Overview#
When an ambulance is en route with a time-critical patient, the receiving Emergency Department needs to know who is coming, what is wrong, and which clinical pathway will be triggered before the bay is even staffed. A pre-alert that arrives only as the trolley rolls through the door is too late to assemble the right team or to clear the right resus space.
The Hospital Pre-Alert and ED Whiteboard Notification module pushes patient demographics, vitals trend, presenting complaint, AMPDS code, ETA, and pathway flag (STEMI, stroke, trauma, paeds, sepsis) to the receiving Emergency Department's whiteboard via HL7 FHIR R4 and signed Standard Webhooks before the ambulance arrives. The pre-alert is generated from the canonical incident together with the ePCR encounter, and the receiving ED's acknowledgement comes back as a dedicated disposition feedback record so the loop closes on the same incident timeline.
Last Reviewed: 2026-05-05 Last Updated: 2026-05-05
Key Features#
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Pre-Arrival Whiteboard Update: Patient demographics, current vitals, presenting complaint, and ETA reach the receiving ED whiteboard before the ambulance turns into the bay.
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Pathway Flag Routing: STEMI, stroke, trauma, paeds, and sepsis flags travel with the pre-alert so the right team can be assembled and the right resus space cleared in advance.
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Incident-Linked Pre-Alert Generation: The pre-alert is composed from the canonical incident plus the ePCR encounter, so call, dispatch, vehicle position, vitals, and complaint all align as a single source.
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Vitals Trend, Not Just Snapshot: Observation resources carry the trend in vitals from first contact onward, giving the ED clinician movement rather than a single point.
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Signed Webhook Delivery: Pre-alert payloads reach the receiving ED via signed Standard Webhooks so the receiver can verify origin and integrity.
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Capability-Aware Destination Matching: A pathway-aware destination roster helps the dispatcher or crew select a hospital that can actually receive the case.
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Closed-Loop Disposition Feedback: The ED's acknowledgement and final disposition return into a dedicated disposition feedback record and surface on the canonical incident timeline.
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Crew Confirmation Step: A confirm-before-send step on the responder mobile app keeps the crew accountable for what is sent in their name.
Use Cases#
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STEMI Activation En Route: A crew flags a confirmed STEMI from the ECG and the cath lab is alerted before the ambulance reaches the hospital ramp.
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Stroke Pathway Pre-Alert: A presumed stroke with last-known-well time, vitals, and ETA reaches the stroke team in time to ready imaging.
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Major Trauma Diversion: Pathway flag and patient profile are pushed to the trauma centre while the dispatcher checks capacity at alternative destinations.
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Paediatric Resus Preparation: Age-banded vitals and presenting complaint reach the paediatric resus team before the patient arrives.
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Sepsis Bundle Preparation: Early warning score and presenting complaint trigger sepsis bundle readiness on the ED whiteboard.
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Inter-Facility Transfer Handoff: A planned transfer carries demographics, vitals trend, and current treatment forward to the receiving facility's whiteboard.
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Closed-Loop Quality Review: Disposition feedback flowing back into the incident timeline supports later review of pre-alert accuracy and pathway outcomes.
Integration#
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HL7 FHIR R4 Encounter and Observation Resources: The pre-alert is assembled as a FHIR bundle that the receiving ED can ingest into existing FHIR-aware whiteboard and EHR systems.
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Signed Webhook Receivers: Receiving EDs validate the HMAC SHA-256 signature on the Standard Webhooks payload before updating the whiteboard.
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Hospital EHR Connectors: Adapters for Beaumont, Mater, St James, Tallaght, Cork, and Galway carry the pre-alert into the local hospital surface where supported.
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Canonical Incident and ePCR Encounter: Pre-alert generation reads from the live incident together with the ePCR encounter; delivery state lives in a dedicated handoff tracking record linked back to the incident.
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Disposition Feedback Loop: Receipt and final disposition flow into a dedicated disposition feedback record and surface on the unified incident timeline alongside dispatch, vitals, and crew narrative.
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Manual and Mobile Composition: A dispatcher composer and a crew confirm screen both produce the same canonical pre-alert object, regardless of who triggers it.
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Pathway-Aware Destination Roster: Capability roster lookups help match the case to a hospital that can actually receive the pathway being flagged.
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AI Partner Assistance: When AI assistance is offered for pre-alert composition or destination suggestion, the suggestion is always reviewable and overridable by the crew or dispatcher before send.
Open Standards#
- HL7 FHIR R4: pre-alert payload uses Encounter, Observation, Patient, Communication, and Coverage resources so the receiving ED can ingest it into FHIR-aware whiteboard and EHR systems.
- HL7 FHIR R5: a forward-compatible bridge keeps receiving systems able to migrate to the newer release without re-integration.
- SMART on FHIR: ED whiteboard authorisation follows the SMART on FHIR application authorisation pattern.
- IHE PCC Emergency Department Referral (EDR): pre-hospital to ED handoff follows the IHE PCC EDR profile so that the handoff is interoperable with conformant EHR and whiteboard products.
- Standard Webhooks (HMAC SHA-256): signed webhook delivery to the receiving ED endpoint uses the Standard Webhooks specification with HMAC SHA-256 signatures so the receiver can verify origin and integrity.
- LOINC: vital sign observations are coded with LOINC so that values are interpreted consistently across receiving systems.
- SNOMED CT: presenting complaint is coded with SNOMED CT so that the clinical concept survives the handoff to the receiving system.
- CloudEvents 1.0: pre-alert lifecycle events follow the CloudEvents 1.0 envelope so they can flow through standard event infrastructure.