Poor EMS documentation reflects cultural tolerance

True loyalty is pushing for improvement, rather than accepting substandard patient care from your peers and co-workers

The main documentation lecture I give to fire departments and EMS agencies all across the country is as much about EMS culture as it is about documentation and it’s as much about the law as it is about documentation.

The reason is simple: One's documentation is a crystal clear reflection of the culture of one's provider agency and it is certainly a reflection of one's understanding — or lack thereof — of the law as it relates to the delivery of EMS. Most importantly, one's documentation is a reflection of the quality of one's own patient care.

Over the years, I have compiled a collection of patient care reports from EMS provider agencies all across America and I use them in my lecture. On the whole, like the examples below from paramedic-written PCRs, they are woefully similar in their absolute disregard for quality care. This begs the question: What the heck is going on out there?

  • PCR identified a 79-year-old female with generalized weakness; pulse over 100, blood pressure 74/40. No EKG. She was transported BLS only.
  • PCR reported an 80-year-old female with a puncture to the chest, left side, midclavicular at about the 4th ICS; pulse was 110, blood pressure 96 by palpation. No EKG. Patient was transported BLS only to the trauma center.
  • PCR documented a 41-year-old pregnant female with acute onset abdominal pain; history of hypertension; pulse over 100 and a systolic blood pressure over 150. No EKG. She was transported BLS only.
  • PCR identified a 66-year-old male "having difficulty catching his breath" after walking; history of "chronic bronchitis" for which he is on three different breathing medications. No EKG. He was transported BLS only.
  • PCR reported a 40-year-old male with intermittent chest tightness; history of hypertension; known medications include ASA and NTG. No EKG. He was transported BLS only.

These represent just a tiny snippet of the hundreds I have seen that are frighteningly similar and the majority of them are from dual-function fire department paramedics. (Before you get offended, see my column where I talk about dual vs. single function EMS) Non-fire EMS providers have the same issues.

In my lectures, I use redacted local PCRs as examples. When I identify PCRs, like those above, to members of the department that created them; the audience — who was laughing and enjoying the class just a minute ago — falls silent. Every time.

After a few seconds of them pondering their feet like children who were just caught ditching class, I point out that these obviously substandard providers are their peers, their coworkers. As far as the public and the law are concerned, if they know about it and do nothing, these substandard providers are them.

Then I ask these questions:

  • You are aware that some providers among your ranks are substandard and you do nothing about it, but who do you think is going to be responsible for treating you when you are injured on a call?
  • Do you want the provider you know to be substandard to be the decision-maker about your life or limb?

It’s not funny anymore … is it?

Their faces change. Lightbulbs go on. They look around at each other like only one of them gets the last seat in the bomb shelter. In my imagination, I see a new resolve in some of their eyes. Maybe not.

Stop and think about the disconnect
It’s just so painfully counterintuitive to me that a group that acts and functions and depends on one another like a family does not hold each other and themselves to the highest of standards in every possible respect.

It is equally counterintuitive to me that an endeavor whose sole purpose is the protection of and care for others does not demand the kind of attention to quality that the general public expects; the attention to quality that you promised when you accepted the job.

The most disturbing irony is that your own lives are dependent upon one another, yet you turn a blind eye to the weakest among you and you call it loyalty. 

Now, before you get to writing the angry emails or Facebook comments, just think about this: if you look around at your co-workers and you are sure that your department is the only one in history that does not have any substandard providers, take a deep breath because it’s you.

I’m just the messenger
I know I can seem a bit preachy sometimes. I’m okay with it because I know that it’s not "me" saying all this; it’s the law.

The same law you have been taught to fear is the very law that will protect you when something goes sideways. The same law that gives you such consternation when you think of lawyers, is the very law that give lawyers, like me, the power and ability to defend and protect you. But only if you abide by the law.

The message
The time has come for all EMS providers to step away from the tradition of silence and dive into the promise the public expects you to keep. You can bet that the law is going to make sure you keep your word.

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