Just for grins and giggles, I signed in to Netflix recently and watched a few episodes of the medical drama from the 70's, "Emergency!" I'm a little young to remember the show when it was on the air, but when I started in EMS, my paramedic partner insisted that I watch some of it. It was a rite of passage. Of course, there was also Bringing Out the Dead starring Nicholas Cage and Mother, Jugs & Speed with Bill Cosby, but those are for another post.
Every time I watch these shows, I'm blown away at how far EMS has come in such a short period. When Johnny and Roy arrived on the scene, they didn't have much - and they didn't know much either. Mayfair Ambulance Service would always show up to transport the patient either to the hospital or the funeral home: whichever was more appropriate. What's bizarre is with all the advances we've made to date, some things haven't changed. Take for example the EMS report. In much the same way we still do today, the characters of Emergency! would call in the radio report to Rampart General Hospital: "Rampart, this is Rescue 51."
To understand why this is such an important observation, and why we still use the radio report, we need to review the purpose it held back in the day. Unlike these days, when EMTs and paramedics are thoroughly and rigorously trained and ambulances are well stocked, the medics back in the 1970s had very little training and even less equipment. The purpose of the radio report was to relay any information medics could to the hospital, and obtain medical direction from the ED physician. The key here is that it was two-way communication. So why hasn't that changed in all this time? Does it need to? Let's see if we can answer that.
I was often very frustrated when I worked in the ED as a STEMI coordinator, when the medics would give me WAY too much information over the radio. Most of it was useless. I remember in the early stages of my career, I asked the nurse who was training me why they give us so much information that we don't need. It seemed like a confusing time drain for everyone. The nurse said, "I don't know, they insist on giving it, so we let them." On the flip side, when I started calling report in the EMS world, I asked the same question: "Why do we tell them all this information?" Again I heard responses such as: "I don't know, they want us to give it, so we give them all the information I can."
When Johnny and Roy called in a report, they relied on the radio for directions such as: "Start an IV and hang D5W" or "Deliver a shock at 400 watt-seconds." The hospital team didn't go beyond the Emergency Department then. Today this isn't the case. Many diagnoses require prompt action by the ED, for example Trauma, OB Emergency, Sepsis, STEMI & Stroke just to name a few. Two-way communication between EMS and the ED is still crucial, but the radio report serves a bigger purpose and it's not for medical direction anymore.
Today, the radio report is about getting the RIGHT information to the ED nurse (not just any and all information). The problem is that the medic and nurse speak two different languages. The paramedic is telling the nurse what's wrong and what they've done to fix it. The nurse is trying to take this information and make some big decisions. Can I triage this patient to the waiting room? Does this patient need additional resources? When a report contains as much excess information as those I both sent and received during my years of clinical practice, it becomes very easy to lose the most valuable information in the chaos.
So again, does this need to change? The answer is a resounding yes. Why hasn’t it changed? There hasn't been a better way. Until now. It's about time!