Our various EMS committees and workgroups, along with our regional stakeholders, agencies and providers, work very hard to improve our regional EMS system.  This page provides a forum for getting information from all of these folks back to the providers regarding notable performances by our providers, changes to standards of care and areas we need to continue to work on.

If you have an article you would like to submit, please submit it here with your phone and email contact information.

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Patient Care Documentation Pearls for Success

The following "Pearls" for completion of patient care documentation are presented by Lt. Melissa Doak of York County Department of Fire & Life Safety and are used within their performance improvement initiatives.  While we encourage all providers to follow their individual agency guidelines and procedures, this material has general applicability and, if adopted, would significantly improve our prehospital documentation in the region.

  • Please try to get Social Security Number (SSN) of the patient or parent/guardian if under 18 years old
  • Please be sure to indicate if a procedure was done or a medication given, did it work? Yes, no, sort of, or not all all, and explain in the narrative.
  • Minimum of 2 sets of Vital Signs on transports if at all possible
  • Signatures……all of them, patient, if patient is unable to sign (AMS, severe pain, dementia, unconscious, etc.) then Next of Kin or Receiving Nurse at ER indicating why the patient was not able to sign
  • Sign your narrative (use you name, initials to identify the author of the narrative), it’s not always the person who logged into the computer, very important when students or those being precepting are writing reports
  • Narratives are important for continuum of care, the medical record of the incident and for billing purposes
  • Check boxes (although at times seem to be duplicating information found in the narrative) are REQUIRED for state data collection and for data that in turn, gets sent to the federal government, make sure all applicable check boxes are completed and if a check box or tab does not apply, mark it as not applicable or not required
  • Don’t leave tabs or check boxes blank, blank boxes indicate incomplete information. If it does not apply, mark the – sign and indicate why, usually not applicable
  • Addresses, please get a complete mailing address for the patient
  • Controlled substances and narcotics-signatures for health practitioner who witnesses the waste at the ER
  • Lights and siren use to the ER, please be sure to document why lights and siren were used en route to the ER in the narrative. Please see the PEMS Transportation & Destination Determination Policy found in your PEMS Protocol Manual, under Procedures, 1.e. to help you with this decision making.
  • Refusals, remember to get a witness signature (when possible) including your other crew members as the witness
  • If ALS is performed and it is a refusal, make sure Online Medical Control is consulted, per protocol. Document this in in the narrative. ALS = any ALS skills including application and interpretationof ECG tracings.
  • Make sure the HIPPA Form is being given to every patient, when you ask them to sign the report, you are asking them to sign a document that says it has been provided
  • Crew members-if EMS1 or another person gets on the medic unit for the transport, be sure they are included on the crew list and document any skills they performed
  • Other units on scene, please be sure to mark “LAW” if law enforcement of any type was on scene, likewise, if another agency is also on scene, that information should also be included such as mutual aid engines or other mutual aid units
  • Some ePCR’s do not detail everyone who responded or assisted in the call. For example, on a chest pain call, usually the engine crew and medic crew both respond when available, but many times, this information is left out on the ePCR. It should be noted everyone who did participate in the call for service, it should be clear in the EMS ePCR narrative
  • Procedures-Use the check boxes when they apply even if the information is contained in your narrative
  • Oxygen is a drug-and therefore should be documented when o2 is given in the medications given section
  • If you are administering medications, you should know whether or not the patient has any allergies (unless of course they are unconscious, etc.) so please make sure this information is documented in the ePCR
  • Weight based drugs given? If yes, there should be a weight of the patient included in the ePCR
  • There is nothing wrong with scanning in the hospital face sheet if one is obtained. Be sure it is shredded after it is scanned in and remember to keep that document confidential following all HIPPA and Patient Privacy laws

Thanks to Lt. Doak for sharing this with us and allowing us to share it with YOU!

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RRMC Announces the Brain Saver Awards for November 2018

Kudos to the following members of Newport News Fire Department:

  • Jeffrey Bendit
  • William Venezia
  • Charles Jorgensen

Thank you for your dedication to our stroke patients! You were each essential in providing a last known well and patient family contact information. Alert was called in the field. The patient received tPA in 30 minutes! Amazing! The patient was discharged to Riverside Rehabilitation Hospital. 

I have placed your certificates in the EMS breakroom. We will have a reception honoring all winners in the summer. More details to come.

Thank you for all the hard work you do,

Sara Watkins MSN, RN  

Stroke Program Coordinator

Riverside Regional Medical Center


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When Things Go Right

Riverside Regional Medical Center – EMS Brain Saver Awards

In September, Sara Geiss, RN – Stroke Program Coordinator, implemented a new initiative to recognize EMS providers in their efforts to provide fast recognition, excellent care and expedite transport of Stroke patients. Use and reporting of the RACE score, obtaining the patient’s last known well time and early hospital notification of a potential stroke patient are all factors considered when determining the Brain Saver Award each month. Certificates will be issued to personally recognize the winning crew each month and then RRMC will host a very special celebration for the winners in July, 2019.

September 2018 Brain Saver Award

Congratulations to Sean Norton and Ryan Austin with Hampton Fire Department. Their dispatch to arrival was 28 minutes- they were essential in providing us a clear last known well and family contact information. This allowed us to have a door to needle of 28 minutes!! The patient was discharged home with minimal residual deficit and a NIHSS stroke scale of 1!

October 2018 Brain Saver Award

Congrats to Gordon Mayer and Kevin Dierstein of Hampton Fire Department for winning Riverside’s October Brain Saver award!! They participated in the care of a stroke patient with a door to needle time of 34 minutes! They were essential in providing the patients last known well and let us know the location of her husband.

Honorable Mention for October: James City County Fire Dept. – Brian Keckler, Jonny Carroll & Chris Judkins – for a GREAT job on October 11th in utilizing your RACE score (Race of 7/NIHSS 15) and recognizing that patient had an extremely high probability of an LVO. Your assessment skills were SPOT ON! The patient had a complete recovery with NIHSS of 0.


The PEMS Council offers are heartiest congratulations to all team members, both EMS and hospital, for the exciting impacts you are all having on stroke management within the region. To have patients calling EMS with severe neurological deficits, then be able to leave the hospital with minimal or no impact from their stroke, is truly amazing. Kudos to you all!

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