1.5. Name of ship
1.6. Call sign
1.7. Date and time (GMT/UTC)
1.8. Course, speed, position
1.5.1. Port of destination is … and is … hours/days away
1.5.2. Nearest port is … and is … hours/days away
1.5.3. Other possible port is … and is … hours/days away
1.6 Local weather (if relevant)
2. Routine particulars about the patient
2.1. Surname of casualty
2.2. Other names of casualty
2.3. Rank
2.4. Job on board (occupation)
2.5. Age and sex
3. Particulars of the illness
3.1. Exactly how did the injuries arise?
3.2. When did the injuries occur?
3.3. What does the patient complain of? (List the complaints in order of importance or severity)
3.4. Give any important past illness/operations/injuries.
3.5. List all medicines/tablets/drugs that the patient was taking before the present injury began and indicate the dose(s) and how often taken
3.6. Has the patient been taking any alcohol or do you think he is taking non-medicinal drugs?
3.7. Does the patient remember everything that happened, or did he lose consciousness even for a very short time?
3.8. If he lost consciousness, describe when, for how long, and the degree of unconsciousness.
4. Results of examination of the ill person
4.1. Temperature, pulse and respiration
4.2. Describe the general condition of the patient
4.3. List what you believe to be the patient’s injuries in order of importance an severity
4.4. Did the patient lose any blood? If so, how much?
4.5. What tests have you done and with what result (urine, other)?
5. Treatment
5.1. Describe the first aid and other treatment you have carried out since the injuries occurred.
5.2. List ALL the medicines/tablets/drugs that the patient has taken or been given since the illness began and indicate the doses and the times given or how often given. Do not use term “standard antibiotic treatment”. Name the antibiotic given.
5.3. How has the patient responded to the treatment given?
6. Problems
6.1. What problems are worrying you now?
6.2. What do you think you need to be advised on?