Medical Incident Plan
{var Organization}
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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) |
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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}
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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} |
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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}
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Ver 0.2
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