aic orientation course - vbems · aic orientation course manual and reference document for vbems...

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AIC Orientation Course

Manual and Reference Document for VBEMS Members 11/16/16

Welcome to VBEMS This course will help to get you

started in your exciting and rewarding adventure with VBEMS. There is a lot of information included in these pages and the document will be updated and added to over time.

We look

forward to

working with

you!

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New Member Introduction Course Objectives

Review VBEMS chain of command

Understand your current status and the Trainee process

Discuss VBEMS staffing and scheduling

Understand the scheduling process and OSCAR

Examine basic duty expectations

Learn how to log into the MDT

Review the Virginia Beach ERS system

Understand special responses

Log into the Electronic Medical Record system

Understand the Protocols

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Virginia Beach Emergency Medical Services

EMS Administration

477 Viking Dr Suite 130

Virginia Beach, VA 23452

Phone: (757) 385-1999

Fax (757) 431-3019

EMS Training

927 South Birdneck Rd

Virginia Beach, VA 23451

Phone: (757) 385-2970

Fax: (757) 437-6560

Routine Hours of Operation: 8:00-5:00, Monday -Friday

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VBEMS Organizational Chart

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Thomas Green

Deputy Chief of EMS

Jason Stroud

Deputy Chief of EMS

Edward Brazle

Chief of EMS

Bruce Nedelka

Division Chief

John Bianco

Division Chief

Kevin Lipscomb

Division Chief

Stewart Martin, MD Operational Medical Director

Deputy Chief of EMS

VBEMS and Rescue Squads

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YOU!

Assistant Squad Commander

Squad Commander

Brigade Chief

Division Chief

Deputy Chief

Chief

The 10 Rescue Squads and

their Squad Captains /

Presidents are under the

command of the EMS Chief

and Deputy Chief.

The EMS Chief and his

command staff along with the

Department of EMS rules and

regulations supersedes any

stations’ by-laws.

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Sample Station/Team Organizational Chart

Schedule Sgt

Operations Lt.

Maintenance Sgt Supply Sgt

Maintenance & Logistics Lt.

Training Sgt

Training Lt.

Assistant Squad Commander

x51

Squad Commander

x50

Brigade Chief

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What is my current status?

Your application has been approved and you are a

“Recruit” with our system

Cannot provide any patient care

The next step is “Intern” on strict supervision with an

orange ID card

Certified providers are assigned to the Member Service

Division until fully released to general supervision as Attendant

and Driver (AIC/DR)

Once released as and AIC/DR, ALS certified providers can

continue to ALS Internship with our Training Division

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Who do I report to?

Recruits can direct any questions to Lynette Dimitry.

While in the Intern status, you have multiple options:

Training/Release/Scheduling/Leave issues

You will be dealing with the BLS/ALS Field Internship Coordinator or

designee for training and release issues

Station specific issues

Members who have already selected a station should follow their

station chain of command for issues involving station membership,

station uniforms and other station related issues.

On-duty issues

Issues arising on duty such as questions, injury, conflicts, maintenance

should be directed towards an EMS supervisor, EMS 1, 2, or 3.

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We are ONE Squad

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Our organization is divided into 10 Rescue Squads with one

purpose….

Our mission of providing the

best, most timely patient

care.

Station Information Rescue 1/22 - Ocean Park - (757) -464-0594

Rescue 2 - Davis Corner - (757) -460-7574

Rescue 4 - Chesapeake Beach - (757) -460-7509

Rescue 5/21 - Princess Anne Courthouse - (757) -427-4688

Rescue 6 – Creeds - (757) -721-6389

Rescue 9/10/19 – Kempsville – (757) -340-5877

Rescue 13 – Blackwater - (757) -421-2200

Rescue 14/8 - Virginia Beach- (757) -437-4830

EMS Station 15 – Thalia – (757) 385-7307

Rescue 16 - Princess Anne Plaza - (757) -385-2864

Rescue 17 – Sandbridge - (757) -219-2917

Here’s a link to our website with additional information about our Volunteer Rescue Stations

http://www.vbems.com/about-us/rescue-stations/

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Individual Rescue Squads

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The city provides fuel, maintenance, radios and some

equipment as well as many other items and benefits to

the stations and members

The stations provide ambulances, soft goods and other

supplies as well as uniforms and many other items and

benefits to its members

Each station has it’s own bylaws, uniforms, policies and

procedures and traditions

The rules and regulations of the EMS Chief, his command staff

and the Department of EMS supersede any stations’ by-laws







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Policies, Procedures, Rules and Regulations

VBEMS falls under many regulatory agencies/departments

Federal

OSHA-required for each agency upon initial entry and annually

updated

State

VAOEMS- http://www.vdh.state.va.us/oems/

Virginia EMS rules and regulations

Local

City of Virginia Beach-city code and requirements

VBEMS Policies and Procedures are located on the VBEMS website

http://www.vbems.com/providers/department-policies/

Tidewater EMS Council

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VBEMS Staffing and “optimized scheduling”

To meet full city coverage, ambulances and crews are

moved strategically throughout the city for coverage

The Optimized Scheduling Coordinator constantly monitors the master

schedule for cancellations, changes and existing gaps in coverage and

augments when necessary

If two stations have a half crew, the Scheduling Coordinator may

combine them

Field Supervisor may split ALS crews

Career medics may augment with a half crew or

may staff additional ambulances

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What does that mean to me?

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Sometimes, you will be required to pull duties with members from others squads

Sometimes, you maybe required to split up your duty crew.

Sometimes, you may be requested to pull duties at another station maybe even with members from others squads.

http://www.vdh.state.va.us/oems/




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How is scheduling done?

OSCAR (Online Submission and Compilation of Availability

Records) is used by all members to submit their available dates

www.frompaper2web.com/oscartrack

Dates must be submitted by the 10th of the preceding

month

Station scheduling officers craft individual station schedules

using the availabilities submitted by their members

All stations meet around the 20th at a scheduling meeting to

maximize staffing

Interns are added after the scheduling meeting

Final schedules are posted and distributed via Oscar

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First Time in

OSCAR/Log in

To create a new account:

Go to website and click on “New User?”

•Create a user name

•Create a password

•Enter your email address that you will want any scheduling items to be sent to

•Click “Submit”

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First Time in

OSCAR/Log in

(cont)

If you have never logged in

before, OSCAR will prompt

you to establish membership

Since you are an EMS

member, enter your Officer

Code number in the space

provided and click “Submit”

The next screen will prompt

you to “Click Here to

Continue”

After this first time, just enter

your user name and password

on the login screen to log in

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http://www.frompaper2web.com/oscartrack

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How to enter dates

into OSCAR

When you log into

OSCAR, Select

the month you

wish to submit

duties for

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How to enter dates

into OSCAR (cont)

As an intern, select EMS- Va Beach Dept of EMS as your Home squad.

You will choose This option until you are released.

The BLS Intern Scheduler will access this list to schedule your shifts.

Then scroll down……

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How to enter dates

into OSCAR (cont)

Check all the shifts that you are

available for-days, nights or both.

Interns must submit a minimum

of 6 availabilities to maximize

the schedule.

If you are willing to run extra

shifts, you can enter the number

of additional shifts and also

submit any notes.

A note might read “can only do

one shift per week” or “can do

days or nights but not a 24 hour

shift”

Click submit!

Check dates

Extra shift

availability goes

here

Special Notes entered here

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How to enter dates

into OSCAR (cont)

When clicking on the

calendar, standard shifts are

selected (06-18 and 18-06).

There is no need to enter times if you are running standard shifts.

(Students and Interns are

not permitted to run partial

shifts without prior

approval so you shouldn’t

need to do anything with

this screen)

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How to enter dates

into OSCAR (cont)

After you click “submit”, a

confirmation screen will appear.

Please take a moment to make sure

it is correct!

If it is not correct, or your schedule

changes after your submission (and

before the 10th), go back to the

OSCAR home page and click on

“Reconfirm or Retract” and follow

the instructions on the next screen.

**To make changes after

the 10th, you must contact

the BLS Intern scheduler.**

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Log out

How to enter dates

into OSCAR (cont)

After you follow the retraction instructions, you will receive an email.

When you click on the link in the email, it will retract your current record (you will get the confirmation screen).

You will have to start all over to resubmit your proper dates.

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I am scheduled for duty!

After the availabilities have been submitted and schedules have been created, you will be notified of your assignments via an Oscar email

If you have a change in events, interns must trade/find coverage with another intern to make sure the shift is covered.

If you become suddenly ill and can not make your shift, you must contact EMS 1 at 274-2946 or EMS 2 at 635-7695 and notify the BLS Intern scheduler.

You should also notify the BLS Intern scheduler if you are late for duty or if you are moved to a new assignment.

If you find that your crew is not fully staffed, you must contact EMS 1 or EMS 2 for a new assignment (unless it will be staffed within 1-2 hours).

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Shift assignments

As an intern, you may or

may not be scheduled at

your home station.

Shifts run from 0600-1800

and from 1800-0600

Schedules are always

changing so make sure you

monitor your email

You can verify your

schedule on the My

Assignments tab in Oscar

any time.

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Important Intern Items to note-Duty

You must wear your EMS ID card whenever you are on

duty or in a city building

Wear the proper uniform while on duty

Shirt tucked in, pants not too loose/tight, shoes tied, belt, etc.

First impressions are important so look the part!

Remember to wear a watch

Try to arrive for duty15 - 30 minutes prior to the start of

shift and be ready to go

You may perform any skills authorized for the EMT BLS

level in the City of Virginia Beach while in the presence

of a released AIC or released ALS provider while on duty

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Professionalism and Accountability

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Be Professional

Make deadlines (schedules, paperwork, projects, etc.)

Be on time or early

Wear the proper uniform

Keep others in the loop and informed

Be Accountable

Know when to ask for help

Take responsibility for your actions

Do the right thing!

Be a reliable member and partner

Driving an Emergency Vehicle

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Members with Defensive Driving Class (DDC) can drive any city

insured vehicles

Only members with Emergency Vehicle Operations Course (EVOC) can drive in emergency mode (with lights and sirens) and interns must have a released driver in the front seat with them Driving lights and sirens is a big responsibility

“Nothing shall release the operator of any such vehicle from civil liability for failure to use reasonable care in such operation.”

Good Samaritan Law does NOT provide immunity from bad driving

Never Run a Red Light

You must be sure the intersection is clear before proceeding

You must slow down at red lights so you can stop before proceeding into the intersection

Members caught on a PhotoSafe red light camera can be subject to discipline and the fines

Members should wear a seatbelt at all times (unless required while

providing patient care in the back of the ambulance) All Patients and equipment should be secured at all times

Members are not permitted to use EMS vehicles to initiate traffic stops

Before the Call

At the start of shift your crew will log into the MDT, the

EMR and sign on over the radio

You must be added to both as part of the crew

MDT (Mobile Data Terminal) provides you with case information such

as the address and comments with updates as sent by dispatch

Can use for status changes, looking up cases, typing messages, etc

EMR (Electronic Medical Record) is how we document patient care

reports

Let your crew know what

your shift training

goals are!

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Incident number

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MDT-Logging in

When you click on the “Logon”

screen, you will enter the following:

Unit ID: ambulance number such as

2222S

Vehicle #: vehicle bumper number

Password: of the person logging on

the vehicle – please have your AIC

help you establish a password ** your

Initial password is your Officer code

number**

Shift: if needed

Officer: officer code/800 number

(first officer # should match the

password)

Portable#: portable radio ID number

Enter subsequent officer codes and

matching portable radio numbers

Press “Logon to system” button or

“enter”

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MDT Logon Troubleshooting

If you are having difficulty with your officer

code/password:

Ensure you are using the right combo of upper/lower case

letters—the MDT defaults to all caps

If it won’t work for you, let your partner try

You will want to have the dispatch supervisor reset your password

Make sure you staff up over the radio so they know you are

manned!

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Emergency Response System

The ERS is an effort from the public safety agencies to

provide a coordinated response

Emergency Communications, EMS, Police and Fire work

together to respond the right units to all emergencies

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Situational Awareness

The public only sees us as one EMS system

The need to be aware of calls throughout the City while

on duty is your responsibility

One missed call, one unprofessional act, one improper

driving technique casts a bad light on the entire

organization

Everyone is watching

We are in a high profile, high risk profession

Dispatching

911 calls are received at the Communications Center (ECCS)

Dispatchers use Emergency Medical Dispatching (EMD) to determine the nature of the emergency with predefined questions

Offer basic first aid instructions if the caller

will accept them

EMS cases are either dispatched as

Priority 1 or Priority 2 based on the EMD

recommendation

Pri1 cases include chest pain, breathing

difficulty, entrapments, etc

Pri 2 cases include illnesses, minor injuries and

other minor situations

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Dispatching (cont)

If in the station, your tones will go off and lights will turn on

If on the road, you will hear your unit dispatched over the

radio and your MDT will chirp

Always monitor the radio!

Units are dispatched based on preset run cards

If your unit is closer, you should offer to that information to the

dispatcher/EMS supervisor

Units may be reassigned by EMS supervisors based on many variables

If responding to calls with multiple units/departments, you may

be assigned a TAC channel-you need to switch to it as soon as

possible

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Radio Communications

Currently use 800 digital trunked system

Must monitor the radio at all times (unless in the station at night)

Need to key the mike an wait for two seconds before speaking (wait for the red light to illuminate)

All communications occur on the EMS Command channel (dispatching, comments, responding, clearing, etc)

EMS Command is located on VB Fire/EMS, channel 1

Tac channels are on VB Fire/EMS, channels 3-13

Hospital channels are on Hosp/LG, channels 1-7

Make sure you know how to operate portable and main radios

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In the event our Primary radio channel goes down

MDT’s and pagers may still be active so pay attention

All units will be advised where to switch radio communications

by the duty supervisor

Shortly after switching, role call for all staffed units will be done

Should also turn on the VHF radio if advised

Loss of radio may be indicated by “Failsoft” on screen with

beeping or other error message


Emergency Flasher If the orange button is depressed on a portable or the emergency

button on the radio, it triggers an alert at communications

Used to “secretly” identify that your unit is in danger

Dispatcher will call your unit and state “ Unit #X, call communications Code 1” If you hit the button in error, you must reply “ Code 1 error” and then

push and hold the orange button until the emergency flasher is cleared, usually a few seconds

If you don’t reply or reply with anything else, the dispatcher will continue to challenge you and start sending assist units and police

If you do not reset the flasher, it will continue to alert and the dispatcher will continue to prompt you as it locks up the system

Instead of using the button, you can say “Mayday” or “Signal 1” to indicate that you are in immediate danger

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Use plain talk Courtesy is assumed (“Can you please show unit x manned” can be

reduced to “Unit x is manned”)

Transmit direct questions and pertinent information, not reasons (“Our computer is broken, can you log us on?” becomes “Log on unit x.”)

When initiating communication over the radio say your Unit # to ___. Examples would be … Unit # to EMS01 or

Unit # to Virginia Beach - for raising the Dispatcher

“Air is restricted” Occurs frequently on police channels but means that no

communication should occur unless the crew requesting the restricted air has something to say

All other units should stay off the radio or use the fire channel until the restriction is lifted

What is a tiered response?

VBEMS uses a tiered response system Ambulances (BLS and ALS)

Ambulances can be BLS (R), Enhanced (S), or ALS (P)

All ambulances are ALS equipped

ALS zone cars-Intermediate/Paramedic A zone car may be dispatched with a BLS ambulance

If the patient does not require ALS transport, the zone car can clear

Fire first-response (BLS and ALS) Engines are dispatched for all Pri 1 cases, or if requested for time and

distance for Pri 2 cases

Engines should leave access on scene for units for best access to the residence

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What to bring in with you on scene

Stretcher

Jumpbag with O2

Life Pack 15

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Specialty Responses-Cardiac Arrest

Police officers with an AED are dispatched

There are over 150 AED’s assigned to the police dept and we have had

many lives saved because of them

All officers are trained in CPR

An ambulance, engine, and EMS supervisor are dispatched

Supervisors and some ambulance carry LUCAS to be used for

compressions (LUCAS Training is included in the OPS II Class)

Dispatchers give CPR and choking instructions

if the caller wants them

Two zone cars are sent

Zone car may be cancelled by EMS supervisor

if ALS is on the engine or ambulance

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Specialty Response-Working Fire

After the working fire is declared, automatic additional units

include an ambulance and an EMS supervisor

Responding units should switch to the assigned Tac channel

Units should be aware of egress from the scene (don’t get

blocked in by a hose)

If no assignment is given, check in with command on arrival

Crews should bring their stretcher, jump bag, monitor and a

back board to the rehab area and be prepared to rehab the

firefighters

If there are patients, additional

ambulances and possibly ALS are sent

as needed

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Specialty Response-Hazmat

An ambulance is sent to all working hazmat cases

Responding units will switch to the assigned Tac channel

and report to command

Depending on the level of hazmat, crews may need to

perform entry and exit physicals on firefighters

EMS will not enter the warm or hot zone

Pay close attention

to staging directions

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Specialty Response-Airport Alert

Virginia Beach sends EMS and fire units to all Norfolk

International Airport Field emergencies

Units will be assigned a Tac channel

Units stage near Miller Store Rd and Burton Station Rd

Airport Fire is in command and works with Norfolk

Fire/Rescue and VB units

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Specialty Response-Police Standby

Includes standbys for warrant service, hostage/barricade, and bomb scares

Unit will be assigned a staging location and unless otherwise notified, crews

need to stay with the vehicle until called in

If requested by SWAT medics, you should monitor the assigned Tac channel

for updates and evolving events

Standbys can be lengthy-the EMS supervisor will relieve crews as needed

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Specialty Response-Entrapment

Standard response includes ambulance, zone car, EMS supervisor, fire engine, ladder and squad truck Alterations in response made

by command or EMS 1, 2 or 3

Personnel inside action area should be in protective gear There are a lot of sharp objects,

trip hazards and increased risk

Units are assigned a Tac channel and should switch upon dispatch

Most often, ambulance crews focus on preparing to receive the patient after extrication is complete

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http://www.norfolkairport.com/images/stories/airport-information/photo-gallery/ORF_Takeoff.jpg

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Specialty Response-Water Rescue

VB has a lot of waterways!

Can include drownings and incidents with water craft

Reach, throw, row…..do not become a victim

Ambulance, zone car, EMS 1, 2 or 3 and marine rescue

team dispatched along with other resources from fire and

police—crews should switch to the assigned Tac channel

If you are the first unit, speak with

witnesses and obtain the point

last seen and gather as much

information as possible

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Specialty Response-Medevac

The AIC on scene can request a helicopter due to time and

distance from the hospital

EMS 1, 2 or 3 may place one on standby prior to units being on scene

based on comments

EMS 1, 2 or 3 determines if Airmed or Nightingale will respond and then

makes request

VBEMS has a medevac helicopter staffed by medics

Airmed is a dual mission aircraft-police/medevac

Must be a paramedic to join

the Medevac team

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Specialty Response-Military Installations

We often respond to military bases-stop at the gate

They will often provide a vehicle escort from gate

We often provide assistance for large events such as the

Oceana Air Show and drills

All units have VB radios and are listed in our CAD

No POV responses

They can request an

ALS only response

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Specialty Response-Mass Casualty

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MCI is an incident that overwhelms the resources

One crew could be overwhelmed by a few patients or a city could be

overwhelmed by hundreds of patients

If first onscene of multiple patients, assume command, perform triage and

share information

5 S’s-Safety, Size-up, Send, Setup, Start

A lot of units are coming so start thinking about staging and scene flow

VBEMS has 2 MCI trucks which can handle approx 50 patients with

supplies

Specialty Response-Interstate calls

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An engine is sent to ALL cases on the interstate or off ramps to assist with traffic control

Ambulances and smaller vehicles should park IN FRONT of the engine

Enter Interstate well behind the reported accident to avoid missing it.

For example if the accident is 264 E/B at Witchduck, get on at Newtown

Wear safety vests, be cautious when

exiting vehicles and always be on

the lookout.

Switch to assigned TAC channel

Specialty Response-Large Scale/Major Events

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There is a potential for unexpected major events

requiring many resources

If an event occurs, do not respond directly to the scene

If you can assist, respond to a station and staff a unit.

Those out on medical or other leave cannot respond

Must have released ID to respond

If there are no units available, stage at the station and

await further instruction.

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Other Items of Note

Declaring a patient deceased

Any released AIC can declare a pt deceased

Sometimes just one provider will enter at PD request to pronounce depending on circumstances

North Landing Bridge

You should call ahead and advise your ETA if using that route

Standbys

We have many large events throughout the year requiring standby units assigned to the event

Should be self-sufficient but may require a unit to stand-by while they are transporting or ALS assistance

Will often have a command structure established with a Tac channel

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Other Items of Note (cont)

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POV Responses

POV responses are not permitted while in intern status

Trainees should only respond to cases while in uniform and on duty

POV responses are never permitted to the interstate

The use of emergency lights in a POV is very highly

discouraged

Operators use them at their own risk and must obey traffic laws or

are subject to ticketing by police

Photography on Scene

You are not allowed to take photos or

recordings while on calls without advance

prior permission from the Chief for any reason


CISM-Critical Incident Stress Management

Contact a EMS supervisor if you feel you or your crew may benefit from CISM

Region has CISM team

Many of our members are very involved

Different levels of team involvement based on incident-from one-on-one to large groups

DNR (Do Not Resuscitate) and DDNR-Durable DNR

VA providers can honor a written DNR order signed by a physician in a licensed facility or the yellow original state DNR form/legible photocopy

DNR jewelry, original POST forms etc. can also be recognized

http://www.vdh.state.va.us/OEMS/Files_page/DDNR/DDNRFactSheet.pdf

Virginia EMS providers CANNOT honor a Living Will or a DNR from another state

If in doubt, contact medical control for advice on how to proceed

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http://www.vdh.state.va.us/OEMS/Files_page/DDNR/DDNRFactSheet.pdf

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Other Items of Note (cont) Child/Elder Abuse Reporting

VA EMS providers are mandated reporters meaning we are responsible to report the suspected abuse directly to APS/CPS within 24 hours Required to report suspected abuse, neglect, or exploitation of elders or

incapacitated adults.

When you suspect that a child is being abused or neglected (physically, mentally, emotionally, sexually)

If you have any doubt as to whether you should report or not, you should report it

Report must be made immediately EMS providers can report the situation directly to the receiving physician in lieu of

reporting

EMS supervisors cannot make a report on your behalf

Reporters should provide the name, age and address or location of the person who is suspected of being abused, and as much information about the abusive situation as possible

http://www.dss.virginia.gov/abuse/

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Accidents involving vehicle insured by the city

Notify EMS supervisor, dispatch and PD immediately

If transporting a patient, request an additional unit for

transport

Do not move the vehicles unless absolutely necessary

Supervisor will determine if vehicle needs to be evaluated by

the city garage

The crew may be subject to a urine screen

Loss/Damage of property insured by the city

Notify squad commander or EMS supervisor as soon as the

loss/damage is noted

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Personal Injury while on duty

If you are injured while on duty, contact EMS supervisor immediately

If proper and timely notification is not made, reimbursement by the

city is not guaranteed

You may be directed to an ER, occupational health or other facility

for emergency treatment

Depending on the injury, you may just complete the paperwork

You will be required to visit Occupational Health for permission to

return to duty

Illness on duty

Illnesses in which you need to go home should be reported to EMS 1

or 2 immediately so coverage for your position can be arranged

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Exposure to blood or body fluids while on duty

True exposure is: “A specific eye, mouth, other mucous membrane,

non-intact skin, or parenteral contact with blood or other potentially

infectious materials that results from the performance of an employee’s

duties”

Clean/flush the affected site immediately

Report the incident to EMS 1, 2 or 3 immediately

EMS supervisor will walk you through reporting steps until you

are handed over to Occupational Health

EMS Admin is notified of the exposure but Occupational

Health deals with all results and contact for your privacy

Your station is not notified unless you tell them

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What if you are charged with a crime?

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If you are charged with a crime involving off duty activities, you

must notify your immediate supervisor and DEMS Division

Chief of Support Services/Admin as per the Criminal Activity

and Traffic Offense Reporting Policy within 24 hours of the

citation/charge

Includes being served, arrested or cited for the following:

Traffic violations involving speed, DUI, reckless driving, suspension or loss of

license----any moving violation or loss of license

All alleged criminal activity that has or may lead to arrest, detainment or

conviction

Any activity that is alleged to be criminal in nature by law enforcement

personnel, including all misdemeanor offenses.

Charges need to be reported-not just convictions


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Privacy and Protected Health Information (PHI)

Any information collected from an individual that is created or

received by a health care provider, relates to the past, present,

or future condition of an individual, and which can reasonably

used to identify an individual.

Includes things such as phone numbers, SSN, record numbers,

addresses, names, license plate number, DOB, email address, photos,

etc.

Must shred any notes containing this information and log out of Field

Bridge when not in use.

Information about calls should not be shared or discussed with

anyone who wasn’t on the case with you

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Patient Refusals

The legal age of consent in VA is 14 years or older

Use your judgment if no adult is readily available in anyone under age 18

Those under 18 who are emancipated or pregnant are also capable of refusing

Patients should be “competent” to refuse meaning alert, oriented, not under the influence and not suffering from an illness or injury that would alter their judgment

If you have concerns about allowing the patient to refuse, contact Medical Control and/or EMS supervisor

A report must be completed including vitals signs and all patient information

Don’t forget signatures and the AMA form

After the call

Patient care records are completed

Unit is put back together and cleaned

Crews will restock approved items from the hospital

Only take what you used (linen included)

Stations maintain stock for refusals and replacement

Some hospitals require the TEMS Exchange form to be completed

Hospitals provide drug and IV boxes for restock

Must leave a completed exchange slip with each box returned

If one item is used, entire box is exchanged

Contact EMS supervisor if you need to delay clearing for

important supplies

Advise over the air that your unit is available

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Electronic Patient Care Reporting (ePCR)

66

Your reports

Are important to your patient and their treatment.

Are used at the local, state, and federal levels.

Are a reflection of your professionalism as a healthcare provider.

Hospitals have direct access to your posted reports and use

them daily.

In 2015, EMS Admin processed 758 requests for reports to

attorneys, medical examiners, patients, or the

City/Commonwealth Attorney.

2016 is on track to exceed those requests.

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When do you need to complete a report?

For every dispatch, whether patient contact is made, including:

Transports, refusals, death pronouncements, public assists, standby

events, or cancellations/no patient contact.

For cancellations, if you are cleared:

By VBFD

VBFD is responsible for the report

By another VBEMS unit

That unit will complete the report

By anyone else (dispatcher, VBPD, etc.)

Ambulance crew is responsible for the report


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Report Requirements

Per Virginia Law (12VAC5-31-1140. Provision of Patient Care Documentation)

Patient care reports are due to the receiving facility at the time of patient transfer.

If unable to provide a full report, an abbreviated (verbal) report is made at the hospital and the full report us due within 12 hours.

Required fields are established at the national, state, and local levels.

Reports must meet a minimum validation score of 98% to be considered complete.

Only complete reports are sent to Virginia or Sentara.

Expect to be contacted to finish an incomplete or missing report.


69

Computer Hardware

Keep your EMR charged.

Reboot it at the start of your shift.

Decon as needed, otherwise be gentle when cleaning the screen.

Shut down when not in use.

Shift supervisors are your first line of support

They have replacement computers, batteries, chargers, and styluses.

You may be asked to document damage or failures to help identify

and correct problems.

You won’t be in trouble if asked to fill this out. Accidents happen. But

issues can’t be fixed if they aren’t reported.

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Mobile Data Terminal (MDT)

Ambulance computer in the front of the ambulance, used to

interact with dispatch, receive call information, etc.

Call a Dispatch Supervisor to reset your password.

Broadcasts the CVB-EMERGENCY Wi-Fi network used by

EMRs.

Reboot the MDT if having problems connecting to the

internet.


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Wi-Fi use

For EMRs, only connect to CVB-EMERGENCY and CARE4U

networks.

This includes your station’s Wi-Fi network.

Connecting to multiple networks has proven to cause connectivity

issues.


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Elite

Our patient care reporting software from our vendor,

ImageTrend.

Is web-based, however it can work offline in Field Mode (away

from Wi-Fi)

You must be connected to Wi-Fi in order to

Login

Download CAD

Look up repeat patients

Zip code lookups

Posting or transferring reports

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Sign in with your username and password

If you lost your password, use self-service to reset it.

Shift supervisors can also reset your password if needed.

If you need additional assistance, email [email protected].


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EKG transmission/download First step is ALWAYS to gently plug the USB cable from the LifePak into

the EMR.

If sending a 12-lead to the hospital Press TRANSMIT on the LifePak and select a HOSPITAL as the site.

Then press SEND.

If downloading 12-lead into the report Launch the Elite Desktop Client and click the Physio-Control

Transfer Wizard button.

Press TRANSMIT on the LifePak and select EMR NOTEBOOK as the site. Then press SEND.

From inside Elite, click the EKG button and find your downloaded data, then click Import Selected.


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Quick reference instructions are available right on your

EMR desktop:

mailto:[email protected]

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Transferring Reports

Used to transfer a report in progress from one EMR to

another.

Be sure to download CAD data first.

View Transfers is keyed off Dispatch Time. Leaving this blank and

transferring will make it difficult to find your report.

It is your choice whether leave the report on the original EMR.

Just be sure you don’t post the report from two different devices or

you will lose data!


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EliteBridge

Website where you can start or complete reports if the EMR

is unavailable.

http://www.vbems.com/elitebridge

Log in with the same username and password as on the EMR.

Also where you will receive CQI messages and patient

outcome information.


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Review

Patient care reports are due within 12 hours of patient turnover.

Minimum validation score is 98% for all reports.

Use only the CVB-EMERGENCY Wi-Fi network.

You must be connected to Wi-Fi to log into Elite, download CAD data, or lookup repeat patients.

If you forget your password, use self-service features to reset it.

Sign into EliteBridge to access your reports after the incident, and, to view Inbox messages about your reports.

If you need assistance:

Contact a shift supervisor when on duty.

Otherwise, email [email protected].



mailto:[email protected]

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Tidewater EMS Council

TEMS integrates and coordinates resources

Coordinates between more than 70 local EMS agencies and 12 hospitals

EMS system planning, regional medical direction, standardized medication and IV exchange system, mass casualty planning, trauma triage planning and quality improvement

Implementation and sustainment of the Hampton Roads Metropolitan Medical Response Team

TEMS agrees on consistent protocols which are approved by the Operational Medical Directors committee

Individual medical directors may expand or limit the regional protocols

Where to find them-TEMS website

http://tidewater.vaems.org/tidewater-ems-council/protocols/2013-protocols/1679-tems-protocol-pocket-guide-2014-06-02/file

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Protocols-Goals and Expectations

Goals

Establish minimum expectations for appropriate patient care

To relieve pain and suffering, improve patient outcomes and do no harm

To ensure a structure of accountability for operational medical directors, facilities, agencies and providers

Protocols are derived from a variety of sources

Expectations

Protocols are designed to be used in conjunction with each other- it is acceptable to use more than one protocol at a time

Providers will maintain a working knowledge of the protocols

Each patient should have a thorough assessment performed

BLS providers should request ALS assistance if any deficiencies are found on the initial assessment

80

Protocols-Format

Introduction

Legend of symbols, Skills delineation, Medication lists

Reference Sections

Adult and pediatric

Burn chart, drip charts, pain scale, APGAR, etc

Protocols

Adult Cardiac and Adult General

Peds Cardiac and Peds General

Each protocol includes flowchart and informational page

Performance Indicators-included for each protocol

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Protocols-Legend of Symbols Teddy bear in the upper right corner of protocol

indicates a corresponding pediatric protocol (age 14 and younger/55 lbs)

Assessment Decision Point

Assessment or Action

Delivery

Treatment

Decision point that can occur independently of other actions or simultaneously

82

Protocols-Legend of Symbols (cont)

Next to “Treatment” boxes, you will note letters

EMT = EMT-Basic

A = EMT-Enhanced

I = EMT-Intermediate

P = EMT-Paramedic

MD = Physician

[Brackets] around the letters indicate PHYSICIAN ORDER

That level can perform the skill but must have permission from med control

Physician Orders require a signature from a receiving practitioner on the EMR

No brackets indicate STANDING ORDER

You can complete the task or skill up to your released level without calling med control for permission

83

Protocols-SO vs. PO Symbols [EMT]

A

I

P

A

I

P

[I]

[P]

Indicates EMT-B can administer the

subcutaneous epi with physician orders

only and all other levels can administer on

standing orders

(EMT-B’s can only use the patient’s Epi-pen)

Indicates EMT-Enhanced and above can

administer Benadryl on standing orders

Can only be administered by EMT-

Intermediate or above and with physician

orders

Epinephrine

1:1000 0.01 mg/kg

SQ/IM

Max dose 0.5 mg

Diphenhydramine

(Benadryl) 50 mg IV,

(IM if IV not available

Consider sedation

Haldol 5mg IM (Large muscle area)

and 2mg Ativan IM

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Protocol of note-

Airway/Oxygenation/Ventilation

Supplemental Oxygen

Many programs teach high flow oxygen for all patients

We base oxygen delivery on the individual patient

Goal for SpO2 (pulse ox) reading is 94% or higher

For patients with adequate respirations

For a pulse ox between 90-93%, consider a nasal cannula at 1-6L

For a pulse ox less than 90%, use a non-rebreather

Upgrade or downgrade as necessary

Provide oxygen for all patients with altered mental status,

hypoperfusion, chest pain, significant trauma, CO exposure or SOB

regardless of the pulse ox reading

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86

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Protocol of note-Spinal Immobilization

To rule out the need for spinal immobilization, the patient must:

Have no positive mechanism

High speed MVC, age extremes, axial load, diving accident, loss of consciousness, etc

Low risk mechanisms can also produce spinal injuries (elderly falls)

Be reliable

Must be calm, cooperative, not impaired by drugs or alcohol, alert and oriented and have no distracting injuries

Distracting injuries can include fractures, dislocations, severe bruising or cuts

Have no spinal tenderness or pain

Have a normal motor and sensory exam

If there are any doubts or questions, immobilize!

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89

90

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High-Performance CPR

High-Performance CPR (pit crew method) is becoming a

standard practice to better patient outcomes.

It’s a practical application of the science

In line with AHA 2010 ECC Guidelines

Standardize approach saves lives!

91

How we’re doing

An average survival rate (SCA) of 34-36%

We use the same measurement tool as Seattle, Wake,

CARES, etc.

National SCA Survival Rate is 30.2% (Valderamma, 2011).

Seattle 56%

Wake Co, NC. 45%

Rochester, MN 58%

Charlotte (Mecklenberg) 52%

While we’re doing good…we can always do better!

92

High Performance CPR

1. Own CPR!

2. Minimize interruptions in

CPR at ALL TIMES

3. Ensure proper depth of

compressions

4. Ensure full chest recoil

5. Ensure proper

compression rate (100-

120)

6. Rotate compressors every

2 minutes

7. Hover hands over chest

during shock

administration

8. Do NOT stop CPR to

place an advanced airway

9. Do NOT stop CPR to

obtain IV/IO access

10. Coordinate

care/movement between

BLS/ALS

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Pausing makes a difference

Pausing DOES make a

difference

Longer pauses in chest

compressions = lower

chances of positive outcome

The longer the pause

preceding shock or following

a shock, the lower the

chances of survival

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95

96

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Trauma

Trauma

Assessment to Protocol

Protocol to Treatment

Spinal Immobilization Protocol

CAT Tourniquet

http://www.youtube.com/watch?v=3-WnRUi5UZI

98

99





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Medical 1 Breathing Difficulty

Assessment to Protocol Waveform Capnography


HHN Albuterol

Analyphalxis EMT may give Albuterol- MDI or Nebulized on Standing orders

Only one dose under standing orders

Breathing Difficulty Albuterol (MDI or HHN) x 2 (Standing orders)

Atrovent Breathing Difficulty

Atrovent (HHN) x 1 (standing orders)

CPAP for enhanced/advanced – coming soon

http://www.youtube.com/watch?v=Xre92Ap0vrA

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102



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Medical 2

Cardiac Arrest Management

Chest Pain

Assessment to Protocol

BLS 12 Lead – coming soon as separate course


Chest Pain/AMI/ACS

ASA- Standing order

NTG – Physician order

Physician order also for Breathing Difficulty HX CHF/Pulmonary edema

104

Protocols-Transport information

All patients

We routinely transport to all of the hospitals located in Virginia

Beach and Sentara Leigh

Our OMD has determined that we should transport patients

to the facility of their choice whenever possible

Closest facility if the patient is unstable or too critical

Will not transport to facilities out our catchment area such as DePaul,

Obici, Maryview, Portsmouth Naval, etc

Transports to Chesapeake Regional, Children’s Hospital of the Kings

Daughters or non-trauma complaints to Sentara Norfolk General

need permission from EMS 1, 2 or 3 prior to transport

May be diverted by medical control to a more appropriate

facility

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Protocols-Transport information (cont)

Trauma patients Trauma centers are Sentara Norfolk General (Level 1) and Sentara

Virginia Beach General (Level 3)

Can transport directly to a trauma center when they meet Trauma center transport criteria

Patients requiring a burn center will go to Norfolk General

Stable pregnant patients greater than 20 weeks should be taken to the Norfolk General trauma center (Unstable and/or less than 20 weeks can start to VBGH—when in doubt, contact Med Control)

Pregnant patients Should be transported to a facility with Labor and Delivery if more

than 20 weeks pregnant

Leigh, Princess Anne and Chesapeake have L& D

Specialty patients Some patients with specialized devices or conditions may require

transport to a specific facility

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Ongoing Training

VBEMS has both ALS and BLS recertification programs

available throughout the year

Many courses online for annual recertification/refresher

Provide EVOC, CPR, ACLS and PALS on a regular basis

Multiple other sources of training from local hospitals,

TEMS, and other agencies

Contact the EMS Training center for information on

advancing to the next certification level

VBEMS offers specialty courses such

as RSI, extrication, medevac, ITLS

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How do I get to the next step?

Complete the following to move to Intern status:

1. Complete this course

2. View the Lifepak 15 information

3. Complete Initial OSHA

4. Complete the new member and OSHA quizzes (bring them with you for step 5)

5. Make appointment with EMS Admin to obtain your Intern ID card

At the appointment, you can expect the following:

Review the quizzes

Review the training process

Questions and answers (Bring questions with you!)

Hands-on with Lifepak

Get your Intern ID!

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I am an Intern! Now what?

Your goal while on strict supervision is:

To demonstrate your ability to function as an EMT intern while

following the policies and protocols established by the City of

Virginia Beach Department of EMS.

That means you need to:

Perform assessments

Provide appropriate patient care

Demonstrate your knowledge of policies, protocols and procedures

Show the ability to drive an ambulance safely in both emergency and

non-emergency modes

Be in charge on calls

Be able to use the radios and computers

Show that you can handle a call “on your own”.

109

Intern process

1. As soon as you are issued your Intern ID, you will need to

submit your dates for scheduling in OSCAR

2. You will run four duties per month (12 hour shifts)

3. An evaluation must be completed for each shift/duty run and

turned in to the BLS Intern Coordinator at Admin

4. Ensure completion of all required courses

ICS-100, 200, 700, 800, EVOC, Hazmat, current CPR and EMT

5. After approximately 3-6 months (12-25 duties) your

internship should be complete or very near completion

6. Be recommended for release and feel comfortable being

released!

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Links for other courses

Once you have passed the final exam, return to the

course completion page and print your certificate,

and provide a copy of the certificate to EMS Admin.

Hazmat-Terrorism Awareness for Emergency First Responders

[AWR160]-- http://www.teexwmdcampus.com/

ICS-100, 200b, 700, 800b-- http://training.fema.gov/IS/NIMS.asp

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http://www.teexwmdcampus.com/

http://www.teexwmdcampus.com/

http://training.fema.gov/IS/NIMS.asp



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Definitions

112

There are many terms and abbreviations used in EMS. Here are some that you may find in this document or may hear someone mention.

Admin-EMS Administration office

AIC (Attendant in Charge)-EMT or higher able to be in charge of patient care and calls

ALS-Advanced Life Support

BLS-Basic Life Support

CAD (Computer Aided Dispatch)-system used to send and record 911case information

EMD (Emergency Medical Dispatch)-process for dispatch to prioritize calls

EMR (Electronic Medical Record)-medical record

EMS 1, 2, 3 -EMS supervisor on duty

Entrapment-person can’t be removed from a car, machine, etc without special tools

ERS (Emergency Response System)-coordinated response to emergencies from multiple agencies

FTO (Field Training Officer)-AIC with specific qualifications to help new members progress

Image Trend-Company name of EMR and documentation system

Intern-certified member working on being released

LP (Lifepak 12/15 )-brand of EKG monitor/AED we use

Definitions (cont)

113

MDT (Mobile Data Terminal)-computer in vehicle that communicates with CAD

MRT (Marine Rescue Team)-certified divers and boat operators for water borne incidents

OMD (Operational Medical Director)-Physician who oversees our service

OSCAR-online schedule submission and management program

POV (Personal Operated Vehicle)-private vehicle

Recruit-brand new member who is awaiting class or a certification

Student-member in EMT class

TAC channel-special radio channel assigned for a specific incident

TEMS (Tidewater EMS Council)-our regional EMS council

Toughbook-computer for entering patient care reports

Trainee-non-released member (recruit, student or intern)

Training-EMS Training center

Zone car-sedan or truck that is staffed with an Intermediate or Paramedic

Thank you!

Thank you for joining VBEMS and reviewing the material.

We know this is a lot of information! You can review this

program anytime and we want you to ask questions all

along the way. You will master these items and so many

more in the coming months.

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