2025 ODEMSA Regional EMS Awards Nominations Form

ITEMS OF NOTE BEFORE STARTING:

• The nominee refers to you as the applicant.
• The Scholarship is an application, NOT a nomination, and is to be completed by the applicant ONLY.
• This application will not be accepted if ALL requested items are not included upon submission.

• CRITERIA: An individual who exemplifies outstanding dedication and service to the statewide Virginia emergency medical services system and has demonstrated a commitment to a comprehensive, integrated system of emergency medical services throughout the Commonwealth.

• ELIGIBILITY: Any living individual in good standing engaged in emergency medical services within the Commonwealth of Virginia with significant contributions at the local, regional, state, and national levels. Individuals should maintain a current Virginia EMS certification (where applicable) and have no outstanding or pending notices of enforcement actions taken against them.

• CRITERIA: An EMS provider, EMS agency or private/public organization that exemplifies innovative excellence and advancement at the local, regional, statewide and national level. Must have demonstrated a commitment to an innovative, comprehensive and unified system of Emergency Medical Services throughout the Commonwealth.

• ELIGIBILITY: Any individual, EMS agency, program, organization, public or private entity involved in Emergency Medical Services.

• CRITERIA: An individual who exemplifies outstanding dedication and service to their community through involvement with EMS. An individual that serves a mentor in the growth and development of the EMS field.

• ELIGIBILITY: Any individual who routinely provides prehospital care, primarily in Virginia, is affiliated with at least one Virginia licensed EMS agency and who is certified as a prehospital EMS provider by the Commonwealth of Virginia.

• CRITERIA: Any individual, EMS organization or EMS response group within the Commonwealth of Virginia that has demonstrated comprehensive and/or significant accomplishments for programs that provide preparedness, response and recovery from natural, man-made and preplanned events, which cause a significant impact on the agency and the community.

• ELIGIBILITY: Any individual currently licensed or official agency that is recognized by the state or federal government that is based in Virginia and is directly responsible for responding to emergencies or disasters and providing the direct delivery of care. Includes Disaster Response Teams, Community Emergency Response Teams, Continuity of Operations Planning, Mass Casualty Incident Training programs, all-hazards planning, emergency management partnerships and surge event planning.

• CRITERIA: An individual who exemplifies outstanding teaching and leadership qualities while participating as an educator in an EMS program. Must have coordinated or consistently demonstrated excellence and a dedication to the education of prehospital EMS providers. The nominee must have participated as an instructor, coordinator or adjunct faculty in an EMS program for at least two years.  Educational programs include: First Responder, EMT-B, EMT Enhanced, EMT Intermediate, EMT Paramedic, continuing education courses, preceptor programs or equivalent EMS training.

• ELIGIBILITY: A physician, nurse, healthcare provider or certified Virginia EMS educator.

• CRITERIA: An EMS agency that exemplifies outstanding professionalism and service to its community; whose high level of patient care is evident by innovative training, community awareness, preventative health programs, public relations efforts and participation in local, regional, state and national EMS systems.

• ELIGIBILITY: Any currently licensed or official agency that is recognized by the state or federal government that is based in Virginia and is directly responsible for responding to emergencies or disasters and providing the direct delivery of care. Includes governmental, commercial, volunteer, hospital, industrial and air ambulance services.

• CRITERIA: Any individual, program, business or licensed EMS agency within the Commonwealth of Virginia that has demonstrated comprehensive or significant accomplishments/programs that contribute or provide for the physical and or mental health, safety and well-being of EMS providers.

• ELIGIBILITY: Any individual or official agency that is recognized by the state or federal government that is based in Virginia and is directly responsible for the health, safety and well-being of all people in Virginia. Examples include EMS provider health and wellness programs (fitness and wellness, cardiovascular health), scene safety programs (aeromedical operations, emergency vehicle operations), and provider injury prevention programs (injury prevention at violent scenes) designed to prevent line of duty death and injury.

• CRITERIA: A nurse who exemplifies outstanding service in emergency medical services; knowledge and performance of EMS nursing skills; and high standards of cooperation and leadership with other EMS personnel and agencies. Highest consideration is given to performing a nursing role in a hospital or clinical setting such as precepting, education or quality assurance programs. Nurses who have demonstrated excellence as a prehospital provider or instructor should be nominated for those categories.

• ELIGIBILITY: Any Virginia licensed nurse serving in an active role with local, regional, statewide and or national EMS.

• CRITERIA: An individual who has demonstrated ability to organize, conduct, manage, problem solve and evaluate within their organization and, by exemplary leadership and administrative skills, improve the effectiveness, response and delivery of EMS.

• ELIGIBILITY: Any person responsible for chairing, presiding over, supervising or administering EMS organizations and/or personnel in Virginia.

• CRITERIA: An emergency medical telecommunicator, public safety answering point administrator, supervisor or training officer whose outstanding dedication and service has demonstrated an exceptional contribution to the improved delivery of emergency medical services in the local, regional, statewide and or national EMS system.

• ELIGIBILITY: An emergency medical telecommunicator, public safety answering point administrator, supervisor or training officer who is employed or volunteers with an emergency medical services dispatch center or public safety answering point in Virginia.

• CRITERIA: An individual or organization that demonstrates outstanding dedication and service to the contribution, development and/or enhancement of EMS for Children in Virginia.

• ELIGIBILITY: An individual or organization with a significant contribution to the development or enhancement of EMS for Children in Virginia. Services cover a continuum of care, from injury prevention to prehospital care, emergency department and hospital services, and rehabilitation.

• CRITERIA: Any individual, EMS organization or EMS response group within the Commonwealth of Virginia that has demonstrated comprehensive and/or significant accomplishments for programs that provide preparedness, response and recovery from natural, man-made and preplanned events, which cause a significant impact on the agency and the community.

• ELIGIBILITY: Any individual currently licensed or official agency that is recognized by the state or federal government that is based in Virginia and is directly responsible for responding to emergencies or disasters and providing the direct delivery of care. Includes Disaster Response Teams, Community Emergency Response Teams, Continuity of Operations Planning, Mass Casualty Incident Training programs, all-hazards planning, emergency management partnerships and surge event planning.

In the “Response 1” box below, summarize and justify why this person should receive this award.

You are encouraged to consider the following questions when providing your response to this section.

1. How has this person exemplified outstanding dedication and service to the statewide Virginia emergency medical services system?
2. Why is this nominee exceptionally qualified and selected for this award?
3. How has this person demonstrated a commitment to a comprehensive, integrated system of emergency medical services throughout the Commonwealth and the Nation?

In the “Response 1” box below, summarize and justify why this person/organization should receive this award.

You are encouraged to consider the following questions when providing your response to this section.

1. How has this individual /organization made a difference in Virginia’s EMS System through innovative contributions and initiatives? Has this innovative initiative been utilized to address a problem that affects the EMS community; identified challenges or gaps in patient care; or enhanced patient satisfaction?
2. What areas of the EMS system have been influenced by the work of the individual or organization?
3. What changes or outcome examples have occurred following the implementation of the new or enhanced program/product developed by the nominee? How were the objectives met? Provide examples and outcome measurements when possible.

In the “Response 1” box below, summarize and justify why this person should receive this award.

You are encouraged to consider the following questions when providing your response to this section.

1. Why is this nominee exceptionally qualified for this award?
2. Explain how this provider exemplifies outstanding dedication, mentorship of the field and investment to their community and delivery of prehospital care through involvement with EMS.

In the “Response 1” box below, summarize and justify why this person should receive this award.

You are encouraged to consider the following questions when providing your response to this section.

1. Describe how this EMS physician exemplifies outstanding leadership and dedication in the delivery of prehospital care.
2. How does this physician go above and beyond their duties to enhance EMS care, education and support of the EMS system in their local, regional, statewide or national EMS groups or committees?
3. Give specific examples (when applicable) of programs, new technologies or procedures that they have researched or implemented.
4. Provide a description of the success and accomplishments of this person in EMS to include honors, awards (civic or professional) that highlights their contribution to EMS and their community.

In the “Response 1” box below, summarize and justify why this person should receive this award.

You are encouraged to consider the following questions when providing your response to this section.

1. Why is this nominee exceptionally qualified and selected for this award?
2. How has this person exemplified and demonstrated a commitment to a comprehensive, integrated education system of emergency medical services throughout the Commonwealth?

In the “Response 1” box below, summarize and justify why this EMS agency should receive this award.

You are encouraged to consider the following questions when providing your response to this section.

1. Why is this nominee exceptionally qualified and selected for this award?
2. How does this EMS agency support their providers?
3. Describe this EMS agency’s enhanced programs, which provide a high level of patient care that is evident through innovative training, community awareness, preventative health programs, public relations efforts and participation in the local, regional, state and national EMS systems.

In the “Response 1” box below, summarize and justify why this person or agency should receive this award.

You are encouraged to consider the following questions when providing your response to this section.

1. Why does this individual or agency’s program or accomplishment deserve to be recognized?
2. Describe the accomplishment/program, including its objectives and target population being served and how it contributes to or provide for the physical and or mental health, safety and well-being of EMS providers.
3. Describe how the physical and or mental health, safety and well-being objectives were met. Provide examples and outcome measurements when possible.

In the “Response 1” box below, summarize and justify why this person should receive this award.

You are encouraged to consider the following questions when providing your response to this section.

1. How does this nurse exemplify outstanding service to EMS?
2. Describe this nominee’s knowledge and performance, interaction and collaboration with EMS personnel and agencies.
3. Does this nominee perform a nursing role in a hospital or clinical setting, such as precepting, educating or quality assurance programs?
4. Does this nurse serve on any local, regional, statewide and or national EMS committees or groups?
5. Additional recognition, awards and or commendations pertaining to EMS.

In the “Response 1” box below, summarize and justify why this person should receive this award.

You are encouraged to consider the following questions when providing your response to this section.

1. How has this individual demonstrated an ability to organize, conduct, manage, problem solve, evaluate, etc within their organization?
2. Does this leader participate on any committees or participate with programs that help to further enhance EMS and patient care within their locality, region, state or nation?
3. How has this individual, through exemplary leadership and administrative skills, improved the effectiveness, response and delivery of EMS?
4. Additional recognition, awards and or commendations pertaining to EMS.

In the “Response 1” box below, summarize and justify why this person should receive this award.

You are encouraged to consider the following questions when providing your response to this section.

1. Describe how this person’s dedication and service has demonstrated an exceptional contribution; improved delivery of emergency medical services in the local, regional, state and national EMS system.
2. Are there any programs or events that they have implemented or educational programs that they have created or enhanced?
3. Does this nominee provide any other volunteer or career services within the EMS system at the local, regional, state and national level?

In the “Response 1” box below, summarize and justify why this person should receive this award.

You are encouraged to consider the following questions when providing your response to this section.

1. How does this individual or organization exemplify outstanding dedication and service delivery to EMS for Children?
2. Describe this individual or organization’s services, which cover a continuum of care from injury prevention to prehospital care, emergency department and hospital services and rehabilitation.
3. Do they participate in programs or committees for EMS for Children?
4. Have they been recognized for their programs or dedication to EMS for Children locally, regionally, statewide or nationally?

In the “Response 1” box below, summarize and justify why this person or agency should receive this award.

You are encouraged to consider the following questions when providing your response to this section.

1. Why does this program/accomplishment deserve to be recognized? Examples include all-hazards planning, emergency management partnerships, work in emergency life cycle, etc.
2. Describe the demonstrated comprehensive and/or significant accomplishments/programs that contribute towards making their communities safer, stronger, better prepared and more resilient through emergency preparedness and response.
3. Describe how the mitigation, preparedness, response, recovery objectives were met. Provide examples and outcome measurements when possible.

In the “Response 2” box below, provide a description of the successes and accomplishments of this person in EMS, to include honors, awards (civic or professional) that highlight their contribution to EMS and the community.

In the “Response 2” box below, provide a description of the success and accomplishments of this person in EMS to include honors, awards (civic or professional) that highlights their contribution to EMS and their community in their local, regional, state and national EMS groups or committees?

In the “Response 2” box below, provide a description of the successes and accomplishments of this person in EMS, to include honors, awards (civic or professional) that highlight their contribution to EMS education.

You are encouraged to consider the following question when providing your response to this section.

1. Does this educator serve on any committees or participate with programs that help to further enhance EMS education and patient care in their local, regional, state, and national EMS groups or committees?

In the “Response 2” box below, describe how this nominee has been recognized for extraordinary EMD services or honors and/or is a leader and advocate for EMS Telecommunications.

You are encouraged to consider the following question when providing your response to this section.

1. Does this nominee serve on any committees or participate with any groups that help to enhance and advocate for EMS and/or telecommunications at the local, regional, state and national level?  

The following items MUST be uploaded below to accompany your application: 

1.  Photo Required: A high-resolution digital photo of you MUST be included. Upload a color photo (with good lighting) with just you in the photo. Only one (1) photo is required, but you may submit up to three (3) if you would like us to choose which one to use.  You may upload a senior photo if you have one though it is not a requirement. 

The following items MUST be uploaded below to accompany your application: 

1.  Photo Required: A high-resolution color digital photo (with good lighting) of just the nominee must be uploaded. For agencies or organizations a group photo, agency logo, or patch must be uploaded. Only one (1) photo is required, but you may submit up to three (3) if you would like us to choose which one to use.

2.  A copy of the applicant’s official high school or GED transcript (no minimum GPA or GED score is required, but will be considered in evaluations)

4.  Please upload two (2) letters of recommendation: 

• "Supporting Document #1" must be a letter from an agency officer
  • attesting to your EMS level of activity within the agency and performance, which is consistent with the highest standards
  • attesting your affiliation with the previously listed Virginia-licensed EMS agency and
  • is on agency letterhead

• "Supporting Document #2" should be a letter attesting to your academic and/or EMS performance, which is consistent with the highest standards.

4. Please upload two (2) letters of recommendation attesting to your academic and/or EMS performance, which is consistent with the highest standards. One of the two letters of recommendation must be from an agency officer attesting to your level of activity within the agency previously listed on the first page of this form. 

2. One letter of support written by someone other than yourself/the nominator must be uploaded to "Supporting Document #1".

3.  Up to two (2) additional supporting documents may be uploaded to "Supporting Document #2" and/or "Supporting Document #3".

Other documents may include:

1. Resume
2. CV
3. A newspaper article written about the nominee
4. blog post from a reputable source (please ensure the web address is included)
5. Additional letters of support

Videos and podcasts are not accepted at this time. However, transcripts may be accepted. 

5.  Proof of the applicant’s affiliation with a Virginia-licensed EMS agency. A statement on agency letterhead.