Purpose: - IEMSA
Purpose:
This policy establishes guidelines for responding to an Alert II or Alert III at the _______________Airport.
Policy:
Crews will only respond when requested to respond to a staging area. This normally will only occur with an alert III, but on occasion may occur with an alert II. Otherwise crews will standby at their departments and be aware of the incident. Run Reports will not be written unless we respond to a staging area.
The ________________________________has created the following matrix to be used in airport response.
Alert I Alert II Alert III
| |Identified as an |Identified as an |Aircraft crash has occurred. |
| |Incoming aircraft |Aircraft with moderate | |
| |with minor difficulty. |to major difficulty. | |
| |Incident handled by | | |
| |_____________, can be |Potential MCI |MCI |
| |upgraded if situation | | |
| |warrants. | | |
|Alpha Response |No action taken |________County page out |_________ County page out. |
| | |Information only. |Information only. |
| | | |______________ dispatches |
|0-9 Occupants | |____________ dispatches |standard alarm +4 additional |
| | |Standard alarm assignment. |EMS units. Possible upgrade |
|Bravo Response |No action taken. |_______ County page out. |________ County page out. All units |
| | |Units stand-by at their |respond to staging dispatches all available |
| | |stations. ______________ |resources. |
|10-50 Occupants | |dispatches standard alarm | |
| | |assignment. |Airport Closed. |
|Charlie Response |No action taken. |_____County page out. |________ County page out. All units |
| | |Depts stand-by at their |respond to staging _________ dispatches all |
| | |stations. . __________ |available |
|51 or Greater | |dispatches standard alarm |resources. |
|Occupants | |assignment. | |
| | | |Airport Closed. |
• Incident Command shall enter into an alert III status if the probability of and alert III is high
• Staging site will be determined by the location of the aircraft.
Purpose:
This policy provides guidance regarding the required communications while on duty.
1. Communications While on Duty
• ECP’s on duty shall be directly available to respond via pager and radio. A radio and pager will be worn by all responding EMS personnel.
• Dispatch and EMS personnel shall have communications capabilities allowing for immediate communication with one another at any time an ambulance is operating within the primary service area.
• There shall be a minimum of two portable radios per vehicle
Purpose:
This policy establishes guidelines for the situation involving the death of a person outside of the hospital setting.
Policy:
1. In the event that upon arrival to the scene and after assessing the patient, the ECP decides to either not start or terminate resuscitative measures, the following procedure will be followed.
• If law enforcement is not on scene, they should be notified.
• Do not disturb the body or anything around the decedent.
• Have dispatch notify the Medical Examiner’s Office after consultation with the police officer on scene or the detective case officer if present.
• A pre-hospital death report form should be completed detailing your finding. A copy of that report should be given to personnel from the Medical Examiner’s Office.
• If the death involves an on the job incident of a Employee, immediate family member of an employee, a homicide, or death of a suspicious nature, the ________should be notified immediately. If the ____________is unavailable, a member of _______________should be notified.
• If there is a request by Medical Examiner Personnel or Law Enforcement that we transport the body to the morgue, ___________________should be contacted for authorization.
• ECP’s should remain on the scene until the medical examiner or a police officer arrives. If a police officer is going to remain on scene, the EMS crew can go back in service when they have gathered appropriate information. If the police officer does not stay on scene, the EMS crew should remain until the Medical Examiner’s office arrives on the scene. Arrangements should be made with the police officer to return to the scene if the EMS crew gets another call.
2. If upon arrival at the scene it is determined that the death scene is an apparent crime scene the following will apply.
• If the police department is on the scene prior to EMS arrival, entry into the scene will be at their discretion. If entry is denied, the police department assumes responsibility for the body and the determination of death. The police department will assume responsibility for any delay in care to the patient caused by limited access to the crime scene by officers. A death report will not be completed by the ECP unless they have contact with the patient and determine death has occurred. A run report will be completed documenting the call and officer in charge of the scene.
• If requested, one Paramedic can accompany an officer into the scene to confirm that death has occurred. The Paramedic should then fill out the death report as usual.
• If ECP’s arrive at a crime scene prior to law enforcement, entry into the scene should be limited if death is determined. Once death is determined, all ECP’s should withdraw from the area and should keep others out of the area until law enforcement arrives. Nothing should be moved or touched unless absolutely necessary to determine death. (i.e., lifting a shirt to place cardiac electrodes). Preservation of the scene is essential for the police department’s investigation. EMS techniques should be altered when possible to preserve evidence.
• Entry into a known crime scene that is unsecured will not be done until police arrive. ECP’s should stage at a safe location when arriving at an unsecured scene. The dispatcher should be advised of your staging status and should be told to advise when the police department has secured the scene and request EMS entry.
Purpose:
This policy provides dispatch personnel guidelines for paging EMS crews to respond a request for ambulance.
Policy:
1. Pager Test
• All pages will be tested nightly at 18:00 hours or as soon as practical after that time.
2. Miscellaneous Pages
• The _____________________will be the only EMS personnel authorized to initiate special pages, except as noted below.
• An ECP may request that dispatch page a member of _______________after the provider has made unsuccessful attempts to contact _________by phone, pager, or radio and the situation is urgent, or in an emergency when the assistance of a supervisor is needed.
3. Encoding the Pagers
• When a request for an ambulance is received, the dispatcher should note the time the call is received and dispatch the appropriate ambulance crew. The appropriate tones should be encoded over the operations frequency ________________________
• Pages will be dispatched similar to the following example:_______________________________________________________________________________________________________________________________________________ When applicable, the name of the business or apartment complex name should also be given. A response code will also be given after using the EMD protocol.
• A patrol officer, when available, is requested to respond to all calls for EMS assistance with the exception of physician’s offices, clinics or nursing facilities.
• The dispatcher will dispatch the Fire Department for medical if indicated by EMD protocol. Ambulance personnel may also request the Fire Department to respond.
Purpose:
The purpose of this policy is to give clear and concise directions for the proper disposal of all one-time use items.
Policy:
1. Proper handling of disposable items should occur anytime patient contact is initiated.
2. At the point that patient care is terminated any and all disposable equipment related to or coming in direct contact with the patient is to be replaced.
3. Items that have not come in contact with any infectious body fluids will be discarded in a standard trash receptacle.
4. Any items that have become contaminated with infectious body fluids shall be disposed of in a properly marked red bag which will then be placed in an OSHA approved biohazard container.
5. Contaminated sharps must be immediately disposed of into a properly placed sharps container.
6. For additional guidance in handling contaminated items, refer to the ______________________Special Blood borne Pathogens Policy and Procedure Manual located in the Safety Program Manual.
Purpose:
To outline the process by which SOG and protocol changes are introduced.
1. Notification Process
• Notification of changes or updates made to SOG’s or patient care protocols shall be made at the time the policy is put into place. All departmental member affected by the changes shall be made aware of the change through the department email system. When possible, the email should contain an attached copy of the changed / updated SOG or protocol.
• The person creating or editing a policy shall be responsible for updating any manuals and providing notification of such updates.
• When possible, department staff should be introduced to pending changes at the departmental meeting prior to the introduction of the update. This will allow for feedback from crew members as well as any needed clarification.
• It will be the responsibility of each staff member affected by SOG change to make themselves familiar with the changes and seek clarification when appropriate.
Purpose:
This policy provides response guidelines to ECP’s. in the operation of Department vehicles
Policy:
1. Notification
• When the dispatcher receives a call for medical assistance, EMS personnel will be immediately notified via radio/pagers.
• The dispatcher will assign a response code to the Crew after completing the EMD protocol.
• The staffed squads will respond without delay in their assigned response areas and advise the dispatcher of all pertinent times.
2. Codes
• Code 1 - Non emergent, no lights or siren
• Code 2 - Emergent lights, and siren (potential life threat)
• Code 3 - Emergent lights and siren (life threat)
• The responding Crew may alter this code if they feel that patient condition or field conditions warrants a change.
➢ An incident report with the reason for altering the response code assigned by dispatch will be filled out and attached to the PCR and turned into the___________________.
3. Operation of Department Vehicles
All Department owned emergency response vehicles will be operated in accordance with the State of Iowa laws regarding emergency and non-emergency response as inserted below. Successful completion of a course in emergency driving techniques and a review of the laws and rules governing emergency vehicle operation are required.
4. Iowa Code
321.231 Authorized emergency vehicles and police bicycles.
1. The driver of an authorized emergency vehicle, when responding to an emergency call or when in the pursuit of an actual or suspected perpetrator of a felony or in response to an incident dangerous to the public or when responding to but not upon returning from a fire alarm, may exercise the privileges set forth in this section.
2. The driver of any authorized emergency vehicle, may:
a. Park or stand an authorized emergency vehicle, irrespective of the provisions of this chapter.
b. Disregard laws or regulations governing direction of movement for the minimum distance necessary before an alternative route that conforms to the traffic laws and regulations is available.
3. The driver of a fire department vehicle, police vehicle, or ambulance, or a peace officer riding a police bicycle in the line of duty may do any of the following:
a. Proceed past a red or stop signal or stop sign, but only after slowing down as may be necessary for safe operation.
b. Exceed the maximum speed limits so long as the driver does not endanger life or property.
4. The exemptions granted to an authorized emergency vehicle under subsection 2 and for a fire department vehicle, police vehicle, or ambulance as provided in subsection 3 shall apply only when such vehicle is making use of an audible signaling device meeting the requirements of section 321.433 or a visual signaling device, except that use of an audible or visual signaling device shall not be required when exercising the exemption granted under subsection 3, paragraph "b" of this section when the vehicle is operated by a peace officer, pursuing a suspected violator of the speed restrictions imposed by or pursuant to this chapter, for the purpose of determining the speed of travel of such suspected violator.
5. The foregoing provisions shall not relieve the driver of an authorized emergency vehicle or the rider of a police bicycle from the duty to drive or ride with due regard for the safety of all persons, nor shall such provisions protect the driver or rider from the consequences of the driver's or rider's reckless disregard for the safety of others.
5. Minimum Driving Requirements
The ECP shall maintain a current Iowa driver’s license. A Class D chauffeur’s license is recommended but not required.
Before the ECP can drive in an emergency situation, the following actions must be successfully completed:
• Complete and pass a course meeting the requirements for emergency driving as outlined in Chapter 321, Code of Iowa.
• On an annual basis, the ECP must complete and pass a annual driving course set up in accordance with International Firefighters Safety and Training Association (IFSTA) standards
6. Driving During Orientation Period
During the three month orientation period, all department candidates will be accompanied by a FTM or FTE while driving emergently.
At their discretion, ________________may approve driving privileges for an ECP prior to meeting the above requirements.
7. Use of Non-departmental Drivers
In certain emergency situations, other public safety employees may be allowed to drive a ___________________ambulance. Other public safety employees may include:
• _________________police officers
• _________________firefighters
• Members of other EMS departments
8. Acceptable Driving Record Criteria
_____________________EMS driving record criteria will be in compliance with ____________________administrative policy _______regarding driver’s license requirements for applicants, employees and volunteers.
9. Initial Check of Driving Record
Following an offer for employment, a record of driving history will be obtained on each new employee through the IA Department of Transportation to ensure compliance with the ___________________ policy regarding driving requirements.
10. Annual Check of Driving Record
A driving history will be obtained on each employee on an annual basis to ensure compliance with the _____________ policy regarding driving requirements.
11. The ECP will notify ______________________________of any change to the status of their driver’s license, or driving privileges.
Purpose:
This policy outlines the procedures for maintaining squads for medical response.
Policy:
1. General Vehicle Maintenance
• It is the responsibility of the entire crew on call to restock and clean the ambulance after each use, i.e., all equipment and supplies will be replaced and put away in their designated areas, the patient compartment floor will be cleaned, trash cans emptied, and all reports completed.
• At the end of each call, the crew will be responsible for completing the following:
➢ Driver – Cleaning the cot, changing the cot linens, clean the patient compartment, emptying trash, replacing oxygen cylinder, supplies, backboards clean and reorganize patient compartment, sanitize equipment and vehicle as necessary.
➢ Primary Care Attendant - Writes the report and fills out other associated reports. This person must be certified at least at the same level as the care provided.
➢ Refuel the squad if levels are at or below 3/4 tank.
➢ *** All ECPs should help each other as needed to get the ambulance back in service as soon as possible.
• Upon returning to the station the driver will make sure the shoreline is plugged in and the ambulance is clean, is without maintenance needs and ready for service. Crews will then replace all supplies which were used, replace oxygen cylinders when at five hundred (500) PSI or less, and replace the spare oxygen bottle if used.
2. Preventive Vehicle Maintenance
• Vehicles will be maintained in accordance with the Federal Motor Carrier Safety Regulations. A copy of these regulations can be obtained from the City’s Building and Fleet Manager.
• Any ECP identifying an area of concern relating to a vehicle will complete an incident report and forward it to the department staff member responsible for vehicle and durable medical equipment maintenance who will in turn schedule the vehicle for repair with the public works department.
➢ Any problem/defect which has been identified as a life/safety issue will be immediately reported to the Lieutenant on duty and the vehicle taken out of service.
3. Equipment Maintenance
The service will contract with an independent provider for Equipment Inspection and Preventive Maintenance. Onsite inspection of medical equipment will occur semi-annually.
• Any ECP identifying medical equipment which needs service or which has malfunctioned will notify the _________________on duty in writing.
➢ Any problem identified which has been identified as a life/safety issue will immediately be reported to the ________and the equipment taken out of service.
4. Cot Maintenance
• The service will contract with an independent provider for Cot Inspection and Preventive Maintenance. Onsite inspection of cots will occur semi-annually.
• Any ECP identifying a cot which needs service or which has malfunctioned will notify the _____________________in writing.
➢ Any problem identified which has been identified as a life/safety issue will immediately be reported to ________________and the cot taken out of service.
Purpose:
To provide guidelines for us of exhaust extraction systems.
Policy:
The system has limitations on its use and proper safety procedures must be followed when near a vehicle
that is moving and attached to the system
1. Installation of the Grabber
When returning to the station, it is the driver’s responsibility to stop the vehicle, assign a person to
exit the vehicle and retrieve the grabber.
The personnel retrieving the grabber shall position near the doorway. The person must never be positioned between the hose and the moving vehicle (behind the hose). As the vehicle slowly backs into the station, the person positions the grabber on the tailpipe and inflates the bladder. It is preferred that the vehicle stops momentarily while the grabber inflates. The person must never be in the path of the tires or vehicle components that could cause a fall. The “drivers” window should be lowered so the driver can hear and see the person through the mirror.
2. System Operation
Anytime a vehicle engine is running in the bays, the system will be hooked up and operational. The
system is not designed for high rpm usage or lengthy engine operations, Excessive heat build-up
within the system could damage critical components.
3. Vehicle Leaving the Station
All vehicles leaving the station shall travel 5 mph or less when exiting the fire station. The driver should periodically view the right side mirror to watch for proper release of the grabber.
4. Personnel or Visitor Positioning
Any person within 10 feet of the exiting apparatus must stop all activity and remain alert and out of the
pathway of the retracting grabber and hose (it may swing back forcefully toward the end of the bay).
Be alert for Fire Fighters dressing into protective clothing near the exiting vehicle. Those dressing
should stop donning until the vehicle has completely exited the doorway and the grabber has retracted.
This is a mandatory order.
5. Personnel Safety
If, at anytime, a person’s safety is jeopardized by moving components, the grabber should be removed manually before apparatus is moved.
6. Malfunctions
Any system malfunction or safety issue must be reported immediately to______________. The individual grabber should be taken out of service until authorized repairs can be made. A copy of the malfunction incident should be forwarded to the_________________________.
7. Training
Plymovent has supplied an Operational Video tape and the tape should be viewed by all personnel. The tape will be kept in each station’s training library that has this type of extraction system.
Purpose:
This policy ensures the physical and mental well being of Firefighters operating at the scene of an emergency with extended exposure to heat or cold. The policy will ensure that the Firefighter’s physical and mental condition does not deteriorate to a point that the safety and integrity of the operation or participants at the operation are jeopardized.
Policy:
This procedure shall apply to all emergency operations where strenuous physical activity or exposure to heat or cold exists.
1. Responsibility
Incident Commander
The incident commander should consider the circumstances of each incident and make adequate provisions early in the incident for the rest and rehabilitation for all members operating at the scene. These provisions should include: medical evaluation, treatment and monitoring, food and fluid replenishment, mental rest, and relief from extreme climate conditions and other environmental parameters of the incident. The Incident Commander will be the final decision-maker as to when crews are returned to duty.
Emergency Medical Services Unit
An EMS unit should be simultaneously dispatched on all working structure fires. Upon arrival at the scene, the crew will stage in a location that will not block them in, yet will provide and area for rehab close to where the Firefighters are working. Immediate attention will be given to bystanders who may be injured at the scene. The EMS Command Staff or Senior Medic will assess the situation at the scene and determine what additional medical resources may be needed. The Command Staff or designee will then set up a rehab operations area and notify the Incident Commander of location and resources available. Any additional EMS resources will be coordinated and staged by the EMS Command Staff or Designee.
2. Communications
Response
The responding EMS crew will go en-route with dispatch on FIRE 1 and will then remain on that channel. All remaining communication will take place on this channel, unless otherwise designated by EMS Command Staff or by Incident Command. It will be highly recommended that major incident communications take place on one of the FIRE OPS or Public Safety Channels. This will allow all three (3) public safety departments the ability to communicate with each other while keeping the main channels clear. All staff should be familiar with how to access these channels on both mobile and portable radios.
Arrival
If the EMS crew is the first to arrive at the scene, they should immediately advise of the situation. (i.e. Squad 1 has arrived, flames are showing from a two (2) story residence) EMS personnel should never downgrade response or try to determine what equipment will be needed at the scene. Communication via the radio should be professional and kept at a minimum. Medic to medic communication should be conducted on the EMS frequencies. Pass Port tags should be given to the Incident Commander as soon as possible after arrival at the scene. The senior medic will wear the blue vest provided in each ambulance with the designation of Rehab Officer. Supervisors will wear blue vests that indicate EMS Command. The EMS Command Staff (if needed) will coordinate between rehab and the command post.
3. Rehabilitation
Location
Upon arrival at the scene, the EMS crews should immediately locate an appropriate area for rehab to be set up. This may need to be established after consultation with the incident commander. It will be important to consider safety, distance for the firefighters to travel, ambulance access, and weather conditions when choosing a rehab location. It should be noted that having rehab next to the ambulance provides easy access to equipment and a visual location for firefighters. Except on fires occupying a large geographical area, it will be important that only one rehab area be set up to ease in confusion about where to go.
Hydration
A critical factor in the prevention of heat injury is the maintenance of water and electrolytes. Water must be replaced at emergency incidents. During heat stress, the member should consume at least one quart of water per hour. The re-hydration solution should be a mixture of water and a commercially prepared activity beverage when possible. Re-hydration is important even during cold weather operations where despite the outside temperature, heat stress may occur during fire fighting when protective equipment is worn. Caffeine beverages should be avoided due to interference with the body’s water conservation mechanisms. Carbonated beverages should also be avoided. Each ambulance will carry a five- (5) gallon water cooler and packages of a re-hydration solution which can be mixed with water at the scene.
Nourishment
When necessary, an attempt should be made to provide food during extended operations. Soups, broths, stews and fresh fruit are recommended due to their high energy levels and fast absorption. Fatty or salty foods should be avoided.
Rest
The “two (2) air bottle rule,” or forty-five (45) minutes of work time, is recommended as an acceptable level prior to mandatory rehabilitation. Members shall re-hydrate (at least eight (8) ounces) while SCBA cylinders are being change. Firefighters having worked for two- (2) full thirty (30) minute rated bottles, or forty-five (45) minutes, shall be immediately placed in a rehabilitation area for rest and evaluation. In all cases, the objective evaluation of a member’s fatigue level shall be the criteria for rehab time. Rest shall not be less than ten (10) minutes and may exceed an hour as determined by the Rehabilitation Officer. Fresh crews, or crews released from the Rehabilitation Group, shall be available in the Staging Area to ensure the fatigued members are not returned to duty before they are rested, evaluated, and released by the Rehab Officer.
4. Documentation
An Emergency Incident Rehabilitation Report will be completed anytime an incident requires implementation of the rehab policy. The report will document vitals, times and assessment of each person that enters the rehab area. Once completed, a copy will be forwarded to the Fire Chief and the EMS Chief.
5. Transportation
Unless immediately occupied by injuries at the scene as they arrive, the responding ambulance will be assigned as the rehab unit and will not be transporting patients. If the responding ambulance encounters injuries at the scene as they arrive, they will treat and transport those patients. In this case, the second ambulance arriving at the scene will establish the rehab area and will be assigned to that location for the duration of the incident unless directed otherwise. The EMS Command Staff or Designee (Senior Medic in Senior Command Staff’s absence) will evaluate the situation and request additional EMS resources as needed. Attention should be given to providing service for the entire city during a major incident.
6. Vital Criteria
❖ Vitals assessed upon entry into rehab
❖ Within normal limits: Rest and re-hydrate for 10 minutes
❖ Outside normal limits: Red Tarp for further assessment and treatment
❖ Mandatory rehab after two air bottles
❖ Re-hydration available while changing first air bottle
❖ Normal Vital Limits: HR less than 110, Systolic BP less than 180, Diastolic less than 110, respirations less than 24
❖ Supplemental Assessment form filled out on red tarp patients.
Green Alert Level – Normal Operations
Blue Alert Level – Heightened level of awareness
Yellow Alert Level - Heightened level of awareness
Orange Alert Level - Heightened level of awareness
Red Alert Level
• All EMS related public education being held at __________________will be cancelled and re-scheduled
• A member of management will be readily available to respond to incidents that are of a major or unusual nature. Once at the scene, the EMS Command Staff representative will coordinate with the other Public Safety Departments in a Unified Command Structure.
• Additional ambulances will be staffed, depending on the situation.
• All EMS Staff will be asked to remain readily available while off duty to the extent that is possible.
• EMS Command Staff will monitor hospital resource status and monitor for implementation of any part of the Response System.
• Bio-terrorism equipment and medications will be checked on a daily basis to maintain familiarity and readiness.
• Mass casualty equipment and supplies will be checked on a daily basis.
• Medical supplies and supplemental oxygen tank supplies will be maintained at a fully stocked level.
• Tactical Medical Equipment and Supplies will be checked on a weekly basis.
• Ambulances will be secured at scenes when possible and practical, unless the ambulance can be visibly monitored by a public safety official.
Purpose:
To provide a reporting mechanism which will provide information on unusual or circumstances which occur during an ECP's tour of duty.
Policy:
1. Definition
An incident is defined as an event which occurs, that is not consistent with routine operations or care of patients. They are incidents that did or could have caused harm to patients, families or employees. Examples include medication errors, patient falls while in the attendance of EMS personnel, loss of personal items, inter-department conflicts, etc.
2. Procedure
• Upon recognizing an event which the ECP feels is not consistent with routine operations or care of patients, an incident report will be completed as soon as feasibly possible. All reports should be completed prior to the end of the current tour of duty.
• While completing the incident report, the ECP will note any identified solutions which could prevent the incident from re-occuring.
• The ECP will list any and all witnesses to the incident on the report including name, address and phone number when available.
• The incident report will be turned in to the _______________________and stamped received by the_______________________. The report will then be forwarded to appropriate management Staff.
• The ________________________will review the incident and make any applicable comments regarding the incident.
• A copy of the completed incident report will be returned to the reporting person.
• The original report will be maintained in the Administrative Offices or in appropriate storage in accordance with the records maintenance policy.
• Incident reports should be entered into the incident report data base.
Purpose:
To provide guidelines for the reporting process of loss or damage of departmental property.
Policy:
1. ECP’s shall submit a written incident report equipment form to __________________________for any loss, damaged, malfunctioning, misuse, or to request repair of departmental property. The report shall be submitted within 24 hours of the incident or immediately if determined to be a safety hazard.
2. Any equipment determined to be a safety hazard will immediately be taken out of service, tagged as out of service and the _________________________notified as soon as feasibly possible.
3. The ____________________on duty or his designee should take action to resolve any reported safety violation and return a written response of action taken to the reporting ECP.
Purpose:
To establish the minimum allowable arrangement of staff needed to staff a scheduled EMS unit.
Policy:
_____________________EMS is licensed by the State of Iowa to operate at the Paramedic level on a 24 hour basis. Two staff members will be assigned to each scheduled ambulance at all times. It will be the policy of ________________________EMS to have, at a minimum, one staff member certified at the Paramedic Specialist level assigned to each unit who is or has:
1. Satisfactorily completed the orientation process.
2. Satisfactorily completed the six-month probationary period.
3. Obtained a level of pre-hospital experience at the Paramedic Specialist where they are proficient in the required skills and knowledge expected of the Medical Director and Management Staff.
The second staff member assigned to each ambulance will be at the minimum:
1. Completed the orientation process.
2. Certified at the EMT-Basic level.
3. Have PRN status with the department.
Unscheduled ambulances must have at a minimum one EMT-Basic and a driver certified in CPR as per state regulations and may function at the level of the highest certified ECP.
Purpose:
This policy provides guidelines for ECP response to team three and team four standby requests and responding while off duty.
Policy:
1. Requesting Team 3 & 4 Standby
When both EMS crews have been assigned to calls, the crew responding to the second request for service should instruct _____________to page for a team three standby immediately after reporting themselves en route to the scene unless it is known that a third crew is immediately available at a station or it is known that a crew that had that responded to a previous request for service will be available within a very short timeframe.
Should a third request for service arise prior to another unit becoming available, the crew responding to the team three call should instruct _______________to page for a team four standby immediately after reporting themselves en route to the scene unless it is known that a fourth crew is immediately available at a station or it is known that a crew that had responded to a previous request for service will be available within a very short timeframe.
Time allowing, crews should utilize the departmental pagers in addition to ________ paging by paging the _________EMS group page at __________and entering ___ for team three requests and ____ for team four requests.
2. Team 3 & 4 Standby Operations
When paging for team three and four standby requests_______ will page using all EMS pages. The first two ECPs that are available to respond for standby requests will promptly notify __________via radio informing them of their medic number and stating that they are available for standby. The ECPs who make themselves available for standby will be responsible to ensure that at least one of them calling in is certified at the Paramedic Specialist level. Should a Paramedic Specialist not be available, they should inform __________that they are to page for a Paramedic Specialist. If a Paramedic Specialist is not available the crew may function at the level of the highest trained crew member.
Crews are encouraged to report to a station once they have made themselves available for standby but it is not required. It should be understood that crews not reporting to the station will not be financially compensated. In the instance where neither ECP reports to a station for standby coverage, the ECPs who have made themselves available will coordinate between each other as to which ECP will be responsible for obtaining an ambulance and responding to the request for service. The other ECP will respond directly to the scene.
3. First Responder
• An ECP not on scheduled call may, as a first responder, respond to calls in their IMMEDIATE vicinity if they feel that their promptness in response can enhance patient care.
• An ECP acting as a first responder will relinquish control of the patient to the scheduled ECP’s on their arrival, unless requested to remain on scene by the ECP in charge.
4. Command Staff
• The ____________may, at any time, respond to supervise and/or assist on any call.
• The ____________will be especially attentive to calls that sound to be of a serious nature.
5. Off-duty Responder
The ECP may use white emergency response lighting on his/her vehicle as authorized by the ______________in accordance with the State of Iowa’s White Light Law.
6. Vehicle Cleaning
Crews responding to team 3 and 4 request who dirty an ambulance are responsible for the cleaning and ensuring that the unit is ready for the next request for service. This includes washing the exterior of the ambulance, restocking and cleaning the interior.
Purpose:
This policy presents the guidelines for patient safety to be utilized during patient care.
Policy:
Safety at Scene
Care should be taken at all times to protect patients from the same general scene hazards that are presented to ECP’s.
Lifting and Movement of Patients
The safety of the patient should be considered while lifting and moving by:
• Assure adequate manpower is present during patient movement
• Using extreme caution during movement over icy or uneven terrain.
• Making certain that persons involved in the movement of the patient understand where and how the patient is to be moved.
• Making sure that the path of movement is clear of obstructions.
Lifting and Moving Equipment
Equipment such as stair-chairs and lifting tarps are provided for both ECP and patient safety and are to be used when appropriate. Household items present in a patient house such as chairs & blankets should not be utilized for patient movement.
Use of Cot
• When possible a person should be assigned to steady the cot during patient placement on the cot.
• When possible, the patient should be secured to the cot with all three straps prior to movement.
• Ensure that the safety latch is secured behind the floor “hook” prior to raising the carriage during patient loading.
• Avoid rolling the cot in a sideways fashion.
• Assure adequate manpower is present during lifting of cot to the raised position.
• Do not exceed the maximum weight load of the cot.
Use of Seatbelts / Airbags
During transports all patients transported on the cot should be restrained to the cot using all three straps unless patient care requires their removal.
Patients transported in the rear of the ambulance who are not placed on the stretcher should be secured in a seat using the lap belts present.
Family, friends and patients who are transported in the front passenger seat of the ambulance must be secured using the lap/shoulder belt present at all times during ambulance movement. Attention should be given to those riding in the front passenger seats that are less than age 12 due to the presence of airbags. If possible, persons less than age 12 should be transported in the rear of ambulance or transported by other means if the airbag cannot be turned off.
All non-patient children transported who are less than age 3 should be transported in an approved car seat secured in the rear of the ambulance if one is available.
Purpose: Establish standards of quality for documentation of patient care .
Policy: All indicated statistical data required on individual forms should be completed, and should include, at a minimum:
1. Date of service
2. Times:
• Time call was received
• Time of dispatch
• Time en route
• Time of on scene arrival
• Time of patient contact
• Time of departure from scene
• Time of arrival at destination
• Time unit becomes available
3. Identification of patient to include:
• Name
• Age
• Sex
• Date of birth
• Address when available
• Phone number when available
• Social security number when available
4. Location of incident
5. Vehicle and crew identification
6. Disposition of patient
7. Other agencies on scene, i.e. other EMS providers, law enforcement.
8. In instances of multiple patient scenes, the number of total patients, and an indication of the patient's relationship to the incident, i.e., patient 1 of 2.
9. Name of transporting agency.
10. Receiving facility to which patient was transported.
11. Impression of patient condition
12. Patient assessment findings shall include the following:
• Chief complaint per statement of patient.
• History of presenting illness or mechanism of injury.
• Past medical history medications, allergies, patient's physician if known.
• Complete vital signs to include:
• Blood pressure
• Pulse rate and quality
• Relative skin temperature, color, and diaphoresis if any
• Respiratory rate and quality
• Lung sounds
• ECG interpretation if indicated
• Blood glucose level is indicated
• Capillary refill status
• Pupil responsiveness
• Level of Consciousness by GCS
• Oxygen saturation levels if indicated
If complete vital signs are not obtained, the reason is to be documented.
Frequency of reassessment should be dependent on the patient's condition with a minimum of vitals once every ten minutes
13. Complete secondary and physical assessment related to findings of primary survey:
• Mental status or neurological exam
• Evaluation of motor and sensory function.
• System specific exam as indicated (i.e. cardiac, GI/GU)
14. Document of patient interventions and response to treatment, including type of intervention, times, identification of who administered medications or initiated invasive procedures and equipment utilized and the degree of response to treatment given.
15. Additional documentation required for specific interventions, i.e.:
• Oxygen therapy: liter flow, type of delivery device.
• Peripheral IV and intraosseous access: location, catheter size, fluid rates, staff initiating, amount infused, time and number of attempts
• Intubation: Route, size of tube, verification of tube placement by auscultation and end tidal CO2 detection, securement of tube, and number of unsuccessful attempts.
• Suction: route, description of fluid, amount suctioned.
• Needle thoracostomy: tracheal position before and after procedure, site, size of needle, presence of free air or fluid, auscultation of breath sounds bilaterally before and after, time and number of unsuccessful attempts.
• CPR: Time started and discontinued, whether CPR in progress on arrival, continuation of CPR.
• Defibrillation/Cardioversion: EKG rhythm interpretation, joules used for each attempt
• External transcutaneous pacing: milliamps and rate at start and at capture.
• Cardiac monitoring: rhythm interpretation on patient encounter form and EKG strip, strip attached to patient record and base hospital copy with notation of patient's name, date, time, lead used.
• Medications: drug name, dosage, route, method: bolus, push, drip infusion
• Pulse oximetry: oxygen saturation percentage at room air or at specific liter flow rate.
• Restraints: include documentation required in "Use of Restraints" policy.
• Spinal immobilization: equipment used, motor and sensory function assessment before and after application.
• NG/OG Tube: Confirmation of placement and indication of gastric return
16. Transferring care:
• When transferring to receiving facility or transporting agency, document name of person accepting the patient.
• A copy or summary of the medical record shall be left at the receiving facility at the time the patient is delivered.
17. Required signatures:
• EMS provider, with identification of their Iowa Department of Public Health certification number and level of certification
• Authorization for payment
• Release of information for payment
• Receipt of Notice of Privacy Practices
• Witnesses of refusal by patient or legal guardian to sign encounter or release form.
18. Refusal of Care or Transportation
• In addition to the above guidelines, documentation should be performed in compliance with the “Refusal of Care or Transport” policy.
19. Completion Deadlines
• Reports are to be completed prior to the end of a scheduled shift unless approved by the____________________.
• Reports for team 3 and 4 responses should be completed within 12 hours after the call.
• Reports are never to be taken home
17. Handling of reports
• All unwritten and written reports will be kept out of plain view.
• Unwritten report should be stored in a drawer, or other location, where the report will be secure and confidential while not being written.
• Reports being transported in the ambulance whether complete or incomplete will be kept in an enclosed folder to protect confidentiality.
18. Student Writing of Reports
• Employees _______________________EMS who may be riding in a student capacity will be allowed to complete reports using the computerized reporting software.
• Other students will be allowed to write reports at the discretion of the staff member who was the primary attendant.
• All reports written by students will be reviewed for content and completeness by the primary attendant.
• All reports written by students will be signed by the student and the primary attendant after the review is complete.
19. Review of Completed Reports
• The__________________, will be responsible for the review and coding of reports written during a shift.
• Reports will be reviewed for completeness and statistical accuracy and routed for corrections when applicable.
• Reports will be “coded” using the appropriate form and secured to the report.
• All completed reports will be turned in to the Billing Department following review and coding.
20. Reports Needing Corrections
• If a report is in need of corrections, it will be marked as such and forwarded on to the Billing Department.
• An email will be sent to the employee responsible for writing the report, as well as to the _______________responsible for that employee, notifying him/her that the correction is needed.
• Reports needing corrections will be placed in the appropriate “basket” in the billing office after initial processing.
• The crew member needing to make a correction should make every effort to get the correction(s) made, the report reprinted if needed and returned to the Billing Department as soon as possible.
Purpose:
This service will insure the inventory and transfer of patient personal property.
Policy:
1. All patient property, which must accompany them to the hospital, will be left in the care of the patient or immediate family member when ever possible. If the emergency care provider is required to take possession of a patient's personal property, she/he will make note of said property on the patient care report and indicate to who the property was released.
2. In the event the emergency care providers find it necessary to go through the patients personal property to ascertain identification, medical information, etc., the ECP will conduct the search with a witness present whenever possible. Items examined and the witness name will be documented in the patient care report.
3. Patient’s property, which will not be accompanying the patient to the emergency department, will not be entrusted to anyone other than a significant other, police officers or someone the patient designates.
4. Patient treatment and transportation will not be delayed to secure property in the case of a life-threatening emergency.
Purpose: To establish guidelines for handling and documenting patient refusal of care or transportation.
Policy:
Whenever a qualified person refuses emergency medical evaluation or treatment, pre-hospital personnel shall utilize the following steps to document the circumstances of the refusal:
1. Evaluate the patient as much as capable or allowed;
2. Document the history and physical on the patient care report (PCR), charting as much information as is available, including refusal of any portion of the evaluation;
3. Determine the appropriate plan of action for the patient, including field treatment and hospital destination.
4. Clearly describe the plan of action to the patient, in easily understandable terms, along with the need for further hospital evaluation.
5. If the patient continues to refuse medical evaluation, treatment, or transport:
• Make every reasonable attempt to convince the patient of the need for further medical evaluation and treatment, including a clear description of the potential risks and consequences of refusing care.
6. Document the following information on the PCR:
• All medical care given including a general assessment of the patient, level of consciousness, any complaint and associated injury or signs / symptoms the patient may have.
• Full set of patient vital signs.
• The apparent competency of the patient to refuse treatment
• Any explanations to the patient, including potential risks and consequences of refusal of care.
• The patient's own words verbalizing an understanding of the event, refusal of care, and an understanding of the potential consequences of refusal of treatment or transport.
• The signature of any witnesses present.
• The patient, parent, or legal representative should sign the authorized refusal form. If the patient, parent, or legal representative refuses to sign, that should be clearly documented.
• As a last resort, if the patient is a minor and the parent or legal guardian is not present at the scene, verbal consent may be obtained from the parent. Caution should be used by the ECP’s when leaving the minor patient without observation due to the absence of an adult or guardian. When possible patient should be left in the observation of an adult or guardian.
7. At no time should pre-hospital personnel put themselves in danger by attempting to treat or transport patients who refuse care. Pre-hospital personnel should use good judgment and the appropriate support agencies for assistance under these circumstances.
Purpose:
To provide guidance in the usage, restocking, disposal and security of drugs and intravenous infusion products for ________________________EMS.
Policy:
______________________EMS will function as a physician based service. All drugs and infusion products shall be provided by a licensed pharmacy or supplier. All drugs and infusion products shall remain the property of the Medical Director.
• The Medical Director shall be the responsible individual for _____________EMS pharmaceuticals.
• Access to drugs and infusion products shall be limited to authorized personnel as determined by the Medical Director.
• Each ambulance shall have drug kits and intravenous fluids on board to provide ALS care per ________________ EMS protocols.
1. Drug Storage
• All stock medications will be kept in the _____________________________________
• All replacement drugs will be stored in a locked cabinet; controlled substances shall be double locked.
• Medications will be stored in accordance with recommended temperatures.
• Refrigerated drugs shall be secured in a locked refrigerator.
• Intravenous fluids shall be stored in the supply room.
• The supply room shall be locked at all times when not in use.
2. Inventory
• Daily inventory of medications shall be done by a member of the off going and on coming crews. This will be completed at ______ when possible.
• All drug kits and intravenous fluids will have a complete inventory done on a weekly basis. This shall include expiration dates as well as numbers on hand. Copies will be turned in to the ECP in charge of pharmacy. __________________EMS shall keep copies of these inventories for a period of 3 years.
3. Disposal of un-used medications
Disposal or destruction of medications or fluids should be properly documented on the waste forms. Disposal or destruction of unused portions of controlled substances shall be documented in writing and signed by 2 emergency care providers. Out dated controlled substance shall be returned to __________________for proper disposal and documentation.
4. Controlled Substances
Controlled substances shall be secured in a separate section of each drug kit and tagged with a numerical security tag. Proper documentation will be required when a tag is removed. A controlled substance form will be filed out to track use and disposal of each drug.
5. Medication Administration
• An ECP shall not administer a drug or intravenous fluid without the verbal or written order of a physician, physician designee, or by written protocol. The service program is responsible for ensuring proper documentation of orders given and drugs administered.
• Any time a drug or fluid is administered all pertinent information should be documented in the pre-hospital care report. Pertinent information would include what was given, who gave it, how it was given, where it was given, the amount given, by what authority it was given and the results of its administration.
6. Storage in Vehicles
• All drugs stored within a vehicle shall be stored in such a manner to ensure proper temperature at all times.
• Each ambulance will be equipped with a high/low temperature marking thermometer, and high/low temperatures will be recorded daily during morning checks. Trends should be identified.
• Medications should be kept between 59°F and 86°F. Efforts to maintain adequate temperature readings should be made as needed.
• If an incident occurs where temperatures have fallen more than 10 degrees out of the acceptable range, an incident report will be completed and turned in to the ________________or his acting who will then notify_____________________.
• All vehicles shall be locked when left unattended.
• Medications cabinets will be locked at all times except during times of patient care.
7. Adverse Reactions
• Adverse reactions to drugs and infusion products shall be documented by means of incident report.
• Drug and infusion product defects shall be documented on the proper form.
8. Governance
All drugs shall be maintained in accordance with the rules of the state board of pharmacy examiners as outline below.
9. Iowa Board of Pharmacy Examiners EMS Guidelines
657 IAC Chapter 11 DRUGS IN EMERGENCY MEDICAL SERVICE PROGRAMS
657—11.1(124,147A,155A) Definitions.
For the purpose of this chapter, the following definitions shall apply:
“Ambulance service” means any privately or publicly owned service program that utilizes ambulances in order to provide patient transportation and emergency medical services.
“Board” means the Iowa board of pharmacy examiners.
“Department” means the Iowa department of public health.
“Drug” means a substance as defined in Iowa Code section 155A.3(13) or a device as defined in Iowa Code section 155A.3(10).
“Emergency medical care personnel” or “provider” means an individual who has been trained to provide emergency and nonemergency medical care at the first-responder, EMT-basic, EMT-intermediate, EMT-paramedic, paramedic specialist level, or other certification levels adopted by rule by the department and who has been issued a certificate by the department.
“Emergency medical technician” means any emergency medical technician or EMT as defined in 641—132.1(147A).
“EMS” means emergency medical services.
“Medical director” means any physician licensed under Iowa Code chapter 148, 150, or 150A who shall be responsible for overall medical direction of the service program and who has completed a medical director workshop, sponsored by the department, within one year of assuming duties.
“Physician” means any individual licensed under Iowa Code chapter 148, 150, or 150A.
“Physician assistant” means any individual licensed under Iowa Code chapter 148C.
“Physician designee” means any registered nurse licensed under Iowa Code chapter 152, or any physician assistant licensed under Iowa Code chapter 148C and approved by the board of physician assistant examiners. The physician designee acts as an intermediary for a supervising physician in accordance with written policies and protocols in directing the actions of emergency medical care personnel providing emergency medical services.
“Responsible individual” means, in a medical director-based service, the medical director for the service; in a pharmacy-based service, the pharmacist in charge of the base pharmacy.
“Service” or “service program” means any medical care ambulance service or nontransport service that has received authorization by the department.
“Supervising physician” means any physician licensed under Iowa Code chapter 148, 150, or 150A. The supervising physician is responsible for medical direction of emergency medical care personnel when such personnel are providing emergency medical care.
657—11.2(124,147A,155A) Ownership of drugs — options.
Ownership of any and all drugs used by an emergency medical service shall be maintained under one of the following options:
11.2(1) Pharmacy-based services. Any and all drugs shall be provided by a licensed pharmacy. Under this arrangement, all drugs shall remain the property of the pharmacy. For purposes of this chapter and unless otherwise noted, the pharmacist in charge of the base pharmacy shall be the responsible individual for the service program.
a. A formal written agreement shall be made between the base 657 IAC Chapter 11 DRUGS IN EMERGENCY MEDICAL SERVICE PROGRAMS
657—11.1(124,147A,155A) Definitions.
For the purpose of this chapter, the following definitions shall apply:
“Ambulance service” means any privately or publicly owned service program that utilizes ambulances in order to provide patient transportation and emergency medical services.
“Board” means the Iowa board of pharmacy examiners.
“Department” means the Iowa department of public health.
“Drug” means a substance as defined in Iowa Code section 155A.3(13) or a device as defined in Iowa Code section 155A.3(10).
“Emergency medical care personnel” or “provider” means an individual who has been trained to provide emergency and nonemergency medical care at the first-responder, EMT-basic, EMT-intermediate, EMT-paramedic, paramedic specialist level, or other certification levels adopted by rule by the department and who has been issued a certificate by the department.
“Emergency medical technician” means any emergency medical technician or EMT as defined in 641—132.1(147A).
“EMS” means emergency medical services.
“Medical director” means any physician licensed under Iowa Code chapter 148, 150, or 150A who shall be responsible for overall medical direction of the service program and who has completed a medical director workshop, sponsored by the department, within one year of assuming duties.
“Physician” means any individual licensed under Iowa Code chapter 148, 150, or 150A.
“Physician assistant” means any individual licensed under Iowa Code chapter 148C.
“Physician designee” means any registered nurse licensed under Iowa Code chapter 152, or any physician assistant licensed under Iowa Code chapter 148C and approved by the board of physician assistant examiners. The physician designee acts as an intermediary for a supervising physician in accordance with written policies and protocols in directing the actions of emergency medical care personnel providing emergency medical services.
“Responsible individual” means, in a medical director-based service, the medical director for the service; in a pharmacy-based service, the pharmacist in charge of the base pharmacy.
“Service” or “service program” means any medical care ambulance service or nontransport service that has received authorization by the department.
“Supervising physician” means any physician licensed under Iowa Code chapter 148, 150, or 150A. The supervising physician is responsible for medical direction of emergency medical care personnel when such personnel are providing emergency medical care.
657—11.2(124,147A,155A) Ownership of drugs — options.
Ownership of any and all drugs used by an emergency medical service shall be maintained under one of the following options:
11.2(1) Pharmacy-based services. Any and all drugs shall be provided by a licensed pharmacy. Under this arrangement, all drugs shall remain the property of the pharmacy. For purposes of this chapter and unless otherwise noted, the pharmacist in charge of the base pharmacy shall be the responsible individual for the service program.
a. A formal written agreement shall be made between the base pharmacy and the service establishing that the EMS is operating as an extension of the base pharmacy with respect to the drugs. The service contract may provide for payment by the service to the pharmacy of reasonable fees or charges for nonproduct pharmacy services.
b. Pharmacies shall provide drugs limited to the drugs listed in the service program’s written protocols.
11.2(2) Medical director-based services. Any and all drugs shall be provided by the medical director. Under this arrangement, all drugs shall remain the property of the medical director. For purposes of this chapter and unless otherwise noted, the medical director shall be the responsible individual for the service program.
Whenever necessary and appropriate, the medical director may consult with a pharmacist in regard to all matters relating to the proper use, storage, and handling of drugs and intravenous infusion products which may be administered to patients of the service program.
657—11.3(124,147A,155A) General requirements.
11.3(1) Exchange program. Any pharmacy may replace drugs, including controlled substances, which have been administered to patients upon receipt of an order issued by a physician, physician assistant, or physician designee so authorized.
11.3(2) Controlled substance prescribing. Controlled substances shall be prescribed only by a person who is so authorized by state law.
11.3(3) Controlled substance disposal or destruction. The disposal or destruction of the unused portion of a controlled substance shall be documented in writing and signed by the paramedic or paramedic specialist responsible for administration of the controlled substance and witnessed by one of the emergency service program personnel or a licensed health care professional. Outdated or unwanted controlled substances shall be returned to the service base for proper disposal or destruction.
11.3(4) Administration of drugs and intravenous infusion products. An appropriately certified EMS provider shall not administer a drug or intravenous infusion product without the verbal or written order of a physician, physician assistant, or physician designee, or by written protocol. The service program’s responsible individual shall be responsible for ensuring proper documentation of orders given and drugs administered.
11.3(5) Drug control policies and procedures. The service program’s responsible individual shall ensure that written drug and intravenous infusion product security and control policies and procedures are developed and implemented for the service. The policies and procedures shall address, but not be limited to, the following:
a. Controlled substances;
b. Medication orders;
c. Adverse drug and intravenous infusion product reaction reports;
d. Drug and intravenous infusion product administration;
e. Drug and intravenous infusion product defect reports and product recalls;
f. Outdated or unused drugs and intravenous infusion products and their timely disposal;
g. Drug and intravenous infusion product inventory control and security;
h. Record keeping;
i. Drug and intravenous infusion product procurement, storage, and ownership;
j. Inspections and frequency of inspections;
k. Drug exchange programs.
657—11.4(124,147A,155A) Procurement and storage.
The responsible individual for the service shall be responsible for the procurement and storage of drugs and intravenous infusion products for the service program.
11.4(1) Temperature. All drugs and intravenous infusion products shall be stored at the proper temperatures as defined by the USP/NF.
11.4(2) Expiration. Any drug or intravenous infusion product bearing an expiration date may not be administered after the expiration date.
11.4(3) Outdates. Outdated drugs and intravenous infusion products shall be quarantined together until such time as the items can be disposed of lawfully.
657—11.5(124,147A,155A) Records.
The responsible individual shall ensure that every inventory or other record required to be kept under Iowa Code chapter 124 or 155A and board rules is maintained by the service program and available for inspection and copying by the board or its representative for at least two years from the date of such inventory or record. Controlled substances inventories shall be maintained for at least four years from the date of the inventory.
657—11.6(124,147A,155A) Inspections.
11.6(1) Inspection by program's responsible individual. The responsible individual for the service program shall ensure proper inspection on a periodic basis of the drugs and intravenous infusion products used by the service. Proof of periodic inspection shall be in writing and made available upon request of the board or department.
11.6(2) Inspection by regulatory agencies. Drugs and intravenous infusion products used by the service program, as well as records maintained by the responsible individual or service program, shall be subject to inspection and audit by the board. Controlled substances and controlled substances records shall also be subject to inspection and audit by the federal Drug Enforcement Administration.
657—11.7(124,147A,155A) Security and control.
The responsible individual for the service program shall ensure that the program’s policies and procedures provide for adequate safeguards against theft or diversion of prescription drugs or devices, controlled substances, and records for such drugs and devices. The following conditions must be met to ensure appropriate control over drugs and intravenous infusion products.
11.7(1) Access authorized. Policies and procedures shall identify who will have access to the drugs and intravenous infusion products.
11.7(2) Limited access. Drugs and intravenous infusion products shall be secured at all times in a manner that limits access to authorized personnel only.
These rules are intended to implement Iowa Code chapter 147A and Iowa Code sections 124.301 and 155A.13. [10/9/2002]
a. pharmacy and the service establishing that the EMS is operating as an extension of the base pharmacy with respect to the drugs. The service contract may provide for payment by the service to the pharmacy of reasonable fees or charges for nonproduct pharmacy services.
b. Pharmacies shall provide drugs limited to the drugs listed in the service program’s written protocols.
11.2(2) Medical director-based services. Any and all drugs shall be provided by the medical director. Under this arrangement, all drugs shall remain the property of the medical director. For purposes of this chapter and unless otherwise noted, the medical director shall be the responsible individual for the service program.
Whenever necessary and appropriate, the medical director may consult with a pharmacist in regard to all matters relating to the proper use, storage, and handling of drugs and intravenous infusion products which may be administered to patients of the service program.
657—11.3(124,147A,155A) General requirements.
11.3(1) Exchange program. Any pharmacy may replace drugs, including controlled substances, which have been administered to patients upon receipt of an order issued by a physician, physician assistant, or physician designee so authorized.
11.3(2) Controlled substance prescribing. Controlled substances shall be prescribed only by a person who is so authorized by state law.
11.3(3) Controlled substance disposal or destruction. The disposal or destruction of the unused portion of a controlled substance shall be documented in writing and signed by the paramedic or paramedic specialist responsible for administration of the controlled substance and witnessed by one of the emergency service program personnel or a licensed health care professional. Outdated or unwanted controlled substances shall be returned to the service base for proper disposal or destruction.
11.3(4) Administration of drugs and intravenous infusion products. An appropriately certified EMS provider shall not administer a drug or intravenous infusion product without the verbal or written order of a physician, physician assistant, or physician designee, or by written protocol. The service program’s responsible individual shall be responsible for ensuring proper documentation of orders given and drugs administered.
11.3(5) Drug control policies and procedures. The service program’s responsible individual shall ensure that written drug and intravenous infusion product security and control policies and procedures are developed and implemented for the service. The policies and procedures shall address, but not be limited to, the following:
a. Controlled substances;
b. Medication orders;
c. Adverse drug and intravenous infusion product reaction reports;
d. Drug and intravenous infusion product administration;
e. Drug and intravenous infusion product defect reports and product recalls;
f. Outdated or unused drugs and intravenous infusion products and their timely disposal;
g. Drug and intravenous infusion product inventory control and security;
h. Record keeping;
i. Drug and intravenous infusion product procurement, storage, and ownership;
j. Inspections and frequency of inspections;
k. Drug exchange programs.
657—11.4(124,147A,155A) Procurement and storage.
The responsible individual for the service shall be responsible for the procurement and storage of drugs and intravenous infusion products for the service program.
11.4(1) Temperature. All drugs and intravenous infusion products shall be stored at the proper temperatures as defined by the USP/NF.
11.4(2) Expiration. Any drug or intravenous infusion product bearing an expiration date may not be administered after the expiration date.
11.4(3) Outdates. Outdated drugs and intravenous infusion products shall be quarantined together until such time as the items can be disposed of lawfully.
657—11.5(124,147A,155A) Records.
The responsible individual shall ensure that every inventory or other record required to be kept under Iowa Code chapter 124 or 155A and board rules is maintained by the service program and available for inspection and copying by the board or its representative for at least two years from the date of such inventory or record. Controlled substances inventories shall be maintained for at least four years from the date of the inventory.
657—11.6(124,147A,155A) Inspections.
11.6(1) Inspection by program's responsible individual. The responsible individual for the service program shall ensure proper inspection on a periodic basis of the drugs and intravenous infusion products used by the service. Proof of periodic inspection shall be in writing and made available upon request of the board or department.
11.6(2) Inspection by regulatory agencies. Drugs and intravenous infusion products used by the service program, as well as records maintained by the responsible individual or service program, shall be subject to inspection and audit by the board. Controlled substances and controlled substances records shall also be subject to inspection and audit by the federal Drug Enforcement Administration.
657—11.7(124,147A,155A) Security and control.
The responsible individual for the service program shall ensure that the program’s policies and procedures provide for adequate safeguards against theft or diversion of prescription drugs or devices, controlled substances, and records for such drugs and devices. The following conditions must be met to ensure appropriate control over drugs and intravenous infusion products.
11.7(1) Access authorized. Policies and procedures shall identify who will have access to the drugs and intravenous infusion products.
11.7(2) Limited access. Drugs and intravenous infusion products shall be secured at all times in a manner that limits access to authorized personnel only.
These rules are intended to implement Iowa Code chapter 147A and Iowa Code sections 124.301 and 155A.13. [10/9/2002]
Purpose:
Response standards are put in place to ensure that _______________EMS obtains acceptable response times and to monitor the interval times that exist during a EMS response.
Call Received to Dispatch:
The expectation is that all calls received by the _______dispatch center will be received, triaged and dispatched in under 1 minute 59 seconds. Calls that do not meet this standard will be investigated through the _________________QA/QI process.
Dispatch to En Route:
During daytime hours crews are expected to be en route in less than 59 seconds from the time of page when responding from their station. Exceptions will be made for crews that may be providing non-dedicated standby at events.
During the night hours crews are expected to be en route in less than two minutes from time of page.
Arrival:
It will be the goal of ___________________EMS to respond to emergent calls (code 2 & 3) in less than 8 minutes and 59 seconds 90% of the time. Should a call take longer, it will be reviewed for causes, any avoidable issues should be addressed with the responding crew. All calls greater than 8 minutes and 59 seconds will be entered into the “Exception Report” for tabulation of statistics.
It will be the goal of ___________________EMS to respond to non-emergent calls (code 1) in less than 9 minutes and 59 seconds 90% of the time. Should a call take longer it will be reviewed for causes, any avoidable issues should be addressed with the responding crew. All calls greater than 9 minutes and 59 seconds will be entered into the “Exception Report” for tabulation of statistics.
Scene Times:
Scene time standards have been established so as not to delay definitive care to patients. It is understood that circumstances do exist and will arise causing delays and extended scene times The scene times goals for calls should be as follows:
• Trauma scene time < 15 minutes
• Medical scene time < 20 minutes
Purpose: To outline procedures for EMS response.
Policy:
EMS Response Zones
The City will be divided into two response zones with the city divided into _______________It will be the responsibility of each crew to be aware of the addresses in their respective response zones.
Squad Rotation
It will be the goal of the department to maintain an ambulance at the center of the City when at all possible. It will be expected that between the hours of 7am and 11pm, when the ambulance responding from station ___ responds to a request for service, the ambulance responding from station __ will rotate to station __. Crews from station __ should not delay in rotating to station __.
Radio Usage and Frequencies
When responding to routine EMS calls for service, ______ will be the channel used unless you are directed to use a different channel by ________ or a decision is made by and Incident Commander to move an incident to a different frequency.
Fire Response
When responding to fire scenes all EMS response communication will be handled on the Fire Page channel. This will include when you announce your unit en route to the scene. Any communications between EMS units will be handled on _____ or ______.
If you are the first arriving unit at a fire scene you will give a scene size-up and take command until the first Fire Department unit arrives. Command will be transferred to that first arriving Fire Department unit. Example: “Squad 213 has arrived on 20th street and we have a house with smoke and flames showing from an upstairs bedroom window. Medic Smith will have command until a Fire unit arrives.
EMS will respond to any Fire Department call that we are paged out for even if EMS is not specified within the page.
EMS will not respond to any Fire Department calls without being paged out. If you feel that a working fire call has gone out and EMS should respond be responding, then the on-duty medic will contact the Fire Department and ask if they would like EMS to respond.
Major Incident Response
Emergency incident communications will take place on a centralized channel as designated by__________. If the Incident Commander feels that the situation warrants the use of a centralized frequency by all three departments, (Police, Fire, EMS) they will request that ________ assign one of the Public Safety Channels for the incident. _______will then advise all responding units to switch to the channel upon arrival at the scene. Each department should use the assigned channel for essential scene operations communications. Each department should try to move to their normal channels for routine scene communications. An example of this might be the need for EMS to contact a parent of a minor patient to get permission to treat. This type of traffic would be handled on the normal EMS channels and staff would then return to the Public Safety channel for scene communications. Other examples might be the Police Department running plate information. Reserving the assigned channel for essential scene communications assures that the channel does not become overrun and that the information being relayed is relevant to scene operations.
If the Incident Commander has not requested a centralized channel, and ___________feels that there is a need for everyone to be on the same channel, they may request from the Incident Commander that this be done.
Motor Vehicle Crash Response
Command
When responding to motor vehicle crashes along with the Fire Department the first arriving EMS (if prior to Fire Department) unit will announce a scene size-up and take command upon arrival using _____. As patient care develops and EMS crews become busy, command may be turned over to an EMS Supervisor or the first arriving Fire Department unit. The first arriving EMS unit will maintain command until a unit arrives to assume command.
If available, the full-time crew member on the first arriving EMS unit will be the incident commander and will be called by name or medic number.
Updates should be given to other responding units such as, the need for extrication, smoking vehicles or fluid leaks using EMS1 channel. This will help to determine what apparatus the Fire Department might need.
All Fire Department units will be going en route and communicating with us on EMS1 on all medical assists or motor vehicle crashes.
Disregarding of Fire Units
Fire Department units can be disregarded on a motor vehicle crash by EMS as long as the police officer(s) on scene is in agreement with the EMS crews that there are no safety hazards, fluid spills/leaks or that their assistance wont be needed for other reasons. Make certain that there will not be the need for assistance from the Fire Department with lifting or other care related issues.
Purpose:
To protect the inventory and assets of the _______________________________.
Policy:
Station access & Alarms
• All entrances to stations should be secured at all times .
• Ambulance bay doors should be kept closed unless ECP’s are working in that area.
• Each employee will be provided with a fob key allowing them access to all EMS/Fire stations through the electronic security system.
• Stations equipped with security alarms shall be alarmed according to the desires of the EMS and Fire command staff.
Identification Badges
• Each employee will be provided with a identification badge indicating their name, job title and certification level. The identification badge is part of an employee’s uniform and will be worn at all times while on duty.
•
Supply storage
• The supply room will be kept locked at all times.
• Keys to the supply room will be issued to on-duty staff at the beginning of each shift and accounted for at the end of the shift.
Vehicles
• When an ambulance must be left unattended at a location other than secured in a station or emergency scene, the ambulance will be locked.
• Medications will be secured in a locked cabinet within the ambulance at all times except during patient care when appropriate, with only staff certified at the Paramedic or Paramedic Specialist level having access via fob key.
Handling of Departmental Keys
• Two large sets of keys with full pharmacy access will be made available for the EMT-PS assigned to each EMS unit.
• Keys will be exchanged from person to person. Keys should not be left unattended.
• All keys will be accounted for at each shift change. If keys are missing the __________shall be notified immediately. If the ________cannot readily locate the keys, the __________will be notified and incident report filled out by all parties involved. The appropriate security measures shall then be taken.
• Failure to follow shift exchange policy or loss of keys will result in disciplinary action. Keys taken home mistakenly by crews are expected to be returned immediately to the appropriate station.
Purpose:
To provide guidelines for students and observers in the wearing of his or her uniform, personal appearance and expectations while obtaining clinical learning experience with _______________EMS. The uniform and appearance of the student or observer provides recognition and professionalism when responding to an emergency or while in public.
Policy:
1. Intoxicants
• No student under the influence of an intoxicant shall report for clinical learning under any circumstances.
• No student shall use or consume intoxicants while attending a scheduled shift.
• No alcohol shall be consumed within eight (8) hours of starting a shift.
• No student shall report to duty and not be able to perform normally due to the effects of alcohol consumption prior to their shift. Poor attitude, tiredness, feeling ill and slow mental decision making ability due to the effects of alcohol will not be tolerated.
2. Medications
• No student shall report to duty under the influence of medication which impairs their mental ability or decision-making whether prescriptions or non-prescriptions unless approved by a member of management.
3. Uniform maintenance
• All students and observers shall keep uniforms clean and neat in appearance.
• Shorts and open toed footwear are unacceptable at all times.
4. Wearing of uniform
• Uniforms shall be worn in a professional manner.
• The uniform worn shall be the uniform required by the student’s or observer’s educational facility.
• Shirts will be well pressed.
• Shoes will be solid black in color.
• Socks/hose shall be dark in color if visible.
5. Name badge
• A name badge that identifies the wearer by name and by student type shall be worn in a visible manner at all times.
6. Confidentiality
• All students and observers will abide by departmental policies regarding patient confidentiality.
7. Liability Waiver
• All students and observers will complete a Passenger Liability Release form prior to beginning ride time.
8. Overnight Arrangements
• When learning or observing during the night-time hours (2300-0700) all attempts to have a bed available for student or observer sleeping will be made. Due to space limitations a private bedroom or bed are not always available. If a student or observer is uncomfortable for any reasons with sleeping accommodations, it is the student’s or observer’s responsibility to notify the ______________on duty. All reasonable attempts will be made to find satisfactory accommodations.
9. Use of Tobacco
• Tobacco use is inconsistent with a professional image for the EMS provider as well as good personal health habits. Therefore, tobacco use, whether “smokeless” (chew or dip) or smoked (cigarettes or cigars) is prohibited except in designated areas located outside of City facilities.
10. Personal Appearance – Male Students and observers
• Hair
➢ The hairstyle shall not be more than medium length and fullness.
➢ A neat pattern on the rear of the neck shall be maintained, the growth must be neatly trimmed near the collar line and shall not exceed over the shirt or the coat collar.
➢ The hair will be cut in a neat and proper manner, which does not reflect on, or detract from the wearing of a uniform.
• Sideburns
➢ Sideburns will be neatly trimmed with straight lines.
➢ The base will be a clean-shaven line and the length of the hair that constitutes the sideburns will be evenly tapered in the same manner as the remainder of the hair on the side of the head.
➢ The base of the sideburn will not extend downward beyond the line parallel to the ground and drawn horizontally from the bottom of the ear lobe. The forward and rear edges will be maintained at a vertical line and shall not exceed one and one-fourth (1-1/4) inches at the broadest point.
➢ The growth shall not be more than one-half (1/2) inch in depth.
• Mustaches
➢ The mustache will extend no lower than the imaginary line drawn horizontally from the corners of the mouth.
➢ The mustache will not extend more than one-fourth (1/4) inch past an imaginary vertical line running from the corners of the mouth.
➢ The hair from the mustache will not extend over the upper-most edge of the upper lip.
➢ The hair of the mustache will be groomed in such a manner so as not to present a bushy appearance.
• Beard
➢ Beards are not recommended. If the student chooses to wear a beard he must be able to successfully pass all HEPA mask requirements.
➢ The beard length will not exceed one-half inch (1/2) in depth and will be groomed in a manner so as not to present a projected bushy appearance.
• Jewelry
➢ Items shall be of a nature which will not detract from the uniform or interfere with the student’s or observer’s duties or cause a hazard to the student.
➢ No earrings or exposed body piercing will be allowed.
• Tattoos
➢ Tattoos shall be covered up, at all times during clinical learning.
11. Personal Appearance – Female Students and observers
• Hair
➢ Free hairstyles shall not land below the bottom of the uniformed collar in the back and no longer on the side than the back edge of the jawbone.
➢ Hair exceeding the above length must be worn pulled up in a secure knot or bun on top of the head.
➢ In all instances, hair will be worn in a neat manner which does not detract from the wearing of the uniform.
• Make-up
➢ Excessive make-up such as dark, heavy eye shadow, false eyelashes and heavy mascara, which would detract from the uniform, is prohibited.
➢ Make-up, if worn, shall be moderate and natural appearing.
• Jewelry
➢ Jewelry items shall be of a nature which will not detract from the uniform or interfere with the student’s or observer’s duties or cause a hazard to the student.
➢ One post earring will be allowed per ear.
➢ No exposed body piercing will be allowed.
• Tattoos
➢ Tattoos shall be covered up, at all times during clinical learning.
Purpose:
To provide guidelines for the emergency care provider in the wearing of his or her uniform and personal appearance while on duty. The uniform and appearance of the emergency care provider provides recognition and professionalism when responding to an emergency or while in public.
Policy:
1. Uniforms furnished by ___________________________
The following uniform articles will be provided or made available by the _______________ for the emergency care provider.
• Uniform dress shirt
• Winter jacket
• Commando style sweater
• Casual dress shirt
• T-shirt
• Rain coat
• Name tags
• EMS protective gear
2. Uniform replacement
• The uniform items will be replaced or changed as deemed necessary by the ________________ or when a request is received and just cause shown.
3. Uniform maintenance
• All ECP’s shall keep uniforms clean and neat in appearance.
4. Surrender of department uniforms
• Upon separation from the department, each ECP shall return all department issued uniforms and markings associated with _____________ EMS in his/her possession to the EMS____________________.
5. Patches on uniform
• Designated service patch will be worn on the right shoulder.
• Approved certification patch will be worn on the left shoulder.
• Other patches may be designated at the discretion of the Chief
6. Name Bar and Other Markings
• Name bars will be issued by the department and displayed on the right breast of Class A uniforms.
7. General Guidelines For All Uniforms
• Uniforms shall be worn in a professional manner.
• Shirts will be clean and well pressed.
• A solid white undergarment shall be worn under the dress and casual uniform shirts.
• Slacks will be navy blue in color and should be worn with a black belt.
• Shoes will be solid black in color providing adequate protection of the feet. Shoes with open toes or heels will not be permissible. Socks/hose shall be dark in color if visible.
8. Day / Night Uniforms
• During the hours of 7a-7p, the white uniform dress shirt or the casual dress shirt shall be worn. Use of each shirt will generally change on a seasonal basis. A memo from ___________________will be sent out in the case where there is a change of uniform shirt.
• During the hours of 7p-7a, blue t-shirts or sweatshirts shall be allowed.
• Keeping professionalism in mind, staff should make a strong effort to ensure that crews are wearing the same uniform shirts in the 7a-7p time frame.
9. Uniform classes / Descriptions
Class A Guidelines
• Class A dress code will be required for events where there is contact with the general public outside of the station setting or when otherwise directed.
• Class A dress is encouraged for professional occasions such as department meetings, contact with civic groups or department associates.
• Dress will consist of department issued white button down dress shirt and navy blue EMS pants.
• Name tags and appropriate brass markings will be worn.
• Dress will be in compliance with the general guidelines for all uniforms
Class B Guidelines
• Class B dress code will serve as the uniform for normal operations within the department.
• Dress will consist of department issued casual / polo shirt or sweater and navy blue EMS pants.
➢ Use of Sweaters
✓ Sweaters may be worn during cold temperatures.
✓ A white, collared departmental issued shirt, turtle-neck, mock turtle-neck or dickie will be worn under the sweater.
• Dress will be in compliance with the general guidelines for all uniforms
Class C Guidelines
• Class C dress code will serve as the uniform for evening and night hours, and for work wear within the Station.
• Department issued T-shirt or sweatshirt and navy blue EMS pants may be worn after 1900.
• EMS jumpsuits may be worn after 2300.
• EMS protective clothing pants may be worn after 2300.
• Hats issued by the department that are clean and appear professional may also be worn after 2300 hours.
• Dress will be in compliance with the general guidelines for all uniforms
10. Personal Appearance – Male Emergency Care Provider:
• Hair
➢ The hairstyle shall not be more than medium length and fullness.
➢ A neat pattern on the rear of the neck shall be maintained, the growth must be neatly trimmed near the collar line and shall not exceed over the shirt or the coat collar.
➢ The hair will be cut in a neat and proper manner, which does not reflect on, or detract from the wearing of the department uniform.
• Sideburns
➢ Sideburns will be neatly trimmed with straight lines.
➢ The base will be a clean-shaven line and the length of the hair that constitutes the sideburns will be evenly tapered in the same manner as the remainder of the hair on the side of the head.
➢ The base of the sideburn will not extend downward beyond the line parallel to the ground and drawn horizontally from the bottom of the ear lobe. The forward and rear edges will be maintained at a vertical line and shall not exceed one and one-fourth (1-1/4) inches at the broadest point.
➢ The growth shall not be more than one-half (1/2) in depth.
• Mustaches
➢ The mustache will extend no lower than the imaginary line drawn horizontally from the corners of the mouth.
➢ The mustache will not extend more than one-fourth (1/4) inch past an imaginary vertical line running from the corners of the mouth.
➢ The hair from the mustache will not extend over the upper-most edge of the upper lip.
➢ The hair of the mustache will be groomed in such a manner so as not to present a bushy appearance.
• Beard
➢ Beards are not recommended. If the employee chooses to wear a beard he must be able to successfully pass all HEPA mask requirements.
➢ The beard length will not exceed one-half inch (1/2) in depth and will be groomed in a manner so as not to present a projected bushy appearance.
• Jewelry
➢ Items shall be of a nature which will not detract from the uniform or interfere with the ECP’s duties or cause a hazard to the ECP. No earrings or exposed body piercing will be allowed.
• Tattoos
➢ Tattoos shall be covered up, at all times, while on duty.
11. Personal Appearance – Female Emergency Care Provider
• Hair
➢ Free hairstyles shall not land below the bottom of the uniformed collar in the back and no longer on the side than the back edge of the jawbone.
➢ Hair exceeding the above length must be worn pulled up in a secure knot or bun on top of the head.
➢ In all instances, hair will be worn in a neat manner which does not detract from the wearing of the uniform.
• Make-up
➢ Excessive make-up such as dark, heavy eye shadow, false eyelashes and heavy mascara, which would detract from the uniform, is prohibited. Make-up, if worn, shall be moderate and natural appearing.
• Jewelry
➢ Jewelry items shall be of a nature which will not detract from the uniform or interfere with the ECP’s duties or cause a hazard to the ECP. One post earring will be allowed per ear. No exposed body piercing will be allowed.
• Tattoos
➢ Tattoos shall be covered up, at all times, while on duty.
Purpose :
This policy will outline the procedures for use of mutual aid.
Policy:
1. ______________________EMS has established 28E agreements for mutual aid with the following agencies:
• __________________________________
• __________________________________
• __________________________________
• __________________________________
• __________________________________
• __________________________________
• __________________________________
2. __________________ EMS has established a 29C statewide mutual aid agreement for use under Iowa Homeland Security provisions. A copy of this agreement is on file in the EMS administrative offices.
3. Situations of short duration may arise in regard to medical emergencies or circumstances which exhaust available personnel and equipment, and require additional or specialty personnel and additional or special equipment that our department may not have available. Examples of when mutual aid may need to be requested would include, MCI’s, hazardous materials, incidents or request for services when the __________does not have an ambulance, appropriate vehicle or staff to respond.
4. Should the need to request mutual aid arise, the __________________or his acting, should be notified following the incident. Request for mutual aid shall state the exact nature of the emergency and shall include the amount and type of equipment and number and skills of personnel equipment needed, and shall specify the location where the personnel and equipment are needed. __________ should be notified of needs and will notify the appropriate agency(s).
5. Every effort should be made to ensure that the assisting agency’s staff and equipment are allowed to return to their individual service areas as soon as reasonably possible.
At the request of an EMS crew, translators and/or interpreters are made available to the department. This is done in cooperation with______________________. The following list of persons is available for such needs. Request should be made through ______________.
|Name |Home Phone |Other Numbers |
|Spanish Interpreters |
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|Vietnamese |
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|Bosnian |
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|Sudanese |
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|South East Asian |
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|Signing For Deaf |
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Purpose:
The purpose of this policy is to provide Medical Director approval of supplies and equipment carried within department ambulances, give clear direction for assuring the restocking of the ambulance and to assure the readiness of our ambulances for emergency response.
Policy:
This policy should be in effect anytime supplies are used or deficiencies are noted from the ambulance.
• At the completion of the call, the ambulance shall be restocked by the crew. The driver for the call will have the responsibility of assuring that the ambulance is returned to pre-call condition.
• A daily squad check shall be completed at the beginning of each shift, any deficiencies shall be corrected so that the ambulance meets the minimum stocking requirements as defined on the checklist.
• A weekly in-depth squad inventory shall be completed weekly on all ambulances with any deficiencies noted and replenished.
• The Medical Director will be made aware of changes made in the equipment and supplies carried within the ambulances. The Medical Director shall approve of equipment and supplies carried within the ambulances.
Purpose
The purpose of this policy is to ensure that emergency response vehicles are maintained in a clean and sanitary condition.
Policy
1. Definitions. For purposes of this section, the following shall apply:
• “Blood” means human blood, human blood components, and products made from human blood.
• “Bloodborne pathogens” means pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatits B virus (HBV) and human immunodeficiency virus (HIV)
• “Contaminated” means the presence of the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface.
• “Contaminated Laundry” means the presence or the reasonably anticipated presence of blood or other potentially infectious materials or the likelihood that they may harbor contaminated sharps.
• “Contaminated Sharps” means any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, and broken glass.
• “Decontamination” means the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal.
• “Other Potentially Infectious Materials” means (1) The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; (2) Any unfixed tissue or organ (other than intact skin) from a human (living or dead)
• “Personal Protective Equipment” is specialized clothing or equipment worn by an employee for protection against a hazard. General work clothes (e.g., uniforms, pants, shirts or blouses) not intended to function as protection against a hazard are not considered to be personal protective equipment.
• “Regulated Waste” means liquid or semi-liquid blood or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or other potentially infectious materials.
• “Universal Precautions” is an approach to infection control. According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens.
2. The exterior of the vehicle will be kept clean whenever possible
• Primary response vehicles will be washed on a daily basis or more often if needed to ensure cleanliness when possible
• Vehicles will be dried following the washing to remove residual water
• Vehicles will receive a coating of external protectant on a regular basis
3. The patient care area will be kept clean and sanitary whenever possible
• Universal precautions shall be observed to prevent contact with blood or other potentially infectious material while decontaminating the vehicle.
4. Handling of contaminated needles and sharps
• Contaminated needles and other contaminated sharps shall not be bent, recapped, or removed except when it can be demonstrated that no alternative is feasible or that such action is required by a specific medical procedure.
➢ Such bending, recapping or needle removal must be accomplished through the use of a mechanical device or a one-handed technique
• Contaminated sharps shall be discarded immediately or as soon as feasible in containers that are:
➢ Closable;
➢ Puncture resistant;
➢ Leakproof on sides and bottom; and
➢ Labeled or color-coded in accordance with OSHA standard 1910.1030
• During use, containers for contaminated sharps will be:
➢ Easily accessible to personnel and located as close as is feasible to the immediate area where sharps are used or can be reasonably anticipated to be found;
➢ Maintained upright throughout use; and
➢ Replaced routinely and not be allowed to overfill.
• Broken glassware which may be contaminated shall not be picked up directly with the hands. It shall be cleaned up using mechanical means, such as a brush and dust pan, tongs, or forceps.
5. All linen that came in contact with the patient shall be exchanged or properly cleaned prior to reuse.
• Contaminated laundry shall be handled as little as possible with minimum of agitation.
➢ Contaminated laundry shall be bagged or containerized at the location where it was used and shall not be sorted or rinsed in the location of use.
➢ Contaminated laundry shall be placed and transported in bags or containers labeled or color-coded in accordance with OSHA standard 1910.1030.
➢ Whenever contaminated laundry is wet and presents a reasonable likelihood of soak-through of or leakage from the bag or container, the laundry shall be placed and transported in bags or containers which prevent soak-through and/or leakage of fluids to the exterior.
➢ All persons who have contact with contaminated laundry wear protective gloves and other appropriate personal protective equipment.
6. All surfaces that came into contact with blood or potentially infectious materials shall be properly decontaminated as soon as feasible
• Extreme caution shall be taken while cleaning non-readily visible areas to avoid personal injury
7. All equipment and working surfaces that could have become contaminated shall be cleaned and checked routinely and shall be decontaminated as necessary.
8. All coverings used for protecting working surfaces shall be removed and replaced as soon as possible after they have been contaminated.
9. All bins, pails, cans, and similar reusable receptacles must be decontaminated on a regularly scheduled basis and cleaned and decontaminated immediately or as soon as possible after visible contamination.
10. Excessively contaminated vehicles or equipment shall be removed from service until such time that they can be adequately decontaminated.
11. Vehicles and equipment will undergo a thorough decontamination on a weekly basis.
Purpose:
The service will insure usage of vehicle safety restraints by EMS personnel, passengers and patients when any service vehicles are in use.
Policy:
1. General concern will be given at all times to the hazardous nature of responding to emergency calls. The risk to EMS personnel as well as the general public is increased by the use of lights and sirens in the response to an emergency call.
2. Prior to response, all vehicle doors, loose equipment and other items carried on the emergency vehicle are to be properly stowed, secured and all doors closed to insure safe transport to the emergency scene. All persons riding in the vehicle are to be secured in their seats with seat belts fastened prior to vehicle movement.
3. Prior to patient transport, all vehicle doors, loose equipment and other items are to be properly stowed, secured and all doors closed. Any equipment necessary for patient care should be secured if possible. The driver will be secured in his/her seat with the seat belt fastened. The patient attendant will be seated and secured with their seat belt in the rear compartment unless patient care requires otherwise. The patient will be secured to the ambulance cot with safety restraints, as patient care permits.
4. Family, friends and patients who are transported in the front passenger seat of the ambulance must be secured using the lap/shoulder belt present at all times during ambulance movement. Attention should be given to those riding in the front passenger seats that are less than age 12 due to the presence of airbags. Persons less than age 12 should be transported in the rear of ambulance or transported by other means if the airbag cannot be turned off.
All non-patient children transported who are less than age 3 should be transported in an approved car seat secured in the rear of the ambulance if one is available.
5. An emergency situation may supercede the above provisions.
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