EMS Communications
The use of first responding fire apparatus to emergency medical calls has added significant value to the service our agencies provide. By arriving at the patient's side sooner and initiating medical care, a predictability better outcome is favored for the patient. As emergency first responders, there is a great deal of information that can be gathered that will in turn reduce the needed scene time by the transporting unit. Depending on the medical presentation, these minutes can have a tremendous impact on the recovery time and prognosis. Utilization of a formatted report when exchanging patient information is a key step.
Much of the information that needs to be relayed is the same information that you will gather during your patient assessment. This includes the details of the SAMPLE survey and results of the chief complaint assessment using the OPQRST mnemonic.
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S - signs and symptoms A - allergies M - medications P - past medical history L - last meal or oral intake E - events prior to the |
O - onset or origin P - provokes or palliates Q - quality of the pain/discomfort R - region and/or radiation S - severity T - time |
While these subjective facts are a critical part of the overall patient care package, if they are forgotten or not reported (during the turnover report) they can be reproduced through repeated assessment questioning. Therefore, the information you acquire during the objective survey may yield details that cannot be replicated once the transporting crew and the first arriving/responding crew part ways.
Relevant information that is attained through first arriving members and should be included as part of the turnover report includes the following:
Presentation on Arrival
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As part of the on-scene size-up, responders are trained to visually scan the scene to pick up important clues to assist in determining what may have occurred. In trauma cases, this information is tied to the evaluation of the mechanism of injury. For medical emergencies, the observations of the scene and the environment can give clues to contributing factors. Initial observations can play a pivotal role in the selection of treatment modalities and should always be relayed to the ambulance crew.
Comments and Actions by Witnesses or Bystanders
At many accident scenes, witnesses and bystanders tend to disperse once trained personnel begin to arrive. As first responders, take the time to interview these players. Ascertain more specific details of the event. Ask if any treatments or medications were administered prior to your arrival. Question them regarding patient movement, actions, verbalizations. There are many lines of questioning that can be followed. Take the time to tap these resources for needed facts and assure that the information is passed along to the transporting crew.
Initial Treatment and Treatment Plan
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As the initial care providers, you will be expected to initiate treatment for the patient. Sometimes, the reason a particular treatment is selected is very evident. At other times, it may not be as clear. As part of your turnover report, take the time to explain to the receiving technicians the reason for beginning a particular protocol (especially for the not-so-obvious ones). This brief explanation will assist in the continued care as the patient is transported.
Response to Treatment
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If medications or other modalities are begun, it is important to identify both the positive and negative outcomes. This may prevent the receiving technician from attempting a therapy that once failed or may provide guidance for further therapies.
Additional Findings of Relevance
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This topic area is used as a catch all for all of the other bits of information gathered. Of note, be sure to relay any directions or instructions that were given to the family (destination/receiving hospital, patient status, etc.), significant medications or allergies, and any identification or insurance cards. Whereas these may not be as pressing as the other facts, failure to promptly relay these details can impact patient care.
In a perfect prehospital care world, there would be enough time on-scene for a complete dialogue between the initial caregivers and the transporting members. However, critical injuries or medical conditions can limit our scene interaction time. Also, the need to have "all hands" focused on the patient(s) can impair our communications. Even under the most distressed conditions, the effective continuum of care requires a brief report.
One reporting style that is designed to be both effective and expedient is the MIVT report. This acronym stands for:
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M - mechanism
I - injuries
V - vital signs
T - treatment
Nearly 20 years ago, the University of California San Diego (UCSD) Life Flight was using this reporting system. The intent of the MIVT report is that it can be transmitted in about 30 seconds and can be used both on-scene and at the receiving medical facility. A MIVT report focuses on four critical areas and emphasizes the description of only positive findings and pertinent negatives. By employing this format, a brief report is possible under the most stressful conditions and important details are not overlooked.
Regardless of the style you use, one cannot disregard the need for an accurate, concise and timely report between the first responders and those responsible for care during transport. This skill is improved with practice and repetition. As with any skill, practice makes permanent, so practice correctly so you will perform correctly.
