EMS OGP 107-15 February 25, 2013 MEDICAL EVACUATION

EMS OGP 107-15 February 25, 2013

MEDICAL EVACUATION TRANSPORTATION UNIT

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1. PURPOSE

1.1 To set forth the policy and procedures for the readiness, staffing, response and operation of the Medical Evacuation Transportation Unit (METU) at special events, unusual assignments, medical facility evacuations and multiple casualty incidents (MCIs).

2. SCOPE

2.1 This procedure applies to all members of the Bureau of EMS and to Voluntary Hospital ambulance personnel who provide pre-hospital emergency medical care in the New York City 911 system.

3. DEFINITIONS

3.1 Medical Evacuation Transportation Unit (METU) A specially configured patient care vehicle which, when properly staffed, can provide transportation for up to twenty-four (24) non-ambulatory patients.

3.1.1 The METU can also be used to transport various combinations of seated and supine patients. When combination transport is required, up to four (4) seated patients can be substituted for three (3) supine patients, for up to thirty-two (32) seated patients.

3.1.2 The METU can be used to provide safe transport of up to ten (10) stable wheelchair chair bound patients involved in Mass Causality Incidents.

3.2 METU as a Bariatric Transport Unit – METU can also be utilized to facilitate the transportation of a bariatric patient. The METU is equipped with a specially modified bariatric stretcher as described in EMS OGP 107-15, Appendix B.

4. ACTIVATION

4.1 Standby- When assigned to standby status, the operator shall report to the METU and prepare it for immediate departure. The operator shall remain with the vehicle, monitoring the Citywide radio frequency for instructions.

4.2 Response- When assigned to respond, the METU shall proceed without delay to the incident scene or other designated location.

FDNY EMSC OGP 107-15 February 25, 2013 Medical Evacuation Transportation Unit

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5. FUNCTION

5.1 At the scene of an assignment, the METU will generally be assigned to the Transport Sector, where it will perform one or more of the following functions:

5.1.1 Transport of non-ambulatory patients requiring transport in the supine position.

5.1.2 Provide an area for the administration of care to patients with minor illnesses or injuries which require transportation to a medical facility.

5.1.3 Provide transportation of bariatric patient(s) requiring special devices and/or securing for safe transport.

5.1.4 Provide safe transport of up to ten (10) stable wheelchair bound patients involved in Mass Causality Incidents.

6. PROCEDURE

6.1 METU operators shall:

6.1.1 Check the assigned vehicle’s fuel and other essential operating components for defects and/or deficiencies. Correct defects and/or deficiencies if possible, and report defects, which cannot be corrected, to the Station Officer.

6.1.2 Perform a vehicle inspection and complete the METU Checklist at the beginning of each tour. Any deficiencies and/or problems that cannot be corrected shall be reported to the Station Officer.

6.1.3 Proceed to assignments as directed without delay.

A. Monitor the Citywide frequency for instructions.

B. Pay close attention to response routes, height restrictions and instructions for placement of the vehicle.

C. Respond to the Staging Area, unless otherwise directed.

6.1.4 Upon arrival, make contact with the Staging Area Manager or appropriate Transport Unit Leader and establish operations as directed.

6.1.5 Control access/egress of all persons entering/leaving the METU. Access to the METU should be limited to patients and essential personnel.

6.1.6 As necessary, assist personnel assigned to the METU, be responsible for the security and distribution of METU equipment, and prepare patient care and tracking documentation for all patients treated on the METU.

6.1.7 Maintain communications with the Transport Unit Leader using a portable radio on the assigned tactical frequency.

FDNY EMSC OGP 107-15 February 25, 2013 Medical Evacuation Transportation Unit

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6.1.8 When released from the scene secure operations and expeditiously return to the

station. Upon arrival at the station, clean, restock, and service the METU prior to securing the vehicle.

6.2 Members assigned to METU as patient care providers shall:

6.2.1 Report to the METU with all appropriate patient care and personal issued equipment.

6.2.2 Assist the METU operator in preparing the METU to receive patients.

6.2.3 Perform patient care in accordance with all applicable REMSCO and FDNY patient care protocols.

6.2.4 Assist Response Physicians in the delivery of emergency medical care as authorized by applicable REMSCO and FDNY patient care protocols.

6.2.5 Perform patient tracking, administrative, and other duties as needed.

6.2.6 Assist the METU operator with cleaning, equipment recovery, and restocking upon completion of operations.

6.3 The Medical Branch Director shall:

6.3.1 Specify if the response of the METU is required.

6.3.2 When the METU is responding, direct the Staging Area Manager and/or Transport Unit Leader to secure a suitable location for the METU in the Transport Sector.

6.3.3 Ensure adequate support is available in the Transport Sector to oversee and control METU operations.

7. APPENDICIES

7.1 OGP 107-15, Appendix A: Medical Evacuation Transportation Unit Illustrations

7.2 OGP 107-15, Appendix B: METU Transport of Bariatric Patients

7.3 OGP 107-15, Appendix C: Medical Evacuation Transportation Unit Checklist (EMS 107.15.01)

BY ORDER OF THE CHIEF OF EMS

EMS OGP 107-15, APPENDIX A February 25, 2013

MEDICAL EVACUATION TRANPORTATION UNIT

ILLUSTRATIONS

1. INTRODUCTION

1.1 The Medical Evacuation Transportation Unit (METU) is a specially configured patient care vehicle which, when properly staffed, can provide transportation for up to twenty-four (24) non-ambulatory patients or a combination of boarded patients and seated patients. When combination transport is required, up to four (4) seated patients can be substituted for three (3) supine patients, for up to thirty-two (32) seated patients.

1.2 There are three (3) METUs deployed as follows:

1.2.1 METU #3 at EMS Division 3, METU #4 at EMS Division 4, METU #5 at EMS Division 5

Figure 1

1.3 The interior of the METU has two (2) rows of stacked portable stretchers along each side of the vehicle, seating for four (4) patient care providers and storage of 30 D-tank oxygen cylinders and a storage case containing 30 oxygen regulators. (Figures 2 and 3).

Figure 2 Figure 3

FDNY EMS OGP 107-15, Appendix A February 25, 2013 METU Illustrations

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1.4 The METU is outfitted with five (5) Portable Suction devices on the forward wall on the

passenger side of the vehicle along with one (1) emergency handheld light. An additional emergency handheld light is located on the rear wall on the driver side of the vehicle (Figures 4 and 5).

1.5 The METU is equipped with an access ramp that shall be deployed for the safe and efficient loading and unloading of patients. The ramp is stored under the vehicle in the chassis frame behind the rear bumper.

1.5.1 The ramp consists of four (4) sections that are attached and assembled as noted. Ambulatory patients can use the front door or ramp to enter/exit the vehicle. This ramp shall be used when a patient needs to enter or be removed from the vehicle on a stretcher, wheelchair or stair chair (Figure 6-9).

Figure 4 Figure 5

Figure 6 Figure 7 Figure 8 Figure 9

Handheld Light


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1.6 The METU is outfitted with additional equipment to aid in the transport of bariatric patients. This

equipment includes:

1.6.1 Modified Stretcher with LBS Bariatric Board attached (Figures 10)

A. The ambulance stretcher on the METU is retrofitted with mounting posts to accommodate the Ferno LBS Bariatric Board and a tow strap (Figure 11)

B. LBS Bariatric Board and Mattress (Figure 12) and a MANTA Bariatric Transfer Sheet (Figure 13)

1.6.2 Vehicle On-board Winch System (Figures 14)

A. An electric winch (rated at 2,500 lbs) is available for use when loading/unloading bariatric patients into/out of the METU via the ramp at a controlled speed. It is controlled by a wireless remote that can be operated from inside or outside the vehicle (Figure 15). When using the winch to load/unload a patient, only the modified stretcher with tow strap shall be used.

Figure 14 Figure 15


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B. Winch wireless remote is turned on/off by depressing both the in and out button

simultaneously until the green indicator light goes on/off (Figure 15 above). The winch can then be operated to load/unload a patient on a stretcher.

C. The winch utilizes a 50 foot synthetic rope rated at 3,500 lbs with a fairlead hook,

which attaches to the ring as pictured above (Figure 16).

1.6.3 Wheelchair and Bariatric Stretcher securing devices

A. The floor of the vehicle has Sure-Lok tracks installed to allow for easy securing of wheelchairs and/or stretchers being used for bariatric patients using the quick connect/disconnect retractor system (Figure 17-18).

Figure 16

Figure 17 Figure 18


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B. Up to ten (10) wheelchairs can be secured down the center aisle or in-lieu of stretchers against the wall (Figure 19 - 20)

C. When using a stretcher for bariatric transport, the stretcher must be secured in the center aisle with side portable stretchers removed from adjacent stretcher bays. (Figure 21).

Figure 19 Figure 20

Figure 21


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1.7 On-board Generator

1.6.1 The vehicle is equipped with a 20Kw diesel generator which powers on-board systems and can provide 120 Volt AC power via the external outlet (Figure 22).


Figure 22

EMS OGP 107-15, APPENDIX B February 25, 2013

MEDICAL EVACUATION TRANSPORTATION UNIT TRANSPORT OF BARIATRIC PATIENTS

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1. PURPOSE

1.1 To set forth the policy and procedures for the response and operation of the Medical Evacuation Transportation Unit (METU) in the context of bariatric patients.

2. SCOPE

2.1 This procedure applies to all members of the Bureau of EMS and to Voluntary Hospital ambulance personnel who provide pre-hospital emergency medical care in the New York City 911 system.

3. DEFINITIONS

3.1 Bariatric Patient: Any patient requiring transport to the hospital whose physical attributes, not limited to weight, size, shape and/or mobility exceeds the capacity of an ambulance operating in the 911 system.

4. SCOPE OF USE

4.1 If a resource encounters a bariatric patient who exceeds the capacity for ambulance transportation they shall request an Officer to respond.

4.2 The Officer shall evaluate the condition and determine if there is a necessity for the METU. If required, the officer shall request the following:

METU

One (1) BLS ambulance

4.3 The Officer shall consider the need for additional resources.

5. PROCEDURE

5.1 At the scene of a bariatric transport the METU operator shall:

5.1.1 Position the METU as close to the assignment as possible without causing undue obstruction to surrounding roadways.

5.1.2 Deploy the ramp utilizing additional personnel at the scene.

FDNY EMS OGP 107-15, APPENDIX B February 25, 2013 Transport Of Bariatric Patients

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5.1.3 Control access/egress of all persons entering/leaving the METU. Only those

pertinent to patient care are to be admitted to the METU.

5.1.4 Maintain communications with the Officer on scene as needed in preparation for the arrival of the patient at the base of the ramp.

5.1.5 Load and transport the patient as directed.

5.1.6 When released secure operations and expeditiously return to the Station. Upon arrival at the Station, clean, restock, and service the METU prior to securing the vehicle.

6. RELATED DOCUMENTS

6.1 FDNY OGP 107-15, Medical Evacuation Transportation Unit

6.2 OGP 107-15, Appendix A: Medical Evacuation Transportation Unit Illustrations

6.2 OGP 107-15, Appendix C: Medical Evacuation Transportation Unit Checklist


EMS 107-15.01 Appendix C (02/13)

MEDICAL EVACUATION TRANSPORTATION UNIT CHECKLIST

Date Time Vehicle # Unit ID Tour

1 2 3

Division / Station Mileage Start

Vehicle Year Vehicle Registration Driver Name / Shield# Fuel (Gal) Mileage End

YES NO VEHICLE YES NO ADMINISTRATIVE SUPPLIES

Brakes Log Book

Lights, Directionals, Reverse, etc. Patient Tracking Forms (25)

Radio(s), on-board / MDT ePCRs (50) Emergency Devices Lights Siren/Horn ePCR Mobile Device (4) Doors / Weather-stripping Triage Tags (300)

Tires Wheel Chock (2)

Locks YES NO MISCELLANEOUS Engine Fluids: Fuel Disposable Gloves, 4 sizes, 1 box ea. Glass / Mirrors Red Bags, small (20) Seat Belts

Driver 4 Crew 16 Patient stations YES NO MEDICAL EQUIPMENT Clean and Sanitary Automatic External Defibrillator (1) DOH Expiration: _____________ Oxygen Regulators (30) in protective case DMV Expiration: _____________ D Cylinders (30) Heater / Air Conditioner (4) Non-Rebreather, Adult (50), Peds (25) Baseboard Heater (2) Nasal Cannula (50), Peds (25) Instrument Panel Portable Suction Unit (5) Exhaust System Rigid Suction Catheter (15) Rear Air Bag Dump System Suction Connecting Tubing (15) MVA Package Sterile Water (1 case) Backup Alarm

Backup Camera Left Right Rear YES NO PERSONAL EQUIPMENT Fire Extinguishers (2) Adult B/P Cuff Gas Card GPS E-Z Pass Pediatric B/P Cuff Hand Held Lights (2) Adult Stethoscope Reflective Safety Triangle (3) in case Pediatric Stethoscope Flares (1 Case) Adult Pocket Mask Orange Traffic Cones (5) Pediatric Pocket Mask 5 Borough Map (1) Helmet Fans (8) Technician Kit Adjustable Stretcher (22) Flashlight/Penlight Body Fluid Tray with Release Valve (8) PPE Ensemble Wheeled Stretcher with 3 Straps (2) Work Gloves Tow Straps Bariatric fittings Goggles Bariatric Patient Transfer Ensemble Sterile OB Kit LBS Board(2) Mattress(2) Manta Sheet(2) Glucose Patient Securment Device bag (5) Watch w/ Second Indicator SureLoc™ tie down device (8) per bag Bandage Shears Wheelchair Lap Belt (2) per bag Infant Swaddler Generator Oxygen Wrench Ramp Assembly System Portable 800 Radio #_______ Bumper Door Lock Section Latches Portable 400 Radio #_______ Ramp Sections (2) Hand Rail (2) Winch System Wireless Remote Tow Cable

DEFECTS / DEFICIENCIES CORRECTIVE ACTION TAKEN

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I have reviewed this checklist and taken the corrective action indicated herein.

________________________________________________ _________

In Service Time:_________ Out of Service Time:_________

Supervisor’s Signature Shield No.

Comments:

EMS OGP 107-15 February 25, 2013 MEDICAL EVACUATION

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