Remembering Ham
by Jeff Covitz
REMEMBER H.A.M.
By Jeff Covitz NREMT-P
I am a paramedic and I work in a very busy 911 system in San Bernardino County in Southern California. I am called to respond to a variety of emergencies that range from stubbed toes to full cardiac arrests and everything in between. Whether it be a minor cut or something truly life threatening, there are basic pieces of information that we MUST obtain from every patient we encounter. I use a little pneumonic to help me remember it: HAM
H= History
A= Allergies
M= Medications
You would think that it would be a simple task to obtain a person's medical history, medication list, and allergies to meds, but you would be surprised how much detective work it sometimes takes to uncover this basic information for a patient.
HISTORY
Your medical history is obviously important as it keys us into the various body systems and complications that could be causing you to have needed us in the first place. A detailed list of your medical problems is essential as it will also dictate things we won't do for you.
For example, if you are a breast cancer survivor, and have had a mastectomy on the right side, it's vital that I have that information as I can't start any right-sided IV's due to the fact that some of your lymph nodes on the right side have probably been removed. This could potentially cause complications for you and affect any IV medications we may give.
ALLERGIES
Your allergies to medications are also extremely important to us. One of the leading causes of death by healthcare provider error involves giving a patient a medication that they are allergic to.
Just about every paramedic can share a story when he or she asked their patient what medications they were taking and they are handed a brown paper bag filled with a variety of loose pills that looks like a package of M&M's. Often we get responses such as "I take the blue ones on Mondays and Wednesdays, I'm supposed to take the white ones every day in the morning but I forget sometimes so I take two the next day to make up for it. I don't know what they're called, starts with an A. I don't take the green pills anymore because they made me pee funny colors." You get the picture.
At times the scene is comical and relatively benign if not annoying to the paramedic who has to squint really hard to see the tiny writing on the pill. However, other times it can mean the difference between life and death. Many of the medications paramedics use to treat acute episodes of shortness of breath, cardiac chest pain and a variety of other conditions can cause allergic reactions in certain people and cause them to go into a deadly condition known as anaphylactic shock. I could write an entire article about anaphylactic shock. Suffice it to say, it's something that can truly ruin your day.
MEDICATIONS
Some common prescription medications people take can also cause severe allergic reactions. Many of these reactions can be reversed in field by a clear-headed paramedic if he or she knows what medication it is they're dealing with. However if, for example, we are running on an acute altered level of consciousness with associated shortness of breath and we have zero information on the patient, we're simply going to revert to what we know: maintain an airway (bag them, oral intubation which involves tubes in uncomfortable places), keep the blood moving (fluids, cardiac drugs, electric cardiac pacing, CPR if necessary), and diesel fuel therapy (drive really fast to the hospital and let the ER doctor figure it out).
One of the hardest pieces of information to extract from a patient is an accurate medication list. Just about every paramedic can share a story when he or she asked their patient what medications they were taking and they are handed a brown paper bag filled with a variety of loose pills that looks like a package of M&M's. Often we get responses such as "I take the blue ones on Mondays and Wednesdays, I'm supposed to take the white ones every day in the morning but I forget sometimes so I take two the next day to make up for it. I don't know what they're called, starts with an A. I don't take the green pills anymore because they made me pee funny colors" You get the picture. At times the scene is comical and relatively benign if not annoying to the paramedic who has to squint really hard to see the tiny writing on the pill. However other times it can mean the difference between life and death.
This is especially true for cancer patients. Many of the drugs cancer patients take are opiates for pain management. If taken incorrectly or in the wrong dose, they can cause the patient to go into respiratory arrest, ie: you stop breathing. If this is allowed to go on for a period of time, your heart will decide it needs a little rest as well and it will stop beating. Most medical professionals consider this a bad thing. The rub is, if your paramedic knows what you have taken, we can give you a medication that can instantly reverse effects of the drug. However, if we're running in the dark it may take us several minutes to figure out what is happening to treat it accordingly. When you are dealing with a patient in respiratory or cardiac arrest, minutes can mean the difference between a good outcome-they live, or a not so good outcome-they do the opposite of live. If you are the conscientious type who can rattle off every condition you have in perfect Latin along with the long chemical name of every medication your on, then kudos for you. However this does me no good if you're unconscious.
Cancer patients also tend to be on a lot of cutting edge medications that aren't commonly known in the medical community. Information on what a newer drug is for and its action is invaluable to the paramedic and emergency physician trying to treat an acute event.
So, what's the solution? WRITE IT ALL DOWN! Below I've come up with a format that you can fit on a single sheet of paper to list your History, Allergies and Meds on along with all the other information a paramedic needs before he or she walks into the emergency room with you
NAME: Joe Blow
DATE OF BIRTH: 6/30/67
AGE: 37 (Yes we want the date of birth AND the age -hard to do the math at 3 AM)
ADDRESS: 1616 Main Street, Los Angeles, CA 90025
TELEPHONE NUMBER: 213-555-2222
SOCIAL SECURITY NUMBER: (we need it because most of your medical records are referenced from it)
(Remember H.A.M.)
HISTORY: CA (Medical abbreviation Cancer -specify what type of cancer; leukemia, lymphoma etc) High Blood pressure, Diabetes, asthma
ALLERGIES TO MEDICATIONS: Penicillin, Sulfa
MEDICATIONS: Oxycontin (include dose in mg), Atenolol (include dose in mg), HCTZ, Lasix, Glucophage, Albuterol
INSURANCE INFORMATION: Blue Cross of CA # 123456 Group#: 789
(Contrary to popular belief, most rides in the ambulance WILL cost you money and having your insurance information handy on scene will save you a lot of headaches later when dealing with the payment.
EMERGENCY CONTACT INFO: Brother- 310-222-3333
CODE STATUS: Do Not Resuscitate orders etc. (Not a cheery subject, but it may be relevant to some people. Keep in mind, if you are a DNR patient, each state has it's own laws regarding what paramedics can and cannot accept as a valid DNR. Some states require that the original legal DNR document be presented in order for us to withhold life-sustaining/resuscitative care. In other states paramedics can accept official bracelets with the DNR information listed. Get to know your laws. If the document is needed to be presented on scene, make sure someone knows EXACTLY where it is, otherwise you will be intubated, defibrillated, have CPR performed on you and be transported to the hospital. It might be a good idea to list the location of the DNR on this information sheet. Remember, a family member saying someone is a DNR is NOT GOOD ENOUGH FOR ME TO WITHOLD CARE. IT MUST BE IN WRITING AND LEGAL.
The day I run on a call and someone hands me a piece of paper with all this information on it, I swear to god I will get down on my knees and kiss their feet. It will not only make my job easier, it will provide the patient with quicker and more definitive medical care.
If you are dealing with an illness right now and the possibility exists that you might need your local EMS to come out and help you, please help us by providing this invaluable information. Your life may depend on it. At the very least you'll have a happy paramedic, and a happy medic always gets the IV on the first stick.
----------
Jeff Covitz (NREMT-P) is a paramedic in San Bernardino County in Southern California. He is also a clinical instructor at the UCLA Center For Prehospital Care. He lives in Los Angeles.
By Jeff Covitz NREMT-P
I am a paramedic and I work in a very busy 911 system in San Bernardino County in Southern California. I am called to respond to a variety of emergencies that range from stubbed toes to full cardiac arrests and everything in between. Whether it be a minor cut or something truly life threatening, there are basic pieces of information that we MUST obtain from every patient we encounter. I use a little pneumonic to help me remember it: HAM
H= History
A= Allergies
M= Medications
You would think that it would be a simple task to obtain a person's medical history, medication list, and allergies to meds, but you would be surprised how much detective work it sometimes takes to uncover this basic information for a patient.
HISTORY
Your medical history is obviously important as it keys us into the various body systems and complications that could be causing you to have needed us in the first place. A detailed list of your medical problems is essential as it will also dictate things we won't do for you.
For example, if you are a breast cancer survivor, and have had a mastectomy on the right side, it's vital that I have that information as I can't start any right-sided IV's due to the fact that some of your lymph nodes on the right side have probably been removed. This could potentially cause complications for you and affect any IV medications we may give.
ALLERGIES
Your allergies to medications are also extremely important to us. One of the leading causes of death by healthcare provider error involves giving a patient a medication that they are allergic to.
Just about every paramedic can share a story when he or she asked their patient what medications they were taking and they are handed a brown paper bag filled with a variety of loose pills that looks like a package of M&M's. Often we get responses such as "I take the blue ones on Mondays and Wednesdays, I'm supposed to take the white ones every day in the morning but I forget sometimes so I take two the next day to make up for it. I don't know what they're called, starts with an A. I don't take the green pills anymore because they made me pee funny colors." You get the picture.
At times the scene is comical and relatively benign if not annoying to the paramedic who has to squint really hard to see the tiny writing on the pill. However, other times it can mean the difference between life and death. Many of the medications paramedics use to treat acute episodes of shortness of breath, cardiac chest pain and a variety of other conditions can cause allergic reactions in certain people and cause them to go into a deadly condition known as anaphylactic shock. I could write an entire article about anaphylactic shock. Suffice it to say, it's something that can truly ruin your day.
MEDICATIONS
Some common prescription medications people take can also cause severe allergic reactions. Many of these reactions can be reversed in field by a clear-headed paramedic if he or she knows what medication it is they're dealing with. However if, for example, we are running on an acute altered level of consciousness with associated shortness of breath and we have zero information on the patient, we're simply going to revert to what we know: maintain an airway (bag them, oral intubation which involves tubes in uncomfortable places), keep the blood moving (fluids, cardiac drugs, electric cardiac pacing, CPR if necessary), and diesel fuel therapy (drive really fast to the hospital and let the ER doctor figure it out).
One of the hardest pieces of information to extract from a patient is an accurate medication list. Just about every paramedic can share a story when he or she asked their patient what medications they were taking and they are handed a brown paper bag filled with a variety of loose pills that looks like a package of M&M's. Often we get responses such as "I take the blue ones on Mondays and Wednesdays, I'm supposed to take the white ones every day in the morning but I forget sometimes so I take two the next day to make up for it. I don't know what they're called, starts with an A. I don't take the green pills anymore because they made me pee funny colors" You get the picture. At times the scene is comical and relatively benign if not annoying to the paramedic who has to squint really hard to see the tiny writing on the pill. However other times it can mean the difference between life and death.
This is especially true for cancer patients. Many of the drugs cancer patients take are opiates for pain management. If taken incorrectly or in the wrong dose, they can cause the patient to go into respiratory arrest, ie: you stop breathing. If this is allowed to go on for a period of time, your heart will decide it needs a little rest as well and it will stop beating. Most medical professionals consider this a bad thing. The rub is, if your paramedic knows what you have taken, we can give you a medication that can instantly reverse effects of the drug. However, if we're running in the dark it may take us several minutes to figure out what is happening to treat it accordingly. When you are dealing with a patient in respiratory or cardiac arrest, minutes can mean the difference between a good outcome-they live, or a not so good outcome-they do the opposite of live. If you are the conscientious type who can rattle off every condition you have in perfect Latin along with the long chemical name of every medication your on, then kudos for you. However this does me no good if you're unconscious.
Cancer patients also tend to be on a lot of cutting edge medications that aren't commonly known in the medical community. Information on what a newer drug is for and its action is invaluable to the paramedic and emergency physician trying to treat an acute event.
So, what's the solution? WRITE IT ALL DOWN! Below I've come up with a format that you can fit on a single sheet of paper to list your History, Allergies and Meds on along with all the other information a paramedic needs before he or she walks into the emergency room with you
NAME: Joe Blow
DATE OF BIRTH: 6/30/67
AGE: 37 (Yes we want the date of birth AND the age -hard to do the math at 3 AM)
ADDRESS: 1616 Main Street, Los Angeles, CA 90025
TELEPHONE NUMBER: 213-555-2222
SOCIAL SECURITY NUMBER: (we need it because most of your medical records are referenced from it)
(Remember H.A.M.)
HISTORY: CA (Medical abbreviation Cancer -specify what type of cancer; leukemia, lymphoma etc) High Blood pressure, Diabetes, asthma
ALLERGIES TO MEDICATIONS: Penicillin, Sulfa
MEDICATIONS: Oxycontin (include dose in mg), Atenolol (include dose in mg), HCTZ, Lasix, Glucophage, Albuterol
INSURANCE INFORMATION: Blue Cross of CA # 123456 Group#: 789
(Contrary to popular belief, most rides in the ambulance WILL cost you money and having your insurance information handy on scene will save you a lot of headaches later when dealing with the payment.
EMERGENCY CONTACT INFO: Brother- 310-222-3333
CODE STATUS: Do Not Resuscitate orders etc. (Not a cheery subject, but it may be relevant to some people. Keep in mind, if you are a DNR patient, each state has it's own laws regarding what paramedics can and cannot accept as a valid DNR. Some states require that the original legal DNR document be presented in order for us to withhold life-sustaining/resuscitative care. In other states paramedics can accept official bracelets with the DNR information listed. Get to know your laws. If the document is needed to be presented on scene, make sure someone knows EXACTLY where it is, otherwise you will be intubated, defibrillated, have CPR performed on you and be transported to the hospital. It might be a good idea to list the location of the DNR on this information sheet. Remember, a family member saying someone is a DNR is NOT GOOD ENOUGH FOR ME TO WITHOLD CARE. IT MUST BE IN WRITING AND LEGAL.
The day I run on a call and someone hands me a piece of paper with all this information on it, I swear to god I will get down on my knees and kiss their feet. It will not only make my job easier, it will provide the patient with quicker and more definitive medical care.
If you are dealing with an illness right now and the possibility exists that you might need your local EMS to come out and help you, please help us by providing this invaluable information. Your life may depend on it. At the very least you'll have a happy paramedic, and a happy medic always gets the IV on the first stick.
----------
Jeff Covitz (NREMT-P) is a paramedic in San Bernardino County in Southern California. He is also a clinical instructor at the UCLA Center For Prehospital Care. He lives in Los Angeles.
