3.1.23 RR D.S. Debrief
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Arizona Western College *
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BIO-299
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Health Science
Date
Jan 9, 2024
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2
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Attachment (B) NV Velerans Affairs MEMORANDUM Date: 3/1/23 From: Jon Tauschek NOD Subj: Medical Emergency Behavioral Emergency Rapid Response To: Emergency Services Committee (MS) / Disruptive Behavior Committee (MH) This memorandum serves as a debriefing summary of a Medical / Behavioral Emergency Response at the Tomah VAMC. The following is to be completed by the Nurse of the Day (NOD) / Designee present at the scene immediately following the emergency / response. Criteria for completing this form: Medical Emergency — 1. Patient's Name: David Swanson 2. Location of Emergency: 401A West Nurses station 3. Date/Time of Emergency: 3/1/23 @ 06:15 HRS 4. Inpatient / Outpatient: Inpatient 5. Time Debriefing Started: 06:45 6. 'What went well during the Emergency situation? Good response from staff/good turnout. Staff immediately cailed for rapid response. 7. What did not go well? Went well - 8. How doyou all feel it went? Went well - 9. Were there any concerns that precipitated the event? No 10. Was anyone confused by the events that took place during the emergency? No 11. What improvements would you suggest? Possibly a different wheelchair. 12. Any additional concerns that you would like addressed? None at this time. 13. Did anyone do an outstanding job? All involved did a good job at obtaining patient information 14. Did you have the necessary tools/training/resources to complete the event at a full performance level? Yes 15. Did you know who was in charge of the Emergency Situation? Yes — Dr. Teske
17. Provider in Charge of Emergency: Dr. Kim MOD 18. Staff involved during the emergency: Staff and others who responded to the Level of PPE Used: (gown, N95, gioves, shield, Emergency or Rapid Response: surgical mask, PAPR,) Paul Ryan RN Surgical Mask and Faceshield Linda Olson RN Surgical Mask Amanda Hallman NA Surgical Mask Sharmila Rowan NA Surgical Mask Jon Tauschek NOD Surgical Mask Dr.Teske MOD Surgical Mask Officer Carter Surgical Mask Officer Ackman Surgical Mask Dewitt Fire Dept. Surgical Mask {una Fire Dept. Surgical Mask 18. Recommendations from you or the response team: None at this time 20. Is there anyone that would benefit from further support such as EAP? No 21. Does anyone have any questions on documenting the event? No Jon Tauschek _MC D Printed Name of staff completing memo Slgnat/efl'ltle of staff completing memo FORWARD COMPLETED MEMO AS INDICATE‘D BELOW: TO MEDICINE SERVICE ADMINISTRATIVE ASSISTANT (MAIL CODE: MS) MS Administrative Assistant will include time on the agenda of the Emergency Services Committee to review these reports. (reference MCM MS-03) TO MENTAL HEALTH SERVICE ADMINISTRATIVE ASSISTANT (MAIL CODE: MH) MH Program Specialist will distribute to the chairperson of the Disruptive Behavior Committee (DBC) and will place on the agenda for review by the DBC. (reference MCM MH-26) CONFIDENTIAL AND PRIVILEGED INFORMATION This review is confidential and privileged under provisions of Title 38, U.S.C. Section 5705, which provides fines up to $20,000 for violation. This material will not be transmitted without proper consent or under authorization as provided by law or regulation.
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