Administration and Leadership, Columns

Readers Discuss Reading and Writing Patient Care Reports

Issue 7 and Volume 40.

Fact Checking

This month a reader expresses skepticism about a source Victoria Bradlee, PA-C, MHS, BS, EMT-B, wrote in her article “Pediatric Deficiencies: How can we improve proficiency in pediatric care?” from the April issue. Bradlee then responds to the reproach. Another reader defends the EMS electronic patient care report (ePCR), as talked about in “Collaborative Data: Rethinking the way EMS does patient care reports,” by Mark E.A. Escott, MD, MPH, FACEP, in the May issue.Questionable Statistic

Questionable Statistic

Regarding the April 2015 article “Pediatric Deficiencies” by Victoria Bradlee, PA-C, MHS, BS, EMT-B: This was a nice article with good intentions and I appreciate JEMS publishing it. However, I feel there’s a statistic within this article that seems questionable and may have quite an effect on those who read it.

While reading about “where the problem begins” on page 47, the author cites several statistics about EMT and paramedic training programs as they relate to pediatric training. It’s stated that paramedic programs “average 8–15 hours devoted to the pediatric population, but there are some programs that don’t devote any time to teaching about the pediatric population.” I found this statistic quite startling. The national educational standards for EMS spend quite a bit of time on the pediatric population. There’s time spent on therapeutic communications, lifespan development, anatomy and physiology, respiratory, trauma, pediatric ALS, obstetrics/neonate, and pediatrics in general. Now, I fully understand that not every educational institutional will teach all of these things, but I find it hard to believe that there are programs in our country that “don’t devote any time to teaching about the pediatric population.”

When looking at the source Bradlee provided for these statistics I was stunned to find it was from 1986!

The national paramedic curriculum has been changed and updated several times in the past 29 years and many programs have become accredited. I know of no state EMS authority whose state curriculum shows “0” for pediatric training hours.

I feel that this statistic is misleading and isn’t representive of the current state of EMS education in our country. Yes, everyone would most likely agree that we could all benefit from more pediatric training. But, the validity of this article is immediately suspect when a source from 1986 is used to cite what current programs are doing. I would challenge Bradlee to provide a source that shows there’s an active, current paramedic program in America that devotes zero hours to pediatric education. And, if there is one, show us that this is a recurring problem and not just an anomaly.

Justin Hunter, MPA, NRP, FP-C
Via email

Author Victoria Bradlee, PA-C, MHS, BS, EMT-B, Responds

Thank you for your response to this article. I appreciate you pointing out this reference as I originally debated about whether or not to use this source. As I’m sure you know, generally sources older than five years aren’t included because of exactly what you pointed out–they’re outdated after that time. I performed a gap analysis prior to writing this article and I was astounded at the lack of research in this particular area.

I agree that the curriculum has been updated many times in the last 29 years and the current curriculum is cited in the original article. However, I found it important to use this article to show that, although there have been updates, there still is no baseline requirement for training on pediatric patients.

While I agree it’s unlikely that many (if any) programs don’t teach pediatric curriculum, it’s still unacceptable that there isn’t a standard being taught throughout the nation. This then also brings to question the content of what exactly is being taught.

The purpose of this article was to raise awareness about the lack of education specific to pediatric medicine in the prehospital setting. Thank you again for taking an interest in the article, I can only hope that it inspires educators, like yourself, to work toward increasing training to better serve future patients.

EMS ePCRs

I think the biggest issue [to completely thorough ePCRs] is going to be time pressure. I can’t speak for other systems, but I am required to justify any time I spend longer than 10 minutes on scene, or I risk the wrath of quality assurance. Even at nursing homes, I don’t have time to do more than glance through the chart for a summary of the patient’s history, meds and allergies. If there’s an ECG in there, that’s a bonus. But if there’s no summary, I don’t have time to dig through a year or two of charting in order to assemble all that information myself, because I also have to deal with the (possibly) emergent situation in front of me in a very limited time. I also don’t have time to wait for all that information to download over a (possibly low-quality) cellular connection, if I have a connection at all.

On the EMS charting side, I’m lucky in that my agency’s call volume is such that I can usually finish my ePCR at the hospital. But it’s not uncommon to get stacked 3–4 call reports deep, at which point details start to blur together. Unlike physicians, though, I don’t have the nursing notes and test results already documented to look at to refresh my memory by the time I get to catch up–often the most I have is some basic information and vital signs written on the back of a glove, and maybe the ECG and vitals printed from the monitor.

My charting is as comprehensive as I can make it–in the context of the incident I was called for, and my treatment of the patient. There’s certainly room for improvement in individuals and the system, but doctors need to understand that EMS reports are a focused snapshot, not a comprehensive report, and read them in that context rather than disregarding them completely.

Jacob Miheve
Via jems.com