Governor S Ems Awards

2013Virginia

EMS Awards Program!

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State EMS Advisory Board and Regional EMS Councils Will Recognize EMS Providers, EMS Agencies and Organizations

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2013Regional EMS Awards Program

The Old Dominion EMS Alliance along with the other 10 Regional EMS Councils will conduct its 2013 Regional EMS Awards program, hold a recognition ceremony and publicize the regional winners in ourRegion. This statewide regional recognitionwill honor the exceptional contributions that members of the Virginia’s EMS system make in their communities and help them to be more visible to the people they serve.

Regional first place winners will be sent by the Regional EMS Councils to the Governor’s EMS Advisory Board to compete at the state level in the

Governor’s EMS Awards.

Governor’s EMS Awards Program

Recipients of the 2013Governor’s EMS Awards will be announced and presented with a certificate signed by the Governor and an awards trophy at the Virginia EMS Awards Reception on Saturday, November 9, 2013 during the 34thAnnual Virginia EMS Symposium at the Norfolk Waterside Marriott, November 6-10, 2013.

Scholarship for High School Senior

$1,000 Scholarship for Outstanding Contribution to EMS

by a High School Senior. The Regional Winner will be Eligible to Win $5,000 Scholarship from Governor’sEMS Advisory Board.

2013REGIONAL COUNCIL EMS AWARDS

NOMINATION FORM

Guidelines

Anyone may submit nominations for the Regional EMS Awards.
For all categories the nomination may be based on a pattern of conduct/activities that has culminated in an exceptional improvement of the emergency medical services system in the locality, region or state. The nomination may also be based on a single unusual event that was beyond ordinary duty.
Using the official 2013 Nomination Form on the Regional EMS Council webpage, nominations can be submitted electronically or typed on the 2013 Nomination Form and e-mailed to the Regional EMS Council.
The person making the nomination should have extensive knowledge of the nominee’s qualifications and carefully select the category that most appropriately matches the nominee’s accomplishments.
The nominee must have current licensure or certification in the category in which he or she has been nominated.
Up to three letters of commendation, newspaper/periodical articles, a brief resume and other materials may be attached to the nomination form, but only three will be accepted.
Any nomination that is not submitted through the Regional Awards Program is invalid and will not be presented to the Governor’s EMS Awards Selection Committee.

Deadline

ODEMSA Regional EMS Awards Nomination Deadline: The deadline for all entries is 5:00 p.m. on Friday, July12, 2013. Mail your signednominations electronically to . Please remember to include a picture of the nominee.

Regional EMS Awards Selection Process

A panel representative of previous Regional EMS Award Winners will review the applications and recommend the Regional winners.

Presentation of Awards

The ODEMSA Regional EMS Awards will be presented during a ceremony to honor all nominees that will be scheduled in July 2013.

INQUIRIES

Please call ODEMSA at (804) 560-3300 or email Holly Sturdevant, ODEMSA Special Programs Coordinator, at if you have questions.

CRITERIA FOR AWARDS

REGIONAL AWARD FOR EXCELLENCE IN EMERGENCY MEDICAL SERVICES

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 individual engaged in emergency medical services.

REGIONAL AWARD TO THE OUTSTANDING PRE-HOSPITAL PROVIDER

CRITERIA: An individual who exemplifies outstanding dedication and service to his or her community through involvement with EMS.

ELIGIBILITY: Any individual who routinely provides pre-hospital care, primarily in Virginia, and is affiliated with at least one Virginia licensed EMS agency and who is certified as a pre-hospital EMS provider by the Commonwealth of Virginia.

REGIONAL AWARD TO THE Physician with OUTSTANDING CONTRIBUTION TO EMS

CRITERIA: An EMS physician who exemplifies outstanding leadership and dedication in the exercise of pre-hospital care.

ELIGIBILITY: Any licensed physician who is actively involved with pre-hospital care, training or mentorship of pre-hospital 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.

REGIONAL AWARD TO THE OUTSTANDING EMSPRE-HOSPITALEDUCATOR

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 pre-hospital 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-B, EMT Enhanced, EMT Intermediate, EMT Paramedic, continuing education courses, preceptor programs or equivalent EMS training.

ELIGIBILITY:A Virginia EMS educator.

REGIONAL AWARD TO THE NURSE WITH OUTSTANDING CONTRIBUTION TO EMS

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 pre-hospital provider or instructor should be nominated for those categories.

ELIGIBILITY: Any Virginia licensed nurse serving in an active position.

REGIONAL AWARD TO THE OUTSTANDING EMS ADMINISTRATOR

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.

REGIONAL AWARD TO THE OUTSTANDING EMS AGENCY

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.

REGIONAL AWARD FOR OUTSTANDING CONTRIBUTION TO EMS HEALTH AND SAFETY

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 health, safety and welfare of EMS providers.

ELIGIBILITY:Any individual, program, business or licensed EMS Agency within the Commonwealth of Virginia.

REGIONAL AWARD FOR OUTSTANDING CONTRIBUTION TO EMS FOR CHILDREN

CRITERIA: An individual, organization or program that exemplifies outstanding dedication and service to the contribution, development and/or enhancement of EMS for children.

ELIGIBILITY: Any individual, organization or program with a significant contribution to the development or enhancement of EMS for children in Virginia. Services cover a continuum of care, from injury prevention to pre-hospital care, emergency department and hospital services, and rehabilitation.

REGIONAL AWARD TO THE OUTSTANDING

EMS TELECOMMUNICATIONS DISPATCHER

Eligibility: An emergency medical telecommunicator, public safety answering point administrator, supervisor or training officer whoseoutstanding dedication and service has demonstrated an exceptional contribution to the improved delivery of emergency medical services in the local, regional or statewide EMS system.

Criteria: An emergency medical telecommunicator, public safety answering point administrator, supervisor or training officer who is employed or volunteers with an organized emergency medical services dispatch center or public safety answering point in Virginia.

REGIONALEMS AWARDS

2013 NOMINATION FORM

Check only one category on this nomination form. Make copies of the form to submit more than one nomination. Nominate only one person, agency or organization in a category. Failure to have nominee in most appropriate category may result in the nomination not being considered.Onlyone award is given in each category.

______Award for Excellence in EMS

______Award to the Outstanding Pre-Hospital Provider

______Award to the Physician with Outstanding Contribution to EMS

______Award to the Outstanding EMSPre-Hospital Educator

______Award to the Nurse with Outstanding Contribution to EMS

______Award to the Outstanding EMS Administrator

______Award to the Outstanding EMS Agency

______Award for the Outstanding Contribution to EMS Health and Safety

______Award for Outstanding Contribution to EMS for Children

______Award to the Outstanding EMS Telecommunications Dispatcher

NOMINEE’S NAME: ______

(first) (middle initial) (last)

ADDRESS: ______City ______State VA ZIP ______

PHONE: Work ______Home ______E-mail ______

AGENCY AFFILIATION: ______POSITION: ______

NOMINATION SUBMITTED BY- NAME: ______

ADDRESS: ______City ______StateVA ZIP ______

NOMINATOR’S PHONE: Work ______Home ______

NOMINATOR’S SIGNATURE ______Date ______

Regional Award for Excellence in EMS

Nomination Form

ELIGIBILITY: Any individual engaged in emergency medical services.

____ Award for Excellence in EMS

Nominee Name:
Address: / Street:
City: / State: / Zip:
E-mail:
Agency Affilation: / Position:
Nomination Submitted By:
Address: / Street:
City: / State: / Zip:
E-mail:
Phone: / Work: / Cell:

NOMINATOR’S SIGNATURE ______Date ______

DOCUMENTATION SUPPORTING NOMINATION

Excellence in EMS

Read each statement carefully and answercompletely. Limit documentation to the information requested. Up to three documents may be attached to the nomination form. Of these items, one letter of support written by someone other than nominator must be included. Other documents may include a resume or CV, a newspaper article written about the nominee, etc.
The following three items must be addressed in a number-by-number format:

Brief Abstract of Person or Agency being Nominated: Provide a background and overview of the nominated individual or EMS Agency. Summarize and justify why this person/program/agency should receive this award.
How has this person/program/agency exemplified outstanding dedication and service to the statewide Virginia emergency medical services system?
Why is this nominee exceptionally qualified and selected for this award?

Brief Description of Contributions byIndividual or EMS Agency Nominated: Describe in detail the criteria and contributions to EMS in Virginia that the nominee has met in this award category.
How has this person/program/agency demonstrated a commitment to a comprehensive, integrated system of emergency medical services throughout the Commonwealth?
Describe the nominee’s qualities and contributions (local, regional and state) to EMS in Virginia.

Success & Accomplishments in EMS: Provide a description of the successes and accomplishments of this person or agency in EMS, to include honors, awards (civic or professional) that highlight their contribution to EMS and the community.

Photo Required: A photo of the nominee must be included. Try to send a color photo (with good lighting) with just the nominee in it. If it is an agency or organization, the photo can be a group shot of agency members, shot of agency headquarters or a logo.

Important: Please send high resolution digital photos with 300 DPI or greater. Please do not send photos of I.D. badges. These are not high enough quality and do not show clearly when presented on a PowerPoint at the Governor’s EMS Awards ceremony. This will help assure the best image when used in publicity and printing.

Regional Award for Outstanding Contribution

to EMS Health & Safety

Nomination Form

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 health, safety and welfare of EMS providers.

ELIGIBILITY: Any individual, program, business or licensed EMS Agency within the Commonwealth of Virginia.

Examples of programs meeting eligibility for this award would 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. Eligible applicants include persons or entities developing or managing such programs.

_____ Award for the Outstanding Contribution to EMS Health and Safety

Nominee Name:
Address: / Street:
City: / State: / Zip:
E-mail:
Agency Affiliation: / Position:
Nomination Submitted By:
Address: / Street:
City: / State: / Zip:
E-mail:
Phone: / Work: / Cell:

NOMINATOR’S SIGNATURE ______Date ______

DOCUMENTATION SUPPORTING NOMINATION

Contribution

to EMS Health & Safety

Brief Description of Individual or EMS Agency Nominated: Provide a brief overview of the nominated individual, program, business or licensed EMS Agency within the Commonwealth of Virginia.
Why does this program/accomplishment deserve to be recognized?

Brief Abstract of Accomplishment/Program: Summarize the justification and criteria for why this nominee’s accomplishment/program should be recognized.
Describe the accomplishment/program, including its objectives and clientele being served.
Describe the demonstrated comprehensive and/or significant accomplishments/programs that make a contribution to or provide for the health, safety and welfare of EMS providers.

The Results/Success of the Program: Provide a description of the results and success of the accomplishment/program.
Describe how the objectiveswere met.
Provide examples and outcome measurements when possible.
Give detailed results analysis of the program.

Regional Award for Nurse with Outstanding Contribution to EMS

Nomination Form

ELIGIBILITY: Any Virginia licensed nurse serving in an active position.

____ Award for Nurse with Outstanding Contribution to EMS

Nominee Name:
Address: / Street:
City: / State: / Zip:
E-mail:
Agency/ Hospital Affiliation: / Position:
Nomination Submitted By:
Address: / Street:
City: / State: / Zip:
E-mail:
Phone: / Work: / Cell:

NOMINATOR’S SIGNATURE ______Date ______

DOCUMENTATION SUPPORTING NOMINATION

Contribution to EMS - Nurse

Brief Abstract of Person being Nominated: Executive summary and justification for why this Nurse should receive this award.
Why does this nurse exemplify outstanding service in emergency medical services?
Describe this nominee’s knowledge and performance of EMS nursing skills.
How does this nominee practice high standards of cooperation and leadership with other EMS personnel and agencies?

Description of Contributions to EMS in Virginia: Describe the nominee’s contributions (local, regional and state) to EMS and emergency nursing in Virginia.
Does this nomineeperform a nursing role in a hospital or clinical setting, such as precepting or quality assurance programs?
Does this nominee demonstrate excellence as a pre-hospital provider or instructor? If so, then would this nominee bebetter suitedfor one of those categories?

Enhancement of EMS Care and Nursing (local, region or state): Describe how this nurse goes above and beyond to assist the EMS system and help provide the best care to their patients.
Does this nurse participate with programs that help to further enhance EMS and patient care?
Does this nurse sit on any local, regional or state committees?