Communications Failure Form (P-405A)

Communications failure is a situation where EMS clinicians are unable to contact a base hospital because of radio or cellular signal weakness, equipment failure (e.g., battery failed, antenna broken), inability to access the radio system with a ‘system busy’ tone or message, or inability to maintain understandable voice contact.

In the event of a communiciations failure, EMS clinicians shall make alternate receiving facility notification and complete all fields below to submit a P-405A Communications Failure Form within twenty-four (24) hours of the incident to the San Diego County EMS Office.

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Approximate geographical location (e.g., I-15 South at Deer Springs Road). This information will be used to record geographic areas with weak radio or cellular service.

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Base Hospitals Contacted

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 Palomar
 Scripps Mercy
 Scripps La Jolla
 Sharp Grossmont
 Sharp Memorial
 Tri-City
 UCSD Hillcrest
 NO BASE HOSPITAL CONTACT ATTEMPTED

Receiving Facility Notification Method

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 Used a cellular phone to contact a base hospital
 Requested the communications center contact a base hospital to relay patient acuity and destination
 Contacted the receiving hospital via the BLS/MT1 zones on the Regional Communications System (RCS) network
 Used a cellular phone to contact receiving hospital directly
 LEMSIS agencies: Posted ePCR to receiving facility prior to arrival
 NO NOTIFICATION MADE TO RECEIVING FACILITY BEFORE ARRIVAL

Verbal Report made to Base Hospital after offload

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 Yes, Base Hospital reporting completed
 No, I did not file a verbal report with the Base Hospital after patient transfer