Chief Complaint - Trauma:
Mechanism of Injury
MVA GSW Knife Unarmed Assault
Struck By Vehicle Machinery
Fall of feet
Extrication Req.
 minutes
Seat Belt Used?   Yes No Unknown
Belt Use Rep. By   Crew Patient Police Other
Presenting Problem
  • Airway Obstruction
  • Resp. Arrest
  • Resp. Distress
  • Cardiac Related
  • Cardiac Arrest
  • Alergic Reaction
  • Syncope
  • Stroke/CVA
  • Seizure
  • Shock
  • Gen. Illness/Malaise
  • Gastro. Distress
  • Diabetic Related
  • Uncons./Unresp.
  • Behavioral Disorder
  • Substance Abuse
  • Poisoning
  • Head Injury
  • Spinal Injury
  • Fracture/Disloc.
  • Amputation
  • Major Trauma:
  • -Blunt
  • -Penetrating
  • Soft Tissue Injury
  • Bleeding/Hemm.
  • OB/GYN
  • Burns:
  • Other:
Head Head Neck Neck Thorax Thorax Abdomen Arm Arm Arm Arm Leg Leg Abdomen Groin Leg Head Thorax Arm Arm Leg Thorax Abdomen Groin Leg