Prepared by the Division of Emergency Medical Services

1. Medical Incident Report Form Education Module for 2011 BLS 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 • Aftercare Instructions Highlight • 2011 MIRF dataset

4. Basic Information & General Instructions

5. Why the MIRF is Important • Medical • The MIRF (both electronic and paper) is part of the patient’s medical file. • The MIRF transfers information between patient care providers. • Legal • Confidentiality • Patient Refusal • MIRF Signature

6. Why the MIRF is Important (continued) • Quality Review • Planning/Funding • Medic unit placement, levy funding • Research • Resuscitation Outcome Consortium (ROC) • Aftercare Instructions Pilot Project

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 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. REVISED!

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 • Low Blood Sugar Information • High Blood Pressure Information • Falls • Community Resources Information REVISED! NEW!

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. • Falls NEW!

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. 2011 MIRF Dataset • Incident Data (in alphabetical order) • Patient Data (in alphabetical order)

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

20. 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

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

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

23. Incident Data (cont.) • Initial (Incident) Dispatch Code (IDC) • Location Type • Outside Agency Incident Number • Property Use (NFIRS) • Reporting Agency Number • Reporting Unit ID Number • Responding from Quarters • Responding in Fire District Code

24. Incident Data (cont.) • Response Delay Type • Response Mode • Treatment Crew Member Name

25. Patient Data (Cont.) • Action Taken • Allergies • 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

26. Patient Data (Cont.) • Flow Chart Time Blood Pressure Pulse Rate Respiratory Rate ECG Rhythm* Oxygen* Pulse Oximetry Glucometry IV fluids (liters) - ALS ONLY DC Shock/AED Used Medications

27. Patient Data (Cont.) • Flow Chart (cont.) ECG Rhythm 01 Sinus Rhythm 02 Asystole 04 Other 11 Ventricular Fibrillation U0 Unknown

28. 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

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

30. Patient Data (Cont.) • Highest Level of Care Provided • Mass Casualty Incident • Medical Facility Contacted Name • Medical Person Contacted Name • MIRF Number

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

32. 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

33. Patient Data (Cont.) • Patient Mechanism Code (refer to the electronic pick list) • Patient Medications Taken at Home • Patient Parent or Legal Guardian • Patient Suspected Alcohol or Drug Use • Patient Type Code

34. 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 • Treatment Crew Member Number for Procedure

35. Patient Data (Cont.) • Safety Equipment • Signature of Person Completing Form • Transport Agency Number • Transport Delay Type • Transport Destination • Transport Unit Number

36. 2011 MIRF Changes

37. Incident Type (NFIRS) Incident Type coding has been revised over the past few years. Here are some highlights of the current coding: 3117 - EMS call, Cancelled at Scene 3119 - EMS call, Unintentional medical alert activation 3214 - EMS call, Vehicle accident with no injuries (use if you want to create a patient record) 3127 - EMS call, Flu-like symptoms 324 - EMS call, Vehicle accident with no injuries (standard NFIRS code-patient record not allowed) 6113 - EMS call, Dispatched & cancelled enroute

38. Medical Incident Report Form Education Module for 2011 BLS THE END Prepared by the Division of Emergency Medical Services Prepared by the Division of Emergency Medical Services