4
FTP
MILFORD AMBULANCE SERVICE
Current Member Training Programs
Field Training Program –
SERVICE OFFICER TRAINING
MILFORD AMBULANCE SERVICE
Field Training Programs
 Town of Milford Ambulance Service
Prepared by: Christopher Rousseau NREMT-I
1 Union Square Milford, NH 03055
Phone 603.673.1087 • Fax 603.673.2273
Table of Contents
Phase I
Lesson One: Introduction
2
Lesson Two: Communication
4
Lesson Three: Affective Domain
8
Lesson Four: Performance Problems 12
Phase II
10
Lesson One: Alcohol /Drugs in the
Workplace
21
Lesson Two: Do’s and Don’ts
22
Lesson Three: Officer Responsibilities 24
Phase III
16
Lesson One: MCI System
26
Lesson Two: Writing Policies
55
Lesson Three: Investigations
58
Lesson Four: Workplace Accident
61
Final Written Exam
66
Appendix
21
Performance skill sheets
22
Index
28
1
1
Phase
LESSON ONE – Introduction and
Successful completion
This manual and training program has been divided into 3 phases, which consist of several lessons to
be completed within each phase. New Service Officers should follow the format of this manual and
complete the phases in the order in which they are presented
T
he following program, known as the Field Training Program, here on in referred to as the FTP, is designed to
facilitate the training of new service officers in departmental rules and regulations and to educate them on how to
manage and operate the service both in conjunction with the director and in his/her absence.
It is understood that some new officers will be coming from other services with prior experience. While it may not be
necessary for them to demonstrate all skills in all phases of this program, they will be required to complete certain Milford
Ambulance procedural sections and show proficiency in those areas. The Director will approve members authorized to
complete an abbreviated FTP.
The FTP is an orientation program designed for the new service officer, however, as noted above - certain aspects of the
program can be used to orient new 'experienced' officers to service policies and procedures. The manual has been written
to incorporate didactic, or call experience with the elements outlined in this manual to maximize learning, skill application
and retention.
Congratulations on becoming an Officer with the Milford Ambulance Service. The position that you have just
undertaken will prove to be an exciting and fulfilling one. It will also come with many more responsibilities than
you have been accustomed to in conjunction with the Service.
Several recent studies have shown that a leading cause of employee unrest and dissatisfaction is not due to
poor compensation or lack of challenging work, but poor management practices by those directly above them.
Consider these findings ...

A 1999 Saratoga Institute study found that at least 50% of employee job satisfaction is determined by the
relationship a worker has with his/her boss.

A 2000 study reported, "After 20 years of research and 60,000 exit interviews, 80% of all employee turnover
can be related to unsatisfactory relationships with the boss." Clearly people don't quit their company as
much as they quit their boss!

The Gallup Organization, in a long-term study of over a million employees in a broad range of
companies, industries and countries, concluded that the length of an employees stay with their organization and
how productive they are while they are there, is determined by their relationship with their immediate supervisor.

The Human Resource Institute recently asked 312 companies to rate the most pressing people issues
faced in their company today. Leadership was the most critical issue to be addressed; with over 70% of the
companies saying it is extremely important!
The good news is that when leadership practices improve, people will stay put and produce more, saving
organizations millions of dollars each year!
Without proper guidance and training this position can become an overwhelming one for many. It is with this in
mind that this training manual was created. This manual will strive to assist you, the new Officer, by giving you a
structured framework from which to base your decisions and help you become an asset and valued member to the
Service.
You will receive the following materials with this program:
1. Officer’s training manual;
2. Situations manual;
Your successful completion of this program will depend on the following:
1. Attendance and completion of the program;
2. Pass the written Officer’s examination
Milford Ambulance Service Officer’s Training Manual
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I C O N
K E Y
 Valuable information

Video
 On-line situations
 On-line quiz(s)
throughout this manual, you will find the above icons. Each one depicts a special feature of this
manual that you, as the trainee, will find extremely helpful in successfully completing this training program. Each one is
specially designed enhancement to provide useful information to a wide range of learning styles.
How to use the icons:
Milford Ambulance Service Officer’s Training Manual
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LESSON TWO – Communication and
Feedback
Cognitive Goals
At the completion of this module the Officer should be able to:
1. Describe the process of active listening
2. State the importance of timely feedback
3. Compare and contrast counseling and evaluation
4. Describe several unique types of questioning that could be used to solicit attendant responses
5. Explain how body language affects one’s verbal communication reception
6. Recognize the need to check for understanding when giving attendants information
7. State the benefits of honest communication in the EMS environment
Psychomotor Goals
At the completion of this module the Officer should be able to:
1. Demonstrate active listening during a role-play exercise;
2. Employ the use of the pause when questioning students in a role-play exercise;
3. Demonstrate the proper use of positive and negative feedback in a counseling scenario;
4. Demonstrate the use of questioning techniques to solicit attendant responses in a mock EMS call;
5. Model body language that is recognized as open, interested and positive.
Affective Goals
At the completion of this module the Officer should be able to:
1. Support the need for positive communication in the EMS environment;
2. Encourage open communication within the Service;
3. Value the need for honesty in everyday communications.
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Declarative
I.
Why this module is important
A.
The ability to communicate well is a key skill for the EMS Officer to possess
1.
II.
It is also a key skill for an EMS provider
B.
Good communication ability is an aspect of professionalism
C.
Many problems within the Service will be caused by, or contain an element of, miscommunication
Communication in the EMS setting
A.
The Officer should create a positive environment for communication
B.
We communicate with people when the subject is both positive and negative, during brainstorming
and problem solving
C.
Praise in public and punish in private
1.
D.
E.
F.
G.
Catch people doing things right, and praise them for good behavior
Feedback
1.
Provide feedback as immediately as possible after the action
2.
Provide feedback about both positive and negative behaviors and performance
3.
Try to begin with positive statements, cover the negative information (via constructive
criticism) and then end on a positive note
Employ active listening
1.
Listen to what another is saying
2.
Listening is a difficult skill to develop, especially when you are engaged in the conversation
and are thinking of a response
3.
Paraphrase and repeat back what was said to verify your own understanding of the message
that you received
Check for understanding in the message you send
1.
Ask the receiver to rephrase what you said
2.
Provide more information as needed for clarification
Use open body language
1.
Hands and arms relaxed
2.
Comfortable personal space
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III.
3.
Give your full attention to speaker
4.
Neutral or positive facial expression
Questioning techniques to use in the field
A.
The "pause"
1.
Ask a question and then wait several seconds for a reply
2.
Used to add emphasis, allow time to process information, or to formulate a response
3.
Helpful when attendants are not focused on you as they will notice the silence and redirect
attention
4.
Allow attendants an equal amount of time to think (think time) before you begin to answer
the question or ask another attendant to answer
a.
Studies have shown that instructors will allow longer think times for students they
believe can actually answer the question
In a classroom setting (the Officer as a teacher)
B.
Calling on students in class
1.
Checks an individual’s level of recall or understanding
2.
Do not always call on the first one with a response
3.
Do not let the fastest replying student dominate the class
4.
Do not single out an individual student
5.
a.
Go around the room in a pattern
b.
Use a prop to pass around with each answer
c.
Work alphabetically through your roster
d.
Draw names or numbers from a hat
Watch the students to determine how comfortable they are with this technique as this may
intimidate shy students
a.
If you establish up front when they can expect to be called upon by using one of the
techniques listed above they may be less anxious
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C.
D.
Open ended questions
1.
Invites dialogue and discussion
2.
May be used to evaluate critical thinking
Move students into small groups for an initial discussion then ask them to report consensus points
to entire group
1.
E.
IV.
Make sure you circulate around the room and ensure students stay on task
Facilitation and coaching
1.
This can be accomplished through individual or small group work
2.
This is a very intensive method of evaluating students
Counseling attendants
A.
Involve appropriate members of the Service while also assuring confidentiality for the attendant
1.
Medical director
2.
Director
3.
Other Service Officers
4.
A full-time staff members
B.
Begin with a friendly greeting
C.
State the facts of the behavior or performance issue, as they are known to you
D.
Allow the attendant an opportunity to explain the situation from their perspective, what he or she
was thinking, and reasons for their action
E.
Confirm they understand the problem, check that you have all the facts, ask for clarification if
needed
F.
State and explain rules, regulations, laws, and standards which govern the behavior and any
consequences
G.
Work together to create a plan of action or intervention
1.
H.
May result in a learning or behavior contract
Review what has been covered, discussed and decided
I.
Close with a positive and supportive message
J.
Document the session in writing
1.
Provide copies to the Director and one for your file
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V.
2.
Inform the attendant of the individuals who received this information
3.
Put a copy of the document in the appropriate attendant file as per MAS policies
4.
Always document, even if you consider it a minor infraction, so you have these documents
as support if problem continues
Use professional ethics in EMS communication
A.
Always be honest
B.
Protect confidentiality
C.
Address people directly
D.
Treat people how you want to be treated

NOTE TO TRAINEE
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LESSON THREE – Affective Domain
Cognitive goals
At the completion of this module the Officer should be able to:
1. Use his or her own words to provide a definition of the affective domain
2. Give examples of attendant behaviors that illustrate desired behaviors or changes in behavior in the affective
domain
3. Within the context of EMS practice, identify examples of affective domain behaviors
Psychomotor goals
There are no psychomotor objectives for this module
Affective goals
At the completion of this module the Officer should be able to:
1. Acknowledge the need to teach to the affective domain
2. Support activities that teach and evaluate the affective domain
3. Value the affective domain of performance for the EMS professional
Declarative
I.
Why this section is important
A.
The affective domain deals with personal issues: attitudes, beliefs, behaviors and emotions
1.
Educators believe it is one of the most difficult areas of thinking to influence
2.
Some educators believe that we cannot influence persons in this area
B.
Officers must carefully cultivate the ethics and values of our profession while setting aside our
personal beliefs and emotions
C.
Officers must understand the degree of responsibility we accept when we step into this
administrative position
1.
We have a strong influence on our attendants
2.
They learn from and model our behaviors
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II.
Terminology and descriptions of the affective domain
A.
B.
III.
Definition of affective domain
1.
The development of judgment used to determine how one will act
2.
The area of education and performance concerned with attitudes, beliefs, behaviors and
emotions
Words that describe the affective domain
1.
Defend
2.
Appreciate
3.
Value
4.
Model
5.
Tolerate
6.
Respect
Importance of affective domain in EMS
A.
The affective domain helps develop professional judgment
1.
Judgment often determines excellence
B.
Ability determines capability and attitude determines performance
C.
The affective domain skills often make up the patient’s perception of the quality of care received
D.
Ideal characteristics include:
1.
Kindness
2.
Honesty
3.
Compassion
4.
Knowledgeable
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IV.
Every patient and professional encounter in EMS uses all three domains, including affective
A.
V.
For example:
1.
Appreciating patient’s pain level and requesting a morphine order
2.
Respecting patient’s modesty and covering him or her with a sheet
3.
Defending or respecting patient’s right to refuse care
4.
Modeling responsible behavior given the autonomous setting of pre-hospital care
Levels of understanding within the affective domain
A.
B.
C.
D.
Receiving
1.
Awareness of the information or value you are presenting
2.
Willingness to receive the information
3.
Attention to the information
Responding
1.
A command response involves doing what is asked when required
2.
A willingness response involves doing the right thing the right way when asked or when
given other choices
3.
Satisfaction in response is when the attendant voluntarily does what is right and feels
satisfaction
Valuing
1.
Acceptance of a value shows that the attendant is aware that the behavior has worth
2.
A preference for a value shows that the attendant selects this behavior over others when
given a choice
3.
A commitment to a value means that the attendant always behaves this way and can defend
or encourage this value in others
Organization
1.
The integration of different beliefs based on experience
2.
Good judgment comes from experience
a.
E.
Experience often develops out of bad judgment or poor decisions
Characterization
1.
Behavior patterns are so ingrained that they are part of the attendant’s lifestyle
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VI.
2.
Consistency means that given a number of situations involving the same value, the reaction
will be automatic, consistent, and defensible
3.
Characterization is when the person is so closely associated with the value that people may
use the name of that value to describe the person
The affective domain in the EMS setting
A.
Officers are role models
1.
Provide mentors for attendants
2.
Be aware constantly of being observed by attendants
B.
Choice of Officers should be done carefully to be sure they model good values
C.
Model values that you want attendants to emulate
1.
Fairness
2.
Compassion
3.
Honesty
4.
Punctuality
5.
Dependability
6.
Preparedness
7.
Competence
8.
Professionalism
9.
Pride
D.
Establish policies that support the affective objectives
E.
Include affective objectives in assessment and grading criteria
F.
Correct behaviors that do not model values during calls and routine work day
G.
Assign new attendants to the Field-Training Program and be available to offer information,
suggestions, and always be approachable.
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LESSON FOUR – Job Performance Issues
Some personal problems can be serious enough to affect all areas of an attendant’s life, including the ability to
perform at work in an acceptable manner. Job performance problems may present in various ways, including:

Absenteeism

On-the-job absenteeism

Job efficiency

Interpersonal relationships

Personal appearance, attitude and behavior
Officer Focus:

Identify and document job performance problems

Know when to notify the Director of the situation
Officer / Director focus

Identify underlying problems

Develop a plan of action

Refer to resources
As an Officer, the most effective means to helping your troubled attendants return to their normal level of job
performance is through...
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ACTIVE SUPERVISION & CONSTRUCTIVE INTERVENTION
This should be based on the following steps:
1. Observing
2. Documenting
3. Preparing
4. Intervening
5.
Following through
Step 1: Observe
... Warning signs and keeping your objectivity.
Think about the following...
Recognize warning signs.
Ask yourself questions about what you observe.

Is this work performance or behavior acceptable?

Is it within MAS policy and procedure?

Is what I observe inappropriate or extreme?

Is it unusual or out of character..
...for this employee?...for this environment?
Consider safety first.

Is what you observe a violation of safety rules or regulations?

Does it cause an "at risk" situation for the attendant? for others? for property?
Be objective.
Objective observations:

What we see and hear
Subjective information is automatically gathered, also.

Thoughts about what you think is going on

Feelings about the situation and the person

Concerns about what might happen
Consider all your information and your reactions.
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Step 2: Document
... if it isn't documented, it didn't happen.
Objective documentation:

Records a set of facts

Substantiates a need for improved work performance
Good documentation helps the Officer:

Recognize patterns of poor performance over time

Provide objective, factual feedback to the attendant

Communicate the importance and necessity of good performance

Initiate a corrective process

Substantiate a need for disciplinary action, when necessary
Good documentation helps the Attendant:

Understand the standard of performance expected from them

Recognize what needs to be changed

Receive factual and appropriate feedback

Avoid denial of a problem
ABC's of Good Documentation
Accuracy:

Write it down. Don't rely on your memory

Record objective facts as they occur

Record job related behavior

Omit hearsay and rumor
Based on Behavior:

Describe specific observed behavior

Omit opinion and assumption
Consistency:

Be fair, be detailed, and be precise.

Document improvement and positive behavior
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Suggestions:

Don't diagnose or label

Don't make assumptions

Don't make accusations
Step 3: Prepare
Start with yourself.

Examine your personal feelings about the attendant and the problem. Acknowledge and accept those
feelings.

Focus on what you want to achieve. What is the desired outcome?

Feeling nervous and/or anxious is normal.
If your feelings are hindering a fair and objective process, consider asking for help from another Officer or the
Director.
Consider the Attendant.

Think of the situation from the attendant's point of view.

What reactions might you expect from the attendant?
o
Defensiveness, hostility, cooperation?
o
Think about ways to acknowledge feelings.

Return to your focus of desired outcome.

This process provides the attendant an opportunity to make changes.

Give the attendant this important message: "You are valued".
Develop a plan of corrective action.

Review MAS policies and procedures that apply.

Review and summarize documentation - remove subjective material.

Decide what is to be done to correct the problem.

Establish bottom line expectations for performance improvement.

Arrange for the meeting considering the attendant’s current behavior.

Assure privacy with no interruptions.

Allow sufficient time for the meeting, but set a time limit.
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Always be mindful if this meeting should take place with the presence of the Director versus just a single Officer
with an attendant. Depending on the circumstances it may be advisable to have a second Officer in on the meeting
for documentation purposes.
Step 4: Intervention
... effective intervention through good communication.
Objective:
Meet with the attendant to address the performance problem and provide opportunity for improvement.
The Officers role

To know supervisory responsibilities

To respond appropriately to signs of deteriorating performance

To provide information in a constructive manner

To listen attentively
The attendant’s role

To make an informed choice about job performance

To be responsible for change
Intervening for poor performance:

Risks the Officer’s relationship with the attendant

Breaks the silence surrounding the performance problem

Describes the attendant’s behavior and how it impacts others

Provides a clear statement of expected job performance

Provides an opportunity for improvement
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Intervention means communicating under pressure. It helps to:

Manage your own emotional investment in the situation

Avoid enabling. Express concern but don't "rescue"

Listen actively, without reacting or interrupting.

Keep the discussion focused on solutions to the problems

Follow up. Specify a time to re-evaluate the attendant’s progress
Step 5: Follow-through
... is an ongoing process.
Once you intervene with an attendant, begin again at Step 1 (observe).

Observe and document job performance.

Pay particular attention to the job issues discussed in the meeting.

Reinforce positive change with acknowledgement and support.

If the attendant's performance does not improve in a reasonable amount of time, further disciplinary action
may be necessary. Follow through.
Barriers That Arise When Addressing Attendant Problems
Denial
The attendant denies that problems exist and insists that the Officer or someone else in the
Service is out to get him or her.
How To Respond:
Stay calm. Have at hand documentation of the attendant’s job performance and/or conduct
and keep the conversation focused on performance issues.
Threats
The attendant threatens you or the organization.
"If you push me, I’ll go to an attorney . . . make a scene in the bay. . . quit here
and now . . . ."
How To Respond:
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Remind the attendant that he or she may do whatever he or she chooses; however, as an
Officer your responsibility is to uphold the MAS policy and find a solution that will help both the
organization and the attendant. If you think you are losing your objectivity or need help to
resolve a conflict with a defensive attendant, seek the help of another Officer or the Director.
Rationalization
The attendant tries to avoid the issue by making excuses.
"If this job wasn’t so stressful, I wouldn’t be making so many mistakes and
wouldn’t be late so often."
How To Respond:
Stay focused on work performance. Avoid being distracted by excuses; let the attendant know
that help is available.
Angry Outburst
The attendant becomes angry. He or she may cry, yell, or scream. This emotional outburst is
intended to scare off the Officer and cause him or her to drop the whole affair.
(In a shouting voice with arms raised) "How dare you accuse me of being late to
work and not getting my rig checks done on time!"
How To Respond:
Do not react! Wait until the attendant has run out of steam and then continue where you left
off; keep the focus on performance issues. If the attendant continues to carry on, reschedule
the meeting.
Denial
The attendant denies that problems exist and insists that the Officer or someone else in the
Service is out to get him or her.
How To Respond:
Stay calm. Have at hand documentation of the attendant’s job performance and/or conduct
and keep the conversation focused on performance issues.
Threats
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The attendant threatens you or the organization.
"If you push me, I’ll go to an attorney . . . make a scene in the bay. . . quit here
and now . . . ."
How To Respond:
Remind the attendant that he or she may do whatever he or she chooses; however, as an
Officer your responsibility is to uphold the MAS policy and find a solution that will help both the
organization and the attendant. If you think you are losing your objectivity or need help to
resolve a conflict with a defensive attendant, seek the help of another Officer or the Director.
Rationalization
The attendant tries to avoid the issue by making excuses.
"If this job wasn’t so stressful, I wouldn’t be making so many mistakes and
wouldn’t be late so often."
How To Respond:
Stay focused on work performance. Avoid being distracted by excuses; let the attendant know
that help is available.
Angry Outburst
The attendant becomes angry. He or she may cry, yell, or scream. This emotional outburst is
intended to scare off the Officer and cause him or her to drop the whole affair.
(In a shouting voice with arms raised) "How dare you accuse me of being late to
work and not getting my rig checks done on time!"
How To Respond:
Do not react! Wait until the attendant has run out of steam and then continue where you left
off; keep the focus on performance issues. If the attendant continues to carry on, reschedule
the meeting.
Be Consistent
Regardless of your personal relationship with an attendant, it is important to treat each person the same when
addressing job performance and/or conduct problems. This is not always easy to do. By following MAS procedures,
you avoid playing favorites. This protects you from being accused of discrimination and can help your relationship
with the people you supervise.
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Maintain Confidentiality
All discussions of an attendant’s job problems should be held in private. No one else should be able to hear the
conversation. If attendants choose to tell coworkers about their private concerns (e.g., results of a drug test), that is
their decision. However, when an attendant tells you something in confidence, you are obligated to keep it between
the two of you.
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2
Phase
LESSON ONE – Alcohol and Drugs in the
Workplace
Despite the fact that the American Medical Association defined alcoholism as a treatable disease in the early 1950s,
many people still believe that people with alcohol and other drug problems drink out of brown paper bags, live on
the streets, and/or cannot hold a job. These beliefs are myths. Most alcohol and other drug abusers have nice
homes, steady jobs, and do not drink out of brown bags.
As an Officer, it is important to be aware of your own beliefs about alcoholism and other drug problems so that
they do not interfere with your job. As with any other managerial responsibility, personal beliefs and prejudices will
need to be put aside.
Attendants Who Report to Work Unfit For Duty
If you are not sure how to manage an attendant who reports to work unfit for duty, consult the Director for advice
and follow MAS policy. In general, it is advisable that you have two Officers or other members verify that the
attendant is not fit to do his or her job. Document the conduct problems as objectively as possible. If all of the
personnel involved decide that the attendant is not fit to do his or her job, the attendant should be sent home via
public transportation or with a family member, or be escorted home by another Officer or attendant. Do not let the
attendant drive home if he or she is not fit to perform the job. The Officer should then decide, based on MAS
policy, the disciplinary actions that should be taken as prescribed in the MAS policy manual.
Alcohol or Other Drug Abuse by another Officer
Alcohol and other drug abuse and addiction are serious illnesses that affect people in all walks of life, in all types of
jobs, and of all ages. The issue is especially touchy when it is another Officer or the Director who is having a
problem with alcohol or other drug abuse. Handling alcohol or other drug abuse of an attendant or another Officer
requires careful thought, and your response will depend on your relationship with him or her.
It is not advisable to confront the situation on your own. Seek the help of another Officer or the Director (if he/she
is not the one in question) who can advise you about your options. Some addictions professionals are trained to
help family members and friends learn about intervention -- a structured form of offering assistance. An addiction
treatment center in your community probably has a staff member who is trained to do intervention.
What to do if you find Illegal Drugs at Work
Use caution. Review MAS policy to see if guidelines have been established for how to handle these situations. Do
not discard or transport the drugs yourself. Seek the help and guidance of another Officer or the Director. Contact
your local police department.
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LESSON TWO – Officer DO’s and DON’T’s
Do’s and Don'ts For Officers
DO:
Prepare what you are going to say ahead of time. Have a plan and stick to it. Say what you have to say
directly and clearly.
Find a place to meet that is private. What is said in the meeting must be kept confidential.
Focus on job performance and conduct -- not on suspected alcohol or other drug abuse, mental illness, or
any other potential reason for performance problems.
Present written documentation of the job performance and/or conduct problems (late reports, absences,
lower productivity, accidents, trouble with coworkers).
Treat all attendants the same. Don’t let age, seniority, friendship, or sympathy affect your evaluation or
allow you to make exceptions for some attendants and not others.
Use a formal yet considerate attitude. If the interview becomes too casual, it will lessen the impact of your
message.
State your expectations for improved performance and/or conduct and what will happen if the expectations
are not met within a specific period of time. Offer suggestions for improving performance and/or conduct.
Arrange for a second meeting to evaluate progress or to discuss disciplinary actions, if necessary.
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DON’T:
Try to diagnose the cause of the attendant’s job performance or conduct problem.
Be distracted by tears, anger, or other outbursts. (Stay focused on job performance and conduct.)
Moralize or judge the attendant.
Cover up for the attendant or accept repeated unlikely excuses.
Back down. (Get a commitment for improved job performance and conduct.)
Threaten discipline unless you are willing and able to carry it out.
Argue with an attendant. If the attendant becomes resistant, reschedule the meeting instead.
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LESSON THREE – Officer Responsibilities
This section of the manual will discuss the specific assigned duties of Service Officers. It will also outline the chain
of command/communication that is to be observed and followed. Each Officer has an important role in seeing
that the Service runs smoothly during day-to-day operations and is charged with working in conjunction with the
full-time Director. It is this framework that provides structure to the organization and creates a sense of
community amongst its members.
Officer Requirements & Responsibilities (general):
-
Incident Command (coordinated with on-duty Paramedic if present),
One evening on-call shift per week,
One 48-hour weekend on-call shift every fifth week,
Projects assigned by the Director,
Attendance at all business & training meetings,
Paperwork necessary for Workers Compensation reportable incidents, Incident reports,
Accessible to membership,
Maintaining and enforcing MAS policies,
Flexible schedule
Officer Responsibilities (specific):
Captain:
Public relations
1st Lieutenant:
Scheduling
Statistics - hours worked per week of volunteer staff
2nd Lieutenant:
Membership paperwork & tracking
Meeting attendance, equipment issue tracking, etc.
3rd Lieutenant:
Training (coordinate with Career staff designee)
Officer Response to Ambulance Calls *:
- Mass casualty incidents,
- Multiple car or multiple patient MVAs,
- Mutual aid into Milford,
- Manpower requests from on-scene ambulance,
- All call tones (including open shifts in schedule)
* (Officer role will include as needed, but not limited to, Incident Command, attending EMT, or extra attendant)
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Officers need to understand the difference between scene command and providing primary patient care. In many
circumstances when a motor vehicle accident call goes out and both the paramedic and Officer arrive on scene, and
a power struggle ensues.
Both the officer and the paramedic are an iatrical part of the overall scene management, but only if each
understands what the other’s role are. When paramedics arrive at a large scene that requires more resources than
one ambulance, they are in charge of overall patient care. The paramedic is actually in charge of patient care on any
scene they arrive at unless they have triaged it to the crew that is on duty at that time.
The paramedic will call for resources that he/she needs to best provide care for their patient. That is where the
Officer comes in. The Officer may not be in charge of the overall patient care, but they are in charge of managing
the scene and making sure that requests are put through to the appropriate resources. For example if the paramedic
requests a helicopter be brought in to town to transport the patient the request will be given to the Officer (EMS
scene commander). The Officer will then make the request of MACC base and ensure that the request is made.
This will free the paramedic up to continue with patient care and management. The two forces are designed to
work synergistically together and not act antagonistically.
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3
Phase
LESSON ONE – Managing Mass Causality
Incidents
INITIAL RESPONSE PHASE
DUTIES OF FIRST ON-SCENE PERSONNEL
The first arriving EMS unit may consist of a minimal number of EMS personnel. Command Officers or additional
EMS units may not be immediately available to assist. It is imperative that the first arriving personnel switch from
the role of "care-giver" to the role of "Mass Casualty Incident Managers". If the MCIMS kit is available, the
Officer's checklists in the portfolios of the kit will start providing step-by-step guidelines that may be followed. The
following are some other general principles the first on-scene personnel should consider:
1. The first on-scene EMS personnel should NOT start treatment.
2. Quickly assess the situation:
A. Estimate the number of patients.
B. Estimate the number of EMS units required.
C. Assess the need for any special equipment or Services.
ESTABLISHMENT OF THE COMMAND POST AND ASSIGNMENT OF THE EMS
COMMANDER
The Command Post should be established by first-in EMS personnel. Immediate EMS command is the
responsibility of the most qualified member of the first on-scene EMS crew. This person is the EMS Commander.
The EMS Commander should stay at the Command Post and not leave it. Command should be transferred only if a
more qualified person arrives.
It must be noted that the EMS Commander is NOT the same as the Incident Commander. The Incident
Commander is in charge of the ENTIRE incident. The EMS Commander is responsible for directing all EMS
Operations. At an MCI, this may be the most critical command position.
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The EMS Commander should address some immediate concerns early on:
1. Request additional EMS units as needed. The EMS EXTRA ALARM ASSIGNMENTS sheets included
in the kit should be utilized if available.
2. Start evacuation and/or triage when personnel become available and it is safe to do so.
3. Establish liaisons with fire and police commanders. Also establish communication with the Incident
Commander and any other safety Service commanders.
If the assignment of EMS Commander changes, the new EMS Commander should respond to the Command Post
as the EMS representative and remain there. The previous Commander may then be reassigned for other duties. If
it has not already been done, the EMS Commander should assign personnel to handle the duties of the other four
(4) EMS Sector Officers.
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COMMAND PHASE
Assigning EMS personnel to the additional positions of EMS sector Officers should not depend on seniority, rank
or popularity. Lives are at stake. This is a time to set aside personal feelings and antiquated ideas. The personnel
MOST QUALIFIED to handle each job should fill each of the five (5) key EMS Sector Officers’ positions. This
may mean an EMT or paramedic well versed in the concept of triage or treatment will be a commander, while a
Lieutenant or Captain may fill the position of caregiver.
ASSIGNING OTHER EMS SECTOR OFFICER POSITIONS
Not all EMS Sector Officer positions may need to be filled. The needs will be dictated by the incident. The EMS
Commander may need to assign:
A Triage Officer, and designate primary and secondary Triage Areas (secondary in case the primary becomes
unusable due to wind shift or other dangers).
A Treatment Officer, and designate primary and secondary Treatment Areas.
A Transportation Officer, who should work closely with the Treatment Officer. The two Officers should
designate a Loading Zone area within the Treatment Area.
An EMS Staging Officer, to report to the designated Staging Area established by the Command Post.
Depending on the situation, this Officer may be responsible for only handling EMS units.
EVALUATION OF OPERATION AND REQUESTS FOR SPECIAL ASSISTANCE
Early evaluation of the operation and requests for special assistance or equipment may be guided by using the EMS
TACTICAL COMMAND BOARD. By referring to this sheet, the EMS Commander may decide there is a need to
request special support agencies or to perform certain duties. The EMS Commander may also find referring to the
LOCAL RESOURCES list helpful, as there may be helpful resources that can easily be overlooked during this
emotionally charged period.
The EMS Commander should continually reevaluate the incident and the need for special units or other assistance.
Additionally, the EMS Commander should request updates from the EMS Sector Officers and offer assistance
where possible. Keep in mind that for the incident to flow smoothly, it is necessary for all command personnel,
both EMS and non-EMS, to work together and continually communicate. Do not forget about the needs and
suggestions of the Incident Commander, Fire Commander, Police Commander and other sector commanders. No
one knows it all.
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CONTROL PHASE
The means of controlling a Mass Casualty Incident depends largely on the type of incident present. MCI's are often
classified as Open or Closed, Contained or Continuing. The strategies for managing each type of incident may vary.
OPEN VERSUS CLOSED INCIDENTS
In an Open Incident, patients are easily accessible or scattered over a wide area. An example of an Open Incident
may be a natural disaster such as a tornado or hurricane, although some man-made disasters may also create Open
Incidents.
In a Closed Incident, patients are not readily accessible. An example of a Closed Incident may be a bus crash,
wherein patients must be extricated or moved in order to reach other patients for triage and treatment.
CONTAINED VERSUS CONTINUING INCIDENTS
When a Contained Incident is encountered, the cause or causes of the incident have been stopped. For instance,
after the bus has crashed, additional injuries will probably not occur.
When a Continuing Incident is encountered, the cause or causes of injury continue. A good example may be toxic
fumes in an office building. Patients may continue to be affected, and additional patients may present themselves as
the incident progresses.
TRIAGE OPERATIONS AND DUTIES OF THE TRIAGE OFFICER
Whether the incident is Open or Closed, Contained or Continuing, one general rule should be followed: All patients
should be seen by a Triage Officer and should be processed through the Treatment Area. Otherwise, maintaining
patient accountability is impossible.
The Triage Officer should be the person most knowledgeable in the principles of triage. Triage is an art, and to finetune one's skills requires constant training. Triage should be performed by BLS certified individuals, thereby freeing
ALS providers for treatment operations.
Commercial triage tags are included in the TRIAGE SUPPLIES portfolio. Another approach to triage involves the
initial marking of the patient with a color-coded ribbon if triage tags are not available (ribbons are also included in
the TRIAGE SUPPLIES portfolio). After arrival at the treatment area, retriaging is performed and a more formal
triage tag is placed on the patient.
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CONTROL PHASE (Cont.)
TRIAGE OPERATIONS AND DUTIES OF THE TRIAGE OFFICER (Cont.)
If patients are to be triaged where found, they should be moved to the Treatment Area after they are triaged. The
Triage Officer should request personnel from EMS Commander to assist in moving patients from the field to the
treatment area. In large or complicated incidents, a Transfer Officer may be appointed to oversee this.
The order in which patients are moved should be based on patient location and severity of condition. Proper care should
be exercised when moving patients so as not to aggravate injuries. The use of spinal immobilization devices (i.e. cervical
collars and backboards) is highly recommended. Patients must be retriaged after they enter the treatment area. A patient's
condition may deteriorate while waiting to be moved or during the move.
TREATMENT OPERATIONS AND DUTIES OF THE TREATMENT OFFICER
The Treatment Officer should not necessarily be the EMS person most qualified in patient care. The job of the
Treatment Officer is more one of an administrator rather than a medical care provider. Personnel who are best
qualified in the area of patient care and treatment should be utilized doing what they do best, treating patients.
Advanced Life Support personnel should be used to treat the more seriously injured patients. Remember, however,
that the Treatment Area is not a hospital. Life-threatening injuries should be stabilized, but time should not be
wasted in treating every minor injury. Patients should be transported to definitive care facilities (i.e. hospitals) as
quickly as stabilization allows.
When establishing the Treatment Area, think BIG. The Treatment Area must be capable of accommodating large
numbers of patients and equipment. Consider the weather, safety of patients and personnel, and possible hazardous
materials dangers. The area should be readily accessible and have clearly designated entrance area and exit area (the
ambulance Loading Zone). A secondary Treatment Area may be designated should the primary area become
unusable for various reasons.
The Treatment Area should be divided into four distinct and well-marked areas, corresponding to triage categories.
The areas can be identified using color-coded flags (included with the kit), barricade tape, and/or tarps. These areas
are:
A. Red (First Priority) - Seriously ill or injured patients. These patients most likely need rapid transport to a
hospital. Examples of patient conditions include: shock, depressed mental state (altered mental status),
airway problems, major uncontrolled bleeding or lacerations and major fracture(s).
B. Yellow (Second Priority) - Patients with moderate injuries that need attention and/or may become life
threatening. These should be the second group of patients transported. Examples of patient conditions
include: lacerations or fracture(s), moderate burns.
C. Green (Third Priority) - Minor injuries (sometimes called the "Walking Wounded"). Treatment and
transportation of these patients may be delayed.
D. Black (Fourth Priority) - Patients who are dead or have injuries which will lead to certain death. This
area serves as the morgue. For psychological reasons, this area should be separate from the other three
treatment areas.
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CONTROL PHASE (Cont.)
TRANSPORTATION OPERATIONS AND DUTIES OF THE TRANSPORTATION OFFICER
(Cont.)
Actual medical control, or control of treatment, may become the responsibility of an on-scene physician or
physicians. This does not mean that the physician becomes Treatment Officer. Additionally, this is not a time for
Advanced Life Support personnel to be hindered by the need for verbal orders to perform life saving procedures.
For an MCI situation, provisions should be made ahead of time to allow ALS personnel to do what is necessary
without verbal orders. Written protocols may be developed for just such cases.
The Treatment Officer will assign duties to EMS personnel as they are sent to the Treatment Area. Additional EMS
personnel may be requested from the Staging Area if needed. Should a large number of personnel be needed in the
Treatment Area, the request should be made through the EMS Commander. A special call may be made for
personnel only. This will prevent the depletion of personnel from the transport units, which could leave ambulances
understaffed.
Patients should only leave the Treatment Area at the direction of the Treatment Officer. This requires an interaction
between the Treatment Officer and the actual treatment personnel. All patient transfers should be coordinated with
the Transportation Officer.
The Treatment Officer is also responsible for making sure an adequate stock of medical supplies is available. The
Treatment Officer should continually consult the MEDICAL EQUIPMENT CHECKLIST to ascertain what
supplies are needed. Supplies may be requested from a supply officer or the EMS Commander may need to acquire
the necessary supplies.
TRANSPORTATION OPERATIONS AND DUTIES OF THE TRANSPORTATION OFFICER
The Transportation Officer has, perhaps, the most complicated and challenging assignment. It is of great
importance that the person filling this position has a good working knowledge of the duties of the Transportation
Officer. Familiarity with the forms and guidelines contained in the TRANSPORTATION OFFICER portfolio of
the kit is also a must.
The Transportation Officer handles all routing of patients from the Treatment Area to the hospital. All hospital
notifications are made by the Treatment Officer, utilizing standard departmental or local communications
procedures. Due to increased radio traffic, the use of cellular telephone communications is highly recommended.
Cellular fax machines may also be helpful if available. Individual ambulances should NOT communicate with
receiving hospitals. This can tie up the radio channels and may interfere with the communications of the
Transportation Officer. It may also result in confusion due to conflicting reports or misunderstandings.
The Transportation Officer correlates the capabilities of receiving hospitals and their bed counts. Telephone
numbers for local hospitals can be recorded in advance on the HOSPITAL PHONE LIST sheet. When
ascertaining hospital capabilities, it is most important to know what the hospital can handle in the Emergency
Department and Surgical Department. The number of ER beds and OR suites is most important. Patients can be
transferred to more distant hospitals for long term care after they are stabilized.
At smaller incidents, this information may be recorded in the appropriate area on the EMS TACTICAL
COMMAND BOARD (the EMS Commander may double as Transportation Officer). In larger incidents, this
information should be recorded on the HOSPITAL CAPABILITY AND PATIENT TALLY SHEET. This sheet
may have to be revised throughout the incident.
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As transport units are needed, the Transportation Officer will contact the Staging Officer who will then send the
proper number and types of units. The Staging Officer should be advised as to whether to send a unit capable of
providing basic, intermediate, or advanced life support while enroute to the hospital.
A part of the Treatment Area should be designated as the ambulance Loading Zone. The Transportation Officer
and Treatment Officer should agree upon the location. The Transportation Officer should also consult with EMS
Commander and the Fire Commander before deciding on the best location for a landing area for aeromedical
helicopters.
A record should be kept of all patients leaving the treatment area using the HOSPITAL TRANSPORTATION
LOG found in the TRANSPORTATION OFFICER portfolio. Additionally, each ambulance crew should be given
a HOSPITAL DIRECTIONS CARD corresponding to the proper hospital destination. These cards should be
filled out in advance.
As the ambulances leave the Loading Zone, the proper hospital should be notified of the pending arrival of
patients. The hospital should be supplied with any pertinent information found on the HOSPITAL
TRANSPORTATION LOG. This may include:
A. Name of the transporting unit
B. Number of patients being transported
C. A brief description of the patients by triage category and/or specific injuries
D. The ETA of the transporting unit
If a multiple part triage tag is used, the Transportation Officer should keep a copy of the triage tag before releasing
the patient. If METTAGS are being used-, keep a corner of the tag with the number on it.
To keep a running tally of the number of patients being sent to each hospital, place hash marks in the appropriate
areas of the HOSPITAL CAPABILITY AND-PATIENT TALLY SHEET. Hash marks should be placed within
the designated areas based on patient condition. Referring to this sheet should prevent overloading any one hospital
with patients, especially critically injured patients. Directly compare the number of patients being sent in each color
category with the hospital's capability filled out earlier.
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CONTROL PHASE (Cont.)
Because hospitals may be few and far between, it may be wise to designate closer hospitals as primary receiving
facilities. EMS units from great distances may be requested to respond to these hospitals. After patients are
delivered to the closer hospitals, they may then be transferred to further facilities, thereby reducing the burden
placed on the closer hospital. Additionally, the initial transport units are then free to return to the MCI scene.
STAGING OPERATIONS AND STAGING OFFICER
To reduce congestion and confusion at the MCI scene, all responding EMS units should report to a designated
Staging Area. The location of the Staging Area should be coordinated with the Incident Commander, EMS
Commander and Fire Commander. The Staging Area should be readily accessible and easy to locate. It is good to
consider the location of the ambulance Loading Zone in the Treatment Area, as a simple route should be planned
from Staging Area to Loading Zone. A Secondary Staging Area may be designated should the primary area become
unusable for various reasons.
Ideally, an EMS Staging Area separated in some way from the fire equipment staging area should be maintained.
The area should be big enough to handle large numbers of ambulances. Additionally, this area should be divided
into three distinct areas based on the medical capabilities of each unit: one for EMS units with Basic Life Support
capabilities, one for Intermediate units, and one for Advanced Life Support (paramedic) units. By keeping the units
so divided, the EMS Staging Officer can quickly ascertain by sight when the supply of units in one area is getting
low. This system also provides for quick dispatch of specific capability units to the Transportation Officer. As more
units are needed, the EMS Commander should be notified. In turn, the EMS Commander will handle
communications with the dispatcher to request additional units.
The Staging Officer should record all pertinent information on the EMS UNIT STAGING LOG. As ambulances
arrive, the Staging Officer should distribute INCIDENT PROTOCOL CARDS to each unit. These cards provide
the crews with a written list of "Do's and Don'ts". On the back of the card, an area is provided for noting pertinent
information about the incident. If possible, the applicable sections on the backs of these cards should be-filled out
prior to the arrival of units to the Staging Area.
As ambulances arrive at the Staging Area, the Staging Officer should ascertain the name of the Officer or person in
charge of that unit. All communications with individual units should be handled through this designated person. All
personnel should stay with their units at all times. Additionally, crews should be notified that radio traffic is to be
handled only by designated EMS Officers, and not by individual ambulance crews.
The Staging Officer should not send any units to the treatment area Loading Zone unless they are requested by
Transportation Officer.
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PUBLIC INFORMATION OFFICER
The media must be viewed as an ally and not an enemy. If media members appear to be out of control, it may be
due to inadequate supervision on the part of command personnel. The job of the Public Information Officer is to
control the media and turn them into an asset, not a liability
The media has a vital job to do, so use this to your advantage. For example, the media may be used to disseminate
evacuation information. Alternatively, hours of news footage shot by television crews may be invaluable in
reviewing and critiquing an incident after its conclusion. Cooperation during the incident is the key to continued
good relations after the incident.
The Public Information Officer is one person, usually appointed by the Incident Commander after consulting with
the Fire Commander, EMS Commander, and Police Commander. Ideally, the Public Information Officer should be
someone who is diplomatic, tactful, concise, and preferably has good public speaking ability.
Only information approved by the Incident Commander should be released. The information may come from the
EMS Commander, Fire Commander, or Police Commander. This information may include, but is not limited to:
A. The type of incident (What happened).
B. Where the incident occurred.
C. When the incident occurred.
D. The number of persons killed or injured (DO NOT RELEASE NAMES).
E. The current status of the incident.
F. Additional information, as decided upon by the Incident Commander.
It is important to remember that ONLY FACTS should be released. Information about the cause of an incident, or
any speculation concerning the incident, should be avoided. Saying too much may place a department or agency on
shaky legal ground, opening the way for future legal action.
The media will want pictures. Work with them on this when possible. If groups of photographers are taken through
the incident area, the Public Information Officer should accompany them. Set ground rules ahead of time as to
what photographers can and cannot photograph. If reporters accompany photographers, it must be made clear that
they are not to interview any patients or emergency personnel without permission. Additionally, no one is to
interfere with the work of any of the emergency Service personnel.
The Incident Commander may wish to set up a Media Assembly Area, where all media members gather to be
briefed by the Public Information Officer. This area may also be equipped with telephones and other items for use
by the media. News conferences and interviews may also be held in this area.
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CONCLUDING THE MASS CASUALTY INCIDENT
Toward the conclusion of the Mass Casualty Incident, the remaining ambulances at the Staging Area may be moved
up to the incident scene. At least one unit should remain on the scene until all emergency activities are completed,
since additional patients may be discovered or scene personnel may become incapacitated.
It is important to notify all participating hospitals and support agencies once the incident is concluded. If ambulance
crews completed separate run reports on patients while enroute to the hospital, copies of the reports should be
requested.
It may be good to have a meeting of the five EMS Sector Officers prior to a larger critique session in which all
agencies and personnel may be involved. The purpose of this meeting is to correlate paperwork, finish
administrative work related to incident, and discuss additional items that must be accomplished before the incident
can really be considered concluded. The Officers may also wish to use this time to analyze statistics and discuss any
personnel concerns they have regarding the incident.
After the EMS Sector Officer's meeting, there is a need for an early critique of the incident. This meeting should
include, at a minimum, command personnel from all areas such as: EMS, fire, rescue, police, hospital, and other
support agencies. The Incident Commander may wish to include other personnel as well. This is the time to BE
CRITICAL AND BE HONEST. Identify areas needing improvement and specific problems which were
encountered. More importantly, though, plan how to better handle the weak areas the next time.
It is very important to consider the needs of the care providers. Emotional and psychological injuries may not
readily be noticed, but are there. If a Critical Incident Stress Debriefing program is available in the immediate area, it
should be readily accessible to all personnel who were involved. This may include more than just the EMS, fire and
police personnel. If a program or team is not locally available, arrangements should be made ahead of time to access
such a program, or other psychological support Services, from a nearby area.
At the end of the incident, the Public Information Officer and Incident Commander should provide a final news
release.
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SUMMARY OF GENERAL GUIDELINES AND PRINCIPLES
To manage the MCI in an organized manner, some additional points merit consideration or repeating.
1. The first on-scene EMS unit should not start treatment. Personnel from this unit should start using the Mass
Casualty Incident Management System. The first unit on the scene should not leave the scene until the conclusion
of the incident.
2. Any responding units arriving before the establishment of a Staging Area should report directly to the Command
Post for their assignments.
3. Definitive markings for Command Post, Triage Area, Treatment Area and Staging Area should be utilized. It is
suggested that a green warning light be used to make the Command Post easily identifiable. Color-coded flags may
also be used.
4. Command personnel should be identified by marker vests.
5. Any EMS personnel entering the primary perimeter must wear proper protective clothing.
6. EMS Sector Officers should give constant updates to the EMS Commander.
7. Emergency Service workers also need support. Should a rescuer, be injured, they should be designated as a Red
patient regardless of the severity of the injury and transported on the next available unit. Leaving them at the scene
will have an additional psychological impact on other rescuers.
8. When at all possible, family units are to be kept together during treatment and transportation phases.
9. An area for responding family members should be designated. It may be helpful to staff this area with clergy and
psychological support personnel.
10. Emergency Service workers also need support. If a Critical Incident Stress Debriefing (CISD) team is available,
it should be utilized both during, and after the incident.
11. Evacuation and relocation procedures, also communications guidelines, should be established by the Incident
Commander or someone designated by the Incident Commander.
12. Initial training in MCI management and continual review is must. All EMS personnel should be thoroughly
familiar with the principles of MCI management to be able to fill the roles of the various EMS Officers at any time.
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USE OF THE KIT
With any piece of emergency equipment, it is important for the people using it to be thoroughly familiar with its use
and operation. We strongly suggest that all department members, not just Officers, be familiar with the Mass
Casualty Incident Management System and its operation. Regular training with the kit will be of benefit.
The system is comprised of four basic components, each of which will be described in detail. The components are:
1) Color-coded Command Vests, 2) Color-coded Marker Flags, 3) the EMS TACTICAL COMMAND BOARD,
and 4) EMS Sector Officer Portfolios. As each component, checklist, or form is explained, the proper item should
be pulled from the kit for reference.
COMMAND VESTS
A color-coded vest is provided for each of the five (5) EMS Sector Officers. Since it may be difficult at times to
read the lettering on the back of the vests, the color-coding facilitates easier identification of the different Officers.
The color-coding is as follows: EMS COMMANDER - Blue, TRIAGE OFFICER - Yellow, TREATMENT
OFFICER - Red, TRANSPORTATION OFFICER - Green, STAGING OFFICER Orange. The identification
vests should be distributed early in the incident to each of the EMS sector Officers.
MARKER FLAGS
Five (5) color-coded marker flags are included with the MCI kit. The location of the Command Post should be
identified using the orange Command Post flag (marked CP) included in the kit. Alternate forms of identification,
such as a green revolving light, may also be used. If a revolving light is used, it is important that the color be distinct
from the colors of emergency lights on responding EMS, fire and police vehicles.
The other four (4) colored flags (red, yellow, green, and black) are used to identify the sections of the Treatment
Area. These flags should be given to the Treatment Officer. These may be driven into the ground, or placed in
some type of base. Suggestions for making a weighted base for the flags are included with the flags.
EMS TACTICAL COMMAND BOARD
The EMS TACTICAL COMMAND BOARD provides the EMS Commander areas to record information about
the Mass Casualty Incident that can be quickly referenced. The information should be noted in the appropriate areas
as needed. In some incidents, it may be helpful to have an additional board for the Transportation Officer.
After unfolding the command board, it may be placed on an easel, the hood of a vehicle, or a desk in a command
vehicle. The board may be written on with a dry erase marker, water-based marker, or grease pencil. As the incident
progresses, the various sections of the board should be filled in. A map of the scene may be drawn. The map may
include general geographical information, as well as note the relationship of the incident site with the locations of
Treatment and Staging Areas.
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CONTENTS OF EMS SECTOR OFFICER'S PORTFOLIOS
Specially developed checklists, forms, and reference cards for each EMS Sector Officer are packaged in individually
labeled portfolios. Necessary pens, grease pencils, mechanical pencils (eliminating the need for sharpening),
secretarial supplies, and miscellaneous specialty items are also in the portfolios. As EMS sector Officers are
assigned, they should be given the proper portfolio. The Officer should quickly review the contents of the portfolio,
and the forms included.
Remember that depending on the size of the incident, not every Officer's position may be assigned. Individual parts
of the kit may be used independently if desired. A working knowledge of the contents of each EMS Sector Officer's
portfolio will allow the EMS Commander to decide which parts of the kit may best be used.
CLIPBOARDS
Each portfolio contains a see-through clipboard. The EMS Sector Officer's checklist is placed within the clipboard,
facing the back so that it can be read when the clipboard is turned over. This allows the Officer to quickly reference
the checklist without flipping pages, and protects the checklist from rain or snow. As each step is completed, a
check may be placed on the corresponding line to the left of the instruction. Keep in mind that the checklists
present suggestions that may need to be adapted as dictated by incident.
The various forms for each Officer should be placed under the clip on the front of the clipboard. Rather than
placing a thick stack of forms under the clip (which may make accessing different forms difficult), the Officer may
wish to place only one or two of each form on the clipboard. As new forms are needed, they may be obtained from
the portfolio to replace completed forms. An area is provided on each form for page numbering to ensure proper
page order.
Since MCI's can occur any type of weather, a plastic sheet protector is included, which may be placed over the
forms on the front of the clipboard. This will help keep the forms dry, and may also be marked on using a grease
pencil. For night operations, a high intensity 30-minute Cyalume light stick may be placed in the clip to illuminate
the front of the clipboard.
IMPORTANT OPERATIONAL NOTE - DO NOT USE DRY ERASE MARKERS TO WRITE ON
THE CLIPBOARDS AS THEY MAY PERMANENTLY MARK THE PLASTIC. USE ONLY GREASE
PENCILS, SUCH AS'THE ONES INCLUDED.
Milford Ambulance Service Officer’s Training Manual
Created January 2003
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CONTENTS OF EMS COMMANDER’S PORTFOLIO
Along with the EMS Tactical Command Sheet, the EMS Commander is provided with a checklist and
reference forms.
ADDITIONAL ALARM ASSIGNMENTS FORM
When developing your pre-plan, it is important to consider which nearby EMS units may be best utilized.
It is also important to be able to access these units quickly, without initial EMS personnel or dispatchers
having to take the time to decide which units to call.
The ADDITIONAL ALARM ASSIGNMENTS form(s) should be completed in advance, based on local
mutual aid agreements. A completed copy should be returned to the EMS COMMANDER portfolio and
another copy should be kept at the dispatch center. Upon determining that a Mass Casualty Incident
exists, initial EMS personnel can simply notify the dispatch center that a 1st, 2nd, 3rd, 4th, or 5th alarm
EMS response is needed. The dispatcher then refers to the completed sheet and dispatches the
appropriate units. Time is not lost while the EMS personnel specifically request each individual unit and
chances for errors in radio communication are minimized. It is important that all EMS personnel and
dispatchers be familiar with the completed form.
When developing an additional alarm system, the appropriate alarm number is written above the vertical
word "ALARM" in the left margin. Each alarm should be built to handle ten patients. This makes it easy
to quickly decide how many alarms are needed. For instance, if a bus crash occurred and there were 31
patients, a "3rd Alarm" assignment should be able to handle it (3 x 10 = 30). It is also important to have
units available at stations within the territory to handle other EMS calls not related to the MCI. This
should be noted in the “1st Alarm" assignment. A sample of a completed EMS EXTRA ALARM
ASSIGNMENT sheet is shown on page 19.
Distant units should be considered when deciding whom to include in the extra alarm assignments. By
dispatching distant units early, response time is reduced should those units eventually be needed. These
units may also be used to staff nearby stations, ensuring that no area is completely without EMS coverage
due to the local units being at the MCI.
Distant units may also be assigned to respond to hospitals near the MCI scene. These units are used to
transport MCI patients from closer hospitals (after the patient has been stabilized) to further hospitals or
special care facilities. This can reduce hospital workload, and allows the initial transport units to return to
the scene if needed.
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LOCAL RESOURCES FORMS
The sections of these sheets should also be filled out in advance with the names of various local support
agencies and special units, as well as their telephone numbers and radio identifiers if applicable. The
completed forms should then be placed back in the EMS COMMANDER portfolio.
If a cellular telephone is available at the Command Post, the information and telephone numbers are
readily available. This allows the EMS Commander to make specific requests for support, and answer any
questions the support agency may have. Chances of information being misunderstood by dispatch
personnel are thereby greatly lessened.
These forms can do more than just provide the EMS Commander with telephone numbers. By looking at
them early into the incident, they may "prompt" the EMS Commander to request a special resource that
he or she may otherwise have forgot was available.
We recommend that a set of copies of these sheets also be kept at your local dispatch center.
CONTENTS OF TRIAGE OFFICER'S PORTFOLIO
Since a large quantity of triage equipment is included in the kit, two portfolios are provided for the Triage
Officer, one marked TRIAGE OFFICER and the other marked TRIAGE SUPPLIES. The first portfolio
contains the clipboard, checklist, and other secretarial items. The second portfolio contains the actual
triage supplies.
At an MCI, the Triage Officer may need to assign support personnel to aid in triaging. Depending on
local protocols, triage tags may be immediately placed on patients, or color-coded ribbon may be used. As
personnel are assigned, the proper equipment (tags or ribbons) should be distributed. Enough tags and
ribbons are included for three people to perform triage. Additional triage supplies may be purchased if
needed.
CONTENTS OF TRIAGE SUPPLIES PORTFOLIO
TRIAGE TAG SYSTEM
Thirty (30) triage tags are included in the TRIAGE SUPPLIES portfolio. These may be divided among
the triage personnel.
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Three triage aprons are included in which the triage tags may be placed. Each person may be given ten (10)
triage tags. The tags should be tied to a patient in such a way that it is easily visible (such as around the wrist or
ankle). The lower portion of the tag is torn off so that the bottom color corresponds to the patient's condition.
Triage tags also serve as patient information sheets. However, the triage personnel should not fill these
out when they are doing the initial triage. After the patient is receiving care in the Treatment Area,
treatment personnel will fill out the tags as necessary.
TRIAGE RIBBON SYSTEM
An inherent problem with triage tags is that since they are made of paper, they do not work well in wet or
moist environments. Water (from rain, snow, or other sources), fuels, even body fluids such as blood, can
quickly destroy the tags or affect them in a way so that they cannot be written on. More and more
departments are therefore choosing to use a colored ribbon when doing the initial field triage.
These ribbons are impervious to moisture, but still provide a highly visible indication of the triage
category the patient has been placed in. The triage tags may then be placed on the patient after the patient
reaches the treatment area, as this is usually a more secure or sheltered environment.
Included in the TRIAGE SUPPLIES portfolio are six (6) ring clips containing triage ribbon. Each ring
contains two colors (red and yellow, or green and black) with 15 ribbons of each color. Triage personnel
should be given two rings, providing them with all four colors of triage ribbon. The rings may be affixed
to belt loops on the right and left sides of the trousers. This will facilitate finding the proper colors, even
in dark environments.
For example, a ring containing red and yellow ribbons may be placed on a belt loop on the right side,
with the red ribbon to the front. A ring containing green and black ribbons is placed on a belt loop on the
left side, with the green ribbon to the front. Depending on whether the person doing triage pulls ribbon
from the left side or right side, front or back, will determine which color is pulled. No visual sorting of
ribbon is necessary.
The kit provides enough ribbons to triage 60 people in each category. The ribbon should be tied to the
patient in a visible location, such as around the wrist or ankle. Color-coding the patient will prioritize
patients for transfer to the Treatment Area, and serve as a reference for treatment personnel as to the
patient's initial condition.
Once transferred to the treatment area, the patient is retriaged and an actual tag is placed on the patient.
The tag then serves as a run report on the patient. If the ribbon system is used, the Triage Officer must
give the triage tags to Treatment Officer early in the incident. Alternatively, the triage tags may be
removed from the TRIAGE SUPPLIES portfolio and placed in the TREATMENT OFFICER portfolio.
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CONTENTS OF TREATMENT OFFICER'S PORTFOLIO
The Treatment Officer is responsible, not for the actual hands-on treatment of patients, but for
organizing the Treatment Area. This includes tracking patients as they enter the area, coordinating patient
release with the Transportation Officer, ensuring adequate supplies are on hand, and ensuring personnel
are utilized appropriately. Along with the Treatment Officer's checklist, two forms are provided to be
filled out by the Treatment Officer.
TREATMENT SECTOR LOG
As patients enter the Treatment Area, the Treatment Officer (or an assigned aide or transcriber) should
note the triage tag number, patient priority (tag color), the sex of the patient, and the time the patient
enters the treatment area. If the patient's name is known, it should also be noted on the log. This may be
important, as if the patient becomes unconscious it may be difficult to identify the patient by name. In
addition, this allows family groups to be readily recognized.
The Transportation Officer will note the time the patient is sent to the hospital. This can be compared
later with the "Time In" column in the Treatment Sector Log to calculate the amount of time patients
spent in the treatment area.
MEDICAL EQUIPMENT CHECKLIST
For large numbers of patients to be treated properly, it is important that appropriate medical supplies are
available. If we make an honest appraisal of the equipment needed, it can be seen that there are not many
categories of supplies that are necessary. Remember that the treatment area is for stabilization, and is not
normally considered a "field hospital". At regular intervals, the Treatment Officer should inventory the
amount of supplies at the Treatment Area using the MEDICAL EQUIPMENT CHECKLIST. If
supplies are needed, the Officer can request these from a Supply Officer (if one has been assigned) or
may request the EMS Commander to order the necessary supplies.
The boxes of the checklist are designed to be checked while working down the column. The time the
supplies were checked and reordered should be noted in the top box. As the Officer checks each supply
category, a notation should be made in the corresponding box BELOW the time as to whether supplies
were OK or reordered.
TRIAGE TAGS
As discussed in the previous section on the-Triage Officer, it may be desirable to wait until the patient
enters the Treatment Area to place an actual triage tag on the patient. If this system is used, the
Treatment Officer should acquire triage tags and aprons from the Triage Officer, unless they have already
been placed in the TREATMENT OFFICER portfolio.
Whether applied by the triage personnel or treatment personnel, the triage tag can be used as a patient
information report. Some tags lend themselves to this task better than others. The Treatment Officer
should see to it that only pertinent information is filled out on the tag. It is not necessary to write an
extensive report. Where multiple-part tags are used, the Treatment Officer or Transportation Officer
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should keep a copy of the tag before the patient is sent to a hospital. The two Officers should agree ahead
of time who will keep the tag part.
CONTENTS OF TRANSPORTATION OFFICER'S PORTFOLIO
As was discussed earlier, the Transportation Officer has a heavy workload. Due to the amount of
paperwork, the Transportation Officer may find it necessary to appoint assistants to do some of the
clerical work. Three forms and a reference card have been designed to help the Transportation Officer
perform in an organized manner.
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CONTENTS OF TRANSPORTATION OFFICER'S PORTFOLIO (Cont.)
HOSPITAL PHONE LIST
This form should be filled out ahead of time with the names of the area hospitals that will be utilized in
the event of an MCI. Multiple sheets are included. We recommend filling one out alphabetically and one
according to proximity, listing the closest hospitals first and the distant hospitals last. The appropriate
telephone number for the hospital (most likely either the emergency room and/or telemetry telephone
number) should be filled in, as well as a notation of what telemetry radio channel capabilities the hospital
has. If the hospital has a helipad, note this as "Yes" or "No".
When the Transportation Officer begins contacting hospitals to inquire as to how many patients they can
handle, this sheet will quickly provide the Officer with the proper telephone number to call.
HOSPITAL CAPABILITY AND PATIENT TALLY SHEET
The Transportation Officer should contact each area hospital which will receive patients from the Mass
Casualty Incident. The name of the hospital, any special capabilities (such as abilities to handle burns ' or
neurological injuries) and the number of patients by triage category or severity the hospital is capable of
treating should be noted on the sheet. Information on this sheet must be updated as hospitals advise on
their changing capabilities.
As patients are transported, the Transportation Officer should keep a running tally of the number of
patients transported to each individual hospital. Hash marks may be placed in the boxes below the Red,
Yellow and Green designations. These numbers can be quickly compared to what the hospital said its
capability is to avoid sending more patients than that hospital can handle. The Transportation Officer
should use as many hospitals as possible to avoid overloading any one hospital with patients.
After the last patient has been transported and the incident has concluded, the Transportation Officer
should review the HOSPITAL TRANSPORTATION LOG and complete the totals sections of the
HOSPITAL CAPABILITY AND PATIENT TALLY SHEET.
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HOSPITAL TRANSPORTATION LOG
As patients leave the Treatment Area and are loaded into ambulances, the Transportation Officer (or an
assigned aide or transcriber) should make notations on the HOSPITAL TRANSPORTATION LOG.
The triage tag number, patient priority (tag color) and patient sex should be noted. Additionally, the
receiving hospital and transportation unit should be noted, along with the time of transportation. If
available, note the patient's name. This is especially helpful since one goal is to send patients from the
same family to the same hospital. Much of this information noted on the log should be relayed to the
receiving hospital after the transport unit leaves the Loading Zone.
Completion of this sheet is important, as much of the information on this sheet will be used for statistical
analysis after the incident. For instance, by comparing the patient priority listed on this sheet with the
priority on the Treatment Sector Log, problems with triage techniques or treatment procedures may be
identified. It may also be noted how many patients deteriorated while awaiting transportation. Time
comparisons may be performed, and a final tally of how many patients each hospital received may be
calculated.
HOSPITAL DIRECTIONS CARDS
It must be realized that due to the possible need for ambulances from well outside the local area, not allresponding crews may be familiar with how to get to local hospitals. Early in the incident, the
Transportation Officer, or someone assigned by the Transportation Officer, should fill out some of the
cards with directions to key hospitals. These cards can then be given to crews as they transport patients to
the respective facilities. This has two advantages:
1. It reduces the possibility of verbal orders being confused and patients being transported to
the wrong hospital.
2. It reduces the possibility of a crew getting lost while enroute to the hospital.
An area is provided at the bottom of the card for writing "Additional Comments". For instance, if the
ambulance crew should pick up certain supplies and return to the treatment area, or if the crew should
return to the staging area or to quarters, this information may be noted.
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CONTENTS OF STAGING OFFICER'S PORTFOLIO
In a large incident, it is advisable to have a separate Staging Officer for handling EMS units only. The
main function of this Officer is to coordinate units arriving at the Staging Area and being sent to the
Loading Zone.
EMS UNIT STAGING LOG
As EMS units arrive at the Staging Area, the proper entries should be made in the log. It is especially
important to note the unit's capability (whether BLS, Intermediate, or Paramedic). All communication
between the Staging Officer and the ambulance crew should be handled through the designated "OfficerIn-Charge".
Since some personnel from arriving ambulances may be needed to assist in the Treatment Area or
perform some other duty, it may be necessary to divide a crew. Note the number of personnel available
from each unit. If some members of the crew must be sent to the Treatment Area or some other area, a
member of the original crew should remain with the unit as a driver. This is important since they will be
familiar with radio operations and what electrical switches control various functions in the ambulance.
INCIDENT PROTOCOL CARDS
Arriving mutual aid units may not be familiar with your system of Mass Casualty Incident management.
Due to the emotionally charged nature of the incident, it is important to maintain early control of these
units. As EMS units arrive at the staging area, the Staging Officer will distribute INCIDENT
PROTOCOL CARDS. The card outlines general rules and guidelines for the personnel to follow. Stress
that these rules are not optional, and should be followed closely.
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CONTENTS OF STAGING OFFICER'S PORTFOLIO (Cont.)
INCIDENT PROTOCOL CARDS (cont.)
The back of the card contains an area for noting the "Staging Area Location" and the "Loading Zone
Location". The Staging Officer should write directions and/or a map from the Staging Area to the Loading
Zone on the back of the card or by someone designated by the Staging Officer. The cards may be filled out
while waiting for the first units to arrive at the Staging Area. An area for noting any "Additional Comments" or
instructions is also on the back of the card. Special points, such as any safety considerations or special
equipment that may be needed, should be noted in this area.
POST-INCIDENT ANALYSIS FORMS
In order to critique the handling of the MCI, and to pinpoint areas that need improvement, it is
important to cross-reference all the information that was noted by various Officers on their individual
forms. Since each Officer kept track of information that only pertained to his or her area, there will be
very little duplication of information. Two primary forms are included to help in incident analysis.
POST-INCIDENT PATIENT ANALYSIS REPORT
After obtaining the patient logs from the Treatment Officer and Transportation Officer, the
POST-INCIDENT PATIENT ANALYSIS REPORT should be completed. This form will allow the
EMS Commander to complete time studies and statistical analysis concerning patient handling and
treatment times.
POST-INCIDENT ANALYSIS REPORT
The POST-INCIDENT ANALYSIS REPORT is a synopsis of essential information about the incident.
It includes areas for noting essential information about the incident itself, patient information such as
number of patients treated and treatment time, and information on the number of ambulances and
hospitals involved.
This form should be completed as soon possible following the Mass Casualty Incident. The EMS
Commander should obtain all completed forms and reports. Information may then be transferred to the
POST-INCIDENT ANALYSIS REPORT. This report may be used for: time studies, statistical analysis
and notification of family members.

NOTE TO TRAINEE
Incident command bags are located on the driver’s side outside compartment of each ambulance.
Trainees should review over their contents regularly
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LESSON TWO – Writing Policies
When was the last time you reviewed your organization's policies? If you're
like many services, writing or updating policies is at the bottom of a lengthy
"to-do" list, and you may even question the value of having written policies
because of the apparently conflicting advice concerning their usefulness. On
one hand, many HR experts advocate having written policies as a way of
communicating your organization's values and practices to employees.
Alternatively, a growing number of attorneys are warning their clients that
poorly drafted policies may land them in court. So, who should you believe?
The short answer is both groups. Upon closer consideration, these positions
are not contradictory. Well-written policies can both serve as an effective
communication device and help you stay out of court, or at least give you a
better chance of prevailing. The following questions and answers will help
define the underlying issues and make clear why written policies that are
carefully developed, updated, and applied are an effective tool that you need.
1. Why are written policies important?
Sound employment policies provide the framework within which an
organization governs its employee relations. A policies and procedures manual
guides both managers and employees as to what is expected and can prevent
misunderstandings about employer policy. In addition, supervisors and
managers are more likely to consistently apply policies that are clearly
communicated in writing.
It is true that written policies, like any record, can be used against an
organization in a lawsuit. Poorly drafted policies often become the main
evidence presented when employees allege that the policies were in fact a
contract that the employer violated. However, policies that are carefully
written so as not to be contracts actually should protect against these claims
and not be a problem. (See number 4, below.) In addition, carefully written
policies can be used to illustrate your commitment to a positive work
environment and nondiscriminatory employment practices. (See number 3,
below.)
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2. Are we required to have written policies?
Although written policies in general are not legally required, certain policies may
be required, or at least be considered an important component in helping
employers establish good faith compliance with federal and state law. For
example, the Supreme Court has indicated that employers may protect
themselves against liability for sexual harassment by having clearly articulated
policies against sexual harassment that include effective complaint procedures.
In addition, the Family and Medical Leave Act requires covered employers to
provide written information regarding employee rights and employer obligations
under the Act. Similarly, certain federal contractors must have written equal
employment opportunity policies. And finally, many state laws require written
harassment policies and policies informing employees about compensation
issues.
3. Does every organization need written policies?
As a general rule, every employer, except maybe those with fewer than 15
employees, should have written policies. Employers with 15 or more employees
are covered by federal discrimination laws (such as Title VII and the Americans
with Disabilities Act) and most state discrimination laws. Written policies are a
good starting point to show your commitment to nondiscriminatory employment
practices. For example, a performance review policy can show the job-related
criteria used to evaluate employees and any safeguards used to ensure the
process is conducted in a fair and objective manner.
Smaller employers should at least consider creating a handbook since it is likely
they already have some policies in writing. For example, employment offer letters
may explain vacation and sick leave accrual while other items, like a posted
memo, may outline pay procedures. Thus, to ensure distribution to all
employees, even the small employer is well advised to compile these memos into
a handbook that is given to every employee.
4. Will we create a contract if we have written policies?
The simple act of putting your policies in writing should not create a binding
contract if the policies are written as guidelines that explain generally or
typically what your requirements are and how employees normally will be
treated. However, you can create a contract by using language that conveys rigid
rules that must be followed exactly as written in all circumstances.
Therefore, you should build flexibility into your wording and steer clear of any
promises that could be interpreted as a contract. Your policies should not, for
example:
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
State that the organization will "only" or "always" do something or
"must" act in a particular way;

Describe employees as "permanent";

State that employees will be terminated only for "cause";

Make promises of job security; or

Use all-inclusive lists, such as in disciplinary procedures or work rules.
Instead, you should use terms such as "generally," "typically," "usually," and
"may" so that managers have flexibility in interpreting and applying the
policies. In addition, you should specifically retain management's right to
update, change unilaterally, and implement all policies as the organization
sees fit. Finally, you should include a strong "at-will" statement that clearly
specifies that all employees (who do not have contracts or collective bargaining
agreements specifying otherwise) may quit at any time and for any reason or
may be terminated at any time and for any reason.
5. What is the difference between a supervisory policy manual and an
employee handbook? Which should we have?
A supervisory policy manual generally is intended as a guide for managers
and supervisors and contains information that they need to implement the
organization's policies. Thus, a supervisory policy usually provides a general
statement of policy followed by several comments that instruct managers how
to apply that policy.
In contrast, an employee handbook is designed for broad distribution to all
employees. It is typically intended to provide general information about the
organization's practices, benefits, hours of work, pay policies, and work rules.
It usually does not include information about supervisory procedures.
At a minimum, you should have an employee handbook that explains your
policies to employees. Many organizations, especially as they grow, also have a
supervisory policy manual to ensure that their managers understand how to
implement the policies. As a practical matter, having supervisory instructions
may be especially prudent in today's legal climate where any inconsistent
application of policy can result in a discrimination claim.
6. What policies should we include?
In choosing policies to include, you should consider the following points:

The culture of your organization and its recurring issues or problems;
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
Any memos on policy topics (such as vacation and holiday schedules)
and past practices (i.e., what you have done in the past to address a
particular employee relations issue); and

The HR practices followed by other organizations in your industry (such
as vacation lengths and leave allowances).
Most employers develop policies on the following topics:

at-will employment,

pay procedures,

benefits (including any paid vacation, sick leave, and holidays, and
other forms of leave),

meal and rest breaks,

personal conduct (work rules),

attendance and punctuality,

sexual and other forms of harassment,

equal employment opportunity,

disciplinary procedures, and

termination.
In addition, many employers include policies on performance appraisals,
smoking, safety procedures, appropriate dress and appearance, use of
communications systems (including the proper use of telephones, computers,
e-mail, and Internet access), and drug and alcohol use.
Remember, your policies should be considered dynamic, not static. You may
need to add to them, revise them, and even delete them as your organization
grows and changes.
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Is the Job Ever Done?
Even when you're finished drafting or updating your policies, your job is not
complete. The policies should be reviewed by your legal counsel to ensure that
they comply with state and federal employment law before they are finalized
and distributed to employees. Further, you should review the policies on a
regular basis to make sure they continue to comply with applicable law and
the needs of your organization. New laws, regulations, and court cases can
affect both policy language and how you implement the policies. Most experts
suggest a thorough review of your policies at least once a year and the use of a
notification Service or publication to keep you posted during the interim.
Finally, when policies are introduced or revised, you should distribute and
thoroughly explain them to all employees.
Clearly written policies that are regularly re-viewed can be both an effective
employee relations tool and a good defense against employee lawsuits. In
contrast, policies that are poorly drafted or applied can have exactly the
opposite effect. They can lower morale and become evidence against you in
court. The key question, therefore, becomes not whether to have written
policies at all, but whether you are willing to invest the necessary amount of
time and effort to make sure they are carefully drafted and properly applied.
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LESSON THREE – Investigations
Every officer confronts it sooner or later. An attendant lodges a complaint about
work-related misconduct — harassment, theft, or violation of a service rule — and
you know you need to investigate the situation. But what’s the best way to
proceed?
Some complaints require only minimal investigation; disputes and fighting among
employees, for example, can usually be resolved informally through talking. Other,
more sensitive complaints, particularly those that could lead to an agency
complaint or civil lawsuit, require a formal investigation. When more formal action
is needed, here are some guidelines:
Get started promptly. During that first meeting with the accuser, identify the
issues. Get all the relevant information you can, such as dates and times of any
incidents and names of witnesses; ask for supporting documents. Ask the accuser,
also known as the complainant, to put the complaint in writing; this helps
eliminate frivolous claims. Let the accuser know there will be a follow-up meeting
after witnesses are interviewed.
No deals.
Do not agree not to investigate just because the complainant asks for anonymity or
confidentiality.
Choose a fact finder.
Decide who will conduct the remaining interviews and gather information. This
could be you, another Officer, or the Director. However, you may want to consult
with an attorney before starting the investigation, because the information gathered
may then be considered privileged. You may also want to have a witness present
during the remaining interviews.
Objectivity is paramount.
Above all else, the investigator must keep an open mind and not be influenced by
personal opinions about the parties involved. The investigator should also
understand the substantive law involved and be familiar with any MAS policies that
may relate to the situation.
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Interview the accused next. Ask if he or she knows why the accuser might make
such an allegation and whether they have had past difficulties. Let the accused
know that no conclusion has been reached yet and that there will be a follow-up
meeting.
Stopgap measures.
Decide whether interim action is needed, such as separating the attendants
involved or suspending the accused with pay.
Interviewing witnesses.
Plan the order of witness interviews and notify the interviewees. If the accused or
accuser has spoken to others about the incidents, be sure to include those people
as witnesses. Prepare questions beforehand and ask them in the same order,
although the interviews may vary somewhat from witness to witness. Get witness
statements in writing or take detailed notes. Encourage witnesses to return later if
they have additional information.
Confidentiality.
Assure everyone that the information they’ve provided will be kept confidential to
the extent possible and that there will be no retaliation. Remind witnesses that
breach of confidentiality will result in disciplinary measures and can also lead to
defamation or invasion of privacy claims.
Reluctant witnesses.
Do not detain reluctant witnesses with threats or force, but do remind them of their
duty to cooperate. Some interviewees may ask to have a witness present. A union
member may usually have a steward present during questioning, and an attorney
may be present if criminal investigators have become involved. Otherwise, an
interviewee is not entitled to have a witness, although allowing it would not
necessarily harm the investigation.
Final interviews.
Interview the accuser and accused one more time. Assess their credibility based on
such factors as demeanor, which side makes sense, and whether witnesses made
conflicting statements.
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Wrap it up.
Once the investigation is complete, the investigator should write up the findings.
Read the findings, then decide on a course of action; have your decision reviewed
by the Director.
Corrective action.
Put the decision in writing and provide a copy to the accused and the accuser to
read if requested but not to keep unless it has been authorized by the Director;
take any necessary corrective action promptly. Get a signed statement from the
accuser acknowledging that he or she knows the steps you have taken. Document
the appropriate personnel files. You may also want to make an appeal process
available.
Follow-up.
If the complaint was found to have merit, follow up with the accuser; find out how
he or she is doing. Address any other problems that were revealed during the
investigation.
One final note:
Remember that government agencies and courts will look at an investigation to see
how thorough and fair it was. A proper investigation now can help protect you
against legal problems later.
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LESSON FOUR– Work Place
Accidents
You are the Officer on duty when an attendant notifies you there’s been a accident and another attendant
has been injured. What should you do? According to Mark Haskins, safety and health manager at Pfizer,
Inc. and a Certified Safety Professional, there’s a definite process that should be followed and it helps to
think about the steps before you’re actually called to action:

Take control at the scene and try to restore order.

Assure first aid and call for emergency Services. Provide immediate care if needed.

Control potential secondary accidents. This includes denying access to people who don’t need to
be on the scene. If there’s been a spill, for example, you don’t want other attendants wandering
through and slipping on something.

Identify people and conditions at the scene. The people are potential witnesses to what happened.
Have someone else take down there names. If you’re alone at the scene, try to at least look
around and notice who’s there.

Preserve physical evidence. Secure the scene and, again, control access. You don’t want evidence
being altered or removed.
Once the immediate emergency is stabilized, these additional steps should be taken:

Evaluate how bad the loss is, how bad it could have been, and whether additional investigation
resources are needed.

Make appropriate notifications. Be sure the Director has been notified; he/she should not learn
about the accident from the newspaper. Also contact families, any necessary regulatory agencies,
and your insurance companies if authorized by the Director.
Other tips
An initial report should be completed and sent to the Director within 24 hours of the accident. A followup report that includes recommended action should be undertaken within 48 hours and completed within
30 days.
Finally, it’s a good idea to have a written procedure to be followed in case of an accident and to train
employees and supervisors in the procedure.
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FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
ACCIDENT REPORTING AND INVESTIGATION
A.
Workers’ Compensation injury is defined as accidental injury or death arising out of and in the
course of employment, and all occupational diseases arising out of and in the course of
employment. There are definite State requirements for reporting these injuries which are
summarized below.
The first thing to do when an accident occurs is to ensure that proper medical treatment
is provided.
1. Report all details of the accident to your supervisor after treatment is sought, if required.
2. Supervisors will see to it that enough information is gathered to accurately complete the
Employee’s First Report of Injury of Occupational Disease (Form 8WC Rev 7/95).
3. The First Report of Injury Form will be completed by the injured employee within twentyfour (24) hours and processed by the Department Head or his/her designee within three (3)
calendar days. The Department Head or his/her designee will also complete the Employee’s
Supplemental Report of Injury (Form 13WCA Rev 11/92) and Wage Schedule [Form
76WCA Rev 12/90) if required.
4. Injuries requiring only common first aid must also be reported following these guidelines.
B.
Employee Accident Investigation
1. All accidents and near misses shall be investigated to determine what did happen, why it
happened, and most importantly, how to prevent it from happening again. A report shall be
completed by the employee’s supervisor and forwarded to the Department Head and JLMC
Chair.
2. Investigate the scene as soon as practicable after the accident. Note conditions, location of
equipment, physical objects, and witnesses. Make notes and draw sketches or take photographs
as needed.
3. Interview witnesses. It is important to do it soon after the accident so it is still fresh in their
mind. Be certain that they understand that no blame is being laid – you are simply trying to
gather facts to prevent a reoccurrence.
4. Interview the victim when the timing is right. Keep in mind his/her physical and emotional
condition.
5. Make recommendations to prevent similar occurrences.
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FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
COMMUNICABLE DISEASE POLICY
A.
Purpose
The following provides a guideline for response on all medical calls or as a first responder to a
citizen or colleague by all employees. This policy is to assure HEALTH AND SAFETY OF
PERSONNEL FROM CONTRACTING A COMMUNICABLE DISEASE.
PROCEDURE
1.
Personnel shall cover any lacerated, chapped, irritated, or otherwise damaged skin that
they may have with an adhesive waterproof dressing. All personnel shall wear latex exam
or surgical gloves on all medical calls. Gloves shall be put on prior to any patient care.
Personnel directly involved in fire suppression or extrication activities are exempt from
the above as long as they have no patient care. Patient stabilization or removal requires
gloves. Extrication personnel are strongly urged to wear latex gloves under fire duty
gloves.
2.
Goggles are to be worn by employees who are providing or assisting with the provision of
care, that may be subject to direct exposure potential during intubation, childbirth, or
when body fluids may be spurting.
3.
Appropriate masks (surgical or respiratory) shall be worn when a patient is suspected of
being infected with a respiratory infection or, coughing or in situations listed in item 2.
4.
Injured or ill parties who are not breathing, or are breathing inadequately, or have a
respiratory rate that requires intervention with artificial respiration, shall be assisted with a
barrier device. Preferably, a bag-valve-mask system with supplemental oxygen and airway
adjuncts will be utilized to ventilate the patient, however, a pocket-mask with one-way
valve is acceptable until the arrival of a bag-valve-mask device.
5.
Personnel are to wash their hands as soon as possible after patient contact. Hands are to
be washed vigorously with soap and warm running water whether protective gloves are
worn or not. Kitchen sink in quarters is not to be used for washing hands. Any skin or
material splattered with body fluid must be washed off as soon as possible.
6.
Any personnel who comes in contact with a patient’s body fluids, (i.e., blood, saliva, urine,
fecal matter or mucosa) or open lesions must, upon return to the station, complete a
NOTICE OF ACCIDENTAL INJURY OR OCCUPATIONAL DISEASE (8aWCA)
and EMERGENCY RESPONSE/PUBLIC SAFETY WORKER INCIDENT REPORT
forms. Supervisors are required to investigate the incident in question and complete and
submit, along with the exposed employee’s paperwork, Form 8WC, EMPLOYER’S
FIRST REPORT OF OCCUPATIONAL INJURY OR DISEASE, to the Town
Executive Assistant and JLMC Chair. Any employee who comes into contact with body
fluids of a patient believed to be in a high risk category or any employee stuck by a used
needle or contaminated “sharps”, shall comply with RSA 141-G, Infectious Disease
Exposure Response, outlined below.
7.
Cleaning and disinfecting of durable equipment, such as laryngoscope blades and handles,
shall be cleaned of organic matter with soap and water then soaked for ten (10) minutes in
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FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
a 10-1 chlorine bleach solution. Cleaning gloves shall be worn during this procedure. All
disposable equipment shall be disposed of in biohazard containers.
8.
Decontamination and LAUNDERING OF PROTECTIVE CLOTHING; Any material
worn or used by the rescuer that becomes contaminated with blood or other body fluids,
to which universal precautions apply, shall be placed and transported in bags or containers
that prevent leakage, preferably, biohazard approved. Personnel involved in the bagging
and transporting of contaminated clothing shall wear gloves. Those materials that are to
be disposed of shall be bagged separately. Protective clothing and work uniforms should
be washed and dried according to manufacturer’s instructions. Boots and leather goods,
as well as personal items may be scrubbed with soap and hot water to remove
contamination. Additionally, hydrogen peroxide can be used, where appropriate, to
denature blood prior to cleaning. These procedures will be done at the hospital, or at the
station, you are assigned to. Under no circumstances, shall contaminated material be
cleaned/laundered at an employee’s residence or public laundromat.
9.
Every person should receive a Tetanus-Diphtheria (TD) booster every ten- (10) years.
10.
Hepatitis B vaccination is available to all emergency/public safety employees, free of
charge, and is recommended for all personnel who are regularly or occasionally exposed
to the blood and/or body fluids of others.
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FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
11.
All departments should have on file the following immunization history for all personnel:
a) Polio series
b) Diphtheria, Tetanus, Pertussis series (DPT)
c) Measles, Mumps, Rubella (MMR) vaccine after 1968 if you are younger than 33 years
old
d) Chicken Pox.
By always following these recommendations, the potential is lessened for contraction of many
communicable diseases while eliminating many hours of worry for you.
SECTION 10
INFECTIOUS DISEASE EXPOSURE RESPONSE
PURPOSE:
New Hampshire RSA 141-G issues the mandate for notifying Firefighters, Emergency Medical Care
Providers, and Police Officers after exposures to a possible infectious disease. The mandate’s intent
is to ensure that the aforementioned employees are provided with testing for and treatment of
communicable disease as a result of exposure in the line-of-duty. Additionally, the Town feels that
any other employee, who, in the course of rendering assistance to an injured or ill party, may have
incurred an unprotected exposure (as defined below) should follow the same procedures as those put
forth in RSA 141-G for Emergency Response/Public Safety Workers. Attached is an example of the
Emergency Response/Public Safety Worker Incident Report Form (Form DPHS [1/90]) per State
Regulation, for the purpose of complying with RSA 141-G.
Definition (RSA 141-G)
Unprotected Exposure – “includes instances of direct mouth-to-mouth resuscitation or the
commingling of blood or other potentially infectious material of a source individual and an
emergency response/public safety worker, which is capable of transmitting an infectious disease
or any other type of exposure that may be designated by the commissioner by rule adopted under
RSA 141-G: 6.”
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FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
PROCEDURE
The following steps should be completed after possible exposure to someone with an
infectious/communicable disease:
1.
Remove any contaminated clothing. Do not remove contaminated pullover shirts
by pulling them over the face, cut off instead.
2.
Immediately clean the exposed area with warm soapy water or waterless cleansing
agent.
3.
After cleansing of the exposed area, seek a medical exam and treatment, if
necessary, at the same facility that the Source party is transported. If the Source
party is not transported to a hospital, report to a hospital emergency department
of your choice within one hour.
4.
At the hospital emergency department, inform the hospital staff of the incident
and where the Source party was transported to, if they were, even if it is to the
same hospital.
5.
Fill out an Exposure Incident Report form as completely as possible before the
end of your shift.
Completed Forms should be filed in accordance with the notations at the bottom of the form:
a.
White: Medical Referral Consultant: Dr. Robert D’Agostino,
28 Jones Rd. Milford NH 03055, 672-2003.
b.
Yellow: Infectious Control Office of facility where source party
(patient) transported. Exposed Milford Ambulance personnel
treated at facility other than the Service’s Medical Resource
hospital (SNHMC) are to forward a copy to the ambulance
Director for submission to SNHMC Infection Control Officer.)
c.
Green: Exposed worker copy.
d.
Goldenrod: State Public Health Division. This copy is to be
forwarded to the Town Administrator’s office for forwarding and
filing with the Notice of Injury Form and Employer’s First Report
of Occupational Injury of Disease Form.
6. Complete and return within 24 hours of exposure required Notice of Accidental Injury
or Occupational Disease Form to the Town Administrator’s office.
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FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
Medical Referral Consultant for the Town of Milford:
Dr. Robert D’Agostino, 28 Jones Road, Milford NH 03055 672-2003.
NOTE
The Medical Referral Consultant’s responsibilities include conducting a medical examination,
evaluation of the exposure, administering appropriate prophylactic treatment and follow-up
treatment and advice to the exposed worker.
TEST RESULTS AND CONFIDENTIALITY
Pursuant to RSA 141-G, exposed worker test results are considered confidential and shall only be
distributed to the exposed worker, medical referral consultant and hospital infection control officer.
Exposed worker consent may be necessary for the exposed worker’s personnel physician to obtain any
test results.
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Date of
incident:
Time of
Incident:
Location
:
Incident
Incident Number:
Responding
Officer:
Incident Situation:
Pos
:
Date:
ALLEGEDLY INVOLVED
ADDRESS
Officer’s Narrative
The Initial Incident:
Interview with Complainant:
Interview with Witnesses:
Investigation Results of the Scene:
Interview with Accused:
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FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
Conclusion:
Officer Recommendations:
INVESTIGATION STATUS
Incident
Assigned
Incident filed
Incident closed
___/___/__
_
___/___/__
_
___/___/__
_
Assigned
to
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FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
FINAL WRITTEN EXAMINATION
SERVICE OFFICERS WRITTEN EXAMINATION
NAME: _________________
DATE: ___________________
COMMUNICATION AND AFFECTIVE DOMAIN
1. MANY PROBLEMS WITHIN THE AMBULANCE SERVICE MAY BE
CAUSED BY?
A.
B.
C.
D.
MISCONDUCT
MISCOMMUNICATION
MISAPPROPRIATION OF FUNDS
MISSED APPOINTMENTS
2. AS AN OFFICER YOU SHOULD PROVIDE FEEDBACK TO
ATTENDANTS?
A.
B.
C.
D.
WITHIN 24 HOURS OF THE INCIDENT
WITHIN 48 HOURS OF THE INCIDENT
AS SOON AS POSSIBLE
NO NEED TO WORRY ABOUT FEEDBACK BECAUSE ITS
NOT IMPORTANT
3. WHEN ASKING A QUESTION OF AN ATTENDANT AND WAITING
SEVERAL SECONDS FOR AN ANSWER, THIS TECHNIQUE IS
CALLED?
A.
B.
C.
D.
PAUSE
MENOPAUSE
WAITING PERIOD
SHRINE’S TECHNIQUE
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FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
4. WHEN PROVIDING FEEDBACK TO AN ATTENDANT FOR A
MISTAKE THAT WAS MADE ON A CALL YOU SHOULD?
A. GET RIGHT TO THE POINT AND TELL THEM WHAT THEY
DID WRONG
B. TELL THE ATTENDANT THAT IT WAS WRONG AND SET UP
A DATE FOR REMEDIAL TRAINING
C. START OUT WITH THE BAD NEWS AND THEN END WITH
POSITIVE NEWS
D. START OUT WITH THE POSITIVE, EXPLAIN THE THINGS
DONE WRONG, AND END AGAIN ON A POSITIVE NOTE
5. WHICH OF THE FOLLOWING ARE CONSIDERED TO BE
PROFESSIONAL ETHICS IN EMS COMMUNICATIONS?
A.
B.
C.
D.
ALWAYS BE HONEST
PROTECT CONFIDENTIALITY
TREAT PEOPLE THE WAY YOU WANT TO BE TREATED
ALL OF THE ABOVE
6. AS AN OFFICER, IT NEEDS TO BE UNDERSTOOD THAT:
A. YOU HOLD LITTLE RESPONSIBILITY IN THIS POSITION
B. YOU HAVE LITTLE INFLUENCE OVER OTHER ATTENDANTS
C. YOU HAVE POWER TO MAKE PEOPLE DO EVERYTHING
YOU WANT
D. YOU HAVE STRONG INFLUENCE OVER OTHER
ATTENDANTS
7. WHICH TERMS ARE CONSIDERED TO BE IDEAL
CHARACTERISTICS OF AFFECTIVE DOMAIN?
A. KINDNESS
B. COMPASSION
C. HATRED
D. SELFISHNESS
E. A AND B
F. C AND D
G.NONE OF THE ABOVE
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FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
8. WHICH OF THE FOLLOWING ARE CONSIDERED TO BE MODEL
VALUES THAT YOU AS AN OFFICER, WANT ATTENDANTS TO
EMULATE?
A.
B.
C.
D.
E.
FAIRNESS
HONESTY
PUNCTUALITY
ALL OF THE ABOVE
A AND B ONLY
JOB PERFORMANCE PROBLEMS
9. WHAT SHOULD AN OFFICER FOCUS ON WHEN DEALING WITH
THE RECOGNITION OF A JOB PERFORMANCE PROBLEM?
A.
B.
C.
D.
HOW MUCH AN ATTENDANT EATS (OVERWEIGHT)
INTERPERSONAL RELATIONSHIPS
ABSENTEEISM
BOTH B AND C
10.
WHICH OF THE FOLLOWING IS CONSIDERED TO BE
ACTIVE SUPERVISION AND INTERVENTION?
A.
B.
C.
D.
E.
F.
11.
DOCUMENTING
PREPARING
LISTENING
TALKING
A AND B
C AND D
WHAT ARE THE ABC’S OF GOOD DOCUMENTATION?
A.
B.
C.
D.
ARBITRATION, BASED
ARBITRATION, BASED
ACCURACY, BASED ON
ACCURACY, BASED ON
ON BEHAVIOR, CONCERN
ON BEHAVIOR, CONSISTENCY
BEHAVIOR, CONCERN
BEHAVIOR, CONSISTENCY
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FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
12.
DURING THE PREPARATION STAGE OF INTERVENTION
WHAT SHOULD THE OFFICER FIRST BEGIN WITH?
A.
B.
C.
D.
THE ATTENDANT
THEMSELVES
THE DIRECTOR
THE TOWN ADMINISTRATOR
13.
FINISH THIS PHRASE “EFFECTIVE INTERVENTION
THROUGH GOOD______”:
A.
B.
C.
D.
COMMUNICATION
DOCUMENTATION
ELABORATION
CELEBRATION
OFFICER RESPONSIBILITIES
14.
WHAT IS THE CORRECT CHAIN OF COMMAND FOR THE
ASSOCIATION SERVICE OFFICERS?
A. DIRECTOR, TOWN ADMINISTRATOR, CAPTAIN, 1ST LT,
2ND LT, 3RD LT
B. TOWN ADMINISTRATOR, CAPTAIN, 1ST LT, 2ND LT, 3RD
LT, DIRECTOR
C. TOWN ADMINISTRATOR, DIRECTOR, 1ST LT, 2NDLT, 3RD
LT, CAPTAIN
D. TOWN ADMINISTRATOR, DIRECTOR, CAPTAIN, 1ST LT,
2ND LT, 3RD LT
15.
THE CAPTAIN IS RESPONSIBLE FOR:
A.
B.
C.
D.
PUBLIC RELATIONS
SCHEDULING
MEMBERSHIP PAPERWORK AND TRACKING
TRAINING
16.
ALL SERVICE OFFICERS ARE ALSO RESPONSIBLE FOR
WHAT OTHER DUTIES LISTED BELOW?
A. INCIDENT COMMAND
B. MUTUAL AID CALLS TO MILFORD
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FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
C. ALL CALL TONES
D. ALL OF THE ABOVE
17.
WHEN AN OFFICER ARRIVES ON THE SCENE OF A LARGE
INCIDENT THEY ARE:
A. IN CHARGE OF THE PATIENT CARE
B. SHOULD HELP OUT WITH PATIENT CARE WHILE DOING
EMS COMMAND
C. SHOULD ONLY MAKE THE REQUESTS THAT THEY WANT
OR SEE FIT
D. WORK IN CONJUNCTION WITH THE PARAMEDIC TO
MAKE REQUESTS FOR OVERALL SCENE MANAGEMENT
INCIDENT COMMAND SYSTEM
18.
WHEN YOU AS THE OFFICER ARRIVE ON THE SCENE OF A
LARGE INCIDENT YOU SHOULD:
A.
B.
C.
D.
SURVEY THE SCENE QUICKLY
ESTABLISH EMS COMMAND
SEE WHO NEEDS YOUR HELP FIRST AND BEGIN THERE
CALL THE HOSPITAL RIGHT AWAY AND TELL THEM TO
PREPARE
19.
ONCE EMS COMMAND HAS BEEN ESTABLISHED WHICH
OF THE FOLLOWING ARE IMMEDIATE CONCERNS THAT NEED
TO BE ADDRESSED?
A. REQUESTING ADDITIONAL EMS UNITS TO THE SCENE
B. START EVACUATION OR TRIAGE WHEN PERSONAL
BECOME AVAILABLE
C. ESTABLISH LIAISONS WITH FIRE AND POLICE
COMMANDERS
D. ALL OF THE ABOVE
20.
WHICH ONE OF THESE POSITIONS IS NOT CONSIDERED
TO BE A SECTOR OFFICER POSITION THAT IS UTILIZED BY
MAS?
A. TRIAGE OFFICER
B. TRANSPORTATION OFFICER
C. LIAISON OFFICER
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FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
D. TREATMENT OFFICER
21.
WHAT IS AN EXAMPLE OF AN OPEN MCI INCIDENT?
A.
B.
C.
D.
22.
BUS CRASH
MOTOR VEHICLE ACCIDENT
PLANE CRASH
TORNADO
WHAT IS THE TRIAGE OFFICER RESPONSIBLE FOR?
A. PLACING TRIAGE TAGS ON PATIENTS
B. PROVIDING TREATMENT TO PATIENTS
C. BEING AN ALS PERSON SO AS TO BE ABLE TO BETTER
TRIAGE THE PATIENTS
D. NONE OF THE ABOVE
23.
WHERE SHOULD THE INCIDENT COMMANDER BE
POSITIONED AT A SCENE?
A. WITH FIRE COMMAND
B. WITH THE PRIMARY AMBULANCE SINCE IT HAS BEEN
TAKEN OUT OF SERVICE
C. WITH EXTRICATION COMMAND FROM THE FIRE
DEPARTMENT
D. AT THE AREA WITH THE MOST DEVASTATION
24.
WHAT SHOULD THE TRANSPORTATION OFFICER PROVIDE
TO THE RECEIVING HOSPITAL WHEN AN AMBULANCE IS
LOADED AND LEAVING THE ACCIDENT SCENE?
A.
B.
C.
D.
NAME OR NUMBER OF TRANSPORTING UNIT
NUMBER OF PATIENTS BEING TRANSPORTED
ETA OF THE TRANSPORTING UNIT
B AND C ONLY
25.
WHO SHOULD PROVIDE THE FINAL NEWS BRIEFING AT
THE CONCLUSION ON THE INCIDENT?
A.
B.
C.
D.
PRIMARY CARE PHYSICIAN
PRIMARY CARE ATTENDANT
POLICE OFFICER IN CHARGE OF THE SCENE
INCIDENT COMMANDER
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FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
POLICIES AND PROCEDURES
26.
WHY ARE WRITTEN POLICIES IMPORTANT FOR MAS TO
HAVE?
A. TO GUIDE OFFICERS AND THE DIRECTOR IN HANDLING
SITUATIONS
B. TO GUIDE ATTENDANTS THOUGH SITUATIONS
C. TO DICTATE WHAT ATTENDANTS ARE EXPECTED TO DO
IN SITUATIONS
D. BOTH A AND B
27.
MAS IS:
A. REQUIRED BY LAW TO HAVE A SET OF POLICIES IN
PLACE BEFORE WE CAN OPERATE AS A SERVICE IN THE
STATE OF NH
B. REQUIRED BY THE FEDERAL GOVERNMENT TO HAVE A
SET OF POLICIES IN PLACE BEFORE WE CAN OPERATE AS
A SERVICE IN THE STATE OF NH
C. BOTH A AND B
D. HAS CREATED A CONTRACT WITH ATTENDANTS WHEN
SOG’S ARE ESTABLISHED
28.
A POLICY MANUAL SHOULD:
A.
B.
C.
D.
USE TERMS LIKE “ONLY”, “MUST”, AND “ALWAYS”
USE TERMS LIKE “GENERALLY”, “USUALLY”, AND “MAY”
CAN USE EITHER SET OF TERMS IN A OR B
SHOULD BE WRITTEN AT A FIFTH GRADE LEVEL SO THAT
ALL PERSONS CAN EASILY UNDERSTAND WHAT IS
WRITTEN
29.
CAREER AND VOLUNTEER EMPLOYMENT WITH MAS IS
CONSIDERED TO BE:
A.
B.
C.
D.
A CONTRACT
AT WILL
RENEWABLE
RE-CERTIFIABLE
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FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
CONDUCTING INVESTIGATIONS
30.
WHEN AN OFFICER RECEIVES A COMPLAINT FROM AN
ATTENDANT HE/SHE SHOULD:
A. ONLY INVESTIGATE THE INCIDENT IF IT OCCURRED
DURING THEIR SHIFT
B. PROMISES THE ATTENDANT THAT CONFIDENTIALITY IS
ASSURED IN ALL CASES
C. NEVER MAKE PROMISES OF CONFIDENTIALITY IN ALL
CASES
D. NONE OF THE ABOVE
31.
WHO CAN AN OFFICER USE AS A “FACT FINDER” IN AN
INVESTIGATION?
A.
B.
C.
D.
32.
ANOTHER SERVICE OFFICER
THE DIRECTOR
ANOTHER SERVICE ATTENDANT
A AND B ONLY
YOU, AS THE OFFICER, CAN:
A. TAKE AN INTERIM ACTION EVEN BEFORE THE
INVESTIGATION IS COMPLETED SHOULD THE SITUATION
WARRANT
B. ONLY TAKE ACTION IN THE EVENT OF A COMPLAINT AT
THE CONCLUSION OF A THOROUGH INVESTIGATION
C. CAN DO ANYTHING YOU WANT TO DO
D. CAN NOT TAKE ANY ACTION AT ALL SINCE YOU ARE NOT
THE DIRECTOR
33.
WHAT IS THE CHRONOLOGICAL ORDER OF INTERVIEWS
DURING AN INVESTIGATION?
A.
B.
C.
D.
WITNESS, ACCUSER, ACCUSED, DIRECTOR
ACCUSER, ACCUSED, WITNESS, OTHER OFFICERS
ACCUSED, WITNESSES, ACCUSER, ACCUSED
NONE OF THE ABOVE
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FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
RESPONDING TO A WORKPLACE ACCIDENT
34.
WHAT IS THE FIRST THING THAT AN OFFICER SHOULD
DO WHEN HE/SHE ARRIVES TO THE SCENE OF A WORKPLACE
ACCIDENT?
A. EVALUATE HOW BAD THE LOSS IS
B. TAKE CONTROL AND PREVENT FURTHER INJURIES IF
NEEDED
C. CONTACT ANOTHER OFFICER WHO HAS MORE
EXPERIENCE
D. CONTACT THE DIRECTOR AND AWAIT HIS ARRIVAL
35.
THE INITIAL INCIDENT REPORT SHOULD BE SENT TO THE
DIRECTOR WITHIN?
A.
B.
C.
D.
48
36
24
12
HOURS
HOURS
HOURS
HOURS
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FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
Officer Training Program
Examination Answer Sheet
Name ___________________________________ Date _______________________
1)
2)
3)
4)
5)
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7)
8)
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35)
A
A
A
A
A
A
A
A
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A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
B
B
B
B
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B
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B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
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D
D
D
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FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
APPENDIX
This section explains the ratings used to rank the trainee.
PASSING MARKS
1 - Mastery of objective: This indicates that the trainee has mastered the objective. The trainee completed the
objective without assistance from the FTO and exceeds the minimum requirements.
2 - Excellence in objective: This indicates that the trainee has demonstrated strong skills and or knowledge in
this objective. There is only slight room for improvement and the objective may or may not have been
completed with assistance from the FTO.
3 - Average ability in objective: This indicates that the trainee has demonstrated an average ability in
performing this objective. There is room for improvement. The trainee may or may not have needed the
assistance of the FTO in completing this objective.
FAILING MARK
4 - Unsatisfactory ability in objective: This indicates that the trainee has not completed the objective
correctly. He/she has not met the minimum standard and needed assistance with completion of the objective.
There is room for improvement and the trainee may improve with the assistance of the FTO.
5 - Poor ability in objective: This indicates that the trainee has not been able to perform the objective and has
demonstrated non-ability to the FTO. The trainee will need much remedial training and assistance from the
FTO to achieve a satisfactory skill performance.
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FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
PERFORMANCE SKILL SHEET CHECK OFF SHEET
Name of Trainee: ________________________________ Date: ___________________
PHASE I
#1
#2
#3
Final
Knowledge of service chain of command
Knowledge of service uniform
Understanding of duty schedule
Protocols exam EMT-I, P only (write in score)
Understands SOG manual
Understands and use of service stretchers
Completion of rig checks and use of rig check sheets
Use of ambulance radios
Completion of roads and streets exam (write in score)
Biohazard/ soiled linen storage
Understanding of where re-stock items are stored
Bay door operations (both auto and manual)
Knowledge of sleeping quarters
Knowledge of crew room and kitchen clean up
Knowledge of bathroom clean up
Logging and billing of calls
Preventing Disease Transmission and Pulse OX (video) X2
PSNH electrical emergencies video training and Heart monitor (video) X2
Knowledge of proper lifting techniques (FERNO video)
PHASE II
#1
#2
#3
Use of suction devices
Thermometer
Contents of first in bag
Use of MAST
Use of stair chair
Contents of Pedi kit
Application of KED
Use of spider straps
Helmet removal
Use of ambulance cots
Frac-Pac and fracture managment
Traction device and bleeding control techniques
Location of medic bag and extra ALS supplies
NOTE: All white boxes must be initialed and dated by an FTO before the skill is considered to be
“complete”. The “final” grade is determined when the trainee demonstrates and completes the last box (#3).
The FTO will place a number grade in the “final” box. Shaded boxes are considered optional and may be
used by the FTO for remedial training as needed.
80
Final
FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
PEDI BOARD (phase II)
#1
#2
#3
#1
#2
#3
#1
#2
#3
Final
Correct location in ambulance
Assumes C-spine stabilization on child
Assess CSM’s on child
Correctly measures collar or horse collar
Correctly applies collar to patient
Demonstrates log roll or straddle lift
Correctly pads under head as needed
Secures child to device properly
Secures hands properly
Reassess CSM’s after splinting
O2 TANKS AND DEVICES (Phase II)
Final
Identifies where portable O2 is stored
Changes the regulator and checks for leaks
Correctly applies a nasal canula to a patient
Correctly applies a non-rebreather to a patient
Changes the main O2 tank and checks for leaks
RUN FORM DOCUMENTATION (On-going)
Completion of 10 PCR’s
(Hand in to FTO-C)
MONITOR/ DEFIB. (Phase II)
Correctly applies monitor leads to a patient
Correctly prints a tracing of said patient
Correctly identifies a patient in need of defib.
Attaches fast patches to leads and to pt’s bare chest
After monitor analyzes pt. Trainee recognizes if it is a shockable rhythm or not. (Must
verbalize)
Correctly depresses “charge” button and confirms no breathing or pulse
Ensures that everyone is clear of patient
Delivers shocks to patient in 200, 200, 360 sequence as needed
Re-assess pt. And determines need for continued CPR for one minute
Demonstrates how to correctly replace tracing paper
Demonstrates how to replace battery and rotation sequence for batteries. Demonstrates
how to clear data card
NOTE: All white boxes must be initialed and dated by an FTO before the skill is considered to be
“complete”. The “final” grade is determined when the trainee demonstrates and completes the last box (#3).
The FTO will place a number grade in the “final” box. Shaded boxes are considered optional and may be
used by the FTO for remedial training as needed.
81
Final
FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
PT. ASSESMENT TRAUMA/MEDICAL (Phase II)
#1
#2
#3
Final
#1
#2
#3
Final
BSI, surveys scene for safety, AVPU, calls for additional help
Maintains c-spine if needed and asses ABC’s. If airway adjuncts are needed, verbalizes
them
Verbalizes appropriate O2 as needed per pt. condition
Determines medical or trauma and need for immediate transport
Verbalizes the Exposing of the Pt as needed and identifies life threatening injuries, and
completes a rapid assessment of patient on scene
Correctly treats the injuries or medical condition that is present
Gathers any DCAP-BTLS or SAMPLE or OPQRST history that is needed
While transporting Pt. Completes a detailed physical exam for either trauma or medical
(which ever Pt. Is currently) reports findings to FTO
Verbalizes trauma team activation as per protocol and/or need for paramedic intercept.
FOR EMT-I, verbalizes the establishment of 2 large bore IV’s and other advanced care
as needed
SPINAL IMMOBILIZATION (Phase II)
Arrives on scene and directs c-spine immobilization
Assess CSM’s before splinting
Correctly measures and applies c-collar or blanket roll
Performs log roll and positions Pt. onto long board
Correctly secures Pt. to board with padding (head last)
Secures hands and re-assess CSM’s
STANDING BOARD
Arrives on scene and directs c-spine immobilization
Assess CSM’s before splinting
Correctly measures and applies c-collar or blanket roll
Positions board behind patient and has one attendant on either side with arms locked
into board and patient
With either side attendant holding c-spine, Pt. is lowered to ground
Pt. Properly positioned, secured, and padded
Hands secured and CSM’s reassessed
NOTE: All white boxes must be initialed and dated by an FTO before the skill is considered to be
“complete”. The “final” grade is determined when the trainee demonstrates and completes the last box (#3).
The FTO will place a number grade in the “final” box. Shaded boxes are considered optional and may be
used by the FTO for remedial training as needed.
82
FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
ASSISTED MEDICATIONS (Phase II)
#1
#2
#3
Final
#1
#2
#3
Final
Identifies a Pt. who has cardiac history and when the need to assist with nitro exists
Verbalizes confirmation of Pt.’s four rights
Verbalizes how this medication will be administered and that medical control is needed
Verbalizes the knowledge of when not to give the medication i.e. hypotension and a Pt.
on certain meds like Viagra
Identifies when ASA would be indicated for oral administration
Verbalizes how it would be administered and what dosage is to be given
Verbalizes when the medication would not be given i.e. when Pt. has all ready taken this
med today, or allergies to med
Verbalizes how to document the giving of these medications on the PCR
GLUCOMETER (Phase II)
BSI considerations taken and Pt. identified
Test site properly cleansed with alcohol prep pad
Glucometer is out of case and test strip inserted
Pt.’s finger penetrated with lancet and sample obtained
Sharps is properly disposed of
Correct reading is obtained and site is cleansed and covered to stop bleeding.
Trainee can recite what a “normal” blood glucose range is for an adult Pt.
Trainee discusses the proper cleaning and disinfecting of equipment
Trainee can demonstrate how to insert daily test/check strip and where the result is
recorded on the rig check sheet
Trainee can demonstrate how to test the glucometer with the testing solution and where
to record the results on the rig check sheet
NOTE: All white boxes must be initialed and dated by an FTO before the skill is considered to be
“complete”. The “final” grade is determined when the trainee demonstrates and completes the last box (#3).
The FTO will place a number grade in the “final” box. Shaded boxes are considered optional and may be
used by the FTO for remedial training as needed.
83
FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
PATIENT REFUSAL AND SIGN OF (On-going)
#1
#2
#3
Final
Completes the entire top portion of the PCR to included the SAMPLE
history box (if no info is required in a box the term “pt. denies” is to be entered)
At least one set of vitals must be taken and documented
Chronological order of events to be written in the large space provided to
include times, what was found, what was done, and a detailed secondary
assessment.
Trainee to verbalize the explanation of why the Pt. should seek medical
attention and shall document same. This should include something similar to
the phrase “accident or incident could warrant unforeseen life threatening injuries that
could lead to life long disabilities and/or death.”
Trainee shall complete both front and back of PCR on scene
Trainee to verbally explain the PCR to the Pt. and verbally explain the “sign
off” on the reverse side before allowing the Pt. to sign name.
Trainee shall disseminate the sheets and give the “hospital” copy to the Pt.
before he/she leaves the scene
Trainee shall verbalize the willingness to return and transport the Pt. if they
should so choose
Trainee shall verbalize when we would not allow a patient to refuse transport
NOTE: All white boxes must be initialed and dated by an FTO before the skill is considered to be
“complete”. The “final” grade is determined when the trainee demonstrates and completes the last box (#3).
The FTO will place a number grade in the “final” box. Shaded boxes are considered optional and may be
used by the FTO for remedial training as needed.
84
FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
INTERMEDIATE SKILLS (On-going)
#1
#2
#3
Final
BSI and all equipment checked prior to application of skills
Proper selection of site for establishment of IV, Tourniquet applied
Trainee cleanses site and punctures the site with correct size of catheter obtaining a
flash
Correct fluid and drip set selected, flushed, and connected to hub of catheter.
Tourniquet removed and line checked for patentcy.
Sharps are properly discarded and IV line is properly secured to Pt. Drip rate is set
accordingly.
BLOOD DRAW
BSI and site is located (hub of existing IV)
Trainee applies the vacutainer and explains the proper color sequence for drawing of
bloods from the site
After bloods are drawn trainee verbally explains disconnecting of vacutainer and
establishment of IV fluid and drip set.
Trainee properly disposes of sharps
Trainee properly labels of blood draw tubes as per protocol
DRIVER PROFICIENCY (Phase III)
#1
#2
#3
Final
Written examination
Head in parking
Back in parking
Parallel parking
Highway driving (on Rte. 101)
Secondary road driving
Backing up through designated course
Emergency driving (with lights)
Fueling at state pumps
Stretcher ride
Driving from hospital
Driving to scene (non-emergency)
Driving to scene (emergency)
Driving to hospital w/ Pt. (non-emergency)
Driving to hospital w/ Pt. (emergency)
N/A
NOTE: Trainees may only drive when they have successfully completed the classroom portion of Phase III.
They MUST have completed the written and submitted it to the FTO-C. Only then may trainees be
permitted to begin the four (4) hours of documented drive time. FTO’s should log the date, start and end times
below as well as their initials for all documented driving time.
85
FIELD TRAINING PROGRAM – SERVICE OFFICER TRAINING
Index
A
Ambulance Policy
Manual, 5
Fueling, 17
ON/OFF switch, 17
Failing marks, 21
P
G
Wet linen, 8
Patch to hosp., 7
Ambulances, 8
Glucometer, 12
Personal items, 8
Ambulance cots, 13
H
PCR, 9
ALS equipment, 15
Portable O2, 10
B
Hospital copy of PCR,
BLS Protocols, 5
Helmet removal, 13
Patient assessment,
Bathrooms, 9
Hare traction device,
13
9
Battery charging, 10
Back boarding, 13
Parking, 17
Head, hand bandage,
Backing (ambulance),
Pulse OX, 12
Pedi bag, 12
14
14
Passing marks, 21
17
Highway driving, 17
Bleeding control, 14
I
Q
R
C
Introduction, 1
Responsibilities, 4
Icons, 3
Rank structure, 5
Cabinet, Ambulance,
Idler, engine, 18
Radios, 6
S
Controlling bleeding,
J
K
14
KED, 13
Stretchers, 8
CEVO, 16
L
Suction, 11
D
Loading stretchers, 8
Short board, 13
Linen, 9
SAM Splint, 14
Defibrillation, 10
Long board, 13
Shoulder splints, 14
Driver education, 16
Long bone, 14
Sling/swath, 14
Driving skills, 17
M
Stiffneck video, 14
Materials provided, 3
Back up alarm, 18
6
Checks, Rig, 8
Cardiac monitor, 10
Conclusion, 20
E
SNHMC, 7
Storage, 8
Stair chair, 12
Stretcher ride, 17
Equipment storage, 8
MACC base, 6
T
Elbow, splinting, 14
Monitor, 10
Table of contents, i
EOA, 15
MAST, 12
Tidiness, 8
Evaluations, 22
Management,
Thermometer, 12
Engine Idler, 18
fractures, 14
Trauma assessment,
Emergency driving,
Medic bag, 15
17
13
Master switch, 18
Traction device, 14
Mastery marks, 21
Thomas half ring, 14
Three point turn, 17
Frequencies, 6
N
O
First in bag, 12
Operations, 6
U
V
Fractures, 14
O2, 10
V-Vac, 11
Figure eight, 14
On-board O2, 11
Vitals, 13
F
FTO-C, 2
Fire department, 5
86
W
X
87