Labels - Severe Trauma Symptoms - Lewisite
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Actor Exercise Assessment Form
EXERCISE “VICTIM” Please complete the following questions at the conclusion of the exercise. This card is to be turned in at the checkout station at the exercise site. Please be accurate with your answers. Your cooperation is important and is SYMPTOMATOLOGY appreciated.
Field Assessment and Treatment: TAG 1. Initial Contact and Triage a. How long did it take response personnel to contact you?______Date of Exercise: [MM/DD/YYYY] Casualty #: ______b. How long did it take response personnel to begin decontaminating you? ______c. Were you examined on the scene more than once? Yes No d. Whom did you talk to, or whom were you assessed by (list all)? Fire EMS Police Other ______VISIBLE SYMPTOMS: e. If you received a multicolored triage tag, what was the BOTTOM color when it was first given to you? Green Yellow Red Black Never received a tag f. What actions did response personnel take as a result of their assessment of your condition?
Child on ground with seizure ______activity ______Swollen eyes, tearing ______2. Treatment: Pallor and diaphoresis a. If conscious, did someone explain your treatment? Yes No b. If conscious, were you given clear instructions? Yes No c. What treatment was given?
______
______
PHYSICAL FINDINGS: ______
3. Did you observe any outstanding actions among the response personnel you observed? Resp: 6 and shallow ______Audible wheezing ______Pulse: 50 ______Hospital (if applicable) BP: 82/76 1. Which hospital did you go to? ______2. Once at the hospital, how long was it until someone examined you? Less than 5 minutes 5 minutes 10 minutes 15 minutes Over 15 minutes I was never examined at the hospital
Exercise Design: Did you observe any problems during your participation in the exercise? What improvements would you suggest? OTHER PATIENT INFORMATION: ______
______
Unresponsive ______Moaning DO NOT LOSE THIS CARD! Excessive salivation and DO NOT LET ANYONE TAKE THIS CARD FROM YOU! runny nose
A ride has been scheduled to return you to the exercise site. If you are not picked up, please call: [Insert number].
Thank you for your participation!
ST (L) EXERCISE “VICTIM” SYMPTOMATOLOGY TAG
Date of Exercise: [MM/DD/YYYY] Casualty #: ______
VISIBLE SYMPTOMS:
Child on ground, moving all extremities Complains of difficulty breathing and blurred vision
PHYSICAL FINDINGS:
Resp: 32 and shallow Audible drooling and wheezing Pulse: 132 BP: 150/90
OTHER PATIENT INFORMATION:
Responsive Able to follow commands Talking but salivating
ST (L) Actor Exercise Assessment Form
Please complete the following questions at the conclusion of the exercise. This card is to be turned in at the checkout station at the exercise site. EXERCISE “VICTIM” Please be accurate with your answers. Your cooperation is important and is appreciated. SYMPTOMATOLOGY Field Assessment and Treatment: 1. Initial Contact and Triage a. How long did it take response personnel to contact you? ______TAG b. How long did it take response personnel to begin decontaminating you? ______Date of Exercise: [MM/DD/YYYY] Casualty #: ______c. Were you examined on the scene more than once? Yes No d. Whom did you talk to, or whom were you assessed by (list all)? Fire EMS Police Other ______e. If you received a multicolored triage tag, what was the BOTTOM color when it was first given to you? Green Yellow Red VISIBLE SYMPTOMS: Black Never received a tag f. What actions did response personnel take as a result of their assessment of your condition? ______Child on ground, moving ______Marked respiratory distress ______
2. Treatment: with obvious abdominal a. If conscious, did someone explain your treatment? Yes No b. If conscious, were you given clear instructions? Yes No discomfort c. What treatment was given? Tearing ______
______PHYSICAL FINDINGS: 3. Did you observe any outstanding actions among the response personnel you observed? ______Resp: 25 and erratic ______
______audible upper airway noise
Hospital (if applicable) and wheezing 1. Which hospital did you go to? ______2. Once at the hospital, how long was it until someone examined you? Pulse: 64 Less than 5 minutes 5 minutes 10 minutes 15 minutes Over 15 minutes I was never examined at the hospital BP: 80/62
Exercise Design: Did you observe any problems during your participation in the exercise? What improvements would you suggest?
______
______OTHER PATIENT INFORMATION: ______
DO NOT LOSE THIS CARD! DO NOT LET ANYONE TAKE THIS CARD FROM YOU! Responsive, anxious Able to follow commands Cannot walk with constricted pupils A ride has been scheduled to return you to the exercise site. If you are not picked up, please call: [Insert number].
Thank you for your participation!
ST (L) Actor Exercise Assessment Form
Please complete the following questions at the conclusion of the exercise. This card is to be turned in at the checkout station at the exercise site. Please be accurate with your answers. Your cooperation is important and is appreciated.
Field Assessment and Treatment: 1. Initial Contact and Triage a. How long did it take response personnel to contact you? ______b. How long did it take response personnel to begin decontaminating you? ______c. Were you examined on the scene more than once? Yes No d. Whom did you talk to, or whom were you assessed by (list all)? Fire EMS Police Other ______e. If you received a multicolored triage tag, what was the BOTTOM color when it was first given to you? Green Yellow Red Black Never received a tag f. What actions did response personnel take as a result of their assessment of your condition?
______
______
______
2. Treatment: a. If conscious, did someone explain your treatment? Yes No b. If conscious, were you given clear instructions? Yes No c. What treatment was given?
______
______
______
3. Did you observe any outstanding actions among the response personnel you observed?
______
______
______
Hospital (if applicable) 1. Which hospital did you go to? ______2. Once at the hospital, how long was it until someone examined you? Less than 5 minutes 5 minutes 10 minutes 15 minutes Over 15 minutes I was never examined at the hospital
Exercise Design: Did you observe any problems during your participation in the exercise? What improvements would you suggest?
______
______
______
DO NOT LOSE THIS CARD! DO NOT LET ANYONE TAKE THIS CARD FROM YOU!
A ride has been scheduled to return you to the exercise site. If you are not picked up, please call: [Insert number].
Thank you for your participation!
ST (L) Actor Exercise Assessment Form
Please complete the following questions at the conclusion of the exercise. EXERCISE “VICTIM” This card is to be turned in at the checkout station at the exercise site. Please be accurate with your answers. Your cooperation is important and is SYMPTOMATOLOGY appreciated. Field Assessment and Treatment: 1. Initial Contact and Triage TAG a. How long did it take response personnel to contact you? ______b. How long did it take response personnel to begin Date of Exercise: [MM/DD/YYYY] Casualty #: ______decontaminating you? ______c. Were you examined on the scene more than once? Yes No d. Whom did you talk to, or whom were you assessed by (list all)? Fire EMS Police Other ______e. If you received a multicolored triage tag, what was the BOTTOM VISIBLE SYMPTOMS: color when it was first given to you? Green Yellow Red Black Never received a tag f. What actions did response personnel take as a result of their assessment of your condition? Complaints of severe respiratory ______distress ______Raspy voice ______2. Treatment: Whites of eyes are reddened and a. If conscious, did someone explain your treatment? Yes No b. If conscious, were you given clear instructions? Yes No watering c. What treatment was given?
Extremely pale and sweating ______
______
______
3. Did you observe any outstanding actions among the response PHYSICAL FINDINGS: personnel you observed? ______
______Resp: 32, shallow ______Hospital (if applicable) Pulse: 80 1. Which hospital did you go to? ______BP: 82/62 2. Once at the hospital, how long was it until someone examined you? Less than 5 minutes 5 minutes 10 minutes 15 minutes Over 15 minutes I was never examined at the hospital
Exercise Design: Did you observe any problems during your participation in the exercise? What improvements would you suggest?
OTHER PATIENT INFORMATION: ______
______Aware; knows name and DO NOT LOSE THIS CARD! location only DO NOT LET ANYONE TAKE THIS CARD FROM YOU! Unable to walk
A ride has been scheduled to return you to the exercise site. If you are not picked up, please call: [Insert number].
Thank you for your participation!
ST (L) Actor Exercise Assessment Form
EXERCISE “VICTIM” Please complete the following questions at the conclusion of the exercise. This card is to be turned in at the checkout station at the exercise site. Please be accurate with your answers. Your cooperation is important and is SYMPTOMATOLOGY appreciated.
Field Assessment and Treatment: TAG 1. Initial Contact and Triage a. How long did it take response personnel to contact you? ______Date of Exercise: [MM/DD/YYYY] Casualty #: ______b. How long did it take response personnel to begin decontaminating you? ______c. Were you examined on the scene more than once? Yes No d. Whom did you talk to, or whom were you assessed by (list all)? Fire EMS Police Other ______VISIBLE SYMPTOMS: e. If you received a multicolored triage tag, what was the BOTTOM color when it was first given to you? Green Yellow Red Black Never received a tag f. What actions did response personnel take as a result of their assessment of your condition?
Child with active seizure ______Skin diaphoretic with loss of ______bowel and bladder control ______2. Treatment: Tearing and marked salivation a. If conscious, did someone explain your treatment? Yes No b. If conscious, were you given clear instructions? Yes No c. What treatment was given?
______PHYSICAL FINDINGS: ______
______
3. Did you observe any outstanding actions among the response Resp: 24 and shallow personnel you observed? Audible wheezing ______Pulse: 54 ______BP: 72/54 ______Hospital (if applicable) 1. Which hospital did you go to? ______2. Once at the hospital, how long was it until someone examined you? Less than 5 minutes 5 minutes 10 minutes 15 minutes Over 15 minutes I was never examined at the hospital OTHER PATIENT INFORMATION: Exercise Design: Did you observe any problems during your participation in the exercise? What improvements would you suggest?
______Unresponsive ______Unable to follow commands ______Moaning only DO NOT LOSE THIS CARD! DO NOT LET ANYONE TAKE THIS CARD FROM YOU! Unable to walk
A ride has been scheduled to return you to the exercise site. If you are not picked up, please call: [Insert number].
Thank you for your participation!
ST (L) Actor Exercise Assessment Form
Please complete the following questions at the conclusion of the exercise. EXERCISE “VICTIM” This card is to be turned in at the checkout station at the exercise site. Please be accurate with your answers. Your cooperation is important and is SYMPTOMATOLOGY appreciated. Field Assessment and Treatment: 1. Initial Contact and Triage TAG a. How long did it take response personnel to contact you? ______b. How long did it take response personnel to begin Date of Exercise: [MM/DD/YYYY] Casualty #: ______decontaminating you? ______c. Were you examined on the scene more than once? Yes No d. Whom did you talk to, or whom were you assessed by (list all)? Fire EMS Police Other ______e. If you received a multicolored triage tag, what was the BOTTOM VISIBLE SYMPTOMS: color when it was first given to you? Green Yellow Red Black Never received a tag f. What actions did response personnel take as a result of their assessment of your condition? Child with marked tearing ______with complaint of blurred ______
vision 2. Treatment: a. If conscious, did someone explain your treatment? Yes No Wheezing with associated b. If conscious, were you given clear instructions? Yes No abdominal cramping c. What treatment was given? ______
______PHYSICAL FINDINGS: ______3. Did you observe any outstanding actions among the response personnel you observed? Resp: 28; audible wheezing ______Pulse: 62 ______
BP: 90/60 Hospital (if applicable) 1. Which hospital did you go to? ______2. Once at the hospital, how long was it until someone examined you? Less than 5 minutes 5 minutes 10 minutes 15 minutes Over 15 minutes I was never examined at the hospital OTHER PATIENT INFORMATION: Exercise Design: Did you observe any problems during your participation in the exercise? What improvements would you suggest?
______Responsive ______Follows commands ______Oriented DO NOT LOSE THIS CARD! DO NOT LET ANYONE TAKE THIS CARD FROM YOU! Able to walk but weak
A ride has been scheduled to return you to the exercise site. If you are not picked up, please call: [Insert number].
Thank you for your participation!
ST (L) Actor Exercise Assessment Form
Please complete the following questions at the conclusion of the exercise. EXERCISE “VICTIM” This card is to be turned in at the checkout station at the exercise site. Please be accurate with your answers. Your cooperation is important and is SYMPTOMATOLOGY appreciated. Field Assessment and Treatment: 1. Initial Contact and Triage TAG a. How long did it take response personnel to contact you? ______b. How long did it take response personnel to begin Date of Exercise: [MM/DD/YYYY] Casualty #: ______decontaminating you? ______c. Were you examined on the scene more than once? Yes No d. Whom did you talk to, or whom were you assessed by (list all)? Fire EMS Police Other ______e. If you received a multicolored triage tag, what was the BOTTOM VISIBLE SYMPTOMS: color when it was first given to you? Green Yellow Red Black Never received a tag f. What actions did response personnel take as a result of their assessment of your condition? Child on ground, not moving ______Runny nose and ______
hypersalivation 2. Treatment: a. If conscious, did someone explain your treatment? Yes No Swollen eyes with tearing b. If conscious, were you given clear instructions? Yes No Pale and diaphoretic c. What treatment was given? ______
______
______
3. Did you observe any outstanding actions among the response PHYSICAL FINDINGS: personnel you observed?
______
______
Resp: 6 and shallow; no ______
audible breath sounds Hospital (if applicable) 1. Which hospital did you go to? Pulse: 32 ______2. Once at the hospital, how long was it until someone examined you? BP: 66/40 Less than 5 minutes 5 minutes 10 minutes 15 minutes Over 15 minutes I was never examined at the hospital
Exercise Design: Did you observe any problems during your participation in the exercise? What improvements would you suggest?
______
OTHER PATIENT INFORMATION: ______
______
Unresponsive DO NOT LOSE THIS CARD! DO NOT LET ANYONE TAKE THIS CARD FROM YOU! Unable to follow commands Moaning only Unable to walk A ride has been scheduled to return you to the exercise site. If you are not picked up, please call: [Insert number].
Thank you for your participation!
ST (L) Actor Exercise Assessment Form
Please complete the following questions at the conclusion of the exercise. EXERCISE “VICTIM” This card is to be turned in at the checkout station at the exercise site. Please be accurate with your answers. Your cooperation is important and is SYMPTOMATOLOGY appreciated. Field Assessment and Treatment: 1. Initial Contact and Triage TAG a. How long did it take response personnel to contact you? ______b. How long did it take response personnel to begin Date of Exercise: [MM/DD/YYYY] Casualty #: ______decontaminating you? ______c. Were you examined on the scene more than once? Yes No d. Whom did you talk to, or whom were you assessed by (list all)? Fire EMS Police Other ______e. If you received a multicolored triage tag, what was the BOTTOM VISIBLE SYMPTOMS: color when it was first given to you? Green Yellow Red Black Never received a tag f. What actions did response personnel take as a result of their assessment of your condition? Child with eyes tearing ______Coughing with abdominal ______
pain and drooling 2. Treatment: a. If conscious, did someone explain your treatment? Yes No b. If conscious, were you given clear instructions? Yes No c. What treatment was given?
PHYSICAL FINDINGS: ______
______
______
Resp: 32 and shallow 3. Did you observe any outstanding actions among the response Audible wheezing personnel you observed? ______
Pulse: 64 ______
BP: 84/78 ______
Hospital (if applicable) 1. Which hospital did you go to? ______2. Once at the hospital, how long was it until someone examined you? Less than 5 minutes 5 minutes 10 minutes 15 minutes OTHER PATIENT INFORMATION: Over 15 minutes I was never examined at the hospital Exercise Design: Did you observe any problems during your participation in the exercise? What improvements would you suggest? Responsive ______
Able to follow commands ______Able to speak DO NOT LOSE THIS CARD! Able to walk DO NOT LET ANYONE TAKE THIS CARD FROM YOU!
A ride has been scheduled to return you to the exercise site. If you are not picked up, please call: [Insert number].
Thank you for your participation!
ST (L) Actor Exercise Assessment Form
Please complete the following questions at the conclusion of the exercise. EXERCISE “VICTIM” This card is to be turned in at the checkout station at the exercise site. Please be accurate with your answers. Your cooperation is important and is SYMPTOMATOLOGY appreciated. Field Assessment and Treatment: 1. Initial Contact and Triage TAG a. How long did it take response personnel to contact you? ______b. How long did it take response personnel to begin Date of Exercise: [MM/DD/YYYY] Casualty #: ______decontaminating you? ______c. Were you examined on the scene more than once? Yes No d. Whom did you talk to, or whom were you assessed by (list all)? Fire EMS Police Other ______VISIBLE SYMPTOMS: e. If you received a multicolored triage tag, what was the BOTTOM color when it was first given to you? Green Yellow Red Black Never received a tag f. What actions did response personnel take as a result of their assessment of your condition?
Anxious child ______
Swollen eyes with tearing ______Blurred vision ______Cough 2. Treatment: a. If conscious, did someone explain your treatment? Yes No b. If conscious, were you given clear instructions? Yes No c. What treatment was given?
PHYSICAL FINDINGS: ______
______
______
Resp: 20 and shallow, audible 3. Did you observe any outstanding actions among the response wheezing personnel you observed? Pulse: 128 ______BP: 134/88 ______
Hospital (if applicable) 1. Which hospital did you go to? ______2. Once at the hospital, how long was it until someone examined you? Less than 5 minutes 5 minutes 10 minutes 15 minutes OTHER PATIENT INFORMATION: Over 15 minutes I was never examined at the hospital
Exercise Design: Did you observe any problems during your participation in the exercise? What improvements would you suggest? Responsive ______Able to follow commands ______Speaking in short sentences ______Able to walk but weak DO NOT LOSE THIS CARD! DO NOT LET ANYONE TAKE THIS CARD FROM YOU!
A ride has been scheduled to return you to the exercise site. If you are not picked up, please call: [Insert number].
Thank you for your participation!
ST (L) ST (L)