Prepared by the Division of Emergency Medical Services BLS Basic Training Course (Complete Dataset) Medical Incident Report Form Education Module for 2010 Prepared by the Division of Emergency Medical Services

Education Module Goals Train new EMS personnel Provide a review for experienced EMS personnel

Education Module Contents Basic information & general instructions Aftercare Instructions Highlight 2010 MIRF dataset

Basic Information & General Instructions

Why the MIRF is Important Medical –The MIRF (both electronic and paper) is part of the patient’s medical file. –The MIRF transfers information between patient care providers. Legal –Confidentiality –Patient Refusal –MIRF Signature

Why the MIRF is Important (continued) Quality Review Planning/Funding –Medic unit placement, levy funding Research –Resuscitation Outcome Consortium (ROC) –Aftercare Instructions Pilot Project

Components of a Good Report Completeness –All available information regarding the incident or patient care should be recorded. Accuracy –Describe exactly what happened. Correct spelling Legibility (on paper forms)

Components of a Good Report (continued) Narrative: use S.O.A.P format: –Subjective –Objective –Assessment –Plan

Basic Instructions An electronic record is created by CAD/Dispatch for every call/incident. When completing the paper (short) form in the field, use a ball point pen and press hard enough to mark through all copies. Complete the electronic record, verifying that the CAD information has been received, and augmenting this information where appropriate. Refer to your agency protocols regarding exceptions to completing the paper (short) form. ******* Agencies using the paper (long) form should complete a form for every call/incident.

Paper MIRF Pages Agency copy EMS copy Medical Review copy Patient copy Aftercare Instructions: The backer provides health information to patients.

Completing the MIRF The person who provided primary care should: Sign your name Print your name Write your EMS number

Follow the instructions on the back of the MIRF. Fill in patient’s name, and the date. Read the statement slowly & clearly to the patient. Ask if they understand what it says. Have the patient/guardian sign in the appropriate spots. If patient/guardian refuses or you are unable to obtain a signature, make a note to that effect. Obtain a signature from a witness and note their EMS agency affiliation or address. Patient Refusal

Aftercare Instructions Highlight

The backer is to be given to ALL patients. Aftercare instructions are located on the back of last page of the MIRF (both short and long form) for a variety of health conditions. CHECK ALL APPLICABLE boxes: Patient was Not Transported / Transported Low Blood Sugar Information High Blood Pressure Information Community Resources Information ******** Heart Attack Warning Signs and Stroke Warning Signs provide additional health information.

Aftercare Instructions Highlight (cont.) Not Transported Patient left at scene or transported by a private occupancy vehicle. Transported Patient transported by BLS, ALS, or a private ambulance.

Aftercare Instructions Highlight (cont.) Low Blood Sugar Patient was treated for hypoglycemia and not transported. High Blood Pressure Patient with a systolic ≥ 160 OR diastolic ≥ 100.

Aftercare Instructions Highlight (cont.) Community Resources – Can be offered to any patient in need of social services including: Caregiver & Disability Resources Domestic Violence Emergency Shelter Financial Assistance for Rent or Utilities Food & Clothing Health Care & Support Groups Legal Help

2010 MIRF Dataset Incident Data (in alphabetical order) Patient Data (in alphabetical order)

Incident Data Action Taken Agency Incident Number Aid Type

Date Time Arrived on Scene Date Time Dispatch Notified Date Time In Service Date Time Last Response Unit Leave Scene Date Time Primary PSAP Notified Date Time Unit Notified by Dispatch Date Time Unit Responded Incident Data (Cont.)

First Agency on Scene ID First EMS Reporting Agency on Scene First Unit on Scene Geocode Incident Data (cont.)

Incident Address Incident City Incident County Incident State Incident Type (NFIRS) Incident Zip Code Incident Data (cont.)

Initial (Incident) Dispatch Code (IDC) Location Type Outside Agency Incident Number Property Use (NFIRS) Reporting Agency Number Reporting Unit ID Number Responding from Quarters Responding in Fire District Code Incident Data (cont.)

Response Delay Type Response Mode Treatment Crew Member Name Incident Data (cont.)

Action Taken Allergies Date/Time Arrived at Patient’s Side Date/Time Arrived at Treatment Facility or Transfer Point Date/Time Extrication is Completed Date/Time Patient Left Scene EMS ID Number of Person Completing Form Patient Data (Cont.)

Flow Chart Patient Data (Cont.) Time Blood Pressure Pulse Rate Respiratory Rate ECG Rhythm* Oxygen* Pulse Oximetry Glucometry IV fluids (liters) - ALS ONLY DC Shock/AED Used Medications

Flow Chart (cont.) Patient Data (Cont.) ECG Rhythm 01 Sinus Rhythm 02 Asystole 04 Other 11 Ventricular Fibrillation U0 Unknown

Flow Chart (cont.) Patient Data (Cont.) Oxygen Mechanism 1 Non-rebreather 2 Nasal Cannula 3 Bag Valve Mask 4 Blow-By 5 Other (see Narrative) 6 BVM + ITD The notes section of the flow chart can be used for notes or for extended flow chart information

Glasgow Coma Eye Opening Component Glasgow Coma Motor Response Glasgow Coma Verbal Response Glasgow Coma Score (GCS) Patient Data (Cont.)

Highest Level of Care Provided Mass Casualty Incident Medical Facility Contacted Name Medical Person Contacted Name MIRF Number Patient Data (Cont.)

Narrative Use the S.O.A.P. format: Subjective Objective Assessment Plan

Onset of Symptoms Patient Age, Units Patient Date of Birth Patient Street Address, City, County, State, Phone Patient First Name, Middle Initial, Last Name Patient Gender Patient Health Care Provider, Phone Patient Data (Cont.)

Patient Mechanism Code (refer to the electronic pick list) Patient Data (Cont.) AC – Accident (non-motor vehicle) For motor vehicle accident continue to use MV EX – Explosives FI – Fireworks

Patient Data (Cont.) Patient Medications Taken at Home Patient Parent or Legal Guardian Patient Suspected Alcohol or Drug Use Patient Type Code

Suspected MI - STEMI Suspected MI – Other Suspected MI now differentiates between STEMI and Other Suspected MI. Patient Data (Cont.) Patient Type Code (Cont.)

Hypoglycemia, caused by insulin Hyperglycemia (>300), patient is diabetic Hyperglycemia (>300), patient is not diabetic or unknown Dialysis problem Diabetic Ketoacidosis and Insulin Reaction are now coded using the new type codes. Patient Data (Cont.) Patient Type Code (Cont.)

Suspected CVA Suspected TIA CVA/TIA now differentiates between CVA and TIA. Patient Data (Cont.) Patient Type Code (Cont.)

Procedures Check all boxes for procedures performed. For procedures only: write the procedure number and the EMS number of the person who performed the procedure Treatment Crew Member Number for Procedure Patient Data (Cont.)

Safety Equipment Signature of Person Completing Form Transport Agency Number Transport Delay Type Transport Destination Transport Unit Number Patient Data (Cont.)

Prepared by the Division of Emergency Medical Services Medical Incident Report Form Education Module for 2010 Prepared by the Division of Emergency Medical Services THE END BLS