Georgia Hospital Profile

Healthcare Facility Emergency
Contact & Cooperative Planning Form

General Information 24 Hour Emergency Contact Numbers Facility Type Facility Name:Georgia Trauma Communications Center Phone: ACUTE CARE: Address: Fax: REHAB: City:, GA Security: NURSING: Main Phone: ED: COMM. CLINIC: Emergency Planning Personnel Title: Name: Phone: Cell: Email: Safety Officer Security Director ED Director Infection Control Pharmacy Director Laboratory Director Disaster Contact Information Incident Command Center Phone Numbers: Radio Information: Primary Location: 800 MHz radio link to EMS: Alternate Location: HAM Radio Frequency(if applicable): Facility Information # of Acute Care Beds # of Emergency Dept. Beds # of Intensive Care Beds # of Coronary Beds # of Newborn Intensive Care Beds # of Post Anesthesia Care Beds # of Burn Unit Beds # of Negative Pressure Rooms # of Negative Pressure Rooms in ED # of Ventilators/Respirators % of Ventilators in use on a daily basis Permanent Internal Decon Facility? Outdoor Permanent Decon Facilities? Outdoor Temporary Decon Facilities? Anticipated Hourly Capacity of ALL Decon. Facilities What is your Surge Capacity (% of Total Number of Beds) Information Last Updated: (information should be updated quarterly and as needed) Trauma Center Designation                (I - II - III - IV - n/a):    NDMS Facility?