2024 Mission: Lifeline® EMS Recognition Interest Form

2024 Mission: Lifeline® EMS Recognition

Interest Form

Mission: Lifeline EMS recognition is the American Heart Association’s program that recognizes prehospital emergency agencies for their quality of care for heart attack and stroke patients. The recognition program focuses on transforming care quality by connecting all heart attack and stroke care components into a seamlessly integrated care system.

Contact Information

To be added to the mailing list for 2024 recognition, please enter your contact information below.

Questions? Please email missionlifeline@heart.org.

First Name*

Last Name*

Email*

Secondary Email (if applicable)

Job Title*

Please select the most appropriate position in the dropdown below.

Select

American Heart Association (AHA) EMS ID

If known, please enter your AHA EMS ID.

Agency Name (Legal Name)*

Enter the name of the agency applying for recognition (no abbreviations please). (i.e., this may be the name printed on your state EMS license).

Street Address*

Street Address (Continued)

City*

State*

Select

Zip Code*

Prehospital Type*

Fire Department

EMS/Ambulance

Police Department

Agency Type*

Please select the most appropriate to describe your agency.

Transport

Non-transport

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