Home
Who We Are
Get to Know Us
What We've Achieved
Equipment
Careers
Services
911 Emergency Response
ALS and Specialty Care Transport
Special Event Services
Special Response Team (SRT)
Provider Resources
EMS Manager
Current Staff
New Hires
Students
Safety Data Sheets
Contact Us
Contact Us
Frequently Asked Questions
Tell Us How We Did
OCA Facebook
Pay My Bill

Orange Cross Ambulance

Home
Who We Are
Get to Know Us
What We've Achieved
Equipment
Careers
Services
911 Emergency Response
ALS and Specialty Care Transport
Special Event Services
Special Response Team (SRT)
Provider Resources
EMS Manager
Current Staff
New Hires
Students
Safety Data Sheets
Contact Us
Contact Us
Frequently Asked Questions
Tell Us How We Did
OCA Facebook
Pay My Bill
Near Miss Date *
Near Miss Approximate Time *
Visibility at the Time of the Event *
Your Role in Event *
Contributing Factos *
If the system change was implemented, how many weeks were there between the time you identified the change until it was implemented?
Describe the lessons learned as a result of the Near Miss Event. (What lessons were learned? What are your suggestions to prevent a similar event? What actions can correct the situation? ) Identifying department indicators that may identify you or your department will not be included in reports. Keep in mind the following topics when preparing your narrative: Chain of events, Communication, Decision Making, Equipment, Incident Command, Role, Sleep Patterns, Situational Awareness, SOP/SOG, Staffing, Task Allocation, Teamwork, Training, Weather.
Did the Event Occur Immediately Following Other Employment or Additional Shifts? *
Number of Staffed Units Operating at the Time of the Event *
How many staffed units where scheduled on the road during the time of the event. Disregard how many units were active or engaged on calls.
Thank you!

Sentinel Event Date *
Sentinel Event Approximate Time *
Your Role in Event *
Contributing Factors *
Sentinel Events are patient safety events which result in Death, Permanent Harm, or Severe Temporary Harm requiring intervention to sustain life. Please describe the event, the actions leading up to it, and any known outcomes.
If the system change was implemented, how many weeks were there between the time you identified the change until it was implemented?
Describe the lessons learned as a result of the Sentinel Event. (What lessons were learned? What are your suggestions to prevent a similar event? What actions can correct the situation?) Identifying department indicators that may identify you or your department will not be included in reports. Keep in mind the following topics when preparing your narrative: Chain of events, Communication, Decision Making, Equipment, Incident Command, Role, Sleep Patterns, Situational Awareness, SOP/SOG, Staffing, Task Allocation, Teamwork, Training, Weather.
Did the Event Occur Immediately Following Other Employment or Additional Shifts? *
Number of Staffed Units Operating at the Time of the Event *
Thank you!

Back to Top
Orange Cross Ambulance, 1919 Ashland Avenue, Sheboygan, WI, 53081, United States920-451-9111info@orangecross.org

Powered by Squarespace