EMS PCR

Scene Size-up

Dispatched at: 
[text name="dispatch" default=""]
Arrived at: 
[text name="arrive" default=""]
Scene safe? 
[checkbox name="scene" value="Yes|No"]
BSI used 
[checkbox name="bsi" value="Gloves|Gowns|Eye protection"]
Number of patients 
[text name="pt#" default=""]
Additional resources used 
[checkbox name="addre" value="ALS|Fire|PD"]
C-spine stabilized? 
[checkbox name="cspine" value="Yes|No"]
Sex: 
[checkbox name="sex" value="Male|Female"]
Age: 
[text name="age" default=""]

Initial Assessment
[checkbox name="AVPU" value="Alert|Verbal|Painful|Unresponsive"]
Chief complaint 
[text name="cc" default=""]
Airway [checkbox name="ariway" value="Patent|Obstructed"]
Breathing[checkbox name="breathing" value="Self maintained|Assisted"]
Circulation 
[checkbox name="circulation" value="No bleeding|Bleeding"]
Transport [checkbox name="trasnport" value="Emergent|Non-emergent"]

Secondary Assessment
S S [text name="ss" default=""]
O [text name="o" default=""]
P [text name="p" default=""]
Q [text name="q" default=""]
R [text name="r" default=""]
S [text name="s" default=""]
T [text name="t" default=""]
A [text name="a" default=""]
M [text name="m" default=""]
P [text name="p" default=""]
L [text name="l" default=""]
E [text name="e" default=""]

Medical 
Pulmonary [checkbox name="pulm" value="WNL"][text name="pulmt" default=""]
Cardiovascular[checkbox name="cardio" value="WNL"][text name="cardiot" default=""]
Neurological [checkbox name="neuro" value="WNL"][text name="neurot" default=""]
Skin[checkbox name="skin" value="WPD"][text name="skint" default=""]
GI GU[checkbox name="gigu" value="WNL"][text name="gigut" default=""]
Reproductive[checkbox name="repor" value="WNL"][text name="reprot" default=""]
Psychological Social[checkbox name="psychsoc" value="WNL"][text name="psychsoct" default=""]

Trauma
[checklist name="DCAPBTLS" value="Deformities, discolorations|Contustions|Abrasions|Punctures, penetration|Burns|Tenderness|Lacerations|Swelling"]
HEENT [text name="heent" default=""]
Chest [text name="chest" default=""]
Abdo [text name="abdo" default=""]
Back [text name="back" default=""]
Extremities [text name="extremities" default=""]

Vitals
Pain [text name="pain" default=""]out of 10
Resp [text name="resp" default=""]
Skin [text name="skinv" default=""]
O2 [text name="o2" default=""]
Pulse [text name="pulse" default=""]
BP [text name="bp" default=""]
Glucose [text name="glucose" default=""]

Treatments [textarea name="rx" default=""]
Transport [textarea name="transports" default=""]

[var name="age"],[var name="sex"]. With a of [var name="cc"], airway is[var name="airway"] and [var name="breathing"].[var name="circulation"] is found. Patient was transported [var name="trasnport"]. Patient states they are feeling [var name="ss"], that started while they were [var name="o"]. Pt has attempted[var name="p"]. States they feel [var name="q"] with [var name="r"] that is [var name="s"] that started [var name="t"]. Pt has [var name="a"] and is currently taking [var name="m"]. Has [var name="p"]past medical history. Last ate [var name="l"]. Pulmonary is [var name="pulm"][var name="pumlt"]. Cardiovascular is [var name="cardio"][var name="cardiot"]. Neurological is [var name="neuro"][var name="cardiot"]. Skin is [var name="skin"][var name="skint"]. GI and GU is [var name="gigu"][var name="gigut"]. Reproductive is [var name="repor"][var name="report"]. Psychological and social is [var name="psychsoc"]. There is found to be [var name="DCAPBTLS"]damage on skin. [var name="heent"], [var name="chest"], [var name="abdo"], [var name="back"], [var name="extremities"]. Vitals are as follow: [var name="pain"] out of 10, [var name="resp"] per minute, [var name="skin v"] skin, oxygen is [var name="o2"], pulse is [var name="pulse"], BP is [var name="bp"], glucose was [var name="glucose"]. Treatment provided: [var name="rx"].