Some of you who are familiar with wildland firefighting are already well
versed in the safety acronym L.C.E.S. It was developed in 1981 and continues to be taught in wildland firefighting curriculum as a handy checklist of things we should have in place when operating in dangerous environments where conditions can change fast.
L.C.E.S. came about when retired U.S. Forest Service Superintendent Paul Gleason looked at fatal fires over the previous 20 years and identified the four elements most likely to save your butt when stuff goes really wrong. The acronym he created is simple and it works.
In wildland firefighting changes in weather and fuel sources can mean that the operating conditions can go from good to “everybody run” in the blink on an eye, so L.C.E.S. is practiced pretty religiously. One area of EMS where I feel is has tremendous application is when we’re working in traffic on accident scenes. I’d like to see us EMS folks adopt the L.C.E.S. mindset any time we’re working in the street or on the roadside.
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SOAP is another one of those EMS acronyms that has endured through the years. I was taught the SOAP format in my EMT class 20 years ago and I’m still teaching it to my EMT students today.
SOAP reporting has a bunch of things going for it. It’s simple, it’s universal, it easily adapts to a multitude of situations and its feels familiar, because it’s the order your brain naturally recalls a memory of something that happened.
If there is one major limiting factor to SOAP it has nothing to do with its design and everything to do with its use. When you were in EMT school we drilled you on the importance of accurate and complete documentation. We frightened you with ideas about the legality, confidentiality and permanence of your medical reports. We worked hard to impress upon you the importance of your reporting and, like most, you probably took these lessons to heart. All of these scare tactics might have given you the idea that your medical report is a serious and formal necessity. Serious yes. Formal … no, not always. In fact, in the case of verbal hand-off reports and even standard report narratives (to a lesser degree), I’d argue that rigid formality works against you.
If you want your reports to shine, especially your SOAP format reports, you need to drop the rigid, robot-like formality. What I want you to get from this unconventional review of how to use SOAP is this: you can adapt the format. You can mix it up. You can play with it. SOAP is our tool. We can use it or disregard it in the ways that we see fit.
From now on, I want you to think of soap as your way of answering these four questions:
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I first heard the BCAPBTLS acronym sometime around 1998 while helping a group of EMT’s practice their skills. I hadn’t been involved in EMT education for several years and I had missed the whole inception of the DCAPBTLS acronym. Dutifully, each aspiring EMT moved from the head to the neck, shoulders, chest and abdomen. Each student verbalized their assessments as they went along and sounded off the acronym in turn.
“I’m exposing the chest and looking for DCAPBTLS.” “I’m checking the abdomen for DCAPBTLS.” On 
and on it went until I finally interjected, “What is this word you all keep using?”
“What word?”
“That word. The Dee Cap something.”
“Oh yeah.” They chimed in and began explaining the purpose of the DCAPBTLS acronym. If I remember correctly, there may also have been a “TIC” component added on to the end as well. If there was, the TIC part has been lost to education history. The students explained that DCAPBTLS was an acronym that was designed to help them remember the various abnormalities that they were looking for during the assessment. Then the funny part happened.
Collectively the students tried to recall all the elements of the acronym. “Deformity, contusions … uh … abrasions.” The room fell silent. “Uh … the T is tenderness.”
“Don’t forget bruising.” Another student chimed in. “Oh, yeah. Bruising.”
By the time the students collectively produced all eight elements of the acronym, several things were clear. The eight elements of DCAPBTLS was not one of them. Before we get in to that, let’s set the record strait. DCAPBTLS stands for:
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