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Huntsville MedFlight Ride-Along Form Purpose:
The Huntsville MedFlight Ride-Along Program provides an opportunity for all types of healthcare providers to experience pre-hospital patient care, patient flight criteria, in-flight procedures, and safe helicopter operations.
Eligibility: 1. Must be at least 18 years of age. 2. Applicant is currently employed as an EMT, Paramedic, Nurse, Firefighter, Police Officer, Dispatcher, or Physician. 3. EMT, Paramedic, Nursing, and Medical students may be eligible to participate in the program at the discretion of the ride-along program coordinator. 4. The applicant must not weigh more than 180 pounds. 5. If you do not meet the criteria listed above you may be considered upon an individual basis 6. You are allowed to fly once a year, unless otherwise approved by MedFlight Management 7. You must bring a picture ID with you to the scheduled ride-along. Dress Code Policy (IMPOTRANT): · Please wear a solid color polo type shirt with khaki or uniform pants (Jeans and Shorts are prohibited) · Boots are recommended but not required. If you do not have boots, leather soled shoes are acceptable (non-slip) Please be aware that professional attire is expected in one of the ways described above. Any one of the flight crew members has the right to send someone home for improper attire at his or her own discretion.
Guidelines: 1. Please arrive at your assigned base at 8 am. The ride-along is generally from 8 am to 4 pm however, if a flight comes in near to the time you are to leave, you can decide to go but be aware the flight may take longer than expected. 2. If you get lost, please call your assigned base. If you are unable to contact anyone, call LifeCom at 1-800-824-4444. MedFlight 1 (256) 828-7053 MedFlight 2 (256) 754-0180 3. Bring money or food to eat. We have a refrigerator, microwave, and stove available for you to use. 4. Bring a jacket for cold weather and dress appropriately to stay warm. 5. There is a chance that you could be left at a hospital or scene if there is weight issue. Please be aware we will arrange transportation for you to get back to your assigned base as soon as possible. If you schedule a Ride-Along and you are a No-Call – No Show on your day to fly you will not be allowed to reschedule for one year. Observer Vest Policy 1. All Ride Along participants are required to wear a provided MedFlight Observer vest. 2. The vest must be worn on all flights. 3. In the event a ride-along does not wear, or refuses to wear the vest, their observation shift will be cancelled at that time. Huntsville MedFlight reserves the right to refuse participation at any time, at the discretion of the pilot or flight crew.
Application The application should be mailed, E-mailed or Faxed to Huntsville MedFlight prior to your scheduled ride-along date. The contact information will be provided below. Thank you for your interest. Please Print Name: _______________________________________________________ Address: ______________________________________________________ ______________________________________________________ Age: ________ Weight ________ Height_________ Agency Affiliation: _______________________________________________ Phone: (Day) ____________________ (Evening) ___________________ E-Mail Address: _________________________________________________
Medical History ___Yes ___No Seizure Disorder ___Yes ___No Diabetes ___Yes ___No Are you pregnant (Only eligible to ride during the first trimester of pregnancy) ___Yes ___No Any other significant health issues Please explain if answered Yes to the Medical History
I confirm that the above physical and medical information is correct. I understand that Huntsville MedFlight reserves the right to verify any physical requirement. If complienece cannot be verified, I understand that would necessitate my exclusion for the program
Ride-along Signature _____________________________ Date_______________
Mailing Address Huntsville MedFlight Attention: Traci Jones 358-A Bolling Road Merdianville, Alabama 35759
Fax Number 256-828-0162
Tcjones@airmethods.com
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