RPI Ambulance Standard Operating Procedures 13FEB2012

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					RPI            STANDARD OPERATING
AMBULANCE      PROCEDURES




      Updated: February 13th, 2012 | Captain Jovan Cruz
RPI Ambulance Standard Operating Procedures                                                                                                                    February 13, 2012


SOP 12-00 ORGANIZATION AND STRUCTURE ....................................................................................................................... 5
SOP 12-01 MISSION STATEMENT ......................................................................................................................................... 6
SOP 12-02 QUALIFICATION PROCEDURES - VOLUNTEER PERSONNEL................................................................................... 7
   APPLICATION PROCEDURES ............................................................................................................................................................ 7
   ORIENTATION .............................................................................................................................................................................. 7
   HEALTH AND SAFETY ..................................................................................................................................................................... 7
SOP 12-03 OPERATIONAL MEMBER TYPES ........................................................................................................................... 9
   INTRODUCTION ............................................................................................................................................................................ 9
   MEMBERSHIP REQUIREMENTS ........................................................................................................................................................ 9
   ACTIVE - I MEMBERSHIP ................................................................................................................................................................ 9
   ACTIVE - II MEMBERSHIP ............................................................................................................................................................... 9
   ADMINISTRATIVE MEMBERSHIP..................................................................................................................................................... 10
SOP 12-04 TRAINING AND PROMOTIONS .......................................................................................................................... 11
   INTRODUCTION .......................................................................................................................................................................... 11
   TRAINING.................................................................................................................................................................................. 11
   TRAINING COMMITTEE ................................................................................................................................................................ 11
   BACK-UP TRAINING..................................................................................................................................................................... 11
   TRAINERS.................................................................................................................................................................................. 12
   PROMOTIONAL BOARDS: STRUCTURE ............................................................................................................................................. 12
   PROMOTIONAL BOARDS: VOTING .................................................................................................................................................. 13
SOP 12-05 OBSERVER ........................................................................................................................................................ 14
   FUNCTIONAL JOB DESCRIPTION ..................................................................................................................................................... 14
     Observer ............................................................................................................................................................................ 14
     Orientation Member ......................................................................................................................................................... 14
   TRAINING.................................................................................................................................................................................. 15
     Ambulance Orientation Member ...................................................................................................................................... 15
SOP 12-06 AMBULANCE ATTENDANT ................................................................................................................................ 16
   FUNCTIONAL JOB DESCRIPTION ..................................................................................................................................................... 16
   TRAINING.................................................................................................................................................................................. 16
SOP 12-07 EMERGENCY VEHICLE OPERATOR ROLES AND RESPONSIBILITIES ...................................................................... 17
   FUNCTION JOB DESCRIPTION ........................................................................................................................................................ 17
   INTRODUCTION .......................................................................................................................................................................... 17
   DEFINITIONS.............................................................................................................................................................................. 17
   DRIVER QUALIFICATIONS.............................................................................................................................................................. 18
   GENERAL DRIVING PROCEDURES ................................................................................................................................................... 18
   EMERGENCY DRIVING PROCEDURES ............................................................................................................................................... 18
   DRIVER’S DUTIES........................................................................................................................................................................ 19
   SPOTTERS ................................................................................................................................................................................. 19
   BACK-UP ALARM ....................................................................................................................................................................... 20
   TRAVEL LIMITS ........................................................................................................................................................................... 20
   TRAINING.................................................................................................................................................................................. 21
      Back-up Driver ................................................................................................................................................................... 21
      Driver ................................................................................................................................................................................. 21
      Driver Trainer .................................................................................................................................................................... 22



Jovan E. Cruz, Captain                                                                                                                                                          1
RPI Ambulance Standard Operating Procedures                                                                                                                     February 13, 2012


SOP 12-08 CREW CHIEF ...................................................................................................................................................... 23
   FUNCTION JOB DESCRIPTION ........................................................................................................................................................ 23
   INTRODUCTION .......................................................................................................................................................................... 23
   QUALIFICATIONS ........................................................................................................................................................................ 23
   GENERAL PROCEDURES................................................................................................................................................................ 24
   CREW CHIEF’S DUTIES ................................................................................................................................................................. 24
   TRAINING.................................................................................................................................................................................. 26
      Back-up Crew Chief ........................................................................................................................................................... 26
      Crew Chief ......................................................................................................................................................................... 26
      Crew Chief Trainer ............................................................................................................................................................. 27
SOP 12-09 SUPERVISORS ................................................................................................................................................... 28
   INTRODUCTION .......................................................................................................................................................................... 28
   QUALIFICATIONS ........................................................................................................................................................................ 28
   DUTIES ..................................................................................................................................................................................... 28
   GRIEVANCES .............................................................................................................................................................................. 29
SOP 12-10 CONDUCT ......................................................................................................................................................... 30
   INTRODUCTION .......................................................................................................................................................................... 30
   PATIENT CONFIDENTIALITY ........................................................................................................................................................... 30
   WEAPONS................................................................................................................................................................................. 30
   SMOKING.................................................................................................................................................................................. 30
   ALCOHOL, CONTROLLED SUBSTANCES, AND MEDICATIONS ................................................................................................................. 30
SOP 12-11 SEXUAL HARASSMENT AND NONDISCRIMINATION .......................................................................................... 32
   SEXUAL HARASSMENT ................................................................................................................................................................. 32
   NONDISCRIMINATION.................................................................................................................................................................. 32
   VIOLATIONS .............................................................................................................................................................................. 32
SOP 12-12 INFECTIOUS DISEASE EXPOSURE AND ON DUTY INJURY ................................................................................... 33
   INTRODUCTION .......................................................................................................................................................................... 33
   PRACTICES ................................................................................................................................................................................ 33
   ON-DUTY INJURY OR EXPOSURE .................................................................................................................................................... 33
SOP 12-13 AMBULANCE/EQUIPMENT INSPECTION, CARE, AND MAINTENANCE ................................................................ 34
   INTRODUCTION .......................................................................................................................................................................... 34
   AMBULANCE MAINTENANCE ........................................................................................................................................................ 34
   EQUIPMENT MAINTENANCE ......................................................................................................................................................... 34
   CLEANING ................................................................................................................................................................................. 35
   ACCIDENTS/DAMAGE TO THE AMBULANCE...................................................................................................................................... 35
   FAILURES .................................................................................................................................................................................. 36
SOP 12-14 DOCUMENTATION ............................................................................................................................................ 37
   INTRODUCTION .......................................................................................................................................................................... 37
   GENERAL PROCEDURES................................................................................................................................................................ 37
   REFUSAL OF MEDICAL ATTENTION (RMA) ...................................................................................................................................... 37
SOP 12-15 REQUESTS FOR SERVICE AND EMERGENCY DISPATCH PROCEDURES ................................................................ 39
   INTRODUCTION .......................................................................................................................................................................... 39
   NOTIFICATION OF CALLS .............................................................................................................................................................. 39



Jovan E. Cruz, Captain                                                                                                                                                           2
RPI Ambulance Standard Operating Procedures                                                                                                                    February 13, 2012


   EMS CALLS ............................................................................................................................................................................... 40
   TRANSPORTATION CALLS.............................................................................................................................................................. 40
   HAZARDOUS MATERIAL CALLS ...................................................................................................................................................... 40
   STAND-BY’S AND MCI ................................................................................................................................................................. 40
   MUTUAL AID ............................................................................................................................................................................. 41
   RPI AMBULANCE UNAVAILABILITY.................................................................................................................................................. 41
SOP 12-16 COORDINATORS ............................................................................................................................................... 42
   INTRODUCTION .......................................................................................................................................................................... 42
   QI COORDINATOR ...................................................................................................................................................................... 42
   CPR COORDINATOR.................................................................................................................................................................... 42
SOP 12-17 UNIFORMS ........................................................................................................................................................ 43
   INTRODUCTION .......................................................................................................................................................................... 43
   PATCHES................................................................................................................................................................................... 43
   PINS, COLLAR BRASS, BADGES ...................................................................................................................................................... 43
   UNIFORM CLASSES ..................................................................................................................................................................... 43
      Class A or Dress Uniform ................................................................................................................................................... 43
      Class B or Casual Uniform ................................................................................................................................................. 44
      “Class C” Uniform and Other Apparel ............................................................................................................................... 44
   FIELDSTATION CREWS.................................................................................................................................................................. 44
SOP 12-18 RADIO COMMUNICATIONS ............................................................................................................................... 45
   DEFINITIONS.............................................................................................................................................................................. 45
   RADIO IDENTIFIERS ..................................................................................................................................................................... 46
   RPI AMBULANCE VEHICLE............................................................................................................................................................ 46
   AMBULANCE 5939 ..................................................................................................................................................................... 46
   HEADQUARTERS–92 COLLEGE AVE. ............................................................................................................................................... 46
   DISPATCHERS............................................................................................................................................................................. 46
SOP 12-19 MUTUAL AID..................................................................................................................................................... 47
SOP 12-20 AMBULANCE LAYOUT/SETUP ........................................................................................................................... 48
   INTRODUCTION .......................................................................................................................................................................... 48
   STRETCHER................................................................................................................................................................................ 48
   SPARE MAKE-UP ........................................................................................................................................................................ 48
   IV FLUID CLIPS/RETAINERS ........................................................................................................................................................... 48
   PORTABLE OXYGEN TANKS ........................................................................................................................................................... 48
   WALL OXYGEN REGULATORS ........................................................................................................................................................ 49
   ONBOARD OXYGEN SYSTEM ......................................................................................................................................................... 49
   COMPLETED PAPERWORK ............................................................................................................................................................ 49
   OTHER EQUIPMENT, TOOLS, ETC. ................................................................................................................................................... 49
SOP 12-21 STANDBY AND EVENT REQUESTS ...................................................................................................................... 50
SOP 12-22 GRIEVANCES AND APPEALS .............................................................................................................................. 51
   INTRODUCTION .......................................................................................................................................................................... 51
   GRIEVANCES .............................................................................................................................................................................. 51
   CHAIN OF APPEALS ..................................................................................................................................................................... 51
   APPEALS ................................................................................................................................................................................... 51
SOP 12-23 DEFIBRILLATOR ................................................................................................................................................. 52



Jovan E. Cruz, Captain                                                                                                                                                          3
RPI Ambulance Standard Operating Procedures                                                                                                                      February 13, 2012


   INTRODUCTION .......................................................................................................................................................................... 52
   CARE AND MAINTENANCE ............................................................................................................................................................ 52
   USE ......................................................................................................................................................................................... 52
SOP 12-24 OUT OF SERVICE ............................................................................................................................................... 53
   INTRODUCTION .......................................................................................................................................................................... 53
   DAY TO DAY TURNOVERS ............................................................................................................................................................. 53
   EXTENDED PERIODS OF ABSENCE ................................................................................................................................................... 53
SOP 12-25 PATIENT TRANSPORT DESTINATIONS ............................................................................................................... 54
   INTRODUCTION .......................................................................................................................................................................... 54
   UNUSUAL RECEIVING FACILITY ...................................................................................................................................................... 54
   RECEIVING FACILITY ON DIVERSION ................................................................................................................................................ 54
   HOSPITAL DESTINATION IN MUTUAL AID SITUATION ......................................................................................................................... 55
   TRANSPORT AND HOSPITAL DESTINATION OF MAJOR TRAUMA PATIENTS .............................................................................................. 55
SOP 12-26 MISCELLANEOUS............................................................................................................................................... 56
   INTRODUCTION .......................................................................................................................................................................... 56
   LOCATING PATIENTS ................................................................................................................................................................... 56
   SPECIAL PATIENTS ...................................................................................................................................................................... 56
      Minors ............................................................................................................................................................................... 56
      Emotionally Disturbed Persons ......................................................................................................................................... 56
   CRIMES .................................................................................................................................................................................... 57
   INCIDENT REPORTING .................................................................................................................................................................. 57
   OBVIOUS AND UNATTENDED DEATH .............................................................................................................................................. 58
   CHILD ABUSE AND MALTREATMENT ............................................................................................................................................... 59
   GERIATRIC OR OTHER PATIENT ABUSE/MALTREATMENT .................................................................................................................... 60
   ABANDONED INFANT................................................................................................................................................................... 60
SOP 12-27 APPROVAL/REVIEW DOCUMENT ...................................................................................................................... 61




Jovan E. Cruz, Captain                                                                                                                                                            4
RPI Ambulance Standard Operating Procedures                                           February 13, 2012



              SOP 12-00 ORGANIZATION AND
                       STRUCTURE
This document is the Standard Operating Procedures (SOPs) of the Rensselaer Polytechnic Institute
Ambulance. If one section of the SOPs is amended, suspended, deleted, or otherwise changed, the
remainder of this document will remain unaffected.

This document is not to supersede any directives, guidelines, or protocols enacted by a higher authority
such as the State of New York, the Regional Emergency Medical Organization of the Hudson Mohawk Valley
Region (REMO-HMVI), or the County of Rensselaer. These guidelines are, furthermore, not to supersede
good clinical judgment on the part of the crew.

According to the RPI Ambulance Constitution, the Captain and Medical Director must agree upon the SOPs.
The Operating Procedures must be reviewed on an annual basis by the same entities. Documentation of this
review will be attached as a separate Policy Statement (see SOP 12-27).

The RPI Ambulance SOPs were originally written in the early 1980’s by George Holdsworth, and amended
and adjusted by Captains Ken Lavelle, John Kim, and Brian Wilde since that time. A major rewrite was
initiated by Captain Chris Holt, and completed by Captain Fabien Nicaise. The SOPs have since been
amended and adjusted by Captains Steve Mitchell, Benjamin Saunders, Veronica Voloshinov, and Eric
Tesoriero. Restructuring of sections and updates reflecting the new officers in the Spring of 2010 were
made by Peter Ragone. Additional changes during Fall 2010 and Spring 2011 made by Matthew Willett. A
major reformatting and additional changes were made during Spring 2012 by Captain Jovan Cruz.




Jovan E. Cruz, Captain                                                                         5
RPI Ambulance Standard Operating Procedures                                             February 13, 2012



             SOP 12-01 MISSION STATEMENT

The mission of this agency is to provide Basic Emergency Medical Services to the Rensselaer Polytechnic
Institute community, and to transport the sick and injured to definitive care. This includes, but is not
limited to the following:
        1. Develop standards, policies, and procedures pertaining to Emergency Medical Services in order
           to maintain proper operation of the RPI Ambulance.
        2. Provide Basic Life Support Ambulance Service to the RPI community.
        3. Conduct EMS Quality Improvement to improve the care provided by the RPI Ambulance.
        4. Provide training and support services to maintain and improve the agency’s equipment and
           personnel resources.
        5. Provide training to the Rensselaer community in order to improve the quality of first aid in the
           community and the world at large.
        6. Request and provide reciprocal services in accordance to the existing provisions of the
           Rensselaer County Ambulance and Rescue Association Mutual Aid Plan in addition to any other
           Mutual Aid Plans that the agency becomes involved in.




Jovan E. Cruz, Captain                                                                            6
RPI Ambulance Standard Operating Procedures                                            February 13, 2012



SOP 12-02 QUALIFICATION PROCEDURES -
        VOLUNTEER PERSONNEL

                                APPLICATION PROCEDUR ES

       1. Interested parties should obtain and complete, in its entirety, a membership form as supplied by
          the administration of the agency.
       2. Membership is contingent upon the membership policies outlined in the Agency’s constitution.
       3. Every member will resubmit a membership form to the administration of the Agency at the
          beginning of each academic year for the purpose of maintaining an up-to-date membership list.


                                          ORIENTATION

       1. Each new member shall participate in a Membership Orientation as prescribed by the Training
          Committee.
       2. The Membership Orientation shall include the following items:
              a.). RPI Ambulance History, Philosophy, and Structure
              b.) RPI Ambulance Operating Policies and RPI Ambulance Constitution
              c.) Risk Management
              d.) Liability and Confidentiality
              e.) Stress management/CISD
              f.) Health and Safety as outlined below
              g.) PCRs, documentation, and Quality Improvement procedures
              h.) Basic scene support
              i.) Basic call mechanics
              j.) Working with other agencies


                                         HEALTH AND SAFETY

       1. All members will undergo an annual training in-service on proper procedures on how to protect
          self and crew. This training will comply with and make use of the Agency Exposure Control Plan
          as maintained by the Captain or designated Coordinator.
       2. The Captain and Training Committee will jointly appoint instructors.
       3. This training will include, but is not limited to, the following:
                a.) OSHA Blood borne and Airborne Pathogens
                b.) Infection Control (Per OSHA-29 CFR 1910.1030)
                c.) Personal Protective Equipment
                d.) NIOSH / N95 Healthcare TB Respirator Fit-Testing and usage
                e.) Exposure Control Plan
                f.) TB Testing and Documentation
                g.) Hepatitis-B Vaccination or Refusal and Documentation
                h.) Facilities safety (including Office, PCF, Ambulance)
                i.) Safety during responses


Jovan E. Cruz, Captain                                                                           7
RPI Ambulance Standard Operating Procedures                                           February 13, 2012


              j.) Basic HAZMAT awareness training
              k.) RPI Ambulance does not require its members to undergo yearly physical examinations;
                  however, it asks all members to provide RPI Ambulance with a copy of or access to their
                  immunization records to insure the safety of all crews and patients.
       4. The instructor will generate documentation of yearly Health and Safety training and the
          administration will maintain this documentation in the person’s permanent file.




Jovan E. Cruz, Captain                                                                          8
RPI Ambulance Standard Operating Procedures                                               February 13, 2012



 SOP 12-03 OPERATIONAL MEMBER TYPES

                                           INTRODUCTION

In order to act as a volunteer for RPI Ambulance, the appropriate qualifications must be met and
maintained for the duration of involvement with RPI Ambulance.


                                MEMBERSHIP REQUIREMENTS

As stated in the Constitution, all members are required to renew membership by attending one general
meeting or providing written notice to the officer board. If a member fails to attend a general meeting or
provide written notice to the officer board, they will be removed from membership – all training previously
completed will be filed, and, upon any readmission to the agency, it will be the determination of the Captain
and Lieutenants as to accepting that member's previous training paperwork or requiring new training.


                                    ACTIVE - I MEMBERSHIP

Active -I members are the members of emergency crews who participate regularly in Agency functions and
regularly attend training drills and general meetings. An Active-I member meets the following
qualifications:
        1. Has submitted a membership form as outlined in SOP 12-02.
        2. Has completed the orientation program outlined in SOP 12-02.
        3. Has completed appropriate annual health and safety training and testing as outlined in SOP 12-
           02 and the agency’s Exposure Control Plan.
        4. Has attended all required training drills or been excused by the Captain or Training Committee.
        5. Has attended all required General Membership meetings or been excused by the Administration.
        6. Has staffed one night crew or special event in the last month.


                                   ACTIVE - II MEMBERSHIP

Active - II members are members who are unable to meet all of the qualifications set forth in Active - I
membership. Former members who visit infrequently and who are unable to regularly attend agency drills
and meetings should fall into this category. Only the Captain may change an Active - II member’s status to
Active – I. Conversely, it is the responsibility of the Captain to assure that any Active - I members who do
not meet all of the appropriate qualifications are changed to Active - II membership. An Active -II member
must meet the following qualifications:
        1. Has submitted a membership form as outlined in SOP 12-02.
        2. Has completed the orientation program outlined in SOP 12-02.
        3. Has completed appropriate annual health and safety training and testing as outlined in SOP 12-
            02.
        4. Has staffed one night crew or special event in the last semester.




Jovan E. Cruz, Captain                                                                              9
RPI Ambulance Standard Operating Procedures                                              February 13, 2012


                              ADMINISTRATIVE MEMBERSHIP

An Administrative Member has been accepted by the membership through the guidelines set forth in the
Agency Constitution, but does not ride actively as part of an EMS crew. There are no operational
qualifications to be an administrative member. In addition, any member that does not qualify for Active – I
and Active – II membership, shall default to Administrative Membership until such time that all paperwork
and training can be brought up to date. Administrative members do not have any Ambulance riding or
event privileges. An Administrative Member must meet the following qualifications:
        1. Has submitted a membership form as outlined in SOP 12-02.




Jovan E. Cruz, Captain                                                                           10
RPI Ambulance Standard Operating Procedures                                               February 13, 2012



   SOP 12-04 TRAINING AND PROMOTIONS

                                           INTRODUCTION

One of RPI Ambulance’s primary missions is to further the training of its members. Another is to provide
competent, professional medical care. This policy seeks to guarantee both.


                                              TRAINING

Training is to be regarded as a priority second only to patient care, and whenever possible, the two should
be integrated.


                                     TRAINING COMMITTEE

The Captain shall establish a training committee, made up of as many members as he sees fit. The
committee should ideally contain a driver trainer, a crew chief trainer and a senior duty supervisor. The
Captain may or may not serve on the committee. The Captain may not be the only member of the Training
Committee except with the express permission of both lieutenants.

Once established, removals and additions to the Training Committee must be approved by at least 50
percent of the committee as well as the Captain, or by the unanimous decision of the Captain and both
lieutenants.

Additionally, once established, the Training Committee must elect a chairperson who will be the face and
responsible party of the Training Committee; issues that need to be brought to the Training Committee or
issues arising from the committee should pass through this individual.

The Training Committee shall be responsible for overseeing all training curricula and shall also stand as the
promotional board, when necessary and applicable. Ideally, the committee should meet on a weekly basis,
and report back to the Captain fortnightly, or as frequently as necessary.


                                        BACK-UP TRAINING

A member who is considered a back-up in a position may act in that position provided there is a trainer for
that position on the crew. The trainer should make every attempt to be with the trainee during the course
of the call. Notable exceptions may include the transport to the hospital, where the trainer and trainee may
be separate briefly. A back up and a trainer satisfy the requirements for a crew.




Jovan E. Cruz, Captain                                                                            11
RPI Ambulance Standard Operating Procedures                                                  February 13, 2012


                                                TRAINERS

The individuals entrusted with the training of other individuals in the Agency shall maintain Active - I
membership status. These trainers will be experienced members credentialed within the agency for the
position they will train. For example, someone who is experienced enough to be a Driver Trainer may not
necessarily be a Crew Chief Trainer. Trainers are appointed by the Training Committee. Consideration of
appointees will not only consist of individuals’ qualifications within a specific area of credentialing, but also
of their ability to teach and train effectively.

For specific qualifications and promotion requirements, please see the appropriate sections:
       Crew Chief                             SOP 12-08, pg. 23
       Driver                                 SOP 12-07, pg. 18
       Attendant                              SOP 12-06, pg. 17
       Emergency Event Supervisor             See Special Event SOPs
        Duty Supervisor                       SOP 12-09, pg. 27

These requirements and qualifications are considered to be the minimum requirements for promotion. It is
often expected that members will do additional training and will be promoted when the Training
committee and Captain are satisfied that they hold the necessary skills required for the promotion. If there
are concerns about the performance of a promotion candidate the Training Committee is to work with the
individual to address the concerns.


                           PROMOTIONAL BOARDS: STRUCTURE

The Promotional Board is a vehicle used by members of RPI Ambulance to progress through the ranks of
the organization’s credentialing structure. The promotional board shall consist of:
       1. Training Committee
       2. Captain
The Promotional Board shall be chaired by the Training Committee Chairperson, except in the case of that
individuals promotion, when the Captain shall act as the Promotional Board Chair.

If the Captain or a member of the Training Committee is the candidate for promotion, their spot will be
back-filled from the hierarchical list. When composing the Promotional Board, the Training Committee will
make an effort to use the highest priority names, but will not make unreasonable concessions in scheduling
or timing of the Promotional Board in order to do so.

It is understandable that not every member of the promotional board will have been involved with all
aspects of a candidates training. Therefore, any member is invited to speak for or against the candidate at
the Promotional Board as this is a time for the promotional board to learn about a candidate’s skills and
competencies. Members may speak about any aspect of the candidate but it is the chair’s duty to ensure
that comments remain relevant. I.e. personal attacks should not be tolerated. During the voting section,
only the actual members of the promotional board may be present.

While the candidate is present, the Promotional Board should take the opportunity to ask relevant
questions of the candidate about his or her competency in the position applied for. Outlandish questions
and inappropriate attitudes are not acceptable.



Jovan E. Cruz, Captain                                                                                12
RPI Ambulance Standard Operating Procedures                                                February 13, 2012


                              PROMOTIONAL BOARDS: VOTING

After the chair has presented the candidate for promotion, and when there are no more questions for the
candidate, the candidate will be asked to leave the room. The candidate will comply.

The chair is the parliamentarian for the voting proceedings. Any and all discussion behind closed doors is
understood to be confidential and will not be discussed with anyone. After discussion is complete to the
satisfaction of the chair, the members of the Promotional Board will vote on the candidate.

Voting will not take place by secret ballot. At least two-thirds members of the Promotional Board must give
a “yes” vote of confidence for the candidate to pass and be credentialed in the position applied for. No
abstentions are acceptable. Members with a potential conflict of interest should not be on the promotional
board, and an alternate should be present as outlined above. Thus, a conflict of interest is not a valid excuse
for an abstention.

If the candidate passes the promotional vote, they will be called back into the room by the members of the
Promotional Board and advised by the Chairperson. If the candidate does not pass the promotional vote,
they will be called back into the room by the members of the Promotional Board and advised of such by the
Chairperson.

Any member who voted “no” should be prepared to outline what additional demonstration of competence
they would like to see before they would register a “yes” vote. This should be done both in writing and
verbally. The candidate shall have the right to ask for a clarification of requests. This is to give the
candidate a fair opportunity to improve in weak areas and become a more viable candidate for the next
promotional board that they petition.

Both promotion approvals and non-approvals will be logged in a “Promotional Board Log” that will contain
every attempt for promotion made by all members. This log will also contain dates of promotion to be used
for determining eligibility for promotion to trainer (i.e 4 months of in-service)




Jovan E. Cruz, Captain                                                                              13
RPI Ambulance Standard Operating Procedures                                               February 13, 2012



                          SOP 12-05 OBSERVER

                              FUNCTIONAL JOB DESCRIPTION

OBSERVER

       The Observer position is for members of any membership status or non-members who are
       interested in riding on an Ambulance Crew for observational and/or informational purposes. Non-
       members desiring to engage in a ride-a-long can be considered observers under this functional
       description. The observer need not have any qualifications, but must adhere to the following
       guidelines:
               1. Be briefed in RPI Ambulance SOPs, Patient Confidentiality, Risk Management, and
                   Infection Control/OSHA.
               2. The Observer will not engage in providing patient care of any kind.
               3. At the discretion of the Crew Chief, the Observer may be asked to sit in the cab
                  compartment while patient care is being extended.
               4. If the number of people on board the Ambulance becomes too large (with ALS providers,
                  multiple patients, family/friend of the patient, etc., the Observer may be left at the scene
                  by the Crew Chief. If this happens, every effort will be made to assure that someone can
                  bring the Observer to the destination to meet up with the Ambulance.
               5. The Observer will sign a form effective for a specified amount of time (to be indicated on
                  the form) agreeing to all of the above. In addition, the form shall indemnify and hold
                  harmless RPI Ambulance, Rensselaer Polytechnic Institute, and all of its members and
                  subsidiaries from any liability in the event of injury, illness, or death.


ORIENTATION MEMBER

       The Orientation Member shall be an Active - I or Active - II member who desires to ride on an
       Ambulance Crew for the purpose of gaining experience, training, or otherwise familiarizing oneself
       with the operations of RPI Ambulance. The Orientation Member:
              1. Shall assist in patient care as requested by the Crew Chief and will act only under the
                  direction of the Crew Chief.
              2. May be asked to sit in the cab compartment by the Crew Chief while patient care is being
                 extended.
              3. If the number of people on board the Ambulance becomes too large (with ALS providers,
                 multiple patients, family/friend of the patient, etc., the Orientation Member may be left at
                 the scene by the Crew Chief. If this happens, every effort will be made to assure that
                 someone can bring the Orientation Member to the destination to meet up with the
                 Ambulance.




Jovan E. Cruz, Captain                                                                             14
RPI Ambulance Standard Operating Procedures                                           February 13, 2012


                                             TRAINING

AMBULANCE ORIENTATION MEMBER

As this is an entry-level position, there is no formal requirement and no training needed except for that
which is required to become a member of RPI Ambulance as stated in SOPs 12-02 and 12-03. This is meant
to be an temporary position. The goal of all orientation members is to become an Ambulance Attendant. It
is expected that Orientation members begin Attendant training before their third night crew.

                                           PREREQUISITES

   1. None

                                           REQUIREMENTS

   1. Must maintain Active - I or Active - II membership in RPI Ambulance.




Jovan E. Cruz, Captain                                                                        15
RPI Ambulance Standard Operating Procedures                                                February 13, 2012



        SOP 12-06 AMBULANCE ATTENDANT

                              FUNCTIONAL JOB DESCRIPTION

The Ambulance Attendant shall be an Active - I or Active - II member who rides on an Ambulance Crew for
the purpose of assisting the Crew Chief with patient care as well as for the purpose of gaining further
experience and training in EMS The Ambulance Attendant shall:
       1. Hold current certification in American Heart Association Healthcare Provider CPR.
       2. Be familiar with the location, use, and function of all medical equipment on board the Ambulance
       3. Possess a working knowledge of RPI Ambulance Operation Policies.
       4. Be familiar with safe techniques for lifting and moving of patients using common equipment.
       5. Pass a training course (to include the above) as prescribed by the Training Committee.
       6. Be approved by the Training Committee and Captain for promotion


                                               TRAINING

The Ambulance Attendant trainee will begin their formal training with a class provided by RPI Ambulance
that will cover the basics and requirements. The Ambulance Attendant should also practice their skills and
knowledge when they are on a crew, with the help and guidance of the Crew Chief in order to increase the
knowledge of the trainee and to build Crew Chief’s confidence in the trainee. The trainee is also
encouraged to attend as many training drills as possible as they are a good source of knowledge and
additional training.



                                             PREREQUISITES

       1. None

                                               PROMOTION

       1. Be CPR for Professional Rescuer certified.
       2. Attend an RPI Ambulance Attendant training class to include:
               a.) Call Dynamics
               b.) Standard Operating Procedures
               c.) In house first aid
               d.) Equipment orientation
       3. Complete the attendant checklist.
       4. Complete the ambulance equipment checklist.
       5. Actively participate in at least one (1) call and receive a passing evaluation from the CC.
       6. Receive a recommendation for promotion from a Crew Chief.




Jovan E. Cruz, Captain                                                                              16
RPI Ambulance Standard Operating Procedures                                               February 13, 2012



    SOP 12-07 EMERGENCY VEHICLE
OPERATOR ROLES AND RESPONSIBILITIES

                                FUNCTION JOB DESCRIPTION

The E.V.O., also known as the Driver, is the person responsible for transporting the patient and crew as
necessary on an EMS or transportation call. The Driver’s responsibilities are outlined in SOP 12-07. The
Emergency Vehicle Operator will meet the following qualifications:
    Must maintain Active - I membership in RPI Ambulance.
    Must possess a NYS Class D License or equivalent.
    Must be credentialed as an Ambulance Attendant for RPI Ambulance and maintain appropriate CPR
       certification.
    Must complete the following FEMA sponsored classes IC-800: National Response Framework, IS-
       700 National Incident Management System (NIMS), ICS 100: Introduction to ICS, and ICS 200: Basic
       ICS.
    Must be trained in safe operation of the ambulance as outlined in SOP 12-07 and 12-06
    Must pass a promotional board as set forth by SOP 12-04 and SOP 12-07.


                                          INTRODUCTION

The driver of the ambulance holds a critical position in the care and treatment of the patient. It is the
driver’s responsibility and obligation to deliver the crew and ambulance to the scene in a safe manner, to
facilitate transport of the patient into the ambulance, to transport the patient and crew while maintaining a
suitable working platform for effective patient care, and to return the crew to quarters or to another
suitable drop off point in a safe and professional manner. The ambulance is a moving advertisement for RPI
Ambulance, Rensselaer Polytechnic Institute, and the entire RPI community. The manner in which the
ambulance is driven and the impression it conveys are the primary contact the majority of the public has
with our agency.


                                            DEFINITIONS

Priority 2 - Ambulance operation using no emergency lights or sirens, following all V&T laws. Synonyms:
Routine, Code 2, Cold.

Priority 1 - Ambulance operation using emergency lights and siren. Synonyms: Emergency, Code 3, Hot.

NB: The driver has responsibility and liability for safe operation and must maintain compliance with RPI
Ambulance driving procedures. The driver is personally liable for any injury or damage sustained during
Priority 1 operation.




Jovan E. Cruz, Captain                                                                            17
RPI Ambulance Standard Operating Procedures                                                 February 13, 2012


                                    DRIVER QUALIFICATIONS

Any individual who drives the ambulance must be properly credentialed as an RPI Ambulance Emergency
Vehicle Operator (a.k.a. driver) or must be a valid driver trainee with a driver trainer present, as described
in SOP 12-07.


                              GENERAL DRIVING PROCEDURES

During all travel of the ambulance, including, but not limited to, travel to dinner or a class meeting, Priority
2 operation or Priority 1 operations, the driver will adhere to the following rules:

        1. A spotter must be used at all times whenever backing the ambulance.
        2. Anyone sitting in any compartment of the ambulance must wear a seat belt anytime the vehicle is
           in motion or in traffic. During patient care, providers in the rear compartment may remove their
           seatbelts if required.
        3. Any non-member passengers should ride in the front compartment of the ambulance and wear
           their seat belt at all times when the vehicle is in motion. In cases of pediatric patients or other
           special cases where the passenger calms or soothes the patient, the passenger may ride with the
           patient but must still wear their seat belt
        4. Headlights are to be used at any time the ambulance is in motion.
        5. Respond to all emergency calls Priority 1 except when downgraded by the Crew Chief. (See SOP
           12-15)
        6. When dispatched to a standby, always respond in Priority 2 mode.; with the exception of Fire
           Standbys which shall be treated as Priority 1.
        7. Return from the hospital in Priority 2 mode.
        8. Transport from the scene to the hospital at the response level designated by the Crew Chief.
        9. Leave the ambulance engine running at all times during a call until arrival at the hospital
        10. Upon arrival at the hospital, shut down the engine prior to unloading the patient.


                            EMERGENCY DRIVING PROCEDURES

During Emergency procedures, the driver will adhere to the following rules in addition to the above and to
NYS Vehicle & Traffic laws:
       1. A complete stop is mandatory before proceeding with caution at all red lights, stop signs, and
           railroad crossings, regardless of response level.
       2. If using the median, turning lane, or a lane of opposing traffic to enter an intersection, come to a
           complete stop before proceeding with caution.
       3. Come to a complete stop at all times for any school bus either in the same lane or in the opposing
           lane with flashing red lights displayed.
       4. Do not exceed posted speed limit by more than ten (10) miles per hour at any time.
       5. Do not exceed posted speed limit at any time when passing through an intersection with the
           green light.
       6. When traveling in a lane of traffic in an opposing direction, do not exceed 20 mph.
       7. Leave warning lights (no less than secondary lights) on if the ambulance is stopped on or at the
           edge of a roadway, or if the ambulance will interfere with traffic, or at any time that the warning
           lights will increase scene safety for EMS personnel.


Jovan E. Cruz, Captain                                                                               18
RPI Ambulance Standard Operating Procedures                                                February 13, 2012


                                          DRIVER’S DUTIES

1. Duties During a Scheduled Duty Crew:
        a) Complete an RPI Ambulance Vehicle/Mechanical Checklist once per shift.
        b) Notify the Duty Supervisor of any problems or discrepancies. (RPI Ambulance Standard
           Operating Procedures 30 May 2011)
        c) If possible, and if the Crew Chief consents, familiarize self and crew with areas of our Primary
           Territory and response areas.
        d) Drive crew where they need to go in a safe manner

2. Duties During a Call:
        a) Be sure that the ambulance is clear of personnel and other obstructions or dangers, and that all
            exterior doors are closed before getting into the driver’s seat.
        b) Verify that all ambulance personnel are in secure positions before moving the ambulance.
        c) Upon starting the ambulance verify that all gauges and operation indicators are within nominal
            ranges, especially fuel level and oil pressure.
        d) Drive to the scene in a safe and efficient manner at an appropriate level of response.
        e) Park at the scene in a position to provide optimal access to the patient while maintaining scene
            safety.
        f) Leave the vehicle running at all times while on scene.
        g) Assist the Crew Chief in providing care on scene as needed.
        h) Upon arrival at the hospital, turn off the ambulance and assist the crew in unloading the patient
            from the patient compartment.
        i) Assist the crew in transferring the patient to the hospital bed.

3. While at the hospital, the following driver’s duties are to be done in the following order, highest priority
   first:
         a) After the patient is unloaded, return to the ambulance and shut off any nonessential items.
             (especially A/C, heat)
         b) Clean and disinfect the ambulance as appropriate per the RPI Ambulance Exposure Control Plan.
         c) Get the stretcher ready for service
         d) Make sure the ambulance is still within Part 800 equipment parameters.
         e) Contact Rensselaer County Dispatcher by phone to obtain run times and number as needed by
             the crew chief
         f) Assist the Crew Chief if requested.


                                               SPOTTERS

To reiterate the previously stated policy, whenever the ambulance is in reverse, all drivers must use a
spotter in order to maintain a safe service and a professional looking ambulance.

To properly spot the vehicle when it is backing up, the spotter should stand approximately 10 feet behind
the ambulance on the driver’s side. The driver should be able to see the spotter at all times and must stop if
the spotter moves to a position where they cannot be seen. Conversely, the spotter should be able to see
the driver’s mirror at all times as well.




Jovan E. Cruz, Captain                                                                              19
RPI Ambulance Standard Operating Procedures                                                 February 13, 2012


The spotter should look out for obstacles and indicate that it is safe to continue in reverse with a left-
handed “come here” motion, palm facing the spotter. To indicate that it is unsafe to continue or that there is
an obstacle in the path of the vehicle, the spotter should make a fist with his or her left hand with the palm
side facing the driver.

There are situations where using an external spotter is impossible. These situations are:
       1. When backing into the hospital ER (Emergency Room)
       2. During the reverse phase of the cone course.

In these two circumstances only, it is permissible for a vehicle occupant in the patient compartment (i.e. the
Crew Chief on a call, or the observing trainee in the cone course) to go to the tailgate end of the crew bench
and look out the back windows the entire time the vehicle is in reverse to be on the lookout for any
obstacles, pedestrians, or other items that would present a hazard to the ambulance.


                                          BACK-UP ALARM

Use common sense when using the back-up alarm. When backing without an external spotter, it must be
used. However, if an external spotter is used, and a loud alarm is not advisable (e.g. backing up near
residences late at night, backing up at the garage after dark, etc.,) the Back-up alarm may be temporarily
deactivated. Unless scene safety considerations prohibit its use, the Back-Up alarm should be used on all
emergency scenes.


                                           TRAVEL LIMITS

It is the driver’s duty to ensure a speedy response to any incident on campus. As such, the driver will be
responsible for assuring the Ambulance is never too far from campus to respond in a safe and efficient
manner. As a minimum, the following boundaries should never be crossed, except on a properly
dispatched mutual aid call:
         North: An east-west line even with TFD. Station 1 (115th St)
         East: A north-south line even with McDonald’s restaurant on Hoosick St.
         South: An east-west line even with TFD. Station 6 (Canal Ave)
         West: The Hudson River
It is also recommended that unless there is a specific reason for travel to the above limits, such as food or
training, the ambulance should remain as much as possible in the area immediately around the campus.
This, however, is left to the discretion of the driver so long as he or she can ensure a safe and efficient
response.


                                          WINTER DRIVING

Before drivers (trainees, back-up or full) are permitted to drive under winter conditions, they must gain the
approval of a driver trainer. Driver Trainers will take the trainee on snow/ice covered roads where there
are little to no hazards and must demonstrate appropriate safe operation in those conditions. The purpose
of this training is to demonstrate the difference in handling of the vehicle in winter conditions including but
not limited to: braking distance, up and down hill operation, traction, maneuverability and visibility.


Jovan E. Cruz, Captain                                                                              20
RPI Ambulance Standard Operating Procedures                                             February 13, 2012


                                             TRAINING

BACK-UP DRIVER

The Driver trainee will begin their formal training with a class provided by RPI Ambulance that will cover
the basics of what is required.

                                            PREREQUISITES

       1. Trainee must be an RPI Ambulance Attendant.

                                            REQUIREMENTS

       1. Must possess a NYS Class D License or equivalent.
       2. Attend an RPI Ambulance E.M.V.O training class to include:
               a) Call Dynamics
               b) Standard Operating Procedures
               c) Applicable Laws
               d) Basic Practical Orientation
       3. Complete Driver Check Sheet and Vehicle Maintenance Sheet
       4. Successfully pass Driver Practical Exam
       5. Successfully pass the cone course prescribed by the 1st Lieutenant
       4. Complete 10 hours of driver training as a third person with a qualified driver trainer and submit
          driver evaluation sheet to the Training Committee or the Captain which will be kept on file.
       5. Drive (2) two non-priority calls and receive passing evaluations from a trainer
       6. Drive (2) priority calls and receive passing evaluations from a trainer
       5. Receive recommendation to become a Back-up Driver from Trainer
       6. Receive joint approval of the Captain and Training Committee



DRIVER

                                            PREREQUISITES

       1. Must be a Back-up Driver

                                            REQUIREMENTS

       1. Complete and Pass one (or more) of the following emergency vehicle operator courses, with
          documentation kept on file by the 1st lieutenant Committee:
               a) Coaching the Emergency Vehicle Operator (CEVO) Ambulance
               b) Emergency Vehicle Operator Course (EVOC)
               c) In House – Emergency Vehicle Defensive Driving (EVDD)
       2. Must complete the following FEMA sponsored classes:
               a) IS-800: National Response Framework



Jovan E. Cruz, Captain                                                                          21
RPI Ambulance Standard Operating Procedures                                            February 13, 2012


               b) IS-700 National Incident Management System (NIMS)
               c) IS 100: Introduction to ICS
               d) IS 200: Basic ICS
       3. Complete a driving tour of the Albany area hospitals with a trainer, using the ambulance utility
       vehicle
       4. Drive (2) calls as a Backup Driver and receive passing evaluations from a Trainer.
       4. Receive recommendation for promotion to become a Full Driver by Trainer.
       5. Receive approval by the Promotional Board


DRIVER TRAINER

                                           PREREQUISITES

       1. Must be an RPI Ambulance Driver

                                           REQUIREMENTS

       1. Be a Driver for 4 months while the ambulance is in service
       2. Drive 3 emergency or non-emergency calls
       3. Assist in teaching a driver class or EVDD
       4. Request to become a trainer
       5. Receive joint approval of the Training Committee and the Captain




Jovan E. Cruz, Captain                                                                         22
RPI Ambulance Standard Operating Procedures                                             February 13, 2012



                         SOP 12-08 CREW CHIEF

                                FUNCTION JOB DESCRIPTION

The Crew Chief is the supervisor of the Ambulance Crew in Medical Protocol and Agency Procedure. The
Crew Chief’s responsibilities are outlined in SOP 12-08. The Ambulance Crew Chief will meet the following
qualifications:
        1. Must maintain Active - I membership as an RPI Ambulance member or Active II with approval of
           Captain.
        2. Must maintain current certification by the New York State Department of Health, Bureau of
           Emergency Medical Services, as an Emergency Medical Technician or higher. Certification from
           any other state alone is not acceptable.
        3. Must maintain current AHA Healthcare Provider CPR or equivalent.
        4. Must meet all criteria for Ambulance Attendant as listed above in SOP 12-06
        5. Must complete the following FEMA sponsored classes IS-800: National Response Framework, IS-
           700 National Incident Management System (NIMS), IS 100: Introduction to IS, and IS 200: Basic
           ICS.
        6. Must pass the Ambulance Crew Chief course as set forth by the Training Committee and Captain.
        7. Must pass a promotional board as set forth by SOP 12-04 and SOP 12-08.


                                         INTRODUCTION

The Crew Chief is the leader of the Ambulance Crew. The New York State Department of Health mandates
that there must be at least one current NYS EMT providing patient care in the patient compartment of the
ambulance in accordance to NYS BLS protocols. The RPI Ambulance Crew Chief has been trained not only
in Basic Life Support treatment of emergency patients, but also in how to appropriately handle situations
that may arise
during any phase of operations. This includes, but is not limited to: dealing with problematic patients,
decision-making, MCI’s, and interacting with other agencies. The Crew Chief is directly responsible for the
conduct and appearance of the Ambulance Crew. All members of the Ambulance Crew should feel
comfortable communicating any questions they may have to the Crew Chief. The Crew Chief may not
necessarily be the highest medical authority on scene, but at RPI Ambulance, the Crew Chief is procedurally
in charge.


                                         QUALIFICATIONS

Any individual who acts in the capacity of Crew Chief must be properly credentialed as an RPI Ambulance
Crew Chief or must be a valid Crew Chief Trainee with a Crew Chief Trainer present. As such, any person
acting as the Crew Chief must meet the qualifications as set forth in SOP 12-08.




Jovan E. Cruz, Captain                                                                          23
RPI Ambulance Standard Operating Procedures                                               February 13, 2012


                                    GENERAL PROCEDURES

       1. If the Crew Chief does not feel comfortable with a situation, a member, or is uncertain how to
          handle a predicament, they should contact the Duty Supervisor.
       2. If a disagreement between RPI Ambulance and an ALS provider exists, the Crew Chief will put
          aside any personal or agency differences and make decisions based in the best interest of the
          patient.
       3. If a disagreement between RPI Ambulance and another EMS agency, dispatch center, Public
          Safety Authority, or other official exists, the Crew Chief will not act on behalf of the agency in
          solving the problem but rather will act in the best interest of the patient. The Crew Chief will
          also immediately notify the Duty Supervisor, who will evaluate the situation and decide how best
          to handle it.
       4. Maintain communications with any/all appropriate dispatch center(s) throughout operations,
          either alone or by designating another crewmember. The Crew Chief is responsible for all of
          these radio communications, though another member may use the radio with the express
          consent of the Crew Chief.
       5. Maintain control of the Ambulance Cellular Phone. No member may use the phone without the
          permission of the Crew Chief.


                                     CREW CHIEF’S DUTIES

       1. Duties during a scheduled Duty Crew:
               a) Make sure that an Ambulance Equipment Checklist is completed by the Crew.
               b) Report any discrepancies or problems to the Duty Supervisor.
               c) Make sure that any vacancies on the crew are filled to assure that all members who want
                   to ride crews are able to do so in a timely manner.
               d) If possible, provide training opportunities for the rest of the Crew.
               e) Maintain Crew morale and try to accommodate the wishes of the Crew.
               f) If a Crew member needs to study while on a duty crew, this will take precedence over
                   driving around and other endeavors. We are students first.
       2. Duties During a Call:
               a) Confirm that there is a crew, and if in 24-Hour Service (i.e. no Duty Crew scheduled), try
                   to include trainees on the call.
               b) Advise the Emergency Vehicle Operator of the appropriate level of response to the scene
                   if different from the standard.
               c) During travel to the scene, plan ahead for any equipment or additional resources (e.g. fire
                   apparatus, Hazmat Unit, additional Ambulances) that may be needed.
               d) Upon arrival, notify appropriate dispatcher(s).
               e) Try to maintain set of response times on a separate sheet.
               f) Prior to egress from the vehicle to the scene, the Crew Chief will assess the scene for
                   safety and advise the Ambulance Crew of how to appropriately protect themselves from
                   any hazards that may be present. The Crew Chief is responsible for the safety of the crew
                   at all times.
               g) The Crew Chief will be in charge of all patient care and will act as the interface between
                   the RPI Ambulance Crew and a provider of a higher level of care.




Jovan E. Cruz, Captain                                                                            24
RPI Ambulance Standard Operating Procedures                                                   February 13, 2012


               h) The Crew Chief will attempt to allow other members to train in positions they are
                   attempting to gain RPI Ambulance credentialing in (e.g. Crew Chief, Attendant) within
                   their level of credentialing (i.e. if the Crew Chief is also a Crew Chief Trainer).
               i) Provide BLS care at the level that RPI Ambulance is certified to provide.
               j) Select the appropriate patient carrying device and use it to bring the patient to the
                   ambulance.
               k) Transport to a Hospital Emergency Department within a reasonable area. The patient
                   has final choice, but the crew chief should make every attempt to convince the patient to
                   go to a local hospital. Take into consideration the geographic ability to get back in
                   service for the next call. The appropriate hospital Emergency Departments are:
                         i.        Samaritan Hospital ER
                         ii.       Saint Mary’s Hospital ER
                         iii.      Ellis Hospital ER
                         iv.       St. Clare’s Hospital ER
                         v.        Albany Medical Center Hospital ER
                         vi.       Saint Peter’s Hospital ER
                         vii.      Albany Memorial Hospital ER
                         viii.     Stratton VA Medical Center ER
               l) If the hospital requests a diversion, attempt to comply as best as possible:
                         i. Explain to the patient the nature of the change and ask if they have another
                              preference.
                         ii. Select next closest hospital if possible.
                         iii. If patient is critical and next hospital is too far, consider continuing to the same
                              hospital
                         iv. Patient transportation during a diversion must follow SOP 12-25
               m) While en route to the medical facility, provide medical care as appropriate.
               n) Use the Ambulance VHF Radio to contact the Emergency Department with the following
                   information:
                         i. Age and gender
                         ii. Chief complaint
                         iii. History of chief complaint
                         iv. Pertinent past medical history and medications
                         v. Pertinent vital signs
                         vi. Treatment rendered by this agency and others (i.e. Oxygen by RPI, Signal 600 by
                              TFD)
                         vii. Estimated time to arrival
               o) Upon arrival at the medical facility, shut down any nonessential ambulance items. (E.g.
                   dome lights, heat or A/C, vent, etc.
               p) Give a report to the appropriate staff member.
               q) If at a hospital ER, assist the registration clerk in obtaining patient information and try to
                   get a face sheet.
               r) Complete paperwork, obtain times and numbers, and notify appropriate dispatch
                   center(s) that we are available for the next call, using the telephone at the medical
                   facility.
               s) Verify that the Driver has prepared the ambulance for the next call.
               t) Leave the medical facility in a reasonable amount of time and return to service as
                   appropriate.



Jovan E. Cruz, Captain                                                                                25
RPI Ambulance Standard Operating Procedures                                                February 13, 2012


                                               TRAINING

The position of Ambulance Crew Chief is the highest credentialed position in the Ambulance Crew.
Becoming an Ambulance Crew Chief involves not only medical proficiency, but also thorough knowledge of
all Operating Policies and an ability to lead the crew effectively. The Crew Chief Trainee should, while
training, act in the capacity of Crew Chief to the best of his or her ability. The training period is a time to
gain experience with a trained Crew Chief on board. The Crew Chief Trainee is encouraged to attend as
many drills as possible as they are a good source of knowledge and training.



BACK-UP CREW CHIEF

                                              PREREQUISITES

       1. Trainee must be an RPI Ambulance Attendant.
       2. Host current certification as a NYS EMT-Basic or higher
       3. Maintain active CPR for Healthcare Provider certification

                                              REQUIREMENTS

       1. Attend an RPI Ambulance Crew Chief training class to include:
               a) Call Dynamics
               b) Standard Operating Procedures
               c) PCR writing
               d) Crew Chief 1 simulated call
       2. Complete PCR writing class
       3. Complete Crew Chief checklist
       4. Complete 1 mock call w/ passing evaluation from CC Trainer before Crew Chief a real call.
       5. Crew Chief 2 calls with a crew chief trainer in the patient compartment and receive passing
          evaluations for both.
       6. Pass the practical exam, including PCR writing
       7. Receive recommendation for promotion by Crew Chief Trainer
       8. Receive joint approval of the Captain and Training Committee


CREW CHIEF

                                              PREREQUISITES

       1. Must be a Back-up Crew Chief

                                              REQUIREMENTS

       1. Must Crew Chief 2 calls as a Back-up Crew Chief, receive a passing evaluation and be
          recommended for promotion by a Crew Chief Trainer.
       2. Must complete the following FEMA sponsored classes:



Jovan E. Cruz, Captain                                                                              26
RPI Ambulance Standard Operating Procedures                                          February 13, 2012


               a) IS-800: National Response Framework
               b) IS-700 National Incident Management System (NIMS)
               c) IS 100: Introduction to ICS
               d) IS 200: Basic ICS
       3. Must student-teach one training course or drill and submit an evaluation form
               a) This training drill must be approved and supervised by the training committee
               b) The purpose of this course is to demonstrate proper training skills while teaching an
                   advance topic to other members of the agency.
       4. Receive recommendation for promotion from a Trainer.
       5. Receive approval by the Promotional Board



CREW CHIEF TRAINER

                                            PREREQUISITES

       1. Must be an RPI Ambulance Crew Chief

                                            REQUIREMENTS

       1. Be a Crew Chief for 4 months while the ambulance is in service
       2. Crew Chief 3 emergency or non-emergency calls
       3. Assist in teaching a Crew Chief class
       4. Request to become a trainer
       5. Receive joint approval of the Training committee and Captain




Jovan E. Cruz, Captain                                                                       27
RPI Ambulance Standard Operating Procedures                                                  February 13, 2012



                         SOP 12-09 SUPERVISORS

                                            INTRODUCTION

In the EMS field, many problems exist, from operations to interpersonal conflict. The position of Supervisor
is created to provide easy access to an experienced member who can act in the capacity of Crew Chief or
Driver if the need arises. The Supervisor also acts as a screen to the Captain so that matters that can be
resolved by the Supervisor don’t need to unduly tie up the Captain. The position of Supervisor is not a
Credentialed Promotion, and as such, it does not fall under the auspices of Training Committee.


                                           QUALIFICATIONS

The Supervisor Shall:
       1. Be currently credentialed as a Crew Chief Trainer, Driver Trainer, and Event Supervisor by RPI
          Ambulance
       2. Maintain at least 70% compliance in agency QI as a Crew Chief.
       3. Have completed an interview with the Captain testing the knowledge of RPI Ambulance
          operations, Standard Operating Policies, Mutual Aid, and the geography of Rensselaer County
          and Surrounding Areas.
       4. Be appointed by the Captain with input from other Line Officers and other Supervisors after the
          successful completion of the aforementioned interview.


                                                  DUTIES

All Supervisors:
        1. Will act as the scheduled Duty Supervisor for at least 24 hours per week.
        2. Must remain within radio range of both RPI Public Safety, Rensselaer County Dispatcher, and the
           Ambulance, and will be able to establish communication to the Ambulance Crew via the
           Ambulance Cellular Phone during their on duty time.
        3. Must carry appropriate Supervisor Identification while on duty.
        4. Should notify the appropriate officer in the proper time, if the Supervisor notices anything that
           requires attention from that officer. For example, the Captain and 1st Lieutenant need to know
           right away that the Ambulance has a flat tire, whereas the Training Committee could probably be
           notified in the morning if one of the CPR manikins is broken.
        5. Will act in an appropriate manner at all times while acting on behalf of RPI Ambulance.
        6. Will not take over care of a patient, driving responsibilities, or any other duties of the crew unless
           patient or crew safety is in jeopardy.
        7. Will file incident reports as necessary to maintain proper documentation of incidents.
        8. The On-Duty supervisor is expected to assist the responding ambulance in the following
           situations
              1. MCI- Any incident that involves more than 2 patients or in which there are patients in
                   excess of the available resource.
              2. Any rescue incident that would involve a crew being on scene an anticipated time
                   exceeding 20 minutes.


Jovan E. Cruz, Captain                                                                                28
RPI Ambulance Standard Operating Procedures                                              February 13, 2012


             3. Any incident where crowd control may cause an issue to the responding units. This
                includes but is not limited to fraternity houses and large events.
             4. Any incident where ALS is requested, where an ALS unit is not available for immediate
                response.


                                            GRIEVANCES

Any grievance with a Supervisor or the actions of a Supervisor will be forwarded as soon as possible, to the
Captain, who will investigate the matter fully. If an individual does not feel comfortable approaching the
Captain, another Supervisor may be notified of the grievance or the member may contact the Grievance
Committee of RPI Ambulance. Care should be taken to avoid a rumor mill when dealing with such
grievances as matters can quickly be blown out of proportion. Always try to use the proper communication
channels.

If the Captain feels that the grievance has merit, the Captain will attempt to mediate any dispute between
the involved parties. If one or both parties are unsatisfied with this approach, the matter will follow SOP
12-22 for grievances and appeals.




Jovan E. Cruz, Captain                                                                           29
RPI Ambulance Standard Operating Procedures                                              February 13, 2012



                            SOP 12-10 CONDUCT

                                          INTRODUCTION

Our conduct and appearance are a very important part of patient care and the image that we extend to the
RPI Community, as well as to the community at large. Poor professional conduct has a negative impact on
patient care and erodes the relationships we have with the community and health care teams. While this
policy statement deals with some specific issues relating to Pre-hospital Emergency Care, conduct should
always be governed by treating all people in a manner in which one would want to be treated in any given
circumstance and reflects positively on the entire organization.


                                 PATIENT CONFIDENTIAL ITY

All information regarding patient contact is confidential in nature, and not a matter of public record. All
requests for information regarding patient contacts or member information must be referred to the
Captain. All information is protected in accordance with the Health Insurance Privacy and Portability Act
(HIPPA). While medical personnel will frequently discuss cases as a learning or Quality Improvement tool,
it must be realized that this information must not be discussed outside the Agency. In no case, including
learning or Quality Improvement, should the patients name or personal information be used.


                                              WEAPONS

Under no circumstances is any member of RPI Ambulance allowed or authorized to carry a weapon. EMS
Personnel are allowed to carry a small-sized folding knife to facilitate rescue and not be used as a weapon.
If a scene is not secure or safe, the crew should not enter and should wait for a Public Safety Agency to
render the scene safe. The Crew Chief should make appropriate notifications if a Public Safety Agency has
not already been dispatched to the scene.


                                               SMOKING

The Surgeon General of the United States has recognized smoking as a health hazard. Accordingly, it is a
danger to the health of patients and co-workers. In addition, RPI Ambulance carries oxygen, which will
accelerate burning and it is therefore a hazard to have any open flame in or near the ambulance. Therefore,
smoking is not permitted in any RPI Ambulance vehicle or any of its associated facilities.

Additionally, as of 1 July 2010, Rensselaer has become a tobacco-free institution, thereby banning use of an
tobacco products anywhere on the campus.


          ALCOHOL, CONTROLLED SUBSTANCES, AND MEDICATIONS

Alcoholic beverages or other controlled substances are not allowed under any circumstances within the
RPI Ambulance building, the Primary Care Facility, any Field station post, or any RPI Ambulance vehicle.


Jovan E. Cruz, Captain                                                                           30
RPI Ambulance Standard Operating Procedures                                                February 13, 2012


Consumption of alcohol by any member is prohibited while in any uniform part, agency apparel and/or
eight (8) hours prior to being on duty. Agency apparel includes RPI Ambulance off-duty wear, uniform, any
item of clothing with the words “RPI Ambulance”, an RPI Ambulance patch or logo on it, or the like.

Under no circumstances is a member allowed to attend a call while their abilities are impaired or their
judgment diminished by any cause, including but not limited to: alcohol, drugs, medication, or lack of sleep.

No person shall be permitted to ride in any agency vehicle while under the influence of alcohol or
intoxicating substances unless they are the patient.

Any member who acts in an official capacity while perceived to be under the influence of a drug, including
alcohol, will be relieved of their duties by the Crew Chief or Supervisor and suspended from Active - I and
Active - II membership until the incident is reviewed by the Captain and Executive Committee.

Any member who is found in possession of alcoholic beverages or other controlled substances on RPI
Ambulance property, including but not limited to RPI Ambulance vehicles, buildings and offices or who is
found to store or provide any alcoholic beverages or other controlled substances to others on RPI
Ambulance property will be relieved of their duties by the Crew Chief or Supervisor and suspended from
Active – I and Active – II membership until the incident is reviewed by the President, the Captain and the
Executive Committee. The committee may temporarily or permanently relieve the member from his or
her Crew Chief, Driver and/or Officer duties. In case an officer is temporarily relieved of his/her duties, the
President will appoint a temporary administrative officer or the Captain will appoint a temporary line
officer until the original officer is allowed to resume his duties in accordance with the Executive Committee
decision. If an officer is permanently relieved of his/her duties, the President will appoint a temporary
administrative officer or the Captain will appoint a temporary line officer until the next General Meeting at
which time a new officer may be elected by the general membership. If the President or the Captain is
temporarily or permanently relieved of his/her duties, the Vice-President or 1st Lieutenant, respectively,
will take over the open position until the original officer is allowed to resume his/her responsibilities or
until the election of the new officer by the membership at the next general meeting.


                                                VISITORS

All guest(s) are the responsibility of the member who invited them to the agency. Guests are expected to
adhere to the rules and regulations of the institute and the RPI Ambulance SOPs. All guests must be
accompanied by an RPI Ambulance member while in any RPI Ambulance Facility including but not limited
to crew quarters, patient care facilities and garage. The member who is acting as host is responsible for the
conduct of his/her guest. Inappropriate guest conduct may result in disciplinary action against the host. A
member or guest may lose privilege of visitation if, in the opinion of the on-duty supervisor or officer,
visitation becomes a detriment to the ability to carry out normal operations or introduces a threat to
agency personnel or property.




Jovan E. Cruz, Captain                                                                              31
RPI Ambulance Standard Operating Procedures                                              February 13, 2012



      SOP 12-11 SEXUAL HARASSMENT AND
             NONDISCRIMINATION

                                     SEXUAL HARASSMENT

RPI Ambulance strives to achieve excellence through its members. As such, RPI Ambulance prohibits sexual
harassment of any type and adheres strictly to the Sexual Harassment Policy as listed in the Rensselaer
Handbook of Student Rights and Responsibilities.


                                      NONDISCRIMINATION

RPI Ambulance adheres to the nondiscrimination policy of Rensselaer Polytechnic Institute. RPI Ambulance
admits qualified individuals to its membership without regard to gender, sexual orientation, marital status,
age, race, color, religion, national or ethnic origin, or disability.


                                             VIOLATIONS

Any discrepancies in adherence to this policy should be brought to the Captain, who will inform the
appropriate parties within the Rensselaer Polytechnic Institute community.




Jovan E. Cruz, Captain                                                                           32
RPI Ambulance Standard Operating Procedures                                             February 13, 2012



            SOP 12-12 INFECTIOUS DISEASE
            EXPOSURE AND ON DUTY INJURY

                                          INTRODUCTION

In order to minimize the risk of infectious disease exposure, all members must employ universal
precautions and proper PPE/BSI in compliance with the agency’s Exposure Control Plan. Refer to the
Exposure Control Plan for specific details.


                                             PRACTICES

In accordance with OSHA regulations, RPI Ambulance created and maintains an Exposure Control Plan
designed to minimize the occurrence of on-duty exposure. The policies set forth in the plan should be
adhered to whenever patient care is being extended. The major requirements are summarized here for
clarity:
         1. Always wear gloves when extending patient care.
         2. When the gloves are soiled, replace them.
         3. Always wash hands after providing care.


                              ON-DUTY INJURY OR EXPOSURE

In the event of an On-Duty Injury or Exposure:
        1. Immediately notify the Duty Supervisor, who will notify the Captain.
        2. Obtain appropriate medical care, and with the assistance of the Duty Supervisor or Captain, fill
            out a “Report of Medical Treatment” form.
        3. Any and all on duty injuries and exposures should be evaluated at a medical facility. If the RPI
            Student Health Center is closed, do not hesitate to seek medical treatment at an ER as soon as
            possible.
        4. Appropriate records of any treatment shall be obtained and maintained by the Captain in a
            confidential manner.
        5. With the Agency’s Medical Director, the Captain will investigate the injury/exposure to
            determine the following:
               a) If RPI Ambulance policy was followed, and if failure to follow policy was the cause of
                  injury/exposure
               b) If appropriate infection control precautions/personal protective equipment were used
                  while providing patient care
               c) Assuming appropriate PPE/BSI was used, if PPE/BSI was used inappropriately or if
                  PPE/BSI failed
               d) Methods to prevent such an exposure or injury in the future.
        6. Copies of these reports will be kept in the member’s confidential personnel file.




Jovan E. Cruz, Captain                                                                          33
RPI Ambulance Standard Operating Procedures                                            February 13, 2012



     SOP 12-13 AMBULANCE/EQUIPMENT
   INSPECTION, CARE, AND MAINTENANCE

                                         INTRODUCTION

In order to respond effectively to emergencies, all vehicles and equipment must be in top operational
condition.


                                AMBULANCE MAINTENANCE

The ambulance will be checked on every crew.

In addition, the First Lieutenant will ensure that the ambulance is serviced in accordance with Ford’s
recommended service plan and that any problems that develop are quickly remedied.

Every effort will be made to see that the ambulance vehicle complies with all state motor vehicle laws and
Part 800 regulations regarding ambulance equipment.

The vehicle will have an annual DMV inspection.

The Captain or his/her designee is responsible for maintaining records including, but not limited to the
following:
     When and where the vehicle was purchased/obtained
     Documentation pertaining to repairs
     Maintenance schedule according to vehicle manufacturer’s instructions
     Documentation pertaining to all maintenance performed on the vehicle

Documentation of vehicle maintenance shall include inspection records as well as records of services
performed either by the RPI Ambulance members, outside vendors, or representatives of the vehicle
manufacturer. This documentation will include any service bulletins or recall notices issued by the
manufacturer and records of compliance with their recommendations. These records shall be kept by the
Captain or his/her designee and shall be made available to the Department of Health upon inspection, as
requested.


                                 EQUIPMENT MAINTENANCE

All equipment will be checked on every crew. Any deficiencies will be reported immediately to the 1st
Lieutenant.

All equipment will be maintained according to the manufacturer’s recommendations including, but not
necessarily limited to the following:
     Performing manufacturer’s recommended calibrations/inspections



Jovan E. Cruz, Captain                                                                         34
RPI Ambulance Standard Operating Procedures                                                February 13, 2012


      Performing manufacturer’s recommended service (including lubrications)
      Replacing and servicing batteries, as applicable
      Proper inspection of all equipment available to the provider
      Proper cleaning and disinfecting procedures

The following equipment will be examined and checked by a third party maintenance company:
    Stretchers and stretcher mounting hardware
    AED
    Pulse Oximeter
    Suction Devices
    Rechargeable Battery Powered Lights
    Manual BP Cuffs
    Patient stabilization/Transportation/Immobilization Devices
    Oxygen Regulators and Delivery Systems


                                               CLEANING

The Ambulance vehicle will be cleaned and equipment/supplies replaced after each ambulance call. The
Emergency Vehicle Operator is responsible for cleaning the driver compartment of the vehicle and the
patient care personnel are responsible for the patient care compartment. Cleaning will be done according
to the Bloodborne and Airborne Pathogens Exposure Control Plan. When soiled, all re-usable equipment
will be cleaned in accordance to the RPI Ambulance Exposure Control Plan. All disposable equipment will
be discarded when soiled, even if not used.

Any safety or maintenance problems with the vehicle will be immediately brought to the attention of the
1st Lieutenant or the Captain.


                         ACCIDENTS/DAMAGE TO THE AMBULANCE

In the event of any accident involving RPI Ambulance, even if there is no damage or injury to any involved
party:
        1. Immediately assess the crew and other involved party or parties for any injuries, and notify the
            appropriate dispatch center(s).
        2. If transporting a patient, discontinue transport. Transfer care and transport of the patient to
            another transport agency. Leaving the scene of an MVA for any reason is considered a hit and
            run. At the discretion of the Crew Chief, if the accident occurs while transporting a critical
            patient and the ambulance can still be driven safely, a crewmember may be left behind at the
            scene while the ambulance continues to the hospital.
        3. Notify the Duty Supervisor, 1st Lieutenant and Captain immediately. Notify RPI Public Safety and
            have DPS and the appropriate police agency take a report. File a report with DPS and the Police,
            regardless of the amount of damage incurred.
        4. The Emergency Vehicle Operator and/or Trainee driving the vehicle at the time of the accident
            will be suspended as a driver but may still participate at other levels (such as Crew Chief or
            Attendant, as applicable). Coverage should be found by the Duty Supervisor to finish the shift, or
            if no cover can be found, the Duty Supervisor will cover the shift.



Jovan E. Cruz, Captain                                                                             35
RPI Ambulance Standard Operating Procedures                                                February 13, 2012


       5. Each member of the Duty Crew will file an incident report with the Captain with regard to how
          the accident occurred.


                                               FAILURES

Any vehicle or equipment failures must be immediately referred to the Captain and 1st Lieutenant in
writing. The captain will then notify the manufacturer(s), the State, and any other applicable entities of the
failure as needed. If the failure resulted in harm to a patient, the details of the injury(s) must also be
detailed and a copy of the PCR should be included in the report to the Captain.




Jovan E. Cruz, Captain                                                                             36
RPI Ambulance Standard Operating Procedures                                               February 13, 2012



                 SOP 12-14 DOCUMENTATION

                                           INTRODUCTION

Good documentation is essential to relay information to other healthcare providers, to obtain management
information, and for medical-legal purposes. RPI Ambulance must comply with all New York State
Department of Health and Regional Emergency Medical Organization documentation programs and will
follow all procedures.


                                     GENERAL PROCEDURES

       1. There will be only one (1) Pre-hospital Care Report (PCR) filled out for each patient. The
          exception is for public events, where an on site PCR and a transport PCR will be completed.
       2. Responsibility for accurate and complete documentation lies with the person listed in the “In
          Charge” box on the PCR. As such, only Crew Chiefs and Crew Chief Trainees who hold an EMT
          card may write PCRs for RPI Ambulance.
       3. The Pink Copy provided by any First Response agency (e.g. TFD.) will be stapled to the PCR and
          left at the hospital along with the RPI Ambulance PCR.
       4. When completing paperwork, the PCR will go on top, followed by any continuation form(s),
          followed by any First Response PCR, followed by any hospital face sheet.
       5. All documentation will be completed in black ink using a ballpoint pen. This ensures clarity in
          reading both the original and any copies made.
       6. All documentation will be legible. Anyone who picks up the PCR needs to be able to read it.
       7. Only abbreviations on the “REMO Approved Abbreviations List” will be used on PCRs.
       8. All documentation will be clear and concise and is up to the judgment of the Crew Chief/Crew
          Chief Trainee how best to document any given incident.
       9. The PCR will be retained for seven years for patients over the age of eighteen. The PCR will be
          retained for seven years after the patient’s eighteenth birthday for patients under the age of
          eighteen.
       10. All information contained in the PCR shall be held in the utmost confidentiality, and held in a
          fireproof safe in accordance with state and local protocols.


                         REFUSAL OF MEDICAL ATTENTION (RMA)

While patients of sound mind and judgment have the right to refuse medical care, a patient’s capability to
make a rational decision often becomes an issue at a later date. For this reason, it is imperative that all
assessment findings and any advice given to the patient is documented in the narrative section of the PCR
before they sign the release.
        1. Complete the PCR first.
        2. Complete the RMA form.
        3. The assessment and your advice indicating they seek medical attention should be read aloud to
           the patient. The patient should be allowed to read the narrative and the disclaimer on the back of
           the PCR as well as the RMA form.



Jovan E. Cruz, Captain                                                                            37
RPI Ambulance Standard Operating Procedures                                                 February 13, 2012


       4. Have the patient sign the RMA on the back of the PCR and the RMA form. Have a reliable witness
           sign both as well, preferably a Law Enforcement Officer or a family member. A member of the
           crew cannot witness a refusal.
       5. Patients under 18 years of age are considered minors under New York State law and are not
           allowed to refuse medical attention unless legally emancipated.
       6. Patients showing visible signs of intoxication or Altered Mental Status are not allowed to refuse
           medical attention. Generally, law enforcement will be on scene of any incident of this type. If the
           patient wishes to refuse medical attention, the help of an officer should be obtained to persuade
           the patient that transport to a hospital ER is in their best interest. Should this fail, a 941 may be
           requested per NYS DOH protocols.
       7. Patients who have been witnessed or admitted to the ingestion of alcohol, but are not showing
           obvious signs of intoxication or Altered Mental Status and wish to refuse medical attention may
           do so after a full assessment is completed. The Crew Chief should advise and request approval
           from both the on duty supervisor and a Medical Control Physician. All information must be
           documented appropriately.
       8. Similarly, if the patient is in need of care and wishes to refuse, try to convince the patient to
           accept care and seek help of law enforcement if necessary. If the patient still refuses to go,
           document well and allow them to leave.
       9. If there is any question whether the patient should RMA or there is a situation of unusual nature
           in which the patient does not want to be transported to the hospital, contact a Medical Control
           Physician and discuss the situation with them and follow their guidance. On your PCR document,
           record the Physician’s three-digit MD number and what they advised you to do.




Jovan E. Cruz, Captain                                                                               38
RPI Ambulance Standard Operating Procedures                                              February 13, 2012



   SOP 12-15 REQUESTS FOR SERVICE AND
    EMERGENCY DISPATCH PROCEDURES

                                          INTRODUCTION

Rensselaer County Bureau of Public Safety is the official dispatcher for RPI Ambulance. All medical
emergency calls originating on campus are transferred to Rensselaer County Emergency Medical
Dispatcher who assigns the priority determinant for the call and dispatches RPI Ambulance. All non-
emergency medical calls originating on campus are transferred to Rensselaer County in the same fashion as
the emergency calls from the Rensselaer County Dispatcher or from the RPI Student Health Center.

Rensselaer County Emergency Medical Dispatcher will also dispatch RPI Ambulance for any mutual aid
calls originating in the county.

Rensselaer County can be reached via the following numbers:
              Emergency Number: 911
              Non-Emergency Numbers: 270-5252 / 270-1037


                                   NOTIFICATION OF CALLS

The county dispatcher will notify the members of RPI Ambulance of the call, including nature and location,
via the high band portables with the accompanying paging tones broadcasted over high band frequency,
155.220, heard on channel 1 (one) or 2 (two) of the RPI Ambulance high band portable radios.

All communications between crew members at any point before, during or after the call and
communications with Rensselaer County Emergency Medical Dispatcher prior to calling en route from the
ambulance shall be done over channel 1 (one), 155.220, of the RPI Ambulance high band portable radios.

Upon recognition of the tones, when a duty crew is available, a Crew Chief, carrying a high band portable,
shall acknowledge the call and confirm the crew with the county dispatcher. In the case when the duty
crew consists of less than 4 people, the Crew Chief, at his/her discretion may ask for one or two additional
members to meet him/her at the ambulance.

If the call comes in during the day when no duty crew is available, any available Crew Chief and a Driver
shall notify the other members of their response and acknowledge the call with Rensselaer County. If only
a Crew Chief or a Drive is available, he/she may ask the Rensselaer County Dispatcher to re-dispatch for a
Crew Chief or a Driver, as necessary. Once the crew is confirmed, the responding Crew Chief shall confirm
the crew with the county dispatcher. Any other members wishing to respond will make a request to the
Crew Chief and upon Crew Chief’s permission meet the crew at the ambulance. Once at the ambulance, the
Driver shall call en route via the 800 MHz mobile radio system mounted in the ambulance. All further
communications with the Rensselaer County Dispatchers and/or other responding agencies shall be done
over the 800 MHz mobile radio system or over the 800 MHz portable radio.




Jovan E. Cruz, Captain                                                                           39
RPI Ambulance Standard Operating Procedures                                                 February 13, 2012



If for some reason the Crew Chief or the Driver is unable to acknowledge the call or confirm the crew with
the Rensselaer County over the high band portables on RPI Ambulance frequency 155.220, he/she may
confirm a crew with the dispatcher via personal telephone if they can do so without undue delay by dialing
270-1037. If the crew is unable to establish communications with the Rensselaer County over the 800
MHz radio system, they may contact the county over the cellular phone located in the RPI Ambulance by
dialing 270-1037.



                                               EMS CALLS

Calls received from the county dispatcher will include a determinant.

Alpha determinant calls will be treated as Priority 2 calls as defined in SOP 12-07.

Bravo, Charlie, Delta, Echo determinant calls will be treated as Priority 1 calls as defined in SOP 12-07.



                                    TRANSPORTATION CALLS

RPI Ambulance routinely transports patients from the RPI Student Health Center who are unable to
ambulate. This is a service which should not be abused. An individual who is on crutches or able to
ambulate with assistance does not need the services of an ambulance. If no other means of transport is
available, RPI Ambulance will attempt to get a crew to transport the patient.


                                HAZARDOUS MATERIAL CALLS

RPI Ambulance is not equipped or trained to handle Hazardous Material (Haz-Mat) situations. As such, no
member may enter Haz-Mat scene until trained professionals have properly decontaminated it. The Crew
Chief is responsible for ensuring the safety of the crew and should keep the crew back far enough to be
away from the hazardous agent.


                                       STAND-BY’S AND MCI

RPI Ambulance is a participant in Mutual Aid with other agencies who may call upon us as a resource in the
event of multiple patient incidents (MCI), long standbys, etc. Response to these scenes will always be in
Priority 2 mode. Lights and sirens will not be used to respond to these incidents unless there is a patient
waiting for our services, in which case the incident is no longer a standby response, but begins a new PCR
as an EMS call.

If the dispatch entity requests RPI Ambulance to respond to an incident Priority 1, then RPI Ambulance will
do so if the Crew Chief feels comfortable with that judgment.




Jovan E. Cruz, Captain                                                                               40
RPI Ambulance Standard Operating Procedures                                           February 13, 2012


                                            MUTUAL AID

RPI Ambulance provides and receives Mutual Aid through signed agreements held with both the
Rensselaer County Ambulance and Rescue Association and the Troy Fire Department. When Rensselaer
County Bureau of Public Safety receives a request for RPI Ambulance from an agency covered under these
agreements, the call will be dispatched as a Mutual Aid call to the requesting agency, and crew/vehicle
acknowledgements will proceed normally.

Any mutual aid call will be handled according to SOP 12-19.

Other agencies within (and outside of) the county may request RPI Ambulance through the Rensselaer
County Mutual Aid Plan. Other agencies/dispatch centers include, but are not limited to:
    Rensselaer County 911/Emergency Communications Center (Town of Brunswick, North Greenbush,
       etc.)
    Mohawk Ambulance Service
    Empire Ambulance Service
    The Watervliet Fire Department
    The Green Island Fire Department
    The Town of Colonie (Colonie EMS)
    The Cohoes Fire Department
    The Albany Fire Department
    The Regional Emergency Medical Alert Center (Re/MAC)


                            RPI AMBULANCE UNAVAILABILITY

If RPI Ambulance is unavailable for a call the next available ambulance according to the mutual aid plan
shall be called. This will happen in accordance with SOP 12-24 and the current dispatch plan with
Rensselaer County Bureau of Public Safety.




Jovan E. Cruz, Captain                                                                        41
RPI Ambulance Standard Operating Procedures                                            February 13, 2012



                    SOP 12-16 COORDINATORS

                                         INTRODUCTION

To assist in the completion of their jobs, the line officers of RPI Ambulance are empowered to appoint
coordinators. This gives the coordinator selected powers that the appropriate officer may have while still
referring all responsibility for the job to the appropriate officer. Some specific positions follow.


                                        QI COORDINATOR

The Quality Improvement Coordinator coordinates the completion of QI audits and tabulates the data and
reports to the Captain. The QI Coordinator and/or the Captain represent RPI Ambulance at meetings of the
Rensselaer County QI Committee. If desired, the Captain may elect to act as the QI coordinator.

The QI coordinator is responsible for ensuring compliance with the Rensselaer County QI program and
thereby the Region and State program. The Captain and QI coordinator should periodically review the
Rensselaer County QI program to evaluate its effectiveness to RPI Ambulance and to ensure it meets all
State and Regional requirements.


                                       CPR COORDINATOR

The CPR Coordinator is in charge of coordinating CPR events sponsored by RPI Ambulance and reports to
the Training Committee. The CPR Coordinator need not be a CPR Instructor but instead assures that
instructors are available to hold scheduled CPR training. The CPR Coordinator should work closely with the
Training Committee and the Vice-President. If desired, the Training Committee may elect to act as the CPR
coordinator.




Jovan E. Cruz, Captain                                                                         42
RPI Ambulance Standard Operating Procedures                                               February 13, 2012



                           SOP 12-17 UNIFORMS

                                           INTRODUCTION

In an effort to gain respect and convey a professional manner to the community, RPI Ambulance has
established different categories of uniform standards. This will provide continuity and an easy way to
communicate the appropriate uniform to members of a Duty Crew.

To prevent untrained members from being identified as emergency medical responders and provide
incentive for members to train, uniforms will only be worn upon promotion to Attendant.


                                               PATCHES

RPI Ambulance patches will only be worn on a white uniform shirt or red RPI Ambulance jacket. The RPI
Ambulance agency patch will be worn on the left shoulder. NYS DOH certification patches of the “Excelsior”
design with tombstone shape and navy blue background will be worn on the right shoulder. If a member
does not hold NYS DOH certification, a 2 inches x 3 inches American flag patch with gold border may be
worn on the right shoulder. No other patches may be worn on any part of the uniform.


                                PINS, COLLAR BRASS, BADGES

Any pin to be worn on the RPI Ambulance uniform must be approved by the Captain. Exceptions are day-to-
day wearing of the red jacket while not on a Duty Crew, though discretion should be used in this matter as
well. The Captain has the right to ask a pin to be removed from an RPI Ambulance jacket.

Officers should wear their collar brass on the collars of their white uniform shirts. Non-officer members are
not required to wear collar brass, but may opt to wear silver caduceus, or a combination of silver “RPI”,
“RPI Ambulance”, “RPIA”, ”EMS”, or “EMT” lettered brass as appropriate.

Badges should not be worn during duty crews. For special events, badges may be worn with the
authorization of the Captain. In some cases, the different role we serve by being an EMS agency and not a
Public Safety agency can play in important role in patient rapport. It is for this reason that we must keep a
clear distinction between RPI Ambulance and other Public Safety agencies.


                                        UNIFORM CLASSES

CLASS A OR DRESS UNIFORM

This is the Dress Uniform used by RPI Ambulance. It consists of:
    White collared RPI Ambulance uniform shirt with T-Shirt worn underneath
    Black slacks or EMS Pants
    Black belt with silver or black buckle


Jovan E. Cruz, Captain                                                                            43
RPI Ambulance Standard Operating Procedures                                                February 13, 2012


       No dangling earrings or jewelry
       Black, shined, closed-toe shoes or boots. No high heels.
       Black socks (if socks visible)
       RPI Ambulance approved red jacket (Seasonal)


CLASS B OR CASUAL UNIFORM

This is the standard uniform used by RPI Ambulance. It consists of:
     Red RPI Ambulance polo shirt with emblazoned RPI Ambulance logo and lettering over left chest.
     No patches or collar brass
     Black slacks or EMS Pants
     Black belt with silver or black buckle
     No dangling earrings or jewelry
     Black, closed-toe shoes or boots. No high heels.
     Black socks (if socks visible)
     RPI Ambulance approved red jacket (Seasonal)



“CLASS C” UNIFORM AND OTHER APPAREL

When not assigned to duty crews, RPI Ambulance members may wear RPI Ambulance apparel such as t-
shirts or sweatshirts with the RPI Ambulance name and logo on them. This apparel does not constitute any
official uniform; as such, duty crews must be in either Class A or Class B uniforms. However, it is
understood that individuals willing to respond to day calls may want to appear professional, but without
having to wear a full Class A or B uniform. In this case, use of this so-called “Class C” uniform is strongly
encouraged.

Ideally, it should look as close to the Class B Uniform as possible, but it is understood that people don’t
always wear their uniforms around campus all day. It consists of:
     A neat un-torn shirt, preferably dark, if possible RPI Ambulance- or EMS oriented. No fluorescent
         or obscene T-shirts are allowed.
     Neat, un-torn pair of pants, preferably dark. Jeans are fine but shorts are not permitted.
     Solid footwear. No open-toed shoes or sandals. No high heels.
     RPI Ambulance approved red jacket


                                      FIELDSTATION CREWS

In fieldstation crews for events such as athletic events, hockey games, concerts, etc., Fieldstation Crew
Chiefs, Fieldstation Attendants, and Fieldstation Orientation Members may wear Class B uniforms.
Fieldstation Event Supervisors at athletic events, hockey games, concerts, etc. must wear either the Class A
or Class B uniform.
All members at Institute and Special Functions (e.g. Special Events/Presentations, Commencement, etc.)
will wear the Class A Uniform. The Captain has the ability to designate any event as a Special Function. If an
event is designated as a Special Function, it should be made such at least one (1) week ahead of time to
allow members to plan accordingly.


Jovan E. Cruz, Captain                                                                             44
RPI Ambulance Standard Operating Procedures                                              February 13, 2012



       SOP 12-18 RADIO COMMUNICATIONS

                                             DEFINITIONS

F.C.C. - The Federal Communications Commission. The Federal agency charged with regulating the use of
radio communications to facilitate fair use by all.

Call sign - The alphanumeric reference sequence given to all operators of radio communications equipment
by the FCC. RPI Ambulance’s call sign is WNFR-574.

Mobile Radio - A radio, usually with transmitting power of about 35-40 watts, mounted in a vehicle, which
uses the vehicle as a power source.

Portable Radio - A radio with power ranging from 1 to 5 watts, which is able to be carried by a person and
has its own power source built-in.

Encoder pad - The touch-tone pad on a radio, which enables it to send the necessary tones to hospital
Emergency Departments to relay information about incoming patients. See D.T.M.F.

D.T.M.F. - Dual Tone Multi-Frequency. A system developed by AT&T/Bell Labs in the 1960’s to allow
numeric signals to be sent over common means of audio communication.

Key up - To activate the Push-to-talk switch on a radio.

Squelch - The ability of a radio to filter out extraneous noise and other transmissions. The threshold
between silence and static can be breached by opening the squelch. There are four types used by RPI
Ambulance:
    C.S.Q. - Carrier Squelch. Squelch with no other special functions. Any transmissions made, as well as
       some extraneous noise, may be heard by the listener.
    P.L. - Private Line system. Generically, C.T.C.S.S. (Continuous Tone Coded Squelch System).
       Channels with a P.L. tone in place will only allow the squelch to open if a sub-audible tone (ranging
       from approximately 30 to 190 Hz) is transmitted simultaneously with any radio transmission.
       Helps to filter out extraneous noise and unwanted transmissions (e.g. by people who share our
       frequency).
    D.P.L. - Digital Private Line. Developed by Motorola, a more sophisticated version of P.L.
    Quik-Call II - A Motorola function that allows a channel to be set to Alert Mode, wherein the squelch
       will only open if a sequential two-tone transmission is given, usually by a dispatcher.

Repeater - A system that hears radio transmissions on one frequency and then simultaneously re-transmits
them on another. Dramatically increases the range of a radio system.




Jovan E. Cruz, Captain                                                                           45
RPI Ambulance Standard Operating Procedures                                             February 13, 2012


                                      RADIO IDENTIFIERS

Any individual using the radio system should use the appropriate identifier. If none of the following
identifiers apply, or a 900-series identifier has not yet been issued and they need to transmit on the RPI
Ambulance frequency, they should describe themselves as “Member (last name)”. For example, John Doe
would identify himself as “Member Doe”. At no time should an individual’s 900 series number be used on
any frequency outside of the Rensselaer Polytechnic Institute Community.

RPI Ambulance Personal Identifiers - range sequentially from 920 through 989 and are assigned to
members upon promotion to Attendant. Once a member has an ID number, that number is assigned to the
member until such time as he or she has not been a member of RPI Ambulance for more than 1 year.

Fieldstation Crews - Should use numbers as outlined in the Fieldstation Policy (see Special Event SOPs.
These numbers range from 900 sequentially through 909 and should be used for no other purpose.

Any Department of Public Safety Officer will use their assigned 200, 300, 500, or 700-series number to
identify themselves. If any DPS officer is also a member of RPI Ambulance, they will be issued an RPI
Ambulance number unique to them. They will use the number for the agency that they are representing at
that time.


                                  RPI AMBULANCE VEHICLE

RPI Ambulance vehicles should use the following identifiers. This is the only identifier to be used when in
interagency communications (e.g. Rensselaer County, etc).


                                        AMBULANCE 5939

The Driver and Crew of Ambulance 39. Individual crew members should refer to each other as their
personal ID numbers. If a crew member is unfamiliar with the personal ID’s of another crew member, they
may refer to them simply as their functional job description within the ambulance crew such as
“Ambulance 39 Driver”.



                           HEADQUARTERS–92 COLLEGE AVE.

On the RPI Ambulance frequency, refer to the office (92 College Ave) as “Quarters”


                                           DISPATCHERS

If we are on RPI Ambulance’s frequency, call the Department of Public Safety. Refer to the dispatcher as
either “Public Safety Headquarters”

In the Rensselaer County Emergency Communications System, refer to the dispatcher as “Dispatcher”.




Jovan E. Cruz, Captain                                                                          46
RPI Ambulance Standard Operating Procedures                                             February 13, 2012



                         SOP 12-19 MUTUAL AID
Under the Rensselaer County Mutual Aid Plan, RPI Ambulance and other Rensselaer County agencies have
the ability to request Mutual Aid from each other under the following constraints:

Rensselaer County will maintain RPI Ambulance run number and response times in accordance with
existing Rensselaer County Dispatch policies.

After being dispatched for a Mutual Aid call, RPI Ambulance will call the requesting dispatcher and request
any information needed such as call location, directions, and patient status.

Upon arrival at the hospital, RPI Ambulance should call arriving the appropriate dispatcher’s frequency
notify the dispatcher that they are returning to RPI’s frequency, and return to RPI Ambulance’s primary
frequency. Then, notify the Rensselaer County Dispatcher that RPI Ambulance is clear of the Mutual Aid call
and back in normal dispatch procedures.




Jovan E. Cruz, Captain                                                                          47
RPI Ambulance Standard Operating Procedures                                                February 13, 2012



    SOP 12-20 AMBULANCE LAYOUT/SETUP

                                           INTRODUCTION

In order to maintain regularity and continuity between different crews, there is a certain approved method
for storing certain pieces of equipment on the ambulance. There is also a certain method to setting up some
pieces of equipment to facilitate patient care.


                                              STRETCHER

The stretcher’s location is self-evident; it goes in the stretcher mounts on the floor of the ambulance. The
attendants should not place their feet on the stretcher during general driving around, as it may jeopardize
the sanitary nature of the stretcher.

Always make certain that the stretcher is properly latched in place and will not come loose during transit.
This is especially important if there is a patient on the stretcher. The stretcher must be in lowest position
in the ambulance for it to be properly secured. The adjustable leg and head ends of the stretcher should be
adjusted as necessary for patient care during a call but should be left flat during general driving. If desired
the head end of the stretcher may be raised one notch to provide some leg space for the attendants riding
in the back.


                                           SPARE MAKE-UP

The make-up on the stretcher is supplemented by a spare make-up to be stored in the vertical shelves next
to the curbside access doors. The spare make-up is to be used in cases where a quick turnaround is needed.
If the spare make-up is used, the crew should replace it as soon as possible. In cases of expected large
volume, more spare make-ups may be kept on the ambulance at the discretion of the Captain and/or the
crew chief.


                                  IV FLUID CLIPS/RETAINERS

The devices provided for holding and securing IV fluid bags are for just that. Do not store other equipment
there as it can fall down at very inopportune moments.


                                  PORTABLE OXYGEN TANKS

In addition to the portable tank stored in the jump bag, two tanks will be stored in the double-tank holder
at the head-end of the crew bench. There should be two full tanks secured here with a regulator on at least
one at all times, except when they are in use. If one is empty it should be replaced a soon as possible. If no
other room is available and tanks must be secured, they should be nestled snugly in the bottom of the crew
bench with the valve end protected by extra linen, towels, etc.




Jovan E. Cruz, Captain                                                                              48
RPI Ambulance Standard Operating Procedures                                                February 13, 2012


                                  WALL OXYGEN REGULATORS

Both wall Oxygen regulators should remain on the action wall area in the two ports on the driver’s side of
the Ambulance. If a patient using oxygen is lying on the crew bench side, the regulator may be moved
during that transport to facilitate easy movement for the crew throughout the patient compartment.


                                  ONBOARD OXYGEN SYSTEM

Whenever the onboard system is used, the system should not remain charged for any longer then
absolutely necessary so as to avoid damaging the system and losing oxygen through leaks, loose fittings,
etc.


                                    COMPLETED PAPERWORK

After a call, any paperwork completed for the call should be stapled together as described in SOP 12-14 and
immediately placed into the “PCR Lockbox” inside of the RPI Ambulance Office whenever possible; non-
duty crew calls may result in paperwork being placed in the “PCR Lockbox” located in the garage. Under no
circumstances are completed PCRs to be left in the ambulance.


                              OTHER EQUIPMENT, TOOLS, ETC.

Not all equipment for the ambulance is listed here. Maintain the remainder of the 1st Lieutenant equipment
and supplies in their proper locations as directed by the Ambulance Lieutenant. Checklists should be done
at the start of every duty crew in accordance with SOP 12-13.


                                                LAPTOPS

Identifier 914 will be reserved for the standby/office laptop. Identifier 915 will be reserved for the duty
laptop located in A-39.

Laptops are the responsibility of the Crew Chief. When not secured in a locked mount, they must always be
attended. When not in use or attended, the laptops must be secured in the mounts with the lock engaged.
Keys for 915 will be secured in the lockbox located on cabinet 6 and keys for 914 will be in the lockbox in
quarters. All Crew Chiefs will be given the combination upon promotion to Crew Chief. Any failure of the
computer, mount or security lock box must be reported to the Duty Supervisor immediately.

All other maintenance and procedures are as outlined by the Captain and 1st Lieutenant in the internal
ePCR procedures.




Jovan E. Cruz, Captain                                                                              49
RPI Ambulance Standard Operating Procedures                                             February 13, 2012



            SOP 12-21 STANDBY AND EVENT
                      REQUESTS
All policies and procedures for handling events outside of duty crews and day calls as previously described
in these SOPs can be found in the RPI Ambulance Special Event Standard Operating Procedures.




Jovan E. Cruz, Captain                                                                          50
RPI Ambulance Standard Operating Procedures                                               February 13, 2012



     SOP 12-22 GRIEVANCES AND APPEALS

                                           INTRODUCTION

Members of an organization often have disagreements, either business or personal. Fair treatment of
everyone is the best policy to avoid problems of this type. This is not always possible and therefore it is
important to have in place a formal system to bring complaints forward so they may be resolved in a fair
and efficient manner.


                                             GRIEVANCES

Disagreements can best be solved by taking the problem directly to the person(s) in question. This brings
the issue into the open so that all parties involved may work to an adequate solution.

Sometimes this does not lead to an equitable solution or simply is not possible because one person is
intimidated or another person comes on too strong. In such cases, the issue should be brought to the
appropriate officer (Captain or President) based on the nature of the complaint. As an alternative, the
member may contact the Grievance Committee of RPI Ambulance.

The Grievance Committee exists to handle complaints among members. All grievance brought to the
committee are strictly confidential. See the Grievance Committee Constitution for details.



                                        CHAIN OF APPEALS

       1. President, Captain, or Grievance Committee
       2. Executive Committee of RPI Ambulance
       3. General Membership of RPI Ambulance
       4. Advisory Committee of RPI Ambulance
       5. Union Executive Board or Judicial Board


                                                APPEALS

In any situation where one or more of the parties are unhappy with decision following a grievance or
previous appeal, that party shall have the right to appeal to the next higher authority. That group shall
handle the appeal in a confidential and professional manner at its next possible opportunity.

Any member of an appeals body with a conflict of interest shall excuse themselves from the proceedings.
For instance, if there is a complaint against the Captain, when the appeal goes before the officer board, the
Captain shall not sit to hear the appeal. If the complaint is against the entire Executive Committee of RPI
Ambulance, that level of appeal shall be skipped.




Jovan E. Cruz, Captain                                                                            51
RPI Ambulance Standard Operating Procedures                                                February 13, 2012



                    SOP 12-23 DEFIBRILLATOR

                                           INTRODUCTION

As part of its continuing mission to provide quality patient care, RPI Ambulance carries an Automated
External Defibrillator. In order to ensure its continued functioning, it is important that the unit be properly
used and cared for.


                                    CARE AND MAINTENANCE

The unit will be tested at the start of each shift. Any deficiencies should be reported to the 1st Lieutenant
immediately.



                                                    USE

       1. The unit will be used in emergency situations only. For training, the training module should be
           used.
       2. In accordance with NYS – DOH protocols, the unit will only be applied on an unconscious person
           who presents without a pulse. The AED should not be used to monitor a conscious patient.
       3. The Crew Chief shall be responsible for and in charge of the AED throughout its use.
       4. If, at any time, a paramedic assumes care of the patient, they will be in charge of patient care, but
           the Crew Chief is still responsible for use of the AED.
       5. The Captain or his designee shall be notified of use as soon as is feasible so that the patient
           record can be properly downloaded and recorded.
       6. The Captain and crew will meet with the agency Physician as soon as feasible to review the crew
           actions and evaluate the use of the AED.




Jovan E. Cruz, Captain                                                                              52
RPI Ambulance Standard Operating Procedures                                                February 13, 2012



                   SOP 12-24 OUT OF SERVICE

                                           INTRODUCTION

By the nature of RPI Ambulance being college based it is recognized that there are periods when members
cannot commit to responding to a call. These may be times when all crew chiefs are in class, a period
before a test, etc. In addition, during summer vacations when students are away, the members may also be
away and the service may be unable to respond. This policy seeks to address the issues regarding this
lapse of service.


                                    DAY TO DAY TURNOVERS

While classes are in session, every effort is to be made by the members to provide a quick response. This is
to be done by having as many regular scheduled crews a possible and by communication among the
members regarding their absences and outside commitments.

In cases where a crew is not available, the call will be turned over for mutual aid. This will be done by
Rensselaer County Dispatch.

If a member does not acknowledge the call within 1 minute, a crew cannot be confirmed within 2 minutes,
or the ambulance is not enroute within 3 minutes, the call will automatically be turned over to mutual aid.
All times are counted from the time of initial dispatch of the ambulance.

In the case of a non-emergency transport from the RPI Student Health Center, the nurse or doctor may
choose to wait longer to try to raise a crew.

In the case of a large incident, the dispatcher will signify so and will continue trying to raise a crew for as
long as feasible.


                              EXTENDED PERIODS OF ABSENCE

If the ambulance will out of service for a scheduled period of time (such as maintenance) all members
should be notified ahead of time (such as by email) and the Public Safety dispatcher should be notified by
phone of the absence of service. This ensures that no time is wasted trying to raise an ambulance for a
patient on campus when it is not available to respond.

If the ambulance will be out service, for any period of time, the Rensselaer County Dispatcher should also
be notified of the absence so that RPI Ambulance is not called for any calls during that period of time.

Any time the ambulance is taken out of service, an “Out-of-Service” sticker should placed over the NYS-DOH
certification sticker.




Jovan E. Cruz, Captain                                                                              53
RPI Ambulance Standard Operating Procedures                                                February 13, 2012



             SOP 12-25 PATIENT TRANSPORT
                     DESTINATIONS

                                           INTRODUCTION

Patients are usually transported to the hospitals in Rensselaer, Albany, or Schenectady Counties. The only
exception to this may occur when RPI 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 facilities in
Rensselaer, Albany, or Schenectady Counties.

The hospital destination, within the areas of Rensselaer, Albany, or Schenectady Counties, will depend on a
variety of factors, including, but not limited to, patient medical condition, patient request, road and weather
conditions, location of the patient’s regular physician, and location of the incident. Under no circumstances
will the a patient be transported to a hospital that is more than 20 minutes further distance than the
nearest hospital according to the NYS BLS Protocols.

Any patient deemed to be in an immediately life-threatening situation will be taken to the nearest
appropriate hospital.


                                UNUSUAL RECEIVING FACILITY

In an emergent situation, if a patient seeks transportation to a hospital outside the area to which the RPI
Ambulance ordinarily transports patients, the patient will be informed of the RPI Ambulance receiving
hospitals, the distances involved, and that no exceptions are made. 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.
If the situation is non-emergent and the patient or caller makes inquiry (e.g. the need to transport a non-
ambulatory stable patient), they shall be referred to the Empire Ambulance Service or Mohawk Ambulance
Service.


                            RECEIVING FACILITY ON DIVERSION

If crew gives a hospital as patient destination and the medical control physician at that receiving hospital
feels that patient condition warrants transport to the nearest facility, the crew will inform the patient and
any accompanying relative, and comply immediately with the medical control order. If once the patient is
enroute to a certain hospital and that hospital medical control orders the ambulance to divert to another
hospital, the crew will inform the patient and will do everything in their power to explain the reasons for
the diversion. 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. If, however, in the opinion of the highest trained member in attendance, the patient’s
request of hospital will cause further harm to the patient, the nearest appropriate hospital will be used. In
all cases of diversion from the patient’s hospital choice, the EMT will record the patient’s request on the
Prehospital Care Report and the reasons for transporting to the closest appropriate hospital.


Jovan E. Cruz, Captain                                                                              54
RPI Ambulance Standard Operating Procedures                                                   February 13, 2012



If a receiving hospital diverts the ambulance to another receiving hospital because of emergency room
conditions as opposed to patient condition, the ambulance will divert if, in the judgment of the
crewmember with the highest level of training, in consultation with medical control, it is determined that
the patient condition is stable enough to warrant diversion. Under these circumstances the patient, whose
condition is stable, is informed that the hospital has requested diversion for the reason stated. If the patient
insists that s/he be taken to the originally requested hospital and the crew is unable to persuade the
patient otherwise, the patient’s hospital destination choice will be honored by the crew and the hospital
informed of the reason that the ambulance will not honor their request for diversion. Generally, patients
who are critical or unstable must be taken to the nearest facility.


               HOSPITAL DESTINATION IN MUTUAL AID SITUATION

In a mutual aid situation, if a hospital is substantially closer than the 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 by cellular telephone.

If in a mutual aid situation, in the rare instance the crew may be transporting a patient to a hospital other
than RPI Ambulance 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 highest trained crew member, compromise the
patient.


        TRANSPORT AND HOSPITAL DESTINATION OF MAJOR TRAUMA
                            PATIENTS

In a major trauma situation, where the crew deems appropriate, the nearest air medical service –
helicopter (Usually Albany Med Flight or Lifeguard) will be requested. The crew will generally meet the
helicopter at a mutually agreeable landing zone enroute to the hospital. Arrangements will be made
through dispatch for the establishment of the landing zone by the appropriate Fire Department.

If Air Medical Service is not available, in almost all instances the nearest hospital is the appropriate
receiving facility. In the rare instance that the crew may be working in an area on a mutual aid request, the
crew chief should keep in mind that Albany Medical Center is a designated trauma center, and may be the
appropriate destination for patients meeting major trauma criteria as found the NYS BLS Protocols.




Jovan E. Cruz, Captain                                                                                 55
RPI Ambulance Standard Operating Procedures                                               February 13, 2012



                   SOP 12-26 MISCELLANEOUS

                                           INTRODUCTION

Several aspects of EMS require policies that do not fit well into the other categories. These are included in
this section. The separate section is not to imply any greater or lesser importance of these policies.


                                       LOCATING PATIENTS

If the ambulance responds to a call and there is no patient found, the crew will work with appropriate first
response and law enforcement agencies (on campus, TFD and DPS respectively). to complete a search of
the area. After a proper search or when released by the appropriate law enforcement agency, the
ambulance may call in service and clear the scene. The PCR will document the search and included all
applicable information.

In performing the search for a patient, RPI Ambulance members will not force entry into any location. They
may enter a Residence Hall using their access card, but may not open the door to a room unless
accompanied by the patient, a friend, a roommate, a Resident Assistant or Associate, or a DPS officer. One
exception occurs if the crew can see inside the room, locate the patient, confirm the patient is in need of
care, and that there are no hazards in the room. See also hazardous scenes later in this policy.


                                        SPECIAL PATIENTS

MINORS

Unless legally emancipated, minors are not allowed to refuse care or transport. At the same time, RPI
Ambulance cannot kidnap the minor and transport them to the hospital. In some cases, DPS will take
custody of the child until a parent can be found. If the minor is refusing treatment and/or transport and
the crew feels that the minor is in need of such care/transport, DPS will be contacted immediately. If the
child runs away, the crew should not endanger themselves by following the child.

In the case of a public function covered by RPI Ambulance, a minor does not need to be signed off if no care
was rendered. I.e., all the crew did was hand the child a band-aid or a cold pack.


EMOTIONALLY DISTURBED PERSONS

As a general rule, RPI Ambulance does not transport patients to a psychiatric facility because of mental
health problems unless the patient also has a medical problem requiring ambulance transportation. If a call
is received for a patient with an unknown problem or history who is showing signs of unusual behavior
(possible psychiatric problem), the crew will proceed to the scene, evaluate the patient with an eye toward




Jovan E. Cruz, Captain                                                                            56
RPI Ambulance Standard Operating Procedures                                                February 13, 2012


possible medical causes for the behavior, and transport the patient to an appropriate facility. In this type of
unknown situation, it is strongly suggested that the crew request assistance from law enforcement.
Patients with behavioral problems should always be treated with respect while protecting their welfare. In
such a situation, it is strongly suggested that the patient care crew consist of at least two persons, one of
whom is the same sex as the patient. If at any time, a patient is a potential harm to the crew or themselves,
a law enforcement officer should be utilized for protect; only a law enforcement officer is able to restrain a
patient.


                                                  CRIMES

Suspicions of crimes should be reported by the Crew Chief to the law enforcement officer on scene (usually
DPS). The crew should not deal with the crime directly. The purpose of EMS is to help those in need not to
chase down the criminals.

In the case of abuse (child, patient, elder, or other domestic violence), notification should be made to the
officer on scene and to the receiving nurse. The Crew Chief should carefully document the scene and all
physical findings. The PCR is not the place to make accusations but should remain an objective assessment
of the situation.


                                      INCIDENT REPORTING

An Incident Report should be completed whenever there is an occurrence that, in the member’s opinion, is
sufficiently unusual to merit special attention and should be reported. All incident reports shall be
reviewed as soon as possible by the most senior officer available and shall be referred to the QI Committee
for review.

An incident report must be completed in the following circumstance. In addition, the reviewing officer is
responsible for documenting the incident and any corrective action taken on the form designated by the
RPI Ambulance for that purpose.
     Unexpected EMS vehicle and patient care equipment failure that could have resulted in harm to a
       patient.

The following incidents must be immediately reported to the Captain or, in his/her absence, the next
highest ranking officer; must be thoroughly documented on an incident report and must be reported to the
NYS Department of Health Bureau of Emergency Medical Services, by telephone, the following day, and in
writing, within five (5) working days:
     Any member of the service is killed or injured to the extent requiring hospitalization or care by a
        physician while on duty.
     Patient care equipment fails while in use, causing patient harm.
     A patient dies, is injured, or is otherwise harmed due to actions of commission or omission by a
        member of the ambulance service.
     An EMS vehicle operated by the service is involved in a motor vehicle crash in which a patient,
        member of the crew, or other person is killed or injured to the extent requiring hospitalization or
        care by a physician.
     It is alleged that any member of the service has responded to an incident or treated a patient while
        under the influence of alcohol or drugs.


Jovan E. Cruz, Captain                                                                              57
RPI Ambulance Standard Operating Procedures                                                February 13, 2012


                           OBVIOUS AND UNATTENDED DEATH

When called to a patient who is in cardiac arrest, the ambulance crew will begin resuscitation (including
defibrillation) and transport the patient as appropriate unless one of the following conditions exists:
     Crew is presented with a valid “Nonhospital Order Not to Resuscitate (DOH-3473)
     The patient is found to be wearing a “Do Not Resuscitate” bracelet
     The patient is found to be obviously dead by showing one of more of the following conditions:
             o Obviously mortal injury
             o Extreme dependent lividity
             o Rigor mortis
             o Tissue decomposition
In each of the above situations, it is imperative that the EMT evaluate the patient’s respirations and carotid
pulse (brachial pulse in infants) to assure that they are absent. The ambulance crew is not to rely on the
reports of bystanders, law enforcement personnel, etc. in regard to the absence of a pulse or “death” of a
patient. Furthermore, if CPR is withheld in any of the above situations, the condition which led the crew to
withhold CPR must be documented on the PCR. If there is any doubt as to whether to start resuscitation,
begin BLS care including defibrillation and contact medical control (either through Re/MAC or individual
hospitals) for direction.

A “health care proxy” or “living will” may not be used in a prehospital EMS situation to determine that
resuscitation measures, including CPR, can be withheld. In a situation where there is no Nonhospital Order
Not to Resuscitate and the patient does not meet any of the other above listed criteria for obvious death,
resuscitation measures should be started and the patient transported unless, upon consultation with
medical control, the medical control physician advises otherwise. Any legal papers regarding a living will or
health care proxy should be taken to the hospital by the ambulance crew and given to the hospital staff.

If the deceased person is a hospice patient with a valid Nonhospital Order Not to Resuscitate, the EMT
should attempt to contact the hospice worker on call and be guided by his/her advice. Hospice will
generally contact the patient’s physician who will sign the death certificate, and the presence of the
coroner is generally not necessary in this situation.

In other situations where there is a death where the patient meets the above guidelines for “obvious
death”, the crew will be guided by the following:
     Contact Rensselaer County Bureau of Public Safety to request law enforcement assistance.
     Remain at the scene until the arrival of the police.

In general, bodies of the deceased are not to be transported. In a situation where the patient is obviously
dead and is in a public place, the crew may, at their discretion, transport the body a short distance to
remove it from public view, but only on the advice of and request from the coroner.

If, as a result of their observations at the scene of a cardiac arrest or unattended death, the crew suspects
an attempted suicide, suicide, or other criminal activity has been involved, the crew will make every
reasonable attempt to preserve evidence while providing whatever patient assessment, care, and/or
transportation is necessary.




Jovan E. Cruz, Captain                                                                             58
RPI Ambulance Standard Operating Procedures                                                February 13, 2012


                           CHILD ABUSE AND MALTREATMENT

NY State EMTs are considered mandatory reporters of Child abuse and Maltreatment per § 413 of the Social
Services Law. The law requires EMTs to report suspected child abuse they come across while performing
their jobs.

§ 415 of the Social Services Law states: “Reports of suspected child abuse or maltreatment made pursuant
to this title shall be made immediately by telephone or by telephone facsimile machine on a form supplied
by the commissioner. Oral reports shall be followed by a report in writing within forty-eight hours after
such oral report. Oral reports shall be made to the statewide central register of child abuse and
maltreatment unless the appropriate local plan for the provision of child protective services provides that
oral reports should be made to the local child protective service”

Oral reports of suspected child abuse and maltreatment shall be made by calling the NYS Child Abuse and
Maltreatment Register at 1-800-635-1522. This phone number is for mandatory reporters only and shall
not be distributed to the general public.

All oral reports shall be followed up in writing using Form DSS-2221-A available from the duty supervisor.
A copy of the completed form shall be attached to the copy of the PCR retained by the agency.

Definitions of suspected child abuse and maltreatment, as well as guidelines for filling a report, are
available from the duty supervisor. All EMTs should familiarize themselves with these definitions and the
guidelines for filing a report.

The EMT should make hospital staff at the receiving facility aware of his/her suspicions during the oral
report to the nurse when patient care is transferred.

The PCR should include documentation of the EMT’s suspicions and documentation that the required
reporting was met.

Immunity from liability for reporting cases of suspected child abuse or maltreatment is provided to those
individuals required to report such cases under §419 of the Social Services Law providing the individual
was acting in ‘good faith’.

§420 of the Social Services law states:
       1. Any person, official or institution required by this title to report a case of suspected child abuse
          or maltreatment who willfully fails to do so shall be guilty of a class A misdemeanor.
       2. Any person, official or institution required by this title to report a case of suspected child abuse
          or maltreatment who knowingly and willfully fails to do so shall be civilly liable for damages
          proximately caused by such failure.




Jovan E. Cruz, Captain                                                                             59
RPI Ambulance Standard Operating Procedures                                              February 13, 2012


           GERIATRIC OR OTHER PATIENT ABUSE/MALTREATMENT

Geriatric abuse and neglect, and other domestic violence, like child abuse and neglect, is a big problem in
our society. The primary sign is unexplained injuries in an elderly or other patient. In the situation where
the crew suspects abuse or neglect of any patient, they should complete a full patient assessment, including
a scene assessment, and report their suspicions to the Emergency Department staff.
      If the patient refuses transportation, and is deemed mentally capable of making an informed
        decision in that regard, the crew should report the situation and their suspicions to the RPI DPS
        and Troy Police Department as soon as reasonably able and document their objective findings on
        the PCR.


                                      ABANDONED INFANT

The Abandoned Infant Protection Act of 2000 allows a parent, guardian, or other legally responsible person
to leave their infant (who must be five days old or younger) at a safe place. This safe place may include an
ambulance station.

In the event that a parent or guardian chooses to relinquish care of their newborn infant to the RPI
Ambulance, the following guidelines should be followed:
       1. Parents are not required to provide their names. In a non-judgmental manner, the EMS provider
          receiving the infant may ask the adult if there is any medical information that is important to
          know in the care of the infant.
       2. The EMS provider receiving the infant at the station must immediately call the Rensselaer County
          dispatcher who in turn will put out a call for the duty crew. The infant will be assessed by the
          crew, cared for according to protocol, as needed, and be transported immediately via ambulance
          to the nearest hospital. A PCR will be completed for the run in the usual manner.
       3. If, at any time, the parent or guardian seeks follow-up information about the child they
          relinquished, they should be referred to the hospital where the infant was transported.




Jovan E. Cruz, Captain                                                                           60
RPI Ambulance Standard Operating Procedures                                        February 13, 2012



SOP 12-27 APPROVAL/REVIEW DOCUMENT
We the undersigned have reviewed the policies contained herein (SOP 12-00 through SOP 12-27) and find
it to be satisfactory policy for RPI Ambulance.




Jovan E. Cruz
Captain, RPI Ambulance




Leslie Lawrence, MD
Medical Advisor, RPI Ambulance




Jovan E. Cruz, Captain                                                                     61

				
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