Attendant's Documentation |
Navigation Instructions |
Notes |
You’re starting your shift. You need to log your crew into Siren. Let’s start Siren and begin the login process. |
Double-tap the Siren Filed User 4 Icon on the desktop to open up the program. |
Logon the Toughbook and Siren Field User at the start of your shift. You’ll be ready to document events as they are dispatched to your crew. |
Select the call sign that you’re working under for the shift. Today, we’ll work under a training call sign 999TR5D. IMPORTANT: Document this event with a Training Unit (a call sign ending with “TR#X”). This will help in logging this as a practice PCR, and not a real BCEHS event. |
Call Sign >
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You can use the search bar, entering “999TR5D” to find the call sign, or you can use the navigation arrows to find the call sign. |
You’re working in an Fixed Wing vehicle today. |
Vehicle Type > Fixed Wing |
Your shift or event may cover multiple vehicles. Try to select the vehicle the best represents the bulk of your event/shift time. |
You’ll log into Siren Field User, using the Siren account you’re provided. Login as a System User. Enter your user name and the initial password you’re provided. |
Add System User > User Name • Enter User Name • Enter Password |
Siren presents account details once you’ve successfully entered your User Name and Password. |
Log in your driver, Partner Partner. The driver is a non-system user, so you will need to enter them into Siren. Partner’s employee number is 123456. Partner is a PCP license level. |
Add Non-System User > Add Non System User • Enter User Name • Enter License • Enter ID # • Add Crew Type |
Non-system users can be logged in as driver, but not as the attendant. |
Set your position as Attendant Set Partner’s position as Driver |
Attendant Driver |
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You’ve entered the crew details for the unit. Proceed to Siren’s Patient List |
Siren Crew Login > OK |
Attendant's Documentation |
Navigation Instructions |
Notes |
We’ll start the event with a Practice PCR. This allows you to create and finalize an ePCR, but it will be treated as a Practice and not be confused with valid patient ePCRs. |
Patient List > Practice PCR |
If the below scenario was a real event, you’d create an ePCR, not a practice ePCR from the Patient List. |
06:28 – You receive a call from dispatch about a type 1 respiratory failure patient in Smithers going to Vancouver General ICU. What you know is that it’s: • A 55-year old female • ARD, secondary to CAP and sepsis • Hypotensive, not intubated, saturations in the low ‘80s • Tachycardic The night pilots have checked the weather and it’s a go. |
Incident > General > Call Received Time/Date |
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Event number is E191234567 MPDS is 6 (Shortness of breath) |
Incident > Incident > General > Event Number Incident > Incident > General > MPDS Determinant |
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06:40 – You’re enroute to the call. |
Incident > Times/Details > Times > En Route to Scene |
On car, you can enter the enroute to incident, incident arrival, en route to destination, and destination arrival times in CAD. These are sent to your Toughbook and populate in Siren. For this scenario, enter the times directly into Siren. |
Once at the airport, the flight crew finishes flight planning and fueling as you load the aircraft. 30 minutes after arrival you are taxiing out onto the runway. |
Incident > Times/Details > Complications/Barriers > Scene Barrier |
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Your weight off wheels time is 07:10. You’re headed to Smithers General Hospital by way of the Smithers airport. |
Incident > Times/Details > Complications/Barriers > Transport Barrier Incident > Incident Location > Enter Smithers General Hospital (in Address 2 Field) |
Select ‘Waiting for crew” or “Resource Availability” |
You arrive at Smithers General Hospital at 09:15. |
Incident > Times/Details > Times > At Scene |
You’re now at the incident location. There’s a lot of equipment to take in, so you may opt to leave the Toughbook in the ambulance and chart using a Patient Information Notebook. You’ll log this detail into Siren later, once the patient is stable or transferred.
Driver's Data Entry |
Navigation Instructions |
Notes |
09:20 – You arrive at patient’s side. |
Incident > Times/Details > Times > At Patient’s Side |
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On arrival, patient is found supine in the hospital bed with a NPA insitu and highflow oxygen being delivered through a non rebreather mask. The patient is rousable with tactile stimulation, has a open airway and is tachypneic with a shallow tidal volume. The radial pulse is weak and rapid with warm dry skin. You note that the patient has an 18 guage IV in her left ACF and a floley catheter insitu with scant urine in the collection bag. |
Primary > Scene Findings
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You obtain the patient’s name from the nurse. They provide you their BC Services Card so that you can enter the details in Siren For this scenario, document yourself as the patient. Use your own BC Service Card to document patient demographics to the Practice PCR. |
Patient ID > Identification > Menu > Scan > Verify Patient Information (edit as required) |
Scan you own BC Services Card. Remember to hold the card approx. 3-5 CM away from the scanner at a 10-15 degrees facing down. The scanner is reading the barcode on the bottom of on the back of the ID. |
The nurse gives you the hand over report stating that the patient is a 55 year old female with a history of hypertension and GERD that had a three day complaint of flu like syptoms with worsening productive cough over the last few days. The patient arrived in the ED 20 hours ago with a complaint of SOB and feeling generally unwell. Her condition has progressively gotten worse over the last 6 hours to the point in which she has tired out and has a decreased LOC. The physician has made a Dx of pneumonia that has progressed to sepsis and potentially ARDS. You collect the patient’s chart and photocopy the initial admitting form and latest lab values. |
Menu > Current ePCR > Attach / Detach (Take a picture of this printed document and attach to the ePCR). Enter pertinent information to the event narraritive (Comments). |
You can take a picture and attach different forms of documentation. It will be available to hospitals using the Siren Notification Board, and will attached to the BCEHS ePCR record.
Pictures will automatically delete off TB within 48 hours |
12:05 – You begin your primary assessment to find: • Neurological – GCS 3-3-3 with a RASS of -4 • Respiratory – SP02 on high flow 02 on 85%, there is a notable increased WOB and a shallow tidal volume, • Cardiovascular – Sinus tachycardia at a rate of 130, a BP of 80/40 with warm day skin • Endocrine – CBG 16 • Muscoskeletal – No remarkable findings |
Vital Signs >Vital Signs> |
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Your exam is complete. Your physiological-based problem list is as follows. • Type one respiratory failure secondary to CAP and ARDS • Shock – Distributive and hypovolemic • Sepsis – pulmonary source |
History > Patient > Complaints/Primary Transfer Diagnosis |
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Respiratory assessment results: Blood gas analysis • PH – 7.09 • PCO2 - 48 • P02 - 50 • HC03 – 14 Other pertanent lab values • Lactate – 12 • Hgb – 90 • Na+ - 146 • Cl- - 108 • K – 4.8 |
Lab Values>Blood Gases> Lab Values> Electrolytes > |
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Your treatment plan consists of hemodynamic resuscitation, RSI, MV, ABX and transport |
Assess/TX > Procedures > Blood Administration |
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You administer a total of 1 litre of plasmalyte and start a low dose infusion of Levophed at 10 mcg/min |
Assess/TX > Procedures > Drug Therapy + SaRC |
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The patients blood pressure is now 100/62 with a heart rate of 118 |
Vital Signs > Vital Signs > |
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You perform a rapid sequence induction and plan for phase two and MV. |
Assess/Tx > Procedures>Drug Therapy+SaRC > Reasons > RSI |
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You administer 50 mg of ketamine, IV. |
Assess/Tx > Procedures > Drug Therapy |
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You administer 100 mg of rocuronium, IV. There’s no complications and the patient is in flaccid paralysis and apnea after one minute. |
Assess/Tx > Procedures > Drug Therapy |
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You are able to pass the endotracheal tube without complication on your first attempt at laryngoscopy |
Assess/Tx > Other Assessments & Procedures > Advanced Airway Registry Form |
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You record the associated situation, complications and responses (SaRC) from the Ketamine and Rocuronium administrations |
Assess/Tx > Procedures > edit > SaRC |
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You plan your MV strategy: • The patient is 100 kg; ideal body weight is 80 kg. • You start with A/C volume of 24 x 60 w FiO2 of 1.0 • PEEP of 10 cm of water pressure. • TI (iTime) of 0.8 seconds • Sensitivity of 3 • Alarm set – PIP at 45 cmH20, Low minmute volume alarm at 13 litres/minute. • Low pressure alarm set at 15 cmH20. |
Assess/Tx > Procedures > Mechanical Ventilation |
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You assess to see if the patient is on safe ground for the initial ventilator strategy. You receive feedback:
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Assess/Tx > Procedures > Mechanical Ventilation |
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Now you plan for phase two of anathesia. You start a propofol infusion 50 mcg/kg/minute as patient’s paralysis will soon wear off. |
Assess/Tx > Procedures > Drug Therapy |
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During this time, you are resucitating their hemodynamics to offset effects of the propofol. • Plasmalyte • 500 mL bolus |
Assess / TX > Procedures > Blood Administration |
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You increase the Levophed infusion to 15 mcg / minute |
Assess/Tx > Procedures > Drug Therapy |
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Now that patient has been on mechanical ventilator for 15 minutes, you need to assess overall homeostasis and acid-based status. You place an arterial line, performing ABG to analyze their blood. |
Assess/Tx > Procedures > IV/IO/Arterial Access Assess/Tx > Procedures > Arterial Line Monitor |
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Conduct blood gas analysis. • PH – 7.20 • PCO2 - 35 • PaC02 - 75 • HC03 – 14 |
Lab Values > Blood Gases > |
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You conduct ongoing monitoring including • Cardiac monitoring • ETCO2 - 32 • Temperature 38.3 • SP02 – 94% |
Vital Signs >Vital Signs > |
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At 11:01, you and your partner load the patient into your ambulance on a stretcher. You’ll transport the patient to St. Paul’s Hospital. |
Outcomes > Patient Disposition/Other |
Complete all 5 fields. |
You travel to airport, by ambulance. The trip is 15 minutes and you monitor the patients’ vital signs and hook up ECG while en route. |
Assess/Tx > Attach Monitor |
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On arrival at the Vancouver airport, you transport the patient to St., Paul’s in an ambulance. While en route, you notify the hospital of your pending arrival. |
Assess/Tx > Procedures > Consultation/Notification |
Continue with the call, proceeding to enter patient history, vitals that are performed. Typically, these are performed by the attendant while on scene, and the driver would document these in Siren.
Driver's Data Entry |
Navigation Instructions |
Notes |
Select a Provider’s Impression for this Patient Event. • In the search bar, type your impression of the Patient. You enter your Chief Impression of Opioid Overdose. • Change Assesment Time as required. |
Impression > Impressions > Provider’s Impression > |
Once, selected, use the to edit this selection. Select if the Patient event was a prehospital or an interfacility Transfer |
Indicate the event is a pre-hospital event. |
Impression > Impressions > Provider’s Impression (Edit the Impression Code you entered) |
This is a common field to forget to enter. It’s mandatory, so if it’s blank, it will alert you when you’re trying to finalize your ePCR. |
12:39 – You arrive at the hospital. |
Incident > Times/Details > Times > At Destination AND Incident > Incident > Destination |
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You stay with the patient and await transfer of care with the PCC. As the patient rests, use the Required Fields section in the Review tab to complete data entry for the ePCR. |
Review > Required > Agency |
The required agency fields help identify the fields required to complete the ePCR. Use the to directly access fields that require completion. You will need to explain why the information was not collected. |
As you explain the event situation, background, your assessment and recommendation to the nurse, you hand over the patient’s wallet. You obtain the nurse’s name and signature for these personal belongings. |
Review > Signatures & Waivers > Patient Valuables |
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13:00 – You transferred care to the hospital |
Incident > Times/Details > Times > Care Transfer |
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You don’t end up using the 40 mgs of Ketamine that you drew up for the RSI so you record the drug wastage.
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Assess/TX > Procedures > Edit the Ketamine already documented. Controlled Drug Wastage. Review > Signatures & Waivers > Controlled Substance Wastage Review > Signatures & Waivers > Controlled Substance Wastage Witness |
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You finalize the PCR. |
Review > Print Preview > Finalize |
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You return to the ambulance, plug in the Toughbook to the printer. You print a copy of the PCR, and provide a copy to the bedside nurse. |
• From the Patient List, Select the Finalized ePCR Review > Print Preview > Patient Care Record Report > Print • Select the Printer you want to print from, Model 2 or 3. |
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From the Patient List, Select the Finalized ePCR Review: |
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Print the ePCR: |