Hospital Ambulance Incident Report

Hospital Ambulance Incident Report

[YOUR COMPANY NAME]

[YOUR COMPANY ADDRESS]


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.


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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