Version 5.0 Field Bridge

Overview The Virginia OEMS has been using State Bridge [VPHIB] for over 11 months now. Their initial push was to insure all Virginia agencies were preparing and submitting Patient Care Reports correctly and in a timely manner. They feel this task is now complete and are now beginning the next step of reviewing the quality of data submitted. Most agencies across Virginia found that they were submitting data at much less than 100% complete. We were tasked with determining the states data requirements and creating validation rules that were inline with these requirements. As a result, there are many more fields that require data. This training is designed to show you each screen and tab and answer any questions about the system.

Ground Rules Narratives – One must be created for ALL calls. Transports, Refusals, Cancelled, Stand-bys… etc .etc. CAD Interface – If you are unable to pull CAD data into the laptop: Check the SPRINT connection. Sometimes Sprint lies, it says you are connected, but you are not. Try GOOGLE. If Sprint has been verified and connected and you are still unable to load the data, contact system administrators. “Not Applicable” or “Not Known”. The state has decided this is not appropriate data submission for some fields. They have been removed as options in these fields. . Some field names have been changed in an attempt to make the data “flow” better.

National Emergency Medical Services Information System. Terminology NEMSIS National Emergency Medical Services Information System. NEMSIS is the national repository that will be used to potentially store EMS data from every state in the nation

Virginia Pre-Hospital Information Bridge Terminology VPHIB Virginia Pre-Hospital Information Bridge VPHIB is used for a variety of uses including: system planning, system evaluation, grants management, support legislative inquiries, contribute to other state and national databases, monitor triage programs and more.

STATE BRIDGE Terminology The ImageTrend State Bridge enables State EMS agencies to securely collect, analyze and report on statewide EMS data

RESCUE BRIDGE Terminology Rescue Bridge is fire and EMS solution incorporating ePCR, fire inspections, pre-planning and inventory data collection and management in a paperless environment.

FIELD BRIDGE Terminology Field Bridge is a pre-hospital patient care data collection and reporting application. Designed to assists EMS personnel in quickly generating complete electronic ePCRs in a mobile environment.

National Fire Information Reporting System: Terminology NFIRS National Fire Information Reporting System: A standard national reporting system used by U.S. fire departments to report fires and other incidents(EMS) to which they respond to.

Virginia Fire Information Reporting System: Terminology VFIRS Virginia Fire Information Reporting System: The Virginia Department of Fire Programs (VDFP) manages these reports. VFIRS is the statewide system for tracking all emergency responses with fire departments in Virginia. 

Log into Field Bridge

Image Trend Ver. 5.0 Training Log into Field Bridge Username Password Verify Database you are signing into. DFREM Co1 Co2 Etc.etc. You can SYNC here or once you have signed in. SETTINGS is where you would SYNC-ALL. SYNC-ALL will reload the entire database.

Image Trend Ver. 5.0 Training Field Bridge SYNC actually loads updated database items from the Rescue Bridge server located in Minnesota. Items in this SYNC include but are not limited to: New or updated member names. New or updated validation rules. New or updated medications. New or updated apparatus. Many more items. Items not loaded are: Records generated on other laptops.

Image Trend Ver. 5.0 Training Now you are ready for the next call. If you staff units, you can pre-fill some information that will forward to the ePCR when you open a new one. They are: Current Unit: Select from the dropdown the unit you will be staffing. Current Shift: Select from the dropdown: Career, Volunteer, Combo Current Crew: Select Add Personnel Select from the dropdown the personnel riding and their position on the unit.

Starting A Call

Image Trend Ver. 5.0 Training When a call comes in: Select DOWNLOAD CAD from the top left screen. A popup of calls, including your unit number, will appear. You can also select [All] which will display all calls and units for several days.

To Scene Tab

Image Trend Ver. 5.0 Training ePCR is now open and ready for input. RED tabs indicate missing data that’s required by the State of Virginia for ePCR reporting. ALL “To Scene” TABS need to be completed for ALL calls. Even Cancelled Calls.

Image Trend Ver. 5.0 Training To Scene – Personnel Tab If you entered crew on the dashboard, this will auto fill. You can also add or remove personnel here if desired. You should verify correct personnel and positions have been added.

Image Trend Ver. 5.0 Training To Scene – Dispatch Information Tab If everything is working with CAD and the server, this data is automatically loaded with the exception of several type of calls. There is a open Image Trend problem ticket on these items.

Image Trend Ver. 5.0 Training To Scene – Dispatch Information Tab If you have to fill any of these fields these out due to CAD service interrupts, PLEASE enter the Incident number as YYXXXXX. (Max of 7 characters) Rip and Tear will display the incident as 2011-12345 DO NOT ENTER the “-” or the “20” for 2011.

Image Trend Ver. 5.0 Training To Scene – Incident Address Tab If everything is working with CAD and the server, this data is automatically loaded with the exception of several fields. They are: Postal Code: First Due Zone:

Image Trend Ver. 5.0 Training To Scene – Incident Address Tab – Postal Code Postal Code: If you are unsure of the postal code, you can use the :Postal Code reference” dropdown and select the correct code. You will find the most used postal codes in and around the Fauquier County area. - If you need one added, see your administrator.

Image Trend Ver. 5.0 Training To Scene – Incident Address Tab – First Due Zone First Due Zone: Select the correct “FIRST DUE ZONE”. Use the zone for the dispatched box number. Example Box 0101 would be zone 01-Warrenton. Box 0701 would be zone 07-Catlett. Etc….

Image Trend Ver. 5.0 Training To Scene – Response Information Tab Response Information has several fields we are unable to [DEFAULT]. They are: Location Type Primary Role of Unit The other fields [DEFAULT] but should be reviewed. Response Request. Vehicle Type. Response Mode to Scene. Response Urgency.

Image Trend Ver. 5.0 Training To Scene – Response Information Tab – Location Type Location Type: Select the correct type.

Image Trend Ver. 5.0 Training To Scene – Response Information Tab – Primary Role of Unit Primary Role of Unit: Select the correct role.

Image Trend Ver. 5.0 Training To Scene – NFIRS – Incident Type Incident Type: Select the correct type from the dropdown. Most used EMS selection are now at the TOP.

Image Trend Ver. 5.0 Training To Scene – NFIRS – Primary Action Taken Primary Action Taken: Select the correct action from the dropdown. Most used EMS selection are now at the TOP.

Patient Information Tab

Image Trend Ver. 5.0 Training Patient Information Patient Information

Image Trend Ver. 5.0 Training Patient Information – Response Disposition Select the correct option Treated and Transported ALS/BLS - if you transport. Treated, Transferred - care if you flew the pt, or turned over to another agency. Treated, Transported by Law Enforcement. Treated, Transport by POV. Treated and Released if you treated and released. Patient Refused Care – Must obtain a signature and reason why they refused. State says: All refusals are AMA. Dead at Scene – If confirmed code. No Treatment Required – if no treatment required. No Patient found – if unable to locate a patient. Unable to locate a patient – if unable to locate. Standby Only – All Fire calls with no patient. Cancelled – If cancelled. Remember - - - Must complete ALL fields on “To Scene” tab and reload CAD times before closing a cancelled call.

Image Trend Ver. 5.0 Training Patient Information – Patient Demographics Enter Last Name and select the REPEAT PATIENT button above. This will search under your agency to see if this patients data is already there.

Image Trend Ver. 5.0 Training Patient Information – Patient Demographics – Repeat Patient If your agency transported within the last 6 months, their name should drop down as shown here. Place curser over the correct one and double click or select the OPEN button to the right of the name. The data will automatically populate the correct fields. The Past Medical Hx will populate as well as long as it was entered by the last provider.

Image Trend Ver. 5.0 Training Patient Information – Patient Demographics All fields in RED are required if you treated in any way, for Patient Refusals, or for DOAs.

Image Trend Ver. 5.0 Training Patient Information – Patient Demographics Last Name – Please not all CAPS or all small letters. (example-Jones… not jones or JONES) . First Name – Same rules as Last name. Enter your Unit Number – (example- M1, A1-1, ) If you transport more that one patient, please add a unique number at the end of your unit number. (example- M1-1,M1-2. or A1-1-1, A1-1-2) Race – Select from dropdown. Ethnicity – Select from dropdown. Gender – Select from dropdown. SSN – Try to obtain, but if you can not, please enter 999-99-9999, Do Not Enter 0’s or 8s. Date of Birth – MM/DD/YYYY Age will auto calculate. Address – If the patient is home, you can select the “GET INCIDENT ADDRESS” bar above and it will auto fill from the dispatched address. Postal code – will auto fill as well. If home address is different, just enter the postal code and select the “ SET FROM POSTAL CODE” bar.

Image Trend Ver. 5.0 Training Patient Information – Past Medical History Medical History selection box – Selecting the (+) will give you a dropdown to select from. Place curser over the correct selection and click once, then move to another and click once again. If you want to remove a selection, just place curser over and click again. Other medical history – Enter any history that is not in the dropdown. History obtained by- Select from dropdown Pregnancy- If Female and between 12 and 50, State requires this data. Patient Medications – Select “Add Patient Medication” and select from dropdown. If medication is not listed, [email Butch, the name of the drug and It will be added to the list] Patient Drug Allergies – Select “Add Patient Medication” and select from dropdown.

Image Trend Ver. 5.0 Training Patient Information – Barriers to Patient Care If any barriers to patient care, change here. We currently [DEFAULT] to None.

Image Trend Ver. 5.0 Training Patient Information – First Responder Agencies / Prior Aid We [DEFAULT] all fields. If any differences just change.

Image Trend Ver. 5.0 Training Patient Information – Vehicular Information If vehicle accident was indicated and injury was indicated ALL fields are required. Select from the dropdowns of each box.

Vitals, Meds, Procedures Tab

Image Trend Ver. 5.0 Training Vitals, Meds, Procedures Vitals, Meds, Procedures

Image Trend Ver. 5.0 Training Vitals, Meds, Procedures – Provider Impression Must enter provider impression. Select from dropdown Must also enter secondary impression. State Required. Can use Not Applicable in this field.

Image Trend Ver. 5.0 Training Vitals, Meds, Procedures – Patient Condition Onset Date/Time – Handy, but not required Chief Complaint – Required Free form text. Duration of that complain – Required Unit of measure – Select from dropdown. Secondary Complain – If applicable. Duration of Secondary Complaint If complain. Alcohol/drug Use – Required Required – [DEFAULT] to NO. Primary Symptom – Required Other Symptoms – Required Anatomic Location Complain – Required Select from dropdown Organ System Complaint – Required

Image Trend Ver. 5.0 Training Vitals, Meds, Procedures – Patient Condition Trauma Information Possible Injury – Required Select from dropdown Cause of Injury – Mechanism of Injury – Select from dropdown. Injury Intent – Height of Fall (feet) – Enter number of feet. If from standing position (enter 1 foot).

Image Trend Ver. 5.0 Training Vitals, Meds, Procedures – Vitals, Meds, Procedures, EKGs Vitals, Meds, Procedures, EKGs tab Enter your Medications. Select the Add Med button. Enter your Procedures. Select the Add Proc button. Enter your Vitals Select the add vitals button. Enter your EKG assessment. Select the Add EKG button Each are defined in the next few slides.

Image Trend Ver. 5.0 Training Vitals, Medications, Procedures, EKGs – ADD VITALS TAB (1) Blood Pressure– Enter numbers Pulse – Enter pulse. Resp – Enter rate. SpO2 – Enter number SpO2 Qualifier – Select from dropdown Pulse Rhythm – Resp. Rhythm – Select from dropdown. BP Location – Patient Position – Remember: Make sure date / time is correct

Image Trend Ver. 5.0 Training Vitals, Medications, Procedures, EKGs – ADD VITALS TAB (2) Pain Scale – Enter numbers . Blood Glucose – Enter number. If meter says High or low, check the appropriate box . ETCO2 – Currently not available. . GCS – Enter number APGAR – Enter a number. Temp F C – Temp Method – Select from dropdown. Crew – Will [DEFAULT] to PCP. Make sure correct name displayed. Response Level – Remember: Make sure date / time is correct

Image Trend Ver. 5.0 Training Vitals, Medications, Procedures, EKGs – ADD VITALS TAB (3) Response Level – Select from dropdown. Stroke Scale – Select from drop down if appropriate. Breathing – Airway – Prior to arrival – Revised trauma Score – Enter number. Pediatric Trauma Score – Remember: Make sure date / time is correct Click Save or Save and New

Image Trend Ver. 5.0 Training Vitals, Medications, Procedures, EKGs – ADD PROC TAB Procedure Name – Select from dropdown Size of Equipment – Enter if appropriate. Location – Attempts – Enter a number Success – Patient Response – Prior to Arrival – Select from dropdown. Crew Id – Make sure correct name is displayed. Authorization – Authorizing Physician – Complication – Select from box. Comments – Short free form to make any comments. Remember: Make sure date / time is correct Click on Save or Save and New.

Image Trend Ver. 5.0 Training Vitals, Medications, Procedures, EKGs – ADD MED TAB Medication Name – Select from dropdown Dosage – Enter number. Dosage Unit – Route – Select from dropdown. Response to Medication – Prior to Arrival – Crew Id – Make sure correct name is displayed. Authorization – Authorizing Physician – Complication – Select from box. Comments – Short free form to make any comments. Remember: Make sure date / time is correct Click on Save or Save and New.

Image Trend Ver. 5.0 Training Vitals, Medications, Procedures, EKGs – ADD EKG TAB Select the correct EKG method – Place curser over correct dot and click. Interpretation – Select from dropdown EKG Ectopy – Select from dropdown. EKG Lead – Cause for Change – AED, Pacing, Co2 Mode Type of Shock – Crew Id – Make sure correct name is displayed. Shock or Pacing Energy – Total Number of Shocks – Enter number. Pacing Rate – Remember: Make sure date / time is correct Click on Save or Save and New.

Image Trend Ver. 5.0 Training Vitals, Meds, Procedures - Assessments You can select: Medical Injury Burn Note – If you select any of the three, you will get a picture of a anatomically correct human. Open with caution in public.

Image Trend Ver. 5.0 Training Vitals, Meds, Procedures – Assessments – Medical Click on the anatomical location of the medical incident and add information. Open with caution in public.

Image Trend Ver. 5.0 Training Vitals, Meds, Procedures – Assessments – Injury Click on the anatomical location of the injury and add information. Open with caution in public.

Image Trend Ver. 5.0 Training Vitals, Meds, Procedures – Assessments – Burn Click on the anatomical location of the burn. One click causes 1st degree.(purple) Two clicks displays 2nd degree.(yellow) Three clicks displays 3rd degree.(red) System also calculates BSA as you click. Open with caution in public.

Image Trend Ver. 5.0 Training Vitals, Meds, Procedures – Cardiac Arrest Cardiac Arrest – [DEFAULT] NO If yes, Change it to YES. Required fields will change to RED, however ALL fields should be reviewed if Cardiac Arrest = YES.

From Scene Tab

Image Trend Ver. 5.0 Training From Scene From Scene

Image Trend Ver. 5.0 Training From Scene – Patient Transport / Positioning All three fields must be completed for transports. Patient moved to Ambulance – Select from dropdown. Patient position in Transport – Semi-Fowlers is the [DEFAULT], Change if necessary. Patient Moved From Ambulance – Stretcher is the [DEFAULT], Change if necessary.

Image Trend Ver. 5.0 Training From Scene – Transport Mode From Scene Select the correct type of mode. [DEFAULT] - No Lights or sirens

Image Trend Ver. 5.0 Training From Scene – Destination Name Select the correct destination. Select the appropriate hospital from the dropdown.

Image Trend Ver. 5.0 Training From Scene – Destination Type Select the correct destination type. Select the appropriate destination type.

Image Trend Ver. 5.0 Training From Scene – Destination Determination Select the correct destination determination. Select the appropriate destination determination.

Image Trend Ver. 5.0 Training From Scene – Mileage Enter correct mileage from the odometer and it must include “tenths”. This is a NIMSIS Starting Mileage – Odometer reading from the station or your beginning location with tenths. Example-[12034.7] At Scene – Odometer reading at the scene of the incident. with tenths Example-[12040.2] At Hospital – Odometer reading at the hospital. with tenths Example-[12050.4] Ending Mileage – Odometer reading when you are back at the station or your original starting place. with tenths Example-[12060.9] Enter LOADED mileage carefully. These are “billed miles” and subject to audit. If you do not transport, you still need the Beginning and Ending Mileage.

Image Trend Ver. 5.0 Training From Scene – Narrative Enter your narrative. Free form text with spell check. Be specific in your narrative. You can use the CHARTED narrative option, HOWEVER, it must be updated and reviewed prior to completion. Remember, if you make note of a Procedure, an EKG, a set of Vitals, or Meds administration, YOU MUST document it under the “Vitals, Meds, Procedures TAB. Also remember – If you didn’t document it , in the court of law, it didn’t happen. It’s not what you remembered, it’s what you wrote down.

Image Trend Ver. 5.0 Training From Scene – Valuables Enter any valuables, belongings the patient may have entrusted you with. You can select from the dropdown, or enter others not listed.

Image Trend Ver. 5.0 Training From Scene – Delay Document any delays you may have encountered. [DEFAULT] is set to NONE on all four. Really only need to document significant delays. Delays by a one minute train passing versus a stopped train. Delays by having to run from outside versus you were coded. Delays by taking extra time to load a patient versus waiting for animal control to gain access to a patient. Delays by taking extra time to complete a long narrative versus hospital not finding you a room for 10 minutes.

Signature Tab

Image Trend Ver. 5.0 Training Signatures Signatures

Image Trend Ver. 5.0 Training Signatures – Patient Signature Signatures Select the HIPAA Consent- Try to explain what HIPAA is. Select the Authorization to Billing. Try to explain Fauquier County Compassionate Billing policy. Billing agency will bill your insurance company first. If no insurance – they will bill the patient--- BUT if they are unable to pay, the bill is waived. Select the Waiver of Liability only of you obtain a Patient Refusal. Have Patient sign whenever possible. If not possible – (unresponsive)- Just take the pen and put your initials in the field.

Image Trend Ver. 5.0 Training Signatures – Against Medical Advise If Patient Refuses transport. Check the box in the top left called – Attach AMA to this Incident. Fill out as much information as possible. Remember this is to cover you.

Image Trend Ver. 5.0 Training Signatures – Technician Signature Technician signs all reports.

Image Trend Ver. 5.0 Training Signatures – Hospital / Receiving Agent Signature Signature obtained by nurse you are turning patient over to. If only BLS procedures performed, this is the only signature you need from the hospital.

Image Trend Ver. 5.0 Training Signatures – Medical Control / Physician Signature Signature obtained by any ER Doctor. If ALS procedures performed, you must obtain a signature from the Doctor.

Image Trend Ver. 5.0 Training Signatures – Controlled Substance Waste Signature 1 Signature must be obtained by any ER nurse if you waste NARCOTICS. If NARCOTICS are used, you must obtain a signature from the Doctor. When replacing the NARCOTICS box: Box must contain all narc’s not used or wasted. Red tag. Printed copy of the Run Sheet with a signature of the Doctor. If you have unused narcotics, the run form must also contain the signature of the nurse that witnessed you waste these narcotics.

Image Trend Ver. 5.0 Training Signatures – Controlled Substance Waste Signature 2 Narcotics that were wasted must be listed below in the dropdown. If more than two narcotics were partially used, document in the narrative and let Image Trend Administrator know.

POWER TOOL BAR Down Left Side of Screen

Image Trend Ver. 5.0 Training Power Tools GCS Select the blue button for each test: Eye Verbal Motor Qualifier Your GCS score is totaled and posted in the Vitals tab automatically. Verify your times field.

Image Trend Ver. 5.0 Training Power Tools VITALS Enter appropriate data for each check: Pulse Respirations Blood Pressure BP Location SpO2 Blood Glucose Your Vitals are posted in the Vitals tab automatically. Verify your times field.

Image Trend Ver. 5.0 Training Power Tools PQRST Select the blue button for each test: Provoked Quality Region Radiation Duration Severity Narrative – Short informative comments only. Your information is posted in the Vitals tab automatically. Verify your times field.

Image Trend Ver. 5.0 Training Power Tools CARDIAC Select the correct medication as it is administered. It will display meds and times to the right. Press OK at the bottom and your meds information is posted in the Vitals tab automatically. Verify your times field.

Image Trend Ver. 5.0 Training Power Tools MEDS Select the green button for each Medication administered: Medication Dose Unit of measure Route Site Response Your MEDs are posted in the Vitals tab automatically. Verify your times field.

Image Trend Ver. 5.0 Training Power Tools PEDIATRIC Select the correct weight of the child: Example 26-30 lbs Correct doses are displayed for that size child. No need for the Pediatric Emergency Tape. (AKA Broselow)

Image Trend Ver. 5.0 Training Power Tools Same as under the Vitals, Meds, Procedures Tab. Click on the anatomical location of the medical incident and add information. Open with caution in public.

Image Trend Ver. 5.0 Training Vitals, Meds, Procedures – Assessments – Injury Same as under the Vitals, Meds, Procedures Tab. Click on the anatomical location of the injury and add information. Open with caution in public.

Image Trend Ver. 5.0 Training Power Tools Same as under the Vitals, Meds, Procedures Tab. Click on the anatomical location of the burn. One click causes 1st degree.(purple) Two clicks displays 2nd degree.(yellow) Three clicks displays 3rd degree.(red) System also calculates BSA as you click. Open with caution in public.

Down Right Side of Screen

Image Trend Ver. 5.0 Training Right Side of Screen Response Times All fields should auto-fill from the CAD data with the exception of: Arrived Patient Only needed if you made patient contact. In Service If you POST before you enter the In Service time, GO BACK AND FIX and RE-POST. This is one of the single most points of STATE failure. Loading CAD data again here is a good idea.

Image Trend Ver. 5.0 Training Right Side of Screen Validation Now we are synchronized with the state codes: If you reach 100% here, we actually are 100% with the state. By selecting this tab, you can see why we are not 100% complete and how many points the STATE takes off. It will take you to the screen with the missing field(s).

Image Trend Ver. 5.0 Training Right Side of Screen Active Protocols Select this tab and you get a dropdown where you can select active protocols. Placing a check mark in the fields will auto-fill the vitals tab.

Image Trend Ver. 5.0 Training Right Side of Screen JotPad Free form note pad. These notes become part of your overall report.

Across the top

Image Trend Ver. 5.0 Training Laptop screen overview

Image Trend Ver. 5.0 Training Top Line View Save Button – Saves the report to the laptop only.

Image Trend Ver. 5.0 Training Top Line View CAD Button – Loads CAD data to the report. Can be used anytime during the call. Will only overwrite the fields supplied by CAD. Incident number Location of call Times Will not overwrite the any other fields you entered.

Image Trend Ver. 5.0 Training Top Line View POST Button – Prepares report to be uploaded (POST) to Minnesota (Rescue Bridge).

Image Trend Ver. 5.0 Training Top Line View POST Button – Note that the system is uploading to Rescue Bridge.

Image Trend Ver. 5.0 Training Top Line View POST Button – Note that the system is validating the report for Rescue Bridge.

Image Trend Ver. 5.0 Training Top Line View POST Button – Posting is now complete. HOWEVER – Remember the POST/SYNC does two things. POST – Posts the report to Rescue Bridge. SYNC – Synchronizes the Field Bridge. If the POST fails – SYNC will still show 100% complete. Don’t be fooled.

Image Trend Ver. 5.0 Training Top Line View PRINT Button – Prepares report to be printed. This may take a few seconds because it is generating a PDF file. Print one copy for the hospital. If you used NARC’s print two copies. One for the hospital. One to accompany the NARCs to the Pharmacy.

Image Trend Ver. 5.0 Training Top Line View MORE Button – History – Tracks all activity for the report.

Image Trend Ver. 5.0 Training Top Line View MORE Button – Transfer Run– Ability to send data to another agency. Example - Catlett starts a call and Medic 1 rendezvous. Catlett can upload the data they have acquired and Medic 1 can complete from there.

Image Trend Ver. 5.0 Training Top Line View MORE Button – Attach – Can attach additional documents to the report. Currently not used.

Image Trend Ver. 5.0 Training Top Line View MORE Button – Delete – You can delete the entire report if desired. Not recommended.

Image Trend Ver. 5.0 Training Top Line View CLOSE Button – Closes that report – Returns you to the Dash Board.

Image Trend Ver. 5.0 Training Verify POST complete Dash Board will display a check mark next to the run.

Any Questions ?