Sample: Sample IAP (Page 7 of 9) (ICS 206) Date From: Date To: 2. Operational Period: Time From: Time To: 1. Incident Name: Cruise Ship HazMat Spill 3. Medical Aid Stations: Contact Paramedics Name Location Number(s)/Frequency on Site? Cruise ship xxx-xxx-xxxx Yes No NPS EMT’s NPS GLBA HQ Bartlett Cove xxx-xxx-xxxx Yes No – Gustavus Emergency Gustavus xxx-xxx-xxxx Yes No Response Yes No Yes No Yes No 4. Transportation (indicate air or ground): Contact Ambulance Service Location Number(s)/Frequency Level of Service Gustavus Emergency Gustavus xxx-xxx-xxxx ALS BLS Response ALS BLS ALS BLS 5. Hospitals: Address, Contact Travel Time Latitude & Longitude Number(s)/ Trauma Burn Hospital Name if Helipad Frequency Air Ground Center Center Helipad Bartlett Memorial 3260 Hospital Drive, xxx-xxx-xxxx 1 hr n/a Yes Yes Yes No Juneau Level:_____ No Yes Yes Yes No Level:_____ No Yes Yes Yes No Level:_____ No Yes Yes Yes No Level:_____ No Yes Yes Yes No Level:_____ No 6. Special Medical Emergency Procedures: If necessary, a float plane will be dispatched from Glacier Bay Airways (697-2249 or 789-9009) and the victim will be flown to Juneau. Conduct GLBA Dispatch in the event of ANY injury. Check box if aviation assets are utilized for rescue. If assets are used, coordinate with Air Operations. 7. Prepared by (Medical Unit Leader): Name: Sherrie Hillman Signature: 8. Approved by (Safety Officer): Name: Signature: Pam Alice ICS 206 IAP Page __7___ Date/Time: 08-19-XX/0200
Sample: Sample IAP (Page 7 of 9) (ICS 206) 1. Incident Name: Cruise Ship HazMat Spill 2. Operational Period: Date From: Date To: Time From: Time To: 3. Medical Aid Stations: Name Location Contact Number(s)/Frequency Paramedics on Site? NPS EMT’s Cruise ship xxx-xxx-xxxx Yes No NPS – GLBA HQ Bartlett Cove xxx-xxx-xxxx Yes No Gustavus Emergency Response Gustavus xxx-xxx-xxxx Yes No Yes No Yes No Yes No 4. Transportation (indicate air or ground): Ambulance Service Location Contact Number(s)/Frequency Level of Service Gustavus Emergency Response Gustavus xxx-xxx-xxxx 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 Bartlett Memorial 3260 Hospital Drive, Juneau xxx-xxx-xxxx 1 hr n/a 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: If necessary, a float plane will be dispatched from Glacier Bay Airways (697-2249 or 789-9009) and the victim will be flown to Juneau. Conduct GLBA Dispatch in the event of ANY injury. Check box if aviation assets are utilized for rescue. If assets are used, coordinate with Air Operations. 7. Prepared by (Medical Unit Leader): Name: Sherrie Hillman Signature: 8. Approved by (Safety Officer): Name: Pam Alice Signature: ICS 206 IAP Page __7___ Date/Time: 08-19-XX/0200