Six Tricks You Can Use Today to Improve Your EMS Narrative Report

The EMS narrative report is the most information-rich part of the EMS patient care report. As I've said before, (here and here), the EMS narrative is the part of the EMS report that provides the most information in a way that humans can actually digest. Unfortunately, there are a lot of EMS people out there that still don't quite "get it" when writing their EMS narratives. Here are some useful tips and tricks that you can start using today that will improve your EMS narratives and improve your overall patient care.

 
  1. You made decisions on the call. Put in the information you used to make them -Every patient's outcome could be directly attributed to your actions and the care that you gave to them. Remember that deciding to give one form of care over another is a decision that you must make with your clinical judgment. Put the information that you used to make the decisions you made in the report. For example, if the patient had Wolf-Parkinson-White syndrome and it was causing a narrow-complex tachyarrhythmia with a ramp-up in the PR interval showing pre-excitation syndrome and you chose to used synchronized cardioversion over adenosine because of it, well then you should probably provide that information in the narrative.
  2. Remember that you're painting a picture with your words – Imagine yourself reading this report several years down the road, perhaps because the patient has sued you and/or your service, or perhaps because your care is being reviewed. In both cases, you won't remember the call clearly because it will have blended in with so many others. You will be held responsible for the content of the report and only the stuff that you wrote in the report will be allowed into court. Be descriptive. Look at the following sentences:

     

    1. "Pt's left lower leg was found to have a fracture below the knee. Fracture splinted in place with pillow splint and tape"

       

    2. "Assessment of Pt's left lower leg showed a probable angulated fracture of the tibia/fibula below the knee. Distal circulation was found to be slowed but present with capillary refill approx. 7 seconds with no palpable pedal pulses and colder skin distally. Unable to straighten Fx due to severe pain and resistance to manipulation. Fracture splinted in place with pillow splint and tape due to the above.

     

    Which one of those sentences tells your medical director more information? Which one of those sentences shows that you're a competent medical provider? Which one of those sentences would you rather base your legal defense off of if the patient decides to sue you for loss of function in their foot? The second one took me 12.4 seconds more to write, but could save years of headaches. It clearly states that you found the injury on assessment (ie, that you didn't cause it) and that you attempted to, but could not restore distal circulation within the scope of field care, and that you did the best you could to take care of it.

 
 
 
  1. Organize the order of information – High school Freshman English teaches students that the way to write a proper essay is the "at least three paragraph" method (I think, because I was sleeping by then, mostly). My teacher taught me (and it was an um, not too long time ago? How many reunions has it been?) the "Tell them what you're going to tell them. Tell them. Then tell them what you told them method" this roughly translates into the "Introductory paragraph", the "body paragraph", and the "Conclusion". A Simple, one-page Freshman essay in three easy steps. In EMS reporting we probably won't often go into three paragraphs (even I don't) but we can use the SOAP (Subjective, Objective, Assessment, treatment Plan) or the chronological methods to organize the information. To put the above all simply, if you're going to say: "Patient was found to have a 3 inch laceration above his eye" don't put it right after the sentence "Patient was complaining of pain above his sphincter"…. It could cause confusion.
  2. Take a few moments to plan what you're going to write - Let's just say that if you're an EMT you're probably no Dave Barry when it comes to writing ability. Therefore you probably cannot just sit down and plop out whatever pops into your head onto the computer screen just like that. Heck, I'm a trained EMS blogger and I can't even do it. Reflect upon the call in your mind before you write the narrative, remember important events and observations. Think about how you want to tell the story to your reader.
  3. Think about documentation during the call – There are certain tools, assessment findings, and procedures in EMS, and any medical practice, that exist only for the purpose of providing fodder for documentation. No, I don't believe that the numerical reading on a pulse-ox exists solely for placing within a patient care report, but I give oxygen whenever I think that their clinical presentation warrants it (or if I just feel like it) However, it's great for documenting in your vital sign trends. Think about it this way, when you come across the unconscious/unknown and get a history and physical assessment that points towards hypoglycemia confirmed by a glucometer reading of 20mg/dl and you're a paramedic (or an Intermediate) you "sweeten them up" with an amp or so of D-50. What do you do next? After the med takes affect you probably recheck the glucose reading to confirm that it worked… so you can write it in your narrative report. You probably also state that the patient became alert and oriented x 3, had return of color, and had good vital signs. There are plenty of these data points to remember. Be mindful of them and they will find your way into your reports, creating great documentation.
  4. Do I really have to say it? Really? Still? – Maybe it's because I'm no good at math so English has to be my "thing" by default… but I hammer people for grammar (I rhymed there, see? Grammar is fun!) The first and best way to get people reading you to think that you are an idiot is to pepper your writing with spelling and grammatical errors. It makes you look dumb. There, I said it. Please pay attention and try to do the best you can with your documentation. Really. Spell check and proofreading are your friends. Go back and read what you wrote. If you wouldn't want your doctor documenting your care record like you just documented your patient's, fix it. Enlist the aid of your partner and get them to proofread it too. Who knows, you may find something that you missed altogether.

EMS documentation doesn't have to be hard, It doesn't have to be tedious, and it certainly doesn't have to be done poorly to save time. Build your narrative structure and style and improve it over time. Before too long, with your work and the help of others, you will be writing quality narratives that will serve your legal butt and your patient's health well.

For more information, please read the following information on the EMS narrative report, SOAP charting, EMS Charting, and EMS Patient Care Reports.

Soapy Pictures – The EMS Narrative Report

More on EMS narrative reporting

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Chris Kaiser aka "Ckemtp"

I am a paramedic trying to advance the idea that the Emergency Medical Services can be made into the profession that we all want it, need it, and know it deserves to be.

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