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 EMS. This award is based on nomination by peers, Service Administration, chart auditors or the SWORBHP Medical Directors. A maximum of four awards per year will be presented.

Nomination forms can be accessed through our website at www.lhsc.on.ca/bhp
All nominations will require the approval of the Service Operator
Deadline for submission of nomination forms in the current year is October 1st
Confirmation of receipt of nomination will be sent by email to the individual submitting the nomination
All decisions will be by consensus of the Medical Directors and Program Manager

Award 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 for the future
Demonstrating outstanding initiative in proposing valid constructive changes to the current structure of EMS with end result of adopting improvements to the current system

Limitations

All actions taken by the paramedic as nominated must be in compliance with the current Basic Life Support Patient Care Standards and Advanced Medical Directives
The paramedic nominated must be a certified paramedic in good standing with the SWORBHP

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.