Pediatric Bag Request

Pediatric Bag Request

Applications are now open with a limited availability for individuals that meet the following criteria:

They live/work 10+ miles from the ambulance garage, and depending on the call, will go even further out to stabilize patients while waiting for the ambulance to arrive.
Are licensed with the SD BMOE as an EMR or higher.
Are attached to a SD EMS Agency that is overseen by a Medical Director.
Are attached to a SD EMS Agency that has a Pediatric Champion.
Individual receiving the bag must agree to complete training.

The resources provided by SD EMS for Children are available for organizations located within South Dakota. If you have any questions, please email us at sdemsc@usd.edu.

Tell us about your Organization:

Organization Name*

Please list the official name of your organization.

Organization Type*

Select or enter value

Organization Address*

City*

State*

Zip Code*

County*

Director*

Director Phone*

Director Email*

Medical Director*

Medical Director Phone*

Medical Director Email*

Pediatric Champion Name*

If your agency does not have a Pediatric Champion currently, you can designate one at www.sdemsc.org .

Individual Information

This section should be filled out with the information of the individual replying to receive the Pediatric Bag.

Applicant First Name*

Applicant Last Name*

Applicant Address*

Applicant City*

Applicant State*

Applicant Zip Code*

Applicant Email*

Applicant Phone Number*

Phone

SDBMOE License Number*

SD BMOE Expiration Date*

License Type*

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