Victim Report
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Version 1999 November Corrections and updates to the webmaster -> mailto:wcg-webmaster [snail] caving [period] org [period] nz?subject=Victim%20Report%20form please NZSS Accident Victim Report (One sheet for each victim) | ||||
| 1. Name |
| Age |
| Gender F / M |
| Next of Kin
(if known) |
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| Address |
| Phone |
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| Medical Condition (Delete not applicable) | |||
| 2. Head | Has patient had a head injury? | Yes / No / Don't know | |
| Is patient conscious? | Yes / No | ||
| Has patient been UNconcious? | Yes / No | ||
| Does the patient seem to be getting | Better / Worse | ||
| Is / Was patient | Dizzy / Seeing stars / Disoriented | ||
| Is / Was patient vomiting | Yes / No | ||
| Is patient coughing up blood? | Yes / No | Bright / Dark / Frothy | |
| Is any fluid coming from ears? | Yes / No | Colour
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| Is any fluid coming from nose? | Yes / No | Colour
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| What is colour of face? | (was patient looked at in carbide/electric light?) |
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| What is colour of lips? |
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| 3. Breathing | Any trouble breathing? | Yes / No
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| 4. Pain | Is there any pain? | Yes / No
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| Where?
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| 5. Breaks | or suspected breaks (include neck and spine) | ||||||
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| 6. Bleeding |
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| 7. Other | Pulse Rate |
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| Can patient walk or move in any way? | Yes / No | ||
| Any known medical conditions? (eg. diabetes, epilepsy, asthma) | Check for Medic-Alert
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| When did the patient last eat? | Drink?
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| What is the risk of Hypothermia? | Low / Medium / High | Is the Patient Wet / Dry? | |
| How is the patient dressed? |
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| What action has already been taken? (eg. medication / comfort) |
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| 8. General Comments |
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