Please report your LifeVac® usage via the form below: Name Contact Number Email Date Address Patient age Indications (if any) eg. MS, Parkinson’s , wheelchair user, Bed ridden etc.? Nature of the blockage (if known) Partial or total blockage Partial blockageTotal blockageUnknown BLS Protocol first followed? YesNo Patient conscious at time of device use? (LifeVac) YesNo Position of patient when LifeVac applied? (sitting, lying down, recovery position, standing, etc.) Number of uses of LifeVac attempted? Hazard successfully dislodged with LifeVac? YesNo Duration of patient choking until recovery? Outcome Did patient receive medical examination afterwards due to BLS being performed YesNo What complications were found, if any, from examination Review/analysis of the device by user Experience handling other choking incidents Views on device before choking incident occurred Pro's to using the device Con's to using the device Critical assessment of the role the device played in the incident Extenuating reasons for its deployment Was it decided BLS protocols were not appropriate to follow
