Diving Rescue Plan Example Form PDF Details

In the realm of swiftwater rescue operations, meticulous planning and preparedness are paramount to ensuring safety and swift response during emergencies. At the heart of these preparations lies the Diving Rescue Plan Example form, a comprehensive document designed to guide rescue teams through the necessary steps and checklist items to effectively manage a rescue situation. This form encompasses vital aspects such as on-site communications requirements, specifying the need for devices like department radios, cell phones for dispatcher contact, and marine VHF radios. It underscores the indispensability of having emergency transport like ambulances readily available, along with emergency equipment such as AEDs, oxygen delivery units, and advanced life support gear. Furthermore, the form places a significant emphasis on identifying trained Emergency Medical Services (EMS) providers among the team and outlines a structured action plan that includes recalling personnel, conducting head counts, stabilizing the patient, and preserving property. Also, detailed within are steps for transferring authority, documenting the incident, and a comprehensive list of emergency phone numbers for swift access. Dive Rescue International, the issuing authority of the form, mandates that all trainers complete and regularly update this document as part of their instructor certification and recertification process, ensuring that it remains an integral component of the rescue team’s readiness strategy.

QuestionAnswer
Form NameDiving Rescue Plan Example Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namespadi rescue diver emergency action plan example, diving emergency action plan pdf, padi rescue plan, diving emergency action plan template

Form Preview Example

Swiftwater Rescue Emergency Action Plan

Location

Checklist

On Site Communications (REQUIRED)

Department Radio / Channel

Cell Phone / Dispatch #

Marine VHF Radio (Channel 16)

Ambulance for Transport?

On Site

By Radio or Telephone

Emergency Equipment in Vicinity

AED or other Cardiac Defibrillator (REQUIRED)

Oxygen Delivery Unit (REQUIRED)

First Aid Kit (REQUIRED) Advanced Life Support Equipment

Identify Trained EMS Providers in the Class

Paramedics

EMTs

Other

Other Items Recommended On Site

Program Training Manual

Department Training Standards

Agency's SOPs/SOGs for Water Operations

Action Plan

Recall all personnel, conduct head count (as needed) Notify dispatch

Time of Accident

River Velocity

Establish Last Seen Point (if necessary)

Request additional resources (as needed)

Stabilize the patient/incident

Conserve property (as appropriate)

Turn patient/scene over to the authority having jurisdiction

Pass on information (as needed)

Document the incident

Obtain statements from witnesses (as needed) Notify Supervisor

Contact Dive Team if needed

Emergency Phone Numbers

Dispatch

Local Emergency Transport

Air Transport

USCG

Dive Team

Divers Alert Network 1-919-684-9111

Dive Rescue International 1-800-248-3483

IADRS 1-800-IADRS-911

Dive Rescue International, Inc. 201 North Link Lane Fort Collins, CO 80524 (800) 248-3483 Fax (970) 482-0893 www.DiveRescueIntl.com

Swiftwater Rescue Emergency Action Plan

A written Emergency Action Plan (EAP) is an important component in mitigating an emergency. In an effort to make certain that a water rescue team is prepared Dive Rescue International requires all trainers to complete the following form and keep a printed copy in their instructor / trainer manual. A completed EAP form needs to be on file at the Dive Rescue International office prior to instructor / trainer certification and recertification. These forms should be updated as needed and resubmitted to Dive Rescue International at a minimum of every three years during the recertification process.

After filling in the necessary blanks on the previous page, complete the information on this page:

Date

Instructor Name

Name of Agency

Address

City

State

 

Zip

 

 

 

 

 

Ext.

 

 

 

 

Work Phone Number

 

 

 

 

 

 

Type

 

 

 

 

 

 

 

 

 

 

 

 

 

Alternate Phone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Work Email

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Home Email

 

 

 

 

 

Remember to keep a printed copy in your trainer manual and on your apparatus. Should an accident happen, all members of your team should be familiar with this plan. NIOSH investigators may likely ask to see a copy of your written Emergency Action Plan. You may also consider adding the Emergency Action Plan to your SOPs/SOGs.

Additional copies of this form are available online at DiveRescueIntl.com

Please note: The EMAIL TO DIVE RESCUE INTERNATIONAL button works with email applications such as Microsoft Outlook Express, Microsoft Outlook, Eudora or Mail. If you currently use an Internet email service such as Yahoo or Hotmail, you will need to save the form and return it manually to swatson@diverescueintl.com using your Internet email service.

Dive Rescue International, Inc. 201 North Link Lane Fort Collins, CO 80524 (800) 248-3483 Fax (970) 482-0893 www.DiveRescueIntl.com

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This PDF form requires particular details to be filled in, so be certain to take whatever time to provide what's asked:

1. Whenever submitting the dive rescue plan, be sure to complete all of the needed blank fields in its associated section. This will help to expedite the work, allowing for your information to be handled fast and appropriately.

Writing section 1 in dan emergency action plan template

2. Once your current task is complete, take the next step – fill out all of these fields - Emergency Equipment in Vicinity, Oxygen Delivery Unit REQUIRED, First Aid Kit REQUIRED, Advanced Life Support Equipment, Turn patientscene over to the, Pass on information as needed, Document the incident, Obtain statements from witnesses, Notify Supervisor, Identify Trained EMS Providers in, Contact Dive Team if needed, Paramedics, EMTs, Other, and Other Items Recommended On Site with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

dan emergency action plan template completion process clarified (stage 2)

As for Obtain statements from witnesses and Advanced Life Support Equipment, make sure you take another look in this current part. These two could be the most important fields in the PDF.

3. This step will be straightforward - fill out every one of the blanks in Date, Instructor Name, Name of Agency, Address, City, Work Phone Number, Alternate Phone Number, Work Email, Home Email, Zip, State, Ext, and Type in order to complete this part.

Stage number 3 for submitting dan emergency action plan template

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