St Mary's County Advanced Life Support BLS Feedback

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What was the Date and Time of the EMS Call? *

YYYY

What is the Incident Number of the Call? *

Which Rescue Squad Company was involved? *

Leonardtown Volunteer Rescue Squad

Mechanicsville Volunteer Rescue Squard

Lexington Park Volunteer Rescue Squad

Ridge Volunteer Rescue Squad

Seventh District Volunteer Rescue Squad

Second District Volunteer Rescue Squad

Hollywood Volunteer Rescue Squad

Calvert County EMS

NDW EMS

Charles County EMS

Other:

What Unit was involved

What is the basis of the concern? *

Compliment

Complaint

Possible Protocol Variation

Safety Concern

Where you directly involved in the incident? *

Yes

Please provide details regarding the incident *

Please provide your contact information

Would you like to be contacted regarding the resolution of this concern?

Yes

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