Telemetry Template:


______________ This GEMS Unit______ , _____________________

Name of Hospital                                     #          your name and cert level


Information only/Request for orders.  We are currently in route to your facility Code___.



We have approximately a_____min ETA.  With a ______year old _____                                                                                 Age                 M/F


Complaining of________________________


Secondary to________________________.  How do you copy?

MOI or Onset


Copy, continuing PT is currently _________________________________________________

(LOC)  i.e.…CAB Aox4,  unc/unresp


With a GCS of _______(if less than 15 give reason for down grade such as repetitive questioning).


Ambulatory on scene? Y/N.  **If Trauma patient**


Give pertinent assessment findings:  Such as but not limited to: Obvious signs of Trauma, significant bleed, abnormal V/S values (i.e. hypertensive, hypotensive etc.


Treatment given:  IV established, 02, in full c-spine, bleeding controlled by pressure bandage, splint applied, Glucose administered etc…


Current set of V/S:  B/P of______ Heart rate of_____Spo2____

Resp Rate of_____Skin signs_______________


If no further questions or orders see you in________.  ________  clear.

ETA        Unit




Sunrise trauma this GEMS Unit 310, Paramedic Merritt,


Information only we are currently in route to your facility Code 3.


We have approximately an 8 min ETA.  With a 64 year old female

Complaining of multisystem trauma

Secondary to an auto vs Ped @ approx 45 mph.  How do you copy?

“Sunrise Trauma Copy , continue”

Copy, continuing PT is currently conscious, semi alert, AOX1, with a positive Loss of consciousness


With a GCS of  13, Marked down for repetitive questioning and being semi obtunded


Patient was not Ambulatory on scene, and found approximately 15 feet from point of impact. There was significant damage to the impact area on the subcompact vehicle.


Give pertinent assessment findings:  Pt remains AOx1, with an obvious unstable pelvis and lower left leg fracture with exposed bone.  Pt also has contusions and crepitus to left lower rib cage. Lung sounds are equal bilateral though the pt. is slightly tachypnic with no current symptoms of a pneumothorax.


Treatment given:  We currently have established bilateral large bore IV’s, Hi flo 02, PT is in full c-spine, bleeding controlled by pressure bandage to left lower leg, pelvis has been stabilized with a sheet.

Current set of V/S:  B/P of 110/70 Heart rate of 112 Spo2 96

Resp Rate of 25, Cool Pale and Diaphoretic


If no further questions or orders see you in 7 minutes 584  clear.

    “No further questions or orders, see you in Seven, Sunrise clear.”