ACCIDENT REPORT FORM (SIDE ONE) FIRST: STAY CALM, check: ABC, Airway, Breathing, Circulation (PULSE) CHECK FOR URGENT INJURIES: SEVERE BLEEDING, SUCKING CHEST WOUNDS. IF VICTIM IS CONSCIOUS, OR IF THERE IS A WITNESS, ASK WHAT HAPPENED: ASK WHERE IT HURTS: COMFORT THE VICTIM TAKE PULSE AND RESPIRATION (RECORD ON THE OTHER SIDE) WHILE WATCHING FOR REACTION FROM PATIENT, AND NOTE PAIN, OR ANYTHING UNUSUAL SCAN VICTIM: HEAD: CHECK FOR WOUNDS: FLUIDS FROM EYES, EARS, NOSE (ok) PUPILS: SAME SIZE? RESPONSIVE TO LIGHT? NORMAL COLOR? (OK) NECK: ( CHECK FOR WOUNDS, OR NOT SYMMETRICAL (OK) CHEST: CHECK FOR NORMAL MOVEMENT WITH BREATHING, UNUSUAL SHAPE (OK) ABDOMEN: CHECK FOR WOUNDS, TIGHTNESS (OK) PELVIS: CHECK FOR SYMMETRY, NORMAL STABILITY (OK) ARMS, LEGS: CHECK FOR WOUNDS, DEFORMITY, MOVEMENT, SENSATION, PULSE AND COLOR BELOW INJURIES (RECORD) (OK) BACK: CHECK FOR WOUNDS, OR DEFORMITY, IS VICTIM BLEEDING UNDERNEATH, OUT OF SIGHT? (OK) SKIN: CHECK FOR COLOR, TEMPERATURE, MOISTNESS (PINK) (BLUE) (WARM) (COLD) (DRY) IS VICTIM CONSCIOUS? COOPERATIVE? LAYING STILL? VICTIMS NAME: NOTIFY: NUMBER: RELATIONSHIP: RESCUERS NAME: DATE: DAY OF WEEK: TIME: TIME OF INCIDENT: DATE: DAY OF WEEK: WHAT TYPE OF PROBLEM: FALL ( ) FALLING ROCK ( ) AVALANCHE ( ) HEART ( ) ILLNESS ( ) COLD ( ) HEAT ( ) SEVERITY: DON'T KNOW( ) CRITICAL( ) SERIOUS( ) VICTIM STABILE( ) VICTIM COMFORTABLE (CAN STAY NIGHT) ( ) RESCUE CONDITIONS: DOWN A HOLE (CREVASSE) ( ) MOUNTAINOUS ( ) WOODED ( ) SWAMP ( ) PINNED ( ) MINE SHAFT ( ) IS BACKBOARD NEEDED? ( ) CAN DRIVE CLOSE ( ) 4WD ( ) CARRY OUT ( ) HELICOPTER LANDING SIGHT AVAILABLE ( ) (BE SURE TO MARK CIRCLE VISIBLE FROM SKY BEFORE LEAVING, "X" MEANS NOT HERE) MAP AVAILABLE?: MARK VICTIM'S LOCATION, LANDMARKS EQUIPMENT ON SITE: ROPES ( ) MOUNTAIN CLIMBING EQUIPMENT SIGNALING DEVICE (MIRROR, FLARE, TWO WAY RADIO, LOUD RADIO) (COMPASS) OTHER ONSITE NEEDS: WATER( ) FOOD( ) TENT( ) HEAT( ) FOR HOW MANY? ( ) RECORD VITAL SIGNS: TIME| BREATHING | PULSE | PUPILS | SKIN RATE INJURY