AmbulanceOperationalManual 110811 Final

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AMBULANCE SERVICES,MINISTRY PUBLIC HEALTH, SOCIAL DEVELOPMENT & LABOUR,

GOVERNMENT OF SINT MAARTEN

November 1st2010Compiled by: drs.Cylred Richardson, Head Ambulance Services

Ambulance Operations Manual

Standard Operating Procedures


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Ambulance Operations Manual

Table of Contents

1.PREFACE .................................................................................................................. 42.INTRODUCTION ....................................................................................................... 53.THEORGANIZATION/CHAIN OF COMMAND..................................................................... 6

3.1MISSION&VISION: ................................................................................................. 73.2THEOBJECTIVES ................................................................................................... 73.3PERSONNEL MANAGEMENT PHILOSOPHY......................................................................... 73.4PERSONNEL ORIENTATION.......................................................................................... 8

4.BASICWORKPOLICIES ............................................................................................... 94.0BASIC PRINCIPLES: .................................................................................................... 9

4.1HOUSE RULES........................................................................................................ 104.2VEHICLE USE.......................................................................................................... 114.3NONSMOKINGPOLICY: ...................................................................................... 124.4RECORDING OF WORKING HOURS: ............................................................................... 124.5PERSONAL BUSINESS: ................................................................................................ 124.6ENGAGING IN OTHER ACTIVITIES: ................................................................................. 134.7TARDINESS ......................................................................................................... 134.8ABSENTEEISM &SICK LEAVE: ....................................................................................... 134.9FUNCTIONING &JOB EVALUATION............................................................................... 134.10 DISCIPLINARYPROCEDURES .............................................................................. 14

5.AMBULANCEVEHICLEOPERATIONPOLICY: ................................................................ 155.0PURPOSE ............................................................................................................ 155.1SPEEDRESTRICTIONS ........................................................................................... 155.2USEOFWARNINGSIGNALS ................................................................................... 155.3EMERGENCYANDNON-EMERGENCYRESPONSEGUIDELINES ................................... 155.4THETWOSECONDRULE ...................................................................................... 165.5INTERSECTIONS .................................................................................................. 165.6EXCESSIVESPEED ................................................................................................. 165.7SIRENCIDE .......................................................................................................... 165.8IRRATIONALBEHAVIOR ....................................................................................... 165.9LIABILITY ............................................................................................................ 16

5.10POLICIESWHILEONDUTY .................................................................................. 176.DUTIES&RESPONSIBILITIES ........................................................................................ 18

6.0UNIFORMS AND APPEARANCE..................................................................................... 186.1REPORTINGFORDUTYANDSCHEDULING ............................................................. 186.2WORKSCHEDULES .............................................................................................. 196.3DAILYASSIGNMENTS ............................................................................................ 196.4AMBULANCECHECKLIST ..................................................................................... 19


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6.5AMBULANCETRIP(SHEETS)FORMS(PRE-HOSPITAL CARE REPORTS) ................................. 206.6AMBULANCE DISPATCH PROCEDURES............................................................................ 206.7RADIO COMMUNICATIONS......................................................................................... 22

7.GENERALPOLICIES&RESPONSIBILITIES ....................................................................... 247.0PROPERUSEOFEQUIPMENT ................................................................................. 24

7.1MAINTENANCEOFVEHICLES ................................................................................ 247.2TRANSPORTATION OFDECEASEDPERSON ............................................................. 247.3DEADONARRIVAL(D.O.A)POLICIES ..................................................................... 247.4ALCOHOL AND OTHER DRUG USE BY AMBULANCE CREW...................................................... 257.5USE OF CELLULAR WHILE OPERATING AMBULANCE DEPARTMENTS VEHICLES............................ 257.6MAINTENANCE OF PATIENT CARE EQUIPMENT................................................................. 257.7USE OF MEDICATION ON THE AMBULANCE...................................................................... 26

ISTAKEHOLDERS ......................................................................................................... 26IIOBJECTIVE ............................................................................................................... 26IIIPHASE1 ................................................................................................................... 26VMANAGEMENTOFMEDICATIONSUPPLY...................................................................... 27VISTORAGE ................................................................................................................ 27

7.8VEHICLE ACCIDENT PROCEDURES................................................................................ 287.9INJURY ON DUTY-CREW............................................................................................ 287.10RELEASE OF INFORMATION AND NOTIFICATIONS............................................................. 29

8.SPECIALCIRCUMSTANCES .......................................................................................... 308.0TREATMENT/TRANSPORT OF MINORS........................................................................... 308.1EMOTIONALLY DISTURBED PATIENTS............................................................................ 308.2PATIENT OR LOCATION NOT FOUND/UNABLE TO GAIN ENTRY............................................ 308.3CRIME SCENE OPERATIONS........................................................................................ 318.4MASS CASUALTY INCIDENTS (MCI) ............................................................................... 31

8.5FIRE/HAZARDOUS MATERIALS (HAZMAT)CALLS............................................................ 32ATTACHMENT 1:PROCESS DESCRIPTIONS PATIENT BILLING.......................................................... 33

INTRODUCTION............................................................................................................... 35

PROCESS #3.1AMBULANCE ASSISTANCE............................................................................... 36

RELEVANT MANAGEMENT INFORMATION.......................................................................... 36

FORMS AND SYSTEMS................................................................................................. 36

PROCESS #3.2REGISTRATION OF AMBULANCE ASSISTANCE......................................................... 44


FORMS AND SYSTEMS................................................................................................. 44

PROCESS #3.3CASH CONTROL.......................................................................................... 48


ATTENTION POINTS &RECOMMENDATIONS.............................................................................. 54ATTACHMENT 2:DISASTER MANAGEMENT ESF-6 ...................................................................... 56

RESPONSIBILITIES &FUNCTIONS....................................................................................... 61FUNCTIONS OF THE SUPPORT AGENCIES.............................................................................. 62

SLS,LABORATORY.......................................................................................................... 62FUNCTIONS OF ESF6.......................................................................................................... 63


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2.ESF6S TASKS&ACTIONS ........................................................................................ 64MITIGATION:ACTIONS OF ACTIVITIES WHICH REDUCE OR ELIMINATE HAZARDS............................... 65

ATTACHMENT 3:ALARM DIAGRAM CODE BLUE,YELLOW &RED................................................... 67ATTACHMENT 4:WORK INSTRUCTIONS &ALARM DIAGRAM CODE BLUE.......................................... 68ATTACHMENT 5:WORK INSTRUCTIONS &ALARM DIAGRAM CODE YELLOW...................................... 80

ATTACHMENT 6:WORK INSTRUCTIONS &ALARM DIAGRAM CODE RED......................................... 100ATTACHMENT 7:INWERKPLANAMBULANCE-VERPLEEGKUNDIGE ..................................... 118

INLEIDING: .............................................................................................................. 119OPBOUW INWERKSCHEMA: ........................................................................................... 120KENNISMAKINGS-/INTRODUCTIEDAG. ............................................................................. 121EVALUATIE VAN DE EERSTE DAG: .................................................................................... 122WEEK 1 .................................................................................................................. 122WEEK 2. ................................................................................................................. 123WEEK 3. ................................................................................................................. 124WEEK 4 .................................................................................................................. 125EVALUATIEGESPREK MET NIEUWE MEDEWERKER WEEK 1. ...................................................... 126EVALUATIE GESPREK MET NIEUWE MEDEWERKER WEEK 2. ...................................................... 127EVALUATIEGESPREK MET NIEUWE MEDEWERKER WEEK 3. ...................................................... 128EVALUATIEGESPREK MET NIEUWE MEDEWERKER WEEK 4: ...................................................... 129EVALUATIEOVERZICHT VAN NIEUWE MEDEWERKER WEEK 1T/M 4. .......................................... 130CHECKLIST T.B.V.HET INWERKPROGRAMMA VAN NIEUWE MEDEWERKER: ................................... 132ALGEMENE KENNIS EN KENNIS VAN DE INVENTARIS VAN DE AMBULANCE...................................... 132DAGEVALUATIE INWERKPLAN NIEUWE MEDEWERKER: .......................................................... 143VR EERSTE OPKOMST VAN NIEUWE MEDEWERKER TE REGELEN. ............................................ 144UITREIKEN DIVERSE ARTIKELEN OP DE EERSTE WERKDAG VAN NIEUWE MEDEWERKER (VPK.) ............. 145

ATTACHMENT 8:INWERKPLANAMBULANCECHAUFFEURS................................................ 146

OPLEIDINGSAANDACHTSPUNTEN AMBULANCECHAUFFEURS: ..................................... 148GEBRUIKVANHETVOERTUIG ................................................................................. 150GEDRAGOPDEWEG: ............................................................................................. 151RIJDENMETBLAUWZWAAI/KNIPPERLICHTEN2OF 3TONIGEHOORN: ....................... 153AANKOMSTPOST: .................................................................................................. 154EINDEDIENST: ....................................................................................................... 154BLOK-INDELINGINWERKPLANAMBULANCECHAUFFEUR ........................................... 155PHTLS ................................................................................................................... 166CHECKLISTINWERKPLAN ....................................................................................... 169DAGVERSLAG INWERKEN.............................................................................................. 172PERIODIEKEVALUATIEFORMULIER INWERKEN ......................................................... 173

EVALUATIEFORMULIER EINDEINWERKPERIODE(NA DE 6EBLOK!)............................. 174EVALUATIEFORMULIER ZELFSTANDIGFUNCTIONEREN .............................................. 176UITREIKEN DIVERSE ARTIKELEN OP EERSTE WERKDAG VAN (CH.) .............................................. 179


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1. PREFACE

This manual is a compilation of Standard Operating Procedures (SOPs) and guidelines as a result of research based inthe field of Emergency Medical Services.

Despite the many challenges over the last year of rewriting and editing in an effort to finalize this manual, it could nothave been realized without the valuable input of management support and specifically the many suggestions receivedfrom staff members of the Ambulance Service.

In addition to other resources available to staff members, the goal of this manual will serve as a resource tool forquestions and answers that the ambulance nurses and assistants may be faced with.


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2. INTRODUCTION

The purpose of this Policies and Procedures Manual is to familiarize each staff member working at the AmbulanceDepartment with his or her responsibilities and duties, so that all staff may be better able to perform a job vital to thecommunity of St. Maarten in which we all live. This document is the Standard Operating Procedures (SOPs) oftheAmbulance Service of Ministry Public Health, Social Development & Labour. It is not presented as a Book of Law,but rather as a Book of Reference with guidelines for everyone to follow and adhere to.

Management realizes that rules or agreements can be forgotten over time, interpreted differently and that in thecourse of time new guidelines or work policies needs to be developed and decided upon by management of theAmbulance Services, Ministry of Public Health, Social Development & Labour or the government of St. Maarten.The majority of these SOPs that were introduced in 2007 has been revised.

Where possible, the logic behind each policy/procedure or guideline will be explained, in order to make clear to the

Ambulance personnel the intent and reasons for implementation.

As an employee of the Ambulance Service of the Government of St. Maarten you have a variety of responsibilities andobligations; these responsibilities and obligations are laid down in several regulations and policies related to the legalposition of civil servants in general.

In this manual the focus will be on standard operating procedures for the Ambulance Service. For any further details,which are not explained in these chapters, you are advised to read your LMA and other laws regulating personnelmatters such as the Employee-Handbook and Introduction Package with the various laws and policies given to everydepartment by the Personnel Department.

These standard operating procedures or guidelines will assist in maintaining a harmonious relationship between all

personnel and the community. The medical protocols of the Netherlands will be adhered too as was taught during theSOSA certified training for ambulance nurses and ambulance drivers/assistants.


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3. THE ORGANIZATION/Chain of Command

The Ambulance Department up until June of 2010 is one of four departments of Sector Public Health that has anexecuting task of providing ambulance services to the community of St. Maarten, 24 hours a day 7 days a week. In

transition to County St. Maarten that will go into effect on October 10

th

2010, the name will be changed to DienstAmbulancehulpverlening (Ambulance Services) and will form part of the Ministry of Sector Public Health, SocialDevelopment and Labour.

The department has an FTE of 24.2 that consist of a department head, operational leader, administrative assistant,certified ambulance nurses, certified ambulance assistants/drivers, a part time medical advisor and dispatchers. Theoperational team consisting of an ambulance nurse and an ambulance assistant works 8-hour shifts aboard theambulance. This includes day, evening and night shifts. The ambulance nurses also functions as shift leaders andtherefore are ultimately responsible for the shift in the execution of their daily tasks whether this is at the ambulanceh e a d q u a r t e r s o r a b o a r d t h e a m b u l a n c e .

The operational leader (manager) forms part of the first line contact with all operational staff members such as the

ambulance nurses, ambulance drivers/assistants and the ambulance dispatchers. The operational leader reportsdirectly to the department head with regards to operational matters of the department. The operational leader isresponsible for the execution of operational matters within the department and the head of the Ambulance Services isultimately responsible for the overall management. The head reports directly to the Secretary General of the MinistryPublic Health, Social Development & Labour and the Secretary General will report to the Minister of Public Health,Social Development & Labour.

3.0 Organizational Structure:


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3.1 MISSION VISION:

Mission

To provide effective, timely and quality emergency medical services at Accidents, Sickness and Injury transport atlarge scale accidents and disasters.

Vision

Provide optimal, efficient and professional pre-hospital care for the general public and visitors of St. Maarten.

3.2 THE OBJECTIVES

The objectives of the Ambulance Service is to guarantee ambulance services 24 hours a day; to guarantee the carryingout of necessary and permitted paramedical and ambulance nursing care that facilitates transportation required due tosickness or accident; to promote realization and maintenance of sufficient qualitative and quantitative facilities for

ambulance services.

The Ambulance Services deals primarily with the general public, visitors and calamities. Although everyone is familiarwith ambulances, very few people are familiar with the details of ambulance care. Ambulances were associated withtransport; they were seen as a means of transporting patients to hospital as quickly as possible. These days, very highquality care is provided at the scene.

Ambulance care is high-quality care provided by professionals receiving life-long training. In this way, the quality towhich every patient is entitled too is assured. This is the specific objective of every ambulance organization and everyambulance dispatch center.

3.3 Personnel Management Philosophy

The Ambulance Services is managed by certain guidelines, policies and procedures to ensure that all personnelconduct themselves in the best interest of patients, peers, and Ministry Public Health, Social Development & Labour.

Our strength depends directly on the contributions made by each of our staff members. Optimal service andefficiency result from individual participation and satisfaction.

Personnel will find an organizational arena that is open, frank and honest in regards to personnel management. Towork together successfully, each staff member must realize that good working relationships are not only a matter ofrules, but are the result of daily decisions, mutual understanding, friendly attitudes, and team spirit.


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3.4 Personnel orientation

Introduction and Orientation:

The introduction and orientation is not limited only to the role of the ambulance and transport service, role of the

new staff member in the organization, and reinforcement of commitment required by the new staff member to besuccessful but also to get an understanding of the organization of the ministry of Ministry Public Health, SocialDevelopment and Labour in general.

New staff:

Orientation for new personnel is provided at a series of orientation sessions planned within the first weeks afteremployment. These sessions are mandatory.

Orientation to ride-outs:

Prior to orientation to ride-outs, Basic Life Support (BLS) Assist Class will be provided if necessary to providetraining on the different equipment used on the ambulances. Teach the proper usage and set-up of specializedequipment if needed.

Following the successful attendance and completion of requirements of the orientation sessions, the new staffmember is permitted to begin orientation on board the ambulance.


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4. BASIC WORK POLICIES

4.0 Basic Principles:

The regulation is based on 7 principles.

1. Everyone is paid to work a minimum of 8 hours. It is now mandatory to register everyones attendance forthe purpose of dealing with absence without leave and to generate data for future policy development.

2.

Department heads are ultimately responsible for registration and for providing correct data.

3. It is imperative for the success of any policy that it is executed, as much as possible, in the same way in everydepartment.

4. Hours of absence without leave will be deducted from ones salary and can lead to disciplinary measures.Therefore it is imperative to register all forms of absence both with and without permission for leave.

5. Where possible some flexibility in the working-hours can be observed as long as a normal working dayremains 8 hours.

6. Lunch break, in principle, is 1 hour and should be taken between 12.00 and 14.00 hrs. Some flexibility ispossible, if the service permits. In both the moment and duration as long as point 5 is being honored. Thelunch break is a minimum of 30 minutes, or is assumed to have been, even if the worker doesnt leave his or

her desk.

7.

It is up to the secretary general, together with the head, to determine whether a department or a section of adepartment or service can have flexible working-hours or not. Arguments not to have flexible working-hours can be of a functional nature. For instance to be able to guarantee the public opening hours, shiftwork, or the special responsibilities of certain public servants. A practical inability to register the workinghours can also be an argument (for instance if workers do their work out in the field).


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4.1 House Rules

1. The ambulance crew room or lounge is open to any staff member or invited visitors during business hours

only.

2. Volunteer staff members are permitted to have visitors between 10:00 am 12:00 noon and/or between14:00 pm16:00 pm. Duty student/trainee employee staff should not have visitors in the workplace.

3. Staff members are not permitted to be in or around the Ambulance Headquarters after consumption ofalcohol or drugs.

4. All departmental equipment and supplies remain at Headquarters for departmental use only and unlessotherwise approved by management.

5. The dispatch area and supervisors offices are off limits except for authorized personnel and use of thesupervisors office is limited to Supervisory staff only.

6. The Ambulance Services related work takes priority in the supervisors office and personal use of thesupervisors office/computer is authorizedonly after Ambulance Services related work has been completed.

7. All other staff and non-supervisory staff members are to use the computers in other designated areas.

8.

Any dishes used in the kitchen are to be washed, dried and put away prior to the ending of each shift and alltrash and cans/bottles must be placed in trash bin.

9. Any supplies, equipment, or personal items used during the shift are to be cleaned thoroughly and/or putaway prior to the end of the scheduled shift.

10. A special effort by management will be made to provide coffee or tea as a courtesy of the ambulanceservices. If coffee/tea or additional kitchen supplies are needed, please inform a supervisor.

11.

Cable TV will be provided as a courtesy and as a means of recreation for the personnel of the AmbulanceServices.

12.

Video games are allowed at night, but should not disrupt operations in any way.


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13. Ambulance Crew jackets are to be hung up when not in use, and personal belongings should be kept lockedin lockers assigned to each staff member or in the bunkrooms during the day. Book bags and coats should bekept neatly hung and NEVER in offices or the ambulance crew (lounge) recreational room.

14. A Telephone is provided as a courtesy; however this is not an answering service. It is expected that all calls

will be brief, so as not to tie up phone lines.

15. All mechanical problems encountered with the ambulances or equipment is to be reported directly to theoperational leader.

4.2 Vehicle use

It is the policy of the Government and in particular for the Ambulance Services of the Ministry of Public Health,Social Development & Labour that vehicle are used only for officially authorized business. In recognizing the need tomeet the standards of this policy, and provide for optimal response to medical emergencies/routine transportationwhile meeting administrative needs, please note:

1. Vehicles will be used first and foremost for the service for which they are intended; Ambulances will bedispatched first to emergencies and non-emergency requests for transportation before all other uses.

2. The ambulances and on-duty response vehicles will not leave without the assigned crew/driver on board,and only for official authorized business.

3. The ambulance crew may use the ambulance for the completion of personal details relating to the job but arealways to be available for calls. It is the responsibility of the shift leader to ensure that the ambulance is in thecompound area and available for emergency & non emergency calls.

4. Use of other vehicles is permissible during the evening and on weekends only for authorized business. Theuse of this vehicle will be logged on the computer automated dispatch (CAD) as appropriate (such as detail),with the person using the vehicle and the reason for use included in the comments section.

5. Dispatch will be notified each time a vehicle leaves the ambulance headquarters and when drivers return to

headquarters. This alerts the dispatcher to the location of the driver at all times.6. The ambulances are to remain in the parking area of headquarters at all times unless on runs as dispatched,

approved details when assigned to supervisor and when the vehicle is out of service for repair. Personalerrands and details are never appropriate.

7.

The keys to all vehicles are kept in the key box. Keys should never leave the building with anyone who is noton-duty.

8.

It is the ambulance driver/assistants responsibility to make sure that all keys are accounted for at thebeginning and the end of his/her shift.

9. Any unit/ambulance that is out of service for maintenance orother problem should be marked on thebulletin board as Out of Service (OOS). Vehicles that are taken in and out of service by the supervisorypersonnel should not be on the road. If there are questions, contact should be made with the supervisor whomarked the unit OOS.

10.

Ambulances are intentionally rotated to spread out vehicle use. The supervisor determines this rotation,and all crews need to follow the information posted on the shift board to determine which unit is first due,second due etc.

11. If you have any question about the appropriateness of using one of the vehicles, contact must be made withthe on-duty supervisor before using the vehicle.


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4.3 NON

SMOKING POLICY:

1. All decisions regarding smoking policy of the federal government reflects adherence to the AmbulanceDepartment smoking policy.

2. In accordance with legislation (P.B. 1996, nr.55), smoking is prohibited inside all government buildings, atthe Ambulance Department and also in the ambulance and response vehicles. We ask each staff member tocontribute to a smoke free and healthy environment.

3. Smoking is only allowed outside of the ambulance building.

4.

Use designated smoking areas if applicable at SMMC if needed after the completion of calls.

4.4 Recording of working hours:

The new working-hours regulation for the entire government civil service went in effect on August 1st2007.

The most important elements of the new regulation are the obligation to register attendance as well as absenteeism ina uniform way throughout the organization of government and the introduction of flexible working hours wherepossible. Registering will generate accurate data for future policy development.

The regulation also provides management with the necessary tools to effectively deal with absence without leavewhen it occurs. Taking appropriate corrective measures is now largely regulated. Similar to the sick-leave policy thedepartment head has a key role in the enforcement of the regulation. The disciplinary measure of giving an officialreprimand is mandated to the sector directors/secretary generals.

Absenteeism and the so called No Show have been deemed major organizational problems by boththe governmentand management. In the past years several instruments have been put into place to deal with the problem such as thesick-leave policy. The No Show committee came to the conclusion that often both management and workers werepart of the problem of long-term absenteeism. Fixing this problem required implementation of several policies. Nextto a new sick-leave policy and procedures for transfers a working-hours regulation will be put in place as a finalinstrument.

4.5 Personal Business:

During working hours, you are not to engage in any business not directly related to our service. This includes the useof telephones, supplies, or equipment, without specific approval of management. We expect you to use yourprofessional discretion in conducting personal business during office hours. If personal telephone calls are necessaryduring working hours, they should be kept as short as possible.


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4.6 Engaging in other activities:

As a Civil Servant you need specific approval from the government to engage in other activities, such as:

Starting a business Working a second job Working as a freelancer

When a conflict of interest is expected, you need to request permission before you start any of these activities. Notadhering to this policy can have consequences.

4.7 TARDINESS

Arriving ten (10) minutes or more after the shift change is tardy and will be dealt with seriously as per services policy.

4.8 Absenteeism Sick Leave:

The successful operation of the Ambulance Services to the community depends on Civil Servants commitment andproductivity. Any circumstance, which causes you to be absent from work must be reported to operational manageror head immediately and no later than three hoursbefore start of duty. Only extreme circumstances can justifyexception to the rule.

In order to establish justifiable absenteeism and to insure you are being paid during sick leave, the service requires a

doctors statement regarding your disability to work in the case you have been sick for three days or longer. Thisstatement should be produced on the fourth day of absenteeism at the latest.

Failure to follow these rules can have repercussions. Illicit absenteeism from work is grounds for deduction of salaryor dismissal. If the head sees ground for deduction of salaries due to absenteeism, the individual staff member will beinformed. This subject, together with frequent tardiness is considered a very important behavioural trait in theorganization. Therefore, it can be listed as a subject in your yearly job evaluation.

4.9 Functioning Job Evaluation

At least once a year every employee will have an evaluation meeting. This should be regarded as an opportunity for an

active dialogue between you and the organization. Your Section Head and Department head are responsible for this.They will prepare this meeting, by inviting you and providing you with a standard Evaluation form.

Based on the conversation a written evaluation of your performance together with a statement of goals for the next12months is prepared. The final Evaluation report will be submitted to the Department Head and can have severalconsequences.


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In cases of excellent performance, one can be recommended for a promotion, graficatie. In case of insufficientperformance, certain goals will be set for your performance within a certain period. In such cases the evaluationperiod will be much shorter than 12 months, and can vary from one week to 6 months.

Possibilities for training, further education or study assignments are also part of the discussion and decision makingduring these evaluation meetings.

4.10 DISCIPLINARY PROCEDURES

Violations of Standard Operational Procedures:

In the event that an apparent violation of operational procedures occurs, a process will be followed to enable anorderly review of the circumstances surrounding the situation.

Except in serious cases of violation requiring immediate action, the following procedures will be followed:

A. First offense: The person will be informed of the situation and that the occasion is his/her first verbalwarning.

B. Second offense: A written warning letter will be given and Personnel Affairs will also be informed of thesituation.

C. Third offense: The person will be suspended, with or without payment, until the government (Council ofMinisters) take a decision on the matter.

Staff with a history of tardiness, unexcused or excessive absenteeism, or other forms of unacceptable behaviourshould be written up and counselled with proper documentation to maintain the standards of the ambulance services,and to keep the person informed of the need for corrective action on his/her part.

In addition to the guidelines for conduct and performance stated previously, the department maintains otherreasonable (LMA) standards such as, but not limited to, those that prohibit staff from fighting, refusing to perform areasonable assignment, being under the influence of alcohol or drugs, engaging in disorderly conduct which threatensthe safety of others, tampering with or falsifying departmental documentation, and actions which jeopardize theimage of the Ministry of Public Health, Social Development & Labour and the Ambulance Services in particular.

A violation of any of the above listed or the LMA identified actions will result in immediate suspension of privilegesand referral to the Council of Ministers for further action.


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5. AMBULANCE VEHICLE OPERATION POLICY:

5.0 PURPOSE

The appearance and operation of all ambulances must reflect to the community that these vehicles are operated in acareful manner, a manner that instils confidence to the patient and ensures the safety of life and property.

5.1 SPEED RESTRICTIONS

There is no need for excessive speed. The purpose of using the red or blue lights and the siren is to keep theambulance moving at a constant, safe speed and not to allow the ambulance to exceed the posted speed limits in any

area.

5.2 USE OF WARNING SIGNALS

An ambulance operator shall not display warning lights and/or sirens except when:

a.

Responding to an emergency callb. Engaged in lifesaving servicesc. Transporting emergency patients who are classified as emergent by the ambulance nurse (paramedic ) on

the ambulance trip report form to a medical facility.

It is acceptable to drive with the headlights on when operating an ambulance or response vehicle when responding toa medical emergency. This increases the general publics awareness of the emergency vehicle.

5.3 EMERGENCY AND NON-EMERGENCY RESPONSE GUIDELINES

Sufficient information should be obtained from the dispatcher prior to responding to give the ambulancedriver/assistant a good idea of where the incident occurred. The dispatcher should give clear, definitive directions tothe driver as to the exact incident location, utilizing the area mapping system.

The ambulance nurse shall operate the communication system en route to the accident, leaving the driver free todrive with as little distraction as possible. While responding to the scene the nurse should also watch for approachingtraffic from the right at all intersections and advise the driver. The driver must ensure, at all times that traffic is clearfrom all directions before proceeding.

Good judgment should be used by the driver at all times. An ambulance is heavier than a passenger car and will take agreater distance to stop. It is also top-heavy and will react differently when rounding curves or cornering.


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The posted speed limit may be exceeded when responding to an emergency incident with emergency lights and siren,only if weather, traffic and road conditions permit the increased speed. An exception will be any school zone with aposted speed limit, which will be obeyed.

5.4 THE TWO SECOND RULE

Always maintain a safe distance between the ambulance and the vehicles in front of it. Use the two second rule togauge this distance.

5.5 INTERSECTIONS

Most serious ambulance and other emergency vehicle accidents happen in an intersection. Remember, using the lightsand siren is merely asking for the right of way. It is essential that the driver approaches all intersections with caution.It is important to realize that many people, while driving, may be day dreaming or talking, with the air conditioningon and the radio or stereo blaring; emergency vehicles are the last thing they are expecting.

5.6 EXCESSIVE SPEED

The majority of documented emergency vehicle accidents occur because the vehicles are travelling too fast. Theambulance driver/assistant must drive defensively and have the vehicle under control at all times. Never let thevehicle or your emotions control you. Ambulances are heavy and take much longer to stop than ordinary vehicles. Anambulance will be also corner differently than a passenger type vehicle. It is much safer to maintain a constant speed,in which traffic is clearing a pathway, than to continually speed up and slow down. The result will be to outrun theeffect of the siren and emergency lights. This is also extremely hard on the vehicle and gives the crew and patient avery uncomfortable and dangerous ride.

5.7 SIRENCIDE

Be aware of this phenomenon. Due to the noise of the siren, the ambulance driver/assistant may be lulled into a false

sense of security, believing that everyone hears the siren and sees the lights, and therefore will yield the right of wayfor the ambulance. At the same time there will be a tendency to increase the speed of the ambulance.

5.8 IRRATIONAL BEHAVIOR

Watch for the unexpected. The sight of flashing lights and the sound of a siren tends to cause people to panic. Attimes they may speed up, slow down, pull to the left, stop short in front of the ambulance, etc.

The ambulance driver/assistant must remain calm and alert. The safety and well being of many people rests with thejudgment and the reactions of the ambulance driver/assistant.

5.9 LIABILITY

1.1.

Whenever an ambulance is damaged through the negligence or misconduct of an ambulanceassistant/operator or through the negligence or misconduct of any other official or employee of thedepartment, all cost incurred in the removal and repair, or in the case of total loss will be for the person(s)account.


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1.2. While the driver of an emergency vehicle giving audible signals should be given the right-of-way, thisprovision does not operate to relieve the ambulance operator from the duty to drive with reasonable care forthe safety of all persons using the public streets, nor shall it protect such driver of any emergency vehiclefrom the consequence of an arbitrary exercise of such right-of- away.

1.3.

The basis for determining responsibility for the negligence or misconduct which caused or precipitated thedamage to the vehicle shall be the findings of the Service Investigation Team (SIT). The Department ofSupport Services shall affix responsibility in accordance with its established procedures and orders.

5.10 POLICIES WHILE ON DUTY

MEALS AND BREAKS

There are no formal meals and break periods for operational staff scheduled during shift time. The emergency natureof the job necessitates a flexible approach to taking breaks and obtaining meals when not engaged in an emergency runor training.

Meals and breaks shall be taken when possible and shall not in any way ever conflict with the systems immediateresponse capability.

Crews are welcome to work on homework, obtain meals or watch television. Ambulance crews are only welcome tonap during night shifts.

TELEPHONES

Telephone calls are to be limited. If personal telephone calls are necessary during working hours, they should be keptas short as possible.


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6.DUTIES RESPONSIBILITIES

6.0 Uniforms and Appearance

One should place the patient at ease by presenting a reassuring appearance. The ambulance personnel should wearclothing that is neat and clean, providing a hygienic as well as professional appearance. Uniforms are to be worn by allon-duty shifts or as approved by the department head.

UNIFORM AND GROOMING REQUIREMENTS ARE AS FOLLOWS:

1.1 The new uniforms are to be worn in its entirety during regular shifts while on duty.1.2 Jeans are not acceptable in combination with regular uniform while on duty for regular shifts1.3 The uniform code for the piketdienst is exceptional however a combination should be made for easy

identification of an ambulance staff member.1.4

Excessive jewelry is discouraged due to the inherent problems associated with small children and convulsivepatients. Wedding bands are acceptable.

1.5 Excessive hair is discouraged.Men:Above the collar, medium afros are acceptable. Beards and sideburns must be well trimmed.

Women:Hairstyles are to be neat and clean with little adornment and should be pinned if necessary not to interferewhile carryout work. Needs to ensure that long hair does not become a safety hazard (entanglement or assault) andthat finger nails are kept short.

1.6 Shoes should be black. Steel toes are highly recommended for ambulance teams aboard the ambulance.Clogs, sandals and athletic shoes are not acceptable.

1.7

Name tags shall be worn over the left breast pocket.1.8

All ambulance nurses and assistants are required to carry their own watch with second hand, as well as a penlightand stethoscope.

6.1 REPORTING FOR DUTY AND SCHEDULING

It is most necessary that ambulance nurses/ ambulance assistants and dispatchers coming on shift are on time so theymay orient themselves to the conditions with which they must work. A minimum of 15 minutes prior to changing ofshifts is required and is acceptable.

Shifts hour are from 07:00 AM to 15:00 PM, 15:00 PM to 23:00 PM and 23:00 PM to 07:00 AM. Once theambulance nurses, assistants and dispatchers have reported for duty, he/she may not leave the department withoutfirst notifying the operational leader or ambulance nurse in charge.

The Ambulance teams is not allowed to take a nap (sleep) during the various shifts except for night shifts howevermust at all time be ready to respond immediately to any emergency call.

Regular and administrative staff working hours ranges from 08:00 AM17:00PM.


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Note: No staff member may leave their duty station without appropriate coverage as approved by the operationalmanager or department head.

6.2 WORK SCHEDULES

a.

Work schedules are prepared at least two (2) weeks in advance by the operational leader (manager) andposted on the bulletin board. Every schedule covers a period of one month. It is your own responsibility tocheck your working schedule for the coming weeks. When you are not present at a specific time, you shouldcall in prior to your absence or delay.

b. Any and all requests for schedule changes should be presented in writing at least two (2) weeks in advance ofthe time the schedule is to be prepared. Emergency requests may be honored at the discretion of the

operational leader (manager) after consultation with the head of the service.

c. Only the operational leader and/or the head are authorized to make schedule changes. Any such changesmust be initialled.

d. All scheduled operational staff is to remain on duty until relieved by the on-coming shift. Ambulance nurses,assistants and dispatchers are considered relieved only after they report to the on-coming shift on amongstother things the condition of vehicle (s) and inventory and any other pertinent information and aftercompletion of all reports for his or her shift.

6.3 DAILY ASSIGNMENTS

The operational leader (manager) will indicate on the weekly time sheet which ambulance nurse is in charge of eachshift. The ambulance nurse in charge will prepare daily assignments for each shift. Any medical technician refusing

to accept his or her assignment shall be disciplined in accordance with the Ambulance Services policy.

6.4 AMBULANCE CHECK LIST

The Ambulance check lists have been designed with patient care, safety and legal back-up in mind. Each list should becompleted by the on-coming ambulance crew at the change of shift, so the off-going and on-coming crew may discussany discrepancies.

The ambulance driver/assistant, at the completion of a run, is responsible for replacement/replenishment of supplies

and cleaning of the ambulance patient compartment. Any missing equipment should be indicated on the check listsand reported to the ambulance nurse/shift leader.

The Ambulance Nurse/shift leader will review and submit completed ambulance check lists to the operational leaderfor review and filling.

Periodic checks of the ambulance may be made by the operational leader or Head.


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6.5 AMBULANCE TRIP (SHEETS) FORMS (Pre-hospital care reports)

The ambulance nurse must complete an Ambulance Trip Form in its entirety each time an ambulance call isanswered. This form become part of the patients permanent record, and is an important legal document; therefore,it is important that they are filled out thoroughly and clearly. They must be completed where possible when handingover of patient to ER and prior to the end of each shift.

There are three (3) copies of the Ambulance Trip Form. The top copy (white) is to be handed over to dispatch fordata entry, reviewed by the operational leader and filed at administration of Ambulance Services. The middle copy(yellow) is to be attached to the patients record at the (ER) hospital. The pink copy is to be given to the patient ifrequested.

Once the ambulance fee is collected, a copy of the receipt should be attached to the trip form of the patient.Note: Make sure all copies are legible.

The ambulance nurse shall make sure that all procedures/materials they provide to patients are noted on the

Ambulance Trip Form. This shall include:- Times Ambulance Calls and Transports- EKGs- Obstetrical assistance outside of hospital- CPR- Intravenous Infusion- Oxygen Therapy- Splinting- Slings- Adaptive Devices e.g. collars- Dressings-

Medications

6.6 Ambulance Dispatch Procedures

All calls must be assumed to be emergent and should be answered with lights and siren unless reliable medicalevaluation from the scene indicates otherwise. Upon receiving a call for an ambulance, it is essential to record thefollowing information and dispatch an ambulance immediately.

A. Maintain contact with the caller until all relevant information is collected.B.

Essential telephone information:a.

Callers phone numberb. Callers namec. Exact location of incidentd. Directions to incident and prominent landmarkse. Nature of incident


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It is important that the following times be accurately recorded:

a.

Time call is receivedb. Dispatch time (time ambulance responds to the incident)c. Arrival time (time the ambulance arrives at the incident)d. Departure time (time ambulance departs incident location)

e.

Hospital arrival time (time the ambulance arrives at the hospital or appropriate destination)

Answer all calls on the emergency line promptly:

a. Try to answer within three (3) ringsb. Expect each call to be an emergency until proved otherwisec.

Answer emergency lines first; administrative lines laterd. Identify yourself and departmente. Record all information

TELEPHONE PROCEDURES

1. All incoming calls must be answered promptly. When multiple phone lines are ringing, callers can be askedto stay on hold once it has been determined that they do not have an emergency.

2. All incoming requests for ambulance and/or medical transport must be entered in the CAD immediatelyeven if only partial information is available (the dispatcher can always return and enter information morecompletely after units have been dispatched).

3.

All ambulance phone lines (912) and (5422111/5206262) are to be answered, Ambulance Services MedicalDispatch this is (your name). All calls should be handled in a professional, friendly and helpful manner.

4. Non business phone lines (5429291, 5429292) are to be answered, Ambulance Service this is (your name).

TAKING AND RECEIVING MESSAGES1. Business calls should be directed to the appropriate person; if that person is not available, a message

including day/date/time, name of caller, and call back number should be taken.2.

Personal calls received in dispatch (calls for personnel) should be referred to the crew room phone.The dispatcher is under no obligation to take personal messages (this is not an answering service); be certainthat if the caller is calling on a business related matter that a message is left.

3. If appropriate, business messages should be left in individual mailboxes.4. Personal home telephone numbers and cellular phone numbers are never to be given out. Offer to take a

message, or forward the caller to the number of the person they would like to speak with. This includes notgiving out numbers of supervisory staff.

RADIO PROCEDURES

1. Always use a clear, calm voice. There is no place for sarcasm, opinion, or rebuttal over the air.2. Keep all messages brief and to the point.3. NEVER use someones name over the air (ambulance team or patient). If necessary, use initials or

ambulance team medic number only.4. After you end a radio conversation, state the military time 10-4.5.

Dispatch is always to make the last transmission.


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STATUS CHECKS

1.

If the ambulance has been on the scene for more than 15 minutes, and the dispatcher has had nocommunication with them, the dispatcher should request a status check as follows: Control to Unit 1 or 2,with a status check A status update can be requested by the dispatcher sooner than 15 minutes, if thedispatcher deems it appropriate.

2.

The ambulance unit in question should respond with either: Unit 1 or 2 Status OK, through continue StatusChecks in situations where there is a question as to the safety of the ambulance crew. With this response,dispatch will continue status checks each 10 minutes until crew clears the scene (or) Unit 1 or 2 All Set,discontinue Status Checks in situations where the ambulance crew is comfortable with their safe ty and doesnot request additional checks.

3.

If no response to a status check is received, contact the Police and ask them to contact their unit on scene.

VEHICLE STATUS

It will be the responsibility of all Ambulance Dispatcher (AMD) to be aware of the vehicle and crew status of all on-duty personnel.

Enroute AssignmentThe responding ambulance team will notify the AMD over the air that Unit #.....is enroute to ........(location) code....... The AMD will respond with the time.

Arrival on sceneUpon arrival at the scene, the responding ambulance team will notify that Unit.....is on the scene. The AMD willrespond with the time.

Departure from the sceneUpon departure from the scene, the responding ambulance team will notify that Unit .....is enroute/available TheAMD will respond with the time.

Arrival at the hospitalUpon arrival at the hospital, the responding ambulance team will notify that Unit.....is at ER, SMMC. The AMDwill respond with the time.

6.7 Radio Communications

The conduct of all persons using an EMS radio must be professional at all times, both on dispatch, police coordinationand medical channels. All messages must be as brief as possible. There should be no inappropriate, profane or

personal remarks at any time.The following order of steps is recommended for the ambulance crew to use when notifying the hospital of patientinformation:

1. Patients age and sex2. Chief ComplaintThe reason why the patient called for help3. Present Illness


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An elaboration of the chief complaint (e.g.What was the pain like, Where does it radiate? How long has itbeen present? Has patient ever had symptoms like these before? Are there any other related symptoms? Etc)

4.

Past Medical HistoryOther significant illnesses or injuries, medications or allergies

5.

Physical Examinationa.

General Appearance- Comfortable or in distress- Level of consciousness

b.

Vital Signs- Pulse- Respirations- Blood pressure- Temperature

To enhance radio communication, the ambulance crew should keep in mind the following points:

1.

Use common language only. Use medical terms whenever possible.2.

Be aware of the rate of speech with which you speak.do not speak too fast or too slowly.3. Emphasize important terms, but do not overemphasize by stressing everything.4. Do not speak too loudly or too softly. Speak decisively, deliberately and in a calm manner.5. Avoid angry comments at all costs. Do not editorialize.

Do not allow your voice to trail off at the end of words and sentences


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7. GENERAL POLICIES RESPONSIBILITIES

7.0 PROPER USE OF EQUIPMENT

7.1 MAINTENANCE OF VEHICLES

Vehicle Maintenance is essential to the provision of appropriate EMS care in any environment. All operational staffshould routinely do up-keep and preventative maintenance of both the interior and exterior of all vehicles.

Driver check sheets are to be completed by the driver, or driver progression at the beginning of each shift. Vehiclesare to be washed, both interior and exterior, and fuelled daily and as otherwise necessary. Any deficiencies should bedocumented on the driver check sheet, and an equipment failure report completed. The fleet coordinator and on-duty Operational Leader/supervisor needs to be notified as well. The vehicle also needs to be tagged out of service aswell. The vehicle service entity needs to be notified in the appropriate time frame.

Additionally, all vehicles in service at the ambulance department are subject to annual inspections and routinepreventative maintenance.

If vehicles are tagged out of service by the facilities supervisor, they can only be returned to service after the specificproblem is rectified.

7.2 TRANSPORTATION OF DECEASED PERSON

Upon receipt of a call for a deceased person, an ambulance will be dispatched to a possible cardiac arrest.

Notification of the Police Department should be made by dispatch to request their response. The Ambulance crewupon arrival at the scene will evaluate the condition of the patient.

A patient who is found to have rigor mortis, decapitation and or perhaps dependent lividity may not receiveresuscitative measures. This patient will be left at the scene under the jurisdiction of the Police Department. The

Police Department will notify the Medical Examiner for pronouncement and removal of the body. The AmbulanceService will not engage in transporting of any deceased person.

7.3 DEAD ON ARRIVAL (D.O.A) POLICIES

D.O.A. cases are classified legally as exclusively under the jurisdiction of the Medical Examiner or designee. In orderto process these cases legally and efficiently, these guidelines must be followed:

a. Immediately notify the Police Department. The Police Department will then determine if the Medical Examinershould be called.

b. Record the name, age, date, time, condition of the body and known circumstances of death.

c. If the patient is not declared a D.O.A. or death has not been pronounced at the scene of the call, all resuscitativemeasures shall be taken in accordance with the protocol. If death is pronounced on the scene, all actions of theambulance crew prior to the declaration of death shall be recorded on the PCR. The Medical Examiner shall benotified as soon as possible through the Ambulance Dispatcher. Law enforcement officers shall be requested torespond if not already on the scene.


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d. If the patient is deemed irretrievable and foul play is suspected or in question, every effort should be made not todisturb the crime scene and law enforcement should secure the scene upon their arrival. EMS personnel shall

remain on scene until released by a law enforcement supervisor or by the Medical Examiner.

7.4 Alcohol and other drug use by ambulance crew

Any crewmember accused of responding to, transporting or treating a patient while under the influence of drugs oralcohol may be:

temporarily suspended from the job

subjected to testing for alcohol or other drugs if the allegation involves operation of an ambulancedepartment vehicle.

referred to police department for investigation

The Ministry of Public Health, Social Development & Labour, specifically the Ambulance Services, takes a strong

stance on the use of alcohol or drugs in the workplace.

It is expected that staff report when assigned or scheduled, in a condition ready to work. Compounding factors suchas the previous nights activities, or even the use of some prescription medications can cause a staff member to beunfit for work/duty. It is the responsibility of the staff member to be in a condition ready for duty when scheduled.Drinking or use of judgment impairing medications (prescription or recreational) is not permitted within 10 hoursbefore a scheduled shift.

Also, on-duty personnel are not allowed to enter establishments that serve alcohol, unless for brief meal pick-ups.Remember that at all times the Ambulance Services uniform is very visible to the general public, and positiveexamples are to be set without exception. This includes any capacity when personnel are on duty for service.

7.5 Use of cellular while operating Ambulance Departments Vehicles

It is prohibited by law to use a cellular phone without an appropriate hands-free device when driving.

Cellular phone use is to be limited when driving vehicles in non-emergency medical transport modes, and must havea hands-free device to be used as well. Cellular phones are not to be used for any reason by anyone driving a vehiclein an emergency response mode. Minimize the use of the cellular phone while you are in the Dispatch Center. If youhave to use your cellular phone while you are on duty try to make it as short as possible.

7.6 Maintenance of Patient Care Equipment

The proper operation of all patient care equipment is essential to the provision of EMS care as a whole. It is of theutmost importance that all equipment be maintained appropriately.

All on-duty Ambulance personnel are to complete ambulance check-lists at the beginning of their shifts. Anyequipment that isnt in proper working order must be taken out of service immediately and replaced with spare

equipment from the storage room. An equipment failure report must also be completed and handed over to theoperational leader/supervisor or placed in mailbox.


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Additionally, all durable medical equipment is subject to preventative maintenance, which is done by an externalentity. All repairs of equipment are done by that entity as well. Irreparable items will be replaced as needed.

7.7 Use of medication on the Ambulance

I STAKEHOLDERS

The stakeholders in this protocol are:

1. The Government of St. Maarten, represented by Ministry of Public Health, Social Development & Labour2. The St. Maarten Medical Center Foundation

II OBJECTIVE

To administer medication aboard the ambulance by the ambulance nurses according to fixed protocols under the finalsupervision by the emergency room physicians of the SMMC.

The emergency room physician will also conduct case management and carry out workshops with the ambulanceteams in order to improve pre-hospital care on St. Maarten.

III PHASE 1

Only medications mentioned in the intervention protocols of SOSA-trained ambulance nurses will be placed on theambulance. For the first three months only the cardiac-arrest protocol will be applied and therefore in that period,the available medications are:

Atropine Epinephrine

These medications will be administered according to the SOSA protocol manual to patients who are in cardiac arrestwithout prior consultation with the emergency room physician.

The ambulance nurse mustcontact the emergency room physician for approval when attending to a patient who isnotin cardiac arrest but with life threatening arrhythmias. The ambulance nurse must submit at all times a copy ofthe run form (rittenformulier) to the emergency room physician for review after administering above listed

medication. Thereafter, the administering of other necessary medication will be considered.


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IV PHASE 2

After the three months period, it will be decided to expand the medication on the ambulance according to the skillsof the ambulance-staff. To improve the skills the nurses will receive at least an additional 400 hours per year ofcontinuous education including additional classes by the staff of the ambulance department at the emergency roomand the intensive care unit of SMMC. (For specifications see appendix Clinical Program)

V MANAGEMENT OF MEDICATION SUPPLY

The Head of the Ambulance Department will be responsible for the selection and purchase of the medication, onceauthorized by an appointed doctor. The medication will be purchased from the pharmacist of SMMC, who willmonitor the storage and distribution of the medication by the Ambulance Department.

VI STORAGE

The medicine will be stored in medicine storage cases in the advance life support kits on the ambulances. Theambulance nurses will be responsible for daily inspections of the medicines for expiration dates and replacementmaking use of a log book.

VII COMMUNICATION

The Ambulance Nurse will contact the Emergency Room Physician by use of the radio communication system or thecellular telephone of the Ambulance Department, in the event of necessary medical supervision prior toadministering of medication.

VIII CONTROL MECHANISM

Inventory and periodical control of the medications will be done by the operational leader at the Ambulance Serviceand a report will be forwarded to the Head of the Department.

Once medicines are used the ambulance nurse in charge of his or her shift need to document and sign off on themedicine box form and also have to guarantee that the ER doctor who authorizes afterwards the use of the medicineand sign off in the run form (rittenformulier).

The Government of St. Maarten will replenish the medicines that are used.

Version 2007, Revised 2010.


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7.8 Vehicle Accident Procedures

This procedure is used in the event an ambulance, transport, or support/response vehicle is involved in any type ofaccident (with another vehicle, with fixed property, etc):

1.

Immediately notify dispatch.2. In all cases STOP and return to the scene of the accident. In cases involving personal injury, or damage to

another vehicle, dispatch will send another vehicle to cover any call that you may be responding to, and/orwill send another ambulance to transport a patient on board.

3. Determine if anyone is injured. Request ambulance(s) as needed. Initiate BLS for injured persons.4.

Dispatch will notify the police to respond to the scene and take a report.5.

Obtain the names, addresses and telephone numbers of all involved parties and witnesses.6. Do not make any statement concerning the assumption of liability. Give out only the information that is

requested and required by the Police Traffic Department.7. The On-duty Supervisor/OL will be notified immediately of any accident, regardless of the severity.8. The OL will notify the EMS head immediately of any accident involving personal injury to any involved

parties.9. Within (12) hours following the accident, the driver (as able) should fill out an Occurrence Report detailing

the circumstances surrounding the accident.

10.

Within (24) hours of the accident, the OL and EMS head will review the reports and forward these to NCWathey Insurances.

11. The Driver involved will refrain from driving immediately following an accident until a supervisorypersonnel review the situation.

The Secretary General of Ministry VSA (Public Health, Social Development & Labour) will be informed if anambulance driver/assistant fails to report any accident or if he or she has a record showing a high accident frequency,or shows an abnormally high accident cost. This will be accompanied by a statement that such failures or poorperformance record is considered to be sufficient justification for the Service to suspend the right of the ambulanceassistant to operate an ambulance.

7.9 Injury on duty-crew

This procedure is used in the event of an injury or death to on-duty staff:

1.

Immediately notify the on-duty supervisor (shift leader).2.

Any injuries will be treated according to protocol3. Dispatch should be notified as soon as is practical.4. The on-duty supervisor, operational leader (manager), EMS head, Secretary General of VSA and other

appropriate department heads will be notified of any incident involving personal injury or death.5. The injured person should be transported to SMMC as appropriate, for evacuation and initiation of

documentation.

6.

Within 12 hours following the incident, the staff involved (as able) should fill out an Occurrence Reportdetailing the circumstances surrounding the incident.

7. Within 24 hours of the incident, the operational manager and EMS head will review the reports and forwardto the Secretary General of VSA.

8. The staff person injured will refrain from handling calls immediately following an on the-job injury until thesupervisory personnel review the situation.

On-the-job injuries and or death are covered under BZV medical insurance. As a result, it is important that all stepsabove be completed as outlined to ensure timely medical care, and the filling of appropriate documentation.


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7.10 Release of Information and Notif ications

This procedure defines the procedures for the release of information to outside agencies, as related to operationaland/or patient information, in meeting the needs of the administrative functions of the Ambulance Services while

maintaining patient confidentiality.Under no circumstances shall ambulance personnel divulge any information to newspapers, radio, or televisionpersonnel. Any request for information should be referred to the EMS head.

1. All releases of information will be made through the EMS head. Release of any and all protected healthinformation will be executed in accordance with the policies and procedures of Sector Public Health, SocialDevelopment & Labour.

2. The ONLY exception is when other law enforcement agencies are involved that can be advised of patientinformation such as name and address. This can be done from ambulance nurse to law enforcement officer,or over the direct line to dispatch police service (DPS) dispatcher, including the general condition of thepatient.

3. All other releases of information (such as to the press, any legal service or risk management) should be

directed to the EMS head.4. At no time should originals or copies of any documentation (run logs, cards, PCRs, etc.) be distributed to

anyone other than authorized ambulance service personnel.5.

Any extraordinary situations should be documented on an occurrence report for follow-up.


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8.SPECIAL CIRCUMSTANCES

8.0 Treatment/Transport of Minors

A minor is defined as a person under the age of 18 years who is not emancipated or mature. Emancipated or matureminors may consent to treatment on their own behalf.If a parent or legal guardian is available to consent to treatment on the minors behalf, the minor and the parent maybe transported to the medical facility should the patients condition permit.If a patient or legal guardian refuses treatment and if the medical problem or injury is life threatening and any delay ofcare will jeopardize the life of the minor, the Ambulance Services may transport the patient without the consent ofthe parent or guardian if authorized by Medical Control. The circumstances shall be documented in the PCR, and acomplete report shall be filed immediately following the call. The Operational Manager should be contacted duringor after the call. The parent or guardian shall be notified of the destination decision.

If the parent or legal guardian refuses treatment and if the medical problem or injury is not life threatening, the

ambulance team shall make an appropriate effort to attempt to convince the parent or guardian to consent. The policyfor refusing medical assistance shall be followed.

If a parent or guardian is not available on a scene to provide consent for a minor, emergency medical care may berendered. The minor shall be transported to the appropriate receiving facility. The Police Department shall benotified of the destination decision. Ambulance crew shall not delay patient care or transport is a parent or guardian isunavailable.

8.1 Emotionally Disturbed Patients

The Ambulance Nurse or shift leader is responsible for determining scene safety. The Ambulance Nurse may chooseto stage the ambulance away from the scene until the police has secured the area.If an emotionally disturbed patient voluntarily requests transport to a psychiatric facility, the Ambulance Services maytransport without the police or patient restraint if the Ambulance Nurse deems it to be safe.If an emotionally disturbed patient refuses treatment or transport, a Mental Health officer and a police officer shouldbe dispatched. Medical control may be contacted to determine the patients ability to decline treatment.

If a patient displays violent tendencies or violence towards crew members, bystanders, or other personnel on scene,the ambulance crew shall retreat, if able, and stage until the scene is secured. Restraints may be deployed or used perprotocol under the following conditions:

The patient has indicated a high potential for violence The police and police doctor has taken charge

Use of restraints shall follow the applicable restraints protocols.

8.2 Patient or Location Not Found/Unable to Gain Entry

Upon arrival on a scene, it is the responsibility of the Ambulance Nurse/shift leader to attempt to locate the patient.If the patient/location is not immediately found, the Ambulance Nurse must contact AMD (Ambulance Dispatch) or


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Police Department to attempt to determine a better location. A search of the immediate area should be performed. Ifno further information can be discerned, a Patient Care Report (PCR) must be filled out, and any significant findingsmust be documented.If the ambulance crew is unable to gain entry to a scene, the Ambulance Nurse shall notify AMD and Police Dispatchand shall document the circumstances in the PCR.

8.3 Crime Scene Operations

A scene shall be considered a crime scene if evidence of a crime or suspected crime is found, including but not limitedto:

Homicide Suicide Rape MVA involving serious injury or death Assault Drugs

Upon the discovery of a crime scene, the police or law enforcement shall be contacted if not already present, andonly personnel necessary to the treatment of the patient shall enter the scene.

On a crime scene, EMS personnel shall work in close communication with law enforcement while performing up totheir standard of care. Care shall be taken to preserve evidence on the scene if possible while providing patient care.The scene and all actions taken by EMS shall be thoroughly documented in the PCR. Preservation of evidence shallnot take priority over patient care.

Once patient care has been completed, or if the scene is deemed unsafe, law enforcement personnel assumecommand of the scene.

8.4 Mass Casualty Incidents (MCI)

For the operational purposes of the Ambulance Services, a Mass Casualty Incidents shall be defined as scenepotentially requiring extraordinary resources. An Operational Leader/manager or Ambulance Services Chief maydeclare an MCI if additional resources are required that exceed the capacity of the Ambulance Services. This does notinclude single patient situations requiring an ALS provider.

Upon declaration of an MCI, the first Ambulance Services personnel on scene shall set up an Incident CommandSystem until the Operational Leader arrives on scene. The first arriving ambulance team/medic is responsible forinitial triage and the request of additional resources, including, but not limited to a command officer.

The Incident Commander/Operational Leader or designated Communication Officer may request the use of adedicated radio frequency through the AMD dispatcher. The Ambulance Services Channel will be used for internalradio communication and the Emergency Channel for the incident.

Upon arrival, the Ambulance Services Operational Leader (MCO) may take over the Incident Command and shallcontinue to maintain an Incident Command System until the incident has been managed.All aspects of incident management shall follow the opschalings guidelines and procedures.


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8.5 Fire/Hazardous Materials (HAZMAT) Calls

The ambulance will automatically be dispatched to all confirmed structural fires or any situations where injury orentrapment may occur. The Ambulance Services will also be dispatched to all hazardous material situations for whichthe Fire Department is dispatched.The Ambulance crew for a Fire or Hazmat stand by, shall remain on the scene, out of service, until released by theSenior Fire Officer in command.

Upon arrival at any major incident where Command has previously been established, the Ambulance Nurse/Medicmust report to the command post and advise the Senior Officers (Fire & or police agencies) of the location of theambulance in case EMS assistance is needed. The ambulance driver/assistant is responsible for staging of theambulance, keeping lanes clear for additional Fire Apparatus and allowing exit for all emergency vehicles. TheAmbulance Nurse shall contact AMD requesting additional ambulance teams to be on alert or to respond to thescene, as necessary, and AMD must make sure that the Operational Leader/MCO and AMBCHIEF has been notifiedof the incident.

The Fire Department will automatically be dispatched to all calls for Motor Vehicle Accidents with a confirmationthat people are trapped.


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MINISTRY OF PUBLIC HEALTH, SOCIAL DEVELOPMENT AND LABOR

Attachment 1: Process Descriptions Patient Billing


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Version 1, SOAB 2011

TABLE OF CONTENTS

INTRODUCTION .................................................................................................................................. 35

PROCESS #3.1AMBULANCE ASSISTANCE ............................................................................................ 36

PROCESS #3.2REGISTRATION OF AMBULANCE ASSISTANCE................................................................... 44

PROCESS #3.3CASH CONTROL.......................................................................................................... 48

ATTENTION POINTS &RECOMMENDATIONS............................................................................................ 54


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Introduction

Goal and tasks of the department

Goal and explanation of the handbook

Maintaining the handbook

Procedure for maintaining the handbook


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Process # 3.1 Ambulance Assistance

I.

Process Definition

Goal

To provide ambulance assistance, receive payments for the assistance and register the assistance accurately on the

ritformulieren.

Risks

The ritformulier is not filled-in accurately or completely.

The basic information needed to receive payment is not registered on the ritformulier.

All the ritformulieren are not submitted or not submitted in a timely manner (within 3 days).

All the collected payments are not submitted on the date of receipt.

Internal controls

a. Periodic controls of the completeness of the ritformulieren.

b.

A match between the Dispatchers Logbook entries and submitted ritformulieren in order to verify that all

ritformulieren have been submitted.

c.

A match between the Deposit Logbook, payment information on the ritformulieren, receipts and submitted

payments in order to verify the completeness of collected payments.

Responsibilities

The Diensthoofd Ambulance Hulpverleningand the Operationele Leider Ambulance Hulpverleningare

responsible for maintaining and updating this process description.

All Personnel of Dienst Ambulance Hulpverlening are required to understand and follow this process

description.

Functions Involved

Ambulance Verpleegkundige

Ambulance Chauffeur

Centralist

Relevant Management Information

Monthly overview of:

Number of calls for ambulance assistance received

Number of calls for ambulance assistance dispatched

Average time between call and arrival of the ambulance

Forms and systems

- Dispatcher logbook

- Ritformulier

- Receipt (credit/debit card)

- Deposit Logbook


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II.

Process Diagram

Function


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III.

Process Description

Nr. Department

- Function

Activity Description

1. Dienst AmbulanceHulpverlening

- Centralist

Receive call forambulance assistance

The Centralist receives the call forambulance assistance.

The Centralist notes the time of the

call, the address and a short description

of the mishap in the Dispatcher Logbook.

Subsequently the Ambulance

Verpleegkundige on call is notified.

N.B.

- The data in the logbook will be

entered into the CAVIS system in a

later stage, together with the data on

the ritformulier.

- A team consists of an Ambulance

Verpleegkundige and an Ambulance

Chauffeur (assistant

Verpleegkundige).

- A Centralist has a medical

background and if needed, will

provide medical support through thetelephone to the caller.

2. Dienst Ambulance

Hulpverlening

- Ambulance

Verpleegkundige

- Centralist

Report on ambulance

assistance

The Ambulance Verpleegkundige

accepts the call from the Centralist and

reports back to the Centralist about the

call for ambulance assistance once at the

location.

The urgency of the call and the time of

arrival are reported to the Centralist.

The Ambulance Verpleegkundige

determines the urgency of the call.

The Centralist registers the time of

arrival in the Dispatcher Logbook.


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Nr. Department

- Function

Activity Description

3. Dienst Ambulance

Hulpverlening

- Ambulance

Verpleegkundige

Provide treatment The Ambulance Verpleegkundige

provides treatment to the patient.

Subsequently the Ambulance

Verpleegkundige decides whether

transportation is required.

If the patient requires transportation,

the Ambulance Chaffeur and

Ambulance Verpleegkundige transport

the patient to the hospital. The

Ambulance Verpleegkundige fills in the

ritformulier en route to the hospital.

Once the patient has been handed over

to the hospital the Ambulance

Verpleegkundige proceeds to seek

payments (step 4).

If the patient does not require

transportation,the Ambulance

Verpleegkundige fills in the

ritformulier and proceeds to seek

payment (step 4).

N.B.

The ritformuliercontains the medical

information of the patient treated by the

Ambulance Verpleegkundige. It also

consists of the following personal

details:

- Full name;

- Date of birth;

-

Gender;

- Address;

- Telephone number;

-

Type of ID;

-

ID number;

- Country that issued ID;

- General practitioner.


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4. Dienst Ambulance

Hulpverlening

- Ambulance

Verpleegkundige

Request payment After the treatment and transport, if

required, the Ambulance

Verpleegkundige inquirers if the patient

will pay via local insurance or fulfill the

payment themselves.

If the patient is locally insured and can

present a valid proof of insurance (card

or letter), the Ambulance

Verpleegkundige notes the following

information on the ritformulier:

- Insurance company name;

- Policy number;

- Insurance expiration date.

The Ambulance Verpleegkundige then

proceeds with step 6.

If the patient will fulfill the payments

themselves or if the patient cannot

provide a valid proof of local insurance,

the Ambulance Verpleegkundiger

inquires if the patient is able to fulfill the

payment at present.

If the patient is able to fulfill the

payment, the Am

AmbulanceOperationalManual 110811 Final

Documents

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