Implementing electronic patient tracking in your EMS agency or fire department can be a challenge. Merely tracking patients in a mass casualty event using paper tags and forms can be overwhelming. This inherent difficulty, coupled with the use of unfamiliar technology, can be more of a deterrent than a tool to improve patient tracking.
Some localities may have tried to implement patient tracking (or resist the idea) because they don’t feel such a technology will be effective. By following some basic lessons, patient tracking technologies can be implemented and become a successful addition to your mass casualty incident (MCI) response.
Two responders scan simulated MCI patients into an
electronic patient tracking system. Photos courtesy Daniel Neal
Implementing Tracking Technology
Over a two-week period, Loudoun County (Va.) Fire and Rescue (LCFR) implemented patient tracking. LCFR is a member of the Northern Virginia Emergency Response System (NVERS). One of the projects of NVERS is the implementation of region-wide electronic patient tracking. Through an Urban Area Security Initiative (UASI) grant, funding was available to implement patient tracking through the HC Patient Tracking System developed by Global Emergency Resources.
Through a four-hour training conducted twice each day, fire and EMS personnel were taught how to utilize patient tracking technology in a simulated MCI. Each session consisted of 20–30 responders presented with 25 patients at a simulated bus crash.
On-duty firefighters were reassigned from their stations to the training academy on their assigned apparatus. The patients consisted of inflatable manikins. This training followed an MCI response training from the previous year.
The simulation was the final piece of the four-hour training that included a short lecture on electronic patient tracking and several guided practice evolutions in using the technology.
Over the two-weeks, nearly 350 personnel participated in 18 identical simulations. These repeated implementations of electronic patient tracking for a simulated 25-patient MCI presented several valuable lessons learned.
Lesson 1: Know the Paper Process
Some organizations seem to think that infusing technology will fix their lack of MCI operations knowledge. Then, when the response fails, they blame the technology.
Before you infuse electronic patient tracking into your MCI operations, you must know MCI operations—specifically patient processing—without it. Software, devices and other high-tech solutions won’t magically solve your lack of MCI operations preparation or training.
One responder completes the disaster tag while another enters
basic information into the electronic patient tracking system.
Before you invest in patient tracking technology, conduct several MCI “life-sized” simulations. Have crews arrive in sequence, then triage and tag patients. Transfer patients
to treatment areas and tag the patients. Then, set up a transportation group for processing the patients and distributing them off the scene.
Don’t do this in a classroom with index cards and simulated victims. Use the training academy grounds and get apparatus together. Go through the motions of actually tracking patients with paper forms, loading them in ambulances and transporting them.
Lesson 2: Tag Before You Scan
Patients must be tagged before they can be scanned. The correct processing of a casualty is a progression from placing color-appropriate ribbon and/or tags on the patient, placing a disaster tag and then scanning the patient into the patient tracking system.
The patient tracking system works efficiently when a barcode or other similar identifier (e.g., QR code) is linked to each patient and is scanned into the system. Scanning these identifiers reduces errors vs. manual entry of a tracking number.
Furthermore, unless the hospitals are linked into the patient tracking system, they’ll still need a disaster tag to obtain patient information. It’s also important to assign specific personnel the responsibility of scanning and placing disaster tags. This ensures they stay focused on the job function and that all patients are appropriately documented.
Lesson 3: The Transportation Group is Key
Placement of patient tracking scanners at the transportation group is the first priority. If you’re limited to a single scanner location, make it the transportation group.
The transportation group is positioned at the patient exit point, where all patients should be checked out and their destination noted. This makes it a logical location every patient who’s being transported is tagged and scanned.
A battalion chief can use the incident commander module of the
patient tracking software to maintain a higher level of situational awareness.
It’s also a good idea to keep an extra patient tracking device at this location in case of a technology failure.
The second place to locate patient trackers is on every ambulance. The third location to place patient trackers is in the treatment areas.
Lesson 4: Scanners Stay Inside Rigs
Crews must leave their patient tracking devices inside their ambulances. The ambulance patient trackers are meant to process patients as they’re transported to their final destination. As ambulances arrive on scene, they should be assigned patients to transport. Obviously, the highest priority patients (i.e., red tags) must be transported first.
Should an ambulance crew be assigned to assist in triage or treatment, they shouldn’t bring patient trackers onto the scene. There’s a strong likelihood that crews might lose track of the patient tracking devices or focus more on tracking than patient care.
The transportation group uses a backboard to protect their forms and electronic patient tracker from a light rain.
Lesson 5: Compile Information in Chunks
Patient tracking technology compiles information onto an electronic record that’s identified by the barcode or a similar unique identifier. This is the true benefit of using patient tracking technology.
Throughout the incident, additional pieces of information are added as the patient is processed through treatment and transport. The system easily compiles this information for each patient into a single record. Therefore, several trackers can enter small pieces of information and all of it can be compiled in the patient’s file.
For example, a patient receives a disaster tag with a barcode in one of the treatment areas. The tag could be scanned and the information entered may only include the patient’s gender, age and triage color. As the patient is checked out by the transportation group, the transporter recorder scans the tag again. At this point, only the hospital destination and transporting ambulance are entered. Then, during transport, the ambulance crew enters the remaining information (e.g., injuries, allergies, vital signs, etc.).
In this example, three different scanners contacted and entered different information that’s compiled into a single patient record. Crews can also attach photographs to the patient’s record. To emphasize this point and introduce this technology to crews during training, it’s helpful to place masks on manikins and require photographs be attached to each patient record.
Lesson 6: Boost Situational Awareness
Patient tracking technology provides additional situational awareness that’s not always available when using paper or other manual systems. As each patient is tracked out through the transportation group, a group or incident commander can monitor the progression of the incident in real-time using information available from the patient tracking software.
For example, hospital managers and incident commanders can maintain awareness of the disposition and destination of patients. For a large-scale MCI, this provides tremendous situational awareness benefits for on-scene incident commanders. On smaller incidents, an EMS branch manager or supervisor can manage an incident from a remote command post.
Lesson 7: Use Realistic Training Scenarios
To implement patient tracking technology, responders have to actually use the technology. This is best accomplished by having EMS and fire personnel, as well as officers, train with the technology using realistic simulation scenarios. This doesn’t mean online training, videos or PowerPoint presentations—personnel must use the technology in an environment similar to one where they’ll actually use it. It’s important to create a manageable, realistic scenario and have responders practice entering patients into and processing them through the tracking system.
Lesson 8: Practice Weekly
Ongoing maintenance of patient tracking skills means performing patient tracking on a weekly or at least regular basis. You can’t train providers to use patient tracking technology and then let too much time go by, only using it again during an actual MCI.
Set goals to require that certain data be entered for each patient and check the effectiveness of the crews and technology.
Lesson 9: Improvise as Needed
Glare can be a factor when using scanning technology. Be prepared to improvise to get a good scan of barcodes or other unique identifiers. This might mean using a backboard to provide shade to scan the MCI tag.
You might be inclined to manually enter numbers instead of scanning, but remember that by using the scan function you’re more likely to avoid errors with data entry.
LCFR found that using realistic training scenarios helps to introduce the tracking technology to crews. Following the two-week period when LCFR implemented patient tracking into our MCI response, a follow-up survey revealed that of 344 respondents, 97% responded that they felt the tracking app would be useful on an MCI.
On July 10th, 2017, LCFR learned the true benefit of the training in MCI response and patient tracking. After a possible hazardous material leak occurred, crews used their strong knowledge of MCI response coupled with patient tracking and were able to triage, track and evaluate 73 patients. As the incident concluded, only one patient was transported.
EMS and fire personnel must have a strong knowledge of MCI operations and manual patient tracking before implementing patient tracking technology. With a strong MCI response capability, patient tracking technology can be readily implemented.