TCCC/IFAK Casualty Report
Date
*
-
Month
-
Day
Year
Date Picker Icon
Evac Status
*
Urgent
Priority
Routine
Name
*
First Name
Last Name
Location:
*
Gender
*
Please Select
Male
Female
Age:
*
MVC
*
MVC
Fall
Burn
Laceration
Crush Injury
GSW
Stabbing
Other (please provide details in "explanation" field)
Explanation:
*
Treatments: (Check all that apply)
Circulation
*
TQ-Extremity
Dressing (Hemostatic)
Dressing (Pressure)
Transport
*
Ground
Aero-Medical
Other
Airway
*
Intact
NPA
Other
Breathing
*
Chest Seal
Other
Transport Agency
*
Receiving Medical Facility
*
1st Responder Name
*
Agency
*
Notes
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Should be Empty: