standard operating guidelines of the gouverneur vol

STANDARD OPERATINGGUIDELINES OF THEGOUVERNEUR VOL.

RESCUE SQUAD, INC.

2013

OCTOBER 2013, NOVEMBER 2013, DECEMBER 2013, JANUARY2014, MAY 2014, JULY 2014, AUGUST 2014, SEPTEMBER 2014,NOVEMBER 2014

GOUVERNEUR VOL. RESCUE SQUAD, INC. | 1024 US HWY 11 Gouverneur, NY 13642

1

SOG Policy # Pg. #

ADMINISTRATIONDefinitions/Job Descriptions………………………………………………………. 2013-101 6

Chain of Command…………………………………………………………………….. 2013-102 10

Orientation/Continuing Education……………………………………………… 2013-103 11

Performance of Duty, Misconduct, Discipline, Suspension andRemoval for Membership……………………………………………………………

2013-104 13

Release of Member/Employee Information……………………………….. 2013-105 17

Telephone Procedures/Emergency Calls to the Building……………… 2013-106 18

Uniforms………………………………………………………………….................... 2013-107 19

Comments/Complaints…………………………………………….................... 2013-108 20

Observers…………………………………………………………………………………... 2013-109 21

Precepting EMS Students…………………………………………………………………. 2013-110 23

Incident/Unusual Occurrence Reports……………………………………….. 2013-111 25

Reportable Incidents to the NYSDOH…………………………………………. 2013-112 26

Public Information/Release of Information to the Media…………… 2013-113 27

Possession and Use of Weapons……………………………………………………… 2013-114 29

Determination of Good Standing……………………………………………….. 2013-115 30

Personal Equipment/Clothing Replacement……………………………….. 2013-116 31

Surveillance Cameras…………………………………………………………………. 2013-117 32

Borrowing Equipment………………………………………………………………… 2013-118 35

Dispatch…………………………………………………………………………………….. 2014-119 36

DMV Driver Records and Monitoring………………………………………….. 2014-120 37

OPERATIONS

2

Radios and Communications………………………………………………………. 2013-201 39

Director Notifications…………………………………………………………………. 2013-202 42

Vehicle Checks……………………………………………………………………………. 2013-203 43

Securing and Storage of Equipment and Medications…………………. 2013-204 45

Safety Restraint Use……………………………………………………………………. 2013-205 47

Driving……………………………………………………………………………………….. 2013-206 48

Driver Training……………………………………………………………………………. 2013-207 51

Backing…………………………………………………………………………………….... 2013-208 52

Emergency Driving………………………………………………………………………. 2013-209 54

Collisions Involving a GVRS Vehicle……………………………………………… 2013-210 57

Response in Privately Owned Vehicles………………………………………… 2013-211 59

Scene Safety……………………………………………………………………………….. 2013-212 60

Patient Care Documentation………………………………………………………. 2013-213 62

Patient Handling…………………………………………………………………………. 2013-214 67

Lifting and Moving Patients………………………………………………………… 2013-215 68

Friends/Family in the Ambulance……………………………………………….. 2013-216 69

Response to Motor Vehicle Collisions…………………………………………. 2013-217 70

Response to a Fire Scene…………………………………………………………….. 2013-218 72

Responding to a Hazardous Materials Incident…………………………… 2013-219 73

Responding to Assist the Police…………………………………………………… 2013-220 75

Responding to a Mass/Multiple Casualty Incident (MCI)……………… 2013-221 76

Dealing with Violent Patients……………………………………………………… 2013-222 84

Treating and Transporting Pt’s with a Psychiatric Problem………….. 2013-223 85

Patient Restraint…………………………………………………………………………. 2013-224 86

3

Unfounded Calls/Unable to Locate a Patient………………………………. 2013-225 87

Unable to Gain Access to a Scene………………………………………………… 2013-226 88

Do Not Resuscitate Orders and Other Advanced Directives…………. 2013-227 89

Confirmed DOA’s and Termination of Resuscitation…………………… 2013-228 91

Patient Refusals………………………………………………………………………….. 2013-229 93

Patient Care and Consent of Minors……………………………………………. 2013-230 94

Request for Transport Out of Service Area………………………………….. 2013-231 95

Standby’s……………………………………………………………………………………. 2013-232 96

Child Abuse and Maltreatment…………………………………………………… 2013-233 99

Elder Abuse and Neglect……………………………………………………………… 2013-234 101

Patient Abuse……………………………………………………………………………… 2013-235 102

Abandoned Infant Protection Act……………………………………………….. 2013-236 103

Reporting of Crimes……………………………………………………………………. 2013-237 104

Hospital Diversions……………………………………………………………………… 2013-238 105

Simultaneous Calls (800.21)………………………………………………………… 2013-239 106

Maximum Receipt interval (800.21)……………………………………………. 2013-240 107

Ambulance Exchange Points……………………………………………………….. 2014-241 108

Vehicle/Equipment/Facility MaintenanceEquipment Preventative Maintenance and Failure……………………… 2013-301 117

Vehicle Preventative Maintenance and Failure…………………………… 2013-302 119

Out of Service Vehicles……………………………………………………………….. 2013-303 121

Vehicle Fuelling…………………………………………………………………………… 2013-304 122

Periodic Cleaning and Decontamination of Vehicles…………………… 2013-305 123

Facility/Property Use and Upkeep………………………………………………. 2013-306 125

4

Tobacco Usage……………………………………………………………………………. 2013-307 127

Members Presence at the Building……………………………………………… 2013-308 128

Cell Phone Usage………………………………………………………………………… 2013-309 129

Washing/Cleaning of POV’s………………………………………………………… 2014-310 130

Vehicle Security………………………………………………………………………….. 2014-311 131

Daily Duties for Career Members………………………………………………… 2014-312 132

Safety and Quality ManagementGeneral Safety Issues………………………………………………………………….. 2013-401 133

Health and Safety Committee…………………………………………………….. 2013-402 135

Critical Incident Stress Management…………………………………………… 2013-403 136

OSHA Compliance Programs……………………………………………………….. 2013-404 137

Workplace Violence……………………………………………………………………. 2013-405 138

Member/Employee Health Examinations……………………………………. 2013-406 141

Glucometer Calibration………………………………………………………………. 2013-407 144

Continuous Quality Improvement………………………………………………. 2013-408 145

FinancialResponsibility……………………………………………………………………………... 2013-501 150

Purchasing………………………………………………………………………………….. 2013-502 151

Budgeting……………………………………………………………………………………. 2013-503 152

Credit Cards………………………………………………………………………………... 2013-504 153

Taxes………………………………………………………………………………………..... 2013-505 154

Accountant…………………………………………………………………………………. 2013-506 155

Financial Misconduct………………………………………………………………….. 2013-507 156

Capital Purchases……………………………………………………………………….. 2013-508 157

5

Training Conferences etc…………………………………………………………….. 2013-509 158

Insurance of Checks…………………………………………………………………….. 2013-510 159

Accounting Software…………………………………………………………………… 2013-511 160

Service Fees………………………………………………………………………………… 2013-512 161

Bank Reconciliation…………………………………………………………………….. 2013-513 162

Planning, Accounts and Investments…………………………………………… 2013-514 163

Conflict of Interest………………………………………………………………………. 2013-515 164

Petty Cash…………………………………………………………………………………… 2013-516 165

Whistle Blower……………………………………………………………………………. 2014-517 166

AppendixGouverneur Central School District Disaster Plan

Cives Steel Company Disaster Plan

Clearwater Paper Corp. Disaster Plan

Kinney Drugs Warehouse Disaster Plan

6

Gouverneur Volunteer Rescue Squad, INC.

Standard Operating Guidelines

Section: Administration Subject: Definitions/Job DescriptionsSOG # 2013-101 Date: October 15, 2013

Page 1 of 4

AEMT – Advanced EMT EMT – Emergency Medical TechnicianALS – Advanced Life Support ILS – Intermediate Life SupportBLS – Basic Life Support PCR – Patient Care ReportDNR – Do not Resuscitate PPE – Personal Protective EquipmentDOA – Dead on Arrival

General Membership Requirements:All Members Regardless of job assignment must:

Be at least 18 years of age. Have the ability to communicate verbally, in person or via telephone and/or radio

equipment. Have the ability to interpret written and oral instructions. Have the ability to use good judgment and remain calm in high stress situations. Have the ability to read English language manuals, write, and converse in English. Meet all requirements of the Public Health Law 800. Complete an application for Membership and Physical exam by a physician. ALL MEMBERS MUST BE APPROVED BY GOUVERNEUR VOL. RESCUE SQUAD, INC.

Worker’s Compensation carrier.

Motor Vehicle Operators:All designated motor vehicle operators as well as any patient care providers who wish tooperate the ambulance vehicle under any circumstances must meet the followingrequirements:

Have a valid NYS Driver’s license with a DMV record acceptable to the GouverneurVol. Rescue Squad, INC. Insurance carrier.

Complete a Driver Preceptor program acceptable to the Gouverneur Vol. RescueSquad, INC.

7

Have Completed a CPR course approved by the American Red Cross, or AmericanHeart Association.

Meet all OSHA and Department of Health Requirements (Infection Control, Hazmat,and HIPAA).

Have good manual dexterity with the ability to perform all tasks related to motorvehicle operations and/or patient care.

Have the ability to bend, stoop, and crawl on uneven terrain. Have the ability to withstand varied environmental conditions such as extreme heat,

cold and moisture.

MVO Job Description:The motor vehicle operator is expected to operate the vehicle in a safe manner according toall applicable Gouverneur Vol. Rescue Squad, INC., policies and procedures. In addition, theMVO may be required to assist at the scene of an emergency with gathering neededequipment, lifting and moving patients. Operation of stretchers, stair chairs, and CPR.

In addition, the motor vehicle operator is responsible for the following:

Maintains the ambulance in operable condition and reports any problems withvehicle operations as soon as possible.

Cleans exterior of the ambulance as needed. Provides assistance in removing the patient from the ambulance and into the

emergency department. Replaces fuel when needed, less than ½ tank. Follows the orders of the Emergency Medical Technician or higher on all ambulance

and rescue calls.

Patient Care Personnel:All patient care personnel must be currently certified by the NYS Department of Health at thelevel of Emergency Medical Technician, Advanced EMT – Intermediate, Advanced EMT –Critical Care, or EMT – Paramedic. Patient care personnel must present their original copy oftheir certificate to the Director of Operations and/or Board of Directors upon applying formembership, and each time the certification is renewed. A photocopy will be made of thecertificate for the members file, and the original returned to the member.

The only exception to this will be persons enrolled in Emergency Medical Techniciancertification training courses. In these case the person may perform patient care tasks withintheir present level of training, but only under the direct supervision of a currently certified

8

member at or above the level of the trainee.

Job Description for ALL Patient Care Providers: Receives call from dispatcher, verbally acknowledges the call to the dispatcher, and

drives safely to the emergency location, either in the ambulance or by private vehicle. Determines the nature and extent of the illness or injury, makes determination of

patient status, and renders appropriate emergency care based on competency level. Assists in lifting, carrying, and transporting patients. Applies light rescue and extricates patient from entrapment as able or calls for

rescue/extrication assistance. Radios dispatcher for additional assistance or services as soon as the need for such

assistance becomes evident. Complies with protocols and regulations in handling deceased patients, notifies

authorities, and arranges for protection of property and evidence at scene until thearrival of police.

Reports verbally and in writing observations regarding patient assessment and care. Replaces supplies, checks all equipment for future use, maintains ambulance in

operable condition or reports problems immediately, ensures ambulance cleanlinessand orderliness of equipment and supplies, decontaminates vehicle interior.

Emergency Medical Technician (EMT):The EMT practices under the supervision and control of the agency medical directory andregional medical control physician. The EMT performs all of the tasks of the basic EMT scopeof practice, including general patient assessment, basic airway management, bleedingcontrol, and basic treatment of shock, emergency childbirth, helmet removal. In addition, theEMT performs basic trauma assessment and care such as spinal immobilization, extremityimmobilization, basic assessment and care of medical emergencies, documentation of care,and defibrillation using an AED.

Paid Day/Night EMT Only:The day/night paid EMT on shall be responsible for but not limited to holding andcompleting the following tasks and licences and certifications:

Class C CDL licence with passenger endorsement. Maintain EMT certification along with CPR/AED. Continuing education as needed to hold EMT certification, or as requested by the

Director of Operations and/or the Board of Directors. Upkeep of building and grounds.

9

Responding to emergency calls and inter-facility transports and coach transports. Vehicle cleanings, rig checks, and Maintenance (checking for oil changes, fluid levels

etc.)

Advanced EMT:The Advanced EMT (I/CC/P) practices under the supervision and control of the agencymedical director and regional medical control physician. Maintain current NYS certification.

Advanced EMT – Intermediate:The EMT-Intermediate performs all of the tasks of an EMT (Emergency Medical Technician),in addition, the following skills are performed by the EMT-I: IV Therapy, endotrachealintubation, and suctioning, and using an AED.

Advanced EMT-Critical CareThe EMT – Critical Care performs all of the task of the EMT-I, with the following additions:ECG monitoring and dysrhythmia interpretation, medication administration such as definedin the protocols, synchronized cardio version, external cardiac pacing, 12 lead EKG, needlechest decompression, and other tasks as defined in the protocols.

EMT – Paramedic:The EMT – Paramedic is the highest level of pre-hospital emergency medical care. TheParamedic performs all of the tasks of a Critical Care Technician with the addition of certainspecialized medications as defined in their protocols, Quick Trach, and other procedures.

Note: The highest level of Emergency Medical care in the pre-hospital setting is in charge atall times unless told otherwise.

Ambulette Operator Job Description:Drive Patients and clients to scheduled doctors’ appointments and other possibleengagements. List of duties and responsibilities are as follows:

Maintain CDL-C license or higher with passenger endorsement. Subject to drug screening. Maintain all required training and testing. Wash, clean, maintain vehicle and equipment. Availability flexible to needs of organization. Report to Director and/or designee.

10

Gouverneur Volunteer Rescue Squad, INC.Standard Operating Guidelines

Section: Administration Subject: Chain of CommandSOG # 2013-102 Date: October 15, 2013

Page 1 of 1

Gouverneur Vol. Rescue Squad, INC., promotes two different types of organization. Wepromote teamwork and consensus building as our leadership style at all levels of theorganization. On the other hand, we have a hierarchal, paramilitary structure similar to thepolice and fire services. This is particularly important at critical moments such as emergencyscenes or MCI’s in order to be prepared to follow the incident command system.

The Chain of Command for GVRS, INC., is as follows: Director of Operations and/or designee. Next Senior Medical

In order for GVRS, INC., to be successful at serving our community, it is important formembers to operate within its organizational structure. There are two important principlesthat must be followed.

Any activity at GVRS, INC., falls under the responsibility of the Director of Operations.The director has the authority to manage all activities relating to their areas ofresponsibility. Members having an interest in undertaking an activity have theresponsibility of coordinating with the responsible director.

Members must work at the direction and discretion of the Director of Operations.

SOG level issues that are not operational are discussed and acted upon at the Board ofDirectors Meetings. Examples of these types of issues are scheduling, SOG changes, etc.Suggestions should be brought to any board member.

Failure to follow these fundamental principles leads to anarchy and directly undermines theability of GVRS, INC., to fulfil its commitment to serve its community.

Any member or employee who violates the Chain of Command during an incidentand/or on the scene of an incident may face immediate suspension or

11

insubordination.


Section: Administration Subject: Orientation/Continuing EducationSOG # 2013-103 Date: October 15, 2013

Page 1 of 2

One fact facing EMS providers today is that we all have to spend a significant amount of timeduring our EMS careers in training and education. This is true for motor vehicle operators aswell as patient care providers. Our agency is responsible for training all of our personnel inhazardous materials recognition, infection control, hazard communications, V&T law,protocols, etc. it is important for all prospective members to understand the timecommitment necessary and that it is simply not enough anymore to be available to respondto calls.

Orientation of PersonnelAll new members will be required to complete and orientation program after being acceptedinto membership by the agency. The orientation will be under the direction of the Board ofDirectors and/or their designee. All new members must complete a probationary periodincluding but not limited to a driver preceptor program etc. During theorientation/probationary period process, the member will work ONLY under the Guidelines,procedures, policies and/or bylaws set in place by the Director of Operations, Board ofDirectors and/or their designee.

This training will include but may not be limited to the following subjects: Review of STANDARD OPERATING GUIDELINES. Infection Disease Orientation plus Exposure Control Plan and Procedures. Emergency Vehicle Operation, V&T Law, Driving Orientation and Practice. MSDS (location of manual). Hazmat awareness. Infection control HIPAA – Health Insurance Portability and Accountability Act (Patient’s confidentiality

and privacy under HIPAA). Tour of building and ambulance vehicle, supplies and equipment. Proper use of equipment.

12

Proper lifting instructions. Proper clothing. Knowledge of duty. Proper radio use. Interfacility transport call answering procedure. Review of MCI equipment and supplies. Basic knowledge of the Cardiac Monitor and ALS Bag. Knowledge of first in Bag (BLS Bag). Complete McNeil & Company Training. Complete a part 800 ambulance equipment check out.

Any motor vehicle operator must be evaluated by the training officer. The Driver PreceptorProgram must be satisfactorily completed before the member is allowed to operate thevehicle unsupervised.

Training/Continuing EducationThe Director of Operations and/or his designee will be responsible for conducting trainingsessions if at all possible, and any additional special sessions as may be required.

The Gouverneur Vol. Rescue Squad, INC., requires that members attend at least twocontinuing education sessions per year. In addition, personnel are required to maintain acurrent CPR card and/or First Aid/CFR/EMT/AEMT card. All personnel certified at the CriticalCare or Paramedic level are strongly encouraged to maintain a current ACLS card.

13


Section: Administration(last updated 5/5/2014)

Subject: Performance of Duty, Misconduct,Discipline, Suspension and Removal forMembership

SOG # 2013-104 Date: October 21, 2013Page 1 of 4

It is extremely important that all members and prospective members realize that any person,whether paid or volunteer, who has agreed to take upon him or herself the responsibility ofproviding emergency medical care, is assuming a very serious obligation. The GouverneurVol. Rescue Squad, INC., takes the protection of the patients who have placed themselves inour care, the health and safety of all of its members, and the health and safety of all personwith whom the Gouverneur Vol. Rescue Squad INC., in fulfilling its duties, comes into contactvery seriously.

Members are expected to act in a professional manner at all times and at no time act in away that may bring discredit to the Gouverneur Vol. Rescue Squad, INC.,. The best disciplinesystem is one that never has to be used. In the vast majority of cases, Gouverneur Vol.Rescue Squad, INC., members know what they have to do, how to do it, and perform all oftheir duties and responsibilities with the utmost professional manner. However, even withthe best intentioned personnel, there are occasional lapses of judgment and action, andthese policies are intended to treat all members in the fairest manner possible.

Maintenance of Patient ConfidentialityAll members must keep all patient care records and calls confidential. Details of calls may bediscussed with hospital staff as may be necessary, and within the agency for training and QIpurposes. Breach of confidentiality will result in disciplinary action. Members will complywith all HIPPA and New York State Department of Health Patient Confidentiality. ALLmembers will sign a patient confidentiality statement for their personnel file. Any violationof Patient Confidentiality may result in criminal and or civil charges.

Alcohol/Drug/Prescription Medication UseAll duty personnel shall refrain from the use of alcohol or any substance which would in theleast impair their judgment or reflexes. Under no circumstances shall any member of the

14

Gouverneur Vol. Rescue Squad, INC., assist as a crew member or driver while under theinfluence of alcohol or any other substance which would in the least impair their judgment,nor shall anyone (except a patient) be permitted to ride in any vehicle owned by theGouverneur Vol. Rescue Squad, INC., while under the influence of alcohol or any otherintoxicating substance. This is a New York State Public Health Law violation, and a reportableincident. Members found guilty will be dismissed from the organization. Drivers and StateCertified Emergency Medical Technicians at all levels will be reported to the New YorkState Department of Health as required by law.

Sexual HarassmentAll members of the Gouverneur Vol. Rescue Squad, INC., have the right to work in anenvironment free from harassment. Furthermore, it is illegal for any member to sexuallyharass another member.

Sexual Harassment is defined as unwelcome sexual advances, request for sexual favours, andother verbal or physical conduct of a sexual nature constitutes sexual harassment.

Any member who believes he or she has been the subject of sexual harassment should reportthe incident or act immediately to the Director of Operations of the Gouverneur Vol. RescueSquad, INC.,. The Gouverneur Vol. Rescue Squad, INC., will promptly investigate allcomplaints. The member alleging sexual harassment will be advised that in order to pursue acomplaint the specifics will have to be put in writing on an incident report. All informationwill be kept confidential and will be discussed only with those who have a need to know inorder either to investigate or resolve the complaint. Any member who the Gouverneur Vol.Rescue Squad, INC., determines has engaged in sexual harassment will be promptlydisciplined. Disciplinary measures may consist of suspension or termination depending on theseverity of the offense. The member also has a right to register a complaint with theappropriate state authority. The member has 72 hours to report the incident to the Directorof Operations and/or his or her designee.

No member will be punished or penalized in any way for reporting an incident which they, ingood faith, feel constitutes sexual harassment.

Professional MisconductProfessional misconduct is defined as any behaviour not conforming to prevailing standardsor laws, that may have a negative impact on a patient, family, of the Gouverneur Vol. RescueSquad, INC.,. Public image and/or operations.

15

Duty CrewIt is the responsibility of every member to sign up on the duty crew calendar at least oneweek in advance. No member shall be placed on the calendar without his/her knowledge andconsent. “On Duty” means that the member will be available for the allotted time, if amember will not be available for any or all of his/her on-call time, he/she must arrange foranother member (at or above the members level of certification, if at all possible) to cover. Itis unacceptable for certified personnel to arrange for a cover from non-certified personnel.Members must realize that our patients’ lives may depend on the immediate availability of acrew, and the members must take this obligation very seriously. Failure to follow theseguidelines may result in disciplinary action.

All Full Members must pull at least 12 hours per week or equivalent to 52 hours a month.Unless waived by the Board of Directors of their Duty Requirement.

All associate members must pull at least 12 hours a month.

All members MUST complete their signup shift or find a replacement of equal level oftraining to finish their shift. If they do not complete their shift and find a replacement thenthe time given will not count. Members MUST clock in with time cards and/or logbooklocated in the radio room. Members will receive only three letters of “Failure to Pull Time”,after the third warning letter the member will be dismissed from the organization.

Discipline/Suspension/Removal from MembershipAny act that may be perceived as misconduct will be documented by a Gouverneur Vol.Rescue Squad, INC., member on an Incident Report and submitted to the Director ofOperations (or in his/her absence, the Vice President of the Board of Directors of theGouverneur Vol. Rescue Squad, INC., in writing within 72 hours. If the Director or designeedeems that disciplinary action is warranted, he/she may at his/her discretion exercise any/allof the following options: (1) Provide verbal counselling to the member, (2) Recommend re-education/re-training, (3) Provide written warning to the member, (4) Suspend the memberfor a period not to exceed 10 days, or (5) Schedule a meeting of the Discipline Committeeand/or Board of Directors to address and resolve the allegations against the member.

Any disciplinary action with any members will remain confidential. When any such disciplinedmember feels the disciplinary action by the Director of Operations (or in his/her absence, theVice President of the Board of Directors) is inappropriate, the following procedure will befollowed. The member will re-address the issue with the Director of Operations for analternate disposition. If the conflict is not resolved, the member may request a meeting of

16

the Board of Directors to address the charges against him/her.

Members may be removed from membership in the Gouverneur Vol. Rescue Squad INC.,after due cause has been shown by an investigation by the Director of Operations and by amajority vote of the Board of Directors of the Gouverneur Vol. Rescue Squad, INC.,.

This policy does not apply to patient care complaints/ concerns. All Patient care complaintsand concerns will be address by the CQI committee.

Professional BehaviorUnprofessional behaviour can often be corrosive to businesses both internally and externally.Gouverneur Rescue holds an expectation for professional behavior as follow.

Professionalism is defined as:The skill, good judgment, and polite behavior that is expected from a person who is trainedto do a job well.

The following IS NOT tolerated:1. Profanity should be used minimally, and is NEVER to be used while in public or on an

ambulance call.2. Discussions about other members, their families and/or members of other agencies

WILL ALWAYS BE POSITIVE. Negative comments MUST BE DONE FACE TO FACE. Thisincludes but is not limited to statements about care, personal life, personal habitsand/or work behavior.

3. Public statements portraying other agencies or business in a poor light will not betolerated.

4. Actions and/or behaviors, which make other members, students, or the generalpublic, feel unwelcome in our building or our ambulance.

5. Bringing your personal life and problems to work is not acceptable.6. Having discussions with people who have no ability to fix the problem.7. Conversations about topics you have no intimate knowledge of.

Action:Gouverneur Rescue has adopted a zero tolerance approach to violations of this policy.Therefore, for this policy, discipline is as follows:First offense: Sent home (career members without pay) for a minimum of 24 hours and awritten reprimand.Subsequent offense: suspension of up to ten days, brought to the discipline committee

17

pending separation from Gouverneur Rescue.


Section: Administration Subject: Release of Member/EmployeeInformation


Members and employees will not release any information about another member oremployee to any person without their expressed consent. Information includes, but is notlimited to, phone numbers, addresses or duty shifts.

If a request for this type of information is received, a message should be taken andforwarded to the member in question or it should be forwarded to the Director ofOperations.

18


Section: Administration Subject: Telephone Procedures/EmergencyCalls to the Building


Telephones are available for members and staff to make local calls. Phone calls and longdistance phone calls should be kept to a minimum as the Gouverneur Vol. Rescue Squad,INC., is a business and calls usually come in and out on a regular basis.

Gouverneur Vol. Rescue Squad, INC., phone numbers are:

• (315) 287-1321- Primary line to be used by individuals trying to contact the Gouverneur

Vol. Rescue Squad, INC.

• (315) 287-3954- Secondary line to be used by individuals trying to contact or its

members

• (315) 287-2229 or (315) 287-3954 for the Director of Operations- Fax line

Incoming calls to the building should be answered in one of the following manners:“Gouverneur Rescue, this is _______ speaking”. Your name (first or last).

Emergency Calls Received at the BuildingIf a call for assistance comes directly to the buildings telephone line, please obtain the:• Call back number• Location of the incident• The Caller’s name• The chief complaintAdvise the caller that you will be responding, but that they must contact 911. Advise Central

Dispatch via phone or radio where you are responding to.

19


Section: Administration Subject: UniformsSOG # 2013-107 Date: October 21, 2013

Page 1 of 1

UniformsDuring the course of an incident, crew members should be clearly identified as members ofthe Gouverneur Vol. Rescue Squad, INC., either by wearing the uniform / jacket or photo IDissued to all Gouverneur Vol. Rescue Squad INC., members. Members will be supplied aShirt and a Jacket. During Probation, Members will be given pants, and a probationary shirt toidentify them as such. Shirts and Jackets will be made available as soon as possible after themember is off probation. They will be based on the size and number of shirts/jackets in stockat the time the member is released from probationary status. There may be a delay to ordershirts/jackets. The Jackets and shirts will be returned to the Gouverneur Vol. Rescue Squad,INC., when they are no longer a member.

All shirts will be Navy Blue / Royal Blue. All Jackets will be Royal/Navy Blue. TheGouverneur Vol. Rescue Squad, INC., owns the logo’s placed on uniforms. The GouverneurVol. Rescue Squad, INC., may deny any member from wearing a shirt or jacket they broughtwith their own money. When members leave the Gouverneur Vol. Rescue Squad, INC., suchpersons may not wear any clothing with Gouverneur Vol. Rescue Squad, INC., logo unlessthey are Exempt Members.

All other necessary clothing that may be needed on a specific incident and/or event shall beprovided at the time it is needed.

20


Section: Administration Subject: Comments/ComplaintsSOG # 2013-108 Date: October 21, 2013

Page 1 of 1

Patients and family members will usually refer any complaints regarding 911 emergency calls,Interfacility transports and/or general behaviour to the Gouverneur Vol. Rescue Squad, INC.,building. Members are normally not the personnel who handle such complaints. However, onoccasion, people may direct comments or complaints to members on duty.

If a patient, family member, or the general public, has a complaint about the vehicle orequipment, document it and be sure the Director of Operations receives it accordingly forcorrective action.

If the patient, family member, or general public has a personnel complaint, please do notbecome defensive and try to argue with the complainant, simply document their issue andoffer to have the Director of Operations contact him or her.

Each complaint will be reviewed with the Director of Operations, and/or the Board ofDirectors accordingly.

All other comments or compliments will be addressed in the proper manner and memberscould be recognized for such actions.

This policy does not apply to patient care complaints/ concerns. All Patient care complaintsand concerns will be address by the CQI committee.

21


Section: Administration Subject: ObserversSOG # 2013-109 Date: October 21, 2013

Pages 1 of 2

The Gouverneur Vol. Rescue Squad, INC., welcomes individuals that are interested in seeingwhat we do. It is beneficial for public relations and as a way to support training in the area.Such individuals are required to follow the rules listed below.

As we require strict appearance policies for our members, we maintain similar standards forobservers. Observers also represent us during the term of their ride out. The following rulesapply:

Neat, clean dress shirt and slacks No jeans Shoes/protective boots Jewellery is limited to: Wedding rings Necklaces kept inside shirt Timepieces Hair will be clean and combed No excessive makeup, perfume or cologne

All regulations regarding the Gouverneur Vol. Rescue Squad, INC., operational policies(smoking, eating in the vehicle, patient Confidentiality, etc.) will be explained to the observerprior to the ride out by the members on duty.

An observer may only ride between the hours of 8:00 am and 10:00 pm. Any exception tothis must be approved by the Director of Operations and/or Board of Directors.

Observers may be denied ride out privileges, if dressed inappropriately. If at any time duringa ride out, an observer displays acts of misconduct, the crew has the right to terminate theride out. If this occurs, advise the Director of Operations, who will then take the appropriateaction.

22

Release of LiabilityAll observers must sign a release of liability waiver prior to riding along on the ambulance.This waiver will be witnessed and signed by the GVRS Member(s) and left in the Director ofOperations mailbox prior to the beginning of their shift.

Non-EMS ObserversNon-EMS Observers shall observe only and not participate in any patient care. They will notparticipate in the lifting and moving of patients or equipment. They are not to discuss casesor patients in public areas and must keep patient information confidential at all times. Andmust sign a Patient Confidentiality Form.

Media RidersMedia riders must be approved by either the Director of Operations and/or the Board ofDirectors and sign a specific waiver detailing additional requirements. In addition, they arenot to take photographs within homes or private buildings or take facial photographs withoutwritten authorization from patients.

23



Section: Administration Subject: Precepting EMS Students

SOG # 2013-110 Date: October 22, 2013

Page 1 of 2

Field Precepting may only occur in the presence of an agreement between the teaching facility andthe Gouverneur Vol. Rescue Squad, INC.,

The following students are eligible to precept at GVRS:

Any students enrolled in a NYS EMS course Students with the approval of the course director for the program they are in

Preceptors

All preceptors will meet the requirements set forth in the Preceptor program and be approved by theTraining Officer, Director of Operations and/or designee.

Procedures

Shifts must be scheduled in advance with the preceptor and/or the course director. No more than one student will be assigned to a preceptor for a given shift. The student will remain on an ambulance with the designated preceptor for the duration of

the shift. The student may only perform skills on a level at which he/she is released by the course

director. Practice during Precepting shifts will be under the direction of the course Medical Director.

All regulations regarding the Gouverneur Vol. Rescue Squad, INC., operational policies (smoking,eating in vehicles, patient confidentiality, etc.) will be explained prior to the ride out by a Gouverneur

24

Vol. Rescue Squad, INC., preceptor.

As we require strict appearance policies for our members, we maintain similar standards for EMSstudents. EMS students also represent us during the term of their ride out. The following rules apply:

Neat, clean dress shirt and blue slacks, no jeans Clothing my not have other agency insignia on it Shoes/protective boots Jewellery limited to : Wedding rings, timepieces and necklaces kept inside shirt

Hair will be clean, combed and off the shirt collar No excessive makeup, perfume or cologne

EMS students will be denied ride out privileges if dressed inappropriately. If at any time during a rideout, a rider displays acts of misconduct, the crew has the right to return the individual. If this occurs,advise the Director of Operations who will take the appropriate actions.

25


Section: Administration Subject: Incident/Unusual OccurrenceReports


The process of reporting incidents at the Gouverneur Vol. Rescue Squad, INC., Requirescertain steps as follows:

An incident report must be written up (either neatly by hand or typed) Your name Reason for the incident report Submitted to the Director of Operations and/or His/her designee or the Board of

Directors.

Incident or Unusual Occurrence Reports are used for vehicle accidents, near misses, propertydamage and all other incidents worthy of documentation; i.e. incidents you feel needdocumentation, incidents that a director has asked you to document or incidents involvingmedication errors or medical device failure that may have led to serious injury or death.These reports are not used for infectious disease exposures or on-the-job injuries.

All reports should be turned into the Director of Operations for follow up.

26


Section: Administration Subject: Reportable Incidents to theNYSDOH


The Director of Operations or Acting Director must notify the NYS Department of Health within 12hours or the following business day, whichever comes first, if any of the followingincidents occur:

A patient is injured, killed or otherwise harmed due to actions of commission or omission by amember of the Gouverneur Vol. Rescue Squad, INC.

A vehicle operated by Gouverneur Vol. Rescue Squad, INC., is involved in a personal injurymotor vehicle collision resulting in a patient, crewmember or other person being killed orinjured to an extent requiring hospitalization or care by a physician.

Any Gouverneur Vol. Rescue Squad, INC., member that is killed or injured to an extentrequiring hospitalization or care by a physician while on duty.

Any patient care equipment fails while in use causing patient harm. It is alleged that any member has responded to an incident or treated a patient while under

the influence of any intoxicating substance.

The definitions of the type of events listed above are very general in nature, as crews have broad andvarying operating conditions and situations. The Department of Health’s interest is in those events inwhich a patient, under the charge and care of a Gouverneur Vol. Rescue Squad, INC., member, isinjured or harmed by acts of commission or omission. Examples might include: failure to maintain anairway, failure to resuscitate, not honouring a properly executed DNR order, dropping a patient, etc.The situations described are not to be considered an all-inclusive list.

Additionally, to meet the requirements of Part 800.21(q) 2 & 3, the DOH requires the reporting of anyline of duty death or serious injury of personnel. This means that if personnel are killed or seriouslyinjured in a sudden or unexpected circumstance, not a chronic situation, a report needs to be made tothe Area Office.

A written report to the Area Office needs to describe the circumstances, outcomes and injuries ordeaths of all involved. A copy of any motor vehicle accident report should be included. TheDepartment will, in each instance, review the report and information submitted and determine if anyfollow up action(s) or additional documentation will be required by the Gouverneur Vol. RescueSquad, INC.

27


Section: Administration Subject: Public Information/Release ofInformation to the Media

SOG # 2013-113 Date: October 22, 2013Pages 1 of 2

In many circumstances, such as fires and motor vehicle collisions, the media may be presentand inquiring about the treatment and/or transport of any patients involved.

Field personnel are limited on the information they may release to the media by HIPAA, NYSConfidentiality Laws and by the Gouverneur Vol. Rescue Squad, INC. Field personnel mayrelease the number of patients and, if it does not allow for the release of protected healthinformation, the hospital destinations; i.e. if there is a one-vehicle collision with one patient,releasing the hospital destination may be a potential release of protected health information.

Any other inquiries should be directed to the officer in charge, the incident commander or tothe police department on scene.

During an MCI or a high-profile incident a public information officer will be appointed byeither the Director of Operations and/or his/her designee, or the Officer in Charge.

The media can be as much of an ally as an adversary. By continuing to promote positive andhonest relations, we can have a more consistent, friendly relationship with the media. If atany time the media impedes you from performing your job, explain the problem and they willgenerally cooperate. They have a job to do just as we do. Cooperation by all parties makes forfewer conflicts.

Strong media relations help us to improve our communications and relationships withvarious media by providing them with information about EMS incidents within their area ofreach. By becoming an ally, we help them do their job and we become the experts in the EMSand medical field. We not only gain media exposure, but also can more easily enlighten themabout the finer points of our job.

Often members of the press will ask to accompany us to observe our work. This allows timefor field providers to demonstrate the many aspects of patient care, both clinical and

28

personal. If a Member of the Media requests a ride along the Media riders must be approvedby either the Director of Operations and/or his/her designee, or the Officer in Charge andsign a specific waiver detailing additional requirements.

Any questions, complaints, commendations or story ideas relating to the media should bemade to the Director of Operations.

29



Section: Administration Subject: Possession and Use of Weapons

SOG # 2013-114 Date: October 22, 2013

Page 1 of 1

Gouverneur Vol. Rescue Squad, INC., members and employees will not possess any sort of a weaponin any Gouverneur Vol. Rescue Squad, INC., vehicle, on any Gouverneur Vol. Rescue Squad, INC.,function or on Gouverneur Vol. Rescue Squad, INC., property. This includes, but is not limited to,firearms, knifes, batons, aerosol deterrents (e.g. Mace, pepper spray) or stun guns.

Knives that serve a utility purpose in assisting with the duties of Gouverneur Vol. Rescue Squad, INC.,staff, and comply with all applicable New York State Laws and regulations, are not covered by thisSOG.

The Director of Operations will determine what constitutes a weapon under this SOG. Lawenforcement officers performing their official law enforcement duties may carry their weapons inaccordance with applicable laws, regulations and/or agency guidelines, except while acting asGouverneur Vol. Rescue Squad, INC., staff.

The use of weapons for scene safety is a law enforcement function. Gouverneur Vol. Rescue Squad,INC., staff identifying a need for such shall immediately retreat from the situation, and summon theappropriate law enforcement agency through county dispatch.

30


Section: Administration Subject: Determination of Good StandingSOG # 2013-115 Date: October 22, 2013

Page 1 of 1

Good standing is defined as completing all required duty hours for the month and completingthe meeting requirement as defined in the by-laws. The required duty hours are as follows:

12 hours per week for full members. 12 hours per month for associate members.

The minimum 12 hours for each member classification must be completed during themember’s regularly scheduled hours unless pre-approved by the Director of Operations or hisdesignee. It is the responsibility of the Member to communicate with the Director ofOperations or his designee if the Member fails to meet their monthly requirement.

A member is determined to be in poor standing if he has not met the meeting requirementand has received a letter stating his lack of duty hours for a period of 2 consecutive months.For a member to then return to good standing, he must meet the meeting requirement andmaintain an adequate number of duty hours, as listed above, for a period of one month.

Removal from Membership shall be at the discretion of the Board of Directors after threeconsecutive months of failing to meet their minimum requirement for duty hours.

31


Section: Administration Subject: Personal Equipment/ClothingReplacement


It is recognized that Gouverneur Vol. Rescue Squad, INC., personnel carry and use personalequipment while on duty and while responding to all call situations. However this canbecome a financial burden if not regulated by the Gouverneur Vol. Rescue Squad, INC.,Therefore the Gouverneur Vol. Rescue Squad, INC., has established some guidelines for thesesituations. In all cases a Special Report will be filled out describing the events, what itemswere damaged and forwarded to the Director of Operations.

Personal Clothing On Duty:If while on duty a Member or Employee should damage personal clothing, The GouverneurVol. Rescue Squad, INC., will reimburse $0.00. All members while on duty are required to bein a duty uniform.

Personal Clothing All Call:If while responding to an All Call a Member or Employee should damage personal clothing,the Gouverneur Vol. Rescue Squad, INC., will reimburse 100% of the cost to replace thedamaged items.

Personal Electronics:The Gouverneur Vol. Rescue Squad, INC., suggests, for Members or Employees protection,that they purchase insurance on their personal equipment. Should a member damage anyelectronic equipment, i.e. cell phones, PDA’s., watches etc., while on Gouverneur Vol. RescueSquad, INC., business The Gouverneur Vol. Rescue Squad, INC., will reimburse the Member orEmployee’s deductible required for their insurance. If the Member or Employee has noinsurance, GVRS will reimburse up to $100.00. This will include watches. There MUST beliable proof and/or witnesses to prove such personal electronics were damaged on theproperty while performing work related duties, and/or while on an incident performingwork related duties.

Eyeglasses will be covered under the GVRS Workers Compensation Insurance SOG.

32


Section: Administration Subject: Surveillance CamerasSOG # 2013-117 Date: October 22, 2013

Pages 1 of 3

SOG

1. Surveillance cameras may be installed in situations and places where the security ofeither property or people would be enhanced.

2. When appropriate, cameras may be placed inside and outside of the building locatedat 1024 US HWY 11 Gouverneur, New York 13642.

Cameras will be used in a professional, ethical, and legal mannerconsistent with all existing Gouverneur Rescue’s policies.

Camera use will be limited to situations that do not violate thereasonable expectation of privacy as defined by law.

3. The Director of Operations, President and/or the Vice-President of the GouverneurVol. Rescue Squad, INC., Surveillance Camera Coordinators. They will manage allactivities of the Surveillance Cameras and report to the Board with their findingswithin the confines of privacy.

4. IF an event occurs the Director of Operations, President and/or the Vice-Presidentwill contact each other to notify each party of the specific event and to discuss whathas taken place.

5. In the event of a confirmed incident (i.e. vandalism or a crime) or incident resulting incharges or a criminal investigation the tapes or copies should be available to thosedoing an investigation, and/or law enforcement agencies at the direction of the Boardof Directors by majority vote which can be done by in person meetings, electronicmeans or by telephone calls and documented accordingly.

Reason for SOG

1. The purpose of this SOG is to regulate the use of surveillance cameras to protect thelegal and privacy interests of the Gouverneur Vol. Rescue Squad, INC., community.

2. The function of surveillance cameras is to assist in protecting the safety and the

33

property of the Gouverneur Vol. Rescue Squad, INC.,3. The primary use of surveillance cameras will be to record images for future

identification of individuals in the event of legal or SOG violations.

SOG Requirements

1. Only authorized personnel, as determined by this SOG and authorized by theBoard of Directors, will be involved in, or have access to, surveillance camera data.

Administrators and designated officials may have access to surveillancecamera data in their areas of responsibility.

Law Enforcement Agencies will have access to all surveillance cameradata if it involves (i.e. vandalism or a crime) and has been an authorizedaction by the majority vote of the seated board.

2. When an incident is suspected to have occurred, the designated personnelDirector of Operations, President, (or) Vice-President and a board memberappointed by the Board of Directors may review the images from surveillancecamera data.

3. All Investigations are too kept within strict confidential and the details will not beshared with any non-involved parties unless board action is required.

Any new surveillance cameras must be approved in advance by theGouverneur Vol. Rescue Squad, INC., Board of Directors by a majorityvote.

Once approved, new surveillance cameras must connect to systemalready in place and installed by trained and certified technicians, and/orauthorized members of the Gouverneur Vol. Rescue Squad, INC.,

Related SOG Information

1. Surveillance cameras will not record or monitor sound.2. Recorded surveillance camera data must be retained for a period of at least 45 days.3. Surveillance camera data is not considered to be Directory Information and may be

subject to confidentiality restrictions, including but not limited to FERPArequirements.

Requests from Gouverneur Vol. Rescue Squad, INC., member’s entities to

34

release information obtained through surveillance cameras must besubmitted to the Director of Operations and to the President of theGouverneur Vol. Rescue Squad, INC., and approved by the Board ofDirectors by a majority vote prior to release. This can be accomplished byin person meetings, electronic means, email, telephone and fax.

All requests from sources external to the Gouverneur Vol. Rescue Squad,INC., to release information obtained through surveillance cameras mustfollow established procedures to request that information be released.

Disruption of cameras views or vandalizing

1. If someone knowingly disrupts the camera’s views or vandalizes them in any waythey will be subject to disciplinary action as described in the Gouverneur Vol.Rescue Squad, INC., Policies and Procedures, SOG# 2013-04, Performance of Duty,Misconduct, Discipline, Suspension and Removal from Membership.

Procedure to follow if you suspect something has occurred

In the event of (i.e. vandalism or a crime) you are to follow this following procedure listedbelow

1. Contact the Director of Operations, President, and/or the Vice-PresidentImmediately

2. Do Not contact any outside agencies3. All complaints must be in writing to the Director or Operations, President, and/or

Vice-President of the Gouverneur Vol. Rescue Squad, INC.,

Exclusions1. Cameras installed or utilized for criminal investigations are subject to appropriate

New York State and Federal laws and are excluded from this SOG.

35



Section: Administration Subject: Borrowing Equipment

SOG # 2013-118 Date: October 29, 2013

Page 1 of 1

Personal use of GVRS equipment, i.e. manikins, AV equipment, etc., may be authorized by theDirector of Operations or his/her designee. All equipment being borrowed must be signedout in a logbook.

When an individual signs out a piece of equipment they understand that they are taking fullresponsibility for the equipment. Which includes but is not limited to, Damaged, lost orstolen equipment.

36



Section: Administration Subject: Dispatch

SOG # 2014-119 Date: January 8, 2014

Page 1 of 1

Central Dispatch and Gouverneur PD dispatch will use the following guidelines whendispatching Gouverneur Rescue.

Duty Crew (308) will be activated for all “first calls”. When the crew responds they willadvise dispatch if another crew is “in house”. If there is a second full crew available thedispatch centers will use the “duty crew” tones (308).

“All call” (309) should only be used when no crew is at station. This includes anytime whichdispatch was advised there is no crew and ALL second activations.

Richville First Responders will be activated for ALL second activations.

37



Section: Administration Subject: DMV Records and Monitoring

SOG # 2014-120 Date: August 4, 2014

Page 1 of 2

1. Purpose: To Ensure that employees driving Gouverneur Volunteer Rescue Squad, Inc. Vehicleshave valid driver licenses and to allow timely receipt of notifications for license events.

2. Responsibility: The Director of Operations will be responsible for implantation andmonitoring of this program.

3. Procedure:a. For purposes of this policy, volunteers are referred to as employees.b. The Federal Driver’s Privacy Protection Act (DPPA) (18 U.S.C. Sec. 2721 et seq.) permits

government agencies, fire companies and emergency medical services access to motorvehicle records for use in carrying out agency functions.

c. Gouverneur Volunteer Rescue Squad, Inc. is enrolled in the New York State Departmentof Motor Vehicles License Event Notification Service (LENS) program.

d. GVRS will receive notification for all current employees for the following license events:

i. Accidents

ii. License Expirations

iii. Convictions

iv. License Restorations

v. Suspensions/Revocations

e. Based upon information received from the LENS program, employees may not be allowedto operate vehicles owned or operated on behalf of Gouverneur Volunteer Rescue Squad, Inc.The Board of Directors will have the authority to determine vehicle use. The Director ofOperations will be responsible for meeting with the employee if a revocation of driving isdetermined.f. All employees will be required to complete the “Authorization and Release for RiskManagement Purposes” form prior to being added to the program. Drivers may be denied

38

vehicle operation until this is completed.g. GVRS will only enrol drivers in LENS that have completed the authorization and willpromptly delete drivers from LENS when they are no longer members of our organization.h. GVRS will notify DMV in writing, within 30 days, of any change to our application forparticipation in the program.i. GVRS will not share personal information with a recipient outside of our organizationwithout an approved recipient agreement specifying their DPAA permissible use for theinformation. Any such agreements will be retained for five (5) years after the date when GVRSlast shared DMV records with the recipient.

39


Section: Operations(last updated 8/5/2014)

Subject: Radios and Communications

SOG # 2013-201 Date: October 22, 2013Pages 1 of 3

Radio procedures and communications during a call are vital to assure that appropriate andadequate orders are being transmitted and received. It is also important for personnel toacknowledge the orders given. Similarly, communications between the dispatch agency,command, the media and other involved parties or agencies must be accurate andprofessional.

Radio Etiquette

1. Remain calm.2. Suggestive or foul language shall not be used under any circumstances.3. Transmission over other parties is not to occur and adequate time is to be allowed for

a response prior to any re-broadcast.4. The use of the radio for non-essential side talk is prohibited.5. Transmissions directly related to critical safety orders takes precedence over all other

transmissions.6. Keep conversations to a minimum.

Radio Identification

All radio transmissions shall begin with the unit being called followed by the calling unit, i.e.“Hey you, it’s me”. Vehicles shall be identified by the unit type and unit number, i.e. “A-174”.Vehicle portables are identified as such, “A-174 portable”. Personal take home portablesshould be identified as such “Portable 71-01”.

40

Channel Use

The following frequencies are in use in St. Lawrence County and Gouverneur Vol. RescueSquad, INC., vehicles:

1. St. Lawrence County Fire F1 Repeater #12. St. Lawrence County Fire F2 Fire Ground Operations3. St. Lawrence County Fire F3 Fire Ground Operations4. St. Lawrence County Fire F4 Talk Around5. St. Lawrence County Fire F1 Repeater #26. State-wide EMS channel7. GVRS Non-emergency communications8. State-wide EMS channel9. State-wide EMS channel10. State-wide EMS Interagency11. Gouverneur Village Police

Common Transmissions

Voice communications should be based on but not limited to the following: “CentralDispatch, A-174” …

• “…out of service.”• “…on scene.”• “…at the hospital.”• “…back in service.”• “…responding.”• “…arriving at _____.”• “…on location.”

Emergency Traffic

When you have emergency radio traffic and the air is cluttered, indicate this to CentralDispatch by stating “Central Dispatch, A-17_, Priority Traffic.” Central Dispatch will thenattempt to clear the air for your transmission.

41

Hospital Clearances

You must use the tones when calling the hospital on the EMS frequency. The three-digit codefor Gouverneur Hospital is 448. Each button should be held for approximately one secondand then state “Gouverneur Hospital A-17_.” A full report should be given to the hospitalusing plain English. Avoid the use of “10” codes.

Out of Area Communications

When traveling outside of Central Dispatch’s radio reception area, the following proceduresshould be followed:• If communications with your hospital destination are necessary, attempt communicationson the EMS Channel. Be sure to obtain the three-digit touch pad code prior to leaving.• If the EMS Channel is unsuccessful, contact Central Dispatch via a cell phone.• Contact Central Dispatch before departure and after arrival at your hospitaldestination

42


Section: Operations Subject: Director NotificationsSOG # 2013-202 Date: October 22, 2013

Page 1 of 1

The Director of Operations will be notified via telephone or the St. Lawrence County 911Center immediately when:• Personnel are involved in an altercation while on-duty.• A GVRS Vehicle is involved in a collision.• Personnel appear to be exhibiting a behaviour that may interfere with his or her ability todo their job.• There is an illness or injury to personnel while on-duty.• There is a major incident such as a working fire, MCI, etc.• There is a major disagreement or incident involving another agency or a hospital.• A GVRS Vehicle will be taken out of service for any reason.• Personnel are involved in an incident that is reportable to the region or the stateDepartment of Health.• Personnel are involved in an incident that is reportable to State Child Abuse Hotline.

The Director of Operations will be notified in writing, by completing a Special Report when:• Any of the above mentioned incidents.• Medical equipment needs repair, breaks down or fails.• A GVRS Vehicle has a mechanical breakdown.• There is an unusual occurrence.• Any customer/patient/general public submits a compliment or complaint.• There is a minor disagreement or incident involving another agency or a hospital.

43


Section: Operations Subject: Vehicle ChecksSOG # 2013-203 Date: October 22, 2013

Pages 1 of 2

Daily Vehicle ChecksEach crew will be responsible for completing a full vehicle check at the beginning of theirshift. This will be documented on the vehicle check sheets located in the Daily Duties Binderlocated in the kitchen. Once completed, the check sheet will remain in the binder. Tocomplete the daily vehicle check:

• Document the date, vehicle ID and the crew of the vehicle• Document the amount of O2 in all bottles• For the Airway bag, confirm all items are in the top compartment and

document the seal #’s or initials on the other compartments.• If a compartment is not sealed, refer to the 800 check sheet and reseal the

compartment Document the rest of the vehicle check in the same manner as above Sign the bottom of the check sheet

During the ShiftThe vehicles should be kept clean and orderly, restocking durable equipment, i.e.backboards, splints, etc., at the hospital, if possible, and other supplies upon returning to thebuilding. Portable equipment must be strapped down at all times when the vehicle is inmotion. This will help to prevent objects from becoming airborne during a collision.

At the completion of the shift, all supplies should be replaced and portable oxygen changed,as needed. The main oxygen tank is changed at 500psi and the portable tanks are changed at1000psi. All trash cans should be emptied including the sharps container, if needed. Theinterior of the vehicle should be wiped down, mopped and vacuumed and then the exteriorof the vehicle washed.

800 ChecksEach vehicle will have a New York State Department of Health 800 check completed once aweek. Each paid employee is assigned an ambulance to 800 and maintain during theirscheduled work days. This will be documented on the vehicle 800 check sheets located in the

44

radio room.

To complete the 800 vehicle check:1. Document the date and vehicle ID2. Complete the decontamination portion of the check sheet, if appropriate.

(Refer to the periodic cleaning and decontamination of ambulances SOGfor further information)

3. Complete the check sheet portion of the forms4. Seal each compartment of portable equipment and each cabinet with a

numbered seal5. Document your initials or print your name on the front page.

45



Section: Operations Subject: Securing and Storage of Equipment andMedications

SOG # 2013-204 Date: October 22, 2013

Page 1 of 2

All portable equipment inside an ambulance or EASV should be secured at all times toprevent them from becoming projectiles during a collision. This includes the airway bag,medic bag, monitor, oxygen cylinders, etc.

Oxygen Cylinders

Any pressurized gas cylinder, i.e. oxygen cylinders, in an ambulance must be mechanicallysecured. Installed oxygen systems must be secured using the OEM supplied securing systemor a similar replacement system that is maintained in proper condition. Portable and sparecylinders must be mechanically fixed in place using a cup & yoke or equivalent device.

Portable cylinders may be packaged in a rigid or padded protective case and then stored in acabinet or strapped to the ambulance cot with the head of the cot in the elevated position. Inall situations the cylinder head and regulator are to be protected. At no time are oxygencylinders to be stored in a cabinet or under the squad bench held in place by other items ofequipment.

Medications

The medic bags, containing syringes, needles, IV start kits or medications, shall be kept in akey-locked compartment inside the ambulance or EASV when not in use for patient care.Syringes, needles, IV start kits or medications not in a bag should be located in key-lockedcompartments within the ambulance. Sharps containers must be secured inside the vehicle.Small sharps containers may be located in the bags as long as the bags are secured inside thevehicle.

46

Controlled substances must be double locked inside the ambulance when not in use. Refer tothe Controlled Substances SOG for further information.

Access to drugs, controlled substances and needles is carefully monitored. Only properlycertified and authorized personnel will have access to or possess keys that allow access tothese items.

All medications and intravenous fluids must be stored in an environment that protects themfrom extreme temperature changes and light according to each medication's manufacturer'sguidelines. This includes all vehicles, cabinets or any other storage facilities wheremedications and intravenous fluids are stored. According to manufacturer's guidelines, mostmedications must be stored at temperatures that range from 59 degrees to 77 degreesFahrenheit. However, temperature ranges may differ from medication to medication.

47


Section: Operations Subject: Safety Restraint UseSOG # 2013-205 Date: October 22, 2013

Page 1 of 1

The Gouverneur Vol. Rescue Squad, INC., requires all its personnel to comply with the NYSVehicle & Traffic Law regarding the use of seatbelts. To ensure the safety of all its personnel,the following are required:

1. All operators and front seat passengers of ambulance service vehicles mustuse seat belts when the vehicle is in motion.

2. All patients not on a patient carrying device and any passengers in thepatient compartment of any ambulance must use seat belts at all timeswhen the vehicle is in motion.

3. All EMS personnel in the patient compartment must use seat belts whenthey are not attending to a patient and the vehicle is in motion.

4. All patients on the stretcher must be secured at all times when the vehicleis in motion or the stretcher is being carried or moved.

5. Any child transported to the hospital should be in the child’s ownprotective restraining device, when available. He/she should be placed inthe device and belted to the stretcher or an ambulance seat.

6. Children under the age of 8 shall not ride in the front seat of theambulance.

7. All operators and passengers in any non-ambulance response vehicle(EASV, ALSFR, etc.) must use seat belts at all times when the vehicle is inmotion.

48



Section: Operations Subject: Driving

SOG # 2013-206 Date: October 22, 2013

Page 1 of 3

We cannot effectively resolve any incident if our emergency response vehicle and personneldo not arrive safely on the scene. Emergency vehicle accidents can have a devastating effecton the squad emotionally as well as financially. Personnel shall exercise extreme cautionand/or due regard, when driving emergency vehicles at all times, this includes responding tocalls, training, maintenance, details, parades, etc. When driving emergency vehicles, assumenothing and expect anything.

The Gouverneur Vol. Rescue Squad, INC., will make every effort to see that the ambulancesand emergency ambulance service vehicles (EASV’s) comply with all NYS motor vehicle lawsand part 800 regulations regarding design. The vehicles will be inspected yearly.

At the Gouverneur Vol. Rescue Squad, INC., quality patient care, including patient safety iswhat we strive to achieve. Without a strong and accountable driving SOG, this would not bepossible. All GVRS vehicles will be driven in a manner consistent with NYS Vehicle and TrafficLaws.

All Gouverneur Vol. Rescue Squad, INC., drivers will complete the GVRS driver trainingprogram and participate in an annual review of their driving records. Drivers will have aninitial driving record check and an annual review. A Gouverneur Vol. Rescue Squad, INC.,driver may be required to provide a written explanation for any suspension or any otherquestionable entry on their driving record. The Gouverneur Vol. Rescue Squad, INC., requiresthat all drivers complete an emergency vehicle operator’s course (EVOC) or certifiedemergency vehicle operators (CEVO) course.

49

General Driving Procedures

All drivers, passengers, riders, patients, etc., will use seatbelts. All providers in the patientcompartment will utilize seatbelts unless doing so will inhibit or compromise patient care.The emergency vehicle driver and/or the person riding in the officer position shall verify thatall personnel are personnel are properly seated and in seat belts before the vehicle is moved.The Gouverneur Vol. Rescue Squad, INC., prohibits the riding on tailboards, sidesteps,running boards, or any other exposed position.

Gouverneur Vol. Rescue Squad, INC., drivers will follow all NYS vehicle and traffic lawspertaining to speed, traffic devices, etc. while driving in a non-emergency mode. And useDUE REGARD when in Emergency Mode.

Headlights will be used at all times. Vehicles should be parked with due regard to others. Parkso that the vehicle will be easily and rapidly accessible. If it is necessary for you to doublepark, the four-way flashers must be on and one person must stay with the vehicle. Alwayspark the vehicle so that it is not necessary for you to back up.

When leaving the vehicle for a short period of time, set the parking brake, turn off theheadlights keeping the parking lights on and place the vehicle in park. Be sure the vehicle is inhigh idle. If temperatures are not too hot or too cold, turn the vehicle off

Turn the vehicles off while at the hospital emergency departments regardless oftemperature and follow the same procedures as above.

Vehicle fuel levels should never go less than 50%.

Circle of Safety

Prior to entering the cab and starting the vehicle, the emergency vehicle driver shall make acircle of safety around the vehicle to see that all equipment is secured, that all compartmentdoors are securely closed and any physical obstructions moved out of the way. During thecircle of safety the emergency vehicle driver shall encircle the vehicle and visually inspect all

50

4 sides and the top of the vehicle before entering the cab. He/she should also verify right sideand rear clearance with his/her partner. This shall be conducted prior to moving the vehicleregardless of whether or not the vehicle is about to leave on an emergency or non-emergency.

Driving in Inclement Weather

1. It is imperative that emergency vehicle drivers adjust their driving to thecurrent weather conditions.

2. Remain alert at all times for changing road conditions including rain, snowand ice and hills, curves and bridges.

3. When traveling in snow, reduce speeds by at least 1/2 and increasefollowing distances cumulatively.

4. When traveling on ice, reduce speeds by at least 2/3 and increasefollowing distances cumulatively.

5. A full four-second following distance should be maintained under normaldriving conditions.

6. During reduced visibility conditions, such as at dusk, night or in fog,increase following distance by one second.

7. During reduced road grip situations, i.e. wet surfaces, increase followingdistance by one second.

8. When driving during snow conditions, increase following distance by twoseconds.

9. When driving in icy conditions, increase following distance by threeseconds.

51


Section: Operations Subject: Driver TrainingSOG # 2013-207 Date: October 22, 2013

Page 1 of 1

We cannot effectively resolve any incident if our emergency response vehicle and personnel do notarrive safely on the scene. Emergency vehicle accidents can have a devastating effect on the squademotionally as well as financially. Personnel shall exercise extreme caution when driving emergencyvehicles at all times, this includes responding to calls, training, maintenance, details, parades, etc.When driving emergency vehicles, assume nothing and expect anything.

The Gouverneur Vol. Rescue Squad, INC., will make every operator complete the DriverPreceptor Program. The driver training will be overseen by the members approved toadminister such training. The preceptors will be responsible for the clearance of members,and any associated paperwork to operate a Gouverneur Vol. Rescue Squad, INC., vehicle.

All Gouverneur Vol. Rescue Squad, INC., drivers will complete the GVRS Driver TrainingProgram and may be subject to participate in an annual review of their driving records.Drivers will have an initial driving record check and may be subject to an annual review.

The training program will consist of but is not limited to:

1. Review of the GVRS Driving SOG and Procedures2. Review of NYS Vehicle and Traffic Laws pertaining to emergency vehicle operation3. Completion an emergency vehicle operator’s course (EVOC) or certified emergency1. vehicle operators (CEVO) course4. Safe driving techniques in Non-emergency and emergency situations.5. Safe Backing Techniques, including backing into the GVRS bays.6. Familiarization with Village and Town of Gouverneur streets and common response

locations. (i.e. nursing homes, medical facilities and public buildings)7. Familiarization with on board switches, including the siren and emergency light

switches

AT NO TIME will a driver in training operate a Gouverneur Vol. Rescue Squad INC., vehiclewithout a cleared GVRS driver in the front passenger seat.

52


Section: Operations Subject: BackingSOG # 2013-208 Date: October 22, 2013

Pages 1 of 2

Backing an emergency vehicle is a very hazardous undertaking. There are many accidents andinjuries which result from improper backing practices. Emergency vehicles of all types areespecially hazardous because of the many blind spots interfering with the driver’s ability tosee hazards. To reduce the risk of accident and injury, the Gouverneur Vol. Rescue Squad,INC., recommends the following practices.

General rules for drivers and spotters1. Avoid backing if at all possible2. Never be in a rush when backing3. Use a spotter if at all possible4. Do not start to back up when unsure of the area5. Do not put the ambulance into reverse gear until it has come to a

complete stop6. When it is dark outside, use the side and rear spotlights to light the area7. Do not disengaged the backup alarm8. Accidents that occur during backing are the responsibility of the driver.

Backing up an ambulance is not a high-speed maneuver. It should be done slowly andcautiously. Backing of the ambulance should be avoided whenever possible. When backing isunavoidable, a spotter should be used outside the vehicle. In addition, a spotter should beused when vehicles must negotiate forward turns with restrictive side clearances and whereheight clearances are uncertain. The purpose of the spotter is to expand the driver’s sensefor the right, left, front and rear space cushions.

When backing the vehicle with a patient in the back, the driver should obtain a spotter if atall possible. If no one is available, the attendant must, as the patient’s condition allows, lookout the rear window to spot for the driver.

Under circumstances where the vehicle is only staffed with a driver, the driver shouldattempt to utilize any available emergency services personnel to act as spotters. When no

53

personnel are available to assist, the driver should park the vehicle, get out and make acomplete survey of the space cushion around all four sides of the vehicle to determine if anyobstructions are present before proceeding to back the vehicle.

Spotters are never permitted to ride the tailboard or running boards while the vehicle is inmotion. The spotter should be positioned at the passenger rear of the vehicle in a visible safezone ten to fifteen feet from the rear of the ambulance. The vehicle should not be backeduntil the spotter is in position and has communicated his or her approval to begin backing byway of a hand signal and voice, when possible. Spotters should remain visible to the driver atall times. Anytime the driver loses sight of the spotter the vehicles should be stoppedimmediately until the spotter is again visible and communication to continue backing is given.

Standard hand signals for spotters to use are described below. Be sure that you havediscussed what hand signals you will use before backing the vehicle.

Straight back: One hand above the head with palm toward the face waving back. Other handat your side.

Turn: Both arms pointing the same direction with the index fingers extended.

Stop: Both arms crossed with hands in fists. Be sure to reinforce the signal by yelling the stoporder loud enough so the driver can hear. A tap on the side of the vehicle could also be used.

Night backing: Signals are the same. The spotter should assure that the spotlights on the rearof the ambulance are turned on before allowing the vehicle to be backed.

54


Section: Operations Subject: Emergency DrivingSOG # 2013-209 Date: October 22, 2013

Page 1 of 3

The Gouverneur Vol. Rescue Squad, INC., will adhere to the New York State Department ofHealth Bureau of Emergency Services SOG 00-13. “The Operation of Emergency MedicalService Vehicles.” It is the responsibility of all Gouverneur Vol. Rescue Squad, INC., Membersto read and adhere to this SOG.

All emergency vehicles should be operated in a manner that provides for the safety of allpersons and property. Safe arrival shall always have priority over unnecessary speed andreckless driving both en route to an emergency incident and en route to the hospital.

There shall be established a code system for the driving of the vehicles defined as follows:

Routine Driving (Code II) - anytime the vehicle is out of the station on an assignment otherthan an emergency run, it shall be considered to be on a Code II. All Code II runs will be madeusing headlights only - no sirens, beacons, or flashers. During Code II response the vehicleshould be driven in a safe manner and does not have any emergency vehicle privilegesprovided in the Vehicle and Traffic Laws.

Emergency Driving (Code III) - shall be limited to response to the scene of what is perceivedto be a "true emergency" run which is defined as any situation in which there is a highprobability of death or serious injury. Once on the scene the decision to run Code III to thehospital is based upon the patient's status as being critical or unstable. If the patient's statusis potentially unstable, it is a medical judgment call. If the patient's condition is stable, he/sheshould be transported Code II to the hospital. All Code III runs will be made using headlights,emergency lights and the siren.

Prompt, safe response shall be attained by:

1. Knowing where you are going.2. Leaving the station in a standard manner:

55

quickly and safely boarding the vehicle all personnel on board, seated and belted station doors fully open Driving defensively and professionally at reasonable speeds. Using warning devices to move around traffic and to request the right of way

in a safe and predictable manner.

Fast response shall not be attained by:

1. Leaving the station before the crew is safely seated and belted, or before the doorsare fully open.

2. Driving too fast for conditions.3. Driving recklessly or without regard for safety.4. Taking unnecessary chances entering an intersection.5. Intimidating or startling other drivers.

Driving Criteria

The vehicles shall respond to the call in a manner consistent with the nature of theemergency. Responses should be made Code II unless it meets the definition for a Code IIIresponse as defined above.

The Incident Commander or first arriving Certified First Responder, EMT, or AEMT shall beresponsible for determining the response status for any additional ambulance servicevehicles going to the scene of the call.

The Senior Medical Person in charge of the patient shall determine whether the patient is tobe transported to the hospital Code III or Code II.

The driver of the vehicle is responsible for the safety of the vehicle, passengers and otherhighway users. The driver should operate at a speed and only perform actions that he/she iscomfortable with, regardless of suggestions or recommendations of other personnel. At notime should the driver operate the vehicle in Code III mode after being told to operate inCode II mode as described above.

Generally Gouverneur Vol. Rescue Squad, INC., vehicles will not exceed posted speed limitsby more than ten (10) miles per hour in rural settings, and five (5) miles per hour in thevillage or reduced speed zones.

56

Gouverneur Vol. Rescue Squad, INC., vehicles shall not exceed posted speed limits whenproceeding through intersections with the green light.

When Gouverneur Vol. Rescue Squad, INC., vehicles approach a red light, a stop sign, orrailroad crossing, they must come to a complete stop before proceeding with caution.

When traffic conditions require Gouverneur Vol. Rescue Squad, INC., vehicles to travel in theoncoming traffic lanes, the maximum speed is twenty (20) miles per hour.

When Gouverneur Vol. Rescue Squad, INC., vehicles use the median (turning lane) or anoncoming traffic lane to approach intersections, they must come to a complete stop beforeproceeding through the intersection with caution.

When more than one emergency vehicle is responding, they should stay a minimum of oneblock apart in the village and one half (1/2) mile apart in the rural settings.

At no time should a police car or other emergency vehicle be allowed to escort you whendriving in an emergency mode.

Driving shall be in a manner consistent with the circumstances of the call and with the NYSV&T laws. At all times the safety of other squad members and the public shall takeprecedence over any other considerations.

The person in charge shall relieve the driver if he fails to obey commands to operate in a safeand prudent manner and the Director of Operations notified immediately after the call.

The member in charge of patient care shall determine whether or not to allow non-membersto accompany the patient, and whether such persons are to be allowed to ride in the front orpatient compartment of the ambulance. The treatment and well-being of the patient shall bethe major consideration in making this decision.

57



Section: Operations Subject: Collisions Involving a GVRS Vehicle

SOG # 2013-210 Date: October 22, 2013

Pages 1 of 2

The Gouverneur Vol. Rescue Squad, INC., will adhere to the New York State Department of HealthBureau of Emergency Medical Services SOGs 01-07 “Guidelines to follow in case of an EMS VehicleCollision”. It is the responsibility of all GVRS Members to read and adhere to this SOG.

Any time a Gouverneur Vol. Rescue Squad, INC., vehicle is involved in a personal injury or propertydamage collision, it must be reported to ensure the proper care of patients, personnel andequipment. Advise Central Dispatch, preferably by telephone, that you have been involved in acollision. Central Dispatch will then dispatch the appropriate agencies. The crew will notify theDirector of Operations immediately. The Director of Operations will to respond to the scene shouldhe deem it necessary.

Do not leave the scene of a personal injury or property damage collision to continue responding to acall.

Utilize all appropriate scene safety procedures and provide initial medical treatment to any injuredpersons until other trained personnel arrive. Personnel involved in the collision shall not transport orobtain refusals from any patients.

The driver of the vehicle will obtain and fill out a GVRS Vehicle Accident Form. This form will then beturned over to the Director of Operations.

The vehicle and all personnel involved are to remain out of service until cleared by the Director ofOperations or his designee. All personnel shall submit an incident report describing the incident, andall the events surrounding it, within 24 hours, when possible. The Director of Operations will schedulethe Driver for a drug screening at the earliest time permissible. The Driver will not return to Driver

58

status until such test is administered and the results are negative.

Responsibilities of the Director of Operations

If available, the Director of Operations will respond to the scene of any collision involving aGouverneur Vol. Rescue Squad, INC., vehicle to obtain photographs, insurance information and assurepolice reports are completed. The Director of Operations will notify the Board of Directors of theincident. The Director of Operations must then complete an incident report of their own detailingtheir findings and forward it to the other Board of Directors for review. The findings from this reviewwill be forwarded to the driver for further action as necessary. The Director of Operations will followand reference New York State Department of Health Bureau of Emergency Medical Services SOG 09-08 “Reporting Incidents Injuries and crashes.”

Review and Recommendations

The Director of Operations will determine as soon as possible following a collision if driving privilegeswill be suspended pending review or if immediate remedial training will be provided.

The review process will depend on:

1. Whether the collision may have been avoided.2. Whether the collision occurred due to a breakdown in training.3. Whether the driver disregarded GVRS SOG’s causing the collision.

Recommendations and actions taken will be consistent with prevailing SOG and will reflect theseverity of the incident. These will be based upon:

1. Incident reports2. Pertinent police documentation3. Testimony of involved persons4. Precedent set in similar incidents

Actions that may be taken include:

1. No action2. Counselling3. Written reprimand4. Remediation/Retraining5. Suspension6. Recommend Discharge

59



Section: Operations Subject: Response in Privately Owned Vehicles

SOG # 2013-211 Date: October 22, 2013

Page 1 of 1

When any member responds to the station or to the scene of an emergency in his/her private vehicle,each member must strictly adhere to all applicable motor vehicle laws. Privately owned vehicles arenot provided with the same exemptions that are provided to emergency vehicles.

No member of the organization will be permitted to violate any motor vehicle laws, including butnot limited to:

1. Speed limits2. Going through traffic control devices3. Passing in an unsafe manner

While it is recognized that timeliness in response to an emergency is important, it is imperative thatall drivers understand that their private vehicles are not emergency vehicles and therefore are notafforded any exemptions or special privileges under state law. Any driver observed breaking anytraffic laws or operating any vehicle in an aggressive or unsafe manner will be subject to disciplinaryaction including, suspension, loss of driving privileges and withdrawal of green light permit.

60


Section: Operations Subject: Scene SafetySOG # 2013-212 Date: October 22, 2013

Pages 1 of 2

The personal safety of the crew is of paramount concern and should always be the firstpriority of the entire crew. However, Director of Operations and/or his/her designee, Officerin Charge, Most senior/highest level of Medical Care has overall responsibility for the crew’ssafety.

Some guidelines to assist in keeping the entire crew safe:1. A portable radio should be kept with the crew at all times2. Assure safety before entering any scene3. Always maintain an escape route for the entire crew at all scenes4. Wear appropriate personal protective equipment (PPE) at all times5. If any member becomes uncomfortable regarding a hazardous condition,

they should advise the person in charge of the concern immediately.

When responding to an incident that presents the potential for an unsafe situation:1. Assure that police are responding2. Shut down the emergency lights and sirens well before approaching the

scene3. Stage at least a block away until the police have secured the scene4. Advise Central Dispatch of your staging location and to advise when the

scene is secure

Once on the scene, the crew should:1. Plan an escape/exit route and determine potential hazards2. Assure proper lighting of the scene inside and out3. Assure that any equipment being carried by crew can be readily dropped in

the event of a need to rapidly exit the scene4. Approach doorways from the side and assure the crew doesn’t stand in

front of doors or windows.5. Do not allow patients or bystanders to block the exit route6. Stay together as a crew whenever possible

61

7. Require TV’s, radios, etc. be turned off to prevent interference with duties8. Require cigarettes, candles or other burning objects to be extinguished9. Require all pets to be secured10. Remove weapons from patients and bystanders reach or access. If

possible, have a law enforcement agency perform this task.

62


Section: Operations Subject: Patient Care DocumentationSOG # 2013-213 Date: October 22, 2013

Page 1 of 5

Documentation is one of the most important things we do. It becomes part of the patient’spermanent medical record, allows us to remember the events of a call years down the roadin case of a lawsuit, justifies the need for personnel and equipment and allows us to bill thepatient for services rendered.

There are several forms of documentation provided for you at the Gouverneur Vol. RescueSquad, INC., GVRS utilizes AmbuPro EMS for their Pre-hospital Care Report (PCR). NorthCountry Regional EMS Council provides a refusal form for patients that choose not to betransported to the hospital, a HIPAA signature form and billing information form along with aNotice of Privacy Practices.

The sections of the PCR are as follows:a. Date

i. Hopefully this is self-explanatory.b. Run number

i. Enter “0” or “0” and it will be filled in later.c. Agency Code

i. This code tells the state what agency the PCR is coming from. GVRSagency code is 4417. This should already automatically beimplemented.

d. Vehicle IDi. This is the vehicle you are in.

e. Agency Namei. This will be automatically filled in for you.

f. Dispatch Informationi. This is the initial information that you receive from Central Dispatch.

(Example1. Chest Pain, Difficulty Breathing, Personal Injury)

g. Call Locationi. This is the address or intersection of the call.

63

h. Location Codei. This lets the state know the city, town or village where the call is

located. This is not necessarily the city, town or village where thepatient lives! These codes are posted on the PCR clipboards.

i. Mileagei. This is a must in order for us to bill. The driver should give this to you

upon arrival at the hospital. You only need to document the number ofmiles from the patient’s residence to the hospital.

j. Call Timesi. You will get these at the hospital by calling Central Dispatch at (315)

386-4591 or by returning to the building and grabbing the fax print outfrom dispatch.

k. Patient Informationi. First Name and Last Name

ii. Addressiii. This is the patient’s mailing address (Some people have PO boxes)iv. Apt. Numberv. Phone number including the area code

vi. City, state and zipvii. Age, date of birth, gender and social security number

viii. If you are unable to obtain the SSN fill in zerosl. Patient Location

i. Fill in the circle for the appropriate location.m. Call Received As

i. Fill in the appropriate circle.n. Patient’s Physician

i. This is the patient’s Primary Care Physician.o. Care in Progress on Arrival

i. Fill in the appropriate circle.p. Mechanism of Injury

i. Fill in the appropriate circle and fill in the blank line, if applicable.q. Extrication required

i. You can get this time from Command or Central Dispatch, if heavyextrication is required.

r. Seatbelt Usedi. Fill in the appropriate circles.

s. Chief Complaint

64

i. This should be what the patient tells you is wrong with them, inquotes. (Example – “I have chest pain”, “My knee hurts”) If the patientis unconscious or unable to speak, you can quote a family member orbystander.

t. Subjective Assessmenti. This is what the patient tells you, what family members tell you and

what bystanders tell you. (subjective = say)u. Presenting problem

i. Choose the appropriate problem.v. Past Medical History

i. Allergiesii. Fill in allergies or if none, write none, No known drug allergies (NKDA)

or No known allergies (NKA).

w. Medical problemi. Fill in the appropriate problem.

ii. Current Medicationsiii. Fill in the patient’s medications. Continue in the comments section, if

necessary.x. Vital Signs

i. This section must be completely filled out or you must document thereason why it is not.

y. Objective Physical Assessmenti. This is what you see. Document your physical exam here. (Objective =

observe)z. Comments

i. Document any other pertinent information here including treatment,where you transported, etc.

aa. Treatment Giveni. Fill in the appropriate treatment(s).

bb. Dispositioni. Document the disposition (i.e. where you transported, refusal,

cancelled) and the corresponding code. These codes are available onthe back of the PCR or on the PCR clipboard.

cc. Crewi. In Charge is the person that is caring for the patient. This person should

also be completing the PCR. Fill in the crew members on the call. EMTnumbers will be filled in automatically if appropriate.

65

Patient Care Reports (PCR)

All calls that are dispatched to GVRS will be entered and submitted as an electronicPCR, regardless of whether or not a crew was available to respond to the call.

All PCR’s should be submitted electronically, and preferably immediately after the calland/or incident is completed.

No person shall leave GVRS without completing their PCR’s. Only the Director ofOperations may grant permission to leave without completing an open PCR. In theevent permission is granted, it is the responsibility of the Employee/Member tocomplete the PCR as quickly as possible.

In the event that no crew was available to respond to a call, it is the duty crew’sresponsibility for ensuring that those calls are entered and submitted prior to the endof the shift.

1. In the event that the electronic PCR system is unavailable, crew members/employee’sshould immediately report the problem to the Director of Operations Immediately.Then complete a paper PCR and later submit the PCR into AmbuPro EMS.

2. If additional information in regards to a patient is found after the PCR has alreadybeen submitted, the person in charge of the call shall document any additionalinformation on an addendum. No changes will be made to the original PCR oncecompleted and submitted.

3. All PCR’s will be maintained for a six year period. The only exception will be a PCRinvolving a minor; this PCR shall be maintained until the minor reaches the age of 21years old.

4. On the PCR, be sure to use the spell check feature wherever the “Spellcheck” symbolis. Fill in all the appropriate treatment given. This is a state requirement and it alsohelps the billing agency staff differentiate between ALS and BLS charges.

Refusal FormsNorth Country Regional EMS Council Refusal forms must be complete on all patient refusals.

66

Refer to the Patient Refusal SOG for further information.

Billing RequirementsAn insurance form must be completed on all patient transports and refusals. This formincludes the patient’s name, social security number, date of birth, telephone number, andinsurance carrier. A signature is required by the patient, or parent/guardian of a minor, toprovide prompt payment to GVRS. If possible try and obtain a copy of the patient’s currentinsurance cards.

If you cannot obtain the billing information or signature, you must document the medicalcondition that prevents it from being obtained. The signature also acknowledges the receiptof the Notice of Privacy Practices (NPP) statement that we are required to provide the patientper Federal law. If a signature is not obtained, you need to document where the SOG was leftwith the patient.

Notice of Privacy PracticesThe NPP is a form required by HIPAA to make your patients aware of how the agency handlesprotected health information, who the agency can release that information to and how thepatient can gain access to their protected health information. This form must be given toevery patient! The patient must also sign the billing form stating that they have received theNotice of Privacy Practices form.

67


Section: Operations Subject: Patient HandlingSOG # 2013-214 Date: October 22, 2013

Page 1 of 1

Too often the basics of patient handling are taken for granted. Improper lifting and movingpatients can cause injury and damage to you, your patient and GVRS. Industry statistics showthat patient drops are a leading cause for claims of negligence. The EMS industry estimatesthere are an estimated 42,000 patient drops annually. The Gouverneur Vol. Rescue Squad,INC., is concerned about these statistics and encourages its members and staff to take intoaccount the following items.

The incidence of patient drops can be attributed to a few generalized areas:1. Improper selection and use of equipment2. Improper balance/strength of crews3. Improper evaluation of scene hazards4. Improper maintenance of equipment5. Equipment failure/malfunctions

Some General Rules for Safe Patient Handling1. Assess the scene for hazards that may inhibit moving the patient safely

(plush carpet, soft ground, inclined surfaces, narrow hallways, etc.)2. Select and utilize the proper lifting device3. Know the weight you’re about to lift (ask the patient’s weight if you can

and add to the weight of the equipment)4. Know your physical abilities and limitations and also those of your partner5. Attempt to apply your physical abilities to your partner’s and to the

situation6. Use proper lifting techniques and keep the weight you’re lifting close to

your body7. Communicate clearly and frequently with your partner(s). Verbalize all

commands8. Don’t hesitate to request assistance with the lift or movement of the

patient

68


Section: Operations Subject: Lifting and Moving PatientsSOG # 2013-215 Date: October 22, 2013

Page 1 of 1

All patients will be given the opportunity to be carried from where they are found to theambulance. If a patient chooses not to be carried, it should be documented on the PCR. Thesame SOG applies to the transfer of patients in to the emergency room from the ambulanceupon arrival at the hospital.

LiftingLifting is an area of great concern for the Gouverneur Vol. Rescue Squad, INC., Training isprovided to all members in the techniques of lifting and the use of proper body mechanics.This training should be used whenever you lift a patient to avoid injury to yourself or thepatient.

Patient PackagingWhenever a patient is being moved they shall be secured to the carrying device, i.e.stretcher, stair chair, using no less than two straps. Patients must also be secured to thestretcher or bench seat whenever the ambulance is in motion. Patient comfort should alwaysbe a thought. Blankets should be used to protect the patient from the outside environmentand to protect their modesty in the event that their clothing has been removed.

Child Safety SeatsWhenever possible a child should be transported to the hospital using his or her own safetyseat secured to the stretcher or a seat in the ambulance.

69



Section: Operations Subject: Friends/Family in the Ambulance

SOG # 2013-216 Date: October 22, 2013

Page 1 of 1

Whenever possible, the family member should ride in the passenger seat of the cab. Certainsituations warrant having a family member in the patient compartment including:

Pediatric patients in need of parental support. Patients that would benefit from family emotional support. Patients that are unmanageable without family nearby. Patients in need of language translation.

Please keep the patient and their family’s needs and point of view in mind when decidingwhere to seat them.

All passengers are required to wear seat belts at all times.

70



Section: Operations Subject: Response to Motor Vehicle Collisions

SOG # 2013-217 Date: October 23, 2013

Pages 1 of 2

Motor vehicle collision responses are a common response for the ambulance.

Scene Safety

Upon arrival, and having performed a size up of the incident, it is imperative that the scene issecured with the assistance of the police and fire departments to assure the safety ofpersonnel. This may include limiting vehicle traffic or completely shutting down the roadway,placing vehicles in park and turning off the ignitions. If it is necessary for ambulancepersonnel to enter a vehicle during extrication to provide treatment, it is imperative thatprotective equipment is worn including but not limited to helmets, safety glasses, extricationjackets, extrication pants, extrication gloves, and reflective break away vests.

Documentation

PCR’S are to be completed for each patient involved in a motor vehicle collision involvinginjuries or with a mechanism of injury that suggests that a patient may be injured evenwithout complaints. PCR’s do not need to be completed on patients that have no complaintsand minor vehicular damage. . A PCR must still be completed for the call describing thedetails and the interactions with individuals on the scene.

Response to scene

No privately operated vehicles should respond to a motor vehicle scene for any reason otherthan the following, the scene is between your residence and the GVRS building or manpoweronly is requested to the scene.

71

Roles of GVRS on a Motor Vehicle Scene

The role of EMS providers at a motor vehicle scene is providing patient care. In accordancewith New York State Department of Health Bureau of EMS Policy statement #98-05 “Pursuantto the provisions of Public Health Law, the individual having the highest level of pre-hospitalcertification and who is responding with authority, “has a duty to act” and therefore isresponsible for providing and/or directing emergency medical care and the transportation ofa patient.” The person holding the highest level of pre-hospital care certification shall assumethe roles of medical incident commander until relieved.

72



Section: Operations Subject: Response to a Fire Scene

SOG # 2013-218 Date: October 23, 2013

Page 1 of 1

GVRS is called to respond to the scenes of structure fires, industrial fires, wild land fires, aswell as many other types of fire scenes. The primary role of EMS is to provide treatment tovictims and/or firefighters and also provide rehab to firefighters as needed.

When dispatched to a fire scene, anticipate fire apparatus response and yield whennecessary. You should let all fire apparatus by you. Unless dispatched to a fire withCONFIRMED entrapment ambulance response should consist of no lights and no siren.

Upon arrival to a fire scene extreme caution must be used. Do not run over any fire hoses ordown wires. Park the ambulance out of the way of all fire apparatus while making sure ifneed be the ambulance has a clear exit to the hospital.

It is a good idea to contact fire incident command for an ambulance staging location. Afterthe ambulance is parked the stretcher and the first in bag should be placed close to the scenewith an EMT with it at all times making sure the Incident commander knows the location.

You must remain on scene until released by the incident commander. If a victim or firefighter requires transport to the hospital, request another ambulance

to the scene for standby.

73



Section: Operations Subject: Responding to a Hazardous MaterialsIncident

SOG # 2013-219 Date: October 23, 2013

Page 1 of 2

A hazardous materials incident can consist of any number of chemicals in any form, liquids,solids or gases. Hazardous materials incidents require a specialized response with specializedequipment. If you are the first unit on scene of an incident that you believe may involve ahazardous material, contact the 911 center and assure that the fire department and aHazmat representative are dispatched.

Response

While en route to an incident, obtain as much information as possible from the 911Center. Begin researching the involved substances while en route, if possible, utilizingthe DOT Emergency Response Guidebook.

Approach the scene from an uphill, upwind direction and do not drive throughunknown clouds, fluids or smoke. Stage any additional units away from the scene untilthey are needed.

On scene Operations

Upon arrival on the scene of an incident that appears to involve hazardous materials,the crew will immediately withdraw to a position of safety, upwind from the incidentand summon appropriately trained assistance by notifying the 911 Center.

Work closely with the fire department and any Hazardous Materials Response Teamthat may be on scene to identify the substance and decide on a plan of action. Assistwith evacuations as necessary.

All GVRS crews should remain in the cold zone unless trained to wear the appropriatePPE to enter the warm zone. GVRS personnel should never enter the hot zone.

74

Descriptions of the exclusionary zones are as follows:

1. Hot Zone – Dangerous area where the incident is occurring. Onlypersonnel with the appropriate PPE are allowed in this area.

2. Warm Zone – Some danger to exposure, but generally safe for trainedpersonnel. There may be a need for PPE. 88

3. Cold Zone – No danger of exposure. Safe for all personnel.

Patients must be decontaminated by the Hazmat team prior to being loaded into anambulance. If the hazardous substance is identified prior to transport, advise Resource so thereceiving hospitals can be prepared to treat patients.

The ambulances must be cleaned and decontaminated after the incident, prior to beingplaced back in service.

75


Section: Operations Subject: Responding to Assist PoliceSOG # 2013-220 Date: October 23, 2013

Page 1 of 1

GVRS may be called to assist the police during certain types of law enforcement incidents.

When responding to these types of incidents:

1. Advise Central Dispatch of your staging location and request they notifyyou when police have secured the scene

2. Remain at least a block away from the scene and out of sight until it hasbeen cleared by law enforcement

• Do not respond to a staging area in a priority mode with lights and sirens on.

76



Section: Operations

(last updated 8/5/2014)

Subject: Responding to a Mass/MultipleCasualty Incident (MCI)

SOG # 2013-221 Date: October 23, 2013

Pages 1 of 8

This plan is based upon the NYS Department of Health MCI Model Plan and the St. LawrenceCounty Multiple/Mass Casualty Response Plan.

A Multiple/Mass Casualty Incident (MCI) is defined as any event that:

Produces several patients Produces a minimal number of patients, but has unusual events surrounding the

incident Affects local hospitals receiving the patients to the point that normal EMS operation

becomes hindered, having an impact on system efficacy. The number of patients out numbers the resources of initial responders.

Many of the guidelines below can be used for incidents having multiple patients that are nottrue mass casualty incidents. The more this plan is implemented on a small scale, the betterthe chance of it being carried out smoothly on a large scale.

MCI Responses

Units listed below will be dispatched/notified as required per the St. Lawrence CountyMultiple/Mass Casualty Response Plan.

Unconfirmed MCI Response

During an unconfirmed MCI in the Gouverneur Volunteer Rescue Squad response area thefollowing units will be dispatched:

A-172 A-173 A-174 A-175 Gouverneur Fire Department

77

The following units will be placed on standby:

Richville First Responders Edwards Ambulance Indian River Ambulance Hermon Ambulance Harrisville Ambulance

Confirmed MCI Response

During a confirmed MCI in the Gouverneur Volunteer Rescue Squad response area thefollowing units will be dispatched:

A-172 A-173 A-174 A-175 Gouverneur Fire Department Richville First Responders Edwards Ambulance Indian River Ambulance Harrisville Ambulance Hermon Ambulance

The following Departments will be placed on standby:

Ogdensburg Rescue Squad Morristown Rescue Squad Canton Rescue Squad Rensselaer falls Rescue Squad Russell Rescue Squad

The following departments will be dispatched for a 2nd alarm:

• Ogdensburg Rescue Squad

• Morristown Rescue Squad

• Canton Rescue Squad

• Rensselaer falls Rescue Squad

• Russell Rescue Squad

78

The following departments will be placed on standby for a 2nd alarm:

Hammond Rescue Squad Star Lake Rescue Squad Evans Mills Ambulance Potsdam Rescue Squad

GVRS Preplanning

Our vehicles are capable of transporting as many patients as you have seat belts for. Duringan MCI you may consider contacting Gouverneur Central School district for a school bus totransport NON-critical Patients with sufficient medical providers on board.

A Smart Triage Pac™ is located in all of our ambulances. They should consist of:

20 Smart Tags 10 Dead Tags 1 Casualty Count/Adult Triage Card 1 Smart Tape 5 Light sticks 2 Pencils 1 Pen

On scene Unit Responsibilities

First Unit On scene

Make immediate contact with the Incident Commander, i.e. fire or police, if they areon scene prior to you.

Assess the scene and provide an initial size up if you are the first unit on scene. Thesize up should include:

1. Location2. Nature3. Any scene safety issues4. Initial victim estimate5. Injury types6. A staging area with access routes7. Location of command

79

• EMS Command should be established in conjunction with other on sceneagencies to avoid duplication of resources.

• The first unit Crew Chief will remain with command unless relieved by adirector.

• The other personnel will begin a primary triage using the START system andSmart Tags.

The following groups/group supervisors should be established as the incident requires:

1. Triage2. Treatment3. Transport4. Staging5. Supply

• Other positions that may need to be established are safety, public informationand stress management.

• In a smaller incident, a person may hold more than one position.

Second Unit on scene

• Contact Command for an assignment.• Expect the roles of triage and/or treatment group supervisor.• Begin secondary triage of patients as they are moved to the treatment area.

Third Unit on scene

• Contact command for assignment and vehicle staging location.• Expect the roles of treatment and/or transport group supervisors.

Fourth Unit on scene

• Contact command for assignment and vehicle staging location.• Expect the role of staging area manager.

All Other Responding Units

• Remain with your vehicles at the staging area unless requested into the scene.• Drivers of units designated as transport vehicles must remain with their

vehicle at all times.• Equipment should be unloaded from non-transport units as requested.

80

ICS Positions

EMS Command

Incident operations MUST be done on an alternate radio frequency.

Radio designator: EMS Command

The Director of Operations, Highest Level of Care, and/or Most Senior Medical Provider ofthe first arriving EMS unit will be assigned to this position and to the incident/unifiedcommand post unless relieved by a director. The responsibilities of EMS Command are:

• Work in cooperation with fire, police and other agencies on scene• Establish an EMS Operations Chief or Medical Branch Director if the incident

requires• Manage the overall EMS response to the incident• Determine the initial need for ambulances, supplies, personnel, etc.• Reassign personnel as needed• Maintain contact with Central Dispatch to request additional resources as

needed• The EMS Commander is responsible for all positions not delegated to others

EMS Operations

Radio designator: EMS Operations Chief or Medical Branch Director

• Oversees the operations of all established branches, groups, etc.• Designates other ICS positions as the incident requires, i.e. treatment,

transport• Advises command of the need for additional resources as required

Triage Group

Radio Designator: Triage Group Supervisor

The Crew Chief of the second arriving unit will be assigned to this position unless alreadyassigned.

The Triage Group Supervisor is responsible for:

• Establishing the extent of the primary triage• Communicating to EMS Command or EMS Operations the progress of triage

and report of the number of patients and their types of injuries• Assigning personnel to move patients to the treatment areas and perform a

secondary triage.

81

Treatment Group

Radio Designator: Treatment Group Supervisor

The Treatment Group Supervisor is responsible for:

• Establishing safe, suitable locations red, green and yellow treatment areas• Ensuring treatment areas are clearly marked• Assigning personnel to each area to provide treatment• Communicate to EMS Command or EMS Operations the need for further

resources as required

Transport Group

Radio Designator: Transport Group Supervisor

The Transport Group Supervisor is responsible for:

• Coordinating the loading of patients into transporting EMS units• Establishing contact with the Resource hospital for patient destinations. This

channel will remain open throughout the entire incident• Appointing a person to communicate with Resource for them• Communicating the need for additional resources to EMS Command or EMS

Operations

EMS Staging Area

Radio Designator: EMS Staging Area Manager

The EMS Staging Area Manager is responsible for:

• Establishing a safe, suitable staging area for EMS personnel and equipmentaway from the incident scene

• Advising EMS Command or EMS Operations of the location and the bestmeans of access

• Ensuring vehicles are parked so as not to block the entrance or egress ofothers

• Sending appropriate vehicles into the scene as requested by EMS Command orEMS Operations

Public Information

Radio Designator: EMS Public Information Officer (PIO)

The EMS Public Information Officer is responsible for:

82

• Disseminating factual and timely progress reports concerning the nature andextent of the incident to the media as per the Incident Commander

• Information that may be released is:1. Casualty count2. Number, type and responding location of EMS personnel and units

operating on the scene3. Age, sex and chief complaint of patients4. Time of the incident5. Location of incident6. Number of people rescued7. Additional resources that may be needed8. Areas for people to avoid9. Traffic information that may assist the public

• Protected Health Information, i.e. names, address, etc. should never bereleased

• Documenting, in chronological order, all information released and submit afinal written report to the Incident Commander 97

Supply Group

Radio Designator: Supply Group Supervisor

The Supply Group Supervisor is responsible for:

• Identifying a safe, suitable location near the treatment areas to house supplies• Requesting additional resources as needed through EMS Command or EMS

Operations• Maintaining logs consisting of supplies requested, the source of those supplies

and who they were issued to and providing this to Incident Command at thetermination of the incident

• Ensuring all equipment has been secured when demobilizing• Arranging for the retrieval of equipment from area hospitals

General Information

• Respond to the scene of an MCI only when directed by Central Dispatch• Drivers and stretchers should remain with their vehicles at all times• The Treatment Group Supervisor may request Resource to issue standing

orders for the incident• Transport to the hospital as directed by the Transport Group Supervisor• Only contact the receiving hospital via telemetry if the patient’s condition

changes and you require new orders• After turning over your patient to the emergency room staff, contact Central

Dispatch to see if you are needed back at the scene

83

Demobilization, Termination and Recovery

As the incident begins to wind down, EMS Command will reassign, rotate and returnequipment that is no longer needed. At this time, assure that you have:

• Collected any of your equipment left on the scene• Collected all appropriate data and turned in triage tag stubs• Turned in any reports requested by EMS Command

EMS Command will advise Central Dispatch of the termination of the MCI after all livepatients have been transported from the scene and a final search has been completed toassure this.

Upon returning to quarters:

• Restock and refuel your vehicle as necessary• Arrange for retrieval of equipment from area hospitals• Determine if CISD will be necessary (Refer to CISM SOG)• Command should complete a final, written report within 7 days of the incident

and turn it in to the Director of Operations• The Directors of Operations should review and revise the MCI plan as needed• Seek financial reimbursement to cover the costs of services, equipment and

supplies used in response to the MCI. Documentation is key in this.

In events of “Short Duration” or small to moderate size MCI’s, the Fire Chief will be the pointof contact with Central Dispatch. The EMS Command will request all resources through theFire Chief to limit the amount of radio traffic and so there is only one point of contact withCentral Dispatch. Once the Fire Chief establishes Command, he/or she will then have CentralDispatch notify Gouverneur Hospital. Responding EMS units should only use routine radiotraffic. Radio traffic on high band fire should be minimal.

84



Section: Operations Subject: Dealing with Violent Patients

SOG # 2013-222 Date: October 23, 2013

Page 1 of 1

Scene safety is the most important skill that New York State Emergency Medical Servicespersonnel are taught. Gouverneur Volunteer Rescue Squad personnel are reminded that theyare responsible for the safety of all crew members at all times. If at any time a crew- memberfeels unsafe, all crewmembers should leave the scene immediately together and LawEnforcement should be notified.

If a patient or bystander becomes violent while on the scene of an incident, the crew’sprimary responsibility is to protect themselves. The crew should remove themselves from thescene and return to the ambulance while awaiting law enforcement to secure the scene.

If the patient is already in the ambulance, the ambulance should be stopped immediately.The crew should attempt to restrain the patient. If this is not possible, the crew should exitthe ambulance and protect themselves until police can restrain the patient.

In any situation where a patient or bystander becomes violent, the crew should assure theirown safety and avoid physical confrontation unless there is no other way to protectthemselves.

85



Section: Operations Subject: Treating and Transporting Pt’s with aPsychiatric Problem

SOG # 2013-223 Date: October 23, 2013

Page 1 of 1

Scene safety is the most important skill that New York State Emergency Medical Servicespersonnel are taught. Gouverneur Volunteer Rescue Squad personnel are reminded that theyare responsible for the safety of all crew members at all times. If at any time a crew- memberfeels unsafe, all crewmembers should leave the scene immediately together and LawEnforcement should be notified.

GVRS may be called to assist or treat a psychiatric patient requiring treatment and transportto a hospital. These patients should be encouraged to do so. The police and family membersmay be able to assist with this. Contacting the medical control physician at Resource or thepatient’s own physician may also aid in the patient’s decision, if needed.

Following these procedures may assist a crew when confronted with these types ofsituations:

• Do not drive to scene in a priority mode with lights and sirens unless there isan immediate life threat.

• Await Law Enforcement, if appropriate, to assure scene safety.• Obtain a complete patient assessment to the level the patient will allow.• Advise the patient that you are there to assist them and make them

comfortable.• • If you are uncomfortable with the actions of a patient, request assistance to

ride with you.

86



Section: Operations Subject: Patient Restraint

SOG # 2013-224 Date: October 23, 2013

Page 1 of 1

Crews may consider the use of soft restraints to protect the patient and others from harm.Restraints should only be used if the patient presents a danger to themselves or others.Restraints must be utilized in accordance with the NYS Mental Health Law. A Police Officer orPeace Officer should be present at the scene prior to the application of restraints. Thepatient should be kept on their back or their sides to assure the restraints don’t restrict thepatient’s breathing or circulation. After application of restraints, the patient should beassessed for circulation, sensation and movement in all extremities at least every fiveminutes throughout transport. Contact medical control.

The following must be documented on the PCR when restraining an individual:

• Why the patient was restrained.• The type of restraint used.• The position of the patient.• The time applied.• The law enforcement agency involved.

No restraints across chest, neck or head that could impede patients breathing. Restraints must beeasily removable and cause no injury to patient.

87



Section: Operations Subject: Unfounded Calls/Unable to Locate aPatient

SOG # 2013-225 Date: October 23,2013

Page 1 of 1

When a crew is dispatched to a location and no patient can be found, the crew should dothe following:

• Verify the address with Central Dispatch and request a call back• Check for additional information from the dispatcher or other agencies

responding to the same location• If the patient is said to be outside, check the general area for the patient• If, after every reasonable effort is made to locate the patient, the patient is

not found, the crew may clear the call as unfounded.

88



Section: Operations Subject: Unable to Gain Access to a Scene

SOG # 2013-226 Date: October 23, 2013

Page 1 of 1

If a crew is dispatched to an address, but is unable to gain entry, the crew should do thefollowing:

• Request Central Dispatch verify the address and make a call back to theresidence to have them open the door

• Attempt to locate a key to the residence at a neighbors• If this is unsuccessful or the party is unable to get to the door, Central Dispatch

will notify the fire department and law enforcement for forcible entry. Whenthis condition occurs:

• Wait for law enforcement and the fire department to arrive at the scene andobtain access to the patient

• Do not try to break down doors as we are not trained or equipped to do thissafely

• If the patient is inside and can be communicated with prior to access, explainto them what is going on.

89



Section: Operations Subject: Do Not Resuscitate Orders and OtherAdvanced Directives

SOG # 2013-227 Date: October 23, 2013

Pages 1 of 2

Crews are to recognize DNR Orders under the following circumstances:

• Transferring a patient from a health care facility with an authorized DNR order,a MOLST (Medical Orders for or an order signed by a physician to accompanythe patient in the ambulance)

• DNR order on an approved form (DOH 3474) or as indicated by DNR bracelet• Refer to New York State DOH SOG 99-10

In the NCEMS Region, Health Care Proxies and Living Wills forms are NOT to be honored byEMS providers.

DNR Patients and Other Interventions

• Do not resuscitate (DNR) means, for the patient in cardiac or respiratoryarrest, NO chest compressions, ventilation, defibrillation, endotrachealintubation, or medications.

• If the patient is NOT in cardiac or respiratory arrest, full treatment for allinjuries, pain, difficult or insufficient breathing, hemorrhage and/or othermedical conditions must be provided.

• Relief of choking caused by a foreign body is usually appropriate, although ifbreathing has stopped, ventilation should not be assisted.

• CPR must be initiated if no Out of Hospital or facility DNR is presented. If aDNR order is presented after CPR has been started, stop CPR.

• For unusual situations or questions on individual patient circumstances,contact medical control.

In the case of health care proxies and living wills, consult with medical control for advice.

90

DNR and Transports

If a DNR patient arrests during transport, you may discontinue treatment, noting the time,and:

• Return the patient to the sending facility, if it is an inter-facility transfer• Continue to the hospital and transfer the patient to an empty bed designated

by the ED staff.

Good Faith Presumptions

If you believe, in good faith, for some reason a DNR has been revoked or does not truly exist,i.e. no paper work exists, you will not be held liable if you initiate CPR and it turns out theorder was still in effect.

Termination of CPR

CPR can be terminated at the scene when:

• Documentation of a DNR is produced.• A physician orders termination of CPR on the scene by either radio or

telephone.

If a physical confrontation is likely due to family member disagreement with the DNR or adecision to terminate CPR, it is then appropriate to continue CPR and transport the patient tothe hospital.

91



Section: Operations Subject: Confirmed DOA’s and Termination ofResuscitation

SOG # 2013-228 Date: October 23, 2013

Pages 1 of 2

DOA’s

The procedures for dealing with a patient who is dead on arrival (DOA) are as follows:

• Notify dispatch and assure a police agency is responding• Document the findings that confirmed the death including:

1. Absence of pulse and respirations2. If ALS, Confirmation of asystole in two different leads on ECG3. Skin color/temperature4. Pupils5. Medical history6. Description of scene7. Rigor mortis, dependent lividity, etc.

• Check with police prior to leaving the scene and obtain a unit number from theofficer in charge of the investigation

• Confirm that the ME has been notified

Termination of Resuscitation

The North Country EMS Regional Protocols call for the termination of resuscitative efforts inadult medical patients who are in asystole and do not respond to ACLS therapy. This can onlybe done through direct communication with Medical Control.

If you have a patient of this kind, dealing with the family and others on the scene becomes ofgreat significance. You can play a very helpful role in addressing some of the family’simmediate needs as they begin to process the death of a family member.

Keep some of these points in mind when you deal with this situation:

• As soon as possible, advise the family that the patient has no activity in theirheart and all interventions have been unsuccessful

• Advise the family that the physician may order an end to resuscitative efforts

92

• If the family protests, advise resource of this fact and transport will be ordered• If the family accepts the possibility of a termination order, keep them advised

of what you are doing as you talk to Medical Control.

When the resuscitation is terminated, explain to the family that the patient has died andoffer your assistance, which may consist of:

• Allowing family to view the patient and explain the events of the resuscitation• Ask if there is someone who can be called to assist the family• Offer your condolences and hear them out for they may just need to talk

Clean up the area leaving all interventions in place and cover the patient unless the familyobjects.

At no time will a body be moved, unless directed by a St. Lawrence County Corner or to gain access toanother patient. The body should be left uncovered and minimize human contact with the body. Thebody should then be secured and turned over to Law Enforcement.

93



Section: Operations Subject: Patient Refusals

SOG # 2013-229 Date: October 23, 2013

Page 1 of 1

All competent adults have the right to refuse medical treatment and/or transport. It is theresponsibility of the pre-hospital care provider to be sure that the patient is fully informedabout their situation and the possible implications of refusing treatment and/or transport.

When a patient or legal guardian refuses treatment or requests that you discontinue furthertreatment of the patient, do not initiate any new treatment modalities. Discuss with thepatient the need for treatment and/or transport.

If the patient still refuses treatment and/or transport and you feel that the patient’scondition requires treatment and/or transport, allow the patient’s family members, friendsor anyone else who is familiar with the patient to try and convince the patient of the need fortreatment and/or transport.

If at this point you are still unable to convince the patient of the need for treatment and/ortransport, contact Medical Control for further advice.

GVRS utilizes the NYS Department of Health policies and protocols and the NCEMS policiesand protocols for obtaining patient refusals.

Only EMT’s and higher levels of care may obtain a refusal.

A PCR must be completed along with the North Country Regional Refusal Form and thepatient or applicable party must sign the refusal on the North Country Regional Refusal Form.

This should be witnessed by a family member, Law Enforcement official or bystander and thewitness should also sign the North Country Regional Refusal Form.

If the patient or applicable responsible party refuses to sign the North Country RegionalRefusal Form then have a family member, Law Enforcement official, or bystander sign as awitness and document the refusal to sign on the North Country Regional Refusal Form.

94



Section: Operations Subject: Patient Care and Consent of Minors

SOG # 2013-230 Date: October 23, 2013

Page 1 of 1

EMS providers are often presented with patients who are considered, by law, to be minors.The issue of providing care or the patient’s right to refuse care becomes a complexcircumstance that EMS providers must address. In the pre-hospital situation, the issue athand is not usually providing care, but rather the failure to treat.

A minor, in New York State, is defined as a person who is under eighteen (18) years of age.

An individual who is legally a minor cannot give effective legal, informed consent totreatment and therefore, conversely, cannot legally refuse treatment.

In cases where the patient is a minor presenting with a non-emergent condition and a parentis not available on scene, attempt to contact a parent or guardian by telephone for consentto treat or refuse. An assessment of the patient should be completed. Fully document allcircumstances including subjective and objective findings, attempts to contact parents, noteany objections or refusals by the patient and all other pertinent situational facts. Lawenforcement should be notified.

• If a parent or guardian is not immediately available, the provider may considercontacting medical control for permission for the minor to sign off if they haveno injuries.

• If a parent or guardian is not available by telephone, law enforcement officialsmay take responsibility for the minor and consent or refuse treatment forthem.

In cases where the patient is a minor presenting with an emergent condition and a parentis not available on scene, consent is implied for treatment and transport.

Always act in the best interest of the patient. Providers must strike a balance betweenabandoning the patient and forcing care. There may be instances in which a minor appearsmature enough to make an independent judgment; however, legally the minor is unable tomake this decision. Always contact Medical Control for assistance if there is any question.

95



Section: Operations Subject: Request for Transport Out of ServiceArea

SOG # 2013-231 Date: October 23, 2013

Page 1 of 1

On occasion we are asked to transport a patient to a hospital out of our primary servicearea.

• In accordance to New York State Department of Health Policy statement#06-01 “All ambulance patients can expect to be informed of the need tobe taken to a medical facility capable of providing appropriate emergencymedical care The triage and transport of out of hospital patients must bebased upon established principles of emergency medical practice,including pre-established state and regional medical protocols andguidelines. For any given patient, the appropriateness of the receivingfacility to provide emergency care is a medical decision. Therefore, thedirection or redirection of a transporting vehicle cannot be made withoutmedical approval based upon established Regional Emergency MedicalServices System protocols2.

Also, the NYS Basic Life Support Protocols, which Part 800 regulations require allEmergency Medical Technicians to comply with specify:

• Major Trauma Protocols – If the patient meets any one of the criteriadelineated in the protocols, they must be transported to a regionaltrauma center3.

• Suspected Stroke – A. Transport the patient to the closest New York StateDepartment of Health designated Stroke Center if the total pre-hospitaltime is less than two hours.

Additionally, a Regional Medical Advisory Committee (REMAC) may have developedtreatment and transport protocols that address local conditions and require that patients betransported to specific facilities in certain situations.

96



Section: Operations Subject: Standby’s

SOG # 2013-232 Date: October 23, 2013

Pages 1 of 3

Emergency Standbys

GVRS provides emergency standbys within our coverage area and elsewhere according to thecounty mutual aid agreement, as dispatched by Central Dispatch. Our role is to provide initialemergency care to emergency workers and to fill the EMS portion of the incident commandsystem.

Upon arrival at a standby, the crew will check in with the Incident Commander anddetermine their assigned staging area. The ambulance should be placed at a location thatallows for a means of egress, if necessary, and does not block access for other respondingunits.

The Crew Chief will contact the Incident Commander or designee and determine whatfunctions are needed. Anticipated roles include:

• Standby for initial management of injured emergency workers• EMS command role• Establishment of a rehabilitation sector

As the first ambulance is dedicated to the scene, any needed equipment at the scene shouldbe removed from that ambulance.

Depending on the nature and location of the incident, appropriate emergency medicalsupplies and equipment should be moved to the EMS/rehabilitation area. Minimally, thisshould include: stretcher, oxygen supplies with bag valve mask, and monitor. Otherequipment is at the Crew Chief’s discretion.

The dedicated ambulance will remain on scene in the desired capacity until released by theIncident Commander. The Crew Chief should continually assess potential patient load andensure adequate resources are available. This assessment should be relayed to the IncidentCommander, Central Dispatch and the Resource Hospital, as appropriate. When needed, theEMS/rehabilitation area will be established in a cold zone.

97

Non-emergency Standby’s

GVRS will try to provide, when requested, non-emergent, pre-scheduled, standbys forcommunity/public events within the district. All such requests shall be referred to theDirector of Operations for authorization.

Non-Emergency Standbys are split into two categories:

• Dedicated• Non-dedicated

Dedicated Non-Emergency Standby

A dedicated standby is a standby in which an ambulance is solely committed to an event orfunction. This standby crew will be responsible for providing medical coverage and treatmentfor any person or persons at the said event. It will not respond to calls outside of the eventand generally will not transport.

The crew will follow the usual crew responsibilities for the shift. The crew will call CentralDispatch and advise that the rig will be on a dedicated standby, the location and that they areunavailable for emergency calls. A dedicated ambulance will not leave the standby for anyreason.

If the standby rig finds a patient that needs transport, the crew will begin treatment andcontact Central Dispatch to start the closest ambulance for transport. The standby rig mayhandle any evaluations or refusals as needed without calling for assistance. A separate Pre-hospital Care Report filled out for each patient contact.

A fee may be charged for a Dedicated Non-Emergency standby. Refer to the StandbyInformation for the Public for further information.

Non-Dedicated Non-Emergency Standbys

A non-dedicated standby is a standby where an ambulance has been requested for an eventor function, but is not committed to the scene and is available to respond to other calls.

The crew will remain in service with Central Dispatch, but on the air at a standby. CentralDispatch should be advised of the location. If the non-dedicated rig finds a patient, treatmentshould be initiated and transport, if required, will be provided. A separate Pre-hospital CareReport filled out for each patient contact. In this case, Central Dispatch is to be notified at theonset of patient evaluation and the rig placed out on a call. This will prevent any unnecessarydelays in response to additional calls.

Crew Requirements for Standbys

Any standby rig will consist of a minimum of a GVRS Driver and a Member-in-Charge. ACritical Care Tech or Paramedic should be considered for a large event or events, which maynecessitate Advanced Life Support assistance. A Member-in-Charge may standby at small

98

events with minimum equipment and a radio or cell phone to communicate with CentralDispatch. At the completion of the any stand-by, a Pre-hospital Care Report will be filled out.

Special Considerations for Sporting Event Standbys

Sporting event standbys must comply with all other policies and procedures.

If the coach or athletic trainer is present at the event, that coach or trainer will beresponsible for the patient until they request EMS to become involved.

99



Section: Operations Subject: Child Abuse and Maltreatment

SOG # 2013-233 Date: October 23, 2013

Pages 1 of 2

When dealing with pediatric emergencies members should remain alert to potential childabuse and maltreatment situations. In the case of suspected child abuse and maltreatment,the crew should immediately initiate all appropriate treatment, protect the child from furtherharm and transport the child to the hospital. If the parent or guardian refuses treatmentand/or transport for the child, law enforcement should be notified to assist in the resolutionof the situation.

Providers must maintain a positive, objective and non-judgmental attitude at all times whendealing with suspected child abuse or maltreatment.

The New York State Social Services Law § 413 requires EMT’s to report suspected child abusethey come across while performing their jobs. The NYS Bureau of EMS does not requiremandated reporter training for the EMT.

Reporting Procedures

Reports of suspected child abuse or maltreatment should be made immediately by telephoneto the NYS Child Abuse and Maltreatment Register. The phone number for the NYS ChildAbuse and Maltreatment Register is 1-800-635-1522. This number is for mandated reportersonly and should not be given out to the public. Oral reports must be followed up with awritten report within 48 hours using Form DSS-2221-A, "Report of Suspected Child Abuse orMaltreatment". This form is available in the crew room as well as on the NYS Department ofHealth website. A copy of the completed and submitted Form DSS-2221-A should be attachedto the agency copy of the Pre-hospital Care Report retained by the agency. All findings shouldbe documented on the PCR and suspicions and the reasons for the suspicions reported to theemergency department. When making a report for suspected child abuse or maltreatment,only one member of the crew must make a report. If GVRS is not the transporting agency onthe call, the crew is still responsible for making a report for suspected child abuse andmaltreatment.

Immunity from Liability

Immunity from liability for reporting cases of suspected child abuse or maltreatment isprovided to those individuals required to report such cases under § 419 of the Social Services

100

Law, so long as the individual was acting in "good faith".

Failure to Report

§ 420 of the Social Services Law states:

1. Any person, official or institution required by this title to report a case ofsuspected child abuse or maltreatment that willfully fails to do so shall be guilty ofa class a misdemeanor.

2. Any person, official or institution required by this title to report a case ofsuspected child abuse or maltreatment that knowingly and willfully fails to do soshall be civilly liable for the damages proximately caused by such failure

101



Section: Operations Subject: Elder Abuse and Neglect

SOG # 2013-234 Date: October 23, 2013

Page 1 of 1

Elder abuse and neglect, like child abuse and neglect, is a big problem in our society. Theprimary sign of abuse is unexplained injuries in the elderly patient. In the situation where thecrew suspects abuse or neglect of an elderly patient, they should complete a full patientassessment, including a scene assessment and report their suspicions to the emergencydepartment staff and.

If the patient refuses transportation and is deemed mentally capable of making an informeddecision, the crew should report the situation and their suspicions to law enforcementofficials as soon as reasonably possible and document their findings in their Pre-hospital CareReport.

There is NO NYS law that requires the reporting of elder abuse and neglect, however theGouverneur Volunteer Rescue Squad’s Director of Operations will follow up with theappropriate agency to attempt to obtain any possible services available for the individual.

102



Section: Operations Subject: Patient Abuse

SOG # 2013-235 Date: October 23, 2013

Page 1 of 1

On a call where the ambulance crew suspects physical or emotional abuse of a patient byanother health care provider.

The crew should follow these guidelines:

• Do not confront or accuse the provider.• Take necessary steps to prevent any further physical injury to the patient.• The incident must be objectively documented on the PCR, including what

actions or injuries were witnessed and what the patient stated about theincident.

• The Director of Operations will follow up with the management of thefacility in question regarding the incident. If the matter is not satisfactorilyresolved, the Director of Operations will continue to pursue the matteruntil an appropriate resolution is achieved.

103



Section: Operations Subject: Abandoned Infant Protection Act

SOG # 2013-236 Date: October 23, 2013

Page 1 of 1

The Abandoned Infant Protection Act was created in Chapter 156 of the Laws of 2000. Underthis provision, a parent, guardian or other legally responsible person may leave their infant(who must be five days old or less) at a safe place.

The law requires that an adult must intend that the child be safe from physical injury, caredfor in an appropriate manner, with an appropriate person, in a suitable location and promptlynotify an appropriate person of the child's location.

People leaving an infant in compliance with this law are not required to provide their names.Such individuals will not be prosecuted as a class E felony of Abandonment of a Child andclass A misdemeanor of Endangering the Welfare of a Child.

In the event a parent or legal guardian chooses to relinquish care of their newborn infant toGVRS, the following guidelines should be considered:

• Parents are not required to provide their names to the safe location or staff. Ina non-judgmental manner, EMS staff may ask the presenting adult if there isany medical information that is important to know in the care of the infant.

• Infants received by GVRS should be transported to the nearest hospital formedical assessment/care. GVRS is not expected to interact with local childprotection service agencies unless directed to do so.

• A Pre-hospital Care Report will be completed for the infant.• If a parent seeks follow up information about the child they relinquished to

the care of GVRS, a referral should be made to the hospital where the infantwas transported or the local office of social services.

104



Section: Operations Subject: Reporting of Crimes

SOG # 2013-237 Date: October 23, 2013

Page 1 of 1

Any time a member believes that they have witnessed or suspect criminal acts; i.e. domesticviolence, etc., during a call or while on duty, they should immediately notify 911 and advisethem of the incident. The 911 Center will advise local law enforcement and the receivinghospital if appropriate.

If on the scene of any crime or possible crime in progress, the crew will not confront thesuspect and should immediately notify law enforcement personnel through Central Dispatch.

105



Section: Operations


Subject: Hospital Diversions

SOG # 2013-238 Date: October 23, 2013

Page 1 of 1

The primary hospital that GVRS transports to is Gouverneur Hospital. There may be timeswhere Gouverneur Hospital is unable to provide adequate care for any further patients. Ifthis occurs, a request may be made by Gouverneur Hospital to divert a patient to anotherfacility. This may also occur if Gouverneur Hospital feels that patient condition warrantstransport to a facility other than itself.

When either of these occurs, the crew will inform the patient and any accompanying relative,and comply immediately with the medical control order.

If the patient is alert, oriented and understands the reason for diversion, but still refusesdiversion from the hospital of choice he will be asked to sign a refusal and will be taken tothe original hospital destination as a “demand” for that particular hospital.

If, however, in the opinion of the highest trained member in attendance, the patient’srequest of hospital will cause further harm to the patient, the most appropriate hospital willbe used.

In all cases of diversion from the patient’s hospital choice, the EMT will record the patient’srequest on the Pre-hospital Care Report and the reasons for transporting to the closestappropriate hospital.

The highest trained provider should also consider the capabilities of the hospitals. NYS DOHEMS #06-01 states patients should be transported to the “closest most appropriate facility”.

106



Section: Operations Subject: Simultaneous Calls (800.21)

SOG # 2013-239 Date: December 12, 2013

Page 1 of 1

In the event that multiple requests for ambulances simultaneously the Highest trained provider shallcommunicate with the 911 center to determine the “highest priority” patient and respond to thatpatient. The dispatch center will then activate for second ambulance and mutual aid as needed tocover both calls. Request Richville First Responders.

107



Section: Operations Subject: Maximum Receipt interval (800.21)

SOG # 2013-240 Date: December 12, 2013

Page 1 of 1

Gouverneur Rescue operates as a combination paid/ volunteer ambulance response service, whichalso services (2) two hospitals with Interfacility transports. Gouverneur Rescue will make everyattempt to ensure a minimum of (1) one ambulance in the service area at all times.

In the event the number of calls exceeds the number of ambulances and/or crews mutual aide shallbe dispatched, as well as Richville Fire First Responders. Saint Lawrence County 911 center will followtheir policies and agreed upon procedures for dispatching mutual aide.

108



Section: Operations Subject: Ambulance Exchange Points

SOG # 2014-241 Date: July 10, 2014

Page 1 of 9

Beginning Aug 1, 2014 the ranges (training area) of Fort Drum will be utilizing local ambulance servicesto transport injuries and illness of the training area.

Observe the following when responding to the ranges:

There are “ambulance exchange points” (see attached maps) they will be clearly marked. Theplan is for the military medics to bring the patients to the ambulance.

UNDER NO CIRCUMSTANCES WILL A GVRS VEHICLE OR PERSONNEL GO PAST AN AMBULANCEEXCHANGE POINT SIGN WITHOUT EITHER AN ESCORT OR A DIRECT RESPONSE FROM CENTRALDISPATCH THAT FORT DRUM 911 HAS APPROVED YOU TO ENTER THE RANGE. This is a largesafety issue, not to mention a logistics issue, as the roads and training areas are poorly marked.

We have attempted to get clarification of level of care, i.e. military medic provides ALS care andwe only have a BLS crew. Albany has not issued a response. Unless you hear otherwise, if amilitary medic did an ALS intervention, they most ride with patient to hospital (if BLS CREW).

All ordinates, weapons, explosives MUST be removed from the patient prior to being placed intothe ambulance. GVRS personnel will not handle any weapon; they will only be handled by othersoldiers.

Range roads can be very hazardous to drive. You MUST observe common sense, and slowerspeeds. Unless otherwise dictated by St. Co. 911 or your escort, flashing lights will be on,HOWEVER siren use should be limited.

117



Section:

Vehicle/Equipment/Facility Maintenance

Subject: Equipment Preventative Maintenanceand Failure

SOG # 2013-301 Date: October 23, 2013

Page 1 of 2

The Buildings & Grounds/Vehicle Maintenance coordinators are responsible for theequipment preventative maintenance schedules following all Manufacturers’ suggestedguidelines. This includes contracted maintenance and in-house maintenance.

Preventative maintenance should include, but is not limited to:

• Performing, or having performed, a manufacturer's recommendedcalibrations/inspections

• Performing, or having performed, a manufacturer's recommended service(including lubrications)

• Replacing and servicing batteries (if applicable)• Proper inspection of all equipment available to providers• Proper cleaning and disinfecting procedures• The following types of equipment are covered by preventive maintenance:• Radios and other communications equipment• Stretchers and stretcher mounting hardware• AED’s/ECG/Manual Defibrillator equipment• Pulse oximeters• Glucometers• Suction devices• Rechargeable battery powered lights• BP Cuffs, manual and automatic• Patient stabilization/transportation/immobilization devices• Oxygen regulators and delivery systems• Ventilators• Infusion devices• Specialized pieces of equipment owned or operated by the service

118

GVRS will maintain complete maintenance records on its equipment. These reports willcontain, but are not limited to:

• When and where the equipment was purchased/obtained• Equipment maintenance schedule per the manufacturer’s instructions• Documentation pertaining to all repairs/maintenance performed on the

equipment

Equipment Failures

All damaged and non-functional equipment must be taken out of service and replacedimmediately. The equipment should be marked out of service and brought to the attention ofthe Supply Manager.

If a piece of equipment fails during an ambulance call, a second vehicle should be called, ifnecessary, and the Central Dispatch Center should then be advised to contact the Director ofOperations.

All EMS agencies are required to notify the NYSDOH, in writing, of all unexpected authorizedEMS response vehicle and/or patient care equipment failures that resulted or may haveresulted in harm to a patient.

Any corrective actions taken by the agency should be included in this report. The intent ofthis report is to track trends in vehicle and equipment failures so that manufacturers andother appropriate agencies may be made aware.

Having the incident identified and reviewed by the service or regional quality improvementprocess does not relieve the agency from these reporting requirements.

119



Section:


Subject: Vehicle Preventative Maintenanceand Failure

SOG # 2013-302 Date: October 28, 2013

Page 1 of 2

Preventative maintenance will include, but is not limited to:

• Annual DMV Inspection• Fluid and filter change intervals• Tire rotation intervals• Fluid level check schedule• Battery check intervals• Inspection of lights and the electrical system• Inspection of belts, hoses and clamps• Inspection of doors and gaskets• Brake service intervals• Evaluation of the heating and cooling system• Schedule of other maintenance procedures particular to vehicle

GVRS will maintain complete maintenance records on all its vehicles. These records will includeinspection reports as well as records of services performed by outside vendors or representatives ofthe vehicle manufacturer. These records may also contain any service bulletins or recall notices issuedby the manufacturer and records of compliance with their recommendations.

Vehicle Failures

In the event of vehicle problems or failures, a second vehicle will be called. The Director of Operationswill be notified.

If a problem occurs that will interrupt an ambulance call in progress, notify the Central DispatchCenter immediately by radio and request another vehicle be dispatched to your location to continuethe transport.

120

If a problem occurs that needs immediate attention but will not interrupt an ambulance call inprogress notify the Central Dispatch Center by phone to report the problem and have the Directornotified.

If a problem occurs that does not require immediate attention, i.e. a light bulb that is out inside thevehicle, note the problem in the vehicle’s logbook.

121



Section:


Subject: Out of Service Vehicles

SOG # 2013-303 Date: October 28, 2013

Page 1 of 1

If a vehicle must be removed from service, whether for vehicle maintenance reasons or lack of patientcare equipment, the following procedure is to be used:

• Place the out of service sign on the steering wheel or windshield of the vehicle.• Notify the Director of Operations• Notify Central Dispatch of the vehicles status

When the vehicle is to be returned to service, the following must be done:

• Assure the vehicle is in compliance with part 800 of the New York State Public HealthLaw.

• Return the out of service sign to its proper location.• Notify Central Dispatch of the updated status.

122



Section:


Subject: Vehicle Fuelling

SOG # 2013-304 Date: October 28, 2013

Page 1 of 1

Vehicles should not be allowed to fall below a 50% fuel level.

GVRS Diesel vehicles are fuelled at the East Side Central School located at 111 Gleason St.Gouverneur, NY 13642. Each vehicle that is to be fuelled at the School have 2 keys that identify thevehicle on the key ring.

Ambulettes have fuel cards inside the vehicle and cannot be used at the school. Ambulettes are to befuelled at the most appropriate gas station at the time fuel is needed. These cards are the same asdescribed below

In the case of transfers out of the area or problems with the East Side School fuel pumps, there arefuel cards in each vehicle to use at gas pumps. To use the card you must have a Driver ID given by theDirector of Operations. The odometer of the vehicle MUST also be entered at the gas pumps withthese cards.

Each vehicle has a fuel log located in the cab of each vehicle. The log needs to be filled out every timea GVRS vehicle is re-fuelled.

123



Section:


Subject: Periodic Cleaning and Decontaminationof Vehicles

SOG # 2013-305 Date: October 28, 2013

Page 1 of 2

To maintain the cleanliness of all vehicles and reduce the risk of contamination to personnel, the caband patient compartment of the ambulances and squad will be cleaned and decontaminated daily asneeded.

At a minimum, all vehicles will be completely cleaned and decontaminated at least once per month.This will then be documented on the appropriate form in the vehicle’s 800 check and OSHA cleaninglogbook.

Procedure

A clean-up kit will be available. This kit will include:

• Two pairs of household utility gloves• Small bucket for soap and water• Soap or cleaning agent• Plastic spray bottle with cleaning agent (labelled as appropriate)• Plastic spray bottle with disinfectant solution or 1:100 bleach solution (labelled as

appropriate and mixed daily or at time of use.)• Disposable towelling• Biohazard red bags• Household garbage bags• Disposable cleaning clothes• Basket carrier to hold cleaning supplies

124

All personnel shall wear utility gloves when cleaning and decontaminating the vehicles. During themonthly decontamination of the vehicle, all seals will be removed from the cabinets, theequipment/supplies removed and the cabinet surfaces cleaned with soap and water followed by a1:100 bleach solution (1/4 cup bleach to one gallon of water) or a department issued disinfectant andallowed to air dry. A full 800 check will then be completed and the cabinets resealed with theappropriate numbered seals.

All surfaces in the vehicles including the floor, ceiling, radio controls, switches, door handles, steeringwheel and gear shifter will be cleaned with soap and water followed by a 1:100 bleach solution or adepartment issued disinfectant and allowed to air dry.

125


Section:Vehicle/Equipment/Facility Maintenance

Subject: Facility/Property Use and Upkeep


Facility

Use of GVRS property while on or off duty is a privilege of membership and must notadversely affect response times or patient care. When a member utilizes a GVRS property,such as the building, training equipment, etc., they are responsible for properly cleaning upand returning the area back to its proper condition. Any personal items/materials broughtinto the building must also be taken out with you. This includes any cleaning items. Anycleaning/chemical items that you wish to leave in the building require an MSDS be placed inthe MSDS Binder.

The building is for the express purpose of housing the vehicles and providing a comfortableplace for on-duty members to standby. All Members and staff have the responsibility ofkeeping the building clean and neat at all times.

This building houses a public safety service and citizens may visit between the hours of 0800and 2200 hours. Citizens may only visit after 2200 hours during an emergency situation or atthe discretion of a Board Member, Crew Personnel in charge, or Director of Operations.

Visitors and observers to the building are responsible for keeping themselves in an orderlymanner. Visitors and observers shall not be in the building without supervision.

The member they are visiting or observing is responsible for assuring that they are supervisedand acting appropriately. The most senior person on duty is ultimately responsible for allvisitors to the building.

Students are allowed in the building from 0700-2300. Students must leave the facility andmay not at any time be permitted to stay overnight.

All members and staff must maintain the work and living quarters in a clean and tidy

126

condition. Daily duty logs are located in the building and must be documented.

Vehicles

GVRS vehicles will not be used for personal business/errands unless the vehicle is fully staffedand ready to respond to an incident.

Personal vehicles are permitted to be the bays overnight IF there is an empty, available bayopen.

127



Section:


Subject: Tobacco Usage

SOG # 2013-307 Date: October 28, 2013

Page 1 of 1

There is NO Tobacco usage allowed inside the building, including the ambulance bays, at any time.This includes both smoke and smokeless tobaccos. The designated smoking areas are located outsideof the back door. Cigarette disposal canisters are located at the designated locations.

New York State Public Health Law Article 13 E restricts smoking in indoor places including places ofemployment. Also, OSHA regulations state that there shall be no smoking within 20 feet of anycompressed cylinder including oxygen (29 CFR 1910.101b). This rules out smoking in any ambulanceor EMS response vehicle as well as inside the ambulance bays where the vehicles are housed.

128



Section:


Subject: Members Presence at the Building

SOG # 2013-308 Date: October 28, 2013

Page 1 of 1

It is recognized by the Members of the Gouverneur Vol. Rescue Squad, INC., that sometimes-unforeseen circumstances occur in one’s life requiring a change in residency because of hardship orpersonal issues. The GVRS building is not a place for Members to establish residency.

As it is the desire of the GVRS to have its Members active and present at our facilities, no membershall have an extended stay without the approval of the Board of Directors, Director of Operationsand/or his/her designee. On a temporary basis, the Director of Operations may grant permissionpending final approval from the Board of Directors. Members may only be exempted from this SOG inthe event of a declared state of emergency or natural disaster.

Should a Member of GVRS feel the need to use this benefit, it is expected they be willing and availableto answer calls for help from the Communities for GVRS services. The member is expected to keep thebunk room clean, sheets and towels washed and their clothes organized and stored properly.

The Member is also expected to clean the bathroom and shower the member has been using. Anyabuse of this benefit may result in being asked to leave immediately by the Director of Operations orthe Board of Directors and may also result in disciplinary actions.

Any Member may not take up either a temporary or extended stay at GVRS for more than a Thirty(30) day period without the approval of the Board of Directors. A Member may be granted anextension by submitting a request in writing to the Board of Directors. The Board of Directors maygrant an exemption in thirty (30) day increments, thus needing the exemption to be reviewed andvoted on at the next Board of Directors meeting.

129



Section:


Subject: Cell Phone Usage

SOG # 2013-309 Date: October 28, 2013

Page 1 of 1

It is recognized by the Members of the Gouverneur Vol. Rescue Squad, INC., that cell phones are avaluable communication tool. However, used at inappropriate times can cause a hazard to GVRSMembers and/or the public.

The following actions are strictly forbidden when operating any GVRS vehicle.

• Text messaging• Sending or reading E-mails• Initiating Phone calls on personal phones.

Cell phones will not be used by any crewmember during an emergency call except for:

• Hospital Notifications• Requests of Dispatch

Cell Phones will not be used while conducting Patient Care except:

• Hospital Notifications• Medical Direction

Cell Phone conversations, verbal or texting, with any person not involved with the call is notacceptable and may constitute a violation of the patients Federal HIPPA and Privacy Rights.

130



Section:


Subject: Washing/Cleaning of POV’s

SOG # 2014-310 Date: January 9, 2014

Page 1 of 1

Washing/cleaning of personally owned vehicles is allowed to be done inside the back bays. Whenfinished with your personal vehicle the bay floor and bay area will be cleaned and if ambulette wasplaced outside will be put back in the building.

Any member who leaves an ambulance and/or ambulette outside overnight or leaves the squadgrounds without putting the ambulance and/or ambulette back in the building or fails to clean thearea that they used will lose their privilege to use the bay area to wash/clean their vehicle in the GVRSbay area.

Failure to put the ambulance and/or ambulette back in the bay areas by a member that removedthem can face disciplinary action per the By-Laws and/or SOG’s.

131



Section:


Subject: Vehicle Security

SOG # 2014-311 Date: January 9, 2014

Page 1 of 1

Ambulances and ambulettes shall remain inside the garage area at all times. If during cold weather anambulance has to be placed outside the ambulance shall remain running with the parking brake on.

Ambulances and/or ambulettes may be placed outside for prolonged periods of time for functionswhere use of the bay is needed with approval from the Director or an Officer.

132



Section:


Subject: Daily Duties for Career Members

SOG # 2014-312 Date: September 8, 2014

Page 1 of 1

Daily Duties for Career Members.

Career Members will be required to perform duties during their shift. This applies to all shift workmembers. These do not apply to members who are normally scheduled mon-fri/thurs day shifts,those members will have duties separately assigned based on the needs of the organization.

There will be a Daily Duties binder located in the kitchen area of the building, the logs will be filled outat the conclusion of every shift. Along with the daily duties log there is a rig check sheet that must becompleted along with it. The comments section of the duty sheets will include all calls orInterfacility transports which GVRS drops. All assigned duties will be completed or it will bedocumented why.

Failure to compete the log or failure to compete the duties, without an acceptable excuse, will resultin progressive discipline as per Gouverneur Rescue Employee Manual.

133



Section: Safety and Quality Management Subject: General Safety Issues

SOG # 2013-401 Date: October 28, 2013

Page 1 of 2

The safety of its members is, and will continue to be, a primary consideration in the operation ofGVRS. Accidents can be prevented or at least controlled through the use of reasonable precautionsand the practice of safe work habits.

Therefore, a Health and Safety Officer is appointed by the Director of Operations and is tasked withthe responsibility of reviewing all policies and procedures related to safety issues.

Regular inspections will be conducted to maintain safe working conditions and safe equipment.Necessary repairs and/or improvements will receive prompt attention.

GVRS has implemented the following policies to assist its members in the prevention of accidents andinjuries. As a member/employee of GVRS, it is your responsibility to observe and obey all the policiesand procedures, as the greatest cause of accidents and injuries is the failure to follow theimplemented safety policies. The following are the established

Policies and procedures related to safety:

• Prior to using any equipment, be sure to read the instructions or be properlyinstructed in the use of the equipment.

• Create your own safety awareness and attitude.• Wear personal protective equipment as the situation dictates or as directed by a

supervisor for the safety needs of the work place.• Learn proper lifting techniques and ask for assistance when needed.• Avoid wearing loose fitting clothing and jewellery.• Observe and obey all warning signs.• Horseplay will not be tolerated.• Protect all employees and safeguard all equipment and property.

134

No member or employee will perform any type of work until they have been fully trained in thecorrect operation, the hazards involved, safety procedures and required safety equipment.

Building Safety

• Beware of slippery floors• Maintain a neat workspace• Walk, never run, in the workplace• Maintain proper lighting for the work area

135



Section: Safety and Quality Management Subject: Health and Safety Committee

SOG # 2013-402 Date: October 28, 2013

Page 1 of 1

The GVRS Director of Operations will appoint a Health and Safety Officer. The Health and SafetyOfficer will address safety at the agency level. The main purpose of having a Health and Safety Officeris to have a qualified individual managing GVRS’s Health and Safety Program.

The Health and Safety Officer will be responsible for developing and maintaining a Health and SafetyCommittee that has been approved by the Director of Operations. The Health and Safety Officer willchair this committee. The Health and Safety Committee meetings will be held at least every 6 months.However, the Health and Safety Officer may schedule meetings as needed. Committee meetingminutes will be recorded.

The Health and Safety Committee will collect appropriate data in order to analyse and help improvethe health and safety of GVRS members and staff. A data collection system will be established thatmaintains records on accidents, injuries, illnesses, deaths or exposures that are, or might be jobrelated. These records will be maintained confidential.

136



Section: Safety and Quality Management Subject: Critical Incident Stress Management

SOG # 2013-403 Date: October 29, 2013

Page 1 of 1

A "critical incident" is defined as any incident capable of producing strong emotional reactions inemergency service workers. These may include the following:

• Death/serious injury of an emergency service worker in the line of duty• Death/serious injury of fire/police personnel in the line of duty• Suicide of a fellow worker• An EMS call including the death or serious injury of a child• An EMS call where a prolonged rescue attempt fails• An EMS call that receives extraordinary media coverage• An EMS call involving death or serious injury of a family member• Mass casualty incidents• Other situations deemed by a director to be a "critical incident"

As soon as possible after a critical incident, a director or peer leader will provide an initial contact,termed a defusing, for those members directly involved in a critical incident.

After being notified by a member, the Director of Operations will arrange for an initial defusing forthose members directly involved in the incident to be performed immediately following the incidentby either a director or a peer leader. The Director of Operations will then assure a Critical IncidentStress Debriefing is arranged to occur as soon as possible after the incident. All other agenciesinvolved in the incident will be notified of the date, time and location of the debriefing. The NorthCountry Critical Incident Stress Management Team will conduct this debriefing.

This is a voluntary program that is provided to assist all of the people involved in the incident. This is aconfidential program where no notes are kept and the results are not discussed outside of themeeting.

137



Section: Safety and Quality Management Subject: OSHA Compliance Programs

SOG # 2013-404 Date: October 29, 2013

Page 1 of 1

GVRS will make every attempt to comply with the standards set forth by the Occupational Safety andHealth Administration (OSHA). In doing so, GVRS has provided a binder that contains all programs,policies and procedures relating to OSHA. The Director of Operations will have them available. Theprograms contained within include:

• General Station Safety including Portable Fire Extinguishers• Exposure Control and Needle Stick Safety Program• Respiratory Protection Program• Hazard Communications Program• Control of Hazardous Energy (Lockout/Tag Out) Program• Confined Space Program• Access to Employee Medical Records• Emergency Response Plan

The Ryan White Officer will be the Director of Operations. All members and employees will makethemselves familiar with these programs. Training in each OSHA Compliance program will occur asstated in each program.

138



Section: Safety and Quality Management Subject: Workplace Violence

SOG # 2013-405 Date: October 29, 2013

Page 1 of 2

Nothing is more important to GVRS than the safety and security of its employees. Threats,threatening behaviour or acts of violence against employees, visitors, guests, or other individuals byanyone on GVRS property will not be tolerated. Violations of this SOG will lead to disciplinary actionwhich may include dismissal.

Any person who makes substantial threats, exhibits threatening behaviour or engages in violent actson GVRS property will be removed from the premises as quickly as safety permits and shall remain offGVRS premises pending the outcome of an investigation. GVRS will initiate a decisive and appropriateresponse. This response may include, but is not limited to, suspension and/or termination of anybusiness relationship, reassignment of job duties, suspension or termination ofemployment/membership and/or criminal prosecution of the person or persons involved.

In carrying out these GVRS policies, it is essential that all personnel understand that no existing GVRSSOG, practice or procedure should be interpreted to prohibit decisions designed to prevent a threatfrom being carried out, a violent act from occurring or a life threatening situation from developing.

All GVRS personnel are responsible for notifying the Director of Operations of any threats which theyhave witnessed, received or have been told that another person has witnessed or received. Evenwithout an actual threat, personnel should also report any behaviour they have witnessed which theyregard as threatening or violent, when that behaviour is job related or might be carried out on acompany-controlled site, or is connected to company employment. Employees are responsible formaking this report, regardless of the relationship between the individual who initiated the threat,threatening behaviour, the person(s) who were threatened or were the focus of the threateningbehaviour.

This SOG also requires all individuals who apply for or obtain a protective or restraining order which

139

lists GVRS locations as being protected areas, to provide to the Director of Operations a copy of thepetition and declarations used to seek the order, a copy of any temporary protective or restrainingorder which is granted and a copy of any protective or restraining order which is made permanent.GVRS understands the sensitivity of the information requested and has confidentiality procedureswhich recognize and respect the privacy of the reporting employee(s).

140



Section: Safety and Quality Management Subject: Member/Employee HealthExaminations

SOG # 2013-406 Date: October 29, 2013

Page 1 of 5

Member/employee health records will be maintained on all employees and members who are eitheractive volunteer or career personnel with GVRS.

This record shall include the following as outlined in the NYS EMS Program SOG Number #88-8:

• Pre-employment physical examination• Immunization record & screening results.• Record of employee/member occupational injuries of illnesses and their course i.e.:

compensation forms filed, Physician’s record, hospital record, etc….• An incident report pertaining to employee (member) exposure to suspected

hazardous materials, toxic products, or true exposures to infectious diseases.• Record of annual physicals.• Record of Physician’s approval to return to active duty after debilitating illnesses or

injuries.

The physical examination should be conducted by a physician or Physician's Assistant who is familiarwith the type of work performed by pre-hospital providers taking into account the risks and functionsassociated with the individual's duties and responsibilities.

The health screening portion of the exam should include a determination of the applicant'simmunization status for the following diseases: Diphtheria, Tetanus, Polio, Measles, Mumps, Rubella,Hepatitis B and Chicken Pox. The applicant should be instructed to bring a copy of his/herimmunization record to the physical exam.

Pre-employment (membership) physicals and health screening, as outlined in the NYS EMS ProgramSOG #88-8, shall be required for all members/employees and are provided at no cost to the

141

member/employee.

These physicals shall include, but are not limited to:

• Medical and Occupational History• Blood Pressure/ Vital Signs• Hearing• Eyes and Vision• Dermatological system• Ears, Nose, Mouth, Throat• Respiratory system• Heart and Vascular system• Gastrointestinal system• Genitourinary system• Endocrine and metabolic systems• Musculoskeletal systems

Routine yearly TB skin testing will be required for all members/employees having contact withpatients. For those individuals who have converted their skin test, this will be waived. Instead, aninitial chest x-ray will be obtained and appropriate counselling provided regarding the need to reportany signs or symptoms of TB. Further chest x-rays will only be obtained when determined necessaryby our agency’s Medical Director.

Health Maintenance

No member or employee will be assigned to emergency response duties until an entrance physicalassessment has been completed and reviewed.

All members and employees will be offered immunization against hepatitis B, measles, mumps,rubella polio, tetanus, and diphtheria through GVRS. The risks and benefits of immunization will beexplained to all members and informed consent obtained prior to immunization.Members/Employees may refuse immunizations or may submit proof of previous immunization.Members/Employees who refuse Hepatitis B immunization will be counselled on the occupational riskof communicable disease and required to sign a refusal of immunization form. Members/Employeeswho initially refuse immunization may later receive immunization upon request.

All active members/employees shall be examined by a Physician or Physician's Assistant on a regularbasis. Members age 39 and under are required to receive a physical every other year. Members age40 and over are required to receive a physical yearly.

142

Any member/employee returning to duty following debilitating illness or injury or communicabledisease, occupational or non-occupational, will, prior to resuming their emergency response duties,be required to submit a note from their physician attesting that they are again able to assumeambulance or emergency medical service duties.

Members or employees who have not satisfied these requirements of examination shall not bepermitted to return to active duty status.

Immunization Status

GVRS will actively attempt to identify and limit the exposure of its members and employees toinfectious diseases in the performance of their assigned duties. The following are therecommendations of the Immunization Practices Advisory Committee (U.S. Department of Health andHuman Services, Public Health Service, and Centres for Disease Control) for adults:

• Tetanus/Diphtheria — "All adults…should complete a series of tetanus anddiphtheria toxoids. A primary series for adults is three doses of preparationscontaining tetanus and diphtheria toxoids, with the first two doses given 6-12 monthsafter the second. Those who have completed the primary series should receive abooster dose every 10 years. The combined toxoids for adult use, (Td), should havebeen used to enhance protection against both diseases. Persons with unknown oruncertain histories of receiving tetanus or diphtheria toxic should be consideredunimmunized and should receive a full three-dose primary series of Td."

• Measles — "…all health personnel born in 1957 or later who may have contact withpatients infected with the measles should be immune. Such persons can beconsidered immune only if they have documentation of having received live-measlesvaccine on or after their first birthday, a record of physician diagnosed measles orlaboratory evidence of immunity. Measles vaccine is recommended for all personslacking such documentation. Combined MMR vaccine is the vaccine of choice ifrecipients are likely to be susceptible to rubella and/or mumps as well as to measles.Adults born before 1957 can be considered immune to measles…"

• Mumps — "While most adults are likely to have been infected naturally with mumps,mumps vaccine may be given to adults, especially males who are consideredsusceptible. Males especially need to consider being vaccinated with this one timeinjection since 20% of adult males who contract mumps develop inflamed testes."

• Rubella — "…health personnel who might be at risk of exposure to patients infectedwith rubella, or who have contact with pregnant patients, should be immune. Rubellavaccine is recommended for all such personnel unless they have either proof ofvaccination with rubella vaccine on or after their first birthday or laboratory evidence

143

of immunity. Combined MMR vaccine is the vaccine of choice if recipients are likely tobe susceptible to measles and/or mumps as well as to rubella." This is a one-timeinjection. Women of childbearing age should consult their physician prior to receivingimmunization.

• Chicken Pox — "Most persons with a clearly positive history of previous varicella areprobably immune. Many with negative or unknown histories may be immune, butsome may also be susceptible." No long-term vaccine is available for varicella. Itshould be noted that the infectious material for this disease is also commonly foundin fluid filled lesions diagnosed as Herpes Zoster or more commonly known asShingles.

• Hepatitis B — "health care personnel who may have contact with blood or bloodproducts should be immune to hepatitis B virus (HBV) infection…Among health carepersonnel with frequent exposure to blood, the prevalence of serological evidence ofHBV is estimated to range between 10% and 30%. Thus blood screening of theseindividuals is neither required nor cost effective. Vaccination of individuals whoalready have antibodies to HBV has not been shown to cause adverse effects." Thehepatitis B vaccine is given in a series of three shots over a six-month period. Inaddition, a booster may be necessary every five years.

• Tuberculosis (TB) Screening — "The tuberculin skin test is the method of choice forTB screening. The Monteux technique is preferred…because it is the most accuratetest available. A two-step procedure can be used to minimize the likelihoodmisinterpretation, a boosted reaction as a true conversion due to recent infection. Inthe two-step approach, an initial tuberculin skin test (Monteux, 5 TUPPD) is given. Ifthis test result is 0-9mm of induration, a second test is given at least one week and nomore than three weeks after the first. The results of the second test should be usedas the baseline test in determining treatment and follow up of these personnel. A skintest result of 10mm of induration or more is considered significant. The two stepapproach, however, may not always be necessary. After the initial TB screening test,policies for repeat testing can be established by the agency’s physician or Physician’sAssistant by considering factors that contribute to the risk that a person will acquirenew infection…For personnel considered to be at significant risk, repeat skin testsmay be necessary on a routine basis (i.e.: yearly). An initial chest x-ray isrecommended for those individuals with history of positive skin tests or those whoconvert skin tests. Yearly chest x-rays of these individuals is not recommended forroutine screenings, however, if a true exposure occurs a chest x-ray is recommendedten weeks after the exposure.

• Polio — All personnel should have taken the three doses of polio vaccine orally intheir childhood years. If this was not done consult your physician for vaccination tothe disease.

144



Section: Safety and Quality Management Subject: Glucometer Calibration

SOG # 2013-407 Date: October 29, 2013

Page 1 of 1

In order to maintain compliance with New York State Public Health Law Title V and the ClinicalLaboratory Improvement Amendments of 1988 (CLIA ’88), the Gouverneur Vol. Rescue Squad, INC.,will maintain a valid Limited Service Laboratory permit.

Weekly glucometer calibrations will be performed and documented to assure compliance with allClinical Laboratory Evaluation Program (CLEP) requirements. Glucometer calibration will beperformed in accordance with the User’s Manual for the appropriate glucometer and documented onthe Weekly Glucometer Calibration Report. These reports will be maintained by the Director ofOperations for a minimum of 7 years.

145



Section: Safety and Quality Management


Subject: Continuous Quality Improvement

SOG # 2013-408 Date: October 29, 2013

Page 1 of 5

The primary goal of an EMS system is to reduce death and disability from injuries and illnesses. Asresearch continues into the impact that pre-hospital care has on the ultimate outcome of patients,the need to evaluate the quality of the care that we as individuals and organizations provide becomesparamount. In order to ensure patients are receiving the best care that can be provided, standards ofcare must be routinely evaluated to identify areas of strengths and weaknesses.

Continuous Quality Improvement (CQI) is a program of systematic evaluation to ensure excellence.Instead of asking “Who caused this to happen?” CQI asks, “What is wrong with the process thatcaused this to happen and what can be done to improve the system?”

Quality improvement activity is a means to guarantee continuous quality of care to patients,educational programs for providers and a means for identifying areas of concern before they becomeproblems. CQI requires the willing cooperation of all members. It must recognize common needs foreducation, structured feedback, professionalism, mutual respect and, above all, confidentiality.

A quality improvement program has several components. These are case reviews, evaluation ofindicators, tracking and evaluation of the program. CQI also evaluates concerns and recognizesexcellence.

To meet the requirement of Article 30 section 3006 GVRS must participate in the CQI process.

• GVRS will participate in the St. Lawrence County CQI Committee for the purpose ofplanned and systematic monitoring of and enhancing the quality and appropriatenessof patient care, clinical performance review and administrative coordination andsupport activities of the service in regard to quality issues. The program will further

146

work to eliminate the causes of identified deficiencies by working toward resolvingidentified problems, improving EMS activities related to patient care, and reinforcingand enhancing positive attitudes, behaviours and practices of GVRS and itsmembers/employees.

GVRS will also actively participate in the Regional CQI program.

• • The service level is the primary level of the CQI program. The majority of CQIactivities will occur at this level. The service level CQI committee may only makerecommendations to the Director of Operations about educational corrective actionsfor a provider. The Director of Operations must approve all policies and proceduresdeveloped by the service level CQI prior to implementation.

The goals of the GVRS CQI Committee are:

• Recognition and acknowledgment of examples of excellent patient care or othercomponents of service organization

• Identification of actual or potential problems concerning patient care and clinicalperformance

• Assessment of the cause and scope of problems identified• Development and recommendation of proposed courses of action to address the

problems identified• Use of information gathered regarding problems identified, whenever service policies

and procedures regarding patient care and support activities are revised• Implementation of actions necessary to correct the identified problems• Monitoring and evaluation of actions taken and the implementation of remedial

action to ensure effectiveness• Referral to the regional medical advisory committee and the regional medical director

or his/her designee, problems which have been identified by the agency but arebeyond the agency’s authority or ability to correct

• Documentation of all measures taken pursuant to this CQI program

The CQI committee will consist of, but is not limited to:

• The CQI Coordinator• The Medical Director• If possible, at least one provider from each level of care provided at GVRS• A representative of the highest level of care provided at GVRS is required• A Registered Nurse• The Director of Operations may attend but not be a member• A quorum shall consist of a minimum of three people (except for unusual

147

circumstances), and at least 1 member must be a Paramedic. The CQI committee willmeet at least every three months, but not less than four times per year. Additionalmeetings to address patient care concerns should be scheduled as needed.

Each meeting should consist of the following agenda items:

• Reading of the confidentiality statement• Discussion of emergent patient care concerns• Recognition of good patient care practice• Follow up discussion of any open reviews• Ongoing PCR reviews, not limited to the following examples:• Cardiac arrest/obvious death• Controlled substance use• Calls resulting in an emergency response to the hospital• Pediatric transports• Multisystem trauma• Shock of any origin• Unconscious-unknown cause• Service/provider/patient/family/hospital complaint• Protocol deviation• Review of PCR’s, in accordance with county and regional requests, for:• Accuracy and completeness• Timeliness of response (measured from the time of call received to time on scene),

including any communication and/or dispatch problems• Completeness of patient assessment• Appropriateness of care based on patient assessment, including evaluation of

compliance with all appropriate protocols• Appropriateness of time spent in patient care on scene• Emergency Department diagnosis and outcome in selected cases, with the assistance

of hospital providers• Review of medical control actions associated with above• Review of dispatch/pre-arrival instruction/communication activities and actions• Establish and/or provide continuing education programs for service improvement.• Review current issues that affect patient care and the service.• Research and development of current techniques and technologies.

The CQI committee will prepare minutes or records of all activities participated in at their meetings.The information that is required to be collected and maintained, including information from the PCRshall be kept confidential. All records pertaining to the CQI process will be kept in a separate lockedand secured file away from all other service records (employee files, etc.).

148

Responsibilities of the CQI Coordinator

The Director will appoint a CQI coordinator to oversee the actions of the CQI committee. The CQIcoordinator shall be at least a NYS Certified AEMT-CC or AEMT-Paramedic, if possible, and should befamiliar with the concepts of the CQI program. This provider appointed should be strongly committedand dedicated to the concepts and goals of a comprehensive CQI program.

The CQI coordinator shall:

• Attend, or appoint someone to attend, the meetings of the service, county andregional CQI committees

• Be responsible for reviewing each PCR for accuracy, completeness andappropriateness of care as soon as possible, but at least once a week

• Review immediately all incident reports pertaining to patient care issues and directany required immediate action to the Director

• Take any immediate action required in consultation with the GVRS Medical Director• Review all patient/family written comments as soon as possible after they are

received, but at least once a week. Refer all comments to the crews involved. Referany negative comments or notations of problems immediately to a director and theCQI committee. Discuss any negative comments or problems with the GVRS MedicalDirector

• At least annually, review the Standard Operating Guidelines of the CQI process andrecommend any changes to the membership and officers.

• At least annually, review the appropriateness and timeliness of the monthly in-service• education programs as related to any identified problems and coordinate with the• Training Coordinator to establish a proposed schedule of in-service education for the

next year• Regularly review the appropriateness and adequacy of equipment and make

recommendations for any upgrades or additional equipment needed.• Cooperate with the regional CQI/Medical Advisory Committees and provide any

information to the regional program as may be necessary or requested• Respond to any inquiries from other EMS services concerning performance reviews of

current or former members

Routine Screening:

Gouverneur Rescue shall perform routine screening on patient care. This includes but is notlimited to random call screens, specific topic screens.

Gouverneur Rescue will randomly screen calls for CQI and research. This willbe an attempt to improve routine care.

All Narcotic administrations will be reviewed and then forwarded to the

149

Medical Director for a review and sign off. This shall occur on a regular basis.

Investigations and Notifications

Investigations of patient care concerns and serious issues will begin within twenty-four hours uponnotification. Serious issues need to be reviewed not more than 30 days from the date the issue wasinitially reported. The Director of Operations and/or Medical Director have the right to suspend anymedical personnel in the event of a perceived life threatening error or life threat to public safetypending CQI investigation.

The following must be referred immediately to the Regional Clinical Coordinator for review:

• Esophageal Intubations• Practicing medicine without a license• Patient abandonment issues• Situations that might immediately place patients in danger• Medication Errors• The following are reportable to NYS Dept. of Health and to the Regional Clinical

Coordinator within twenty-four hours:• Noncompliance with Part 800.15• Noncompliance with Part 800.16• A patient dies, is injured or is otherwise harmed due to actions of commission or

omission by a member of GVRS.

The Appeal Process

If an individual provider disagrees with the educational corrective action set by the service CQIcommittee, he or she may appeal this decision in writing to the Director of Operations within 30 daysof the decision. The Director of Operations will decide if the issue is appropriate for them to review.Service CQI issues that cannot be resolved at the service level will look to the Region for assistance.

150



Section: Financial Subject: Responsibility

SOG # 2013-501 Date: November 25, 2013

Page 1 of 1

Gouverneur Vol. Rescue Squad INC., shall remain the highest level of fiscal responsibility. The Directoralong with the Treasurer of the Board of Directors and the entire Board of Directors will work tomaintain proper accounting practices and financial transparency.

The Primary responsibility of the Board of Directors is the financial security of Gouverneur Vol. RescueSquad Inc. All Members of the Board of Directors assume liability for the fiscal management of theOrganization.

151



Section: Financial Subject: Purchasing


Page 1 of 1

Gouverneur Rescue will use vendors whenever possible for purchases, and maintain accounts withthese vendors and keep the accounts in good standing. Upon delivery the packing list shall becompared with the delivery to ensure that all items are delivered.

When a vendor is not practical for use or unable to supply the needed goods in a timely fashion, apurchase at a store may be used. In this event, prior to the items being “put away” a second person,who is not related to or living with the purchaser shall also check to make sure all the items arepresent, sign the receipt and both will put all of the items away.

The Director is authorized to make purchases for the purpose of Operational Need. The Director maymake purchases to replace equipment and supplies used in the day-to-day operations of theOrganization. The Director is not authorized to make purchases that that fall into the “CapitalPurchase” Policy.

No Purchases shall be made on behalf of the Organization for any purpose other than operations andtraining without a vote of a quorum of The Board of Directors.

152



Section: Financial Subject: Budgeting


Page 1 of

The Director along with the Treasurer of the Board of Directors shall prepare annual budget to beapproved by the Board of Directors. The Director will be responsible for ensuring that the budget isbeing adhered to. The Director and the Treasurer of the Board of Directors will prepare statementsfor the monthly Board of Directors meeting.

As part of the Budgeting process, monies shall be allocated for the Director to authorize training formembers to maintain their certifications. This includes CPR, ACLS, PALS, PHTLS, etc. This does notinclude attendance to conferences or travel expenses to attend these classes, only the cost of theclass and supplies needed for the class.

153



Section: Financial Subject: Credit Cards


Page 1 of 1

Gouverneur Vol. Rescue Squad Inc., shall maintain two credit cards for point of service purchases. Thefirst card shall be carried and the responsibility of the Director of Operations. The second credit cardshall be either in possession of the President of the Board of Directors or in a locked safe in thePresident of the Board of Directors office. This credit card should only be used for needed supplies inthe absence of the Director. If the card is in a safe, it shall be signed in and signed out as needed, alltransactions shall be closely monitored and scrutinized.

154



Section: Financial Subject: Taxes


Page 1 of 1

The Treasurer of the Board of Directors and the Director of Operations will ensure that the financialrecords of the Gouverneur Vol. Rescue Squad, Inc., are delivered to the accountant by the secondMonday of the month of March. The Treasurer and the Director shall report to the Board of Directorswhen the financial records are dropped off at the accountant’s office and will also report when theaccountant has completed the taxes and the taxes have been filed with the Internal Revenue Service.

155



Section: Financial Subject: Accountant


Page 1 of 1

Gouverneur Vol. Rescue Squad, Inc., will utilize the services of a reputable Accounting Firm withexperiences or “specialization” in non-profit accounting

The Director and the Board of Directors will work with the Accounting Firm to maintain a highstandard of fiscal accountability and responsibility.

156



Section: Financial Subject: Financial Misconduct


Page 1 of 1

Any suspected or alleged Financial Misconduct by any member of the Gouverneur Vol. Rescue Squad,Inc., shall be reported to the Director or the highest-ranking officer on the Board of Directors who isnot named in the allegation. The following steps shall immediately be taken:

1. The “accused” member(s) will be denied access to ANY office or documents of theorganization.

2. All data on the security camera system will be downloaded onto two (2) separate CD’s. TheCD’s shall be kept in the possession of two (2) board officers or members off site.

3. The Accounting Firm will be contacted, requesting an audit of the financial records andadvising the accountant of the situation.

4. The Board of Directors shall carry out any recommendation of the accountant. This includesbut is not limited to prosecuting any criminal activity.

All members of the Board of Directors and the Director of Operations are responsible for the financialaspects of the organization. By not reporting suspected financial misconduct members of the Board ofDirectors and the Director of the Gouverneur Vol. Rescue Squad, Inc., may be held criminally or civillyliable.

157



Section: Financial Subject: Capital Purchase


Page 1 of 1

Gouverneur Vol. Rescue Squad, Inc., considers any operation purchase greater than $2,000 a capitalpurchase. It also considers any non-operational purchase greater than $250 a capital expense.

For this policy purchase is considered the procurement of an object(s) that replaces or adds to currentassets of the Gouverneur Vol. Rescue Squad, Inc.

The Board of Directors or the Director will use the Capital Purchase policy at any time there isquestion as to the approved amounts.

Prior to authorization of a capital purchase the board must:

1. Task the Capital Purchase Committee to research and obtain a minimum of 3 quotes. TheCapital Purchase Committee will then make a recommendation on the “best value to meetthe need of the organization”. The committee should involve the input from the memberswho would be using the product. I.e. medical equipment should involve appropriate medicalpersonnel.

2. The Capital Purchase Committee shall determine if the purchase is appropriate based on thecurrent budget situation. This includes statements from the lenders on monthly payments,interest rates, and down payment fund availability.

3. In “non-emergency” purchases Gouverneur Vol. Rescue Squad, Inc., will produce a minimumof thirty five percent (35%) down payment.

4. The Capital Purchase Committee will then present to the Membership of Gouverneur Vol.Rescue Squad, Inc., along with the Board of Directors. A two-thirds majority of the generalmembership must vote in favour for the purchase to carry.

158



Section: Financial Subject: Training Conferences, etc.


Page 1 of 1

Gouverneur Vol. Rescue Squad, Inc., unless otherwise stated will consider any request of a non-careermember to attend a conference for purposes of education that may benefit the organization. TheBoard of Directors and the membership shall produce guidelines for the requirements of themembership to attend conferences.

The Gouverneur Vol. Rescue Squad, Inc., will not typically compensate career members forconferences, unless otherwise negotiated. If the organization requires a specific class as part ofcontinued employment the organization will compensate travel expenses. In the event that thetraining or knowledge would benefit the organization the board may consider covering all or a portionof the expenses. The Board of Directors and/or the Director may approve payroll deduction.

159



Section: Financial Subject: Insurance of Checks


Page 1 of 1

Gouverneur Vol. Rescue Squad, Inc., will issue checks, only with documentation as to why the check isbeing issued. This includes, but is not limited to invoices for approved purchases or services, receiptsfor reimbursement for approved purchases or compensation for travel expenses.

The Director will receive invoices and receipts and write the checks on computer software which isrecommended by the accountant. Once the check is written the Treasurer of the Board of Directorswill review all written checks, then contact two (2) members of the Board of Directors to sign thechecks.

Any questions or inconsistency of the invoice, the treasurer and/or the Director will contact thecreditor and question the invoice.

160



Section: Financial Subject: Accounting Software


Page 1 of 1

Gouverneur Vol. Rescue Squad, Inc., will purchase and maintain accounting software based on therecommendation of the accountant. All accounting data on the computer will be routinely backed-upboth off-site through automatic back up and through the accountant’s website. The organization willmaintain an agreement with a computer repair company to provide maintenance and support for thecomputers.

The Director and the Treasurer of the Board of Directors will be the only persons authorized to accessthe accounting program. Any attempt to manipulate the data, crash the computer or the program orremove data will be considered financial misconduct. Anyone who does malicious damage to theaccounting computer will be responsible for any and all costs associated with restoring the data. Theywill also be prosecuted to the fullest extent of the law.

161



Section: Financial Subject: Service Fees


Page 1 of 1

The Board of Directors along with the Director will on a routine basis evaluate all service contractswith the Gouverneur Vol. Rescue Squad, Inc. In the event that a comparable service can be obtainedfor a lesser cost to the organization, the Board and the Director shall evaluate the cost/benefit ofcontracting with the cheaper company.

162



Section: Financial Subject: Bank Reconciliation


Page 1 of 1

Once the bank statement is received and opened, the Director and/or the Treasurer of theGouverneur Vol. Rescue Squad, Inc., will reconcile the banks statement. Under normal operatingconditions this will be done within seven (7) days of receipt of the bank statement.

163



Section: Financial Subject: Planning, Accounts and Investments


Page 1 of 1

Gouverneur Vol. Rescue Squad, Inc., may elect to maintain several bank accounts and investments.The Organization will attempt to maintain an account for emergency operations.

This account should contain enough monies for the organization to operate for one calendarmonth in an austerity budget situation.

The organization should also attempt to maintain an account for capital purchases.

This account should have monies placed in it with the intent of use as a down payment forcapital purchases.

When monies are available, the Gouverneur Vol. Rescue Squad, Inc., will consider financialinvestments in secure interest yielding accounts, such as Money Markets and/or CD’s.

164



Section: Financial Subject: Conflict of Interest


Page 1 of 1

No member of the Gouverneur Vol. Rescue Squad, Inc., Board of Directors shall at any time have afinancial stake in any decision made. This includes but is not limited to any decision that could benefitany corporation, business or asset of the Board Member, family member, significant other, orsomeone living with, the Board member.

165



Section: Financial Subject: Petty Cash


Page 1 of 1

Gouverneur Vol. Rescue Squad, Inc., does not typically keep petty cash on hand. In the event thatcash is needed two authorized persons will obtain the cash from the bank used by the organization.Both will sign the receipt, and all uses of the money must be accounted for with “official receipts”.Any money not accounted for will be the responsibility of the persons who signed for the cash.

166



Section: Financial Subject: Whistle Blower


Page 1 of 2

Gouverneur Rescue requires directors, officers and employees to observe high standards of businessand personal ethics in the conduct of their duties and responsibilities. As employees andrepresentatives of the Gouverneur Rescue we must practice honesty and integrity in fulfilling ourresponsibilities and comply with all applicable laws and regulations.

Reporting Responsibility

This Whistleblower Policy is intended to encourage and enable employees and others to raise seriousconcerns internally so that Gouverneur Rescue can address and correct inappropriate conduct andactions. It is the responsibility of all board members, officers, employees and volunteers to reportconcerns about violations of Gouverneur Rescue’s code of ethics or suspected violations of law orregulations that govern Gouverneur Rescue’s operations.

No Retaliation

It is contrary to the values of Gouverneur Rescue for anyone to retaliate against any board member,officer, employee or volunteer who in good faith reports an ethics violation, or a suspected violationof law, such as a complaint of discrimination, or suspected fraud, or suspected violation of anyregulation governing the operations of Gouverneur Rescue. An employee who retaliates againstsomeone who has reported a violation in good faith is subject to discipline up to and includingtermination of employment.

Reporting Procedure

Gouverneur Rescue has an open door policy and suggests that employees share their questions,concerns, suggestions or complaints with their supervisor. If you are not comfortable speaking withyour supervisor or you are not satisfied with your supervisor’s response, you are encouraged to speakwith the Director. Supervisors and managers are required to report complaints or concerns aboutsuspected ethical and legal violations in writing to the Gouverneur Rescue’s Director, who has theresponsibility to investigate all reported complaints. Employees with concerns or complaints may alsosubmit their concerns in writing directly to their supervisor, the organization’s Compliance Officer orthe President of Board of Directors.

Compliance Officer

The Gouverneur Rescue’s Director is responsible for ensuring that all complaints about unethical or

167

illegal conduct are investigated and resolved. The Compliance Officer will advise the Board ofDirectors of all complaints and their resolution and will report at least annually to the Treasure oncompliance activity relating to accounting or alleged financial improprieties.

Accounting and Auditing Matters

The Gouverneur Rescue s Director shall immediately notify the Audit Committee/Finance Committeeof any concerns or complaint regarding corporate accounting practices, internal controls or auditingand work with the committee until the matter is resolved.

Copyright ©2010 National Council of Nonprofits

This information is for educational and informational purposes only and should not be consideredlegal or other professional advice for specific matters. Prior to adopting this sample document fortheir own use, nonprofits should seek the advice of their own professional advisors.

Acting in Good Faith

Anyone filing a written complaint concerning a violation or suspected violation must be acting in goodfaith and have reasonable grounds for believing the information disclosed indicates a violation. Anyallegations that prove not to be substantiated and which prove to have been made maliciously orknowingly to be false will be viewed as a serious disciplinary offense.

Confidentiality

Violations or suspected violations may be submitted on a confidential basis by the complainant.Reports of violations or suspected violations will be kept confidential to the extent possible,consistent with the need to conduct an adequate investigation.

Handling of Reported Violations

The Gouverneur Rescue’s Director will notify the person who submitted a complaint and acknowledgereceipt of the reported violation or suspected violation. All reports will be promptly investigated andappropriate corrective action will be taken if warranted by the investigation.

Compliance Officer: * {Note: The Compliance Officer may be a board member, the ExecutiveDirector, or a third party designated by the organization to receive, investigate and respond tocomplaints.}

standard operating guidelines of the gouverneur vol

Documents