EMS Mutual Aid Survey

Union County Office of Emergency Management
Emergency Medical Services Mutual Aid

Name of agency:

Name of person providing info:

Title of person providing info:

Contact phone number:

ext. (NXX-NXX-XXXX format please)

Contact e-mail address:

Dispatch center name:

Dispatch center phone number:

(NXX-NXX-XXXX format please)

What are the hours of your first shift? (ex: 0600-1800)

What are the hours of your second shift? (ex: 1800-2300)

What are the hours of your third shift, if any? (ex: 2300-0600)

Sunday

	First Shift	Second Shift	Third Shift
Ambulances with crew in quarters/vehicle:
Ambulances with duty crew elsewhere:
Ambulances with backup/scramble crew:
Will your agency respond to a mutual aid request for a "normal" EMS call?
Will your agency respond to a mutual aid request for a "long-duration" EMS call?
Will your agency bring rehab equipment if requested?

Copy Sunday to remainder of week
(you can still edit individual days below)

Monday

	First Shift	Second Shift	Third Shift
Ambulances with crew in quarters/vehicle:
Ambulances with duty crew elsewhere:
Ambulances with backup/scramble crew:
Will your agency respond to a mutual aid request for a "normal" EMS call?
Will your agency respond to a mutual aid request for a "long-duration" EMS call?
Will your agency bring rehab equipment if requested?

Tuesday

	First Shift	Second Shift	Third Shift
Ambulances with crew in quarters/vehicle:
Ambulances with duty crew elsewhere:
Ambulances with backup/scramble crew:
Will your agency respond to a mutual aid request for a "normal" EMS call?
Will your agency respond to a mutual aid request for a "long-duration" EMS call?
Will your agency bring rehab equipment if requested?

Wednesday

	First Shift	Second Shift	Third Shift
Ambulances with crew in quarters/vehicle:
Ambulances with duty crew elsewhere:
Ambulances with backup/scramble crew:
Will your agency respond to a mutual aid request for a "normal" EMS call?
Will your agency respond to a mutual aid request for a "long-duration" EMS call?
Will your agency bring rehab equipment if requested?

Thursday

	First Shift	Second Shift	Third Shift
Ambulances with crew in quarters/vehicle:
Ambulances with duty crew elsewhere:
Ambulances with backup/scramble crew:
Will your agency respond to a mutual aid request for a "normal" EMS call?
Will your agency respond to a mutual aid request for a "long-duration" EMS call?
Will your agency bring rehab equipment if requested?

Friday

	First Shift	Second Shift	Third Shift
Ambulances with crew in quarters/vehicle:
Ambulances with duty crew elsewhere:
Ambulances with backup/scramble crew:
Will your agency respond to a mutual aid request for a "normal" EMS call?
Will your agency respond to a mutual aid request for a "long-duration" EMS call?
Will your agency bring rehab equipment if requested?

Saturday

	First Shift	Second Shift	Third Shift
Ambulances with crew in quarters/vehicle:
Ambulances with duty crew elsewhere:
Ambulances with backup/scramble crew:
Will your agency respond to a mutual aid request for a "normal" EMS call?
Will your agency respond to a mutual aid request for a "long-duration" EMS call?
Will your agency bring rehab equipment if requested?

Please list any specialized resources your agency can make available (with days/hours available, if not 24x7):

Comments/Notes about your agency's willingness and/or ability to help other agencies: