Incident

Response

✏️Incident Number: This will be the ACAD Trip # 🔎
✏️Run Number: this will be the ACAD Trip #
- 🛑Each patient will have a separate trip number
☑️Run Type:
- 911 Response – If Dispatched by ACSD or ACAD for an emergency call
- Medical Transport – Returns
- Mutual Aid – If we respond to a call outside our area per a request
- Public Assistance/Other Not Listed – Other
- Emergency Interfacility transport – If we ever have an emergency transfer
☑️Priority:
- Emergent – Make immediate preparations to handle the call.
- Non-Emergent – Scheduled runs
- ~~Emergent Downgraded to Non-Emergent~~ – (Don’t Use)
- ~~Non-Emergent upgraded to Emergent~~ – (Don’t Use)
☑️Response Mode Descriptors: (Optional Field)
☑️Shift: Choose the shift you are currently working
☑️Unit: Truck License #
☑️Units Level of Care: (Level of crew on the truck not level of care given)
- BLS-Basic / EMT (Choose if 2 EMTS are the crew)
- ALS-Paramedic (Choose if crew member is ALS)
  - 🛑 It doesn’t matter what the call is, even returns, are ALS if a medic on board.
☑️Vehicle: Truck License #
☑️EMD Complaint: Choose best choice based on actual dispatch complaint
✏️EMD Card: This is the card based on ACAD Dispatch Protocols
☑️Responding From: Pick the best zone from the choices 🔎
☑️Requested by: Do your best
☑️First Unit on Scene: Are you the First EMS unit from ACAD on scene (Ambulance)

Scene

Predefined: Common Addresses that are entered in already
- When you choose predefined, you choose a location type, then you will get a list of choices from the drop down.
Address: Enter in the actual address yourself If you use predefined, then the next choice of Location Type will give you the predefined choices. If you use address, then you must choose your own location type.
☑️Location Type: (When choosing Predefined above)
- (Can Change so check often)
  - Home/Residence
    - Catalpa
    - Park Avenue Apts
    - White Oak Manor
    - A few “Loyalty Customers” are listed
  - Nursing Home
    - Laverna
    - Shady Lawn
  - Street or Highway (No predefined choices – use manual entry)
  - Police/Jail
    - Andrew County Sheriff’s Department
  - Hospital
    - Mosaic Life Care – St. Joseph
    - Mosaic Life Care – Maryville
  - Place of Business (No predefined choices – use manual entry)
  - Public Building (No predefined choices – use manual entry)
  - Industrial Place (No predefined choices – use manual entry)
  - Doctor’s Office /Clinic
    - Northwest Health
    - SSM Health
  - Place of Recreation / Sport
    - BJ Skate Center
    - Camp Geiger
    - Duncan Hills Golf Course
    - Duncan Park
    - Messick Park
    - Savannah Youth Sports Complex
  - Lake, River, Ocean (No predefined choices – use manual entry)
  - Mine / Quarry (No predefined choices – use manual entry)
  - EMS Provider (Air) – Air services
  - EMS Provider (Ground) – Ground Services
  - Other Specified Place – (No predefined choices – use manual entry)
    - Use when nothing else fits
  - Military Base – (No predefined choices – use manual entry)
  - School
    - Local Schools listed
- Try predefined first. Then check the list. If your choice is not on the list choose regular address and manually enter in the address.
✏️Location Type: (When choosing Address above)
- ✏️Location Name: (Business name)
- ✏️Address: Correct address of the location of pickup
- ✏️Apt/Suite/Room: Use as needed
- ✏️City
- ☑️State
- ✏️Zip
- 🛑 You can use the magnifying glass to look up zip and county
- 🛑 If you get a wrong county and can’t erase, click predefined and then address above again and it will clear it all.
☑️Zone: Pick the best zone from the choices. 🔎
☑️Mass Casualty: (Optional)

Personnel

☑️Add Crew
- Choose Crew Member from staff and press EDIT
- Press Edit Button to bring up “Edit”
- ☑️Role:
  - Driver: Who drove to the destination
  - Lead: Main attendant & responsible for the report
  - Other: an others who rode in the ambulance at any time to drive or help with patient care.
- ☑️Personal Protective Equipment
  - Choose all appropriate
☑️Add Non-Crew
- ✏️First Name: Their first name
  - 🛑When typing in the first name of the First Responder you need to put in parentheses (FIRE) or (POLICE)
- ✏️Last Name:
- ☑️Affiliation:
- ☑️Role
- ☑️Personal Protective Equipment
  - Choose all appropriate
🛑Anyone riding in the ambulance when its moving is a member of the crew.
🛑People who provide care and not ride should not be listed as a crew member.

Disposition

☑️Disposition
- Transported No Lights / Siren* – L&S Not used at any time on the way to destination
  - ☑️Transport Mode Descriptors: (Optional)
    - Transport method: Select Best Choice
    - Transport Due to: Select Best Choice (Closest Facility best choice usually)
  - ☑️Transport Method
  - ☑️Transport Due To
    - 🛑Use “Closest Facility” whenever possible – Best Choice
- Transported Lights / Siren* – L&S Used at some time on the way to destination
  - ☑️Transport Mode Descriptors: (Optional)
    - Transport method: Select Best Choice
    - Transport Due to: Select Best Choice (Closest Facility best choice usually)
  - ☑️Transport Method
  - ☑️Transport Due To
    - 🛑Use “Closest Facility” whenever possible – Best Choice
- Patient Refused Evaluation/Care (Without Transport)*- Refusal
  - ☑️Reason for Refusal: Select Best Choice
- Patient Treated, Transferred Care to Another EMS professional*
  - ☑️Transport Method
  - ☑️Transport Due To
    - 🛑Use “Closest Facility” whenever possible – Best Choice
  - ☑️Transferred to: Select Best Choice
  - ☑️Transferred Unit: Select
    - 🛑Use this for transferring to BLS Truck
- Patient Dead on Scene – Resuscitation Attempted (without Transport) – Called On scene
- Patient Dead on Scene – No Resuscitation Attempted (Without Transport) – DOA
- Standby Public Safety, Fire, or EMS operational Support
- Cancelled (Prior to Arrival on Scene) – Cancelled before you make it to the scene
- Cancelled on Scene/No Patient Found – Use this for no patient found once on scene or as an example accidental set off of medic alert button (Or cat did it)

Destination

🛑Destination works exactly like scene. 🛑Hospital is the default picked.

Chart #: This is the number given by the hospital (Optional at Present Time)
Patient #: (Not Used)
Trauma Registry: (Not Used)
Request Review: (Not Used)

Times

☑️Press Set Times Button to set times
Call Received: Unless noted otherwise, use the dispatched time
Dispatched: Enter Time
En Route: Enter Time
On Scene: Enter Time
At Patient: Enter Time
Depart Scene: Enter Time
Call Closed: Available Time
☑️Dispatch Delays: None unless you happen to know of one
☑️Response Delays: If > 4 min mark all that apply
☑️Scene Delays: >30 min mark all that apply
☑️Transport Delays: if delays are encountered; mark all that apply
☑️Turn Around Delays: > 20 min; mark all that apply

Mileage

💡You can use the google maps button, but make sure it is within a mile or so of what you have written down.
Scene: On Scene mileage
Destination: Mileage at Destination

Additional

☑️Additional Agencies: List all Agencies on the Scene; ACAD EMS Command (899) if on the call
☑️Additional Responders: List all Applicable
- If Ambulance Director on scene then mark 899 unless rides into hospital, then make a member of the crew.
- Make sure to list First Responding Departments.
  - Only list Savannah First Responders if you call them out. Not if they just show up unannounced.
✏️Additional Comments: Any other comments
- 🛑This field does not print on the Report

Patient

Demographics

✏️First Name: Enter First Name of Patient 🔎
✏️Middle Name: Enter Middle Name of Patient
✏️Last Name: Enter Last Name of Patient 🔎
✏️Social Security Number: Enter Social Security # of Patient 🔎
✏️Date of Birth: Enter Birth date of Patient
- 🛑Try to import patient… That way we don’t make a bunch of patients we have to merge
✏️Weight: Enter Weight of Patient
☑️Gender: Choose the best choice
☑️Race: Choose the best choice
☑️Ethnicity: (Optional)

Contact

✏️Address 🔎
- Includes Address, Apt/Suite/Room, City, State, Zip, and County
✏️Phone Number 🔎
✏️Driver’s License (Optional)
✏️Physician Last Name: Enter if you know it
✏️Physician First Name: Enter if you know it
☑️Advanced Directive: (Optional) unless a DNR situation

History

☑️Fill in as many choices as applicable 🔎
🛑If something is not listed, choose “Other” and edit comments
🛑Do not use “UTO” unless you actually can’t obtain the information, then choose a reason.

Allergies

☑️Fill in as many choices as applicable 🔎
🛑If something is not listed, choose “Other” and edit comments
🛑Do not use “UTO” unless you actually can’t obtain the information, then choose a reason.

Medications

☑️Fill in as many choices as applicable 🔎
🛑If something is not listed, choose “Other” and edit comments
🛑Do not use “UTO” unless you actually can’t obtain the information, then choose a reason.

Belongings

☑️Fill in as many choices as applicable

Vitals

Top Line
- TIme & Date: Make sure they are correct
- AVPU: 🛑Required for any Blood Pressure Taken
- Side:🛑Required for any Blood Pressure Taken
- Position:🛑Required for any Blood Pressure Taken
- 1 AVPU minimum
Blood Pressure
- If you record a blood pressure Method should be marked.
- 🛑2 Sets of Vital Signs on Transports 🔎
  - If you do not get 2 sets on a transport, reason should be documented in narrative
- 🛑1 Set of Vital signs on Refusals 🔎
  - If you do not get a set of vitals on a refusal, documentation of refusal of vital signs should be in the narrative of the report.
Pulse
- If you record a pulse, you should mark the Rhythm and Strength
Respiration
- If you record a Respiration, you should mark Quality and Rhythm
SPO2/ETCO2/CO
- If you record a SPO2 you should mark whether on O2 or not.
Temp/Glucose
- If you record a temp, you should mark Temperature Method.
- Possible Septic, fever, or infectious disease patient’s should have a temp
- Glucose should be recorded in numbers unless meter reads “High” or “Lo” then those should be selected.
- Glucose on all acutely altered patient’s and seizures/strokes.
Scoring
- 1 GCS is required on every patient.
ECG
- Type, Rhythm, and MI Suspected should be completed
- EKG strips attached or imported 🔎
- If you use a 4 lead and a 12 lead there should be a strip for each.
Pain Scale
- Record at least 1 per patient.

Flow Chart

Treatments that occur Prior to Arrival (PTA) should NOT be listed in the treatment section of the flow chart. Those treatment done PTA should be listed in the Narrative of the report in the HPI area.
Each box clicked will open a screen with choices to pick from.

Airway

Oxygen
CPAP
Suction
Orotracheal Intubation
ETI Verification
King Airway
Manual Airway
NPA
OPA
Heimlich maneuver
Magill Forceps
Pleural Decompression
Surgical Cricothyroidotomy

Critical Care

ALS Assessment –Required by QA 🔎

Defib / Cardio / Pace

Mechanical CPR
CPR
Manual Defibrillation
Cardioversion
Pacing
Vagal maneuvers
CPR Discontinued
AED Defibrillation

IV Therapy

IV Therapy
IV Bolus
Intraosseous

Medications

All the meds we use

Other

Ice Pack
Nasal Clamp
Scoop Stretcher
Stretcher – Required by QA 🔎
12 lead
Stair chair
General Comment
Transport Alert – General contact when not other alerts applicable 🔎
STEMI Alert 🔎
Stroke Alert 🔎
Trauma Alert 🔎
C-Spine Clearance
Spinal Motion Restriction
Splint Fx/Dislocation
Bleeding Control
Burn Care
Irrigation
Sling/Swathe
Bandaging
Taser Barb Removal
OB Delivery
Tourniquet
Traction Splint
Patient Restraint – This is not cot straps, but rather restraining a violent patient
Warming
Helmet Removal
Consult – medical control contact separate from transport alert

Provider / Response / Complication are required on all flow Chart choices

Assessment

The assessment area is an area to be very cautious of. It is easy to mark things on this assessment area and then contradict your assessment or even history of present illness.
The Initial Assessment is required. The Ongoing Assessment is not required.
If you don’t select something in the categories below, they will show on your report as “Not Assessed”
You can use the positive and negatives section and also need to use the Anatomical Model for any trauma.
There is a comment section for each section but really most comments should be in the Narrative of the report.

Mental Status
Skin
HEENT
Chest
Abdoment
Back
Pelvis
Extremities
Neurological

Narrative

Clinical Impression

☑️Primary Impression
- Pick the choice for the situation. If there is absolutely nothing that matches, use “Need for continuous medical supervision”.
☑️Secondary Impression: Optional
☑️Protocol Used: The main protocol you used to treat your patient
☑️Chief Complaint System: (Choose Appropriate)
☑️Medical/Trauma: (Choose Appropriate)

Supporting Signs/Symptoms

QA will look to make sure you have supporting symptoms listed
Max of 5 – Please use all applicable
- Abdomen and Digestive System
  - Abdominal Distention; Abdominal rigidity; Abdominal tenderness; Abdominal tenderness – rebound; Aphagia; Ascites; Belching; Colic; Constipation; Diarrhea; Fecal incontinence; Gastric ulcer; Gastritis; GI Hemmorhage; Heartburn; Hematemesis; Indigestion; Jaundice; Nausea; Nausea and vomiting; Projectile vomiting; Rectal bleeding; Vomiting
- Allergic Reaction
  - Allergic urticaria (hives); Food allergy; Big list of drug types for possible reactions
- Behavioral/Emotional State:
  - Anxiety or worries; Auditory hallucinations; Combative or violent behavior; Depression; Emotional Stress; Excessive crying; Hallucinations; Homicidal ideations; irritability and anger; nervousness; Restlessness and agitation; Slowness and poor responsiveness; Suicidal ideations; visual hallucinations
- Burns
  - Many body sites listed
- Cardiovascular
  - Anemia; Atrial fibrillation; Automated implantable cardiac defibrillator; Bradycardia; Cardiac arrest; Cardia arrhythmia; Chest pain (cardiac); Essential primary hypertension; Hypotension; Orthostatic hypotension; Palpitations; Presence of cardiac pacemaker; ST elevation MI; Tachycardia; Ventricular fibrillation
- Childbirth
  - Review as needed
- Cognitive Functions and Awareness
  - Altered mental status; Alzheimer’s disease; Confusion/disorientation; Dementia; Drowsiness; Intoxication; TIA
- Convulsion/Seizure
  - Absence, partial, Grand Mal seizure; Convulsion; Febrile Seizure; Generalized seizures;
- Generalized Symptoms
  - Accidental poisoning; Aphasia; Chills (without fever); Dehydration; Diaphoresis; Edema; Fatigue; Fever; Hemorrhage/bleeding; hypothermia; Malaise; Migraine head; Slurred speech; Syncope and collapse, Vertigo, Weakness
- Genitourinary
  - Abnormal uterine and vaginal bleeding; Dysuria; Excessive urine; Hematuria; urinary incontinence;
- Injuries
  - Many Choices
- Metabolic
  - Hyperglycemia; Hypoglycemia
- Neuro-Musculoskeletal
  - Abnormal involuntary movements; Contracture; Cramp and spasm; Facial droop; Fasciculations/twitching; Lack or coordination; Repeated falls; Tremor
- No Patient Complaint (Should be very rare)
- Obvious Death
  - Decapitation; Decomposition; Dependent Lividity; Rigor mortis; Severe Traumatic injuries
- Other
  - You type what you want
- Pain
  - Abdomen – (LLQ) (LUQ) (RLQ) (RUQ) pain; Abdominal pain – acute; Abdominal pain – generalized; Anterior chest – wall pain; Headache; Hip pain; pain (unspecified); many other specific pains listed
- Paralytic Syndromes
  - Hemiplegia; Monoplegia; paralysis; Paraplegia; Quadriplegia
- Respiratory
  - Acute respiratory distress; Apnea; Chest pain on breathing; Choking; COPD; Dyspnea; Hiccough; Hyperventilation; Nosebleed/epistaxis; orthopnea; Shortness of Breath; Snoring; Stridor; Tachypnea; Wheezing
- Shock (All are diagnosis and should be avoided)
- Skin
  - Burning/prickly/tingling sensation of skin; Cyanosis; Flushing; Hives; Itching; Numbness; other skin changes; Pallor; Pressure ulcer; Rash; swelling/mass/lump; Urticaria
- Somnolence
  - Coma; Somnolence; Stupor or Semicoma; unconsciousness
- Weight/Food Intake
  - Abnormal weight gain; Abnormal weight loss; Anorexia; Overweight; Polydipsia
There are a few more choices in most categories, but these should be the basic one we use.

Patient Complaint

✏️Chief Complaint
- What the patient tells you.
✏️Duration of Chief Complaint / Unit: Fill in the duration
✏️Secondary Complaint: (Optional)
✏️Duration of Secondary Complaint / Unit: (Optional)
☑️Patient Activity: Choose all that are applicable
☑️Patient Level of Distress: Choose the best choice
☑️Anatomical Location: Choose the best choice

Injuries

☑️Was the Patient Injured?
- If “No” is chosen all fields in this section remain closed and you can move to next section
☑️Primary Injury: Choose the best choice
☑️Injury Details: Choices will change based on the Primary Injury you chose above.
☑️Place of Injury: Choose the best choice
✏️Date of Injury: Enter date

Factors Affecting Care

☑️Barriers to Care: Choose the one that affected care the most or none
☑️Alcohol/Drugs: Choose the best choice
☑️Pregnancy: if yes, you will have to fill the OB form out

Patient Transport

☑️How was patient moved TO ambulance – Choose the best choice
☑️How was patient moved FROM ambulance – Choose the best choice
☑️Patient position during transport – Choose the best choice
☑️Condition of patient at destination – Choose the best choice

Narrative

The narrative section is explained in detail on the Narrative Page

Forms

Acute coronary Syndromes: Use if Chest Pain
Advanced Airway: Use if ET
Cincinnati Stroke Scale: Use if CVA / TIA
Burns: Use if Burns
CPR: Use if Cardiac Arrest
Motor Vehicle Collision: All MVC
Obstetrical: OB or Pregnant patient
Spinal Immobilization Screening Tool: Trauma of any kind
CDC 2011 Trauma Guidelines: Trauma
Outbreak Screening

Billing

Do Not Use Anything in This Section!

Signatures

Note: This section is for Electronic signatures, which is the preferred method.

Billing Authorization (Patient Signature)

Section 1 (Patient Physically Able to Sign)
- ☑️Notice of Privacy Practices Provided marked yes (Because you did)
- ☑️Billing Authorization marked Yes
- ☑️HIPAA Acknowledgment marked Yes on both questions
- ✏️Patient Full Name Typed (Relation if a parent only)
- ✏️Patient Signature (Parent if minor)
- 🛑All signatures should have a witness – Crew may witness this
- ✏️Witness Printed Name
- ✏️Witness Address (ACAD is fine if a staff member)
- ✏️Witness Signature
Section 2 (Patient Unable to Physically sign and a Representative is willing)
- ✏️Mark Privacy Practices Given
- ☑️Mark the category of Authorized Rep that is signing
- ✏️Reason patient is unable to sign
- ✏️Printed Name of the Authorized person
  - 🛑Relation or Title needs to follow Printed Name
- ✏️Signature
Section 3 (Patient Unable to Physically sign and no Rep is present)
- EMS Personnel Signature
  - ✏️Reason patient is unable to sign
  - ✏️EMS Personnel Printed Name
  - ✏️Signature of EMS Personnel
- Facility Representative
- ☑️Mark Notice of Privacy Practices
- ✏️Title of Representative
- ✏️Printed Name of Representative
- ✏️Signature of Representative

Provider Signatures (Crew)

Choose provider from from dropdown
Sign in the box
This will automatically put in credentials
All ACAD Staff list must sign!

Receiving Signature

Receiving Signature
- ✏️Print receiving persons Full Name and Title
- ✏️Have them sign in the box
Acknowledgement of Paperwork Received (Optional)
- ✏️Print receiving persons Full Name and Title
- ✏️Have them sign in the box
Airway Confirmation (Only for Field Intubations)
- ✏️Print receiving persons Full Name and Title
- ✏️Have them sign in the box

Refusal

Capacity Assessment
- ☑️Legal (Choose all appropriate)
- ☑️Decision Making (Choose all appropriate)
- ☑️Medical (Choose all appropriate)
Medical Command
- ☑️Contact Method – Choose Most Appropriate
- ✏️Contact Name – Who you talked to
- ☑️Orders – Choose
- ✏️Time & Date contacted
- ✏️Comments – Any other comments they had
Patient Notifications

This is notification made by the ambulance crew

☑️Patient / Parent / Guardian notifications (Choose all appropriate)
✏️Additional – Type in what you want
☑️Provider – Select who made the notification
✏️Provider who made the notification signs
Patient Refusals
- ☑️Patient Refusals Mark what they refused (Choose all appropriate)
- ✏️Patient Refusal Comments: Any other comments
- ☑️Signature of: Mark who the signature is by:
  - ✏️Parent/Legal Guardian Name: This box will appear if you select parent or guardian above.
- ✏️Have them sign
- ✏️ Witness Name: Type in Witness Full Name and DSN/relation/address
  - Refer to ACAD Policy and Treatment Guidelines for who can witness.
  - All refusals need a witness
- ✏️Witness Signature: Have witness sign

Controlled Substances

☑️Medication Name
✏️Medication Amount Wasted
✏️Select “Other Button”
✏️Witness Full Name
✏️Witness Title
✏️Have them sign

There are more places if additional Medications wasted

Attachments

All trips should have an attachment. If there is Dispatch will not make you a Dispatch Sheet, then scan a piece of paper that has “No Dispatch Sheet” written on it. This should only be done if Dispatch refuses to make one.
Order for Paperwork to be scanned

Dispatch Sheet
Face Sheet
Signature Form (If paper form was obtained)
PCS Form
Transfer of Care (If paper form was obtained)
EKG Strips if not imported
Other Documentation

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