Ambulance Operations Manual

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1 Ambulance Operations Manual Standard Operating Procedures AMBULANCE SERVICES, MINISTRY PUBLIC HEALTH, SOCIAL DEVELOPMENT & LABOUR, GOVERNMENT OF SINT MAARTEN November 1 st 2010 Compiled by: drs.cylred Richardson, Head Ambulance Services

2 Ambulance Operations Manual Table of Contents 1. PREFACE INTRODUCTION THE ORGANIZATION/CHAIN OF COMMAND MISSION &VISION: THE OBJECTIVES PERSONNEL MANAGEMENT PHILOSOPHY PERSONNEL ORIENTATION BASIC WORK POLICIES BASIC PRINCIPLES: HOUSE RULES VEHICLE USE NON SMOKING POLICY: RECORDING OF WORKING HOURS: PERSONAL BUSINESS: ENGAGING IN OTHER ACTIVITIES: TARDINESS ABSENTEEISM & SICK LEAVE: FUNCTIONING & JOB EVALUATION DISCIPLINARY PROCEDURES AMBULANCE VEHICLE OPERATION POLICY: PURPOSE SPEED RESTRICTIONS USE OF WARNING SIGNALS EMERGENCY AND NON-EMERGENCY RESPONSE GUIDELINES THE TWO SECOND RULE INTERSECTIONS EXCESSIVE SPEED SIRENCIDE IRRATIONAL BEHAVIOR LIABILITY POLICIES WHILE ON DUTY DUTIES & RESPONSIBILITIES UNIFORMS AND APPEARANCE REPORTING FOR DUTY AND SCHEDULING WORK SCHEDULES DAILY ASSIGNMENTS AMBULANCE CHECK LIST

3 6.5 AMBULANCE TRIP (SHEETS) FORMS (PRE-HOSPITAL CARE REPORTS) AMBULANCE DISPATCH PROCEDURES RADIO COMMUNICATIONS GENERAL POLICIES & RESPONSIBILITIES PROPER USE OF EQUIPMENT MAINTENANCE OF VEHICLES TRANSPORTATION OF DECEASED PERSON DEAD ON ARRIVAL (D.O.A) POLICIES ALCOHOL AND OTHER DRUG USE BY AMBULANCE CREW USE OF CELLULAR WHILE OPERATING AMBULANCE DEPARTMENT S VEHICLES MAINTENANCE OF PATIENT CARE EQUIPMENT USE OF MEDICATION ON THE AMBULANCE I STAKEHOLDERS II OBJECTIVE III PHASE V MANAGEMENT OF MEDICATION SUPPLY VI STORAGE VEHICLE ACCIDENT PROCEDURES INJURY ON DUTY-CREW RELEASE OF INFORMATION AND NOTIFICATIONS SPECIAL CIRCUMSTANCES TREATMENT/TRANSPORT OF MINORS EMOTIONALLY DISTURBED PATIENTS PATIENT OR LOCATION NOT FOUND/UNABLE TO GAIN ENTRY CRIME SCENE OPERATIONS MASS CASUALTY INCIDENTS (MCI) FIRE/HAZARDOUS MATERIALS (HAZMAT) CALLS ATTACHMENT 1: PROCESS DESCRIPTIONS PATIENT BILLING INTRODUCTION PROCESS # 3.1 AMBULANCE ASSISTANCE RELEVANT MANAGEMENT INFORMATION FORMS AND SYSTEMS PROCESS # 3.2 REGISTRATION OF AMBULANCE ASSISTANCE RELEVANT MANAGEMENT INFORMATION FORMS AND SYSTEMS PROCESS # 3.3 CASH CONTROL RELEVANT MANAGEMENT INFORMATION ATTENTION POINTS & RECOMMENDATIONS ATTACHMENT 2: DISASTER MANAGEMENT ESF RESPONSIBILITIES & FUNCTIONS FUNCTIONS OF THE SUPPORT AGENCIES SLS, LABORATORY FUNCTIONS OF ESF

4 2. ESF 6 S TASKS & ACTIONS MITIGATION: ACTIONS OF ACTIVITIES WHICH REDUCE OR ELIMINATE HAZARDS ATTACHMENT 3: ALARM DIAGRAM CODE BLUE, YELLOW & RED ATTACHMENT 4:WORK INSTRUCTIONS & ALARM DIAGRAM CODE BLUE ATTACHMENT 5:WORK INSTRUCTIONS & ALARM DIAGRAM CODE YELLOW ATTACHMENT 6:WORK INSTRUCTIONS & ALARM DIAGRAM CODE RED ATTACHMENT 7: INWERKPLAN AMBULANCE- VERPLEEGKUNDIGE INLEIDING: OPBOUW INWERKSCHEMA: KENNISMAKINGS-/ INTRODUCTIEDAG EVALUATIE VAN DE EERSTE DAG: WEEK WEEK WEEK WEEK EVALUATIEGESPREK MET NIEUWE MEDEWERKER WEEK EVALUATIE GESPREK MET NIEUWE MEDEWERKER WEEK EVALUATIEGESPREK MET NIEUWE MEDEWERKER WEEK EVALUATIEGESPREK MET NIEUWE MEDEWERKER WEEK 4: EVALUATIEOVERZICHT VAN NIEUWE MEDEWERKER WEEK 1 T/M CHECKLIST T.B.V. HET INWERKPROGRAMMA VAN NIEUWE MEDEWERKER: ALGEMENE KENNIS EN KENNIS VAN DE INVENTARIS VAN DE AMBULANCE DAGEVALUATIE INWERKPLAN NIEUWE MEDEWERKER: VÓÓR EERSTE OPKOMST VAN NIEUWE MEDEWERKER TE REGELEN UITREIKEN DIVERSE ARTIKELEN OP DE EERSTE WERKDAG VAN NIEUWE MEDEWERKER (VPK.) ATTACHMENT 8: INWERKPLAN AMBULANCE CHAUFFEURS OPLEIDINGSAANDACHTSPUNTEN AMBULANCECHAUFFEURS: GEBRUIK VAN HET VOERTUIG GEDRAG OP DE WEG: RIJDEN MET BLAUW ZWAAI/ KNIPPERLICHT EN 2 OF 3 TONIGE HOORN: AANKOMST POST: EINDE DIENST: BLOK-INDELING INWERKPLAN AMBULANCECHAUFFEUR PHTLS CHECKLIST INWERKPLAN DAGVERSLAG INWERKEN PERIODIEK EVALUATIEFORMULIER INWERKEN EVALUATIEFORMULIER EINDE INWERKPERIODE (NA DE 6 E BLOK!) EVALUATIEFORMULIER ZELFSTANDIG FUNCTIONEREN UITREIKEN DIVERSE ARTIKELEN OP EERSTE WERKDAG VAN (CH.)

5 1. PREFACE This manual is a compilation of Standard Operating Procedures (SOPs) and guidelines as a result of research based in the field of Emergency Medical Services. Despite the many challenges over the last year of rewriting and editing in an effort to finalize this manual, it could not have been realized without the valuable input of management support and specifically the many suggestions received from staff members of the Ambulance Service. In addition to other resources available to staff members, the goal of this manual will serve as a resource tool for questions and answers that the ambulance nurses and assistants may be faced with. 4

6 2. INTRODUCTION The purpose of this Policies and Procedures Manual is to familiarize each staff member working at the Ambulance Department with his or her responsibilities and duties, so that all staff may be better able to perform a job vital to the community of St. Maarten in which we all live. This document is the Standard Operating Procedures (SOP s) of the Ambulance Service of Ministry Public Health, Social Development & Labour. It is not presented as a Book of Law, but rather as a Book of Reference with guidelines for everyone to follow and adhere to. Management realizes that rules or agreements can be forgotten over time, interpreted differently and that in the course of time new guidelines or work policies needs to be developed and decided upon by management of the Ambulance Services, Ministry of Public Health, Social Development & Labour or the government of St. Maarten. The majority of these SOP s that were introduced in 2007 has been revised. Where possible, the logic behind each policy/procedure or guideline will be explained, in order to make clear to the Ambulance personnel the intent and reasons for implementation. As an employee of the Ambulance Service of the Government of St. Maarten you have a variety of responsibilities and obligations; these responsibilities and obligations are laid down in several regulations and policies related to the legal position of civil servants in general. In this manual the focus will be on standard operating procedures for the Ambulance Service. For any further details, which are not explained in these chapters, you are advised to read your LMA and other laws regulating personnel matters such as the Employee-Handbook and Introduction Package with the various laws and policies given to every department by the Personnel Department. These standard operating procedures or guidelines will assist in maintaining a harmonious relationship between all personnel and the community. The medical protocols of the Netherlands will be adhered too as was taught during the SOSA certified training for ambulance nurses and ambulance drivers/assistants. 5

7 3. THE ORGANIZATION/Chain of Command The Ambulance Department up until June of 2010 is one of four departments of Sector Public Health that has an executing task of providing ambulance services to the community of St. Maarten, 24 hours a day 7 days a week. In transition to County St. Maarten that will go into effect on October 10 th 2010, the name will be changed to Dienst Ambulancehulpverlening (Ambulance Services) and will form part of the Ministry of Sector Public Health, Social Development and Labour. The department has an FTE of 24.2 that consist of a department head, operational leader, administrative assistant, certified ambulance nurses, certified ambulance assistants/drivers, a part time medical advisor and dispatchers. The operational team consisting of an ambulance nurse and an ambulance assistant works 8-hour shifts aboard the ambulance. This includes day, evening and night shifts. The ambulance nurses also functions as shift leaders and therefore are ultimately responsible for the shift in the execution of their daily tasks whether this is at the ambulance h e a d q u a r t e r s o r a b o a r d t h e a m b u l a n c e. The operational leader (manager) forms part of the first line contact with all operational staff members such as the ambulance nurses, ambulance drivers/assistants and the ambulance dispatchers. The operational leader reports directly to the department head with regards to operational matters of the department. The operational leader is responsible for the execution of operational matters within the department and the head of the Ambulance Services is ultimately responsible for the overall management. The head reports directly to the Secretary General of the Ministry Public Health, Social Development & Labour and the Secretary General will report to the Minister of Public Health, Social Development & Labour. 3.0 Organizational Structure: 6

8 3.1 MISSION &VISION: Mission To provide effective, timely and quality emergency medical services at Accidents, Sickness and Injury transport at large scale accidents and disasters. Vision Provide optimal, efficient and professional pre-hospital care for the general public and visitors of St. Maarten. 3.2 THE OBJECTIVES The objectives of the Ambulance Service is to guarantee ambulance services 24 hours a day; to guarantee the carrying out of necessary and permitted paramedical and ambulance nursing care that facilitates transportation required due to sickness or accident; to promote realization and maintenance of sufficient qualitative and quantitative facilities for ambulance services. The Ambulance Services deals primarily with the general public, visitors and calamities. Although everyone is familiar with ambulances, very few people are familiar with the details of ambulance care. Ambulances were associated with transport; they were seen as a means of transporting patients to hospital as quickly as possible. These days, very high quality care is provided at the scene. Ambulance care is high-quality care provided by professionals receiving life-long training. In this way, the quality to which every patient is entitled too is assured. This is the specific objective of every ambulance organization and every ambulance dispatch center. 3.3 Personnel Management Philosophy The Ambulance Services is managed by certain guidelines, policies and procedures to ensure that all personnel conduct themselves in the best interest of patients, peers, and Ministry Public Health, Social Development & Labour. Our strength depends directly on the contributions made by each of our staff members. Optimal service and efficiency result from individual participation and satisfaction. Personnel will find an organizational arena that is open, frank and honest in regards to personnel management. To work together successfully, each staff member must realize that good working relationships are not only a matter of rules, but are the result of daily decisions, mutual understanding, friendly attitudes, and team spirit. 7

9 3.4 Personnel orientation Introduction and Orientation: The introduction and orientation is not limited only to the role of the ambulance and transport service, role of the new staff member in the organization, and reinforcement of commitment required by the new staff member to be successful but also to get an understanding of the organization of the ministry of Ministry Public Health, Social Development and Labour in general. New staff: Orientation for new personnel is provided at a series of orientation sessions planned within the first weeks after employment. These sessions are mandatory. Orientation to ride-outs: Prior to orientation to ride-outs, Basic Life Support (BLS) Assist Class will be provided if necessary to provide training on the different equipment used on the ambulances. Teach the proper usage and set-up of specialized equipment if needed. Following the successful attendance and completion of requirements of the orientation sessions, the new staff member is permitted to begin orientation on board the ambulance. 8

10 4. BASIC WORK POLICIES 4.0 Basic Principles: The regulation is based on 7 principles. 1. Everyone is paid to work a minimum of 8 hours. It is now mandatory to register everyone s attendance for the purpose of dealing with absence without leave and to generate data for future policy development. 2. Department heads are ultimately responsible for registration and for providing correct data. 3. It is imperative for the success of any policy that it is executed, as much as possible, in the same way in every department. 4. Hours of absence without leave will be deducted from one s salary and can lead to disciplinary measures. Therefore it is imperative to register all forms of absence both with and without permission for leave. 5. Where possible some flexibility in the working-hours can be observed as long as a normal working day remains 8 hours. 6. Lunch break, in principle, is 1 hour and should be taken between and hrs. Some flexibility is possible, if the service permits. In both the moment and duration as long as point 5 is being honored. The lunch break is a minimum of 30 minutes, or is assumed to have been, even if the worker doesn t leave his or her desk. 7. It is up to the secretary general, together with the head, to determine whether a department or a section of a department or service can have flexible working-hours or not. Arguments not to have flexible workinghours can be of a functional nature. For instance to be able to guarantee the public opening hours, shift work, or the special responsibilities of certain public servants. A practical inability to register the working hours can also be an argument (for instance if workers do their work out in the field). 9

11 4.1 House Rules 1. The ambulance crew room or lounge is open to any staff member or invited visitors during business hours only. 2. Volunteer staff members are permitted to have visitors between 10:00 am 12:00 noon and/or between 14:00 pm 16:00 pm. Duty student/trainee employee staff should not have visitors in the workplace. 3. Staff members are not permitted to be in or around the Ambulance Headquarters after consumption of alcohol or drugs. 4. All departmental equipment and supplies remain at Headquarters for departmental use only and unless otherwise approved by management. 5. The dispatch area and supervisors offices are off limits except for authorized personnel and use of the supervisors office is limited to Supervisory staff only. 6. The Ambulance Services related work takes priority in the supervisors office and personal use of the supervisor s office/computer is authorized only after Ambulance Services related work has been completed. 7. All other staff and non-supervisory staff members are to use the computers in other designated areas. 8. Any dishes used in the kitchen are to be washed, dried and put away prior to the ending of each shift and all trash and cans/bottles must be placed in trash bin. 9. Any supplies, equipment, or personal items used during the shift are to be cleaned thoroughly and/or put away prior to the end of the scheduled shift. 10. A special effort by management will be made to provide coffee or tea as a courtesy of the ambulance services. If coffee/tea or additional kitchen supplies are needed, please inform a supervisor. 11. Cable TV will be provided as a courtesy and as a means of recreation for the personnel of the Ambulance Services. 12. Video games are allowed at night, but should not disrupt operations in any way. 10

12 13. Ambulance Crew jackets are to be hung up when not in use, and personal belongings should be kept locked in lockers assigned to each staff member or in the bunkrooms during the day. Book bags and coats should be kept neatly hung and NEVER in offices or the ambulance crew (lounge) recreational room. 14. A Telephone is provided as a courtesy; however this is not an answering service. It is expected that all calls will be brief, so as not to tie up phone lines. 15. All mechanical problems encountered with the ambulances or equipment is to be reported directly to the operational leader. 4.2 Vehicle use It is the policy of the Government and in particular for the Ambulance Services of the Ministry of Public Health, Social Development & Labour that vehicle are used only for officially authorized business. In recognizing the need to meet the standards of this policy, and provide for optimal response to medical emergencies/routine transportation while meeting administrative needs, please note: 1. Vehicles will be used first and foremost for the service for which they are intended; Ambulances will be dispatched first to emergencies and non-emergency requests for transportation before all other uses. 2. The ambulances and on-duty response vehicles will not leave without the assigned crew/driver on board, and only for official authorized business. 3. The ambulance crew may use the ambulance for the completion of personal details relating to the job but are always to be available for calls. It is the responsibility of the shift leader to ensure that the ambulance is in the compound area and available for emergency & non emergency calls. 4. Use of other vehicles is permissible during the evening and on weekends only for authorized business. The use of this vehicle will be logged on the computer automated dispatch (CAD) as appropriate (such as detail), with the person using the vehicle and the reason for use included in the comments section. 5. Dispatch will be notified each time a vehicle leaves the ambulance headquarters and when drivers return to headquarters. This alerts the dispatcher to the location of the driver at all times. 6. The ambulances are to remain in the parking area of headquarters at all times unless on runs as dispatched, approved details when assigned to supervisor and when the vehicle is out of service for repair. Personal errands and details are never appropriate. 7. The keys to all vehicles are kept in the key box. Keys should never leave the building with anyone who is not on-duty. 8. It is the ambulance driver/assistant s responsibility to make sure that all keys are accounted for at the beginning and the end of his/her shift. 9. Any unit/ambulance that is out of service for maintenance or other problem should be marked on the bulletin board as Out of Service (OOS). Vehicles that are taken in and out of service by the supervisory personnel should not be on the road. If there are questions, contact should be made with the supervisor who marked the unit OOS. 10. Ambulances are intentionally rotated to spread out vehicle use. The supervisor determines this rotation, and all crews need to follow the information posted on the shift board to determine which unit is first due, second due etc. 11. If you have any question about the appropriateness of using one of the vehicles, contact must be made with the on-duty supervisor before using the vehicle. 11

13 4.3 NON SMOKING POLICY: 1. All decisions regarding smoking policy of the federal government reflects adherence to the Ambulance Department smoking policy. 2. In accordance with legislation (P.B. 1996, nr.55), smoking is prohibited inside all government buildings, at the Ambulance Department and also in the ambulance and response vehicles. We ask each staff member to contribute to a smoke free and healthy environment. 3. Smoking is only allowed outside of the ambulance building. 4. Use designated smoking areas if applicable at SMMC if needed after the completion of calls. 4.4 Recording of working hours: The new working-hours regulation for the entire government civil service went in effect on August 1 st The most important elements of the new regulation are the obligation to register attendance as well as absenteeism in a uniform way throughout the organization of government and the introduction of flexible working hours where possible. Registering will generate accurate data for future policy development. The regulation also provides management with the necessary tools to effectively deal with absence without leave when it occurs. Taking appropriate corrective measures is now largely regulated. Similar to the sick-leave policy the department head has a key role in the enforcement of the regulation. The disciplinary measure of giving an official reprimand is mandated to the sector directors/secretary generals. Absenteeism and the so called No Show have been deemed major organizational problems by both the government and management. In the past years several instruments have been put into place to deal with the problem such as the sick-leave policy. The No Show committee came to the conclusion that often both management and workers were part of the problem of long-term absenteeism. Fixing this problem required implementation of several policies. Next to a new sick-leave policy and procedures for transfers a working-hours regulation will be put in place as a final instrument. 4.5 Personal Business: During working hours, you are not to engage in any business not directly related to our service. This includes the use of telephones, supplies, or equipment, without specific approval of management. We expect you to use your professional discretion in conducting personal business during office hours. If personal telephone calls are necessary during working hours, they should be kept as short as possible. 12

14 4.6 Engaging in other activities: As a Civil Servant you need specific approval from the government to engage in other activities, such as: Starting a business Working a second job Working as a freelancer When a conflict of interest is expected, you need to request permission before you start any of these activities. Not adhering to this policy can have consequences. 4.7 TARDINESS Arriving ten (10) minutes or more after the shift change is tardy and will be dealt with seriously as per services policy. 4.8 Absenteeism & Sick Leave: The successful operation of the Ambulance Services to the community depends on Civil Servants commitment and productivity. Any circumstance, which causes you to be absent from work must be reported to operational manager or head immediately and no later than three hours before start of duty. Only extreme circumstances can justify exception to the rule. In order to establish justifiable absenteeism and to insure you are being paid during sick leave, the service requires a doctor s statement regarding your disability to work in the case you have been sick for three days or longer. This statement should be produced on the fourth day of absenteeism at the latest. Failure to follow these rules can have repercussions. Illicit absenteeism from work is grounds for deduction of salary or dismissal. If the head sees ground for deduction of salaries due to absenteeism, the individual staff member will be informed. This subject, together with frequent tardiness is considered a very important behavioural trait in the organization. Therefore, it can be listed as a subject in your yearly job evaluation. 4.9 Functioning & Job Evaluation At least once a year every employee will have an evaluation meeting. This should be regarded as an opportunity for an active dialogue between you and the organization. Your Section Head and Department head are responsible for this. They will prepare this meeting, by inviting you and providing you with a standard Evaluation form. Based on the conversation a written evaluation of your performance together with a statement of goals for the next12 months is prepared. The final Evaluation report will be submitted to the Department Head and can have several consequences. 13

15 In cases of excellent performance, one can be recommended for a promotion, graficatie. In case of insufficient performance, certain goals will be set for your performance within a certain period. In such cases the evaluation period will be much shorter than 12 months, and can vary from one week to 6 months. Possibilities for training, further education or study assignments are also part of the discussion and decision making during these evaluation meetings DISCIPLINARY PROCEDURES Violations of Standard Operational Procedures: In the event that an apparent violation of operational procedures occurs, a process will be followed to enable an orderly review of the circumstances surrounding the situation. Except in serious cases of violation requiring immediate action, the following procedures will be followed: A. First offense: The person will be informed of the situation and that the occasion is his/her first verbal warning. B. Second offense: A written warning letter will be given and Personnel Affairs will also be informed of the situation. C. Third offense: The person will be suspended, with or without payment, until the government (Council of Ministers) take a decision on the matter. Staff with a history of tardiness, unexcused or excessive absenteeism, or other forms of unacceptable behaviour should be written up and counselled with proper documentation to maintain the standards of the ambulance services, and to keep the person informed of the need for corrective action on his/her part. In addition to the guidelines for conduct and performance stated previously, the department maintains other reasonable (LMA) standards such as, but not limited to, those that prohibit staff from fighting, refusing to perform a reasonable assignment, being under the influence of alcohol or drugs, engaging in disorderly conduct which threatens the safety of others, tampering with or falsifying departmental documentation, and actions which jeopardize the image of the Ministry of Public Health, Social Development & Labour and the Ambulance Services in particular. A violation of any of the above listed or the LMA identified actions will result in immediate suspension of privileges and referral to the Council of Ministers for further action. 14

16 5. AMBULANCE VEHICLE OPERATION POLICY: 5.0 PURPOSE The appearance and operation of all ambulances must reflect to the community that these vehicles are operated in a careful manner, a manner that instils confidence to the patient and ensures the safety of life and property. 5.1 SPEED RESTRICTIONS There is no need for excessive speed. The purpose of using the red or blue lights and the siren is to keep the ambulance moving at a constant, safe speed and not to allow the ambulance to exceed the posted speed limits in any area. 5.2 USE OF WARNING SIGNALS An ambulance operator shall not display warning lights and/or sirens except when: a. Responding to an emergency call b. Engaged in lifesaving services c. Transporting emergency patients who are classified as emergent by the ambulance nurse (paramedic) on the ambulance trip report form to a medical facility. It is acceptable to drive with the headlights on when operating an ambulance or response vehicle when responding to a medical emergency. This increases the general public s awareness of the emergency vehicle. 5.3 EMERGENCY AND NON-EMERGENCY RESPONSE GUIDELINES Sufficient information should be obtained from the dispatcher prior to responding to give the ambulance driver/assistant a good idea of where the incident occurred. The dispatcher should give clear, definitive directions to the driver as to the exact incident location, utilizing the area mapping system. The ambulance nurse shall operate the communication system en route to the accident, leaving the driver free to drive with as little distraction as possible. While responding to the scene the nurse should also watch for approaching traffic from the right at all intersections and advise the driver. The driver must ensure, at all times that traffic is clear from all directions before proceeding. Good judgment should be used by the driver at all times. An ambulance is heavier than a passenger car and will take a greater distance to stop. It is also top-heavy and will react differently when rounding curves or cornering. 15

17 The posted speed limit may be exceeded when responding to an emergency incident with emergency lights and siren, only if weather, traffic and road conditions permit the increased speed. An exception will be any school zone with a posted speed limit, which will be obeyed. 5.4 THE TWO SECOND RULE Always maintain a safe distance between the ambulance and the vehicles in front of it. Use the two second rule to gauge this distance. 5.5 INTERSECTIONS Most serious ambulance and other emergency vehicle accidents happen in an intersection. Remember, using the lights and siren is merely asking for the right of way. It is essential that the driver approaches all intersections with caution. It is important to realize that many people, while driving, may be day dreaming or talking, with the air conditioning on and the radio or stereo blaring; emergency vehicles are the last thing they are expecting. 5.6 EXCESSIVE SPEED The majority of documented emergency vehicle accidents occur because the vehicles are travelling too fast. The ambulance driver/assistant must drive defensively and have the vehicle under control at all times. Never let the vehicle or your emotions control you. Ambulances are heavy and take much longer to stop than ordinary vehicles. An ambulance will be also corner differently than a passenger type vehicle. It is much safer to maintain a constant speed, in which traffic is clearing a pathway, than to continually speed up and slow down. The result will be to outrun the effect of the siren and emergency lights. This is also extremely hard on the vehicle and gives the crew and patient a very uncomfortable and dangerous ride. 5.7 SIRENCIDE Be aware of this phenomenon. Due to the noise of the siren, the ambulance driver/assistant may be lulled into a false sense of security, believing that everyone hears the siren and sees the lights, and therefore will yield the right of way for the ambulance. At the same time there will be a tendency to increase the speed of the ambulance. 5.8 IRRATIONAL BEHAVIOR Watch for the unexpected. The sight of flashing lights and the sound of a siren tends to cause people to panic. At times they may speed up, slow down, pull to the left, stop short in front of the ambulance, etc. The ambulance driver/assistant must remain calm and alert. The safety and well being of many people rests with the judgment and the reactions of the ambulance driver/assistant. 5.9 LIABILITY 1.1. Whenever an ambulance is damaged through the negligence or misconduct of an ambulance assistant/operator or through the negligence or misconduct of any other official or employee of the department, all cost incurred in the removal and repair, or in the case of total loss will be for the person(s) account. 16

18 1.2. While the driver of an emergency vehicle giving audible signals should be given the right-of-way, this provision does not operate to relieve the ambulance operator from the duty to drive with reasonable care for the safety of all persons using the public streets, nor shall it protect such driver of any emergency vehicle from the consequence of an arbitrary exercise of such right-of- away The basis for determining responsibility for the negligence or misconduct which caused or precipitated the damage to the vehicle shall be the findings of the Service Investigation Team (SIT). The Department of Support Services shall affix responsibility in accordance with its established procedures and orders POLICIES WHILE ON DUTY MEALS AND BREAKS There are no formal meals and break periods for operational staff scheduled during shift time. The emergency nature of the job necessitates a flexible approach to taking breaks and obtaining meals when not engaged in an emergency run or training. Meals and breaks shall be taken when possible and shall not in any way ever conflict with the system s immediate response capability. Crews are welcome to work on homework, obtain meals or watch television. Ambulance crews are only welcome to nap during night shifts. TELEPHONES Telephone calls are to be limited. If personal telephone calls are necessary during working hours, they should be kept as short as possible. 17

19 6.DUTIES & RESPONSIBILITIES 6.0 Uniforms and Appearance One should place the patient at ease by presenting a reassuring appearance. The ambulance personnel should wear clothing that is neat and clean, providing a hygienic as well as professional appearance. Uniforms are to be worn by all on-duty shifts or as approved by the department head. UNIFORM AND GROOMING REQUIREMENTS ARE AS FOLLOWS: 1.1 The new uniforms are to be worn in its entirety during regular shifts while on duty. 1.2 Jeans are not acceptable in combination with regular uniform while on duty for regular shifts 1.3 The uniform code for the piketdienst is exceptional however a combination should be made for easy identification of an ambulance staff member. 1.4 Excessive jewelry is discouraged due to the inherent problems associated with small children and convulsive patients. Wedding bands are acceptable. 1.5 Excessive hair is discouraged. Men: Above the collar, medium afros are acceptable. Beards and sideburns must be well trimmed. Women: Hairstyles are to be neat and clean with little adornment and should be pinned if necessary not to interfere while carryout work. Needs to ensure that long hair does not become a safety hazard (entanglement or assault) and that finger nails are kept short. 1.6 Shoes should be black. Steel toes are highly recommended for ambulance teams aboard the ambulance. Clogs, sandals and athletic shoes are not acceptable. 1.7 Name tags shall be worn over the left breast pocket. 1.8 All ambulance nurses and assistants are required to carry their own watch with second hand, as well as a penlight and stethoscope. 6.1 REPORTING FOR DUTY AND SCHEDULING It is most necessary that ambulance nurses/ ambulance assistants and dispatchers coming on shift are on time so they may orient themselves to the conditions with which they must work. A minimum of 15 minutes prior to changing of shifts is required and is acceptable. Shifts hour are from 07:00 AM to 15:00 PM, 15:00 PM to 23:00 PM and 23:00 PM to 07:00 AM. Once the ambulance nurses, assistants and dispatchers have reported for duty, he/she may not leave the department without first notifying the operational leader or ambulance nurse in charge. The Ambulance teams is not allowed to take a nap (sleep) during the various shifts except for night shifts however must at all time be ready to respond immediately to any emergency call. Regular and administrative staff working hours ranges from 08:00 AM 17:00PM. 18

20 Note: No staff member may leave their duty station without appropriate coverage as approved by the operational manager or department head. 6.2 WORK SCHEDULES a. Work schedules are prepared at least two (2) weeks in advance by the operational leader (manager) and posted on the bulletin board. Every schedule covers a period of one month. It is your own responsibility to check your working schedule for the coming weeks. When you are not present at a specific time, you should call in prior to your absence or delay. b. Any and all requests for schedule changes should be presented in writing at least two (2) weeks in advance of the time the schedule is to be prepared. Emergency requests may be honored at the discretion of the operational leader (manager) after consultation with the head of the service. c. Only the operational leader and/or the head are authorized to make schedule changes. Any such changes must be initialled. d. All scheduled operational staff is to remain on duty until relieved by the on-coming shift. Ambulance nurses, assistants and dispatchers are considered relieved only after they report to the on-coming shift on amongst other things the condition of vehicle (s) and inventory and any other pertinent information and after completion of all reports for his or her shift. 6.3 DAILY ASSIGNMENTS The operational leader (manager) will indicate on the weekly time sheet which ambulance nurse is in charge of each shift. The ambulance nurse in charge will prepare daily assignments for each shift. Any medical technician refusing to accept his or her assignment shall be disciplined in accordance with the Ambulance Services policy. 6.4 AMBULANCE CHECK LIST The Ambulance check lists have been designed with patient care, safety and legal back-up in mind. Each list should be completed by the on-coming ambulance crew at the change of shift, so the off-going and on-coming crew may discuss any discrepancies. The ambulance driver/assistant, at the completion of a run, is responsible for replacement/replenishment of supplies and cleaning of the ambulance patient compartment. Any missing equipment should be indicated on the check lists and reported to the ambulance nurse/shift leader. The Ambulance Nurse/shift leader will review and submit completed ambulance check lists to the operational leader for review and filling. Periodic checks of the ambulance may be made by the operational leader or Head. 19

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