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FORMS

Performance Improvement Event(s) Data Joint Trauma System, Version 1.1, 28 Oct 2021 Additional Interventions D Immobilization not performed when indicated D (-collar D Pelvic binder D Spinal motion restriction D SAM splint for extremity 0 Rigid eye shield □ Hypothermia prevention not init

(MERCuRY) Circulation Date I I D Rhythm not recorded I D Blood product transfusion protocol D Indicated and successfully performed D Deviation from airway management protocol D Performed when not indicated D Not performed when indicated D Capability not available □ IV/IO not inserted e

Military Enroute Care Registry First Name I I Airway □ SSN □ PSSN I Mission Leg# D D Advanced non-surgical airway placement I D Indicated and successfully performed D Performed when not indicated D Not performed when not indicated D Attempted unsuccessfully D Cricothyroidotomy

Last Name I PSSN/SSNI Mission# I Documentation D Standard form not used D Patient identification not completed D Dispatched versus assessed category differ D Dispatched category higher than assessed D Dispatched category lower than assessed D MIST report mechanism not correct D MIST

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