• VHAC Incident Report

    VHAC Incident Report

  • Click Here for Instructions

    Reporting Schedule:

    March-Q3 PY  |  June-Q4 PY  |  September-Q1 CY  |  December-Q2 CY

    PY=Prior Year  CY=Current Year

    Schedule was developed to align with public reporting and registry harvest dates.

    • SECTION 1 - GENERAL INFORMATION 
    • Who is completing this form?*
    • Date of Last Meeting
       - -
      2 digit month, 2 digit day, 4 digit year
    • Date of NEXT Meeting
       - -
      2 digit month, 2 digit day, 4 digit year
    • SECTION 2 – FIRST MEDICAL CONTACT METRICS 
    • FIRST MEDICAL CONTACT
      Rows
    • FIRST MEDICAL CONTACT (New Format)
      Rows
    • SECTION 3 – CARDIOGENIC SHOCK PERFORMANCE MEASURES 
    • SHOCK METRICS (TO BE PROVIDED BY ALL PROGRAMS)
      Rows
    • SHOCK METRICS
      Rows
    • SECTION 4: EMS METRICS REPORTING  

    • VHAC is piloting the collection of select EMS metrics to better understand regional STEMI systems of care, documentation practices, and opportunities to support EMS-hospital collaboration. Please complete the fields below if the data is available. If a metric is unavailable or may not fully reflect actual practice, please explain in the notes section.

      Please report data specific to the VHAC region for which you are submitting this report.

    • Data Source
    • SECTION 5 – EMS EDUCATION SESSIONS  
    • EMS Education Sessions
      Rows
    • SECTION 6 – SITE-SPECIFIC INFORMATION 
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