# EMR handover to EMT/Medics



## Javaman (Sep 25, 2013)

Hi Guys, I recently found this forum and I've been learning a lot from your experiences in the field. I'm a fairly new EMR (3 years) at an manufacturing company. We aren't dedicated providers but are occasionally paged to act as first responders to handle the little things or provide BLS support until EMTs can arrive for the more serious issues. The response time is usually pretty quick for the ambulance to arrive so we only have a couple of minutes or less with the patient, just enough to begin doing the OPQRST and SAMPLEs. The thing I was wondering about was what information should be passed on by us EMRs to the EMTs? If the patient is A&Ox4, wouldn't the histories and stuff be better told directly to the EMTs by the patient? It feels really akward to list all that out to the responders if the patient is sitting right there. Certainly initial vitals should be passed on but would you rather hear the rest from us or the patient? Thanks.


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## CALEMT (Sep 25, 2013)

For my turnover reports to RN's, medics, or even EMT's. I usually give the chief complaint (sometimes dispatch gives a different cc or something with the pt changes). I'll give a summary of OPQRST, SAMPLE, or DECAPBTLS if pertinent   Also give vitals, skin v/s, A&O, GCS. Any medications the pt has taken recently and hand said meds over if I take them with us. I get reports from CNA's, LVN's and RN's I tend to find the info is a little more credible, but with that said I always confirm everything with the pt. For me I have no preference.


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## Jambi (Sep 25, 2013)

Javaman said:


> Hi Guys, I recently found this forum and I've been learning a lot from your experiences in the field. I'm a fairly new EMR (3 years) at an manufacturing company. We aren't dedicated providers but are occasionally paged to act as first responders to handle the little things or provide BLS support until EMTs can arrive for the more serious issues. The response time is usually pretty quick for the ambulance to arrive so we only have a couple of minutes or less with the patient, just enough to begin doing the OPQRST and SAMPLEs. The thing I was wondering about was what information should be passed on by us EMRs to the EMTs? If the patient is A&Ox4, wouldn't the histories and stuff be better told directly to the EMTs by the patient? It feels really akward to list all that out to the responders if the patient is sitting right there. Certainly initial vitals should be passed on but would you rather hear the rest from us or the patient? Thanks.



Just run down your assessment when "turning over" to arriving responders. This includes medical history.  Patient stories change, or they "mis-remember," etc., so give the info because it acts like a check-and-balance by providing one more avenue of inquiry.

A common approach is SBAR
S: Situation
B: Background
A: Assessment
R: Recommendation

Example

S: 47 year old male found with an altered level of consciousness at his desk, but with ABC's intact. 

B: Pt's co-workers state he is a diabetic and has been having a hard time because his Dr is adjusting his medication. We found diabetic medication (give the names) and a glucometer with it's last reading being 46.  Pt
s BGL journal also shows inconsistent readings , but his medications appear to have been taken appropriately based on the dates prescribed and the estimated number remaining. Pt's friends also tell us that this happens one or two times a year.  Pt's friends also told us that he has not had any complaints of other unusual changes this week.

A: (Some redundancy here so repeat as you see fit) ALOC with purposeful movement, groaning, and eye opening to painful stimuli with ABC's intact and unchanging. No obvious signs of trauma (DCAPBLS-TIC), or other condition. Vitals: 164/86; 76 S/R; 12 resp/min with clear lungs; Pupils PEARL but sluggish; etc.

(The above will likely cover the first parts of this. List any unusual findings outside of what was already discussed. If conscious and able to talk, share SAMPLE and OPQRST findings. Vital signs and Pt changes or responses to treatment.)

R: Everything we've found points to a diabetic emergency (hypoglycemic)and our assessment findings support that, so that's the route of treatment we've taken. Because he's a known medication-controlled diabetic that's altered, but still able to maintain his airway, I was just about to administer 15gms of oral glucose.

Now this is likely a bit excessive, but I wanted to be descriptive so you had a decent example.  The key here is to simply let those arriving know what the "deal is" and the circumstances leading up to it/anything unusual.  Then you share what you found (assessment).  The recommendation can be intimidating to some because he or she may not feel qualified to "recommend" something to someone with different or "higher" training.  What it really is is a chance to explain your line or reasoning, how you interpreted your findings, and what you were planning to do about them; as well as what you expect to be the results of your treatment.

I hope this wasn't overkill


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## CALEMT (Sep 25, 2013)

Jambi said:


> Patient stories change, or they "mis-remember," etc., so give the info because it acts like a *check-and-balance* by providing one more avenue of inquiry.



That right there. Also like that SBAR mnemonic Jambi, that will definitely come in handy!


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## Christopher (Sep 25, 2013)

Javaman said:


> Hi Guys, I recently found this forum and I've been learning a lot from your experiences in the field. I'm a fairly new EMR (3 years) at an manufacturing company. We aren't dedicated providers but are occasionally paged to act as first responders to handle the little things or provide BLS support until EMTs can arrive for the more serious issues. The response time is usually pretty quick for the ambulance to arrive so we only have a couple of minutes or less with the patient, just enough to begin doing the OPQRST and SAMPLEs. The thing I was wondering about was what information should be passed on by us EMRs to the EMTs? If the patient is A&Ox4, wouldn't the histories and stuff be better told directly to the EMTs by the patient? It feels really akward to list all that out to the responders if the patient is sitting right there. Certainly initial vitals should be passed on but would you rather hear the rest from us or the patient? Thanks.



I work as an EMT on an industrial fire brigade and we frequently do handovers to the county paramedics (I'm also a paramedic with them). We care less about the patient's name/age/etc than we do about your findings.

As far as history/meds/allergies, I just want big tickets. For example, "he had a heart attack a month ago," is big ticket. "He has GERD," not a big ticket. "He is allergic to amoxicillin," is little ticket, while, "he is allergic to aspirin," is big ticket.

In order to get good at it, you should do SOAP or SBAR; pick one and have everybody train on it. Practice, practice, practice!

SOAP for a Medical:
Subjective - 47 year old male with "chest pressure" rated 7 of 10
Objective - Located substernal, not reproducible with palpation, moves down left arm, sweating like you wouldn't believe.
Assessment - P50, BP92/54, RR16, lung sounds clear and equal bilaterally.
Plan - O2 via NC @ 4L/min, 324mg ASA PO.

SOAP for a Trauma:
Subjective - 51 year old female, right hand crushed in press
Objective - Obvious Fx to right index/middle/ring fingers, trapped in press for <1 minute, Takes 81mg ASA each day, GCS15, denies loss of consciousness
Assessment - Good radial pulses, bleeding controlled w/ gauze, no apparent Fx to palm/wrist
Plan - wrapped hand for bleeding, arm placed in splint for good measure, ice pack applied

We like quick, to the point reports!

We previously carried tiny notebooks on our persons which had a mini-Patient Care Report on each page, with just enough room for the pertinent info. If you write this stuff down for the paramedics they will love you forever always.

If you guys need like a sample form, send me a PM and I'll see what I can do (perhaps even send you one if I can find it).


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