SOAP Narrative for EMS: Complete Guide 2026
Master EMS patient care report documentation with SOAP narratives. Real examples for trauma, cardiac, respiratory, and behavioral calls with templates you can use immediately.
5 Full Examples
Ready to use templates
What is the SOAP Format in EMS?
SOAP is a documentation framework that organizes your patient care report into four sections: Subjective (what the patient tells you), Objective (what you observe and measure), Assessment (your clinical impression), and Plan (what you did). This structure ensures comprehensive documentation and clear communication with receiving facilities.
The SOAP Format Explained for EMS
Understanding each component with EMS-specific elements
Subjective
What the patient (or bystanders) tell you. Chief complaint, history of present illness, symptoms, and relevant medical history.
EMS Elements to Include:
- Chief complaint in patient's own words
- History of present illness (HPI)
- OPQRST for pain (Onset, Provocation, Quality, Radiation, Severity, Time)
- SAMPLE history (Signs/Symptoms, Allergies, Medications, Past medical history, Last oral intake, Events)
- Mechanism of injury (MOI) from witnesses
- Patient-reported symptoms
Pro Tips:
- • Quote the patient directly when possible
- • Document who provided information if not patient
- • Note if patient is unresponsive or altered
- • Include pertinent negatives (e.g., "denies chest pain")
Objective
What you observe, measure, and assess. Vital signs, physical exam findings, and clinical observations.
EMS Elements to Include:
- Vital signs (BP, HR, RR, SpO2, temp, glucose, EtCO2)
- Level of consciousness (AVPU or GCS)
- Physical exam findings (head-to-toe)
- Skin condition (color, temperature, moisture)
- Pupil response (PERRL)
- Cardiac rhythm (if monitored)
- Scene observations and MOI details
Pro Tips:
- • Document ALL vital signs taken with times
- • Include trending of vitals if multiple sets
- • Be specific: "2cm laceration to left forehead" not "cut on head"
- • Document what you see, not what you think
Assessment
Your clinical impression based on subjective and objective findings. Working diagnosis or differential.
EMS Elements to Include:
- Primary impression/working diagnosis
- Differential diagnoses considered
- Patient acuity level
- Clinical reasoning
- Risk stratification
- Transport priority determination
Pro Tips:
- • Use standard medical terminology
- • It's okay to have a broad impression: "abdominal pain, unknown etiology"
- • Include severity: "acute MI," "possible stroke"
- • Document basis for your assessment
Plan
What you did and what happened. Treatments, interventions, response, and transport decisions.
EMS Elements to Include:
- All interventions performed
- Medications administered (drug, dose, route, time)
- IV access attempts and success
- Airway management
- Patient response to treatment
- Transport decision and destination
- Reason for destination choice
- Patient positioning during transport
Pro Tips:
- • Include times for all interventions
- • Document response to each treatment
- • Note any declined treatments with refusal documentation
- • Include hospital notification and ETA
Complete SOAP Narrative Examples
Real-world examples for common EMS call types. Use these as templates for your documentation.
Chest Pain / Suspected STEMI
62-year-old male with crushing chest pain radiating to left arm
Subjective
Unit dispatched for chest pain. Upon arrival, found 62 y/o male seated in recliner, clutching chest, diaphoretic. Patient states, "It feels like an elephant is sitting on my chest." Pain began approximately 45 minutes ago while watching television. Patient describes pain as 9/10, crushing, substernal with radiation to left arm and jaw. Associated symptoms include shortness of breath, nausea, and diaphoresis. Patient took one aspirin 325mg before our arrival with no relief. SAMPLE History: - Signs/Symptoms: Chest pain, SOB, nausea, diaphoresis - Allergies: NKDA - Medications: Lisinopril 10mg daily, metformin 500mg BID, atorvastatin 40mg daily - Past Medical History: HTN, DM2, hyperlipidemia - Last Oral Intake: Dinner 3 hours ago - Events: Sudden onset while at rest
Objective
General: Alert and oriented x4, moderate distress, diaphoretic, pale Vitals (initial): BP 168/102, HR 98 irregular, RR 22, SpO2 94% RA, BGL 186 mg/dL Vitals (post-treatment): BP 142/88, HR 88, RR 18, SpO2 98% on O2 HEENT: Pupils equal, round, reactive to light Cardiac: Irregular rhythm, no murmurs Lungs: Clear bilaterally, no rales or wheezing Abdomen: Soft, non-tender Extremities: No edema, peripheral pulses present and equal Skin: Pale, cool, diaphoretic 12-Lead ECG: ST elevation in leads V1-V4, II, III, aVF. Reciprocal depression in aVL.
Assessment
Primary Impression: Acute ST-Elevation Myocardial Infarction (STEMI), anteroseptal with inferior involvement Patient presenting with classic ACS symptoms including crushing substernal chest pain with radiation, associated symptoms of SOB, nausea, and diaphoresis. ECG findings consistent with acute STEMI. High-risk presentation requiring emergent PCI.
Plan
- O2 via NC at 4 LPM, SpO2 improved to 98% - 18g IV established left AC - Aspirin 324mg PO (patient already took 325mg prior to arrival - total 649mg) - Nitroglycerin 0.4mg SL x1, BP post-nitro 148/90, pain decreased to 7/10 - Second NTG 0.4mg SL, pain decreased to 5/10 - 12-Lead transmitted to receiving facility - STEMI alert activated at St. Mary's Medical Center, Cath Lab team notified - Morphine 4mg IV for continued pain, pain now 3/10 - Patient transported emergent, Code 3, to St. Mary's Medical Center (closest PCI-capable facility) - Patient remained stable throughout transport - ETA to destination: 12 minutes - Full report given to ED and Cath Lab team upon arrival
Motor Vehicle Collision (MVC)
Restrained driver in moderate-speed collision with airbag deployment
Subjective
Unit dispatched to MVC on Highway 101 at mile marker 23. Upon arrival, found single vehicle into guardrail, moderate front-end damage, airbag deployed. Driver is 34 y/o female, restrained by seatbelt, ambulatory on scene. Patient states she was traveling approximately 45 mph when she swerved to avoid debris in roadway. States, "I hit my head on something and my neck really hurts." Patient reports 6/10 neck pain, worse with movement. Also complains of mild chest wall tenderness from seatbelt. Denies loss of consciousness, states she remembers entire event. Denies headache, vision changes, numbness, or tingling. SAMPLE History: - Signs/Symptoms: Neck pain, chest wall tenderness - Allergies: Penicillin (rash) - Medications: Birth control pills - Past Medical History: None significant - Last Oral Intake: Coffee and muffin 2 hours ago - Events: Swerved to avoid debris, lost control, struck guardrail
Objective
General: Alert and oriented x4, ambulatory on scene, mild distress Vitals: BP 134/82, HR 92, RR 18, SpO2 99% RA HEENT: Small contusion to forehead (from airbag), pupils equal and reactive, no Battle's sign, no raccoon eyes, no CSF drainage from ears/nose C-Spine: Midline cervical tenderness at C5-C6, no step-off deformity Cardiac: Regular rate and rhythm Lungs: Clear bilaterally Chest: Seatbelt contusion across chest, tender to palpation over sternum, no crepitus Abdomen: Soft, non-tender, no seatbelt sign Extremities: Full ROM, no deformity, sensation intact Neuro: GCS 15 (E4V5M6), strength 5/5 all extremities, sensation intact
Assessment
Primary Impression: Motor Vehicle Collision with cervical spine tenderness - Mechanism concerning for cervical spine injury (high-speed impact, airbag deployment, neck pain with midline tenderness) - Low risk for internal injury (restrained, airbag deployed, soft abdomen) - Meets trauma center criteria due to mechanism and cervical spine tenderness
Plan
- Manual C-spine stabilization initiated immediately - Cervical collar applied - Patient moved to stretcher using standing takedown - 20g IV established right forearm - Patient secured to stretcher in supine position - Ongoing neuro reassessment: no changes noted - Transport to Regional Trauma Center (Level II, closest appropriate facility) - Code 2 transport - Trauma alert called to receiving facility - Patient remained hemodynamically stable throughout transport - Full report given to trauma team
Respiratory Distress / Asthma
8-year-old with severe asthma exacerbation
Subjective
Unit dispatched for pediatric difficulty breathing. Upon arrival, found 8 y/o male sitting tripod on couch, visible respiratory distress. Mother states patient has history of asthma, symptoms started approximately 2 hours ago after playing outside. Patient has used his rescue inhaler (albuterol) 4 times without relief. Mother states patient has had 2 prior hospitalizations for asthma, last one 6 months ago required ICU admission. No recent URI symptoms. Patient able to speak in 2-3 word sentences, states "I... can't... breathe." SAMPLE History: - Signs/Symptoms: Severe dyspnea, wheezing, unable to speak full sentences - Allergies: None known - Medications: Albuterol PRN, Flovent BID (mother unsure if taken today) - Past Medical History: Asthma (severe persistent), 2 prior hospitalizations including 1 ICU admission - Last Oral Intake: Lunch 4 hours ago - Events: Playing outside, gradual onset of symptoms
Objective
General: Alert, severe respiratory distress, tripod positioning, speaking in 2-3 word sentences Vitals (initial): BP 110/70, HR 142, RR 40, SpO2 88% RA, Temp not obtained Vitals (post-treatment): BP 108/68, HR 118, RR 28, SpO2 96% on O2 Weight (estimated): 25 kg HEENT: No nasal flaring initially, present during initial assessment Cardiac: Tachycardic, regular Lungs: Diffuse expiratory wheezing bilaterally, decreased air entry at bases, subcostal and intercostal retractions present Skin: Pale, mild diaphoresis Mental Status: Alert, anxious, age-appropriate responses
Assessment
Primary Impression: Severe acute asthma exacerbation - High-risk features: History of ICU admission, poor response to home nebulizer, accessory muscle use, SpO2 <90%, unable to speak full sentences - Pediatric respiratory emergency requiring aggressive bronchodilator therapy - At risk for respiratory failure if not responsive to treatment
Plan
- High-flow O2 via non-rebreather mask at 15 LPM, SpO2 improved to 93% - Continuous albuterol 2.5mg via nebulizer initiated immediately - Ipratropium 500mcg added to nebulizer - IV attempted x2, unsuccessful due to patient distress and movement - After initial nebulizer: wheezing improved, SpO2 96%, speaking in short sentences - Methylprednisolone 50mg IM (2mg/kg) administered - Second albuterol nebulizer in progress during transport - Transport emergent, Code 3, to Children's Hospital (pediatric specialist facility) - Mother transported with patient for pediatric age - Base hospital contacted, Dr. Martinez notified, orders confirmed - Patient showing improvement, HR down to 118, RR 28 upon arrival - Detailed handoff to pediatric ED team
Altered Mental Status / Diabetic Emergency
55-year-old found unresponsive with diabetes history
Subjective
Unit dispatched for unresponsive person. Upon arrival, found 55 y/o male on kitchen floor, unresponsive. Wife states patient is diabetic and didn't eat breakfast this morning. Last seen normal 1 hour ago. Patient became "confused and sweaty" approximately 30 minutes ago, then became unresponsive. Wife provides history: - Patient is insulin-dependent diabetic x 15 years - Takes Lantus at bedtime and Humalog with meals - Took his Lantus last night as usual - Did NOT eat breakfast this morning - No recent illness or alcohol use - Similar episode 2 years ago that resolved with glucose SAMPLE History: - Signs/Symptoms: Unresponsive, diaphoretic - Allergies: Sulfa drugs - Medications: Lantus 40 units qHS, Humalog sliding scale, lisinopril, metformin - Past Medical History: DM Type 1 x 15 years, HTN - Last Oral Intake: Dinner last night (wife states patient refused breakfast) - Events: Took insulin, no breakfast, became confused then unresponsive
Objective
General: Unresponsive to voice, withdraws to pain (GCS 7: E1V2M4) Vitals: BP 148/88, HR 112, RR 20, SpO2 97% RA, BGL 28 mg/dL HEENT: Pupils equal at 4mm, reactive Skin: Pale, cool, profoundly diaphoretic Cardiac: Tachycardic, regular rhythm Lungs: Clear bilaterally Abdomen: Soft Extremities: No medical alert bracelet, no track marks Neuro: GCS 7, withdraws equally to painful stimuli, no focal deficits noted
Assessment
Primary Impression: Severe hypoglycemia with altered mental status - Classic presentation: Insulin-dependent diabetic, missed meal, unresponsive with BGL 28 mg/dL - Profound diaphoresis and tachycardia consistent with hypoglycemia - No evidence of stroke or other etiology
Plan
- 18g IV established right AC - Dextrose 50% 25 grams (50mL) IV push administered - Repeat BGL at 5 minutes: 142 mg/dL - Patient awoke, GCS improved to 15 - Patient oriented to person, place, time, event - Patient able to state name, date, location - Offered oral glucose, patient consumed 15g oral glucose gel - Repeat BGL at 15 minutes: 168 mg/dL - Wife educated on hypoglycemia signs and importance of eating with insulin - Patient refused transport after full explanation of risks - Refusal documentation completed with witness (wife) - Patient demonstrated understanding, signed AMA form - Wife to stay with patient, will call 911 if symptoms return - Follow-up with PCP recommended within 24 hours
Behavioral Emergency
Suicidal patient with recent overdose attempt
Subjective
Unit dispatched for psychiatric emergency, police on scene. Upon arrival with PD, found 28 y/o female on couch, awake, tearful. Patient states she took "a bunch of pills" approximately 2 hours ago in attempt to harm herself. Patient initially reluctant to speak but eventually states she took 15-20 tablets of acetaminophen 500mg (7.5-10 grams estimated). Patient reports significant depression following recent divorce. States she has been having suicidal thoughts for 2 weeks. Denies previous suicide attempts. Patient now expresses regret about overdose and is cooperative with care. SAMPLE History: - Signs/Symptoms: Suicidal ideation, reported overdose, nausea - Allergies: NKDA - Medications: Sertraline 100mg daily (reports compliance) - Past Medical History: Depression x 5 years, no prior psychiatric hospitalizations - Last Oral Intake: Acetaminophen 2 hours ago, dinner last night - Events: Divorce finalized this week, increasing depression, impulsive overdose
Objective
General: Alert, oriented x4, tearful, cooperative, no acute distress Vitals: BP 118/76, HR 84, RR 16, SpO2 99% RA Mental Status Exam: - Appearance: Disheveled, poor hygiene - Behavior: Cooperative, good eye contact - Mood: "Terrible" (patient's words) - Affect: Flat, tearful at times - Thought Process: Linear, goal-directed - Thought Content: Passive SI, no current homicidal ideation - Perception: No hallucinations reported - Cognition: Alert, oriented x4 - Insight: Fair - expresses regret about overdose - Judgment: Impaired - recent overdose attempt Physical Exam: - HEENT: Normal - Cardiac: Regular rate and rhythm - Lungs: Clear - Abdomen: Mild RUQ tenderness on palpation (concerning for early hepatotoxicity) - Skin: No evidence of self-harm
Assessment
Primary Impression: Intentional acetaminophen overdose with suicidal intent - Significant ingestion estimated 7.5-10g APAP - Within NAC treatment window (<8 hours) - Psychiatric emergency requiring involuntary hold given recent attempt - RUQ tenderness concerning, needs STAT acetaminophen level and LFTs
Plan
- Verbal de-escalation successful, patient cooperative - 20g IV established left forearm - Normal saline at TKO rate - Ondansetron 4mg IV for nausea (APAP overdose may cause nausea) - Poison Control contacted: Recommend NAC protocol given timing and estimated dose - Police to accompany for psychiatric hold paperwork - Transport to University Hospital (has psychiatric unit and toxicology) - Patient placed on Form 5150 (danger to self) - Patient remained calm and cooperative during transport - Detailed handoff to ED including poison control recommendations - Social worker notification requested
Common EMS Documentation Mistakes
Avoid these pitfalls in your SOAP narratives
Vague documentation
"Patient was in pain"
"Patient reports 8/10 sharp chest pain, substernal, radiating to left arm"
Specific documentation helps receiving providers understand patient condition
Missing times
"Gave IV fluids and reassessed"
"1425: NS 500mL bolus initiated. 1445: Reassessed, BP improved to 110/70"
Timing is critical for medical-legal documentation and continuity of care
Diagnosis instead of impression
"Assessment: Myocardial infarction"
"Assessment: Suspected acute coronary syndrome based on clinical presentation"
EMS providers assess and suspect; physicians diagnose
Incomplete vital signs
"Vitals stable"
"BP 122/78, HR 88, RR 16, SpO2 98% RA, BGL 112"
All vital signs should be documented numerically with times
Missing pertinent negatives
"Patient has headache"
"Patient has headache. Denies neck stiffness, photophobia, recent trauma, or fever"
Pertinent negatives show your differential thinking and rule-outs
Copy-paste syndrome
Using identical narrative for every patient
Individualized narrative reflecting THIS patient's specific presentation
Generic narratives miss important details and suggest poor assessment
EMS Documentation Best Practices
Tips for writing better SOAP narratives
Structure
- Follow SOAP format consistently for every call
- Use clear paragraph breaks between sections
- Keep narrative concise but complete
- Include all required elements per your agency protocol
Content
- Document what you find, not what you expect to find
- Include pertinent negatives to show your differential
- Quote patients directly when clinically relevant
- Document every intervention with time and response
Legal Protection
- "If it wasn't documented, it wasn't done"
- Document all refusals with detailed informed consent discussion
- Note witnesses when appropriate
- Avoid inflammatory or judgmental language
- Document your clinical reasoning
Efficiency
- Develop templates for common call types
- Use standardized abbreviations approved by your agency
- Complete documentation as soon as possible after call
- Use voice-to-text technology when appropriate
Frequently Asked Questions
What is a SOAP narrative in EMS?
A SOAP narrative is a standardized documentation format used in EMS patient care reports (PCRs). SOAP stands for Subjective (patient's symptoms and history), Objective (vital signs and physical exam findings), Assessment (your clinical impression), and Plan (interventions and transport decisions). This format ensures comprehensive, organized documentation that facilitates continuity of care.
How do you write an EMS narrative?
Write an EMS narrative by following the SOAP format: Start with Subjective (chief complaint, OPQRST for pain, SAMPLE history), then Objective (all vital signs with times, physical exam findings), then Assessment (your working impression), and finally Plan (all interventions with times and patient response, transport decision). Be specific, use medical terminology, and document times for everything.
What should be included in the subjective portion of EMS SOAP notes?
The Subjective section should include: the chief complaint in the patient's words, history of present illness, OPQRST (for pain), SAMPLE history, mechanism of injury from witnesses, relevant past medical history, and any pertinent negatives the patient denies. Always note who provided the history if not the patient.
How long should an EMS narrative be?
An EMS narrative should be as long as necessary to completely document the call but as concise as possible. Simple calls may be 200-300 words, while complex calls (cardiac arrests, traumas, pediatrics) may be 500-800 words. Quality matters more than length - ensure all required elements are present and your clinical reasoning is clear.
What are common EMS documentation mistakes?
Common mistakes include: vague descriptions ("patient in distress" instead of specific findings), missing times for interventions, incomplete vital sign documentation, using diagnosis terms instead of impressions, copying narratives between patients, forgetting pertinent negatives, and poor organization. Always proofread before submitting.
Do EMTs and paramedics use the same SOAP format?
Yes, both EMTs and paramedics use SOAP format, but the depth differs based on scope of practice. Paramedics may include more detailed assessments (12-lead interpretation, advanced airway documentation) and interventions (medications, IV access). The structure remains the same; the content reflects the provider's assessment capabilities and interventions.
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