Wilderness First Aid Report Form PDF Details

When an incident occurs in a wilderness or remote area, a well-documented aid report is crucial for ensuring the safety and well-being of those involved. The Wilderness First Aid Report Form serves as an essential tool in this process, providing a systematic way to record the details of an injury or illness that occurs far from traditional medical facilities. This form captures a wide array of vital information, starting with the patient's name, age, and the time and date of the incident. It goes on to detail the mechanism of injury or nature of the illness, encompassing everything from falls and illnesses to bites and stings. The form is comprehensive, covering the initial assessment of the patient’s condition, including consciousness, airway, breathing, circulation, and disability, as well as the environmental conditions. The secondary assessment records the level of responsiveness, chief complaint, signs and symptoms, allergies, medications, and pertinent past medical history, alongside the last intake/output and events leading up to the incident. It also includes the recording of vital signs, both initially and ongoing, and a hands-on physical examination. Details about the patient’s address, the person completing the form, their level of training, and relationship to the patient are incorporated, as well as instructions for rescue requests. Information on the exact location, first aid provided, and the on-site plan, including whether evacuation is needed and the specifics of the evacuation plan, are also integral parts of the form. This document ensures that a thorough record is kept, aiding in both the immediate care and future understanding of wilderness incidents.

QuestionAnswer
Form NameWilderness First Aid Report Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namestrailer accident report form, wilderness form rescue, wilderness first aid boy scouts, first aid observation report form

Form Preview Example

Wilderness and Remote First Aid Report Form/Rescue Request

Report Form

Patient’s Name:

Evacuation Evaluation

Age:

Time of incident: _______ AM/PM

Date:

Mechanism of Injury (MOI) /Nature of illness: (circle all that apply)

Time Started:

Fall, Illness, Cold, Heat, Burn, Allergy, Bite, Sting, Other ________________

Primary (Initial) Assessment

Brief Description of Incident

Consciousness

 

Airway

 

Breathing

 

Circulation

 

Disability

 

Environment and Expose

 

Secondary (Focused) Assessment

 

Level of Responsiveness (LOR)

 

Chief Complaint

 

Signs and Symptoms

 

Allergies

 

Medications

 

Pertinent Past Medical History

 

Last Intake/Output

 

Events Leading Up to the Incident

 

 

Vital Signs

Initial

Ongoing

Ongoing

Ongoing

 

Time

 

 

 

 

Hands‐On Physical Exam (DOTS)

LOR (AVPU)

 

 

 

 

Head/Neck

Breathing (Rate and

 

 

 

 

 

Quality) 12‐20

 

 

 

 

Chest

Pulse (Rate and

 

 

 

 

 

Quality) 50‐100

 

 

 

 

Abdomen

Skin (Color, Temp,

 

 

 

 

 

Moisture) PWD

 

 

 

 

Pelvis

Pupils (Equal, Round,

 

 

 

 

 

Reactive to Light)

 

 

 

 

Legs/Arms

CSM (Circulation,

 

 

 

 

 

Sensation, Motion)

 

 

 

 

Back

Patient’s Address:

 

 

 

 

 

 

 

 

 

Completed by

Notify (Name and Phone Number)

 

 

 

Level of Training

Relationship

 

 

 

 

Rescue Request

Exact Location (include map if possible)

 

First Aid Given

Quadrangle:__________ Section: __________

 

 

Area Description

 

 

 

 

Terrain

 

 

 

 

Local Weather

 

 

 

 

 

 

 

 

 

 

On‐Site Plans

 

 

 

 

___ Stay

 

 

 

 

___ Evacuate to:

 

 

 

 

Stay overnight: Yes or No

 

 

 

 

On‐site equipment: (circle all that apply)

 

 

Tent, Stove, Food, Insulation, Flare, CB Radio, Other_________

 

Evacuation needed: Carry‐out, Helicopter, Lowering, Raising

Evacuation Plan

Equipment needed: Rigid Litter, Food, Water, Other __________

 

 

 

 

 

Party members remaining: Beginners, Intermediate, Experts

 

 

 

 

 

 

Name

 

Notify

 

Phone

 

 

 

 

 

 

 

How to Edit Wilderness First Aid Report Form Online for Free

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Step 1: Click the "Get Form" button in the top section of this webpage to access our PDF tool.

Step 2: Once you access the file editor, you'll see the document ready to be filled in. In addition to filling in various fields, you can also perform other actions with the form, namely putting on your own words, changing the original text, inserting graphics, affixing your signature to the PDF, and much more.

This PDF will require particular information to be entered, therefore you should definitely take the time to enter exactly what is required:

1. Start filling out your trailer accident report form with a selection of necessary fields. Collect all of the necessary information and make certain nothing is forgotten!

form rescue request conclusion process shown (part 1)

2. Given that the previous part is finished, you need to include the necessary details in Report Form Patients Name Age Date, Chest, Abdomen, Pelvis, LegsArms, Back, Completed by Level of Training, Ongoing, Ongoing, Ongoing, Initial, Vital Signs Time LOR AVPU, Rescue Request Exact Location, and First Aid Given so you're able to go to the next stage.

Ongoing, LegsArms, and Pelvis inside form rescue request

Those who work with this document generally make some mistakes while completing Ongoing in this part. Make sure you revise everything you enter right here.

3. The following portion is all about Rescue Request Exact Location, Name, Notify, Phone, and Evacuation Plan - fill in each of these fields.

Filling in segment 3 of form rescue request

Step 3: Ensure your information is correct and then just click "Done" to continue further. Sign up with us right now and instantly get access to trailer accident report form, ready for download. Each and every change made is conveniently preserved , meaning you can customize the file at a later stage when required. We do not share or sell the details you type in whenever completing documents at FormsPal.

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