NEW Run Sheet Training Information

1
NEW Run Sheet Training Information To be used
starting 1 April 2006 February 2006
2
The EMS Run Sheet

• Revised to comply with EMSIRS-2 Data Elements
• All shaded areas are required by the State for
  reporting

3
The EMS Run Sheet

• Date Month/Day/Year Essential in EMSIRS-2 and
  will affect several elements
• Run
• Refer to local SOPs.
• A number should be assigned to each patient at an
  incident
• Number of Patients at the Scene
• Single
• Multiple
• None

4
The EMS Run Sheet

• EMD Was Emergency Medical Dispatching performed?
• Yes, with Pre-arrival Instructions
• Yes, with no Pre-arrival Instructions
• No

5
The EMS Run Sheet

• MCI Was the event a Mass Casualty Incident as
  defined by county or local standards?
• Yes
• No

6
The EMS Run Sheet

• Unit The specific unit call sign for the unit
  preparing the report
• Refer to departmental guidelines
• Example M2-1
• Primary Role The role of the unit preparing the
  report
• Non-transport (Role is to provide care but not
  transport)
• Rescue
• Supervisor
• Transport (Role is to provide care and transport,
  
• even if no transport occurred)

7
The EMS Run Sheet

• Destination The ODH hospital code of the
  receiving facility
• Type The type of destination the patient was
  transferred to
• Hospital ED, OR or LD
• Other EMS provider (air)
• Other EMS Provider (ground)
• Other

8
The EMS Run Sheet

• Prior Aid Any care provided prior to the arrival
  of the EMS unit
• Any value from medications or procedures
• Prior care not provided
• Unknown if care provided
• This does not apply to care provided in a
  Emergency Facility to Emergency Facility transfer

9
The EMS Run Sheet

• Performed by The type of individual who provided
  the care (includes care provided prior to
  responder arrival)
• EMS provider
• Law Enforcement
• Layperson
• Patient
• Other Healthcare provider
• Unknown
• Time Time care was provided

10
The EMS Run Sheet

• Outcome The outcome or result of the prior care
  provided
• Improved
• Worsened
• Unchanged
• Unknown

11
The EMS Run Sheet

• Crew Members The names and certification levels
  of the crew members on the incident
• First Responder
• EMT-Basic
• EMT-Intermediate
• EMT-Paramedic
• Nurse (RN or LPN)
• Others Personnel on-scene not listed above or
  not providing care (Police)

• Physician (MD or DO)
• Student
• Other Healthcare Provider
• Other non-healthcare provider

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The EMS Run Sheet

• Service The type of service requested of the EMS
  service responding
• 911 Response Responded to a request within
  their jurisdiction
• ED-to-ED transfer Performed an inter-facility
  transfer
• Medical Transport Request for transport to a
  medical facility
• Mutual Aid Responded to a request outside the
  agencies jurisdiction

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The EMS Run Sheet

• Incident Address Self-explanatory
• City Self-explanatory, Can Use City Name Or 5
  Digit FIPS Code
• County Self-explanatory, Can Use County Name Or
  2 Digit County Code
• Zip Self-explanatory

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The EMS Run Sheet

• Incident Site Location where the incident
  occurred
• Home/Residence
• Farm
• Mine or Quarry
• Industrial Place or Premises
• Place of Recreation or Sport
• Street or Highway
• Public Building

• Trade or Service
• Healthcare Facility
• Residential Institution
• Lake, River, Reservoir
• Other location
• Unknown

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The EMS Run Sheet

• Name Patients name (refer to departmental
  procedure)
• Address Patients address
• City
• State
• Zip Code
• Sex Patients gender
• Male
• Female
• Unknown

16
The EMS Run Sheet

• Race Patients race
• American Indian/Alaska Native
• Asian
• Black or African-American
• Native Hawaiian or Pacific Islander
• White
• Other race
• Unknown

17
The EMS Run Sheet

• Ethnicity Patients ethnicity
• Hispanic or Latino
• Non-Hispanic or Latino
• Unknown

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The EMS Run Sheet

• Phone Refer to departmental SOPs
• Pt ID Number Refer to departmental SOPs, usually
  patients social security number
• RN/Physician Signature Transfer of care should
  only be to a Nurse or Physician at the receiving
  facility. (not a reportable element)

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The EMS Run Sheet

• ED Diagnosis/Disposition If known, the
  disposition of the patient from the ED
• Admitted to Hospital floor
• Admitted to Hospital ICU
• Not Applicable
• (not transported to an ED)

• Death
• Released
• Transferred to another hospital
• Unknown/Not available

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The EMS Run Sheet

• ED Diagnosis/Disposition If known, the
  disposition of the patient from the Hospital
• Death
• Discharged
• Transfer to hospital
• Transfer to nursing home

• Transfer to other
• Transfer to rehab facility
• Unknown/Not available

21
The EMS Run Sheet

• Method of Payment How will the EMS agency be
  reimbursed for this incident
• Commercial Insurance
• Medicare
• Medicaid
• Not Billed (for any reason)

• Other Government
• Self pay/Pt. has no insurance
• Workers Compensation
• Unknown

22
The EMS Run Sheet

• Date of Birth Patients date of birth
• If you know the patients age but not the DOB,
  use Jan. 1 of the appropriate year
• If DOB and age unknown, approximate and use Jan.
  1 of the appropriate year

23
The EMS Run Sheet

• Condition Code (pending)
• This list of codes is in draft at the federal
  level
• When the codes are finalized, they will be
  implemented

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The EMS Run Sheet

• Response Times Self explanatory
• Refer to the EMSIRS-2 Data dictionary for further
  clarifications
• Pre-existing Conditions List of pertinent
  medical conditions
• If a list was given to the ED, document See
  attached or List given to ED Staff
• Family Physician/Surgeon If the patient has more
  than one physician, list the one that would be
  pertinent to the chief complaint or provider
  assessment.

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The EMS Run Sheet

• Medical Control Receiving medical control or
  physician who gave directives or orders
• If no orders or directives were given then refer
  to departmental guidelines
• Allergies List pertinent medication or other
  allergies
• Comm Communication type when calling Medical
  Control

26
The EMS Run Sheet

• Medications
• It is important to have a list of current
  medications and dose and frequency information
• If the patient supplies a list that can be left
  at the hospital, it should be stated in this
  section, (ex. 'see attached list' or list given
  to ED staff)
• If the patient does not have a list, and time
  allows, include the name of the medication, dose
  and frequency of use

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The EMS Run Sheet

• Nature of Call Complaint reported by dispatch
• Use the codes listed in the EMSIRS-2 Data
  Dictionary
• Use the code that is closest to the report from
  dispatch or as reported by the walk-in patient

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The EMS Run Sheet

• Primary Symptom The primary sign or symptom as
  related by the patient or observed by EMS
• Use the codes in the EMSIRS-2 Data Dictionary
• This is one of the four elements used to
  determine the EMS Reason for Encounter (RFE)

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EMS Reason for Encounter (RFE)

• Previous version only had one data element which
  was either too vague or too specific
• New version as defined by a national study
• Expanded to four data elements
• Presence of injury
• Primary symptom
• Anatomical location of complaint
• Organ system affected

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The EMS Run Sheet

• Other Symptoms Other related signs or symptoms
  as related by the patient or observed by EMS
• Use the codes in the EMSIRS-2 Data Dictionary
• This will enhance the accuracy of the EMS Reason
  for Encounter (RFE)

31
The EMS Run Sheet

• Destination Determination The reason EMS chose
  to transport or deliver the patient to the
  destination
• Closest Facility
• Diversion
• Family Choice
• Insurance Status
• Law Enforcement Choice
• On-line Medical Direction

• Other
• Patient Choice
• Patients Physicians Choice
• Protocol
• Specialty Resource Center

32
The EMS Run Sheet

• Factors Affecting EMS Delivery Barriers to
  patient care
• Developmentally impaired
• Hearing impaired
• Language
• None
• Physically impaired

• Physically restrained
• Speech impaired
• Unattended or Unsupervised
• Unconscious

33
The EMS Run Sheet

• Patient Disposition Type of disposition,
  treatment, or transport of the patient
• Cancelled
• Dead at scene
• No patient found
• No treatment required
• Patient refused care

• Treated and released
• Treated/Transferred care
• Treated/Transported by EMS
• Treated/Transported by LE
• Treated/Transported by private vehicle

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The EMS Run Sheet

• Trauma Criteria Reason the patient was
  transported to a trauma facility
• Will be one of the Trauma Triage Guideline
  criteria
• Refer to the EMSIRS-2 Data Dictionary

35
The EMS Run Sheet

• Injury Indicate whether there is an injury or
  not
• Yes or No
• This is one of the Reason for Encounter (RFE)
  elements

36
The EMS Run Sheet

• Mechanism of Injury General category of the
  cause of injury
• Refer to the EMSIRS-2 Data Dictionary

37
The EMS Run Sheet

• Protective Devices Safety equipment in use at
  the time of injury by the patient
• Child Restraint
• Eye Protection
• Helmet
• Lap Belt
• None
• Other

• Personal floatation device
• Protective clothing
• Protective gear
• Shoulder belt
• Unknown

38
The EMS Run Sheet

• Protective Devices Also can indicate if airbags
  deployed affecting the patient
• No airbag present
• No airbag deployed
• Airbag deployed front
• Airbag deployed side
• Airbag deployed other
• Not known

39
The EMS Run Sheet

• Primary Impression Most significant condition
  which lead to treatment
• Refer to the EMSIRS-2 Data Dictionary
• Secondary Impression Secondary condition which
  lead to treatment
• Refer to the EMSIRS-2 Data Dictionary

40
The EMS Run Sheet

• Run Type Record the level of care actually
  provided
• BLS, Emergency
• ALS Level 1, Emergency (Refer to EMSIRS-2 Data
  Dictionary)
• ALS Level 2, Emergency (Refer to EMSIRS-2 Data
  Dictionary)
• Specialty Care Transport
• Rotary Wing
• Not applicable (no patient contact)

41
The EMS Run Sheet

• DNR Indicate whether or not advanced directives
  were followed
• State EMS DNR form (DNR-CC or DNR-CC arrest)
• Other Healthcare DNR form
• Living will
• Family/Gaurdian request for DNR (w/o
  documentation)
• Other
• None

42
The EMS Run Sheet

• Vitals Initial B/P, Pulse and Respirations are
  required
• Record time signs checked
• Record SaO2, if monitored
• Record EKG, if monitored
• Record pupillary findings
• Record skin condition

43
The EMS Run Sheet

• Glascow Coma Score Required with every patient
• Eye Opening
• Verbal Response
• Motor Response

44
The Glascow Coma Score

• Adult

45
The Glascow Coma Score

• Child (2-5 years)

46
The Glascow Coma Score

• Infant(0-2 years)

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The EMS Run Sheet

• Narrative
• To be written by the primary care provider
• An explanation of patient assessment for signs
  and symptoms obtained through history,
  observation and patient examination
• A list of procedures and patient responses or
  changes as a result of treatment or other changes
  in condition while the patient is your care
• This is your record of what was found, what
  skills were performed and how the patient
  responded or changes that occurred.

48
The EMS Run Sheet

• Narrative
• Use appropriate medical terminology.
• Document all findings of your assessment, even
  those that are normal. (pertinent negatives)
• Whenever possible, quote the patient---or other
  source of information---directly.
• Use acceptable and approved abbreviations and
  acronyms.
• If you do not know how to spell a word,
  look it up or use another word

49
The EMS Run Sheet

• Narrative
• Never include slang, biased statements, or
  irrelevant opinions.
• Include only objective information.
• Subjective part of your narrative comprises any
  information that you elicit during your patients
  history.
• Objective part of your narrative usually includes
  your general impression and any data that you
  derive through inspection, palpation,
  auscultation, percussion, and diagnostic testing.

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The EMS Run Sheet

• SOAP
• Subjective
• Objective
• Assessment
• Plan

• CHART
• Chief Complaint
• History
• Assessment
• Rx (Treatment)
• Transport

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The EMS Run Sheet

• Narrative
• Any unusual circumstances
• The person writing the narrative must sign or
  initial it at the end.
• This is the most important portion of a report.
• IF YOU THINK IT NEEDS TO BE DOCUMENTED, DOCUMENT
  IT.

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The EMS Run Sheet

• HIPPA Disclaimer
• To be signed by the patient, acknowledging that
  they have been informed of their rights under
  HIPPA laws
• Refer to Departmental SOPs

53
The EMS Run Sheet

• Patient Treatments List each treatment or
  intervention given to the patient
• All therapy attempted should be listed
• If successful or unsuccessful
• Indicate unsuccessful if attempt failed
• Indicate time of treatment/intervention
• If measurable, indicate amount of the intervention

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The EMS Run Sheet

• Patient Treatments List each treatment or
  intervention given to the patient
• If applicable, indicate the route of
  administration
• List justification of therapy
• Standing Orders (SO)
• Emergency Department Physician (EDP)
• On-Scene Physician (OSP)

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The EMS Run Sheet

• Patient Treatments List each treatment or
  intervention given to the patient
• Indicate provider who administered therapy in
  int
• Refer to departmental procedures
• Recommended Number associated with provider from
  the Crew Members section
• List any complications to treatment or
  intervention

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The EMS Run Sheet

• Medications Given List each medication given to
  the patient
• Refer to the EMSIRS-2 Data Dictionary for the
  list of acceptable medications
• If a medication if given multiple times, list
  each administration separately
• Oxygen is a medication and should be listed here

57
The EMS Run Sheet

• Medications Complications Any abnormal effect to
  the patient from the medication given
• Refer to the EMSIRS-2 Data Dictionary for the
  list of complications
• No medication complication is acceptable

58
The EMS Run Sheet

• Intervention/Procedure Any procedures performed
  on the patient
• Refer to the EMSIRS-2 Data Dictionary for the
  list of procedures or intervention
• Vital signs are an assessment tool, not an
  intervention

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The EMS Run Sheet

• Intervention/Procedure Complications Any
  abnormal effect to the patient from the
  procedure/intervention
• Refer to the EMSIRS-2 Data Dictionary for the
  list of complications
• No complication is acceptable

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The EMS Run Sheet

• Drug/Alcohol Use Indicates the potential use of
  drugs or alcohol by the patient
• Smell of alcohol on breath
• Patient admits to alcohol use
• Patient admits to drug use
• Alcohol or drug paraphernalia at scene
• No indicators of alcohol/drug use
• Unknown

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The EMS Run Sheet

• Type of Injury Type of injury suffered by the
  patient
• Blunt
• Penetrating
• Burns
• Other

62
The EMS Run Sheet

• Anatomical Location Primary anatomical location
  of the chief complaint (This is
  a RFE element)
• Abdomen
• Back
• Chest
• Extremity-upper
• Extremity-lower
• General/Global/Whole body
• Genitalia
• Head
• Neck

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The EMS Run Sheet

• Organ System Primary organ system affected by
  the current injury/illness
• (This is a RFE element)
• Cardiovascular
• CNS/Neurologic
• Endocrine/Metabolic
• Gastrointestinal
• Global/Whole Body
• Musculoskeletal
• Obstetric/Gynecologic
• Psychiatric
• Pulmonary
• Renal
• Skin

64
The EMS Run Sheet

• Type of Dispatch Delay Cause of any delay in
  dispatching EMS. This info should be obtained
  from the dispatchers
• Caller (Uncooperative)
• High Call Volume
• Language Barrier
• Location (Unable to Obtain)
• No Units Available
• None
• Other
• Scene Safety (Not secure for EMS)
• Technical Failure
• Unknown

65
The EMS Run Sheet

• Type of Response Delay Cause of any delay in the
  response of EMS
• Crowd
• Directions
• Distance
• Diverted
• HazMat
• None
• Other
• Safety
• Staff Delay
• Traffic
• EMS Unit Involved in Vehicle Crash
• EMS Unit Vehicle Failure
• Weather

66
The EMS Run Sheet

• Type of Scene Delay Cause of any delays on scene
  that resulted in a longer scene time
• Crowd
• Directions
• Distance
• Diversion (Hospital)
• Extrication gt20 minutes
• HazMat
• Language Barrier
• None
• Other
• Continued

67
The EMS Run Sheet

• Type of Scene Delay Cause of any delays on scene
  that resulted in a longer scene time
• Other
• Safety
• Staff Delay
• Traffic
• EMS Unit Involved in Vehicle Crash
• EMS Unit Vehicle Failure
• Weather
• Not applicable

68
The EMS Run Sheet

• Type of Transport Delay Cause of any delays in
  the transport of the patient to the destination
• Crowd
• Directions
• Distance
• Diversion
• HazMAt
• None
• Other
• Continued

69
The EMS Run Sheet

• Type of Scene Delay Cause of any delays in the
  transport of the patient to the destination
• Safety
• Staff Delay
• Traffic
• EMS Unit Involved in Vehicle Crash
• EMS Unit Failure
• Weather
• Not Applicable

70
The EMS Run Sheet

• Type In-service Delay Cause of any delays in
  returning to service
• Clean up
• Decontamination
• ED Overcrowding
• Equipment Failure
• Equipment Replenishment
• None
• Other
• Staff Delay
• Vehicle Failure
• Not Applicable

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The EMS Run Sheet

• Cardiac Arrest Indicates cardiac arrest in the
  patient
• Yes, prior to EMS arrival
• Yes, after EMS arrival
• No

72
The EMS Run Sheet

• Cause of Cardiac Arrest Indication of the cause
  of cardiac arrest
• Presumed cardiac
• Trauma
• Drowning
• Respiratory
• Electrocution
• Other

73
The EMS Run Sheet

• Resuscitation Attempted Measures used to attempt
  to resuscitate the patient who was or is in
  cardiac arrest
• Attempted defibrillation
• Attempted ventilation
• Initiated chest compressions
• Not attempted-Considered futile/DOA
• Not attempted-DNR Orders
• Not attempted-Signs of Circulation

74
The EMS Run Sheet

• Response Mode to Scene Indicates whether or not
  lights and sirens where used enroute to the scene
• Initial lights sirens, downgraded to no lights
  sirens
• Initial no lights sirens, upgraded to lights
  and sirens
• Lights sirens
• No lights sirens
• Also to be used for the walk-in

75
The EMS Run Sheet

• Transport Mode from the Scene Indicates whether
  or not lights and sirens where used enroute to
  the destination
• Initial lights sirens, downgraded to no lights
  sirens
• Initial no lights sirens, upgraded to lights
  and sirens
• Lights sirens
• No lights sirens