OVERVIEW - SBES / CFARS



OVERVIEW

The High Bridge Emergency Squad was established in 1953. The mission of the Squad is to provide year-round emergency medical, tactical and marine services to the Borough of High Bridge and the surrounding communities. The following document lays out the general procedures by which the squad runs it operation on a day-to-day basis. Designed to complement the Squad Bylaws and the Administrative Operating Guidelines (AOGs), these Standard Operating Guidelines are organic; changing frequently to meet the ever evolving needs of the Squad and the communities it serves.

1. INTRODUCTION

1.1 Purpose

The Chief of the High Bridge Emergency Squad (HBES) has established these Standard Operating Guidelines (SOGs) for which the squad member (volunteer or per- diem) will use as guidance to facilitate EMS and Rescue services. For activities within the normal scope of practice for which Squad members are trained and qualified to carry out that are not specifically discussed here, the guidance set forth by the Department of Health of the State of New Jersey or similar appropriate regulatory agency is to be followed.

1.2 Scope

These guidelines will establish the work practices for all anticipated areas of line operation within HBES. All members will receive a copy of these SOGs and will be required to review this document and practice the standards defined herein.

1.3 Control

It will be the responsibility of the line officers to administer and monitor these SOGs. However, it is considered each member’s responsibility to understand and adhere to these guidelines for which they are accountable. Additionally, it is the member’s responsibility to ensure that their copy of the SOGs is current and up-to-date. To facilitate updates, a revision chart is available in the Appendix of this SOGs.

Violation of these SOGs by any member may be sufficient cause for suspension or recommendation for expulsion from the organization. All violations will be documented and reviewed by the Chief, who will make a recommendation to the Executive Committee.

Any and all deviation from these SOGs must be documented with the completion of an incident report form for review and, when necessary, action by the Executive Committee.

2. ORGANIZATION

For the purpose of this document, a “member” is defined as part of HBES in good standing. A member is expected to conduct themselves in an ethical, professional, respectful and team-orientated manner, and within the scope of their training and the HBES scope of practice. The membership committee will review all applicants in concordance with the executive committee. All applicants will be subject to background check and police check. The body will then vote to accept or reject the application.

2.1 EMS Member

EMS members provide basic life support services to the Borough of High Bridge and neighboring communities. Members in this category must complete a Probationary period of at least six but not more than 24 months. During that time, the members are expected to fulfill the following requirements.

a. Satisfactorily complete HBES Driver Training and Cardiopulmonary Resuscitation (CPR) within 90 days of joining the Squad

b. Upon completion of HBES Driver Training and CPR, be assigned to and participate in four (4) crew shifts per month

c. Urged to Enroll in Emergency Medical Technician (EMT) course as soon as possible within two years of membership

d. Attend two-thirds of all meetings held during period

e. Attend two-thirds of all drills held during period

f. Hold EMT certification for a minimum of three months receiving recommendation to Active status

EMS members that have satisfactorily completed the requirements of the Probationary period will be recommend by the Chief and voted on by the membership to receive Active status. To maintain Active status as an EMS member, the following minimum commitments must be met:

a. Complete 24 hours of call coverage (crew nights, calls and stand-bys) per month

b. Strongly urged to attend as many meetings as possible with a minimum of four monthly meetings each year.

c. Attend four drills per year (EMS and/or rescue based on certification)

When responding to calls, EMS members must maintain a professional appearance and be properly attired for the role they will play on the scene and in patient care. This means that all EMS members must wear the Squad-issued uniform and, when necessary (i.e. fire calls, tactical and, if properly certified, marine), have available and wear the correct Squad-issued protective equipment. Members that do not meet the proper standards for appearance, uniform and equipment on a call will not be allowed to participate in that call. Active EMS Member Participation on the Marine Team: Active status EMS members are also eligible to participate in Marine team operations. To join the Marine team, EMS members must complete the requirements outlined under “Marine” in the Rescue category. Active EMS members may elect to participate only on the Marine team and, if so, are exempt from the tactical requirements of the Rescue category.

2.2 Rescue Associate

HBES Members who are rescue associates must complete the following activities during their Probationary period. The Probationary period will last a minimum of six months and a maximum of 24 months and complete the following:

a. Complete HBES Driver Training - Ambulance, CPR, and Cascade Training within 90 days of joining the Squad

b. Complete HBES Driver Training – Rescue Vehicles within 180 days of joining the Squad

c. Attend two-thirds of all drills during probationary period

d. Complete Vehicle Rescue Awareness within first six months

Rescue members that have satisfactorily completed the requirements of the Probationary period will be recommend by the Chief and voted on by the membership to receive active status.

a. To maintain their Active status, Rescue members must complete the following minimum requirements:

b. Complete Vehicle Rescue Operations within first 18 months of membership

c. Attend two-third of all rescue meetings each year

d. Attend two-third of rescue drills (tactical and/or marine, based on certification)

e. Attend four monthly meetings per year

f. To participate on Marine Team: must complete Water Rescue Awareness within one year. Water Rescue Operations must be completed within two years.

Members who are open water lifeguard certified may join the marine team once an interview and a reference check with a supervisor has been performed. The open water lifeguard certification will count as proper training after proper equipment familiarization.

g. To operate the boat: must hold a valid NJ Boat Operator License

When responding to calls, Rescue members must maintain a professional appearance and be properly attired for the role they will play on the scene and, if fully-certified EMS, in patient care. This means that all Rescue members must wear the Squad-issued uniform and, when necessary (i.e. fire calls, tactical and, if properly certified, marine support), have available and wear the correct Squad-issued protective equipment. Members that do not meet the proper standards for appearance, uniform and equipment on a call will not be allowed to participate in that call.

2.3 Line Officers

HBES line officers are as follows: Chief, Deputy Chief, Captain, Lieutenant (appointed).

Each officer will operate within the elected Bylaw definition and will be expected to demonstrate commitment to the overall integrity of these SOGs.

The following operation chart will be used for the direction of responsibility

CHAIN OF COMMAND

CHIEF

Oversees all EMS and Rescue Operations

DEPUTY CHIEF

• Establishes crews for standbys

• Oversees all EMS and Rescue Operations

• Stands in when the chief is absent

CAPTAIN

• Establishes Duty Crews

• Oversees all Crew Chiefs

• Oversees all EMS and Rescue Operations

• Stands in when the chief and deputy chief are absent

LIEUTENANT

• Responsible for tasks delegated by other officers

• Stands in when other officers are absent

*Line Officers will always conduct themselves in a professional manner; encourage appropriate performance with emphasis on service to the members and community to which they serve.

HBES Officers will always maintain an open door policy.

2.4 Crew Chiefs

The Crew Chief will oversee patient care, seeking more advanced care if circumstances warrant. They will appoint a suitable driver for the transporting ambulance, will review and approve the completed Patient Care Report and will guarantee that all equipment used during the call is cleaned and/or replaced as necessary and that the ambulance is left ready for the next call (including at least three-four tank of fuel, sufficient oxygen, etc.).

Additionally, Crew Chiefs should obtain Incident Command System (ICS 200) training to gain an understanding of the guidelines that shape calls involving multiple responding agencies. For Crew Chiefs that oversee regular duty crews, it is also their responsibility to see to it that rig checks are completed and that they have sufficient manpower to cover their shift (see also “Crew Composition and Safety”).

For all EMS calls, the HBES member responsible for ensuring that the highest level of patient care quality is maintained is the Line officer, Crew Chief or senior member on the call. Which member is designated the Crew Chief is determined by the following criteria:

I. Any EMS line officer that responds to a call and verbally assumes patient care is the Crew Chief.

2. However, if a responding EMS line officer is not available to complete patient care, including transportation to the hospital and approval of the Patient Care Report, he/she should designate/hand-off to another member as Crew Chief.

3. A Crew Chief is any member designated by the line officers to lead a scheduled “duty” crew.

4. If neither a line officer nor an assigned Crew Chief is available, the most senior EMS member on the call should verbally assume the duties of Crew Chief.

As circumstances warrant, the Crew Chief will also be called upon to mentor cadets and provide guidance to probationary members assigned to their crew.

2.5 Team Leaders

EMS/Rescue

It may be necessary to assign team leaders to MCIs and to larger team groups to facilitate

the overall direction and completion of an incident. Team leaders will be assigned by the

Chief or officer in charge (OIC).

2.6 Cadets

As discussed in the Bylaws, a Cadet member is any “individual between the ages 14 and 18 who wishes to develop first aid skills.” Cadet members will serve an probationary period for at least six months.

Cadet Program SOGs contained in document dated 2013.

3. COMMUNICATIONS

3.1 General

All radio communications should be professional and limited to pertinent information. Every effort should be made to maintain patient confidentiality.

3.2 Response to Station

All HBES members will be assigned an IAmResponding account to utilize when responding to the station. The member should use IAmResponding to notify other members and HCC that he/she is responding to the station. Portable radios should not be used for station response unless operating on High Bridge EMS Private channel or unless the individual is a line officer.

3.3 Response to Incidents

Proper radio terminology (outlined below) should be used when communicating on any public safety frequency or channel. Deviation from such terminology will result in disciplinary action. If multiple incidents are in progress, the radio operator should specify which incident the crew/unit are responding to.

1. Signing on the unit

a. Hunterdon County, (Unit Name/Number) is on radio and awaiting crew.

i. The first arriving driver and/or EMT should sign the unit on.

2. Responding

a. Hunterdon County, (Unit Name/Number) is responding.

i. Once the unit has a full crew, HCC should be notified that the unit is responding to the incident.

3. Arrival on scene

a. Hunterdon County, (Unit Name/Number) is arriving on location.

4. Transporting to the Hospital

a. Hunterdon County, (Unit Name/Number) is transporting to (Hospital name).

5. Arriving at the hospital

a. Hunterdon County, (Unit Name/Number) is arriving at (Hospital name).

6. Departing the hospital

a. Hunterdon County, (Unit Name/Number) is leaving (Hospital name).

7. Back in coverage area / back at station

a. Hunterdon County, (Unit Name/Number) is back at station, off radio.

8. Special Cases

a. RMA

i. Hunterdon County, (Unit Name/Number). RMA obtained. Clear and available.

b. Access to patient delayed / obstructed

i. Hunterdon County, (Unit Name/Number), patient access has been delayed due to (Reason). We will advise when patient access has been made.

ii. Hunterdon County, (Unit Name/Number), patient access has been made.

c. CPR/AED

i. Hunterdon County, (Unit Name/Number), CPR has been started.

ii. Hunterdon County, (Unit Name/Number), 1 shock has been administered

iii. Hunterdon County, (Unit Name/Number), no shock advised

d. Suspected opiate overdose

i. Hunterdon County, (Unit Name/Number), narcan has been administered.

e. Anaphylaxis

i. Hunterdon County, (Unit Name/Number), Epi-Pen has been administered.

f. Crew Chief Discretion

i. Any action or treatment the crew chief deems necessary to be documented/timestamped, HCC may be notified.

ii. Hunterdon County, (Unit Name/Number), (treatment or action completed).

4. INCIDENT COMMAND STRUCTURE

4.1 EMS Sector Command Structure

EMS sector command is as follows: Qualified Ranking EMS officers, Crew chief, Team Leader, senior member. A minimum of ICS 100 is recommended.

4.2 Rescue Sector Command Structure

Rescue Team command is as follows: Qualified Ranking Rescue officers, Team Leaders or senior members. Rescue members in command of a rescue operation must have a documented awareness level of the tactical operation.

*Regardless of Command Structure an EMT or appropriate certified/licensed medical authority is always in charge of patient care.

Incident Command Structure

Command will be established on all incidents involving more then a one unit response or when responding with other EMS or Fire agencies.

When HBES is dispatched as the lead agency, it will be the responsibility of the Squad to handle and set a Command Structure.

When EMS Command is established it will be designated with the closest street name or land mark. e.g., (“Main Street Command” or “Spruce Run Command”)

When HBES is dispatched as a support agency, HBES units will abide by the existing command structure no further designation is required unless prompted by Hunterdon County Communications (HCC).

Responding units will communicate with command when arriving on scene, for staging and assignments and when clearing the scene to station or hospital. There is no need to transmit this information to HCC. When command is established it will be the IC’s duty to log rig movement and patients with HCC.

As always, all radio transmissions will be professional and limited to pertinent information.

Accountability tags will be used to track HBES members’ locations and assignments during incidents, with one left with the IC and one visible on the HBES member’s uniform.

5. EMS OPERATIONS

5.1 Responding to EMS Calls

To ensure that the highest standards in patient care are maintained, the following procedures are in place to govern every call response.

• Line officers ONLY may respond directly to the scene, with the exception of calls where the scene has not been secured (see note below on scene safety).

• Fully-certified active EMS members that must pass the scene to get to the building may go directly to the scene. Any member that responds to the scene must advise the rig by radio or phone that they are on location.

• Trainee members and Cadets may not respond to the scene.

• Members may go to the scene with permission of an officer or when expressly requested to go to the scene, i.e. when manpower is requested to the scene.

o Members should take care not to block the entrance/egress of apparatus on the scene

Use of Lights and Sirens: The operation of all HBES apparatus will conform to the guidelines established by the Hunterdon County Squad Chiefs Association for the use of lights and sirens in emergency and non- emergency responses, including:

• Sirens will be used with lights when responding to all EMS/Rescue calls and confirmed structure fires and when transporting ALS patients to the hospital (unless directed otherwise by ALS personnel or Crew Chief)

• Neither lights nor sirens will be used when responding to fire alarm activations and when transporting BLS patients to the hospitals

A Note on Scene Safety: All members are to use caution on scenes containing violence or potential violence such as suicide attempts, domestic disputes, or calls involving weapons. In these cases, members will stage at a safe location and await instructions from patrol.

Vehicle Operation Safety: HBES members responding to calls, both in personal vehicles and Squad apparatus, must observe all state traffic laws. Safety of the public, the crew, and the patient is of the utmost importance.

5.2 Transporting To The Hospital

While en route to the appropriate care facility on a call without ALS personnel, the Crew Chief or a designated member should phone ahead to the receiving facility with a report on the patient’s condition. Typically, a report should include a patient age and gender, chief complaint, vital signs and the rig’s estimated time of arrival (ETA) at the facility.

5.3 Crew Composition and Safety

Per NJ Department of Health OEMS regulations, BLS ambulance crews must consist of two fully certified EMTs. The only exception is when a waiver is issued by NJ DOH OEMS or the NJ Governor. HBES provides crew coverage in two ways: Duty and General alert.

5.3.1 Duty Crews

Duty Crews typically consist of a designated Crew Chief, EMTs and a designated driver. It should also be noted that, although line officers are permitted to respond directly to the scene, every effort should be made to allow the crew on duty to establish and maintain satisfactory patient care.

Duty crews typically provide EMS coverage Sunday through Friday, 18:00 to 06:00 hours, and weekends (on a rotating basis) from 08:00 hours on Saturday until 20:00 hours on Sunday.

Certain calls received during duty crew coverage are also considered general alert calls. These calls are: auto accidents, fire alarms, cardiac arrests, and disasters. In the event of these calls, duty crews should respond as normal. Additional members may also respond to provide manpower. These additional members should follow the general alert call procedures outlined below. Finally, every effort should be made for the duty crew to assume care and transport.

Rig Checks: A Rig check must be completed within the first hour of the start of each duty crew’s shift, including any rotating shifts. Although the Crew Chief is responsible for seeing that rig checks are completed and proper equipment is available to their crew, it is expected that each crew member participate in their duty crew’s rig check. Rig checks will be accomplished and documented.

Coverage Replacement: If any member assigned to a Duty crew is unable to cover their shift, it is the member’s responsibility to obtain coverage and then notify the Crew Chief on duty of that coverage. If despite exhaustive efforts, and no coverage is available, it is that members responsibility to inform the Captain no less than 72 hours of the start of that shift.

Members shall attempt to gain coverage by completing the following:

• Send out an email to all members requesting coverage that specifies the exact time of start and finish of the shift. This shall be done no less than 2 weeks prior to the need of coverage.

• Personally reach out via phone call/text to active EMT’s. A list of contact information is posted in the office.

Upon the Chief’s discretion, paid staff may be used to fill the shift.

See the Trustee Uniform Policy for full list of uniforms and protective equipment.

5.3.2 General Alert Crews

In the event of an EMS general alert call, all HBES responding members must report to the Squad building for calls unless they must drive past the scene to get to the building. A call is considered a general alert call if it meets the following criteria:

• The call is a second call

• The call is for a cardiac arrest

• The call involves a technical rescue

• When the initial responding unit requests a general re-alert

When responding to general alert calls, existing response guidelines should be followed.

Again, in the event of general alert calls where a duty crew is also responding, every effort should be made for the duty crew to assume care and transport.

Second Calls. If a second call is dispatched while the first crew is located within the coverage area, all additional units may be cancelled. Use caution when canceling additional units as extra manpower could be used to assist on the second call. If a second call is dispatched while the first crew is located further than 10 minutes away from the scene, allow a second crew or mutual aid to handle the call.

5.5 Fire Call Procedures

HBES responds to fire calls with two primary purposes: 1) to provide medical support to both the firefighters and any patients that may be affected by the incident; and 2) to provide cascade services and, if requested, rehab operations via the tactical rescue truck. For this purpose, all fire-related calls are considered general alert calls, with a desired minimum of two ambulances and the tactical rescue truck.

When responding to fire calls, HBES members will assign priority based on the existence of patients. For fire calls with no reported patients, HBES members and vehicles should yield to responding fire vehicles and personnel.

Rehabilitation

Once on scene of a fire call, the HBES Chief, EMS line officer or designated Crew

Chief will take the following steps:

1. Make contact with the Incident Commander (typically, the highest-ranking fire officer on scene).

2. Work with Fire Command to establish a rehabilitation area to monitor firefighters’ health during the incident (Note: It is the responsibility of Fire Command to ensure that firefighters visit rehab according to their SOGs).

3. Maintain contact with EMS Sector or Incident Commander as necessary, advising of any critical patient statuses and transport activities.

4. The senior EMS member on the scene may request additional units, including but not limited to:

a. Additional BLS units

b. ALS units

c. County Rehab units

d. County EMS Coordinator, etc.

A note on medical monitoring: These rehabilitation guidelines also apply to ambulances dispatched to support rescue activities as outlined in Section 6 Rescue Operations.” The safety and health of the rescuers is the primary priority for both fire and rescue calls. Rest and medical monitoring of all personnel in an appropriate area, with protection from the elements as needed, must be provided. The EMS Sector leadership can declare any firefighter or rescuer unfit to continue and will notify the Incident Commander.

Uniform and Protective Equipment On Fire Calls: All members, regardless of their level of training or function on the crew must be attired with the appropriate uniform and safety equipment. Members lacking proper, Squad-issued protective equipment will not be permitted to participate in a fire call.

See the Trustee Uniform Policy for full list of uniforms and protective equipment.

For fire call procedures for cascade and rehab services, refer to the ‘Rescue Operations” section of these SOGs.

5.6 Standby Procedures

Participating in standbys is an important public relations function. When covering a standby, the crew will wear proper Squad-issued uniforms as well as any necessary additional protective equipment.

In the event of a call separate from the standby, the standby crew should remain at the event and allow a second crew to be formed to handle the call. The exception to this procedure is the event of a life-threatening general alert call (see general alert call definition in “EMS Calls” section). In these special circumstances, the Crew Chief may decide to have the standby crew respond and request a second crew to take over the standby.

5.7 Post Call Wrap-Up

Before leaving the rig ready for the next call, the crew is responsible for cleaning and/or replacing necessary equipment, assessing the oxygen bottles’ levels, and inspecting the rig to see that the fuel level is at least half a tank and there is no visible damage to the ambulance. Equipment left with the patient at the hospital is to be noted on the ambulance status board in the bay. Any damaged or broken equipment should be detailed in an incident report, noted on the board and reported immediately to the Director of Equipment.

Restocking Equipment at Hospital: If possible, crews may restock supplies available at the hospital. These items include, but are not limited to: sheets, blankets, and pillows.

5.8 Debriefing: Critical Incident Stress Debriefing (CISD)

Crews are encouraged to review their calls as a routine part of their post call wrap-up. This provides a forum for discussing best practices and laying out procedures for approaching future calls.

In addition, particularly stressful calls may require intervention with professionals trained in critical incident stress debriefing (CISD). The debriefing should take place shortly after a serious and emotional taxing event. It is designed to provide a forum for emergency responders to release their stress. In Hunterdon County, the Apollo Team provides EMS providers with CISD support. Crew Chiefs that feel their crew would benefit from a debriefing should work with the Chief to make the necessary arrangements. The Apollo Team can be reached through Mercer County

Communications Center at 609.394.3600. Additional information is available at .state.nj .us/healthldresponse/stress.html.

5.9 Paid Crew

27 Rescue is the paid daytime EMS service provided by HBES in partnership with the Lebanon Township Volunteer Fire Department (Station 19) and Califon Rescue Squad (Station 44) wherein a rig staffed with two EMTs is provided by the High Bridge Emergency Squad (Station 14). Based at the LTVFD building, 27 Rescue responds to calls within the Station 14, Station 19 and Station 44 coverage areas during its hours of operation. HBES members should follow these procedures when responding to calls with 27 Rescue:

a. 27 Rescue hours of operation are between the hours of 06:00 to 18:00 hours, Monday through Friday, excluding weekend holidays.

b. Only HBES members with Active EMS status (see “Membership Categories”) may respond directly to the scene of calls within Station 14’s coverage area to assist 27 Rescue. These members must complete a Patient Care Report to receive credit for their response. The only exception is cardiac arrest calls.

c. In the event of a cardiac arrest, properly certified HBES members may respond directly to the scene. These members must complete a Patient Care Report to receive credit for their response.

d. For general alert calls (i.e.: fire calls, motor vehicle crashes) HBES members should report to the building to staff additional ambulances and the tactical rescue truck (Rescue 145).

e. If a second call is received while the 27 Rescue crew has not completed a first assignment or has not returned to the coverage area, HBES members should report to the building to staff an ambulance and handle the second call.

f. The 27 Rescue crew will be responsible for patient care unless a HBES line officer is on scene and assumes command.

6. RESCUE OPERATIONS

6.1 Responding to Tactical Rescue Calls

The tactical rescue team assists the fire department with rescue calls.

For each of these services, the minimum response is the tactical rescue truck and an ambulance (see “EMS Operations” section for guidelines on ambulance responses).

Tactical rescue vehicles and equipment will be checked and documented on a regular weekly schedule, as outlined by the Captain or designee.

Cascade

Cascade services are provided by HBES through its rescue team. Only HBES members who have been trained to use the cascade system should respond with the tactical rescue truck to provide these services. A minimum of two cascade-trained HBES members are required to respond as a cascade service. In addition, HBES members who are part of the rescue team and require hands-on instruction with the cascade system may ride-along for training purposes. Through EMS Sector, HBES members responding with the tactical rescue truck will take the following steps to establish cascade services for the incident:

1. Work with IC to establish a location for cascade services.

2. Provide necessary cascade and lighting services at the direction of Fire Command.

3. Only HBES trained and proficient in the operations of the cascade system can oversee cascade operations.

4. Following release from the scene, it is the responsibility of the senior HBES member or designated team leader assigned to provide cascade services to inspect cascade equipment, see that tools utilized are properly maintained and stowed and, if necessary, depleted air banks are refilled.

Rehab

In addition to cascade services, HBES members assigned to the tactical rescue truck on fire calls may also be required to establish rehab services. If necessary, EMS Sector command may assign a non-rescue team HBES member to provide rehab services. These members report to the senior rescue team member assigned to the tactical rescue truck.

Through EMS Sector, HBES members responding with the tactical rescue truck will take the following steps to determine the need for and, if necessary, establish rehab services:

1. Coordinate efforts with HBES members overseeing cascade services.

2. Provide rehab services to the extent available through the tactical rescue truck.

3. On large-scale or long-term incidents, work with IC to secure additional rehab resources, as necessary.

4. Following release from the scene, it is the responsibility of the senior HBES member or designated team leader assigned to provide rehab services to inspect cascade equipment, see that equipment utilized is properly maintained and stowed and, if necessary, replenish from existing stock or make request for rehab supplies to be restocked.

Uniforms and Protective Equipment —All HBES rescue team members (both rescue associates and EMS members) responding to a call to provide cascade and/or rehab services must be attired in the correct Squad-issued protective equipment.

See the Trustee Uniform Policy for full list of uniforms and protective equipment.

6.3 Responding to Marine Rescue Calls

HBES currently operates a marine rescue unit, including rescue boats, trailer, and tactical rescue support vehicle and/or appropriate towing vehicle (for towing and equipment hauling). The HBES marine rescue team members will respond to requests for water search and rescue calls as the primary agency in its coverage area and may also respond to mutual aid requests from other agencies. Guidelines discussed below should be followed accordingly.

Marine rescue vehicles and equipment will be checked and documented on a regular weekly schedule, as outlined by the Captain or designee.

Marine rescue team members may be rescue associates or EMS members. Within the marine rescue team, there are two classifications based on training and physical ability:

• Operator —permitted to operate the marine unit for search and rescue and facilitate a rescue from shore or dock. The Boat Operator will also be in charge of unit operations and radio communications.

• Rescue swimmer —permitted to enter the water from shore, dock, or boat to facilitate a rescue.

The HBES will only respond to water search and rescue calls which fall under its current training and scope of practice. It is the responsibility of the Officer-in-Charge to determine the marine equipment necessary for the rescue or search.

When dispatched as the primary agency for a water search and/or rescue. The marine unit will need to ensure the following:

• A separate BLS crew and ambulance to monitor rescuer health.

• Ensure another marine rescue team has been alerted or one is presently responding or operating on scene.

• Three (3) marine rescue qualified members with a two (2) rescue swimmer minimum.

• No more than four (4) team members will man and operate a HBES vessel

• Utilize proper ability, size and weight when assembling team.

• Use only designated tow vehicles when applicable. (WR 145 or Car 145)

When dispatched for a mutual aid to assist in water search and rescue:

Three (3) trained marine rescue team members with a two (2)-rescue swimmer minimum

• No more than four (4) team members will man and operate a HBES boat.

• Utilize proper ability, size and weight when assembling team.

• Use only designated tow vehicles when applicable. (WR 145 or Car 145)

• When arriving on scene, the marine rescue team will avail itself to the officer in charge of that scene.

• Again, HBES marine rescue team members and apparatus will only be utilized within the scope of its training and practice as outlined in these SOGs.

• All marine rescue team members will wear appropriate marine rescue gear as classified below (classes of gear will also be posted at the Marine Station in the bay).

• All HBES members —including both marine team members and support members operating within 10 feet of a body of water shall be required to wear a PFD with safety whistle and light.

• Proper body substance isolation (BSI) and scene safety precautions will be observed at all times.

In addition, HBES members will also utilize the following classes of equipment, dictated by scene conditions and safety concerns:

Marine Command and Radio Operations

• When dispatched ICS will be utilized

• Primary command and operations will utilize Ambo 5/ TAC 1/SPEN 4 ( Spruce Run, Round Valley )

• A portable or mobile radio with protective covering will be onboard during all boat operations

• The PFD whistle will be blown when in distress, immediate response is needed or danger is present

Marine Pre-Operation

Prior to putting the marine team apparatus in service, the HBES marine rescue team will ensure the following:

• Secure the trailer hitch, including hitch lock, safety chain and electric hook-up

• Secure boat to trailer and check for proper boat inflation

• Check gas level in main tank and ensure that spare tank is available and full

• Check battery for operation and confirm that drain plugs are in place

• Load and prepare for transport required safety equipment, including proper “class” for anticipated services.

Marine Operation.

All HBES marine rescue call will follow these guidelines when responding to calls for marine services:

• The senior officer or member with the appropriate training on the scene will establish Incident Command (IC), notifying HCC of location of command post.

• Size up the scene on arrival and monitor changing conditions. The members’ and team’s safety is the first priority.

• Determine the number of patients, their condition and their last known location if they cannot be seen from shore.

• Utilize accountability tag system, with one left with IC on land. If no personnel are land-based during rescue effort, request FD to establish IC. Accountability tags will be clipped to trailer.

• Model rescue efforts after the reach, throw, row and go theory

• No below surface rescue or recovery efforts will be made.

• Time stamp launch of HBES and supporting rescue vessels.

• Monitor weather conditions. Rescue attempts will not be made if the conditions exceed either the team’s or the vessel’s capabilities.

• HBES will not assume liability for any non-HBES vessel.

• Time stamp rescue and/or recovery.

• Following release from the scene, it is the responsibility of the senior HBES member or designated team leader assigned to provide marine rescue services to inspect marine equipment, see that equipment utilized is properly maintained and stowed and, if necessary, replenish from existing stock. Steps include:

o All equipment will be washed with fresh water and, if necessary, proper detergent after each use —all cleaned equipment will be hung to dry and stowed when dry

o Boat will be inspected and any damaged noted and repaired or communicated to the Assistant Director of Equipment — Rescue. Also, boat will be checked for proper inflations

o Batteries will be checked and charged if needed (main, PFD, and portable)

o Top off boat fuel and ensure that vehicles each have at least three quarters tank of fuel

o Complete incident report with narrative indicating cause for initial dispatch, team activities, outcome and referencing any relevant patient care report(s)

Drills

With the seasonal nature of marine rescue service requests, it is of critical importance that the marine team drills frequently enough to ensure retention and use of proper techniques and maintain familiarization with the necessary equipment. Prior to each marine team drill, the Chief, Captain or the next appropriate officer must be contacted for approval no less than 72 hours in advance.

For all drills, the following must be ensured:

• A minimum of three (3) qualified marine rescue team members will be required to conduct a training exercise.

• An ambulance with two EMTs (either marine rescue team or not) will be available to help ensure marine rescue team health. This ambulance and EMTs must be staged by the shore.

• A portable radio will be carried at all times

• Park supervisor’s office and the ranger’ office will be notified of the drill no less than 12 hours in advance

• Spruce Run Contact Info: 908.638.8572

Use of small watercraft: On small bodies of water and as conditions warrant, the Officer-in-Charge may choose to utilize specialized water rescue equipment, including small watercraft. In such operations, a maximum of two (2) appropriately trained rescuers will man this equipment. For use of small watercraft, see additional pertinent guidelines for safety and tethering as outline in Section 6.5.

6.5 Responding to Ice/Cold Water Rescue Calls

Purpose

To establish guidelines and procedures for the safe and efficient conduct of ice and cold water rescue operations.

Scope

These procedures and guidelines will be used during any cold water or ice rescue operation within the squad’s response area and on mutual aid calls to other departments.

Upon being alerted for cold water or ice rescue services, HBES will respond in WR 145, with a minimum of four (4) trained ice rescue personnel, cold water rescue suits, helmets, water rescue ropes and the ice rescue sled with gear.

As with all rescue activities, one (1) BLS ambulance from HBES or a mutual aid agency will also respond to monitor the health of the rescuers.

When responding to requests for cold water and/or ice rescue services, the HBES cold water/ice rescue team will follow these guidelines:

1. The Officer-in-Charge (OIC) on the scene will establish Incident Command (IC), notifying HCC to establish radio control and the location of the command post.

2. Assess scene safety and size-up, including:

a. Identify any hazards or conditions that may provide a threat to the safety of the rescuers and/or the patient(s)

b. Establish the number of patients, their condition and their last known location if they cannot be seen from shore.

c. Determine the equipment necessary to support rescue activities

3. Request additional support, if deemed necessary, including:

a. Local police for crowd and traffic control

b. Alert the appropriate mutual aid agency, with special consideration given to those with equipment and training in cold water and ice rescue.

c. Local or mutual aid dive teams (GSURU or 17 Rescue)

d. Advanced Life Support (ALS)

e. Aeromedical (Do not land aeromedical on the ice)

Safety of all personnel responding to the scene is paramount. Procedures will include but will not be limited to the following:

• Primary rescuers and back-up personnel will be equipped with cold water rescue and or immersion suits. Whenever possible all rescuers within 10 feet of the shore, as well as, the primary rescuer will be equipped with Class “C” water rescue equipment (see description in Section 6.4).

• All rescuers within 10 feet of the shore must wear PFDs

• The primary rescuer will be tethered using the D ring harness of the cold water suit. Shore crew will control tether lines and ensure that ropes, carabineers and zippers are secured.

• Specialized equipment (i.e., the ice rescue sled) will also be tethered with an attendant shore crew

• A separate length of rope may be used with a loop on each end to tether the rescuer to the sled, placing a loop at that point and using a carabineer attached that loop the tether hitch of the sled. The end of the rope now attaches to the D ring of the suit.

• Primary and back-up rescuers should be equipped with ice awls for their own use or for use by the patient.

• Whenever possible, each rescuer should have a back-up person to assume their tasks, if needed.

• Following release from the scene, it is the responsibility of the senior HBES member or designated team leader assigned to provide cold water/ice rescue services to inspect the equipment, see that equipment utilized is properly maintained and stowed and, if necessary, replenish from existing stock. Steps include:

• All equipment will be washed with fresh water and, if necessary, proper detergent after each use —all cleaned equipment will be hung to dry and stowed when dry

• Specialized equipment (i.e., ice rescue sled) will be inspected and any damaged noted and repaired or communicated to the Assistant Director of Equipment Rescue.

o Complete Patient Care Report with narrative indicating cause for initial dispatch, team activities, outcome and referencing any relevant patient care report(s)

Animal rescues: The guidelines indicated here are for the safety and protection of human life. Animal rescues (saving pets off boats) are at the discretion of the IC and should only be attempted if the safety of the rescuers can be assured. Dog snare should be used and contact with the rescued animal should be minimized.

7. TRANSPORTATION AND DOCUMENTATION

7.1 Patient Care and Transportation

The goal of patient care and transportation is to stabilize the patient to extent that the HBES crew is trained and to transport the patient to the nearest appropriate facility. Deviations from transporting to the closest appropriate facility can be made at the discretion of the highest ranking EMT on the crew. Tasks on scene include —but are not limited to — gathering patient information, carrying equipment from and to the rig, treating the patient and recording pertinent information on the Patient Care Report. For patients’ whose conditions warrant special consideration, the crew should work with HCC to obtain the appropriate manpower. Similarly, for patients that require a higher level of care, HBES crews should follow Hunterdon County standards for utilizing the necessary and available advanced life support (ALS) services and alternate modes of transportation (i.e., aeromedical transportation). Hospital diverts shall be treated as a courtesy. Patients may still be transported to a hospital on divert. Hospitals on ER bypass will not be able to accept further patients and the crew should not transport the patient to that hospital.

7.2 Advanced Life Support (ALS)

When a patient’s condition requires intervention by advanced life support (ALS) services, HBES members will request ALS services through HCC. HBES members must indicate the nature of their request (e.g., difficulty breathing). Once ALS arrives on scene and affirmatively assumes responsibility for patient care, HBES members will follow ALS direction pertaining to patient care, However HBES SOGs will not be deviated from. Any HBES member who agrees to drive an MICU unit must be cleared to drive HBES equipment.

7.3 Aeromedical

Aeromedical services should be requested in accordance with the criteria for helicopter use established by the New Jersey Department of Health and Senior Services. Generally, aeromedical support should be requested when a patient’s condition requires rapid transport to a higher-level care facility than can be effectively reached by ground transportation. In addition, aeromedical can be utilized as a primary ALS unit. Aeromedical can also be requested for search and rescue calls.

Only pre-designated landing zones (LZ) will be utilized. HBES members, through EMS Sector (if established), should request support services (e.g., fire department response) to have an LZ established for the helicopter.

For more information on New Jersey EMS Helicopter Response Program and criteria for helicopter use, visit the New Jersey Department of Health and Senior Services Web site at .

7.4 Transportation of Patient’s Family Members

At the discretion of the Crew Chief and in agreement with the designated driver, one member of the patient’s family may be permitted to ride in the ambulance to the hospital. This passenger should ride in the front passenger seat and must be seat belted. At the discretion of the Crew Chief, one parent and/or legal guardian of a minor patient may be allowed to ride in the back — in the jump seat and seat belted. Unless contraindicated by the child’s medical condition and/or the use of appropriate immobilization devices, pediatric patients should be transported in an approved child safety seat. The child seat should be placed and secured on the stretcher and/or on the jump seat. Under no circumstances should a child seat be placed in the front seat of the rig or on the sidewise bench seats.

7.5 Physical Restraints

Patients shall not be placed and/or transported in physical restraints unless:

1. A physician or court has authorized the placement of the restrains;

2. The patient is in the custody of a law enforcement officer; or

3. The medical condition of the patient mandates transportation, and treatment at, a healthcare facility, and the patient manifests such a degree of behavior that he or she:

a. Poses serious physical danger to himself or herself or to others; or

b. Causes serious disruption to ongoing medical treatment that is necessary to sustain his or her life or to prevent disability.

Patients placed in physical behavioral restraints shall not be restrained for a period greater than one hour unless:

1. A physician or court has authorized the utilization of the restraints for longer than one hour; or

2. The patient is personally accompanied by a law enforcement officer

Physical behavioral restraints shall not be of a type, or utilized in a manner,

that causes undue physical discomfort, harm or pain to a patient. Hard restraints,

such as handcuffs, are specifically prohibited unless a law enforcement officer

accompanies the patient. A patient placed in any type of restraint shall be closely

monitored to ensure that his or her airway is not compromised in any way. In no

circumstance shall a patient be placed prone (that is, face-down) on a stretcher

while in restraints.

1. If a crewmember reasonably believes that his or her personal safety is in jeopardy, the crewmember should retreat from the scene and call for police assistance. The crewmember should return to the scene in order to assess and treat the patient only when the scene has been secured. Such retreat shall not be considered patient abandonment unless the crewmembers leave the scene and/or advise the dispatch center that they are available for other calls

Crewmembers shall not wear or carry any weapons or explosives while on

duty. For the purpose of this chapter, the terms "weapons" and "explosives"

include not only offensive weapons, but also defensive weapons such as stun

guns, stun batons, air tasers, pepper spray, mace defensive spray and/or

telescopic steel batons.

The rationale for placing and/or transporting a patient in physical behavioral

restraints, and the type of restraints utilized, shall be clearly stated in the patient

care report.

7.6 Crime Scenes

At scenes where police on location suspect a crime has been committed, HBES members should be sensitive to the need to preserve crime scene evidence. Every reasonable effort should be made to leave any body fluid, body position or clothing in the area which may be considered evidence of a suspected crime undisturbed. However, patient care is considered the highest priority for HBES members and efforts to preserve crime scene evidence must not unreasonably impede treatment and transport of patients under HBES members’ care.

7.7 Deceased Patients

If the crew is able to determine, within the abilities of their training, that a patient is dead on arrival (DOA), the police will likely treat the location as a potential crime scene. Since no patient care is to be provided, HBES should be considerate of the requirements of the police, the family and the deceased.

The county medical examiner’s office will handle transportation of patients that are deceased on scene, unless otherwise decided by a line officer or crew chief only. If, however, ALS pronounces a patient in a HBES rig, the rig should continue to the receiving facility in non- emergency mode. Once the patient’s body is delivered to the appropriate department, a signature on the Patient Care Report from a member of that organization will be required for release. A nurse should sign off on Patient Care Report.

7.8 Hospital Arrival

Upon arrival at the hospital, the crew should follow instructions from the appropriate hospital staff for releasing the patient to the higher level of care. The Crew Chief or a designated crew member should provide a concise report to the hospital staff that will assume responsibility for the patient. Under no circumstances will a patient be left unattended or turned over to hospital staff lacking medical authority.

7.9 Pre-Arranged Non-Emergency Transportations

All pre-arranged non-emergency transportations will be handled as manpower permits. When transporting a patient non-emergency, light and sirens are not to be used. All pre-arranged transports will be cleared with the Chief or, in his/her absence, a HBES EMS line officer.

7.10 Refusal of Medical Attention (RMAs)

If a patient refuses medical attention, he/she must sign the Refusal of Medical Treatment and Transport form. The Crew Chief or designated crew member is responsible for explaining to the patient their right to refuse medical treatment and that signing the form releases the HBES crew from providing care. Appropriate risks of refusal including, but not limited to death, should be explained to the patient. A police officer or another appropriate adult bystander should also sign the form, witnessing the patient’s refusal.

If a patient is a minor (any patient under 18 years of age) and the patient’s legal guardian is not on scene to sign, or is not an emancipated minor, transport of such patient will be made under implied consent. If minors are placed under police custody or placed into police care, separate documentation will be made.

After completing an RMA, the crew should alert HCC that they are available, stating how many RMAs were obtained so message is recorded on tape. Example of a radio transmission:

“Hunterdon, BLS 14-53 is available, 2 RMAs obtained.”

Use of the term “RMA:” The use of the term RMA should not be used over the radio to describe a patient’s condition prior to the documented completion of a patient’s “refusal of medical attention” (RMA).

7.11 Non-HBES Member Ride Along

A request in writing must be submitted to the Executive Committee for review, personal waiver and concurrence with the insurance provider must be obtained. Ride alongs can be cancelled at any time for any reason.

7.12 Patient Care Reports

A Patient Care Report must be completed for every HBES unit and crew that was dispatched and responded. The proper completion of the appropriate Patient Care Report is the responsibility of the Crew Chief. Completed Patient Care Reports are to be placed in a designated secure location to help maintain patient confidentiality. All crew members participating on a call with a unit or on-scene assisting the unit will be documented on the Patient Care Report.

Patient Care Report (PCR)

Patient Care Reports should be completed on EMSCharts. Reports should be signed and locked within 24 hours of the completion of the call.

“On Scene” Member Documentation

Members who respond directly to the scene who initiate patient care prior to the arrival of the BLS unit should complete a patient care report on EMSCharts.

Patient Care Report Quality Control

On a monthly basis, the Chief or designee, will review Patient Care Reports. QA flags must be addressed within 48 hours of their issuance. Members are encouraged to request a meeting with a line officer to discuss QA flags as needed.

7.13 Incident Reports

Incident Reports shall be used for the documentation of any unusual occurrence during the day-to-day operations of the squad incident that deviates from the relevant Squad guideline. Incident reports are confidential and should be submitted to the Chief for review and, if necessary, action by the Executive Committee — which will review all incidents within five (5) days of report submission.

Member Review and Disciplinary Action

Any incident reports involving member(s) actions will be reviewed by the Executive Committee and appropriate disciplinary action (including, but not limited to, verbal warnings, suspensions and recommendations for expulsion) will be taken in accordance with the relevant Administrative Operating Guidelines (AOG). Any member recommended for expulsion will automatically placed on suspension, pending outcome of a vote by the body.

7.14 Activity Sheets

Activity sheets will be used to document member(s) activity during a non-dispatched event. This document is for internal HBES functions and is not to be used for any patient documentation.

8. PATIENT PRIVACY MANAGEMENT

As an EMS provider, HBES is bound by patient confidentiality and will comply with both Health Insurance Portability and Accountability Act (HIPAA) and relevant patient confidentiality laws. HBES members are prohibited from sharing information about patients with any individual or agency that was not directly involved in providing care to that patient. In addition, HBES members must not proactively contact patients and/or their families following the conclusion of a call. Any matters that seem to warrant such interaction should be referred to the Chief.

All requests for information, including requests for copies of Patient Care Reports and other pertinent documents, should follow this procedure:

a. All requests for copies of Patient Care Reports and other call records must be channeled through the Chief or a designated line officer

b. In cases where the patient (or parents of a minor patient) requests copies of the PCR, the patient (or parent of minor patient) may request a copy of the PCR by filing a patient release form with the Chief or President. The Chief or President will be responsible for transferring any related information and copies of Patient Care Reports to the patient.

c. If an outside agency, including but not limited to the prosecutor’s office, police department, a correctional facility, requests information regarding a call, or if they request copies of Patient Care Reports and/or related documents, they must obtain a subpoena which should be filed with the Chief or President and reviewed by the Squad attorney. The Chief or President will then transmit copies of the requested documents to the attorney for appropriate distribution.

d. The Chief must notify the President of all requests for information.

9. MEDIA

HBES members are not to discuss HBES activities including, but not limited to, details of calls (both EMS and Rescue), patient(s) status, or patient outcomes with any outside agency, including members of the media. Any media requests are to be directed immediately to the attention of the Squad-appointed spokesperson or a member of the Executive Committee, in keeping with the relevant Administrative Operating Guideline (AOG).

10. INJURY, EXPOSURE AND ILLNESS

10.1 Injury

If any injury of any kind occurs while on duty with HBES, the injured person or crew chief will have the appropriate medical services rendered. Contact with a line officer and an incident report will be made. An injury occurring while on an active call shall be handled as a second call and the injured member will no longer be utilized on that call. A doctor’s note addressed to the squad will be required for return to active status. Members will be placed on medical leave during their inactive period.

10.2 Exposure

HBES will utilize the exposure control policy located in the Appendix of these SOGs.

10.3 Illness

If a member has an illness which is diagnosed as contagious or has an illness which affects their ability to perform their job function, then they will be placed on medical leave. A doctor’s note addressed to the squad will be required for return to active status.

11. LEAVE OF ABSENSE (LOA)

Only active HBES members in good standing may request leaves of absence (LOA). The three types of LOAs are:

• Academic —Active members may request an LOA to attend academic institutions. Both full-time students and employed, part-time students are eligible for leave. Academic LOA cannot exceed nine consecutive months. Members must request leave, in writing, from the Executive Committee. Written requests must include: date of leaves, academic institution and stated permission and contact information to confirm enrollment.

• Medical —Active members may request an LOA due to a medical condition that prevents the member from participating fully in HBES activities. The length of a medical LOA will be based on a written recommendation made by the HBES member’s physician or equivalent care provider. Members must request leave, in writing, from the Executive Committee. Requests must include a medical professional’s written recommendation, date of leaves.

• Personal — Active members may request an LOA to attend to personal business. The length of a personal LOA will be at the discretion of the Executive Committee and the member. Requests must be made in writing and include the reason for leave and dates of absence. Requests for personal leave will remain confidential.

Any Probationary member’s probation period will reset if a LOA is required.

Members on LOA greater than six weeks must return all Squad-issued equipment, including any uniforms, pagers, and radios.

12. VEHICLES

12.1 Equipment Designation

HBES equipment will be designated per Hunterdon County guidelines. Currently, the squad operates the following units:

14-51-a four-wheel drive BLS ambulance

14-52 -a BLS ambulance

14-53 -a BLS ambulance

Rescue 145 -a tactical rescue vehicle

Water Rescue/Utility 145 -a marine/ice rescue vehicle and tactical support vehicle (with trailer hitch)

Car 145 -a four-wheel drive command unit (with trailer hitch)

Marine 145 – a metal hulled marine vessel

Marine 145-1 – an inflatable marine vessel

Gator 145 – a four-wheel drive off road rescue vehicle capable of patient transport

In addition, HBES will utilize the following equipment for specialized rescue operations:

• Ice Rescue Sled

• Small watercraft (Kayak/Surf Board)

12.2 Equipment Maintenance

HBES will maintain and provide upgrades to its vehicles on a routine maintenance schedule and on an “as needed” emergent basis. Vehicle maintenance logs will be stored in the bay and updated with all routine maintenance, damages, malfunctions and associated repairs noted —as needed. Vehicle repairs that substantially affect the vehicle’s ability to respond to emergencies will be reported immediately to the Director of Equipment and the Chief. Expenditures for emergency repairs and scheduled maintenance will be governed by the relevant SOGs.

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