Emergency Services Trauma Flow Sheet
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Emergency Services Trauma Flow Sheet
Hospital Logo
Patient Sticker
Date:
Patient Arrival Time:
N/A Pre-Hospital Treatment
Transporting Ambulance_____________________________________________________________________________________
O2 @ ______L/min/
IV: Needle size______________
Backboard
NC
NRB
Ambu
LR
_________________
Long
Short
Ked
Airway
Medications ________________
Scoop
Oral
Nasal
Other
_____________________________
Bilateral Head Supports
ET tube # _____ @ _____cm
C-Collar on: Yes____ No ____
Splint on _________________
Ice on __________________
CPR started @ (time)______________
Dressing ________________
Other __________________
Date of Injury:
___________________
Time of Injury:
__________
Pre-hospital trauma team alert notification:
Yes
No
Hospital Trauma Team Activation Yes____ No____
Time of Trauma Team Activation: _______________
Trauma Team Members
Type of Vehicle
Team members notified:
Time Called
Time Arrived
Car
Pedestrian
Nurses x _________________
Truck
ATV
Physician / CNP / PA
Motorcycle
Boat
Lab
Bicycle
X-ray
Other_____________________________________
Other ____________________
Mechanism of Injury
Restraint Devices
Speed of vehicle ________ MPH
Rollover
Lap belt
Airbag deployed
Number of vehicles
Ejected
Shoulder belt
Helmet
1
2
3
>3
Rearend
Car seat
Unrestrained
Steering wheel deformity
T-Bone
Starred windshield
Head on
Fall
Penetrating
Blunt
Thermal
Other
Fell from:
GSW
Assault
Burn
Hanging
Stabbing
Crush
Heat exposure
Near drowning
Height____________ ft.
Other
Other
Cold exposure
Animal related
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