Date:  03/01/10 to 02/28/11

Who:  Law Enforcement agencies, First Responder organizations, Fire Departments (who respond to all medicals), Ambulance Services

Amount:   A grant award of $1,000 per unit will be available.  (NOTE:  Each department will only be allowed one award)

Priorities:  No existing defibrillators or an existing defibrillator 7+ years old and/or defibrillators which cannot be programmed to meet
current American Heart Association standards

Requirements:   Procure a medical director, if not already in place, complete training, which at a minimum meets Greater Northwest or American Heart guidelines and pay initial invoice in full (Greater Northwest will reimburse departments $1,000 per unit upon receipt of payment proof; copy of invoice AND check.)  Payment proof must be submitted to Greater Northwest within 90 days of request or funds will be forfeited. 

Number of Awards/Due Date:  A total of 10 grants will be awarded—applications are due September 1, with awards beginning September15, 2010. 

Application Process:  Complete the information below and return to us via fax (218-759-8995) or mail (2300 24th St NW, Suite 103, Bemidji, MN 56601)

Greater Northwest EMS Defibrillator Grant Form

 Department Name:  ______________________________  Manager:  ______________________________

Address:  _______________________________________  City/State/Zip:  _________________________

Day Telephone:  _________________________________  Fax:  __________________________________

Email:  _________________________________________

FIRST RESPONDERS/FIRE DEPARTMENTS

1)  (15 points)  Does your department currently have a defibrillator?

  rYes  rNo

 2)  (5 points)  If yes:  Is it more than 7 years old? 

  rYes  rNo

 3)  (5 points)  If yes:  Is it programmable to meet current AHA guidelines?  

  rYes  rNo

 LAW ENFORCEMENT

1)  (15 points)  Does each car patrolling have a defibrillator?

  rYes  rNo

 2)          (5 points)  If yes:  Are any more than 7 years old?

rYes  rNo

 3)  (5 points)  If yes:  Are they all programmable to meet the current AHA guidelines?  

  rYes  rNo

 AMBULANCE SERVICES

1)  (15 points)  Does each licensed ambulance have a defibrillator?

  rYes  rNo

 2)          (5 points)  If yes:  Are any more than 7 years old?

rYes  rNo

 3)  (5 points)  If yes:  Are they all programmable to meet the current AHA guidelines?