January 2019 Memo

The responses that you provide will be recorded and filed. 

PCR's: 

• If you have not started, please document the run numbers as 19-0000. Please make sure to use zeros as placeholders, it makes the data much easier to sort. 
• Be sure to log out of iPCR when you have completed, faxed, and submitted your chart. 
• Your first responsibility when doing crew change should be updating the crew in the iPCR tablet. There have been numerous occasions where the off-going crew names are on PCR's they did not respond to. 
• Billing signatures are more important now than ever! Please obtain patient signature's on every chart. If you cannot get the patient signature, you MUST document the MEDICAL reason why they cannot sign and have a family member or pt rep sign on their behalf. ONLY IF A FAMILY MEMBER/PT REP IS NOT AVAILABLE  can you use the receiving facility rep's signature. 
• If Air Medical is requested and transports the patient, choose "AIR MEDICAL" in the destination/hospital section and document the physical address of the LZ. Also, MILEAGE from the scene to the LZ needs to be documented or else it will not be paid. If it is only 0.1 mile, document "0.1" mile.
• An ALS assessment MUST be completed for Priority 1 & 2 calls. 
• Insurance information needs to be completed and/or updated if needed, for every call where treatment or transport is initiated. 
• Recently, we have had charts come back for lack of documentation and assessment explaining why the patient needed to go to the hospital. We are not allowed to refuse 911 requests and usually the patient/caller/subject explains why they need to go to the hospital. This needs to be documented and pertinent positives and negatives presented. If you feel the patient is abusing the system, please fill out an incident report form so it can be addressed through the proper channels.  

Patient Transport:

• When transporting patients, please transport to the patient's preferred hospital, especially if they are receiving treatment from a specialist or specialized department. Closest facility should be used when there is not a preference or the patient's condition is unstable and needs immediate care. This also needs to be documented in the chart as such. I.E.- if a patient just had an angiogram a week ago at Rochester General and is currently having chest pain with no airway obstruction or life threatening injuries, they should be transport back to RGH. 
  

New Items: 

• RSI Kits have been added to the COVA ambulances. Some of the meds need refrigeration and the entire kit should be kept in the cooler/refrigerator if possible. COVA 61 has a small fridge and currently some of the medications are in the fridge with the cardizem and some are in the red kit. We will be finding a more permanent cooler for that ambulance. IF A RSI KIT IS USED, please fill out an incident report and make sure Laurie is notified. 
• All bags or cabinets with needles MUST be sealed, locked, and/or secured. This is a State policy and the region is cracking down on it. 
• Dropped/Missed calls need to be documented. This means that if a call is dispatched in our district, and we do not cover it, a PCR should still be filled out and "no crew available" selected. It takes 1 minute and should not be ignored.
• We are trying to get a better hold on mutual aid requests. In iPCR in the dispatch information there is a spot for "type of response" which is just above the call nature. If you are responding M/A to Medina, Kendall, Holley, Elba, etc. please select "Mutual Aid" instead of 911. Also, in the dispatch notes below the mileage, indicate where we are going M/A to. 

Responsibilities: 

• Every attempt should be made to respond, transport, and return to service in a safe and quick manner. There have been times where a crew has been delayed at the hospital, but this is not something that is an everyday thing. Stopping to chat with other crews, shop, or sit down at a restaurant to eat is inappropriate! If anyone is caught doing this or intentionally "dragging" to respond to or get back in service, without management permission, will be subject to the progressive disciplinary policy. 
  
• Per NYS DOH the ambulances should be locked at ALL times, (hospital, base, store, or wherever you are).  To facilitate this each crew member will be responsible to carry a set of keys for the ambulance. These should be transferred at crew change or hung in a specified place if the ambulance is out of service. If the garage doors are left open, the ambulances MUST be locked. 
  
• Documentation of vehicle problems MUST be documented via the form on the website. If a vehicle is taken out of service, a form is required to be filled out. Also, during the winter months, ANY ambulance that is parked outside should have a space heater on and it should be checked daily by crew members to make sure there are no problems. 
• The ambulances need to be rinsed off or washed after every call. If the salt and road spray dries, it will not be able to be rinsed and you will have to wash it with soap. 
• The inside of the patient compartment also needs to mopped and wiped with disinfectant wipes after each call. 
• The cleanliness of the ambulances have been less than expected and this needs to be improved upon immediately. Thank you for your anticipated cooperation. 

The responses that you have provided will be filed in your employee file.