Montgomery County Fire & Rescue MAIS Form

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Vital
Signs

Record the first set of vital signs based on the findings of your primary assessment of your patient. Vital signs are recorded using combinations of responses for hundreds (100, 200), tens (10 - 90), and units (1 - 9). A systolic pressure of 216 would have the responses for 200, 10, and 6 filled in. All vital signs are recorded in the same manner.
Use the 0 (zero) responses only for patients who were monitored and found to have no vital signs (i.e. cardiac arrest). Do NOT mark zero responses for patients whose vital signs are unobtainable.
The "P" response in the Diastolic blood pressure section should be marked to record that a blood pressure was taken by palpation.

Glucometer:	Darken the Glucometer response if you monitor blood glucose. You should note the blood glucose value in the boxes provided in the lower right corner of the form.
LOC PTA:	Level of Consciousness Prior to Arrival: Mark Yes if there are signs or testimony that your patient was unconscious prior to the arrival of your unit. Mark No if there were no indications of loss of consciousness
Lungs	Mark the Normal response(s) for Right and/or Left lung(s) if your primary assessment found equal, clear breath sounds. Mark the Wheeze response(s) for Right and/or Left lung(s) if your primary assessment found whistling type breath sounds associated with narrowing or spasm of the smaller airways. Mark the Rales responses(s) for Right and/or Left lung(s) if your primary assessment found abnormal breath sounds due to the presence of fluid in the smaller airways. Mark the Rhonchi response(s) for Right and/or Left lung(s) if your primary assessment found abnormal breath sounds due to the presence of fluid or mucous in the larger airways.
Glasgow Coma Score	Mark the appropriate responses for Glasgow Coma Score eye, motor, and verbal responses. Verbal responses should be determined based on the patient’s age. See the reverse side of the MAIS form for Glasgow Coma Score response definitions.

Last edited: 2/16/2005