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Focused Audit Tool – TRAUMA
Plains To Peaks
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Focused Audit Tool – TRAUMA
Focused Audit Tool – TRAUMA
Your Name
First
Last
Your Email Address
Reporting Agency
*
Please Choose
#1 Fire Protection District
Action Care
American Medical Response
Black Forest Fire Rescue
Broadmoor FPD
Burlington FPD
Calhan FPD
Cascade FPD
Cheyenne County Ambulance
Cimarron Hills FPD
City of Colorado Springs Fire Department
City of Fountain Fire Department
Colorado Centre FPD
Colorado Springs Police Comm Center
Community Ambulance Service
Cripple Creek Emergency Services
Cripple Creek Police Dispatch
Crystal Park VFD
Divide FPD
Donald Wescott FPD
Edison VFD
El Paso County Sheriff's Comm Center
Ellicott FPD
Evans US Army Ambulance
Falcon FPD
Flagler FPD
Florissant FPD
Four Mile Emergency Services
Four Mile FPD
Ft. Carson Fire Dept
Genoa VFD
Green Mountain Falls FPD
Hanover FPD
Hugo Volunteer Fire and Ambulance
Karval FPD
Keefe Memorial Hospital
Kit Carson County Ambualnce Service
Kit Carson County Memorial Hospital
Kit Carson County Sheriff's Office Dispatch
Limon Ambulance Service
Limon VFD
Lincoln Community Hospital
Lincoln Community Hospital Ambulance
Lincoln County Sherrif's Office Dispatch
Manitou Springs Fire Dept
Memorial Star Transport
Mountain Communities FPD
NE Lincoln FPD
NE Teller County FPD
Palmer Lake VFD
Penrose St. Francis FFL
Penrose St. Francis Health Services
Peterson AFB Fire Dept
Peyton FPD
Pikes Peak Regional Hospital
Schreiver AFB Fire Dept
Security Village Fire Dept
Seibert FPD
Southwest Teller County EMS
Stratmoor Hills FPD
Stratton FPD
SW Hwy 115 FPD
Teller County Sherrif's Office Dispatch
Tri County FPD
Tri Lakes FPD
UCH-Memorial Health System
USAFA Fire Dept
Ute Pass Regional Ambulance District
Victor VFD
Vona FPD
West Cheyenne FPD
Other
Other Reporting Agency
Date of Call
*
MM slash DD slash YYYY
Level of Care
Please Choose
Paramedic
First Responder
RN / Other
EMT
Was Patient transported?
*
Yes
No
If NO, why?
*
REFUSAL
DOA
Treat/Release
POV
Transport Agency
*
Please Choose
AMR
Fire Transport
Other Ambulance
Tri-Lakes
Transport Destination
*
Please Choose
University Health Memorial Central Hospital
University Health Memorial North Hospital
Centura Health Penrose Main Hospital
Centura Health Penrose St. Francis Hospital
Evans Army hospital
Keefe Memorial hospital
Kit Carson county memorial hospital
Lincoln community hospital
Pikes peak regional hospital
Parkview
St. Thomas Moore
St. Mary Corwin
Skyridge
Parker
Why was this destination chosen?
*
Please Choose
Patient Request
Closest Appropriate
Divert
Response to Emergency Department:
Please Choose
Code 2
Code 3
Chief Complaint
*
Assessment (if different)
Mechanism of Trauma
*
Please Choose
Blunt Force
High Velocity Penetrating Force
Low Velocity Penetrating Force
Crushing
Blast
Fall
Laceration
Impaled
Other
If Other
*
Result of Trauma
*
Please Choose
Open fracture
Closed Fracture
Sprain/Strain
Spinal Injury
Dislocation
Multisystem
Other
If Other
*
Scene Time
*
Please Choose
0-5
6-10
11-15
16-20
21-25
26-30
31-35
36-40
Greater then 40
Why?
Extrication
*
Yes
No
If yes, how long until pt contact?
*
Glasgow Coma Score
*
Initial
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Glasgow Coma Score
*
At time of transport
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Procedures
Rapid Trauma Assessment:
*
Yes
No
If indicated, performed?
*
Yes
No
If NO, why?
*
Focused Assessment
*
Yes
No
If indicated, performed?
*
Yes
No
If NO, why?
*
Spinal Immobilization: Indicated
*
Yes
No
If indicated, performed?
*
Yes
No
If NO, why?
*
Vital Signs
*
Yes
No
If indicated, performed?
*
Yes
No
If NO, why?
*
IV Access
*
Yes
No
If indicated, performed?
*
Yes
No
If NO, why?
*
Advanced Airway
*
Yes
No
If indicated, performed?
*
Yes
No
If NO, why?
*
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