Global Registry on Incendiary Weapons (Supplemental Data)
Thank you for continuing onto this form. The following fields are optional, but can provide valuable supplementary data. We understand that you may be limited by time or resources. If you are unable to answer a field, you may leave it blank or fill with "NA".

Only complete this form after you have completed the original module: https://forms.gle/vyKFKSXNMcwjxArE6
Please use the same unique patient identifier from the original module to correctly link data. 

Contact our team at explosiveweaponstraumacare@gmail.com for further information on this study or with any questions pertaining filling out this form. 
IRB exemption approval: #STUDY00021130

Thank you kindly for contributing. 
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Unique Patient Data Identifier: 

Please enter your initials, followed by today's date (mmdd), and the current time.

Ie: My name is John Doe, it is August 22nd at 3:12 pm (15:12) = JD08221512

Note: Please use the same unique patient identifier from the original form to correctly link data. 
Prehospital Data, if available. 
How was the patient transported from the point of injury to the health facility? (Select all that apply)
How long did it take for the patient to arrive at the health facility from the time of injury? (in hours)
Patient Physiology
This section queries about patient status and vitals. Please complete any fields you are able to. 

If the information in this section is not available to you or feasible to obtain, leave blank.
If available, what was the patient's GCS (Glascow Coma Scale, 3-15) on arrival?
Patient blood pressure on arrival (SBP/DBP), if available.
Patient HR on arrival, if available.
Patient oxygen saturation on arrival (%), if available. 
Patient Hemoglobin, if available. 
Injury Severity Score (1-75), if available. 
Patient Management and Outcomes
This section queriers about patient care interventions and outcomes. Please complete any fields you are able to.

If the information in this section is not available to you or feasible to obtain, you may proceed to form submission. 
Did the patient require mechanical ventilation?
Clear selection
Did the patient require blood transfusion?
Clear selection
If yes, how many units of blood product were given?
Did the patient undergo any surgical procedures at your facility?
Clear selection
If yes, how many procedures did they undergo at your facility?
If yes, provide a description of procedures performed and the timeframe from time of injury (if available). 
Was this patient admitted to the ICU?
Clear selection
Did the patient undergo an amputation?
Clear selection
What was the outcome for this patient?
Clear selection
If the patient outcomes was transferred to another facility or discharged, how long were they admitted at your facility (Days or hours)? If transferred, where were they sent?
Did this patient sustain any injuries that will result in a long-term functional disability? This includes loss of vision or sight, loss of hearing, paresis, paralysis, aphasia, amputation, etc. 
Clear selection
If yes, please describe which long-term functional disabilities are present. Check all the apply. 
If the patient outcome was death, what was the suspected cause? (ie: bleeding, brain death, respiratory failure, etc)
Clear selection
If the patient outcome was death, how long after the initial injury did the patient die? Estimate to the best of your ability. Indicate weeks, days, or hours. 
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