HomeMy WebLinkAboutDispatch Review CheklistBEAUMONT FIRE -RESCUE - QUALITY ASSURANCE PROGRAM
DISPATCH REVIEW CHECK LIST
[i] Incident #: [z] Unit:
[4] Dispatcher (if known):
[s] EMT AIC (if known):
[6] Reviewed by: [ ] MASG QA Coordinator
[ ] MASG QA Chair
[ ] Other
[ ] Other
[ ] Other
[ ] Other
[ ] Other
[3] DATE/TIME OF CALL:
Name:
Name:
Name:
Name:
Name:
Name:
Name:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
[7] Priority: Based on [ ] SFRF [ ] Tape [s] Nature of Call:
[9] Dispatched As: [io] Dispatch Time:
[ii] Extenuating Circumstances: [ ] Yes [ ] No [12] if Yes, explain:
[13] Age of Patient: [ia] Gender: [ ] F [ ] M [is] Patient Care Level [ ] BLS [ ] Intermediate [ ] Paramedic
A. CLINICAL AUDIT A= Acceptable/Appropriate I= Improvement Needed U= Unacceptable/Inappropriate
RFI = Requires Further Investigation NA= Not Applicable
A I U RFI NA
[16] Dispatch Time
[17] Quickest Unit Dispatched
[is] Problem & Directions Clear
[19] Dispatch ofBLS/ALS
[zo] Trauma Team Activation
[211 Dispatch of Add. Resources
[zs] B. NOTES
[29] C. ACTION TAKEN BY DISPATCH.
[so] D. ACTION TAKEN BY QA COMMITTEE
[31] E. ACTION TAKEN BY EMS DIRECTOR
[32] F. FOLLOW-UP REQUESTED
A I U RFI NA
[22] Cancellation
[23] Policy Adherence
[24] Radio Reception
[zs] Overall Performance
[z6] Other:
[27] Other:
[ ] notification only
[ ] notification only
[ ] notification only
[ ] none
[ ] see attached pages
[ ] see attached pages
[ ] see attached pages
[ ] see attached pages
[ ] see attached pages