HAMILTON

COUNTY

EMERGENCY

MEDICAL

SERVICES

OPERATING

GUIDELINES

April 1, 2006

TABLE OF CONTENTS

Purpose #2

Mission Statement #3

Organizational Structure #4

Articles 1 thru 4 Index #5 thru 7

Article I – Internal Affairs #8 thru 48

Article II – Units and Stations #49 thru 58

Article III – Operational Procedures #59 thru 96

Article IV – Tactical Plans #97 thru 125

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PurposeThese Operational Guidelines shall be the published and accepted standards for conduct, operations, patient care, and any other guidelines, which may apply to Hamilton County Emergency Medical Services. (HCEMS).

ScopeThese Operational Guidelines shall govern all employees of Hamilton County Emergency Medical Services.

Posting and PlacementA hard copy and computer copy of these Operational Guidelines shall be placed in each EMS Station or facility for review. Each new employee shall receive a hard copy during orientation, which will be turned back in to training at the completion of orientation.

InterpretationHCEMS Management shall interpret and provide clarification on all Operational Guidelines.

Implementing Directive and EnforcementThese Operational Guidelines shall supersede and make obsolete any editions previously published. These OG’s shall take effect on April 1, 2006, at 07:00 hours with periodic updates as needed. HCEMS Management shall have the responsibility and the authority to enforce these OG’s. HCEMS Management shall be authorized to deviate from these OG’s when needed to better manage a situation. Failure to abide by these OG’s shall be grounds for disciplinary action and be a violation of the Hamilton County General Government Employees Handbook, Section 300.

_________________________Donald L. Allen Sr.DirectorHamilton County Emergency Services

_________________________Kenneth L. WilkersonChiefHamilton County Emergency Medical Services

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MISSION STATEMENTHamilton County Emergency Medical Services, hereafter known as HCEMS, is a Division of Hamilton County Emergency Services and under the Command of the Hamilton County Mayor. The Administrator of Human Services oversees our Director who serves as the appointing authority. We all ultimately answer to the voter, our customer.

HCEMS shall provide timely and proactive Emergency Medical Treatment in the form of basic and advanced life support when needed or requested.

HCEMS strives to have a positive impact on people’s lives. Our service should be an example for others. We shall endeavor to lead by example and forge a path for others to follow.

HCEMS considers all patients to be our customer, and we intend to meet our customer’s needs where possible. HCEMS shall practice both INTERNAL and EXTERNAL Customer Service. We shall treat each other first and foremost as our own family and internal customers. With this behavior, we are prepared to serve our external customers in the way that exemplifies the highest standard of medical care and our primary service goal: PATIENT CARE FIRST.

HCEMS employees will conduct themselves in the highest standard of professionalism, courtesy, mutual respect, and integrity. Our journey is to strengthen, train, correct, support, manage, referee, coach, counsel and lead each other in a manner that promotes positive growth and a positive organizational climate. This journey is a process and is never ending. We will always strive to have an excellent working relationship with our fellow peer groups in Emergency Services, as they are external customers as well.

HCEMS foundation of core principles are leadership, training, mutual respect, customer service, and teamwork. This foundation allows us to accomplish our goal of patient care in the highest standard.

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Customer Service Officer

ARTICLE I: INTERNAL AFFAIRS

Section A - Uniforms and Appearance (revised)

Section B - Reporting for Duty (revised #2 and #3)

Section C - Personal Behavior (revised #19and #21)

Section D - On Duty Meals (revised #7)

Section E - Log Books and Station Boards

Section F - Leave Time and Swaps (revised #9 e, #10)

Section G - Awards Program (revised)

Section H - File Maintenance

Section I - Training (revised #5)

Section J - Observation Program

Section K - Student Clinical Rotations (revised)

Section L - Quality Assurance Program

Section M - Customer Service

Section N - Part Time Employee Field Orientation (revised)

ARTICLE II: UNITS AND STATIONS

Section A - Unit Readiness and Vehicle Maintenance

Section B - Station Duties

Section C - Station Maintenance

Section D - Station Visitors (revised #1)

Section E - Work Station Assignment (revised)

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ARTICLE III: OPERATIONAL PROCEDURES

Section A - Protective Clothing Use & Injury Prevention (revised #8 and 9)

Section B - Protective Clothing Maintenance (revised cleaning and care)

Section C - Patient Transport (revised #7 Paramedic Transport & #1 DOA)

Section D -Supply Acquisition (revised #6)

Section E - Refusal of Service

Section F - Documentation

Section G - Severe Weather Alerts (revised #14)

Section H - Driving Procedures

Section I - HCEMS Vehicle Involved in an Accident (revised #11)

Section J - Accident Review Team

Section K - Infection Control

Section L - Radio and Telephone Communications (revised #1 med comm...)

Section M - Controlled Substances and Medications

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ARTICLE IV: TACTICAL PLANS

Section A - Unit Relocation and District Coverage

Section B - Motor Vehicle Accident

Section C - Air-medical Request

Section D - Scene Management (revised #8 & #9)

Section E - Incident Command System (revised #1)

Section F - Rest and Rehabilitation (Rehab)

Section G - Hazardous Materials (Haz-Mat)

Section H - Destination Guidelines

Section I - Technical Rescue

Section J - Radiological Response

Section K - Tactical Medical Unit / Medical Bike Team (revised)

HCEMS OPERATIONAL GUIDELINES

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ARTICLE I - INTERNAL AFFAIRS

Section A - Uniforms and Appearance

Scope: This guideline shall encompass all Uniformed HCEMS employees.

Purpose: This guideline shall provide a means of defining what uniform is appropriate for use while at work and at any given function. Uniformity is difficult to achieve in large organizations. As such, the employee should pay close attention to the specificity of the guidelines. The uniform allows for rapid identification of crew members, makes a neat and professional presentation to the public, and builds espirit-de-corps. Emphasis is placed on safety and a conservative appearance.

Definitions:

Administrative Staff - Supervisors not assigned to Field EMS Teams.

Shift Supervisors - Supervisors with overall responsibility for operations on an individual shift, designated by the rank of Captain.

District Supervisors – Supervisors assigned to one of three districts, East, West, and Central, designated by the rank of Lieutenant.

Team Members - EMT’s and Paramedics assigned to Field EMS Teams and Support Services both full and part time.

Duty Uniform - Basic uniform worn year round by Team Members and Supervisors.

Dress Uniform - Special Occasion Uniform worn by all personnel as per these guidelines.

Administrative Staff Uniform - The Director of Emergency Services dictates what the Administrative Staff shall wear according to the duties or options given them. This shall include civilian dress where applicable.

Specialty Teams Uniform - The Chief Officers may assign such Teams or personnel variances to this policy based upon their specific duties with strict limitations to each.

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PRESENTABLE - All uniform items shall be neatly kept and polished where appropriate. All patches and embroidery shall be sewn completely. All clothing items will be free of rips and tears, and will not show excessive wear. Supervisors will be responsible to ensure that all clothing items are presentable. No type of decoration or appurtenance shall be worn on the uniform unless authorized by these guidelines or addendums.

Duty Uniform

The Duty Uniform shall be worn as a minimum year round.

OneShirt shall be Flying Cross, deluxe tropical blend, and light blue in color, short or long sleeved. Supervisors shall wear white. The undershirt will be worn underneath. Supervisors will wear a plain white T-shirt under the Flying Cross. Supervisors will maintain the embroidered T-Shirt as a uniform option. ID Badge shall be worn on the right shoulder, picture facing forward.

TwoUndershirt will be Jerzee brand T-shirt #03202, heavy-duty 50/50 blend, navy blue in color, short sleeve. Supervisors shall wear white. When worn under the uniform shirt, the sleeves of the undershirt will not extend past the sleeves of the uniform shirt. Embroidery on the undershirt will be identical to the Flying Cross shirt with the addition of the letters "HCEMS" embroidered on the back.

ThreePants shall be pro-tuff EMS 101P style or equivalent, navy blue in color. Zippers on the legs are optional, however if zippers are added to the pant leg they will be zipped closed. Pants will not be bloused, pegged or tucked inside the boot.

FourBlack boots shall be worn and will be lace-up, smooth toe and at least 8" high. Boots will be brush polished and not show obvious wear. A high gloss or "spit shine" is not required. Boots will not have decorative buckles or straps.

FiveBlack belts shall be worn. Belts will not have decorative or obtrusive buckles.

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SixThe following accessories may be worn on the belt or optionally a black duty belt, as long as they are either black leather or black nylon:

Quick-release clip for radio caseCommercial holster for scissors, penlight etc.Multi-tool in a black leather or nylon case.Personal pager or cell-phoneFlashlight in black leather or nylon holderSmall case for BSI

Supervisors or staff required to carry an additional pager, cell phone, or radio are authorized to do so. Field staff will not carry other service’s radios, pagers, or scanners.

Insignia Placement on the Shirt:

Left Shoulder - HCEMS Service Patch 1" from the shoulder seam and centered on the shoulder.

Left Chest - HCEMS Badge embroidered over the badge loop.

Right Chest - Name and Rank identification, “two line format”. Top line is rank spelled out and second line is first initial and last name, embroidered ½” block lettering.

Examples of the standard two line format used on all items requiring one’s name:

EMT Paramedic Lieutenant Captain Deputy ChiefT. Smith T. Smith T. Smith T. Smith T. Smith

Right Shoulder - Tennessee patch with rockers or National Registry patch as per level of licensure.

All Embroidery shall be in Gold Block

Navy blue ball caps may be worn with Hamilton County E.M.S. embroidered logo on front. Rear of Cap shall have the standard two line name and rank format. Captains and Chiefs will have two arcs of laurel leaves in gold on the bill.

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SupervisorsSupervisors are required to wear insignia of rank on the collar. Shift supervisors will wear dress uniform pants. Dress shoes may be substituted for boots. The chest insignia may be metal badge, rank and name tag as well.

Dress UniformThe Dress Uniform will be worn as directed. This uniform is appropriate for special occasions such as court appearances, funerals, or when representing the service at special functions. It is worn as the equivalent of the civilian "coat and tie".

Jacket and PantsThe jacket will be the Fechheimer #38800. Pants will be Fechheimer #38200. Gold Eagle buttons are required on the coat. All badges are issued. The jacket will be tailored to present a neat appearance. It will not be so tight as to create deformity to the material by the shape of the body and will not be so loose as to appear to hang or drape. The male sleeve may touch, but not extend past the heel of the hand. The female sleeve should not extend beyond the wrist. Pant legs should be tailored so that the material does not bunch at the foot, or cause more than one "break" in the front crease.

Insignia Placement:

Left Shoulder - HCEMS Service Patch, 1" from the shoulder seam and centered on the sleeve.

Right Shoulder - Tennessee patch with rockers as per level of licensure. The National Registry Patches will not be worn with the dress uniform.

Left Chest - Metal badge pinned through the badge loop. The badge will be worn in an upright position, centered over the pocket.

Right Chest - Name plate, will be New Hermes style with gold satin finish, clutch back. Engraving will be name and rank in two line format, in black block capital letters. It will be 1/2" wide by 2 3/8" long, with lettering 1/8" high. Placement will be 1/8" above the top seam of the pocket, parallel with the top seam, and centered over the button. Citation bars will be worn above the nametag.

Left Sleeve – Service stripes are authorized, one per three years of service. (Coats and all long sleeved shirts). Placement will be 2 3/4" from the bottom edge of the sleeve, at a 45 degree angle to the bottom edge of the sleeve.

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Right Sleeve - Gold bands will be worn full circumference on the Dress Coat as follows:

Chief - One Wide, Four NarrowDeputy Chief - One Wide, Three NarrowAssistant Chief - One Wide, Two NarrowCaptain - One Wide, One NarrowLieutenant - One WideSergeant - One NarrowParamedics and EMT's - no bands

Placement will be 2 3/4" from the bottom edge of the right sleeve to the bottom edge of the first stripe.

Collar Insignia - Rank will be identified on the shirt collar as follows:

Chief - “Chief” spelled out in gold metal letters, with gold leaf borderDeputy Chief - “Deputy Chief” spelled out in gold metal letters.

Assistant Chief - “Assistant Chief” spelled out in gold metal lettersCaptain - Two gold metal barsLieutenant - One gold metal barSergeant - Gold metal ChevronsParamedic - 13/16” gold metal caduceus with the letter “P” superimposed EMT - 13/16” gold metal caduceus

Placement of rank on the collar will be 1 1/4" from the point of the collar and with the centerline of the insignia in line with the point of the collar.

Epaulets - Gold Metal “HCEMS” in bar format will be worn on the epaulets of the coat.

Headgear - Service caps will be worn with the Dress Uniform at all times. The cap should be fitted to allow for proper wear. The cap will be worn with the bottom edge parallel to the ground, with the bill of the cap no more than three fingers off the bridge of the nose.

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Rank will be identified as follows on the dress hats:

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Chief - White hat, gold band, and two arcs of laurel leaves in gold on the bill.

Deputy Chief - White hat, gold band, two arcs of laurel leaves in gold on the bill.

Assistant Chief - White hat, gold band, two arcs of laurel leaves in gold on the bill.

Captain - Navy blue hat, gold band, two arcs of laurel leaves in gold on the bill.

Lieutenant - Navy blue hat, gold band, plain bill.

Sergeant - Navy blue hat, gold band, plain bill.Paramedic and EMT - Navy Blue Hat, black band and bill.

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OneThe shirt will be the same style as the Work Uniform, but long sleeved.Supervisors will wear white. The ID badge will not be worn.

TwoShoes will be low quarter, Oxford style, with patent leather or high quality poromeric finish with smooth toe. Black dress socks will be worn.

ThreeFull length navy blue tie will be worn. A standard four-in-hand tie is recommended, although a clip-on or Velcro closure is acceptable. The tie should be worn so that no shirt material is visible above the top edge of the tie. If a clip-on or Velcro closure is used, the device should not be visible.

FourA black leather belt with gold buckle will be worn.

Inclement Weather and Warmth Options

OneA Navy Blue Our Heroes Inc. Style #525 cut # 1432 shirts may be worn with the work uniform only and insignia placement shall be the same as the duty uniform. With HCEMS embroidered on the back and no shoulder patches. The ID Badge shall be worn on the right shoulder picture facing forward. This item is commonly referred to as the “work shirt”.

TwoA Navy Blue Wooly-Pully type V-neck sweater is permitted for administrative staff only. Insignia will be placed the same as on the shirt. The ID Badge shall be worn on the right shoulder picture facing forward.

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ThreeThe winter coat shall be the North Face / Horace Small. The coat shall have the HCEMS badge on the left chest and the two-line name and rank format on the right chest (embroidered), with the service patch on the left sleeve and licensure patch on the right sleeve.

FourA Hartwell #4530 Packer Pouch Jacket, navy in color may be worn. Insignia is as follows:

Left Chest - HCEMS embroidered badge logo.Right Chest - Name and Rank in two line format.Front Flap - HCEMS in 1” letters.Back - HCEMS in 7” letters.

FiveA solid dark blue toboggan may be worn. Gold ½” HCEMS block lettering will be centered on the front. As an alternate to the toboggan, a solid dark blue fleece headband may be worn bearing the same lettering as the toboggan.

SixThe shift supervisor may direct the removal of the shirt to accommodate for extreme heat conditions. A district supervisor may allow the removal of the shirt for an individual incident when conditions are such that the continued wear of the shirt could be hazardous to the crewmember or might result in the item being damaged. The crewmember may remove the shirt at their own discretion if bunker gear is being worn for safety reasons.

SevenPersonal protective clothing is provided for crewmember protection on individual scenes and is not an acceptable alternative to the prescribed uniform. The shift supervisor may authorize the routine wear of bunker gear in extreme cold weather or under unusual circumstances.

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EightCrew members may wear an Anvil brand mock turtleneck, style #20468, navy blue in color or Cross Creek brand turtleneck, style #13467, navy blue in color under the long sleeve duty uniform shirt or the work shirt. Both of these items must be embroidered with the letters “HCEMS” in ¼ inch lettering on the neck, with the lettering offset to the wearer’s left, ½ inch from the centerline of the neck. Supervisors will wear white.

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Minimum Purchase and Storage Requirements

OneThe following uniform items will be purchased and maintained at all times.

a. Three Duty Uniforms with at least one stored in a locker at one’s work station as an on duty change of uniform.

b. One Dress Uniform stored in a locker at one’s work station when not being used or cleaned.

c. Boots, belts, shoes, etc. necessary for uniforms.

TwoAll other uniform items are considered optional purchases.

Appearance and Grooming

OneAll employees will maintain exceptional personal hygiene when on duty.

TwoShirts will be tucked in at all times.

ThreeShirts will be buttoned to the second button from the top. Sleeves will not be rolled up.

FourAny type of jewelry or decorative item that could present a safety hazard is not permitted.

FiveUnderclothing shall not extend past the sleeves, collars, or pant legs.

Male Employees

OneGoatees and beards are not permitted. Employees will be clean shaven.

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TwoMustaches will be neatly trimmed and not extend below the corner of the mouth.

ThreeSideburns will be neatly trimmed and not extend past the ear opening.FourHair will be neat and not extend below the collar. Hair will not be dyed in a garish or unnatural color.

FiveEarrings or other ear decorations are not permitted. Jewelry is limited to an engagement ring/wedding set, medic alert jewelry, and wristwatch. Necklaces if worn should be kept inside the shirt. Body piercings are not permitted to be worn unless they are naturally covered by clothing. Tongue piercing is not permitted.

SixMale employees are not allowed to wear makeup. Underwear will be worn at all times.

SevenChest hair will not be visible.

Female Employees

OneHair shall be neat and pulled back for safety reasons. Hair should not fall below the shoulders at any time. Hair holding devices are permitted, with the emphasis placed on functionality rather than aesthetics. They should be navy blue or black and not formed to represent things such as flowers and animals. When wearing the dress uniform, hair should be worn up or pulled back in such a manner as to allow for proper wear of the headgear.

TwoJewelry that may present as a safety hazard will not be worn while on duty, i.e. dangling earrings, loose necklaces or bracelets, etc. Jewelry is limited to an engagement ring/wedding set, medic alert jewelry, and wristwatch. Necklaces if worn should be kept inside the shirt. Earrings will be limited to simple gold or silver studs, only one in each ear. Body piercings are not permitted to be worn unless they are naturally covered by clothing. Tongue piercing is not permitted.ThreeUnderwear and brassieres shall be worn at all times.

FourCosmetics should be worn in a subdued and conservative manner. Garish or extreme colors such as black, purple, fluorescent or colors that stand in stark

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contrast to the natural complexion are not allowed. Cosmetics will not have a caked or streaked appearance. Fingernails will not exceed 1/4" in length. Fingernail polish will not be extreme or garish in color, or multi-toned.

Section B - Reporting for Duty OneEmployees shall report for duty at their assigned station by 07:00 each shift. Employees will be relieved at 07:00 the following morning by the oncoming shift. If for some reason an employee’s relief is not present by 07:00, the employee shall contact the district supervisor. At no time will an employee abandon his/her duty station without the approval of the on duty supervisor.

TwoPersonnel shall use their assigned Hamilton County Emergency Services employee computer access code to clock in and out each shift worked. If for any reason an employee is unable to clock in or out, the shift supervisor should be notified immediately. At no time is an employee permitted to clock another employee in or out.

ThreeAll HCEMS personnel are subject to be called in to report for duty at anytime should circumstances arise warranting such action. These situations include but are not limited to: Mass Casualty Incidents, natural disasters, weather related emergencies, etc. The decision to activate additional personnel will be made by either the County Mayor, Director of Emergency Services, the EMS Chief, the EMS Deputy Chief, or their designee.

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Section C - Personal Behavior

OneEmployees are held accountable for all rules, regulations, policies, procedures, etc. of Hamilton County EMS and Hamilton County General Government, including the Hamilton County Employees Handbook.

TwoEmployees shall show mutual respect for each other and supervisors should be addressed by their rank, or rank and last name, especially in view of the public. Employees shall refrain from the use of profanity, vulgar, obscene or abusive language or actions toward each other or the public.

ThreeEmployees shall not be under the influence of, nor shall they have in their possession, any alcoholic beverages or illegal drugs while on or within Hamilton County property. Employees shall not allow any person to be on or within Hamilton County property that is under the influence of, or has possession of, such.

FourAlcoholic beverages, sleeping pills, prescription medications or any other depressants or stimulants that could impair judgment or ability shall not be used within eight hours prior to an employee reporting for work. If under the care of a physician, a doctor’s note shall be required before a prescription for this type medication can be taken on duty. The employee shall notify his/her district supervisor.

FiveThe use of tobacco products is permitted outside our stations only. Employees who use such are responsible for the proper disposal of all cigarette butts, chews, etc. Tobacco products are not to be used within ten (10) feet of any ambulance.

SixEmployees shall maintain a neat and clean station at all times. Our buildings are public property and should stay presentable. Sleeping will not be allowed prior to 1200 hours. Exceptions to this must be approved by the Shift Supervisor.

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Employees shall not steal from the service, fellow employees, patients, etc. Those found vandalizing, stealing, forcing doors, cutting locks, etc. shall be disciplined.

EightEmployees shall respect and maintain the furniture and station facilities provided for them. Each employee is responsible to protect and prevent abuse of our furnishings.

NineEvery employee is expected to exemplify the highest level of professionalism and pride possible. Public relations are a non-stop function and one’s behavior should be an example respected by all. Employees are to be courteous to the public at all times.

TenEmployees shall practice economy in the use of station supplies, metered services, etc. and see that waste is avoided. They shall not leave televisions on, water running, excessive lighting on, etc. when not needed or being used.

ElevenEmployees shall notify their district/shift supervisor, and administration, within twenty-four hours if they change place of residence or telephone number. It shall be the employee’s responsibility to maintain a constant level of communication with their supervisor.

TwelveEmployees shall promptly notify their district supervisor of all matters coming to their attention that could affect the interest and welfare of the service.

ThirteenNo employee shall use the uniform, badge or prestige of the service for the purpose of personal gain. No employee shall accept or receive a reward, fee, or gift from any person for services related to the performance of duty unless given direct permission from the Chief.

FourteenEmployees shall not loan, sell, give away, or appropriate any service property. Employees shall not pilfer or be guilty of theft.

FifteenInefficiency or indifference of employees in the performance of duty shall be grounds for discipline. The wrongful or injurious exercise of authority on the part

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of any employee shall be grounds for discipline.

SixteenEmployees shall not conduct any activity while on duty which would be considered inappropriate or misleading to the public in fulfilling our mission. This includes any questionable act, which in the eyes of administration, is not well received.

SeventeenInsubordination, which is defined as the failure of an employee to comply with a request, directive, or order issued by a ranking supervisor, will not be tolerated. Employees guilty of such shall be disciplined. Insubordination shall also be defined as abusive language and/or blatant disrespect to a ranking supervisor.

EighteenAn employee shall notify one’s ranking supervisor immediately if said employee is arrested, accused, investigated, or convicted of any crime as stated in the Hamilton County Government Employees Handbook. This includes any charge, investigation, or action against any employee related to their licensure by the State EMS Division or Board.

NineteenWeapons, as defined by Tennessee State Law, shall not be carried on HCEMS medic units, with the exception of Tactical personnel.

TwentyEmployees shall not willfully or knowingly place themselves or their partners in a dangerous or hostile situation. HCEMS endorses a “STAND BACK” policy. The law enforcement agency having jurisdiction is trained, equipped, and charged with mitigating such situations.

Twenty OneEmployees shall not post any Hamilton County General Government and /or HCEMS photos, uniforms, equipment or vehicles on computer web sites for personal use. This includes any acts of questionable nature. Photos of any job-related scenes or events are prohibited unless they are directly associated with mission needs or requirements. The personal use, dissemination, or distribution of any original or reproduced image is also prohibited. Patient privacy is paramount and all efforts must be directed at maintaining that anonymity and confidentiality.

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Section D - On Duty Meals

OneAll meals will be eaten in the individual medic unit’s assigned district. Units on relocation may eat in the district in which they are relocated, alarms and time permitting.

TwoUnits shall remain in-service during meal times.

ThreeOnly one on-duty medic crew may eat at any one location. The shift supervisor may grant an exception if needed and coverage allows.

FourUnits shall break for meals only as alarms and duties allow.

FiveThe use of station kitchens is strongly encouraged.

SixNo food or drink shall be consumed in the medic unit at any time. Food may be carried in the cab of the unit, in closed containers, back to the station.

SevenMedic units are allowed one, one-hour meal, out of station in a 24 hour shift. Medic units may not leave the station for the purpose of an out-of-station meal. Only when returning from an alarm, assignment etc. are out-of-station meals permitted.

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Section E - Station Boards and log books

OneThe station log is to be completed each shift.

TwoThe following information shall appear in the station logbook:

A. Date, Day of Week, Team on DutyB. Crew on DutyC. Time on DutyD. Time of Radio CheckE. Any maintenance performed on the stationF. Any maintenance that is needed on the stationG. Any maintenance performed on unitH. Any maintenance needed to be performed on unit I. Any station duties performed that day J. Amount of fuel obtained for unitK. Any problems or comments about the station or unitL. List any equipment left at a hospital if not picked up during the shift.M. List any medications that need to be replaced.

ThreeOnly pertinent information is to be written in the logbooks. Personal complaints, problems between crews, grievances or any other non-business type entries, are not permitted.

FourThe bulletin board shall be kept neat and organized at all times. Memos and announcements that are more than thirty days old shall be placed in the station memo file for future reference. Schedules, calendars, special event notices, etc. that is appropriate for public viewing may stay on the board as long as they are current.

FiveE-mail shall be read at the beginning of each shift and should be checked periodically thru out the shift. E-mails will not be deleted prior to being read.This is a vital source of our communication.

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Section F - Leave Time and Swaps

OnePersonnel are entitled to accrue leave time as stipulated in the Hamilton County Employee Handbook, Section 502.

TwoEmployees shall be charged with one hour of leave time for every hour they are off. Employees who have exhausted all leave time must request leave without pay in writing through the Director of Emergency Services.

ThreePersonnel requesting sick time will notify their supervisor no later than two hours prior to start of the shift. Notification as soon as possible would be appreciated.

FourVacations will be requested no later than one month prior to need and will be approved by the Shift Supervisor based upon personnel availability.

FiveIf a conflict occurs for leave time on the same day between personnel, the conflict will be decided according to the following guidelines:

A. Seniority with Hamilton County EMS in accordance with the HCEMS Service time policy.

B. A notice of at least 30 days is necessary for one employee to “bump” another employee regardless of seniority.

SixMedic Units shall be staffed at all times. Only the Shift Supervisor or a ranking supervisor may authorize a medic unit to be out of service. Personnel may not leave their duty station or medic unit without permission from the on duty Shift Supervisor or ranking supervisor.

SevenPersonnel injured on duty will be charged accrued time starting the shift following the injured shift. Employees will then be paid according to Hamilton County Policy upon the exhaustion of accrued time.

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Personnel leaving their duty station before completion of shift will be charged personal leave time for time remaining in shift. This will be termed as unscheduled leave.NinePersonnel will be allowed to swap duty time with personnel on different shifts based upon the following criteria:

a. Supervisors must swap with peer supervisors.

b. Employees may swap with other employees on teams other than their own regardless of sector. Swaps are preferred with same station employees.

c. Employees are not allowed to travel on duty to other stations for swaps.

d. Swaps will be for 12 or 24 hours only. 7am-7pm, 7pm-7am, or the entire shift. Swaps will be submitted and approved at least 72 hours before started.

e. Swaps must be completed in the seven-day pay period and the maximum amount of hours any employee may swap in a seven-day period is 48. The period is from Wednesday-Tuesday.

f. Swaps are a privilege and staffing issues come first. Supervisors are not required to move employees to accommodate a swap and may cancel a swap at any time when in the best interest of the service or to maintain Class A staffing.

g. Administration may alter or cancel the swap program when in the best interest of the service.

TenLeave and swap requests must be filled out completely and approved by the Shift Supervisor before they occur. It is the responsibility of the employee to obtain the necessary approval and signature of their supervisor. Employees are to E-mail and/ or call their supervisors as paperwork can sometimes be misplaced or delayed inadvertently.

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Section G - Awards Program

OneThe following medals may be given to employees for actions performed or service given. They are listed in order of precedence, indicating the order in which they should be worn.

Medal of Honor - Given for outstanding and heroic performance of duty where recipient’s life was in danger and whose actions were crucial in saving a life.

Medal of Honor (Posthumously) - Given for an employee killed in the line of duty.

Grand Cordon Medal –Given to the employee selected as “Medic of the Year.” Employees of HCEMS select from their ranks each year a “Medic of the Year.” This person is one who the employees of the service feel has exhibited outstanding performance in one’s duties and portrays the highest level of professionalism. Any employee who is at least an EMT with HCEMS is eligible for this honor.

Honorable Service Medal - Given to an employee for every three years of uninterrupted service with HCEMS.

Educational Achievement Medal - Given to an employee who graduates from college with a degree.

Exceptional Duty Medal - Given to an employee who has shown performance above and beyond the call of duty. This may be for the performance of additional assignments, or implementation and/or teaching of programs, or any other outstanding achievement that may bring acclaim to the employee and/or HCEMS.

The Chief’s Award – Given to a Supervisor who has shown performance above and beyond the call of duty. This may be for the performance of additional assignments, or implementation and/or teaching of programs, or any other outstanding achievement that may bring acclaim to the employee and/or HCEMS.

The Samaritan Medal - Given to a civilian for helping to save or saving a life.

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Honorable Discharge Medal - Given to an employee who leaves or retires from HCEMS, who has at least 20 years of service, and has served the community in an outstanding and honorable fashion.

Two Citation bars are worn ¼ above the name tag. The bottom edge of the citation bar should be parallel to the name tag and centered over the button. When multiple citations bars are worn, they are worn in order of precedence with the highest award closest to the heart. Multiple awards should be worn in rows of three, end to end, so that no space is visible between the bars. The overall length of the row should be centered over the button

ThreeAny supervisor may recommend an employee or civilian for a medal. Employees may recommend through their ranking supervisor. The Shift Supervisor and Chiefs must vote unanimously to award the medal. Recommendations must be in writing and cite complete details of the actions, accomplishments or incident if possible.

FourAppurtenances, which are decorations worn on the citation bar, indicate multiple awarding of a particular medal. These are defined as follows:

A. Silver Star - 2nd medal awardedB. Gold Star - 3rd medal awardedC. Oak Leaf - 4th medal awardedD. Gold Acorn - 5th medal awardedE. Any subsequent awarding will be decided at that time.

FiveDevices are badges or insignia authorized for wear on the dress uniform coat. They are worn with the bottom edge ½ above the citation bars, centered over the button. Currently the only authorized device is the National Registry Pin.

SixThe Quality Assurance Team shall select each month a “QA Medical and Trauma Call of the Month.” From these, a “QA Medical and Trauma Call of the Year” shall be awarded to the teams on these alarms.

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SevenHCEMS awards “Blue Ribbon Commendations” for excellence in customer service and patient care. Any patient, citizen, employee, or supervisor may recommend someone for a Blue Ribbon Commendation. Annually, the employee who receives the most Blue Ribbons each year will receive the “Grand Blue Ribbon Commendation Award.”

EightHamilton County Personnel gives a length of service award to all employees in 5 year increments. It is authorized for wear on the dress uniform jacket. It shall be worn on the right coat pocket flap, centered between the button and the seam. Only the most current pin should be worn

NineEmployees of HCEMS select from their respective teams, each year a“Stretcher Bearer of the Year.” This person is one whom the employees of the service feel has worked hard to improve his/her skills, patient care, customer service, and general performance in our service. Any employee who is at least an EMT with HCEMS is eligible for this honor.

Section H - File Maintenance38

OneA copy of all certifications and licenses will be kept on file at administration, in each employee’s training file.

TwoIt is the responsibility of the Training Officer to ensure that all personal training files are maintained and in proper order according to Tennessee EMS Regulations.

ThreeIt is the responsibility of each individual employee to submit a current copy of all licenses and certifications to the Training Officer.

FourWhen a certification or license expires, the renewal shall be copied and sent to administration within seven days of receipt of the renewal.

FiveAny certification, license, or document not on file shall be considered expired until proof is shown otherwise. Personnel with expired mandatory licenses will be suspended until licensure is updated and current.

Section I - Training 

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OneTraining will be scheduled by the Training Officer according to Tennessee Department of EMS Regulations and the needs of the service. State EMS requires 12 hours be provided each year per employee. TwoTopics for training shall be set by administration according to state requirements, need, course curriculum, and availability of resources. ThreeEach crew shall report to the designated training site at least ten minutes prior to the start of the session, as alarms allow. FourTraining sessions which are cancelled or rescheduled shall be approved by the Training Officer. FiveCrews may train on an individual basis outside of the scheduled training as duties and alarms allow. Such training includes equipment familiarization, ACLS review, BTLS review, etc. SixA training form shall be completed and turned in to the Training Officer for all additional training. SevenAdministration may assign additional training to personnel if deemed necessary, EightRecords of training shall be kept on file for annual State audits. NineACLS & BTLS will be provided in house several times throughout the year. 

Section J - Observation Program

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Approved Observers – Family, friends 18 or older, and any personnel affiliated with a fire department or rescue squad within the HCEMS jurisdiction. Personnel who are certified/licensed as a medical professional (physician, nurse, EMT, etc.) may ride as approved by administration.

Approved Time Frame – 10:00 hours to 22:00 hours

Proper Dress: Navy blue or black uniform pants, light blue/navy blue dress shirt or golf shirt. No T-Shirts allowed. Black socks with black shoes/boots.

OnePersons wishing to observe must obtain permission from the affected District Supervisors as well as the affected medic crew.

TwoPersons wishing to observe must make the request at least seventy-two hours prior to the shift in which they wish to observe.

ThreeA release of liability and wavier form must be signed by all observers. A new form must be completed and signed on each observation ride.

FourObservers will be under the direction of the lead medic and/or a supervisor.

FiveObservers may be asked to leave at any time by the lead medic and/or a supervisor.

SixEach observer shall be limited to 32 hours per month.

SevenUnder no circumstances are there to be 4 persons on the medic unit without the approval of a supervisor. Alarms are excluded if patient care warrants the need.

EightUnder no circumstances are observers to perform invasive procedures or function alone.

Section K - Student Clinical Rotations

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Preceptor: A HCEMS Paramedic who has been approved by administration and the Paramedic Program Director as a field trainer/evaluator.

Clinical Shift: 07:00 hours to 22:00 hours.

Approved Clinical Uniform: Navy blue or black uniform pants, light blue, navy, or white dress shirt or golf shirt. No T-shirts allowed. Black socks with black shoes/boots.

OneParticipation in the clinical program is voluntary on the part of the preceptors.

TwoA clinical schedule will be forwarded to the training officer and supervisors where available.

ThreeThe designated preceptor shall accompany the students in the patient compartment on all alarms.

FourStudents shall be allowed to perform skills appropriate for the level of training in which the student is currently involved. The preceptor, however, has the right to refuse the performance of any skill in which the preceptor does not feel comfortable allowing the student to perform.

FiveThe preceptor shall intervene and take over patient care in the event the preceptor feels that the student’s course of action will endanger the patient’s well being.

SixIn the event of a problem between the student and a member of the medic crew, the student may be removed from the medic unit by the preceptor or a supervisor. In this event, the Clinical Coordinator or the Program Director of the educational facility will be contacted as soon as possible.

SevenThe student will meet the medic unit at the station. In the event the unit is not in station, the student shall wait outside the station and not enter until the medic unit arrives.EightAll students shall be subject to all HCEMS procedures, and policies.

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NineHCEMS personnel who are enrolled in Paramedic School shall not be permitted to count any on duty time as clinical time.

TenStudents shall report no earlier than 10 minutes to the start of the clinical shift. They shall depart by 22:00 hours, unless on an alarm.

ElevenPreceptors function in conjunction with the educational programs and shall complete any documentation or procedures as required.

TwelvePreceptors shall not discuss the performance of a student with other shift personnel or students. Administration reserves the right to investigate any situation or any person’s performance as deemed necessary.

ThirteenIn the event of a scheduling error and two students show up to ride, the ranking supervisor will be notified. The supervisor will make any reassignment decisions. It is the student’s responsibility to notify the educational facility Clinical Coordinator of the conflict. The following criteria will be considered in this situation:

a. Paramedic students take precedent over EMT students.b. If both students are of the same standing, the ranking supervisor

will make the determination.

FourteenThe Shift Supervisor may alter the student’s assignment if needed for proper team functioning.

Section L - Quality Assurance Program

One43

The Quality Assurance Program for HCEMS shall be conducted by the Quality Assurance (Q/A) Team. This Team is comprised of the Customer Service Officer, District Supervisors, the HCEMS Medical Director, and any other Physician Advisors of the service. The Chairperson of the QA Team shall be the Medical Director. In the absence of the Medical Director, a Physician Advisor shall be the chairperson. If a Physician Advisor is unavailable, the Customer Service Officer shall be the chairperson.

TwoEach month the QA Team shall hold a meeting where a report of the previous month’s trip reports, patient care, documentation, etc. is given and reviewed.

ThreeAlarms shall be reviewed as directed by the Team. Statistics and any other information needed by the Team shall be received and reviewed.

FourThe purpose of the Q/A program is to ensure that quality and correct patient care is given in a consistent and timely manner, utilizing proper procedures, protocols and/or standing orders.

FiveEach reviewing member shall select a trip report which portrays excellent documentation, patient care, and effective and proper use of standing orders and protocols for both medical and trauma. These reports shall be given to the Training Officer, Customer Service Officer and the Deputy Chief to be considered for Q/A Call of the Month.

SixThe Q/A Team shall be empowered to call any and all personnel before it in order to conduct business and to fulfill their mission. This is not a disciplinary process and no one is allowed in except the affected employee(s) and specific team members reviewing any case. Attendance at such hearings is mandatory.

SevenEmployees may attend a meeting by requesting to do so through their ranking supervisor. Employees are allowed, as facilities will accommodate. The employees are there only to observe the process but will not attend confidential matters dealing with specific employees called before the Q/A Team.

Section M – Customer Service44

Customer Service: The art of performing assigned duties with a positive attitude, professionalism, respect, competence, honesty, service to the public and co-workers regardless of personal belief or opinion, and in a manner worthy of the trust the public has placed in our profession.

OneEmployees are Hamilton County EMS. When you present yourself to the customer you represent the whole service and the perception of Hamilton County EMS depends on the professional service you provide. The service you provide should be, and is expected to be, superior to other services, both in care and service.

TwoEmployees are expected to meet the medical needs, as well as the emotional needs, of each patient. Each patient will present with different needs. It is up to the employee to identify and meet those needs without compromising medical or ethical standards.

ThreeEmployees shall practice both internal and external customer service at all times.

FourEmployees will be treated as internal customers at all times.

FiveEmployees will consider each patient, other public safety agencies, and the public at large as external customers.

SixEmployees will treat all customers with respect regardless of race, sex, age, disabilities, financial status, political affiliation, creed, nationality or the employee’s personal feelings about the situation.

SevenEmployees will treat all customers with mutual respect, courtesy, and professionalism, with the goal being restoration of health, while respectfully controlling the situation at all times in a non-judgmental or non-confrontational

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manner. Employees should seek to care for the patient in a manner consistent with our service’s mission.

EightThe employee’s primary focus shall be on patient care. Issues such as billing and insurance are not part of patient care. Billing and insurance questions will be referred to administration.

NineEmployees will be accountable for their actions and conduct themselves in a manner appropriate for a public servant. While all situations are different, every effort should be made to create a positive outcome for our patients. While a positive medical outcome for the patient may not be possible, every effort should be made to provide a positive impact on the people’s lives we touch, not just for the patients.

TenEmployee’s shall not impose or express personal feelings, political affiliation, convictions, religious beliefs, or opinions upon patients or other customers at any time. ElevenIn the event of a complaint from an internal or external customer, it should be forwarded the Customer Service Officer for investigation and/or resolution.

TwelveAll complaints or issues of dissatisfaction about the service should be handled in a confidential and professional manner. When appropriate, the Customer Service Officer will brief Administration on complaints not resolved to the customer’s satisfaction.

Section N – New Employee Field Orientation

One

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New full and part-time employees will orientate a minimum of 116 hours. The field orientation time will be completed as follows:

a. Complete nine 12 hour shifts on a District Supervisor unit. The employee must work 3 shifts at night and encounter a minimum

of 6 different District Supervisor in all 3 sectors.

b. Complete 8 hours in supply.

TwoThe District Supervisor will complete a written daily evaluation, which will be submitted to the training officer for review.

ThreeThe employee will complete the orientation packet during the field orientation. This completed packet will be submitted to the Training Officer before being released to work.

FourPart-time employees have 4 weeks to complete the program, working a maximum of 36 hours per week.

FiveFull time employees will complete the orientation while on shift. Employee will finish the orientation as soon as possible. The Shift Supervisor will oversee the training and report to the Training Officer.

SixFull time employees will be evaluated by the District Supervisor who is assigned the employee.

HCEMS OPERATIONAL GUIDELINES

ARTICLE II – UNITS AND STATIONS47

Section A - Unit Readiness and Vehicle Maintenance

OneThe on-duty crew shall completely inspect, check off, wash, and clean their assigned unit and have it ready for inspection by 08:30 hours, alarms permitting. If the unit is not acceptable, the crews shall communicate such and have deficiencies corrected before any crew member leaves. The district supervisor shall intervene if crews cannot agree.

TwoThe inspection shall consist of completing the mechanical check-off form, the ambulance supply form, and the equipment check-off and order form.

ThreeAny new damage to the vehicle, an extremely low supply situation, a mechanical, or low fuel problem, etc. that would take the unit out of service, compromise safety, or interfere with our mission, should be brought to the attention of one’s district supervisor.

FourThe unit shall be refueled daily. The amount of fuel taken on is to be recorded in the station log book. The unit shall have over one half of the total fuel capacity at shift change. An effort to change shifts with a full tank of fuel is recommended.

FiveIf the unit is on an alarm at shift change, it shall be fueled prior to returning to the station, or as directed by a supervisor. All units shall be refueled no later than 23:00 hours to comply with paragraph four.

SixAny damaged or missing equipment or supplies, etc., should be brought to the attention of support services for repair or replacement and proper forms completed. If support services (supply division) is unavailable or off duty, contact the shift supervisor.

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SevenMaintenance, whether scheduled or unscheduled, will be coordinated by the Shift Supervisor or the supervisor having jurisdiction. A note detailing the deficiencies shall be placed on the dashboard of the unit by the crew placing the unit out of service.

EightSupervisors shall keep administrative and support vehicles presentable at all times.

NineCrew members SHALL NOT make any changes to the units without approval from Administration. Examples are radios, CD players, altering of unit chassis or module wiring or equipment, emergency warning devices or any other item as determined by Administration. If in doubt, ask.

TenWhile at the hospitals crewmembers shall leave the ambulances running. Every effort shall be made to move the ambulance to an appropriate parking area ASAP after the patient(s) has been unloaded to keep the hospital lanes open and keep exhaust fumes from entering the buildings.

ElevenWhile a crew is mobile in district in the ambulance and decides to stop at a public venue, for whatever the reason, the vehicle is to be parked and TURNED OFF. An appropriate area for rapid response will be necessary.

TwelveThe ambulance shall be locked at all times while out in public, unless attended by a crewmember.

ThirteenTobacco products are NOT permitted to be used in, or within 10 ft. of, the ambulance at any time under any circumstance.

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FourteenPersonal equipment and/or bags are not permitted to be used on the ambulance without authorization from our Medical Director. If such equipment and bags are authorized they shall be secured and/or stored in a compartment in a manner that is safe and unimposing to patient care or our mission as a service. Said employee will assume full responsibility for their personal equipment while it is on the ambulance.

Section B - Station Duties

Daily Duties

Paragraphs 1 and 2 shall be completed at shift change.50

Paragraph 3 shall be completed by 10:00 hours each shift.Paragraphs 4 and 5 shall be completed by 23:00 hours each shift.

If the station is not satisfactory to the on-coming crew, the off-going crew will complete any needed duties before any crew member leaves. The District Supervisor will intervene if needed.

OneA shift change report will be given to the on-coming crew by the off-going crew. This will consist of unit status, station status, road conditions, and any needed supplies, etc.

TwoThe designated paramedics shall exchange the narcotics keys after counting the narcotics together. In case of a double paramedic unit, both on duty paramedics are responsible.

ThreeAll areas of the station shall be cleaned and organized. The floors shall be swept and mopped where applicable. All supplies, equipment, hoses, etc. shall be properly stored if not in use. If trash pick-up day, the trash is to be placed out appropriately. The beds are to be made up.

FourThe kitchen facilities shall be cleaned and organized. The eating area and tables are to be cleaned, all dishes washed, dried, and put away in cabinets. All cabinets are to be organized and cleaned, if necessary.

FiveThe trash from the station baskets is to be bagged and placed in the large trash container in the bay. The bay trash container should be emptied as needed and washed out. All dirty service linen is to be placed in the proper receptacle.SixThe station shall be kept neat, clean, and organized at all times.

Weekly Duties

These duties are to be completed every Wednesday or when needed, alarms permitting.

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OneThe bay shall be organized, swept, washed, rinsed, and squeezed. Do not wax the bay floors. All lockers, closets, cabinets, etc. shall be emptied, cleaned and organized.

TwoThe refrigerator shall be cleaned, inside and out. Any food in the refrigerator that has spoiled shall be disposed of. The stove is to be cleaned, including burners, drip pans, and eye rings. All ovens and racks are to be cleaned.

ThreeSmokers shall clean out the cigarette bucket. The paperwork is to be organized in the desk. All cabinets shall be cleaned and polished with furniture polish. All station windows, sills, blinds and ledges shall be cleaned inside and out.

FourThe station grounds shall be patrolled and all trash picked up and placed in the trash receptacle in the bay. The driveway and apron shall be washed off and swept where applicable.

FiveThe unit is to be cleaned and disinfected, inside and out, including all compartments, after the equipment has been removed. The unit will remain in-service.

SixThe bathrooms, including all fixtures, shall be cleaned and disinfected.

SevenEnvironmental system filters are to be inspected, cleaned, or replaced where able.

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Section C - Station Maintenance and Repair

OneWhen an appliance, environmental system, operating component, electrical fixture, etc. is in need of repair, the crew on duty shall notify their district supervisor by E-mail and by verbal conversation. This information shall be forwarded to the Shift Supervisor having jurisdiction, who will then contact the Hamilton County Maintenance Department for follow up and coordination of the needed repair.

TwoIf the problem needs immediate attention, (bay door, heater during the winter, etc.) the on-duty Shift Supervisor shall be notified and will take the appropriate course of action. All station logs shall be completed accordingly.

ThreeMinor maintenance issues, such as changing of light bulbs, tightening of screws, regular and proper care of assigned equipment and station facilities, shall be provided by the crews where able.

FourCrew members are not allowed to rewire or alter the phone or computer systems. Phone line jacks, computer system drives, printers, etc. shall not be altered without permission from Administration. If in doubt, ask. Answering machines of any type are not allowed on station phone lines and crews shall always answer the phone with their Medic Unit number and last name.

Section D - Station Visitors

OneThe visitation hours shall be from 10:00 hours to 22:00 hours.

TwoVisitors are not allowed in the bedrooms at any time.

ThreeHCEMS crews are responsible for the conduct of visitors within our facilities. When in our facilities, they are bound by our regulations and guidelines. If in doubt, ask them to leave.

FourAnimals and/or pets are not permitted in the station facility. Exceptions to this rule are those animals assisting the handicapped.

FiveFamilies of crew members are welcome as long as they do not infringe upon the privacy and work environment of other crew members.

SixSupervisors shall have final say on any and all visitors in our stations and our vehicles.

Section E - Work Station Assignment

Seniority – Service Time Guideline

Although Hamilton County Government does not have a formal seniority policy, Hamilton County employees leave accrual rate and longevity pay are based on continuous uninterrupted full time service (Section 401.14 of the Employee Handbook). Employees who were re-hired or re-instated prior to May 16th, 2001, are the only exception to this rule.

OneHamilton County Emergency Medical Services will use the most recent hire date in the EMS Department to establish the Employee Service Time Date. Prior assignments within Hamilton County Government will not be considered in establishing this date. The Service Time Date will determine an employee’s seniority position within HCEMS.

TwoWhen more than one employee has the same hire date, the date they were licensed will determine the seniority position. In the event the hire date and license date are the same, the employee with the lowest license number will determine seniority.

ThreeThe Deputy Chief of Operations will be charged with obtaining the official and accurate hire dates from Human Resources to establish the seniority list based on uninterrupted service time in HCEMS.

FourThe Deputy Chief of Operations will provide the seniority list to the Shift Supervisor.

FiveThe seniority list will be used to determine station assignments and vacation and holiday leave time dates.

SixStation assignment re-bid process will begin on September 15th and rotations will occur on October 1st in odd years. Assignments will be based on an employee’s seniority, rank, and consistent Advanced Life Support Paramedic coverage. The Deputy Chief of Operations and /or the Chief of Administration will approve station assignments.

SevenDistrict Supervisors shall select from among the supervisor stations based upon their uninterrupted time as an officer. In the event of the same promotion date, license date will be used to determine seniority. In the event of the same promotion date and license date, their license number will be used to determine seniority. District Supervisors will select a paramedic partner and must have the approval of the Shift Supervisor, Deputy Chief and /or Chief.

EightEmployees shall choose a station assignment in the order of the employee with the most seniority down to the least seniority on that shift. When a basic EMT chooses a station, the resulting partner must be a paramedic. Floaters may choose which floater station they float from as part of the seniority list. A float station is defined as a station in which a District Supervisor is assigned.

NineEmployees should understand that they are choosing their own stations and partners within this system and that they will live with their choices. Problems with partners will be worked out with each other, as other employees will be affected in any moves.

TenWhen a vacancy occurs at a station, it will be filled by seniority on the shift as long as Paramedic coverage is assured. In the event no one bids on a station, the senior floater will be assigned, unless Paramedic coverage is required. If a Paramedic floater is available, he/she will be assigned to the vacancy. If a Paramedic floater is not available, then the Paramedic with the least seniority from a double medic truck shall fill the vacancy.

ElevenIt shall be understood that Shift Supervisors may need to move personnel to assure Paramedic coverage to accommodate days off, swaps, special training situations, or other needs. This guideline will not interfere with the Shift Supervisor’s authority to lead and manage the team.

TwelveThe Shift Supervisor, under the following criteria, will coordinate requests for a station change from an employee:

a. The employee will notify their ranking supervisor in writing requesting the change and reasons why. An attempt will be made to

resolve any problems that may require the move.

b. The Shift Supervisor will assure that the employees on the individual shift are aware of the change at the affected stations.

c. The Shift Supervisor will review the move with the Deputy Chief. The best interest of the service and team operations will be first and foremost as a major “jumble” will not be allowed.

ThirteenThis system is designed to provide a continued sense of “ownership” of equipment and facilities and breed consistency in employee/supervisor relations and district familiarization.

HCEMS OPERATIONAL GUIDELINES

ARTICLE III – OPERATIONAL PROCEDURES

Section A - Protective Clothing Use and Injury Prevention

OneThe purpose of issuing and wearing protective clothing, and other injury prevention devices is to assist the employees of HCEMS in maintaining as safe a working environnent as possible. This equipment does not, however, take the place of sound and prudent judgment. Alertness is the ultimate protector in any hazardous situation.

TwoNothing in this section shall prevent the wearing of protective clothing when the employee deems it needed. In all cases, protect yourself as well as you are able in order to prevent injury.

ThreeFull protective clothing shall be worn on at least the following situations:

a. Motor vehicle accidents involving extrication, fires, or obvious hazards (i.e. fuel spills, large amounts of glass, etc.)

b. Working structure fires unless the crew is very distant from the structure. c. Haz-Mat incidents, radiological incidents, chemical incidents, etc., where

the clothing will afford protection in transporting patients. Radiological response kits may be substituted.

d. Any other situation, such as construction sites, where protective clothing may prevent or lessen the potential injury.

FourStatistics have shown that the use of helmets, gloves, and eye protection are the most needed in injury prevention. Therefore, use these items as much as possible. When in doubt, put it on.

FiveThe most common injury to EMS personnel is your back. Always lift with your legs and keep your back straight and firm. Do not lift a loaded stretcher and twist. Walk with the weight.

SixBallistic Armor, as issued, shall be worn as directed, and at least on situations involving penetrating injuries, domestic disorders, unruly crowds, SWAT or special police call-outs, etc.

SevenHCEMS protective equipment may not be utilized when working for other agencies.

EightWhen approaching a railroad crossing, the driver shall remove his headset until the crossing is clear. The driver has discretion to remove the headset whenever necessary when approaching dangerous and/or blind intersections.

NinePart-time and/or new employees who do not have protective gear shall not be allowed in the action circle and/or danger zones.

Section B - Protective Clothing Maintenance

OneIt is the responsibility of individual personnel to provide proper maintenance, care and cleaning of their issued protective clothing.

TwoAfter returning from an incident in which protective clothing was worn, it shall be cleaned and inspected. Dirt or any other substance which has come in contact with the clothing shall be washed off. This shall be done as alarms allow.

ThreeAny damage found to the clothing upon inspection shall be reported to Support Services.

Section C - Patient Transport

Patient Information and Confidentiality

OneHIPAA regulations shall be adhered to at all times. Patient information can only be given to those agencies directly involved in patient care or the incident.

TwoNo information regarding the patient shall be given to the press, relatives, or bystanders without being cleared through Administration.

ThreeThe name of the patient shall, under no circumstances, be given out over the air.

FourNo HCEMS personnel shall talk to an attorney about a call without the approval of Administration.

FiveAll patient information shall be properly secured at all times:

a. All paperwork shall be kept in the confidential file.b. Computer screens containing patient information shall not be left opened

and unattended.c. All unnecessary paperwork containing patient information shall be shredded.

Juvenile Patients

OneAll juvenile patients shall be treated and transported to an emergency department if not accompanied by a parent or guardian. See Section E of this Article.

TwoIf the patient's parents or guardian can be contacted and they can come to the scene within a fifteen-minute time frame, then the medic crew can wait on them, providing there are no other patients and circumstances such as call volume allow. If other patients are in need of transport, then the juvenile patient is to be transported. No refusal of service may be received over the telephone.

Three

If juvenile patient(s) are married or have children, they are considered emancipated and are able to assume legal responsibility for themselves.

Patients in Custody

OnePatients placed in custody of law enforcement shall not be transported by HCEMS unless the arresting officer or another officer from that agency can accompany the patient to the emergency department.

TwoIn the event the responsible law enforcement agency cannot accompany the medic unit, the crew shall advise the officers that neither HCEMS nor its employees are responsible if the patient chooses to leave the medic unit or the hospital.

Violent or Combative Patients

OneIf a patient, family member or bystander becomes violent or combative and needs to be restrained or removed from the scene, law enforcement officers shall be notified immediately, if they are on the scene. If they are not on the scene, EMS personnel shall contact Communications and advise them of the current situation.

TwoIf the situation on the scene becomes life threatening and law enforcement is not present, EMS personnel shall contact Communications and initiate a Code 443 signal.

ThreeHCEMS personnel should not become involved in the physical restraint of a patient or bystander except to protect themselves or the patient.

FourIn the event EMS personnel become the victim of physical violence, charges should be filed with the law enforcement agency in whose district the incident occurred and the ranking Supervisor notified, who will ensure all incident reports are properly completed.

Paramedic Transport

OneA paramedic shall accompany all patients transported in HCEMS units.

TwoThe lead medic shall determine the mode of transport to the hospital. (Emergency or non-emergency)

ThreeHCEMS will not transport direct admit patients or patients to a doctor's office unless approved by Administration or we are declared in business for such convalescent transports. HCEMS shall only transport to an emergency department or the Forensic Center.

FourHCEMS shall not transport any emergency type of alarm to a hospital that does not have EMS radio communications capabilities as their normal operations.

FivePatients shall be transported to the hospital of their choice, provided it is within reasonable limits, meets injury or treatment facility requirements, or is approved by a ranking Supervisor. The Shift Supervisor shall evaluate transports to Hutcheson E.R. Patients requesting inappropriate facilities shall be transported per regional or local directives/destination guidelines.

SixIn the event of a disaster, weather emergency or when the patient condition warrants such, the destination may be overridden by the paramedic and the patient may be taken to the nearest appropriate hospital.

SevenIn the event of a hospital to hospital transport, a nurse from the transferring hospital shall accompany the patient to the receiving hospital, when appropriate.

EightHCEMS is not responsible for the return of hospital or first responder personnel when transporting, however the crew of the medic unit may, at their own discretion, return such personnel with the understanding that the unit is in-service and subject to a call.

NineOnly one family member (rider) is allowed to accompany the patient to the hospital. The family member shall ride in the front passenger seat unless, in the

opinion of the lead paramedic, the presence of the family member in the patient compartment of the unit would enhance patient care. The decision to allow or refuse a rider shall be at the discretion of the medic crew. The medic crew shall consider patient care, safety, and customer service when making their decision.

TenThe maximum number of patients that can be transported at one time is restricted by the availability of vehicle safety restraints and the number of patients that can be properly cared for.

ElevenPersonnel may request additional assistance whenever deemed necessary and feasible.

DOA Transport

OneHCEMS shall transport all DOA's to the Forensic Center.

TwoWhen crewmembers confirm a DOA, they shall notify dispatch and request Law Enforcement, if not already on scene, and protect any crime scenes. Crews shall attempt to obtain patient information. Once the Law Enforcement agency arrives, the crew shall brief the officer and return to service.

ThreeDeceased victims are under the oversight of the Medical examiner's office and the local Law Enforcement Agency. They shall have jurisdiction and the responsibility for the deceased. EMS units may be pulled from such scenes as needed for alarm response.

FourHCEMS personnel may utilize our "Forensic" transport unit as they deem necessary. This unit shall be maintained by support services. Personnel using this unit are held responsible to return this unit to service in clean and acceptable condition and ready for the next alarm where it may be needed. If problems are found that cannot be resolved by the crew, Support Services should be notified.

FiveDecisions for discontinuing CPR should be made prior to transport. Once transport begins do not discontinue life support. The patient shall be transported to the nearest appropriate medical facility.

Emergency Department Bypass

OneBypass should only be initiated when delayed patient care or system overload directly impacts the mission to our service area.

TwoAnytime an ambulance presents a patient to an emergency department and transfer to the facility is, or is potentially, delayed longer than 15 minutes, dispatch will be notified. They in turn will notify the Shift Supervisor, who will respond to the affected facility for personal evaluation of the situation.

ThreeThe Shift Supervisor, after evaluation, will notify Dispatch of an E.D. Bypass, if in his/her estimation the situation will not rapidly correct itself and will potentially cause a backlog of H.C.E.M.S. ambulances at that facility. Dispatch will then notify all units of the bypass situation. Units currently in transit to that facility will continue to their destination. Units beginning transporting during the event will not transport to the facility and will explain to all patients the need for transport to another facility. The facility chosen for destination will be the closest appropriate facility and transport time must be less than potential wait time at the original facility. Local destination protocol (trauma, stroke alert, code stemi) takes precedence over the bypass decision.

FourThe Shift Supervisor, if possible, will remain at the facility until the situation is corrected. He/she will then notify Dispatch of the cancellation of the bypass status. Dispatch in turn will notify all units of the return to normal transport operations.

FiveThe bypass may be initiated by a District Supervisor if he is on the transport unit affected by the transfer delay, but must be approved by the Shift Supervisor, who will personally notify Dispatch of the bypass. A Chief Officer will be consulted in any situation outside of the parameters for approval of initiation of bypass.

Section D - Supply Acquisition

OneEmployees shall complete their station and unit supply check-off forms and place them in the station out-going mail box. Supply requests will be made the shift

before the delivery day in accordance with par levels on the unit supply check-off form. If it is an order day for a particular station, this order shall be sent no later than 7 a.m. on delivery day. Request shall be made in by E-mail to supply at: EMSSUPPLY@EXCH.HAMILTONTN.GOV . An e-mail will also be sent stating no supplies are needed when applicable. If e-mail service is unavailable requests shall be called in by telephone to supply by 7 am. The Support Services Division will deliver supplies according to these requests.

TwoSupport Services should be notified immediately anytime critical or state required supplies are needed. In the event of a depletion of supplies after normal operating hours and on weekends, employees shall notify their Shift Supervisor and arrangements will be made for the acquisition of the needed supplies from Support Services.

ThreeEmployees having ideas or suggestions for the acquisition of a new product or item shall provide the Supply Officer with said information.

FourLarge amounts of supplies shall not be kept in individual stations. Inventories should be limited to par levels on the unit supply check-off form or the station check-off form.

FiveMedic unit crews SHALL NOT restock supplies to First Responders agencies. The First Responder’s Department representative shall obtain all First Responder supplies from Support Services in accordance with established procedures.

SixAny time a piece of Patient Care equipment experiences a failure, Support Services, and the Shift Supervisor shall be notified. The medic unit will be out of service in the event of a Patient Care equipment failure until the problem is resolved or the equipment replaced. Anytime a piece of Patient Care equipment fails, it shall not be used for patient care until authorized by Support Services. An

incident report shall be completed by the crewmember experiencing the failure. Patient Care includes the following: Cardiac Monitor, blood glucose monitor, pulse oximeter, blood pressure monitors, capnography equipment and any other piece of medical equipment not listed. Medic crews shall not attempt repairs.

SevenEmployees or students shall not use Non-HCEMS medical equipment or supplies unless approved by the Medical Director, Deputy Chief or Chief.

EightMedication shall be replaced according to the medication replacement policy in this SOG.

Section E - Refusal of Service

OneWhen crews are confronted with a patient who is refusing treatment or transport, the crew should have the patient sign a refusal of service form. This form will be completed along with the trip report.

TwoIf the patient refuses to sign the form, attempt to have a third party, such as a police officer, if on the scene, witness the refusal and sign the form. Adequate documentation is of the utmost importance.

ThreeIn order for a patient to refuse treatment, transport, or go against medical advice, such advice must have been given. If a patient should be transported to a hospital, give the medical reasons for the potential consequences to the patient, within your training and scope, if transport is refused.

FourIf medical care is obviously needed and the patient still refuses treatment or transport, contact Medical Control for assistance in making a determination. Follow the direction of Medical Control.

FiveJuveniles, as defined by Tennessee State Law, shall be treated unless a parent or legal guardian refuses treatment or transport. If the juvenile's life is in jeopardy, contact Medical Control and follow their directives. A juvenile cannot sign a refusal of service form. An emancipated minor (defined as a juvenile that is married or has a child) is the only exception to the aforementioned rule.

SixCrews shall not accept telephone instructions from a parent or guardian. Instead transport without delay to a medical facility. DO NOT WAIT ON THE SCENE ANY LONGER THAN 15 MINUTES FOR THE PARENT OR GUARDIAN TO ARRIVE. TRANSPORT OR CLEAR THE SCENE AND IF NECESSARY, CONSULT WITH YOUR RANKING SUPERVISOR.

SevenA representative of the school system and/or a school principal may sign the refusal for minor students who are under school oversight or control.

Eight Every effort should be made to transport the patient. However, if a patient of legal age still refuses to be transported or treated, clear the scene and document well. We cannot make people go to the hospital. If a patient refuses to sign a refusal form, Law Enforcement or another witness shall sign and document in comments section.

Nine

The refusal form will be read to the patient and they shall receive a copy of the Notice of Privacy Practices.

TenAsk patient permission to do an assessment and check vitals on all patients that refuse transport. Do not touch any patient that does not give you permission.

Section F - Documentation

OneA hard copy written Medical Assessment Chart shall be completed on every alarm where a patient is assessed and treated. A soft copy of every alarm assigned a run number shall be entered in the station computer complete and correct. If the computer system is down, a hard copy billing sheet shall be completed and forwarded to billing. The computer reports should be properly transmitted to

billing. These reports shall be completed by the end of the shift in which the alarm occurred. Exceptions are at the discretion of the Shift Supervisor.

TwoThe Medical Assessment Chart should be completed at the hospital, provided there is sufficient coverage of medic units. Twenty minutes shall be the maximum time allotted for the completion of routine calls and unit turnaround. Crews shall notify dispatch if the unit has a delay in returning to service.

ThreeAll narratives shall be completed using the H.A.T. format.

FourAll Medical Assessment Chart's and all other reports and forms shall be completed in black ink.

Section G - Severe Weather Alerts

OneIn the event of severe weather conditions such as major thunder or snow storms, tornados, flooding or other weather related emergencies, HCEMS shall be placed on a severe weather alert.

Two

Chief Officers and/or the on-duty Shift Supervisor shall be advised of the weather situation and determine the need of a severe weather alert.

ThreeIn the event that a severe weather alert is initiated after 19:00 hours, the on-coming Shift Supervisor shall be paged by Communications and notified of the situation.

FourThe on-coming Shift Supervisor shall report to their assigned duty station at least two hours early in order to coordinate on-coming crews and stay appraised of the situation.

FiveIn the event the weather prohibits the on-coming crew from reporting to their duty station, the crew shall notify the appropriate supervisor no later than 06:00 hours. At this point the on-duty supervisor may advise the following:

a. Report to a different duty station.b. Wait until weather conditions lesson, then report to an assigned station.

SixIn the event of a severe weather alert, the on-duty crews will be subject to work overtime to maintain minimum staffing until relief crews report for duty.

SevenDuring a severe weather alert, the on-duty Shift Supervisor shall be briefed by Communications periodically with a weather update from the National Weather Service.

EightDuring a severe weather alert, the on-duty Shift Supervisor may determine the following:

a. All units must remain in stations unless on an alarm, relocation or to fuel the units.b. Special considerations, such as raising bay doors or other directives may be issued.

NineDuring a severe weather alert, all units shall utilize main roads as much as possible. Units shall avoid secondary roads unless required for response on an alarm. The unit shall proceed with caution on all secondary roads until traction is compromised, then the fire department having jurisdiction, or other resources shall be called for assistance.

TenIn the event of snow and ice, units shall not make use of driveways or dirt roads. Every effort must be made not to disable the unit. The unit shall request assistance from the fire department having jurisdiction or other appropriate resources.

ElevenIn the event of a severe weather alert, crews may utilize whatever means available for transporting the patient from the residence to the unit and if necessary, the hospital.

TwelveIn the event of a severe weather alert, medic crews may utilize an aero medical service to transport the patient if the unit cannot readily access and/or transport the patient.

ThirteenAt any time a Chief Officer or the on-duty Shift Supervisor may cancel a severe weather alert.

FourteenThe Shift Supervisor shall maintain a list of all shift employees that are to report to work 12 hours early and/or stay 12 hours late when operating on a 36-hour shift.

FifteenSupport Services will amend order and delivery schedules for supplies as dictated by weather conditions. Delivery may be canceled completely and unit come to supply as they return to quarters from the hospitals if items needed are critical or if necessary units will be met at a central location.

Section H - Driving Procedures

OneAny person operating a HCEMS vehicle shall be a Hamilton County Emergency Services employee. In an emergency situation Non-Hamilton County Emergency

Services personnel shall not operate a HCEMS vehicle without the direct approval of the Director, a Chief Officer, or the Shift Supervisor.

TwoAny employee operating a HCEMS vehicle shall have a valid Tennessee driver's license with an F endorsement or equivalent in their possession at all times. No employee shall operate a HCEMS vehicle without supervision prior to completing the required driver orientation period.

ThreeAny and all condition codes noted on the driver’s license should be strictly adhered to at all times while operating a HCEMS vehicle.

FourNo person shall operate a HCEMS vehicle while under the influence of any chemical or medication, prescription and alcoholic beverage or otherwise, which could alter judgment or reflexes.

FiveAny person taking prescription medication, as per paragraph four, shall notify their on-duty Shift Supervisor for driving approval prior to operating a HCEMS vehicle.

SixDirectional signals shall be used at all times.

EightAny person operating or riding in a HCEMS vehicle must fasten their seat belt, unless its use would preclude providing patient care.

NineThe use of any tobacco products and food product consumption is prohibited in the vehicle. Per Tennessee State Regulations smoking is prohibited within 10 ft. of an ambulance.

TenThe driver of an HCEMS vehicle shall use prudent judgment and shall operate the vehicle in a responsible manner at all time and with special caution on unpaved roads. The medic unit should not be driven into non-traveled areas such as across

curbs into grass or other areas with poor clearance that would cause damage or where the unit will become stuck in mud or other low traction situations.

ElevenAny backing shall be done with a spotter, if available. If a spotter is not available, the operator shall do a 360 degree walk around and visual clearance check prior to backing. The back-up alarm must be activated.

TwelveEach station shall have at all times in their reference material, a copy of the HCEMS "Safe Vehicle Operating Supplement." The information in the “Safe Vehicle Operating Supplement” shall be a part of this SOG and adhered to at all time. The Supplement contains information specific to operating within our service area and useful driving procedures.

ThirteenThe drivers of an HCEMS vehicle shall ensure all vehicle doors and compartments are closed prior to moving the vehicle.

FourteenThe driver of an HCEMS vehicle shall insure that the bay doors are completely up and stopped prior to placing the vehicle in motion and exiting the station. After exiting the station the driver and the partner should insure the bay door is completely shut before leaving the station.

FifteenAnytime an HCEMS vehicle is parked the parking brake shall be applied. Medic units shall use wheel chocks at all times when the unit is parked on an incline.

Emergency Operating Mode

One

Any person operating a HCEMS vehicle, in the emergency mode, shall have completed an Emergency Vehicle Operations Course, Coaching the Emergency Vehicle Operator Ambulance (CEVO Ambulance), or approved equivalent.

TwoAll audible and visual warning systems shall be used when operating the vehicle in the emergency mode. While at the scene of an emergency the use of visual warning shall be used when necessary to protect the vehicle from hazards.

ThreeDuring an emergency response, vehicles shall obey all State laws in regard to emergency response unless this SOG provides stricter guidelines.

FourHCEMS vehicles may exceed the posted speed limit as weather conditions, due care, and caution permit. At no time will a vehicle exceed the posted speed limit by more than twenty miles per hour. The regard for the safety of the public shall always be the primary concern.

FiveVehicles operating in the emergency mode have the right of way; you should operate the vehicle as if you are “requesting the right of way.” At no time should the special provisions of emergency response be exercised in a careless or reckless manner.

Six

When approaching a controlled intersection in the emergency mode, units will do the following:

a. When approaching a traffic signal displaying a red or yellow signal, the vehicle shall come to a complete stop. All crew members should check the intersection for approaching vehicles and other hazards to ensure safe travel through the intersection. The unit should proceed only after all traffic has yielded the right of way and the intersection is clear. The same shall hold true for controlled intersections displaying a stop sign.

b. When approaching an intersection displaying a yield sign, the vehicle shall slow to a safe speed in order to stop if needed. All crew members should check the intersection for approaching vehicles and other hazards to ensure safe travel through the intersection. The unit should proceed only after all vehicles have yielded the right of way and the intersection is clear.

c. When approaching an intersection displaying a green signal, the vehicle shall slow and prepare to stop if needed. All crew members should check the intersection for approaching vehicles and other hazards to ensure safe travel through the intersection. The unit should proceed only after all vehicles have yielded the right of way and the intersection is clear.

SevenWhen operating in the emergency mode, vehicles should not pass another vehicle that is operating in the emergency mode unless the vehicle yields or directs you to do so.

EightWhen operating in the emergency mode, traffic should be passed on the left. If a vehicle must be passed on the right, all crew members should check for vehicles that may be a hazard to ensure safe travel past the vehicle(s) being passed on the right. The unit should proceed only after all vehicles have yielded the right of way.

NineWhen operating in the emergency mode, vehicles shall use all directional signals at all times when making turns. The vehicles hazards flashers shall not be used while the vehicle is in motion.

Ten

When approaching a school crossing zone or a school bus with flashing lights, the operator shall slow and stopping when necessary, regardless of the emergent response unless directed otherwise by the school patrol officer or bus driver.

ElevenThe unique hazards of driving require operators to use extreme caution and to be alert and prepared to react to the unexpected.

TwelveOperators shall obtain a confirmed visual clearance of all railroad intersections prior to crossing, to include stopping if needed.

Section I - HCEMS Vehicle Involved in an Accident

Accident: Anytime an HCEMS vehicle is damaged by another vehicle or the HCEMS vehicle causes damage or is damaged

while in motion.

Major Accident: An accident that involved personal injury, another vehicle or object, and which caused substantial damage as assessed by Administration.

Minor Accident: An accident that does not involve personal injury, but does involve another vehicle or object and caused minor damage as assessed by Administration.

OneAny time a HCEMS vehicle is involved in an accident, the unit shall stop immediately as close as to the scene as safely as possible. Communications shall be notified immediately and the driver will report the exact location of the accident, any injuries, number of vehicles and any property involved. Communications will notify the Shift Supervisor, page the Director of Emergency Services, Chief Officers and Support Services

TwoThe driver of the involved vehicle shall ensure that the following steps are taken:

a. Perform a rapid assessment of all injuries.b. Update Communications of the incident conditions and additional

resources required (i.e. EMS, Fire, or Extrication).c. Care for the injured parties as needed and able..

ThreeThe emergency lighting of the vehicle shall be turned on to provide for safety of the scene when necessary. All crew members shall remain with the vehicle unless needed to treat injuries or provide traffic control.

FourThe driver and other crew member(s) shall not discuss the accident with anyone other than the investigating law enforcement agency or HCEMS Administration or the Accident Review Team. Do not admit guilt to any of the involved parties.

Five

Administration shall determine the status of the HCEMS vehicle.

SixIf an HCEMS vehicle damages property (other than county-owned) or causes injury, the law enforcement agency having jurisdiction shall be notified.

SevenThe HCEMS vehicle will not be moved unless so directed by the investigating officer or a HCEMS supervisor. Photographs will be taken if possible prior to moving the vehicle.

EightAll crew members of a HCEMS vehicle involved in an accident will be required to undergo a drug and alcohol screen with results given to Administration. The location of the drug screen will be determined by Administration.

NineCrew members shall complete any needed reports as directed by Administration immediately following the accident including information and reports requested by the HCEMS Accident Review Team.

TenAny operator of a HCEMS vehicle, involved in a major accident, shall be suspended from driving until reinstated by Administration.

ElevenAccidents Review Team shall review all accidents.

TwelveThe Shift Supervisor or District Supervisor shall ensure the following:

a. A member of the Accident Review Team and Shift Supervisor will respond to the scene when possible. If the on duty Accident Review Team member is unable to respond the Shift Supervisor along with the Supervisor of the Accident Review Team shall respond. If no member of the Accident Review Team is available the Shift Supervisor will respond andcomplete the HCEMS Accident Report and make pictures. The Accident report, incident reports, and photos shall be forwarded to the Supervisor of the Accident Review Team within 24 hours.

b. The Director, Chief and Deputy Chief shall be notified on all Accidents.

c. The Supervisor of the Accident Review Team is to be notified if not responding in Section a above.

ThirteenThe HCEMS Shift Supervisor or the Supervisor of the Accident Review Team shall ensure that the Hamilton County Accident Report is completed and forwarded to the Director of Emergency Services, Chief, Deputy Chief and Risk Management within 24 hours of the accident.

Section J - Accident Review Team

OneThe purpose of this Team is to provide a consistent peer review of all vehicle accidents and assist in training of our vehicle operators in an effort to determine action that could have prevented or will prevent accidents. They shall be empowered to collect, organize, and analyze all reports and facts related to an accident. They shall then present a report to Administration.

TwoThe Team shall consist of the following:

a. The Supervisor assigned to coordinate the Team.b. One Member EMT as designated from A, B, C Shift.c. The Deputy Chief, if a member of the Team is in review.d. Members of the Accident Review Team and others as approved by the Supervisor of The Accident Review Team the Training Officer and Deputy Chief will be appointed HCEMS Vehicle Operation Instructors. The Supervisor of the team and the Training Officer will insure proper training of appointees before those appointed are allowed to train.

ThreeThe Team shall meet as needed following an accident to perform the duties of Paragraph One. The Team shall have the authority and responsibility to require the presence or cooperation of any employee in order to conduct its business. At no time will the business of the Team interfere with a law enforcement investigation or disciplinary action of HCEMS Administration.

FourThe Supervisors will be briefed by the Deputy Chief of the Team's report. Administration, as is appropriate, will issue any discipline.

Section K - Infection Control

Contaminated - The presence or reasonably anticipated presence of infectious materials or blood on an item or surface.

Contaminated Sharps - Any contaminated object that can penetrate the skin.

Contaminated Exposure - Reasonably anticipated skin, eye, mucous membrane or peranteral contact with blood or other potentially infectious material.

Exposure Incident - A specific eye, mouth other mucous membrane, non-intact skin or peranteral contact with blood or other potentially infectious material.

Protective Equipment - Specialized clothing or other equipment worn by an employee for protection against a hazard. (I.e. latex gloves, eye protection, caps, gowns, etc.)

Universal Precautions

OneAll personnel when in contact with any patient shall wear Gloves, at a minimum.

TwoEye protection shall be worn if any remote chance exists of blood or other materials splashing on the medic crew.

ThreeAny and all Sharps shall be disposed of in the provided Sharps containers.

FourNeedles shall not be recapped.

FiveAll needles should be accounted for upon leaving the scene.

Six

All personnel shall wash hands after each alarm, after cleaning the unit or equipment, after checking off the unit, or any other time there is a chance of a contaminated exposure.

SevenContaminated items shall be disposed of at the hospital in the proper container. In the event the items must be disposed of at the medic station, place in the Infection Control Container.

EightAll contaminated equipment shall be cleaned immediately after use with a germicidal cleaner. If it cannot be cleaned, the piece of equipment shall be turned into the Supply Officer for replacement if necessary.

NineThe medic unit will be decontaminated as needed after each alarm.

TenA medical file shall be kept on each employee, full and part-time, at Administration. These files are to contain a record of the employee's hepatitis vaccine, pre and post vaccination titers, and a copy of any exposure incident. These files are to be kept confidential. Access to the files shall be limited to the Chief Officer's, Medical Director, Customer Service Officer and the Training Officer. Each employee shall also have access to their individual file.

ElevenIn the event of an exposure incident, employees Shift and District Supervisors is to be notified immediately, an incident report is to be completed and faxed to Risk Management and turned in to the Customer Service Officer, and the employee is to register in the emergency room and be evaluated by the emergency room physician. A copy of the incident report and the emergency room record shall be placed in the employee's medical file kept at Administration.

TwelvePrior to leaving the scene of any incident, if time and patient care allow, the medic crew must coordinate with other personnel on scene to make sure any contaminated waste is property disposed of. If no other personnel are on the scene, then the medic crew must try to clear the area for any and all waste. HCEMS and the involved medic crews are responsible for all contaminated waste on the scene.

Section L - Radio and Telephone Communications

Code 443 - A situation in which a crew or members of a crew are in a dangerous situation and needs emergency law enforcement assistance. This is for life threatening situations only.

Status Check - Statement in which Communications is inquiring on the safety of the crew or circumstances of an alarm in progress.

Medical Director - The Physician Advisor(s) of HCEMS.

Medical Control - The receiving facility's emergency room physician.

MEDCOMM - The Regional Communications Center responsible for coordinating all Hospital related radio traffic.

Trauma Control - The emergency room physician on duty at Erlanger Medical Center.

Day to Day Operations

OneIt is the responsibility of the Hamilton County Emergency Services Communications Division to receive and dispatch EMS alarms, except still alarms, or units coming upon an incident. Medic units will notify communications immediately of these situations.

TwoOnly necessary and pertinent information will be transmitted by radio.

ThreeRadio communications shall be kept simple and easy to understand, utilizing plain English language.

FourCommunications shall be kept clean, clear and concise.

Five

Proper radio etiquette shall be adhered to at all times. Misconduct on the radio or telephone will not be tolerated in any form.

SixThe use of profane or obscene language is prohibited.SevenUsing the radio, "Red" phone line, or Data Lines for personal business is prohibited. Crews are prohibited from tampering with the phone lines and radio equipment in any form.

EightWhen initiating radio traffic with Communications, give unit identification and wait for a response before continuing with traffic.

NineWhen a medical sector is initiated, or multiple unit incidents are in progress, the dispatcher or a ranking supervisor may assign certain units to a different tactical frequency.

TenAll information given to Communications shall be given once, unless Communications requests that it be repeated.

ElevenIn the event of a Code 443, the "air is cleared" for that particular unit. All other communications shall cease on said frequency until operations are returned to normal by Communications. All on Duty Supervisors and Chiefs shall be notified by dispatch, ASAP!!!

TwelveCommunications shall perform a status check when a medic unit is involved in a potentially dangerous alarm or is on an alarm for an extended period of time.

ThirteenCommunications shall conduct a radio test every day at 07:30 hour’s alarms permitting to test each mobile and portable radio.

FourteenDo not contact Communications during alarms by cell phone unless you are requested to do so. Command functions by Supervisors shall be used with discretion but are permitted.

FifteenCrews shall answer their phones using their medic unit number and last name.

SixteenCrews shall not use personal cell phones while driving the ambulance, unless directive to do so by their supervisor.Notification of Alarms and Related Radio Traffic

OneThe following procedure shall be used when units are in station according to the example provided:

a. Communications shall notify the Medic Unit by red phone.“Phone M-4 and give them a MVC at 2200 Amnicola Hwy, cross street Wisdom.”

b. The Medic Unit shall have 2 minutes to inform communications they are responding in their unit by stating the following. “Medic-4 responding.”

c. Communications shall acknowledge this traffic by sounding Alert tone 3, three times and state “Medic-4 responding to 2200 Amnicola Hwy, cross street Wisdom, reported MVC.”

d. The Medic Unit shall then confirm the dispatched location by stating “Medic-4 clear on 2200 Amnicola Hwy.”

TwoThe following procedure shall be used when units are on the air according to the example provided:

a. Communications shall call for the Medic Unit. “Medic 4”

b. When the Medic Unit answers, Communications shall sound Alert 3, three times, state “Medic 4 respond to 2200 Amnicola Hwy, cross street Wisdom, reported MVC.”

c. The Medic Unit shall acknowledge by stating “Medic 4 responding clear on 2200 Amnicola Hwy.”

d. Supervisor notifications shall be the same as in the previous example.

ThreeWhen units are ordered to perform a rapid turnaround, Communications shall Sound Alert 1, and state the following, “All units perform a rapid turnaround.” If the appropriate units have not cleared in 10 minutes, then the Shift Supervisor is to be notified for assistance with unit turnaround.

FourCommunications will have map page and grid numbers available, as time allows, if the Medic Unit requests such. However, it is the responsibility of the Medic Unit to find the alarm and Communications responsibility to help them as needed.

FiveThe following are accepted wording of EMS Unit Movement:

a. "Medic 4 responding"b. "Medic 4 on the scene"c. The word "transport" is used for Non-emergency traffic and the word "Emergency" is used for emergency traffic to the hospital.

1. "Medic 4 transporting to Erlanger, mileage 12.

2. "Medic 4 emergency traffic to Erlanger, mileage 12.

d. “Medic 4 at Erlanger, mileage 20”.e. “Medic 4 available enroute to destination.”

1. "Medic 4 available enroute to quarters"2. "Medic 4 available enroute to______."

f. “Medic 4 in quarters"

g. Units out of Station shall be "mobile" or "mobile" enroute to their location such as the shop, training, etc.

Medical Communications

OneCommunications with MEDCOM shall be established along with a chief complaint, at the earliest possible convenience or when warranted for patient care.

TwoIf a patient meets the Tennessee Trauma Destination Guidelines, Trauma Control shall be notified through MEDCOM.

ThreeIf MEDCOM cannot be raised on the radio, contact Hamilton County Communications and have them contact MEDCOM and advise them of your situation.

FourIf Paragraph Three is not possible, contact your destination hospital and your Shift Supervisor.

FiveIf patient is in a life-threatening condition, and MEDCOM cannot be contacted, and Paragraphs 3 and 4 are not possible, treat the patient condition to the best of your ability. The Shift Supervisor shall be notified of any such situation immediately and may render assistance as rank is commensurate with medical authority in accordance to the parameters of the Medical Director.

SixWhen communicating with MEDCOM, the paramedic must depict the patient thoroughly to the physician (in other words, paint a picture). If this is not done, then the physician cannot make an accurate assessment of the situation and may not be inclined to grant any orders or procedures beyond your standing orders.

SevenOnce a physician begins directing care for the patient, this does not absolve the paramedic from poor judgment or communications with the physician.

EightCommunications should be brief and to the point.

NinePatient confidentiality shall be maintained at all times.

Section M - Controlled Substances and Medications

OneAll medications carried on the medic units shall be administered to a patient only under the order of a physician either via standing orders, protocols, or direct Medical Control contact.

TwoAll medications used on an alarm will be listed on the Medical Assessment Chart in the Orders section. This will be accompanied by the ordering physician's signature. If standing orders, the HCEMS Medical Director will sign during his review of the alarm.

ThreeWhen a controlled medication is used, replacements will be obtained in accordance with HCEMS medication replacement policy below. When using a controlled medication from the NARCBOX® the blue number seal shall be placed inside the NARCBOX® after being removed. No other medication is needed for the patient the NARCBOX® shall be sealed with the black “Do Not Use” and relocked and secured in the controlled medication cabinet on the medic unit. The medication replacement form for the controlled medication used will be kept with the NARCBOX® at all times for more efficient medication replacement. The entire NARCBOX® will accompany the Medication Replacement form.

FourThe 5 “R” principles shall be followed when administering drugs. The right drug, the right patient, the right dosage, the right time and the right route.

Storage

OneNarcotics will be stored in sealed NARCBOXES® at all times when not in use. At no time will any NARCBOX® be stored with out a tamper seal affixed. The NARCBOXES® shall be stored in the small locked box in the locked compartment on the medic unit. The keys to all locks are to be carried by the designated paramedic at all times while on duty. Each time the paramedic responsible for the controlled medication changes (shift change, swaps, or other personnel change) the oncoming paramedic and the off going paramedic will insure that all NARCBOXES® are sealed with either a blue numbered seal or a black “Do Not Use” seal and that the lock is secure. If a black sealed NARCBOX® is present the on coming shift will verify that the Medication Replacement form is with the NARCBOX® and that the form correctly reflects the medication that is missing from the NARCBOX®. The count and inspection will be completed by both shifts prior to transferring the narcotics keys. The on coming shift will notify their district supervisor of the used medication. Any NARCBOX® that is missing, does not have a tamper seal affixed or the Medication Replacement Form is missing or incorrect will be treated as medication that has been lost or tampered with. Supervision shall be notified immediately. Medication with a black “Do Not Use” seal or no tamper seal will not be used.

TwoExceptions to the above rules are the storage area in the Supervisor's office and the drug box carried in the Supervisor's assigned vehicle. At no time will narcotics not be in a sealed NARCBOX® unless actively being used for patient care.

ThreeThe Medical Director and Administration shall determine quantities of medications carried. These amounts shall be standard for all medic units.

FourNo medications are to be carried in personal jump bags since they are not allowed on the Medic Unit.

Discarding

OneOut of date medications shall be turned in to the District Supervisor for replacement. A medication replacement form shall be completed and kept with the NARCBOX® at all times. Non-controlled medication shall be returned to supply.

TwoWhen requesting replacement for controlled medications do not list expired drugs and administered drugs on the same form.

ThreeAny portion of medications opened but not used in the course of patient care shall be discarded upon arrival at the hospital. The medication shall be wasted in a sink and the container shall be disposed of properly using universal precautions.

FourAll crew members shall witness the wastage of a controlled substance as well as Hospital Emergency Department Medical staff if able.

FiveA discarded medication form is to be filled out on all wasted controlled substances.

SixIf the medication is not disposed of at the hospital, then the on-duty shift supervisor should be made aware of the situation and should sign the Discarded Drug Form and witness the wastage.

SevenIn the event that a controlled medication is broken or a wrong medication is opened or drawn up, the District Supervisor shall be notified immediately, an incident report completed and a discard and replacement form completed. The District Supervisor shall notify the Shift Supervisor immediately.

EightWhen crews are checking the NARCBOX® medications, any apparent tampering shall be reported to the District and Shift Supervisors immediately.

Nine

Discovery of any lost, stolen, unsealed or evidence of tampering with narcotics or controlled substance will result in mandatory drug testing for all assigned unit personnel.

Replacement

Controlled Medication Request

OneFollowing each use of controlled medication or if the NARCBOX® is opened but no medication administered the Paramedic who administered the medication or broke the seal shall complete a Hamilton County EMS Medication Replacement Form. An incident number for each controlled substance shall be listed on the form. The form shall remain with the NARCBOX® that the medication was used from at all times. The district supervisor or shift supervisor shall be contacted for replacement.

In the event the replacement is for a broken controlled medication an incident report shall accompany the form and the NARCBOX® detailing how the medication was damaged. The damaged controlled substance container shall be placed inside a small sharps container and shall be forwarded with the above items.

If the replacement is for an expired medication the NARCBOX® with the expired medication must accompany the replacement form. If medication is lost or stolen the District Supervisor and/or Shift Supervisor shall be notified immediately. All controlled medication request shall be forwarded to the District and /or Shift Supervisor only. No controlled medication will be replaced without a completed Hamilton County EMS Medication Replacement Form. Controlled medications that have been tampered with, lost, or stolen will not be replaced until the HCEMS Chief and Deputy Chief have been notified and direct replacement.

Issue of Controlled Medication

OneAnytime controlled medication is issued to a medic unit the District Supervisor shall annotate the Hamilton County EMS Medication Replacement form in the dispensed column with the quantity of medication that was issued. If the medication is not replaced the dispensed column shall be left blank. The District and/or Shift Supervisor shall ensure that controlled medications have an incident number, expired, or damaged noted on the form prior to replacement. Controlled

medication will only be issued as a complete set of controlled medication in a sealed NARCBOX®.

District Supervisors

OneDistrict supervisors requesting controlled medication replacement shall complete a medication inventory sheet for their inventory and this form must be accompanied by supporting Hamilton County EMS Medication Replacement forms and sealed NARCBOXES® from the medic units for controlled substances. No controlled medication will be replaced unless there is a supporting medication inventory sheet and Hamilton County EMS Medication Replacement forms to document the controlled medication request and sealed NARCBOXES®. The controlled medication request shall be submitted to the Shift Supervisor for replacement or Support Services at the discretion of the Shift Supervisor. If the Hamilton County EMS Medication Replacement forms do not support the inventory requested shortages in the inventory will be treated as lost or stolen medication. The replacement of non-controlled medication shall be requested from Support Service Services. In the event of unavailability of Support Services the District and/or Shift Supervisor may replace medications. The Support Service representative or District and/or Shift Supervisor issuing the medication will annotate medication issued on the medication inventory sheet. If a controlled medication is lost or stolen the HCEMS Chief and Deputy Chief shall be notified immediately.

Shift Supervisor

OneShift Supervisors requesting controlled medication replacement shall complete a medication inventory sheet for their inventory and this form must be accompanied by supporting Hamilton County EMS Replacement Forms from the medic unit crews and sealed NARCBOXES®. If the controlled medication replacement requested was issued to a District Supervisor the supporting documentation submitted to the District Supervisor from the medic unit will be given to the Shift Supervisor and forwarded with the inventory form from the District Supervisor and then accompanied by the Shift Supervisor’s inventory form. No controlled medication will be replaced unless there are supporting medication inventory sheets and Hamilton County EMS Medication Replacement Forms to document the medication request and sealed NARCBOXES®. The Support Services representative issuing the medication will annotate medication issued on the medication inventory sheet. If the Hamilton County EMS Medication Replacement

Forms do not support the controlled substance inventory requested shortages in the inventory will be treated as lost and/or stolen medication. In the event the Shift Supervisor cannot contact Support Services and a critical need exists the Deputy Chief shall be contacted. If controlled medication is lost or stolen the HCEMS Chief and Deputy Chief shall be notified immediately.

TwoAnytime controlled medication is replaced the entire NARCBOX® will be replaced. The only personnel authorized to remove the black “Do Not Use” seal are HCEMS Support Service employees and Chief Officers.

Non-controlled Medication Replacement

OneNon-controlled medication will be ordered from Support Services on regular supply order days. In the event of a critical shortage after Support Services normal hours replacements may be obtained from the District and/or Shift Supervisors.

Disposal of Medication

OneExpired and broken controlled substance medication that is returned to the District and/or Shift Supervisor must be returned to Support Services for proper disposal. Controlled Medications will be kept secured even if expired. Non-controlled medication that is expired will be returned to Support Services for proper disposal. No medication controlled or non-controlled will be disposed of by any employee other than Support Service employees.

HCEMS OPERATIONAL GUIDELINES

ARTICLE IV – TACTICAL PLANS

Section A - Unit Relocation for District Coverage

OneIn all of the following staging proposals it is imperative that dispatch ascertain the probable in-service time of the next available unit in said sector before assigning a unit to stage. It is our recommendation that if the probable in-service time be less than 10 minutes then NO unit shall be sent to stage.

Stage WestThe general staging area for the west sector shall be Harrison Ln. @ Dayton Pike in the parking lot of Hardees Restaurant. This is the best centrally located area in the west sector, which provides good access to all areas of the sector including Mowbray Mountain, City of Soddy Daisy via Dayton Pike, Middle Valley via Harrison Lane, and Hixson via Highway 27. The following shall apply to the above staging area:

a. When 4 and 12 are out, 2 shall come south to the above-described staging area to provide adequate coverage for the west sector.

b. When 2, 4, and 12 are out, 14 shall come north to the above-described staging area to provide adequate coverage for the west sector.c. When 2, 4, 12, and 14 are out, Medic 6 shall come north to the above-described staging area to provide adequate coverage for the west sector.d. When 2 and 12 are out, 4 shall come north to the above-described staging area to provide adequate coverage for the west sector.e. When 2 and 4 are out, 12 may stay at their station for staging.

Stage EastThe general staging area for the east sector should be Bonny Oaks Dr. @ Lee Hwy. in the parking lot of Northern Tools. This is the best centrally located area in the east sector, which provides good access to all areas of the sector including Ooltewah via I- 75 North, Collegedale via Lee Hwy, East Brainerd via Jenkins Rd. and upper and lower Highway 58 via Bonny Oaks and Hickory Valley Rd. The following shall apply to the above staging area:

a. When 1, 5 and 7 are out, 3 shall go to stage east to provide adequate coverage for the east sector.b. When 1, 3, 5 and 7 are out, 11 shall go to stage east to provide adequate coverage for the east sector.c. When 1, 3, 5, 7, and 11 are out, 14 shall go to stage east to provide adequate coverage for the east sector.d. When 3, 5 and 7, are out, 1 shall go to stage east to provide adequate coverage for the east sector.

Stage SouthThe general staging area for stage south shall be medic 9’s quarters. This is the best central location in the southern part of the county and provides easy access to all areas of the sector including Lookout Mountain via Broad St., Red Bank via I-27 North, Brainerd via I-75 East or McCallie Tunnels, east Chattanooga via Amnicola Hwy, Tiftonia via I-24 West. The following shall apply to the above staging area:

a. When 6, 9, 10 and 13 are out, 14 shall come to stage south to provide adequate coverage for the south end of the county.b. When 6, 9, 10, 13 and 14 are out, 11 shall come west to provide adequate coverage for the south end of the county.

Stage Central

The general staging area for the central sector shall be Medic 14’s quarters. Stage central shall only be used when we are down to one (1) “in-service” unit in the county. The shift supervisor or designee will have the responsibility to deviate from the above staging area if necessary.

Two Unit relocations will be coordinated by Communication with the Shift Supervisor having general oversight and final approval. “Chute Times” shall be the same as for alarms which is two minutes. Communications shall work closely with the Shift Supervisor to ensure the proper flow of units and coverage.

ThreeCommunications may order a “rapid turn-a-round” of units to provide better district coverage. This order should be given when over fifty percent of the fleet is committed on alarms. When this order is given, all units at hospitals will clear within ten minutes and their Shift Supervisor shall be notified if they do not. Unit’s enroute to the hospital shall clear upon arrival within the same time frame. The clearance times are for when no additional alarms are received, which if received, must be taken regardless of allotted times.

Four First Response agencies should be used as is appropriate for their response criteria and potential critical patients. First Responders should only be used as needed and not abused.

Section B - Motor Vehicle Accident (MVA)

Action Circle - The area within a 10-15 foot radius of involved vehicles.

Lead Medic - The paramedic who assumes the role of primary care provider for a particular incident.

OneWhen a unit arrives on the scene of an MVA, it shall park no less than 50 feet from the involved vehicles to ensure a safe working zone away from the damaged vehicles. Protective clothing shall be worn as is available and appropriate.

TwoIf there is obvious danger such as fire, hot electrical wires, unstable vehicle or any type of hazardous materials, the crew shall not approach the scene until the fire department having jurisdiction has secured the scene.

ThreeUpon arrival at an MVA, the lead medic shall perform a quick survey of the scene and relay to Communications all pertinent information such as correct location, number of patients, number of vehicles involved, additional medic units needed, etc.

FourIf the fire department having jurisdiction arrives on the scene prior to EMS, the lead medic shall report to the Incident Commander for patient information and further assignments.

FiveIf the fire department having jurisdiction arrives after EMS, a crew member shall give a report on the situation and patient update to the Incident Commander as time allows.

SixIf extrication is involved in removing the patient, the lead medic shall relay all pertinent information to the rescue sector officer, such as the patient condition, the need for rapid extrication and any relevant suggestions on how to free the patient.

SevenIf during the extrication operation a crew member is not involved in direct patient care, the crew member shall obtain the necessary equipment needed for patient packaging and coordinating all radio communications. All equipment used shall be staged outside the action circle. Units should be positioned as to provide access to all equipment and allow access away from the scene in a timely manner.

EightBefore leaving the scene after the patient is loaded, the driver of the unit shall perform a quick check of the scene for any equipment that might have been left.

NineAfter the patient has been transferred to the hospital staff, the lead medic is responsible for report writing and the driver is responsible for cleaning the medic unit to enable a timely turnaround.

Section C – Aero medical Request

OneAny patient meeting the Tennessee Trauma Destination Guidelines is a candidate for aero medical transport, provided that at least one of the following conditions:

a. Entrapment in which the extrication will last longer than 15 minutes and the patient will benefit from aero medical transport.b. The arrival of the patient to the trauma center will be enhanced via aero medical transport.c. Traffic or weather conditions prohibit rapid ground transport.d. The patient is not easily accessible by a ground unit.e. Mass casualty incidents.f. Ground transport to the trauma center will exceed 20 minutes.

TwoAny patient in an immediate life-threatening medical emergency is a candidate for aero medical transport if any of the criteria in paragraph one exists.

ThreeThe lead medic shall determine whether or not aero medical transport is necessary.

FourThe following should be considered when using aero medical transport:

a. Is the aircraft on the scene when the crew is ready to transport the patient?

b. Will the scene time be greatly delayed using aero medical transport?

Five

Aero medical transport is just an alternate means of transportation, not a higher medical priority. The patient(s) is the responsibility of the HCEMS lead medic until properly transferred.

Section D - Scene Management

OneThis section is intended to provide basic principles for scene approach, assessment, and mitigation. While there are hundreds of types of scenes EMS personnel will encounter, there are still several basic guidelines that should always be followed. True scene management begins before you leave the station by having an understanding of your job knowledge, role, proper equipment that has been checked, and the right frame of mind to work in.

TwoRegardless of the type of alarm you are dispatched to, the first and foremost concern should be the safety of everyone involved in the alarm. HCEMS endorses a "stand back" policy on domestic violence, shootings, stabbings, or any other scene that has not been properly "cleared" by the law enforcement agency having jurisdiction. We cannot help others if we become injured. When in doubt, stay out and use prudent judgment. Judgment must be your guide, because patient care must be given as soon as possible.

ThreeThe placement of the Medic Unit is important. Do not use the unit as a blocking device between you and traffic as the unit could become involved in an accident and disabled. The unit as well as the crew should be protected at all times. If the unit is in a hazardous area such as parked in the roadway or on a fire-rescue scene, leave the warning lights on. If you are in a driveway, off the road, a parking lot, you may consider turning off the warning lights as this will assist you in crowd control. Always try to avoid backing whenever possible.

Four

As you are approaching the scene, the patient, or a crowd, be quick to identify yourself as a Paramedic or EMT even if it seems obvious. The sooner people know you are medical help, the more relaxed they will be on average. Approach with a cool, confident and politely "directing behavior." You are now there and everything is going to be OK! You have to develop trust very quickly. Do not judge a person, the circumstances, the environment or anything else. You are a medical professional, not a judge, so be compassionate, and the rest will fall into place. Treat everyone like they were your own family!

FiveAlways be looking for a way out! Most CPR's happen in the upstairs back bedroom around the corner between the bed and the wall. You can prevent this by "reading the room or your scene." Attempt to get the big picture as you approach! Try not to trap yourself in! Take the time to move furniture, people, and the patient if necessary.

SixIf your scene does not "feel right," it probably is not right! Be proactive and look around. You may find something you missed. Watch out for each other as four eyes are better than two.

SevenBe courteous to the first responders and the law enforcement agencies on your scene. We are all on the same team. If they have something to say, listen and get a report as proper transfer of patient care would dictate. You would be insulted if you were not acknowledged, appreciated, and be made to feel a part of the team. Do unto to them as you would want and avoid burning this bridge since they are not there to "get your stretcher" for you. If procedures are done wrong, be skillful and tactful in your correction. Make time to train and discuss things in a positive way.

EightWhen taking equipment from your unit, remember what you take out you must always bring back plus the patient. You are required to carry in your equipment and properly assess the patient. As soon as you are able, get the patient to your "office" to continue your assessment. Organize your equipment as best you can.

Avoid "bradyation" which is the inevitable and complicated tangling of every conceivable tube, line, device, and procedure known to the EMS profession.

NineIf you have been issued protective clothing, USE IT!!!!!

TenIf you are on a crime scene, do the following:

a. If the patient is obviously dead, then protect the crime scene by limiting access, not moving items in the room, and very limited movement of the body. Leave all weapons where they were found and do not destroy finger prints.

b. If you are not involved in patient care, you are coordinating for the law enforcement agency having jurisdiction who is working with the medical examiner. Assist any way you can.

c. If you need to attempt resuscitation, give treatment, do not endanger yourself. The goal is to preserve as much evidence as possible.

ElevenThe most common role you perform on a scene has two distinct identities. You must be both a leader and a manager. You lead people and manage equipment. Do not mix the two! They interact with each other but have a distinct difference. You may have to direct other personnel to perform skills and procedures, retrieve equipment, etc.

TwelveBasic guidelines of scene management are as follows:

a. Approach with caution and Be Safe

b. Lead people

c. Treat the patient

d. Manage equipment

e. Arrive and leave with the knowledge that you did well and made a positive difference in someone's life.

Section E - Incident Command System (ICS)

OneHCEMS functions on incidents which may require the use of the ICS. When the ICS is instituted, the HCEMS ranking officer is usually designated as the medical sector officer (MSO).

TwoA medical sector should be established any time two or more medic units are committed to one incident. The first arriving lead medic should report to the incident commander (IC) and become medical sector. The IC may have already appointed a medical sector, however, if not the case, get a report and establish Medical Sector. The highest ranked and licensed medical authority with HCEMS will become the medical sector. It is most appropriate for an employee, preferably a supervisor of HCEMS, to be the medical sector officer.

ThreeThe primary responsibility of the arriving unit(s) is patient care and the med sector should be established only when personnel are available to do so. The district or shift supervisor shall ensure that med sector is established when needed. The district and/or shift supervisor shall function as med sector until relieved by a ranking officer or until the incident is terminated.

Four

An off-duty supervisor may function as med sector when available, designated and on the scene. This function will end when the off-duty supervisor is relieved by a ranking officer, the district and/or shift supervisor or the incident is terminated.

FiveThe medical command shall be responsible for the coordination of all medical related resources on the scene or responding to the scene. The medical command may designate sub-sectors as needed. These may include triage, transportation, rehabilitation (rehab), etc... When sectors have been established, sector identification will be used on the radio rather than personal unit identification (i.e. Med Sector to Communications, or Med Sector to Triage, etc.) EMS supervisors or Communications shall dictate the use of all talk groups, radio channels, or tactical frequency usage when needed. All radio traffic must go thru the medical commander and not each individual sectors talking to dispatch.

SixIn a large-scale incident or a mass casualty incident, a medical command structure may look like the following:

IC

Medical Commander

Medical Sector

Triage, Treatment, Transportation, Logistics and Safety

SevenThe purpose of the Medical Commander and/or Medical Sector is to allow the coordination and effective use of personnel, equipment, medic units, and to proper channel communication. When used effectively, this system will allow all parties, including supervisors, paramedics and EMT's to focus on the top priority, patient care.

EightThe first arriving personnel will have to function as triage officer if needed. The first arriving medic unit is used as an "equipment" unit for the triage area and may be stripped accordingly.

NineThe first arriving Supervisor reports to triage and assumes Medical Sector. Sub-sectors are designated as needed and proper resources are called for.

TenThe Transport Sector oversees the transport of all patients to facilities. He will need a scribe and should communicate with Med Com as well as Medical Command.

ElevenSupervisors are directed to bring additional resources as needed such as additional medic units, the command trailer, other logistics and mass casualty units, etc. Manpower shall be utilized from any available agency.Section F - Rest and Rehabilitation (Rehab)

OneThe Rehab Sector shall be established by the first arriving medic unit or as directed by the IC. It should be utilized where large numbers of Emergency Service personnel are working on an incident.

TwoThe purpose of this sector is to monitor the health and physical condition of emergency personnel on an incident. Any responder who has engaged in a period of exercise or physically demanding operations should report to the rehab area. The med sector shall be responsible for requesting any resources needed and shall direct such in a manner to achieve optimum operation of the sector.

ThreeCare given at this sector could include, but not be limited to, refreshments, drinks, food, ice, medical care and observation, etc... A clean salvage cover or other suitable items should be set up in a location which will not interfere with the operations of the incident.

FourIf HCEMS is required to transport personnel, then additional medic units shall be called to the scene. The Rehab Sector should be staffed by one medic unit at a

minimum. The med sector should determine from the incident the commitment that will be needed for this sector.

Section G - Hazardous Materials (Haz-Mat)

OneThe role that HCEMS provides in any hazardous materials incident is a supportive role. This organization will not become involved in any primary rescue, decontamination, or mitigation in any haz-mat incident.

TwoIf dispatched to what is believed to be a haz-mat incident, from a safe distance attempt to determine if a true haz-mat incident exists. Evacuate all parties including you. Do not jeopardize your safety or that of your crew to mitigate such instances.

ThreeThe responding medic unit will contact the IC to ascertain where the rehab sector will be established. HCEMS shall work as a support and rehab sector with haz-mat and fire department personnel.

FourAt the earliest convenience, the medic crew should ascertain from the IC what type of chemical or substance is involved. This information should be passed on to the destination hospital(s) as soon as possible if patients are to be transported.

Five

HCEMS personnel should attempt to obtain vital signs from all haz-mat personnel prior to entering the hot zone for baseline information and medical history.

SixAfter decontamination, all haz-mat personnel will be reevaluated and monitored for any significant change in condition.

SevenIf at any time the lead medic feels that a haz-mat or rescue worker needs to be removed from active status, the IC should be notified immediately.

EightGenerally one medic unit is designated strictly for the haz-mat team and additional units are called for transport of any other victims. This shall be at the discretion of the medical sector.

NineWhen transporting a haz-mat victim, remove as much of the unnecessary equipment from the back of the unit to the exterior compartments as possible to reduce the risk of contamination. At the end of the incident, clean-up should be expedited.

Section H - Destination Guidelines

OneTennessee Trauma and Pediatric Destination Guidelines shall be used to qualify all pediatric and adult trauma victims.

TwoIf a patient meets the criteria set forth in the guidelines, trauma control shall be notified through Med Com.

ThreeIf a patient chooses a facility other than the recommended one, notify trauma control through Med Com of the situation and let the physician make the determination.

FourHamilton County EMS protocol shall be used to qualify all Stroke, Cardiac, and Pediatric non-trauma patients. These protocols have been adopted by local medical oversight control and the Regional Communications Center Executive Committee. Any variance from these destinations shall be documented by justification within the patient transport record.

FiveAny other destination protocols that are adopted and/or approved within the Hamilton County EMS service area shall be used to qualify all patients addressed by the protocols. All destination protocols adopted and/or approved shall be considered as the local standard of care for destination determination.

Section I - Technical Rescue

Definitions

IC - Incident CommandMC - Medical CommanderMS – Medical Sector

Lead MedicParamedic who has assumed the role of primary care provider for a particular incident.

OneThe medic unit shall set up an initial medical staging area with the approval of the IC.

TwoThe lead medic shall report to the IC or Command Post (whichever is in use) and remain in contact with the IC until relieved by a ranking officer or until the incident is terminated.

ThreeThe MS shall relay information on the patient to medical staging as soon as it becomes available.

FourThe MS shall make a quick assessment of the situation to determine whether additional medic units are needed for rehab or patient care. This assessment should be ongoing.

FiveAny additional in-coming medic units shall report to the medical staging area. Upon arrival, crews should relay to MS the number of personnel on the unit and skill level of each.

SixNo HCEMS personnel should leave medical staging without the direct permission of the MS.

SevenHCEMS personnel shall not engage in direct patient care until the rescue operation has been terminated and the patient is brought to medical staging. Basic patient care shall be provided by rescue personnel while the rescue operation is in progress unless directed otherwise by the MS.

EightWhile HCEMS strives to provide the highest level of patient care possible, we must realize our limitations. Our scope of operations does not include engaging in technical rescue operations. These skills require special training and many hours of practice. Even though some HCEMS personnel may possess expertise in the areas of technical rescue, these procedures are not within the purview of this organization.

NineIt is important that a one-victim rescue operation which utilizes a large number of rescue personnel can develop into a mass casualty situation in a split second.

Section J - Radiological Response

OneAlthough there is a nuclear plant in Hamilton County, HCEMS is faced with the possibility of responding to a radiological emergency in many types of situations. Transportation incidents provide the most common threat of such.

TwoIn case of a known radiological incident at the Sequoyah Nuclear Plant, the TVA Rad-Con personnel shall be on-site to monitor the patient throughout the incident. The patient is to be treated according to the HCEMS standard of care regarding medical treatment. TVA personnel shall advise about the radiation aspect of the situation.

ThreeIf Sequoyah experiences a nuclear accident, EMS personnel on duty will receive all instructions from the EOC. All personnel should don the personal monitoring devices and protective clothing as directed.

FourDuring a nuclear disaster, administration shall follow the assignments and procedures set forth in the Hamilton County Disaster Plan.

FiveIf a medic unit responds to an off site situation that becomes a radiological incident, the Shift Supervisor is to be notified immediately for monitoring equipment. The patient is to be treated for any and all life threatening problems, whether or not monitoring equipment is readily available as per paragraph six.

SixWhen responding to an off-site radiological incident, the crew must ensure compliance with Section G of this article. As the incident operations allow, the patient and the medic crew should be moved as far away from the contaminant as possible. Then the patient should be treated accordingly.

SevenThe medic crew must evaluate the potential danger to themselves. When in doubt, stay out! Allow the proper response agency to properly mitigate the incident.

Section K- Tactical Medical Unit (Swat)

OneSince its inception, a hallmark of Hamilton County EMS has been its willingnessto adapt to new requirements and to search for and utilize additional resources.The HCEMS Tactical Medical Unit is a flexible, highly trained and rapidlydeployable unit providing the highest level of pre-hospital emergency care in allsituations and environments.

The Tactical Medical Unit will be responsible for a wide range of tactical EMS situations. This team will be trained in advanced skills, Haz-Mat, special weapons and tactics training for deployment with local law enforcement. The team will enhance communication and interaction between the general public, team members and may be utilized at school events, career day functions or other public relations events.

TwoParticipation with the Tactical Medical Unit is considered a privilege. As such, strict standards will be taken into consideration in the selection of applicants.

Candidates will be selected based on the following criteria:

a. The candidate must be a paramedic.

b. The candidate must have an exemplary record of performance with HCEMS.

c. The candidate must submit an application with a letter, detailing personal and professional history and an explanation of why they want

to be on the team, through the chain of command.

The candidate must complete a physical ability test consisting of:

Tactical Medical Team

a. A 1 mile run within 8 minutes b. 40 sit-ups in one minute c. 40 push-ups in one minute d. One man carry for 100 yards. Forty Five second time limit.

e. The candidate must also complete a 25 question written test which will be graded 0-100. f. After the physical ability and written tests qualified applicants will

interview with the Special Operations Unit officers and the Deputy Chief.

Factors considered during the interview process:

a. Ability to function independently in high stress situationsb. Leadership potentialc. Ethical standardsd. Demonstrated willingness to correct personal shortcomingse. Personal appearance

A failure to meet the standards for the Tactical Medical Team may be cause for removal. In addition, removal from the team may be enacted as a disciplinary measure for infractions unrelated to the team at the discretion of the Chief Officers. The Medical Tactical Team is a part of Hamilton County EMS, not a stand alone agency.

ThreeTwo Medics from each shift will be assigned to the Tactical Medical Team. The HCEMS Shift Supervisor assigned to the Tactical Medical Team will be ultimately responsible for the Team. The District Supervisor that is assigned to the Tactical Medical Team will work in conjunction with the Shift Supervisor. If the Shift Supervisor is not available, then the District Supervisor will be ultimately responsible for the team.

FourDeployment of Tactical Medical Team (SWAT).

a. All Swat “call ups” will be approved through the Chief and/or Deputy Chief or their representative prior to the team’s response.

b. Once a request has been made for the Tactical Medical Team each member of the team along with the Deputy Chief of EMS will respond

to the designated area as a rally point.

c. Once on the scene, the EMS ranking officer will report to the command post.

e. On all Swat related call-ups an on duty HCEMS medic unit, regardless of location, will be dispatched. The EMS ranking officer will contact dispatch to direct the medic unit to their staging location. An on duty Shift Supervisor will also be dispatched to the location.

TACTICAL EMS

One - Mission Hamilton County EMS medical tactical team will deliver advanced patient care in a variety of non-conventional settings. To achieve this, the team will operate as a branch of the Hamilton County Sheriff’s Department SWAT Team. The tactical medical team goal is to provide the highest level of medical care that can safely be accomplished on every incident, through the use of specially trained personnel.

Two - PurposeThe purpose of this document is to establish guidelines for the training and operation of the team in the tactical environment. This policy regulates all Tactical Medical personnel responding to incidents involving Hamilton County SWAT and law enforcement operations of a hazardous or high-risk nature. This may include, but not be limited to:

a. Providing special assets and equipment managed by HCEMS.

b. Providing emergency medical services to local law enforcement and civilians.

c. Assist with hazardous material identification, containment, and advice on disposal.

Three – TrainingTraining will be conducted with the Hamilton County SWAT Team on a monthly basis or as directed by the Tactical Commander. Team members will be required to complete the following courses.

a. HCSO transition course to obtain weapons certification and commission. b. Basic SWAT course.c. An approved Tactical EMS course.

In addition, each team member will be required to:a. Take part in a regular PT program.b. Qualify with all assigned weapons as required by HCSO.c. Attend all training sessions unless excused by a team officer.

d. Maintain all certifications as required by HCEMS.

Four - EquipmentAll law enforcement equipment will be supplied by the Hamilton County Sheriff’s Department. Hamilton County EMS will supply all medical equipment. Team members will be responsible for all issued gear. Issued items will be secured both on duty and off duty. Team equipment is to be used only during official duties. Report lost, stolen, or broken equipment to the team officers. Each member will only wear uniforms and equipment approved by the Tactical Commander.

Five – USE OF FORCEThe Hamilton County EMS special operations unit will abide by the rules set forth within the Hamilton County Sheriff Department’s “Use of force” policy.(See appendix 1) Six - HAZ-MAT RESPONSEThe special operations team will respond to HAZ-MAT calls as requested by the Chattanooga or Hamilton County HAZ-MAT teams. The primary focus of the tactical medical team at a HAZ-MAT response will be patient care; however, the team will be trained to assist the HAZ-MAT team as needed or directed by incident command.

SEVEN

The Tactical Medical Team will be a very elite division of HCEMS. The members will have to be extremely dedicated to physical fitness, the community and the service. They must be a role model for fellow health care providers. They are expected to have exemplary attendance and work related performances.

ROLL OF THE MEDICAL BIKE TEAM

The Medical Bike Team will serve as a means to provide rapid ALS response at large outdoor events with heavy pedestrian traffic. This team will enhance communication and interaction between the general public and HCEMS team members as well as provide rapid ALS care to patients in areas or situations inaccessible to large emergency response vehicles.

There are several benefits to this faster response:

a. The patient is more rapidly entered into the EMS system.

b. Greater interaction between the community and the EMS providers.

c. A general increase in physical fitness in the employees who enter into the program creating a healthier employee.

RESPONSE SITUATIONS:

a. Large community events held within Hamilton County

b. Foot races

c. Bike races

d. Educational and teaching programs

e. Other events not specifically listed above that the Bike Team might be called upon for support.

TRAINING

a. Officers and Members of the Bike Medical Team will attend an IPMBA sponsored cycle course prior to achieving operational status on the Bike Team

b. Monthly meetings will be held, 75% attendance of these meetings is mandatory. These meetings may involve training, introduction of new equipment, rides or all of the above.

NOTIFICATION OF THE BIKE TEAMAll requests for the Bike Team must go through the Chief and/or Deputy Chief, with the Medical Bike Team Supervisor being notified.

UNIFORM

a. SHIRT; will be cool max golf style shirt with cuffed sleeves. White for officers, medium blue for team members.

b. PANTS; will be “Olympic” brand patrol pants navy blue in color style # redl11.

c. HELMET; will be a black road helmet with a visor.

d. JACKET; will be light and waterproof.

e. SHOES; Bates Spec Ops Bike shoe or similar model. Black in color.

f. GLOVES; will be black in color

g. SUN/EYEGLASSES; will be black in color “Oakley” style glasses (prescription eyewear excluded from these requirements)

h. Uniforms requirements may be amended by the team officers.

QUALITY ASSURANCE

a. Assuring adequate treatment of patients

b. Reduction of response times at community events

c. Increase physical performance of Team Members

QA will be completed by Team Officers after each event and reported to Administration.

NOTIFICATION of HCEMS MEDICAL BIKE TEAMOnce notification of an event has been cleared through the chain of command, the Team Leader will notify the members of the upcoming event. Once the Team has been notified the Team Leader will notify the Shift Supervisor and inform them of the duration and location of the event. The Shift Supervisor and Medical Bike Team Leader will make provisions for ambulance coverage for the event, if needed. All team members will rally at HCEMS supply. From that point the team will utilize the designated Medical Bike Team Vehicle to respond to the event.

ORGANIZATIONAL PHASE

Upon arriving at supply the Team Leader will:

1. Contact communications and advise them the team has arrived at supply

2. Advise communications OIC which channel will be used by the team for the event

3. Assign members to do a complete inspection of all equipment and bikes.

OPERATIONAL PHASE

The Team Leader will:

1. Be aware of the location of all team members

2. Notify communications the team is on scene and the event has begun.

3. Notify the team all radio traffic will occur only on the assigned frequency for the remainder of the event

4. Advise event command of all the incidents that involve patient care and /or transport.

5. Advise communications when the event is over and the team is back in service.

OPERATIONAL RESPONSIBILITIES

Primary:

1. Provide in field medical care

2. Establish egress and access points through the event site

Secondary:

1. Act as liaison between the public and HCEMS

2. Encourage helmet use and bike safety

3. Direct the public how to contact HCEMS for a bike safety program in their area

PROHIBITED PROCEDURES:

a. At no time will Bike Team members wear their uniform in lieu of their standard duty uniform while riding on an ambulance.

b. At no time will a team member respond to a site outside their event coverage area, unless directly told to do so by the Team Leader or event command post.

c. At no time will a team member ride without a helmet.

COMMUNICATIONS:All communications will go through HCEMS communications or the command post of the assigned event.

`a. Bike Team members will be assigned call signs BIKE 1 – 6

b. The Medical Bike Team Leader will use his/her radio #, if the Team Leader is not a supervisor, he/she will be

assigned BIKE 1

TRANSPORTATION

HCEMS will provide transportation of all patients requiring transport.

a. The ambulance assigned to the event will provide transportation from the event site to the hospital

b. The Bike Team providing care will give report to the on duty crew turn over patient care and return to service.

DOCUMENTATION

Event Report

a. The Medical Bike Team Leader will complete a post event summary of all actions that occurred during the event. This summary will be turned in to administration upon completion.

TRAINING

a. Training will be held monthly and is mandatory for all members

b. Topics will be decided by team leader with input from team members

c. Absence from training is excused if on duty personnel are unable to find coverage.

Due to the nature of the team, training is essential and will be strictly monitored.