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The Hat Trick Method of Completing EMS Reports
By Mike Kennamer, Northeast Alabama Community College
 

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 consistency.
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.

• Avoid double 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.

• Record times accurately. Make sure procedure times do not contradict dispatch times.

• 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 professional EMT.

• Don’t ramble. 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.

• Critique the 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 attorney.

This article 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 importance.

H: History
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 should include:

• Onset of pain, duration, and quality

• Past medical history of cardiac problems

• Treatment prior to arrival (example: took three aspirin at home)

When applied to a trauma call, like a motor vehicle collision, the history should include:

• Description of scene

• Mechanism of injury

• Seat belt or helmet worn

• Any loss of consciousness, etc.

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 patient’s history.

A: Assessment
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 clinical assessments.

T: Treatment
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.

T: Transport
The second T in HAT TRICK is transport. Noted in this section should be:

• Receiving facility where patient was transported

• In what position was patient transported

• Any pertinent changes en route

Nontransport personnel can use this section to indicate the transfer of care to a transport unit. In this case the following should be noted:

• Planned receiving facility where patient was transported

• Who patient was transported by (service and unit number)

• Condition upon departure

• Time that care was transferred to transport personnel

R: Report
The R in HAT TRICK is for report. This section should show:

• To whom report was given

• What type of report was given (oral, written, or both)

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.

K: Kritique
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 the EMT.

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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