STATEMENT TOOL
Emergent medical necessity
Select the clinical impression, interventions, and transport contraindication.
Primary Impression:
Interventions Performed:
Why Transport by Other Means Was Contraindicated:
-- Select Contraindication --
Risk of rapid deterioration without EMS support
Need for continuous medical supervision
Inability to ambulate or tolerate upright position
Requirement for advanced care and monitoring
Patient behavior posed safety concern
Absence of capable caregiver at scene
Requirement for specialized transport equipment
Risk of airway compromise en route
Need for continuous medication administration
Need for advanced respiratory support
Need for cardiac monitoring en route
Hemodynamic instability
Altered level of consciousness requiring monitoring
Risk of exacerbation of symptoms during transport
Combative or unpredictable patient requiring restraint
Need for continuous assessment and documentation
Potential for spinal injury requiring immobilization
Significant pain limiting mobility and function
Orthopedic instability requiring stabilization devices
Bleeding requiring EMS hemorrhage control
Increased risk of worsening injury during non-EMS transport
Generate Medical Necessity Statement
Generated Statement
Use in medical necessity
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