“Patient Safety and Provider Recognition Program”
The EMS Event Reporting Program is a comprehensive Patient Safety and EMS Provider Recognition program. EMS Events may be reported through the chain of command or anonymously. The policy, forms and instructions are below. Questions and comments about this program can be sent to Craig Stroup, EMS QI Coordinator at firstname.lastname@example.org.
Reporting is encouraged by all who encounter an actual or potential patient event, potential safety event, system concern, or exemplary care delivered within the Contra Costa County EMS system. Please use the EMS Event Reporting Form to provide a concise description of the event. No patient names or other personal information should be reported on this form. A hard copy version of this form is available below in the "Resources" section and may be completed and submitted via fax (925-646-4379) if desired.
- EMS Event policy (Goldenrod #32) (PDF)
- EMS Event report form and instructions (PDF)
Use to report a patient safety or provider recognition event
- EMS Event QI Review form and instructions (PDF)
This form is for EMS Agency QI Coordinators only
Contact Craig Stroup at email@example.com for electronic version
- EMS Event Reporting Decision Tree (PDF)
- EMS Event Reporting Training (PPT)
Contra Costa EMS
1340 Arnold Drive, Suite 126
Martinez, CA 94553
Office Hours: 8:00 am - 5:00 pm Monday through Friday