun 25, 2006)

DT4EMS said:
			
		

> Good luck.




I really think this is a problem with our legal system and not us and we should not have to waste time and write everything out in a ridiculous way to avoid be harassed by some low life scum sucking lawyer looking to make money.  Lawyers will always be able to find something wrong with our PPCR.  It is our job to stand up to them.  If you didn't document it, you didn't do it.  This is what i hear all the time.  Next thing you know, one of us will be working a cardiac arrest and we will document the hell out of it and explain our treatment in pain staking detail and then some idiot lawyer will say "why did you drag the pt instead of using the stretcher because we didn't document it.  And so we will start documenting when we use the stretcher and then there will be something else that comes up and it will never stop until we start standing up for ourselves.


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## DT4EMS (Jun 25, 2006)

Guardian said:
			
		

> I really think this is a problem with our legal system and not us and we should not have to waste time and write everything out in a ridiculous way to avoid be harassed by some low life scum sucking lawyer looking to make money.  Lawyers will always be able to find something wrong with our PPCR.  It is our job to stand up to them.  If you didn't document it, you didn't do it.  This is what i hear all the time.  Next thing you know, one of us will be working a cardiac arrest and we will document the hell out of it and explain our treatment in pain staking detail and then some idiot lawyer will say "why did you drag the pt instead of using the stretcher because we didn't document it.  And so we will start documenting when we use the stretcher and then there will be something else that comes up and it will never stop until we start standing up for ourselves.



Belive me I feel your pain. I hate paperwork as much as the next guy, but it is a reality. Most of our common abbreviations have even been removed from the in-hospital setting becasue of too many medication errors.

The first time you testify,(and you did everything right on scene) it will change your whole perspective on how you write a report. No matter how well you write a report, it can be picked apart. The difference is the majority and what the jury believes. If the attorney "shows" the jury that everyone else(true or not) has removed abbreviations from reports, but you or your service have not, it appears like you don't care about keeping up with standards.

You and I both know that is not true, or you wouldn't be posting on an EMS forum but if it takes a couple more minutes to write out a report to save face on the witness stand...... I will write a longer report.


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## fm_emt (Jun 25, 2006)

DT4EMS said:
			
		

> The first time you testify,(and you did everything right on scene) it will change your whole perspective on how you write a report. No matter how well you write a report, it can be picked apart. The difference is the majority and what the jury believes. If the attorney "shows" the jury that everyone else(true or not) has removed abbreviations from reports, but you or your service have not, it appears like you don't care about keeping up with standards.



Our county has a list of approved abbreviations. Anything on the list is not allowed. 

Too many damn lawyers!


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## DT4EMS (Jun 25, 2006)

fm_emt said:
			
		

> Our county has a list of approved abbreviations. Anything on the list is not allowed.
> 
> Too many damn lawyers!



Ditto!!! You got that right!!


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## rhan101277 (Aug 22, 2008)

At what point during the assessment do you ask these questions?  Do you ask them on every run?  If pt. has no obvious injuries but still wants to be transported do you feel silly asking them.  Do you ask them during routine transports, that are not 911 calls?

I also wonder that during hectic scenes, when people are hurt really bad.  You start asking, What's your name? Do you know where you are? What time is it? etc.  Does morning, afternoon, nigh-time count as passing answers?  I just don't see most people being able to fire off, yeah its 7:30 at night/PM etc.


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## MedicPrincess (Aug 22, 2008)

Normally you won't just go firing off a list of preplanned questions to determine CAO level with every patient.  It's part of your patient assessment technique.  Everyone will approach their initial pt assessment a little different..... unlike the check sheet in school.

Eventually you will get to all of the questions.  When you approach your patient and introduce yourself, normally they will tell you your name.

Alert to Name

As you ask them what they called you for, where are they hurting, or whatever.....and they answer you back...

Alert to Events

See what I'm saying.  And yes, even on my BS transfers I document CAOx whatever it is, and if there is any negative finding which one(s) they are and if that is their norm.


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## BossyCow (Aug 22, 2008)

We have a small grid in which we write the abbreviation. I teach AOx4. But, in the narrative we write out that the person was alert and oriented to Person, place, time and event, or whichever of the combo applied. Same with the AVPU the abbreviation has to be explained in the narrative.


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## daedalus (Aug 22, 2008)

I was taught AOx4. Person, place, event, and purpose

the last as in "where were you headed in your car before the crash"


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## Ridryder911 (Aug 22, 2008)

Usually it is A/O/x4 = Person, Place, Time & Event.


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## RESQ_5_1 (Aug 24, 2008)

Luckily, on our ePCRs, we can't use abbreviations. I never use them in my narratives either. And, most of the info is filled out using drop-down boxes. These contain words and phrases that are acceptable and clear in their wording.


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