HIGHLAND AMBULANCE EMS, Inc.
Table of Contents
HIGHLAND AMBULANCE EMT MANUAL
Welcome! This manual calls to your attention the general rules that will assist in making your service satisfactory to you and Highland Ambulance EMS, Inc. (hereinafter referred to as Highland). Your manual will help you understand what is expected of you and serve as a guide. It is your responsibility to become thoroughly familiar with the contents of your manual, and to retain it as a reference. Specific policies and practices may be found as an appendix to this manual and are subject to change.
This manual does not constitute any type of employment contract and may be subject to change at any time.
Highland Ambulance welcomes all qualified EMT’s. Highland Ambulance does not discriminate on the basis of race, creed, national origin, religion, gender, sexual preference, age or financial status.
For each position on the staff of Highland, there shall be established minimum requirements and a position description as to the experience, education, licensing or other abilities and/or qualifications considered necessary for satisfactory performance of the essential duties of the position.
New employees are selected through a process that may include, but is not limited to, written application, personal interviews, and professional reference checks. Prior to employment, job-related background checks or health examinations may also be conducted for designated jobs, as determined by Highland.
Pre-employment checks may include:
· Verification of prior employment, education, or credentials
· Criminal and/or driving record history checks
· A health exam, which may be required if appropriate. This will take place after the offer of employment but prior to start of work.
Highland may conduct some or all of these background checks for applicants selected for designated positions. Information acquired as a result of a background check may or may not be held confidential.
Highland may require driving-record history checks for positions or employees whose work requires operation of a motor vehicle. Any employee whose work for Highland entails operation of a motor vehicle must present and maintain a valid driver’s license and a driving record acceptable to Highland.
Any driver about whom Highland has concerns, regardless of driving history, may be denied the privilege of operating a Highland vehicle.
Changes in your driving record must be reported by you to your supervisor.
Failure to inform Highland of changes to your driving record may result in disciplinary action that may include dismissal.
Highland employees must meet all state and federal licensing requirements to operate any Highland vehicle.
Certain positions may require the prospective employee to undergo a physical exam prior to the start of actual employment to ensure the employee’s ability to perform the essential functions of the job. Highland covers the cost of mandated health exams.
EMTs hired by Highland will undergo an orientation program consisting of a review of the personnel manual and ambulance policies, review of records and record-keeping procedures, and supervised ambulance inventory.
The supervised ride-along period will include: Observation of patient care practices, supervised care of patients, supervised documentation and re-stocking, and supervised driving.
The orientation period will extend until the EMT is cleared to function as an employee. The length of the orientation period depends on previous experience, availability and call volume.
We strive to deliver the best possible patient care at all times, as demonstrated by:
· Our respect for human dignity
· Our concern for the patient’s physical and emotional well-being
· Our adherence to state and local policies and protocols
We are health care professionals and as such are bound by the patient’s right to privacy. We do not violate the patient’s right and expectation of confidentiality. Examples of situations which violate confidentiality include:
· Discussion or call review in a public location, where the discussion can be overheard by members of the general public
· Comments or release of information to the news media without the patient’s written permission
· Release of the written patient trip report to any person or organization, including law enforcement, unless we have the patient’s written permission or a legal subpoena
· The discussion of or relaying of patient information to other medical professionals who do not have a “need to know”
We are bound by the ethics of the healthcare profession to act in the patient’s best interests, even when contrary to our own opinions or self-interest. Unethical behavior is any behavior which directly or indirectly threatens that obligation. Occasionally unethical is also illegal behavior. Examples of ethical violations include:
· Theft from a patient, a healthcare facility, or the ambulance service
· failure to respond to an ambulance call when obligated by duty to do so
· Lying to a patient, to bystanders, to hospital staff, or ambulance service personnel
· Deliberately misdocumenting patient information, or in any way falsifying patient records
· Verbal or physical abuse of a patient, bystander or other health provider
Highland EMT’s are courteous, respectful, and professional in their dealings with the public and other healthcare providers
· Navy EMT-style work pants
· White uniform shirt, with EMT and services patches
· (Optional: plain white or navy t-shirt or turtleneck worn under the shirt)
· black boots or shoes, polished
· assigned uniform coat
Employees may choose to wear a navy EMT-style sweater over their uniform shirt, provided the appropriate patches are in place
The uniform must clean and wrinkle-free. A spare uniform set-up or approved jumpsuit must always be available in case of contamination.
· A uniform the same as the full-time day crew, a jumpsuit, or other approved apparel
· A jumpsuit: night and week-end staff are issued approved jumpsuits, which protect personal clothing, provide visibility and scene safety and ensure professional appearance and ease of identification as Highland EMTs.
· Black boots or shoes, polished
Only patches and insignia that represent Highland and the EMT profession are to be worn. Political, personal interest, or other insignia are not to be worn as part of the uniform.
Approved nametags are issued and must be worn whenever the EMT is on company assignment. Patients are assured by Federal Law (Patient’s Bill of Rights) the right to know the identity of the individuals providing care.
All EMTs shall maintain personal cleanliness habits. Perfumes or after-shaves are to be avoided in order to protect patients with allergies and respiratory distress.
Hair is clean. Long hair (below collar length) is tied back or put up when working, for personal safety.
Facial hair that prevents respirator face to facepiece seal is not allowed. Moustaches which are kept trimmed and neat are permissible provided they do not extend lower than the corner of the mouth. (Facial hair may prevent proper HEPA mask fit)
For professional appearance and personal safety reasons, jewelry should not be worn, with the following exceptions
· One pair of stud earrings are permissible
· wedding rings or flat rings are permissible provided that the employee engages in proper hand-washing technique to prevent contamination of the skin beneath the ring surface
· exceptions will be allowed only with explicit permission from the service director or the Personnel Committee of the Board of Directors
Recent studies indicate that artificial nails worn by healthcare providers may harbor and transmit germs, even when gloves are worn and good hand washing techniques are maintained. Many hospitals now ban artificial nails on direct-care employees. Highland EMTs are not permitted to wear artificial nails when providing direct patient care. All Highland EMTs will keep their fingernails trimmed and filed to a moderate length. Nail polish, if worn, is light or clear, and maintained in good condition.
The Highland fully supports personal appearance as an expression of individuality; however the on-duty EMT is aware that we are in the public eye as health-care professionals. Our appearance is our first communication with patients as we endeavor to gain their trust and confidence. Unusual hair coloring or hair styles, heavy makeup or other cosmetic alterations may contribute to confusion a misapprehension from the patient. The service director will make the final decision regarding professional image.
EMTs will adhere to the professional conduct standards established herein including, but not limited to safe practices, substance abuse policy, dispatch and communications policy.
All EMT’s will show respect for their fellow EMT’s and First Responders. Respect will be given to the members of the Board of Directors and the Service Director at all times. Anyone visiting the Highland facilities will be treated with respect.
All EMT’s are obligated to respond to shifts for which they have indicated a willingness to provide coverage; it is each EMT’s own responsibility to seek coverage if a problem arises; the designated scheduler can assist as needed. The EMT seeking coverage will notify the duty partner of changes.
Any replacement personnel must be approved by the Service Director. I.e. if any full-time EMT wishes to take a day off, they must get prior approval from the Director. The replacement EMT must be approved by the Service Director. If the Service Director is available, he/she will work the day instead of hiring a per diem person to fill the day shift.
All EMTs are obligated to complete incident reports in the event of any action contrary to normal procedures which may affect patient care or well-being, safety of staff, vehicle operation, Highland accounts or property. Documentation of such events does not occur within a Patient Care Report, but is completed in narrative form on a separate paper. The incident report is sequestered for initial review and follow-up by the Service Director. Examples of events requiring incident reports include, but are not limited to; needle sticks, theft or loss of ambulance equipment, minor accidents with no personal injury involving an ambulance, assault of a patient or EMT, damage to a patient’s property, or placing a patient in restraints, etc.
In the event of a motor vehicle accident involving an ambulance, the ambulance will be placed out of service, and the personnel involved will immediately notify the service director or the board of directors.
Any problems with fellow EMTs or
Paramedic intercepts will be directed to the Service Director in writing. No
complaints are to be given to ER staff or doctors. No complaints are to be
talked about with other Paramedics or EMT’s.
Worker’s Compensation is provided to cover any paid employee experiencing on-duty injury. Proper procedure must be followed in order to expedite a claim. Failure to follow reporting procedure may result in a significant delay in funds availability due to deadlines and limitations imposed by the covering insurance agency.
· The Service Director will be notified immediately. In the case where the Service Director is the injured party, a member of the personnel committee of the Board of Directors will be notified by dispatch.
· If medical attention is required, the employee will report to the designated occupational health center. If the injury is life or limb-threatening, the employee will immediately be transported to the nearest emergency department.
· An Incident Report and any other forms required by the insurance company must be completed within 24 hours of the injury.
· Care will be co-coordinated by the insurance agency and the organization’s designated physician. In some cases this may mean that the employee may use his/her personal physician. Situations will vary depending on the circumstances and nature of injury.
· If the employee is out of work for an extended period of time, the insurance company may require periodic paperwork completion and physician examination.
· The employee may not return to full duty until medical clearance is provided in writing. In some situations, the organization may ask for an independent medical evaluation to assure medical clearance
Highland EMT’s are responsible to maintain a clean, safe, and secure working environment. Office space and garage are kept clean and sanitary. Non-Highland individuals are not permitted access unless accompanied by an employee. Non-employee visits are limited to 15 minutes with the exception of Goshen fire personnel and state inspectors.
In the event that a violation of Highland policies or rules occurs, an investigation will be made by the Service Director. Discipline penalties are appropriate to the offense, as determined by Highland, acting through its Personnel Subcommittee.
Highland strives to educate and retain its EMTs whenever possible. The purpose of progressive discipline is to discourage a repetition of unacceptable behavior, allow the individual to accept the responsibility for his/her actions, and to provide remediation. The steps of the Highland Progressive Discipline Policy are
· A verbal warning with a written record of the same will be placed in the individual’s personnel file. The Service Director or a member of the personnel subcommittee may take this action independent of the Personnel Subcommittee
· A written warning advising the individual that he/she could be subject to suspension or discharge should the offense be repeated or other serious offenses occur. This action is taken after advisement from the Personnel Subcommittee.
· Suspension of the individual, with a full written record placed in the employee file. This action is taken after advisement from the Personnel Subcommittee.
· Discharge of the EMT, with a full written record placed in the personnel file. This action is taken after advisement from the Personnel Subcommittee.
Progressive Discipline applies to the discipline accumulated for violations of all general offenses, regardless of whether or not they are of the same nature.
Examples of infractions which may result in disciplinary action include but are not limited to
· unexcused or repeated tardiness
· abuse of sick time
· reporting for duty under the influence of drugs/alcohol
· at-fault ambulance accident
· unprofessional behavior
· abuse of Highland property
· failure to adhere to state and federal laws and regulations
· assault and battery on a patient, bystander or health care professional
· shift abandonment without prior approval
Highland protects and preserves the confidentiality of all personnel records per State and Federal Law;
EMT’s may access their personnel files by
· Notifying the Personnel Subcommittee in writing
· Inspecting file(s) in the presence of management
· File corrections in writing with the Personnel Subcommittee
· Request a photocopy of their personnel file. Subsequent requests will only be for records placed in the personnel file after the first request.
EMT’s may not
· Remove or tamper with information contained in the file
· Photocopy portions of the file
Personnel records will be kept in the Corporation files. Copies of EMT cards and drivers’ licenses will be kept so that OEMS inspectors can gain access for review of expiration dates.
This section contains specific information about employee benefits, and is subject to change.
Highland provides full-time EMT’s with 8 paid holidays and 2 paid floating holidays during each calendar year. These holidays are listed below
· New Year’s Day
· President’s Birthday
· Memorial Day
· Independence Day
· Labor Day
· Columbus Day
· Thanksgiving Day
· Christmas Day
· Martin Luther King Day
· Veteran’s Day
If Independence Day, Christmas Day or New Year’s Day falls on a Saturday. The Friday prior to the holiday will be the paid holiday, if one of these holidays fall on Sunday, the following Monday will be the paid holiday.
The EMT must work the day before and day after any holiday to receive holiday pay, unless those days are scheduled days off.
Full-time EMT’s are expected to take holidays as earned time off. If an EMT chooses to work on one or both of the floating holidays, he/she must elect to take one or both of those days off at a different time during the same calendar year. Holiday time off not taken during the calendar year will be forfeited. EMT’s are asked to provide at least 10 days advanced notice in writing of his/her intent to take time off in lieu of working on a floating holiday so that a substitute can be secured for duty coverage.
Highland has made a commitment to provide ambulance coverage staffed by on duty paid EMT’s Monday through Friday between the hours of 8:00 AM and 4:00 PM. Holidays are no exception. Full-time EMT’s are not expected to work on holidays, therefore Highland volunteer EMT’s will be offered holiday work with pay. With the approval of the ambulance service director, full-time EMT’s may work holidays, Thanksgiving Night, Christmas Eve, and New Year’s Eve if all volunteer EMT’s have been contacted and none are available to work.
Compensation rates will be determined annually by the Board of Directors at their annual meeting.
· Pay periods will run from Monday thru Friday, with checks being issued on the following Thursday.
· On call times are 6 am-8am and 4 pm-6 pm and will be paid the stipend as determined by the Board of Directors. If the full time EMT’s respond to a call during this on call time period, they will automatically be paid time and a half for that time only.
· Time and a half for all other shifts will be paid after 40 hours of actual hours worked. Holidays, vacation and sick days etc., are not considered hours worked.
All volunteer EMT’s will participate in a lottery to determine the call lists for vacation & sick days, scheduled holidays, special holidays and Thanksgiving Night, Christmas & New Year’s Eve. At the beginning of each fiscal year, the ambulance service directors will conduct a drawing at a meeting of the EMT’s and establish 4 EMT call lists, i.e. for vacation and sick days, scheduled holidays, special holidays and Thanksgiving Night, Christmas Eve and New Year’s Eve respectively. The call lists will be posted and given to all EMT’s. Full-time EMT’s will only be eligible to fill these holidays after all Volunteer EMT’s have been contacted and none are available.
Each Highland full-time EMT is allowed up to 15 vacation days. After one year 5 days are allowed. The first year is one year from day of hire. Upon completion of the 2nd full year of employment, ten days are allowed. After three years each EMT is allowed up to fifteen days of vacation. EMT’s are asked to provide at least 10 days advance notice in writing of his/her intent to take multiple vacation days so that a substitute can be secured for duty coverage. Full-time EMT’s are asked to not schedule the same vacation dates during the year to assure all daily operational procedures will be executed when working with the substitute EMT’s If vacation days end up not being used on the full-time EMT’s annual employment anniversary, up to 5 vacation days may be carried forward into the next year with the permission of the Personnel Committee of the Board of Directors.
Each Highland full-time EMT is allowed 3 paid sick days to be accumulated on a prorated basis during the calendar year. If the days are unused at the end of the calendar year, full-time EMT’s will be paid for each sick day not used in a lump sum payment. Sick days do not accumulate and cannot be carried forward into the next year calendar.
The full time EMT’s must have coverage for any Doctors, Dentist or other personal appointments. The EMT’s may use their sick time, personal time, or vacation time for these appointments. Time off without pay may be allowed but must have the Service Director’s or his/her designee’s permission prior to taking time off.
Full time EMT’s will receive Bereavement Days as follows
· Five days for Spouse, Significant Other, Parent, or Children (including foster children)
· Three days for Grandparents, Sisters or Brothers
· Other circumstances will be considered prior to taking time off.
This section contains specific policies and practices pertaining to the operation of the licensed ambulance service, and is subject to change
Highland complies with 105 CMR section 170.335, which states that no person shall discriminate on the grounds of race, color, religion, national origin, age, sex, sexual orientation, ancestry or disability in any aspect of the provision of ambulance service or in employment practices.
All Emergency Medical Technicians (EMTs) in service to Highland will comply with all regulatory requirements issued by the Massachusetts Department of Public Health and all administrative requirements issued by OEMS.
All EMTs must be currently certified as Massachusetts Emergency Medical Technicians, at a minimum, and must renew their certification every two years
All EMTs will carry on their person the following credentials
· Current EMT certification card
· Current CPR certification and AED
· Valid motor vehicle operator’s license
· Region I semi-automatic defibrillator certification
Each EMT will provide originals of the above-listed credentials, which will be examined and verified by Highland Service Director. Copies of each credential will be kept on file in Highland Corporation files in the EMT personnel files in order for designated personnel to have access for review of expiration dates. The Service Director is responsible for maintaining records of credentials and verifying that only currently credentialed EMTs are in service to Highland.
If any of the required credentials are not provided or are missing, the individual EMT is considered out-of-service and is prohibited from functioning as an attendant on the ambulance until the required certification(s) have been provided.
All Highland EMTs will be familiar with and operate within the scope of the Massachusetts Statewide Treatment Protocols, a current copy of which will be available in crew quarters and on the ambulance.
Highland will comply with and operate with the scope of the Region 1 protocols, including the Point-of-entry plan outlined in the Region 1 Policies and Procedures and all Highland EMTs will comply with the Region 1 Resuscitation Policies for patients with comfort care and DNR orders. A current copy of the Region 1 Policies and Procedures will be available in crew quarters and on the ambulance.
When Highland transports a patient, the ambulance is staffed with a minimum of two (2) ambulance attendants, both of whom will at a minimum be currently certified at the EMT-Basic Level. The following arrangements for securing additional appropriately trained staff to assist ALS personnel are as follows: Back-up/Mutual Aid with ALS service providers with whom Highland has signed agreements with will be called to provide ALS backup: AMR, BHS and County Ambulance See pg. 17.
All EMTs in Service to Highland will conduct themselves professionally in accordance with the standards mandated by their certification.
Each EMT is responsible for providing safe transportation and appropriate treatment without delay and to act in the patient’s best interests at all times.
Each on-duty EMT will wear a uniform and identification which clearly identifies him or her as an employee of Highland
Week-day employees will wear a uniform shirt and uniform pants
Night, Weekend, and Day (“call”) employees will wear the designated jumpsuit.
EMTs will follow appearance and professional behavior standards as outlined in their personnel handbook, including but not limited to;
· Behavior standards
· Maintenance of confidentiality
· Personal hygiene
· General conduct
EMTs will refrain from the use of drugs, alcohol, or gambling during their on-duty shifts and for a minimum of eight hours prior to reporting for duty. Use of alcohol or illicit drugs while on duty is cause for immediate suspension for the protection of patients and staff. Other penalties may ensue, up to and including dismissal.
Any prescribed or over the counter medications which may affect alertness and must be used while on duty will be accompanied by a doctor’s note. The Service Director must be made aware of the medication and will make a final determination as to fitness for duty.
Any EMT driving the Highland ambulance who is involved in a motor vehicle crash, regardless of the level of damage or injury, will submit to a urine drug screen. EMTs found positive for illegal drugs or elevated alcohol levels are subject to dismissal.
Every respirator wearer shall receive fitting instructions including demonstrations and practice in how the respirator should be worn, how to adjust it and, how to determine if it fits properly. Respirators shall not be worn when conditions prevent a good seal. Such conditions may be a growth of beard, sideburns, a skull cap that projects under the face piece, or temple pieces on glasses. Also, the absence of one or both dentures can seriously affect the fit of a face piece. The EMT’s diligence in observing these factors shall be evaluated by periodic check. To assure proper protection, the face piece fit shall be checked by the wearer each time he/she puts on the respirator. This may be done by following the manufacturers face piece fitting instructions. Each individual shall sign off on the Highland respirator Fit Test Form.
The vehicle(s) and contents will be clean, safe, and in good working condition at all times. The day crew will perform inventory checks and routine fluid checks each shift. Fuel status will be maintained at ¾ tank. Inventory sheets will be maintained on file at crew quarters for a minimum of one year. Supply cabinet inventory is conducted weekly, and the Service Director will be informed as to needed equipment or supplies.
Any crew; day, night or weekend, which provides patient care, is responsible for
· completing trip paperwork (run sheet, billing info)
· replace cot linens
· restock all equipment and supplies used
· Decontaminate cot, backboard, straps, etc.
· Sweep vehicle floor, at a minimum (wash if contaminated) and garage floor if necessary
· leave red biohazard bags at the hospital
· communicate, by written note or other means, if equipment was left at a hospital, if equipment is broken, faulty or missing, or if the ambulance needs mechanical attention
· leave the ambulance neat and in a “state of readiness” for the next ambulance call
The ambulance is locked if it must be left unattended and out of sight of the crew.
Sanitary practices are maintained in accordance with all regulations, administrative requirements and protocols. Cleaning of the ambulance equipment, and disposal of linens and supplies, is carried out using appropriate BSI precautions.
The ambulance, its interior and all equipment shall be cleaned and sanitary at all times
After each patient transport
· The ambulance will be cleaned with disinfectant spray located in the bench compartment
· The stretcher and all patient surfaces will be cleaned with a disinfecting solution/spray per manufacturer’s directions
· Linens will be disposed of in accordance with receiving hospitals procedures
· Disposable contaminated equipment will be handled in accordance with receiving hospital procedures
· Contaminated sharps will be placed into the approved sharps container located adjacent to the work surface in the ambulance
· The ambulance doors will be left open for up to 10 minutes to provide thorough air exchange
The ambulance will not be identified as “back in service” until all sanitary practices have been completed.
Any mechanical failure must immediately be reported to the Service Director and the designated ambulance maintenance supervisor. A written report must follow.
If Highland should experience a mechanical failure during patient transport, the EMTs will contact Northampton Control via landline or cellular phone and request the nearest available back-up ambulance be dispatched to continue patient transport.
The patient attendant will remain with the patient, while the driver secures the vehicle appropriately (chock blocks, emergency triangles) and conducts traffic control.
The patient attendant will continue to monitor the patient and will provide a complete report to the back up ambulance.
The event will be documented on the trip sheet and a mechanical failure report will be completed. The mechanical failure report is maintained on file at Highland headquarters.
Upon completion of patient transfer to the back-up ambulance, a tow-truck will be engaged to return the ambulance to the ambulance garage.
Northampton Control will be notified that the ambulance is out-of-service and back-up services will be engaged for calls in the Highland service area.
Northampton Control will be notified when the ambulance is back in service.
The acquisition, security and disposal of all medications will be done in accordance to 105 CMR 170.700. The acquisition, handling, dispensing, disposal and accounting of all medications for HAEMS will adhere to the Hospital’s (CDH) policies in accordance to The Ambulance Service Agreement signed by both parties.
· A permanent bound “Controlled Substance Usage Log” will be kept for all usage and audited on a regular basis by management.
· All medications will be stored in a locked medication box and all Controlled Substances will be secured with a double locked system to include the locked medication box. The Usage Log will be kept secure with the medication box.
· Medication acquisition will be done through CDH’s Pyxis System and/or pharmacy.
· Disposal/Waste of Controlled Substances must be witnessed and signed for by qualified hospital staff.
For Loss and Tampering notify the Service Director immediately.
The Service Director will then
· Notify Food & Drug with 48 hours
· Notify OEMS with 48 hours
· Notify CDH pharmacy and Medical Control Doctor
· Implement drug testing of all staff involved
Highland will issue equipment and supplies to EMT’s on its active roster. Examples of equipment or supplies provided include portable radio, pager, jumpsuit, nametag, ambulance garage key, etc. All personnel are required to immediately report any defect, loss, or malfunction of issued equipment and supplies. EMTs are responsible for the return their issued materials at the conclusion of their tenure with Highland.
A supply cabinet for ambulance re-stocking will be maintained in the ambulance garage. Access keys are to be found on the ambulance key ring.
Highland is in compliance with all regulations, administrative requirements and protocols regarding the stocking of supplies.
Medical supplies and linens are maintained at the ambulance garage in a clean, enclosed storage area which is accessible to all employees.
The Service Director or designated employee is responsible for the management and stocking of the supply area.
The ambulance is re-stocked during the daily inventory with supplies from the storage area. Written inventory logs are maintained on file at the ambulance headquarters.
Certain supplies are “exchange” items with various hospitals. EMTs restock on a one-for-one exchange basis, using the currently available exchange lists from each hospital.
A weekly inventory of the supply area will be conducted which identifies and anticipates stock at minimum supply, or stock nearing expiration dates.
Monthly orders are submitted to supply vendors. Orders may also be placed on an “as needed” basis by the Service Director.
All purchases must be approved by the Service Director before ordering. After ordering, the order slips will be given to Service Director. Upon arrival of the supplies, the invoice will be compared to the order slip and the packing slip will be filed.
Daily inspections of all biomedical equipment are completed by EMTs as part of the ambulance inventory check-list. Inspection may be visual or functional, depending on manufacturer’s recommendation. Equipment that is found faulty will be taken out of service for immediate repair. If, as a result of equipment failure, the ambulance is taken out of service, Highland’s backup services will be notified
The semi-automatic defibrillator will be inspected visually each day for signal light indicators of problems identified during its daily self-check. On the 1st Monday of each month, the unit will be activated to ensure proper function
Highland maintains a Memorandum of Agreement with Cooley Dickinson, Noble Hospital, Berkshire Medical, and Franklin Medical (NADAMS REGIONAL? for the acquisition and replacement of epinephrine auto-injectors. The memorandums specify quality assurance, treatment protocol compliance, training, record keeping, storage, and disposal issues.
Highland stores two adult auto-injectors and two junior auto-injectors in a locked box in a clearly identifiable ambulance cabinet. Inspections for quantity and expiration date are included as part of the daily ambulance inventory. Use of an auto-injector during patient care is recorded in the Highland call log, which is filed daily at crew quarters. Replacement of used auto-injectors occurs as needed. The Service Director and one other designee are authorized to exchange or replace auto-injectors. Disposal of the used auto-injector is provided for in the Hazardous Waste Disposal Section of these policies. Training in the use of the auto-injectors will be refreshed yearly for all Highland EMTs.
An acquisition and maintenance log is kept in a secure file in ambulance quarters. The log is maintained by the Service Director or designee. Discrepancies between the acquisition log and the actual supply are subject to investigation by the Board of Directors of Highland, acting through its designee.
All sharps (needles, bristojets, etc.) are placed uncapped into the designated sharps container. Half-full containers are snap-locked and turned in at receiving Emergency Department for disposal, according to their procedures. Used sharps are immediately placed into the sharps container; they are not placed, set or stuck anywhere else. Sharps only are to be placed into the approved sharps container.
All other biohazardous material, including any disposable items contaminated with body fluids and IV supplies, are placed into red Biohazard bags. A supply of small “red bags” is carried on the ambulance. The bags are used during patient care, and then are disposed of at the receiving hospital by placement into “contaminated” or “biohazard” containers. Red bags containing biohazardous material must not be used for other patients or left on the ambulance.
Red biohazard bags may not be used for regular trash. The purpose if a red biohazard bag is to indicate hazardous material requiring incineration. Sealed red bags are not to be re-opened.
It is expected that biohazardous material is cleaned from the ambulance following patient drop-off at the receiving hospital. Any biohazardous material discovered during the course of daily cleaning and inventory will be placed into a red biohazard bag. This bag will be placed into a marked container in the ambulance garage.
Occasionally biohazardous material will be collected in a no-transport situation. In such cases material will be placed into a red biohazard bag, which is stored in a marked contained in the ambulance garage. The contents of the container will be disposed of.
Medical waste is defined as “untreated solid waste generated during the administration of medical care including but not limited to infectious waste” Included are such items as;
· Discarded used or unused sharps or syringes
· Any container or disposable item filled or saturated with body fluids
· Sharps and syringes are placed by EMT’s into approved sharps containers.
· Pads, gauze or other disposable items are placed into supplied “red bags.” Red bags are left at the receiving hospital after each patient transport.
· All linen is treated as contaminated and is left at the receiving hospital according to its policies.
· Since the public may perceive other items as medical waste, such as oxygen masks, disposable gloves, IV tubing and bags, these items are also disposed of at a hospital in the approved containers.
Only designated management personnel are authorized to speak with members of the news media. Questions should be referred to the service director.
Questions, concerns, or information needed by law enforcement or other public safety officials will also be referred to the Service Director.
Patient Trip Records are not released to any party except by written patient release or legal subpoena. The exceptions to this practice are:
· Release to a Medical Examiner
· Release to authorized billing agents
· MA OEMS ambulance inspectors are entitled to review paperwork, (including patient records relative to any complaint) and to inspect the ambulance at any time. Staff will notify the service director that the inspector is on the premises, but will not delay in providing any requested paperwork or access to the vehicle
Highland ambulance is equipped with two-way communications between the ambulance, each attendant and the dispatch center at Northampton Control. Specific policies regarding radio communication with Northampton Control are maintained in the employee handbook.
Highland maintains direct two-way communications with hospital emergency departments to which the ambulance service routinely transports patients. EMTs will notify the receiving hospital of all incoming patients in a timely manner. Any EMT who needs to speak directly with Medical Control regarding a patient will request a “Signal 300” if they are a basic level, “Signal 400” if they are intermediate level, or “Signal 600” if they are paramedic level.
In the event of two-way radio communication failure, Highland is equipped with a cellular phone for hospital or dispatch communication. All EMT’s will follow state and regional protocols.
Highland has a portable two-way radio for medical directions. This radio can be transported to the scene of illness or injury.
Highland is dispatched through Northampton Control 911 based at the Northampton State Police Barracks. The hours during which ALS will be provided with consideration of the P/B waiver are Monday-Friday 8a-4p and Saturday & Sunday 6a-2p. Any change of hours must be approved by the Service Director and/or the Board of Directors. All changes will be immediately submitted to Northampton Control and other designated dispatch centers and necessary agencies.
Each EMT is provided with portable radio or pager that receives a specified tone from Northampton Control indicating a need for a response to an emergency medical scene.
Upon receiving said emergency dispatch tone the responding EMT identifies him/herself with med # and acknowledges the address of the emergency.
All requests for dispatch of additional medical units and back up units are carried out by Northampton Control at the request of on-scene Highland EMTs.
Highland’s designation is “77”. The ambulance assignments are “77-A1”, “77-A2”, and “77-A3”
All personnel are assigned a med-ID number, and they will use it in conjunction with the service designation, e.g. “77Med 20”
When a call tone is received, EMTs will notify Northampton Control by signing on with their Med-ID numbers, and state, “responding to scene” or “responding to ambulance quarters.”
When the ambulance leaves quarters en route to the call, Northampton Control is notified by using the 77-A1, 77-A2, 77-A3 designation, and “responding to ___________”. At that time any updates may be provided by Northampton Control.
Northampton Control is updated whenever the ambulance status changes e.g. arrival on scene, en-route to _____ Hospital, intercepting with ALS, etc., so that times may be recorded.
Northampton Control is notified when the ambulance clears the hospital en route back to the service area, and upon arrival in quarters.
Unnecessary radio chatter must be avoided. Use a professional tone, speaking slowly and clearly. Do not discuss confidential matters over the air, such as patient name or sensitive information. A cell phone is available for further discussion, inability to receive radio communications, or to request other information without tying up the airwaves.
After punching in the correct radio codes for phone (or requesting patch from C-Med), contact the hospital by stating “_____________ Hospital from Highland Ambulance” When the hospital acknowledges you, begin your report. Your patient report should be brief (no more than 45 seconds) and include only the most important information
· Patient age and sex
· Level of Consciousness
· Nature of Illness or Injury
· Patient physician, if known
· Current vitals and pertinent findings
· Treatment initiated (oxygen, c-spine, etc.)
If you need to speak with the Medical Control Physician about your patient, request a “Signal 300”, “Signal 400”, or “Signal 600” at the beginning of your report, and wait for the physician to sign on. Otherwise you may end up repeating your entire report again! Again, a cell phone is available for hospital communications
All messages will be left on the answering machine for review by the Service Director. If the Service Director is out of the office they will be left on the machine until his/her return. Vacations, etc. are the only exceptions.
Listening or eaves dropping will not be tolerated. If a phone call or meeting involves daytime or volunteer staff, you will be advised. Corporate calls involving the Service Director, members of the Board of Directors or vendors are not the concern of the full time EMT’s or the volunteers. If a call involves you, you will be notified.
For all dispatched requests for an ambulance: Under normal operating circumstances, at minimum one (1) EMT must respond to the station and bring the ambulance to the scene of the call.
Example: The first EMT (scheduled or not) that “signs-on” the air with the dispatch center and reports he/she is responding to the scene due to his/her close proximity to the call, the next or second EMT to sign-on the air must respond to the ambulance and then respond to the scene with the ambulance.
Under certain/special circumstances a first responder (that has had ambulance training) may respond with the ambulance to a scene if two(2) EMT’s are either on or enroute to the scene.
Highland will transport the emergency patient to the nearest appropriate hospital, taking into consideration patient stability, nature of the emergency and patient request. In the case of an unstable patient for whom Advanced Life Support is unavailable, the patient will be transported to the closest emergency department.
Warning lights will be used when transporting patients to the emergency department. The use of the siren will be determined based on the patient’s condition and risk of being affected by the sound of the siren. The policy regarding intersections, stoplights and passing motor vehicles, as listed previously, will be followed when transporting to the Emergency Department
Patients being returned from a facility, non-emergency transports to appointments, or any other non-emergency reason for transport require that the ambulance travel with the flow of traffic. No lights or siren will be used. The ambulance will not exceed the speed limit or safe road conditions.
When the ambulance is returning from the emergency department or from a patient refusal, it will travel with the flow of traffic. No lights or sirens will be used. The ambulance will not be dispatched to and will not respond to an emergency within its service area if it is outside its service area.
Highland shall not be used to transport a dead body except in special circumstances where it is in the interest of public health and/or safety to do so.
Highland EMTs will follow the Statewide Treatment Protocols when determining the necessity for resuscitation. In particular
· Dependent lividity with accompanying rigor mortis
· Any other injury incompatible with life shall be used as determining factors
· In situations involving a dead body the EMTs shall notify the Massachusetts State Police
· The ambulance shall remain on scene until released by the State Police or Medical Examiner’s Office
Highland, in compliance with 105 CMR 170.355, will not refuse, in the case of an emergency, to dispatch an available ambulance to provide life support at the scene, or to transport a patient to an appropriate health care facility within our regular operating area.
Upon receipt of an emergency call by Northampton Control, Highland ambulance shall be promptly dispatched. However, if the Northampton Control dispatcher has reason to believe at the time the call is received that the Highland ambulance will not be available for dispatch within five minutes, Northampton Control will immediately contact the designated back-up service(s). In addition the Northampton Control Dispatcher shall contact the back-up service (s) when for any reason the Highland ambulance is not available for response within five minutes of receipt of the call.
When the Northampton Control Dispatcher has reason to believe that another ambulance has the capacity to reach the scene in a significantly shorter period of time, the Northampton Control Dispatcher shall immediately notify police or fire in the town in which the emergency has occurred, or an ambulance service with the capacity of reaching the scene in a shorter period of time.
Highland shall not transfer a patient between health care facilities who is receiving medical treatment that is beyond the training and certification capabilities of the EMTs staffing the ambulance unless an additional health care professional with that capability accompanies the patient.
When additional personnel are required/needed at a scene Northampton Control is to be contacted and requested to tone for additional personnel to respond to the scene.
If a second call comes in while the first/primary ambulance is not available, Northampton Control will automatically tone for additional staff and dispatch our second ambulance to respond. If no additional staff is available the Control Center will automatically dispatch mutual aid from the nearest available and appropriate resource.
Highland personnel must obtain informed consent in order to treat and or transport. Adults who are capable of making informed consent must be advised of plans of treatment and transport, and must also be informed of potential medical consequences should they refuse treatment or transportation.
Adult patients who appear incapable of making informed consent (i.e., under the influence of drugs or alcohol, suicidal gestures, disoriented, etc.) may be treated and transported under the implied consent doctrine. In such cases Highland personnel are acting in the best interest of the patient and the patient care report will reflect their observations
Unconscious adults are treated under the implied consent doctrine. If a comfort care document is present, EMTs will act according the Comfort Care guidelines.
Minors are unable to grant consent to treat and are unable to refuse care for themselves. A minor is defined as an individual who is under 18 years of age, and who is not emancipated by means of marriage, pregnancy/motherhood, or relief of the court system, military service, or other reasons as defined by the Commonwealth
Highland personnel at the scene of a critical or potentially critical illness or injury of a minor, when no parent or guardian is present, will treat and transport under the doctrine of implied consent.
In the case of non-life threatening calls, if the parent or guardian is not available to grant consent, the child may be examined to ensure his/her own safety. Basic aid such as control of bleeding may be performed. Efforts must be made to obtain consent. Occasionally this will require a delay in transport. If, on physical exam, no injury is discovered, the child may be left in the custody of a responsible adult (school nurse, school official, law enforcement), and continued efforts to reach the parent will be made. Documentation will be completed. Wherever feasible, Highland personnel will speak, in person or by phone, to the parent(s) or legal guardian(s) to advise them of the prior exam
Per MGL Section 12A, C 111C, “an injured child who is being transported to a hospital or other medical treatment facility by an ambulance or other emergency vehicle shall be accompanied by a parent on such parents request, unless the emergency medical technician or other person in charge determines that a medical situation is life-threatening or that the presence of a parent would create potential risk to such child. Such determination shall be noted in a written report of said emergency and a copy of such report shall be sent to such parent within 30 days of such determination.”
When it is necessary to restrain a patient, for the purpose of ensuring patient and or crew safety, Highland EMTs will use either commercially available soft leather straps, or padded cloth restraints. Police handcuffs or tie wraps will not be used.
There are many reasons to restrain patients for their own safety, including but not limited to
· Medical conditions, such as
· Head trauma
· Drug or toxic ingestion
· Diabetic reaction
· Psychiatric conditions, such as
· Active hallucinations or other acute psychotic break
· Section 12 involuntary committal
Agitated or disruptive patients who must be restrained require a minimum of four persons to perform safe restraint.
Law enforcement personnel may be used to assist in the restraint process. A patient will be secured supine or semi-reclining on the stretcher at four points: both wrists and both ankles, plus the standard stretcher straps. Extremely agitated or disruptive patients will be secured supine with one wrist above the head and one wrist at the side, to prevent use of abdominal muscles for escape. An additional strap will be places just above the knees. At all times the EMTs will ensure the restrained patient’s patent airway and the presence of distal pulses. Suction will be immediately available.
Due to the dangers of restraint asphyxiation, Highland EMTs will never restrain a patient in the prone position on the stretcher.
In cases involving involuntary commitment (Section 12) EMTs must have available a copy of the order prior to transport.
Any patient who has been placed into restraints will not be released from restraint. Upon arrival at the receiving facility, a verbal report will be provided giving the reasons for the restraint. If necessary, the Highland restraints will remain on the patient for a period of time after transfer.
Occasionally persons under arrest must be transported by ambulance. When such persons are in handcuffs a police officer must accompany the patient in the ambulance. This insures the ability to quickly release the handcuffs in case of a sudden need for resuscitation. In cases where law enforcement prefers to follow the ambulance via cruiser, the handcuffs must be removed prior to transport. Highland EMTs, regardless of any previous law enforcement training, do not take custody of handcuffed patients or handcuff keys.
Highland adheres to the MGL C 89 Section 7B and C 90 Section 14 relative to use of lights and warning signals, operation of an emergency vehicle and operation of motor vehicles in the vicinity of a school bus.
· All Highland EMTs are trained in the procedures for using lights and warning signals. This training will be provided annually by the designated Safety Officer
· Any First Responder that drives the Highland ambulance will complete this training
· New personnel will complete documented training prior to driving the ambulance
All emergency responses will utilize lights and siren (as needed), the only exception being the overnight hours with minimal traffic, when continuous siren use is unnecessary. Warning siren, if not already engaged, will be used (as needed) in addition to emergency lights at least 1,000 feet prior to any intersection or stoplight, and will continue until the ambulance is safely through the intersection. Courtesy and safety require that when the ambulance is using the warning lights, the siren or air horn be activated prior to passing motor vehicles.
If the ambulance must be left parked in the roadway, the warning lights will be left flashing. The ambulance is positioned so as to protect staff from motor vehicle crashes, but out of the flow of traffic wherever possible. At private residences, EMTs will make every effort to park the ambulance in such a manner that is safe. If the unit is parked in a driveway, the warning lights will be shut down.
Highland shall ensure that basic life support emergency ambulance service is available to the public, specifically to the towns of
Within the service’s regular operating area on a 24 hour day, seven day week basis, either by providing the service’s own personnel and ambulance, or by written arrangements for back-up with the following services
· Shelburne Falls
At any time, should Highland be unable to respond to a critical or unknown illness or injury after a third tone or in Williamsburg after the second tone, our designated backup service(s) will be activated as follows
o Shelburne Falls
o Shelburne Falls
o Shelburne Falls
Northampton Control may also dispatch local first responders directly to the scene to provide care.
Highland will maintain records in conformance with all applicable regulations, administrative requirements and statewide treatment protocols.
Records will be prepared and maintained and are subject to inspection by the Department of Public Health at any time. Such records include, but are not limited to
· Patient care reports
· Patient refusal of treatment
· Ambulance and equipment inventory logs
· Ambulance mechanical records
· Biomedical equipment maintenance records
· Employee certification records
· Employee immunization records and unprotected exposure report
· Vehicle registration
· FCC licensure
All records are stored in such a manner as to insure reasonable protection from water and fire damage. Records will be maintained for a minimum of three years, except patient care reports which will be maintained in accordance with current OSHA recommendations.
Trip records will be completed for all transports, regardless of destination. The EMT completing the patient care report will deliver a copy of the report to the receiving facility with the patient, where it will become a part of the patient’s medical record.
Unprotected exposure forms will be competed as needed and left at the receiving facility.
Highland employees will complete all necessary service paperwork pertaining to any transports, refusals or cancellations promptly upon completion of the run.
Highland is in compliance with CMR 170.225 which permits ambulance inspectors to visit the premises, including headquarters, crew quarters, ambulance garage and vehicles at any time. Inspectors are entitled to full access to the vehicle and any records, including but not limited to, patient trip records, employee certification records, call records, refusal of service records, inventory and maintenance records.
Highland shall appoint an Infection Control Officer in compliance with 105 CMR 170.340. Said Infection Control Officer is responsible for
· Enforcing the Infection Control Policies of Highland
· Receiving notification from health care facilities regarding exposures to infectious diseases
· Informing all EMTs of requirements and practices related to the reporting of exposures to infectious diseases
· Any and all record keeping related to the above responsibilities
Highland strives to ensure the safety of its EMTs by developing and enforcing an Exposure Control Plan. The purpose of the Plan is to protect EMTs against Bloodborne (body fluid) pathogens, including but not limited to
And airborne diseases, especially
· and chicken pox
Other diseases, although less common, must be guarded against. Examples include
· Meningococcal disease
· Hemorrhagic fevers
· And other diseases as yet undetermined
Infection Control Practices of Highland include
· Hand washing, following each and every patient contact. Waterless cleanser is provided in the ambulance; however EMTs are expected to wash their hands with soap and water as soon as possible. Germicidal soap and water should be used. Lather hands for a minimum of 30 seconds, rinse, then use a paper towel to turn off the faucet.
· Protective gloves are to be used for all patient contacts. Non-latex gloves are provided.
· Personal Protective Equipment, including gloves, goggles, HEPA masks, gowns and infection control kits are stocked on the ambulance and are to be used as appropriate. Each EMT is issued a personal respirator (HEPA) mask following fit-test procedures.
· All equipment and work surfaces are cleaned with disinfectant following each patient contact. One-use patient items are disposed of according to the receiving hospitals procedures.
· Used sharps are disposed of by ALS personnel in the sharps box provided in the ambulance. EMTs are not to handle or dispose of sharps unless they have been trained in proper disposal procedure.
· Immunization Program
o All Highland EMTs are offered the B vaccination serum at not cost. EMTs refusing the series must sign a release form.
o EMTs who have already received the Hepatitis B series must provide a copy of their immunization record. Failure to do so can result in termination. If records are lost or unobtainable, a titer will be offered at no cost. Results of the titer will determine if the employee is immune, or needs a repeat series or booster, which will be provided at no cost.
o A TB mantoux is required at time of employment and then yearly from each employee, at no cost. Mantoux results must be provided and are to be maintained in the health records. An employee with a positive Mantoux will receive counseling from the designated health service and treatment or follow up in accordance with the latest CDC (Center for Disease Control) recommendations.
o Recognition of High Risk Environments and hazardous procedures The CDC has identified certain environments and procedures as being “high risk” for exposure to TB or other airborne diseases, including
§ aerosolized medication treatment
§ sputum induction
§ endotracheal intubation
§ entering rooms housing individuals with confirmed or suspected infectious TB
§ transporting patients in confined space (ambulance) who have suspected or confirmed TB
In these situations EMTs are required to wear HEPA masks. The air vent in the patient compartment should be turned on the promote air exchange.
An unprotected exposure is defined as contact with body fluids on skin openings such as
· Open cuts or sores
· Hangnails or cuticle tears
· Extremely dry (cracked) skin
· Or other bodily fluid contact such as
· Fluid splashed into eyes, nose, or mouth
· Human bites.
· Or possible injected body fluids as would occur in needle sticks
If the EMT experiences an unprotected exposure to blood or body fluids, the care provider is required to submit an Unprotected Exposure Form for each incident. The EMT will complete the form as soon as possible upon arrival at the hospital, and will submit it to the designated Infection Control Nurse, along with a copy of the patient care report. The facility’s after-hours practices will be followed up in the case of night/weekend exposure.
As soon as patient care has been transferred, The EMT must wash the area thoroughly with germicidal soap and water, or flush the area as appropriate.
The facility is required to follow-up by notifying pre-hospital responders of an exposure to a blood borne pathogen only if the proper form has been filed. The EMT will also notify the designated Service Infection Control Officer of the incident as soon as possible, and will complete any necessary paperwork required by the agency to ensure proper coverage and follow-up.
Per MGL Chapter 51A, Emergency Medical Technicians are mandated reporters of abuse. Highland employees will report any suspicion of or witnessed abuse or assault against any person. EMTs will make a verbal report to Emergency Department personnel. EMTs are also responsible to notify the appropriate agency (Department of Social Services, Department of Mental Retardation, Elder Abuse Reporting Agency), and to provide all requested written documentation to said agencies. Highland EMTs will document the findings of the physical examination, document all pertinent patient comments, treat injuries, and preserve evidence, including patient clothing.
Elder Abuse is physical, emotional, sexual or financial abuse of any person over the age of 60. To report Elder Abuse call the
Department of Elder Affairs hotline 1-800-322-0551
Defined as: Mentally retarded or otherwise mentally and/or physically disabled, and wholly or partially dependent on another person (caretaker) for daily living needs.
To report physical, emotional, sexual or financial abuse
DPPC Hotline: 1-800-426-9009
EMT’s are mandated reporters of abuse and neglect. Do not assume that a verbal report to the Emergency Department or your trip sheet is sufficient notification. YOU are required to notify DSS yourself in suspected cases of abuse and neglect, or face potential fines of up to $1,000.00
DSS regulations (11 CMR, section 2.00) define abuse and neglect as follows
· Abuse the non-accidental commission of any act by a caretaker upon a child under the age of 18 which causes, or creates a substantial risk of physical or emotional injury: or constitutes a sexual offense under the laws of the Commonwealth: or any sexual contact between a caretaker and a child under the care of that individual. This definition is not dependent upon location (i.e. abuse can occur while the child is in an out-of-home or in-home setting)
· Neglect is the failure by a caretaker, either deliberately or through negligence or inability, to take those actions necessary to provide a child with minimally adequate food, clothing, shelter, medical care, supervision, emotional stability and growth, or other essential care: provided however, that such inability is not due solely to inadequate economic resources or solely to the existence of a handicapping condition. This definition is not dependent upon location (i.e. neglect can occur while the child is in an out-of-home or in-home setting)
· Physical Injury is death, or fracture of a bone, subdural hematoma, burns, impairment of any organ, and any other such nontrivial injury; or soft tissue swelling or skin bruising, depending on such factors as the child’s age, circumstances under which the injury occurred and the number and location of bruises; or addiction to a drug or drugs at birth; or failure to thrive.
· Emotional Injury is an impairment to or disorder of the intellectual or psychological capacity of a child as evidenced by observable and substantial reduction in the child’s ability to function within a normal range of performance and behavior.
· Caretaker is defined as parent, step-parent, guardian, or any household member entrusted with the responsibility for a child’s health and welfare; also, any other person entrusted with the responsibility for a child’s health and welfare, both in and out of the home, including: relatives, teachers or school staff in a school setting, day care workers, child care workers, including babysitters, foster parents, staff at a group care facility, school bus drivers, etc.
Weekdays, 9:00 am to 5 pm (DSS offices)
Weekends, holidays or after hours:
Child-At-Risk Hotline 1-800-792-5200
Child-At-Risk Hotline 1-800-792-5200
I understand that a violation of these procedures or any other Highland Ambulance policy shall result in discipline against me, up to and including termination.
Receipt of these updated policies is acknowledged.
Signed this___________ day of _____________, 20__
Emergency Medical Technician Signature