Run Forms

A fundamental tenet of the street medic is that you do not criticize another medic if you were not there on the call yourself.

Countless times I have had people come to me and tell me what so and so medic did on a call and can I believe how stupid they were.

But most of the time when you actually talk to the medic and hear first hand what actually happened, there is quite a different spin on the story.

The other problem with criticizing another medic is it always seems that shortly thereafter fate whips itself around and you find yourself in a difficult situation, doing something foolish yourself, and as it is happening, you know deep down it is payback for your dissing another.

I write all this as an introduction to a situation I find myself in that is a key part of my new part-time job as an EMS clinical coordinator. It is now my job to read run forms.

The run form police? Me? Oh my.

How do I handle this? How can I do one job and yet be faithful to my street medic creed?

This is how I am trying to handle it.

I say aloud, “I was not there. I do not know what happened. I cannot judge on what actually happened. But I can judge on the story you have written. You may have provided great care and I respect you for that, but what you have written here does not tell the story of your heroism, and we need to work on that.”

I actually am enjoying reading the run forms. I do so at lunch. I go up to the cafeteria, get myself a turkey and bacon sandwich on rye with a slice of jack cheese and a leaf of lettuce, a bag of mesquite barbecue chips and a Diet Coke over ice and then back at my desk, I pull out the stack and I read.

I don’t read the run forms red pen in hand. I read them as a true fan of EMS. Others may pop in DVDs of old episodes of Emergency, me I prefer (my eternal love for Dixie McCall aside) these yellow or pink carbon copies that tell tales of true life.

A well-written run form puts me right there on the scene. I see the sixty-three year old man, sitting upright, struggling to breathe. I can hear the rales in his lungs. Feel the edema in his feet and see the JVD in his neck. I am worried by the low pulse sat reading, the high blood pressure. When the medic squirts the nitro under his tongue it is as if I am doing it myself. I cheer as an IV line goes in on the first try and rise applauding as the medic straps on the CPAP, and the patient almost instantly begins to relax. Well done! Well done! Bravisimo!

The stories I have read! The medic does a 12-Lead. Huge ST-elevation and then a mad dash for the hospital ensues. The patient codes at the hospital door, but the medics are quick with the defibrillator. Boom! Boom! and a perfusing rhythm returns.

While others may talk about the latest episode of ER or what happened at the Olympics or the political convention speeches, I wish they could read what I have read so I could say “How about that call on the highway? Or the 3rd Degree heart block? Or can you believe the story of the unsigned DNR?

What is even better is if the patient was delivered to my hospital, I can — right from my desk access the ED records — to read the next episode — what happened to the patient in the ED.

I hope the medics are learning not to run in fear from me as I pursue them, calling after them, “We must talk about that call on Main Street.”

I don’t want to get on them about how they left out the time of their 2nd set of vitals or how they misspelled “consciousness,” I want to tell them what happened to the characters. He had a 95% occlusion of the LAD or she had a sub arachnoid bleed. Or she got a pacemaker and is doing fine. Or after ten days your cardiac arrest patient walked out of the hospital on his own.

What delight I get when I read a great case I can later share with all the medics at case reviews!

But sometimes I do have questions. I was reading your story and you gave your patient atropine. I couldn’t quite follow why. Part of the narrative must be missing. Or it says you got a refusal, but you left out my favorite part where you try to convince them to go and you detail all the things that can happened to them if they don’t. You might think it is boring, but I love that part!

I have never been the greatest run form writer myself, but I find that reading other’s run forms is helping me improve the writing of my own. I am reading both masterworks and stories that should never leave the slush pile. Now on days when I am back on the street I am thinking of someone else reading my form and I am trying to do my best to tell them the complete story to make them feel as if they were right there beside me at the patient’s side.

9 Comments

  • Michael Morse says:

    Our patient contact is just the beginning for them. I’ve often thought it would make an interesting and informative story to follow the patient’s experience from their first contact, (us) all the way through to discharge, or whatever the outcome. Hippa laws prevent that, but in my opinion it would make us all better EMT’s and Paramedics to see where our interventions ultimately lead.Good luck with your new job.

  • Anonymous says:

    If it makes you feel any better, I’ve always been the chart/file audit/coder person in my lifetime- and yes it does set you apart from everyone but someone’s got to do it! But eventually the realization sets in that its in the best interest of everyone, primarily the patient! On top of that it is indeed cool to read those runs and go wow did that really happen!Good luck! and enjoy!

  • Rogue Medic says:

    PC,You need to blend in a bit more. Too easy to spot you coming. :-)Michael Morse,HIPAA does not prevent EMS from following up on what happened with the patient. Misinterpretation of the law by better to say no than to make a mistake hospital personnel is the problem. HIPAA was not really written by Kafka, it is just a rumor. The law allows for follow up for quality control purposes, so you should talk to someone at your agency and see if they will pursue this information for you. Too many people will come up with any excuse to avoid doing their job. HIPAA is just the excuse they use for being lazy and worthless.The documentation goes to insurance companies, so it isn’t as if the chart is top secret.

  • Bianca Castafiore says:

    I am a new reader of your blog and wish to congratulate you on the fine writing, and an equally fine *tenor* of respect for your patients and colleagues. It’s refreshing.

  • brendan says:

    Mike- There IS someone at RIHER who will get you patient outcomes with a name, DOB, and date/time of arrival. They haven’t really advertised it but I was at the meeting. Hopefully I’ll see you soon so I can give you the name.

  • Anonymous says:

    Congrats on being in EMS Mag!cs

  • Anonymous says:

    I’m seeing someone loving, but wishing more credit for their jobs here. Anyway, you might wanna change courses and work for some international air ambulance services, the ones you can access online. I gurss that would be a change.

  • Anonymous says:

    I do quite enjoy the mythical powers that HIPPA has come to possess. Once, I was on my way to work and saw a baby crawling closer and closer to an open manhole cover. The child appeared to have a hospital bracelet on. I didn’t want to violate the infant’s privacy or HIPPA rights, so I let him craw into the hole. I’m sure everything turned out well. Maybe.

  • Zach says:

    So CQI managers aren’t out to get us? hmmm, I must be working the wrong county.I hate the horrible traumas that we fly off to some University trauma center and never hear a thing about. It would be nice to get an update or some sort of closure or know if you made any sort of a difference at all. The gap is a glaring one and needs to be bridged.

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