ER Report Ignores EMS Assessment, Actions

E

elsacloud

Forum Ride Along
Messages
8
Reaction score
0
Points
0
My life was saved by an EMS team that spent 22 minutes stabilizing me before transport to ER.

Their Assessment noted I had vomited about 300 ml of blood with many golfball sized clots before they arrived and another 100-200ml after. They immediately started oxygen (I lost consciousness shortly after they arrived, and could hear but not see even though my eyes were open before that; I regained consciousness in the ambulance). They gave me an IV wide open and added ondansetron to it.

My first set of vitals were pulse:130, RR 24, BP 94/50 and I was pale grey, cool, disphoretic. When I arrived at the hospital, they were pulse: 96, RR 16, BP 100/64.

I know all this becausae I went to the EMS office and got a copy of the report delivered by the team to the ER.

I had earlier gone to get my hospital records (I always do this. Why? Because they are mine.) and the EMS report was not among them. I returned a second time to Med Records and still they could not produce them.

My second visit was to submit a 3-page outline of things that needed to be amended on the hospital's reports.

My main complaint, the one I find outrageous, is this summary of how I came to be at the ER, which was repeated with small variations on the Discharge Summary, History & Physical, and Consultation docs:

"She became dizzy and came to the ER for further evaluation."

There is no mention anywhere of the interventions or assessments of the EMS team. It's like I just got dizzy and strolled into the ER -- and then was found to be in need of 4 transfusions because of a spurting gastric ulcer.

This is the first time I've ever had to have the help of the EMS. The team that treated me saved my life.

So I don't know what is normal or typical in this situation. Are the Discharge Summary, History & Physical, and Consultation docs supposed to just reflect what happened only after I arrived at the hospital? Even if I came by ambulance? Even if it took 22 minutes of treatment before the EMS team brought me in lights/siren (Echo 3)?

Surely this can't be right?

No actual harm was done me -- I was infuriated on behalf of the EMS and for some reason furiously insulted that my extreme experience was made to sound like a case of the vapors -- but still....

Does this happen regularly? Are you infuriated by it? What would you do in my place?

And thanks to all of you. Thank you for doing this job.
 
Sometimes EMS run reports don't make it all the way into the chart, even when they should. This can be either the fault of the EMS team if they don't deliver the report to the hospital, or the fault of the hospital if they have the report and don't put it in the file. That obviously doesn't excuse the hospital from ignoring the paramedics report and essentially lying about your chief complaint though, since the hospital needs to be treating based off of the paramedics verbal report as well as the docs assessment.
 
It is hard to know if this is standard practice for hospitals, because we often don't see what is in the pt's chart after treatment. However, we always do leave a patient care report with the chart before departing the hospital. What they do with it after that point is out of our control.

Typically we give our report to the Nurse, and they pass the information on to the doctor when he sees the patient. So, the discharge summary the doctor writes in the chart will depend on the story the nurse passes on. But, in your case, it sounds like your condition was quite acute, I'd imagine a report would have been given directly to the Doc by paramedics, so I can only speculate on why the information on your arrival was so vague.
 
Your situation sounds like it was a very involved call. There is often (in busy systems) little time afforded to complete such a detailed report, before returning to service. What is in your discharge report, may be what little the ER staff could recall from the verbal history given when care was turned over. If the written EMS report/narrative is not completed at the ER (and handed over), the hospital chart most likely will not have it, with the exception of ALS/BLS interventions and vital signs. It often has very little to do with "ignoring" or omitting details. There are many shifts where I don't get to complete a full narrative until after I have returned to service. I work both sides of the coin, ER and EMS, so I understand first hand how some things don't always cross over like we think they should. Unless you are concerned about negligence or substandard care, at the hands of the ER or EMS crew, I think you can bury the hatchet. Maybe take some time and write a nice letter to the EMS Chief about how good you feel the crew handled your care :)
 
Thanks, I have already written a thank-you letter to the EMS.

I know the ER MD received the EMS report because there is a box for the Physician Signature in the middle of the EMS report page, and it is signed, and that same name appears on the Emergency Dep't. Discharge Summary to admit me to the hospital.

I don't think any harm was done to me, but I worry about sloppiness in documentation. It just doesn't seem right to me.

The EMS team that was on the case for a total of 66 minutes documented accurately.

Why couldn't the ER get it together in the 5 hours and 50 minutes I spent with them? There are other errors as well, like on my Discharge Summary my hematocrit for my 1645 blood chem is 30, but on the Lab Result page itself it is 26.6. Even little things -- like the EMS Assessment accurately noted a "large amt of dark red blood in Pt's hair" while the Physical's General Appearance in the ER noted "trace blood around the mouth" (and my hair had not yet been washed. My pillowcase in ER was red.).

The GI Consultant in the ER did a great job fixing the problem. But there wouldn't have been a problem to fix if the EMS hadn't done their job.

I guess I just want people to get the credit they deserve when they do an outstanding job.
 
A rare Treat!

Huge gift, your post here, and your Blog was exceptional. Thank You!

What strikes me as most wonderful was that you actually took the time to learn about what we do, and citizen to citizen, laid it out so people could better understand the "unsung Hero" aspect of the profession.

There's a rumbling in the air, though. I think you'll be seeing medics getting a broader image of themselves and what they do. I think most here agree that the people doing the work today are going to have to strengthen the profession and make it more of a career path than a transient's hideout.

That's where the work lies and to have voices on the outside cheering it all on is a real gift!

I personally appreciate your comment about the depiction of medics as desensitized and you coming to their defense. EMS is a challenging field in many, many aspects that are rarely discussed. Hopefully, many more people like yourself will take the time to listen to their bigger stories.

Also, I just cannot find ANY justification for the absence of the Ambulance Report in the Hospital Record. The Ambulance is an arm of the Hospital and INTEGRAL to the treatment history of the patient. The Admission Report is way off. Something ain't right and I think you deserve to find out why.
 
Last edited by a moderator:
elsacloud said:
...it is signed, and that same name appears on the Emergency Dep't. Discharge Summary to admit me to the hospital.
Click to expand...

That actually may explain it right there. If the crew (for what ever reason) isn't able to get the report done before you are admitted there is a lower chance their report will make it into your chart in a timely manner.

If it happens while the chart is still in the ED, someone usually just sticks it on the clipboard and that is that. If it gets sent to the central medical records place separate from your chart it gets stuck in the pile of crap they have to scan into the computer.
 
Last edited by a moderator:
Some hospitals, in my experience, don't give a crap about our run reports. It may be due to their own ignorance, or may be due to some idiot EMS providers that have nullified any progress to be seen as actual healthcare providers... but more likely it's a mixture of the two.



But also, to an extent, much of what we do in the field is essentially seen as more of a stabilization than part of a long-term treatment regimen, as correct or incorrect as that truly is.





Glad you're doing better :)
 
1st, I'm glad you're doing well now, and the thanks you give here are truly appreciated

2nd, The run report being signed doesn't mean that it was completed at the time of signing. At my service, even if all you have on your report is the run number and the patient's name, we are required to get the signature of the nurse (or doc, or whomever) we turned over to.
 
elsacloud said:
I know the ER MD received the EMS report because there is a box for the Physician Signature in the middle of the EMS report page, and it is signed, and that same name appears on the Emergency Dep't. Discharge Summary to admit me to the hospital.
Click to expand...

Just because there is a signature does not mean they have a copy of the report. Some services are all computer based now and the crew dont complete the trip sheet until hours after the call. Even the paper trip sheets we have at my service dont have carbon copies anymore. I usually walk in with a blank trip sheet and fill it out later. Very rarely will I ever get to complete one before going back in service.
 
Well, the EMS crew reports arriving at hospital at 16:29 and last sentence of Assessment is "Reports and care to staff." The EMS crew is available for call at 15:02.

The Hospital has arrival at 4:32 pm, Time Care Began/Triage at 4:45, and Disposition at 4:54. I don't know what happened between 4:32 and 4:45 -- could that be when the report was being written/delivered verbally? And I don't know what Disposition means.

Thanks for taking the time to address my questions!
 
elsacloud said:
Well, the EMS crew reports arriving at hospital at 16:29 and last sentence of Assessment is "Reports and care to staff." The EMS crew is available for call at 15:02.

The Hospital has arrival at 4:32 pm, Time Care Began/Triage at 4:45, and Disposition at 4:54. I don't know what happened between 4:32 and 4:45 -- could that be when the report was being written/delivered verbally? And I don't know what Disposition means.

Thanks for taking the time to address my questions!
Click to expand...

I'm assuming you mean they're available at 1702?

The ambulance crew likely put their arrival time as when they pulled into the ER bay, 1629. The hospital likely put arrival as when they addressed the triage nurse or other individual to notify them that they had arrived, 1632.

between 1632 and 1645, any number of things could have been happening, the hospital may have been busy, and the triage nurse couldn't get to you until then, or perhaps there was an offload delay and they were having trouble clearing a bed for you. There's really no way any of us would be able to tell.
 
Right! 17:02. No time travel was involved.

My memory is that as soon as I arrived the ER crew got busy. I was in a bigger than I'd ever seen room in the ER, having never before come in an ambulance, one with posters on the wall telling nurse 1, nurse 2, nurse 3, etc. where to stand and what to do. I think they cut my clothes off me pretty much immediately.

When I looked at the timeline, I just wondered if maybe a patient can't "belong" --so to speak --to two different services at once. In other words, until EMS finishes their report and signs off on me, I can't be in the Hospital's system.

It really doesn't matter, I know, I just am one curious cat.
 
elsacloud said:
Well, the EMS crew reports arriving at hospital at 16:29 and last sentence of Assessment is "Reports and care to staff." The EMS crew is available for call at 15:02.

The Hospital has arrival at 4:32 pm, Time Care Began/Triage at 4:45, and Disposition at 4:54. I don't know what happened between 4:32 and 4:45 -- could that be when the report was being written/delivered verbally? And I don't know what Disposition means.

Thanks for taking the time to address my questions!
Click to expand...

The ambulances times are when they told dispatch that they got somewhere etc. They probably pulled into the ER at 1629 and then depending on the crew/your status it might have taken some time to get into the ER and such. Also the 1632 might be when you got registered in the ER.

Between getting to the ER and available any number of things could have happened. Restock, waiting for a face sheet, raiding the EMS lounge.

At my service we have 20 minutes at the ER from arrival to available before we get questioned about it, sometimes theres alot to do. It sounds like you were a critical patient so re-stocking and clean up may have taken some time.

I cant speak for your service but at mine we can usually take the full 20 to clear the ER just by cleaning, restocking and getting the necessary paperwork done.

What I forgot to add last time is that I'm happy that you are grateful for the care EMS provided for you. Many people overlook it and think of EMS as a glorified taxi service.
 
I thought 33 minutes or whatever turn-around between calls pretty quick since I assumed that the team would be interviewed about its report by the ER staff and have a bunch of forms to fill out.

And then I read somewhere that EMS teams have to decontaminate the ambulance themselves before their next call. I think it was in the context of a post about spurting esophageal varices in a rural area -- a new EMT had asked how to stop bleeding when you can't apply pressure.

This is another thing I don't think most laypeople ever consider. I don't know why, but it really surprised me. It just never occurred to me you guys have to clean up your own vehicles. I mean, surgeons don't decontaminate the OR after they finish with them do they? ER doctors don't clean up the cubicles between patients, right? But once I thought about it, I realized: the ambulance has to be ready for the next emergency, and if you guys don't clean it up, then who will?

I guess I see ambulances more as traveling emergency rooms than as taxicabs.
 
I had a low level admin job at a hospital. That facility had a patient advocate.

Did you speak to the patient advocate at the hospital if there is one) to review your care ?

It is possible they might arrange a meeting between you and the EMS (if hosp based) or the docotor to address your concerns.
 
elsacloud said:
I guess I see ambulances more as traveling emergency rooms than as taxicabs.
Click to expand...


In my EMT basic class the instructor told us the first day that EMT's do not save lives. Lives are saved in the hospital.

An EMT keeps the patient from getting any worse and rapidly transports him or her to the hospital.

IMHO, a taxi, an ER, and an ambulance are three distinct things.
 
The EMS and Hospital are separate entities. I've written the EMS and told them I thought they did a great job.

As for the Hospital, I filed a request that my Medical Records be amended, specifically, that the statement that I "became dizzy and came to the ER for further evaluation" be revised to better reflect what happened prior to my arrival in the ER.

Maybe the reason I have a bleeding ulcer is because something like that -- substituting "became dizzy" for hematemesis and melena -- really bothers me.

I was told by Medical Records that I would have a response to my request within 90 days. Stay tuned.
 
I am not sure I quite understand.

Did you get better ?

Do you believe your outcome was affected by the medical report ?

I am not an expert, but I dont see how "changing" the ER report will help you personally.

Did you speak to a lawyer ?

If there are 'damages', and they can establish that your care was affected by this oversight, then you may have a case.

It would also hinge on whether they treated you in a different way than the other patients.

(I do have experience with malpractice cases as an insurance investigator awhile back)
 
You must log in or register to reply here.
Back
Top