Level 3 Field Operations Guide (fog) or Handbook


US&R TASK FORCE PATIENT CARE FORM (CONTINUED)



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US&R TASK FORCE PATIENT CARE FORM (CONTINUED)

INTERVENTIONS AND PATIENT COURSE

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

ENTRAPMENT TIME:

CONDITION:

DIAGNOSIS: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________

A
OFFICIAL
CCEPTING MEDICAL RESOURCE:


MAIL



PERMIT



DESTINATION:


POSITION:

SIGNATURE:

POSITION:


PRINT NAME:

MED TM MNGR SIGN:

TO: Definitive-Care Center Physician: This patient was treated by a special medical team. Please complete and return the attached card so that a follow-up evaluation may occur. If possible, please detail patient's course, outcome and any comments on the reverse side of the card.



R


EQUISITION FOR SUPPLIES, EQUIPMENT, AND/OR SERVICES



AFTER-ACTION DEBRIEFING

INCIDENT


OPERATIONAL PERIOD

DATE TIMES



REPORTING

UNIT ESF #9



FORM 2/95

US&R—006

MANAGEMENT COORDINATION

[ ] Intra-task force cooperations

[ ] integration of local jurisdiction's system

COMMUNICATIONS

[ ] intra-task force

[ ] inter-task force

[ ] with DFO, EOC, POA and other facilities

PLANNING/BRIEFING ACTIVITIES

[ ] planning sessions

[ ] task force briefings

[ ] shift scheduling/rotation/change over

[ ] resource utilization

BASE OF OPERATIONS LAYOUT/SET-UP

[ ] physical layout/site safety

[ ] cache set-up/organization

[ ] adequacy of sleeping/feeding/sanitation arrangements, etc.

MEDICAL ISSUES

[ ] care/treatment of task force personnel

[ ] canine issues

[ ] victim treatment/hand-off

[ ] management of controlled drugs/medicines/supplies and adequacy of the cache

[ ] victim summary


SUPPLY/LOGISTICS ISSUES

[ ] property accountability

[ ] resource tracking (between work sites, etc.

[ ] tool care/maintenance

[ ] resupply requests
PERSONAL SAFETY ISSUES

[ ] use of personal protective gear

[ ] rest/feeding/rehabilitation of personnel

[ ] emergency signaling procedures

[ ] CISD monitoring/intervention
INTERPERSONAL SKILLS/PERSONAL PERFORMANCE

[ ] task force management personnel



[ ] task force personnel






IST LEADER DATE TIME

DISTRIBUTION:








GENERAL MESSAGE



TO:

POSITION

FROM:

POSITION

SUBJECT

DATE

TIME

MESSAGE



































REPLY





































DATE

TIME

SIGNATURE/POSITION

ICS Form 213, 1/79 NFES 1336


APPENDIX E
NOTES & COMMENTS

































































































































































NOTES & COMMENTS






































































































































































NOTES & COMMENTS

































































































































































NOTES & COMMENTS
































































































































































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