Services & Forms
Quality Improvement Program

Some of the activities of the QI program include establishing requirements for provider priviledges and standards development. For more information on our QI program please contact Mr. Damon Obiden, KCEMS QI Coordinator.

Click here to view and print a QI Incident report form.

For more information about this service:

E-mail: dobiden@kcems.org

Infection Control Program
Click here for the PA419 Form

Click here for the PA57 Form

In the event of an exposure to an EMS provider within the KCEMS system, first contact your immediate supervisor. He/She will contact our office at 616.451.8438. If there is no response to your call within 30 minutes contact MEDCOM at 616.391.5319

For more information about this service:

E-mail: dobiden@kcems.org

AED Resources

If you are interested in AEDs for use in an EMS medical first response agency, click here

If you are interested in AEDs for use in an industrial setting or for a public facility, click here

For more information about this service:

E-mail: thayes@kcems.org

Do Not Resuscitate (DNR) Order
Download DNR Form

Download DNR Cobra Form

Download DNR for Religious Reasons Form

A Michigan Law was passed in 1996 which allows the use of a pre-hospital Do Not Resuscitate (DNR) Order. For the DNR order to be accepted by EMS personel, it must be on a form substantially the same as prescribed by law. For more details check out our DNR Q & A Page.

For more information about this service:

E-mail: dobiden@kcems.org

Drug Bag Exchange Program

The Drug Bag Exchange Program is a cooperative effort of regional hospital pharmacies. If you agency or pharmacy is in need of additional Blue or Green bags please contact our office. If you are a pharmacy representative and are interested in learning more about possible participation in this program we will be happy to answer any questions.

For more information about this service:

E-mail: dobiden@kcems.org

IV Pack Inventory Check List

Drug bag Inventory Check List

Controlled Substance Restocking Log

EMS Patient Care Records (Run Forms)

The KCEMS System had developed a comprehensive, user friendly Transporting and Non-transporting EMS Run Form. These forms are also widely used outside the KCEMS System. Toni Hayes will be happy to answer any questions about our forms and how to go about ordering..

For more information about this service:

E-mail: thayes@kcems.org

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