Section IV-1

 

EMS Operations

 

Purpose:  To establish general guidelines for the response and management of Three Star Volunteer Fire Department personnel to emergency and non-emergency situations involving provision of medical care.

 

Scope:  Three Star Volunteer Fire Department provides EMS services under the direction of the Baptist Memorial Hospital - Tipton Ambulance Service and its Medical Director. Individual EMS personnel will be under the direction of the Three Star Fire Department EMS Officer.  Basic Life Support (BLS) medical care and stabilization will be provided consistent with the scope of practice of the certified EMS provider.  Advanced Life Support (ALS) protocols may only be practiced by Three Star EMS providers with the express authorization of the Medical Director or his designee.

 

Policy:

 

At EMS assist incidents, Three Star Volunteer Fire Department apparatus and personnel remain under the command and control of the Chief of Department and his/her Officers until the arrival of Tipton County ambulance service.  Upon arrival, Three Star EMS personnel will provide a comprehensive report to ambulance service staff and then further assist ambulance service personnel as they assume patient care.

 

Personnel – All personnel responding to an EMS call must be at least CPR/AED certified.  Each EMS response must include a minimum of one person who is a licensed First Responder.  Upon arrival at the fire station, certified First Responders, EMT’s and Paramedics have priority over those only CPR/AED trained, to respond to the call.  Wherever possible, but not at the cost of delaying response, at least one EMT should respond if available, otherwise licensed First Responders should respond.  A minimum of two (2) personnel should respond to all calls.  Typical EMS responses should include a maximum of four (4) responders.  However, if the situation warrants additional personnel, responding officers can request and direct responders accordingly.  The four responder policy indicated previously does not include the Chief, Assistant Chief or EMS Officer who have the latitude to respond as deemed appropriate.

 

Privately Owned Vehicles (POV) will not be allowed on EMS scenes unless specifically directed by the senior officer on the incident.  The exception to this rule is that the Fire Chief, Assistant Chief or EMS Officer may respond to the scene as deemed appropriate.

 

Apparatus Response

 

Rescue 3 is the primary response unit for all EMS calls within the Three Star Fire Department Fire Management Zone.  This policy can be revamped by senior officer responding to the incident or Incident Commander (IC) at the scene if it determined that additional support is needed.

 

Brush Truck 3 is the primary response unit for Mutual Aid EMS incidents.

 

Rescue 3 will respond to all vehicle accidents with or without entrapment, regardless of location.  Additional personnel should always respond with E31 or E32 for additional manpower unless disregarded by IC on the scene.

 

Communications

 

Upon being dispatched to an EMS incident acknowledgment of the incident dispatch must be made.  Any Officer responding shall acknowledge the dispatch ONLY after completely understanding the type of incident, location, and any other amplifying information.  If any question exists about the location or details, dispatch will be contacted for clarification.  Only then will Three Star Fire Department personnel acknowledge receipt of call. If no officers are in district, or it is unknown who is in district, the senior qualified EMS provider in district shall acknowledge the call.  If no qualified EMS providers (First Responder, EMT or Paramedic) are available to acknowledge the call, then dispatch will be notified that no qualified First Responders are available and that Three Star Fire Department is unable to respond.   This declination of the call will only be done after dispatch activates tones a second time.

 

The county fire channel (Channel 1) will be used to relay information to the Baptist Tipton ambulance unit responding.  If necessary, dispatch will request the ambulance switch to the county fire channel.  Proper medical terminology and plain language communications will be used whenever possible to relay patient information.  At no time will personal or identifying information (name, initials, etc.) will be given via open-air radio signal. Failure to adhere to this provision may constitute a violation of federal Health Information Personal Privacy Act (HIPPA) laws.

 

Documentation

 

EMS REPORTS – At each EMS incident, an EMS report will be completed.  The only exception to this policy is where Three Star emergency response personnel had no patient contact and provided no patient care of any kind.   An example of this exception would be if Ambulance Service arrives before Three Star units and assumes patient care.  Another example would be arriving on the scene of an accident after the ambulance and performing only fire related duties.  Assisting the movement of patient to unit is not considered patient care and therefore requires no EMS report.  Executing any medical care in support of the ambulance service patient care would indicate an EMS report would be required. However, the incident must be documented utilizing a departmental fire report.  All EMS reports will be written on designated EMS Incident Report Forms in triplicate.  The back (second) copy should be provided to ambulance personnel on scene where practical for inclusion in patient medical records.  When the back (second) copy cannot be provided to the Ambulance Service or in the case where ambulance is disregarded prior to arrival, the copies will be maintained in a locked container at the fire station.  Additionally, each EMS incident will be entered into the designated fire incident reporting system, whether our units arrive at the scene or are disregarded to arrival.

 

EMS Incident reports will be reviewed for completeness and accuracy by the senior EMS person or highest certified EMS person that made the call.

 

Medical care documents are legal instruments subject to subpoena in legal proceedings.  As such, documentation must be as complete as circumstances allow.  To ensure comprehensive and correct reporting of events on EMS incidents, the senior medically qualified individual on the EMS incident is responsible for completing EMS reports. Though vital signs, history and personal information may be acquired by a junior qualified provider, narrative description of incident is the responsibility of the senior qualified provider.  Allowing a junior qualified provider to complete the narrative does not dismiss the senior provider from responsibility for its contents.  The senior provider must review and indicate concurrence by signing the report.

 

Supplies – Most supplies, such as bandages, oxygen mask, cervical collars, etc. will be restocked on as used by Baptist Tipton ambulance service. If the unit is unable to restock on scene, most extra supplies will be available at the fire station. It is the EMS response crew’s responsibility to restock after each and every call.  The EMS Officer must be notified if any supplies cannot be restocked immediately after an incident.  Action can then be taken to obtain restock from the Ambulance Service.  EMS Officer should also be made aware of supplies being removed from the EMS supply cabinet.  Do this by placing a note in the mailbox for the EMS Officer.

 

Disregarding an ambulance – In the event a patient refuses transport and treatment prior to the ambulance arriving or the medical exam does not dictate transport, the responding EMS crew may advise the ambulance so.  The senior EMS provider or officer on the scene will advise the ambulance crew via open-air radio of the patient’s condition, including vital signs and any complaints/mechanism of injury or nature of illness.  It will then be left to the ambulance crew’s discretion whether to continue their response or to disregard.

 

Attire – Turnout gear will be taken, but not necessarily worn, on every call.  Everyday attire is preferred for medical calls at private residences.  If clothes are dirty or excessively worn, wear turnout gear.  Full turnouts will still be required for all vehicle accidents and extrication calls until deemed safe by Incident Commander.

 

Personal Protective Equipment / BSI – Latex gloves will be worn on all medical calls and in any situation where there is a possibility of contact with blood and / or body fluids. Where indicated, responders should consider wearing surgical masks.  Care will be taken to minimize exposure to all bodily fluids.  Should contact be made with bodily fluids, responder should use waterless cleaner from medical bags to perform gross decontamination on the scene.  Completely sanitize exposed areas and equipment on return to station. (Section II-7 Infection Control).

 

Traffic Accidents – On arrival of responding units to traffic accidents, Three Star EMS responders will first assess the scene to ensure scene safety.  Thereafter, a rapid triage of possible injuries will be conducted to determine which patients require immediate attention.  Pending arrival of Ambulance Service, the senior EMS provider on scene will direct patient care, ensuring a minimum of one licensed EMS provider remains with patient(s) at all times.  This will ensure continued assessment of patient status and prevent patient abandonment. 

 

Personal Information Protection – No patient information shall be shared with anyone other than those directly involved with the patient care. This is to ensure the patient’s right to privacy and to conserve his/her personal dignity (See Section I-12).

 

Responsibilities:

 

It is the responsibility of each EMS provider to communicate any problems or concerns experienced on any emergency call with the Fire Chief, Assistant Chief and/or EMS Officer.

 

It is the joint responsibility of all EMS providers, Fire Chief, Assistant Chief and EMS Officer to ensure all personnel comply with the guidelines established herein and that all certifications are kept current and on file.

 

All personnel are expected to provide the same level of care that a person with similar training would provide under similar circumstances. All licensed EMS providers are expected to use knowledge and skills to the best of your ability under the circumstances of the emergency situation.  This is known as the standard of care and it is incumbent upon each provider to maintain the highest standard.

 

The scope of care the EMS provider gives is defined by the level of training obtained, as well as EMS protocols established by the Tipton County EMS Director and Three Star Fire Department EMS Supervisor.

 

When responding to emergency situations, all members will respond swiftly and safely, obeying all guidelines as set for forth in this manual.  Upon arriving on the scene, personnel will make certain that the scene is safe and when called to do so, assist in other activities at the scene, always adhering to the scope of their training.  Personnel will gain access to the patient in a swift but safe and coordinated manner.  When the situation dictates, special rescue or other access tools should be deployed in an orderly and safe manner but only by qualified operators. 

 

Patient assessments and requisite care should always be done with safety in mind.  The scene must be safe and all firefighters and officers must use all practical safety measures to ensure they are  protected from injury and disease.  Personnel must always exercise BSI (Body Substance Isolation)  when rendering medical assistance or facilitating access to an injured or ill individual (See Section II-7).

 

All trauma patients shall be treated for suspected spinal and neck injury, unless otherwise indicated.  Following Airway, Breathing and Circulation, Spinal Immobilization must be made a priority.  Disentangle, free, lift, and move the patient only if you can do so without causing additional injury to the patient and yourself.  Carefully stabilize, package, and only then properly transfer the patient to the responding EMS Unit.