Lesson 7: Communication and documentation

Under stress, the page you wrote tells a story your memory will not. This is the least exciting lesson in the class and one of the two or three most useful, because it costs nothing, needs no equipment, and measurably changes what an arriving paramedic can do. Here is the problem it solves. When something goes badly wrong, the people present lose their ability to recall detail accurately and to answer questions in a useful order. Ask somebody in that state what medication their spouse takes and you will get a colour and a vague guess. Meanwhile the arriving crew needs specific information immediately, and every minute they spend reconstructing it is a minute not spent treating. Writing a few things down in advance, and a few more during, transfers the work to a version of you that is calm and has time.

Three things by the end. First, what dispatch needs from a nine one one call, in order, because the order genuinely matters and most people give it backwards. Second, a SAMPLE history card for every household member, which is a five-minute job per person and is the single highest-value piece of paper in your kit. Third, keeping brief timed notes during a long incident, so that when the crew arrives you can hand over a sequence rather than an impression. All three are things you prepare when nothing is happening. That is the whole design: preparation you cannot do during an emergency, done before one.

SAMPLE is the six-item history a paramedic collects on arrival, and writing it down in advance means you hand over a card instead of trying to remember. Signs and symptoms: what is actually wrong and what you observed. Allergies, particularly to medications. Medications, with brand names, doses and how often, which is the item people cannot reproduce under stress and the item clinicians most need. Past medical history, meaning the conditions and surgeries that matter. Last oral intake, food and drink and when, which matters for anaesthesia and for diabetic emergencies. And events, meaning what led up to this. Make one card per household member. Put a copy in each person's wallet and a copy on the fridge, because those are the two places emergency responders are trained to look. Update it whenever a medication changes, and put a date on it so anybody reading it knows how current it is.

Dispatch needs six things and the order is not arbitrary, because calls drop and callers become unable to continue, so the most important information goes first. Where: the address, including apartment number, floor and any access detail like a gate code. Location first, every time, because if the call ends there, help is still coming. How: a call-back number. What: the nature of the emergency in one plain sentence, not a narrative. Who: the patient's age, sex, and whether they are conscious and breathing, which is what determines the response sent. Then answer the questions asked and follow the instructions given, including CPR instructions, because the dispatcher is trained to talk you through it. And stay on the line until told otherwise. Two additions worth pre-planning: know your own address as it appears to dispatch, which differs from the postal address in some rural areas, and know how somebody gets in if the door is locked.

Two minutes on this, and it is a household conversation rather than an individual one. Who calls nine one one? Who unlocks the door and meets the crew outside? Who stays with the patient? Who gets the children out of the room? If you live alone, the question changes shape: who has a key, and does anybody know your medical history? The reason to assign these in advance is that in practice all of it lands on one person while everyone else stands still, and that person then has to choose between the patient and the door. Assigning takes about five minutes at a kitchen table, and it is the difference between a crew being met at the kerb and a crew standing outside a locked building.

Recap. Six items for dispatch, in this order: where, how, what, who, then answer and follow instructions, then stay on the line. Location first, because a dropped call after the address still gets help moving. SAMPLE cards in every wallet and on the fridge, dated, one per household member, updated when medications change. And pre-assigned household roles, agreed by name, so that nobody has to choose between the patient and the front door. Every one of these is a task for a quiet evening. None of them can be done once the emergency has started, which is exactly why this is the lesson people skip and the one that most reliably improves the outcome.