THE RESQPIN PROGRAM WAS ESTABLISHED BY ADVANCED CIRCULATORY SYSTEMS TO RECOGNIZE BOTH PREHOSPITAL (EMS) AND INHOSPITAL CAREGIVERS, WHEN THEIR QUALITY RESUSCITATIVE EFFORTS HAVE CONTRIBUTED TO THE SUCCESSFUL RESUSCITATION OF THEIR PATIENT FOLLOWING RESQPOD USE.

Upon receipt, your ResQPin(s) will be mailed to you. In addition, you or your team will be recognized on Advanced Circulatory System’s website. Thanks for your excellence in patient care!

To receive your ResQPin, complete this form

Fields marked with a are required.

I am/we are prehospital (EMS) caregiver(s) whose resuscitative efforts with the ResQPOD resulted in a successful resuscitation.   I am/we are hospital caregiver(s) whose resuscitative efforts with the ResQPOD resulted in a successful resuscitation.
Name of person submitting form:
Caregiver Name(s):
Name of hospital/EMS agency:
Contact Phone:
Address:
City:
State:
Zip:
Contact Email:
Date of cardiac arrest:
Gender: Male Female Patient age:   Brief description of your resuscitation: