SCAN INTERNATIONAL

SCAN DAVAO RESPONDER

TORIL AREA
ACCIDENT DETAILS
Patient Name: _____________________________________________ Age: __________ Sex: __________
Address: __________________________________________________ Time of Accident: ______________
Location of Accident: _______________________________________ Date of Accident: ______________
Mechanics of injury: Medical: Trauma: Contact Number: ______________
INITIAL CONDITION OF PATIENT:

Airway Breathing Pulse LOC Pupils L R

Clear Normal Full Alert Reacting
Shallow Weak Confused Fixed
Required Deep Irregular Verbal Equal
Attention
ABSENT PAIN
ABSENT Oximeter Mild Size
Record Deep
Unresponsive – Unconscious: for/since? ______________.
Suffered Convulsions: for/since? __________________. 1 st BP = 2nd BP =

CAUSE OF ACCIDENT: _______________________________________________________

Findings from Head to Toe – Systematic & Thorough. OBSERVATIONS:
Head: ____________________________________________________ Abrasion: ______________
Chest: ____________________________________________________ Burn: __________________
Abdomen: ________________________________________________ Cold: __________________
Pelvis: ____________________________________________________ Fracture: _______________
Extremities: _______________________________________________ Hemorrhage: ___________
Back/Spine: _______________________________________________ Laceration: _____________
Symptoms – what patient tells you Pain: __________________
__________________________________________________________ Swelling: _______________
Allergies: Medications – Foods – Pollen/Grasses/Plants – Stings/Bites Skill Condition: _________
___________________________________________________________ Estimated blood loss: _____
Medications: Last Ins & Outs:
What? __________________________________ Fluids @? _________________________________
Why? ___________________________________ Foods @? _________________________________
Last taken? ______________________________ Event Prior to accident (black out, dizziness)
Past Medical History: _________________________________________
________________________________________ Treatment: ______________________________

Assisted by: _____________________________ Indorse to: _______________________________