Johns Hopkins Pcr
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Hopkins Emergency Response Unit Care Report ~
~
~''''''''''-d'-<>':
Date of Call
[[ill [[ill
ITIIIIIJ
In Service
Call Rec'd
Call No.
Name
Dispatch Information
Address
Call Location
~------_._-----------------_._-+-------------
Phone Age
Freshman Sex
DOB
Chief COlllplaint
Male Female
Sophomore
Junior
Senior
o Airway Obstruction o Respiratory Arrest o Respiratory Distress o Cardiac Arrest Allergic Reaction
Stroke Gastro-Intestinal Distress Diabetic Related (Potential) Seizure Behavioral Disorder Substance Abuse Pain
o None o Allergy to _ o Hypertension o Stroke o Seizures o Diabetes oCOPD o Cardiac o Other (List) o Asthma
Other
Security Officer
o
o Alert o Regular o Irregular Rate: o Regular o Irregular Rate:
o Regular o Irregular
o o o o
Trauma- Blunt Trauma-Penetrating Soil Tissue Injury Bleeding / Hemorrhage OB/GYN Bums Other
Poisoning
o Shock o Head Injury o Spinal Injury o Fracture / Dislocation o Amputation _
o Verbal
Current Medications (list)
o Painful o Unresp, o Alert o Verbal o Painful o Unresp, o Alert o Verbal o Painful o Unresp,
Normal
o Unremarl
o Dilated 0 o Constrictedo o Sluggish 0
o Unreactive 0 o Normal 0 o Dilated 0 o Constricted 0 o Sluggish 0 o Unreactive 0 o Normal 0 o Dilated 0 o Constrictedo o Sluggish 0 o Unreactive 0
I
o Oxygen Administered @ [TI via o Airway Cleared o Oral/Nasal Airway
_
Bleeding / Hemorrhage Controlled Spinal Irnrnobilization Neck and Back Limb Irnrnobilized by Splinting (Heat) or (Cold) applied Primary Survey Secondary Survey
Crew Member
o Monitored Vital Signs o Calmed and Reassured Patient o Suction Used o Artificial Ventilation Method o C.P,R. Started @ time o Defibrillation No, Times o Other o Other o Other
Heat Cold Hazardous Material Obvious Death
_
Tn'atmcnt GiHn
o
Faculty
SlIbjccti\ c .\sscsslIlcnt
P,'csenting Problem
o o o o o
Grad.
T"ansfc" of Ca"e
o Released o HC (Open / Next) o via Security to: o Union Memorial o Other _ o Medic # _ DRMA
_ _ _ _
Crew Member
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