3.17.23 RR D.P. Debrief
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School
Arizona Western College *
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Course
BIO-299
Subject
Medicine
Date
Jan 9, 2024
Type
Pages
2
Uploaded by BailiffDanger11609
Attachment (B) MEMORANDUM Date: 03/17/2023 From: Robert Korish, RN 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
–
Behavioral Emergency –
Rapid Response –
1.
Patient’s Name:
Daniel Peplinkski 2.
Location of Emergency: Building 401, 1st floor, canteen 3.
Date/Time of Emergency: 03/17/2023 @0924 4.
Inpatient / Outpatient: Inpatient 5.
Time Debriefing Started: 0935 6.
What went well during the Emergency situation? Veteran was evaluated within a timely manner. No injury noted. 7.
What did not go well? Nothing observed. 8.
How do you all feel it went? The rapid response went well. Police, Fire, and the MOD responded in an acceptable amount of time. 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? None. 12.
Any additional concerns that you would like addressed? No. 13.
Did anyone do an outstanding job? No. 14.
Did you have the necessary tools/training/resources to complete the event at a full performance level? Yes. X
15.
Did you know who was in charge of the Emergency Situation? Yes. 17. Provider in Charge of Emergency: Dr. Coffey
18. Staff involved during the emergency: See Medical Emergency Memo- Summary of Participants 19. Recommendations from you or the response team: None. 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. Robert Korish, RN NOD _________________________________ Printed Name of staff completing memo Signature/Title of staff completing memo FORWARD COMPLETED MEMO AS INDICATED 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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