Step 2

Describe

DIRECTIONS – Describe the event in 3–5 words. Use words from the trigger where applicable.

Assign Proximal Cause of Event
5 Categories of Proximal Cause
Category 1	PC1
Description: Actions By Patient
Definition: The AE was the result of action(s) by the patient.
Example(s): (E)Patient with capacity refuses transport to a specialty care facility. (F)Patient with capacity refuses treatment specified in protocol. (G)Patient with capacity discontinues ongoing therapy. (H)Patient takes action that results or may result in harm to themselves or others.

Category 2	PC2
Description: Actions By Provider
Definition: The AE was the result of action(s) or inaction(s) by the crew.
Category 2.1 – HEMS Crew (PC 2.1) Example(s): Medication errors Procedural errors (i.e., esophogeal intubation) Failure to zero the A-line prior to vehicle / aircraft moving. Failure to confirm orders from medical command. Failure to activate cath-lab for STEMI patient Failure to treat pain (e.g., extremity pain or treatment as indicated by protocol or medical oversight) Documentation error Inability to establish vascular access after a reasonable amount of time or number of attempts Failure to administer 02 to a hypoxic patient Failure to physically or chemically restrain a patient that is perceived to be at risk of harm to themselves or the crew
Category 2.2 – Non-HEMS (PC 2.2) Example(s): Delay in patient care due to delays by the referring or receiving facility (e.g., patient in CT scanner, patient receiving dialysis).
NOTE--- this is not where we will assign any issues related to equipment (i.e. stretcher drops) or failure to stock equipment. Those will be / should be assigned to Category 3; Medical or Vehicle Equipment.

Category 3	(PC 3)
Description: Medical or Vehicle Equipment
Definition: Failure of the equipment, failure to troubleshoot and correct common problems with the equipment, or failure to remove defective equipment from service.
Category 3.1 – HEMS Crew (PC 3.1) Example(s): Suctioning device malfunctioned during use. An unanticipated malfunction with transport vehicle. Nasal capnography not available or 02 supply diminished during transport. All or any stretcher drop, tip, or malfunction. Malfunction of laryngoscope or ET tube (e.g., bulb failure or balloon failure) Fluid or medication pump failure or malfunction. Ventilator malfunction Failure of cardiac monitor Missing equipment that is needed for use.
Category 3.2 – Non-HEMS (PC 3.2) Example(s): Delay in transport due to patient’s weight Delay in transport due to lack of appropriate equipment (non-hems)

Category 4	(PC 4)
Description: Environmental / Scene Factors
Definition: Factors that may result from weather conditions or factors on the ground/scene (or other). This includes temperature, light, and scene safety.
Example(s): Cold causing fogging of optics on a Video laryngoscope system. Freezing of fluids or drugs (e.g., mannitol). Diversion to a non-trauma center due to weather conditions for a trauma patient. Scene not safe delaying landing or take-off, prolonging on-scene time or pre-arrival (e.g., a remote landing zone). Delay in managing patient’s airway due to prolonged extrication. Delay due to prolonged arrival by ground or intercepting crew. A delay in patient packaging and transport due to weather.

Category 5	(PC 5)
Description: Undetermined by Chart Review
Definition: The proximal cause of the AE (regardless of severity) cannot be determined by the information available in the chart