Hospital Ambulance Incident Report
[YOUR COMPANY NAME]
[YOUR COMPANY ADDRESS]
I. Incident Details
Date of Incident: | May 15, 2050 |
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Time of Incident: | 2:30 PM |
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Location: | Elm Street, Springfield |
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Ambulance Unit Number: | 502 |
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Dispatch Number: | 12345 |
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II. Patient Information
Patient Name: | Percy Park |
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Age: | 68 |
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Gender: | Male |
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Medical History: | Hypertension, Type 2 Diabetes |
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Allergies: | Penicillin |
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III. Incident Description
On May 15, 2050, at approximately 2:30 PM, Ambulance Unit 502 was dispatched to Elm Street, Springfield, in response to a 68-year-old male patient, Percy Park, experiencing cardiac arrest. Upon arrival, paramedics found the patient unresponsive, with no pulse and no breathing. Immediate Advanced Cardiac Life Support (ACLS) protocols were initiated.
IV. Medical Interventions
a. Initial Assessment
Primary Survey: Unresponsive, no pulse, no breathing
Secondary Survey: No visible signs of trauma, pupils non-reactive
b. Interventions Performed
Time | Intervention | Details | Outcome |
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2:35 PM | CPR Initiated | High-quality chest compressions | No change |
2:36 PM | AED Attached | Shock advised | Shock delivered |
2:38 PM | IV Line Established | Normal saline infusion | No change |
2:40 PM | Medication Administered | 1 mg Epinephrine IV push | ROSC achieved |
2:42 PM | Ventilation Support | Bag-valve mask with oxygen | Stable airway |
2:45 PM | Transport Initiated | Continuous monitoring | En route to the hospital |
V. Crew Information
Paramedic 1: | [YOUR NAME], EMT-P |
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Paramedic 2: | Robert Johnson, EMT-P |
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Driver: | Michael Brown, EMT |
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VI. Outcome
The patient achieved Return of Spontaneous Circulation (ROSC) at 2:40 PM after the administration of Epinephrine and the delivery of one shock. The patient was stabilized and transported to [YOUR COMPANY NAME], arriving at 2:55 PM. The hospital was notified of the incoming patient and prepared for immediate advanced cardiac care.
VII. Follow-Up Actions
Report Submission: This report will be submitted to hospital administration and the patient care quality committee for review.
Debriefing Session: A debriefing session will be conducted with the ambulance crew to discuss the incident and identify any areas for improvement.
Equipment Check: All equipment used during the incident will be checked and restocked as necessary.
Patient Follow-Up: Follow-up with the hospital for patient outcomes and any additional information required.
Prepared by:
Name: | [YOUR NAME], EMT-P |
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Date: | May 15, 2050 |
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Reviewed by:
Name: | Robert Johnson, EMT-P |
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Date: | May 15, 2050 |
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