Journal Imagine that you are a fire service or emergency management administrator, and you notice that one of your employees is making jokes about a serious traumatic incident for which he was on the

Medical Plan (ICS 206)

1. Incident Name:							2. Operational Period:		Date From: ate				Date To: ate
Time From: HHMM					Time To: HHMM
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:

ICS 206

Medical Plan

Purpose. The Medical Plan (ICS 206) provides information on incident medical aid stations, transportation services, hospitals, and medical emergency procedures.

Preparation. The ICS 206 is prepared by the Medical Unit Leader and reviewed by the Safety Officer to ensure ICS coordination. If aviation assets are utilized for rescue, coordinate with Air Operations.

Distribution. The ICS 206 is duplicated and attached to the Incident Objectives (ICS 202) and given to all recipients as part of the Incident Action Plan (IAP). Information from the plan pertaining to incident medical aid stations and medical emergency procedures may be noted on the Assignment List (ICS 204). All completed original forms must be given to the Documentation Unit.

Notes:

The ICS 206 serves as part of the IAP.
This form can include multiple pages.

Block Number	Block Title	Instructions
1	Incident Name	Enter the name assigned to the incident.
2	Operational Period Date and Time From Date and Time To	Enter the start date (month/day/year) and time (using the 24-hour clock) and end date and time for the operational period to which the form applies.
3	Medical Aid Stations	Enter the following information on the incident medical aid station(s):
Name	Enter name of the medical aid station.
Location	Enter the location of the medical aid station (e.g., Staging Area, Camp Ground).
Contact Number(s)/Frequency	Enter the contact number(s) and frequency for the medical aid station(s).
Paramedics on Site?  Yes  No	Indicate (yes or no) if paramedics are at the site indicated.
4	Transportation (indicate air or ground)	Enter the following information for ambulance services available to the incident:
Ambulance Service	Enter name of ambulance service.
Location	Enter the location of the ambulance service.
Contact Number(s)/Frequency	Enter the contact number(s) and frequency for the ambulance service.
Level of Service  ALS  BLS	Indicate the level of service available for each ambulance, either ALS (Advanced Life Support) or BLS (Basic Life Support).
5	Hospitals	Enter the following information for hospital(s) that could serve this incident:
Hospital Name	Enter hospital name and identify any predesignated medivac aircraft by name a frequency.
Address, Latitude & Longitude if Helipad	Enter the physical address of the hospital and the latitude and longitude if the hospital has a helipad.
Contact Number(s)/ Frequency	Enter the contact number(s) and/or communications frequency(s) for the hospital.
Travel Time Air Ground	Enter the travel time by air and ground from the incident to the hospital.
Trauma Center  Yes Level:______	Indicate yes and the trauma level if the hospital has a trauma center.
Burn Center  Yes  No	Indicate (yes or no) if the hospital has a burn center.
Helipad  Yes  No	Indicate (yes or no) if the hospital has a helipad. Latitude and Longitude data format need to compliment Medical Evacuation Helicopters and Medical Air Resources
6	Special Medical Emergency Procedures	Note any special emergency instructions for use by incident personnel, including (1) who should be contacted, (2) how should they be contacted; and (3) who manages an incident within an incident due to a rescue, accident, etc. Include procedures for how to report medical emergencies.
 Check box if aviation assets are utilized for rescue. If assets are used, coordinate with Air Operations.	Self explanatory. Incident assigned aviation assets should be included in ICS 220.
7	Prepared by (Medical Unit Leader) Name Signature	Enter the name and signature of the person preparing the form, typically the Medical Unit Leader. Enter date (month/day/year) and time prepared (24-hour clock).
8	Approved by (Safety Officer) Name Signature Date/Time	Enter the name of the person who approved the plan, typically the Safety Officer. Enter date (month/day/year) and time reviewed (24-hour clock).