1. A quick reference to using ESO
ESO Work Flow Guide
A quick reference to using ESO

2. Introduction
Hello!
Welcome to the ESO Work Flow Guide. The purpose of this document is to serve as a quick reference guide for documentation of a standard call in ESO. This document is derived from the ESO User Guide.
For a complete guide on how to use ESO, please refer to the User Reference Guide for King County, Washington.
For a guide to documenting specific scenarios, please refer to the Scenarios documents.
If you have any questions regarding this document please contact Dan Henwood ) or Sofia Husain ).

3. ePCR Landing Page
To go to the ESO Pro™ ePCR Suite landing page, click on the Electronic Patient Care Record (ePCR) link in the Navigation Panel.

4. ePCR Landing Page Incident List
The Incident List contains a list of the last 50 incidents (either in locked or draft status) that have been generated over the course of the last seven days. The sort order defaults to draft status calls listed first.
Incidents are presorted by date and time. You can change the way incidents are sorted by clicking on any of the column headings such as Status, Patient Name, etc. 
When an incident is created or selected so that the Incident Detail screen is displayed, you can return to the Main menu by clicking the HOME button (the button farthest to the left in the upper tool bar on each page). The LOGOUT button on the far right of each page can be used to log out of the system from any page at any time.

5. Importing CAD Data Importing CAD Data
If the Computer-Assisted Dispatch (CAD) interface is active:
Click the CAD button to see a list of any incidents that are available for import.
Selecting an incident will automatically open up a new incident detail and pre-fill any mapped fields.

6. Updating CAD information
Updating a record
CAD import is dependent upon internet connectivity. If you do not have connectivity and wish to start your record, select ADD from beneath the incident list on the landing page and begin your patient care documentation. When you are ready to import from CAD:
1. Go to the Incident Details page within the record you have created (do NOT return to the landing page of the program as this CAD button will create an additional record and not update your current record).
2. Be sure you have your unit and the incident number for your incident entered into the appropriate data fields and click on the gray CAD button next to the date field.
3.CAD data will auto populate into the appropriate fields.
4.At this point, you can also update the record with additional CAD data at any point during the call. The CAD import will overwrite any data you manually enter into data fields.

7. Screenshot Annotation Key
Those fields enclosed by red boxes should always be filled in if you have the information, or can obtain the information.
Dash boxes must be filled out if applicable to the situation
Fields marked with an * are further defined in the following slide(s)

8. Record Creation in ePCR- BLS
Inclusion Criteria
All calls with a patient(s) – each patient should have a separate BLS ePCR. Additional BLS units do not require an ePCR. BLS responses with a different agency will necessitate the creation of an ePCR for both agencies, however, the level of detail for each ePCR will depend on what services were provided by each agency
Cancelled enroute and cancelled at scene calls
No patient found calls
False Alarm if the unit started enroute (defined as the unit began rolling)
Standby calls
Patient assists (should contain basic patient information)

9. Record Creation in ePCR- BLS
Exclusion Criteria
In agency
Any EMS call you are dispatched to and subsequently cancelled prior to responding
Cancelled EMS calls unless you are the primary BLS unit
For multiple unit cancelled calls, the Aid car is the primary unit (otherwise engine if no Aid car). Only one BLS unit needs to create an ePCR for cancelled calls (enroute or on scene)
Out of primary agency
Only one BLS record for cancelled out-of-agency calls

10. Record Creation in ePCR- ALS
Inclusion Criteria
All calls with patient(s) who receive treatment and/or transport via Medic Unit (treatment includes exam or evaluation)
Cancelled enroute and cancelled at scene Medic Units should create an ePCR if they are responding out of agency. If in-agency (responding with your agency’s BLS unit), then no ePCR is needed
No patient found, Standby and False Alarms all require an ALS ePCR if responding outside your agency’s jurisdiction

11. Record Creation in ePCR- ALS/BLS
Exclusion Criteria
ALS Calls (in agency)
Any EMS call you are dispatched to and subsequently cancelled prior to responding
For cancelled calls (enroute or at scene) within your agency’s jurisdiction, where a BLS ePCR is being created, no ALS ePCR is required (ALS cancelled call record will be created in the background)
Unit substitution calls – no record creation for unit that didn’t take the call
ALS Only Calls (Applies to ALL KCM1 calls, and out of jurisdiction for ALS/BLS agencies)
Unit substitution calls – no record creation for unit that didn’t take the call, provided that the Unit is cancelled prior to responding
MSO Calls
Generally an ePCR is not required. MSO treatments and MSO name are added to Medic Unit ePCR as PTA and no MSO PCR is required provided the Medic unit is from the same agency
Cancelled MSO responses do not require an ePCR unless the call is out of agency and there is no other ALS unit from your agency on the call

12. Incident: Response Information*
The Response section documents the type of call, response mode, the reporting unit, and whether the unit responded from in quarters or out of quarters. *

13. Definition: *Run Type Run Type Description 911 Response - Emergency
Used for the vast majority of your calls
Intercept
Your unit is dispatched to intercept another unit, and provide treatment and/or transport
Emergency Interfacility Transfer
Your unit is dispatched to transport a critically ill patient from one facility to another
Non-Emergency Interfacility Transfer
Your unit is dispatched to transport a non-critical patient from one facility to another
Mutual Aid
Your unit is dispatched to provide mutual aid on an incident. Choosing this option will activate the adjacent “Mutual Aid” field where you can provide the reason your unit was providing mutual aid
Standby
Your unit was dispatched to a scene, but will only treat a patient, if necessary. For example, your unit was dispatched to a fire, but may or may not treat a patient. If your unit was dispatched to a call with another agency, and you did not provide any treatment or transport, use this option

14. Definition: *Mutual Aid
Mutual Aid allows you to provide the reason your unit was providing mutual aid. This is not the same as the NFIRS Mutual Aid, which only denotes which type of mutual aid you’re receiving  or providing (automatic or manual)

15. Incident: Scene Information*

16. Definition: *Mass Casualty
MCI is any incident in which EMS resources are overwhelmed by the number and severity of casualties.

17. Incident: City/ Zip Code Look-up
If you enter the zip code, then click on the magnifying glass next to the zip code field, the
City, County and State of the incident location will auto-fill. (Likewise, a reverse lookup
 can be used to help find a zip code when a city is selected.)

18. Incident Detail: Personnel
Add personnel by clicking the ADD button on the bottom left.
The LEAD position is the person responsible for writing the patient care report for that particular call. Select the appropriate crew members and select ADD.

19. Incident: Disposition/ Destination* * * * *
DEFINE: Disposition and Refusal Reason
Disposition documents whether the patient was treated and/or transported, and to what destination. Many destination locations (hospital ERs, for example) are pre-built into the system and that facility’s address will auto populate the address fields when a destination is chosen.
Many of the validation rules are based on which Disposition you choose for the incident.
Level of Service refers to the level of treatment that this patient received by your agency.
Click the magnifying glass to use zip codes and city look-up tools.

20. Definition: *Disposition
Description
Transported No Lights/Siren
Patient was treated and transported by your unit (reporting unit) with no lights/siren
Transported Lights/Siren
Patient was treated and transported by your unit (reporting unit) with lights/siren
No Treatment, No Transport
Your unit provided no treatment, and the patient was not transported
Treatment, No Transport
Your unit provided treatment, and the patient was not transported
Patient Care Transferred
Patient care was transferred to another unit, either for continuation of care (such as from an Aid car to a Medic Unit), or for transport
Treated, Transported by Private Vehicle
Your unit treated the patient, but the patient declared that they would transport themselves or take a taxi to a health care facility
Treated, Transported by Law Enforcement
Your unit treated the patient, but the patient was transported to a health care facility from the scene in a law enforcement vehicle
Call Cancelled
The call was cancelled enroute to the scene
Standby
Your unit was dispatched to a scene, but your services were not required and your unit was eventually cancelled at scene
No Patient Found
Your unit arrived at the scene, but no patient could be found
Dead on Scene, Transport
Patient was DOA, and your unit transported the patient
Dead on Scene, No Transport
Patient was DOA, and your unit did NOT transport the patient

21. Definition: *Transported Due To
Transported Due To allows you to specify the reason the patient was transported, which typically will be Protocol for BLS and Other for ALS.

22. Definition: *Requested By
Requested By is used to document who authorized or requested the transport.

23. Definition: *Diverted From
Diverted From is used to document the original destination facility before the diversion.

24. Definition: *Refusal Reason
Description
Against Medical Advice (AMA)
The patient refuses transport to a medical facility, against the advice of EMS personnel. Have the patient complete and sign the Patient Refusal form.
Patient to seek further care in POV
The patient has chosen to seek further care, and will provide their own transportation, either a privately owned vehicle or a taxi
Patient does not feel injury/illness requires ambulance
The patient has decided that their injury does not warrant transport to a medical facility for further evaluation or treatment.
Patient in custody of law enforcement
The patient was remanded to the custody of law enforcement, and therefore EMS will not transport the patient
Other
Choose Other if none of the above reasons apply. Choose this option if you (EMS personnel) feel that the patient does not need further evaluation or treatment.

25. Incident: Incident Times
Incident Times will be populated from CAD when you choose your responding unit from the CAD page to create the incident, and can be updated via the CAD button on the Incident page (do not use the CAD button on the Incident List page)
Any date/time fields previously entered will be overwritten if you update the CAD information by using the CAD button.

26. Incident: Additional Agencies & Delays
To track delays in response times, choose "Delayed Response." Then select the appropriate reason for the delay from the menu on the left.
Delays in responding MUST be recorded (including ‘none’). Delays in transporting MUST be recorded if patient is transported (including ‘none’)
Additional Agencies
Use this section to document any other responding agencies that were on scene. Pre-loaded agencies can be found by using the “Add” button. Information regarding other responders that are not pre-loaded can be entered using the radio buttons and comments field to the right. All appropriate agencies will be pre-loaded into the ‘Additional Agencies’ list for each agency. Document any agencies that you respond with on the call.

27. Incident Detail: NFIRS
Complete the NFIRS section to record the Incident Type, Property Use, and the Mutual Aid (Aid) received or given, if any. Also record the Actions (NFIRS Actions Taken). This information will auto-populate their respective fields in the ESO Fire module, or in Zoll using the ESO-Zoll interface.

28. Patient: Demographics
Enter patient demographic information by filling out each available field with information that you have available for your patient.
Every patient must have an age. When you enter a date of birth, the system will auto-calculate age. If you do not have a DOB for your patient, click the ESTIMATE box to input an estimated age.

29. Patient: Contact
Click the "Copy Address" box to auto-populate the patient address with the current incident address. Reminder – you can use the zip code and city look-ups via the magnifying glass to facilitate city, state, and county population.

30. Patient: Adding Additional Patients
Adding an Additional Patient
To document an additional patient on a call that was treated by the same responding unit, click the “+” button. The fields will clear so that you may enter the new patient information, including the patient Disposition.
After entering new information and switching tabs, note that the additional patient name has been added to the upper tool bar.

31. Patient: Adding Medical Hx, Allergies, Medications
Select the ADD button.  
Click the button that corresponds with the data you wish to enter (Medical History/ Allergies/Meds).
Select the appropriate medication, allergy, or history from the list on the right (you may select as many items as you wish).
This section cannot be left blank, so select “Denies,” “NKDA,” or “Unknown” if appropriate to complete documentation.
Select “Other” if the patient’s meds, allergies, or history are not in the drop-down menu. Document the specific med, allergy, or history in the comment box.
Click “Add” on the bottom right when your list is complete.
To delete an item from your list, click the red “x” to the right of the item.

32. Vitals: Vital Signs
All vitals should be documented in ESO and/or on the Short Form.
Enter the time the vital signs were taken using a 24-hr hhmm format (hoursminutes, no colon).
Modify the date as necessary (the date will default to the call received date, and the time will default to the current time).
If you are not certain about the exact time of measurement, enter an estimated time based on best judgment.
Tab and type through to enter data, or click the box in the upper right of each section to open a big button view for ease of data entry.
Select the A, V, P, or U and the LEFT/RIGHT (blood pressure taken in which arm) and the patient position tabs at the top of the page to enter the appropriate information. * *

33. Definition: *Respiration Rhythm
Respiration Rhythm documents the regularity of respirations. Choices are Regular, Irregular, Ventilated, or Assisted

34. Definition: *Respiration Quality
Respiratory Quality quantifies the type of respirations occurring. Choices are Normal, Labored, Shallow, Absent, Ventilated, or Assisted

35. Vitals: Trauma Scoring
Select the trauma score pull-out tab. Document the patient’s Glasgow Coma Scale information as applicable for all patients. The software will auto-calculate the Revised Trauma Score based on the GCS, BP, and RR for this set of vital signs. A pediatric trauma score is also available as necessary.

36. Flow Chart: Treatments
Select a treatment category from the bottom of the screen or the treatment details pull-out on the right side.
Any treatments provided or medications administered during this incident MUST be FULLY documented. The treatment date/time is ALWAYS required. If you don’t know the exact time, use an estimate.

37. Assessment: Initial and Ongoing
Initial and Ongoing Assessments
There are two assessment options in the assessment page: Initial and Ongoing. Enter the time of your assessment at the bottom of the page. If you don’t know the exact time, use an estimate or leave it blank if a time estimate cannot be ascertained.
At least one exam MUST be performed.
Together with the Anatomical Man (see next slide), you will be able to objectively identify the patient’s condition, and will need less detail in the Narrative.
To document assessment of a body area in more detail, select that area and add details as appropriate. Choose the affected body area on the left and then indicate pertinent positive or negative findings by selecting the + or – next to the affected area. Comments can be made as necessary in each section.

38. Assessment: Anatomical Man
The anatomical man is an excellent way to visually document the patient’s condition. Select the body in the upper right corner in order to display an anatomical figure. Note that all injuries/conditions placed on the body via the Anatomical Man will also be transferred to the data grid automatically.
Select the type of injury on the left and then place the injury on the affected part of the body. Use the zoom feature to focus on more detailed parts of the body.
You may rotate the body to show six different views. You also may modify the figure to represent a male, female, child, or infant by selecting the appropriate figure from the options on the right.
Edit any injury selection(s) you have made by selecting “Edit” and then clicking “Delete.”

39. Narrative: Clinical Impression
In addition to a written narrative, each PCR is required to have clinical impression information recorded. Primary Impression and at least one set of Supporting Signs/Symptoms for each treated and/or transported patient are required. The Primary Impression and Supporting Signs/Symptoms (one Primary and its associated Signs/Symptoms) are the equivalent of the King County Patient Type Code. Agencies may choose to record a second set of Impression / Signs / Symptoms to further document the patient’s condition. Please note that many King County Patient Type Codes map directly to a Primary Impression.
The Chief Complaint is the primary symptom or symptoms that the patient states as a reason for seeking medical care.

40. Narrative: Injury/ Other Factors
King County: You should complete the Patient Injured and if applicable, Alcohol/Drugs, for all patients. Select Yes for Patient Injured to enable the associated fields. Primary and Injury Details are equivalent to King County’s Mechanism of Injury field. Place of Injury allows you to document the physical location of where the injury occurred.
Record observations about patient alcohol and/or drug use via the Alcohol/Drugs drop-down list.

41. Importance of the Narrative
Things to consider while writing a narrative:
Should be an overall summary of the patient encounter
Tells a subjective story
More difficult/ complicated cases must have more detail
If using a tablet, the narrative will be the only written document of the incident and the patient care
NOTE: The narrative does not have to be completed on scene and can be completed back in quarters or at the hospital, if necessary.

42. Narrative: Narrative Box
The narrative section can be used to document subjective information or objective data that isn’t already recorded in another area of the report (use the Assessment tab for recording objective information).
Narrative Section: The Narrative section is required to complete the patient encounter documentation. The bare minimum content here must be sufficient to tell the story of the incident. Using the Assessment tab covers the objective portion of the Narrative, but does not give a complete picture of the patient encounter.

43. Narrative Examples

44. More Narrative Examples

45. Even More Narrative Examples

46. Narrative: Appended Narrative
The appended narrative can be utilized to add information to a previously locked call. This section can be accessed while the call is in locked status to add any clinical data that is pertinent but was left out of documentation (for example, failure to document oxygen administration to an intubated patient).
Make the comments in the APPENDED NARRATIVE box and click UPDATE to add them to the record. The record will include the name of the provider making the comments, the date/time the comments were made, and what specific comments were made.

47. Specialty Patient
Specialty Patient sections have been added to allow detailed documentation of particular patient encounters. Select the specific situation you wish to document. Only those situations pertaining to the KC Data Standard are initially enabled in ESO. Agencies may wish to add additional situations via the Admin Console to more fully document the patient encounter.

48. Specialty Patient: Aftercare Instructions
 Aftercare Instructions should be left with all non-transported patients, and you should document what information you conveyed to the patient. Select ‘N/A’ for patients that are DOA, GOA, AMA, or ‘No’ for transported patients. If ‘N/A’ or ‘No’ are selected, the remaining fields will be greyed out.

49. Signatures
For tablet users: collect all applicable signatures on the tablet
For non-tablet users: collect all applicable signatures on the short form
If patient refused care, complete the patient refusal form and obtain the patient signature
Obtain all signatures, including provider signature(s), before syncing the incident from the tablet (signatures are read-only on the computer)

50. Data Validation
The validation process reviews the report and alerts the writer of any missing or deficient data. If there is data missing in a particular section, you will see the word “Missing” in that section. Click on the section, and you will be navigated to the field in which you need to add or modify data. To perform the data validation check, click on the check box OR the lock button. Note: If you select the lock button, the case will lock after you complete the data validation.