The Laingholm First Responder's Review Of Patient Reporting

Patient Reporting covers more than just taking the patient's vital signs. It gives the ambulance officers some idea as to when and how the patient will be transported. Later it gives the hospital staff a yardstick by which they can measure the patient's progress, clues as to what may be wrong with the patient, and cautionary notes to make sure there are no embarrassing slip-ups. A patient with an unreported latex allergy is going to be in deep schtuckum on entering a typical emergency care scenario. We need to record anything that is relevant and useful to the emergency care process as a whole.

As It Comes

The easiest way to look at reporting is to imagine what a keen doctor is going to want to know. "What the heck happened here?" Comes pretty high on the list of questions, and so we need to note down the Mechanism of Injury - if we know it - and the Chief Complaint if the patient is conscious, the results of a preliminary survey if they are not. So far, the patients have tended to want to tell us about their problems, and we'll cover that bit later. A picture is worth a thousand words, so there is a nice little humanoid shillouette on a reporting form for us to draw in the injuries.

So our astute doctor now knows what happened to the patient, but this needs to be put in context. Is the patient allergic to anything we may put near them, or that they may have come in contact with? Medical alert bracelets and similar jewelry need checking as part of our primary survey if the patient is uncommunicative. Were seatbelts worn? Who took the biker's helmet off? These may affect how the doctor views later symptoms.

Medication is important; the patient may have taken something that they should not have , they may require some urgently as a diabetic for example. Note a recent case where bystanders helpfully administered a triple dose of GTN! As we have found out often, the medication also gives us a clue as to what the patient is suffering from and rounding up the medicines and any doctor's notes is a useful service that we perform and will establish part of the medical history that we need to note down.

Hospitals are keen on knowing when the patient last ate or drank, or consumed ethanol (marked as eth). It may have made them crook, but more likely they are considering if the patient will puke during surgery.

Finally, it is always worth asking the patient what happened prior to the accident if possible. This establishes that they know what was going on and may reveal a forgotten lapse of consciousness. Their breathing patterns can be observed, and their state of consciousness gathered, as can their emotional state which may be important when diagnosing hyperventilation. Bystanders may also want to tell us their version of what happened, which may or may not clarify the situation. They may be able to tell you of details that ambulance and the hospital will want to know, such as if the airway was obstructed before you arrived, or if the patient has vomited - both things that need to be written down whether they happen before or after you arrive.

The Pain!

Usually our patients are in some form of pain. What we need to note is fairly basic: When did it start, and what is is doing now? This open-ended question hopefully provides us not with the time when the pain starts and it's period (if any), but often reveals what they were doing to cause the pain, where it was, where it is now, and how bad it is. They may need some further coaxing to reveal the pain on a scale of 1-10, or whether the pain is stabbing, constant, radiating or intermittent.

Other symptoms have a quality though. The pulse can be rapid, faint, thready, intermittent. Breathing can be wheezing, shallow, laboured. Bleeding can be profuse, slight, pulsing with arterial force, or oozing from a large graze. Sorry, you weren't just having lunch were you?

Vital signs we can manage, and just in case we forget what needs to be written down, the required parameters are written down on our notepads. A sheet containing the Glascow coma scale lurks within the contents of the trauma bag, but usually a report of the patient's state of consciousness will suffice.

Mnemonic City

A couple of good ones here for mnemonic-spotters. First for chief complaints, and pain in particular:

P - Provokes; what provokes and alleviates pain.
Q - Quality of the pain.
R - Region and Radiation
S - Severity
T - Timing; onset and duration.

Now for the history in general:

S - Signs (what you see) and symptoms (what the patient tells you)
A - Allergies
M - Medications
P - Past & Present medical history
L - Last meal (hopefully not...)
E - Events before the incident

This and other interesting documents can be found at http://family.gen.nz/launchpad