Image Trend Elite Job Aid

Version 2.0 12/1/2017

Contents I. PURPOSE ..................................................................................................................................... 4 II. STATEMENTS ............................................................................................................................... 4 III. CHARTING PROCEDURES .............................................................................................................. 4 1. Charting on the “FIELD” version of Image Trend gives you the option to enter crew names for the entire shift or per incident. .................................................................................................................. 4 2. Select “New Incident” .................................................................................................................. 5 3. Import Computer Aided Dispatch (CAD) information .................................................................... 5 4. Incident Information .................................................................................................................... 6 5. Import your vital signs from the Zoll Monitor ............................................................................... 7 6. Patient Info and History ............................................................................................................... 8 7. Vitals-Lab-Rad .............................................................................................................................. 8 8. Exam and Specialty Info ............................................................................................................... 9 8. Interventions ............................................................................................................................. 10 9. Narrative ................................................................................................................................... 10

Narrative Example: ..................................................................................................................... 11

Power Tools and Situation Tools ................................................................................................. 13

Charting Intubation Procedures .................................................................................................... 15

Charting Interventions/Procedures Not Found With a Power Tool .......................................... 16

Charting Prior to Arrival (PTA) Interventions ................................................................................ 16

Charting Lab Values/Radiology Results not Found With a Power Tool .......................................... 17

10. Impressions-FollowUp................................................................................................................ 17 a. Impression ................................................................................................................................. 17 b. Follow up ................................................................................................................................... 17 11. Signatures .................................................................................................................................. 18 a. Signatures .................................................................................................................................. 18

Finishing the Chart.............................................................................................................................. 18

1. Validation Scores ................................................................................................................... 18

2. Save and Post ......................................................................................................................... 18

3. Attaching documents .............................................................................................................. 18

Appendix .............................................................................................................................................. 20

Standards for Physical Assessment ..................................................................................................... 20

Adult .......................................................................................................................................... 20

Pediatric .................................................................................................................................... 21

Neonatal .................................................................................................................................... 22

Obstetrical assessment .............................................................................................................. 23 Items that need to be documented per procedure: ............................................................................. 23

Advanced airway........................................................................................................................ 23

Chest tube ................................................................................................................................. 24

Escharotomy .............................................................................................................................. 24

Intra-aortic Balloon Pump (IABP) ................................................................................................ 24

Needle Thoracostomy ................................................................................................................ 24

NG/OG tube insertion ................................................................................................................ 25

Pacing ........................................................................................................................................ 25

PA Catheter ............................................................................................................................... 25

Pericardialcentesis ..................................................................................................................... 25

Pigtail insertion .......................................................................................................................... 26

Vascular Access .......................................................................................................................... 26

Arterial line ................................................................................................................................ 26

Central venous access ................................................................................................................ 26

Intra-osseous needle placement ................................................................................................ 26

Peripheral venous catheter ........................................................................................................ 26

Umbilical Artery Catheter insertion ............................................................................................ 26

Umbilical Vein Catheter insertion ............................................................................................... 27

Image Trend Elite Job Aid

I. PURPOSE A. The purpose of this job aid is to provide a consistent level of guidance and

explanation for all Indiana University Health LifeLine team members in regards

to the required standard for clinical charting and documentation.

II. STATEMENTS A. Overview: The Image Trend Elite Job Aid was developed to set a minimum standard

for expectations in transport charting for all LifeLine crew members. This document

is not intended to be all inclusive due to the fact that every patient clinical condition

and procedure cannot be determined. It is the expectation that all LifeLine clinical

crew members strive to document a complete record of patient care provided.

B. This job aid is subject to change as the Image Trend EPCR continues to be developed.

Changes will be communicated and this job aid updated as warranted.

C. Information highlighted in red is considered a required field and will lower the final

validation score which may prevent chart closure.

D. Throughout the document tips and hints are denoted in Italics as Notes

E. The Image Trend EPCR has been formatted to default to chart settings that will hide

fields that are not relevant based on certain parameters. For example: The neonatal

fields will be hidden from view if the patient is over the age of 6 months OR

Obstetrical fields will be hidden on all male patients. This option can be over-ridden

if necessary.

III. CHARTING PROCEDURES 1. Charting on the “FIELD” version of Image Trend gives you the option to

enter crew names for the entire shift or per incident.

a. If you are going to be in the same unit with the same crew all day you may add the crew information here

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b. If you are on the WEB version or are likely to change vehicles or crew follow the steps below to add crew members to the chart.

2. Select “New Incident” a. From the incident page you will see

“Show full chart” at the bottom. This

feature customizes the visible fields to

coincide with the run type. You may

choose to view all charting fields by

choosing “yes”. The feature defaults to “no”.

3. Import Computer Aided Dispatch (CAD) information

**Note: CAD information is subject to availability of information and must be checked for

accuracy. CAD information can only be changed in the Flight Vector Program. Any

changes made to CAD information in the Image Trend Elite document will be over-ridden to

the original CAD information if imported multiple times.

a. Information imported includes:

i. Incident number

ii. Dispatch priority

iii. Incident/Patient Disposition

iv. Mileage

v. Dispatch known times

1. Note…Arrived-Patient time will need to be entered by the crew.

vi. EMS Vehicle (Unit) Number

vii. Response Mode to Scene

viii. Primary Role of the Unit

ix. Vehicle Dispatch Location

x. Scene Location Name, incident address, and GPS location

xi. Destination Name and address (if known)

xii. Patient Name, gender, and date of birth

b. Information imported should be checked for accuracy

c. Any required field that is not populated by the import should be completed by the

crew

d. Fields that appear highlighted in red require

manual data entry and must be completed to

complete the chart (see below)

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4. Incident Information a. Incident

i. Incident Number

ii. Emergent or Non-emergent

1. Lights and sirens, whether used or not has no

bearing on whether or not the transport was

emergent vs non-emergent.

iii. Type of Service

1. Scene (911), interfacility, Intercept

iv. Incident/Patient Disposition

1. Transport mode

2. Treated and not transported

3. Refusal

v. Dispatch Complaint (needs to

be completed)

b. Unit

vi. EMS Call Sign (Team)

vii. Response Mode

1. Lights and sirens, whether used or not has no bearing on whether

or not the transport was emergent vs non-emergent.

viii. Type of Response Delay

ix. Primary Role of the Unit

1. Ground vs Air

x. Level of Care

1. BLS/ALS/CCT

c. Crew

xi. Click “+Add” to add a crew member

xii. Each must be added separately

d. Scene

xiii. Check CAD information for accuracy

xiv. Incident Location Type must be entered by the

crew

e. Transport Info i. Transport mode From Scene

1. For the most part this will be “No Lights

& Sirens”

2. This has no bearing on Emergent VS

non-emergent in the incident information tab

ii. How patient was moved to ambulance/aircraft

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1. Defaults to stretcher

2. Change if necessary

iii. Position of patient during transport

iv. Transport delay

1. If applicable. If no delay in transport click not applicable

v. EMS Transport Method is required

vi. Transport Details

1. Click “+Add” to add the

details below

2. Ambient Temp

3. Flight

a. Altitude

b. Hearing Protection

f. Destination address

xv. Check CAD information for accuracy

xvi. Reason for choosing destination (diversion, Closest, Etc…)

xvii. Type of destination required (Hospital inpatient, ECF, etc…)

xviii. Unit Type is where you actually took the patient. (PICU, NICU, OR,

etc…)

5. Import your vital signs from the Zoll Monitor e. Only events recorded in the Zoll will be transferred.

i. HR, NIBP, SPO2, Temps taken with the temp probe, Waveforms

f. Items associated with the vital signs will need to be entered manually

i. Open the vital sign to be altered by clicking on the arrow in the timeline

1. The BP cuff and pulse oximeter placement will need to be added to

the first set of vital signs only unless moved.

2. Pain scales

3. Glascow Coma Scales (GCS)

4. Correct any incorrect vital signs imported with the data

5. Correct/delete any waveforms imported with the data

ii. Or you may open the vital signs from the left side

by clicking on the

and add information there.

iii. Enter any missing items. You

may also enter comments into

the comments box

iv. You may also enter your vital signs manually using the vitals

power tool.

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6. Patient Info and History *Note…Based on dispatch information not all fields pictured above will

populate unless you click “Show full chart” from the incident page

a. Patient info

1. Check CAD information for accuracy

2. Age is required

i. To calculate patient age. Click inside the Date of Birth box and click

out of it. The age will auto calculate

3. Weight

b. Past Patient History

1. Begin typing the patient history in the “medical/Surgical History” box

2. The program will take you to that condition on the list for selection

3. Pertinent negatives (not applicable, unresponsive, etc) can be find by clicking

the symbol.

c. Medications/Allergies

1. Process is the same as above

2. NKA can be found by clicking the symbol

d. Neo/Fetal History

1. Fill fields in as appropriate

e. OB: CCT/HROB and OB/Delivery: ALS/BLS

1. Separate tabs based on level of service provided. If you are charting under

“full chart” be sure to click the correct tab

2. Fill in the known information

f. Closest Relative

1. Fill out if known information

7. Vitals-Lab-Rad a. It is preferred to document lab values and diagnostic test results using the powertools

(explained below)

b. Imported vital signs that have required items missing (pain scores, etc…) will be

marked by

a. Click in the vital sign box with the to see the missing fields (outlined in

red)

i. GCS will autocalculate based on your selections

ii. Isolette temp is documented here

iii. Patient temp and method are charted here

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8. Exam and Specialty Info a. Exams

1. Click on the “+Add” button to add an exam

2. Choose the correct assessment type from the list

i. Primary Neonatal

ii. Primary Adult/Pediatric

3. Information defaults to “normal” values.

Uncheck the items that are in need of changing by clicking the next to

that item. Then choose the correct assessment from the pick list

4. Each assessment item has a

“Details” box associated with it.

Enter the specifics of the assessed

item in this box.

5. Certain assessment details require

the boxes to be opened to chart the assessment items

i. Eye

ii. Spine

iii. Abdomen

iv. Extremities

**Note: An assessment is not considered completed until all systems are addressed

b. Focused exams

1. Used for assessments that have changed or for repeat assessments of a

single system or medical device

i. can be entered by clicking the “+Add” button and choosing the

appropriate exam

c. Other exam options

i. Trauma (only visible if you click Possible Injury

“yes”)

a) Used for any traumatic injury patient.

b) Mechanism of injury, injury factors and trauma center

criteria are state reporting factors and aid in data mining

c) Shock index

information is required

ii. Cardiac Arrest (only visible if you

click Cardiac Arrest “yes…”

a) You may choose prior to

arrival or after arrival.

iii. MVC (Only visible if you click Possible Injury “yes”)

a) Covers the details of any motor vehicle accident

iv. Obstetrics (Should only appear for an OB patient)

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a) Currently in development. There is a text box in this field

so that a narrative of the obstetrical assessment can be charted

here.

b) The HROB RN will be the primary charter in this field.

c) Refer to the appendix to see the minimum standards for OB

assessment

8. Interventions a. In most cases, information found in these fields is easily charted

with a powertool. See Powertool section below.

b. Should any of these fields appear highlighted

in red it means there is a required element

missing. This field must be completed to

complete the chart

9. Narrative- follow the format below

**Note: The narrative is not intended to be where the whole of the charting is completed. It

is intended to be a summary of the call. The specific details of the transport need to be

documented in the body of the chart under the appropriate searchable heading.

2. Paragraph 1 a. Dispatch to Arrival at Bedside (HPI in Golden Hour)

i. Asset/Team, Sending Facility (including unit), Receiving Facility (including unit)

ii. Patient Diagnosis at time of dispatch i. List any emergent/time sensitive procedures required (Cath lab,

surgical procedure, etc…) iii. Indication for mode of transport and level of care iv. Patient’s History of Present Illness

i. Reason for transport (medical necessity) ii. Associated Signs/ Symptoms

iii. Pertinent past medical history (Relevant to what is going on now)

b. Paragraph 2 1. Arrival at Bedside to Loading in Asset for Transport 2. Initial/Doorway Assessment (general impression/pertinent overview) 3. Medical Management at Sending Facility/ Scene

a. Patient presentation(impression including degrees and limits of function) b. Prior to arrival treatments

i. Medications, procedures, lab work, radiology ii. Please provide quotations when relevant to care

c. Paragraph 3 1. Care given during transport 2. Treatments to be continued during transport. (IV drips, Vent, etc…) 3. Interventions and care provided during transport

a. Titrations

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b. Medications given c. Procedures completed d. Ventilator changes

d. Paragraph 4 1. Unloading at Destination to Safe Hand-Off 2. Report and safe hand-off given with time of patient care hand-off

a. Medication reconciliation note

Narrative Example:

CCT Adult

LL2 dispatched to Reid ED to transfer a 73 year old male patient diagnosed with a SAH to IU Methodist.

CT head w/o contrast reveals SAH in right cerebral hemisphere and “large acute right subdural

hematoma with 2 cm left shift”. Sending physician requests air transport due to critical nature of illness, management of vasoactive medications, management of mechanical ventilation and the need for rapid

transport for specialty neurosurgical services not available at Reid.

Per sending RN report, patient struck his head on a ‘’coffee table’’ post fall at approximately 0300. Wife describes progressive level of altered consciousness throughout the day with marked changes to left arm

motor function. Treatment prior to arrival of the transport team included Intubation and autovent, NG,

foley catheter, and 2 PIVS: noted with Propofol infusion. Staff had previously administered 10 mg of vitamin K and 8 mg Zofran IVP prior to arrival. Unit 1 of FFP was being administered upon arrival.

Patient is currently prescribed Coumadin therapy.

Patient was transported directly to IU Methodist OR without incident. Point of Care labs obtained and

ventilator changes made. Medications, therapies and FFP continued during transport.

Transfer of care and full verbal report to RN, MD, and OR team at bedside. Medication reconciliation performed. ETT placement confirmed by CRNA at bedside. Safe hand off complete at 0215.

CCT NEO

LifeLine G12 requested to transport the above patient from Union Hospital in Terre Haute NICU to Riley

Children’s Hospital NICU for previously undiagnosed transposition of the great vessels. Pt was born to a

G1 now P1 mother at 39+4 via spontaneous vaginal delivery. At birth patient’s apgars were 6 at 1 minute

and 8 at 5 minutes. Patient was initially placed skin to skin with mother when nurse and mother noticed

patient appeared to by cyanotic. At 1 hour of life patient was taken to the NICU. Upon arrival in the

NICU. Patient was placed on a pulse oximeter and found to have an Spo2 of 70%. Pt was placed on 5l of

VapoTherm. An IV was placed on the R hand and D10 was initiated. A CXR was done. CBC, BMP, and

blood cultures were sent. Upon assessment a murmur was auscultated and an echo was ordered. The

echo showed transposition of the great vessels. At this time a UVC placed and PGEs were started at .05

mcg/kg/hr. Due to the need for surgical invention, cardiology services, and higher level of NICU care

G12 was requested to transport patient with NNP.

Upon arrival to bedside, patient found to have IV sl and UVC with D10 and PGEs running. Pt on monitor

in warmer. Patient remains on 5L VapoTherm with no evidence of apnea noted.

Pt resting throughout transport. Fluids maintained and infusing through UVC. Point of Care labs

obtained. Patient remains on 5L heated high flow. Pt remained nested and belted throughout transport.

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0630 Transfer of care and full verbal report to RN, MD, RT, and NNP. Fluids transferred to unit alaris

pump. IV and UVC remain intact. Patient placed on opti-flow 5L 40%. Parents called and notified of

arrival.

Transfer ALS

ALS Unit 110 called to Small Hospital ED to transport a patient to Methodist ED. Care and report received from Becky RN. Pt presented 2 hours prior to request for transfer to sending facility ED from

home with complaint of acute onset chest pressure without known Hx of CAD. Evaluation in ED found

patient to have anterior STEMI on 12 lead with elevated troponin levels. Pt being accepted in Methodist ER by Cardiology, invasive cardiac cath not available at sending facility. Pt requires ALS ambulance

transport for continuous monitoring, management of vasoactive medication and rapid transport for

invasive cardiology procedure.

At time of ALS assessment patient found reclined in ED bed 6 is a 55 y/o M complaining of mild chest

pain. Care prior to arrival included nitroglycerine infusion, IV’s x2, Morphine, Lovenox and baby ASA.

Continuous ECG monitoring and NTG Infusion continued during transport. Repeat 12 lead ECG identified STEMI. NS Lock flushed, is patent. O2 therapy maintained via NC. Zofran and Fentanyl

administered for c/o continued chest pressure and nausea during transport.

Pre-arrival report called. No orders requested or received. Pt assisted to Methodist ED bed. Care and

verbal report to Megan RN at bedside.

Scene Call BLS

BLS Unit 101 called for a 911 response to a residence for a patient with injuries from a fall. The husband of the patient called 911 for his wife when she complained of hip pain from a ground level fall. Pt

reported that she was attempting to feed the family cat when she slipped and fell onto the kitchen tile

floor. Pt was unable to get up from the floor and the husband was unable to assist her. No care was

provided prior to EMS arrival. Patient requires transport to the closest facility with emergency

orthopedic capabilities.

At time of BLS assessment, 68 y/o female patient found supine on the floor inside the home in mild

distress and discomfort. Patient denies loss of consciousness, is confused but is able to localize pain and

express complaints. L Lower ext is notably shortened compared to the R. Pt pelvis/hip secured with

immobilizer.

Pt transported to the closest appropriate facility with ortho facilities available in position of comfort,

semi-fowlers with blanket/pillow supporting splint. Pt condition was without changes during continued

BLS monitoring. Pre-Arrival report called. At Hospital ED, pt lifted with staff assistance to bed. Care

released with verbal report given to Becky RN at bedside.

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Power Tools and Situation Tools **Notes: The intent of a power tool is to group items together into one field. These

are items that would be found in multiple places in the charting system but have

been grouped together for ease of use. EXAMPLE: Each item on a Chem 7 would

have to be entered individually from the Vitals-Lab-Rad tab on the left side of the

chart or you could use the Labs power tool and enter them all in one place. Saving

time spent charting.

** Situation tools group powertools together. These items are grouped together to

facilitate charting commonly used items. EXAMPLE: ALS/BLS situation tool lists

items commonly charted by this service line

**Note: Each power tool has a comment box to chart details of the intervention being charted.

a. Commonly used Power Tools

i. Charting Events

a. Events (formerly known as the event log)

ii. Charting Medical Control

a. Control Co (any time medical control is contacted)

iii. Charting Vascular Access

a. Vascular Access (IVs, arterial lines, central lines, IO, RIC, etc)

b. UA/UV lines

iv. Charting Medications

a. Med-Single

b. Med-Drip

c. Pain and sedation (has a repeat last option)

v. Charting Blood products

a. Blood- (PRBC, Whole blood, Platelets, FFP)

vi. Charting advanced cardiac care items

a. IABP set ( settings-Frequency, trigger, insertion site)

b. IABP vital (ADP, pulses)

c. Pacing (external), internal is in development

d. 12 lead

vii. Charting Labs

a. Labs (Chem 7, CBC)

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b. Lab-CG4+ (ABG, lactate)

c. Lab-CG8+ (ABG, NA, K, iCa, Glucose, Hgb, Hct)

vi. Charting Airway

a. Airway (OPA, NPA, airway suctioning, foreign body removal,

airway opened)

b. Airway PTA (ALL existing advanced airways…ETT, Trach,

King airway, etc)

c. RSI Situation tool. See below

vii. Charting ventilator information

a. Vent set (settings the patient is placed on for transport and any

changes made during transport)

b. Vent round (every 15 minute vent rounds- PIP, Pplat, VTE,

minute volume, etc)

vii. Charting interventions associated with trauma

a. pericardialcentesis, needle thoracostomy, escarotomy, Spinal

immobilization, pelvic sling, burn care, tourniquets

b. Situation tools-

1. Group Powertools together

2. Clicking on any box in a situation tool will take you to that

power tool. Once complete with that item click OK to be

taken back to the situation tool home page

i. Critical Care

ii. Peds/Neo

iii. ALS/BLS

iv. RSI

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Charting Intubation Procedures

RSI Situation Tool

Situation tools group power tools together. The RSI situation tool brings all of the items in the power tools and procedures lists necessary to chart the RSI into one tool.

You may chart advance airway attempts using this tool regardless of the use of medications to assist intubation.

o LMA, King Airway, combitube, ETT, etc.

The procedure is as follows: a. Open the situation tool

i. Each item available to chart during an RSI attempt will appear as an option

Medications, preoxygenation, intubation, confirmation, OG/NG tube insertion

ii. Click each to chart the information pertaining to that option.

** Note: Clicking “OK” when done with each option will return you to the Home page for the

RSI situation tool so that you may continue to chart your procedure.

**Note: There is no reason to click the RSI situation tool more than once. You may chart

multiple attempts/medications/airway interventions all from this one tool.

Each one will have a date/time box and crew member option so that you can chart who did what, in what order and at what time.

Multiple attempts at intubation can be charted here by selecting the intubation option multiple times and documenting the time/crew

member and the details associated with each procedure. Each attempt

requires its own individual procedure note including the reason for

unsuccessful placement/complications.

If a rescue device is placed that can also be charted under the intubation option and selecting the

appropriate device.

iii. Items not covered in the pick lists can be documented in the “Comments” box. iv. When the airway intervention documentation is complete.

You should be on the home page for the RSI situation tool.

By clicking “OK” from this page you will have completed

your Airway intervention charting.

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Charting Interventions/Procedures Not Found With a

Power Tool

Note: If there is no power tool for an intervention (Chest tube/pigtail insertions,

transvenous pacing-internal, etc) it needs to be charted under the “Interventions” tab from

the left side of the chart. You will find them in the pick list. Details for these procedures

can easily be charted in the

comments box.

Charting Prior to Arrival (PTA) Interventions

Many interventions are in place when the transport crew arrives.

While these items need to be mentioned in the narrative as to their existence PTA, the details associated with their care and maintenance during the transport need to be

documented using either the power tools or the Interventions/procedures tab. This allows for items continued/maintained during our care to be searchable/trackable for

reporting purposes.

The procedure is as follows:

EXAMPLE existing peripheral IV

a. Locate the appropriate power tool Vascular access b. Click “Yes” in the PTA yes/no box

i. This should default the crew name to not required. ii. If a name is required you may choose “*Provider*Provider” from the pick

list

iii. Date and time should default to not required for PTA items c. Fill in the appropriate information

i. Items not covered in the pick lists can be documented in the “Comments” box

EXAMPLE existing advanced airway

a. Locate the appropriate power tool Airway PTA a. Click “Yes” in the PTA yes/no box

i. This should default the crew name to not required. ii. If a name is required you may choose “*Provider*Provider” from

the pick list

iii. Date and time should default to not required for PTA items b. Fill in the appropriate information

i. Items not covered in the pick lists can be documented in the “Comments” box

ii. Remember to chart 3 methods of airway confirmations on all existing advanced airways.

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Charting Lab Values/Radiology Results not Found With a

Power Tool

Lab values and radiology reports that are relevant to the patient care can be entered from

the left side of the chart if not found in the power tools.

The procedure is as follows:

a. Click “+Add”

b. Click on the LAB or Rad option

c. Click PTA Yes of performed prior to arrival or No if the item was performed

during transport

d. Select the item resulted from the pick list and enter the value resulted

e. Click “OK”

10. Impressions-FollowUp a. Impression

i. Primary and secondary impressions

i. Mandatory items and are charted from the pick list

ii. Multi-level list

1. You may click in the box and begin typing to find your

primary impression from the list OR

2. Click on the list icon to find the multilevel list

a. This list will appear on the left hand side of the

chart

b. Click on the appropriate item to be taken to a list of

items associated with that

ii. Chief complaint organ system

i. chart from the pick list

**Note: Primary Impression is linked to ICD-10 codes and is mandatory to close the

chart. Primary symptom is subjective and is not necessary to close the chart.

**Primary symptom is not the same as primary impression. Please fill in all known fields

b. Follow up i. To be completed on every CCT transports

ii. Click “+Add”

iii. Write the person spoken with and the phone number in the comments box

iv. AHC transports

ii. Chart “Immediate follow up un-necessary, AHC transfer” in the

comment box

v. Return transports

iii. Chart “Immediate follow up un-necessary, return transport” in the

comment box

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11. Signatures a. Signatures

i. Click “+Add”

ii. Click the appropriate signature

iii. Sign in the box and click “OK”

iv. Both crew members must sign the chart

Finishing the Chart

1. Validation Scores

a. Validation scores exist to manage “close call rules”

b. A validation score of

IV. CROSS REFERENCES L04-095 Documentation Requirements

Vairkko online learning tool for Image Trend Documentation

V. REFERENCES/CITATIONS Centers of Medicare Chapter 10

- Medicare Benefit Policy Manual Chapter 10 – Ambulance Services Centers of Medicare Chapter 15

- Medicare Claims Processing Manual Chapter 15 - Ambulance Indiana State EMS Commission

- Levels of EMS Personnel Certification

X. RESPONSIBILITY LifeLine Program Director and Medical Directors

XI. APPROVAL BODY LifeLine Director and Medical Directors

XII. APPROVAL SIGNATURES Approved By:

___________________________________ ______________

Cory Hall EMTP, RN Date

Director, LifeLine

XIII. DATES Approval Date:

Effective Date:

Revision Dates:

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Appendix

Standards for Physical Assessment

Adult a. Skin

i. Temperature ii. Edema

iii. Moisture iv. Cap refill v. Injury/abnormality

b. Neurological i. Mental status

ii. Level of consciousness c. HENT

i. Head (injury/abnormality, pain) ii. Face (injury/abnormality, pain, stability)

iii. Eyes (PERRL, Pupil size, injury/abnormality) d. Respiratory

i. Effort ii. Sounds

iii. Equality e. Cardiovascular

i. Rate ii. Rhythm

iii. Murmur iv. Pulses

f. Neck/Spine i. Injury/abnormality

g. Abdomen i. Bowel sounds

ii. Abnormalities iii. Pain

h. Extremities i. Injuries

ii. Pain iii. Sensation iv. Circulation v. Movement

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Pediatric a. Skin

i. Temperature ii. Edema

iii. Moisture iv. Cap refill v. Injury/abnormality

b. Neurological i. Mental status

ii. Level of consciousness iii. Age appropriate iv. Tone

c. HENT i. Head (injury/abnormality, pain)

ii. Face (injury/abnormality, pain, stability) iii. mouth iv. Eyes (PERRL, Pupil size, injury/abnormality) v. Fontanelle for

Neonatal j. General

i. Responsiveness ii. Distress

iii. Movement of extremities k. Eyes l. HENT

i. Fontanelle ii. Ears

iii. Characteristics of gestational age iv. Oral mucosa v. Palate

vi. Lips vii. Molding of sutures

m. Neck n. Respiratory

v. Effort vi. Sounds

vii. Equal viii. Muscle use

o. Cardiovascular v. Rate

vi. Rhythm vii. Murmur

viii. Pulses p. GI

i. Bowel sounds ii. Appearance

iii. Umbilical cord iv. Abnormalities v. Anus exam

vi. Liver q. GU

i. Appearance ii. Parts as per gender

r. Musculoskeletal i. Spine

ii. clavicles iii. digits

s. Integumentary i. Skin (color, appearance, deformities)

t. Neurologic i. Tone

ii. Reflexes

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Obstetrical assessment (all of the assessments for an adult patient +) a. Gestational age of fetus b. Estimated date of confinement c. Gravida/Para status d. Presence of prenatal care e. Reported pregnancy complications f. Signs of fetal well being

a. Fetal movement b. “reassuring” toco strips if available c. Fetal heart rate

g. Last known vaginal exam results

a. Cervical dilation and effacement

h. Current contraction frequency and intensity

i. Deep tendon reflexes if on a magnesium infusion

Items that need to be documented per procedure:

**Note: all procedures performed by LifeLine personnel need to have an

indication for and any complications resulting from the procedure documented

** Note: All procedures performed by LifeLine personnel must have the outcome

of the procedure documented. (ie: IV site flushes easily without swelling, pain or

redness) Advanced airway

a. Cricothyrotomy i. Identification of landmarks

ii. Length of midline incision iii. Tube size and type iv. Adjuncts used for placement (bougie) v. Tube securement device (tape, trach ties, etc…)

vi. Presence or absence of crepitus vii. Reason for aborted attempt. Clear documentation of why attempt was

unsuccessful

b. Intubation i. Oxygen saturations before and after the procedure

ii. The lowest oxygen saturation documented DURING each attempted intubation

iii. Blade type and size iv. ETT size and depth v. Visualization of the airway structures

vi. 3 Methods of tube placement confirmation vii. Method of tube securement

viii. Reasons for an aborted attempt. Clear documentation of why the attempt was unsuccessful

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c. King LT i. Size and depth of insertion

ii. Amount of air placed in the device to achieve a good seal iii. Ease of ventilation iv. Method of tube securement v. Reasons for aborted attempt. Clear documentation of why the attempt was

unsuccessful

Chest tube a. Insertion

i. Tube size ii. Skin prep

iii. Incision made over the fifth rib for insertion into the 4th and 5th intercostal space

iv. Tube securement (sutures, tape, etc…) v. Amount and type of drainage

vi. Documentation of chest seal device (Heimlich valve or chest drainage system) a. Existing

i. Chest tube size ii. Location

iii. Depth (if known…if not it is appropriate to document that no holes are visible upon inspection)

iv. How is the chest tube secured v. Drainage system intact and connections secured with tape

vi. Water seal intact vii. Presence or absence of an air leak

viii. Tidaling (fluctuation) in the water seal with spontaneous respirations ix. Drainage type, color, amount upon arrival and at hand-off x. Amount of suction applied and that the suction was continued throughout

transport

Escharotomy a. Location for incisions b. Length and depth of incisions c. Presence of bleeding/drainage

Intra-aortic Balloon Pump (IABP) a. Catheter type, size and location b. Insertion site condition and dressing c. Circulation to affected extremity d. Waveform analysis (waveforms need to be printed and attached to the chart)

i. Inflation/deflation e. Timing f. Trigger g. Full auto or semi auto h. Absence of evidence of blood in the helium tubing

Needle Thoracostomy a. Location b. Site preparation

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c. Catheter size and type d. Air/Blood/Fluid escaped

NG/OG tube insertion a. Tube type and size b. Insertion location c. Method of tube securement d. Tube depth e. Confirmation methods (Air bolus, aspiration of stomach contents, etc.) f. Type, amount and color of aspirate g. Placed to low intermittent suction or clamped

Pacing a. External

i. Underlying rhythm ii. Pad placement

iii. Rate iv. Energy setting v. Electrical and mechanical capture

b. Internal pacing (Epicardial wires) i. Site condition

ii. Number of wires iii. Unused wires are insulated iv. Mode (AV sequential or VVI) v. AV interval (Usually 150ms and only for dual pacing modes)

vi. mA vii. Rate

viii. Sensitivity (Demand or Asynchronous) ix. Underlying rhythm

c. Transvenous i. Catheter size and location

ii. Site condition and dressing type iii. Pacing wire insertion depth iv. Mode (Dual or Single channel) v. AV interval (Usually 150ms and only for dual pacing modes)

vi. mA vii. Rate

viii. Sensitivity (Demand or Asynchronous) ix. Underlying rhythm

PA Catheter a. Introducer size and location b. Site condition and dressing c. PA catheter depth at patient contact and at hand-off (55 cm is normal for an adult) d. Connected to transducer system e. Waveform analysis (waveforms need to be printed and attached to the chart)

Pericardialcentesis a. Skin prep b. Location for insertion

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c. Amount and type of draining removed (If applicable) Pigtail insertion

d. Skin prep e. Catheter size f. location g. Sterile technique used h. Tube securement (sutures, tape, etc…) i. Amount and type of drainage j. Documentation of chest seal device k. Chest xray interpretation post procedure

Vascular Access a. Arterial blood draw

i. Pulse quality (palpable or not) ii. Catheter size and type

iii. Location of insertion iv. Allen’s test v. Pressure held for 5 minutes if unsuccessful (or for an ABG, one time

draw)

vi. Circulation to affected extremity post procedure

Arterial line i. Catheter size, type and location

ii. Site condition and dressing iii. Sterile technique used (for insertion) iv. Circulation to affected extremity v. Connected to transducer system

vi. Waveform analysis (waveforms need to be printed and attached to the chart)

Central venous access (including PICC, TLC, DLC, cordis introducer) i. Catheter type and location/number of lumens

ii. Insertion site condition and dressing iii. Which port is infusing what

Intra-osseous needle placement i. Needle size

ii. Insertion location iii. Methods of confirmation or correct placement iv. Securement device

Peripheral venous catheter i. Catheter size and type

ii. Location of insertion iii. Site condition and dressing iv. Presence or absence of swelling/redness

Umbilical Artery Catheter insertion i. Catheter size and depth

ii. Site condition/selection iii. Sterile technique used iv. Method of securement v. Lower extremity circulation

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vi. Connected to transducer system vii. Waveform analysis (waveforms need to be printed and attached to the chart)

Umbilical Vein Catheter insertion viii. Catheter size and depth

ix. Site condition/selection x. Sterile technique used

xi. Method of securement xii. Lower extremity circulation

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