TO: ALS, BLS and QRS services
RE: Patient Care Reports and Medical Command
FROM: Christopher J. Heile
DATE: November 7, 2006
Effective January 1, 2007, EMMCO West will be implementing some QI initiatives to help:
Ensure that Medical Command Physicians are filling out medical command forms for all case where medical command is sought
Monitor the flow of trauma patients for consistency with the trauma destination protocol
It is essential that several portions of the PCR be completed appropriately. If they are, that should cover most of the service’s part of the QI process.
We need to make sure that the medical command section of the PCR is filled out consistently. This is the only mechanism we have to verify that Medical Command Forms are being completed by physicians. EMMCO West is going to verify that the number of medical command forms completed by the hospitals match the number of times medical command is marked on the PCRs.
Here are some general guidelines for filling out the form, followed by some examples: General guidelines
If you perform skills within the ALS scope of practice, and do not specifically speak with medical command, mark Protocol
If you contact medical command for any reason, whether ALS or BLS, mark Cell, Radio or Phone.
BLS calls and BLS crews will almost always mark None Required.
If the ALS crew gets on board a BLS ambulance, the ALS crew should mark the medical command section and the BLS crew should leave their medical command section blank unless they specifically called medical command prior to ALS arrival.
Here are the different scenarios we have in the field:
An ALS ambulance responds, the paramedic does an assessment and transports the patient BLS. None required
A BLS ambulance is dispatched for a low acuity call and transports the patient BLS. None Required
A BLS ambulance responds to an emergency and calls medical command for a refusal or after patient assisted medication. Cell, Radio, or Phone Mark Protocol if you are unable to reach medical command for any reason following the procedure or medication.
An ALS ambulance responds, the ALS crew does an assessment and starts an IV, monitors the cardiac rhythm, give one round of medication x, and do not have to contact medical command because the patient is stable and/or the ambulance arrives at the hospital. Protocol
An ALS ambulance responds, the ALS crew does an assessment and starts an IV, monitors the cardiac rhythm. The ALS crew reaches the medical command line in the flow sheet and call medical command to give medication x. Cell, Radio, or Phone
An ALS ambulance responds, the ALS crew does an assessment and starts an IV, monitors the cardiac rhythm. The ALS crew reaches the medical command line in the protocol, cannot reach command via radio or cell because of location and give an appropriate medication that is listed in the flowsheet but is under the medical command line. Protocol
An ALS ambulance responds, does an assessment, starts an IV, and monitors the cardiac rhythm. The ALS provider reaches the medical command line in the protocol and says “I can’t believe I have to call command for this. I’m going to give this medication without contacting medical command.” . None (and a violation of the Act and Regulations)
A BLS ambulance is on scene. The ALS crew arrives and the paramedic calls medical command and releases care to the BLS crew. The BLS Crew marks None Required the ALS crew marks Cell, radio, or phone
Notes: If you are a BLS service in a county that has separate "ALS and BLS patches", and you are requesting medical command, request an ALS patch. The Command Facility ID should only be marked if you are marking Cell, Radio, or Phone. When functioning under protocol, leave the section blank because we have medical command authorization from a physician, not a facility.
Communications difficulty is a field in some software programs that is not captured by the state dataset. You may continue to use this field as long as some other field is filled out in accordance with the above guidelines.
The second project involves the designation of trauma patients. EMMCO West is going to use the research code to classify the trauma patients. Please mark the research code as follows:
0001 – Category 1 trauma patient
0002 – Category 2 trauma patient
0003 – Category 3 trauma patient
0004 – Patient that is extremely and critically ill or injured and requires transport to the closest receiving facility due to TRAUMA
0005 – Patient who is DOA due to TRAUMA
I have contacted the software vendors and this should not be a difficult transition:
QuickTrip for the Internet users will find the field available in the application shortly. QuickTrip users can replace a file called research.txt with an updated file. I can e-mail the file to services. It needs copied into the folder where QuickTrip is installed (generally quickt99). The values will then be available in the program. RAM Software users may enter the value into the software (0002 for example)Med-Media will be making this available for their users. EMS Charts may have this available before you receive this letter.
If you have any questions, feel free to contact me. QuickTrip users can e-mail me at firstname.lastname@example.org to get the replacement research.txt file.