After every call, a WARDS Report must be completed, including for fire alarms and standbys. These reports need to be completed within 24 hours, and any major incidents need to have the report completed immediately after returning from the call.
If you choose to do the report from a secure home computer, ALL original paperwork must remain at the station, you can take copies home. All paperwork must be kept secure at all times and when the report is completed the paperwork must be shred.
The instructions to complete a WARDS report is as follows.
- Access WARDS by going to: http://www.emswards.org.Log in using the same credentials that you use to log into the Wisconsin DHS E-Licensing site.Agree to the Privacy Statement.Select the Incidents drop down list and select Add Run.
- Click on Options, which is next to Search.Select Expand All Panels.
- Complete the report with as much detail as possible.Be sure to use the correct date for the Incident Date (if the call occurred at 2300, it may be the next day when you start the report).
- On the right side of the screen, select Response Times to enter times provided by dispatch.
- Enter the next Incident Number that is available from the clipboard.This starts with the year, followed by the call number (i.e. 16-0432).This number is also the call number.
- For Treatment and Transport Disposition, if the patient is transported and an AEMT/EMT-I is onboard, select Treated, Transported by EMS (ALS).If the patient is transported and there are only EMT-Bs onboard, select Treated, Transported by EMS (BLS).
- When entering personnel, remember that someone always drives.Also, be sure to include any first responders and/or fire company personnel.You must always have two licensed EMTs on a call.
- Under the call conditions tab, by default all delays are filled in with No-Delay.If there is a delay, be sure to update these boxes and explain the delay in the narrative.On-scene time should be kept to a minimum, with 10-15 minutes as the standard.
- Under the patient information tab, be sure to check if the patient is a repeat.Some information will be brought in if the patient has had a previous incident with Whitewater Rescue Squad.Be sure to verify all information that is automatically imported for repeat patients.
- The history tab is the current complaint from the patient’s point of view.Chief complaint and secondary complaint are what the patient tells you.Try to enter as much information into the Past Medical History, Medical Allergies, and Medications as you can.If this information is automatically added for a repeat patient, double check all information that has been added.
- Under the assessment tab, choose the appropriate responses from a medical perspective.Be sure to complete the Medical Assessment and Injury Assessment (if applicable).
- The Vitals/Treatment tab is where you enter everything that you did.Be sure to include every procedure (an assessment and blood sugar check are procedures), every set of vitals, and every medication.When entering information, click Hide/Show Extra Controls to provide additional information, such as the arm a blood pressure was acquired on, the patient’s capnography reading, or the protocol used to provide a procedure.
- For the blood glucose procedure, be sure to include the result in the comments section
- The Trauma, Cardiac Arrest and STEMI tabs are for special case incidents.If your call is one of these types, be sure to complete the appropriate information.
- Remember, trauma is based off the mechanism of injury – all falls, motor vehicle accidents, etc, are considered possible traumatic injuries.
- For transport, be sure to choose the correct hospital and enter in the mileage that was written down by the driver.
- Life threat should be answered according to the patient’s status.If the ambulance went emergent to the hospital, odds are that the answer to Life Threat would be yes.
- When choosing how the destination was chosen, be sure to properly document the choice.
- Closest (appropriate) facility: Mercy Janesville, Dean/St. Marys Janesville, Fort Hospital, Aurora Summit and Aurora Lakeland could all be considered closest facility.
- Specialty Resource Center: If the patient requires a trauma center, burn center, bariatric chamber, etc., be sure to select this option.
- Police Choice: If the patient is in protective custody or the patient is under arrest and the Police Department requests transport to a particular facility (usually Aurora Lakeland), select this option.
- Patient’s Choice: If the patient selects a hospital that is not a normal hospital/farther than is necessary, select this option.However, the patient may be responsible for paying for mileage, so be sure to discuss this with the patient prior to transport.
- Patient position during transport should be entered.Normally, a patient is transported in a semi-fowler position.However, at times this may be different, based on illness or injury.
- Normally, a patient is moved to the ambulance via stretcher.If a stair chair is utilized, and the patient is placed on a stretcher, then moved to the ambulance, choose stretcher as the movement method and document the stair chair usage in your narrative.
- For the narrative tab, document if any belongings were transported with the patient (such as a purse, wallet or hearing aid), and where the items were left (such as with the patient, or the staff).Under service defined questions, answer all questions appropriately.
- A resident is anyone that has a pillow in our territory, including, but not limited to, college students and summer home residents.
- Once all information is entered, you should select Medical Abstract WI form the drop down list and hit Set Narrative.Be sure that no information is located within the narrative as that information will be overwrote.
- Once the narrative information is added, provide a detailed account of everything that happened on the call.
- If the patient signed off, be sure to complete the Against Medical Advice (AMA) section.
- Under signatures, EMS Provider Signatures and Pt unable to sign, click on your name and save the signature.
- If you begin the report but are unable to finish it immediately, in the left hand corner, change Status to In Progress.Once you complete the report, change it back to N/A.DO NOT set the status to Completed.
- Reports that are set to completed have been reviewed by Whitewater Rescue Squad and are ready for billing
- Requires Review denotes that there is a problem with the report and you should review the addendums to make necessary corrections/additions.
- Once completed, click on the PDF symbol on the right under the Actions column and review the report.If you note any errors or need to add information, make the necessary changes.Otherwise, print off the report and place it in the observation reports box for a mentor to review the report.
The narrative is arguably the most important part of the WARDs report. Accurate, detailed reports help to refresh your memory if you ever get called to court, but more importantly, provides a better picture for the medical staff at the hospital after you transfer care. There are a number of recommendations that you should follow when developing your narratives.
First, break up your report into three or four paragraphs. Each paragraph will provide information for a different part of the incident.
- The first paragraph should detail the dispatch and transit information. This paragraph should include what the crew was dispatched to, what vehicle went en-route, and if anyone met the crew on scene. In addition, provide any dispatch updates relayed during the response. You should also explain if there were any delays in dispatch or response times.
- The second (and third) paragraph(s) should include details regarding what occured on scene. This should include what various personel did on, which procedures were performed (and their outcomes), if there were any complications or developments, findings from the patient assessment, motor vehicle crash details, etc. Be sure to document any delays that occurred on scene, and try to keep things in order, to make it easier to follow. When stating a procedure was completed, or a set of vitals were obtained, be sure to include the data (such as the blood pressure, IV size, IV location, size of splint, how much O2, where was it placed – nasal or non-rebreather, etc).
- The final paragraph is the arrival at the hospital. Include who patient care was tranferred to (the name of the RN taking the report is best), any complications, and any other relevant details. If there was a turn around delay, acknowledge that as well.
- At the end of your report, add your initials showing that you completed the report.
Any delay in our service should be noted in the report. Whenever a second page is made for a call, that could be considered a delay, especially if the ambulance is waiting at the station. In most situations, we want to be out of the station within 5 minutes of page, on scene soon after that, and only on scene for approximately 10-15 minutes. Any deviation from those benchmarks could be considered a delay. For example – if only one EMT is at the station and has to repage, then there should be a Delay to Response noted as “Staff Delay”, and that should be explained in the narrative. If the crew is responding to Johnstown (south-west corner of our territory), it may take 15 minutes of driving. In this case, add a Delay to Response of “Distance” and explain it in the narrative. If it is snowing and the ambulance is only able to go at a speed of 20 m.p.h out to Whitewater Lake, you could not a “Weather” delay. The same goes for Delays on Scene, Delays during Transport or Turn around Delays. The key is to select all appropriate Delays in the WARDS report under Call Conditions, and then explain the delay in detail, in the narrative.
Patient or Bystander Comments
Whenever a statement is made to you or a crewmember, it should be encapsulated with quotes, and the statement should be written exactly as stated. In some cases this is not possible. This could also include any movement (such as a thumbs up, head shaking up and down or left to right, etc) or the lack of response.
Do not be afraid to describe what you saw around you. This could include details relevant to the situation, such as needles or drugs found by the Police Department for a suspected opiate overdose, or that the patient was found without any seatbelt bruising even though the patient stated they were wearing their seatbelt when they collided with a pole at 40 mph. It could also include signs of neglect, such as pressure sores on a patient’s back, cigarette burns on a child, etc.
If you are reviewing a report completed by another crew member, you should never change their report. If you have additional information to add, add that information after the other narrative(s) and sign the addition with your initials. If there is an error in the report, you should contact the EMT to have them make the change.
Sign Off/Lift Assist
For a sign off or lift assist, it is real easy to not provide as much detail to the incident as it deserves. This calls feel, at the time, as “easy” because the patient is not being transported to the hospital, and thus may not be in any danger. All Sign Off and Lift Assists should be detailed just as a PNB would be detailed. If a patient is signed off, and turns out to have an underlying issue (such as internal bleeding), the narrative will outline if the crew followed all appropriate protocols and performed an in-depth examination prior to signing the patient off.
Example: If a patient wanted to sign off and had no pain, the crew should still perform a quick head to toe assessment to ensure that no bruising was present. This exam should be noted in the narrative. If this is done, and the patient turns out to have internal bleeding, the narrative would show that no bruising was present, thus reducing the liability on the crew.