1. Prepared by the Division of Emergency Medical Services Refresher Course Medical Incident Report Form Education Module for 2011 Prepared by the Division of Emergency Medical Services

2. Education Module Goals Refresh EMS personnel on why the Medical Incident Report Form (MIRF) is important Update EMS personnel on changes to the 2011 MIRF

3. Education Module Contents Basic information & general instructions Aftercare Instructions Highlight 2011 MIRF changes

4. Basic Information & General Instructions

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

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

7. 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)

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

9. 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.

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

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

12. 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

13. Aftercare Instructions Highlight

14. 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 Low Blood Sugar Information High Blood Pressure Information Falls Community Resources Information

15. 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.

16. 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. Falls

17. 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

18. Aftercare Instructions Highlight (cont.) Once the appropriate boxes on the backer have been checked, tear the sheet at the perforation and give to the patient. Be sure to enter the same information into your record management system (for electronic agencies).

19. 2011 MIRF Changes

20. Incident Type (NFIRS) Incident Type coding has been revised over the past few years. Here are some highlights of the current coding: 3117 -EMS call, Cancelled at Scene 3119 -EMS call, Unintentional medical alert activation 3214 -EMS call, Vehicle accident with no injuries (use if you want to create a patient record) 3127 -EMS call, Flu-like symptoms 324 -EMS call, Vehicle accident with no injuries (standard NFIRS code-patient record not allowed) 6113 -EMS call, Dispatched & cancelled enroute

21. Prepared by the Division of Emergency Medical Services Medical Incident Report Form Education Module for 2011 Prepared by the Division of Emergency Medical Services THE END Refresher