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					                      Standard Operating Procedures




NORTHEAST TENNESSEE
Regional Medical Communications Center




Med Com
Standard Operating Procedures
                               Resource Coordination Center
  Routine and Emergency Operations Procedures

Prepared By
     Document Owner(s)                                             Project/Organization Role




Procedure Manual Version Control
     Version          Date            Author                       Change Description




Note The content of a manual does not constitute nor should it be construed as a guide to all situations.
This manual is a guide for most foreseeable situations tasked of the RMCC.

The Northeast Tennessee RMCC Council, at its option, may change, delete, suspend, or discontinue
parts or the procedures in its entirety, at any time without prior notice.




Effective 3/14/2007          The RMCC Council, at its option, may change, delete, suspend or             Page 1
Version 1.0              discontinue parts or the procedure in its entirety, at any time without prior
                        notice. In the event of a policy change, employees will be notified. Any such
                                 action shall apply to existing as well as to future employees.
                                                          Standard Operating Procedures



TABLE OF CONTENTS
1     INTRODUCTION ................................................................................................................................... 3

2     STANDARDS OF CONDUCT ............................................................................................................... 4

3     COMMUNICATIONS ROUTING ........................................................................................................... 6

4     MULTIPLE CASUALTY INCIDENTS & MUTUAL AID ......................................................................... 8

5     ALERTS ............................................................................................................................................... 10

6     HRTS ................................................................................................................................................... 11

7     CHEMPACK ........................................................................................................................................ 12

8     COMMUNICATIONS MONITORING................................................................................................... 13

9     AMBULANCE STRIKE TEAM ............................................................................................................ 15

10 CRITICAL INCIDENT STRESS MANAGEMENT (CISM) ................................................................... 16

11 ACRONYMS ........................................................................................................................................ 17




Effective 3/14/2007                The RMCC Council, at its option, may change, delete, suspend or                                        Page 2
Version 1.0                    discontinue parts or the procedure in its entirety, at any time without prior
                              notice. In the event of a policy change, employees will be notified. Any such
                                       action shall apply to existing as well as to future employees.
                                              Standard Operating Procedures




1         INTRODUCTION

          This document has been developed by Northeast Tennessee Regional Medical Communications
          Center Council (RMCC Council) in order to familiarize RMCC Operators with MedCom (RMCC)
          and provide information about key policies and procedures at the Northeast RMCC.



1.1       History

      The purpose and goal of the Resource Coordination Center (T.C.A. – 68-140-204)

      A statewide system of emergency medical service - area telecommunications shall be developed by the
      Tennessee Department of Health, which shall be responsible for the introduction and coordination of such
      system into the state emergency preparedness plan.
      Each EMS region within the State of Tennessee shall have a resource coordination center (RCC), also
      known as Regional Communications Center, or more specifically a Regional Medical Communications
      Center (RMCC) as the coordination and communications deal with medical facilities and emergency
      medical assets in this context.
      The RMCC shall be a central coordination point to delineate lines of communication between all stake-
      holders in the region’s emergency medical community. These include, but are not limited to: 9-1-1/EMS
      Dispatch Centers, ambulance services, hospitals, and emergency management agencies.
      Due to the regional focus and scope of operations, it was reasoned that the regional aeromedical services
      with flight coordination centers in Tennessee be approached in their willingness to serve as an RMCC for
      their respective areas within the State of Tennessee. Emergency Communications Districts had been
      utilized initially when the RCC program was implemented and centers were designated. It was further
      rationalized that county 9-1-1 centers are the first resource to become overwhelmed due to the influx of
      callers when an event develops within it’s jurisdiction, while aeromedical services do not take calls from the
      general public and have an operational area encompassing most if not all counties within their EMS region.
      The RMCC shall routinely monitor and respond to ambulance traffic within the region to facilitate hospital
      communications either by DTMF encoding, Med-Channel assignment, or frequency control of 155.340 MHz
      as needed to prevent unintentional harmful interference of simultaneous transmissions by EMS/Hospitals
      within the region. The RMCC shall also assist in notification of hospital advisory & diversion status to the
      region’s facilities and ambulance services as directed. The RMCC shall serve as a non-partisan information
      conduit, but is not responsible or tasked with routing ambulances to certain hospitals unless so-directed by
      the State EMS Office, Incident Commander, or Incident Medical Transport Officer in the event of a disaster.
      With the potential for system abuse, the RMCC shall have transparent operations within the medical
      community and any lack of impartiality, whether actual or perceived, will be investigated as necessary to the
      satisfaction of the RMCC Council and/or State EMS Division.




Effective 3/14/2007         The RMCC Council, at its option, may change, delete, suspend or             Page 3
Version 1.0             discontinue parts or the procedure in its entirety, at any time without prior
                       notice. In the event of a policy change, employees will be notified. Any such
                                action shall apply to existing as well as to future employees.
                                             Standard Operating Procedures




1.2     Changes in Procedure

        This manual supersedes all previous policies and procedures for RMCC operation.

        While every effort is made to keep the contents of this document current, the RMCC Council
        reserves the right to modify, suspend, or terminate any of the policies and procedures described
        in the manual with or without prior notice.

        Policy/Procedure changes will be submitted to the Chairman of the RMCC Executive Committee
        for presentation to the RMCC Council. Action may be taken at the next regularly scheduled
        RMCC meeting to consider the proposal. A two-thirds majority of voting members present will be
        required to effect change in Standard Operating Procedures.




2       STANDARDS OF CONDUCT


2.1     General Guidelines

        All RMCC personnel are urged to become familiar with RMCC rules and standards of conduct
        and are expected to follow these rules and standards faithfully in doing their own jobs and
        conducting the center’s business.

        Radio Codes and Signals will not be utilized in any written or verbal communications.



2.2     Confidential Information and Nondisclosure

        By continuing employment in the RMCC, RMCC Personnel agree that they will not disclose or
        use any of the RMCC’s confidential information, either during or after their employment. The
        RMCC sincerely hopes that its relationship with its RMCC Personnel will be long-term and
        mutually rewarding. However, employment with the RMCC assumes an obligation to maintain
        confidentiality, even after an employee leaves the RMCC’s employ.



2.3     Ethical Standards

        The RMCC insists on the highest ethical standards in conducting its business. Doing the right
        thing and acting with integrity are the two driving forces behind the RMCC’s great success story.
        When faced with ethical issues, RMCC Personnel are expected to make the right professional
        decision consistent with non-biased principles and standards.



Effective 3/14/2007        The RMCC Council, at its option, may change, delete, suspend or             Page 4
Version 1.0            discontinue parts or the procedure in its entirety, at any time without prior
                      notice. In the event of a policy change, employees will be notified. Any such
                               action shall apply to existing as well as to future employees.
                                             Standard Operating Procedures


2.4     Use of Equipment

        The RMCC will provide RMCC Personnel with the equipment needed to do their job. None of this
        equipment should be used for personal use, nor removed from the physical confines of The
        RMCC—unless it is approved for a job that specifically requires use of equipment outside the
        physical facility.



2.5     Use of Computer, Phone, and Mail

        RMCC property, including HRTS computers, toll-free telephone lines and radios should be used
        only for conducting official business. The HRTS (Hospital Resource Tracking System) is for
        official RMCC use only.



2.6     Complaint Procedure


             2.6.1    Personnel (field, dispatch, facility, etc.) who have a RMCC question or
                      complaint should first discuss it with their immediate supervisor.

                 1. RMCC Supervisor to be notified of RMCC procedural complaints

                 2. RMCC Council to be notified if RMCC issue not resolved


        2.6.2    Personnel, who observe, learn of, or, suspect a violation of the Standards of Conduct of
                 the RMCC or the Rules and Regulations of the Tennessee Department of Health –
                 Division of EMS, should immediately report the violation in accordance with the following
                 procedures:
                 1. Notify Immediate Supervisor
                 2. Notify Regional EMS Consultant




2.7     Corrective Procedure

        The RMCC and/or RMCC Council will work to resolve issues in a timely, confidential manner.



2.8     Suggestions

        The RMCC Council encourages suggestions and good ideas about making the RMCC a more
        efficient operation and enhancing service to RMCC Stakeholders. All stakeholders can help bring
        ideas to the attention of the RMCC Council. All suggestions are valued.




Effective 3/14/2007        The RMCC Council, at its option, may change, delete, suspend or             Page 5
Version 1.0            discontinue parts or the procedure in its entirety, at any time without prior
                      notice. In the event of a policy change, employees will be notified. Any such
                               action shall apply to existing as well as to future employees.
                                              Standard Operating Procedures



3 Communications Routing

3.1     Traditional Ambulance Radio Traffic will remain unchanged.

      The primary day to day operation of an RMCC has historically been that of ―operator‖, dialing DTMF codes
      for ambulances wanting to talk to a specific hospital on the HEAR system (155.340 MHz – Hospital
      Emergency Ambulance Radio), and when communications failures disable an ambulance or hospital from
      connecting with the other – information is relayed via telephone or other radio frequencies to the receiving
      entity for the ambulance crew.


               3.1.1 Hospital Encoding
          When an EMS provider contacts the RMCC requesting a line to a hospital, RMCC personnel will
          have the ambulance switch over to 155.340 MHz, if the frequency is clear, and dial the DTMF
          code for the hospital requested. Should the hospital not answer after two attempts, RMCC
          personnel will offer to contact the hospital Emergency Department by telephone and relay the
          information for the EMS provider.

          If a hospital radio is not working, and the RMCC has been apprised of this situation, the RMCC
          will make this information known to the ambulance, and offer to either patch the ambulance
          through on 155.340 to the hospital on another frequency band (UHF or 800 MHz where possible),
          contact the hospital by telephone and relay the information, or give the ambulance a number to
          contact the emergency department via cellular telephone.

          RMCC personnel will inform ambulances transporting to a facility of any applicable advisory
          status –i.e. diversion- but will not re-direct any ambulance to an alternate facility. Should a facility
          being contacted for an EMS provider request transport to another facility (i.e.-diversion status,
          etc.), RMCC personnel will give the information to the ambulance crew word-for-word.

          When hospital diversion or service advisories have been issued, the RMCC relays this
          information to all EMS providers on 155.205 via regional radio broadcast. It has been required
          that all EMS providers monitor 155.205 MHz in the specifics of the EMS Telecommunications
          Plan – though not all EMS providers monitor this frequency as stipulated. Future considerations
          allow the establishment of select-call monitoring, as with the hospitals. This will require EMS
          Dispatch entities to utilize DTMF coded squelch and require a DTMF encoder/decoder to alert
          other dispatch agencies and the RMCC. The codes have been identified as ―0‖ + the county
          numeric code (i.e. 090 for Washington County).


3.2     Frequency Patching

        Where allowed by the local system owner, the RMCC may cross-patch frequencies to allow an incoming
        ambulance to contact a facility or another EMS provider in a temporary console bridge by patching
        frequencies together. This may allow the patching of a provider on 155.280 to a hospital talk group on an
        800 MHz system – for example.
        Console bridging will not be allowed on the main EMS frequencies of 155.205 or 155.340 for more than a
        few minutes, due to the number of users on the system and users in adjacent states that would be
        impacted.




Effective 3/14/2007         The RMCC Council, at its option, may change, delete, suspend or             Page 6
Version 1.0             discontinue parts or the procedure in its entirety, at any time without prior
                       notice. In the event of a policy change, employees will be notified. Any such
                                action shall apply to existing as well as to future employees.
                                             Standard Operating Procedures


3.3    Channel Assignment
       State VHF (Very High Frequency) frequencies have been designated for specific use.


             3.3.1    155.205 MHz will be used as the primary routing frequency, for calling the RMCC,
                      and initial mutual aid contacts. This frequency is utilized by the State of Virginia as an
                      EMS mutual aid frequency, and is used by other EMS agencies in other bordering
                      states. The State EMS Telecommunications Committee has recommended all EMS
                      providers use a DPL of 205 on this frequency in the near future.

             3.3.2    155.280 MHz will be used for primary hospital to hospital communications. EMS
                      agencies may be approved for use of this frequency as a secondary user on a case
                      by case basis.

             3.3.3    155.295 MHz will be utilized for on-scene use for EMS coordination at events. The
                      Department of Health has also agreed to allow this frequency to be used at mass-
                      vaccination clinics by Health Services. This frequency is for mobile and portable use
                      only.

             3.3.4    155.340 MHz is identified nationally as the ―HEAR‖ frequency (Hospital Emergency
                      Ambulance Radio), and is dedicated solely for EMS to hospital communications. This
                      frequency will also be used by the RMCC to contact hospitals via radio.


3.4    Recordings of Communications

                 Recordings may be made available to an agency/facility of their transmissions for
                 ongoing quality assurance. Each request must be submitted in writing to the RMCC
                 Supervisor from an official of the department or facility involved.




Effective 3/14/2007        The RMCC Council, at its option, may change, delete, suspend or             Page 7
Version 1.0            discontinue parts or the procedure in its entirety, at any time without prior
                      notice. In the event of a policy change, employees will be notified. Any such
                               action shall apply to existing as well as to future employees.
4 Multiple Casualty Incidents & Mutual Aid
4.1     In the event of a Multiple Casualty Incident

              4.1.1 RMCC will take proactive measures
                  When learning of a multiple casualty event, which may require mutual aid resources, the
                  RMCC will Alert surrounding dispatch centers and hospital emergency departments via
                  155.205 MHz and 155.340 MHz using county-specific DTMF codes, or the all call code
                  (911). The Regional EMS Consultant and Regional Hospital Coordinator(s) will also be
                  notified when learning of an event, or potential event. No agencies will be dispatched or
                  asked to respond. It will be made clear that this is an advisory only, and services will be
                  contacted individually if their resources are needed.



4.2     RMCC Activation of Mutual Aid

      If the RMCC is contacted by an official or dispatch center for mutual aid resources, the number and type of
      resources requested will be obtained, along with the caller’s name, telephone number, any additional
      information warranted by the situation (i.e. Weather, Haz-Mat, etc..) location of the command post, staging
      area, and where responding units and personnel should report and to whom they should check in. The
      caller should also identify the local radio frequency being utilized for coordination on scene and have the
      transport officer contact the RMCC for estimated casualties so that facilities can be notified for real-time bed
      and service data via immediate HRTS update.


              4.2.1 EMS Activation
                  The RMCC will contact the closest EMS agencies and work away from the event until
                  sufficient resources are located to respond to the incident as requested by the local jurisdiction.
                  All ambulances are to check in with the RMCC for resource tracking from home location and
                  check in at the incident. The Regional EMS Consultant will also be contacted. The Regional
                  EMS Consultant may also ask the RMCC to contact the State EOC (SEOC) to assure they are
                  notified of the event.

              4.2.2 Hospital Activation
                  The RMCC will alert hospitals via 155.340 MHz call-out, and follow up with phone calls to
                  facilities who will most likely be receiving patients to determine their immediate
                  capabilities until they have updated online with the HRTS (Hospital Resource Tracking
                  System) network.


4.3     Notification of Regional Hospital EOCs and Bordering States

        Notification of facilities and jurisdictions bordering the Northeast Tennessee Region should be
        accomplished directly by RMCC as needed. The State EOC shall also be notified, and is to be
        tasked with additional out-of-state notifications as necessary.




Effective 3/14/2007          The RMCC Council, at its option, may change, delete, suspend or             Page 8
Version 1.0              discontinue parts or the procedure in its entirety, at any time without prior
                        notice. In the event of a policy change, employees will be notified. Any such
                                 action shall apply to existing as well as to future employees.
                                              Standard Operating Procedures


4.4     Ambulance Routing

      The RMCC will make the information gathered from the hospitals available to the Incident
      Commander, Medical Transport Officer, or EMS Consultant as necessary.
      The RMCC will not make hospital transport decisions but will route ambulances as directed by the Incident
      Commander, Transport Officer, or Regional Consultant.



4.5     Helicopter Operations

      When mutual aid aeromedical helicopters are requested, these shall be coordinated and controlled through
      the RMCC. Such operation shall instill safe coordinated operation for in-region and out-of-region services
      with a local control point.
      The air ambulance will be directed to the Landing Zone designated by the Incident Commander or
      Medical Transporting Officer.

      Air ambulances shall establish contact on VHF helicopter common frequency 123.025 MHz for air to
      air communications, which will also be monitored by the RMCC. The medical crew will coordinate
      ground communications through the dedicated aeromedical transport frequency identified by the
      Incident Commander. This frequency will also be monitored by the RMCC when possible.

      In the event an aircraft does not posses UHF or VHF ground radio capability (i.e. military) they may
      communicate on the ____________ aircraft Unicom frequency which can be relayed by the RMCC to
      the hospitals or Incident Commander.

      Alternate frequencies identified for local aeromedical use by the Civil Air Patrol:               ______.______

                                                                                                        ______.______




Effective 3/14/2007         The RMCC Council, at its option, may change, delete, suspend or              Page 9
Version 1.0             discontinue parts or the procedure in its entirety, at any time without prior
                       notice. In the event of a policy change, employees will be notified. Any such
                                action shall apply to existing as well as to future employees.
                                             Standard Operating Procedures



5 ALERTS
5.1    Alerting System Participants
       Each County contact point and hospital facility shall be alerted and notified when the RMCC learns of:
            Severe Weather Warnings
            Multiple Casualty Incident (alert potentially effected counties/facilities)
            Homeland Security Threat Level change
            Major highway artery closures or traffic delays
            Local Event requiring the closure of a facility
            Activation of the Regional Ambulance Strike Team
            Need for Immediate HRTS Status update from hospitals.

        EMS agencies will be alerted using all-call or county-specific codes of DTMF on 155.205 MHz.
        Hospitals will be alerted using all-call or county-specific codes of DTMF on 155.340 MHz.




Effective 3/14/2007        The RMCC Council, at its option, may change, delete, suspend or             Page 10
Version 1.0            discontinue parts or the procedure in its entirety, at any time without prior
                      notice. In the event of a policy change, employees will be notified. Any such
                               action shall apply to existing as well as to future employees.
6 HRTS
      Hospital Resource Tracking System (“hurts”)

      The Tennessee Department of Health’s - Hospital Resource Tracking System (HRTS) is a stand-alone web
      based system for the unified reporting of hospital data sets.
      Hospitals are required to report available beds, available services, and closed services (of those available)
      on a daily basis. In the event of a disaster, facilities would be asked to update their data for real-time use.
      Routine status reporting would only list open and closed services of a facility to the RMCC, Regional EMS
      Consultant, and Regional Hospital Coordinator, as well as the State EOC. Each facility can only view its
      data, but may view the open and closed services of facilities as other stakeholders during normal use.
      In the event of a disaster, State Health or the RMCC can create a Disaster Event within a HRTS area to
      make the last entered set of real numbers available to the RMCC and other emergency (EMS/Hospital
      Coordinator/EMA) officials. The RMCC, and others will utilize this information to inform event transport
      officers so they can make decisions as to where patients will be transferred or transported for their
      individual needs and to not overload any one facility.
      In the event of Pandemic Influenza, the RMCC will monitor Pandemic Influenza data requested by the
      Tennessee Department of Health and provided by hospitals on a daily basis.


6.1     HRTS Activation
        Upon learning of a disaster event, the RMCC shall initiate a ―disaster‖ event in the HRTS system.
        When the event is created, this will allow full data set information to be displayed to those officials
        in need within the region and State EOC (Emergency Operations Center).

        The RMCC should also Alert facilities affected of the immediate need for an updated data set using
        the alert policy.

        The RMCC will contact the Regional EMS Consultant and Regional Hospital Coordinator(s)
        immediately after establishing an event in the HRTS program.


6.2     HRTS Exercise
        When utilizing HRTS for a disaster exercise, the actual HRTS system will NOT be utilized. The
        Tennessee Department of Health has established an EXERCISE Function in a separate section to
        prevent the unintentional data set corruption which may occur during an exercise. The actual real-
        time data last entered into HRTS will not be affected.




Effective 3/14/2007          The RMCC Council, at its option, may change, delete, suspend or             Page 11
Version 1.0              discontinue parts or the procedure in its entirety, at any time without prior
                        notice. In the event of a policy change, employees will be notified. Any such
                                 action shall apply to existing as well as to future employees.
7 CHEMPACK
      CHEMPACK refers to a pre-positioned package of chemical agent antidotes located in caches
      throughout the State of Tennessee. The Northeast Tennessee region houses two CHEMPACKS
      routinely, with another being brought in to the region during major events (i.e. Bristol Motor
      Speedway NASCAR races)

      The CHEMPACK units are identified as Hospital and EMS CHEMPACKS. The Hospital
      CHEMPACKS house multi-dose vials and some auto-injectors of medications that would be required
      for the treatment of adult and pediatric patients exposed to a nerve agent. The EMS CHEMPACK
      contains Mark-I kits for the treatment of 1,000 adult patients exposed to nerve agents.

7.1    CHEMPACK Activation
       CHEMPACK Activation may be requested from Hospital, EMS, and 9-1-1 Contacts (identified by
       the Department of Health CHEMPACK Procedures). Upon request for CHEMPACK Activation, the
       requisite information will be obtained (Who’s requesting, What happened – is happening, When did
       it occur, Where did it occur, Why is nerve agent suspected, How do we need to get the
       CHEMPACK to you –delivery point).

             7.1.1 CHEMPACK MOVEMENT
                 CHEMPACK housing authorities will be contacted regarding the activation of
                 CHEMPACK, to prepare for immediate pickup of the transporting agency.

                 CHEMPACK transport agencies will be dispatched for EMS and/or Hospital transport and
                 instructed where to pick up their unit.

                 Regional Hospital Coordinator(s) and Regional EMS Consultants will be notified.

                 Regional EMS Providers and Hospitals will be alerted.

                 State EOC will be notified, as will the East Tennessee RMCC.


7.2    CHEMPACK Exercise
       The list of CHEMPACK contact numbers will be checked biannually (at least before every major
       NASCAR race at Bristol Motor Speedway).

       CHEMPACK deployment exercises will utilize an exercise package of similar size and packaging,
       provided by the Tennessee Department of Health.




Effective 3/14/2007        The RMCC Council, at its option, may change, delete, suspend or             Page 12
Version 1.0            discontinue parts or the procedure in its entirety, at any time without prior
                      notice. In the event of a policy change, employees will be notified. Any such
                               action shall apply to existing as well as to future employees.
8 COMMUNICATIONS MONITORING
8.1    Regional

             8.1.1 EMS Dispatch Centers
                 The RMCC shall perform weekly radio checks on 155.205 MHz with all EMS Dispatch
                 Entities/9-1-1 Centers in the Northeast Tennessee Region. These checks shall be made
                 using open channel monitoring or DTMF calling on both the All-Call (911) code, and
                 Individual County (0+county code) codes to assure continued system capability to
                 contact each county dispatch point in the event of an emergency.

             8.1.2 Hospital Emergency Departments
                 The RMCC shall perform weekly radio checks on 155.340 MHz with each hospital in the
                 Northeast Tennessee Region. These checks will be made using DTMF calling using the
                 all-call code (911) and each facility’s code as supplied by the State Division of EMS.

             8.1.3 Communications Failure
                 Where any problems exist with communications or alerting using DTMF within the region,
                 the agency/facility and Regional EMS Consultant will be notified and will work with the
                 RMCC to identify and correct the problem in conjunction with the regional resource.



8.2    Script Format
       Radio checks shall use a standard script for these communications checks:
       “WQFY386, Johnson City Med-Com on the air for Radio Check (Day, Date, Time). All
       Stations please stand by: (roll-call each facility)…
       …Recalling: (stations that did not answer)
       … Radio Check Complete. Johnson City Med-Com Clear, (time)”


       * All call and facility/county specific codes may be alternated each week for testing.


8.3    Inter-Regional
       The RMCC shall perform testing of inter-regional communications on a weekly basis.
       The Northeast Tennessee RMCC shall contact the Knoxville RMCC (―Med-Link 2‖) using 155.205 MHz,
       UHF Med-Channels (pre-identified with Knoxville), and 800 MHz systems where pre-identified.
       The RMCC shall also contact the State Emergency Operations Center on a monthly basis using the
       frequency identified by TEMA (Tennessee Emergency Management Agency).


8.4    Communications checks with other entities
       The RMCC shall also conduct monthly communications checks with:
            Regional EMS Consultant
            Regional Hospital Coordinator(s) – to include Counterparts in VA, NC, KY.
            Regional Health Operations Center (RHOC)


Effective 3/14/2007        The RMCC Council, at its option, may change, delete, suspend or             Page 13
Version 1.0            discontinue parts or the procedure in its entirety, at any time without prior
                      notice. In the event of a policy change, employees will be notified. Any such
                               action shall apply to existing as well as to future employees.
                                             Standard Operating Procedures


            THP District Office (Fall Branch)
            County Emergency Operations Centers, when identified
            Hospital Amateur Radio Stations (using ―ham‖ equipment)



8.5    Database Management
       The RMCC staff shall regularly update all information on contact lists at least twice annually.

8.6    Large/Special Events
       During large events or special operations (Bristol NASCAR race, or Mass Gathering Event), the RMCC
       will establish daily communications checks with the EMS component at the command post. These shall
       be conducted daily for the duration of each event, or at shift changes where warranted to assure
       continued communications.
       Local officials shall coordinate all EMS Command Post activities and communications plans, to include
       communications checks, with the RMCC.




Effective 3/14/2007        The RMCC Council, at its option, may change, delete, suspend or             Page 14
Version 1.0            discontinue parts or the procedure in its entirety, at any time without prior
                      notice. In the event of a policy change, employees will be notified. Any such
                               action shall apply to existing as well as to future employees.
9 Ambulance Strike Team
      An Ambulance Strike Team (AST) is an EMS mutual aid unit identified by the Federal Emergency
      Management Agency for mutual aid response and implemented by the Tennessee State Division of EMS.
      An Ambulance Strike Team is defined as a set of five ambulances of common type (ALS or BLS) staffed
      appropriately, licensed/permitted appropriately in the home state, along with a supervisor and
      supervisor/support vehicle. This is the common unit for mutual aid response in the State of Tennessee.
      Where a mixed ALS/BLS team is utilized, it is identified as an Ambulance Task Force. Where a mixed
      ambulance/response unit/etc.. team is utilized; it is identified as an EMS Task Force. Task Force being the
      identifier of a mixed resource team with the same goal.


9.1     RMCC Responsibility
        The RMCC in each region of the state is responsible for the alerting and coordination of the AST
        deployment and response to its assigned rally point, or point of disembarking. It shall also be the
        contact point for all communications from and to the AST for region 1 to assure a proper flow of
        information to personnel.

        The AST leaders will be pre-identified as they are trained and vehicles equipped to support a strike team.
        In the same manner, services will be pre-identified in their ability to provide ambulances and personnel
        for ambulances /crews that are stocked and available for mobilization as part of an AST.


9.2     Strike Team Activation
        The RMCC, when notified by the State EOC or another RMCC will locate an available AST Leader and
        five ALS ambulances within the region who can participate as part of the AST for deployment. The
        Regional EMS consultant will be notified, and a rally point will be identified for reporting in and checking
        equipment. The AST leader will be provided all requisite information relative to the mission.




Effective 3/14/2007         The RMCC Council, at its option, may change, delete, suspend or             Page 15
Version 1.0             discontinue parts or the procedure in its entirety, at any time without prior
                       notice. In the event of a policy change, employees will be notified. Any such
                                action shall apply to existing as well as to future employees.
10 Critical Incident Stress Management (CISM)
     The Northeast Tennessee Critical Incident Stress Management Team is administered by the State Division
     of Emergency Medical Services’ Regional Office. The CISM Team provides debriefing and stress
     management services to emergency response personnel and the general public upon request after the
     critical event involving unusual levels of stress.


10.1 Activation
       When notified of a need for Critical Incident Stress Management services in or out of the region, the
       Regional EMS Consultant will be contacted. If unable to contact the regional consultant, the Regional
       CISM Team Clinical Coordinator will be contacted. In the event neither of the above parties can be
       contacted within 20 minutes, Frontier Health will be contacted using their 24 hour contact number, and/or
       the Region 2 EMS Consultant will be notified via the Knoxville RMCC.




Effective 3/14/2007        The RMCC Council, at its option, may change, delete, suspend or             Page 16
Version 1.0            discontinue parts or the procedure in its entirety, at any time without prior
                      notice. In the event of a policy change, employees will be notified. Any such
                               action shall apply to existing as well as to future employees.
                                             Standard Operating Procedures



11 ACRONYMS
     AST                  Ambulance Strike Team
     ALS                  Advanced Life Support
     BLS                  Basic Life Support
     CHEMPACK             Chemical-antidote Package
     CISM                 Critical Incident Stress Management (formerly Critical Incident Stress Debriefing)
     DPL                  Digital Private Line™, Digital Coded Squelch
     DTMF                 Dual Tone Multi Frequency (i.e. Touch-Tone ™)
     EMS                  Emergency Medical Services
     EOC                  Emergency Operations Center
     GHz                  Gigahertz
     Haz-Mat              Hazardous Materials
     HEAR                 Hospital Emergency Ambulance Radio
     HRTS                 Hospital Resource Tracking System
     MHz                  Megahertz
     NASCAR               National Association for Stock Car Auto Racing
     RHOC                 Regional Health Operations Center (regional State Health Department EOC)
     RMCC                 Regional Medical Communications Center (formally RCC per T.C.A.)
     TCA                  Tennessee Code Annotated
     TEMA                 Tennessee Emergency Management Agency
     THP                  Tennessee Highway Patrol
     VHF                  Very High Frequency (radio frequencies from 30-300 MHz)
     UHF                  Ultra High Frequency (radio frequencies from 300 MHz to 3 GHz)




Effective 3/14/2007        The RMCC Council, at its option, may change, delete, suspend or             Page 17
Version 1.0            discontinue parts or the procedure in its entirety, at any time without prior
                      notice. In the event of a policy change, employees will be notified. Any such
                               action shall apply to existing as well as to future employees.

				
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