Excellent CHART

CHART is Chief complaint, History, Assessment, Rx (treatment), Transport. It is the EMS default in many agencies because treatment and transport are first-class sections — the two places billing QA and receiving nurses look first.

C — Chief complaint

One line in the patient's words when you have them: "I can't catch my breath." Add the setting only if it is the complaint (chest pain after shoveling). Do not paste the whole SAMPLE into C.

H — History

This is OPQRST + SAMPLE + historians + events. Excellent H is specific: missed furosemide, +3 lb in three days, two-pillow orthopnea since 01:50. Pertinent negatives belong here (denied chest pain, no fever). Name the historian when the patient cannot give the story.

A — Assessment

In CHART, A is the physical exam plus vitals, not the SOAP-style impression alone. Include work of breathing, lung sounds, edema, skin, GCS, and serial numbers. You may close A with a one-line impression (suspected CHF exacerbation) so the reader is not guessing.

Rx — Treatment

Every intervention: dose, route, time, indication, and response. CPAP 5 cmH2O at 02:28, SpO2 88%→94%. Nitroglycerin 0.4 mg SL at 02:32, SBP stayed above 110. "Gave meds" is not Rx.

T — Transport

Destination, position, mode, who watched the monitor, course en route, bedside report, who followed. Medical necessity lives here: could not lie flat, required CPAP, not safe for private vehicle. If they refused, T becomes the refusal pack instead of a destination.

Walkthrough — fictional nighttime CHF

C: "I can't catch my breath. I haven't been able to lie flat."

H: 72 y/o, onset ~01:50, two-pillow orthopnea; adult child reports +3 lb and missed last night's furosemide. Denied chest pain, no fever. Meds: furosemide, lisinopril, metoprolol.

A: Upright in recliner, 3–4 word dyspnea, bilateral crackles, mild JVD, 2+ pretibial edema. 02:26 BP 168/94 HR 108 RR 28 SpO2 88% RA. 02:38 SpO2 94% on CPAP 5, RR 22. Suspected CHF exacerbation.

Rx: Sat fully upright. CPAP 5 cmH2O 02:28 tolerated. Nitroglycerin 0.4 mg SL 02:32.

T: ALS, semi-Fowler on CPAP, to the ED; child followed; bedside report. Required ALS because of hypoxia and CPAP.

CHART failure modes

• C is a paragraph; H is empty.
• Rx has no times or response.
• T is only "transported to hospital."
• Assessment has a BP once and no lung sounds.
• Using Rx: as a heading is correct — do not expand it to a drug list without the heading if your agency wants CHART.

DCHART is the next lesson. If your FTO starts every narrative with dispatch time and position found, write DCHART, not bare CHART.