# Turn over to hospital personnel



## iancg1 (May 5, 2011)

Hi all, how do you do your turn overs to hospital personnel? Others like it short while some are more detailed. Does your agency have guidelines? Thanks.


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## medtech421 (May 5, 2011)

iancg1 said:


> Hi all, how do you do your turn overs to hospital personnel? Others like it short while some are more detailed. Does your agency have guidelines? Thanks.



My company has no guidelines for oral or written reports.  I do know of one service that has a call-in guideline sheet for when you give your en-route report.  I go to 5 different ER's and it varies with each one.  Of course, the situation dictates whether or not you are going to go into detail.  Many times in this area if the pt is A/Ox4 and doesnt have anything going on that requires immediate action, they just want to know v/s and tx you administered.  The rest they get from pt interview.


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## MrBrown (May 5, 2011)

We use MIST  

Mechanism
Injuries
Scene
Treatment

For example 

"This is John, 72 years, 18 hours post some sort of nasopharyngeal biopsy which started bleeding about 8pm last night, got progressively worse, has lost about 300ml of blood, BP 100/60, he's had about a half litre of saline"


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## DesertMedic66 (May 5, 2011)

iancg1 said:


> Hi all, how do you do your turn overs to hospital personnel? Others like it short while some are more detailed. Does your agency have guidelines? Thanks.



We have 12 points we have to say when we do a call in enroute. We have to do a call in before we get to the hospital. Then once we arrive we give a more detailed report of our patient and what is going on.


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## WolfmanHarris (May 5, 2011)

I find it depends entirely on the triage RN, the hospital and the Pt. 
Some nurses happy to get just a few sentences run down, CTAS and the basics to fill out the form.
Two of our hospitals triage RN handles report to the RN that will be attending to that Pt. At on of our hospitals we give report again when we place the Pt. I prefer the latter and for complex cases I'll still find the RN and give report.
Basic cut and dry Pt's get an obviously quicker report than the more involved ones and the head scratchers. 
And finally resus Pt.'s, major trauma, CVA, etc. we end up giving report right to the physician in the treatment room and more often than not hang around and help during the initial work-up.


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## EMT-IT753 (May 5, 2011)

We have 2 hospitals in our city. One is a Level II and the other is a Level III.

The II is really rude to medics and you have about 30 seconds to give bedside report if even that. 

The III is much better in that regard. In fact their trauma coordinator tells the RN's that when we are ready to give our report, they will "Shut up" and give us 90 seconds to give our hand off report. The coordinator wants to hear what we have to say since they were not at the scene to get important details. 

I realize in critical cases time is important, but so is our findings that we do not give over the radio due to tying up airwaves.


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## WolfmanHarris (May 5, 2011)

EMT-IT753 said:


> The III is much better in that regard. In fact their trauma coordinator tells the RN's that when we are ready to give our report, they will "Shut up" and give us 90 seconds to give our hand off report. The coordinator wants to hear what we have to say since they were not at the scene to get important details.



We have two regional trauma centres in the area. I've only been to St Mike's  trauma room in Toronto though and it has a large sign just inside the door called "Trauma Room Expectations." I don't remember all the details but there was one point I enjoyed:
During hand off and report from Paramedics are personnel are to be quiet to allow the trauma team leader and recording RN to hear full report.

And as a result we have seemless transfer of care and are usually kept around for a bit until the TTL and consults have all the first hand info they might need.


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## abckidsmom (May 5, 2011)

Simple cases, quick, two-sentence presentation, with any addenda that are needed.

More complex cases, I present the history and ROS just highlighting what's key, and what I did or didn't do.  I don't take well to being blown off by the staff, so if they do blow me off, I will say something in that moment like, "I'll just wait right here while you get him settled" or "Am I giving you report or is someone else taking Mr So and So?"

It's easy to demand to be treated like a healthcare provider if you really are one.  Manners matter, and making sure the crabby people don't wreck your day or the patients' is important.


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## DesertMedic66 (May 5, 2011)

We call the hospital on our cell phones enroute to give the hospital a good idea of what we are bringing in. Once we arrive a team from the hospital will take over and our medic will give a full report to a RN or Doctor. The medic doesn't have to rush the report because there is already a team working on the patient based on the info we gave enroute. It works extremely well and allows for a seamless hand off.


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## NomadicMedic (May 5, 2011)

abckidsmom said:


> Simple cases, quick, two-sentence presentation, with any addenda that are needed.
> 
> More complex cases, I present the history and ROS just highlighting what's key, and what I did or didn't do.  I don't take well to being blown off by the staff, so if they do blow me off, I will say something in that moment like, "I'll just wait right here while you get him settled" or "Am I giving you report or is someone else taking Mr So and So?"
> 
> It's easy to demand to be treated like a healthcare provider if you really are one.  Manners matter, and making sure the crabby people don't wreck your day or the patients' is important.



^ This.

I do the same. However, when I'm _really_ getting blown off by a nurse, (and it's usually a travel nurse, float, someone who's new or doesn't work in the ER often) I'll stick my head out of the PT's room and ask the charge nurse, "Who's taking report in here?" 

Works like a champ.

I'm lucky that I now know most of the nurses at the various EDs pretty well. And if the same nurse who took the radio report is in the room, I'll just say, "nothing changed since we talked last..."


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## HotelCo (May 5, 2011)

I give a short report most of the time (unless it's a complex pt), and ask of there is anything else they'd like to know. (everything I know should be on the run sheet as well).


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## phideux (May 6, 2011)

I like to keep on the nurses good side. I'll give them whatever pertinent info I got, which varies greatly depending on the situation. While I'm giving my info, I'm usually hooking the patient up to the hospitals monitor, and starting the nurses first set of vitals for them.
(habit I guess, I just finished about 400hrs of clinicals in the ER. While there I was the official IV, Blood Draw, 12 Lead, vitals, patient history guy).  
We're getting ready to run about 20 million people through here in the next 5 months of tourist season. With 3 large motorcycle rallies thrown in for some extra excitement. I like being one of the guys the ER nurses like on a crazy Friday night.


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## iancg1 (May 6, 2011)

Thanks guys. Most of the time we do it pretty quickly here too. Pt name, age, and MIST.


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## zmedic (May 6, 2011)

HotelCo; said:
			
		

> I give a short report most of the time (unless it's a complex pt), and ask of there is anything else they'd like to know. (everything I know should be on the run sheet as well).



Be aware that unless your run sheet is completely filled out and handed to the nurse when you move the patient over, it will likely never be looked at. It sucks but fact of life. I know it's often not possible to have your run form done in areas with short transport times. But the MD/RN isn't going to go hunting for the form half an hour later, they are just going to ask the patient the info.


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## MrBrown (May 6, 2011)

This is true, the hospital copy of the PRF will go into the folder but will probably never be looked at


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## mycrofft (May 6, 2011)

*We had bad interface.*

Ambulance company had a form dictated by local health dept, but local ER's felt they were not included in the planning (in fact, no one was). These legal sized three-carbon copy extravaganza's were regularly thrown out as we handed them across.


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## Monkey (May 6, 2011)

If it's any sort of interfacility, then short due to the fact the nurse has gotten a turnover from the other RN (IE: ER to ER, SNF to ER, vice versa, etc, ad naseum)

If it's a 911 or the like, then detailed as possible.


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## AMF (Jun 12, 2011)

Wait, you hand the nurses your PCR?  Like, as in a piece of paper?

You do have computers in your ambulance, right?

Some nurses have a habit of just brushing off the paramedics and getting the subjective from the patient again or waiting to evaluate, which is often like ignoring half the report.

Which is great when the paramedic is actually an ER doctor.


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## HotelCo (Jun 12, 2011)

AMF said:


> Wait, you hand the nurses your PCR?  Like, as in a piece of paper?
> 
> You do have computers in your ambulance, right?



My company does paper PCRs too, and no computers in the ambulance.


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## fortsmithman (Jun 12, 2011)

AMF said:


> Wait, you hand the nurses your PCR?  Like, as in a piece of paper?
> 
> You do have computers in your ambulance, right?
> 
> ...





HotelCo said:


> My company does paper PCRs too, and no computers in the ambulance.



So does my service.


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## Tigger (Jun 12, 2011)

AMF said:


> Wait, you hand the nurses your PCR?  Like, as in a piece of paper?
> 
> You do have computers in your ambulance, right?
> 
> ...



As does mine, apparently Zoll software and Windows 7 do not get along currently.


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## Akulahawk (Jun 12, 2011)

AMF said:


> Wait, you hand the nurses your PCR?  Like, as in a piece of paper?
> 
> You do have computers in your ambulance, right?





HotelCo said:


> My company does paper PCRs too, and no computers in the ambulance.


A couple companies that I've worked for over the years had some kind of ePCR (I forget exactly what it was) but also carried a paper version, just in case the computer crashed. 

I got really good at doing the PCRs quickly. I'd do the verbal report and end it with something like: "I'll have the chart for you in a couple minutes" and I really would usually have it done by then... and turn it into the team (or the very nurse) that actually took report. Somebody would at least glance at it... before it disappears into the patient's ED chart somewhere.


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## nemedic (Jun 12, 2011)

Tigger said:


> As does mine, apparently Zoll software and Windows 7 do not get along currently.



And once they do, then the only browser the Zoll stuff will work on will be IE. PITA for me and my Mac, but mostly because I am too lazy to partition my HD and boot windows as well


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## EMTswag (Jun 14, 2011)

over the radio? age, gender, what happened, what he looks like (condition wise), what we did for him, how far away we are, do you require anything further? 

In the hospital? whatever it is they ask for.


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## csly27 (Jun 24, 2011)

we had to call in our reports by radio or cell phone.. I mainly used cells we just gave the basics pt age, cc, hx, how far out we were and if they had any info for us, mostly it went smooth sometimes if u forgot to call in they would get pissy.


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## Dougy (Jul 10, 2011)

iancg1 said:


> Hi all, how do you do your turn overs to hospital personnel? Others like it short while some are more detailed. Does your agency have guidelines? Thanks.



No guidelines here. The nurses at the receiving ER's ask us all the questions they need. We give them a copy of our runsheet so they have everything we had. They sign off that they are taking care, and we are out of there.



> we had to call in our reports by radio or cell phone.. I mainly used cells we just gave the basics pt age, cc, hx, how far out we were and if they had any info for us, mostly it went smooth sometimes if u forgot to call in they would get pissy.



We used to use HEAR radio's.. before my time (I'm 18, just started last November).. now it's cell phone for most of the ER's except HUMC, where we just show up.


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## EMSrush (Jul 10, 2011)

abckidsmom said:


> I don't take well to being blown off by the staff, so if they do blow me off, I will say something in that moment like, "I'll just wait right here while you get him settled"



I'll definitely be borrowing this one later on this evening...


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## medicdan (Jul 10, 2011)

AMF said:


> Wait, you hand the nurses your PCR?  Like, as in a piece of paper?
> 
> You do have computers in your ambulance, right?
> 
> ...



Some services put a printer in each ambulance and expect the crew to complete the PCR and print it before leaving the ED. Others have an EMS printer at the ED (EMS room), still others have the server fax a copy of the PCR to the ED when it is completed (wherever the crew is at the time).


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## TransportJockey (Jul 10, 2011)

Everywhere I've worked we call in a quick heads up via radio or phone (radio here in NM, phone in TX and CO), and then I give the RN/Resus team/Trauma team a longer verbal report that goes more in depth. I've been giving them often enough that I basically do my own thing and when I get done I ask if they have any questions for me. Very rarely do they.
And as for PCRs... We finish them sometime during the day and once we submit them to NM EMSTARS they get faxed to the hospital. We don't give paper run forms to the hospitals.


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## EMTswag (Jul 11, 2011)

Dougy said:


> No guidelines here. The nurses at the receiving ER's ask us all the questions they need. We give them a copy of our runsheet so they have everything we had. They sign off that they are taking care, and we are out of there.
> 
> 
> 
> We used to use HEAR radio's.. before my time (I'm 18, just started last November).. now it's cell phone for most of the ER's except HUMC, where we just show up.



Yeah no hospital in my area actually answers HEAR anymore haha. And I think I know where youre going with that... MOST hospitals we call ahead to, except that one hospital whose staff we all hate


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## Too Old To Work (Jul 12, 2011)

I just keep talking til the nurse has had enough and assigns me a room. It usually doesn't take that long. Sometimes I'll eat onions for lunch and stand real close to her. That often speeds things up. Occasionally, just to see if they are listening, I'll throw in patient's favorite vegetable, shoe size, and birth stone.


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## 8jimi8 (Jul 12, 2011)

MIVT:

Mechanism of injury

Injuries sustained

Vitals

Treatment

If they need more, give the sample hx.  Speak up, so the doc and the techs can hear you.


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## Melclin (Jul 13, 2011)

All this strict structure makes me think of the staccato talking EMT on American TV shows like ER. 

I find in general handover is more of a conversation and the structure changes depending on the pt. 

This is John, now you've gotta watch John he's cheeky aren't you John. Anyway John has a 1 month hx of chest pain on exertion. It hasn't been previously investigated or anything, ahhh, he's then experienced the sudden onset at rest of what he describes as heavy central chest pain radiating to to his R shoulder at about 10 this morning, so about 2 hours ago now. He waited around for a bit before calling us and we've got to him about 45 mins ago, found him to have what sounds like cardiac chest pain and some nausea. He's been haemodynamically stable the whole time, obs unremarkable other than some mild hypertension at 160/85, we've given him 300 of aspirin of course, 2 lots of 300mcg GTN, his pain hasn't changed at all, we've then popped a total of 7.5mg of morph in, and he's now pain free. He's also had 10 of maxolon to good effect. Ah...he doesn't have any cardiac hx and the only other medical hx is diabetes...yep type 2... ahh, and no allergies.  

Trauma centre handovers are a bit more formal.
This is 62 year old John. John was the driver of a family sedan that was involved in a high speed head on collision at approximately 1630 this afternoon. There was significant cabin intrusion killing the other two passengers and trapping John so there was about a 40 minute delay for extrication and we found him to have significant blunt injuries to his head, a flail segment, and an open fracture to his L tib fib. He was initially GCS 13, hypotensive at 75 systolic before the extrication and in considerable pain, responsive to 2 L of saline and 45 of morphine. Last pressure was 125/85 at HR 98, Saturating well on 8 litres but he does desaturate quickly without o2 and he's been throwing VEs fairly often. Equal breath sound bilaterally, still GCS 13, No meds, hx or allergies that we've been able to ascertain. 

Then come the steady stream of further questions from the trauma team.   

We rarely give hospital notification unless people are seriously ill. The last hospital note I gave went: "Ah yes, ______ Hospital, we're about 15 out with an 82 year old male post conscious collapse at 2330, presenting with R sided hemiplegia and dysphasia - ?stroke. He's GCS 15 and hypertensive at 185 over 85. Has a BSL of 3.9 that we're correcting now and unless there's anything further we'll see you in 15." 

I don't know that they're perfect, but these are all handovers that I've given, they were well received.


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## lightsandsirens5 (Jul 13, 2011)

No agency specific SOGs. I have kinda developed my own way. Like Melclin says, it is kind of conversational. 

On the way in, we give a quick heads up on the radio. ETA, age, sex, VERY brief rundown of illness or injuries, major treatments (Ie. fully immobilized, intubated, cpr (Ha ha ha), etc), ask for any questions or orders. 

We arrive and get a room assignment then we give a more detailed report to the receiving RN. That is when I go into the details like OPQRST, SAMPLE, details of the MVA and the scene, full treatments, pertinent negatives, things like that.

Oh yea, and don't go giving report to a tech, you will only have to give it again to the RN. Ha!


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## TransportJockey (Jul 13, 2011)

lightsandsirens5 said:


> Oh yea, and don't go giving report to a tech, you will only have to give it again to the RN. Ha!



Depends where  All three patients I transported yesterday report was given to a tech and care turned over to them. In NM I can turn over to an equivalent or higher cert/licensure. These techs were either EMT-Ps working triage or EMT-I/P working as a senior tech


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## lightsandsirens5 (Jul 13, 2011)

TransportJockey said:


> Depends where  All three patients I transported yesterday report was given to a tech and care turned over to them. In NM I can turn over to an equivalent or higher cert/licensure. These techs were either EMT-Ps working triage or EMT-I/P working as a senior tech



True. So far as I know however here in WA, a Tech falls below an EMT-B on the food chain.


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## adamjh3 (Jul 13, 2011)

When going to the ER we have to make a radio report to the receiving hospital, I have a note pad that I take notes on scene with. 

Age, gender, chief, History pertinent to incident, past medical history, meds, allergies, assessment and treatment. 

My cat scratch notes end up helping me put out something like this:


> (hospital) ER, this is ghetto medics #49 bringing you a 15 year old female, chief complaint today is going to be traumatic head pain. Patient complains of pain on the forehead which started after she repeatedly struck her head against a concrete wall out of frustration. Patient and bystanders report no loss of consciousness. Upon examination we've noted a 1" hematoma about 2" superior to the right eye. secondary assessment also reveals several superficial hesitation marks on the anterior side of her right forearm we've got the bleeding controlled and the wounds dressed. Also patient has some bruising and redness on her left hand where the patient states she may have also struck the wall with her hand. Patient has a history of depression and bipolar disorder, list of meds upon arrival, no known allergies, Vital signs are stable, ETA 10 minutes, anything else we can get for you?



And then when I call the hospital they go and rain on my parade and say they just want the patient's, age, gender, chief, and ETA. 

My actual turn over to hospital staff runs about like my narratives and radio reports do; if they want it brief I'll let them know how they were found, how they ended up there, quick rundown of what we found (possible fx'd hand, hematoma on the forehead), any abnormal vitals, a brief Hx, and allergies.


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## Dougy (Jul 17, 2011)

EMTswag said:


> , except that one hospital whose staff we all hate


I've called several nurses the 4 letter word that rhymes with punt and I've called some what you call a female dog. One responded to me with 'I am ten times more qualified then you to treat this patient'.. to which I responded with 'really? you could have fooled me with the way i've seen you handle things'.. I got a death stare 

One also said she was old enough to be my mother and I should show some respect.. and then told me to :censored: off.. so I told her she actually looked old enough to be my grandmother. Score.


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## Akulahawk (Jul 18, 2011)

Dougy said:


> I've called several nurses the 4 letter word that rhymes with punt and I've called some what you call a female dog. One responded to me with 'I am ten times more qualified then you to treat this patient'.. to which I responded with 'really? you could have fooled me with the way i've seen you handle things'.. I got a death stare
> 
> One also said she was old enough to be my mother and I should show some respect.. and then told me to :censored: off.. so I told her she actually looked old enough to be my grandmother. Score.


And if you were my probationary employee under FTO... You'd be done if I heard you say that. Period. If I were your FTO, you'd be FAILED instantly. If I were your boss and you a regular employee... you'd be looking at spending some quality unpaid time off at the minimum. Yes, we all know people like that. Picking fights with them doesn't do anyone any favors. 

Those Nurses now probably are looking closely at YOU for med mistakes to report YOU for.


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## katgrl2003 (Jul 18, 2011)

Akulahawk said:


> And if you were my probationary employee under FTO... You'd be done if I heard you say that. Period. If I were your FTO, you'd be FAILED instantly. If I were your boss and you a regular employee... you'd be looking at spending some quality unpaid time off at the minimum. Yes, we all know people like that. Picking fights with them doesn't do anyone any favors.
> 
> Those Nurses now probably are looking closely at YOU for med mistakes to report YOU for.



Agreed


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## mycrofft (Jul 18, 2011)

*I was always impressed with how the victim's friends do it at the ER.*

Drive up with windows open, slow to five mph, roll victim out the door, scream "Hey, there's a guy dying out here!" then accelerate off in a cloud of blue smoke. Amazingly little paperwork.


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## firecoins (Jul 18, 2011)

mycrofft said:


> Drive up with windows open, slow to five mph, roll victim out the door, scream "Hey, there's a guy dying out here!" then accelerate off in a cloud of blue smoke. Amazingly little paperwork.



thats how I roll.


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## mycrofft (Jul 18, 2011)

*That was you?*

From a real incident.
A local "doc in the box" TWICE had detoxers left outside at night, but they didn't open until next morning.h34r:


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## medicdan (Jul 18, 2011)

mycrofft said:


> Drive up with windows open, slow to five mph, roll victim out the door, scream "Hey, there's a guy dying out here!" then accelerate off in a cloud of blue smoke. Amazingly little paperwork.



It's called the homeboy ambulance! Haven't you heard, they're hiring (hint to some CA EMTs).


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## the_negro_puppy (Jul 19, 2011)

Every place is different. Most private hospitals couldnt give a :censored::censored::censored::censored: about what we have done or seen with the patient. Probably because they get a low volume of ambulance transports, do their best to reject us over the phone because they don't want to work.

The biggest public hospitals are probably the most respectful in listening to our handovers. I always laugh when we get dismissed or ignored by nurses during a hand over, who then have to chase us down after to ask questions.

I even did a handover today, where I stated "The pt has been given 3ml methoxyflurane and 5mg IV morphine. She obviously also has a cannula in". The nurse then said "Was the morphine IV or IM and how much did you give.


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## mycrofft (Jul 19, 2011)

*You obviously interrupted her nap.*

Or is the an American ex-pat?


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## Melclin (Jul 19, 2011)

the_negro_puppy said:


> Every place is different. Most private hospitals couldnt give a :censored::censored::censored::censored: about what we have done or seen with the patient. Probably because they get a low volume of ambulance transports, do their best to reject us over the phone because they don't want to work.



I find ward nurses to be most annoying (with the obvious exception of nursing homes etc). Like everyone else in hospital, they don't fart in less than 10 minutes and it kinda clashes with our "lets get this show on the road" attitude and they rarely have the information I want.


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## usalsfyre (Jul 19, 2011)

Melclin said:


> I find ward nurses to be most annoying (with the obvious exception of nursing homes etc). Like everyone else in hospital, they don't fart in less than 10 minutes and it kinda clashes with our "lets get this show on the road" attitude and they rarely have the information I want.



+1

Not to mention their always the ones who refuse to give you a peer-peer report and have a sealed envelope of info "you don't need" when doing a facility-facility transfer. Notable times I've had this issue include tele to bigger facility ICU and floor to cath lab! Plus, you can watch them ignoring you when you attempt to give report.


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## TransportJockey (Jul 19, 2011)

usalsfyre said:


> +1
> 
> Not to mention their always the ones who refuse to give you a peer-peer report and have a sealed envelope of info "you don't need" when doing a facility-facility transfer. Notable times I've had this issue include tele to bigger facility ICU and floor to cath lab! Plus, you can watch them ignoring you when you attempt to give report.



You mean the same envelope I almost always opened right after they told me I didn't need to know what was inside of it?


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## usalsfyre (Jul 19, 2011)

TransportJockey said:


> You mean the same envelope I almost always opened right after they told me I didn't need to know what was inside of it?



That's the one. I always do the same thing.


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## jjesusfreak01 (Jul 19, 2011)

TransportJockey said:


> You mean the same envelope I almost always opened right after they told me I didn't need to know what was inside of it?



I usually open the envelope right in front of them to get the basic stuff, and then read through everything on the way. I don't think they've ever given me grief for it. I get that i'm not really giving report to the receiving facility on an IFT call, but that doesn't mean I don't want to know the patients medical history and medications in case something should happen on the way.


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## firecoins (Jul 20, 2011)

I love nursing home emergencies.  Get called for the high temp.  Arrive on the floor.  The Nurses just point where the patient is. Pt is clearly going in resp failure. At this time the CNAs try and kick you out of the room so they can change the patient's diaper or something. The nurses aren't done with the paperwork and they want you to transport the patient to some community hospial 30 minutes away bypassing 3 closer hospitals, 2 of which are trauma center cause that is the patient's "preference".  

And what report do the nurses give you?  I just came on, its not my patient, I am covering for someone else and thats what the MD ordered.


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## mycrofft (Jul 20, 2011)

*They're bypassing because the pt's MD has no priviliges locally.*

Maybe.


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## daj72 (Jul 21, 2011)

firecoins said:


> And what report do the nurses give you?  I just came on, its not my patient, I am covering for someone else and thats what the MD ordered.



It sounds _just _like in Denmark. :blink: It must be a contagious nursing home thing.!


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## Melclin (Jul 21, 2011)

daj72 said:


> It sounds _just _like in Denmark. :blink: It must be a contagious nursing home thing.!



Honestly nursing home nurses must work 30 minute shift or something. 

*The nursing home drill:* 
-Turn up (usually lights and sirens because they've reported a warped version of what was wrong with the pt).
-Wait outside the door or at reception for someone to direct you because there was nothing more than the nursing home address in the dispatch.
-The person who eventually comes, didn't know there was an ambulance coming and doesn't know who called it. (Honestly, the lay public, a bunch of perfect strangers, is almost always better at mobilising to provide first aid and direct us to the pt, than any nursing home I've ever been too).
-X minutes later we get a room number or someone comes to get us.
-The directions/room number is invariably wrong.
-Upon arriving we receive either a piss poor handover or are simply pointed at the pt and left (probably preferable)
-If there is someone there to answer questions they never know the answers because: (a) he/she is no usually their pt, or (b) they just came on, or (c) the seem perplexingly incapable of actually answering the question, ? arse covering, ? stupid.
-The pt invariably turns out to be completely fine (when we arrive lights and sirens), is seriously ill and has been grossly mismanaged usually for hours (when we arrive on a low priority)/is dead.
-We wait around for someone to find the files, print off transfer paperwork.
-We eventually treat/transport.


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## Akulahawk (Jul 21, 2011)

firecoins said:


> I love nursing home emergencies.  Get called for the high temp.  Arrive on the floor.  The Nurses just point where the patient is. Pt is clearly going in resp failure. At this time the CNAs try and kick you out of the room so they can change the patient's diaper or something. The nurses aren't done with the paperwork and they want you to transport the patient to some community hospital 30 minutes away bypassing 3 closer hospitals, 2 of which are trauma center cause that is the patient's "preference".
> 
> And what report do the nurses give you?  I just came on, its not my patient, I am covering for someone else and thats what the MD ordered.


One of my "favorites" is "weakness and lethargy"... That can mean anything, but usually it means one of two things. One is your patient is _seriously_ septic and about to die. Two is your patient is your patient is actually having an MI and needs to go yesterday. Three, your patient is just about to die (because it's time) and they don't want the death on their books... 

Another favorite is "failure to thrive" as that usually means that your patient now can't swallow and nobody noticed that the patient is actually having a CVA or the patient somehow now needs their G-Tube replaced two days ago. 

The complaint is anything that _isn't_ an emergency because that would mean the ambulance company would automatically turn the call over to 911... I don't know how many calls I've been on as an EMT that should have gone to 911 but didn't because the facility is just eye-sight distance away from the hospital and (most likely) calling 911 would make them look bad...


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## rmabrey (Jul 21, 2011)

Well rather than start a new thread, this sounds like a good spot. The other day I had a pedestrian hit by a truck (very slow moving truck). The ER obviously was very over hyped for this and should have been able to tell when we BLS'd the run that it wasnt serious. Pt had no relevant medical Hx and took no meds. The nurse however asked if he was a smoker.........Im new to EMS but this is not a pre-hospital question so why ask? He was young so maybe he is new as well


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## saskvolunteer (Jul 21, 2011)

Our ER staff ask each new patient admitted to the ER if they smoke or drink. I thought it was a pretty common question asked to establish a patient hx.


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