Hospital Notification Form
Catawba County Emergency Medical Services System will no=
tify
a receiving facility (hospitals only) of our pending arrival as soon as is
practically possible. We will=
make
an effort to notify the receiving facility, at least 10 minutes prior to our
arrival, of all patients who have a significant injury or illness.
The following priority system should be utilized:
Priority 1
Priority 1 should be utilized =
when
the attending technician needs to consult with on-line medical control or n=
eeds
to notify on-line medical control of an incoming patient that will need
immediate, extensive or specialized care.
Priority 1 should also be used
when the patient is receiving Advanced Life Support care and the attending
technician needs on-line medical control for additional orders.
Priority 2
Priority 2 should be used when=
the
patient is receiving Advanced Life Support care as per the Treatment Protoc=
ols
of
<=
span
style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family:Arial'>Prio=
rity 3
Priority 3 should be used when=
the
patient is receiving Basic Life Support care as per the Treatment Protocols=
of
These patient should be sent
through triage is possible.
After acknowledgment by the facility the following
information should be relayed:
“
Mechanism or Injury / History of Present Illness:
_______________________________________________________
Chief Complaint:
___________________________________________________________________________=
_______
Glascow Coma Score: ______Trauma Score (if indicated):
______Protocol being followed: ___________________
Vital Signs: BP________&=
nbsp; &nbs=
p; &=
nbsp; Pulse_________=
&=
nbsp; &nbs=
p; &=
nbsp; &nbs=
p; Resp
Rate__________
Extrication Required: Yes or No = Estimat= ed Time of Extrication: _______ &nb= sp; ETA: ______________