On-line PreHospital Save Award Nomination

Region 1

Western Massachusetts Emergency Medical Services, Inc.  

Welcome to the new WMEMS - Region 1 On-line Pre-Hospital Save Award Nomination process! We are very pleased that you are taking the time to nominate someone for one of the many WMEMS Awards and Recognitions. 

The big change in the new awards program is that 95% of the process is done on-line. You are still required to send a hard-copy of the patient run form to the WMEMS office by fax or USPS mail. Eventually, 100% of the nomination process will be acheived using only this on-line system.

Before you begin the online submission process, please take a moment to read ALL of the instructions below.

Good luck!  

Categories  

The WMEMS Awards Committee recognizes the efforts of prehospital and civilian providers through three categories of awards:

1.PrehospitalSave:

A prehospital save is presented when EMS personnel or a civilian are directly responsible for maintaining or improving a patient's condition in the prehospital setting. This action then allows the patient to lead a meaningful and productive post-incident life whereas the demise of the patient would have occurred without the intervention. We also include cases of exceptionally demonstrated skills done within the realm of certification, which enhance a patient's condition and/or recovery.

2.Meritorious:

Refer to an individual's effort which exceeds the call of duty while on or off the job. We will not present awards to people who foolishly enter dangerous situations.

3. Recognition:

To recognize an individual whose efforts within their field are directly responsible for benefiting the prehospital field. rescues, incidents of longduration or calls of a difficult nature can also apply to this category.

Nomination Approval

If the nomination is approved by the Awards Committee, a letter informing the recipient of the award will be sent, a certificate presented at the appropriate County EMS Committee award function during EMS Week in May and authorization to wear the appropriate bar (dependent upon dept or company policy). We ask that the individual organizations purchase the citation bars. Management will receive a copy of the recipient's letter for two reasons:  

1. Notifies management that the nomination was received and approved.

2. Provides management with a copy of award letter for recipient's personnel file.

Deadline for Submissions

In order to allow for the Awards Committee to review nominations and for the office to print the certificates, all nominations must be submitted by the March 1st. The award certificates will be presented during the County EMS Committee's award function during EMS Week (always the third week in May).

Instructions  

Step 1 - Complete and Submit Sections 1 and 2 using the on-line application below

Step 2 - Black-out or remove all patient demographic (i.e., name, address, SS#, etc.) information on Run Form

Step 3 - Mail or Fax a hard-copy of Run Form using the WMEMS contact information below  

             (BLS and ALS Run Form if intercept utilized)  

             Your award submission cannot be processed until WMEMS receives a copy of the Run Form  

Step 4 - Please feel free to mail or fax any additional call information

Section 1  * - Required  

Names of all responders and their service affiliation (i.e. Police Dept., Fire Dept., Dispatcher, Ambulance)

(Please print name as you wish it to appear on award certificate; do not use abbreviations)

CALL PERSONNEL:           

      First Name                            Last Name                                 Agency/Organization  

*1.   

*2. 

3. 

4. 

5. 

6  

7.

8. 

9. 

10. 

Please enter additional personnel name(s) & agency(s) here:

ex. John Doe / ABC Ambulance Service

*Call Date (mm/dd/yyyy):   Call #:   *Unit Number: 

Section 2:   * - Required  

*Patient Name: 

*Patient Contact Info (Phone, Address, etc.): 

*Patient Pick-up Location (Street, City/Town, State, Zip): 

*Receiving Hospital: 

*Patient Transferred from Receiving Hospital to (home, other hospital):

*Patient Follow-up/outcome:  

*Person Filing Nomination:         

*Daytime Phone for Person Completing Application (111)-222-3333:   

Note: ALL information must be submitted in order for the Awards Committee to consider this request.    

                                                                     Important!                                                                     

    Mail or Fax hard-copy of Run Form using the WMEMS contact information below   

  (BLS and ALS Run Form if intercept utilized)   

Your award submission cannot be processed until WMEMS receives a copy of the Run Form    

Western Massachusetts Emergency Medical Services Committee, Inc.

168 Industrial Park Drive, Northampton, MA 01060

413-586-6065 (voice)  413-586-0947 (fax) wmems@wmems.org (email)

www.wmems.org