Prepared by the Division of Emergency Medical Services

1. Medical Incident Report Form Education Module for 2010 Refresher Course Prepared by the Division of Emergency Medical Services 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 2010 MIRF

3. Education Module Contents • Basic information & general instructions • Aftercare Instructions Highlight • 2010 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 availableinformation 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. 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. Aftercare Instructions Highlight

14. 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. CHECKALL 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.

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.

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. 2010 MIRF Changes

20. Incident Type (NFIRS) • Incident Type coding has been revised to better align with NFIRS rules about requiring a patient record. • 3212-EMS call, Cancelled enroute  6113 • 3213-EMS call, Cancelled at Scene  3117 • 3214-Vehicle accident with no injury  3118 (Optional) • 3216-Unintentional medical alert activation  3119 • NEW! 3217-EMS call, Flu-like symptoms

21. Patient Mechanism Codes REVISED! • AC – Accident (non-motor vehicle) For motor vehicle accident, continue to use MV • EX – Explosives • FI – Fireworks NEW! NEW!

22. Patient Mechanism Codes (cont.) The following mechanism code is no longer in use: • HZ – Hazardous

23. Patient Parent or Guardian • Patient Parent or Legal Guardian information replaces the Nearest Relative information.

24. Patient Type Codes • Suspected MI - STEMI • Suspected MI - Other Suspected MI now differentiates between STEMI and Other Suspected MI. NEW! NEW!

25. Patient Type Codes (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. NEW! NEW! NEW! NEW!

26. Patient Type Codes (cont.) • Suspected CVA • Suspected TIA CVA/TIA now differentiates between CVA and TIA. NEW! NEW!

27. Patient Type Codes (cont.) The following type codes are no longer in use: • 601 – XX – Hazardous materials • 999 – XX – Unknown mechanism of injury

28. Procedures The following procedures are no longer in use: • 33 – Low Blood Sugar Alert • 34 – High Blood Sugar Alert • 35 – High Blood Pressure Alert

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