PEMS Regional Outstanding EMS Call of the Year Nomination Form


Criteria for this award: Any EMS response by licensed EMS agency in the PEMS region.

Incident:*
Agencies or Organizations involved:*
Date of event:
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Submitter Information
Submitted by:*
Submitter E-mail:*
Submitter Phone:*
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Brief Description of Incident:
Describe the event. Include unusual complexities, coordination issues, problems overcome, etc.*
What is it about this call that demonstrates mutual aid, integration of multiple system components, interagency interfacing and cooperation, or complex assessment and rescue?*
Resume/CV:
Describe how the call conforms to standard EMS protocols of prehospital care, including scene safety.*
Supporting Documents:
Upload High Resolution Photographs:
Other supporting documents (newspaper/periodical articles, press releases, etc.)
Ready to submit?

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