Prepared by the Division of Emergency Medical Services

Refresher Course

Medical Incident Report Form

Education Module for 2011

Prepared by the Division of Emergency Medical Services

Education Module Goals

• Refresh EMS personnel on why the Medical Incident Report Form (MIRF) is important

• Update EMS personnel on changes to the 2011 MIRF

Education Module Contents

• Basic information & general

instructions

• Aftercare Instructions Highlight

• 2011 MIRF changes

Basic Information & General Instructions

Why the MIRF is Important

• Medical– The entire MIRF (both electronic form and

paper form) is part of the patient’s medical file.

– The paper MIRF transfers information between patient care providers.

• Legal– Confidentiality– Patient Refusal– MIRF Signature

Why is the MIRF is Important (continued)

• Quality Review – Agency and system-wide

• Planning/Funding– Medic unit placement, levy funding

• Research– Resuscitation Outcome Consortium (ROC)– Aftercare Instructions Pilot Project

Components of a Good Report

• Completeness– All available information regarding

the incident or patient care should be recorded.

• Accuracy– Describe exactly what happened.

• Correct spelling• Legibility (on paper forms)

Components of a Good Report

(continued)•Narrative: use S.O.A.P

format:– Subjective– Objective– Assessment– Plan

Basic Instructions• An electronic record is created by CAD/Dispatch for every

call/incident.

• When completing the paper (short) form in the field, use a ball point pen and press hard enough to mark through all copies.

• Complete the electronic record, verifying that the CAD information has been received, and augmenting this information where appropriate.

• Refer to your agency protocols regarding exceptions to completing the paper (short) form.

*******

• Agencies using the paper (long) form should complete a form for every call/incident.

Paper MIRF Pages

• Agency copy

• EMS copy

• Medical Review copy

• Patient copy

• Aftercare Instructions: The backer provides health information to patients.

Completing the MIRF

The person who provided primary care should:

• Sign your name• Print your name• Write your EMS number

• Follow the instructions on the back of the MIRF.

• Fill in patient’s name, and the date.• Read the statement slowly & clearly to the

patient. Ask if they understand what it says.

• Have the patient/guardian sign in the appropriate spots.

• If patient/guardian refuses or you are unable to obtain a signature, make a note to that effect.

• Obtain a signature from a witness and note their EMS agency affiliation or address.

Patient Refusal

Aftercare Instructions Highlight

Aftercare Instructions Highlight

The backer is to be given to ALL patients.

Aftercare instructions are located on the back of last page of the MIRF (both short and long form) for a variety of health conditions. CHECK ALL APPLICABLE boxes:

• Patient was Not Transported• Low Blood Sugar Information• High Blood Pressure Information• Falls• Community Resources Information

Aftercare Instructions Highlight (cont.)

• Not TransportedPatient left at scene or transported by a private

occupancy vehicle.

• Transported

Patient transported by BLS, ALS, or a private

ambulance.

Aftercare Instructions Highlight (cont.)

• Low Blood SugarPatient was treated for hypoglycemia and not

transported.

• High Blood PressurePatient with a systolic ≥ 160 OR diastolic ≥ 100.

• Falls

Aftercare Instructions Highlight (cont.)

• Community Resources – Can be offered to any patient in need of social services including:

• Caregiver & Disability Resources• Domestic Violence• Emergency Shelter• Financial Assistance for Rent or Utilities• Food & Clothing• Health Care & Support Groups• Legal Help

Aftercare Instructions Highlight (cont.)

• Once the appropriate boxes on the backer have been checked, tear the sheet at the perforation and give to the patient.

• Be sure to enter the same information into your record management system (for electronic agencies).

2011 MIRF Changes

Incident Type (NFIRS)

Incident Type coding has been revised over the past few years. Here are some highlights of the current coding:

3117 - EMS call, Cancelled at Scene 3119 - EMS call, Unintentional medical alert activation3214 - EMS call, Vehicle accident with no injuries (use

if you want to create a patient record)3127 - EMS call, Flu-like symptoms324 - EMS call, Vehicle accident with no injuries

(standard NFIRS code-patient record not allowed)6113 - EMS call, Dispatched & cancelled enroute

Prepared by the Division of Emergency Medical Services

Medical Incident Report FormEducation Module for 2011

Prepared by the Division of Emergency Medical Services

THE END

Refresher