Picking up from where I left off in my previous post, there are a few more boxes left to read on the Ambulance or EMS Report, and then there is a narrative or Assessment.
In the center of my form are vital sign readings. One thing that surprised me at first was that although the EMS arrived at my home at 16:00 and started oxygen at 16:04, the first set of vitals is for 16:15. That must have been when I got loaded into the ambulance. Prior to that, the EMS had to see where I was and what was happening, and get the oxygen started. Then I had to get carried from the house, secured on a gurney, and then the gurney was carried to the ambulance. While one team member [#709] ran an EKG strip, another [#332] took the first set of vitals and then a minute or two later started the IV.
The team took my vitals every 5 minutes. These included pulse, respiration rate, blood pressure, and oxygen saturation. My glucose was measured and my pupils were marked as =R, which I think means equally responsive or reactive. Skin color/condition was “pale, diaphoretic, cool.” Diaphoretic means sweating. When these three descriptions appear together, something is wrong.
Next is AVPU. This stands for Alert, Verbal, Pain, and Unresponsive. Alert is normal awareness, Verbal means that the patient responds if spoken to, Pain means that patient responds by flinching or pulling away from a source of pain, and Unresponsive means just what it says. Verbal is tried before Pain. Your possible grades are: A, V, P, U.
Last in this section is Glasgow, with 3 subheadings: Eyes, Verbal, and Motor. Glasgow is short for Glasgow Coma Scale (GCS) and like the AVPU is a way of assessing level of consciousness. However, here you get a score for each of the 3 subcategories. Eyes scores range from 1 to 4, with 1=Unresponsive, 2=Pain, 3=Verbal, and 4=Alert. There are 5 possible scores for Verbal: 1=unresponsive, 2= moans, 3=inappropriate answers or remarks, 4=confused but coherent answers, and 5= alert. Motor measures movement with 6 possible outcomes: from none=1 to normal=6. The three scores are added, and, to simplify, a score less than or equal to 8 means there may have been a severe head injury, while one greater than or equal to 13 means minor or none.
Finally, there is a space for Event Address and Physical Location of the Patient. In my case, these were my address and “prone on the floor in the living room.”
That does it for fill in the blanks.
Now we move to Assessment, starting with EMT Field Impression. This isn’t the same as diagnosis; making a diagnosis isn’t the EMTs’ job and they don’t have the time or resources to do it. In my case, hematemesis and melena were listed there. Hematemesis is what the EMTs saw, and my husband told them about the melena. These are effects, though; it was up to the hospital to determine the cause.
Then there is a space for Immediate History, which is what happened prior to the EMTs’ arrival and what they immediately saw for themselves when they arrived.
The Narrative describes the actions taken and recounts some of the material found in the boxes. The first thing I see are “BSI – ABC’s: RR 24 non-labored O2.” BSI means Body Substance Isolation. The team put their gloves on before handling me. ABCs are Airway (Assess, clear & manage), Breathing(Rate, rhythm & quality, lung sounds) , and Circulation (Rate, rhythm & quality, obvious bleeding). My rate of respiration was 24 (normal is 15-20), so they started the oxygen. Then skin color and condition are listed, along with the Glasgow scores from above. Next come descriptions that didn’t have a place in the boxes: “very weak — unable to stand — large amount of dark red blood on floor and in Pt’s [patient’s] hair — nauseous — carry to stretcher — load and secure.”
After that, “v/s [vital signs] — cardiac monitor, sinus tach — IV. ” So now I’m in the ambulance, they’ve taken the first set of vitals, done an EKG, and started an IV. Sinus tach is short for Sinus tachycardia, which means rapid heartbeat, and when I look at the v/s boxes, I find the first recorded pulse is 130, well above normal. There are a few other new terms here. Trendelenburg: This means that when I was lying in the ambulance, my feet were positioned higher than my head. Bolus, followed by BP ↑, HR↓. Earlier under rate for IV, I noted it described as “open.” Bolus means fluids were delivered quickly through the IV (as contrasted to a drip rate), and what followed was that my blood pressure (BP) which had been 94/50 rose to 100/64, while my heart rate (HR) dropped from 130 to 96.
Finally, “Echo 3 to [Hospital name] ER D46 [ER cubicle, I guess].”On a cover sheet I saw that there were various levels of transport. “With lights/siren” is called Echo 3, and “no lights/siren” is called Echo 1, for some reason.
Last note: “Reports and care to staff.”