MEDICAL PLAN (ICS 206 WF)
Controlled Unclassified Information//Basic
ICS 206 WF (03/18)
Controlled Unclassified Information//Basic
FOR A NON-EMERGENCY INCIDENT, WORK THROUGH CHAIN OF COMMAND TO REPORT AND TRANSPORT INJURED
PERSONNEL AS NECESSARY.
FOR A MEDICAL EMERGENCY: IDENTIFY ON SCENE INCIDENT COMMANDER BY NAME AND POSITION AND ANNOUNCE
"MEDICAL EMERGENCY" TO INITIATE RESPONSE FROM IMT COMMUNICATIONS/DISPATCH.
Use the following items to communicate situation to communications/dispatch.
CONTACT COMMUNICATIONS / DISPATCH (Verify correct frequency prior to starting report)
Ex: "Communications, Div. Alpha. Stand-by for Emergency Traffic."
INCIDENT STATUS: Provide incident summary (including number of patients) and command structure.
Ex: “Communications, I have a Red priority patient, unconscious, struck by a falling tree. Requesting air ambulance to Forest Road 1 at (Lat./Long.) This will be the Trout
Meadow Medical, IC is TFLD
Jones. EMT Smith is providing medical care.”
. INITIAL PATIENT ASSESSMENT: Complete this section for each patient as applicable (start with the most severe patient)
Patient Assessment: See IRPG page 106
Treatment:
. TRANSPORT PLAN:
Evacuation Location (if different): (Descriptive Location (drop point, intersection, etc.) or Lat. / Long.) Patient's ETA to Evacuation Location:
Helispot / Extraction Site Size and Hazards:
. ADDITIONAL RESOURCES / EQUIPMENT NEEDS:
Example:
Paramedic/EMT, Crews, Immobilization Devices, AED, Oxygen, Trauma Bag, IV/Fluid(s), Splints, Rope rescue, Wheeled litter, HAZMAT, Extrication
. COMMUNICATIONS: Identify State Air/Ground EMS Frequencies and Hospital Contacts as applicable
Severity of Emergency / Transport
Priority
☐ RED / PRIORITY 1 Life or limb threatening injury or illness. Evacuation need is IMMEDIATE
Ex: Unconscious, difficulty breathing, bleeding severely, 2
o
– 3
o
burns more than 4 palm sizes, heat stroke, disoriented.
YELLOW / PRIORITY 2 Serious Injury or illness. Evacuation may be DELAYED if necessary.
Ex: Significant trauma, unable to walk, 2
o
– 3
o
burns not more than 1-3 palm sizes.
GREEN / PRIORITY 3 Minor Injury or illness. Non-Emergency transport
Ex: Sprains, strains, minor heat-related illness.
Nature of Injury or Illness
&
Mechanism of Injury
Brief Summary of Injury or Illness
(Ex: Unconscious, Struck by Falling Tree)
Transport Request
Air Ambulance / Short Haul/Hoist
Ground Ambulance / Other
Patient Location Descriptive Location & Lat. / Long. (WGS84)
Incident Name
Geographic Name + "Medical"
(Ex: Trout Meadow Medical)
On-Scene Incident Commander
Name of on-scene IC of Incident within an
Incident (Ex: TFLD Jones)
Patient Care
Name of Care Provider
(Ex: EMT Smith)
7. CONTINGENCY: Considerations: If primary options fail, what actions can be implemented in conjunction with primary evacuation method? Be thinking
ahead.
8. ADDITIONAL INFORMATION: Updates/Changes, etc.
REMEMBER: Confirm ETA's of resources ordered. Act according to your level of training. Be Alert. Keep Calm. Think Clearly. Act Decisively.
