Fort Collins Interagency Dispatch Center

MEDICAL EMERGENCY CHECK LIST

FTC States: “All Units, There is a Medical Emergency, Please Clear This Frequency”

****ALL INCIDENTS SHOULD BE COORDINATED BY THE APPROPRIATE COUNTY OR NPS 911 CENTER. USE THIS FORM ONLY IF FTC IS THE ONLY CONTACT POINT****

****Immediately Start Electronic Recording and All Radio Operators Begin Written Log****

Incident Name:
Date:
Time:
Reporting Party:
Nature of Injury:
Location of Patient:
Is There an EMT with the Patient? / Yes / No
Who is the EMT with the Patient?

Vital Patient Information

Time: / Pulse: / Blood Pressure:
Age: / Sex: / Respirations:
Resource Identification:

(Crew Name, Overhead, etc…)

Notes:

Transportation Request

Air Transportation: / Ground Transportation:
Point of Pickup:
Latitude: / Longitude:
Directions:

(Continued on Back)

Time: / Caller: / Notes:

ACCIDENT COMMUNICATION PROCEDURE FOR FTC

Contact the Local 911 Center, IC, FDO and Line Officer in all injury situations. DO NOT use the name of the injured individual over the radio. Methods of evacuation should be based on the severity of the injury.

Non-Emergency Ground Transport – Minor and non-life threatening serious injuries. Vehicles may transport from the scene or from ICP.

Non-Emergency Air Medivac – Minor and non-life threatening serious injuries in remote areas without road access. Helicopter transport.

Emergency Air Medivac – Any life or limb-threatening injury or illness. Critical and life threatening serious injuries. Helicopter transport.

MEDIVAC INFORMATION

Is the injury:critical______serious_____minor_____

Type of injury:______

Is the patient conscious?Yes_____no_____

Is the patient experiencing any difficulty breathing? Yes_____No_____

Is an EMT present and giving treatment?Yes_____No_____

Is an EMT needed?Yes_____No_____

Is Advanced Life Support ( ALS) neededYes_____No_____

Specific location of patient (DP/HELISPOT/GPS coordinates)______

______

Medivac Radio Procedures Check List

Clear the Command Channel for critical and serious injuries

“All units, restrict traffic to EMERGENCY traffic ONLY; we have a medical incident.

Immediately notify the unit FDO on duty

Acquire pertinent medivac information on form above.

If air transportation is required, notify IC and /or Air Support

Keep log of all departure and arrival times and other pertinent information in Red ink

When the emergency is over, clear all radio traffic for normal use.

Notify unit Compensation/Claims if FDO has not

Have the following Unit Leaders initial after incident is complete.

RADOFTC Center ManagerFDOLine Officer

______

Date and Time ____/____/______hrs.

FTC AREA 911 DISPATCH CENTERS
DISPATCH CENTER /

DEPARTMENT PHONE NUMBER

/ DISPATCH NUMBER / DISPATCH FAX
Adams County: Brighton, Co. /

303-654-1850

/ 303-288-1535 / 303-287-2942
Arapahoe County: Centennial / 303-795-4711 / 303-795-4711
720-874-3965 / 720-874-3954
Boulder County /

Boulder, CO

/ 720-564-2975
303-441-4444 / 303-441-4480
Broomfield CountyBroomfield, Co. / Contact Dispatch / 24hr.
303-438-6400 / 303-438-6485
Clear Creek County /

Georgetown, CO

303-679-2376 / 303-679-2393
303-679-2394 / 303-679-2442
ColoradoState Patrol /

Northeast CO

Ft.Collins / 303-239-4501
970-224-3027 / 303-239-4485
970-224-3151
Denver County / Contact Dispatch / 720-913-2000 / 720-913-2020
Estes Park /

Estes Park, CO

/ 970-586-4000 / 970-586-4496
Evergreen Fire Dispatch /

Evergreen, CO

/ 303-674-2323
Fort Collins Police /

Fort Collins, CO

/ 970-221-6545 / 970-221-6864
Jefferson County Dispatch /

Jefferson County

/ 303-277-0211
Gilpin County /

Golden, CO

(5 miles N of Blackhawk at Hwy 46/Hwy 119) / 303-582-5500
or 5511 / 303-582-3758
Grand County /

Hot Sulphur Springs, CO

970-725-3343 / 970-725-3311 / 970-725-3227
Jackson County: Walden, Co. / Contact Dispatch / 970-723-4242 / 970-723-4740
Kit Carson County:Burlington / 719-346-8934 / 719-346-9325 / 719-346-7282
Larimer County (900) /

Fort Collins, CO

/ 970-416-1985 / 970-498-9105
Logan County: Sterling, Co. / Contact dispatch / 970-522-3512 / 970-522-1267
Loveland also for Berthoud and Big Thompson /

Loveland, CO

Dispatch / 970-667-2151
970-962-2200 / 970-962-2914
MorganCounty /

Fort Morgan, CO

/ 970-867-8531 / 970-542-3400
Poudre Fire Authority /

Fort Collins, CO

/ 970-221-6546 / 970-221-6864
Phillips County: Holyoke, Co. / 970-854-3644 / 970-854-2735 / 970-854-4069
Summit County: Breckenridge / 970-453-2232 / 970-668-8600 / 970-668-4224
Washington County: Akron / 970-345-2244 / 970-848-0464 / 970-848-0160
Weld County /

Greeley, CO

/ 970-356-1212 / 970-304-6501
AlbanyCounty /

Laramie, WY

/ 307-721-2526 / 307-721-5341
Laramie County: Cheyenne / 307-633-4700 / 307-637-6524 / 307-637-6599

REQUEST INFORMATION - HELICOPTER AMBULANCE

  1. Injury Information:

1. Total personnel involved in mishap ______

2. Time of mishap ______

3. Type or extent of injuries (vitals, other medical personnel on scene):

______.

______.

______.

______.

B. Mishap Site Information:

1. Unit/Agency:______.

2. Contact telephone number:______.

3. Radio frequency to contact unit/agency: VHF-AM_____ VHF-FM______

4. Location of mishap:

a. Township______Range______Section______1/4 Section______

b. Latitude______Longitude______

c._____Nautical miles at______Degrees from______VOR

d. Prominent landmark: Distance______.

Direction______.

5. Site Contact:______.

Radio frequency at mishap site:

Primary: VHF-AM______, VHF-FM______

Secondary: VHF-AM______, VHF-FM______

6. Other known aircraft in the area (call signs):______.

Air-to-Air Frequency:

Primary: VHF-AM______, VHF-FM______.

Secondary: VHF-AM______, VHF-FM______.

7. Special information, flight hazards, etc.:______.

______.

______.

8. Landing site(s) and conditions (is it completed or when will it be completed):

______.

______.

9. Proximity of landing site to mishap site: ______.

______.

______.

10. Nearest available AV Gas/Jet A fuel: ______.

11. Conditions at the mishap site:

Wind direction___ , Wind velocity ___,

Ceiling and visibility____ , Obstructions to visibility ____,

Obstructions to visibility______.

Temperature _____,

Degrees (F or C)_____ , Elevation______, Sunrise ___

Sunset_____ , Description of Terrain______

Note: EMS helicopters do not usually carry extrication equipment nor are the EMS personnel always trained in

these procedures: Ensure that if is capability is needed, it is immediately ordered from a locally known source

(the local sheriff is a logical contact point).

HELICOPTER AMBULANCE SERVICE IN FTC AREA

LOCATION / FACILITY / CALL SIGN / TYPE
A/C / PHONE NUMBER / LAT/LONG / COMM-ENTS
Denver North
CO37
Denver Central CO04
Summit County Medical Center, Frisco
Colorado Springs,
CO CO23 / St. Anthony’s Hospital Systems “Flight For Life”
Pinrose Hospital / Lifeguard 1
Lifeguard 2
Lifeguard
3 / AS-350 B-3
AS-350 B-3
AS-350 B-3 / 303-629-3900
1-800-332-3123 / 39 44.360’ x 105 02.290’
39 34.090’ x 106 04.430’
38 56.370’
104 43.080’ / St. Anthony’s can also provide fixed wing EMS capability to any hospital requested
Skyridge
Fredrick/Firestone
Aurora North / Aurora Presbyterian Hospital “Airlife” / Airlife 72
Airlife 73
Airlife 74 / Bell 407
Bell 407
Bell 407 / 303-360-3400800-821-1994
877-243-8247 / Has fixed wing capability
Greeley, CO CO98 / North Colorado Medical Center “Medavac” / Medavac 911 / Bell 407 / 800-247-5433 / 40 24.57’ x 104 42.17’ / Greeley, CO98CO
Erie / Medavac / Bell 407 / 800-247-5433
Cheyenne, WY (Warren AFB) FEW (to mob contact AFRCC 800-851-3051) / Military Assistance Traffic & Safety MAST / Blade # / UH-1N / 07:30-16:30
307-773-2001Other Hours307-773-3921 / 41 08’ x 104 52’ / Request MAST Helicopter. Hoist and infrared capabile.
COMMERCIAL PHONE / 24 HOUR PHONE
LOCAL LAW ENFORCEMENT: / 911
COUNTY/STATE LAW ENFORCEMENT: / 911
HOSPITAL: Poudre Valley Hospital – Fort Collins / 970-495-7000
HOSPITAL: Medical Center of the Rockies / 970-624-1854: 24-Hour
970-624-1854: Front Desk
HOSPITAL: University Hospital - Aurora / 720-848-0000 / Has Burn Center
HOSPITAL: McKee Medical Center / 970-669-4640
HOSPITAL: North Colorado Medical
Center - Greeley / 970-352-4121 / Has Burn Center
ROCKY MOUNTAIN POISON CENTER: / 800-332-3073
GROUND AMBULANCE SERVICE: / 911 / 911
LOCAL UTILITY COMPANIES:
GAS:
ELECTRIC: / 911 / 911
EMS HELICOPTER: / See Helicopter Ambulance Service
MILITARY HELICOPTER (EMS): / Contact AFRCC
800-851-3051
FIXED WING AMBULANCE SERVICE:

TRANSPORTING INJURED PERSONNEL BY HELICOPTER

USING “HEAR” (Hospital Emergency Administrative Radio) SYSTEM

When transporting injured personnel by helicopter under Agency Contract, the local Dispatch Center will telephone the appropriate hospital and request they monitor their “HEAR” system radio. The aircraft pilot or manager will tune in the “HEAR” Frequency (normally 155.340 as primary) on the aircraft multi channel radio and establish direct communication with the hospital staff. Helicopter will verify frequency through the Dispatch Center.

Local Police will be requested to secure landing area when needed.

This procedure is to be used only for emergencies that warrant immediate hospital service.

EMERGENCY RESPONSE TELEPHONE LIST

FOREST SERVICE ACCIDENT/INCIDENT AGENCY CONTACT LIST

FOREST CONTACT / NAME / OFFICE/CELL/PAGER / HOME PHONE
DOI-AM / USFS / 1-888-4MISHAP
1-888-464-7427
FOREST SUPERVISOR / Glenn Casamassa / 970-295-6601
P-571-214-3777 / C-970-219-3114
H-970-689-3180
FOREST AVIATION OFFICER / Geoff Bell / See below / Sell below
FIRE MANAGEMENT OFFICER / Geoff Bell / 970-295-6631
970-229-8636 Pager / H- 970-667-1406
C- 970-217-9814
Fort Collins Interagency Dispatch Center / 970-295-6800
ADMINISTRATIVE OFFICER / Robin Winston / 970-295-6694 / H-970-674-9401
C-720-635-4443
PUBLIC INFORMATION OFFICER / John Bustos / 970-295-6674 / H-970-225-0677
C-970-556-3850
LAW ENFORCEMENT OFFICER / Robert Bryant / 970-295-6678 / H-
C-
FOREST SAFETY MANAGER / Matthew Clementi / 970-295-6672 / H-
C-970-217-0190