Award Categories and Nomination Forms

Fill out a form in one of the below categories that you think most closely aligns with the reason that you are submitting the nomination and a  PEMS staff member will contact you for more information.

Excellence in EMS  Download the PDF here .  Download the Word document here . (Fill out the application and fax to 804-302-6073 or scan and send to: This email address is being protected from spambots. You need JavaScript enabled to view it.).

• CRITERIA: An individual who exemplifies outstanding dedication and service to the statewide Virginia
  emergency medical services system, and has demonstrated a commitment to a comprehensive, integrated system of
  emergency medical services throughout the Commonwealth.
• ELIGIBILITY: Any living individual, in good standing, engaged in emergency medical services within the
  Commonwealth of Virginia, with significant contributions at the local, regional, state and national level. Individuals
  should maintain a current Virginia EMS certification (where applicable) and have no outstanding or pending notices
  of enforcement actions taken against them.

Regional EMS Award for Innovation Excellence in EMS     Download the PDF here   or      Download the Word document here . (Fill out the application and fax to 804-302-6073 or scan and send to: This email address is being protected from spambots. You need JavaScript enabled to view it.).).

• CRITERIA:  An EMS provider, EMS agency or private/public organization involved in Emergency Medical Services that exemplifies innovative excellence and advancement in the statewide Virginia Emergency Medical Services system, and that has demonstrated a commitment to an innovation, comprehensive and unified system of Emergency Medical Services throughout the Commonwealth.
• ELIGIBILITY: Any individual, EMS agency, program, organization, public or private entity involved in Emergency Medical Services.

Outstanding EMS Leadership (formerly named Outstanding EMS Administrator)  Download the PDF here .    Download the Word document here.  (Fill out the application and fax to 804-302-6073 or scan and send to: This email address is being protected from spambots. You need JavaScript enabled to view it.).).

• CRITERIA: An individual who has demonstrated ability to organize, conduct, manage, problem solve and evaluate within his or her organization and, by exemplary leadership and administrative skills, improve the effectiveness, response and delivery of EMS.
• ELIGIBILITY: Any person responsible for chairing, presiding over, supervising or administering EMS organizations and/or personnel in Virginia.

Outstanding EMS Agency   Download the PDF here . Download the Word document here . (Fill out the application and fax to 804-302-6073 or scan and send to: This email address is being protected from spambots. You need JavaScript enabled to view it.).

• CRITERIA: An EMS agency that exemplifies outstanding professionalism and service to its community; whose high level of patient care is evident by innovative training, community awareness, preventive health programs, public relations efforts and participation in local, regional and statewide EMS systems.
• ELIGIBILITY: Any currently licensed or official agency that is recognized by the state or federal government that is based in Virginia and is directly responsible for responding to emergencies or disasters and providing the direct delivery of care. Includes governmental, commercial, volunteer, hospital, industrial and air ambulance services.

Outstanding Prehospital Provider    Download the PDF here . Download the Word document here . (Fill out the application and fax to 804-302-6073 or scan and send to: This email address is being protected from spambots. You need JavaScript enabled to view it.).

• CRITERIA: An individual who exemplifies outstanding dedication and service to his or her community through involvement with EMS. An individual that serves a mentor in growth and development of the EMS field.
• ELIGIBILITY: Any individual who routinely provides prehospital care, primarily in Virginia, is affiliated with at least one Virginia licensed EMS agency, and who is certified as a prehospital EMS provider by the Commonwealth of Virginia.

Physician with Outstanding Contribution to EMS   Download the PDF here . Download the Word document here . (Fill out the application and fax to 804-302-6073 or scan and send to: This email address is being protected from spambots. You need JavaScript enabled to view it.).

• CRITERIA: An EMS physician who exemplifies outstanding leadership and dedication in the exercise of prehospital care.
• ELIGIBILITY: Any licensed physician who is actively involved with prehospital care, training or mentorship of prehospital providers in the Commonwealth. This can include emergency room physicians, operational medical directors, or other physicians who dedicate their time and knowledge to furthering education and patient care in EMS.

Nurse with Outstanding Contribution to EMS     Download the PDF here . Download the Word document here . (Fill out the application and fax to 804-302-6073 or scan and send to: This email address is being protected from spambots. You need JavaScript enabled to view it.).

• CRITERIA: A nurse who exemplifies outstanding service in emergency medical services; knowledge and performance of EMS nursing skills; and high standards of cooperation and leadership with other EMS personnel and agencies. Highest consideration is given to performing a nursing role in a hospital or clinical setting such as precepting or quality assurance programs. Nurses who have demonstrated excellence as a prehospital provider or instructor should be nominated for those categories.
• ELIGIBILITY: Any Virginia licensed nurse serving in an active position.

Outstanding Prehospital Educator  Download the PDF here . Download the Word document here . (Fill out the application and fax to 804-302-6073 or scan and send to: This email address is being protected from spambots. You need JavaScript enabled to view it.).

• CRITERIA: A provider who exemplifies outstanding teaching and leadership qualities while participating as an educator in an EMS program. Must have coordinated or consistently demonstrated excellence and a dedication to the education of prehospital EMS providers. The nominee must have participated as an instructor, coordinator or adjunct faculty in an EMS program for at least two years. Educational programs include: First Responder, EMT-Basic, EMT Enhanced, EMT Intermediate, EMT Paramedic, continuing education courses, preceptor programs or equivalent EMS training.
• ELIGIBILITY: A Virginia EMS educator.

Outstanding Contribution to EMS for Children  Download the PDF here . Download the Word document here . (Fill out the application and fax to 804-302-6073 or scan and send to: This email address is being protected from spambots. You need JavaScript enabled to view it.).

• CRITERIA: An individual, organization or program that exemplifies outstanding dedication and service to the contribution, development and/or enhancement of EMS for children in Virginia.
• ELIGIBILITY: An individual, organization or program with a significant contribution to the development or enhancement of EMS for children in Virginia. Services may cover a continuum of care, from injury prevention to prehospital care, emergency department and hospital services, and rehabilitation.

Outstanding Contribution to EMS Telecommunication   Download the PDF here . Download the Word document here . (Fill out the application and fax to 804-302-6073 or scan and send to: This email address is being protected from spambots. You need JavaScript enabled to view it.).

• CRITERIA: An emergency medical telecommunicator, public safety answering point administrator, supervisor or training officer whose outstanding dedication and service has demonstrated an exceptional contribution to the improved delivery of emergency medical services in the local, regional , statewide and or national EMS system.
• ELIGIBILITY: An emergency medical telecommunicator, public safety answering point administrator, supervisor or training officer who is employed by or volunteers with an organized emergency medical services dispatch center or public safety answering point in Virginia.

Outstanding Contribution to EMS Health & Safety  Download the PDF here . Download the Word document here . (Fill out the application and fax to 804-302-6073 or scan and send to: This email address is being protected from spambots. You need JavaScript enabled to view it.).

• CRITERIA: Any individual, program, business or licensed EMS agency within the Commonwealth of Virginia that has demonstrated comprehensive and/or significant accomplishments/programs that make a significant contribution to or provide for the physical or mental health, safety and well-being of EMS providers.
• ELIGIBILITY: Any individual or official agency that is recognized by the state or federal government that
  is based in Virginia and is directly responsible for the health, safety and well-being of all people in Virginia.
  Examples include EMS provider health and wellness programs (fitness and wellness, cardiovascular health),
  scene safety programs (aeromedical operations, emergency vehicle operations), and provider injury prevention
  programs (injury prevention at violent scenes) designed to prevent line of duty death and injury. 

Outstanding Contribution to EMS Emergency Preparedness & Response  Download the PDF here . Download the Word document here . (Fill out the application and fax to 804-302-6073 or scan and send to: This email address is being protected from spambots. You need JavaScript enabled to view it.).

• CRITERIA: Any individual, EMS organization or EMS response group within the Commonwealth of
  Virginia that has demonstrated comprehensive and/or significant accomplishments for programs that provide
  preparedness, response and recovery from natural, man-made and preplanned events, which cause a significant
  impact on the agency and the community.
• ELIGIBILITY: Any individual currently licensed or official agency that is recognized by the state or federal
  government that is based in Virginia and is directly responsible for responding to emergencies or disasters and
  providing the direct delivery of care. Includes Disaster Response Teams, Community Emergency Response
  Teams, Continuity of Operations Planning, Mass Casualty Incident Training programs, all-hazards planning,
  emergency management partnerships and surge event planning.

Outstanding Contribution to EMS by a High School Senior or GED Recipient   Download the PDF here .   Download the Word document here . (Fill out the application and fax to 804-302-6073).

• This competitive $1,000 scholarship will be awarded to a high school senior or GED recipient under the age of 21, who has been affiliated with an EMS agency for at least 90 days, and who is currently enrolled or will be enrolled in an institution of higher learning or an accredited ALS training program in the coming year.

  The Regional Winner will receive a $1,000 Scholarship for Outstanding Contribution to EMS by a High School Senior or GED recipient. The Regional Winner will be Eligible to Win $5,000 Scholarship at the State level.

Call of the year (Regional Award)  Submit Online! or Download the PDF here . Download the Word document here . (Fill out the application and fax to 804-302-6073).

• CRITERIA: An outstanding EMS call which occurred in the Peninsulas EMS Region in the last year that demonstrates mutual aid, integration of multiple system components, interagency interfacing and cooperation, or complex assessment and rescue. The call must conform to standard EMS protocols of prehospital care, including scene safety.
• ELIGIBILITY: Any Peninsulas EMS region EMS call, from initiation into the system until resolution at a health care facility, thus including the roles of dispatcher, EMS agencies, EMS providers, bystanders, hospital care providers and/or others who provided EMS.

Previous EMS Award Winners