The purpose of this referral is to improve the quality
and efficiency of patient care in the Western Virginia region. This form is intended for positive and negative
comments regarding EMS incidents in the Western Virginia region. Submission of this document initiates further
review of the specific incident. The intent of this form is to identify "system" issues. All information
obtained through this process will remain confidential. This information will be used by the EMS Agency
and Operational Medical Director (OMD) for the purposes of Quality Improvement (QI) and Performance
Improvement (PI) with the ultimate goal being improved patient care and offer solutions to improve the system as a whole.