1.3 Check all of your specialty services available on a 24-hour/day on-call basis? (Describe plan for any services not available) Cardiology General surgery ☐ ☐ Cardiovascular surgery Neonatology ☐ ☐ Anesthesiology Neurosurgery ☐ ☐ Interventional Radiology Genetics ☐ ☐ Biomedical Engineering Social Work ☐ ☐ Neurology Nephrology ☐ ☐ Critical Care Specialist Pulmonology ☐ ☐ Hospitalist Hematology/Oncology ☐ ☐ Infectious Disease Gastroenterology ☐ ☐ Other: ☐ Insert additional information here. 1.4 Check available support services and/or consultants that are available (Describe plan for any services and/or consultants not available) gas laboratory Chemistry and hematology laboratory ☐ ☐ Blood Bank Pharmacy ☐ ☐ Cardiovascular operating room with Radiology including cranial ultrasound and ☐ ☐ cardiopulmonary bypass capabilities CAT scan Occupational and/or Physical Therapy Developmental/rehabilitation Specialist ☐ ☐ Nutritionist Pastoral Care ☐ ☐ Interpreter services ☐ Insert additional information here. 1.5 Outline available inter-hospital transport services for patients on ECLS. If you do not provide ECLS transport services, please detail your plan for transporting patients on ECLS to or from your center in case of emergent need. Insert answer here. 1.6 Describe the ECLS Medical Director position responsible for the overall operation of the Center. Provide medical specialty: Insert answer here. Outline specifics of the scope of Directors responsibilities:
1.3 Check all of your specialty services available on a 24-hour/day on-call basis? (Describe plan for any services not available) ☐ Cardiology ☐ General surgery ☐ Cardiovascular surgery ☐ Neonatology ☐ Anesthesiology ☐ Neurosurgery ☐ Interventional Radiology ☐ Genetics ☐ Biomedical Engineering ☐ Social Work ☐ Neurology ☐ Nephrology ☐ Critical Care Specialist ☐ Pulmonology ☐ Hospitalist ☐ Hematology/Oncology ☐ Infectious Disease ☐ Gastroenterology ☐ Other: Insert additional information here. 1.4 Check available support services and/or consultants that are available (Describe plan for any services and/or consultants not available) ☐ gas laboratory ☐ Chemistry and hematology laboratory ☐ Blood Bank ☐ Pharmacy ☐ Cardiovascular operating room with cardiopulmonary bypass capabilities ☐ Radiology including cranial ultrasound and CAT scan ☐ Occupational and/or Physical Therapy ☐ Developmental/rehabilitation Specialist ☐ Nutritionist ☐ Pastoral Care ☐ Interpreter services Insert additional information here. 1.5 Outline available inter-hospital transport services for patients on ECLS. If you do not provide ECLS transport services, please detail your plan for transporting patients on ECLS to or from your center in case of emergent need. Insert answer here. 1.6 Describe the ECLS Medical Director position responsible for the overall operation of the Center. Provide medical specialty: Insert answer here. Outline specifics of the scope of Directors responsibilities:
ELSO%20Award%20Application%20Worksheet%202018.docx