🚑 EMS Narrative Generator
911
📻 Call Info
▼
Call Type
911 Emergency
IFT (Interfacility Transfer)
Sending Facility
Sending Physician
(optional)
Reason for Transfer
(optional)
Unit Number
Nature of Call
Response — Lights & Sirens
L&S Throughout
Without L&S
L&S → Downgraded
No L&S → Upgraded to L&S
Transport — Lights & Sirens
L&S Throughout
Without L&S
L&S → Downgraded
No L&S → Upgraded to L&S
👤 Patient Demographics
▼
Patient Age
Patient Sex
Male
Female
Symptoms Onset (ago)
Scene Description
Chief Complaint
Stated CC
No Verbalized CC
What PT States About the Call
Last Oral Intake (LOI)
PT States
Unknown
Clock time + date
Date
Time
LOI UNKNOWN PER PT.
Loss of Consciousness (LOC)?
Denied
Yes
Unknown
PT Speaking In
GCS
Eye (E)
—
4 — Spontaneous
3 — To Voice
2 — To Pain
1 — None
Verbal (V)
—
5 — Oriented
4 — Confused
3 — Words
2 — Sounds
1 — None
Motor (M)
—
6 — Obeys
5 — Localizes
4 — Withdraws
3 — Flexion
2 — Extension
1 — None
—
Barriers to Care
None
Present
Select All That Apply
Language Barrier
Altered Mental Status
Hearing Impairment
Visual Impairment
Cognitive Impairment
Intoxication / Substance Use
Other
Language (specify)
Other Barrier (specify)
How Barrier Was Addressed (optional)
🧠 Alert & Orientation
▼
Knows Current President
Yes
No
Knows Time (Month/Year)
Yes
No
Aware of Events Leading to Call
Yes
No
Knows Personal Information (Self)
Yes
No
📋 OPQRST / Assessment
▼
Include OPQRST?
Yes
No — Omit
+ Add Pain Location
DCAP Abnormalities (leave blank if none)
🧬 Stroke Assessment
Include in Narrative?
No — Omit
Yes
FAST Overall Result
Negative
Positive
Inconclusive
Component Assessment
Overall Abnormal Findings
BGL (mg/dL)
Last Known Well
C-Collar Applied?
No
Yes
Reason
Neck Pain
Back Pain
Head Strike
Severe MOI
Additional Notes
🚗 Motor Vehicle Collision
▼
Include MVC in Narrative?
No
Yes
MVC Details
Vehicle Type
Passenger Vehicle
Pickup Truck
Motorcycle
Bicycle
Pedestrian
Other
PT Position in Vehicle
Driver
Front Passenger
Rear Passenger
Unrestrained (ejected area)
Impact Area(s) — check all that apply
Frontal
Rear
Driver-Side (Left)
Passenger-Side (Right)
Rollover
PT Restrained?
Yes — Seatbelt
No — Unrestrained
Helmet (motorcycle/bicycle)
Airbags Deployed?
Yes
No
Unknown
Vehicle Intrusion?
Yes
No
PT Ejected?
Yes
No
Estimated Speed / Other Details (optional)
🏥 Fall
▼
Include Fall in Narrative?
No
Yes
Fall Details
How Did the Fall Occur?
Approximate Fall Height
Ground Level / Standing
< 6 Feet
> 6 Feet
Unknown
Fall Surface
Concrete / Pavement
Hardwood / Tile
Carpet
Grass / Dirt
Stairs
Other
Head Strike?
Yes
No
Unknown
LOC Associated with Fall?
Yes
No
Unknown
Witnessed?
Yes — Witnessed
Unwitnessed
Additional Fall Notes (optional)
💓 Vital Signs
▼
+ Add Vital Set
🧩 Behavioral Health / BA & Marchman Act
▼
BH Call?
No
Yes
Type of Act
Baker Act
Marchman Act
Both
Who Initiated?
Law Enforcement
MH Professional
Physician
Family Member
EMS Crew
Other
Initiator — Specify
Document / Form Reference
Initiating Agency / Officer
Behavioral Symptoms
Physical Restraints Applied?
No
Yes
Restraint Details
Type
Soft 4-Point
Soft 4-Point (Swimmer's)
LEO Handcuffs
Authorization
Medical Direction (Phone)
Dispatch (Phone)
Written Protocol
LE Authority on Scene
Reason Needed
Circ / Neuro Checks
Yes — WNL
Not Performed
🛻 Transfer to Stretcher
▼
Transfer Method
Extremity Carry
Drawsheet
Lateral Transfer
Walking
Standing Pivot
Other
Reason / Notes
Position on Stretcher
Supine
Semi-Fowler's
Fowler's (Sitting)
Trendelenburg
Lateral Recumbent
Other
Hot / Cold Pack?
None
Cold Pack
Hot Pack
Applied To
Events During Transport
Leave blank to use default monitoring statement. Fill in to override with specific transport events.
🏥 Destination & Transfer to Bed
▼
Destination Hospital
Destination Room
(optional)
Accepting Individual
Transfer to Bed Method
Extremity Carry
Drawsheet
Lateral Transfer
Walking
Standing Pivot
Other
Reason for Bed Transfer (if applicable)
🚫 Refusal of Care
▼
Refusal Occurred?
No
Yes
What Was Refused?
Transport
Treatment
Specific Intervention
Assessment / Vitals Check
GCS at Time of Refusal
A&O at Time of Refusal
Decisional Capacity
Demonstrates Decisional Capacity
Lacks Decisional Capacity
Specific Risks Discussed
Example: INTRACRANIAL HEMORRHAGE DUE TO HEAD INJURY AND ANTICOAGULANT USE, RISK OF STROKE, DETERIORATION, PERMANENT DISABILITY, AND DEATH
PT Able to Repeat Back?
Yes
No
Medical Direction Contacted?
Yes
No
✍️ Signature
▼
Signature Type
Type 1 – PT signs at destination
Type 2 – PT signs on scene
Type 3 – Signed on behalf of PT
Rep on Scene?
Yes
No
Type 2 Reason
Type 3 Reason
HAR Number
(optional — appears at end of narrative)
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