HTML Preview Medical Threat Assessment page number 1.
MTA Template provided by NCTMA – the North Carolina Tactical Medical Association
Medical Threat Assessment / Preplanning Template
Operational Information
Date: Location: Latitude:
Time: Longitude:
Operation type
& no. involved
Warrant
(#):
Suspect
(#):
Hostage
(#):
Protection
(#):
Open Terrain
Search (#):
Other:
(#):
LE Personnel
Tactical: EMS / Medics: Detectives: Patrol: K9:
Other:
(#):
Hospital Facilities Type Address Distance ED Contact No.
1
WFU / Baptist Medical Center Trauma Center (Level 1) Medical Center Blvd, Winston-Salem, NC (336) 713-9100
2
Forsyth Medical Center Community Hospital 3333 Silas Creek Parkway, Winston-Salem, NC (336)
3
Helicopter Plan
Primary aircraft: AirCare Contact no: (336) 716-3669 Alternate aircraft: MedCenter Air (Charlotte) 800-421-9195
Landing
Zone
Address: Latitude: Longitude:
LZ Type: Obstructions / Debris:
Weather
Temp Hi: Precip (%): Heat Index:
Hydration & Rest Guide (for operations >4 hrs)
Temp Lo: Sunrise AM Cold Risk? Yes / No WB Temp
<60 60-78 78-82 82-85 85-88 88-90 >90
Wind (mph): Sunset PM Uniform Adjustments? Yes / No H20 Qt/hr
0.5 0.5 0.5 0.75 1.0 1.5 2.0
Humidity (%): Night Ops Yes / No Recs: Rest min/hr
0 0 0 10 15 30 40
Animal Threats
Domestic Animals Yes / No #: Types:
Animal Control:
(xxx) xxx-xxxx
(vs “Obtain via
dispatch”)
Poisonous Snakes Yes / No #: Types:
Wild Animals Yes / No #: Types:
Police Dogs Yes / No #: Police Vet: Dr. ________________ Vet contact no: (xxx) xxx-xxxx After hrs contact no: (xxx) xxx-xxxx
Police Vet address:
Plant Threats
Poisonous plant exposure likely? Yes / No Types:
Poison Control:
(800) 222-1222
Uniform Adjustments needed? Yes / No Recommendations:
Hazardous Materials
Ignition risks or NFDD
use anticipated?
Yes / No Types:
Recommendations
Nomex? Yes / No
Other special PPE? Yes / No
List:
HazMat Team:
(xxx) xxx-xxxx
(vs “Obtain via
dispatch”)
Clandestine Lab? Yes / No Types:
Industrial chemicals? Yes / No Types:
Other HazMats? Yes / No Types:
Public Works
Street Closings Yes / No Location: Gate Access Yes / No Location / Code:
Road Hazards Yes / No Location: EMS Staging Yes / No Location:
Extended Operations
Work cycles determined Yes / No List: Restroom facilities determined: Yes / No List:
Nutrition secured / checked Yes / No List: Sleep area determined: Yes / No List:
Other