Harbor:Screening EMS Patients

EMS: Screening Ambulance Patients

ALS & BLS Direct to triage (2/5/18)

• ALS or BLS patients with the following:
  • Stable Vital Signs
    • T 36-38C
    • HR 60-100
    • SBP 100-210, DBP 60-120
    • RR 12-20
  • Ambulatory
  • Cleared by Charge RN
  • If your patient meets all 3 criteria, take them directly to the physician in triage
• Charge RN must:
  • Quick-register the patient AND
  • Use the Pre-Hospital template to enter:
    • VS
    • EMS unit
    • Brief statement about patient being stable and ambulatory to triage

Patients not meeting "Direct to Triage" criteria

• AED Charge:
  • Quick-registers patient
  • If clearly needs to stay AED and Room Available
    • Place in room
    • Assign to appropriate team (purple/green) based on room
    • Notify Senior Resident via Spectralink that EMS is waiting to give report
    • Hold EMS personnel until physician arrives (30 min max)
  • If no rooms available, alternate assignment to Purple or Green (for screening) while EMS waits at the wall
    • Notify Senior Resident via Spectralink that EMS is waiting to give report
    • Hold EMS personnel until MD arrives (30 minute max)
  • Once patient screened by senior resident
    • If assigned "AED" by screening MD, place patient in next available room (patient will stay with the screening team regardless of geographical room assignment)
    • If assigned "Triage" by screening MD, take patient to triage for physician in triage to perform MSE

• Senior Resident:
  • Regardless of whether patient is in room or on wall, respond to request to screen as soon as is reasonably possible (to avoid keeping EMS too long)
    • Take EMS report
    • Release ALS personnel (Paramedics -- BLS may have to stay until patient in room)
  • If the patient is in the hall and after brief evaluation appears stable for triage/WR, discuss with your attending
    • If attending agrees, then use .edambutriage note but do NOT click the "MSE"
      • Revised .edambutriage : This patient was brought in by EMS for ___. I initiated the medical screening exam and feel the patient is stable to go to triage at this time. The patient is ambulatory, vital signs are stable, and they will have their MSE continued by the provider in triage. I discussed the case with Dr. ____ who agrees with this plan.
    • Write "Triage" in the RN Comments column
    • These patients will then go to team triage for MSE & RN triage, financial screening, tasking, then location based on the triage provider's notation in the RN Comments column

• MICN
  • ALS Arrivals ONLY
    • Download and print 2 copies of ePCR (aka EMS Report Form)
    • Place stickers on them
    • Leave 1st copy with patient’s RN
    • Give 2nd copy to clerk

Chappell 1/31/18

See Also

• Harbor:Operations manual