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Stony Brook Volunteer Ambulance Corps 4780 SUNY Stony Brook, NY 11790 HQ Office 631-632-6737 Headquarters 631-632-6899 Fax 631-632-4108 mouse here for more contact information
September 11th, 2001 Never Forget
Dedication to members of the SBVAC family serving in Iraq
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Standard Operating Procedures Revised August 2004
Table of Contents
Article Title
I: Definitions II: Definition of this Document III: General Policies and Regulations IV: Uniform and Appearance Policies V: Training and Qualifications VI: The Division of Duties VII: Public Information Policies VIII: Interdepartmental Relations IX: In Quarters Shift Procedures X: General Procedures of Emergency Service XI: Procedures of an Emergency Call XII: ALS Company Policies XIII: Multiple Casualty Incident Procedures XIV: Infectious Control Procedures XV: Training Procedures XVI: Special Events Coverage XVII: Health Standards XVIII: First Responder Vehicle XIX: Summer Service
Article I: Definitions
A.) AEMT – Advanced Emergency Medical Technician including the certifications of EMT-I, EMT-CC, and EMT-P B.) ALS – Advanced Life Support C.) BLS – Basic Life Support D.) BSI – Body Substance Isolation (formerly known as Personal Protective Equipment (PPE)) E.) CC – Crew Chief F.) Chief – Chief of Operations G.) Chief’s Office – Refers to the office positions of Chief of Operations, 1st Assistant Chief, and/or 2nd Assistant Chief. H.) CME – Continuing Medical Education I.) CPR – Cardiopulmonary Resuscitation J.) DOH – Department of Health K.) DOT – Department of Transportation L.) Drugs – Shall include all non-prescription drugs including alcohol or medications taken for recreational purposes, and all prescription medications that may cause drowsiness, inattentiveness, or any mind-altering drug or alcohol. M.) EH&S – Environmental Health & Safety N.) EMT – Emergency Medical Technician including the certifications of EMT-B O.) EVO – Emergency Vehicle Operator P.) FTO – Field Training Officer Q.) HAZMAT – Hazardous Materials R.) HQ – Headquarters S.) MCI – Multiple Casualty Incident T.) MVA – Motor Vehicle Accident U.) NYS – New York State V.) OSHA – Occupational Safety and Health Administration W.) PCR – Prehospital Care Report X.) Police Officer – Shall include State University Police at Stony Brook, Suffolk County Police and New York State Police unless specifically stated otherwise. Y.) President’s Office – Refers to the positions of President and Vice President. Z.) Primary Operating Territory – The State University of New York at Stony Brook campus. May be used interchangeably with “District”, and does not include any portion of Niccoll’s Rd (Suffolk County Route 97), the Long Island State Veteran’s Home, or the University Hospital Medical Center at Stony Brook. a.) RMA – Refusal of Medical Assistance b.) SOPs – Standard Operating Procedure c.) Top Five Officers – Refers to the office positions within the Chief’s Office and the President’s Office.
Article II: Definition of this Document
Section 2.1: General Purpose The purpose of the Stony Brook Volunteer Ambulance Corps., Incorporated, henceforth known within this document as the SBVAC, Standard Operating Procedures shall be to define policy and procedure, as well as, to aid in the smooth functioning of the SBVAC during the course of normal operations.
Section 2.2: With Regard to Future Administrations The SBVAC SOPs will serve as a guide to future administrations to refer to when making policy and procedure modifications as necessary at any future date.
Section 2.3: With Regard to Membership The SBVAC SOPs will serve to give the members of the SBVAC a listing of policies and procedures to follow during emergency and non-emergency situations.
Section 2.4: Scope of this Document These SOPs are designed to be complete and to supplement the brevity and any ambiguities of the SBVAC By-Laws. These SOPs shall cover all aspects of operation ranging from day to day of all emergency and non-emergency procedures.
Section 2.5: Applications of this Document These SOPs shall be the procedures and protocols by which the SBVAC shall follow. All aspects of these SOPs shall apply to all members of the SBVAC unless specifically stated otherwise. At no time shall these SOPs supersede any item or section stated within the SBVAC By-Laws. It shall be the duties of all the designated officers of the SBVAC to ensure that all members adhere to these SOPs, as well as the By-Laws of this organization.
Article III: General Policies and Regulations
Section 3.1: Attendance It shall be mandatory that all active members of the SBVAC be present at SBVAC HQ for all assigned weekday and weekend shifts. If a member of the SBVAC cannot be present due to extenuating circumstances, said member must find a replacement with the same, or greater, medical and shift qualifications. Said member must also notify the Crew Chief of the shift that will be missed as well as the Vice President, either verbally or in writing prior to said shift. Invalid excuses or any other violation of this section is punishable by immediate suspension and subsequent dismissal.
Subsection 3.1.1: Advanced Life Support Providers In the event that an ALS provider cannot secure coverage from another ALS provider, said member may attempt to find coverage from a BLS provider.
Subsection 3.1.2: Difficulties with Shift Coverage In the event that a member of the SBVAC is unable to find an adequate replacement, and said member has an excuse with extenuating circumstances involving situations such as medical, family, etc., said member may then contact the Vice President to arrange for coverage. Notification for coverage must be at least twenty-four (24) hours in advance. Such notice shall be delivered both verbally and in writing.
Section 3.2: Absences Any absences from shift by a member of the SBVAC in which said member has found an adequate replacement as per Section 3.1 of these SOPs will be tolerated so long as such absences are not deemed excessive. Absences from shift by a member of the SBVAC due to medical or personal reasons must be discussed with the Vice President and then be brought forth to the officers to determine the allowable extent of such absences. Any problems requiring extended or repeating periods of absence from shift by a member of the SBVAC must be similarly addressed. Violations of this section will not be tolerated and will result in suspension and subsequent dismissal.
Section 3.3: Lateness All members of the SBVAC are required to report to shift on time. No members of the SBVAC should be consistently late to shift for any reason. Exceptions may be granted by the Vice President only. Repeated lateness by a member as per this section must be reported to the Vice President, both verbally and in writing, and will subject said member to disciplinary actions which may include suspension and subsequent dismissal.
Section 3.4: Physical and Mental Condition
Subsection 3.4.1: Definition of Ailments or Injuries When reporting for duty, a member of the SBVAC shall be in good physical and psychological condition. There must be no ailment or injury, which may prevent said member from the performing and completion of any required duties. There must also be no ailment or injury, which may pose a risk to patient or crew.
Paragraph 3.4.1.1: Reporting of Ailment or Injury Any ailment or injury that may prevent said member from the performing and completion of any required duties must be immediately reported to the Crew Chief, Chief, and the Vice President. If such ailment or injury prevents said member from completing their responsibilities, said member must find a replacement as per the aforementioned guidelines.
Subsection 3.4.2: Use of Intoxicants and Drugs The use of any material satisfying the definition of drugs is strictly forbidden eight (8) hours prior to shift, responding to calls, or operating or riding in any company vehicle. It is also strictly forbidden to report for shift, operate or ride in any company vehicle, or respond to calls if any substance satisfying this definition was used more than eight (8) hours prior and the effects are still seen. Any violation of this subsection shall result in the immediate suspension and subsequent dismissal of such member. No lesser actions are permissible as punishment.
Section 3.5: Gratuities No member of the SBVAC shall at any time accept or receive any money, gift, item, or service in return for services rendered in the capacity as a member of the SBVAC. If any persons or organization would like to thank the SBVAC for any services rendered, they should be directed to mail a donation to the SBVAC.
Section 3.6: Parking
Subsection 3.6.1: SBVAC Vehicle Parking The three parking spaces located adjacent to Stimson College, reserved for the SBVAC shall be used for the vehicles belonging to the SBVAC. Exceptions may be deemed valid by office only. Violations will result in the ticketing and/or towing of the offending vehicle at the owner’s expense and the loss of all parking privileges.
Subsection 3.6.2: Ambulance Personnel Parking Parking should be reserved in the parking area adjacent to Stimson College. If any problems involving ticketing occur, it should be brought to the on-duty crew chief’s attention, who shall inform an officer. This should be done promptly, both verbally and in writing. Members of the SBVAC may utilize the spaces designated in this subsection only while on shift, while conducting SBVAC business, or while in headquarters, and must remove their vehicles upon termination of such activities. At no time is any SBVAC member to park in the handicapped spaces or fire zones near Stimson College.
Section 3.7: Presence in SBVAC Office No personnel other than the designated officers of the SBVAC shall be allowed to enter or remain in the Corps office without the permission and presence of an officer. Any repeated or multiple violation of this Section shall result in immediate suspension and subsequent dismissal. No lesser actions are permissible as punishment.
Section 3.8: Presence in the Fanny Brice Building SBVAC HQ shall consist of all rooms allocated to the SBVAC in the Fanny Brice building. All policies set forth in this section shall be strictly adhered to. Any violations of this section may be punishable by suspension and subsequent dismissal and possible Police intervention.
Subsection 3.8.1: Non-SBVAC Personnel Non-SBVAC personnel are those persons who are not members of the SBVAC. Such persons shall be permitted in the SBVAC HQ by accompaniment of SBVAC personnel and shall not be left alone at any time. No more than three (3) non-SBVAC personnel are permitted to accompany one (1) SBVAC member. The SBVAC member accompanying the non-SBVAC personnel shall be responsible for and held accountable for such personnel's actions.
Paragraph 3.8.1.1: Exceptions Non-SBVAC personnel who are permitted to be left alone in SBVAC HQ shall include any police officer or EH&S Fire Marshall. Other exceptions may be granted by a Top Five Officer at any time.
Subsection 3.8.2: Other Areas in Fanny Brice All areas in the Fanny Brice building not allocated to the SBVAC henceforth shall be known as the Fanny Brice Area. All members and their guests should refrain from entering rooms in the Fanny Brice Area when the room is not open to the general public.
Section 3.9: Messages for Members Personal calls and messages for members of the SBVAC should be kept to a minimum, but will be tolerated as long as the frequency of such messages are not deemed excessive. Any message for a SBVAC member not present at quarters will be recorded on a slip of paper detailing the date, time, and name of the person taking the message, and the message itself. Such paper will then be placed in the Member Correspondence box near the entrance to HQ or in the appropriate officer’s mailbox. At no times are there to be any messages or personal memos to be taped or tacked up in any of the rooms without an officer’s initial. The dry erase boards in the crew room are designated for important imminent announcements only.
Section 3.10: Posting of Memoranda Due to the large number of members in the SBVAC, it is necessary to utilize memos to communicate policy, procedure, and any other pertinent information. All such memos shall be placed upon the appropriate boards as described herein. All SBVAC members must read all posted memoranda when they report for shift, and are held accountable for any information posted if the said member has had adequate time to read such memos.
Subsection 3.10.1: Recreation Room Bulletin Boards There are three bulletin boards located inside the SBVAC recreation room. Any officer may authorize the posting of SBVAC memoranda on the bulletin boards after initialing such memoranda. At no times shall any unapproved or Non-Corps memoranda be posted in the SBVAC quarters. Such memoranda will be removed and the poster subject to disciplinary action.
Section 3.11: Securing of Equipment All SBVAC equipment must be kept secure to prevent loss and theft at all times. All SBVAC vehicles will be kept locked while not in use and in view by the duty crew.
Section 3.12: Securing of Quarters All doors to HQ shall be locked whenever the on-duty crew leaves, regardless of purpose or any members that remain behind. The SBVAC Office shall remain closed and locked at all times except when a designated Officer of the SBVAC is within. Any problems securing HQ shall be brought forth to the Vice-President immediately. Any problems securing HQ shall be concluded with the filing of a Standard Incident Report form.
Section 3.13: Use of Personal Property The use of personal property of a member of the SBVAC while serving on the ambulances is permitted, but not encouraged. Any member of the SBVAC can carry and use personal property and items while serving on the ambulances provided such personal property and items are regularly stocked by SBVAC. Any member of SBVAC can carry and use personal property and items not regularly stocked by the SBVAC while serving on the ambulances provided such personal property and items are approved by the Chief (30) and the Lieutenant (60) prior to use.
Section 3.14: Pre-hospital Care Report (PCR) Confidentiality and Filing Procedures
1. The Agency (white) copy of the PCR must be filed in a secure location, with access limited to the Chief’s Office, the Secretary, and the authorized Quality Improvement Coordinator or their designees. 2. The PCR or its contents are not to be discussed with any individual not authorized to have access to such information. 3. Prior to filing the PCR, the document shall be kept in a secure location with limited access. 4. Agency copies of PCRs shall be kept on file for no less than six (6) years or three (3) years after the individual receiving medical treatment named on the PCR reaches eighteen years old, whichever period of time is longer. 5. Agency copies of PCRs generated for non-transport activity (RMAs, Standbys, etc.) must be kept on file by the agency for at least six (6) years from the date of the activity. The yellow copy is to be sent to Medical Control by the Secretary for inclusion in the NYS database by the 20th of each month. The pink copy may be destroyed. 6. When using PCRs for QA/QI or training purposes, the patient’s name, address, telephone number, and the NYS certification numbers of those providing medical treatment should be blocked out. A photocopy of the document should be produced for these purposes with the original document left intact and maintained in accordance with this policy. Copies of the PCR prepared for QA/QI purposes should be destroyed when such copies are no longer needed for QA/QI purposes. 7. When an agency receives a PCR (yellow) copy with a request for the completion of essential fields, it is to be kept in a secure location until reviewed and completed by the Chief, 1st Assistant Chief, or their designee. The completed PCR should be mailed back to the designated PCR collection location as soon as possible. 8. All PCRs must be completed in black ink. 9. PCRs may only be released upon the receipt of a release form signed by the patient or when subpoenaed by an attorney on behalf of a patient. Patients shall have uninhibited access to their own records, and a record of disclosure shall be kept. PCR can only be picked up in person by the patient. The patient must present with a photo I.D. prior to releasing any records. As per Section 7.4, all requests for PCRs shall be forwarded to the President or Vice President of the SBVAC.
Section 3.15: Quality Improvement SBVAC shall participate in Suffolk County EMS’s quality improvement program in addition to internal PCR review performed by the Chief or 1st Assistant Chief. Additionally, formal QA/QI review of all ALS calls and randomly selected BLS calls shall be performed at least bi-monthly by one of the SBVAC’s physician advisors.
Section 3.16: Medications Used by EMT-Bs This policy shall cover all medications regionally approved for administration by EMT-Bs, including Albuterol for inhalation, Epinephrine auto-injectors,and Mark I Chemical Agent Antidote kits. Subsection 3.16.1: Storage in Vehicles Albuterol shall be stored in the oxygen bags and oxygen therapy cabinets in each ambulance. Adult Epinephrine auto-injectors shall be stored in the trauma bags in each ambulance. Pediatric Epinephrine auto-injectors shall be stored in the pediatric bags in each ambulance. Mark I Chemical Agent Antidote kits shall be stored in a designated cabinet on each ambulance.
Paragraph 3.16.1.1: Quantity in Vehicles The Lieutenant, in consultation with the Chief, shall determine the appropriate quantity of each medication to be carried in the ambulances.
Line 3.16.1.1.1: Epinephrine Auto-Injectors As per SBVAC’s agreement with Suffolk County, at least three adult and three pediatric, and at most six adult and six pediatric Epinephrine auto-injectors must be carried in each ambulance.
Subsection 3.16.2: Storage in Headquarters All BLS medications shall be secured behind the cage in the Equipment Room and may only be accessed by an Officer.
Subsection 3.16.3: Restocking All medications used on a call that are unable to be restocked at the hospital are to be restocked at headquarters as soon as possible after the call. The Lieutenant shall be responsible for ensuring that all medications are not expired and that sufficient quantity as per Paragraph 3.16.1.1 is maintained at all times. The ambulance is not to go back in service unless it is in compliance with the minimum equipment requirements of DOH Part 800.
Subsection 3.16.4: Administration Administration of medications for use by EMT-Bs shall only be performed in accordance with NYS and Suffolk County BLS protocols. Medical Control MUST be contacted immediately following the call in accordance with Subsection 11.5.2 of these SOPs.
Section 3.17: Residence Hall Access Cards In each company vehicle there shall be proximity key card programmed to grant access to any residence hall in the University. These cards are individually assigned to each vehicle and are not interchangeable between vehicles. Each crew shall verify the presence of this card at the beginning of every shift as part of their required rig check, and shall notify the Chief immediately if it is absent. These key cards are not to be removed from their assigned location in the company vehicle for ANY reason other than gaining entry to the scene of an emergency call. If a key card is removed for this purpose, it shall be returned to its proper location within the vehicle immediately upon the return of the crew to the ambulance. Any violation of this section shall be grounds for immediate suspension. Subsequent termination from the SBVAC may be considered at the discretion of the Chief’s Office., dependant upon the circumstances surrounding the incident. Subsection 3.17.1: Out of Service Vehicles If a vehicle is temporarily placed out-of-service for repair or any other reason, and will be accessed by non-corps personnel, the Chiefs shall remove the key card from the vehicle and place it in HQ for safe keeping. The key card shall be returned to the vehicle immediately upon its return to in-service status.
Article IV: Uniform and Appearance Policies
Section 4.1: On-Duty Uniform
Subsection 4.1.1: Probationary Members All non-certified probationary members shall wear the company jumpsuit and black shoes while on shift. Clothing underneath the jumpsuit shall consist of at minimum, shorts and a t-shirt. Underneath uniform clothing shall consist only of the following colors: white, grey, black or blue.
Paragraph 4.1.1.1: Certified Probationary Members Certified probationary members shall be permitted to wear the uniform described in Subsection 4.1.2. If this uniform is unavailable, the jumpsuit must be worn.
Subsection 4.1.2: General Membership All members while on shift are required to wear the approved company polo shirt, EMT/BDU equivalent blue-black pants, and black shoes as approved by office. Shirts must be tucked in. If this uniform is unavailable for adequate reasons, the jumpsuit may be worn as stipulated in Subsection 4.1.1.
Paragraph 4.1.2.1: Overnight Crews Overnight crews are not required to wear their company uniform while remaining in HQ on the condition that they are prepared to don an appropriate uniform prior to leaving the building for either emergency or non-emergency reasons.
Subsection 4.1.3: Service Patch Each jumpsuit or polo shirt for the members of the SBVAC shall have the patch of the SBVAC sewn on the left sleeve with the top of the patch one inch below the seam of the shoulder. The SBVAC patch shall not be used or displayed in any other fashion whatsoever.
Subsection 4.1.4: Level of Training Patch Each jumpsuit or polo shirt for the members of the SBVAC shall have the patch bearing the highest level of training for such member that the suit belongs to sewn on the right sleeve with the top of the patch one inch below the seam of the shoulder.
Paragraph 4.1.4.1: Misrepresentation No member shall wear a uniform or borrow another member’s uniform bearing another member’s name, or a patch of training higher than their current certification. At no point shall any member respond to a call bearing the insignia or name of another agency.
Subsection 4.1.5: OSHA Gear Pants and jackets approved by the Occupational Safety and Health Administration as resistant to blood borne pathogens (OSHA gear) shall be available in HQ at all times for use by the on duty crew or personnel responding to ambulance calls. These garments are intended to supplement, and not replace, the standard on-duty uniform as described in Subsection 4.1.1 and Subsection 4.1.2. Any member of the on-duty (or responding) crew may choose to wear the OSHA gear when responding to emergency calls at his or her own discretion.
Paragraph 4.1.5.1: Removal From HQ OSHA gear is not to be removed from HQ except for use on an emergency call, or by the duty crew if they are leaving HQ for any reason. Non-contaminated OSHA gear shall be returned to the proper location in HQ immediately upon the return of the crew to HQ. Contaminated gear is to be placed in a red bag and left in HQ. The Lieutenant shall be notified immediately of the presence of contaminated OSHA gear.
Line 4.1.5.1.1: Chief’s Vehicles The Chief and Assistant Chiefs, at the Chief’s discretion, may store one set (jacket and pants) of OSHA gear in their personal vehicles for use when responding as a Chief of SBVAC to the scenes of emergency calls. No other use shall be permitted.
Paragraph 4.1.5.2: Required Use at Roadway Scenes All personnel responding to any emergency call known to be situated on a roadway shall don the appropriate OSHA gear prior to responding.
Paragraph 4.1.5.3: Required Use at Mutual Aid Calls All personnel responding to any emergency call outside of the SBVAC’s primary operating territory shall don the appropriate OSHA gear prior to responding. Calls to the Long Island State Veterans Home shall not be considered mutual aid calls under this Paragraph.
Paragraph 4.1.5.4: Crew Chief or Officer’s Discretion At the scene of an emergency call, or when responding to an emergency call, the Crew Chief or any Operational Officer may require all or some members of the crew to don OSHA gear.
Paragraph 4.1.5.5: Scheduled Cleaning and Decontamination The Lieutenant shall ensure that any OSHA gear that is not contaminated with any chemicals or bodily fluids is cleaned regularly in an interval and manner in accordance with all of the manufacturer’s recommendations. Additionally, the Lieutenant shall ensure that any contaminated OSHA gear is decontaminated and cleaned as soon as possible after the incident in accordance with all of the manufacturer’s recommendations. Section 4.2: Officer Dress Uniform When deemed appropriate, the dress uniform for the designated Officers of the SBVAC shall consist of a long sleeve white uniform shirt, blue-black uniform pants, matching blue tie, black belt, and black shoes. A SBVAC Officer pin shall be placed in the center of the tie, and pins designating the officer’s rank shall be worn on the collar. An approved nametag bearing the officer’s name and title shall be worn on the right side of the chest. An official SBVAC Officer’s badge designating the officer’s rank shall be worn on the left side of the chest. The only acceptable commendation bars shall be those issued by the Chief’s Office as described in Section 4.5. Additional pins and bars are to be worn above the badge on a badge holder, subject to prior approval by the Chief. A short sleeve white uniform shirt may be substituted on certain occasions at the discretion of the Office. Ties shall not be worn when a short sleeve uniform shirt is used.
Section 4.3: Member Dress Uniform When deemed appropriate, the dress uniform for the members of the SBVAC shall consist of a long sleeve light blue uniform shirt, blue-black uniform pants, matching blue tie, black belt, and black shoes. An official SBVAC general member’s badge may be worn on the left side of the chest. The only acceptable commendation bars shall be those issued by the Chief’s Office as described in Section 4.5. Additional pins and bars may be worn above the badge on a badge holder, subject to prior approval by the Chief. Non-officers are not to wear collar pins, with the exception of service awards. A short sleeve blue uniform shirt may be substituted on certain occasions at the discretion of the Office. Ties shall not be worn when a short sleeve uniform shirt is used.
Section 4.4: On Call Status During periods that the SBVAC is on “On Call” Status, it is recommended but not required that all members responding don their uniform as per Section 4.1 prior to arriving on the scene of the emergency call. If this uniform is unavailable, a blue, white or grey SBVAC T-shirt may be substituted. At no time may a member bear the insignia or name of another company or department.
Section 4.5: Commendation Bars Commendation bars shall be worn only with the Member Dress Uniform and the Officer Dress Uniform, and shall be worn above the official SBVAC badge on a black badge holder. Commendation bars shall be worn, from top to bottom, in the order that they appear within this section.
Subsection 4.5.1: Meritorious Service Award Deserving members shall be awarded a Meritorious Service Award for intelligent and valuable actions during an emergency call that are deemed to be “above and beyond the call of duty.” Nominations for this award shall be made in writing to the Chief’s Office.
Subsection 4.5.2: Mark Frumkin Memorial Chief’s Award The Mark Frumkin Memorial Chief’s Award shall be awarded once per semester, excluding the summer session, to the CC deemed to have provided the most dedicated service to the SBVAC during that semester. Recipients shall be determined solely by the Chief of Operations.
Subsection 4.5.3: Pre-hospital Save Award A pre-hospital save award shall be awarded for the successful resuscitation of a cardiac arrest patient. To be considered for a pre-hospital save award, the patient must have had no pulse upon arrival of the first emergency unit (including PD or EH&S), or must have had no pulse at any time while under the care of the SBVAC crew. The patient must be brought into the receiving hospital with a pulse, and the patient must survive until hospital admission (transfer out of the Emergency Department to another unit of the hospital). Any crew wishing to be considered for this award must submit a written request to the Chief’s Office including the number of the PCR for the call. This award shall be given to all members of the SBVAC who were participants in the eligible call.
Subsection 4.5.4: Childbirth Award A childbirth award shall be awarded for the complete and successful delivery of a child by a SBVAC crew. The child must not have been born prior to the arrival of SBVAC personnel, and must have been born prior to arrival at the hospital. Cutting of the umbilical cord and/or delivery of the placenta are not necessary for a crew to be eligible for this award. Any crew wishing to be considered for this award must submit a written request to the Chief’s Office including the numbers of the PCRs for the call. This award shall be given to all members of the SBVAC who were participants in the eligible call.
Subsection 4.5.5: Field Training Officer Bar The Field Training Officer bar may only be worn by FTOs and Chiefs of the SBVAC.
Subsection 4.5.6: World Trade Center Bar An approved World Trade Center memorial bar may be worn by any member desiring to wear one. Only bars with the approved design may be worn.
Section 4.6: Mourning Badge Covers A black elastic band may be worn horizontally over the center of the badge to signify mourning when attending a funeral. A mourning band may also be worn upon notification of the line of duty death of a member of any EMS or fire department in Suffolk County, until the funeral occurs. Other uses of a mourning band must be approved by the Chief.
Article V: Training and Qualifications Policies
Section 5.1: Minimum Progress Rate The Minimum Progress Rate for members of the SBVAC shall be defined as those minimum requirements set forth in regards for training and advancement of all members of the SBVAC as defined by the Captain (50) at the beginning of every semester.
Subsection 5.1.1: Definition of Minimum Progress Rate The Minimum Progress Rate will include, but may not be limited to, requirements for the completion of First Aid Classes, CPR, and EMT Courses, as well as CME's and/or departmental training sessions by every member of the SBVAC as defined by the Captain.
Section 5.2: SBVAC Members
Subsection 5.2.1: All Members All members must possess at all times a valid and current CPR certification deemed appropriate by the Captain. CFR, EMT and AEMT certifications do not imply CPR certification, and are NOT acceptable substitutes for a valid and current CPR certification under this subsection. Any member in violation of this subsection shall complete an acceptable CPR certification or refresher course within a reasonable period of time as determined by the Captain, not to exceed one semester.
Subsection 5.2.2: Crew Chiefs To hold the rank of CC in SBVAC, the member in question must successfully complete the following: · Be currently certified as a New York State EMT or AEMT · Have a complete working knowledge of all SBVAC policies and procedures including but not limited to the By-Laws and SOPs of SBVAC · Have a working knowledge of emergency medical care and practical skills at their current level of their training. · Prior to becoming a CC, said member must complete the "Driver AB class”. The member in question need not hold the position of EVO, or possess a valid New York State driver’s license. · Pass a certification examination issued by the 1st Assistant Chief (31) in consultation with the Chief. · After completing the CC exam, satisfactorily run two (2) emergency calls in the presence of a Field Training Officer and one (1) emergency call with a Bravo or greater response level in the presence of any Chief. · Within six (6) months of becoming a CC, complete an approved HAZMAT awareness course or higher certification as deemed appropriate by the Chief or Captain.
Paragraph 5.2.2.1: EMT-Critical Care Certification Prior to taking an EMT-Critical Care course, the said member must hold the rank of CC and attendance of the course must be approved by the Chief’s Office.
Paragraph 5.2.2.2: Field Training Officers Field Training Officers (FTOs) shall be the only crew chiefs who, at their own discretion, are permitted to allow EMTs or AEMTs who are not CC’s to be “in charge” of any emergency call. The FTO must supervise all contact between the patient and the trainee, and must remain in the patient compartment with trainee during transport to the hospital. Additionally, the FTO may override any decision, medical or otherwise, the trainee may make, and shall be ultimately responsible for the outcome of the emergency call. This paragraph shall be strictly enforced.
Line 5.2.2.2.1: Evaluation Forms Upon completion of any emergency call during which an FTO permitted a non-CC EMT or AEMT to act in an “in charge” capacity, the FTO shall submit a completed evaluation form as supplied by the 1st Assistant Chief.
Line 5.2.2.2.2: Level of Care A trainee under the supervision of an FTO may operate to the highest extent their level of training allows, however they may NOT operate at a higher level of care than that of the FTO. Only Suffolk County Advanced Life Support Preceptors, approved by the Chief and 1st Assistant Chief, are permitted to supervise non-crew chief AEMTs and AEMT students operating at the Advanced Life Support level.
Line 5.2.2.2.3: Chief’s Office as FTOs Each member of the Chief’s Office shall automatically hold the status of Field Training Officer unless otherwise stated by the Chief, and may, at their option, act in the capacity of FTO without being remaining in the passenger compartment of the ambulance during transport.
Subsection 5.2.3: EVOs To operate a vehicle registered to the SBVAC, the member in question must hold a valid, non-restricted New York State Driver’s License, eyeglass restrictions not withstanding so long as they are adhered to. EVOs shall have a thorough understanding of the laws governing Emergency Vehicle Operations, campus roadways, and routes to all local hospitals.
Paragraph 5.2.3.1: EVO Requirements To hold the rank of an EVO in SBVAC, the member in question must pass certification through a written and oral examination as well as a practical evaluation driving the ambulance, and must complete and comply with any additional requirements as set forth by the 2nd Assistant Chief (32) and Chief. Within six (6) months of becoming an EVO, the member must complete an approved HAZMAT awareness course or higher certification as deemed appropriate by the Chief or Captain.
Line 5.2.3.1.1: Ineligibility Members may not operate a SBVAC vehicle in any capacity if they: 1. Have more than nine (9) points on their license if driving more than two (2) years. 2. Have more than six (6) points on their license if driving less than two (2) years. 3. Have had two (2) or more chargeable accidents within the previous eighteen (18) months if driving more than two (2) years. 4. Have had one (1) chargeable accident if driving less than two (2) years. 5. Have a DUI or DWI conviction.
Line 5.2.3.1.2: Driver Trainers Driver Trainers shall be appointed at the beginning of each semester by the 2nd Assistant Chief and shall be the only members permitted to train non-EVOs on the operations any SBVAC vehicle. With the exception of the driver trainer, absolutely no passengers may be present in any vehicle while it is being operated by a driver trainee.
Line 5.2.3.1.3: Senior Driver Trainers Senior Driver Trainers shall have the ability to recommend to the 2nd Assistant Chief driver trainees whom they feel may be qualified to take the EVO exam. Additional responsibilities may be granted by the 2nd Assistant Chief and the Chief on an individual basis. Such responsibilities may include but are not limited to: the ability to perform initial in-servicing training sessions, lights and sirens training sessions, and the ability to evaluate a driver trainee on their required final emergency call.
Paragraph 5.2.3.2: Miscellaneous All drivers must submit their license numbers for verification to the company. This information will be held as confidential. All drivers shall be reevaluated annually by the 2nd Assistant Chief or Chief.
Subsection 5.2.4 Continuing Education The office of SBVAC shall conduct a minimum of four (4) company-training sessions per semester under the supervision of the Captain. The office shall announce the four (4) training dates at the first general membership meeting of each semester in order to ensure an adequate time period in which the members may free time for the allotted dates. The Captain shall also announce at this meeting the required number of company trainings each member shall be required to attend.
Paragraph 5.2.4.1: Penalties Any active full member failing to attend the aforementioned training requirements will be subject to immediate disciplinary action. Any probationary member failing to complete the aforementioned required trainings shall have their application for membership in the following semester denied.
Article VI: The Division of Duties
All Officers of the SBVAC shall have the additional following duties, and shall have the authority to appoint aides as per Section 6.3 of these SOPs.
Section 6.1: The Operational Board The Chief shall be responsible for the day-to-day operational duties of SBVAC.
Subsection 6.1.1: Duties of the Chief of Operations The Chief shall be responsible for the day-to-day operational duties of the SBVAC.
Paragraph 6.1.1.1: Temporary Changes by the Chief The Chief may substitute temporary changes in operational policy and procedure when such changes are needed immediately. The Chief must notify all Operational Officers of the SBVAC of changes to operational policy and procedure as soon as possible. The Chief shall convene a meeting of the Officers of the SBVAC, who shall determine if such changes shall remain in effect.
Paragraph 6.1.1.2: Scene of an Ambulance Call The Chief shall be the Officer in charge of all operations at the scene of an ambulance call involving the SBVAC.
Paragraph 6.1.1.3: Absence of the 1st Assistant Chief and/or 2nd Assistant Chief The Chief shall, in the absence of the 1st Assistant Chief and/or 2nd Assistant Chief, assume all duties and responsibilities of the absent officer or officers.
Paragraph 6.1.1.4: Best Interest of the Corps The Chief shall at all times work in the best interest of the SBVAC as determined by the Officers of the SBVAC.
Paragraph 6.1.1.5: In Charge of Inquiries The Chief shall be in charge of all inquiries of the day-to-day operations of the SBVAC as well as the business of the Operational Board of the SBVAC.
Paragraph 6.1.1.6: Special Events CC/EVO The Chief, in consultation with the 1st Assistant Chief may appoint a special event’s CC. The Chief, in consultation with the 2nd Assistant Chief may appoint a special event’s EVO.
Paragraph 6.1.1.7: Relations With Outside Agencies The Chief shall act as the liaison between the SBVAC and all outside agencies related to emergency operations and the like, including (but not limited to) neighboring fire or EMS departments, Suffolk County EMS, and the NYS Department of Health.
Subsection 6.1.2: Duties of the 1st Assistant Chief The 1st Assistant Chief shall be responsible for the supervision of all Operational Officers of the SBVAC with the exception of the Chief.
Paragraph 6.1.2.1: Temporary Changes by 1st Assistant Chief The 1st Assistant Chief may substitute temporary changes in the operational policy and procedure when such changes are needed immediately. The 1st Assistant Chief must notify all Operational Officers of the SBVAC of changes to operational policy and procedure as soon as possible. The 1st Assistant Chief shall convene a meeting of the Officers of the SBVAC, who shall determine if such changes shall remain in effect.
Paragraph 6.1.2.2: Scene of an Ambulance Call The 1st Assistant Chief shall, at the scene of an ambulance call involving the SBVAC, be the second in command, in charge of all operations, or in the absence of the Chief, be the first in command.
Paragraph 6.1.2.3: Supervision of Operations The 1st Assistant Chief shall be in charge of supervising all of the daily SBVAC operations.
Line 6.1.2.3.1: Advanced Life Support The 1st Assistant Chief shall be responsible for all ALS equipment and training. If the 1st Assistant Chief is not a qualified ALS provider, he or she shall appoint and oversee, in consultation with the Chief the most suitable ALS provider for these duties.
Line 6.1.2.3.2: Communications Equipment The 1st Assistant Chief, in consultation with the Chief, shall be responsible for the inventory, maintenance, installation, and distribution of all communications assets and related accessories belonging to the SBVAC. Communications assets shall include, but not be limited to: pagers, portable two-way radios, mobile two-way radios, base station two-way radios and tone encoders, and cellular telephones. The 1st Assistant Chief shall keep a detailed record of each piece of equipment and the location or member to which it is assigned.
Paragraph 6.1.2.4: CC Training The 1st Assistant Chief shall, in consultation with the Chief, be directly responsible for the training of CCs and potential CCs.
Line 6.1.2.4.1: CC Meetings The 1st Assistant Chief shall hold at least one (1) CC meeting, mandatory for all CCs, and at least ten (10) CC training sessions per semester.
Line 6.1.2.4.2: CC Selection The 1st Assistant Chief shall, in consultation with the Chief, have the power to appoint qualified members of the SBVAC to the rank of CC. The 1st Assistant Chief shall inform the office of any new CCs.
Line 6.1.2.4.3: Field Training Officer Selection The 1st Assistant Chief shall, in consultation with the Chief, appoint highly qualified crew chiefs of the SBVAC to the position of Field Training Officer (FTO). The 1st Assistant Chief shall, in consultation with the Chief, also have the power to remove any member from the position of FTO. Each semester, the 1st Assistant Chief shall post in HQ a list of all current FTOs.
Subsection 6.1.3: Duties of the 2nd Assistant Chief
Paragraph 6.1.3.1: Drivers The 2nd Assistant Chief shall be responsible for the oversight and training of all EVOs and operators of any SBVAC vehicles.
Line 6.1.3.1.1: EVO Meetings The 2nd Assistant Chief shall hold at least one (1) EVO meeting, mandatory for all EVOs per semester.
Line 6.1.3.1.2: Senior Driver Trainers The 2nd Assistant Chief, in consultation with the Chief, shall appoint highly qualified driver trainers of the SBVAC to the position of Senior Driver Trainer. The 2nd Assistant Chief, in consultation with the Chief, shall have the power to remove any member from the position of Senior Driver Trainer. Each semester, the 2nd Assistant Chief shall post in HQ a list of all current Driver Trainers and Senior Driver Trainers.
Line 6.1.3.1.3: Driver Training The 2nd Assistant Chief shall driver train each member actively pursuing driver training at least once per semester for the purpose of evaluating the trainee’s progress. The 2nd Assistant Chief shall also driver train, within two weeks of notification, any member recommended in writing by the Chief, 1st Assistant Chief, or any Senior Driver Trainer for the purpose of determining whether the member should take the EVO exam.
Paragraph 6.1.3.2: Vehicle and Maintenance Operations The 2nd Assistant Chief, in consultation with the Chief, shall have the authority to make policy and procedure with regard to SBVAC vehicle and maintenance operations.
Line 6.1.3.2.1: Driver check The 2nd Assistant Chief shall ensure that a mechanical check (driver check) shall be done each shift ensuring the vehicle is fit for use as per NYS DOT and DOH requirements, and shall complete a driver check at least once per month on each vehicle. During on-call periods and the summer session, the 2nd Assistant Chief shall complete a driver check at least once weekly on each vehicle.
Line 6.1.3.2.2: Vehicle maintenance This operations policy addresses Section 800.21(p)(8) of the New York State EMS Code which requires that every certified ambulance service “shall have and enforce written policies concerning” preventive maintenance requirements for all authorized EMS response vehicles and patient care equipment.
The following Inspection/Maintenance shall be done every 2,500 miles:
1. Change oil and filter. 2. Lubricate all chassis fittings, king pins, and inspect front suspension. 3. Lubricate the universal joints. 4. Check the level of the power steering, transmission, and differential fluid. 5. Check the batteries (gravity per cell) and clean connection terminals. 6. Inspect emission control system canister (for damage). 7. Check return lines from carburetor/fuel injector system to canister and fuel tank. 8. Check pump and belt drive. 9. Check the fuel filler cap (must be original equipment). 10. Inspect fuel lines for leaks. 11. Turn air conditioning/heating system on for 10 minutes to determine proper distribution and or heating or cooling devices. 12. Check coolant system and hoses. 13. Inspect all alarm and warning devices. 14. Check operation of wipers and blades. 15. Inspect radios and antennas. 16. Road test by 2nd Assistant Chief. 17. Set wheel lug nuts to proper torque.
The following Inspection/Maintenance shall be done every 5,000 miles:
1. Inspect, clean and lubricate face cam of fuel injector pump (if applicable). 2. Check engine idle speed, throttle operation and idle return spring. 3. Inspect and lubricate body mechanisms. 4. Drain water from fuel filter bowl (diesel vehicles).
The following Inspection/Maintenance shall be done every 10,000 miles:
1. Change the air cleaner, fuel filter and positive crankcase ventilation (PCV) filter. 2. Change the automatic transmission fluid and filter. 3. Check the battery switch and isolator system. 4. Replace spark plugs. 5. Check distributor cap, rotor and spark plug wiring. 6. Check the operating temperatures at both the front and rear for air conditioning and heating. 7. Check the condition of the coolant fluid/gas and all parts of the air conditioning system. 8. Adjust all doors. 9. Inspect and lubricate the weather stripping, latches, door positioners, hood latch, and spare tire support system. 10. Inspect all cabinets, tighten and adjust all screws. 11. Inspect and repair upholstery. 12. Polish all paint and chrome. 13. Inspect braking system.
The following Inspection/Maintenance shall be done every 20,000 miles:
1. Replace battery cables. 2. Test battery and starter voltage draw. 3. Check radiator thermostat. 4. Check radiator cap, inspect radiator for leaks, and replace hoses as needed. 5. Check brake master cylinder fluid level.
Line 6.1.3.2.1: Record of Vehicle Failures The 2nd Assistant Chief shall, in consultation with the Chief, maintain a record of all unexpected Ambulance and Emergency Ambulance Service Vehicle failures and corrective actions taken on a DOH approved form. A copy of this record shall be submitted to the DOH with the SBVAC’s biennial recertification application.
Paragraph 6.1.3.3: Insurance Matters The 2nd Assistant Chief shall, with consultation from the Vice President and the Treasurer, assist in matters pertaining to insurance.
Subsection 6.1.4: Duties of the Captain (Training Officer)
Paragraph 6.1.4.1: Organization of Courses The Captain shall have the responsibility for the organization of all training courses offered to and required of SBVAC members.
Line 6.1.4.1.1: Selection of Members The Captain shall select SBVAC members for various training courses.
Paragraph 6.1.4.2: Training Requirement The Captain shall dictate the training requirements for all members of the Stony Brook Volunteer Ambulance Corps. The Captain shall forward to the Vice President a list of all members, who did not complete their training requirements.
Line 6.1.4.2.1: On Shift Training The Captain shall create a portfolio of trainings to be completed by all probationary members while on shift. These trainings shall be done under the supervision of a CC or designated aide as assigned by the Captain.
Line 6.1.4.2.2: Minimum Progress Rate The Captain shall set the minimum progress rate of all SBVAC members at the beginning of every semester.
Subsection 6.1.5: Duties of the Lieutenant (Equipment Officer) The Lieutenant shall be responsible for the stocking of all SBVAC vehicles as per NYS DOT Part 800 requirements. The Lieutenant shall be responsible for the ordering of all SBVAC supplies and uniforms, and shall have the authority to make policy and procedure regarding the checking, care, maintenance, and replacement of all SBVAC equipment. Preventive maintenance for medical equipment shall be completed as per manufacturer suggestions. Equipment variety and changes in types are too numerous to delineate in a single administrative policy. Preventive maintenance for the stretchers and stairchairs shall be conducted at least every six months or as recommended by the manufacturer.
Paragraph 6.1.5.1: Rig Checks The Lieutenant shall ensure that an ambulance equipment check is completed every shift and all necessary supplies are on the ambulance. The Lieutenant shall also ensure that all patient care equipment is in a clean and working order. If any discrepancies arise, the on-duty CC shall inform the Lieutenant and note such discrepancies on the rig check sheet. All completed rig check sheets are to be filed and stored for easy future reference. These records are subject to inspection by the New York State Department of Health.
Line 6.1.5.1.1: On-Call Periods During on-call periods, the Lieutenant shall ensure that rig check is completed at least once weekly on each vehicle.
Line 6.1.5.1.2: Record of Equipment Failures In the event of the discovery of any failed of defective patient care equipment that could have resulted in harm to a patient, the Lieutenant shall, in consultation with the Chief’s Office, maintain a record of such failures and corrective actions taken on a DOH approved form. A copy of this record shall be submitted to the DOH with the SBVAC’s biennial recertification application. If the equipment failure causes harm to a patient, the procedures described in Paragraph 11.2.7.1 must also be followed.
Paragraph 6.1.5.2: Uniforms The Lieutenant shall ensure that uniform orders are placed in a timely fashion at the beginning of every semester, and shall be responsible for distributing them when they arrive. The Lieutenant shall ensure that all uniforms and jumpsuits that are owned by the company are washed regularly and kept in usable condition.
Section 6.2: The Executive Board Subsection 6.2.1: Duties of the President The President (90) shall have the major function of acting as a liaison between the SBVAC and the State University of Stony Brook Administration.
Paragraph 6.2.1.1: Temporary Changes by the President The President may substitute temporary changes in administrative policy and procedure when such changes are needed immediately. The President must notify all Officers of the SBVAC of changes to administrative policy and procedure as soon as possible. The President shall convene a meeting of the Officers of the SBVAC, who shall determine if such changes shall remain in effect. The President is not to institute any changes in any operational proceedings.
Paragraph 6.2.1.2: Public Relations Officer Status The President shall serve as the public relations officer of the SBVAC.
Paragraph 6.2.1.3: Best Interest of the Corps The President shall at all times work in the best interest of the SBVAC as determined by the Officers of the SBVAC.
Paragraph 6.2.1.4: In Charge of Inquiries The President shall be in charge of all inquiries related to the business of the Executive Board of the SBVAC.
Subsection 6.2.2: Duties of the Vice President The Vice President (91) shall be responsible for the day-to-day administrative duties of the SBVAC. The Vice President shall, with consultation from the Treasurer (92) and the 2nd Assistant Chief, shall be in charge of matters pertaining to insurance. The Vice President shall also be responsible for the assignment of the weekday and weekend shifts for all members. The Vice President shall be responsible for maintaining accurate records of all the members’, including but not limited to, awards, citations, disciplinary actions, etc… The Vice President shall also maintain member health records as described in Section 17.3.
Paragraph 6.2.2.1: Selection of Members The Vice President shall oversee a committee comprised of the Office and any members who participate in the applicant interview process. This committee shall be responsible for the selection of all SBVAC personnel.
Subsection 6.2.3: Duties of the Treasurer The Treasurer (92) shall have the duties and responsibilities of the SBVAC financial accountability, including the budget.
Paragraph 6.2.3.1: Disbursement of Funds The Treasurer shall, with the approval of the Officers of the SBVAC, pay bills, issue checks, and reimburse parties for services rendered.
Paragraph 6.2.3.2: Sponsoring Agencies The Treasurer shall, along with the President, meet with all agencies that provide the SBVAC with funding.
Subsection 6.2.4: Duties of the Secretary The Secretary (93) shall conduct all the correspondences of the SBVAC. The Secretary shall issue notices of all meetings of the SBVAC and keep attendance of all those that attend.
Paragraph 6.2.4.1: Record of Calls The Secretary shall keep a confidential record of all ambulance calls and the personnel involved.
Paragraph 6.2.4.2: Statistics of Calls The Secretary shall provide monthly statistics of the response of all ambulance calls including records of the personnel responded from the SBVAC.
Paragraph 6.2.4.3: Quality Assurance of Patient Care Reports The Secretary shall examine all PCRs, in recording calls, to ensure that all data is filled in appropriately and report any shortcomings to the Chief or the 1st Assistant Chief.
Section 6.3: Aides to the Officers Aides are not Officers themselves, nor shall they have the authority of Officers, keys to the office, nor appointed a radio call sign. Aides shall have a term of office concurrent with the Officer who so appointed them.
Subsection 6.3.1: Definition of Aides Aides shall be defined as the assistants to that Officer of the SBVAC who appointed them.
Subsection 6.3.2: Approval of Aides Aides must be approved by a majority vote of the Officers of the SBVAC before appointment to their position.
Subsection 6.3.3: Responsibilities of Aides Aides shall have the duties and responsibilities assigned and so designated by the Officer whom they were appointed by.
Subsection 6.3.4: Command Authority of Aides Aides shall, at the scene of an ambulance call involving the SBVAC, act only in their capacity, Attendant, EVO, etc., and seniority, and shall not exercise any special command authority.
Subsection 6.3.5: Removal of Aides Aides may be removed from their position at any time, without prior consent from the Office of SBVAC, by the Officer who appointed them.
Section 6.4: Chain of Command at an Emergency Scene The Chain of Command at an emergency scene is defined as the order of authority of all those present at an emergency scene in charge of scene control.
Subsection 6.4.1: The Chain of Command The chain of command at an emergency scene will be as follows: - Chief of Operations (30) - 1st Assistant Chief (31) - 2nd Assistant Chief (32) - Line Officer Crew Chiefs in accordance to rank - Field Training Officers (FTO) in order of arrival - On-Duty Crew Chiefs - Additional Crew Chiefs in order of arrival
Paragraph 6.4.1.1: Officers Who Are on the Duty Crew If any line officer crew chief is a member of the primary crew that responded, such officer is only within the chain of command as an “On-Duty Crew Chief” unless relieved by someone of equal standing. This Paragraph shall not apply to any Chief Officer. At any scene where the Incident Command System is invoked, the Chain of Command shall no longer apply in a linear fashion as described in this Subsection. Instead, the highest member in the Chain of Command, as described in this Subsection, shall assume the role of, or appoint another person to the role of, the Incident Commander.
Section 6.5: Duties of the CCs
Subsection 6.6.3: Emergency Response CCs shall, in consultation with the EVO, decide upon the proper type of response needed during an ambulance call. All decisions regarding type of response shall be made in accordance with Subsections 11.1.1 and 11.3.4 of this document.
Section 6.6: Duties of the EVOs EVOs shall have the responsibility of driving the ambulances to the scene of an emergency call, to the hospital, and back to base in a manner approved by the 2nd Assistant Chief. Must possess a current valid driver’s license issued by the State of New York. EVOs must operate the service vehicles in compliance with all applicable provisions of the Vehicle and Traffic Laws of the State of New York, and agree to periodic reviews of the New York State Department of Motor Vehicle records by an authorized officer or member of the agency. In addition, they must meet all requirements described in Subsection 5.2.3 of this document.
Subsection 6.6.1: Radio Transmissions EVOs shall be responsible for transmitting their status to the dispatcher.
Subsection 6.6.2: Status in Ambulance EVOs may be directed by the CC (or by any member in the chain of command) to remain in the ambulance at the scene of an emergency call. If this is the case, the EVO shall remain in the ambulance, in radio contact, until called by the CC to render aide, or to transport equipment between the ambulance and the scene, or otherwise directed by any member listed within the chain of command. Exceptions are to be made accordingly, such as in the placing of flares at the scene of an auto accident.
Section 6.7: Duties of the Attendants Attendants shall provide assistance to the CC in the rendering of emergency medical care as so designated by the CC.
Subsection 6.7.1: Equipment Check Attendants shall be responsible for the checking of all equipment at the beginning of every shift and as so designated by the Lieutenant and must have a thorough working knowledge of all ambulance equipment and its use.
Section 6.8: Duties of Probationary members Probationary Members shall be responsible for assisting the Attendant(s) in equipment check on every shift and shall only participate in patient care at the discretion of the CC.
Section 6.9: Emergency Medical Technicians
Subsection 6.9.1: EMT-B Must demonstrate competency when assessing a patient, and handling emergencies using Basic Life Support equipment and techniques. Must be able to perform CPR, control bleeding, provide non-invasive treatment of hypoperfusion, stabilize / immobilize injured bones and the spine, and manage environmental emergencies and emergency childbirth. Must be able to use a semi-automatic defibrillator. Must be able to assist patients with self-administration or administer emergency medications as described in state and local protocol. Must keep EMT-B and CPR certifications current.
Subsection 6.9.2: AEMT-Intermediate Must demonstrate competency in all EMT-B skills and equipment usage. Must be able to provide Advanced Life Support using intravenous therapy, defibrillator and advanced airway adjuncts to control the airway in cases of respiratory and cardiac arrest. Must keep EMT-I and CPR certifications current.
Subsection 6.9.3: AEMT-Critical Care Must demonstrate competency in all EMT-B skills and equipment usage. Must be able to provide Advanced Life Support using the AEMT-Intermediate skills and equipment. Must be able to administer appropriate medications. Must keep EMT-CC, ACLS and CPR certifications current.
Subsection 6.9.4: AEMT-Paramedic Must be capable of utilizing all EMT-B and AEMT-intermediate skills and equipment. Must be able to perform under Advanced Cardiac Life Support (ACLS) and Basic Trauma Life Support (BTLS) standards. Must be knowledgeable and competent in the use of a cardiac monitor/defibrillator and intravenous drugs and fluids. Must keep EMT-P, ACLS and CPR certifications current. The EMT-Paramedic has reached the highest level of pre-hospital care certification.
Section 6.11: All Positions Complies with regulations in handling deceased, notifies authorities and arranges for protection of property and evidence at scene. Replaces supplies, properly disposes of medical waste. Properly cleans contaminated equipment according to established guidelines. Checks all equipment for future readiness. Maintains ambulance in operable condition. Ensures cleanliness and organization of ambulance, its equipment and supplies. Determines vehicle readiness by checking operator maintainable fluid, fuel and air pressure levels. Maintains familiarity with all specialized equipment.
Article VII: Public Information Policies
Section 7.1: Privileged Information Any information contained on a call sheet shall be treated as confidential information and shall not be discussed with or disclosed to anyone except the SBVAC members or observers personally involved in the call, the SBVAC Officers, Hospital Staff as necessary for patient care, or any Police Officer present at the scene of an emergency call.
Subsection 7.1.1: Police Officers Requesting Privileged Information Police Officers not present at the scene of an emergency call may NOT be given confidential information regarding any patients at said call. Any such requests shall be forwarded to the Chief and President immediately.
Section 7.2: Public Information Any queries that may ensue at the completion of a call must be promptly referred to the Chief or the President. The CC may disclose that there was a call, the nature of the call, and the hospital to which the patient was transported. No other information shall be disclosed.
Section 7.3: Media The President and Chief must be advised as soon as possible of any inquiries from the press. If the President is not available, then the Vice President must be notified. Any release of information must be deemed appropriate in accordance with Section 7.1 and Section 7.2 of this document and any applicable sections of the By-Laws of the SBVAC by the Chief of Operations.
Subsection 7.3.1: Cooperation with Media At all times, the SBVAC shall make every attempt to cooperate with the media without sacrificing patient confidentiality, unless such cooperation interferes with patient care.
Subsection 7.3.2: Difficulties with Media If the media is interfering with patient care at the scene of any emergency call, a Police Officer shall be requested to intervene.
Subsection 7.3.3: Operational Inquiries In accordance with Paragraph 6.1.1.5 of this document, the Chief shall be in charge of all inquiries of the day-to-day operations of the SBVAC as well as the business of the Operational Board of the SBVAC. Additionally, the Chief shall be in charge of any inquiry relating to any specific emergency call.
Subsection 7.3.4: Executive Inquiries In accordance with Paragraph 6.2.1.4 of this document, the President shall be in charge of all inquiries related to the business of the Executive Board of the SBVAC.
Section 7.4: Release of Documents PCRs shall only be released to the receiving hospital.
Subsection 7.4.1: Request for Documents Any requests for copies or viewing of the PCR should be referred to the President or the Vice President, to whom at their discretion may grant permission to comply with such requests. As per Section 3.14, all requests must be received in writing, and must be accompanied by permission to release the PCR executed by the patient or someone authorized to grant such release on behalf of the patient. The Chief of Operations must be consulted before the President or Vice President may release any documents.
Article VIII: Interdepartmental Relations
Section 8.1: Police Officers The CC on duty will handle all dealings with Police Officers at the scene of an ambulance call, including any requests for information by an Officer at the scene.
Subsection 8.1.1: At the Scene While the Police Officer is in charge of the scene, the SBVAC crew is in charge of patient care.
Subsection 8.1.2: Discrepancies with Police Officers Any conflicts arising on the scene of an emergency call with the Police Department should not be addressed until after the patient is appropriately cared for. Conflicts should be avoided at all costs. Any problems shall be reported to the Chief’s Office both verbally and in writing.
Section 8.2: Residence Life Building Staff Residence Life Building Staff shall consist of Residence Assistants (RAs), Residence Hall Directors (RHDs), and Quad Directors. Their responsibilities are limited to the filing of incident reports as per University Guidelines. At no time should patient care be delayed due to resident life staff.
Section 8.3: University Health Service Administrators If a University Health Service Administrators requests information or has questions pertaining to the service rendered by the SBVAC, they shall be referred to the Chief’s Office.
Section 8.4: Student Health Service Center Staff Student Health Service Center has a varied medically experienced staff. It is urged to obtain a full report from any health care provider passing patient care to the SBVAC. All patient care should be reinitiated as if no previous knowledge was obtained. In addition, hospital staff should be notified origin of patient when giving hospital present via radio.
Section 8.5: Long Island State Veterans Home All calls that are received from the Veterans Home must be regarded as an emergency. Patient care can never be jeopardized in order to wait for paperwork to be photocopied. Due to the general severity of patients and inaccuracy of dispatch information in regards to the nature of calls received from the Long Island State Veterans Home, any mutual aid calls to the LISVH received from the Emergency Dispatch system regardless of graded response shall be upgraded to a lights and sirens response. After contact with patient, it is at the discretion of the crew chief to downgrade to a cold response.
Section 8.6: Local Fire Departments The Stony Brook University campus is jointly protected by the Stony Brook Fire Department and the Setauket Fire Department. Either agency may be called upon for mutual aid or encountered at the scene of an incident requiring a fire department response. The Incident Commander, or the SBVAC member on scene who places highest within the SBVAC Chain of Command shall coordinate with the person in command of any fire department operation.
Subsection 8.6.1: Emergency Calls Outside the SBVAC’s District The situation may arise where a SBVAC ambulance is flagged down for or mistakenly dispatched to an incident that is outside our Primary Operating Territory as defined in Article I. While operating at any such incident, no additional SBVAC resources are to be requested to the scene without first requesting the resources or permission from the agency having jurisdiction over the incident. Line 8.6.1.1: Flagged Down Outside the SBVAC’s District Upon being flagged down at any incident outside the SBVAC’s district, the crew shall immediately notify MEDCOM via radio or telephone of the exact nature, exact location, and (if known) which fire or EMS district the incident is located within. The crew shall direct MEDCOM to notify the appropriate agency, and MEDCOM shall notify SBVAC’s crew via radio if the outside agency will be responding to the incident.
Line 8.6.1.2: Dispatched to an Incident Outside the SBVAC’s District Immediately upon the discovery that an incident to which the SBVAC has been dispatched is not entirely located within our district, the crew shall immediately notify MEDCOM via radio or telephone of the exact location of the incident, and (if known) which fire or EMS district the incident is located within. The crew shall direct MEDCOM to notify the appropriate agency, and MEDCOM shall notify SBVAC’s crew via radio if the outside agency will be responding to the incident.
Line 8.6.1.3: Exceptions This Subsection shall not apply to any incident at the Long Island State Veterans Home or at University Hospital Medical Center at Stony Brook. Additionally, this Subsection shall not apply to any incident to which the SBVAC is dispatched for a signal 24 (mutual aid).
Article IX: In Quarters Shift Procedures Section 9.1: In House Duties The following duties are required to be completed on every shift in the order listed below. It is also the responsibility of the crew to check the memo boards for any additional duties required or changes in procedure.
Subsection 9.1.1: Rig Check and Driver Check The EVO on the shift must complete a Driver Check sheet at the start of the tour as specified by the 2nd Assistant Chief. The attendants and probationary members of the shift must complete a Rig Check sheet as per the Lieutenant. Any AEMTs permitted to operate at the Advanced Life Support Level, regardless of their position on the crew, must complete an ALS Rig Check sheet as per the 1st Assistant Chief or ALS Coordinator.
Subsection 9.1.2: On-Shift Training All on-shift training, as set forth by the Captain shall be completed before the end of the tour. It is the CC’s responsibility to complete all on-shift training. In the event of ambulance calls preventing the completion of on-shift training, it shall be completed the following week.
Subsection 9.1.3: HQ Cleanliness It is the responsibility of the CC to ensure that HQ is in a clean and usable state at all times. The incoming CC does not need to accept the responsibilities of the shift until HQ is in a clean and usable state. If any problems arise, an Officer of SBVAC should be notified verbally and in writing. If the incoming CC accepts the responsibilities of the shift, it becomes that CC’s responsibility to ensure HQ is in a clean and usable state at the completion of the tour regardless of the origin of any discrepancies.
Subsection 9.1.4: Miscellaneous Responsibilities Any other tasks as required by the office shall be completed before the conclusion of the tour.
Section 9.2: Food in Company Vehicles Absolutely no eating or drinking will be tolerated in any company vehicle at any time. Exception shall only be made for the purpose of providing rehabilitation at an incident. Food and beverages may be transported in an ambulance provided that at no time shall there be any food or beverage in the patient compartment. Alcoholic beverages may not be present in any company vehicle at any time, without exception.
Subsection 9.2.1: Plastic containers As per NYS Part 800 requirements, any volume of liquid in excess of 249 milliliters must be in a plastic container to be transported on the ambulance.
Section 9.3: Non-Corps. Work Any work not related to the SBVAC may only be done when all Corps work has been completed. The SBVAC should be considered a responsibility similar to a paying job.
Section 9.4: State of Readiness The on duty crew of the SBVAC will always be in a state of readiness as stated by NYS DOT protocols and the SBVAC SOPs.
Section 9.5: Change of Tours
Subsection 9.5.1: General Information All members of the SBVAC should arrive promptly to each shift so as to assure a smooth transition of personnel at the change of tours. If any members are late, those from the preceding tour must remain until adequate coverage is maintained. No member may leave until dismissed by the duty CC within reasonable limits.
Paragraph 9.5.1.1: Procedure for Missing Personnel If any SBVAC personnel fail to arrive at the appointed time for their assigned shifts, the Crew Chief should attempt to contact them by telephone and notify the Vice President.
Article X: General Procedures of Emergency Service
Section 10.1: Pagers Officers and other personnel are to be given pagers to respond to calls. Each pager is the responsibility of the member to whom it is assigned. At no time shall a member give a pager to any other member without the direct approval of the Chief’s Office. If a member shall be unavailable for response for an extended period of time, the pager must be returned to the Chief’s Office.
Subsection 10.1.1: Use of Pagers Pagers shall be utilized whenever the SBVAC is providing on-duty service to its District or if the on-duty crew is not in headquarters. If there is no scheduled on-duty crew, members may respond to the ambulance or first responder vehicle in an “on-call” capactiy as necessary.
Section 10.2: Additional Personnel Any personnel as approved by the Chiefs of SBVAC, wishing to respond to the scene of an emergency call with the intent of providing emergency care prior to the on-duty crew’s arrival must have in their possession a “Crash Kit” with the necessary supplies to provide BLS care as approved by the Lieutenant.
Subsection 10.2.1: Officers Chief Officers may respond to the scene of any emergency call to oversee the functioning of the crew and ensure their safety. Other operational line officers may not respond to the scene of any emergency call unless granted specific prior permission by the Chief’s Office.
Subsection 10.2.2: AEMTs Any AEMT credentialed to provide Advanced Life Support by SBVAC as per Section 12.1 may respond to the scene of any emergency call they reasonably believe may require ALS interventions.
Subsection 10.2.3: Other Personnel Off-duty personnel may not respond to any scene unless granted prior approval from the Chief’s Office. Exception shall only be made if a signal 3 for additional personnel is requested by the duty crew or an officer. Additional personnel responding to the scene shall assist the duty crew and shall serve at the expense of the duty Crew Chief.
Paragraph 10.2.3.1: At Scene Prior to Crew If any off duty personnel are at the scene prior to the on duty crew's arrival, they will give a report of any information they have obtained and relinquish aid to the CC unless otherwise instructed.
Paragraph 10.2.3.2: Emergency Calls at a Roadway With the exceptions of personnel listed in Subsection 10.2.1 and Subsection 10.2.2, and personnel responding for a signal 3 requesting additional personnel to the scene, no personnel may respond to the scene of an emergency call situated on a roadway type setting.
Section 10.3: Use of Personal Property Responding personnel as per Section 3.13 of the SOPs may use personal property.
Subsection 10.3.1: Personal Vehicles Personal vehicles are not to be used to respond to calls unless given approval by the Chiefs of SBVAC. At no times shall a member drive in any area designated as “inner quad” or “academic mall” unless otherwise directed by an Officer.
Paragraph 10.3.1.1: Green Light It is advised, but not required, that personnel who regularly respond with their personal vehicles purchase a green light for their vehicle as outlined by the NYS DOT. In addition, said member must contact the Chief to receive a “green light card” to authorize the use of such lights.
Paragraph 10.3.1.2: Blue lights The use of blue lights is prohibited when responding as a member of SBVAC, unless prior consent is granted by the Chief’s Office.
Paragraph 10.3.1.3: Red Lights (Emergency Ambulance Service Vehicles) The use of red lights in a personal vehicle is strictly regulated by NYS law. The use of red lights may be granted solely at the discretion of the Chief and is strictly prohibited otherwise. Authorizing a personal vehicle to display red lights requires that the vehicle be classified as an Emergency Ambulance Service Vehicle (EASV) and that the appropriate paperwork is filed with the NYS DOH. The procedure for DOH authorization of an EASV is found in NYS EMS Policy Statement 01-01. It is strongly recommended that a copy of the policy statement and these SOPs be carried in the vehicle for reference purposes.
Line 10.3.1.3.1: Training Requirements The owner of a personally owned vehicle classified as an EASV must hold a minimum NYS certification of EMT. In addition, SBVAC shall require that the member using their personal vehicle as an EASV be a Crew Chief and an EVO with the company.
Line 10.3.1.3.2: Equipment Requirements The EASV must be stocked to meet the requirements of Part 800.26 at all times. All equipment shall be the responsibility of the member. The equipment must be checked and inventoried at least biweekly using a NYS DOH Inspection Worksheet for EASVs. This form may be found in the NYS EMS Agency Operational Resource Guide. Completed forms must be given to the Lieutenant who will file them accordingly, as these forms are subject to state inspection.
Line 10.3.1.3.3: Maintenance The member shall be responsible for maintaining the EASV and equipment in accordance with all manufacturers’ recommendations.
Line 10.3.1.3.4: ALS Equipment As per Suffolk County protocols, ALS equipment, such as sharps, and medications, is not to be carried in a personally owned EASV except as stated in Subsection 12.2.5.
Line 10.3.1.3.5: Insurance Coverage The EASV must be insured by the owner of the vehicle, however any accident that occurs while responding to a call shall be covered by SBVAC’s insurance policy.
Line 10.3.1.3.6: Vehicle Response Policy The EASV is to respond using the protocols specified in Subsection 11.1.1 and may respond to Headquarters or the scene of any call unless otherwise specified by the Chief.
Line 10.3.1.3.7: SBVAC Records SBVAC shall keep on file copies of the following for any vehicle certified as an EASV: EMT certification, Driver’s License, Vehicle Registration, Proof of Insurance, DMV Safety/Emissions inspection verification, a copy of the DOH issued Emergency Vehicle Authorization Card, and Equipment Checklists.
Line 10.3.1.3.8: Expiration of Authorization The expiration date of the EASV authorization shall be determined by the Chief, but must not exceed the expiration of the member’s NYS EMT certification. The authorization shall be automatically considered invalid if the individual is no longer an active member of SBVAC or if the individual is not a currently certified NYS EMT or AEMT.
Line 10.3.1.3.9: Inspection by SBVAC Any EASVs authorized by SBVAC are subject to state inspection, and SBVAC will be held accountable by the DOH for any violations. Therefore, any vehicle authorized by SBVAC as an EASV may be inspected by any member of the Chief’s Office at any time for the purpose of ensuring compliance with Part 800 and correcting any potential violations. It is recommended that such an inspection be conducted at least once per semester.
Line 10.3.1.3.10: Revocation of Authorization The Chief may revoke an EASV authorization for any reason at any time with or without explanation. When an authorization is revoked or expired, the Chief shall mail a written notice to the NYS DOH.
Section 10.4: Non-Corps. Personnel in Company Vehicles No Non-Corps personnel shall ride in any vehicle owned by the SBVAC at any time with the following exemptions:
Subsection 10.4.1: Patients and Acquaintances Non-SBVAC personnel permitted in the ambulances shall include the patient and no more than one of the patient's acquaintances. The patient’s acquaintance must ride in the front passenger seat and remain buckled for the duration of the trip. Exceptions may be granted at the discretion of the CC (i.e. transporting a minor).
Subsection 10.4.2: Medical Staff Non-SBVAC personnel permitted in the ambulances shall include any nurses, Physicians, or EMS personnel of higher medical ability, or as deemed appropriate by the CC.
Subsection 10.4.3: Police and Fire Marshals Any police officer or fire marshal may be permitted to ride in any company vehicle as deemed appropriate by the CC.
Subsection 10.4.4: Observers
Section 10.5: Crew Chief Responsibilities
Subsection 10.5.1: CC Responsibilities
Paragraph 10.5.1.1: Patient Care The CC on duty will be responsible for the administration of all patient care while on shift and the safety of the crew.
Paragraph 10.5.1.2: Ambulance The CC on duty will be responsible for the ambulance and its equipment while on shift.
Paragraph 10.5.1.3: Problems on Shift The CC on duty will be responsible for the notification to the Officers of the SBVAC of any problems or difficulties that occurred while on shift.
Paragraph 10.5.1.4: Communications The CC on-duty will be responsible for communicating with hospital staff concerning any patients being transported to the hospital. The CC shall assist the EVO in communicating with the dispatcher.
Paragraph 10.5.1.5: Incidents Requiring Immediate Notification The CC on-duty will be responsible for the immediate notification to the Officers of the SBVAC by telephone no later than the following business day and by writing no later than five (5) business days in every instance in which the crew encounters a situation outside of normal operating procedures.
Subsection 10.5.2: EVO Responsibilities The EVO will be responsible for the driving operations of the emergency vehicle at all times and its contents while on shift.
Paragraph 10.5.2.1: Communications The EVO shall be responsible for all radio communications with the assistance of the CC to MEDCOM. MEDCOM must be kept advised of the vehicle’s status at all times during a call situation, including, but not limited to, Signals 2, 18, 21, 28 and 5.
Paragraph 10.5.2.2: On Scene Vehicle Procedures All SBVAC vehicles shall be positioned in a manner to facilitate crew accessibility to the scene and the equipment on the ambulance.
Line 10.5.2.2.1: Ambulance Unsupervised As appropriate, the engine shall be left running in high idle, any needed warning lights left on, the parking brake engaged, the ignition override engaged and the keys removed. The driver shall also ensure that all doors are locked before leaving the vehicle unattended. Paragraph 10.5.2.3: Collision with Ambulance If involved in a collision, the crew shall: 1. Protect the scene with warning lights or flares. If the vehicles are in a hazardous location and they are drivable, they may be moved to the side of the street. 2. Notify MEDCOM, preferably by telephone, that the unit is involved in an collision, and: a. Request the Chief’s Office and Police to respond to scene as well as any necessary fire apparatus. b. If the ambulance was en route to the scene of a call, instruct MEDCOM to dispatch another ambulance to that assignment. c. If the ambulance is transporting a patient and has been rendered inoperable, instruct MEDCOM to send an additional ambulance to transport the patient. If the ambulance has not been rendered inoperable, inform MEDCOM that an additional ambulance for the current patient is not necessary. 3. Ascertain if there are any injuries to any SBVAC personnel or others involved in the collision. 4. If the ambulance is transporting a patient who is critical or unstable, the ambulance is not rendered inoperable, and there are no other critical or unstable patients at the scene, instruct the other vehicle operator to remain at the scene and await the return of the ambulance. Give the involved party our company name, vehicle identifier, and the EVO’s name, and record their name, vehicle type, make, and license number before leaving the scene with the patient. If the crew has an extra person, leave them at the scene to begin paperwork. 5. Administer patient care to any injured persons and request additional ambulance(s) as necessary. 6. Not make any statements to other drivers concerning the collision, and speak only with police and patients until a Chief arrives on scene. Exchange necessary information with others involved. Record the police officers name, shield number, any tickets issued, and draw a rough sketch of the accident scene. 7. Obtain name, address, telephone number, and brief statement from any witnesses. 8. Ensure that even the minor injuries are well documented and receive appropriate emergency department follow-up as needed. 9. Complete an incident report within twenty-four (24) hours of any collision. 10. Any driver involved in an accident will be immediately suspended from driving pending a safety hearing and review of driving skills by the Chief’s Office.
Paragraph 10.5.2.4: Vehicle Breakdown In the event that a SBVAC vehicle breaks down either during the course of an emergency call or under normal operating procedures, the EVO will advise MEDCOM and request a Chief of SBVAC to respond to the scene. The incident shall be recorded as per Line 6.1.3.2.1 of these SOPs. If the vehicle failure occurs during normal operations, an Incident Report is not required, but may be requested at the discretion of the Chief’s Office.
Line 10.5.2.4.1: Emergency Call If the vehicle breaks down during the course of an emergency call, MEDCOM shall be instructed to tone out for another SBVAC ambulance, if available, or request mutual aid from another agency to respond to the appropriate location. An Incident Report must be completed, and the incident recorded as per Line 6.1.3.2.1 of these SOPs.
Subsection 10.5.3: Attendant Responsibilities The Attendant will be responsible for assisting with patient care as directed by the CC.
Subsection 10.5.4: Probationary Members' Responsibilities The probationary member is responsible for carrying out actions as deemed appropriate within their level of training as instructed by the CC.
Section 10.6: Use of Portable Radios Portable radios are the responsibility of the CC and are to be handled and used only by the CC unless otherwise directed or in the case of an emergency.
Subsection 10.6.1: Radio Identifiers If the user of a portable radio does not have an assigned radio identifier, 5-35-16A, 16B, or 17A may be used.
Paragraph 10.6.1.1 Executive Officers are not to use commissioner radio identifiers over the radio. They will use the identifier corresponding to their vehicle or portable.
Section 10.7: Change of Tours It is the responsibility of the previous crew to exchange any information or knowledge necessary to the functioning of the following crew. No crewmembers may leave before their appropriate replacement arrives for shift, unless a reasonable amount of time has passed, or dismissed by the on-duty CC.
Section 10.8: Refueling of Vehicles It is the responsibility of all crews to refuel the on-duty vehicle when the fuel level drops to three-quarters capacity or below.
Section 10.9: Additional Assistance
Subsection 10.9.1: Additional Personnel In the event that additional personnel or ambulances are needed at the scene, MEDCOM must be contacted by the CC with the appropriate signal and request.
Subsection 10.9.2: Mutual Aid In the event that mutual aid is necessary, the CC will contact MEDCOM with the appropriate signal and state what is required at the scene of the emergency call.
Subsection 10.9.3: Advanced Life Support In the event that the CC determines, either before arrival at scene or upon arrival at scene, that Advanced Life Support interventions may be necessary, a Signal 3 for ALS to respond to scene may be transmitted through MEDCOM. The CC must initiate and continue any BLS care and preparations for transport, including transfer to the ambulance, as if no ALS assistance was available. Even if ALS personnel are known to be en route, transport is not to be delayed at any time to wait for an ALS response.
Section 10.10: Mutual Aid SBVAC shall participate in Suffolk County Deprartment of Fire Rescue and Emergency Services (FRES) mutual aid plan, and authorizes MEDCOM to request mutual aid responses on our behalf as necessary. MEDCOM shall request mutual aid in accordance with their own protocols, taking into account the incident location, location of the mutual aid agency, primary service territory, authorized level of service, staff and apparatus availability, and any other pertinent information when requesting mutual aid on behalf of SBVAC.
Subsection 10.10.1: SBVAC Unable to Respond In the event that SBVAC is unable to respond to an emergency call in its response area, MEDCOM shall request an appropriate mutual aid response on behalf of SBVAC.
Paragraph 10.10.1.1: Maximum Call Receipt Interval Two minutes after the initial activation of an emergency call, a Signal 3 (request for additional crew) shall be activated by MEDCOM if no unit is on the air. Four minutes after the initial activation of an emergency call, a second Signal 3 shall be activated by MEDCOM if no unit is on the air. Five minutes after the initial activation of a call, MEDCOM shall request an appropriate mutual aid response on behalf of SBVAC if there is no unit on the air.
Line 10.10.1.1.1: Standby A standby (Signal 9) may be requested if a full crew is known to be responding and it is expected that the ambulance will be en route within a timely manner.
Line 10.10.1.1.2: MCI and Disaster Operations During an MCI or Disaster situation, as determined by Suffolk County FRES, the maximum call receipt interval shall not be in effect.
Section 10.11: Inter-facility Transports SBVAC does not routinely provide inter-facility transport services, however the need to perform an inter-facility transport may arise. An inter-facility transport may be authorized at the discretion of a Chief, provided there is a second crew available to cover any emergency calls during the time of the transport.
Section 10.12: Minimum Staffing The ambulance must be staffed by an EVO and a Crew Chief at all times, with the following exceptions.
Subsection 10.12.1: Driver Training The minimum staffing requirement for a vehicle that is driver training is waived, however there must be at least one NYS EMT on ambulance at all times.
Subsection 10.12.2: Personnel On-Scene An EVO may drive the ambulance to the scene of a call with the expectation of meeting a Crew Chief who is already on-scene. A Crew Chief/Driver may drive the ambulance to the scene of a call with the expectation of meeting an EVO who is already on scene.
Subsection 10.12.3: Non-Corps Drivers On-Scene At the Chief’s discretion, certain Non-Corps members such as police officers or fire marshals may be permitted to drive a company vehicle. At the beginning of each semester the Chief shall determine who, if anyone, these people are. Therefore, a Crew Chief/Driver may drive the ambulance to the scene of a call if they are able to verify, through MEDCOM or other means, that an approved Non-Corps driver is already on-scene and is willing to drive the ambulance from scene.
Subsection 10.12.3: Chief’s Discretion Other exceptions to the minimum staffing requirement may be granted at the discretion of any Chief Officer, provided that there is at least an EMT on any in-service ambulance at all times.
Article XI: Procedures of an Emergency Call The following is a general guideline to follow during the course of an emergency call. All knowledge obtained through EMT class, CC training, EVO training, and any other applicable training as well as regulations by the Chief’s Office should be incorporated into the rational decisions made throughout the course of the emergency call.
Section 11.1: En route to the Scene When responding to an emergency, the EVO shall respond in a reasonable and prudent manner with due regard.
Subsection 11.1.1: Lights and Sirens The use of Emergency Warning Devices should follow the rule of “all or none”. The decision on whether or not such emergency warning devices shall be used will be based on the graded response information given by the dispatcher.
Paragraph 11.1.1.1: Types of Response A cold response is a response in which no emergency warning devices are used. A hot response is a response in which all emergency warning devices are utilized.
Paragraph 11.1.1.2: Graded Response Responses shall be graded by MEDCOM in the following manner: Alpha, Bravo, Charlie, Delta and Echo response. During an Alpha response, all responding units shall respond cold. During a Bravo response, the first responding unit shall respond hot and all additional units shall respond cold. During a Charlie response, the same guidelines for a Bravo response shall be followed. During a Delta or Echo response, all responding units shall respond hot. Alpha and Bravo calls are associated with BLS care. Charlie and Delta calls are associated with ALS care. Echo calls are associated with an immediate life threat, and are also ALS emergencies. For the purposes of this paragraph, the “first responding unit” shall be defined as the ambulance, first-responder vehicle, or personally owned EASV (as described and authorized under Paragraph 10.3.1.3) that first proceeds en route to the emergency call.
Line 11.1.1.2.1: Additional Time Needed for an Alpha Call When an Alpha call is dispatched, responding personnel do not have increased time to contact MEDCOM. In the event the responding crew is en route to the hospital or at the hospital with a prior patient, the crew must contact MEDCOM, and if able to respond within fifteen minutes may request MEDCOM to put them on a standby with an approximate time until available. If the crew will not be able to respond within fifteen minutes, the crew shall request an additional unit to respond to the scene of the Alpha call.
Line 11.1.1.2.2: Prioritizing Responses If the responding crew, while en route to a call, receives a dispatch for a second call, they may NOT divert the response based on dispatch priority. In extreme situations, the CC or any Chief may, solely at his or her discretion, divert the response of the ambulance to a second call deemed to be severely life threatening in nature, provided the ambulance is not within sight or sound range of the original call. When diverting, the responding crew must inform MEDCOM of the change in response and request another ambulance to be dispatched for the original call. Any time the ambulance is diverted, the Chief shall be notified immediately upon completion of the call and the CC or the Chief who ordered the ambulance to divert shall complete an Incident Report within 48 hours.
Line 11.1.1.2.3: Incident Under Control If, at any time, a responding crew is informed that a Signal 4 has been declared by MEDCOM, a Chief or by a police officer, the crew shall immediately downgrade their response to cold.
Subsection 11.1.2: Radio Transmissions Radio transmissions should be kept short, concise, and appropriate.
Subsection 11.1.3: Approach to a Motor Vehicle Accident The ambulance should be placed at the scene of an MVA in a manner as to minimize the exposure of the crew to oncoming traffic. If flares have not been set up prior to the ambulance’s arrival, the EVO shall position flares as necessary to direct traffic away from the MVA.
Subsection 11.1.4: Opticom Traffic Signal Pre-emption System The Opticom system shall only be used when responding “hot” to the scene of a call or to the hospital as per Subsection 11.1.1 of these SOPs. Any other use will not be tolerated.
Paragraph 11.1.4.1: Training Any person who has not been trained in the use of the Opticom system may not use the system. The 2nd Assistant Chief, in consultation with the Chief, shall determine the appropriate training program and shall ensure that this program complies with the Town of Brookhaven’s regulations.
Paragraph 11.1.4.2: Inappropriate Use The Chief’s Office shall hold a hearing to determine whether a member accused of using the Opticom system inappropriately has indeed done so.
Line 11.1.4.2.1: First Offense Upon a finding of any individual’s first inappropriate use of the system, said individual shall be suspend from operating any SBVAC vehicles equipped with Opticom emitters for a period of not less than one year. No other punishments may be substituted, however additional punishments may be assigned as deemed appropriate by the Chief’s Office.
Line 11.1.4.2.2: Second Offense Upon a finding of any individual’s second inappropriate use of the system, said individual shall be dismissed from the SBVAC. No lesser actions are permissible as punishment.
Section 11.2: On Scene Procedures
Subsection 11.2.1: Refusal of Medical Assistance A patient’s refusal of medical assistance (RMA) may be obtained only in accordance with the following protocols:
Paragraph 11.2.1.1: High Risk Criteria An RMA should not be considered without contacting Medical Control if any of the following conditions exist:
1. The patient has an altered mental status. 2. The patient is less than 18 or older than 70 years of age. 3. The patient has neurological, cardiac, or respiratory symptoms. 4. The patient’s Glasgow Coma Score is less than 15. 5. The patient’s vital signs are outside of normal limits. 6. There is suspected alcohol or drug use involved. 7. There is a carbon monoxide exposure.
Paragraph 11.2.1.2: No Injuries or Illness In the event that SBVAC responds to a reported medical emergency where both the individuals at the scene and the Crew Chief believe that no injuries or illness exist and that there are no individuals requiring or requesting EMS assistance:
1. A PCR shall be completed using the following disposition codes, 008 “ Gone on arrival “ or 009 “Unfounded” 2. A physical assessment may be necessary to make the determination that there are no patients on the scene. 3. Consider the criteria specified in Paragraph 11.2.1.1 before determining that there are no patients at the scene. 4. An RMA signature is not required but is suggested for purposes of documentation.
Paragraph 11.2.1.3: Refusal of Treatment and/or Transport If in the judgment of the Crew Chief there is a patient at the scene who requires treatment or ambulance transport and refuses treatment and or transport:
1. If the Crew Chief believes that ambulance transport is indicated, Medical Control must be contacted. 2. If the patient continues to refuse either treatment or transport after Medical Control is contacted, the refusal must be documented thoroughly on the PCR, signed by the patient, and witnessed by a Police Officer, preferably. 3. In the event that a patient receives BLS treatment but refuses transportation by ambulance, and the Crew Chief agrees that the ambulance transportation is not warranted and no high-risk illness or injury exists as specified in Paragraph 11.2.1.1, Medical Control need not be contacted. This decision, and any recommended follow-up by the patient, should be noted on the PCR and the RMA signed by the patient, indicating he/she has refused transportation. 4. In situations with multiple patients where only some are transported, such as MVAs, an RMA must be obtained from every patient that is not transported. 5. In all cases where there is no transport to a hospital, the Secretary must send the yellow copy of the PCR to the PCR collection site at Medical Control at the University Hospital.
Paragraph 11.2.1.4: Refusal of Medical Aid by Minors Minors, not under direct supervision of a parent or guardian, shall be allowed to refuse medical aid only after Medical Control has been contacted and the patient has spoken to a Medical Control Physician. If the Medical Control Physician allows the patient to RMA then the crew shall have the patient sign the back of the PCR and follow the aforementioned guidelines. The PCR should be documented to reflect the situation and the Medical Control Physician’s ID number documented as well.
Line 11.2.1.4.1: Refusal of Medical Aid by Minors Under Five (5) Years of Age Any child under five (5) years of age under direct supervision of a parent or guardian may not be permitted to RMA without contacting Medical Control and receiving approval from a Medical Control Physician.
Paragraph 11.2.1.5: Refusal of Medical Aid by the Elderly Any person over the age of seventy (70) may not be permitted to RMA without contacting Medical Control and receiving permission from a Medical Control Physician.
Subsection 11.2.2: Lack of Cooperation If the CC deems necessary, regardless of reason, a Police Officer may be requested to accompany the patient in the patient compartment.
Paragraph 11.2.2.1: Uncooperative Patient / Suspected Psychiatric Patient If a patient is being uncooperative or if a life threatening condition exists, any patient may be placed under protective custody by a Police Officer. If the patient is experience a possible psychiatric emergency and may pose a danger to themselves, the crew, or other people, it is strongly recommended that a Police Officer accompany the patient in the ambulance during transport.
Line 11.2.2.1.1: Restraints If necessary, approved restraints may be applied by the Police Officer. In addition, the CC must notify the receiving hospital of the restraints applied and reasons, as well as document it on the PCR. Vehicle mileage should be documented on the PCR and with MEDCOM.
Paragraph 11.2.2.2: Uncooperative Bystander If a bystander is being uncooperative or is hampering patient care, the Police should be contacted for assistance.
Paragraph 11.2.2.3: Prisoner Patient Procedure If transport of a prisoner/patient is required, a Police Officer must ride with the crew in the patient compartment. Vehicle mileage should be documented on the PCR and with MEDCOM.
Line 11.2.2.3.1: Hospital Notification If the ambulance is transporting a prisoner/patient, the CC must advise the hospital that the ambulance has a Police Officer on board for a patient in custody.
Subsection 11.2.3: Cardiac Arrest / Unattended Death
Paragraph 11.2.3.1: Police Department Presence If the Police Department is not present at the scene of a cardiac arrest upon the arrival of the first arriving EMS unit, a sector car response must be requested before the EMS unit transports the patient or leaves the scene following the determination that pre-hospital care and transport are not required. Do not delay transport if the Police Department is not on the scene.
Paragraph 11.2.3.2: Obligation to Perform CPR In cardiac arrest situations, certified EMS providers are obligated to perform CPR or other prescribed resuscitative measures, unless a valid New York State “Do Not Resuscitate” (DNR) form or bracelet is presented, or there are signs of obvious death present.
Line 11.2.3.2.1: Bystander CPR In instances where bystander CPR is initiated prior to the arrival of the EMS unit and it is determined by the arriving EMS personnel that there are signs of obvious death present, the EMS personnel may elect to refrain from continuing resuscitative measures.
Paragraph 11.2.3.3: Crime Scene Operations Any location at which a cardiac arrest or an unattended death found, and where there are no family members or witnesses present, it is to be considered a crime scene until otherwise designated by proper authority. Refer to Subsection 11.2.11 for Crime Scene operating procedures.
Paragraph 11.2.3.4: Deceased on Arrival If a patient is determined to be dead upon arrival, the CC must notify the Police and no transport shall be attempted. The appropriate paperwork shall be filed.
Paragraph 11.2.3.5: Medical Control Contact Suffolk County protocol requires that Medical Control be contacted at 631-444-3600 for a post-call Signal 34 following any cardiac arrest, whether or not an AED was applied. The Crew Chief is responsible for placing this call. Refer to Section 11.5 for the proper procedure to follow.
Subsection 11.2.4: By-stander Assistance The CC may utilize any bystander assistance. This includes the Police, Environmental Health and Safety, and any other persons encountered at the scene of a call. Appropriate documentation must be completed.
Subsection 11.2.5: Unable to Locate Patient If the crew arrives at the reported scene of a medical emergency and is unable to locate the patient, they shall take the following actions:
1. Confirm, through the dispatcher, that they have the correct address. 2. Confirm, through the dispatcher, that a telephone call back was made to verify the alarm location. 3. Sound the siren/horn for fifteen (15) second intervals for no less than one (1) minute. 4. Confirm, or if necessary, request Police Department response to the scene. 5. Confirm with Police and/or Environmental Health & Safety on-scene the location of the alarm.
If, after an adequate search effort, the call is determined to be unfounded, a PCR must be completed with all actions taken at the scene documented and all times noted. In addition, MEDCOM must be notified.
Subsection 11.2.6: Unable to gain entry If patient access cannot be accomplished through normal procedures, the Police should be called to gain entry to buildings. If Heavy Rescue, HAZMAT or any other resources are required, MEDCOM shall be contacted for assistance. The Crew should not place themselves in danger to gain access to a patient. If forcible entry is necessary, the following guidelines must be adhered to:
1. The crew must confirm that the patient is in a secured building/area or in a locked or inaccessible private residence before forcible entry is attempted by the Crew. 2. If the crew is unable to confirm that the patient is present in a secured, locked or inaccessible location, the Police Department is to assume responsibility for a forcible entry decision. 3. In the event of a fire or suspected fire at the location in question, the Fire Department shall assume the forcible entry responsibilities. 4. Fire Department assistance in forcible entry may be requested if the SBVAC crew and the Police are not equipped to provide forcible entry.
Subsection 11.2.7: Unusual Incidents Any incidents outside the norm occurring at the scene of a call, whether involving patient, crew, or other, shall be fully documented on the PCR, in addition to the immediate notification to the Chief’s Office, and the filing of an Incident Report Form.
Paragraph 11.2.7.1: Reportable Incidents to the New York State Bureau of EMS
1. A patient dies, is injured, or harmed due to the actions of a member of the ambulance service. 2. An EMS response vehicle/ambulance is involved in a motor vehicle crash in which a patient, member of the crew, or other person is killed or injured to the extent of requiring hospitalization or the care of a physician. 3. Any member of the ambulance service is killed or injured in the line of duty to the extent of requiring hospitalization or the care of a physician. 4. Patient care equipment fails or is misused causing harm to a patient. 5. It is alleged that any member of the ambulance service has responded to a call or has treated a patient while under the influence of alcohol or drugs. This includes prescription drugs that may impair the thought process or mechanical/physical abilities of the patient care providers.
Line 11.2.7.1.1: Incident Report: A SBVAC Incident Report shall be completed for agency records when any incident specified in Paragraph 11.2.7.1 is reported to the New York State Bureau of EMS.
Subsection 11.2.8: Hospital Disposition The crew shall transport a patient in critical or unstable status to University Hospital. If the patient is in a stable condition, the patient should be transported to University Hospital, but may be transported to Mather Hospital, and St. Charles Hospital at the patient’s request. Patients should not be transported to any other hospitals.
Paragraph 11.2.8.1: Patient Request to an Out of Area Hospital If a patient requests an out of area hospital, the crew shall inform the patient of our response policy. If the patient still requests a hospital out of the response area, Medical Control should be contacted for advice in addition to a Chief officer if available, to obtian a possible solution to the situation. The on-duty crew shall not transport a patient to a hospital when such transport will put them out of service for an extended period of time, unless an appropriate backup is available.
Paragraph 11.2.8.2: Inter-Facility Transports This policy does not apply to inter-facility transports which are ordered by a physician, and which may or may not require that a physician accompany the patient. Transport shall be made to the hospital requested by the physician ordering the transport. If at any time the patient’s condition becomes unstable, the CC shall divert the ambulance to the closest hospital at that time.
Paragraph 11.2.8.3: Multiple Casualty Incidents This policy does not apply to mass casualty incidents, where triage functions may dictate transportation of patients to other than the nearest medical facility. When transporting from the scene of an MCI, transport will be to the hospital specified by the Transportation Officer, Incident Commander, or other authorized individual.
Paragraph 11.2.8.4: Mutual Aid and Calls Outside the SBVAC’s District This policy does not apply when transporting a patient as a response to a request for mutual aid from another company, or when otherwise transporting from calls outside the SBVAC’s district. In such a situation, the patient shall be transported to the closest hospital unless NYS protocol and/or medical control require a different destination hospital based on the patient’s condition. Transport to other hospitals shall be considered at the patient’s request as per Paragraph 11.2.8.1.
Line 11.2.8.4.1: Long Island State Veterans Home For the purposes of this Paragraph, calls to the Long Island State Veterans Home shall not be considered mutual aid responses.
Subsection 11.2.9: Hospital Diversion: Section 405.19 (e) (4) of the NYS Hospital Code authorizes hospitals to request diversion of ambulances to other facilities when the acceptance of another critical patient might endanger the life of that or another patient. A request for diversion does not require that the ambulance divert from that facility. EMS personnel are not obligated to honor such a request if they believe that a critically ill or injured patient’s condition warrants transport to the nearest hospital. If it is determined that the patient is stable, the diversion request may be honored. Contact Medical Control to assist in the transport decision. Complete documentation on the PCR should fully describe the reason(s) for the EMS provider’s (non)diversion decision.
Subsection 11.2.10: HAZMAT Situations SBVAC shall participate in Suffolk County’s HAZMAT response plan and shall operate under Suffolk County’s Guidelines for Response to HAZMAT Incidents with Contaminated or Potentially Contaminated Patients. A copy of this document may be obtained from any officer. Paragraph 11.2.10.1: HAZMAT Standbys In the event of a HAZMAT emergency on campus, EH&S will require an ambulance to standby. The SBVAC will situate themselves as instructed by EH&S.
Line 11.2.10.1.1: Relief of crews In the event that this standby goes beyond normal crew times and/or crewmembers need to be dismissed, additional crew can be toned out. The on-coming crew shall take the secondary ambulance to the scene; relieve the on-scene crew, which shall then take the secondary ambulance back to HQ. This Line shall also apply to fire standbys.
Paragraph 11.2.10.2: Chemical Protective Clothing Four sets of chemical protective clothing, including full face air purifying respirators, shall be located in each ambulance. Each member shall be properly trained in the donning and use of these items. The chemical protective clothing affords the user Level C protection, and is to be used in “warm to cold” zones exclusively. The chemical protective clothing is to be used in any situation where the CC or any operational officer suspects that the crew may come into contact with equipment or patients not be completely decontaminated of any known or suspected hazardous materials. AT NO TIME SHALL ANY MEMBER ENTER INTO ANY AREA DESIGNATED AS OR SUSPECTED TO BE A “HOT ZONE”, EVEN WHILE WEARING THE CHEMICAL PROTECTIVE CLOTHING.
Line 11.2.10.2.1: Notification Procedure Immediately following any call at which the Chemical Protective Clothing is utilized, the crew must notify the Chief. An Incident Report is to be filed within 48 hours.
Subsection 11.2.11: Operating at a Crime Scene or Suspected Crime Scene The primary responsibility of EMS personnel operating at a crime scene or suspected crime scene is to render proper emergency medical care to those persons in need of such care. Patient care shall not be compromised in order to protect the crime scene or evidence. However, every attempt should be made not to disturb any physical evidence at the scene if possible. EMS providers should be aware of the responsibilities of other agencies operating at crime scenes. The actions and observations of EMS providers at crime scenes are frequently an important part of court testimony, requiring accurate documentation at the time of the incident.
Paragraph 11.2.11.1: Definition of Crime Scene A crime scene shall be defined as any location at which evidence of a crime or suspected crime is found including, but not limited to, homicide, suicide, sexual assault, chemical, biological, nuclear, or explosive weapon release, vehicle pedestrian accidents, or other MVAs involving serious injury or death. Any location at which a deceased is found is to be considered a crime scene until otherwise designated by the proper authority.
Paragraph 11.2.11.2: Crime Scene Operations After evaluating the scene for potential hazards, the following steps should be taken:
1. Consider the entire location as being involved in the crime scene. 2. Upon entering or leaving the scene, use a single path of travel if possible and have all personnel entering or leaving the scene use the same path. 3. Limit the number of EMS providers entering the scene to only those necessary to evaluate, treat and/or remove patients. All non-essential EMS providers are to remain outside the crime scene. 4. If a presumptive diagnosis of obvious death is made, refrain from otherwise moving or disturbing the victim’s remains. 5. Refrain from using sinks, toilets, or telephones within the immediate area of the crime scene. 6. Remove nothing from the crime scene and restrict the handling of any objects found on the scene. 7. Offer information on observations pertinent to the incident to the proper authority. Do not offer information or observations to those who do not have a legal need for such information or observations. 8. Restrict comments and opinions to known facts when speaking to other authorities. Inter-department communications regarding the incident shall be directed to the proper authority at the scene. Do not offer information to unauthorized parties such as the media, civilians, or other agencies as this may impede the investigation. 9. Complete all PCRs and related records pertaining to the incident accurately, using specific language to indicate the position in which the patient was found, the presence of visible wounds and other pertinent data including the clinical information that led to the decision to withhold resuscitative measures. PCRs are legal documents subject to subpoena and must be complete, legible and accurate. Subsection 11.2.12: Suspected Child Abuse or Maltreatment, Sexual Assault, Elder Abuse,Patient Abuse, and Spousal Abuse
After evaluating the scene for potential hazards, the following steps should be taken:
1. Avoid unnecessary disturbance of the patient or physical evidence. Limit physical patient contact to the treatment of injuries only. Do not cleanse or cover wounds unless absolutely necessary. Discourage the patient from rinsing, showering, combing hair, changing clothes, or brushing teeth. 2. Notify the Police Department immediately upon determination that a crime has occurred. The patient’s permission is NOT needed to make such notification. 3. Limit the patient interview to pre-hospital medical care questioning pertinent to visible injuries or those claimed by the patient. Reenactment of the assault/incident may not be conducive to a good patient care outcome. 4. If the patient must be transported prior to the arrival of the Police Department, advise the patient not to wash or discard clothing worn during the incident. If possible and where appropriate, transport the patient with a female technician in attendance. 5. The patient is not only a victim of physical trauma, but also a victim of emotional/psychological trauma. Treat the patient accordingly. 6. All ambulances shall transport the patient to the hospital designated by the Suffolk County transport protocol and these SOPs. If a request is made to deviate from protocol, i.e., to a SANE Center, contact Medical Control at 631-689-1430. Where possible, try to honor the patient’s request concerning the destination hospital. 7. Prepare a PCR. Keep accurate records of the times, any findings and observations, and treatments rendered. 8. Avoid discussing the patient or the incident within hearing range of the patient or the patient’s family.
Paragraph 11.2.12.1: Reporting of Suspected Child Abuse or Maltreatment New York State Social Services Law requires Emergency Medical Technicians to report suspect child abuse or maltreatment they come across while performing their duties. Members who are not EMTs are not mandated reporters under the law, however they are encouraged to discuss with their Crew Chief any suspicions of child abuse they come across while responding as a member of SBVAC. Members are asked to use their “best judgment” when considering whether or not a case constitutes abuse. Line 11.2.12.1.1: Definition of Child Abuse An “abused child” is a child less than eighteen (18) years of age whose parent or other person legally responsible for his/her care: 1. Inflicts or allows to be inflicted upon the child’s serious physical injury; or 2. Creates or allows to be created a substantial risk of physical injury; or 3. Commits or allows to be committed against the child a sexual offense as defined in the penal law.
Line 11.2.12.1.2: Definition of Child Maltreatment A “maltreated child” is a child under eighteen (18) years of age who has had serious physical injury inflicted upon him/her by other than accidental means. A "maltreated child" is also a child under eighteen (18) years of age whose physical, mental or emotional condition has been impaired, or is in danger of becoming impaired as a result of the failure of his/her parent(s), or other person legally responsible for his/her care to exercise a minimum degree of care: 1. In supplying the child with adequate food, clothing, shelter, education, medical or surgical care, though financially able to do so, or offered financial or other reasonable means to do so; or 2. In providing the child with proper supervision or guardianship; or 3. By unreasonable inflicting, or allowing to be inflicted, harm or substantial risk thereof, including the infliction of excessive corporal punishment; or 4. By using a drug or drugs; or 5. By using alcoholic beverages to the extent that he/she loses self-control of his/her actions; or 6. By any other acts of a similarly serious nature requiring the aid of the Family Court. In the event that any EMT who is a member of SBVAC suspects that a child is being abused or maltreated while on duty the following steps must be performed:
1. If the EMT is not the Crew Chief on the call, he/she must inform the Crew Chief of his/her suspicions. 2. The Crew Chief shall notify the Emergency Department staff of their suspicions and findings upon arrival at the hospital. 3. The Crew Chief must document on the PCR all relevant patient assessment findings, observations, times, and treatment provided. Be as objective as possible in documenting the reasons for suspecting abuse. 4. If every EMT on the crew does not support the suspicion of child abuse or maltreatment, indicate on the PCR which EMTs are suspecting of abuse and which EMTs are not. The Crew Chief must document the suspected abuse by another EMT even if they are not suspecting themselves. 5. Immediately upon the crew returning to headquarters, a Chief Officer is to be notified who will be responsible for ensuring that this procedure is followed according to applicable protocol and law. 6. The Crew Chief shall telephone the NYS Child Abuse and Maltreatment Register at 1-800-635-1522 as soon as possible after the call. If the Crew Chief is not suspecting of child abuse, any EMT on the crew who is suspecting of abuse must call. Only one telephone call needs to be placed per incident regardless of the number of EMTs on the crew who suspect abuse. The person calling shall inform the operator if they are making a report for multiple EMTs. Oral reporting by telephone is required by law to be made immediately following the incident. 7. Form DSS-2221-A, Report of Suspected Child Abuse or Maltreatment, shall be filled out as soon after the incident as possible by the Crew Chief or EMT on the crew who is suspecting of child abuse. Only one form shall be filed per incident regardless of the number of EMTs on the crew, however the names of all EMTs suspecting of abuse should be indicated on the form. This form may be found in the NYS EMS Agency Operational Resource Guide, or on the internet. This written report must be mailed or faxed to the local Child Protective Services office within 48 hours of reporting the incident by telephone. 8. A SBVAC Incident Report shall be completed by every member of the crew and kept on file.
Line 11.2.12.1.4: Immunity From Liability Immunity from liability for reporting cases of suspected child abuse or maltreatment is provided to those individuals required to report such cases under S 419 for the Social Services Law so long as the individual was acting in “good faith”.
Line 11.2.12.1.5: Failure to Report S 420 of the Social Services Law states: 1. Any person, official or institution required by this title to report a case of suspected child abuse or maltreatment who willfully fails to do so shall be guilty of a class A misdemeanor. 2. Any person, official or institution required by this title to report a case of suspected child abuse or maltreatment who knowingly and willfully fails to do so shall be civilly liable for the damages proximately caused by such failure.
Subsection 11.2.13: Treatment of Minors A minor, in New York State, is described as a person under the age of eighteen (18) years of age. It is further described by General Obligations Law S 1-202, Domestic Relations Law S 2, and Public Health Law S 2504.
Paragraph 11.2.13.1: Consent for Medical Treatment The following is excerpted from Public Health Law S 2504:
1. Any person who is eighteen (18) years of age or older, or is the parent of a child or has married, may give effective consent for medical, dental, health and hospital services for him/herself, and the consent of no other person shall be necessary. 2. Any person who have been married or who has borne a child may give consent for medical, dental, health and hospital services for his/her child. 3. Any person who is pregnant may give effective consent for medical, dental, health and hospital services relating to prenatal care. 4. Medical, dental, health and hospital services may be rendered to persons of any age without the consent of a parent or legal guardian when, in a physicians judgment, an emergency exists and the person is in immediate need of medical attention and an attempt to secure consent would result in delay of treatment, which would increase the risk to the person’s life or health. 5. Anyone who acts in good faith based on the representation by a person that he is eligible to consent pursuant to the terms aforementioned shall be deemed to have received effective consent.
Paragraph 11.2.13.2: Treatment of Minors if Consent Cannot be Obtained Complete an assessment of the patient. Fully document all circumstances including subjective and objective findings. Attempt to contact parents or responsible parties, note any objections or refusals by the patient and all other pertinent situational facts. Include witness statements. Act in the best interest of the patient. There may be instances in which a minor appears mature enough to make an independent judgment, however legally, the minor is unable to make a decision. Common sense, prior agreements, sufficient documentation, and acting in the best interest of the patient must prevail. Contact Medical Control for assistance if necessary. Refer to Paragraph 11.2.1.4 regarding Refusal of Medical Assistance by a minor. Subsection 11.2.14: Role of On-Scene Health Care Professionals On occasion, a physician or other medical professional may be present at the scene of an out-of-hospital emergency.
Paragraph 11.2.14.1: Designated EMS Physicians The EMS Medical Director, a Medical Control Physician, or a Designated EMS Field Physician may provide on-scene medical control in accordance with Suffolk County protocols. These physicians may accompany the patient to the hospital, but are NOT obligated to do so.
Paragraph 11.2.14.2: Other Physicians In the event that a non-designated physician is at the scene and wishes to assume responsibility for the care of a patient, the physician must be properly identified. Acceptable forms of identification include, but are not limited to, a medical society card, professional organization membership card, or vehicle registration. Until proper identification has been established, the Crew Chief shall render care to the patient in the usual manner. To assume responsibility for the care of a patient, an on-scene physician must agree to assume all responsibility for the patient, document the assumption of responsibility on the PCR, and agree to accompany the patient to the hospital in the ambulance. If the on-scene physician agrees to these terms, the physician’s orders may be carried out. However, such orders must conform to the level of training of the EMT or AEMT on scene and to New York State and Suffolk County BLS and ALS protocols. Any out-of-protocol procedures initiated by a non-designated physician will remain the responsibility of that physician at the scene and during transport. Medical Control need not be contacted until the post-event telephone report, unless the EMT or AEMT is uncomfortable with the non-designated physician’s actions.
If the on-scene physician is reluctant to agree to these terms, or orders an out-of-protocol procedure, the EMT or AEMT must contact Medical Control. The Medical Control Physician will make a judgment concerning the on-scene physician’s participation and responsibility. Communication between the two physicians is encouraged. If the on-scene physician refuses to communicate with the Medical Control Physician, the EMT or AEMT must inform the on-scene physician that they may only accept the orders of the Medical Control Physican.
Line 11.2.14.2.2: Physician at the Site of a Disaster Once a scene has been declared a disaster by a county official, the orders of any properly identified on-scene physician may be followed and documented on the PCR or triage tag.
Paragraph 11.2.14.3: Role of Physician Extenders at the Scene If a “Physician Extender” (Physician Assistant or Nurse Practitioner) is present at an emergency in their usual employment setting, and requests to assume responsibility for the care of the patient, under the license of their absentee supervising physician, the “physician extender” may do so, provided that the individual has been properly identified. Acceptable forms of identification include, but are not limited to, a state registration certificate or professional society card. Until proper identification has been established the EMT or AEMT shall render care to the patient in the usual manner. The “physician extender” must abide by the terms and conditions defined for “other physicians” as stated in Paragraph 11.2.14.2 of these SOPs. A “physician extender” outside the normal setting of his/her usual place of employment may not provide on-scene medical direction.
Paragraph 11.2.14.4: Other Health Care Professionals at the Scene In any event where a health care professional other than a physician or physician extender, as specified above, is at the scene, the EMT or AEMT is to maintain responsibility for patient care.
Section 11.3: Response to Hospital Procedures
Subsection 11.3.1: Hospital Notification The receiving hospital shall be contacted via radio of the status of any incoming patient as soon as appropriate patient care and assessment has been completed.
Subsection 11.3.2: Hospital Quiet Zone The area immediately surrounding University Hospital is considered a “Quiet Zone” and the use of audible warning devices should be limited to absolute necessity only.
Subsection 11.3.3: Multiple Transports Any SBVAC ambulance may transport more than one patient at a time according to the following guidelines. At no time should any patient be permitted to sit in the front cab unless under extreme circumstances. All patients must remain in the patient care compartment of the vehicle accompanied and under the direct supervision of at least one (1) EMT.
Paragraph 11.3.3.1: Transporting Critical or Unstable Patients It is strongly recommended that only one (1) Critical or Unstable patient be transported at any given time. If under special circumstances two (2) Critical or Unstable patients may be transferred at one time. There must be at minimum one (1) EMT in the patient compartment attending to each patient with no more than five (5) total passengers in the patient compartment including both crew and patients. Up to four (4) patients may be transported at one time in the patient care compartment of the vehicle. Three (3) patients may be situated on the bench while one (1) patient is situated on the stretcher. All patients shall be properly restrained during transport. There must be a minimum of one (1) EMT in the patient compartment at all times to attend to the patients, though it is recommended that there be at least one EMT per patient if possible. There shall be no more than five (5) passengers in the patient care compartment including both crew and patients at any time. It is at the discretion of the EMT in the patient care compartment as to how many patients may be transported at once.
Subsection 11.3.4: Lights and Sirens Usage The crew chief shall determine the need for emergency warning devices while transporting the patient to the hospital. If the response to the hospital requires a higher priority response than dispatched, the EVO, when contacting MEDCOM about their status, shall also inform MEDCOM that they have upgraded their response and give the appropriate new response.
Paragraph 11.3.4.1: Opticom Traffic Pre-emption System Usage Use of the Opticom system while transporting a patient to the hospital shall be permitted only if all other emergency warning devices are being used as per Subsection 11.3.4. The guidelines in Subsection 11.1.4 shall also apply.
Section 11.4: At Hospital Procedures
Subsection 11.4.1: Arrival at Hospital All patients shall be escorted into the hospital either on a stretcher or in a wheelchair depending on their condition.
Subsection 11.4.2: Equipment at Hospital All equipment used during the course of a call shall be restocked at the discretion of the EMS office. If certain pertinent supplies cannot be restocked immediately, the Lieutenant shall be contacted.
Subsection 11.4.3: Cleaning/Decontamination and Restocking of Vehicles/Equipment At the conclusion of every call, the following procedures must be carried out prior to calling the unit back in service or responding to any other calls. If it is necessary to return to headquarters prior to completing restocking/cleaning, a “Signal 5, negative 28” may be given. The vehicle is not to be called “back in service” if it is not decontaminated and restocked in compliance with NYS DOH Part 800 requirements for minimum equipment.
1. Prepare vehicle for cleaning/decontamination: a. Always wear utility gloves throughout clean-up procedure. b. Remove used or soiled linen and place in a designated bag for laundering. c. Discard any soiled dressings, bloody materials, and other contaminated, non-sharps in a red bag and leave at the Hospital. d. Place reusable equipment that needs reprocessing in a plastic bag (any color other than red). e. Check the vehicle for any needles or other sharps which may have been left and carefully dispose in a sharps container. 2. Check for areas soiled with blood or other visible body substances and remove. a. Remove moist blood and other body substances with disposable toweling and discard in a red bag. b. Spray cleaner on affected area and remove any remaining blood or body substances. Dispose of towels in a red bag. c. Spray disinfectant on affected area, wipe over the surface, and allow to air dry. Dispose of towels in a red bag. 3. Spray cleaner on remaining surfaces with which the patient had contact as well as surfaces which were used in the course of providing pre-hospital care. Wipe the surface with toweling and allow to air dry.
4. Restock any disposable supplies used at the hospital and ensure that all essential equipment is present as required by Part 800. This includes, but is not limited to, at least one KED and at least one backboard.
Section 11.5: Post-Call Procedures
Subsection 11.5.1: Automated External Defibrillator Reporting For medical-legal, quality improvement and system wide data analysis purposes, all events where the AED is used must be reported to the EMS system. An AED event must be reported in the prescribed manner by the technician of record whenever an AED is used, regardless of whether or not the device delivers a shock. This includes cases where care is transferred to an ALS provider. The following steps outline the reporting procedure:
1. Medical Control must be contacted via telephone at 631-444-3600, as soon as possible after the call, to register demographic information. The Crew Chief is responsible for making this telephone call. 2. If the Zoll Monitor/Defibrillator was used as an AED, the Crew Chief must print the event summary within 90 minutes of the call to prevent this data from being automatically erased. The printout is obtained by pressing ‘Summary,’ followed by ‘Print Chart’ and ‘Print All’. 3. The Crew Chief is responsible for contacting any Chief after the call. The Chief will then ensure that the protocols specified in this subsection have been properly carried out and will arrange for all necessary materials to be mailed to Suffolk County EMS. 4. The hard copy of the event log (or micro-cassette tape), ECG summary and a copy of the PCR are to be forwarded to the EMS Division at the below address within 24 hours of the call. Suffolk County EMS P.O. Box 6100 Hauppauge, N.Y. 11788-0099 Att: AED Coordinator After any ALS call, or any BLS call during which a medication (such as albuterol, nitroglycerin, or epinephrine) is administered, Medical Control must be contacted at 631-444-3600 for a Post-Call Signal 34. Medical Control must also be contacted following any cardiac arrest, whether or not the AED was applied. Post-call contact must also be made after any call during which Medical Control was contacted unless it is specifically stated that a Post-Call 34 is not required.
Article XII: ALS Company Policies
These procedures shall be for company policy only and shall not supersede any state, or local policies and procedures on the administration of Advanced Life Support.
Section 12.1: ALS Credentialed Providers
Subsection 12.1.1: Credentialed AEMTs In order to become a credentialed AEMT to operate at the ALS level within SBVAC the following guidelines must be realized. All decisions on whether an individual may operate at the ALS level reside with the Chief and 1st Assistant Chief. The Chief and 1st Assistant Chief may override any stipulated guidelines. The following guidelines are based under the assumption that said individual has already gained clearance to operate in Suffolk County according to local protocol.
· Complete at least five (5) ALS calls with an approved Suffolk County preceptor. Inter-facility transports shall not be considered an acceptable ALS call. · Obtain a written statement by a Suffolk County preceptor with whom the majority of the ALS calls were performed, stating the preceptor’s professional opinion on the preparedness for said individual to operate in a solo environment. If the preceptor possesses valid reasons for no longer holding Suffolk County preceptor status and shows adequate experience in the field of EMS, the Suffolk County preceptor status requirement may be waived at the discretion of the Chief or 1st Assistant Chief.
Paragraph 12.1.1.1: Credentialing the Chief or 1st Assistant Chief In the event that the AEMT desiring to be credentialed as an ALS provider within SBVAC is the Chief, the 1st Assistant Chief and the 2nd Assistant Chief shall be solely responsible for all decisions in accordance with the guidelines stated above. In the event that the AEMT desiring to be credentialed as an ALS provider within SBVAC is the 1st Assistant Chief, the Chief and the 2nd Assistant Chief shall be solely responsible for all decisions in accordance with the guidelines stated above.
Paragraph 12.1.1.2: NYC REMAC Certified Paramedics Any paramedic that possesses a current valid NYC REMAC certification may automatically operate at the ALS level, with approval of the Chief and 1st Assistant Chief.
Subsection 12.1.1: Suffolk County ALS Preceptor Status Suffolk County ALS Preceptors shall be the only providers permitted to observe non-credentialed AEMT’s and AEMT students performing advanced skills on emergency calls or in controlled practice environments. AEMT students shall only be allowed to practice advanced skills while actively enrolled in a current EMT-CC or EMT-P class within Suffolk County. Medical Control shall be contacted during any emergency call at which an AEMT student is in the presence of a preceptor.
Paragraph 12.1.1.1: Approved Preceptors Preceptors must have written approval from the Chief and 1st Assistant Chief in order to act in the capacity of a preceptor within the company.
Paragraph 12.1.1.2: Nomination of New Preceptors The Chief, in conjunction with the 1st Assistant Chief, may choose to nominate to Suffolk EMS any credentialed ALS provider for appointment as a Suffolk County ALS Preceptor. The SBVAC shall only nominate ALS providers known to meet the requirements imposed upon potential preceptors by Suffolk EMS, including, but not limited to: · The potential preceptor must have provided active ALS service within Suffolk County for a period of at least one year. · The potential preceptor must have provided advanced care to at least twelve patients within the one-year period preceding nomination. · The potential preceptor must be free of any major incidents on record with Suffolk EMS and/or Medical Control within the one-year period preceding nomination. Section 12.2: Company Protocols
Subsection 12.2.1: Blood Glucose Determination Blood Glucose Determination will be performed adhering to the guidelines set forth by Suffolk County ALS protocols or as directed by an authorized medical control physician. The following protocols were established for the Accu-Chek Advantage glucometer. Use of the glucometer should follow the set procedures as dictated to the operators’ manual for the Accu-Chek Advantage Glucometer in accordance with Suffolk County Protocol.
Paragraph 12.2.1.1: Equipment Maintenance The Lieutenant shall be responsible for maintaining the glucometers. This maintenance includes, but is not limited to, calibration and control testing in accordance with manufacturer specifications. These checks shall be performed whenever a new batch of reagent strips is utilized. The Lieutenant shall maintain these equipment checks in the form of a written log. Any problems with ALS equipment shall be directed to the 1st Assistant Chief or the Lieutenant.
Paragraph 12.2.1.2: Clinical Protocols After determining need for blood glucose analysis and choosing a suitable site, the site shall be prepared with an alcohol or betadine prep pad. The blood shall be analyzed for glucose in the manner prescribed in the Accu-Chek owner’s manual. After analysis is complete, the patient’s blood glucose level should be recorded on the PCR and treated appropriately according to Suffolk County Protocol.
Subsection 12.2.2: Sharps No person is permitted to remove, restock, practice with, or otherwise handle any sharps if that person is not a credentialed Advanced Life Support provider with SBVAC as per Section 12.1. This includes students in EMT-CC courses and AEMTs who are not cleared for ALS.
Paragraph 12.2.2.1: Restocking of Sharps The Chiefs and the Lieutenant may handle sharps if they are not credentialed ALS providers for the purposes of restocking only.
Paragraph 12.2.2.2: Disposal of Used Sharps Any person who discovers used sharps that have not been properly disposed of may place them in a sharps container as per Section 14.3.
Paragraph 12.2.2.3: AEMT Students AEMT students may handle and practice with sharps only while under the direct supervision of a Suffolk County ALS Preceptor who is also a credentialed ALS provider for SBVAC.
Subsection 12.2.3: Contact with Medical Control Although “O2/IV/Monitor” is the standard of care for EMT-CCs and EMT-Ps and does not require routine on-line contact with Medical Control, such on-line contact is still required whenever a patient fits a protocol, exhibits abnormal vital signs or EKG, presents with a cardiac, respiratory or neurological chief complaint, or in any other situation where the AEMT determines that physician consultation is in order. In any situation, on-line contact with Medical Control is required by Suffolk County Protocol within 20 minutes of initial patient contact.
Paragraph 12.2.3.1: Post-call Signal 34 Medical Control must be contacted at the completion of any call during which an ALS intervention or diagnostic procedure was performed.
Paragraph 12.2.3.2: Catastrophic Communications Failure In the event of Catastrophic Communications Failure, as defined by Suffolk County protocols, on-line contact with Medical Control is no longer necessary. Standing Orders as well as Medical Control Options which the AEMT reasonably believes will benefit the patient may be carried out. All interventions must be documented appropriately on the PCR. Only Suffolk County EMS may declare a state of Catastrophic Communications Failure, and MEDCOM will notify SBVAC in the event one is declared.
Subsection 12.2.4: Endotracheal Intubation Prevention of unrecognized esophageal intubation is of paramount importance and is a medical and legal necessity. Therefore the use of an End-Tidal CO2 monitor, an ET tube verification device (such as a Tube-Check bulb), AND immobilization of the head are required on ALL endotracheal intubations performed in Suffolk County.
Subsection 12.2.5: ALS Equipment in Personal Vehicles As per Suffolk County protocol, except as provided for in the next paragraph, ALS personnel are NOT authorized to carry any item that requires a physician’s prescription in their private vehicle. Such items include, but are not limited to, needles, syringes, medications, and defibrillators.
The only circumstance under which such equipment may be legitimately carried in a private vehicle is when the vehicle operator is serving in the capacity of an “ALS first-responder” for SBVAC. The ALS equipment may be carried ONLY with the prior knowledge and approval of the Chief’s Office. All such ALS equipment must be able to be used under protocols applicable to the AEMT’s level of certification, and MUST include, but is not limited to, IV administration supplies and fluids, monitor/defibrillator, endotracheal intubation equipment, telemetry equipment, and communications equipment. The AEMT operating the vehicle shall be responsible for all equipment and medications, and must ensure that they are operational and non-expired.
Subsection 12.2.6: Patient Transfer Protocol A New York State certified EMS provider with a higher level of certification may transfer responsibility for the ongoing care of a patient to a provider with a lesser New York State certification if the following conditions are met:
1. The provider with the higher level of certification must have assessed the patient and made an affirmative decision to transfer care of the patient to a provider with a lesser certification. 2. The provider with the higher level of certification must have made the determination that the patient will not require any care or skills which would be possessed by the provider with the higher level of certification and not possessed by the provider with the lesser level of certification. 3. The provider with the lesser level of certification must agree to assume responsibility for patient car. If the provider with the lesser level of certification refuses to accept that responsibility, the provider with the higher level of certification must continue to care for the patient until the transfer to the hospital is complete. 4. If either provider who is a party to the transfer has any questions concerning the appropriateness of the transfer they must contact Medical Control for a physician consultation. 5. The patient transfer must be documented on the PCR.
Subsection 12.2.7: Securing of ALS Equipment, Medications and Sharps in Vehicles All ALS supplies, with the exception of medications approved for use by EMT-B’s, are to be secured in a locked cabinet on the vehicle at all times when they are not in use.
Paragraph 12.2.7.1: Exceptions The Lieutenant and the 1st Assistant Chief may, at their discretion, decide to stock certain ALS supplies outside of the locked cabinets, so long as these supplies do not contain sharps or medications. Examples may include, but are not limited to, intravenous fluids, administration sets and endo-tracheal tubes.
Paragraph 12.2.7.2: ALS Keys Keys to the locked ALS cabinets on the vehicles shall only be given to and carried by credentialed AEMTs as per Section 12.1 of these SOPs, the Lieutenant, and the Chiefs.
Subsection 12.2.8: Securing of ALS Equipment, Medications and Sharps in Headquarters All ALS supplies that are stored in headquarters shall be secured behind the locked cage in the equipment room. Only Officers have access to this area for the purpose of restocking BLS supplies, however only credentialed AEMTs as per Section 12.1 of these SOPs, the Lieutenant, and the Chiefs are permitted to handle ALS medications and sharps.
Article XIII: Multiple Casualty Incident Procedures
The procedures followed during the course of an MCI shall follow all applicable New York protocols in addition to any other training received such as Incident Command Systems. SBVAC shall participate in Suffolk County’s Multiple Casualty Incident and Disaster plan, and shall operate under Suffolk County’s Disaster and MCI Management procedures. Copies of these procedures are available from any officer. 1. Upon arrival to the scene of the emergency call, the Crew Chief on duty shall make the determination of need. 2. MEDCOM shall be notified immediately of the situation and updated constantly as to the development of the situation including all area locations. In addition, MEDCOM shall be instructed to tone out all line officers to respond to the scene, and a request for any available personnel to respond to Headquarters to standby. 3. MEDCOM shall also be instructed to request mutual aid for any necessary units along with a description of the amount requested, i.e. 5 Ambulances, 2 Heavy Rescue Units, etc. 4. Command Post shall be set up and an Incident Commander (IC) appointed. The IC shall be the on-duty CC until relieved as stipulated in Section 6.4, or until responsibilities are passed off.
Article XIV: Infection Control Procedures
Infection Control Procedures shall be consistent with current guidelines for emergency workers as most recently published by the Centers for Disease Control and Occupational Safety and Health Administration.
Section 14.1: OSHA Bloodborne Pathogen Regulations As per OSHA Bloodborne Pathogens Regulations (29 CFR 1910.1030), all members must wear protective equipment.
Subsection 14.1.1: Body Substance Isolation BSI protection should be selected with careful considerations for each specific situation, and the overall risk associated with the task. Factors to consider during evaluation include type of body fluid and volume of blood or body fluid.
Section 14.2: Universal Precautions/Body Substance Isolations
Paragraph 14.2.1.1: Body fluids Body fluids are defined as blood, sputum, saliva, semen, vaginal secretions, wound draining, amniotic fluids, breast milk, tears, urine, and feces.
Paragraph 14.2.1.2: Exposure Exposure is defined as the actual direct contact to the above secretions. Potential exposure is defined as to the potential for an exposure to occur. Clinical judgment enters into all decisions.
Subsection 14.2.2: Responsibility All members are responsible for complying with these policies.
Subsection 14.2.3: Procedures 1.) Protective attire is to be used to prevent accidental exposure to blood and other body fluids. a.) Gloves must be worn when touching mucus membranes or non-intact skin of all patients and changed between all patient contacts. b.) Gloves must be worn when having contact with blood or body fluids and when handling items containing or contaminated with blood or body fluids. c.) Gloves must be worn for performing venipuncture and other vascular access procedures.
d.) If a glove is torn or a needle stick or other injury occurs which will decrease the ability to function as a barrier during an invasive procedure, the glove must be changed as promptly as safety permits, and the needle or instrument removed from the sterile field. e.) If splashing of blood or other body fluids is likely to occur, and eye, nose or mouth contamination can be reasonably anticipated, protective eye coverings must be worn, in addition to a mask, gloves, and a gown or other protective clothing. 2.) All procedures involving blood or other potentially infectious body fluids shall be performed in such a manner as to minimize splashing, spraying and generation of droplets. 3.) Gloves, surgical masks, and protective eyewear must be worn for all invasive procedures. Invasive procedures include all procedures that commonly result in generation of droplets, splashing of blood or body fluids, or generation of bone chips. Gowns or aprons made of materials that provide an effective barrier must be worn during invasive procedures. a.) An invasive procedure is defined as surgical entry into tissues, cavities, or organs. Repair of traumatic injuries: i.) The manipulation, cutting or removal of any oral or perioral tissues during which bleeding or potential for bleeding exists. ii.) A vaginal or caesarian delivery or other obstetric procedures during which bleeding may occur. a.) Gloves, gowns, and face shields must be worn when handling the placenta or newborn infant until blood and amniotic fluids have been removed from the infant’s skin. Gloves should be worn during post delivery care of the umbilical cord. 4.) Hands and any other skin must be washed thoroughly and immediately with soap/water or waterless soap, or flush mucous membranes if accidentally contaminated with blood or body fluids. Hands must be washed immediately or as soon as possible after the removal of gloves and/or other personal protective equipment. 5.) All BSI shall be removed prior to leaving the work area. It must be placed in the appropriate designated area of disposal receptacle. 6.) Contaminated sharp items (needles, and other sharp instruments) should be considered as potentially infectious and be handled with extraordinary care to prevent accidental injuries. 7.) Disposable syringes and needles and other sharp items should be placed into puncture resistant containers. To prevent needlestick injuries, needles should not be recapped, purposefully bent, broken, clipped, or otherwise manipulated by hand. 8.) Resuscitation bags or mouthpieces are to be used in place of mouth-to-mouth resuscitation and must be readily available where they are likely to be needed. 9.) Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in the work areas where there is a likelihood of occupational exposure. 10.) Food and drink shall not be kept on shelves, in cabinets, or on counters where blood or potentially infectious material is present. 11.) If a percutaneous (e.g. needle stick, bites, lacerations, etc.) ocular, mucous membrane, or open skin lesion exposure to blood or body fluids occurs, immediate evaluation for necessary management is required. This includes the filing of an Incident Report. 12.) When caring for and/or performing a procedure on an uncooperative/combative patient, caution should be taken to prevent exposure to blood or body fluids. Assistance should be utilized in these situations. 13.) All equipment and environmental and working surfaces shall be cleaned and decontaminated after contact with blood or other potentially infectious material. 14.) Hospital shall be notified of the need for isolation prior to bringing patient into the hospital.
Section 14.3: Disposal of Needles and Syringes (Sharps) All needles and syringes should be disposed of immediately to prevent accidental injury.
Subsection 14.3.1: Procedures 1.) Personnel should exercise meticulous care when handling syringes and needles contaminated with blood. Accidental needlesticks should be avoided. If an accident occurs, it should be reported to the 2nd Assistant Chief and an Incident Report filed. Follow up will be done by the company or personal physician. 2.) Disposable needles and syringes are used and never reused. 3.) Used needles should not be purposely bent, because an accidental needle puncture may occur. They should be immediately discarded in the impervious puncture resistant container located in each ambulance. These containers shall be puncture resistant, leak proof on the sides and bottom, and have a biohazard label. 4.) Filled puncture proof containers should have the top locked on the opening. Drop off container at the hospital when full. Equipment and Supply Officer (60) shall arrange regular assessment of need.
Section 14.4: Care of Equipment Used in Isolation All equipment touched by the patient and personnel providing care for the isolation patient must be cleaned, disinfected, and sterilized before being used on another patient.
Subsection 14.4.1: Procedure All equipment removed from the ambulance must be bagged and arranged for drop off at hospital. Consult the Lieutenant or 2nd Assistant Chief for details.
Section 14.5: Blood Spill Policy Cleaning of all spills consisting of blood or body fluids must be done in such a manner as to avoid contamination of other surfaces.
Subsection 14.5.1: Procedures 1.) Spills of blood or body fluids are to be covered with chlorinated encapsulating powder as soon as it is noticed. 2.) The person cleaning the spill will wear gloves and a mask with face shield. 3.) After the congealed product of the spill has been removed and placed in a red plastic bag for disposal as regulated medical waste, the area is to be decontaminated using an approved disinfectant that is tuberculocidal when used at recommended dilutions. 4.) The mop head is to be changed and red bagged for transport to a storeroom for laundering. 5.) The mopping bucket and mop handle is to be decontaminated immediately following use. 6.) Reusable latex gloves are to be decontaminated prior to removal, and hands are to be washed immediately following removal.
Section 14.6: HIV Positive Health Care Workers In accordance with principles and recommendations by the New York State Department of Health, January 1991 Policy statement, the SBVAC has adopted the following guidelines. 1.) HIV infected health professionals may continue all professional practices for which they are qualified with strict adherence to infection control practices. 2.) Limiting the practice of HIV infected Health Care professionals is not necessary unless: a.) There is clear evidence that the worker poses a significant risk of transmitting infection through the inability to meet basic infection control standards. b.) They are functionally unable to care for patients based on the individual’s ability to perform up to generally accepted standards and practices expected of all health care personnel. 3.) Decisions about the work responsibilities of HIV infected health care workers with functional impairment or lack of infection control competence will be made on a case-by-case basis involving the worker’s personal physician. 4.) Education of health care personnel regarding the following principles should be performed: a.) Health care workers are encouraged to learn their HIV status to protect and improve their own health. b.) HIV infected individuals are encouraged to seek periodic evaluation for functional limitations that could significantly compromise quality of care. c.) HIV infected health care workers are encouraged to inform the SBVAC when there is a significant risk of comprised patient care. 5.) The SBVAC is not required by New York State Law to disclose information to patients about HIV infection in personnel. 6.) In the event a situation warrants disclosure, a workers written consent to release information must be obtained. The disclosure to the patient will not identify the infected worker. The New York State Department of Health (DOH) will be informed if disclosure of information is to be done, and the DOH will provide technical assistance.
Section 14.7: Periodic Cleaning of Rescue Vehicles The interior and exterior of the ambulances shall be cleaned periodically according to the following guidelines:
1. On a weekly basis, the floors, walls, interior and exterior cabinets and drawers, benches, and other surfaces will be cleaned thoroughly. 2. The vehicle shall be cleaned using the same cleaning agent as used between responses and after transports. 3. A cleaning supply kit containing household utility gloves, plastic spray bottle with cleaning agent, plastic spray bottle with disinfecting solution or a bottle with concentrated household bleach to be diluted with water (1:100), disposable towels, plastic bags (red bags and household plastic bags) and a carrying device for the cleaning supplies, shall be kept in a central location. The Lieutenant will be responsible for maintaining these supplies. 4. Carpeting and permeable seat covers are not permitted in the patient compartment of ambulances due to the difficulties encountered in keeping them clean and sanitary. 5. A designated disinfecting area shall be assigned for all medical equipment cleaning and disinfecting. Dirty or contaminated emergency medical equipment shall not be cleaned or disinfected in fire or ambulance station’s kitchen, living, sleeping or personal hygiene areas. 6. Appropriate protective infection control garments and equipment, such as fluid resistant clothing, splash-resistant eyewear, and medical gloves, shall be used whenever there is a potential for exposure to body fluids or potentially infectious material during cleaning and disinfecting. 7. All disinfectants shall be registered and approved for use by the U.S. Environmental Protection Agency and shall be registered as tuberculocidal. 8. Dirty or contaminated run-off from emergency medical equipment and cleaning and disinfecting solutions shall be disposed of into a sanitary sewer system. 9. Metal, electronic equipment, and emergency medical equipment shall be cleaned and disinfected according to the manufacturers’ instructions. 10. Reusable emergency medical equipment that comes in contact with blood or other bodily fluids shall require cleaning and high level disinfecting as per manufacturers’ suggestions. 11. Environmental surfaces shall be cleaned and disinfected as per manufacturers’ suggestion.
Any member may take Continuing Medical Education courses. The details of the CME should be brought forth to the Captain. Members wishing to partake in a CME should make every attempt to allow advanced notice to the Captain so as to ensure placement in the CME class.
Section 15.1: Interdepartmental Drills These drills may involve outside agencies. These drills require the express permission of the Chief’s Office with collaboration of the Captain.
Article XVI: Special Events Coverage
Any agency requesting the service of ambulance coverage must submit a written request to the SBVAC office detailing date, time, and type of event at least two weeks prior to the event.
Section 16.1: Emergency Care at an Athletic Standby
Section 16.2: Transporting at a Standby
Section 16.3: Documentation at Mass Gathering Events When SBVAC provides a standby crew for a large event, such as a concert, where many patients are anticipated, a mass gathering event patient log must be kept on the NYS approved form. This form may be found in the NYS EMS Operational Resource Guide. Every patient treated or transported must be logged on this form regardless of whether a PCR is completed. A PCR must be used for any patient who is transported, or any patient the Crew Chief believes needs to go to the hospital but refuses transport. The patient log must be treated like a PCR and kept on file using the same procedures.
Article XVII: Health Standards
Section 17.1: Yearly physical All members are required to have a yearly physical to ensure that they are in a fit state to work on an ambulance. The physical will in no way serve to prevent any person from membership, but rather to help identify level of activity that can be safe for the member.
Section 17.2: Ill or Injured Member If any member of the SBVAC becomes injured due to events outside of the SBVAC, they shall be put on a medical leave of absence until a physician deems them fit for active service.
Section 17.3: Member Health Records Member health records will be maintained on all members who are active personnel with the SBVAC. This record shall include the following as outlined in the NYS EMS Program Policy Statement Number 88-8: 1. Pre-employment physical examination; 2. Immunization record and screening results; 3. Record of member occupational injuries or illnesses and their course, i.e.: compensation forms filed, Physician’s record, hospital record, etc.; 4. SBVAC incident reports pertaining to member exposure to suspected hazardous materials, toxic products, or true exposures to infectious diseases; 5. Record of annual physicals; 6. Record of Physician’s approval to return to active duty after debilitating illnesses or injuries.
Subsection 17.3.1: Pre-employment Physicals Pre-employment health physicals and screening, as outlined in the NYS EMS Program Policy Statement Number 88-8, shall be required for all members beginning service after September 1, 2002. Members who began active service prior to this date will be offered the opportunity to participate in any agency provided testing or inoculation program.
Subsection 17.3.2: Tuberculosis Testing Routine yearly tuberculosis (TB) testing will be required for all members having contact with patients. For those who have converted their skin test, this SOP will be waived. Instead, an initial chest x-ray will be obtained and appropriate counseling provided regarding the need to report any signs or symptoms of TB. Further chest x-rays will only be obtained when determined necessary by our agency’s Medical Director.
Subsection 17.3.3: Storage of Member Health Records Members’ health records shall be stored in a secured location separate from the personnel files. Members’ health records shall be considered extremely confidential. As such, access to members' health records shall be restricted to the Vice-President and the Chief’s Office. These files are to be accessed only as necessary strictly to update the information contained within, or for reference in the event of an emergency.
Section 17.4: Hepatitis B Vaccination SBVAC shall offer Hepatitis B vaccinations to all new members at no charge. Any member who chooses not to receive this vaccination must either provide proof of immunity to Hepatitis B or sign a vaccine declination form. This form shall be kept with the member’s health record.
Section 17.5: Required Fit Testing All members shall be fit tested yearly for N95 respirators (HEPA masks) and full-face air purifying respirators (gas masks). Fit testing shall be conducted more frequently for members suspected to have changed mask sizes due to the gain or loss of weight or other factors.
Subsection 17.5.1: Facial Hair Members shall not be permitted to have facial hair that interferes with the proper fit and seal of an N95 or full-face respirator.
Article XVIII: First Responder Vehicle Section 18.1: Location
Section 18.2: Categories of Response Under this category, members who are approved to sign-out 5-35-80 from headquarters and use it to respond to calls must remain within 2 miles of the following borders: No further north than Route 25A, no further south than Oxhead Rd, no further west than Stony Brook Road, and no further east than Nicolls Rd. The operator must respond to every ambulance call and attempt to coordinate the response of the ambulances. The vehicle should be refueled before it is returned to the station.
Subsection 18.2.2: Secondary Response Response under this category applies to alarms in which 5-35-80 responds with the ambulance or 5-35-80 responds to a second ambulance call. Unit 5-35-80 will be staffed at minimum with an approved crew chief/driver. Only one additional personnel may respond in 5-35-80.
Subsection 18.2.3: Non-Emergency Use While not intended for company business, Unit 5-35-80 may be assigned as needed by the Chief’s Office to handle EMS business that is not associated with an alarm. Under this category, minimum staffing requirements are not in effect, but every attempt should be made to have Unit 5-35-80 staffed with a crew chief/driver. There is no need, under this category, for the operator of the vehicle to be a qualified crew chief/driver.
Section 18.3: Users of 5-35-80 a. Have a valid EMT certification or higher. b. Be a valid crew chief and driver who are approved by the Chiefs of SBVAC to operate the first responder vehicle. c. Consistently demonstrate the ability to be responsible and prudent when operating at alarms. At incidents such as MCI’s, Unit 5-35-80 should act as the EMS command post. It should be parked as close to the incident command post as possible, or where designated.
Section 18.5: PCRs
Section 18.6: Vehicle Check
Section 18.7: Mutual Aid
Section 18.8: Suspension of Privileges
Section 18.9: Fuel Level
Section 18.10:Vehicle Log
Section 18.11: Alpha Responses Unit 5-35-80 may respond to Alpha calls at the discretion of the user provided there is a full crew on-duty.
Section 18.12: Officer On-Call An officer approved by the Chiefs of SBVAC to use 5-35-80 for the purposes of Officer On-Call may utilize 5-35-80 during the time period that the Officer is On-Call. Such Officer On-Call may respond to calls at their discretion provided there is a full crew available to respond. If the Officer On-Call responds to an emergency call with 5-35-80 they may not utilize any of the emergency warning devices unless they are an approved user of 5-35-80. The Officer On-Call must also obey all guidelines set forth by Article 17.
Section 18.12: Radio Identifier When 5-35-80 is transporting one or more operational line officers, the radio identifier of the highest ranking officer being transported may be used for all radio communications.
Article XIV: Summer Service
The Summer Crew shall consist of members receiving subsidized housing and members living elsewhere who volunteered to take part in summer service. All standard operating procedures should be followed with exceptions listed herein.
Section 19.1: Application for summer service All active members in good standing interested in summer service, both those requesting subsidized housing and those living elsewhere, shall fill out the summer service application. The form is to be given to the Vice President. The Chiefs, President, and Vice President shall review all requests and will determine which members, based on standing, rank, and seniority, in SBVAC fulfill requests for subsidized housing. If the member does not remain in good standing and does not fulfill all of the semester’s requirements before the end of the semester, their housing shall be forfeited.
Section 19.2: Duties of the Members in Summer Service
Subsection 19.2.1: The On-duty Crew The on-duty crew shall consist of no more than a Crew Chief, Driver, and two (2) attendants. A person of higher rank may be substituted for any position as long as the crew size is four (4) persons or less. Each member receiving subsidized housing is required to serve 40 hours per week or as coverage is needed for their specific position. The on-duty crew shall stay within the assigned residence hall or, if they choose to leave the hall, they must stay together at all times. This crew can go anywhere within SBVAC's response district as per Section 18.2.1 with the following change: the crew may only travel a distance of one mile outside the stated borders. All members receiving subsidized housing shall be required to do weekend shifts. The shifts will be divided evenly between these members as needed by their position. The weekend schedule shall be posted in a predetermined spot or distributed to all members no later than the Wednesday prior to the weekend at 2359 hrs. It shall be the responsibility of the Vice President to complete this schedule. If the Vice President is not present as part of the summer crew, it shall be the responsibility of the President to complete this schedule. If the neither the Vice President or the President are not present as part of the summer crew it shall be the responsibility of the highest ranking operations officer or their designee to complete.
Subsection 19.2.3: Maintaining of Equipment and Vehicles At least once a day the vehicles must be checked for equipment and fuel. This duty is to be rotated among the shifts. At least once a week the vehicles will be washed inside and out. This duty will be rotated among the weekend shifts.
Subsection 19.2.4: Standbys If a standby is necessary, a second crew other than the duty crew will be assigned if the second ambulance is available. If not, then the on-duty crew shall attend the standby.
Subsection 19.2.5: Second calls In the event of a second call, all available personnel are to respond to the second ambulance and the first full crew to arrive at the ambulance shall respond.
Section 19.3: Dorm Residence Conduct Code All SBVAC in-quarters residence members shall follow all school rules for summer housing as stated in the Student Conduct Code and the Division of Campus Residences policy manual.
Section 19.4: Dress Code The dress code for summer service shall be the same as per Section 4.4 of the SBVAC SOPs.
Section 19.5: Pagers Pagers will be assigned to individual members. If a room has two SBVAC members of whom only one (1) has a pager, the issued pager shall be loaned to the other member for the duration of their shift. The member initially responsible for the pager still retains the responsibility of the pager. If an excess of pagers are available, they will be distributed to the members based on rank and seniority.
Section 19.6: Officer Meetings Officer meetings shall be held at least biweekly or as needed at a time convenient for the majority of the officers present on summer crew.
Section 19.7: Training
Subsection 19.7.1: CC training CC training shall occur at the discretion of the 1st Assistant Chief or Chief.
Subsection 19.7.2: Driver training Driver training shall occur at the discretion of the 2nd Assistant Chief or Chief.
Subsection 19.7.3: Training sessions Training sessions are optional for the summer crew and shall occur at the discretion of the Captain or Chief. All members shall adhere to any training requirements established for the summer. Failure to comply with the training requirements can lead to, but not limited to, the removal of summer housing, disciplinary action, suspension, and dismissal from SBVAC.
Last updated on 07/03/2002 00:23:55
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