PEMS Medical Control Incident Report
Fax Copy of PPCR to PEMS at (804) 693-6234
Date: Time: PPCR #
EMS Agency:
AIC: Technician 2:
Technician 3:
Receiving Facility:
Receiving Physician:
Submitted by: Email:
Reasons for Review (Check appropriate boxes):
Unable to establish contact with Medical Control
Physician not available Communications Failure
Medical Control treatment needed but not performed
Life threatening situation Non-life threatening situation
Medical Control treatment initiated without physician order:
Regarding treatment orders from on-line Medical Control Physician
Regarding EMS patient treatment or actions
SUMMARY: