Fire And EMS Run Card Form

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Fire and EMS Run Card FormMunicipalityFire AgencyEMS AgencyDispatchIncident TypeAerialBrushEngineTankerRescueRun Card NumberCounty Fire Box #DES Use ONLYOther(Specify number and apparatus typeneeded; ie 1-RH, 1-SP)Station Dispatches(List station numbers that should bedispatched; ie Sta44, Sta36)AFA-1AIR EMERGENCY-1AIR EMERGENCY-2BRUSH FIRE-1BRUSH FIRE-2BRUSH FIRE-3BRUSH FIRE-4BOMB THREAT STANDBY-1BOMB THREAT STANDBY-2**BUILDING COLLAPSE-1BUILDING COLLAPSE-2CMA*-1CMA*-2FIRE POLICE-1FIRE RELOCATE-1Page 1 of 8

Fire and EMS Run Card FormMunicipalityFire AgencyEMS AgencyDispatchIncident TypeAerialBrushEngineTankerRescueRun Card NumberCounty Fire Box #DES Use ONLYOther(Specify number and apparatus typeneeded; ie 1-RH, 1-SP)Station Dispatches(List station numbers that should bedispatched; ie Sta44, Sta36)FLUIDS/DEBRIS DOWN-1HAZMAT*-1HAZMAT*-2HELICOPTER STANDBY-1MEDICAL ASSIST-1MISC FIRE-1MISC FIRE-2MVA ENTRAPMENT-1MVA ENTRAPMENT-2MVA ENTRAPMENT W/FIRE-1MVA ENTRAPMENT W/FIRE-2MVA WITH INJURIES-1MVA WITH INJURIES-2MVA WITH INJ/FIRE-1MVA WITH INJ/FIRE-2Page 2 of 8

Fire and EMS Run Card FormMunicipalityFire AgencyEMS AgencyDispatchIncident TypeAerialBrushEngineTankerRescueRun Card NumberCounty Fire Box #DES Use ONLYOther(Specify number and apparatus typeneeded; ie 1-RH, 1-SP)Station Dispatches(List station numbers that should bedispatched; ie Sta44, Sta36)MVA UNKNOWN INJ-1MVA UNKNOWN INJ-2MVA UNKNOWN W/FIRE-1MVA UNKNOWN W/FIRE-2PUMP-1PUMP-2**RESCUE-1RESCUE-2RESCUE CONFINED SPACE-1RESCUE CONFINED SPACE-2RESCUE HIGH ANGLE-1RESCUE HIGH ANGLE-2RESCUE TRENCH-1RESCUE TRENCH-2Page 3 of 8

Fire and EMS Run Card FormMunicipalityFire AgencyEMS AgencyDispatchIncident TypeAerialBrushEngineTankerRescueRun Card NumberCounty Fire Box #DES Use ONLYOther(Specify number and apparatus typeneeded; ie 1-RH, 1-SP)Station Dispatches(List station numbers that should bedispatched; ie Sta44, Sta36)SEARCH-1SEARCH-2STRUCTURE INVESTIGATION-1STRUCTURE FIRE ENTRAP-1STRUCTURE FIRE ENTRAP-2STRUCTURE FIRE-1STRUCTURE FIRE-2STRUCTURE FIRE-3STRUCTURE FIRE-4TREE DOWN-1TREE DOWN-2**VEHICLE FIRE-1VEHICLE FIRE-2WATER ACCIDENT-1WATER ACCIDENT-2Page 4 of 8

Fire and EMS Run Card FormMunicipalityFire AgencyEMS AgencyRun Card NumberResource TypeCounty Fire Box #DES Use ONLYUnit ListAerial Trucks [10]Default ListBrush [25]Default ListEngine [25]Default ListRescue [10]Default ListTanker [25]Default ListResource TypeUnit ListResource TypeAirMedical Assist [5]ARFFRehab [1]ATV [5]RIT [5]Canteen [1]Scuba [1]Collapse [1]Spill [5]Foam [2]TTFFire Police [5]TrafficMarine [5]UtilityUnit List* DESIGNATES THERE IS A "W/SYMPTOMS" CALL TYPE ALSO. EMS WILL BE DISPATCHED ON THE "W/SYMPTOMS" CALL TYPE IF THEY ARE NOT LISTED IN THE CMAOR HAZMAT RESPONSE.** 2ND ALARM ONLY REQUIRED IF "OIC" IS LISTED ON 1ST ALARM.Page 5 of 8

Fire and EMS Run Card FormMunicipalityResource TypeCall Type #'sUnit TypeUnit TypeUnit TypeUnit TypeUnit TypeUnit TypeUnit TypeUnit TypeUnit TypeUnit TypeRescue TypeRescue TypeRescue TypeRescue TypeWater AccidentBuilding Collapse,Rescue TrenchRescue Confined SpaceRescue High AngleFire AgencyEMS AgencyUnit ListRun Card NumberCounty Fire Box #DES Use ONLYCall Type List1. AFA2. Air Emergency3. Brush Fire4. Bomb Threat Standby5. Building Collapse6. CMA7. Fire Relocate8. Fluids/Debris Down9. Hazmat10. Helicopter Standby11. Misc Fire12. MVA Entrapment13. MVA Entrapment w/Fire14. MVA with Injuries15. MVA with Injuries/Fire16. MVA Unknown17. MVA Unknown w/Fire18. Pump19. Rescue20. Rescue Confined Space21. Rescue High Angle22. Rescue Trench23. Search24. Structure Fire w/Entrapment25. Structure Fire26. Structure Investigation27. Tree Down28. Vehicle Fire29. Water AccidentPage 6 of 8

Fire and EMS Run Card FormMunicipalityFire AgencyEMS h:10th:11th:12th:Run Card NumberCounty Fire Box #DES Use ONLYCall Types1. Airway Obstruction2. ALS Medical3. ALS Trauma4. Assault/Fight Injury5. BLS Medical6. BLS Trauma7. Cardiac/Respiratory Arrest8. Class 4 Mental9. Class 5 DOA10. Domestic Injury11. Lift Assist12, Overdose13. Shooting14. Stabbing15. Suicide16. UnconsciousOut of County Abbreviations:List call types where QRS from a fire department is required on initial dispatch*NOTE - ALS companies MUST be listed in the SAME order as the BLS columnBU BucksLH LehighCC ChesterMC MontgomeryLN LancasterSC SchuylkillLB LebanonExample: Montgomery County 369 MC 369Page 7 of 8

Fire and EMS Run Card FormMunicipalityFire AgencyEMS AgencyRun Card NumberCounty Fire Box #DES Use ONLYAuthorization PageThis page must be completed by the individuals authorized to submit run card changes perthe Emergency Services Run Card Change Authorization Form on file.Fire Department AuthorizationName:Title:Date:Signature:EMS (Ambulance) AuthorizationName:Title:Date:Signature:Page 8 of 8

EMS Agency Run Card Number: County Fire Box # DES Use ONLY: Fire and EMS Run Card Form Page 5 of 8 * DESIGNATES THERE IS A "W/SYMPTOMS" CALL TYPE ALSO. EMS WILL BE DISPATCHED ON THE "W/SYMPTOMS" CALL TYPE IF THEY ARE NOT LISTED IN THE CMA OR HAZMAT RESPONSE. ** 2ND AL

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