SOP 100

1. Defibrillators—Automatic External Defibrillators AED 500/AED 1000 and Manual Defibrillators LifePak 12/LifePak 15

2. Determine the following parts are present and in good condition: a. Two fully charged batteries installed in the monitor/defibrillator. b. One fully charged spare battery onboard the Rescue Unit to be used in those situations where a battery goes dead and the Rescue Unit is not in quarters. . c. Patient cable with twelve leads with no visible breaks in cable. d. SpO2 cable with finger sensor with no visible breaks. e. Blood pressure cuffs and extension tubing, all in good serviceable condition. f. At least two batteries in charger at the station. g. Inspect defibrillation cords and ensure good condition. h. Check for sufficient paper on EKG printout roll. Activate printout and inspect for proper function. 3. Turn power on b. Complete "User Test" (LifePak 12/15 Only). When finished, ensure printout indicates "User Test Complete". c. Complete Transmission Test d. Complete Test Load

EMS Administrative Captain (702)

2. Will serve as EMS Liaison with other Department divisions and other City Departments as directed. 4. Will respond to Mass Casualty Incidents and assist with EMS activities. 8. Will supervise light duty personnel assigned to EMS.

voluntary consent

- The paramedic should first attempt to obtain voluntary consent of the patient.

EMS Training Liaison (759)

1. Assist with coordinating Initial and Continuing EMS training of fire-rescue personnel to meet Dallas Fire-Rescue, Texas Department of State Health Services and National Registry requirements. 2. Liaison with EMS training schools.

Unlisted abbreviations that are acceptable to use are the following:

1. Hospitals, clinics or other medical facilities: When abbreviating facilities, use the first letter of each word of the proper title and ONLY abbreviate the facility if it is already written in entirety on the EPCR as the response location or destination. 2. Fire: When abbreviating a fire department response, "FD" MUST follow any letters used to abbreviate the city or municipality fire department. 3. Police: When abbreviating a police department or Police Officer response, "PD" MUST follow any letters used to abbreviate the city or municipality police department. 4. Sheriff: When abbreviating a sheriff department or Sheriff Officer response, "SO" MUST follow any letters used to abbreviate the city or municipality sheriff department.

EMS Quality Management Lieutenant (761)

1. Reviewing 100% of probationary Medic's run reports. 2. Reviewing 3% to 5% of previous day's run reports.

Multiple Alarm Fires

1. Two EMS Field Supervisor and Rescue Unit will be dispatched Code 3 on all second alarm fires. 2. An EMS Field Supervisor will report to the Command Post and establish an EMS Branch and be the EMS Branch Supervisor unless relieved by the EMS Staff Captain or higher ranking EMS officer. 3. The second arriving EMS Field Supervisor will establish Rehab. 4. All Rescue Units will report to the staging area 6. Rescues will exercise caution to avoid being blocked in by later arriving apparatus or deployment of large diameter hose. Paramedics should monitor the location of their Rescue Units frequently throughout the incident to insure that their ability to transport has not been compromised. 7. While operating at EMS emergencies, Rescue Units and EMS Field Supervisor will monitor and communicate on the primary EMS channel, unless otherwise directed. While operating at multiple alarm fires, Rescue Units and EMS Field Supervisor will monitor and communicate on the fire ground channel, unless otherwise directed.

Helicopter Safety

1. When the helicopter is landing and taking off, ground personnel should keep a 100' distance. 2. Never approach the helicopter until the pilot signals to do so. 3. Always approach the helicopter from the front, not the rear. NEVER APPROACH THE TAIL OF THE AIRCRAFT. The tail rotor moves so fast that it sometimes can't be seen. Always remain in view of the pilot, and walk, do not run. 4. Avoid wearing unsecured hats, ties, or jewelry around the helicopter. 5. If approaching the helicopter while the rotor blade is moving, bend at the waist. The blade can flex down to 5 feet, 7 inches. 6. Do not smoke within 100 feet of the helicopter due to hazards created by fuel and medical oxygen aboard the helicopter. 7. Safety considerations when flying in the helicopter include buckling seat belts and securing equipment in the helicopter.

Section Chief (701)

7. Respond to Mass Casualty Incidents and 3-alarm fires and assist the incident commander as directed. 9. Provide representation for DFRD at meetings to include but not limited to the following: a. UTSW Medical Directors Council / BioTel b. Other organizations as necessary

Landing Zone

A. A 100' x 100' site that is free of debris and/or other obstacles such as high power lines, trees, or buildings is required. B. At night, illuminate the area with flashing lights from Rescues or police cars. Flares should not be used, as they present a fire hazard. C. Do not shine spotlights up at the helicopter, as they blind the pilot. D. Shine spotlights on any nearby obstacle that might pose a problem for the pilot, such as a power line or pole.

Fire Company Response

A. A fire company will be dispatched on all of the following: 1. Major accidents a. One Rescue Unit and one engine will be dispatched on all major accidents. b. Major accidents occurring on known highway/freeway locations will have a truck company dispatched in addition to the Rescue and engine. Truck companies may also be requested by the company officer at any accident location, if needed. 2. Heart attacks 3. Unconscious persons 4. Shootings and stabbings 5. Other emergencies when significantly closer than the nearest Rescue Unit and/or the nature of the call indicates that it would be of value to the patient. 6. If the Rescue Unit arrives first and the fire company is not needed, the Rescue Unit may disregard them. B. When fire company personnel assist with transport, the fire company officer and Rescue Crew will coordinate the return of the member(s) to the station. Battalion Chief and Field Supervisor will assist in returning members to station if it would require the Rescue Unit to go a significant distance away from their district5.

Safety Guidelines

A. A minimum of 2 Operators is needed to manipulate the stretcher when there is a patient on it. C. ALL patient restraint straps must be utilized at all times

Communicable Disease Coordinator (775)

A. A registered nurse licensed to practice in the state of Texas who is experienced in pre-hospital care and familiar with the design and operation of the Department's EMS system will serve as the Department's Communicable Disease Coordinator. The Communicable Disease Coordinator is directly responsible to the Assistant Chief, EMS Division for the proper and efficient performance of duties. The Communicable Disease Coordinator: 1. Will develop, implement and manage a communicable disease program dealing with exposures and procedures for preventing them. It will be necessary to coordinate with nine shift duty officers, paramedics, area hospitals, and the Health Department to follow up on exposures and recommend appropriate treatment.

City Liability

A. All injuries involving possible City liability must be reported to the police for investigation. B. Enter information about the following patients in the narrative of the EPCR: C. Injuries with City vehicles involved. D. Injuries from falls on City streets or sidewalks. - CAO E. Injuries in City-owned buildings or on City-owned property. F. Possible work-related injuries or illnesses involving city employees will be reported to the Rescue unit dispatcher so that the appropriate city department may be notified. It should be noted on the Incident screen of EPCR that it is a City Employee.

Scope and Purpose

A. An air ambulance is available 24 hours on a call basis. There are four situations that are considered prime indicators for requesting emergency helicopter response: 1. Congested traffic at the accident scene or en route to the receiving facility. 2. Extended extrication time of a critically injured or ill patient. If called during extrication, the helicopter can be on hand at the scene, ready to transport the patient as soon as extrication is completed. 3. Rescue Unit unable to reach the patient due to terrain. 4. Anticipated extended travel time to receiving facility due to distance.

Calling For Helicopter Response

A. DFR Rescue Unit personnel considering calling a helicopter for transport have two options: 1. They can place the helicopter on "Standby Alert," directing the flight crew to standby on the helipad where they can be in flight on a moment's notice. This can reduce flight time by five important minutes. A response time of approximately ten (10) minutes can be expected to any area within the city limits provided the helicopter is available locally. 2. DFRD personnel can also request the helicopter immediately for transport, or "Alert Go". B. When helicopter response is requested, the closest EMS Field Supervisor will respond. C. To request a helicopter to "Standby Alert," DFR personnel must follow these procedures: 1. "Standby Alert" 2. DFR personnel determines the need for helicopter transport of patient. 3. DFR personnel contacts Fire Dispatch and requests helicopter on "Standby Alert." 4. If at any point the DFRD field personnel decide the helicopter is not needed, Fire Dispatch will be notified. The "Standby Alert" will then be cancelled via the helicopter response dispatcher. 5. To call a helicopter for an "Alert Go", DFRD personnel should follow these guidelines: 6. DFR personnel determine the need for helicopter transport of patient. 7. DFR personnel contact Fire Dispatch and requests helicopter on "Alert Go." 8. If the helicopter has already lifted off, and DFR personnel decide the helicopter is not needed, Fire Dispatch will be notified. Fire Dispatch will then abort the helicopter via helicopter response dispatch or via aircraft radio. (Air Abort.)

Disinfecting procedures

A. Daily cleaning procedure for all Rescue Units. B. These guidelines are provided for the prevention of transmission of pathogenic organisms. To ensure a clean and safe working environment for our employees and the citizens we serve, strict adherence to these guidelines must be followed: 1. The Station Officer is to ensure that these procedures are carried out each shift prior to 0900 hours, if possible. 2. Gloves will be worn while using disinfecting agents during cleaning procedures. In addition, a gown and mask will also be worn when cleaning areas with heavy bloodstains. 3. Utilize only department approved germicidal cleaners. 4. Disinfect all interior surfaces and equipment. Follow equipment cleaning instructions to prevent damage, particularly to electronic equipment. 5. A tuberculocidal aerosol disinfectant will be used for a final spray down of the entire, and allowed to air dry. Avoid spraying equipment. Stretchers, LifePak, laptops, etc. need to be wiped down and not sprayed. The aerosol (Lysol) can be sprayed on a napkin and wiped onto surfaces. 6. Every time equipment (i.e. medical kit, etc.) is taken out of the Rescue Unit for patient care, Rescue Unit and equipment should be cleaned and/or disinfected as appropriate.

EMS Shift Supervisor (781, 782, 783, 784)

A. EMS Shift Supervisors are Lieutenants who maintain certification or licensure as a Paramedic, in addition to training and knowledge of the management of EMS operations. They are directly responsible to the Staff Captain. B. EMS Supervisor Lieutenants shall: 1. Assist Deputy Chiefs, Battalion Chiefs, and Station Officers in the supervision of the field operations of all paramedics and Rescue units in their zone. 2. Respond to the scene of any incident where 3 or more DFR Rescues are responding, paramedics have requested a Field Supervisor, or other incidents where an EMS officer is needed. 3. Respond to second alarm fires and perform as the Rehab Officer.

Care of the Asbestos Contaminated Patient

A. If a known or suspected exposure to asbestos has occurred, the following measures are to be followed BEFORE PLACING THE PATIENT IN THE Rescue Unit: 1. Put on particulate respirator mask, fluid resistant gown, and disposable gloves, ensuring that the gown wristlets fit over the gloves. 2. Close interior compartment doors to provide protection for supplies and equipment in the patient compartment. 3. Place air conditioning on non-circulating air and open back windows if possible. B. After placing patient in Rescue Unit: 1. Provide patient care as needed. 2. Notify BioTel that you are transporting an asbestos contaminated patient to Parkland Hospital. C. Decontamination of Rescue Unit and Personnel 1. Ask emergency department personnel for assistance with proper disposal of contaminated items. 2. Notify HazMat team for assistance with decontamination of equipment and Rescue. Do not go back into service until cleared by HazMat officer. 3. Contact Field Supervisor as soon as patient care is transferred. Communicable disease exposure follow-up procedures should be followed upon completion of decontamination.

Non-Patient Criteria

A. In order to determine that a person is NOT a patient, the person must: 1. Be awake, alert, oriented and cooperative. 2. Must state that they have no complaints. 3. Must be ambulatory without assistance. 4. Must exhibit NO external sign of trauma (lacerations, abrasions, etc.). 5. Must NOT exhibit ANY signs of alcohol or drug intoxication. 6. Must be willing to give their name for documentation. 7. Mechanism of injury cannot meet ANY Trauma Center criteria as defined in UTSW/BioTel Treatment Guidelines. Motor Vehicle Collisions (MVC) - If a person meets ALL above criteria, his/her name SHALL BE documented on the Electronic Patient Care Report (EPCR) as being involved in the MVC. The narrative will state he/she meets NO criteria for being a PATIENT. Multiple "non-patient" names may be documented on one EPCR under "Multi Person Refusal".

Transporting DOA'S

A. Normally, the Dallas Fire-Rescue Department will not transport DOAs to the Medical Examiner's Office. However, in situations where the removal of the body from a highly visible area would be of benefit to the public, DOAs will be transported to the Medical Examiner's Office after the police having jurisdiction in the case have released the body and requested such action. The following procedures will apply: 1. Drive to Parkland Hospital Emergency Department Code 1. 2. Contact BioTel 3. Notify the Triage Nurse upon arrival. 4. The Rescue Unit will be guided by the directions of the physician or Parkland staff.

Abandoned Infants

A. On September 1, 1999, the State of Texas passed a law that allows a parent to abandon an infant at the location of an emergency medical service provider, without prosecution for child abandonment. The law reads as follows: "An emergency medical services provider licensed under Chapter 773, Health and Safety Code, shall, without a court order, take possession of a child who is 30 days old or younger, if the child is voluntarily delivered to the provider by the child's parent and the parent did not express intent to return for the child." B. Should any fire station in the Dallas Fire-Rescue Department be presented with an infant under this circumstance, they are to take the following actions. 1. Take possession of the child. Protect the physical health and/or safety of the child. 2. Immediately have the fire company (or Rescue Unit) placed out of service. 3. Have Fire-Rescue Communications dispatch a Rescue Unit, if there is not one at their location. 4. The responding Rescue Unit will immediately transport the infant to Children's Medical Center of Dallas for evaluation. 5. The responding Rescue Unit will also notify Child Protective Services at 800-252- 5400. BioTel will also be notified of the situation.A. On September 1, 1999, the State of Texas passed a law that allows a parent to abandon an infant at the location of an emergency medical service provider, without prosecution for child abandonment. The law reads as follows: "An emergency medical services provider licensed under Chapter 773, Health and Safety Code, shall, without a court order, take possession of a child who is 30 days old or younger, if the child is voluntarily delivered to the provider by the child's parent and the parent did not express intent to return for the child." B. Should any fire station in the Dallas Fire-Rescue Department be presented with an infant under this circumstance, they are to take the following actions. 1. Take possession of the child. Protect the physical health and/or safety of the child. 2. Immediately have the fire company (or Rescue Unit) placed out of service. 3. Have Fire-Rescue Communications dispatch a Rescue Unit, if there is not one at their location. 4. The responding Rescue Unit will immediately transport the infant to Children's Medical Center of Dallas for evaluation. 5. The responding Rescue Unit will also notify Child Protective Services at 800-252- 5400. BioTel will also be notified of the situation.

Communications

A. Operational Control CareFlite II can communicate with DFR on Channels 1 or 2. The call sign is "CareFlite II." The requesting company may talk directly to the pilot and/or crew as soon as they have lifted off. B. Medical Control 1. Med Channel 4 will be used to contact Biotel for continuity of care; i.e., the same physician will still be working with the same physician extender. C. Helicopter Capacity 1. Normal capacity for Careflight is 2 litters and 2 nurses or 1 nurse and 1 paramedic. However, if the patient is extremely unstable and/or CPR is in progress with the thumper, only one patient may be transported.

Paramedic Drivers

A. Paramedic Drivers are DFRD paramedics who hold the rank of Driver Engineer and shall be responsible for maintaining the ability to perform their duties as a paramedic in the DFR EMS system. They will maintain any and all certifications, pass any and all qualifying exams, and meet any and all requirements and/or standards set by the Department, the Texas Department of State Health Services (DSHS), and/or the Medical Director. B. In addition to the Driver Engineer responsibilities found in DFR ERB 100; Section L and Paramedic Responsibilities found in EMS 100.12, Paramedic Drivers shall: 1. Assist station officer, in ensuring that all medics assigned to their station are current on all continuing education modules required by the DSHS to include: a. On-site library/station modules b. Self-study computer based training modules 2. Assist station officer with maintaining and scheduling Rescue rotations and not allow a variance of more than 96 hours, plus or minus per quarter, per individual medic. 3. Assist station officer by ensuring the Controlled Substance Policy is properly followed and documented. 4. Assist station officer that all controlled substance licenses DPS, DEA, DSHS are valid with current dates. Original copies are mailed directly to each station. When received, they shall be forwarded to the EMS Administration Lieutenant immediately upon receipt. 5. Assist station officer that daily DFR Form 208 is accurate and completed each shift during morning inventory. 6. Assist station officer to monitor crew and contact CISM as needed. 7. Assist EMS Field Supervisor to ensure that all medics assigned to their station have a thorough understanding of and abide by the EMS Guidelines, EMS Policies/Procedures, and have proficient knowledge in the application of such processes. 8. Be responsible for maintenance and replacement issues related to the Rescue and all equipment assigned to it. 9. Will review with their crewmembers all materials relating to care and operation of new EMS equipment issued to the Rescue. Standard Operating Procedures Page 10 of 13 10. Be responsible for the EMS supply lockers and make sure they are stocked in accordance with the DFR Rescue Equipment/Supply list to ensure overstock is kept to minimum. 11. Be proficient in the use of currently used computer hardware/software and cardiac monitor/defibrillator. 12. Have thorough knowledge of the internship guidelines and evaluation process of paramedic trainees listed in DFR EMS SOP 116.00 Certification/Recertification (specifically sections 116.04 and 116.05). 13. Supervise yearly BP, EKG, and TB screening for personnel assigned to their station, and other personnel as assigned. Will be responsible for the maintenance of records related to the BP and EKG screening for their Station/Shift personnel. 14. Will act as EMS Control on assigned incidents until relieved by higher ranking EMS officer. When relieved of EMS Command, will brief and assist EMS Command as ordered. 15. Will review the Rider/Interns progress, ensuring all needed forms are completed, and discuss any issues needed with the Rider/Intern to ensure a productive educational experience. When available, will ride at least 3 times, including last ride, with the Rider/Intern to verify skills assessment. 16. After receiving appropriate/required training, perform the duties of the EMS Field Supervisor when designated. 17. Ensure all new issued EMS equipment is added to Rescue inventory in the station log book inventory.

Special Events Lieutenant (721)

A. The Special Events Lieutenant is a Lieutenant who maintains certification or licensure as a Paramedic, in addition to training and knowledge of the management of EMS operations. They are directly responsible to the Special Events Captain for the proper and efficient performance of duties.

Paramedics

A. Paramedics are DFRD personnel who have successfully completed a Paramedic training program approved by the Medical Director and have current EMT-Paramedic level licensure or certification as required by the Texas Department of State Health Services. B. DFRD members who maintain Paramedic certification/licensure shall: 1. Be directly responsible to the Station Officer at their station of assignment for the proper and efficient performance of duties including proper and efficient Rescue Unit response and operation, patient care, and overall quality of EMS delivery. 2. Bear joint responsibility for the proper care, treatment, and documentation of their patient(s) and shall have the authority to utilize other DFRD personnel as necessary at the scene of an emergency. Page 11 of 13 a. Should there be disagreement as to whether or not a patient should be transported, the patient will be transported. b. When a patient is being transported in the Rescue Unit, the paramedic providing the patient care shall be in charge. A patient will NEVER be transported without a paramedic in the back with the patient. c. In non-medical decisions, the ranking officer on scene (or if no officer, the ranking paramedic) shall be in charge. d. With regards to patient assessment and transport, all decisions will be made in favor of the patient. 3. Duties a. Respond to all requests for service to which they may be dispatched and provide patient-oriented emergency medical care, documentation and transportation to the best of their ability. b. Exercise precautionary measures and good judgment in the interest of safety and safe driving. c. Be responsible for the Rescue Unit's care and maintenance, equipment, and supplies. d. Be excluded from watch duty while acting as primary crew members of a Rescue Unit. e. Perform such other duties as required by their Station Officer or EMS Supervisor. f. Have a thorough understanding of, and abide by, all standing orders and guidelines for therapy and Standard Operating Procedures. g. Do not engage in any advanced life support procedure without the direction of a physician or standing order for treatment. h. Be responsible for exercising good judgment in the application of all guidelines for therapy and procedures established by the DFRD EMS Division and/or University of Texas Southwestern Medical Center at Dallas. i. Will contact medical control/BioTel any time there is a deviation made from established guidelines and/or procedures. 4. Paramedics are responsible for maintaining the ability to perform their duties as a paramedic in our system. They will maintain any and all certifications, pass any and all qualifying exams, and meet any and all requirements and/or standards set by the Department, the Texas Department of State Health Services, and/or the Medical Director.

Press Relations

A. Paramedics should direct interview requests to the Public Information Officer.

Communicable Diseases

A. Patient Care: The only time communicable disease cases will be transported is when they are in need of emergency medical treatment. For preventative reasons, all Rescue Unit/Fire- Rescue crews will follow the precautionary procedures listed below while the determination of transport is being made. The following procedures will begin as soon as practical after an employee knows or has reason to suspect that he/she has been exposed to a contagious disease, or has sustained an unprotected exposure to blood or body fluids. 1. Exposures requiring notification include, but are not limited to, the following: a. Mouth-to-mouth resuscitation b. needlestick c. splashes d. or aerosol of blood or body fluids into eyes, nose or mouth e. non-intact skin or open lesions f. puncture injuries g. human bites resulting in broken skin h. exposures to possible or suspected TB i. meningitis j. Pertussis (Whooping Cough) k. rash illnesses l. other suspected airborne diseases, 2. Exposed personnel shall IMMEDIATELY notify the EMS Field Supervisor of the Rescue Unit zone involved. The EMS Field Supervisor will determine if an actual exposure occurred and direct paramedics accordingly. The EMS Field Supervisor shall notify that member's Station officer and Communicable Disease Coordinator of serious exposures as soon as possible by telephone to ensure an immediate response to the situation. 3. Exposed personnel will also notify their Station Officer who will then notify the appropriate Deputy Chief, through channels, as soon as possible on the shift of the occurrence. After 2200 hours this notification may be made via electronic mail. No patient information will be sent via electronic mail. 4. All blood exposures will be evaluated by the EMS Field Supervisor and the EMS Communicable Disease Coordinator (775) for possible chemoprophylaxis. The Communicable Disease Coordinator will provide all exposure follow-up and case management. 5. The exposed personnel will initiate the Dallas County Communicable Disease Exposure Form that is carried on the Rescue Unit. The Emergency Department Charge Nurse initiates this form at the hospital. 6. If the exposed personnel are unable to respond to the appropriate hospital immediately, they will advise their EMS Field Supervisor to initiate the Dallas County Communicable Disease Form. 7. If the patient is not transported, the member exposed should obtain all information possible for identification and notify the EMS Field Supervisor immediately and his/her station officer as soon as practical. 10. The Station Officer notifies, via electronic mail, his/her Battalion Chief, and the appropriate Deputy Chief. The message states that the appropriate EMS Field Supervisor was notified of the exposure and at what time the notification occurred. 11. After the notifications have been made, the Station Officer will then ensure a Form 356, RM1a and other required on-duty injury reports are completed for the exposure and sent in through proper channels. The 356 is sent to 775 through the appropriate EMS Field Supervisor. THE EXPOSED MEMBER WILL NOT CONTACT THE HOSPITAL CONCERNING PATIENT RESULTS. THIS IS PROHIBITED BY LAW.

Supply Procedures

A. Peak Demand supplies will be ordered using the normal procedures using the Internal Document System (IDS) and delivered on routine delivery dates. B. Station Officers bear ultimate responsibility for the condition and stocking of Rescue Units assigned to their stations, including Peak Demand Rescue Units.

Police Assistance

A. Police normally respond non-emergency. They will respond emergency, or "Code 3," when immediate danger to a life exists. In situations where the paramedic feels the police are needed "Code 3", the paramedic will state the request along with a brief but complete description of the problem. Exception: If the paramedic feels open speech requesting the police would place his/her life in danger, simply give the Rescue Unit call numbers, and when acknowledged, state "Code Blue."

Portable Radios

A. Portable radios are assigned to both members of the Rescue. When away from the station, both portables will be carried and powered on to the appropriate channel. B. One radio will always be on EMS primary channel 2. C. Depending on the incident assigned to, the second crew member will tune their radio to Channel 1 or other as directed by the incident commander. D. The portable radios carried on the Rescue Unit will not be left in the front seat at any time. Both portable radios will be carried at all times while the paramedics are away from the station. E. Non DFR riders will not carry or operate the portable radios for any reason. F. Rescues will be locked at all times when Rescue personnel are away from the Unit. 1. A Rescue Unit will not be used to do grocery shopping for station personnel. 2. One member will monitor the primary Rescue Unit channel and MDC at all times when not operating at an emergency. 3. If it is necessary for a Rescue Unit to pick up supplies at a hospital and both crew members are required, the following procedures will be used: a. Request permission from the primary Rescue Unit Channel Dispatcher to go out-of service to pick up supplies and give an estimated time out. b. Pick up supplies and clear as soon as possible. c. Maximum allowable time to be out-of-service to pick up supplies will be 10 minutes. d. If any problem arises that will require more than the allocated 10 minutes, the Rescue Unit will clear and notify the appropriate EMS Field Supervisor.

BioTel

A. The BioTel base, located at Parkland, is responsible for securing a physician and providing paramedics with additional assistance as requested. The BioTel staff will monitor the primary and alternate Rescue Unit Channels, Medical Channels 1, 2, 3, 4 and the Dallas Fire-Rescue Department Mainline (670-4791). B. When contacting BioTel on telemetry equipment, EMS personnel will begin the message with the Rescue Unit call numbers and what their needs are. When acknowledged, the medical report will be given to the BioTel nurse, paramedic, or physician if available. C. To assure that there are no misunderstandings of orders given by physicians, all procedures, medications, etc. will be repeated back to the physician prior to implementation. D. Should the paramedics need to contact BioTel and the mobile radio is inoperative, the cellular phone should be used. E. Rescue Unit personnel will notify BioTel of hospital destination via MDC when transporting patients to a hospital. F. In the event the MDC is inoperable, the notification may be made by apparatus radio. Notification will be made by cellular phone only as a last resort. The following information should be relayed: 1. Hospital destination 2. Patient priority/code 3. Estimated time of arrival 4. Age/sex of patient 5. Chief complaint G. The dispatcher (660) will monitor the transmission and make appropriate entries into the computer terminal. BioTel will relay medical information to the receiving hospital. H. When transporting Code 3 to any hospital, contact with BioTel must be made via DFR Radio channel 2. I. Paramedics will also notify BioTel on Medical Channels when reporting special situations not limited to the following: 1. Trauma Activation Response Teams (TART) 2. Stroke Center Activations 3. Cath Lab Activation 4. Decontamination Events 5. Any other hospital or emergent needs, alerts or activationslimited to the following:

Electronic Patient Care Report (EPCR) Coordinator (750)

A. The EPCR Coordinator holds the rank of Captain

Overload Plan

A. The Overload Plan is a short-term adjustment permitting Rescue Units to transport patients to a hospital with a minimum of transport time. F. No patient will be allowed to refuse treatment and/or transportation due to the Overload Plan being in effect. Patients refusing service due to hospital destination will be transported to the hospital of their choice, provided that their hospital of choice is capable of providing appropriate care, and is not on advisory. BioTel will then be contacted and informed of the transport.

Fire Dispatch

A. The Rescue Unit dispatcher (Channel 2) shall be notified on all of the following so Dallas Police Department can be notified: 1. Major accidents 2. Cuttings/stabbings 3. Shootings 4. Attempted suicides 5. Aggravated assaults 6. Disturbances 7. Injuries occurring on City property 8. Any other occasion, when in the opinion of EMS personnel, police might be needed. B. When an incident involves possible work-related injuries or illnesses involving a City employee, dispatch will be notified so that the appropriate City Department may be contacted.

Preserving Evidence

A. The actions of the first persons at the scene of a crime contribute materially to the apprehension and prosecution of the person committing that crime. B. When Rescue Unit personnel arrive at the scene of a crime prior to the arrival of the police, they should first ascertain that it is safe to approach the patient. Once this has been determined, they should approach and examine the patient, bearing in mind the necessity for preserving evidence. C. If anything must be moved to make the examination, it should be documented in the narrative of the EPCR and told to police investigating officers. When immediate transportation is not necessary, Rescue Unit personnel should remain at the scene to protect the area until the arrival of the police. D. Guns, knives, and other weapons that must be moved shall be moved only with utmost caution and only if a police officer is not there to move them. Weapons that must be picked up shall be picked up with exam gloves so as not to smudge any fingerprints. Whenever possible, weapons shall be picked up by rough parts such as the handle. E. If transportation of a patient is required prior to arrival of a police unit, only then should a weapon be transported. F. If foul play is suspected, Rescue Unit personnel shall not presume that the police have been notified.

EMS Transport Policy

A. The goal of the EMS Division is to provide the highest quality pre-hospital care available to all requests for medical assistance. This transport policy necessitates that paramedics exercise good judgment when determining which patients will not be transported. In all cases, the well-being of the patient shall be the paramount consideration. B. Refer to the UTSW/BioTel Destination Policy for additional guidance. C. In situations where there is doubt whether or not transportation should be provided, the paramedics will provide transportation. Additionally, any situation in which a physician recommends patient transport will require transportation.

On-Duty City Employees

A. The paramedic will notify the Rescue Unit dispatcher that an on-duty City employee is being transported. The employee's name will not be given.

TERMINATION OF FIELD RESUSCITATION Procedures

A. The paramedic's based care/ treatment shall be on the situation, needs of the family, and the experience and judgment of the paramedics on the scene. B. Each time the paramedics choose to implement the procedures for Termination of Field Resuscitation, they must immediately notify Fire Dispatch. 1. Fire Dispatch will then dispatch the closest EMS Field Supervisor to the scene. This will be a Code 3 response. a. The role of the EMS Field Supervisor will be to monitor the situation b. Mentor paramedics and assure compliance with protocol c. Attend to the immediate needs of the family on scene C. The guideline for a termination of resuscitation efforts in the out-of-hospital setting will apply to the ADULT patient who experiences a non-traumatic cardiac arrest and meets the specific criteria indicating futility for further resuscitation efforts. D. During the initial resuscitation effort, EMS personnel or appropriate Fire-Rescue personnel will apprise the family of the progress of the resuscitative efforts, and will begin to advise the family of the on-line medical direction and eventually the recommendation to terminate efforts if there is no further response to treatment. E. After a full disclosure of resuscitation efforts and possible termination procedure, if any family member or responsible party indicates their objection to termination of resuscitation efforts, the resuscitation effort will continue until care is assumed by the receiving hospital emergency department. As usual, EMS personnel will take EMS and community safety into consideration during transport. F. EMS personnel will contact the Medical Examiner's office at 214-920-5900, to provide necessary information when field pronouncement has occurred. G. The EMS Field Supervisor will remain on scene as long as necessary. H. At all times, Dallas Fire-Rescue personnel will be attentive to the social and psychological support needs of the family or friends. I. Information surrounding the events of the resuscitative efforts and the time of death will be properly recorded on the EPCR. Documentation should include, but not be limited to: 1. Patient information (name, address, date of birth, etc.) 2. Medical condition of the patient, including history, medications, allergies 3. Treatment provided 4. Patient response to treatment 5. Scene situation, including family response to situation 6. Witness information 7. Time of pronouncement by physician 8. Pronouncing physician's name

Assistance with Emergencies

A. The paramedics will determine promptly if additional equipment and/or assistance is needed. 1. Paramedics will request additional resources as needed, from the EMS dispatcher. 2. Should a DFR Rescue Unit that is operating in another city require assistance, an appropriate request will be made, via the DFRD Rescue Unit Dispatcher. 3. Only DFR personnel will serve as Rescue Unit drivers. B. Should circumstances require professional medical attention or advice, the paramedics will communicate with BioTel on the appropriate Med channel and notify a Field Supervisor, if appropriate.

Medical Director

A. The purpose of the Medical Director is to provide physician control for the medical direction/supervision of pre-hospital care delivered by certified EMS personnel.

Contaminated Sharps / Medical Waste Disposal

A. These boxes are for medical waste only. Medical waste includes only: 1. Properly closed and marked sharps containers. 2. Properly closed and marked red biohazard bags containing medical waste other than sharps. B. Station officers are responsible for: 1. Ensuring the area is kept tidy, and does not create a hazardous condition for station personnel. Biohazard containers must be located in areas not readily accessible to the public e.g. citizens visiting the station on voting days, for station tours, etc. 3. Verify the weight of waste and sign the electronic "Waste Manifest Form". All requests for the pickup of medical waste material will be coordinated through 740 at 670-4311. C. Paramedics are responsible for: 1. Dropping off sharps containers that are properly closed and not over-filled, to a designated removal site. 2. Dropping off biohazard waste that is properly contained in the red biohazard bags supplied by EMS Supply, to a designated removal site. (Double bagging may be appropriate.) 3. All medical waste is to be deposited in the boxes at the removal site and will be marked with the Apparatus Unit number, using a black permanent marker. 4. Once a biohazard box is full, it must be properly closed, and another box started. (Folding instructions are on the box.) 5. Making sure they do not leave medical waste in a hazardous condition. The contractor will not pick up boxes that are leaking or are not properly and completely closed. 6. All Rescues have sharps containers for used needle and syringe disposal, and red biohazard waste bags for other biohazard waste. Since any member may assist in patient care and area cleanup where sharps may have been used or other medical waste generated, everyone should be aware that medical waste is a definite health hazard. 7. In order to prevent needless injury and subsequent medical treatment, members handling sharps: a. Will not attempt to reinsert needles into their sheaths. Standard Operating Procedures Page 7 of 8 b. Will not break needle from any syringe prior to disposal; discard the entire unit. c. Will not overfill the sharps containers. The line on the side of the container indicates the proper level of filling. d. Will order a new container from EMS Supply on appropriate days. Containers should be deposited at a medical waste pick-up site when two-thirds full. e. Will not empty the sharps container for possible reuse. f. Will not dispose of sharps containers in any public trash container or dumpster. g. Will not stick contaminated needles in mattresses, seat cushions, etc., or place needles anywhere but in the contaminated needle container. D. The medical waste removal contractor is responsible for: 1. Supplying all necessary boxes, liners, and labels to each pick-up site. 2. Picking up properly closed and labeled boxes of medical waste from all removal sites on a monthly basis and as requested. 3. Picking up spills only when caused by their own personnel. 4. Responding to as-needed pick-up calls at the EMS Division office and Fire Maintenance.

Preparation for Transport

A. Weight Factors: The helicopter can carry approximately 4,000 pounds, including equipment, staff, and patients. B. Weather: Excessive high winds, falling snow or sleet, fog or thunderstorms may ground the helicopter. However, the helicopter can fly in some conditions that would slow or stop a ground ambulance, such as snow and ice on the ground, or high water. C. Patient Preparation: Establish life support according to DFRD protocol. Anticipate use of the scoop stretcher to facilitate moving the patient to the helicopter backboard. IVs may be placed on pressure pumps for transport to facilitate patency. D. When possible, leave the patient in the Rescue Unit until the aircraft lands and the flight nurse is available for patient assessment and guidance in loading. Should the patient be outside the Rescue Unit on the helicopter's arrival, protect the patient from wind and flying debris. Inform the family there is no room for anyone to accompany the patient. Valuables should be given to family members when appropriate.

Relatives and Friends of Patient

A. When juveniles require transportation to hospitals, parents are encouraged to accompany their children in the Rescue Unit. C. All passengers are required to use seatbelts and other safety devices while the vehicle is in motion.

Animal Bite Victims

A. When paramedics answer a call where the patient is the victim of an animal bite, or a suspected animal bite, the Animal Control Department, City of Dallas, has requested that we contact them as soon as possible. B. If the patient is transported, also notify Fire Dispatch that you are transporting a suspected animal bite victim.

Transportation from Location to Hospital

A. When patients are being transported, a certified paramedic must ride in the patient compartment and provide patient care. An intern is not considered a paramedic until certified by the State and, therefore, should not be left alone with a patient during transportation.

signal 27

A. When the fire company arrives before the Rescue Unit and notifies the Rescue Unit of a Signal 27, the Rescue Unit will reduce its speed and continue Code 1. B. ALS engines will disregard the Rescue, complete the EPCR (Electronic Patient Care Report) and follow the normal Rescue procedures indicated in # 3. C. Rescue Unit personnel will, before clearing the scene, do the following: 1. Complete EPCR and supply police on scene with any information needed including the time the Signal 27 was determined. 2. Coordinate with police on placing initial call to the Medical Examiner's Office to relay medical information on the deceased. The Medical Examiner's phone number is 214-920- 5900. 3. Fire-Rescue Department Personnel will maintain control of the location until the arrival of a police element. D. If a Rescue Unit is at the scene of a Signal 27, unassisted, they shall request a fire company, Code 1, to the scene to assist the Rescue as needed with control of the scene until: 1. The police arrive 2. The Medical Examiner arrives 3. If the police or Medical Examiner arrives before the fire company, the Rescue Unit crew shall disregard the responding fire company before clearing the scene.

Unattended Children

A. When transporting parent, guardian, or keepers of unattended children, paramedics should leave any unattended children with police or other person as directed by the parent or guardian. B. If the patient's condition does not permit this, the paramedics shall notify the dfrd dispatcher and fire-rescue department equipment will be sent to the location until the arrival of police. Paramedics will not leave unattended children until arrival of other DFRD personnel.

Language Line Services

AT&T provides a service for language interpretation for DFRD Call 1-800-523-1786 Input the DFRD Client ID number - 904048 Will be prompted by line operator to provide "PIN" code. This is your employee number

Special Events Captain (720)

Administer the Special Events program by maintaining a roster of current members; coordinating with the EMS Deputy Chief, Section Chief, and Special Events Lieutenant to support approval/disapproval recommendations concerning new members and all disciplinary action.

Disposition of a Patient's Weapon:

An armed patient or family member will never be allowed to ride in a DFRD Rescue Unit. When a patient is refusing to relinquish their weapon and requires medical attention, the paramedics should request an EMS Field Supervisor and police. B. If the nature of the call involves response by police, i.e. MVA, have police take possession of the weapon. If the nature of the call does not require a police response, for example, Medical Emergency or Unconscious Person, and the patient is away from their residence, the paramedic should safely handle the weapon and turn it over to the security officer at the arriving hospital and document actions in EPCR.

Intoxication

An intoxicated person not needing medical care (after careful and complete medical screening) should be reported to the police. Be available and standby to protect the person from injury and direct the police in case the subject should move. In the event of a long ETA for the police (over 10-15 minutes), an engine company may be requested to standby with the subject. In all cases, the rationale for not transporting the patient will be thoroughly documented in the EPCR.

Mandatory Offer of Transport

B. Adult Refusal of Service Should a patient refuse treatment and/or transportation, the paramedic shall explain the consequences of non-treatment and non-transportation to the patient. If patient continues to refuse treatment and/or transport, paramedics will then contact BioTel. 2. If the patient refuses to sign, this shall be noted and accompanied by the signature of a witness or witnesses when possible. It must be clearly explained to the patient that they are refusing our services against medical advice.

equipment

B. For Unconscious Person, Cardiac (Chest Pain), Breathing Difficulty, Seizures, CVA, or as needed based on dispatch comments 1. Medical Bag 2. LifePak 12 or 15 3. Oxygen C. High Rise or large building (i.e. warehouse) - All cases will require the following equipment to be taken on initial entry regardless of call type: 1. Stretcher with Oxygen 2. Medical Bag 3. LifePak 12 or 15 4. Backboard and X-Collar 5. Other equipment optional by type of reported case.

Hospital Destination Procedures

B. If no hospital is specified, or the Overload Plan is in effect, the patient shall be transported to the closest hospital that can handle the patient's condition. C. In the event of disasters, patients will not be given the choice of hospitals but rather will be transported to hospitals according to proximity of disaster, condition of patient, and ability of hospitals to receive additional patients, as determined by BioTel. D. VA Hospital is not included in our Overload Plan. Transportation to VA with a nonveteran may be done only in an unusual, extreme emergency such as the inability to establish an airway. The patient will be stabilized and then transported to the proper hospital by a Rescue Unit as a continuation of the original run. 1. The Communications Shift Duty Officer will determine whether the original Rescue Unit will remain at the hospital to await stabilization or clear. 2. Anytime a non-veteran is transported to VA, the EMS Field Supervisor will be notified immediately. 3. A memo will be sent to the EMS Deputy Chief through channels with details concerning the incident. E. Paramedics will ordinarily transport patients to hospital Emergency Departments f. Any paramedic having a conflict with hospital personnel will notify his/her EMS Field Supervisor and/or BioTel as soon as possible. G. After patients are released to the hospital and the Rescue Unit equipment is secured, the Rescue Unit will clear and leave the hospital.Any paramedic having a conflict with hospital personnel will notify his/her EMS Field Supervisor and/or BioTel as soon as possible. G. After patients are released to the hospital and the Rescue Unit equipment is secured, the Rescue Unit will clear and leave the hospital.

EMS Staff Captain (780)

B. The EMS Staff Captain shall: 1. Supervise and manage the workload of EMS Supervisor Lieutenants. 2. Respond to mass casualty incidents and perform the control function designated by the Section Chief of EMS. 6. Respond to third alarm fires and assume command of EMS operations.

Activation of Additional Reserve Rescue Units

B. The Fire-Rescue Department Communications Shift Duty Officer requests 806, 807, 780 and the appropriate EMS Field Supervisor to initiate the loading and staffing procedures of Rescue Units with paramedics.

Battery Power Level

B. The indicator lights GREEN when the battery is fully charged, or has adequate charged power. C. The indicator flashes RED when the battery needs to be re-charged or replaced. When the indicator is flashing red, the stretcher has approximately three (3) patient lifts remaining. D. Each Rescue with a Power Stretcher has been equipped with a Battery charging system, and one (1) extra battery; one battery should stay in the charger on the Rescue and the second on each Rescue unit's stretcher. Contact your EMS Field Supervisor with any stretcher mechanical or charging system problems.

Cleaning the Power-Pro Ambulance Stretcher

B. The stretcher should be thoroughly cleaned after each use. C. If the stretcher is going to be exposed to large amounts of water (ex: hose down), the battery MUST BE REMOVED.

Deputy Chief (700)

C. Act as EMS Liaison to: 1. City of Dallas Office of Emergency Management 2. MMRS Steering Committee 3. Dallas County Medical Operations Center Steering Committee

Assistant Chief of EMS (803)

C. Act as EMS Liaison to: 1. State of Texas Emergency Operations Center 2. Texas Department of State Health Services 3. North Central Texas Trauma Regional Advisory Committee

Adjusting Stretcher Height

C. In the event of loss of electrical function, the Power-Pro is equipped with a manual override to allow manual operation of the stretcher. D. The RED manual release lever is located along the patient left side of the lower lift bar at the foot-end of the stretcher. E. To lower the stretcher with the manual release: 1. Must have one operator at each end of stretcher. 2. Operators must lift the stretcher weight slightly off the wheels when a patient is on it in order for the manual release lever to work. 3. Operator at the foot-end pulls the manual release lever. 4. Both operators support the weight of the stretcher and patient while raising and lowering. 5. A MINIMUM OF 2 OPERATORS IS REQUIRED WHEN ADJUSTING STRETCHER HEIGHT IF THERE IS A PATIENT ON IT

Contingency Plan

Contingency Rescue Unit activation may be initiated during off peak hours, utilizing the Peak Demand Rescue Units when, in the judgment of the Communications Shift Duty Officer, Rescue Unit response time and/or coverage warrants such action. A. Peak Demand Rescue Units will be fully loaded and staffed with two paramedics available for immediate activation. 1. The Station Officer is responsible for ensuring that the Peak Demand Rescues are fully stocked and Form 208 has been completed. 2. Peak Demand crews will be responsible for ensuring that Peak Demand Rescues are fully stocked prior to leaving at the end of their tour. B. Communications will notify the Operations Deputy Chief of the need to put the Peak Demand(s) in service. Communications SDO will advise the appropriate EMS Field Supervisor. Staffing will be provided by the Station Officers, Battalion Chiefs, or Deputy Chiefs as needed.

EMS Quality Management Captain (760)

Coordination of all activities pursuant to providing the highest quality out-of hospital emergency medical care.

Forcible Entry (Residential)

D. The fire company officer will be responsible for seeing the building is secured. 1. If no emergency is found after forcible entry, and no one is in the building, Fire-Rescue Department personnel will not leave the scene until the building is secured. This is to prevent burglars from turning in false alarms and standing by until we leave the scene. 2. In the event damage has been done during forcible entry and no resident has returned prior to our securing the building and leaving the scene, a note shall be left on the door with instructions to call the appropriate Field Deputy Chief for an explanation of the circumstances that caused the forcible entry. 3. The Field Deputy Chief, if contacted by a citizen in this regard, will advise the complainant to Contact Risk Management at 214-670-3120.

Tuberculosis Screening Procedures

DFR offers Tuberculosis screening annually to EMS first responder personnel. The Tuberculosis Skin Test (TST), and/or Chest X-ray are the methods used by DFR to screen for Respiratory Tuberculosis. The injection site is read in 48 or 72 hours from the administration date. No induration is recorded as 0mm. 3. If the raised induration measures 10 mm or more, a second TST is administered on the oppose arm with a new bottle with a different lot number of the antigen. 4. The second TST is read in 48 or 72 hours. 5. If the second TST is 10 mm or more, the TST is positive and the employee is referred by the Communicable Disease Coordinator to the Tuberculosis Elimination Clinic at Dallas County Health and Human Services for evaluation and treatment. 6. Once an employee has two consecutive positive TST readings, the employee is considered converted. The employee no longer is to have TST. The employee is instructed to only have chest x-rays annually.

Definition of a Patient

DFRD personnel shall consider a patient ANY person requesting medical assistance or any person for whom a third party requests medical assistance for and is found to be sick or injured.

Universal Policy

EMS personnel shall not recommend any specific lawyer, doctor, private ambulance company or other specific service or organization, directly call any of the above, offer legal or medical advice, or recommend any medications, prescription or over-thecounter.

code 3

Emergency lights and sirens, cautiously traveling at a higher speed and coming to a complete stop at red lights and stop signs. 3. BioTel MUST be contacted by radio or phone when transporting Code 3 to a hospital. 4. Other codes of transport are strictly prohibited regardless of time of day. The patient's condition and vital signs will determine the code of travel to the hospital.

Reporting For Court

Failure to appear in compliance with a summons will be treated as a refusal to follow an order and will result in severe disciplinary action.

DALLAS AIRPORTS

IT CANNOT BE OVEREMPHASIZED THAT RUNWAYS MUST NOT BE CROSSED WITHOUT PROPER ESCORT AND CLEARANCE, REGARDLESS OF CIRCUMSTANCES.

implied consent

If involuntary consent is not available, the paramedic should determine whether or not implied consent exists to treat the patient. In the adult, in order to have implied consent, the patient must be (1) unconscious, and (2) suffering from what reasonably appears to be a life-threatening disease, illness, or injury. All adult patients who are truly unconscious may be treated under the doctrine of implied consent. 4.If the paramedic cannot obtain consent at any of the three levels stated above and reasonably believes that there is significant risk of death or disability to the patient if treatment or transportation is not provided, the paramedic shall immediately notify BioTel of the need for legal assistance. 5. If treatment or transportation is not ordered by the BioTel physician, the paramedic shall: a. Type the reason for refusal on the EPCR in the narrative. b. Document the apparent nature and severity of the illness or injury on the EPCR. c. Document the BioTel physician's name. d. Obtain the signature of the patient on the EPCR in the box titled "Refusal of Transportation/Treatment", if possible, as refusing treatment or transportation. e. Obtain the names of one to two witnesses to the refusal, if possible. DPD officers can serve as a witness to the patient's refusal.

implied consent

If involuntary consent to treat a child cannot be obtained, the paramedic should determine whether or not there is implied consent to treat the child. Implied consent with children exists when: i. the parent has not refused permission to treat or transport the child. ii. the child is suffering from an injury or illness. 8. If the paramedic is unable to obtain consent to treat the child by voluntary, involuntary, orimplied means, and the paramedic reasonably believes that the injury or illness of the child involves a significant risk of death or disability to the child if treatment or transportation is delayed, the paramedic shall follow the protocol previously described by immediately contacting BioTel for guidance and direction. (refer D.4) 9. If the parent or person with legal authority is only available over the phone and refusing treatment and/or transport, contact BioTel.

Lost And Found

If unable to deliver to the patient, the personal effects will be marked with patient's name (if known), incident number, date or date found and by whom, then sent through channels to the EMS Division.

Involuntary Consent

If voluntary consent cannot be obtained, or is not available, the paramedic will attempt to determine the existence of involuntary consent to treat the adult patient.

Involuntary Consent -

If voluntary consent cannot be obtained, the paramedic should attempt to determine the existence of involuntary consent to treat the child. Involuntary consent to treat a child exists when the child is under arrest, when the child is in the custody of a child welfare worker (see comments on child abuse), or when the child is in the custody of a State agency.

MALPRACTICE NOTIFICATION

In the event any paramedic is served papers or is notified of anticipated legal action, the appropriate EMS Field Supervisor will be notified immediately.

TROUBLESHOOTING CAD/EPCR DOWNTIME

In the event either CAD or the EPCR vendor software is down, two options exist to record patient encounters until the system returns to normal. A. Option 1). Medics shall continue to utilize the EPCR vendor software on the laptop in an offline capacity to record patient information and obtain signatures. All data WILL BE stored on the hard drive until normal online functions are restored and the data can be transmitted electronically to the EPCR vendor server for distribution. B. Option 2). A hardcopy paper Form 200 MAY BE utilized to record a complete patient encounter and obtain signatures. However, this method requires that an electronic version of the Patient Care Report be created by the medic and entered into the EPCR vendor system later once the software has returned online before the process can be considered complete. 1. Once the EPCR has been entered and completed, the hardcopy paper Form 200 must then be forwarded to the EPCR Captain (750) at 1551 Baylor St, Suite 300, for retention.

Unusual Calls

Listed below are some examples of unusual calls: 1. Paramedics held at gunpoint while trying to assist an injured person, and being prevented from giving such assistance. 2. Calls involving multiple casualties where the appropriate EMS Field Supervisor did not arrive on the scene prior to the injured being transported. 3. Public concern incidents (i.e., food contamination, hydrogen sulfide suicide, large number of patients with unusual symptoms, or other potential bioterrorism events). 4. Any incident the paramedic feels is out of the normal scope of practice which could include a cornucopia of circumstances.

Suicide Notes

The Police Department must be notified of all suicides or attempted suicides. If the suicide is by hanging and it is necessary to cut the body down, do not cut or untie knots. If the victim is dead, the noose needs be left intact about the neck to aid in criminal investigation. D. Any suicide notes shall be taken with the patient when necessary to transport prior to police arrival.

Blood Pressure and ECG Screening

Paramedics will coordinate with the Station Officers in January to administer a BP reading and ECG testing for each Department member. DFR Form 316 Record Card.

EMS Training Coordinator (758)

The EMS Training Coordinator holds the rank of Captain is directly responsible to the Section Chief, EMS, for the proper and efficient performance of duties. Will serve as EMS liaison officer with the Texas Department of Health EMS Bureau concerning paramedic certification and recertification.

109.00 EQUIPMENT 109.01 General Guidelines

Rescue will be kept in a clean, orderly, and serviceable manner. B. In the event that any durable equipment other than backboards must be left at a hospital notify the appropriate EMS Field Supervisor upon leaving the hospital. C. Each morning, the on-coming paramedics staffing the Rescue will complete the electronic Daily Rescue Equipment Inventory form, Form 208, and the Controlled Substance Log. Missing items will be noted and replaced, and a Form 124, Report of Loss of Minor Tools and Equipment will be completed and sent through channels. Paramedics going off-duty will be held responsible for any unreported missing equipment. 1. The Daily Rescue Equipment Inventory Form (208) is an electronic form found on the IDS under the Inventory tab. It will be signed by each paramedic staffing the Rescue and also by the station officer by 0900 every morning. 2. The Controlled Substance Log will be signed off by two members assigned to the apparatus that day by 0900 every morning. D. Exterior cleaning for all Rescues - All exterior surfaces should be washed daily, weather permitting.

Smoking/Tobacco

Smoking is prohibited in the cab and patient compartment at all times. Paramedics will not use any form of tobacco or other related products at any time while in the Rescue Unit or during contact with the public.

Operating in Hazardous Environment

The Fire-Rescue Department Incident Commander at the scene will be responsible for ensuring that Rescue personnel wear protective gear as the situation demands. E. The paramedics will be responsible for ensuring that persons riding the Rescue Unit as a third party do not enter the area without protective clothing. F. Fire-Rescue Department issued firefighting helmets will be worn when going on or near construction sites and other such times when appropriate. Helmets will always be worn by EMS personnel when working at fires or disaster areas.

Documentation

TRANSMITTING EPCR to BioTel and receiving Hospitals: The paramedic must transmit a TRANSPORT TO HOSPITAL FORM to BioTel as early as possible on all transported patients with the following: a. Hospital name b. Priority c. Code d. Estimated Time of Arrival (ETA) e. Patient Age f. Patient Gender g. Trauma Type, if necessary h. Patient Response i. Blood Pressure (BP) j. Glasgow Coma Scale (GCS) k. Pulse Rate l. Respiratory Rate m. Comments, free form text EPCR: An EPCR MUST BE produced on any call where patient contact was made. EPCR requirements include: 1. Complete patient demographics: a. Full name b. Date of Birth (DOB) c. Gender d. Ethnicity e. Current phone number where the patient can be reached f. Current address g. Insurance information, if available h. Driver License/ ID #, if available i. Height and weight, as available j. Medications, prescription and/or Over the Counter (OTC) medications, as available. The paramedic SHALL list each medication name individually and SHALL REFRAIN from documenting "MULTI" or "POLY-PHARMACY" k. Allergies to medications and/or pertinent food l. Pertinent medical history 2. Patient Assessment MUST BE completed on every patient, to include: a. Signs and symptoms b. Mechanism of Injury/Mechanism of Illness Impression c. Chief Complaint (patient's exact pertinent medical quote) d. One (1) set of complete vitals on all patient refusals e. Two (2) sets of complete vitals on all patient transports The narrative ensures continuity of care and serves as an important part of the patient's medical record. Refusals: When the patient meets mandatory offer of transport and refuses treatment or transportation Against Medical Advice (AMA), the paramedic will contact BioTel before clearing the scene informing BioTel that the patient is a mandatory offer of transport and is refusing treatment and or transport. The Patient Refusal portion of the EPCR SHALL BE completed and signed by the patient. Any specific comments regarding the refusal SHOULD BE noted in the narrative of the EPCR. A witness signature SHOULD BE obtained in the "Witness" section of the EPCR, if possible. Attachments: Any time paramedics attach the ECG monitor to a patient, regardless of symptoms, the ECG (4 Lead and/or 12-Leads or Combo Pads) WILL BE attached to the EPCR. addendum-If an EPCR addendum is necessary, contact your EMS Field Supervisor and/or EPCR Captain (750).

Surrogate

The paramedic should seek consent from either the parents of the child, court appointed guardian, or other person with legal authority, such as school personnel. The consent of only one parent is required for treatment.

Rotation of Rescue Unit Crews

The time period to be considered for 50% rotation of duties shall be quarterly. A variance of no more than 96 hours plus or minus per quarter per individual will be allowed. Only the hours actually worked at a fire station by a member shall be considered in the 50% rotation, with the exception of trade time. A paramedic shall not ride any Rescue Unit for more than four (4) consecutive 24-hour shifts. Time will be calculated in increments of 6 hours. Station Officers or their designee are responsible for maintaining the Paramedic Rotation Record. This record will be kept electronically and sent to Battalion Chief at the end of each quarter. Scheduling should be done at least one month in advance to avoid problems before they occur. Any problem should be passed to the appropriate Battalion Chief at the earliest possible time for resolution on a district basis.

Disregard-

This disposition is used when a Rescue Unit is disregarded by Fire Dispatch, DFRD crew on location of an incident, or Dallas Police personnel. Once a Rescue Unit is on location or has made patient contact, the "Disregarded" disposition cannot be used. This is ONLY to be used when disregarded by fire or police personnel prior to arrival.

Traffic Accident Procedures (Rescue Unit Not Involved

Under normal circumstances, it is NOT NECESSARY TO WAIT FOR POLICE TO ARRIVE AT THE SCENE PRIOR TO TRANSPORTING INJURED PATIENTS When police accident investigators are on location prior to transport AND THE PATIENT'S CONDITION IS STABLE, paramedics may allow officers to gather basic information from the patient and to provide the patient with information concerning the disposition of the vehicles, belongings, etc.

Patient Assessment

Vital signs (including but not limited to; pulse, blood pressure, respiratory rate) will be assessed on ALL patients. Other diagnostics such as ECG, O2 Sat, D-Stick are also required as indicated based on patient presentation. If vital signs are not obtained, the reason SHALL BE documented in the narrative.

Estimated Time Out (ETO)

When this information is requested, provide the dispatcher with the best estimate of time out on that particular call. If the patient will be transported to an area hospital, simply state your Rescue Unit call number followed by "we will be transporting."

EMS Administrative Lieutenant (740)

Will serve as audit coordinator for EPA. Will respond to mass casualty incidents

6. Unloading the Stretcher from a Vehicle - Manual Method

a. Disengage the stretcher from the stretcher bracket. b. 2 OPERATORS: i. Operator 1 - Grasp the stretcher at the foot-end. Pull the stretcher out while pressing the manual release lever to lower the undercarriage to its fully extended position. Pull the stretcher out until the safety bar engages the safety hook. Operator 2 should verify that the bar engages the safety hook. ii. Operator 2 - Stabilize the stretcher during the unloading operation. iii. Operator 2 - Push the safety bar release lever forward to disengage the safety bar from the safety hook in the patient compartment.

5. Oxygen Equipment

a. Large Cylinder - replace if below 500 psi. b. Small Cylinder - replace if below 1000 psi.

5. Loading the Stretcher into a Vehicle - Manual Method

a. Place the stretcher in the loading position (any position where the loading wheels meet the vehicle floor height). b. Push the stretcher forward until the load wheels are on the patient compartment floor and the safety bar passes the safety hook. (There must be a safety hook installed in every vehicle that will be utilizing the Power-Pro). c. 2 OPERATORS: i. Operator 1 - Grasp the stretcher frame at the foot end. Lift the foot end of the cot until the weight is off the latching mechanism. Squeeze and hold the release handle. ii. Operator 2 - Grasp the base frame. After the foot end operator has lifted the stretcher and squeezed the release handle, raise the undercarriage until it stops in the uppermost position and hold it there. iii. Both Operators - Push the stretcher into the patient compartment until the stretcher is firmly secured.

3. Special circumstances which permit a child to consent:

a. The child is married. b. The child is unmarried and pregnant and the illness or injury affects the pregnancy. c. The illness or injury involves drug abuse by the child. d. The child is on active duty in the armed forces. e. The child is 16 years of age or older, living separate or apart from the parent or guardian, and is not dependent upon the parent or guardian for support or maintenance. f. The child is suffering from a venereal disease or serious contagious disease. g. The child is a victim of child abuse. 5. If the child does not meet any of the special circumstances listed above, it is necessary to attempt to obtain surrogate consent for treatment of the child.

10. Special Problems

a. Unattended Minor: i. If a parent or guardian is not present and a child needs treatment or transportation, the child will be treated under the doctrine of implied consent. ii. The EMS Shift Supervisor should be notified of this situation so that legal consultation may be obtained, if indicated. b. Child Abuse: i. In cases involving child abuse, the child may consent to his/her own treatment. ii. If parent or guardian is not present, the child may be treated under the doctrine of implied consent as stated above. iii. Paramedics are required to report child abuse to the appropriate law enforcement agencies. If transporting, police will be contacting after transferring care to hospital staff. If parents are refusing treatment and/or transport, police shall be requested to scene. iv. If a child is treated against the wishes of the parents, at the request of a police officer or child welfare worker, the police officer or child welfare worker shall accompany the child to the hospital. v. If neither the child nor the parent will consent to treatment and police or child welfare worker do not order treatment, BioTel should be contacted, and the procedure for refusal should be employed immediately. vi. All actions should be thoroughly documented in the narrative of the EPCR. c. Mentally Ill Persons i. If a mentally ill patient is suffering from what reasonably appears to be an injury or illness, the paramedic shall attempt to obtain consent to treat either adults or children as has previously been indicated. ii. If a mentally ill patient is violent or clearly psychotic (i.e., not oriented as to time, place, or person), the paramedic shall request the presence of a police officer to assist in protecting or restraining the patient, as may be required during treatment and transportation. Standard Operating Procedures Page 5 of 8 iii. If the patient has taken ANY actions to hurt themselves, they need to be transported by DFRD regardless of whether they appear stable at time of patient assessment. This would include ingestion of any medications/drugs or any trauma. iv. An APOWW (Apprehension by Police Officer Without Warrant) patient cannot refuse treatment and/or transport. v. Green Oaks, Timberlawn, and other such psychiatric facilities do NOT have the capability to diagnose and treat medical or traumatic injuries regardless of how minor they may present. These patients MUST be transported to an emergency room. Once cleared, the ER will arrange transport to the appropriate psych facility.

Patient Interrogation

investigating officers are permitted to question patients at the scene when such interrogation does not jeopardize the patient's welfare.

Dallas Fire-Rescue Department's EMS Division is a part of D/FW Airport's Emergency Plan. Notification

the Airport will notify DFRD Communications when the plan is activated and our services are requested. Command and Staging will be designated. A. Our response will be: 1. One EMS Field Supervisor to respond to Command. 2. Two Rescue Units to respond to Staging. C. The designated staging areas are the five DFW Fire Stations. D. When Rescue Units are needed at the crash site, escorts will be provided to guide them in.