Ics 206 Wf Form PDF Details

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QuestionAnswer
Form NameIcs 206 Wf Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesics medical form, ics 206 form, nwcg ics forms, nwcg form

Form Preview Example

MEDICAL PLAN (ICS 206 WF)

Controlled Unclassified Information//Basic

1. Incident/Project Name

2. Operational Period

3.Ambulance Services

Name

Complete Address

Phone

&

EMS Frequency

Advanced Life Support (ALS)

Yes No

4. Air Ambulance Services

Name

Phone

Type of Aircraft & Capability

 

 

 

 

 

 

 

 

 

5.

Hospitals

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GPS Datum – WGS 84

 

 

 

 

 

 

 

 

 

 

 

 

Coordinate Standard

 

 

 

 

 

 

 

 

Name

 

 

Degrees Decimal Minutes

 

 

 

 

Helipad

Level

 

 

 

 

Travel Time

 

 

 

 

 

DD° MM.MMM’ N - Lat

 

 

of Care

 

 

 

 

 

 

 

 

 

Complete Address

 

 

 

Air Gnd

Phone

Yes

No

 

 

DD° MM.MMM’ W - Long

 

Facility

 

 

 

 

 

 

 

 

 

 

 

 

Lat:

 

 

 

 

 

 

☐

☐

 

 

 

 

Long:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VHF:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lat:

 

 

 

 

 

 

☐

☐

 

 

 

 

Long:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VHF:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lat:

 

 

 

 

 

 

☐

☐

 

 

 

 

Long:

 

 

 

 

 

 

 

 

 

 

 

 

VHF:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lat:

 

 

 

 

 

 

☐

☐

 

 

 

 

Long:

 

 

 

 

 

 

 

 

 

 

 

 

VHF:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.

Division | Branch |

Group

 

Area Location Capability

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMS Responders & Capability:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Equipment Available on Scene:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Medical Emergency Channel:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ETA for Ambulance to Scene:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Air:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ground:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Approved Helispot:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lat:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Long:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMS Responders & Capability:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Equipment Available on Scene:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Medical Emergency Channel:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ETA for Ambulance to Scene:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Air:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ground:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Approved Helispot:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lat:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Long:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ICS 206 WF (03/18)

Controlled Unclassified Information//Basic

 

MEDICAL PLAN (ICS 206 WF)

 

Controlled Unclassified Information//Basic

7. Name & Location

Remote Camp Location(s)

 

 

 

Point of Contact:

 

 

 

EMS Responders & Capability:

 

 

 

Equipment Available on Scene:

 

 

 

Medical Emergency Channel:

 

 

 

ETA for Ambulance to Scene:

 

 

 

Air:

 

 

 

Ground:

 

 

 

Approved Helispot:

 

 

 

Lat:

 

 

 

Long:

 

 

 

Point of Contact:

 

 

 

EMS Responders & Capability:

 

 

 

Equipment Available on Scene:

 

 

 

Medical Emergency Channel:

 

 

 

ETA for Ambulance to Scene:

 

 

 

Air:

 

 

 

Ground:

 

 

 

Approved Helispot:

 

 

 

Lat:

 

 

 

Long:

 

 

8. Prepared By (Medical Unit Leader)

9. Date/Time

10. Reviewed By (Safety Officer)

11. Date/Time

ICS 206 WF (03/18)

Controlled Unclassified Information//Basic

MEDICAL PLAN (ICS 206 WF)

Controlled Unclassified Information//Basic

Medical Incident Report

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.

U s e t h e f o l l o w i n g i t e m s t o c o m m u n i c a t e s i t u a t i o n t o c o m m u n i c a t i o n s / d i s p a t c h .

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.”

 

☐ RED / PRIORITY 1 Life or limb threatening injury or illness. Evacuation need is IMMEDIATE

Severity of Emergency / Transport

☐

Ex: Unconscious, difficulty breathing, bleeding severely, 2o – 3o burns more than 4 palm sizes, heat stroke, disoriented.

YELLOW / PRIORITY 2 Serious Injury or illness. Evacuation may be DELAYED if necessary.

Priority

☐

Ex: Significant trauma, unable to walk, 2o – 3o burns not more than 1-3 palm sizes.

 

GREEN / PRIORITY 3 Minor Injury or illness. Non-Emergency transport

 

 

Ex: Sprains, strains, minor heat-related illness.

Nature of Injury or Illness

 

 

 

&

 

 

Brief Summary of Injury or Illness

Mechanism of Injury

 

 

(Ex: Unconscious, Struck by Falling Tree)

 

 

 

 

Transport Request

 

 

Air Ambulance / Short Haul/Hoist

 

 

Ground Ambulance / Other

 

 

 

 

 

 

 

Patient Location

 

 

Descriptive Location & Lat. / Long. (WGS84)

 

 

 

 

Incident Name

 

 

Geographic Name + "Medical"

 

 

(Ex: Trout Meadow Medical)

 

 

 

On-Scene Incident Commander

 

 

Name of on-scene IC of Incident within an

 

 

Incident (Ex: TFLD Jones)

 

 

 

Patient Care

 

 

Name of Care Provider

 

 

(Ex: EMT Smith)

 

 

 

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

Patient Assessment: See IRPG page 106

Treatment:

4. TRANSPORT PLAN:

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

Helispot / Extraction Site Size and Hazards:

5. ADDITIONAL RESOURCES / EQUIPMENT NEEDS:

Example: Paramedic/EMT, Crews, Immobilization Devices, AED, Oxygen, Trauma Bag, IV/Fluid(s), Splints, Rope rescue, Wheeled litter, HAZMAT, Extrication

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 *

COMMAND

AIR-TO-GRND

TACTICAL

7.CONTINGENCY: Considerations: If primary options fail, what actions can be implemented in conjunction with primary evacuation method? Be thinking ahead.

8.ADDITIONAL INFORMATION: Updates/Changes, etc.

REMEMBER: Confirm ETA's of resources ordered. Act according to your level of training. Be Alert. Keep Calm. Think Clearly. Act Decisively.

ICS 206 WF (03/18)

Controlled Unclassified Information//Basic

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This PDF doc will involve specific information; in order to guarantee correctness, please make sure to heed the subsequent tips:

1. Start completing your nwcg form with a group of major blanks. Consider all the necessary information and ensure not a single thing omitted!

The right way to fill in ics medical form stage 1

2. Once your current task is complete, take the next step – fill out all of these fields - Complete Address, Degrees Decimal Minutes DD MMMMM N, DD MMMMM W Long, Travel Time Air, Gnd, Phone, Lat, Long VHF, Lat Long VHF, Lat Long VHF, Lat Long VHF, Division Branch Group, Area Location Capability, of Care Facility, and Yes No with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Part number 2 for completing ics medical form

It's very easy to make errors while filling out the Lat Long VHF, therefore make sure that you take a second look before you'll finalize the form.

3. Within this part, look at Approved Helispot, Lat, Long, EMS Responders Capability, Equipment Available on Scene, Medical Emergency Channel, ETA for Ambulance to Scene, Air, Ground, Approved Helispot, Lat, Long, ICS WF, and Controlled Unclassified. Every one of these should be filled out with utmost attention to detail.

Writing part 3 in ics medical form

4. It's time to fill out the next section! Here you will have all these Name Location, Remote Camp Locations, Point of Contact, EMS Responders Capability, Equipment Available on Scene, Medical Emergency Channel, ETA for Ambulance to Scene, Air, Ground, Approved Helispot, Lat, Long, Point of Contact, EMS Responders Capability, and Equipment Available on Scene fields to do.

Tips to prepare ics medical form portion 4

5. As you come near to the end of your document, you'll find just a few extra points to do. In particular, Ex Communications I have a Red, Meadow Medical IC is TFLD Jones, Ex Unconscious difficulty, RED PRIORITY Life or limb, Ex Significant trauma unable to, Ex Sprains strains minor, Severity of Emergency Transport, Priority, Nature of Injury or Illness, Mechanism of Injury, Transport Request, Patient Location, Incident Name, OnScene Incident Commander, and Patient Care must all be filled out.

Part no. 5 for filling in ics medical form

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