AMERICAN MEDICAL RESPONSE—SACRAMENTO VALLEY

Patient Care Report

DATE 9-23-02	SERVICE PROVIDER AMERICAN MEDICAL RESPONSE		VEHICLE # 07	SHIFT Pod 07	PROVIDER/UNIT # 253 B			PCR NUMBER 501285464
CALLED/DISPATCHED 2012	EN ROUTE 2012	ARRIVED SCENE: 2016 AT PT: 2016	LEAVE SCENE: 2033 AT DEST: 2040		TRANS CODE / PRIORITY 21D		CLEAR: 2110 IN SRV: 2110

CALL LOCATION (NAME AS APPLICABLE/ADDRESS)

Emerald Hills .

FIRST RESPONDER/MEDIC AGENCY

TRANSFER OF CARE

☐ YES ☐ NO

PATIENT NAME (LAST, FIRST) BOICE JUAN W	AGE 81	Y/M/D Y	DOB 2/1/21	GENDER ☑ MALE ☐ FEMALE
PATIENT ADDRESS / STREET 1550 Education Way	CITY Auburn		STATE / ZIP CA 95602	PHONE NUMBER 888-8247

PRIMARY PROBLEM / CHIEF COMPLAINT

SYNCOPAL VS MECHANICAL FALL c̄ HEAD INJ

PAST MEDICAL HISTORY: ☐ NONE ☐ HYPERTENSION ☐ CARDIAC ☐ DIABETES ☐ SEIZURES ☐ RESP ☐ STROKE ☐ PSYCHIATRIC ☐ OTHER
HX: ALZHEIMERS, HTN, OSTEOPOROSIS, COMPRESSION FX
CURRENT MEDICATIONS / COMPLIANCE: ☐ YES ☐ NO MAR, REPORT SHEET TO RN	ALLERGIES: ☐ UNKNOWN ☐ NKDA N.K.D.A.	WEIGHT	KG / LBS

TIME

GCS

PULSE

RESP

CO2

PAIN

EKG

TIME

GCS

PULSE

RESP

CO2

PAIN

EKG

E | V | M

2016

4 4 6

N/T

/10

SFC

/10

2024

4 4 6

100/74

/10

SFC

/10

2038

4 4 6

102/76

/10

SINUS

SFC

/10

PROTOCOL: ☐ CHEST PAIN ☐ GENERAL SYMPTOMS ☐ STEMI ☐ PAIN RELIEVED ☐ TRANSMITTED ☐ 12-LEAD GIVEN

HEAD Hematoma @ forehead, facial trauma	NECK Ø JVD non tender	PUPILS / PERRL PERRL R4 > LF R3-4 Little
CHEST E/E/P = Expansion	LUNG SOUNDS CLR =	TRAUMA CRITERIA: ☐ MECHANISM ☐ ANATOMY ☐ PHYSIOLOGY
ABDOMEN Soft non tender	BACK / FLANK Ø PAIN	BLOOD SUGAR: 103 TIME:	BLOOD SUGAR 2: TIME:
PELVIS Incontinent Bowel / Urine	EXTREMITIES States cannot move Rt arm/leg	CAP REFILL: < 2 SEC
SKIN: W-P-D	NEURO: ☐ NORMAL ☐ ABNORMAL CONFUSED	EMS START TIME:	FIRST DEFIB TIME:

Called to ALZHEIMERS UNIT of RETIREMENT CENTER FOR 81 YOM FALL OUT of Chair - UNWITNESSED UNC. MECHANICAL VS SYNCOPAL. PT FOUND PRONE ON FLOOR NEAR CHAIR. AWAKE CONFUSED (NORMAL PER STAFF) ∅ PAIN ON PALP. LOG ROLLED TO FULL SPINAL PRECAUTIONS. INCONTINENT URINE / Bowel. HAS HEMATOMA TO FOREHEAD RT LAT ORBIT, NOT ZYGOMA. STATES CANNOT MOVE

TIME: 2025	O2 @ LPM: 2	VIA: ☑ CANNULA ☐ BAG VALVE ☐ CPAP	☐ OPA ☐ NPA ☐ ETT ☐ COMBITUBE	PULSE OX INITIAL: 98% AFTER O2: 98%
AIRWAY: ☐ CLR ☐ OBST		ASPIRATION: ☐ YES ☐ NO		SUCTION: ☐ YES ☐ NO
INTUBATION: TIME: _____ ET SECURED AT: _____ CM AT THE _____ USES _____ BY: _____ TUBE SIZE: _____ NUMBER ATTEMPTS: _____ SUCCESSFUL: ☐ YES ☐ NO
CONFIRMATION: ☐ LUNG SOUNDS ☐ ETCO2 WAVEFORM ☐ CHEST RISE ☐ EPIGASTRIC AUSCULTATION ☐ EDD M.D. VERIFICATION SIGNATURE: _______________________

TIME	FLUID	SOLUTIONS	GAUGE	LOCATION	RATE	TOTAL VOL	ATTEMPTS	SUCCESS	BY
2025	☑ IV ☐ IO	NS	20	LF F/A	TKO ☐ OPEN ☐ BOLUS	200cc	2	☑ YES ☐ NO	SFC

IMMOBILIZATION: ☑ C-COLLAR ☑ BACKBOARD ☐ SPLINT LOCATION: _________________

POSITION: ☑ SUPINE ☐ LATERAL ☐ PRONE ☐ SITTING ☐ HEAD ELEV ☐ FEET ELEV

ARMS, BUT DOES SO (NOT to Command THOUGH) EQUALLY. WEAK GRIPS, EQUAL PULL. BGL 103, O2, OSC. C-2 > SAFH IN ACTIVE
∅ OTHER Δ's

FULL SPINAL PRECAUTIONS

TIME	HOSPITAL CONTACTED: ☐ SMMC ☐ SAFH ☐ SDH ☐ MAIN ☐ PHONE ☐ KGH ☐ MSJ ☐ MERCY ☐ OTHER: ____________ ☐ RADIO	MICN/MD NAME: ___________________	FORM LEFT W/PT? ☑ YES ☐ NO CONT. ATTACHED? ☐ YES ☐ NO
DESTINATION: SAFH CARE TRANSFERRED TO: RN		REASON: ☑ PT/FAMILY REQUEST ☐ LAW ☐ TRAUMA CRITERIA ☐ CLOSEST ☐ PHYSICIAN ORDER ☐ DIVERSION ☐ PCP ☐ SPECIALTY CENTER TYPE: _______
☐ STANDING ORDERS ☐ COMMUNICATION FAILURE ORDERS		DISPOSITION: ☐ TREATED/TRANSPORTED ☐ CANCELLED ☐ AMA ☐ REFUSED ☐ DEAD AT SCENE
PRIMARY ATTENDANT SIGNATURE / NAME: 2753 David K 49217		SECONDARY ATTENDANT:	PRECEPTOR SIGNATURE:

BILLING/OFFICE COPY Revised 4/07

Kittle

EXHIBIT NO. 27

4-6-11
C. RANSOM