State of Alaska Mandatory EMS Reporting Requirements
All EMS personnel are required under Alaska Statutes to report certain injuries and conditions,
either verbally or by written report, to various state and local agencies.
The written forms for several agencies are found on the AFD Sharepoint website in “AFD Forms”
under “EMS Forms.”
Documentation of a verbal or written report shall be made in the Electronic Patient Care Report.
If you have questions or need assistance in completing the documents, contact the shift EMS
Battalion Chief.
Reporting gunshot wounds, stab wounds, and severe burns to the Department of Public
Safety
Under Alaska Statute AS 08.64.369 (c) Health care providers are to make certain that an oral
report of the below injuries are made promptly to the Department of Public Safety, a local law
enforcement agency, or a village public safety officer (written reports need to be made with
respect to burns):
 second or third degree burns to five percent or more of a patient's body;
 a burn to a patient's upper respiratory tract or laryngeal edema due to the inhalation of
super-heated air;
 a bullet wound, powder burn, or other injury apparently caused by the discharge of a
firearm;
 an injury apparently caused by a knife, axe, or other sharp or pointed instrument, unless
the injury was clearly accidental; and
 an injury that is likely to cause the death of the patient, unless the injury was clearly
accidental.
Written Reporting
Burn Injuries
 Burn injuries that meet the criteria in AS 08.64.369 (HEALTH CARE PROFESSIONALS
TO REPORT CERTAIN INJURIES):
o Second or third degree burns to five percent or more of a patient's body.
o A burn to a patient's upper respiratory tract or laryngeal edema due to the
inhalation of super-heated air.
 The form that shall be used is called DPS_Burn_Reporting_Form.pdf and is located at:
AFD Sharepoint website in “AFD Forms” under “EMS Forms.”
 The DPS reporting form shall be completed immediately following the event. The PDF
document can be filled out on the computer, and printed and faxed to (907) 269-0102, or
emailed directly to burn.reports@alaska.gov.
 The electronic document shall be stored with the accompanying ePCR, or hard copy of
the report submitted to the AFD EMS Billing Office.