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RSI Not-Performed Notification
Please complete this form every time you as the RSI clinician gets called out for an RSI and the RSI does not get performed for ANY reason.
This form is mandatory to be completed for every such circumstance.
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MM
/
DD
/
YYYY
Incident #
*
Your answer
RSI Clinician Full Name & Badge #:
*
Your answer
What did you respond on
*
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Engine
Truck/Squad
EMS Supervisor
Safety 5
Medic Unit
Chief
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