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Incident Number: V2000360 Patient Name: Mercado, Miguel <br />Incident Date/Time: 01/20/2020 23:26:10 <br />23:48:05 Dale,-Epinephrine 0.1 lntraoss 1 mg Improved None Sta ndi <br />Ryan MG/ML eous (MilUgram ng <br />(P38789 (1:10,000) (10) s) Order/ <br />) Proto <br />col <br />23:55:21 Dale, Epinephrine 0.1 lntraoss 1 mg Unchange None Base <br />Ryan MG/ML eous (Millig ram d Hospit <br />(P38789 (1:10,000) (10) s) al <br />) Order <br />00:00:26 Dale, Epinephrine 0.1 lntraoss 1 mg Unchange None Base <br />Ryan MG/ML eous (Milligram d Ho spit <br />(P38789 (1:10,000) (10) s) al <br />) Order <br />00:02:02 Dale, Sodium lntraoss 50 mEq Unchange None Base <br />Ryan Bicarbonate eous (Miltiequiv d H ospit <br />(P38789 (10) alents) al <br />) Order <br />00:08:02 Dale, Epinephrine 0.1 lntraoss 1 mg Unchange None Base <br />Ryan MG/ML eous (Milligram d Hospit <br />(P38789 (1 :10,000) (10) s) al <br />) Order <br />00:09:13 Dale, Normal saline lntrave 200ml Not None Standi <br />Ryan nous (Milliliters) Applicabl ng <br />(P38 789 (IV) e Order/ <br />) Proto <br />col <br />Airway Confirmation and Details <br />For EtCO2 assessments see Patient Vitals and Waveform <br />Graphics where available. <br />Call Disposition <br />Type of Service: 911 Response (Scene) <br />Response Mode: Code 3 <br />Response Delay: <br />Location Type: Residential: Single-family residen ce <br />{SFR), Apartment, Condo, Mobile <br />Home <br />Incident Address: <br /> <br />Scene GPS Location: <br />Patient Disposition: 911 BHC-Treated and Tra nsported <br />ALS With Base Hospital Con ta ct <br />Transport Mode: Ground-Ambulance/Code 3 <br />• Transport Delay: <br />Destination Type: Hospital-Emergency Department <br />Destination: UCI Medical Center <br />101 The City Drive S Orange, CA <br />92868 <br />Dest. Determ.: Regional Specialty Center <br />(Trauma/Cardiac/Stroke) <br />Outcomes <br />Final Patient Severe <br />Acuity: <br />Response Times and Mileage . <br />EMS Agency Name: Fountain Valley Fire Department <br />PCR #: ca2a4d0a46f1453f81898d0d 1 ccf <br />eb65 <br />Transporting Agency: Ca r e Ambulance Service <br />(1639131436) <br />Printed: 0 1/22/2020 08:55 <br />Page 8 of 9