Edwin Leap, MD
This piece was originally printed in Emergency Medicine News
The 20 codes for EMS; describing the indescribable
How many times have you heard this on the radio: “Yeah, base, this is Medic 3, and we’re 15 minutes from your facility with a 38 year old white male with, uh, with, 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 guys and gals, 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 what the diagnosis is. Thank heavens for ‘Medical Screening Exam’, 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. Now, 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 education, and leave even the brightest going, ‘I just don’t get it…’.
So, in order to help our EMS colleagues, and facilitate our 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, non-urgent, 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 bed-mate
20-304 Overdose on nicotine after recent coronary stint (also known as Acute MI)
20-305 Overdose on non-lethal 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 bar-stool
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 of body (see 20-505)
20-602 Antler wounds from attempting to field dress game animal ‘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, non-urgent, 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 non-urgent 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 4 ppd 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 so through my website. 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’.
Oh my God that was the funniest thing I have read in a long time, I aspirated an ice cube when I read the one about field dressing a dear that is “mostly dead.”
The people who have never worked in an ER will think you are making this up without realizing that you have seen every one of these patients at some time or another.
By midnight last night, we’d already seen half of those patients. None of the animal related ones, though. Those usually come in on Sundays after church. We never have any shortage of 20-805, though. If anyone needs to borrow a couple……
Oh man. We have plenty of the 20-302 and the 20-305 at our ER. Especially the weekend nights that I work.
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These would be very useful, here’s a couple I’ve noticed with some regularity…
20-1000: (Foreign object) inserted in (name orifice)
Surpringly this seems to be most often irretrievable tampons and neuva rings.
20-1100: Pregnancy, possible
20-1101: Pregnancy, Over 20 weeks, just realized
Hmmm, this post appears a bit misogynistic, coincidence I swear!
Muahhahha….. oh man. Love the list.
Let me add the 20-1200 series, for the orthopaedic injuries.
20-1200- Any fracture resulting from the delusion of enhanced martial arts prowess post-drugs (usually both)
20-1201- Greenstick fracture of radius from imitating Dragonball Z.
20-1203- Dislocated hip prosthesis while climbing over turnstile( I swear this happened)
I think I just relived my ER rotation.
i am like addict on trampolines, they are very nice addition to you gaming stuffs*-~
my kids just love to jump all day lon on trampolines, they are addicted to it.;,
the nicotine in cigarette actually makes me very lively during long driving hours`,.
nicotine can really make you an addict, stay away from cigarettes in the first place *’.
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They are definately going to make an appearance at my 21st birthday this weekend!
I am not real excellent with English but I find this real leisurely to interpret.