Prolonged Field Care MTF handover sheet
PRIOROTY I INFORMATIONI am
Rank, Name
aPJ/68W/18D/
CRF
from unit
I´m bringing in a critical / non
critical
years old male/
female
patient
who is a Coalition(non)military/non coalition security/civilian/opposing
force(POW)
The patient got injured by IED/GSW/RPG/accident/fall/other
hrs. ago
at location
Evacuation time hrs by air / land
Injuries sustained: TBI / penetrating/bunt trauma / amputation / arterial bleeding /
bleeding
Eye injury / burns / fracture / intoxication / laceration / other
Probem
s NO
W:
<C>
NONE / critical bleeding leg / groin / arm / axilla / neck/ hemodynamic instability
A NONE / Airway obstruction / opened airway / respiratory acidosis
B NONE / low-high respiration rate / thorax injuries / tension pneumothorax / other
C NONE / low-high blood pressure / low-high pulse-rate / bleeding / low O2-saturation / other
D NONE / A V P U / pupils / pain / spinal injury / fracture / other
E NONE / low-high body temperature / wet clothes / other
Other information:
PRIORITY II INFORMATION
Trea
tment
given:
<C>
NONE / Tourniquet + TIME ! / hemostatic agent / wound packing / pressure bandage
A NONE / cric / SGA(LT) / ET / NPA / OPA / positioning
B NONE / chest seal / ND / chest tube / other
C NONE / i.v. / i.o. / blood / fluids / recovery position / other
D NONE / splint / spine stabilization / sedation-analgesia / burn dressing / other
E NONE / hypothermia prevention / hyperthermia treatment/ changed clothes / other
Medication: Analgesic / Antibiotics / Oxygen l/min
Fluids: Crystalloid / colloids (ml total)
N K D A If so, which? diseases / allergies
No Known Diseases / Allergies
Other information not covered above:
Prolonged Field Care MTF handover sheet
PRIOROTY I INFORMATIONI am
Rank, Name
aPJ/68W/18D/
CRF
from unit
I´m bringing in a critical / non
critical
years old male/
female
patient
who is a Coalition(non)military/non coalition security/civilian/opposing
force(POW)
The patient got injured by IED/GSW/RPG/accident/fall/other
hrs. ago
at location
Evacuation time hrs by air / land
Injuries sustained: TBI / penetrating/bunt trauma / amputation / arterial bleeding /
bleeding
Eye injury / burns / fracture / intoxication / laceration / other
Probem
s NO
W:
<C>
NONE / critical bleeding leg / groin / arm / axilla / neck/ hemodynamic instability
A NONE / Airway obstruction / opened airway / respiratory acidosis
B NONE / low-high respiration rate / thorax injuries / tension pneumothorax / other
C NONE / low-high blood pressure / low-high pulse-rate / bleeding / low O2-saturation / other
D NONE / A V P U / pupils / pain / spinal injury / fracture / other
E NONE / low-high body temperature / wet clothes / other
Other information:
PRIORITY II INFORMATION
Trea
tment
given:
<C>
NONE / Tourniquet + TIME ! / hemostatic agent / wound packing / pressure bandage
A NONE / cric / SGA(LT) / ET / NPA / OPA / positioning
B NONE / chest seal / ND / chest tube / other
C NONE / i.v. / i.o. / blood / fluids / recovery position / other
D NONE / splint / spine stabilization / sedation-analgesia / burn dressing / other
E NONE / hypothermia prevention / hyperthermia treatment/ changed clothes / other
Medication: Analgesic / Antibiotics / Oxygen l/min
Fluids: Crystalloid / colloids (ml total)
N K D A If so, which? diseases / allergies
No Known Diseases / Allergies
Other information not covered above: