Those Darn Kids!

These darn kids and their new-fangled toys!

Call me old fashioned if you want to, but allow me to hike my EMS pants way up higher than my belly button and talk in my Old Grizzled Medic voice for a second here. You see, the kids these days are doing something that just tans my hide. What, with their iPhones, and their iPods, and their iPads, and me with my iGlasses and the Etch-a-Sketch… Confound it! I just don’t understand.

You see, Youngins’ back in my day we didn’t have all of these fancy techno-toys that we do now. When it came to running on the ambulance, we made do with what we had and that was the way we liked it. What, with all of the trudging 20 miles to work in the feet of snow uphill with the both ways and whatnot we earned our measly pittances and then trudged back home to our coal-heated shacks to jitterbug away the three hours we got off of work in between our 120 hour shifts. We didn’t need all the pansy stuff you enjoy now.

We did our medical care to the best of our abilities then. We actually had to LIFT our patients into the ambulances on the cot, rather than having the little button lift 700lbs with one finger. We had to look at actual paper maps to find addresses, rather than having the nice lady in the GPS tell us where to go. Heck, we even had to write paper reports on our EMS calls BY HAND USING A PEN.

Paper reports written by hand do one thing and only one thing very well. They suck. They are simply awesome at sucking. They stink on ice. They are medieval torture devices left over from the Monty Python version of the Spanish Inquisition and honestly, the day we switched over to computerized reporting I stabbed a wooden stake through a stack of the dreaded Illinois “Bubble Sheet” EMS report forms. Then I poured gasoline on them, turned around and flicked a match behind my back as I walked away in slow motion without looking back at the explosion and flames. I was wearing sunglasses. It was epic.

It was just like this, but without the little girl. Also I was shirtless, and pastier.

Paper reports could be documented at the patient’s side but it just always seemed so darn inconvenient to do so. I did it occasionally during long transports, or when we were running back-to-back calls and I wanted to jot down the high-points of each call on the report form so I could accurately remember them when I got the chance to catch up on my paperwork. It wasn’t uncommon to be down four or five reports in those days because we were just so dad-gum busy and the reports took so blasted long to `complete. A stack of those paper reports could give you writers’ cramp for days. Especially the Illinois “Bubble Sheet” forms which I used for years, they were awful monstrosities constructed to worship the demon “ScAnTr0nn” who mandated that little bubbles be filled out perfectly for every name, address, and number you scrawled on the form. Those evil little dots cost me hours of my life, a good amount of my hair, and most of my sanity. After using the awful bubble sheets for years, I switched systems to a place that utilized a somewhat less-evil paper report form, and then back to a place that still used the hated bubble sheets, and then Huzzah! To a place that had computers.

Although I must admit that the hand-strength I developed from writing those awful things made my one-handed beer can crushing trick a hit at parties.

The first report I wrote on a computer was a simple little form written on a then state of the art laptop that weighed approximately 17523lbs. It took forever to load, locked up and lost reports frequently, and was an absolute gift from God. Then, the regional EMS system stepped in and put computers in the EMS report rooms at the hospitals because nobody could ever figure out how to hook up their ambulance laptops to the ancient dot-matrix printers they’d provided for us. Those programs were sweet! I hate switching my hand between a mouse and a keyboard 15 times per second to enter data and the reports we used on the desktop were forms I could simply use the keyboard with the whole time. I actually typed faster than the program could keep up and knew just how many times I had to tab through a list to mark the correct spot on the form without seeing it on the screen. I’d end up having the report typed out a few seconds before the machine caught up and put the words on the screen. It. Was. Awesome.

Still, those reports were something that could only be done away from the patient’s side. We all had note pads to jot down info we wanted to put on the report while we were treating the patient and we took those notes to the computer to enter into the report. Nowadays, them kids with their fancy technology have Toughbooks with touch-screens that they use to write their EMS reports and since their invention, I’ve noticed a trend.

It first started when I noticed my medic protoge Chad had a habit of bringing the toughbook in with him to emergency calls. He’d grab the jump kit, the o2 bag, and the computer. Then, while he was interviewing and assessing the patient, he’d be starting their report.

This dismayed me. Again, call me a crazy old coot and an old-fogey’ but I believe that we should not only focus 100% on the events of the call and upon what the patient is telling us, but also that we should give the appearance that we are doing so. You just can’t make me believe that a patient is going to feel that we are listening to that which ails them and are paying attention to their needs when we have our nose in a lap-top. Sure, it may save time on the overall reporting process by allowing the EMT to get an early start on the documentation, but it also ends up taking more time on scene to wait for the computer to enter in information. I also think that it takes away the EMTs ability to fully observe everything that is going on with the patient and the scene around them. It robs one of their situational awareness and of the nuances of the patient assessment.

That, and it’s just plain rude.

It bothers me enough that I launched a whole ridicule-based diatribe against my young protoge and shamed him into no longer bringing the computer into calls with him. I have no problem if he begins the report at the patient’s side during transport as long as he has completed everything that needs to be done and he makes sure to monitor the patient thoroughly. That’s cool, I guess. I am glad that he won’t have to suffer the pain of hand-written EMS reporting. That’s a cross us Grizzled Old Medics bore for you with honor.

You’re welcome. Now get off my lawn, and STOP USING THE COMPUTER IN FRONT OF THE PATIENT!

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  • Msparamedic

    I still have paper reports here. I’ll run 8-10 calls back to back and have to try to catch up before we get a new influx of calls that I call “night watch.” I’d kill for ePCR… But I dont start jotting notes until right before my ER report and I have a clear picture. See? There is hope for the generation!

    • Ckemtp

      I’m going to start up a collection fund to get you an ePCR. Really. Maybe our friends at Zoll can help.

      • ZOLL?!?! HAHAHAHAHAHAHAHAHAHAHAHAHA We have been user there CAD/Billing software for a little over 2yrs and just got a quote to add ePCR ….. $2,000 for server Upgrade and then $3,000 per Computer (Not counting the Computer) for our 14 truck company with the computers not counting the monthly wireless data charge $65,000 for the upgrade plus addtional $6,500 per year for support! – Done Ranting – Sorry

        • Ckemtp

          Holy Crap! That’s ungodly expensive! Wow…
          Sent from my U.S. Cellular BlackBerry® smartphone

    • N3qtrtme

      Talk to ESO Solutions or some of the billing companies… they will pay for the laptops and no servers are necessary. Good luck!

  • in_the_city

    How is the statement, “Sir/Madam, I’m going t write down what your saying on this tiny note pad” different than, “Sir/Madam, I’m going to chart the information your giving me on my fancy computer”?

    I’m not saying do the narrative, but recording vital signs, assessment findings, meds, and past medical history, I don’t see how thats different from taking notes on a piece of paper.

    I guess I dont see it as rude if you tell people what you are doing is necessary.

    But all thats just me because I’m still using paper. But I can knock a paper PCR out in 10 minutes or less unless it’s something crazy.

    Oh and on a purely personal note… IL department of public health just issued NEW bubble sheets. It makes the old ones look like a hug from a care bear. 3 times as long, and places to record insurance information. It’s evil.

    • JPINFV

      From what I’ve seen with ePCRs there are different pages for different parts of information. So switching between different parts of the subjective (e.g. history of present illness, medical history, medications, allergies, etc) also means switching between different pages on the ePCR. Paper PCRs, on the other hand, allow you to more seamlessly switch between different categories since all of the boxes for those categories are on the same page.

  • Awesome post. We still use those triplicate copy pen/paper PCR’s here, and we have to complete them before we leave the hospital. We have them on a clipboard and while we don’t take them on scene, we do use it to fill out the name, insurance info, next of kin, and vitals. However! I refuse to actually write the body of the PCR or fill in any of the other blanks while I’m with the patient. It makes me feel like I’m ignoring them and it bugs me. So after we’ve transferred care at the hospital there’s a little desk where we go to finish the paperwork. Then the hospital gets a copy to put with the chart and we are back in service.

  • Anonymous

    You guys have computers? And motorized stretchers? Damn.

  • I dunno, I can write a report faster on paper than the people who’ve been trained to do it on the computer can enter their data. And god forbid you work a call with someone who’s not in the system.

    Now don’t get me wrong. I’m an IT guy for a living. Really. I fix computers all day long, and I play with them when I’m off duty. But adding technology to this aspect of our jobs isn’t really helping.

  • Jon

    I find this whole thing rather hilarious, I could just imagine my partner bringing in an etch-A-Sketch and jotting down his notes on that…he most likely doesn’t even know what that is!

    The people who have failed to learn the most basic things like remembering a patients name (that is not already written down on your toughbook) and having to write down vitals on your sweaty glove, and having to actually take a quick non-union break from work for 10 minutes at the hospital to enjoy some apple juice and whatever seemingly over-healthy snacks are in the break room at the hospital to write a report or even god forbid you should have to circle some bubbles on a piece of paper!

    I thoroughly enjoy those days when we get a call and we get to the hospital and my partner has informed me that his toughbook crashed and he can’t remember any of the information he wrote down while doing his assessment…it gives me great satisfaction when I am the only old (but still quite young) guy who can still run a call even when our computers are down!

    I think it would be a wise thing to make younger medics learn how to draw circles and remember things, it makes the worst situations much easier to handle…

    On another side note, I will say that there are benefits of these not so tough book-like things my partner lugs around as they have contributed (a small amount) to our overall patient care. When we arrive on-scene of a guy who I have never ran a call on and he is unconscious, I can pull up the address on the laptop and get a record of previous calls, and those times when he is all alone without a medic alert, I can have the computer tell me that we have ran x number of calls in the past year on a person (that the computer describes in detail i.e. age, sex, hair color, dob, weight and height) who has some medical condition, like diabetes, this would give me enough information to start a line and run some D-50. I have also had the occasional “safety alert” on our MDT that will alert me that the address I am enroute to has had previous instances of assault on officers or medics, in which case I will gladly let dispatch know while enroute that we will need an officer on scene.

    Computer are a godsend, but those who have not learned the basics will be royally screwed when they go down…

    I would also like to thank the genius who thought of the Etch-A-Sketch, as I have now come up with the next prank for half blind partner who would never notice the difference between his toughbook and my Etch-A-Sketch!

  • Unclelarry911

    I love this guy. I began EMS in 1977 for Ralph’s Ambulance, Used Cars, Wrecker Service, Auto Parts on the KY, WV border. We didn’t have a communications radio, we had a bag of dimes! After a run, we had to stop at every pay phone & call in for any responses. I ain’t making this up, kids. Federal Twinsonic light bar & Q-Siren.

  • I still like writing everything on paper. Or, to take a page from some old dude who drives an ambulance, a piece of wide tape on my leg. If nothing else, it gets the patient talking – asking questions – and when they see me writing stuff down as their talking, it makes them feel like I’m paying attention to them (when I’m not looking directly at them, that is.)Just my .02..

  • My service uses ePCRs and has motorized Strykers :p But the only time I’ll work on my report when I’m with my patient is when I’m doing a long transfer to the City Trauma Center. Other than that, it’s notes on a glove, or tape on my leg, and I’ll type out a quick report when we’re done with the call waiting at our ED

    And this comes from one of the baby EMTs at my service 🙂

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