muhlenberg_pcr

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MUHLENBERG COLLEGE EMS, DATE ~ F C A L L ,, , ,, , ,., . I LIGHTSUSEDo ~ g E N E

o ~ ~ ~ ~ E

Patient Care ReportCALL REeD

MILEAGE ARRIVEDSTARTFROMSCENEEND I-+---t-----jARRIVED

AT HaSP f-+--+-+--COMPLETE IL---'-------'_-'-

CARE IN PROGRESS ON ARRIVAONONE OPD/FD 0 OTHER EM

A 0 S

CAMPUS ADDRESSAMPUS EXTHOME ADDRESS

CALL LOCATION

OCITIZEN 0 OTHER HPoSports o Fall of __ eet ONone oMachinery E 0 oStruck by vehicle o Unarmed assualt OOthe, G 0E B X M F MCPD Officer(s) on sceneHEALTH PROFESSIONAL CONTACTED

Other Assisting Units

EYES VERBAL MOTOR@Spontan. @Oriented G)None @Obeys Comm. (glPain-ExteOUnremarkabieCool 0 PaleWarm 0 Cyanotic @ToVoice @Confused @Pain-Local G)NoneMoist 0 Flushed (glTo Pain @Inapprop. @Pain-Withdr.Dry 0 Jaundiced G)None (glGarbled @Pain-FlexionOUnremarkable EYES VERBAL MOTOR@Spontan. @Oriented G)None @Obeys Comm. @Pain-ExteCool 0 PaleWarm 0 Cyanotic @ToVo ice @Confused @Pain-Local G)NoneMoist 0 Flushed (glToPa in @Inapprop. @Pain-Withdr.=- -----'=...L-'=_D_ry"----'O Jaundiced G)None @Garbled @Pain-Flexion

CURRENT MEDS. (LIST)OPain ___Chest Pain OVomiting [ ]Denied OCVA/TIA OSeizure

Breathing [J 0 iahrrhea OChoking OMI o Behavioral o Hypertensiono Headache OBurn [ I T I% [ ]CHF o Diabetes OAsthmaDizziness OSeizure OGenerallliness OAngina OSyncope OMigraine

OBehavioral 0 OOther

TREATMENT GIVENMoved on stairchairWalked to First Response UnitAirway clearedOral/Nasal AirwayOxygen Administered @ L.P.M., Method _nSuction UsedC.P.R. in progress upon arrival by: 0 Citizen 0 PD/FD/Other CFR 0 OtherC.P.R. started @ Time [ ITO Time from arrest until CPR [=rrJ MinutesAutomat ic Defibrillation No. of times 0 By:Bleeding/Hemorrage Controlled (Method) _Spinal Immobilization Neck & BackLimb Immobilized by 0 Fixation 0 TractionOther _IN CHARGE o DRIVER NAMEEMT#

BLEEDING oLACERATION oABRASION o S.HH.CONTUSIONAVULSION o ST. LUKNUMBNESS o MCHCQ OTHERDEFORMITYSWELLING

AMPUTATIONBURNPAIN

TENDER


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MUHLENBERG COLLEGE EMSPatient Care Report, , ,, , ,, , , CALL REC'DDATE OF CALL

ARRIVEDNAME ADDRESSHOME PHONE CAMPUS EXT CAMPUS ADDRESS FROMSCENEDISPATCH INFO CALL LOCATION

L--'_---'------'--ARRIVEDCALL REC'D AS AT HOSPo EMERGENCY

DNONEMERGENCY COMPLETEo STANDBYAG

D f-- - - - - - - - - - - - -- - - - - - - - - -1FUBJECTIVE ASSESSMENT

HEALTH SERVICE NOTIFIED? HEALTH PROFESSIONAL ON CALLDMVA (, / seat belt used_) o Fall of __ eet DGSW DMachineryDStruck by vehicle DUnarmed assualt DKnife 0 YES 0 NO 0 I --

PRESENTING PROBLEM o Allergic Reaction 0 Unresponsive 0 Shock 0 Major Trauma 0 OB/GYNIf more than one checked, circle primary 0 Syncope 0 Seizure 0 Head Injury 0 Trauma-Blunt [J Burnso Airway Obstruction o Stroke/CVA 0 Behavioral Disorder 0 Spinal Injury 0 Trauma-Penetrating Environmentalo Respiratory Arrest 0 General Illness/Malaise 0 Substance Abuse (Potential) [ ] Fracture/Dislocation 0 Soft Tissue InJury Heato Respiratory Distress o Gastro-Intestinal Distress 0 Poisoning (Accidental) 0 Amputation o Bleeding/Hemorrhage Coldo Cardiac Related (Potential) 0 Hazardous MateriaRate: o Alert 0 Normal 0 DUnremarkableDRegular o Voice 0 Dilated 0 0 Cool o Pale

DShallow DRegular o Pain 0 Constricted 0 0 Warm 0 CyanoDLabored Dlrregular o Unresp.

Rate: Rate: o AlertDRegular o VoiceDShallow DRegular o PainDLabored o Irregular o Unresp

o Cardiac Arrest

o Hypertension o Strokeo Seizures o Diabeteso COPD o Cardiac

0 Sluggish 00 No-Reaction 00 Normal 00 Dilated 00 Constricted 00 Sluggish 00 No-Reaction 0

0 Moist o Flushe0 Dry o JaundDUnremarkable

0 Cool o Pale0 Warm 0 Cyano[J MOist [J Flushe0 Dry o Jaund

OBJECTIVE PHYSICAL ASSESSMENT

TREATMENT GIVENo Moved on stairchair 0 Medication Administered (see comments)o Walked to First Response Unit 0 Bleeding/Hemorrage Controlled (Method)o Airway cleared 0 Spinal Immobilization Neck & Backo Oral/Nasal Ainway 0 Limb Immobilized by 0 Fixation 0 Tractiono Oxygen Administered @ rn LP.M., Method 0 Heat or cold applied (circle one)o Suction Used 0 Baby Delivered @ Time _o C.PR. in progress upon arrival by: 0 Citizen 0 PD/FD/Other CFR 0 Other 0 Othero C.P.R. started @ Time [II[] Time from arrest until CPR [ I I J Minuteso Automatic Defibrillation No. of times D By: 0 AEMS DCETRONIA DOTHERTRANSPORTED TO: 0 L.V. CEDAR CREST 0 LV 17TH ST 0 SACRED HEART 0 HEALTH CENTER 0 OTHER:C IN CHARGE DRIVER NAMER I----,---,--,---,--,----,----hr,-:=::--,--,-----,--,---,-----,EW EMT#

DNONE

_

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TYPICAL VITAL SIGNS RANGESADULT

BLOOD PRESSURE 90 - 140 SYSTOLIC60 - 90 DIASTOLICPULSE 60 - 100 BEATS/MINUTERESPIRATIONS 12 - 20 BREATHS/MINUTE

CHILDBLOOD PRESSURE 80 - 110 SYSTOLICPULSE 80 - 100 BEATS/MINUTERESPI RATIONS 15 - 30 BREATHS/MINUTE

INFANT (Newborn to 1 Yr.)BLOOD PRESSURE 2X Patient's age + 80PULSE 120 - 140 BEATS/MINUTERESPIRATIONS 25 - 50 BREATHS/MINUTE

THE RULE OF NINES9 Estimation of BurnedBody Surface(PERCENT)i 18 (Front) i18 (Back)i' 18

9 9

189 (Front)1818 18 i (Back)14

\ i /.,/ I,

ADULT INFANT

I , have been advised that medicalassistance on my behalf is necessary and that refusal to accept pre-hospitalcare and transporation to a healthcare facility may imperil my health or resultin death. I assume all risks, consequences and costs of my decision not toaccept pre-hospital care and/or transportation to a healthcare facility, and Irelease Muhlenberg College, its officers, agents, licensed healthcareprofessionals, employees and members of the Emergency Medical Services'from any and all liability arising from my decision.

Name: _ Signature:----------- Date: Witness: _ Signature: - - - - - - - - - - - - Date:

MUHLENBERG COLLEGE EMERGENCY MEDICAL SERVICESEST. 1999

"Serving Our Campus With Pride"9/04

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