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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