In emergency medicine, every second counts. You're juggling critical patients, making split-second decisions, and moving fast.

There isn’t time to stop and document it all.

We’ve put together these SOAP report guidelines to help you write faster, clearer EMS notes. Whether you’re working through a high-speed trauma case or a complex cardiac event, the right approach to documentation keeps your team informed and your patients safe.

Let’s break it down.

The SOAP note format

You're in the EMS— time is of the essence. You probably already have a love-hate relationship with SOAP notes.

SOAP stands for:

• Subjective: The patient’s history, symptoms, and reported concerns.
• Objective: Measurable data, including:
  • Vital signs
  • Lab results
  • Physical exam findings
• Assessment and Plan: The clinician’s analysis of the patient’s condition and next steps for treatment or management.

SOAP notes might not be your favorite task, but they’re the glue that keeps EMS teams on the same page — even in the middle of chaos.

Don't believe me?

Check out these use cases below.

SOAP method: Use cases in emergency medical services

In an EMS environment, SOAP notes can bring order to the chaos. Here are some key examples:

1. Motor Vehicle Collision (MVC) Patient

Traffic accidents are common casualties faced in the ED. Here's a sample SOAP note:

Subjective

• Patient is a 30-year-old female who arrived via ambulance after a rear-end collision.
• Reports severe neck pain and a throbbing headache since the accident.
• Denies loss of consciousness but complains of mild dizziness and nausea.
• Medical history: No known chronic conditions; no current medications.

Objective

• Vital Signs: BP 132/80 mmHg, HR 98 bpm, RR 18 breaths/min, SpO₂ 98%.
• Physical Exam:
  • General: Appears alert, in moderate distress due to pain.
  • Neck: Tenderness along the cervical spine, limited range of motion due to pain.
  • Neuro: Cranial nerves grossly intact; no focal deficits. Normal pupil reaction.
  • Skin: No significant lacerations, minor abrasions on forearm.
• Imaging: Cervical spine X-ray pending.
• Labs: Basic metabolic panel and FBC ordered; no critical abnormalities noted so far.

Assessment

• Likely cervical strain (whiplash); no immediate evidence of fracture or intracranial injury based on initial exam.
• Low suspicion for significant head injury but will continue to rule out concussion.

Plan

1. Continue cervical spine precautions until imaging definitively rules out fractures.
2. Administer NSAIDs (e.g., ibuprofen) or acetaminophen for pain relief, considering muscle relaxants if needed.
3. Observe for signs of neurological changes or increased intracranial pressure (ICP).
4. If imaging is clear and patient remains stable, consider discharge with neck support and outpatient follow-up instructions.
5. Counsel patient on red-flag symptoms (worsening headache, vomiting, confusion) that warrant immediate return.

2. Chest pain/possible cardiac event

Another common complain found in the ED is the possible chest pain scenario. Here's a sample:

Subjective

• 58-year-old male presents with central, pressure-like chest pain radiating to the left arm and jaw for approximately 45 minutes.
• Reports feeling anxious, diaphoretic, and slightly nauseous.
• Past medical history: Hypertension, hyperlipidemia. Family history of coronary artery disease.
• Medications: Takes atorvastatin and lisinopril regularly.

Objective

• Vital Signs: BP 148/92 mmHg, HR 110 bpm (tachycardic), RR 20 breaths/min, SpO₂ 97% on room air.
• Physical Exam:
  • General: Pale, diaphoretic, mildly anxious.
  • Cardiac: Tachycardic, no significant murmurs.
  • Lungs: Clear bilaterally.
• EKG: ST-segment depressions in leads II, III, and aVF (suggestive of possible ischemia).
• Labs: Cardiac enzymes (troponin) drawn; first set pending. Electrolytes within normal limits.

Assessment

• Suspected Non-ST-Elevation Acute Coronary Syndrome (NSTE-ACS) or unstable angina.
• Patient’s risk factors and EKG changes warrant urgent cardiac evaluation.

Plan

1. Start IV access, place on continuous cardiac monitoring.
2. Administer aspirin (chewable) if no contraindications.
3. Initiate sublingual nitroglycerin if BP remains stable, and consider morphine for pain control if needed.
4. Repeat EKG in 15-30 minutes.
5. Consult cardiology for possible stress test or urgent catheterization based on troponin trends and patient stability.

3. Diabetic emergency (hypoglycemia)

Now, let's look at a common case of hypoglycemia.

Subjective

• 45-year-old female with Type 1 diabetes mellitus arrives confused and diaphoretic.
• Colleague states the patient was found disoriented at work, unable to recall last insulin dose or meal.
• Past medical history: Type 1 diabetes since age 15, no known diabetic complications reported.

Objective

• Vital Signs: BP 120/70 mmHg, HR 100 bpm, RR 16 breaths/min, SpO₂ 98% on room air.
• Fingerstick Glucose: 42 mg/dL (indicating hypoglycemia).
• Exam: Patient is responsive but oriented only to person, tremulous, sweaty.
• Labs: Stat BMP shows no other acute abnormalities, but awaiting additional results to rule out electrolyte imbalances.

Assessment

• Acute symptomatic hypoglycemia likely due to insulin dosing mismatch and/or inadequate dietary intake.

Plan

1. Administer 25 g of 50% dextrose (D50W) IV push; recheck blood glucose in 15 minutes.
2. Monitor patient’s mental status and vitals closely; initiate IV fluids if needed.
3. Once stabilized, assess patient’s home insulin regimen and dietary habits; involve diabetes educator as needed.
4. Consider admission if there are concerns about the patient’s ability to manage insulin dosing or social support.

These samples show one thing: organization is everything in an emergency situation.

SOAP report guidelines for EMS

In the EMS, there's no time for note bloat. Keep your progress notes clear, concise, and actionable.

Here’s how to make them work for you:

1. Keep it brief, but complete

• Focus on vital information — skip unnecessary background info.
• Use short, direct sentences to make the note easy to scan.

Example: Instead of "The patient states that they started experiencing severe chest pain about 45 minutes ago, which has been getting progressively worse," try "45M with 45 min of worsening chest pain."

2. Prioritize critical information

• In high-acuity cases, lead with the most urgent details (e.g., unstable vitals, airway concerns).
• If needed, supplement with a secondary patient care report when more time allows.

3. Use a template or tool

• A structured SOAP note template keeps things efficient and consistent.
• Use the standardized format and time-saving structure to focus on key details without extra fluff.

Grab your free SOAP note template here.

4. Use standardized abbreviations

• EMS teams rely on quick, universal shorthand (e.g., SOB for shortness of breath, c/o for complaints of).
• Avoid uncommon abbreviations that could cause confusion. It's not time to reinvent the wheel.

“I make use of shorthand and common medical abbreviations. These cutbacks on words not only quicken the process of documentation but also ensure clarity in the notes.” — Dr. Sam Singh; Winit Clinic

5. Be objective and neutral

• Stick to facts and observable signs rather than assumptions.
• Instead of “patient seems intoxicated,” write “slurred speech, unsteady gait, strong odor of alcohol on breath.”

6. Ensure continuity of care

• Your SOAP note should set up the next clinician for success — whether in the ED or another facility.
• Include treatment provided, patient response, and next steps to avoid redundancy or miscommunication.

SOAP vs. APSO: Switching Things Up

There's a hot debate in the Med School subreddit. Is SOAP outdated?
The APSO format flips SOAP, putting Assessment & Plan first.

APSO: A Modern Alternative?

Team SOAP or Team APSO?

Either way, the goal is the same — making your notes work for you, not the other way around. There are benefits to SOAP and APSO (with passionate fans on both sides).

• SOAP is the longest standing format: it's easily recognizable and more shareable than its APSO counterpart.
• But the APSO note front-loads all the crucial information to the top, making an overly detailed note more practical and glanceable.

And 80% of clinicians are fans. Survey respondents were “satisfied” or “very satisfied” with the APSO note format.

AI Scribes in the EMS

Wouldn't it be nice if your notes just... wrote themselves? Good news — they can.

AI scribes take medical dictation to the next level.

These hands-free note-taking tools are able to listen and process a conversation, turning your patient encounter into a finished medical note.

📌 Try Freed's AI scribe at no cost today. No credit card required.

Using AI in EMS Patient Care: Why It Matters

Picture this: Multiple patients are rushed into the ED. You're the resident on call.

The last thing on your mind is... when to write progress notes.

Here's how healthcare providers can lean on AI in real time.

1. Hands-free note-taking

Focus on care, not typing medical notes.

2. Patient-centric consults

In the EMS, having your full focus on the patient is crucial in identifying possible clinical complications. Keep your eyes and mind on your patient the whole time.

3. No more pajama time

Your work should end with your shift. By letting AI do the heavy lifting, you can quickly review your notes, then add them to your EHR with an easy integration.

Wrapping Up

SOAP notes in EMS are a necessary evil. But they don’t have to slow you down.

AI-powered documentation means less paperwork, more patient care.

Freed makes sure your notes keep up — so you can focus on what truly matters.

Try Freed at no cost today. No credit card required.