HICS 254 - DISASTER VICTIM/PATIENT TRACKING

PURPOSE:
The HICS 254 Disaster Victim/Patient Tracking records the triage, treatment, and disposition of victims/patients of the event seeking medical attention

NOTES
The form is completed upon arrival of the first patient and updated periodically. Copies of the form are sent to the Planning Section Patient Tracking Manager each hour or as arranged, and at the end of each operational period until disposition of the last victim(s) are known. If additional pages are needed, use another HICS 254 and repaginate as needed.

1. Incident Name:
Enter the name assigned to the incident.

2. Operational Period
Enter the start date (mm/dd/yyyy) and time (24-hour clock) and end date and time for the operational period to which the form applies.

3. Area
Enter the triage or specific treatment area (e.g., Triage, Immediate Treatment Area).

Field Tag Number
Enter field triage tag number.

Medical Record Number
Enter hospital medical record number if available.

Name
Enter the full name of victim/patient.

Sex
Enter sex: M for male, F for female, or leave blank.

DOB / Age
Enter date of birth and age, numbers only.

Triage Category
Enter the triage category assigned to patient:
Immediate - Delayed - Minor - Expectant - Expired

Location
Enter location of procedure.

Disposition
Enter the disposition category:
(D) Discharge (A) Admit (S) Surgery (T) Transfer (M) Morgue

Disposition Time
Enter the disposition Time, 24 hour clock.

Prepared by
Enter the name of the person preparing the form. Since this is a radio delivered form, a typed name is same as signature. Enter date (m/d/y), time prepared (24-hour clock), and Facility.

More Information

You can save your completed HTML to a text file. This will allow you to reload the ICS 254 with ALL entered form data. You do this prior to submitting the form. Then you can open a new 254 and load the saved HTML form data. NOTE: Date and Times will be the previous, so change if needed. This is much like using FireFox and the addon Formlet. It will save the info as a text file with the Date and Time as a file name. Now you can use any browser, save your form, (as many versions as you like), and then re-populate.

This form also allows for pasting data from a spreadsheet with TAB delineation. You would create a spreadsheet to MATCH the HTML template for data in "3. Area". Do not exceed the data entry box input lengths or the info will not be seen properly if printed. You can do 10 columns and up to 10 rows of data. It is suggested you experiment and test to understand how this works. Once mastered it can be a time saver in the field for data entry.

NOTE on printing.

Printing this form is dependent upon your selected printer and its settings. Various Web Browsers and and their viewing sizes are not all the same. Printing from a browsers print function may be different from the operating systems default print mode. Select what works for you, for both printing and viewing. You may print direct to the printer as a HTML or save as a PDF then print the PDF. In some instances Landscape mode may print better than Portrait.

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Copy and Paste Data From Spreadsheet

Copy the data from the spreadsheet, then click the button "Parse Data"
TAB delineation and entry data needs to not exceed HTML entry box input lengths.
10 columns and up to 10 rows of information.

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HICS 251 – FACILITY SYSTEM STATUS REPORT
  HICS - Hospital Incident Command System



   1. Incident Name   {var Incident_Name}

      Page {var Page}  Of   {var Page1}    
  
  2. Operational Period    (#):   {var OpNum}

         Date From:   {var DateFrom}    To:  {var DateTo}

         Time From:   {var TimeFrom}       To:   {var TimeTo}
  3. Name of Department / Unit Reporting Status Below    {var Department}       Contact Number: {var Contactnumber}
4. System 5. Status 6. Comments If not fully functional, give location, reason, and estimated time/resources for necessary repair. Identify who reported or inspected.
4a. Power {var DMa} {var Commenta}
4b. Lighting {var DMb} {var Commentb}
4c. Water {var DMc} {var Commentc}
4d. Sewage/Toilets {var DMd} {var Commentd}
4e. Nurse Call System {var DMe} {var Commente}
4f. Medical Gases / Oxygen {var DMf} {var Commentf}
4g. Communications IT system, telephones, pagers {var DMg} {var Commentg}

7. Remarks (Cracked walls, broken glass, falling light fixtures, etc.)

{var Remarks}

  8. Prepared By:   {var PreparedName}   Date / Time: {var DateTime}   FACILITY :  {var Facility}                  

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