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State EMS Mobilization Request
NYS DOH EMS MOBILIZATION REQUEST
This is an actual NYS DOH EMS Mobilization Request. One person from each EMS agency should report resources that are available for deployment at this time using this form.
NYS EMS Mobilization Request
Mobilization Request Number
Deployment Contact Information
Agency Deployment Point of Contact
Deployment Contact Phone Number (24/7)
Deployment Contact Email Address
Agency Information
EMS Agency Code
EMS Agency Name
Primary County of Operation
- None -
Albany
Allegany
Bronx
Broome
Cattaraugus
Cayuga
Chautauqua
Chemung
Chenango
Clinton
Columbia
Cortland
Delaware
Dutchess
Erie
Essex
Franklin
Fulton
Genesee
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
St. Lawrence
Saratoga
Schenectady
Schoharie
Schuyler
Seneca
Steuben
Suffolk
Sullivan
Tioga
Tompkins
Ulster
Warren
Washington
Wayne
Westchester
Wyoming
Yates
Please report
ONLY
the resources that are available for deployment.
Personnel Available For Deployment
Please provide the number of personnel available for deployment
NYS CFR
NYS EMT
NYS AEMT
NYS EMT-CC
NYS Paramedic
Critical Care Paramedics
Equipment Available For Deployment
Please provide the number of assets available for deployment.
BLS Ground Ambulance Available
ALS Ground Ambulance Available
Critical Care - ALS Ground Ambulance
Air Ambulance Available
BLS Non-Transport Vehicle Available
ALS Non-Transport Vehicle Available
Person Submitting Survey
Name
Company
Email
Phone
Comments
Submit