HEMS Vent ICU Transfer Narrative Template

Chief Complaint: [text name="cc" default=" " size="55"]

Dispatch Info: TAME requested to [checkbox name="referringcheckbox" value="Eastern New Mexico Medical Center in Roswell, NM|Artesia General Hospital in Artesia, NM|Carlsbad Medical Center in Carlsbad, NM|Mountain View Regional Medical Center in Las Cruces, NM|Lincoln County Medical Center in Ruidoso, NM|Covenant Health Hobbs Hospital in Hobbs, NM"] [text name="referringblank" default=" " size="55"] for an interfacility transfer to [checkbox name="receivingcheckbox" value="Eastern New Mexico Medical Center in Roswell, NM|Artesia General Hospital in Artesia, NM|Carlsbad Medical Center in Carlsbad, NM|Mountain View Regional Medical Center in Las Cruces, NM|Lincoln County Medical Center in Ruidoso, NM|Covenant Health Hobbs Hospital in Hobbs, NM|University Medical Center in El Paso, TX|University Medical Center in Lubbock, TX|Covenant Women's & Children's in Lubbock, TX|Del Sol Medical Center in El Paso, TX|University of New Mexico Hospital in Albequerque, NM"] [text name="receivingblank" default=" " size="55"].  [text name="referringmd" default=" " size="55"] has requested air medical transport of this patient, and [text name="receivingmd" default=" " size="55"] has agreed to receive this patient in transfer. Patient is being transferred to [text name="receiving2" default=" " size="55"] for a higher level of care and [text name="specialty" default=" " size="55"] services not available at the sending facility. [text name="receiving3" default=" " size="55"] is the closest appropriate facility with both the services this patient needs, as well as an available bed.  Patient is being transferred by air medical to reduce out of hospital time [text name="airtime" default=" " size="55"] hours vs [text name="groundtime" default=" " size="55"] hours by ground). This patient also requires medications and interventions outside the scope of practice of local ground EMS. Additionally, there are no ground EMS units available in the area to complete the transport.  

HPI: [text name="age" default=" " size="55"]-year-old [text name="sex" default=" " size="55"] with a history of [text name="hx" default=" " size="55"] who presented to [text name="refering4" default=" " size="55"] via [text name="modeofarrival" default=" " size="55"].  Per report patient [text name="eventsleadingup" default=" " size="55"].

ER Course:  Pt was seen and evaluated by hospital staff and found to have [text name="erdiagnosis" default=" " size="55"].  Treatments as listed below and in hospital medical record.  Pt being transferred for higher level of care/services not available at sending (as noted above in HPI).  Pt is being transferred via air to reduce morbidity/mortality associated with increased out of hospital time and the presence of critical care providers as pt is at high risk for decompensation.  Additionally, there are no ground critical care services available at sending.  

Treatments PTA: [text name="txpta" default=" " size="55"].


PMH: [text name="pmh" default=" " size="55"].
PSH: [text name="psh" default=" " size="55"].

Meds: [text name="meds" default=" " size="55"].
Allergies: [text name="allergies" default=" " size="55"].

ROS: The remainder of a 10 pt review of systems was negative and/or unobtainable unless otherwise indicated in the HPI.

Physical Exam
VS reviewed and as documented. RN notes reviewed.
Gen: [text name="gen" default="resting in bed, intubated, sedated, in no acute distress" size="55"]
HEENT: [text name="heent" default="normocephalic, atraumatic, pupils PERRL, 7.5 ETT 23 cm @ teeth, OGT in place" size="55"]
Neck: [text name="neck" default="Supple, trachea midline" size="55"]
CV: [text name="cards" default="Normocardic, regular, no obvious M/R/G, extremities warm, well perfused" size="55"]
Resp: [text name="resp" default="normal WOB, symmetric chest rise and fall, lungs clear" size="55"]
Abd: [text name="abd" default="Soft, non-traumatic, non-distended, no palpable organomegaly, bowel sounds present" size="55"]
MSK: [text name="msk" default="no obvious deformity, no edema, pulses 2+ bilaterally" size="55"]
GU: [text name="gu" default="foley in place, amber urine" size="55"]
Rectal: [text name="rectal" default="Deferred" size="55"]
Neuro: [text name="neuro" default="sedated, intubated, RASS-4" size="55"]
Skin: [text name="skin" default="warm, dry, good turgor" size="55"]

Access: 
CVL: [text name="centralvenousaccess" default="Not present" size="55"]
PIV: [text name="peripheralvenousaccess" default=" location/size,patency flushed without s/s of infiltration" size="55"]
Arterial: [text name="arterialaccess" default="Not present" size="55"]

Labs: Reviewed. Remarkable for [text name="labvalues" default=" " size="55"]. Please see hospital documentation for full details
EKG: [text name="ecg" default="Normal Sinus Rhythm with no ectopy noted" size="55"]
Imaging: [text name="imaging" default="Reviewed" size="55"] 

MDM: All labs, history, and imaging reports reviewed independently. History discussed with patient care team.  Upon review of the patient’s chief complaint, history of present complaint, past medical history, physical exam findings, diagnostic imaging results, and lab results, it is determined that the patient is experiencing [text name="diagnosismdm" default=" " size="55"] 
Appropriate PPE precautions taken. Pt attached to cardiac monitor. [text name="tempprobe" default="Esophageal temp probe placed without difficulty." size="55"]  Pt attached to transport ventilator with settings as noted below:

Ventilator Management:
Patient Current Ventilator Settings in the sending facility:
Mode- [text name="variable_1" default=" "]
Breath Type- [text name="variable_2" default=" "]
Frequency- [text name="variable_3" default=" "]
I-Time- [text name="variable_4" default=" "]
Vt- [text name="variable_5" default=" "]
PEEP- [text name="variable_6" default=" "] cmH20
FiO2- [text name="variable_7" default=" "]
Pressure Support- [text name="variable_8" default=" "]
PiP- [text name="variable_9" default=" "]
Pplat- [text name="variable_10" default=" "]
ETT Cuff Pressure- [text name="variable_22" default=" "]
Patient Placed on Transport Ventilator with Settings:
Mode- [text name="variable_11" default=" "]
Breath Type- [text name="variable_12" default=" "]
Frequency- [text name="variable_13" default=" "]
I-Time- [text name="variable_14" default=" "]
Vt- [text name="variable_15" default=" "]
PEEP- [text name="variable_16" default=" "] cmH20
FiO2- [text name="variable_17" default=" "]
Pressure Support- [text name="variable_18" default=" "]
PiP- [text name="variable_19" default=" "]
Pplat- [text name="variable_20" default=" "]
ETT Cuff Pressure- [text name="variable_21" default=" "]


[text name="ivpump" default="Pt IV drips maintained at rates as documented above and transferred to transport IV pumps." size="55"]
[text name="ptmove" default="Pt was moved to stretcher. HOB elevated 30 degrees" size="55"]
[text name="ptmove2" default="Transfer to helicopter uneventful.  All ventilator parameters and ETCO2 stable after every transition/move. Flight safety briefing given, ear and eye protection applied." size="55"]

Transport Course: [text name="transportcourse" default="Throughout the duration of the flight..." size="55"]

Upon arrival at receiving facility, pt transferred out of aircraft to hospital bed uneventfully. Pt care and report given to RN and all questions answered prior to departure from facility. ETT placement verified with each patient movement. Pt belongings and transport paperwork left with staff.

Assessment/Impression
[text name="impression1" default=" " size="55"]
[text name="impression2" default=" " size="55"]
[text name="impression3" default=" " size="55"]
[text name="impression4" default=" " size="55"]
[text name="impression5" default=" " size="55"]
[text name="impression6" default=" " size="55"]
[text name="impression7" default=" " size="55"]
[text name="impression8" default=" " size="55"]
[text name="impression9" default=" " size="55"]
[text name="impression10" default=" " size="55"]

Intake: [text name="intake" default=" " size="55"]mL. 
Output: [text name="output" default=" " size="55"]mL. 

Cabin Temp Initial: [text name="cabintemp1" default=" " size="55"]F cabin HVAC applied
Cabin Temp Ending: [text name="cabintemp2" default=" " size="55"]F


As a result of the dynamic pre-hospital environment in which limited resources are available the times noted in this patient care report may be approximated. 
Chief Complaint:

Dispatch Info: TAME requested to for an interfacility transfer to . has requested air medical transport of this patient, and has agreed to receive this patient in transfer. Patient is being transferred to for a higher level of care and services not available at the sending facility. is the closest appropriate facility with both the services this patient needs, as well as an available bed. Patient is being transferred by air medical to reduce out of hospital time hours vs hours by ground). This patient also requires medications and interventions outside the scope of practice of local ground EMS. Additionally, there are no ground EMS units available in the area to complete the transport.

HPI: -year-old with a history of who presented to via . Per report patient .

ER Course: Pt was seen and evaluated by hospital staff and found to have . Treatments as listed below and in hospital medical record. Pt being transferred for higher level of care/services not available at sending (as noted above in HPI). Pt is being transferred via air to reduce morbidity/mortality associated with increased out of hospital time and the presence of critical care providers as pt is at high risk for decompensation. Additionally, there are no ground critical care services available at sending.

Treatments PTA: .


PMH: .
PSH: .

Meds: .
Allergies: .

ROS: The remainder of a 10 pt review of systems was negative and/or unobtainable unless otherwise indicated in the HPI.

Physical Exam
VS reviewed and as documented. RN notes reviewed.
Gen:
HEENT:
Neck:
CV:
Resp:
Abd:
MSK:
GU:
Rectal:
Neuro:
Skin:

Access:
CVL:
PIV:
Arterial:

Labs: Reviewed. Remarkable for . Please see hospital documentation for full details
EKG:
Imaging:

MDM: All labs, history, and imaging reports reviewed independently. History discussed with patient care team. Upon review of the patient’s chief complaint, history of present complaint, past medical history, physical exam findings, diagnostic imaging results, and lab results, it is determined that the patient is experiencing
Appropriate PPE precautions taken. Pt attached to cardiac monitor. Pt attached to transport ventilator with settings as noted below:

Ventilator Management:
Patient Current Ventilator Settings in the sending facility:
Mode-
Breath Type-
Frequency-
I-Time-
Vt-
PEEP- cmH20
FiO2-
Pressure Support-
PiP-
Pplat-
ETT Cuff Pressure-
Patient Placed on Transport Ventilator with Settings:
Mode-
Breath Type-
Frequency-
I-Time-
Vt-
PEEP- cmH20
FiO2-
Pressure Support-
PiP-
Pplat-
ETT Cuff Pressure-






Transport Course:

Upon arrival at receiving facility, pt transferred out of aircraft to hospital bed uneventfully. Pt care and report given to RN and all questions answered prior to departure from facility. ETT placement verified with each patient movement. Pt belongings and transport paperwork left with staff.

Assessment/Impression











Intake: mL.
Output: mL.

Cabin Temp Initial: F cabin HVAC applied
Cabin Temp Ending: F


As a result of the dynamic pre-hospital environment in which limited resources are available the times noted in this patient care report may be approximated.

Result - Copy and paste this output:

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