LINE 1 – LOCATION________________________________________ (UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator of Pickup Site Location; Encrypt if Using NonSecure Means of Communication)
LINE 2 – RADIO FREQUENCY _______________________________ (Radio Frequency at Pickup Site; Call Sign, and Suffix)
LINE 3 – NUMBER OF PATIENTS(P) __________________________ (Number of Patients by Precedence. Report Only Applicable Information and Encrypt the Brevity
Codes:
A – URGENT
B – URGENT-SURG
C – PRIORITY
D – ROUTINE
E – CONVENIENCE)
If two or more categories must be reported in the same request, insert the word BREAK between each category.)
LINE 4 – SPECIAL EQUIPMENT
(Encrypt the Applicable Brevity Codes.
A – None
B – Hoist
C – Extraction Equipment
D - Ventilator)
LINE 5 – NUMBER OF PATIENTS(T)__________________________ (Total Number of Patients by Type.
L + # of PNT – Litter
A + # of PNT – Ambulatory)
LINE 6 – SECURITY OF PICK-UP SITE ________________________
(N – No Enemy Troops in Area
P – Possibly Enemy Troops in Area (approach with caution)
E – Enemy Troops in Area (approach with caution)
X – Enemy Troops in Area (armed escort required))
LINE 6 – NO. TYPE OF WOUND, INJURY, OR ILLNESS (PEACETIME) __________________________________________________________ (Specific Information Regarding Patient Wounds by Type)
LINE 7 – METHOD OF MARKING AT Landing Zone _____________________ (Encrypt the Brevity Codes:
LINE 5 – NUMBER OF PATIENTS(T)__________________________ (Total Number of Patients by Type.
L + # of PNT – Litter
A + # of PNT – Ambulatory)
LINE 6 – SECURITY OF PICK-UP SITE ________________________
(N – No Enemy Troops in Area
P – Possibly Enemy Troops in Area (approach with caution)
E – Enemy Troops in Area (approach with caution)
X – Enemy Troops in Area (armed escort required))
LINE 6 – NO. TYPE OF WOUND, INJURY, OR ILLNESS (PEACETIME) __________________________________________________________ (Specific Information Regarding Patient Wounds by Type)
LINE 7 – METHOD OF MARKING AT Landing Zone _____________________ (Encrypt the Brevity Codes:
A – Panels
B – Pyrotechnic signal
C – Smoke Signal (colour)
D – None
E – Other)
LINE 8 – PATIENT NATIONALITY AND STATUS __________________________ (Number of Patients in Each Category Need Not be Transmitted. Encrypt Only the Applicable Brevity Codes:
A – Coalition Military
B – Coalition Civilian
C – Non-Coalition Military
D – Non-Coalition Civilian
E – EPW)
LINE 9 – NBC CONTAMINATION Wartime___________________________ (NBC Contamination; Use Brevity Codes:
N = Nuclear
B = Biological
C = Chemical
U = Unknown
A = All Clear)
LINE 9 – TERRAIN DESCRIPTION Peacetime___________________________ (Description of Terrain Features at the Proposed Pick-up Site)
B – Pyrotechnic signal
C – Smoke Signal (colour)
D – None
E – Other)
LINE 8 – PATIENT NATIONALITY AND STATUS __________________________ (Number of Patients in Each Category Need Not be Transmitted. Encrypt Only the Applicable Brevity Codes:
A – Coalition Military
B – Coalition Civilian
C – Non-Coalition Military
D – Non-Coalition Civilian
E – EPW)
LINE 9 – NBC CONTAMINATION Wartime___________________________ (NBC Contamination; Use Brevity Codes:
N = Nuclear
B = Biological
C = Chemical
U = Unknown
A = All Clear)
LINE 9 – TERRAIN DESCRIPTION Peacetime___________________________ (Description of Terrain Features at the Proposed Pick-up Site)
MIST Report
M Mechanism of injury and time of injury (if known)
I Injury or illness
S Symptoms and vital signs
T Treatment given
M: A brief description of the mechanism of injury. For example: IED, GSW (gunshot wound), Blast, Rollover, Fall
M: A brief description of the mechanism of injury. For example: IED, GSW (gunshot wound), Blast, Rollover, Fall
I: A brief description of the injuries sustained starting with the most
serious first. Highlight life-threatening injuries. Example:
bilateral lower extremity amputations.
S: Vital signs or significant symptoms. For instance, BP 90/Palp
and difficulty breathing.
T: Treatments rendered. For example, tourniquets applied with
bleeding controlled; ketamine 50mg IM.
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