Thousand Islands EMS
Thank you for your interest in joining Thousand Islands EMS, which will provide Emergency Medical Services to the towns of Clayton and Orleans. We current anticipate having some paid staff, but the rest of the service will be provided by volunteers. The following information will help us in our planning for the new squad.
City, State, Zip ______________________________________________________
Telephone______________________ Email ______________________________
Have you been, or are you now, a member of an EMS service? _________
If yes, which squad?__________________________________________________
We’ll need a variety of skills. In order to help us with planning for the new service, we’ll need to know what level of certification you now hold, used to hold, or would like to train for:
Current Expired Future
q q qNone
q q qDriver
q q qFirst Aid
q q qCPR
q q qCertified First Responder/CFR-D
q qq Basic EMT/EMT-D
q q qAdvanced EMT- Intermediate (Level II)
q q qAdvanced EMT - Critical Care (Level III)
q qq Paramedic (Level 4)
In addition, we’ll need to know what times of day and days of the week you would like to be available to respond.
You may have a special skill or profession which would benefit the squad. Care to tell us what it is? ___________________________________
Any other thoughts you’d care to share?