What We Do

Professional Ambulance (PRO) provides emergency medical services (EMS) to the City of Cambridge, Massachusetts in conjunction with the Cambridge Fire, Police and Emergency Communications Departments. Additionally, we provide EMS to Harvard University and the Massachusetts Institute of Technology. PRO has proudly served the citizens, students, and visitors of Cambridge for over 35 years.

Bordered by Boston, Somerville, Arlington, Belmont, and Watertown; Cambridge is approximately six square miles with the country's fifth highest population density. Ethnically and culturally diverse, the resident population of 100,000 swells to nearly 400,000 during the day. The City of Cambridge is a bio-tech center with six miles of riverfront, over one-hundred hi-rise structures, and 5 mass transit stations including a commuter rail that traverses the city. Three universities, two colleges, three hospitals, and a 900,000 square foot shopping center also call Cambridge home.

Relatively small in size, PRO staffs a fleet of 10 ambulances with fifty field providers. Our paramedics and EMTs work in a tiered system utilizing both basic life support (BLS) and advanced life support (ALS) ambulances supported by state-of-the-art technology including automatic vehicle location (AVL), global positioning system (GPS), computer aided dispatch (CAD) and LIFEPAK 12 cardiac monitor/defibrillators. PRO's ongoing Continuous Quality Improvement Program mandates retrospective review of 100% of calls and includes monthly M&M rounds with medical directors. PRO's Staff Development program is dedicated to providing training and support to all field providers. Annually, we respond to over 21,000 calls including over 16,000 emergencies.

Mission

To Provide Superior Emergency Medical Services From Our Patient's Point of View.

PRO is committed to delivering high-performance ambulance service by achieving the highest levels of:

• Clinical Excellence;
  
  
• Response Time Reliability;
  
  
• Economic Efficiency;
  
  
• Customer Satisfaction; and,
  
  
• Employee Satisfaction.

PRO will measure all of these system elements from the perspective of our patients, customers, and employees while working continuously to improve on each and every one of them.

Management

Larry Stone, President- As the founder and President of Professional, Larry is the driving force and conscience of the company. Larry is an EMT, Emergency Medical Dispatcher, and regularly participates in company training and continuing education. He is always accessible to the staff as well as the people and the entities that PRO serves. Larry has continuously maintained his office space in accessible areas enable him to interact with the staff and remain a part of daily operations. Larry has been recognized by many community organizations for his unwavering commitment to the community he serves. He has been featured in JEMS and the Boston Globe for his work in EMS.

Bill Mergendahl, CEO- Bill has been with Professional since 1987 and has served in his current position since 1990. He is responsible for all aspects of the daily operation and administration of the company and continues to work as a field provider. Bill has extensive experience in reimbursement and regulatory issues. Continuously involved in EMS system issues, Bill participates in state, regional and local committees, including the Statewide Diversion Taskforce and the Cambridge LEPC. Currently he serves on the Board of Directors of the Massachusetts Ambulance Association and the Metro Boston EMS Council. Bill holds a law degree from Northeastern University School of Law and is a paramedic.

Rachid Sbay, Director of Operations- Rachid has over 14 years of EMS experience and has been involved with PRO in various roles since 1993. Rachid originally began working as an EMT and he has been a paramedic for over 11 years. First, as a Field Supervisor, Rachid served as a presence in the field for both patients and providers. In his current role, he is responsible for all administrative duties within the operations function, Staff Development, New Employee Orientation, as well as all field operations.

Keri Cook , Director of CQI- Keri has been with Professional in various capacities since 1989. She is a paramedic and assumed her current position in 2006. Keri is responsible for all aspects of PRO's Continuous Quality Improvement Program. In this role, Keri reviews all patient care reports, collects clinical data, and manages several special projects. Keri also coordinates the hiring process at PRO interviewing all candidates. Keri manages these programs while still continuing to serve as a field paramedic.

Laura Terry, Director of Administration- Laura started with PRO in 2006 as the DIrector of Communications. In 2007 Laura became the Director of Administration. Laura maintains all PRO employees' personnel files online using Ninth Brain Suite including all certifications and re-certifications. Laura plays a vital operations role in coordinating the schedules of all field providers as well as many other vital roles.

Teresa Cruz, Director of Reimbursement- Teresa has been with Professional since 1990. She has served in her current role since 1993. Teresa is responsible for all aspects of the accounts receivable function at PRO. She coordinates the office staff and has implemented all of PRO's initiatives in electronic billing and collections. Teresa has often served as an experienced resource for outside entities with questions regarding EMS billing issues.

Ethan McKenney, Director of Communications- Ethan started with Professional interning as the Assistant to the CEO in 2005. He was originally brought on to facilitate PRO in achieving the CAAS Accreditation. Ethan worked on numerous projects including CAAS Accreditation, developing a comprehensive Fleet Maintenance Program, coordinating a Six Sigma program, and maintaining PRO's Policy and Procedure Manuals. He began full-time in 2007 and in 2008 was promoted to his current position. He is responsible for PRO's Dispatch function, Communication CQI Program, and day-to-day operations of the Communication Center.

Service Area

Cambridge EMS System

In the summer of 2003 PRO and CFD, with the support of Cambridge Emergency Communications and South Middlesex EMS submitted a proposal to develop a model EMS system based on our unique public/private partnership. At that time the current EMS system had served Cambridge well. As the system evolved with increasing call volume and preparedness becoming a preeminent issue, it was apparent that CFD should begin providing ALS level care to address the myriad situations that the City of Cambridge could be confronted with. The addition of CFD ALS resources to an already high functioning EMS system represented an opportunity for Cambridge to increase the level of emergency care being delivered to its citizens. The new EMS system would serve as a model predicated on focus and flexibility.

In Spring 2005, after months of preparation, the new system went online. The system is based on the deployment of multiple, one paramedic (P/B) staffed resources and has proven to be highly effective. Participants focus on what they do best; CFD focuses on rescue, mitigation, and ALS first response to an incident as PRO focuses on ALS patient care, patient transport, and EMS system functions.

This flexibility allows for delivery of the highest level of care to patients, in the most efficient manner with ALS reaching virtually every emergency patient in one of the busiest service areas in Massachusetts. In the vast majority of cases, we are better able to staff to the condition of the patient by providing two paramedics at the scene and two paramedics in the back of the ambulance to care for the highest acuity patients.

The effectiveness of Cambridge EMS relies on the presence of several key elements, all vital to the provision of the highest level of quality EMS for any community. These elements are derived from the NHTSA EMS Agenda for the Future. They are:

• Integration of Health Services
  
  
• EMS Research
  
  
• Legislation and Regulation
  
  
• System Finance
  
  
• Human Resources
  
  
• Medical Direction
  
  
• Education Systems
  
  
• Public Education
  
  
• Prevention
  
  
• Public Access
  
  
• Communications Systems
  
  
• Clinical Care
  
  
• Information Systems
  
  
• Evaluation

Specific elements and roles related to emergency responses within the Cambridge EMS system are:

Emergency Medical Dispatch - Cambridge Emergency Communications Department: Trained Emergency Medical Dispatchers (EMDs) provide call-taking, dispatch to fire and rescue units, CAD entry, and pre-arrival instructions.

ALS and BLS First Response and Rescue - Cambridge Fire Department

Engine / Ladder Companies: Staffing: 3 - 4 firefighters trained to the BLS Level. Firefighters provide rescue, initial on-scene triage, and initiate medical care at the BLS Level (first responders and/or EMTs) utilizing SAEDs and BLS equipment.

Rescue Company: Staffing: 4 firefighters including at least one Firefighter/Paramedic. Firefighters with highly specialized training provide specialized rescue, fire suppression, hazmat response, special details, etc., and initiate medical care at the ALS level utilizing a full complement of ALS and Rescue equipment. Rescue is also a transport capable ambulance during times of extreme system demand.

Squads: Staffing: 2 Firefighters, at least one Firefighter/Paramedic. Firefighter/Paramedics and firefighters with highly specialized training provide medical care at the ALS level, specialized ALS rescue, fire suppression, hazmat services, etc., utilizing a full complement of ALS and rescue equipment.

ALS and BLS Transport - Professional Ambulance Service

Paramedic Ambulances: Staffing: 2 Paramedics or 1 Paramedic & 1 EMT initiate, continue and/or assume medical care, relieve front-line fire rescue personnel for additional responses, and transport patient to the hospital.

Basic Life Support Ambulances: Staffing: 2 EMTs. In periods of peak demand, two EMTs initiate or continue medical care, relieve front-line fire rescue personnel for additional responses, and transport patient to the hospital.

Medical Direction

South Middlesex EMS (SMEMS) has provided every aspect of medical oversight playing a vital role in quality assurance and education since the inception of ALS in Cambridge and surrounding communities. Drawing on the resources of several area hospitals including Mount Auburn Hospital and Cambridge Health Alliance, SMEMS has established itself as a medical control entity of the highest caliber. Dr. Gary Setnik, SMEMS Medical Director, and John Conceison, SMEMS Executive Director, have been a part of SMEMS leadership since its inception. It is through their expertise and experience, and the expertise and experience of each and every medical control physician in the system, that outstanding medical oversight and physician resources have always been available.

Longstanding formal relationships currently exist between all Cambridge EMS entities and field providers and SMEMS medical control. SMEMS requires specific credentialing for all ALS field providers and medical control physicians. Monthly SMEMS ALS M&M Rounds are well attended by both Cambridge EMS field providers and medical control physicians. CFD, PRO, and SMEMS offer a combined total of over 100 hours of OEMS approved free EMS continuing education, every year at convenient times and locations. Refreshers and recertification classes are also readily available and accessible to all.

Larry Stone and Chester Eskholme founded Professional Ambulance Service in 1969. Both men had strong ties to the Cambridge-Somerville community with Larry bringing medical experience from having served aboard a Naval Hospital ship during Vietnam. Their combined knowledge of the area and the fact that they were two of the only 500 certified Emergency Medical Technicians in Massachusetts created a perfect match for starting an ambulance company. With a single ambulance and an office on the Cambridge-Belmont line, Larry and Chester proudly served all communities that requested their assistance.

Eager to grow, PRO signed an agreement with the City of Cambridge in 1972 to provide back-up ambulance services to the Cambridge Fire Department. With the addition of a second ambulance that year they began to focus their attention on the Boston area. PRO transported patients for Boston City Hospital, multiple nursing facilities, and private residents. The increased call volume necessitated additional ambulances and a second location.

By 1973, Larry and Chester opened another location in the City of Boston. They wanted to serve Boston's larger facilities, specifically the Children's Hospital. At this time EMS was still in its infancy and few providers were capable of handling specialized transports. The Children's staff needed to transport critically ill or injured children from outlying facilities back to their hospital for proper care. PRO solved the staff's dilemma by building a custom ambulance for these transports, thereby securing the Children's contract.

Throughout the years, PRO recognized steady growth despite increased competition from new providers. PRO's reputation as an EMS leader in the Metro-Boston area was well earned and established by 1979. Even then, Larry and Chester were still regularly working as partners on an ambulance. Tragically, Chester suddenly passed away from an aneurysm in 1980 leaving Larry as the sole owner of the business. At this point, Larry brought in his wife Cathy to provide administrative and business support. Eventually, Larry and Cathy would also bring in their three daughters to serve in PRO's billing department.

In 1986 PRO initiated its Advanced Life Support (ALS) service. Standing orders, online medical direction, and physician oversight were all handled by a newly formed association of area hospitals, South Middlesex Emergency Medical Services (SMEMS). Physicians from The Cambridge Hospital and Mount Auburn Hospital provided medical control for the paramedics working on the ALS ambulances. By 1988, ALS was available 24 hours a day, 7 days a week. In 1990 Bill Mergendahl, an EMT and dispatcher at PRO throughout his undergraduate years at Boston University, assumed responsibility for daily operations. Throughout the 1990s business continued with a growing focus being placed on City of Cambridge programs for the elderly, youth and under served. During this time, Bill evolved into his current role as CEO with Larry as PRO's President. Recent years have seen dramatic changes in EMS and at PRO.

After the tragic events of September 11, 2001 a renewed emphasis was placed on emergency preparedness. PRO extended its commitment to training and education within the community. In early 2002 PRO began what would become a continuous project to update antiquated systems and equipment taking advantage of state-of-the-art technology whenever possible. These changes enabled PRO to redouble and formalize its efforts in the areas of Continuous Quality Improvement (CQI) and Staff Development. On April 1, 2005 the already unique symbiotic public/private partnership between PRO and the Cambridge Fire Department was greatly enhanced as the Cambridge Fire Department initiated its ALS service.

Today, PRO is still a family owned and operated organization. Several dedicated, long-time employees have helped PRO retain its unique character during a period of ambulance service consolidation and companies becoming more "corporate". Just as in 1969, the patients and employees are treated as family and the equipment is maintained as if it were their own. More than anyone, Larry knows what it's like to work on an ambulance and understands how important it is to appreciate your job. You'll still find Larry working on an ambulance at a charitable event, a community function, or even a local football game, imparting his values to every newly hired employee.

1.1.A. Overview

New employees at PRO are in an extremely difficult situation. No matter how much training or orientation you receive, you will be unavoidably thrust into the world of EMS. With the high volume of emergency work here at PRO, a new employee must always be prepared to deal with situations that they have never come across. You must also be prepared to acclimate yourself to the different personalities and procedures that you will encounter.

All personnel with a significant amount of time here at PRO will be expected to assist and train new employees. This training will include paperwork, procedures, and driving among other things. All PRO "veterans" and new employees are expected to get along and work together. Leave all personality conflicts outside. We are a comparatively small company that does a high volume of work. The staff needs to function as a closely-knit group.

All new employees will be evaluated on paperwork, attitude, and overall performance. Use this manual and your common sense to consistently improve all aspects of your performance.

1.1.B. New Employee Orientation Program Paperwork Packet

All new employees will be oriented to the operation of PRO by using the New Employee Orientation Program Checklist as a guide. Every new employee is continuously encouraged to ask questions. All staff members should be willing and able to assist every new employee or to at least point them in the right direction to have their questions answered.

1.2.A. Credentials, Ongoing Training and Continuing Medical Education (CME)

The Commonwealth of Massachusetts -Department of Public Health - Office of Emergency Medical Services (OEMS) will certify and re-certify all EMTs and Paramedics. Crew configurations consist of two (2) EMT-Basics for Basic Life Support (BLS), two (2) EMT-Paramedics for Advanced Life Support, or one (1) EMT-Basic and one (1) EMT-Paramedic (ALS) for Advanced Life Support when both crew members have been cleared for P/B service. An EMT-Basic and an EMT-Paramedic may work together pursuant to a P/B waiver supported by Region IV and issued by OEMS. Blanket waivers are occasionally issued to allow an EMT and a paramedic to work together at the paramedic level during times of extreme weather conditions or other special circumstances. The Commonwealth of Massachusetts does not recognize the National Registry of EMTs as a valid certification.

All field providers must meet Massachusetts OEMS, re-certification requirements, consisting of twenty-eight (28) hours of continuing education, renewal of appropriate CPR, ACLS (if applicable) certification, and the appropriate refresher program every two years.

Additionally, all EMTs must be certified through PRO's Continuing Medical Education Program which hasbeen developed with physician oversight by PRO's Medical Director. A significant portion of PRO's CME is available online through NBS. Face-to-face and practical training is regularly available at PRO as stand-alone programs or in conjunction with NBS. PRO has a state-of-the-art human patient simulation lab that is utilized as an integral part of the CME program.

ALL EMPLOYEES MUST CARRY THEIR CURRENT CARDS ON THEIR PERSON AT ALL TIMES WHEN WORKING ON AN AMBULANCE. YOU MUST CARRY YOUR EMT CARD, DRIVER'S LICENSE, CPR CARD, AND ACLS CARD (IF APPLICABLE).

IT IS THE RESPONSIBILITY OF ALL EMPLOYEES TO MAINTAIN CURRENT CERTIFICATIONS. FAILURE TO MAINTAIN REQUIRED CERTIFICATIONS MAY RESULT IN IMMEDIATE DISMISSAL.

1.3.A. Staffing of Ambulances

All BLS ambulances will be staffed with a minimum of two EMTs at all times.

All Paramedic/ALS ambulances will be staffed with a minimum of two EMT-Ps at all times or by one EMT and one EMT-P when both crew members are specifically qualified by PRO to do so.

ALS ambulance service will be provided 24 hours a day, seven days a week.

1.3.B. Duties

No matter what job or position you are hired for at PRO, always remember that there are times when you will be asked and required to perform duties that you may not like. There may be times when you are called upon to do transfers, sweep the garage, move ambulances, run errands, work as a driver, work as an attendant, teach EMS related subjects, and do other tasks as designated by a supervisor or dispatcher. All personnel will be expected to accept this and cooperate.

Tasks should be equally divided as much as possible but you must again realize and accept that it does not always work out that way. All types of duties are necessary to keep the company functioning at a high level. Afterward, if you have a reasonable question, by all means, address it to an appropriate person. We appreciate your help and understanding regarding this issue and this aspect of your employment.

1.4.A. Guidelines for Appropriate Conduct

As an integral member of the PRO team, you are expected to accept certain responsibilities, adhere to high standards of personal conduct, and exhibit a high degree of personal integrity at all times. This not only involves showing sincere respect for the rights and feelings of others but also demands that you refrain from any behavior that might be harmful to you, your coworkers, PRO, or that might be viewed unfavorably by the people we service or by the public at large.

WHETHER YOU ARE ON OR OFF DUTY, YOUR CONDUCT REFLECTS ON PRO. YOU ARE, CONSEQUENTLY, REQUIRED TO OBSERVE THE HIGHEST STANDARDS OF PROFESSIONALISM AT ALL TIMES.

ANY TYPE OF BEHAVIOR AND/OR CONDUCT THAT PRO CONSIDERS INAPPROPRIATE COULD LEAD TO DISCIPLINARY ACTION UP TO AND INCLUDING TERMINATION OF EMPLOYMENT WITHOUT PRIOR WARNING, AT THE SOLE DISCRETION OF THE COMPANY.

Listed below are some of the rules and regulations of PRO. This list should not be viewed as being all-inclusive. These behaviors and/or conduct, include, but are not limited to, the following:

1. Falsifying employment or other PRO records;

2. Violating PRO's nondiscrimination and/or anti-harassment policy;

3. Soliciting gratuities from patients or the entities that we serve;

4. Establishing a pattern of excessive absenteeism or tardiness;

5. Reporting to work intoxicated or under the influence of non-prescribed drugs;

6. Illegally manufacturing, possessing, using, selling, distributing, or transporting illegal drugs;

7. Bringing or using alcoholic beverages on PRO property or using alcoholic beverages while engaged in PRO business off PRO's premises, except where authorized;

8. Fighting or using obscene, abusive, or threatening language or gestures;

9. Stealing property from coworkers, patients, entities that we serve, or PRO;

10. Having unauthorized firearms, weapons, or restraints such as handcuffs on PRO premises or while conducting PRO business;

11. Disregarding safety or security regulations;

12. Engaging in insubordination; and

13. Failing to maintain the confidentiality of patient information or PRO information.

IF YOUR PERFORMANCE, WORK HABITS, OVERALL ATTITUDE, CONDUCT, OR DEMEANOR BECOMES UNSATISFACTORY IN THE JUDGMENT OF PRO, BASED ON VIOLATIONS EITHER OF THE ABOVE OR OF ANY OTHER PRO POLICIES, RULES, OR REGULATIONS, YOU WILL BE SUBJECT TO DISCIPLINARY ACTION, UP TO AND INCLUDING DISMISSAL.

1.4.B. Courtesy and Politeness

Working in EMS is always a trying and testing position. When you are on the job or when you are wearing your uniform, you are seen as a representative of Professional Ambulance Service.

As a representative of the company, you must maintain a courteous, polite, and in control demeanor at all times.

Occasionally, you will be subject to verbal abuse, unsavory duties, and somewhat "difficult" people. When you find yourself in this position, remember that you are there for a reason. You are there to help a sick, injured, or infirm person. The people we serve depend on you and expect you to be neat, clean, courteous, polite, and in control of yourself and the situation you are dealing with.

Always be ready to work in concert with your partner and other people on the scene, not in conflict. If you lack any one of these attributes or if you disregard them, yourself, your patient, your co workers, and the service will suffer. This is an unacceptable situation. You must always strive to be better and try harder for everyone concerned.

1.4.C. S-T-A-R-C-A-R-E: Values and Guidelines for Conduct

PRO's values and guidelines for conduct can best be summarized by STAR CARE. PRO and its employees will be dedicated to these standards. We will use STAR CARE as our guide To Provide Superior Emergency Medical Services From Our Patient's Point of View.

Safe-- Were my actions safe - for me, for my colleagues, for other professionals and for the public?

Team-based-- Were my actions taken with due regard for the opinions and feelings of my co-workers including those from other agencies?

Attentive-- to human needs Did I treat my patient as a person? Did I keep h/her warm? Was I gentle? Did I use h/her name throughout the call? Did I tell h/her what to expect in advance? Did I treat h/her family and or relatives with similar respect?

Respectful-- Did I act toward my patient, my colleagues, my first-responders, the hospital staff and the public with the kind of respect that I would have wanted to receive myself?

Customer-accountable-- If I were face to face right now with the customers I dealt with on this response, could I look them in the eye and say "I did my very best for you."

Appropriate-- Was my care appropriate medically, professionally, legally and practically, considering the circumstances I faced?

Reasonable-- Did my actions make sense? Would a reasonable colleague of my experience have acted similarly, under the same circumstances?

Ethical-- Were my actions fair and honest in every way? Are my answers to these questions?

1.4.D. Discipline Process

(1) Policy

PRO, IN ITS SOLE DISCRETION, WILL DETERMINE WHEN TO WARN, REPRIMAND, OTHERWISE DISCIPLINE, OR DISCHARGE EMPLOYEES IN THE MANNER AND DEGREE PRO DEEMS APPROPRIATE.

(2) Progressive Discipline

Generally, PRO adheres to a progressive discipline policy; however, PRO may begin the discipline process at any step, or advance to any step at PRO's sole discretion based on the circumstances at hand.

The levels of discipline are as follows:

1. Record of Conversation- documented and acknowledged via PRO's email.

2. Written Warning - documented on Corrective Action/Written Warning Form. A written warning could also be accompanied by a Decision Day.

3. Decision Day - documented on Decision Day Form and completed by the employee during paid time outside of PRO. A Decision Day is eight (8) hours paid time away from PRO to complete a form documenting the employee's decision as to whether they wish to remain employed at PRO. The employee must return for their next shift with either a letter of resignation; or the completed form that documents their acknowledgement and understanding of the inappropriate conduct, their commitment to absolutely correct the inappropriate conduct, and their acknowledgement and understanding that unless the inappropriate conduct is corrected they will be discharged.

4. Discharge

(3) Use of Disciplinary Action

Supervisors and management staff are authorized to use disciplinary action in varying degrees.

• Supervisors are authorized to issue records of conversation, verbal warnings, written warnings, and relieve personnel from duty pending further action.
  
  
• The CEO and the President are authorized to issue all levels of disciplinary action including Discharge.

(4) Complaint/Conflict Resolution

Employees may utilize the Complaint/Conflict Resolution Policy outlined in this handbook to dispute the administration of disciplinary action.

1.5.A. Obtaining Uniforms

PRO provides every employee with uniform. You will be fit for uniforms at the completion of your hiring process and receive your uniforms at the end of your new hire orientation (NEOP) and before you begin your third ride time. Your New Hire administrator will schedule your fitting.

Our uniform provider is:

Simon's (ask for Karen)

329 Lynnway

Lynn, MA 01901

(781) 595-2644

Fax (781) 596-1950

New Hire employees will be issued

3 in 1 Jacket with PRO LOGO

3 Pants with reflective striping

2 Job Shirts with PRO LOGO

3 Polo with PRO LOGO

2 (3) Pack SS T

In addition to the above items new hires will be given 6 PRO points to choose additional items, such as mock T-Necks, Long Sleeve T shirts, belts, boots or any additional items offered. Point allocation will be discussed at uniform fitting and points may only be redeemed at this time. Uniform points will not carry over for another time.

Full time employees will receive a designated amount of PRO POINTS to replenish their uniform wardrobe each January. Employee may allocate these points as they see fit, in so doing assuring they have an adequate amount of uniform pieces for the year. Ordering sheets will be made available each January to Employees and are required to be submitted by the due date to receive new uniform pieces.

Please see the CEO or Director of Administration with any questions.

1.5.B. Proper Uniform

All personnel are to wear their uniforms properly at all times when on duty.

o Only PRO uniform items may be worn while on duty.

o A short sleeve, Long sleeve or mock turtle neck, issued by Pro are the only items that may be visible under a UNIFORM shirt. Only current PRO EMS logo items may be visible as your top layer, if you are wearing one of the non logo issued under layers, they must remain as an under layer at all times. Please plan accordingly for weather.

 

o You must wear your assigned radio, and key FOB, and have them on, at all times when on duty.

 

o Your UNIFORM must remain clean, unwrinkled, neat, and in good repair. UNIFORM items that are faded, torn, or worn are not acceptable. If your uniform endures damage from anything other than natural wear and tear or your lack of care, please contact a supervisor for direction of uniform piece replacement. This includes material or functional defects, fading or shrinkage. Please note that some of your uniforms pieces are covered with anti microbial material that makes them safe for you and stain resistant, improper washing will reduce this feature for you, so please follow washing instructions on each care tag.

Uniform items include:

o Professional Ambulance EMS pants with silver reflective striping

 

o Professional Ambulance Job shirt (embroidered)

 

o Professional Ambulance Mock turtleneck

 

o Professional Ambulance blue polo shirt (embroidered)

 

o Professional Ambulance Short Sleeve/ Long Sleeve Navy Blue under layer Tee Shirt

 

o Professional Ambulance baseball hat (embroidered)

 

o Professional Ambulance winter hat (embroidered)

 

o Professional Ambulance Fleece Jacket with logo and patches

 

o Professional Ambulance High Visibility Rain Jacket with reflective logo

 

o Any Black boots with "postal approved, slip resistant" traction

 

o Any Plain Black Belt

 

o Appropriate radio clip/holster/harness

You are responsible for the care and maintenance of your uniforms. You should always have spare uniform items available. If for any reason your uniform becomes soiled during your shift, you are to return to quarters for your own spare uniform. If your uniform is damaged beyond cleaning or repair while working at a scene please see the CEO for assistance in replacing it.

1.5.C. Wearing Uniform When Not on Duty

No Professional employee shall wear an identifiable uniform item when not on duty. This particularly applies to wearing an identifiable uniform item in an establishment that serves alcohol. If it is your intention to go out after work you should plan to have a change of clothes. ANY OFF DUTY EMPLOYEE OBSERVED WEARING AN IDENTIFIABLE UNIFORM ITEM IN AN ESTABLISHMENT THAT SERVES ALCOHOL WILL BE SEVERELY DISCIPLINED UP TO AND INCLUDING DISCHARGE.

1.5.D. Personal Hygiene and Appearance

All personnel are required to present themselves at the beginning of their shift as someone proud to represent this organization and your profession. This presentation includes your personal hygiene. It is imperative that all employees are clean, showered, and presentable.

If an individual is emitting a malodorous air, from a uniform or his or her person, it is not fair to patients or partners. The offending party will be requested to shower or wash the uniforms at the base or asked to leave by the supervisor for the remainder of the shift. There will be no pay for this time lost. We are a professional organization and must present ourselves as such 24 hours per day 7 days a week.

Hair must be short and neat at all times. Employees should wear their hair short or pinned back for their own safety. Unnaturally colored hair is not permitted, i.e. purple, orange, red, etc.

Mustaches must be neat and trimmed. Facial hair that interferes with the seal of a respirator is not permitted. All personnel must be clean-shaven.

Male employees are prohibited form wearing earrings while on duty. Female employees may not wear earrings that hang down. Facial jewelry of any type is not permitted. Professional Ambulance discourages the wearing of large rings while on duty. Rings have the potential to cut through gloves, creating an environment of possible exposures.

Employees should not wear cologne or perfume while on duty. Your taste may not be that of another. Some patients may be allergic or made uncomfortable by these products.

Shoes and/or boots must be cleaned and shined. A shoeshine box is always available at the base, located in the crew room.

Good safety risk management awareness and practice at all levels is a critical success factor for any EMS organization. Risk is inherent in everything that an EMS organization does: treating patients, determining service priorities, managing a project, purchasing new medical equipment, taking decisions about future strategies, or even deciding not to take any action at all.  The PRO Risk Management Strategy provides the framework for the management of all risks, including organizational, financial and clinical risks at every level of the organization. The aim of the strategy is to create a more coordinated, systematic and focused approach to the management of risk.

Strategy objectives

1. Raise the quality of care provided by the PRO to patients, employees and others through the identification, control and elimination or reduction of all risks to an acceptable level.

2. Understand the underlying causes of adverse incidents and ensure that lessons are learned from the experience.

3. Ensure that managers and staff at all levels in the organization are clear of their personal responsibilities with regards to risk management.

4. Understand the many risks faced by PRO, their causes and cost and to transfer risks where unacceptable or unavoidable.

5. Provide a safe environment and facilities for patients, employees and visitors.

6. Minimize the costs diverted to risk funding.

7. Maximize the resources available for patient services and care.

We have continued to revise and update our strategy and it now provides a system for evaluating the known or potential risks within PRO and then categorizing them into high, medium, low or insignificant priorities.
Any areas that fall into the first three categories are entered onto a risk register with action plans to eliminate the risks, or at least reduce them to an acceptable level.

Risk Responsibilities

PRO splits its management of risk into financial and corporate, infrastructure, clinical, and health and safety. A number of individuals have specific management responsibilities:

Financial and Corporate Risk
PRO has a responsibility to operate in line with GAAP and to ensure corporate risk is reduced through complying with all legal requirements related to tax, finance, and corporate structure.  PRO regards as ‘corporate, any risks that do not fall under the headings of financial, infrastructure, clinical or health and safety. The CEO has overall responsibility for all financial and corporate risk.
 
Infrastructure Risks
The CEO is responsible for all risks arising out of the provision, use, operation and maintenance of the PRO’s vehicle fleet, its facility, and all of its technology and communication systems.

Clinical Risk
PRO has a duty of care to ensure its patients receive appropriate care in a safe environment and that all that can be done is done to minimize the risk of harm coming to its patients. This is done through learning lessons from complaints, claims, and from clinical incidents reported by staff.  Additionally, PRO utilizes a formal CQI Plan that incorporates prospective, concurrent, and retrospective activities to track and address clinical risk.  The Director of CQI has overall responsibility for clinical risk.

Health and Safety Risk
As an employer, PRO has a specific responsibility to provide a safe working environment for its staff and any other individual (including patients) who are affected by the work of the organization. One way this is done is by learning lessons from incidents that are reported by staff and by proactively seeking to reduce health and safety risks.  The Director of Administration has general responsibility for health and safety.

Infectious Disease Exposure
This is found in it’s entirety in the Bloodborne Pathogen Exposure Control Plan, the Respiratory Protection Plan for TB and the TB Exposure Control Plan.

Suspected Civil Risk
Further information on PRO’s plan to prevent any suspected civil risk can be found in PRO’s CQI Plan, Health and Safety Plans, Policies and Procedure Manual, and Employee Handbook. Through the extensive in-house training and the continuing education of its employees, PRO hopes to minimize any civil risk associated with the company.

Overview

PRO is firmly committed to maintaining a safe and healthy work environment. To achieve this goal, PRO has implemented comprehensive safety policies. These policies are designed to prevent workplace injuries, accidents and illnesses.

The success of any safety program depends on the safety consciousness and cooperation of everyone in the organization. Employees at every level are expected to assist PRO in the prevention of workplace accidents and injuries and are expected to follow all safety and health rules. It is the duty of each employee to adhere to all safety rules and to report any potential safety hazards to his or her supervisor immediately.

ANY INJURY THAT OCCURS ON THE JOB, EVEN A SLIGHT CUT OR STRAIN, MUST BE REPORTED IMMEDIATELY ON AN ATLANTIC CHARTER - EMPLOYEE INCIDENT REPORT AND VERBALLY TO A SUPERVISOR OR THE DISPATCHER, AS SOON AS POSSIBLE.

Workers' Compensation insurance is provided according to state law for occupational injuries or diseases. PRO pays for the cost of this insurance. Specific information regarding Workers' Compensation can be obtained from the CEO.

More information regarding Employee Health and Safety can be found in Professional Ambulance's Health and Safety Plans.

ALL EMPLOYEES ARE RESPONSIBLE FOR WORKING SAFELY AND MAINTAINING A SAFE AND HEALTHY WORK ENVIRONMENT.

2.2.A. Duties of the CEO

The CEO can be reached at 617.492.2700 x 501. The CEO is responsible for the overall implementation and maintenance of the organization's safety policies. The CEO's duties in regard to the safety policies include, but are not limited to the following:

1) Ensure that managers and supervisors are trained in workplace safety and are familiar with the safety and health hazards which employees under their immediate direction or control may be exposed to, as well as applicable laws, regulations and the organization's safety rules and policies;

2) Ensure that employees are trained in accordance with these safety policies and as required by federal, state and local regulations;

3) Inspect, recognize, and evaluate work hazards on a continuing basis;

4) Develop methods for abating work hazards;

5) Ensure that work hazards are abated in a timely and effective manner;

6) Trace the cause of accidents, mishaps and incidents;

7) Conduct periodic risk assessments within the organization; and

8) Conduct accident/illness investigations.

9) Chair the Safety Committee consisting of the supervisory staff and field providers.

The CEO may assign some or all of these tasks to other individuals.

2.2.B. Duties of Supervisors

All supervisors are responsible for the safety and health of the employees of PRO and for the safety and health of individuals who interact with PRO. To fulfill this duty, each supervisor must:

1) Become familiar with all applicable safety and health laws and regulations, and with the organization's rules and policies relating to workplace safety and health;

2) Ensure that all employees are properly trained in workplace safety and health. This includes training in general safe work practices, as well as specific instruction with respect to hazards specific to each employee's job assignment;

3) Ensure that all employees do, in fact, perform their work in a safe and healthy manner consistent with the organization's rules and policies;

4) Take all reasonable steps necessary to avoid unsafe working conditions, accidents, injuries and illnesses;

5) Regularly inspect PRO offices and its equipment for workplace hazards and submit a written Incident Report or complete a NBS QI Incident to report any unsafe workplace conditions;

6) Ensure that unsafe and unhealthy working conditions are corrected promptly;

7) Immediately report all workplace accidents, injuries, illnesses, or "near misses", to the CEO, using a NBS QI Incident or written Incident Report; and

8) Serve on the Safety Committee as necessary and attend all required meetings.

2.2.C. Duties of Employees

All employees are required to conduct themselves in a manner consistent with PRO's safety rules and policies. To fulfill this duty, each employee must:

1) Comply with all organizational safety rules, policies and procedures;

2) Comply with all organizational operating rules, policies and procedures;

3) Immediately report all workplace accidents, injuries or illnesses involving the employee, or to which the employee is a witness, to a supervisor; and

4) Immediately report all unsafe conditions or hazards to a supervisor or the CEO, by submitting a NBS QI Incident or written Incident Report. Employees may report such conditions or hazards anonymously.

2.2.D. Contractors and Other Workers

In addition to all employees, this program covers all other workers who the organization contracts or directs and directly supervises on the job to the extent such workers are exposed to work site and job assignment specific hazards. All such workers must:

1) Attend all required meetings (including safety meetings);

2) Comply with all organizational safety rules, policies and procedures;

3) Comply with all organizational operating rules, policies and procedures;

4) Immediately report all workplace accidents, injuries or illnesses involving the employee, or to which the employee is a witness, to his or her supervisor;

5) Immediately report all unsafe conditions or hazards to a supervisor or to the CEO, using an Incident Report. Employees may report such conditions or hazards anonymously using this form; and

6) Such workers will receive appropriate training.

2.3.A. Hazard Assessment and Control

PRO will conduct regularly scheduled safety and health inspections. These inspections will be performed as follows:

Office - Quarterly

Garage - Quarterly

Company Vehicles - Daily

The purpose of these periodic inspections is to ensure that all identified hazards are corrected or controlled and to identify, correct and control any new hazards that have arisen in the workplace. A Professional Ambulance Safety Inspection Report Form and/or Vehicle Checklists will be utilized during these inspections.

The CEO will perform these periodic scheduled inspections or delegate the responsibility for performing such inspections.

In addition to scheduled inspections and ongoing review, the CEO may arrange for unscheduled, surprise inspections. The list of subjects for these inspections will be chosen randomly.

2.3.B. Employee Reporting of Hazards

Employees are required to immediately report any unsafe condition or hazard they discover in the workplace to a dispatcher, supervisor or the CEO. Submit a NBS QI Incident or written Incident Report for this purpose. No employee will be disciplined or discharged for reporting any workplace hazard or unsafe condition.

Employees who wish to remain anonymous may report unsafe conditions or hazards by submitting a NBS QI Incident without identifying themselves.

PRO takes all reports of unsafe conditions seriously. Prompt attention will be given to all actual and potential hazards that have been reported to the organization. PRO will inform the employee (if known to PRO) who reported the hazard of the action that was taken to correct the hazard or the reasons why the condition was determined not to be hazardous. There will be no discrimination against any employee who reports unsafe working conditions or workplace hazards. Indeed, employees are encouraged and required to do so.

2.3.C. Newly Discovered Safety and Health Concerns

PRO will respond to new workplace safety and health concerns as soon as they are discovered. All hazards will be corrected, controlled or abated in a timely manner based on the severity of the hazard. Any hazard that poses an imminent risk of harm to employees will be corrected immediately. All other hazards will be corrected as soon as feasible. If for any reason a hazard cannot be corrected, the CEO must be notified immediately, and the CEO will notify all exposed employees and follow all other notification requirements. Supervisors must report workplace safety and health concerns to the CEO immediately. The CEO or his designee will set a target date for correction of any hazards that cannot be abated immediately. Potentially affected employees will be notified of any newly identified hazard in a timely manner.

2.3.D. Hazards That Give Rise to a Risk of Imminent Harm

It is this organization's intent to immediately abate hazards which give rise to a risk of imminent harm. When a hazard exists that the organization cannot abate immediately without endangering employees and/or property, all exposed personnel will be removed from the area of potential exposure, except those necessary to correct the hazardous condition. All employees involved in correcting the hazardous condition will receive appropriate training and will be provided with necessary safeguards and personal protective equipment.

2.3.E. Correcting the Hazard and Preventing Recurrences

The CEO will ensure that the proper personnel are assigned responsibilities to take all steps necessary to correct the hazard and avoid similar accidents in the future. Preventive action will include, if necessary:

o Replacing all defective or broken tools and/or equipment.

o Revising or adding to the safety policies.

o Re-training Employees.

o Monitoring the hazard to ensure that it remains corrected or controlled.

2.3.F. Hazard Communication

1) Overview

PRO believes communication with employees concerning workplace hazards and the methods used to control them will help create the safest possible work environment. PRO, therefore, places a great deal of importance on communicating with employees about health and safety issues.

PRO's system for communicating with employees on safety and health issues include:

a) Providing a copy of the safety policies to every employee. Employees are required to read and be familiar with its terms.

b) Safety Committee meetings will be held every three months at a minimum and will be conducted by an employee designated by the CEO. The committee shall discuss issues such as:

i) New hazards that have been introduced or discovered in the workplace.

ii) Causes of any recent accidents or injuries and the methods adopted by the organization to prevent similar incidents in the future.

iii) Any health or safety issue deemed to be worthy of reinforcement.

c) Minutes of all Safety Committee meetings will be documented.

2) Anonymous Notification Procedures

PRO has a system of anonymous notification whereby employees who wish to inform the organization of workplace hazards may do so anonymously by submitting a NBS QI Incident without identifying themselves. The CEO will investigate all such reports in a prompt and thorough manner.

3) Postings and Emails

PRO will post and email safety or health information on a regular basis.

4) Company Memos

PRO will regularly issue memos and health and safety information in the newsletter. Most often, these memos will be sent to all staff via email.

5) Training

PRO has training requirements designed to instruct each employee on general safety procedures as well as on safety procedures specific to the employee's job. These training requirements are described in greater detail in the section entitled Safety and Health Training.

2.4.A. Ongoing Workplace Review

Every manager, supervisor, and employee must engage in daily, ongoing, safety and health monitoring and inspection of their work area. Any potential safety or health concerns should be reported to the dispatcher, a supervisor, or to the CEO.

2.4.B. OSHA Regulations

The Occupational Safety and Health Act of 1970 requires employers to ensure, so far as possible, every working woman and man in the nation, safe working conditions. The Act also requires employees to comply with occupational safety and health standards, since the purpose of the Act cannot be obtained without the fullest cooperation of the employees.

The CEO will review and be familiar with the provisions of the OSHA regulations relevant to the organization's workplace. Copies of these regulations will be kept in the CEO's office. All supervisory staff must review, be familiar with, and train their employees with regard to the portions of the safety orders that apply to their particular function.

2.4.C. New Matters

The CEO will arrange for an inspection/investigation of any new substance, process, procedure, or equipment introduced into the workplace. The CEO will also arrange for an inspection and investigation whenever the organization is made aware of a new or previously unrecognized hazard.

2.4.D. Specific Health Care Concerns

The CEO will ensure that all personnel in contact with patients are familiar with, and trained in, proper infection control and patient transfer procedures.

2.4.E. Documentation of Inspections

All scheduled or unscheduled inspections (except for the daily ongoing monitoring of work areas) will be documented on a Safety Inspection Report Form. If any item is rated as unsatisfactory, the person conducting the inspection must submit a NBS QI Incident or written Incident Report. These reports will be retained by the organization forever electronically.

2.5.A. Enforcement of the Safety Program

VIOLATION OF PRO'S SAFETY POLICIES OR SAFETY RULES MAY RESULT IN DISCIPLINE UP TO AND INCLUDING TERMINATION.

2.5.B. Safety and Health Training

Awareness of potential health and safety hazards, as well as knowledge of how to control such hazards, is critical to maintaining a safe and healthy work environment and preventing injuries, illness, and accidents in the workplace. PRO is committed to instructing employees in safe and healthy work practices. To achieve this goal, the organization will provide training to employees on general safety procedures and on any specific safety procedures for each employee's job. Training will be provided as follows:

1) Upon hiring;

2) Whenever an employee is given a new job assignment for which training has not previously been provided;

3) Whenever new substances, processes, procedures, or equipment that represents a new hazard are introduced into the workplace;

4) Whenever the organization is made aware of a new or previously unrecognized hazard; and

5) Whenever the organization, CEO, or any supervisor believes additional training is necessary.

2.5.C. Areas of Training for Employees

All employees will receive training on the following subjects:

o General Safe Work Practices

o Fire Procedures

o Safety Rules

In addition, employees will receive training on the specific hazards associated with their jobs.

2.5.D. Supervisor Training

Supervisors shall be apprised of, and provided with, appropriate training and instruction with regard to safety and health hazards to which employees may be exposed. To accomplish this task, the CEO or a designee will:

1) Conduct sessions for all supervisors informing them of any new substances, processes, procedures or equipment that have been introduced into the workplace;

2) Distribute written safety and health communications to the supervisors whenever the CEO believes it necessary to inform them of particular hazards or concerns;

3) Update the organization's safety rules, procedures and policies on a regular basis, and distribute the updates to all supervisors; and

4) Take all other actions necessary to keep the organization's supervisors informed about workplace hazards that may affect their employees.

2.5.E. Documentation of Training

Training will be documented using attendance sheets and via NBS. This documentation will be retained forever electronically.

2.5.F. Safety Committee

A Safety Committee has been established at PRO; however, SAFETY IS EVERYONE'S RESPONSIBILITY. Safety will be discussed regularly at the Safety Committee Meeting. The Safety Committee is responsible for ensuring compliance with the requirements of the Act and Company policy by investigating and eliminating unsafe and unhealthy working conditions.

2.6.A. Transferring

All patients will be transferred to or from the ambulance on the stretcher when necessary. Patients, who are readily ambulatory, such as psychiatric patients who are not flight risks, can be walked under close supervision.

o STRETCHER PATIENTS WILL ALWAYS BE SECURED TO THE STRETCHER WITH THREE STRAPS AND THE SHOULDER HARNESS.

o When transporting a patient on a stretcher the patient will be turned on a level surface and brought head first to the waiting ambulance.

o When rolling a stretcher patient, the stretcher should be maintained at one-half height and must be carefully handled by both crew members.

o Never leave a stretcher patient unattended

These actions serve to prevent patient tipping injuries.

2.6.B. Carrying

When carrying a patient down stairs, the patient always travels feet first when sitting up, and feet first when lying flat.

WHENEVER AN EMPLOYEE DOES NOT THINK THAT HE OR SHE IS ABLE TO SAFELY LIFT OR CARRY A PATIENT, THE EMPLOYEE IS REQUIRED TO CALL FOR A LIFT ASSIST. ALWAYS ERR ON THE SIDE OF CAUTION AND CALL FOR A LIFT ASSIST IF YOU THINK THAT YOU MAY NEED ONE.

DO NOT SEEK ASSISTANCE FROM OR ALLOW ANY UNTRAINED BYSTANDER TO AID IN MOVING ANY PATIENT.

When transporting a patient on a scoop stretcher or backboard, at least three straps must be used to secure the patient. For patient and employee safety, the patient is transferred to the stretcher in a lowered position. The restraints from the stretcher are then used to secure the patient and backboard.

2.7.A. Overview

The key to employee safety regarding the use of lifting equipment and the movement of patients is proper body mechanics. Before lifting the patient, the employee evaluates the situation, makes certain they are aware of what needs to be done and assures they have the necessary equipment and assistance to accomplish the task.

The equipment is positioned by placing the wheelchair, stretcher, or other equipment, as close to the patient as possible and in proper alignment for the shortest and easiest transfer. Necessary adjustments are made by raising or lowering the equipment to bed level or vice versa, and by lowering any handrails or side rails. These steps minimize the amount of lowering or lifting required. The wheels on the chair or bed must be locked.

Transfer the patient by sliding them as far as possible on a draw sheet, then lifting them smoothly onto the stretcher or other equipment. Holding the patient close helps balance and reduces strain on the arms and back. Keeping the feet apart provides a stable base and helps maintain balance, leaving more energy for lifting. Employees should use their arms and legs in proper proportion. Bending the elbows to hold the patient close makes the lift easier.

Lifting is always done in unison. When working with others, everyone must know what to do in advance and move at the same time as a team. Counting out loud may help. Sudden, jerky movements are to be avoided.

2.7.B. Body Mechanics

Moving any object safely depends on knowledge and understanding of these basic guidelines:

a) Balance

It takes a certain amount of effort just to balance the weight of one's own body. Keeping a low center of gravity over a stable base expends less energy by balancing the load, making more energy available for lifting and carrying.

b) Pull or Push When Possible

Less energy is used to pull or push than to lift an object. When lifting or carrying, the force must be overcome and the load balanced at the same time. By pulling or pushing, it is only necessary to overcome the friction between the object being moved and the surface on which it rests. The strongest muscles should be used.

c) Avoid Twisting

If it is necessary to turn while lifting or moving something, it is better to change the position of the feet than to twist at the waist. By moving the feet, it is possible to balance the load being carried and minimize the strain on the back and abdominal muscles.

2.7.C. Common Lifting Techniques and Equipment

The actual procedures used may vary slightly from those listed below, depending on the methods of training, the required movement, personnel and materials available.

a) From Stretcher
When transferring a patient from the stretcher, it is necessary to adjust the height so it is even with the bed. The attendants should stand on either side of the patient and grasp the draw sheet at the patient's shoulders and hips. A third attendant may be needed to support a patient's legs. Pulling the draw sheet tight, the attendants move the patient across the stretcher to the bed. The same method should be utilized when transferring a patient from the bed to the stretcher.

b) To Wheelchair
When helping a patient from a bed or stretcher to a wheelchair, the attendant should lift the patient, holding the patient around the waist. Holding the patient close, the attendant lifts, helping the patient rise to a standing position. The attendant then turns the patient and lowers him into the chair. Another method that is commonly used is where one attendant approaches the patient from behind, coming under the arms and grasping the patient's wrists. The second attendant takes the patient behind the knees and lifts the patient on a verbal count.

c) Think Ahead
Attendants should always think ahead and be sure to assess each patient's medical condition, strength, mobility, etc. before attempting to lift or carry. The patient should be informed exactly as to what is going to happen, so as to calm any fears and encourage their cooperation.

d) Don't Guess
Only those procedures with which the employee is familiar are to be used. Guessing what the procedure is, improvising, or failing to exercise proper judgment when lifting or moving a patient may be harmful to everyone.

e) OPERATIONS GUIDELINES FOR POWER PRO XT STRETCHER

1. Used the cot only as described in this manual.
2. Read all labels and instructions on the cot before using the cot.
3. Use a minimum of two (2) operators to manipulate the cot while a patient is on the cot. If additional assistance is needed.
4. Do not adjust, roll or load the cot into a vehicle without advising the patient. Stay with the patient and control the cot at all times.
5. The ambulance cot can be transported in any position. Stryker recommends transporting the patient in as low a position as is comfortable for the operators to maneuver the cot.
6. Only use the wheel lock(s) during patient transfer or without a patient on the ambulance cot.
7. Always use the restraint straps.
8. Use properly trained helpers when necessary to control the cot and patient.

   WARNING

9. Improper usage of the RUGGED POWER PRO XT ambulance cot can cause injury to the patient or operator. Operate the ambulance cot only as described in this manual.
10. Entanglement in powered ambulance cot mechanisms can cause serious injury. Operate the ambulance cot only when all persons are clear of the mechanisms.
11. Practice changing height positions and loading the ambulance cot until operation of the product is fully understood. Improper use can cause injury.
12. Do not allow untrained assistants to assist in the operation of the ambulance cot. Untrained technicians/assistants can cause injury to the patient or themselves.
13. Do not ride on the base of the ambulance cot. Damage to the cot could occur, resulting in injury to the patient or operator.
14. Transporting the cot sideways can cause the cot to tip, resulting in possible damage to the product and/or injury to the patient or operator. Transporting the cot in a lowered position, head or foot end first, will minimize the potential of a cot tip.
15. Grasping the cot improperly can cause injury. Keep hands, fingers and feet away from moving parts. To avoid injury, use extreme caution when placing you hands and feet near the base tubes while raising and lowering the ambulance cot.

    CAUTION

Before operating the cot, clear any obstacles that may interfere and cause injury to the operator or patient.

1. Always use all restraint straps to secure the patient on the cot. An unrestrained patient may fall from the cot and be injured.
2. Never leave a patient unattended on the ambulance cot or injury could result. Hold the ambulance cot securely while a patient is on the product.
3. Never apply the optional wheel lock(s) while a patient is on the cot. Tipping could occur in the cot is moved while the wheel lock is applied, resulting in injury to the patient or operator and/or damage to the cot.
4. Side rails are not intended to serve as a patient restraint device. Failure to utilize the side rails properly could result in patient injury.
5. Hydraulically raising and lowering the cot may temporarily affect electronic patient monitoring equipment. For best results, patient monitoring should be conducted when the cot is idle.

USING THE TRANSFER FLAT

When transferring large patients, use of the transfer flat is recommended.

AMBULANCE COT MOTION

1. Make sure all the restraint straps are securely buckled around the patient.
2. The cot can be in any position for rolling.
3. When rolling the cot with a patient on it, position an operator at the foot end and one at the head end of the cot at all times.
4. During transport, approach door sills and/or other lower obstacles squarely and lift each set of wheels over the obstacle separately.

   WARNING
   

High obstacles such as curbing, steps or rough terrain can cause the ambulance cot to tip, possibly causing injury to the patient or operator. Transporting the cot in lower positions can reduce the potential of a cot tip. If possible, obtain additional assistance or take an alternate route.

CAUTION

The ambulance cot can be set at any height position. Establish the required load height for the ambulance cot prior to placing the unit into service.

LOADING THE COT INTO A VEHICLE(OCCUPIED TWO OPERATORS) - POWERED METHOD

Loading an occupied cot into the vehicle requires a minimum of two (2) trained operators.
When loading the cot into a vehicle, an operator should remember the following important issues:

1. There must be a safety hook properly installed in the vehicle so that the bumper does not interfere with the front legs of the base frame.

   WARNING
   

Failure to install and use the vehicle safety hook can result in injury to the patient or operator. Installed and use the hook as described in this manual.

1. Cot operators must be able to lift the total weight of the patient, cot and any items on the cot. The higher an operator must lift the cot, the more difficult it becomes to hold the weight. An operator may need help loading the cot if he is small or if the patient is too large to lift safely.

   CAUTION
   

Loading, unloading or changing the position of a loaded ambulance cot requires a minimum of two (2) trained operators. The operator (s) must be able to lift the total weight of the patient, cot and any other items on the cot.

Place the cot in a loading position (any position where the loading wheels meet the vehicle floor height). Roll the cot to the open patient compartment. Lift the vehicle bumper to the raised position (if possible).
Push the cot forward until the load wheels are on the patient compartment floor and the safety bar passes the safety hook.

For maximum clearance to lift the base, pull the cot to lift the base, pull the cot back until the safety bar engages the safety hook. Operator two should verify that the bar engages the safety hook.

Operator 1- Grasp the cot frame at the foot end and push the retract (-) button until the undercarriage of the cot retracts fully.

Operator 2- Securely grasp the cot outer rail to stabilize the cot during retraction.

Both Operators- Push the cot into the patient compartment, until the cot engages the cot fastener.

WARNING

When using a standard ambulance cot fastener, do not load the cot into the vehicle with the head section retracted. Loading the cot with the head section retracted may cause the product to tip or not engage properly in the cot fastener, possibly causing injury to the patient or operator and/or damage to the cot.

HIGH SPEED RETRACT/EXTEND

1. The ambulance cot is equipped with a high-speed retract mode to expedite loading/unloading the cot into and out of a vehicle.
2. The undercarriage rapidly retracts towards its uppermost position once the weight of the ambulance cot and patient is off the wheels. Press the retract (-) button to actuate the control switch.
3. The undercarriage rapidly extends towards its lowermost position once the weight of the ambulance cot and patient is off the wheels. Press the extend (+) button to actuate the control switch.

   WARNING
   

Whenever the weight of the ambulance cot and patient is off the wheels, the ambulance cot will automatically enter the high speed retract mode is the retract (-) button is pressed.
Once the weight is off the ground, the operator(s) must support the load of the patient, ambulance cot and any accessories. Failure to support the load properly may cause injury to the patient or operator.

LOADINNG THE COT (OCCUPIED) INTO A VEICLE WITH TWO OPERATORS AT THE FOOT END

1. Place the cot in a loading position (any position where the loading wheels meet the vehicle floor height). Roll the cot to the open patient compartment. Lift the vehicle bumper to the raised position (if possible).
2. Push the cot forward until the load wheels are on the patient compartment floor and the safety bar passes the safety hook.
3. For maximum clearance to lift the base, pull the cot back until the safety bar engages the safety hook. One operator should remain at the foot end while the second operator engages the safety hook as described above.
4. The second operator should return to the foot end both operators should lift the cot while one operator push the retract (-) button until the undercarriage of the cot retracts fully.
5. Both operators should push the cot into the patient compartment, until the cot engages the cot fastener (not included).

LOADING THE COT INTO A VEHICLE (SINGLE OPERATOR) – POWERED METHOD

Loading an unoccupied cot into the emergency vehicle can be accomplished by a single operator.

WARNINGS

1. The one person loading and unloading procedures are for use only with an empty ambulance cot. Do not use the procedures when loading/unloading a patient. Injury to the patient or operator could result.
   
   
   1. Place the ambulance cot into a loading position (any position where the load wheels of the head section meet the vehicle floor height).
   2. Roll the ambulance cot to the open door of the patient compartment.
   3. Lift the vehicle bumper to the raised position (if possible).
   4. Push the ambulance cot forward until the load wheels are on the patient compartment floor and the safety bar passes the safety hook.
   5. For maximum clearance to lift the base, pull the ambulance cot until the safety bar engages the safety hook. Operator two should verify that the bar engages the safety hook.
   6. Grasp the ambulance cot frame at the foot-end and press the retract (-) button, until the undercarriage of the ambulance cot retracts into its uppermost position.
   7. Push the ambulance cot into the patient compartment until the ambulance cot engages the cot fastener.
   
   
2. When using a standard ambulance cot fastener, do not load the cot into the vehicle with the head section retracted. Loading the cot with the head section retracted may cause the cot to tip or not engage properly in the cot fastener, possibly causing injury to the patient or operator and/or damage to the cot.

UNLOADING THE COT FROM A VEHICLE- POWERED METHOD

Unloading the cot from the vehicle while a patient is on the cot requires a minimum of two (2) operators, positioned at each end of the ambulance cot. Each operator must grasp the ambulance cot frame securely.
Disengage the cot from the cot fastener.
Lift the vehicle bumper to the raised position (if possible).

WARNINGS

1. Do not press the extend (+) button until the safety bar engages the safety hook.
   
   
   1. Operator 1- Grasp the ambulance cot out of the patient compartment until the safety bar engages the safety hook. Operator two should verify that the bar engages the safety hook.
   
   
2. To avoid injury, verify the safety bar has engaged the safety hook before removing the ambulance cot from the patient compartment.
   
   
   1. Operator 2- Stabilize the cot during the unloading operation by securely grasping the outer rail.
   2. Operator 1- Depress the extend (+) button to lower the undercarriage to its fully extended position.
   3. Operator 2- Push the safety bar release lever forward to disengage the safety bar from the safety hook in the patient compartment.
   
   
3. Do not pull or lift on the safety bar when unloading the cot. Damage to the safety bar could result in injury to the patient or operator could occur.
   
4. Remove the load wheels from the patient compartment of the vehicle.

   CAUTION

1. When unloading the cot from the patient compartment, ensure the caster wheels are safely set on the ground or damage to the product may occur.
2. Do not “jog” the cot past the load height while the safety bar is engaged.
3. Unloading an unoccupied ambulance cot from a vehicle can be accomplished by a single operator.

UNLOADING THE COT FROM A VEHICLE – POWERED METHOD

WARNINGS

1. The one person loading and unloading procedures are for use only with an empty ambulance cot. Do not use the procedures when unloading a patient. Injury to the patient or operator could result.
   
   
   1. Disengage the cot from the cot fastener.
   2. Lift the vehicle bumper to the raised position (if possible).
   3. Grasp the cot frame at the foot end. Pull the cot out of the patient compartment until the safety bar engages the safety hook. Operator two should verify that the bar engages the safety hook.
   
   
2. Do not pull or lift on the safety bar when unloading the cot. Damage to the safety bar could result and injury to the patient or operator could occur.

1. Depress the extend (+) button to lower the undercarriage to its fully extended position.
2. Push the safety bar release lever forward to disengage the safety bar from the safety hook in the patient compartment.
3. Remove the load wheels from the patient compartment of the vehicle.

CAUTION

When unloading the ambulance cot from the patient compartment, ensure the caster wheels are safely set on the ground or damage to the cot may occur.
Do not “jog” the cot past the load height while the safety bar is engaged.

LOADING THE COT INTO A VEHCILE- MANUAL METHOD

To load the cot with the manual release:

Place the cot in a loading position (any position where the loading wheels meet the vehicle floor height). Roll the cot to the open door of the patient compartment. Lift the vehicle bumper to the raised position (if possible).

Push the cot forward until the loading wheels are on the patient compartment floor and the safety bar passes the safety hook.

For maximum clearance to lift the base, pull the cot back until the safety bar engages the safety hook.

1. Operator 1 – Grasp the cot frame at the foot end. Lift the foot end of the cot until the weight is off the latching mechanism. Squeeze and hold the release handle.
2. Operator 2 – Stabilize the cot by placing your hand on the outer rail. Grasp he base frame, after the foot end operator has lifted the cot and squeezed the release handle, raise the undercarriage until it stops in the uppermost position and hold it there,
3. Both Operators – Push the cot into the patient compartment, engaging the cot fastener.
   
   NOTE – When operating the manual release, avoid rapid lifting or lowering of the base o movement may appear sluggish; lift with a slow constant motion.

UNLOADING THE COT FROM A VEHICLE – MANUAL METHOD

Unloading the cot from the vehicle while a patient is on the cot requires a minimum of two (2) operators, positioned at each end of the ambulance cot. Each operator must grasp the ambulance cot frame securely.
Disengage the cot from the cot fastener. Lift the vehicle bumper to the raised position (if equipped).

Operator 1 – Grasp the ambulance cot frame at the foot end. Pull the manual release lever to lower the undercarriage to its fully extended position. Pull the cot out of the patient compartment until the safety bar engages the safety hook. Operator two should verify that the bar engages the safety hook.

WARNINGS

1. To avoid injury, verify the safety bar has engaged the safety hook before removing the ambulance cot from the patient compartment.
   
   
   1. Operator 2 – Stabilize the cot during the unloading operation by securely grasping the outer rail.
   2. Operator 2 – Push the safety bar release lever forward to disengage the safety bar from the safety hook in the patient compartment.
   
   
2. Do not pull or lift on the safety bar when unloading the cot. Damage to the safety bar could result and injury to the patient or operator could occur.
   
3. Remove the load wheels from the patient compartment of the vehicle.

   CAUTION
   

When unloading the cot from the patient compartment, ensure the caster wheels are safely set on the ground or damage to the product may occur.

UNLOADING THE COT FROM A VEHICLE – MANUAL METHOD

Unloading an unoccupied ambulance cot from a vehicle can be accomplished by a single operator.

WARNINGS

The one person loading and unloading procedures are for use only with an empty ambulance cot. Do not use the procedures when unloading a patient. Injury to the patient or operator could result. Disengage the cot from the cot fastener. Lift the vehicle bumper to the raised position (if possible). Grasp the cot frame at the foot end. Pull the manual release lever to lower the undercarriage to its fully extended position. Pull the cot out of the patient compartment until the safety bar engages the safety hook. Operator two should verify that the bar engages the safety hook. Do not pull or lift on the safety bar when unloading the cot. Damage to the safety bar could result and injury to the patient or operator could occur. Remove the load wheels from the patient compartment of the vehicle.

CAUTION

When unloading the ambulance cot from the patient compartment, ensure the caster wheels are safely set on the ground or damage to the product may occur.

Hydraulic fluid will become more viscous when the cot is used for extended periods in cold temperatures.

When using the manual release function to extend the base during unloading in cold weather conditions, hold the release lever engaged for approximately one second after the cot wheels touch the ground to minimize sagging of the litter as the cot is removed from the ambulance.

ADJUST THE COT HEIGHT

Changing height of the cot while a patient is on the cot requires a minimum of two (2) operators, positioned at each end of the ambulance cot.

1. Operator 1 – Grasp the ambulance cot frame at the foot-end. Actuate the control switch, depress either the (+) or (-) button depending on desired travel direction, and allow the littler to raise/lower to the desired position.
   
2. Operator 2 – Maintain a firm grip on the outer rail until the ambulance cot is securely in position.
   

   WARNING
   

Grasping the ambulance cot improperly can cause injury. Keep hands, fingers and feet away from moving parts. To avoid injury, use extreme caution when placing your hands and feet near the base tubes while raising and lowering the ambulance cot. 

NOTE: If the push button switch remains activated, the motor will remain halted until the operator releases the button. Once the push button is released, actuate the extend (+) button again to “jog” the cot height up further.

CAUTION

Do not “jog” the ambulance cot past the established load height of the product when the safety bar engages the vehicle safety hook or damage may occur to the product.

OPERATING THE RETRACTABLE HEAD SECTION

The head section telescopes from a first position suitable for loading the ambulance cot into an emergency vehicle to a second position retracted within the litter frame. When retracted, the ambulance cot can roll in any direction on the caster wheels even in the lowest position, allowing improved mobility and maneuverability.

To extend the head section:

1. Grasp the outer rail with one hand for support and release the lever, rotate the lever towards the head end of the cot to release the head section from the locked position.
2. While holding the handle in the released position, pull the head section away from the litter frame, lengthening the head section until it engages in the fully extended position.

To retract the head section:

1. Grasp the outer rail with one hand for support and release the lever, rotate the lever towards the head end of the cot to release the head section from the locked position.
2. While holding the handle in the released position, push the head section toward the litter frame, retracting the head section until it engages in the retracted position.

   WARNING
   

To avoid injury, always verify that the head section is locked into place prior to operating the ambulance cot.
When using a standard ambulance cot fastener, do not attempt to load the ambulance cot into the patient compartment with the head section retracted. Loading the ambulance cot with the head section retracted may cause the cot to tip or not engage properly in the cot fastener, possibly causing injury to the patient or operator and/or damage to the cot.

BATTERY OPERATION

The ambulance cot is supplied with two removable 24-volt batteries as the power source. To install the battery, align the tabs in the battery enclosure and push the battery into the enclosure until the latch clicks into place.

To remove the battery, locate the red battery release along the patient left side of the foot end control enclosure. Push the battery release the latch. Slide the released battery out of the left.

To reinstall the battery, align the tabs in the battery enclosure and push the battery into the enclosure until the latch clicks into place. The indicator will light GREEN, if the battery is fully charged or has adequate battery power. If the indicator flashes red, the battery needs to be charged or replaced.

NOTE: Keep your spare battery on the charger at all times. Batteries slowly lose power when not on the charger.

WARNING

1. To avoid risk of electric shock, never attempt to open the battery pack for any reason. Ifi the battery pack case is cracked or damaged, do not insert it into the charger. Return damaged battery packs to a service center for recycling.
2. Do not remove the battery when the ambulance cot is activated.
3. Avoid contact with a wet battery enclosure. Contact may cause injury to the patient or operator.

   CAUTION
   

Remove the battery if the cot is not going to be used for an extended period of time (over 24 hours).

CLEANING

The RUGGED POWER PRO XT ambulance cot is designed to be power washable. The unit may show some signs of oxidation or discoloration from continuous washing, however, no degradation of the cot’s performance characteristics or functionality will occur due to power washing as long as the proper procedures are forward.

Thoroughly clean the cot once a month. Clean Velcro AFTER EACH USE. Saturate Velcro with disinfectant and allow disinfectant to evaporate. (Appropriate disinfectant for nylon Velcro should be determined by the service.)

WASHING PROCEDURE

1. Remove the battery! The battery and charger are not imersible or power washable.
2. Follow the cleaning solution manufacturer’s dilution recommendations exactly.
3. The preferred method Stryker Medical recommends for power washing the ambulance cot is with the standard hospital surgical cart washer or hand held wand unit.

WASHING LIMITATIONS

WARNING

Use any appropriate personal safety equipment (goggles, respiratory, etc.) to avoid the risk of inhaling contagion. Use of power washing equipment can aerate contamination collected during the use of the cot.

CAUTION

1. DO NOT STEAM CLEAN OR ULTRASONICALLY CLEAN THE UNIT.
2. Maximum water temperature should not exceed 180Deg F / 82Deg C.
3. Maximum air dry temperature (cart washers) is 240Deg / 115Deg C.
4. Maximum water pressure should not exceed 1500 psi / 130.5 bar. If a hand held wand is being used to wash the unit, the pressure nozzle must be kept a minimum of 24 inches (61 cm) from the unit.
5. Towel dry all casters and interface points.
6. Failure to comply with these instructions may invalidate any/all warranties.
7. Remove the battery before washing the cot.

In general, when used in those concentrations recommended by the manufacturer, either phenolic type or quaternary type disinfectants can be used. Iodophor type disinfectants are not recommended for use because staining may result.

Suggested cleaners for the cot surfaces are:

1. Quaternary Cleaners (active ingredient – ammonium chloride)
2. Phenolic Cleaners (active ingredient – o-phenyl phenol)
3. Chlorinated Bleach Solution (5.25% - less than 1 part bleach to 100 parts water)

Avoid over saturation and ensure the cot does not stay wet longer than the chemical manufacturer’s guidelines for proper disinfecting.

WARNING

SOME CLEANING PRODUCTS ARE CORROSIVE AND MAY CAUSE DAMAGE TO THE COT IF USED IMPROPERLY. If the products above are used to clean the cots, measures must be taken to insure the cots are wiped with clean water and thoroughly dried following cleaning. Failure to properly rinse and dry the cots will leave a corrosive residue on the surface of the cots, possibly causing premature corrosion of critical components.

NOTE: Failure to follow the above directions when using these types of cleaners may avoid this products warranty.

REMOVAL OF IODINE COMPOUNDS

Use a solution of ½ tablespoons Sodium Thiosulfate in a pint of warm water to clean the stained area. Clean as soon as possible after staining occurs. If stains are not immediately removed, allow solution to soak or stand on the surface. Rinse surface which have been exposed ti the solution in clear water before returning unit to service.

WARNING

Failure to properly clean or dispose of contaminated mattress or cot components will increase the risk of exposure to blood borne pathogens and may cause injury to the patient or the operator.

h) Use of the Stair Chair – STRYKER Chair Pro (new stair chair)

These guidelines are based on a STRYKER Chair Pro stair chair. The STRYKER Chair Pro chair is designed to aid in the movement of a patient in a seated position either by rolling on the wheels or by carrying in situations where a larger device, such as a stretcher, cannot be maneuvered. These instructions are general. Attendants should secure the patient with restraints and should never leave the patient unattended.

1. Operational Features

The maximum load on this specific piece of equipment is 500 pounds (159 kg). To open the chair, grasp the seat and back frame and separate them. The chair should be unfolded completely with the locks engaged. The locking of the chair should be confirmed visually by checking that both sides of the lock bar are engaged. The locking of the chair should also be confirmed visually by checking that both sides of the lock bar are engaged over the crossbar. To fold the chair, lift the lock bar, grasp the seat frame and pull it toward the head frame.

2. Carrying Handles

Handles are provided at the head and the foot of the chair. Handles should be used on all transports. A firm grip on the handles with the palms of the hands is necessary, because the palms are stronger than the fingers alone. If you elect to not use the handles on the chair you must be certain that your grip is certain and sure.

3. Restraints

The chair is equipped with two restraints for patient security. They should be used whenever there is a patient on the chair. The restraints support the patient's legs and feet, preventing them from swinging their legs from side to side. The other restraint is secured around the patient's chest to ensure that the patient does not fall off the side.

4. Placing the Patient

A recognized patient handling technique should be used to place the patient on the chair.

5. Securing the Patient

After placing the patient on the chair and fastening the restraints, the attendants move to positions at the front and rear of the chair. The rear attendant grasps the chair frame then tilts the chair back until the weight is balanced on the chair wheels. The chair can be rolled without lifting.

6. Carrying the Patient

To carry the patient, the same tilt-back and balance procedures are used. The attendants grasp the front and rear carrying handles simultaneously, using the "3" count method. On level surfaces, the front carrying handles should be in the stored position. The front attendant may face either direction while carrying. When carrying on stairs, the front attendant should have the carrying handles in the up position and should face the patient.

i) Stair Chair - Sirocco (old stair chair)

1. General Operation Guidelines

1. Chair operation requires a minimum of two trained operators.
2. Operators may need help when working with heavy patients.
3. Follow standard emergency patient-handling procedures when operating the chair.
4. Stay with the patient at all times.
5. Always use the patient restraints/seatbelts.

2. Unfolding the Chair (Before Rolling the Chair)

Release the upper handle and move it to the upright position. Be sure the patient's back is fully against the back panel. If using the head pad, be sure the patient's head is properly and comfortably positioned on the pad and ensure that the restraints are fastened and adjusted.

3. Rolling the Chair on Level Surfaces

The control operator shall adjust the upper handle to a comfortable position, making sure the brake is in the "Off" position. Push the two-wheel lock pin to the right so the chair can roll on four wheels. Lean the chair back until the patient's weight is on the wheels and begin rolling the chair. The assisting operator should be ready to help the control operator roll the chair over doorframes and other obstacles. Use the lover handle to lift the chair if necessary.

4. Rolling the Chair in Confined Spaces

When rolling the chair in confined spaces, the wheel assemblies can be locked in the two-wheel position to gain additional maneuverability.
The control operator pushes the two-wheel lock pin to the left "On" so the chair can roll on two wheels. Lean the chair back until the patient's weight is on the wheels, and there are only two wheels contacting the floor. Then begin rolling the chair.
The assistant operator should be ready to help the control operator roll the chair over doorframes and other obstacles. Use the lower handle to lift the chair if necessary.

5. Rolling the Chair Down Stairs

Once the patient is seated and restrained, both operators will adjust the upper and lower handles to the lifting positions. If necessary the control operator shall raise or lower the upper-handle shaft to provide a better grip. Push the two-wheel lock pin to the right "Off" to allow the wheel assemblies to rotate as you go down the stairs. Push the brake lever down "On" to help control wheel assembly rotation speed as you go down the stairs.

The assistant operator will stand in position on the stairs and grasp the lower handle.

The control operator will lean the chair back until the patient's weight is on the wheels and position the wheel assemblies squarely at the top of the stairs. Both operators will roll the chair down the stairs. The control operator guides the chair and the assistant operator assists as required.

When rolling the chair down stairs, the operators can pause, providing they maintain a firm grip on the upper and lower handles.

If there is a need to maneuver the chair on the stairs, the control operator may need to adjust the upper-handle shaft to a higher or lower position.

6. Rolling the Chair Up Stairs

Once the patient is seated on the chair and restrained, adjust the upper and lower handles to the lifting positions. If necessary, the control operator shall raise or lower the upper-handle shaft to provide a better grip. Push the two-wheel lock pin to the right "Off" to allow the wheel assemblies to rotate as you go up the stairs. Verify that the brake lever is "Off" so the wheel assemblies will rotate freely as you go up the stairs.

Once both operators are in position and grasping the handles, lean the chair backward until the patient's weight in on the transport wheels. Roll the chair to the foot of the stairs, positioning both wheel assemblies squarely against the stair riser. Both operators will then roll the chair up the stairs. The control operator guides and pulls the chair and the assistant operator pushes.

2.7.D. Breaks and Rest Cycles

PRO allows all field providers who work shifts of more than four (4) consecutive hours, a reasonable rest period with pay. All employees shall be authorized and permitted to take rest periods which, insofar as practicable shall be in the middle of each work period. Employees are also afforded a rest period between the hours of 22:00 - 06:30. PRO may interrupt a rest period for emergency calls, non-emergency calls, stand-bys, and post coverage when necessary.

All PRO personnel are issued a sleeping bag for use at PRO base sleeping quarters. The use of any Hospital linens is strictly prohibited at PRO base sleeping quarters.

It is the intent of PRO to provide a safe environment for all its employees. Accident and injury prevention is an important part of your job. By working together, we can achieve a safer workplace. Your ideas and safe working practices are extremely important to a successful safety program. PRO will endeavor to make safety everyone's responsibility.

The purpose of a loss control program is to protect our employees, the patient and the organization. Its main function is to eliminate or reduce hazards within our organization, which in turn decreases the probability of loss. When losses occur, they adversely affect productivity, efficiency, and health. Loss Control's objective is to minimize the adverse effects of these factors in our workplace. A few individuals cannot accomplish this goal; it requires every employee to become involved in order for it to be successful.

PRO's ongoing process to manage loss control and risk involves all aspects of PRO's safety policies and is predominantly focused on the work of the Safety Committee. The Safety Committee manages the ongoing process of assessing risk and mitigating hazards through observation and subsequent implementation of improved practices and/or safety measures. Safety Committee minutes will show assessed risks, the follow-up plan implemented to reduce risks and the results of these efforts.

2.9.A. Vehicle Contacts

The National Safety Council's study, entitled Accident Facts, looked at emergency vehicle crashes over a nine-year period between 1986 and 1994. They found that ambulances average 2,956 accidents annually. That is eight (8) accidents every day that involve an ambulance. Out of those statistics, the average number of fatalities involving an ambulance accident is one person every two weeks.

When you consider the amount of time you spend driving, your chance of a vehicle contact certainly increases by virtue of being on the road all day. It is understandable that some vehicle contacts are avoidable while others are not.

As an employee of PRO, you have been instructed in the safe operation of an emergency vehicle by supervisors and senior staff. It is imperative to understand exactly what to do if you find yourself involved in a company vehicle contact.

2.9.B. General Guidelines

1) Vehicle Contact Information

If you are involved in a vehicle contact with a company vehicle:

All vehicle contacts involving company vehicles will be reported immediately to the dispatcher who will notify a supervisor. If you are injured and are able to visually assess the situation notify dispatch of what kind of help you require. If you are not injured, you are to assess the situation and instruct dispatch of the help you require. It is important to render medical assistance to any other party involved.

A Post Motor Vehicle Contact Kit is in each ambulance in the BLS Cabinet E. It contains a one-time use camera and PRO’s Accident Policy. This Kit must be used in the event of a vehicle contact.

At a minimum the following information should be obtained:

o Name and address of operator

o Name and address of owner

o Make, model, and year of vehicle involved

o Registration number of vehicle and validity of inspection sticker

o Driver's license number/state of operator

o Insurance company

o Names and addresses of all passengers

o Names and addresses of all injured parties

o Location and time

o Damage sustained to all vehicles

o Name of responding police officer

With the Camera enclosed in the Vehicle Contact Kit found in every ambulance:

o All four (4) sides of the ambulance with close ups of damaged areas;

o All four (4) sides of other vehicle(s) involved with close ups of any damage;

o The street behind and ahead of the vehicle contact;

o Any Stationary objects involved in the vehicle contact; and

o If you run out of pictures on the camera, advise dispatch to bring another camera.

2) Vehicle contacts occurring with a patient on board

If the patient being transported is stable, there are no injuries, and damage is minimal, advise the other party or parties involved that police are en route and proceed to the hospital with your patient. Advise dispatch of the location of the accident

If the patient being transported is unstable, no serious injuries have been incurred, and damage is minimal, advise the other party involved that the police and another ambulance are en route and proceed to the hospital with your patient. Advise dispatch of the location of the accident.

In situations where the patient is stable and injuries have been incurred, notify dispatch to send any help that you require. If the patient being transported and crew are uninjured, you are to remain on scene until another ambulance arrives, then proceed to the hospital with your patient.

In situations where there is an unstable patient and serious injuries are incurred, the crew should exercise their best judgment and request appropriate assistance from dispatch or a supervisor.

3) Vehicle contacts occurring while responding to a call

If you are involved in a vehicle contact while responding to an emergency call you must notify dispatch immediately. If another ambulance is available to respond within a reasonable time frame the dispatcher will send another ambulance to the original call.

Dispatch may determine that the circumstances dictate that the ambulance involved in the vehicle contact should continue on the original response based on the nature of the call or an inordinate delay in the response of another unit. If there are no injuries, and damage is minimal, advise the other parties involved that police are en route and proceed to the emergency call.

In situations where injuries have been incurred, notify dispatch to send any help that you require and render treatment and transport as necessary.

2.9.C. Accident Investigation and Review

All work related accidents will be investigated in a timely manner. Minor incidents and near misses will be investigated as well as serious accidents. A near miss is an incident that, although not serious, could have resulted in a serious injury or significant property damage. Investigation of these instances may avoid serious accidents in the future.

1) Responsibility For Accident Investigation

A supervisor or the CEO must investigate all work related accidents. After investigating an accident, a supervisor must submit a NBS QI Incident or written Incident Report. The CEO will ensure that the investigation was thorough and that proper action has been taken to avoid similar accidents in the future.

2) Procedures for Investigating Accidents

All accidents shall be investigated as soon as possible. In conducting an inquiry, the supervisor investigating the accident, at a minimum, shall:

a) Visit the accident scene if possible. This will ensure the facts are still fresh in the witnesses' minds.

b) The investigator should interview the employee as soon as he is physically and mentally able.

c) Interview witnesses to the accident either at the scene or as soon after the accident as possible.

d) Document details graphically, using photographs, sketches, or diagrams wherever appropriate.

e) Submit a NBS QI Incident or written Incident Report.

f) Save or preserve all physical evidence.

3) Reporting Procedures

Accidents resulting in personal injury, death, or property damage, shall be reported to the Office of Emergency Medical Services (OEMS) within five days following any accident involving an ambulance. The written report shall be a copy of the approved Registry of Motor Vehicles Operator's Report of Motor Vehicle Accident.

The driver must complete an Operator's Report of Motor Vehicle Accident after any accident involving a company vehicle.

All Accident Reports and Incident Reports or NBS QI Incident submissions must be completed by both crew members prior to the end of your shift.

All employees will document any injuries sustained. Any employee involved in an accident will not make any statement to anyone on scene, aside from the responding officer and the supervisor.

2.9.D. Safety Committee

The Safety Committee will review selected accidents involving a PRO vehicle as determined by the CEO. Employees involved in a collision will be invited to attend the meeting in order to present the facts of the case. The Safety Committee will make a ruling based upon whether it could be deemed as a preventable accident. The employee will be notified of the ruling immediately following the meeting.

All accidents may subject the employee to the following disciplinary actions:

a) Non-preventable accident;

1. No action

b) First preventable accident may include one or all of the following;

1. Driver Remediation

2. Written Warning

c) Second preventable accident;

1. Termination

See Professional Ambulance Service Health and Safety Plans in NBS.

3.1.A. Arriving On Time

Crews are encouraged to arrive at least 10 minutes prior to scheduled start time. It is your responsibility to determine ambulance assignment, and prepare your vehicle for service by your scheduled start time. All PRO crew members are assigned a permanent Key FOB and Radio to keep. They must ensure that they bring these items with them to every shift, and if they are missing either item, they should report it to a Supervisor.

3.1.B. Ambulance and Equipment Assignment

After punching in you should immediately:

• alert the dispatcher you're in; and
  
  
• determine your ambulance assignment;
  

3.1.C. Preparing Your Vehicle For Service

1.) Cleanliness

Vehicles should be clean (interior and exterior). Your assigned vehicle should have been cleaned by Support Services. If your vehicle is not clean it is your responsibility to notify a Supervisor. This will allow the supervisory staff to address the problem with Support Services. You may need to clean, check, and stock your unit.

2.) Preventive Maintenance

Vehicle preventive maintenance should occur after every shift. The crew should ensure that there is a Green Tag in the unit they are assigned to before removing the unit from the garage. The Green Tag shows that a Daily Vehicle Checklist has been completed and the unit has been checked by a Support Services Technician.

If for any reason the Green Tag is not in the vehicle you should assume the checkout was not completed. If this is the case, check with the Support Services Technician on duty for further details. If there is no Support Services staff available, crew members should complete a Daily Vehicle Checklist themselves prior to putting the unit into service.

It is important to let the dispatcher or a Supervisor know if either the DVC was not started or completed.

Regardless, you should always do a walk around exterior inspection noting the following:

• Deteriorated condition of paint and body
  
  
• Presence of fluids on ground under vehicle
  
  
• Condition of tires (low pressure, cuts, bubbles, missing lug nuts, etc.)
  
  
• Emergency lights

The items noted previously are checked as part of the daily preventive maintenance check, however, it is good practice to take a walk around your ambulance prior to turning a wheel as you will be the one operating the vehicle in emergency situations throughout the day. It's in your best interest to ensure there is no unreported damage, leaking fluids that may cause critical faults or emergency light(s) or switches that may have been deactivated.

Report any and all vehicle problems, broken equipment or damage to the dispatcher and/or Supervisor. A "Vehicle Maintenance Report" should be completed and turned into dispatch or a supervisor as soon as the discrepancy is realized. The absence of a "Vehicle Maintenance Report" signifies no damage/no repairs needed and that the vehicle, when assigned, was in perfect working order.

3.) Checklists

a) Daily Vehicle Checklist (DVC): A Daily Vehicle Checklist (DVC) must be completed for each shift. Each checkbox should be checked. A continuous straight line marked through multiple checkboxes is not acceptable. If you are on multiple shifts (16, 24, etc.) in the same vehicle only one checklist will be required. * While normally you will remain in the same vehicle for a 24 hour shift, on some occasions you may have to switch ambulances during the shift. In this case, you will be required to ensure that a DVC for that vehicle has been completed via a Green Tag present in the Ambulance. *During extreme weather it may be necessary to check vehicle fluids every eight hours

The unit should have a Green Tag before the unit leaves the base.

Cabinets that have broken seals should be inventoried and restocked by Support Services. Only Supervisors and the Support Services Officer have seals for cabinets.

Supervisors or the Support Services Officer will re-inventory the cabinet before it is resealed to provide another check to enhance the integrity of the system.

Crews should make an attempt to have cabinets resealed by a Supervisor or Support Services prior to leaving the base. If a Supervisor and Support Services are unavailable, make a notation on your checklist that the cabinet has been inventoried and restocked, but has been left unsealed.

b) Vehicle Audit Checklist (VAC): To ensure compliance with this policy, Supervisors or the Support Services Officer will routinely "Audit" units. Each ambulance will be audited at random times, on a weekly basis. The purpose of a vehicle audit is first, to ensure the integrity of the equipment onboard all units and second, to ensure DVCs are filled out accurately.

c) Vehicle Compliance Checklist (VCC): As part of your daily duties, you may be required to "strip" an ambulance and complete a Vehicle Compliance Checklist (VCC). Each ambulance will have a VCC completed at least once every nine weeks.

The purpose of the VCC is to ensure the integrity of the equipment onboard all units, to ensure sealed cabinets are compliant with State regulations, to ensure PRO's DVC policy is effective, and to maintain a clean and hazard-free environment in the ambulance.

4. ALS Drug Books

The ALS drug books must be initialed by BOTH crew members prior to beginning each shift. This may seem like a small item but the law requires it. These books will also be audited on a regular basis to ensure proper initials and counts.

3.1.D. Placing Your Ambulance In-service

After preparing your vehicle for service, as outlined in the preceding section, you should carry out the following steps to place your vehicle in service:

1. Gather your belongings (lunch bag, cooler, rain gear, backpack, etc.) and place them in your ambulance in such a way as to keep them from becoming projectiles in a crash i.e. secured behind seats.

2. Ensure that a DVC has been completed by Support Services Technician by the existence of a Green Tag on the dashboard.

3. You should immediately leave the base and head to your posting location, appropriate facility as directed by the dispatcher, or a centralized location. Throughout your shift the dispatcher will assign you to man a specific post. Assignments can come over the radio or by your pager. It is your responsibility to proceed directly to the assigned post area once you have been instructed by the dispatcher.

3.2.A. Crew Member Responsibilities

1.) Driver

Responsible for mechanical aspects of vehicle and tools, clean-up, make-up and restocking following calls. The driver also has a responsibility to assist the attendant with paperwork and other duties when necessary or requested.

The driver is also primarily responsible for reporting the following events to dispatch for entry into RightCAD:

• Vehicle in service and start of shift
  
• Acknowledging call
  
• En route to scene ("Responding")
  
• On scene ("Out")
  
• Pt contact
  
• Delayed on scene/waiting
  
• Transporting ("Occupied")
  
• On arrival at destination/facility (with mileage)
  
• Delayed at destination/facility
  
• Clear/in service
  
• Returning to/In the primary service area ("City")

2.) Attendant

Primarily responsible for patient care when the unit is occupied. Responsible for completing paperwork (keep in mind both crew members are responsible for what is in the paperwork). The attendant is also responsible to assist the driver with clean-up, restocking, and other duties when necessary or requested.

Remember, these are the divisions of labor, but they should not prohibit crew members and crews from working together and assisting in proper completion of all duties.

If your partner or another crew needs and/or asks for assistance, and your duties are completed or not as pressing, step in and help.

Develop a good working relationship with your partner, not an adversarial or mechanical one. Without working together on a scene, be it a routine transfer or a life-threatening emergency, the only people who suffer will be the patients. Personal disputes and individual personal problems are your own. Do not bring them to a scene and impose them on a patient's safety or comfort. Doing so is unacceptable and inexcusable.

3.2.B. Returning To Service Following A Call

Returning to service and getting ready to respond to the next call is critical. Once patient care is properly transferred to the receiving staff, the crew's primary focus must be on getting back in service and becoming ready to respond to the next call.

This means:

• equipment cleaned and replaced
  
• ambulance cleaned and disinfected, and
  
• stretcher made with a sheet, blanket, pillow and towel

Paramedic crews must pay particular attention to this due to the nature of their make-up, equipment replacement, and limited availability. With limited ALS resources in this and surrounding communities, paramedic crews must get ready to respond to the next call immediately and without delay. This means both members working to get in service first with the paperwork coming second.

PAPERWORK MUST BE COMPLETED WITH IN 20 MINUTES AFTER COMPLETEING THE CALL.

If at all possible, paperwork should be completed after calling in service but prior to departing the receiving facility. A copy of the completed paperwork must be left with the receiving facility staff. This copy will normally be left via fax.

Crews should be back in service, dispatch notified and the vehicle ready to respond as soon as possible after arrival to the drop-off facility. Occasionally you may be unavoidably delayed; however, all attempts should be made to return to service as soon as possible.

If upon arrival at the facility you anticipate a delay in returning to service it's important to notify dispatch as soon as possible. This will provide the dispatcher with a more accurate idea as to when you'll become available and allows for an explanation of the exception into RightCAD.

3.3.A. End of Shift Duties

Crews are not permitted to return to base without permission from the dispatcher. No crews should return to base unannounced. The dispatcher, under normal circumstances, will attempt to return crews to base approximately thirty (30) minutes prior to end of shift. Upon being cleared to return to base, the following must be done:

1.) Vehicle must be fueled.

After you are cleared to return to base for shift you should head immediately to the gas station for fueling. All vehicles are to be returned at the end of shift "FULL". The vehicle is to be fueled at the end of every shift.

2.) Place a Red Tag in the windshield of the ambulance so the Support Services Technicians know to check and clean the vehicle, and removed all trash from the vehicle. Red Tags can be found in the Garage at PRO Base next to the washing machines.

3.) Paperwork

Paperwork must be completed and synced immediately after completion of a call whenever possible. The RightCAD system will send pages to each crew member with run numbers and times of all jobs at the completion of each run.

The patient demographic sheet and the physician necessity from should have a run number before it is turned in to dispatch.

All paperwork must be completed and checked in by the dispatcher before either crew member punches out and departs upon completion of their shift. The dispatcher must clear you to leave.

4.) Responsibilities

Never, UNDER ANY CIRCUMSTANCES, leave any vehicle that you have worked in without the following:

• At least 1/2 tank of fuel (full tank unless special circumstances)
  
  
• And put a Red Tag on dash board.
  

These things are imperative. Some are potentially life and death. Occasionally, a crew will have to immediately respond. We all must feel comfortable that the preceding items are always going to be present.

In this profession it is probable that you will work later than your scheduled off time for a variety of reasons. RETURNING LATE TO THE BASE (PAST YOUR OFF TIME) DOES NOT RELEIVE YOU OF YOUR END OF SHIFT DUTIES.

3.3.B. Relief and Other Responders Availability

Dispatchers and crews coming off shift must not punch out and leave unless there is adequate coverage available in the service area. If the only PRO ALS unit(s) is on a call, the ALS crew that is coming off shift must remain until a PRO ALS unit is available to cover the city. BLS crews who are coming off shift may also be required to remain on duty until there is adequate PRO coverage available.

Dispatchers and crews coming off shift must not punch out and leave unless scheduled relief is punched in. You are required to stay until adequate coverage can be attained.

PERSONNEL ARE NOT PERMITTED TO SLEEP IN ANY AREA EXCEPT THE BUNK ROOM BETWEEN THE HOURS OF 22:00 - 06:30.

ALL OF THE FOLLOWING TASKS MUST BE COMPLETED BEFORE GOING TO SLEEP.

Cleaning the Crew Room, Offices, Kitchen, and designated areas within Cambridge Hospital

• Blankets, towels, pillows, sheets, etc. should be removed from the recliners
  
• All Counters, Surfaces, and Recliners should be wiped down with Fantastik
  
• Table and chairs should be cleaned with Fantastik
  
• No garbage should be left in any area
  
• Floors should be vacuumed
  
• Debris should be removed from all areas
  
• Old food should be removed from the refrigerator (ask first)

At any time you may be called upon to perform duties and tasks outside of those outlined in the "Duties" sections.

YOU ARE REQUIRED TO PERFORM ANY REASONABLE TASK ASSIGNED TO YOU BY ANY SUPERVISOR, MEMBER OF MANAGEMENT, OR DISPATCHER ACTING ON THEIR BEHALF.

These duties may include, but are not limited to:

• Cleaning/sweeping of the wash bay and garage
  
• Cleaning of additional vehicles
  
• Cleaning of a vehicle you are not assigned to
  
• Cleaning the dispatch office
  
• Emptying of the trash
  
• Stocking of the supply room
  
• Cleaning of the crew room
  

IN ACCORDANCE WITH REQUIREMENTS OF FEDERAL AND STATE ANTI-DISCRIMINATION STATUTES, PROFESSIONAL AMBULANCE SERVICE, AND NO PERSON IN ITS EMPLOY, SHALL DISCRIMINATE ON THE GROUNDS OF RACE, COLOR, CREED, RELIGION, SEX, SEXUAL ORIENTATION, AGE, NATIONAL ORIGIN, ANCESTRY OR DISABILITY IN ANY ASPECT OF THE PROVISION OF AMBULANCE SERVICE OR IN EMPLOYMENT PRACTICES.

3.7.A. Primary Service Area and Duties

PRO and all of its employees have the responsibility and duty to respond to all emergency calls in our regular operating area. PRO's regular operating area is defined as the geographic boundaries of the City of Cambridge, the property of Harvard University, and the property of the Massachusetts Institute of Technology, and every community contiguous to Cambridge. The dispatcher shall post units throughout the regular operating area to ensure the best "coverage" of the area.

PRO and its EMS personnel, shall not refuse in the case of an emergency to dispatch an available ambulance and to provide emergency response, assessment and treatment, within its regular operating area, in accordance with the Statewide Treatment Protocols, at the scene or during transport, or to transport a patient to an appropriate health care facility.

(1) Upon receipt of a call to respond to an emergency, PRO shall immediately dispatch a Class I ambulance.

(2) If the PRO dispatcher believes at the time a call is received that a Class I ambulance is not available for immediate dispatch, the dispatcher shall immediately contact the ambulance service's backup service pursuant to 105 CMR 170.385. If the ambulance service dispatcher believes that another ambulance service has an ambulance that can reach the scene in a significantly shorter period of time, the dispatcher shall immediately notify:

(a) The other ambulance service, which shall immediately dispatch an ambulance, and

(b) Police or fire in the town in which the emergency has occurred.

3.7.B. Duty to Treat and Transport to Closest Appropriate Facility

All patients must be delivered to the nearest appropriate facility at all times at a minimum. PRO will strive to honor specific patient requests for transport to a more distant facility based on the condition of the patient and current emergency loads and stresses on the EMS system in the area. The crew caring for the patient will make this determination with input from dispatch, a supervisor, and/or medical control if necessary.

3.7.C. Transport of a Deceased Person

No PRO vehicle shall transport a dead body, except in special circumstances when it is in the interest of public health and/or safety to do so or when ordered to do so by the senior official on scene.

3.7.D. Parent Rights

Any parent requesting to accompany a minor child in the ambulance shall be allowed to do so unless it is determined that this would hinder patient care (i.e. parent uncontrollably upset). If a parent is denied the right to accompany a child, the reasons must be completely and thoroughly documented on the trip report.

3.8.A. Hot Weather Operations

Hot weather can present problems for vehicle operations. The following procedures are necessary to ensure vehicles will operate at maximum performance.

1) Shut unit down whenever possible when back at the base.

2) Prior to shutting down or starting up, make sure all lights, master switch and A/C (front and back) are off and the windows up.

3) When operating A/C units, walk thru door should be closed, windows up, rear unit off or on low speed when unoccupied by a patient.

4) Check vehicle fluids often (oil, coolant, transmission, brake, and power steering).

3.8.B. Cold Weather Operations

Garage door will remain closed at all times day or night. The crews and dispatchers will operate the doors to keep heat loss to a minimum. Do not open the door then go and start the ambulance. This keeps the door open longer than necessary.

1) Employee vehicles should be parked in the garage or in designated spaces outside as close together as possible. Keys to employee vehicles must be left at the base on the keyboard every shift. This will allow for snow removal and plowing.

2) When storing ambulances for the overnight, snow should be cleaned off outside. Heavy snow and ice build up around lower fenders, running boards, and mud flaps should be removed outside.

3) Excess snow, water, and sand on garage floor must be dispersed immediately. Puddles of water and debris are potential hazards and obviously slippery.

4) Guidelines for overnight crews staying at the Cambridge Hospital (TCH) are as follows their ambulances in to one of the outlets in the ambulance bay. Each ambulance is equipped with a 25 foot extension cord, located in the backboard cabinet. Also, the ambulance bay at TCH has multiple grounded outlets. On overnights when the temperature is expected to be below freezing, such as this weekend, crews posting at TCH should plug. This will accomplish two goals: first, the batteries, which drain quicker in cold weather, will remain fully charged, and second, the power will run the block heater, keeping the engine warm and making it easier to start. On these overnights the ambulance should be plugged in as soon as you arrive at TCH , and you will need to remember to unplug your ambulance and take the cord with you before you leave . This procedure will not be necessary during the day as the ambulances are busy and running enough to stay warm and charged. Please note that the outlets in the ambulance bay are located near the exit along the concrete wall on your left, so ambulances should park accordingly.

5) ALL ON DUTY PERSONNEL ARE RESPONSIBLE FOR SNOW AND ICE REMOVAL FROM IN AND AROUND THE BASE. WALKWAYS AND DOORWAYS ARE HIGH TRAFFIC AREAS AND MUST BE KEPT CLEAR AND DRY WITHOUT FAIL.

3.9.A. Equipment to Patient Side

BLS must always bring a first aid kit (jump kit), oxygen bag, and SAED on all emergency calls. Additionally, depending on the type of call, stair chair, blanket, immobilization equipment and/or stretcher should be brought when necessary and possible.

ALS should always bring the first-in bag, airway bag, cardiac monitor, and other BLS and extrication equipment as circumstances warrant.

3.9.B. Continuity of Care

All PRO field providers will maintain the continuity of patient care by not discontinuing any treatment, or leaving any patient until care has been properly and completely turned over to the staff of the receiving facility. Oxygen, cardiac monitors, and your undivided attention to the patient must remain in place until care is transferred.

3.9.C. Handling a Stretcher and "Packaging" a Patient

All stretchers should always have a pillow, blanket (weight appropriate for the season), towel, and sheet on them. Remember to utilize these items. Always cover your patients with the appropriate items to keep them warm and comfortable. If it is raining or very cold, wrap a towel around the patient's head. Keeping a patient warm and dry is one of the most basic and important things you can do.

Over the shoulder straps must be used in conjunction with the three (3) stretcher straps at all times. Do not store these straps under the mattress. They should always be accessible. When you have a patient on your stretcher, always do the following:

1) Blanket and cover the patient properly. During cold weather, utilize heavy blankets and cover the patient's head with a towel. ALWAYS PROTECT EVERY PATIENT'S PRIVACY.

2) Keep the patient as comfortable as possible.

3) When rolling the patient on a stretcher the stretcher should be maintained at one-half height to prevent tipping. Have two people attending the stretcher when it is raised at all.

4) Pull stretcher feet first whenever possible.

5) Put the head of the stretcher into an elevator first.

6) When using a stair chair, place a blanket down, then a sheet, and wrap the patient. Keep a blanket and sheet on the stair chair at all times. Store the stair chair with them so that they are always there.

7) Pay attention to patient's hands and feet when moving them through narrow spaces or down stairs.

8) NEVER LEAVE A PATIENT UNATTENDED

All of these may seem like small and trivial points, but if you have ever been on a stretcher, you know how important these things are to the patient's safety, comfort, and state of mind.

3.9.D. Comfort Care (Do Not Resuscitate Orders)

The only recognized Do Not Resuscitate (DNR) order in Massachusetts outside of a licensed health care facility is a Comfort Care order. A valid Comfort Care order will be a specific Comfort Care form or bracelet and must be present in order to withhold resuscitative measures. A physician, nurse practitioner, or a physician's assistant can sign a Comfort Care form.

A facility licensed to provide health care services may, on the authority of its license, cancel ALS or BLS that is responding or has established direct patient contact, including the cessation of resuscitation, when the licensed health care facility assumes full responsibility for the cancellation decision. ALS or BLS so cancelled would have no further obligation to respond, assess, treat or transport. EMTs must document the cancellation by the licensed facility on their trip (or dispatch) record.

3.9.E. Physician On Scene

Occasionally, you may respond to a call where a physician is on scene. If a physician who is on scene requests to be involved with patient care all of the following procedures must be followed.

1) The physician must show their identification indicating their credentials as a physician with this information being documented on the trip report.

2) The EMS provider should contact the medical control physician via radio or cellular phone to allow the physician on scene to speak directly to the medical control physician. The medical control physician will determine if the on scene physician may assume responsibility for the patient.

3) The on scene physician who assumes responsibility for the care of any patient must accompany the patient in the ambulance during transport to the receiving emergency department.

Printed cards with this policy are maintained on all PRO vehicles and can be given to a physician who expresses interest in participating in patient care.

3.10.A. Safety Restraints - Adult and Pediatric (Seatbelts)

ALL EMPLOYEES, THIRD RIDERS, FAMILY MEMBERS AND PATIENTS RIDING IN ANY PRO VEHICLE ARE REQUIRED TO WEAR THEIR SEAT BELTS OR SAFETY RESTRAINTS. THE ONLY EXCEPTION TO THIS IS THE ATTENDANT WHO MAY BE UNRESTRAINED ONLY TO ADMINISTER PATIENT CARE. NO CHILDREN UNDER THE AGE OF 12 ARE PERMITTED TO RIDE IN THE CAB OF THE AMBULANCE AT ANY TIME.

There are two (2) safety restraints located in the cab of every ambulance, with four (4) in the patient compartment. Three (3) sets of safety restraints are mounted along the wall of the squad bench. The fourth is located at the technician seat.

All stretcher patients are to be secured to the stretcher at all times. An unrestrained patient can fall off causing injury. There are three (3) safety restraints that are required to be used in securing the patient. They are:

Lower Safety Restraint - Secure around the patient's lower legs. (mid tibia)

Upper Safety Restraint - Secure around the patient's upper legs. (mid femur)

Harness Restraints - Secure one shoulder restraint over each shoulder so they are resting over the chest area and secure each shoulder strap into the third restraint located just at the waist.

Adjust all the straps so they safely secure the patient without causing discomfort or impairing circulation.

To unfasten any of the above restraints, press the release button on the receiver end of the restraint.

It is important to keep the restraints fastened on the stretcher when not in use to prevent them from interfering with the stretcher's operational capabilities.

Worn, frayed, or soiled safety restraints should be reported immediately for replacement.

Pediatric patients will be secured in the Ferno Pedi Mate and secured to the stretcher. The Ferno Pedi Mate is designed for a 10 to 40 pound child. If you are called on to transport a child smaller than 10 pounds, attempt to blanket, swaddle, and pad around the baby to add the bulk required for the baby to fit securely in the Ferno Pedi Mate. If this is not possible or impracticable, swaddle and pad the baby in the parent's arms and secure both the parent and the baby to the stretcher.

Children who are not patients, that must be transported, should be placed in an appropriate car seat. Car seats for children between the weight of 0-65 lbs are maintained at PRO and will be delivered to a scene if practicable.

3.10.B. Violent Patient Restraint Policy

The safety of the patient, community, and responding personnel is of paramount concern when following this policy.

Restraints are to be used only when necessary in situations where the patient is potentially violent and is exhibiting behavior that is dangerous to self or others. Pre-hospital personnel must consider that aggressive or violent behavior may be a symptom of medical conditions such as head trauma, alcohol, drug-related problems, metabolic disorders, stress, or psychiatric disorders.

The method of restraint used shall allow for adequate monitoring of vital signs and shall not restrict the ability to protect the patient's airway or compromise neurological or vascular status.

If a patient is an immediate danger to self or others a Section 12 ("pink paper") is not required for you to restrain them.

The police should be called whenever it appears that a patient may need to be restrained in the field or whenever a patient is being picked up in the community under a Section 12.

Restraints such as handcuffs that are applied by law enforcement require an officer to remain available at the scene and during transport to remove or adjust the restraints for patient safety.

This policy is not intended to negate the need for law enforcement personnel to use appropriate restraint equipment that is approved by their respective agency to establish scene management control.

The following procedures should guide pre-hospital personnel in the application of restraints and the monitoring of the restrained patient.

1) Restraint equipment applied by pre-hospital personnel must be either padded leather restraints or soft restraints (i.e., stretcher restraints, seat-belt type, or triangular bandages applied correctly). All methods must allow for quick release. Whenever possible, patients should be restrained using PRO's equipment and restraints. All PRO stretchers have separate restraints on the stretcher for arms and under the mattress for legs. It should not be necessary to transport patients in the hospital's restraints.

2) PRO personnel shall not apply any of the following forms of restraint:

o Hard plastic ties or any restraint device requiring a key to remove.

o Backboard or scoop stretcher as a "sandwich" restraint.

o Restraining a patient's hands and feet behind the patient, i.e., hog-tying.

o Methods or other materials applied in a manner that could cause vascular, neurological, or airway compromise.

3) Restraint equipment applied by law enforcement for example, handcuffs, plastic ties or "hobble" restraints, must provide sufficient slack in the restraint device to allow the patient to straighten the abdomen and chest, and to take full tidal volume breaths.

4) Restraint devices applied by law enforcement require the officer's continued presence to ensure patient and scene management safety. The officer shall accompany the patient in the ambulance or follow, by driving in tandem with the ambulance on a predetermined route. A method to alert the officer of any problems that may develop during transport should be discussed prior to leaving the scene.

5) Pre-hospital personnel must ensure that the patient's position does not compromise respiratory/circulatory systems, or does not preclude any necessary medical intervention to protect the patient's airway should vomiting occur.

6) Restrained extremities should be evaluated for pulse quality, capillary refill, color, nerve and motor function every 5 minutes. It is recognized that the evaluation of nerve and motor status requires patient cooperation, and thus may be difficult or impossible to monitor.

7) Restrained patients shall be transported to the closest appropriate emergency department except in the case of a "Section 12" where a direct admission to a psychiatric facility has been pre-arranged.

8) Restrained patients should not be carried down stairs in a stair chair. A violent patient cannot be properly restrained in a stair chair. Furthermore, a violent patient that is sitting in a stair chair could throw the rescuers off balance while carrying. Violent patients who must be carried down stairs should be restrained on a scoop stretcher.

3.10.C. Documentation of Restraint

Documentation on the Trip Sheet shall include:

1) The reason(s) restraints were necessary.

2) Which agency that applied the restraints (i.e., EMS, law enforcement, other).

3) Information and data regarding the monitoring of circulation to the restrained extremities.

4) Information and data regarding the monitoring of respiratory status while restrained.

5) What types of restraints were applied.

If at any time you need further clarification on the above, please contact a supervisor.

3.10.D. Transport of Psychiatric Patients

In most cases, psychiatric patients will be ambulatory. Psychiatric patients who are ambulatory and not a flight risk can be walked to the ambulance under close supervision. Often, the act of placing these patients on a stretcher could be counterproductive and a source of agitation. Ambulatory psychiatric patients should be transported on the stretcher whenever possible. At a minimum, these patients must be seated in the tech seat or on the squad bench with their seatbelt on.

YOU MUST ALWAYS SIT BETWEEN A SEAT-BELTED PSYCHIATRIC PATIENT AND THE BACK DOORS OF THE AMBULANCE. THE DOORS OF THE AMBULANCE MUST ALWAYS BE LOCKED. THESE PROCEDURES WILL SLOW A PSYCHIATRIC PATIENT WHO ATTEMPTS TO JUMP OUT OF A MOVING AMBULANCE.

These procedures will also provide the driver with an opportunity to bring the ambulance to a stop when dealing with a psychiatric patient who suddenly attempts to flee.

When two male crew members transport a female psychiatric patient, the driver will call dispatch and relay the starting and ending mileage of the trip. The dispatcher will log the mileage and times in RightCAD.

Upon arrival at the receiving facility, you are not relieved of responsibility for any patient until the staff of the receiving facility releases you. There is a common misconception that once the paperwork is transferred that the patient is no longer your responsibility. This is not accurate. Every patient remains your responsibility until the patient is properly accepted and the staff of the receiving facility relieves you. All facilities are different. If you encounter a problem at a receiving facility you should contact dispatch as soon as possible for assistance.

3.10.E. Transport of Disabled Person with No Medical Complaint

Whenever possible attempt to contact a handicapped accessible taxicab as a first resort. The City of Cambridge has a contract to make these accessible taxis available 24/7. Dispatchers are authorized to commit PRO to pay for this service. Contact: Accessible Cambridge Taxi (ACT) at 1-800-616-1228

Occasionally, you may be called on to transport a disabled person with no medical complaint to a location other than a hospital when there is no other safe and suitable means of transportation available. Even though the disabled person has no current medical complaint, their disability necessitates accessible transportation. These situations most often arise in the context of disabled persons who are police prisoners who cannot be safely transported in the police wagon. These situations also surface when a disabled person with no current medical complaint requires accessible transportation to a local shelter or to court.

For the patient to be taken to a location other than a hospital, the patient must not have any current medical complaint whatsoever. The Cambridge Police and local hospitals usually generate these calls.

Disabled persons must always be transferred to an ambulance cot and secured for transport.

3.10.F. Transporting of Patient with a Service Animal

Service animals, for example, guide dogs utilized by visually impaired persons, shall be permitted to accompany the patient in the ambulance or wheelchair van unless the presence of the service animal will disrupt emergency or urgent patient care or there is some basis for the crew members to believe that the safety of the crew, the patient or others would be compromised by the presence of the service animal in the ambulance or wheelchair van.

EMS personnel should assess the level of care required to provide competent medical attention to the patient.

When the presence of a service animal in the ambulance might interfere with patient care, jeopardize the safety of the crew, the patient or others, or cause damage to the ambulance or equipment, personnel should make other arrangements for simultaneous transport of the service animal to the receiving facility. Unless emergency conditions dictate otherwise, absolutely every effort must be made to reunite the patient with the service animal at the time of the patient’s arrival at the receiving facility or other destination.

Acceptable alternative methods of transporting a service animal to the receiving facility include, but are not necessarily limited to, family members, friends or neighbors of the patient, or a law enforcement official. Attempt to obtain and document the consent of the patient for transport of the service animal by such person. If no such individuals are available, contact the service base or PSAP and request that additional manpower respond to transport the service animal.

Personnel should document on the patient care report instances where the patient utilizes a service animal, and should document on the patient care report whether or not the service animal was transported with the patient. If the service animal is not transported with the patient, a separate incident report should be maintained by the ambulance service describing the reasons that the service animal was not transported with the patient.

3.11.A. Locking Ambulances and Equipment

YOUR AMBULANCE IS TO BE LOCKED AT ALL TIMES.

This includes all doors and outside compartments. One key FOB is provided to each crew member. Leave the ignition key in the vehicle at all times. Carry the key FOB on your person at all times. ALS must pay particular attention to this. The ALS drug box is to be sealed, inside of the locked ambulance.

3.11.B. Shutting Down Ambulances at Hospitals

Your ambulance should be shut down and the batteries turned off upon arrival at a hospital. This procedure is necessary to cut down on vehicle exhaust fumes entering the facility. Ambulances should never be shut off at the scene of a call unless it is absolutely necessary.

3.12.A. Hospital Diversion

Hospital diversion status can be ascertained by dispatch through the diversion website. All diversions will be paged out to each on-duty crew member through RightCAD.

If at all possible, a patient should not be transported to a facility that is on diversion. If a patient is unstable, requires cardiac cath, requires level 1 trauma care, or adamantly requesting transport to a facility that is on divert, you must notify the receiving facility and inform them that you are transporting the patient to them.

A hospital cannot refuse to accept you unless the facility is completely closed due to an event such as an internal disaster or a power outage (Code Black).

3.12.B. Delays

Any delay should be reported as soon as possible to the dispatcher and should be documented. Common delays that you may encounter include, but are not limited to, delays of longer than 15 minutes in a hospital triage area waiting for a bed, delays on the floor of a hospital for paperwork or a bed not being ready, delays in responding to a call due to a train, traffic, and extended extrications. Delays should be documented in CAD, trip sheets, written Incident Report, and/or as a NBS QI Incident as necessary.

3.12.C. Fire Standbys

BLS, and ALS when requested, will be doing fire standbys. The following are requirements and considerations when on a fire standby:

1) Back down into fire scenes whenever possible to facilitate pulling out and away.

2) Position your vehicle on scene where it is out of the way and where additional arriving fire apparatus will not block it in. Leave your vehicle in a place where you can get out. YOU MUST CHECK YOUR VEHICLE CONTINUOSLY TO ENSURE THAT IT DOES NOT GET BLOCKED IN. RELOCATE YOUR VEHICLE/S AS NECESSARY TO FACILITATE ACCESS TO, AND EGRESS FROM THE SCENE.

3) Update other crews and dispatcher as to the best access to the scene, standby location, and if the building is occupied.

4) Shut your emergency lights down if you are out of harm's way.

5) STAY WITH YOUR PARTNER IN AN APPROPRIATE LOCATION THAT CAN ALSO BE SET UP AS A TREATMENT AND REHAB AREA WITH IMMEDIATE ACCESS TO YOUR EQUIPMENT AND THE SCENE. POSITION YOURSELVES SO THAT YOU ARE READILY APPARENT TO THE INCIDENT COMMANDER AND/OR NOTIFY THEM OF YOUR LOCATION.

6) Periodically update the dispatcher of your status and needs.

7) Call for the ISU (PRO's MCI truck) immediately if it appears that the incident will be extensive. The ISU has equipment for rehab, additional supplies, and items for displaced fire victims.

3.13.A. Details

Occasionally, you may be assigned to a detail. Details sometimes require two crew members and an ambulance but usually, only one person is requested and assigned. When assigned to a detail, you are required to wear your uniform, have a jump bag, oxygen bag, and an SAED at a minimum.

Always be aware of what the event is and who is in charge. You will be required to be aware of how to call for assistance and transporting resources. As each venue is different, you must be aware of procedures such as these before the detail. All paperwork requirements still apply when assigned to a detail. You must document care, treat and releases and AMA's. Basic patient information should be documented but be aware that PRO does not bill patients who are not transported.

3.13.B. Third Riders

PRO encourages the practice of third riding to promote training in EMS. To that end, PRO has historically allowed third riders such as medical students, interns and residents, high school and college students, paramedic interns, EMT students, private citizens, and providers interested in employment. PRO allows or disallows riders at its sole discretion.

All third riders are required to abide by the following:

o Third Riders must be 18 years of age or older (unless they have parental consent) and have a valid CPR card.

o Schedule "Third Rider" shift time with the supervisory staff of PRO and be on time for shift.

o Dress in blue pants (no jeans), black footwear, and a white or blue polo shirt. You may be issued a PRO sweatshirt or jacket in the event of inclement weather.

o Follow instructions of the crew that you are with unless you feel that you are being placed in a hazardous situation.

o You must agree to maintain patient confidentiality at all times, now and in the future.

o You will be expected to assist the crew that you are with their assigned tasks such as cleaning and/or washing the ambulance.

o In order to participate as a third rider you will be required to sign this "Third Rider Waiver Form"

All PRO staff members should work with third riders to answer questions and assist them in their experience. The PRO staff members are ultimately responsible for the third rider. You must be aware of where any third rider is and not allow them to act beyond their role as a third rider. The PRO staff member is ultimately in charge of the third rider and should immediately report any problems or concerns with third riders to a supervisor.

All PRO staff members must be aware of patient confidentiality issues at all times.

Discussing any information regarding the care or circumstances of any patient's care is strictly prohibited.

Trip reports are only released to the patient or to a person who has a signed waiver or other legal authority from the patient. Trip reports and specific case information will be used for QA/QI purposes as appropriate.

Do not discuss patient information in any public place such as an elevator or restaurant.

ALWAYS CONSIDER AND RESPECT THE PRIVACY OF EVERY PATIENT, NO MATTER WHAT HIS OR HER CONDITION. ALWAYS PROTECT A PATIENT'S MODESTY AS MUCH AS POSSIBLE, KEEP THE PATIENT COVERED, AND BE AWARE OF THEIR CIRCUMSTANCES AND FEELINGS.

Given the nature of our work, it is imperative that we maintain the confidence of patient information that we receive in the course of our work. PRO prohibits the release of any patient information to anyone outside the organization unless required for purposes of treatment, payment, or health care operations. Additionally, discussions of Protected Health Information (PHI) within PRO should be limited. Acceptable uses of PHI within the organization include, but are not limited to, exchange of patient information needed for the treatment of the patient, billing, and other essential health care operations, peer review, internal audits, and quality assurance activities.

PRO provides services to patients that are private and confidential and you are a crucial step in respecting the privacy rights of PRO's patients. In the rendering of EMS, patients provide personal information and that such information may exist in a variety of forms such as electronic, oral, written or photographic and that all such information is strictly confidential and protected by federal and state laws.

You must comply with all confidentiality policies and procedures set in place by PRO during your entire employment or association with PRO. If you, at any time, knowingly or inadvertently breach the patient confidentiality policies and procedures, you must notify PRO's Privacy Officer (CEO) immediately. In addition, a breach of patient confidentiality may result in disciplinary action, up to and including, discharge.

3.15.A. Triage to BLS

On many calls, ALS will respond with BLS in a two-tiered response. This leads to issues surrounding the transfer of care, or both ALS and BLS staying with a patient. PRO paramedics will consider the following guidelines when on calls with any BLS (PRO, Rescue, Cataldo, etc.).

1) Do not apply a cardiac monitor or check the blood sugar of a patient who you think may be transferred to BLS care. These are ALS procedures that you should not be doing unless you have some doubt as to the patient's condition. (i.e. Altered mental status, pleuritic chest pain) If you have some doubt as to the patient's condition you should be working-up and transporting the patient. Certainly the thought behind this is that we do not treat monitors or glucometers but patients. Obtaining normal results from these procedures does not enable you to make the determination that a patient is clear for BLS transport.

2) IF ANY PROVIDER DOES NOT FEEL COMFORTABLE WITH A PATIENT OR REQUESTS THAT ALS ASSUME CARE OF THE PATIENT, ALS WILL ASSUME CARE OF THE PATIENT.

3) Whenever ALS transfers patient care to BLS, ALS will document their evaluation of the patient on a BLS trip report.

3.15.B. Cardiac Monitor Procedures

1) Every ALS patient, emergency and transfer, will be transferred with a cardiac monitor unless there is an extreme circumstance calling for the contrary.

2) LifePack 12 data for every ALS patient must be downloaded to TabletPCR immediately following completion of the call. Additionally, Lifepack 12s and LifePack 500's from CFD shall be downloaded into TabletPCR as soon as possible following the completion of the call.

3) Patients should be left on a cardiac monitor until care is transferred to the staff at the receiving facility.

4) Every patient with a complaint that appears to be cardiac related will receive a 12 Lead EKG whenever possible.

3.15.C. SMEMS ALS Rounds

All ALS personnel must attend nine (9) ALS M&M's per year, of which a minimum of one (1) each quarter must be at the SMEMS ALS M & M. There are limited exceptions to this policy and it will be strictly enforced.

3.15.D. ALS Transfers

All ALS personnel must attend an OEMS approved ALS Inter-facility Training Program. These programs are held periodically by PRO, SMEMS and other agencies. Please see a supervisor for details and scheduling. One crew member must be certified to handle an inter-facility transfer and attend the patient during transport.

3.16.A. Calling for ALS

Many calls that you will respond to are triaged as a BLS response that will result in a patient requiring ALS treatment. BLS must evaluate situations quickly and call for ALS as soon as possible. This will allow an ALS crew to respond as you package and extricate the patient.

IF YOU ARE CONFRONTED WITH A PATIENT WHO YOU FEEL MAY NEED ALS YOU SHOULD REQUEST ALS FROM DISPATCH IMMEDIATELY. DO NOT ASSUME THAT ALS IS NOT AVAILABLE OR TOO FAR AWAY TO INTERCEPT YOU.

Always have an ALS unit start toward you and work to establish an intercept even after you have initiated transport. Update the ALS unit that is responding to your call as soon as you are able. An update for ALS should be short and concise including the patient's age and chief complaint.

Normally you will not wait on scene with a patient who is packaged and ready for transport. In most cases you will initiate transport and contact the responding ALS unit or dispatch by radio to set up an intercept.

KEEP IN MIND THAT THE ULTIMATE GOAL IS TO HAVE ALS REACH THE PATIENT IN THE SHORTEST AMOUNT OF TIME.

Every situation is different. Sometimes it might make sense to stop briefly or wait to allow ALS to reach you. This will sometimes be the fastest route to ALS rather than proceeding to the hospital when ALS is 30 seconds away from you. Communication will be critical in these situations.

3.16.B. BLS Triage to ALS

ANY BLS PROVIDER WHO IS NOT COMFORTABLE WITH ANY PATIENT CAN INSIST THAT ALS ASSUME CARE OF ANY PATIENT AND ALS WILL COMPLY.

Based on the situation, ALS will ideally transport the patient in the ALS unit or will ride with the BLS unit if necessary. ALS will document this transport no matter what level of care the patient receives. BLS will document the call as "ALS to handle".

ALS is expected to accommodate a BLS provider who requests that ALS assume care of any patient. The ALS provider should speak to the BLS after the call to discuss any issues or thoughts once care of the patient has been transferred to the receiving facility.

3.16.C. BLS Canceling ALS

After completing an appropriate patient assessment and having determined that a patient does not require the activation of an ALS intercept or ALS treatment in accordance with the Statewide Treatment Protocols; and there is no foreseeable need for ALS treatment based on the patient's condition or mechanism of injury, BLS may cancel responding ALS.

BLS may also cancel ALS if it is determined that the patient can be transported to an appropriate health care facility in less time than it would take ALS to arrive on scene or intercept BLS during transport.

3.17.A. Care and Maintenance of Reusable Items

Proper technique in cleaning reusable ambulance equipment ensures that the equipment is safe for the next crew and patient and protects them from coming in contact with potentially infectious agents. Guidelines for cleaning reusable items are found in the PRO Health and Safety Plans.

All equipment is to be cleaned of obvious debris and fully cleaned and disinfected before being returned to service. All personnel shall wear gloves when cleaning reusable items. No one should be subjected to having soiled equipment in any company vehicle. Always utilize universal precautions when cleaning any item. Always assume all items are contaminated.

3.17.B. Disposable Items

The majority of the equipment used by PRO is disposable. If a disposable piece of equipment is contaminated it should be immediately disposed of in a red biohazard receptacle. Consult a supervisor or the dispatcher if there is any doubt in your mind as to whether an item is disposable or reusable.

All sheets and linen should be exchanged at, and returned to the hospital. Do not leave dirty linen in an ambulance or bring it back to the base.

3.18.A. Drivecam Video System

Each PRO Ambulance has a Drivecam audio and video recording device installed. The Drivecam camera is used to capture driving events that result in forward or side G force while driving. Events such as hard braking, traveling too fast around a turn, or an accident will be captured by Drivecam. The cameras are downloaded on a regular basis and the events are reviewed by supervisory staff. PRO will provide positive and negative feedback to drivers based on the events and archive each notable event to a folder for each driver.

IT IS STRICTLY FORBIDDEN TO TAMPER WITH DRIVECAM IN ANY FASHION.   DISABLING OR TAMPERING WITH DRIVECAM COULD RESULT IN IMMEDIATE DISCIPLINARY ACTION UP TO AND INCLUDING TERMINATION.

3.19.A. Vehicle Operations Overview

Driving an emergency vehicle is an immense responsibility. Responding to a scene, then transporting a patient to the hospital are procedures that are often devalued in importance. Always remember that if you do not perform these two tasks with care, prudence, and professionalism the worst will happen. You must get to a scene and safely transport the patient to the hospital to accomplish anything. There are many issues to be addressed relating to emergency vehicle operation. Both the driver and tech are responsible for safe and appropriate navigation to calls.

Equipment and personal belongings in the front and back of the ambulance; including, but not limited to, items such as backpacks and portable radios should be secured at all times.  Monitors, oxygen equipment and jump bags must be secured in equipment cabinets unless they are being used for patient care, at which time equipment should be secured in the patient compartment during use. This policy is in place to prevent items from falling on patients or crew and/or becoming projectiles if the vehicle is involved in an accident or sudden stop.

All new employees will complete the Driver Training  Program as part of the New Employee Orientation Program.

3.19.B. Vehicle Locked at ALL Times

Your vehicle is to be locked at all times while unattended, all doors, windows and compartments included. One key FOB is provided to each crew member. Leave the ignition key in the vehicle and keep the key FOB on your person at all times. Your ambulance will lock automatically after 30 seconds of being unlocked.  If you have any problems with the key FOB or the automatic lock function on an ambulance please see an operations supervisor immediately.

Personal vehicles parked at Pro base must be left with the keys in the ignition in case the vehicle must be moved. The garage is monitored continuously be a security camera system in the case that anything happens to your personal vehicle.

3.19.C. Seatbelts Required

ALL PERSONNEL ARE REQUIRED TO WEAR SEATBELTS WHILE IN THE FRONT SEATS OF A MOVING VEHICLE. ANY STAFF MEMBER FOUND NOT WEARING A SEATBELT WILL BE SUBJECT TO PROGRESSIVE DISCIPLINE.

All passengers must wear seatbelts whether they are in the front seat or in the patient compartment.

3.19.D. Starting the Vehicle

1. Transmission in PARK

2. All electrical switches OFF

3. Module switch OFF

4. Ignition switched to ON

5. Wait for glow plug indicator (wait to start light) to go out

6. Start ambulance

7. Check voltage: Minimum of 12.5 volts

3.19.E. Call Information

When you are given a call, emergency or otherwise, make sure that you have the details correct and write them down. If you are not sure and you need help, ASK! Do not let your pride or embarrassment stand in the way of doing your job. You must get there to do any good.

GETTING LOST AND NOT ASKING FOR HELP IMMEDIATELY IS INEXCUSABLE.

3.20.A. General Ambulance Driving and Parking Guidelines (UPDATED PROCEDURES)

THE AMBULANCE OPERATOR'S PRIMARY RESPONSIBILITY IS THE SAFE TRANSPORT OF THE PATIENT. DO NOT RISK AN ACCIDENT OR INJURY.

Smooth driving refers to driving that will not stress or traumatize the patient, permitting the attendant to safely provide medical care to the patient. Your headlights should be on at all times for safety.

REMEMBER, YOU ARE THE PERSON WHO IS MOST IN CONTROL OF SAFETY WHEN RESPONDING OR TRANSPORTING ON A PRIORITY.

Updated Procedures for Driving and Parking

1. Drivers shall endeavor to avoid the neighborhood streets in the vicinity of Mt. Auburn Hospital with the exception of Brattle Street and Mt. Auburn Street when not responding to, or transporting from, an emergency scene. Drivers shall also endeavor to use siren and horn only as necessary in this area. Implemented: October 15, 2005.
2. Drivers shall not park on the ODD side of JFK Street and will SHUT DOWN vehicles when parked on JFK Street AT ANY TIME. Implemented: February 15, 2006.
3. Drivers shall endeavor to enter rotaries from the far left lane and exit rotaries from the far right lane. Implemented: June 5, 2006.
4. Drivers shall NOT utilize Smith Place and Concord Ave to enter or leave PRO base. Drivers are directed to use the controlled intersection at Concord Ave and Moulton Street when returning to or leaving PRO base. Drivers shall also endeavor to use siren and horn only as necessary in this area. Implemented: July 15, 2006.

3.20.B. Transportation Considerations

No medical emergency, however severe, justifies driving in a manner that risks loss of control of the vehicle, or that relies on other drivers or pedestrians to react ideally.

A decision to transport emergently must be based upon reasonable cause to believe that the medical emergency justifies the risks incurred when demanding the right-of-way through traffic. However, any doubt as to the seriousness of the emergency must be resolved in favor of the patient.

All personnel should be aware that high-speed transportation of patients is often unnecessary, and sometimes harmful. A high-speed transport with its associated noise, sudden starts, stops, and sway can:

o Frighten the patient.

o Put a stabilized patient into shock.

o Disrupt ongoing medical treatment or injure personnel providing treatment.

o Aggravate certain medical conditions sufficient to cause death or permanent disability to the patient; i.e., spinal injuries, serious fractures, and heart attacks.

‘Smooth driving’ principles should be observed at all times.  Smooth driving refers to driving that will not stress or traumatize the patient, permitting the attendant to safely provide medical care.

Sufficient notice of the ambulance's approach must be given to allow other motorists and pedestrians to yield the right-of-way. Proper use of signaling equipment is, by itself, not enough.   You should always presume that other drivers do not hear the siren under most conditions, and particularly at an intersection. Be aware that other drivers often have difficulty in locating the source of the siren.

NEVER ASSUME THAT THE USE OF LIGHTS AND SIREN WILL CLEAR THE WAY THROUGH TRAFFIC OR THAT A MOTORIST OR PEDESTRIAN IN THE VICINITY WILL DO WHAT IS EXPECTED AFTER BECOMING AWARE OF THE AMBULANCE. WATCH FOR THE REACTION OF OTHER VEHICLES AND PEOPLE TO THE SIREN AND BE PREPARED TO MANEUVER ACCORDINGLY.

An ambulance operator must anticipate particular hazards during emergency operation, they include:

o Blind intersections

o Driveways

o Motorists with impaired hearing and;

o Inattentive drivers

o Pedestrians

An ambulance transporting a stable patient should never travel over the posted speed limit.  Regardless of patient condition, never travel at a speed that does not permit complete control of the vehicle at all times. 

3.20.C. Law of Due Regard

ALL DRIVERS MUST DRIVE WITH "DUE REGARD" FOR THE SAFETY OF OTHERS USING THE ROADWAYS.

State vehicle statutes provide special privileges to an operator of an emergency vehicle; however, this does not relieve the operator from the duty and responsibility to drive with "due regard" for the safety of others.  A driver can be cited or held personally liable for damages if he/she exercises this privilege without justifiable cause, or in an imprudent manner.   All emergency vehicle operators should be familiar with MGL Chapter 89, section 7B, “Operation of Emergency Vehicles”. 

Due regard can be defined as driving in a manner to avoid any predictable collision.

As noted above, the emergency vehicle driver must provide adequate warning to others by using the warning devices, and by controlling their speed to allow other motorists time to react to their warning.

3.21.A. Driving Standards

1) Use of Headlights

Headlights are to remain on whenever vehicle is in motion.  All lights must be turned off when vehicle is powered off.

2) Systematic Eye Movements

Drivers should search for, identify and anticipate potential hazards by scanning the near, middle and distant areas in front of, and to the sides of, the vehicle.

3) Constant Rate Acceleration

Drivers should move their foot slowly from the brake to the accelerator, gradually rolling the vehicle forward, thereby overcoming inertia forces, gradually and smoothly.

4) Smooth Braking

The driver should anticipate braking situations early and reduce speed ahead of time by releasing pressure from the accelerator. The engine compression will gradually slow the vehicle. The driver then applies the brake gradually, and just before the vehicle comes to a complete stop, reduces brake pressure so the vehicle does not jerk to a stop.

5) Following Distance

When traveling at less than 40 MPH in ideal daytime conditions, the driver should maintain a four second following distance to maintain a cushion of safety in front of the vehicle.  To measure an adequate distance,  choose a vehicle in front of the ambulance and observe it passing  a stationary object.,  The ambulance driver then counts, "1001, 1002, 1003, 1004" and should not pass the same object until four seconds have elapsed. When traveling at speeds above 40 MPH, increase the cushion of safety to five seconds. 

Double the Distance: When you have a patient on board and when you are driving in darkness, rain, fog, smoke, or limited by other factors such as fatigue.

Triple the Distance: When the road surface has snow, packed snow, ice, or black ice.

This added cushion allows a driver additional reaction time to safely navigate any obstacle or hazard.  

6) Ten-second Lane Change

Drivers should anticipate and plan for lane changes in advance. They should signal in advance to advise other drivers of their intention. After signaling, the driver then drifts towards the centerline, and before entering the lane makes a second check of both mirrors and over their shoulder for vehicles in their blind spots. Sit forward in your seat while checking mirrors to minimize ambulance blind spot.  Gradually and smoothly move to the next lane.

7) Rear and Side-space Cushion

Through systematic eye movements, a driver should remain aware of vehicles and objects surrounding their vehicle. By adjusting their speed or position, they maintain a cushion of space on all sides and to the rear of their vehicle.

8) Avoiding Rear-end Collisions

Rear-end collisions can be avoided by maintaining a safe following distance, thinking and looking far enough ahead so that you can anticipate the need to stop, controlling your speed, and not allowing your vehicle to roll backwards into another vehicle.

To avoid rear-end collisions the driver must practice the use of safe following and stopping distances. In order to understand the problem, and what the emergency vehicle driver must do to avoid rear-end collisions, they need a total understanding of the following:

o Rear-end collisions are the third most common type of collision; responsible for 15% of all ambulance accidents.

o A driver must know the distance required to allow the vehicle to stop before, or steer around, an object that suddenly appears or another vehicle that suddenly stops in front of the vehicle.

a) Following distances: To drive safely, the driver must maintain adequate following distances, and understand the three (3) factors that make up your total stopping distance.

i) Perception distance

ii) Reaction distance

iii) Braking distance
 

Stopping Distances at Various Speeds in Ideal Conditions  

VEHICLE SPEED	STOPPING DISTANCE
10 MPH	18 Feet
20 MPH	52 Feet
30 MPH	100 Feet
40 MPH	169 Feet
50 MPH	280 Feet
60 MPH	426 Feet

b) The Four Second Rule for Road Safety: Apply the principles outlined above in section 3.21.A.4.

9) Stopping at Intersections

Stopping at Controlled Intersections:

Always stop your vehicle so that your front bumper does not extend into or over a "Pedestrian Lane" or the first "white line" in front of your vehicle. Stop your vehicle so that you can see a minimum of two feet of road surface between your vehicle and the first "white line" in front of your vehicle.

Stopping in Traffic at Controlled Intersections:

Use the “Rear Tire Concept”-

Remain far enough behind (12-15 feet) a vehicle stopped in front of your vehicle to observe the front vehicle's rear tires and a small amount of pavement. This provides adequate room to turn the vehicle around without backing up.

In either case, when stopped, keep your right foot on the brake pedal with pressure applied. Do not take your right foot off the brake pedal and start to accelerate until the vehicle in front of you has started to move and is accelerating. When starting in traffic, anticipate the vehicle in front of you will make a sudden stop.

10) Backing Policy

While backing, one (1) individual is positioned eight to ten (8-10) feet behind the left rear of the vehicle and maintains visual and voice contact with the driver.

The driver of any company vehicle is responsible for the safe backing of the unit. The driver shall not place the unit in the reverse gear and start backing until the following procedures have been completed:

i) The unit has come to a complete stop.

ii) A spotter is in place eight (8) to ten (10) feet at the left rear of the unit. Eye contact has been made with the spotter through the left-hand side rear-view mirror and voice and hand communications have been established with the spotter.  The spotter helps guide the driver to slowly back the vehicle. This practice greatly reduces the possibility of backing mishaps.   

Spotters must get out of the unit and survey the right side and rear area for obstacles that would damage the unit, or be damaged by the unit, if contact were made during the backing process.

Drivers are cautioned never to be in a hurry when backing up or parking. They are instructed not to start to back up or park when they are unsure of the area behind the vehicle.  When no employee is available to be a spotter, the driver must visually survey the area and back slowly using extreme caution, with the back-up alarm on.

11) Parking the Ambulance

The driver of any company vehicle is responsible for the safe and prudent parking of any company vehicle.  Always park the vehicle in a safe area to protect the crew, patient and the unit. When parking to the operator's blind side, use a spotter. Do not pull forward into a parking space or driveway. Always back into the parking area, so that you have a safe and efficient exit. Nose in parking is strongly discouraged unless no other option exists.  Always be aware of overhangs and low clearances when operating or parking any vehicle.

Use caution when parking at scenes with multiple responding vehicles (fire, police), assuring that the ambulance is not “parked in” by others.  It is the responsibility of the driver to park in a location that will allow prompt patient transport.  If you are unsure of the best place to park at a scene, consult fire alarm or dispatch as needed.

3.21.B. Emergency Driving Standards

The following standards should be utilized as a guideline to follow in addition to the driving standards found above.

REMEMBER, YOU ARE THE PERSON WHO IS MOST IN CONTROL OF SAFETY WHEN RESPONDING OR TRANSPORTING ON A PRIORITY.

1) Use of Warning Devices

Your headlights should be on at all times. When driving on an emergency, the driver activates all emergency lights (excluding the four-way flashers) and the siren. It is better to use the siren too much rather than not enough. The siren must be sounded and sustained for several seconds to enable other drivers and other responding emergency vehicles to hear you.

DO NOT "CHIRP" THE SIREN. THIS WARNING IS NOT ADEQUATE FOR OTHERS TO HEAR YOU AND REACT.

The driver must always balance the factors of location, time of day or night, and the need to provide adequate warning and notice to other drivers. The driver should maintain a four-second following distance to allow other drivers adequate time to react and reduce the intimidating effects of an emergency vehicle's warning devices.

2) Passing Vehicles

When an ambulance approaches another vehicle traveling in the same direction as the ambulance, the driver positions the ambulance three (3) to four (4) feet further to the left and advises motorists of their intention to pass them on the left, using the siren.

3) Approaching an Intersection Facing a Red Light

When the ambulance is located 150 feet before an intersection, the driver lifts his foot off the accelerator and transfers it to the brake pedal. Even with the siren on, the driver must bring the ambulance to a complete stop before entering the crosswalk and intersection. When the driver can see every lane with either, a vehicle stopped and eye contact made with its driver, or the ambulance crew can see far enough down a vacant lane (usually 150 feet) to eliminate any threat from approaching traffic, the ambulance operator can proceed with extreme caution.

4) Lane Control Under Emergency Operation

When driving on an emergency, the ambulance should be in the far left lane of traffic in the direction you are traveling. An exception to this guideline is one-way streets and avenues. In these cases, you should travel in the center lane as it provides the most space for you to maneuver and to allow other vehicles to move out of your way.

The general public is required by law to pull to the right, nearest curb on one-way streets and avenues, when they see or hear an emergency vehicle approaching from the front or rear of their vehicle and the emergency vehicle is on an emergency response.

The left turn lane should not be used as a response lane. The only exceptions are:

o Clearing an intersection, before proceeding through under the law of "due regard"

o Heavily congested traffic

o Directed by a police officer

You should never pass on the right unless necessary or directed to do so by a law enforcement officer.

When passing on the right, use the following guidelines:

o When you have no choice but to pass on the right, it shall be done with the utmost caution, and under the law of "due regard".

o Expect and anticipate other vehicles will move to the right, when you are passing on the right. They will!

When approaching an intersection under emergency operation, do not attempt a right turn from the left lane until other vehicles have stopped and acknowledged that you are taking a right turn. Stay in the left lane, and use your partner to clear you on the right and stop traffic as you cautiously make the right turn. This procedure will reduce the chance that the other driver will drive into your side as you turn to the right in front of their path.

When stopped in traffic, attempt to leave one or two vehicle lengths between your vehicle and the vehicle in front of you, in case you are dispatched to an emergency call.

5) Transporting Relatives and Friends in the Ambulance

When it is necessary for a friend or relative to be a passenger in the ambulance, they shall sit in the front right seat and be secured with a seat belt before the vehicle is placed in motion. Only one passenger should accompany the patient in the ambulance, unless absolutely necessary.

A family member of a child may be permitted to ride in the patient compartment if the situation warrants, i.e., the child is upset and the family member is able to calm them.

Individual circumstances will dictate whether the child of an injured adult should be allowed to ride in the patient compartment.  All children of “car seat” age must be secured in the ambulance in a car seat or a PediMate.  If there are more children needing transport with an injured adult than car seats available, contact dispatch or fire alarm as appropriate for additional response to transport children. 

DO NOT TRANSPORT CHILDREN IN REGULAR “ADULT” SEATBELTS.   NEVER TRANSPORT A CHILD “IN THE ARMS” OF AN ADULT THAT IS SECURED TO THE STRETCHER.

When transporting an ill or injured patient and they do not speak or understand English, you may allow a passenger in the patient compartment to assist in translating and communicating with the patient.

When it is necessary for a passenger to ride in the patient compartment, he or she must be seated in the seat at the head of the stretcher, and secured with a seat belt.

Only PRO personnel and authorized medical personnel are permitted in the patient compartment when a critical patient is being transported.

6) Safe Following Distances for Emergency Vehicles Following Other Emergency Vehicles

When operating on an emergency, the operator of the vehicle will stay back a minimum of 300 feet, or allow a buffer zone of 300 feet between their vehicle and other emergency vehicles in front of their vehicle. When approaching an intersection other drivers may hear only one siren, not both. Most drivers will enter the intersection as soon as the first emergency vehicle clears not realizing that there is another emergency vehicle right behind.

A significant following distance will also provide the operator of the following vehicle more time to react if the first emergency vehicle is involved in an accident going through the intersection. There could be other emergency vehicles responding from your left or right, and you may not be able to hear or distinguish their siren from the emergency vehicle in front of you. Try to utilize a different tone on your siren from the vehicle in front of you to help other drivers discern the presence of a second emergency vehicle.

The law mandates that no vehicle shall follow an emergency vehicle closer than 300 feet.

If you are involved in an intersection accident and you are the second emergency vehicle, you could be found negligent and guilty of failure to use "due regard." Remember the following:

o Other drivers must be able to hear and see you

o You must give sufficient warning to other drivers, so they are able to stop in time.

YOU DO NOT HAVE THE RIGHT OF WAY, YOU CAN ONLY REQUEST OTHER VEHICLES YIELD TO YOU, ALLOWING YOU TO PROCEED WITH “DUE REGARD”.

7) Maximum Speed

When traveling in the emergency mode, the ambulance driver must not exceed speeds greater than ten (10) MPH above the posted speed limit. At no time may a vehicle be driven at a speed greater than that needed to maintain constant control of the vehicle (i.e., speeds much less than the posted speed limit may be warranted for inclement weather, traffic and other restrictive conditions).

8) Route of Travel

Before leaving on an emergency response, the driver must first establish the most appropriate route of travel. Drivers consider factors such as street conditions, time of day, one-way versus two-way streets, traffic patterns, height restrictions, and pedestrian traffic.   

9) Pre-call Preparation

Emergency vehicle drivers must make every effort to assure that they maintain a constant state of readiness. Every detail must be attended to, from backing the vehicle into its parking spot, to having every aspect of the vehicle and equipment inspected, to being able to get to the vehicle rapidly.

10) Reducing Distractions

When driving in the emergency mode, particularly at intersections, the driver should try to avoid using the radio or allowing other distractions to affect his/her ability to maintain constant control and awareness of the ambulance. Always try to give the hospital notification prior to leaving the scene of a call so that you can devote your full attention to driving to the hospital.

DRIVERS SHOULD NOT BE TALKING ON A CELL PHONE WHILE DRIVING UNLESS ABSOLUTELY NECESSARY.
UNDER NO CIRCUMSTANCE SHOULD DRIVERS SEND OR READ EMAIL OR TEXT MESSAGES WHILE OPERATING ANY PRO VEHICLE.

FAILURE TO MEET ONE OR MORE OF THE ABOVE COULD BE CONSIDERED AS SHOWING A LACK OF "DUE REGARD" FOR THE SAFETY OF OTHERS AND A VIOLATION OF THE LAW AND COMPANY POLICY.

3.22.A. Inventory Control

Storage:

When an ambulance is in service as a BLS Unit the Drug Box will be locked by the combination lock provided in every ambulance and access by non-authorized individuals is prohibited. Paramedics are the only authorized personnel to access the Drug Box.

The Controlled Substances must be removed from the ambulance if it is out of the control of PRO. When removed from the ambulances the controlled substances must be locked securely in the Support Services cage and the ambulance should have a "NO ALS GEAR" sign. This should be done by either a Dispatcher, Supervisor, or Support Services Technician.

All PRO vehicles are to be sealed and locked at all times. Medications are kept in sealed boxes, bags, and/or compartments inside the locked vehicle.

• The ALS drug box is to be sealed inside of the locked vehicle.
  
  
• The ALS First in bag has a compartment containing the Schedule II and IV drug box (containing 20 mg Morphine, 20 mg Valium, 10 mg Versed, 10 mg Ativan) that is to be sealed at all times inside of the locked vehicle.
  
  
• The Schedule II and IV drug box is sealed with a numbered tag and is inside of a secured compartment in the ALS first in bag, inside of the locked vehicle.
  
  

Daily Vehicle Checklists:

Prior to the start of shift the Support Services Technician(s) will complete a Daily Vehicle Checklist (DVC). The seal number on the Schedule II and IV drug box should be recorded by the paramedic crew member. If the seal is missing or broken a Supervisor should be notified, a seal replaced, and the new seal number recorded in the Drug Log and on the DVC.

Drug Books:

An ALS Drug Log is assigned to each ALS vehicle. The log is to remain with the respective ALS equipment should that equipment be placed in an alternate vehicle or location. The ALS Drug Log must be initialed by BOTH (ALS and BLS) crew members prior to beginning each shift. ALS Drug Logs must also be marked to reflect when the vehicle is out of service to ensure that all shifts are documented, this is done by the Support Services Officer via a weekly audit of the Drug Log.. This may seem like a small item, however, law requires it. These books will be audited on a regular basis to ensure compliance to this policy.

3.22.B. Re-Stocking

PRO maintains an agreement to replace used, expired and/or damaged medications with the Cambridge Hospital and the Mount Auburn Hospital. Procedures for replacement at each facility vary. A SMEMS Medication Replacement Form must be completed when replacing medications.

3.22.C. Accountability

Access, care and handling of the drug box, first-line drug case, narcotics box and ultimately all medications, are the responsibility of the paramedic(s) on the assigned ALS unit on each shift. Liability for the loss of drug boxes, medications and controlled substances rests with the paramedic(s) on the assigned ALS unit on each shift.

3.22.D. Loss

Loss of any controlled substances will be cause for submission of a written Incident Report or NBS QI Incident and a Drug Incident Report to be completed and sent to the CEO. In addition, the following agencies shall be notified within twenty-four (24) hours of any related loss:

• Massachusetts Office of Emergency Medical Services
  
  
• Massachusetts Drug Control Program (Drug Incident Report Faxed to Program)
  
  
• South Middlesex Emergency Medical Consortium
  
• Police department with jurisdiction where the loss occurred

3.22.E. Temperature Sensitive Supplies

Temperature sensitive ALS supplies, including but not limited to medications and IV solutions, must be monitored and maintained in the temperature controlled environment inside the ambulance. If an ambulance and/or its medications and IV solutions cannot be maintained in a properly controlled environment, temperature sensitive supplies must be removed and stored in a climate controlled environment at PRO.

Any temperature sensitive ALS supplies that have been exposed to extreme temperatures for a significant period of time are to be placed out of service, disposed of and replaced by the Support Services Officer or Supervisor.

Vehicles should be assigned to specific call types based on the nature of the call. The following are the types of vehicles available for assignment

• Advanced Life Support (P)
• Radio/CAD designation: P1, P2, P3, P4, etc.
  
• Basic Life Support (A)
• Radio/CAD designation: Ex. - A1, A2, A3, A4, etc.
  
• Field Provider (EMT, MEDIC)
• Radio/CAD designation: Corresponding Employee I.D. Number
  
• Incident Support Unit (ISU)
• Radio/CAD designation:ISU

3.24.A. Emergency

1. The most appropriate unit when dispatching a Priority 1 or Priority 2 call is the appropriate unit that can be on scene in the least amount of time.

2. If a hailed and paged unit does not respond within 1 minute the dispatcher should assign the response to the next most appropriate unit.

3. If a unit advises they are closer to a call than the assigned unit the dispatcher should utilize GPS (request an ETA of both units if GPS is down), assess the information and make a determination, reassigning the call if necessary.

4. Units assigned to Priority 3 and Priority 4 calls should be reassigned to Priority 1 or Priority 2 calls when necessary. Emergency calls take precedence even if it results in a late arrival to a scheduled non-emergency call.

5. If a unit is at a destination, on arrival for pick-up or drop-off, and that unit is the only appropriate unit that could respond to a call, the dispatcher should ask the unit if they can come on the air or come out for a response. If the unit acknowledges they can handle the call and call "on the air" the response should be assigned to that unit.

6. All emergency calls involving psychiatric patients should have the appropriate law enforcement agency dispatched simultaneously. Crews should be reminded to enter the scene only after it is deemed safe by law enforcement. Information regarding calls that come in privately should be relayed to ECC for law enforcement dispatch.

7. Dispatchers are required to take all emergency calls and ascertain all relevant information from any source, location or area and dispatch the appropriate resources and outside agencies if necessary. Dispatchers must not make callers with an emergency access the EMS system twice.

8. A unit assigned to an emergency call that on-sites another emergency call or has a mechanical failure should be removed from the original response. The next most appropriate unit should be immediately assigned to the cover original response. The original unit may be reassigned if the unit clears the on-site and is still the most appropriate unit to respond to the original call. Vehicles experiencing mechanical problems should not be reassigned to another call.

9. Dispatchers may assign units to an emergency response outside of the regular operating area if mutual aid or "coverage" is requested by a respective outside agency.

3.24.B. Non-Emergency

1. Under normal circumstances, a unit should not be assigned a Priority 3 or Priority 4 call that will cause them to work past their off time. This will not always be possible as call volume can dictate that units come in early and/or stay late.

2. Non-emergency calls should be assigned and dispatched so that the scheduled pick-up time can be met.

A specific response priority must be assigned to every call. Only certain vehicles can be assigned to specific response priorities/types, (e.g., the chair car cannot be assigned to an Emergency or Priority 1 response). The following are the response priorities in descending order from highest to lowest priority:

3.25.A. Emergency

Priority 1 - Life Threatening or Potentially Life Threatening Emergency Response

• 911 or privately generated emergency call.
  
• Compliant response time is < 8:59 from the call started time in RightCAD Dispatch, until the time the wheels of the ambulance stop at the scene of the call.
  
• Unit should clear/become available as soon as possible after arrival at destination.

Priority 2- Non-Life Threatening Emergency Response

• 911 or privately generated emergency call.
  
• Compliant response time is < 8:59 from the call started time in RightCAD Dispatch, until the time the wheels of the ambulance stop at the scene of the call.
  
• Unit should clear/become available as soon as possible after arrival at destination.

Fire/Hazmat Stand-by

• Medical coverage stand-by requested by 911 or another public safety entity.
  
• Compliant response time is < 8:59 from the call started time in RightCAD Dispatch, until the time the wheels of the ambulance stop at the scene of the call.
  
• Unit clears when released by the public safety entity assuming Incident Command.

3.25.B. Non-Emergency

Priority 3 - Non-Emergency Response - Pick up on arrival

• Non-emergency call. Pick-up is ASAP.
  
• Compliant response time is < 30 minutes from receipt of request.
  
• Unit should clear/become available as soon as possible after arrival at destination.

Priority 4 - Non-emergency Response - Scheduled transfer

• Non-emergency call. Pick-up at a scheduled time requested.
  
• Compliant response time is within 15 minutes of scheduled pick-up time.
  
• Unit should clear/become available as soon as possible after arrival at destination.

Detail / Stand-by

• Bayside detail, football game, parade, outdoor event.
  
• Compliant response is a unit/field provider at the stand-by prior to the scheduled start of coverage.
  
• Unit/field provider should clear/become available as soon as possible after the scheduled end of coverage time.

3.26.A. Receiving Facilities

Every patient transported should be transported to the closest appropriate facility. There are some circumstances in which a patient may need to be transported to a facility better equipped to deal with a specific illnesses or injuries. In the event of a trauma patient or burn patient it is advised to deliver the patient to a Level 1 Trauma Center or a Burn Center. Additionally, patient requests can be honored depending on the patient's condition and call volume.

If field units are unsure as to what destination may best suit the patient's needs, they are directed to contact medical control or the dispatcher for assistance.

Level 1 Trauma Centers

Beth Israel Hospital (no pediatrics)

Massachusetts General Hospital

Brigham & Women's Hospital (no pediatrics)

Boston Medical Center

Children's Hospital (pediatrics only)

NEMC Floating Hospital (pediatrics only)

 

Burn Centers

Massachusetts General Hospital

Brigham & Women's Hospital

 

Cardiac Cath Facilities for STEMI

Mount Auburn Hospital

Massachusetts General Hospital

Brigham & Women's Hospital

Boston Medical Center

Beth Israel Hospital

St. Elizabeth's

 

Stroke Centers

All Boston area Facilities

3.26.B. Hospital Diversion Status

Diversions are to be monitored by viewing the Statewide Ambulance Diversion Website, which must be open and running on the dispatcher's desktop.

All diversions should also be entered into RightCAD for immediate crew notification. To enter diversion information while in RightCAD, go to the VIEW drop down menu and select "Diversions". The diversion window will open. Click the "Add" button. Add the facility. Be certain to include/exclude the appropriate department(s). e.g. TCH L&D only.

The dispatcher must constantly monitor the Hospital Diversion Website for regional hospital statuses.

3.26.C. Hospital Notification

At times it may be necessary for the dispatcher to notify a receiving facility of the status of an incoming patient. All entry notes to TCH and MAH will be done directly by the Unit on scene through the appropriate CFD portable Channel 7. Entry notes can also be done by the Unit on scene through C-Med. If necessary, entry notes to facilities can be relayed through the dispatcher. The dispatch phone has a ring down or speed dials to all local emergency departments.

Entry notifications should be concise and include the patient's age, sex, chief complaint, treatment and ETA. Entry notifications are not necessary for Boston hospitals unless the patient presents with a life-threatening condition. After the hospital has been notified by a dispatcher, the dispatcher should inform the unit that the transfer of information is complete and the receiving facility is awaiting their arrival.

3.26.D. Point of Entry Plans

All patients meeting the designated criteria for trauma should be transported to an appropriate facility per the Region IV Trauma Point of Entry Plan.

All patients with stroke symptoms should be transported to the closest appropriate facility per the Region IV Stroke Point of Entry Plan.

PRO utilizes a specific point of entry plan that requires all patients with >1mm of ST elevation be transported to a facility with cardiac cath capability.

PRO also uses a specific point of entry plan for patients requesting transport to MIT Medical or Harvard University Health Services.

If you ever have any question or doubt regarding where to transport a patient always contact Medical Control or a supervisor.

3.27.A. Clinical Standards

PRO is dedicated to providing the highest level of patient care. We will endeavor to ensure that every patient receives personalized, compassionate and professional care. Specific established quality improvement procedures must be followed. PRO reviews 100% of our calls to have an accurate evaluation of the operational, administrative and procedural activities of the system as it relates to the delivery of patient care. The supervisory staff evaluates trip sheets in an effort to objectively track performance of both individuals and the overall system.

The supervisory staff will work with the SMEMS Executive Director and the SMEMS Medical Director and take an active role in the evaluation of protocols, procedures, and patient care standards with constant re-evaluation based on events and progressions made within the system. The supervisory staff will tabulate a monthly statistical analysis on individual compliance.

"Case Review" sessions will be held on a monthly basis by the supervisory staff and by SMEMS. Issues that involve protocol changes in patient care will require participation of all levels of the system.

3.27.B. Clinical and Response Time Non-Compliance

All employees who have been found operating out of compliance with the Statewide Treatment Protocols will be subject to immediate remediation with the supervisory staff. In the event of a serious issue, it will be brought to the attention of the SMEMS Executive Director who will notify the Medical Director of the protocol violation. The employee may be orally counseled and/or be disciplined up to and including termination.

Any deviation from the Statewide Treatment Protocols will subject the employee to remediation with the supervisory staff. The employee may also be required to ride with supervisory staff when deemed necessary.

Any employee who has repeated paperwork problems will be orally counseled and may be required to ride with the supervisory staff. Repeated paperwork problems will be dealt with as a disciplinary problem and will subject the employee to further disciplinary action up to and including termination.

Response time compliance will be monitored on a daily, weekly, monthly and annual basis for trends and to develop procedures to continuously improve performance.

PRO employees are instructed to properly transport patient's personal belongings when requested to do so. Various items may include clothes, flowers, personal belongings, etc.

Crewmembers will account for these items upon arrival at the receiving facility. In the event crews find items that were not left with the patient upon delivery, notify Dispatch immediately.

Dispatch will make every attempt to:

• Allow the ambulance to immediately return to the receiving facility to return these items.
  
• Notify another ambulance crew to facilitate return.
  
• If neither option is possible due to ambulance traffic, the patient's items will be secure in the Dispatch office for return by administration at the earliest possible time.

The patient and/or facility will be notified as to the events and expected time of delivery of the items.

4.1.A. Overview

Under normal circumstances dispatch is a relatively stress free position but at times, it can be extremely demanding. The dispatcher must always know the status of all units and crew members.

THE DISPATCHER SHOULD SATELLITE UNITS IN PARTICULAR AREAS TO MAXIMIZE COVERAGE AND MINIMIZE RESPONSE TIMES.

It is imperative that all dispatchers have a thorough knowledge of our service area/surrounding area to assign the most appropriate unit in a rapid and safe manner. Overall, the dispatcher must be prepared for anything and capable of routinely handling multiple tasks simultaneously.

DISPATCHERS MUST BE PREPARED FOR FIELD SERVICE AT ALL TIMES. TO THAT END, ALL DISPATCHERS MUST BE IN UNIFORM AT ALL TIMES.

4.1.B. Employment Qualifications

All employees assigned to dispatch must meet the requirements and qualifications outlined in the Dispatcher job description. All dispatchers are required to have and maintain the following certifications and training:

• American Heart Association CPR (BLS)
• MPDS Emergency Medical Dispatcher
• Complete the ProEMS Dispatch NEOP
  

4.1.C. Emergency Medical Dispatch (EMD)Certification

Staff employed in the position of Dispatchers are required to gain both initial certification as an Emergency Medical Dispatcher and to maintian this qualification via relevant recertification process.

PRO mandates that certain requirements are met for the certifications and re-certification of all Emergency Medical Dispatchers (EMDs).

Procedure

• EMD Certification
  • All current and future personnel employed in the position of Communications Center Calltaker/Dispatcher are required to obtain Emergency Medical Dispatcher Certification with the National Academy of Emergency Medical Dispatch (NAEMD).
  • PRO will provide the necessary training and re-training opportunities to facilitate acquisition of this qualification.
  • In the event that an employee does not pass the certification examination on the first attempt, he/she will be provided with supportive training based on feedback received from the NAEMD. Any EMD student who does not pass the certification exam will then be invited to take the re-test, conducted by the NAEMD via telephone.
  • Should the Communications Dispatcher still be unsuccessful in passing the re-test, they will be invited to participate in a complete EMD course in the future. They may then take the certification examination and if necessary, the re-test on one occasion.
• EMD Re-Certification
  • Communications Dispatchers are required to maintain current EMD certification as mandated by the NAEMD. This currently requires completion of a minimum of 24 hours Continuing Dispatch Education per every two (2) year period, achieving a pasing score in an open book EMD examination at two (2) year intervals, and maintaining current CPR certification.
  • PRO will provide all necessary opportunities for completion of the Continuing Dispatch Education require and CPR recertification. It will also maintian CDE records and a record of EMD certification status.
  • Details of CDE requirements are contained in a separate CDE-specific policy.
• Certification Expiration, Revocation or Suspension
• Should a Communications Dispatcher’s NAEMD EMD certification expire or become void due to suspension or revocation, the employee will be removed from EMD call-taking until the EMD certification is reinstated or renewed.

4.2.A. Dispatch Priorities

A specific response priority is assigned to every call by the Dispatcher. The following are the response priorities in descending order from highest to lowest priority:

Priority 1 - EMERGENCY, LIFE THREATENING (Emergency lights and siren are used)
Priority 2 - EMERGENCY, NON-LIFE THREATENING (Emergency lights and siren are used)
Priority 3 - ASAP, NON-EMERGENCY (Any non-emergency call requesting a pick-up ASAP)
Priority 4 - SCHEDULED, NON-EMERGENCY (Any non-emergency call that has a scheduled pick-up time)

Standby/Detail - Events (football standby, parade, fire standby, etc.) Detail is any scheduled or unscheduled event medical coverage

4.2.B. Dispatch Format

The following format will be used to dispatch:

Emergency

• Unit number/ID being hailed
• Unit acknowledges
• Dispatch priority
• Exact location of the call (business name or landmark if known)
• Nature of the call
• Sex/age of patient and additional info on call if known
• Additional responders
• Time of dispatch
• Repeat Unit number/ID
• Additional information, landmarks, or presence of danger shall be given as it becomes available.

Unit will acknowledge receipt of the call and confirm accuracy of such information by repeating it back to the dispatcher.

Example:

Dispatch: "Pro Base calling P2"

P2: "P2 answering"

Dispatch: "P2, Priority 1, Cambridge Family Health, 2067 Mass Ave, Suite #2, 84 year old female, Difficulty Breathing, with Engine 4 and Rescue 1 @ 14:45, P2"

P2: "P2, received, 2067 Mass Ave"

• Simultaneoulsy, RightCAD will send a page to the assigned crew in the following format:
• Response Priority
• Call Type
• Pick-Up Location (Including department and apt/ste/rm number)
• Pick-Up City
• Complaint
• Run Number
• Pick-Up Time
• Dispatch Comments
 

Example:

Page: P1, ALS, 2067 MASS AVE, SUITE 2 , CAMBRIDGE, DIFFICULTY BREATHING, Run#1731, 11:58, 62 YOF

Non-Emergency

•  Unit number/ID being hailed
• Unit Acknowledges
• Dispatch priority
• Pick-Up Location/Floor number (if private residence, obtain call back number)
• Drop-Off Location 
• Special equipment considerations (IV, cardiac monitor, meds, oxygen, extra attendant, etc.) 
• Pick-Up time
• Repeat unit number /ID

  Example:

  Dispatch: "Pro Base calling A1"

A1: "A1 answering"

Dispatch: "A1, Priority 3, Mount Auburn Hospital, Cath Lab, returning to the Cambridge Hospital 4W, bring in your 02, patient is ready now, A1"

A1: "We have it, Mount Auburn Cath Lab"

• Simultaneously, RightCAD will send a page to the assigned crew in the following format:
• Response Priority
• Call Type
• Pick-Up Location (Including department and Apt/Ste/Rm number)
• Run Number
• Pick-Up Time
• Patient Name
• Drop-Off Location (Including Apt #, etc)
• Dispatch Comments

Example:

Page: P3, BLS, MT AUBURN HOSPITAL, CATH LAB, CAMBRIDGE, Run#1731, 11:58, DOE, JOHN, BEAR HILL NURSING CENTER, BRING IN YOUR 02

4.2.C Medical Priority Dispatch (MPD) System Use

Call taking and dispatch for medical assistance shall be provided in a standardized manner following approved Medical Priority Dispatch System (MPDS) protocols for 911 caller interrogation, assigning determinant codes, and providing post dispatch and pre-arrival instructions.

Pro will provide all Emergency Medical Dispatchers (EMDs) with approved procedures and practices for safe and effective Emergency Medical Dispatching. Those procedures and practices include interrogating the caller, assigning an accurate determinant code, providing telephone assistance, and communicating necessary information to rescue personnel and other responders.

 Procedure

• Medical Priority Dispatch System (MPDS) Protocols
  • ProQA (A software program containing MPDS protocols for Emergency Medical Dispatching) is provided at each call-takin position.  In addition, a flip-card set containing MPDS protocols for Emergency Medical Dispatching is provided in dispatch in case of computer failure.
  • These protocols provide standardized medical interrogation questions, post-dispatch instructions, pre-arrival instructions and dispatch determinant codes.
  • The protocol flip-card set shall be kept in dispatch at all times.
  • The MPDS protocols have been approved by senior management and the Medical Director of PRO.
  • The MPDS protocols shall be followed on all incoming EMS-related emergency calls.
• Interrogation
  • All attempts to obtain Case Entry and Key Questions information from the caller will be made by utilizing good communication techniques and reading the questions exactly as written in the protocol.
    • If the scripted protocol question is not understood, or the caller does not initially provide an answer, the EMD may re-phrase the question in an appropriately clarified form.
    • Questions may only be omitted if the answer is obvious or has already been clearly provided.
    • EMDs may adjust the script to address first party callers.
    • Status of consciousness, including “alertness” and “ability to talk” may be inferred as obvious when the caller is the patient.
    • For languages other than English, the EMD will utilize language line to get a translator on the line.  The translator will act as an intermediary and will ask the protocol questions and provide all instructions contained in the protocol, whenever possible.
• Determinant Codes and Responses
  • The MPDS interrogation protocols will be used to select and enter that applicable MPDS determinant code in the designated field of the CAD call-entry screen.
  • Response configurations and modes will not be altered at this time by the use of the MPDS.
• Relay of Information to Responding Units
  • The following items shall be regarded as the minimum information to be passed to all responding personnel.
    • The location of the incident
    • The chief complaint
    • The age of the patient
    • The MPDS determinant code
    • The status of consciousness
    • The status of breathing
  • Any critical incident information that the call-taker receives after responders have been alerted, and prior to their arrival on scene, will be relayed to the responding units. This includes any responder or patient safety information and drastic changes in the patient’s condition or in scene circumstances.
• Post-Dispatching Instructions
  • The EMD giving PDIs will follow the protocol, giving instructions appropriate to each individual call, and avoiding free-lance information.
  • PDIs shall be provided to the caller whenever possible and appropriate to do so.
  • Should the workload of the dispatch center require it (e.g. as a result of unanswered incoming 911 calls), the EMD will apply the “emergency rule” and temporarily suspend the provision of PDIs to callers.
• Pre-Arrival Instructions (PAIs)
  • PAIs shall be provided directly from the scripted text listed on each PAI Panel on protocol cards A through Z. The EMD giving PAIs will follow the script, avoiding free-lance information, unless it enhances and does not replace the written protocol scripts.
  • PAIs shall be provided to the caller whenever possible and appropriate to do so.
  • When unanswered emergency calls are in the queue while an EMD is providing PAIs, and after responding crews have been alerted, the EMD will apply the “emergency rule” and temporarily suspend the provision of PAIs to callers. Whenever the emergency rule is applied and callers are placed on hold, the EMD will provide a short explanation to the caller, including instructions to stay on the line. The EMD, as soon as possible, will return to the caller to complete PAI instructions.

4.2.D Maintaining Current EMD Standards

PRO Communications Center will maintain the most current EMD practices by implementing the latest version of the MPDS within one (1) year of its official release by the National Academy of Emergency Medical Dispatch. PRO will provide all of its certified EMDs with the necessary training to use the latest version of the MPDS.

PRO will provide all EMDs the latest version of the MPDS protocols and necessary training in order to keep up-to-date with the most recent practices and standards in Emergency Medical Dispatch. As new research and technologies in emergency medicine become available, EMDs will require new skills, protocols and practices to deliver the best possible care to the patients and the community.

 Procedure

• The National Academy of Emergency Medical Dispatch will notify PRO when a new release of the MPDS is available for use.
• PRO will acquire the new release of the MPDS for all EMD calltaking positions, and schedule a date for on-line use of the new system.
• The EMD Medical Director will evaluate and approve the use of the new version of the MPDS.
• All EMDs will be provided the updated training necessary to effectively use the new version of the MPDS.
• All EMD quality improvement personnel will be provided necessary training on the updated version of the MPDS.
• All members of the MDRC and Steering Committee will be provided information on the updated version of the MPDS.
• All field EMS responders will be provided information on the updated version of the MPDS.

4.3.A. Responsibility to Dispatch

The Department of Public Health - Office of Emergency Medical Services Responsibility to Dispatch, Treat and Transport (105 CMR 170.355)

(A) No service, or agent thereof, shall refuse in the case of an emergency to dispatch an available EMS vehicle to provide emergency response and life support at the scene or to transport a patient to an appropriate health care facility within its regular operating area, in accordance with the applicable service zone plan.

(B) (Omitted)

(C) Prior to the approval of a service zone plan, and until no later than December 31, 2006:

(1) No licensed ambulance service or its agents shall refuse to dispatch an available ambulance to provide emergency response and/or transport in its regular operating area.

(2) Upon receipt of a call to respond to an emergency, the ambulance service shall immediately dispatch a Class I ambulance.

(3) If the ambulance service dispatcher believes at the time a call is received that a Class I ambulance is not available for immediate dispatch, the dispatcher shall immediately contact the ambulance service's backup service pursuant to 105 CMR 170.385. If the ambulance service dispatcher believes that another ambulance service has an ambulance that can reach the scene in a significantly shorter period of time, the dispatcher shall immediately notify:

(a) The other ambulance service, which shall immediately dispatch an ambulance, and

(b) Police or fire in the town in which the emergency has occurred

(D) (Omitted)

(E) Each service whose regular operating area includes all or part of the service zone in which a mass casualty incident occurs must immediately dispatch available EMS resources upon request by the primary ambulance service.

4.3.B. Primary Dispatch Responsibilities

1) Provide professional and courteous service while receiving incoming calls from the public or other public safety entities requesting emergency and non-emergency assistance; achieve and maintain control of call and provide proper interrogation to obtain necessary information to determine the appropriate response and priority by using the MPDS Protocols.

2) Dispatch appropriate unit(s) according to the acuity and location of the call and provide appropriate information as required while simultaneously maintaining radio contact with and monitoring the status of all field units.

3) Prioritize requests for, and dispatch appropriate resources to, non-emergency transports based on customer relationship.

4) Utilize RightCAD, maintain accurate record and log of all incidents including address of incident, times, type of response, unit number, crew names, patient name and disposition.

5) Maintain awareness of all field units' status and location through RightCAD, GPS/AVL, radio communication, and any other means available and assist in coordinating the activities of all field units.

6) Monitor multiple public safety radio frequencies, hospital diversions and video surveillance screens; operate a variety of communications equipment, including radio consoles, paging systems, telephones, computer aided dispatch systems and multiple computer programs/systems.

7) Communicate with other public safety agencies, hospitals, public works departments, support services and any other entity as needed to request or forward necessary information.

8) Serve as shift supervisor in the absence of a supervisory staff member.

9) Monitor the ePCR Sync Status screen to ensure all PCRs are synced prior to crew leaving.

PRO's regular operating area is defined as the geographic boundaries of the City of Cambridge, the property of Harvard University, and the property of the Massachusetts Institute of Technology, and all jurisdictions contiguous to Cambridge. The dispatcher shall post units throughout the regular operating area to ensure the best "coverage" of the area.

Posts are not meant to require units to be parked in a set location. Posts are flexible coverage areas designed to focus available units on a specific portion of the city. Assigning units to a Post allows the dispatcher to assure that calls are given to the closest appropriate unit and response times are reduced.

PRO uses three posts:

Harvard Square: any centralized location in or around Harvard Square including the Cambridge Hospital

Uptown: any location north or west of Harvard Square including Harvard Square. Ex.- Mt. Auburn Hospital, Fresh Pond, Porter Sq., North Cambridge.

Downtown: any location south or east of Harvard Square including Harvard Square. Ex. - Central Square, East Cambridge, Kendall Square, Magazine Beach.

Units will be posted at the discretion of the dispatcher; however it is generally accepted to post as follows:

ALS:

BLS:

PRO Communications Center will maintain the most current EMS response assignment plan, using response assignments for each of the MPDS determinant descriptors (sub-determinant codes) approved by the EMD Steering Committee. The EMD Medical Director will review the EMS response assignment plan annually, and recommend any proposed changes to the EMD Steering Committee. The EMD Steering Committee will make any changes to the EMS response assignment plan.

PRO seeks to ensure the EMS response assignment plan is maintained and kept current with any changes in EMS law, policy, procedures, research and standards. In order to meet the needs of the local community, the MPDS response assignment will subject to annual review and revision.

Procedure

• The EMD system Medical Director will evaluate the EMS response assignment plan annually, by comparing response assignments for each MPDS determinant descriptor to available data, including patient outcome information, local EMS policies and procedures, and the availability of system resources.
• The EMD system Medical Director will make recommendations for any proposed changes to the EMS response assignment plan. He/she will list specific MPDS codes for which response changes are proposed, with a written rational for each proposed change.
• The EMD Steering Committee will approve and make final any proposed changes to the EMD response assignment plan.
• All agency personnel will be notified in writing of response plan changes no later than seven (7) days before actual implementation of the new plan.

4.6.A. Origin of Call (Ordering Facility)

Emergency and non-emergency calls can originate from a variety of sources. On both emergency and non-emergency calls originating from a healthcare facility you must record the department or floor as well as the calling party's name. RightCAD populates (fills in) most of this information for you on known facilities and residences of patients in our database. If the information is not automatically populated the dispatcher should enter the info. If the information is automatically populated the dispatcher should verify the information by reading it back to the caller.

Emergency Calls

Dispatchers should document the origin of all emergency calls (P1 or P2) by entering the most appropriate caller using the "ORDERING FACILITY" drop down box (located under Tab 2, "Medical"). RightCAD automatically populates the ordering facility field. This field must be changed to reflect the correct caller. The caller's telephone number must be ascertained and entered on all emergency calls received from a source other than Cambridge 9-1-1. "ORDERING FACILTY" will occasionally have new callers and entities added. Please pay attention to these changes and enter the correct caller as this information is vital.

Non-Emergency Calls

Dispatchers should document the origin of all non-emergency calls (P3 & P4) by entering the most appropriate caller using the "ORDERING FACILITY" drop down box (located under Tab 2) that will automatically prompt the RightCAD user. RightCad automatically populates the ordering facility field with the pick-up facility name. This should be verified and changed as necessary. Ex.- patient traveling from MGH to MIT may have been ordered by MIT, not MGH.

4.6.B. Call Type

A specific call type must be assigned to every incident. Vehicles should be assigned call types based on the nature of the call. The following are the call types:

Advanced Life Support (ALS)

Based on the complaint or request; any emergency or non-emergency call requiring ALS assessment, skills, procedures, or monitoring. (e.g., chest pain, shortness of breath, etc.)

Basic Life Support (BLS)

Based on the complaint or request; any emergency or non-emergency call requiring only BLS skills, procedures or monitoring. BLS calls can be assigned to an ALS or BLS vehicle. (e.g., Lifeline alarm, man down, etc.)

Detail

Any scheduled or unscheduled emergency medical coverage provided to an event, entity, incident or area. A detail should be assigned the type of response that was requested. (e.g., football stand-by, Harvard Graduation, fire stand-by, etc.)

4.7.A. Emergency

THE DISPATCH OF EMERGENCY CALLS SHOULD TAKE PLACE WITHIN THIRTY (30) SECONDS FROM THE TIME THE CALL IS RECEIVED.

The dispatcher is to make every effort to ascertain, at the earliest possibility, whether a potential for danger exists. If there is a question of danger to a crew on any call such as weapons or Hazmat, the dispatcher will alert the police department and/or fire department. It is important to remember that responding units are not to enter a potentially dangerous situation until it has been determined that the scene is safe and secure.

All dispatchers are required to obtain and enter the following information into RightCAD on private (non-911/ECC) emergency callers, most often by utilizing ProQA:

• Location/Street Address/Apartment number/Inside or Outside*
  
  
• City (enter zip code)*
  
  
• Nature of the call (Transport Reason)*
  
  
• Age of Patient (Dispatch Comments)
  
  
• Level of consciousness (Dispatch Comments)
  
  
• Patient's breathing status (Dispatch Comments)
  
  
• Number of Patients (Dispatch Comments)
  
  
• Origin of Call (Ordering Facility)*
  
  
• Caller's Name
  
  
• Phone number that caller is calling from (Ordering Facility Phone)*
  
  
• Any relevant information for the crew's information or documentation purposes (Dispatch Comments)

  *In order to assign an emergency response to an appropriate unit, RightCAD requires data be entered into these fields along with Call Type and Priority.

Dispatchers should document the origin of all emergency calls by entering the most appropriate caller using the "ORDERING FACILITY" drop down box that will automatically prompt the RightCAD user.

ALL DISPATCHERS ARE REQUIRED TO TAKE ALL EMERGENCY CALLS AND ASCERTAIN THE ABOVE INFORMATION FROM ANY AND EVERY SOURCE OR LOCATION AND DISPATCH THE APPROPRIATE RESOURCES AND OUTSIDE AGENCIES IF NECESSARY. DISPATCHERS MUST NOT MAKE CALLERS WITH AN EMERGENCY ACCESS THE EMS SYSTEM TWICE. e.g.,- if a patient or facility calls for an emergency in Dedham the dispatcher should take all information and inform the patient that the local EMS will be notified. The dispatcher will then immediately notify the fire department in that locale. Local fire department phone numbers are located in the RightCAD Rolodex.

4.7.B. Non-Emergency

The dispatch of non-emergency calls should take place as soon as possible/feasible to ensure a timely response to both Priority 3 and Priority 4 responses. All dispatchers will be required to obtain the following information on non-emergent callers and enter required information into RightCAD.

• Patient's name*
  
  
• Pick-up Location/Street Address/Floor number (if private residence, obtain call back number)*
  
  
• Pickup time*
  
  
• Drop-off Location/Street Address/Floor number*
  
  
• Ordering Facilty*
  
  
• Ordering Facility Caller's Name*
  
  
• Insurance information and medical necessity information for calls originating from a private residence or a facility that we do not regularly service. Ask a supervisor or the billing office if you are unsure of whether the patient's insurance will cover a particular service.

  *In order to assign a non-emergency response to an appropriate unit, RightCAD requires data be entered into these fields along with Call Type and Priority.

Dispatchers should document the origin of all non-emergency calls (P3 & P4) by entering the most appropriate caller using the "ORDERING FACILITY" drop down box (located under Tab 2) that will automatically prompt the RightCAD user. RightCad automatically populates the ordering facility field with the pick-up facility name. This should be verified and changed as necessary. e.g.- patient traveling from MGH to MIT may have been ordered by MIT, not MGH.

All information should be verified by the dispatcher by verbally repeating all pertinent information back to the caller.

If a Priority 3 or Priority 4 call cannot be dispatched so that a unit can be on scene in accordance with the compliant response times the facility should be notified by telephone.

4.7.C. ALS Inter-facility Transport - Specialty Care Transport (SCT)

Specialty Care Transport can be an Emergency or Non-Emergency transport in which the patient is transferred from facility to another facility, who requires specialized care by a paramedic with additional training and/or physicians/nurses during transport.

• Patient's name*
  
  
• Pick-up Location/Street Address/Floor number (if private residence, obtain call back number)*
  
  
• Pickup time*
  
  
• Drop-off Location/Street Address/Floor number*
  
  
• Ordering Facilty*
  
  
• Ordering Facility Caller's Name*

1. Is the patient unstable?
   
   
2. What are the current medications or procedures?
   
   
3. How many IV drips are they currently receiving?
   
   
4. Is this patient intubated?

4.7.D. Incident Address Verification

Address verification shall be completed in a standardized manner following approved practices and procedures as contained in this policy.

PRO will provide all Emergency Medical Dispatchers (EMDs) with approved procedures and practices for obtaining and verifying an accurate and complete address and phone number.

Procedure

1. Answering the Emergency Phoneline

All emergency phone lines will be answered in the following manner:
If the caller is unable to provide a numeric address, the calltaker will say, “Please give me the best location you have for the incident?”

2. CAD System Entry and Verification
   1. The calltaker will enter the address or location provided by the caller into the CAD system using the most accurate information available from the caller (This could be a numeric address, intersection, business, landmark, etc.)
   2. Where ANI/ALI information is available AND the caller is calling from the exact location where help is needed, the calltaker will verify the address information obtained by using the ANI/ALI screen, accepting the address given by the caller ONLY when the ANI/ALI information exactly matches the caller’s information. If tehre is no ANI/ALI match, the calltaker will verify the address using step C (below).
   3. Where ANI/ALI information is not available OR the caller is not at the actual location where help is needed, the calltaker will verify the address (or location) by stating the following: “Please repeat the address/location for confirmation.”
   4. For all residential (or suspected residential) locations where there is no ANI/ALI information OR ANI/ALI information does not match the exact location given by the caller, the calltaker will ask “Is this a house or an apartment?” and correctly enter this information into the CAD incident.
   5. For all non-residential locations, the calltaker will obtain all necessary access information, which may include: building name, business name, floor number, office or suite number, specific entrance instructions, and intersection or street segment (for roadway incidents)
   6. Once the calltaker has entered the address/location into the CAD system, he/she will geo-verify the entered address/location by ensuring that CAD returns a valid address or location AND is matches the initial information entered and obtained from the caller.
   7. The calltaker will then ask for and verify the phone number using the same process described above in B and C.

4.7.E. Obvious Death

EMDs will handle obvious death and expected death cases by following the protocol and local procedures approved by the system Medical Director.

PRO will provide EMDs wth a medically approved process for potential obvious death and expected death situations.

Procedure

1. Obvious Death Definition
   1. For dispatch purposes ‘Obvious Death’ is defined as a patient’s condition that can be identified as incompatible with life, after all information has been obtained on the Case Entry protocol, and protocol 9 (Cardiac or Respiratory Arrest/Death). Resuscitative measures including PAIs for breaths and chest compressions will not be provided in any ‘Obvious Death’ and ‘Expected Death’ situation.
   2. Once the EMD determines the patient to be not conscious and not breathing, through proper application of the MPDS, the following conditions may be considered by the dispatcher to constitute ‘Obvious Death’:

1. Cold and stiff in a warm environment
2. Decapitation
3. Explosive gunshot wound to the head
4. Decomposition
5. Non-recent death (confirmed as being greater than six (6) hours)
6. Severe injuries obviously incompatable with life
7. Incineration
8. Submersion (confirmed as being greater than 24 hours)

The dispatche must be sure that the presence of at least one of the above conditions is unquestionable. The EMD must get specific answers to all applicable questions on protocol card 9 to arrive at an ‘obvious death’ determination

3. Once the EMD determines the patient to be not concious and not breathing, through proper application of the MPDS, the following conditions may be considered by the dispatcher to constitute ‘Expected Death’:

1. Terminal Illness
2. DNR Order

The EMD must get specific answeres to all applicable questions on protocol card 9 to arrive at an ‘expected death’ determination.

2. EMD Actions in the Event of Identification of Unquestionable Obvious Death or Expected Death
   1. Code all obvious death cases as 9-B-1, and inform responders of specific obvious death condition determined.
   2. Code all expected death cases as 9-Omega-1.
   3. Do not provide PAIs.
   4. If possible, keep the calle ron the line and provide emotional support.
3. Cases Requiring Pre-Arrival Instructions
   1. EMDs shall attempt pre-arrival instructions on all cardiac/respiratory arrest cases where the obvious death and expected death determinants (9-B-1 and 9-Omega-1) are not applied.
   2. When pre-arrival instructions are required (as defined in ‘A’ above), EMDs are not to ask permission to give PAIs. Do not say “Would you like me to tell you how to do CPR?”
   3. If the caller refuses to follow PAIs, say, “The ambulance is on its way, but this is important to give the patient the best possible chance until it arrives.” Repeat as necessary.
   4. If the caller still refuses to administer aid, ask if there is someone else you can speak to.
   5. If no one else is available attempt to keep the caller on the line and provide emotional support. Make it clear that if they change their mind about providing patient care you will tell them exactly what to do.
   6. Remain polite and coutreous at all times.

4.7.A. Emergency

THE DISPATCH OF EMERGENCY CALLS SHOULD TAKE PLACE WITHIN THIRTY (30) SECONDS FROM THE TIME THE CALL IS RECEIVED.

The dispatcher is to make every effort to ascertain, at the earliest possibility, whether a potential for danger exists. If there is a question of danger to a crew on any call such as weapons or Hazmat, the dispatcher will alert the police department and/or fire department. It is important to remember that responding units are not to enter a potentially dangerous situation until it has been determined that the scene is safe and secure.

All dispatchers are required to obtain and enter the following information into RightCAD on private (non-911/ECC) emergency callers, further information needed will be obtained by utilizing ProQA:

• Location/Street Address/Apartment number/Inside or Outside

• City (enter zip code)
  
  
• Nature of the call (Transport Reason)
  
  
• Origin of Call (Ordering Facility)
  
  
• Caller's Name
  
  
• Phone number that caller is calling from (Ordering Facility Phone)
  
  
• Any relevant information for the crew's information or documentation purposes (Dispatch Comments)

Dispatchers should document the origin of all emergency calls by entering the most appropriate caller using the "ORDERING FACILITY" drop down box that will automatically prompt the RightCAD user.

ALL DISPATCHERS ARE REQUIRED TO TAKE ALL EMERGENCY CALLS AND ASCERTAIN THE ABOVE INFORMATION FROM ANY AND EVERY SOURCE OR LOCATION AND DISPATCH THE APPROPRIATE RESOURCES AND OUTSIDE AGENCIES IF NECESSARY. DISPATCHERS MUST NOT MAKE CALLERS WITH AN EMERGENCY ACCESS THE EMS SYSTEM TWICE. e.g.,- if a patient or facility calls for an emergency in Dedham the dispatcher should take all information and inform the patient that the local EMS will be notified. The dispatcher will then immediately notify the fire department in that locale. Local fire department phone numbers are located in the RightCAD Rolodex.

4.7.B. Non-Emergency

The dispatch of non-emergency calls should take place as soon as possible/feasible to ensure a timely response to both Priority 3 and Priority 4 responses. All dispatchers will be required to obtain the following information on non-emergent callers and enter required information into RightCAD.

• Patient's name*
  
  
• Pick-up Location/Street Address/Floor number (if private residence, obtain call back number)*
  
  
• Pickup time*
  
  
• Drop-off Location/Street Address/Floor number*
  
  
• Ordering Facilty*
  
  
• Ordering Facility Caller's Name*
  
  
• Insurance information and medical necessity information for calls originating from a private residence or a facility that we do not regularly service. Ask a supervisor or the billing office if you are unsure of whether the patient's insurance will cover a particular service.

  *In order to assign a non-emergency response to an appropriate unit, RightCAD requires data be entered into these fields along with Call Type and Priority.

Dispatchers should document the origin of all non-emergency calls (P3 & P4) by entering the most appropriate caller using the "ORDERING FACILITY" drop down box (located under Tab 2) that will automatically prompt the RightCAD user. RightCad automatically populates the ordering facility field with the pick-up facility name. This should be verified and changed as necessary. e.g.- patient traveling from MGH to MIT may have been ordered by MIT, not MGH.

All information should be verified by the dispatcher by verbally repeating all pertinent information back to the caller.

If a Priority 3 or Priority 4 call cannot be dispatched so that a unit can be on scene in accordance with the compliant response times the facility should be notified by telephone.

4.7.C. ALS Inter-facility Transport - Specialty Care Transport (SCT)

Specialty Care Transport can be an Emergency or Non-Emergency transport in which the patient is transferred from facility to another facility, who requires specialized care by a paramedic with additional training and/or physicians/nurses during transport.

• Patient's name*
  
  
• Pick-up Location/Street Address/Floor number (if private residence, obtain call back number)*
  
  
• Pickup time*
  
  
• Drop-off Location/Street Address/Floor number*
  
  
• Ordering Facilty*
  
  
• Ordering Facility Caller's Name*

1. Is the patient unstable?
   
   
2. What are the current medications or procedures?
   
   
3. How many IV drips are they currently receiving?
   
   
4. Is this patient intubated?

4.7.D. Incident Address Verification

Address verification shall be completed in a standardized manner following approved practices and procedures as contained in this policy.

PRO will provide all Emergency Medical Dispatchers (EMDs) with approved procedures and practices for obtaining and verifying an accurate and complete address and phone number.

Procedure

1. Answering the Phone-line

All emergency phone lines will be answered in the following manner:
If the caller is unable to provide a numeric address, the calltaker will say, “Professional Ambulance. This call is recorded.”

2. CAD System Entry and Verification
   1. The calltaker will enter the address or location provided by the caller into the CAD system using the most accurate information available from the caller (This could be a numeric address, intersection, business, landmark, etc.)
   2. The calltaker will verify the address (or location) by stating the following: “Please repeat the address/location for confirmation.”
   3. For all residential (or suspected residential) locations , the calltaker will ask “Is this a house or an apartment?” and correctly enter this information into the CAD incident.
   4. For all non-residential locations, the calltaker will obtain all necessary access information, which may include: building name, business name, floor number, office or suite number, specific entrance instructions, and intersection or street segment (for roadway incidents)
   5. Once the calltaker has entered the address/location into the CAD system, he/she will geo-verify the entered address/location by ensuring that CAD returns a valid address or location AND is matches the initial information entered and obtained from the caller.
   6. The calltaker will then ask for and verify the phone number using the same process described above in B.

4.7.E. Obvious Death

EMDs will handle obvious death and expected death cases by following the protocol and local procedures approved by the system Medical Director.

PRO will provide EMDs with a medically approved process for potential obvious death and expected death situations.

Procedure

1. Obvious Death Definition
   1. For dispatch purposes ‘Obvious Death’ is defined as a patient’s condition that can be identified as incompatible with life, after all information has been obtained on the Case Entry protocol, and protocol 9 (Cardiac or Respiratory Arrest/Death). Resuscitative measures including PAIs for breaths and chest compressions will not be provided in any ‘Obvious Death’ and ‘Expected Death’ situation.
   2. Once the EMD determines the patient to be not conscious and not breathing, through proper application of the MPDS, the following conditions may be considered by the dispatcher to constitute ‘Obvious Death’:

1. Cold and stiff in a warm environment
2. Decapitation
3. Explosive gunshot wound to the head
4. Decomposition
5. Non-recent death (confirmed as being greater than six (6) hours)
6. Severe injuries obviously incompatable with life
7. Incineration
8. Submersion (confirmed as being greater than 24 hours)

The dispatche must be sure that the presence of at least one of the above conditions is unquestionable. The EMD must get specific answers to all applicable questions on protocol card 9 to arrive at an ‘obvious death’ determination

3. Once the EMD determines the patient to be not concious and not breathing, through proper application of the MPDS, the following conditions may be considered by the dispatcher to constitute ‘Expected Death’:

1. Terminal Illness
2. DNR Order

The EMD must get specific answers to all applicable questions on protocol card 9 to arrive at an ‘expected death’ determination.

2. EMD Actions in the Event of Identification of Unquestionable Obvious Death or Expected Death
   1. Code all obvious death cases as 9-B-1, and inform responders of specific obvious death condition determined.
   2. Code all expected death cases as 9-Omega-1.
   3. Do not provide PAIs.
   4. If possible, keep the calle ron the line and provide emotional support.
3. Cases Requiring Pre-Arrival Instructions
   1. EMDs shall attempt pre-arrival instructions on all cardiac/respiratory arrest cases where the obvious death and expected death determinants (9-B-1 and 9-Omega-1) are not applied.
   2. When pre-arrival instructions are required (as defined in ‘A’ above), EMDs are not to ask permission to give PAIs. Do not say “Would you like me to tell you how to do CPR?”
   3. If the caller refuses to follow PAIs, say, “The ambulance is on its way, but this is important to give the patient the best possible chance until it arrives.” Repeat as necessary.
   4. If the caller still refuses to administer aid, ask if there is someone else you can speak to.
   5. If no one else is available attempt to keep the caller on the line and provide emotional support. Make it clear that if they change their mind about providing patient care you will tell them exactly what to do.
   6. Remain polite and coutreous at all times.

Emergency Medical Dispatchers shall handle all calls for emergency ambulance assistance using established caller management and customer service practices. It is understood that not all callers will be calm and/or cooperative. EMDs will anticipate those situations and respond as trained professionals, following the MPDS protocols to the best of their ability and providing emotional care and comfort to callers.

PRO’s goal is to provide all EMDs with a well-defined procedure for managing callers and providing those callers with sufficient reassurance, emotional comfort and customer service. PRO EMDs will handle all calls for emergency ambulance assistance using established caller management and customer service practices. EMDs will anticipate situations when callers are not calm and/or cooperative and respond as trained professionals, following the MPDS protocols to the best of their abitlity and providing emotional care and comfort to callers.

Procedure

1. Caller Reassurance and Explanaions
   1. After completing Case Entry, the EMD will say to the caller, “the ambulance is on the way to help you now. Please stay on the line. I need to ask you a few more questions so that I can tell you what to o to help the patient.” OR “My partner is dispatching the ambulance right now, I’m going to ask you a few more questions and give you some instructions before help arrives.”
   2. Politely but firmly focus the caller on answering all questions as you ask them. If callers loose their focus, get agitated or uncooperative, say, “Sir/Madam, it’s important I get this information so I can tell you exactly what to do to help.” Repeat this as often as necessary using exactly the same phrasing.
2. Coping with Distressed, Hysterical, Aggressive and Abusive Callers
   1. It is recognized that some callers will be highly distressed, uncooperative and, at times, abusive. All of these callers behave this way because they are frightened and feel helpless. When faced with these callers, the EMD will maintain a professional demeanor and caring approach.
   2. The EMD will remain calm and courteous at all times.
   3. The EMD will maintain normal speaking volume and a professional, caring voice tone, avoid yelling and any display of anger or contempt.
   4. Whenever possible, the EMD will give clear, breif explanations as to what he/she is doing and why. For example, explain to the caller why they will be put on hold (so tha tyou can get the ambulanc eon the way to them).
   5. The EMD will continually reassure callers that he/she is there to help. It may be necessary to repeat this. The EMD will explain that trained help is on the way, and repeat it when necessary.
   6. The EMD will, when necessary, obtain and use a callers first name or title (Jane, Bill, Mr. Jones, Mrs. Stevens, etc.)
   7. The EMD will use ‘REPETITIVE PERSISTENCE.’ Give the caller an action, followed by a reason for complying with the action. Repeat this, using exactly thte same phrasing, and in a calm level voice, as often as is necessary until the caller listens and cooperates.
   8. The EMD will, when necessary, use ‘POSITITVE AMBIGUITY.’ Do not ‘lie’ to the caller, even if motivates by kindness. Do not make promises or create unrealistic expectations for the caller. Examples follow:
   9. During pre-arrival instructions, the EMD will give the caller firm but gentle encouragement.
   10. When the caller is unable to answer questions or perform rescue techniques after the EMD makes multiple attempts to employ sound caller management techniques, the EMD will calmly ask the caller to speak to someone else.
   11. The EMD will never make any statements that foster or create feelings of helplessness, guilt or panic in a caller.
   12. The EMD will never threaten a caller in any way, or engage in any discriminatory, derogatory or demeaning behavior toward the callers, patients, family members or bystanders, explicitly or implicitly, through language, attitude, or voice intonation.
3. Caller Management When Providing Pre-Arrival Instructions
   1. The EMD will not ask permission to give instructions (i.e. Do not say “Would you like me to tell you how to do CPR?” or “I can give you CPR instructions if you want to try.”).
   2. If the calle rrefuses to follow PAI’s, the EMD will say: “The ambulance is on its way, but this is important in order to give the patient the best possible chance until professional help arrives.” Repeat as necessary.
   3. If the caller still refuses to administer aid, the EMD will ask if there is someone else there to speak to.
4. Caller Management for Third Party Calls
   1. The EMD will not assume that third party callers know nothing, even if they say they know nothing.
   2. The EMD will always attempt to ask all CASE Entry and Key Questions of thied-party callers.
   3. Whenever possible, the EMD will ask the caller if he/she will go back to the patient to render aid. If the agree, the EMD will give PDIs and PAIs.
   4. Once the EMD has made several attempts to gather information without success, he/she may choose to terminate the call, once it has been determined that the caller has no further information and cannot or will not get close to the patient or the incident.

From the moment a call is received the dispatcher has several events that must be recorded. RightCAD will automatically record and time-stamp each unit's progress when data is entered by the dispatcher. The following is a list of all events that must be recorded along with the associated drop down box choices:

Dispatched / Assigned:

Unit has been assigned a call by the dispatcher prior to acknowledging they are en route.

En route:

Unit is physically underway or moving toward a call. A unit cannot be "en route" if the crew is not physically in their unit, responding.

At Scene: (The dispatcher will be prompted for an At Scene/On Arrival Status on emergency calls):

Unit has arrived at the address of their call. Commonly referred to as "out". (e.g., "A1out at the Mount Auburn", "P2 out with Rescue")

Patient Contact/ On the Floor:

The moment actual crew members from the responding unit arrive at the patient's side.

Transporting:

Unit is occupied with a patient that is underway or en route to a facility to drop off a patient.

At Destination (The dispatcher will be prompted for a transporting mileage):

Unit has reached the destination of their transport.

Available:

Unit is clear and available for assignment to the next call.

Checking the Well-being of a Crew

Every effort should be made to contact a crew that does not respond to radio traffic or has been on scene for an extended period of time to establish their well being.

If a crew contacts dispatch to report a violent or disruptive situation the dispatcher should immediately contact CPD over the direct CPD line. It is the dispatcher's responsibility to be aware of ALL crew's whereabouts, status and wellbeing at all times.

On occasion it will be necessary for dispatchers to cancel units from a response, to exchange units, or reassign a call to another unit. Dispatchers are strongly cautioned that once a unit is responding to a call assigning another unit that appears physically closer may not always be appropriate. Consider the time of day, time needed to look up the call and plan a route, and actual response time.

During a response or transport a unit may get cancelled or become delayed for several reasons that need to be documented. Details to document unusual circumstances should be entered in the comment section of the call.

Dispatchers should document all cancellations and unassignments by entering the most appropriate reason on all "Cancelled", "Unassigned" or "Reassigned" calls by using the various drop-down boxes that will automatically prompt the RightCAD user. Take the time to pick the most accurate reason.

Dispatchers should also make notes and add comments as appropriate to best document the circumstances and provide additional information on the cancellation.

The dispatcher may utilize an outside agency for Priority 1 or Priority 2 calls if the response time of a PRO unit will be significantly greater than that of the outside resource. Another agency or fire department may be significantly closer or there may be no PRO units available for response.

The following hierarchy should be followed when assigning outside resources. (Acuity level of call and location of call should be considered):

For BLS calls:

1. Cataldo Ambulance Service

2. Armstrong Ambulance Service

3. Cambridge Fire Department

4. Fallon Ambulance Service

5. Boston EMS

For ALS Calls

1. Cambridge Fire Department

2. Cataldo Ambulance Service

3. Armstrong Ambulance Service

4. Fallon Ambulance Service

5. Boston EMS

All equipment is to be used in accordance with its operating instructions and is not to be abused in any manner. If you don't know, ASK! Any out-of-service equipment or any questions regarding equipment should be reported to a supervisor as soon as possible.

4.12.A. RightCAD Dispatching

PRO utilizes RightCad by Zoll Data Systems to monitor, track and record all data regarding incidents. All dispatchers must input all required data for EVERY incident. Procedures for documenting incidents have been thoroughly outlined in the preceding sections.

Logging In/Out of the Network.:

When taking over responsibility for dispatch, the dispatcher is required to log in to the network and then RightCAD. Personalization of the RightCAD desktop is permitted. When releasing the desk to another dispatcher, the dispatcher should first log out of RightCAD, then log out of the network.

4.12.B. RightCAD Paging

Paging is done through the RightCAD interface and is used for the dispatcher to communicate information to field staff that have provided their cell phone as a paging device.

The RightCAD system will automatically deliver pages to crews assigned to ambulances detailing call information and times.

The procedure for manually paging an employee is as follows:

While in RightCAD, go to the FILE drop down menu and select "Paging". The paging window will open. Highlight and select the name or group on the right, adding it to the paging box to the right. Type your message. Click on the "Send" button on the bottom of the window.

When paging an individual, please put their name at the beginning of the page and be as specific as possible with messages. i.e. "Merg, call PRO. ALS open shift tonight 4-12"

In the event you would like to page multiple employees, groups are set up in RightCAD for this purpose. The groups you can page are ALL, ALS, BLS, Dispatchers, Fleet Maintenance, Supervisors, and Management. For example, if you are trying to fill an open ALS shift, select the group name, which in this case is ALS, type your message and send. You have just paged every paramedic employed by Professional Ambulance with your message. You can also select more than one employee by holding the "Ctrl" key and clicking on the name of each person that you want to page.

Unauthorized group pages should not be sent out between the hours of 2100 - 0900 unless an emergency situation exists. If necessary, page selected people individually during these times.

4.12.C. RightCAD Rolodex

The RightCAD Rolodex, a contact manager for all facilities, entities and field staff, can be accessed through the RightCAD interface by going to the VIEW drop down menu and selecting "Rolodex". Enter the first few letters of the crew member or facility you are looking for.

4.12.D. RescueNET Dispatch Log

The Dispatch Log, which can be accessed through the RightCAD interface by going to the VIEW drop down menu and selecting "RescueNet Dispatch Log", is to be used as a daily log of the following activities/events:

Sick Calls:

When an employee calls in sick it should be documented as follows.

SICKOUT/employee name/shifts out for/time of call/who called/reason for sickout

Example: SICKOUT/Mergendahl/8-4, 4-12/7:50/Ben Mergendahl/overworked

Late for Shift:

LATE/employee name/how late/time of call/start time/who called/reason for tardy

Example: LATE/Mergendahl/running 30 mins late/8:02/8:00/Mergendahl/partying until 4 AM

Unit involved in an MVA:

MVA/unit number/driver name/a-driver name/injuries?/damage assessment/supervisor incident was reported to

Example: MVA/275/Mergendahl/Swanson/no injuries/right, front-end, minor/Larry

Complaints/Compliments:

All complaints and/or compliments should be logged and a written Incident Report or NBS QI Incident must be submitted. Provide a brief summary including crew member/members involved and party reporting the incident.

Example: Mergendahl/Swanson were commended by Deputy Morrissey for a job well done on Run #1023.

Unrecovered Equipment:

Any equipment reportedly left at a hospital or facility should be noted.

Example: 295 left a full set at the 155 at approximately 1500.

Critical Vehicle Failures:

A critical vehicle failure (CVF) is any time a vehicle is unable to complete a response or a transport because of some failure. This includes a flat tire, overheating, electrical failure.

The dispatcher should document all CVFs in the Dispatch Log including the unit/vehicle ID, crew members, a brief description of the problem/situation and outcome, if applicable and a written Incident Report or NBS QI Incident must be submitted.

Example: 252/Mergendahl/Swanson/transmission failed while transporting patient to TCH ER. ALS2 sent to complete transport. Tow truck called and 252 towed back to base.

Vehicle Failures:

A vehicle failure is any failure resulting in the vehicle being placed out of service for any period of time.

The dispatcher should document vehicle failures in the Dispatch Log including the unit/vehicle ID, crew members, a brief description of the problem/situation and outcome, if applicable and a written Incident Report or NBS QI Incident must be submitted.

Example: 285/Mergendahl/Swanson/battery died at 110 after a call.

Unit was jumped by 275. Back in service within 20 minutes.

Other Information:

In addition, the Log can be used to pass along any relevant information to the next dispatcher as well as to convey information to a supervisor. The Log will be reviewed every morning by the Director of Communications, Director of Operations, and the CEO. The Log is a permanent record - you cannot erase an entry once it has been saved. Begin the message with the intended recipients name followed by a brief message, question or request.

Example: JENN/ Jones's trip information is messed up. Can you review? Thx, Bob.

JAY/ ALS says they are all out of 18g angios. Can you order more? Thx, Jeff

4.12.E. RightCAD Reminders

On occasion it will be necessary to enter information about an upcoming event into RightCAD. This is not a standing order or recurring transport, this would be an unusual circumstance requiring the notification of a dispatcher in the future e.g., NSTAR calls to say they will be cutting power for 15 minute periods on December 19, 2006 starting at 2100.

a) Use the following procedure to enter Reminders:

b) Ctrl "T" as if you were entering a call.

c) Enter "Reminder" as the last name. Choose "Reminder, This is a" as the patient.

d) Enter PRO in the pick-up facility field.

e) Choose REMINDER! As the Call Type.

f) Choose REMINDER as the Priority.

g) Choose REMINDER as the Transport Priority.

h) Enter the message/reminder in the notes area.

If you are alerted to a reminder (there will be an audible tone and the REMINDER! Will show up in Open Work window) review the REMINDER in the Trip Summary Window.

To acknowledge the reminder, after review, right click the REMINDER! In Open Work and cancel the REMINDER. Use "REMINDER ACKNOWLEDGED" as the cancel reason. If the reminder requires follow-up, recreate a new reminder or add the information to the RescueNet Dispatch Log, outlined further in Section Q4 of this Policy.

4.12.F. Fire Radio (800mhz)

The fire radio is mounted at dispatch. The Cambridge Fire Department (CFD) refers to dispatch as "PRO Base." You will notice a number and series of letters on the display of the fire radio that are "4 PRO AMB." The fire radio is to remain in the scan mode at all times. You can check this by ensuring that the "Scan" light is illuminated.

This radio will scan with Channel 4 set up as a priority channel. This radio is powered by a 10-amp power supply located in the server room behind Dispatch. If you notice power to the radio is interrupted, check that the power supply button is in the "On" position.

Never attempt to enter or delete any frequency in this radio. Dispatchers should utilize appropriate radio behavior while on the air.

4.12.G. Company Radio (400mhz)

The company radio is mounted at dispatch. Dispatch is referred to as "PRO Base." This radio shall remain on channel 4 at all times.

This radio is powered by a 10-amp power supply located in the server room behind dispatch. If you notice power to the radio is interrupted, check that the power supply button is in the "On" position.

Never attempt to enter or delete any frequency in this radio. Dispatchers should utilize appropriate radio behavior while on the air.

4.12.H. Cambridge ECC Computer Monitors

There is a monitor located at dispatch to check emergency vehicle status and call information in Cambridge. These monitors are non interactive and software of any type shall not be loaded into the computer at any time.

4.12.I. Racal Mirra Series 2 Voice Recorder

The voice recorder tapes six selected telephone lines and both radio frequencies; 617-492-2700, 2701, 2702, 8484, CFD, CPD, and TCH are recorded lines. There is an icon on the dispatch computer desktop to access the last two hours of recorded telephone calls and radio transmissions. Click on the icon, find the entry that you want to review and click on it. Supervisory staff can retrieve recordings of all archived telephone and radio transmissions whenever necessary.

The alarm/warning buzzer will sound once every second when the internal memory is nearly full. It will sound continuously when the memory is full. It is necessary to alert a supervisor to replace the storage media at this point.

4.12.J. Partner 18 Phone System

The telephone should be answered as quickly as possible. The following script should be used when answering the phone: "Professional Ambulance, your call is recorded. Is this an emergency?"

The dispatcher should be able to maintain multiple calls if necessary. Routine and non-emergency calls should be placed on hold if multiple lines are ringing. Emergency requests take precedence over non-emergency and routine business calls.

The dispatcher shall know how to direct incoming phone calls to appropriate extensions or voice mailboxes, transfer calls to inside and outside lines and conference 3rd parties into our phone system. No personal long distance phone calls are permitted unless it is absolutely necessary.

The following answering order should be observed for incoming telephone calls:

• Cambridge ECC
  
  
• Cambridge Police
  
  
• 2700 -2702
  
  
• TCH
  
  
• 8484, 8555

4.12.K. Ninth Brain Suite

The dispatcher should have a working knowledge of Ninth Brain Suite (NBS).

Access to NBS is gained by directing your web browser to NBS at https://vsm.themercygroup.com/logon.asp.

The User ID is your last name in lowercase letters, password is case sensitive, and the Company Number is 2043.

4.12.L. Radio Frequency Manager

There are scanners in the dispatch area. The dispatchers should monitor other outside (including outside of Cambridge) public safety and EMS entities as necessary or directed.

4.12.M. Ambulance Diversion Website

On the dispatch computer's desktop, there is an icon labeled "Hospital Diversion". This icon is a link to https://hd.dph.state.ma.us/login.asp

The ID to access this website is 3214PRO. The password is also 3214PRO.

This website must always be running in the background to enable the dispatcher to constantly monitor the regional hospital status. The speaker level on the PC should be set to a level that allows the dispatcher to hear all audio prompts. Volume on the workstation should not be turned down to "tune out" the audible status update indicator (ringing).

4.13.A. End of Shift/Hand-off to On-coming Dispatcher

The dispatch area should be free of debris at all times. At the end of your shift before handing off to the on-coming dispatcher the following should be done:

• Remove all trash, food, beverages from work area
  
• Empty the trash can
  
• Clean counter with Fantastik

Any required information should be noted in the RescueNet Dispatch Log, if not already done.

All open tasks/applications/windows on the PC should be closed. The off-going dispatcher should log out of RightCAD and the network.

The off-going dispatcher should pass along any information regarding status of crews, equipment in need of recovery at facilities and any other relevant information. All information should be documented in the RescueNet Dispatch log. The icon for the log is located on the toolbar next to the question mark.

All paperwork from crew will be scanned prior to leaving at the end of your shift.

The dispatcher is responsible for notifying all Supervisors:

• Multiple Alarm Fires
  
• Mass Casualty Incidents
  
• Any Power Failures
  
• Complaints requiring immediate action/response
  
• Company Vehicle Accidents
  
• On-duty employee injury, illness or death

If you find yourself in a situation where you are unsure whether to notify management of some type of event, you should make the notification.

Notifications can be made using the State Department of Homeland Security's HHAN system. All dispatchers should be familiar with utilizing the HHAN system. If you have any questions about HHAN use, there are instructions and a link to the site located on the desktop of the "Internet Computer".

4.15.A. Phone Failure

In the event you lose the power to the telephones, it is important to determine if it is the telephone company lines or the Avaya/Lucent telephone equipment. The Avaya/Lucent system is PRO's telephone equipment. To test the lines, locate the Dispatch Systems Failure Phones located in the Dispatch cabinet drawer. Here you will find 8 telephones that are not plugged into any equipment. These are your test phones. On the wall behind the dispatch desk you will notice eight (8) telephone jacks. Starting with the line marked "00", remove the jack line and replace it with the jack line on the test phone, and note if there is a dial tone or not. Repeat the steps for all other lines.

The lines that do not have a dial tone indicate that the problem is in the line coming into the building and that you will need to contact the telephone company. To contact the telephone company to request immediate service dial:

617.555.1515

Inform the telephone company that this is an emergency ambulance service.

If you heard a dial tone on the tested lines, the problem lies in our Avaya/Lucent telephone system. Comtel is PRO's vendor for telephone issues. To contact Comtel to request immediate service dial:

781.935.4388 - Follow voice prompts

Notification of management shall be done on an outside line or cell phone by a crew member, if necessary. If all phone lines are dead, notify the ECC over the fire radio on Channel 5. Notify the Cambridge Hospital (TCH) and the Mt. Auburn Hospital (MAH) over the fire radio on Channel 7 TCH and Channel 7 MAH respectively. Also have crews verbally notify or call HUPD, HUHS, MITPD, MIT Infirmary, Neville Manor Nursing Home, Cataldo, and Armstrong. Advise the staff to dial 9-1-1 for all emergencies, and the ECC will dispatch us.

4.15.B. RightCAD Failure

In the event of the failure of RightCAD the dispatcher should immediately begin to dispatch using the paper log system. Paper logs can be found in the Dispatch Cabinet. Alert all units via radio that pages will not be generated for calls. At the end of the event, all calls should be updated in RightCAD. A page should be generated alerting all crews that the paging system is back up and running.

4.15.C. Radio Failures

Mechanical Failure of Dispatch Radio- Use the portable radio in dispatch or a truck-mounted radio to re-establish communications with all field units.

Failure of 800 or 400 frequency bands- Attempt to utilize the alternate frequency that is functioning properly. Advise all units via the functioning band and by pager that one band is down. Require all units to contact dispatch over the functioning band to acknowledge the failure. If both frequency bands are down require crews to contact dispatch via the landline. All crews should be notified they will be dispatched via pager.

Dispatcher should send pages frequently to update crews as to the status of the radio failure. When service has been restored to normal, all crews should be notified via pager and both frequencies. Crews should be required to come up on the appropriate band acknowledging receipt of the updated status.

4.15.D. Pager Failure

In the event of failure of the paging system, all units will be advised over the radio that pages will not be generated for any calls. A page should be sent when the system returns to normal.

4.16.A. Power Failure Procedures

IN THE EVENT ALL POWER IS LOST IN THE BUILDING, THE EMERGENCY LIGHTS WILL AUTOMATICALLY ILLUMINATE WITHIN A FEW SECONDS. WHEN POWER IS RESTORED THE GENERATOR WILL SHUT OFF AUTOMATICALLY.

4.16.B. Communications Center Failure Procedures

PRO maintains a diesel generator capable of providing nearly instantaneous emergency power automatically to our building and all of its systems within five (5) seconds of a power failure.  Additionally, all PRO computers have battery back-up/UPS in place to protect against power surges and prevent data loss.

PRO maintains a Nextel cellular telephone and two (2) dedicated Comcast Cable telephone lines in the event of Verizon telephone service interruption or generator failure during a power loss.  Verizon will be instructed to forward all calls to the Comcast Cable lines.  Additionally, PRO can operate both radio frequencies for vehicle and portable radio communications in the event of generator failure by utilizing portable radios in dispatch.

Should the PRO Communications Center need to be evacuated, all dispatch and communications center operations could continue by moving to the Harvard University Police Station located at 1033 Mass Ave in Cambridge. A PRO dispatcher can utilize the cubicle provided by HUPD. If you are not familiar with where the Pro Backup Communications Center is at HUPD ask the Officer at the Front Desk of HUPD. PRO’s main telephone number, 617.492.2700 is forwarded to the Pro Backup Communications Center at all times providing capability to accept simultaneous emergency calls. 

The Pro Backup Communications Center has internet access that can be used by the PRO dispatcher to VPN into the PRO RightCAD server at 31 Smith Place.

Paper logs are available if access to CAD is not possible or unsuccessful.

4.17.A. Radio Etiquette

The conduct of employees using PRO radios must be professional at all times. Speak slowly, clearly and concisely. There should be no inappropriate, profane or personal remarks at any time. Your radio traffic should be well thought out and succinct and you should "echo" or repeat instructions back to the dispatcher. If at any time you are unsure or did not clearly understand the message ask for it to be repeated. Do not acknowledge a message if you are unsure what was said.

Keep the microphone 1-3 inches away from your mouth. Depress and hold the push-to-talk button on the microphone for 1 second before and after transmitting to prevent "clipping" your message.

4.17.B. Radio Equipment

It is your responsibility to ensure you have your radio on you before your scheduled start time. Make absolutely sure that you have an appropriately charged battery and that your radio remains on throughout your shift. The volume should be turned up. You must keep your portable radio on your person at all times when not in your vehicle.

Portable "Fire" Radio

This is a portable 800mhz radio. Each member of the crew will carry a "Fire" Portable. This radio is to remain on channel 4 and in the "scan" mode. This radio is to be utilized for all communication when out of the vehicle.

• Utilize channel 14 for communications in the MBTA stations and the Galleria Mall.
  
  
• Utilize channel 5 on for communications directly with Fire Alarm and CFD units assigned to EMS calls.
  
  
• Each Field Provider is issued a portable radio with 2 batteries upon hire. They must ensure proper function and charge of the radio and batteries before the start of every shift.

Mobile "Company" Radio

This is a mobile 400mhz radio installed in the cab of each ambulance. This radio is to remain on channel 4, being utilized when crews are in the ambulance. Utilize the mobile "Company" radio to notify C-MED.

4.17.C. Radio Traffic

When communicating via the radio, identify yourself, then continue with your message:

"P2, out at 237 Franklin with Rescue 1"

Typical response: "P2, you're out with Rescue 1 at 15:32"

When hailing Dispatch/another unit, identify yourself, then the party you're calling:

"P2 calling PRO Base"

Typical response: "PRO Base answering P2"

When hailing the Mt. Auburn or Cambridge Hospitals, state the facility name, identify yourself, then continue with your message:

"Cambridge Hospital, P2 with a BLS entry note"

Typical Response: "Cambridge Hospital online, go ahead PRO."

If you believe you have emergency traffic (e.g., you are in a life-threatening situation, MVA, etc.) hail dispatch and state you have emergency traffic. The dispatcher will inform all other units to stand-by.

"P1 calling PRO Base with emergency traffic"

Typical Response: "All units, stand-by with your traffic, go ahead P1"

4.18.A. Required Transmissions

From the moment a call is assigned there are several events that must be verbalized to the dispatcher over the air. They are:

En route:

Unit is physically underway or moving toward a call. A unit cannot be "en route" if you are not physically in the unit, responding.

Example: "P1, en route to 237 Franklin"

At Scene:

Unit has arrived at the address of their call. Commonly referred to as "out".

Example: "P1, out at 237 Franklin with Rescue 1"

Patient Contact:

The moment the crew has arrived at the patient's side.

Example: "P1, patient contact"

Transporting:

Unit is occupied with a patient and is underway or en route to a facility to drop off a patient. *Note: Reset the trip odometer to zero

Example: "P1, transporting 1, P1-ALS to the Cambridge"

At Destination with Mileage:

Unit has reached the destination of their transport.

Example: "P1, on arrival at the Cambridge, 1.1"

Available:

Unit is clear and available for assignment to the next call.

Example: "P1, clear and available at the Cambridge"

4.18.B. Acknowledging Transmissions

It is your responsibility to always keep dispatch informed of your location and status. With only one dispatcher, things can often become hectic. Some radio transmissions do not need to be acknowledged. Calling off, clearing, and calling en route on non emergency transfers are examples. Give your unit number and your message. Rest assured, your message has been heard, even if it is not acknowledged. If your radio traffic is a notification or needs to be acknowledged, by all means, call until you are acknowledged.

4.19.A. Overview

Dispatch is equipped with ring down lines or speed dial capability to all area emergency rooms. For ALS or BLS calls going to TCH ER or MAH ER, your entry note can go through fire portable Channel 7 TCH or 7 MAH respectively. All other BLS hospital entry notes will go through PRO dispatch.

Entry notifications should be concise and include the patient's age, sex, chief complaint, treatment, and ETA. Please note that entry notifications are not required to Boston hospitals unless the patient presents with a life threatening condition. Relay all pertinent patient information to the dispatcher so they can give an appropriate entry note to the receiving facility. The dispatcher will then inform you that the transfer of information is complete and the facility is awaiting your arrival.

Attempt to hail the receiving facility two (2) times. If the facility does not answer contact dispatch to relay your entry notification.

4.19.B. C-Med Entry Notes

If you must notify C-Med for medical control or for entry notifications, the following procedure should be followed:

i) Switch to channel C-Med 4 on your vehicle radio-this is Med-4. Here you will contact Boston C-Med. Ex.-"Boston C-Med, Professional P3 calling" they will answer. You then can request your hospital patch along with your location so they can determine which tower to utilize. Ex.-" Requesting medical control from the Cambridge Hospital - we are in Cambridge."

ii) Boston C-Med will then assign you a Med channel. This will usually be Med2, Med 5, or Med7. Switch your radio accordingly. The hospital will meet you on the assigned channel. You can then give your notification or request for medical control. Remember, BLS must contact medical control for certain Epi-Pen and SAED cases per statewide protocol.

4.19.C. Medical Control by Telephone

Medical control is also available by telephone.

It is important that dispatchers occasionally check the status of crews at all call locations when a unit has been on scene for an extended period of time. Your only communication link outside of the ambulance is your portable radio. Every effort will be made to contact a crew that does not respond to radio traffic or has been on scene for an extended period of time to establish their well being. If the dispatcher cannot confirm your safety, the dispatcher will initiate a police response.

If you find yourself in a violent or disruptive situation alert the dispatcher who will in turn notify the police.

4.21.A. Two-way Paging

Two-way paging can be done by using your cell phone's text message capability. While it is not mandatory, it is recommended that you have your cell phone set-up to receive pages. If you are able to receive pages your phone must be with you while on duty, as dispatch instructions, notifications and other critical information is sent via this device.

4.21.B. Cellular Telephones

Except in an emergency, cellular telephone communication is prohibited when operating any PRO vehicle.

4.21.C. Telephone Calls to Dispatch

Any unit concerned with the dispatch or assignment of a call can contact the dispatcher or a supervisor after handling the call. You should not call dispatch prior to completing your assigned run. There should be no confrontations over the telephone.

4.22.A. AT&T Language Line

Any time that a PRO employee encounters a Language Diversity problem PRO has the ability to utilize the Language Line service for both emergency and non-emergency situations. In each of the First Aid Bags in all Pro vehicles there is a packet with information of how to use the Language Line service and a backup copy will also be held in Dispatch. There is one card for emergency calls with a separate account number and one card for non-emergency calls. PRO has access to over-the-phone interpretation 24 hours a day and 7 seven days a week with this service. Instructions on how to use the service are on the cards and proper training will be provided to all PRO employees.

Language Line Emergency 800.523.1786 - ID# 126018

Language Line Non-emergency 866.874.3972 - ID# 126019

4.23.A. Communication Equipment Preventative Maintenance

All PRO communication equipment will recieve Preventative Maintenance annually through an outside vendor who will provide documentation of the process.

The Contiuning Dispatch Education (CDE) process shall follow a standardized procedure as detailed below and as required by the National Academy of Emergency Medical Dispatch to meet EMD re-certification standards.

PRO will provide all dispatch pesonnel with ongoing education and skills maintenance for the use of the Medical Priority Dispatch System. Such Continuing Dispatch Education (CDE) processes shall be sufficeint to meet the requirements of the National Academy of Emergency Medical Dispatchers for re-certificaiton.

Procedure

1. CDE Program Management
   1. The Medical Dispatch Review Committee (MDRC) shall be responsible for defining the topics that the CDE program will address.
   2. Appropriate CDE topics may be identified in a number of different ways:

1. As a result of the MDCR’s recommendations (baed on the QIU’s findings)
2. Via direct requests for further action by the QIU
3. Via requests from EMDs

3. The Director of Communications and/or the Director of Operations shall be responsible for scheduling educational opportunities as necessary to address the needs identified above.
4. The Director of Communications shall be responsible for ensuring that necessary educational opportunities are:

1. Delivery by qualified personnel (as defined by the Director of Communications)
2. Adequate in their content/format to address the identified learning need / objective
3. Relevant to EMDs and their associated work
4. Attended by all EMDs

5. The MPDS QIU Coordinator shall be responsible for ensuring that approprate records are maintained regarding the CDE program in the QIU filing system and for each EMD individualy.
6. The MPDS QIU Coordinator shall be responsible for ensuring that a CDE Lesson Plan is completed to an adequate standard for all classroom based education
1. Meeting NAEMD Re-Certification Requirements
   1. The MPDS QIU Coordinator shall be responsible for ensuring that all EMDs are given adequate opportunity to meet NAEMD re-certification requirements.
   2. If it appears likely that an EMD will not meet NAEMD recertification requirements, the MPDS QIU Coordinator must inform that individual’s Supervisor at the earliest opportunity.
   3. EMDs are ultimetly responsible for ensuring that they attend sufficient educational opportunities to meet NAEMD re-certification requirements. They must alert their Supervisor of any likely problems in this area.
2. Types of CDE
   1. The following are acceptable formats and their associated maximum hours for CDE:

1. Workshops and seminars (16 hours minimum / maximum)
2. Attendance at planning and management meetings (e.g. MDRC) (8 hours maximum)
3. Quality assurance and case review (8 hours maximum)
4. Review of EMS related audio, video and written materials (4 hours maximum)
5. Public education (4 hours maximum)
6. MPDS protocol review (4 hours maximum)
7. Miscellaneous, such as ride-alongs and work experence (4 hours maximum)

2. The minimum CDE requirement in any given year shall be 12 hours of completed CDE pe EMD, at least eight hours of which shall be didactic in nature.
3. In addition to the CDE hours, types, and topics discussed above, each EMD must maintain current CPR certification.
4. The bulk of the subject matte raccepted as fulfilling NAEMD requirements will be directly related to the scienc eof Emergency Medical Dispatch and the use of the MPDS. However, other EMS-related material will be considered by the NAEMD for its educational relevance.
3. CDE Program Objectives
   1. Development of a bette runderstanding of telecommunications and of the EMD’s specific roles and responsibilities.
   2. Improving skill in the use or application of all component parts of the MPDS, including interrogation and prioritization.
   3. Providing opportunities for discussion, practice of skills, and for constructive feedback of performance.

The quality improvement process shall follow a standardized procedure as detailed below and as required by the National Academy of Emergency Medical Dispatch to meet accreditation standards.

PRO seeks to provide all dispatch personnel with the understanding and skills as they relate to the eficient and effective provision of quality assurance for the Medical Priority Dispatch System (MPDS). Such qualit yasurance processes shall be sufficient to meet the requirements of the National Academy of Emergency Medical Dispatch for accreditation of PRO as a Dispatch Center of Excellence.

Procedure

• Quality Improvement Case Review

1. A sampling of at least 25 EMS cases per week shall be randomly selected and evaluated by the EMD Quality Improvement Unit (QIU).
2. An approximately equal number of calls shall be reviewed for each individual EMD.
3. Minimum protocol compliance levels will be set and issued in a separate “Incremental Compliance Policy.”

• Case Review Feedback Process

1. Completed Case Evaluation Records (CERs) generated by the AQUA database will be forwarded to ___ on a regular basis.
2. ___ will distribute each CER to the relevant dispatcher. Both Supevisor and the EMD may add their comments to the forms and both must sign it.
3. When circumstances dictate, the Supervisor will develop an action plan and document this on the form. A deadline for completion of the action plan will be given. Action plans may be necessary if remedial training is required.
4. Supervisors may use the form to request further QIU follow-up or action if required. Examples of QIU action include requests for a particular Continuing Dispatch Education topic to be covered, a letter of commendation be submitted, or that a problem be raised at the Medical Dispatch Review Committee meeting.
5. Completed forms must be returned to the QIU within 14 days of receipt by the Supervisor.
6. The QIU must be informed of the completion of any action plan noted on the form.
7. A copy of the completed form will be kept by the QIU int the EMD’s QIU file.

• QIU Database / Individual EMD Complaince Reports

1. Complaince data for individual EMDs shall be generated from the AQUA database and forwarded to Supervisors on a monthly basis. Data on individual dispatcher’s performance will be treated as confidential; veiwed only by the EMD’s supervisor and the necessary administrative, training and quality improvement staff.
2. Action plans will be developed, when necessary, based on average and/or cumulative compliance scores. A dedline for completion of the action plan will be given.
3. Supervisors may use the form to request further QIU follow-up or action if required.
4. Completed forms must be returned to the QIU  within 14 days of their receipt by the Supervisor.
5. The QIU shall be informed of the completion of any action plan noted on the form.
6. A copy of the completed form will be kept by the QIU in the EMD’s QIU file.

• QIU Database / Shift Compliance Reports

1. Compliance data for each shift overall may be generated from the AQUA database and posted on the MPDS bulletin board in dispatch at monthly intervals by the QIU.
2. Shift compliance scores may be reviewed by administrative staff, and corrective action taken when necessary.
3. The QIU will be informed of the completion of any action plan.
4. A copy of each Shift Complaince Report will be kept by the QIU in the Shift’s QIU file.

• QIU Database / Dispatch Summary Compliance Reports

1. A Quality Improvement Summary Complaince Report will be generated from the AQUA database and copie dto each member of the MRDC at monthly intervals. The Steering Committee will receive quarterly updates on monthly center-wide complaince.
2. The MDRC will review the Qualit yImprovement Summary Complaince Report at quarterly intervals. The Steering Committee will evaluate and approve any policy changes and resource allocation plans proposed by the MDRC.
3. Upon reciept of a form, the QIU will review the tape of the relevant call and evaluate the case for complaince to protocol.
4. A reply to the initiator of the query or feedback will be provided within 14 days of receipt of the form by the QIU.
5. Copies of the completed Medical Dispatch Feedback Reprot will be kept by the QIU in the relevant EMD’s file and in a file dedicated to completed Medical Dispatch Feedback Reports.
6. Copies of the completed Medical Dispatch Feedback Report will be distributed by the QIU to the Directro of Communications, the Medical Director and the Supervisor.

It is the policy of PRO’s Communications Center to comply with the Medical Priority Dispatch System (MPDS) protocols. EMDs are required to meet regular minimum performance/compliance requirements as detailed below. Remedial training and education will be provided for EMDs that do not meet minimum compliance levels.

PRO seeks to provide clear EMD performance requirements nad minimum compliance levels, and remedial training and education for individuals scoring below minimum compliance levels.

Procedure

• Compliance

Each individual EMD is required to meet the following average MPDS compliance scores:

• 95% Case Entry Compliance
• 90% Key Question Compliance
• 95% Chief Complaint selection accuracy
• 90% Post Dispatch Instructions
• 95% Pre-Arrival Instructions
• 90% Final Dispatch Determinant Code accuracy
• 90% Total Compliance Score

• Discipline VS. Quality Improvement
  • When compliance becomes a discipline versus quality improvement problem, the quality improvement unit will identify the individual to the Director of Communications.
  • All on-line remedial training shall be handled by the Director of Communications or the Director of Operations.
  • All discipline cases shall be handled according to current disciplinary policy and via the chain of command for the individual concerned.

• Trigger Points for Disciplinary Action

An EMD may be subject to disciplinary action after sufficient remedial training and performance improvement interventions have not yielded desired results. Disciplinary action may result from any of the following:

• In the first six (6) months after certification as an EMD:
• Failure to achieve the required compliance levels as detailed aboev in two (2) out of three (3) months.
• Following a six (6) month period of certification as an EMD:
• Failure to achieve 95% Case Entry compliance in two (2) out of three (3) months.
• Failure to achieve 90% Key Question compliance in two (2) of three (3) months.
• Failure to achieve 95% Chief Complaint selection accuracy in two (2) out of three (3) months.
• Failure to achieve 90% Dispatch Life Support Instruction compliance in two (2) of three (3) months.
• Failure to achieve 90% Final Determinant Coding compliance in two (2) of three (3) months.

5.1.A. Overview

Disposable medical equipment and supplies serve a medical purpose, are not useful to an individual in the absence of an illness or injury, and are intended for one-time or single patient use. Disposable items are discarded after their intended use. Consult a Supervisor if there is any doubt in your mind as to whether an item is disposable or reusable. The following are examples of disposable medical equipment and supplies:

• Suction Canister/Tubing
  
  
• Bandaging
  
  
• Sterile Water / Normal Saline
  
  
• All other equipment not listed under Durable Medical Equipment and not intended for repeated medical use

5.1.B. Use

All employees should be totally familiar with the use and maintenance of all equipment and supplies within the vehicle in which he or she is working. All equipment and supplies are to be used in the manner for which they were intended. Instruction on the use of equipment and supplies will be provided by any Supervisor or Field Training Officer (FTO). IF YOU DON'T KNOW HOW TO USE IT, ASK.

5.1.C. Disposal

Any disposable item that has been opened or removed from its original packaging is considered "used" and should be discarded and not considered for future patient use. Used, but not contaminated disposable waste can be discarded in any waste receptacle. Any disposable item that has come in contact with body fluid must be considered contaminated. All contaminated, disposable materials must be considered potentially infectious and placed in impervious red plastic bags clearly marked with the bio-hazardous waste symbol and sealed prior to disposal. Grossly contaminated or wet, dripping waste must be doubled bagged. Red bio-hazard waste bags should be disposed of at the receiving facility in bio-hazard waste containers after patient care has been terminated, prior to returning your unit to service.

ALWAYS UTILIZE UNIVERSAL PRECAUTIONS WHEN CLEANING ANY ITEM - ASSUME ALL ITEMS ARE CONTAMINATED. NO ONE SHOULD BE SUBJECT TO HAVING SOILED OR CONTAMINATED EQUIPMENT IN ANY COMPANY VEHICLE.

5.1.D. Restocking

PRO's equipment and supplies exceed the minimum requirements set forth by state guidelines for all Class I ambulances. A properly stocked ambulance should be more than sufficient to get you through most shifts. In the event that you need to re-stock before your shift is complete, attempt to do so at the receiving facility prior to returning to service. If you are unable to re-supply at the facility contact the Dispatcher for permission to return to PRO Base to re-supply your ambulance. All disposable medical equipment and supplies are located in the Supply Room. If it appears the equipment/supplies you need are not available in the supply room, or that we are running low, alert a Support Service Technician, the Dispatcher or a Supervisor. It is expected that your ambulance be sufficiently stocked at all times.

5.1.E. Linen

All dirty sheets and linen should be exchanged at, and returned to the receiving facilities. Do not leave dirty linen in the ambulance or bring it back to base.

5.1.F. Expired and Expiring Meds/Equipment

Certain disposable medical equipment and most medications have expiration dates. Any disposable medical equipment or medication that has expired should be placed out of service and/or discarded of and replaced immediately. Any disposable medical equipment or medication that will expire within nine (9) weeks from the date of the Vehicle Compliance Check should also be replaced.

5.2.A. Overview

Durable medical equipment and supplies primarily serve a medical purpose, are not useful to an individual in the absence of an illness or injury and are intended to withstand repeated use. Durable items are cleaned, sanitized and placed back in service after their intended use. Consult a Supervisor if there is any doubt in your mind as to whether an item is disposable or durable (reusable). The following are examples of durable medical equipment and supplies:

• Onboard Suction
  
• Portable Suction
  
• Monitor / Defibrillator
  
• Med Infusion Pump
  
• Pulse Oximeter
  
• Ambulance Stretcher
  
• Stair Chair
  
• Scoop Stretcher
  
• Glucometer*
  
• Oxygen Delivery Device*
  
• Backboard*
  
• Padded Board Splint*
  
• Traction Splint*
  
• KED*
  
• Stethoscope*
  
• B/P cuff*

*Some "reusable" equipment should be considered "disposable" if it is grossly contaminated or cleaning/sanitizing would require exuberant effort. Such items should be replaced rather than cleaned.

5.2.B. Use

All employees should be totally familiar with the use and maintenance of all equipment and supplies within the vehicle in which he or she is working. All equipment and supplies are to be used in the manner for which they were intended. Instruction on the use of equipment and supplies will be provided by any Supervisor. If you don't know how to use it, ASK.

5.2.C. Cleaning and Sanitizing

Proper technique in cleaning and sanitizing reusable ambulance equipment ensures that the equipment is safe for the next crew and patient, protecting them from potentially infectious agents. All equipment is to be cleaned of obvious debris and fully cleaned and disinfected before being returned to service. Always utilize Universal Precautions when cleaning any item - assume all items are contaminated. No one should be subject to having soiled or contaminated equipment in any company vehicle.

1) Suction Unit - Onboard

Units with a fixed canister and disposable liner:

Disassemble the suction unit. Place the contaminated sani-liner in a red bio-hazard bag and discard. Wash the plastic bottle and vacuum container head with warm water and disinfectant. Care should be taken that no liquid enters the vacuum gauge. A brush should be used to clean the patient hose stem. After cleaning, the components should be thoroughly rinsed with clear water and wiped down with a clean rag. After inspection for any worn, broken, or defective parts the suction unit will be reassembled, the sani-liner replaced and the entire unit checked for proper function.

Units with disposable collection canisters:

Disassemble the suction unit. Remove the disposable canister. Remove the disposable tubing and catheter. Place both the disposable canister and the disposable tubing/catheter in a red bio-hazard bag and discard. Replace the canister and the tubing/catheter. Care should be taken that no liquid enters the vacuum gauge. A brush should be used to clean the patient hose stem. After cleaning, the components should be thoroughly rinsed with clear water and wiped down with a clean rag. After inspection for any worn, broken, or defective parts, the portable suction unit will be reassembled and checked for proper function.

2) Suction Unit - Portable

Remove the disposable canister. Remove the disposable tubing and catheter. Place both the disposable canister and the disposable tubing/catheter in a red bio-hazard bag and discard. Replace the canister and the tubing/catheter. Wipe the unit housing with a clean cloth dampened with disinfectant, rinse with a clean cloth dampened with water. After inspection for any worn, broken, or defective parts, the portable suction unit will be reassembled and checked for proper function.

3) Monitor / Defibrillator

Lifepak 12:

Clean the LIFEPAK 12 defibrillator/monitor, cables, and accessories with a damp sponge or cloth moistened with hot, soapy water or isopropyl alcohol. Do not clean any part of this device or accessories with bleach, bleach dilution, or phenolic compounds. Do not use abrasive or flammable cleaning agents. Use only cleaning solutions that are non-abrasive, non-staining and are diluted with water. Rinse accordingly with a damp clean cloth.

 

4) IVAC Med System III, Med Infusion Pump

Clean the IVAC Med System III with a damp sponge or cloth moistened with hot, soapy water. Do not clean any part of this device or accessories with bleach, bleach dilution, or phenolic compounds. Do not use abrasive or flammable cleaning agents. Use only cleaning solutions that are non-abrasive, non-staining and are diluted with water. Disconnect the power cord from the external power connector, on the side of the pump. Inspect the pump's outside surfaces for damage (any cracks or punctures may allow fluid to enter).

5) Pulse Oximeter

Oximeter:

Clean the Nonin Pulse Oximeter with a damp sponge or cloth moistened with hot, soapy water or isopropyl alcohol. Do not clean any part of this device or accessories with bleach, bleach dilution, or phenolic compounds. Do not use abrasive or flammable cleaning agents. Use only cleaning solutions that are non-abrasive, non-staining and are diluted with water. Rinse accordingly with a damp clean cloth.

Sensors:

Do not clean any part of this device or accessories with bleach, bleach dilution, or phenolic compounds. Do not use abrasive or flammable cleaning agents. Do not immerse the sensors in liquid to clean. Clean sensors with an isopropyl alcohol wipe. Pediatric sensors used by PRO are intended for one-time use and should be discarded after patient use.

6) Glucometer

Clean the Bayer Glucometer with a damp sponge or cloth moistened with hot, soapy water or isopropyl alcohol. Do not clean any part of this device or accessories with bleach, bleach dilution, or phenolic compounds. Do not use abrasive or flammable cleaning agents. Use only cleaning solutions that are non-abrasive, non-staining and are diluted with water. Do not immerse the glucometer in liquid. Rinse accordingly with a damp clean cloth.

7) Oxygen Delivery Device

A flowmeter that has been contaminated with any patient secretions/excretions, i.e. blood, sputum, urine, feces, bile, etc., shall be cleaned and disinfected by the crew. The exterior surface of the flowmeter will be cleaned by wiping with a cloth or sponge dampened with warm water and disinfectant. If contaminant has entered the internal part of the flowmeter, it is to be placed in a red bio-hazard bag, disposed of and replaced.

8) Stretchers

Any stretcher, wheelchair or stair chair that has been contaminated with any patient excretions/secretions shall be cleaned and disinfected by the crew. The stretcher, wheelchair or stair chair will be thoroughly cleaned by washing with warm water and disinfectant and then wiped down with a clean rag. Be sure to dry thoroughly. If the straps of these devices become contaminated follow the procedures outlined under "Straps" for cleaning. If the straps are grossly contaminated consider their replacement. Batteries should always be removed before cleaning.

9) Stretcher Mattresses

All mattresses shall be inspected for any cuts, tears, or worn areas on their covers and immediately replaced or repaired if any defects are noted. Any mattress that has become contaminated with any patient excretions/secretions shall be cleaned and disinfected by the crew using a disinfectant cleaning product and a clean rag.

10) Stair chairs

Any stretcher, wheelchair or stair chair that has been contaminated with any patient excretions/secretions shall be cleaned and disinfected by the crew. The stretcher, wheelchair or stair chair will be thoroughly cleaned by washing with warm water and disinfectant and then wiped down with a clean rag. Be sure to dry thoroughly. If the straps of these devices become contaminated follow the procedures outlined under "Straps" for cleaning. If the straps are grossly contaminated consider their replacement.

11) Backboard, Orthopedic Stretcher (scoop)

The crew shall clean any backboard and/or scoop stretcher that has been contaminated with any patient excretion/secretions. The backboard and/or scoop stretcher will be thoroughly cleaned by washing with warm water and disinfectant and then wiping it down with a clean rag.

12) Padded Board Splints, Traction Splint, Upper Body Splint (KED)

The crew shall clean any splint and/or KED that has been contaminated with any patient excretion/secretions. The splint and/or KED, will be thoroughly cleaned by washing with warm water and disinfectant and then wiping it down with a clean rag. Some "reusable" equipment should be considered "disposable" if it is grossly contaminated or cleaning/sanitizing would require exuberant effort. Such items should be replaced rather than cleaned.

13) Straps

The crew shall clean any strap that is contaminated. The strap will be placed in a red biohazard bag and returned to quarters. Straps should be buckled prior to entering the washing machine. Launder the strap in the washing machine on a "Hot" setting with detergent and disinfectant added. Do not use bleach. Remove the strap and hang to dry. Do not put straps in dryer. Some "reusable" equipment, including straps, should be considered "disposable" if it is grossly contaminated or cleaning/sanitizing would require exuberant effort. Such items should be replaced rather than cleaned.

14) Stethoscopes and B/P Cuffs

Stethoscopes and B/P cuffs should be cleaned between each patient use. The crew shall thoroughly clean any stethoscope and/or B/P cuff that has been contaminated with any patient excretion/secretions. The stethoscope and/or B/P cuff will be thoroughly cleaned by washing with warm water and disinfectant and then wiping it down with a clean rag. Some "reusable" equipment, including a stethoscope or B/P cuff, should be considered "disposable" if it is grossly contaminated or cleaning/sanitizing would require exuberant effort. Such items should be replaced rather than cleaned.

Note: The above is a short list of examples. Please keep in mind that items such as stethoscopes, trauma shears, floors, seats, and steering wheels are often contaminated and must be cleaned and disinfected.

5.2.D. Inspection and Maintenance

All durable medical equipment shall be inspected by a Supervisor or Support Services Technician for proper operation prior to being placed in service. All durable medical equipment will be inspected weekly, with the results documented on a Vehicle Audit Checklist.

All patient handling equipment (i.e., stretchers, scoops, stair chairs) shall be inspected and lubricated on a regular schedule by an outside vendor per the manufacturer's maintenance guide. Any outside manufacturer or contracted, licensed and insured technician providing service to PRO is responsible for maintaining and submitting maintenance records upon request.

1) Suction Unit - Onboard

Units with a fixed canister and disposable liner:

During the Vehicle Audit the Supervisor should check the following;

• Mechanical integrity of all controls and switches
  
  
• Inspect the condition of tubing, hoses, couplings, bottles, and filter

  Examine for signs of dirt, damage, and/or deterioration.

  Check seating of rubber stoppers.

• Change filters where applicable
  
  
• Confirm that a suction liner is in place
  
  
• Check operation of overflow protection device where applicable
  
  
• Test maximum vacuum and rate of vacuum rise where applicable

Units with disposable collection canisters:

During the Vehicle Audit the Supervisor should check the following;

• Mechanical integrity of all controls and switches
  
  
• Inspect the condition of tubing, hoses, couplings, bottles, and filter

  Examine for signs of dirt, damage, and/or deterioration.

  Check seating of rubber stoppers.

• Change filters where applicable
  
  
• Check operation of overflow protection device where applicable
  
  
• Test maximum vacuum and rate of vacuum rise where applicable

2) Suction Unit - Portable

During the Vehicle Audit the Supervisor should check the following;

• Unit should be fully charged
  
  
• Mechanical integrity of all controls and switches
  
  
• Inspect the condition of tubing, hoses, couplings, bottles, and filter

  Examine for signs of dirt, damage, and/or deterioration.

  Check seating of rubber stoppers.

• Change filters where applicable
  
  
• Check operation of overflow protection device where applicable
  
  
• Test maximum vacuum and rate of vacuum rise where applicable

3) Monitor / Defibrillator

Lifepak 12:

PRO maintains a service agreement with Physio-Control for the preventive maintenance and repair of our Lifepak 12s. During the Vehicle Audit the Supervisor or Support Services Officer should visually inspect the patient cable, therapy cable, limb leads and other associated cables/accessories, ensuring all cables, cords and connectors are in good condition and void of any cuts, cracks, frays or bent pins. Verify the batteries are fully charged and ensure that the unit is clean and void of any cracks or other signs of damage. Any problems or discrepancies should be reported to the Director of Operations, the monitor placed OOS and replaced with another unit. All necessary repairs shall be handled by an authorized Physio-Control technician.

 

4) IVAC Med System III, Med Infusion Pump

There is no "in-house" repair of the IVAC Pump. Any problems or discrepancies should be reported to the GM, the pump placed OOS and replaced with another unit. All necessary repairs shall be handled by an authorized technician.

5) Pulse Oximeter

There is no "in-house" repair of the Nonin Pulse Oximeter or sensor. Any problems or discrepancies should be reported to the Support Services Officer, the oximeter/sensor placed OOS and replaced with another unit/sensor. All necessary repairs shall be handled by an authorized technician.

6) Glucometer

Except for replacing the battery, there is no repair of the glucometer. Any problems or discrepancies should result in the glucometer being placed OOS and replaced with another unit. These are considered disposable if they are inoperable.

7) Oxygen Delivery Device

There is no repair of the oxygen delivery device. Any problems or discrepancies should result in the oxygen delivery device placed OOS and replaced with another unit. These are considered disposable if they are inoperable.

8) Stretchers

During the Vehicle Audit the Supervisor should check the following:

• Are all components present?
  
• Are the restraints present?
  
• Do all moving parts move freely?
  
• Do the side arms raise and lower properly?
  
• Does the shock frame operate properly?
  
• Does the transporter lock in each position?
  
• Does the transporter load/unload properly?
  
• Does the safety hook engage the safety bar?
  
• Does the transporter roll easily?
  
• Are all screws, nuts, rivets and roll pins securely in place?

PRO maintains a service agreement with STRYKER for the preventive maintenance and repair of our STRYKER PRO POWER COTS (stretchers). Any problems or discrepancies should be reported to the Supervisor, the stretcher placed OOS and replaced with a spare. All necessary repairs shall be handled by STRYKER.

9) Stretcher Mattresses

The stretcher mattresses should be inspected for any rips, tears, punctures or degradation of any kind. Mattresses in any of the above conditions should be repaired or replaced.

10) Stair Chairs

During the Vehicle Audit the Supervisor or Support Services Technician should check the following:

• Are all components present?
  
• Are the restraints present?
  
• Do all moving parts move freely?
  
• Does the transporter roll easily?
  
• Are all screws, nuts, rivets and roll pins securely in place?
  
• Is the vinyl seat free of tears, holes and punctures?

PRO maintains a service agreement with STRYKER for the preventive maintenance and repair of all our stair chairs. Any problems or discrepancies should be reported to a Supervisor or the Support Services Technician, the stair chair placed OOS and replaced with a spare. All necessary repairs shall be handled by STRYKER.

11) Backboard, Orthopedic Stretcher (scoop)

Backboards:

There is no repair of backboards. Any problems or discrepancies should result in the backboard being placed OOS and replaced with another unit.

Scoop Stretcher:

PRO maintains a service agreement with EMSAR for the preventive maintenance and repair of our Ferno Model 65 Scoop Stretchers. Any problems or discrepancies should be reported to a Supervisor, the scoop stretcher placed OOS and replaced with another unit. All necessary repairs shall be handled by EMSAR.

12) Padded Board Splints, Traction Splint, Upper Body Splint (KED)

During the Vehicle Audit the Supervisor should check the following:

• Are all components present?
  
  
• Are the straps properly installed?
  
  
• Are the straps/velcro in good condition?
  
  
• Are all buckles free of visible damage and do they operate properly?
  
  
• Is all stitching secure?
  
  
• Do all moving parts move freely (traction splint only).

There is no repair of these items. Any problems or discrepancies should result in the equipment being replaced. These are considered disposable if they are inoperable or grossly contaminated. Follow the directions outlined previously in the "Cleaning" section of this policy.

13) Straps/Restraints

There is no repair of straps/restraints. Any problems or discrepancies should result in the straps/restraints being replaced. These are considered disposable if they are inoperable or grossly contaminated. Follow the directions outlined previously in the "Cleaning" section of this policy.

14) Stethoscopes and B/P Cuffs

There is no repair of stethoscopes and/or B/P cuffs. Any problems or discrepancies should result in the stethoscope or B/P cuff being replaced with another unit. These are considered disposable if they are inoperable or grossly contaminated.

5.2.E. Rechargeable or Battery Operated Equipment

1) Portable Suctions

The LCSU portable suction units have a "Low Battery" light. If the "Low Battery" light is illuminated and the unit is plugged in to the outlet inside the ambulance, place unit OOS and notify a Support Service Technician, Dispatcher, and/or Supervisor and take a spare from the cage in the garage. The LCSU’s should be charging at all times when in the ambulance therefore the “Low Battery” light should never be illuminated.

If you use the unit during your shift, it should be cleaned.

2) Monitor / Defibrillator

Lifepak 12 Batteries

Lifepak 12 batteries have a 4 bar LED that indicate the amount of charge each battery is holding. All batteries (both those in the Lifepak and spares in the ambulance) should be checked at the beginning of each shift. No battery should be placed into service without ALL 4 LEDs green, indicating a full charge. Batteries that are not fully charged should be returned to the Battery Support System (charger) in Dispatch. Any faulty battery should be taken out of-service and turned over to a Supervisor for replacement.

3) IVAC Med System III, Med Infusion Pump

The Med Infusion Pump should remain plugged into the ambulance inverter in the patient compartment at all times when not in use.