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Performance Improvement First Responder

1.Date:
2.Name of Entity:
3.Person Completing Report:
4.Performance Improvement Criteria / Indicators
Number of trauma-related patients pronounced dead on scene this quarter.
5.Number of occurrences of prolonged wait times for EMS provider response to scene this quarter.
6.Specific Occurrence Report
Age:
7.Gender:
8.Chart Identification #:
9.Mechanism of Injury:
10.Identified injuries and pertinent information:

11.Patient Outcome:
12.Provider Discussion:

13.Contributing Factors