This form is intended to assist NTRAC in developing CPR transport protocols. Please fill out this form completely after each decision to transport a patient to the hospital or call death on scene following a cardiac arrest. Do not place any protected health information on this form. This information will be kept secure and used for process improvement and data collection only.
|Q6||Reason for cardiac arrest|
Treatment Prior To Arrival
|Q8||Signs and symptoms incompatible with life|
|Q10||If yes, who iniated CPR|
|Q18||If yes, reason for transport|