ePRF Helper

Electronic Patient Report Form Helper

This is aimed at those new to pre-hospital clincal work to help with patient reporting.
This tool may have clinical inaccuracies, missing things or other errors
No data is saved or retained

Patient Details

Name

Provided Unknown Refused

Date of Birth

Provided Unknown Refused

Age Sex

Male Female Other

Address

Provided No Fixed Abode Unknown Refused

Past Medical History (PMHx) Taking medication?

Yes No

Medical conditions?

Yes No

Allergies?

Yes No

Known to social work?

Yes No Unknown

Presenting Complaint (PC) What is the main issue the patient needs help with right now?

History of Presenting Complaint (HxPC) What led to this problem? (What happened, when/how long ago did it start, how has it changed over time?) Priority symptoms / mechanisms (tick all that apply)

How long have symptoms been present?

Was there a witness?

Any similar episodes before?

Pain score (0-10)

On Arrival (O/A) ACVPU

A – Alert C – Confusion (new) V – Voice P – Pain U – Unresponsive

Position / activity you found them in Who was already on scene?

Family / friends Venue staff / security Police Scotland Other

Any treatment given before your arrival?

On Examination (O/E) Airway – what did you find?

Normal Obstructed Maintained manually Adjunct in place (OPA/NPA)

Breathing – what did you find? Circulation – what did you find?

Normal Tachycardic (>100) Bradycardic (<60) Pale / mottled Active bleeding Cap refill >2 sec

Disability – what did you find? Exposure – rapid head-to-toe

Normal Head / face injury Chest injury Abdominal injury Limb injury External bleeding Temp < 35 °C or > 38 °C

Additional Notes (elaborate on O/E findings)

Observations and Vital Signs

Management / Treatment Given Additional management notes

Job Details / Narrative Tell the story of this job from start to finish - what happened, how you managed it, and the outcome

Escalation

Medical Centre Handover Handed over to Medical Centre?

Yes No

Discharge Outcome