Medical Incident Report Form Education Module for 2011

Medical Incident Report Form Education Module for 2011 Refresher Course Prepared by the Division of Emergency Medical Services

Education Module Goals • Refresh EMS personnel on why the Medical Incident Report Form (MIRF) is important • Update EMS personnel on changes to the 2011 MIRF

Education Module Contents • Basic information & general instructions • Aftercare Instructions Highlight • 2011 MIRF changes

Basic Information & General Instructions

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

Why is the MIRF is Important (continued) • Quality Review – Agency and system-wide • Planning/Funding – Medic unit placement, levy funding • Research – Resuscitation Outcome Consortium (ROC) – Aftercare Instructions Pilot Project

Components of a Good Report • Completeness – All availableinformationregarding the incident or patient care should be recorded. • Accuracy – Describe exactly what happened. • Correct spelling • Legibility (on paper forms)

Components of a Good Report (continued) • Narrative: use S. O. A. P format: – Subjective – Objective – Assessment – Plan

Basic Instructions • An electronic recordis 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) formshould complete a form for every call/incident.

Paper MIRF Pages • Agency copy • EMS copy • Medical Review copy • Patient copy • Aftercare Instructions: The backer provides health information to patients.

Completing the MIRF The person who provided primary care should: • Sign your name • Printyour name • Write your EMS number

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.

Aftercare Instructions Highlight

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 APPLICABLEboxes: • • • Patient was Not Transported Low Blood Sugar Information High Blood Pressure Information Falls Community Resources Information

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.

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

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

Aftercare Instructions Highlight (cont. ) • Once the appropriate boxes on the backer have been checked, tear the sheet at the perforation and give to the patient. • Be sure to enter the same information into your record management system (for electronic agencies).

2011 MIRF Changes

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

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