SWORBHP Medical Directors Award of Excellence Nomination Form

The Medical Directors Award of Excellence will be awarded to paramedics who have been recognized for excellence in prehospital and paramedic care. This award is based on nomination by peers, service leadership and/or administration, chart auditors, or the SWORBHP Medical Directors. A maximum of four awards per year will be presented.

Nominations:

The deadline for submission of nomination forms is December 31st annually.
Nomination forms can be accessed through the SWORBHP website: https://www.sworbhp.ca
Nominators will receive a receipt of confirmation of each nomination submitted via email.

Award Criteria – Criteria includes, but is not limited to:

Outstanding clinical judgment and actions during a difficult or complicated clinical scenario
Demonstrated leadership in a complicated multiple agency response
Leadership and participation in education or administration activities over and above regular clinical responsibilities
Advancing the practice of paramedicine by advocating on behalf of paramedics in multiple agency strategic planning
Demonstrating outstanding initiative in proposing valid constructive changes to the current structure of EMS with the end result of adopting improvements within the current system

Limitations

All decisions will be made by consensus of the Medical Directors and supported by the SWORBHP leadership team.
The paramedic nominated must be a certified paramedic or paramedic student in good standing with SWORBHP, and the Service Operator
All actions taken by the nominated paramedic must be in compliance with the current Basic and Advanced Life Support Patient Care Standards.

Award recipients will have their name engraved on a plaque which is displayed at the Base Hospital office in London and will receive a personalized certificate.

Please note that you will be receiving an email of this form once submitted.
To comply with privacy, please ensure that you DO NOT
include any patient or confidential information within your submission.

Nomination Form

First Name of Paramedic Being Nominated:

Last Name of Paramedic Being Nominated:

Name(s) of Individual Submitting Nomination:

Email:

Name of Service Operator Approving Nomination:

Call Date:

Service:

Run #:

Which criteria, as outlined in the description of the award apply to this nomination?

Briefly... Briefly describe (no more than 250 words) the actions taken by the paramedic, and your rationale as to why he/she isdeserving of the Medical Directors Award of Excellence. Please include, if appropriate, the ACR run number to allowfor cross reference of specific clinical information for review by the Medical Director review team. Please do notinclude any personal patient identifiers.