Dispatch

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KENTUCKY AMBULANCE RUN REPORT
USAGE AND COMPLETION INSTRUCTION
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BRIEF HISTORY

• Kentucky changed run forms in July 1999 to the
  current form in use today.
• The run forms are intended to capture data
  required by the National Highway Traffic and
  Safety Administration (NHTSA) and the
  Commonwealth of Kentucky.
• Since the forms went into effect, any type of
  real appreciable data collection has never been
  maintained. This can be attributed to the
  non-user friendly electronic data collection
  program that was distributed to each service in
  1999 and the extraordinary cost of data
  collection from the contracted vendor.
  Additionally, the data that was captured was not
  reported in such a fashion that the industry
  could use.

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WHERE ARE WE NOW?

• KBEMS is in the process of developing a true
  data collection system that will capture the
  previously required NHTSA and Kentucky data
  elements .
• It is important for all service providers to
  ensure crews are completing the EMS run form in
  its entirety. The primary purpose of the run
  form is to provide history and care rendered to
  your patient en-route to the treatment facility.
  The collection of data will better assist both
  local and state government to establish a
  comprehensive report and to use as justification
  in future funding requests.

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Dispatch
This is the name of the Ambulance service as
shown on your license.
Ambulance or unit (i.e. Med 22, EMS 7)
4 digit service license
Dispatch assigned
The location the unit actually responds from,
such as a station number, hospital name, or
street location.
This is the five digit sequential numbering
system, which starts over every January 1st at
0001 hours. If multiple patients are treated,
assign either an alpha or numeric trailer to
identify each patient
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Incident Information
Be sure to indicate the County. This is
important for mutual aid responses. DO NOT simply
use a road or street name without a street number
or mileage figure!
This refers to the type of run you are sent on
(i.e. MVC, Man Down, Possible Heart Attack, etc.)
This refers to where the patient was found. (i.e.
in drivers seat or car, in street, bedroom,
front lawn of residence, etc.)
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Response
Check if your response was delayed
Times recorded in 24 hr. format (300 pm 1500)
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Aid Before Arrival
Check the appropriate box(es) to indicate anyone
who assisted the patient before your arrival.
More than one check box may be used.
Use check boxes to indicated any other types of
agencies responding to the scene. For combined
fire/EMS or Rescue/EMS agencies, check the boxes
for the role(s) actually performed by the agency
on scene.
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Patient History
This space is provided for listing the reason the
ambulance was called once you arrive on scene and
have assessed the patient(i.e., fall, doctors
appointment, chest pain, etc.).
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Crew Members
See next slide for appropriate information to be
placed in these boxes.
Each person should write their own name and
numbers. That eliminates the question if he/she
really made the response.
Check appropriate box
This is the type of scene or location where you
pick the patient up. Check only one box.
If presented with a EMS DNR form, mark it!
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Crew Members Cont.
Circle DRIVER or ATT. for each person listed in
this section.
A.    EMTs enter certificate number (DO NOT
PUT A, B, ETC. AFTER CERTIFICATE NUMBER)
Example EMT-B 12345 would be listed as
12345 B.    Paramedics enter certificate
number followed by the letter P C.    First
Responders enter F and the last six digits of
your certification number D.    Physician
enter MD in the space provided, followed by
your license number E.     Registered Nurse
enter RN in the space provided, followed by
your license number F. Other
indicate highest level of training if none of the
above, i.e. Driver only, CPR, first aid, EMT
trainee, etc. Include in the Narrative a
description of duties performed.
  NOTE If more than three crewmembers are
involved, check the Additional crew listed in
the Narrative box and list the remaining
crewmembers by name and certification number in
the text of the Narrative Box on Page 2.
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Patient Demographic Information
Complete all
P.I. indicates Pacific Islander
Indicate if patient was physically restrained by
means other than Immobilization, or the straps on
the stretcher (i.e. handcuffs by law enforcement
or soft restraints to keep patient from harming
themselves or others) and why.
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Medical / Cardiac Info
DIS Disease UNK Unknown SPEC Specify SUBST
Substance
If witnessed, ask about first two blocks
NA Not Applicable
If terminated, indicate in narrative of such.
Make sure Medic signs the form
If an AED was used, record here. Explain in
narrative who shocked.
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Physical
This area refers to your findings on the initial
patient assessment, as well as the secondary
assessment. Check all boxes that apply.
Best alternative!
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BLS Procedure Code
Eye, Verbal, Motor are the individual ratings to
complete the Glascow Coma Scale.
RTS
Revised Trauma Score
PROC Procedure ATT Attempts
SUC Suction
ASST Assisted BD Board
ELEV Elevation DEFIB Defibrillation
DELIV Delivery RESP Respiration SBP
Systolic Blood Pressure
DBP Diastolic Blood Pressure
TEMP Temperature
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Patient Disposition
TRANSF Transferred TR
Transported POV Privately
Owned Vehicle
REQ. Required
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Primary Impression Code
OBSTR Obstruction REACT Reaction
LOC Loss of Consciousness PSYCH
Psychological CARD Cardiac
RHYT Rhythm DIST
Disturbance HYPERTHER
Hyperthermia HYPOVOL Hypovolemia
PREG Pregnancy OB
Obstetrics RESP
Respiratory CVA
Cerebral Vascular Accident HEMMOR Hemorrhage

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Representative Signatureand EMS Care Provider
Signature at treatment facility. On home
transfers, ask individual or family member to
sign. (not critical for home trips)
The person writing the narrative should sign here
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Report Id
Same as side one
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BLS/ALS Procedure Codes
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Medication Administered
This block is for BLS and ALS (BLS Epi,
Glutose, Neb or Nitro) ALS all appropriate
24 hour time
List the power setting for the first, second, and
third shocks (as appropriate) for manual
defibrillation.
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Cause of Injury
Injury caused by
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Supplementary Information
This section required if MVC (i.e. vehicle,
motorcycle, ATV, or if accident occurs on water).
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Narrative
Although not technically required, complete
narrative as if you have to give the same report
one year later. Be specific. Make sure all
abbreviations are correct! Use extra paper if
needed. REMEMBER IF IT IS NOT IN WRITING YOU DID
NOT DO IT!!!!!!!!!
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QUESTIONS ?