Clinical Aviations

Flight Info & Crew

Operations

Safety

Critical Issues

Submission

Date of Flight

Operating Base

Transport / Run Number

Was this an aborted flight?

Crew #1

Crew #2

Crew #3 (if applicable)

Pilot in Command

Second in Command

Type of Flight

Did the transport mode change at any time?

Did you submit supply usage in Operative IQ?

Was a ground ambulance used to transport crew or patient?

Was aircraft cabin temperature maintained between 10–35°C during patient legs?

Any response delays?

Any radio communication difficulties?

Any difficulties with sending facility or scene command?

Any difficulties with receiving facility?

Any unexpected conditions that would have altered your FRAT or acceptance of flight?

Any crewmembers exposed to bloodborne pathogens during mission?

Was a sterile cockpit maintained during all Critical Phases of Flight?

Safety restraints used during transport? (Applies to patient and crew)

Ambulance lights and/or sirens used during transport?

Critical Issues During Transport

Critical Issues Comments

Any other unanticipated issues (enter NONE if not applicable)

Was this section completed and reviewed by all crew members including both pilots?

Individual responsible for submission