Ambulance Standard Operating Procedures

RPI AMBULANCE

STANDARD OPERATING PROCEDURES

Updated: August 28th, 2012 | Captain Mark H. O‟Donnell

RPI Ambulance Standard Operating Procedures

August 28th, 2012

SOP 12-00 ORGANIZATION AND STRUCTURE ....................................................................................................................... 5 SOP 12-01 MISSION STATEMENT ......................................................................................................................................... 6 SOP 12-02 QUALIFICATION PROCEDURES - VOLUNTEER PERSONNEL.................. PERSONNEL............................. ....................... ....................... ...................... ...................... .................... ......... 7

APPLICATION PROCEDURES .......................... ......................................... ............................. ............................ ............................ ............................ ............................ ............................ ............................ ............................ ................. ... 7 ORIENTATION ............................ .......................................... ............................ ............................ ............................ ............................. ............................. ............................ ............................ ............................ ............................ ................... ..... 7 HEALTH AND SAFETY ............................ ........................................... ............................. ............................ ............................ ............................ ............................ ............................ ............................ ............................ ........................ ..........7 SOP 12-03 OPERATIONAL MEMBER TYPES ........................................................................................................................... 9

INTRODUCTION ............................ .......................................... ............................ ............................. ............................. ............................ ............................ ............................ ............................ ............................ ............................ ................. ... 9 MEMBERSHIP REQUIREMENTS ........................... ......................................... ............................ ............................ ............................ ............................. ............................. ............................ ............................ .......................... ............9 SOP 12-04 TRAINING AND PROMOTIONS .......................................................................................................................... 11

INTRODUCTION ............................ .......................................... ............................ ............................. ............................. ............................ ............................ ............................ ............................ ............................ ............................ ................ 11 TRAINING........................... ......................................... ............................ ............................ ............................ ............................ ............................ ............................ ............................. ............................. ............................ ........................ ..........11 TRAINING COMMITTEE ............................ .......................................... ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ .................... ......11 PROBATIONARY TRAINING ............................ ........................................... ............................. ............................ ............................ ............................ ............................ ............................ ............................ ............................ ................ 12 TRAINERS ........................... ......................................... ............................ ............................ ............................ ............................ ............................ ............................ ............................. ............................. ............................ ........................ ..........12 PROMOTIONAL BOARDS: STRUCTURE ........................... .......................................... ............................. ............................ ............................ ............................ ............................ ............................ ............................ ................ 12 PROMOTIONAL BOARDS: VOTING ............................ .......................................... ............................ ............................ ............................ ............................ ............................ ............................ ............................. .................... .....12 SOP 12-05 OBSERVERS AND OBSERVERS ........................................................................................................................... 14

RIDE-ALONG OBSERVER ............................ .......................................... ............................ ............................ ............................ ............................. ............................. ............................ ............................ ............................ ................. ... 14 OBSERVER............................ .......................................... ............................ ............................. ............................. ............................ ............................ ............................ ............................ ............................ ............................ ...................... ........14 SOP 12-06 AMBULANCE ATTENDANT ................................................................................................................................ 15

INTRODUCTION ............................ .......................................... ............................ ............................. ............................. ............................ ............................ ............................ ............................ ............................ ............................ ................ 15 TRAINING........................... ......................................... ............................ ............................ ............................ ............................ ............................ ............................ ............................. ............................. ............................ ........................ ..........15 SOP 12-07 AMBULANCE DRIVER ........................................................................................................................................ 16

INTRODUCTION ............................ .......................................... ............................ ............................. ............................. ............................ ............................ ............................ ............................ ............................ ............................ ................ 16 GENERAL DRIVING PROCEDURES .......................... ......................................... ............................. ............................ ............................ ............................ ............................ ............................ ............................ ...................... ........16 EMERGENCY DRIVING PROCEDURES ........................... ......................................... ............................ ............................. ............................. ............................ ............................ ............................ ............................ ................. ... 16 DRIVER S DUTIES .......................... ........................................ ............................ ............................. ............................. ............................ ............................ ............................ ............................ ............................ ............................ ................ 17 SPOTTERS ............................ .......................................... ............................ ............................. ............................. ............................ ............................ ............................ ............................ ............................ ............................ ...................... ........17 BACK-UP ALARM ............................ .......................................... ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ........................... .............18 TRAVEL LIMITS ........................... ......................................... ............................ ............................ ............................ ............................. ............................. ............................ ............................ ............................ ............................ ................. ... 18 WINTER DRIVING ............................ .......................................... ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ........................... .............18 TRAINING........................... ......................................... ............................ ............................ ............................ ............................ ............................ ............................ ............................. ............................. ............................ ........................ ..........19 ’

SOP 12-08 AMBULANCE CREW CHIEF ................................................................................................................................. 21

INTRODUCTION ............................ .......................................... ............................ ............................. ............................. ............................ ............................ ............................ ............................ ............................ ............................ ................ 21 GENERAL PROCEDURES ............................ .......................................... ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ .................... ......21 CREW CHIEF S DUTIES .......................... ......................................... ............................. ............................ ............................ ............................ ............................ ............................ ............................ ............................ ...................... ........21 TRAINING........................... ......................................... ............................ ............................ ............................ ............................ ............................ ............................ ............................. ............................. ............................ ........................ ..........22 ’

SOP 12-09 FIRST RESPONSE DRIVER ................................................................................................................................... 25

INTRODUCTION ............................ .......................................... ............................ ............................. ............................. ............................ ............................ ............................ ............................ ............................ ............................ ................ 25 RESPONSIBILITIES ............................ .......................................... ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ........................... .............25 GENERAL DRIVING PROCEDURES .......................... ......................................... ............................. ............................ ............................ ............................ ............................ ............................ ............................ ...................... ........25

Mark H. O‟Donnell, O‟Donnell, Captain

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August 28th, 2012

EMERGENCY DRIVING PROCEDURES ........................... ......................................... ............................ ............................. ............................. ............................ ............................ ............................ ............................ ................. ... 25 TRAINING........................... ......................................... ............................ ............................ ............................ ............................ ............................ ............................ ............................. ............................. ............................ ........................ ..........26 SOP 12-10 EVENT EMS SUPERVISORS ................................................................................................................................ 27

INTRODUCTION ............................ .......................................... ............................ ............................. ............................. ............................ ............................ ............................ ............................ ............................ ............................ ................ 27 TRAINING........................... ......................................... ............................ ............................ ............................ ............................ ............................ ............................ ............................. ............................. ............................ ........................ ..........27 SOP 12-11 DUTY SUPERVISORS .......................................................................................................................................... 28

INTRODUCTION ............................ .......................................... ............................ ............................. ............................. ............................ ............................ ............................ ............................ ............................ ............................ ................ 28 UALIFICATIONS .......................... Q UALIFICATIONS ........................................ ............................ ............................. ............................. ............................ ............................ ............................ ............................ ............................ ............................ ................ 28 DUTIES ............................ .......................................... ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................. ........................... ............28 GRIEVANCES ............................ .......................................... ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................. .................... .....29 SOP 12-12 COORDINATORS ............................................................................................................................................... 30

INTRODUCTION ............................ .......................................... ............................ ............................. ............................. ............................ ............................ ............................ ............................ ............................ ............................ ................ 30 QI COORDINATOR ........................... ......................................... ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ........................... .............30 CPR COORDINATOR ........................... .......................................... ............................ ........................... ............................ ............................. ............................. ............................ ............................ ............................ ........................ ..........30 SOP 12-13 UNIFORMS ........................................................................................................................................................ 31

INTRODUCTION ............................ .......................................... ............................ ............................. ............................. ............................ ............................ ............................ ............................ ............................ ............................ ................ 31 PATCHES ............................ .......................................... ............................ ............................ ............................ ............................ ............................ ............................ ............................. ............................. ............................ ........................ ..........31 PINS, COLLAR BRASS, BADGES ........................... ......................................... ............................ ............................ ............................ ............................. ............................. ............................ ............................ ........................ ..........31 UNIFORM CLASSES ............................ ........................................... ............................ ........................... ............................ ............................. ............................. ............................ ............................ ............................ ........................ ..........31 SOP 12-14 DISPATCH AND RESPONSE PROCEDURES .......................................................................................................... 33

INTRODUCTION ............................ .......................................... ............................ ............................. ............................. ............................ ............................ ............................ ............................ ............................ ............................ ................ 33 RESPONSE LEVELS ............................ .......................................... ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ........................... .............33 UNAVAILABILITY............................ RPI AMBULANCE UNAVAILABILITY .......................................... ............................ ............................ ............................ ............................ ............................ ............................ ............................. .................... .....33 EMS CALLS .......................... ........................................ ............................ ............................. ............................. ............................ ............................ ............................ ............................ ............................ ............................ ...................... ........33 TRANSPORTATION CALLS ............................ .......................................... ............................ ............................ ............................ ............................. ............................. ............................ ............................ ............................ ................. ... 35 HAZARDOUS MATERIAL CALLS ........................... ......................................... ............................ ............................ ............................ ............................. ............................. ............................ ............................ ........................ ..........35 STAND -BY S AND MCI.......................... ......................................... ............................. ............................ ............................ ............................ ............................ ............................ ............................ ............................ ...................... ........35 ’

SOP 12-15 PATIENT TRANSPORT DESTINATIONS ............................................................................................................... 36 SOP 12-16 MUTUAL AID ..................................................................................................................................................... 38 SOP 12-17 OUT OF SERVICE ............................................................................................................................................... 39

INTRODUCTION ............................ .......................................... ............................ ............................. ............................. ............................ ............................ ............................ ............................ ............................ ............................ ................ 39 DAY TO DAY TURNOVERS ........................... ......................................... ............................ ............................ ............................ ............................. ............................. ............................ ............................ ............................ ................. ... 39 EXTENDED PERIODS OF ABSENCE .......................... ......................................... ............................. ............................ ............................ ............................ ............................ ............................ ............................ ...................... ........39 SOP 12-18 SPECIAL EVENT PROCEDURES ........................................................................................................................... 40

SPECIAL EVENT COVERAGE REQUESTS ........................... .......................................... ............................. ............................ ............................ ............................ ............................ ............................ ............................ ................ 40 FIRST AID ROOM OPERATION ............................ .......................................... ............................ ............................ ............................ ............................. ............................. ............................ ............................ ........................ ..........40 EVENT TYPE CLASSIFICATION ........................... ......................................... ............................ ............................ ............................ ............................ ............................ ............................ ............................. ........................... ............41 EVENT RADIO COMMUNICATIONS .......................... ......................................... ............................. ............................ ............................ ............................ ............................ ............................ ............................ ...................... ........41 SPECIAL EVENT OPERATIONS ........................... ......................................... ............................ ............................ ............................ ............................ ............................ ............................ ............................. ........................... ............42 PAPERWORK AND EQUIPMENT MAINTENANCE ........................... ......................................... ............................ ............................. ............................. ............................ ............................ ............................ ................. ... 43 SOP 12-19 DOCUMENTATION ............................................................................................................................................ 44

INTRODUCTION ............................ .......................................... ............................ ............................. ............................. ............................ ............................ ............................ ............................ ............................ ............................ ................ 44


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GENERAL PROCEDURES ................................................................................................................................................................44 PAPER PCR RETENTION AND STORAGE ............................................................................................................................................ 44 REFUSAL OF MEDICAL ATTENTION (RMA) ......................................................................................................................................44 SOP 12-20 RADIO COMMUNICATIONS ............................................................................................................................... 46 SOP 12-21 AMBULANCE/EQUIPMENT INSPECTION, CARE, AND MAINTENANCE................................................................ 47

INTRODUCTION .......................................................................................................................................................................... 47 AMBULANCE AND FIRST RESPONSE VEHICLE MAINTENANCE ................................................................................................................ 47 EQUIPMENT MAINTENANCE .........................................................................................................................................................47 CLEANING .................................................................................................................................................................................48 ACCIDENTS/DAMAGE TO RPI AMBULANCE VEHICLES .................................................................................................................. 48 FAILURES ..................................................................................................................................................................................48 SOP 12-22 AMBULANCE LAYOUT/SETUP ........................................................................................................................... 50

INTRODUCTION .......................................................................................................................................................................... 50 STRETCHER ................................................................................................................................................................................50 SPARE MAKE-UP ........................................................................................................................................................................ 50 IV FLUID CLIPS/RETAINERS ........................................................................................................................................................... 50 PORTABLE OXYGEN TANKS ........................................................................................................................................................... 50 WALL OXYGEN REGULATORS ........................................................................................................................................................50 ONBOARD OXYGEN SYSTEM .........................................................................................................................................................51 COMPLETED PAPERWORK ............................................................................................................................................................ 51 OTHER EQUIPMENT, TOOLS, ETC. ...................................................................................................................................................51 LAPTOPS ...................................................................................................................................................................................51 SOP 12-23 DEFIBRILLATOR ................................................................................................................................................. 52

INTRODUCTION .......................................................................................................................................................................... 52 CARE AND MAINTENANCE ............................................................................................................................................................ 52 USE ......................................................................................................................................................................................... 52 SOP 12-24 CONDUCT ......................................................................................................................................................... 53

INTRODUCTION .......................................................................................................................................................................... 53 PATIENT CONFIDENTIALITY ........................................................................................................................................................... 53 WEAPONS.................................................................................................................................................................................53 SMOKING ..................................................................................................................................................................................53 ALCOHOL, CONTROLLED SUBSTANCES, AND MEDICATIONS ................................................................................................................. 53 VISITORS ...................................................................................................................................................................................54 SOP 12-25 GRIEVANCES AND APPEALS .............................................................................................................................. 55

INTRODUCTION .......................................................................................................................................................................... 55 GRIEVANCES ..............................................................................................................................................................................55 CHAIN OF APPEALS .....................................................................................................................................................................55 APPEALS ...................................................................................................................................................................................55 SOP 12-26 SEXUAL HARASSMENT AND NONDISCRIMINATION .......................................................................................... 56

SEXUAL HARASSMENT .................................................................................................................................................................56 NONDISCRIMINATION ..................................................................................................................................................................56 VIOLATIONS ..............................................................................................................................................................................56 SOP 12-27 INFECTIOUS DISEASE EXPOSURE AND ON DUTY INJURY ................................................................................... 57

Mark H. O‟Donnell, Captain

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August 28th, 2012

INTRODUCTION .......................................................................................................................................................................... 57 PRACTICES ................................................................................................................................................................................57 ON-DUTY INJURY OR EXPOSURE ....................................................................................................................................................57 SOP 12-28 MISCELLANEOUS............................................................................................................................................... 58

INTRODUCTION .......................................................................................................................................................................... 58 LOCATING PATIENTS ...................................................................................................................................................................58 SPECIAL PATIENTS ......................................................................................................................................................................58 CRIMES ....................................................................................................................................................................................59 INCIDENT REPORTING ..................................................................................................................................................................59 OBVIOUS AND UNATTENDED DEATH .............................................................................................................................................. 59 CHILD ABUSE AND MALTREATMENT ............................................................................................................................................... 60 GERIATRIC OR OTHER PATIENT ABUSE/MALTREATMENT .................................................................................................................... 61 ABANDONED INFANT...................................................................................................................................................................61 SOP 12-29 APPROVAL/REVIEW DOCUMENT ...................................................................................................................... 62


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SOP 12-00 ORGANIZATION AND STRUCTURE This document is the Standard Operating Procedures (SOPs) of the Rensselaer Polytechnic Institute Ambulance. If one section of the SOPs is amended, suspended, deleted, or otherwise changed, the remainder of this document will remain unaffected. This document is not to supersede any directives, guidelines, or protocols enacted by a higher authority such as the State of New York, the Regional Emergency Medical Organization of the Hudson Mohawk Valley Region (REMO-HMVI), or the County of Rensselaer. These guidelines are, furthermore, not to supersede good clinical judgment on the part of t he crew. According to the RPI Ambulance Constitution, the Captain and Medical Director must agree upon the SOPs. The Standard Operating Procedures must be reviewed on an annual basis by the same entities. Documentation of this review will be attached as a separate Policy Statement (see SOP 12-29). The RPI Ambulance SOPs were originally written in the early 1980‟s by George Holdsworth , and amended and adjusted by Captains Ken Lavelle, John Kim, and Brian Wilde since that time. A major rewrite was initiated by Captain Chris Holt, and completed by Captain Fabien Nicaise. The SOPs have since been amended and adjusted by Captains Steve Mitchell, Benjamin Saunders, Veronica Voloshinov, and Eric Tesoriero. Restructuring of sections and updates reflecting the new officers in the Spring of 2010 were made by Peter Ragone. Additional changes during Fall 2010 and Spring 2011 made by Matthew Willett. A major reformatting and additional changes were made during Spring 2012 by Captain Jovan Cruz. A major update was made by Mark O‟Donnell to combine the Special Event SOPs, add First Response-59, new uniforms and ePCRs in the Fall of 2012.


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SOP 12-01 MISSION STATEMENT The mission of this agency is to provide Basic Emergency Medical Services to the Rensselaer Polytechnic Institute community, and to transport the sick and injured to definitive care. This includes, but is not limited to the following: 1. Develop standards, policies, and procedures pertaining to Emergency Medical Services in order to maintain proper operation of the RPI Ambulance. 2. Provide Basic Life Support Ambulance Service and Special Event Medical Services to the RPI community. 3. Conduct EMS Quality Improvement to improve the care provided by the RPI Ambulance. 4. Provide training and support services to maintain and improve the agency‟s equipment and personnel resources. 5. Provide training to the Rensselaer community in order to improve the quality of first aid in the community and the world at large. 6. Request and provide reciprocal services in accordance to the existing provisions of the Rensselaer County Ambulance and Rescue Association Mutual Aid Plan in addition to any other Mutual Aid Plans that the agency becomes involved in.


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SOP 12-02 QUALIFICATION PROCEDURES - VOLUNTEER PERSONNEL APPLICATION PROCEDURES 1. 2. 3.

Interested parties should obtain and complete, in its entirety, a membership form as supplied by the administrative officers of the agency. Membership is contingent upon the membership policies outlined in the Agency‟s Constitution. Every member will resubmit a membership form to the administration of the Agency at the beginning of each academic year for the purpose of maintaining an up-to-date membership list. This can be done electronically on the Agency website.

ORIENTATION 1. 2.

Each new member shall participate in a Membership Orientation as prescribed by the Training Committee. The Membership Orientation shall include the following items: a) RPI Ambulance History, Philosophy, and Structure b) RPI Ambulance Standard Operating Procedures and RPI Ambulance Constitution c) Risk Management d) Liability and Confidentiality e) Stress management/CISM f) Health and Safety as outlined below g) ePCRs, documentation, and Quality Improvement procedures h) Basic scene support i) Basic call mechanics j) Working with other agencies

HEALTH AND SAFETY 1.

2. 3.

All members will undergo an annual training in-service on proper procedures on how to protect self and crew. This training will comply with and make use of the Agency Exposure Control Plan as maintained by the Captain or designated Coordinator. The Captain and Training Committee will jointly appoint instructors. This training will include, but is not limited to, the following: a) OSHA Blood-borne and Airborne Pathogens b) Infection Control (Per OSHA-29 CFR 1910.1030) c) Personal Protective Equipment (PPE) d) NIOSH / N95 Healthcare TB Respirator Fit-Testing and usage e) Exposure Control Plan f) TB Testing and Documentation g) Hepatitis-B Vaccination or Refusal and Documentation h) Facilities safety (including Office, First Aid Rooms, Ambulance) i) Safety during responses j) Basic HAZMAT awareness training


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k)

RPI Ambulance does not require its members to undergo yearly physical examinations; however, it asks all members to provide RPI Ambulance with a copy of or access to their immunization records to insure the safety of all crews and patients. 4. The instructor will generate documentation of yearly Health and Safety training and the administration will maintain this documentation in the person‟s permanent file.


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SOP 12-03 OPERATIONAL MEMBER TYPES INTRODUCTION In order to act as a volunteer for RPI Ambulance, the appropriate qualifications must be met and maintained for the duration of involvement with RPI Ambulance.

MEMBERSHIP REQUIREMENTS As stated in the Constitution, all members are required to renew membership every semester by attending one General Meeting or providing written notice to the officer board. If a member fails to attend a General Meeting or provide written notice to the officer board, they will be removed from membership – all training previously completed will be filed, and, upon any readmission to the agency, it will be the determination of the Captain and Lieutenants as to accepting that member's previous training paperwork or requiring new training.

AC TI VE ME MB ERSH IP Active members are the members who participate regularly in Agency functions and regularly attend training drills and General Meetings. An Active member meets the following qualifications: 1. Has submitted a membership form as outlined in SOP 12-02. 2. Has completed the orientation program outlined in SOP 12-02. 3. Has completed appropriate annual health and safety training and testing as outlined in SOP 12-02 and the agency‟s Exposure Control Plan. 4. Has attended all required training drills or been excused by the Captain or Training Committee. 5. Has attended all required General Membership meetings or been excused by the Administration. 6. Has staffed one night crew or special event in the last month.

INACTIVE MEMBERSHIP Inactive members are members who are unable to meet all of the qualifications set forth for Active membership. Former members who visit infrequently and who are unable to regularly attend agency drills and meetings should fall into this category. Only the Captain may change an Inactive member‟s status to Active. Conversely, it is the responsibility of the Captain to assure that any Active members who do not meet all of the appropriate qualifications are changed to Inactive membership. An Inactive member must meet the following qualifications: 1. Has submitted a membership form as outlined in SOP 12-02. 2. Has completed the orientation program outlined in SOP 12-02. 3. Has completed appropriate annual health and safety training and testing as outlined in SOP 12-02. 4. Has staffed one night crew or special event in the last semester.


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ADMI NI ST RATI VE ME MB ERS HI P An Administrative Mem ber has been accepted by the membership through the guidelines set forth in the Agency Constitution, but does not ride actively as part of an EMS crew. There are no operational qualifications to be an administrative member. In addition, any member that does not qualify for Active or Inactive membership shall default to Administrative Membership until such time that all paperwork and training can be brought up to date. Administrative members do not have any Ambulance riding or event privileges. An Administrative Member must meet the following qualifications: 1. Has submitted a membership form as outlined in SOP 12-02.


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SOP 12-04 TRAINING AND PROMOTIONS INTRODUCTION One of RPI Ambulance‟s primary missions is to further the training of its members. competent, professional medical care. This policy seeks to guarantee both.

Another is to provide

TRAINING Training is to be regarded as a priority second only to patient care, and whenever possible, the two should be integrated. For specific qualifications and promotion requirements, please see the appropriate sections: Attendant SOP 12-06, pg. 17 Driver SOP 12-07, pg. 18 Crew Chief SOP 12-08, pg. 23 First Response Driver SOP 12-09, pg. 25 Event EMS Supervisor SOP 12-10, pg. 27 Duty Supervisor SOP 12-11, pg. 28 These requirements and qualifications are considered to be the minimum requirements for promotion. It is often expected that members will do additional training and will be promoted when the Training Committee and Captain are satisfied that they hold the necessary skills required for the promotion. If there are concerns about the performance of a promotion candidate the Training Committee is to work with the individual to address the concerns.

TRAINING COMMITTEE The Captain shall establish a training committee, made up of as many members as he sees fit. The committee should ideally contain a driver trainer, a crew chief trainer and a senior duty supervisor. The Captain may or may not serve on the committee. The Captain may not be the only member of the Training Committee except with the express permission of both Lieutenants. Once established, removals and additions to the Training Committee must be approved by at least 50 percent of the committee as well as the Captain, or by the unanimous decision of the Captain and both Lieutenants. Additionally, once established, the Training Committee must elect a chairperson who will be the face and responsible party of the Training Committee; issues that need to be brought to the Training Committee or issues arising from the committee should pass through this individual. The Training Committee shall be responsible for overseeing all training curricula (including all training documents and the scheduling of classes) and shall also stand as the promotional board when necessary and applicable. Ideally, the committee should meet on a weekly basis, and report back to the Captain fortnightly, or as frequently as necessary.


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PROBATIONARY TRAINING A member who is considered a probationary in a position may act in that position provided there is a trainer for that position on the crew. The trainer should make every attempt to be with the trainee during the course of the call. Notable exceptions may include the transport to the hospital, where the trainer and trainee may be separate briefly. A probationary and a trainer satisfy the requirements for a crew.

TRAINERS The individuals entrusted with the training of other individuals in the Agency shall maintain Active membership status. These trainers will be experienced members credentialed within the agency for the position they will train. For example, someone who is experienced enough to be a Driver Trainer may not necessarily be a Crew Chief Trainer. Trainers are appointed by the Training Committee. Consideration of appointees will not only consist of individuals‟ qualifications within a specific area of credentialing, but also of their ability to teach and train effectively.

PROMOTIONAL BOARDS: STRUCTURE The Promotional Board is a vehicle used by members of RPI Ambulance to progress through the ranks of the organization‟s credentialing structure. The promotional board shall consist of: 1. Training Committee 2. Captain The Promotional Board shall be chaired by the Training Committee Chairperson, except in the case of that individual‟s promotion, when the Captain shall act as the Promotional Board Chair. The training committee and Captain shall also establish a list of promotional board alternates to serve on the board in the case of a conflict of interest. It is understandable that not every member of the promotional board will have been involved with all aspects of a candidate‟s training. Therefore, any member is invited to speak for or against the candidate at the Promotional Board as this is a time for the promotional board to learn about a candidate‟s skills and competencies. Members may speak about any aspect of the candidate but it is the chair‟s duty to ensure that comments remain relevant and respectful (i.e. personal attacks should not be tolerated). During the voting portion, only the actual members of the promotional board may be present. While the candidate is present, the Promotional Board should take the opportunity to ask relevant questions of the candidate about his or her competency in the position applied for. Outlandish questions and inappropriate attitudes are not acceptable.

PROMOTIONAL BOARDS: VOTING After the chair has presented the candidate for promotion, and when there are no more questions for the candidate, the candidate will be asked to leave the room. The candidate will comply. The chair is the parliamentarian for the voting proceedings. Any and all discussion behind closed doors is understood to be confidential and will not be discussed with anyone. After discussion is complete to the satisfaction of the chair, the members of the Promotional Board will vote on the candidate.


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Voting will not take place by secret ballot. At least two-thirds members of the Promotional Board must give a “yes” vote of confidence for the candidate to pass and be credentialed in the position applied for. No abstentions are acceptable. Members with a potential conflict of interest should not be on the promotional board, and an alternate should be present as outlined above. Thus, a conflict of interest is not a valid excuse for an abstention. After the completion of the vote, the candidate will be called back into the room by the members of the Promotional Board and advised by the Chairperson of the result. Any member who voted “no” should be prepared to outline what additional demonstration of competence they would like to see before they would register a “yes” vote. This should be done both in writing and verbally. The candidate shall have the right to ask for a clarification of requests. This is to give the candidate a fair opportunity to improve in weak areas and become a more viable candidate for the next promotional board that they petition. Both promotion approvals and non-approvals will be logged in a “Promotional Board Log” that will contain every attempt for promotion made by all members. This log will also contain dates of promotion to be used for determining eligibility for promotion to trainer (i.e 4 months of in-service).


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SOP 12-05 OBSERVERS AND OBSERVERS RIDE-ALONG OBSERVER The Ride-Along Observer position is for non-members who are interested in riding on an Ambulance Crew for observational and/or informational purposes. The Ride-Along observer need not have any qualifications, but must adhere to the following guidelines: 1. Be briefed in RPI Ambulance SOPs, Patient Confidentiality, Risk Management, and Infection Control/OSHA. 2. The Ride-Along Observer will not engage in providing patient care of any kind. 3. At the discretion of the Crew Chief, the Ride-Along Observer may be asked to sit in the cab compartment while patient care is being extended. 4. If the number of people on board the Ambulance becomes too large (with ALS providers, multiple patients, family/friend of the patient, etc.), the Ride-Along Observer may be left at the scene by the Crew Chief. If this happens, every effort will be made to assure that someone can bring the Ride Along Observer to the destination to m eet up with the Ambulance. 5. The Ride-Along Observer will sign a form effective for a specified amount of time (to be indicated on the form) agreeing to all of the above. In addition, the form shall indemnify and hold harmless RPI Ambulance, Rensselaer Polytechnic Institute, and all of its members and subsidiaries from any liability in the event of injury, illness, or death.

OBSERVER The Observer shall be an Active or Inactive member who desires to ride on an Ambulance Crew for the purpose of gaining experience, training, or otherwise familiarizing oneself with the operations of RPI Ambulance. The Observer: 1. Shall assist in patient care as requested by the Crew Chief and will act only under the direction of the Crew Chief. 2. May be asked to sit in the cab compartment by the Crew Chief while patient care is being extended. 3. If the number of people on board the Ambulance becomes too large (with ALS providers, multiple patients, family/friend of the patient, etc., the Observer may be left at the scene by the Crew Chief. If this happens, every effort will be made to assure that someone can bring the Observer to the destination to meet up with the Ambulance.

OBSERVER TRAINING As this is an entry-level position, there is no f ormal requirement and no training needed except for that which is required to become a member of RPI Ambulance as stated in SOPs 12-02 and 12-03. This is meant to be a temporary position. The goal of all Observers is to become an Ambulance Attendant. It is expected that Observers begin Attendant training before their third night crew.


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SOP 12-06 AMBULANCE ATTENDANT INTRODUCTION The Ambulance Attendant shall be an Active or Inactive member who rides on an Ambulance Crew for the purpose of assisting the Crew Chief with patient care as well as for the purpose of gaining further experience and training in EMS. The Ambulance Attendant shall: 1. Be familiar with the location, use, and function of all medical equipment on board the Ambulance 2. Possess a working knowledge of RPI Ambulance Standard Operating Procedures 3. Be familiar with safe techniques for lifting and moving of patients using common equipment

TRAINING It is highly recommended that the Ambulance Attendant trainee will begin their formal training with a class provided by RPI Ambulance that will cover the basics and requirements. The Ambulance Attendant should also practice their skills and knowledge when they are on a crew, with the help and guidance of the Crew Chief in order to increase the knowledge of the trainee and to build Crew Chief‟s confidence in the trainee. The trainee is also encouraged to attend as many training drills as possible as they are a good source of knowledge and additional training.

PREREQUISITES 1.

Be a member of RPI Ambulance

PROMOTIONAL REQUIREMENTS 1. 2. 3. 4. 5. 6.

Hold a Professional Rescuer CPR certification. Complete the Attendant Checklist as prescribed by the Training Committee. Complete the Ambulance Equipment Checklist. Actively participate in at least one (1) call or two (2) simulated calls and receive a passing evaluation from the CC. Optional: Attend the RPI Ambulance Attendant Training Class. Receive a recommendation for promotion from a Crew Chief.


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SOP 12-07 AMBULANCE DRIVER INTRODUCTION The driver of the ambulance holds a critical position in the care and treatment of the patient. It is the driver‟s responsibility and obligation to deliver the crew and ambulance to the scene in a safe manner, to facilitate transport of the patient into the ambulance, to transport the patient and crew while maintaining a suitable working platform for effective patient care, and to return the crew to quarters or to another suitable drop off point in a safe and professional manner. The ambulance is a moving representative of RPI Ambulance, and the Rensselaer Polytechnic Institute community, Therefore the safe and professional operation of the vehicle are paramount to conveying a positive image of both RPI and RPI Ambulance. Any individual who drives t he ambulance must be pro perly credentialed as an RPI Ambulance Driver or must be a valid Driver Trainee with a Driver Trainer present, as described in SOP 12-07.

GENERAL DRIVING PROCEDURES During all travel of the ambulance, including, but not limited to, travel to dinner or a class meeting, Priority II operation or Priority I operations, the driver will adhere to the following rules: 1. 2.

3.

4. 5. 6. 7. 8. 9.

A spotter must be used at all times whenever backing the ambulance. Anyone sitting in any compartment of the ambulance must wear a seat belt anytime the vehicle is in motion or in traffic. During patient care, providers in the rear compartment may remove their seatbelts only if absolutely required. Any non-member passengers should ride in the front compartment of the ambulance and wear their seat belt at all times when the vehicle is in motion. In cases of pediatric patients or other special cases where the passenger calms or soothes the patient, the passenger may ride with the patient but must always wear their seat belt while the ambulance is in motion. Headlights are to be used at any time the ambulance is in motion. Respond to all calls in accordance with SOP 12-14 Return from the hospital in Priority II mode. Transport from the scene to the hospital at the response level designated by the Crew Chief. Leave the ambulance engine running in high idle at all times during a call until arrival at the hospital Upon arrival at the hospital, shut down the engine prior to unloading the patient.

EMERGENCY DRIVING PROCEDURES When the ambulance is being operated in Priority II mode, as defined in SOP 12-14, the driver will always adhere to NYS Vehicle & Traffic laws. When the ambulance is operated in Priority I mode, as defined in SOP 12-14, the Ambulance Driver will adher e to the following rules in addition to the above and t o NYS Vehicle & Traffic laws: 1. A complete stop is mandatory before proceeding with caution at all red lights, stop signs, and railroad crossings, regardless of response level. 2. If using the median, turning lane, or a lane of opposing traffic to enter an intersection, come to a complete stop before proceeding with caution. 3. Come to a complete stop at all times for any school bus either in the same lane or in the opposing lane with flashing red lights displayed. 4. Do not exceed posted speed limit by more than ten (10) miles per hour at any time.


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Do not exceed posted speed limit at any time when passing through an intersection with the green light. When traveling in a lane of traffic in an opposing direction, do not exceed 20 mph. Leave warning lights (no less than secondary lights) on if the ambulance is stopped on or at the edge of a roadway, or if the ambulance will interfere with traffic, or at any time that the warning lights will increase scene safety for EMS personnel.

DRIVER‟S DUTIES 1.

Duties a) b) c)

during a Scheduled Duty Crew: Complete an RPI Ambulance Vehicle/Mechanical checklist once per shift Notify the Duty Supervisor of any problems or discrepancies If possible, and if the Crew Chief consents, familiarize self and crew with areas of our Primary Territory and response areas d) Drive crew where they need to go in a safe manner

2.

Duties during a Call: a) Be sure that the ambulance is clear of personnel and other obstructions or dangers, and that all exterior doors are closed before getting into the driver‟s seat b) Verify that all ambulance personnel are in secure positions before moving the ambulance c) Upon starting the ambulance verify that all gauges and operation indicators are within nominal ranges, especially fuel level and oil pressure d) Drive to the scene in a safe and efficient manner at an appropriate level of response e) Park at the scene in a position to provide optimal access to the patient while maintaining scene safety. f) Leave the vehicle running at all times while on scene g) Assist the Crew Chief in providing care on scene as needed h) Upon arrival at the hospital, turn off the ambulance and assist the crew in unloading the patient from the patient compartment i) Assist the crew in transferring the patient to the hospital bed

3.

While at the hospital, the following driver‟s duties are to be done in the following order, highest priority first: a) After the patient is unloaded, return to the ambulance and shut off any non-essential items (especially A/C, heat) b) Clean and disinfect the ambulance as appropriate per the RPI Ambulance Exposure Control Plan. c) Get the stretcher ready for service d) Ensure that the ambulance is still within NYS Part 800 equipment parameters e) Contact Rensselaer County Dispatcher by phone to obtain dispatch times and run number as needed by the crew chief f) Assist the Crew Chief as requested

SPOTTERS To reiterate the previously stated policy, whenever the ambulance is in reverse, all drivers must use a spotter in order to maintain a safe service and a professional looking ambulance.


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To properly spot the vehicle when it is backing up, the spotter should stand approximately 10 feet behind the ambulance on the driver‟s side. The driver should be able to see the spotter at all times and must stop if the spotter moves to a position where they cannot be seen. Conversely, the spotter should be able to see the driver‟s mirror at all times as well. The spotter should look out for obstacles and indicate that it is safe to continue in reverse with a left-handed “come here” motion, palm facing the spotter. To indicate that it is unsafe to continue or that there is an obstacle in the path of the vehicle, the spotter should make a fist with his or her left hand with the palm side facing the driver. There are situations where using an external spotter is impossible. These situations are: 1. When backing into the hospital Emergency Department 2. During the reverse phase of the cone course. In these two circumstances only, it is permissible for a vehicle occupant in the patient compartment (i.e. the Crew Chief on a call, or the observing trainee in the cone course) to go to the tailgate end of the crew bench and look out the back windows the entire time the vehicle is in reverse to be on the lookout for any obstacles, pedestrians, or other items that would present a hazard to the ambulance.

BACK-UP ALARM Use common sense when using the back-up alarm. When backing without an external spotter, it must be used. However, if an external spotter is used, and a loud alarm is not advisable (e.g. backing up near residences late at night, backing up at the garage after dark, etc.,) the back-up alarm may be temporarily deactivated. Unless scene safety considerations prohibit its use, the back-up alarm should be used on all emergency scenes and when backing at the hospital.

TRAVEL LIMITS It is the driver‟s duty to ensure a speedy respo nse to any incident on campus. As such, the driver will be responsible for assuring the Ambulance is never too far from campus to respond in a safe and efficient manner. As a minimum, the following boundaries should never be crossed, except on a properly dispatched mutual aid call: North: An east-west line even with TFD station 1 (115th St) East: A north-south line even with McDonald‟s restaurant on Hoosick St. South: An east-west line even with TFD station 6 (Canal Ave) West: The Hudson River It is also recommended that unless there is a specific reason for travel to the above limits, such as food or training, the ambulance should remain as much as possible in the area immediately around the campus. This, however, is left to the discretion of the driver so long as he or she can ensure a safe and efficient response.

WINTER DRIVING Before drivers (trainees, probationary or full) are permitted to drive under winter conditions, they must gain the approval of a driver trainer. Driver trainers will take the trainee on snow/ice covered roads where there are little to no hazards and must demonstrate appropriate safe operation in those conditions. The purpose of this training is to demonstrate the difference in handling of the vehicle in winter conditions including but not limited to: braking distance, up and down hill operation, traction, maneuverability and visibility.


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TRAINING PROBATIONARY DRIVER The Driver trainee will begin their formal training with a class provided by RPI Ambulance that will cover the basics of what is required.

PREREQUISITES 1.

Trainee must be an RPI Ambulance Attendant and hold an active CPR certification

PROMOTIONAL REQUIREMENTS 1. 2.

3. 4. 5. 6. 7. 8. 9. 10.

Must possess a NYS Class D License or equivalent. Attend an RPI Ambulance emergency vehicle training class to include: a) Call Dynamics b) Standard Operating Procedures c) Applicable Laws d) Basic Practical Orientation Complete Driver Check Sheet and Vehicle Maintenance Sheet Successfully pass Driver Practical Exam st Successfully pass the cone course prescribed by the 1 Lieutenant Complete 5 hours of driver training as a third person with a qualified driver trainer and complete driver log sheet to the Training Committee or the Captain which will be kept on file. Drive two (2) Priority-II calls and receive passing evaluations from a trainer Drive two (2) Priority-I calls and receive passing evaluations from a trainer Receive recommendation to become a Probationary Driver from Trainer Receive joint approval of the Captain and Training Committee

DRIVER PREREQUISITES 1.

Must be a Probationary Driver

PROMOTIONAL REQUIREMENTS 1.

2.

3. 4.

Complete and pass one (or more) of the following emergency vehicle operator courses, with documentation kept on file by the Training Committee: a. Coaching the Emergency Vehicle Operator (CEVO) Ambulance b. Emergency Vehicle Operator Course (EVOC) c. In House – Emergency Vehicle Defensive Driving (EVDD) Must complete the following FEMA sponsored classes: a. IS-100: Introduction to the Incident Command System (ICS) b. IS-200: Basic ICS c. IS-700: National Incident Management System (NIMS) d. IS-800: National Response Framework Complete a driving tour of the Albany area hospitals with a trainer Drive two (2) calls as a Backup Driver and receive passing evaluations from a Trainer.


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August 28th, 2012

Receive recommendation for promotion to become a Full Driver by Trainer. Receive approval by the Promotional Board

DRIVER TRAINER PREREQUISITES 1.

Must be an RPI Ambulance Driver


Be a Driver for 4 months while the ambulance is in service Drive three (3) EMS calls Assist in teaching an RPI Ambulance Driver or EVDD class under the supervision of a Driver Trainer Request to become a trainer Receive recommendation for promotion from a Trainer Receive joint approval of the Training Committee and the Captain


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SOP 12-08 AMBULANCE CREW CHIEF INTRODUCTION The Crew Chief is the leader of the Ambulance Crew. The New York State Department of Health mandates that there must be at least one current NYS EMT providing patient care in the patient compartment of the ambulance in accordance to NYS BLS protocols. The RPI Ambulance Crew Chief has been trained not only in Basic Life Support treatment of emergency patients, but also in how to appropriately handle situations that may arise during any phase of operations. This includes, but is not limited to: dealing with problematic patients, decision-making, MCI‟s, and interacting with other agencies. The Crew Chief is directly respo nsible for the conduct and appearance of the Ambulance Crew. All members of the Ambulance Crew should feel comfortable communicating any questions they may have to the Crew Chief. The Crew Chief may not necessarily be the highest medical authority on scene, but at RPI Ambulance, the Crew Chief is procedurally in charge. Any individual who acts in the capacity of Crew Chief must be properly credentialed as an RPI Ambulance Crew Chief or must be a valid Crew Chief Trainee with a Crew Chief Trainer present. As such, any person acting as the Crew Chief must meet the qualifications as set forth in SOP 12-08.

GENERAL PROCEDURES 1. 3. 4.

5.

6.

If the Crew Chief does not feel comfortable with a situation, a member, or is uncertain how to handle a predicament, they should contact the Duty Supervisor. If a disagreement between RPI Ambulance and an ALS provider exists, the Crew Chief will put aside any personal or agency differences and make decisions based in the best interest of the patient. If a disagreement between RPI Ambulance and another EMS agency, dispatch center, Public Safety Authority, or other official exists, the Crew Chief will not act on behalf of the agency in solving the problem but rather will act in the best interest of the patient. The Crew Chief will also immediately notify the Duty Supervisor, who will evaluate the situation and decide how best to handle it. Maintain communications with any/all appropriate dispatch center(s) throughout operations, either alone or by designating another crewmember. The Crew Chief is responsible for all of these radio communications, though another member may use the radio with the express consent of the Crew Chief. Maintain control of the Ambulance Cellular Phone. No member may use the phone without the permission of the Crew Chief.

CREW CHIEF‟S DUTIES 1.

2.

Duties during a scheduled Duty Crew: a) Make sure that an Ambulance and First Response Vehicle Equipment Checklist is completed by the Crew. b) Report any discrepancies or problems to the Duty Supervisor. c) Make sure that any vacancies on the crew are filled to assure that all members who want to ride crews are able to do so in a timely manner. d) If possible, provide training opportunities for the rest of the Crew. e) Maintain Crew morale and try to accommodate the wishes of the Crew. f) If a Crew member needs to study while on a duty crew, this will take precedence over driving around and other endeavors. We are students first. Duties during a Call:


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a) Confirm that there is a crew, and try to include trainees on the call. b) Advise the Ambulance Driver of the appropriate level of response to the scene if different from the standard. c) Respond to the scene in accordance with SOP 12-14 d) During travel to the scene, plan ahead for any equipment or additional resources (e.g. fire apparatus, Hazmat Unit, additional Ambulances) that may be needed. e) Upon arrival, notify appropriate dispatcher(s). f) Prior to egress from the vehicle to the scene, the Crew Chief will assess the scene for safety and advise the Ambulance Crew of how to appropriately protect themselves from any hazards that may be present. The Crew Chief is responsible for the safety of the crew at all times. g) The Crew Chief will be in charge of all patient care and will act as the interface between the RPI Ambulance Crew and a provider of a higher level of care. h) The Crew Chief will attempt to allow other members to train in positions they are attempting to gain RPI Ambulance credentialing in (e.g. Crew Chief, Attendant) within their level of credentialing (i.e. if the Crew Chief is also a Crew Chief Trainer). i) Provide BLS care at the level that RPI Ambulance is certified to provide. j) Select the appropriate patient carrying device and use it to bring the patient to the ambulance. k) Transport to a Hospital Emergency Department in accordance with SOP 12-15. l) While en route to the medical facility, provide medical care as appropriate. m) Use the Ambulance VHF Radio to contact the Emergency Department with the following information: i. Age and gender ii. Chief complaint iii. History of chief complaint iv. Pertinent past medical history and medications v. Pertinent vital signs vi. Treatment rendered by this agency and others (i.e. Oxygen by RPI, IV by TFD) vii. Estimated time to arrival n) Upon arrival at the medical facility, shut down any nonessential ambulance items. (E.g. dome lights, heat or A/C, vent, etc. o) Give a report to the appropriate Emergency Department staff member. p) If at a hospital ER, assist the registration clerk in obtaining patient information and try to get a face sheet. q) Complete paperwork, obtain times and numbers, and notify appropriate dispatch center(s) that the ambulance is available for the next call. r) Verify that the Driver has prepared the ambulance for the next call. s) Leave the medical facility in a reasonable amount of time and return to service as appropriate.

TRAINING The position of Ambulance Crew Chief is the highest credentialed position in the Ambulance Crew. Becoming an Ambulance Crew Chief involves not only medical proficiency, but also thorough knowledge of all Operating Policies and an ability to lead the crew effectively. The Crew Chief Trainee should, while training, act in the capacity of Crew Chief to the best of his or her ability. The training period is a time to gain experience with a trained Crew Chief on board. The Crew Chief Trainee is encouraged to attend as many drills as possible as they are a good source of knowledge and training.


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PROBATIONARY CREW CHIEF PREREQUISITES 1. 2. 3.

Trainee must be an RPI Ambulance Attendant Host current certification as a NYS EMT-Basic or higher (no other state is acceptable) Maintain active CPR for Healthcare Provider certification


2. 3. 4. 5. 6. 7. 8. 9.

Attend an RPI Ambulance Crew Chief training class to include: a) Call Dynamics b) Standard Operating Procedures c) PCR writing Crew Chief 1 simulated call Complete PCR writing class Complete Crew Chief checklist Complete 1 mock call w/ passing evaluation from CC Trainer before taking a real call. Crew Chief 2 calls with a crew chief trainer in the patient compartment and receive passing evaluations for both. Pass the practical exam, including PCR writing Receive recommendation for promotion by Crew Chief Trainer Receive joint approval of the Captain and Training Committee

CREW CHIEF PREREQUISITES 1.

Must be a Probationary Crew Chief


Must Crew Chief 2 calls as a Probationary Crew Chief, receive a passing evaluation and be recommended for promotion by a Crew Chief Trainer. 2. Must complete the following FEMA sponsored classes: a) IS-100: Introduction to the Incident Command System (ICS) b) IS-200: Basic ICS c) IS-700: National Incident Management System (NIMS) d) IS-800: National Response Framework 3. Must student-teach one training course or drill and submit an evaluation form a) This training drill must be approved and supervised by the training committee b) The purpose of this course is to demonstrate proper training skills while teaching an advanced topic to other members of the agency. 4. Receive recommendation for promotion from a Trainer 5. Receive approval by the Promotional Board


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CREW CHIEF TRAINER PREREQUISITES 1.

Must be an RPI Ambulance Crew Chief


Be a Crew Chief for 4 months while the ambulance is in service Crew Chief 3 emergency or non-emergency calls Assist in teaching a Crew Chief class Request to become a trainer Receive recommendation for promotion from a Trainer Receive joint approval of the Training committee and Captain


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August 28th, 2012

SOP 12-09 FIRST RESPONSE DRIVER INTRODUCTION The responsibility of the First-Response Driver is to drive First Response-59 safely to the scene of an EMS call, from headquarters to the garage or to the location of a special event. The job of First Response Driver is very different from that of Ambulance Driver; therefore the responsibilities and requirements are different. This position is an additional certification of for RPI Ambulance Crew Chiefs and Drivers rather than an individual qualification.

RESPONSIBILITIES The First Response Driver will perform a vehicle and equipment checklist at the start of every shift. He/She will also be responsible for the security, care and upkeep of the vehicle for the duration of the shift.

GENERAL DRIVING PROCEDURES During all operation of the first response vehicle the following procedures will be adhered to: 1. 2. 3. 4. 5. 6.

A spotter must be used at all times whenever backing the vehicle. The driver and all passengers in the first response vehicle shall wear a seatbelt at all times during any operation of the vehicle. Headlights are to be used at any time the vehicle is in motion. Respond to all calls in accordance with SOP 12-14. The First Response Driver will adhere to the Travel Limits and Winter Driving rules designated in SOP 12-07 Every effort should be made to have a Crew Chief with the vehicle in the event that it is flagged down for assistance.

EMERGENCY DRIVING PROCEDURES 1.

2.

When the first response vehicle is being operated in Priority II mode, the First Response Driver will always adhere to NYS Vehicle & Traffic laws. When the first response vehicle is operated in Priority I mode the First Response Driver will adhere to the following rules in addition to the above and to NYS Vehicle & Traffic laws: a. A complete stop is mandatory before proceeding with caution at all red lights, stop signs, and railroad crossings, regardless of response level. b. If using the median, turning lane, or a lane of opposing traffic to enter an intersection, come to a complete stop before proceeding with caution. c. Come to a complete stop at all times for any school bus either in the same lane or in the opposing lane with flashing red lights displayed. d. Do not exceed posted speed limit by more than ten (10) miles per hour at any time. e. Do not exceed posted speed limit at any time when passing through an intersection with the green light. f. When traveling in a lane of traffic in an opposing direction, do not exceed 20 mph. Leave warning lights (no less than secondary lights) on if the vehicle is stopped on or at the edge of a roadway, or if the ambulance will interfere with traffic, or at any time that the warning lights will increase scene safety for EMS personnel.


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August 28th, 2012

If the emergency lights are left on at the scene, the vehicle‟s engine should remain running. Should the vehicle be left on scene during a transport to the hospital, the vehicle should be moved out of the roadway to a safe parking spot, the lights and engine shut down and the vehicle locked and secured. The vehicle should be retrieved as soon as possible after returning from the hospital.

TRAINING PREREQUISITES 1. 2.

Be an RPI Ambulance Crew Chief or RPI Ambulance Driver Hold a valid NYS Class D driver‟s license or equivalent

PROMOTIONAL REQUIREMENTS 1. 2. 3. 4. 5. 6. 7.

Perform a First Response-59 equipment and a vehicle checklist Log 5 hours of driving time in First Response-59 under the supervision of a Driver Trainer Pass the First Response-59 cone course Pass the RPI Ambulance Driver Practical Exam in either 5939 or FR-59 Drive at least two (2) calls with at least one call being a priority 1 call, in either 5939 or FR-59 under the supervision of a Driver Trainer Request promotion to First Response Driver Receive joint approval from the Training Committee and Captain


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SOP 12-10 EVENT EMS SUPERVISORS INTRODUCTION Event EMS Supervisors (EES) are qualified Crew Chiefs who manage personnel and resources at RPI Ambulance Special Events. EES are trained in the supervision multiple field crews during large special events, proper radio procedure and inter-agency operations and incident management. They are also capable of treating and calling for the transport of patients.

TRAINING Event EMS Supervisors (EES) should be trained in and show proficiency in the following skills: 1. 2. 3. 4. 5.

Large scale event and personnel management Radio communications Decision making under stressful situations Working with other agencies and organizations Patient care

PREREQUISITES 1.

Be an RPI Ambulance Crew Chief

PROMOTIONAL REQUIREMENTS 1. 2. 3.

Be the EES- In Charge of two (2) events under the supervision of an EES and receive a passing evaluation Complete the EES checklist. Request promotion to EES from the Captain and Training Committee.


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SOP 12-11 DUTY SUPERVISORS INTRODUCTION In the EMS field, many problems exist, from operations to interpersonal conflict. The position of Supervisor is created to provide easy access to an experienced member who can act in the capacity of Crew Chief or Driver if the need arises. The Supervisor also acts as a screen to the Captain so that matters that can be resolved by the Supervisor don‟t need to unduly tie up the Captain. The position of Supervisor is not a Credentialed Promo tion, and as such, it does not fall under the auspices of Training Committee.

QUALIFICATIONS The Supervisor Shall: 1. Be currently credentialed as a Crew Chief Trainer, Driver Trainer, First Response Driver and Event EMS Supervisor by RPI Ambulance 2. Maintain at least 70% compliance in agency QI as a Crew Chief. 3. Have completed an interview with the Captain testing the knowledge of RPI Ambulance operations, Standard Operating Policies, Mutual Aid, and the geography of Rensselaer County and Surrounding Areas. 4. Be appointed by the Captain with input from other Line Officers and other Supervisors after the successful completion of the aforementioned interview.

DUTIES All Supervisors: 1. Will act as the scheduled Duty Supervisor for at least 24 hours per week. 2. Must remain within radio range of RPI Public Safety, the Rensselaer County Dispatcher, and the Ambulance, and will be able to establish communication to the Ambulance Crew via Cellular Phone during their on duty time. 3. Must carry appropriate Supervisor Identification while on duty. 4. Should notify the appropriate officer in the proper time, if the Supervisor notices anything that requires st attention from that officer. For example, the Captain and 1 Lieutenant need to know right away that the Ambulance has a flat tire, whereas the Training Committee could probably be notified in the morning if one of the CPR manikins is broken. 5. Will act in an appropriate manner at all times while acting on behalf of RPI Ambulance. 6. Will not take over care of a patient, driving responsibilities, or any other duties of the crew unless patient or crew safety is in jeopardy. 7. Will file incident reports as necessary to maintain proper documentation of incidents. 8. The On-Duty supervisor is expected to assist the responding ambulance in the following situations: a. MCI- Any incident that involves more than 2 patients or in which there are patients in excess of the available resource b. Any rescue incident that would involve a crew being on scene an anticipated time exceeding 20 minutes c. Any incident where crowd control may cause an issue to the responding units. This includes but is not limited to fraternity houses and large events d. Any incident where ALS is requested, where an ALS unit is not available for immediate response


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GRIEVANCES Any grievance with a Supervisor or the actions of a Supervisor will be forwarded as soon as possible, to the Captain, who will investigate the matter fully. If an individual does not feel comfortable approaching the Captain, another Supervisor may be notified of the grievance or the member may contact the Grievance Committee of RPI Ambulance. Care should be taken to avoid a rumor mill when deal ing with such grievances as matters can quickly be blown out of proportion. Always try to use the proper communication channels. If the Captain feels that the grievance has merit, the Captain will attempt to mediate any dispute between the involved parties. If one or both parties are unsatisfied with this approach, the matter will follow SOP 12-25 for grievances and appeals.


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S O P 1 2 - 1 2 C O O R D I N AT O R S INTRODUCTION To assist in the completion of their jobs, the line officers of RPI Ambulance are empowered to appoint coordinators. This gives the coordinator selected powers that the appropriate officer may have while still referring all responsibility for the job to the appropriate officer. Some specific positions follow.

QI COORDINATOR The Quality Improvement Coordinator coordinates the completion of QI audits and tabulates the data and reports to the Captain. The QI Coordinator and/or the Captain represent RPI Ambulance at meetings of the Rensselaer County QI Committee. If desired, the Captain may elect to act as the QI coordinator. The QI coordinator is responsible for ensuring compliance with the Rensselaer County QI program and thereby the Region and State program. The Captain and QI coordinator should periodically review the Rensselaer County QI program to evaluate its effectiveness to RPI Ambulance and to ensure it meets all State and Regional requirements.

CPR COORDINATOR The CPR Coordinator is in charge of coordinating CPR events sponsored by RPI Ambulance and reports to the Training Committee. The CPR Coordinator need not be a CPR Instructor but instead assures that instructors are available to hold scheduled CPR training. The CPR Coordinator should work closely with the Training Committee and the Vice-President. If desired, the Training Committee may elect to act as the CPR coordinator.


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August 28th, 2012

SOP 12-13 UNIFORMS INTRODUCTION In an effort to gain respect and convey a professional manner to the community, RPI Ambulance has established different categories of uniform standards. This will provide continuity and an easy way to communicate the appropriate uniform to members of a Duty Crew.

PATCHES RPI Ambulance patches will only be worn the black duty uniform shirt or red RPI Ambulance jacket. The RPI Ambulance agency patch will be worn on the left shoulder. NYS DOH certification patches of the “Excelsior” design with tombstone shape and navy blue background will be worn on the right shoulder. If a member does not hold NYS DOH certification, a 2 inches x 3 inches American flag patch with gold border or NYS DOH “Emergency Medical Services” tombstone patch may be worn on the right sho ulder. No other patches may be worn on any part of the uniform.

PINS, COLLAR BRASS, BADGES Any pin to be worn on the RPI Ambulance uniform must be approved by the Captain. The Captain has the right to ask a pin to be removed from any RPI Ambulance uniform. Officer and Supervisor badges may be worn with the Duty Uniform and carried with the Casual Uniform to serve as identification. In some cases, the different role we serve by being an EMS agency and not a Public Safety agency can play in important role in patient rapport. It is for this reason that we must keep a clear distinction between RPI Ambulance and other Public Safety agencies.

UNIFORM CLASSES DUTY UNIFORM This is issued uniform that is used by RPI Ambulance. It consists of: Black collared RPI Ambulance uniform shirt with black T-Shirt worn underneath for Crew Chiefs, Drivers and Officers Officer bars for line officers, officer pins for administrative officers, silver caduceus for non-officers Red “Trainee” polo for attendants, ride-along observers, observers, and trainees Black slacks or black EMS-style pants Black belt with silver or black buckle No dangling earrings or jewelry Black, shined, closed-toe shoes or boots. No high heels. Black socks (if socks visible) RPI Ambulance approved red jacket (Seasonal) 

       


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CASUAL UNIFORM When not assigned to duty crews, RPI Ambulance members may wear RPI Ambulance apparel such as t-shirts or sweatshirts with the RPI Ambulance name and logo on them. This apparel does not constitute any official uniform; as such, duty crews must be in the duty uniform. Members responding to calls while not on a scheduled duty crew do not have to wear the full Duty Uniform; however will wear the Casual Uniform. The Casual Uniform consists of: A plain neat un-torn shirt, preferably dark, if possible RPI Ambulance- or EMS oriented. fluorescent or obscene T-shirts are allowed. Neat, un-torn pair of pants, preferably dark. Jeans are fine but shorts are not permitted. Solid footwear. No open-toed shoes or sandals. No high heels. RPI Ambulance approved red jacket 

  


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SOP 12-14 DISPATCH AND RESPONSE PROCEDURES INTRODUCTION Rensselaer County Bureau of Public Safety is the official dispatcher for RPI Ambulance. All medical emergency calls originating on campus are transferred to the Rensselaer County Emergency Medical Dispatcher who assigns the priority determinant for the call and dispatches RPI Ambulance. All non-emergency medical calls originating on campus are transferred to Rensselaer County in the same fashion as the emergency calls from the Rensselaer County Dispatcher or from the RPI Student Health Center. Rensselaer County Emergency Medical Dispatcher will also dispatch RPI Ambulance for any mutual aid calls originating in the county. Rensselaer County can be reached via the following numbers: Emergency Number: 911 Non-Emergency Numbers: (518)-270-5252 / (518)-270-1037

RESPONSE LEVELS Priority II – 5939 or First Response-59 operation using no emergency lights or sirens, following all V&T laws. Synonyms: Routine, Code 2, Cold. Priority I – 5939 or First Response-59 operation using emergency lights and siren. Synonyms: Emergency, Code 3, Hot. NB: The driver has responsibility and liability for safe operation and must maintain compliance with RPI Ambulance driving procedures. The driver is personally liable for any injury or damage sustained during Priority I operation.

RPI AMBULANCE UNAVAILABILITY If RPI Ambulance is unavailable for a call the next available ambulance according to the mutual aid plan shall be called. This will happen in accordance with SOP 12-16 and the current dispatch plan with Rensselaer County Bureau of Public Safety.

EMS CALLS The county dispatcher will notify the members of RPI Ambulance of the call, including nature and location, with the accompanying paging tones via the high band portables broadcast over frequency 155.220, heard on channel 1 (one) or 2 (two) of the RPI Ambulance high band portable radios. Calls received from the county dispatcher will include a determinant:  

Alpha determinant calls will be treated as Priority II as defined above. Bravo, Charlie, Delta, and Echo determinant calls will be treated as Priority I as defined above.


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All radio communications between crew members before, during and after the call should be done over RPI Ambulance high band radio (155.220MHz). Any communication to the Rensselaer County Dispatcher shall be done via the 800MHz system. If the Crew Chief or Driver is unable to contact the Dispatcher via the 800MHz system they may contact the Dispatcher via cellular telephone by dialing (518)-270-1037.

RESPONSE TO EMS CALLS NO SCHEDULED DUTY CREW 1. 2.

3.

4. 5.

Upon notification of an EMS call, all efforts should be made to see that 5939 responds to the scene with a full crew. If a First Response Driver qualified Crew Chief has been assigned to First Response-59 or can get to First Response-59 quickly, he/she may respond to the scene with the vehicle. The responding Crew Chief will advise other members of his/her response via the high band radio and also the Rensselaer County Dispatcher via the 800 MHz radio. He/she shall make an effort to contact an Ambulance Driver to bring 5939 to the scene. As soon as the Crew Chief is sure that no Ambulance Driver is able to respond with 5939, he/she shall contact the Rensselaer County Dispatcher to request mutual aid for a transport. If the Crew Chief determines that the call is to be an RMA, he/she may cancel the transporting ambulance with the Rensselaer County Dispatcher If there is an Ambulance Driver available, he/she should respond to the garage to bring 5939 to the scene. Any regular Crew Chief and any other members may respond directly to the garage to respond with 5939. If a full crew of a Driver and a Crew Chief cannot be raised, the responding crew members may contact the dispatcher to have the call re-dispatched to complete the crew. Trainees may respond to the garage to respond with 5939. No member other than an RPI Ambulance Crew Chief should respond directly to the scene of an EMS call unless they are already on scene.

DURING A SCHEDULED DUTY CREW 1.

2. 3.

Upon notification of an EMS call, the on-duty Crew Chief or Driver shall acknowledge the call and confirm the crew with the Rensselaer County Dispatcher via the 800 MHz system. The on-duty Crew Chief may respond to the scene via First Response-59 if the rest of the crew has adequate means of transport to the garage that will not cause an undue delay in the response of 5939. The on duty Driver is responsible for responding to the scene with 5939. First Response-59 may be used to convey the entire duty crew to the garage so that the crew may respond to the scene in 5939. No member other than an RPI Ambulance Crew Chief should respond directly to the scene of an EMS call unless they are already on scene.

RESPONSE TO MUTUAL AID CALLS 1. 2.

First Response-59 should not respond to the scene of any mutual aid call if 5939 is available unless specifically requested by the Rensselaer County Dispatcher. If 5939 is already on an EMS call and a mutual aid call is dispatched, a First Response Driver qualified Crew Chief may respond to the scene with First Response-59.


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TRANSPORTATION CALLS RPI Ambulance may perform a non-emergency transport, (e.g. patient returning to campus after surgery) if requested, with the approval of the Captain. This is a service which should not be abused. An individual who is on crutches or able to ambulate with assistance does not need the services of an ambulance. If no other means of transport is available, RPI Ambulance will attempt to get a crew to transport the patient.

HAZARDOUS MATERIAL CALLS RPI Ambulance is not equipped or trained to handle Hazardous Material (Haz-Mat) situations. As such, no member may enter Haz-Mat scene until trained professionals have properly decontaminated it. The Crew Chief is responsible for ensuring the safety of the crew and should keep the crew back far enough to be away from the hazardous agent.

STAND-BY‟S AND MCI RPI Ambulance is a participant in Mutual Aid with other agencies who may call upon us as a resource in the event of multiple patient incidents (MCI), long standbys, etc. Response to these scenes will always be in Priority II mode with the exception of Fire Standbys. Lights and sirens will not be used to respond to these incidents unless there is a patient waiting for our services, in which case the incident is no longer a standby response, but begins a new PCR as an EMS call. If the dispatch entity requests RPI Ambulance to respond to an incident Priority I, then RPI Ambulance will do so if the Crew Chief feels comfortable with that judgment.


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SOP 12-15 PATIENT TRANSPORT DESTINATIONS INTRODUCTION Patients are usually transported to the hospitals in Rensselaer, Albany, or Schenectady Counties. The only exception to this may occur when RPI Ambulance has responded to a mutual aid request and the usual receiving hospital(s) of the agency requesting mutual aid is substantially closer than one of the facilities in Rensselaer, Albany, or Schenectady Counties. The hospital destination, within the areas of Rensselaer, Albany, or Schenectady Counties, will depend on a variety of factors, including, but not limited to, patient medical condition, patient request, road and weather conditions, location of the patient‟s regular physician, and location of the incident. The patient will have final choice; however the crew chief should attempt to convince the patient to go to a local hospital. Under no circumstances will the a patient be transported to a hospital that is more than 20 minutes further distance than the nearest hospital according to the NYS BLS Protocols.

Any patient deemed to be in an immediately life-threatening situation will be taken to the nearest appropriate hospital. The appropriate hospital Emergency Departments are: 1. Samaritan Hospital ER, Troy, NY 2. Saint Mary‟s Hospital ER, Troy, NY 3. Ellis Hospital ER, Schenectady, NY 4. St. Clare‟s Hospital ER, Schenectady, NY 5. Albany Medical Center Hospital ER, Albany, NY 6. Saint Peter‟s Hospital ER, Albany, NY 7. Albany Memorial Hospital ER, Albany, NY 8. Stratton VA Medical Center ER, Albany, NY

UNUSUAL RECEIVING FACILITY In an emergent situation, if a patient seeks transportation to a hospital outside the area to which the RPI Ambulance ordinarily transports patients, the patient will be informed of the RPI Ambulance receiving hospitals, the distances involved, and that no exceptions are made. If the patient refuses transportation, the “Refusal of Transportation” policy will be followed. The members will inform the patient of the possible medical consequences of his/her action, and have the patient sign a refusal of transportation statement. If the situation is non-emergent and the patient or caller makes inquiry (e.g. the need to transport a nonambulatory stable patient), they shall be referred to the Empire Ambulance Service or Mohawk Ambulance Service.


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RECEIVING FACILITY ON DIVERSION If crew gives a hospital as patient destination and the medical control physician at that receiving hospital feels that patient condition warrants transport to the nearest facility, the crew will inform the patient and any accompanying relative, and comply immediately with the medical control order. If once the patient is enroute to a certain hospital and that hospital medical control orders the ambulance to divert to another hospital, the crew will inform the patient and will do everything in their power to explain the reasons for the diversion. If the patient is alert, oriented and understands the reason for diversion but still refuses diversion from the hospital of choice; s/he will be asked to sign a refusal and will be taken to the original hospital destination. If, however, in the opinion of the highest trained member in attendance, the patient‟s request of hospital will cause further harm to the patient, the nearest appropriate hospital will be used. In all cases of diversion f rom the patient‟s hospital choice, the EMT will record the patient‟s request on the Prehospital Care Report and the reasons for transporting to the closest appropriate hospital. If a receiving hospital diverts the ambulance to another receiving hospital because of emergency room conditions as opposed to patient condition, the ambulance will divert if, in the judgment of the crewmember with the highest level of training, in consultation with medical control, it is determined that the patient condition is stable enough to warrant diversion. Under these circumstances the patient, whose condition is stable, is informed that the hospital has requested diversion for the reason stated. If the patient insists that s/he be taken to the originally requested hospital and the crew is unable to persuade the patient otherwise, the patient‟s hospital destination choice will be honored by the crew and the hospital informed of the reason that the ambulance will not honor their request for diversion. Generally, patients who are critical or unstable must be taken to the nearest facility.

HOSPITAL DESTINATION IN MUTUAL AID SITUATION In a mutual aid situation, if a hospital is substantially closer than the usual receiving hospitals, that hospital will be utilized. If communication with dispatch and/or the receiving hospital is impaired, a real possibility in some mutual aid instances, the crew will utilize all BLS and ALS standing orders as appropriate, and then follow the regional communication difficulty protocol. The destination hospital will be contacted as soon as possible, either by radio or by cellular telephone. If in a mutual aid situation, in the rare instance the crew may be transporting a patient to a hospital other than RPI Ambulance usual receiving hospitals, if a diversion is requested, the crew will divert only if the diversion does not in any way, in the judgment of the highest trained crew member, compromise the patient.

TRANSPORT AND HOSPITAL DESTINATION OF MAJOR TRAUMA PATIENTS In a major trauma situation, where the crew deems appropriate, the nearest air medical service – helicopter (Usually Albany Med Flight or Lifeguard) will be requested. The crew will generally meet the helicopter at a mutually agreeable landing zone enroute to the hospital. Arrangements will be made through dispatch for the establishment of the landing zone by the appropriate Fire Department. If Air Medical Service is not available, in almost all instances the nearest hospital is the appropriate receiving facility. In the rare instance that the crew may be working in an area on a mutual aid request, the crew chief should keep in mind that Albany Medical Center is a designated trauma center, and may be the appropriate destination for patients meeting major trauma criteria as found the NYS BLS Protocols.


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SOP 12-16 MUTUAL AID Under the Rensselaer County Mutual Aid Plan, RPI Ambulance and other Rensselaer County agencies have the ability to request Mutual Aid from each other under the following constraints: 





Rensselaer County will maintain RPI Ambulance run number and response times in accordance with existing Rensselaer County Dispatch policies. After being dispatched for a Mutual Aid call, RPI Ambulance will call the requesting dispatcher and request any information needed such as call location, directions, and patient status. Upon arrival at the hospital, RPI Ambulance should call arriving the appropriate dispatcher‟s frequency notify the dispatcher that they are returning to RPI‟s frequency, and return to RPI Ambulance‟s primary frequency. Then, notify the Rensselaer County Dispatcher that RPI Ambulance is clear of the Mutual Aid call and back in normal dispatch procedures.


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SOP 12-17 OUT OF SERVICE INTRODUCTION By the nature of RPI Ambulance being college based it is recognized that there are periods when members cannot commit to responding to a call. These may be times when all crew chiefs are in class, a period before a test, etc. In addition, during summer vacations when students are away, the members may also be away and the service may be unable to respond. This policy seeks to address the issues regarding this lapse of service.

DAY TO DAY TURNOVERS While classes are in session, every effort is to be made by the members to provide a quick response. This is to be done by having as many regular scheduled crews a possible and by communication among the members regarding their absences and outside commitments. In cases where a crew is not available, the call will be turned over for mutual aid. This will be done by Rensselaer County Dispatch. If a full crew cannot be raised, the responding crew members should request mutual aid as soon as it is known that a full crew is not en route to the ambulance. If a member does not acknowledge the call within 3 minutes, a crew cannot be confirmed within 6 minutes, or the ambulance is not enroute within 9 minutes, the call will automatically be turned over to mutual aid. All times are counted from the time of initial dispatch of the ambulance. In the case of a large incident, the dispatcher will signify so and will continue trying to raise a crew for as long as feasible.

EXTENDED PERIODS OF ABSENCE If the ambulance will be out service, for any period of time, the Rensselaer County Dispatcher should be notified of the absence so that RPI Ambulance is not dispatched for any calls during that period of time. If the ambulance will be out of service for a scheduled period of time (such as maintenance) all members should be notified ahead of time (such as by email) and the Public Safety dispatcher should be notified by phone of the absence of service. This ensures that no time is wasted trying to raise an ambulance for a patient on campus when it is not available to respond. Any time the ambulance is taken out of service, an “Out-Of-Service” sticker should be placed over the NYS-DOH certification sticker.


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SOP 12-18 SPECIAL EVENT PROCEDURES Special event medicine is a major aspect of the duties that RPI Ambulance performs on the RPI Campus. The following SOPs are the rules that define the operations of RPI Ambulance but should not supersede good clinical judgment of the supervisors and the crew. All New York State Department of Health (DOH) and Regional Emergency Medical Organization (REMO) rules and regulations should be followed.

SPECIAL EVENT COVERAGE REQUESTS nd

Upon receipt of a Request for medical Coverage at a Special Event, the 2 Lieutenant will check to see if there are enough available personnel willing to volunteer for the event. The request will be submitted to the Captain to approve the event and to determine the level of coverage for the event.

FIRST AID ROOM OPERATION A significant majority of RPI Ambulance‟s special event standbys occur in venues in which RPI Ambulance operates a First Aid Room that is fully stocked according to Part 18 of the NYS Sanitary Code. The following procedures are to be followed when operating within these facilities.

EAST CAMPUS ATHLETIC VILLAGE FIRST AID ROOM All personnel shall enter East Campus Athletic Village (ECA V) via the North Entran ce and proceed up the stairs to the First Aid room. The ambulance and or First Response Vehicle shall be parked along the fence adjacent to the field. Only Line Side officers, crew chiefs and drivers should have electronic card access to the ECAV First Aid Room. Prior to the start of the event, each Crew Chief must complete a field bag equipment checklist. If the event is a Type II or III event in the stadium, the First Aid Room must be staffed by an Event EMS Supervisor (EES) who will complete a First Aid Room equipment checklist. After the event the lights sh ould be shut off and the door closed.

HOUSTON FIELD HOUSE FIRST AID ROOM All personnel shall enter the Houston Field House (HFH) via the South side/ B lot entrance and produce on demand an RPI Ambulance issued Identification Card. The keys to the HFH FAR are locked up in a lockbox next to the door. Only EES and Line Officers have the combination to the lockbox. At the end of the event, the lights should be turned off, the door locked and the keys returned. Prior to the start of the event, each Crew Chief must complete a trauma and infection control bag equipment checklist and the Crew Chief or Event EMS Supervisor shall complete a First Aid Room Equipment checklist.


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During the event, he First Aid Room shall always be staffed by at least one crew chief. If the event is a Type II or III event, the event must be staffed by an Event EMS Supervisor (EES). In order of importance, a crew chief should be stationed in Section 7 first, then Section 15, then Section 1. At T ype II and III events the Fieldhouse log book should be filled out by the Event EMS Supervisor. This log will detail personnel attendance, event title, spectator attendance, crew movements and patient interactions.

EVENT TYPE CLASSIFICATION The following classification of event types is based on the level of coverage provided by RPI Ambulance.. The Captain will approve the level of coverage at least three (3) days prior to the event.

TYPE I EVENT Type I events are events that have a long duration and low attendance that do not necessitate the placement of field crews. Minimum coverage for Type I Events will include at least one (1) Crew Chief with a trauma bag and oxygen duffel and First Response-59 (or a FAR at the discretion of the Crew Chief- In Charge).

TYPE II EVENT Type II events are events that have a large attendance (up to 5000) that necessitate the placement of field crews (e.g. hockey games). Minimum coverage for Type II Events will include at least one Event EMS Supervisor (EES), two (2) Crew Chiefs with trauma bags and oxygen duffels, the Ambulance with a driver and First Response-59 (or a FAR at the discretion of the EES-IC).

TYPE III EVENT Type III events are events that have a large attendance over 5000 people and that will require the ambulance be on dedicated standby for part of or the entire duration of the event (e.g. Commencement). Minimum coverage for Type III Events will include at least two (2) Event EMS Supervisors (EES), three (3) Crew Chiefs with trauma bags and oxygen duffels, First Response-59 (or a FAR at the discretion of the EES-IC) and the Ambulance with a driver on dedicated standby.

EVENT RADIO COMMUNICATIONS At the start of Type II and III events the f ollowing radio check will be completed by the Event EMS Supervisor –In Charge (EES-IC) over the RPI Ambulance frequency (155.220MHz): “At , Radio Station WNFR-574, RPI Ambulance Emergency Medical Services, unit 900 in-service.” At Type III events the Event EMS Supervisor will contact the Rensselaer County Dispatcher by telephone and inform them of the RPI Ambulance units dedicated to the special event. For example “5939 and First Response59 are dedicated to an event at the .” At the end of the event, the Dispatcher must


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be informed that the units are clear of the event and back in service by telephone. In addition hourly radio tests will be performed by the Event EMS Supervisor: “At , Radio Station WNFR-574, HFH Emergency Medical Service, units in the field stand-by to acknowledge: “At , all units in service, unit 900.” To Notify the EES- In Charge of a medical call, the field crew will contact the EES-IC in the following manner: Field Crew: “ to 900” “Go ahead.” 900: Field Crew: “ responding to for an investigation.” “Received at .” 900: At the closing of Type II and II I events, the Event EMS Supervisor will make the following radio sign -off: “At , Radio Station WNFR-574, RPI Ambulance HFH Emergency Medical Services, Unit 900 outof-service.”

CALL SIGNS The EES-In Charge will assign all call signs for use during an event. The EES-In Charge shall use the call sign “900”. When speaking with the Rensselaer County Dispatcher the EES-In Charge shall use the call sign “Car 4” unless another line officer car number has been assigned. Roving EES shall use the call signs 908 and 909. Field Crews shall use the call signs 901-907. If an Ambulance Driver has been designated to remain with the Ambulance, their call sign shall be 939.

SPECIAL EVENT OPERATIONS OPENING PROCEDURES Members who wish to attend the event should sign up on the website. The EES-IC may dismiss any members who did not sign up or if there are more members than needed for the event. RPI Ambulance personnel should arrive prior to the start of the event. The EES-In Charge (EES-IC) (or Crew Chief-In Charge for smaller events) should make contact with the requesting organization to get any additional information about the event and to alert the organization to where medical personnel can be found throughout the event. All crew chiefs should be given a radio and the EES -IC should have a portable 800 MHZ radio at their disposal to communicate with the Rensselaer County Dispatcher. The EES-IC should assign all members in attendance to field crews led by a Crew Chief. The EES-IC will assign each field crew to a specific location for the duration of the event. Field Crews may be rotated throughout the course of the event, however the location of crews should not change throughout the course of the event should spectators or staff come looking for aid.


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INCIDENT PROCEDURES Upon receiving notification of a medical incident (e.g. by Public Safety, Walk ups etc.) the field crew should notify the EES- In Charge by radio as outlined in the radio procedure. The EES-IC may also dispatch a field crew to a location to investigate a potential medical incident. If the patient approaches the EES-IC, he/she may recall a field crew to assist with care. If available, the nearest Roving EES will respond to the medical incident to assist the field crew. Whenever possible, the patient should be moved quickly from the environment to an appropriate location for treatment. This location may be, but not limited to, a shaded area, a first aid room, or the ambulance. When a transport is to be made, the EES-In Charge shall notify the Rensselaer County Dispatcher by telephone that RPI Ambulance is making the transport (if unavailable, mutual aid should be requested). The EES-IC shall notify the dispatcher of the age, gender and location of the patient as well as the nature of the incident and whether or not it is an emergency transport. The ambulance driver should bring the ambulance as close to the patient as possible. If additional resources (ALS, Haz-Mat, law enforcement, etc.) are required, only the EES-IC shall request them from Rensselaer County. Field Crews may request assistance from the RPI Department of Public Safety if the field crew feels their safety is in jeopardy. If one of the First Aid Rooms or an area in which a patient is treated becomes contaminated during an incident, Public Safety will be notified to request Environmental Services to clean the facility. All other equipment shall be cleaned when soiled in accordance with the RPI Ambulance Exposure Control Plan. All OSHA mandated safety equipm ent should be restocked as soon as possible after an incident.

CLOSING PROCEDURES The Roving EES (or the lowest numbered field crew) will communicate to the EES-IC that the event has concluded. The EES-IC will recall all field crews based on the number of spectators remaining in the area or depending on the coverage that is required. The field crews will return and restock their trauma bag and oxygen duffel. The EES-IC will dismiss personnel from the event at their discretion. Field Crews should not enter a First Aid Room if a patient is b eing treated inside. The RPI Ambulance standby form and Part 18 event logs should be completed by the EES-In charge and nd submitted with the equipment checklists to the 2 Lieutenant. Before leaving the venue the EES or Crew Chief In Charge should make contact with the event organizer to inform them that RPI Ambulance is leaving the area.

PAPERWORK AND EQUIPMENT MAINTENANCE For all events the RPI Ambulance Standby Form should be filled out. For Type II and III events the Part 18 Incident Log, and the Part 18 Public Function Event Report should be filled nd out and copies turned over to the organization requesting coverage. The Captain and 2 Lieutenant will review the RPI Ambulance event log and Part 18 event forms. Copies of these forms will be held for four (4) years after the date on the form. nd

The 2 Lieutenant will review all equipment checklists and restock as necessary after the event. All equipment in nd the First Aid Rooms will be inspected and maintained by the 2 Lieutenant in accordance with SOP 12-21.


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SOP 12-19 DOCUMENTATION INTRODUCTION Good documentation is essential to relay information to other healthcare providers, to obtain management information, and for medical-legal purposes. RPI Ambulance must comply with all New York State Department of Health (DOH) and Regional Emergency Medical Organization (REMO) documentation programs and will follow all procedures. RPI Ambulance uses an electronic Patient Care Report (ePCR) to document all patient and call information to comply with DOH and REMO requirements.

GENERAL PROCEDURES 1. 2.

3. 4. 5.

There will be only one (1) electronic Pre-hospital Care Report (ePCR) filled out for each patient. Responsibility for accurate and complete documentation lies with the person listed as the “Primary Caregiver” on the ePCR. As such, only RPI Ambulance Crew Chiefs and Crew Chief Trainees who hold an EMT card may author ePCRs for RPI Ambulance. In the event that a Crew Chief Trainee authors an ePCR, the “student” box will be selected for the Trainee and the “Preceptor” box will be checked for the Trainer. All documentation will be clear and concise and is up to the judgment of the “Primary Caregiver” how best to document any given incident. The ePCR laptops shall remain locked up at all times when not in use on a call or during training. To protect confidential patient information no person shall remain logged in to the ePCR software while the computer is unattended.

PAPER PCR RETENTION AND STORAGE After May 2012, RPI Ambulance switched to electron ic Pre-Hospital Care Reports (ePCRs) f rom a written system. The paper PCRs written by RPI Ambulance prior to this must remain in RPI Ambulance‟s custody according to the following rules: 1.

2.

The PCR will be retained for seven (7) years for patients over the age of eighteen (18). The PCR will be retained for seven (7) year s after the patient‟s eighteenth (18) birthday for patients under the age of eighteen (18). All information contained in the PCR shall be held in the utmost confidentiality, and held in a fireproof safe in accordance with State and Local protocols.

REFUSAL OF MEDICAL ATTENTION (RMA) While patients of sound mind and judgment have the right to refuse medical care, a patient‟s capability to make a rational decision often becomes an issue at a later date. For this reason, it is imperative that all assessment findings and any advice given to the patient is documented in the narrative section of the PCR before they sign the release. 1. Complete the PCR first. 2. Complete the RMA form.


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3.

4.

5. 6.

7.

8.

9.

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The assessment and your advice indicating they seek medical attention should be read aloud to the patient. The patient should be allowed to read the narrative and the disclaimer on the back of the PCR as well as the RMA form. Have the patient sign the RMA on the back of the PCR and the RMA form. Have a reliable witness sign both as well, preferably a Law Enforcement Officer or a family member. A member of the crew cannot witness a refusal. Patients under 18 years of age are considered minors under New York State law and are not allowed to refuse medical attention unless legally emancipated. Patients showing visible signs of intoxication or Altered Mental Status are not allowed to refuse medical attention. Generally, law enforcement will be on scene of any incident of this type. If the patient wishes to refuse medical attention, the help of an officer should be obtained to persuade the patient that transport to a hospital ER is in their best interest. Should this fail, a 941 may be requested per NYS DOH protocols. Patients who have been witnessed or admitted to the ingestion of alcohol, but are not showing obvious signs of intoxication or Altered Mental Status and wish to refuse medical attention may do so after a full assessment is completed. The Crew Chief should advise and request approval from both the on duty supervisor and a Medical Control Physician. All information must be documented appropriately. Similarly, if the patient is in need of care and wishes to refuse, try to convince the patient to accept care and seek help of law enforcement if necessary. If the patient still refuses to go, document well and allow them to leave. If there is any question whether the patient should RMA or there is a situation of unusual nature in which the patient does not want to be transported to the hospital, contact a Medical Control Physician and discuss the situation with them and follow their guidance. On your PCR document, record the Physician‟s three-digit MD number and what they advised you to do.


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SOP 12-20 RADIO COMMUNICATIONS RADIO IDENTIFIERS PERSONNEL IDENTIFIERS Any Department of Public Safety Officer will use their assigned 200, 300, 500, or 700-series number to identify them. If any DPS officer is also a member of RPI Ambulance, they will be issued an RPI Ambulance number unique to them. They will use the number for the agency that they are representing at that time. RPI Ambulance Car Numbers: Car numbers are to be used in all external communications with Rensselaer nd County and other agencies. The Captain is Car 1; First Lieutenant Car 2; 2 Lieutenant, Car 3; On-Duty Supervisor, Car 4; On-Duty Crew Chief, Car 5; On-Duty Driver, Car 6.

If none of the following identifiers apply, or a 900-series identifier has not yet been issued and a member needs to transmit on the RPI Ambulance frequency, they should describe themselves as “Member (last name)”. For example, John Doe would identify himself as “Member Doe”. RPI Ambulance 900 Identifiers: Range sequentially from 920 through 990 and are assigned to members upon promotion to Attendant and completing their first call as a driver trainee or crew chief trainee. Once a member has an ID number, that number is assigned to the member until such time as he or she has not been a member of RPI Ambulance for more than 1 year. At no time should an individual‟s 900 series number be used on any frequency outside of the Rensselaer Polytechnic Institute Community. Special Event 900 Identifiers: These numbers ranging sequentially from 900 to 908 are outlined SOP 12-18. Special use 900 Identifiers: Range sequentially from 909 to 919 and 994 to 999 and shall be assigned as stated in these Standard Operating Procedures or at the discretion of the Captain. On-Duty Attendants shall use the numbers 992 and 993. 939 and 959 are restricted due to their similarity to the vehicle numbers

VEHICLE CALL SIGNS The ambulance may be referred to within the agency as A-39 or 5939. External to the agency, the ambulance will only be referred to as 5939. The first response vehicle may be referred to within the agency as “F-R” or “First Response-5-9”. External to the agency, the first response vehicle will only be referred to as “First Response-5-9”.

HEADQUARTERS – 92 COLLEGE AVE On the RPI Ambulance frequency, refer to the office (92 College Ave) as “Quarters”

DISPATCHERS On RPI Ambulance or RPI Department of Public Safety, refer to the dispatcher as “Public Safety Headquarters” In the Rensselaer County Emergency Communications System, refer to the dispatcher as “Dispatcher”.


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SOP 12-21 AMBULANCE/EQUIPMENT I N S P E C T I ON ON , C A R E , A N D MAINTENANCE INTRODUCTION In order to respond effectively to emergencies, all vehicles and equipment must be in top operational condition.

AM A M B U L A N C E A N D F I R S T R E S P O N S E V E H I C L E MA I N TE N A N C E The ambulance and first response vehicle will be checked on every crew. In addition, the First Lieutenant will ensure that the ambulance is serviced in accordance with Ford‟s recommended service plan and that any problems that develop are quickly remedied. Every effort will be made to see that the ambulance vehicle complies with all state motor vehicle laws and Part 800 regulations regarding ambulance equipment. The vehicles will have an annual DMV inspection. The Captain or his/her designee is responsible for maintaining records including, but not limited to the following: When and where the vehicle was purchased/obtained Documentation pertaining to repairs Maintenance schedule according to vehicle manufacturer‟s instructions Documentation pertaining to all maintenance performed on the vehicle    

Documentation of vehicle maintenance shall include inspection records as well as records of services performed either by the RPI Ambulance members, outside vendors, or representatives of the vehicle manufacturer. This documentation will include any service bulletins or recall notices issued by the manufacturer and records of compliance with their recommendations. These records shall be kept by the Captain or his/her designee and shall be made available to the Department of Health upon inspection, as requested.

EQUIPMENT MAINTENANCE All equipment will be checked on every crew. Any deficiencies will be reported im mediately to the 1st Lieutenant. All equipm ent will be maintained according to the manufacturer ‟s recommendations including, but not necessarily limited to the following: Performing manufacturer‟s recommended calibrations/inspections Performing manufacturer‟s recommended service (including lubrications) Replacing and servicing batteries, as applicable Proper inspection of all equipment available to the provider Proper cleaning and disinfecting procedures     

The following equipment will be examined and checked by a third party maintenance company:


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Stretchers and stretcher mounting hardware AED Pulse Oximeter Suction Devices Rechargeable Battery Powered Lights Manual BP Cuffs Patient stabilization/Transportation/Im mobilization Devices Oxygen Regulators and Delivery Systems

CLEANING The Ambulance vehicle will be cleaned and equipment/supplies replaced after each ambulance call. The Ambulance Driver is responsible for cleaning the driver compartment of the vehicle and the Crew Chief is responsible for the patient care compartment. Cleaning will be done according to the Bloodborne and Airborne Pathogens Exposure Control Plan. When soiled, all re-usable equipment will be cleaned in accordance to the RPI Ambulance Exposure Control Plan. All disposable equipment will be discarded when soiled, even if not used. st

Any safety or maintenance problems with the vehicle will be immediately brought to the attention of the 1 Lieutenant or the Captain.

AC A C C I D E N T S / D A M AG E T O R P I A M B U L A N C E VE H I C L E S In the event of any accident involving RPI Ambulance, even if there is no damage or injury to any involved party: 1. Immediately assess the crew and other involved party or or parties for any injuries, and notify the appropriate dispatch center(s). 2. If transporting a patient, discontinue transport. Transfer care and and transport of the patient to another transport agency. Leaving the scene of an MVA for any reason is considered a hit and run. At the discretion of the Crew Chief, if the accident occurs while transporting a critical patient and the ambulance can still be driven safely, a crewmember may be left behind at the scene while the ambulance continues to the hospital. 3. Notify the Duty Supervisor, 1st Lieutenant and Captain immediately. Notify RPI Public Safety and have DPS and the appropriate police agency take a report. File a report with DPS and the Police, regardless of the amount of damage incurred. 4. The Ambulance/First Response Driver and/or Trainee driving the vehicle at the time of the accident will be suspended as a driver but may still participate at other levels (such as Crew Chief or Attendant, as applicable). Coverage should be found b y the Duty Supervisor t o finish the shif t, or if no cover can be found, the Duty Supervisor will cover the shift. 5. Each member of the Duty Crew will file an incident report with the Captain with with regard to how the accident occurred.

FAILURES Any vehicle or equipment equipm ent failures must be immediately ref erred to the Captain and 1st Lieutenant in writing. writing . The Captain will then notify the manufacturer(s), the State, and any other applicable entities of the failure as needed. If the failure resulted in harm to a patient, the details of the injury(s) must also be detailed and a copy of the PCR should be included in the report to the Captain.


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RADIO EQUIPMENT st

The 1 Lieutenant or his/her designee shall keep an inventory of all agency radio equipment and ensure that all radio equipment is kept in good working order. All 800 MHz radio equipm ent shall be serviced only by the designated Rensselaer County repair service. All other radio equipment should be ser viced by the appropriate vendor.


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SOP 12-22 AMBULANCE LAYOUT/SETUP INTRODUCTION In order to maintain regularity and continuity between different crews, there is a certain approved method for storing certain pieces of equipment on the ambulance. There is also a certain method to setting up some pieces of equipment to facilitate patient care.

STRETCHER The stretcher‟s location is self -evident; it goes in the stretcher mounts on the floor of the ambulance. The attendants should not place their feet on the stretcher during general driving around, as it may jeopardize the sanitary nature of the stretcher. Always make certain that the stretcher is properly latched in place and will not come loose during transit. This is especially important if there is a patient on the stretcher. The stretcher must be in lowest position in the ambulance for it to be properly secured. The adjustable leg and head ends of the stretcher should be adjusted as necessary for patient care during a call but should be left flat during general driving. If desired the head end of the stretcher may be raised one notch to provide some leg space for the attendants riding in the back.

SPARE MAKE-UP The make-up on the stretcher is supplemented by a spare make-up to be stored in the vertical shelves next to the curbside access doors. The spare make-up is to be used in cases where a quick turnaround is needed. If the spare make-up is used, the crew should replace it as soon as possible. In cases of expected large volume, more spare make-ups may be kept on the ambulance at the discretion of the Captain and/or the crew chief.

IV FLUID CLIPS/RETAINERS The devices provided for holding and securing IV fluid bags are for just that. Do not store other equipment there as it can fall down at very inopportune moments.

PORTABLE OXYGEN TANKS In addition to the portable tank stored in the jump bag, two tanks will be stored in the double-tank holder at the head-end of the crew bench. There should be two full tanks secured here with a regulator on at least one at all times, except when they are in use. If one is empty it should be replaced a soon as possible. If no other room is available and tanks must be secured, they should be nestled snugly in the bottom of the crew bench with the valve end protected by extra linen, towels, etc.

WALL OXYGEN REGULATORS


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Both wall Oxygen regulators should remain on the action wall area in the two ports on the driver‟s side of the Ambulance. If a patient using oxygen is lying on the crew bench side, the regulator may be moved during that transport to facilitate easy movement for the crew throughout the patient compartment.

ONBOARD OXYGEN SYSTEM Whenever the onboard system is used, the system should not remain charged for any longer then absolutely necessary so as to avoid damaging the system and losing oxygen through leaks, loose fittings, etc.

COMPLETED PAPERWORK Any patient care paperwork should eith er be shredded or placed in the PCR lockbox in the office for r eview.

OTHER EQUIPMENT, TOOLS, ETC. st

Not all equipment for the ambulance is listed here. Maintain the remainder of the 1 Lieutenant equipment and st supplies in their proper locations as directed by the 1 Lieutenant. Checklists should be done at the start of every duty crew in accordance with SOP 12-13.

LAPTOPS Identifier 914 will be reserved for the special event/First Response-59 laptop. Identifier 915 will be reserved for the duty laptop located in 5939. Laptops are the responsibility of the Crew Chief. When not secured in a locked mount, they must always be attended. When not in use or attended, the laptops must be secured in the mounts with the lock engaged. Keys for 915 will be secured in the lockbox located on cabinet 6 and keys for 914 will be in the lockbox in quarters. All Crew Chiefs will be given the combination upon promotion to Crew Chief. Any failure of the computer, mount or security lock box must be reported to the Duty Supervisor immediately. st

All other maintenance and procedures are as outlined by the Captain and 1 Lieutenant in the internal ePCR procedures.


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SOP 12-23 DEFIBRILLATOR INTRODUCTION As part of its continuing mission to provide quality patient care, RPI Ambulance carries an Automated External Defibrillator. In order to ensure its continued functioning, it is important that the unit be properly used and cared for.

CARE AND MAINTENANCE The unit will be tested at the start of each shift. immediately.

Any deficiencies should be reported to the 1st Lieutenant

USE 1. 2. 3. 4. 5. 6.

The unit will be used in emergency situations only. For training, the training module should be used. In accordance with NYS – DOH protocols, the unit will only be applied on an unconscious person who presents without a pulse. The AED should not be used to monitor a conscious patient. The Crew Chief shall be responsible for and in charge of the AED throughout its use. If, at any time, a paramedic assumes care of the patient, they will be in charge of patient care, but the Crew Chief is still responsible for use of the AED. The Captain or his designee shall be notified of use as soon as is feasible so that the patient record can be properly downloaded and recorded. The Captain and crew will meet with the agency Physician as soon as feasible to review the crew actions and evaluate the use of the AED.


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SOP 12-24 CONDUCT INTRODUCTION Our conduct and appearance are a very important part of patient care and the image that we extend to the RPI Community, as well as to the community at large. Poor professional conduct has a negative impact on patient care and erodes the relationships we have with the community and health care teams. While this policy statement deals with some specific issues relating to Pre-hospital Emergency Care, conduct should always be governed by treating all people in a manner in which one would want to be treated in any given circumstance and reflects positively on the entire organization.

PATIENT CONFIDENTIALITY All information regardi ng patient contact is confidential in nature, and not a m atter of public record. All requests for information regarding patient contacts or member information must be referred to the Captain. All information is protected in accordance with the Health Insurance Privacy and Portability Act (HIPPA). While medical personnel will frequently discuss cases as a learning or Quality Improvement tool, it must be realized that this information must not be discussed outside the Agency. In no case, including learning or Quality Improvement, should the patients name or personal information be used.

WEAPONS Under no circumstances is any member of RPI Ambulance allowed or authorized to carry a weapon. EMS Personnel are allowed to carry a small-sized folding knife to facilitate rescue and not be used as a weapon. If a scene is not secure or safe, the crew should not enter and should wait for a Public Safety Agency to render the scene safe. The Crew Chief should make appropriate notifications if a Public Safety Agency has not already been dispatched to the scene.

SMOKING The Surgeon General of the United States has recognized smoking as a health hazard. Accordingly, it is a danger to the health of patients and co-workers. In addition, RPI Ambulance carries oxygen, which will accelerate burning and it is therefore a hazard to have any open flame in or near the ambulance. Therefore, smoking is not permitted in any RPI Ambulance vehicle or any of its associated facilities. Additionally, as of 1 July 2010, Rensselaer has become a tobacco-free institution, thereby banning use of any tobacco products anywhere on the campus.

ALCOHOL, CONTROLLED SUBSTA NCES, AND MEDICATI ONS Alcoholic beverages or other controlled substances are not allowed under any circumstances within the RPI Ambulance building, the Prim ary Care Facility, any Field station post, or any RPI Ambulance vehicle. Consumption of alcohol by any member is prohibited while in any uniform part, agency apparel and/or eight (8) hours prior to being on duty. Agency apparel includes RPI Ambulance off-duty wear, uniform, any item of clothing with the words “RPI Ambulance”, an RPI Ambulance patch or logo on it, or the like.


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Under no circumstances is a member allowed to attend a call while their abilities are impaired or their judgment diminished by any cause, including but not limited to: alcohol, drugs, medication, or lack of sleep. No person shall be permitted to ride in any agency vehicle while under the influence of alcohol or intoxicating substances unless they are the patient. Any member who acts in a n official capacity while per ceived to be under the influ ence of a drug, including alc ohol, will be relieved of their duties by the Crew Chief or Supervisor and suspended from Active and Inactive membership until the incident is reviewed by the Captain and Officer Board. Any member who is found in possession of alcoholic beverages or other controlled substances on RPI Ambulance property, including but not limited to RPI Ambulance vehicles, buildings and offices or who is found to store or provide any alcoholic beverages or other controlled substances to others on RPI Ambulance property will be relieved of their duties by the Crew Chief or Supervisor and suspended from Active and Inactive membership until the incident is reviewed by the President, the Captain and the Officer Board. The committee may temporarily or permanently relieve the member from his or her Crew Chief, Driver and/or Officer duties. In case an officer is temporarily relieved of his/her duties, the President will appoint a temporary administrative officer or the Captain will appoint a temporary line officer until the original officer is allowed to resume his duties in accordance with the Officer Board decision. If an officer is permanently relieved of his/her duties, the President will appoint a temporary administrative officer or the Captain will appoint a temporary line officer until the next General Meeting at which time a new officer may be elected by the general membership. If the President or the Captain is temporarily or permanently relieved of his/her duties, the Vice-President or 1st Lieutenant, respectively, will take over the open position until the original officer is allowed to resume his/her responsibilities or until the election of the new officer by the membership at the next general meeting.

VISITORS All guest(s) are the responsibility of the member who invited them onto agency or campus property. Guests are expected to adhere to the rules and regulations of the institute and the RPI Ambulance SOPs. All guests must be accompanied by an RPI Ambulance member while in any RPI Ambulance Facility including but not limited to crew quarters, first aid rooms and garage. The member who is acting as host is responsible for the conduct of his/her guest. Inappropriate guest conduct may result in disciplinary action against the host. A member or guest may lose privilege of visitation if, in the opinion of the on-duty supervisor or officer, visitation becomes a detriment to the ability to carry out normal operations or introduces a threat to agency personnel or property.


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SOP 12-25 GRIEVANCES AND APPEALS INTRODUCTION Members of an organization often have disagreements, either business or personal. Fair treatment of everyone is the best policy to avoid problems of this type. This is not always possible and therefore it is important to have in place a formal system to bring complaints forward so they may be resolved in a fair and efficient manner.

GRIEVANCES Disagreements can best be solved by taking the problem directly to the person(s) in question. This brings the issue into the open so that all parties involved may work to an adequate solution. Sometimes this does not lead to an equitable solution or simply is not possible because one person is intimidated or another person comes on too strong. In such cases, the issue should be brought to the appropriate officer (Captain or President) based on the nature of the complaint. As an alternative, the member may contact the Grievance Committee of RPI Ambulance. The Grievance Committee exists to handle complaints among members. All grievance brought to the committee are strictly confidential. See the Grievance Committee Constitution for details.

CHAIN OF APPEALS 1. 2. 3. 4. 5.

President, Captain, or Grievance Committee Officer Board of RPI Ambulance General Membership of RPI Ambulance Advisory Committee of RPI Ambulance Union Executive Board or Judicial Board

APPEALS In any situation where one or more of the parties are unhappy with decision following a grievance or previous appeal, that party shall have the right to appeal to the next higher authority. That group shall handle the appeal in a confidential and professional manner at its next possible opportunity. Any member of an appeals body with a conflict of interest shall excuse themselves from the proceedings. For instance, if there is a complaint against the Captain, when the appeal goes before the officer board, the Captain shall not sit to hear the appeal. If the complaint is against the entire Officer Board of RPI Ambulance, that level of appeal shall be skipped.


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SOP 12-26 SEXUAL HARASSMENT AND NONDISCRIMINATION SEXUAL HARASSMENT RPI Ambulance strives to achieve excellence through its members. As such, RPI Ambulance prohibits sexual harassment of any type and adheres strictly to the Sexual Harassment Policy as listed in the Rensselaer Handbook of Student Rights and Responsibilities.

NONDISCRIMINATION RPI Ambulance adheres to the nondiscrimination policy of Rensselaer Polytechnic Institute. RPI Ambulance admits qualified individuals to its membership without regard to gender, sexual orientation, marital status, age, race, color, religion, national or ethnic origin, or disability.

VIOLATIONS Any discrepancies in adherence to this policy should be brought to the Captain, who will inform the appropriate parties within the Rensselaer Polytechnic Institute community.


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SOP 12-27 INFECTIOUS DISEASE EXPOSURE AND ON DUTY INJURY INTRODUCTION In order to minimize the risk of infectious disease exposure, all members must employ universal precautions and proper PPE/BSI in compliance with the agency‟s Exposure Control Plan. Refer to t he Exposure Control Plan for specific details.

PRACTICES In accordance with OSHA regulations, RPI Ambulance created and maintains an Exposure Control Plan designed to minimize the occurrence of on-duty exposure. The policies set forth in the plan should be adhered to whenever patient care is being extended. The major requirements are summarized here for clarity: 1. Always wear gloves when extending patient care. 2. When the gloves are soiled, replace them. 3. Always wash hands after providing care.

ON-DUTY INJURY OR EXPOSURE In the event of an On-Duty Injury or Exposure: 1. Immediately notify the Duty Supervisor, who will notify the Captain. 2. Obtain appropriate medical care, and with the assistance of the Duty Supervisor or Captain, fill out a “Report of Medical Treatment” form. 3. Any and all on duty injuries and exposures should be evaluated at a medical facility. If the RPI Student Health Center is closed, do not hesitate to seek medical treatment at an ER as soon as possible. 4. Appropriate records of any treatment shall be obtained and maintained by the Captain in a confidential manner. a. With the Agency‟s Medical Director, the Captain will investigate the injury/exposure to determine the following: b. If RPI Ambulance policy was followed, and if failure to follow policy was the cause of injury/exposure c. If appropriate infection control precautions/personal protective equipment were used while providing patient care 5. Assuming appropriate PPE/BSI was used, if PPE/BSI was used inappropriately or if PPE/BSI failed 6. Methods to prevent such an exposure or injury in the future. 7. Copies of these reports will be kept in the member‟s confidential personnel file.


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SOP 12-28 MISCELLANEOUS INTRODUCTION Several aspects of EMS require policies that do not fit well into the other categories. These are included in this section. The separate section is not to imply any greater or lesser importance of these policies.

LOCATING PATIENTS If the ambulance responds to a call and there is no patient found, the crew will work with appropriate first response and law enforcement agencies (on campus, TFD and DPS respectively) to complete a search of the area. After a proper search or when released by the appropriate law enforcement agency, the ambulance may call in service and clear the scene. The PCR will document the search and included all applicable information. In performing the search for a patient, RPI Ambulance members will not force entry into any location. They may enter a Residence Hall using their access card, but may not open the door to a room unless accompanied by the patient, a friend, a roommate, a Resident Assistant or Associate, or a DPS officer. One exception occurs if the crew can see inside the room, locate the patient, confirm the patient is in need of care, and that there are no hazards in the room. See also hazardous scenes later in this policy.

SPECIAL PATIENTS MINORS Unless legally emancipated, minors are not allowed to refuse care or transport. At the same time, RPI Ambulance cannot kidnap the minor and transport them to the hospital. In some cases, DPS will take custody of the child until a parent can be found. If the minor is refusing treatment and/or transport and the crew feels that the minor is in need of such care/transport, DPS will be contacted immediately. If the child runs away, the crew should not endanger themselves by following the child. In the case of a public function covered by RPI Ambulance, a minor does not need to be signed off if no care was rendered. I.e., all the crew did was hand the child a band-aid or a cold pack.

EMOTIONALLY DISTURBED PERSONS As a general rule, RPI Ambulance does not transport patients to a psychiatric facility because of mental health problems unless the patient also has a medical problem requiring ambulance transportation. If a call is received for a patient with an unknown problem or history who is showing signs of unusual behavior (possible psychiatric problem), the crew will proceed to the scene, evaluate the patient with an eye toward possible medical causes for the behavior, and transport the patient to an appropriate facility. In this type of unknown situation, it is strongly suggested that the crew request assistance from law enforcement. Patients with behavioral problems should always be treated with respect while protecting their welfare. In such a situation, it is strongly suggested that the patient care crew consist of at least two persons, one of whom is the same sex as the patient. If at any time, a patient is a potential harm to the crew or themselves, a law enforcement officer should be utilized for protect; only a law enforcement officer is able to restrain a patient.


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CRIMES Suspicions of crimes should be reported by the Crew Chief to the law enforcement officer on scene (usually DPS). The crew should not deal with the crime directly. The purpose of EMS is to help those in need not to chase down the criminals. In the case of abuse (child, patient, elder, or other domestic violence), notification should be made to the officer on scene and to the receiving nurse. The Crew Chief should carefully document the scene and all physical findings. The PCR is not the place to make accusations but should remain an objective assessment of the situation.

INCIDENT REPORTING An Incident Report should be completed whenever there is an occurrence that, in the member‟s opinion, is sufficiently unusual to merit special attention and should be reported. All incident reports shall be reviewed as soon as possible by the most senior officer available and shall be referred to the QI Committee for review. An incident report must be completed in the following circumstance. In addition, the reviewing officer is responsible for documenting the incident and any corrective action taken on the form designated by the RPI Ambulance for that purpose. Unexpected EMS vehicle and patient care equipment failure that could have resulted in harm to a patient. 

The following incidents must be immediately reported to the Captain or, in his/her absence, the next highest ranking officer; must be thoroughly documented on an incident report and must be reported to the NYS Department of Health Bureau of Emergency Medical Services, by telephone, the following day, and in writing, within five (5) working days: Any member of the service is killed or injured to the extent requiring hospitalization or care by a physician while on duty. Patient care equipment fails while in use, causing patient harm. A patient dies, is injured, or is otherwise harmed due to actions of commission or omission by a member of the ambulance service. An EMS vehicle operated by the service is involved in a motor vehicle crash in which a patient, member of the crew, or other person is killed or injured to the extent requiring hospitalization or care by a physician. It is alleged that any member of the service has responded to an incident or treated a patient while under the influence of alcohol or drugs. 

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OBVIOUS AND UNATTENDED DEATH When called to a patient who is in cardiac arrest, the ambulance crew will begin resuscitation (including defibrillation) and transport the patient as appropriate unless one of the following conditions exists: Crew is presented with a valid “Nonhospital Order Not to Resuscitate (DOH-3473) The patient is found to be wearing a “Do Not Resuscitate” bracelet The patient is found to be obviously dead by showing one of more of the following conditions: Obviously mortal injury o Extreme dependent lividity o Rigor mortis o Tissue decomposition o   


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In each of the above situations, it is imperative that the EMT evaluate the patient‟s respirations and carotid pulse (brachial pulse in infants) to assure that they are absent. The ambulance crew is not to rely on the reports of bystanders, law enforcement personnel, etc. in regard to the absence of a pulse or “death” of a patient. Furthermore, if CPR is withheld in any of the above situations, the condition which led the crew to withhold CPR must be documented on the PCR. If there is any doubt as to whether to start resuscitation, begin BLS care including defibrillation and contact medical control (either through Re/MAC or individual hospitals) for direction. A “health care prox y” or “living will” may not be used in a prehospital EMS situation to determine that resuscitation measures, including CPR, can be withheld. In a situation where there is no Nonhospital Order Not to Resuscitate and the patient does not meet any of the other above listed criteria for obvious death, resuscitation measures should be started and the patient transported unless, upon consultation with medical control, the medical control physician advises otherwise. Any legal papers regarding a living will or health care proxy should be taken to the hospital by the ambulance crew and given to the hospital staff. If the deceased person is a hospice patient with a valid Nonhospital Order Not to Resuscitate, the EMT should attempt to contact the hospice worker on call and be guided by his/her advice. Hospice will generally contact the patient‟s physician who will sign the death certificate, and the presence of the coroner is generally not necessary in this situation. In other situations where there is a death where the patient meets the above guidelines for “obvious death”, the crew will be guided by the following: Contact Rensselaer County Bureau of Public Safety to request law enforcement assistance. Remain at the scene until the arrival of the police.  

In general, bodies of the deceased are not to be transported. In a situation where the patient is obviously dead and is in a public place, the crew may, at their discretion, transport the body a short distance to remove it from public view, but only on the advice of and request from the coroner. If, as a result of their observations at the scene of a cardiac arrest or unattended death, the crew suspects an attempted suicide, suicide, or other criminal activity has been involved, the crew will make every reasonable attempt to preserve evidence while providing whatever patient assessment, care, and/or transportation is necessary.

CHILD ABUSE AND MALTREATMENT NY State EMTs are considered mandatory reporters of Child abuse and Maltreatment per § 413 of the Social Services Law. The law requires EMTs to report suspected child abuse they come across while performing their jobs. § 415 of the Social Services Law states: “Reports of suspected child abuse or maltreatment made pursuant to this title shall be made immediately by telephone or by telephone facsimile machine on a form supplied by the commissioner. Oral reports shall be followed by a report in writing within forty-eight hours after such oral report. Oral reports shall be made to the statewide central register of child abuse and maltreatment unless the appropriate local plan for the provision of child protective services provides that oral reports should be made to the local child protective service” Oral reports of suspected child abuse and maltreatment shall be made by calling the NYS Child Abuse and Maltreatment Register at 1-800-635-1522. This phone number is for mandatory reporters only and shall not be distributed to the general public. All oral reports shall be followed up in writing using Form DSS-2221-A available from the duty supervisor. A copy of the completed form shall be attached to the copy of the PCR retained by the agency.


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Definitions of suspected child abuse and maltreatment, as well as guidelines for filling a report, are available from the duty supervisor. All EMTs should familiarize themselves with these definitions and the guidelines for filing a report. The EMT should make hospital staff at the receiving facility aware of his/her suspicions during the oral report to the nurse when patient care is transferred. The PCR should include documentation of the EMT‟s suspicions and do cumentation that the required reporting was met. Immunity from liability for reporting cases of suspected child abuse or maltreatment is provided to those individuals required to report such cases under §419 of the Social Services Law providing the individual was acting in „good faith‟. §420 of the Social Services law states: 1. Any person, official or institution required by this title to report a case of suspected child abuse or maltreatment who willfully fails to do so shall be guilty of a class A misdemeanor. 2. Any person, official or institution required by this title to report a case of suspected child abuse or maltreatment who knowingly and willfully fails to do so shall be civilly liable for damages proximately caused by such failure.

GERIATRIC OR OTHER PATIENT ABUSE/MALTREATMENT Geriatric abuse and neglect, and other domestic violence, like child abuse and neglect, is a big problem in our society. The primary sign is unexplained injuries in an elderly or other patient. In the situation where the crew suspects abuse or neglect of any patient, they should complete a full patient assessment, including a scene assessment, and report their suspicions to the Emergency Department staff. If the patient refuses transportation, and is deemed mentally capable of making an informed decision in that regard, the crew should report the situation and their suspicions to the RPI DPS and Troy Police Department as soon as reasonably able and document their objective findings on the PCR. 

ABANDONED INFA NT The Abandoned Infant Protection Act of 2000 allows a parent, guardian, or other legally responsible person to leave their infant (who must be five days old or younger) at a safe place. This safe place may include an ambulance station. In the event that a parent or guardian chooses to relinquish care of their newborn infant to the RPI Ambulance, the following guidelines should be followed: 1. Parents are not required to provide their names. In a non-judgmental manner, the EMS provider receiving the infant may ask the adult if there is any medical information that is important to know in the care of the infant. 2. The EMS provider receiving the infant at the station must immediately call the Rensselaer County dispatcher who in turn will put out a call for the duty crew. The infant will be assessed by the crew, cared for according to protocol, as needed, and be transported immediately via ambulance to the nearest hospital. A PCR will be completed for the run in the usual manner. 3. If, at any time, the parent or guardian seeks follow-up information about the child they relinquished, they should be referred to the hospital where the infant was transported.


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