MIRF REPORT
Request:
Fell off play equipment
Campus:
Fallbrook
Location/Building:
[68]
Date of Incident:
May 9, 2026
Time of Incident:
6:35 PM
Number of Patients for this Incident:
[75]
List Patient(s) Name, Age, Parent/Guardian (if under 18),… :
Russell dubrock 4years 6 months dad jeff DuBrock
Describe Medical Event:
Fell off play structure ladder 1in bruise above right eye no open skin.
Actions Taken by Team Members:
[79]
Number of NCSM Team Members Involved:
[81]
List Name(s) of NCSM Team Members Involved:
Zach Heinemann
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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