Austraumaplan: Final November 2011

Appendix 5 - Affected Jurisdictional Template

Page last updated: 30 November 2011

Affected Jurisdiction template

Exact location of incident
Location of health response command
Location of primary health response
Site:

Local Hospital(s):

Major referral Hospital(s):

Type of Incident
Hazards/ Special considerations
Number of casualties

Estimated or confirmed

Cat 1 (Red)

Adult:

Paed:

Cat 2 (Yellow)

Adult:

Paed:

Cat 3 (Green)

Adult:

Paed:

Deceased

Adult:

Paed:

Special Requirements

Not immediately available

Response Teams: Pre-HospitalResponse Teams HospitalTransportEquip
Emergency Ambulance Officers/Paramedics:

Patient Transport Officers:

Ambulance Operational Managers – Paramedic:

Ambulance
General Purpose:

Medical:

 
 
 
 
 
Emergency

Surgical/
Theatre

Intensive care

Burns

Paediatrics
MedicalNursing
 
 
 
 
 
 

Staffed Bed Available now
ICU
Ventilated
ICU
Non-ventilated
Burns
<25%
Burns
>25%
General Ward
AdultLocal: Local: Local: Local: Local:
State:State:State:State:State:
PaediatricLocal: Local: Local: Local: Local:
State:State:State:State:State:
Staffed Bed Available within 24 hours
ICU
Ventilated
ICU
Non-ventilated
Burns
<25%
Burns
>25%
General Ward
AdultLocal: Local: Local: Local: Local:
State:State:State:State:State:
PaediatricLocal: Local: Local: Local: Local:
State:State:State:State:State:

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically ill/injured patients.

ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated, without access to ventilation.