| Cty |
Always
color in '15', regardless of what county in which
we may be operating. This number reflects the unit's base jurisdiction |
|
| Unit |
4-digit
unit number. i.e.: Medic 39 would be 0039.
In the rare occasion that a non-EMS unit transports the patient and
has to fill out the MAIS form, replace the alpha identifier with the
unit type numeric identifier listed below. Fill in the rest of the
fields from right to left and use leading zeros where necessary.
0
= EMS unit
1 = Engine - Example: E291 = 1 2 9 1
2 = Truck / Aerial - Example: T29 = 2 0 2 9
3 = Rescue Squad - Example: RS29 = 3 0 2 9; RS291 = 3 2 9 1
4 = Other |
| High
Staff |
Indicate
the highest certification level among the providers on your unit.
Mark only one certification level. The "Other" response
should be marked if the highest certification level is not listed.
|
| Dispatch |
Mark
the ALS or BLS response based on the life support level assigned to
this call at dispatch. Mark only one dispatch level |
| 1st
Due |
Mark
Yes if your unit was considered the first due unit for this call.
If your unit was not the first due, mark the No response. Mark only
one first due response. |
| No
Care Rendered |
If
you were dispatched to a call that resulted in no patient care by
your unit, you should indicate the reason no care was required.
Mark only one response.
|
| PDOA:
Patient was Presumed Dead on the arrival of your unit at
the scene. |
| Cancel:
Your response was cancelled while your unit was en route
or upon the arrival of your unit at the scene. |
| False:The
call was determined to be false; EMS was not required. |
| No
Pt: The potential need for patient care existed but was not
required, standby status. |
| Refuse:
Patient refused all care and transportation. |
| Unit
2: Your unit was not required to provide care because other
unit(s) at the scene were managing the patient(s). |
| Priority |
Record
the triage priority for your patient based on Maryland EMS guidelines.
|
| One
Critically ill or injured. Requires immediate attention. A delay in
treatment may be harmful to patient. |
| Two
Less serious condition. Requires emergency medical attention. |
| Three
Non-emergent condition. Requires medical attention but not on an emergency
basis. |
| Four
Does not require medical attention and may not require transport.
|
N/A
Priority assessment does not apply to this call (for example,
no patient). |
| Pt.
Age |
Patients between the ages of 1 and 31 days old should
have the D response marked along with the appropriate
number of days. |
| If
your patient is between 2 and 11 months old, you
should mark the M response as well as responses for
the appropriate number of months. |
| Leave
the M and D responses blank for patients one year of age or
older, and darken the responses corresponding to their age
in years. |
| Gender |
Mark
the response that corresponds to your patient’s gender. |
 |
| The
Annotated Code of Maryland, requires that any state agency requiring
use of a form which identifies individuals by race, shall include
instructions that multi-racial respondents may select all
applicable racial categories. Respondents shall select their
own answers, except when it is not possible for the respondent to
do so. A form that requires identification of individuals by race
shall include a separate question about whether a respondent is of
Hispanic or Latino origin, with the question preceding the racial
category question. |
Seniors
