MIRF REPORT

Request:
Medical

Campus:
Vista

Location/Building:
[68]

Date of Incident:
September 17, 2023

Time of Incident:
11:20 AM

Number of Patients for this Incident:
[75]

List Patient(s) Name, Age, Parent/Guardian (if under 18),… :

Theresa Worthy: 60s

Describe Medical Event:

Theresa experienced a mechanical fall after tripping on a play center in the children’s ministry. Theresa fell to the ground and struck her left shoulder on the wall. Patient denied any loss of consciousness. Physical exam revealed tenderness to the left shoulder with no visible signs of trauma. Patient displayed regular use of the affected extremity with complete range of motion.

Actions Taken by Team Members:
[79]

Number of NCSM Team Members Involved:
[81]

List Name(s) of NCSM Team Members Involved:

Justin Murphy
Gabriel Robinson
Kim Ellrott

Was medical attention accepted?”:
Yes

Medical attention was refused by (name and relationship to… :

Was 911 emergency service called?:
No

Was patient transported via 911 emergency services?:
No

What hospital was victim transported to?:

NCS team lead:
[249]


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