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HomeMy WebLinkAboutEMS-13 - Prehospital Care ReportFIRST RESPONDER   PREHOSPITAL CARE REPORT Date        FRESNO / KINGS / MADERA  EMS #        EMERGENCY MEDICAL SERVICES  Fire Incident #                       Patient Name:       Gender:  Male  Female Age:      Years  Months  Days Unit:        Patient Address:          Arrive:       Location of Incident:       DOB:       Weight:       Pt Contact:       Chief Complaint Cardiac Arrest Information   Pulseless/Non-Breathing  GCS        LOC X      Witnessed:  Public  Police  Rescuer  None  Complaint:       CPR Started:  Public  Police  Rescuer  None  P       Down Time to CPR:   CPR Started:       Q       Treatment Defibrillation  R       Time S R/S W/S Pulse CPR Inil.  S          200 360 Y N 1 Min.   T                     Vital Signs               Time Resp H/P Pulse Cap Refill Pupils Skin                                                                                                                                                                                    Past Medical History  Denied  Unknown  Cardiac (Unspecific)                MI  Psych  CHF  Angina  COPD  CVA                Hypertension  Diabetes  GI  Cancer  Seizures  Pacemaker Patient Outcome  RAS  1144     Patient Refused Evaluation  Code Called At Scene  Medications        Denied BLS Therapy         Unknown O2  N/C  Mask  DV  BVM Time:              Liters  2  6  15   Allergies        Denied Airway  OPA  NPA  Suction          Unknown  Hemorrhage Control  Splint  Physical WNL ABN   Spine Immobilization  Oral Glucose  Heart        DNR:  Form Time Term. CPR:        Neck          Medallion  Medical  Trauma  Back        Init. Team Members Cert No.  Chest                           Abdomen                           Pelvic                           Extremities        Transfer to Ambulance Transport Unit No.       Neuro        Signature:    PATIENT COPY