2023 Ohio EMSC Pediatric Clinical Saves Award Nomination Form


Please complete the form below to nominate a prehospital EMS or Emergency Department team for the 2023 Ohio EMSC Pediatric Clinical Saves Award. Encounters must have occurred in Ohio during 2023. (Children's hospitals and pediatric transport teams are not eligible.)

Submissions for nominations are due by January 31, 2024.

Please do not include any patient identifying information in this nomination form.

Your information
Nominee information
Encounter information
Incident information
Please briefly describe the encounter and why you feel your nominee(s) deserve a Pediatric Clinical Saves Award. Do not include patient identifying information (unless you are the patient/guardian).