April 1, 2006
TABLE OF CONTENTS
Mission Statement #3
Organizational Structure #4
Articles 1 thru 4 Index #5 thru 7
Article I – Internal Affairs #8 thru 48
Article II – Units and Stations #49 thru 58
Article III – Operational Procedures #59 thru 96
Article IV – Tactical Plans #97 thru 125
These Operational Guidelines shall be the published and accepted standards
for conduct, operations, patient care, and any other guidelines, which may
apply to Hamilton County Emergency Medical Services. (HCEMS).
These Operational Guidelines shall govern all employees of Hamilton
County Emergency Medical Services.
Posting and Placement
A hard copy and computer copy of these Operational Guidelines shall be
placed in each EMS Station or facility for review. Each new employee shall
receive a hard copy during orientation, which will be turned back in to
training at the completion of orientation.
HCEMS Management shall interpret and provide clarification on all
Implementing Directive and Enforcement
These Operational Guidelines shall supersede and make obsolete any
editions previously published. These OG’s shall take effect on April 1,
2006, at 07:00 hours with periodic updates as needed. HCEMS
Management shall have the responsibility and the authority to enforce these
OG’s. HCEMS Management shall be authorized to deviate from these OG’s
when needed to better manage a situation. Failure to abide by these OG’s
shall be grounds for disciplinary action and be a violation of the Hamilton
County General Government Employees Handbook, Section 300.
Donald L. Allen Sr.
Hamilton County Emergency Services
Kenneth L. Wilkerson
Hamilton County Emergency Medical Services
Hamilton County Emergency Medical Services, hereafter known as
HCEMS, is a Division of Hamilton County Emergency Services and under
the Command of the Hamilton County Mayor. The Administrator of Human
Services oversees our Director who serves as the appointing authority. We
all ultimately answer to the voter, our customer.
HCEMS shall provide timely and proactive Emergency Medical Treatment
in the form of basic and advanced life support when needed or requested.
HCEMS strives to have a positive impact on people’s lives. Our service
should be an example for others. We shall endeavor to lead by example and
forge a path for others to follow.
HCEMS considers all patients to be our customer, and we intend to meet our
customer’s needs where possible. HCEMS shall practice both INTERNAL
and EXTERNAL Customer Service. We shall treat each other first and
foremost as our own family and internal customers. With this behavior, we
are prepared to serve our external customers in the way that exemplifies the
highest standard of medical care and our primary service goal: PATIENT
HCEMS employees will conduct themselves in the highest standard of
professionalism, courtesy, mutual respect, and integrity. Our journey is to
strengthen, train, correct, support, manage, referee, coach, counsel and lead
each other in a manner that promotes positive growth and a positive
organizational climate. This journey is a process and is never ending. We
will always strive to have an excellent working relationship with our fellow
peer groups in Emergency Services, as they are external customers as well.
HCEMS foundation of core principles are leadership, training, mutual
respect, customer service, and teamwork. This foundation allows us to
accomplish our goal of patient care in the highest standard.
ARTICLE I: INTERNAL AFFAIRS
Section A - Uniforms and Appearance (revised)
Section B - Reporting for Duty (revised #2 and #3)
Section C - Personal Behavior (revised #19and #21)
Section D - On Duty Meals (revised #7)
Section E - Log Books and Station Boards
Section F - Leave Time and Swaps (revised #9 e, #10)
Section G - Awards Program (revised)
Section H - File Maintenance
Section I - Training (revised #5)
Section J - Observation Program
Section K - Student Clinical Rotations (revised)
Section L - Quality Assurance Program
Section M - Customer Service
Section N - Part Time Employee Field Orientation (revised)
ARTICLE II: UNITS AND STATIONS
Section A - Unit Readiness and Vehicle Maintenance
Section B - Station Duties
Section C - Station Maintenance
Section D - Station Visitors (revised #1)
Section E - Work Station Assignment (revised)
ARTICLE III: OPERATIONAL PROCEDURES
Section A - Protective Clothing Use & Injury Prevention (revised #8 and 9)
Section B - Protective Clothing Maintenance (revised cleaning and care)
Section C - Patient Transport (revised #7 Paramedic Transport & #1 DOA)
Section D -Supply Acquisition (revised #6)
Section E - Refusal of Service
Section F - Documentation
Section G - Severe Weather Alerts (revised #14)
Section H - Driving Procedures
Section I - HCEMS Vehicle Involved in an Accident (revised #11)
Section J - Accident Review Team
Section K - Infection Control
Section L - Radio and Telephone Communications (revised #1 med comm...)
Section M - Controlled Substances and Medications
ARTICLE IV: TACTICAL PLANS
Section A - Unit Relocation and District Coverage
Section B - Motor Vehicle Accident
Section C - Air-medical Request
Section D - Scene Management (revised #8 & #9)
Section E - Incident Command System (revised #1)
Section F - Rest and Rehabilitation (Rehab)
Section G - Hazardous Materials (Haz-Mat)
Section H - Destination Guidelines
Section I - Technical Rescue
Section J - Radiological Response
Section K - Tactical Medical Unit / Medical Bike Team (revised)
HCEMS OPERATIONAL GUIDELINES
ARTICLE I - INTERNAL AFFAIRS
Section A - Uniforms and Appearance
Scope: This guideline shall encompass all Uniformed HCEMS employees.
Purpose: This guideline shall provide a means of defining what uniform is
appropriate for use while at work and at any given function. Uniformity is difficult
to achieve in large organizations. As such, the employee should pay close
attention to the specificity of the guidelines. The uniform allows for rapid
identification of crew members, makes a neat and professional presentation to the
public, and builds espirit-de-corps. Emphasis is placed on safety and a
Administrative Staff - Supervisors not assigned to Field EMS Teams.
Shift Supervisors - Supervisors with overall responsibility for operations on an
individual shift, designated by the rank of Captain.
District Supervisors – Supervisors assigned to one of three districts, East, West,
and Central, designated by the rank of Lieutenant.
Team Members - EMT’s and Paramedics assigned to Field EMS Teams and
Support Services both full and part time.
Duty Uniform - Basic uniform worn year round by Team Members and
Dress Uniform - Special Occasion Uniform worn by all personnel as per these
Administrative Staff Uniform - The Director of Emergency Services dictates
what the Administrative Staff shall wear according to the duties or options given
them. This shall include civilian dress where applicable.
Specialty Teams Uniform - The Chief Officers may assign such Teams or
personnel variances to this policy based upon their specific duties with strict
limitations to each.
PRESENTABLE - All uniform items shall be neatly kept and polished where
appropriate. All patches and embroidery shall be sewn completely. All clothing
items will be free of rips and tears, and will not show excessive wear. Supervisors
will be responsible to ensure that all clothing items are presentable. No type of
decoration or appurtenance shall be worn on the uniform unless authorized by
these guidelines or addendums.
The Duty Uniform shall be worn as a minimum year round.
Shirt shall be Flying Cross, deluxe tropical blend, and light blue in color, short or
long sleeved. Supervisors shall wear white. The undershirt will be worn
underneath. Supervisors will wear a plain white T-shirt under the Flying Cross.
Supervisors will maintain the embroidered T-Shirt as a uniform option. ID Badge
shall be worn on the right shoulder, picture facing forward.
Undershirt will be Jerzee brand T-shirt #03202, heavy-duty 50/50 blend, navy blue
in color, short sleeve. Supervisors shall wear white. When worn under the
uniform shirt, the sleeves of the undershirt will not extend past the sleeves of the
uniform shirt. Embroidery on the undershirt will be identical to the Flying Cross
shirt with the addition of the letters "HCEMS" embroidered on the back.
Pants shall be pro-tuff EMS 101P style or equivalent, navy blue in color. Zippers
on the legs are optional, however if zippers are added to the pant leg they will be
zipped closed. Pants will not be bloused, pegged or tucked inside the boot.
Black boots shall be worn and will be lace-up, smooth toe and at least 8" high.
Boots will be brush polished and not show obvious wear. A high gloss or "spit
shine" is not required. Boots will not have decorative buckles or straps.
Black belts shall be worn. Belts will not have decorative or obtrusive buckles.
The following accessories may be worn on the belt or optionally a black duty belt,
as long as they are either black leather or black nylon:
Quick-release clip for radio case
Commercial holster for scissors, penlight etc.
Multi-tool in a black leather or nylon case.
Personal pager or cell-phone
Flashlight in black leather or nylon holder
Small case for BSI
Supervisors or staff required to carry an additional pager, cell phone, or radio are
authorized to do so. Field staff will not carry other service’s radios, pagers, or
Insignia Placement on the Shirt:
Left Shoulder - HCEMS Service Patch 1" from the shoulder seam and centered on
Left Chest - HCEMS Badge embroidered over the badge loop.
Right Chest - Name and Rank identification, “two line format”. Top line is rank
spelled out and second line is first initial and last name, embroidered ½” block
Examples of the standard two line format used on all items requiring one’s name:
EMT Paramedic Lieutenant Captain Deputy Chief
T. Smith T. Smith T. Smith T. Smith T. Smith
Right Shoulder - Tennessee patch with rockers or National Registry patch as per
level of licensure.
All Embroidery shall be in Gold Block
Navy blue ball caps may be worn with Hamilton County E.M.S. embroidered logo
on front. Rear of Cap shall have the standard two line name and rank format.
Captains and Chiefs will have two arcs of laurel leaves in gold on the bill.
Supervisors are required to wear insignia of rank on the collar. Shift supervisors
will wear dress uniform pants. Dress shoes may be substituted for boots. The
chest insignia may be metal badge, rank and name tag as well.
The Dress Uniform will be worn as directed. This uniform is appropriate for
special occasions such as court appearances, funerals, or when representing the
service at special functions. It is worn as the equivalent of the civilian "coat and
Jacket and Pants
The jacket will be the Fechheimer #38800. Pants will be Fechheimer #38200.
Gold Eagle buttons are required on the coat. All badges are issued. The jacket will
be tailored to present a neat appearance. It will not be so tight as to create
deformity to the material by the shape of the body and will not be so loose as to
appear to hang or drape. The male sleeve may touch, but not extend past the heel
of the hand. The female sleeve should not extend beyond the wrist. Pant legs
should be tailored so that the material does not bunch at the foot, or cause more
than one "break" in the front crease.
Left Shoulder - HCEMS Service Patch, 1" from the shoulder seam and centered
on the sleeve.
Right Shoulder - Tennessee patch with rockers as per level of licensure. The
National Registry Patches will not be worn with the dress uniform.
Left Chest - Metal badge pinned through the badge loop. The badge will be worn
in an upright position, centered over the pocket.
Right Chest - Name plate, will be New Hermes style with gold satin finish, clutch
back. Engraving will be name and rank in two line format, in black block capital
letters. It will be 1/2" wide by 2 3/8" long, with lettering 1/8" high. Placement
will be 1/8" above the top seam of the pocket, parallel with the top seam, and
centered over the button. Citation bars will be worn above the nametag.
Left Sleeve – Service stripes are authorized, one per three years of service. (Coats
and all long sleeved shirts). Placement will be 2 3/4" from the bottom edge
of the sleeve, at a 45 degree angle to the bottom edge of the sleeve.
Right Sleeve - Gold bands will be worn full circumference on the Dress Coat as
Chief - One Wide, Four Narrow
Deputy Chief - One Wide, Three Narrow
Assistant Chief - One Wide, Two Narrow
Captain - One Wide, One Narrow
Lieutenant - One Wide
Sergeant - One Narrow
Paramedics and EMT's - no bands
Placement will be 2 3/4" from the bottom edge of the right sleeve to the bottom
edge of the first stripe.
Collar Insignia - Rank will be identified on the shirt collar as follows:
Chief - “Chief” spelled out in gold metal letters, with gold leaf
Deputy Chief - “Deputy Chief” spelled out in gold metal letters.
Assistant Chief - “Assistant Chief” spelled out in gold metal
Captain - Two gold metal bars
Lieutenant - One gold metal bar
Sergeant - Gold metal Chevrons
Paramedic - 13/16” gold metal caduceus with the letter “P”
EMT - 13/16” gold metal caduceus
Placement of rank on the collar will be 1 1/4" from the point of the collar and with
the centerline of the insignia in line with the point of the collar.
Epaulets - Gold Metal “HCEMS” in bar format will be worn on the epaulets of the
Headgear - Service caps will be worn with the Dress Uniform at all times. The
cap should be fitted to allow for proper wear. The cap will be worn with the
bottom edge parallel to the ground, with the bill of the cap no more than three
fingers off the bridge of the nose.
Rank will be identified as follows on the dress hats:
Chief - White hat, gold band, and two arcs of laurel leaves in
gold on the bill.
Deputy Chief - White hat, gold band, two arcs of laurel leaves
in gold on the bill.
Assistant Chief - White hat, gold band, two arcs of laurel leaves
in gold on the bill.
Captain - Navy blue hat, gold band, two arcs of laurel leaves in
gold on the bill.
Lieutenant - Navy blue hat, gold band, plain bill.
Sergeant - Navy blue hat, gold band, plain bill.
Paramedic and EMT - Navy Blue Hat, black band and bill.
The shirt will be the same style as the Work Uniform, but long sleeved.
Supervisors will wear white. The ID badge will not be worn.
Shoes will be low quarter, Oxford style, with patent leather or high quality
poromeric finish with smooth toe. Black dress socks will be worn.
Full length navy blue tie will be worn. A standard four-in-hand tie is
recommended, although a clip-on or Velcro closure is acceptable. The tie should
be worn so that no shirt material is visible above the top edge of the tie. If a clip-
on or Velcro closure is used, the device should not be visible.
A black leather belt with gold buckle will be worn.
Inclement Weather and Warmth Options
A Navy Blue Our Heroes Inc. Style #525 cut # 1432 shirts may be worn with the
work uniform only and insignia placement shall be the same as the duty uniform.
With HCEMS embroidered on the back and no shoulder patches. The ID Badge
shall be worn on the right shoulder picture facing forward. This item is commonly
referred to as the “work shirt”.
A Navy Blue Wooly-Pully type V-neck sweater is permitted for administrative
staff only. Insignia will be placed the same as on the shirt. The ID Badge shall be
worn on the right shoulder picture facing forward.
The winter coat shall be the North Face / Horace Small. The coat shall have the
HCEMS badge on the left chest and the two-line name and rank format on the right
chest (embroidered), with the service patch on the left sleeve and licensure patch
on the right sleeve.
A Hartwell #4530 Packer Pouch Jacket, navy in color may be worn. Insignia is as
Left Chest - HCEMS embroidered badge logo.
Right Chest - Name and Rank in two line format.
Front Flap - HCEMS in 1” letters.
Back - HCEMS in 7” letters.
A solid dark blue toboggan may be worn. Gold ½” HCEMS block lettering will be
centered on the front. As an alternate to the toboggan, a solid dark blue fleece
headband may be worn bearing the same lettering as the toboggan.
The shift supervisor may direct the removal of the shirt to accommodate for
extreme heat conditions. A district supervisor may allow the removal of the shirt
for an individual incident when conditions are such that the continued wear of the
shirt could be hazardous to the crewmember or might result in the item being
damaged. The crewmember may remove the shirt at their own discretion if bunker
gear is being worn for safety reasons.
Personal protective clothing is provided for crewmember protection on individual
scenes and is not an acceptable alternative to the prescribed uniform. The shift
supervisor may authorize the routine wear of bunker gear in extreme cold weather
or under unusual circumstances.
Crew members may wear an Anvil brand mock turtleneck, style #20468, navy blue
in color or Cross Creek brand turtleneck, style #13467, navy blue in color under
the long sleeve duty uniform shirt or the work shirt. Both of these items must be
embroidered with the letters “HCEMS” in ¼ inch lettering on the neck, with the
lettering offset to the wearer’s left, ½ inch from the centerline of the neck.
Supervisors will wear white.
Minimum Purchase and Storage Requirements
The following uniform items will be purchased and maintained at all times.
a. Three Duty Uniforms with at least one stored in a locker at one’s
work station as an on duty change of uniform.
b. One Dress Uniform stored in a locker at one’s work station when
not being used or cleaned.
c. Boots, belts, shoes, etc. necessary for uniforms.
All other uniform items are considered optional purchases.
Appearance and Grooming
All employees will maintain exceptional personal hygiene when on duty.
Shirts will be tucked in at all times.
Shirts will be buttoned to the second button from the top. Sleeves will not be
Any type of jewelry or decorative item that could present a safety hazard is not
Underclothing shall not extend past the sleeves, collars, or pant legs.
Goatees and beards are not permitted. Employees will be clean shaven.
Mustaches will be neatly trimmed and not extend below the corner of the mouth.
Sideburns will be neatly trimmed and not extend past the ear opening.
Hair will be neat and not extend below the collar. Hair will not be dyed in a garish
or unnatural color.
Earrings or other ear decorations are not permitted. Jewelry is limited to an
engagement ring/wedding set, medic alert jewelry, and wristwatch. Necklaces if
worn should be kept inside the shirt. Body piercings are not permitted to be worn
unless they are naturally covered by clothing. Tongue piercing is not permitted.
Male employees are not allowed to wear makeup. Underwear will be worn at all
Chest hair will not be visible.
Hair shall be neat and pulled back for safety reasons. Hair should not fall below
the shoulders at any time. Hair holding devices are permitted, with the emphasis
placed on functionality rather than aesthetics. They should be navy blue or black
and not formed to represent things such as flowers and animals. When wearing the
dress uniform, hair should be worn up or pulled back in such a manner as to allow
for proper wear of the headgear.
Jewelry that may present as a safety hazard will not be worn while on duty, i.e.
dangling earrings, loose necklaces or bracelets, etc. Jewelry is limited to an
engagement ring/wedding set, medic alert jewelry, and wristwatch. Necklaces if
worn should be kept inside the shirt. Earrings will be limited to simple gold or
silver studs, only one in each ear. Body piercings are not permitted to be worn
unless they are naturally covered by clothing. Tongue piercing is not permitted.
Underwear and brassieres shall be worn at all times.
Cosmetics should be worn in a subdued and conservative manner. Garish or
extreme colors such as black, purple, fluorescent or colors that stand in stark
contrast to the natural complexion are not allowed. Cosmetics will not have a
caked or streaked appearance. Fingernails will not exceed 1/4" in length.
Fingernail polish will not be extreme or garish in color, or multi-toned.
Section B - Reporting for Duty
Employees shall report for duty at their assigned station by 07:00 each shift.
Employees will be relieved at 07:00 the following morning by the oncoming shift.
If for some reason an employee’s relief is not present by 07:00, the employee shall
contact the district supervisor. At no time will an employee abandon his/her duty
station without the approval of the on duty supervisor.
Personnel shall use their assigned Hamilton County Emergency Services employee
computer access code to clock in and out each shift worked. If for any reason an
employee is unable to clock in or out, the shift supervisor should be notified
immediately. At no time is an employee permitted to clock another employee in or
All HCEMS personnel are subject to be called in to report for duty at anytime
should circumstances arise warranting such action. These situations include but are
not limited to: Mass Casualty Incidents, natural disasters, weather related
emergencies, etc. The decision to activate additional personnel will be made by
either the County Mayor, Director of Emergency Services, the EMS Chief, the
EMS Deputy Chief, or their designee.
Section C - Personal Behavior
Employees are held accountable for all rules, regulations, policies, procedures, etc.
of Hamilton County EMS and Hamilton County General Government, including
the Hamilton County Employees Handbook.
Employees shall show mutual respect for each other and supervisors should be
addressed by their rank, or rank and last name, especially in view of the public.
Employees shall refrain from the use of profanity, vulgar, obscene or abusive
language or actions toward each other or the public.
Employees shall not be under the influence of, nor shall they have in their
possession, any alcoholic beverages or illegal drugs while on or within Hamilton
County property. Employees shall not allow any person to be on or within
Hamilton County property that is under the influence of, or has possession of,
Alcoholic beverages, sleeping pills, prescription medications or any other
depressants or stimulants that could impair judgment or ability shall not be used
within eight hours prior to an employee reporting for work. If under the care of a
physician, a doctor’s note shall be required before a prescription for this type
medication can be taken on duty. The employee shall notify his/her district
The use of tobacco products is permitted outside our stations only. Employees
who use such are responsible for the proper disposal of all cigarette butts, chews,
etc. Tobacco products are not to be used within ten (10) feet of any ambulance.
Employees shall maintain a neat and clean station at all times. Our buildings are
public property and should stay presentable. Sleeping will not be allowed prior to
1200 hours. Exceptions to this must be approved by the Shift Supervisor.
Employees shall not steal from the service, fellow employees, patients, etc. Those
found vandalizing, stealing, forcing doors, cutting locks, etc. shall be disciplined.
Employees shall respect and maintain the furniture and station facilities provided
for them. Each employee is responsible to protect and prevent abuse of our
Every employee is expected to exemplify the highest level of professionalism and
pride possible. Public relations are a non-stop function and one’s behavior should
be an example respected by all. Employees are to be courteous to the public at all
Employees shall practice economy in the use of station supplies, metered services,
etc. and see that waste is avoided. They shall not leave televisions on, water
running, excessive lighting on, etc. when not needed or being used.
Employees shall notify their district/shift supervisor, and administration, within
twenty-four hours if they change place of residence or telephone number. It shall
be the employee’s responsibility to maintain a constant level of communication
with their supervisor.
Employees shall promptly notify their district supervisor of all matters coming to
their attention that could affect the interest and welfare of the service.
No employee shall use the uniform, badge or prestige of the service for the purpose
of personal gain. No employee shall accept or receive a reward, fee, or gift from
any person for services related to the performance of duty unless given direct
permission from the Chief.
Employees shall not loan, sell, give away, or appropriate any service property.
Employees shall not pilfer or be guilty of theft.
Inefficiency or indifference of employees in the performance of duty shall be
grounds for discipline. The wrongful or injurious exercise of authority on the part
of any employee shall be grounds for discipline.
Employees shall not conduct any activity while on duty which would be
considered inappropriate or misleading to the public in fulfilling our mission. This
includes any questionable act, which in the eyes of administration, is not well
Insubordination, which is defined as the failure of an employee to comply with a
request, directive, or order issued by a ranking supervisor, will not be tolerated.
Employees guilty of such shall be disciplined. Insubordination shall also be
defined as abusive language and/or blatant disrespect to a ranking supervisor.
An employee shall notify one’s ranking supervisor immediately if said employee is
arrested, accused, investigated, or convicted of any crime as stated in the Hamilton
County Government Employees Handbook. This includes any charge,
investigation, or action against any employee related to their licensure by the State
EMS Division or Board.
Weapons, as defined by Tennessee State Law, shall not be carried on HCEMS
medic units, with the exception of Tactical personnel.
Employees shall not willfully or knowingly place themselves or their partners in a
dangerous or hostile situation. HCEMS endorses a “STAND BACK” policy. The
law enforcement agency having jurisdiction is trained, equipped, and charged with
mitigating such situations.
Employees shall not post any Hamilton County General Government and /or
HCEMS photos, uniforms, equipment or vehicles on computer web sites for
personal use. This includes any acts of questionable nature. Photos of any job-
related scenes or events are prohibited unless they are directly associated with
mission needs or requirements. The personal use, dissemination, or distribution of
any original or reproduced image is also prohibited. Patient privacy is paramount
and all efforts must be directed at maintaining that anonymity and confidentiality.
Section D - On Duty Meals
All meals will be eaten in the individual medic unit’s assigned district. Units on
relocation may eat in the district in which they are relocated, alarms and time
Units shall remain in-service during meal times.
Only one on-duty medic crew may eat at any one location. The shift supervisor
may grant an exception if needed and coverage allows.
Units shall break for meals only as alarms and duties allow.
The use of station kitchens is strongly encouraged.
No food or drink shall be consumed in the medic unit at any time. Food may be
carried in the cab of the unit, in closed containers, back to the station.
Medic units are allowed one, one-hour meal, out of station in a 24 hour shift.
Medic units may not leave the station for the purpose of an out-of-station meal.
Only when returning from an alarm, assignment etc. are out-of-station meals
Section E - Station Boards and log books
The station log is to be completed each shift.
The following information shall appear in the station logbook:
A. Date, Day of Week, Team on Duty
B. Crew on Duty
C. Time on Duty
D. Time of Radio Check
E. Any maintenance performed on the station
F. Any maintenance that is needed on the station
G. Any maintenance performed on unit
H. Any maintenance needed to be performed on unit
I. Any station duties performed that day
J. Amount of fuel obtained for unit
K. Any problems or comments about the station or unit
L. List any equipment left at a hospital if not picked up during the shift.
M. List any medications that need to be replaced.
Only pertinent information is to be written in the logbooks. Personal complaints,
problems between crews, grievances or any other non-business type entries, are not
The bulletin board shall be kept neat and organized at all times. Memos and
announcements that are more than thirty days old shall be placed in the station
memo file for future reference. Schedules, calendars, special event notices, etc.
that is appropriate for public viewing may stay on the board as long as they are
E-mail shall be read at the beginning of each shift and should be checked
periodically thru out the shift. E-mails will not be deleted prior to being read.
This is a vital source of our communication.
Section F - Leave Time and Swaps
Personnel are entitled to accrue leave time as stipulated in the Hamilton County
Employee Handbook, Section 502.
Employees shall be charged with one hour of leave time for every hour they are
off. Employees who have exhausted all leave time must request leave without pay
in writing through the Director of Emergency Services.
Personnel requesting sick time will notify their supervisor no later than two hours
prior to start of the shift. Notification as soon as possible would be appreciated.
Vacations will be requested no later than one month prior to need and will be
approved by the Shift Supervisor based upon personnel availability.
If a conflict occurs for leave time on the same day between personnel, the conflict
will be decided according to the following guidelines:
A. Seniority with Hamilton County EMS in accordance with the HCEMS
Service time policy.
B. A notice of at least 30 days is necessary for one employee to “bump”
another employee regardless of seniority.
Medic Units shall be staffed at all times. Only the Shift Supervisor or a ranking
supervisor may authorize a medic unit to be out of service. Personnel may not
leave their duty station or medic unit without permission from the on duty Shift
Supervisor or ranking supervisor.
Personnel injured on duty will be charged accrued time starting the shift following
the injured shift. Employees will then be paid according to Hamilton County
Policy upon the exhaustion of accrued time.
Personnel leaving their duty station before completion of shift will be charged
personal leave time for time remaining in shift. This will be termed as
Personnel will be allowed to swap duty time with personnel on different shifts
based upon the following criteria:
a. Supervisors must swap with peer supervisors.
b. Employees may swap with other employees on teams other than their
own regardless of sector. Swaps are preferred with same station
c. Employees are not allowed to travel on duty to other stations for swaps.
d. Swaps will be for 12 or 24 hours only. 7am-7pm, 7pm-7am, or the entire
shift. Swaps will be submitted and approved at least 72 hours before
e. Swaps must be completed in the seven-day pay period and the maximum
amount of hours any employee may swap in a seven-day period is 48.
The period is from Wednesday-Tuesday.
f. Swaps are a privilege and staffing issues come first. Supervisors are not
required to move employees to accommodate a swap and may cancel a
swap at any time when in the best interest of the service or to maintain
Class A staffing.
g. Administration may alter or cancel the swap program when in the best
interest of the service.
Leave and swap requests must be filled out completely and approved by the Shift
Supervisor before they occur. It is the responsibility of the employee to obtain the
necessary approval and signature of their supervisor. Employees are to E-mail
and/ or call their supervisors as paperwork can sometimes be misplaced or delayed
Section G - Awards Program
The following medals may be given to employees for actions performed or service
given. They are listed in order of precedence, indicating the order in which they
should be worn.
Medal of Honor - Given for outstanding and heroic performance of duty
where recipient’s life was in danger and whose actions were crucial in
saving a life.
Medal of Honor (Posthumously) - Given for an employee killed in the line
Grand Cordon Medal –Given to the employee selected as “Medic of the
Year.” Employees of HCEMS select from their ranks each year a “Medic of
the Year.” This person is one who the employees of the service feel has
exhibited outstanding performance in one’s duties and portrays the highest
level of professionalism. Any employee who is at least an EMT with HCEMS
is eligible for this honor.
Honorable Service Medal - Given to an employee for every three years of
uninterrupted service with HCEMS.
Educational Achievement Medal - Given to an employee who graduates
from college with a degree.
Exceptional Duty Medal - Given to an employee who has shown
performance above and beyond the call of duty. This may be for the
performance of additional assignments, or implementation and/or teaching
of programs, or any other outstanding achievement that may bring acclaim
to the employee and/or HCEMS.
The Chief’s Award – Given to a Supervisor who has shown performance
above and beyond the call of duty. This may be for the performance of
additional assignments, or implementation and/or teaching of programs, or
any other outstanding achievement that may bring acclaim to the employee
The Samaritan Medal - Given to a civilian for helping to save or saving a
Honorable Discharge Medal - Given to an employee who leaves or retires
from HCEMS, who has at least 20 years of service, and has served the
community in an outstanding and honorable fashion.
Citation bars are worn ¼ above the name tag. The bottom edge of the citation bar
should be parallel to the name tag and centered over the button. When multiple
citations bars are worn, they are worn in order of precedence with the highest
award closest to the heart. Multiple awards should be worn in rows of three, end to
end, so that no space is visible between the bars. The overall length of the row
should be centered over the button
Any supervisor may recommend an employee or civilian for a medal. Employees
may recommend through their ranking supervisor. The Shift Supervisor and
Chiefs must vote unanimously to award the medal. Recommendations must be in
writing and cite complete details of the actions, accomplishments or incident if
Appurtenances, which are decorations worn on the citation bar, indicate multiple
awarding of a particular medal. These are defined as follows:
A. Silver Star - 2nd medal awarded
B. Gold Star - 3rd medal awarded
C. Oak Leaf - 4th medal awarded
D. Gold Acorn - 5th medal awarded
E. Any subsequent awarding will be decided at that time.
Devices are badges or insignia authorized for wear on the dress uniform coat.
They are worn with the bottom edge ½ above the citation bars, centered over the
button. Currently the only authorized device is the National Registry Pin.
The Quality Assurance Team shall select each month a “QA Medical and Trauma
Call of the Month.” From these, a “QA Medical and Trauma Call of the Year”
shall be awarded to the teams on these alarms.
HCEMS awards “Blue Ribbon Commendations” for excellence in customer
service and patient care. Any patient, citizen, employee, or supervisor may
recommend someone for a Blue Ribbon Commendation. Annually, the employee
who receives the most Blue Ribbons each year will receive the “Grand Blue
Ribbon Commendation Award.”
Hamilton County Personnel gives a length of service award to all employees in 5
year increments. It is authorized for wear on the dress uniform jacket. It shall be
worn on the right coat pocket flap, centered between the button and the seam. Only
the most current pin should be worn
Employees of HCEMS select from their respective teams, each year a
“Stretcher Bearer of the Year.” This person is one whom the employees of the
service feel has worked hard to improve his/her skills, patient care, customer
service, and general performance in our service. Any employee who is at least an
EMT with HCEMS is eligible for this honor.
Section H - File Maintenance
A copy of all certifications and licenses will be kept on file at administration, in
each employee’s training file.
It is the responsibility of the Training Officer to ensure that all personal training
files are maintained and in proper order according to Tennessee EMS Regulations.
It is the responsibility of each individual employee to submit a current copy of all
licenses and certifications to the Training Officer.
When a certification or license expires, the renewal shall be copied and sent to
administration within seven days of receipt of the renewal.
Any certification, license, or document not on file shall be considered expired until
proof is shown otherwise. Personnel with expired mandatory licenses will be
suspended until licensure is updated and current.
Section I - Training
Training will be scheduled by the Training Officer according to Tennessee
Department of EMS Regulations and the needs of the service. State EMS requires
12 hours be provided each year per employee.
Topics for training shall be set by administration according to state requirements,
need, course curriculum, and availability of resources.
Each crew shall report to the designated training site at least ten minutes prior to
the start of the session, as alarms allow.
Training sessions which are cancelled or rescheduled shall be approved by the
Crews may train on an individual basis outside of the scheduled training as duties
and alarms allow. Such training includes equipment familiarization, ACLS review,
BTLS review, etc.
A training form shall be completed and turned in to the Training Officer for all
Administration may assign additional training to personnel if deemed necessary,
Records of training shall be kept on file for annual State audits.
ACLS & BTLS will be provided in house several times throughout the year.
Section J - Observation Program
Approved Observers – Family, friends 18 or older, and any personnel affiliated
with a fire department or rescue squad within the HCEMS jurisdiction. Personnel
who are certified/licensed as a medical professional (physician, nurse, EMT, etc.)
may ride as approved by administration.
Approved Time Frame – 10:00 hours to 22:00 hours
Proper Dress: Navy blue or black uniform pants, light blue/navy blue dress shirt
or golf shirt. No T-Shirts allowed. Black socks with black shoes/boots.
Persons wishing to observe must obtain permission from the affected District
Supervisors as well as the affected medic crew.
Persons wishing to observe must make the request at least seventy-two hours prior
to the shift in which they wish to observe.
A release of liability and wavier form must be signed by all observers. A new form
must be completed and signed on each observation ride.
Observers will be under the direction of the lead medic and/or a supervisor.
Observers may be asked to leave at any time by the lead medic and/or a supervisor.
Each observer shall be limited to 32 hours per month.
Under no circumstances are there to be 4 persons on the medic unit without the
approval of a supervisor. Alarms are excluded if patient care warrants the need.
Under no circumstances are observers to perform invasive procedures or function
Section K - Student Clinical Rotations
Preceptor: A HCEMS Paramedic who has been approved by
administration and the Paramedic Program Director as a field
Clinical Shift: 07:00 hours to 22:00 hours.
Approved Clinical Uniform: Navy blue or black uniform pants, light blue, navy, or
white dress shirt or golf shirt. No T-shirts allowed. Black socks
with black shoes/boots.
Participation in the clinical program is voluntary on the part of the preceptors.
A clinical schedule will be forwarded to the training officer and supervisors where
The designated preceptor shall accompany the students in the patient compartment
on all alarms.
Students shall be allowed to perform skills appropriate for the level of training in
which the student is currently involved. The preceptor, however, has the right to
refuse the performance of any skill in which the preceptor does not feel
comfortable allowing the student to perform.
The preceptor shall intervene and take over patient care in the event the preceptor
feels that the student’s course of action will endanger the patient’s well being.
In the event of a problem between the student and a member of the medic crew, the
student may be removed from the medic unit by the preceptor or a supervisor. In
this event, the Clinical Coordinator or the Program Director of the educational
facility will be contacted as soon as possible.
The student will meet the medic unit at the station. In the event the unit is not in
station, the student shall wait outside the station and not enter until the medic unit
All students shall be subject to all HCEMS procedures, and policies.
HCEMS personnel who are enrolled in Paramedic School shall not be permitted to
count any on duty time as clinical time.
Students shall report no earlier than 10 minutes to the start of the clinical shift.
They shall depart by 22:00 hours, unless on an alarm.
Preceptors function in conjunction with the educational programs and shall
complete any documentation or procedures as required.
Preceptors shall not discuss the performance of a student with other shift personnel
or students. Administration reserves the right to investigate any situation or any
person’s performance as deemed necessary.
In the event of a scheduling error and two students show up to ride, the ranking
supervisor will be notified. The supervisor will make any reassignment decisions.
It is the student’s responsibility to notify the educational facility Clinical
Coordinator of the conflict. The following criteria will be considered in this
a. Paramedic students take precedent over EMT students.
b. If both students are of the same standing, the ranking supervisor
will make the determination.
The Shift Supervisor may alter the student’s assignment if needed for proper team
Section L - Quality Assurance Program
The Quality Assurance Program for HCEMS shall be conducted by the Quality
Assurance (Q/A) Team. This Team is comprised of the Customer Service Officer,
District Supervisors, the HCEMS Medical Director, and any other Physician
Advisors of the service. The Chairperson of the QA Team shall be the Medical
Director. In the absence of the Medical Director, a Physician Advisor shall be the
chairperson. If a Physician Advisor is unavailable, the Customer Service Officer
shall be the chairperson.
Each month the QA Team shall hold a meeting where a report of the previous
month’s trip reports, patient care, documentation, etc. is given and reviewed.
Alarms shall be reviewed as directed by the Team. Statistics and any other
information needed by the Team shall be received and reviewed.
The purpose of the Q/A program is to ensure that quality and correct patient care is
given in a consistent and timely manner, utilizing proper procedures, protocols
and/or standing orders.
Each reviewing member shall select a trip report which portrays excellent
documentation, patient care, and effective and proper use of standing orders and
protocols for both medical and trauma. These reports shall be given to the Training
Officer, Customer Service Officer and the Deputy Chief to be considered for Q/A
Call of the Month.
The Q/A Team shall be empowered to call any and all personnel before it in order
to conduct business and to fulfill their mission. This is not a disciplinary process
and no one is allowed in except the affected employee(s) and specific team
members reviewing any case. Attendance at such hearings is mandatory.
Employees may attend a meeting by requesting to do so through their ranking
supervisor. Employees are allowed, as facilities will accommodate. The employees
are there only to observe the process but will not attend confidential matters
dealing with specific employees called before the Q/A Team.
Section M – Customer Service
Customer Service: The art of performing assigned duties with a positive attitude,
professionalism, respect, competence, honesty, service to the public and co-
workers regardless of personal belief or opinion, and in a manner worthy of the
trust the public has placed in our profession.
Employees are Hamilton County EMS. When you present yourself to the customer
you represent the whole service and the perception of Hamilton County EMS
depends on the professional service you provide. The service you provide should
be, and is expected to be, superior to other services, both in care and service.
Employees are expected to meet the medical needs, as well as the emotional needs,
of each patient. Each patient will present with different needs. It is up to the
employee to identify and meet those needs without compromising medical or
Employees shall practice both internal and external customer service at all times.
Employees will be treated as internal customers at all times.
Employees will consider each patient, other public safety agencies, and the public
at large as external customers.
Employees will treat all customers with respect regardless of race, sex, age,
disabilities, financial status, political affiliation, creed, nationality or the
employee’s personal feelings about the situation.
Employees will treat all customers with mutual respect, courtesy, and
professionalism, with the goal being restoration of health, while respectfully
controlling the situation at all times in a non-judgmental or non-confrontational
manner. Employees should seek to care for the patient in a manner consistent with
our service’s mission.
The employee’s primary focus shall be on patient care. Issues such as billing and
insurance are not part of patient care. Billing and insurance questions will be
referred to administration.
Employees will be accountable for their actions and conduct themselves in a
manner appropriate for a public servant. While all situations are different, every
effort should be made to create a positive outcome for our patients. While a
positive medical outcome for the patient may not be possible, every effort should
be made to provide a positive impact on the people’s lives we touch, not just for
Employee’s shall not impose or express personal feelings, political affiliation,
convictions, religious beliefs, or opinions upon patients or other customers at any
In the event of a complaint from an internal or external customer, it should be
forwarded the Customer Service Officer for investigation and/or resolution.
All complaints or issues of dissatisfaction about the service should be handled in a
confidential and professional manner. When appropriate, the Customer Service
Officer will brief Administration on complaints not resolved to the customer’s
Section N – New Employee Field Orientation
New full and part-time employees will orientate a minimum of 116 hours. The
field orientation time will be completed as follows:
a. Complete nine 12 hour shifts on a District Supervisor unit. The
employee must work 3 shifts at night and encounter a minimum of 6
different District Supervisor in all 3 sectors.
b. Complete 8 hours in supply.
The District Supervisor will complete a written daily evaluation, which will be
submitted to the training officer for review.
The employee will complete the orientation packet during the field orientation.
This completed packet will be submitted to the Training Officer before being
released to work.
Part-time employees have 4 weeks to complete the program, working a maximum
of 36 hours per week.
Full time employees will complete the orientation while on shift. Employee will
finish the orientation as soon as possible. The Shift Supervisor will oversee the
training and report to the Training Officer.
Full time employees will be evaluated by the District Supervisor who is assigned
HCEMS OPERATIONAL GUIDELINES
ARTICLE II – UNITS AND STATIONS
Section A - Unit Readiness and Vehicle Maintenance
The on-duty crew shall completely inspect, check off, wash, and clean their
assigned unit and have it ready for inspection by 08:30 hours, alarms permitting. If
the unit is not acceptable, the crews shall communicate such and have deficiencies
corrected before any crew member leaves. The district supervisor shall intervene if
crews cannot agree.
The inspection shall consist of completing the mechanical check-off form, the
ambulance supply form, and the equipment check-off and order form.
Any new damage to the vehicle, an extremely low supply situation, a mechanical,
or low fuel problem, etc. that would take the unit out of service, compromise
safety, or interfere with our mission, should be brought to the attention of one’s
The unit shall be refueled daily. The amount of fuel taken on is to be recorded in
the station log book. The unit shall have over one half of the total fuel capacity at
shift change. An effort to change shifts with a full tank of fuel is recommended.
If the unit is on an alarm at shift change, it shall be fueled prior to returning to the
station, or as directed by a supervisor. All units shall be refueled no later than
23:00 hours to comply with paragraph four.
Any damaged or missing equipment or supplies, etc., should be brought to the
attention of support services for repair or replacement and proper forms completed.
If support services (supply division) is unavailable or off duty, contact the shift
Maintenance, whether scheduled or unscheduled, will be coordinated by the Shift
Supervisor or the supervisor having jurisdiction. A note detailing the deficiencies
shall be placed on the dashboard of the unit by the crew placing the unit out of
Supervisors shall keep administrative and support vehicles presentable at all times.
Crew members SHALL NOT make any changes to the units without approval
from Administration. Examples are radios, CD players, altering of unit chassis or
module wiring or equipment, emergency warning devices or any other item as
determined by Administration. If in doubt, ask.
While at the hospitals crewmembers shall leave the ambulances running. Every
effort shall be made to move the ambulance to an appropriate parking area ASAP
after the patient(s) has been unloaded to keep the hospital lanes open and keep
exhaust fumes from entering the buildings.
While a crew is mobile in district in the ambulance and decides to stop at a public
venue, for whatever the reason, the vehicle is to be parked and TURNED OFF. An
appropriate area for rapid response will be necessary.
The ambulance shall be locked at all times while out in public, unless attended by a
Tobacco products are NOT permitted to be used in, or within 10 ft. of, the
ambulance at any time under any circumstance.
Personal equipment and/or bags are not permitted to be used on the ambulance
without authorization from our Medical Director. If such equipment and bags are
authorized they shall be secured and/or stored in a compartment in a manner that is
safe and unimposing to patient care or our mission as a service. Said employee will
assume full responsibility for their personal equipment while it is on the
Section B - Station Duties
Paragraphs 1 and 2 shall be completed at shift change.
Paragraph 3 shall be completed by 10:00 hours each shift.
Paragraphs 4 and 5 shall be completed by 23:00 hours each shift.
If the station is not satisfactory to the on-coming crew, the off-going crew will
complete any needed duties before any crew member leaves. The District
Supervisor will intervene if needed.
A shift change report will be given to the on-coming crew by the off-going crew.
This will consist of unit status, station status, road conditions, and any needed
The designated paramedics shall exchange the narcotics keys after counting the
narcotics together. In case of a double paramedic unit, both on duty paramedics
All areas of the station shall be cleaned and organized. The floors shall be swept
and mopped where applicable. All supplies, equipment, hoses, etc. shall be
properly stored if not in use. If trash pick-up day, the trash is to be placed out
appropriately. The beds are to be made up.
The kitchen facilities shall be cleaned and organized. The eating area and tables
are to be cleaned, all dishes washed, dried, and put away in cabinets. All cabinets
are to be organized and cleaned, if necessary.
The trash from the station baskets is to be bagged and placed in the large trash
container in the bay. The bay trash container should be emptied as needed and
washed out. All dirty service linen is to be placed in the proper receptacle.
The station shall be kept neat, clean, and organized at all times.
These duties are to be completed every Wednesday or when needed, alarms
The bay shall be organized, swept, washed, rinsed, and squeezed. Do not wax the
bay floors. All lockers, closets, cabinets, etc. shall be emptied, cleaned and
The refrigerator shall be cleaned, inside and out. Any food in the refrigerator that
has spoiled shall be disposed of. The stove is to be cleaned, including burners, drip
pans, and eye rings. All ovens and racks are to be cleaned.
Smokers shall clean out the cigarette bucket. The paperwork is to be organized in
the desk. All cabinets shall be cleaned and polished with furniture polish. All
station windows, sills, blinds and ledges shall be cleaned inside and out.
The station grounds shall be patrolled and all trash picked up and placed in the
trash receptacle in the bay. The driveway and apron shall be washed off and swept
The unit is to be cleaned and disinfected, inside and out, including all
compartments, after the equipment has been removed. The unit will remain in-
The bathrooms, including all fixtures, shall be cleaned and disinfected.
Environmental system filters are to be inspected, cleaned, or replaced where able.
Section C - Station Maintenance and Repair
When an appliance, environmental system, operating component, electrical fixture,
etc. is in need of repair, the crew on duty shall notify their district supervisor by E-
mail and by verbal conversation. This information shall be forwarded to the Shift
Supervisor having jurisdiction, who will then contact the Hamilton County
Maintenance Department for follow up and coordination of the needed repair.
If the problem needs immediate attention, (bay door, heater during the winter, etc.)
the on-duty Shift Supervisor shall be notified and will take the appropriate course
of action. All station logs shall be completed accordingly.
Minor maintenance issues, such as changing of light bulbs, tightening of screws,
regular and proper care of assigned equipment and station facilities, shall be
provided by the crews where able.
Crew members are not allowed to rewire or alter the phone or computer systems.
Phone line jacks, computer system drives, printers, etc. shall not be altered without
permission from Administration. If in doubt, ask. Answering machines of any
type are not allowed on station phone lines and crews shall always answer the
phone with their Medic Unit number and last name.
Section D - Station Visitors
The visitation hours shall be from 10:00 hours to 22:00 hours.
Visitors are not allowed in the bedrooms at any time.
HCEMS crews are responsible for the conduct of visitors within our facilities.
When in our facilities, they are bound by our regulations and guidelines. If in
doubt, ask them to leave.
Animals and/or pets are not permitted in the station facility. Exceptions to this rule
are those animals assisting the handicapped.
Families of crew members are welcome as long as they do not infringe upon the
privacy and work environment of other crew members.
Supervisors shall have final say on any and all visitors in our stations and our
Section E - Work Station Assignment
Seniority – Service Time Guideline
Although Hamilton County Government does not have a formal seniority policy,
Hamilton County employees leave accrual rate and longevity pay are based on
continuous uninterrupted full time service (Section 401.14 of the Employee
Handbook). Employees who were re-hired or re-instated prior to May 16th, 2001,
are the only exception to this rule.
Hamilton County Emergency Medical Services will use the most recent hire date
in the EMS Department to establish the Employee Service Time Date. Prior
assignments within Hamilton County Government will not be considered in
establishing this date. The Service Time Date will determine an employee’s
seniority position within HCEMS.
When more than one employee has the same hire date, the date they were licensed
will determine the seniority position. In the event the hire date and license date are
the same, the employee with the lowest license number will determine seniority.
The Deputy Chief of Operations will be charged with obtaining the official and
accurate hire dates from Human Resources to establish the seniority list based on
uninterrupted service time in HCEMS.
The Deputy Chief of Operations will provide the seniority list to the Shift
The seniority list will be used to determine station assignments and vacation and
holiday leave time dates.
Station assignment re-bid process will begin on September 15th and rotations will
occur on October 1st in odd years. Assignments will be based on an employee’s
seniority, rank, and consistent Advanced Life Support Paramedic coverage. The
Deputy Chief of Operations and /or the Chief of Administration will approve
District Supervisors shall select from among the supervisor stations based upon
their uninterrupted time as an officer. In the event of the same promotion date,
license date will be used to determine seniority. In the event of the same promotion
date and license date, their license number will be used to determine seniority.
District Supervisors will select a paramedic partner and must have the approval of
the Shift Supervisor, Deputy Chief and /or Chief.
Employees shall choose a station assignment in the order of the employee with the
most seniority down to the least seniority on that shift. When a basic EMT chooses
a station, the resulting partner must be a paramedic. Floaters may choose which
floater station they float from as part of the seniority list. A float station is defined
as a station in which a District Supervisor is assigned.
Employees should understand that they are choosing their own stations and
partners within this system and that they will live with their choices. Problems with
partners will be worked out with each other, as other employees will be affected in
When a vacancy occurs at a station, it will be filled by seniority on the shift as long
as Paramedic coverage is assured. In the event no one bids on a station, the senior
floater will be assigned, unless Paramedic coverage is required. If a Paramedic
floater is available, he/she will be assigned to the vacancy. If a Paramedic floater
is not available, then the Paramedic with the least seniority from a double medic
truck shall fill the vacancy.
It shall be understood that Shift Supervisors may need to move personnel to assure
Paramedic coverage to accommodate days off, swaps, special training situations, or
other needs. This guideline will not interfere with the Shift Supervisor’s authority
to lead and manage the team.
The Shift Supervisor, under the following criteria, will coordinate requests for a
station change from an employee:
a. The employee will notify their ranking supervisor in writing requesting
the change and reasons why. An attempt will be made to resolve any
problems that may require the move.
b. The Shift Supervisor will assure that the employees on the individual shift
are aware of the change at the affected stations.
c. The Shift Supervisor will review the move with the Deputy Chief. The
best interest of the service and team operations will be first and foremost as
a major “jumble” will not be allowed.
This system is designed to provide a continued sense of “ownership” of
equipment and facilities and breed consistency in employee/supervisor relations
and district familiarization.
HCEMS OPERATIONAL GUIDELINES
ARTICLE III – OPERATIONAL PROCEDURES
Section A - Protective Clothing Use and Injury Prevention
The purpose of issuing and wearing protective clothing, and other injury
prevention devices is to assist the employees of HCEMS in maintaining as safe a
working environnent as possible. This equipment does not, however, take the
place of sound and prudent judgment. Alertness is the ultimate protector in any
Nothing in this section shall prevent the wearing of protective clothing when the
employee deems it needed. In all cases, protect yourself as well as you are able in
order to prevent injury.
Full protective clothing shall be worn on at least the following situations:
a. Motor vehicle accidents involving extrication, fires, or obvious hazards
(i.e. fuel spills, large amounts of glass, etc.)
b. Working structure fires unless the crew is very distant from the structure.
c. Haz-Mat incidents, radiological incidents, chemical incidents, etc., where
the clothing will afford protection in transporting patients. Radiological
response kits may be substituted.
d. Any other situation, such as construction sites, where protective clothing
may prevent or lessen the potential injury.
Statistics have shown that the use of helmets, gloves, and eye
protection are the most needed in injury prevention.
Therefore, use these items as much as possible. When in
doubt, put it on.
The most common injury to EMS personnel is your back. Always lift with your
legs and keep your back straight and firm. Do not lift a loaded stretcher and twist.
Walk with the weight.
Ballistic Armor, as issued, shall be worn as directed, and at least on situations
involving penetrating injuries, domestic disorders, unruly crowds, SWAT or
special police call-outs, etc.
HCEMS protective equipment may not be utilized when working for other
When approaching a railroad crossing, the driver shall remove his headset until
the crossing is clear. The driver has discretion to remove the headset whenever
necessary when approaching dangerous and/or blind intersections.
Part-time and/or new employees who do not have protective gear shall not be
allowed in the action circle and/or danger zones.
Section B - Protective Clothing Maintenance
It is the responsibility of individual personnel to provide proper maintenance, care
and cleaning of their issued protective clothing.
After returning from an incident in which protective clothing was worn, it shall be
cleaned and inspected. Dirt or any other substance which has come in contact with
the clothing shall be washed off. This shall be done as alarms allow.
Any damage found to the clothing upon inspection shall be reported to Support
Section C - Patient Transport
Patient Information and Confidentiality
HIPAA regulations shall be adhered to at all times. Patient information can only be
given to those agencies directly involved in patient care or the incident.
No information regarding the patient shall be given to the press, relatives, or
bystanders without being cleared through Administration.
The name of the patient shall, under no circumstances, be given out over the air.
No HCEMS personnel shall talk to an attorney about a call without the approval of
All patient information shall be properly secured at all times:
a. All paperwork shall be kept in the confidential file.
b. Computer screens containing patient information shall not be left opened
c. All unnecessary paperwork containing patient information shall be
All juvenile patients shall be treated and transported to an emergency department if
not accompanied by a parent or guardian. See Section E of this Article.
If the patient's parents or guardian can be contacted and they can come to the scene
within a fifteen-minute time frame, then the medic crew can wait on them,
providing there are no other patients and circumstances such as call volume allow.
If other patients are in need of transport, then the juvenile patient is to be
transported. No refusal of service may be received over the telephone.
If juvenile patient(s) are married or have children, they are considered emancipated
and are able to assume legal responsibility for themselves.
Patients in Custody
Patients placed in custody of law enforcement shall not be transported by HCEMS
unless the arresting officer or another officer from that agency can accompany the
patient to the emergency department.
In the event the responsible law enforcement agency cannot accompany the medic
unit, the crew shall advise the officers that neither HCEMS nor its employees are
responsible if the patient chooses to leave the medic unit or the hospital.
Violent or Combative Patients
If a patient, family member or bystander becomes violent or combative and needs
to be restrained or removed from the scene, law enforcement officers shall be
notified immediately, if they are on the scene. If they are not on the scene, EMS
personnel shall contact Communications and advise them of the current situation.
If the situation on the scene becomes life threatening and law enforcement is not
present, EMS personnel shall contact Communications and initiate a Code 443
HCEMS personnel should not become involved in the physical restraint of a
patient or bystander except to protect themselves or the patient.
In the event EMS personnel become the victim of physical violence, charges
should be filed with the law enforcement agency in whose district the incident
occurred and the ranking Supervisor notified, who will ensure all incident reports
are properly completed.
A paramedic shall accompany all patients transported in HCEMS units.
The lead medic shall determine the mode of transport to the hospital. (Emergency
HCEMS will not transport direct admit patients or patients to a doctor's office
unless approved by Administration or we are declared in business for such
convalescent transports. HCEMS shall only transport to an emergency department
or the Forensic Center.
HCEMS shall not transport any emergency type of alarm to a hospital that does not
have EMS radio communications capabilities as their normal operations.
Patients shall be transported to the hospital of their choice, provided it is within
reasonable limits, meets injury or treatment facility requirements, or is approved by
a ranking Supervisor. The Shift Supervisor shall evaluate transports to Hutcheson
E.R. Patients requesting inappropriate facilities shall be transported per regional
or local directives/destination guidelines.
In the event of a disaster, weather emergency or when the patient condition
warrants such, the destination may be overridden by the paramedic and the patient
may be taken to the nearest appropriate hospital.
In the event of a hospital to hospital transport, a nurse from the transferring
hospital shall accompany the patient to the receiving hospital, when appropriate.
HCEMS is not responsible for the return of hospital or first responder personnel
when transporting, however the crew of the medic unit may, at their own
discretion, return such personnel with the understanding that the unit is in-service
and subject to a call.
Only one family member (rider) is allowed to accompany the patient to the
hospital. The family member shall ride in the front passenger seat unless, in the
opinion of the lead paramedic, the presence of the family member in the patient
compartment of the unit would enhance patient care. The decision to allow or
refuse a rider shall be at the discretion of the medic crew. The medic crew shall
consider patient care, safety, and customer service when making their decision.
The maximum number of patients that can be transported at one time is restricted
by the availability of vehicle safety restraints and the number of patients that can
be properly cared for.
Personnel may request additional assistance whenever deemed necessary and
HCEMS shall transport all DOA's to the Forensic Center.
When crewmembers confirm a DOA, they shall notify dispatch and request Law
Enforcement, if not already on scene, and protect any crime scenes. Crews shall
attempt to obtain patient information. Once the Law Enforcement agency arrives,
the crew shall brief the officer and return to service.
Deceased victims are under the oversight of the Medical examiner's office and the
local Law Enforcement Agency. They shall have jurisdiction and the
responsibility for the deceased. EMS units may be pulled from such scenes as
needed for alarm response.
HCEMS personnel may utilize our "Forensic" transport unit as they deem
necessary. This unit shall be maintained by support services. Personnel using this
unit are held responsible to return this unit to service in clean and acceptable
condition and ready for the next alarm where it may be needed. If problems are
found that cannot be resolved by the crew, Support Services should be notified.
Decisions for discontinuing CPR should be made prior to transport. Once transport
begins do not discontinue life support. The patient shall be transported to the
nearest appropriate medical facility.
Emergency Department Bypass
Bypass should only be initiated when delayed patient care or system overload
directly impacts the mission to our service area.
Anytime an ambulance presents a patient to an emergency department and transfer
to the facility is, or is potentially, delayed longer than 15 minutes, dispatch will be
notified. They in turn will notify the Shift Supervisor, who will respond to the
affected facility for personal evaluation of the situation.
The Shift Supervisor, after evaluation, will notify Dispatch of an E.D. Bypass, if in
his/her estimation the situation will not rapidly correct itself and will potentially
cause a backlog of H.C.E.M.S. ambulances at that facility. Dispatch will then
notify all units of the bypass situation. Units currently in transit to that facility will
continue to their destination. Units beginning transporting during the event will
not transport to the facility and will explain to all patients the need for transport to
another facility. The facility chosen for destination will be the closest appropriate
facility and transport time must be less than potential wait time at the original
facility. Local destination protocol (trauma, stroke alert, code stemi) takes
precedence over the bypass decision.
The Shift Supervisor, if possible, will remain at the facility until the situation is
corrected. He/she will then notify Dispatch of the cancellation of the bypass status.
Dispatch in turn will notify all units of the return to normal transport operations.
The bypass may be initiated by a District Supervisor if he is on the transport unit
affected by the transfer delay, but must be approved by the Shift Supervisor, who
will personally notify Dispatch of the bypass. A Chief Officer will be consulted in
any situation outside of the parameters for approval of initiation of bypass.
Section D - Supply Acquisition
Employees shall complete their station and unit supply check-off forms and place
them in the station out-going mail box. Supply requests will be made the shift
before the delivery day in accordance with par levels on the unit supply check-off
form. If it is an order day for a particular station, this order shall be sent no later
than 7 a.m. on delivery day. Request shall be made in by E-mail to supply at:
EMSSUPPLY@EXCH.HAMILTONTN.GOV. An e-mail will also be sent
stating no supplies are needed when applicable. If e-mail service is unavailable
requests shall be called in by telephone to supply by 7 am. The Support Services
Division will deliver supplies according to these requests.
Support Services should be notified immediately anytime critical or state required
supplies are needed. In the event of a depletion of supplies after normal operating
hours and on weekends, employees shall notify their Shift Supervisor and
arrangements will be made for the acquisition of the needed supplies from Support
Employees having ideas or suggestions for the acquisition of a new product or item
shall provide the Supply Officer with said information.
Large amounts of supplies shall not be kept in individual stations. Inventories
should be limited to par levels on the unit supply check-off form or the station
Medic unit crews SHALL NOT restock supplies to First Responders agencies.
The First Responder’s Department representative shall obtain all First Responder
supplies from Support Services in accordance with established procedures.
Any time a piece of Patient Care equipment experiences a failure, Support
Services, and the Shift Supervisor shall be notified. The medic unit will be out of
service in the event of a Patient Care equipment failure until the problem is
resolved or the equipment replaced. Anytime a piece of Patient Care equipment
fails, it shall not be used for patient care until authorized by Support Services. An
incident report shall be completed by the crewmember experiencing the failure.
Patient Care includes the following: Cardiac Monitor, blood glucose monitor,
pulse oximeter, blood pressure monitors, capnography equipment and any other
piece of medical equipment not listed. Medic crews shall not attempt repairs.
Employees or students shall not use Non-HCEMS medical equipment or supplies
unless approved by the Medical Director, Deputy Chief or Chief.
Medication shall be replaced according to the medication replacement policy in
Section E - Refusal of Service
When crews are confronted with a patient who is refusing treatment or transport,
the crew should have the patient sign a refusal of service form. This form will be
completed along with the trip report.
If the patient refuses to sign the form, attempt to have a third party, such as a police
officer, if on the scene, witness the refusal and sign the form. Adequate
documentation is of the utmost importance.
In order for a patient to refuse treatment, transport, or go against medical advice,
such advice must have been given. If a patient should be transported to a hospital,
give the medical reasons for the potential consequences to the patient, within your
training and scope, if transport is refused.
If medical care is obviously needed and the patient still refuses treatment or
transport, contact Medical Control for assistance in making a determination.
Follow the direction of Medical Control.
Juveniles, as defined by Tennessee State Law, shall be treated unless a parent or
legal guardian refuses treatment or transport. If the juvenile's life is in jeopardy,
contact Medical Control and follow their directives. A juvenile cannot sign a
refusal of service form. An emancipated minor (defined as a juvenile that is
married or has a child) is the only exception to the aforementioned rule.
Crews shall not accept telephone instructions from a parent or guardian. Instead
transport without delay to a medical facility. DO NOT WAIT ON THE SCENE
ANY LONGER THAN 15 MINUTES FOR THE PARENT OR GUARDIAN
TO ARRIVE. TRANSPORT OR CLEAR THE SCENE AND IF
NECESSARY, CONSULT WITH YOUR RANKING SUPERVISOR.
A representative of the school system and/or a school principal may sign the
refusal for minor students who are under school oversight or control.
Every effort should be made to transport the patient. However, if a patient of legal
age still refuses to be transported or treated, clear the scene and document well.
We cannot make people go to the hospital. If a patient refuses to sign a refusal
form, Law Enforcement or another witness shall sign and document in comments
The refusal form will be read to the patient and they shall receive a copy of the
Notice of Privacy Practices.
Ask patient permission to do an assessment and check vitals on all patients that
refuse transport. Do not touch any patient that does not give you permission.
Section F - Documentation
A hard copy written Medical Assessment Chart shall be completed on every alarm
where a patient is assessed and treated. A soft copy of every alarm assigned a run
number shall be entered in the station computer complete and correct. If the
computer system is down, a hard copy billing sheet shall be completed and
forwarded to billing. The computer reports should be properly transmitted to
billing. These reports shall be completed by the end of the shift in which the alarm
occurred. Exceptions are at the discretion of the Shift Supervisor.
The Medical Assessment Chart should be completed at the hospital, provided there
is sufficient coverage of medic units. Twenty minutes shall be the maximum time
allotted for the completion of routine calls and unit turnaround. Crews shall notify
dispatch if the unit has a delay in returning to service.
All narratives shall be completed using the H.A.T. format.
All Medical Assessment Chart's and all other reports and forms shall be completed
in black ink.
Section G - Severe Weather Alerts
In the event of severe weather conditions such as major thunder or snow storms,
tornados, flooding or other weather related emergencies, HCEMS shall be placed
on a severe weather alert.
Chief Officers and/or the on-duty Shift Supervisor shall be advised of the weather
situation and determine the need of a severe weather alert.
In the event that a severe weather alert is initiated after 19:00 hours, the on-coming
Shift Supervisor shall be paged by Communications and notified of the situation.
The on-coming Shift Supervisor shall report to their assigned duty station at least
two hours early in order to coordinate on-coming crews and stay appraised of the
In the event the weather prohibits the on-coming crew from reporting to their duty
station, the crew shall notify the appropriate supervisor no later than 06:00 hours.
At this point the on-duty supervisor may advise the following:
a. Report to a different duty station.
b. Wait until weather conditions lesson, then report to an assigned station.
In the event of a severe weather alert, the on-duty crews will be subject to work
overtime to maintain minimum staffing until relief crews report for duty.
During a severe weather alert, the on-duty Shift Supervisor shall be briefed by
Communications periodically with a weather update from the National Weather
During a severe weather alert, the on-duty Shift Supervisor may determine the
a. All units must remain in stations unless on an alarm, relocation or to fuel
b. Special considerations, such as raising bay doors or other directives may
During a severe weather alert, all units shall utilize main roads as much as
possible. Units shall avoid secondary roads unless required for response on an
alarm. The unit shall proceed with caution on all secondary roads until traction is
compromised, then the fire department having jurisdiction, or other resources shall
be called for assistance.
In the event of snow and ice, units shall not make use of driveways or dirt roads.
Every effort must be made not to disable the unit. The unit shall request assistance
from the fire department having jurisdiction or other appropriate resources.
In the event of a severe weather alert, crews may utilize whatever means available
for transporting the patient from the residence to the unit and if necessary, the
In the event of a severe weather alert, medic crews may utilize an aero medical
service to transport the patient if the unit cannot readily access and/or transport the
At any time a Chief Officer or the on-duty Shift Supervisor may cancel a severe
The Shift Supervisor shall maintain a list of all shift employees that are to report to
work 12 hours early and/or stay 12 hours late when operating on a 36-hour shift.
Support Services will amend order and delivery schedules for supplies as dictated
by weather conditions. Delivery may be canceled completely and unit come to
supply as they return to quarters from the hospitals if items needed are critical or if
necessary units will be met at a central location.
Section H - Driving Procedures
Any person operating a HCEMS vehicle shall be a Hamilton County Emergency
Services employee. In an emergency situation Non-Hamilton County Emergency
Services personnel shall not operate a HCEMS vehicle without the direct approval
of the Director, a Chief Officer, or the Shift Supervisor.
Any employee operating a HCEMS vehicle shall have a valid Tennessee driver's
license with an F endorsement or equivalent in their possession at all times. No
employee shall operate a HCEMS vehicle without supervision prior to completing
the required driver orientation period.
Any and all condition codes noted on the driver’s license should be strictly adhered
to at all times while operating a HCEMS vehicle.
No person shall operate a HCEMS vehicle while under the influence of any
chemical or medication, prescription and alcoholic beverage or otherwise, which
could alter judgment or reflexes.
Any person taking prescription medication, as per paragraph four, shall notify their
on-duty Shift Supervisor for driving approval prior to operating a HCEMS vehicle.
Directional signals shall be used at all times.
Any person operating or riding in a HCEMS vehicle must fasten their seat belt,
unless its use would preclude providing patient care.
The use of any tobacco products and food product consumption is prohibited in the
vehicle. Per Tennessee State Regulations smoking is prohibited within 10 ft. of an
The driver of an HCEMS vehicle shall use prudent judgment and shall operate the
vehicle in a responsible manner at all time and with special caution on unpaved
roads. The medic unit should not be driven into non-traveled areas such as across
curbs into grass or other areas with poor clearance that would cause damage or
where the unit will become stuck in mud or other low traction situations.
Any backing shall be done with a spotter, if available. If a spotter is not available,
the operator shall do a 360 degree walk around and visual clearance check prior to
backing. The back-up alarm must be activated.
Each station shall have at all times in their reference material, a copy of the
HCEMS "Safe Vehicle Operating Supplement." The information in the “Safe
Vehicle Operating Supplement” shall be a part of this SOG and adhered to at all
time. The Supplement contains information specific to operating within our service
area and useful driving procedures.
The drivers of an HCEMS vehicle shall ensure all vehicle doors and compartments
are closed prior to moving the vehicle.
The driver of an HCEMS vehicle shall insure that the bay doors are completely up
and stopped prior to placing the vehicle in motion and exiting the station. After
exiting the station the driver and the partner should insure the bay door is
completely shut before leaving the station.
Anytime an HCEMS vehicle is parked the parking brake shall be applied. Medic
units shall use wheel chocks at all times when the unit is parked on an incline.
Emergency Operating Mode
Any person operating a HCEMS vehicle, in the emergency mode, shall have
completed an Emergency Vehicle Operations Course, Coaching the Emergency
Vehicle Operator Ambulance (CEVO Ambulance), or approved equivalent.
All audible and visual warning systems shall be used when operating the vehicle in
the emergency mode. While at the scene of an emergency the use of visual warning
shall be used when necessary to protect the vehicle from hazards.
During an emergency response, vehicles shall obey all State laws in regard to
emergency response unless this SOG provides stricter guidelines.
HCEMS vehicles may exceed the posted speed limit as weather conditions, due
care, and caution permit. At no time will a vehicle exceed the posted speed limit by
more than twenty miles per hour. The regard for the safety of the public shall
always be the primary concern.
Vehicles operating in the emergency mode have the right of way; you should
operate the vehicle as if you are “requesting the right of way.” At no time should
the special provisions of emergency response be exercised in a careless or reckless
When approaching a controlled intersection in the emergency mode, units will do
a. When approaching a traffic signal displaying a red or yellow signal,
the vehicle shall come to a complete stop. All crew members should
check the intersection for approaching vehicles and other hazards to
ensure safe travel through the intersection. The unit should proceed
only after all traffic has yielded the right of way and the intersection is
clear. The same shall hold true for controlled intersections displaying a
b. When approaching an intersection displaying a yield sign, the vehicle
shall slow to a safe speed in order to stop if needed. All crew members
should check the intersection for approaching vehicles and other
hazards to ensure safe travel through the intersection. The unit should
proceed only after all vehicles have yielded the right of way and the
intersection is clear.
c. When approaching an intersection displaying a green signal, the
vehicle shall slow and prepare to stop if needed. All crew members
should check the intersection for approaching vehicles and other
hazards to ensure safe travel through the intersection. The unit should
proceed only after all vehicles have yielded the right of way and the
intersection is clear.
When operating in the emergency mode, vehicles should not pass another vehicle
that is operating in the emergency mode unless the vehicle yields or directs you to
When operating in the emergency mode, traffic should be passed on the left. If a
vehicle must be passed on the right, all crew members should check for vehicles
that may be a hazard to ensure safe travel past the vehicle(s) being passed on the
right. The unit should proceed only after all vehicles have yielded the right of way.
When operating in the emergency mode, vehicles shall use all directional signals at
all times when making turns. The vehicles hazards flashers shall not be used while
the vehicle is in motion.
When approaching a school crossing zone or a school bus with flashing lights, the
operator shall slow and stopping when necessary, regardless of the emergent
response unless directed otherwise by the school patrol officer or bus driver.
The unique hazards of driving require operators to use extreme caution and to be
alert and prepared to react to the unexpected.
Operators shall obtain a confirmed visual clearance of all railroad intersections
prior to crossing, to include stopping if needed.
Section I - HCEMS Vehicle Involved in an Accident
Accident: Anytime an HCEMS vehicle is damaged by another vehicle
or the HCEMS vehicle causes damage or is damaged while
Major Accident: An accident that involved personal injury, another vehicle or
object, and which caused substantial damage as assessed by
Minor Accident: An accident that does not involve personal injury, but does
involve another vehicle or object and caused minor damage as
assessed by Administration.
Any time a HCEMS vehicle is involved in an accident, the unit shall stop
immediately as close as to the scene as safely as possible. Communications shall
be notified immediately and the driver will report the exact location of the
accident, any injuries, number of vehicles and any property involved.
Communications will notify the Shift Supervisor, page the Director of Emergency
Services, Chief Officers and Support Services
The driver of the involved vehicle shall ensure that the following steps are taken:
a. Perform a rapid assessment of all injuries.
b. Update Communications of the incident conditions and additional
resources required (i.e. EMS, Fire, or Extrication).
c. Care for the injured parties as needed and able.
The emergency lighting of the vehicle shall be turned on to provide for safety of
the scene when necessary. All crew members shall remain with the vehicle unless
needed to treat injuries or provide traffic control.
The driver and other crew member(s) shall not discuss the accident with anyone
other than the investigating law enforcement agency or HCEMS Administration or
the Accident Review Team. Do not admit guilt to any of the involved parties.
Administration shall determine the status of the HCEMS vehicle.
If an HCEMS vehicle damages property (other than county-owned) or causes
injury, the law enforcement agency having jurisdiction shall be notified.
The HCEMS vehicle will not be moved unless so directed by the investigating
officer or a HCEMS supervisor. Photographs will be taken if possible prior to
moving the vehicle.
All crew members of a HCEMS vehicle involved in an accident will be required to
undergo a drug and alcohol screen with results given to Administration. The
location of the drug screen will be determined by Administration.
Crew members shall complete any needed reports as directed by Administration
immediately following the accident including information and reports requested by
the HCEMS Accident Review Team.
Any operator of a HCEMS vehicle, involved in a major accident, shall be
suspended from driving until reinstated by Administration.
Accidents Review Team shall review all accidents.
The Shift Supervisor or District Supervisor shall ensure the following:
a. A member of the Accident Review Team and Shift Supervisor will
respond to the scene when possible. If the on duty Accident Review Team
member is unable to respond the Shift Supervisor along with the
Supervisor of the Accident Review Team shall respond. If no member of
the Accident Review Team is available the Shift Supervisor will respond and
complete the HCEMS Accident Report and make pictures. The Accident
report, incident reports, and photos shall be forwarded to the Supervisor of
the Accident Review Team within 24 hours.
b. The Director, Chief and Deputy Chief shall be notified on all Accidents.
c. The Supervisor of the Accident Review Team is to be notified if not
responding in Section a above.
The HCEMS Shift Supervisor or the Supervisor of the Accident Review Team
shall ensure that the Hamilton County Accident Report is completed and forwarded
to the Director of Emergency Services, Chief, Deputy Chief and Risk Management
within 24 hours of the accident.
Section J - Accident Review Team
The purpose of this Team is to provide a consistent peer review of all vehicle
accidents and assist in training of our vehicle operators in an effort to determine
action that could have prevented or will prevent accidents. They shall be
empowered to collect, organize, and analyze all reports and facts related to an
accident. They shall then present a report to Administration.
The Team shall consist of the following:
a. The Supervisor assigned to coordinate the Team.
b. One Member EMT as designated from A, B, C Shift.
c. The Deputy Chief, if a member of the Team is in review.
d. Members of the Accident Review Team and others as approved by the
Supervisor of The Accident Review Team the Training Officer and Deputy
Chief will be appointed HCEMS Vehicle Operation Instructors. The
Supervisor of the team and the Training Officer will insure proper training
of appointees before those appointed are allowed to train.
The Team shall meet as needed following an accident to perform the duties of
Paragraph One. The Team shall have the authority and responsibility to require the
presence or cooperation of any employee in order to conduct its business. At no
time will the business of the Team interfere with a law enforcement investigation
or disciplinary action of HCEMS Administration.
The Supervisors will be briefed by the Deputy Chief of the Team's report.
Administration, as is appropriate, will issue any discipline.
Section K - Infection Control
Contaminated - The presence or reasonably anticipated presence of infectious
materials or blood on an item or surface.
Contaminated Sharps - Any contaminated object that can penetrate the skin.
Contaminated Exposure - Reasonably anticipated skin, eye, mucous membrane
or peranteral contact with blood or other potentially infectious material.
Exposure Incident - A specific eye, mouth other mucous membrane, non-intact
skin or peranteral contact with blood or other potentially infectious material.
Protective Equipment - Specialized clothing or other equipment worn by an
employee for protection against a hazard. (I.e. latex gloves, eye protection, caps,
All personnel when in contact with any patient shall wear Gloves, at a minimum.
Eye protection shall be worn if any remote chance exists of blood or other
materials splashing on the medic crew.
Any and all Sharps shall be disposed of in the provided Sharps containers.
Needles shall not be recapped.
All needles should be accounted for upon leaving the scene.
All personnel shall wash hands after each alarm, after cleaning the unit or
equipment, after checking off the unit, or any other time there is a chance of a
Contaminated items shall be disposed of at the hospital in the proper container. In
the event the items must be disposed of at the medic station, place in the Infection
All contaminated equipment shall be cleaned immediately after use with a
germicidal cleaner. If it cannot be cleaned, the piece of equipment shall be turned
into the Supply Officer for replacement if necessary.
The medic unit will be decontaminated as needed after each alarm.
A medical file shall be kept on each employee, full and part-time, at
Administration. These files are to contain a record of the employee's hepatitis
vaccine, pre and post vaccination titers, and a copy of any exposure incident.
These files are to be kept confidential. Access to the files shall be limited to the
Chief Officer's, Medical Director, Customer Service Officer and the Training
Officer. Each employee shall also have access to their individual file.
In the event of an exposure incident, employees Shift and District Supervisors is to
be notified immediately, an incident report is to be completed and faxed to Risk
Management and turned in to the Customer Service Officer, and the employee is to
register in the emergency room and be evaluated by the emergency room
physician. A copy of the incident report and the emergency room record shall be
placed in the employee's medical file kept at Administration.
Prior to leaving the scene of any incident, if time and patient care allow, the medic
crew must coordinate with other personnel on scene to make sure any
contaminated waste is property disposed of. If no other personnel are on the scene,
then the medic crew must try to clear the area for any and all waste. HCEMS and
the involved medic crews are responsible for all contaminated waste on the scene.
Section L - Radio and Telephone Communications
Code 443 - A situation in which a crew or members of a crew are in a dangerous
situation and needs emergency law enforcement assistance. This is for life
threatening situations only.
Status Check - Statement in which Communications is inquiring on the safety of
the crew or circumstances of an alarm in progress.
Medical Director - The Physician Advisor(s) of HCEMS.
Medical Control - The receiving facility's emergency room physician.
MEDCOMM - The Regional Communications Center responsible for
coordinating all Hospital related radio traffic.
Trauma Control - The emergency room physician on duty at Erlanger Medical
Day to Day Operations
It is the responsibility of the Hamilton County Emergency Services
Communications Division to receive and dispatch EMS alarms, except still alarms,
or units coming upon an incident. Medic units will notify communications
immediately of these situations.
Only necessary and pertinent information will be transmitted by radio.
Radio communications shall be kept simple and easy to understand, utilizing plain
Communications shall be kept clean, clear and concise.
Proper radio etiquette shall be adhered to at all times. Misconduct on the radio or
telephone will not be tolerated in any form.
The use of profane or obscene language is prohibited.
Using the radio, "Red" phone line, or Data Lines for personal business is
prohibited. Crews are prohibited from tampering with the phone lines and radio
equipment in any form.
When initiating radio traffic with Communications, give unit identification and
wait for a response before continuing with traffic.
When a medical sector is initiated, or multiple unit incidents are in progress, the
dispatcher or a ranking supervisor may assign certain units to a different tactical
All information given to Communications shall be given once, unless
Communications requests that it be repeated.
In the event of a Code 443, the "air is cleared" for that particular unit. All other
communications shall cease on said frequency until operations are returned to
normal by Communications. All on Duty Supervisors and Chiefs shall be
notified by dispatch, ASAP!!!
Communications shall perform a status check when a medic unit is involved in a
potentially dangerous alarm or is on an alarm for an extended period of time.
Communications shall conduct a radio test every day at 07:30 hour’s alarms
permitting to test each mobile and portable radio.
Do not contact Communications during alarms by cell phone unless you are
requested to do so. Command functions by Supervisors shall be used with
discretion but are permitted.
Crews shall answer their phones using their medic unit number and last name.
Crews shall not use personal cell phones while driving the ambulance, unless
directive to do so by their supervisor.
Notification of Alarms and Related Radio Traffic
The following procedure shall be used when units are in station according to the
a. Communications shall notify the Medic Unit by red phone.
“Phone M-4 and give them a MVC at 2200 Amnicola Hwy, cross street
b. The Medic Unit shall have 2 minutes to inform communications they are
responding in their unit by stating the following. “Medic-4 responding.”
c. Communications shall acknowledge this traffic by sounding Alert tone 3,
three times and state “Medic-4 responding to 2200 Amnicola Hwy, cross
street Wisdom, reported MVC.”
d. The Medic Unit shall then confirm the dispatched location by stating
“Medic-4 clear on 2200 Amnicola Hwy.”
The following procedure shall be used when units are on the air according to the
a. Communications shall call for the Medic Unit. “Medic 4”
b. When the Medic Unit answers, Communications shall sound Alert 3, three
times, state “Medic 4 respond to 2200 Amnicola Hwy, cross street Wisdom,
c. The Medic Unit shall acknowledge by stating “Medic 4 responding clear
on 2200 Amnicola Hwy.”
d. Supervisor notifications shall be the same as in the previous example.
When units are ordered to perform a rapid turnaround, Communications shall
Sound Alert 1, and state the following, “All units perform a rapid turnaround.” If
the appropriate units have not cleared in 10 minutes, then the Shift Supervisor is to
be notified for assistance with unit turnaround.
Communications will have map page and grid numbers available, as time allows, if
the Medic Unit requests such. However, it is the responsibility of the Medic Unit
to find the alarm and Communications responsibility to help them as needed.
The following are accepted wording of EMS Unit Movement:
a. "Medic 4 responding"
b. "Medic 4 on the scene"
c. The word "transport" is used for Non-emergency traffic and the word
"Emergency" is used for emergency traffic to the hospital.
1. "Medic 4 transporting to Erlanger, mileage 12.
2. "Medic 4 emergency traffic to Erlanger, mileage 12.
d. “Medic 4 at Erlanger, mileage 20”.
e. “Medic 4 available enroute to destination.”
1. "Medic 4 available enroute to quarters"
2. "Medic 4 available enroute to______."
f. “Medic 4 in quarters"
g. Units out of Station shall be "mobile" or "mobile" enroute to their location
such as the shop, training, etc.
Communications with MEDCOM shall be established along with a chief
complaint, at the earliest possible convenience or when warranted for patient care.
If a patient meets the Tennessee Trauma Destination Guidelines, Trauma Control
shall be notified through MEDCOM.
If MEDCOM cannot be raised on the radio, contact Hamilton County
Communications and have them contact MEDCOM and advise them of your
If Paragraph Three is not possible, contact your destination hospital and your Shift
If patient is in a life-threatening condition, and MEDCOM cannot be contacted,
and Paragraphs 3 and 4 are not possible, treat the patient condition to the best of
your ability. The Shift Supervisor shall be notified of any such situation
immediately and may render assistance as rank is commensurate with medical
authority in accordance to the parameters of the Medical Director.
When communicating with MEDCOM, the paramedic must depict the patient
thoroughly to the physician (in other words, paint a picture). If this is not done,
then the physician cannot make an accurate assessment of the situation and may
not be inclined to grant any orders or procedures beyond your standing orders.
Once a physician begins directing care for the patient, this does not absolve the
paramedic from poor judgment or communications with the physician.
Communications should be brief and to the point.
Patient confidentiality shall be maintained at all times.
Section M - Controlled Substances and Medications
All medications carried on the medic units shall be administered to a patient only
under the order of a physician either via standing orders, protocols, or direct
Medical Control contact.
All medications used on an alarm will be listed on the Medical Assessment Chart
in the Orders section. This will be accompanied by the ordering physician's
signature. If standing orders, the HCEMS Medical Director will sign during his
review of the alarm.
When a controlled medication is used, replacements will be obtained in accordance
with HCEMS medication replacement policy below. When using a controlled
medication from the NARCBOX® the blue number seal shall be placed inside the
NARCBOX® after being removed. No other medication is needed for the patient
the NARCBOX® shall be sealed with the black “Do Not Use” and relocked and
secured in the controlled medication cabinet on the medic unit. The medication
replacement form for the controlled medication used will be kept with the
NARCBOX® at all times for more efficient medication replacement. The entire
NARCBOX® will accompany the Medication Replacement form.
The 5 “R” principles shall be followed when administering drugs. The right drug,
the right patient, the right dosage, the right time and the right route.
Narcotics will be stored in sealed NARCBOXES® at all times when not in use. At
no time will any NARCBOX® be stored with out a tamper seal affixed. The
NARCBOXES® shall be stored in the small locked box in the locked compartment
on the medic unit. The keys to all locks are to be carried by the designated
paramedic at all times while on duty. Each time the paramedic responsible for the
controlled medication changes (shift change, swaps, or other personnel change) the
oncoming paramedic and the off going paramedic will insure that all
NARCBOXES® are sealed with either a blue numbered seal or a black “Do Not
Use” seal and that the lock is secure. If a black sealed NARCBOX® is present the
on coming shift will verify that the Medication Replacement form is with the
NARCBOX® and that the form correctly reflects the medication that is missing
from the NARCBOX®. The count and inspection will be completed by both shifts
prior to transferring the narcotics keys. The on coming shift will notify their
district supervisor of the used medication. Any NARCBOX® that is missing, does
not have a tamper seal affixed or the Medication Replacement Form is missing or
incorrect will be treated as medication that has been lost or tampered with.
Supervision shall be notified immediately. Medication with a black “Do Not Use”
seal or no tamper seal will not be used.
Exceptions to the above rules are the storage area in the Supervisor's office and the
drug box carried in the Supervisor's assigned vehicle. At no time will narcotics not
be in a sealed NARCBOX® unless actively being used for patient care.
The Medical Director and Administration shall determine quantities of medications
carried. These amounts shall be standard for all medic units.
No medications are to be carried in personal jump bags since they are not allowed
on the Medic Unit.
Out of date medications shall be turned in to the District Supervisor for
replacement. A medication replacement form shall be completed and kept with the
NARCBOX® at all times. Non-controlled medication shall be returned to supply.
When requesting replacement for controlled medications do not list expired drugs
and administered drugs on the same form.
Any portion of medications opened but not used in the course of patient care shall
be discarded upon arrival at the hospital. The medication shall be wasted in a sink
and the container shall be disposed of properly using universal precautions.
All crew members shall witness the wastage of a controlled substance as well as
Hospital Emergency Department Medical staff if able.
A discarded medication form is to be filled out on all wasted controlled substances.
If the medication is not disposed of at the hospital, then the on-duty shift
supervisor should be made aware of the situation and should sign the Discarded
Drug Form and witness the wastage.
In the event that a controlled medication is broken or a wrong medication is
opened or drawn up, the District Supervisor shall be notified immediately, an
incident report completed and a discard and replacement form completed. The
District Supervisor shall notify the Shift Supervisor immediately.
When crews are checking the NARCBOX® medications, any apparent tampering
shall be reported to the District and Shift Supervisors immediately.
Discovery of any lost, stolen, unsealed or evidence of tampering with narcotics or
controlled substance will result in mandatory drug testing for all assigned unit
Controlled Medication Request
Following each use of controlled medication or if the NARCBOX® is opened but
no medication administered the Paramedic who administered the medication or
broke the seal shall complete a Hamilton County EMS Medication Replacement
Form. An incident number for each controlled substance shall be listed on the
form. The form shall remain with the NARCBOX® that the medication was used
from at all times. The district supervisor or shift supervisor shall be contacted for
In the event the replacement is for a broken controlled medication an incident
report shall accompany the form and the NARCBOX® detailing how the
medication was damaged. The damaged controlled substance container shall be
placed inside a small sharps container and shall be forwarded with the above
If the replacement is for an expired medication the NARCBOX® with the expired
medication must accompany the replacement form. If medication is lost or stolen
the District Supervisor and/or Shift Supervisor shall be notified immediately. All
controlled medication request shall be forwarded to the District and /or Shift
Supervisor only. No controlled medication will be replaced without a
completed Hamilton County EMS Medication Replacement Form. Controlled
medications that have been tampered with, lost, or stolen will not be replaced until
the HCEMS Chief and Deputy Chief have been notified and direct replacement.
Issue of Controlled Medication
Anytime controlled medication is issued to a medic unit the District Supervisor
shall annotate the Hamilton County EMS Medication Replacement form in the
dispensed column with the quantity of medication that was issued. If the
medication is not replaced the dispensed column shall be left blank. The District
and/or Shift Supervisor shall ensure that controlled medications have an incident
number, expired, or damaged noted on the form prior to replacement. Controlled
medication will only be issued as a complete set of controlled medication in a
District supervisors requesting controlled medication replacement shall complete a
medication inventory sheet for their inventory and this form must be accompanied
by supporting Hamilton County EMS Medication Replacement forms and sealed
NARCBOXES® from the medic units for controlled substances. No controlled
medication will be replaced unless there is a supporting medication inventory sheet
and Hamilton County EMS Medication Replacement forms to document the
controlled medication request and sealed NARCBOXES®. The controlled
medication request shall be submitted to the Shift Supervisor for replacement or
Support Services at the discretion of the Shift Supervisor. If the Hamilton County
EMS Medication Replacement forms do not support the inventory requested
shortages in the inventory will be treated as lost or stolen medication. The
replacement of non-controlled medication shall be requested from Support Service
Services. In the event of unavailability of Support Services the District and/or Shift
Supervisor may replace medications. The Support Service representative or
District and/or Shift Supervisor issuing the medication will annotate medication
issued on the medication inventory sheet. If a controlled medication is lost or
stolen the HCEMS Chief and Deputy Chief shall be notified immediately.
Shift Supervisors requesting controlled medication replacement shall complete a
medication inventory sheet for their inventory and this form must be accompanied
by supporting Hamilton County EMS Replacement Forms from the medic unit
crews and sealed NARCBOXES®. If the controlled medication replacement
requested was issued to a District Supervisor the supporting documentation
submitted to the District Supervisor from the medic unit will be given to the Shift
Supervisor and forwarded with the inventory form from the District Supervisor and
then accompanied by the Shift Supervisor’s inventory form. No controlled
medication will be replaced unless there are supporting medication inventory
sheets and Hamilton County EMS Medication Replacement Forms to document
the medication request and sealed NARCBOXES®. The Support Services
representative issuing the medication will annotate medication issued on the
medication inventory sheet. If the Hamilton County EMS Medication Replacement
Forms do not support the controlled substance inventory requested shortages in the
inventory will be treated as lost and/or stolen medication. In the event the Shift
Supervisor cannot contact Support Services and a critical need exists the Deputy
Chief shall be contacted. If controlled medication is lost or stolen the HCEMS
Chief and Deputy Chief shall be notified immediately.
Anytime controlled medication is replaced the entire NARCBOX® will be
replaced. The only personnel authorized to remove the black “Do Not Use”
seal are HCEMS Support Service employees and Chief Officers.
Non-controlled Medication Replacement
Non-controlled medication will be ordered from Support Services on regular
supply order days. In the event of a critical shortage after Support Services normal
hours replacements may be obtained from the District and/or Shift Supervisors.
Disposal of Medication
Expired and broken controlled substance medication that is returned to the District
and/or Shift Supervisor must be returned to Support Services for proper disposal.
Controlled Medications will be kept secured even if expired. Non-controlled
medication that is expired will be returned to Support Services for proper disposal.
No medication controlled or non-controlled will be disposed of by any employee
other than Support Service employees.
HCEMS OPERATIONAL GUIDELINES
ARTICLE IV – TACTICAL PLANS
Section A - Unit Relocation for District Coverage
In all of the following staging proposals it is imperative that dispatch ascertain the
probable in-service time of the next available unit in said sector before assigning a
unit to stage. It is our recommendation that if the probable in-service time be less
than 10 minutes then NO unit shall be sent to stage.
The general staging area for the west sector shall be Harrison Ln. @ Dayton Pike
in the parking lot of Hardees Restaurant. This is the best centrally located area in
the west sector, which provides good access to all areas of the sector including
Mowbray Mountain, City of Soddy Daisy via Dayton Pike, Middle Valley via
Harrison Lane, and Hixson via Highway 27. The following shall apply to the above
a. When 4 and 12 are out, 2 shall come south to the above-described staging
area to provide adequate coverage for the west sector.
b. When 2, 4, and 12 are out, 14 shall come north to the above-described
staging area to provide adequate coverage for the west sector.
c. When 2, 4, 12, and 14 are out, Medic 6 shall come north to the above-
described staging area to provide adequate coverage for the west sector.
d. When 2 and 12 are out, 4 shall come north to the above-described staging
area to provide adequate coverage for the west sector.
e. When 2 and 4 are out, 12 may stay at their station for staging.
The general staging area for the east sector should be Bonny Oaks Dr. @ Lee Hwy.
in the parking lot of Northern Tools. This is the best centrally located area in the
east sector, which provides good access to all areas of the sector including
Ooltewah via I- 75 North, Collegedale via Lee Hwy, East Brainerd via Jenkins Rd.
and upper and lower Highway 58 via Bonny Oaks and Hickory Valley Rd. The
following shall apply to the above staging area:
a. When 1, 5 and 7 are out, 3 shall go to stage east to provide adequate
coverage for the east sector.
b. When 1, 3, 5 and 7 are out, 11 shall go to stage east to provide adequate
coverage for the east sector.
c. When 1, 3, 5, 7, and 11 are out, 14 shall go to stage east to provide
adequate coverage for the east sector.
d. When 3, 5 and 7, are out, 1 shall go to stage east to provide adequate
coverage for the east sector.
The general staging area for stage south shall be medic 9’s quarters. This is the
best central location in the southern part of the county and provides easy access to
all areas of the sector including Lookout Mountain via Broad St., Red Bank via
I-27 North, Brainerd via I-75 East or McCallie Tunnels, east Chattanooga via
Amnicola Hwy, Tiftonia via I-24 West. The following shall apply to the above
a. When 6, 9, 10 and 13 are out, 14 shall come to stage south to provide
adequate coverage for the south end of the county.
b. When 6, 9, 10, 13 and 14 are out, 11 shall come west to provide adequate
coverage for the south end of the county.
The general staging area for the central sector shall be Medic 14’s quarters. Stage
central shall only be used when we are down to one (1) “in-service” unit in the
county. The shift supervisor or designee will have the responsibility to deviate
from the above staging area if necessary.
Unit relocations will be coordinated by Communication with the Shift Supervisor
having general oversight and final approval. “Chute Times” shall be the same as
for alarms which is two minutes. Communications shall work closely with the Shift
Supervisor to ensure the proper flow of units and coverage.
Communications may order a “rapid turn-a-round” of units to provide better
district coverage. This order should be given when over fifty percent of the fleet is
committed on alarms. When this order is given, all units at hospitals will clear
within ten minutes and their Shift Supervisor shall be notified if they do not.
Unit’s enroute to the hospital shall clear upon arrival within the same time frame.
The clearance times are for when no additional alarms are received, which if
received, must be taken regardless of allotted times.
First Response agencies should be used as is appropriate for their response criteria
and potential critical patients. First Responders should only be used as needed and
Section B - Motor Vehicle Accident (MVA)
Action Circle - The area within a 10-15 foot radius of involved vehicles.
Lead Medic - The paramedic who assumes the role of primary care provider for a
When a unit arrives on the scene of an MVA, it shall park no less than 50 feet from
the involved vehicles to ensure a safe working zone away from the damaged
vehicles. Protective clothing shall be worn as is available and appropriate.
If there is obvious danger such as fire, hot electrical wires, unstable vehicle or any
type of hazardous materials, the crew shall not approach the scene until the fire
department having jurisdiction has secured the scene.
Upon arrival at an MVA, the lead medic shall perform a quick survey of the scene
and relay to Communications all pertinent information such as correct location,
number of patients, number of vehicles involved, additional medic units needed,
If the fire department having jurisdiction arrives on the scene prior to EMS, the
lead medic shall report to the Incident Commander for patient information and
If the fire department having jurisdiction arrives after EMS, a crew member shall
give a report on the situation and patient update to the Incident Commander as time
If extrication is involved in removing the patient, the lead medic shall relay all
pertinent information to the rescue sector officer, such as the patient condition, the
need for rapid extrication and any relevant suggestions on how to free the patient.
If during the extrication operation a crew member is not involved in direct patient
care, the crew member shall obtain the necessary equipment needed for patient
packaging and coordinating all radio communications. All equipment used shall
be staged outside the action circle. Units should be positioned as to provide access
to all equipment and allow access away from the scene in a timely manner.
Before leaving the scene after the patient is loaded, the driver of the unit shall
perform a quick check of the scene for any equipment that might have been left.
After the patient has been transferred to the hospital staff, the lead medic is
responsible for report writing and the driver is responsible for cleaning the medic
unit to enable a timely turnaround.
Section C – Aero medical Request
Any patient meeting the Tennessee Trauma Destination Guidelines is a candidate
for aero medical transport, provided that at least one of the following conditions:
a. Entrapment in which the extrication will last longer than 15 minutes and
the patient will benefit from aero medical transport.
b. The arrival of the patient to the trauma center will be enhanced via
aero medical transport.
c. Traffic or weather conditions prohibit rapid ground transport.
d. The patient is not easily accessible by a ground unit.
e. Mass casualty incidents.
f. Ground transport to the trauma center will exceed 20 minutes.
Any patient in an immediate life-threatening medical emergency is a candidate for
aero medical transport if any of the criteria in paragraph one exists.
The lead medic shall determine whether or not aero medical transport is necessary.
The following should be considered when using aero medical transport:
a. Is the aircraft on the scene when the crew is ready to transport the
b. Will the scene time be greatly delayed using aero medical transport?
Aero medical transport is just an alternate means of transportation, not a higher
medical priority. The patient(s) is the responsibility of the HCEMS lead medic
until properly transferred.
Section D - Scene Management
This section is intended to provide basic principles for scene approach, assessment,
and mitigation. While there are hundreds of types of scenes EMS personnel will
encounter, there are still several basic guidelines that should always be followed.
True scene management begins before you leave the station by having an
understanding of your job knowledge, role, proper equipment that has been
checked, and the right frame of mind to work in.
Regardless of the type of alarm you are dispatched to, the first and foremost
concern should be the safety of everyone involved in the alarm. HCEMS endorses
a "stand back" policy on domestic violence, shootings, stabbings, or any other
scene that has not been properly "cleared" by the law enforcement agency having
jurisdiction. We cannot help others if we become injured. When in doubt, stay out
and use prudent judgment. Judgment must be your guide, because patient care
must be given as soon as possible.
The placement of the Medic Unit is important. Do not use the unit as a blocking
device between you and traffic as the unit could become involved in an accident
and disabled. The unit as well as the crew should be protected at all times. If the
unit is in a hazardous area such as parked in the roadway or on a fire-rescue scene,
leave the warning lights on. If you are in a driveway, off the road, a parking lot,
you may consider turning off the warning lights as this will assist you in crowd
control. Always try to avoid backing whenever possible.
As you are approaching the scene, the patient, or a crowd, be quick to identify
yourself as a Paramedic or EMT even if it seems obvious. The sooner people
know you are medical help, the more relaxed they will be on average. Approach
with a cool, confident and politely "directing behavior." You are now there and
everything is going to be OK! You have to develop trust very quickly. Do not
judge a person, the circumstances, the environment or anything else. You are a
medical professional, not a judge, so be compassionate, and the rest will fall into
place. Treat everyone like they were your own family!
Always be looking for a way out! Most CPR's happen in the upstairs back
bedroom around the corner between the bed and the wall. You can prevent this by
"reading the room or your scene." Attempt to get the big picture as you approach!
Try not to trap yourself in! Take the time to move furniture, people, and the
patient if necessary.
If your scene does not "feel right," it probably is not right! Be proactive and look
around. You may find something you missed. Watch out for each other as four
eyes are better than two.
Be courteous to the first responders and the law enforcement agencies on your
scene. We are all on the same team. If they have something to say, listen and get a
report as proper transfer of patient care would dictate. You would be insulted if
you were not acknowledged, appreciated, and be made to feel a part of the team.
Do unto to them as you would want and avoid burning this bridge since they are
not there to "get your stretcher" for you. If procedures are done wrong, be skillful
and tactful in your correction. Make time to train and discuss things in a positive
When taking equipment from your unit, remember what you take out you must
always bring back plus the patient. You are required to carry in your equipment
and properly assess the patient. As soon as you are able, get the patient to your
"office" to continue your assessment. Organize your equipment as best you can.
Avoid "bradyation" which is the inevitable and complicated tangling of every
conceivable tube, line, device, and procedure known to the EMS profession.
If you have been issued protective clothing, USE IT!!!!!
If you are on a crime scene, do the following:
a. If the patient is obviously dead, then protect the crime scene by limiting
access, not moving items in the room, and very limited movement of the
body. Leave all weapons where they were found and do not destroy finger
b. If you are not involved in patient care, you are coordinating for the law
enforcement agency having jurisdiction who is working with the medical
examiner. Assist any way you can.
c. If you need to attempt resuscitation, give treatment, do not endanger
yourself. The goal is to preserve as much evidence as possible.
The most common role you perform on a scene has two distinct identities. You
must be both a leader and a manager. You lead people and manage equipment.
Do not mix the two! They interact with each other but have a distinct difference.
You may have to direct other personnel to perform skills and procedures, retrieve
Basic guidelines of scene management are as follows:
a. Approach with caution and Be Safe
b. Lead people
c. Treat the patient
d. Manage equipment
e. Arrive and leave with the knowledge that you did well and made a
positive difference in someone's life.
Section E - Incident Command System (ICS)
HCEMS functions on incidents which may require the use of the ICS. When the
ICS is instituted, the HCEMS ranking officer is usually designated as the medical
sector officer (MSO).
A medical sector should be established any time two or more medic units are
committed to one incident. The first arriving lead medic should report to the
incident commander (IC) and become medical sector. The IC may have already
appointed a medical sector, however, if not the case, get a report and establish
Medical Sector. The highest ranked and licensed medical authority with HCEMS
will become the medical sector. It is most appropriate for an employee, preferably
a supervisor of HCEMS, to be the medical sector officer.
The primary responsibility of the arriving unit(s) is patient care and the med sector
should be established only when personnel are available to do so. The district or
shift supervisor shall ensure that med sector is established when needed. The
district and/or shift supervisor shall function as med sector until relieved by a
ranking officer or until the incident is terminated.
An off-duty supervisor may function as med sector when available, designated and
on the scene. This function will end when the off-duty supervisor is relieved by a
ranking officer, the district and/or shift supervisor or the incident is terminated.
The medical command shall be responsible for the coordination of all medical
related resources on the scene or responding to the scene. The medical command
may designate sub-sectors as needed. These may include triage, transportation,
rehabilitation (rehab), etc... When sectors have been established, sector
identification will be used on the radio rather than personal unit identification (i.e.
Med Sector to Communications, or Med Sector to Triage, etc.) EMS supervisors or
Communications shall dictate the use of all talk groups, radio channels, or tactical
frequency usage when needed. All radio traffic must go thru the medical
commander and not each individual sectors talking to dispatch.
In a large-scale incident or a mass casualty incident, a medical command structure
may look like the following:
Triage, Treatment, Transportation, Logistics and Safety
The purpose of the Medical Commander and/or Medical Sector is to allow the
coordination and effective use of personnel, equipment, medic units, and to proper
channel communication. When used effectively, this system will allow all parties,
including supervisors, paramedics and EMT's to focus on the top priority, patient
The first arriving personnel will have to function as triage officer if needed. The
first arriving medic unit is used as an "equipment" unit for the triage area and may
be stripped accordingly.
The first arriving Supervisor reports to triage and assumes Medical Sector.
Sub-sectors are designated as needed and proper resources are called for.
The Transport Sector oversees the transport of all patients to facilities. He will
need a scribe and should communicate with Med Com as well as Medical
Supervisors are directed to bring additional resources as needed such as additional
medic units, the command trailer, other logistics and mass casualty units, etc.
Manpower shall be utilized from any available agency.
Section F - Rest and Rehabilitation (Rehab)
The Rehab Sector shall be established by the first arriving medic unit or as directed
by the IC. It should be utilized where large numbers of Emergency Service
personnel are working on an incident.
The purpose of this sector is to monitor the health and physical condition of
emergency personnel on an incident. Any responder who has engaged in a period
of exercise or physically demanding operations should report to the rehab area.
The med sector shall be responsible for requesting any resources needed and shall
direct such in a manner to achieve optimum operation of the sector.
Care given at this sector could include, but not be limited to, refreshments, drinks,
food, ice, medical care and observation, etc... A clean salvage cover or other
suitable items should be set up in a location which will not interfere with the
operations of the incident.
If HCEMS is required to transport personnel, then additional medic units shall be
called to the scene. The Rehab Sector should be staffed by one medic unit at a
minimum. The med sector should determine from the incident the commitment
that will be needed for this sector.
Section G - Hazardous Materials (Haz-Mat)
The role that HCEMS provides in any hazardous materials incident is a supportive
role. This organization will not become involved in any primary rescue,
decontamination, or mitigation in any haz-mat incident.
If dispatched to what is believed to be a haz-mat incident, from a safe distance
attempt to determine if a true haz-mat incident exists. Evacuate all parties
including you. Do not jeopardize your safety or that of your crew to mitigate
The responding medic unit will contact the IC to ascertain where the rehab sector
will be established. HCEMS shall work as a support and rehab sector with haz-mat
and fire department personnel.
At the earliest convenience, the medic crew should ascertain from the IC what type
of chemical or substance is involved. This information should be passed on to the
destination hospital(s) as soon as possible if patients are to be transported.
HCEMS personnel should attempt to obtain vital signs from all haz-mat personnel
prior to entering the hot zone for baseline information and medical history.
After decontamination, all haz-mat personnel will be reevaluated and monitored
for any significant change in condition.
If at any time the lead medic feels that a haz-mat or rescue worker needs to be
removed from active status, the IC should be notified immediately.
Generally one medic unit is designated strictly for the haz-mat team and additional
units are called for transport of any other victims. This shall be at the discretion of
the medical sector.
When transporting a haz-mat victim, remove as much of the unnecessary
equipment from the back of the unit to the exterior compartments as possible to
reduce the risk of contamination. At the end of the incident, clean-up should be
Section H - Destination Guidelines
Tennessee Trauma and Pediatric Destination Guidelines shall be used to qualify all
pediatric and adult trauma victims.
If a patient meets the criteria set forth in the guidelines, trauma control shall be
notified through Med Com.
If a patient chooses a facility other than the recommended one, notify trauma
control through Med Com of the situation and let the physician make the
Hamilton County EMS protocol shall be used to qualify all Stroke, Cardiac, and
Pediatric non-trauma patients. These protocols have been adopted by local
medical oversight control and the Regional Communications Center Executive
Committee. Any variance from these destinations shall be documented by
justification within the patient transport record.
Any other destination protocols that are adopted and/or approved within the
Hamilton County EMS service area shall be used to qualify all patients addressed
by the protocols. All destination protocols adopted and/or approved shall be
considered as the local standard of care for destination determination.
Section I - Technical Rescue
IC - Incident Command
MC - Medical Commander
MS – Medical Sector
Paramedic who has assumed the role of primary care provider for a particular
The medic unit shall set up an initial medical staging area with the approval of the
The lead medic shall report to the IC or Command Post (whichever is in use) and
remain in contact with the IC until relieved by a ranking officer or until the
incident is terminated.
The MS shall relay information on the patient to medical staging as soon as it
The MS shall make a quick assessment of the situation to determine whether
additional medic units are needed for rehab or patient care. This assessment
should be ongoing.
Any additional in-coming medic units shall report to the medical staging area.
Upon arrival, crews should relay to MS the number of personnel on the unit and
skill level of each.
No HCEMS personnel should leave medical staging without the direct permission
of the MS.
HCEMS personnel shall not engage in direct patient care until the rescue operation
has been terminated and the patient is brought to medical staging. Basic patient
care shall be provided by rescue personnel while the rescue operation is in progress
unless directed otherwise by the MS.
While HCEMS strives to provide the highest level of patient care possible, we
must realize our limitations. Our scope of operations does not include engaging in
technical rescue operations. These skills require special training and many hours
of practice. Even though some HCEMS personnel may possess expertise in the
areas of technical rescue, these procedures are not within the purview of this
It is important that a one-victim rescue operation which utilizes a large number of
rescue personnel can develop into a mass casualty situation in a split second.
Section J - Radiological Response
Although there is a nuclear plant in Hamilton County, HCEMS is faced with the
possibility of responding to a radiological emergency in many types of situations.
Transportation incidents provide the most common threat of such.
In case of a known radiological incident at the Sequoyah Nuclear Plant, the TVA
Rad-Con personnel shall be on-site to monitor the patient throughout the incident.
The patient is to be treated according to the HCEMS standard of care regarding
medical treatment. TVA personnel shall advise about the radiation aspect of the
If Sequoyah experiences a nuclear accident, EMS personnel on duty will receive
all instructions from the EOC. All personnel should don the personal monitoring
devices and protective clothing as directed.
During a nuclear disaster, administration shall follow the assignments and
procedures set forth in the Hamilton County Disaster Plan.
If a medic unit responds to an off site situation that becomes a radiological
incident, the Shift Supervisor is to be notified immediately for monitoring
equipment. The patient is to be treated for any and all life threatening problems,
whether or not monitoring equipment is readily available as per paragraph six.
When responding to an off-site radiological incident, the crew must ensure
compliance with Section G of this article. As the incident operations allow, the
patient and the medic crew should be moved as far away from the contaminant as
possible. Then the patient should be treated accordingly.
The medic crew must evaluate the potential danger to themselves. When in
doubt, stay out! Allow the proper response agency to properly mitigate the
Section K- Tactical Medical Unit (Swat)
Since its inception, a hallmark of Hamilton County EMS has been its willingness
to adapt to new requirements and to search for and utilize additional resources.
The HCEMS Tactical Medical Unit is a flexible, highly trained and rapidly
deployable unit providing the highest level of pre-hospital emergency care in all
situations and environments.
The Tactical Medical Unit will be responsible for a wide range of tactical EMS
situations. This team will be trained in advanced skills, Haz-Mat, special weapons
and tactics training for deployment with local law enforcement. The team will
enhance communication and interaction between the general public, team
members and may be utilized at school events, career day functions or other public
Participation with the Tactical Medical Unit is considered a privilege. As such,
strict standards will be taken into consideration in the selection of applicants.
Candidates will be selected based on the following criteria:
a. The candidate must be a paramedic.
b. The candidate must have an exemplary record of performance with
c. The candidate must submit an application with a letter, detailing personal
and professional history and an explanation of why they want to be on the
team, through the chain of command.
The candidate must complete a physical ability test consisting of:
Tactical Medical Team
a. A 1 mile run within 8 minutes
b. 40 sit-ups in one minute
c. 40 push-ups in one minute
d. One man carry for 100 yards. Forty Five second time limit.
e. The candidate must also complete a 25 question written test which
will be graded 0-100.
f. After the physical ability and written tests qualified applicants will
interview with the Special Operations Unit officers and the Deputy
Factors considered during the interview process:
a. Ability to function independently in high stress situations
b. Leadership potential
c. Ethical standards
d. Demonstrated willingness to correct personal shortcomings
e. Personal appearance
A failure to meet the standards for the Tactical Medical Team may be cause for
removal. In addition, removal from the team may be enacted as a disciplinary
measure for infractions unrelated to the team at the discretion of the Chief
Officers. The Medical Tactical Team is a part of Hamilton County EMS, not a
stand alone agency.
Two Medics from each shift will be assigned to the Tactical Medical Team. The
HCEMS Shift Supervisor assigned to the Tactical Medical Team will be ultimately
responsible for the Team. The District Supervisor that is assigned to the Tactical
Medical Team will work in conjunction with the Shift Supervisor. If the Shift
Supervisor is not available, then the District Supervisor will be ultimately
responsible for the team.
Deployment of Tactical Medical Team (SWAT).
a. All Swat “call ups” will be approved through the Chief and/or Deputy
Chief or their representative prior to the team’s response.
b. Once a request has been made for the Tactical Medical Team each
member of the team along with the Deputy Chief of EMS will respond to the
designated area as a rally point.
c. Once on the scene, the EMS ranking officer will report to the command
e. On all Swat related call-ups an on duty HCEMS medic unit, regardless of
location, will be dispatched. The EMS ranking officer will contact dispatch
to direct the medic unit to their staging location. An on duty Shift Supervisor
will also be dispatched to the location.
One - Mission
Hamilton County EMS medical tactical team will deliver advanced patient care in
a variety of non-conventional settings. To achieve this, the team will operate as a
branch of the Hamilton County Sheriff’s Department SWAT Team. The tactical
medical team goal is to provide the highest level of medical care that can safely be
accomplished on every incident, through the use of specially trained personnel.
Two - Purpose
The purpose of this document is to establish guidelines for the training and
operation of the team in the tactical environment. This policy regulates all Tactical
Medical personnel responding to incidents involving Hamilton County SWAT and
law enforcement operations of a hazardous or high-risk nature. This may include,
but not be limited to:
a. Providing special assets and equipment managed by HCEMS.
b. Providing emergency medical services to local law enforcement
c. Assist with hazardous material identification, containment, and
advice on disposal.
Three – Training
Training will be conducted with the Hamilton County SWAT Team on a monthly
basis or as directed by the Tactical Commander. Team members will be required to
complete the following courses.
a. HCSO transition course to obtain weapons certification and
b. Basic SWAT course.
c. An approved Tactical EMS course.
In addition, each team member will be required to:
a. Take part in a regular PT program.
b. Qualify with all assigned weapons as required by HCSO.
c. Attend all training sessions unless excused by a team officer.
d. Maintain all certifications as required by HCEMS.
Four - Equipment
All law enforcement equipment will be supplied by the Hamilton County Sheriff’s
Department. Hamilton County EMS will supply all medical equipment. Team
members will be responsible for all issued gear. Issued items will be secured both
on duty and off duty. Team equipment is to be used only during official duties.
Report lost, stolen, or broken equipment to the team officers. Each member will
only wear uniforms and equipment approved by the Tactical Commander.
Five – USE OF FORCE
The Hamilton County EMS special operations unit will abide by the rules set forth
within the Hamilton County Sheriff Department’s “Use of force” policy.
(See appendix 1)
Six - HAZ-MAT RESPONSE
The special operations team will respond to HAZ-MAT calls as requested by the
Chattanooga or Hamilton County HAZ-MAT teams. The primary focus of the
tactical medical team at a HAZ-MAT response will be patient care; however, the
team will be trained to assist the HAZ-MAT team as needed or directed by incident
The Tactical Medical Team will be a very elite division of HCEMS. The members
will have to be extremely dedicated to physical fitness, the community and the
service. They must be a role model for fellow health care providers. They are
expected to have exemplary attendance and work related performances.
ROLL OF THE MEDICAL BIKE TEAM
The Medical Bike Team will serve as a means to provide rapid ALS response at
large outdoor events with heavy pedestrian traffic. This team will enhance
communication and interaction between the general public and HCEMS team
members as well as provide rapid ALS care to patients in areas or situations
inaccessible to large emergency response vehicles.
There are several benefits to this faster response:
a. The patient is more rapidly entered into the EMS system.
b. Greater interaction between the community and the EMS providers.
c. A general increase in physical fitness in the employees who enter into the
program creating a healthier employee.
a. Large community events held within Hamilton County
b. Foot races
c. Bike races
d. Educational and teaching programs
e. Other events not specifically listed above that the Bike Team might be
called upon for support.
a. Officers and Members of the Bike Medical Team will attend an IPMBA
sponsored cycle course prior to achieving operational status on the Bike
b. Monthly meetings will be held, 75% attendance of these meetings is
mandatory. These meetings may involve training, introduction of new
equipment, rides or all of the above.
NOTIFICATION OF THE BIKE TEAM
All requests for the Bike Team must go through the Chief and/or Deputy Chief,
with the Medical Bike Team Supervisor being notified.
a. SHIRT; will be cool max golf style shirt with cuffed sleeves. White for
officers, medium blue for team members.
b. PANTS; will be “Olympic” brand patrol pants navy blue in color style #
c. HELMET; will be a black road helmet with a visor.
d. JACKET; will be light and waterproof.
e. SHOES; Bates Spec Ops Bike shoe or similar model. Black in color.
f. GLOVES; will be black in color
g. SUN/EYEGLASSES; will be black in color “Oakley” style glasses
(prescription eyewear excluded from these requirements)
h. Uniforms requirements may be amended by the team officers.
a. Assuring adequate treatment of patients
b. Reduction of response times at community events
c. Increase physical performance of Team Members
QA will be completed by Team Officers after each event and reported to
NOTIFICATION of HCEMS MEDICAL BIKE TEAM
Once notification of an event has been cleared through the chain of command, the
Team Leader will notify the members of the upcoming event. Once the Team has
been notified the Team Leader will notify the Shift Supervisor and inform them of
the duration and location of the event. The Shift Supervisor and Medical Bike
Team Leader will make provisions for ambulance coverage for the event, if
needed. All team members will rally at HCEMS supply. From that point the team
will utilize the designated Medical Bike Team Vehicle to respond to the event.
Upon arriving at supply the Team Leader will:
1. Contact communications and advise them the team has arrived at
2. Advise communications OIC which channel will be used by the
team for the event
3. Assign members to do a complete inspection of all equipment and
The Team Leader will:
1. Be aware of the location of all team members
2. Notify communications the team is on scene and the event has
3. Notify the team all radio traffic will occur only on the assigned
frequency for the remainder of the event
4. Advise event command of all the incidents that involve patient care
and /or transport.
5. Advise communications when the event is over and the team is
back in service.
1. Provide in field medical care
2. Establish egress and access points through the event site
1. Act as liaison between the public and HCEMS
2. Encourage helmet use and bike safety
3. Direct the public how to contact HCEMS for a bike safety program
in their area
a. At no time will Bike Team members wear their uniform in lieu of
their standard duty uniform while riding on an ambulance.
b. At no time will a team member respond to a site outside their event
coverage area, unless directly told to do so by the Team Leader or
event command post.
c. At no time will a team member ride without a helmet.
All communications will go through HCEMS communications or the command
post of the assigned event.
`a. Bike Team members will be assigned call signs BIKE 1 – 6
b. The Medical Bike Team Leader will use his/her
radio #, if the Team Leader is not a supervisor, he/she will be
assigned BIKE 1
HCEMS will provide transportation of all patients requiring transport.
a. The ambulance assigned to the event will provide transportation
from the event site to the hospital
b. The Bike Team providing care will give report to the on duty crew
turn over patient care and return to service.
a. The Medical Bike Team Leader will complete a post event summary
of all actions that occurred during the event. This summary will be
turned in to administration upon completion.
a. Training will be held monthly and is mandatory for all members
b. Topics will be decided by team leader with input from team
c. Absence from training is excused if on duty personnel are unable to
Due to the nature of the team, training is essential and will be strictly