I agree that rambling like a schizophrenic is not helpful. But that's a different matter.
If by "fluff" you mean the sort of filler needed to give flow to the events, I find that helpful because I think most people want to read the narrative as a self-contained story, something that paints a picture rather than just reporting facts.
Here's another example. Again, there are other ways to do it. But I think something like this tells the reader everything they might want to know about "what happened," both quantitatively and qualititively, the sequence in which it happened, and with necessarily detail but not too much redundancy (assuming other "checkbox" recording has taken place). Read it like you're a supervisor doing QI... or a lawyer. Then imagine painting the same picture without the "filler."
You are being sued for delayed response time and medical malpractice (sure, its frivolous, yet happens all time)
Dispatched emergent to Denmark St. and Mulvaney Rd. in Waltham for an MVA.
What is emergent in your system? Where were you, what time of day was it? How was the weather? Did you wear your seat belt? Do you always? Did you go out the night before? Did you drink? Do you do drugs? Have you ever done drugs? When was your last EVOC/CEVO course? What have you done to keep it "current"? Were you responding from a station? Is this where you unit is normally stationed? Was the music radio on? Do you have cell phone? Do you social media? Were you texting or youtubing or anything else prior to this call? Did you text or use your phone in any way during the response to this call? MVA? Can you explain what a MVA is? Technically there are no MVAs, only MVCs.
Arrived with Waltham FD to find two vehicles in the center of the road. A small sedan has a heavily damaged back end with 2ft of compression; a midsize SUV is behind it with a broken windshield and crushed front left wheelwell. An adult male is found ambulatory, who states he was the driver of the sedan, with no apparent injury and denying any complaints. He states that he needs no care but wants his son evaluated, a teenaged male still in the front passenger seat, who also appears well and denies complaints. The father states they were struck from behind at unknown speed while stopped at a light. Both occupants endorse restraints, and there is no gross intrusion or airbag deployment. They are left in care of FD and a second unit is requested for further care.
When did you assess all of this damage? Before patient care or after? Studies show we do not remember as well as we think we do (basketball/gorilla test as evidence). Did you take pictures? Why were these not in your report? Earlier you said you did not use your phone, now you did? Are you saying the damage you saw is a result of the crash? Are you a crash expert? What is the age of the teenager, adult or minor? High speed rear impact and no "apparent injury"...did you physically assess them? Did you palpate head to toe as instructed? Did you attempt any basic exam other than just speaking to them? Do I need to remind you about mechanism of injury and "hidden injuries"? If you did these, you did not document them. If you did do these things I am gonna segue into my next line of questioning and shred you. How much time did you spend on this assessment? So you did not physically examine them but you handed care over to a "lower level of care", is this correct? (Unless the FD are Basics as well, then we drop this point and move on). So your total exam of these two is they "appear to be well", can you elaborate on that very subjective statement. If they do not need care, why did you request a second unit? Why did you not request a second unit upon arrival when noting the heavy damage and multiple patients, especially noting the fact you are a BLS unit? You state they "endorse restraints", did you visualize any marks on their thoracic cavities?
An adult male is found in the driver’s seat of the SUV, slumped to the right against his seatbelt. He groans to painful stimulus but does not rouse. His skin is pale and cool, respirations are slow and irregular at 8/min, and radial pulse is thready and regular at 124. Breath sounds are grossly clear and equal. Oxygen is provided at 15LPM by NRB. An open abrasion is present on his left forehead, with blood found on the left upright support. There is no other obvious external trauma. A frontal airbag is deployed. There is starring of the windshield, seemingly from the airbag, and no other interior damage. ALS is requested.
Is his seat belt intact? What painful stimuli method did you deploy? (hope you didn't sternal rub). Did he have any purposeful movement after the painful stimuli or did he only groan? Was his groan a result of the stimuli or just coincidence as he is actually groaning from his injuries? So he had no purposeful movement when you did this test? Was this test ever repeated? What do you mean his respiration's are irregular? Are the shallow, sighing, noisy, what? Can you define what is meant by "thready pulse"? How many seconds did you check for a pulse? Did you check a pulse anywhere else? Are you sure the starring of the windshield was not an existing issue? Are you a crash expert again? Why would you imply it is from the bag, why would you not just say windshield is starred? Do you like playing detective? I see you have CSI skills too noting the blood on the post. Can you define abrasion? How big or how small was it? Have you had an abrasion cause so much bleeding that it is transferred to another object, enough for you to notice it? Surely this was more than a simple scrape..."an abrasion".
The patient is manually stabilized and a C-collar is applied; he is rapidly extricated, exposed, and fully immobilized to a long spine board. He is placed on our stretcher and secured with straps x5 and rails x2, then loaded onto A104. (A11 arrives and assumes care of the other patients; see their runsheet for further.) Transport emergently to Intergalactic Trauma Center with continuing assessment en route.
You call this a rapid extrication? Can you please tell me what your definition of "rapid" is because at this point in time you have assessed vehicle positioning, vehicle damage, interviewed two other patients, and are now deciding to "rapidly" extricate this patient. How did you manually stabilize the patient? What size collar did you apply? How did you immobilize him to a long spine board? Did you inspect his back prior to immobilizing? What was the weather again? So you exposed the patient completely, as in removed every piece of clothing? Did you have no concern for his privacy? Are you aware youtube videos by passerbyers were uploaded within an hour of this crash? Why did you not provide a sheet and some cover? How many firefighters were on scene at this time? Are you aware of the over use and abuse of long spine boards? Do you read current medical journals within your respective field? What is an emergent transport defined as? Were lights and sirens and fast speed truly indicated or should a more smooth, expedient transport ensued? How did you properly maintain assisted ventilations while being flung all over the back of the ambulance? Who was driving? Why? Who was in back with you? Why? What is a continuous assessment and what does that entail as we already have shown you are slow in delivery of care, you do not fully examine patients and you are haphazard in maintaining their dignity?
Bleeding from the head wound is minor. There is diagonal bruising of the chest consistent with seatbelt trauma, and no other major bleeding or deformity. The trachea is midline and there is no appreciable JVD. Chest rise is equal bilaterally, the ribs are stable, and the abdomen is supple and without distension. Vitals note a BP of 184/100, HR 80, and increasingly shallow respirations at 6/min. A grossly dilated right pupil is also noted to develop en route. An OPA is inserted and well-tolerated. Ventilations are assisted by BVM with mild hyperventilation at a rate of 20/min.
The bleeding is minor? It is an abrasion right? Was there any need to control it and if so, how? In what direction was the bruising and where exactly did it start and where did it end? Did you physically palpate every extremity and check for perfusion? Has there been any color changes or improvements noted? Can you elaborate on the significance of JVD, especially as how it relates to a trauma patient or are you merely throwing out a term which sounds good? Is having JVD a good thing or a bad thing in a flat lying trauma patient? Can you demonstrate the most effective method for determining JVD? How are breath sounds? In what fields? How did the abdomen look? Did the dilated pupil just occur as you did not mention it previously? Did you even check earlier? The patient had slow and irregular respiration at a rate of 8 when you first "assessed" him, however you have waited until now to start assisting the respirations? How much time has elapsed? How is his oxygen saturation? How is his color in the finger tips, lips, any cyanosis going on?
P4 intercepts at this time and assumes dual-medic care.
How long were you on the road before the intercept? Where did you intercept?
[Documentation note: See PCR 121512 for full patient demographics, billing, and ALS care en route.]
Strong work.