Effective: 06-22-20
Supersedes: CE 200
Purpose: To inform all EMS providers of Company, Regional and State Regulations regarding hospital entry notifications.
Policy: Hospitals will be notified of incoming patients and their medical conditions in a timely and organized manner. Per OEMS Regulations 105, CMR 170.300 et al., Medical Control contact should be over a recorded line.
Definition(s):
Entry Note refers to a radio or telephone communication with a hospital emergency department informing the receiving facility of a patient’s medical condition and estimated time of arrival.
Emergency Response refers to a request for emergency care and transportation of a sick or ill individual is made via the 911 systems or directly to the dispatch center necessitating a priority response. These are termed “HOT or “COLD” responses.
Non-Emergency Response refers to a pre-scheduled transport request for a stable patient that will not require emergent or urgent care on route or upon arrival at the hospital. These are non-priority responses.
Specialized Resources refers to any resource that a hospital needs to make arrangements for prior to the arrival of the transporting unit. For example, including, but not limited to:
· Security
· STEMI, STROKE or Trauma team
· Respiratory Therapy (including CPAP, BiPAP, intubated, or vented patients)
· Code Team
· Burn Unit
· Multiple Patients regardless of patient priority
· Decontamination unit
· Interpretive services
· Hyperbaric Unit
· Electrical Therapy (external cardiac pacing)
Procedure:
Transport entry notification requirements:
NOTE: The below refers to the patient condition as opposed to Dispatch response criteria
Priority 1 Transports: Entry notifications will be made to all hospitals for patients transported priority 1 regardless of the dispatch priority.
Priority 2 Transports: Entry notification will be made to all hospitals (EXCEPT for Boston Medical Center, Massachusetts General Hospital, Children’s Hospital in Boston, Beth Israel Deaconess and Brigham and Women’s unless specialized hospital resources are needed) for priority 2 patients regardless of the dispatch priority.
Priority 3 Transports: Entry notifications will be made to all hospital (EXCEPT for Boston Medical Center, Massachusetts General Hospital, Children’s Hospital in Boston, Beth Israel Deaconess and Brigham and Women’s unless specialized resources are needed) for priority 3 patients.
Entry notifications are generally not required for non-emergency pre-scheduled transports (priority 4) except when:
· The patient’s condition has deteriorated enroute necessitating upgrading of the transport priority.
· Upon arrival at a location for a pre-scheduled transport, the patient’s medical condition is determined to require emergency care and transportation.
· A psychiatric patient has become violent or a psychiatric patient being transported with a section (12) committal in force is a flight risk.
· A patient is being transported on a ventilator.
Contents of an Entry Notification
The contents of an entry notification will vary according to the acuity of the patient, the time available to the EMS provider to make an entry note and the level of certification of the EMS provider. Entry notes should rarely exceed 45-60 seconds in duration. All entry notes shall contain the following elements:
· Age
· Sex
· Chief Complaint(s)
· Vital Signs, Lung Sounds, SaO2 readings, Blood Glucose readings, and other pertinent physical findings
· A brief description of the treatment provided
· Estimated time of arrival at the hospital
The following additional information shall be included in all entry notes when applicable:
· If the patient is a minor, whether or not a parent is onboard or has been notified.
· The patient has a potentially communicable disease that requires hospital staff to take precautions to protect themselves.
· The patient is originating from the scene of a Hazardous Materials Incident.
· The patient is chronically ventilator dependent.
· Hospital Security is needed to contain and control the patient.
BLS entry notifications of priority one patients shall include a short history of the present illness and pertinent past medical history in addition to the standard entry note elements. BLS entry notes of priority two and three patients generally require only the standard information.
ALS entry notes shall include the standard elements of all entry notes and the following, when applicable:
· Past Medical History
· Medications
· Medication allergies
· ECG interpretation
· ALS treatments that have been administered
Following an entry note, the hospital may have questions regarding the patient’s condition. Be prepared to answer them as completely as possible.
Radio Entry Notification
The C-Med radio should be your primary means of entry notifications for priority 1 and 2 transports/patients. All radio traffic is recorded for your protection. In our systems we use regional C-Med systems and our crews are reminded to request a med channel on med-4 from there you will receive a channel assignment and connectivity with the receiving hospital.
To hail one of the C-Meds, select the proper channel on the radio & state: “Boston C-Med Brewster (EasCare) Ambulance Service Ambulance 9”
Give the C-Med operator at least 15 seconds to answer the radio. When the CMED Operator answers, give your unit number, location, hospital, and type of notification (entry notification, medical control, etc).
If unable to contact CMED, you will contact the dispatcher and inform them that you were unable to contact C-Med and will need to give an entry note through the dispatch center. Keep the entry note brief. Also, as soon as practically feasible please complete an Electronic Incident Report regarding this situation.
Telephone Entry Notification
Telephone entry notifications are acceptable as a backup to radio entry notifications for priority one and two patients or low acuity (priority three) patients. Twiage capable facilities can be notified through the twiage app-based product.
Remember: OEMS requires Medical Control and Patient Care notifications to be over a recorded line.
The information provided via telephone shall be the same information required for radio notifications. Some hospitals require that only a nurse or physician receive an entry notification.
Preface your notification with the statement: “This is Brewster (EasCare) Ambulance Service Ambulance (vehicle #) with an ALS (or BLS) priority 1/2/3 entry notification.” The hospital staff will then ask you to wait while a nurse is summoned, or they will take the information.