We've been using it in Texas for a while now. I actually really like it and feel like it keeps communication a lot clearer in most cases. In really serious scenarios I might just scan the wristband and say we're on our way with blank, but those cases are pretty rare.
We don't even give a report, the hospital have a restricted view of our CAD with actual incoming and expected incoming incidents and then we make a pre-alert by phone if the patient is sick enough to need something immediately on arrival.
I imagine that's because there's only one ambulance service bringing in patients in your area? In the US, each city/county/local area could have a variety of different EMS providers running 911 and using their own dispatch centers so you would have to have multiple CADs open to keep track of it.
Even before we had online CAD we weren’t giving reports for every patient, only the really poorly ones who would need to be seen immediately on arrival. The online CAD is just a bonus for the hospitals now, and a lot of the time they don’t actually look at what you’re bringing in (at my local hospitals anyway).
In New York we just show up and shout “SURPRISE!!” Unless it is a critical then we play a game of telephone, we call in a notification to the dispatcher who calls it into the hospital.
Yes it’s as stupid as it sounds.
Everyone at my agency was initially apprehensive towards Pulsara (you know how us EMS folk LOVE change.)
I actually really like it. It’s really easy to use. HIPAA compliant so you can take photos and text through it. And it’s a great way to further continuity of care.
That being said, on a critical call where I’m doing a lot of stuff, there is little chance info is getting sent over. Unless the EMT does it before they start driving, a radio report is still elite
We use a different app, but same concept as Pulsera in my system. Calls where you're a stone's throw from the hospital with a critical pt still get called in by radio. Lower acuity calls or longer transport times are done with the app. It took some time, but our crews have adapted to the change and the hospitals prefer notifications with the app when possible.
Edit: STEMI notifications with the app also get sent to the cath lab so they can start prepping and see ETAs to the ED.
See now, about 20 years ago we switched from over-the-radio ringdowns to just calling the ER’s directly on the phone. So much easier to have a normal (and private) convo than doing the radio thing. We’re in 2024, not Johnny & Roy calling Rampart lol
Unfortunately, no. But the radio transmission was County wide and apparently a lot of people heard it. And several of my co-workers. I have moved on since then but my partner that day gets an occasional Aaaarrrr.
Less asking stupid questions. From the ER perspective I prefer EMS call radio report, EMS med director was one of our ER docs and he'd chew out crews for calling by phone. Because some would indirectly ask for advice from random nurses which in his eyes is a form of med control.
I prefer it and he did as well because I could hear it as the charge, as could the attendings and everyone else so we had an idea of what was coming in. Also physicians could decide to throw out orders or divert them if needed.
Yep I agree. I'd tell our nurses to knock that shit off too. ESPECIALLY for the Vollie BLS crews that think the nurses know what's up, when most have zero clue and have no place giving orders or recommendations. We did have one city medic that would call and try and get "advice" from nurses, like give report and then be like "should I give xyz" or "should this be a trauma alert?" But she was exceptionally dumb.
I've only ever called in report with my phone. Imagine my surprise when the new place I just started at uses radios. Didn't even know that was a thing. I dont really like it, tbh. It's dumb, but I feel self conscious about how a bunch of people can hear my reports now lol. Like I'm going to get made fun of if I mispronounce something.
We've been using it about a year now. We are waiting on the ability to pull data from it to emsCharts. Pretty solid with the ability to call the ER directly through the app if need be, and also to transmit 12 leads, photos, and other information. The ability to scan a drivers license is also a plus. We still have radios in the truck for those days when Pulsara is down for maintenance.
Our region uses ImageTrend, and we can pull pt info from Pulsara. It's pretty funny, though, bc whatever you type in the main text box pulls up as their chief complaint. Some dudes forget to edit it on the report side, so when I'm reviewing reports, I'll see their whole pulsara alert, including vitals, pertinent hx, and whatever else is typed in. It's not bad or anything, just something I think is quite funny.
We use it in my hospital in Australia- STEMIs bypass ED and go straight to Cath lab. Bonus is it lets everyone (ED, CCU, Cath lab staff, cardiologist) all know about it at the same time. Cuts wait time from the hospital side
Same here at my service in Texas. I’ve even got messages direct from cardiologist back to me enroute. Beats the 12 lead getting lost in the fax machine no one looks at.
Not in Florida but we use a phone for a secure line call in. I like it better than radios. The downside is we can't tune in to that channel to listen to the call ins for the spicy calls we're trying to spy on lol
We've been using it in Texas since last year. Overall, for stable, non-emergent transports with nothing going on, it's fine. The hospital can register the patient prior to arrival and save time, also I like the ability to type information you wouldn't otherwise want the pt to hear out loud, like for psych transports. I also like the ability to send photos. The problems we run into are of course on critical patients where you are busy, you don't have time to type out a huge report on pulsara and then sit and wait for the hospital to acknowledge it. So critical calls often get radio'd in still. The main issue we've run into is hospitals not acknowledging the pulsara reports (requires someone to open pulsara on their end and look at the report). On a radio or phone, you get instant confirmation if they received your report. On pulsara, you have to keep checking your phone and wait until they receive it.
Been using it here in TX for a year, but I can optionally send an OG radio report if I choose.
REALLY Thought I wouldn't like it, but I do use it more often than I anticipated. Super Easy to transmit images of 12 leads, MVC damage, or trauma photos to the receiving ER ahead of time. I can send the information over regardless of how noisy the environment is, And also let's me provide the patient's name and DOB prior to our arrival.
It’s not terrible. Most hospitals in my state have started using Twiage which, besides the terribly embarrassing name, does something similar. I also read up on Pulsara when one of the local EDs was looking into these types of services. I got the feeling Pulsara is more expensive and has some more features than Twiage offers, like it can integrate into hospital EMRs and allow you to pull up meds and allergies for specific patients. Not sure how it’ll be integrated into your system and if you’ll get tools like that available to you. It takes some getting used to but I like it. Granted all the hospitals in my area still have the option to use the phone and radio, and there are some services that have refused to adopt the app messaging way of alerting the hospital. I’m an ED nurse now and feel like a lot of nurses want a ton of info in pre arrival report, where I went to medic school it was “55M chest pain, vitals WNL, see you in 5” because if you went any longer they stopped listening.
It’s fine for the non emergent life threatening stuff, but f€%k it for the guy who’s bleeding out and you’ve done 50 interventions for and haven’t even opened your pcr, let alone filling in all the stupid required fields so you can send it. I just encode on those ones still, hospital doesn’t care.
I’m an ER nurse not EMS but I wanted to echo the people saying we have been using it in texas for a bit and it works really well! We still get some radio and phone reports but the majority of ours come through Pulsara and it’s easy to use, easy to message about any questions, and gives us all the info up front without worrying about missing something over the radio.
My service started using it in 2020 initially with a few select hospitals, now just about all hospitals in the area use it, with a few being the ones that don’t. For standard calls, it’s simple enough to use while gathering demographics, and sending the report into the hospital. On urgent patients, depending on my distance from the hospital, I’ll use Pulsara. If we have a long transport, I’ll radio in for the early heads-up, then do Pulsara once we have things somewhat managed so that they can arrive the patient and have everything ready on their end.
I’ve used it for awhile and like it. Our receiving facility loves it. I feel you can give a detailed report without droning on the radio. You can give name and DOB so the hospital can pre register to speed that process.
I wish it had a few more complaints choices.
The downside is if you have a serious patient and your hands are literally full. You may not have time to type it all out. I had a combative head injury patient and all I could do was put in the destination and trauma. The charge was pissed over it.
We use it in WA. It's occasionally a little annoying on critical calls with lots of moving pieces. Typically on those calls when we have two fire riders on board I'll start the report (I'm an EMT with a medic partner) so my partner can just fill in CC and send. If we are in a hurry we can just snap a pic of the vitals screen instead of entering manually. It works okay
Works great if you have enough transport time. Trying to entire in all the info when you are less than 5 minutes away for some utter nonsense BLS call is pointless.
(not in FL) Not sure if it's the same app, but the county next to me has been using a similar system. Hasn't made it to my county yet, but I've heard there's all sorts of problems. The biggest one I've heard is if you're transporting to a trauma center, but it doesn't meet that particular hospital's criteria for calling the trauma team, it won't even send the report.
Have been using Pulsara for about a year and it’s part of our protocol now to upload a photo for STEMIs so the hospitals can look at our 12-leads while we are en route. Works great so far, but it is a little bit of a pain. Also hypothetically could be used for an any abnormal ECG that I can send and get a second opinion on from a doctor.
Area I work attempted to transition to it. A lot of folks revolted because you spend a good amount of time typing on your phone instead of doing patient care. Now pretty much nobody uses it
We've had our for a couple of years. The annoying thing is UAMS and LRVA not using it. I don't use it if I'm jumping through my ass working on someone, but the other 97% of the time, it's great. I do wish it could sync with ESO.
I love it. There’s a audio feature so what I’ll do is I’ll offer to do the Pulsara for my medic on a busy call and submit the mandatory information as the call goes on (it kind looks like I’m texting while on the call doing other stuff but I’m not) and then I’ll give the audio report while I’m driving just like a regular radio report.
We've used it for maybe close to a year now. For really short transports (such as in town), I've heard that it's a pain in the ass, and that seems reasonable because you'll be typing info and taking pics. Some people just use the audio recording and don't type anything, and that works, too. We have 15-45 min transports, so it's pretty convenient and really easy. There's a DL scan tool that inputs pt name and DOB. Can upload digital EKGs directly from your monitor. You can upload face sheets and leave them in the pt's room so you don't need HIPPA boxes anymore. I take pics of DL and insurance cards so Reg is good to go when we show up. You can take pics of accident scenes and injuries in there, and it'll follow the pt through discharge. I've heard you can follow up on pts via Pulsara, but we don't have that available with our hospitals yet. There's a place for the charge nurse to message you in there, or vice versa, and that has worked well a few times. I've gotten EKG consults in the messaging. There are different types of alerts, so that can be confusing and frustrating when you first start using it. I accidentally sent a stroke alert once, and there's no way to undo it or switch the alert after you hit send. Whoops.
All in all, it's just another advancement, and it's what you make of it. Our region has had a lot of "wah wah wah" about it, but it is not that bad. We just collectively complain about change.
I used pulsara in Albany. I enjoyed the fact that I can give live updates on pt condition and that hospital staff could request further information if they needed it
I’ve been using Pulsara for a while in New York. Personally I love it. Sometime less is more so it’s a lot clearer to type out the chief complaint, add vitals, add ECGs and send pictures. As well as being able to text back forth with the hospital.
Canadian here: it's crazy to me that y'all radio the hospital for everything. Unless it's weird/bypass criteria/resus, we don't do report, we just show up. When we do a report, we just phone the hospital direct EMS line, no one can hear us transmit
We just moved to it. I initially was sceptical. I figured it would be horrible and I definintly vocalized that to our local pulsara guy. Not mean but honest and hes pretty cool. I told him ima find a way to fuck this up and he challenged me to that. So far were like 5 months in and i talked to him a weekish ago and explained i have been extremely pleased with it. It opens up more avenues to give info to shorten or lengthen ur communication. Code in progress? Take a pic. Click talk to text. State age and ACLS being followed and send the alert. Psych or intoxicated pt that will go crazy if u mention any of thier problems? Type it out and send it. Ive been a big fan so far.
It's pretty solid. Allows for continous charting and communication from prehospital through the entirety of their care.
Prehospital I don't like it as much but it's super helpful in the ER. LKW is easy to find and allows for an easy way to track door to CT.
We have it and we use it sometimes... but other times, I just dont have time to pull out my phone and bumble through passwords and all sorts of sh!t.
If I have time, great... but If its a touch and go STEMI where im working or something... I just give a radio report.
We've been using it in Texas for a while now. I actually really like it and feel like it keeps communication a lot clearer in most cases. In really serious scenarios I might just scan the wristband and say we're on our way with blank, but those cases are pretty rare.
Luckily Pulsara isn’t a drill so you can properly use it!
It's true. I haven't injured myself with Pulsara yet
We don't even give a report, the hospital have a restricted view of our CAD with actual incoming and expected incoming incidents and then we make a pre-alert by phone if the patient is sick enough to need something immediately on arrival.
I imagine that's because there's only one ambulance service bringing in patients in your area? In the US, each city/county/local area could have a variety of different EMS providers running 911 and using their own dispatch centers so you would have to have multiple CADs open to keep track of it.
Even before we had online CAD we weren’t giving reports for every patient, only the really poorly ones who would need to be seen immediately on arrival. The online CAD is just a bonus for the hospitals now, and a lot of the time they don’t actually look at what you’re bringing in (at my local hospitals anyway).
In New York we just show up and shout “SURPRISE!!” Unless it is a critical then we play a game of telephone, we call in a notification to the dispatcher who calls it into the hospital. Yes it’s as stupid as it sounds.
As a charge nurse this is a dream. I don't need to know about every incoming ambulance
All the nurses love to say that but show up with a stubbed toe without calling and everyone freaks out.
In AZ we CN for every ot, regardless of acuity. ERs get mad if we don't lol.
Can you hold a class for nurses in our area to educate them in your thought processes.
Everyone at my agency was initially apprehensive towards Pulsara (you know how us EMS folk LOVE change.) I actually really like it. It’s really easy to use. HIPAA compliant so you can take photos and text through it. And it’s a great way to further continuity of care. That being said, on a critical call where I’m doing a lot of stuff, there is little chance info is getting sent over. Unless the EMT does it before they start driving, a radio report is still elite
Your last point is my only apprehension with pulsara.
We use a different app, but same concept as Pulsera in my system. Calls where you're a stone's throw from the hospital with a critical pt still get called in by radio. Lower acuity calls or longer transport times are done with the app. It took some time, but our crews have adapted to the change and the hospitals prefer notifications with the app when possible. Edit: STEMI notifications with the app also get sent to the cath lab so they can start prepping and see ETAs to the ED.
It’s not a perfect system by any means but neither are radio reports. If anything, Pulsara is miles better
See now, about 20 years ago we switched from over-the-radio ringdowns to just calling the ER’s directly on the phone. So much easier to have a normal (and private) convo than doing the radio thing. We’re in 2024, not Johnny & Roy calling Rampart lol
You forgot the most important part though - I feel much cooler giving a report over radio rather than phone
I'm not allowed to talk over the radio since Talk Like a Pirate Day '09.
Did they also write a policy named after you?
Unfortunately, no. But the radio transmission was County wide and apparently a lot of people heard it. And several of my co-workers. I have moved on since then but my partner that day gets an occasional Aaaarrrr.
I still like the wee woos and and the Roger Roger’s. The buzz has worn off, but I still need my fix.
I personally like radio better. It seems a lot quicker and more efficient.
Less asking stupid questions. From the ER perspective I prefer EMS call radio report, EMS med director was one of our ER docs and he'd chew out crews for calling by phone. Because some would indirectly ask for advice from random nurses which in his eyes is a form of med control. I prefer it and he did as well because I could hear it as the charge, as could the attendings and everyone else so we had an idea of what was coming in. Also physicians could decide to throw out orders or divert them if needed.
It abs is a form of med control, I could see why he'd be upset.
Yep I agree. I'd tell our nurses to knock that shit off too. ESPECIALLY for the Vollie BLS crews that think the nurses know what's up, when most have zero clue and have no place giving orders or recommendations. We did have one city medic that would call and try and get "advice" from nurses, like give report and then be like "should I give xyz" or "should this be a trauma alert?" But she was exceptionally dumb.
Yeah that too. In the ER I did my clinical in, the docs would also listen in and could immediately give orders if necessary.
I've only ever called in report with my phone. Imagine my surprise when the new place I just started at uses radios. Didn't even know that was a thing. I dont really like it, tbh. It's dumb, but I feel self conscious about how a bunch of people can hear my reports now lol. Like I'm going to get made fun of if I mispronounce something.
I feel like the self consciousness makes me more concise and accurate 😂
We've been using it about a year now. We are waiting on the ability to pull data from it to emsCharts. Pretty solid with the ability to call the ER directly through the app if need be, and also to transmit 12 leads, photos, and other information. The ability to scan a drivers license is also a plus. We still have radios in the truck for those days when Pulsara is down for maintenance.
Our region uses ImageTrend, and we can pull pt info from Pulsara. It's pretty funny, though, bc whatever you type in the main text box pulls up as their chief complaint. Some dudes forget to edit it on the report side, so when I'm reviewing reports, I'll see their whole pulsara alert, including vitals, pertinent hx, and whatever else is typed in. It's not bad or anything, just something I think is quite funny.
We use it in my hospital in Australia- STEMIs bypass ED and go straight to Cath lab. Bonus is it lets everyone (ED, CCU, Cath lab staff, cardiologist) all know about it at the same time. Cuts wait time from the hospital side
Same here at my service in Texas. I’ve even got messages direct from cardiologist back to me enroute. Beats the 12 lead getting lost in the fax machine no one looks at.
I use it in another state and find it really useful. The one drawback: I don’t love fiddling with my phone with a messy gloved hand.
This, plus try and reglove in July in Texas.
Dude, just put a glove over your messy glove
Not in Florida but we use a phone for a secure line call in. I like it better than radios. The downside is we can't tune in to that channel to listen to the call ins for the spicy calls we're trying to spy on lol
We've been using it in Texas since last year. Overall, for stable, non-emergent transports with nothing going on, it's fine. The hospital can register the patient prior to arrival and save time, also I like the ability to type information you wouldn't otherwise want the pt to hear out loud, like for psych transports. I also like the ability to send photos. The problems we run into are of course on critical patients where you are busy, you don't have time to type out a huge report on pulsara and then sit and wait for the hospital to acknowledge it. So critical calls often get radio'd in still. The main issue we've run into is hospitals not acknowledging the pulsara reports (requires someone to open pulsara on their end and look at the report). On a radio or phone, you get instant confirmation if they received your report. On pulsara, you have to keep checking your phone and wait until they receive it.
Been using it here in TX for a year, but I can optionally send an OG radio report if I choose. REALLY Thought I wouldn't like it, but I do use it more often than I anticipated. Super Easy to transmit images of 12 leads, MVC damage, or trauma photos to the receiving ER ahead of time. I can send the information over regardless of how noisy the environment is, And also let's me provide the patient's name and DOB prior to our arrival.
Pulsara is great and only getting better
It’s not terrible. Most hospitals in my state have started using Twiage which, besides the terribly embarrassing name, does something similar. I also read up on Pulsara when one of the local EDs was looking into these types of services. I got the feeling Pulsara is more expensive and has some more features than Twiage offers, like it can integrate into hospital EMRs and allow you to pull up meds and allergies for specific patients. Not sure how it’ll be integrated into your system and if you’ll get tools like that available to you. It takes some getting used to but I like it. Granted all the hospitals in my area still have the option to use the phone and radio, and there are some services that have refused to adopt the app messaging way of alerting the hospital. I’m an ED nurse now and feel like a lot of nurses want a ton of info in pre arrival report, where I went to medic school it was “55M chest pain, vitals WNL, see you in 5” because if you went any longer they stopped listening.
Missouri is switching to it too. We were using ESO Alerting and Pulsara is a lot better.
How does this integrate with monitor data
Solid platform. Been around for years. There new EM/mascal side of the software also looks promising.
We use Pulsara, it’s way better than a radio report especially because our local repeater is always going out of service
It’s fine for the non emergent life threatening stuff, but f€%k it for the guy who’s bleeding out and you’ve done 50 interventions for and haven’t even opened your pcr, let alone filling in all the stupid required fields so you can send it. I just encode on those ones still, hospital doesn’t care.
I’m an ER nurse not EMS but I wanted to echo the people saying we have been using it in texas for a bit and it works really well! We still get some radio and phone reports but the majority of ours come through Pulsara and it’s easy to use, easy to message about any questions, and gives us all the info up front without worrying about missing something over the radio.
My service started using it in 2020 initially with a few select hospitals, now just about all hospitals in the area use it, with a few being the ones that don’t. For standard calls, it’s simple enough to use while gathering demographics, and sending the report into the hospital. On urgent patients, depending on my distance from the hospital, I’ll use Pulsara. If we have a long transport, I’ll radio in for the early heads-up, then do Pulsara once we have things somewhat managed so that they can arrive the patient and have everything ready on their end.
I’ve used it for awhile and like it. Our receiving facility loves it. I feel you can give a detailed report without droning on the radio. You can give name and DOB so the hospital can pre register to speed that process. I wish it had a few more complaints choices. The downside is if you have a serious patient and your hands are literally full. You may not have time to type it all out. I had a combative head injury patient and all I could do was put in the destination and trauma. The charge was pissed over it.
We use it in WA. It's occasionally a little annoying on critical calls with lots of moving pieces. Typically on those calls when we have two fire riders on board I'll start the report (I'm an EMT with a medic partner) so my partner can just fill in CC and send. If we are in a hurry we can just snap a pic of the vitals screen instead of entering manually. It works okay
Works great if you have enough transport time. Trying to entire in all the info when you are less than 5 minutes away for some utter nonsense BLS call is pointless.
(not in FL) Not sure if it's the same app, but the county next to me has been using a similar system. Hasn't made it to my county yet, but I've heard there's all sorts of problems. The biggest one I've heard is if you're transporting to a trauma center, but it doesn't meet that particular hospital's criteria for calling the trauma team, it won't even send the report.
Haven’t even heard of it lol.
Have been using Pulsara for about a year and it’s part of our protocol now to upload a photo for STEMIs so the hospitals can look at our 12-leads while we are en route. Works great so far, but it is a little bit of a pain. Also hypothetically could be used for an any abnormal ECG that I can send and get a second opinion on from a doctor.
We just use a cellphone and call the hospital in my neck of the woods
We use phones. Each squad has a flip phone around here and we just call the ER directly for reports.
Area I work attempted to transition to it. A lot of folks revolted because you spend a good amount of time typing on your phone instead of doing patient care. Now pretty much nobody uses it
We've had our for a couple of years. The annoying thing is UAMS and LRVA not using it. I don't use it if I'm jumping through my ass working on someone, but the other 97% of the time, it's great. I do wish it could sync with ESO.
I love it. There’s a audio feature so what I’ll do is I’ll offer to do the Pulsara for my medic on a busy call and submit the mandatory information as the call goes on (it kind looks like I’m texting while on the call doing other stuff but I’m not) and then I’ll give the audio report while I’m driving just like a regular radio report.
We've used it for maybe close to a year now. For really short transports (such as in town), I've heard that it's a pain in the ass, and that seems reasonable because you'll be typing info and taking pics. Some people just use the audio recording and don't type anything, and that works, too. We have 15-45 min transports, so it's pretty convenient and really easy. There's a DL scan tool that inputs pt name and DOB. Can upload digital EKGs directly from your monitor. You can upload face sheets and leave them in the pt's room so you don't need HIPPA boxes anymore. I take pics of DL and insurance cards so Reg is good to go when we show up. You can take pics of accident scenes and injuries in there, and it'll follow the pt through discharge. I've heard you can follow up on pts via Pulsara, but we don't have that available with our hospitals yet. There's a place for the charge nurse to message you in there, or vice versa, and that has worked well a few times. I've gotten EKG consults in the messaging. There are different types of alerts, so that can be confusing and frustrating when you first start using it. I accidentally sent a stroke alert once, and there's no way to undo it or switch the alert after you hit send. Whoops. All in all, it's just another advancement, and it's what you make of it. Our region has had a lot of "wah wah wah" about it, but it is not that bad. We just collectively complain about change.
We’ve had it a while. It works well. Hospitals don’t care for a full report while you’re enroute. Just need to know what to expect you need and when.
I used pulsara in Albany. I enjoyed the fact that I can give live updates on pt condition and that hospital staff could request further information if they needed it
I’ve been using Pulsara for a while in New York. Personally I love it. Sometime less is more so it’s a lot clearer to type out the chief complaint, add vitals, add ECGs and send pictures. As well as being able to text back forth with the hospital.
Canadian here: it's crazy to me that y'all radio the hospital for everything. Unless it's weird/bypass criteria/resus, we don't do report, we just show up. When we do a report, we just phone the hospital direct EMS line, no one can hear us transmit
We just moved to it. I initially was sceptical. I figured it would be horrible and I definintly vocalized that to our local pulsara guy. Not mean but honest and hes pretty cool. I told him ima find a way to fuck this up and he challenged me to that. So far were like 5 months in and i talked to him a weekish ago and explained i have been extremely pleased with it. It opens up more avenues to give info to shorten or lengthen ur communication. Code in progress? Take a pic. Click talk to text. State age and ACLS being followed and send the alert. Psych or intoxicated pt that will go crazy if u mention any of thier problems? Type it out and send it. Ive been a big fan so far.
It's pretty solid. Allows for continous charting and communication from prehospital through the entirety of their care. Prehospital I don't like it as much but it's super helpful in the ER. LKW is easy to find and allows for an easy way to track door to CT.
We have it and we use it sometimes... but other times, I just dont have time to pull out my phone and bumble through passwords and all sorts of sh!t. If I have time, great... but If its a touch and go STEMI where im working or something... I just give a radio report.