How many times have you heard this on the radio: Base, this is Medic 3, and we’re 15 minutes from your facility with a 38-year-old white male with, uh, some chest pain, numbness all over, headache, and anxiety, as well as some bruises from a fall. He says his pain radiates from his earlobes to his nipples, and well, we’ll just give you more details on arrival, base. This is Medic 3 clear.

God love those paramedics. The truth is, if we doctors were on the truck ourselves, we still wouldn’t know what the diagnosis was. Frequently, when I discharge people from the emergency department, I still don’t know the diagnosis. Thank heavens for medical screening exams because that’s about the best I can do some nights.

But I have come to realize that if the medics can’t figure out what to call it in the field, I may be just as puzzled. Physicians live with a much greater sense of ambiguity than paramedics do. Paramedics have to work within the confines of more straightforward algorithms, designed to save life in a pinch. But people are puzzling, and sometimes their emergencies and actions defeat the most obvious treatment plans and educations, leaving even the brightest saying, I just don’t get it.

A 20-601 is a patient with lacerations from letting his pit bull eat off his body

To help our EMS colleagues and facilitate preparation on the hospital end of things, I’ve compiled a list of signals based on common complaints transported by ambulance and loosely based on our old friends, the 10 codes. These are much more specific, and much more likely to be used on a daily basis. (Personally, I think they might be useful CPT codes as well.) I mean, what’s a medic to say when the patient’s complaint is bitten by ex-wife’s pet squirrel? Or penis stuck in mixer bowl?

I’ve attempted to answer those questions with the following system of 20 codes. Feel free to post near your EMS desk! They just might catch on.

20-100 Chest pain from stupid argument.

20-101 Chest pain from anxiety.

20-102 Chest pain from trampoline injury.

20-103 Chest pain from being punched by wife.

20-104 Chest pain from boring/dead-end job.

20-105 Chest pain, nonurgent, not otherwise specified.

20-200 Laceration from altercation with small child.

20-201 Laceration from argument with dog.

20-202 Laceration from reaching through broken window for beer.

20-203 Laceration from opening beer with mouth.

20-204 Laceration from inappropriate use of household implement while naked.

20-205 Laceration from stupid activity, not otherwise specified.

20-300 Overdose on normal dose of Xanax.

20-301 Overdose on normal dose of Ambien (also known as sleep).

20-302 Overdose on ridiculous amount of alcohol, attributed to some pill in drink.

20-303 Overdose on confidence, resulting in sound beating or ugly bedmate.

20-304 Overdose on nicotine after recent coronary stent (also known as acute MI).

20-305 Overdose on nonlethal substance, not otherwise specified (like flour).

20-400 Back pain from lifting refrigerator alone.

20-401 Back pain from lifting uncooperative farm animal.

20-402 Back pain from having bizarre sex with obese spouse.

20-403 Back pain from assuming normal, standing posture while morbidly obese.

20-404 Back pain from threat of imminent employment or loss of benefits.

20-405 Back pain, unverifiable, not otherwise specified.

20-500 Intoxication with fall onto face.

20-501 Intoxication with fall out of bed.

20-502 Intoxication with fall from barstool.

20-503 Intoxication in the face of angry spouse.

20-504 Intoxication on mouthwash. (So she won’t know I’m drunk.)

20-505 Intoxication with ridiculous injury, not otherwise specified.

20-600 Multiple wounds from Jello wrestling with raccoons.

20-601 Lacerations from letting pit bull eat off body. (See 20-505.)

20-602 Antler wounds from attempting to dress game animal which was mostly dead.

20-603 Bites from attempting to dress ferret as Ballerina Barbie.

20-604 Lacerations to eyelids from attempting to bathe cocaine-intoxicated cat.

20-605 Animal-related wounds, not otherwise specified.

20-700 Multiple stings from attempting to add hornet’s nest to collection. In June.

20-701 Burns from attempting to kill yellow-jackets with gasoline, while smoking.

20-702 Envenomation from attempting to cuddle with pit viper.

20-703 Small red mark, believed to be spider bite.

20-704 Bite or envenomation with offending creature in possession. (No, no, no!)

20-705 Bite or envenomation, nonurgent, not otherwise specified.

20-800 Patient wearing demeaning but hilarious attire (e.g. bootylicious on shorts).

20-801 Patient in need of immediate arrest.

20-802 Patient with wife in ambulance, girlfriend coming by private auto. (Surprise!)

20-803 Extraordinarily attractive patient (probably needs decon).

20-804 Patient with nonurgent but completely unintelligible complaint.

20-805 Patient annoying, not otherwise specified.

20-900 Shortness of breath from walking to refrigerator.

20-901 Shortness of breath from thrilling episode of reality show.

20-902 Shortness of breath from argument with prom date.

20-903 Shortness of breath from smoking four packs per day in small room full of cat fur.

20-904 Shortness of breath from wrestling with law enforcement.

20-905 Shortness of breath, no objective signs, not otherwise specified.

As you can see, this system is still in its infancy. However, if you would like to submit codes of your own, please do. We could revolutionize both EMS and billing! And we could learn to speak in cryptic but hilarious code behind the backs of our more illustrious clients.

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