Radio Reports, Do They Listen?

[Simusid]

We transported a 94 YOF the other day with a c/c of "uncontrollable shaking". As expected we did a stroke assessment. The medic was giving the radio report to the ED. It was all very generic except that he accidentally said "Boston Stroke Scale indications are all positive" rather than "all negative". The ED acknowledged and did not question. I mentioned it to him right away and he said "oh crap" but didn't correct via radio.

We arrived about 2 minutes later and I was very surprised that we weren't met at the door with "Is this the stroke patient?"

Basically it made me wonder what the ED really hears and cares about.

 

[Veneficus]

We transported a 94 YOF the other day with a c/c of "uncontrollable shaking". As expected we did a stroke assessment. The medic was giving the radio report to the ED. It was all very generic except that he accidentally said "Boston Stroke Scale indications are all positive" rather than "all negative". The ED acknowledged and did not question. I mentioned it to him right away and he said "oh crap" but didn't correct via radio.

We arrived about 2 minutes later and I was very surprised that we weren't met at the door with "Is this the stroke patient?"

Basically it made me wonder what the ED really hears and cares about.

It depends...

Do you work in an area saturated by the most minimally trained? Is the volume of patients the ED sees very high? Who is answering the phone?

If the majority of local EMS providers are not very good compared to the standards of the medical/nursing community, not a public safety perspective, said providers might not give any weight to your report. All they care about is how long before you come.

Some high volume EDs want only to know if the pt is seriously ill or not.

What EMS thinks is important, what a nurse thinks is important, and what a physician thinks is important can be very different things.

I have a great story about calling a hospital where a nurse picked up the phone, I gave report to include an unstable pelvis, flail chest and a needle decompression for a pneumo on a patient who fell 3 stories before landing chest first on a guardrail. When I arrived the place was normal as can be and when I asked where the trauma team was a nurse looked at me quizically and said "If you wanted a trauma team why didn't you say this patient was a trauma alert?"

One hospital it is a helo dispatch center that picks up the phone and if you need orders they page a physician. They have a whole form of questions from vital signs to history, and after you answer it all, they send a one sentence page to the charge nurse that looks something like:

69 y/o male difficulty breathing ETA 5 minutes. (which by the time you finish answering all the questions you are in the parking lot because the transport times are short and the nurse gets the page 30 seconds after you arrive)

Sometimes medics don't even know when they are looking at an emergent patient because the pathology wasn't covered in medic school.

In all systems I have ever heard of when you get to the ED they take vitals an assess the patient. At that point maybe you could add an important finding or possible trend, but absent that, nothing that can't be read from your report. (Which is usually not read anyway unless spot checked or red flagged for your medical director.)

I especially like flags for narcotics usage. Particularly with pain management protocol like "2mg morphine every 10 minutes to a maximum of 10 mg." Might as well tell them to "man up and take the pain." (but that is another thread)

long and short, the chances anyone cares past patient age, chief complaint, and an important catch phrase like "trauma alert, stroke patient, or STEMI" is very remote in my experience.

 

[mycrofft]

Does you ER cuturally consider EMT's as "savages"?

Some have it as a matter of belief that whatever is done in the field is either useless or detrimental.

 

[MrBrown]

Depends how your system works really; if you call in for every single patient it and give one of those long, laborous reports out the Paramedic book then yeah I can see why they might just be like "yeah, yeah, whatever ...."

We don't have to call for all patients, only those who are status one (critical problem) or two (serious problem). Example "Hi it's Brown from Ambulance, got a 53 year old male new onset severe chest pain, somewhat relieved with GTN, ST elevation in anterior leads otherwise stable, status two, be with you in five minutes"

 

[NomadicMedic]

It's a case of YMMV.

In the Seattle area, there are several hospitals that only want to know you're coming. That's it. If you try to tell them vitals, they say, "I don't need that..." and hang up. The Level I trauma Center doesn't even want to know if BLS is coming. Don't call. Ever. Unless, of course, you're a Medic calling for orders.

However, on the other side of the mountains, the hospitals really want to know what's coming, even if you're bringing in a non priority BLS patient, so they can get a room ready or assemble the trauma team or have RT there if you need it... It just all depends on where you're bringing the patient.

As an aside, I called a trauma alert for a 1 vehicle rollover the other day, and when I got there with the patient, the Doc was amazed that I not only had pictures of the vehicle for him to look at, but I also had 2 16g lines in the guy. (I guess he was used to getting trauma patients with a 20 in the hand. hahaha)

 

[Veneficus]

Some have it as a matter of belief that whatever is done in the field is either useless or detrimental.

When all the patients are put on a spine board, high flow O2, brought in coded after being down for an unknown time, an 8+ minute response time, 20 minutes of ACLS on scene is it any wonder?

IN yet another of my anecdotes I witnessed an EMS unit bring in a 28 y/o who reportedly gave birth the day before who had rigor. When they pressed on her chest her legs raised up. When we looked at them they said "We were hoping you could do something for her!"

(Sorry, I left my magic wand that I raise the dead with at home today)

Another awesome one was 6 patients from a house fire completely burned to a crisp all with CPR in progress brought in simultaneously with red triage tags.


Nothing screams "healthcare professional" like emotion without reason.

 

[JPINFV]

When I was in Boston I gave a handful (N=exceedingly small) of notifications and just used the same entry note that I used in So. Cal. (age, sex, C/C, ETA, anything pertinately wrong or special needs). Despite everyone at my company telling me that "I'm doing it wrong," which included the fact that I call every hosptial that I'm going to (including all of the Boston hospitals), I never once had the RN ask for more info. However, remember, the plural of ancedote is not data.

 

[Akulahawk]

In my years in the Santa Clara County EMS system, it's a little different... The ED's seem learn who is who on the radio (or the phone, now) and either take whatever you give them with a pound of salt or they'll attentively listen to what you have to say about the patient. Good medics, they'll listen to. The not so good, well... thanks for bringing in the patient.

 

[KillTank]

I have asked a charge nurse this same question. She answered "all we listen for is Code, Level, Vitals stable/unstable, ETA, and Chief Complaint. Everything else we get when ya give us a oral" I guess it also depends on the PT. I'm sure a level III trauma wouldn't really be payed attention to as much as a level I trauma.

 

[rescue99]

We transported a 94 YOF the other day with a c/c of "uncontrollable shaking". As expected we did a stroke assessment. The medic was giving the radio report to the ED. It was all very generic except that he accidentally said "Boston Stroke Scale indications are all positive" rather than "all negative". The ED acknowledged and did not question. I mentioned it to him right away and he said "oh crap" but didn't correct via radio.

We arrived about 2 minutes later and I was very surprised that we weren't met at the door with "Is this the stroke patient?"

Basically it made me wonder what the ED really hears and cares about.

You were shocked not being met at the door?? I'd be more shocked if you had been met with a 94 Y/O pt.

 

[Flight-LP]

We transported a 94 YOF the other day with a c/c of "uncontrollable shaking". As expected we did a stroke assessment. The medic was giving the radio report to the ED. It was all very generic except that he accidentally said "Boston Stroke Scale indications are all positive" rather than "all negative". The ED acknowledged and did not question. I mentioned it to him right away and he said "oh crap" but didn't correct via radio.

We arrived about 2 minutes later and I was very surprised that we weren't met at the door with "Is this the stroke patient?"

Basically it made me wonder what the ED really hears and cares about.

What is the Boston Stroke Scale?

 

[JPINFV]

What is the Boston Stroke Scale?

Basically Massachusetts stole the Cincinnati Stroke Scale and made a specific wording for the slurred speech check mandatory.

 

[Flight-LP]

Basically Massachusetts stole the Cincinnati Stroke Scale and made a specific wording for the slurred speech check mandatory.

So the same criteria then?

 

[Aidey]

In my years in the Santa Clara County EMS system, it's a little different... The ED's seem learn who is who on the radio (or the phone, now) and either take whatever you give them with a pound of salt or they'll attentively listen to what you have to say about the patient. Good medics, they'll listen to. The not so good, well... thanks for bringing in the patient.

This pretty much. I work in a decent sized system but the nurses to get to know us. I see the same people on a fairly regular basis and the nurses who answer the radio frequently definitely learn the different medics and weigh the reports differently.

I must be doing something right because the last few times I've brought a patient in code to our main hospital the doc has met us in the room. I take that as a good sign I'm not blowing things out of proportion.

 

[JPINFV]

So the same criteria then?

Yes.

 

[wolfwyndd]

Basically it made me wonder what the ED really hears and cares about.

In this area it depends on a couple of things. 1. Which hospital we are transporting too. Our level 2 hospital north of us has ONE nurse / staff member that listens up to the radio part time. If they are busy and we make three attempts at contact we might not get an answer. If we NEED medical control it sometimes takes them a few minutes before we can get them. If it's something serious, they'll met us at the door, but more often then not, they just acknowledge. On the other hand our level one trauma center has a TEAM of nurses / staff that JUMP when the radio goes off. They'll listen CLOSELY and sometimes actually discuss treatment options and frequently ask questions. I've done clinicals at both hospitals and it's clear why one is a level 1 and the other is not just based in the quality of the staff.

 

[MrBrown]

Remember triage, triage, triage.

You are giving the hospital staff a quick report to enable them to make a preliminary triage decision regarding your patient. Pertinant details and any significant findings is really what is key.

Does the hospital need to know thier respiration rate and what kind of IV you have established? No, it's totally irrelevant unless you have a respiratory patient!

Does the hospital need to know what position the patient is in or who you are? No, it's totally irrelevant.

Remember, you as the ambo are making objective assessments, judgements and decisions about your patient. Hospital staff should respect your clinical decisions and you should respect them by not babbling on and on and on a load of stuff that has no relevance. If you do this they will gain confidence and respect for what you say and take you seriously.

Give the hospital a quick idea of how sick the patient is so that they can active appropriate resources and clear out resus or call down the surgical consultant or something like that.

For example

"Twenty year old male, status asthmaticus unresponsive to salbutamol and adrenaline, status one, see you in five minutes"

"Eighty five year old female, slip and fall, fractured right neck of femur, no other injury, pain adequately controlled with morphine and ketamine, status two, see you in five minutes"

Quick, simple and to the point.

 

[wolfwyndd]

Remember triage, triage, triage.

For example

"Twenty year old male, status asthmaticus unresponsive to salbutamol and adrenaline, status one, see you in five minutes"

"Eighty five year old female, slip and fall, fractured right neck of femur, no other injury, pain adequately controlled with morphine and ketamine, status two, see you in five minutes"

While I agree, triage, triage, triage, is the key, in both of the examples you gave, ALL of our local hospitals would want / need more information then that.

With the first example they'd wanna know if the patient was actually having difficulty breathing still (are they on O2, if so, how, a set of vitals wouldn't hurt either and whether or not we've started an IV or pushed anything else). If they were, it wouldn't be uncommon to have a respiratory tech waiting for us upon arrival to start some intervention.

In the second example we wouldn't state an actual fracture (unless the bone was sticking out). We WOULD state , obvious deformity, or severe pain upon palpation, or significant bruising of whatever our findings actually where. All our local hospitals, guaranteed, would ask for a set of vitals to see whether she was, or starting to go, in shock from hypovolemia AND whether she was on O2 and IV started.

I understand that both of the above are just example. But around here, neither of those examples would fly. And part of that might be your transport time. When I ran in Laurel, MD, we were never more then THREE MINUTES from our closest hospital, maybe 15 from our second closest. Out here near Dayton, OH our SHORTEST transport is 20 minutes and our longest could be 35 minutes. Your examples would be totally acceptable back in Laurel, but in Dayton it wouldn't work.

 

[MrBrown]

With the first example they'd wanna know if the patient was actually having difficulty breathing still (are they on O2, if so, how, a set of vitals wouldn't hurt either and whether or not we've started an IV or pushed anything else). If they were, it wouldn't be uncommon to have a respiratory tech waiting for us upon arrival to start some intervention.

Do you not give a handover to the hospital staff on arrival or are they just complete morons? I don't think saying "status asthmaticus unsresponsive to adrenaline and salbutamol" makes it very hard to fathom up what your treatment so far has been.

In the second example we wouldn't state an actual fracture (unless the bone was sticking out). We WOULD state , obvious deformity, or severe pain upon palpation, or significant bruising of whatever our findings actually where. All our local hospitals, guaranteed, would ask for a set of vitals to see whether she was, or starting to go, in shock from hypovolemia AND whether she was on O2 and IV started.

You are not inspiring confidence in me when it comes to whomever you give your patient too.

Honestly do they care that much about whether nana has a lock in or some oxygen on? I just cannot understand how it makes the slightest lick of difference!

Sounds to me like they do not trust you.

I should clarify that we have a national set of status codes for our patients which are used in triage; one is critical, two is serious problem and three is minor.

If I ring up the hospital and say I have a post cardiac arrest patient who is "status one" then they will know to expect somebody who is very critically sick, we'll go straight into resus and they have probably alerted the duty CCU and/or intensive care registrar/specalist whereas if I say somebody is status three then they'll probably end up in chairs or in the hall.

We also hand over to one of the nursing staff unless we're going straight into resus. For example with the asthma patient I would say something like "this is Bob, asthma started six hours ago gotten progressively worse, we've had him for 20 minutes, sats have gone from 97 to 91, air entry was poor when we first turned up and its now almost nonexistant, can't hear a wheeze, had continious nebs, .3 of adrenaline IM and we've hung a drip"

 

[trevor1189]

This is the exact reason that our local hospital has specific codes for critical patients.

CLASS 1 STEMI ALERT or CLASS 1 Cath Lab Patient.

CLASS 1 STROKE ALERT

CLASS ONE TRAUMA Patient for a general trauma alert.

CLASS ONE Post Arrest, ARCTIC Protocol

Also, with these patients our communications center will usually call the ER on the red "hotline" phone to insure the proper resources are ready on arrival.