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<br />RESCUE - MEDICAL INFORMAITON <br /> <br />Patient Name: Age: D.O.B. Sex: Phone: <br /> M F <br />Patient Address: Reason for Call: COMPANY <br /> A B C <br />Primary Surveyl Breathing Pulse L.O.C. Pupils L R <br /> Airway Normal Regular Conscious Normal - <br /> - <br /> Rapid Irregular Unconscious Dilated <br /> - - <br />Normal Slow Full Oriented Constricted <br /> Irregular Weak Disoriented Non-Reactive <br />Partial Obstruction Labored Absent Alert Skin <br /> None Drowsy <br />Complete Obstruction Responsive Warm / Dry <br /> Unresponsive Cool/Moist <br /> Cyanotic <br />Vital Time B/P Pulse ResD. C.P.R. Performed: Defibrillator Used: <br />1. Yes No Yes No <br />Sign. 2. By Whom: By Whom: <br />Historv <br />Medications <br />Allergies: <br />Remarks, Description of the Incident: <br /> A <br /> 1 <br /> I <br />Weather Conditions: I <br /> n <br /> 9 <br /> 1 <br />ACKERMANN. R. HERZOG, D. ST. HILAIRE, A. d <br /> e <br />BECHTHOLD, C. JOHNSON, B. TEWS, D. n <br /> t <br />BOETTCHER. W. KAMP, T. TROSVIL, F. s <br />BUCHHOLZ M. KITZMILLER G. VANVLEET. M. <br />BURTS ON. T. KOLLMANN, M. WECKWERTH, R. <br />EDMAN. P. KUEHNE S. WHITE. J. <br />FIESTER, N. LUND, B. WILKERSON, B. <br />FLASPETER. M. MARSH, L. <br />FORWARD T. PURO S. <br />GILBERT. D. SAGER, R. <br />GILMER. J. STAPLES. T. <br />HANSON S. <br />Vehicles Responding (Circle All Responding) <br /> Cl C2 C3 El E2 Tl T2 T3 Rl Ul Gl G2 G3 <br />Number of Firefighters Attending: <br />Time Spent: Hours: Minutes: <br /> <br />@kathy/alduspag.021/fire/incident.pm6 <br />