Graduate level Final and Journal

1. Incident Name:

2. Operational Period:

Date From: 7/26/2018

Date To: 7/28/2018

Time From: 0700

Time To: 1900

3. Medical Aid Stations:

Name

Location

Contact Number(s)/Frequency

Paramedics on Site?

Camp ground

Emergency location

233-125

☒ Yes ☐ No

☐ Yes ☐ No

☐ Yes ☐ No

☐ Yes ☐ No

☐ Yes ☐ No

☐ Yes ☐ No

4. Transportation (indicate air or ground):

Ambulance Service

Location

Contact Number(s)/Frequency

Level of Service

ground

To emergency location

911

☐ ALS ☒ BLS

☐ ALS ☐ BLS

☐ ALS ☐ BLS

☐ ALS ☐ BLS

5. Hospitals:

Hospital Name

Address, Latitude & Longitude if Helipad

Contact Number(s)/ Frequency

Travel Time

Trauma Center

Burn Center

Helipad

Air

Ground

☐ Yes Level: ____

☐ Yes ☐ No

☐ Yes ☐ No

☐Yes Level: ____

☐ Yes ☐ No

☐ Yes ☐ No

☐ Yes Level: ____

☐ Yes ☐ No

☐ Yes ☐ No

☐ Yes Level: ____

☐ Yes ☐ No

☐ Yes ☐ No

☐ Yes Level:

☐ Yes ☐ No

☐ Yes ☐ No

6. Special Medical Emergency Procedures:

☐ Check box if aviation assets are utilized for rescue. If assets are used, coordinate with Air Operations.

7. Prepared by (Medical Unit Leader):

Name:

Signature:

8. Approved by (Safety Officer):

Name: peter

Signature:

ICS 206

IAP Page p.m

Date/Time: 7/27/2018 12:00 AM

Block Number

Block Title

Instructions

1

Incident Name

Enter the name assigned to the incident.

2

Operational Period

Date and Time From

Date and Time To

Enter the start date (month/day/year) and time (using the 24-hour clock) and end date and time for the operational period to which the form applies.

3

Medical Aid Stations

Enter the following information on the incident medical aid station(s):

Name

Enter name of the medical aid station.

Location

Enter the location of the medical aid station (e.g., Staging Area, Camp Ground).

Contact Number(s)/Frequency

Enter the contact number(s) and frequency for the medical aid station(s).

Paramedics on Site?

Yes No

Indicate (yes or no) if paramedics are at the site indicated.

4

Transportation (indicate air or ground)

Enter the following information for ambulance services available to the incident:

Ambulance Service

Enter name of ambulance service.

Location

Enter the location of the ambulance service.

Contact Number(s)/Frequency

Enter the contact number(s) and frequency for the ambulance service.

Level of Service

ALS BLS

Indicate the level of service available for each ambulance, either ALS (Advanced Life Support) or BLS (Basic Life Support).

5

Hospitals

Enter the following information for hospital(s) that could serve this incident:

Hospital Name

Enter hospital name and identify any predesignated medivac aircraft by name a frequency.

Address, Latitude & Longitude if Helipad

Enter the physical address of the hospital and the latitude and longitude if the hospital has a helipad.

Contact Number(s)/ Frequency

Enter the contact number(s) and/or communications frequency(s) for the hospital.

Travel Time

Air

Ground

Enter the travel time by air and ground from the incident to the hospital.

Trauma Center

Yes Level:______

Indicate yes and the trauma level if the hospital has a trauma center.

Burn Center

Yes No

Indicate (yes or no) if the hospital has a burn center.

Helipad

Yes No

Indicate (yes or no) if the hospital has a helipad.

Latitude and Longitude data format need to compliment Medical Evacuation Helicopters and Medical Air Resources

6

Special Medical Emergency Procedures

Note any special emergency instructions for use by incident personnel, including (1) who should be contacted, (2) how should they be contacted; and (3) who manages an incident within an incident due to a rescue, accident, etc. Include procedures for how to report medical emergencies.

Check box if aviation assets are utilized for rescue. If assets are used, coordinate with Air Operations.

Self explanatory. Incident assigned aviation assets should be included in ICS 220.

7

Prepared by (Medical Unit Leader)

Name

· Signature

Enter the name and signature of the person preparing the form, typically the Medical Unit Leader. Enter date (month/day/year) and time prepared (24-hour clock).

8

Approved by (Safety Officer)

Name

Signature

Date/Time

Enter the name of the person who approved the plan, typically the Safety Officer. Enter date (month/day/year) and time reviewed (24-hour clock).