Date and time of the call:
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Now Y-M-D H:M
County
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Albany Allegany Bronx Broome Cattaraugus Cayuga Chautauqua Chemung Chenango Clinton Columbia Cortland Delaware Dutchess Erie Essex Franklin Fulton Genessee Greene Hamilton Herkimer Jefferson Kings Lewis Livingston Madison Monroe Montgomery Nassau New York Niagara Oneida Onondaga Ontario Orange Orleans Oswego Otsego Putnam Queens Rensselaer Richmond Rockland Saratoga Schenectady Schoharie Schuyler Seneca St. Lawrence Steuben Suffolk Sullivan Tioga Tompkins Ulster Warren Washington Wayne Westchester Wyoming Yates
Agency
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Kingston Fire Department Henrietta Fire District Fort Drum Fire & EMS Chautauqua County Hazmat Response Team (Agency 1078) Stephentown Fire District #1 Grafton Volunteer Emergency Relief Helderberg Ambulance Cassadaga Volunteer Fire Department Stanley Hose Co. Inc. Kennedy Volunteer Fire Department Twin City Ambulance Gates Fire District Main-Transit Fire Department Big Tree VFC Hoags Corners Volunteer Ambulance Perinton Volunteer Ambulance Springville Fire Clymer Volunteer Fire Department Cohoes Fire Department Getzville Fire Company Genesee Valley EMS Pittsford Volunteer Ambulance Massena Volunteer Emergency Unit Putnam Valley Volunteer Ambulance Corps City of Watertown Fire Department Town of Livonia Ambulance District #1 Rapids Volunteer Fire Company, Inc. Cambria Volunteer Fire Co First Volunteer Fire Company of Bergholz, Inc South Seneca Community Volunteer Ambulance Corp Inc Sea Breeze Fire District Lake Shore Fire District - Rochester Lancaster Volunteer Ambulance Corps Sinclairville Volunteer Fire Company Rotterdam EMS Mattydale Fire Department Lacona Volunteer Fire Department Aurora-Ledyard Fire District Monroe Ambulance Henrietta Ambulance Eastchester Volunteer Ambulance Peekskill VAC Ogdensburg Volunteer Rescue Squad Niagara Falls Fire Department Greenburgh Police Department Syracuse Fire Department Warsaw Rescue Squad Rome Fire Department Evans Mills Volunteer Ambulance Squad, Inc. Green Island Fire Department Lake Mohegan Fire District EMStar Ambulance Penn Yan Area Volunteer Ambulance Corps Town of Hancock Ambulance Varysburg Volunteer Fire Department Rescue Squad Dundee Emergency Squad Lewis County Search & Rescue Youngstown Volunteer Fire Co. Attica Fire Department Walton Fire Department Emergency Squad Cooperstown Medical Transport, Inc. Franklin EMS Whitesboro Fire Department Central Oneida County Vol. Amb. Corps Livingston County EMS Rose Fire Company Scranton VFC Hamburg Volunteer Fire Department Blasdell VFD Vestal Volunteer Emergency Squad Inc. Clausson Raught Community Rescue Squad Cortlandt Community Volunteer Ambulance Corps Duanesburg Volunteer Ambulance Corps South Jefferson Rescue Squad, Inc. Lorraine Volunteer Fire Co Inc. Union Volunteer Emergency Squad Latham Fire Department Spencer Volunteer Emergency First Aid Squad Phelps Ambulance Inc Durham Ambulance Inc. Ravena Rescue Squad Inc. Worcester EMS Cairo Ambulance Town of Hoosick Rescue Squad Adams Fire Company Grand Gorge Rescue Squad Parishville Volunteer Fire Company, Inc. Tritown Volunteer Rescue Squad Thousand Islands Emergency Rescue Service Greenport Rescue Squad Harris Corners Fire Department Jonesville Fire Department Cowlesville Fire Company Darien Lake Theme Park Bergen Fire Department Bethany Volunteer Fire Department Alabama Fire Department Leroy Ambulance, Inc Natural Bridge Volunteer Ambulance Carthage Area Rescue Squad Lisbon Volunteer Fire District North Greenbush Ambulance Scarsdale Volunteer Ambulance Corps Commack Volunteer Ambulance Corps East Northpont Fire Department Greenlawn Fire Department Dix Hills Fire Department Union Center Fire Company Inc. Mercy Flight, Inc. Wolcottsville Volunteer Fire Company Auburn Fire Department Lima Volunteer Ambulance Cattaraugus County Sheriff's Office SRT Fayetteville Fire/EMS Mohawk Ambulance Service West Winfield FD Ambulance Brockport Volunteer Ambulance Corps Central Bridge Fire Department Town of Colonie EMS Mastic Beach Ambulance Company Port Jefferson EMS Old Forge Volunteer Ambulance Springfield Fire Department City of Salamanca Ambulance Service Franklinville Volunteer Fire Department Lindenhurst Fire Department Exchange Ambulance Corp of the Islips Mastic Volunteer Ambulance Southampton Volunteer Ambulance, Inc. Clyde Ambulance Service Hilton Fire Department Farmingville Fire Department Eden Emergency Squad Lake Shore Volunteer Fire Co. Inc. - Hamburg Randolph Regional EMS Coram Fire & EMS Shelter Island Town EMS Fair Harbor First Rescue Eastfarmingdale Volunteer Fire Company Inc. Sag Harbor Volunteer Ambulance Emergency Ambulance Service Rural Metro Rochester Rural Metro Corning Western Turnpike Rescue Squad Ronkonkoma Fire Department Selden Fire Department Brentwood Legion Ambulance Nyack Community Ambulance Corps Medford Ambulance Deer Park Fire Department City of Oneonta Fire Department Alexandria Bay Fire Department East Hampton Village Ambulance Association Mendon Fire Department Manorville Community Ambulance Valatie Rescue Squad Centereach Fire District Shirley Community Ambulance Yaphank Fire District North Area Volunteer Ambulance Corps Inc. Vista Fire Department Galway Emergency Medical Services Newark Arcadia EMS Riverhead Volunteer Ambulance Corps Inc. (RVAC) Ridgewood Volunteer Ambulance Corps Harpursville Fire Department Middlesex Valley Volunteer Ambulance Service Guilford Fire Department EMS Rockland Mobile Care North Lindenhurst Fire Department City of Lockport Fire Department Brocton Fire Department Frewsburg Fire Company Central Islip-Hamppauge Volunteer Ambulance Lyncourt Fire Department Gerry Volunteer Fire Department Hamlin Volunteer Ambulance Indian River Ambulance Service Medina Fire Department Fulton Fire Department Utica College Emergency Medical Services Bay Shore Brightuaters Rescue Ambulance Cedarville Ambulance Edmeston Fire Department Emergency Squad East Moriches Community Ambulance Richmond County (RCA) Ambulance Service Community Ambulance Co. Hampton Bays Volunteer Ambulance Corp. West Babylon Fire Department Solvay Fire Department Speculator Volunteer Ambulance Corps, Inc. Morris EMS Bloomville Fire Department Emergency Squad SUNY Geneseo First Response Mobile Life Support Services Center Moriches Fire Department Brighton Fire Department Westhampton Ambulance Chenango Bridge Fire Company Forestville Fire Department Inc Naples Ambulance Inc. East Worcester First Responders Bay Ridge Rescue Squad City of Batavia Fire Department Hague Volunteer Fire Department Main Emergency Squad Inc. Mountaindale FD First Aid Squad North East Joint Fire District WCA Services Corp/Alstar EMS RIT Ambulance Stamford Fire Department Town of Catskill Ambulance Monroe Volunteer Ambulance Village of Madison Ambulance Colesville VAS Islip Fire Department SOMAC Union Hill Volunteer Ambulance Corp Williamsville Fire Department Pindar's Corners First Responders Islip Terrace Fire District Hinsdale Maplephurst Pleasant Valley Fire Department Turin Volunteer Ambulance Ogdensburg Fire Department First Responders Skenesborough Emergency Squad North Queensbury Fire Department Swormville Fire Company Rural/Metro Medical Services of Central NY South Orangetown Ambulance Corps S&S Volunteer Ambulance Service Inc. Dansville Ambulance Company Brownville Joint Fire District Johnsburg Emergency Squad Endicott Fire Department Pekin Fire Company Inc. Onondaga Hill Fire Department Cornell Hook & Ladder Candor Emergency Squad Inc. Gainesville Fire Department Churchville Volunteer Fire Department Union Vale Fire District Southampton Village Volunteer Ambulance Wyandanch Wheatley Heights Ambulance Honeoye Falls Fire Department Gilbertsville Fire Department Emergency Squad Irondequoit Ambulance Kiryas Joel Volunteer EMS, Inc. Westford First Responders Chateaugay Fire Department Indian Lake Volunteer Ambulance Corps Rural Metro Buffalo Avon Rotary Lions Ambulance Service Waterford Rescue Squad Sheldon VFC Holtsville Fire District Lewisboro VAC City of Bighamton Fire City of Cortland Fire Department Sidney EMS Bust Fire Department, Inc. Jefferson Rescue Squad South Lockport Fire Company Big Moose Ambulance Co. Inc. West Seneca Fire District #1 Chevra Hatzalah - Canarsie (K) Otego Emergency Squad Oneonta State Emergeny Squad Schenevus Maryland EMS Woodgate Fire Department Inc. Southern Cayuga Instant Aid Tri Community Ambulance Service, Inc. Greenwood Lake Ambulance, Inc. Chili Volunteer Ambulance Service New York State Task Force 2 Laurens Emergency Squad Jamaica Estates Holliswood So. Bayside VAC Green Emergency Squad, Inc. Cherry Creek Fire District Ridge Road Fire District Norfolk Volunteer Rescue Squad Holbrook Fire District Granville Rescue Squad Warners Memphis Fire District Eaton Fire District Alexander Fire Department East Avon Fire Department Village of New Square Ambulance Service Northampton Ambulance Service Dobbs Ferry Volunteer Ambulance Smithtown Fire District North Patchogue Fire Department Village of Manlius Ambulance and EMS Kirkville Fire Company East Brentwood Fire Department Warrensburg EMS Inc. Tusten Volunteer Ambulance Roscoe Rockland Volunteer Ambulance Corp. Terryville Fire Department Sound Beach Fire Department Schuyler Ambulance Inc. Bristol Volunteer Fire Department Bridgehampton Fire Department RPI Ambulance City of Tonawanda Fire Department Cicero Fire Department Darien Emergency Medical Service, Inc. Darien Center Chemical Fire Company, Inc. Andes EMS Town of Macedon Ambulance Service, Inc. West Glens Falls EMS Minerva Volunteer Fire Department Rescue Squad Lakeland Fire District New Hartford Fire Department The Cambridge Valley Rescue Squad Inc. Treadwell EMS Copiague Fire District Maple Springs Fire Company, Inc. Mayville Fire Department Crystal Beach Volunteer Fire Department Jamestown Fire Department Greenville Rescue Squad Inc. Inlet Volunteer Ambulance Service Strykersville Volunteer Fire Department Inc. West Seneca Fire District #6 Instacare EMS Cuba Ambulance Service Fishers Fire District Fairview Fire Department Kendall Fire Department Coventry Emergency Squad, Inc. Brookfield Fire Department Rescue Hubbardsville Fire Department Camden Volunteer Fire Rescue Lenape Volunteer Ambulance Corp Hewlett Bay Fire District Bellmore-Merrick EMS Plainview Volunteer Fire Department East Meadow Fire Department North Bellmore Fire District Bethpage Fire District Rockville Center Fire Department South Farmingdale Fire Department Baldwin Fire District Williston Park Fire Department Jericho Fire Department Rhinecliff Rescue Squad Northshore Volunteer Emergency Squad Newstead VFD Oceanside Fire Department Greater Baldwinsville Ambulance Unadilla EMS Fairville Volunteer Fire Department Paul Smiths Gabriels Volunteer Fire Department North Seneca Ambulance Inc. Fancher Hulberton Murray Fire Co. Hawthorne Fire Department / EMS Mexico Volunteer Fire Department Town of Owego Fire District Town of Coxsackie Ambulance Fort Covington EMS, Inc. Maybrooke Fire District American Legion Ambulance Service Gouverneur Volunteer Rescue Squad Manhasset-Lakeville Fire Department Patchogue Ambulance Wantagh Fire Department Mount Morris Ambulance Bolton EMS Inc. Donald McFee Memorial Ambulance Service Ridgeway Volunteer Fire Company Old Erie Emergency Services Inc. Town of Carlton Fire Co. No. 1 Bovina EMS Vienna Fire Department Windsor Emergency Services, Inc. South New Berlin Rescue Squad Melville Fire Department Danby Rescue Garrison Ambulance Dewitt Fire District Forestport Fire Fighters West Islip Fire Department Masonville Fire District Ambulance Amityville Fire Department North Syracuse Fire Department North Java Fire Department Livonia Fire District Atlantic Beach Rescue South Hempstead Fire Department Cheshire Volunteer Fire Department Wales Center Volunteer Fire Company Superior Ambulance Service, Inc. City of Dunkirk Fire Department East Seneca Volunteer Fire Company East Fishkill Fire District Town of Mamaroneck Ambulance District Port Leyden Ambulance Scho/Wright Ambulance Service Brighton Volunteer Ambulance Brier Hill Volunteer Fire Department Cattaraugus Area Ambulance Panama Fire Department Upper Mountain Volunteer Fire Company of Lewiston NY Knolls Atomic Power Lab Oriskany Fire Rampo Valley Ambulance Corps Oriskany Falls Volunteer Fire Department Mineola Volunteer Ambulance Company Chevra Hatzalah - West Side (WS) Chevra Hatzalah - Boro Park (B) Chevra Hatzalah - Crown Heights (CH) Chevra Hatzalah - Flatbush (F) Chevra Hatzalah - Lower East Side (ES) Chevra Hatzalah - Queens (Q) Chevra Hatzalah - Riverdale (RD) Chevra Hatzalah - Rockaway (RL) Chevra Hatzalah - Staten Island (SI) Chevra Hatzalah - Upper Eastside (M) Chevra Hatzalah - Washington Heights (Y) Chevra Hatzalah - Williamsburg (W) Greenville Fire District Harpurs Ferry Student Volunteer Ambulance Yorkshire Fire Department New Windsor Ambulance Greater Lenox Ambulance Service Inc. Penfield Volunteer Emergency Ambulance Reserve Hose West Seneca Fire District #3 Barker Fire Department Sylvan Beach Volunteer Fire Department Town of Watertown Ambulance Defreestville Fire Department Wynantskill Fire Department City of Rensselaer Fire Department Medway-Grapeville Fire District East Islip Fire Department East Quogue Fire Department Vernon Center Volunteer Fire Department Thomas Corners Fire Department Findley Lake Fire Department Genoa Volunteer Fire District Laurelton Fire District Columbia University EMS Clark Mills Fire Department Larchmont Fire Department Albany County Sheriff's Office Oxford Fire Department Emergency Squad Springs Fire District Ballston Lake EMS Harrisville Rescue Squad Hamlin Morton Walker Fire District City of Glen Cove Volunteer EMS Fort Edward Rescue Squad Huntington Community First Aid Squad Florence Volunteer Fire Company Smithfield Eaton Volunteer Ambulance Momentive Performance Materials Brigade Clarence Center Volunteer Fire Co. Newcomb Rescue Squad Frankfort Fire Department Ambulance Lake George Emergency Squad St. Johnsburg Fire Company, Inc. Town of Newburgh Ambulance Byron Rescue Squad Nassau Ambulance, Inc. Stewart Manor Fire Department North Pole Fire Company, Inc. Friendship Ambulance Squad Wading River Fire District Ulster Hose Co #5 Purchase College EMS New Paltz Rescue Squad Onesquethaw Volunteer Fire Company, Inc. Apalachin Fire Department Sandy Creek Fire Department Lake Placid Volunteer Ambulance Ellenville First Aid & Rescue Squad South Country Ambulance Marbletown First Aid Unit Geneseo Fire Department Orchard Park Fire District EMS, Inc. Rensselaer Falls VRS Inc. Sand Lake Ambulance Quogue Village Police Department Bombay Fire & Rescue Cornell University EMS Valhalla Ambulance Corps Ridge Fire District New City Volunteer Ambulance/Rescue Squad Seaford Fire Department Schuyler County Volunteer Ambulance Inc. Westbury Fire Department Magee Volunteer Fire Department Webster EMS Holland Fire District #1 Hobart Fire EMS Delhi Fire District EMS Ripley Fire District St. Paul Blvd Fire District Nissequogue Fire and Rescue Bemus Point VFD Gloversville Fire Department Melrose Fire District Medical Transport Service Inc. Chili Fire Department Grand Island Fire Company Finger Lakes Gaming & Racetrack Oswego Town Fire District Limestone Volunteer Fire Department (Carrollton Joint Fire District) Honeoye Falls Mendon Volunteer Ambulance Wrights Corners Fire Company Inc. Henderson Fire Department Inc. Flatlands Volunteer Ambulance Corps Inc. Memorial Volunteer Fire Co. of Chaffee-Sardinia Somers Fire District Williamson Volunteer Ambulance Lewiston Fire Company No. 2 Flushing Community Volunteer Ambulance Corps Inc. Burke Volunteer Fire Department Groton Fire Department Ambulance Wendelville Fire Co. Glen Park Volunteer Fire Department Lakewood Fire Department Pound Ridge Volunteer Ambulance Corp Alden EMS Department Varna Volunteer Fire Company Gowanda Ambulance Service Mohegan Volunteer Fire Association Ambulance Corps Yorkville Fire Department Westchester EMS East Rockaway Fire Department Cassville Fire Department East Shelby Fire Company Scottsville Fire Department Spring Hill Community Ambulance Corps Skidmore College EMS Halfmoon-Waterford Fire District #1 Oyster Bay Fire Department Eaton's Neck Fire Rescue Bennington Volunteer Fire Company Spencerport Fire Department Tioga Center Emergency Squad St. Regis Falls Ambulance Richville Fire Department Glens Falls Fire Department Ambulance Instacare EMS Silver Springs Rescue Squad Munnsville Fire Department Palermo Fire Department Border City Fire Department Stony Brook Volunteer Ambulance Corps Cattaraugus Indian Reservation Volunteer Fire Department (CIRVFD) Berkshire Fire District Ambulance East Williston Fire Department Akwesasne Mohawk Ambulance SUNY Cortland EMS Miller Hose Fire Co. Stanley-Hahh-Gorham Volunteer Ambulance Monticello Casino and Raceway Senior Care EMS Saranac Lake Volunteer Rescue Squad Carlisle Fire Department Rescue Squad North White Plains Fire Department Belfast Rescue Squad Walworth Ambulance Inc. King Ferry Fire Department Falconer Fire Department Smithfield Fire Department Chenango Ambulance Service Inc. North Collins Emergency Squad Farmingdale Fire Department Silver Waters Community Ambulance Service Esperance Volunteer Fire Department Middle Island Fire District Nichols Joint Fire District Bangor Volunteer Fire & EMS Wantaugh Levittown Volunteer Ambulance Corps Ardsley-Secor Volunteer Ambulance Corps Bellmore Fire Department Empress Ambulance Boston Emergency Squad Jamaica Hospital Medical Center MediSys Ambulance Service, Inc. Flushing Hospital Medical Center F.B. Peck Hose Company/Northside Fire District Bedford-Stuyvesant Ambulance Corps Fairmont Fire District Tuscarora Volunteer Ambulance Mortons Corners VFD Hoosic Valley Rescue Squad, Inc. Massapequa Fire Department Delmar-Bethlehem EMS Eastern Wayne EMS South Line Fire District Scotia Fire Department Town of Esopus Volunteer Ambulance Squad Quaker Street Fire Company Angelica Rescue Squad Owego Fire Department EMS Conesville Rescue Squad West Glens Falls Fire Company No 2 Victor-Farmington Volunteer Ambulance Heuvelton Volunteer Fire Department New York Mills Fire Department Summit Fire District Rescue Squad Northport Fire Department Constable Volunteer Firemen, Inc. Ontario Volunteer Emergency Squad Olive First Aid Unit, Inc. Canandaigua Fire Department Northern Ambulance Corps, LLC North Greece Fire District Richmond Fire Department #1 Five Quad Volunteer Ambulance Service Charlton Fire Department IRA Volunteer Fire Department Scriba Volunteer Fire Department North Lawrence Fire/First Responders Walden Ambulance Corp (Town of Montgomery Ambulance) Montgomery Fire District Village of Minoa Ambulance Western Area Volunteer Emergency Services, Inc. Bay Ridge Volunteer Fire Company Millgrove Volunteer Fire Department Town of Highlands Volunteer Ambulance Corps Newton Abbott Fire Company Watkins Glen Fire Department South Wilson Fire Company Gasport Chemical Hose Co. West Hempstead Fire Department Town Line Volunteer Fire Company Wellsville Volunteer Ambulance Corps St. Regis Falls Fire Department Town of Tully Ambulance District Town of Ashland Ambulance Service Himrod Fire Department Constableville Volunteer Fire Co. Inc. McConnellsville VFD Scio First Responders Town of Windham Ambulance Amity Rescue Squad Raquette Lake Volunteer Ambulance Squad Plotterkill Volunteer Fire Co. Inc. South Otselic Fire Department Emergency Squad Atlantic Steamer Fire Company No. 1 New Hyde Park Fire Department Cazenovia Fire Department Fairview Fire District Cooperstown Fire Department Emergency Squad Hartwick Fire Department Emergency Squad Phoenix Fire Department
Patient's age
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in years, if < 1 year please enter the number of years followed by 'm' i.e. 1m
Patient's gender
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Male Female
Patient's weight in kg
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Look under APPLICATIONS - File Repository on the left hand side of this screen for lbs to kg conversions
Does the patient have a history of anaphylaxis?
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Yes No
Does the patient have a prescription for or carry epinephrine?
* must provide value
Yes No
Has the patient ever used their epinephrine?
* must provide value
Yes No Unknown
Was epinephrine administered prior to EMS arrival?
* must provide value
Yes No Unknown
Was the patient experiencing any of the following symptoms?
* must provide value
Check all that apply
Were initial vital signs taken?
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Yes No
Initial systolic blood pressure
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Initial diastolic blood pressure
* must provide value
Initial oxygen saturation
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Was this a room air sat?
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Yes No Not documented
Initial respiratory rate
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Initial lung sounds
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check all that apply
Was epinephrine administered by EMS?
* must provide value
Yes No
What was the initial dose?
* must provide value
0.15 mg 0.3 mg
Was the proper dose of epinephrine administered?
* must provide value
Yes No
Who was this dose administered by?
* must provide value
EMT AEMT EMT- CC Paramedic
Were post injection vitals taken?
* must provide value
Yes No
Systolic blood pressure
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Diastolic blood pressure
* must provide value
Oxygen saturation
* must provide value
Was this a room air sat?
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Yes No Not documented
Respiratory rate
* must provide value
Post injection lung sounds
* must provide value
check all that apply
Was a second dose of epinephrine administered?
* must provide value
Yes No
What was the second dose?
* must provide value
0.15 mg 0.3 mg
How many minutes did the provider wait after giving the first dose before the second dose was administered?
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in minutes
What symptoms was the patient experiencing before the second dose was administered?
* must provide value
Check all that apply
Do you feel a second dose of epinephrine should have been administered?
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Yes No
If epinephrine was not administered, did the provider document why?
* must provide value
Yes No
Was this patient transported to a hospital?
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Yes No
Primary care provided by:
* must provide value
BLS ALS
Specify why they were not transported:
* must provide value
Submit
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