You are welcome to adapt this chart for your own purposes

 
Casualty's name:                                         First Aider:

Date:             Times of readings:

          

 LEVEL OF RESPONSE

Eyes

 Open spontaneously           
Open to speech          
Open to pain          
No response          

Speech

 Responds sensibly to questions          
Seems confused          
Uses inappropriate words          
Noises          
No response          

Movement

 Obeys commands          
Points to pain          
Moves away from pain          
Bends in response to pain          
Stretches in response to pain          
No response          

 PULSE
Speed Number of beats in 1 minute          
Strength Write if weak (W), strong (S) or normal (N)          
Rhythm Regular (R) or irregular (I)          

 BREATHING
Speed Number of breaths in 1 minute          
Noise Noisy (N) or quiet (Q)          
Difficulty Easy (E) or difficult (D)          
Rhythm Regular (R) or irregular (I)          
Depth Deep (D), shallow (S) or normal (N)          

 

Date this page was lasted edited: 08/04/2004

 

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