Skip to content

Performance Improvement Air Medical

1.Reporting Quarter
2.Name of Entity:
3.Person Completing Report:
4.Performance Improvement Criteria / Indicators
Number of occurrences scene time greater than 20 minutes this quarter.
5.Performance Improvement Criteria / Indicators
Number of occurrences greater than 30 minutes from dispatch to arrival on scene this quarter.
6.Number of occurrences lift off time > 10 minutes from time mission accepted.
7.Explanation of above:

8.Number of missed flights this quarter.
9.Explanation of above:

10.For each patient above who was transferred out of TSA-D what was the determining diagnosis or factor that led to transfer out of TSA-D?
11.Specific Occurrence Report
Age:
12.Gender:
13.Chart Identification #:
14.Mechanism of Injury:
15.Identified injuries and pertinent information:

16.Patient Outcome:
17.Provider Discussion:

18.Contributing Factors