SEFD PCR

DISPATCHED:
SEFD was dispatched via radio for a [text name="dispatch_1" default=" "] [select name="variable_age" value="Year old | Month old | Day old"][select name="dispatched_1" value=" Male | Female"]
DISPATCH DETERMIND CHIEF COMPLAINT:[text name="CC" size = 55 default=" "]

APPARATUS RESPONDED:
[checkbox name="variable_5" value="C601|C602|B601
|B602|B603|P601|P603|T601|R601|R602|R603|R604|R605|R606|R607|R608|R609|R610|POV"][text name="variable_4" default=" "]

First Apparatus on scene:
[select name="variable_66" value="C601|C602|B601
|B602|B603|P601|P603|T601|R601|R602|R603|R604|R605|R606|R607|R608|R609|R610|POV"]

RESPONSE Mode: [checkbox name="RESPONSE_1" value="EMERGENT|NONEMERGENT|WITH LIGHTS/SIRENS|WITH NO LIGHTS NO SIRENS|NO LIGHTS NO SIRENS|UPGRADED TO EMERGENT|DOWNGRADED TO NONEMERGENT"][text name="RESPONSE" default=" "]

UPON ARRIVAL:
[textarea name="arrival_1" default=" "]

ON SCENE PATIENTS CHIEF COMPLAINT:[text name="CC" size = 55 default=" "]

NOI/MOI:
[textarea name="HX_OF_PRESENT_ILLNESS" default=" "]

PAST MEDICAL Hx:
[textarea name="pmhx" default=" "]

Medications:[checkbox name="variable_medicatios" value="None | Insulin | Hypertension medication "][text name="variable_stuff" default=" "]

ALLERGIES:[checkbox name="allergies_check" value="NKDA|PENICILLIN|SULFA|LATEX"][textarea name="allergies" default=" "]

[comment memo="***Ignore if no pain remember to delete***"]
Pain Assessment:
Onset: [text name="O" size = 55 default=" ***When did it start What were they doing*** "]
Provoking/Relieving Factors: [text name="P" size = 55 default=" ***What makes it feel better or worse*** "]
Quality/Described As: [text name="q" size = 55 default=" ***Describe the pain*** "]
Radiation: [text name="r" size = 55 default=" ***Where else does it go*** "]
Severity: [checkbox name="variable_severity" value="1 out of 10 :)|2 out of 10|3 out of 10|4 out of 10|5 out of 10 :(|6 out of 10|7 out of 10|8 out of 10|9 out of 10|10 out of 10 :{"][text name="s" size = default=" "]
Acute/Chronic condition: [textarea name="t" size = default=" "]
[comment memo="***Ignore if no pain remember to delete***"]

Patients positioning:
[checkbox name="variable_1" value="Supine Position|Fowler’s Position|Tripod Position|Seated position|Prone Position|Lateral Position|Sims’ Position|Lithotomy Position|Trendelenburg’s Position|Reverse Trendelenburg’s Position|Knee-Chest Position"] [textarea name="position" size = default=" "]

Initial ABC's:
-Airway: [checkbox name="airway" value="airway open|airway patent|no airway obstructions|Normal|airway positioned to open|airway not patent|obstructions to airway|requires airway adjunct"][textarea name="airway" default=" "]

-Breathing: [checkbox name="breathing" value="breathing spontaneously|breathing regular|adequate respirations|appropriate tidal volume|no apparent life threats to breathing|Normal|not breathing spontaneously|irregular respirations|inadequate respirations|inadequate tidal volume|apparent life threats to breathing"][textarea name="breathing" default=" "]

-Circulation: [checkbox name="circulation" value="no obvious bleeding|pulses intact|skin color appropriate|cap refill less than 2 seconds|no life treats to circulation status|Normal|hemorrhage present|hemorrhage controlled|TQ applied|pulses not intact|skin color not appropriate|cap refill more than 2 seconds|life threatening concerns with circulation"][textarea name="ros_constitutional" default=" "]

[comment memo="***What did your Patient complain about***"]
Patients Signs and symptoms:

-Level of Consciousness: [checkbox name="loc" value="alert|oriented|Person|Place|Time |Event|disoriented |arousable by verbal stimuli|arousable by painful stimuli|unresponsive"][textarea name="ros_loc" default=" "]

-Constitutional: [checkbox name="ros_constitutional_check" value="no fever|no chills|no weakness|no fatigue|no malaise|fever|chills|weakness|malaise|not assessed / no complaint"][textarea name="ros_constitutional" default=" "]

-HEENT: [checkbox name="ros_heent_check" value="no vision changes|no ear pain|no nasal congestion|no sore throat|no cough|not assessed / no complaint"][textarea name="ros_heent" default=" "]

-Cardiovascular: [checkbox name="ros_cardio_check" value="No chest pain|no palpitations|no swelling of extremities|Normal|chest pain|palpitations|swelling of extremities|not assessed / no complaint"][textarea name="ros_cardio" default=" "]

-Respiratory:[checkbox name="ros_resp_check" value="No shortness of breath|no hemoptysis|no dyspnea|Normal|shortness of breath|hemoptysis|dyspnea|not assessed / no complaint"][textarea name="ros_resp" default=" "]

-GI: [checkbox name="ros_gi_check" value="no change in appetite|no abdominal pain|no hematemesis|Normal|change in appetite|abdominal pain|hematemesis|Nausea|vomiting|diarrhea|not assessed / no complaint"][textarea name="ros_gi" default=" "]

-GU: [checkbox name="ros_gu_check" value="no urinary frequency|no urinary urgency|no dysuria|no hematuria|no leakage of urine|Normal|urinary frequency|urinary urgency|dysuria|hematuria|leakage of urine|not assessed / no complaint"][textarea name="ros_gu" default=" "]

-Muscle Skeletal: [checkbox name="ros_msk_check" value="no back pain|no joint pain|no muscle aches|no generalized muscle pain|no neck pain|Normal|back pain|joint pain|muscle aches|generalized muscle pain|neck pain|not assessed / no complaint"][textarea name="ros_msk" default=" "]

-Skin: [checkbox name="ros_skin_check" value="no rash|no bruising|no lesions|no itching|Normal|rash|bruising|lesions|itching|not assessed / no complaint"][textarea name="ros_skin" default=" "]

-Neuro: [checkbox name="ros_neuro_check" value="no headache|no dizziness|no syncope|no loss of consciousness|Normal|headache|dizziness|syncope|loss of consciousness| last seen normal |not assessed / no complaint"][textarea name="ros_neuro" default=" "]

-Psych: [checkbox name="ros_psych_check" value="denies Suicide ideation/homicide ideation|no hallucination|no depression|no anxiety|Normal|suicide ideation\homicide ideation|hallucinations|depressed|anxious|not assessed / no complaint"][textarea name="ros_psych" default=" "]

-Endocrine: [checkbox name="ros_endo_check" value="no heat/cold intolerance|no excessive thirst|no polyuria|Normal|heat intolerance|cold intolerance|excessive thirst|polyuria|not assessed / no complaint"][textarea name="ros_endo" default=" "]

-Hematologic: [checkbox name="ros_heme_check" value="no excessive bruising|no excessive bleeding|Normal|excessive bruising|excessive bleeding|not assessed / no complaint"][textarea name="ros_heme" default=" "]

[comment memo="*** Detailed Assessment Findings ***"]
PHYSICAL ASSESMENT EXAM

--General: [checkbox name="pe_general_check" value="Well developed/well nourished|Well appearing|in no acute distress|malnourished|in acute distress|obese| not assessed / no complaint"][textarea name="pe_general" default=" "]

--HEENT: [checkbox name="pe_heent_check" value="normocephalic|atraumatic|PERRLA|white sclera|conjunctiva pink/red|ears patent|no bleeding|bleeding|positive HALO test|negative HALO test|dry mucous membranes|extra salivation |normal mucous|normal pharynx|no trauma to mouth|Normal|trauma to face|trauma to mouth|not assessed / no complaint"][textarea name="pe_heent" default=" "]

--Cardiovascular: [checkbox name="pe_cardio_check" value="Regular rate and rhythm|no jugular vein distention|no edema|peripheral pulses intact|no cyanosis|capillary refill less than 2 seconds|Normal|irregular rate|irregular rhythm|JVD present|edema present|no peripheral pulses|cyanosis present|capillary refill greater than 2 seconds|bleeding|trauma|atraumatic|not assessed / no complaint"][textarea name="pe_cardio" default=" "]

--Respiratory: [checkbox name="pe_resp_check" value="Clear to Auscultation bilaterally|no rales, rhonchi, wheezes|no retractions|no accessory muscles being used|no stridor|Normal|wheezing|upper respiratory congestion|Diminished breath sounds|not assessed / no complaint"][textarea name="pe_resp" default=" "]

--GI:[checkbox name="pe_gi_check" value="atraumatic|BS present in all 4 quadrants|abdomen soft/non-tender to palpation|non-distended|No rigidity|no guarding|no masses|Normal|Trauma present|Tender abdomen|Rigid abdomen|distended abdomen|Guarding present|masses present|not assessed / no complaint"][textarea name="pe_gi" default=" "]

--MSK: [checkbox name="pe_msk_check" value="normal Range of movement|no pain on palpation|strength 5/5 in all extremities|Normal|abnormal range of motion|pain on palpation|strength not present in all extremities|not assessed / no complaint"][textarea name="pe_msk" default=" "]

--Skin: [checkbox name="pe_skin_check" value="no rash|no lesion|no discoloration|pink|warm|dry|pale|cool|cyanotic|flushed|clammy|hot|Normal|not assessed / no complaint"][textarea name="pe_skin" default=" "]

--Neuro: [checkbox name="pe_neuro_check" value="Grossly oriented X 4|gait normal|sensation intact|normal reflexes|smile normal|speech not slurred|Normal|Neuro not grossly intact|gait abnormal|sensation absent|no reflexes|smile not symmetrical|slurred speech|not assessed / no complaint"][textarea name="pe_neuro" default=" "]

--Psych: [checkbox name="pe_psych_check" value="Pleasant, calm and cooperative|Judgement and insight intact|makes a plan|understands treatment|thought process normal|normal affect|At baseline|unpleasant|not calm| not cooperative|does not make plan|does not understand treatment|not assessed / no complaint"][textarea name="pe_psych" default=" "]

--Hematologic: [checkbox name="pe_heme_check" value="no tenderness or masses palpated|no bruises|no bleeding|Normal|tenderness/masses|bruising|bleeding|not assessed / no complaint"][textarea name="pe_heme" default=" "]

TREATMENT:
[checkbox name="treatment_1" value="No treatment or interventions made on scene by SEFD|oxygen therapy 2L via Nasal cannula | oxygen therapy High flow 15L via Non Rebrether| oxygenation via BVM |administer oral glucose, Glutose15 15gm Per os|Cardiopulmonary Resuscitation |immobilization of extremity | immobilization due to C-spine precautions due to MOI"][textarea name="Treatment" default=" "]

TRANSPORT: [checkbox name="pe_trans_check" value="Secured to stretcher|3 straps|loaded for transport|Code 3|Code 1|with firefighter on board|patient refusal|AMA|released to PD EDO|released to PD custody |no transport|lift assist only| by Life ambulance| by Elite ambulance"][text name="pe_trans" default=" "]
DISPATCHED:
SEFD was dispatched via radio for a
DISPATCH DETERMIND CHIEF COMPLAINT:

APPARATUS RESPONDED:


First Apparatus on scene:


RESPONSE Mode:

UPON ARRIVAL:


ON SCENE PATIENTS CHIEF COMPLAINT:

NOI/MOI:


PAST MEDICAL Hx:


Medications:

ALLERGIES:

***Ignore if no pain remember to delete***
Pain Assessment:
Onset:
Provoking/Relieving Factors:
Quality/Described As:
Radiation:
Severity:
Acute/Chronic condition:
***Ignore if no pain remember to delete***

Patients positioning:


Initial ABC's:
-Airway:

-Breathing:

-Circulation:

***What did your Patient complain about***
Patients Signs and symptoms:

-Level of Consciousness:

-Constitutional:

-HEENT:

-Cardiovascular:

-Respiratory:

-GI:

-GU:

-Muscle Skeletal:

-Skin:

-Neuro:

-Psych:

-Endocrine:

-Hematologic:

*** Detailed Assessment Findings ***
PHYSICAL ASSESMENT EXAM

--General:

--HEENT:

--Cardiovascular:

--Respiratory:

--GI:

--MSK:

--Skin:

--Neuro:

--Psych:

--Hematologic:

TREATMENT:


TRANSPORT:

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.45, 86 form elements, 90 boilerplate words, 12 text boxes, 33 text areas, 34 checkboxes, 3 drop downs, 4 comments, 405 total clicks
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