| | 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 | | | |
| Q17 | If yes, reason for transport | | | | |
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