Tourniquet On Person- USE REPORT
SUBMIT FOR EACH TOURNIQUET USE
Agency & Case-Run # *
Your answer
Officer's Name: *
Your answer
Officer's email and contact phone number: *
Your answer
Date of Call *
MM
/
DD
/
YYYY
Transporting Ambulance AND Receiving Hospital? *
Your answer
Time of Call *
Time
:
Time of Tourniquet Application *
Time
:
Tourniquet used was On Your Person (gun belt, boot, vest, other) *
If no Tourniquet On Person was the tourniquet from an aid bag or other location? *
Location of Tourniquet Application *
Required
Patient Gender *
Required
Patient Age (Years old) *
Your answer
Type and Cause of Injury? (Gunshot, Laceration, Stabbing, Etc.) *
Your answer
Did Body Cam or Dash Cam capture the tourniquet application? *
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