Reading Your Ambulance or EMS Report, Part 1

Let’s say you too got hauled off in the ambulance and are as morbidly curious as I am and so got hold of the report your Emergency Medical Services team left with the ER.

Now what? How do you read this thing? What do these abbreviations mean?

I spent a fair amount of time googling these questions, and to save you the bother, I’ll walk you through mine. I have a lot of blank boxes on mine, so I didn’t research these, but I imagine the boxes on mine that are filled are fairly routine. I assume too that the forms are pretty standard from EMS to EMS.

The page I’m interested in is headed by the usual stuff: name, date of birth, allergies, medications, relevant medical history.

The first thing I wanted to see was what happened when.  This is documented in a box called Event Times, roughly in the center of the page. In my case, the first time noted (and a 24-hour clock is always used), 1556 [3:56 pm] is next to “Crew TOC.” I found one reference to TOC as “Traffic Operations Center”; what I think is meant here is time the crew received the call from dispatcher at 911. Next, Enroute Scene, also 1556. Then Arrive Scene, 1600. Next, Enroute Facility, 1622. Arrive Facility, 1629. Available for Call, 1702. This tallies well with what my family remembers, that is, that the ambulance got to our house minutes after my husband called 911 [actually, 4], and they worked to stabilize me for about 20 minutes before leaving for the hospital [22, in fact]. Once they got me to the hospital, they were busy for 33 minutes filing reports and cleaning up the ambulance, I guess, before being again ready for action.

How the ER doctor could summarize this timeline as “She became dizzy and came to the emergency room for further evaluation” remains to be seen.

Back to the top of the form.

The first box I get a tick in relates to oxygen delivery: nasal cannula, one of those plastic tubing things that hook on behind your ears so it stays in place while two little tube prongs deliver air to you through your nose.

I’m going to skip a box for now to get to Medications. Interestingly, oxygen is considered one. I find that at 1604, EMT #709 (the crew is identified by numbers, not names) began giving me a dose of 6 using route NC. NC is nasal cannula. I learned that an NC “can only comfortably provide oxygen at low flow rates, 0.25-6 litres per minute (LPM), delivering a concentration of 24-40%,” so I figure a dose of 6 means 6 litres per minute. At 1617 I received 4mg of Ondansetron [an anti-vomiting drug] by way of my IV.

Above Medications is a place for recording information about IVs. The first two boxes are straightforward: Time and By [whom (id number)]. Next is  Cath. This is short for catheter and is what you and I call the needle. In the box beneath that heading I found “18,”  the size of the needle, no cath, that is usually used on adults.

Next heading is Site, for example, right wrist. Under Fluid Type NS is ticked: normal saline. Rate is designated as “open”; this means that the purpose of the IV was to get fluids into me quickly to help restore falling blood pressure that results from blood loss and shock. Something that might appear there instead is TKO or KVO:  KVO is Keep Vein Open; TKO is To Keep Open. In these cases, an EMT explains, “The drip rate is minimal – only to keep the vein open and to prevent obstructions from forming so future infusions will properly flow. TKO and KVO are interchangeable. Wide open: to infuse the fluid as fast as the vein/cannula/gravity will allow.” The next box is  Amt Infused; in my case,  750 ml.

Finally, there is this heading: Attempts. Starting IVs can be difficult. My report shows it took 2 tries to get an IV started. I’ve since learned that most EMS are supposed to make only 2 or 3 attempts at placing IVs before going to the next level, an IO. IV stands for intravascular, vascular means veins. IO stands for  intraosseous, osseous means bone. Let’s put it this way: some of the tools involved in IOs look like mini power drills. I’m not going there. You can if you want. Just click here.

Then we have Cardiac Monitoring and Transmission where it is noted that EMT 709 started a 4-lead EKG on me at 1615. A 4-lead is used for monitoring purposes; should my complaint have been chest pain or something along those lines, a 12-lead EKG reading would have been done.

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