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Performance Improvement EMS Provider

Please send information when discovered throughout the quarter so review can be started prior to RAC meetings.
SEND TO: thamilton@fishercountyhospital.com or denid@rpmh.net
1.Quarter Reporting
2.Name of Entity:
3.Person Completing Report:
4.Number of Trauma Patients sedated in the field?
5.Provide an explanation of why the sedation was needed
6.Performance Improvement Criteria / Indicators
Number of times scene time > 20 minutes for an injury-related call this quarter.
7.If the scene time was > than 20 minutes, why?
8.Performance Improvement Criteria / Indicators
Number of times >30 minutes from dispatch time to scene time for an injury-related call this quarter.
9.If the scene time was > than 30 minutes, why?
10.Number of trauma related pediatric resuscitations/activiations
11.Number of patients that met the RAC-D definition of “Major Trauma” that were transported to hospitals outside of RAC-D this quarter.
12.For each patient above who was transferred out of TSA-D what was the determining diagnosis or factor that led to transfer out of TSA-D?
13.Number of trauma-related patients pronounced dead on scene this quarter without the oppotunity for improvement?
14.Number of trauma deaths with opportunity for improvement this quarter.
15.Number of times Air Medical Services requested but unable to respond to a trauma patient this quarter.
16.Explain why Air Medical was unable to respond to the trauma patient?
17.How many times was Air Medical Services unable to respond to a Stroke patient this quarter?
18.Why was Air Medical not able to respond to a Stroke Patient?
19.How many times was Air Medical unable to respond to a Stemi patient this quarter?
20.Why was Air Medical not able to respond to a Stemi patient?
21.How many Stroke patients were transported by EMS to a RAC-D hospital from the scene?
22.If the Stroke patient was transported outside of the RAC-D area, where was the patient taken and why?
23.How many STEMI patients were transported by EMS to a RAC-D hospital from the scene?
24.If the STEMI patient was transported outside of the RAC-D area, where was the patient taken and why?
25.Specific Occurrence Report (LEAVE THIS AREA BLANK IF YOU ARE NOT NEEDING THE PI COMMMITTEE TO REVIEW THE CHART)
Age:
26.Gender:
27.NO NAMES - Chart Identification #:
28.Mechanism of Injury:
29.Identified injuries and pertinent information:

30.Patient Outcome:
31.Reason for RAC PI Committee review
Please send information when discovered throughout the quarter so review can be started prior to RAC meetings. SEND TO: thamilton@fishercountyhospital.com or denid@rpmh.net