WALWORTH FIRE DEPARTMENT
AMBULANCE
STANDARD
OPERATING
GUIDELINES
Approved February 1, 2007
Fire Chief Gary Germano
Ambulance Chairman Paul Phillips
Walworth Fire Department Ambulance
Standard Operating Guidelines
TABLE OF CONTENTS
PAGE
Section 1: INTRODUCTION
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Section 2: PERSONNEL
2.1 General Requirements of All Members
2.2 Emergency Vehicle Operators
2.3 Patient Care Personnel
2.4 General Responsibilities of Officers
2.5Orientation and Continuing Education
2.6 Performance of Duty
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Section 3: MAINTENANCE
3.1 Vehicles
3.2 Facility
3.3 Equipment
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Section 4: OPERATIONS
4.1 Call Procedures
4.2 Mutual Aid
4.3 Rescue Situations
4.4 Requests for On-Scene Stand-bys
4.5 Hospital Destination
4.6 Incident Management
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Section 5: SAFETY MANAGEMENT
5.1 Vehicle Operation
5.2 Scene Safety
5.3 Work Environment Health & Safety
5.4 Accident/Illness Reporting & Investigation
5.5 Hazardous Materials
5.6 Pathogen Exposure Control
5.7 Required Reports
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Section 6: QUALITY MANAGEMENT
6.1 Quality Improvement Program
6.2 Quality Improvement Coordinator
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ADDENDUM
Incident Report
Member Profile
New Member Orientation
TB Screening
Medic Qualification Card
Driver Qualification Card
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Standard Operating Guidelines
SECTION 1: INTRODUCTION
The Standard Operating Guidelines of the WFD Ambulance is to provide direction for its
personnel on daily operations, requirements of membership, job descriptions, and safety
issues.
The SOG’s are divided into the following sections:
 Personnel
 Maintenance
 Operations
 Safety Management
 Quality Management
Each section is marked with the date approved/implemented. The ambulance committee
reviews all SOG’s at least annually.
The effectiveness of SOG’s begins and ends with the personal commitment of every
WFD Ambulance member. Each member is expected to be thoroughly familiar with the
policies and procedures, and must agree, in writing, at the time of his/her application for
membership to abide by these policies and procedures.
EMS by its very nature is very unpredictable and personnel are expected to make sound,
split-second decisions. So, while no policy/procedure manual can hope to address all
possible situations, it gives a general guideline which makes the decision process easier
and operations safer and more efficient. The focus of SOG’s therefore, is on health,
safety, and operational issues critical to effective EMS operations and designed for the
legal and personal protection of each WFD Ambulance member and their patients.
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SECTION 2: PERSONNEL
SECTION 2.1: GENERAL REQUIREMENTS OF ALL MEMBERS
All members, regardless of job assignment must:
 Agree to abide with the bylaws and standard operating guidelines of the WFD
Ambulance, Fire Department and commissioners
 Be a member in good standings with the Walworth, Lincoln, or West Walworth Fire
Departments.
 Have satisfactory physical and mental health to carry out all usual WFD Ambulancerelated responsibilities and obligations
 Have the ability to communicate verbally, in writing, via telephone and radio
equipment
 Have the ability to interpret written and oral instructions
 Have the ability to use good judgment and remain calm in high-stress situations
 Have the ability to be unaffected by loud noises and flashing lights
 Have the ability to read English language manuals, write, and converse in English
 Have knowledge of radios and proper communication skills
 Have the ability to accurately discern street signs
 Have good manual dexterity, with ability to perform all tasks related to motor vehicle
operation and/or patient care
 Have the ability to bend, stoop, and crawl on uneven terrain
 Have the ability to withstand varied environmental conditions such as extreme heat,
cold, and moisture
 Have the ability to work in low light and difficult conditions
SECTION 2.2: EMERGENCY VEHICLE OPERATORS
All designated motor vehicle operators as well as any patient care providers who wish to
operate the ambulance or Medic 25 (under any circumstances) must meet the following
requirements:
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Have a valid NYS Driver’s License with a MV record acceptable to the WFD
Ambulance’s Insurance Carrier
Be over the age of 21
Complete an EVOC or CEVO course and maintain current certification. In house
training may be acceptable if a class is not currently available (with D/O approval).
Have knowledge of local hospital locations and main and alternate routes of travel.
All operators cleared after February 1, 2007, must maintain current CPR certification
Be able to read, understand, and operate instrumentation, switches, and gauges
Be familiar with equipment and placement
Ability to properly drive a vehicle in reverse and ability to position vehicle in proper
bay
Drivers will be cleared on each separate type of vehicle (fly car, type I, & type III rig)
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At any time driving privileges can be suspended by the D/O. This can be for lack of
call taking, any driving related complaints received, or not following the SOG’s. After
retraining, driving privileges may be reinstated by the D/O.
EMERGENCY MOTOR VEHICLE OPERATOR
Job Description
The emergency motor vehicle operator is expected to operate the vehicle in a safe manner
according to all applicable WFD Ambulance’s SOG’s and NYSDOH Policy Statement
00-13 dated 11/01/00. In addition, the emergency motor vehicle operator is responsible
for the following:
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Assisting the medic in completing all duties listed on the “Post-Call Checklist”
Providing assistance moving patient on scene or at the hospital
Gathering and operating needed equipment
Operation of the stretcher and stair chair
Rescue operations (procedures not involving medical aspects of patient care)
Performing CPR on patients.
Running radios as needed. If the other member is in the passenger seat, they are
encouraged to assist with the lights, siren, radios and map reading so driver can have
their attention on driving.
SECTION 2.3: PATIENT CARE PERSONNEL
All patient care personnel must be currently certified by the NYS Department of Health
and maintain the level of Certified First Responder (CFR), CFR-Defibrillation (CFR-D),
Emergency Medical Technician (EMT), EMT-Defibrillation (EMT-D), Advanced EMTIntermediate, Advanced EMT-Critical Care, or EMT-Paramedic. Patient care personnel
must present their original copy of their certificate to the D/O upon applying for
membership, and each time the certification is renewed. A photocopy will be made of the
certificate for the member’s file, and the original returned to the member. The only
exception to this will be persons enrolled in certification training courses who may
perform patient care tasks within their present level of training, but only under the direct
supervision of a currently certified member at or above the level of the trainee. CPR
trained personnel may help with CPR. All patient care must be in accordance with
applicable NYS approved protocols, FLREMS approved protocols or by a medical
control physician. The chief, D/O, medical director, or state DOH may suspend a medics
right to practice at anytime.
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PATIENT CARE PERSONNEL
Job Description
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All personnel shall conduct themselves according to the expectations outlined in
Section 800.15 of Chapter 6 Title 10 of the NYS Emergency Medical Services Code
Part 800 Regulations.
Determines the nature and extent of the illness or injury, makes determination of
patient status, and renders appropriate emergency care based on competency level.
Assists in lifting, carrying, and transporting patients.
Applies light rescue and extricates patient from entrapment as able while wearing
approve PPE.
Complies with all protocols and regulations per NYS DOH and REMAC in handling
patients.
Assists the driver in completing all duties listed on the “Post-Call Checklist”.
CERTIFIED FIRST RESPONDER (CFR) AND CFR-DEFIBRILLATION (CFR-D)
On scene, Certified First Responders will perform patient care tasks within their level of
training according to current NYS-DOH and REMAC standards of care. In the
ambulance, the CFR will perform patient care tasks under the supervision of an EMT or
Advanced EMT.
EMERGENCY MEDICAL TECHNICIAN AND EMT-D
The EMT and EMT-D will perform patient care tasks within their level of training
according to current NYS-DOH and REMAC standards of care.
ADVANCED EMT
The Advanced EMT (I/CC/P) practices under the supervision and control of the agency
medical director and medical control physician. In addition to maintaining current NYS
certification, the Advanced EMT must also meet all of the skills practice and CME
requirements of the Regional Medical Advisory Committee.
ADVANCED EMT – INTERMEDIATE
The EMT-Intermediate will perform patient care tasks within their level of training
according to current NYS-DOH and REMAC standards of care.
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ADVANCED EMT-CRITICAL CARE
The EMT-Critical Care will perform patient care tasks within their level of training
according to current NYS-DOH and REMAC standards of care.
EMT-PARAMEDIC
The EMT-Paramedic is the highest level of pre-hospital emergency medical care
provider. The Paramedic will perform patient care tasks within their level of training
according to current NYS-DOH and REMAC standards of care.
It is recommended that the EMT-Critical Care and EMT-Paramedic maintain a currently
valid ACLS, BTLS, PALS card
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SECTION 2.4: GENERAL RESPONSIBILITIES OF OFFICERS
AMBULANCE CHAIRMAN/DIRECTOR OF OPERATIONS:
The Ambulance Chairman/Director of Operations (D/O) shall be elected as per the WFD
By Laws. The D/O will oversee all the actions and functions of the Walworth Ambulance
and its members and tend to the needs of said members. The D/O is responsible for all
members and officers that fall under this position. The responsibilities of the D/O
include:
1. Delegation of tasks and authority as needed.
2. Attendance at most operational, administrative, monthly, line officer, or special
meetings, or delegate the proper personnel to represent the ambulance at said
meeting.
3. Offering monthly reports and/or any report requested of the D/O.
4. Maintenance of all mutual aid agreements and cohesiveness of the Walworth,
West Walworth, and Lincoln EMS personnel.
5. Final review of all medic and driver certifications and clearance.
6. Insuring that the yearly fund drive is sent out by June 1.
7. Ordering of medical supplies, office supplies, and equipment as needed.
8. Review of all medic and driver training and training expenses in coordination with
the training officer.
9. Review of all bills submitted to ambulance.
10. Upholding the Walworth Fire District and Walworth Ambulance SOG’s and ByLaws and take proper disciplinary action as needed.
11. Obtaining bi-yearly NYS-DOH certifications.
12. Maintenance of all member files and certifications.
13. Responsibility to the WFD Fire Chief in all operational matters.
14. Responsibility to the WFD President in all administrative matters.
AMBULANCE TREASURER
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Responsible for all moneys and accounts held by the Walworth Ambulance.
Supply the membership with a monthly, written report of income and expenses.
Provide a report at the monthly FD meeting
Send out “Thank You” letters as related to donations
Assure that local funeral homes have proper envelopes for use in donating to the
ambulance.
AMBULANCE LIEUTENANTS
The D/O shall appoint up to six Ambulance Lieutenants (three of which will be members
of the ambulance committee) and an unlimited number of supporting staff positions in
order to efficiently delegate the responsibilities of operating the WFD Ambulance. The
responsibilities of these officers shall be determined by the D/O annually. A written job
description for each officer shall be provided to the WFD Fire Chief.
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SECTION 2.5: ORIENTATION AND CONTINUING EDUCATION
One inevitable fact facing EMS providers today is that we all have to spend a significant
amount of time during our EMS careers in training and education. This is true for motor
vehicle operators as well as patient care providers. Our agency is responsible for training
all of our personnel in hazardous materials recognition, infection control, hazard
communications, V&T law, protocols, etc. It is important for all prospective members to
understand the time commitment necessary and that it is simply not enough anymore to
be available to respond to calls.
ORIENTATION OF PERSONNEL
All new members will be required to complete an orientation program after being
accepted into membership by the agency. The orientation will be under the direction of
the D/O or a designated lieutenant.
This orientation will include but may not be limited to the following subjects:
1. Review of Standard Operating Guidelines
2. Infection Disease Orientation plus Exposure Control Plan and Procedures
3. Emergency Vehicle Operation, V&T Law, Driving Orientation, and Practice
(Unless member will never be responsible for vehicle operation)
4. MSDS
5. Hazmat Awareness
6. Vehicle Maintenance
7. Tour of Building and Ambulance Vehicle, Supplies and Equipment
8. Review of Rescue and MCI Equipment and Supplies
9. ALS Orientation (AEMT’s only)
CLEARING OF MEDICS
A cleared medic may perform the duties of such independently and without trainer
supervision. The clearing process will include familiarization with ambulance equipment,
location of supplies, and at least six written evaluations from medic trainers (a medic
trainer can be any medic that has been cleared for at least two years.) As the medic
completes training requirements, it will be recorded on a “Medic Qualification Card” (see
appendix). Any EMT with prior experience may have a modified clearing process if the
D/O determines the need for such. The D/O will provide final approval. A cleared medic
will have received a letter from the D/O relating such.
Based on the direction of the Medical Director, an EMT must remain active, taking at
least one transporting call every three months in order to remain a cleared medic. If an
EMT fails to meet this requirement, they will be placed back into training and will have
to take three calls under the supervision of a medic trainer. Failure to take a transporting
call for more than one year will result in the EMT having to repeat the entire clearing
process.
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CLEARING OF DRIVERS
A cleared driver may perform the duties of such independently and without trainer
supervision. The clearing process will include familiarization with ambulance equipment,
location of supplies, and at least four written evaluations from driver trainers (a driver
trainer can be any driver that has been cleared for at least one year and has attended an
EVOC course). As the driver completes training requirements, it will be recorded on a
“Driver Qualification Card” (see appendix). Any driver with prior experience may have a
modified clearing process if the D/O determines the need for such. The D/O will provide
final approval. A cleared driver will have received a letter from the D/O relating such.
In order to remain a cleared driver, one must remain active, taking at least one
transporting call every six months. If a driver fails to meet this requirement, they will be
placed back into training and will have to take three calls under the supervision of a
driver trainer. Failure to take a transporting call for more than one year will result in the
driver having to repeat the entire clearing process.
TRAINING/CONTINUING EDUCATION
A lieutenant designated by the D/O will be responsible for conducting monthly training
sessions and any additional special sessions as may be required or requested. The forth
Monday of each month will be Ambulance meeting at 1900 followed by EMS training for
that month. Certain EMS training drills will be mandatory (such as EpiPen updates,
Albuterol updates, and FLREMS protocol updates).
The WFD Ambulance suggests that each member attend as many continuing education
sessions as possible. The cost for these classes will be paid for by the ambulance if the
member is in “good standing” as defined by these SOG’s. Books and supplies will be
paid for any classes associated with EMS training. Tuition to a college course will not be
included. Conferences and other events held outside the area can be attended and will be
evaluated on cost and numbers attending. Number of attendees and multiple trips by a
member will be reviewed by the D/O. Any member who has not taken a call in over six
months will not be sponsored to refresh their EMT card or to advance in certification
level.
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SECTION 2.6: PERFORMANCE OF DUTY
It is extremely important that all members and prospective members realize that any
person, whether paid or volunteer, who has agreed to take upon him or herself the
responsibility of providing emergency medical care, is assuming a very serious
obligation. The WFD Ambulance takes very seriously the protection of the patients who
have placed themselves in our care, the health and safety of all of its members, and the
health and safety of all persons with whom the WFD Ambulance, in fulfilling its duties,
comes into contact. Members are expected to act in a professional manner at all times
and at no time to act in a way that may bring discredit to the WFD Ambulance.
MAINTENANCE OF PATIENT CONFIDENTIALITY: HIPPA
All WFD Ambulance personnel shall abide by all current HIPPA laws. All members
must keep all patient care records and calls confidential. Details of calls may be discussed
with hospital staff as may be necessary, and within the agency for training and QI
purposes. Breach of confidentiality will result in disciplinary action to be determined by
the D/O and fire chief.
ALCOHOL/DRUG/SMOKING/PRESCRIPTION MEDICATION USE
On-duty or responding personnel shall refrain from the use of alcohol or any substance
which would in the least impair their judgment or reflexes. Under no circumstances shall
any member of the WFD Ambulance assist as a crew member or driver while under the
influence of alcohol or any other substance which would in the least impair their
judgment. There is to be no smoking in any ambulance, or while on scene of an
ambulance call. At the hospital you must follow their guidelines.
SEXUAL HARASSMENT
All members of the WFD Ambulance shall abide by the WFD sexual harassment policies.
Any member who believes he or she has been the subject of sexual harassment should
report the incident immediately to the fire chief. The chief will promptly investigate all
complaints in a 72 hour time frame.
The member alleging sexual harassment will be advised that in order to pursue a
complaint the specifics will have to be put in writing on an incident report. All
information will be kept confidential and will be discussed only with those who have a
need to know in order either to investigate or resolve the complaint. Any member who the
chief determines has engaged in sexual harassment will be promptly disciplined.
Disciplinary measures may consist of suspension or termination depending on the severity
of the offense. The member also has a right to register a complaint with the appropriate
state authority.
No member will be punished or penalized in any way for reporting an incident which
they, in good faith, feel constitutes sexual harassment.
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PROFESSIONAL MISCONDUCT
Professional misconduct is defined as any behavior not conforming to prevailing
standards or laws, that may have a negative impact on a patient, his/her family, and/or of
the WFD Ambulance’s public image and/or operations.
DISCIPLINE/SUSPENSION/REMOVAL FROM MEMBERSHIP
Any act that may be perceived as misconduct will be documented by a WFD Ambulance
member on an Incident Report and submitted to the D/O (or in his/her absence, the
ranking WFD Ambulance officer) within 24 hours. Investigation into patient care-related
matters shall not be the responsibility of any officer who is not certified to provide patient
care. The designated officer will conduct an investigation into the incident and report
findings to the Fire Chief. After consultation with the Chief, the D/O may, at his/her
discretion, exercise any/all of the following options:
(1) Provide verbal counseling to the member
(2) Require reeducation/retraining
(3) Provide a written warning to the member
(4) Suspend the member from driver or medic privileges
(5) Schedule a meeting of the Chief and Ambulance Committee to address and
resolve the allegations against the member.
Any disciplinary action with any members will remain confidential, although suspensions
must be announced. When any such disciplined member feels the disciplinary action by
the chief or D/O is inappropriate, the following procedure will be used:
1. The member will re-address the issue with the chief or D/O for an alternate
disposition.
2. If the conflict is not resolved, the member is entitled to a meeting of the chiefs and
ambulance committee.
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SECTION 3: MAINTENANCE
SECTION 3.1: VEHICLES
The WFD Ambulance will make every effort to see that the ambulance vehicle complies
with all state motor vehicle laws and NYS DOH Part 800 regulations regarding
ambulance design. All vehicles will be inspected yearly.
After completion of each run, the motor vehicle operator will be responsible for an
inspection of the vehicle and inform the appropriate ambulance lieutenant, maintenance
lieutenant, D/O, or chief of any problems (in that order). Any member can take an
ambulance out of service for safety concerns but must make contact with the D/O to
advise him/her.
SECTION 3.2: FACILITY
The WFD Ambulance will make every effort to work with the Fire Commissioners in
providing an enjoyable environment. We must do our part and keep areas clean. Laundry
will be cleaned as needed by a vender and put away. No infectious waste is to be kept
outside the ambulances.
SECTION 3.3: EQUIPMENT
All equipment will be checked carefully when received before it is put in service to assure
that it meets the needs of the service and is in good working order. All equipment will be
maintained according to manufacturer’s specifications.
Preventative Maintenance of Ambulance/Equipment
WFD Ambulance is committed to provide a safe and healthy environment for our
members and patients. With that in mind the following policy was developed in regard to
preventative maintenance of response vehicles and equipment.
1. All members are required to notify the designated ambulance lieutenant of any
suspected equipment failures, no matter how small the problem.
2. In cases where a problem has been detected, the affected ambulance and/or equipment
will be taken OUT OF SERVICE until the problem can be corrected. The D/O and
the Wayne County E-911 Dispatcher must be notified if this occurs.
3. All ambulances and equipment are inspected every month by designated lieutenants to
detect possible equipment failures, and to ensure that the appropriate equipment is
carried.
4. A standard inspection report will be utilized for all inspections of EMS vehicles and
equipment. In cases where a manufacturer has established an inspection report for a
particular piece of equipment, that form will be utilized. A maintenance contract will
be maintained for life Pac equipment.
5. All inspection reports will be available on site at the firehouse.
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SECTION 4: OPERATIONS
SECTION 4.1: CALL PROCEDURES
AREA COVERED
The Town of Walworth will be the primary area of coverage, as per the current Town
Contract. In addition mutual aid coverage is in effect under the Mutual Aid Agreement of
the Wayne County Emergency Medical Services. In extreme emergency, the WFD
Ambulance will provide coverage as it is reasonably able.
DISPATCHING
The ambulance and/or personnel of the WFD Ambulance will be dispatched only through
the Wayne County E-911 dispatcher. If the request for aid comes to a member directly,
s/he should notify a Wayne County E-911 dispatcher as soon as possible. If the fly car or
ambulance responds to an emergency that was not “toned out”, the crew should request
that the dispatcher “tone-out” Walworth to advise.
When requesting additional resources at the scene of an emergency, personnel shall make
all requests through the Wayne County E-911 dispatcher. Requests should not be made
using cells phones unless radios are inoperable.
CREW
A full ambulance crew shall be defined according to Section 800.21 of Chapter 6 Title 10
of the NYS Emergency Medical Services Code Part 800 Regulations…at least 2
members, including a cleared driver and cleared certified EMT medic (approved
observers may also be allowed). In every case, an EMT or Advanced EMT will be in
attendance with the patient. If advanced life support procedures are being carried out, an
Advanced EMT must be in charge in the patient compartment. When a patient is in the
patient compartment, s/he shall be under the observation of an EMT or Advanced EMT at
all times. The ambulance may respond to the scene of an incident with only the driver on
board, if the medic is on or near location. This will only be done with the knowledge and
permission of the cleared EMT on location that they are in charge of patient care and
must transport with the patient.
UNIFORM
During the course of an incident, crew members should be clearly identified as members
of the WFD Ambulance. PPE will be worn while working in any hazardous conditions, or
when instructed to do so by officer. The ambulance will provide a uniform to all cleared
medics. This uniform will include one white EMS shirt and one pair of EMS pants to be
picked up by member at the designated uniform store.
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FLY-CAR / MEDIC 25
A fly car can be a very valuable tool for an EMS agency. Medic 25 can serve a variety of
valuable purposes, whether BLS or ALS. There are several guidelines to insure that the
fly-car is properly utilized at all times:
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When in service, Medic 25 must remain with in five (5) miles of the ambulance
district (unless the D/O grants special permission.)
Medic 25 may respond to any location they are dispatched to as a mutual aid
BLS/ALS medic. If a full ambulance crew is requested, Medic 25 should report to the
fire hall to fill the request, especially if they have to pass by the firehouse (unless a
driver quickly comes on the air and indicates that they can bring the rig).
Medic 25 is by design a first response vehicle. If a full crew is not identified or a call
is presented as serious (respiratory or cardiac problem) Medic 25 should leave the
firehouse as first response vehicle (if no ambulance driver has already arrived).
Once on location, Medic 25 is to evaluate the patient and start treatment. If a full
ambulance crew arrives, Medic 25 may turn patient care over to them (if level of care
permits). This way Medic 25 can return to service. If Medic 25 would rather transport
with the patient, they may choose to do so.
Medic 25 is to respond non-emergency to all fire calls in the town and start rehab
services until a full ambulance can respond. Medic 25’s duty is medical at this point
(not firefighting).
RADIOS
All official communications during an emergency call should be made over the properly
designated radio channels. Crew members responding to a call will inform the dispatcher
that they are available and responding with level of care and medic number. Medics
should also clarify whether they are available to transport, or are only first responding. If
a full crew is en route as a duty crew, that also should be relayed to dispatcher. The medic
should further inform the dispatcher upon his/her arrival at the scene. Personnel
responding to the fire hall should request re-toning the call upon arrival at the fire hall.
The ambulance should inform the dispatcher immediately when en route to the scene,
upon arrival at the scene, and when en route to the hospital.
MAXIMAL CALL RECEIPT INTERVAL
When a call is received, the dispatcher will generate an alert tone and message via radio,
and crew will be asked to respond. If there is no or insufficient response within 3 minutes,
the tones will be repeated once and another voice message given. If within 6-8 minutes no
response is received, or insufficient crew response is received, the nearest available
mutual aid ambulance will be immediately requested. The dispatcher will continue to
attempt to raise a crew, and any available certified (EMS) personnel will be sent to the
scene to care for the patient until the mutual aid ambulance and crew arrives this should
be with medic 25 so you have equipment. Wayne County ALS (if available) can also be
used as a BLS medic for the ambulance crew.
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MEDIC IN CHARGE & TRANSFER OF CARE
In responding, and at the scene of an incident, the senior EMT-Paramedic shall be in
charge. In cases where there is no EMT-Paramedic at the scene, the senior Advanced
EMT, or in the absence of an Advanced EMT, the senior EMT will be in charge. It is
assumed that the person in charge will bear in mind that once an EMT or Advanced EMT
takes responsibility for a patient’s care, that responsibility should be continued, within the
limits of the crew member’s training.
Any CFR, EMT, or Advanced-EMT who starts patient care on scene, should provide a
full patient report when patient care is transferred to the senior medic who arrives on
scene.
Once the ambulance is underway with patient on board, the senior Advanced EMT or
EMT in attendance in the patient compartment shall be in charge.
PHYSICIAN OR P.A. ON SCENE
In circumstances where a Physician or Registered Physician’s Assistant offers assistance
on scene, the Operational Protocols of the Finger Lakes Regional EMS Council shall be
followed.
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SPECIFIC CALL SITUATIONS
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PATIENT CANNOT BE LOCATED – The crew will make every reasonable effort to
locate a patient if they believe a report of an emergency to be legitimate. The crew
will enlist the assistance of law enforcement personnel as deemed necessary. In any
case, if the call is believed to be legitimate, the local law enforcement agency with
jurisdiction in that location will be informed of the incident as soon as it becomes
obvious that the crew is having considerable difficulty locating the patient. Wayne
County E-911 dispatchers are instructed to record a call-back number in every
possible incident, and if one is available, the dispatcher will re-call the person who
reported the incident and get further directions and details.
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ENTRY CANNOT BE GAINED TO THE SCENE OF AN INCIDENT - In the
situation where the location of the patient is locked (inaccessible), the local law
enforcement agency with jurisdiction in that location will be contacted. If, after trying
all available exits and trying to reach the patient by phone through the dispatcher, no
access is possible, explain this to the police agency and let them make access
decisions. The crew may enter the home by forced entry only with the full knowledge
of and with the permission of the appropriate law enforcement agency. The
circumstances of the call will be fully documented on the PCR and on an incident
report.
If there is a significant delay in law enforcement arrival, the Medic in Charge may
determine the need for immediate forced entry, and the crew may make the access
decision. If the crew is unable to gain entry through their own means, they should
request fire/rescue to gain forced entry.
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A PATIENT JUDGED TO BE IN NEED OF MEDICAL ASSISTANCE REFUSES
TREATMENT AND/OR TRANSPORTATION
The following guidelines and procedures have been established to assist members in
utilizing the Refusal of Medical Treatment/Transport dispositions, with the objective
of providing an enhanced standard of care and reducing potential liability to the
ambulance service.
Refusal of Medical Treatment/Transport should never be encouraged; every
effort should be made to transport patient(s) to a hospital or healthcare facility
for evaluation.
2. Patient(s) must have mental capacity to fully understand refusal of medical
treatment/transport and all potential consequences:
a. Patient(s) must be alert and oriented x 3.
b. Patient(s) must have a G.C.S. of no less than 15.
3. Patient(s) under the influence of alcohol or drugs should not be granted a
refusal of medical treatment/transport.
4. Psychiatric patients or patients who relate a desire to harm themselves or
others should not be granted a refusal of treatment/transport. (I.e. suicidal or
homicidal patients).
1.
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5. All decisions and efforts to persuade patients should be documented on the
PCR and should include one full set of vitals.
 CALL LAW ENFORCMENT FOR POSSIBLE MHA.

TREATING MINORS - Minors will be treated in emergency situations regardless of
the presence of a parent or guardian following the legal doctrine of implied consent.
In such a situation, the WFD Ambulance will make every reasonable effort to contact
the child’s parent/guardian either directly, or through a law enforcement agency, and
will not delay treatment or transportation while doing so. If the minor is refusing
treatment and/or transport and the crew feels that the minor is in need of such
care/transport, the appropriate law enforcement agency will be contacted immediately.

PSYCHIATRIC PATIENTS - REMAC has developed the following guidelines,
which it urges all services and providers to follow when there is a request for a
psychiatric transport.
1. If a patient has a psychiatric condition or decompensation and is not suffering
from an injury, obvious medical illness, or intoxication from drugs or alcohol should
be taken to the closest appropriate hospital with psychiatric services.
2. Psychiatric patients with substantial impairment from drugs or alcohol as
manifested by decreased level of consciousness or an inability to safely ambulate
independently should be taken to the closest hospital.
3. Any psychiatric patient with a traumatic injury should be transported to the closest
hospital.
4. Any individual with a potential history of significant overdose should go to the
closest hospital.
5. In unclear situations Medical Control should be contacted for a decision on the
appropriate destination of the patient.
Additionally, law enforcement or security services have on occasion instructed crews
as to where patients are to be transported. This is not only inappropriate but may at
times not be in the best interest of the patient, which is who we are there to serve.

CRIME SCENES / A CRIME IS SUSPECTED - If, as a result of their observations
during a given ambulance call, the crew suspects that criminal activity has been
involved, the crew will report their suspicions to the local law enforcement agency
with jurisdiction in that location as soon as reasonably able. If during receipt of a call,
the dispatcher suspects that a crime has been involved, s/he will notify law
enforcement as soon as reasonably able, before the arrival of the ambulance crew on
scene. The crew will make every reasonable attempt to preserve evidence while
providing whatever patient care/transportation is necessary without delay.
Disturb the scene as little as possible without hindering your ability to treat the
patient. Be aware of holes in the patient’s clothing made by bullets, knives, or other
weapons. Avoid cutting through these holes, trying to cut large pieces of cloth that
preserve the holes. If you must cut through holes, remember who did the cutting. Save
all clothing. If items must be moved to facilitate treatment of a patient, remember
their original position and report it to the appropriate authority.
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Do not add anything to the scene (i.e. cigarette butts, candy or gum wrappers,
equipment wrappers). Leave as few footprints as possible. Follow the procedure for
on-scene DOA’s.

CHILD ABUSE/NEGLECT IS SUSPECTED - When dealing with pediatric
emergencies, WFD Ambulance members should remain alert to potential child
abuse/neglect situations. In the case of suspected child abuse/neglect, the crew should
immediately initiate all appropriate treatment, protect the child from further abuse,
and transport the child to the hospital. All objective findings should be documented
on the PCR (the observed conditions which raised the suspicion of abuse) including
an objective description of parental actions and verbatim documentation of key
statements made by parents and others. Suspicion of the abuse/neglect, and the
reasons for that suspicion will be reported to the physician or nurse at the receiving
emergency department also fill out mandated forms to report potential abuse.
If a parent/caretaker refuses care and/or transportation for the child, the crew will
report the suspected abuse/neglect to the proper authorities as soon as they are
reasonably able. The crew should then remain available to discuss the situation with
the proper authority, or the Child Protective Services representative.
The crew must maintain a positive, objective, non-judgmental attitude when dealing
with a suspected child abuse/neglect situation.

GERIATRIC ABUSE/NEGLECT IS SUSPECTED - Geriatric abuse and neglect, like
child abuse and neglect, is a big problem in our society. The primary sign is
unexplained injuries in an elderly patient. In the situation where the crew suspects
abuse or neglect of an elderly patient they should complete a full patient assessment,
including a scene assessment, and report their suspicions to the proper authorities.

DOMESTIC VIOLENCE
It is the policy of WFD Ambulance that none of our crew members are to respond into
a Domestic Violence scene unless a law enforcement agency has a unit on the scene.
If the ambulance should arrive prior to law enforcement, it should park in a safe
location, as close to the scene as possible, ensuring that crew members are not placed
in a compromising situation. Crew members should never respond by POV to calls
involving domestic violence or abuse.
If a crew arrives on a scene that was not reported as a domestic violence call and they
suspect that domestic violence has occurred, then a request should be made for a law
enforcement agency to be dispatched to the scene immediately. If the scene becomes
violent following entry but prior to law enforcement response/arrival, try to retreat
(with the victim if possible). Remember crew safety comes first!
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Domestic Violence Subjective Assessment
The ambulance may provide a "SAFE" environment for the victim of Domestic Violence
to admit that there is a problem or ask for assistance. One or more of the following
sample questions may be asked of all victims of injury or in cases where there is a high
level of suspicion based on the documented indicators. An exception is when the cause of
injury is clearly known or obvious.
All of the sample questions may not be appropriately asked of all patients. The EMT must
decide which should be asked and how, if necessary, they may be modified. Ask the
patient direct, non-threatening questions in an empathetic manner. Emphasize that these
questions are asked of all injured patients and all other patients where there is particular
concern. You may find if difficult to ask these questions. However, asking these
questions should be part of your patient assessment. It is the first step toward appropriate
care.
Sample Questions:
1. We often see people with injuries such as yours which are caused by someone else,
could this be happening to you?
2. You seem frightened. Has anyone hurt you?
3. Sometimes patients tell me they have been hurt by someone close to them. Could this
be happening to you?
4. Sometimes when others are overprotective and jealous, they react strongly and use
physical force. Could this be happening to you?
5. Are you afraid of anyone in your household?
6. Has any household member physically hurt you or threatened you?
If a child is involved who provides information that gives you reasonable cause to suspect
child abuse or neglect, do not ask further questions. Simply be positive and receptive if
the child continues to speak.
Domestic Violence Indicators/Observations










Patient fearful of household member.
Patient reluctant to respond when questioned.
Patient is in an unusually isolated, unhealthy, or unsafe living environment.
Patient exhibits poor personal hygiene/inappropriate clothing.
Patient and household member give conflicting accounts of incident.
A history which is inconsistent with the injury or illness.
Household member is angry or indifferent towards patient and refuses to provide
necessary assistance.
Household member refuses/hesitates to permit transport to hospital.
Household member seeks to prevent the patient from interacting privately or speaking
openly.
Household member concerned about a minor patient problem but not the patient's
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

serious health issue.
Previous or repeat police/EMT response to scene, indicating frequent violence in
household.
Unexplained delay in seeking treatment for injury.
An Incident Report will be generated by the crew for any of the above mentioned
situations.
CPR, ADVANCED DIRECTIVES, and UNATTENDED DEATH
PURPOSE
This policy statement provides guidelines to be followed by ambulance crews to
determine when to start CPR, how to treat patients with Advanced Directives, and actions
to take with regard to Unattended Deaths.
GENERAL ACTIONS
Cardiopulmonary Resuscitation
NYS DOH, Bureau of EMS Policy Statement #89-56 outlines the circumstances under
which CPR is to be initiated.
In the event that CPR (including Advanced Life Support) is initiated and further
examination reveals that the patient has signs of obvious death (as outlined in the NYS
DOH Policy Statement), Medical Control shall be contacted to determine if resuscitation
efforts should be discontinued. If, in such cases, resuscitation is terminated by Medical
Control, the patient should be packaged and removed to a receiving hospital by funeral
service.
In the event that a patient in need of CPR is a child, CPR (including Advance Life
Support) shall be initiated and continued throughout transport to a receiving hospital,
unless gross signs of obvious death are observed prior to initiating CPR.
Advanced Directives
NYS DOH, Bureau of EMS Policy Statement #92-01 outlines the application of
Advanced Directives in the Prehospital EMS environment.
Do Not Resuscitate (DNR) Orders
A DNR order is only an order not to perform measures to restore cardiac function
or assist respiratory ventilation in the event of respiratory or cardiac arrest. It is
not an order to withhold other treatments such as ALS intervention or oxygen
therapy that would improve existing respiratory ventilation and cardiac functions
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in the absence of an arrest. There are two types of DNR orders that the crew may
encounter: The Hospital DNR order and the Non-Hospital DNR order.
By statute, no ambulance personnel (or other EMS personnel) shall be subject to
criminal or civil penalties, nor deemed to have engaged in unprofessional conduct
for any actions taken reasonably and in good faith with regard to a DNR order.
Non-Hospital Do Not Resuscitate (DNR) Orders
The application of Non-Hospital DNR orders by ambulance personnel is relative
to care provided a patient who is not admitted to an acute care hospital, nursing
home, in-patient hospice unit, or psychiatric hospital.
Non-Hospital DNR orders must be on an official form DOH-3474 (2/92) entitled
State of New York, Department of Health, Nonhospital Order Not to Resuscitate
(DNR Order).
Copies of this completed form are acceptable and can be relied upon as authentic.
A Non-Hospital DNR must be complied with unless:
1.
Ambulance personnel have a good faith belief that the order has been revoked
or canceled, or
2. Persons, other than the ambulance personnel, object to the order and a physical
confrontation seems likely if the ambulance personnel ignore such persons'
objections, and begin resuscitation, or
3. The Medical Control physician directs that the order be disregarded based on
significant and exceptional medical circumstances.
Health Care Proxy
A Health Care Proxy is a document signed by a competent adult (the Principal)
which designates another person (the Agent) to make any decision to consent, or
refuse to consent, to health care (the Health Care Decision). There is no official
Health Care Proxy form, but whatever form is used must be signed and dated by
an adult patient and two witnesses.
The application of the Health Care Proxy by ambulance personnel is very limited,
but is as follows:
1. The Agent designated in the Proxy will have the authority to make Health
Care Decisions for the principal.
2. The Agent's authority commences only after a determination by a physician,
as required, is made, in writing, that the Principal lacks capacity to make
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health care decisions (the physician must be present at the scene to do this).
3. The decision of the Agent designated in the Proxy will take priority over a
DNR order, unless the Proxy provides that the Agent may not make decisions
regarding resuscitation.
4. The Health Care Proxy Law requires that the attending physician confirm the
patient's (Principal's) continued lack of capacity prior to complying with each
of the Agent's Health Care Decisions and that the Agent must make an
informed decision based on the present circumstances and in consultation
with a licensed physician. This means that the ambulance personnel will not
be able to carry out the decisions of an Agent unless the physician is present
and in contact with the Agent.
Living Wills
A Living Will is a document in which an individual sets forth his/her desires
regarding the provision of or withholding of medical treatment. There is no
statutory recognition of living wills in New York. The courts of New York have,
however, recognized the validity of a living will which provides "clear and
convincing" evidence of the patient's intentions.
Living wills will not dictate the actions of ambulance personnel because of the
practical difficulties in determining their validity and their application in the
particular circumstances.
Medical Control should be advised of the existence of a living will and the
document should accompany the patient to the receiving facility.
Unattended Death
In the event that a patient exhibits signs of obvious death as described in NYS DOH,
Bureau of EMS Policy Statement #92-01, it is considered an unattended death. In such
case, CPR would not be initiated and the following steps should be taken:
1. Contact the communications center and request a police officer and/or
medical examiner to the scene;
2. Record all clinical signs of obvious death on the PCR, including the fact that
resuscitation was not initiated, the time that the police or medical examiner
was called and arrived at the scene and the time that the patient was released
to the police or medical examiner;
3. Have the police officer or medical examiner sign the "Release" portion of the
white section of the PCR;
4. Assist family members as appropriate;
5. A squad member must stay with the patient until the medical examiner and
police arrive. Note the time of their arrival on the PCR.
6. Provide emotional support to any family members if needed.
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TRANSPORT GUIDELINES
PASSENGERS
As a general rule, passengers other than patients shall not be carried on the ambulance.
This rule shall be waived only when such waiver, in the judgment of the crew at the
scene, will confer a substantial benefit to the patient, and then only at the convenience of,
and with the consensus of the crew.
SECURING THE VEHICLE
The driver is responsible for parking and securing the ambulance vehicle in a safe manner
at all times in order to safeguard the vehicle and equipment. Keys should never be left in
an unattended ambulance at the hospital.
SEAT BELT USE
All drivers and front seat passengers of the ambulance vehicle shall wear seat belts when
the vehicle is in motion. Ambulance personnel in the patient compartment must use seat
belts when they are not providing patient care or setting up for a patient. Non-ambulance
personnel (such as police officers, parent of minor being transported, etc.) must wear seat
belts when the vehicle is in motion.
All patients shall be secured with all stretcher belts at all times when the vehicle is
motion or when the stretcher is being carried or moved. Children shall be transported
secured to the stretcher, or in a properly secured child restraint seat.
ADVANCED LIFE SUPPORT
ALS services are provided as needed when an Advanced EMT is available. It must be
understood that due to the nature of volunteer services, that there may be times when an
AEMT is not available. In such cases, appropriate BLS care will be rendered and ALS be
requested, as needed, through mutual aid.
All A-EMT’s are under medical direction from the WFD Ambulance medical director
and the on-line physician at the medical control hospital. They will adhere to all current
NYS BLS Protocols and Regional ALS Protocols and guidelines established by the
Regional Medical Advisory Committee regarding In-service/Continuing Education
requirements.
MEDICATIONS/DRUG BAGS
Any medications carried by the ambulance will be under direct control of the Medical
Director and the medical control facility pharmacy. At no time will any ambulance
personnel place a medication on board without the written permission and guidance of the
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Medical Director, or without in-service education regarding its use, contraindications,
administration, and side effects. All medications will be kept in a locked compartment at
all times when not being used for patient care purposes.
Drug bags shall be subject to a monthly inventory by the lieutenant in charge of ALS.
Any medications expiring within the next month will be ordered or picked up and shall be
replaced in the drug bag.
The drug bag will be kept in a locked compartment in the vehicle at all times when not
being used for patient care purposes. IV fluids need not be locked.
REQUESTS FOR OUTSIDE ALS PROVIDERS
The crew shall abide by the guidelines set up in the Finger Lakes Regions EMS System
Protocols when deciding whether to request ALS for emergency calls. These guidelines
are outlined in Section 4.13 “ALS Intercept Utilization”. It is important to note that the
closest ALS service should be utilized. All requests for ALS must be made over the radio
with Wayne County Dispatch to avoid any confusion over the status of responding units.
Crews are not to directly contact ALS services using cell phones. If incident command
has been established on scene, all requests for additional resources must be made through
the use of the incident command system.
REQUESTS FOR AIR MEDICAL SERVICES
WFD Ambulance crews shall abide by the Bureau of EMS Policy Statement 05-05
“Guidelines for Helicopter Utilization Criteria for Scene Response” (9-12-05).
WFD Ambulance crews shall also abide by Section 4.2 of the 2006 edition of the Finger
Lakes Regions EMS System entitled Air Medical Utilization Guidelines which states:
“Air medical services should be considered for the following:
1. Patients who meet the vital signs or injury criteria for trauma care when ground
transport time is greater than 15 minutes to a trauma center.
2. A multiple casualty incident
3. A remote/wilderness area, difficult terrain, or any other time when a ground
ambulance is unable to access the patient in a reasonable time frame
4. Any unstable patient when ground transport to the nearest hospital exceeds 15
minutes.”
DOCUMENTATION OF PATIENT CARE
REMAC has advised that “Part 800.15 requires all certified providers to complete a PCR
for each patient treated. Additionally, as part of the EMS system, BLSFR must participate
in the regional quality assurance program, and patient documentation is the foundation
of quality assurance.”
The crew shall prepare a complete report for every incident dispatched to, whether or not
a patient is cared for, using the New York State Pre-Hospital Care Report (PCR) form
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(version 5) in the ambulance or at the firehall. One copy should be left at the hospital if a
patient was transported, and the remaining copies placed in a LOCKED BOX/CABINET
at the fire hall for data processing, review, and filing with the WFD Ambulance records.
Patient confidentiality will be maintained at all times in this process. At the end of each
month, the “research” copy of the PCR will be forwarded to the Finger Lakes Regional
EMS Program Agency for entry into the state data system.
The PCR will thoroughly and accurately reflect the results of patient evaluation and
treatment. It will include, but not be limited to, patient statistical data, call times,
mechanism of injury as appropriate, medical history, medications, allergies, subjective
assessment, objective assessment, frequent assessment of vital signs, treatment record,
crew names, levels of certification and numbers, record of any changes in patient
condition en route, patient destination or call disposition.
At a minimum one (1) full set of vitals must be recorded, with additional sets taken with
extended patient contact. It is suggested that vitals be repeated a minimum of every 15
minutes; however, vitals should be taken every five minutes for unstable patients.
Each PCR can be reviewed by the D/O, and the designated QA/QI person. Any question
regarding adequacy/completeness of treatment and/or documentation will be discussed
with the crew involved. In addition, all ALS calls will be reviewed by the Medical
Director as needed or his/her designee, and any question regarding the care rendered will
be discussed with the AEMT/s involved. The WFD Ambulance will participate in the
Quality Assurance program of the Finger Lakes Regional EMS Council.
CALL WRAP-UP
After each call, the crew is responsible for completing all actions listed on the “Post-Call
Checklist”, and preparing the vehicle and building immediately for the next incident.
SECTION 4.2: MUTUAL AID
REQUESTED FROM ANY AMBULANCE
The WFD Ambulance is a signatory to the Mutual Aid Plan through Wayne County. The
WFD Ambulance will provide mutual aid if reasonably able to do so as requested.
MUTUAL AID REQUEST TO WFD AMBULANCE PRIMARY OPERATING
TERRITORY
If it is known that the ambulances will be out of service for maintenance, lack of
personnel, etc., the D.O., or in his/her absence the next certified senior officer will be
responsible for securing pre-arranged mutual aid service for as long as needed.
If the second ambulance is out of service on another emergency and an additional call is
received, the nearest appropriate ambulance will be requested immediately by the Wayne
County E-911 dispatcher. In addition, depending on the nature of the call, the Wayne
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County E-911 dispatcher may call for any ambulance patient care personnel who are
available to go to the scene of the second emergency and care for the patient until the
mutual aid ambulance and crew arrives. It should be expected that there may be times
when such additional personnel are not available.
TWO CALLS RECEIVED SIMULTANEOUSLY
If two calls are received simultaneously, the crew member with the highest level of
training in consultation with the Wayne County E-911 dispatcher will be responsible for
making a decision of priority. A mutual aid ambulance or back up crew will be requested
for the second call as soon as possible, and first responders requested to the call location.
SECTION 4.3: RESCUE SITUATIONS
The WFD Ambulance primary responsibility is for the care and transportation of ill or
injured persons. However, because of the nature of our geographical area, the WFD
Ambulance at times may be requested to assist in the rescue of injured or ill patients from
remote areas or areas where access is difficult.
The WFD Ambulance will only participate in such rescue situations if there are able
WFD Ambulance personnel willing and trained to assist in any given incident. WFD
Ambulance personnel will not engage in any activity requiring technical skill/knowledge
(e.g. climbing, rope work, etc.) with which the member is not trained. The personal safety
of all WFD Ambulance personnel is of utmost importance in all rescue operations.
ICE/COLD WATER RESCUE
WFD Ambulance personnel will only assist with rescue of persons from cold/ice water if
conditions are deemed safe for rescue personnel. All ice rescue activities will be directed
by a WFD chief or trained member (or by mutual aid agreement a member of another
emergency organization) who has completed a recognized training program in cold/ice
water rescue.
CONFINED SPACE RESCUE
WFD Ambulance is committed to providing a safe and healthful work environment for
our members. In pursuit of this endeavor, the following Confined Space Protocol (CAP)
is provided to eliminate or minimize the risk of injury to a member in accordance with
OSHA confined Space Standard, Title 29 Code of Federal Regulations 1910.146
The Fire Department Chief is responsible for the implementation of the Confined Space
Protocol. He/she will maintain and update the written CSP at least annually. The plan will
also be updated whenever necessary to include new or modified tasks and procedures and
new or expanded job classifications that may affect how we handle a confined space
emergency. The Chief will be ultimately responsible for training, documentation of
training, and making the written CSP available to all members.
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Those members who reasonably anticipate to be responding to a confined space
emergency incident are required to comply with the procedure and work practices
outlined in the CSP.
CONFINED SPACE PROTOCOL/EMERGENCY PROCEDURES
Effective June 4, 2006, any and all extrication from the scene of a confined space incident
will be done by properly trained members of the specialized responding unit on the scene
of the call.
In the event that the Agency arrives at the scene and the condition of the patient(s)
warrants immediate extrication, then any crew member who has been properly trained by
an approved training class or facility and has the appropriate equipment may assist with
the extrication.
Those members must have been trained in the following areas and provide documentation
and a copy of the certification to the Captain/Training Coordinator of this agency:
1. Trained in the proper use of SCBA (self-contained breathing apparatus.)
2. Trained in the proper use of all high-angle equipment.
SECTION: 4.4: REQUESTS FOR ON-SCENE STAND-BYS/TRANSPORTS
Occasionally the WFD Ambulance is asked by community organizations to provide prearranged on-scene stand-by services for special events (e.g., athletic events, county fairs,
etc.). In such cases, the WFD Ambulance policy shall be as follows:
The request for the standby must be made to the WFD Ambulance by the responsible
agency in a timely manner, so that all details are clearly understood, including the time
commitment requested from the WFD Ambulance members. This should be in writing.
At the WFD, the D/O, following receipt of the request, will make the decision. The standby will be approved if the details are acceptable to all of the WFD Ambulance members
who are free and willing to participate in it. Those members will be expected to make a
commitment to be available on the times and dates involved.
If a stand-by request is not able to be approved, the responsibility of the WFD Ambulance
for that event will be limited to responding to requests for emergency medical care, as per
the usual WFD Ambulance procedures.
Request for transports are not encouraged and will only be granted when approved by the
D/O. The ambulance service is an emergency service provider and needs to be kept as
such. Paid services are available for transport services. When a crew is on a transport, a
full back up crew needs also to be available for emergency calls. This will be arranged by
the D/O or his/her designated lieutenant.
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SECTION 4.5: HOSPITAL DESTINATION
The WFD Ambulance transports patients primarily to hospitals in Wayne, Ontario, and/or
Monroe Counties. The primary exception to this may occur when the WFD Ambulance
has responded to a mutual aid request and the usual receiving hospital(s) of the agency
requesting mutual aid is substantially closer than one of the usual health care facilities.
PATIENT SEEKS TRANSPORTATION TO A HOSPITAL OTHER THAN THE WFD
AMBULANCE USUAL RECEIVING HOSPITALS
In an emergency situation, if a patient seeks transportation to a hospital outside the area to
which the WFD Ambulance ordinarily transports patients, the patient will be informed of
the WFD Ambulance receiving hospitals and the distances involved. If the patient refuses
transportation, the “Refusal of Transportation” policy will be followed. The members will
inform the patient of the possible medical consequences of his/her action, and have the
patient sign a refusal of transportation statement.
EMERGENCY PATIENT DESTINATIONS AND HOSPITAL DIVERSION
The WFD Ambulance will abide by Bureau of EMS Policy Statement 06-01 (1-11-06)
This policy states “Based on the mechanism of injury, assessment findings, treatment,
state and local protocol, a patient, in need of emergency medical care must be taken to
the nearest appropriate health care facility capable of treating the illness, disability or
injury of the patient. Ambulance services are under no obligation to transport patients to
medical facilities not licensed under Article 28 of the Public Health Law. It is expected
that the EMS provider will consult with a medical control physician, should there be
questions of protocol, policies, procedures and transport destinations.
A patient's choice of hospital or other facility should be complied with unless
contraindicated by state, regional or system/service protocol or the assessment by a
certified EMS provider shows that complying with the patient's request would be
injurious or cause further harm to the patient. Patient transfer can be arranged following
emergency care and stabilization. In such cases, the EMT should fully document the
patient's request and the reasons for the alternate destination decision, including any
medical control consultation.”
An example of this would be transporting to trauma centers and stroke centers.
HOSPITAL DIVERSION REQUESTS
“A hospital may notify the EMS system of a temporary inability to provide care in the
emergency department (ED) and request ambulances divert patients to an alternate
hospital facility. A request to divert to another facility may be honored by EMS providers.
A diversion request does not mean the hospital ED is closed, but usually means the
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current emergency patient load exceeds the Emergency Department's ability to treat
additional patients promptly. If the patient's condition is unstable and the hospital
requesting diversion is the closest appropriate hospital, ambulance service personnel
should notify the hospital of the patient's condition and to expect the patient's arrival.
This procedure should also be followed when a patient demands transport to a facility on
diversion. The hospital may not refuse care for a patient presented. Should an issue arise,
the EMS provider should consult with a medical control physician.”
If the patient is alert, oriented, and understands the reason for diversion but still refuses
diversion from the hospital of choice, s/he will be asked to sign a refusal and will be
taken to the original hospital destination.
HOSPITAL DESTINATION IN MUTUAL AID SITUATION
In a mutual aid situation, if a hospital is substantially closer than our usual receiving
hospitals, that hospital will be utilized. If communication with dispatch and/or the
receiving hospital is impaired, a real possibility in some mutual aid instances, the crew
will utilize all BLS and ALS standing orders as appropriate, and then follow the regional
communication difficulty protocol. The destination hospital will be contacted as soon as
possible, either by radio or cellular telephone.
If in a mutual aid situation, in the rare instance the crew may be transporting a patient to a
hospital other than WFD Ambulance’s usual receiving hospitals, if a diversion is
requested, the crew will divert only if the diversion does not in any way, in the judgment
of the medic in charge, compromise the patient.
HOSPITAL DESTINATION IN MAJOR TRAUMA PATIENTS
In a trauma situation, from our area of primary operating territory and most of our mutual
aid areas, in most instances the nearest hospital is the appropriate receiving facility. The
crew chief should keep in mind that Strong Memorial and Rochester General Hospitals in
Rochester, Upstate Medical in Syracuse, and Arnot-Ogden in Elmira are designated
trauma centers and may be the appropriate destination for patients meeting major trauma
criteria as found the NYS-DOH and FLREMS BLS Protocols.
REMAC advises that “While REMAC acknowledges that not every situation is the same,
gross deviations from the Trauma Protocol are problematic. The protocol was developed
with the use of accepted regional, state and national standards, and refined through out
the years to insure that individuals that are injured in the region receive optimal patient
care in a timely and appropriate manner. Deviations from this protocol violate accepted
regional and national standards, and could put patients at risk for less than positive
outcome. Therefore, it is imperative that (patient care providers) review Section 2.0 –
Adult Trauma Protocol, and Section 3.10 – Pediatric Trauma Protocol of the 2006
edition of the regional protocols. In summary, both of these protocols outline treatment
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and transport condition, including transport to appropriate trauma centers and the use of
flight evacuation when appropriate.”
SECTION 4.6: INCIDENT MANAGEMENT
The WFD Ambulance shall utilize the National Incident Management System (NIMS) in
accordance with the Bureau of EMS Policy Statement 06-05 (6-5-06). The WFD
Ambulance will manage all incidents and preplanned events using the incident command
system. All request for additional resources at the scene of an incident are to be made
though Incident Command.
All WFD Ambulance personnel will be trained in the aspects of NIMS though the
appropriate required courses. Many are available as self-study courses on-line. All
personnel are required to complete the appropriate required courses within the time frame
established by the WFD.
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SECTION 5: SAFETY MANAGEMENT
SECTION 5.1: VEHICLE OPERATION
EMERGENCY DRIVING
Types of Responses:
Non- emergency Operations - anytime an EMS response vehicle is out of the station on
an assignment other than an emergency run shall be considered to be a non-emergency
operation.
Emergency Operations- shall be limited to any response to a scene, which is perceived
to be a true emergency situation. True emergencies are a response to any situation in
which there is a high probability of death or life threatening illness or injury. The risk of
emergency operations must be demonstrably able to make a difference in patient
outcome.
First and Foremost — DO NO Harm !
1. Emergency operations are authorized only to responses deemed by protocol to be
emergency in nature where the risks associated with emergency operations
demonstrably make a difference in patient outcome.
2. Upon dispatch, emergency operations are only authorized when the driver decides
that the dispatch call type justifies an emergency response. If the driver is not a
certified EMT/AEMT, they should consult with the medic in charge to determine
if the dispatch information justifies an emergency response.
3. All operations considered non-emergency shall be made using headlights only - no
light bars, beacons, corner or grill flashers or sirens shall be used. During a nonemergency operation, the EMS response vehicle should be driven in a safe manner
and is not authorized to use any emergency vehicle privileges as provided for in
the V & T Law.
4. Emergency operations are authorized at a scene when it is necessary to protect the
safety of EMS personnel, patients or the public.
5. EMS response vehicles do not have an absolute right of way, it is qualified and
cannot be taken forcefully
6. During an emergency operation the vehicle's headlights and all emergency lights
shall be illuminated and the siren used as required in the vehicle and traffic law.
7. Once on the scene, the decision for determining the type of response for additional
EMS vehicles responding to the scene shall be made by a NYS certified provider
following assessment of the scene and all patients. It will be the responsibility of
that certified responder to notify the dispatcher or other responding units of the
type of response that is warranted, emergency or non-emergency.
8. The EMT/AEMT in charge of patient care, following assessment of the patient,
shall be responsible for determining the response type en route to the hospital
9. EMS response vehicles shall not exceed posted speed limits by more than ten (10)
miles per hour.
10. EMS response vehicles shall not exceed posted speed limits when proceeding
through intersections with a green signal or no control device.
11. When an EMS response vehicle approaches an intersection, with or without a
control device, the vehicle must be operated in such a manner as to permit the
driver to make a safe controlled stop if necessary.
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12. When an EMS response vehicle approaches a red light, stop sign, stopped school
bus or a non controlled railroad crossing, the vehicle must come to a complete
stop.
13. The driver of an EMS response vehicle must account for all lanes of traffic prior
to proceeding through an intersection and should treat each lane of traffic as a
separate intersection.
14. When an EMS response vehicle uses the median (turning lane) or an oncoming
traffic lane to approach intersections, they must come to a complete stop before
proceeding through the intersection with caution.
15. When traffic conditions require an EMS response vehicle to travel in the
oncoming traffic lanes, the maximum speed is twenty (20) miles per hour.
16. The use of escorts and convoys is discouraged. Emergency vehicles should
maintain a minimum distance of 300 - 400 feet when traveling in emergency
mode in ideal conditions. This distance should be increased when conditions are
limited.
Even if lights and siren are used, the driver must remember that a fast trip is not always a
safe trip. Road, weather, and traffic conditions will serve as indicators of prudent and
reasonable speed. Very high speed is never indicated, regardless of patient condition. The
driver must keep the safety of crew and other vehicles uppermost in his/her mind at all
times, regardless of patient condition.
Drivers may use cell phones while driving only if necessary for emergency
communication. Drivers may not use cell phones for unrelated purposes.
MOTOR VEHICLE OPERATOR ILLNESS
If, at any time, the operator of the vehicle becomes ill, or in any way his/her ability to
operate the vehicle becomes impaired, s/he must pull to the shoulder of the road at once
and inform the rest of the crew. The crew chief will then make a decision whether another
crew member will operate the ambulance or another ambulance will be called.
BACKING THE VEHICLE
It is strongly recommended that when backing the ambulance an outside “spotter” will be
used to direct the driver in backing and to observe safety precautions. If this is not
possible when a patient is on board due to patient care activities, the driver will first walk
behind the vehicle to observe for any obstacles or safety hazards.
When backing into the driveway and garage at the WFD, a member shall serve as an
outside “spotter” and guide the driver in safe backing of the vehicle.
ACCIDENT INVOLVING THE AMBULANCE VEHICLE
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Whenever there is an accident involving an EMS vehicle, the crew is to follow the
guidelines in Section 4.5 Vehicle Response and Operations of the WFD SOG’s.
SECTION 5.2 SCENE SAFETY
Scene safety is the primary concern for all personnel responding to an incident. If the
scene is deemed not safe, WFD Ambulance personnel will maintain a safe distance until
the appropriate agency has made it safe.
To help accomplish this purpose, the following rules will apply:
1. Dispatch will get as much information as possible to allow the necessary
agencies to be dispatched and responding crews to make the appropriate
decisions.
2. A fire company should be dispatched simultaneously with the ambulance to all
reports of vehicle accidents.
3. Police will be dispatched simultaneously to all reports of unknown problems,
domestic violence, gunshots, stabbing, intoxicated patients, suicides, and
assaults.
4. If a patient becomes violent once the crew is with the patient, the crew’s
primary responsibility is to remove themselves to safety immediately, if at all
possible. Personnel must avoid physical confrontation unless no other way
exists for the crew to protect themselves.
ENTERING THE SCENE/PROTECTIVE EQUIPMENT
When working at the scene of a motor vehicle accident, building collapse, or similar
situation, WFD Ambulance personnel will not enter the scene/vehicle/building, etc.
without first assuring stability of the scene. The crew shall wear appropriate personal
protective equipment such as heavy duty work gloves, helmet, turn out gear, etc. if there
is broken glass, sharp metal, or other similar hazards. Personnel without appropriate
personal protective equipment will maintain a safe distance during that phase of the
incident which might expose them to injury. In appropriate situations where visibility
may be limited, WFD Ambulance personnel are also instructed to use the rescue coats
carried in the ambulance or PPE issued to members.
VIOLENT SITUATIONS OR PERSONS
When a call is received for a violent patient, to a scene where violence has occurred, or to
an unknown situation where violence is a possibility, law enforcement assistance will be
requested immediately if not already dispatched. WFD Ambulance personnel will not
enter the scene until they are assured that the scene is safe (generally after the arrival of
police.)
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If a patient or bystander becomes violent after the ambulance arrives on scene, the crew’s
primary responsibility will be to protect themselves and to remove themselves to
a safe, secure area immediately and remain there until the scene is secured by law
enforcement officer/s.
If a patient already in the ambulance becomes violent, the patient shall be restrained by
the crew and a law enforcement officer/s summoned to meet the ambulance as quickly as
possible. If this is not safe pull ambulance to side of road, turn off ambulance power, take
keys out and exit the ambulance until police arrive and control the situation.
CRIME SCENES
DO NOT ENTER THE SCENE UNTIL IT IS DETERMINED SAFE. Leave the scene,
with the patient if possible, if your safety is threatened.
In all of the above situations, the primary responsibility of the crew will be to protect
themselves and to avoid physical confrontation, unless no other way exists for the crew to
protect themselves.
SECTION 5.3: WORK ENVIRONMENT HEALTH AND SAFETY
It is the policy of the WFD Ambulance to promote a healthy working environment and
promote health conscious behavior by its members. Members are strongly reminded that
their own safety takes priority in any WFD Ambulance-related activities.
BACK INJURY PREVENTION PROGRAM
A back injury prevention program is available to all members and offered to all members
and offered to all new members during their orientation. All in-services involving any
lifting and carrying will stress back injury safety and prevention.
MATERIAL SAFETY DATA SHEETS
The WFD safety/maintenance committee will maintain a list of the chemical/hazardous
materials used by the WFD Ambulance in the form of Material Safety Data Sheets. These
MSDS will be available in a notebook in the dispatch area of the fire house. As part of
the member orientation procedure, each new member will be acquainted with the MSDS
and the protective/safety measures the member can take.
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SECTION 5.4: ACCIDENT/ILLNESS REPORTING AND INVESTIGATION
ILLNESS/INJURY REPORTING
Should an illness or injury occur while a member is involved in any WFD Ambulance
related activity, a “Personal Injury/Illness Investigation Report” will be completed by the
member involved, if at all possible, or a witness (crew chief if available) present at the
time the illness/injury occurred. The report will be reviewed by the Chief or Safety
Officer as soon as possible. In addition, it will be reviewed by the Safety Committee, and
any recommendations made to prevent future such occurrences will be reviewed at a
subsequent meeting of the WFD Ambulance.
INSURANCE
The WFD Ambulance maintains appropriate insurance at all times.
ACCIDENT INVESTIGATION
The review and investigation of all accidents is necessary to improve the overall safety
record. Investigation includes identification of the factors that contributed to the accident
and determination of whether or not the accident was preventable and what factors, if any,
may prevent any further accidents of this type.
Preventable accidents are classified:
I - Willful disregard of established policies or procedures
II - Failure to do everything reasonable to prevent an accident, without the existence of
extenuating circumstances.
III - Failure to do anything reasonable to prevent an accident, with extenuating
circumstances
A written report is to be completed on every accident including contributing factors,
individual role/s, preventability, and accident classification. Copies of the report are
furnished to the officer in charge and placed in the personnel file of the member/s
involved after review with that member. Retraining or disciplinary action may be taken
depending on circumstances and/or number of previous incidents.
SECTION 5.5: HAZARDOUS MATERIALS
As part of their orientation, all new members of the WFD Ambulance will be required to
attend a Hazardous Materials Awareness Orientation which will be developed by the
Safety officer.
This program will include information on how to use the Material Safety Data Sheets on
file. If any member notices a chemical in use that does not have a MSDS, s/he should
notify the Safety Officer who will in turn attempt to obtain the sheet.
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WFD Ambulance personnel are not trained to and do not operate within a hazardous
materials hot zone. However, since there is a strong potential that ambulance personnel
may be first responders to the scene of a HAZMAT incident, personnel will be given a
short HAZMAT awareness orientation. If, upon response to an EMS incident, the crew
suspects that hazardous materials are involved and pose a potential threat to responding
personnel, the crew will stay at a safe distance, upwind, and will notify a Hazardous
Material Response team.
Every member of the WFD Ambulance is urged to take the “EMS HAZMAT Awareness”
Training Course at the earliest available opportunity.
SECTION 5.6: PATHOGEN EXPOSURE CONTROL
PURPOSE: To establish the procedure to be followed to minimize the exposure of Fire,
Rescue, and EMS personnel to serious blood borne and/or airborne
infections.
INFECTION CONTROL TRAINING
In-house training, in compliance with OSHA Regulation 29 CFT Part 1910.1030, will be
provided yearly to all personnel through the use of video tapes, printed material, and
lectures available through the County of Wayne Fire Coordinator, the County of Wayne
EMS Coordinator, Finger Lakes Regional EMS Council, or the Wayne County Public
Health Office.
HEALTH MAINTENANCE
1. The WFD commissioners offer at no expense voluntary Hepatitis B
vaccinations to all members with potential for exposure. Members who choose
not to accept the vaccine must sign a declination form, but may be vaccinated
at a later date if they so choose.
2. All patient-care providers are encouraged to undergo regular screening for
tuberculosis exposure.
3. All patient-care providers are required to undergo regular health physicals
provided by the fire commissioners.
4. The WFD Ambulance also offers appropriate medical follow up and/or
counseling after an exposure incident.
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PERSONAL PROTECTIVE EQUIPMENT
Appropriate personnel protective equipment should always be worn to help reduce the
risk of exposure. The equipment will be available to all personnel and will include:
1. Disposable latex and/or trauma gloves for any task involving blood or any
other body fluids. Personnel should change gloves frequently to ensure
maximum protection. A change of gloves must be performed between each
patient.
2. Appropriate fire-fighting gloves when working around MVA’s, extrication,
and/or fires.
3. Disposable full face masks and gowns which meet OSHA standards shall be
worn when a splash hazard is present from blood or other body fluids.
4. Resuscitation Equipment: The use of disposable pocket masks and/or
mechanical respiratory equipment with a one-way valve will be used
whenever possible.
SCENE OPERATIONS
Precautionary measure must be observed during all patient contact in which there is a
danger of contamination of the crew.
1. Rescue workers must attend to any and all personal open lacerations on
themselves before working on a victim.
2. Rescue workers should wash hands and other exposed skin surfaces with antimicrobial soap and water as soon as possible after contact with blood or other
body fluids.
3. Dispose of all infected or potentially infected items including disposable
gloves in a leak-proof red bag identified as medical waste. Dispose of the red
bag at the appropriate hospital(s) in the red-bagged containers.
4. Any equipment which is not disposable and is reusable must be
decontaminated immediately, or as soon as possible. If these items are to be
transported back to your facility to be decontaminated, they must be red
bagged and kept secure until appropriately decontaminated.
5. Appropriate disposable clothing shall be worn when cleaning up blood or
body fluids. OSHA-approved cleaning products shall be used to
decontaminate equipment and areas which have come into contact with blood
or body fluids.
6. Leave all linen at the hospital for laundering.
7. Contaminated clothing should be removed as soon as practical. It is
recommended that all contaminated clothing be washed in a bleach- or
OSHA-approved solution.
8. All sharps must be disposed of in appropriate sharps containers. Leave these
full containers at the appropriate hospitals and replace with new containers.
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POST RESPONSE
Cleaning and decontamination of the ambulance and/or equipment should be performed
as soon as practical.
DISINFECTION OF AMBULANCE/EQUIPMENT
Clean-up procedures for the ambulance after each call should include:
1. Appropriate disposable clothing shall be worn when cleaning up blood or
body fluids. OSHA-approved cleaning products shall be used to
decontaminate equipment and areas which have come into contact with blood
and/or body fluids.
2. Remove used or soiled linen and place in designated bag for laundering at the
hospital.
3. Place any soiled dressings, blood materials, and any other non-sharp materials
in a red bag and leave at appropriate hospitals.
4. Place any reusable equipment in a leak-proof plastic bag (not red) for
cleaning.
5. Check for any needles or other sharps and disposes of in the appropriate
sharps container.
6. Clean all surfaces which were in contact with blood or any other body fluids
with appropriate OSHA-approved cleaning solutions. Use paper toweling and
discard in a red bag.
7. Wipe with OSHA-approved cleaning solutions all affected areas and allow to
air dry. All contaminated disposable paper towels used for this cleanup must
be red bagged and disposed of properly. If a cloth towel is used, it should be
placed in a laundry bag and taken back to the hospital for appropriate
laundering.
8. Spray disinfectant on affected areas and allow to air dry.
9. Spray cleaner on remaining surfaces with which the patient had contact as well
as surfaces which were used in the course of providing prehospital care. Wipe
with paper toweling and allow to air dry.
10. Maintain a clean-up kit consisting of: household utility gloves, plastic spray
bottle with disinfectant solution or spray bottle with concentrated household
bleach diluted with water (1:100 dilution approximates ¼ cup bleach per
gallon of water), disposable toweling, plastic bags (hospital red bags and
household plastic bags), disposable gloves.
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ADDITIONAL CREW PRECAUTIONS
The blood, body fluids, and tissues of all patients are considered potentially infectious,
and Universal Precautions will be used for all patient contact. Following any patient
contact, the crew member should:
1. Wash hands with antimicrobial soap and water for 10 to 15 seconds. If soap
and water are not available, members should use the antiseptic waterless hand
cleaner which will be provided in the vehicle. This procedure should be
followed:
 after removing gloves
 after each patient contact
 after handling potentially infectious materials
 after cleaning or decontaminating equipment
 after changing linen on stretcher
 upon arrival at hospital after completing patient care
1. Contaminated uniforms or crew clothing should be removed at the hospital.
Any contaminated crew clothing should not be washed in a home laundry
system.
2. The member should shower if body fluids were in contact with skin under
clothing.
3. Contaminated shoes should be brush-scrubbed with a hot solution of soapy
water, rinsed with clean water, and allowed to air dry.
4. Any suspected exposure should be reported immediately to the designated
officer of WFD Ambulance and form filled out.
AIRBORNE PATHOGENS
TB should be suspected and precautions taken in any patient who complains of
respiratory symptoms of more than two weeks duration, or any patient with a respiratory
symptom of any duration who is a member of a high-risk group.
Crew Precautions
1. Wear disposable gloves and follow all universal precautions to avoid contact
with body fluids.
2. If possible, place a disposable mask on the patient; the attending technicians
should also wear disposable masks.
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3. Open the patient compartment windows of the ambulance and use the exhaust
fan.
4. Avoid contact with sputum. Any sputum-contaminated tissues, oxygen masks,
suction devices, etc., should be placed in a red biohazard bag and disposed of
at the hospital.
5. All linens should be left at the hospital.
6. Notify the hospital physician assigned to the patient and be guided by his/her
suggestions for medical follow-up.
7. Follow routine decontamination/disinfect ion procedures for ambulance and
equipment. Air ambulance out well.
8. Crew should follow standard decontamination procedures.
SECTION 5.7: REQUIRED REPORTS
REQUIREMENTS TO REPORT TO THE HEALTH DEPARTMENT
Under the requirement of Part 800.21 (q.1), WFD Ambulance will report any of the
following by telephone to the New York State Department of Health, Bureau of EMS, no
later than the following business day and in writing within five (5) working days every
instance in which:
1. A patient dies, is injured or otherwise is harmed due to action of commission
or omission by a member.
2. An ambulance is involved in a motor vehicle accident in which a patient,
member of the crew, or other person is killed or injured to the extent requiring
hospitalization or care by a physician.
3. Any member is killed or injured to the extent requiring hospitalization or care
by a physician while on duty.
4. Patient-care equipment fails while in use, causing patient harm.
5. It is alleged that any member has responded to an incident or a patient while
under the influence of alcohol or drugs.
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SECTION 6: QUALITY MANAGEMENT
SECTION 6.1: QUALITY IMPROVEMENT PROGRAM
INTRODUCTION AND PHILOSOPHY
The WFD Ambulance, has a strong commitment to working with the various appropriate
agencies in continuously improving the quality of the patient care delivered by the WFD
Ambulance. The WFD Ambulance shall abide by the guidelines and expectations
outlined in Section 3006 of Article 30 of the State of New York Public Health Law.
Quality Improvement (QI) is a program of systematic evaluation to ensure excellence. It
is a judgment as to what is good and what is bad, linked to a system intended to effect
positive change. Quality Improvement is used to measure the quality of care provided (by
individuals and the agency), to arrive at a judgment about quality and to change the care
processes, if necessary, to avoid adverse outcomes.
The basic steps in a quality assurance program are:

Selecting a subject for study, which includes an operational definition of the condition
or procedure under study and a definition of patients to be included;

Developing criteria and standards, defining acceptable levels of quality;

Collecting data;

Comparing data to criteria and standards in order to identify deficiencies and areas of
excellence;

Determining causes of deficiencies and taking corrective action, including:
1. determining who or what is expected to change;
2. determining who is responsible for implementing action;
3. determining what action is appropriate, and;
4. determining when it is expected to occur.
A successful Quality Improvement program requires the willing cooperation of all WFD
Ambulance members. It must recognize their common needs for education, structured
feedback, professionalism, mutual respect, and confidentiality of all quality improvement
activities.
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SECTION 6.2: QI COORDINATOR
The D/O will appoint an agency Quality Improvement Coordinator. The QI Coordinator
shall be a cleared medic. The appointment shall be made yearly at the annual meeting of
the WFD Ambulance committee. The member appointed as QI Coordinator should be
familiar with the concepts of the QI program and be strongly committed and dedicated to
the concepts and goals of a comprehensive QI program.
The Quality Improvement Coordinator shall:








Attend meetings of the Quality Assurance Committee.
Be responsible for reviewing each PCR for accuracy, completeness, and
appropriateness of care (in time for submission to REMAC each month.)
Review immediately all Incident Reports indicating deviation from regional or state
protocols, and direct any required immediate action to the appropriate WFD
Ambulance officer.
Review all patient/family written comments as soon as possible after they are
received, but at least once a month. Refer all comments to the crews involved. Refer
any substantive negative comments or notations of problems immediately to the D/O
and QI committee. Discuss any substantive negative comments or problems with the
WFD Ambulance medical director if directed to by the D/O.
At least annually, review with the Ambulance Training Lieutenant the appropriateness
and timeliness of the monthly in-service education programs as related to identified
problems, and publishes a schedule of proposed in-service programs for the following
year.
Regularly review the appropriateness and adequacy of equipment and make
recommendations for any upgrades or additional equipment needed. Assure that
ambulance supplies and equipment meets or exceeds the requirements of Part 800 of
the NYS EMS Code.
Cooperate with the regional QI/Medical Advisory Committee/s and provide any
information to the regional program as may be necessary or requested.
Respond to any inquiries from other EMS services concerning performance reviews
of current or former WFD Ambulance members.
QUALITY IMPROVEMENT COMMITTEE
WFD Ambulance hereby agrees to develop and participate in a Quality Improvement
Committee for the purpose of planned and systematic monitoring of and enhancing the
quality and appropriateness of patient care, clinical performance review, and
administrative coordination and support activities of the service in regard to quality
issues. The program will further work to eliminate the causes of identified deficiencies by
working toward resolving identified problems, improving EMS activities related to
patient care, and reinforcing and enhancing positive attitudes, behaviors and practices of
the WFD Ambulance and its members. The QA committee will be headed by the QI
chairman and up to two additional medics. These medics will be picked by QA chairman
and approved by D/O.
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The WFD Ambulance will also actively participate in the Regional Quality Improvement
program of the Finger Lakes Regional EMS Council.
The following are the goals of participation in the Quality Improvement Committee:
 Recognition and acknowledgment of examples of excellent patient care or other
components of service organization
 Identification of actual or potential problems concerning patient care and clinical
performance;
 Assessment of the cause and scope of problems identified;
 Development and recommendation of proposed courses of action to address the
problems identified
 Use of information gathered regarding problems identified, whenever service policies
and procedures regarding patient care and support activities are revised;
 Implementation of actions necessary to correct the identified problems;
 Monitoring and evaluation of actions taken and the implementation of remedial action
to ensure effectiveness;
 Referral to the regional medical advisory committee and the regional medical director
or his/her designee, problems which have been identified by the agency but are
beyond the agency’s authority or ability to correct;
 Documentation of all measures taken pursuant to this QI program.
The WFD Ambulance agrees that the following documents and parameters may be
reviewed by the QI Committee and will be furnished to the Committee:
 Letters of commendation and complaint raised by patients, their families, and other
concerned parties;
 Recommendations received from hospitals to which the WFD Ambulance regularly
transports patients;
 All incident reports involving deviation from protocols
 PCR’s as requested
 Standard Operating Guidelines
The WFD Ambulance further agrees that certain specific parameters regarding WFD
Ambulance practice and performance may be reviewed by the QI committee periodically.
These parameters include:
 Accuracy and completeness of the PCR
 Timeliness of response (measured from the time of call received to time on scene),
including any communication and/or dispatch problems
 Completeness of patient assessment
 Appropriateness of care based on patient assessment, including evaluation of
compliance with all appropriate protocols
 Appropriateness of time spent in patient care on scene
 Emergency Department diagnosis and outcome in selected cases, with the assistance
of hospital providers
 The credentials and performance of all persons providing emergency medical care on
behalf of the WFD Ambulance
 This credential review will, at a minimum, include:
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
a) a review to assure that the member is appropriately certified by the NYS
Department of Health;
b) a review of the in-service education activity of the member in light of
compliance with WFD Ambulance requirements;
c) a review to assure that each ALS provider is currently authorized to practice at
the advanced level within the regional ALS system.
The performance review will include, at a minimum:
a) Review of any compliments or complaints received concerning the care
provided by the member, from patients, hospitals, medical control facilities,
agency or system medical directors, etc.
b) Review to determine whether any recommendations or significant adverse
actions concerning the individual member have been taken by any other
health care provider for whom the member provides care, by the DOH, or, if
the member practices as an Advanced EMT, by the medical director(s) of the
WFD Ambulance and Finger Lakes Regional EMS REMAC.
The WFD Ambulance further agrees:

That the QI committee will prepare contemporaneous minutes or records of all
activities. All such reports shall maintain patient confidentiality.

That the committee will generally meet monthly.

That the QI committee may recommend to the WFD D.O. the appointment of member
teams to resolve specific identified problems or develop other improvements.

To send at least two representatives to the QI committee, preferably one BLS and one
ALS. These representatives will be appointed annually at the annual meeting.
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STANDARD OPERATING PROCEDURES
ADDENDUM
1. Incident Report
2. Member Profile
3. New Member Orientation
4. TB Screening
Approved February 1, 2007
Fire Chief Gary Germano
Ambulance Chairman Paul Phillips
Walworth Fire Department Ambulance
Standard Operating Guidelines
Walworth Fire Dept. Ambulance
Walworth, NY
EMS INCIDENT REPORT
Name of Person Completing Report ___________________________
Date Report Completed ______________ Time Report Completed ________
NATURE OF INCIDENT:
Mechanical
 Ambulance / Vehicle Breakdown
 Ambulance / Vehicle Malfunction
 Ambulance / Vehicle Damage
 Malfunction of Medical Equipment
 Missing EMS Equipment / Supplies
 Driving / Safety Issue
Personnel
 Member Injury
 Patient Injury
 Bystander Injury
 Needle/Sharp Stick
 Blood/Body Fluid Exposure
 Known/Suspected Communicable
Disease Exposure
 Patient Care / Protocol Issue
 Other / Unusual Occurrence ________________________________
Date of Incident _______________ Time of Incident ___________________
Date and Time Reported to Officer in Charge __________________________
Location of Incident ______________________________________________
Ambulance Run Number (As Applicable) ___________________
Describe Incident in Full:
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
Signature of Person Completing Form ________________________
Date ________
Signatures of Witnesses to Incident:
Print Name ________________________________ Sign ________________________________ Date ____________
Print Name ________________________________ Sign ________________________________ Date ____________
Signature of Officer Receiving Report ________________________ Date ________
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EMS Incident Report Continuation Form
INJURY REPORT
Name of Injured Person __________________________
Describe Injury in Full:
Describe Treatment Given by Ambulance Crew:
Follow-up Treatment:
 Admitted to hospital _________________
 Treated at _______________ ED and released
 Refused Treatment by Ambulance Crew
 Refused treatment at Hospital
 Treated at ________________ED but refused admission AMA
 Treated by Clinic/Private Physician __________________________
 Other ________________________________________________________
Reported to Worker’s Compensation Insurance Company (As applicable)
Date ___________________________ By Whom ______________________
Follow-up Information:
iii
Walworth Fire Department Ambulance
Standard Operating Guidelines
EMS Incident Report Continuation Form
Needle/Sharp Stick - Blood/Body Fluid Exposure
Name of Person Exposed ___________________________________
Date this report is being completed ____________
Name of Person Completing Report ___________________________
Date Exposure Reported to Designated Officer _____________________
Exposure Record:
Date __________________________ Time ___________________________
Job/Duty being performed by worker at time of exposure:
Details of Exposure



Type of Fluid or Material ________________________________________
Amount of Fluid or Material _____________________________________
Severity of Exposure (For subcutaneous exposure, give depth of injury & whether fluid was injected; For
mucous membrane or skin exposure, state extent and duration of contact, and the condition of the skin, i.e., intact,
abraded, chapped, etc.)

Source Individual Tested for HBV/HIV?  Yes*  No  Consent Not Obtained
*Results of testing of source’s blood will be made available ASAP to the exposed
member, and the member will be informed of the applicable laws and regulations concerning
disclosure of the identity and infectious status of the source individual.
Member referred for follow-up testing and/or treatment?  Yes
iv
 No
Walworth Fire Department Ambulance
Standard Operating Guidelines
EMS Incident Report Continuation Form
Suspected Communicable Disease Contact
Not for Blood/Body Fluid Exposure)
Give as many details as are available at the time you are completing this report:
Hospital to which patient was transported ___________________________
Date hospital Infection Control Nurse was contacted __________________
Name of Infection Control Nurse ___________________________________
Follow-up recommended and record of follow-up:
v
Walworth Fire Department Ambulance
Standard Operating Guidelines
Walworth Fire Dept. Ambulance
MEMBER PROFILE
Name ________________________ Date of Birth ______________
Address ________________________________________________
Telephone ___________ Driver’s License Number ______________
SS# _______________ Date of Acceptance as Member _________
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
LEVEL OF SERVICE:
 Dispatcher
Dates: __________________________________________________________
_______________________________________________________________
 Motor Vehicle Operator
Dates: __________________________________________________________
_______________________________________________________________
 Certified:
Certified First Responder # ________
Dates (Original & Recertification):_____________________________________
________________________________________________________________
______________________________________________________________
EMT # ________
Dates (Original & Recertification): _____________________________________
________________________________________________________________
______________________________________________________________
AEMT # ________
Level:
Dates (Original & Recertification):
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
vi
Walworth Fire Department Ambulance
Standard Operating Guidelines
Member Profile Continued
EMS RELATED COURSES:
CTC _____________________ PPCC ______________________
AAPS ____________________ HAZMAT ___________________
ACLS __________________________________________________
LAB INSTRUCTOR _________________ I/C __________________
ICE RESCUE ___________________
OTHER ________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
INSERVICE RECORD:
Date:
Topic:
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
vii
Walworth Fire Department Ambulance
Standard Operating Guidelines
Walworth Fire Dept. AMBULANCE
Walworth, NY
NEW MEMBER ORIENTATION
NAME ___________________________
ITEM
DATE RECORD OPENED _________________
DATE/S COMPLETED
INITIALS OF
RESPONSIBLE
PERSON
_____________________________________________________________________________
Application
Personnel & Health Records Started
_____________________________________________________________________________
Physical Assessment/Exam
_____________________________________________________________________________
References
_____________________________________________________________________________
Uniforms
_____________________________________________________________________________
 Radio  Plectron  Scanner  Pager
Issued and Instructions
_____________________________________________________________________________
Building code Issued
 Front Door  Garage Door  ALS Cabinet (ALS Only)
_____________________________________________________________________________
Combinations Given
 Garage Door  Drug Cabinet (ALS Only)
_____________________________________________________________________________
Blue Light and Card Issued; Blue Light Orientation - Driving to a Call
_____________________________________________________________________________
MSDS
_____________________________________________________________________________
Review of Standard Operating Policies & Procedures
_____________________________________________________________________________
PCR’s and Documentation
_____________________________________________________________________________
On Duty Schedule and Responsibilities
_____________________________________________________________________________
Call Procedures
_____________________________________________________________________________
Incident Reports
_____________________________________________________________________________
Ambulance Headquarters Orientation
_____________________________________________________________________________
Garage Door - Electrical Failure
_____________________________________________________________________________
Emergency Vehicle Operation - Laws and Guidelines
_____________________________________________________________________________
Driving Orientation - Complete Motor Vehicle Operator Orientation Form
_____________________________________________________________________________
Blood borne/Airborne Exposure Control Plan Orientation
_____________________________________________________________________________
Hazmat Awareness Orientation
_____________________________________________________________________________
viii
Walworth Fire Department Ambulance
Standard Operating Guidelines
Walworth Fire Dept. Ambulance
TB SCREENING
Today’s Date_______________
Name__________________________________________________
Address ________________________________________________
Telephone _______________
Date of Birth _________________
Physician _________________ Allergies ____________________

Are you taking any medications? Yes No If so, what are they?
_______________________________________________________

Have you had any immunizations in the past 8 weeks? Yes No

Have you ever had known contact to someone with TB? Yes No
If so, under what circumstances, and how long ago? _________
_______________________________________________________

Have you ever had a positive tuberculin test? Yes No

Do you have any respiratory symptoms at this time? Yes No
If yes, what are they? _____________________________________

Date of last PPD or Tine test ________ Results _______________

I give permission for the Walworth Fire Dept. to administer PPD test for
tuberculosis.
Signature ________________________
Date Given ____________ Signature of Person Administering Test
__________________________
Manufacturer ___________________ Lot Number _____________ Expiration
Date ____________
Date Read ____________ Results ______________
ix