Why is it important to communicate with the receiving hospital?
- To allow the hospital to have the right room, the right equipment, and the right personnel prepared (if available) or to otherwise allow the facility to plan for the patient’s arrival
- To give medical control an opportunity to determine if they are the best facility to care for your patient or if the definitive care for your patient is at another facility
What are the components of a hospital radio report (be brief and concise)
- Unit and personnel identification
- ALS or BLS patient
- Patient’s age, gender
- Chief complaint (include general appearance and degree of distress)
- Associated symptoms
- Brief, pertinent history of present illness or injury (include description of scene or incident, if pertinent)
- Pertinent medical history, medications, and allergies (only what is pertinent to the patient’s current problems do not provide a list of his/her entire history/medications; there usually isn’t a need to provide allergies over the radio
- Pertinent physical examination findings
- Level of consciousness
- Vital signs
- ECG results and transmission (if applicable)
- Diagnostic findings (e.g., glucose)
- Other pertinent observations and significant findings
- Any treatment given
- Estimated time of arrival
- Request for orders from or further questions for medical direction physician
Why is it important to keep the report brief and concise?
- Allows you to return to patient care more quickly
- Permits the ED to prepare for your patient and call in appropriate resources, if necessary
- Consumes less time for the busy ED staff
What do you do when you’re pulling into the hospital parking lot (or otherwise on the grounds of the hospital) and are told by medical control to divert to another facility?
First and foremost, if you’re calling the hospital while pulling onto the hospital grounds, you probably waited too long to call in your report and you’re putting yourself, the patient, and the hospital in this predicament. The hospital certainly does not appreciate (understandably so) when we call in our report and tell them we’re pulling into their parking lot that barely gives them any advance notice and otherwise defeats the purpose of calling in a radio report. We should always give the hospital at least a five minute ETA, so be sure to plan your in-transport activities to allow for you to give the hospital sufficient notice prior to your arrival. If you are unable to give the hospital at least a five minute ETA, be sure to state why at the beginning of your report so they’ll understand why you were only able to give them short notice. Alternatively, if you’re very close to the hospital and time and the patient’s condition permits, call the hospital either before leaving the scene or as soon as you leave the scene, but do not unnecessarily delay transport just to give the radio report. If you think there’s chance you could be diverted, be sure to call the hospital ASAP.
Second, if you were unable to give more advance notice and are told to divert after you’re already on the hospital grounds, you have a couple options. It is important to remember that EMTALA does not apply to EMS only the hospital. Politely tell/remind the hospital that you are on their grounds. If the physician still insists that you divert to another facility, then divert to that facility.Â Donâ€™t forget to document the diversion in your ePCR!
We are all part of the healthcare team and we must work together efficiently. While we may have the best picture of the patient’s current condition, the hospital may know some things we don’t. Not only does the physician have a better idea of your patient’s differential diagnoses, but he/she also has better awareness of the hospital’s capabilities and resources. Depending on the circumstances, it may be in the patient’s best interests to not go to the closest facility, but to go to the facility that can provide definitive care for the patient. Even though you may be on the hospital grounds, if you take your patient to the other facility as the physician ordered, you may be avoiding the potentially lengthy transfer process and may be getting the patient to definitive care sooner, which is most likely in the patient’s best interests.
Per TEMS protocol, patients (including trauma patients) with an uncontrolled airway, uncontrolled hemorrhage, or with CPR in progress are to be transported to the closest hospital for stabilization and transfer. Even if the physician wants you to divert to another facility, these patients must go to the closest facilityâ€”politely inform the hospital you are unable to divert and will be coming to their facility.