Prolonged Field Care MTF handover sheet

PRIOROTY I INFORMATIONI am

Rank, Name

aPJ/68W/18D/

CRF

from unit

I´m bringing in a critical / non

critical

years old male/

female

patient

who is a Coalition(non)military/non coalition security/civilian/opposing

force(POW)

The patient got injured by IED/GSW/RPG/accident/fall/other

hrs. ago

at location

Evacuation time hrs by air / land

Injuries sustained: TBI / penetrating/bunt trauma / amputation / arterial bleeding /

bleeding

Eye injury / burns / fracture / intoxication / laceration / other

Probem

s NO

W:

<C>

NONE / critical bleeding leg / groin / arm / axilla / neck/ hemodynamic instability

A NONE / Airway obstruction / opened airway / respiratory acidosis

B NONE / low-high respiration rate / thorax injuries / tension pneumothorax / other

C NONE / low-high blood pressure / low-high pulse-rate / bleeding / low O2-saturation / other

D NONE / A V P U / pupils / pain / spinal injury / fracture / other

E NONE / low-high body temperature / wet clothes / other

Other information:

PRIORITY II INFORMATION

Trea

tment

given:

<C>

NONE / Tourniquet + TIME ! / hemostatic agent / wound packing / pressure bandage

A NONE / cric / SGA(LT) / ET / NPA / OPA / positioning

B NONE / chest seal / ND / chest tube / other

C NONE / i.v. / i.o. / blood / fluids / recovery position / other

D NONE / splint / spine stabilization / sedation-analgesia / burn dressing / other

E NONE / hypothermia prevention / hyperthermia treatment/ changed clothes / other

Medication: Analgesic / Antibiotics / Oxygen l/min

Fluids: Crystalloid / colloids (ml total)

N K D A If so, which? diseases / allergies

No Known Diseases / Allergies

Other information not covered above:

Prolonged Field Care MTF handover sheet

PRIOROTY I INFORMATIONI am

Rank, Name

aPJ/68W/18D/

CRF

from unit

I´m bringing in a critical / non

critical

years old male/

female

patient

who is a Coalition(non)military/non coalition security/civilian/opposing

force(POW)

The patient got injured by IED/GSW/RPG/accident/fall/other

hrs. ago

at location

Evacuation time hrs by air / land

Injuries sustained: TBI / penetrating/bunt trauma / amputation / arterial bleeding /

bleeding

Eye injury / burns / fracture / intoxication / laceration / other

Probem

s NO

W:

<C>

NONE / critical bleeding leg / groin / arm / axilla / neck/ hemodynamic instability

A NONE / Airway obstruction / opened airway / respiratory acidosis

B NONE / low-high respiration rate / thorax injuries / tension pneumothorax / other

C NONE / low-high blood pressure / low-high pulse-rate / bleeding / low O2-saturation / other

D NONE / A V P U / pupils / pain / spinal injury / fracture / other

E NONE / low-high body temperature / wet clothes / other

Other information:

PRIORITY II INFORMATION

Trea

tment

given:

<C>

NONE / Tourniquet + TIME ! / hemostatic agent / wound packing / pressure bandage

A NONE / cric / SGA(LT) / ET / NPA / OPA / positioning

B NONE / chest seal / ND / chest tube / other

C NONE / i.v. / i.o. / blood / fluids / recovery position / other

D NONE / splint / spine stabilization / sedation-analgesia / burn dressing / other

E NONE / hypothermia prevention / hyperthermia treatment/ changed clothes / other

Medication: Analgesic / Antibiotics / Oxygen l/min

Fluids: Crystalloid / colloids (ml total)

N K D A If so, which? diseases / allergies

No Known Diseases / Allergies

Other information not covered above: