Form or Fiction?
You’re dispatched to a workplace for a 44-year-old male who reportedly fainted. On arrival, he’s back at his desk and appears well. You ask if he needs help; he says “No, I’m good,” and returns to his computer. He declines to give his name and no vitals are taken
ACR + Form 72
Visual contact with the patient the call was for = ACR + Form 72, even without formal identification or refusal.
Crew:
PR1: PC Wakefield (documenting)
PR2: PCP Singh
Dispatch Complaint: Chest pain
CTAS: 2
Clinical Impression: Chest wall pain
Vitals Recorded:
HR 84, BP 132/82, RR 18, SpO2 97%, GCS 15 — recorded once at 13:08 by PR2
Treatment Provided:
ASA 160 mg PO administered at 13:12
12-lead ECG completed at 13:09
Transfer of Care:
“Verbal report provided to RN at ED triage. Patient walked into department.”
InHx:
“Pt found seated in kitchen on arrival, A&O x3. Reports intermittent sharp left-sided chest pain x3 days, worsened by movement. Denies SOB, nausea, or radiation. 12-lead completed showing NSR. ASA 160 mg administered. Pt walked to stretcher without assistance. Transported Code 4. No complaints en route. Handover given to RN.”
❓ Question Prompt:
This narrative would fail QA under OADS v4.0.
Identify the critical documentation omission that violates the standards
Only one set of vital signs is documented.
Crew:
PR1: PCP Fraser (documenting)
PR2: PCP McKenna
Dispatch Complaint: Headache
Clinical Impression: Migraine
Patient: 34-year-old female
Vitals:
Set #1: HR 76, BP 118/72, RR 16, SpO₂ 98%, Temp 36.8°C, GCS 15
Set #2: HR 74, BP 116/70, RR 16, SpO₂ 98%, GCS 15
Narrative:
“Pt reports a history of migraines. Onset this morning, no visual disturbance or neuro symptoms. Vitals stable x2. Pt requested not to be transported, stating she has medication at home and has experienced similar symptoms before. Risks, benefits, and consequences explained. Pt signed Form 72. No signs of distress noted. Cleared scene.”
Does this refusal meet all OADS v4.0 documentation expectations?
Yes
This is a textbook refusal
Crew:
PR1: PCP Navarro (documenting)
PR2: PCP Hale
Call Type: Difficulty breathing – Code 4 transport
Incident Details:
During a Code 4 respiratory distress call, the crew attempted to apply the cardiac monitor for continuous vitals en route. The unit powered on but failed to recognize lead placement and displayed repeated lead failure alerts.
Crew resorted to manual vitals and completed one ECG with a portable backup monitor at hospital. No harm occurred to the patient.
InHx:
“Defib monitor failed to detect cardiac leads. Repeated lead faults. ECG obtained at ED using backup monitor. Vitals monitored manually during transport. No adverse outcome to patient.”
Does this require an incident report under OADS v4.0?
Yes — this requires an incident report under OADS v4.0, Section 8.
Specifically, the standard mandates reporting for:
“Malfunctioned, missing, or unavailable patient care equipment while assigned to a patient call.”
Crew:
PR1: ACP Martins (documenting)
PR2: PCP Vong
Call Type: Assault – 911 call from bystander
Patient: 15-year-old male
Findings on Scene:
Pt alert, GCS 15, appears mildly agitated
Small laceration over left eyebrow, swelling to right wrist
Pt states he was punched, doesn’t want any “fuss” or attention
Denies pain, declines vitals, refuses all assessment and care, but agrees to transport to hospital at mother’s insistence
Pt is transported Code 3, no treatment rendered
Documentation Summary:
One paramedic listed as “Lead”
No vitals documented
CTAS left blank
Refusal section left blank
Narrative: “Pt transported to hospital after physical altercation. Denied care on scene. Refused vitals and treatment. Taken to ED with mother. No injuries noted.”
No Form 72 completed
No mention of risks explained
No documentation of patient’s capacity or parental authority assumption
Under OADS v3.0, this documentation may have passed QA.
Identify at least three distinct OADS v4.0 compliance issues or omissions that make this call non-compliant — and explain why.
This documentation fails compliance under OADS v4.0 due to multiple omissions:
1. No Form 72 Completed for Refused Care
2. Refusal Section Left Blank
3. No CTAS Assigned
4. Missing Documentation of Risk Explanation or Capacity
5. Only One Set (or Zero Sets) of Vitals
A bystander flags you down for a “guy having a seizure” behind a store. No dispatch call exists for this. You locate the patient, who is awake and alert. He refuses care and signs a refusal.
ACR + Form 72
No 911 call was made, but you had patient contact and obtained a valid refusal. Form 72 still required per standard refusal pathway.
Crew:
PR1: ACP Belanger (documenting)
PR2: PCP Ross
Dispatch Complaint: Abdominal pain
CTAS: 3
Clinical Impression: Abdominal pain – undifferentiated
Vitals Recorded:
Set #1 (17:44): HR 88, BP 128/78, RR 16, SpO₂ 98%, Temp 36.7°C, BGL 5.6 mmol/L, GCS 14
Set #2 (17:52): HR 90, BP 126/82, RR 16, SpO₂ 99%, GCS 14
Treatment Provided: None
Refusal Section:
Form 72 completed
Refusal signed by patient at 17:54
Risks, benefits, and consequences explained
Refusal applies to assessment and transport
Patient will care for himself further
InHx:
“Pt found seated on couch. Appears confused but cooperative. Reports mild intermittent lower abdominal pain since this morning. Denies vomiting, diarrhea, fever. Vitals obtained. BGL 5.6 mmol/L. Pt declined further assessment and transport, stating he has a family doctor appointment tomorrow. Risks, benefits, and consequences were explained. Pt signed Form 72. Second vitals remained stable. Cleared scene without incident.”
This refusal appears complete at first glance.
What serious documentation issue would trigger a QA or patient safety concern under OADS v4.0?
The patient’s GCS is 14 and the narrative describes confusion
Crew:
PR1: PCP Lafleur (documenting)
PR2: PCP Hall
Dispatch Complaint: 38-year-old female with nausea and vomiting
Clinical Impression: Not determined
Patient Contact:
Patient answered the door on arrival.
Vitals:
None taken (patient refused)
Treatment:
None provided
📋 Form 72 Section (as documented):
InHx:
“Pt met crew at door. Spoke clearly and stated she felt better. Declined assessment and transport. Stated she didn’t want to go to the hospital. Pt signed Form 72. No further care provided.”
This refusal appears valid. Under OADS v4.0, what critical element is missing that would result in an audit failure?
There is no documentation that risks, benefits, and consequences were explained.
Crew:
PR1: ACP Patel (documenting)
PR2: PCP Walker
Call Type: Chest pain – 52-year-old male
Disposition: Pt transported Code 4 to ED
Clinical Impression: Cardiac Ischemia
Details:
Pt c/o dull, central chest pain (5/10), started ~30 minutes prior
No radiation, but associated nausea and diaphoresis present
Vitals stable x2; GCS 15
ASA 160 mg PO administered
Nitroglycerin 0.4 mg SL administered with positive response
No 12-lead ECG was performed
Crew stated the 3-lead showed NSR, and no “changes” were evident
Pt transported Code 4; shortly after ED triage, pt became VSA and was resuscitated in ED
InHx:
“52 y/o male with central CP, nausea, and diaphoresis. ASA and Nitro given. 3-lead ECG showed NSR. 12-lead not completed based on stable presentation and improvement with Nitro. Transported Code 4. Pt arrested shortly after ED triage.”
Does this require an Incident Report under OADS v4.0?
If so, which reporting criterion applies, and why?
Yes — this requires an Incident Report under OADS v4.0.
It meets Criterion #2:
Deviation or omission of a Ministry standard, directive, or treatment that caused a negative outcome
Crew:
PR1: PCP Dhillon (documenting)
PR2: PCP Evans
Call Type: Low-speed rear-end MVC, 2 vehicles
Patient: 24-year-old male, driver of Vehicle 1
Findings:
Pt standing outside vehicle on arrival
Denies injury or pain
No physical assessment performed
No vitals obtained
Pt stated “I’m good, don’t need anything” and walked away from scene
Documentation Summary:
Under OADS v4.0, what specific documentation error or omission would trigger a QA flag?
Form 72 is required under OADS v4.0 — even if no care is provided
You’re dispatched to a public park for “unconscious male.” You arrive, search the area with police for 25 minutes, and eventually spot a man sitting upright on a bench. You make eye contact, but he stands and walks away without speaking.
ACR + Form 72
Visual contact with the individual tied to the 911 call = Form 72. Even without a conversation or signature, both forms are required.
Crew:
PR1: PCP Vega (documenting)
PR2: PCP Lowe
Dispatch Complaint: Mental health – suicidal ideation
CTAS: 2
Clinical Impression: Acute psychiatric crisis
Vitals Recorded:
Set #1 (21:03): HR 92, BP 134/84, RR 20, SpO₂ 99%, Temp 36.4°C, GCS 15
Set #2 (21:22): HR 96, BP 138/88, RR 18, SpO₂ 99%, GCS 15
Treatment Provided: Supportive care, verbal de-escalation, voluntary transport
Transfer of Care Section:
“Patient walked into ED upon arrival. Crew returned to service.”
Narrative:
“Pt located in bedroom, cooperative but tearful. States he has been overwhelmed and told a friend he was considering suicide. No plan or means disclosed. Pt agreed to voluntary transport. No abnormal findings on exam. Vitals stable x2. Pt remained calm en route. Upon arrival, pt exited vehicle and walked away from ambulance bay before triage. Crew called out to pt and followed briefly but lost visual contact. Security notified.”
What required documentation is missing, and why is this a variance under OADS v4.0?
A Form 72 was not completed, despite this being a 911 call for a specific individual
Crew:
PR1: ACP Young (documenting)
PR2: PCP Malik
Dispatch Complaint: Chest discomfort
Clinical Impression: Suspected cardiac ischemia
Patient: 61-year-old male
Vitals:
Set #1: HR 92, BP 138/88, RR 18, SpO₂ 96%, Temp 36.6°C, GCS 15
Set #2: HR 90, BP 134/84, RR 18, SpO₂ 97%, GCS 15
Treatment Provided:
ASA 160 mg PO
12-lead ECG
IV NS TKVO in left forearm
Refused Care:
Declined Nitroglycerin, stating “It gives me headaches”
InHx:
“Pt found seated upright in dining chair complaining of substernal chest pressure, 5/10 severity, non-radiating. Onset 45 min prior. ASA 160 mg PO administered. 12-lead ECG completed – no acute STEMI noted. IV NS TKVO initiated in L forearm. Nitro offered for suspected cardiac ischemia, but pt declined, stating he experienced severe headaches from it in the past and didn’t want it. Vitals stable x2. Pt consented to transport. Code 3 to ED without event. Verbal report given at triage. No further complaints during transport.”
The call was clinically appropriate and the patient was transported to hospital.
What key documentation error violates OADS v4.0 and would result in a QA variance?
There is no documentation that the risks, benefits, and consequences of refusing Nitroglycerin were explained to the patient.
Crew:
PR1: ACP Blake (documenting)
PR2: PCP Singh
Dispatch Complaint: “Altered LOC – elderly male, possible stroke”
Location: Apartment complex, 10th floor
Disposition: Pt transported Code 4 to ED
Incident Details:
Building access code not provided by caller
Concierge not present; no building manager reachable by dispatch
Delay of 17 minutes before access obtained via police
On arrival, 81 y/o male found on floor beside bed, vomiting, GCS 10
Pt had reportedly been speaking and alert when caller left ~40 mins prior
CTAS 2, priority stroke protocol initiated
Pt deteriorated to GCS 7 en route to ED
Narrative Excerpt:
“Call received for elderly male – altered LOC. Crew delayed 17 minutes gaining access to secured building due to no access code or staff. Entry obtained by police. Pt found on floor, vomiting, GCS 10. Symptoms consistent with stroke. Pt deteriorated en route. Transported Code 4.”
Is this a reportable incident under OADS v4.0?
If so, which criterion applies — and what key event triggers the report?
Yes — this requires an Incident Report.
It meets OADS v4.0 Criterion #3:
A delay in accessing a patient that caused harm, deterioration, or a negative outcome
Crew:
PR1: ACP Harris (documenting)
PR2: PCP Salazar
Call Type: 911 call for chest pain
Patient: 59-year-old male, hypertensive, known cardiac history
Findings:
Pt alert and oriented, CTAS 2
Complaining of 6/10 substernal chest pain
ECG: Normal sinus rhythm, no ST changes
ASA administered
Pt refused Nitro, stating: “I’ve had it before, it gives me a headache”
Pt agreed to Code 3 transport to hospital
No Form 72 completed
Refusal section on ACR left blank
Narrative notes: “Pt refused Nitro. Tolerating pain. Transported Code 3 without incident.”
What change in OADS v4.0 makes this scenario non-compliant — and what should have been completed?
Under OADS v4.0, a Form 72 must be completed for any refusal of care, including individual medications.
You’re dispatched for a fall at a school. Upon arrival, the school nurse says the student is “okay now” and was sent home with a parent 5 minutes before you arrived. You verify the name and time with staff, but you never see the child
Form 71
No visual contact with the patient = Form 71 applies. ACR/Form 72 not required.
Crew:
PR1: PCP Raymond (documenting)
PR2: PCP D’Souza
Dispatch Complaint: Chest discomfort
CTAS: 2
Clinical Impression: Suspected cardiac ischemia
Call Times:
Dispatched: 08:31
On Scene: 08:36
Pt Contact: 08:37
Depart Scene: 08:46
At Hospital: 08:57
Transfer of Care: 08:59
Vitals:
Set #1 (08:45): HR 102, BP 148/92, RR 20, SpO₂ 96%, GCS 15
Set #2 (08:55): HR 98, BP 142/88, RR 18, SpO₂ 98%, GCS 15
Treatment Provided:
ASA 160 mg PO administered at 08:28
12-lead ECG completed at 08:43
Transfer of Care:
“Verbal report given to triage RN. Pt stable on arrival. No further intervention required.”
InHx:
“Pt seated in kitchen upon arrival. Reports tight central chest pressure beginning 20 minutes prior. Vitals obtained. 12-lead completed showing sinus tachycardia. ASA 160 mg given PO. Pt transported Code 3. Stable en route. Handover completed.”
This documentation appears thorough, but violates OADS v4.0.
What specific timing issue is present, and why is it a compliance concern?
The ASA administration is time-stamped at 08:28, which is:
Crew:
PR1: ACP Singh (documenting)
PR2: PCP Emeka
Dispatch Complaint: Weakness / "not acting right" per coworker
Clinical Impression: Generalized weakness – unclear etiology
Patient: 58-year-old male
Patient Presentation:
Pt found seated at work lunchroom table
Slow speech and vague responses
States he “just needs to sleep”
Coworker reports pt seemed confused earlier, dropped his coffee, and had to sit down
Vitals:
Set #1: HR 84, BP 128/86, RR 18, SpO₂ 97%, Temp 36.4°C, BGL 5.9 mmol/L, GCS 14
Set #2: HR 80, BP 126/82, RR 16, SpO₂ 98%, GCS 14
Treatment Provided:
Vitals monitored
No medications or interventions provided
Disposition:
Pt declined transport, stating he felt better. Signed Form 72.
📋 Refusal of Care Section (as documented):
InHx:
“Pt found seated in staff breakroom. Responded to questions but speech slow. Alert to name, unsure of date. Coworker concerned about earlier confusion. Pt reports fatigue and wants to go home. Denies pain, trauma, or illness. GCS 14 x2. No abnormal vitals. Pt declined further care or transport. Signed Form 72. Remained stable throughout. Crew cleared scene.”
The patient signed a Form 72 and had normal vitals. What critical documentation issue makes this refusal invalid under OADS v4.0?
There is no documentation that the crew assessed or considered the patient's decision-making capacity, despite clear signs of altered mentation
📝 Scenario: Excessive Fentanyl Dosing – Pt Requires BVM Support
Crew:
PR1: ACP Kumar (documenting)
PR2: PCP Hatfield
Call Type: MVC – single vehicle rollover
Disposition: Pt transported Code 4 to ED
Patient: 36-year-old female
Details:
Pt alert, oriented, GCS 15
Obvious right femur deformity; pain rated 9/10
Vitals: HR 116, BP 138/90, RR 18, SpO₂ 98%
100 mcg Fentanyl IV administered initially
After 5 minutes, pt stated pain was “unchanged”
Crew administered second 100 mcg Fentanyl IV
Within minutes: RR dropped to 6, patient became unresponsive
BVM initiated for approx. 4 minutes until pt began spontaneous respirations
No Narcan administered
Pt transported Code 4
InHx:
“Pt received total of 200 mcg IV Fentanyl in two doses, 5 mins apart. Pain unchanged after first dose. Shortly after second dose, pt became unresponsive and bradypneic. BVM initiated until pt resumed breathing. No Narcan given. No further complications during transport.”
Does this require an Incident Report under OADS v4.0?
If so, what criteria does it meet — and what specific deviation must be addressed?
Yes — this requires an Incident Report.
This meets OADS v4.0 Criterion #2:
Deviation or omission of a Ministry standard, patient care directive, or treatment that caused harm or a negative outcome
Crew:
PR1: ACP Romano (documenting)
PR2: PCP Jensen
Call Type: Elderly fall with leg deformity
Patient: 84-year-old female, GCS 15
Care Provided:
Full primary and secondary survey completed
2 sets of vitals recorded
Fentanyl 50 mcg IV administered
Limb splinted and secured
Code 3 transport to ED
Documentation Highlights:
All fields completed, including vitals, treatment, and CTAS
Narrative thoroughly outlines events
No field completed for “Treatment Paramedic”
No reference to which crew member administered Fentanyl or performed splinting
What new mandatory documentation element introduced in OADS v4.0 makes this chart non-compliant?
OADS v4.0 introduced a mandatory field identifying which paramedic completed each treatment.
You're dispatched for a 33-year-old male with chest tightness. On scene, he consents to assessment and transport. Vitals and a 12-lead ECG are completed. You transport Code 3 to the ED. Upon arrival in the ambulance bay, before a nurse accepts report or initiates triage, the patient states he feels better and abruptly walks off. He refuses to re-engage, does not sign any refusal, and leaves the premises.
ACR + Form 72
Paramedics had visual and physical contact, assessment and treatment occurred, and transport began
Crew:
PR1: ACP Jeffers (documenting)
PR2: PCP Nhan
Dispatch Complaint: Dizziness
CTAS: 3
Clinical Impression: Vertigo
Vitals Recorded:
Set #1 (14:12): HR 80, BP 124/76, RR 16, SpO₂ 99%, GCS 15
Set #2 (14:24): HR 78, BP 122/74, RR 16, SpO₂ 99%, GCS 15
Treatment Provided Section:
ASA 160 mg PO
Oxygen via nasal cannula at 2 LPM
12-lead ECG
IV established
Transport Section:
Code 4 to ED
Transfer of care completed at 14:52
Form 72 Section:
Form 72: Completed and signed at 14:30
Refusal reason: "Patient declined transport"
InHx:
“Pt located seated in bedroom, complaining of dizziness and light-headedness. Vitals stable x2. 12-lead ECG performed, IV established in RA cephalic vein. ASA administered PO. Oxygen applied. After discussion, pt refused further care and transport, stating symptoms had resolved. Risks and consequences explained. Form 72 completed and signed. Pt remained stable throughout. Cleared scene without incident.”
This ACR contains detailed documentation and appears complete.
What is the serious documentation contradiction, and why is it a compliance issue under OADS v4.0?
There is a critical contradiction between the narrative/Form 72 and the structured ACR fields:
Crew:
PR1: PCP Ahsan (documenting)
PR2: PCP Markov
Dispatch Complaint: RTC – bicycle vs. parked car
Clinical Impression: Soft tissue injury to lower leg
Patient: 15-year-old male
Incident Details:
Pt struck parked car while riding bicycle alone
Sustained abrasions to right shin and right elbow
Denies LOC, vomiting, or dizziness
Alert, oriented x3, cooperative
States: “I’ve had worse, I don’t need help.”
Vitals:
Set #1: HR 88, BP 118/76, RR 16, SpO₂ 99%, Temp 36.7°C, GCS 15
Set #2: HR 84, BP 116/74, RR 16, SpO₂ 98%, GCS 15
Care Provided:
Wound cleaned with sterile gauze
Analgesia offered and refused by patient
No medications administered
Form 72:
Completed and signed for refusal of analgesic medication only
"Refusal applies to: analgesic administration"
Risks discussed and documented
No Form 72 completed for transport refusal
InHx:
“15 y/o male involved in minor RTC. Superficial abrasions to RLE and RUE. Pt alert and oriented x3, GCS 15 x2. Denies pain requiring treatment. Offered analgesia, which he declined after discussion of risks and benefits. Form 72 completed for medication refusal. Pt repeatedly stated he did not want to go to hospital and understood potential risks of untreated minor injuries.
Mother arrived on scene and insisted on transport, stating, ‘I don’t care if he says no — he’s going.’ Despite pt’s ongoing refusal, crew transported Code 3 to local ED per parental request. Documented rationale: ‘Crew deferred to mother as presumed medical authority for minor. Patient therefore no longer able to refuse transport.’
No Form 72 completed for transport refusal. Pt cooperative during transport but stated en route: ‘I already told you guys I wasn’t going.’”
This patient signed a Form 72 for medication refusal, was transported Code 3 against his will, and was reportedly calm and oriented.
Why is this a serious documentation failure under OADS v4.0?
The patient was legally capable of refusing transport, but the paramedics improperly deferred to parental authority and failed to complete a Form 72 for transport refusal.
Scenario: Dispatch Delay – Stroke Patient Delayed Nearly 6 Hours
Crew:
PR1: ACP Whittaker (documenting)
PR2: PCP Li
Dispatch Complaint: “Elderly female, general weakness”
Disposition: Transported Code 4 to designated stroke centre
Details:
72-year-old female; symptom onset (confusion, facial droop, weakness) began at 08:50
911 call placed by husband at 09:05, reporting slurred speech, left arm weakness, and confusion
Call miscoded as “general weakness” and held in queue due to low-priority classification
No unit assigned until 14:12 — 5 hours and 7 minutes after the call
Paramedics arrived at 14:34
Found patient with obvious left-sided hemiparesis, facial droop, and expressive aphasia
Stroke protocol initiated immediately; CTAS 2; Code 4 transport
ED arrival: 15:09
CT performed at 15:38
Neurology documented that the patient was barely within the stroke window, and that EMS dispatch delay prevented early intervention
Patient admitted with permanent left-sided hemiparesis
Narrative Excerpt:
“911 call placed by husband at 09:05 for slurred speech and weakness. Dispatch coded complaint as ‘general weakness’ and held call until 14:12. Crew arrived at 14:34. Patient with L hemiparesis and aphasia. Stroke protocol activated. ED arrival 15:09. Imaging 15:38. Stroke team noted critical delay in prehospital response may have worsened outcome.”
Does this scenario meet the criteria for a mandatory Incident Report under OADS v4.0?
If so, which specific criterion applies — and what makes it reportable?
Yes — this requires an Incident Report.
It meets Criterion #3:
A delay in accessing a patient that caused a negative outcome
Crew:
PR1: PCP Murray (documenting)
PR2: PCP Zhang
Call Type: Diabetic emergency – 911 call placed by neighbor
Patient: 62-year-old male, known diabetic
Findings:
Pt confused on arrival; GCS 14 (E4, V4, M6)
BGL: 5.6 mmol/L
Pt denies needing help, repeatedly stating “I’m fine”
Refuses transport and any treatment
Crew documents:
One set of vitals
“Patient refused further care. Will self-monitor. No follow-up arranged.”
No CTAS documented
Refusal section left blank
No Form 72 completed
Under OADS v4.0, identify at least two documentation omissions or compliance issues that make this scenario non-compliant.
This scenario is non-compliant under OADS v4.0 due to the following
1. Incomplete Refusal Documentation (Form 72 Required)
2. No Second Set of Vitals
3. CTAS Missing