Victim Information Card
EMS Information:
Pt Number: 1
Patient Information:
Name: Bashuir, Yousof
Age: 62 Gender: M
BP: 100/76 HR: 140 RR: 24 Temp: 102F
Wt (Kg): 90
Chief Complaint: fever, cough, SOB
Hx: Asthma
Medical Center Information:
Other: returned from trip to Saudi Arabia 3 days prior
Additional Information: extreme fatigue, emotionally aggitated
Medical Record Number: ______________________
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Instructions: unable to breath tired
Acting tips: Express extreme panic about illness. State you know you will die. Act very weak and ill, unable to breathe fully
Dx: suspect MERS
EMS Information:
Pt Number: 2
Patient Information:
Name: Al-Balawi, Abdul
Age: 58 Gender: M
BP: 130/86 HR: 140 RR: 60 Temp: 103F
Wt (Kg): 65
Chief Complaint: worsening flu-like sx, developing pneumonia
Hx: Conduct disorder
Medical Center Information:
Other: colleague of Yousof Bashir (#1), returned from Saudi Arabia 3 days prior
Additional Information: extreme fatigue, difficulty breathing, emotionally aggitated
Medical Record Number: ______________________
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Instructions: very tired, difficulty breathing
Acting tips: Express extreme panic about illness. Demand you be given ZMAPP meds immediately. State you know you will die. Act very weak and ill, unable to breathe fully
Dx: suspect MERS
EMS Information:
Pt Number: 3
Patient Information:
Name: Hamdan, Faris
Age: 59 Gender: M
BP: 102/62 HR: 100 RR: 30 Temp: 102F
Wt (Kg): 70
Chief Complaint: worsening flu-like sx, developing pneumonia
Hx: None
Medical Center Information:
Other: colleague of Yousof Bashir (#1), returned from Saudi Arabia 3 days prior
Additional Information: extreme fatigue, difficulty breathing, concerned about exposure
Medical Record Number: ______________________
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Instructions: very tired, difficulty breathing
Acting tips: Say you know you are very ill and are concerned about dying. Ask to be given ZMAPP meds. Act very weak and ill, unable to breathe fully
Dx: suspect MERS
EMS Information:
Pt Number: 4
Patient Information:
Name: Jones, Gordon
Age: 43 Gender: M
BP: 140/98 HR: 170 RR: 60 Temp: 101F
Wt (Kg): 84
Chief Complaint: flu-like sx.
Hx: Prematurity
Medical Center Information:
Other: Among a group of 5 returned from Dubai 2 days prior; healthcare worker at a Dubai hospital
Additional Information: fever, cough, difficulty breathing, concerned about exposure
Medical Record Number: ______________________
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Instructions: very tired, difficulty breathing
Acting tips: Say you know you are very ill and are concerned about dying. Act weak and ill, unable to breathe fully
Dx: suspect MERS
EMS Information:
Pt Number: 5
Patient Information:
Name: Amaladin, Deborah
Age: 30 Gender: F
BP: 140/88 HR: 110 RR: 18 Temp: 101F
Wt (Kg): 60
Chief Complaint: flu-like sx.
Hx: Panic attacks
Medical Center Information:
Other: Among a group of 5 returned from Dubai 2 days prior; healthcare worker at a Dubai hospital
Additional Information: fever, cough, difficulty breathing, concerned about exposure
Medical Record Number: ______________________
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Instructions: very tired, difficulty breathing
Acting tips: Say you know you have been exposed and are concerned about being ill. Act weak and ill, unable to breathe fully
Dx: suspect MERS
EMS Information:
Pt Number: 6
Patient Information:
Name: Hussein, Daniel
Age: 33 Gender: M
BP: 98/66 HR: 80 RR: 20 Temp: 101F
Wt (Kg): 70
Chief Complaint: flu-like sx.
Hx: None
Medical Center Information:
Other: Among a group of 5 returned from Dubai 2 days prior; did not visit or work at a hospital in that country
Additional Information: fever, cough, concerned about exposure
Medical Record Number: ______________________
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Instructions: headache, dizziness, fatigue
Acting tips: act mildly ill, slightly achy, able to breathe but light dry cough. Say you are concerned about being exposed to MERS and becoming ill.
Dx: suspect MERS
EMS Information:
Pt Number: 7
Patient Information:
Name: Patel, Nadish
Age: 29 Gender: M
BP: 80/48 HR: 150 RR: 45 Temp: 101F
Wt (Kg): 64
Chief Complaint: flu-like sx.
Hx: None
Medical Center Information:
Other: Among a group of 5 returned from Dubai 2 days prior; did not visit or work at a hospital in that country
Additional Information: fever, cough, concerned about exposure
Medical Record Number: ______________________
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Instructions: weak, fatigued
Acting tips: act mildly ill, slightly achy, able to breathe but light dry cough. Say you are concerned about having MERS and becoming really sick.
Dx: suspect MERS
EMS Information:
Pt Number: 8
Patient Information:
Name: Miller, Jessica
Age: 29 Gender: F
BP: 78/58 HR: 126 RR: 32 Temp: 101F
Wt (Kg): 64
Chief Complaint: flu-like sx.
Hx: None
Medical Center Information:
Other: Among a group of 5 returned from Dubai 2 days prior; did not visit or work at a hospital in that country
Additional Information: fever, cough, concerned about exposure
Medical Record Number: ______________________
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Instructions: weak, fatigued
Acting tips: act mildly ill, slightly achy, able to breathe but light dry cough. Say you know you have MERS and are concerned about getting sick.
Dx: suspect MERS
EMS Information:
Pt Number: 9
Patient Information:
Name: Martin, Pamela
Age: 45 Gender: F
BP: 130/72 HR: 100 RR: 28 Temp: 98.7F
Wt (Kg): 70
Chief Complaint: headache
Hx: Asthma
Medical Center Information:
Other: On a transfer flight from Atlanta to LA, was seated next to a group of Arabic travelers returning from the Middle East
Additional Information: anxious
Medical Record Number: ______________________
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Instructions: panicky, anxious
Acting tips: act easily upset, panicky, nervous. State that you know you got MERS from passengers on the plane. Report you have had therapy for panic attacks in the past.
Dx: worried well
EMS Information:
Pt Number: 10
Patient Information:
Name: Jameson, Morgan
Age: 33 Gender: M
BP: 112/50 HR: 90 RR: 16 Temp: 98.6F
Wt (Kg): 72
Chief Complaint: headache, sweaty
Hx: Repaired congenital heart disease as child
Medical Center Information:
Other: Attended a business meeting with colleagues that traveled to the Middle East, none of those travelers are ill
Additional Information: shaking, easily agitated
Medical Record Number: ______________________
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Instructions: panicky, anxious
Acting tips: act easily upset, panicky, nervous. State you are worried that you might have MERS.
Dx: worried well
EMS Information:
Pt Number: 11
Patient Information:
Name: Johnson, Samantha
Age: 42 Gender: F
BP: 100/52 HR: 80 RR: 15 Temp: 99F
Wt (Kg): 60
Chief Complaint: headache, sweaty
Hx: MRCP, seizure disorder
Medical Center Information:
Other: Attended a party with guests from the Middle East, none of those guests are ill; wife of Michael Johnson
Additional Information: shaking, easily agitated
Medical Record Number: ______________________
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Instructions: panicky, anxious
Acting tips: act easily upset, panicky, nervous. State you know you and your husband have MERS.
Dx: worried well
EMS Information:
Pt Number: 12
Patient Information:
Name: Johnson, Michael
Age: 44 Gender: M
BP: 90/70 HR: 110 RR: 32 Temp: 98.6F
Wt (Kg): 84
Chief Complaint: none/fine
Hx: None
Medical Center Information:
Other: Attended a party with guests from the Middle East, none of those guests are ill; husband of Samantha Johnson
Additional Information: normal
Medical Record Number: ______________________
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Instructions: panicky, anxious
Acting tips: act easily upset, panicky, nervous. State you are worried that you and your wife might have been exposed to MERS.
Dx: worried well
EMS Information:
Pt Number: 13
Patient Information:
Name: Samuelson, Ira
Age: 52 Gender: M
BP: 90/44 HR: 130 RR: 12 Temp: 99F
Wt (Kg): 70
Chief Complaint: headache, sweaty
Hx: Hypothyroidism
Medical Center Information:
Other: Had a layover in Israel following a business meeting in Greece
Additional Information: fatigued
Medical Record Number: ______________________
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Instructions: panicky, anxious
Acting tips: act easily upset, panicky, nervous. State you are worried that you have been exposed to MERS.
Dx: worried well
EMS Information:
Pt Number: 14
Patient Information:
Name: Al-Dimashqui, Hassan
Age: 65 Gender: F
BP: 110/68 HR: 118 RR: 18 Temp: 102F
Wt (Kg): 80
Chief Complaint: flu-like sx., muscle aches, dry cough
Hx: Depression, pregnant 32 weeks
Medical Center Information:
Other: Traveled to Yemen, arrived in the United States 20 days ago, became ill 2 days ago
Additional Information: fatigue, cough
Medical Record Number: ______________________
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Instructions: weak, dry cough, feverish
Acting tips: act mildly ill, slightly achy, able to breathe but light dry cough. State you are worried that you were exposed to MERS on your recent trip.
Dx: ILI
EMS Information:
Pt Number: 15
Patient Information:
Name: Farmiga, Millicent
Age: 43 Gender: F
BP: 138/78 HR: 100 RR: 20 Temp: 100F
Wt (Kg): 90
Chief Complaint: flu-like sx., muscle aches, dry cough
Hx: Crohn's
Medical Center Information:
Other: Traveled to Philippines, arrived in the US 4 days ago, became ill 1 day ago
Additional Information: fatigue, cough
Medical Record Number: ______________________
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Instructions: weak, dry cough, feverish
Acting tips: act mildly ill, slightly achy, able to breathe but light dry cough. State you know you are ill with a bad flu.
Dx: ILI
EMS Information:
Pt Number: 16
Patient Information:
Name: Fadel, Safniyaa
Age: 35 Gender: F
BP: 88/40 HR: 140 RR: 16 Temp: 100F
Wt (Kg): 77
Chief Complaint: flu-like sx., muscle aches, dry cough
Hx: None
Medical Center Information:
Other: Had guests from Saudi Arabi visit and stay at her home, guests not ill
Additional Information: fatigue, cough
Medical Record Number: ______________________
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Instructions: weak, dry cough, feverish
Acting tips: act mildly ill, slightly achy, able to breathe but light dry cough. State you are worried you have been exposed to MERS.
Dx: ILI
EMS Information:
Pt Number: 17
Patient Information:
Name: Farooq, Kalib
Age: 48 Gender: M
BP: 98/56 HR: 130 RR: 20 Temp: 99F
Wt (Kg): 84
Chief Complaint: flu-like sx.
Hx: chronic lung disease, prematurity
Medical Center Information:
Other: Traveled to Saudi Arabia, arrived in the United States 16 days ago, became ill 1 day ago
Additional Information: fatigue, cough
Medical Record Number: ______________________
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Instructions: weak, dry cough, feverish
Acting tips: act mildly ill, slightly achy, able to breathe but light dry cough. Say you are concerned about being exposed to MERS.
Dx: ILI
EMS Information:
Pt Number: 18
Patient Information:
Name: Siam, Abrim
Age: 64 Gender: M
BP: 82/40 HR: 160 RR: 50 Temp: 98.6 F
Wt (Kg): 64
Chief Complaint: fall, headache, bleeding
Hx: None
Medical Center Information:
Other: none
Additional Information: bruise, laceration
Medical Record Number: ______________________
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Instructions: headache, dizziness
Acting tips: act easily upset, disoriented
Dx: forehead lacertaion
EMS Information:
Pt Number: 19
Patient Information:
Name: Karoon, Abdul
Age: 57 Gender: M
BP: 114/68 HR: 80 RR: 22 Temp: 99 F
Wt (Kg): 90
Chief Complaint: excessive diarrhea, vomiting
Hx: ADHD
Medical Center Information:
Other: no history of travel
Additional Information: nausea, diarrhea, vomiting
Medical Record Number: ______________________
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Instructions: nausea, dehydration
Acting tips: clutch stomach, act nauseous
Dx: GI
EMS Information:
Pt Number: 20
Patient Information:
Name: Sanchez, Britney
Age: 74 Gender: F
BP: 140/94 HR: 125 RR: 24 Temp: 98.6 F
Wt (Kg): 65
Chief Complaint: fall, twisted ankle
Hx: Coronary heart disease, emphysema
Medical Center Information:
Other: none
Additional Information: swollen right ankle
Medical Record Number: ______________________
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Instructions: swelling and bruising on right ankle
Acting tips: severe pain in ankle, unable to walk
Dx: ankle sprain
EMS Information:
Pt Number: 21
Patient Information:
Name: Baum, Marge
Age: 70 Gender: F
BP: 98/54 HR: 116 RR: 40 Temp: 98.6 F
Wt (Kg): 64
Chief Complaint: chest, weakness
Hx: Seasonal allergies
Medical Center Information:
Other: smoker, overweight
Additional Information: pale, sweaty, pain 10 out of 10
Medical Record Number: ______________________
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Instructions: pain in chest
Acting tips: clutch chest, anxious
Dx: micardial infarction
EMS Information:
Pt Number: 22
Patient Information:
Name: Tunis, Mallory
Age: 42 Gender: F
BP: 138/68 HR: 100 RR: 13 Temp: 98.6F
Wt (Kg): 62
Chief Complaint: bipolar disorder, prior history of mental health care
Hx: Anxiety disorder
Medical Center Information:
Other: not psychotic
Additional Information: suicidal
Medical Record Number: ______________________
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Instructions: awaiting transfer to psych facilities
Acting tips: you feel suicidal, tell the doctor that you have the means and intention to kill yourself
Dx: suicidal
EMS Information:
Pt Number: 23
Patient Information:
Name: Jones, Frank
Age: 17 Gender: M
BP: 98/58 HR: 88 RR: 20 Temp: 98.6F
Wt (Kg): 75
Chief Complaint: headache, dizzy
Hx: HIV
Medical Center Information:
Other: tackled hard during football practice
Additional Information: head trauma
Medical Record Number: ______________________
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Instructions: needs scan
Acting tips: act tired, dioriented
Dx: concussion
EMS Information:
Pt Number: 24
Patient Information:
Name: Morgenstern, Tracey
Age: 28 Gender: F
BP: 100/64 HR: 65 RR: 14 Temp: 99F
Wt (Kg): 60
Chief Complaint: excessive diarrhea, vomiting
Hx: diabetic type I
Medical Center Information:
Other: traveled to Mexico, ate the local food and drank the water
Additional Information: nausea, diarrhea, vomiting
Medical Record Number: ______________________
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Instructions: nausea, dehydration
Acting tips: clutch stomach, act nauseous. Say that you think you are ill due to getting MERS in Mexico
Dx: GI
EMS Information:
Pt Number: 25
Patient Information:
Name: Saussman, Mary
Age: 20 Gender: F
BP: 124/78 HR: 89 RR: 18 Temp: 102F
Wt (Kg): 55
Chief Complaint: flu-like sx.
Hx: None
Medical Center Information:
Other: college student, no recent travel
Additional Information: fever, body aches, cough
Medical Record Number: ______________________
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Instructions: weak, dry cough, feverish
Acting tips: act mildly ill, slightly achy, able to breathe but light dry cough
Dx: ILI
EMS Information:
Pt Number: 26
Patient Information:
Name: Baldwin, John
Age: 25 Gender: M
BP: 160/104 HR: 70 RR: 18 Temp: 101F
Wt (Kg): 60
Chief Complaint: flu-like sx.
Hx: None
Medical Center Information:
Other: college student, no recent travel
Additional Information: fever, body aches, cough, difficulty breathing
Medical Record Number: ______________________
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Instructions: weak, dry cough, feverish
Acting tips: act very ill, unable to breathe
Dx: ILI
EMS Information:
Pt Number: 27
Patient Information:
Name: Thomas, Meredith
Age: 62 Gender: F
BP: 126/76 HR: 130 RR: 20 Temp: 101F
Wt (Kg): 95
Chief Complaint: flu-like sx.
Hx: Sickle cell disease
Medical Center Information:
Other: chronic smoker, obese, no recent travel
Additional Information: fever, body aches, cough, difficulty breathing
Medical Record Number: ______________________
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Instructions: weak, dry cough, feverish
Acting tips: act very ill, unable to breathe
Dx: ILI
EMS Information:
Pt Number: 28
Patient Information:
Name: Franklin, Peter
Age: 8 Gender: M
BP: 110/68 HR: 89 RR: 26 Temp: 102F
Wt (Kg): 46
Chief Complaint: flu-like sx.
Hx: Sickle cell disease
Medical Center Information:
Other: hist. of asthma
Additional Information: fever, body aches, cough, difficulty breathing
Medical Record Number: ______________________
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Instructions: weak, dry cough, feverish
Acting tips: act very ill, unable to breathe
Dx: ILI
EMS Information:
Pt Number: 29
Patient Information:
Name: Wilson, Marc
Age: 50 Gender: M
BP: 118/86 HR: 65 RR: 13 Temp: 102F
Wt (Kg): 80
Chief Complaint: flu-like sx.
Hx: None
Medical Center Information:
Other: hypertensive, overweight
Additional Information: fatigue, cough
Medical Record Number: ______________________
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Instructions: weak, dry cough, feverish
Acting tips: act very ill, unable to breathe
Dx: ILI
EMS Information:
Pt Number: 30
Patient Information:
Name: Pullido, Clarissa
Age: 44 Gender: F
BP: 128/66 HR: 100 RR: 16 Temp: 100F
Wt (Kg): 100
Chief Complaint: flu-like sx.
Hx: Bipolar disorder
Medical Center Information:
Other: diabetic, overweight
Additional Information: fever, body aches, cough
Medical Record Number: ______________________
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Instructions: weak, dry cough, feverish
Acting tips: act mildly ill, slightly achy, able to breathe but light dry cough
Dx: ILI
EMS Information:
Pt Number: 31
Patient Information:
Name: Wright, Kim
Age: 3 Gender: F
BP: 114/56 HR: 130 RR: 40 Temp: 102F
Wt (Kg): 17
Chief Complaint: flu-like sx.
Hx: None
Medical Center Information:
Other: preschool student
Additional Information: fever, body aches, cough
Medical Record Number: ______________________
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Instructions: weak, dry cough, feverish
Acting tips: act mildly ill, disoriented, achy, able to breathe but light dry cough. Parent of child says they are worried the child may have MERS.
Dx: ILI
EMS Information:
Pt Number: 32
Patient Information:
Name: Cooper, Lucy
Age: 2 Gender: F
BP: 100/70 HR: 155 RR: 60 Temp: 100F
Wt (Kg): 15
Chief Complaint: flu-like sx.
Hx: None
Medical Center Information:
Other: in daycare
Additional Information: fever, weakness, inability to eat
Medical Record Number: ______________________
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Instructions: weak, feverish
Acting tips: act disoriented, cranky. Parent of child says they are worried the child may have MERS.
Dx: ILI
EMS Information:
Pt Number: 33
Patient Information:
Name: Fallon, Daniel
Age: 4 Gender: M
BP: 112/64 HR: 144 RR: 30 Temp: 102F
Wt (Kg): 20
Chief Complaint: flu-like sx.
Hx: None
Medical Center Information:
Other: hist. of asthma, preschool student
Additional Information: fever, body aches, cough, difficulty breathing
Medical Record Number: ______________________
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Instructions: weak, dry cough, feverish
Acting tips: act very ill, unable to breathe. Parent of child says they are sure child has MERS and will die "because he already has asthma". Parent demands that child be given ZMAPP meds immediately!
Dx: ILI
EMS Information:
Pt Number: 34
Patient Information:
Name: Dean, Becky
Age: 5 Gender: F
BP: 98/54 HR: 122 RR: 14 Temp: 101F
Wt (Kg): 24
Chief Complaint: flu-like sx.
Hx: Lupus
Medical Center Information:
Other: hist. of asthma, preschool student
Additional Information: fever, body aches, cough, difficulty breathing
Medical Record Number: ______________________
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Instructions: weak, dry cough, feverish
Acting tips: act very ill, unable to breathe. Parent of child says they are sure child has MERS and will die "because he already has asthma". Parent asks that child be given ZMAPP meds.
Dx: ILI
EMS Information:
Pt Number: 35
Patient Information:
Name: Lopez, Roberto
Age: 65 Gender: M
BP: 90/48 HR: 110 RR: 30 Temp: 102F
Wt (Kg): 99
Chief Complaint: flu-like sx.
Hx: history ALL
Medical Center Information:
Other: smoker, overweight
Additional Information: fever, body aches, cough, difficulty breathing
Medical Record Number: ______________________
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Instructions: weak, dry cough, feverish
Acting tips: act very ill, unable to breathe
Dx: ILI
EMS Information:
Pt Number: 36
Patient Information:
Name: Amigaza, Francis
Age: 70 Gender: M
BP: 156/92 HR: 98 RR: 17 Temp: 100F
Wt (Kg): 84
Chief Complaint: flu-like sx.
Hx: DM II, HTN, CHF
Medical Center Information:
Other: hypertensive, hist. of heart disease
Additional Information: fever, weakness, inability to eat
Medical Record Number: ______________________
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Instructions: weak, feverish
Acting tips: act disoriented, cranky
Dx: ILI
EMS Information:
Pt Number: 37
Patient Information:
Name: Petrovich, Alexis
Age: 55 Gender: F
BP: 130/78 HR: 77 RR: 15 Temp: 101F
Wt (Kg): 70
Chief Complaint: flu-like sx.
Hx: Pregnant 29 weeks
Medical Center Information:
Other: COPD
Additional Information: fever, body aches, cough, difficulty breathing
Medical Record Number: ______________________
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Instructions: weak, dry cough, feverish
Acting tips: act very ill, unable to breathe
Dx: ILI
EMS Information:
Pt Number: 38
Patient Information:
Name: Tomiga, Brad
Age: 30 Gender: M
BP: 122/72 HR: 64 RR: 16 Temp: 102F
Wt (Kg): 80
Chief Complaint: flu-like sx.
Hx: Deafness
Medical Center Information:
Other: no chronic illnesses
Additional Information: fever, body aches, cough
Medical Record Number: ______________________
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Instructions: weak, dry cough, feverish
Acting tips: act mildly ill, slightly achy, able to breathe but light dry cough
Dx: ILI
EMS Information:
Pt Number: 39
Patient Information:
Name: Major, Linette
Age: 27 Gender: F
BP: 100/60 HR: 90 RR: 16 Temp: 101F
Wt (Kg): 80
Chief Complaint: flu-like sx., muscle aches, dry cough
Hx: None
Medical Center Information:
Other: no chronic illnesses
Additional Information: fever, body aches, cough
Medical Record Number: ______________________
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Instructions: weak, dry cough, feverish
Acting tips: act mildly ill, slightly achy, able to breathe but light dry cough
Dx: ILI
EMS Information:
Pt Number: 40
Patient Information:
Name: Farrel, Eliza
Age: 50 Gender: F
BP: 96/52 HR: 101 RR: 20 Temp: 99F
Wt (Kg): 86
Chief Complaint: flu-like sx.
Hx: None
Medical Center Information:
Other: Traveled to Italy, arrived in the United States 5 days ago, became ill 1 day ago, no layovers
Additional Information: fatigue, cough, emotionally agitated
Medical Record Number: ______________________
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Instructions: weak, dry cough, feverish
Acting tips: act mildly ill, slightly achy, able to breathe but light dry cough. State you are worried that you got MERS from "the middle eastern people on the plane". Say you have heard about ZMAPP meds and demand you be given some.
Dx: ILI
EMS Information:
Pt Number: 41
Patient Information:
Name: Al-Ghamdi, Samiri
Age: 68 Gender: M
BP: 120/80 HR: 118 RR: 32 Temp: 101F
Wt (Kg): 90
Chief Complaint: worsening flu-like sx, developing pneumonia
Hx: ESRD, on dialysis
Medical Center Information:
Other: retired, traveled to Arizona
Additional Information: fever, body aches, cough
Medical Record Number: ______________________
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Instructions: weak, dry cough, feverish
Acting tips: act very ill, unable to breathe.
Dx: ILI
EMS Information:
Pt Number: 42
Patient Information:
Name: Atwi, Moussa
Age: 42 Gender: F
BP: 114/78 HR: 120 RR: 22 Temp: 102F
Wt (Kg): 62
Chief Complaint: flu-like sx.
Hx: None
Medical Center Information:
Other: no chronic illnesses, no recent travel
Additional Information: fever, body aches, cough
Medical Record Number: ______________________
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Instructions: weak, dry cough, feverish
Acting tips: act mildly ill, slightly achy, able to breathe but light dry cough
Dx: ILI
EMS Information:
Pt Number: 43
Patient Information:
Name: Oh, Sarah
Age: 37 Gender: F
BP: 144/82 HR: 80 RR: 16 Temp: 101F
Wt (Kg): 67
Chief Complaint: flu-like sx., muscle aches, dry cough
Hx: CAD, hx stroke, DM, HTN
Medical Center Information:
Other: no chronic illnesses
Additional Information: fever, body aches, cough
Medical Record Number: ______________________
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Instructions: weak, dry cough, feverish
Acting tips: act mildly ill, slightly achy, able to breathe but light dry cough
Dx: ILI
EMS Information:
Pt Number: 44
Patient Information:
Name: Wheeler, Kelly
Age: 16 Gender: F
BP: 138/68 HR: 75 RR: 12 Temp: 102F
Wt (Kg): 69
Chief Complaint: fever, cough, SOB
Hx: Spina bifida, VPS
Medical Center Information:
Other: hyepertensive, obese
Additional Information: extreme fatigue
Medical Record Number: ______________________
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Instructions: unable to breath tired
Acting tips: act very weak and ill, unable to breathe fully
Dx: ILI
EMS Information:
Pt Number: 45
Patient Information:
Name: Brown, Theo
Age: 6 Gender: M
BP: 110/76 HR: 80 RR: 16 Temp: 102F
Wt (Kg): 27
Chief Complaint: flu-like sx.
Hx: None
Medical Center Information:
Other: hist. of asthma, elementary school student
Additional Information: fever, body aches, cough, difficulty breathing
Medical Record Number: ______________________
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Instructions: weak, dry cough, feverish
Acting tips: act very ill, unable to breathe
Dx: ILI
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