Which complications must be documented in the QA plan?

• A. Hypotension, extreme bradycardia or tachycardia, increasing chest pain, dysrhythmia, altered mental status, and changes in neurological examination
• B. Hypertension and mild headaches only
• C. Only chest pain and shortness of breath
• D. No complications need to be documented

Answer: (A)

Documenting what goes wrong or changes in the patient’s condition during EMS care is essential for QA. The listed complications are significant signs that something has worsened or gone wrong in the course of treatment or transport, and they deserve formal review. Low blood pressure can indicate shock or poor perfusion and needs follow-up to see if care was effective. Very slow or very fast heart rhythms are dangerous and require immediate attention; they reveal underlying issues with cardiac function or response to therapy. Worsening chest pain can signal ongoing or evolving cardiac ischemia, which changes how the patient should be managed. Any abnormal heart rhythm (dysrhythmia) is a clear safety concern needing documentation and review. Changes in mental status or neurological examination point to possible hypoxia, altered perfusion, stroke, or other neurologic injury, all of which require QA analysis to ensure protocols were applied correctly.

Hypertension with mild headaches, presenting chest pain and shortness of breath, or no complications at all do not by themselves represent adverse events that warrant QA documentation in the same way. The QA plan focuses on significant deteriorations or adverse responses that prompt review and potential process improvements, hence the emphasis on the comprehensive list above.