1. BLS Medical Incident Report Form Education Module for 2011
Basic Training Course
(Complete Dataset)
Welcome to the Medical Incident Report Form Education Session. This presentation was put together for use by EMS agencies to train personnel on how to complete the 2011 BLS Medical Incident Report Form (MIRF).
This presentation is designed to be generic in content and does not reflect individual agency data collection systems. You are welcome to amend the document to meet your agency needs and preferences.
All comments and suggestions for changes to this presentation should be addressed to:
Emergency Medical Services Division
401 5th Avenue, Suite 1200
Seattle, WA 98104
ATTN: Michele Plorde
Prepared by the Division of Emergency Medical Services
Prepared by the Division of Emergency Medical Services

2. Education Module Goals
Train new EMS personnel
Provide a review for experienced EMS personnel
GOALS:
To train new EMS personnel in King County on how to use the current BLS Medical Incident Report Form (MIRF).
To update experienced EMS personnel in King County on how to use the latest MIRF form.

3. Education Module Contents
Basic information & general instructions
Aftercare Instructions Highlight
2011 MIRF dataset
Education Module Contents:
Basic information: Importance of the MIRF
General instructions: Basic guidelines for completing MIRFs
2011 MIRF dataset: Step by step instructions for every data element in the King County dataset

4. Basic Information & General Instructions

5. Why the MIRF is Important
Medical
The MIRF (both electronic and paper) is part of the patient’s medical file.
The MIRF transfers information between patient care providers.
Legal
Confidentiality
Patient Refusal
MIRF Signature
The MIRF reports are read by many people. The information is used for different purposes. The more accurate and thorough your MIRF, the better and the more professional it appears.
Medical: The Medical Incident Report Form is a medical document and is part of the patient’s medical record. Both the electronic MIRF and the paper short form are part of the patient’s electronic record. The electronic information provided is NOT merely the ‘data’, but actually part of the medical record. Therefore, when completing a MIRF, it is important to maintain confidentiality and be thorough.
Legal: MIRFs may be subpoenaed for court cases and you may be called to testify perhaps well after the incident has occurred. MIRFs will help you recall the incident and provide documentation of exactly what was done.
Confidentiality: Medical information you collect about a patient is confidential. Please remember the following guidelines in regards to confidentiality:
Only give a patient’s medical information to someone who has a legal right as dictated by your agency’s written release of patient records policy.
Only put sensitive information into your report if it impacts the care or treatment decisions concerning that patient, and only if it is for the patient’s benefit.
Federal and State laws exist regarding confidentiality/privacy (WAC, HIPAA)
Don’t leave any MIRFs laying around the station, even just for a moment. Keep them in a folder or in designated covered spots. Store MIRFs in locked, secure locations.
Patient Refusal: If you are unable to get consent for treatment or transport, follow the instructions for completing the patient refusal form on the back of the first page of the MIRF.
MIRF Signature: The EMS personnel who obtains the history and performs the exam must complete the MIRF.

6. Why the MIRF is Important (continued)
Quality Review
Planning/Funding
Medic unit placement, levy funding
Research
Resuscitation Outcome Consortium (ROC)
Aftercare Instructions Pilot Project
Quality Review: A supervisor in your agency, as well as the EMS Division, review run reports for quality of patient care and system evaluation. It is also used by training officers to evaluate an individual’s progress and performance.
Planning/ Funding: MIRFs provide statistical information about the number and type of emergency responses and the mechanism and type of injuries or illnesses. Such information is important for justifying funding, locating medic units, and planning for future services. City and county councils and fire commissioners want to see reliable information before making expensive funding commitments.
Research: MIRF information is an important part of EMS efforts to evaluate new types of care or dispatch. Examples include the Resuscitation Outcome Consortium (ROC) and the SPHERE research projects.

7. Components of a Good Report
Completeness
All available information regarding the incident or patient care should be recorded.
Accuracy
Describe exactly what happened.
Correct spelling
Legibility (on paper forms)
Writing an accurate and thorough MIRF report is very important. The data you provide in your report has a direct impact on the patient as well as others in the EMS system. A thorough report makes it easier to understand the patient’s condition.
Completeness:
All available information regarding the incident and patient care should be recorded.
Fill out the entire MIRF as completely as possible. This information is analyzed by both your agency and the EMS Division. Such information is critical in implementing improvements to our regional EMS system, planning for new services, and determining funding.
Document all of your actions and observations.
Accuracy:
Describe exactly what happened. Be honest and candid about what you saw and did. Be objective and factual as if you were a bystander watching the incident.
Never try to cover up documentation errors – draw a single line through the error and continue writing.

8. Components of a Good Report (continued)
Narrative: use S.O.A.P format:
Subjective
Objective
Assessment
Plan
The SOAP format is simple and provides a framework for all of the necessary information while following a directed-exam patient assessment. Fill out the narrative as accurately and thoroughly as possible, keeping in mind that future readers of the narrative should be able to visualize what you experienced in person. In cases of legal review, the narrative is usually the first MIRF element examined.
Narrative: Use the S.O.A.P. format:
Subjective - What you were told regarding the patient. What you learned from the patient, bystanders, or witnesses. Briefly tell the story of what happened, including major symptoms and complaints described by the patient. Should include mechanism of injury, medical history, and medications.
Objective - The objective section documents your physical exam, including vital signs and results of physical assessments. It should focus on the chief complaint and reflect a systemic physical exam.
Assessment - Your best guess about the patient’s medical condition. This is not a diagnosis but your impressions about the patient’s condition.
Plan - What you plan to do to address the assessed conditions.

9. Basic Instructions
An electronic record is created by CAD/Dispatch for every call/incident.
When completing the paper (short) form in the field, use a ball point pen and press hard enough to mark through all copies.
Complete the electronic record, verifying that the CAD information has been received, and augmenting this information where appropriate.
Refer to your agency protocols regarding exceptions to completing the paper (short) form.
*******
Agencies using the paper (long) form should complete a form for every call/incident.
An electronic record is created for every call (including cancelled calls and patient refusals).
Exceptions for completing a paper ‘short’ form may include cancelled calls or no illness/no injury calls. Refer to your agency protocols for guidance.
Use a ball point pen and press hard enough to mark through all copies of the paper ‘short’ form. Again, this is very important because all copies of the MIRF should clearly reflect the same information. Writing on a hard surface helps writing show up on all copies.

10. Paper MIRF Pages REVISED! Agency copy EMS copy Medical Review copy
Patient copy
Aftercare Instructions: The backer provides health information to patients.
REVISED!
Agency Copy (Black)
You keep this copy. This is the agency legal copy. If subpoenaed, this is the one used.
EMS Copy (Red)
Submit a copy to the EMS Division only for CPR & Defibrillation incidents and for agreed upon research studies.
Medical Review Copy (Green)
This is reviewed by training officers, medical directors, etc. for quality assurance.
Patient (Brown)
This copy goes with the patient to definitive care.
NOTE: All copies must be the same. Any changes made should be reflected on all copies.
Revised: Aftercare Instruction (Black)
This is a backer with instructions for patients with health information provided by EMS provider. 10

11. Completing the MIRF The person who provided primary care should:
Sign your name
Print your name
Write your EMS number

12. Patient Refusal Follow the instructions on the back of the MIRF.
Fill in patient’s name, and the date.
Read the statement slowly & clearly to the patient. Ask if they understand what it says.
Have the patient/guardian sign in the appropriate spots.
If patient/guardian refuses or you are unable to obtain a signature, make a note to that effect.
Obtain a signature from a witness and note their EMS agency affiliation or address.

13. Aftercare Instructions Highlight
Aftercare Instructions are being highlighted for additional training. 13

14. Aftercare Instructions Highlight
The backer is to be given to ALL patients.
Aftercare instructions are located on the back of last page of the MIRF (both short and long form) for a variety of health conditions. CHECK ALL APPLICABLE boxes:
Patient was Not Transported
Low Blood Sugar Information
High Blood Pressure Information
Falls
Community Resources Information
REVISED!
NEW! 14

15. Aftercare Instructions Highlight (cont.)
Not Transported
Patient left at scene or transported by a private occupancy vehicle.
Transported
Patient transported by BLS, ALS, or a private ambulance. 15

16. Aftercare Instructions Highlight (cont.)
Low Blood Sugar
Patient was treated for hypoglycemia and not transported.
High Blood Pressure
Patient with a systolic ≥ 160 OR diastolic ≥ 100.
Falls
NEW! 16

17. Aftercare Instructions Highlight (cont.)
Community Resources – Can be offered to any patient in need of social services including:
Caregiver & Disability Resources
Domestic Violence
Emergency Shelter
Financial Assistance for Rent or Utilities
Food & Clothing
Health Care & Support Groups
Legal Help

18. 2011 MIRF Dataset Incident Data (in alphabetical order)
Patient Data (in alphabetical order)
The following reflects the remaining 2011 EMS dataset.

19. Incident Data Action Taken Agency Incident Number Aid Type
(Incident Level) Action Taken: NFIRS code that best describes the most significant action taken at the incident level and at the unit (apparatus) level. This will allow the EMS Division to determine cancelled calls and standbys on a unit by unit basis. This is especially important for ALS calls where the BLS unit is NOT cancelled and the ALS unit IS cancelled. Does not apply to non-NFIRS agencies.
Agency Incident Number: Enter the unique numeric incident number assigned to your agency. Do not use any unit or agency identifiers.
Aid Type: Mutual aid given or received. Mutual aid defined as requested aid; Automatic aid - sent by dispatch. For fire departments, if dispatched together, then automatic aid is provided, if called from the scene, then mutual aid is provided.

20. Incident Data (Cont.) Date Time Arrived on Scene
Date Time Dispatch Notified
Date Time In Service
Date Time Last Response Unit Leave Scene
Date Time Primary PSAP Notified
Date Time Unit Notified by Dispatch
Date Time Unit Responded
Date Time Arrived on Scene: Date and time unit stops physical motion at scene (last place that the unit or vehicle stops prior to assessing the patient). MM,DD,YYYY and HH:MM:SS
Date Time Dispatch Notified: Date and time of first connection with EMS dispatch. This used to be called 'call time' on the paper MIRF. It is now called 'Time Dispatch Notified'.
Date Time in Service: Date and time response unit back in service or available for response. MM,DD,YYYY and HH:MM:SS Not "Date/Time" that the unit leaves the scene. Rather, the time the unit is back in service and available for the next call.
Date Time Last Response Unit Leave Scene: Date and time last response unit leaves scene. MM,DD,YYYY and HH:MM:SS
Date Time Primary PSAP Notified: ate and time call is first received by Primary Public Service Answering Point or other designated entity. MM,DD,YYYY and HH:MM:SS. Currently this information is not available in cases where the Dispatch Center is also not the PSAP.
Date Time Unit Notified by Dispatch: Date and time response unit is notified by EMS dispatch. Format should be coded as MM,DD,YYYY and HH:MM:SS This is commonly referred to as "Dispatch Time".
Date Time Unit Responded: Date and time the responding unit begins physical motion toward the scene. MM,DD,YYYY and HH:MM:SS. Commonly called 'turnout time'.

21. Incident Data (cont.) First Agency on Scene ID
First EMS Reporting Agency on Scene
First Unit on Scene
Geocode
First Agency on Scene ID: The ID number of the first EMS Agency to arrive at the scene. If you are the first agency, enter your agency's ID.
First EMS Reporting Agency on Scene: First EMS reporting agency on scene? Are you the first agency on scene that will be responsible for recording the incident information?
First Unit on Scene: The unit number of the first EMS unit to arrive at the scene. Must be entered except for cancelled enroute calls.
Geocode: Ascertain the correct King County EMS geocode from your geocode map. This number may be up to four digits. This code is numeric only.

22. Incident Data (cont.) Incident Address Incident City Incident County
Incident State
Incident Type (NFIRS)
Incident Zip Code
Incident Address: Address, patient transfer point, or location where patient was found, or, if no patient, address to which unit responded.
Incident City: City (if applicable) where patient was found or to which unit responded.
Incident County: County incident took place in.
Incident State: State incident occurred in. Information to be generated from other sources, not to be filled in by EMS personnel unless the incident occurred outside of the state of Washington.
Incident Type (NFIRS): NFIRS Incident Type Code from the NFIRS Basic Module. This information will help the EMS Division in characterizing responses as EMS or Fire. Does not apply to non-NFIRS agencies.
Incident Zip Code: Zip code where patient was found or where unit responded.

23. Incident Data (cont.) Initial (Incident) Dispatch Code (IDC)
Location Type
Outside Agency Incident Number
Property Use (NFIRS)
Reporting Agency Number
Reporting Unit ID Number
Responding from Quarters
Responding in Fire District Code
Initial (Incident) Dispatch Code (IDC): The Initial Dispatch Code should be obtained from the dispatch center that dispatched your unit. This code comes directly from the criteria-based dispatch guidelines implemented countywide. Agencies should not modify the IDC, nor create one themselves if an IDC is not received from the dispatch center.
Rationale: Valuable for comparing the actual findings once the EMS crew arrived on scene to the initial dispatch code. This will help dispatchers refine the process they use to determine what resources are needed to more accurately dispatch the appropriate resources to the patient.
Location Type: Mark the geographic location type where the patient was found.
Rationale: When paired with incident types may be very useful for directing prevention programs to specific locations or populations.
Outside Agency Incident Number: Incident numbers for outside agencies providing mutual aid to an incident.
Property Use (NFIRS): The location of the incident. This information is mapped to the 'Location Type' pick list for those agencies that are required to collect Property Use (those agencies do NOT need to collect the 'Location Type' data). Does not apply to non-NFIRS agencies.
Reporting Agency Number: State FDID number for your agency. For agencies not assigned an FDID, a KC EMS assigned number should be used.
Reporting Unit ID Number: Unit Identification Number assigned by EMS provider agency.
Responding from Quarters: Was the unit in quarters at the time of the alarm?
Responding in Fire District Code: This is the fire district service area where the incident occurred. Use code as assigned by King County EMS or State the FDID code.

24. Incident Data (cont.) Response Delay Type Response Mode
Treatment Crew Member Name
Response Delay Type: The response delays, if any, of the unit associated with the patient encounter. For example, if traffic conditions affect your response, ‘traffic’ should be chosen from the list of delay types.
Response Mode: Enter the response mode used en route to this call.
Treatment Crew Member Name: Complete the treatment crew member names on your electronic form per your agency protocol. Record all treatment crew member names as indicated on the paper ‘short’ form.

25. Patient Data (Cont.) Action Taken Allergies
Date/Time Arrived at Patient’s Side
Date/Time Arrived at Treatment Facility or Transfer Point
Date/Time Extrication is Completed
Date/Time Patient Left Scene
EMS ID Number of Person Completing Form
Date/Time Arrived at Patient’s Side: Date and time response personnel establish direct contact with patient. MM,DD,YYYY and HH:MM:SS Not to be used in all instances, only where there is deemed to be a delay between arriving at the scene and initial patient contact (~ 1 minute). Examples may include patients that are in high rise buildings, in a remote area distant from any roads, unsafe or staged scenes, or otherwise not readily accessible. Arrived at scene = arrived at staging.
Date/Time Arrived at Treatment Facility or Transfer Point : Date and time when patient arrives at treatment facility or transfer point. MM,DD,YYYY and HH:MM:SS
Date/Time Extrication is Completed: Date and time that extrication was completed. Extrication means removal from an entrapment or entanglement by using special tools or devices. It includes entrapment from any source, not just those resulting from motor vehicle accidents. Completed by both ALS and BLS.
Date/Time Patient Left Scene: Date and time transporting unit begins physical motion from scene. MM,DD,YYYY; HH:MM:SS Should be reported by the transporting agency.
EMS ID Number of Person Completing Form: The ID number assigned by the EMS Agency to the person who completed the EMS data entry for this report.

26. Patient Data (Cont.) Flow Chart Time Blood Pressure Pulse Rate
Respiratory Rate
ECG Rhythm*
Oxygen*
Pulse Oximetry
Glucometry
IV fluids (liters) - ALS ONLY
DC Shock/AED Used
Medications
TIME: Record the time the vitals were taken in 24 hour format
BLOOD PRESSURE: Enter both Systolic & Diastolic blood pressure.
The first systolic blood pressure observed, in mm of HG.
The first diastolic blood pressure observed, in mm of HG.
If measured by palpation enter P. If blood pressure measured by doppler, enter D. (i.e. 170/P or 132/D).
PULSE RATE: Indicate patient’s palpated or ausculated pulse rate expressed in beats per minute. Leave blank if no pulse rate was obtained. The pulse rate must be palpated or ausculated. An electrical rhythm is not sufficient, as the patient could have electromechanical dissociation (pulseless electrical activity).
RESPIRATORY RATE: Unassisted patient respiratory rate expressed as respirations per minute.
PULSE OXIMETRY: If Pulse Oximeter is used, record the patient’s oxygen saturation (02 saturation from 0 to 100%.). Enter numbers only.
GLUCOMETRY: If glucometry was conducted, record all measurements.
DC SHOCK: Record defibrillations in this box by indicating the number of Joules of the shock. Also indicate the date and time the first defibrillation shock was delivered.
Medications Admin. By EMS Personnel: Medications given to patient by EMS personnel.

27. Patient Data (Cont.) Flow Chart (cont.) ECG Rhythm 01 Sinus Rhythm
02 Asystole
04 Other
11 Ventricular Fibrillation
U0 Unknown
Revision: New coding.
ECG RHYTHM: Record the ECG Rhythm. If unknown or unavailable, check unknown.

28. Patient Data (Cont.) Flow Chart (cont.) Oxygen Mechanism
1 Non-rebreather
2 Nasal Cannula
3 Bag Valve Mask
4 Blow-By
5 Other (see Narrative)
6 BVM + ITD
The notes section of the flow chart can be used for notes or for extended flow chart information
Revision: New coding.
OXYGEN: Indicate the mechanism of O2 delivery to the patient. Also record flow volume for initial O2 provided to the patient, in liters/min.

29. COMPONENTS OF THE GLASGOW COMA SCORE
Patient Data (Cont.)
Glasgow Coma Eye Opening Component
Glasgow Coma Motor Response
Glasgow Coma Verbal Response
Glasgow Coma Score (GCS)
GLASGOW COMA SCORE (GCS)
GCS is a standardized system for assessing the level of consciousness (or neurological response) of the patient. GCS provides information about severity of neurologic disorder. Reaction scores are in numerical values.
The total GCS is obtained by adding the scores of three areas:
Eye opening
Verbal response
Motor response
Essential for trauma patients, desired for head bleeds, neurological patients, and suspected drug overdoses. Optional for other patients.
A score of 7 or less indicates coma, and a score of 9 or more rules out coma.
COMPONENTS OF THE GLASGOW COMA SCORE
EYE OPENING
Patients eye opening component of the Glasgow Coma Scale.
Mark the box which most closely describes the patient’s opening of his/her eyes.
4. Spontaneously
3. To Voice
2. To Pain
1. No Response
VERBAL RESPONSE
Patients verbal component of the Glasgow Coma Scale
Mark the box which best describes the patient’s verbal response.
5. Oriented – the patient is oriented.
4. Confused – the patient appears confused but uses appropriate words.
3. Inappropriate words – the patient uses inappropriate words.
2. Incomprehensible – the patients verbalizations are incomprehensible
1. No Response – the patient has no verbal response
MOTOR RESPONSE
Patients verbal component of the Glasgow Coma Scale.
Mark the box which best describes the patient’s motor response.
6. Obeys Commands – Patient obeys commands
5. Locates Pain – Patient locates the pain
4. Withdraw from Pain – the patient withdraws purposely from pain
3. Flexion to Pain – the patient flexes or bends arm(s) in response to sternal or orbital ridge pressure
2. Extension to Pain – the patient extends arm(s) in response to orbital or sternal pressure
1. No Response – patient exhibits no response to any pain stimuli

30. Patient Data (Cont.) Highest Level of Care Provided
Mass Casualty Incident
Medical Facility Contacted Name
Medical Person Contacted Name
MIRF Number
Highest Level of Care Provided: Indicates the highest level of care provided to the patient at the scene.
Mass Casualty Incident (MCI): Indicates if existing EMS resources were overwhelmed and the event was considered an MCI.
Medical Facility Contacted Name : Name of medical facility contacted. Leave blank if no facility contacted.
Medical Person Contacted Name : Name of the medical person contacted. Leave blank if no person contacted.
MIRF Number : Indicates pre-printed unique number located on MIRF.

31. Patient Data (Cont.) Narrative Use the S.O.A.P. format: Subjective
Objective
Assessment
Plan

32. Patient Data (Cont.) Onset of Symptoms Patient Age, Units
Patient Date of Birth
Patient Street Address, City, County, State, Phone
Patient First Name, Middle Initial, Last Name
Patient Gender
Patient Health Care Provider, Phone
Onset of Symptoms:
Record as elapsed time (Days, hours, and minutes)
Rationale: This information is helpful to emergency department personnel. It is also valuable in determining how quickly aid is requested when a medical emergency occurs. In the future we may be able to better educate the public to call for help sooner when it is medically appropriate.
Patient Age, Units: If age is unknown make an estimate. If a child is less than two years old, enter number of months, or days, whichever is appropriate. Do not enter months if the patient is more than two years old. Units:
1 Years
2 Months
3 Days
4 Hours
5 Minutes
Patient Date of Birth: MM,DD,YYYY If you unable to obtain the patient’s date of birth leave it blank.
Patient Address, City, County, State, Phone: Please do your best to provide as much information as possible. If homeless write NONE.
Patient Gender: Use unknown for those patients whose gender is not identified.
Patient Healthcare Provider, phone: Enter the name and number of a private physician, hospital, or clinic if obtainable

33. Patient Data (Cont.)
Patient Mechanism Code (refer to the electronic pick list)
Patient Medications Taken at Home
Patient Parent or Legal Guardian
Patient Suspected Alcohol or Drug Use
Patient Type Code
Patient Medications taken at Home: Record the name of all prescribed medications taken by the patient at home for those medications not in the provided list. Record the ID of all prescribed medications taken by the patient at home.
Patient Parent or Legal Guardian replaces the Nearest Relative information.
Patient Suspected Alcohol or Drug Use: Detected smell of alcoholic beverages on the patient's breath or suspected the use of drugs. Check Yes or No for all trauma/injury incidents. If unknown or not applicable, leave blank.
Patient Type Code: The EMS personnel’s impression of the patient’s primary problem or most significant condition which led to the management.

34. Patient Data (Cont.) Procedures
Check all boxes for procedures performed.
For procedures only: write the procedure number and the EMS number of the person who performed the procedure
Treatment Crew Member Number for Procedure
PROCEDURES: Check only the boxes of any procedures performed.
PROCEDURE NUMBER AND EMS NUMBER: This section is used to identify individuals who performed special procedures.
If procedure are performed, write the procedure number and the EMS number of the EMS personnel who performed the procedure. All other procedures do not need EMS numbers.
If the same procedure was performed by two persons (e.g., I.V.s or DC shock by EMT), then the procedure number must be written twice, followed by each of the EMS numbers.
Rationale: Intended to provide planners and educators with procedures used, by whom, and in what types of situations. Thus it is a measure of how well the protocols are working to provide a patient with the best care possible.
Treatment Crew Member Number for Procedure: This section is used to identify individuals who perform special procedures. If the same procedure was performed by two persons, then the procedure must be written twice, followed by each of the EMS numbers. Record only procedures your agency performs.

35. Patient Data (Cont.) Safety Equipment
Signature of Person Completing Form
Transport Agency Number
Transport Delay Type
Transport Destination
Transport Unit Number
Safety Equipment: Safety equipment used by the patient at the time of the injury.
Signature of Person Completing Form: Enter the name of the individual that wrote the report.
Transport Agency Number: Write the transporting agency code based on best information available at the time, even if it was not your agency who transported. Required for all incidents where there is a patient.
Transport Delay Type: The transport delays, if any, of the unit associated with the patient encounter (see response delay for example).
130 Directions 135 Distance
140 Diversion HazMat
150 None Other
160 Safety Staff Delay
170 Traffic Vehicle Crash
180 Vehicle Failure Weather
125 Crowd
Transport Destination: Enter the code of the transport destination for each patient, if it is known. Required for all incidents where the patient was transported.
Transport Unit Number: Provide the unit designation/code that identifies the transporting unit for patient transport.

36. 2011 MIRF Changes
The following reflects changes made in the 2011 EMS dataset. 36

37. Incident Type (NFIRS)
Incident Type coding has been revised over the past few years. Here are some highlights of the current coding:
EMS call, Cancelled at Scene
EMS call, Unintentional medical alert activation
EMS call, Vehicle accident with no injuries (use if you want to create a patient record)
EMS call, Flu-like symptoms
EMS call, Vehicle accident with no injuries (standard NFIRS code-patient record not allowed)
EMS call, Dispatched & cancelled enroute 37

38. BLS THE END Medical Incident Report Form Education Module for 2011
THANK YOU!
Prepared by the Division of Emergency Medical Services
Prepared by the Division of Emergency Medical Services