Fire and EMS Run Card Form

Transcription

1 Incident Type (New Incident Types are in BOLD) Dispatch Aerial Brush Engine Tanker Rescue Other (Specify number and apparatus type needed; ie 1-RH, 1-SP) Station Dispatches (List station numbers that should be dispatched; ie Sta44, Sta36) AFA-1 AIR EMERGENCY-1 AIR EMERGENCY-2 BRUSH FIRE-1 BRUSH FIRE-2 BRUSH FIRE-3 BRUSH FIRE-4 BOMB THREAT STANDBY-1 BOMB THREAT STANDBY-2** BUILDING COLLAPSE-1 BUILDING COLLAPSE-2 CMA*-1 CMA*-2 FIRE POLICE-1 FIRE RELOCATE-1 Page 1 of 8

2 Incident Type (New Incident Types are in BOLD) FLUIDS/DEBRIS DOWN-1 HAZMAT*-1 HAZMAT*-2 HELICOPTER STANDBY-1 MEDICAL ASSIST-1 MISC FIRE-1 MISC FIRE-2 MVA ENTRAPMENT-1 MVA ENTRAPMENT-2 MVA ENTRAPMENT W/FIRE-1 MVA ENTRAPMENT W/FIRE-2 MVA WITH INJURIES-1 MVA WITH INJURIES-2 MVA WITH INJ/FIRE-1 MVA WITH INJ/FIRE-2 Dispatch Aerial Brush Engine Tanker Rescue Other (Specify number and apparatus type needed; ie 1-RH, 1-SP) Station Dispatches (List station numbers that should be dispatched; ie Sta44, Sta36) Page 2 of 8

3 Incident Type (New Incident Types are in BOLD) Dispatch Aerial Brush Engine Tanker Rescue Other (Specify number and apparatus type needed; ie 1-RH, 1-SP) Station Dispatches (List station numbers that should be dispatched; ie Sta44, Sta36) MVA UNKNOWN INJ-1 MVA UNKNOWN INJ-2 MVA UNKNOWN W/FIRE-1 MVA UNKNOWN W/FIRE-2 PUMP-1 PUMP-2** RESCUE-1 RESCUE-2 RESCUE CONFINED SPACE-1 RESCUE CONFINED SPACE-2 RESCUE HIGH ANGLE-1 RESCUE HIGH ANGLE-2 RESCUE TRENCH-1 RESCUE TRENCH-2 Page 3 of 8

4 Incident Type (New Incident Types are in BOLD) SEARCH-1 SEARCH-2 STRUCTURE INVESTIGATION-1 STRUCTURE FIRE ENTRAP-1 STRUCTURE FIRE ENTRAP-2 STRUCTURE FIRE-1 STRUCTURE FIRE-2 STRUCTURE FIRE-3 STRUCTURE FIRE-4 TREE DOWN-1 TREE DOWN-2** VEHICLE FIRE-1 VEHICLE FIRE-2 WATER ACCIDENT-1 WATER ACCIDENT-2 Fire and EMS Run Card Form Aerial Brush Engine Tanker Rescue Dispatch Other (Specify number and apparatus type needed; ie 1-RH, 1-SP) Station Dispatches (List station numbers that should be dispatched; ie Sta44, Sta36) Page 4 of 8

5 Resource Type Aerial Trucks [10] Brush [25] Rescue [10] Tanker [25] Fire and EMS Run Card Form Unit List Resource Type Unit List Resource Type Unit List Air Medical Assist [5] ARFF Rehab [1] ATV [5] RIT [5] Canteen [1] Scuba [1] Collapse [1] Spill [5] Foam [2] Fire Police [5] Marine [5] * DESIGNATES THERE IS A "W/SYMPTOMS" CALL TYPE ALSO. EMS WILL BE DISPATCHED ON THE "W/SYMPTOMS" CALL TYPE IF THEY ARE NOT LISTED IN THE CMA OR HAZMAT RESPONSE. ** 2ND ALARM ONLY REQUIRED IF "OIC" IS LISTED ON 1ST ALARM. TTF Traffic Utility Page 5 of 8

6 Resource Type Aerial Trucks [10] Rescue [10] Rescue [10] Tanker [25] Tanker [25] Tech Rescue/Rescue Water Accident Tech Rescue/Rescue Building Tech Rescue/Rescue Confined Space Tech Rescue/Rescue High Angle Rescue Call Type #'s Unit List Call Type List 1. AFA 2. Air Emergency 3. Brush Fire 4. Bomb Threat Standby 5. Building Collapse 6. CMA 7. Fire Relocate 8. Fluids/Debris Down 9. Hazmat 10. Helicopter Standby 11. Misc Fire 12. MVA Entrapment 13. MVA Entrapment w/fire 14. MVA with Injuries 15. MVA with Injuries/Fire 16. MVA Unknown 17. MVA Unknown w/fire 18. Pump 19. Rescue 20. Rescue Confined Space 21. Rescue High Angle 22. Rescue Trench 23. Search 24. Structure Fire w/entrapment 25. Structure Fire 26. Structure Investigation 27. Tree Down 28. Vehicle Fire 29. Water Accident Page 6 of 8

7 Municipality Fire Agency EMS Agency Run Card Number 0 0 BLS QRS ALS* Call Types 1st: 2nd: 3rd: 4th: 5th: 6th: 7th: 8th: 9th: 10th: 11th: 12th: 1. Airway Obstruction 2. ALS Medical 3. ALS Trauma 4. Assault/Fight Injury 5. BLS Medical 6. BLS Trauma 7. Cardiac/Respiratory Arrest 8. Class 4 Mental 9. Class 5 DOA 10. Domestic Injury 11. Lift Assist 12, Overdose 13. Shooting 14. Stabbing 15. Suicide 16. Unconscious Out of County Abbreviations: List call types where QRS from a fire department is required on initial dispatch BU = Bucks LH = Lehigh *NOTE - ALS companies MUST be listed in the SAME order as the BLS column CC = Chester MC = Montgomery LN = Lancaster SC = Schuylkill LB = Lebanon Example: Montgomery County 369 = MC 369 Page 7 of 8

8 Municipality Fire Agency EMS Agency Fire Department Authorization Name: Title: Date: Signature: Title: Date: Signature: Authorization Page Run Card Number EMS (Ambulance) Authorization Name: This page must be completed by the individuals authorized to submit run card changes per the Emergency Services Run Card Change Authorization Form on file. Page 8 of 8