Medical Plan (ICS 206)

1. Incident Name:	2. Operational Period: Date From: Date To: Time From: Time To:
3. Medical Aid Stations:
Name	Location	Contact Number(s)/Frequency	Paramedics on Site?
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
4. Transportation (indicate air or ground):
Ambulance Service	Location	Contact Number(s)/Frequency	Level of Service
ALS BLS
ALS BLS
ALS BLS
ALS BLS
5. Hospitals:
Hospital Name	Address, Latitude & Longitude if Helipad	Contact Number(s)/ Frequency	Travel Time	Trauma Center	Burn Center	Helipad
Air	Ground
Yes Level:_____	Yes No	Yes No
Yes Level:_____	Yes No	Yes No
Yes Level:_____	Yes No	Yes No
Yes Level:_____	Yes No	Yes No
Yes Level:_____	Yes No	Yes No
6. Special Medical Emergency Procedures:
Check box if aviation assets are utilized for rescue. If assets are used, coordinate with Air Operations.
7. Prepared by (Medical Unit Leader): Name: Signature:
8. Approved by (Safety Officer): Name: Signature:
ICS 206	IAP Page _____	Date/Time: