Wrapping up an incredible week at #NAEMSP2025! Honored to teach data analysis in the Quality & Safety 2-Day Preconference and present on implementing EMS transport to the DC Stabilization Center. Grateful for the opportunity to share and learn!

Thrilled to see 3 🚑s at the DC Stabilization Center today! Since opening in Oct '23, DC Fire and EMS has diverted nearly 3,000 pts with primary substance use complaints from EDs to the DCSC for top-notch behavioral healthcare. Proud to now be neighbors with our new DCFEMS HQ next door! #EMSsky

This morning’s sunrise made the early wake-up for an ambulance shift completely worth it.

12/ Longitudinal EMS documentation isn’t just about reducing the burden on providers—it’s about delivering better care to patients. Let's build systems that match how EMS truly operates and integrate seamlessly with the rest of healthcare. 🌍🚑 #EMS #HealthIT #PrehospitalCare #medsky

11/ The future of EMS documentation could be one record per patient, with:
Shared demographic and clinical data
Separate sections for each provider’s contribution
Attribution for individual roles (just like physicians, nurses, PT/OT notes in a hospital)

10/ Longitudinal documentation could streamline this process:
• A single record with multiple encounters makes matching seamless.
• MIH teams could see all prior EMS contacts in one place.
• At the point of care, EMS could query past EKGs to identify acute vs. chronic changes in real time.

9/ Why is this an issue?
• Minor data errors (e.g., wrong DOB or a misspelled name) can make it difficult to match records.
• Addresses frequently change, further complicating record retrieval.
• EMS providers waste time searching through or disregard past records altogether.

8/ Longitudinal EMS documentation has huge potential for Mobile Integrated Health (MIH) efforts and improving care continuity. High-volume utilizers often generate many EMS records. When each is a separate, incident-based document, it creates challenges for matching and continuity.

7/ Here’s why this approach would be a game-changer for EMS systems:
🕒 Providers focus only on their contribution.
✅ Shared data prevents conflicting documentation.
📊 Easier to analyze for QI, research, and system improvements.
🤝 Aligns EMS with hospital and healthcare standards.

6/ Shared information like demographics, allergies, medications, and vital signs could be entered once and accessed by all contributors. Each provider would focus on documenting their part of the care, significantly reducing the documentation burden.

5/ Imagine if EMS documentation worked more like hospital EHRs. A single record could house multiple contributors, with sections for each provider or team:
• First response note (engine/truck company)
• Transport note (ambulance crew)
• Supervisor note (if applicable)

4/ Each PCR is a standalone document. Demographics, medications, allergies, and even vitals are often duplicated across all PCRs, leading to inefficiencies and opportunities for discrepancies. This system is time-consuming and prone to conflicting documentation. 🤯

3/ In a tiered EMS system, it’s not uncommon for a single patient incident to result in multiple PCRs. For example, a cardiac arrest might involve:
• A first-arriving fire engine writing one PCR 🧑‍🚒
• The transporting ambulance writing another 🚑
• A supervisor writing yet another note 📋

2/ In EMS, documentation is typically incident-based. Each patient encounter generates a separate PCR, which serves as an incident report rather than a longitudinal record. This contrasts sharply with hospital EHRs, where patient records compile all encounters into one cohesive chart.

EMS documentation is stuck in the past. While hospitals use advanced EHRs to create unified patient records, EMS still relies on incident-based PCRs that are siloed, repetitive, and inefficient.

Let’s explore why it’s time for a change—and how it could transform EMS. (a 🧵)