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Hopkins Emergency Response Unit Care Report ~ ~


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Date of Call Call No. Call Rec'd In Service

Name Dispatch
Information
Address Call
Location
~------_._-----------------_._-+-------------
Phone
Freshman Sophomore Junior Senior Grad. Faculty Other

Age DOB Sex Security


Male Female Officer
Chief COlllplaint SlIbjccti\ c .\sscsslIlcnt

P,'csenting Problem Stroke o Poisoning Trauma- Blunt o Heat


Gastro-Intestinal Distress o Shock Trauma-Penetrating o Cold
o Airway Obstruction Diabetic Related (Potential) o Head Injury Soil Tissue Injury o Hazardous Material
o Respiratory Arrest Seizure o Spinal Injury Bleeding / Hemorrhage o Obvious Death
o Respiratory Distress Behavioral Disorder o Fracture / Dislocation OB/GYN
o Cardiac Arrest Substance Abuse o Amputation Bums
Allergic Reaction Pain _ Other _

o None o Alert Normal o Unremarl<able


o Allergy to _
o Verbal o Dilated 0 o Cool 0 Pale
o Hypertension o Stroke o Constrictedo o Warm 0 Cyanotic
o Seizures o Diabetes o Regular
o Irregular
o Painful
o Unresp,
o Sluggish 0 o Moist 0 Flushed
oCOPD o Cardiac o Unreactive 0 O D D Jaundiced
o Other (List) o Asthma Rate: o Alert o Normal 0 o Unremarl<able
o Verbal o Dilated 0 o Cool 0 Pale
Current Medications (list) o Regular o Painful o Constricted 0 o Warm 0 Cyanotic
o Irregular
o Sluggish 0 o Moist 0 Flushed
o Unresp, o Unreactive 0 o 0 Jaundiced
Rate: o Alert o Normal 0 o Unremarkable
o Verbal o Dilated 0 o Cool 0 Pale
o Regular o Painful o Constrictedo o Warm 0 Cyanotic
o Sluggish 0 o Moist 0 Flushed
o Irregular o Unresp, o Unreactive 0 o Dry 0 Jaundiced

Tn'atmcnt GiHn I T"ansfc" of Ca"e


o Oxygen Administered @ [TI via _ o Monitored Vital Signs o Released
o Airway Cleared o Calmed and Reassured Patient DRMA
o Oral/Nasal Airway o Suction Used o HC (Open / Next)
o Bleeding / Hemorrhage Controlled o Artificial Ventilation Method _ o via Security to:
o Spinal Irnrnobilization Neck and Back o C.P,R. Started @ time _ o Union Memorial
o Limb Irnrnobilized by Splinting o Defibrillation No, Times o Other _
o (Heat) or (Cold) applied o Other _ o Medic # _
o Primary Survey o Other _
o Secondary Survey o Other
Crew Member Crew Member

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