BLS MIRF Education Module

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Medical Incident Report Form
Education Module for 2011
Refresher Course
Prepared by the Division of Emergency Medical
Services
Prepared by the Division of Emergency Medical
Services
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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

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Education Module Contents

• Basic information general instructions
• Aftercare Instructions Highlight
• 2011 MIRF changes

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Basic Information General Instructions
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Why the MIRF is Important

• Medical
• The entire MIRF (both electronic form and paper
  form) is part of the patients medical file.
• The paper MIRF transfers information between
  patient care providers.
• Legal
• Confidentiality
• Patient Refusal
• MIRF Signature

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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

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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)

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Components of a Good Report(continued)

• Narrative use S.O.A.P format
• Subjective
• Objective
• Assessment
• Plan

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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.

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Paper MIRF Pages

• Agency copy
• EMS copy
• Medical Review copy
• Patient copy
• Aftercare Instructions The backer provides
  health information to patients.

REVISED!
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Completing the MIRF

• The person who provided primary care should
• Sign your name
• Print your name
• Write your EMS number

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Patient Refusal

• Follow the instructions on the back of the MIRF.
• Fill in patients 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.

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Aftercare Instructions Highlight
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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

REVISED!
NEW!
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Aftercare Instructions Highlight (cont.)

• Not Transported
• Patient left at scene or transported by a
  private occupancy vehicle.
• Transported
• Patient transported by BLS, ALS, or a private
  ambulance.

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Aftercare Instructions Highlight (cont.)

• Low Blood Sugar
• Patient was treated for hypoglycemia and not
  transported.
• High Blood Pressure
• Patient with a systolic 160 OR diastolic
  100.
• Falls

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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

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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).

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2011 MIRF Changes
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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 activation 3214 - EMS call, Vehicle
accident with no injuries (use if you want to
create a patient record) 3127 - EMS call,
Flu-like symptoms 324 - EMS call, Vehicle
accident with no injuries (standard NFIRS
code-patient record not allowed) 6113 - EMS
call, Dispatched cancelled enroute
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Medical Incident Report Form
Education Module for 2011
Refresher
THE END
Prepared by the Division of Emergency Medical
Services
Prepared by the Division of Emergency Medical
Services