HTML Preview Patient Run Sheet page number 1.
Initial Information
Date: Time:
Dispatcher:
Person Making Report: Government Employee: (Y/N)
Patient Information
Number of patients: (Every patient gets their own patient run sheet)
Sex: Age: Flight Weight:
Name: (Shouldn’t be broadcast over the radio)
Chief complaint, extent of injuries: (What’s wrong?)
Mechanism of injury or illness: (How it happened)
Decision! Is this a Medical Emergency or a Non Emergency Medical
Transport?
Medical Emergency Patient Run Sheet
Vital Signs
AVPU: (Mental Status) BP: Pulse:
{} ALERT {} VERBAL {} PAINFUL {} UNRESPONSIVE
Skin Color & Temp: Respirations:
IV Started: Y/N
Medically Trained Personnel on Scene:_______________________________________
Medications Administered:
Site Information
Site Contact Name: Ground Contact #:
Fire Name: Fire #:
Radio Frequency FM: Air to Ground:
Latitude: Longitude:
Physical Description: (Mile Marker, Highway)
Additional Resources Needed: (Law enforcement, agency personnel, search and rescue)
Transport Needs: (Air Ambulance helicopter or if more than one patient fix wing. Consider ordering an air
attack if using air ambulance.)
Helispot Location and Size: (Proximity to injury site. Needs to be big enough for medium ship)
Weather: ________________________Temp:_______________Elevation:____________
Other Aircraft:____________________Flight Hazards:____________________________
Information to be obtained and passed on to scene
Resources en-route:
Estimated time of resource arrival:
Radio Frequencies:
Trauma or Burn Center notified:
Supervisor Notified:________________________________________________________