NEW Run Sheet Training Information

To be used starting 1 April 2006

February 2006

The EMS Run Sheet

• Revised to comply with EMSIRS-2 Data Elements

• All shaded areas are required by the State for reporting

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

The EMS Run Sheet

• EMD: Was Emergency Medical Dispatching performed?

– Yes, with Pre-arrival Instructions

– Yes, with no Pre-arrival Instructions

– No

The EMS Run Sheet

• MCI: Was the event a Mass Casualty Incident as defined by county or local standards?

– Yes

– No

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)

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 L&D– Other EMS provider (air)– Other EMS Provider (ground)– Other

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

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

The EMS Run Sheet

• Outcome: The outcome or result of the prior care provided

– Improved– Worsened– Unchanged– Unknown

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

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

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

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

The EMS Run Sheet

• Name: Patient’s name (refer to departmental procedure)

• Address: Patient’s address – City– State – Zip Code

• Sex: Patient’s gender – Male– Female– Unknown

The EMS Run Sheet

• Race: Patient’s race

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

The EMS Run Sheet

• Ethnicity: Patient’s ethnicity

– Hispanic or Latino– Non-Hispanic or Latino– Unknown

The EMS Run Sheet

• Phone: Refer to departmental SOPs

• Pt ID Number: Refer to departmental SOPs, usually patient’s 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)

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

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

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– Worker’s Compensation– Unknown

The EMS Run Sheet

• Date of Birth: Patient’s date of birth

– If you know the patient’s 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

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

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.

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

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

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

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)

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:

1. Presence of injury2. Primary symptom3. Anatomical location of complaint4. Organ system affected

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)

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– Patient’s Physician’s Choice– Protocol– Specialty Resource Center

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

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

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

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

The EMS Run Sheet

• Mechanism of Injury: General category of the cause of injury

– Refer to the EMSIRS-2 Data Dictionary

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

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

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

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)

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

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

The EMS Run Sheet

• Glascow Coma Score: Required with every patient

– Eye Opening

– Verbal Response

– Motor Response

The Glascow Coma Score

• Adult

Eye opening

Spontaneous 4

Responds to verbal stimuli 3

Responds to painful stimuli 2

No response 1

Verbal Response

Oriented 5

Confused 4

Inappropriate words 3

Incomprehensible words 2

No response 1

Motor Response

Obeys commands 6

Localizes Pain 5

Withdraws from pain 4

Flexion 3

Extension 2

No response 1

The Glascow Coma Score

• Child (2-5 years)

Eye opening

Spontaneous 4

Responds to verbal stimuli 3

Responds to painful stimuli 2

No response 1

Verbal Response

Oriented 5

Confused 4

Inappropriate words 3

Grunts, garbled speech 2

No response 1

Motor Response

Obeys commands 6

Localizes Pain 5

Withdraws from pain 4

Flexion 3

Extension 2

No response 1

The Glascow Coma Score

• Infant(0-2 years)

Eye opening

Spontaneous 4

Responds to verbal stimuli 3

Responds to painful stimuli 2

No response 1

Verbal Response

Coos, babbles 5

Irritable cry, consolable 4

Cries to pain 3

Moans to pain 2

No response 1

Motor Response

Normal movement 6

Withdraws to touch 5

Withdraws to pain 4

Flexion 3

Extension 2

No response 1

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.

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…

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 patient’s 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.

The EMS Run Sheet

CHARTChief ComplaintHistoryAssessmentRx (Treatment)Transport

SOAP

Subjective

Objective

Assessment

Plan

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.

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

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

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)

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

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

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

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

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

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

The EMS Run Sheet

• Type of Injury: Type of injury suffered by the patient

– Blunt

– Penetrating

– Burns

– Other

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

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

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

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

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 >20 minutes– HazMat– Language Barrier– None– Other

Continued…

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

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…

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

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

The EMS Run Sheet

• Cardiac Arrest: Indicates cardiac arrest in the patient

– Yes, prior to EMS arrival

– Yes, after EMS arrival

– No

The EMS Run Sheet

• Cause of Cardiac Arrest: Indication of the cause of cardiac arrest

– Presumed cardiac– Trauma– Drowning– Respiratory– Electrocution– Other

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

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”

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