Hopkinsville Fire & EMS Ambulance Request

1

Select the type of Ambulance request below:* This field is required.

Patient Transport

Special Event/Standby

2

Does the patient have or do they wish to have a Do Not Resuscitate order (DNR)?* This field is required.

YESNO

3

DO NOT RESUSCITATE (DNR) Information - Kentucky law forbids EMS from recognizing any DNR request unless it's specifically spelled out on the "Kentucky Emergency Medical Services Do Not Resuscitate (DNR) Order or on the Medical Orders for Scope of Treatment (MOST) form. Furthermore, the original form should be accessible by EMS when arriving to transport the patient. "Hospital DNRs" cannot be honored. Therefore, if the patient wishes to not be resuscitated by EMS, please download one of the attached forms and fill it out following the supplied instructions. If you need assistance completing the forms, please advise the Captain and we will be happy to assist. Informational Document

4

KY EMS DNRInformational Document

5

What type of transport will this be?* This field is required.

JSMC or BACH Origin Only - Immediate request to transport a patient to another hospital (Not to Cumberland Hall or WSH).

JSMC or BACH Origin Only - Scheduled Transport to another Hospital (to include Cumberland Hall and WSH) for continued care

Discharge from a Hospital or facility

Scheduled Medical Transport (Dialysis, Wound-care, Appointments, etc.) in days or weeks from today.

Transportation directly to an Emergency Room from an out-of-hospital location.

A representative from HFD has directed you to choose this PCS-only option. **Please do not select this option unless you have been advised to do so**.

6

STOP!

If the patient is to be transported directly to the Emergency Room it is considered to be an immediate request for service and must be processed through our Emergency Communications Center, even if you believe the patient's complaint or condition is not an emergency. Stop and call 911 or 270-890-1300 for an Ambulance.

7

Does the patient have Medicare OR Medicaid?

YESNO

8

Emergency Interfacility Transports

Next, you will be directed to Scheduling and Patient Registration.

After completing that form, call the on-duty Captain to confirm the Emergency Transfer Request.

If the Captain does not answer, contact ECC at 270-890-1300 and advise them that an Emergency Transfer Request is holding and that the on-duty Captain needs to be notified.

9

Non-Emergency Interfacility Transports

Step 1 — Complete Scheduling and Patient Registration
You will first be directed to Scheduling and Patient Registration.

Step 2 — Notify the On-Duty Captain
After submitting the form, call the on-duty Captain to confirm the Transfer Request at 270-890-1459.

Step 3 — If the Captain Does Not Answer:

Between 0700–2100

Leave a voicemail with the details of the Transfer Request.
Keep in mind that Command Staff may be unavailable because they are responding to another emergency.
If you have not received a return call within 30 minutes, call the on-duty Captain again.

Between 2100–0700

If the on-duty Captain does not answer, call ECC at 270-890-1300.
Advise ECC that you have a non-emergency interfacility transfer holding.

10

Convalescent Transportation (Dialysis, wound-care, appointments, etc.)

Next, you will be directed to Scheduling and Patient Registration.

Complete that form and someone will contact you within 8 hours for scheduling and within the hours of 0800 and 2000.

24 hour notice is required except due to extenuating circumstances.
The time you request is not guaranteed and is based on available resources.

11

Discharges

Next, you will be directed to Scheduling and Patient Registration.

A representative will contact you within 1 hour.

Discharges will be arranged for JSMC ED 24/7, if resources allow.
Discharges from any other location will only occur between the hours of 8am and 8pm except for extenuating circumstances. A representative will return your call during these hours to confirm transport.