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Chart Review — Fixed Wing Operations
1
Flight Info
2
General Care
3
Trauma & Neuro
4
Airway
5
Vent & Misc
Flight Information
1. Operating Base
Select Base
Riyadh
Al-Ula
Other
Ground School
2. Date of Flight
3. Mission / Trip Number
4. Customer Name
Select...
Al-Ula
Charter
MOI
SRCA
5. Was any part of the mission operated as a "Night Flight"? (10pm – 4am)
Select...
Yes
No
6. In minutes, what was the scene time?
Patient Details
7. Patient Population
Select...
Adult >14 years of age
Pediatric 30 days to <14 years of age
Neonate <29 days of age
8. Patient Gender
Select...
Male
Female
9. Patient Type
Select...
Cardiac
Neuro
Trauma
Medical
Other - Not Listed
10. Chief Complaint / Provider Impression
Select Chief Complaint
ABDOMINAL PAIN
AIRWAY OBSTRUCTION
ALLERGIC / ANAPHYLACTIC REACTION
ALTERED MENTAL STATUS
ANIMAL BITE
ASSAULT
ASTHMA ATTACK / COPD
BACK PAIN (NON-TRAUMATIC)
BACK PAIN (TRAUMATIC)
BURNS
CARDIAC ARREST (NON-TRAUMATIC)
CARDIAC ARREST (TRAUMATIC)
CHANGE IN MENTAL STATUS
CHEST PAIN (STEMI)
CHEST PAIN
CHILDBIRTH / LABOR
CHOKING (FBAO)
CO POISONING / HAZMAT
CONGENITAL HEART DEFECTS
CVA / STROKE
DEHYDRATION
DIABETIC PROBLEM
DROWNING / NEAR DROWNING
DRUG / ALCOHOL PROBLEM
ELECTROCUTION / LIGHTNING
EYE PROBLEM
FALL
FEVER
HEADACHE
HEAT / COLD EXPOSURE
HEMORRHAGE / LACERATION
HYPERTENSION
HYPOTENSION / SHOCK
NAUSEA / VOMITING
NEUROLOGICAL DEFICIT
OB / GYN COMPLAINT
OVERDOSE / POISONING
PAIN (GENERAL)
PEDIATRIC MEDICAL
PSYCHIATRIC / BEHAVIORAL
RESPIRATORY ARREST
RESPIRATORY DISTRESS
SEIZURE
SEPSIS
SHORTNESS OF BREATH
SYNCOPE / NEAR SYNCOPE
TRAUMA - MVC
TRAUMA - PENETRATING
TRAUMA - OTHER
UNCONSCIOUS / FAINTING
OTHER
Personnel
11. Primary AMC Full Name
12. Primary AMC Employee Number
13. Secondary AMC Full Name
14. Secondary AMC Employee Number
15. Other AMC Full Name (if applicable)
16. Other AMC Employee Number (if applicable)
Chart Reviewer
17. Chart Reviewer Last Name
Next →
General Patient Care and Management
18. Aborted call
Select...
Yes
No
19. Aborted call reason documented
Select...
N/A
Yes
No
Vitals & Mental Status
20. Did the AMC document three (3) complete sets of vital signs including assessment of mental status?
Select...
Yes
No
21. Did the patient have an altered mental status or a focal neurologic deficit?
Select...
Yes
No
Unknown - Not Documented
22. If Yes above, was a blood glucose documented? (Use N/A if Q21 is "No")
Select...
N/A
Yes
No
Access & Medications
23. Did AMC establish IV/IO access?
Select...
Yes - IV Access
Yes - IO Access
No
24. Did the AMC administer medications?
Select...
Yes - IV
Yes - IO
Yes - IM
Yes - IN
Yes - Oral
No
25. Did the AMC administer blood or blood product?
Select...
Yes - Infuse Blood
Yes - Infuse Blood Product
Yes - Continued Blood/Blood Product
No
26. Did the AMC document intake and output?
Select...
Yes
No
Pain Management
27. Did the AMC document a pain assessment using an appropriate pain scale?
Select...
Yes
No
28. Initial Pain Score?
Select Score
0 — No Pain
1
2
3
4
5 — Moderate
6
7
8
9
10 — Worst Pain
Sedated Patient Prior to Patient Contact
Inadequate Sedation Provided by the Sending Hospital
Unable to Read
29. Was pain rated >3 managed appropriately?
Select...
N/A
Yes
No
30. If pain rated >3 was not managed appropriately, please provide details
Decompensation & Monitoring
31. Patient decompensation post narcotic, benzodiazepine or ketamine administration
Select...
N/A
Yes
No
32. Did the AMC document ETCO2 monitoring with narcotic, benzodiazepine or ketamine administration?
Select...
N/A
Yes
No
33. Did the AMC document Qualitative or Quantitative patient temperature?
Select...
Yes
No
Hypoxia
34. Did the patient experience hypoxia at any point during transport? (SpO2 <90%)
Select...
Yes
No
35. If Yes above, was the appropriate interventions completed including oxygen administration?
Select...
N/A
Yes
No
Blood Pressure
36. Documented blood pressure of adult patient less than 90 systolic or <5th percentile in children <14 years of age?
Select...
Yes
No
37. If Yes, was the low blood pressure of this patient due to hemorrhage? (Use N/A if Q36 is "No")
Select...
N/A
Yes
No
38. If Yes, appropriate interventions for patient with hemorrhagic shock? (Use N/A if Q36 is "No")
Select...
N/A
Yes
No
39. If Yes, appropriate interventions for patient with non-hemorrhagic hypotension? (Use N/A if Q36 is "No")
Select...
N/A
Yes
No
Cardiac & Interventions
40. Does patient have a complaint of cardiac-related chest pain or current history of cardiac-related chest pain?
Select...
Yes
No
41. For patient with cardiac-related chest pain, is 12-lead ECG performed or documented? (Use N/A if Q40 is "No")
Select...
Yes - Performed
Yes - Documented
No
N/A
42. Did the patient have a central line?
Select...
Yes
No
43. Did the patient have a chest tube?
Select...
Yes
No
44. Was CPR performed on this patient during AMC care?
Select...
Yes
No
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Next →
Trauma Section
45. Did the AMC document PMS for all General Medical during initial assessment and turn of care? (Use N/A only for non-trauma patients)
Select...
N/A
Yes
No
Neuro Section
46. Neuro — was this hemorrhagic stroke?
Select...
Yes
No
47. If Yes above, was SBP less than 160 (OR 20% less than initial MAP for SBP >200) at transfer of care? (Do not use N/A if Neuro patient)
Select...
N/A
Yes
No
← Back
Next →
Airway Management
48. Did the patient have an endotracheal tube or supraglottic device prior to AMC arrival?
Select...
Yes
No
49. Did the patient require advanced airway placement by AMC?
Select...
Yes
No
50. Did the AMC secure the airway utilizing one of the following?
Select...
ETT w/stylet
ETT w/bougie
Supraglottic airway device
Cricothyrotomy
N/A
51. If ETT was used (Video/Direct)?
Select...
N/A
Video
Direct
52. How many total attempts to place the advanced airway were made?
Select...
N/A
1
2
3
4
53. Did the AMC use a supraglottic airway as the initial device for advanced airway management?
Select...
N/A
Yes
No
54. Did the AMC use an endotracheal tube as the initial device for advanced airway management?
Select...
N/A
Yes
No
55. Verification of Endotracheal Tube (ETT) placement?
Select...
N/A
Direct visualization
Symmetric breath sounds
Both
Induction & RSI
56. Did oxygen saturation drop below 90% within 10 minutes of induction medications?
Select...
N/A
Yes
No
Oxygen saturation was below 90% prior to RSI
57. Were appropriate measures taken to correct hypoxia before intubation?
Select...
N/A
Yes
No
58. Did SBP drop below 90 mmHg (Adults) or <5th percentile in children <14 years?
Select...
N/A
Yes
No
SBP was below 90mm Hg prior to RSI
59. Were appropriate measures taken to correct hypotension before intubation? (Use N/A if Q58 is "No")
Select...
N/A
Yes
No
60. Did the AMC follow all the elements of RSI guidelines?
Select...
N/A
Yes
No
Capnography
61. Was advanced airway placement confirmed with waveform capnography?
Select...
N/A
Yes
No
62. Was advanced airway monitored with waveform capnography during flight?
Select...
N/A
Yes
No
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Next →
Ventilator Management
63. Was the patient with an advanced airway connected to mechanical ventilation? (Use N/A only for non-vented patients)
Select...
N/A
Yes
No
64. Were tidal volumes within acceptable range / kg? (Use N/A only for non-vented patients)
Select...
N/A
Yes
No
65. Was the patient on CPAP/BiPap? (Use N/A for ETT patients)
Select...
N/A
Yes
No
Miscellaneous
66. Documented patient decompensation?
Select...
Yes
No
67. If Yes above, what phase of transport did decompensation occur?
Select...
N/A - No patient decompensation
Referring Bedside
Ground Transport (Referring)
In-Flight
Ground Transport (Receiving)
Receiving Bedside / Turn of Care
68. If Yes above, did any of the following occur? (choose primary only)
Select...
N/A
ACLS guidelines followed
CPR performed during transport
Dislodgement of devices
Fluid resuscitation
Inotropes started
Intubation attempted
Needle decompression
Persistent hypoxia <90%
RSI guidelines followed
69. Transport times completed?
Select...
Yes
No
70. Turn of care process documented
Select...
Receiving Hospital (Bedside)
To Ground Ambulance
To Another Air Medical Crew
Other
Not Documented
71. Did any operational reportable events occur during transport?
Select...
Adverse drug event
Equipment failure
Medication error
None
Near miss
Crew injury
Patient injury
72. Does chart need further review?
Select...
Yes
No
73. General Chart Comments
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