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St Mary's County Advanced Life Support BLS Feedback
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* Indicates required question
What was the Date and Time of the EMS Call?
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MM
/
DD
/
YYYY
What is the Incident Number of the Call?
*
Your answer
Which Rescue Squad Company was involved?
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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
Your answer
What is the basis of the concern?
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Compliment
Complaint
Possible Protocol Variation
Safety Concern
Where you directly involved in the incident?
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Yes
No
Please provide details regarding the incident
*
Your answer
Please provide your contact information
Your answer
Would you like to be contacted regarding the resolution of this concern?
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No
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