Hospital Ambulance Incident Report

[YOUR COMPANY NAME]

[YOUR COMPANY ADDRESS]

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I. Incident Details

Date of Incident:	May 15, 2050
Time of Incident:	2:30 PM
Location:	Elm Street, Springfield
Ambulance Unit Number:	502
Dispatch Number:	12345

II. Patient Information

Patient Name:	Percy Park
Age:	68
Gender:	Male
Medical History:	Hypertension, Type 2 Diabetes
Allergies:	Penicillin

III. Incident Description

On May 15, 2050, at approximately 2:30 PM, Ambulance Unit 502 was dispatched to Elm Street, Springfield, in response to a 68-year-old male patient, Percy Park, experiencing cardiac arrest. Upon arrival, paramedics found the patient unresponsive, with no pulse and no breathing. Immediate Advanced Cardiac Life Support (ACLS) protocols were initiated.

IV. Medical Interventions

a. Initial Assessment

• Primary Survey: Unresponsive, no pulse, no breathing

• Secondary Survey: No visible signs of trauma, pupils non-reactive

b. Interventions Performed

Time	Intervention	Details	Outcome
2:35 PM	CPR Initiated	High-quality chest compressions	No change
2:36 PM	AED Attached	Shock advised	Shock delivered
2:38 PM	IV Line Established	Normal saline infusion	No change
2:40 PM	Medication Administered	1 mg Epinephrine IV push	ROSC achieved
2:42 PM	Ventilation Support	Bag-valve mask with oxygen	Stable airway
2:45 PM	Transport Initiated	Continuous monitoring	En route to the hospital

V. Crew Information

Paramedic 1:	[YOUR NAME], EMT-P
Paramedic 2:	Robert Johnson, EMT-P
Driver:	Michael Brown, EMT

VI. Outcome

The patient achieved Return of Spontaneous Circulation (ROSC) at 2:40 PM after the administration of Epinephrine and the delivery of one shock. The patient was stabilized and transported to [YOUR COMPANY NAME], arriving at 2:55 PM. The hospital was notified of the incoming patient and prepared for immediate advanced cardiac care.

VII. Follow-Up Actions

1. Report Submission: This report will be submitted to hospital administration and the patient care quality committee for review.

2. Debriefing Session: A debriefing session will be conducted with the ambulance crew to discuss the incident and identify any areas for improvement.

3. Equipment Check: All equipment used during the incident will be checked and restocked as necessary.

4. Patient Follow-Up: Follow-up with the hospital for patient outcomes and any additional information required.

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Prepared by:

Name:	[YOUR NAME], EMT-P
Date:	May 15, 2050

Reviewed by:

Name:	Robert Johnson, EMT-P
Date:	May 15, 2050

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