Download Cardiac Arrest Highlight (cont.)

Medical Incident Report Form
Education Module for 2008
Refresher
Course
Prepared by the Division of Emergency Medical Services
Prepared by the Division of Emergency Medical Services
Education Module Goals
• Refresh EMS personnel on why the MIRF
is important
• Update EMS personnel on changes to
the 2008 MIRF
Education Module Contents
• Basic information & general instructions
• Cardiac arrest highlight
• 2008 MIRF changes
Basic Information & General
Instructions
Why the MIRF is Important
• Medical
– The entire MIRF (both electronic form and paper
‘short form’) is part of the patient’s medical file.
– The MIRF transfers information between patient care
providers.
• Legal
– Confidentiality
– Patient Refusal
– MIRF Signature
Why is the MIRF is Important
(continued)
• Quality Review
• Planning/Funding
– Medic unit placement, levy funding
• Research
– Resuscitation Outcome Consortium (ROC)
– Supporting Public Health with Emergency
Responders (SPHERE)
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 & press hard enough to mark through all copies.
• Complete the electronic record verifying that the CAD information is
accurate.
• 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.
MIRF Pages
• Agency copy
• EMS copy
• Medical Review copy
• Patient copy
• Cardiac worksheet (Short Form Only):
A reminder sheet to assist EMS Personnel in
collecting CPR data in the field. May be discarded.
Completing the MIRF
The person who provided primary care
should:
• Sign your name
• Print your name
• Write your EMS number
Patient Refusal
• 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.
Cardiac Arrest Highlight
Cardiac Arrest Highlight
Research findings from cardiac arrest data have
improved patient care and saved lives.
When CPR is performed by EMS personnel, fill out the ENTIRE
CPR section including:
• Was cardiac arrest witnessed?
• Did patient arrest after EMS
arrival?
• Who initiated CPR?
• Was AED/PAD used?
• What was the initial arrest rhythm?
•Did paramedics cease
resuscitation upon arrival?
• Estimated elapsed times
• Time of return of spontaneous
circulation
• What was the patient outcome?
Cardiac Arrest Highlight (cont.)
• Cardiac Arrest Witnessed
If someone directly saw or heard the patient collapse, then
the arrest is considered witnessed and you should mark
“Yes”. If the patient’s collapse was not seen or heard, but
found after an unknown length of time, it is considered
unwitnessed and you should mark “No”.
• Arrest After Arrival of EMS Personnel
Did the arrest occur after the arrival of emergency
personnel?
Cardiac Arrest Highlight (cont.)
• CPR Initiated By
Indicate the first person to begin CPR:
1
2
3
4
5
6
7
8
First Responder/Police
Fire Department (BLS)
Paramedic (ALS)
Ambulance
MD/RN
Citizen with Dispatch Assistance
Citizen without Dispatch Assistance
CPR Not Attempted
Cardiac Arrest Highlight (cont.)
• AED/PAD Used
Was AED/PAD used?
1
2
3
4
Citizen – No Shock
Citizen – Shock
First Responder/Police – Shock
First responder/Police – No Shock
Cardiac Arrest Highlight (cont.)
• Initial ECG Rhythm
First observed cardiac rhythm by paramedic:
01 Sinus Rhythm
02 Asystole
03 PEA
04 Other
05 Atrial Fibrillation
11 Ventricular Fibrillation
12 Ventricular Tachycardia
U0 Unknown
Cardiac Arrest Highlight (cont.)
• Paramedics Cease Resuscitation On Arrival
Indicate if resuscitation was ceased by paramedics within the first
few minutes of arrival on scene due to DNR orders, compelling
reasons, or conditions not compatible with life.
• Estimated Elapsed Time (minutes) from
Collapse to Call
For witnessed arrest only; the estimated number of minutes
between collapse of the patient and the reporting party reaching
the correct agency by phone. If the collapse was unwitnessed or
you cannot estimate the time, do not enter anything.
Cardiac Arrest Highlight (cont.)
• Estimated Time (minutes) from Collapse to
CPR
For witnessed arrests only, the estimated number of minutes from
the patient’s collapse to the time CPR was initiated.
• Time Return of Spontaneous Circulation
Time of the return of any palpable pulse. A palpable pulse would be
one detectable by manual palpation of a major artery, usually the
carotid.
Cardiac Arrest Highlight (cont.)
• Patient Outcome
Complete for all cardiac arrest patients.
01 DOA
02 Expired at Scene (including during transport)
03 Admitted to ER
04 Expired at ER
05 Admitted to Hospital
06 Unknown
Cardiac Arrest Highlight (cont.)
• When CPR is performed…
– Mail the red copy of the MIRF and a printout
of your electronic record to the EMS Division
within 4 days of the event.
2008 MIRF Changes
• Incident Data (in alphabetical order)
• Patient Data (in alphabetical order)
Incident Data
• Initial (Incident) Dispatch Code (IDC)
The IDC is received from the dispatch center that dispatched
your unit. If no IDC is given or obtainable, leave blank.
Incident Data (cont.)
• Response Delay Type
The response delays, if any, of the unit associated with the patient
encounter.
130
140
150
160
170
180
125
Directions
Diversion
None
Safety
Traffic
Vehicle Failure
Crowd
135
145
155
165
175
185
Distance
HazMat
Other
Staff Delay
Vehicle Crash
Weather
Incident Data (cont.)
• Response Mode
Patient Data
• Action Taken
1
2
3
4
5
Exam Only: Examined but no treatment performed
Exam & Assist: Treatment/medical assistance given
No Exam: Did not examine patient
Patient Refused Exam, Treatment, and/or Transport
Service Aid/Patient Assist: Patient needed help but did not need
exam
Patient Data (Cont.)
• Flow Chart
Time
Blood Pressure
Pulse Rate
Respiratory Rate
ECG Rhythm*
Oxygen*
Pulse Oximetry
Glucometry
IV fluids (liters)
DC Shock/AED Used
Medications
*Revised data elements (see next slide)
Patient Data (Cont.)
• Flow Chart (cont.)
ECG Rhythm*
01 Sinus Rhythm
02 Asystole
03 PEA
04 Other
05 Atrial Fibrillation
11 Ventricular Fibrillation
12 Ventricular Tachycardia
U0 Unknown
Patient Data (Cont.)
• Flow Chart (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
Patient Data (Cont.)
• Mass Casualty Incident
Indicates if existing EMS resources were
overwhelmed and event was considered an MCI.
• MIRF Number
Indicates pre-printed unique number located on
MIRF
Patient Data (Cont.)
• Procedures
Check all boxes for procedures performed.
For procedures 12-31 only: write the
procedure number and the EMS number of
the person who performed the procedure
Procedure: 36 – 12 Lead
Procedure: 37 – End Tidal CO2/Capnography
Patient Data (Cont.)
• Transport Delay Type
The transport delays, if any, of the unit associated with the
patient encounter
Medical Incident Report Form
Education Module for 2008
Refresher
THE END
Prepared by the Division of Emergency Medical Services
Prepared by the Division of Emergency Medical Services