FEMA EXERCISE ACTOR BRIEFING
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EXERCISE “VICTIM”
SYMPTOMATOLOGY TAG
Date of Exercise: [MM/DD/YYYY] Casualty #: ________
VISIBLE SYMPTOMS:
Excited and anxious
Vomiting
Pinpointed pupils
PHYSICAL FINDINGS:
Resp: 26
Pulse: 64
BP: 120/80
OTHER PATIENT INFORMATION:
Aware; knows name and location
Able to walk
Actor Exercise Assessment Form
Please complete the following questions at the conclusion of the exercise. This card is to be turned in at the checkout station at the exercise site. Please be accurate with your answers. Your cooperation is important and is appreciated.
Field Assessment and Treatment:
1. Initial Contact and Triage
a. How long did it take response personnel to contact you? _______
b. How long did it take response personnel to begin decontaminating you? ____________
c. Were you examined on the scene more than once? £ Yes £ No
d. Whom did you talk to, or whom were you assessed by (list all)? £ Fire £ EMS £ Police £ Other ______________
e. If you received a multicolored triage tag, what was the BOTTOM color when it was first given to you? £ Green £ Yellow £ Red £ Black £ Never received a tag
f. What actions did response personnel take as a result of their assessment of your condition?
________________________________________________________
________________________________________________________
________________________________________________________
2. Treatment:
a. If conscious, did someone explain your treatment? £ Yes £ No
b. If conscious, were you given clear instructions? £ Yes £ No
c. What treatment was given?
________________________________________________________
________________________________________________________
________________________________________________________
3. Did you observe any outstanding actions among the response personnel you observed?
________________________________________________________
________________________________________________________
________________________________________________________
Hospital (if applicable)
1. Which hospital did you go to? ________________________________
2. Once at the hospital, how long was it until someone examined you?
£ Less than 5 minutes £ 5 minutes £ 10 minutes £ 15 minutes £ Over 15 minutes £ I was never examined at the hospital
Exercise Design: Did you observe any problems during your participation in the exercise? What improvements would you suggest?
________________________________________________________
________________________________________________________
________________________________________________________
DO NOT LOSE THIS CARD!
DO NOT LET ANYONE TAKE THIS CARD FROM YOU!
A ride has been scheduled to return you to the exercise site. If you are not picked up, please call: [Insert number].
Thank you for your participation!
EXERCISE “VICTIM”
SYMPTOMATOLOGY TAG
Date of Exercise: [MM/DD/YYYY] Casualty #: ________
VISIBLE SYMPTOMS:
Worried
Concerned and frantic Complaining of being hot
PHYSICAL FINDINGS:
Resp: 14
Pulse: 68
BP: 118/72
OTHER PATIENT INFORMATION:
Aware; knows name, location, and time but slow to respond
Able to follow directions
Able to walk
Actor Exercise Assessment Form
Please complete the following questions at the conclusion of the exercise. This card is to be turned in at the checkout station at the exercise site. Please be accurate with your answers. Your cooperation is important and is appreciated.
Field Assessment and Treatment:
1. Initial Contact and Triage
a. How long did it take response personnel to contact you? _______
b. How long did it take response personnel to begin decontaminating you? ____________
c. Were you examined on the scene more than once? £ Yes £ No
d. Whom did you talk to, or whom were you assessed by (list all)? £ Fire £ EMS £ Police £ Other ______________
e. If you received a multicolored triage tag, what was the BOTTOM color when it was first given to you? £ Green £ Yellow £ Red £ Black £ Never received a tag
f. What actions did response personnel take as a result of their assessment of your condition?
________________________________________________________
________________________________________________________
________________________________________________________
2. Treatment:
a. If conscious, did someone explain your treatment? £ Yes £ No
b. If conscious, were you given clear instructions? £ Yes £ No
c. What treatment was given?
________________________________________________________
________________________________________________________
________________________________________________________
3. Did you observe any outstanding actions among the response personnel you observed?
________________________________________________________
________________________________________________________
________________________________________________________
Hospital (if applicable)
1. Which hospital did you go to? ________________________________
2. Once at the hospital, how long was it until someone examined you?
£ Less than 5 minutes £ 5 minutes £ 10 minutes £ 15 minutes £ Over 15 minutes £ I was never examined at the hospital
Exercise Design: Did you observe any problems during your participation in the exercise? What improvements would you suggest?
________________________________________________________
________________________________________________________
________________________________________________________
DO NOT LOSE THIS CARD!
DO NOT LET ANYONE TAKE THIS CARD FROM YOU!
A ride has been scheduled to return you to the exercise site. If you are not picked up, please call: [Insert number].
Thank you for your participation!
EXERCISE “VICTIM”
SYMPTOMATOLOGY TAG
Date of Exercise: [MM/DD/YYYY] Casualty #: ________
VISIBLE SYMPTOMS:
Complaining of headache Lightheadedness
Broken bones
PHYSICAL FINDINGS:
Resp: 18
Pulse: 120
BP: 120/80
OTHER PATIENT INFORMATION:
Aware; knows name and location
Actor Exercise Assessment Form
Please complete the following questions at the conclusion of the exercise. This card is to be turned in at the checkout station at the exercise site. Please be accurate with your answers. Your cooperation is important and is appreciated.
Field Assessment and Treatment:
1. Initial Contact and Triage
a. How long did it take response personnel to contact you? _______
b. How long did it take response personnel to begin decontaminating you? ____________
c. Were you examined on the scene more than once? £ Yes £ No
d. Whom did you talk to, or whom were you assessed by (list all)? £ Fire £ EMS £ Police £ Other ______________
e. If you received a multicolored triage tag, what was the BOTTOM color when it was first given to you? £ Green £ Yellow £ Red £ Black £ Never received a tag
f. What actions did response personnel take as a result of their assessment of your condition?
________________________________________________________
________________________________________________________
________________________________________________________
2. Treatment:
a. If conscious, did someone explain your treatment? £ Yes £ No
b. If conscious, were you given clear instructions? £ Yes £ No
c. What treatment was given?
________________________________________________________
________________________________________________________
________________________________________________________
3. Did you observe any outstanding actions among the response personnel you observed?
________________________________________________________
________________________________________________________
________________________________________________________
Hospital (if applicable)
1. Which hospital did you go to? ________________________________
2. Once at the hospital, how long was it until someone examined you?
£ Less than 5 minutes £ 5 minutes £ 10 minutes £ 15 minutes £ Over 15 minutes £ I was never examined at the hospital
Exercise Design: Did you observe any problems during your participation in the exercise? What improvements would you suggest?
________________________________________________________
________________________________________________________
________________________________________________________
DO NOT LOSE THIS CARD!
DO NOT LET ANYONE TAKE THIS CARD FROM YOU!
A ride has been scheduled to return you to the exercise site. If you are not picked up, please call: [Insert number].
Thank you for your participation!
EXERCISE “VICTIM”
SYMPTOMATOLOGY TAG
Date of Exercise: [MM/DD/YYYY] Casualty #: ________
VISIBLE SYMPTOMS:
Muscle twitching
Nausea
PHYSICAL FINDINGS:
Resp: 28
Pulse: 84
BP: 110/70
OTHER PATIENT INFORMATION:
Drowsy
Confused
Unsteady on feet
Actor Exercise Assessment Form
Please complete the following questions at the conclusion of the exercise. This card is to be turned in at the checkout station at the exercise site. Please be accurate with your answers. Your cooperation is important and is appreciated.
Field Assessment and Treatment:
1. Initial Contact and Triage
a. How long did it take response personnel to contact you? _______
b. How long did it take response personnel to begin decontaminating you? ____________
c. Were you examined on the scene more than once? £ Yes £ No
d. Whom did you talk to, or whom were you assessed by (list all)? £ Fire £ EMS £ Police £ Other ______________
e. If you received a multicolored triage tag, what was the BOTTOM color when it was first given to you? £ Green £ Yellow £ Red £ Black £ Never received a tag
f. What actions did response personnel take as a result of their assessment of your condition?
________________________________________________________
________________________________________________________
________________________________________________________
2. Treatment:
a. If conscious, did someone explain your treatment? £ Yes £ No
b. If conscious, were you given clear instructions? £ Yes £ No
c. What treatment was given?
________________________________________________________
________________________________________________________
________________________________________________________
3. Did you observe any outstanding actions among the response personnel you observed?
________________________________________________________
________________________________________________________
________________________________________________________
Hospital (if applicable)
1. Which hospital did you go to? ________________________________
2. Once at the hospital, how long was it until someone examined you?
£ Less than 5 minutes £ 5 minutes £ 10 minutes £ 15 minutes £ Over 15 minutes £ I was never examined at the hospital
Exercise Design: Did you observe any problems during your participation in the exercise? What improvements would you suggest?
________________________________________________________
________________________________________________________
________________________________________________________
DO NOT LOSE THIS CARD!
DO NOT LET ANYONE TAKE THIS CARD FROM YOU!
A ride has been scheduled to return you to the exercise site. If you are not picked up, please call: [Insert number].
Thank you for your participation!
EXERCISE “VICTIM”
SYMPTOMATOLOGY TAG
Date of Exercise: [MM/DD/YYYY] Casualty #: ________
VISIBLE SYMPTOMS:
Excessive sweating
Disorientation
Drooling
PHYSICAL FINDINGS:
Resp: 22
Pulse: 88
BP: 124/82
OTHER PATIENT INFORMATION:
Aware; knows name
Able to walk
Actor Exercise Assessment Form
Please complete the following questions at the conclusion of the exercise. This card is to be turned in at the checkout station at the exercise site. Please be accurate with your answers. Your cooperation is important and is appreciated.
Field Assessment and Treatment:
1. Initial Contact and Triage
a. How long did it take response personnel to contact you? _______
b. How long did it take response personnel to begin decontaminating you? ____________
c. Were you examined on the scene more than once? £ Yes £ No
d. Whom did you talk to, or whom were you assessed by (list all)? £ Fire £ EMS £ Police £ Other ______________
e. If you received a multicolored triage tag, what was the BOTTOM color when it was first given to you? £ Green £ Yellow £ Red £ Black £ Never received a tag
f. What actions did response personnel take as a result of their assessment of your condition?
________________________________________________________
________________________________________________________
________________________________________________________
2. Treatment:
a. If conscious, did someone explain your treatment? £ Yes £ No
b. If conscious, were you given clear instructions? £ Yes £ No
c. What treatment was given?
________________________________________________________
________________________________________________________
________________________________________________________
3. Did you observe any outstanding actions among the response personnel you observed?
________________________________________________________
________________________________________________________
________________________________________________________
Hospital (if applicable)
1. Which hospital did you go to? ________________________________
2. Once at the hospital, how long was it until someone examined you?
£ Less than 5 minutes £ 5 minutes £ 10 minutes £ 15 minutes £ Over 15 minutes £ I was never examined at the hospital
Exercise Design: Did you observe any problems during your participation in the exercise? What improvements would you suggest?
________________________________________________________
________________________________________________________
________________________________________________________
DO NOT LOSE THIS CARD!
DO NOT LET ANYONE TAKE THIS CARD FROM YOU!
A ride has been scheduled to return you to the exercise site. If you are not picked up, please call: [Insert number].
Thank you for your participation!
EXERCISE “VICTIM”
SYMPTOMATOLOGY TAG
Date of Exercise: [MM/DD/YYYY] Casualty #: ________
VISIBLE SYMPTOMS:
Lightheaded
PHYSICAL FINDINGS:
Resp: 18
Pulse: 70
BP: 110/60
OTHER PATIENT INFORMATION:
Aware; knows name and location
Unable to walk
Actor Exercise Assessment Form
Please complete the following questions at the conclusion of the exercise. This card is to be turned in at the checkout station at the exercise site. Please be accurate with your answers. Your cooperation is important and is appreciated.
Field Assessment and Treatment:
1. Initial Contact and Triage
a. How long did it take response personnel to contact you? _______
b. How long did it take response personnel to begin decontaminating you? ____________
c. Were you examined on the scene more than once? £ Yes £ No
d. Whom did you talk to, or whom were you assessed by (list all)? £ Fire £ EMS £ Police £ Other ______________
e. If you received a multicolored triage tag, what was the BOTTOM color when it was first given to you? £ Green £ Yellow £ Red £ Black £ Never received a tag
f. What actions did response personnel take as a result of their assessment of your condition?
________________________________________________________
________________________________________________________
________________________________________________________
2. Treatment:
a. If conscious, did someone explain your treatment? £ Yes £ No
b. If conscious, were you given clear instructions? £ Yes £ No
c. What treatment was given?
________________________________________________________
________________________________________________________
________________________________________________________
3. Did you observe any outstanding actions among the response personnel you observed?
________________________________________________________
________________________________________________________
________________________________________________________
Hospital (if applicable)
1. Which hospital did you go to? ________________________________
2. Once at the hospital, how long was it until someone examined you?
£ Less than 5 minutes £ 5 minutes £ 10 minutes £ 15 minutes £ Over 15 minutes £ I was never examined at the hospital
Exercise Design: Did you observe any problems during your participation in the exercise? What improvements would you suggest?
________________________________________________________
________________________________________________________
________________________________________________________
DO NOT LOSE THIS CARD!
DO NOT LET ANYONE TAKE THIS CARD FROM YOU!
A ride has been scheduled to return you to the exercise site. If you are not picked up, please call: [Insert number].
Thank you for your participation!
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