MIRF REPORT
Request:
Medical
Campus:
Carlsbad
Location/Building:
[68]
Date of Incident:
July 28, 2019
Time of Incident:
11:30 AM
Number of Patients for this Incident:
[75]
List Patient(s) Name, Age, Parent/Guardian (if under 18),… :
Patient 1of 1: Alex Bushma
Age: 12
Parent: Ada Katya 760-672-4613
Describe Medical Event:
Patient pinched right middle finger while folding a folding chair. Bruising evident, good motion, good sensation in finger, no deformity except for minor depression at first knuckle. Capillary refill was normal. Mother was in service and was notified and responded right away. Ice applied and patient returned to Pipeline class. Mother advised to monitor and seek additional care if necessary.
Actions Taken by Team Members:
[79]
Number of NCSM Team Members Involved:
[81]
List Name(s) of NCSM Team Members Involved:
Jim Kline
Greg Cantor (lead)
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]
If any revisions or updates are needed to be made to this incident, complete the form below.
Please select a valid form