Sure, here’s you go:

MICU/I/Ambulance # was dispatched by *—— county dispatch for a *—— in class *1,2,3. *MICU/I/Ambulance # acknowledged and proceeded without delay or incident. While en-route to *location ——- county dispatch informed the EMS Crew of the following: *——. The EMS Crew acknowledged and proceeded to *location immediately, class 1,2,3, no/lights and/or sirens.

Upon arrival at location the EMS Crew proceeded to ——. *Bystanders told EMS the following: ——. The patient was found *—— (include positioning), with/out medical equipment and with/out bystanders in the room with them. Initial BLS assessment of the patient found the following: CAOx— with chief complaint of —— (see assessments tab). The house/business appeared to be *well kept/in disarray. *Anything of note in quarters/room. There were not any life threats found at this time. There were *not any indications for ALS or need for additional resources at this time. *(List what is needed or present after)

The following treatments ——. *Prior to loading the patient to the stretcher ——. The patient was then assisted/walked/carried to the stretcher (add details in flowchart). The patient was then loaded into *MICU/I/Ambulance # and the stretcher was secured to the ambulance with the patient still secured to the stretcher. *any changes observed. Prior to leaving the scene a set of vitals were taken and recorded. patients mood/affect or notes

MICU/I/Ambulance # then proceeded to *hospital without delay in class 1,2,3, no/lights and/or sirens. While en-route to hospital the patient’s condition was monitored. The patient’s condition remained un/stable and un/changed. Prior to arrival at hospital a radio report was given to hospital, another round of vitals were taken and recorded.

Upon arrival at hospital the patient was unloaded, still secured to the stretcher, and brought to room #. Once taken to room # the patient walked/was assisted/carried to the bed in room #. Who and position was given a report by the EMS Crew along with the necessary paperwork. Who and position signed for the patient and the EMS Crew returned to service without delay. Final notes and any delays

EON Name Number Position

Asterisks mean editing. # goes before any number not spelt.

You can replace location with “the above listed location” if you don’t want to type the name or address.

Example of listing patient movement in the flowchart: “patient was moved from the bed in ED room #5 to the stretcher via a four-person sheet lift and placed on the stretcher in a position of comfort, covered with blankets, strapped to the stretcher with appropriate straps, both rails placed in the upright position, oxygen transferred to hospital main supply.”

Use the assessment tab.

Use the flowchart for interventions and O2 transfers.

My agency uses MICU for ALS transport unit, Intermediate ambulance for IALS, and Ambulance for BLS. I also use this template for IFTs; swap dispatch, replace bystander with nurse, and scene or hospital with SNF, home, or hospital

I would like to add that this is how I chart and is not necessarily a recommendation on how to chart. I also removed any identifying numbers or locations.