On Scene Handoff Reports

RedAirplane

RedAirplane

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There was a thread that touched on this earlier, but I'd appreciate some help with giving on scene handoff reports. (Handoff from a BLS first response unit to an ALS transporting unit).

I find that on scene I get a little rushed or flustered so I either omit something or my handoff report comes out awkwardly.

Practicing at home with past scenarios I've dealt with, I can deliver a good report, but it takes a whopping two minutes on the stopwatch. Is that too long?

Do you have any suggestions on how to practice?

Here's an example of my handoff as practiced at home, which seems to take two minutes if I don't rush it.

"Mr. Doe, these are the paramedics and they are going to be taking over from me. This is Mr. John Doe, a 57 year old male with a chief complaint of chest pain. Mr. Doe was in the Starbucks over there when he experienced sudden chest pain and walked up to the police and asked for medical aid. He sat down on the curb here and hasn't been able to get up. He describes the pain as a severe pressure in the region of the sternum and denies radiation of the pain to other parts of the body. Mr. Doe denies drug allergies and reports a history of "heart and liver" problems, but can't clarify and doesn't know the names of his medications. He was last eating in the Starbucks. Our exam found no trauma to the chest or obvious difficulty breathing. Mr. Doe has pale, cool, wet skin with vital signs of HR 120, RR 20, BP 100/P. We placed him on 2 L of oxygen via N/C and gave him a blanket. Is there anything about our care for Mr. Doe thusfar that I can clarify for you, and is there anything we can do to be of assistance to you?"
 
"Hey guys this is John. He is 57 years old and has a C/C of chest pain while he was standing in line at Starbucks. Once the pain started he sat down on the curb and hasn't been able to get up. He states the pain is a severe substernal pressure that is non-radiating. Denies allergies, has a Hx of an unknown heart and liver issue and takes unknown medication for them. No trauma to the chest and he denies SOB. His vitals are ______. We gave him 2Lpm O2. Any additional information you would like to know?"

I don't hand over care to often in the prehospital setting (just pretty much to flight crews) and the hand overs we get from fire is literally "this is John and he is having chest pain".
 
As a medic that interfaces with BLS crews pretty often, I don't need much of a hand off from you.

"This is John and he's been having chest pain".

Not that I don't trust you, but I'll ask my own questions and do my own assessment.

The only other thing I care about is what you've done that will impact my treatment. Like NTG or ASA.

That's it.
 
Subjective- the quick story of how 911 was activated

Objective- abnormal vitals or physical exam vitals ("vitals are normal" is satisfactory, or say "vitals are normal except for...")

Assessment- what's your DDx, differential diagnoses, or what do you think is causing symptoms.

Plan- what intervention have you started and how is he responding.

"This is John Doe he 57 and had sudden onset if chest pain and exercise intolerance. He has a Hx of heart and liver disease but can't elaborate, and he doesn't know the names of his meds. No allergies. Vitals are normal but skin waa pale cool and diaphoretic before we put him on 2 liters. Anything else I can do for you?"
-give a hand written sheet with patients name, age, date of birth, list of meds allergies etc, vitals and times, interventions and times.

Verbal reports are not for fine detail, no one has that much attention span. Give the important facts verbally and details on a run sheet.
 
Agree with the rest. The ALS crew will (or should) do the whole assessment again themselves. No need to waste time. More than likely they ALS crew isn't paying much attention to you anyways.

Complaint, vitals and interventions. Done.
 
So something like this would suffice?

"Hey guys, this is John, a 57 year old male complaining of chest pain. He walked here from the Starbucks and can't get up now. We got him on oxygen and gave him 324 of ASA PO. Here's his medical history and vitals."
 
I think you went from one extreme to the other. The report above makes you sound like a lazy provider, it indicates you didn't ask about meds, Hx, allergies etc. Give me pertinent ones or say no significant ABC, but don't just leave it all out.

Verbal reports are a skill that need to be practiced, you'll get it.
 
Well, he did give the medical history (presumably including allergies and meds) and vitals. I think that report is short, sweet, and to the point. There's nothing more I would need as the ALS provider.
 
Any tips on practicing? It's very difficult to come up with a realistic practice scenario. Things seem to move a lot faster in real life than in a scenario you watch or read through.
 
RedAirplane said:
Any tips on practicing? It's very difficult to come up with a realistic practice scenario. Things seem to move a lot faster in real life than in a scenario you watch or read through.
Click to expand...

I don't think you need to practice. Just focus on keeping in mind the few things that you know ALS providers want to know, and tell them. Relax and speak naturally when you give report. It will get easier with time, but in the meantime there's really no need to stress over it.
 
Ewok Jerky said:
I think you went from one extreme to the other. The report above makes you sound like a lazy provider, it indicates you didn't ask about meds, Hx, allergies etc. Give me pertinent ones or say no significant ABC, but don't just leave it all out.

Verbal reports are a skill that need to be practiced, you'll get it.
Click to expand...

How does that make him sound like a lazy provider? More than enough info to get us started for someone coming into our ambulance. Anymore and you are just wasting your breath. Unless the pt is unable to talk for some reason now, then you'll be asking the same crap again, and probably again if you are about to give a ned.
 
RedAirplane said:
Any tips on practicing? It's very difficult to come up with a realistic practice scenario. Things seem to move a lot faster in real life than in a scenario you watch or read through.
Click to expand...

Scenarios IMO will not help you much. If you know OPQRST and SAMPLE you'll be fine. You'll notice that even when long time paramedics try a scenario, it is "difficult" for them due to how unrealistic it is.

It sounds like you know how to at least do a BLS level assessment. Write your findings on a little piece of paper if you have to. After a while you'll notice you don't need the paper anymore.

Biggest advice is to just relax and stop getting worked up over something that in reality, is very simple.

You're an event EMT right? It may be a while before you get the OT contacts you need. Especially different types of patients.
 
Chewy20 said:
Scenarios IMO will not help you much. If you know OPQRST and SAMPLE you'll be fine. You'll notice that even when long time paramedics try a scenario, it is "difficult" for them due to how unrealistic it is.

It sounds like you know how to at least do a BLS level assessment. Write your findings on a little piece of paper if you have to. After a while you'll notice you don't need the paper anymore.

Biggest advice is to just relax and stop getting worked up over something that in reality, is very simple.

You're an event EMT right? It may be a while before you get the OT contacts you need. Especially different types of patients.
Click to expand...

Yes, right now I am in an event medical role.
 
RedAirplane said:
So something like this would suffice?

"Hey guys, this is John, a 57 year old male complaining of chest pain. He walked here from the Starbucks and can't get up now. We got him on oxygen and gave him 324 of ASA PO. Here's his medical history and vitals."
Click to expand...
That's fine for me. Two minutes is way to long and I just can't remember that. A brief recount of what led to your arrival, what you've done, and anything abnormal. Relevant history is worth mentioning. But better yet, write all that down. It isn't that I don't care what you have to say, I just won't remember all of it.
 
It sure is interesting how things are done elsewhere. As little as 10 years ago, the ED nurses would essentially disregard our story and vitals, even if the most recent set was acquired while giving report. About 7 years ago, that started to change. Initial ED charts began including our most recent set of vitals rather than have them complete their own. They started paying more attention to what we said. A few years later (and with help from other influential persons), if we advised that CPAP would be required, before we had CPAP in the field, it would be available upon arrival.

We've essentially told the ED, in not so many words, that they need to listen to us and that we are worthy of their trust. As it stands today, we have an outstanding relationship with the ED. Rarely are questions asked as to why we did or did not perform an intervention.

That said, we don't have multiple EMS agencies covering the same territory, so the only time an outside service is present is if they were the closest unit to the call after their transfer. We usually get sent to relieve them so they can get back to their coverage area. I have yet to see a medic from one service dismiss the report from the initial EMS provider. We have a good relationship with outside crews and have yet to have reason to no take their report at face value. To us, this falls under the professionalism umbrella as we presume our colleagues and counterparts to be competent and respectable. It is rarely otherwise and we know who they are.

RedAirplane: A thorough report of your observations and findings are what we want and need. Your first written report is excellent and we won't have to waste time or annoy the patient by asking the questions you already have. We would then carry on from where you left off and see where additional questioning brings us.
 
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