Purpose Statement

The Critical Care fields within the ePCR provide additional documentation options for EMS providers caring for critically ill or injured patients, particularly during interfacility and Critical Care transports.

These additional fields allow providers to capture specialized patient care information that may not be included in standard ePCR documentation, including:

• Neonatal documentation for neonatal patients
• Fluid intake and output
• Ventilator settings

These fields supplement the standard ePCR and allow providers to more accurately document specialized care provided during transport.

Background Information

Critical Care Transport may involve patients who require advanced monitoring, specialized equipment, or other care beyond what is commonly provided during a standard EMS response.

The Critical Care fields provide additional documentation options while allowing providers to continue completing the standard EMS documentation required for the patient encounter.

Required Permissions

Users must have permission to access and document EMS incidents and ePCRs.

Depending on agency configuration, appropriate access may include:

• Incident Documentation access
• Permission to create or edit ePCRs
• Access to applicable Critical Care fields

Video

Step-by-Step Guide

Step 1: Open the ePCR

Navigate to the applicable ePCR and complete the standard patient care documentation required by your agency.

When applicable, use the additional Critical Care fields to document specialized care provided to the patient.

Step 2: Complete the Neonatal Section

For neonatal patients only which are those that are 28 days old or less, complete the Neonatal section of the ePCR (age must be entered before Neonatal section will appear on left colum).

The Neonatal section is intended specifically for documentation associated with neonatal patients.

Step 3: Document Fluid Intake and Output

Navigate to the Ins and Outs section to document the patient's fluid intake and output.

1. Document Originating IV Fluids – Enter the volume of IV fluids the patient received at the originating facility. Values can be measured to the nearest 0.01.
2. Record Transport IV Fluids – Enter the volume of IV fluids administered during transport.
3. Document Oral Intake – Enter originating and during-transport oral fluid volumes when applicable.
4. Record Urine Output – Enter urine output from the originating facility and during transport. These values are automatically calculated as negative values.
5. Document Emesis – Enter emesis volumes from the originating facility and during transport. These values are automatically calculated as negative values.
6. Record Bowel Movements – Enter bowel movement information during transport and specify whether it is measured by count or volume.
7. Document Blood Loss – Enter estimated blood loss from the originating facility and during transport. These values are automatically calculated as negative values.
8. Add Notes – Use the In's and Outs Notes field to provide additional information or context.
9. Review Calculations – Review the automatically calculated Total In, Total Out, and Net Fluid values to assess the patient's documented fluid balance.

Step 4: Document Ventilator Settings

Navigate to the Ventilator Settings area when documenting a patient receiving ventilatory support.

1. Select Vent Model – Select the specific ventilator model being used, such as the Hamilton T1 or another configured model

   

2. Choose Vent Mode – Select the applicable ventilation mode:
   • Adaptive Support Ventilation (ASV)
   • Synchronized Intermittent Mandatory Ventilation (SIMV)
   • Bilevel Positive Airway Pressure (BiPAP)
   • Continuous Positive Airway Pressure (CPAP)
   • Noninvasive Ventilation (NIV)
   • Noninvasive Ventilation – Spontaneous/Timed (NIV-ST)
   • Pressure Controlled Ventilation (PCV)
   • Synchronized Controlled Mandatory Ventilation (SCMV)
   • Airway Pressure Release Ventilation (APRV)
   • Pressure Support Ventilation (PSV)
3. Specify Circuit Type – Select the applicable circuit type, including single limb, dual limb, or high-flow nasal cannula.
4. Enter Rate – Document the respiratory rate setting.
5. Record FiO2 – Enter the oxygen percentage (FiO2 %).
6. Document Tidal Volume – Enter the tidal volume (Vt) in mL. The supported numeric range is 0–2000.
7. Set PEEP – Enter the PEEP value in cmH2O. The supported numeric range is 0–35.
8. Record Inspiratory Time – Enter the inspiratory time (Ti) in seconds.
9. Document I Ratio – Enter the inspiratory-to-expiratory ratio, such as 1:3 or 1:2.
10. Enter Peak/Plateau Pressures – Document applicable peak and/or plateau pressures in cmH2O.
11. Record ETCO2 – Enter the ETCO2 value and waveform characteristics.
12.   Hit Save and Close

Best Practices

• Complete Critical Care fields whenever they are applicable to the patient's care.
• Use the Neonatal section only for neonatal patients.
• Document intake and output values as accurately as possible and review the calculated totals.
• Verify that fluid output values are represented correctly when reviewing the patient's net fluid balance.
• Confirm ventilator settings and units before entering values.
• Document ventilator settings that accurately reflect the equipment being used.
• Continue completing all applicable standard ePCR documentation in addition to the Critical Care fields.

Troubleshooting & FAQs

Why don't I see the Critical Care fields?

Availability may depend on agency configuration or user permissions. Contact your First Due administrator if expected Critical Care documentation options are unavailable.

When should I use the Neonatal section?

The Neonatal section should be used for neonatal patients only.

How is fluid balance calculated?

The Ins and Outs functionality calculates Total In, Total Out, and Net Fluid based on the documented values. Outputs such as urine, emesis, and estimated blood loss are automatically calculated as negative values.

What ventilator modes can be documented?

Available modes include ASV, SIMV, BiPAP, CPAP, NIV, NIV-ST, PCV, SCMV, APRV, and PSV.

What is the supported tidal volume range?

Tidal Volume (Vt) supports numeric values from 0–2000 mL.

What is the supported PEEP range?

PEEP supports numeric values from 0–35 cmH2O.