CFR-D Manual

Question 0

CFR-D CHAPTER 2: WHEN APPROACHING THE SCENE, THE OFFICER SHALL PERFORM THE FOLLOWING: “BARNS”

Answer 0

“BARNS”

B - BSI (Ensure BSI procedures are used and PPE is on)

AR - Additional Resources (determine need for additional resources)

N - Number of patients

S - Safety (observe scene for safety of MEMBERS PATIENTS AND
BYSTANDERS)

Question 1

CFR-D CHAPTER 2: STAFFING GUIDELINES

Answer 1

• Company Officers shall ensure that 2 CFR-D FIREFIGHTERS will be
  working each tour. Officers shall notify their Battalion for needed
  details prior to the start of the tour.
• In order to be in service as a CFR-D unit, there shall be a minimum of
  2 trained MEMBERS (OFFICERS & FFS) with current CFR-D
  certification.
• CFR-D units must BEGIN each tour with 2 CERTIFIED
  FIREFIGHTERS. If DURING THE TOUR the CFR-D staffing reduces to
  1 FF AND 1 OFFICER, the unit will remain available for CFR-D
  response.
• During roll call the Officer will determine the number of CFR-D
  personnel on duty. If that number has fallen below the minimum, the
  Officer shall notify the Dispatcher and Battalion and enter the event in
  the company journal.
• Without 2 CFR-D certified MEMBERS, the company shall not respond
  to any CFR-D calls. The company may still be dispatched for calls
  received directly from the public to assist civilians.

Question 2

CFR-D CHAPTER 2: KEY POINTS

Answer 2

• When an EMS Unit or certified ambulance agency is on scene and a
  CFR-D unit arrives, the Fire Officer will confer with the EMS unit or
  certified ambulance agency to ensure both units have responded to
  the same INCIDENT. The CFR-D unit will remain on scene and assist
  until it is determined that their assistance is no longer needed.
• Individuals may identify themselves as patients or may be identified to
  the company as patients by family, friends or bystanders. Once an
  individual has been identified as a patient, the Company must
  evaluate, render appropriate treatment and generate a PCR. An
  individual is considered a patient if:A) The individual is sick or injuredB) The individual was exposed to a situation or condition that could
  have the potential to cause injury: smoke condition, CO, MVA.
• If it is determined that the patients CUPS status is either CRITICAL or
  UNSTABLE, the Officer shall:
  1. Ask dispatcher for an ETA of the responding ambulance
  2. Advise dispatcher to relay the seriousness of the patient’s condition
     to the responding EMS unit.
  3. Packaging efforts must begin immediately while treating life threats.
     Immobilize to a spine board if indicated.
     Note: If patient is P or S, perform the appropriate focused physical
     exam for the patient.
• If DECON of a member, PPE and/or equipment used is required, the
  Company will not be available until the situation has been rectified.
• If equipment has been left with the patient or supplies have been
  expended and the Company does not have the minimum amount
  required, the Company is to go back in service for fire duty but advise
  the DISPATCHER AND BATTALION that it is not available for CFR-D
  responses. If this occurs, the company is to IMMEDIATELY return to
  quarters and replace the equipment and supplies, and notify the
  Dispatcher when it is available for CFR-D response.
• If during a CFR-D response a verbal alarm for an additional sick or
  injured person is received, the company shall make every attempt to
  make patient contact and notify the dispatcher. If contact is made with
  the 2nd patient, the company shall not leave the scene UNTIL
  RELIEVED BY EMS OR THE PATIENT LEAVES THE SCENE.

Question 3

CFR-D CHAPTER 2: INFORMATION PROVIDED TO DISPATCH - “CHRIS AND CHARLIE CAN PLAY RUGBY”

Answer 3

WHEN REQUESTING AN AMBULANCE, COMPANIES MUST PROVIDE THE FOLLOWING INFORMATION TO THE DISPATCHER (ALSO DONE IF EMS HAS NOT ARRIVED BY THE COMPLETION OF THE INITIAL ASSESSMENT): “Chris And Charlie Can Play Rugby”

C - CUPS status

A - Age

C - Chief complaint

C - CPR initiated or not

P & R - Pulse and respiratory rate

• Patients sex is NOT needed

Question 4

CFR-D CHAPTER 2: WHEN MUST A CFR-D UNIT TRANSMIT A 10-99

Answer 4

TRANSMIT A 10-99:

1. Confirmed Cardiac/Resporatory arrest (company performing CPR)
2. When Officer determines that Company will likely remain on scene
   for 30 minutes or more.
3. When unit requests EMS ETA and EMS reports no unit available.

Question 5

CFR-D CHAPTER 2: WHEN UNITS SHOULD NOT BEGIN RESUSCITATION EFFORTS “LORD DNR”

Answer 5

“LORD DNR”

L - Lividity

O - Obvious Death

R - Rigormortis

D - Decomposition

DNR - Valid DNR

• A PCR must still be completed for DOA to document that company
  properly examined the patient.

Question 6

CFR-D CHAPTER 2: PATIENTS WHEREABOUTS UNKNOWN

Answer 6

What to do if patients whereabouts are unknown and company has conducted a complete search of the area:

1. Officer shall review response printout for additional information.
2. If after checking the information, no patient is found, officer shall
   verify the information with the Dispatcher.
3. After re-verification of the information, the company shall attempt to
   contact neighbors, superintendent and/or security personnel. If no
   patient is found, the officer shall enter a 10-92 via MDT and return
   to service. The officer shall make a notation in the COMPANY
   JOURNAL.

• If after a search the patient is located but the company can’t gain
  access to the patient, the company shall use any and all resources to
  gain access and render aid.

Question 7

CFR-D CHAPTER 2: FORCIBLE ENTRY AT CFR-D RESPONSES

Answer 7

• If after a search the patient is located but the company can’t gain
  access to the patient, the company shall use any and all resources to
  gain access and render aid.
• If forced entry is the only option:
  1. Request PD
  2. If others within premises deny access to patient, the officer shall
     immediately request PD. POLICE DEPARTMENT WILL DETERMINE
     appropriate action to take.
• Who safeguards if FE is performed? “POOR”
  Safeguarded by members until custodianship is turned over to:P - PD
  O - Owner
  O - Occupant
  R - Responsible personNote: The responsibility of safeguarding premises shall not be
  delegated to EMS personnel. This includes the arrival of PD.

Question 8

CFR-D CHAPTER 2: IF A PATIENT REFUSES MEDICAL AID

Answer 8

• If a patient RMAs, the CFR-D unit shall ensure that the patient is alert
  and oriented. The unit shall encourage the patient to remain on scene
  until EMS arrives. The unit shall notify the Dispatcher, and remain on
  scene until EMS arrives. The unit must complete a PCR, and if the
  patient leaves, the unit shall notify the dispatcher and leave the scene.
• If an EDP refuses medical aid, the Officer shall request PD and remain
  on scene until EMS arrives.

Question 9

CFR-D CHAPTER 2: CFR-D UNITS AND NYPD ESU

Answer 9

• If a CFR-D unit arrives on scene and ESU has already initiated patient
  care, the ESU EMTs retain responsibility for patient care. If ESU does
  not require FD assistance, the officer shall transmit a 10-91. If
  assistance is required, ESU has medical authority until the arrival of
  ambulance.
• If ESU arrives after the CFR-D unit initiates patient care, the CFR-D
  unit retains responsibility for patient care until a transporting agency
  assumes patient responsibility. If ESU assumes the role of higher level
  pre-hospital care provider, the company shall release the patient to
  ESU. However, if ESU is not equipped with a defibrillator, the CFR-D
  unit will retain patient care responsibilities.

Question 10

CFR-D LEGAL GUIDELINES

Answer 10

• Aid to minors: if minor is suffering from a life threatening illness or
  injury, immediate medical intervention must be provided, regardless of
  whether the parent or guardian is available, or refuses to give consent.
• If the parent or guardian refuses medical treatment, treatment should
  still be provided whenever the minor is suffering from a life threatening
  injury and it is apparent that a delay in treatment, even minimal, would
  jeopardize the minors life.
• If the illness or injury is non-urgent, treatment shall be provided unless
  the parent or guardian refuses to allow treatment. If parent or guardian
  refuses to allow treatment, unit shall explain reasons for treatment,
  consequences if treatment is not provided, notify dispatcher, call
  telemetry and remain on scene until EMS arrives.
• When a CFR-D unit suspects child abuse, they shall report it to EMS.
  The officer shall make an entry in the company journal, including the
  names of those notified and their unit designation.
• Living Will and Health Care Proxies are NOT VALID in the pre-hospital
  setting. Units shall continue treatment if presented with living will or
  health care proxy.

Question 11

DNR ORDERS

Answer 11

• DNRs are VALID in pre-hospital setting. They are only an order not to
  perform CPR. Unit should still provide other treatments, such as
  supplemental oxygen.
• If presented with DNR, officer is to notify dispatcher. The unit is to
  follow the DNR unless it has been revoked verbally or in writing.
• DNR must be a copy of the NYS Out Of Hospital DNR form. The
  patients attending physician must sign and date form, which must
  contain the patients name, date of birth, the MDs signature and
  license number and the date issued.
• A DNR DOES NOT need a current date.
• DNR bracelet is to be treated same way as a DNR order.
• Nursing homes DNRs do not have to be on a specific form, each
  facility may have their own variation. Nursing homes do not have to
  utilize the NYS Out of Hospital DNR form. THE MINIMUM
  REQUIREMENT IS THAT IT CONTAINS A PHYSICIANS SIGNATURE.
• Whenever FD units and EMS are operating at an incident, the ranking
  Fire Officer on the scene is the IC. The IC shall be responsible for all
  decisions at the scene with the exception of patient care matters.
• Members shall comply with all orders and directions of the IC
  concerning the safety of personnel. If a pre-hospital care provider
  receives an order that is detrimental to the patient’s condition,
  contrary to good patient care or in violation of medical protocols, the
  member shall inform the IC and continue providing patient care. If the
  IC persists in giving such an order, the member is required to prepare
  and forward a written statement to OMA.
• DNR and DNR Bracelets are valid in the field.
• Health Care Proxy and Living Wills are NOT valid in the field.
• The IC = The ranking fire officer is responsible for all decisions at the
  scene with the exception of patient care matters.
• Patient care decisions are made by the HIGHEST level pre-hospital
  emergency medical provider at the scene for patient care. If an EMS
  Deputy Chief is on scene and he is an EMT and there are Paramedics
  on scene, the paramedics are in charge of patient care decisions
  because they are the higher medical authority.

Question 12

WHO DOES CFR-D AT DIFFERENT INCIDENTS

Answer 12

1. COLLAPSE = 2nd & 3rd due Engine companies
2. CHEMICAL ATTACK/SUBWAY = 2nd & 3rd due Engine companies
3. HAZMAT = 1st, 2nd & 3rd due Engine companies

Question 13

HIV / AIDS

Answer 13

HIV/AIDS

1. There is no evidence that HIV can be transmitted through air, water,
   food, or casual body contact. Although AIDS is an infectious disease,
   it cannot be spread in the same manner as the common cold or
   measles.
2. There is no evidence of HIV being transmitted by the sharing of
   drinking glasses, dishes, eating utensils, toilets, drinking fountains,
   telephones, clothing, money, towels, linens, or toothbrushes.
3. There are 4 confirmed methods of transmitting AIDSA) Sexual relations resulting in semen-to-blood or blood-to-blood
   contact.B) Exposure to certain blood components (e.g. transfusions)C) Passage of blood through mucous membranes (mouth, eyes,
   nose, rectum) open wounds of the skin, or sharing of needles. This
   can include punctures through skin with a contaminated sharp
   object or contact with blood or other bodily fluids with broken or
   non-intact skin.D) From mother to fetus or newborn

Question 14

HEPATITIS

Answer 14

HEPATITIS

1. Viral Hepatitis is caused through contact with Hepatitis A (HAV),
   Hepatitis B (HBV), Hepatitis C (HCV), and other types of Hepatitis.
   Hepatitis D and E have been identified but are still under
   investigation.
2. HBV has an extended life. It can remain infectious on surfaces for
   several weeks. However, for HBV to be contagious and produce
   infection, it must enter the blood stream.
3. HCV is produced by a viral agent. It is spread through blood to blood
   and sexual contact. It can cause both acute and chronic liver disease.
   There is no vaccine but treatment is available for chronic liver
   disease. According to the CDC the risk factors include IV drugs,
   cocaine and the use of contaminated needles.

Question 15

TUBERCULOSIS

Answer 15

TUBERCULOSIS

1. TB is an airborne disease that is spread through the air when a
   person with active pulmonary TB coughs and releases TB droplets
   into the air.
2. Casual exposure does not normally result in transmission of TB. The
   TB organism does not readily cause active disease in the majority of
   people who come into contact with it.
3. Most individuals who encounter the TB organism do not become
   infected, while others may become infected but are able to contain
   the infection. These persons with TB infection but no active disease
   are not infectious. They are not sick themselves and cannot make
   others sick.
4. Disposable body bags shall be available for the transportation of
   deceased persons. They may be obtained from the DEPUTY CHIEF
   on scene. If a Deputy Chief is not on scene, the IC shall call a Deputy
   Chief to the scene.

Question 16

CFR-D 5 - PRE HOSPITAL CARE REPORTS

Answer 16

• PCR should be filled out using a black ball point pen.
• Three part form
  A) Part 1 give to OMA via bag by end of each tour
  B) Part 2 filed in quarters
  C) Part 3 given to EMS (if not given to EMS forward with part 1)
• Separate PCR for each patient
• Not required unless patient care is provided
• Completed when making patient contact
  A) Any instance where a CFR has visualized, approached,
  communicated with, initiated a history or a physical exam.
  B) Using an AED, performing CPR, administering oxygen
  C) Immobilizing, stabilizing or any other patient care requiring CFRD
• Only document care provided by CFR members
• Officer assigns members to complete PCR form, although he takes
  responsibility for its accuracy.
• All times recorded on the PCR are written in military time, four digits
  are ALWAYS used.
• Vehicle ID = enter the number of the company that responds to the
  call preceded by a “5” for an Engine company, “7” for a
  Ladder company, “8” for a Squad company, and “10” for
  a Rescue company.
• First/last name = print patients first/last name in designated boxes,
  use only letters NO APOSTROPHIES, DASHES,
  PERIODS OR SLASHES.
• If there is not enough space available for entire name, fill in as many
  letters as possible.
• If unable to obtain name, a description of patients gender preceded
  by “unknown” shall be written in these boxes (ex: Unknown male).
  This area shall NEVER be left blank and “Jane/John Doe” shall not be
  used.
• Address = enter the patients mailing address as completely as
  possible. If unable to obtain address, this area shall be left
  BLANK.
• Social Security Number = enter patients 9 digit security # if known. If
  this number is unobtainable, leave blank.
• Extrication required = If patient had to be extricated whether from a
  motor vehicle or any situation where
  extraordinary measures and/or equipment must
  be used to disentangle a patient for treatment.

      A) Details of situation that required extrication should be entered 
          in the Comment section.
  
      B) Enter the number of minutes required to extricate the patient 
          determined from the time the unit is "at scene" until the patient 
          is free to be removed.

• Chief complaint = enter patients statement of problem IN HIS OR
  HER OWN WORDS (“My chest hurts”). If the patient
  is unresponsive write “patient unresponsive”. If
  someone other than patient tells you the chief
  complaint, write EXACTLY what was said and who
  said it (Mother states “My baby is sick”)
• Vitals = note the time each set of vitals is taken, if vital signs cannot
  be obtained, indicate the reason why in the “comments”
  section. A minimum of 1 set of vitals is required for all adult
  patients except for cardiac arrests and DOAs. For cardiac
  arrests and DOAs, respiration and pulse are documented as
  “0”. Blood pressure is not taken and the space is left blank.
• Treatment given = All treatment given shall fall within the scope of
  practice of a FDNY CFRD regardless of the level of
  certification.

     A) CPR in progress on arrival by...only use this section to 
         document cardiac arrest care that took place prior to the arrival 
         of the CFRD company. If this is indicated, units shall also 
         document who was performing CPR at the time of their arrival.
  
     B) Citizen - any mom trained person administering patient care.
  
     C) PD/FD/Other 1st responder - a member of the Police and / or 
          Fire Departments or a Certified First Responder.
  
      D) Other - A NYS certified pre-hospital care provider, physician or 
                       nurse caring for the patient.

• Crew = names and certification numbers of the CFRD certified
  members who provided patient care…name of the member in
  charge of the call shall be entered in the first box and the
  second CFRD certified members name shall be entered into
  the second box (drivers name). If the chauffeur does not
  provide patient care, DO NOT enter his or her name on the
  PCR. If there are more than 4 CFRD certified members on the
  call, lost the additional names in the comment section.
• Circle the name of the member completing the PCR.

Question 17

CARDIAC ARREST / AED

Answer 17

Whenever a CFRD company applies and turns on their AED during a cardiac resuscitation attempt:

1) Fax original PCR to OMA immediately upon return to quarters.
Document AED serial number on PCR.

2) A COPY of the PCR and the AED module turned into CFRD depot.
3) AED exchanged for a new one
4) CFRD DEPOT OFFICER will forward AED and copy of PCR to OMA

Question 18

PATIENTS CUPS STATUS

Answer 18

1) C - Critical - Person is either CPR, in respiratory arrest or requiring
and receiving life sustaining ventilator/circulatory
support.

2) U - Unstable - Poor general impression, unresponsive without a gag
reflex, responsive but unable to follow commands,
difficulty breathing.

3) P - Potentially Unstable - Pale skin, complicated childbirth,
uncontrolled bleeding, severe pain, severe
chest pain, inability to move any part of the
body.

4) S - Stable - Minor illness, minor isolated injury

5) Critical/Unstable patient = packaging efforts must begin immediately
while treating life threats.

6) Potentially Unstable/Stable = perform appropriate focused physical
exam on the patient.

7) FD personnel will begin resuscitation efforts unless one of the
following conditions exist “LORD DNR”

     A) Lividity
     B) Obvious Death
     C) Rigor Mortis
     D) Decomposition
     E) DNR