As responders, you are a valuable part of the quality improvement loop. This form should be used to notify EHP/HVA leadership of any potential issues with a dispatch or scene that needs to be investigated, and also to recognize dispatch or crews for performance that is well done.
This form should be used for the following types of situations, but is not limited to:
Concerns about the level of care, scene safety issues that were not relayed, chief complaint protocol used by the EMD, and final coding/priority of the call.
Recognition or praise for performance well done for the dispatcher walking the caller through CPR, childbirth, choking, bleeding control, or an event that a dispatcher or call taker went above and beyond, etc. or for the paramedics on scene.