Refusals
What is the minimum set of vitals you must obtain for a patient refusal?
Non-transports require a single set of vitals.
How do you post your report with the validation score below 95% so you can save your progress and work on the report from the desktop?
Click on the Post button then a pop up will appear, uncheck the box that says "Mark EMS Incident as Finished on Post." This will upload your report as is to the server so you may work on it later. This also prevents you from losing all of the information if your MDC crashes. Post Often!
Demonstrate how to check your Announcements to find important information from QA.
In the Image Trend Dashboard at the bottom of the screen you will see "Announcements". Select this and a screen will open and display all of the current announcements from QA. There often contain important updates or trends where we need to improve. The updates can be for both EMS and Fire reporting.
What federal law protects patient information from being disclosed without consent?
HIPAA - Health Insurance Portability and Accountability Act of 1996.
A patient is uncooperative and refuses to give you their name. How should this be documented in Image Trend?
In the name fields document their name as "Unknown" to satisfy the name requirements. Describe the patient in your narrative ex: Mid 30's causation male wearing a black hoodie and jeans.
What two critical elements must be documented to be legally complaint in the case of a refusal?
Capacity assessment (your physical and mental assessment of the patient) and risks must be explained to the patient.
Ex. You respond to a patient with chest pains and your ECG isn't normal. The patient refuses so you must explain that chest pains are not normal and they can lead to further complications up to the possibility of death.
On your MDC, start a report if you haven't already. Find the patient refusal checklist.
If you are unable to find it this is due to your disposition not being selected as "Patient Refusal." Once you select this disposition you will see the refusal module appear. This is due to a visibility rule.
Demonstrate downloading CAD into your report.
On the top bar of Image Trend you will see CAD with an arrow pointing down. Select this and a list of calls will populate on the next screen. Find your call then use the arrow pointing down to the far right of that call and it will pull the CAD info into your report.
You receive a subpoena at home for something related to work. What should you do?
Contact the QA Coordinator (Kelly Schaaf). The QA Coordinator will ask you to bring in the subpoena and will walk you through the steps as well as coach you on what to expect, things to say and not say.
How many providers must confirm a DOA?
For a DOA a minimum of 2 providers must confirm the DOA and the names of both providers that confirmed must be recorded in Image Trend. They can be recorded in the Cardiac Arrest module under Patient Encounter. The providers level of certification does not matter, it can be done by two BLS providers or any combination of EMS certification.
In a refusal, what must you document to show the patient had decision-making capacity?
This is made simple by using the Refusal Checklist. The patient must be:
Alert and oriented, risks explained, competent to refuse care, complications of refusal must be understood, advised they may contact 911 again if necessary
What is the correct way to document a patient's chief complaint?
In their own words using quotes. If they give you multiple symptoms use the most severe. Ex: Patient is having chest pains, a cough, recent fever, and sore from a fall they had yesterday.
Chief Complaint: Chest Pains
Additional symptoms can be documented in other fields but this is their Chief Complaint.
Ex: Patient says, I fell and heard a loud pop in my ankle.
Chief Complaint "I fell and heard a loud pop in my ankle"
Find the MRN (Medical Record Number) entry in Image Trend.
Hint: It is hidden behind an validation rule.
You must first set a transport disposition. Once you make the selection it is located under Patient Disposition>Hospital Information. It is the first selection at the top of the screen.
After you have completed your report, what is the maximum number of hours the State requires you to have them posted?
12 hours. After that your report will fail. QA will review it and if it is not completed by the review you will receive an email to complete the report as soon as possible.
You receive an email from QA that says your report needs to be corrected.
1: How do you access the report?
2: What if you can't find it?
3: What if it is Locked?
1: You can access the report through Image Trend Live/Desktop.
2: If you can't find it your name is likely not included in the Unit Personnel section. You will need to contact the person that worked on the report to include you.
3: If it is Locked, email any of us in QA or give us a call. We can unlock it quickly so you can get into it and make the corrections.
You respond on a call which results in a transport and the patient refuses to allow you to take a blood pressure. They state "The cuff hurts too much when it squeezes". Demonstrate where to document the patient refused this specific procedure.
Under Patient Disposition>Disposition Information. The fourth selection from the top is "Incident/Patient Disposition". In the drop down there is a selection for "Transport with Refusal of Treatment/Procedure." Selecting this will open the Refusal module. Enter the Refusal Checklist and scroll to the bottom, you will find "If Applicable, List Specific Items Refused." Here you can also obtain the patients signature.
How many and which signatures are required for all transports?
2 signatures are required.
AIC MUST sign all of their reports
Transfer of Care signature. This can be obtained from the person you turn the patient over to or if the patient was sent to triage, have the triage nurse sign.
Your validation score is below 100% and you want to correct your report. Name two different ways to identify the problem.
The areas that need attention will be RED. Once you find the area that needs attention there will be an "!" next to the area. If you click on the "!" it will tell you why it is still red. The other way is to click on the validation score at the bottom of your report. This will show a list of areas that need attention. To go directly to the area that needs attention select the arrow next to the are you want to work on. (Helpful Hint: Remember your "Timeline" in the upper right corner of your report and your search bar in the upper left)
What is the difference between a public assist and a patient refusal?
A public assist is a call that has zero medical complaints. Ex. You respond to an elderly patient that needs transferring from their recliner to their wheelchair. You handle the transfer for them and patient has no complaints.
If the patient fell or indicates they have ANY medical complaint then it is a patient refusal. WHEN IN DOUBT FILL IT OUT!
Provider writes: "No Injuries noted"
Patient refused a full assessment (maybe they were irritable, intoxicated, or just didn't want anyone touching them).
You only got vitals and a quick look-over but did not do a head-to-toe.
Why is this a problem? What is the better way to document this situation?
No injuries noted implies that you did an assessment. Don't ever document something you did not do. Instead simply write exactly what happened.
Ex: Upon arrival patient was irritable and crews suspected ETOH on board due to multiple alcohol bottles open in the room with the patient. Patient admits to alcohol use in the last two hours. Patient would not allow crews to do an assessment, all assessments are based on basic observations and information received only.
This would be an HPI and you can list assessments based on what you observed. Such as patient has unlabored breathing and able to speak in full sentences. You can get this information by simply speaking to them.
If the patient refuses and is in need of further evaluation/care you can begin the process of an ECO. Safety first, if HPD isn't there call for them. Contact your EMS supervisor and/or the OMD. Search for "Emergency Capacity Evaluation" or go to Patient Disposition>Disposition Information and scroll to the bottom. This opens the "Emergency Capacity Evaluation" module. This is similar to the refusal check list. Simply answer the questions in these fields. Your supervisor will assist with the rest including the DC-491 form.
You are on Ambulance 306 and need to complete a Unit Report. Demonstrate how to do this in Image Trend.
On the left menu column at the very bottom is NFIRs.
Select "EMS Call [with or without transport]."
Select "Yes" to "Are you the Primary Unit require dot complete the Fire Report?"
Go to Fire Incident
In the bottom right corner select "Apparatus"
Complete the Unit report by making sure that the Unit Personnel is listed properly and include a short narrative such as "EMS call with one patient transported."
You respond to a patient with stage 4 cancer because their breathing has become shallow. The patient has a valid DNR and the family has given it to you. The patient passes in your presence and you honor the DNR. Other than selecting "Reason for not initiating CPR" as "Valid DNR or Approved Alternative" what is the best way to prove you had a valid DNR? Demonstrate your answer
The number one way to protect yourself and prove you had a valid DNR in hand is to have a picture of it in Image Trend. To take a picture use the hamburger menu at the bottom of your report and select Attachments>Add New>Document Type=DNR>Take Photo.
You and your engine crew respond with Tuckahoe Volunteer Rescue Squad. The call is for a minor cut on the patients arm and TVRS says they will handle patient care and transport. Who must do a report?
State EMS regulations and VA Code 32.1-116.1, each separate EMS agency whose members have patient contact shall complete an ePCR.
You respond to a call where the patient says "He was strangling me". Find the correct protocol. Also why is it important to spend time with this type of call?
Strangulation/Choking etc...
Located in Handtevy
Protocol = Quick Reference>EMS Strangulation S&S Form
In the state of Virginia strangulation/choking is considered attempted murder.