# Presentation: 411393

## Patient Reception Team Operations

**Patient Reception Team Operations**

***At the end of this session participants should be able to discuss the roles and responsibilities of the Patient Reception Teams (PRTs), including PRT composition, development and training requirements.***

## 
Five General Principles to Remember
Team Composition
Incident Command System
Patient Reception Area Operations
Patient Reception Triage and Patient Management
Patient Reception Team Training

***Five General Principles to Remember***
***Team Composition***
***Incident Command System***
***Patient Reception Area Operations***
***Patient Reception Triage and Patient Management***
***Patient Reception Team Training***

**Patient Reception Team Operations**

**Overview**

## When the big one hits you will only do what you do every day
What happens when you have a plane load of patients...

***When the big one hits you will only do what you do every day***
***What happens when you have a plane load of patients...***

**Five General Principles to Remember: Principle #1**

**Patient Reception Team Operations**

## EMS does NOT work in an Mass Casualty Incident  environment
These types of incidents require:
Task Level planning
Tactical Level planning
Strategic Level planning

***EMS does NOT work in an Mass Casualty Incident  environment***
***These types of incidents require:***
***Task Level planning***
***Tactical Level planning***
***Strategic Level planning***

**Five General Principles to Remember: Principle #2**

**Patient Reception Team Operations**

## If you don’t manage the PRT someone else will
You have a legal and ethical responsibility to ensure the delivery of competent care

***If you don’t manage the PRT someone else will***
***You have a legal and ethical responsibility to ensure the delivery of competent care***

**Five General Principles to Remember: **
**Principle #3**

**Patient Reception Team Operations**

## You MUST have PRT Standard Operation Procedures (SOPs)
Not the same as a disaster plan
Coaching “play book”
Equivalent to a medical protocol
Incident specific

***You MUST have PRT Standard Operation Procedures (SOPs)***
***Not the same as a disaster plan***
***Coaching “play book”***
***Equivalent to a medical protocol***
***Incident specific***

**Five General Principles to Remember: Principle #4**

**Patient Reception Team Operations**

## Don’t get sucked into the ‘who’s in charge argument’
Have a “plan”
Know your state laws, local governing authorities, agency standards and protocols, etc.
Know what you are responsible for
Unify command and cooperate
If you don’t, only the patient suffers

***Don’t get sucked into the ‘who’s in charge argument’***
***Have a “plan”***
***Know your state laws, local governing authorities, agency standards and protocols, etc.***
***Know what you are responsible for***
***Unify command and cooperate***
***If you don’t, only the patient suffers***

**Five General Principles to Remember: Principle #5**

**Patient Reception Team Operations**

## May be comprised of individuals from the VAMC Primary Receiving Center with support from community agencies
Community Fire/EMS personnel
Community emergency service organizations
American Red Cross , Salvation Army, etc
City/County Emergency Management Agency
Private patient transportation services
Military
Number and type of personnel based upon individual Primary Receiving Center and community support capabilities

**Team Composition**

***May be comprised of individuals from the VAMC Primary Receiving Center with support from community agencies***
***Community Fire/EMS personnel***
***Community emergency service organizations***
***American Red Cross , Salvation Army, etc***
***City/County Emergency Management Agency***
***Private patient transportation services***
***Military***
***Number and type of personnel based upon individual Primary Receiving Center and community support capabilities***

**Patient Reception Team Operations**

## Appropriate mix of clinical, clinical support, and administrative staff

Consider local and state laws and governing authorities related to community support
EMS scope of practice in patient reception operations
EMS treatment protocols at the reception site
Liability and worker’s compensation coverage

Sufficient staff identified and trained to support 24/7 operational requirements

Capabilities influence “through put” reporting

**Team Composition**

***Appropriate mix of clinical, clinical support, and administrative staff***
***Consider local and state laws and governing authorities related to community support***
***EMS scope of practice in patient reception operations***
***EMS treatment protocols at the reception site***
***Liability and worker’s compensation coverage***
***Sufficient staff identified and trained to support 24/7 operational requirements***
***Capabilities influence “through put” reporting***

**Patient Reception Team Operations**

**Notes:**
Define “through put”

## Structuring patient reception operations and team composition on the principles of incident command ensures a common organizational understanding by all entities involved

Incident command features a flexible organization and management process that is capable of escalating or decreasing response operations based upon pre-planned, current or projected requirements

**Incident Command System**

***Structuring patient reception operations and team composition on the principles of incident command ensures a common organizational understanding by all entities involved***
***Incident command features a flexible organization and management process that is capable of escalating or decreasing response operations based upon pre-planned, current or projected requirements***

**Patient Reception Team Operations**

## Right Treatment - Right Patient - Right Time
Early transportation to definitive care
Patient Tracking and distribution 
Careful coordination of resources
Safety 

***Right Treatment - Right Patient - Right Time***
***Early transportation to definitive care***
***Patient Tracking and distribution ***
***Careful coordination of resources***
***Safety**** *

**Incident Command Goals**

**Patient Reception Team Operations**

## YOU set the tone
The first five minutes set the stage for the whole incident 
Learn to set the tone and be in command

***YOU set the tone***
***The first five minutes set the stage for the whole incident ***
***Learn to set the tone and be in command***

**Incident Commander**

**Patient Reception Team Operations**

## Rapidly “Size-Up”
Set the tone
Order/cancel  resources
Initiate SOPs
Plan strategy

***Rapidly “Size-Up”***
***Set the tone***
***Order/cancel  resources***
***Initiate SOPs***
***Plan strategy***

**Incident Management Team**

**Patient Reception Team Operations**

## Deploy resources 
Delegate
Review and revise 
Communicate

***Deploy resources ***
***Delegate***
***Review and revise ***
***Communicate***

**Incident Management Team**

**Patient Reception Team Operations**

## Incident Management Team
Maintains overall management of the event
Establishes objectives and priorities
Devises appropriate strategies
Establishes clear lines of communication and information sharing
Positions filled by most qualified and trained personnel, not necessarily based on seniority

**Incident Command Structure**

***Incident Management Team***
***Maintains overall management of the event***
***Establishes objectives and priorities***
***Devises appropriate strategies***
***Establishes clear lines of communication and information sharing***
***Positions filled by most qualified and trained personnel, not necessarily based on seniority***

**Patient Reception Team Operations**

**Notes:**
Narrative description of each incident management team function

## Operations Section

***Operations Section***

**Incident Command Structure**

**Patient Reception Team Operations**

**Notes:**
Narrative description of each functional position and team.

## Logistics Section

***Logistics Section***

**Incident Command Structure**

**Patient Reception Team Operations**

**Notes:**
Narrative description of each functional position and team.

## Planning/Admin Section

***Planning/Admin Section***

**Incident Command Structure**

**Patient Reception Team Operations**

**Notes:**
Narrative description of each functional position and team.

## Finance Section

***Finance Section***

**Incident Command Structure**

**Patient Reception Team Operations**

**Notes:**
Narrative description of each functional position and team.

## Patient Reception Team Operations

**Patient Reception Area Operations**

**Patient Reception Team Operations**

## Patient Reception Team Operations

**Patient Reception Area Operations**

**Patient Reception Team Operations**

**Notes:**
Patient reception operations are unique to individual sites, support facilities, etc.

## Key factors:
Do what works for your location?
Patient movement flow within the area
Cones, colored tarps, flags, etc to easily identify flow patterns and treatment/staging areas
Be sure everyone is familiar with site layout
Allow workable separation between areas

***Key factors:***
***Do what works for your location?***
***Patient movement flow within the area***
***Cones, colored tarps, flags, etc to easily identify flow patterns and treatment/staging areas***
***Be sure everyone is familiar with site layout***
***Allow workable separation between areas***

**Patient Reception Area Operations**

**Patient Reception Team Operations**

## P-1

**P-1**

**P-2**

**P-3**

**IN**

**OUT**

**Patient Reception Team Operations**

## Atlanta PRA

***   ***

***Atlanta PRA***

- Hangar 746

- Hangar 747

- Deplane/Escort

- CC Triage

- Security

- Triage

- Flight Line

- Shelter Staging

- Medical Needs

- Med Supplies

- Green Team

- Yellow Team

- Red Team

- EMS Staging

- Transportation Flow

- Transpo Coord

- Transpo Coord

- MACC

- Evacuee Documentation

- Chairs/ Holding

- Food

- Mass Transpo Staging

- Mobile CMD Post

- Transpo CMD Post

- Animal Control

- Chapel

- Animal Control

## Houston PRA

***   ***

***Houston PRA***

## Birmingham PRA

***   ***

***Birmingham PRA***

## Establish incident command and assign personnel to appropriate teams
“Size Up” the situation – Section Chiefs report operational capabilities and identified shortfalls (personnel, supplies, equipment, etc)
Be sure everyone knows the full scope of operations and their respective roles
Utilize “waiting time” as “practice time”

***Establish incident command and assign personnel to appropriate teams***
***“******Size Up” the situation – Section Chiefs report operational capabilities and identified shortfalls (personnel, supplies, equipment, etc)***
***Be sure everyone knows the full scope of operations and their respective roles***
***Utilize “waiting time” as “practice time”***

**Initial Patient Reception Area Operations**

**Patient Reception Team Operations**

## Identify ability to sustain 24/7 operations
Sufficient personnel for two 12-hr shifts
Personnel accountability procedures
Personnel support services
Feeding, rest areas, etc
Reliable re-supply processes
End of shift de-briefing

***Identify ability to sustain 24/7 operations***
***Sufficient personnel for two 12-hr shifts***
***Personnel accountability procedures***
***Personnel support services***
***Feeding, rest areas, etc***
***Reliable re-supply processes***
***End of shift de-briefing***

**Sustaining Patient Reception **
**Area Operations**

**Patient Reception Team Operations**

## Uniqueness of VA-DoD Contingency Plan patient reception triage
Patients have already been in the medical stabilization and treatment “pipeline”
Patients have been “stabilized” prior to transport
Reception operations must be prepared for patient who’s status changes enroute
Overall, a quick process prior to last leg of patient movement to definitive care hospital

***Uniqueness of VA-DoD Contingency Plan patient reception triage***
***Patients have already been in the medical stabilization and treatment “pipeline”***
***Patients have been “stabilized” prior to transport***
***Reception operations must be prepared for patient who’s status changes enroute***
***Overall, a quick process prior to last leg of patient movement to definitive care hospital***

** ****Patient Reception Triage **
**and Patient Management**

**Patient Reception Team Operations**

## Primary triage
Initial size-up and triage mode
Rapid triage and tagging (no writing)
Minimal ABC care provided
Done “ in situ ”

***Primary triage***
***Initial size-up and triage mode***
***Rapid triage and tagging (no writing)***
***Minimal ABC care provided***
***Done “ in situ ”***

***Secondary triage***
***Done in the treatment area after or collecting station***
***A more complete assessment***
***Tags used for documentation, ID and tracking***

**Patient Reception Triage**

**Patient Reception Team Operations**

***Two types of triage***

## Identify priority 
Can be used to “track the patients”
International Standard-NATO

**Patient Reception Triage **
**and Tagging Systems**

***Identify priority ***
***Can be used to “track the patients”***
***International Standard-NATO***

**Patient Reception Team Operations**

## Can be
Colored plastic tape
Labels
Cards or tags
Other tags are appropriate

***Can be***
***Colored plastic tape***
***Labels***
***Cards or tags***
***Other tags are appropriate***
** **

**Patient Reception Team Operations**

**Patient Reception Triage **
**and Tagging Systems**

## RED=Priority #1
AKA: Immediate, urgent, emergent, critical
Life threatening problems
Cardiovascular, pulmonary, hemorrhage, Severe head-Alt. Mental Status

***RED=Priority #1***
***AKA: Immediate, urgent, emergent, critical***
***Life threatening problems***
***Cardiovascular, pulmonary, hemorrhage, Severe head-Alt. Mental Status***

**Patient Reception Team Operations**

**Patient Reception Triage **
**and Tagging Systems**

## RED=Priority #1“Coaching Version”
A stretcher patient who would normally be given urgent ALS care
All injured rescuers are tagged P-1 

***RED=Priority #1******“Coaching Version”***
***A stretcher patient who would normally be given urgent ALS care***
***All injured rescuers are tagged P-1 ***

**Patient Reception Team Operations**

**Patient Reception Triage **
**and Tagging Systems**

## Yellow=Priority #2
AKA: Delayed, non-urgent, or urgent
Burns(no resp inv.) Extremity injuries, spinal injuries, awake alert head injury

***Yellow=Priority #2***
***AKA: Delayed, non-urgent, or urgent***
***Burns(no resp inv.) Extremity injuries, spinal injuries, awake alert head injury***

**Patient Reception Team Operations**

**Patient Reception Triage **
**and Tagging Systems**

## Yellow=Priority #2“Coaching Version”
Stretcher patients who would get BLS level care
In routine EMS, elective ALS care based on MOI

***Yellow=Priority #2******“Coaching Version”***
***Stretcher patients who would get BLS level care***
***In routine EMS, elective ALS care based on MOI***

**Patient Reception Team Operations**

**Patient Reception Triage **
**and Tagging Systems**

## Green=Priority #3
AKA: Minor, walking wounded
Minor injuries, ambulatory
Beware of occult  injury ... respect the MOI 

***Green=Priority #3***
***AKA: Minor, walking wounded***
***Minor injuries, ambulatory***
***Beware of occult  injury ... respect the MOI ***

**Patient Reception Team Operations**

**Patient Reception Triage **
**and Tagging Systems**

## Green=Priority #3“Coaching Version”
Ask everyone who can walk to go to a location you specify
They are the P-3s
You must then re-triage them after the others are triaged

***Green=Priority #3******“Coaching Version”***
***Ask everyone who can walk to go to a location you specify***
***They are the P-3s***
***You must then re-triage them after the others are triaged***

**Patient Reception Team Operations**

**Patient Reception Triage **
**and Tagging Systems**

## Black=Priority 4 or 0
AKA: Dead, deceased or “expectant”
Those obviously dead and those who are mortally injured
Very controversial “ethics”

***Black=Priority 4 or 0***
***AKA: Dead, deceased or “expectant”***
***Those obviously dead and those who are mortally injured***
***Very controversial “ethics”***

**Patient Reception Team Operations**

**Patient Reception Triage **
**and Tagging Systems**

## Black=Priority 4 or 0“Coaching Version”
Obviously dead
Those who would get ALS heroics consider tagging yellow
Most rescuers won’t condemn someone to death

***Black=Priority 4 or 0******“Coaching Version”***
***Obviously dead***
***Those who would get ALS heroics consider tagging yellow***
***Most rescuers won’t condemn someone to death***

**Patient Reception Team Operations**

**Patient Reception Triage **
**and Tagging Systems**

## A continuous process 
Many will need to be re-triaged
Stressful
Use tagging at every day incidents to stay current with your tagging system 

***A continuous process ***
***Many will need to be re-triaged***
***Stressful***
***Use tagging at every day incidents to stay current with your tagging system***

**Patient Reception Team Operations**

**Patient Reception Triage **
**and Tagging Systems**

## Objective: rapid, safe movement of patients to definitive care facility
Patient transportation resources define movement capability
On-site operations must be prepared to manage patients awaiting transportation
Patient staging area staffing
Supplies and equipment
Patient comfort measures

***Objective: rapid, safe movement of patients to definitive care facility***
***Patient transportation resources define movement capability***
***On-site operations must be prepared to manage patients awaiting transportation***
***Patient staging area staffing***
***Supplies and equipment***
***Patient comfort measures***

**On-Site Patient Management**

**Patient Reception Team Operations**

## Individual Training:
Incident Command Courses
Patient Reception Operations Plans and Procedures
Patient Reception Conferences
Team Training:
Exercise – Exercise – Exercise
Flight Line Safety
Aircraft patient loading and off-loading
Litter carry techniques

***Individual Training:***
***Incident Command Courses***
***Patient Reception Operations Plans and Procedures***
***Patient Reception Conferences***
***Team Training:***
***Exercise – Exercise – Exercise***
***Flight Line Safety***
***Aircraft patient loading and off-loading***
***Litter carry techniques***

**Patient Reception Team Training**

**Patient Reception Team Operations**

## Five General Principles to Remember
Reception Team Composition
Reception Team Incident Command Structure
Patient Reception Area Operations
Patient Reception Triage and Patient Management
Patient Reception Team Training

**Summary**

***Five General Principles to Remember***
***Reception Team Composition***
***Reception Team Incident Command Structure***
***Patient Reception Area Operations***
***Patient Reception Triage and Patient Management***
***Patient Reception Team Training***

**Patient Reception Team Operations**