Anonymized patient identification
Lot
Age
Gender – Bitte auswählen –malefemalediverse
Previous illness
Anticoagulant use yesnounknown
Anatomical region of injury ExtremitiesTrunk/AbdomenInguinalHead/Neckothers
Type of bleeding arterialvenous/mixedunknown
Type of injury Gunshot woundStab woundShrapnel injuryAmputation woundothers
Complementary hemostatic measure TorniquetPressure dressingothers
Could the bleeding be controlled with SpeedM®? completelypartiallynot at allcomment
Wie How many products were used on this patient? 1>1
Was repackedreapplied
Were there any unexpected reactions? noyes Have the instructions for use been looked at before use? yesnocommment
Evaluate the opening of the package: easydifficultin darknessin wet/snow conditions
Further comments
