ICS-209 County Input Form - New Jersey EMS Task Force Incident Management Team - EMS MACC

New Jersey EMS Task Force Incident Management Team - EMS MACC

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ICS-209 Counties ESF8 EMS Input Form

This form is used to submit data to the NJ EMS MACC from NJ County EMS Coordinators and other allied partners with updates for ESF8 Activities

ICS-209 Counties ESF8 EMS SitRep Input

* Indicates required field

Name *

First

Last

County/Region *

Email *

Phone Number *

Status of BLS Staffing in your jurisdiction *

Well below normal Below normal Normal Above Normal Well Above Normal Unknown

Status of ALS Staffing in your jusrisdiction *

Well below normal Below Normal Normal Above Normal Well above normal Unknown

EMS Call Volume *

Well below normal Below normal Normal Above normal Well above normal Unknown

General Response Times *

Normal Extended Severely Extended Unknown

Specialty EMS Resources in use (i.e. EMSTF resources, Off-Road Ambulance Vehicles such as gators, ASAPs, etc). *

Any Specialty EMS Resources OUT OF SERVICE and REASON (make sure to report NJEMSTF assets in mobile reporter as well) *

Any EMS Jurisdictional Agencies OUT OF SERVICE and REASON *

Operational/Dispatch Communications for EMS Status *

Normal Operating Remotely Overloaded On Backup/Manual procedures Unknown

Any INCIDENT RELATED Deaths? If so, #: *

Any INCIDENT RELATED Injuries/Illnesses? If so, # *

Any other relevant information *

Submit to EMS MACC

Telephone

1-973-878-9911

eFax

1-302-340-6881

Email

[email protected]

After Action Survey - NJ PAPAL DEPLOYMENT