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Evolution of the

Emergency Medical
Services Profession: A
Case Study of EMS Run
Reports
BY ROGER MUNGER

What is a run report?


Alternatively referred to as prehospital care reports (PCRs) and trip sheets, run reports are a
preprinted form which records the nature of an EMS call and what, if any, actions prehospital
care providers took during [an] emergency (Munger 330).

The typical run report features a combination of fill-in-the-blanks, check boxes, short answer,
and narrative spaces.
The run report reflects not just one professions interests, but severalincluding doctors,
nurses, and lawyers.

Why study run reports?


To observe how the practices and shared interests of various professions have shaped the design
of the run report form over time (330).
To observe the hierarchy among the EMS and medical professions, and how language enforces
such hierarchy.
there is a movement in the EMS community away from considering providers as mere
technicians. EMS personnel, collectively referred to as providers, are working to establish
themselves as a profession with the recognition, status, and pay on par with other medical or
allied health professions (330).
Munger considers the run report essential to attaining such legitimacy.

The Study
Study observes run reports from 1965-1995, taken from an upstate New York volunteer
ambulance service, Skyview.
For his study, Munger analyzed run reports, examined related archival materials, and interviewed
people who played key roles in the development of the run report form (331).
He finds that Skyviews run report form evolved in response to several changes in the medical
field.
As the EMS profession grew, technicians were given more specialized training, facilitating the
need for additional narrative space in the run report (331).

Run Reports Reflect Primary


Practice of Transporting Patients
(1942-1965)
Prior to 1965, both EMS and medicine had little interest in information concerning patient care
in a prehospital setting (332).
Skyviews primary focus at this point was transporting patients to nearby hospitals. Providers
were drivers, not medical professionals.
Narrative spaces are extremely brief. Basic information is conveyed through a series one to two
word answers and checkboxes.
Large amount of form space dedicated to vehicle information: gas level, tire condition, etc. This
reflects the emphasis on EMS as a transportation service not a medical service.

Run Reports Reflect New Skills and


Training (1965-1972)
During the mid-1960s the medical profession became more interested in the care provided to
patients outside the hospital, and EMS personnel acquired skills and equipment to better care
for patients (334). Training provided by medical professions (American College of Surgeons,
American College of Emergency Physicians).
Run narratives became longer, more comprehensive. They were much more in-depth, and
recorded the events of an accident more accurately.
The language and terminology used in many reports from this period reflects the new
competencies gained by EMS personnel.
The run report began to reflect the interests of law as well. Munger relates a story of an RN
instructing an EMS personnel to contradict protocol. Since this could be recorded in the run
narrative, the EMS provider could not be blamed for contradicting protocol.

Run Reports Reflect Need for


System-Wide Monitoring (19731980)
The Emergency Medical Services System Act is passed in 1973, encouraging the development of
comprehensive regional EMS systems throughout the country (336). In order to secure funding,
run reports now focused on collection of hard data.

Check boxes and diagrams returned, making the collection of quantifiable data easier.
Providers had approximately the area of three postage stamps in which to make Comments.
(337).
Providers felt that check boxes were too vague, that they did not accurately portray the events
of an emergency, or the pre-hospital procedures that were performed.
This was the first time providers indicated that they had more to say than the form allowed.

Run Reports Feature More Space for


Writing Narratives (1980-1984)
Funding was cut to several healthcare services during the 1980s. This caused competition to
develop between the EMS and medical communities.
It was, thus, that providers at Skyview in the early eighties used the lined white spaces in their
run reports to demonstrate their professions value to the communityBy contributing more
than check marks on the run report form, EMS professionals had proof that their profession had
value (339).
Exercising autonomy through language, establishing authority/identity through the written
word.

Run Reports Reflect the Needs of


Several Professions (1985-1995)
A period of re-definition for the EMS community. In order to legitimize EMS, collection of
scientific data became more important.
Run reports (now called PCRs) returned to emphasizing check boxes, the collection of
quantifiable data. Providers in the field opposed this, claiming some information could not be
expressed using check boxes alone (341).
Providers and medical professionals would eventually reach a compromise after three re-hauls
of the PCR form.

The war fought over the design of PCRs during this period illustrate*s+ how the form evolved to
accommodate the practices of providers in the field and affiliated professions interests in easily
quantifiable data (342).

Conclusions
Research on writing in the professions suggests that the professions maintain their status
through various written texts. That is, through disciplinary genres, individual professions are able
to establish a source of power and authority that is distinct from other professions (344).

The run report, then, is sort of like a recording of power. We can observe the hierarchy of the
various professions through the language and design of the run report over time.
Rather than representing trivial paperwork, medical forms such as the EMS run report hold
valuable data on the forces that shape the forms and the practices of the professionals who use
them (344).

Conclusions
EMS services remain non-autonomous at conclusion of study (1995). Their procedures and
practices are, to some extent, still controlled by the needs of the medical profession for a
method of indirect supervision and data collection.

Mungers study is interesting because it raises questions concerning identity, authority, and
language. How our command of language, through written documents such as the PCR,
determines our social status; our placement within a particular social or professional hierarchy.
We might also see how document composition takes into consideration the competencies and
interests of readers. PCRs were composed with EMS providers in mind. Providers played a large
role in shaping the documents design. Keeping in mind our emphasis on creating readercentered texts we might see how this is relatable to our coursework.

Activity
Run Reports of literature.

Resources
Munger, Roger. "Evolution of the Emergency Medical Services Profession: A Case Study of EMS
Run Reports." Technical Communication Quarterly 9.3 (2000): 329-46. Web.