Not long ago, I saw one of our emergency medicine resident physicians furiously looking through papers at the nursing station. I watched him for a bit and finally asked, "What are you looking for?" He glanced up and said, "The EMS sheet for Crit 4. I can't find it." I started to help him look through the endless stack of papers in the emergency department (ED) and we finally found it. He grabbed the pink run sheet and disappeared into a treatment room.
Believe it or not, the EMS run report is very important to emergency physicians. It often provides a different perspective on the patient and their complaint. Large EDs like ours commonly use totally paperless (so they say) patient tracking and record systems. These programs use various preprogrammed cues and prompts that guide the staff and physicians to document the patient's course through the ED. They're extraordinarily detailed with time, date and provider information. But, even with this degree of documentation, it's often hard to get a clear picture of the patient's complaint. This is where the EMS run report comes into play.
One of the fundamental functions of EMS has been to bring sophisticated emergency care to the patient's side. The founders of EMS actually referred to EMS as a component of the hospital emergency room. I think this concept is true. There's truly a continuum of care that begins with EMS and continues into the ED and subsequently, into the hospital. But, the continuum of care is based upon bidirectional communications between all parties involved. As an attending emergency physician in the ED of a big university hospital, I rarely interact with paramedics and EMTs. The so-called "handoffs" now occur primarily between the EMS crew and the nursing staff.
The information EMS personnel glean in the field about a patient is extremely important to emergency physicians as we care for our patients. I can't count the number of times that something I read in the EMS report helped guide me in subsequent assessment and care. I remember seeing a patient who had been in the ED for a while and had reportedly fallen. But when I reviewed the EMS report, it showed that she had experienced some chest pain and subsequent syncope. This finding changed our strategy all together.
A Good Report
So, although most EMS personnel dread the run report, it's extremely important. As you complete these reports keep the three major goals in mind:
- Provide information to subsequent health-care professionals about the patient and their treatment in the prehospital setting. This information helps the nursing staff, emergency physicians and even physicians who will be caring for the patient in the hospital.
- Provide essential information for proper billing of the patient. There's a direct correlation between the detail of the report and the level of reimbursement subsequently provided for care and transport of the patient.
- Provide a legal record of the call's circumstances. There have been many cases where poor documentation was a factor in EMS personnel losing a lawsuit and many cases where good documentation has resulted in EMS personnel winning a lawsuit -- or, more likely, not being sued in the first place.
Most EMS services emphasize the latter two of these goals. The point of this article is to get you to think about the first goal as well. As you prepare your report, think of it as a written message to the emergency physician who will be caring for your patient. What do you think they need or would like to know? Talk often with local emergency physicians to learn what information from the prehospital setting is particularly important in ED decision-making. Likewise, we should provide you feedback and information about the patients you transport. Ask if the information isn't volunteered.
The work EMS providers perform is important and lifesaving. And, the information you provide to us in the ED is invaluable. Please keep up the good work!