Tips to Write Better NY State PCR’s
PCR Legible: The PCR is written so that anyone is able
to read & understand
what is documented. There should be no “blackouts”. Mistakes should have
one line through them & initialed. Remaining white space is not “x”ed or
lined out. Just initial the end of your narrative.
Patient personal information: The patients complete
name, address, phone #,
date of birth, age, sex and physician is indicated. Use None, Unknown,
Denies or UTO(unable to obtain) instead of leaving a box blank and explain
in comments. Care in progress section completed for every patient.
Dispatch info/location: The Agency name, dispatch
information, call
location, check one box, call type as received, and mileage are all
completed. Remember dispatch info is generally the type of call.
All times recorded: Self-explanatory. Use military
time and included all
four digits for each time. The only times allowed to be missing from the
hospital copy of the PCR are “in service” and “in quarters”.
Chief complaint: Why the patient called the ambulance.
It should be
recorded in the patient’s own words using “quotation marks”. Duration of
complaint should also be recorded when applicable to complaint, e.g. chest
pain, difficulty breathing, abdominal pain, etc. If patient cannot respond,
write “unresponsive “ as chief complaint. On trauma patients, mechanism of
injury & seat belt use sections completed.
Subjective assessment: Expansion of patient’s
complaints describing the
symptoms the patient has. If you document in a narrative form, you may
start your narrative here and continue it in the objective physical
assessments and comments sections.
Presenting problem: At least one box checked. If more
than one problem is
checked the primary one should be circled. “Pain” & “Other” require
further details (such as type, location, duration, & severity for pain and
“none” for other).
Vital Signs: At least two complete sets with times
sets should be recorded.
A baseline set when the first patient contact is made. Subsequent sets
based on patient’s condition (every 5 minutes for unstable patients, every
15 minutes for stable ones). If any particular vitals signs cannot be
recorded, document reason in comments. E.g. Patient refused. Have patient
sign RMA, circling treatment.
Objective physical exam: Every patient should receive
a detailed physical
exam or a vectored exam based on their complaints. E.g.:
CNS trauma - presence of distal pulse, motor, sensation findings;
Breathing problems - lung sounds, JVD;
Chest pain - presence of pedal edema, ascites, JVD;
Abdominal pain - rigid or soft abdomen;
Extremity fractures - swelling, deformity, presence of distal pulse, motor,
sensation findings, etc.
Past medical History/allergies: Check off all that
apply. Use None, Unknown,
Denies or UTO(unable to obtain) instead of leaving the box blank and explain
in comments.
Medications: List all meds including dosage when
possible. Continue in
comments if more space is needed. Use None, Unknown, Denies or UTO(unable to
obtain) instead of leaving the box blank and explain in comments.
Disposition/Disp.Code: This should explain how call
was completed.
Transports to hospital should have hospital name and hospital code
documented. Proper code for calls where patient is not transported. See
Other notes below.
Crew names/EMT numbers: Self-explanatory. Use first name or initial when
agency has more than one member with the same last name.
Appropriate treatment: Remember the old saying: “If you didn’t write it
down, it didn’t occur”. All BLS treatments should be recorded even if
performed by ALS. No ALS treatments should be recorded on BLS PCR. Please
remember to check off how the patient was moved to ambulance and the
position they were transported.
On scene time appropriate: All trauma patients
classified as unstable or
critical should be removed from the scene within 10 minutes of arrival. All
medical patients should be removed from the scene within 20 minutes of
arrival. If on scene times exceed this, an explanation of why should be
documented.
Other notes:
All RMA’s must be documented as completely as any other patient. This
includes vital signs, mechanism of injury and steps taken to convince
patient to receive treatment &/or transport.
Patients that do not complain of injuries, and do not have any mechanism of
injury are not patients. Since they are not patients, they do not require a
RMA. The call disposition should be recorded as “no patient found” or
“canceled”.
DOA’s require only one set of vital signs and should not have a blood
pressure recorded. We must document signs of obvious death (and check that
box as presenting problem), dependant lividity, rigor mortis, or tissue
decomposition. If we don’t we should have treated the patient! DNR’s must
also be documented & a copy attached to PCR.
If a call is cancelled by ALS, it should be recorded as canceled and no
patient information need be recorded. To do so makes it appear we had
patient contact. E.g. ALS taking an RMA prior to BLS arriving on scene &
beginning care.
If you are going to omit a section because it was performed by the paramedic
or the paramedic acted as EMT on the call, make sure to obtain a copy of the
PCR and attach it to the BLS PCR. Document ALS PCR# and paramedic’s name in
comments section.