INTERFACE WITH FIREHOUSE:

A Firehouse INCIDENT Report MUST be completed for every incident, including EMS incidents. As in the past the Incident Report should be completed by the 1st responder or other non-transporting apparatus when multiple units respond.

A Firehouse UNIT Report MUST be completed for each unit on an incident, including EMS incidents. The pre-printed MAIS number MUST be transcribed into the Firehouse Unit Report for all units completing a MAIS form.

• The location for MAIS number entry into the Firehouse Unit report is as follows:
  
  
• depress the Other tab,
  
  
• depress the User Fields tab,
  
  
• depress the MAIS tab. There are 5 fields for MAIS number entry. Enter the pre-printed MAIS number into the top field.
  
  
• Use the additional fields if you have multiple patients and therefore additional MAIS forms.

Only ONE MAIS form is to be completed for each patient. Only the unit that transports the patient (or obtains the patient refusal for non-transport situations) will complete a MAIS form. Other units that assess and/or treat the patient are required to complete an Additional Narrative.

A MAIS Additional Narrative Form should be used to document the following:

• If an ALS provider downgrades a patient for BLS transport, document the event on a MAIS Additional Narrative.
  
  
• Any time you feel you need to document your event more thoroughly (and you are not completing the MAIS form), document the event using a MAIS Additional Narrative.
  
  
• Place all completed MAIS and Additional Narratives in the lock box for collection. Once collected, all MAIS and Additional Narratives will be combined to form a complete record. It is OK to have 1 MAIS form and 2 or more Additional Narratives as part of the legal document. The important thing is to document your actions.
  
  
• MAIS forms and Additional Narratives should be placed in the lock boxes. All other paperwork, patient info sheets, 4x4s with vitals, etc (including carbon paper) should be shredded.

The Patient Information Sheet is no longer required. You may continue to use the Patient Information Sheet (or any other method) to gather information but ALL patient information and treatments are to be documented on the MAIS form. The MAIS form is the only acceptable documentation to be provided to the receiving facility. With the exception of the MAIS form, all paperwork containing patient information must be shredded.

THE MAIS REPORT:

The MAIS form may be completed either in pen or pencil

The MAIS form contains 3 copies. If a patient is transported, the hospital copies of the COMPLETED MAIS form and Additional Narrative should be left at the receiving facility (see specific instructions below). The MAIS form is the only acceptable documentation to be provided to the receiving facility. The other copies should be taken back to the station.

• HOSPITAL COPY (yellow). This should be given to the receiving facility staff. This becomes part of the hospital record.
  
  
• MIEMSS RECORD (top copy). This should be placed into the Fire Station MAIS Form lock box. The forms will be picked up by MCFRS personnel on a regular basis.
  
  
• OFFICIAL COPY (middle copy). This copy should be used to transcribe the MAIS number and other appropriate information into the Firehouse Unit report. When complete, the Official Copy should be placed into the Fire Station MAIS form lock box.
  
  
• NOTE - Patient Refusal: The back of the OFFICIAL COPY contains the PATIENT REFUSAL form. The OFFICIAL COPY MUST be used to document all patient refusals. When complete, the official copy should be placed in the Fire Station MAIS form lock box.
  
  

A provider may not maintain or store in their possession any document containing patient information, assessment, care or other confidential patient information.

The incident number (last 6 digits) MUST be placed on all copies of the MAIS form. This should be done prior to submitting the report to the receiving facility staff. The incident number should be transcribed from your CAD printout or MDC terminal onto the MAIS form. Again, only use the last 6 digits of the incident number.

The Response Location MUST filled in. Fill in the dispatched location (or corrected location) into the Response Location field.

In the Provider 1 field, fill in the FSID number and Name of the CHARGE EMTB or ALS Provider. Use the additional provider fields to enter the FSID number and name of providers who administer AED, Meds, BLS care, or an ALS treatment. These numbers will only be used with the corresponding treatment fields at the bottom of the report and in the narrative. If you need to document more than 3 providers, list provider 4, 5, etc starting on the first line of the MAIS narrative. If no AED, Meds or ALS treatment is administered then there should only be one provider listed.

It is not necessary to fill in unit times on the MAIS form. Response times are captured in CAD and will be integrated into the MIEMSS data submittal by IT.

The County code for Montgomery County is 15.

You MUST fill in the UNIT field.

You MUST fill in the "Dispatched As" field. Darken either ALS or BLS.

In the Procedures field, darken the "attempt" or "successful" bubble when applicable and darken the provider number who delivered the care. This should correspond with the provider numbers at the top of the page. If you need to document more than 3 providers, list provider 4, 5, etc starting on the first line of the MAIS narrative.

In the Special Purpose field, darken the bubble corresponding to "Additional Narrative" when applicable.

The Charge Provider must sign the MAIS form. Obtain a receiving "Hospital Signature" when appropriate.

Document the first and last vitals in the two fields beneath the signature lines. Additional vitals should be documented in the narrative.

You MUST fill in a local variance for all transported patients. In the VARIANCE field (VAR), darken "A" for ALS transport and "B" for BLS transport. This will be used to assist with QA on EMD and "dispatched as" versus "transported as". This info is very important as we continually evaluate the effectiveness of EMD.

With the exception of the fields discussed above, all remaining fields MUST be completed when they apply to your patient or treatment.

You MUST complete an Additional Narrative anytime you need more space than is provided at the bottom of the MAIS form. Remember to darken the Addit Narr bubble. Document patient refusals appropriately using the Additional Narrative.