EMS policies Flashcards
What is the definition of a defusing?
An on scene assessment of personnel exposed to an incident.
What is the definition of a debriefing?
Structured discussion taking place 24-72hours after and incident.
A request for activation of the CISM team should go through who?
Dispatch from the incident commander.
Who schedules units OOS for a debriefing?
CISM coordinator and or Incident commander.
Property damage and bodily injury reports include what?
loss or damage to county property and or property belonging to members of the public- NOT ARISING FROM A VEHICLE ACCIDENT
damage or losses to county property will be reported to who?
immediate supervisor.
All injuries sustained at a county facility should be handled how?
Notify dispatch for an incident #
Tracking # from the FOO
complete medical report
property and liability report faxed to risk mgt and BC.
How are stretcher malfunctions handled?
Remove from service Tag with "DO NOT USE" OUT OF SERVICE Contact FOO for rescue OOS and sequester stretcher @ HQ Contact EMSAR technician Contact manufacturer of stretcher- Ferno or stryker Contact District captain complete I-43 for pt's that are injured Complete I-43 for stretcher malfunction Complete injury form for personnel if necessary Complete supervisor report form Place in IBEM as High priority Notify CQI Notify central shop
Who is the clearinghouse for all citizens complaints?
Operations division.
Which complaints can be documented on the Citizens complaint form I-51?
incidents, procedures, and personnel
After taking the complaint and filling out the complainant section, what happens next?
Must notify the BC verbally.
If the BC is not available to notify verbally of a citizens complaint, then what?
Notify the DC or supervisor of the complaint before transmitting.
Where is the tracking number obtained for a citizens complaint?
Fire rescue administrative secretary or FOO
Who handles complaints based on Fire Codes?
BOSS
In complying with county’s discrimination and sexual harrasement policy “personnel are prohibited from:”
- using a county computer to send offensive jokes or material
- using a county computer or connection in a county facility to connect to a site that is sexually offensive.
- Displaying material offensive to others
- Viewing programs, cell phones pictures or network sites that are offensive
- Sexting or texting which may be offensive
What actions can a supervisor take to address sexual harassment or discrimination?
Assure the inappropriate behavior is stopped
Speak to the persons directly involved
Document the incident
Issue a counseling form
Where should documentation for harassment of sexual or discriminatory nature be logged?
Station log book or memo
PBCFR __________sexual relationships between a supervisor and a subordinate.
STRONGLY DISCOURAGES
Where can a person file a charge of sexual or discrimination?
Office of internal affairs for Fire Rescue
Diversity and development section of PBC human resources
(FCHR) Florida commission on Human relations
(EEOC) Equal opportunity commission at Miami
PBC (OEO) office of equal opportunity
How long is the time frame to file a sexual harassment or discrimination claim?
EEOC or OEO- 300 days
FCHR- 365 days
What are the 4 parts to the workplace violence policy?
- prohibited behaviors
- identifiable characteristics
- warning signs
- response to violent acts or threats
What are prohibited behaviors? 7 of them
Hitting, kicking, punching, slapping, shoving, an indivdual
Threatening harm to an individual, his/ her family , friends, associates
Intentional destruction of property owned or operated by dept
Making harassing calls, letters, electronic communication
Foul language to another in a hostile manner
Intimidating or coercing and employee
Harassing surveillance- “stalking”
What are the identifiable characteristics?
35-50 y/o male
prefers own company
fascination with weapons or military subjects
Displays few outside interests
Equates job to self-esteem
Hx of interpersonal conflicts
Sense of entitlement
exhibits extreme views, paranoid behavior
experienced a stress such as health or family
Displays unwelcome comments or behaviors at work
Senses real or perceived danger of discipline
What are warning signs?
threats to self or others inappropriate anger and rage Despondence Persistent perceptions of injustice Erratic behavior Violence against a family member. obsessive harassment and stalking paranoia and delusions substance abuse
If an employee observes any warning signs in another employee, who gets notified?
The next level supervisor- ultimately to a minimum level of the deputy chief
How are “non-imminent threats/ danger” handled
Report immediately to their supervisor unless it is the supervisor and then report to the next level supervisor.
Next is forwarded to the minimum level of Deputy Chief.
How are Imminent threats or dangers handled?
Immediately make a call to 911
secondarily call FOO or dispatch
Notifications to District Captain, DC, BC, division chief, Deputy chief
Once a citizens complaint investigation is completed by the District Captain or DC, who gets notified?
BC
A, IRE or immediately reportable event includes what?
an event that occurs anytime emergency calls training public education emergency or non emergency situation.
What are examples of IRE- immediately reportable events?
- Action or inaction that caused harm to a member of the public, patient, or employee
- Equipment failure that “…..”
- Any on-duty event that is illegal, unethical or immoral
- Potential for litigation
- politically sensitive or have ramifications
- event that causes the media to scrutinize the department
How are notifications made for an IRE?
Employee must notify their supervisor as soon as possible and can be done by telephone or face to face.
When does an IRE need to be reported?
as soon as witnessed or becomes aware
When may the district chief be contacted directly?
If the next level supervisor is not IMMEDIATELY available.
Who may deem a unit of of service in regards to an IRE?
District chief or equivalent supervisor
What are the steps in dealing with an IRE?
Initiate preliminary investigation collect statements from persons collect contact information make sketches take pictures replace items and put unit back in service
When does the IRE form need to be completed?
By the end of shift
What is a DRE- delayed reportable event?
” That had the POTENTIAL to do harm but did NOT result in harm”
Who secures items during an IRE?
Personnel will secure items and leave them undisturbed as is practical. The DC or equivalent supervisor will maintain security of items.
For reporting a DRE, who completed the form and by when?
Personnel who first reported the event- complete the Reportable event form by the end of shift.
When can an individual be referred for remediation or discipline with regards to CQI?
If found that the individual has a repeated pattern of errors
What are the most common means of reporting events to CQI?
field personnel via chain of command
Via Reportable event policy with the exception of using the form for ems
hospitals via complaint
patients via complaint
What are the definitions of the categories of EMS CQI?
adverse event
near miss
error
What is a adverse event?
an incident causing injury or other medical condition as a result of treatment by personnel rather than the underlying condition-
(causing more harm)
What is a Near Miss?
where an incident had the potential to do harm as a result of treatment by personnel but DID NOT harm the pt.
What is a CQI error?
failure of a planned action or the use of the wrong plan
EMS CQI reports are to be reported how?
via Email.
What are examples of adverse events and near misses that should be reported to the EMS CQI officer?
Airway issues
electrical therapy issues
protocol deviation issues
advanced procedure issues- paralytics, cric, decompression
repetitive minor issues
other issues that cause or has potential to do harm to a pt
What issues are to be EMS CQI but handled at the battalion level?
Spelling and typographical errors
lack of detail
intra-report inconsisentcies
protocol deviations without pt harm and have LITTLE potential to do harm.
Minor errors identified at the EMS CQI officer level shall be emailed to who?
district captain.
Possible committee recommendations after analysis from CQI are?
System faults for changes in policy, procedure, aor protocol
Learning points or lessons learned
crew remedial training.
EMS protocols and procedures shall be reviewed how often?
periodically
Responsibility of accurate inventory of controlled substances on a ALS unit are who’s?
Each paramedic, lieutenant, company officer
When are controlled substances to be inventoried?
At each change of custody
Where are controlled substances stored on the EMS captains units?
in a metal box with a keyed locking mechanism
Who has the responsibility for controlled substances if the assigned person is unable to continue in that capacity?
Company officer
Where must the controlled substance log be kept?
on the unit in the same vicinity as the controlled substances container.
What is the first order of business for off going and on coming crews?
inventory of the controlled substances
What shall be documented in the Controlled Substance inventory log?
Control number or lot number
expiration date of each individual medication
After using a controlled substance when must the box be re-sealed?
immediately after removing the necessary medication
or as soon as reasonably possible thereafter.
What are the controlled substances log form numbers?
V-09A- controlled substances inventory log
What 2 forms must entries be made when replacing controlled substances?
V-09B Controlled substances distribution log
V-09C EMS captain controlled substance distribution log
What is the procedure for reporting broken or altered controlled substances?
report immediately to the EMS captain
EMS captain to notify the rescue division
Complete I-43 loss/ damage to county property
“Broken “ to filled in case/ incident number column
What is the procedure for reporting missing or lost controlled substances?
notify EMS captain immediately
EMS captain to notify the rescue division- after hours (PAGED)
off going EMS captain to remain until rectified and released by the on-going captain.
report I-43
How are missing drug logs handled?
The same way missing or lost controlled substances are.
How are expired controlled substances handled?
return drugs to the EMS captain
“EXPIRED” will be written in the case/incident column
Schedule III and IV drugs may be disposed of by EMS captain
Schedule II - fentanyl must be hand delivered to the rescue division
“EXPIRED/ WASTE” to be written in V-09C case/incident column
What are the Scheduled controlled substances?
II- fentanyl
III- versed
IV- ketamine
What are the minimum par quantities of Controlled substances to be carried on each unit?
Rescues Engines EMS capt SPLOPS
Fentanyl (4) 100mcg (2) 100mcg (15) 100mcg ——–
Versed (4) 5mg (2) 5mg (15) 5mg (30) 10mg ***
Ketamine ————- ———— (5) 500mg ———
How does the EMS replenish battalion level controlled substances?
ON- duty EMS captain to notify rescue division and pick u in person.
EMS captain to sign the “controlled substance perpetual Inventory log”
Battalion level procurement of non-controlled substances is in accordance with which policy?
IV-4
What is the temperature range for storage of medical supplies at the station?
70-75 degrees
What is the temperature for storage of medications and fluids on emergency vehicles?
65-80 degrees
What is the rotation of medications order?
Blue bag rescue - Closest expiration date
Backup on rescue
Blue bag on Engine
Supply closet station- Longest expiration date
Expired medications that are not controlled substances are to be kept where?
in a designated “quarantined” area in the station supply closet.
What may expired medications be used for?
approved training purposes
What are the 6 rights of medication administration?
Right Patient Right Route Right Dose Right Medication Right Indication Right time and frequency.
If medication errors are made how are they handled?
immediately report to receiving physician and then immediately report to EMS captain.
Exposure control manual addresses which areas 5 of them?
Exposure risk measures for prevention exposure determination care and cleaning biomedical waste.
What is the definition of a “significant exposure”?
1. exposure through needle stick, instruments or sharps to the following body fluids: Blood or any body fluid containing visible blood semen vaginal secretions CSF synovial fluid pleural fluid peritoneal fluid pericardial fluid amniotic fluid.
- exposure of mucous membranes to fluid listed above
- exposure to skin that is chapped, abraded, dermatitis w/ fluid above
- exposure to airborne contagions- ie TB
What type of significant exposure does not meet the criteria for HIV testing on a source pt?
Airborne contagions
What are the measures to be taken after a significant exposure?
Clean the wound
Notify the EMS captain
Employee to accompany the source pt to hospital
Complete physician notification form V11-A
Advise physician about significant exposure and request pt be tested
Agree to be tested for HIV antibodies V-IIC
Follow hospital guidelines for post exposure tx., 1-2 hours
Fill out hospital’s exposure book using incident # for confidentiality
Complete PBCFR exposure form prior to the end of shift
Report to the Occupational health clinic immediately or next day
Discontinue post exposure tx when contacted by clinic pt is neg
Follow precautions after exposure- laundry, sex, blood donations
Send all documents to exposure control officer.
What are the Supervisors responsibilities post significant exposure?
Make sure exposure form is completed prior to end of shift
Fill out supervisor incident report
Fill out casualty section in ARI
Injury tracking number from FOO
All documents to the exposure control officer.
What are the EMS captains responsibilities post significant exposure?
- Make sure employee requests source testing on pt
if hospital doesn’t comply consult ER physician, then Medical Director - Notify the Exposure control officer asap during normal hours
- IF employee receives post exposure tx, or unusual, or emergency situation have the communications center page Exposure officer Anytime.
- Contact the hospital to ensure source testing and f/u instructions
- Contact the health clinic
- Ensure exposure form is completed before end of shift
- Ensure completeness of forms
- Forward forms to exposure control officer.
