Form 1050

1050 General Guidlines

  • All lines must be filled out or circled on each 1050, with the exception of #15. Do not circle multiple options.
  • If there is no applicable information for the line, write N/A. No dashes or x’s
  • Write legibly.
  • Try to refrain from writing notes in margins. If absolutely necessary, leave the upper left corner blank for dispatch’s use later.
  • Always get your 1050 checked by a second year or higher PRO patroller once finished. They must legibly initial the 1050.
  • Always turn your 1050 into the bump box before the end of the day.
  • UTO (unable to obtain): use this abbreviation when you physically cannot get information; i.e., patient is unconscious, low A&O and cannot remember information, patient refuses information or if patient is unable to sign due to injury. If applicable, give an explanation for specific UTO’s.
  • DNO (Did not obtain): use this if you forgot to ask for the information. This is not an acceptable alternative for information you do not want to ask for.
  • If a mistake is made, make a single line through and initial beside it. Do not scribble words out.
  • If you are having difficulty getting patient information, you can call the season pass office with patient’s name for additional information—wait to write UTO.

 

Specifics:

  1. Once you’ve released or transferred the patient, call dispatch (3445) to give them the patient’s name, and they’ll give you the dispatch time. Please call as soon as possible, and do not use military time.
  2. Try to get a phone number to reach the patient while on the hill (cell), otherwise any number is acceptable. If it is a minor without a cell, parent’s number is preferred.
  3. Ask for the email. If it is a minor, put parent’s email. If patient does not have an email address, put “none stated”
  4. Must have an occupation. If patient states “student,” ask for parent’s occupation. If patient is retired or unemployed, ask for prior occupation. If patient is a homemaker, ask for partner’s occupation. None or N/A is not acceptable.
  5. If a “common” incident on a ski run in ski gear, write N/A. This would only be applicable if the incident was a slip and fall.
  6. If there was a prior injury, note what and when it was in the complaint section.
  7. If in a terrain park, ask for number of times on the feature, not number of times on the trail.
  8. Write the patient’s actual complaint. Do not diagnose the injury, but be as specific as possible. Identify the body part and a descriptor; i.e., left arm abrasion, right lower leg deformity, lip laceration.
  9. If the patient does not take medication, write “none stated.”
  10. This should be in the patient’s own words, in quotations. Try to get a complete description, in complete sentences. If patient is a child, write their description, not the parent’s. If patient is unconscious/low A&O, do not write witnesses’ description—note UTO and patient’s condition.
  11. This line is always signed. If patient is a minor, they cannot sign—you must have a guardian sign. If guardian is contacted via phone, write parent’s name, and note that you contacted via phone. If patient unable to sign, note UTO and reason. Race team coaches can sign for minors in their care.
  12. This must be the actual location, as printed on the map, where the injury occurred.

Differentiate between Upper/Lower runs, if listed as separate runs on the map.

If the injury occurred in a terrain park, note which feature—as specific as possible. If the patient contact took place at a different location then the injury, first note injury location, then note patient contact location.

  1. If this is a collision, you must also fill out applicable lines on the back of the 1050, and the orange collision paperwork (and exchange with parties involved). If the other party has left the scene, note this. You can call for an additional patroller to help with paperwork, especially if you are not familiar with it.
  2. Write “exam,” not assess. Concisely describe treatment/transport/transfer of care. If the scene was a TAR (Treat and Release) or FAR (First Aid Refusal), specifically note this. If patient refused a specific action, such as a splint or transport via ambulance, note specifically.
  3. Patient/Patient’s guardian must sign here if FAR, or if patient refused a specific action with TAR or transport.
  4. Circle applicable trail where injury occurred. If injury happened in the terrain park on a feature, circle the orange oval. If the injury occurred on a terrain park run, but not on a feature, circle the applicable trail designation, not the orange oval. If this happened on Epic Race, it is also considered an orange oval. All trees/glades are black diamonds. If injury did not occur on a run, such as a slip/fall or a fall at the top of a lift, cross out all options and write N/A.
  5. Injury level: 1 is catastrophic, 4 is a very simple treat and release.
  6. A.I. is Accident Investigation—Circle if a scene requires official investigation. Most calls will not, and those that do will have a supervisor or AI team member deciding an investigation is necessary. If you are unsure, leave blank and ask a senior patroller. SRS stands for ski and ride school; circle if applicable.
  7. Race team is included in ski school. If you write the instructor’s name here, you do not need to list them as a potential witness. Get the instructor’s full name, and if the instructor is not on scene, i.e., left with class, incident happened earlier, call ski school to obtain name.
  8. If not a collision, do not circle yes or no—just put N/A on the line. Make sure line 12 on the front of the 1050 was filled out, and that collision paperwork is filled out and lower sections exchanged, with the top section attached to the 1050.
  9. On most calls, witness information is not needed. You will never take witness statements—only contact information. If the patient is A&Ox3 or worse, positive loss of consciousness, or too young to relay event, then any witness information is acceptable. Third party (not associated with patient) is always best, but in the previous examples, a family member or friend is fine. If the patient remembers the event but there is a possibility of an investigation, third party witnesses are strongly advised. If you suspect witnesses are needed, you can call for additional patrollers to help with paperwork, particularly if you are not familiar with the witness paperwork.
  10. List the full name of all patrollers on the scene. If you were the one to fill out the 1050, sign the line behind your name as well. All nationals should write first and last name—no “National Smith.”