Clinical Aviations

Flight Date

Flight Number

What shift did you work?

Day

Night

Night/NVG

What type of flight was this?

Fixed Wing

HEMS (Scene Call)

HEMS / IFT

Patient's Gender

Male

Female

Patient's Group

Adult

Pediatric (1 Year - 14 Years)

Infant/neonate ( less than 1 year)

Patient Condition

Stable

Moderate

Critical

Did the patient require advanced airway management by AMC?

Yes

Already on Mechanical Ventilator

No

First attempt done by AMC?

LMA

ETT

None

Intubation Details

Yes, I did intubation.

No, assisted.

N/A

How many total attempts for advanced airway management were performed by the crew?

First attempt.

Second attempt.

Third attempt

Failed intubation

N/A

As an individual, how many attempts did you make for advanced airway management?

First attempt.

Second attempt.

Third attempt

Failed intubation

N/A

Failed Intubation Action

LMA

BVM

N/A

Have you connected the patient to a mechanical ventilator?

Yes

No

IV Access

Yes, I did

No

Failed.

Medication Administration

Yes, I did

No

Not Needed

Needle Decompression

Yes, I did

No

Failed.

IO Access

Yes, I did

No

Failed.

Does the patient require CPR?

Yes

No

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