EMS Quality Assurance Update

EMS Quality Assurance Office

January 2004 - No. 1

This is the first publication of the EMS Quality Assurance Update. These updates will be distributed on a quarterly basis to inform all providers of new and changing EMS issues at both the State and County level. For any questions or4 comments please contact Lt. Andrew Bluestein in the EMS Quality Assurance Office at 301-583-1862.

State Issues:

• E-Mais (electronic MAIS forms) are being piloted in Washington and Harford County. Expect E-MAIS or a similar program coming to Prince George's County within the next two years.
• The MIEMSS Pediatric Medical Directors (PMAC) wish to advise all providers that, per the American Academy of Pediatrics, it is no longer appropriate to immobilize a pediatric patient in a child safety seat. It is now appropriate to remove a suspected pediatric trauma patient from the child safety seat and immobilize him or her onto an appropriate immobilization device. (See the attached handout on removing a patient from a child safety seat).

• Prince George's Hospital Center would like to remind all providers that any Emergency Department can, and must treat an emergency psychiatric patient. It is inappropriate to bypass the closest hospital to bring a psychiatric patient to Prince Georges Hospital Center.
• Prince George's Hospital Center would also like to remind all providers that any priority 4 patient brought to Prince Georges Hospital Center must be checked in through the Emergency Department. The Emergency Room administration requests that you drive into the ambulance parking area, come inside and inform an Emergency Room staff member that you have a body in your ambulance. They will check the body into the hospital's computer and then they will most likely direct you to drive the body to the rear of the hospital, to the morgue.

• It is imperative that all AEDs be downloaded after any use. Lifepack monitors must be downloaded every shift. The Quality Assurance Office uses these downloads to provide the State with required information as well as to review and document patient care per State law (COMAR). If these downloads are not done, the information becomes lost as the monitors and AEDs recycle through their memory hardware.
• It is also imperative that all providers fill out the State mandated Cardiac Arrest Form on all cardiac arrest patients. This information is used by both the County and State to analyze the effectiveness of current medical protocols. These forms should be filled out by all units who have direct patient contact, and should be forwarded, with a copy of the MAIS form to the EMS Quality Assurance Office at the Fire Services Building.
• The Department has had several issues over the last several months with questionable patient refusals. Please remember that if you, as a provider, prompt or encourage a patient to sign a refusal, you could be legally responsible for any consequences of that refusal. The best policy is to advise the patient of their right to refuse treatment and transport, and if you have concerns or reservations about them refusing you should advise the patients of your concerns and document this on a MAIS narrative. Please remember that neither a minor, nor an adult who is not completely mentally alert can sign for a medical refusal. Please thoroughly assess any patients level of alertness, and make sure they completely understand what they are signing before you allow them to sign for a refusal. If there is a need to transport against a minor or incompetent adult's wishes, get assistance from the County Police.
• Please forward any complaints or concerns about Hospital staff, Nursing homes, Doctors offices, Clinics or any other health care facilities to Lt. Bluestein in the Quality Assurance Office. Any complaint or concern should be in statement form with all the information enclosed. This should include; date, time, unit, incident number, facility, room number, staff involved, and a detailed account of what the problem was.

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