Prepared by the Division of Emergency Medical Services

1. Medical Incident Report Form Education Module for 2008 ALS Basic Training Course (Complete Dataset) Prepared by the Division of Emergency Medical Services Prepared by the Division of Emergency Medical Services

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

3. Education Module Contents • Basic information & general instructions • Cardiac arrest highlight • 2008 MIRF dataset

4. Basic Information & General Instructions

5. 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

6. 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)

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 & 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 form.

10. 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. NEW!

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

12. 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.

13. Cardiac Arrest Highlight

14. 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?

15. 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?

16. Cardiac Arrest Highlight (cont.) • CPR Initiated By • Indicate the first person to begin CPR: • 1 First Responder/Police • 2 Fire Department (BLS) • 3 Paramedic (ALS) • 4 Ambulance • 5 MD/RN • 6 Citizen with Dispatch Assistance • 7 Citizen without Dispatch Assistance • 8 CPR Not Attempted

17. Cardiac Arrest Highlight (cont.) • AED/PAD Used • Was AED/PAD used? • 1 Citizen – No Shock • 2 Citizen – Shock • 3 First Responder/Police – Shock • 4 First responder/Police – No Shock REVISED!

18. 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 REVISED!

19. 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. NEW!

20. 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.

21. 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 REVISED!

22. 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.

23. 2008 MIRF Dataset • Incident Data (in alphabetical order) • Patient Data (in alphabetical order)

24. Incident Data • Action Taken • Agency Incident Number • Aid Type

25. Incident Data (Cont.) • 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

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

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

28. Incident Data (cont.) REVISED! • 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. • Location Type • Outside Agency Incident Number • Property Use (NFIRS)

29. Incident Data (cont.) • Reporting Agency Number • Reporting Unit ID Number • Responding from Quarters • Responding in Fire District Code

30. Incident Data (cont.) • Response Delay Type The response delays, if any, of the unit associated with the patient encounter. NEW! 130 Directions 140 Diversion 150 None 160 Safety 170 Traffic 180 Vehicle Failure 125 Crowd 135 Distance 145 HazMat 155 Other 165 Staff Delay 175 Vehicle Crash 185 Weather

31. Incident Data (cont.) • Response Mode • Treatment Crew Member Name REVISED!

32. 1 Exam Only: Examined but no treatment performed 2 Exam & Assist: Treatment/medical assistance given 3 No Exam: Did not examine patient 4 Patient Refused Exam, Treatment, and/or Transport 5 Service Aid/Patient Assist: Patient needed help but did not need exam Patient Data • Action Taken REVISED!

33. Patient Data (Cont.) • Allergies • Blunt/Penetrating Injury – Blunt or Both • Blunt/Penetrating Injury – Penetrating to Chest/Abdomen • Blunt/Penetrating Injury – Penetrating - Other

34. Patient Data (Cont.) • 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

35. Patient Data (Cont.) • Flow Chart REVISED! 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)

36. 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 REVISED!

37. 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 REVISED!

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

39. Patient Data (Cont.) • Highest Level of Care Provided • Mass Casualty Incident Indicates if existing EMS resources were overwhelmed and event was considered an MCI. • Medical Facility Contacted Name • Medical Person Contacted Name • MIRF Number Indicates pre-printed unique number located on MIRF NEW! NEW!

40. Patient Data (Cont.) • Narrative • Use the S.O.A.P. format: • Subjective • Objective • Assessment • Plan

41. Patient Data (Cont.) • 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

42. Patient Data (Cont.) • Patient Nearest Relative Name, Phone, Relationship • Patient Mechanism Code • Patient Medications Taken at Home, ID • Patient Suspected Alcohol or Drug Use • Patient Type Code

43. 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 • Treatment Crew Member Number for Procedure NEW! NEW!

44. Patient Data (Cont.) • Safety Equipment • Signature of Person Completing Form • Transport Agency Number • Transport Delay Type The transport delays, if any, of the unit associated with the patient encounter • Transport Destination • Transport Unit Number NEW!

45. Patient Data (Cont.) • Trauma Band Number • Trauma Criteria Met? • Trauma Triage (TTC)

46. Medical Incident Report Form Education Module for 2008 ALS THE END Prepared by the Division of Emergency Medical Services Prepared by the Division of Emergency Medical Services