I am currently working in a TCU and managed to send out two people within 30mins of each other last night. While giving report to the medics I found myself wondering if it was too much or not enough and what exactly they learn in training.
When I give report I find myself talking to the medic like I would another nurse or MD. Situation, variations in vitals, most recent labs, and diagnosis.
I am curious though when I tell a medic that I guiaced the patients vomit and it was positive and the hgb drawn today was 8.2 and their UA/UC was clean... if they know what the heck I am talking about.
Could some of the people here who are paramedics give me a heads up on what kind of report you need and what kind of training you have regarding diagnosis and labs are?
I am just really not familiar with the education a paramedic receives so I am never sure if the report I am giving is adequate.
What kind of report do medics like to hear when they enter the realm of LTC and TCU?
I tend to give a brief history of while they are in TCU, any major events while they are with us, and then get more specific as to why I am calling. Any any significant recent labs and most recent set of vital signs.
To answer your question, I'll tell you I can't answer your question. What education do they have or what do they understand. It will vary greatly. I have taken many patients from various facilities. You can be giving me report and see me as the local fireman just riding the ambulance, what the heck would I know about lab values and such. So, am I a 15yr ER\Flight RN, or new paramedic fresh out of school. You won't know.
It sounds like the reports you are giving are fine. Too much information is certainly better than not enough. Your bases are covered.
I am currently working in a TCU and managed to send out two people within 30mins of each other last night. While giving report to the medics I found myself wondering if it was too much or not enough and what exactly they learn in training.
When I give report I find myself talking to the medic like I would another nurse or MD. Situation, variations in vitals, most recent labs, and diagnosis.
I am curious though when I tell a medic that I guiaced the patients vomit and it was positive and the hgb drawn today was 8.2 and their UA/UC was clean... if they know what the heck I am talking about.
Could some of the people here who are paramedics give me a heads up on what kind of report you need and what kind of training you have regarding diagnosis and labs are?
I commend you for seeking out how to better enable a strong relationship with our paramedic peers. But if your facility usually uses the same company, may I suggest you speak with a liasion for the company you use? I am sure they'd appreciate your desire to build a strong professional relationship and can give you first hand information about the type of information they may need (I'm also thinking of any local issues that may arise that might not be addressed on this forum.)
I commend you for seeking out how to better enable a strong relationship with our paramedic peers. But if your facility usually uses the same company, may I suggest you speak with a liasion for the company you use? I am sure they'd appreciate your desire to build a strong professional relationship and can give you first hand information about the type of information they may need (I'm also thinking of any local issues that may arise that might not be addressed on this forum.)
Good idea. Another approach is to flat out ask the medics what info they want or need after you give them report. Gets right to the point. They will appreciate it also.
I guess if it's out to LTC, SNF I would know that I would be calling ahead to the nurses at the target facility with the details. But when I look at someone who now has to take my patient out the door and assure they arrive in good condition I'd assume they would want to know certain things. Basically what would I want to know if I showed up and you asked me to take this sick person somewhere in my car. I'm gonna want to know DX/TX brief, AOx?, and any details (affect). Mobility. Body alterations: surgery, skin wounds, lines, drains, deformity. Vitals. Pain where and when, etc. Cardiac/resp issues. I think it helps anybody to get a quick brief on Mr. Smith almost an intro to him if you can provide one. It helps orient you to this person quickly and then you tend to retain the other data easier. I guess attach a person to the body. That kind of thing helps me in a huge way.
Regardless of education level I would say the following applies to paramedics good, bad, and mediocre:
Why you called.
What are the patient's symptoms?
What the patient is like normally and what is different today?
What is the patient's medical history?
Does the the patient have any allergies?
What is the patient's code status?
What medications is the patient on and have there been any recent changes to the meds?
Is there anything you want us to tell the ED or that you think is important for us to know? e.g. the patient has a history of L sided weakness from a previous stroke.
Don't be afraid to get specific when answering these! For example it is very frustrating to be told you were called because an elderly person with a history of dementia is acting "confused". Be specific about their mental status and behavior. Do they talk, do they make sense when they talk, can they hold a normal conversation, what's their normal orientation, are they normally agitated or anxious?
As far as labs and tests keep it simple. As someone said earlier there are lots of medics who may not know lab ranges but they know what the results indicate. So just say the patient is anemic or the patient's potassium is low rather than the Hgb was 7 or the K+ was 2.9.
It seems like UA results and hgb levels are overkill, to me.....not because they won't understand, they just don't necessarily need all that info to safely get the patient from point A to point B. Of course, I am usually sending them to a less acute level of care, so the patients' major issues are resolved (or at least stabilized).
true... your pretty much always sending the patient with their information anyway (which will include the h and h). not that the medic is incompetent... but i have a feeling a newer medic might just remember the basics like "the patient is vomitting blood". i dont know... i just have a feeling that sometimes the "numbers" get lost in the shuffle and your giving more info then is needed by the medic.
What the patient is like normally and what is different today?
What is the patient's medical history?
Does the the patient have any allergies?
What is the patient's code status?
What medications is the patient on and have there been any recent changes to the meds?
Is there anything you want us to tell the ED or that you think is important for us to know? e.g. the patient has a history of L sided weakness from a previous stroke.
This.
Keep it on target with what is needed to get from point A to point B and not to overwhelm with a lot of information which might bury the important need to knows.
One more thing to address is vascular access. Not all Paramedics are allowed to access central lines including PICCs and various other long term indwelling catheters. Some of the terms for these devices might be unfamiliar with them until they see it. One Paramedic knew he could not access any port on a Swan Ganz but was sure a PA catheter would be okay. If they are allowed, it may have been awhile and it doesn't hurt to do a quick review which isn't insulting to them about access and compatibility. Making them aware of shunts, grafts or flaps and other vascular situations which might prevent establishing another line or is made known to whoever is drawing labs or doing BPs at the other facility is an important but often overlooked piece of information.
Remember, every interfacility transport needs a different amount and type of information in report depending on the patient, the sending facility, and destination.
Medsurg discharging a pt back to the ALC that is 10 minutes down the road... this is different than say a rural hospital sending the patient to a trauma center 2 hours down the road... and that's different than LTC sending a patient to the dialysis center across town... and that is different than the small ICU sending the patient down the street to the teaching hospital for specialty surgery.
What is relevent always changes, but medics are people: give them the information important to patient care for the time they will have the patient, whatever else will help them see the big picture, and key points you want emphasized to the receiving facility just in case they miss it in your phone report.
Medics are like nurses... some are brilliant, some have a few rocks rattling around in their skulls.
in my fair commonwealth there is a legal difference between an emt (emergency medical tech) (can be as little as 80 hours education and clinical) and a paramedic (800+ hours of education and clinical). the terms are not interchangeable. i'll bet it's the same where you are. ask.
I might be mistaken but I think most of us were referring to paramedics responding to an emergency at a nursing facility. Even if EMTs are responding they still need to know things like signs/symptoms, history, meds, allergies, and code status.
I am a paramedic and am going to go through nursing school. I am one of those that likes more information instead of less. I do a lot of interfacility transfers ranging from an hour to four hours. I promise you that a lot can go wrong in just a short amount of time. One case I had was a cancer pt with an extensive medical history who is now hypotensive with a hemoglobin of 6. Ok, so I am going to be on the road for three hours with this pt. Long story short pt drops their pressure to the 70's and I am squezzing that fluid in and ready to start dopamine cause I can't dilute them that much! I like to know what is going on because when I walk into the recieving facility I like to be able to tell them what is going on, what has happened, and what I have done to help fix the problem. We need to know what is going on. If you belive it is relevant tell us! The majority of us want to know.
the paramedic curriculum was based on the RN curriculum, there are areas such as long term care that we dont go over, but for the most part we learn the same stuff in school. over the years paramedics may forget things like lab values and your abbreviations. but most of the medics out there are smart, even to ones playing angry bird.
as a paramedic i want to know everything...in its simplest form, IE short and sweet, tell me what you would want to know if you where going to be trapped in the elevator with this patient for the next few hours. start with why you called us, (upgrade in care, discharge...). I want to know recent vitals and trends, current treatments/meds and any recent changes, and A/O changes? DNR status, and allergies.
i will generally do a quick head to toe before accepting care and ask you specific questions about the patient that may come up. about the labs, tell me if someting is high or low, blood where it shouldn't be... and give me a copy of the labs i will review it all later. if it is an upgrade in care tell me everything you are going to tell the RN you call report to. if it is a discharge home, i generally dont care about much of anything. also read the patch on the shoulder and please know the difference between "EMT" and "PARAMEDIC". if all else fails think EMT=CNA, paramedic=RN. hope that helped, if not ask the next medic you give report to.
FF-PHRN
60 Posts
To answer your question, I'll tell you I can't answer your question. What education do they have or what do they understand. It will vary greatly. I have taken many patients from various facilities. You can be giving me report and see me as the local fireman just riding the ambulance, what the heck would I know about lab values and such. So, am I a 15yr ER\Flight RN, or new paramedic fresh out of school. You won't know.
It sounds like the reports you are giving are fine. Too much information is certainly better than not enough. Your bases are covered.