Prehospital Archives

The book notes we can use the EMS providers leave facility time. In two cases this morning the patient left later on the ED timeline than on the EMS record, but the abstraction was of the EMS leave time. Understanding everyone’s watch / clock could be a little different, I want to review at our network peer tomorrow. Historically I abstracted using the timeline first as my hierarchy = as in my head the hospital should be recording when the patient left. I would refer to the EMS trip sheet only when the timeline was either missing an OTF time or it didn’t make sense i.e. the patient was at CC before the referring facility said they left Schuylkill. What would be your guidance on this matter? Should a hierarchy reflect the latest time or ED documentation first?

I would look for the hospital documentation first, using the latest time from the hospital, and using EMS time if you cannot find documentation of time left, or if it is illogical. We added the option to use EMS time because often the referring facility records are missing data. If the times seem incongruent, you …

Continue reading “The book notes we can use the EMS providers leave facility time. In two cases this morning the patient left later on the ED timeline than on the EMS record, but the abstraction was of the EMS leave time. Understanding everyone’s watch / clock could be a little different, I want to review at our network peer tomorrow. Historically I abstracted using the timeline first as my hierarchy = as in my head the hospital should be recording when the patient left. I would refer to the EMS trip sheet only when the timeline was either missing an OTF time or it didn’t make sense i.e. the patient was at CC before the referring facility said they left Schuylkill. What would be your guidance on this matter? Should a hierarchy reflect the latest time or ED documentation first?”

I have a question about extrication with a house fire victim. House fire with 3 people entrapped in fire with fire fighters extricating patient to front porch when ems arrived and ems along with fire department carried patient to safer location in yard away from fire. There is not a 20-minute delay from arriving on scene to leaving scene time due to pt being critical and ems left without waiting for ALS units due to need of securing airway. Did extrication happen? I want to say yes because if the fire dept did not assist patient out of house and then from porch the pt would have died and that would be a delay in treatment. I just want to make sure my thinking is correct or if it is not because of the lack of delay in treatment on just Ems end.

You are correct in your thinking! Extrication is defined as any action that disentangles or frees from entrapment or delays in transport. Since the fire department rescued the patient from the building fire, this would qualify as yes for extrication. The primary intent of this element is to give a reason for delays in transport. …

Continue reading “I have a question about extrication with a house fire victim. House fire with 3 people entrapped in fire with fire fighters extricating patient to front porch when ems arrived and ems along with fire department carried patient to safer location in yard away from fire. There is not a 20-minute delay from arriving on scene to leaving scene time due to pt being critical and ems left without waiting for ALS units due to need of securing airway. Did extrication happen? I want to say yes because if the fire dept did not assist patient out of house and then from porch the pt would have died and that would be a delay in treatment. I just want to make sure my thinking is correct or if it is not because of the lack of delay in treatment on just Ems end. “

I am currently working on a patient that gets admitted to OSH for medical reasons. Two days later while doing therapy falls from chair and dx with a fx from the fall. Patient is then transferred to our facility for treatment 3 days after injury at OSH. For scene provider would I want to choose walk-in as patient was in facility at time of injury? For admission date would it be the date and time of injury, anything done prior to injury would be voided?

We recommend using walk-in as the scene provider and recording the time of injury as the admission date/time. This allows for abstraction to really begin with the injury/fall and not with their initial admission at the referring facility.

The data element “Was patient extricated?” states that extrication is defined as any action that disentangles or frees from entrapment or delays in transport. Is there a time frame the registry should go by when determining a delay in transport?

There is no specific timeframe. While intent is to document if there is a delay, there does not need to be a delay to report extrication.

If a patient is given pre hospital Ketamine, would you answer the question in the clinical tab, yes to chemically sedated, I would like to ask the same question for chemically paralyzed if such medication is given such as Rocuronium? There has been discussion that these drugs do not stay in the patients system for very long.

The PTOS Manual provides examples of common paralyzing drugs under the Paralyzing Drugs data element. Rocuronium is included within these examples. Under GCS qualifiers, I recommend Rocuronium be recorded as a paralyzing drug and Ketamine be recorded under sedation. Note that each of these agents has a slightly different duration of action (as you mention), …

Continue reading “If a patient is given pre hospital Ketamine, would you answer the question in the clinical tab, yes to chemically sedated, I would like to ask the same question for chemically paralyzed if such medication is given such as Rocuronium? There has been discussion that these drugs do not stay in the patients system for very long.”

I’m looking for direction regarding a case that was seen post MVA and left AMA prior to imaging results. He was called back to the ED and transferred out for care. He initially was brought in direct from scene of MVA by EMS. His second visit, where he was transferred out to higher level of care, he was brought in by EMS from home. How do I address the EMS data?

It sounds like you have two separate encounters here. The first, I’m assuming, is nonPTOS as the patient most likely left AMA prior to meeting a portion of the inclusion criteria (i.e. LOS). The second encounter should be captured as a separate trauma record that will be PTOS. Information about the injury itself will remain …

Continue reading “I’m looking for direction regarding a case that was seen post MVA and left AMA prior to imaging results. He was called back to the ED and transferred out for care. He initially was brought in direct from scene of MVA by EMS. His second visit, where he was transferred out to higher level of care, he was brought in by EMS from home. How do I address the EMS data?”

When a patient is a transfer in from another facility and are being transferred by helicopter (ambulance drives patient and helicopter crew to LZ from referring facility) what set of vital signs do you use, the first set when the patient leaves the hospital or the fist set when the helicopter takes off from LZ?

You are to record the first assessment of each vital sign after the patient leaves the facility.

Please clarify the x-rays at referring facilities. If patient has a hip x-ray, there isn’t a specific code under the BW0 anatomical regions. Do you want us to use the BW01ZZZ for abdomen and pelvis or the BQ0 code that is specifically hip?

If the x-ray is for the hip specifically, I recommend using the BQ0 code. If it is a diagnostic x-ray that is of the entire pelvis that happened to identify a hip injury, that is when I would use the BW01ZZZ code. If you would like to send over the documentation you have, we can …

Continue reading “Please clarify the x-rays at referring facilities. If patient has a hip x-ray, there isn’t a specific code under the BW0 anatomical regions. Do you want us to use the BW01ZZZ for abdomen and pelvis or the BQ0 code that is specifically hip?”

If patient had a head CT at the non-acute care hospital but not at our facility, how do we answer “did PT receive CT during resusc”?

You may enter 1, yes. It sounds like you have documentation from the non-acute care hospital. If this is the case, you will enter 2, no, for is this a transfer patient element. But you will then enter 1, yes, for documentation available from outside facility on the Referring Facility tab.

I have a patient transferred from a hospital by ambulance to us however during transport patient had a seizure and called for a helicopter to transport the rest of the way would we record this as ambulance/helicopter rendezvous or just helicopter?

This would meet ambulance/helicopter rendezvous, as both provided part of the transport from the referring facility to you.