Page 298 - 2023 SMOG Digital

FORMS

TIME. Record all time local 24 hour military format, hh:mm
GENDER. (mark as appropriate)
MECHANISM OF INJURY (mark as appropriate – use other for DNBI or if unknown – describe)

INJURY (mark the diagram where the trauma/injury or disease is located – if there are more than
one injury, identify each with the mechanism of injury)
VITAL SIGNS (input vital signs at least hourly)

Pain Score:
0 – Pain free
1 – Very minor annoyance-occasional minor twinges

2 – Minor annoyance-occasional
3 – Annoying enough to be distracting

4 – Can be ignored if you are really involved in your work, but still distracting,
5 – Can’t be ignored for more than 30 minutes.
6 – Can’t be ignored for any length of time, but you can still go to work and participate in
social activities.

7 – Make it difficult to concentrate, interferes with sleep, you can still function with effort
8 – Physical activity severely limited. You can read and converse with effort. Nausea and
dizziness may occur.
9 – Unable to speak, crying out or moaning uncontrollable- pain makes you pass out
10 – Unconscious. Pain makes you pass out.

FIRST RESPONDERS (self-explanatory)
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TREATMENTS (mark as appropriate) and annotate location where appropriate

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