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Part of NREMT Skillset
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Authors Josh Hantke
Published 2021
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This page is intended to show examples of three different styles of narrative writing, the SOAP method, CHART method, and a freeform method. No one of these narrative styles is better than the others and narratives will often change depending on the information available in the rest of the patient care report. Narratives are ever-changing and adaptive to the circumstances of a call, these examples are just that: examples, and should not be used as perfect templates. These narratives will all be written for the same patient, call information found below. Some assumptions that certain aspects of the call are charted in different areas of the PCR such as: response characteristics and medic number, vital signs, response/scene/transport/hospital times, full patient demographics.

Call Information[edit | edit source]

The time is 1045 and M145 is dispatched code 3 to a call for a 22 year old man who fell off his bicycle and is now complaining of right arm pain. Enroute at 1047, M145 is downgraded to code 2 by dispatch. M145 arrives on scene at 1054 to a park with minimal traffic and the local fire department arriving on scene. The patient is conscious on approach sitting upright on the grass and is holding his right forearm which shows an obvious deformity upon visual inspection. The patient's bike is next to him and shows minor damage. Bystanders say that the patient was riding on the sidewalk and slowed to avoid a jogger when his front wheel went off the sidewalk and he fell laterally, landing on his side with right arm outstretched. The patient was slowing down and was almost stopped at the time of the accident; estimated speed was 2-3 mph. The patient was wearing a helmet and did not lose consciousness, his story matches with that of bystanders; the patient states that he "heard a crack" from his right arm followed by significant pain similar to the bones that he has broken in the past. Patient contact made by M145 at 1055 The patient is AxO 4 and GCS 15 and is able to recall before, during, and after the event. The patient takes no medications and has no allergies or significant medical history. The patient ate breakfast earlier this morning and has had no issues when he goes to the bathroom. The patient's only complaint is "sharp, stabbing" right arm pain 8/10 with no radiation, palliation, provoked by movement or palpation. The patient denies head, neck, or back pain and has CSM intact x4; patient has pink, warm, and dry skin signs. Assessment of the injury shows early stages of bruising and an obvious deformity to the middle of the right forearm with obvious crepitus on palpation. The patient's arm is immobilized and placed in a sling and swathe with an ice pack by the fire department while M145 performs vital signs and obtains initial readings of 136/88, 100 bpm strong and regular, 16 RR deep, regular and unlabored, pupils 3 mm PERRL, LS clear and equal bilaterally, with a SPO2 of 98% on room air at 1058. ALS response is deemed unneeded due to local protocol; the patient is helped to the gurney and loaded into the ambulance with his bicycle. The fire department clears the call at 1110 after restocking from the ambulance crew. The patient is transported code 2 to the local ER at 1111. Only one other set of vital signs is obtained during transport: 134/80, 92 bpm strong and regular, 16 RR deep, regular and unlabored, pupils 3 mm PERRL, LS clear and equal bilaterally, with a SPO2 of 99% on room air at 1113. The patient's pain reduces to 6/10 with the same quality, radiation, provocation/palliation, and severity. No other treatments are provided enroute. The patient denies any other complaints than his arm pain for the duration of transport. M145 arrives at the hospital at 1120 and transfers patient care to an ER RN at 1124 after obtaining all required signatures. M145 clears the hospital at 1136 after equipment cleaning.

SOAP[edit | edit source]

S- Patient complains of "sharp, stabbing" right arm pain 8/10 with no radiation, palliation, provoked by movement or palpation. Patient states that he was riding his bike when his wheel went off the sidewalk while he was attempting to avoid a jogger; patient fell to the right and landed on his right arm and "heard a crack". The patient was helmeted and did not lose consciousness. The patient is AxO 4 and GCS 15; patient able to recall before, during, and after event consistent with bystander stories. Patient denies history, allergies, or medications.

O- Patient vital signs stable throughout transport. Secondary assessment reveals obvious bruising, pain, deformity, and crepitus to the right forearm. Continued secondary assessment unremarkable. Patient's helmet shows no obvious external or structural damage.

A- Patient complains of pain similar to broken bones that he has had in the past. Patient presentation suggests broken/fractured bone. Patient will be treated per local protocol.

P- Patient's right arm stabilized with cardboard splint and placed in sling and swathe with ice pack for pain control. Patient reports reduction in pain to 6/10. Patient transported code 2 to ER. Patient care transferred to ER RN.

CHART[edit | edit source]

C- Patient is a 22 year old male complaining of "sharp, stabbing" right arm pain 8/10 with no radiation, palliation, provoked by movement or palpation.

H- The patient was riding his bicycle on the sidewalk and slowed to miss a jogger; patient's front wheel went off sidewalk and he fell sideways onto his right arm and "heard a crack". Patient denies history, medications or allergies. Patient states that he ate a normal breakfast earlier this morning.

A- Patient exhibits no obvious respiratory distress and is conscious upon EMS approach. Patient assessment reveals CSM intact x4. Assessment of the injury shows early stages of bruising and an obvious deformity to the middle of the right forearm with obvious crepitus on palpation. The patient denies head/neck/back pain. Patient is AxO 4 and GCS 15. Patient's vital signs are stable and described in vitals section of PCR.

R- Patient's right forearm immobilized with cardboard splint and sling and swathe. Cold pack placed to reduction in stated pain to 6/10. Patient placed in position of comfort.

T- Patient transported code 2 to ER. Patient remains stable throughout transport. Turnover report given to ER RN, patient care transferred.

Freeform[edit | edit source]

This method of narrative writing uses the writer's discretion about what should be included in the PCR. This can lead to substantially shorter or longer narratives that are more easily adapted to "odd" calls, but be aware that using a freeform method for a narrative can increase the chances of "missing" information because there is no defined path to follow.

Arrived to find patient sitting upright on grass of park with bicycle beside him. Patient is conscious and tracks EMS upon approach. Patient has PWD skin signs and is in no apparent respiratory distress. Patient is a 22 yo Male who was riding his bicycle on the sidewalk when he slowed to miss a jogger. Patient states that his front wheel left sidewalk causing him to fall to the right onto his outstretched arm. Bystanders corroborate patient's story. Patient denies LOC and head/neck/back pain; patient was helmeted and recalls before, during, and after event. Patient assessment reveals no obvious life threats or bleeding. Crepitus, deformity, and bruising noted to the right forearm with "sharp, stabbing" 8/10 non-radiating pain that is provoked by palpation or manipulation; CSM intact x4. Patient answers all questions appropriately and follows commands. Patient denies history, medications, or allergies. Patient's arm immobilized with cardboard splint and sling/swathe. Cold pack placed for pain management to relief of pain to 6/10. Patient assisted to gurney and loaded into ambulance. Patient transported code 2 to ER. Patient denies Nausea, Vomiting, Diarrhea, Lightheadedness, Dizziness, CP, SOB, HA, Recent illness, Changes to vision/hearing, Numbness/tingling, Weakness. Patient has been eating and drinking normally with no issues during urination or defecation. Patient monitored during transport. Turnover report given to RN, patient care transferred.