Handing over to rescue personnel Name: Date of birth/CPR: Date: Ship's name: Port call at: Name of examiner: Takes medicine name: Hypersensitivity to medicine/which: – Name of relative: Tel. no.: Not informed Informed □ □ What has happened describe the situation – A: Airway Action Guidelines Secure free airways Give oxygen 6 l/min 9 l/min If unconscious tongue depressor □ □ – □ Head fixation Neck support provided □ Neck/back No symptoms Pains Lesion * See reverse side □ □ □ B: Respiration Action Guidelines Respiratory rate Normal Laboured Superficial None □ □ □ □ Chest No symptoms Pains Lesion * See reverse side □ □ □ Used cardiopulmonary resuscitation: Yes No Action in case of heart failure: □ □ Start at: __________ Used defibrillator: Yes No □ □ C: Circulation Action Guidelines Pulse The pulse can be felt on the wrist Yes No On the neck Yes No □ □ □ □ Pulse quality Fast Slow Regular Irregular □ □ □ □ Skin colour Normal Pale Bluish Reddish □ □ □ □ Skin feels Warm and dry Cool and dry Warm and moist Cool and moist □ □ □ □ Capillary response Reacts in less than 2 seconds Reacts after more than 2 seconds □ □ Bleeding control Stopped bleeding Where? * See page 2 □ Inserted cannula yes no Administered NaCl. at __________ hours no – □ □ □ □ D: Disability Action Guidelines Level of consciousness Awake Reacts to speech Reacts to pain No reaction □ □ □ □ Control over pupillary reflex Normal reaction to light Abnormal: Describe □ Action Examine for other injuries Belly No symptoms Pains: Lesion: * See reverse side □ □ □ Pelvis No symptoms Pains: Lesion: * See reverse side □ □ □ Arms/legs No symptoms Pains: Lesion: * See reverse side □ □ □
Handing over to rescue personnel Name: Date of birth/CPR: Date: Ship's name: Port call at: Name of examiner: Takes medicine – name: Hypersensitivity to medicine/which: Name of relative: Tel. no.: Informed □ Not informed □ What has happened – describe the situation A: Airway Action Guidelines Secure free airways Give oxygen 6 l/min □ 9 l/min □ If unconscious – tongue depressor □ Head fixation Neck support provided □ Neck/back No symptoms □ Pains □ Lesion □ * See reverse side B: Respiration Action Guidelines Respiratory rate Normal □ Laboured □ Superficial □ None □ Chest No symptoms □ Pains □ Lesion □ * See reverse side Action in case of heart failure: Start at: __________ Used cardiopulmonary resuscitation: Yes □ No □ Used defibrillator: Yes □ No □ C: Circulation Action Guidelines Pulse The pulse can be felt on the wrist Yes □ No □ On the neck Yes □ No □ Pulse quality Fast □ Slow □ Regular □ Irregular □ Skin colour Normal □ Pale □ Bluish □ Reddish □ Skin feels Warm and dry □ Cool and dry □ Warm and moist □ Cool and moist □ Capillary response Reacts in less than 2 seconds □ Reacts after more than 2 seconds □ Bleeding control Stopped bleeding □ Where? * See page 2 Inserted cannula – yes □ no □ Administered NaCl. □ at __________ hours no □ D: Disability Action Guidelines Level of consciousness Awake □ Reacts to speech □ Reacts to pain □ No reaction □ Control over pupillary reflex Normal reaction to light □ Abnormal: Describe Action Examine for other injuries Belly No symptoms □ Pains: □ Lesion: □ * See reverse side Pelvis No symptoms □ Pains: □ Lesion: □ * See reverse side Arms/legs No symptoms □ Pains: □ Lesion: □ * See reverse side
Handing%20over%20to%20rescue%20personnel.docx