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EMS Football Roamer Stat Sheet
mmiddleton
2024-10-03T13:49:51-05:00
EMS Roamer Stat Form – Missouri
EMS Roamer Stat Sheet
"
*
" indicates required fields
Medic Name
*
First
Last
Opponent Team Name
*
Soccer 6.8.24 Mexico vs Brazil
Concert 6.15.24
Notre Dame
McNeese
Bowling Green
Missouri
LSU
New Mexico State
Texas
Location
*
North 1
North 2
North 3
East 1
East 2
East 3
South 1
South 2
South 3
West 1
West 2
West 3
Other
Other Roamer
*
Check this box if you had no patients:
No patient contacts
Treat and Release Totals
Refusals & Minor Care
Only include refusals and minor care/treat and release. Do not include any transfers to main/ambulance
Complaint
Quantity
Bandaid (minor cuts/blisters/etc.)
Feminine Hygiene Products
Headache (non-traumatic)
Unconscious / Fainting (Near)
Heat / Cold Exposure
Abdominal Pain / Problem
Allergies (Reactions) / Envenomations (Stings, Bites)
Animal Bites / Attacks
Assault / Sexual Assault / Stun Gun
Back Pain (Non-Traumatic or Non-Recent Trauma)
Breathing Problems
Burns (Scalds) / Explosion (Blast)
Carbon Monoxide / Inhalation / Haz Mat / CBRN
Cardiac or Respiratory Arrest / Death
Chest Pain / Chest Discomfort (Non-Traumatic)
Choking
Convulsions / Seizures
Diabetic Problems
Drowning / Near Drowning / Diving / SCUBA Accident
Electrocution / Lightning
Eye Problems / Injuries
Falls
Heart Problems / AICD
Hemorrhage / Lacerations
Inaccessible Incident / Other Entrapments (Non-traffic)
Overdose / Poisoning (Ingestion)
Pregnancy / Childbirth / Miscarriage
Psychiatric / Abnormal Behavior / Suicide Attempt
Sick Person (Specific Diagnosis)
Stab / Gunshot / Penetrating Trauma
Stroke (CVA) / Transient Ischemic Attack (TIA)
Traffic / Transportation Incidents
Traumatic Injuries (Specific)
Add
Remove
Transfer Totals
Transfers to Aid Station
Complaint
Quantity
Abdominal Pain / Problem
Allergies (Reactions) / Envenomations (Stings, Bites)
Animal Bites / Attacks
Assault / Sexual Assault / Stun Gun
Back Pain (Non-Traumatic or Non-Recent Trauma)
Breathing Problems
Burns (Scalds) / Explosion (Blast)
Carbon Monoxide / Inhalation / Haz Mat / CBRN
Cardiac or Respiratory Arrest / Death
Chest Pain / Chest Discomfort (Non-Traumatic)
Choking
Convulsions / Seizures
Diabetic Problems
Drowning / Near Drowning / Diving / SCUBA Accident
Electrocution / Lightning
Eye Problems / Injuries
Falls
Headache (non-traumatic)
Heat / Cold Exposure
Heart Problems / AICD
Hemorrhage / Lacerations
Inaccessible Incident / Other Entrapments (Non-traffic)
Overdose / Poisoning (Ingestion)
Pregnancy / Childbirth / Miscarriage
Psychiatric / Abnormal Behavior / Suicide Attempt
Sick Person (Specific Diagnosis)
Stab / Gunshot / Penetrating Trauma
Stroke (CVA) / Transient Ischemic Attack (TIA)
Traffic / Transportation Incidents
Traumatic Injuries (Specific)
Unconscious / Fainting (Near)
Add
Remove
Transfers to Main from Aid Station
Complaint
Quantity
Abdominal Pain / Problem
Allergies (Reactions) / Envenomations (Stings, Bites)
Animal Bites / Attacks
Assault / Sexual Assault / Stun Gun
Back Pain (Non-Traumatic or Non-Recent Trauma)
Breathing Problems
Burns (Scalds) / Explosion (Blast)
Carbon Monoxide / Inhalation / Haz Mat / CBRN
Cardiac or Respiratory Arrest / Death
Chest Pain / Chest Discomfort (Non-Traumatic)
Choking
Convulsions / Seizures
Diabetic Problems
Drowning / Near Drowning / Diving / SCUBA Accident
Electrocution / Lightning
Eye Problems / Injuries
Falls
Headache (non-traumatic)
Heat / Cold Exposure
Heart Problems / AICD
Hemorrhage / Lacerations
Inaccessible Incident / Other Entrapments (Non-traffic)
Overdose / Poisoning (Ingestion)
Pregnancy / Childbirth / Miscarriage
Psychiatric / Abnormal Behavior / Suicide Attempt
Sick Person (Specific Diagnosis)
Stab / Gunshot / Penetrating Trauma
Stroke (CVA) / Transient Ischemic Attack (TIA)
Traffic / Transportation Incidents
Traumatic Injuries (Specific)
Unconscious / Fainting (Near)
Add
Remove
Transfers Directly to Main
Complaint
Quantity
Abdominal Pain / Problem
Allergies (Reactions) / Envenomations (Stings, Bites)
Animal Bites / Attacks
Assault / Sexual Assault / Stun Gun
Back Pain (Non-Traumatic or Non-Recent Trauma)
Breathing Problems
Burns (Scalds) / Explosion (Blast)
Carbon Monoxide / Inhalation / Haz Mat / CBRN
Cardiac or Respiratory Arrest / Death
Chest Pain / Chest Discomfort (Non-Traumatic)
Choking
Convulsions / Seizures
Diabetic Problems
Drowning / Near Drowning / Diving / SCUBA Accident
Electrocution / Lightning
Eye Problems / Injuries
Falls
Headache (non-traumatic)
Heat / Cold Exposure
Heart Problems / AICD
Hemorrhage / Lacerations
Inaccessible Incident / Other Entrapments (Non-traffic)
Overdose / Poisoning (Ingestion)
Pregnancy / Childbirth / Miscarriage
Psychiatric / Abnormal Behavior / Suicide Attempt
Sick Person (Specific Diagnosis)
Stab / Gunshot / Penetrating Trauma
Stroke (CVA) / Transient Ischemic Attack (TIA)
Traffic / Transportation Incidents
Traumatic Injuries (Specific)
Unconscious / Fainting (Near)
Add
Remove
Transfers to Main for Ride Out
Complaint
Quantity
Bandaid (minor cuts/blisters/etc.)
Feminine Hygiene Products
Headache (non-traumatic)
Unconscious / Fainting (Near)
Heat / Cold Exposure
Abdominal Pain / Problem
Allergies (Reactions) / Envenomations (Stings, Bites)
Animal Bites / Attacks
Assault / Sexual Assault / Stun Gun
Back Pain (Non-Traumatic or Non-Recent Trauma)
Breathing Problems
Burns (Scalds) / Explosion (Blast)
Carbon Monoxide / Inhalation / Haz Mat / CBRN
Cardiac or Respiratory Arrest / Death
Chest Pain / Chest Discomfort (Non-Traumatic)
Choking
Convulsions / Seizures
Diabetic Problems
Drowning / Near Drowning / Diving / SCUBA Accident
Electrocution / Lightning
Eye Problems / Injuries
Falls
Heart Problems / AICD
Hemorrhage / Lacerations
Inaccessible Incident / Other Entrapments (Non-traffic)
Overdose / Poisoning (Ingestion)
Pregnancy / Childbirth / Miscarriage
Psychiatric / Abnormal Behavior / Suicide Attempt
Sick Person (Specific Diagnosis)
Stab / Gunshot / Penetrating Trauma
Stroke (CVA) / Transient Ischemic Attack (TIA)
Traffic / Transportation Incidents
Traumatic Injuries (Specific)
Add
Remove
Transfers Directly to an Ambulance
Complaint
Quantity
Abdominal Pain / Problem
Allergies (Reactions) / Envenomations (Stings, Bites)
Animal Bites / Attacks
Assault / Sexual Assault / Stun Gun
Back Pain (Non-Traumatic or Non-Recent Trauma)
Breathing Problems
Burns (Scalds) / Explosion (Blast)
Carbon Monoxide / Inhalation / Haz Mat / CBRN
Cardiac or Respiratory Arrest / Death
Chest Pain / Chest Discomfort (Non-Traumatic)
Choking
Convulsions / Seizures
Diabetic Problems
Drowning / Near Drowning / Diving / SCUBA Accident
Electrocution / Lightning
Eye Problems / Injuries
Falls
Headache (non-traumatic)
Heat / Cold Exposure
Heart Problems / AICD
Hemorrhage / Lacerations
Inaccessible Incident / Other Entrapments (Non-traffic)
Overdose / Poisoning (Ingestion)
Pregnancy / Childbirth / Miscarriage
Psychiatric / Abnormal Behavior / Suicide Attempt
Sick Person (Specific Diagnosis)
Stab / Gunshot / Penetrating Trauma
Stroke (CVA) / Transient Ischemic Attack (TIA)
Traffic / Transportation Incidents
Traumatic Injuries (Specific)
Unconscious / Fainting (Near)
Add
Remove
Other
Unable to Locate
Complaint
Quantity
Abdominal Pain / Problem
Allergies (Reactions) / Envenomations (Stings, Bites)
Animal Bites / Attacks
Assault / Sexual Assault / Stun Gun
Back Pain (Non-Traumatic or Non-Recent Trauma)
Breathing Problems
Burns (Scalds) / Explosion (Blast)
Carbon Monoxide / Inhalation / Haz Mat / CBRN
Cardiac or Respiratory Arrest / Death
Chest Pain / Chest Discomfort (Non-Traumatic)
Choking
Convulsions / Seizures
Diabetic Problems
Drowning / Near Drowning / Diving / SCUBA Accident
Electrocution / Lightning
Eye Problems / Injuries
Falls
Headache (non-traumatic)
Heat / Cold Exposure
Heart Problems / AICD
Hemorrhage / Lacerations
Inaccessible Incident / Other Entrapments (Non-traffic)
Overdose / Poisoning (Ingestion)
Pregnancy / Childbirth / Miscarriage
Psychiatric / Abnormal Behavior / Suicide Attempt
Sick Person (Specific Diagnosis)
Stab / Gunshot / Penetrating Trauma
Stroke (CVA) / Transient Ischemic Attack (TIA)
Traffic / Transportation Incidents
Traumatic Injuries (Specific)
Unconscious / Fainting (Near)
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