Vessel Emergency Response and Patient Care Report.Pages

PCR Patient Care Report

SITUATIONAL Date of incident:___/____/___ Time:______hrs AWARENESS

Incident Location:______Scene Safe? • Breathing YES/NO? Patient Name:______• No Breathing = CPR! • EMS/USCG Notiﬁed? • AED on Scene? Address:______• AED Deployed? • AED On? Phone Number:______• PPE for BBP? • Check Scene Again! DOB:____/____/____ Gender: Male Female • All resources notiﬁed? • Do you need medical NOK (Family Contact) Name:______• direction? Re-check the scene, • is it safe? Relationship:______

Phone___(_____)_____-______

Chief Complaint:______

VITAL SIGNS

TIME BP HR RR SKIN TEMP PULSE AxO GCS PAIN OX LEVEL

Sick:____ Not Sick:____ Does this injury require a hospital visit? Yes:___ No:___ Was USCG/911 called? Yes:___ No:___ Was the patient transported? Yes:___ No:___

Courtesy of Northwest Response, LLC. www.northwestresponse.com First Aid, CPR/ AED Training & AED Sales SAMPLE:

S:______(signs & symptoms) A:______(allergies) M:______(medications) P:______(prior medical history) L:______(last oral intake-food/water) E:______(events leading up to-what were you doing)

OPQRST:

O:______(onset- When did it happen) P:______(provocation-what makes it better or worse) Q:______(quality of pain 0-10) R:______(radiation of pain) S:______(any swelling) T:______(any tenderness or use time of incident/illness)

Courtesy of Northwest Response, LLC. www.northwestresponse.com First Aid, CPR/ AED Training & AED Sales Head:______

Chest:______

Abdo:______

Lwrext:______

UprExt:______

Back:______

NARRATIVE: ______

______

______/______/______Patient Signature/ Guardian Date

______/______/______Crew Member Signature Date

Remember, all information gathered on the PCR is conﬁdential and is not to be shared with anyone other than EMS. Once ﬁlled out, and if EMS is on scene, hand off the form to EMS or destroy the form immediately after the patient has left your care.

Please respect the patients privacy.

Courtesy of Northwest Response, LLC. www.northwestresponse.com First Aid, CPR/ AED Training & AED Sales VESSEL MEDICAL EMERGENCY RESPONSE CHECK LIST NOTIFICATIONS SHOULD BE MADE ON VHF 16

VESSEL NAME: ______REGISTRATION______

ON-BOARD CELL/MOBILE NUMBER(S): ______

ENSURE ALL ONBOARD ARE WEARING LIFE JACKETS

TIME & DATE VESSEL SAFE NOTIFICATIONS VESSEL # OF PERSONS VESSEL AND SECURE MADE LOCATION ONBOARD DESCRIPTION

MED-EVAC PREP Helicopter rotor wash is very powerful and any unsecured items may turn into ﬂying projectiles.

ITEM COMPLETED Secure all loose items on deck Lower and secure sails All onboard are wearing a life jacket The helicopter is likely to approach your boat on the port stern quarter, because it gives the pilot optimal visibility from the cockpit. So unless instructed otherwise, set your course so that the wind is 45 degrees off your port bow Never shine a light or strobe directly toward the helicopter, and never ﬁre ﬂares in the vicinity of the helicopter. Wait for the rescuers to tell you what to do, and then do it.

Typically the Rescue Swimmer will be lowered to your deck ﬁrst, and the air crew will then send down either a rescue litter or basket.

Always allow the rescue device to touch the deck before handling it. During its ﬂight, the aircraft builds up a static electric charge; anyone who reaches up to take hold of the rescue device will get a shock.

For a high hoist or a hoist in a conﬁned space, a trail line may be lowered ﬁrst. Deck personnel can guide the rescue device to the deck with this line as long as they do not touch the rescue device itself. Do not tie the trail line or hoist cable to any part of the vessel. Until the hoist is complete, a crew member must tend this line at all times to keep the line from fouling.

Courtesy of Northwest Response, LLC. www.northwestresponse.com First Aid, CPR/ AED Training & AED Sales ASSESS COLD PATIENT

1. From outside ring to centre: assess Consciousness, Movement, Shivering, Alertness 2. Assess whether normal, impaired or no function 3. The colder the patient is, the slower you can go, once patient is secured 4. Treat all traumatized cold patients with active warming to upper trunk 5. Avoid burns: following product guidelines for heat sources; check for excessive skin redness COLD STRESSED, MILD HYPOTHERMIA NOT HYPOTHERMIC 1. Handle gently 3. Insulate/ vapour barrier 1. Reduce heat loss 3. Move around/ 2. Have patient sit or (e.g., add dry exercise to warm up lie down for at 4. Give heat to clothing) least 30 min. upper trunk 2. Provide 5. Give high-calorie high-calorie food/drink food or drink CO 6. Monitor for at US N IO S least 30 min. C C S IO N T U 7. Evacuate if no O N S C E L improvement A M SHIVER I E M IN M V R G P O O A N I M LER R A T E

M O

T V

O T E IF COLD & N M

AL E

UNCONSCIOUS N T G T NO N ASSUME SEVERE RI HIVE HYPOTHERMIA S S U IO SC N SEVERE CO MODERATE HYPOTHERMIA HYPOTHERMIA

1. Treat as Moderate Hypothermia, and 1. Handle gently 6. Give heat to upper trunk 2. 60-second breathing/pulse check 2. Keep horizontal 3. No standing/walking 7. Volume replacement 3. No – Start CPR with warm 4. Evacuate carefully ASAP 4. No drink or food intravenous 5. Insulate/ fluid (40-42°C) vapour barrier 8. Evacuate carefully

BICOrescue.com CARE FOR COLD PATIENT

SUGGESTED SUPPLIES FOR SEARCH/RESPONSE TEAMS IN COLD ENVIRONMENTS: 1 - Tarp or plastic sheet for 1 - Plastic or foil sheet (2 x 3 m) for vapour barrier vapour barrier outside placed inside sleeping bag sleeping bag 1 - Source of heat for each team member (e.g., chemical 1 - Insulated ground pad heating pads, or warm water in a bottle or hydration bladder), or each team (e.g., charcoal heater, chemical / 1 - Hooded sleeping bag electrical heating blanket, or military style Hypothermia (or equivalent) Prevention and Management Kit [HPMK])

INSTRUCTIONS FOR HYPOTHERMIA WRAP The Burrito” 1. Dry or damp clothing: Leave clothing on IF Shelter / Transport is less than 30 minutes away, THEN Wrap immediately 2. Very wet clothing: IF Shelter / Transport is more than 30 minutes away, THEN Protect patient from environment, remove wet clothing and wrap 3. Avoid burns: follow product instructions; place thin material between heat and skin; check hourly for excess redness

1 Tarp or Pad 2 Plastic

Plastic Sleeping Bag or Blanket or Foil Apply Heat 4

2 3

3 4 9

5 8 7

The First Aid Kit What’s in it?

We get asked quite often what are the best supplies to have in a first aid Northwest Response kit. The answer is not all that easy as kits can be quite task specific. The Gig Harbor, WA best place to start is to ask yourself “what might I need the kit for?” What are the types of injuries or sudden illnesses I may need to attend Emergency Medical to? And where will you be using the kit? Home, office, car, boat, job site? Response Training Get The Basics + Most kits come with the basics of wound care, but almost all pre-made kits are lacking in one area or another. Off the shelf kits are a great place to start, but are often packed full of items that may never get used (but nice to have) and the available space in the kits leave very little room to add additional supplies.

The Northwest Response EMS Teams kits are shop built from hundreds of items and have evolved over time to load up on the items we use the most. Our EMS station kits come in three sizes, jump-kit (shoulder bag) for fast response, two station kits that are quite literally two large tool box’s jammed full of supplies, and a roll-in-roll out kit for smaller special events.

Northwest Response www.northwestresponse.com 1 May 4, 2018

The Kit Before you buy a kit, bag or case; ask yourself where will your ﬁrst aid kit live? Does it need to be weather proof? Is space a consideration? Look at the space where you will want to house your kit, measure it and then go shopping.

If you want to build a kit, consider a soft sided one like a backpack. If moisture is an issue, a good waterproof tool box is just ﬁne. Pre-packed reﬁll kits are available for the DIY, or start with a pre-made kit with extra room to add additional supplies.

Compartmentalize Your Supplies When building a kit from scratch buy your supplies ﬁrst then look for a case or bag to store all your supplies and equipment.

Pack “like” items in sub-compartments within your kit and label them. The choices for clear snap lid box’s are seemingly limitless, and all big box stores carry them in a large variety of styles and sizes. There are also color coded bags available to help with easy identiﬁcation of “like supplies”.

Will you carry an AED? If you are a remote adventurer like boating; we highly recommend acquiring an AED. Let us know if you are in the market for an AED, and we can certainly help you in your buying decision.

The List We have put together a list of supplies that will help you in starting to build your kit and of course not all of the items are a necessity; your kit will evolve just as ours do.

Remember to take a First Aid, CPR/AED class!

Northwest Response www.northwestresponse.com 2 May 4, 2018

• A GOOD PLACE TO • Flexible Large Adhesive START Bandages 2" x 4” • First aid book and Apps • Finger-tip Bandages • CPR Mask • Butterfly strips • BVM (bag valve mask) • 2"x4" fabric bandage strip • Blood pressure cuff kit • Petroleum or Burn Gell Gauze (3" x 9”) • Stethoscope • Shears • Cervical collar • Trauma Shears • Disposable Airway Kit • Forceps • Mini Mag Flashlight • Splinter Forceps • Sutures • Small Cold Packs • Nitrile Examination gloves • Burn Pad (4" x 4”) • Abdominal pad 5"x9" • Burn Sheet • Safety pins • Gauze Rolls (4" NS) • Casualty blanket 84"x52" Silver/OD • Gauze Rolls (3" NS) • Hand sanitizer 2oz. • Triple Antibiotic Ointment • Calamine lotion 6oz. • Antihistamine • Hand soap • Non Coated Aspirin • Antimicrobial Wipes • Ibuprofen • Sting and bite swabs • Individual Saline tubes • Universal/Sam Splint • Eye Wash (4 oz.) • 6" elastic bandage • Instant Glucose • Coban self-adherent wraps • Bio-Hazard Bags • 4"x4" sterile gauze • Molded Surgical Masks • High Grade Fabric Athletic/ • AED (Automated External Medical tape Defibrillator) • BleedStop bandages • TPA: Thermal Protective Aid (warming rescue bag) • Quick Clot • O2 Cylinder with NRB & • CAT-T or SWAT-T Tourniquet Nasal Cannulas • Eye pad • Motion Sickness Patches, or • Eye Wash (4 oz) pills. • Triangular bandage • Activated Charcoal 40"x40"x56" • 1"x3" fabric bandage strips

Northwest Response www.northwestresponse.com 3 VESSEL MEDICAL EMERGENCY RESPONSE CHECK LIST NOTIFICATIONS SHOULD BE MADE ON VHF 16

VESSEL NAME: ______REGISTRATION______

ON-BOARD CELL/MOBILE NUMBER(S): ______

ENSURE ALL ONBOARD ARE WEARING LIFE JACKETS

TIME & DATE VESSEL SAFE NOTIFICATIONS VESSEL # OF PERSONS VESSEL AND SECURE MADE LOCATION ONBOARD DESCRIPTION

MED-EVAC PREP Helicopter rotor wash is very powerful and any unsecured items may turn into ﬂying projectiles.

Typically the Rescue Swimmer will be lowered to your deck ﬁrst, and the air crew will then send down either a rescue litter or basket.

Courtesy of Northwest Response, LLC. www.northwestresponse.com First Aid, CPR/ AED Training & AED Sales PASSENGER STATEMENT OF HEALTH

I,______state that I have no know pertinent previous medical condition(s), I’m not taking any prescribed medications, and attest by my signature below that I am ﬁt to travel.

No medications No known medical conditions See below

Signed______Dated______

CONFIDENTIAL

We take HIPAA and passenger conﬁdentiality very seriously. This form will be returned to you at the conclusion of your voyage. If you have a medical condition, please verify with your personal physician that you are well enough to travel on the itinerary you have chosen. If you are pregnant, on dialysis, traveling with oxygen or using electric medical equipment you need to notify ship’s medical personnel or Captain with this form.

VOYAGE INFORMATION

Preﬁx ____ First Name ______M.I. ___ Last Name ______

Age at time of sailing ______Are you traveling alone? Yes ___ No ___

Name of traveling companion ______

Insurance Company ______Insurance Company Telephone ______

KNOWN CONDITIONS

1. Please list any pertinent illnesses or operations:

2. Please list any current prescriptions and/or over the counter medications:

3. Please list any allergies or medications you may be allergic to:

4. Please list any equipment that you will be bringing onboard the ship (i.e oxygen concentrator, wheelchair, liquid oxygen, pacemaker etc.). If bringing oxygen cylinders or liquid oxygen, please specify how many and which size:

5. Hospitalized in the past year? Yes ____ No ____

6. Any exacerbations within the past year? Yes ____ No ____

7. Do you think that you are medically ﬁt to travel? Yes ____ No ____

If a Yes has been checked for questions 5 or 6, please include details in the section provided below. All medical information is for use by the ship’s Captain or physician for emergency situations.

COMMENTS

DOCTOR’S INFORMATION

Doctor’s Name ______

Address ______

Telephone ______Email ______

PLEASE NOTE

Be advised that we strongly recommend that all passengers purchase travel insurance which provides coverage for appropriate medical care and repatriation or medical evacuation. Some insurance policies may not cover pre-existing medical conditions, nor provide coverage for all medical services. Some policies may not provide the funds necessary for treatment nor evacuation until the passenger has returned home. Medical care and evacuation can be very expensive.

The information that I have stated above is correct to the best of my knowledge.

Signature ______Dated ______

Courtesy of Northwest Response www.northwestresponse.com Radio Call Frequency: High Site: DF Bearing: Time: Date: UCN: Initials: -- Initial SAR Check-sheet --

About the Distressed Vessel 1. Position Type of Position Lat/Long Loran Lines Geographic Location How determined? 2. Number of Persons Aboard ADULTS: CHILDREN: TOTAL: Health or medical concerns? 3. Nature of Distress (if PIW complete additional PIW box below)

4. Description of Vessel Including… Length Color Type Name of Vessel

at anchor? Y N 5. Have all persons aboard the vessel put on Personal Flotation Devices. ***** ADVISE VESSEL OF INTENDED ACTIONS AT THIS TIME *******

6. Determine Initial Severity/Emergency Phase (done by Watch Supervisor) [ ] Distress [ ] Uncertainty [ ] Alert [ ] Dispatch Resources/Activate SAR Alarm. Additional Information is needed. [ ] Advise vessel of Coast Guard’s Actions. Complete one or more of the following: [ ] Brief Group/District [ ] Supplemental Check-sheet [ ] Provide Emergency Instructions to Vessel in Distress. [ ] Overdue Check-sheet [ ] Issue UMIB. [ ] Flare Sighting Check-sheet [ ] Complete additional Check-Sheets as Situation [ ] MEDEVAC/MEDICO Check-sheet Dictates. [ ] Grounding Check-sheet [ ] Refer to D1 SARPLAN.

About any People in the Water Number: Confirmed? Description PFD? Time: Exp suit? Light?

Complete all of the above before shifting frequency; Complete below before hanging up phone.

About the Reporting Source Name of Reporting Source Name of Reporting Source Vessel Call back number (with area code) Is this a cell phone number? Address of Reporting Source

About the On Scene Weather Wind Seas Swells Visibility

K-1 Page 1 of 1 SUPPLEMENTAL SAR CHECKSHEET

VESSEL [ ] Document/Official [ ] State Reg. Communications Equipment [ ] VHF-FM [ ] HF [ ] Other:______[ ] Cellular #:______Frequencies: Homeport: Flag: Navigation Equipment: [ ] LORAN [ ] GPS [ ] Radar [ ] Fathometer [ ] Other: Usage Cause of incident: Survival Equipment: [ ] EPIRB Class/Type:______Prominent Features [ ] VDS/Flares [ ] Flashlight [ ] Raft/Lifeboat [ ] Dinghy/Skiff Hull Material [ ] Food/Water [ ] Foul Wx Gear

PEOPLE [ ] Owner [ ] Operator [ ] POB [ ] Owner [ ] Operator [ ] POB Name:______Name:______Address:______Address:______Phone:______Phone:______Age: DOB: Male / Female Age: DOB: Male / Female [ ] Owner [ ] Operator [ ] POB [ ] Owner [ ] Operator [ ] POB Name:______Name:______Address:______Address:______Phone:______Phone:______Age: DOB: Male / Female Age: DOB: Male / Female ADDITIONAL COMMENTS:

ACTIONS Communications Schedule: Set and Drift: [ ] Not a Factor Start Time: ______Frequency:______Set:______[ ] True Drift:______[ ] Kts Time Interval: [ ] Mag. [ ] Mph [ ] 15 Min [ ] 30 Min [ ] 60 Min [ ] Other DMB Type:______Freq:______Remarks: DMB Inserted Relocated Time: ______Position: ______N ______N ______W ______W

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