TITLE 836 INDIANA EMERGENCY MEDICAL SERVICES COMMISSION
836 IAC 1-1-5
Reports and records
Authority: IC 16-31-2-7
Affected: IC 4-21.5; IC 16-31-3
Sec. 5.
(a) All emergency medical service provider organizations shall comply with this section.
(b) All emergency medical service provider organizations shall participate in the emergency medical service system review by collecting and reporting data elements. The elements shall be submitted to the agency by the fifteenth of the following month by electronic format or submitted on disk in the format and manner specified by the commission. The data elements prescribed by the commission are as follows:
(1) Provider organization number.
(2) Date of incident.
(3) Time call received.
(4) Incident number.
(5) Service type.
(6) Time of dispatch.
(7) Location type.
(8) Patient name.
(9) Response number.
(10) Patient car record number.
(11) Patient zip code.
(12) Gender.
(13) Race.
(14) Time unit responding.
(15) Time of arrival at scene.
(16) Time unit left scene.
(17) Time available for service.
(18) Lights and siren to scene.
(19) Lights and siren used from scene.
(20) Level of care provided.
(21) Provider impression.
(22) Mode of injury.
(23) Incident/patient disposition.
(24) Vehicle type.
(25) Destination/transferred to.
(26) Destination determination.
(27) Time of arrival at destination.
(28) Incident location.
(29) Date of birth.
(30) Medical history.
(31) Signs and symptoms.
(32) Injury description.
(33) Safety equipment.
(34) Suspected drug/alcohol use.
(35) Pulse rate.
(36) Respiratory rate.
(37) Respiratory effort.
(38) Systolic blood pressure.
(39) Skin perfusion.
(40) Glasgow eye opening.
(41) Glasgow verbal component.
(42) Glasgow motor component.
(43) Airway treatment.
(44) Stabilization treatment.
(45) Miscellaneous treatment.
(46) Medication name.
(47) Research code.
(48) Crew member one number.
(49) Crew member two number.
Basic life support nontransport provider organizations are required to submit data elements only for runs on which a defibrillator is used. If the defibrillator is not used on any runs during a month, then the basic life support nontransport provider organization shall report “no runs” on its monthly report for that month.
(c) Each emergency medical services provider organization shall retain all records required by this rule for a minimum of three (3) years, except for the following records that shall be retained for a minimum of seven (7) years:
(1) Audit and review records.
(2) Run reports.
(3) Training records.
(d) An emergency medical service provider organization that has any certified vehicles involved in any traffic accident investigated by a law enforcement agency shall report that accident to the agency within ten (10) working days on a form provided by the agency.
(e) Each provider organization, except basic life support nontransport provider organization, shall maintain accurate records concerning the assessment, treatment, or transportation of each emergency patient, including a run report form in an electronic or written format as prescribed by the commission as follows:
(1) A run report form shall include, at a minimum, the following:
(A) Name.
(B) Identification number.
(C) Age.
(D) Sex.
(E) Date of birth.
(F) Race.
(G) Address, including zip code.
(H) Location of incident.
(I) Chief complaint.
(J) History, including the following:
(i) Current medical condition and medications.
(ii) Past pertinent medical conditions and allergies.
(K) Physical examination section.
(L) Treatment given section.
(M) Vital signs, including the following:
(i) Blood pressure.
(ii) Pulse.
(iii) Respirations.
(iv) Level of consciousness.
(v) Skin temperature and color.
(vi) Pupillary reactions.
(vii) Ability to move.
(viii) Presence or absence of breath sounds.
(ix) The time of observation and a notation of the quality for each vital sign.
(N) Responsible guardian.
(O) Hospital destination.
(P) Radio contact via UHF or VHF.
(Q) Name of patient attendants, including emergency medical service certification numbers
and signatures.
(R) Vehicle certification number.
(S) Safety equipment used by patient.
(T) Date of service.
(U) Service delivery times, including the following:
(i) Time of receipt of call.
(ii) Time dispatched.
(iii) Time arrived scene.
(iv) Time of departure from scene.
(v) Time arrived hospital.
(vi) Time departed hospital.
(vii) Time vehicle available for next response.
(viii) Time vehicle returned to station.
(2) The run report form shall be designed in a manner to provide space for narrative notation of
additional medical information.
(3) A copy of the completed run report form shall be provided to the receiving facility when the patient is delivered unless it is not feasible; however, the form shall be provided to the receiving
facility no later than twenty-four (24) hours after the patient is delivered.
(4) When a patient has signed a statement for refusal of treatment or transportation services, or
both, that signed statement shall be maintained as part of the run documentation.
(f) Each basic life support nontransport provider organization shall maintain, in a manner prescribed by the commission, accurate records, including a run report form, concerning the assessment and treatment of each emergency patient as follows:
(1) A run report form shall be required by all basic life support nontransport provider organizations,
including, at a minimum, the following:
(A) Name.
(B) Identification number.
(C) Age.
(E) Sex.
(F) Race.
(G) Physician of the patient.
(H) Date of birth.
(I) Address, including zip code.
(J) Location of incident.
(K) Chief complaint.
(L) History, including the following:
(i) Current medical condition and medications.
(ii) Past pertinent medical conditions and allergies.
(M) Physical examination section.
(N) Treatment given section.
(O) Vital signs, including the following:
(i) Pulse.
(ii) Blood pressure.
(iii) Respirations.
(iv) Level of consciousness.
(v) Skin temperature and color.
(vi) Pupillary reactions.
(vii) Ability to move.
(viii) Presence or absence of breath sounds.
(ix) The time of observation and a notation of the quality for each vital sign.
(P) Responsible guardian.
(Q) Name of patient attendants, including emergency medical services certification numbers
and signatures.
(R) Vehicle emergency medical services certification number.
(S) Responding service delivery times, including the following:
(i) Time of receipt of call.
(ii) Time dispatched.
(iii) Time arrived scene.
(iv) Time of patient released to transporting emergency medical services.
(v) Time vehicle available for next response.
(T) Date of service.
(U) Safety equipment used by patient.
(2) The report form shall provide space for narrative description of the situation and the care
rendered by the nontransport unit.
(3) A signed statement for refusal of treatment or transportation services, or both, shall be
maintained as part of the run documentation.