Emergency Medical Services Radio Report
Complete this concise report to hand off key emergency incident details to receiving teams. Do not enter sensitive or confidential information.
Incident Number
*
EMS Unit Identifier
*
Agency Name
*
Dispatch Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Scene Location (Address or Landmark)
*
Primary Impression
*
Please Select
Trauma
Medical
Cardiac
Respiratory
Neurological
Other
Patient Age Group
*
Please Select
Infant (0-1 year)
Child (1-12 years)
Adolescent (13-17 years)
Adult (18-64 years)
Older Adult (65+ years)
Unknown
Patient Gender
*
Please Select
Male
Female
Non-binary
Unknown
Patient Status on Arrival
*
Please Select
Stable
Critical
Deceased
Unknown
Transport Destination
*
Submit Report
Should be Empty: