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Cortlandt Community Volunteer Ambulance Corps, Inc.
Standard Operating Guidelines
2007
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The following policies and procedures have been developed in accordance with the requirements of the State EMS Code (Part 800) and Article 30 of the NYS Public Health Law for Emergency Medical Services. References are made throughout this manual to specific NYSDOH Policy Statements.
This manual represents the Standard Operating Guidelines of the Cortlandt Community Volunteer Ambulance Corps, Inc. as of July, 2007 and will be reviewed annually by the CCVAC Line Officers & Board of Directors to ensure that it meets the current needs of the organization and is inclusive of any new policy statements or requirements issued by the NYSDOH.
Any changes or additions to this manual will be reviewed annually with the membership. A current copy of this manual is available on line (www.ccvac.us) and is located in the Ready Room and EMS and Business Offices and is accessible to all members at all times.
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Cortlandt Community Volunteer Ambulance Corps, Inc.
STANDARD OPERATING GUIDELINES
Table of Contents
1. General Operating Procedures
1.1 Standards of Conduct
1.2 Sexual Harassment
1.3 Confidential Information
1.4 Non-Discrimination Policy
1.5 Training, Requirements and Certifications
1.6 Crew Positions / Chain of Command
1.7 Dress Code and Uniforms
1.8 Green Lights
1.9 Return of CCVAC Property
1.10 Drug and Alcohol Use
1.11 Smoking, Food and Drink
1.12 Theft and Loss
1.13 Gifts
1.14 Visitors
1.14.1 Ride Along Policy
1.15 Ambulance and Preventive Maintenance
1.15.1 Cleaning and Decontamination of Ambulance and Equipment
1.16 Supply and Equipment Inventory and Storage
1.16.1 Personal Equipment Used in Emergency Responses
1.16.2 Storage, Integrity, and Security of Medications and Drug Boxes
1.16.3 Oxygen Systems and Equipment
1.17 Membership Roles & Responsibilities
1.17.1 Qualifications and Specific Duties of Captain and Lieutenants
1.17.2 General Membership
1.17.3 Job Descriptions
1.17.4 Media Relations/Billing Inquires
1.18 General Emergency Vehicle Operators Requirements
2.1 General Safety Rules
2.2 Safety Training
2.3 Exposure Control
2.4 Decontamination
2.5 Hazardous Materials Plan
2.5.1 Unknown Dry Substance/Suspected Anthrax Response
2.6 Physical Exams, TB Testing, Hepatitis B
2.7 Material Safety Data Sheets
2.8 Member Injuries
2.9 Workers’ Compensation
2.10 CISM Referral
2.11 Incident Reporting Requirements
3. Emergency Medical Response and Care
3.1 Scheduling
3.2 Dispatch Policy
3.3 Response to Calls
3.4 Mass or Multiple Casualty Incidents (MCIs)
3.5 Radio Operations
3.6 Driving the Ambulance
3.6.1 Non-Emergency Driving
3.6.2 Emergency Vehicle Operations Policy
3.6.3 Motor Vehicle Accidents Involving the Ambulance
3.7 NYS/BLS Protocols
3.8 Non-Emergency Transport
3.9 Mutual Aid to Neighboring Towns
3.10 Psychiatric Transports
3.11 Paramedic (ALS) Response
3.11.1 Helicopter Transport (Stat Flight)
3.12 Transfer of Care
3.12.1 Transition of Care
3.13 Medical Control
3.13.1 Quality Improvement Program
3.14 Refusal of Medical Attention
3.15 Unfounded Calls
3.16 Entry into Premises
3.17 Pronouncement
3.18.1 Assessment
3.18.2 Documentation
3.18.3 Reporting and Removal
3.19 Do Not Resuscitate Orders (DNR’s)
3.20 Advance Directives
3.21 Minors
3.21.1 Abandoned Infant
3.22 Restraint
3.23 Police Custody
3.24 Crime Scenes
3.25 Child Abuse Reporting
3.26 Elder Abuse, Patient Abuse and other Domestic Violence Reporting
3.27 Other Crimes
3.28 Destination
3.29 Restocking
3.30 Sharps/BioHazard Disposal
3.31 Equipment Failure and Out-of-Service Vehicle Procedure
3.32 Diversions
4. Contingency Plan and Stand bys
4.1 Failure of Radio Communications
4.2 Power Failure at Headquarters
4.3 Ambulance Out of Service
4.4 Inclement Weather Plan
4.5 Rehabilitation Van 8805
4.6 Fire Stand bys
4.7 MCI Plan
1. General Operating Guidelines
1.1 Standards of Conduct
Professionalism
Professionalism is defined as: One who has professional status, methods, character, or standards. When responding to a call, one should be of a frame of mind conducive to the job to be performed. While representing this organization, it is incumbent upon you to treat everyone in a professional, dignified manner that will reflect well upon both yourself and the Corps.
When wearing CCVAC insignia members are expected to act in a professional manner. By wearing the insignia of CCVAC, you are still a public representative of the Corps.
The determination of professional behavior will be made by the crew chief in charge of a shift, or any corps officer at any time.
All members will at all times use good judgment, within the parameters of their training or generally accepted social, ethical or legal guidelines.
The determination of good judgment will be made by the crew chief in charge of a shift, or any corps officer at any time.
All members are expected to act in a manner that ensures the safety of all people involved in a particular operation. These operations include, but are not limited to EMS scenes, training evaluations, corps sponsored social events, and general operations.
Safe conduct is considered to include correct use of appropriate safety equipment and apparel to prevent injury or contamination.
The determination of safe conduct will be made by the crew chief in charge of a shift, or any corps officer at any time.
All corps members will conduct themselves in an honest, responsible and mature manner at all times, and in all situations. All corps members will also conduct themselves in a way that is conducive and supportive of the smooth operation of the corps.
Members will at all times treat each other, patients and members of the public with respect, and dignity.
The determination of acceptable conduct will be made by the crew chief in charge of a call, or any corps officer at any time.
Serious violations of this section may result in immediate expulsion from the corps
At no time, will any member discuss CCVAC business outside CCVAC with a non-member. (I.E. discuss a call with patient’s name being mentioned, discuss a problem in the Corps to anyone outside the Corps.)
It is the responsibility of every member to know and abide by the current By-Laws, Standard Operating Guidelines and Policies of the corps.
All By-Laws, Standard Operating Guidelines and Policies of the corps will be interpreted by the individual officers of the corps.
In the event of a dispute over interpretation, the Board of Directors will decide, however the interpretation made by an individual officer will stand until executive action is taken, unless overruled by a higher ranking officer.
Amendment of Policies - These Standard Operating Guidelines and Policies may, from time to time, be reviewed and amended by the Captain.
All By-Laws, Standard Operating Guidelines and Policies of the corps will be enforced by the officers of the corps.
Enforcement under this section may be selective at the discretion of the individual officer, and may be accompanied by disciplinary action including but not limited to:
Verbal Reprimand
Letter of Reprimand
Incident Reports
One Day Suspension
Suspension of Member Privileges
Additional Service to the Corps
Suspension
Expulsion
Probationary members suspended for any reason will be expelled from the corps.
3 Incident Reports in a 6 month period = suspension.
Disciplinary action taken under this document, may be appealed by the member so charged, to the Board of Directors. Such appeals must be requested of the president, or vice-president and will be heard on an as soon as possible basis by the Board but not necessarily before the next scheduled meeting.
The crew chief is responsible for the general operations of the Corps and Crew on their call unless relieved of that responsibility, or superseded by an officer. The crew chief will continue this responsibility during EMS Operations, unless relieved or superseded by a line officer.
1.2 Sexual Harassment
Sexual Harassment is any unwanted verbal or physical advance, sexually explicit derogatory statement or sexually discriminatory remark made by someone in a workplace or educational setting which is offensive or objectionable to the recipient, cause the recipient discomfort or humiliation, or interfere with the recipient’s job performance or educational progress. Sexual harassment is a violation of law and is intolerable in either the educational or employment setting. Sexual harassment is considered a form of misconduct and sanctions will be enforced against individuals engaging in sexual harassment and against personnel who knowingly allow such behavior to continue.
Sexual harassment, hazing and discrimination will not be tolerated. Should a patient, member, applicant, visitor or other person believe they are being subjected to such behavior, they should file a formal complaint, in writing, to the Captain or President. The Board of Directors shall review the complaint and take necessary actions to resolve the situation. (Refer to NYSDOH Policy Statement 00-11: Sexual Harassment; Appendix 1)
1.3 Confidential Information
As part of our mission, we are exposed to a great deal of confidential and private information about our patient’s lives. All call related information should only be passed on to the appropriate medical or public safety personnel who require this information in order to provide direct care to the patient or in some way lawfully discharge their duty. It is important to our organization’s mission that we maintain the community’s trust and that we not violate their confidences. As a result, do not share specific details about calls with others, including your families, and do not discuss this type of information where others may overhear you. No information should be shared with the press. All press inquires must be referred to the Captain. Please remember, there are strict laws regarding confidentiality, all patient information (such as PCRs) must be kept confidential. After each call, the Crew Chief will place the PCR, and any other related patient information, in the locked box located in the Radio Room. Only Line Officers, the QA/QI Coordinator and the Privacy Officer will have access to this locked box. (Refer to NYSDOH Policy Statement 02-05: PreHospital Care Report; Appendix 2 & 33)
1.4 Non-Discrimination Policy
CCVAC does not unlawfully discriminate against any person on the basis of race, color, religion, gender, national origin, age, handicap, veteran status, or sexual orientation. Our discrimination policy notwithstanding, all riding members of the Corps must meet the standards promulgated by the New York State Department of Health, Bureau of EMS Functional Position Description for EMS Personnel (Refer to NYSDOH Policy Statement 00-10: The Functional Position Description of an EMT-B; Appendix 3).
1.5 Training, Requirements, and Certifications
The mission of the Corps is to provide emergency medical care and transportation to our community. As a result, New York State Law and Corps policy requires that members who ride on the ambulance maintain a variety of certifications in emergency medical care and vehicle operation, and attend training sessions to ensure competency.
Each riding member shall:
1. Be at least 18 years of age, physically capable of carrying out the duties required of him or her.
2. Complete and pass an AHA CPR/AED program (provided by CCVAC). CPR and Defibrillation must be renewed bi-annually.
3. Demonstrate knowledge of the function, use, and location of all ambulance equipment and supplies (covered during CCVAC Training).
4. Drivers must be at least 21 years of age, complete the Corps’ VFIS driver training program, and have a driving record acceptable to the Captain.
5. If acting as a Crew Chief, must have completed and passed a NYS Emergency Medical Technician (EMT-B) or higher-level course. EMT status must be renewed as needed. CCVAC participates in the NYS Pilot Recertification Program that allows an EMT who is in continuous practice, demonstrates competency and completes appropriate continuing education, to renew their certification without taking a certification exam. Individual participation is voluntary. Participants cannot allow their certification to expire. Expired certifications are not eligible for renewal in this program. Any EMT whose certification expires will need to enroll in a certified refresher course.
The Program requires 72 hours of continuing education credits. CCVAC drills and training provided to all members can be applied to 48 of the 72 hours. The remaining 24 core content hours must be acquired through training provided by a New York State Certified Instructor Coordinator (CIC). CCVAC will assist all participating EMTs in obtaining this core curriculum training. Core curriculum hours can be obtained through Westchester County Regional EMS Office CIC core refresher training and Cortlandt Regional Paramedic refresher training. Courses will be posted on CCVAC’s CME Board. The participant requirements, and all related forms for this recertification program is available for all EMTs to read in the Communications room. Further information is available at: www.health.state.ny.us/ EMT’s should complete a Continuing Education Form (CME), available in the Ready Room or Captains Office, for each course taken or call audit attended and give it to the Captain Pilot Program Coordinator for filing in their personnel folders. Copies of member’s CPR and EMT cards, as well as a copy of their driver’s license, shall be filed in each member’s personnel file.
6. All EMTs are responsible for recertification as needed. CCVAC may reimburse members on an individual basis for book fees for any EMT Original or Recertification Course approved by the Captain.
1.6 Youth Corps
The purpose of The Cortlandt Community Volunteer Ambulance Corps, Inc. Youth Corps is; to teach community youths about the emergency medical services through training and hands on experience. Any local youth between 16 and 18 years of age may apply for membership. Once trained youth Corps members are allowed to make calls as attendants. No Youth Corps member may be in the building without an adult member. No Youth Corps member may be in the building after 2100 hours (9 PM) except for training or official meetings.
1.7 Dress Code and Uniforms
All members on a call should wear at least their Corps identification card. There are no dress codes for responding to calls but OSHA regulations say no open toed shoes, sandals nor shorts should be worn. Members may wear additional pins and insignias on clothing as long as they are appropriate and are not misleading and nor disapproved by a Line Officer. All clothing must present a neat and clean appearance.
Uniforms must be worn during parades, special events, and when so instructed by the line officers to do so. Official Corps Uniform consists of:
1. Pants – navy blue in color, straight leg or BDU style
2. Shirts – White button down, short or long sleeve (weather based)
3. Footwear – Black sneakers or boots
4. Belt – white as issued
5. Patches – CCVAC, EMT on right sleeve and American Flag on left sleeve
6. Optional items
a. EMS collar brass
b. EMT shield
c. Award pins
d. Service pins
e. Hats
f. Corps issued identification cards
7. Jackets: (optional)
a. Those supplied by corps.
b. Those purchased by members that have approved by corps administration.
8. Sweaters (optional, winter)
a. Commando style with appropriate logo
9. Sweatshirt:
a. Fire “job” approved by corps with appropriate logo
b. Pullover as approved by corps administration
Cleaning of uniform will be the responsibility of the member except, in case of decontamination. Any members’ personal clothing/uniform that is contaminated while on corps business shall be cleaned by CCVAC.
Members are restricted from wearing jewelry that will interfere with the performance of duties.
1.8 Green Lights
Green lights are used to alert citizens of our community that CCVAC members are responding to an emergency. When displaying a green light in or on your car, you are a visible representative of CCVAC. Accordingly, whether the light is in use or not, you should drive in a safe manner. Since many drivers are unaware of what green lights represent, they may not yield to you. Keep this in mind. Don’t drive aggressively or in a manner which may endanger either yourself or other drivers. New York State Vehicle and Traffic Law does not require other vehicles to yield right of way to vehicles displaying green lights, nor does New York State permit vehicles displaying a green light to violate speed limits or traffic signals.
Each riding member, after having obtained an CCVAC green light authorization by the Captain, may affix one green light in or on his/her vehicle. This written authorization will be issued on an annual basis and should be kept in your vehicle at all times. The green light may only be used when responding to emergency calls. Members must exercise due caution when responding to calls.
Should you become involved in a motor vehicle accident in your personal vehicle while responding to a call, you are personally liable for the accident.
CCVAC does not authorize any member to use red lights or sirens in their personal vehicles.
1.9 Return of CCVAC Property
Any CCVAC property issued or entrusted to you must immediately be returned to a Line Officer at the time of your resignation, dismissal from the Corps, or upon request of a Line Officer. Although normal wear-and-tear is expected, you are responsible for any lost or damaged items at replacement cost.
1.10 Drugs and Alcohol Use
The possession of illegal drugs and the consumption of alcohol and/or illegal drugs are forbidden on CCVAC property. Members are prohibited from being on CCVAC property while under the influence of any mood-altering drug, including alcohol. Members engaged in operational activities who appear to be under the influence of any mood-altering drug, including alcohol, shall be immediately suspended. Organizational functions off premises may involve the consumption of alcohol in a lawful and sensible manner.
1.11 Smoking, Food, and Drink
Smoking, eating, and drinking are prohibited in work areas (including the ambulance) where there is a reasonable potential of occupational exposure. Food and beverage may be transported, in its original container, in the front cab of the ambulance but will not be consumed anywhere inside the vehicle or CCVAC garage. Eating and drinking are allowed in designated areas. Smoking is prohibited inside the ambulance, within 20 feet of the ambulance, as well as within the CCVAC building. (Refer NYSDOH Policy Statement 00-07; No Smoking Policy; Appendix 4)
1.12 Theft and Loss
Because of the openness of our organization and our role within the community, theft of any type will be dealt with in the strongest means possible, including criminal and civil action. Theft includes, but is not limited to, unauthorized use of CCVAC equipment and supplies for personal use. All incidents of loss of non-disposable equipment should be reported to a Line Officer.
1.13 Gifts
Individual members or employees are not permitted to accept personal gifts from vendors or patients without previous approval from the Captain or President. At NO TIME will any member receive a cash gift. Any cash gifts must be sent to CCVAC as a donation, no exceptions.
1.14 Visitors
While visitors are encouraged, so that the community may be made more aware of our mission, visitors are not permitted to be in the building unless accompanied by a member. Visitors are not permitted on calls.
1.14.1 Ride-Along Policy
As part of our continuous effort to recruit new members (Prospective applicants & students) this program offers each prospective member an opportunity to see what it is like to ride on an ambulance. EMT students that are currently attending a NYS certified EMT course will be allowed to ride along with the appropriate paperwork submitted by the course sponsor of the program. (Any non-member regardless of circumstances must complete a waiver form.)
1.15 Ambulance and Equipment Preventive Maintenance
Maintaining vehicles, as well as equipment, is essential to an agency’s performance. CCVAC strives to ensure that their vehicles are operating in an efficient and safe condition at all times. Crew Chief and/or driver should spot check vehicle prior to responding on a call. The ambulances and equipment are inspected by the Maintaince and Equipment Committees weekly. A log of maintenance and repairs will be kept in a separate file in the Radio Room for each vehicle and its equipment. Owner’s Manuals and Operator’s guides are located in the Maintenance Office and equipment is maintained, calibrated and inspected according to the manufacturer’s recommendations (Refer to NYS DOH Policy Statement 02-11: Preventive Maintenance of EMS Vehicles and Equipment; Appendix 5 A, B, C, D, E).
1.15.1 Cleaning and Decontamination of Ambulances and Equipment
Each duty crew must keep the ambulance and its equipment in a clean and disinfected condition. The interior of the ambulance, and equipment, shall be cleaned with the appropriate level of disinfecting cleaner after each call. Cleaning supplies are located on each ambulance, as well as in the CCVAC garage.
1.16 Supply and Equipment Inventory and Storage
Conducting periodic equipment and vehicle inspections helps prevent problems and equipment failures. These inspections also serve as verification that the ambulances meet the requirements listed in NYSDOH Policy Statement 98-08: EMS Vehicle Signing and Labeling, Appendix 6). To ensure that each vehicle is operating efficiently and fully stocked, the ambulances and all equipment and supplies will be thoroughly checked by the Equipment Committee each week. The weekly inspection will include a check and inventory of ALL equipment and Medical bags. As well, a check of all battery-operated equipment (including AEDs) will be performed weekly. The following equipment will be checked each week:
Flow Meters: shall be cleaned and disinfected by the crew if it has been contaminated with any patient secretions. If contaminant has entered, the internal part of the flow meter place in a red bag and contact an equipment committee member.
Suction unit portable/In house: disassemble the unit discard the canister, tubing and suction catheters. Wash the wall unit with a dampened warm water cloth and disinfectant. Replace all supplies used. After inspection reassemble and check for proper function.
Stretchers, Stretcher mattresses, and Stair chair: Clean and disinfectant with warm water and disinfectant and then wiped down with a clean towel.
Straps: The crew shall clean straps that are contaminated and check after each call for straps that must be replaced.
Backboards, Scoop, Splints, KED: Clean contaminated equipment with any patient excretion/secretion. The unit(s) must be thoroughly clean by washing with warm water and disinfectant and then wiping with a clean rag.
B/P Cuff: Red bag contaminated B/P cuffs and dispose the bag in the hospital’s appropriate red hazard collection bin. Notify the equipment committee that a replacement is needed.
Defibrillator: The crew should inspect the unit after use for contamination. Replace pads and paper. Clean and make sure the B/P cuff, pulse Ox is working. If the Battery light shows low battery replace when the rig is back at the Corps.( supplies in the AED: (2) Defibrillation pads, razor, monitoring pads, pulse ox, tape, roll of paper)
Disposable items: The majority of the equipment used by the Corps is disposable. If a disposable piece of equipment is contaminated it must be disposed of in a red biohazard bag.
Check sheets, completed during these inspections, should note that the vehicle, supplies, and equipment are in order, free from defects; equipment properly stored and secured, and also note any deficiencies. When possible, the deficiencies will be corrected immediately. Those that cannot be corrected, a Line Officer and the Maintainance Coordinator should be contacted immediately. A technician by the manufacturer will perform any required repairs to AED’s or Cardiac Monitors. (Refer to NYSDOH Policy Statement 98-14: Ambulance Equipment Inventory; Appendix 7)
1.16.1 Personal Equipment Used in Emergency Responses
A personal first-response kit containing items such as: penlight, shears, tape, gauze, blood pressure cuff and stethoscope etc.; may be used by individual members who are qualified to respond to an emergency. This equipment is to be maintained, and stored in a proper manner. It may be stored in their personal vehicles and accompany them to an emergency call if they are responding prior to the arrival of the ambulance. Any personal equipment stolen or misplaced is the responsibility of the individual, not the ambulance corps. Any items used on a call may be restocked by CCVAC.
1.16.2 Storage, Integrity, and Security of Medications and Drug Boxes
Due to the unique nature of the PreHospital environment, medications that are stored and used are subjected to extreme environmental changes. This may have a negative impact on the stability, strength, quality and purity of these medications.
These medications are issued under the authority of CCVAC’s Medical Director who provides ongoing training in regard to their usage. Only CCVAC EMT-Bs, who are appropriately trained by the Medical Director or his/her designate, may administer Epinephrine or Albuterol to patients.
These medications are stored in an appropriate-labeled container, along with protocols and manufacturer’s directions. Special attention is given to the proper storage temperature ranges suggested by the manufacturers. Each time these medications are used, the Crew Chief is responsible for proper documentation on the PCR as well as notification of usage to the CCVAC Captain or appropriate officer. Used Epi-Pens should be discarded either in the sharps container on the CCVAC ambulance. Each CCVAC ambulance contains the same medications as discussed above. Any vehicle that carries medication and is parked outside during inclement weather, the medication bag will be brought into headquarters to a climate-controlled environment.
(Refer to NYSDOH Policy Statements: 00-06, Security of Drug Boxes and Drug Paraphernalia on EMS Response Vehicles; 00-14, Storage and Integrity of Pre-Hospital Medications and Intravenous Fluids; 00-15, Storage and Safe Guarding of Medications administered by EMT-Bs, Appendix 9 A, B, C).)
1.16.3 Oxygen Systems and Equipment
The oxygen systems in CCVAC’s ambulances are maintained in accordance with the original equipment manufacturer’s specifications and inspected periodically for leaks, cleanliness and system integrity. These systems are checked during the weekly ambulance inspection. Any defects, malfunctions or deficiencies noted by the crew should be reported immediately to a Line Officer and Fleet Coordinator. All onboard and portable oxygen cylinders are inspected, tested and filled by an authorized oxygen distributor on an as-needed basis. Crew Chiefs are responsible to check onboard oxygen levels after each call and replace if the level falls below 500 psi. Portable oxygen cylinders will be replaced when the level falls below 500 psi. Full and empty oxygen cylinders are located in the appropriately designated storage area in the ambulance garage. (Refer to NYSDOH Policy Statement 98-06; Ambulance Oxygen Systems and Equipment, Appendix 10)
As a safety precaution, CCVAC strictly enforces its “No Smoking” policy at all times.
1.17 Membership and Job Descriptions
Roles/Responsibilities of the Line Officers (Captain and Lieutenants)
1) The Line Officer’s first and most important responsibility is to provide the best patient care possible as outlined in NY State protocol.
2) The Line Officer will be a role model and a team leader for all members.
3) Each Line Officer will be assigned special duties to be carried out throughout the year, and as they arise by the Captain.
4) Each Officer will be expected to ride a duty crew weekly.
5) Each Officer is expected to participate in all major parades and functions
6) Each officer must maintain the minimum level of certification they held at election
7) ALL SOG’s should be enforced at all times!!!
8) The Line Officer will speak to crew members if any incident should take place and ensure that the proper paperwork is filled out and filed, and the appropriate person is contacted regarding the incident.
9) The Line Officer will notify Captain if any Corps vehicle is involved in an accident, start filling out the proper paperwork, and relieve the driver of their duties until an investigation is completed by the review board.
10) The Line Officer will attend all Monthly membership meetings. If unable to attend you will notify the Captain and/or President and give them any report for the meeting as well as notification that you are unable to attend.
11) As a Line Officer you are an Officer 24 hrs. a day, 7 days a week. You will act in accordance with this at all times. You are assigned a radio, USE it if things are going on and you are on call or in the Town.
1.17.1 Qualifications and Specific Duties of Captain and Lieutenants
In order to be Captain you must have served at least 12 consecutive months in good standing as a Lieutenant. To run for Lieutenant you must have served as an active EMT in good standing for at least 12 consecutive months
All elected line officers are expected to serve at least one duty crew shift a week and march in all major CCVAC parades.
Captain:
It shall be the duty of the Captain to see the efficient operation of the Corps, as authorized by the Board of Directors, in carrying out the purposes of the Corps.
It shall be the duty of the Captain to enforce the Standard operating procedures and operating regulations of the Corps. He/She shall be accountable for all property belonging to the Corps.
The Captain shall inspect all Pre-Hospital /care Reports (PCR’S).
The Captain shall be responsible for and insure the smooth operations of all committees under his/her jurisdiction. (Training, Equipment, Ambulance Maintenance, Duty Crew, Stand- by, Radio Committees). He/she shall appoint, with advice for his/her line officers, chairpersons for all such designated committees. He/she shall be empowered to delegate supervision of any of the committees to either of his/her Lieutenants and .or the training officer. Delegation of duties to the Lieutenants and or training office shall not relieve the Captain of his/her responsibilities for the carrying out of his/her duties.
The Captain does not supersede the authority of the crew chief on any calls, unless he official removes the crew chief from duty for cause.
Lieutenants:
It shall be the duty of the First Lieutenant to aid the Captain and to follow his/her directives as needed to ensure the smooth operation of Corps.
He/she shall act in place of the Captain at any time that the captain is unavailable or is unavailable or indisposed either by absence or illness.
First Lieutenant:
The duties of the first Lieutenant are to be in charge of the equipment and ambulance maintenance committee. (He/She shall ensure that all ambulances are maintained at least to the Department of Health inventory and equipment list). The first Lieutenant does not supersede the authority of the crew chief on any call.
The first Lieutenant shall maintain the health and immunization record files of the members.
Second Lieutenant:
The second Lieutenant shall act in place of the first Lieutenant in his absence. He/She shall provide the necessary policies, evaluate standards and implement them as necessary and advise the Captain in the tools and equipment necessary to address OSHA standards. He/She shall act as the liaison of the Corps to OSHA, the Center for Disease Control and the area health facilities.
1.17.2 General Membership
Guidelines for application and membership requirements and process are covered in the By-Laws of Cortlandt Community Ambulance Corps.
1.17.3 Job descriptions of adult riding members are as follows:
General requirements of all members
All members, regardless of job assignment must:
1. Be at least 16 years of age
2. Agree to abide with the bylaws and standard operating guidelines of the Ambulance Corps.
3. Have satisfactory physical and mental health to carry out all usual CCVAC related responsibilities and obligations.
4. Have the ability to: communicate verbally, via telephone and radio equipment;
5. interpret written and oral instructions;
6. use good judgment and remain calm in high-stress situations;
7. be unaffected by loud noises and flashing lights;
8. read English language manuals, write, and converse in English;
9. calculate weight and volume ratios;
10. accurately discern street signs, addresses, manuals and road maps;
11. bend, stoop and crawl on uneven terrain;
12. lift, carry and balance up to 125 pounds (250 pounds with assistance);
13. withstand varied environmental conditions such as extreme heat, cold, and moisture;
14. work in low light and confined spaces;
15. interview patients, family members and bystanders;
16. document in writing all relevant information in prescribed format in light
17. of legal ramifications of such;
18. converse with members and hospital staff with regard to the status of the patient.
19. Have good manual dexterity, with ability to perform all tasks related to motor vehicle operation and or patient care.
Crew Chief: All crew chiefs shall be NYS certified at the minimum EMT-B level. All crew chiefs must be approved by the Captain, and may be appointed after completing the Crew Chief training program, riding as a crew chief in training for a minimum of 10 calls and PCR documentation QA/QI completed by the QA/QI Coordinator
The crew chief is responsible for the ambulance and crew during a call unless replaced for cause by a Line Officer. The crew chief will immediately notify a Line Officer or the Captain of any unusual circumstances or problem that arises.
It is the crew chief’s responsibility to determine the severity of the call and direct the crew as to the type of care and equipment to be used, and what medical facility a patient will be transported to. The crew chief will instruct the driver as to the use of lights and sirens after assessing the patient’s condition, and will keep the driver updated as to any necessary change in the operation of the vehicle.
The crew chief is responsible for completing a patient care report for every call or standby. A release form from responsibility (RMA) must be signed when a patient refuses treatment and/or transport A PCR must be completed when a call is cancelled if the ambulance has left headquarters. All PCRs are to be placed in the locked receptacle located in the communications as soon as possible after returning to headquarters.
The crew chief will decide who will ride in the ambulance, in addition to the patient and the crew. The name and relationship of any additional passenger will be noted on the PCR.
The crew chief will be responsible for communicating with the receiving hospital, either by cell phone or radio.
The crew chief, upon arrival at the hospital with a patient, must advise the staff of the patient’s condition at the scene and en- route. The white copy of the PCR must be signed on the back by a nurse (or doctor in the Connecticut hospitals) that the patient has been received. The pink hospital copy is left with a nurse or placed in the patient’s file bin. (Refer to NYS DOH Policy Statement 02-05; Pre-Hospital Care Report; Appendix 2)
The crew chief is responsible for all equipment on the ambulance and must see that items are replaced and restocked. Note on the run report sheet and on the whiteboard in the garage any equipment left at a hospital, or any item that was not replaced.
While all crew chiefs must be certified New York State EMT-Bs, many of CCVAC’s drivers are also certified. Original certifications are to be produced when first joining CCVAC and whenever recertifying. A copy will be placed in each member’s personnel file along with copies of any continuing medical education classes attended. All personnel records are available for inspection by the DOH upon request. (Refer to NYSDOH Policy Statement 00-10: The Functional Job Position EMT-B, Appendix 3)
Crew Members: An ambulance crew can consist of as many as 4 members. One crew member, the crew chief, must be an EMT-B or higher certification
Emergency Medical Technician EMT-B
Members whom have taken and successfully completed the NYS certified EMT course. The EMT performs basic trauma assessment and care such as extremity immobilization, basic assessment and care of medical emergencies, documentations of care on the PCR’S and defibrillation using the AED.
Certified First Responders:
Members that have completed the NYSCFR course and are required to attend four CCVAC training courses a year. The CFR once cleared by the Captain may respond on Ambulance call within their level of training including general patient assessment, basic airway management, bleeding control, and assist the EMT with spinal immobilization and splitting. CFR will perform patient care tasks under the supervision of an EMT or Paramedic. No CFR under 18 should respond directly to a scene.
Attendant:
Members that have completed CPR/AED training and advanced first aid may ride as attendants. Attendants will never be put in charge of patients. Attendants may never replace certified members on a crew.
Driver:
All designated motor vehicle operators as well as any patient care providers who wish to operate the ambulance rescue vehicle under any circumstances must meet the following requirements.
The Captain and driver trainer must approve prospective drivers. When a member has completed driver training he/she will be checked by a driver trainer who will verify that all testing standards have been met. The driver trainer may require a refresher training session and drivers are required to stay current with the operations of the ambulance.
A member must be 21 years of age, and must be off probation or at the discretion of the Captain, before beginning driver training. ALL CCVAC drivers will have to successfully complete a VFIS /EVOC Driver Training Course, prior to beginning the Driver Training program. Each driver must also have a current CPR/AED card and advanced first aid on file .
The vehicle operator is expected to operate the vehicle in a safe manner according to all applicable policies and procedures as well as the NYS vehicle and traffic law. In addition, the operator may be required to assist at the scene of an emergency with gathering needed equipment, lifting and moving patients, operation of stretchers and stair chair, rescue operations and CPR.
· Uses appropriate body substance isolation procedures
· Maintains the ambulance in operable condition and reports any problems with the vehicle operation to an officer.
· Keeps a record of mileage and the dispatch times
· Cleans the passenger compartment of the ambulance as needed
· Provides assistance in removing the patient from the ambulance and into the emergency department
· Notifies an officer when fuel is needed
Drivers are to report to headquarters when a call is received unless instructed otherwise by the crew chief. Drivers may not respond to a scene unless a request for additional personnel has been issued by 60 Control.
1.17.3 Media Relations / Billing Inquires
In the event a member is requested to provide information to the press, the following policy is to be followed:
1. Explain to the caller/individual that you cannot release any information
2. Refer the caller/individual to the line officer or board member that is handling the situation
3. Press releases are to be made only by those administrators as approved.
Request for billing information:
Do not answer any billing questions; instead refer them to our billing company, Mutlimed. Their phone number is posted above the phone in the ready room and radio room.
1.18 General Emergency Vehicle Operators Requirements
1. Due to the lack of general driving experience and considering the amount of training and related activities of a young member of an emergency service organization, all members and staff under the age of twenty-one (21) will not be allowed to drive emergency vehicles in a code 3 response. An eighteen (18) year old member may drive the Fly-car or Rehab van but never in a code 3 situation.. No exceptions.
2. The trainee's driving of emergency vehicles will be limited to training and non-emergency activities. Exceptions: If an emergency situation occurs and there is not a certified operator present at the time, and the trainee has been trained sufficiently and approved by the officer in charge to act in this capacity, the trainee may operate the vehicle during that emergency.
· Detailed training records will be kept on all trainees during their training period. The training records should include, but not be limited to, hands-on experience and four (4) hours classroom/ten (10) hours "hands-on" minimum annually.
3. All Level III Trainees will be allowed to drive as needed with approval of Line Office or Captain.
4. It will be the sole responsibility of the Captain to take whatever measures needed to ensure all driving requirements are met. Any deviation will be up to the Captain and in the best interest of the Ambulance Corps.
5. As you know, a new law has been passed in Westchester County. At no time, will any driver of a motor vehicle operate a cellular phone while his/her vehicle is in motion.
With this in mind, we have also instituted a new policy, whereas “At no time while operating an CCVAC vehicle will you be talking on your personal cellular”. Anyone found using a cellular/Nextel phone for personal purposes while driving will be subject to disciplinary action and possible suspension from the Ambulance Corps. Any questions or concerns, feel free to contact any Line Officer, the Captain or the President.
6. When Crew personnel is sufficient, any time you are backing the ambulance anywhere, you are to have someone get out of the ambulance and spot you into the space or the place you are attempting to back into.
7. Any adult may with an officer’s permission move an ambulance on CCVA property i.e., pull out to wash or change duty rigs in the garage.
Revocation of driving privileges
Class A Violation
An individual who has a Class A violation within the past three (3) years normally receives a license suspension from the Department of Motor Vehicles, which issued the license. In addition VFIS guidelines call for suspension of driving privileges for anyone convicted of a Class A violation for a period of eighteen (18) months. Additionally, any of these individuals would also be required to attend an approved driver-improvement program or equivalent training, and be recertified to operate emergency vehicles.
Class B Violation
Any individual who has a combination of two (2) Class B moving violation convictions and/or chargeable accidents in a three (3) year period will be issued a warning letter from the Captain or Chief Administrative Officer of the emergency service organization.
Any individual who has a combination of three (3) moving violation convictions and/or chargeable accidents in a three (3) year period will be issued a suspension of driving department vehicles for a period of ninety (90) days by the Captain or Chief Administrative Officer of the emergency service organization.
Any individual who has more than three (3) moving violation convictions or three (3) chargeable accidents or any combination of more than three (3) of the formerly stated violations in a three (3) year period will be issued a suspension of driving department vehicles for a period of one (1) year. In addition, the same individual would be required to complete an approved driver improvement program and be recertified to operate emergency vehicles.
Note: Unusual circumstances with individual cases would be evaluated on a one-to-one basis.
Any individual who has a combination of two (2) Class B moving violations or chargeable accidents in a three (3) year period will be issued a warning letter from the Captain or Chief Administrative Officer of the emergency service organization.
Any individual who has more than two (2) Class B moving violation convictions or chargeable accidents or a combination of more than two (2) of the above in a three (3) year period will be issued a suspension of driving department vehicles for a period of one (1) year. In addition, this individual would be required to complete an approved driver improvement program and be recertified to operate emergency vehicles.
Violations
Designations of Type A and Type B violations are based on a survey of state point systems. Violations receiving higher numbers of points are classed as Type A.
Type A Violations
o Driving while intoxicated
o Driving under the influence of drugs.
o Negligent homicide arising out of the use of a motor vehicle (gross negligence).
o Operating during a period of suspension or revocation.
o Using a motor vehicle for the commission of a felony.
o Aggravated assault with a motor vehicle.
o Operating a motor vehicle without owner's authority.
o Permitting an unlicensed person to drive.
o Reckless driving.
o Hit and run driving.
Type B Violations
Any moving violations not listed as Type A violations. (Exceeding Posted speed limit is a Type B violation.)
Note: Any member with approval to operate any CCVAC vehicle who receives a type A or B violation must notify the Captain, or if it is the captain the President, in writing within 2 days of the violation. If the violation occurs out of state the member must make the notification when they return to New York. Unusual circumstances with individual cases would be evaluated on a one-to-one basis. Failure to do so will result in lose of driving privileges and may result in a corps suspension.
Approved Drivers with no emergency medical training must attend at least four (4) CCVAC training sessions a year.
2. Safety and Health Issues
2.1 General Safety Rules
CCVAC could list numerous safety rules and still not cover every potential situation. All safety rules can be boiled down to “Members should exercise common sense at all times and in all situations.” Once you find a safety hazard, STOP. Don’t leave problems unattended without taking measures to warn others and/or mitigate any danger.
In addition to exercising common sense, members must pay heed to the following specific rules:
1. Members shall wear a shirt, long pants and close-toed shoes at all times when on a call. Full turnout must be worn by all members participating in a vehicle extrication or at other hazardous scenes.
2. Members shall wear appropriate protective equipment when dealing with bodily fluids or other dangerous conditions such as fires, vehicle extrication, hazardous materials, etc.
3. Members shall wear reflective clothing when working on a dark roadway.
4. No member shall enter a hazardous environment such as a building fire or a confined space.
2.2 Safety Training
CCVAC will provide all members with appropriate safety training as a part of new member orientation. Safety training will also be included in ongoing training sessions.
2.3 Exposure Control (Refer to CCVAC Exposure Control Plan)
Blood borne pathogen training, in accordance with OSHA standard 29 CFR 1910.1030, “Occupational Exposure to Bloodborne Pathogens,” is provided for all members as part of new member orientation and ongoing training. CCVAC has a separate, comprehensive Infection Control Plan, which can be found in the Ready room. Each member must review the plan in detail and sign a form verifying their understanding of its contents.
When an exposure to a member occurs, they should immediately seek medical care and report the incident to a Line Officer and the Infection Control Officer (OSHA/Safety Officer). At an appropriate time an Incident Report and exposure form MUST be completed and submitted to the Captain. The single most important infection control technique is washing your hands with hot, soapy water. All members will wash their hands, whenever practical, before and after patient contact. As health care providers, we are exposed to significantly more infectious illnesses than the average citizen. The best way to avoid cross-contamination of CCVAC members is to enforce this policy vigorously.
The patient compartment of the ambulance shall be cleaned, with an appropriate disinfectant solution, after calls and as needed Disinfecting the patient compartment frequently helps limit exposure to blood and body fluids. (Refer to Appendix 34 & 11 A, B, C, and D)
If you are caring for a patient and wearing gloves, be aware that what you touch after patient contact can be contaminated and will need to be disinfected. Changing gloves after patient contact, but before touching other equipment, can reduce the possibility of contamination. All necessary PPE is located on each of the ambulances and should be used according to recommendations in the CCVAC ICP.
2.4 Decontamination
Equipment contaminated on a call with blood or bodily fluids will be decontaminated at the hospital or upon arrival back at CCVAC headquarters according to the CCVAC ICP. Gross decontamination of blood borne pathogens may begin at the hospital destination. (Refer to Appendix 11 A, B, C, and D)
2.5 Hazardous Materials Plan
CCVAC members are required by the federal government to be trained to the level of Hazardous Material ‘Awareness’ Level. All members will participate in ongoing training for Hazardous Material ‘Awareness.” This section highlights some specific advice in the event of an incident involving hazardous materials:
o Call and warn the fire and police departments;
o Stay uphill and upwind. If you can see the site, you’re too close. Don’t be afraid to retreat;
o Stop the traffic and effect all necessary evacuations;
o The DOT Hazardous Material Placard Manual is in the driver’s console of each ambulance.
o Each vehicle has a pair of binoculars – Use them!
o Anyone who is ‘down’ and not moving in the “hot zone” is considered dead.
o Don’t risk your life to drag out a body;
o Tell anyone coming out of the “hot zone” to “Strip and Sit” downhill from you.
o Up to 80% of gross decontamination occurs when clothing is removed.
o As long as the contaminant is non-reactive to water, hose them off.
2.5.1 Unknown Dry Substance/Suspected Anthrax Response
(NYSDOH Policy Statement 01-08; Appendix 12)
When responding to a call involving a package, envelope or substance suspected of being Anthrax, there are some precautions to take:
1. Confirm scene safety and type of incident. Do not enter an affected area until a competent authority has determined the scene to be safe.
2. If you arrive on the scene first, notify competent authority.
3. If an unknown substance has been found in the air handling system, evacuate the premises immediately and notify the competent authority.
4. Anthrax is not contagious. Person to person transmission has never been reported.
5. There will be little or no need for prehospital medical care. Do not transport the individual to a hospital, unless other medical conditions need to be addressed (i.e., chest pain, severe anxiety). Patients should not be transported to a hospital.
6. If patient insists on being transported to the hospital, contact medical control for consultation.
7. If you transport to the hospital, notify the receiving hospital that you are bringing a patient who has been exposed to a powder/unknown substance and request the hospital to have staff meet you outside of the ER.
8. Create a list of individuals who were in the area of exposure to be given to the incident commander or local police, and public health officials. All, or most individuals, should be released home with self-monitoring instructions.
9. The need for testing of the substance will be determined by appropriate authorities.
10. Lab tests take at least 24 hours to complete. There is no harm to an individual waiting for lab results before beginning appropriate medical treatment.
11. The Center for Disease Control (CDC) has advised that no treatment isnecessary for Anthrax in an otherwise health person exposed to an unknown powder/substance.
12. If you arrive at a scene where patients have been decontaminated, follow the guidelines above, but assist in addressing individual concerns about infection and treatment.
13. If you arrive at a scene where patients have not been decontaminated, and there is an observable substance, contact a competent authority and perform the following:
a. If powder is on patient’s skin or clothing, ask the patient to remove their outer clothing. If the patient is unable to do this, put on PPE (gloves, mask and eye protection) and remove the patients outer or exposed clothing.
b. The patient’s clothing should be secured by the patient (if possible),in a clear plastic bag and left with the competent authorities on scene.
c. Contact the appropriate local agency responsible for decontamination.
14. Remember you are considered health care providers who the public expects will be knowledgeable about Anthrax. You may be the highest medical authority at the scene. Be prepared to work with local or state public health officials in calming public fears regarding these incidents.
2.6 Physical Exams, TB Testing, and Hepatitis B: Member health records will be maintained on all members who are active riding members of the Cortlandt Community Volunteer Ambulance Corps, Inc. This record shall include the following, (as outlined in the NYS EMS Program Policy Statement 88-8: Guidelines for Employee (Member) Health Records; Appendix 13) and will be subject to a biennial review by the CCVAC OSHA/Safety Officer:
o Pre-membership and annual physical examination are not required.
o Immunization records and screening results;
o Record of member occupational injuries or illnesses and their course; i.e. compensation forms filed, physician’s record, hospital record, etc;
o CCVAC incident report pertaining to member exposure to suspected hazardous materials, toxic products, or exposure to infectious diseases;
o Record of annual physicals;
o Record of physician’s approval to return to active duty after a debilitating illness or injury.
Routine yearly PPD skin testing will be required for all members having contact with patients. For those individuals who have converted their PPD test, this SOG will be waived. Instead, an initial chest x-ray will be obtained and appropriate counseling provided regarding the need to report any signs or symptoms of TB. Further chest x-rays will only be obtained when determined necessary by our agency’s Medical Director.
Hepatitis B vaccination shall be offered to all riding members and employees. Any member or employee who has previously been vaccinated shall provide written documentation, and at the discretion of the health care practitioner, may be offered a titer test to determine immunity. Any member or employee who has not been previously vaccinated, and who refuses the vaccine, shall complete a Hepatitis B Declination Form
2.7 Material Safety Data Sheets
In order to ensure a safe environment, CCVAC is required by the federal government to provide information outlining the risks and safe use of a variety of potentially harmful substances used by the Corps. This information is contained in a file consisting of a series of Material Safety Data Sheets. All members and employees are encouraged to review the book to check for any new additions.
2.8 Member Injuries
CCVAC wants to ensure that if a member is injured while performing Corps duties, the member will receive prompt and appropriate medical care. As a result, the Corps requires that members who are injured immediately seek medical assistance, contact the Captain, and provide CCVAC with written notice in an Incident Report as soon as possible. In accordance with law, CCVAC maintains Workers’ Compensation Insurance on behalf of the membership.
2.9 Workers’ Compensation
Workers’ Compensation is a state-mandated insurance plan, which provides for medical expenses, rehabilitation services and payment for lost wages in the event of an on-the-job injury. All members are covered by Workers’ Compensation from their first day as a member and coverage continues until the member resigns. Notice regarding benefits and availability of Workers’ Compensation shall be posted in the Ready Room.
2.10 CISM Referral
CCVAC understands that the tasks performed by its members and employees can be very emotionally demanding and there are some events so stressful that members may have problems coping afterwards. In preparation for these situations, CCVAC has arranged for referral to a regional Critical Incident Stress Management (CISM) Team. CISM members are all volunteers who work in emergency services, have been exposed to similar overwhelming experiences, and who have had special training in teaching coping techniques. In the event of a particularly stressful call, please call the Captain immediately and he/she will arrange for a CISM within 24 hours.
2.11 Incident Reporting Requirements
The purpose of this policy is to clarify the requirements of Section 21.q of Part 800, which specifies Incident Reporting responsibilities, and requirements for EMS services. Reports must be made for incidents in which a patient under the charge and care of the service was injured or harmed by actions or omissions of a service member as well as for on duty death or injury of a service member.
The Captain is required to notify the DOH Area Office of the occurrence of any incident or circumstances in which a patient, or member is harmed, injured, or killed in any of the circumstances listed below. Questionable situations should be referred to the area office for resolution.
Notification must be made to the DOH office by telephone by the close of business the day following the incident and in writing within five days.
The following types of situations must be reported to the DOH:
1. A patient dies, is injured, killed or otherwise harmed due to actions of commission or omission by a member of the ambulance service;
2. An EMS response 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;
3. Any member of the ambulance service, while on duty, is killed or injured to the extent requiring hospitalization or care by a physician;
4. Patient care equipment fails while in use, causing patient harm;
5. It is alleged that any member of the ambulance service has responded to an incident or treated a patient while under the influence of alcohol or drugs.
The DOH’s interest is in those events in which a patient, under the charge and care of the service, is injured or harmed by acts of commission or omission by a service member. Examples might include failure to maintain an airway, failure to resuscitate, not honoring a properly executed DNR order, dropping a patient, etc. The situations described here are not to be considered an all inclusive list.
The DOH also requires the reporting of any line of duty death or serious injury of a member. If a member is killed or seriously injured in a sudden or unexpected circumstance (not a chronic situation) a report to the Area Office must be made.
The written report to the Area Office should describe the circumstances, outcomes and injuries or deaths of all involved. A copy of any motor vehicle accident report should be included.
Services are to notify the Bureau of EMS in writing; of all unexpected authorized EMS response vehicle and/or patient care equipment failure that could have resulted in harm to a patient. One example is a defibrillator failing to discharge. Any corrective actions taken by the service should be included. The intent of this section is to track trends in vehicle or equipment failures so that reports may be made to manufacturers and other appropriate agencies.
In addition, the US Food and Drug Administration (FDA) require mandatory medical device reporting (Refer to NYSDOH Policy Statement 98-11; Incident Reporting Requirements, Appendix 15).
3. Emergency Medical Responses and Care
3.1 Scheduling
In an effort to provide emergency service to the community, CCVAC maintains a duty crew Sunday thru Thursday from 2300 hrs until 0700 hrs. All riding members are encouraged to participate on a duty crew. At no time can more than 4 members be on a crew (crew chief, driver, crew, attendant) A copy of the current duty crews is posted in the Ready Room At all other times members respond as needed. Members are requested to listen to their pagers at all other times and respond as needed. Members must make 20 calls a year to be in good standing.
3.2 Dispatch Policy
All requests for emergency medical response will be dispatched, via pager system, by 60 Control. In the event that CCVAC or a member receives a request for emergency ambulance service by other means (telephone call or walk-in at headquarters), the member will notify 60 Control who will page out the call to advise the Paramedic, and Line Officers and that the ambulance is on a call.
3.3 Response to Calls
In accordance with Section 3005-A, Article 30 of the Public Health Law, the minimum staffing for a CCVAC ambulance on an emergency call is one EMT and one driver. An EMT must attend the patient at all times. At no time shall an CCVAC ambulance respond to an emergency call when the driver is not assured of having an EMT on the scene upon his arrival (Refer to NYSDOH Policy Statement 01-4: EMT Staffing for Volunteer Ambulance Services; Appendix 17).
When an emergency call is received over the pager system, a crew shall assemble and respond via radio to 60 Control, identifying them with their radio call number (88__) and acknowledge they are responding to the call.
In the event that there is insufficient staff, CCVAC will notify 60 Control to dispatch for an additional crew to respond. If there is no response within 60 seconds, 60 Control will be advised to call for a Mutual Aid response to come in and cover the call.
If ALL ambulances are engaged in patient transport, and unavailable to respond to another emergency call, notify 60 Control to dispatch the nearest available mutual aid service meeting necessary location, level of service and availability requirements.
At minimum, the crew shall bring the appropriate jump kit, the oxygen bag, and prepare to bring the appropriate means of patient transport (carrying device) into each call. Other equipment such as the AED, immobilization devices, suction, etc. shall be carried to the patient as needed.
Every on-duty member who responds to a call should be listed on the PCR. The PCR is to be filled out by the Crew Chief or Paramedic and placed in the locked PCR box located in the communications room immediately following the call.
3.4 Mass or Multiple Casualty Incidents (MCIs)
A mass or multiple casualty incident (MCI) is defined as one in which the number of potential patients exceeds the resources currently available. In practice, when ours are the first and second ambulances to respond to an event in which there are more than four patients, the event qualifies as an MCI. (In certain cases, the severity of the injuries may necessitate a third ambulance when there are only three patients).
In such an event, the MCI plan should be activated. Each member of the crew has specific responsibilities under this plan. The Crew Chief is responsible for conducting a rapid scene size-up and determining what resources are required. Any EMT’s on the crew should begin rapid triage. DO NOT BEGIN TREATING PATIENTS. Drivers are responsible for staying with the ambulances and coordinating communications.
As with all procedures in this manual, use common sense and good judgment in determining the amount and type of additional resources you will require. Small-scale MCI’s may only require one additional ambulance. In this case, you should ask 60 Control to request a mutual aid response.
For large-scale MCI’s, follow the procedures contained in the MCI command kit (located in the outside, front driver-side compartment of ALL ambulances). The Captain, or any Line Officer acting on behalf of the Captain, should be notified of the MCI. You may request that page ALL CCVAC members to respond either to the scene for manpower or to headquarters for an ambulance or to pick up additional supplies. The response of resources from other communities for a large-scale MCI should be coordinated through 60-Control via landline (Refer to Appendix 16, A, B, C)
3.5 Radio Operations
Only those members approved by line officers shall operate radios during any and all CCVAC operations and on our communication channels.
When using radio on any frequency, all members shall identify themselves properly by using their designated identification number or unit number
A. Normal radio operations:
1. Be brief,
2. Use plain English, no 10-Codes
3. Hold microphone close to mouth,
4. Press transmit button for 1.5 seconds prior to speaking,
5. Speak clearly, distinctly, slowly, and do not over modulate,
6. Do not argue with communications or supervisor,
7. Be patient, 60 Control may be busy and unable to respond to you immediately,
8. Repeat address when responding,
9. When responding alert communications,
10. Assure that all transmissions are acknowledged,
11. If advised to stand-by, do so and wait to be recalled,
12. Upon arriving at scene advise ,
13. Transmission of false or deceptive information is prohibited,
14. Transmission of profane language is prohibited and is severely disciplined,
15. Professionalism is expected, joking and laughing is prohibited.
B. Emergency Radio Operations
1. Radio communications is limited to priority messages,
2. Scene command, line officer or control will advise all personnel that emergency communications are in effect with the designated radio code and without need or explanation,
3. On scene communications shall use channel 3 as to not interfere with other operations,
4. Only scene command, line officer may use fire band to communicate with fire incident commander and only on priority level
3.6 Driving the Ambulance (88-B1, 88-B2 and 88-B3)
Only driver certified CCVAC members may drive the ambulance. All drivers shall carry their driver’s license on their person at all times. Drivers, passengers and members shall wear seat belts at all times. Children shall be restrained in an appropriate child safety seat. Any member 18 years of age may operate the Paramedic Fly-Car in a non-emergency mode to the hospital or back to headquarters after being cleared by Captain.
3.6.1 Non-Emergency Driving
When operating the ambulance in non-emergency mode, all drivers must observe all applicable traffic laws. Headlights must be on at all times, but other lights and sirens should not be used. Keep in mind that the ambulance is a highly visible public vehicle. Take time to extend every courtesy to other drivers. Notify an officer when the tank is below ½ if you do not have a refueling code. When leaving the ambulance in the garage, plug in the battery conditioner.
Never retract the snow chains while the vehicle is in a stopped position!
Do not idle any vehicle inside the garage. The alarm system is very sensitive. Dangerous carbon monoxide levels may build up and cause death or injury.
3.6.2 Emergency Vehicle Operation Policy
NYS - EMS Policy
q Every EMS response vehicle must be driven safely at all times, usually not exceeding the speed limit. Drivers exercising any of the NYS V&T Law privileges must do so cautiously and with due regard for the safety of all others.
q Types of Responses –
o Non-emergency Operations – any time an EMS response vehicle is out of the station on an assignment other than an emergency run, shall be considered to be a routine operation. All routine operations will be considered non-emergency and shall be made using headlights only – no light bars, beacons, corner or grill flashers or sirens shall be used. During a non-emergency operation, the ambulance shall be driven in a safe manner and is not authorized to use any emergency vehicle privileges as provided for in the V&T Law.
o Emergency Operations – shall be limited to any response to the scene or the hospital where the driver of the emergency vehicle actually perceives, based on instructions received or information available to him or her, the call to be a true emergency. EMD dispatch classifications6, indicating a true or potentially true emergency should be used to determine the initial response type. Patient assessments made by a certified care provider should determine the response type (usually C or U as an emergency) to the hospital. In order for a response to be a true or potentially true emergency, the operator or certified care provider must have an articulable7 reason to believe that emergency operations may make a difference in patient outcome. During an emergency operation, headlights and all emergency lights shall be illuminated and the siren used as necessary.
q Each EMS response vehicle operator must recognize that the emergency vehicle has no absolute right of way, it is qualified and cannot be taken forcefully8.
Emergency Vehicle Operations
First and Foremost – DO NO Harm!
1. Emergency operations are authorized only to responses deemed by dispatch protocol to be emergency in nature where the risks associated with emergency operations demonstrably make a difference in patient outcome.
2. Upon dispatch, emergency operations are only authorized when the dispatch call type justifies an emergency response.
3. All routine operations will be considered non-emergency and shall be made using headlights only – no light bars, beacons, corner or grill flashers or sirens shall be used. During a routine operation, the ambulance should be driven in a safe manner and is not authorized to use any emergency vehicle privileges as provided for in the V&T Law.
4. Emergency operations are authorized at a scene when it is necessary to protect the safety of EMS personnel, patients or the public.
5. EMS response vehicles do not have an absolute right of way, it is qualified and cannot be taken forcefully.
6. During an emergency operation the vehicle’s headlights and all emergency lights shall be illuminated and the siren used as necessary.
7. Once on the scene, the decision for determining the type of response for addition EMS vehicles responding to the scene shall be made by a NYS certified provider following assessment of the scene and all patients.
8. The certified EMS provider in charge of patient care, following assessment of the patient, shall be responsible for determining the response type enroute to the hospital.
9. EMS response vehicles shall not exceed posted speed limits by more than ten (10) miles per hour.
10. EMS service vehicles shall not exceed posted speed limits when proceeding through intersections with a green signal or no control device.
11. When an EMS response vehicle approaches a red light, stop sign, stopped school bus or a railroad crossing, the vehicle must come to a complete stop.
12. When an EMS response vehicle uses the median (turning lane) or an oncoming traffic lane to approach intersections, they must come to a complete stop before proceeding through the intersection with caution.
13. When traffic conditions require an EMS response vehicle to travel in the oncoming traffic lanes, the maximum speed is twenty (20) miles per hour.
14. The use of escorts and convoys is not permitted.
15. The driver of an EMS response vehicle must account for all lanes of traffic prior to proceeding through an intersection.
CCVAC owned vehicles (marked ambulances, fly cars,) will implement the use of emergency lights and sirens when involved in an emergency response.
CCVAC owned vehicles qualify as authorized emergency vehicles under the New York State Vehicle and Traffic Laws, and therefore are subject to the conditions of said laws.
"The provisions of Title VII, Article 23, Section 1104 of the New York Vehicle and Traffic Law do not relieve the driver of an authorized emergency vehicle from the duty to drive with “due regard” for the safety of all persons nor shall such provisions protect the driver from the consequences of his reckless disregard for the safety of others." (New York Vehicle and Traffic Law)
1. Only certified CCVAC drivers may operate Corps vehicles in emergency mode.
2. All CCVAC Emergency Vehicles will be operated in a SAFE and prudent manner at all times.
3. All CCVAC Emergency Vehicles when operated in an Emergency Response mode (Code III) will use all available emergency lights and siren.
4. All CCVAC Emergency Vehicles when operated in an Emergency Response Mode (Code III) will come to a complete STOP at ALL controlled intersections insuring that entry into and passage through the intersection can be completed safety.
5. All CCVAC Emergency Vehicles will obey all posted speed limits unless the quicker response is absolutely necessary and directly related to life threatening situations. These quicker responses may only be engaged in if they do not endanger life or property.
6. All CCVAC Emergency Vehicles will be operated in a non-emergency mode (CODE 1) unless emergency operation (CODE III) is necessary from a patient care standpoint.
7. All CCVAC Emergency Vehicles will under no circumstances operate greater than 1O MPH over the posted speed limit.
8. All CCVAC Emergency Vehicles will under no circumstances operate greater than 20 MPH when proceeding on the wrong side of the road against the flow of traffic.
9. CCVAC Ambulances may engage in Emergency Response from whatever location the vehicle is in when it receives a request for said response.
10. No CCVAC driver may respond CODE III in an CCVAC vehicle other than the "Responding Ambulance" unless explicitly authorized by an CCVAC Line Officer.
11. Warning lights must be turned on prior to moving a vehicle for an emergency response
12. No CCVAC vehicle may be driven Code III with non CCVAC members except ambulances with patients in life threatening situations.
13. No person driving or in charge of a motor vehicle shall permit it to stand unattended without first stopping the engine, locking the ignition, removing the key from the vehicle, and effectively setting the brake thereon and, when standing on any grade, turning the front wheels to the curb or side of the highway, provided, however, the provision for removing the key from the vehicle shall not require the removal of keys hidden from sight about the vehicle for convenience or emergency.
When responding to emergency calls, use extreme caution. Although ambulances may violate some traffic laws for due cause, drivers are responsible for safe operation of the vehicle at all times and assume responsibility in the event of an accident. You may be personally liable for any accident. Your negligence could cause injury to yourself, your colleagues, your patient, and bystanders.
When the emergency scene is a home or building, park safely and put on the parking brake, leaving the scene lights and the headlights on. Position the vehicle so that patients will be exposed to the elements for as little time as possible. DO NOT leave the back doors of the ambulance open for any longer than necessary as it allows carbon monoxide to build up in the patient compartment, promotes theft, and alters temperature.
When arriving at the scene of an emergency on the street, park the vehicle so that the crew and patient are safe from oncoming cars, and put on the emergency brake. On scene, consider reducing the number of emergency lights engaged to reduce rubbernecking and the ‘moth effect’. Consider turning off headlights if they will blind oncoming drivers. Place road flares if necessary (or triangles) if hazards exist. These warning devices should be placed a significant distance in advance of the accident in order to achieve optimal warning value. No member should be operating on the scene of an emergency on a roadway without reflective clothing, especially at night.
When on the scene of a fire, do not block the hydrant or the front of the building. At any fire, MCI, or unusual response situation, establish a command post in a position where you can maintain egress, keep the driver with the vehicle, have the crew remove the stretcher, backboard, head blocks, collars, technician’s bag, and oxygen and stay by the ambulance ready to respond. Have the Crew Chief report to the ranking fire or police officer for instructions. When on the scene of a hazardous materials event, remember to park up hill and upwind. In a hostile situation maintain safe distance and consult police for specific instructions.
When at the scene of an MCI, remember that if you are first on the scene, your first responsibility is to call for additional resources, establish a command post, then begin triage and treat patients. Transport is the responsibility of secondary units.
(Refer to NYSDOH Policy Statements 00-13: Operation of EMS Vehicles; and 89-04: Standard Operating Procedures to Follow in Respect to Backing and Parking the Ambulance, Appendix 19, A and B).
3.6.3. Motor Vehicle Accidents Involving the Ambulance or Rapid Response Car
1. Stop and protect the scene with warning lights and/or flares. If the vehicles are in a hazardous location or blocking traffic, they may be moved to the side of the street.
2. Notify dispatch immediately to request the following:
a. The appropriate police agency.
b. Any other necessary services such as Fire Department or towing service, etc.
c. If the EMS vehicle was enroute to the scene of a call notify the dispatcher to immediately dispatch another EMS unit to that assignment. If the accident is ‘minor’ and there are no injuries,exchange vital information (noted below under item 3) and proceed to the call. Advise the police of this action.
d. If a patient was being transported in the ambulance and the ambulance has been rendered inoperable, have the dispatcher send an ambulance to transport the patient. If an ambulance, or the First Response Vehicle is taken out of service as the result of an accident or mechanical failure, notify 60 Control immediately, and place an “Out of Service” vehicle sign on the vehicle
3. If the patient being transported is unstable and the ambulance is not rendered inoperable, and there are no other unstable patients on the scene, then instruct the other vehicle operator to remain at the scene until police arrive and provide them with:
a. Service name;
b. Vehicle identifier; and
c. The ambulance operator’s name.
d. Record the name, vehicle type, make, and license number of the other vehicle before leaving the scene with your patient.
e. If the crew has an extra person, leave him/her at the scene to begin the paperwork.
4. If a stable patient is being transported assure that care is being provided to the patient by an EMT while awaiting the arrival of the police, if waiting will not cause excessive delay. While waiting for police to arrive exchange information then continue transport to the original destination upon arrival of the police. Return to the scene after delivering the patient to their destination.
5. Administer patient care to any injured persons.
6. Notify a Line Officer, and the Captain (you should make this notification yourself).
7. If there is no patient exchange necessary, obtain information from other involved person (license, registration and insurance card). Record the police officer’s name, shield number, department, if any tickets are issued and make a rough sketch of the pertinent aspects of the scene.
8. Obtain name, address, telephone number and a brief statement from any witness.
9. Make sure even the minor injuries are well-documented and receive appropriate emergency department follow-up as needed.
10. Per 10 NYCRR Part 800.21, our Captain will report to the Department of Health EMS Bureau Representative for our region, within 24 hours, any Accident involving personal injury and/or any accident results in an Ambulance being placed out of service.
11. New York State Vehicle and Traffic Law also requires the owner of any vehicle involved in an accident resulting in any personal injury, death and/or damage exceeding $1,000 (to any one vehicle) to file a report with the Department of Motor Vehicles within 10 days. The required MV-104 form may be obtained at any police station or DMV office (Refer to NYSDOH Policy Statement 01-07: Guidelines to Follow in Case of an EMS Vehicle collision; Appendix 20).
If a Line Officer Captain agree that the accident was unavoidable, then the Accident Review Board is unnecessary, but proper documentation must be submitted. If the CCVAC vehicle is not in a normal operating condition, it should be removed from service and considered unsafe. The Captain should be contacted, by the member making arrangements for towing.
The CCVAC driver is relieved of duties on scene by the Line Officer, as deemed necessary by the Line Officer; the driver is subject to urine test. The Accident Review Board or Line Officer will review all accidents.
Chemical Tests. Any person who operates a motor vehicle in this state shall be deemed to have given consent to a chemical test of one or more of the following: breath, blood, urine, or saliva, for the purpose of determining the alcohol and/or drug content of the blood provided that such test is administered by or at the direction of a police officer with respect to a chemical test of breath, urine or saliva or, with respect to a chemical test of blood, at the direction of a police officer.
Appropriate information should be given upon request to police. Requests for information about vehicle insurance and registration should be directed to the Captain
Accident Review Board Procedures
This document will outline the reporting and investigation procedures to be followed in case of an accident involving one of the vehicles owned by CCVAC.
1. The Captain,is to be notified of ANY accident involving a corps vehicle, no matter how minor.
2. After a member has had an accident, and all proper procedures have been followed on scene, as per CCVAC SOG’s, the driver and crew are to return to CCVAC Headquarters (if no injuries are involved), and complete Accident Report and Incident Report in order to document what had occurred. (If possible, information should be included from other parties involved. Include all information as it actually happened.
3. Each accident will be given a unique identification number to be included on all pertinent paperwork, and to be included in the accident log.
4. The Captain will convene an Accident Review Board. All completed paperwork will be forwarded to the ARB chairperson.
5. Next, the driver will contacted by the ARB advising him/her of the time/date of the accident review session.
6. The Accident Review Board (ARB) will be comprised of 1 Line Officer, 1 Administrative Officer, 3 randomly selected corps members, and will be run by the ARB Chairperson. The Captain will also be a member of the ARB unless involved in the accident. In this case the First Lieutenant will convene the ARB.
7. The purpose of the ARB session is to review the circumstances surrounding the incident, and to help identify causative factors and any remedial steps that need to be taken. The driver, any witnesses, and others involved will discuss all facts and issues, including outside reports, photos, etc. as applicable.
8. After the session, the ARB will review the situation and all pertinent factors, and remake a decision as to the availability of the incident, based in part on the point scale shown on the attached exhibit, and any remediation necessary.
9. The paperwork and results, and recommendations will be given final review by the Captain/First Lieutenant. The Captain/First Lieutenant will have final decision-making power. A Summary will be forwarded to the Board of Directors, The driver may appeal the decision to the Board of Directors
10. These results will be communicated to the driver, in writing, within one week of the review session.
3.7 NYS / BLS Protocols
All emergency medical care provided by CCVAC shall conform to Westchester County Regional EMS and New York State Protocols. Copies of these protocols are in the Ready Room. Each EMT may access this copy at CCVAC headquarters or on-line at www.health.state.ny.us and www.wremsco.org.
3.8 Non-Emergency Transports
The Captain must approve a non-emergency transport request. Transports are secondary to emergency calls. A second crew and secondary ambulance must be used on a transport call. No transport is to leave headquarters until the emergency ambulance is back in territory and available. If a transport is delayed in leaving, the hospital or person requesting transport should be notified.
3.9 Mutual Aid to Neighboring Towns
Because demand for emergency medical services is unpredictable and demand may occasionally outstrip resources, CCVAC has entered into Mutual Aid agreements with Westchester County. CCVAC will provide a fully staffed ambulance to respond to emergencies in the neighboring area.
Should a crew be paged to a Mutual Aid ambulance call, they should respond as usual. If the crew if not familiar with the neighboring area, the crew may contact 60 Control to request directions or an escort from the neighboring town.
Should the Mutual Aid request be for assistance at an MCI, all communications should go through 60 Control. Request the staging location and report to the Staging Officer upon arrival.
All CCVAC policies remain in effect during a Mutual Aid response unless otherwise noted in the Mutual Aid contract. All Mutual Aid calls should be marked “Mutual Aid” in the dispatch information section of the PCR. (Refer to NYSDOH Policy Statement 95-04: EMS Mutual Aid, Appendix 21).
3.10 Psychiatric Transports
Patients with psychiatric emergencies will be transported to the closest 9-1-1 receiving hospital with psychiatric care.. In cases where a psychiatric patient has a medical emergency, the destination decision will follow regular protocol. These patients could potentially have violent tendencies. To insure the safety of the crew and the patient, it may be necessary for a police officer to accompany unstable or potentially dangerous patients in the ambulance.
3.11 Paramedic (ALS) Response
At this time when available a Cortlandt Regional Paramedic will be dispatched simultaneously with CCVAC. When the paramedic arrives on the scene, a crewmember should guide him/her to the patient and give an initial report. Keep in mind that once the paramedic arrives, he/she becomes the highest medical authority on scene. EMTs should continue to perform BLS skills, including preparation for transport, and assist the paramedic as requested. For a major trauma patient who is not in cardiac arrest and who has a manageable airway, begin transport to the closest Trauma Center (Westchester Medical Center) and arrange for paramedic intercept en route. For major trauma patients in cardiac arrest or with an unmanageable airway, begin transport to the closest hospital and arrange for paramedic intercept en route. The standard for major trauma scene time is ten minutes. The goal is to have the patient at the trauma center within 60 minutes of the accident.
3.11.1 Helicopter Transport (Stat Flight)
Aero medical transport should be considered in situations wherein the transport of critically ill/injured patient(s) to an appropriate medical facility will be faster by helicopter than by ground ambulance, if time is determined to be a factor in patient care.
Police, Fire or CCVAC will evaluate the situation/condition and, if necessary, place a helicopter on standby via 60 Control.
A helicopter can be requested to respond to the scene when:
o ALS personnel request a helicopter;
o BLS personnel request a helicopter;
o when ALS is delayed or unavailable;
o In the absence of an EMS agency, any emergency agency can request a helicopter.
If it is later determined by the highest qualified EMS personnel (EMT-B, EMT-I, EMT-CC, EMT-P) on the scene that a helicopter is not needed, it must be cancelled as soon as possible.
Transport of a patient by helicopter should be considered under the following conditions:
o Ground transportation to the appropriate critical care facility will exceed 30 minutes;
o The helicopter can be airborne and transport to the designated hospital quicker than an ambulance can transport the patient(s) to the nearest appropriate hospital;
o Ground transportation is compromised;
o A proper helicopter-landing site is available;
o A Multiple Casualty Incident (MCI) threatens to overload local capabilities;
o Difficult access situations (e.g., wilderness rescue, EMS access or egress is impeded at the scene, traffic, or other situations cleared by the helicopter team);
o Helicopter should not be called for patients that are in cardiac arrest (except for hypothermic patients).
o Transport of trauma patients by helicopter falls under the helicopter trauma transport protocol.
60 Control should be notified if more than one patient requires air transport. If available, one medivac helicopter will be dispatched per critical patient requiring air transport.
3.12 Transfer of Care
When transferring care to Emergency Department staff, it is CCVAC’s policy that care may only be transferred to a licensed or certified clinical care provider. Report must be both verbal and written on a PCR, which must be signed by the licensed or certified clinical care provider (RN, NP, PA or MD) All the patient’s belongings must be transferred.
3.12.1 Transition of Care
With the passage of Chapter 552 of the Laws of 1998 (Public Access Defibrillation) and more recently, Chapter 578 of the Laws of 1999 (Epinephrine Auto-Injector), EMS providers may encounter situations where a patient has been defibrillated or administered epinephrine prior to EMS arrival. It is important that there be smooth and orderly “transition of care” between civilians and EMS providers as well as between EMS providers of different levels. This includes the transfer of information and continuation of appropriate care (Refer to NYSDOH Policy Statement 00-03: Transition of Care; Appendix 22).
Public Access Defibrillation: When arriving at a call where a patient is being treated by a “first responder” with an AED, you should immediately confirm the patient’s status (responsive, unresponsive, apneic, pulseless, etc.), and determine if a “shock” is indicated. The “first responder’s” AED should remain on the patient until a full cycle of the AED has been completed. An ALS provider usually changes the AED and/or pads when the patient is ready for transport or upon treatment.
For patients where “no shock” is indicated, you should continue CPR (verify that CPR is being performed correctly) and prepare for immediate transport.
For patients where “shock” is indicated, you should administer follow current AHA and NYSDOH guidelines “shock” and prepare for immediate transport.
The Crew Chief should attempt to gather the following information:
1. How long the patient has been down;
2. When was CPR initiated;
3. When was the patient first “shocked”;
4. How many “shocks” the patient
has received; and
5. Any pertinent patient history that is available.
Epinephrine Auto-Injector for Anaphylactic Reactions with Respiratory Distress or Shock: When arriving on the scene of a patient experiencing an anaphylactic reaction, if the patient is being treated by a “first responder” who has administered epinephrine by an auto-injector, you should immediately confirm the patient’s status. Pay close attention to the patient’s airway, respiratory distress and any signs or symptoms of hypoperfusion. Treat the patient appropriately, request ALS and prepare for immediate transport, if a Paramedic is not already on scene.
The Crew Chief should attempt to gather the following information:
1. Determine the substance the patient was exposed to;
2. How long ago the exposure occurred;
3. The initial symptoms the patient reported;
4. The time and dosage of the epinephrine administered;
5. The name of the individual who administered it; and
6. The patient’s response to the treatment.
Medical Control must be contacted prior to administering a second epinephrine injection (Refer to NYSDOH Policy Statement 00-03: Transition of Care; Appendix 22).
Aspirin Administration:
The Department of Health has approved EMT-B’s to administer aspirin to those patients who are classified as cardiac related patients.
Ensure medication is not expired
If a patient has not taken aspirin and has no history of aspirin allergy and no evidence of recent GI Bleed administer two (2) 81mg nonenteric chewable (baby) aspirin.
Record all patient care information including the patient medical history and all treatment provided on the PCR.
3.13 Medical Control
CCVAC operates under the medical license of our Medical Director. The Medical Director is responsible for ensuring quality within our organization, and may establish medical standards for our agency. The Medical Director shall be a physician, approved by the Board of Directors, and trained as a medical doctor or doctor of osteopathic medicine and licensed in the State of New York. The Medical Director shall have particular knowledge of current EMS practices, be a Westchester County MAC’d physician, and he/she, or his/her delegate, is responsible for all CCVAC training and continuing education.
Medical Control can be divided into Westchester County Region on-line (spoken) Medical Control, and Westchester County Region and New York State’s off-line (written) Medical Control (Refer to NYSDOH Policy Statements 03-07: Providing Medical Direction; and, 95-01: Providing Medical Control, Appendix 23 A and B).
Westchester County’s Region on-line Medical Control consists of Medical Control provided by hospital-based physicians in accordance with State and Regional protocol. You may contact any destination hospital at any time for physician advice. Contact may be by telephone or via the HEAR radio.
Document physician contact and hospital/physician name on the PCR.
CCVAC’s Medical Director approves medical protocols and conducts appropriate retrospective call reviews. Quality insurance call reviews will include review of all defibrillation events, all medication and narcotic administration, all assistance with medication, all cardiac arrests, unusual calls and at least 10% of randomly selected calls.
CCVAC participates in the Quality Improvement Program with Westchester County Emergency Medical Services Council.
Off-line Medical Control consists of policies/protocols promulgated by the NYS DOH BEMS SEMAC and Westchester County Regional EMS Council/Regional Medical Advisory Committee.
3.13.1 Quality Improvement Program
In accordance with Article 30, Section 3006, of the NYSDOH Bureau of Emergency Medical Services EMS Service Operational Resource Guide, CCVAC participates in the Westchester County’s Emergency Medical Services Council Quality Improvement Program. The purpose of this Program is to monitor and evaluate the quality and appropriateness of the medical care provided by CCVAC, and the other participating agencies and to pursue opportunities to improve patient care and to resolve identified problems. All agency members who participate in this Program and attend meetings will sign a Confidentiality Agreement.
This Program includes a Committee of at least five members, at least three of whom do not participate in the provision of care by the services. At least one member is a physician, and the others are nurses, EMTs or AEMTs, or other appropriately qualified allied health personnel.
The Committee will review care rendered to patients by the participating agencies and notify the governing body of significant deficiencies and recommend policy and procedure changes as necessary. The Committee will periodically review the credentials and performance of all persons providing emergency medical care on behalf of the agencies. As well, the Committee will review information concerning compliance with standard of care procedures and protocols, grievances filed by patients or their families, and the occurrence of any incidents injurious or potentially injurious to patients and will participate in system-wide evaluation. Data collected by the Committee will be presented to the Regional Medical Advisory Committee. Any records, including PCR data, which identifies names of individuals, will be kept confidential. The Committee’s responsibilities and objectives are clearly outlined in Article 30, Section 3006 of the NYS DOH EMS Service Operational Resource Guide (Appendix 24).
3.14 Refusal of Medical Attention
Patients have the right to accept or refuse treatment; that right may be infringed upon only if the patient or responsible guardian/proxy doesn’t have the capacity to make the decision to accept or refuse the service.
When a patient or guardian/proxy refuses treatment or transport all of the following will be documented:
1. Attempt to gain an understanding of the rationale for refusal, include family whenever possible. Document if the patient was or was not the person requesting EMS. Investigate acceptable alternatives with the patient. Provide all appropriate care that the patient permits.
2. Evaluate mental status and capacity for decision-making in this specific situation. Include any findings as they pertain to the absence or presence of intoxicants.
3. Explain reasonably anticipated consequences and potential risks of refusing care more than once. Include a family member or bystander to ask the patient to agree and document their names.
4. Communicate with medical control if the crew feels that refusing care would be seriously detrimental to the patient’s best interest or if the patient’s refusal would reasonably lead to a threat to public safety.
5. Involve the appropriate police agency. The police officer should witness the patient’s signature on the PCR. Document officer’s shield number.
6. Also include the following:
a. Findings (e.g. chief complaint, past medical history and history of present illness (including any acute psychiatric illness), 1 set of vital signs, general appearance, physical exam or patient’s refusal to permit a physical exam, mental status and behavior);
b. Recommendation for follow-up;
c. Signature of patient or guardian/proxy on PCR. If patient or guardian/proxy refuses to sign, document refusal;
d. If police officer is not on scene, print name, title or relationship and signature of independent witness not from EMS agency.
7. Ensure patient reads RMA or read RMA to patient. If the patient only speaks a language other than English, try to have a competent bilingual third party read the RMA to the patient in the patient’s language and document the interpreter’s name. Have the patient verbally confirm that he understands what the RMA says and agrees to it in the presence of the witness before signing the RMA. Inform the patient about alternatives to care and inform the patient that he/she can call 911 again without penalty if they change their mind or their condition worsens.
8. Medical Control will be contacted on ALL ALS RMA’s. The MD’s name and advice will be documented on the PCR.
9. Try to ensure that the patient is left with another competent person.
3.15 Unfounded Calls
If a patient cannot be located Buchanan PD and/or NY State Police and/or Westchester County Police (The Police) will attempt to make phone contact if they have a call back number. Along with The Police a sweep of the area will be done in an attempt to locate the patient. Any type of search inside of a residence will be conducted by The Police only, at no time should a member or employees put themselves in harms way. Use common sense. If the patient still is not located, all attempts should be documented on a PCR and placed in the communications room PCR lock box..
3.16 Entry into Premises
Unless there is an obvious and compelling reason, CCVAC will not break into premises without police or fire department assistance. Police shall be requested to any scene where the crew cannot gain access to the premises, if they are not already on scene. Should the police determine that the call is unfounded without gaining entry to the premises, document the officer’s name and shield number on the PCR.
3.17 Pronouncement
Pronouncement of Death is the process of recognition and documentation of the physical signs of death. It is the basis of the decision not to engage in resuscitation efforts. Certification of Death is the legal documentation required at the end of a life. A concise and complete statement of the terminal event and its causes, it is witnessed by the signature of a physician as per NYS Public Health Law.
3.18.1 Assessment
Patients may be pronounced dead and unable to be resuscitated when pre-hospital providers have found, in addition to apnea and pulselessness that one or more of the following conditions exist:
o Tissue decomposition;
o Rigor mortis;
o Extreme dependent lividity;
o Obvious mortal injury (decapitation, exsanguinations, etc.)
o A valid Do Not Resuscitate (DNR) order.
In addition to these conditions, pre-hospital providers should also attempt to determine:
o Confirmation with an AED that “No Shock Advised” or presence of asystole in 3 leads;
o Any significant medical history or traumatic event;
o Time lapse since patient was last seen alive;
o Assess surroundings and consider possible crime scene. If so, the crew shall leave the scene, and contact police if not already on scene. Crime Scene procedures, as explained in Section 3.25, shall be followed.
As with any patient, EMS can contact Medical Control for consultation if there are questions regarding the patient’s presentation and the decision not to attempt resuscitation.
3.18.2 Documentation
As per NYSDOH policy, a PCR must be generated for each call. The disposition code 010 (Other) should be used with the description “obvious death” entered in the disposition box.
A PCR for a pre-hospital pronouncement of death should include:
o A description of the body’s physical location and presentation;
o
Any significant medical history or traumatic event;
Existing physical conditions, which precluded performance of resuscitation
efforts;
o Time of pronouncement
o Any EMS contact with Medical Control;
o In whose custody the body was left.
Since the body will not be transported to the hospital, a copy of the PCR may be left with the law enforcement or medical examiner representative on scene as part of the official record
3.18.3 Reporting and Removal
As per the “Guide to Reporting Deaths to the Medical Examiner,” all unlawful, violent, unattended, sudden or suspicious deaths, either known or suspected, must be immediately reported to the ME’s office. If a death appears to meet these criteria, EMS should contact local police, if not already on scene, and take care not to move the body or disturb the area unnecessarily. The police will notify the ME’s office and preserve any evidence. For all other deaths, the Medical Examiner still must be notified. The deceased’s attending physician will be contacted by police or the Medical Examiner’s Office regarding the completion of the Death Certificate. Based on all the information provided, the Medical Examiner’s Office will decide to authorize removal of the body from the police.
It is possible that, in some special situations, the police may order EMS to transport a body to the closest hospital if, in their judgment, expedient removal of the corpse is necessary.
3.19 DNR Orders
CCVAV members shall observe and comply with all valid Non-hospital DNR (Do Not Resuscitate) orders issued on the standard DOH Non-hospital DNR form (Refer to NYSDOH Policy Statement 99-10: Frequently Asked Questions Regarding DNRs, Appendix 26 A and B). If a patient wears a DOH standard DNR bracelet, the EMT should assume that a DNR order is in place. Just because the patient has a DNR form doesn’t mean that you should discontinue all care. If transporting the patient, the form and/or bracelet should be taken to the hospital with the patient. If CPR has been initiated prior to the form being presented, it may be discontinued upon presentation of the standard form without contacting Medical Control. For unusual situations or questions, contact Medical Control.
3.20 Advance Directives
At the current time, although New York State does permit Health Care Proxies and Living Wills, the State Department of Health has issued a policy stating that they are not valid in the prehospital setting. Therefore, the crew should provide care, transport the patient to the hospital, and allow the hospital personnel to make decisions regarding advance directives.
3.21 Minors
Minors are defined as persons under the age of 18 years. Minors who have a psychological, medical or surgical emergency do not have the ability to refuse medical care. As a result, in the absence of a parent or guardian, emergency care and transport is provided for minors under the doctrine of implied consent. The crew should make every effort to contact a parent or guardian.
There are three exceptions to this rule: minors who are married can refuse treatment for themselves or their children; female minors with children can refuse for themselves or their children; and, finally, minors who have been legally emancipated can refuse for themselves or their children. An emancipated minor is one who is: enlisted in the armed forces of the United States of America; requesting treatment for drug abuse or sexually transmitted disease; living alone and self sustaining and otherwise ruled emancipated by a competent authority. If treatment and/or transport is refused by the patient, an RMA must be appropriately completed, signed, and witnessed as explained in Section 3.14 (Refer to NYSDOH Policy Statement 99-09: Patient Care and Consent for Minors; Appendix 27).
3.21.1 Abandoned Infant
Under the Abandoned Infant Protection Act, Chapter 156 of the Laws of 2000; a parent, guardian, or other legally responsible person, may leave their infant (who must be 5 days old or less) at a safe place. The law requires that an adult must intend that the child be safe from physical injury, cared for in an appropriate manner, with an appropriate person, in a suitable location and promptly notify an appropriate person of the child’s location. People leaving an infant in compliance with this law are not required to provide their names. County district attorneys have individually defined what constitutes a safe place within their county. Some suggested safe places include hospitals, police stations and fire stations.
Individuals who give up their infants do not automatically surrender their parental rights and may later seek to reclaim the child. It is important to note that this legislation does not amend provisions of the Social Services law, which make abandonment of an infant reportable to the NYS Central Register for Child Abuse and Maltreatment.
In the event a parent or legal guardian chooses to relinquish care of their newborn infant to an emergency medical service agency; the following guidelines should be considered:
1. Parents are not required to provide their names to the safe location or staff. In a non-judgmental manner, EMS staff may ask the presenting adult if there is any medical information that is important to know regarding the infant.
2. EMS services and systems may want to contact their County Office of the District Attorney to determine what, if any locations have been identified as “safe places” by the District Attorney.
3. Infants received by an EMS service agency should be transported to the nearest hospital for medical assessment and care. The agency should not be expected to interact with local child protection service agencies unless directed to do so.
4. If a parent seeks follow-up information about the child they relinquished to the care of the EMS service agency, a referral should be made to the hospital where the infant was transported or the local office of social services.
(NYSDOH Policy Statement 01-05: Abandoned Infant Protection Act, Appendix 28)
3.22 Restraint
When necessary for the patient and/or crew’s safety, in addition to the straps on the stretcher a patient may be restrained using the least amount of force and restraint necessary. Remember that the most effective restraint device is a calm, firm, professional demeanor. The first step is to request the police to place the patient in temporary police custody. In the absence of the police, the EMT should attempt to gain permission from the patient’s parent (if a minor) or guardian, or contact medical direction for advice. In the event that neither the police nor a parent or guardian (for a minor) is present, the EMT may restrain the patient if it is safe (for both the crew and patient) and you determine that the patient may be a danger to himself or others. It is preferred that at least three crewmembers are present.
If the crew is in danger, the appropriate thing to do is retreat!
Patients should be transported with a crewmember of the same gender, if possible. Any patient who is handcuffed shall be considered in police custody. Patients should never be transported face down or with their respiratory capacity restricted in any way. All restrained patients must be continually monitored.
3.23 Police Custody
All patients in police custody shall be handcuffed. No patient shall be transported face down or with his or her respiratory capacity restricted in any way. Patients in police custody shall be accompanied by a police officer at all times. It is strongly preferred that all police officers carrying handguns sit in the Captain’s chair. A victim of a significant violent crime should be accompanied by a police officer. The officer should maintain the chain of custody for all evidence. CCVAC members should make an effort not to interfere with or contaminate any potential evidence. If it is at all possible and the police officer agrees, do not handcuff the patient to the stretcher. In the event of an accident this may cause a hindrance to removal of the patient.
3.24 Crime Scenes
If called to a potential crime scene where there is any danger, do not enter until the police have secured the scene. If the police are not present and the crew finds itself in danger, leave the scene and call the police. When called to a crime scene that is safe and already secured by the police, the first priority is to provide emergency medical care and transportation to the patient. The second priority is to protect the integrity of the crime scene. This means minimizing the number of crewmembers on the scene, touching only what is necessary, wearing gloves, and alerting police to any physical evidence. Keep both goals in mind, but remember their priority.
3.25 Child Abuse Reporting
Under an amendment to the New York State Department of Health Social Services Law, effective February 1, 2002, an EMT/Paramedic who comes across suspected child abuse while performing his or her duties must report the case as follows: (Refer to NYSDOH Policy Statement 02-01: Requirement to Report Instances of Suspected Child Abuse or Maltreatment; Appendix 29 A & B).
1. Document the injuries and the statements of the suspected abusers on the PCR.
2. Give an oral report to the ER describing the suspected abuse.
3. As soon as possible, provide an oral report to the NYS Child Abuse Maltreatment Register at: 1-800-635-1522.
4. Notify the Captain of the suspected abuse as soon as the call is over.
5. Within 48 hours of the oral report, the Crew Chief must complete a written report on Form LDSS-2221-A; Report of Suspected Child Abuse or Maltreatment (Refer to Appendix 29 B), and attach a copy of the form to the agency copy of the PCR.
Under this amendment to the law, willful failure of an EMT/Paramedic to properly report a case of suspected child abuse is a Class A Misdemeanor. It is important to remember that although the parent may be the abuser, the needs of the injured child should come first. This may mean having the possible abusive parent accompany the child in order to make the child more comfortable, or separating the parent from the child. Don’t confront the abuser. Use common sense. All confidentiality policies still apply.
NY Social Services Law, Section 419 States: “Any person (mandated by law or not), official or institution participating in good faith in the making of a report, taking photographs, placing a child in protective custody or providing a service pursuant to the duties of the child protective service according to the law has immunity from any liability, civil or criminal, that might otherwise result for such actions. For the purpose of any proceeding, civil or criminal, the good faith of persons, officials or institutions required reporting cases of child abuse or maltreatment is presumed as long as they were acting in the discharge of their duties and within the scope of their employment. This protection does not apply to acts of willful misconduct or gross negligence.”
3.26 Elder Abuse, Patient Abuse and other Domestic Violence Reporting
In the event that the crew suspects abuse, neglect or maltreatment, the crew shall document the injuries and/or injury patterns (and any relevant statements) on the PCR. In addition, an oral report will be given to the ER staff and the police. The crew should report the incident to the Captain following the call. Don’t confront the possible abuser. Use common sense. All confidentiality policies still apply.
3.27 Other Crimes
When an ambulance crew reasonably believes that a crime has been committed, request that the police respond and report suspicions to the police officer. Report the incident to the Captain following the call.
3.28 Destination
CCVAC’s goal is to transport in the safest and most efficient manner in order to ensure availability of ambulance service for the community. Crews should use their best judgment in selecting the appropriate hospital. Unstable or potentially unstable patients should be transported to the closest receiving hospital ER or psychiatric center. Trauma patients who fit the New York State Adult Major Trauma or Pediatric Major Trauma protocols should be transported to the closest Trauma Center (Westchester Medical), unless the patient is in cardiac arrest or has an unstable airway in which case transport to the nearest hospital.
Environmental factors and road conditions should be considered when selecting a destination. Under normal circumstances the only transportation destinations for our agency are: Hudson Valley Hospital Center, Phelps Memorial Hospital Center, Westchester Medical Center. As a matter of policy, we do not transport patients to doctor’s offices or other such facilities.
3.29 Restocking
Upon completion of a call, the Crew Chief is responsible for seeing that the ambulance is returned to a state of operational readiness, including restocking of all used supplies. The crew shall restock linens and disposable equipment at the receiving hospital or at headquarters. Crewmembers should also check for CCVAC equipment left behind at the hospital on previous calls. Extra linens, equipment, and supplies are located in either the back supply room or the Supply cabinet in the ambulance bay. If the crew is unable to restock any necessary items, contact the Captain or appropriate officer for assistance. Any CCVAC equipment left at the hospital should be noted on the whiteboard behind the duty rig.
3.30 Sharps/Biohazard Disposal
All sharps, including IV catheters, shall be disposed of in an appropriate sharps container. These containers are located on each ambulance. When full, sharps containers shall be appropriately sealed and disposed of in the hospital emergency department. Use common sense. CCVAC discourages any members from handling any sharps and suggests that only the attending paramedic do so.
All items contaminated with blood or other potentially infectious material should be disposed of in a red biohazard bag. Whenever possible, the red bag should be disposed of in the appropriate BioHazard receptacle located in the emergency department at the hospital
3.31 Equipment Failure and Out-of-Service Vehicle Procedure
Should equipment be found to be missing or non-operational during routine rig checks, the crew shall immediately contact a Line Officer or the Captain. Should mandated equipment necessary for the current patient’s care or transport be found to be missing or non-operational during a call, the crew shall provide all possible care and request another ambulance or mutual aid ambulance for transport. Should the equipment not be necessary for the current patient’s care or transport, complete the call and inform a Line Officer immediately following the call.
When an ambulance is removed from service, whether for vehicle maintenance reasons or lack of patient care equipment, and it is believed that this removal will be temporary, the following procedure is to be used:
1. Place an “Out of Service” sign on the outside of the driver’s window.
2. Notify 60 Control, and the Captain that the vehicle is out of service.
When an ambulance that has been temporarily removed from service is returned to service the Captain, or appropriate officer, will perform the following:
1. Assure that the vehicle is in compliance with Part 800 of the codes of the New York State Department of Health.
2. Remove the “Out of Service” sign.
3. Notify 60 Control that the vehicle is back in service.
When an ambulance is permanently removed from service the Captain or appropriate officer will perform the following:
1. Notify in writing, on official letterhead, the appropriate State EMS Representative of the following vehicle information:
o Make
o Year
o Vehicle/Radio ID
o License Plate Number
2. Remove ALL New York State EMS logos from the sides and rear of the vehicle.
3. Remove the Department of Health Certificate of Inspection sticker from the windshield.
Contingency plans to address communications and other equipment failures are in Section 4.
3.32 Diversions
Diversion status is a courtesy requested by a hospital in unusual circumstances. In this event the hospital will notify, each agency by fax including 60 Control of the status. If an area hospital goes on diversion, the ambulance crew should make an effort to redirect stable patients to another hospital within 15 minutes’ travel time. Non-stable medical patients (C. U. P patients), without a paramedic, must go to the closest hospital. Non-stable patients receiving paramedic intervention may be diverted to another location if approved by the paramedic. Keep in mind that diversion is only a request, and that no hospital can refuse to accept a patient requesting emergency care.
In the unlikely event of a hospital closure due to an emergency, have contact 60 Control for instructions regarding destination so that adjacent hospitals are not overwhelmed.
4. Contingency Plans and Stand bys
4.1 Failure of Radio Communications
Should radio communications fail with 60 Control, we may use a telephone or ambulance cell phone to contact 60 Control. We may also try to use alternate Fire frequencies on the ambulance.
Should radio communications fail with the receiving hospital, we may use a cell phone (personal or on ambulance) to directly contact medical control or the receiving hospital. Numbers for 60 Control and all receiving hospitals are located in each ambulance rear compartment by the cell phone and radio.
4.2 Power Failure at Headquarters
CCVAC headquarters is equipped with a generator back up system, which will run all essential equipment until the problem can be resolved. The generator runs on natural gas and therefore does not need to be fueled. Any problems with the generator going on in a power failure, a Line Officer must be notified. DO NOT attempt to fix the generator.
In the event of a power failure, garage doors should operate normally but can be manually raised after pulling down on the white rope, which disconnects the latch connecting the linkage to the door.
4.3 Ambulance Out of Service
In the event our ambulance is out of service (for any reason), the Captain, or other officer, shall be promptly notified by a crewmember. The Captain, or other officer shall promptly notify 60 Control. An “Out-Of-Service” Sticker will immediately be placed on the vehicle.
4.4 Inclement Weather Plan
In the event of inclement weather that threatens public safety or integrity of infrastructure, the Captain, or other line officer, shall coordinate planning for standbys and or overnight crews in headquarters. Such weather conditions may include: Heavy rain or flooding, ice, snow, high heat, high winds, etc. Examples of anticipated actions may include standby at headquarters or other location, and use of alternate vehicles (buses or fire apparatus) for access through high water or snow.
4.5 Rehabilitation Van 8805
All EMT’S who will be in charge of the Rehab Unit must be cleared by the Captain
In order to respond to emergency calls, 8805 must have:
1. Driver/EMT or a driver and an EMT;
2. A driver only may not respond alone unless requested by a CCVAC officer or crew chief on scene, where they will meet a EMT who will be put in charge of the vehicle and its operations for the duration of the incident;
3. The EMT in charge will make sure the vehicle is restocked after each use;
4. While on scene the vehicle can be turned off;
5. A generator will be accessible and will be put in the van prior to responding to a scene;
6. When using a generator, place generator in front of the vehicle to run with proper ventilation;
It is the sole purpose of the Disaster Rehab Unit to provide Fire Rehab and support for MCI’s.
Answering Calls:
1. 8805 will be the second due for a structure fire.
2. 8805 may respond mutual aide if requested by 60 control.
An EMT must be on the van in order to respond outside our district.
Responding to a scene
1. Safely reach the scene
2. Use due regard when responding lights and sirens.
Drivers responsibilities
1. Keep track of times and mileage
2. Fuel must be topped off at ¾ of tank, if driver or crew does not have a code for pump, notify an officer or a member of the maintenance committee
3. Restock supplies used.
4. Park vehicle and make sure it is locked.
4.6 Fire stand bys
4.7 MCI Plan
In the event that CCVAC is called upon to respond to a large-scale MCI outside of our jurisdiction, members shall assemble at our headquarters and the Captain, or other line officer, will determine which members shall respond on the call, how calls within our jurisdiction will be handled, and what equipment/apparatus to assign. Small scale MCI’s outside of our jurisdiction will usually require a response from a crew, and ambulance to the scene.
APPENDIXES
available at Headquarters
1. Sexual Harassment: NYSDOH Policy Statement 00-11
2. Pre Hospital Care Report: NYSDOH Policy Statement 02-05
3. The Functional Position Description of EMT-B: NYSDOH Policy Statement 00-10
4. No Smoking Policy: NYSDOH Policy Statement 00-07
5. Preventive Maintenance of EMS Vehicles and Equipment: NYSDOH 02-11; CCVAC Maintenance Procedures; AED Maintenance ;Cot and Stair Chair Maintenance; Maintenance Checklist.
6. EMS Vehicle Signing and Labeling: NYSDOH Policy Statement 98-08
7. Ambulance Equipment Inventory: NYSDOH Policy Statement 98-14
8. Personal Equipment on Ambulance Vehicles: NYSDOH Policy Statement 98-03
9. Security of Drug Boxes and Drug Paraphernalia on EMS Response Vehicles: NYSDOH Policy Statement 00-06; Storage and Integrity of Pre-Hospital Medications and Intravenous Fluids: NYSDOH Policy Statement 00-14; Storage and Safe Guarding of Medications Administered by EMT-Bs: NYSDOH Policy Statement 00-15
10. Ambulance Oxygen Systems and Equipment: NYSDOH Policy Statement 98-06
11. Unknown Dry Substance/Suspected Anthrax Response: NYSDOH Policy Statement 01-08
12. Guidelines For Employee (Member) Health Records: NYSDOH Policy Statement 88-8
13. Incident Reporting Requirements: NYSDOH Policy Statement 98-11
14. EMS Use of the Incident Command System: NYSDOH Policy Statement 1-02; Incident Command Structure; S.T.A.R.T. System
15. EMT Staffing For Volunteer Ambulance Services: NYSDOH Policy Statement 01-04
16. The Operation of Emergency Medical Services Vehicles: NYSDOH Policy Statement 00-13; Sample Standard Operating Procedures to Follow in Respect to Backing and Parking the Ambulance: NYSDOH Policy Statement 89-04
17. Ride Along Policy
18. Guidelines to Follow in Case of an EMS Vehicle Collision: NYSDOH Policy Statement 01-07
19. EMS Mutual Aid: NYSDOH Policy Statement 95-04
20. Transition of Care: NYSDOH Policy Statement 00-03
21. Providing Medical Direction: NYSDOH Policy Statement 03-07; Providing Medical Control: NYSDOH Policy Statement 95-01
22. Quality Improvement Program: Article 30, Section 3006 of NYSDOH EMS service Operational Resource Guide
23. Physician Release Form
24. Frequently Asked Questions About DNRs: NYSDOH Policy Statement 99-10; NYSDOH Non-hospital Order Not to Resuscitate
25. Patient Care and Consent for Minors: NYSDOH Policy Statement 99-09
26. Abandoned Infant Protection Act: NYSDOH Policy Statement 01-05
27. Requirements to Report Instances of Suspected Child Abuse or Maltreatment: NYSDOH Policy Statement 02-01; Form LDSS-2221-A, Report of Suspected Child Abuse or Maltreatment
28. Out of Service Vehicles: NYSDOH Policy Statement 89-14
29. CCVAC Youth Corp Policy
30. HIPPA Compliance Program
31. CCVAC Exposure Form
32. CCVAC Uniform Policy