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)
–
–
–
–
Physician (MD or DO)
Student
Other Healthcare Provider
Other non-healthcare provider
Others: Personnel on-scene not listed above or not providing care (Police)
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.
2.
3.
4.
Presence of injury
Primary symptom
Anatomical location of complaint
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
Eye opening
• Adult
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
Eye opening
• Child
(2-5 years)
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
Eye opening
• Infant
(0-2 years)
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
CHART
Chief Complaint
History
Assessment
Rx (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