Level 3 Field Operations Guide (fog) or Handbook



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MEDICAL PLAN

1. INCIDENT

NAME


2. DATE

PREPARED



3. TIME

PREPARED




4. OPERATIONAL PERIOD

5. INCIDENT MEDICAL AID STATIONS

MEDICAL AID STATIONS

LOCATION

PARAMEDICS

YES

NO



























































6. TRANSPORTATION

A. AMBULANCE SERVICES

NAME

ADDRESS

PHONE

PARAMEDICS

YES

NO










































































B. INCIDENT AMBULANCES

NAME

LOCATION

PARAMEDICS

YES

NO



























































7. HOSPITALS

NAME

ADDRESS

TRAVEL TIME

PHONE

HELIPAD

BURN CENTER

AIR

GRND

YES

NO

YES

NO











































































































8. MEDICAL EMERGENCY PROCEDURES











9. PREPARED BY (MEDICAL. UNIT LEADER)

10. REVIEWED BY (SAFETY OFFICER)






ICS 206 8-78

ICS - Safety





GENERAL MESSAGE


TO:

POSITION

FROM:

POSITION

SUBJECT

DATE

TIME

MESSAGE
































REPLY





































DATE

TIME

SIGNATURE/POSITION

ICS Form 213, 1/79 NFES 1336

UNIT LOG


1. INCIDENT NAME

2. DATE

PREPARED


3. TIME

PREPARED


4. UNIT NAME/ DESIGNATORS

5. UNIT LEADER (NAME AND POS.)

6. OPERATIONAL

PERIOD


7. PERSONNEL ROSTER ASSIGNED

NAME

ICS POSITION

HOME BASE








































































































































8. ACTIVITY LOG (CONTINUE ON REVERSE)

TIME

MAJOR EVENTS



























































ICS 214











US&R TASK FORCE PATIENT CARE FORM

DATE:

TIME:

PT. NAME:

AGE: SEX:

LOCATION:

SS #: - -

MISSION NAME:

TASK FORCE:


MEDICAL HISTORY

MEDICATIONS/ALLERGIES

________________________________________

________________________________________

________________________________________

________________________________________

________________________________________

________________________________________

_____________________________

_____________________________

_____________________________

_____________________________

_____________________________

_____________________________

PHYSICAL EXAM



__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

MEDICATIONS

VITAL SIGNS

TYPE

DOSE

ROUTE

TIME

INITIALS


TIME

B.P.

PULSE

RESP.

TEMP.
























































































































































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