I read a lot of posts and comments about professionalism in EMS. There are all sorts of prescriptions for accomplishing that, including suggestions of licensing, community based paramedicine, EMS 2.0, and of course obeisance to evidence based something or other.
All of these suggestions miss the point. IF EMS is to be regarded as a profession within the larger profession of medicine, then people in EMS need to act as if they are professionals. That doesn’t include stamping your feet in your side zipper boots and demanding to be treated as a professional. That’s just self promotion and frankly pouting.
What it does included is speaking and writing as a professional, using proper sentence structure, spelling, and medical terminology.
Those of you who have read this blog know that I blame the 1994 revision of the basic EMT curriculum as being the downfall of BLS education and practice in the US. It also, again in my opinion, made the hill to becoming a paramedic higher and steeper. The pre 1994 curriculum included a lot of theory and medical terminology. I had to learn all of the types of fractures, the types of shock and their effects, some anatomy, and lots of other items that were discarded in the 1994 revision as not being necessary for BLS personnel. I won’t delve in to the history of that revision, the time constraints both to rolling out the new curriculum and number of hours for the course. None of that is relevant these days, so I’m skipping it.
What is relevant is that the result was what many people refer to as the “dumbing down” of BLS education.
This seems to have effected ALS education as well. In my new life I read a lot of Patient Care Reports from providers who work for our client systems. My job is to review them and look for errors of various types. I’m specifically, by company policy, not allowed to score a PCR on spelling or sentence construction. That drives me crazy because I can only envision nurses and doctors smirking as they read these reports. Professionals indeed.
Here are a few examples of errors I’ve seen over the past few days. I’m not making any of this up,
“Pt complains of soarness in his leg.”
“Pt states that he is SOB.”
“Pt insisted and attimate about walking outside.”
“my clinical impression is bowel perfication”
“after cooling the irait pt”
My point is not to give you folks cheap laughs. My point is that when other medical professionals read this sort of thing it diminishes their respect for EMS professionals.
Herewith are a few suggestions for completing a PCR in a form which will maximize the utility of the information that you are trying to convey to hospital staff and other people that may read them later on.
Spelling. I started with that. If you are using an ePCR system and it doesn’t have spell check, then use other resources or pick another word or phrase that will convey you message. Google via computer or smart phone is a really good spell check program.
Punctuation and Capitalization. Use them, please. Start each sentence with a capital, end it with a period. Use capitals for proper names. Use commas where appropriate. Don’t use ALL CAPITALS, because it’s hard to read.
Abbreviations. If you are using an ePCR system, avoid them. As someone pointed out in a class “BS” can mean breath sounds, blood sugar, bowel signs, or maybe bra size. Some people like to make up their own, which is just confusing.
Terminology. Use the proper terms for anatomy, complaints, past medical history, and examination results. “Blood Glucose” is the medical professionals term, “blood sugar” is what a layman says. If you can’t name it, describe it. Don’t use a word unless you are completely sure of the meaning and the spelling.
Patient this, patient that. I see a lot of reports where every sentence starts out “Patient…” We get the point, you’re talking with the patient, you’re examining the patient, you’re treating the patient. The same people who complain about how much they have to write add in a lot of extraneous words. Here’s a suggestion, start out like this “87 year old female complaining of dyspnea…” Don’t even use the work “Patient” once in your report. It takes a bit of practice, but after a while you’ll find it’s much easier to write a report that way.
SOAPIE and CHART. Use either one of those formats in your report, they will help you organization your thoughts and your narrative. Both are easy to use, both have advantages, both have disadvantages. Your system might require you to use one or the other, but it seems that a lot of systems don’t have much in the way of requirements when it comes to formatting a PCR. Even if the system doesn’t have a format or style requirement, you should. An organized report is easier to read, easier to extract information from, and just looks more, well, professional.
When people talk about college degrees for paramedics, I usually counter that those degrees should start out with the basics. I won’t go all political here, but it’s pretty obvious that a lot of people graduate from high school without basic math or writing skills. Many colleges now require freshmen to take placement exams and often those students have to take remedial English and Math classes. I’d hate to think that paramedic and EMT classes need to do the same thing, but some days I wonder.
That’s today’s gripe, advice, and rant, all in one. Do with it what you will.