Medical Incident Plan
{var Organization}

FOR A NON-EMERGENCY INCIDENT, WORK THROUGH CHAIN OF COMMAND TO REPORT AND TRANSPORT INJURED
PERSONNEL AS NECESSARY. FOR A MEDICAL EMERGENCY: IDENTIFY ON-SCENE INCIDENT COMMANDER BY NAME AND POSITION AND ANNOUNCE "MEDICAL EMERGENCY" TO INITIATE RESPONSE FROM IMT COMMUNICATIONS/DISPATCH.

{var IsExercise}

 Use the following items to communicate situation to communications/dispatch.

1. CONTACT COMMUNICATIONS / DISPATCH (Verify correct frequency prior to starting report)
    Ex: "Communications, Div. Alpha. Stand-by for Emergency Traffic."
2. INCIDENT STATUS: Provide incident summary (including number of patients) and command structure.
    Ex: “Communications, I have a Red priority patient, unconscious, struck by a falling tree. Requesting air ambulance to Forest Road 1 at (Lat./Long.)
    This will be the    Trout Meadow Medical, IC is TFLD Jones. EMT Smith is providing medical care.”

Severity of Emergency / Transport Priority {var Severity}
Nature of Injury or Illness & Mechanism of Injury {var fild2a} Brief Summary of Injury or Illness
(Ex: Unconscious, Struck by Falling Tree)
Evacuation Request {var fild2b} Air Ambulance / Short Haul/Hoist Ground Ambulance / Other
Patient Location {var fild2c} Descriptive Location & Lat. / Long. (WGS84)
Incident Name {var fild2d} Geographic Name + Medical (Ex: Trout Meadow Medical)
On-Scene Incident Commander {var fild2e} Name of on-scene IC of Incident within an Incident (Ex: TFLD Jones)
Patient Care {var fild2f} Name of Care Provider (Ex: EMT Smith)

3.I NITIAL PATIENT ASSESSMENT: Complete this section for each patient as applicable (start with the most severe patient)

Patient Assessment: (See IRPG PAGE 106)
{var fild3a}

Treatment
{var fild3b}

4. EVACUATION PLAN:
Evacuation Location (if different): (Descriptive Location (drop point, intersection, etc.) or Lat. / Long.) Patient's ETA to Evacuation Location:

{var fild4a}

Helispot / Extraction Site Size and Hazards:

{var fild4b}

5.ADDITIONAL RESOURCES / EQUIPMENT NEEDS:
{var fild5}

6.COMMUNICATIONS: Identify State Air/Ground EMS Frequencies and Hospital Contacts as applicable

Function Channel Name/Number Receive (RX) Tone/NAC * Transmit (TX) Tone/NAC *
{var fld6a} {var fld6b} {var fld6b} {var fld6d} {var fld6e} {var fld6f}
{var fld6g} {var fld6h} {var fld6i} {var fld6j} {var fld6k} {var fld6l}
{var fld6m} {var fld6n} {var fld6o} {var fld6p} {var fld6q} {var fld6r}
7. CONTINGENCY: Considerations: If primary options fail, what actions can be implemented in conjunction with primary evacuation method? Be thinking ahead..
{var fild7}
8. ADDITIONAL INFORMATION: Updates/Changes, etc.
{var fild8}
REMEMBER: Confirm ETAs of resources ordered. Act according to your level of training. Be Alert. Keep Calm. Think Clearly. Act Decisively.

 Date/Time  {var DateTime} 

 Latitude and longitude: LAT  {var mapLat}      LON  {var mapLon}      MGRS {var MGRS}     Grid  {var Grid}

 Location  {var Location}       

  Ver 0.2

 

 

Check-in form Information

This form is normally sent only upon initial check in, unless other arrangements are made. There is a separate CHECK OUT form that can be used when closing the station.

The SETUP Icon top left allows you to add your agency or groups name to the template. It will remain as such until you change it. You can clear the title by opening SETUP again and use your space bar.

In the Send To: entry field, you can pre address the form. This will stay as such until you change or clear it. Many groups send the check in form to a common address(s). Separate calls or Emails with a semicolon; You can always modify prior to posting the message.

Copy and paste to a spreadsheet is available, TAB separation, located in the bottom portion of the sent text message.

Printing this form is dependent upon your selected printer and its settings. Various Web Browsers and and their viewing sizes are not all the same. Printing from a browsers print function may be different from the operating systems default print mode. Select what works for you, for both printing and viewing. You may print direct to the printer as a HTML or save as a PDF then print the PDF. In some instances Landscape mode may print better than Portrait.

You may enter manually Decimal Degrees: 32.5042,-116.9834 or enter MGRS Coordinates: 11SNR0184195204 or 11S NR 01841 95204.

Providing GPS information is optional but very valuable. We encourage you to do so.
LAT/LON: The form accepts only Decimal Degree latitude and longitude. 4 decimals are preferred.
N/E/S/W: North and East are positive numbers in Decimal Degrees, South and West are negative numbers in Decimal Degrees. For example, the Hollywood Sign is located at Decimal Degrees 34.1341, -118.3215 NOTE: For auto entered GPS decimal coordinates to work, you must have a connected and configured GPS device working with Winlink Express. Otherwise manual entry in the indicated format can be used.


The Winlink Check-in, Check-out and Position Report forms endeavour to provide you with useful options such as latitude/longitude, and MGRS so you can move seamlessly between coordinate systems used by different organizations.

Without properly formatted GPS coordinates this form cannot be mapped in Winlink Express.

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