VASARS Dispatch Incident Report

VASARS Dispatch Incident Report

• Document No.

• Conducted on

  Date
• 10503 Wakeman Drive Manassas, VA 20110 866-246-9552
  Address

• Name of Person Taking Report:

• Date/Time of Report:

  Date

• Responding Crew:

• Pilot:

• Flight Officer #1

• Flight Officer #2

• Other:

Time Line:

• Dispatch Time/Date:

  Date

• Wheels Up:

  Date

• Arrival Time on Incident:

  Date

• Departure Time from Incident:

  Date

• Return to Base. Down Safe and Secure

  Date

Incident Information

• Type of Incident

  Select PLI LE Support SAR Coast Guard Request Training Other

  • PLI
  • LE Support
  • SAR
  • Coast Guard Request
  • Training
  • Other

• Agency Requesting Service

• Agency Point of Contact/Title

• EOC:

• Mobile Number:

• Other Contact Numbers:

• Command Frequency:

• Incident Address:

• City

• State

• Zip

• GPS Coordinates:

• PLS Frequency

• Target information

• Add media

  Media

• Was Patient Contact Established?<br>

  Yes

  No

• Patient Name

• Date of Birth

• SSN

• Address

• City

• State

• Zip

• Type of insurance

• Drug allergies

• Medications

• Vital signs

• Level of consciousness

  awake and oriented

  disoriented

  not arousable

  unresponsive

• Pulse

• Respirations

  normal

  labored

  shallow

• Lung sounds

  clear

  rales

  diminished

  wheezing

• Blood pressure

• Respirations rate

• SPO2

• Was Treatment Provided?

  Yes

  No

• Describe Patient Condition and Treatment Provided:

• Treatment Provided By:

• Transfer of care

  Yes

  No

  N/A

• Agency

• Signature of agencies Provider

  Sign

• Incident Narrative