The Hat Trick Method of Completing EMS Reports
EMTs learn, from
their first day of school, to present themselves as professionals in
attitude, appearance, and actions. Basic skills are learned and
practiced until they become second nature. Most pre-hospital care
professionals could do CPR in their sleep.
Documentation, however, is one skill that many EMTs neither enjoy
nor feel comfortable with. The problem is not that the EMS provider
doesn’t know how to write a report. The problem seems to be that
most EMTs do not have a specific system for writing a report.
Everyone has a system for CPR and assessment and follows protocols
or algorithms for cardiovascular and trauma care. However, many EMTs
do not consistently follow a system for writing EMS reports.
According to a survey of EMS professionals who regularly review EMS
reports for quality assurance, four common points emerge. According
to those surveyed, medical information in EMS reports should meet
the following criteria:
1. Write pertinent details. EMS
reports should be concise and to the point. That which is pertinent
should be covered in great detail. That which is not pertinent
should be omitted.
2. EMS reports should be written
in a similar pattern each time. A system will help ensure
3. Cardiac calls dictate the
need for a strong history.
4. Trauma calls dictate the need
for a strong assessment.
One should consider the following general
guidelines for writing EMS reports:
Fill in all the
blanks. If a blank doesn’t apply, simply cross it out.
entries. Besides wasting time, writing information twice exposes
the EMT to potential for conflicting entries. For example, if
the EMT notes in the check-off boxes that the patient’s skin is
hot and dry and later notes in the narrative that the skin is
warm and moist, he has shot a huge hole in his credibility.
accurately. Make sure procedure times do not contradict dispatch
Print neatly. A
professional image is just as important in an EMS report as it
is in any other situation. One of the easiest ways to make it
neat is to print in all capital letters. The report should leave
an impression of a neat, orderly, precise, organized and
Perhaps the easiest way to avoid the tendency to ramble in a run
report is to follow a systematic approach to writing the report.
One such system is described in this article.
report. Always take two or three minutes to review the EMS
report before it is filed. It is much better to find a silly
error than for that same error to be found by someone else’s
presents the HAT TRICK system for writing the narrative portion of
an EMS run report. While it is not the only system available, it is
designed specifically for prehospital care providers. Other systems,
like SOAP notes and CHART, may be successfully adapted for
prehospital care. Regardless of which system is used, it is
important that the prehospital professional select, learn, and use a
system that will help assure consistency in report writing.
The HAT TRICK is divided into two sections: HAT is listed in the EMS
report narrative. TRICK is not listed as such, but is of equal
The H in HAT TRICK is for history. This, in essence, is why EMS was
called. Included in this section would be pertinent past medical
history, history of present illness, and events leading up to the
accident or illness. When applied to a cardiac call, the history
Onset of pain,
duration, and quality
history of cardiac problems
to arrival (example: took three aspirin at home)
When applied to a
trauma call, like a motor vehicle collision, the history should
The history sets up
what has happened and why EMS was needed. It should not be very
lengthy. However, it is generally necessary to write a longer
history for a cardiac patient due to the need to concentrate on the
The A in HAT TRICK is for assessment. This should include findings
from the patient assessment as well as signs, symptoms, and
complaints. Pertinent negatives, where applicable, should also be
included, as should cardiac monitoring and other diagnostic and
The first T in HAT TRICK stands for treatment. The procedures and
treatments performed should be listed in chronological order.
Procedures times, along with who performed invasive procedures,
should be noted.
The second T in HAT TRICK is transport. Noted in this section should
facility where patient was transported
position was patient transported
changes en route
personnel can use this section to indicate the transfer of care to a
transport unit. In this case the following should be noted:
receiving facility where patient was transported
Who patient was
transported by (service and unit number)
Time that care
was transferred to transport personnel
The R in HAT TRICK is for report. This section should show:
The importance of
the report cannot be overemphasized as this indicates that a proper
and legal transfer of care took place.
I: In Service
The I in HAT TRICK is for in service. This is meant to
note the time that care was relinquished to the receiving facility.
C: Compile Attachments
The C in HAT TRICK refers to the need to compile attachments to the
report. Any rhythm strips, EKGs, or associated orders should be
attached to the report.
The K in the HAT TRICK system stands for possibly the most important
part of the entire HAT TRICK system. It stands for critique. Always
take a few minutes to scan over what has been written. The time to
locate and correct mistakes is when the call is fresh in the mind of
Regardless of whether an EMT uses the HAT TRICK method or an
alternative method for writing run reports, a system should be used.
A systematic approach helps prevent errors and reinforces the
professionalism of the EMT.
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