Call in to the hospital
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First in foremost, think about what you are going to say before you say it. Sounds simple, but early on consider taking the time to "rehearse" in your head what you're going to say. Or write some notes before hand, no one is going to see it and your patient is not going to notice. Figure out ahead of time the information the ER wants so you don't have to go stumbling around for something you haven't figured out yet.
As to the content, the report to the ER goes something like this:
XYZ ambulance ## coming to you BLS [or ALS] non-emergent [or emergent] with a ## age male [or female] with a chief complaint of _________ sustained from [mechanism of injury]. Patient is GCS ## with vitals of BP #, Pulse #, RR# SpO2 #. The patient is/has been [interventions] and we are about ## minutes out. Can I get you anything else sir/ma'am?
I use the same format for every report, that way it's harder to stumble over your words when you know what you are going to say. I also try to make sure I have my vitals in front of me so I don't waste time looking for or trying to remember them. I'm not really sure why the ER cares about the vitals unless they are unusual, especially since half the hospitals we go make us get another set in triage.
Some ERs are also nice enough to have an EMS phone line, these make the reports a little less nerve racking since many times not everyone can hear you in the ER. Ask around, such lines might exist in your area.
As to the content, the report to the ER goes something like this:
XYZ ambulance ## coming to you BLS [or ALS] non-emergent [or emergent] with a ## age male [or female] with a chief complaint of _________ sustained from [mechanism of injury]. Patient is GCS ## with vitals of BP #, Pulse #, RR# SpO2 #. The patient is/has been [interventions] and we are about ## minutes out. Can I get you anything else sir/ma'am?
I use the same format for every report, that way it's harder to stumble over your words when you know what you are going to say. I also try to make sure I have my vitals in front of me so I don't waste time looking for or trying to remember them. I'm not really sure why the ER cares about the vitals unless they are unusual, especially since half the hospitals we go make us get another set in triage.
Some ERs are also nice enough to have an EMS phone line, these make the reports a little less nerve racking since many times not everyone can hear you in the ER. Ask around, such lines might exist in your area.
usafmedic45
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"You're going to be sooooo pissed at us for bringing this to your hospital but...."
"It's bad, it's real bad" *whimper*
In all seriousness, my medical director used to teach the following standard:
"A good call-in is like a woman's skirt: long enough to cover the essentials but short enough to keep interest. Your call-ins are more like a Wonderbra: Attention getting but mostly built up on false pretenses."
MSDeltaFlt
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Whatever method You use please remember this. Regarding radio reports brevity is key. Radios do not act like the old telephone party lines. Meaning while your mic is keyed noone else can talk until You are finished. Someone else might be needed to call in a report as well and they'll have to wait.
Also, depending on the hospital/staff, they might not listen past a certain point, especially if you keep talking. So keep it brief.
Also, depending on the hospital/staff, they might not listen past a certain point, especially if you keep talking. So keep it brief.
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I wish I could say this so badly for 90% of my call-ins. Very, very badly.
"Hello ma'am, we're coming you with our second bariatric psych hold of the day..."
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Brown has yet to figure out WTF makes you all so obsessed with this whole BLS vs ALS patients and doubts the hospital cares
Which is why they should not be included, unless abnormal
I've wondered the same. Ive heard people call in and say they have a chest pain patient with "ACLS protocols in effect". WTF? That never made sense to me. It just seems like overcomplicating which is annoying. just like saying ALS or BLS patient. That sounds dumb.
Around here some of the ERs ask us what priority the patient is. Each ER seems to have a different opinion of what each priority means. Now I just tell them what's wrong and anything of importance and they can figure it out.
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Anjel
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I say
Bravo 123 en route priority (1,2,3) with a #yr old f/m pt. Complaining of (Insert MOI/NOI). All vitals are stable (or if unstable I say what they are) at this time. If I did anything for the pt I will it here... ETA of # min.
They respond with whatever they need or say clear.
I say clear.
and all done.
EDIT: The Bravo or Alpha lets them know what they can expect to be done when pt arrives. That's what I was told.
And some medics will say "en route with cardiac arrest full ALS in place". Which means IVS, intubated, etc.
Bravo 123 en route priority (1,2,3) with a #yr old f/m pt. Complaining of (Insert MOI/NOI). All vitals are stable (or if unstable I say what they are) at this time. If I did anything for the pt I will it here... ETA of # min.
They respond with whatever they need or say clear.
I say clear.
and all done.
EDIT: The Bravo or Alpha lets them know what they can expect to be done when pt arrives. That's what I was told.
And some medics will say "en route with cardiac arrest full ALS in place". Which means IVS, intubated, etc.
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hippocratical
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firetender
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If this gets confusing, just remember to understand the answers to these questions yourself, as applicable:
Who
what
when
where
how
why
Who
what
when
where
how
why
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They (an ER) told me to mention it, so I do. It makes sense to me. If you're coming in with a patient c/o dehydration and you remark that you are BLS, no one is going to ask why fluid replacement was not started. The ER staff knows the patient coming has had little done in the way of treatment if you remind them that you are BLS.
If the ER staff wants it, they get it. Not every part of the world operates in quite the same way. And yes, I think it is stupid to include all the vitals, but I try to be the EMT that the triage nurse does not direct his or her scorn at.
socalmedic
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in socal they care, BLS means they can send us to the waiting room and leave the patient there. ALS means they need to get a bed ready.
socalmedic
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pm me your email address i have some notes for you...
traumaluv2011
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So far I haven't had a priority transport, but I was told if we did have one, we should tell them: MOI/NOI, what injuries they may have, what we are doing to treat them, and ETA
Melclin
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We only chat to the hospitals when we're coming in lights and sirens, which is pretty rare. Don't you guys have separate channels for that sort of thing anyway?
I always write out the relevant details on my notepad for every job to make sure I don't miss anything at handover, so I just use that for my notifications.
ETA, Age/gender, relevant hx, presenting signs and symptoms, relevant vitals, ETA.
I give them my ETA twice, because they always seem to ask again when I don't.
"Austin ED on air"
"Good morning, Austin, from the Preston car. We're about 15 minutes out with a 72 year old gentlemen, recent hx of TIAs, today presenting with 45 minutes of left sided facial droop and dysphasia, ? stroke. He's GCS 15, hypertensive at 190/95 but all the rest of his numbers are good and unless you've got any questions we'll see you in 15."
Even then, when you see the bits of paper they write your notification down on, they still just say, "72, ?stroke, GCS15", which is reasonable, thats all they need to know to clear a resus cubicle and page the relevant people, but I bet you they'd wanna know more if you just said that on air.
I always write out the relevant details on my notepad for every job to make sure I don't miss anything at handover, so I just use that for my notifications.
ETA, Age/gender, relevant hx, presenting signs and symptoms, relevant vitals, ETA.
I give them my ETA twice, because they always seem to ask again when I don't.
"Austin ED on air"
"Good morning, Austin, from the Preston car. We're about 15 minutes out with a 72 year old gentlemen, recent hx of TIAs, today presenting with 45 minutes of left sided facial droop and dysphasia, ? stroke. He's GCS 15, hypertensive at 190/95 but all the rest of his numbers are good and unless you've got any questions we'll see you in 15."
Even then, when you see the bits of paper they write your notification down on, they still just say, "72, ?stroke, GCS15", which is reasonable, thats all they need to know to clear a resus cubicle and page the relevant people, but I bet you they'd wanna know more if you just said that on air.
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I too always wondered why they asked for that information yet never wrote it down. They are going to get all that information at the bedside/triage as well.
We have regional channels that are monitored by a dispatcher at the county medical control point. There is one channel to hail them (CMED) on, and then they direct you to another one of four channels and patch you straight to the ER. I like this better than having the hospitals have their own channel, this way you can head to hospitals that you don't know their frequency but still give an entry note.
We are also supposed to give entry notes for all transports, even non-emergent types (non-combative psych holds, etc.). I guess it helps the hospital plan for an ambulance arrival, but I don't think an entry note actually speeds the process, at least where I am. Some places will assign rooms based on radio reports, but not here.
JPINFV
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CMED? I'm assuming MA here.
When I worked in Boston I only had the chance to run a handful of emergency calls over those 6 months, and I always called in either by radio or by cell phone. However, listening to other people give reports I got the impression that the vast majority of providers gave too long and too detailed reports. In my (not so) humble opinion, an entry note that doesn't require something special (like a trauma, STEMI, etc) or online medical control should be under 30 seconds and more towards 15 seconds, and only the pertinent details. "[Company] BLS Unit 75 enroute to your facility with a 35 year old female with a C/C of flu like symptoms. Patient currently stable, ETA 15 minutes. Any questions?" Unless there's something dramatic, I simply don't see any need for anything else that can't wait for the transfer report. Does it matter if the patient's pulse is 60 or 80?
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Yes sir, MA indeed. I start to feel dumb after talking for more than 30 seconds, so I try to cap it at that. Once I tried the "vitals in normal range" line and was promptly asked for all the vitals, so now I just give it all to them and patiently wait for the day that the receiving hospitals realize that they do nothing with the info I give.
Working in Boston primarily, I don't usually call anything in and just show up at triage and page a triage nurse, that seems to be the standard practice. Obviously traumas, strokes, STEMIs, and anything where we got an ALS intercept get called into the major Boston hospitals. The suburban hospitals want an entry note for everything.
Melclin
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mmmmhmmm testify!
I hear there is an interesting trial starting at one hospital here. It involves them making our ePCR tablets compatible with the hospital computers, so we can electronically transfer a quick summary from the field, triage the patient and role straight from the ambulance into a bed every time. As if all our hospital delays were simply because we were waiting to be triaged :wacko: but its an interesting idea though. I like any idea that smooths out the gaps and makes us more an extension of the ED. Basically it means we'll be triaging the pts in the field so I think its ganna cause some problems with some paramedics not being quite as familiar with specific triage criteria as they should be.