Required before first use

Training aid only — not a medical device or ePCR

NarrativeCoach is an educational PWA for practicing EMS narrative writing on fictional scenarios.

It is NOT:
• a medical device, clinical decision support, or protocol authority
• a NEMSIS / agency ePCR or legal/billing advisor
• CAPCE / CE credit (no CE claims)

NEVER enter real patient names, addresses, DOBs, MRNs, or other PHI.

All scenarios are fictional and watermarked TRAINING SCENARIO.

Scoring uses a deterministic rubric. AI feedback is disabled by default (ENABLE_AI_FEEDBACK=false). Do not send PHI to language models.

You are responsible for following your agency policies, medical direction, and applicable law when documenting real calls (use your agency ePCR — or a field builder like HandoffNote — not this trainer).

TRAINING SCENARIO

dyspnea · high

CHF Dyspnea with Crackles

Nighttime CHF orthopnea with missed furosemide and 3 lb gain. Document CPAP response, crackles, and denied chest pain/fever from the call sheet.

Never enter real PHI. Drafts stay on-device (IndexedDB). No LLM forwarding. Not a medical device / ePCR.

Learn the bar

Sample narrative

Excellent SOAP example for this fictional drill · scores 100 (Defensible)

View sample

TRAINING SCENARIO

Study the structure, quotes, times, negatives, and response — then write your own from the call sheet. Do not paste this as your scored draft.

TRAINING SCENARIO — S: 72 y/o female, estimated 78 kg, English-speaking, GCS 15 / AOx4. Historian: Patient and adult child (weight gain, meds). Patient/historian stated "I can't catch my breath. I haven't been able to lie flat." Chief complaint: Progressive dyspnea for about 2 hours. Onset: Progressive over about 2 hours; woke at 01:50 unable to lie flat. Provocation/palliation: Worse lying flat; slightly better sitting upright; no exertion tonight. Quality: Air hunger; tightness across the chest without pain. Radiation/location: No radiation; denied chest pain. Severity: Dyspnea 8/10 at contact; 5/10 after CPAP. Time/duration: Symptoms ongoing since ~01:50. Signs/symptoms: Orthopnea, two-pillow, mild nonproductive cough, ankle swelling, no fever, no chest pain. Allergies: Codeine (nausea). Medications: Furosemide 40 mg daily (missed last night); lisinopril 10 mg; metoprolol 25 mg BID; potassium 20 mEq. Past medical history: CHF with reduced EF; hypertension; no COPD by report. Last oral: Light dinner ~18:00; few sips of water since. Events: Increasing ankle swelling 3 days; +3 lb; tonight sudden orthopnea; child called 911. Pertinent negatives: denied chest pain; no fever. This TRAINING SCENARIO includes dyspnea, crackles, CPAP, CHF. Care included CPAP, nitroglycerin.

O: Location: Single-family home, downstairs living room / recliner. Scene: Night call. Patient sitting bolt-upright in a recliner, two pillows, speaking 3–4 word sentences. Home O2 concentrator visible but not in use. Adult child present. No smoke or CO concern. ALS on scene.. Exam: Sitting bolt-upright; 3–4 word dyspnea; Bilateral crackles mid-to-base; no wheeze; Mild JVD; 2+ pretibial pitting edema; Skin cool, slightly diaphoretic; no rash; Abdomen soft; no focal neuro deficit. Serial vitals: 02:26 BP 168/94 HR 108 RR 28 SpO2 88% RA; GCS 15, pain 0/10, skin cool, moist. 02:38 BP 154/88 HR 98 RR 22 SpO2 94% CPAP 5 cmH2O; GCS 15, pain 0/10.

A: Working impression for this TRAINING SCENARIO: CHF Dyspnea with Crackles — Progressive dyspnea for about 2 hours.

P: Treatments: Sat patient fully upright. CPAP 5 cmH2O at 02:28 — tolerated; SpO2 88% → 94%. Nitroglycerin 0.4 mg SL at 02:32 — no hypotensive drop. Cardiac monitor; ALS transport. Response: Work of breathing and speech improved on CPAP. SpO2 88% RA → 94% on CPAP. Denied chest pain throughout.. Ambulance transport and monitoring were required; private vehicle was not appropriate. ALS transport, semi-Fowler on CPAP, to the nearest ED. Adult child followed. Bedside report.

TRAINING SCENARIO

Call sheet

Fictional source facts. Do not invent times, quotes, or vitals. Never add real PHI.

Medic 7 · dispatched 02:18 · on scene 02:24

A 72 y/o woman with known CHF has had two hours of worsening shortness of breath and cannot lie flat. Her child reports a 3 lb weight gain over three days and missed last night's furosemide. She denies chest pain and fever. You find bilateral crackles and SpO2 88% on room air. CPAP at 5 cmH2O brings SpO2 to 94% and speech improves. One nitroglycerin SL is given with SBP remaining above 110. Transport upright to the ED.

Dispatch

72-year-old, difficulty breathing, possible CHF. Caller is adult child in the home.

Location

Single-family home, downstairs living room / recliner

Scene

Night call. Patient sitting bolt-upright in a recliner, two pillows, speaking 3–4 word sentences. Home O2 concentrator visible but not in use. Adult child present. No smoke or CO concern. ALS on scene.

Patient

72 y/o female, estimated 78 kg, English-speaking, GCS 15 / AOx4

Historian

Patient and adult child (weight gain, meds)

Chief complaint

Progressive dyspnea for about 2 hours

Quote

“I can't catch my breath. I haven't been able to lie flat.”

OPQRST

Onset: Progressive over about 2 hours; woke at 01:50 unable to lie flat
Provocation: Worse lying flat; slightly better sitting upright; no exertion tonight
Quality: Air hunger; tightness across the chest without pain
Radiation: No radiation; denied chest pain
Severity: Dyspnea 8/10 at contact; 5/10 after CPAP
Time: Symptoms ongoing since ~01:50

SAMPLE

Signs / symptoms: Orthopnea, two-pillow, mild nonproductive cough, ankle swelling, no fever, no chest pain
Allergies: Codeine (nausea)
Medications: Furosemide 40 mg daily (missed last night); lisinopril 10 mg; metoprolol 25 mg BID; potassium 20 mEq
Past history: CHF with reduced EF; hypertension; no COPD by report
Last oral: Light dinner ~18:00; few sips of water since
Events: Increasing ankle swelling 3 days; +3 lb; tonight sudden orthopnea; child called 911

Exam

Sitting bolt-upright; 3–4 word dyspnea
Bilateral crackles mid-to-base; no wheeze
Mild JVD; 2+ pretibial pitting edema
Skin cool, slightly diaphoretic; no rash
Abdomen soft; no focal neuro deficit

Vitals

Time	BP	HR	RR	SpO₂	GCS	Pain	Skin
02:26	168/94	108	28	88% RA	15	0/10	cool, moist
02:38	154/88	98	22	94% CPAP 5 cmH2O	15	0/10	—

Timeline

▸02:18 — dispatched dyspnea
▸02:24 — on scene; patient upright in recliner
▸02:26 — first vitals; crackles noted
▸02:28 — CPAP 5 cmH2O started (patient consented, no vomiting)
▸02:32 — nitroglycerin 0.4 mg SL; SBP 168
▸02:38 — SpO2 94%; repeat vitals
▸02:42 — departed upright on CPAP
▸02:55 — ED arrival; report to RN

Treatments

Sat patient fully upright
CPAP 5 cmH2O at 02:28 — tolerated; SpO2 88% → 94%
Nitroglycerin 0.4 mg SL at 02:32 — no hypotensive drop
Cardiac monitor; ALS transport

Response

Work of breathing and speech improved on CPAP. SpO2 88% RA → 94% on CPAP. Denied chest pain throughout.

Disposition

ALS transport, semi-Fowler on CPAP, to the nearest ED. Adult child followed. Bedside report.

Live completeness

0/10

Quote or attributionQuote the patient or historian
Times (HH:MM)Stamp dispatch, interventions, or transport
Vitals with numbersBP, HR, RR, or SpO2
Dose + routee.g. 324 mg PO, 0.4 mg SL
Response / trendWhat changed after treatment
Pertinent negativesName what was denied or absent
Why EMS / transportMedical necessity or capacity/refusal pack
Disposition / handoffDestination, refusal, or bedside report
Key facts 0/4dyspnea, crackles, CPAP, CHF
SOAP structureUse the section labels for this format

Narrative format

Free = preferred format · Pro unlocks all

Subjective · Objective · Assessment · Plan

○ Subjective○ Objective○ Assessment○ Plan

Insert from call sheet

0 chars · 0 words · ⌘/Ctrl+Enter scores

Subjective — Complaint, quotes, OPQRST/SAMPLE

Objective — Exam, vitals, measurements

Assessment — Working impression

Plan — Tx, response, transport, disposition

Need a field paste-out builder? See HandoffNote — NarrativeCoach is academy drills only.