Preview
FILED: YATES COUNTY CLERK 09/14/2023 10:47 AM INDEX NO. 2023-5239
NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 09/14/2023
EXHIBIT B
FILED: YATES COUNTY CLERK 09/14/2023 10:47 AM INDEX NO. 2023-5239
NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 09/14/2023
10-29.-2022 13:55 .. (412) 569-7163 ZdLL De t a 59s t ems 1/4
.
PRID: 79000257, Page 1 of 4 Patient Name:
1P82D:79000257 RUN NUMBERt:221526
Service:Penn Yan Area Volunteer Date:October 26, 2022
Ambulance Corps Team:BLa
Base:PYAVAC Headquarters Crew 1:Driver/Pilo.t -
Unit:2 - 62A2 - Besponse
Transport,Driver/Pilot
shift:6 pm - 11 pm Martin, 2,oren
Mass Casualty:N.o guT-
Emergency Response (Primary Crew 2:Priinary Caregiver - Scene,Primary
Response Area) Unscheduled Categiver - Transport
Response Mode:Emergent (Immediate Response)
' ·Huey, Sarah
-Node Descriptorm:Lights and sirens
Moved.Via:Stretcher Transport Node:Emergent (Immediate Responae)
Position:8itting, Node Descriptors:No Lighta or Sirena
Disposition:Treated s T× w/ Medic SS YCALS Moved From:stretcher
Amb. Transport coda:Tnitial Trip Transportunable to alt without assistance.
Asse'sament:Unable to stand without
. assistance
Unable to walk without assistance
stretcherPL safety and comfort, per
Purpose:protocol
.. Ph. Condition:Unchanged
Ref Other Type:Street and highway Receiving /Hospital
Referring / Scene:Mimrod Rd Deatination:Soldiers & Sailora Hemorial
Matmaker Hospital
Mimrod, NY 14842
Yates County Emergency Department
United states Hospital (General)
Requester:Yates County 911 418 North Main street 1
Penn Yan, NY 14527-1013
315-531-2500
. least Name:
Address: 4 H rod R Ld Hiles 5.8 Received 18 15
City: Rimrod BT:NY Dispatch: 18 15
tip:14842
county: Yatés EnRoute: 18 16
country: United states
At Patient: 18:25
Åge: ses: M Weight: Leave Ref: 18:48
10y 42 kg
Height At Rea: 19:00
subscriber: We Available: 19119
..
Race: White, non-Hispanic
Description The pt was sitting in the back of the vehicle that struck him. The pt was being treated by Himrod
First Responders. The weather was cool and the sun was being to set.
riest Agency Unit on Scene7: Yes
Num. Patients On Scene: 1
satient Beldngings: The pt had the clothes' on his back. The pt's bike was left with family.
Other EMS: Himrod Fire Departmen't, YATES COUNTY ALS
Other Agencies: Other EMS Agency, Law, Fire
Patient complained about headache, shou.1der pain and elbow pain.
Anatomic Location: ead,Extremity - Upper
Patient Activity: etivity, bike riding
' s ,'
'Mintopy ap spesent 11 anes s ,
Patient had been atuck by vehicle while riding his bike on the road. The pt had been riding his bike about a mile
down the road to get a rake at the local hardware atore.
FILED: YATES COUNTY CLERK 09/14/2023 10:47 AM INDEX NO. 2023-5239
NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 09/14/2023
10-29-2022 13:55 (412) 569-7163 . ZDL L De t a E y s.t ams 2/ 4
PRID: 79000257, Page 2 of 4 Patient Name.
, 4.one - . None . , None.
< . ,-N ' "
MourplogacqA Summ
Level of Loss of Consciousness- #144ÈJÆj: C6too $441
Consciousness Alert No
. . E V M
Chemically Paralyzed: No Tot
Int: 4 & 6 = 15
stroke·seale: cincinnati (CPSS) Negative
Nauso'
Comments: PL was A50 X2 with good CMS in all extremities
Neurological Present: Speech Normal, Gait-Abnormal, Strength-Normal, Carebellar
Punction-Normal
Nantal Present: Confused, Oriented-Perso,n, Oriented-Place, Slowneas and poor
responsiveness, Altered mental status, unspecifiedc Stupor
Ri . LA: Normal Normal
Size: Normal . Normal RA: Normal Normal
React: Reactive Reacti've LL: Normal Normal
RL: Normal Normal
Status: Patent ,
Effort: Normal
Performed By: Patient
Sounds: L: Clear R: Clear
Outcome: Unchanged sounds: Clear bilateral lung sounds
comments: P-t was abl.e to maintain his own airway . Comments: Pt was at 96% on RA
JVD: Not Apprepiated Cap. Refill: Less than 2 Seconds
Carotid:
comments: regular pulse Radial: Normal Normal
Strong . . .
. Femoral:
Involved: 1
Airbag: No Airbag Present
t.ocation of Pt in vehic1a: Front Seat-Left Side (or notorcycle driver)
vehicle Empach: 12
Extrication Required: No
Reason for Encounter: -Injury/Trauma
Drugs/Alcohol?: None
Drug/Alcohol Indicaters
Unable to Complete
Prament:
Intentional: No .
Work Related: No
Injury Cause: Notor Vehicle Traffic Accident, Getteral, Pedal Cyclist Injured
Neehanism: NYC - Public
Equipment:, None
Auto v. Pedestrian/Bicyclist Thrown, Run Over, or > 20 MPR Impact, EMS Provider
Risk Factors Present:
Judgment, Bjection
, ,'
'tnitial Phys4eak FindÅ
Assessment .,
Head: Bruis.ing/Contuaions Findings: PT had bruisiñg on right side of. his heac;
Naok Findings: No DCAP-BTLS, pt reports no pain, injury or complaint, but the pt was placed in a" C-Collar by
FILED: YATES COUNTY CLERK 09/14/2023 10:47 AM INDEX NO. 2023-5239
NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 09/14/2023
10 29-2022 13:55 (412) 569-7163 ZOLL Dat a Sys t ems 3/4
PRID: 79000257, Page 3 of 4 Patient Name: Delbert Burkh
First Riesponders
Cheat Findings: No DCAP-gTLS, pt reports no pain, injury or complaint
Abdominal comments: No DCAP-BILS, pt reports no pain, injury or complaint
Abdominal Appearance: Normal, Non distended.
Abdominal Palpation: No pain when palpated
Palvia Findings: Not Assessed
Back Findings: No DCAP-BTLS, pt reports no pain, injury or complaint
Right Arm: Tenderness
Extremity rindings: PT had bruising on his right elbow, a.nd right shoulder.
Entremity Raetraints: None used/ needed
Skin Findings: Pink warm and dry,
system: Musculoskeletal
Symptoms: Pain (General)
Impression: Traumatic injury
Initial Patient Acuity: Critical (Red)
Time ' . ECG
R.0 REG B.P. RA 8p02 Resp Rhythm GCS
Nethod
R.R. Method Method LOC Reap Effort Stroke Scale
Action omment .
Asiaa
Penn Yan A2 arrived on location, S. Huey and L. Martin placed on the. proper PPE per the current
guidelines.
18:25 114 '
122 / 70 Y 98 18 4/S/6
Electric Nonitor Art. Alert Normai , Cincinnatii (CPSS)
- Pulse On Line . Negative
ATP the pt sitt£ng on the back of a vehicle. The pt history was given to S. Ruey. S. Huey requested a
helicopter from Himrod's irst Responder Captain.. The pt was assisted to the stretcher, securely strapped
to the stretcher, covered with a blanket and loaded into the ambulance without incident. ,
taso 112 122 / 70 Y 98 18 4/S/6
Electric Monitor Auto. Restless Normal Cincinnati (CPSS)
- Pulse On cuff Negative
The ph was resting on the stretcher. The pt's family was outside talking to Medic 55, J. Houck. The pt's
family refused to fly the pt to strong. The pt's family wanted to see a doctor at SAS before going to
Strong despite efforts made by Medic 55 and other Himrod First Responders.
15:35 124 181 / 81 Y 98 18 4/S/6 .
Electric Nonitor Au4.e. Restless Normal
- cardine Cuff
The pt was resting on the stretcher, The pt was becoming lethargic. The pt kept asking "what do you
want". The pt was speaking English when EMS first arrived at the pt. The pt was switchin9 to speaking
Dutch. The pt was resting on the stretcher when his mother came into the ambulance along with his
grandfather. The pt would answer most of their questLions appropriately. The pt couldn't remember what he
was doing, but then he remembered he was after a rake to rake up leaves.
18:50 114 144 / 84 Y 100 la 3/S/6
Electric Nonitor Auto. Agitated Normal
- cardise cuff
The pt was speaking with S. Huey and his mother. The pe was answering most questions appropriately.
15:45 119 144 / a4 Y 100 18 3/5/6
'
Electric Monitor Auto. Responde to Normal
- Cardiac cuff Voice
Penn Yan A2 went enroute to S&S with Medic 55 on board per the family's request. The pt was resting on
the stretcher, The pt would answer questions when asked, but his eyes were shut. The pt would open them
·upon request but would quickly shut them again.
1S:00 91 127 / HQ Y 100 18 3/4/6
Electric Nonitor Aute. Responds to Normal
- Cardiac Cuff Voice
Arrived-at Sas. The doctor and two nursee met the ambulance out in the ambulance ba'y. The· pt was quickly
assessed lay the MD. The No explained to the pt's mother that the pt needed to go to Strong to be assessed
and treated by a pediatric facility. The.pt's mother agreed to fly the pt, The nurse began her assessment
of the pt in the ambulance, The lights were turned off for the nurse to complete a proper assessment once
FILED: YATES COUNTY CLERK 09/14/2023 10:47 AM INDEX NO. 2023-5239
NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 09/14/2023
10-29-2022 13:55 (4127 569-7163 ZOLL De t a Ess t ems 4/4
PRID: 79000257, Page 4 of 4 Patient Name:
the lights turned back on the pt began to vomit. The pt was unloaded from the 'ambulance and brought to
Room 6 in th's ED. The pt remained on the atretcher as the pt was going to be flown and Mercy Flight was
encoute with an 8 minute ETA.
Ramponse Factors Affecting Care: None
Scene Factors Af fecting Care: None.
Transportation Pactors Af fecting Care: None
Dispatch Factors: None
Turn-Around Factors: None
Paperwork from Referring: HIPAA Form
Paperwork to Receiving: HIPAA ,Form
Preview
FILED: YATES COUNTY CLERK 09/14/2023 10:47 AM INDEX NO. 2023-5239 NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 09/14/2023 EXHIBIT B FILED: YATES COUNTY CLERK 09/14/2023 10:47 AM INDEX NO. 2023-5239 NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 09/14/2023 10-29.-2022 13:55 .. (412) 569-7163 ZdLL De t a 59s t ems 1/4 . PRID: 79000257, Page 1 of 4 Patient Name: 1P82D:79000257 RUN NUMBERt:221526 Service:Penn Yan Area Volunteer Date:October 26, 2022 Ambulance Corps Team:BLa Base:PYAVAC Headquarters Crew 1:Driver/Pilo.t - Unit:2 - 62A2 - Besponse Transport,Driver/Pilot shift:6 pm - 11 pm Martin, 2,oren Mass Casualty:N.o guT- Emergency Response (Primary Crew 2:Priinary Caregiver - Scene,Primary Response Area) Unscheduled Categiver - Transport Response Mode:Emergent (Immediate Response) ' ·Huey, Sarah -Node Descriptorm:Lights and sirens Moved.Via:Stretcher Transport Node:Emergent (Immediate Responae) Position:8itting, Node Descriptors:No Lighta or Sirena Disposition:Treated s T× w/ Medic SS YCALS Moved From:stretcher Amb. Transport coda:Tnitial Trip Transportunable to alt without assistance. Asse'sament:Unable to stand without . assistance Unable to walk without assistance stretcherPL safety and comfort, per Purpose:protocol .. Ph. Condition:Unchanged Ref Other Type:Street and highway Receiving /Hospital Referring / Scene:Mimrod Rd Deatination:Soldiers & Sailora Hemorial Matmaker Hospital Mimrod, NY 14842 Yates County Emergency Department United states Hospital (General) Requester:Yates County 911 418 North Main street 1 Penn Yan, NY 14527-1013 315-531-2500 . least Name: Address: 4 H rod R Ld Hiles 5.8 Received 18 15 City: Rimrod BT:NY Dispatch: 18 15 tip:14842 county: Yatés EnRoute: 18 16 country: United states At Patient: 18:25 Åge: ses: M Weight: Leave Ref: 18:48 10y 42 kg Height At Rea: 19:00 subscriber: We Available: 19119 .. Race: White, non-Hispanic Description The pt was sitting in the back of the vehicle that struck him. The pt was being treated by Himrod First Responders. The weather was cool and the sun was being to set. riest Agency Unit on Scene7: Yes Num. Patients On Scene: 1 satient Beldngings: The pt had the clothes' on his back. The pt's bike was left with family. Other EMS: Himrod Fire Departmen't, YATES COUNTY ALS Other Agencies: Other EMS Agency, Law, Fire Patient complained about headache, shou.1der pain and elbow pain. Anatomic Location: ead,Extremity - Upper Patient Activity: etivity, bike riding ' s ,' 'Mintopy ap spesent 11 anes s , Patient had been atuck by vehicle while riding his bike on the road. The pt had been riding his bike about a mile down the road to get a rake at the local hardware atore. FILED: YATES COUNTY CLERK 09/14/2023 10:47 AM INDEX NO. 2023-5239 NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 09/14/2023 10-29-2022 13:55 (412) 569-7163 . ZDL L De t a E y s.t ams 2/ 4 PRID: 79000257, Page 2 of 4 Patient Name. , 4.one - . None . , None. < . ,-N ' " MourplogacqA Summ Level of Loss of Consciousness- #144ÈJÆj: C6too $441 Consciousness Alert No . . E V M Chemically Paralyzed: No Tot Int: 4 & 6 = 15 stroke·seale: cincinnati (CPSS) Negative Nauso' Comments: PL was A50 X2 with good CMS in all extremities Neurological Present: Speech Normal, Gait-Abnormal, Strength-Normal, Carebellar Punction-Normal Nantal Present: Confused, Oriented-Perso,n, Oriented-Place, Slowneas and poor responsiveness, Altered mental status, unspecifiedc Stupor Ri . LA: Normal Normal Size: Normal . Normal RA: Normal Normal React: Reactive Reacti've LL: Normal Normal RL: Normal Normal Status: Patent , Effort: Normal Performed By: Patient Sounds: L: Clear R: Clear Outcome: Unchanged sounds: Clear bilateral lung sounds comments: P-t was abl.e to maintain his own airway . Comments: Pt was at 96% on RA JVD: Not Apprepiated Cap. Refill: Less than 2 Seconds Carotid: comments: regular pulse Radial: Normal Normal Strong . . . . Femoral: Involved: 1 Airbag: No Airbag Present t.ocation of Pt in vehic1a: Front Seat-Left Side (or notorcycle driver) vehicle Empach: 12 Extrication Required: No Reason for Encounter: -Injury/Trauma Drugs/Alcohol?: None Drug/Alcohol Indicaters Unable to Complete Prament: Intentional: No . Work Related: No Injury Cause: Notor Vehicle Traffic Accident, Getteral, Pedal Cyclist Injured Neehanism: NYC - Public Equipment:, None Auto v. Pedestrian/Bicyclist Thrown, Run Over, or > 20 MPR Impact, EMS Provider Risk Factors Present: Judgment, Bjection , ,' 'tnitial Phys4eak FindÅ Assessment ., Head: Bruis.ing/Contuaions Findings: PT had bruisiñg on right side of. his heac; Naok Findings: No DCAP-BTLS, pt reports no pain, injury or complaint, but the pt was placed in a" C-Collar by FILED: YATES COUNTY CLERK 09/14/2023 10:47 AM INDEX NO. 2023-5239 NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 09/14/2023 10 29-2022 13:55 (412) 569-7163 ZOLL Dat a Sys t ems 3/4 PRID: 79000257, Page 3 of 4 Patient Name: Delbert Burkh First Riesponders Cheat Findings: No DCAP-gTLS, pt reports no pain, injury or complaint Abdominal comments: No DCAP-BILS, pt reports no pain, injury or complaint Abdominal Appearance: Normal, Non distended. Abdominal Palpation: No pain when palpated Palvia Findings: Not Assessed Back Findings: No DCAP-BTLS, pt reports no pain, injury or complaint Right Arm: Tenderness Extremity rindings: PT had bruising on his right elbow, a.nd right shoulder. Entremity Raetraints: None used/ needed Skin Findings: Pink warm and dry, system: Musculoskeletal Symptoms: Pain (General) Impression: Traumatic injury Initial Patient Acuity: Critical (Red) Time ' . ECG R.0 REG B.P. RA 8p02 Resp Rhythm GCS Nethod R.R. Method Method LOC Reap Effort Stroke Scale Action omment . Asiaa Penn Yan A2 arrived on location, S. Huey and L. Martin placed on the. proper PPE per the current guidelines. 18:25 114 ' 122 / 70 Y 98 18 4/S/6 Electric Nonitor Art. Alert Normai , Cincinnatii (CPSS) - Pulse On Line . Negative ATP the pt sitt£ng on the back of a vehicle. The pt history was given to S. Ruey. S. Huey requested a helicopter from Himrod's irst Responder Captain.. The pt was assisted to the stretcher, securely strapped to the stretcher, covered with a blanket and loaded into the ambulance without incident. , taso 112 122 / 70 Y 98 18 4/S/6 Electric Monitor Auto. Restless Normal Cincinnati (CPSS) - Pulse On cuff Negative The ph was resting on the stretcher. The pt's family was outside talking to Medic 55, J. Houck. The pt's family refused to fly the pt to strong. The pt's family wanted to see a doctor at SAS before going to Strong despite efforts made by Medic 55 and other Himrod First Responders. 15:35 124 181 / 81 Y 98 18 4/S/6 . Electric Nonitor Au4.e. Restless Normal - cardine Cuff The pt was resting on the stretcher, The pt was becoming lethargic. The pt kept asking "what do you want". The pt was speaking English when EMS first arrived at the pt. The pt was switchin9 to speaking Dutch. The pt was resting on the stretcher when his mother came into the ambulance along with his grandfather. The pt would answer most of their questLions appropriately. The pt couldn't remember what he was doing, but then he remembered he was after a rake to rake up leaves. 18:50 114 144 / 84 Y 100 la 3/S/6 Electric Nonitor Auto. Agitated Normal - cardise cuff The pt was speaking with S. Huey and his mother. The pe was answering most questions appropriately. 15:45 119 144 / a4 Y 100 18 3/5/6 ' Electric Monitor Auto. Responde to Normal - Cardiac cuff Voice Penn Yan A2 went enroute to S&S with Medic 55 on board per the family's request. The pt was resting on the stretcher, The pt would answer questions when asked, but his eyes were shut. The pt would open them ·upon request but would quickly shut them again. 1S:00 91 127 / HQ Y 100 18 3/4/6 Electric Nonitor Aute. Responds to Normal - Cardiac Cuff Voice Arrived-at Sas. The doctor and two nursee met the ambulance out in the ambulance ba'y. The· pt was quickly assessed lay the MD. The No explained to the pt's mother that the pt needed to go to Strong to be assessed and treated by a pediatric facility. The.pt's mother agreed to fly the pt, The nurse began her assessment of the pt in the ambulance, The lights were turned off for the nurse to complete a proper assessment once FILED: YATES COUNTY CLERK 09/14/2023 10:47 AM INDEX NO. 2023-5239 NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 09/14/2023 10-29-2022 13:55 (4127 569-7163 ZOLL De t a Ess t ems 4/4 PRID: 79000257, Page 4 of 4 Patient Name: the lights turned back on the pt began to vomit. The pt was unloaded from the 'ambulance and brought to Room 6 in th's ED. The pt remained on the atretcher as the pt was going to be flown and Mercy Flight was encoute with an 8 minute ETA. Ramponse Factors Affecting Care: None Scene Factors Af fecting Care: None. Transportation Pactors Af fecting Care: None Dispatch Factors: None Turn-Around Factors: None Paperwork from Referring: HIPAA Form Paperwork to Receiving: HIPAA ,Form