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Patient & Incident Data Additional Resources on Scene

Call Date

23-10-2024

Call No

4561

Dispatch Time

10:00

Accepted Time

09:00

On Scene Time

09:00

Leave The Scene Time

10:30

AT Health Care Facility Time

08:30

Service Time

11:24:00

Total Call Time

11:24:00

Call Type

Fire Fighting

Call Category

Housing

Call Sub Category

Houses

Governorate

AL-Batinah South

Wilayat

Wadi Al - Muawil

Incident Location

wadi

Station

Musanah Civil Defence and Ambulance Center

Factors Affecting EMS

Directions, Refuse Receiving Patient, Others

Factors Affecting EMS - Refuse Receiving Patient

Type of Hospital Name of the Hospital Reason ?
Government Hospital Al Seefa Health Center Reason

Other: 

Comments

Additional Resources On Scene

Additional Resources On Scene

Royal Oman Police Formations,
Military & Government Entities,
Private Sector Entities

Royal Oman Police Formations

Royal Oman Police Formations,
Oil and Gas Facilities,
Hazardous Materials Team

Military & Government Entities

Royal Army of Oman,
Royal Air Force of Oman,
Royal Navy of Oman,
Ministry of Health

Private Sector Entities

Nama Group(Electricity, Water and WasteWater),
Rural Areas Electricity Company(Tanweer's),
Dhofar Power Company

Case Category

Call Type

Fire Fighting

Call Category

Housing

Call Sub Category

Houses

Patient Care Data

Civil ID / Passport No

2310202409

Patient Name

Ahlam Khamis Hilal

Gender

Male

Nationality

Omani

Age

39

Contact No

81436273

Address

Seeb

Legal Guardian Name

Saif Mohammed Ali

Contact No

98396382

Relationship

Brother

Insurance Details - Medical Insurance Details - Vehicle

Policy Number : 12345-ABP-001

Insurance Status : Active

Insurance Company : Oman Reinsurance Company SAOG

Medical Insurance Expiry Date : 24-11-2024

Policy Number : 12345-ABP-002

Insurance Status : Active

Insurance Company : Takaful Oman Insurance S.A.O.G

Vehicle Plate No & Code : 466 .. ب ب .. مسقط

Patient Assessment & Management

General Impression:

Comments

LOC:

Conscious

Chief Complaint / MIO:

Chief Complaint

Airway:

Not Clear

Airway Not Clear:

Blood, Secretions, Foreign body

Breathing:

Normal

Breathing Normal:

Equal Air Entry Both Side

Breathing Abnormal:

Decreased Air Movement, Gasping

Circulation:

PULSE(Peripheral), Skin

Circulation Pulse:

Present, weak

Circulation Skin:

Cyanosis, Cool, Pink

Resuscitation Required:  Required

Head:

Deformities, Deformities, Burns

Head Burns:

1 °

PUPILS: 

PUPILS, Equal, Reactive Left, Dilated Right

PUPILS Comments: 

user Comments

Neck: 

Deformities, Burns, Lacerations

Neck Burns:

2 °
Abdomen:  Left Up Quadrant, Right Up Quadrant, Left Down Quadrant, Right Down Quadrant

Left Up Abdomen: 

Abrasions, Tenderness, Swellings, Burns

Burns: 

2 °

Right Up Abdomen: 

Burns, Rigid Guarding, Rigid Guarding

Burns: 

1 °

Left Down Abdomen: 

Punctures Penetrations, Burns, Deformities

Burns: 

2 °

Right Down Abdomen: 

Contusions, Burns, Abrasions

Burns: 

3 °
Chest:  Left, Right

Left Chest: 

Abrasions, Burns, Lacerations

Left Chest Burns: 

1 °

Right Chest: 

Burns, Tenderness, Wheeze

Right Chest Burns: 

3 °

Pelvic / Genitalia: 

Punctures Penetrations, Burns, Stable

Pelvic / Genitalia Burns:

2 °
Back:  Thoracic, Lumbar, Sacrum, NO DCAP BTLS

Back Thoracic: 

Lacerations, Burns, Stable

Burns: 

2 °

Back Lumbar: 

Burns, Tenderness, Wheeze

Burns: 

3 °

Back Sacrum: 

Abrasions, Lacerations, Burns

Burns: 

1 °
Upper EXT: Left, Right, NO DCAP BTLS

Upper EXT Left: 

Deformities, Abrasions, Burns

NO DCAP BTLS

Pulse, Motor, Sensory

Upper EXT Left Burns: 

1 °

Upper EXT Left PMS

Pulse:Present

Motor:Present

Sensory:Absent

Upper EXT Right: 

Punctures Penetrations, Burns, Lacerations

NO DCAP BTLS

Pulse, Motor, Sensory

Upper EXT Right Burns: 

1 °

Upper EXT Left PMS

Pulse:Present

Motor:Present

Sensory:Absent
Lw EXT : Left, Right, NO DCAP BTLS

Lw EXT Left: 

Burns, Tenderness, Wheeze

NO DCAP BTLS

Pulse, Motor, Sensory

Lw EXT Left Burns: 

1 °

Lw EXT Left PMS

Pulse:Present

Motor:Present

Sensory:Absent

Lw EXT Right: 

Contusions, Burns, Abrasions

NO DCAP BTLS

Pulse, Motor, Sensory

Lw EXT Right Burns: 

1 °

Lw EXT Left PMS

Pulse:Present

Motor:Present

Sensory:Absent

History of Present illness:

 Pain

History of Present illness comments:

 Comments

Onset: test

Signs & Symptoms: test

Provocation: test

Allergies: test

Quality: test

Medications: test

Radiation: test

Past Medical History: COPD, DM, Others

Other: comments

Severity: 123

Last Oral Intake: 131

Time: 10:10

Event: oay

Vital signs
Time / Vs AVPU BP P R.R O 2 SAT RBS GCS RHYTHM APGAR Burn (PSA)
12:00:00 Alert 44 4 Asystole 0%

FIELD IMPRESSION

Comments
Impacted Person Seatbelt Child Seatbelt Airbag Helmet Severity of accident Pregnancy
Driver Yes Yes No No Significant Yes

Weeks: ………………………………
Transport Category Transport Transport Type Location Type
Transport Blue Ground Transport

Education Facility: Public School

Transport Category:

Non Transport Category

PDOA Type

Rigor Mortis, Dependent Lividity, Decapitation, Decomposition
Airway: OPA, NPA, Combi, ETT, LMA

OPA Size: 1

 OPA Done By:

EMS Provider 1

NPA Size: 6

 NPA Done By:

EMS Provider 1

ETT Size: 2.5

 ETT Done By:

EMS Provider 1

LMA Size: 6

 LMA Done By:

EMS Provider 1
Combi Done By: EMS Provider 1
Oxygen / LPM: Nasal, SFM, NRM, BVM

Nasal: Adult

 Nasal Done By:

EMS Provider 1

SFM: Pediatric

 SFM Done By:

EMS Provider 1

NRM:Adult

 NRM Done By:

EMS Provider 1

BVM: Pediatric

 BVM Done By:

EMS Provider 1
Immobilization: C.COLLAR, KED, LBB, Scoop, Stair

C.COLLAR: Adult

 C.COLLAR Done By:

EMS Provider 1
KED Done By:

EMS Provider 1

 LBB Done By:

EMS Provider 1
Scoop Done By:

EMS Provider 1

 Stair Done By:

EMS Provider 1
Splinting: Rigid, Traction
Rigid Done By: EMS Provider 1
Traction EMS Provider 1
Electrical Intervention: AED, Defibrillation

AED Shock Delivered: Yes

 How many times?:  1
AED Done By: EMS Provider 1
Defibrillation Done By: EMS Provider 1
Electrical Intervention: Cardioversion, TCP
Cardioversion
TIME Dose
11:00 2
TCP
TIME Current
11:35 3

Others

Bandage Done By

EMS Provider 1

Cold Pack Done By

EMS Provider 3

Warming Done By

EMS Provider 2

Cooling Done By

EMS Provider 5

Bleeding Control Done By

EMS Provider 1

Irrigation Done By

EMS Provider 1

Suction Done By

EMS Provider 6

NGT (Size)

EMS Provider 18

NGT Done By

EMS Provider 2

Burn Care Done By

EMS Provider 1

Assist Delivery

Actual Delivery

Assist Delivery Done By

EMS Provider 3

Others

write the comments
Actual Delivery
Time of Delivery Type Gender Resuscitation Obstetric Care Done
10:10 A live Male Narrative: 

text of the Narrative

Suction, Warming, Clip & Cut Umbilical Cord
I.V / IO / IM
Vital Type Site Time Size Attempt No Done By
I.V rr44 12:00 PM 2 4 EMS Provider 1

Medications Detail
Time Medication Dose Route Administered by Signature
10:20 Inj.Adenosine 3mg/1ml Injection 2 Oural EMS Provider 1

Narrative:

Comments

Resuscitation Outcome: 

Improve
Written By:  Signature: 
Received By:  Signature: 
MD Comments:  Signature: 
Belonging Handover:  No

Patient Resuscitation
Suspected Cause Of Arrest Pre-EMS Arrival Information Airway Placement Confirmation -Modes

Cardiac Arrest

Respiratory Arrest

Trauma

Electrical Shock

Suicide

Drugs/ Poison

Drowning

Abuse

Terminal illness

 Pre EMS Arrival

Witness

Estimated downtime:  ………

Untwines

Unknown

 Direct cord visualization Yes
Bilateral Breath Sound UnEqual

RT, LF
CPR Progress

Yes

time initiated:  ……………………

 Pulse Oximetry ……………………
Waveform Capnography Yes
AED Applied

Yes

By: ……………………

Time:……………………
ET CO2 Detector Applied
Airway Indication & Procedures
Gag Reflex Clear airway Suctioned Tube Type Size Number Of Attempts Location Performed
Treatment
Time B/P P Rhythm INTERVENTION RESPONSE (ROSC)
Ventilation (CPR) Defibrillation Medication

Narrative:

Comments

Resuscitation Outcome: 

Improve
Written By:  Signature: 
Received By:  Signature: 
MD Comments: 

Staff Info

EMT1

.........................

EMT2

...................................

Ambulance Operator

...................................

Duty EMS Supervisor

Called

Duty Medical Director

Attended

Student ID

.........................
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