CASUALTY REPORT FORM - Active First Aid

1 CASUALTY REPORT FORMC omplete as much of this form as possible. The form should remain with thecasualty at all First AID 999/112 ask for POLICE then request MOUNTAIN RESCUEPERSONAL DETAILS OF CASUALTYNEXT OF KIN DETAILSSex:Name:Age:Address:Tel:Name:Rel ationship:Tel:OTHER USEFUL CASUALTY INFORMATIONS igns and symptoms:Allergies:Medications:Past Medical History:Last Meal:Events - what has happened:DESCRIPTION OF ACCIDENT/ILLNESSTime:Details:Give a full and detailed accountINFORMATION FOR MOUNTAIN RESCUEYour mobile/telephone number:Your location: Grid Ref:Another mobile number:Description of your location:How many in the group:Age ranges of the group:Any pre-existing medical conditions inthe group: If yes detail below:Clothing description of group.

2 ( colours rather than brand)Information on weather:( in cloud/windy)ADDITIONAL INFORMATIONENVIRONMENTAL: Information on the ground conditions snow/ ice or dangerous locationCASUALTY:Date of Birth: / /CONSCIOUS - Clear and OpenCONSCIOUS - But with an Airway ProblemUNCONSCIOUS EMERGENCY: Dial 999/112 Check & Open(Chin lift head tilt/jaw thrust)If they remain unconsciousthis is an EMERGENCYP resent and NORMALP resent NOT NORMALABSENT EMERGENCY: Dial 999/112 CPR(between 10 & 30 breaths per minute)(shallow/deep/rapid/slow/painful) EMERGENCYIMMEDIATE ACTION(PRIMARY SURVEY - ABC s)AirwayBreathingCir culationNo life-threatening bleedingLIFE-THREATENING BLEEDING:EMERGENCY: Dial 999/112 External bleedingTummy tender/distendedBroken pelvis/ thigh boneInjuries FoundDescription of FindingsLevel of Response: AVPUAsk CASUALTY or next of kin about S AMPL E (see overleaf) First Aid GivenTimeMedication given/takenTimeDoseCASUALTY EXAMINATIONPain score012345678910No PainSevere PainACTIVE First AID VITAL SIGNSTIMEAVPU = A=ALERT V=REPONDS TO VOICE P=REPONDS TO PAIN U=UNRESPONSIVEL evels of ResponseA VPUBREATHING RATEPULSEPAIN SCORE FROM 0- 1 0