MIRF REPORT
Request:
Medical
Campus:
San Marcos/Escondido
Location/Building:
[68]
Date of Incident:
May 2, 2022
Time of Incident:
10:00 AM
Number of Patients for this Incident:
[75]
List Patient(s) Name, Age, Parent/Guardian (if under 18),… :
Adam Smith (DOB 9/4/19)
Dad: Alex Smith (760) 525-1355
Mom: Rosa Smith (760) 330-7688
Describe Medical Event:
Child was being hugged by another child, when the other child let go, Adam fell back and hit his head on the floor causing a large bump to the back of his head.
Evaluated, ice pack provided, and child’s father was advised to seek further medical attention if desired/needed.
Actions Taken by Team Members:
[79]
Number of NCSM Team Members Involved:
[81]
List Name(s) of NCSM Team Members Involved:
Beckie La Cart
Aaron Via
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?:
Palomar
NCS team lead:
[249]
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