EPHRATA COMMUNITY HOSPITAL - EHSF



POLICIES MANUAL

FOR

ADVANCED/BASIC LIFE SUPPORT SERVICE

Original Date- January 1991

Revised Dates- January 1994 January 1997

January 2000

January 2003

January 2006

Appreciation and acknowledgement to Ephrata Community Hospital Advanced Life Support Service for providing these electronic Sample License Policies

Table of Contents

Policy 1 Management of Personnel Safety Pages 3-7

Policy 2 Substance Abuse in the Workplace Page 8

Policy 3 Placement and Operation of Ambulances Page 9

Policy 4 Patient Management Page 10

Policy 5 Use of Lights and Warning Devices Pages 11-15

Policy 6 Weapons and Explosives Page 16

Policy 7 Completion of EMS Patient Care Reports Page 17-19

Policy 8 Satisfying Documentation Requirements Page 20

Policy 9 Satisfying Ambulance Standards Page 21

Policy 10 Satisfying Equipment and Supply Requirements Page 22

Policy 11 Satisfying Personnel Requirements Page 23

Policy 12 Communicating with PSAPs Page 24

Policy 13 Accident Injury and Fatality Reporting Page 25

Policy 14 Medical Command Notification Page 26

Policy 15 Dissemination and Protection of Patient

Information Page 27

Policy 16 Participation in Statewide and Regional

Quality Improvement Programs Page 28

Policy 17 Drug Use Control and Security Page 29

Policy 18 Exposure Control Plan Pages 30-48

Policy 19 Infection Control Plan Pages 49-68

Policy 1- Management of Personnel Safety

Policy 1-1 Caution with Emergency Response and Horse Drawn Vehicles

Policy-It is mandatory that care be exercised at all times during an emergency response. However, due to the high incidence of horse drawn vehicles within the response zone, special care must be taken.

Procedure- When a horse drawn vehicle is observed, discretion is to be used as to whether or not the siren should be turned off so as not to frighten the horse causing an accident.

Policy 1-2 Cooperation with Ancillary Services

Policy- It is the policy of to work closely with ancillary services to provide optimum patient care through use of the expertise and skills of all levels of certification and ancillary services present. This strengthens patient care and provides additional safety to both patients and crewmembers.

Procedure- Upon arrival on scene, acknowledgement of the Advanced/Basic Life Support Service, Rescue and fire services and police are to occur. Their evaluation is paramount in the success of the team concept of patient care and crew safety. Each should continue to function in their realm, cooperating to give expedient quality care and safety to all personnel.

Policy 1-3 Fire and Rescue Assistance

Policy- In order to provide safety to the crew and the patient, it is mandatory that appropriate support services be present.

Procedure- If appropriate services are not dispatched and deemed necessary, appropriate services are to be requested.

Policy 1-4 Hazardous Situations

Policy- It is of the utmost importance that the crew looks toward the safety of themselves and the unit when arriving at the scene of an incident, then the safety of other

persons on scene and finally patients on scene

Policy 1- Management of Personnel Safety

Policy 1-4 Hazardous Situations

Procedure: 1. Upon arrival, the scene is to be surveyed for any potentially dangerous situations.

2. Clearance is to be obtained from fire and/or rescue services on location prior to entering a vehicle and/or scene.

3. Vehicles are to be checked for stabilization and fire potential.

4. Protective gear is to be work as indicated.

5. Police are to be requested to enter and clear residences or scenes prior to crew entry if the situation appears suspicious.

6. Unknown substances are to be identified via placards if available or by manifest.

7. If in doubt as to the situation, do not approach a scene until appropriate authorities have given clearance.

Policy 1-5 Driving

Policy- By Pennsylvania law, no emergency vehicle may exceed the accepted posted speed. Therefore, at all times staff should abide by the law governing motor vehicles in the State of Pennsylvania. In addition, under Statewide BLS Protocols, use of lights and sirens are defined for life threatening conditions when transporting patients.

Procedure: 1. Excessive speed and/or reckless is not to be tolerated. Any member of the crew has the right to request a reduction in speed.

2. If the driver does not comply with the request, the crew member will

direct the driver to decrease the speed immediately. Such action will

require a written statement to be given to the Advanced/Basic Life

Support Unit Manager and Advanced/Basic Life Support Coordinator

explaining the circumstances.

3. A second written complaint within six (6) months of the first will result in suspension from driving the unit for not less than ten (10) shifts. A third infraction will cause suspension from driving for not less than thirty (30) days.

4. All drivers will observe relevant traffic laws.

Policy 1- Management of Personnel Safety

Policy 1-5 Driving

Procedure: 5. Drivers will not be addicted to, or will not drive under the influence of drugs or alcohol.

6. Drivers must be free of any physical or mental disease that may impair his/her ability to drive an emergency vehicle.

7. Drivers may not have been convicted within the last four (4) years of driving under the influence of alcohol or drugs, and within the last two (2) years, has not been convicted of reckless driving or had a driver’s license suspended under the point system.

8. Any driver convicted as stated in #7 above will successfully complete an emergency vehicle operator’s course of instruction after their conviction.

9. All drivers must have a valid Pennsylvania drivers license and be twenty-one (21) years of age or older.

10. It is recognized that each incident must be considered in its own setting and disciplinary action taken accordingly.

11. All new crewmembers will receive instruction during driving training.

12. In the event of an accident, the driver shall be suspended from driving until completion of the accident investigation.

13. In the event a driver has been consistently approached by crew

regarding driving problems, the Unit Manager and/or Advanced/Basic

Life Support Coordinator has the authority to suspend driving

privileges.

14. All crewmembers will comply with Pennsylvania Law governing the use of seatbelts.

15. Specific situations identifies as life-threatening are those in which the unit may respond emergency to the hospital with a patient on board. (See BLS Statewide Protocol 123)

Policy 1-6 No Smoking in the Ambulance

Policy- Due to the hazards present with smoking in an enclosed space with oxygen present, no smoking will be allowed in the Pennsylvania State Certified/Recognized. EMS Vehicle.

Policy 1- Management of Personnel Safety

Policy 1-6 No Smoking in the Ambulance

Procedure: Infractions are to be reported with appropriate action taken when necessary by the Unit Manager and/or Operations Chief.

Policy 1-7 Scene Control

Policy: In compliance with the Pennsylvania Health Services guidelines, the service recognizes that control of all aspects of patient management at an emergency scene shall be the responsibility of the individual from the dispatched service in attendance who has the highest level of EMS certification/recognition and is affiliated or dispatched with a service whose response area includes the incident scene.

Procedure: Individuals shall be recognized based on the following hierarchy of certification/recognition;

1. Health Professional

2. EMT-Paramedic

3. Emergency Medical Technician

4- First Responder

5- Ambulance Attendant

Policy 1-8 Emergency Response

Policy: EMS will respond on emergency situation under the criteria as established by Act 45, Act 82 and EMD Priority Dispatch.

Procedure: 1. Advanced/Basic Life Support and Basic Life Support responding to an incident scene or to an emergency care facility may use emergency lights and audible warning devices for cases involving patient with life threatening illnesses or injuries as dispatched. Use of emergency lighting on scene is permissible for safety purposes.

2. Advanced/Basic Life Support and Basic Life Support responding to an incident scene or to an emergency care facility may not use emergency lights and audible warning devices for cases involving patient that do not have life threatening illnesses or injuries.

Policy 1- Management of Personnel Safety

Policy 1-9 Driver Designation

Policy: To provide safety for the crew and other motorists, all drivers will complete a driver orientation/evaluation program. This program will be the responsibility of the Unit Manager/ Operations Chief. A driver/trainer

may be appointed who holds state EVOC instructor certification. Additionally, all current drivers will be evaluated annually per the Unit Manager. Appropriate forms for documentation of driving skills will be completed.

Procedure:

1. All new members, upon approval of application, will be given an orientation packed to include driver orientation material.

2. The driver/trainer will arrange to meet with the new crewmember for unit orientation and review of driving policies.

3. As much as possible, the new crewmember will be assigned to a crewmember for driving evaluation.

4. It will be the responsibility of the Unit Manager to advise the on- duty crew of the driver in training.

5. No driver in training will be allowed to serve as the sole driver until completion of this program.

6. Appropriate evaluation forms will be completed and upon satisfactory completion of this program, the new staff member will be elevated to driver.

7. The schedule will indicate the driver in training with a D.T. noted by the individual’s name.

8. All Advanced/Basic Life Support drivers will have yearly checks completed by the Hospital’s Insurance Carrier regarding validity of license and clearance of infractions.

Policy 2 Substance Abuse in the Workplace

Policy: As a healthcare provider, the Advanced/Basic Life Support Services refuses to allow the mixture of intoxicating beverages or drugs while functioning on the units. The Human Resource Policy regarding this abuse will be strictly followed.

The possession, consumption or “being under the influence” of intoxicating beverages or drugs either while on duty or while at station is grounds for immediate dismissal.

The use of either intoxication beverages or drugs prior to reporting to duty so that such use can be detected by physical criteria such as smell, slurred speech or unsteady demeanor may result in immediate disciplinary action up to and including dismissal and a request for complaint investigation to the Regional Council.

Procedure: 1. Immediate activation of Human Resource Policy regarding substance abuse in the Workplace.

2. If such a situation is suspected, each crewmember is responsible for reporting the offense immediately to the Unit Manager and/or Advanced/Basic Life Support Coordinator.

3. Any crewmember suspected of such abuse should be removed as driver and direct patient care giver pending investigation.

Policy 3 Placement and Operations of Ambulances

Policy: The Advanced/Basic Life Support Services will be located at the stations indicated in the license application and will primarily responds from that area to provide optimum patient care response. Units will become available when they are the closest unit to the dispatch and/or within their response area.

Procedure: 1. The PSAP will be notified if a unit is stationed at another location e.g. stand-by at community event, sports event, etc.

2. All units will operate under required licensure equipment, staffing and response modes.

3. Approved trip reports will be completed on all responses. These will include required patient information and will be completed within twenty-four (24) hours of the call.

4. Initial reports will be given to the receiving facility at the time of patient arrival.

Policy 4 Patient Management

Policy: The Advanced/Basic Life Support member in charge of the crew will be responsible for all patient care and for assuring that each patient has the appropriate level of provider delivering patient care.

Procedure: 1. It will be the responsibility of the crewmember to make sure an adequate number of appropriate level of providers are available and that additional providers are requested to the scene if needed.

2. All necessary equipment and supplies are to be available to provide the appropriate care.

3. All patients are to be managed within the Statewide BLS and ALS Protocols.

4. Patients are to be taken to the appropriate receiving facility as defined by Protocol.

Policy 5 Use of Lights and Warning Devices

1) Policy: Intent

Operators of EMS vehicles are afforded the privilege of using emergency lights and sirens (L&S) to decrease their response time to life-threatening or potentially life-threatening conditions. Operating emergency vehicles with L&S increases the potential for emergency medical vehicle crashes (EMVCs). Studies have shown that L&S may only decrease transport time by a couple of minutes in most systems and by less than one minute in many systems. Every decision to use L&S response/transport must be based upon the patient’s clinical condition, the estimated time saved by an L&S response/transport, and the increased risk of an EMVC during L&S response/transport.

This Policy is in accordance with the EMS Act of 1985, as amended, and further defines section 1005.10(g). In addition, this protocol is secondary to, and does not contradict, the Pennsylvania Motor Vehicle Code (75 Pa C.S.) and BLS Statewide Protocol 123.

2) SCOPE

a) This applies to all licensed Advanced/Basic Life Support, basic life support and quick response vehicles

b) The following procedures are mandatory:

i. L&S may only be used when responding to or transporting a patient with life-threatening or potentially life-threatening condition

ii. The EMS vehicle driver is responsible for the mode of response to the scene based upon information available at dispatch and regional medical dispatch (EMD) protocols

iii. It is almost never appropriate to transport the patient using emergency warning lights without using the siren when exercising any moving privileges granted to EMS vehicles.

iv. Mode of transport for inter-facility transfers will be based upon the medical protocol and the direction of the referring physician who provides the orders for patient care during the transport

v. All EMS vehicle operators must be restrained by a seat belt before the vehicle is placed in motion

vi. No L&S will be used when advanced life care is not indicated (I.E. Advanced/Basic Life Support cancelled by basic life support or Advanced/Basic Life Support released by medical command)

Policy 5 Use of Lights and Warning Devices

L&S may be indicated in some situations where Advanced/Basic Life Support is indicated but not available or cancelled, because they cannot rendezvous with the basic life support ambulance prior to transport to the closest appropriate receiving facility.

vii. The EMS Practitioner primarily responsible for patient care during transportation will determine the mode of transportation based upon the medical condition of the patient.

c) The following procedures are suggested:

i. L&S will both be used when exercising any moving privilege granted to EMS vehicles responding in an emergency mode as defined by the Pennsylvania Motor Vehicle Code (75 Pa. C.S.)

ii. Low-beam headlights will be on (functioning as day-time running lights) at all times while operating EMS vehicles during L&S and non-L&S driving

iii. Seatbelts or restraints will be securely fastened to the following individuals when the vehicle is in motion:

1. All non-EMS passengers in the cab and patient compartment

2. All patients

3. All EMS providers when patient care allows

4. All infants and toddlers should be transported in a child seat if their condition allows

3) DISPATCH RESPONSE PROTOCOL

a) General Statement

The EHSF, with the approval of the Pennsylvania Department of Health, has adopted the Medical Priority Dispatch (MPD) Program for the region. All PSAP’s have trained personnel and program materials to conduct the MPD Program

The Medical Priority Dispatch Program is a comprehensive, nationally-recognized program for emergency medical dispatch. The MPD Program defines the appropriate EMS resources and response mode for emergency medical calls.

Policy 5 Use of Lights and Warning Devices

Based on program criteria, the PSAP telecommunicator will instruct dispatched EMS services on the response mode.

b) Protocol Criteria

The following protocol criteria will define when an EMS service responds with L&S is appropriate:

i. EMS services dispatched by the PSAP will respond to the emergency call, as instructed by the telecommunicator, based on the MPD Program criterion and response mode.

ii. Changes in the response mode can occur, as directed, by the PSAP telecommunicator or based on additional information available to the EMS service. If a change occurs justification for response mode change must be documented on the patient care report and/or EMS service incident report

iii. The response mode has been modified to reflect the regional EMS system. The modification has been reviewed, and approved by the Regional Medical Director, as follows:

1. Class 3 – Closest Basic Life Support Ambulance without L&S

2. Class 2 – Closest Basic Life Support Ambulance with L&S

3. Class 2 – Closest Basic and/or Advanced/Basic Life Support Ambulance with L&S

4) TRANSPORTATION PROTOCOL

a) General Statement

Emergent transport should be used in any situation in which the most highly trained EMS Practitioner believes that the patient’s condition will be worsened by a delay equivalent to the time that can be gained by emergent transport. A medical command physician may be used to assist with this decision. The justification for using this criterion should be documented on the Patient Care Report.

Note; In most cases (up to 95% of EMS calls), EMS can perform the initial care required to stabilize the patient’s condition to a point where the small amount of time gained by L&S transport will not affect the patient’s medical condition or outcome.

Policy 5 Use of Lights and Warning Devices

b) Protocol Criteria

The following medical criteria will define when patient transportation to a receiving facility with L&S is appropriate:

i. Vital signs (outside listed limits with possibly related illness or injury)

1. Systolic BP< 90mmHg with possibly related disease or trauma

2. Systolic BP> 200 mmHg with possibly related disease or trauma

3. Respiratory rate > 32 per minute with patient as relaxed as possible

4. Respiratory rate 32 per minute or < 10 per minute

iv. Cardiac

1. Cardiopulmonary arrest (including persistent ventricular fibrillation, hypothermia, overdose/poisoning, pediatric arrest). Patients in asystole that have not responded to standard Advanced/Basic Life Support intervention may not warrant the risks associated with L&S transport

2. Severe uncontrolled hemorrhage of any source

3. Diastolic BP > 130 mmHg with possibly related disease or trauma

Policy 5 Use of Lights and Warning Devices

v. Trauma

1. Penetrating wound to head, chest, or abdomen except for obviously superficial wounds

2. Penetrating or blunt neck trauma except obviously superficial or mild wounds

3. Two or more suspected proximal long-bone fractures

4. Suspected pelvic fracture

5. Flail chest

vi. Neurologic

1. Glasgow Coma Score of ................
................

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