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  • Warning - Make Sure The Scene Safe Before Entering The Scene

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    dewi s
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    1) This appears to be a form for documenting patient information and treatment from an emergency response. It includes fields for patient details, incident details, protective equipment used, hazards present, chief complaint, injuries, vital signs, treatment, and follow up. 2) The form collects information such as name, date of birth, incident date and time, location, type of accident, protective gear used, oxygen levels, hazardous materials, number of patients, injuries, vital signs over time, symptoms, treatment given, and recommended follow up care. 3) It is used to thoroughly document an emergency response incident for record keeping and to ensure proper follow up care.

    Original Description:

    Anamnesa

    Original Title

    Captain Report

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    1) This appears to be a form for documenting patient information and treatment from an emergency response. It includes fields for patient details, incident details, protective equipment used, hazards present, chief complaint, injuries, vital signs, treatment, and follow up. 2) The form collects information such as name, date of birth, incident date and time, location, type of accident, protective gear used, oxygen levels, hazardous materials, number of patients, injuries, vital signs over time, symptoms, treatment given, and recommended follow up care. 3) It is used to thoroughly document an emergency response incident for record keeping and to ensure proper follow up care.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    11 views1 page

    Warning - Make Sure The Scene Safe Before Entering The Scene

    Uploaded by

    dewi s
    1) This appears to be a form for documenting patient information and treatment from an emergency response. It includes fields for patient details, incident details, protective equipment used, hazards present, chief complaint, injuries, vital signs, treatment, and follow up. 2) The form collects information such as name, date of birth, incident date and time, location, type of accident, protective gear used, oxygen levels, hazardous materials, number of patients, injuries, vital signs over time, symptoms, treatment given, and recommended follow up care. 3) It is used to thoroughly document an emergency response incident for record keeping and to ensure proper follow up care.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 1

    Surname: First Name: Middle Name: DOB

    Patient # use 24 hours Location : > Retreatment


    Time > Incident > Arrival > Depart > Employee # Yes >
    Date Incident > mm / dd / yy > Sex > Male Female No >
    Type of Accident > MVA Fire Landslide Illness Spill Work Acc Disaster False Alarm Others :
    Personal Protective Equipment > Glove Mask Face Shield Gowns Eye Glass Class > A B C D Suit

    WARNING - MAKE SURE THE SCENE SAFE BEFORE ENTERING THE SCENE
    Gas > Yes No Electricity > On Off O2 Level > OK SCBA Power > On Off

    Hazardous Material Spilled Type : Gasoline Gas Diesel Chemical Reagent Others :

    Chief Complaint:
    Patient/Incident

    Number of Patients (circle) > Patients Version of Incident:

    > 1 2 3 4 5 6 7
    8 9 10 X >>> Above 10

    Additional Help > Hospital Security Police Dept Other Dept :

    Injury Code (Mark on figure) Main Condition/Problem


    F > Fracture Abdominal Pain/Problem Fitting Convusing
    L > Laceration > Allergies & Medical Reaction Headache
    A > Abrasion Altered Level of Conciousness Heat/Cold exposure
    H > Haemorrhage Back Pain OD/Ingestions/Poisonings
    T > Tenderness Breathing Problems/Asthma Obstetric
    C > Contusion Burns Stroke/C.V.A
    D > Dislocation Cardiac Arrest Trauma
    B > Burms Chest Pain (non traumatic) Trauma Penetrating
    P > Pains Diabetic Problems Other (Non Specific)
    R > Rigidity Electrocution/Electric Shock
    S > Swelling Eye Problems/Injuries

    Patient Status > Lying Sitting Standing


    Airway Level of Conciousness Skin & Temperature Equipment
    Breathing A Alert Normal Warm Cervical Collar
    Circulation V Respond to Voice Pale Sweaty Spine Board
    P Respond to Pain Cyanotic Hot Scoop Stretcher
    Vital Signs
    U Unresponsive Flushed/Red Cold S.K.E.D
    Blood Pressure Respiration Pupils Breath Sounds K.E.D
    Time Pulse
    Systolic Diastolic Rate Size React Size React Airway
    R l R L R l R L Manual Position
    Suction
    Oral Airway
    HISTORY LMA
    S Signs and Symptoms : Follow up Treatment/Referral O2 Therapy :
    A Allergies : Medium Concentration
    M Medication : Ambulance/Hospital High Concentration
    P Pertinent History : Doctor 100% on Demand
    L Last Oral Intake : Sent Home Litre / Minute
    E Events prior to Incident : Further Re Treatment > 2- 6 6-10 12-15
    Return to Work Other :
    Treatment:

    Initial/Call Sign

    Team Name: Time All Clear by OSC > Team Captain >

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