EMS transports

Harris County ESD 11 was dispatched to a reported location for a priority [select name="priority" value="1|2|3|4"] [select name="variable_4567" value="Complaint|abdominal pain|advanced send|allergic reaction|animal attack|assault|back pain|breathing problems|burn|CO poisoning|cardiac arrest|chest pain|childbirth|choking|cold exposure| diabetic problems|drowning|electrocuted|eye problems|fainting|fall|fire assist|headache|heart problems|heat exposure|hemorrhage|motor vehicle incident|overdose|pregnancy problem|psychiatric emergency|seizure|shooting|stabbing|sick person|stroke|structure fire|traumatic injury|unknown problem|unconscious person"]. Medic [select name="unit" value="440|441|442|443|444|445|446|447|448|449"] responded [select name="variable_8114321" value="emergency traffic|non-emergency"] [select name="delay" value="without incident or delay|and staged for law enforcement"]. [checkbox memo="FRO" memo_size="medium" memo_style="" memo_color="black" name="fro" value=""][conditional field="fro" condition="(fro).is('')"]Fire department was added to the incident due to dispatch determinant.[/conditional][checkbox memo="GOA" memo_size="medium" memo_style="" memo_color="black" name="goa" value=""][conditional field="goa" condition="(goa).is('')"]On arrival, EMS was unable to locate the patient. EMS searched in the area with no patient found. Medic [var name="unit"] returned to service.


Bodhi Brown
NREMT-P, LP
ICP-FTO
ID Number: 189[/conditional][checkbox memo="MVC" memo_size="medium" memo_style="" memo_color="black" name="mvc" value=""][conditional field="mvc" condition="(mvc).is('')"]EMS arrived on scene and found a [select name="number" value="1|2|3|4|5"] car accident with [select name="damage" value="minor|moderate|major"] damage. EMS noted [select name="airbag" value="positive|no"] airbag deployment.[/conditional][checkbox memo="Fire Assist" memo_size="medium" memo_style="" memo_color="black" name="fa" value=""][conditional field="fa" condition="(fa).is('')"]EMS provided medical standby for the duration of the fire incident. EMS made no patient contact during the incident and EMS was later released by command. Medic unit returned to service.


Bodhi Brown
NREMT-P, LP
ICP-FTO
ID Number: 189[/conditional][checkbox memo="DOA" memo_size="medium" memo_style="" memo_color="black" name="doa" value=""][conditional field="doa" condition="(doa).is('')"]On arrival, EMS made patient contact and located 1 [select name="sex" value="male|female"] patient located [text name="loc" default=""]. The patient was unresponsive, pulseless and apneic. EMS noted obvious signs of death including [checkbox name="obvious" value="cold skin|rigor mortis|decomposition|brain tissue|obvious catastrophic trauma"]. EMS informed control of DOS and time of death. EMS remained on scene to obtain patient demographic information and perform an investigation. EMS contacted Life gift and patient demographic information and events leading to the death were given. Medic [var name="unit"] later returned to service.


Bodhi Brown
NREMT-P, LP
ICP-FTO
ID Number: 189[/conditional]

[checkbox memo="ALS Transport" memo_size="medium" memo_style="" memo_color="red" name="tsp" value=""][conditional field="tsp" condition="(tsp).is('')"][textarea name="ass" default="EMS located the patient" cols="160" rows="4"] A primary physical assessment was performed and baseline vitals were obtained. [checkbox memo="12 lead" memo_size="medium" memo_style="" memo_color="blue" name="lead" value=""][conditional field="lead" condition="(lead).is('')"]EMS obtained a 12 lead EKG due to the patient's symptoms and complaint.[/conditional][checkbox memo="Sedation" memo_size="medium" memo_style="" memo_color="blue" name="con" value=""][conditional field="con" condition="(con).is('')"] Due to the patient requiring sedation EMS requested additional resources and a EMS supervisor to respond. EMS established a safety officer and performed a consult for sedation. EMS ensured that the patient was not in a restricted position that could compromise the patient treatment. EMS consult was approved, EMS provided sedation as documented in chart. EMS implemented the SNORES algorithm to prevent post sedation hypoxia. Patient was placed on required monitoring after the patient was sedated. [/conditional]

[textarea name="ast" default="" cols="160" rows="4"]EMS [select name="variable_uir51" value="assisted|moved"] the patient to the EMS [select name="device" value="stretcher|bench seat"], the patient was placed in a [select name="position" value="fowlers position|high fowlers|supine position|sitting position"] and was secured with lap belts and shoulder straps. EMS placed side rails in a locked and upright position and EMS moved the patient to the medic unit for transport. [textarea name="treat" default="EMS obtained vascular access as noted in chart. " cols="160" rows="4"] [checkbox memo="DSI" memo_size="medium" memo_style="" memo_color="black" name="dsi" value=""][conditional field="dsi" condition="(dsi).is('')"]EMS elected to secure the patient's airway by performing a DSI procedure. EMS began pre-oxygenation; EMS placed a nasal cannula on the patient at 15LPM. The patient's head was placed at a 15-degree angle to prevent the regurgitation of gastric contents. EMS insured that full, cardiac monitoring, SPO2, and EtCo2 waveform capnography were on the patient and giving accurate readings. Blood pressure cycle monitoring was set to every 3 minutes. EMS confirmed patent vascular access and ensured that the patient was hemodynamically stable. EMS performed a consult to procedure with the procedure. EMS procedure was approved. The patient was sedated with Ketamine while EMS prepared all equipment including a [select name="tubesize" value="7.0|7.5|8.0"] endotracheal tube. EMS prepared paralyzing medication and push-dose epinephrine. EMS had backup airway options ready including an Igel and surgical airway with 6.0 ETT. EMS performed a clinical consult via [select name="consult" value="in-person|phone"]. EMS informed EMS supervisor of the reasoning DSI was indicated and the patient's current status. EMS reported all vitals and the treatments performed prior to the DSI procedure. EMS supervisor advised [select name="consult" value="to proceed with the DSI procedure|stop the DSI procedure"]. EMS cycled 1 more blood pressure and confirmed the patient remained at the needed criteria for the procedure. EMS then performed a time-out and ensured all providers were ready and knew their roles. EMS also voiced the backup plans and requested if anyone had objections. No objections were voiced so the procedure continued. EMS administered paralyzing medication as noted and allowed the medication to take full effect. EMS then intubated the patient utilizing the video laryngoscope. EMS confirmed the tube passed through the cords. EMS confirmed tube placement with lung sounds and EtCo2 waveform. EMS secured the ETT, and the patient was placed on a ventilator with documented settings. EMS administered an additional dose of Ketamine and the patient was placed on a Ketamine infusion for continued sedation.[/conditional]Transport to the emergency room began [select name="variable_14" value="non-emergency|emergency"]. 

EMS continued to monitor the patient for changes in symptoms and hemodynamics during transport.[checkbox memo="" memo_size="medium" memo_style="" memo_color="black" name="other" value=""][conditional field="other" condition="(other).is('')"][textarea name="other" default="" cols="160" rows="4"][/conditional] Approximately 10 minutes from the emergency department [select name="variable_12347ght1" value="patient report|stroke alert|ETO|level 1 trauma|sepsis alert|cardiac arrest"] was given to receiving facility. On arrival at the emergency department, the patient was [select name="variable_1" value="assisted|moved"] to the emergency department [select name="variable_1678" value="room|bed|triage|chair|wheelchair|lobby|CT scanner"]. EMS gave a full patient report to receiving [select name="variable_18876123ed" value="ER staff|nurse|physician|nurse practitioner|neuro team|trauma team|operating room team"]. EMS obtained needed patient information and signatures, [select name="variable_98823431" value="EMS placed patient belongings in ER room|EMS returned belongings to the patient|patient belongings were given to family"]. EMS obtained transfer of care signatures by patient's primary nurse, the patient's personal and insurance information was obtained. Consent to transport signature was [select name="signature" value="obtained|UTBO due to reasoning documented in chart"]. EMS completed all documentation and Medic [var name="unit"] returned to service.


Bodhi Brown
NREMT-P, LP
ICP-FTO
ID Number: 189 [/conditional][checkbox memo="BLS Transport" memo_size="medium" memo_style="" memo_color="red" name="blstsp" value=""][conditional field="blstsp" condition="(blstsp).is('')"][textarea name="ass" default="On arrival, " cols="160" rows="4"] EMS performed a primary physical assessment and obtained a set of baseline vitals as noted in chart. [textarea name="ast" default="Vital signs and physical exam showed " cols="160" rows="4"]EMS [select name="variable_uir51" value="assisted|moved"] the patient to the EMS [select name="device" value="stretcher|bench seat"], the patient was placed in a [select name="position" value="fowlers position|high fowlers|supine position|sitting position"] and was secured with lap belts and shoulder straps. EMS placed side rails in a locked and upright position and EMS moved the patient to the medic unit for transport. Transport to the emergency room began non-emergency.

EMS continued to monitor the patient for changes in symptoms and hemodynamics during transport.[checkbox memo="" memo_size="medium" memo_style="" memo_color="black" name="other" value=""][conditional field="other" condition="(other).is('')"][textarea name="other" default="" cols="160" rows="4"][/conditional] Approximately 10 minutes from the emergency department [select name="variable_12347ght1" value="patient report|stroke alert|ETO|level 1 trauma|sepsis alert|cardiac arrest"] was given to receiving facility. The patient continued to remain stable and no changes were noted. On arrival at the emergency department, the patient was [select name="variable_1" value="assisted|moved"] to the emergency department [select name="variable_1678" value="room|bed|triage|chair|wheelchair|lobby|CT scanner"]. EMS gave a full patient report to receiving [select name="variable_18876123ed" value="ER staff|nurse|physician|nurse practitioner|neuro team|trauma team|operating room team"]. EMS obtained needed patient information and signatures, [select name="variable_98823431" value="EMS placed patient belongings in ER room|EMS returned belongings to the patient|patient belongings were given to family"]. EMS obtained transfer of care signatures by patient's primary nurse, the patient's personal and insurance information was obtained. Consent to transport signature was [select name="signature" value="obtained|UTBO due to reasoning documented in chart"]. EMS completed all documentation and Medic [var name="unit"] returned to service.


Bodhi Brown
NREMT-P, LP
ICP-FTO
ID Number: 189 [/conditional][checkbox memo="Refusal AMA" memo_size="medium" memo_style="" memo_color="red" name="ama" value=""][conditional field="ama" condition="(ama).is('')"][textarea name="ass" default="On arrival, " cols="160" rows="4"] EMS performed a primary physical assessment and obtained a set of baseline vitals as noted in chart. [textarea name="ast" default="Vital signs and physical exam showed " cols="160" rows="4"]

EMS expressed that based on the patient's condition and presenting symptoms EMS recommended transport to the ER. The [select name="subject" value="patient|mother|father|grandparent|patient's guardian|patient's family|patient's power of attorney"] has expressed their decision to refuse medical treatment and transport against medical advice. They state they do not believe the present condition warrants further assessment, treatment, and transport by emergency medical services. The [var name="subject"] is awake and alert and responding to EMS appropriately without clinical concern. EMS determined that the [var name="subject"] has intact decision-making capacity. The risks of refusing care have been explained to the [var name="subject"], including, [text default="" size="60"], worsening of their condition, incapacitation, subsequent illness or injury, or absolute worst-case scenario, death. The benefits of care by EMS and transport to the emergency department have also been explained. EMS provider treatment, diagnostic testing, and definitive treatment were offered but continued to be denied. The [var name="subject"] clearly understands that evaluation by EMS is not equivalent to a complete hospital workup under the care of a physician. The [var name="subject"] understands and states the risks and benefits of EMS care and transport back to EMS. The [var name="subject"] also tells EMS that they understand that not being transported to the ER by EMS could pose a signifiant health risk to the patient.
[checkbox memo="CONSULT" memo_size="medium" memo_style="bold" memo_color="black" name="con" value=""][conditional field="con" condition="(con).is('')"] 
EMS contacted HCESD 11 [select name="sup" value="301|302|303|321|322|323|Chief Clinical Officer Jordan Anderson|CES Dustin Yates|Dr. Sarah McClure|clinical consult"] for a high-risk AMA refusal. EMS informed [var name="sup"] that the [var name="subject"] was awake and alert and had the full capacity to refuse EMS. EMS informed [var name="sup"] of the patient’s vitals and assessments along with any treatments performed. EMS expressed all concerns about why the patient needed to be transported and why the [var name="subject"] did not want transport to the ER by EMS. EMS was advised by [var name="sup"] that the [var name="subject"] does have the capacity and is allowed to refuse further care and transport to the hospital. [var name="sup"] requested to ensure the [var name="subject"] has a plan after EMS leaves and to proceed and let the [var name="subject"] refuse EMS transport to the emergency room.
[/conditional]
Despite multiple attempts by myself and my partner to convince the [var name="subject"] to be transported to the hospital for further evaluation and treatment, the [var name="subject"] remains adamant that EMS transport is not wanted. EMS confirmed that the [var name="subject"] is oriented, clear of mind, and has the capacity to understand the presented information. EMS informed the [var name="subject"] that EMS personnel are not physicians and there is much more diagnostic testing and/or imaging to rule out serious illnesses or injuries. The [var name="subject"] recognizes that there may be a serious injury or illness which could get worse without proper medical attention, even though they feel fine at the present time. The [var name="subject"] understands that they may change their mind and call 9-1-1 if treatment or assistance is needed later. The [var name="subject"] also understands that treatment is available at an emergency department 24 hours a day or from their primary physician. The [var name="subject"] has been informed that they will sign a refusal of continued care and transport which holds Harris County ESD 11 Mobile Healthcare not responsible for any negative outcomes on the patient's health. EMS remained on the scene to answer all needed questions from everyone. EMS obtained all needed information and required patient information. EMS obtained [var name="subject"] signatures and Medic [var name="unit"] returned to service.

Bodhi Brown
NREMT-P, LP
ICP-FTO
I.D 189
[/conditional][checkbox memo="CPR Field Termination" memo_size="medium" memo_style="" memo_color="red" name="f" value=""][conditional field="f" condition="(f).is('')"]EMS located the patient, patient was found pulseless and apneic. Patient was warm with no obvious signs of death; resuscitative efforts were started. EMS began manual CPR and cardiac pads were paced on the patient's chest. IO access was obtained, and patient was administered first round of cardiac medications. Airway was secured with an Igel that was confirmed with chest rise and EtCo2 waveform. EMS advised control that ALS was in place. The patient was moved to a LUCAS device during a pulse check. Lucas device was secured with neck and arm straps. After ALS care was in place EMS addressed all H's and T's as needed based on the mechanism of the cardiac arrest and the patient's history. EMS continued to provide ALS resuscitative efforts for [select name="time" value="20|30"] minutes. EMS continued to do intermittent pulse checks every 2 minutes with a pre-charged cardiac monitor. EMS delivered [select name="def" value="no|1|2|3|4|"] defibrillations during resuscitative efforts and no signs of circulation were achieved. After [var name="time"] minutes of resuscitative efforts, EMS addressed the patient's family. EMS informed the family that EMS was able to perform all needed advanced life-saving interventions that a hospital would be able to do. EMS told the family that the patient's heart has not at any point gone into a shockable or sustainable rhythm and that the patient's prognosis is poor. EMS informed the family that EMS is going to stop resuscitative efforts after the next rhythm check. EMS, fire, and EMS supervisor on the location went over all treatments and procedures that were performed. EMS informed all crews that resuscitative efforts were going to be terminated. EMS asked if any provider on scene had any objections or concerns, including other treatment options or reasons for transport. No responding providers advised any concerns or objections with terminating all life saving efforts. EMS spoke to the family and informed them of the steps taken to save the patient. EMS informed the family that all the efforts that have been done are the same steps that the hospital would take in an attempt to restart the patient's heart. EMS expressed and highly recommended the family to come and see the patient prior to stopping CPR. EMS stopped CPR and the time of death was called at [text name="tod" default=""]. EMS remained on the scene to clean up supplies and provide emotional support to the family members. EMS contacted Life Gift and provided them with all needed patient information. Medic [var name="unit"] cleared the scene and returned to service.


Bodhi Brown
NREMT-P, LP
ICP-FTO
I.D 189
[/conditional][checkbox memo="CPR Transport" memo_size="medium" memo_style="" memo_color="red" name="t" value=""][conditional field="t" condition="(t).is('')"]EMS located the patient, patient was found pulseless and apneic. Patient was warm with no obvious signs of death; resuscitative efforts were started. EMS began manual CPR and cardiac pads were paced on the patient's chest. IO access was obtained, and patient was administered first round of cardiac medications. Airway was secured with an airway Igel that was confirmed with chest rise and EtCo2 waveform. EMS advised control that Advanced Life Support (ALS) was in place. The patient was moved to a LUCAS device during a pulse check. Lucas device was secured with neck and arm straps. After ALS care was in place EMS addressed all H's and T's as needed based on the mechanism of the cardiac arrest and the patient's history. EMS continued to do intermittent pulse checks every 2 minutes with a pre-charged cardiac monitor.

[textarea name="ast" default="" cols="160" rows="4"] Due to the patient's response to EMS interventions, EMS initiated patient transport. EMS moved the patient to the EMS stretcher, the patient was placed in a supine position and was secured with lap belts and shoulder straps. EMS placed side rails in a locked and upright position and EMS moved the patient to the medic unit for transport. Transport to the emergency room began emergency traffic.

EMS continued to monitor the patient for changes in hemodynamics during transport.[checkbox memo="" memo_size="medium" memo_style="" memo_color="black" name="other" value=""][conditional field="other" condition="(other).is('')"][textarea name="other" default="" cols="160" rows="13"][/conditional] Approximately 10 minutes from the emergency department patient was given to receiving facility. On arrival at the emergency department, the patient was moved to the emergency department room. EMS gave a full patient report to receiving ER staff. EMS obtained needed patient information and signatures, [select name="variable_98823431" value="EMS placed patient belongings in ER room. EMS obtained transfer of care signatures by patient's primary nurse, the patient's personal and insurance information was obtained. Consent to transport was unable to be obtained due to reasoning documented in chart. EMS completed all documentation and Medic [var name="unit"] returned to service.


Bodhi Brown
NREMT-P, LP
ICP-FTO
ID Number: 189 [/conditional]
Harris County ESD 11 was dispatched to a reported location for a priority . Medic responded . FRO GOA MVC Fire Assist DOA

ALS Transport BLS Transport Refusal AMA CPR Field Termination CPR Transport

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Sandbox Metrics: Structured Data Index 0.79, 116 form elements, 510 boilerplate words, 3 text boxes, 11 text areas, 18 checkboxes, 36 drop downs, 31 variables, 17 conditionals, 72 total clicks
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