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RPI AMBULANCE
STANDARD OPERATING PROCEDURES
Updated: August 28th, 2012 | Captain Mark H. O‟Donnell
RPI Ambulance Standard Operating Procedures
August 28th, 2012
SOP 12-00 ORGANIZATION AND STRUCTURE ....................................................................................................................... 5 SOP 12-01 MISSION STATEMENT ......................................................................................................................................... 6 SOP 12-02 QUALIFICATION PROCEDURES - VOLUNTEER PERSONNEL................................................................................... 7 APPLICATION PROCEDURES ............................................................................................................................................................ 7 ORIENTATION .............................................................................................................................................................................. 7 HEALTH AND SAFETY ..................................................................................................................................................................... 7 SOP 12-03 OPERATIONAL MEMBER TYPES ........................................................................................................................... 9 INTRODUCTION ............................................................................................................................................................................ 9 HIP REQUIREMENTS ........................................................................................................................................................ 9 SOP 12-04 TRAINING AND PROMOTIONS .......................................................................................................................... 11 INTRODUCTION .......................................................................................................................................................................... 11 TRAINING.................................................................................................................................................................................. 11 TRAINING COMMITTEE ................................................................................................................................................................ 11 PROBATIONARY TRAINING ............................................................................................................................................................ 12 TRAINERS.................................................................................................................................................................................. 12 PROMOTIONAL BOARDS: STRUCTURE ............................................................................................................................................. 12 PROMOTIONAL BOARDS: VOTING .................................................................................................................................................. 12 SOP 12-05 OBSERVERS AND OBSERVERS ........................................................................................................................... 14 RIDE-ALONG OBSERVER .............................................................................................................................................................. 14 OBSERVER................................................................................................................................................................................. 14 SOP 12-06 AMBULANCE ATTENDANT ................................................................................................................................ 15 INTRODUCTION .......................................................................................................................................................................... 15 TRAINING.................................................................................................................................................................................. 15 SOP 12-07 AMBULANCE DRIVER ........................................................................................................................................ 16 INTRODUCTION .......................................................................................................................................................................... 16 GENERAL DRIVING PROCEDURES ................................................................................................................................................... 16 EMERGENCY DRIVING PROCEDURES ............................................................................................................................................... 16 DRIVER’S DUTIES........................................................................................................................................................................ 17 SPOTTERS ................................................................................................................................................................................. 17 BACK-UP ALARM ....................................................................................................................................................................... 18 TRAVEL LIMITS ........................................................................................................................................................................... 18 WINTER DRIVING ....................................................................................................................................................................... 18 TRAINING.................................................................................................................................................................................. 19 SOP 12-08 AMBULANCE CREW CHIEF................................................................................................................................. 21 INTRODUCTION .......................................................................................................................................................................... 21 GENERAL PROCEDURES................................................................................................................................................................ 21 CREW CHIEF’S DUTIES ................................................................................................................................................................. 21 TRAINING.................................................................................................................................................................................. 22 SOP 12-09 FIRST RESPONSE DRIVER ................................................................................................................................... 25 INTRODUCTION .......................................................................................................................................................................... 25 RESPONSIBILITIES ....................................................................................................................................................................... 25 GENERAL DRIVING PROCEDURES ................................................................................................................................................... 25
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EMERGENCY DRIVING PROCEDURES ............................................................................................................................................... 25 TRAINING.................................................................................................................................................................................. 26 SOP 12-10 EVENT EMS SUPERVISORS ................................................................................................................................ 27 INTRODUCTION .......................................................................................................................................................................... 27 TRAINING.................................................................................................................................................................................. 27 SOP 12-11 DUTY SUPERVISORS .......................................................................................................................................... 28 INTRODUCTION .......................................................................................................................................................................... 28 QUALIFICATIONS ........................................................................................................................................................................ 28 DUTIES ..................................................................................................................................................................................... 28 GRIEVANCES .............................................................................................................................................................................. 29 SOP 12-12 COORDINATORS ............................................................................................................................................... 30 INTRODUCTION .......................................................................................................................................................................... 30 QI COORDINATOR ...................................................................................................................................................................... 30 R COORDINATOR.................................................................................................................................................................... 30 SOP 12-13 UNIFORMS ........................................................................................................................................................ 31 INTRODUCTION .......................................................................................................................................................................... 31 PATCHES................................................................................................................................................................................... 31 PINS, COLLAR BRASS, BADGES ...................................................................................................................................................... 31 UNIFORM CLASSES ..................................................................................................................................................................... 31 SOP 12-14 DISPATCH AND RESPONSE PROCEDURES .......................................................................................................... 33 INTRODUCTION .......................................................................................................................................................................... 33 RESPONSE LEVELS....................................................................................................................................................................... 33 RPI AMBULANCE UNAVAILABILITY.................................................................................................................................................. 33 EMS CALLS ............................................................................................................................................................................... 33 TRANSPORTATION CALLS.............................................................................................................................................................. 35 HAZARDOUS MATERIAL CALLS ...................................................................................................................................................... 35 STAND-BY’S AND MCI ................................................................................................................................................................. 35 SOP 12-15 PATIENT TRANSPORT DESTINATIONS ............................................................................................................... 36 SOP 12-16 MUTUAL AID..................................................................................................................................................... 38 SOP 12-17 OUT OF SERVICE ............................................................................................................................................... 39 INTRODUCTION .......................................................................................................................................................................... 39 DAY TO DAY TURNOVERS ............................................................................................................................................................. 39 EXTENDED PERIODS OF ABSENCE ................................................................................................................................................... 39 SOP 12-18 SPECIAL EVENT PROCEDURES ........................................................................................................................... 40 SPECIAL EVENT COVERAGE REQUESTS ............................................................................................................................................. 40 FIRST AID ROOM OPERATION ....................................................................................................................................................... 40 EVENT TYPE CLASSIFICATION ........................................................................................................................................................ 41 EVENT RADIO COMMUNICATIONS ................................................................................................................................................... 41 SPECIAL EVENT OPERATIONS ........................................................................................................................................................ 42 PAPERWORK AND EQUIPMENT MAINTENANCE ................................................................................................................................. 43 SOP 12-19 DOCUMENTATION ............................................................................................................................................ 44 INTRODUCTION .......................................................................................................................................................................... 44
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GENERAL PROCEDURES................................................................................................................................................................ 44 PAPER PCR RETENTION AND STORAGE ............................................................................................................................................ 44 REFUSAL OF MEDICAL ATTENTION (RMA) ...................................................................................................................................... 44 SOP 12-20 RADIO COMMUNICATIONS ............................................................................................................................... 46 SOP 12-21 AMBULANCE/EQUIPMENT INSPECTION, CARE, AND MAINTENANCE ................................................................ 47 INTRODUCTION .......................................................................................................................................................................... 47 AMBULANCE AND FIRST RESPONSE VEHICLE MAINTENANCE ................................................................................................................ 47 EQUIPMENT MAINTENANCE ......................................................................................................................................................... 47 CLEANING ................................................................................................................................................................................. 48 ACCIDENTS/DAMAGE TO RPI AMBULANCE VEHICLES .................................................................................................................. 48 FAILURES .................................................................................................................................................................................. 48 SOP 12-22 AMBULANCE LAYOUT/SETUP ........................................................................................................................... 50 INTRODUCTION .......................................................................................................................................................................... 50 STRETCHER................................................................................................................................................................................ 50 SPARE MAKE-UP ........................................................................................................................................................................ 50 IV FLUID CLIPS/RETAINERS ........................................................................................................................................................... 50 PORTABLE OXYGEN TANKS ........................................................................................................................................................... 50 WALL OXYGEN REGULATORS ........................................................................................................................................................ 50 ONBOARD OXYGEN SYSTEM ......................................................................................................................................................... 51 COMPLETED PAPERWORK ............................................................................................................................................................ 51 OTHER EQUIPMENT, TOOLS, ETC. ................................................................................................................................................... 51 LAPTOPS ................................................................................................................................................................................... 51 SOP 12-23 DEFIBRILLATOR ................................................................................................................................................. 52 INTRODUCTION .......................................................................................................................................................................... 52 CARE AND MAINTENANCE ............................................................................................................................................................ 52 USE ......................................................................................................................................................................................... 52 SOP 12-24 CONDUCT ......................................................................................................................................................... 53 INTRODUCTION .......................................................................................................................................................................... 53 PATIENT CONFIDENTIALITY ........................................................................................................................................................... 53 WEAPONS................................................................................................................................................................................. 53 SMOKING.................................................................................................................................................................................. 53 ALCOHOL, CONTROLLED SUBSTANCES, AND MEDICATIONS ................................................................................................................. 53 VISITORS................................................................................................................................................................................... 54 SOP 12-25 GRIEVANCES AND APPEALS .............................................................................................................................. 55 INTRODUCTION .......................................................................................................................................................................... 55 GRIEVANCES .............................................................................................................................................................................. 55 CHAIN OF APPEALS ..................................................................................................................................................................... 55 APPEALS ................................................................................................................................................................................... 55 SOP 12-26 SEXUAL HARASSMENT AND NONDISCRIMINATION .......................................................................................... 56 SEXUAL HARASSMENT ................................................................................................................................................................. 56 NONDISCRIMINATION.................................................................................................................................................................. 56 VIOLATIONS .............................................................................................................................................................................. 56 SOP 12-27 INFECTIOUS DISEASE EXPOSURE AND ON DUTY INJURY ................................................................................... 57
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INTRODUCTION .......................................................................................................................................................................... 57 PRACTICES ................................................................................................................................................................................ 57 ON-DUTY INJURY OR EXPOSURE .................................................................................................................................................... 57 SOP 12-28 MISCELLANEOUS............................................................................................................................................... 58 INTRODUCTION .......................................................................................................................................................................... 58 LOCATING PATIENTS ................................................................................................................................................................... 58 SPECIAL PATIENTS ...................................................................................................................................................................... 58 CRIMES .................................................................................................................................................................................... 59 INCIDENT REPORTING .................................................................................................................................................................. 59 OBVIOUS AND UNATTENDED DEATH .............................................................................................................................................. 59 CHILD ABUSE AND MALTREATMENT ............................................................................................................................................... 60 GERIATRIC OR OTHER PATIENT ABUSE/MALTREATMENT .................................................................................................................... 61 ABANDONED INFANT................................................................................................................................................................... 61 SOP 12-29 APPROVAL/REVIEW DOCUMENT ...................................................................................................................... 62
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SOP 12-00 ORGANIZATION AND STRUCTURE This document is the Standard Operating Procedures (SOPs) of the Rensselaer Polytechnic Institute Ambulance. If one section of the SOPs is amended, suspended, deleted, or otherwise changed, the remainder of this document will remain unaffected. This document is not to supersede any directives, guidelines, or protocols enacted by a higher authority such as the State of New York, the Regional Emergency Medical Organization of the Hudson Mohawk Valley Region (REMO-HMVI), or the County of Rensselaer. These guidelines are, furthermore, not to supersede good clinical judgment on the part of the crew. According to the RPI Ambulance Constitution, the Captain and Medical Director must agree upon the SOPs. The Standard Operating Procedures must be reviewed on an annual basis by the same entities. Documentation of this review will be attached as a separate Policy Statement (see SOP 12-29). The RPI Ambulance SOPs were originally written in the early 1980‟s by George Holdsworth, and amended and adjusted by Captains Ken Lavelle, John Kim, and Brian Wilde since that time. A major rewrite was initiated by Captain Chris Holt, and completed by Captain Fabien Nicaise. The SOPs have since been amended and adjusted by Captains Steve Mitchell, Benjamin Saunders, Veronica Voloshinov, and Eric Tesoriero. Restructuring of sections and updates reflecting the new officers in the Spring of 2010 were made by Peter Ragone. Additional changes during Fall 2010 and Spring 2011 made by Matthew Willett. A major reformatting and additional changes were made during Spring 2012 by Captain Jovan Cruz. A major update was made by Mark O‟Donnell to combine the Special Event SOPs, add First Response-59, new uniforms and ePCRs in the Fall of 2012.
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SOP 12-01 MISSION STATEMENT The mission of this agency is to provide Basic Emergency Medical Services to the Rensselaer Polytechnic Institute community, and to transport the sick and injured to definitive care. This includes, but is not limited to the following: 1. Develop standards, policies, and procedures pertaining to Emergency Medical Services in order to maintain proper operation of the RPI Ambulance. 2. Provide Basic Life Ambulance Service and Special Event Medical Services to the RPI community. 3. Conduct EMS Quality Improvement to improve the care provided by the RPI Ambulance. 4. Provide training and services to maintain and improve the agency‟s equipment and personnel resources. 5. Provide training to the Rensselaer community in order to improve the quality of first aid in the community and the world at large. 6. Request and provide reciprocal services in accordance to the existing provisions of the Rensselaer County Ambulance and Rescue Association Mutual Aid Plan in addition to any other Mutual Aid Plans that the agency becomes involved in.
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SOP 12-02 QUALIFICATION PROCEDURES - VOLUNTEER PERSONNEL APPLICATION PROCEDURES 1. Interested parties should obtain and complete, in its entirety, a hip form as supplied by the istrative officers of the agency. 2. hip is contingent upon the hip policies outlined in the Agency‟s Constitution. 3. Every member will resubmit a hip form to the istration of the Agency at the beginning of each academic year for the purpose of maintaining an up-to-date hip list. This can be done electronically on the Agency website.
ORIENTATION 1. Each new member shall participate in a hip Orientation as prescribed by the Training Committee. 2. The hip Orientation shall include the following items: a) RPI Ambulance History, Philosophy, and Structure b) RPI Ambulance Standard Operating Procedures and RPI Ambulance Constitution c) Risk Management d) Liability and Confidentiality e) Stress management/CISM f) Health and Safety as outlined below g) ePCRs, documentation, and Quality Improvement procedures h) Basic scene i) Basic call mechanics j) Working with other agencies
HEALTH AND SAFETY 1. All will undergo an annual training in-service on proper procedures on how to protect self and crew. This training will comply with and make use of the Agency Exposure Control Plan as maintained by the Captain or designated Coordinator. 2. The Captain and Training Committee will tly appoint instructors. 3. This training will include, but is not limited to, the following: a) OSHA Blood-borne and Airborne Pathogens b) Infection Control (Per OSHA-29 CFR 1910.1030) c) Personal Protective Equipment (PPE) d) NIOSH / N95 Healthcare TB Respirator Fit-Testing and usage e) Exposure Control Plan f) TB Testing and Documentation g) Hepatitis-B Vaccination or Refusal and Documentation h) Facilities safety (including Office, First Aid Rooms, Ambulance) i) Safety during responses j) Basic HAZMAT awareness training
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k) RPI Ambulance does not require its to undergo yearly physical examinations; however, it asks all to provide RPI Ambulance with a copy of or access to their immunization records to insure the safety of all crews and patients. 4. The instructor will generate documentation of yearly Health and Safety training and the istration will maintain this documentation in the person‟s permanent file.
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SOP 12-03 OPERATIONAL MEMBER TYPES INTRODUCTION In order to act as a volunteer for RPI Ambulance, the appropriate qualifications must be met and maintained for the duration of involvement with RPI Ambulance.
HIP REQUIREMENTS As stated in the Constitution, all are required to renew hip every semester by attending one General Meeting or providing written notice to the officer board. If a member fails to attend a General Meeting or provide written notice to the officer board, they will be removed from hip – all training previously completed will be filed, and, upon any reission to the agency, it will be the determination of the Captain and Lieutenants as to accepting that member's previous training paperwork or requiring new training.
ACTIVE HIP Active are the who participate regularly in Agency functions and regularly attend training drills and General Meetings. An Active member meets the following qualifications: 1. Has submitted a hip form as outlined in SOP 12-02. 2. Has completed the orientation program outlined in SOP 12-02. 3. Has completed appropriate annual health and safety training and testing as outlined in SOP 12-02 and the agency‟s Exposure Control Plan. 4. Has attended all required training drills or been excused by the Captain or Training Committee. 5. Has attended all required General hip meetings or been excused by the istration. 6. Has staffed one night crew or special event in the last month.
INACTIVE HIP Inactive are who are unable to meet all of the qualifications set forth for Active hip. Former who visit infrequently and who are unable to regularly attend agency drills and meetings should fall into this category. Only the Captain may change an Inactive member‟s status to Active. Conversely, it is the responsibility of the Captain to assure that any Active who do not meet all of the appropriate qualifications are changed to Inactive hip. An Inactive member must meet the following qualifications: 1. Has submitted a hip form as outlined in SOP 12-02. 2. Has completed the orientation program outlined in SOP 12-02. 3. Has completed appropriate annual health and safety training and testing as outlined in SOP 12-02. 4. Has staffed one night crew or special event in the last semester.
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ISTRATIVE HIP An istrative Member has been accepted by the hip through the guidelines set forth in the Agency Constitution, but does not ride actively as part of an EMS crew. There are no operational qualifications to be an istrative member. In addition, any member that does not qualify for Active or Inactive hip shall default to istrative hip until such time that all paperwork and training can be brought up to date. istrative do not have any Ambulance riding or event privileges. An istrative Member must meet the following qualifications: 1. Has submitted a hip form as outlined in SOP 12-02.
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SOP 12-04 TRAINING AND PROMOTIONS INTRODUCTION One of RPI Ambulance‟s primary missions is to further the training of its . competent, professional medical care. This policy seeks to guarantee both.
Another is to provide
TRAINING Training is to be regarded as a priority second only to patient care, and whenever possible, the two should be integrated. For specific qualifications and promotion requirements, please see the appropriate sections: Attendant SOP 12-06, pg. 17 Driver SOP 12-07, pg. 18 Crew Chief SOP 12-08, pg. 23 First Response Driver SOP 12-09, pg. 25 Event EMS Supervisor SOP 12-10, pg. 27 Duty Supervisor SOP 12-11, pg. 28 These requirements and qualifications are considered to be the minimum requirements for promotion. It is often expected that will do additional training and will be promoted when the Training Committee and Captain are satisfied that they hold the necessary skills required for the promotion. If there are concerns about the performance of a promotion candidate the Training Committee is to work with the individual to address the concerns.
TRAINING COMMITTEE The Captain shall establish a training committee, made up of as many as he sees fit. The committee should ideally contain a driver trainer, a crew chief trainer and a senior duty supervisor. The Captain may or may not serve on the committee. The Captain may not be the only member of the Training Committee except with the express permission of both Lieutenants. Once established, removals and additions to the Training Committee must be approved by at least 50 percent of the committee as well as the Captain, or by the unanimous decision of the Captain and both Lieutenants. Additionally, once established, the Training Committee must elect a chairperson who will be the face and responsible party of the Training Committee; issues that need to be brought to the Training Committee or issues arising from the committee should through this individual. The Training Committee shall be responsible for overseeing all training curricula (including all training documents and the scheduling of classes) and shall also stand as the promotional board when necessary and applicable. Ideally, the committee should meet on a weekly basis, and report back to the Captain fortnightly, or as frequently as necessary.
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PROBATIONARY TRAINING A member who is considered a probationary in a position may act in that position provided there is a trainer for that position on the crew. The trainer should make every attempt to be with the trainee during the course of the call. Notable exceptions may include the transport to the hospital, where the trainer and trainee may be separate briefly. A probationary and a trainer satisfy the requirements for a crew.
TRAINERS The individuals entrusted with the training of other individuals in the Agency shall maintain Active hip status. These trainers will be experienced credentialed within the agency for the position they will train. For example, someone who is experienced enough to be a Driver Trainer may not necessarily be a Crew Chief Trainer. Trainers are appointed by the Training Committee. Consideration of appointees will not only consist of individuals‟ qualifications within a specific area of credentialing, but also of their ability to teach and train effectively.
PROMOTIONAL BOARDS: STRUCTURE The Promotional Board is a vehicle used by of RPI Ambulance to progress through the ranks of the organization‟s credentialing structure. The promotional board shall consist of: 1. Training Committee 2. Captain The Promotional Board shall be chaired by the Training Committee Chairperson, except in the case of that individual‟s promotion, when the Captain shall act as the Promotional Board Chair. The training committee and Captain shall also establish a list of promotional board alternates to serve on the board in the case of a conflict of interest. It is understandable that not every member of the promotional board will have been involved with all aspects of a candidate‟s training. Therefore, any member is invited to speak for or against the candidate at the Promotional Board as this is a time for the promotional board to learn about a candidate‟s skills and competencies. may speak about any aspect of the candidate but it is the chair‟s duty to ensure that comments remain relevant and respectful (i.e. personal attacks should not be tolerated). During the voting portion, only the actual of the promotional board may be present. While the candidate is present, the Promotional Board should take the opportunity to ask relevant questions of the candidate about his or her competency in the position applied for. Outlandish questions and inappropriate attitudes are not acceptable.
PROMOTIONAL BOARDS: VOTING After the chair has presented the candidate for promotion, and when there are no more questions for the candidate, the candidate will be asked to leave the room. The candidate will comply. The chair is the parliamentarian for the voting proceedings. Any and all discussion behind closed doors is understood to be confidential and will not be discussed with anyone. After discussion is complete to the satisfaction of the chair, the of the Promotional Board will vote on the candidate.
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Voting will not take place by secret ballot. At least two-thirds of the Promotional Board must give a “yes” vote of confidence for the candidate to and be credentialed in the position applied for. No abstentions are acceptable. with a potential conflict of interest should not be on the promotional board, and an alternate should be present as outlined above. Thus, a conflict of interest is not a valid excuse for an abstention. After the completion of the vote, the candidate will be called back into the room by the of the Promotional Board and advised by the Chairperson of the result. Any member who voted “no” should be prepared to outline what additional demonstration of competence they would like to see before they would a “yes” vote. This should be done both in writing and verbally. The candidate shall have the right to ask for a clarification of requests. This is to give the candidate a fair opportunity to improve in weak areas and become a more viable candidate for the next promotional board that they petition. Both promotion approvals and non-approvals will be logged in a “Promotional Board Log” that will contain every attempt for promotion made by all . This log will also contain dates of promotion to be used for determining eligibility for promotion to trainer (i.e 4 months of in-service).
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SOP 12-05 OBSERVERS AND OBSERVERS RIDE-ALONG OBSERVER The Ride-Along Observer position is for non- who are interested in riding on an Ambulance Crew for observational and/or informational purposes. The Ride-Along observer need not have any qualifications, but must adhere to the following guidelines: 1. Be briefed in RPI Ambulance SOPs, Patient Confidentiality, Risk Management, and Infection Control/OSHA. 2. The Ride-Along Observer will not engage in providing patient care of any kind. 3. At the discretion of the Crew Chief, the Ride-Along Observer may be asked to sit in the cab compartment while patient care is being extended. 4. If the number of people on board the Ambulance becomes too large (with ALS providers, multiple patients, family/friend of the patient, etc.), the Ride-Along Observer may be left at the scene by the Crew Chief. If this happens, every effort will be made to assure that someone can bring the RideAlong Observer to the destination to meet up with the Ambulance. 5. The Ride-Along Observer will sign a form effective for a specified amount of time (to be indicated on the form) agreeing to all of the above. In addition, the form shall indemnify and hold harmless RPI Ambulance, Rensselaer Polytechnic Institute, and all of its and subsidiaries from any liability in the event of injury, illness, or death.
OBSERVER The Observer shall be an Active or Inactive member who desires to ride on an Ambulance Crew for the purpose of gaining experience, training, or otherwise familiarizing oneself with the operations of RPI Ambulance. The Observer: 1. Shall assist in patient care as requested by the Crew Chief and will act only under the direction of the Crew Chief. 2. May be asked to sit in the cab compartment by the Crew Chief while patient care is being extended. 3. If the number of people on board the Ambulance becomes too large (with ALS providers, multiple patients, family/friend of the patient, etc., the Observer may be left at the scene by the Crew Chief. If this happens, every effort will be made to assure that someone can bring the Observer to the destination to meet up with the Ambulance.
OBSERVER TRAINING As this is an entry-level position, there is no formal requirement and no training needed except for that which is required to become a member of RPI Ambulance as stated in SOPs 12-02 and 12-03. This is meant to be a temporary position. The goal of all Observers is to become an Ambulance Attendant. It is expected that Observers begin Attendant training before their third night crew.
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SOP 12-06 AMBULANCE ATTENDANT INTRODUCTION The Ambulance Attendant shall be an Active or Inactive member who rides on an Ambulance Crew for the purpose of assisting the Crew Chief with patient care as well as for the purpose of gaining further experience and training in EMS. The Ambulance Attendant shall: 1. Be familiar with the location, use, and function of all medical equipment on board the Ambulance 2. Possess a working knowledge of RPI Ambulance Standard Operating Procedures 3. Be familiar with safe techniques for lifting and moving of patients using common equipment
TRAINING It is highly recommended that the Ambulance Attendant trainee will begin their formal training with a class provided by RPI Ambulance that will cover the basics and requirements. The Ambulance Attendant should also practice their skills and knowledge when they are on a crew, with the help and guidance of the Crew Chief in order to increase the knowledge of the trainee and to build Crew Chief‟s confidence in the trainee. The trainee is also encouraged to attend as many training drills as possible as they are a good source of knowledge and additional training.
PREREQUISITES 1. Be a member of RPI Ambulance
PROMOTIONAL REQUIREMENTS 1. 2. 3. 4.
Hold a Professional Rescuer R certification. Complete the Attendant Checklist as prescribed by the Training Committee. Complete the Ambulance Equipment Checklist. Actively participate in at least one (1) call or two (2) simulated calls and receive a ing evaluation from the CC. 5. Optional: Attend the RPI Ambulance Attendant Training Class. 6. Receive a recommendation for promotion from a Crew Chief.
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SOP 12-07 AMBULANCE DRIVER INTRODUCTION The driver of the ambulance holds a critical position in the care and treatment of the patient. It is the driver‟s responsibility and obligation to deliver the crew and ambulance to the scene in a safe manner, to facilitate transport of the patient into the ambulance, to transport the patient and crew while maintaining a suitable working platform for effective patient care, and to return the crew to quarters or to another suitable drop off point in a safe and professional manner. The ambulance is a moving representative of RPI Ambulance, and the Rensselaer Polytechnic Institute community, Therefore the safe and professional operation of the vehicle are paramount to conveying a positive image of both RPI and RPI Ambulance. Any individual who drives the ambulance must be properly credentialed as an RPI Ambulance Driver or must be a valid Driver Trainee with a Driver Trainer present, as described in SOP 12-07.
GENERAL DRIVING PROCEDURES During all travel of the ambulance, including, but not limited to, travel to dinner or a class meeting, Priority II operation or Priority I operations, the driver will adhere to the following rules: 1. A spotter must be used at all times whenever backing the ambulance. 2. Anyone sitting in any compartment of the ambulance must wear a seat belt anytime the vehicle is in motion or in traffic. During patient care, providers in the rear compartment may remove their seatbelts only if absolutely required. 3. Any non-member engers should ride in the front compartment of the ambulance and wear their seat belt at all times when the vehicle is in motion. In cases of pediatric patients or other special cases where the enger calms or soothes the patient, the enger may ride with the patient but must always wear their seat belt while the ambulance is in motion. 4. Headlights are to be used at any time the ambulance is in motion. 5. Respond to all calls in accordance with SOP 12-14 6. Return from the hospital in Priority II mode. 7. Transport from the scene to the hospital at the response level designated by the Crew Chief. 8. Leave the ambulance engine running in high idle at all times during a call until arrival at the hospital 9. Upon arrival at the hospital, shut down the engine prior to unloading the patient.
EMERGENCY DRIVING PROCEDURES When the ambulance is being operated in Priority II mode, as defined in SOP 12-14, the driver will always adhere to NYS Vehicle & Traffic laws. When the ambulance is operated in Priority I mode, as defined in SOP 12-14, the Ambulance Driver will adhere to the following rules in addition to the above and to NYS Vehicle & Traffic laws: 1. A complete stop is mandatory before proceeding with caution at all red lights, stop signs, and railroad crossings, regardless of response level. 2. If using the median, turning lane, or a lane of opposing traffic to enter an intersection, come to a complete stop before proceeding with caution. 3. Come to a complete stop at all times for any school bus either in the same lane or in the opposing lane with flashing red lights displayed. 4. Do not exceed posted speed limit by more than ten (10) miles per hour at any time.
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5. Do not exceed posted speed limit at any time when ing through an intersection with the green light. 6. When traveling in a lane of traffic in an opposing direction, do not exceed 20 mph. 7. Leave warning lights (no less than secondary lights) on if the ambulance is stopped on or at the edge of a roadway, or if the ambulance will interfere with traffic, or at any time that the warning lights will increase scene safety for EMS personnel.
DRIVER‟S DUTIES 1. Duties during a Scheduled Duty Crew: a) Complete an RPI Ambulance Vehicle/Mechanical checklist once per shift b) Notify the Duty Supervisor of any problems or discrepancies c) If possible, and if the Crew Chief consents, familiarize self and crew with areas of our Primary Territory and response areas d) Drive crew where they need to go in a safe manner 2. Duties during a Call: a) Be sure that the ambulance is clear of personnel and other obstructions or dangers, and that all exterior doors are closed before getting into the driver‟s seat b) that all ambulance personnel are in secure positions before moving the ambulance c) Upon starting the ambulance that all gauges and operation indicators are within nominal ranges, especially fuel level and oil pressure d) Drive to the scene in a safe and efficient manner at an appropriate level of response e) Park at the scene in a position to provide optimal access to the patient while maintaining scene safety. f) Leave the vehicle running at all times while on scene g) Assist the Crew Chief in providing care on scene as needed h) Upon arrival at the hospital, turn off the ambulance and assist the crew in unloading the patient from the patient compartment i) Assist the crew in transferring the patient to the hospital bed 3. While at the hospital, the following driver‟s duties are to be done in the following order, highest priority first: a) After the patient is unloaded, return to the ambulance and shut off any non-essential items (especially A/C, heat) b) Clean and disinfect the ambulance as appropriate per the RPI Ambulance Exposure Control Plan. c) Get the stretcher ready for service d) Ensure that the ambulance is still within NYS Part 800 equipment parameters e) Rensselaer County Dispatcher by phone to obtain dispatch times and run number as needed by the crew chief f) Assist the Crew Chief as requested
SPOTTERS To reiterate the previously stated policy, whenever the ambulance is in reverse, all drivers must use a spotter in order to maintain a safe service and a professional looking ambulance.
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To properly spot the vehicle when it is backing up, the spotter should stand approximately 10 feet behind the ambulance on the driver‟s side. The driver should be able to see the spotter at all times and must stop if the spotter moves to a position where they cannot be seen. Conversely, the spotter should be able to see the driver‟s mirror at all times as well. The spotter should look out for obstacles and indicate that it is safe to continue in reverse with a left-handed “come here” motion, palm facing the spotter. To indicate that it is unsafe to continue or that there is an obstacle in the path of the vehicle, the spotter should make a fist with his or her left hand with the palm side facing the driver. There are situations where using an external spotter is impossible. These situations are: 1. When backing into the hospital Emergency Department 2. During the reverse phase of the cone course. In these two circumstances only, it is permissible for a vehicle occupant in the patient compartment (i.e. the Crew Chief on a call, or the observing trainee in the cone course) to go to the tailgate end of the crew bench and look out the back windows the entire time the vehicle is in reverse to be on the lookout for any obstacles, pedestrians, or other items that would present a hazard to the ambulance.
BACK-UP ALARM Use common sense when using the back-up alarm. When backing without an external spotter, it must be used. However, if an external spotter is used, and a loud alarm is not advisable (e.g. backing up near residences late at night, backing up at the garage after dark, etc.,) the back-up alarm may be temporarily deactivated. Unless scene safety considerations prohibit its use, the back-up alarm should be used on all emergency scenes and when backing at the hospital.
TRAVEL LIMITS It is the driver‟s duty to ensure a speedy response to any incident on campus. As such, the driver will be responsible for assuring the Ambulance is never too far from campus to respond in a safe and efficient manner. As a minimum, the following boundaries should never be crossed, except on a properly dispatched mutual aid call: North: An east-west line even with TFD station 1 (115th St) East: A north-south line even with McDonald‟s restaurant on Hoosick St. South: An east-west line even with TFD station 6 (Canal Ave) West: The Hudson River It is also recommended that unless there is a specific reason for travel to the above limits, such as food or training, the ambulance should remain as much as possible in the area immediately around the campus. This, however, is left to the discretion of the driver so long as he or she can ensure a safe and efficient response.
WINTER DRIVING Before drivers (trainees, probationary or full) are permitted to drive under winter conditions, they must gain the approval of a driver trainer. Driver trainers will take the trainee on snow/ice covered roads where there are little to no hazards and must demonstrate appropriate safe operation in those conditions. The purpose of this training is to demonstrate the difference in handling of the vehicle in winter conditions including but not limited to: braking distance, up and down hill operation, traction, maneuverability and visibility.
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TRAINING PROBATIONARY DRIVER The Driver trainee will begin their formal training with a class provided by RPI Ambulance that will cover the basics of what is required.
PREREQUISITES 1. Trainee must be an RPI Ambulance Attendant and hold an active R certification
PROMOTIONAL REQUIREMENTS 1. Must possess a NYS Class D License or equivalent. 2. Attend an RPI Ambulance emergency vehicle training class to include: a) Call Dynamics b) Standard Operating Procedures c) Applicable Laws d) Basic Practical Orientation 3. Complete Driver Check Sheet and Vehicle Maintenance Sheet 4. Successfully Driver Practical Exam st 5. Successfully the cone course prescribed by the 1 Lieutenant 6. Complete 5 hours of driver training as a third person with a qualified driver trainer and complete driver log sheet to the Training Committee or the Captain which will be kept on file. 7. Drive two (2) Priority-II calls and receive ing evaluations from a trainer 8. Drive two (2) Priority-I calls and receive ing evaluations from a trainer 9. Receive recommendation to become a Probationary Driver from Trainer 10. Receive t approval of the Captain and Training Committee
DRIVER PREREQUISITES 1. Must be a Probationary Driver
PROMOTIONAL REQUIREMENTS 1. Complete and one (or more) of the following emergency vehicle operator courses, with documentation kept on file by the Training Committee: a. Coaching the Emergency Vehicle Operator (CEVO) Ambulance b. Emergency Vehicle Operator Course (EVOC) c. In House – Emergency Vehicle Defensive Driving (EVDD) 2. Must complete the following FEMA sponsored classes: a. IS-100: Introduction to the Incident Command System (ICS) b. IS-200: Basic ICS c. IS-700: National Incident Management System (NIMS) d. IS-800: National Response Framework 3. Complete a driving tour of the Albany area hospitals with a trainer 4. Drive two (2) calls as a Backup Driver and receive ing evaluations from a Trainer.
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5. Receive recommendation for promotion to become a Full Driver by Trainer. 6. Receive approval by the Promotional Board
DRIVER TRAINER PREREQUISITES 1. Must be an RPI Ambulance Driver
PROMOTIONAL REQUIREMENTS 1. 2. 3. 4. 5. 6.
Be a Driver for 4 months while the ambulance is in service Drive three (3) EMS calls Assist in teaching an RPI Ambulance Driver or EVDD class under the supervision of a Driver Trainer Request to become a trainer Receive recommendation for promotion from a Trainer Receive t approval of the Training Committee and the Captain
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SOP 12-08 AMBULANCE CREW CHIEF INTRODUCTION The Crew Chief is the leader of the Ambulance Crew. The New York State Department of Health mandates that there must be at least one current NYS EMT providing patient care in the patient compartment of the ambulance in accordance to NYS BLS protocols. The RPI Ambulance Crew Chief has been trained not only in Basic Life treatment of emergency patients, but also in how to appropriately handle situations that may arise during any phase of operations. This includes, but is not limited to: dealing with problematic patients, decision-making, MCI‟s, and interacting with other agencies. The Crew Chief is directly responsible for the conduct and appearance of the Ambulance Crew. All of the Ambulance Crew should feel comfortable communicating any questions they may have to the Crew Chief. The Crew Chief may not necessarily be the highest medical authority on scene, but at RPI Ambulance, the Crew Chief is procedurally in charge. Any individual who acts in the capacity of Crew Chief must be properly credentialed as an RPI Ambulance Crew Chief or must be a valid Crew Chief Trainee with a Crew Chief Trainer present. As such, any person acting as the Crew Chief must meet the qualifications as set forth in SOP 12-08.
GENERAL PROCEDURES 1. If the Crew Chief does not feel comfortable with a situation, a member, or is uncertain how to handle a predicament, they should the Duty Supervisor. 3. If a disagreement between RPI Ambulance and an ALS provider exists, the Crew Chief will put aside any personal or agency differences and make decisions based in the best interest of the patient. 4. If a disagreement between RPI Ambulance and another EMS agency, dispatch center, Public Safety Authority, or other official exists, the Crew Chief will not act on behalf of the agency in solving the problem but rather will act in the best interest of the patient. The Crew Chief will also immediately notify the Duty Supervisor, who will evaluate the situation and decide how best to handle it. 5. Maintain communications with any/all appropriate dispatch center(s) throughout operations, either alone or by designating another crewmember. The Crew Chief is responsible for all of these radio communications, though another member may use the radio with the express consent of the Crew Chief. 6. Maintain control of the Ambulance Cellular Phone. No member may use the phone without the permission of the Crew Chief.
CREW CHIEF‟S DUTIES 1. Duties during a scheduled Duty Crew: a) Make sure that an Ambulance and First Response Vehicle Equipment Checklist is completed by the Crew. b) Report any discrepancies or problems to the Duty Supervisor. c) Make sure that any vacancies on the crew are filled to assure that all who want to ride crews are able to do so in a timely manner. d) If possible, provide training opportunities for the rest of the Crew. e) Maintain Crew morale and try to accommodate the wishes of the Crew. f) If a Crew member needs to study while on a duty crew, this will take precedence over driving around and other endeavors. We are students first. 2. Duties during a Call:
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a) Confirm that there is a crew, and try to include trainees on the call. b) Advise the Ambulance Driver of the appropriate level of response to the scene if different from the standard. c) Respond to the scene in accordance with SOP 12-14 d) During travel to the scene, plan ahead for any equipment or additional resources (e.g. fire apparatus, Hazmat Unit, additional Ambulances) that may be needed. e) Upon arrival, notify appropriate dispatcher(s). f) Prior to egress from the vehicle to the scene, the Crew Chief will assess the scene for safety and advise the Ambulance Crew of how to appropriately protect themselves from any hazards that may be present. The Crew Chief is responsible for the safety of the crew at all times. g) The Crew Chief will be in charge of all patient care and will act as the interface between the RPI Ambulance Crew and a provider of a higher level of care. h) The Crew Chief will attempt to allow other to train in positions they are attempting to gain RPI Ambulance credentialing in (e.g. Crew Chief, Attendant) within their level of credentialing (i.e. if the Crew Chief is also a Crew Chief Trainer). i) Provide BLS care at the level that RPI Ambulance is certified to provide. j) Select the appropriate patient carrying device and use it to bring the patient to the ambulance. k) Transport to a Hospital Emergency Department in accordance with SOP 12-15. l) While en route to the medical facility, provide medical care as appropriate. m) Use the Ambulance VHF Radio to the Emergency Department with the following information: i. Age and gender ii. Chief complaint iii. History of chief complaint iv. Pertinent past medical history and medications v. Pertinent vital signs vi. Treatment rendered by this agency and others (i.e. Oxygen by RPI, IV by TFD) vii. Estimated time to arrival n) Upon arrival at the medical facility, shut down any nonessential ambulance items. (E.g. dome lights, heat or A/C, vent, etc. o) Give a report to the appropriate Emergency Department staff member. p) If at a hospital ER, assist the registration clerk in obtaining patient information and try to get a face sheet. q) Complete paperwork, obtain times and numbers, and notify appropriate dispatch center(s) that the ambulance is available for the next call. r) that the Driver has prepared the ambulance for the next call. s) Leave the medical facility in a reasonable amount of time and return to service as appropriate.
TRAINING The position of Ambulance Crew Chief is the highest credentialed position in the Ambulance Crew. Becoming an Ambulance Crew Chief involves not only medical proficiency, but also thorough knowledge of all Operating Policies and an ability to lead the crew effectively. The Crew Chief Trainee should, while training, act in the capacity of Crew Chief to the best of his or her ability. The training period is a time to gain experience with a trained Crew Chief on board. The Crew Chief Trainee is encouraged to attend as many drills as possible as they are a good source of knowledge and training.
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PROBATIONARY CREW CHIEF PREREQUISITES 1. Trainee must be an RPI Ambulance Attendant 2. Host current certification as a NYS EMT-Basic or higher (no other state is acceptable) 3. Maintain active R for Healthcare Provider certification
PROMOTIONAL REQUIREMENTS 1. Attend an RPI Ambulance Crew Chief training class to include: a) Call Dynamics b) Standard Operating Procedures c) PCR writing 2. Crew Chief 1 simulated call 3. Complete PCR writing class 4. Complete Crew Chief checklist 5. Complete 1 mock call w/ ing evaluation from CC Trainer before taking a real call. 6. Crew Chief 2 calls with a crew chief trainer in the patient compartment and receive ing evaluations for both. 7. the practical exam, including PCR writing 8. Receive recommendation for promotion by Crew Chief Trainer 9. Receive t approval of the Captain and Training Committee
CREW CHIEF PREREQUISITES 1. Must be a Probationary Crew Chief
PROMOTIONAL REQUIREMENTS 1. Must Crew Chief 2 calls as a Probationary Crew Chief, receive a ing evaluation and be recommended for promotion by a Crew Chief Trainer. 2. Must complete the following FEMA sponsored classes: a) IS-100: Introduction to the Incident Command System (ICS) b) IS-200: Basic ICS c) IS-700: National Incident Management System (NIMS) d) IS-800: National Response Framework 3. Must student-teach one training course or drill and submit an evaluation form a) This training drill must be approved and supervised by the training committee b) The purpose of this course is to demonstrate proper training skills while teaching an advanced topic to other of the agency. 4. Receive recommendation for promotion from a Trainer 5. Receive approval by the Promotional Board
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CREW CHIEF TRAINER PREREQUISITES 1. Must be an RPI Ambulance Crew Chief
PROMOTIONAL REQUIREMENTS 1. 2. 3. 4. 5. 6.
Be a Crew Chief for 4 months while the ambulance is in service Crew Chief 3 emergency or non-emergency calls Assist in teaching a Crew Chief class Request to become a trainer Receive recommendation for promotion from a Trainer Receive t approval of the Training committee and Captain
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SOP 12-09 FIRST RESPONSE DRIVER INTRODUCTION The responsibility of the First-Response Driver is to drive First Response-59 safely to the scene of an EMS call, from headquarters to the garage or to the location of a special event. The job of First Response Driver is very different from that of Ambulance Driver; therefore the responsibilities and requirements are different. This position is an additional certification of for RPI Ambulance Crew Chiefs and Drivers rather than an individual qualification.
RESPONSIBILITIES The First Response Driver will perform a vehicle and equipment checklist at the start of every shift. He/She will also be responsible for the security, care and upkeep of the vehicle for the duration of the shift.
GENERAL DRIVING PROCEDURES During all operation of the first response vehicle the following procedures will be adhered to: 1. A spotter must be used at all times whenever backing the vehicle. 2. The driver and all engers in the first response vehicle shall wear a seatbelt at all times during any operation of the vehicle. 3. Headlights are to be used at any time the vehicle is in motion. 4. Respond to all calls in accordance with SOP 12-14. 5. The First Response Driver will adhere to the Travel Limits and Winter Driving rules designated in SOP 12-07 6. Every effort should be made to have a Crew Chief with the vehicle in the event that it is flagged down for assistance.
EMERGENCY DRIVING PROCEDURES 1. When the first response vehicle is being operated in Priority II mode, the First Response Driver will always adhere to NYS Vehicle & Traffic laws. When the first response vehicle is operated in Priority I mode the First Response Driver will adhere to the following rules in addition to the above and to NYS Vehicle & Traffic laws: a. A complete stop is mandatory before proceeding with caution at all red lights, stop signs, and railroad crossings, regardless of response level. b. If using the median, turning lane, or a lane of opposing traffic to enter an intersection, come to a complete stop before proceeding with caution. c. Come to a complete stop at all times for any school bus either in the same lane or in the opposing lane with flashing red lights displayed. d. Do not exceed posted speed limit by more than ten (10) miles per hour at any time. e. Do not exceed posted speed limit at any time when ing through an intersection with the green light. f. When traveling in a lane of traffic in an opposing direction, do not exceed 20 mph. 2. Leave warning lights (no less than secondary lights) on if the vehicle is stopped on or at the edge of a roadway, or if the ambulance will interfere with traffic, or at any time that the warning lights will increase scene safety for EMS personnel.
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3. If the emergency lights are left on at the scene, the vehicle‟s engine should remain running. 4. Should the vehicle be left on scene during a transport to the hospital, the vehicle should be moved out of the roadway to a safe parking spot, the lights and engine shut down and the vehicle locked and secured. The vehicle should be retrieved as soon as possible after returning from the hospital.
TRAINING PREREQUISITES 1. Be an RPI Ambulance Crew Chief or RPI Ambulance Driver 2. Hold a valid NYS Class D driver‟s license or equivalent
PROMOTIONAL REQUIREMENTS 1. 2. 3. 4. 5.
Perform a First Response-59 equipment and a vehicle checklist Log 5 hours of driving time in First Response-59 under the supervision of a Driver Trainer the First Response-59 cone course the RPI Ambulance Driver Practical Exam in either 5939 or FR-59 Drive at least two (2) calls with at least one call being a priority 1 call, in either 5939 or FR-59 under the supervision of a Driver Trainer 6. Request promotion to First Response Driver 7. Receive t approval from the Training Committee and Captain
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SOP 12-10 EVENT EMS SUPERVISOR S INTRODUCTION Event EMS Supervisors (EES) are qualified Crew Chiefs who manage personnel and resources at RPI Ambulance Special Events. EES are trained in the supervision multiple field crews during large special events, proper radio procedure and inter-agency operations and incident management. They are also capable of treating and calling for the transport of patients.
TRAINING Event EMS Supervisors (EES) should be trained in and show proficiency in the following skills: 1. 2. 3. 4. 5.
Large scale event and personnel management Radio communications Decision making under stressful situations Working with other agencies and organizations Patient care
PREREQUISITES 1. Be an RPI Ambulance Crew Chief
PROMOTIONAL REQUIREMENTS 1. Be the EES- In Charge of two (2) events under the supervision of an EES and receive a ing evaluation 2. Complete the EES checklist. 3. Request promotion to EES from the Captain and Training Committee.
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SOP 12-11 DUTY SUPERVISORS INTRODUCTION In the EMS field, many problems exist, from operations to interpersonal conflict. The position of Supervisor is created to provide easy access to an experienced member who can act in the capacity of Crew Chief or Driver if the need arises. The Supervisor also acts as a screen to the Captain so that matters that can be resolved by the Supervisor don‟t need to unduly tie up the Captain. The position of Supervisor is not a Credentialed Promotion, and as such, it does not fall under the auspices of Training Committee.
QUALIFICATIONS The Supervisor Shall: 1. Be currently credentialed as a Crew Chief Trainer, Driver Trainer, First Response Driver and Event EMS Supervisor by RPI Ambulance 2. Maintain at least 70% compliance in agency QI as a Crew Chief. 3. Have completed an interview with the Captain testing the knowledge of RPI Ambulance operations, Standard Operating Policies, Mutual Aid, and the geography of Rensselaer County and Surrounding Areas. 4. Be appointed by the Captain with input from other Line Officers and other Supervisors after the successful completion of the aforementioned interview.
DUTIES All Supervisors: 1. Will act as the scheduled Duty Supervisor for at least 24 hours per week. 2. Must remain within radio range of RPI Public Safety, the Rensselaer County Dispatcher, and the Ambulance, and will be able to establish communication to the Ambulance Crew via Cellular Phone during their on duty time. 3. Must carry appropriate Supervisor Identification while on duty. 4. Should notify the appropriate officer in the proper time, if the Supervisor notices anything that requires st attention from that officer. For example, the Captain and 1 Lieutenant need to know right away that the Ambulance has a flat tire, whereas the Training Committee could probably be notified in the morning if one of the R manikins is broken. 5. Will act in an appropriate manner at all times while acting on behalf of RPI Ambulance. 6. Will not take over care of a patient, driving responsibilities, or any other duties of the crew unless patient or crew safety is in jeopardy. 7. Will file incident reports as necessary to maintain proper documentation of incidents. 8. The On-Duty supervisor is expected to assist the responding ambulance in the following situations: a. MCI- Any incident that involves more than 2 patients or in which there are patients in excess of the available resource b. Any rescue incident that would involve a crew being on scene an anticipated time exceeding 20 minutes c. Any incident where crowd control may cause an issue to the responding units. This includes but is not limited to fraternity houses and large events d. Any incident where ALS is requested, where an ALS unit is not available for immediate response
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GRIEVANCES Any grievance with a Supervisor or the actions of a Supervisor will be forwarded as soon as possible, to the Captain, who will investigate the matter fully. If an individual does not feel comfortable approaching the Captain, another Supervisor may be notified of the grievance or the member may the Grievance Committee of RPI Ambulance. Care should be taken to avoid a rumor mill when dealing with such grievances as matters can quickly be blown out of proportion. Always try to use the proper communication channels. If the Captain feels that the grievance has merit, the Captain will attempt to mediate any dispute between the involved parties. If one or both parties are unsatisfied with this approach, the matter will follow SOP 12-25 for grievances and appeals.
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SOP 12-12 COORDINATORS INTRODUCTION To assist in the completion of their jobs, the line officers of RPI Ambulance are empowered to appoint coordinators. This gives the coordinator selected powers that the appropriate officer may have while still referring all responsibility for the job to the appropriate officer. Some specific positions follow.
QI COORDINATOR The Quality Improvement Coordinator coordinates the completion of QI audits and tabulates the data and reports to the Captain. The QI Coordinator and/or the Captain represent RPI Ambulance at meetings of the Rensselaer County QI Committee. If desired, the Captain may elect to act as the QI coordinator. The QI coordinator is responsible for ensuring compliance with the Rensselaer County QI program and thereby the Region and State program. The Captain and QI coordinator should periodically review the Rensselaer County QI program to evaluate its effectiveness to RPI Ambulance and to ensure it meets all State and Regional requirements.
R COORDINATOR The R Coordinator is in charge of coordinating R events sponsored by RPI Ambulance and reports to the Training Committee. The R Coordinator need not be a R Instructor but instead assures that instructors are available to hold scheduled R training. The R Coordinator should work closely with the Training Committee and the Vice-President. If desired, the Training Committee may elect to act as the R coordinator.
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SOP 12-13 UNIFORMS INTRODUCTION In an effort to gain respect and convey a professional manner to the community, RPI Ambulance has established different categories of uniform standards. This will provide continuity and an easy way to communicate the appropriate uniform to of a Duty Crew.
PATCHES RPI Ambulance patches will only be worn the black duty uniform shirt or red RPI Ambulance jacket. The RPI Ambulance agency patch will be worn on the left shoulder. NYS DOH certification patches of the “Excelsior” design with tombstone shape and navy blue background will be worn on the right shoulder. If a member does not hold NYS DOH certification, a 2 inches x 3 inches American flag patch with gold border or NYS DOH “Emergency Medical Services” tombstone patch may be worn on the right shoulder. No other patches may be worn on any part of the uniform.
PINS, COLLAR BRASS, BADGES Any pin to be worn on the RPI Ambulance uniform must be approved by the Captain. The Captain has the right to ask a pin to be removed from any RPI Ambulance uniform. Officer and Supervisor badges may be worn with the Duty Uniform and carried with the Casual Uniform to serve as identification. In some cases, the different role we serve by being an EMS agency and not a Public Safety agency can play in important role in patient rapport. It is for this reason that we must keep a clear distinction between RPI Ambulance and other Public Safety agencies.
UNIFORM CLASSES DUTY UNIFORM This is issued uniform that is used by RPI Ambulance. It consists of: Black collared RPI Ambulance uniform shirt with black T-Shirt worn underneath for Crew Chiefs, Drivers and Officers Officer bars for line officers, officer pins for istrative officers, silver caduceus for non-officers Red “Trainee” polo for attendants, ride-along observers, observers, and trainees Black slacks or black EMS-style pants Black belt with silver or black buckle No dangling earrings or jewelry Black, shined, closed-toe shoes or boots. No high heels. Black socks (if socks visible) RPI Ambulance approved red jacket (Seasonal)
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CASUAL UNIFORM When not assigned to duty crews, RPI Ambulance may wear RPI Ambulance apparel such as t-shirts or sweatshirts with the RPI Ambulance name and logo on them. This apparel does not constitute any official uniform; as such, duty crews must be in the duty uniform. responding to calls while not on a scheduled duty crew do not have to wear the full Duty Uniform; however will wear the Casual Uniform. The Casual Uniform consists of: A plain neat un-torn shirt, preferably dark, if possible RPI Ambulance- or EMS oriented. fluorescent or obscene T-shirts are allowed. Neat, un-torn pair of pants, preferably dark. Jeans are fine but shorts are not permitted. Solid footwear. No open-toed shoes or sandals. No high heels. RPI Ambulance approved red jacket
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SOP 12-14 DISPATCH AND RESPONSE PROCEDURES INTRODUCTION Rensselaer County Bureau of Public Safety is the official dispatcher for RPI Ambulance. All medical emergency calls originating on campus are transferred to the Rensselaer County Emergency Medical Dispatcher who assigns the priority determinant for the call and dispatches RPI Ambulance. All non-emergency medical calls originating on campus are transferred to Rensselaer County in the same fashion as the emergency calls from the Rensselaer County Dispatcher or from the RPI Student Health Center. Rensselaer County Emergency Medical Dispatcher will also dispatch RPI Ambulance for any mutual aid calls originating in the county. Rensselaer County can be reached via the following numbers: Emergency Number: 911 Non-Emergency Numbers: (518)-270-5252 / (518)-270-1037
RESPONSE LEVELS Priority II – 5939 or First Response-59 operation using no emergency lights or sirens, following all V&T laws. Synonyms: Routine, Code 2, Cold. Priority I – 5939 or First Response-59 operation using emergency lights and siren. Synonyms: Emergency, Code 3, Hot. NB: The driver has responsibility and liability for safe operation and must maintain compliance with RPI Ambulance driving procedures. The driver is personally liable for any injury or damage sustained during Priority I operation.
RPI AMBULANCE UNAVAILABILITY If RPI Ambulance is unavailable for a call the next available ambulance according to the mutual aid plan shall be called. This will happen in accordance with SOP 12-16 and the current dispatch plan with Rensselaer County Bureau of Public Safety.
EMS CALLS The county dispatcher will notify the of RPI Ambulance of the call, including nature and location, with the accompanying paging tones via the high band portables broadcast over frequency 155.220, heard on channel 1 (one) or 2 (two) of the RPI Ambulance high band portable radios. Calls received from the county dispatcher will include a determinant: Alpha determinant calls will be treated as Priority II as defined above. Bravo, Charlie, Delta, and Echo determinant calls will be treated as Priority I as defined above.
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All radio communications between crew before, during and after the call should be done over RPI Ambulance high band radio (155.220MHz). Any communication to the Rensselaer County Dispatcher shall be done via the 800MHz system. If the Crew Chief or Driver is unable to the Dispatcher via the 800MHz system they may the Dispatcher via cellular telephone by dialing (518)-270-1037.
RESPONSE TO EMS CALLS NO SCHEDULED DUTY CREW 1. Upon notification of an EMS call, all efforts should be made to see that 5939 responds to the scene with a full crew. 2. If a First Response Driver qualified Crew Chief has been assigned to First Response-59 or can get to First Response-59 quickly, he/she may respond to the scene with the vehicle. The responding Crew Chief will advise other of his/her response via the high band radio and also the Rensselaer County Dispatcher via the 800 MHz radio. He/she shall make an effort to an Ambulance Driver to bring 5939 to the scene. As soon as the Crew Chief is sure that no Ambulance Driver is able to respond with 5939, he/she shall the Rensselaer County Dispatcher to request mutual aid for a transport. If the Crew Chief determines that the call is to be an RMA, he/she may cancel the transporting ambulance with the Rensselaer County Dispatcher 3. If there is an Ambulance Driver available, he/she should respond to the garage to bring 5939 to the scene. Any regular Crew Chief and any other may respond directly to the garage to respond with 5939. 4. If a full crew of a Driver and a Crew Chief cannot be raised, the responding crew may the dispatcher to have the call re-dispatched to complete the crew. 5. Trainees may respond to the garage to respond with 5939. No member other than an RPI Ambulance Crew Chief should respond directly to the scene of an EMS call unless they are already on scene.
DURING A SCHEDULED DUTY CREW 1. Upon notification of an EMS call, the on-duty Crew Chief or Driver shall acknowledge the call and confirm the crew with the Rensselaer County Dispatcher via the 800 MHz system. The on-duty Crew Chief may respond to the scene via First Response-59 if the rest of the crew has adequate means of transport to the garage that will not cause an undue delay in the response of 5939. The on duty Driver is responsible for responding to the scene with 5939. 2. First Response-59 may be used to convey the entire duty crew to the garage so that the crew may respond to the scene in 5939. 3. No member other than an RPI Ambulance Crew Chief should respond directly to the scene of an EMS call unless they are already on scene.
RESPONSE TO MUTUAL AID CALLS 1. First Response-59 should not respond to the scene of any mutual aid call if 5939 is available unless specifically requested by the Rensselaer County Dispatcher. 2. If 5939 is already on an EMS call and a mutual aid call is dispatched, a First Response Driver qualified Crew Chief may respond to the scene with First Response-59.
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TRANSPORTATION CALLS RPI Ambulance may perform a non-emergency transport, (e.g. patient returning to campus after surgery) if requested, with the approval of the Captain. This is a service which should not be abused. An individual who is on crutches or able to ambulate with assistance does not need the services of an ambulance. If no other means of transport is available, RPI Ambulance will attempt to get a crew to transport the patient.
HAZARDOUS MATERIAL CALLS RPI Ambulance is not equipped or trained to handle Hazardous Material (Haz-Mat) situations. As such, no member may enter Haz-Mat scene until trained professionals have properly decontaminated it. The Crew Chief is responsible for ensuring the safety of the crew and should keep the crew back far enough to be away from the hazardous agent.
STAND-BY‟S AND MCI RPI Ambulance is a participant in Mutual Aid with other agencies who may call upon us as a resource in the event of multiple patient incidents (MCI), long standbys, etc. Response to these scenes will always be in Priority II mode with the exception of Fire Standbys. Lights and sirens will not be used to respond to these incidents unless there is a patient waiting for our services, in which case the incident is no longer a standby response, but begins a new PCR as an EMS call. If the dispatch entity requests RPI Ambulance to respond to an incident Priority I, then RPI Ambulance will do so if the Crew Chief feels comfortable with that judgment.
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SOP 12-15 PATIENT TRANSPORT DESTINATIONS INTRODUCTION Patients are usually transported to the hospitals in Rensselaer, Albany, or Schenectady Counties. The only exception to this may occur when RPI Ambulance has responded to a mutual aid request and the usual receiving hospital(s) of the agency requesting mutual aid is substantially closer than one of the facilities in Rensselaer, Albany, or Schenectady Counties. The hospital destination, within the areas of Rensselaer, Albany, or Schenectady Counties, will depend on a variety of factors, including, but not limited to, patient medical condition, patient request, road and weather conditions, location of the patient‟s regular physician, and location of the incident. The patient will have final choice; however the crew chief should attempt to convince the patient to go to a local hospital. Under no circumstances will the a patient be transported to a hospital that is more than 20 minutes further distance than the nearest hospital according to the NYS BLS Protocols.
Any patient deemed to be in an immediately life-threatening situation will be taken to the nearest appropriate hospital. The appropriate hospital Emergency Departments are: 1. Samaritan Hospital ER, Troy, NY 2. Saint Mary‟s Hospital ER, Troy, NY 3. Ellis Hospital ER, Schenectady, NY 4. St. Clare‟s Hospital ER, Schenectady, NY 5. Albany Medical Center Hospital ER, Albany, NY 6. Saint Peter‟s Hospital ER, Albany, NY 7. Albany Memorial Hospital ER, Albany, NY 8. Stratton VA Medical Center ER, Albany, NY
UNUSUAL RECEIVING FA CILITY In an emergent situation, if a patient seeks transportation to a hospital outside the area to which the RPI Ambulance ordinarily transports patients, the patient will be informed of the RPI Ambulance receiving hospitals, the distances involved, and that no exceptions are made. If the patient refuses transportation, the “Refusal of Transportation” policy will be followed. The will inform the patient of the possible medical consequences of his/her action, and have the patient sign a refusal of transportation statement. If the situation is non-emergent and the patient or caller makes inquiry (e.g. the need to transport a nonambulatory stable patient), they shall be referred to the Empire Ambulance Service or Mohawk Ambulance Service.
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RECEIVING FACILITY ON DIVERSION If crew gives a hospital as patient destination and the medical control physician at that receiving hospital feels that patient condition warrants transport to the nearest facility, the crew will inform the patient and any accompanying relative, and comply immediately with the medical control order. If once the patient is enroute to a certain hospital and that hospital medical control orders the ambulance to divert to another hospital, the crew will inform the patient and will do everything in their power to explain the reasons for the diversion. If the patient is alert, oriented and understands the reason for diversion but still refuses diversion from the hospital of choice; s/he will be asked to sign a refusal and will be taken to the original hospital destination. If, however, in the opinion of the highest trained member in attendance, the patient‟s request of hospital will cause further harm to the patient, the nearest appropriate hospital will be used. In all cases of diversion from the patient‟s hospital choice, the EMT will record the patient‟s request on the Prehospital Care Report and the reasons for transporting to the closest appropriate hospital. If a receiving hospital diverts the ambulance to another receiving hospital because of emergency room conditions as opposed to patient condition, the ambulance will divert if, in the judgment of the crewmember with the highest level of training, in consultation with medical control, it is determined that the patient condition is stable enough to warrant diversion. Under these circumstances the patient, whose condition is stable, is informed that the hospital has requested diversion for the reason stated. If the patient insists that s/he be taken to the originally requested hospital and the crew is unable to persuade the patient otherwise, the patient‟s hospital destination choice will be honored by the crew and the hospital informed of the reason that the ambulance will not honor their request for diversion. Generally, patients who are critical or unstable must be taken to the nearest facility.
HOSPITAL DESTINATION IN MUTUAL AID SITUATION In a mutual aid situation, if a hospital is substantially closer than the usual receiving hospitals, that hospital will be utilized. If communication with dispatch and/or the receiving hospital is impaired, a real possibility in some mutual aid instances, the crew will utilize all BLS and ALS standing orders as appropriate, and then follow the regional communication difficulty protocol. The destination hospital will be ed as soon as possible, either by radio or by cellular telephone. If in a mutual aid situation, in the rare instance the crew may be transporting a patient to a hospital other than RPI Ambulance usual receiving hospitals, if a diversion is requested, the crew will divert only if the diversion does not in any way, in the judgment of the highest trained crew member, compromise the patient.
TRANSPORT AND HOSPITAL DESTINATION OF MAJOR TRAUMA PATIENTS In a major trauma situation, where the crew deems appropriate, the nearest air medical service – helicopter (Usually Albany Med Flight or Lifeguard) will be requested. The crew will generally meet the helicopter at a mutually agreeable landing zone enroute to the hospital. Arrangements will be made through dispatch for the establishment of the landing zone by the appropriate Fire Department. If Air Medical Service is not available, in almost all instances the nearest hospital is the appropriate receiving facility. In the rare instance that the crew may be working in an area on a mutual aid request, the crew chief should keep in mind that Albany Medical Center is a designated trauma center, and may be the appropriate destination for patients meeting major trauma criteria as found the NYS BLS Protocols.
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SOP 12-16 MUTUAL AID Under the Rensselaer County Mutual Aid Plan, RPI Ambulance and other Rensselaer County agencies have the ability to request Mutual Aid from each other under the following constraints:
Rensselaer County will maintain RPI Ambulance run number and response times in accordance with existing Rensselaer County Dispatch policies.
After being dispatched for a Mutual Aid call, RPI Ambulance will call the requesting dispatcher and request any information needed such as call location, directions, and patient status.
Upon arrival at the hospital, RPI Ambulance should call arriving the appropriate dispatcher‟s frequency notify the dispatcher that they are returning to RPI‟s frequency, and return to RPI Ambulance‟s primary frequency. Then, notify the Rensselaer County Dispatcher that RPI Ambulance is clear of the Mutual Aid call and back in normal dispatch procedures.
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SOP 12-17 OUT OF SERVICE INTRODUCTION By the nature of RPI Ambulance being college based it is recognized that there are periods when cannot commit to responding to a call. These may be times when all crew chiefs are in class, a period before a test, etc. In addition, during summer vacations when students are away, the may also be away and the service may be unable to respond. This policy seeks to address the issues regarding this lapse of service.
DAY TO DAY TURNOVERS While classes are in session, every effort is to be made by the to provide a quick response. This is to be done by having as many regular scheduled crews a possible and by communication among the regarding their absences and outside commitments. In cases where a crew is not available, the call will be turned over for mutual aid. This will be done by Rensselaer County Dispatch. If a full crew cannot be raised, the responding crew should request mutual aid as soon as it is known that a full crew is not en route to the ambulance. If a member does not acknowledge the call within 3 minutes, a crew cannot be confirmed within 6 minutes, or the ambulance is not enroute within 9 minutes, the call will automatically be turned over to mutual aid. All times are counted from the time of initial dispatch of the ambulance. In the case of a large incident, the dispatcher will signify so and will continue trying to raise a crew for as long as feasible.
EXTENDED PERIODS OF ABSENCE If the ambulance will be out service, for any period of time, the Rensselaer County Dispatcher should be notified of the absence so that RPI Ambulance is not dispatched for any calls during that period of time. If the ambulance will be out of service for a scheduled period of time (such as maintenance) all should be notified ahead of time (such as by email) and the Public Safety dispatcher should be notified by phone of the absence of service. This ensures that no time is wasted trying to raise an ambulance for a patient on campus when it is not available to respond. Any time the ambulance is taken out of service, an “Out-Of-Service” sticker should be placed over the NYS-DOH certification sticker.
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SOP 12-18 SPECIAL EVENT PROCEDURES Special event medicine is a major aspect of the duties that RPI Ambulance performs on the RPI Campus. The following SOPs are the rules that define the operations of RPI Ambulance but should not supersede good clinical judgment of the supervisors and the crew. All New York State Department of Health (DOH) and Regional Emergency Medical Organization (REMO) rules and regulations should be followed.
SPECIAL EVENT COVERA GE REQUESTS nd
Upon receipt of a Request for medical Coverage at a Special Event, the 2 Lieutenant will check to see if there are enough available personnel willing to volunteer for the event. The request will be submitted to the Captain to approve the event and to determine the level of coverage for the event.
FIRST AID ROOM OPERA TION A significant majority of RPI Ambulance‟s special event standbys occur in venues in which RPI Ambulance operates a First Aid Room that is fully stocked according to Part 18 of the NYS Sanitary Code. The following procedures are to be followed when operating within these facilities.
EAST CAMPUS ATHLETIC VILLAGE FIRST AID ROOM All personnel shall enter East Campus Athletic Village (ECAV) via the North Entrance and proceed up the stairs to the First Aid room. The ambulance and or First Response Vehicle shall be parked along the fence adjacent to the field. Only Line Side officers, crew chiefs and drivers should have electronic card access to the ECAV First Aid Room. Prior to the start of the event, each Crew Chief must complete a field bag equipment checklist. If the event is a Type II or III event in the stadium, the First Aid Room must be staffed by an Event EMS Supervisor (EES) who will complete a First Aid Room equipment checklist. After the event the lights should be shut off and the door closed.
HOUSTON FIELD HOUSE FIRST AID ROOM All personnel shall enter the Houston Field House (HFH) via the South side/ B lot entrance and produce on demand an RPI Ambulance issued Identification Card. The keys to the HFH FAR are locked up in a lockbox next to the door. Only EES and Line Officers have the combination to the lockbox. At the end of the event, the lights should be turned off, the door locked and the keys returned. Prior to the start of the event, each Crew Chief must complete a trauma and infection control bag equipment checklist and the Crew Chief or Event EMS Supervisor shall complete a First Aid Room Equipment checklist.
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During the event, he First Aid Room shall always be staffed by at least one crew chief. If the event is a Type II or III event, the event must be staffed by an Event EMS Supervisor (EES). In order of importance, a crew chief should be stationed in Section 7 first, then Section 15, then Section 1. At Type II and III events the Fieldhouse log book should be filled out by the Event EMS Supervisor. This log will detail personnel attendance, event title, spectator attendance, crew movements and patient interactions.
EVENT TYPE CLASSIFICATION The following classification of event types is based on the level of coverage provided by RPI Ambulance.. The Captain will approve the level of coverage at least three (3) days prior to the event.
TYPE I EVENT Type I events are events that have a long duration and low attendance that do not necessitate the placement of field crews. Minimum coverage for Type I Events will include at least one (1) Crew Chief with a trauma bag and oxygen duffel and First Response-59 (or a FAR at the discretion of the Crew Chief- In Charge).
TYPE II EVENT Type II events are events that have a large attendance (up to 5000) that necessitate the placement of field crews (e.g. hockey games). Minimum coverage for Type II Events will include at least one Event EMS Supervisor (EES), two (2) Crew Chiefs with trauma bags and oxygen duffels, the Ambulance with a driver and First Response-59 (or a FAR at the discretion of the EES-IC).
TYPE III EVENT Type III events are events that have a large attendance over 5000 people and that will require the ambulance be on dedicated standby for part of or the entire duration of the event (e.g. Commencement). Minimum coverage for Type III Events will include at least two (2) Event EMS Supervisors (EES), three (3) Crew Chiefs with trauma bags and oxygen duffels, First Response-59 (or a FAR at the discretion of the EES-IC) and the Ambulance with a driver on dedicated standby.
EVENT RADIO COMMUNICATIONS At the start of Type II and III events the following radio check will be completed by the Event EMS Supervisor –In Charge (EES-IC) over the RPI Ambulance frequency (155.220MHz): “At
STANDARD OPERATING PROCEDURES
Updated: August 28th, 2012 | Captain Mark H. O‟Donnell
RPI Ambulance Standard Operating Procedures
August 28th, 2012
SOP 12-00 ORGANIZATION AND STRUCTURE ....................................................................................................................... 5 SOP 12-01 MISSION STATEMENT ......................................................................................................................................... 6 SOP 12-02 QUALIFICATION PROCEDURES - VOLUNTEER PERSONNEL................................................................................... 7 APPLICATION PROCEDURES ............................................................................................................................................................ 7 ORIENTATION .............................................................................................................................................................................. 7 HEALTH AND SAFETY ..................................................................................................................................................................... 7 SOP 12-03 OPERATIONAL MEMBER TYPES ........................................................................................................................... 9 INTRODUCTION ............................................................................................................................................................................ 9 HIP REQUIREMENTS ........................................................................................................................................................ 9 SOP 12-04 TRAINING AND PROMOTIONS .......................................................................................................................... 11 INTRODUCTION .......................................................................................................................................................................... 11 TRAINING.................................................................................................................................................................................. 11 TRAINING COMMITTEE ................................................................................................................................................................ 11 PROBATIONARY TRAINING ............................................................................................................................................................ 12 TRAINERS.................................................................................................................................................................................. 12 PROMOTIONAL BOARDS: STRUCTURE ............................................................................................................................................. 12 PROMOTIONAL BOARDS: VOTING .................................................................................................................................................. 12 SOP 12-05 OBSERVERS AND OBSERVERS ........................................................................................................................... 14 RIDE-ALONG OBSERVER .............................................................................................................................................................. 14 OBSERVER................................................................................................................................................................................. 14 SOP 12-06 AMBULANCE ATTENDANT ................................................................................................................................ 15 INTRODUCTION .......................................................................................................................................................................... 15 TRAINING.................................................................................................................................................................................. 15 SOP 12-07 AMBULANCE DRIVER ........................................................................................................................................ 16 INTRODUCTION .......................................................................................................................................................................... 16 GENERAL DRIVING PROCEDURES ................................................................................................................................................... 16 EMERGENCY DRIVING PROCEDURES ............................................................................................................................................... 16 DRIVER’S DUTIES........................................................................................................................................................................ 17 SPOTTERS ................................................................................................................................................................................. 17 BACK-UP ALARM ....................................................................................................................................................................... 18 TRAVEL LIMITS ........................................................................................................................................................................... 18 WINTER DRIVING ....................................................................................................................................................................... 18 TRAINING.................................................................................................................................................................................. 19 SOP 12-08 AMBULANCE CREW CHIEF................................................................................................................................. 21 INTRODUCTION .......................................................................................................................................................................... 21 GENERAL PROCEDURES................................................................................................................................................................ 21 CREW CHIEF’S DUTIES ................................................................................................................................................................. 21 TRAINING.................................................................................................................................................................................. 22 SOP 12-09 FIRST RESPONSE DRIVER ................................................................................................................................... 25 INTRODUCTION .......................................................................................................................................................................... 25 RESPONSIBILITIES ....................................................................................................................................................................... 25 GENERAL DRIVING PROCEDURES ................................................................................................................................................... 25
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EMERGENCY DRIVING PROCEDURES ............................................................................................................................................... 25 TRAINING.................................................................................................................................................................................. 26 SOP 12-10 EVENT EMS SUPERVISORS ................................................................................................................................ 27 INTRODUCTION .......................................................................................................................................................................... 27 TRAINING.................................................................................................................................................................................. 27 SOP 12-11 DUTY SUPERVISORS .......................................................................................................................................... 28 INTRODUCTION .......................................................................................................................................................................... 28 QUALIFICATIONS ........................................................................................................................................................................ 28 DUTIES ..................................................................................................................................................................................... 28 GRIEVANCES .............................................................................................................................................................................. 29 SOP 12-12 COORDINATORS ............................................................................................................................................... 30 INTRODUCTION .......................................................................................................................................................................... 30 QI COORDINATOR ...................................................................................................................................................................... 30 R COORDINATOR.................................................................................................................................................................... 30 SOP 12-13 UNIFORMS ........................................................................................................................................................ 31 INTRODUCTION .......................................................................................................................................................................... 31 PATCHES................................................................................................................................................................................... 31 PINS, COLLAR BRASS, BADGES ...................................................................................................................................................... 31 UNIFORM CLASSES ..................................................................................................................................................................... 31 SOP 12-14 DISPATCH AND RESPONSE PROCEDURES .......................................................................................................... 33 INTRODUCTION .......................................................................................................................................................................... 33 RESPONSE LEVELS....................................................................................................................................................................... 33 RPI AMBULANCE UNAVAILABILITY.................................................................................................................................................. 33 EMS CALLS ............................................................................................................................................................................... 33 TRANSPORTATION CALLS.............................................................................................................................................................. 35 HAZARDOUS MATERIAL CALLS ...................................................................................................................................................... 35 STAND-BY’S AND MCI ................................................................................................................................................................. 35 SOP 12-15 PATIENT TRANSPORT DESTINATIONS ............................................................................................................... 36 SOP 12-16 MUTUAL AID..................................................................................................................................................... 38 SOP 12-17 OUT OF SERVICE ............................................................................................................................................... 39 INTRODUCTION .......................................................................................................................................................................... 39 DAY TO DAY TURNOVERS ............................................................................................................................................................. 39 EXTENDED PERIODS OF ABSENCE ................................................................................................................................................... 39 SOP 12-18 SPECIAL EVENT PROCEDURES ........................................................................................................................... 40 SPECIAL EVENT COVERAGE REQUESTS ............................................................................................................................................. 40 FIRST AID ROOM OPERATION ....................................................................................................................................................... 40 EVENT TYPE CLASSIFICATION ........................................................................................................................................................ 41 EVENT RADIO COMMUNICATIONS ................................................................................................................................................... 41 SPECIAL EVENT OPERATIONS ........................................................................................................................................................ 42 PAPERWORK AND EQUIPMENT MAINTENANCE ................................................................................................................................. 43 SOP 12-19 DOCUMENTATION ............................................................................................................................................ 44 INTRODUCTION .......................................................................................................................................................................... 44
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GENERAL PROCEDURES................................................................................................................................................................ 44 PAPER PCR RETENTION AND STORAGE ............................................................................................................................................ 44 REFUSAL OF MEDICAL ATTENTION (RMA) ...................................................................................................................................... 44 SOP 12-20 RADIO COMMUNICATIONS ............................................................................................................................... 46 SOP 12-21 AMBULANCE/EQUIPMENT INSPECTION, CARE, AND MAINTENANCE ................................................................ 47 INTRODUCTION .......................................................................................................................................................................... 47 AMBULANCE AND FIRST RESPONSE VEHICLE MAINTENANCE ................................................................................................................ 47 EQUIPMENT MAINTENANCE ......................................................................................................................................................... 47 CLEANING ................................................................................................................................................................................. 48 ACCIDENTS/DAMAGE TO RPI AMBULANCE VEHICLES .................................................................................................................. 48 FAILURES .................................................................................................................................................................................. 48 SOP 12-22 AMBULANCE LAYOUT/SETUP ........................................................................................................................... 50 INTRODUCTION .......................................................................................................................................................................... 50 STRETCHER................................................................................................................................................................................ 50 SPARE MAKE-UP ........................................................................................................................................................................ 50 IV FLUID CLIPS/RETAINERS ........................................................................................................................................................... 50 PORTABLE OXYGEN TANKS ........................................................................................................................................................... 50 WALL OXYGEN REGULATORS ........................................................................................................................................................ 50 ONBOARD OXYGEN SYSTEM ......................................................................................................................................................... 51 COMPLETED PAPERWORK ............................................................................................................................................................ 51 OTHER EQUIPMENT, TOOLS, ETC. ................................................................................................................................................... 51 LAPTOPS ................................................................................................................................................................................... 51 SOP 12-23 DEFIBRILLATOR ................................................................................................................................................. 52 INTRODUCTION .......................................................................................................................................................................... 52 CARE AND MAINTENANCE ............................................................................................................................................................ 52 USE ......................................................................................................................................................................................... 52 SOP 12-24 CONDUCT ......................................................................................................................................................... 53 INTRODUCTION .......................................................................................................................................................................... 53 PATIENT CONFIDENTIALITY ........................................................................................................................................................... 53 WEAPONS................................................................................................................................................................................. 53 SMOKING.................................................................................................................................................................................. 53 ALCOHOL, CONTROLLED SUBSTANCES, AND MEDICATIONS ................................................................................................................. 53 VISITORS................................................................................................................................................................................... 54 SOP 12-25 GRIEVANCES AND APPEALS .............................................................................................................................. 55 INTRODUCTION .......................................................................................................................................................................... 55 GRIEVANCES .............................................................................................................................................................................. 55 CHAIN OF APPEALS ..................................................................................................................................................................... 55 APPEALS ................................................................................................................................................................................... 55 SOP 12-26 SEXUAL HARASSMENT AND NONDISCRIMINATION .......................................................................................... 56 SEXUAL HARASSMENT ................................................................................................................................................................. 56 NONDISCRIMINATION.................................................................................................................................................................. 56 VIOLATIONS .............................................................................................................................................................................. 56 SOP 12-27 INFECTIOUS DISEASE EXPOSURE AND ON DUTY INJURY ................................................................................... 57
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INTRODUCTION .......................................................................................................................................................................... 57 PRACTICES ................................................................................................................................................................................ 57 ON-DUTY INJURY OR EXPOSURE .................................................................................................................................................... 57 SOP 12-28 MISCELLANEOUS............................................................................................................................................... 58 INTRODUCTION .......................................................................................................................................................................... 58 LOCATING PATIENTS ................................................................................................................................................................... 58 SPECIAL PATIENTS ...................................................................................................................................................................... 58 CRIMES .................................................................................................................................................................................... 59 INCIDENT REPORTING .................................................................................................................................................................. 59 OBVIOUS AND UNATTENDED DEATH .............................................................................................................................................. 59 CHILD ABUSE AND MALTREATMENT ............................................................................................................................................... 60 GERIATRIC OR OTHER PATIENT ABUSE/MALTREATMENT .................................................................................................................... 61 ABANDONED INFANT................................................................................................................................................................... 61 SOP 12-29 APPROVAL/REVIEW DOCUMENT ...................................................................................................................... 62
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SOP 12-00 ORGANIZATION AND STRUCTURE This document is the Standard Operating Procedures (SOPs) of the Rensselaer Polytechnic Institute Ambulance. If one section of the SOPs is amended, suspended, deleted, or otherwise changed, the remainder of this document will remain unaffected. This document is not to supersede any directives, guidelines, or protocols enacted by a higher authority such as the State of New York, the Regional Emergency Medical Organization of the Hudson Mohawk Valley Region (REMO-HMVI), or the County of Rensselaer. These guidelines are, furthermore, not to supersede good clinical judgment on the part of the crew. According to the RPI Ambulance Constitution, the Captain and Medical Director must agree upon the SOPs. The Standard Operating Procedures must be reviewed on an annual basis by the same entities. Documentation of this review will be attached as a separate Policy Statement (see SOP 12-29). The RPI Ambulance SOPs were originally written in the early 1980‟s by George Holdsworth, and amended and adjusted by Captains Ken Lavelle, John Kim, and Brian Wilde since that time. A major rewrite was initiated by Captain Chris Holt, and completed by Captain Fabien Nicaise. The SOPs have since been amended and adjusted by Captains Steve Mitchell, Benjamin Saunders, Veronica Voloshinov, and Eric Tesoriero. Restructuring of sections and updates reflecting the new officers in the Spring of 2010 were made by Peter Ragone. Additional changes during Fall 2010 and Spring 2011 made by Matthew Willett. A major reformatting and additional changes were made during Spring 2012 by Captain Jovan Cruz. A major update was made by Mark O‟Donnell to combine the Special Event SOPs, add First Response-59, new uniforms and ePCRs in the Fall of 2012.
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SOP 12-01 MISSION STATEMENT The mission of this agency is to provide Basic Emergency Medical Services to the Rensselaer Polytechnic Institute community, and to transport the sick and injured to definitive care. This includes, but is not limited to the following: 1. Develop standards, policies, and procedures pertaining to Emergency Medical Services in order to maintain proper operation of the RPI Ambulance. 2. Provide Basic Life Ambulance Service and Special Event Medical Services to the RPI community. 3. Conduct EMS Quality Improvement to improve the care provided by the RPI Ambulance. 4. Provide training and services to maintain and improve the agency‟s equipment and personnel resources. 5. Provide training to the Rensselaer community in order to improve the quality of first aid in the community and the world at large. 6. Request and provide reciprocal services in accordance to the existing provisions of the Rensselaer County Ambulance and Rescue Association Mutual Aid Plan in addition to any other Mutual Aid Plans that the agency becomes involved in.
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SOP 12-02 QUALIFICATION PROCEDURES - VOLUNTEER PERSONNEL APPLICATION PROCEDURES 1. Interested parties should obtain and complete, in its entirety, a hip form as supplied by the istrative officers of the agency. 2. hip is contingent upon the hip policies outlined in the Agency‟s Constitution. 3. Every member will resubmit a hip form to the istration of the Agency at the beginning of each academic year for the purpose of maintaining an up-to-date hip list. This can be done electronically on the Agency website.
ORIENTATION 1. Each new member shall participate in a hip Orientation as prescribed by the Training Committee. 2. The hip Orientation shall include the following items: a) RPI Ambulance History, Philosophy, and Structure b) RPI Ambulance Standard Operating Procedures and RPI Ambulance Constitution c) Risk Management d) Liability and Confidentiality e) Stress management/CISM f) Health and Safety as outlined below g) ePCRs, documentation, and Quality Improvement procedures h) Basic scene i) Basic call mechanics j) Working with other agencies
HEALTH AND SAFETY 1. All will undergo an annual training in-service on proper procedures on how to protect self and crew. This training will comply with and make use of the Agency Exposure Control Plan as maintained by the Captain or designated Coordinator. 2. The Captain and Training Committee will tly appoint instructors. 3. This training will include, but is not limited to, the following: a) OSHA Blood-borne and Airborne Pathogens b) Infection Control (Per OSHA-29 CFR 1910.1030) c) Personal Protective Equipment (PPE) d) NIOSH / N95 Healthcare TB Respirator Fit-Testing and usage e) Exposure Control Plan f) TB Testing and Documentation g) Hepatitis-B Vaccination or Refusal and Documentation h) Facilities safety (including Office, First Aid Rooms, Ambulance) i) Safety during responses j) Basic HAZMAT awareness training
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k) RPI Ambulance does not require its to undergo yearly physical examinations; however, it asks all to provide RPI Ambulance with a copy of or access to their immunization records to insure the safety of all crews and patients. 4. The instructor will generate documentation of yearly Health and Safety training and the istration will maintain this documentation in the person‟s permanent file.
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SOP 12-03 OPERATIONAL MEMBER TYPES INTRODUCTION In order to act as a volunteer for RPI Ambulance, the appropriate qualifications must be met and maintained for the duration of involvement with RPI Ambulance.
HIP REQUIREMENTS As stated in the Constitution, all are required to renew hip every semester by attending one General Meeting or providing written notice to the officer board. If a member fails to attend a General Meeting or provide written notice to the officer board, they will be removed from hip – all training previously completed will be filed, and, upon any reission to the agency, it will be the determination of the Captain and Lieutenants as to accepting that member's previous training paperwork or requiring new training.
ACTIVE HIP Active are the who participate regularly in Agency functions and regularly attend training drills and General Meetings. An Active member meets the following qualifications: 1. Has submitted a hip form as outlined in SOP 12-02. 2. Has completed the orientation program outlined in SOP 12-02. 3. Has completed appropriate annual health and safety training and testing as outlined in SOP 12-02 and the agency‟s Exposure Control Plan. 4. Has attended all required training drills or been excused by the Captain or Training Committee. 5. Has attended all required General hip meetings or been excused by the istration. 6. Has staffed one night crew or special event in the last month.
INACTIVE HIP Inactive are who are unable to meet all of the qualifications set forth for Active hip. Former who visit infrequently and who are unable to regularly attend agency drills and meetings should fall into this category. Only the Captain may change an Inactive member‟s status to Active. Conversely, it is the responsibility of the Captain to assure that any Active who do not meet all of the appropriate qualifications are changed to Inactive hip. An Inactive member must meet the following qualifications: 1. Has submitted a hip form as outlined in SOP 12-02. 2. Has completed the orientation program outlined in SOP 12-02. 3. Has completed appropriate annual health and safety training and testing as outlined in SOP 12-02. 4. Has staffed one night crew or special event in the last semester.
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ISTRATIVE HIP An istrative Member has been accepted by the hip through the guidelines set forth in the Agency Constitution, but does not ride actively as part of an EMS crew. There are no operational qualifications to be an istrative member. In addition, any member that does not qualify for Active or Inactive hip shall default to istrative hip until such time that all paperwork and training can be brought up to date. istrative do not have any Ambulance riding or event privileges. An istrative Member must meet the following qualifications: 1. Has submitted a hip form as outlined in SOP 12-02.
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SOP 12-04 TRAINING AND PROMOTIONS INTRODUCTION One of RPI Ambulance‟s primary missions is to further the training of its . competent, professional medical care. This policy seeks to guarantee both.
Another is to provide
TRAINING Training is to be regarded as a priority second only to patient care, and whenever possible, the two should be integrated. For specific qualifications and promotion requirements, please see the appropriate sections: Attendant SOP 12-06, pg. 17 Driver SOP 12-07, pg. 18 Crew Chief SOP 12-08, pg. 23 First Response Driver SOP 12-09, pg. 25 Event EMS Supervisor SOP 12-10, pg. 27 Duty Supervisor SOP 12-11, pg. 28 These requirements and qualifications are considered to be the minimum requirements for promotion. It is often expected that will do additional training and will be promoted when the Training Committee and Captain are satisfied that they hold the necessary skills required for the promotion. If there are concerns about the performance of a promotion candidate the Training Committee is to work with the individual to address the concerns.
TRAINING COMMITTEE The Captain shall establish a training committee, made up of as many as he sees fit. The committee should ideally contain a driver trainer, a crew chief trainer and a senior duty supervisor. The Captain may or may not serve on the committee. The Captain may not be the only member of the Training Committee except with the express permission of both Lieutenants. Once established, removals and additions to the Training Committee must be approved by at least 50 percent of the committee as well as the Captain, or by the unanimous decision of the Captain and both Lieutenants. Additionally, once established, the Training Committee must elect a chairperson who will be the face and responsible party of the Training Committee; issues that need to be brought to the Training Committee or issues arising from the committee should through this individual. The Training Committee shall be responsible for overseeing all training curricula (including all training documents and the scheduling of classes) and shall also stand as the promotional board when necessary and applicable. Ideally, the committee should meet on a weekly basis, and report back to the Captain fortnightly, or as frequently as necessary.
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PROBATIONARY TRAINING A member who is considered a probationary in a position may act in that position provided there is a trainer for that position on the crew. The trainer should make every attempt to be with the trainee during the course of the call. Notable exceptions may include the transport to the hospital, where the trainer and trainee may be separate briefly. A probationary and a trainer satisfy the requirements for a crew.
TRAINERS The individuals entrusted with the training of other individuals in the Agency shall maintain Active hip status. These trainers will be experienced credentialed within the agency for the position they will train. For example, someone who is experienced enough to be a Driver Trainer may not necessarily be a Crew Chief Trainer. Trainers are appointed by the Training Committee. Consideration of appointees will not only consist of individuals‟ qualifications within a specific area of credentialing, but also of their ability to teach and train effectively.
PROMOTIONAL BOARDS: STRUCTURE The Promotional Board is a vehicle used by of RPI Ambulance to progress through the ranks of the organization‟s credentialing structure. The promotional board shall consist of: 1. Training Committee 2. Captain The Promotional Board shall be chaired by the Training Committee Chairperson, except in the case of that individual‟s promotion, when the Captain shall act as the Promotional Board Chair. The training committee and Captain shall also establish a list of promotional board alternates to serve on the board in the case of a conflict of interest. It is understandable that not every member of the promotional board will have been involved with all aspects of a candidate‟s training. Therefore, any member is invited to speak for or against the candidate at the Promotional Board as this is a time for the promotional board to learn about a candidate‟s skills and competencies. may speak about any aspect of the candidate but it is the chair‟s duty to ensure that comments remain relevant and respectful (i.e. personal attacks should not be tolerated). During the voting portion, only the actual of the promotional board may be present. While the candidate is present, the Promotional Board should take the opportunity to ask relevant questions of the candidate about his or her competency in the position applied for. Outlandish questions and inappropriate attitudes are not acceptable.
PROMOTIONAL BOARDS: VOTING After the chair has presented the candidate for promotion, and when there are no more questions for the candidate, the candidate will be asked to leave the room. The candidate will comply. The chair is the parliamentarian for the voting proceedings. Any and all discussion behind closed doors is understood to be confidential and will not be discussed with anyone. After discussion is complete to the satisfaction of the chair, the of the Promotional Board will vote on the candidate.
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Voting will not take place by secret ballot. At least two-thirds of the Promotional Board must give a “yes” vote of confidence for the candidate to and be credentialed in the position applied for. No abstentions are acceptable. with a potential conflict of interest should not be on the promotional board, and an alternate should be present as outlined above. Thus, a conflict of interest is not a valid excuse for an abstention. After the completion of the vote, the candidate will be called back into the room by the of the Promotional Board and advised by the Chairperson of the result. Any member who voted “no” should be prepared to outline what additional demonstration of competence they would like to see before they would a “yes” vote. This should be done both in writing and verbally. The candidate shall have the right to ask for a clarification of requests. This is to give the candidate a fair opportunity to improve in weak areas and become a more viable candidate for the next promotional board that they petition. Both promotion approvals and non-approvals will be logged in a “Promotional Board Log” that will contain every attempt for promotion made by all . This log will also contain dates of promotion to be used for determining eligibility for promotion to trainer (i.e 4 months of in-service).
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SOP 12-05 OBSERVERS AND OBSERVERS RIDE-ALONG OBSERVER The Ride-Along Observer position is for non- who are interested in riding on an Ambulance Crew for observational and/or informational purposes. The Ride-Along observer need not have any qualifications, but must adhere to the following guidelines: 1. Be briefed in RPI Ambulance SOPs, Patient Confidentiality, Risk Management, and Infection Control/OSHA. 2. The Ride-Along Observer will not engage in providing patient care of any kind. 3. At the discretion of the Crew Chief, the Ride-Along Observer may be asked to sit in the cab compartment while patient care is being extended. 4. If the number of people on board the Ambulance becomes too large (with ALS providers, multiple patients, family/friend of the patient, etc.), the Ride-Along Observer may be left at the scene by the Crew Chief. If this happens, every effort will be made to assure that someone can bring the RideAlong Observer to the destination to meet up with the Ambulance. 5. The Ride-Along Observer will sign a form effective for a specified amount of time (to be indicated on the form) agreeing to all of the above. In addition, the form shall indemnify and hold harmless RPI Ambulance, Rensselaer Polytechnic Institute, and all of its and subsidiaries from any liability in the event of injury, illness, or death.
OBSERVER The Observer shall be an Active or Inactive member who desires to ride on an Ambulance Crew for the purpose of gaining experience, training, or otherwise familiarizing oneself with the operations of RPI Ambulance. The Observer: 1. Shall assist in patient care as requested by the Crew Chief and will act only under the direction of the Crew Chief. 2. May be asked to sit in the cab compartment by the Crew Chief while patient care is being extended. 3. If the number of people on board the Ambulance becomes too large (with ALS providers, multiple patients, family/friend of the patient, etc., the Observer may be left at the scene by the Crew Chief. If this happens, every effort will be made to assure that someone can bring the Observer to the destination to meet up with the Ambulance.
OBSERVER TRAINING As this is an entry-level position, there is no formal requirement and no training needed except for that which is required to become a member of RPI Ambulance as stated in SOPs 12-02 and 12-03. This is meant to be a temporary position. The goal of all Observers is to become an Ambulance Attendant. It is expected that Observers begin Attendant training before their third night crew.
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SOP 12-06 AMBULANCE ATTENDANT INTRODUCTION The Ambulance Attendant shall be an Active or Inactive member who rides on an Ambulance Crew for the purpose of assisting the Crew Chief with patient care as well as for the purpose of gaining further experience and training in EMS. The Ambulance Attendant shall: 1. Be familiar with the location, use, and function of all medical equipment on board the Ambulance 2. Possess a working knowledge of RPI Ambulance Standard Operating Procedures 3. Be familiar with safe techniques for lifting and moving of patients using common equipment
TRAINING It is highly recommended that the Ambulance Attendant trainee will begin their formal training with a class provided by RPI Ambulance that will cover the basics and requirements. The Ambulance Attendant should also practice their skills and knowledge when they are on a crew, with the help and guidance of the Crew Chief in order to increase the knowledge of the trainee and to build Crew Chief‟s confidence in the trainee. The trainee is also encouraged to attend as many training drills as possible as they are a good source of knowledge and additional training.
PREREQUISITES 1. Be a member of RPI Ambulance
PROMOTIONAL REQUIREMENTS 1. 2. 3. 4.
Hold a Professional Rescuer R certification. Complete the Attendant Checklist as prescribed by the Training Committee. Complete the Ambulance Equipment Checklist. Actively participate in at least one (1) call or two (2) simulated calls and receive a ing evaluation from the CC. 5. Optional: Attend the RPI Ambulance Attendant Training Class. 6. Receive a recommendation for promotion from a Crew Chief.
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SOP 12-07 AMBULANCE DRIVER INTRODUCTION The driver of the ambulance holds a critical position in the care and treatment of the patient. It is the driver‟s responsibility and obligation to deliver the crew and ambulance to the scene in a safe manner, to facilitate transport of the patient into the ambulance, to transport the patient and crew while maintaining a suitable working platform for effective patient care, and to return the crew to quarters or to another suitable drop off point in a safe and professional manner. The ambulance is a moving representative of RPI Ambulance, and the Rensselaer Polytechnic Institute community, Therefore the safe and professional operation of the vehicle are paramount to conveying a positive image of both RPI and RPI Ambulance. Any individual who drives the ambulance must be properly credentialed as an RPI Ambulance Driver or must be a valid Driver Trainee with a Driver Trainer present, as described in SOP 12-07.
GENERAL DRIVING PROCEDURES During all travel of the ambulance, including, but not limited to, travel to dinner or a class meeting, Priority II operation or Priority I operations, the driver will adhere to the following rules: 1. A spotter must be used at all times whenever backing the ambulance. 2. Anyone sitting in any compartment of the ambulance must wear a seat belt anytime the vehicle is in motion or in traffic. During patient care, providers in the rear compartment may remove their seatbelts only if absolutely required. 3. Any non-member engers should ride in the front compartment of the ambulance and wear their seat belt at all times when the vehicle is in motion. In cases of pediatric patients or other special cases where the enger calms or soothes the patient, the enger may ride with the patient but must always wear their seat belt while the ambulance is in motion. 4. Headlights are to be used at any time the ambulance is in motion. 5. Respond to all calls in accordance with SOP 12-14 6. Return from the hospital in Priority II mode. 7. Transport from the scene to the hospital at the response level designated by the Crew Chief. 8. Leave the ambulance engine running in high idle at all times during a call until arrival at the hospital 9. Upon arrival at the hospital, shut down the engine prior to unloading the patient.
EMERGENCY DRIVING PROCEDURES When the ambulance is being operated in Priority II mode, as defined in SOP 12-14, the driver will always adhere to NYS Vehicle & Traffic laws. When the ambulance is operated in Priority I mode, as defined in SOP 12-14, the Ambulance Driver will adhere to the following rules in addition to the above and to NYS Vehicle & Traffic laws: 1. A complete stop is mandatory before proceeding with caution at all red lights, stop signs, and railroad crossings, regardless of response level. 2. If using the median, turning lane, or a lane of opposing traffic to enter an intersection, come to a complete stop before proceeding with caution. 3. Come to a complete stop at all times for any school bus either in the same lane or in the opposing lane with flashing red lights displayed. 4. Do not exceed posted speed limit by more than ten (10) miles per hour at any time.
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5. Do not exceed posted speed limit at any time when ing through an intersection with the green light. 6. When traveling in a lane of traffic in an opposing direction, do not exceed 20 mph. 7. Leave warning lights (no less than secondary lights) on if the ambulance is stopped on or at the edge of a roadway, or if the ambulance will interfere with traffic, or at any time that the warning lights will increase scene safety for EMS personnel.
DRIVER‟S DUTIES 1. Duties during a Scheduled Duty Crew: a) Complete an RPI Ambulance Vehicle/Mechanical checklist once per shift b) Notify the Duty Supervisor of any problems or discrepancies c) If possible, and if the Crew Chief consents, familiarize self and crew with areas of our Primary Territory and response areas d) Drive crew where they need to go in a safe manner 2. Duties during a Call: a) Be sure that the ambulance is clear of personnel and other obstructions or dangers, and that all exterior doors are closed before getting into the driver‟s seat b) that all ambulance personnel are in secure positions before moving the ambulance c) Upon starting the ambulance that all gauges and operation indicators are within nominal ranges, especially fuel level and oil pressure d) Drive to the scene in a safe and efficient manner at an appropriate level of response e) Park at the scene in a position to provide optimal access to the patient while maintaining scene safety. f) Leave the vehicle running at all times while on scene g) Assist the Crew Chief in providing care on scene as needed h) Upon arrival at the hospital, turn off the ambulance and assist the crew in unloading the patient from the patient compartment i) Assist the crew in transferring the patient to the hospital bed 3. While at the hospital, the following driver‟s duties are to be done in the following order, highest priority first: a) After the patient is unloaded, return to the ambulance and shut off any non-essential items (especially A/C, heat) b) Clean and disinfect the ambulance as appropriate per the RPI Ambulance Exposure Control Plan. c) Get the stretcher ready for service d) Ensure that the ambulance is still within NYS Part 800 equipment parameters e) Rensselaer County Dispatcher by phone to obtain dispatch times and run number as needed by the crew chief f) Assist the Crew Chief as requested
SPOTTERS To reiterate the previously stated policy, whenever the ambulance is in reverse, all drivers must use a spotter in order to maintain a safe service and a professional looking ambulance.
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To properly spot the vehicle when it is backing up, the spotter should stand approximately 10 feet behind the ambulance on the driver‟s side. The driver should be able to see the spotter at all times and must stop if the spotter moves to a position where they cannot be seen. Conversely, the spotter should be able to see the driver‟s mirror at all times as well. The spotter should look out for obstacles and indicate that it is safe to continue in reverse with a left-handed “come here” motion, palm facing the spotter. To indicate that it is unsafe to continue or that there is an obstacle in the path of the vehicle, the spotter should make a fist with his or her left hand with the palm side facing the driver. There are situations where using an external spotter is impossible. These situations are: 1. When backing into the hospital Emergency Department 2. During the reverse phase of the cone course. In these two circumstances only, it is permissible for a vehicle occupant in the patient compartment (i.e. the Crew Chief on a call, or the observing trainee in the cone course) to go to the tailgate end of the crew bench and look out the back windows the entire time the vehicle is in reverse to be on the lookout for any obstacles, pedestrians, or other items that would present a hazard to the ambulance.
BACK-UP ALARM Use common sense when using the back-up alarm. When backing without an external spotter, it must be used. However, if an external spotter is used, and a loud alarm is not advisable (e.g. backing up near residences late at night, backing up at the garage after dark, etc.,) the back-up alarm may be temporarily deactivated. Unless scene safety considerations prohibit its use, the back-up alarm should be used on all emergency scenes and when backing at the hospital.
TRAVEL LIMITS It is the driver‟s duty to ensure a speedy response to any incident on campus. As such, the driver will be responsible for assuring the Ambulance is never too far from campus to respond in a safe and efficient manner. As a minimum, the following boundaries should never be crossed, except on a properly dispatched mutual aid call: North: An east-west line even with TFD station 1 (115th St) East: A north-south line even with McDonald‟s restaurant on Hoosick St. South: An east-west line even with TFD station 6 (Canal Ave) West: The Hudson River It is also recommended that unless there is a specific reason for travel to the above limits, such as food or training, the ambulance should remain as much as possible in the area immediately around the campus. This, however, is left to the discretion of the driver so long as he or she can ensure a safe and efficient response.
WINTER DRIVING Before drivers (trainees, probationary or full) are permitted to drive under winter conditions, they must gain the approval of a driver trainer. Driver trainers will take the trainee on snow/ice covered roads where there are little to no hazards and must demonstrate appropriate safe operation in those conditions. The purpose of this training is to demonstrate the difference in handling of the vehicle in winter conditions including but not limited to: braking distance, up and down hill operation, traction, maneuverability and visibility.
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TRAINING PROBATIONARY DRIVER The Driver trainee will begin their formal training with a class provided by RPI Ambulance that will cover the basics of what is required.
PREREQUISITES 1. Trainee must be an RPI Ambulance Attendant and hold an active R certification
PROMOTIONAL REQUIREMENTS 1. Must possess a NYS Class D License or equivalent. 2. Attend an RPI Ambulance emergency vehicle training class to include: a) Call Dynamics b) Standard Operating Procedures c) Applicable Laws d) Basic Practical Orientation 3. Complete Driver Check Sheet and Vehicle Maintenance Sheet 4. Successfully Driver Practical Exam st 5. Successfully the cone course prescribed by the 1 Lieutenant 6. Complete 5 hours of driver training as a third person with a qualified driver trainer and complete driver log sheet to the Training Committee or the Captain which will be kept on file. 7. Drive two (2) Priority-II calls and receive ing evaluations from a trainer 8. Drive two (2) Priority-I calls and receive ing evaluations from a trainer 9. Receive recommendation to become a Probationary Driver from Trainer 10. Receive t approval of the Captain and Training Committee
DRIVER PREREQUISITES 1. Must be a Probationary Driver
PROMOTIONAL REQUIREMENTS 1. Complete and one (or more) of the following emergency vehicle operator courses, with documentation kept on file by the Training Committee: a. Coaching the Emergency Vehicle Operator (CEVO) Ambulance b. Emergency Vehicle Operator Course (EVOC) c. In House – Emergency Vehicle Defensive Driving (EVDD) 2. Must complete the following FEMA sponsored classes: a. IS-100: Introduction to the Incident Command System (ICS) b. IS-200: Basic ICS c. IS-700: National Incident Management System (NIMS) d. IS-800: National Response Framework 3. Complete a driving tour of the Albany area hospitals with a trainer 4. Drive two (2) calls as a Backup Driver and receive ing evaluations from a Trainer.
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5. Receive recommendation for promotion to become a Full Driver by Trainer. 6. Receive approval by the Promotional Board
DRIVER TRAINER PREREQUISITES 1. Must be an RPI Ambulance Driver
PROMOTIONAL REQUIREMENTS 1. 2. 3. 4. 5. 6.
Be a Driver for 4 months while the ambulance is in service Drive three (3) EMS calls Assist in teaching an RPI Ambulance Driver or EVDD class under the supervision of a Driver Trainer Request to become a trainer Receive recommendation for promotion from a Trainer Receive t approval of the Training Committee and the Captain
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SOP 12-08 AMBULANCE CREW CHIEF INTRODUCTION The Crew Chief is the leader of the Ambulance Crew. The New York State Department of Health mandates that there must be at least one current NYS EMT providing patient care in the patient compartment of the ambulance in accordance to NYS BLS protocols. The RPI Ambulance Crew Chief has been trained not only in Basic Life treatment of emergency patients, but also in how to appropriately handle situations that may arise during any phase of operations. This includes, but is not limited to: dealing with problematic patients, decision-making, MCI‟s, and interacting with other agencies. The Crew Chief is directly responsible for the conduct and appearance of the Ambulance Crew. All of the Ambulance Crew should feel comfortable communicating any questions they may have to the Crew Chief. The Crew Chief may not necessarily be the highest medical authority on scene, but at RPI Ambulance, the Crew Chief is procedurally in charge. Any individual who acts in the capacity of Crew Chief must be properly credentialed as an RPI Ambulance Crew Chief or must be a valid Crew Chief Trainee with a Crew Chief Trainer present. As such, any person acting as the Crew Chief must meet the qualifications as set forth in SOP 12-08.
GENERAL PROCEDURES 1. If the Crew Chief does not feel comfortable with a situation, a member, or is uncertain how to handle a predicament, they should the Duty Supervisor. 3. If a disagreement between RPI Ambulance and an ALS provider exists, the Crew Chief will put aside any personal or agency differences and make decisions based in the best interest of the patient. 4. If a disagreement between RPI Ambulance and another EMS agency, dispatch center, Public Safety Authority, or other official exists, the Crew Chief will not act on behalf of the agency in solving the problem but rather will act in the best interest of the patient. The Crew Chief will also immediately notify the Duty Supervisor, who will evaluate the situation and decide how best to handle it. 5. Maintain communications with any/all appropriate dispatch center(s) throughout operations, either alone or by designating another crewmember. The Crew Chief is responsible for all of these radio communications, though another member may use the radio with the express consent of the Crew Chief. 6. Maintain control of the Ambulance Cellular Phone. No member may use the phone without the permission of the Crew Chief.
CREW CHIEF‟S DUTIES 1. Duties during a scheduled Duty Crew: a) Make sure that an Ambulance and First Response Vehicle Equipment Checklist is completed by the Crew. b) Report any discrepancies or problems to the Duty Supervisor. c) Make sure that any vacancies on the crew are filled to assure that all who want to ride crews are able to do so in a timely manner. d) If possible, provide training opportunities for the rest of the Crew. e) Maintain Crew morale and try to accommodate the wishes of the Crew. f) If a Crew member needs to study while on a duty crew, this will take precedence over driving around and other endeavors. We are students first. 2. Duties during a Call:
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a) Confirm that there is a crew, and try to include trainees on the call. b) Advise the Ambulance Driver of the appropriate level of response to the scene if different from the standard. c) Respond to the scene in accordance with SOP 12-14 d) During travel to the scene, plan ahead for any equipment or additional resources (e.g. fire apparatus, Hazmat Unit, additional Ambulances) that may be needed. e) Upon arrival, notify appropriate dispatcher(s). f) Prior to egress from the vehicle to the scene, the Crew Chief will assess the scene for safety and advise the Ambulance Crew of how to appropriately protect themselves from any hazards that may be present. The Crew Chief is responsible for the safety of the crew at all times. g) The Crew Chief will be in charge of all patient care and will act as the interface between the RPI Ambulance Crew and a provider of a higher level of care. h) The Crew Chief will attempt to allow other to train in positions they are attempting to gain RPI Ambulance credentialing in (e.g. Crew Chief, Attendant) within their level of credentialing (i.e. if the Crew Chief is also a Crew Chief Trainer). i) Provide BLS care at the level that RPI Ambulance is certified to provide. j) Select the appropriate patient carrying device and use it to bring the patient to the ambulance. k) Transport to a Hospital Emergency Department in accordance with SOP 12-15. l) While en route to the medical facility, provide medical care as appropriate. m) Use the Ambulance VHF Radio to the Emergency Department with the following information: i. Age and gender ii. Chief complaint iii. History of chief complaint iv. Pertinent past medical history and medications v. Pertinent vital signs vi. Treatment rendered by this agency and others (i.e. Oxygen by RPI, IV by TFD) vii. Estimated time to arrival n) Upon arrival at the medical facility, shut down any nonessential ambulance items. (E.g. dome lights, heat or A/C, vent, etc. o) Give a report to the appropriate Emergency Department staff member. p) If at a hospital ER, assist the registration clerk in obtaining patient information and try to get a face sheet. q) Complete paperwork, obtain times and numbers, and notify appropriate dispatch center(s) that the ambulance is available for the next call. r) that the Driver has prepared the ambulance for the next call. s) Leave the medical facility in a reasonable amount of time and return to service as appropriate.
TRAINING The position of Ambulance Crew Chief is the highest credentialed position in the Ambulance Crew. Becoming an Ambulance Crew Chief involves not only medical proficiency, but also thorough knowledge of all Operating Policies and an ability to lead the crew effectively. The Crew Chief Trainee should, while training, act in the capacity of Crew Chief to the best of his or her ability. The training period is a time to gain experience with a trained Crew Chief on board. The Crew Chief Trainee is encouraged to attend as many drills as possible as they are a good source of knowledge and training.
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PROBATIONARY CREW CHIEF PREREQUISITES 1. Trainee must be an RPI Ambulance Attendant 2. Host current certification as a NYS EMT-Basic or higher (no other state is acceptable) 3. Maintain active R for Healthcare Provider certification
PROMOTIONAL REQUIREMENTS 1. Attend an RPI Ambulance Crew Chief training class to include: a) Call Dynamics b) Standard Operating Procedures c) PCR writing 2. Crew Chief 1 simulated call 3. Complete PCR writing class 4. Complete Crew Chief checklist 5. Complete 1 mock call w/ ing evaluation from CC Trainer before taking a real call. 6. Crew Chief 2 calls with a crew chief trainer in the patient compartment and receive ing evaluations for both. 7. the practical exam, including PCR writing 8. Receive recommendation for promotion by Crew Chief Trainer 9. Receive t approval of the Captain and Training Committee
CREW CHIEF PREREQUISITES 1. Must be a Probationary Crew Chief
PROMOTIONAL REQUIREMENTS 1. Must Crew Chief 2 calls as a Probationary Crew Chief, receive a ing evaluation and be recommended for promotion by a Crew Chief Trainer. 2. Must complete the following FEMA sponsored classes: a) IS-100: Introduction to the Incident Command System (ICS) b) IS-200: Basic ICS c) IS-700: National Incident Management System (NIMS) d) IS-800: National Response Framework 3. Must student-teach one training course or drill and submit an evaluation form a) This training drill must be approved and supervised by the training committee b) The purpose of this course is to demonstrate proper training skills while teaching an advanced topic to other of the agency. 4. Receive recommendation for promotion from a Trainer 5. Receive approval by the Promotional Board
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CREW CHIEF TRAINER PREREQUISITES 1. Must be an RPI Ambulance Crew Chief
PROMOTIONAL REQUIREMENTS 1. 2. 3. 4. 5. 6.
Be a Crew Chief for 4 months while the ambulance is in service Crew Chief 3 emergency or non-emergency calls Assist in teaching a Crew Chief class Request to become a trainer Receive recommendation for promotion from a Trainer Receive t approval of the Training committee and Captain
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SOP 12-09 FIRST RESPONSE DRIVER INTRODUCTION The responsibility of the First-Response Driver is to drive First Response-59 safely to the scene of an EMS call, from headquarters to the garage or to the location of a special event. The job of First Response Driver is very different from that of Ambulance Driver; therefore the responsibilities and requirements are different. This position is an additional certification of for RPI Ambulance Crew Chiefs and Drivers rather than an individual qualification.
RESPONSIBILITIES The First Response Driver will perform a vehicle and equipment checklist at the start of every shift. He/She will also be responsible for the security, care and upkeep of the vehicle for the duration of the shift.
GENERAL DRIVING PROCEDURES During all operation of the first response vehicle the following procedures will be adhered to: 1. A spotter must be used at all times whenever backing the vehicle. 2. The driver and all engers in the first response vehicle shall wear a seatbelt at all times during any operation of the vehicle. 3. Headlights are to be used at any time the vehicle is in motion. 4. Respond to all calls in accordance with SOP 12-14. 5. The First Response Driver will adhere to the Travel Limits and Winter Driving rules designated in SOP 12-07 6. Every effort should be made to have a Crew Chief with the vehicle in the event that it is flagged down for assistance.
EMERGENCY DRIVING PROCEDURES 1. When the first response vehicle is being operated in Priority II mode, the First Response Driver will always adhere to NYS Vehicle & Traffic laws. When the first response vehicle is operated in Priority I mode the First Response Driver will adhere to the following rules in addition to the above and to NYS Vehicle & Traffic laws: a. A complete stop is mandatory before proceeding with caution at all red lights, stop signs, and railroad crossings, regardless of response level. b. If using the median, turning lane, or a lane of opposing traffic to enter an intersection, come to a complete stop before proceeding with caution. c. Come to a complete stop at all times for any school bus either in the same lane or in the opposing lane with flashing red lights displayed. d. Do not exceed posted speed limit by more than ten (10) miles per hour at any time. e. Do not exceed posted speed limit at any time when ing through an intersection with the green light. f. When traveling in a lane of traffic in an opposing direction, do not exceed 20 mph. 2. Leave warning lights (no less than secondary lights) on if the vehicle is stopped on or at the edge of a roadway, or if the ambulance will interfere with traffic, or at any time that the warning lights will increase scene safety for EMS personnel.
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3. If the emergency lights are left on at the scene, the vehicle‟s engine should remain running. 4. Should the vehicle be left on scene during a transport to the hospital, the vehicle should be moved out of the roadway to a safe parking spot, the lights and engine shut down and the vehicle locked and secured. The vehicle should be retrieved as soon as possible after returning from the hospital.
TRAINING PREREQUISITES 1. Be an RPI Ambulance Crew Chief or RPI Ambulance Driver 2. Hold a valid NYS Class D driver‟s license or equivalent
PROMOTIONAL REQUIREMENTS 1. 2. 3. 4. 5.
Perform a First Response-59 equipment and a vehicle checklist Log 5 hours of driving time in First Response-59 under the supervision of a Driver Trainer the First Response-59 cone course the RPI Ambulance Driver Practical Exam in either 5939 or FR-59 Drive at least two (2) calls with at least one call being a priority 1 call, in either 5939 or FR-59 under the supervision of a Driver Trainer 6. Request promotion to First Response Driver 7. Receive t approval from the Training Committee and Captain
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SOP 12-10 EVENT EMS SUPERVISOR S INTRODUCTION Event EMS Supervisors (EES) are qualified Crew Chiefs who manage personnel and resources at RPI Ambulance Special Events. EES are trained in the supervision multiple field crews during large special events, proper radio procedure and inter-agency operations and incident management. They are also capable of treating and calling for the transport of patients.
TRAINING Event EMS Supervisors (EES) should be trained in and show proficiency in the following skills: 1. 2. 3. 4. 5.
Large scale event and personnel management Radio communications Decision making under stressful situations Working with other agencies and organizations Patient care
PREREQUISITES 1. Be an RPI Ambulance Crew Chief
PROMOTIONAL REQUIREMENTS 1. Be the EES- In Charge of two (2) events under the supervision of an EES and receive a ing evaluation 2. Complete the EES checklist. 3. Request promotion to EES from the Captain and Training Committee.
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SOP 12-11 DUTY SUPERVISORS INTRODUCTION In the EMS field, many problems exist, from operations to interpersonal conflict. The position of Supervisor is created to provide easy access to an experienced member who can act in the capacity of Crew Chief or Driver if the need arises. The Supervisor also acts as a screen to the Captain so that matters that can be resolved by the Supervisor don‟t need to unduly tie up the Captain. The position of Supervisor is not a Credentialed Promotion, and as such, it does not fall under the auspices of Training Committee.
QUALIFICATIONS The Supervisor Shall: 1. Be currently credentialed as a Crew Chief Trainer, Driver Trainer, First Response Driver and Event EMS Supervisor by RPI Ambulance 2. Maintain at least 70% compliance in agency QI as a Crew Chief. 3. Have completed an interview with the Captain testing the knowledge of RPI Ambulance operations, Standard Operating Policies, Mutual Aid, and the geography of Rensselaer County and Surrounding Areas. 4. Be appointed by the Captain with input from other Line Officers and other Supervisors after the successful completion of the aforementioned interview.
DUTIES All Supervisors: 1. Will act as the scheduled Duty Supervisor for at least 24 hours per week. 2. Must remain within radio range of RPI Public Safety, the Rensselaer County Dispatcher, and the Ambulance, and will be able to establish communication to the Ambulance Crew via Cellular Phone during their on duty time. 3. Must carry appropriate Supervisor Identification while on duty. 4. Should notify the appropriate officer in the proper time, if the Supervisor notices anything that requires st attention from that officer. For example, the Captain and 1 Lieutenant need to know right away that the Ambulance has a flat tire, whereas the Training Committee could probably be notified in the morning if one of the R manikins is broken. 5. Will act in an appropriate manner at all times while acting on behalf of RPI Ambulance. 6. Will not take over care of a patient, driving responsibilities, or any other duties of the crew unless patient or crew safety is in jeopardy. 7. Will file incident reports as necessary to maintain proper documentation of incidents. 8. The On-Duty supervisor is expected to assist the responding ambulance in the following situations: a. MCI- Any incident that involves more than 2 patients or in which there are patients in excess of the available resource b. Any rescue incident that would involve a crew being on scene an anticipated time exceeding 20 minutes c. Any incident where crowd control may cause an issue to the responding units. This includes but is not limited to fraternity houses and large events d. Any incident where ALS is requested, where an ALS unit is not available for immediate response
Mark H. O‟Donnell, Captain
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RPI Ambulance Standard Operating Procedures
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GRIEVANCES Any grievance with a Supervisor or the actions of a Supervisor will be forwarded as soon as possible, to the Captain, who will investigate the matter fully. If an individual does not feel comfortable approaching the Captain, another Supervisor may be notified of the grievance or the member may the Grievance Committee of RPI Ambulance. Care should be taken to avoid a rumor mill when dealing with such grievances as matters can quickly be blown out of proportion. Always try to use the proper communication channels. If the Captain feels that the grievance has merit, the Captain will attempt to mediate any dispute between the involved parties. If one or both parties are unsatisfied with this approach, the matter will follow SOP 12-25 for grievances and appeals.
Mark H. O‟Donnell, Captain
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RPI Ambulance Standard Operating Procedures
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SOP 12-12 COORDINATORS INTRODUCTION To assist in the completion of their jobs, the line officers of RPI Ambulance are empowered to appoint coordinators. This gives the coordinator selected powers that the appropriate officer may have while still referring all responsibility for the job to the appropriate officer. Some specific positions follow.
QI COORDINATOR The Quality Improvement Coordinator coordinates the completion of QI audits and tabulates the data and reports to the Captain. The QI Coordinator and/or the Captain represent RPI Ambulance at meetings of the Rensselaer County QI Committee. If desired, the Captain may elect to act as the QI coordinator. The QI coordinator is responsible for ensuring compliance with the Rensselaer County QI program and thereby the Region and State program. The Captain and QI coordinator should periodically review the Rensselaer County QI program to evaluate its effectiveness to RPI Ambulance and to ensure it meets all State and Regional requirements.
R COORDINATOR The R Coordinator is in charge of coordinating R events sponsored by RPI Ambulance and reports to the Training Committee. The R Coordinator need not be a R Instructor but instead assures that instructors are available to hold scheduled R training. The R Coordinator should work closely with the Training Committee and the Vice-President. If desired, the Training Committee may elect to act as the R coordinator.
Mark H. O‟Donnell, Captain
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RPI Ambulance Standard Operating Procedures
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SOP 12-13 UNIFORMS INTRODUCTION In an effort to gain respect and convey a professional manner to the community, RPI Ambulance has established different categories of uniform standards. This will provide continuity and an easy way to communicate the appropriate uniform to of a Duty Crew.
PATCHES RPI Ambulance patches will only be worn the black duty uniform shirt or red RPI Ambulance jacket. The RPI Ambulance agency patch will be worn on the left shoulder. NYS DOH certification patches of the “Excelsior” design with tombstone shape and navy blue background will be worn on the right shoulder. If a member does not hold NYS DOH certification, a 2 inches x 3 inches American flag patch with gold border or NYS DOH “Emergency Medical Services” tombstone patch may be worn on the right shoulder. No other patches may be worn on any part of the uniform.
PINS, COLLAR BRASS, BADGES Any pin to be worn on the RPI Ambulance uniform must be approved by the Captain. The Captain has the right to ask a pin to be removed from any RPI Ambulance uniform. Officer and Supervisor badges may be worn with the Duty Uniform and carried with the Casual Uniform to serve as identification. In some cases, the different role we serve by being an EMS agency and not a Public Safety agency can play in important role in patient rapport. It is for this reason that we must keep a clear distinction between RPI Ambulance and other Public Safety agencies.
UNIFORM CLASSES DUTY UNIFORM This is issued uniform that is used by RPI Ambulance. It consists of: Black collared RPI Ambulance uniform shirt with black T-Shirt worn underneath for Crew Chiefs, Drivers and Officers Officer bars for line officers, officer pins for istrative officers, silver caduceus for non-officers Red “Trainee” polo for attendants, ride-along observers, observers, and trainees Black slacks or black EMS-style pants Black belt with silver or black buckle No dangling earrings or jewelry Black, shined, closed-toe shoes or boots. No high heels. Black socks (if socks visible) RPI Ambulance approved red jacket (Seasonal)
Mark H. O‟Donnell, Captain
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CASUAL UNIFORM When not assigned to duty crews, RPI Ambulance may wear RPI Ambulance apparel such as t-shirts or sweatshirts with the RPI Ambulance name and logo on them. This apparel does not constitute any official uniform; as such, duty crews must be in the duty uniform. responding to calls while not on a scheduled duty crew do not have to wear the full Duty Uniform; however will wear the Casual Uniform. The Casual Uniform consists of: A plain neat un-torn shirt, preferably dark, if possible RPI Ambulance- or EMS oriented. fluorescent or obscene T-shirts are allowed. Neat, un-torn pair of pants, preferably dark. Jeans are fine but shorts are not permitted. Solid footwear. No open-toed shoes or sandals. No high heels. RPI Ambulance approved red jacket
Mark H. O‟Donnell, Captain
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RPI Ambulance Standard Operating Procedures
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SOP 12-14 DISPATCH AND RESPONSE PROCEDURES INTRODUCTION Rensselaer County Bureau of Public Safety is the official dispatcher for RPI Ambulance. All medical emergency calls originating on campus are transferred to the Rensselaer County Emergency Medical Dispatcher who assigns the priority determinant for the call and dispatches RPI Ambulance. All non-emergency medical calls originating on campus are transferred to Rensselaer County in the same fashion as the emergency calls from the Rensselaer County Dispatcher or from the RPI Student Health Center. Rensselaer County Emergency Medical Dispatcher will also dispatch RPI Ambulance for any mutual aid calls originating in the county. Rensselaer County can be reached via the following numbers: Emergency Number: 911 Non-Emergency Numbers: (518)-270-5252 / (518)-270-1037
RESPONSE LEVELS Priority II – 5939 or First Response-59 operation using no emergency lights or sirens, following all V&T laws. Synonyms: Routine, Code 2, Cold. Priority I – 5939 or First Response-59 operation using emergency lights and siren. Synonyms: Emergency, Code 3, Hot. NB: The driver has responsibility and liability for safe operation and must maintain compliance with RPI Ambulance driving procedures. The driver is personally liable for any injury or damage sustained during Priority I operation.
RPI AMBULANCE UNAVAILABILITY If RPI Ambulance is unavailable for a call the next available ambulance according to the mutual aid plan shall be called. This will happen in accordance with SOP 12-16 and the current dispatch plan with Rensselaer County Bureau of Public Safety.
EMS CALLS The county dispatcher will notify the of RPI Ambulance of the call, including nature and location, with the accompanying paging tones via the high band portables broadcast over frequency 155.220, heard on channel 1 (one) or 2 (two) of the RPI Ambulance high band portable radios. Calls received from the county dispatcher will include a determinant: Alpha determinant calls will be treated as Priority II as defined above. Bravo, Charlie, Delta, and Echo determinant calls will be treated as Priority I as defined above.
Mark H. O‟Donnell, Captain
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All radio communications between crew before, during and after the call should be done over RPI Ambulance high band radio (155.220MHz). Any communication to the Rensselaer County Dispatcher shall be done via the 800MHz system. If the Crew Chief or Driver is unable to the Dispatcher via the 800MHz system they may the Dispatcher via cellular telephone by dialing (518)-270-1037.
RESPONSE TO EMS CALLS NO SCHEDULED DUTY CREW 1. Upon notification of an EMS call, all efforts should be made to see that 5939 responds to the scene with a full crew. 2. If a First Response Driver qualified Crew Chief has been assigned to First Response-59 or can get to First Response-59 quickly, he/she may respond to the scene with the vehicle. The responding Crew Chief will advise other of his/her response via the high band radio and also the Rensselaer County Dispatcher via the 800 MHz radio. He/she shall make an effort to an Ambulance Driver to bring 5939 to the scene. As soon as the Crew Chief is sure that no Ambulance Driver is able to respond with 5939, he/she shall the Rensselaer County Dispatcher to request mutual aid for a transport. If the Crew Chief determines that the call is to be an RMA, he/she may cancel the transporting ambulance with the Rensselaer County Dispatcher 3. If there is an Ambulance Driver available, he/she should respond to the garage to bring 5939 to the scene. Any regular Crew Chief and any other may respond directly to the garage to respond with 5939. 4. If a full crew of a Driver and a Crew Chief cannot be raised, the responding crew may the dispatcher to have the call re-dispatched to complete the crew. 5. Trainees may respond to the garage to respond with 5939. No member other than an RPI Ambulance Crew Chief should respond directly to the scene of an EMS call unless they are already on scene.
DURING A SCHEDULED DUTY CREW 1. Upon notification of an EMS call, the on-duty Crew Chief or Driver shall acknowledge the call and confirm the crew with the Rensselaer County Dispatcher via the 800 MHz system. The on-duty Crew Chief may respond to the scene via First Response-59 if the rest of the crew has adequate means of transport to the garage that will not cause an undue delay in the response of 5939. The on duty Driver is responsible for responding to the scene with 5939. 2. First Response-59 may be used to convey the entire duty crew to the garage so that the crew may respond to the scene in 5939. 3. No member other than an RPI Ambulance Crew Chief should respond directly to the scene of an EMS call unless they are already on scene.
RESPONSE TO MUTUAL AID CALLS 1. First Response-59 should not respond to the scene of any mutual aid call if 5939 is available unless specifically requested by the Rensselaer County Dispatcher. 2. If 5939 is already on an EMS call and a mutual aid call is dispatched, a First Response Driver qualified Crew Chief may respond to the scene with First Response-59.
Mark H. O‟Donnell, Captain
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TRANSPORTATION CALLS RPI Ambulance may perform a non-emergency transport, (e.g. patient returning to campus after surgery) if requested, with the approval of the Captain. This is a service which should not be abused. An individual who is on crutches or able to ambulate with assistance does not need the services of an ambulance. If no other means of transport is available, RPI Ambulance will attempt to get a crew to transport the patient.
HAZARDOUS MATERIAL CALLS RPI Ambulance is not equipped or trained to handle Hazardous Material (Haz-Mat) situations. As such, no member may enter Haz-Mat scene until trained professionals have properly decontaminated it. The Crew Chief is responsible for ensuring the safety of the crew and should keep the crew back far enough to be away from the hazardous agent.
STAND-BY‟S AND MCI RPI Ambulance is a participant in Mutual Aid with other agencies who may call upon us as a resource in the event of multiple patient incidents (MCI), long standbys, etc. Response to these scenes will always be in Priority II mode with the exception of Fire Standbys. Lights and sirens will not be used to respond to these incidents unless there is a patient waiting for our services, in which case the incident is no longer a standby response, but begins a new PCR as an EMS call. If the dispatch entity requests RPI Ambulance to respond to an incident Priority I, then RPI Ambulance will do so if the Crew Chief feels comfortable with that judgment.
Mark H. O‟Donnell, Captain
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RPI Ambulance Standard Operating Procedures
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SOP 12-15 PATIENT TRANSPORT DESTINATIONS INTRODUCTION Patients are usually transported to the hospitals in Rensselaer, Albany, or Schenectady Counties. The only exception to this may occur when RPI Ambulance has responded to a mutual aid request and the usual receiving hospital(s) of the agency requesting mutual aid is substantially closer than one of the facilities in Rensselaer, Albany, or Schenectady Counties. The hospital destination, within the areas of Rensselaer, Albany, or Schenectady Counties, will depend on a variety of factors, including, but not limited to, patient medical condition, patient request, road and weather conditions, location of the patient‟s regular physician, and location of the incident. The patient will have final choice; however the crew chief should attempt to convince the patient to go to a local hospital. Under no circumstances will the a patient be transported to a hospital that is more than 20 minutes further distance than the nearest hospital according to the NYS BLS Protocols.
Any patient deemed to be in an immediately life-threatening situation will be taken to the nearest appropriate hospital. The appropriate hospital Emergency Departments are: 1. Samaritan Hospital ER, Troy, NY 2. Saint Mary‟s Hospital ER, Troy, NY 3. Ellis Hospital ER, Schenectady, NY 4. St. Clare‟s Hospital ER, Schenectady, NY 5. Albany Medical Center Hospital ER, Albany, NY 6. Saint Peter‟s Hospital ER, Albany, NY 7. Albany Memorial Hospital ER, Albany, NY 8. Stratton VA Medical Center ER, Albany, NY
UNUSUAL RECEIVING FA CILITY In an emergent situation, if a patient seeks transportation to a hospital outside the area to which the RPI Ambulance ordinarily transports patients, the patient will be informed of the RPI Ambulance receiving hospitals, the distances involved, and that no exceptions are made. If the patient refuses transportation, the “Refusal of Transportation” policy will be followed. The will inform the patient of the possible medical consequences of his/her action, and have the patient sign a refusal of transportation statement. If the situation is non-emergent and the patient or caller makes inquiry (e.g. the need to transport a nonambulatory stable patient), they shall be referred to the Empire Ambulance Service or Mohawk Ambulance Service.
Mark H. O‟Donnell, Captain
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RECEIVING FACILITY ON DIVERSION If crew gives a hospital as patient destination and the medical control physician at that receiving hospital feels that patient condition warrants transport to the nearest facility, the crew will inform the patient and any accompanying relative, and comply immediately with the medical control order. If once the patient is enroute to a certain hospital and that hospital medical control orders the ambulance to divert to another hospital, the crew will inform the patient and will do everything in their power to explain the reasons for the diversion. If the patient is alert, oriented and understands the reason for diversion but still refuses diversion from the hospital of choice; s/he will be asked to sign a refusal and will be taken to the original hospital destination. If, however, in the opinion of the highest trained member in attendance, the patient‟s request of hospital will cause further harm to the patient, the nearest appropriate hospital will be used. In all cases of diversion from the patient‟s hospital choice, the EMT will record the patient‟s request on the Prehospital Care Report and the reasons for transporting to the closest appropriate hospital. If a receiving hospital diverts the ambulance to another receiving hospital because of emergency room conditions as opposed to patient condition, the ambulance will divert if, in the judgment of the crewmember with the highest level of training, in consultation with medical control, it is determined that the patient condition is stable enough to warrant diversion. Under these circumstances the patient, whose condition is stable, is informed that the hospital has requested diversion for the reason stated. If the patient insists that s/he be taken to the originally requested hospital and the crew is unable to persuade the patient otherwise, the patient‟s hospital destination choice will be honored by the crew and the hospital informed of the reason that the ambulance will not honor their request for diversion. Generally, patients who are critical or unstable must be taken to the nearest facility.
HOSPITAL DESTINATION IN MUTUAL AID SITUATION In a mutual aid situation, if a hospital is substantially closer than the usual receiving hospitals, that hospital will be utilized. If communication with dispatch and/or the receiving hospital is impaired, a real possibility in some mutual aid instances, the crew will utilize all BLS and ALS standing orders as appropriate, and then follow the regional communication difficulty protocol. The destination hospital will be ed as soon as possible, either by radio or by cellular telephone. If in a mutual aid situation, in the rare instance the crew may be transporting a patient to a hospital other than RPI Ambulance usual receiving hospitals, if a diversion is requested, the crew will divert only if the diversion does not in any way, in the judgment of the highest trained crew member, compromise the patient.
TRANSPORT AND HOSPITAL DESTINATION OF MAJOR TRAUMA PATIENTS In a major trauma situation, where the crew deems appropriate, the nearest air medical service – helicopter (Usually Albany Med Flight or Lifeguard) will be requested. The crew will generally meet the helicopter at a mutually agreeable landing zone enroute to the hospital. Arrangements will be made through dispatch for the establishment of the landing zone by the appropriate Fire Department. If Air Medical Service is not available, in almost all instances the nearest hospital is the appropriate receiving facility. In the rare instance that the crew may be working in an area on a mutual aid request, the crew chief should keep in mind that Albany Medical Center is a designated trauma center, and may be the appropriate destination for patients meeting major trauma criteria as found the NYS BLS Protocols.
Mark H. O‟Donnell, Captain
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SOP 12-16 MUTUAL AID Under the Rensselaer County Mutual Aid Plan, RPI Ambulance and other Rensselaer County agencies have the ability to request Mutual Aid from each other under the following constraints:
Rensselaer County will maintain RPI Ambulance run number and response times in accordance with existing Rensselaer County Dispatch policies.
After being dispatched for a Mutual Aid call, RPI Ambulance will call the requesting dispatcher and request any information needed such as call location, directions, and patient status.
Upon arrival at the hospital, RPI Ambulance should call arriving the appropriate dispatcher‟s frequency notify the dispatcher that they are returning to RPI‟s frequency, and return to RPI Ambulance‟s primary frequency. Then, notify the Rensselaer County Dispatcher that RPI Ambulance is clear of the Mutual Aid call and back in normal dispatch procedures.
Mark H. O‟Donnell, Captain
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August 28th, 2012
SOP 12-17 OUT OF SERVICE INTRODUCTION By the nature of RPI Ambulance being college based it is recognized that there are periods when cannot commit to responding to a call. These may be times when all crew chiefs are in class, a period before a test, etc. In addition, during summer vacations when students are away, the may also be away and the service may be unable to respond. This policy seeks to address the issues regarding this lapse of service.
DAY TO DAY TURNOVERS While classes are in session, every effort is to be made by the to provide a quick response. This is to be done by having as many regular scheduled crews a possible and by communication among the regarding their absences and outside commitments. In cases where a crew is not available, the call will be turned over for mutual aid. This will be done by Rensselaer County Dispatch. If a full crew cannot be raised, the responding crew should request mutual aid as soon as it is known that a full crew is not en route to the ambulance. If a member does not acknowledge the call within 3 minutes, a crew cannot be confirmed within 6 minutes, or the ambulance is not enroute within 9 minutes, the call will automatically be turned over to mutual aid. All times are counted from the time of initial dispatch of the ambulance. In the case of a large incident, the dispatcher will signify so and will continue trying to raise a crew for as long as feasible.
EXTENDED PERIODS OF ABSENCE If the ambulance will be out service, for any period of time, the Rensselaer County Dispatcher should be notified of the absence so that RPI Ambulance is not dispatched for any calls during that period of time. If the ambulance will be out of service for a scheduled period of time (such as maintenance) all should be notified ahead of time (such as by email) and the Public Safety dispatcher should be notified by phone of the absence of service. This ensures that no time is wasted trying to raise an ambulance for a patient on campus when it is not available to respond. Any time the ambulance is taken out of service, an “Out-Of-Service” sticker should be placed over the NYS-DOH certification sticker.
Mark H. O‟Donnell, Captain
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SOP 12-18 SPECIAL EVENT PROCEDURES Special event medicine is a major aspect of the duties that RPI Ambulance performs on the RPI Campus. The following SOPs are the rules that define the operations of RPI Ambulance but should not supersede good clinical judgment of the supervisors and the crew. All New York State Department of Health (DOH) and Regional Emergency Medical Organization (REMO) rules and regulations should be followed.
SPECIAL EVENT COVERA GE REQUESTS nd
Upon receipt of a Request for medical Coverage at a Special Event, the 2 Lieutenant will check to see if there are enough available personnel willing to volunteer for the event. The request will be submitted to the Captain to approve the event and to determine the level of coverage for the event.
FIRST AID ROOM OPERA TION A significant majority of RPI Ambulance‟s special event standbys occur in venues in which RPI Ambulance operates a First Aid Room that is fully stocked according to Part 18 of the NYS Sanitary Code. The following procedures are to be followed when operating within these facilities.
EAST CAMPUS ATHLETIC VILLAGE FIRST AID ROOM All personnel shall enter East Campus Athletic Village (ECAV) via the North Entrance and proceed up the stairs to the First Aid room. The ambulance and or First Response Vehicle shall be parked along the fence adjacent to the field. Only Line Side officers, crew chiefs and drivers should have electronic card access to the ECAV First Aid Room. Prior to the start of the event, each Crew Chief must complete a field bag equipment checklist. If the event is a Type II or III event in the stadium, the First Aid Room must be staffed by an Event EMS Supervisor (EES) who will complete a First Aid Room equipment checklist. After the event the lights should be shut off and the door closed.
HOUSTON FIELD HOUSE FIRST AID ROOM All personnel shall enter the Houston Field House (HFH) via the South side/ B lot entrance and produce on demand an RPI Ambulance issued Identification Card. The keys to the HFH FAR are locked up in a lockbox next to the door. Only EES and Line Officers have the combination to the lockbox. At the end of the event, the lights should be turned off, the door locked and the keys returned. Prior to the start of the event, each Crew Chief must complete a trauma and infection control bag equipment checklist and the Crew Chief or Event EMS Supervisor shall complete a First Aid Room Equipment checklist.
Mark H. O‟Donnell, Captain
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RPI Ambulance Standard Operating Procedures
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During the event, he First Aid Room shall always be staffed by at least one crew chief. If the event is a Type II or III event, the event must be staffed by an Event EMS Supervisor (EES). In order of importance, a crew chief should be stationed in Section 7 first, then Section 15, then Section 1. At Type II and III events the Fieldhouse log book should be filled out by the Event EMS Supervisor. This log will detail personnel attendance, event title, spectator attendance, crew movements and patient interactions.
EVENT TYPE CLASSIFICATION The following classification of event types is based on the level of coverage provided by RPI Ambulance.. The Captain will approve the level of coverage at least three (3) days prior to the event.
TYPE I EVENT Type I events are events that have a long duration and low attendance that do not necessitate the placement of field crews. Minimum coverage for Type I Events will include at least one (1) Crew Chief with a trauma bag and oxygen duffel and First Response-59 (or a FAR at the discretion of the Crew Chief- In Charge).
TYPE II EVENT Type II events are events that have a large attendance (up to 5000) that necessitate the placement of field crews (e.g. hockey games). Minimum coverage for Type II Events will include at least one Event EMS Supervisor (EES), two (2) Crew Chiefs with trauma bags and oxygen duffels, the Ambulance with a driver and First Response-59 (or a FAR at the discretion of the EES-IC).
TYPE III EVENT Type III events are events that have a large attendance over 5000 people and that will require the ambulance be on dedicated standby for part of or the entire duration of the event (e.g. Commencement). Minimum coverage for Type III Events will include at least two (2) Event EMS Supervisors (EES), three (3) Crew Chiefs with trauma bags and oxygen duffels, First Response-59 (or a FAR at the discretion of the EES-IC) and the Ambulance with a driver on dedicated standby.
EVENT RADIO COMMUNICATIONS At the start of Type II and III events the following radio check will be completed by the Event EMS Supervisor –In Charge (EES-IC) over the RPI Ambulance frequency (155.220MHz): “At
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