Policies and Procedures

Policies (Downloadable PDFs)

Most of these pdfs can also be accessed from the Connecteam app.

Protocols

The protocols are also in the Connecteam App in a tree format that is searchable and easy to navigate. You can download a pdf copy below.

Procedures

Procedures are the way we do things on a day to day basis.

General

Shift Duties

Updated 11/01/2021

Beginning Shift Responsibilities:

• Ensure assigned ambulance
• Alert Dispatch with unit # and Both Crew Members DSN’s or last names
• Check your assigned ambulance and restock as needed as a crew.
• Log onto IOps360 and check for:
  • Daily Schedule and Events for that day
  • Check Notifications
  • New Memos
  • Check for Required Training (Con Ed) that needs to be completed
  • Check certifications expiring soon
  • and other items that need review or completed
• Log into Staff Center
  • Check Administrator Messages
• Log In to the ESO system for:
  • Messages from QA for items that need correction
  • If there are items that need correction, please correct as soon as possible
  • Check service announcements
• Check your mailbox in the front office 

Beginning Shift Responsibilities should be completed prior to any other activities except for responding to a call and other work duties.

During your shift:

• Complete Daily Day shift Duties / Projects at After Round Table Meeting – All Ambulance Crew Members Together
• Complete Daily Night shift Duties at 21:00 – All Ambulance Crew Members Together
• Respond to calls that are dispatched without delay
• Complete your patient care reports
• Perform any needed online training
• Respond to requests for community events as assigned
• Ensure all areas of the District are presentable always
• If you make a mess, clean it up immediately

30 minutes prior to the end of your shift:

• Ensure your ambulance is restocked and resupplied.
• Ensure fuel is above 3/4 tank.
• Ensure the Large O2 tank has a minimum of 300psi available.
• Ensure the cot O2 tank has 100psi available.
• Ensure all trash and laundry are removed.
• Ensure the back of the ambulance is mopped and ready for the next shift.
• Ensure cab of the ambulance is cleaned with all trash and personal items removed.
• Ensure the ambulance is washed and clean on the outside for the next shift.
  • If the crew is late tripped crew will not stay to wash outside of the ambulance.
• Ensure ambulance is plugged in.
• Ensure any messes you made from your shift are cleaned up.
• Leave at the end of your shift once properly relieved by oncoming personnel.
• Complete Hours Change Request if hours worked were not what you were scheduled.
• Before the end of your shift, remove all personal items from bedroom and ready it for the next person. No staff should have personal items in bedrooms while not on duty.

Completion Times/Dates

• ePCR reports shall be completed before the end of the shift that the trip occurred in.
  • If you can not complete your report by the end of your shift the Administrator or Supervisors need to approve waiting.
  • If the Administrator or Supervisors are not available and the run ended within an hour of your off time, enter in the trip log, start the report on ESO (Minimum of Trip Number Entered), and enter the form on the online form for incomplete trips.
  • Trips that are not completed as above must be completed per the following schedule:
    • Full time and Part Time staff need to complete in the first 4 hours of your next shift. Note if your not scheduled any shifts for more than 7 days, refer to timeline for PRN and Reserve.
    • PRN and Reserve need to complete trip within 3 days.
  • In any account if you are “Late Tripped” it is still preferred that you stay and complete your paperwork.
• Training assigned by the Administrator should be completed in the shift you are currently working, or on your next shift if off duty while reading the assignment.
• Any Assignment or activity the Administrator assigns a due date and or time to, must be completed by the due date and or time.
• If you are unable to make a due date and or time for any reason, it is your responsibility to contact the Administrator and get approval for an alternate due date and or time.  This must be done in a reasonable time before the original due date and or time, and only for valid reasons.

Duties/Chores

General

It is expected first and foremost that you pick up after yourself.  If you make a mess, clean it up right away.  This is the same for dishes. When Cleaning the rooms/areas listed below every part of that room should be cleaned. This includes but is not limited to walls wiped down, cobwebs removed, door and window sills wiped down, floor mopped, carpets vacuumed, appliances wiped down, drawers cleaned, cabinets cleaned, shelves dusted or wiped down, glass cleaned, toilets cleaned with proper cleaning agents, items replenished, clutter removed, etc. Dayshift 9am – Do the Color Assigned on Schedule / Nightshift 9pm – Do Nightly Duties Updated 2/15/2021

Green – A

Empty Trash Cans if 1/2 Full. (Check all!)Front Paperwork Room / Front Bathroom Kitchen Living Room Bedrooms Outside Walk Around removing Trash and Debris 

Blue – B

Empty Trash Cans if 1/2 Full. (Check all!)Front Paperwork Room / Front Bathroom Classroom Back Bathroom Exterior Windows Cleaned 

Red – C

Empty Trash Cans if 1/2 Full. (Check all!)Front Paperwork Room / Front BathroomSupply Room Storeroom (Laundry) Bays – Sprayed and Squeegeed Air Conditioner Cleaned (Weather Appropriate)  

Nightly

Empty Trash cans that are over 1/2 full. (Check all!)Removed clutter from Front Paperwork Room. Mop Front Paperwork Room & Bathroom General walk-through to ensure no clutter of entire inside  

Patient Care Reports

Per state law a Patient Care Report (PCR) will be completed for each call for service (Dispatch).  A Separate PCR will be entered for each patient encountered. PCR should be completed as soon as possible after the transport has been completed to ensure the best recollection for that encounter.  At worst each report must be completed prior to the end of the duty shift. Each PCR will documented in the ESO system.  Data elements will be completed as thoroughly as possible and all data elements should be included unless they are not applicable. Each PCR will include a narrative that will include all the elements below.  The only elements that may be omitted are not applicable items… Example: Movement at Destination on a refusal would be omitted. 

1. Dispatch and Response
   1. Dispatched by who
   2. Dispatched for what reason
   3. How you responded
   4. Other dispatch or response pertinent details
2. Scene Description
   1. Units on Scene
   2. Location and Position of Patient
   3. General Impression and Level of Distress of the Patient
   4. PPE Used on scene besides gloves
   5. Other pertinent scene details
3. Movement at the scene
   1. How the patient got to your stretcher
   2. Position transported in.
4. History of present illness or injury
   1. Chief Complaint
   2. Associated Complaints
   3. What’s the story behind why you are there?
   4. Statements from Patient, Bystanders, and other providers
   5. Other pertinent HPI details
5. General Assessment and Focused based on Complaints.
6. Diagnostic Testing and Address abnormal findings found.
7. Provider Impression (Separated so it is clearly seen)
8. Treatments Provide to include reason, treatment, and result.
9. On Going Assessment and changes
   1. Continuous monitoring
   2. Re-evaluate previous complaint and assess for change
   3. Other changes
   4. Contact with Receiving Facility
10. Destination Details
    1. Movement at Destination
    2. Transfer of Care
    3. Overall Change in Patient from Initial Presentation
11. Other Items of Note

 Additional Situations Cancelled En-routes

• Who cancelled you and why cancelled.

Refusals

• Document offer of transport at least twice.
• Document a refusal of offer to transport.
• What the patient is doing, example: patient going to ER via private vehicle.

Returns

• WHY the patient you are taking needed an ambulance.

Dead on Scene

• Disposition of the body.
• Who contacted to determine death.
• Who and why cancelled. Also, still need the responding to the call part of the scene area.

Emergency Drivers should be listed in the crew section and should be noted in the narrative that an emergency driver was used for the benefit of patient care.

Controlled Substances

Locations

All controlled substances will be in one of the following 3 locations

• Locked in the Administrator’s Office
• Locked in the controlled substance cabinet in the ambulance

Daily Count

• The controlled substances that are in the ambulances will be counted daily and signed by 2 staff members with at least 1 staff member being a Paramedic or Nurse.  This include in service and out of service ambulances.
• Counts will be done with 2 people present at the time of opening the cabinet.
• Counts will show Unit, Date, Counts of each controlled substance, and signatures from 2 staff members.
• Any irregularities of the log discovered through daily count, will an incident report will be made.  Please copy the log and place the copy in the Administrator’s Mailbox.
  • If you can not sign where you are supposed to, do not draw lines to do so.  Just fill out an incident report and copy the log and place copy in mailbox.
  • If you sign where you are not supposed supposed to, do not draw alter.  Just fill out an incident report with exactly what happened and copy the log and place copy in mailbox.

Monthly Checks

• Each month (On assigned day) the controlled substance box will be opened.
• Dates will be written down for tracking of future out dated medications.
• Each controlled substance will be inspected to assure that no tampering has taken place.
• Box will be retagged and documented that “outdates” were the reason for opening the box.

General

• Paramedics and Nurses are the keepers of the narcotic keys. In the case of a BLS Crew, the senior EMT will keep the key, but box should not be accessed without a paramedic or Nurse present.
• Keys should be passed from crew to crew during shift change.
• Controlled substances will remain in a tagged clear container.
• When a tag is broken for any reason, documentation on the controlled substance log must be made,

Outdates

• If an out dated controlled substance is found it will be documented as moved to “outdates” on the controlled substance form and given to the Administrator.
• Out dated controlled substances will not be discarded.

Restocking

• Restocking will be done through the Administrator
• In an emergency, verbal permission can be given to Office Manager may allow access by 2 paramedics/nurses.  

Missing Controlled Substances

• In the event that a controlled substance is suspected as missing, an immediate incident report must be made and Administrator must be contacted as soon as possible.

Breakage

• In the event of breakage of a controlled substance, an incident report will be made and the container will be kept and safely given to the Administrator.

Usage

• Any use of Controlled Substances during patient care must have complete documentation including all of the following:
•  
  • Document usage in the ePCR report.
  • Document Waste in the ePCR report.
  • Document usage and waste in the ambulance log book in the ambulance.
  • Document usage and waste on a Controlled Substance Usage Report. Attach the report to the documents of the ePCR, place 1 copy in the folder with the paperwork, and place 1 copy in the mailbox of the Administrator.

Response

Ambulance Rotation

Normal Ambulance RotationAll three Ambulances In-service:6a incoming moves to the ambulance that was not used the day before8a incoming moves to the ambulance that the 6a crew from yesterday was inOne Ambulance Out of Service:Both crews remain in the same ambulances.Maintenance Caveat:If an ambulance is scheduled for maintenance or deep cleaning/inventory that day, don’t rotate into it.If the 6a crew could not rotate, then the 8a crew stays in the one they were in. 

First up call rotationCrews are second out for 29 minutes at the beginning of their shift and second out 90 minutes before the end of their shift.When crews are both outside of the times above, second out will be the crew that has done the last call.A call is any response that generates a run number.If there is a crew change at 6:00 p.m. or 8:00 p.m.  the oncoming crews will fall into the call rotation wherever it might be.There may be times when a crew runs back to back calls for whatever reason.  This is the luck of the draw of EMS.

Responding to Calls

The primary function of all staff is to respond to emergency calls.When crew members are dispatched to a call they will make every effort to immediately respond to that call for service. No matter what the rotation, if you are closer to a dispatched emergency call, you are to respond.

• If it is close to shift change, the and the other crew is available they can also respond and if time and situation permits, the crew remaining on duty can transport.

Response Mode to Scene

Andrew County Ambulance District Policy States the following: Responding to a call:The crew is responsible for the mode of response to the scene based upon information available at dispatch. Response mode may be altered based upon additional information that is received by the dispatch center while the EMS vehicle is enroute to scene.Lights and sirens are allowed while responding to a call involving a patient who presents or is in good faith perceived to present a combination of circumstances resulting in a need for immediate medical intervention.This procedure is an extension of the policy stated above. With the fact that Dispatch is provided by another agency, and that agency is not utilizing EMD protocols or not relaying those to us, we must have a guideline showing what conditions would meet the policy of need for immediate medical intervention.  The following list is a compiled list of conditions that generally should be considered to meet that guideline in order to respond with Lights and Sirens to the scene to provide an ALS Assessment and treatment and transport of the patient:

• Altered LOC / Decreased LOC
• Dyspnea
• Syncope
• Abnormal Vital Signs
• Acute Pain
• Pain unknown if actute or not.
• Unknown bleeding
• Severe Pain
• Chest Pain
• Abdominal Pain
• Head Pain
• Unknown injury
• Vomiting
• Burns
• MVC
• Seizures
• Overdose
• Suicide attempts
• Stroke Symptoms or Signs
• Choking
• Drowing
• Allergeic Reaction / Anaphylaxis
• Animal Bite to unknown location
• Gun Shot Wound
• Knife Wounds

• Any other condition the crew feel present a potential for need of immediate assessment.

One Stop:If either member of the crew decides that Lights and sirens should not be used, for either response or transport, the response will be no lights and sirens. If the policy above is utilized by the crew because of a disagreement, both members will create an incident report and the Administrator will review. Additional Guidelines: There may still be times when running Lights and Sirens is not best for the situation.  But that should be the rarity rather than the rule.

Providing Mutual Aid for a Scene Response

If we have 2 crews available we can respond immediately to any neighboring county at their request.

Responding To Call With Another Agency Onscene

In the case where you arrive and another agency is onscene:

1. Obtain report from onscene agency.
2. Unless there is a specific reason that the other agency needs to transport the patient, you assume care and treat and transport the patient.
3. If there is a specific reason the other agency should transport and is willing:
   1. Allow them to transport
   2. Complete a patient care report
   3. Complete an incident report with specific details of why you felt it was in the best interest of the patient to be transported by that other agency.

Fire Standby

• We will respond Non Emergency to any working structure fire, fire alarm, smoke showing, flames, etc.

• We will respond Non Emergency for any fire that is not extinguished in 5 minutes upon arrival of fire department.

• We will respond Non Emergency for any request from a specified fire department.

• We will respond Non Emergency for any call where evacuation of large number of people are possible (Schools, Nursing Homes, etc)

• We will respond Emergency to any scene where a potential patient has been identified.

Dispatching First Responders

Bolckow / Fillmore / Rosendale First Responders

• Paged through Andrew County Sheriff’s Department
• Crew can request for:
  • Severe Chest Pain
  • Severe Respiratory Distress
  • Severe Traumatic Injury
  • Unresponsive
  • Cardiac / Respiratory Arrest
  • Expected Ambulance Delay
  • Request of on scene Police or medically trained personnel
  • Request of on scene ambulance crew

Savannah First Responders

• Paged Through Andrew County Sheriff’s Department
• Crew can request for:
  • Cardiac / Respiratory Arrest
  • Expected Ambulance Delay
  • Request of on scene Police or medically trained personnel
  • Request of on scene ambulance crew

Cosby / Helena Fire Department (ONLY ONCE YOU HAVE ARRIVED ON SCENE!)

• Paged by Andrew County Sheriff’s Department
• Can be sent for:
  • Emergency Driver
  • Lifting Assistance

Documentation of Savannah & Cosby First Responders

• When Savannah or Cosby First Responders are utilized
  • Document in your PCR the name of each First Responder on the scene.
  • Mark on the envelope turned into the office in the corner by the trip #, the words “First Responders”

Emergency Drivers There are 3 requirements in order to allow anyone to driver the ambulance.  You need to point blank ask these three questions before allowing anyone to operate our truck:

1. Are you an active member of the police or fire department?
2. Do you possess a valid Missouri Driver License? (Best to see it, but I understand emergencies)
3. Do you have experience in operating emergency vehicles?

When someone drives the ambulance you need to put them as a crew member on the report.After their first name in the ESO you need to put (Fire) or (Police) which ever they are in parenthesis 

Hazardous Materials

A hazardous Materials incident can be very serious Andrew County Ambulance District will only respond to a HAZMAT scene once Incident Command and a “Safe Zone” has been established.  ACAD will remain at all times in the “Cold Zone” or “Safe Zone”.

Ambulances will not respond until an exact threat has been identified and the “Safe Zone” has been established.

Trip Sheets

Ambulance Reports / Trip Number

Each ambulance response for a call for service will receive a unique “Trip Number”. The following guidelines are for the Trip Numbers

• An ambulance report will be written for each time using the trip number:
  • Request from Andrew County Sheriff’s Department Dispatch
  • Walk in request to the ambulance district.
  • Phone request that results in a responding ambulance.
• Cancelled trips will have 1 trip number.  Each Patient seen will receive a separate trip number whether they refuse or are transported.
• Each time you interact with a patient it will be considered an encounter with the following two exceptions:
  • Interacting with someone who is not a patient, did not call for help, or is not someone that someone else called to check on.
  • A routine blood pressure check that is without symptoms and without readings that are outside normal limits.
• Trip sheets will NOT be pulled, but will be pulled if a patient encounter takes place:
• Fire Standby (Changed 5/22/2019)
• Football games
• Community Outreach
• BP Checks
• On any event that a trip sheet is not pulled, it will be logged as a community engagement.
• Once a call is dispatched, even if it is cancelled before you go en-route, there will be a trip written on it with a trip number.

Assigning Trip Sheets

• Once you return to the station from a call that you need a trip number for you must immediately assign yourself to the trip on the trip log.
• You will take the next available number in line.
• There should never be any blanks in the trip log.
• If there are any issues, contact Administrator immediately.

Trip Sheet Paperwork:

• Once you have everything scanned, place the paperwork in a Clasp Envelope and close with the clasp.
• In the top right corner with long edge up and clasp side to back and right, write the trip number in an easy to read size in ink or marker.
• If the trip is a refusal, write “10-22” or “refusal” under the trip #.
• After you have done that there is a locked cabinet in the front office that has a slot on the top. Slide the envelope into the top of cabinet.
• Make sure you have everything you need before you put it in there since you cannot get it out without an office person to open the cabinet for you.
• There should always be at least an attachment of the dispatch sheet.  In the rare case that dispatch does not make a sheet and refused to make one, you should write on a piece of paper “Dispatch refused to make a sheet”  and attach that.  There also should always be an envelope in the file also.

Responding Off Duty

Staff members that are off duty may respond to assist ambulance crews on calls within our service area.  The following will be observed when responding:

• Staff members are not issued blue light cards and will respond by following all traffic laws.
• When arriving on scene before the ambulance, remember all safety guidelines.  if you do assess the patient, you need to give patient handoff report immediately upon arrival of the ambulance crew.
• When you arrive after the ambulance, present yourself to the ambulance crew and offer assistance.  They have the scene.  If they use you fine, if they don’t, then depart from the scene.  The ambulance crew has the scene.
• This is voluntary and done without pay.
• Thank you for being an awesome team member and patient advocate by offering your time to help!

Community Engagement

Community Interaction is of utmost importance to the District.  These are the general guidelines for Community Engagement. Community Engagement consists of:

• Community Information
• Community Education
• Community Relations

Community Engagement Team:Will consist of volunteer District staff who are tasked with planning community engagement events and programs General Operations for Community Events:The following are the different types of coverage for events

• Level 1 – Dedicated (Will not leave unless life threat is present elsewhere) (this is usually a paid event) (Will be listed on Crew Schedule)
• Level 2 – Cover when not on calls (Means someone needs to be there until over – Unless on calls)
  • On long events, crews may switch out as they determine is best. (each crew is different, work it out!)
  • If covering for event with large amount of people, stay until majority of people have left.
• Level 3 – Make an Appearance
  • Stop by and say hello – Make sure you are seen and you appear happy to be there. (Generally 15-30 minutes) It is a judgement call how long to stay.  Try to arrive early and get a sense of how long you should stay.  
  • Tours of the ambulance should always be available
  • If there are large amounts of people make arrangements to stay longer or take turns with other crew.
  • There may be times when crews are sent to events where food is served or offered.  It is not mandatory that the crew eats.  A polite no thanks will suffice and it is still appreciated that we attended to be seen.
• Level 4 – Special (Will have special notes about the event – Read those notes and follow them)

Start time on the events means that you are at the event at that time (This does not mean leave shed at that time) If switching due to shift change or long coverage, crew has to arrive and make contact with other crew before first crew leaves. Each member of the crew is responsible to ensure community events are covered and covered in a positive way.The Community Events box on the dashboard is meant as a quick look feature only After you see there is an event you must check the main Events Calendar page to determine the level of the event. If it is still unclear or there is any question then treat it as a cover unless on calls. Community Event InformationWhen gathering information for a community event or potential try to obtain as much as possible of the following:

• Date of Event (Mandatory)
• Start and end time (Mandatory)
• Location of Event (Mandatory)
• Type of Event
• Activities of Event
• Number of people expected
• Ambulance positioning and egress (Where to go and how are you going to get out)
• Any other important notes

Approval

• Events that require using District Funds must be pre-approved by the Administrator.
• Events that present early should be approved by the Administrator to attend.
• Events that present on the day of the event and cost nothing, can be approved by crews.

Community Engagement Documentation

• This is reported each time on a separate tab in on the trip log.

Conclusion: Community Engagement is important to the continued support our community gives us.  It is one of the values of the District.  This needs to be a high priority for all staff members. 

Human Resources

Call Outs

Call 816-897-0549 – Tell them your name, your shift, and reason for calling out Do not leave a message.  

If no one answers, call back. 

Uniform Procedures (Updated 9/13/21)

Ambulance Personnel Uniform Procedure It is accepted that the majority of shifts scheduled at ACAD are 2 back to back 12-hour shifts.  It is also accepted that 24 hours is a long time at work, and it is reasonable, at times, to wear something beyond the normal uniform. At the same time, it should be noted that we should keep a professional appearance for the public. This procedure addresses this.

Wearing of the Uniform

• Staff must wear “Full Uniform” in Public Areas.
  
• Staff may wear “Modified Uniform” when in Staff Areas.
  
• Staff may wear “Modified Uniform” from 3pm to 7am in the front office, and in the front area of building and pads when washing trucks, so long as there are no meetings, trainings, or commuity events ocuring at the district at that time.

Staff Areas: Staff area that is considered private for staff only are the kitchen, living room, 4 bedrooms, classroom, bays, stock room, dirty linen room, back stock room, and back bathroom. In order for those areas to be considered private and staff areas, the door between the front paperwork office and the living quarters must be closed.

Public Areas: Public areas are Front Paperwork Office, Office Managers Officer (Unless locked), Administrator’s Office (unless the door is closed) front bathroom, and anywhere outside of the building.

If there are meetings, training, or community events all areas are Public Areas at that time except bedrooms.

Changing Areas: Changing may only be done in bedrooms and bathrooms. 

“Full Uniform” for Ambulance Personnel: Navy Blue T-Shift, Navy Blue  Polo, Navy Blue Sweatshirt, Navy Blue hoodie with ACAD Logo and ACAD name. EMS Pants or EMS Style pants that are Navy Blue or Black. Belts are recommended and will be required if personnel are unable to keep all areas of their mid-body covered at all times. Black boots or Black shoes with ankle support.  Boots/shoes zipped up and tied when out of the station. In colder weather, ACAD provided jacket may be worn, if not provided any dark color coat or jacket with no advertising attached. 

“Modified Uniform” for Ambulance Personnel: When in Staff Areas, staff may wear navy blue, black, or gray sweat pants or other pants that do not form tightly to the body.Navy blue, black, or gray Basketball knee-length shorts that do not form tightly to the body and do not ride high on the thighs. They may also wear Socks or other Non-Duty footwear that covers the entire foot instead of their duty boots or shoes. District shirts must be worn at all times. Staff may always choose to full uniform during non-business hours. 

Office Personnel Uniform ProcedureOffice personnel are expected to present a professional welcome to the visitors of ACAD. Office personnel may wear shirts and apparel purchased by ACAD.  They may also wear polos or other professional-looking shirts with no logos or designs on them. Office personnel may wear ems pants, slacks, clean nice looking jeans, or khakis.  No tight-fitting pants or pants that have holes or are in bad repair. Shoes that cover the entire foot.  

Instructor Uniform Procedure Instructors and adjuncts are preferred to wear full uniform, but at the very minimum are required to follow the Office personnel Uniform Procedure.

Uniform Orders

Purchasing of Uniform Items 8/6/2020 All uniform purchases must be pre-approved by the Administrator. All uniforms approved will be bought by the District.All items will remain District property and subject to return at the end of employment.District will not reimburse staff for items bought by staff. 

Shirts and pull overs are purchased generally twice a year Pants, boots, and belts throughout the year (Jan-Nov) 

Fill out a uniform request.  Separate requests for shirts/pullovers vs other items.

Attendance Event Report

An Attendance Report needs to be completed each time a person:

• Is late beginning their shift (Staff member is responsible)
• Call out for a shift (Person Taking call / Filling Shift responsible)
• Leaves early from a shift (Hours Change must be completed)

Time Sheet Procedures (12/8/21)

Changes for late or early calls

• If a staff member stays for a late call, then it is their responsibility to change their time on the schedule.
• When changing time, put the call # in the notes.

Changes when 1 staff member covers for another

• If one staff member covers time for another it is the responsibility of BOTH staff members to change their times on the schedule and put the reason in the notes.

The default for Call in days for Full Time Staff

• When a person calls in sick for a day, you will receive ATO (if available) for that shift by default.
• If you wish something different to occur, Email administrator before Monday morning @8:00 on the week of Payroll

The Default for time missed on the Schedule for Full Time Staff

• Full time will given ATO (If Available) to make 48 total hours in a week.
• If you wish something different to occur, Email administrator before Monday morning @8:00 on the week of Payroll

Handling Phone Calls

Staff Call Outs

Emergency Fill (Call in Less than 3 hours before the start of the shift)

• Removed requirement to follow the call list in order

Regular Fill (Call in before 3 hours before the start of the shift)

• When calling staff members start at the top of the Call List and work your way down.
• IF the shift is an EMT shift, skip the Medics first and if no EMTS take the shift, start back at the top and call the Medics.
• If shift was double medic, fill with EMT.
• Fill full 12 hour blocks before splitting.
• Must have minimum of 1 paramedic on ambulance unless unable to fill otherwise and Administrator should be made aware.

The Attendance Report:

• Attendance Event on IOps360 will be filled out as soon as possible after shift is filled.

Transfers Originating From Out Of County

• Crew Levels
  • Must have both on duty crews available.
  • Call and have a standby crew available
  • If you can’t find a standby crew, deny the trip
• Must have the following information prior to sending crew:
  • Patient Name
  • Insurance Information
  • Destination information
  • Transferring Physician
  • Receiving Physician
  • Reason for Transfer (Specific Service Not available at transferring facility)
  • Face sheet and EMTALA/COBRA form Faxed

 Note: Also before sending the crew call the ambulance service that covers that transferring hospital:1. Inform them of the reqeust from the hospital to transfer from where to where2. Obtain verbal permission3. Obtain name of person authorizing the transport from the ambulance service

Returns To County (Skilled Nursing Facility, Nursing Home, Residence) (Update 10/15/2021)

Generally, we will transfer patients from Mosaic to a residence or skilled nursing facility as a routine transfer back to our District.

Process for Returns

• Complete a Routine Trasfer Form and follow directions on that form.

• Must have 2 available crews
  • If a crew has not picked up the patient yet, and the other crew goes out on a call, hold the original crew at a close safe location.
  • If that second crew transports, the crew that was holding their position will return and the crew transporting to the hospital will complete the return.
  • If there will be a delay call to inform the hospital of the delay and estimated arrival time.
• Keeping a crew available for emergencies is a priority

ACAD FAX# 855-365-9986

Logisticare

This section is only for calls where Logisticare is the payer Returns from the ER to a location within our coverage area can be scheduled and handled 24 hours a day by the crews

• Logisticare Fax with Approval Number on it must be in hand.
• Face Sheet from Hospital needed.

 All other logisticare transports must be pre-approved by Administrator or Office Manager.

• If calls come in after hours or weekends apologize and tell them they can not be approved until business hours.

Airgas

If Airgas calls, we need to check and see how many large tanks and small tanks of oxygen we are empty on then follow the following:

If 2 or more big tanks are empty – Order the number empty of Big and Little Tanks.

If 4 or more Little tanks are empty – Order the number of empty Big and little tanks.

If there are less than 2 empty Big and less than 4 empty little, say we are good and order none.

Communication

Ambulance Communication

When responding to calls contact “Andrew County” via our channel.

Communications include:

• When responding (State unit / Location responding from)
• When arriving On Scene (Mileage given)
• When Leaving the Scene
• When Arriving at destination (Mileage given)
• When Available from destination

When communicating with the hospital staff may use the hospital radio or their cell phones.

When giving report the following should be given:

• Agency & Unit
• Age and gender of patient
• Chief complaint / Associated complaints
• Pertinent assessment findings
• Pertinent negative assessment findings
• Treatments provided
• Orders being requested
• Any other pertinent items
• ETA to facility

Administrator Contact

Notify by Calling

• Serious Injury to any on duty staff
• Damage to ambulances or building
• Under 18 Death
• Death or Serious Injury to any employee or family member of employees
• Customer complaints of any kind
• Any incident you feel Administrator should know about

Communications Capabilities

Base Station

• Motor Turbo Digital Radio with ACAD Channels
  • Monitored through speaker system throughout building at all times
• Analog Radio with county channels
  • Andrew County Sheriff’s Main channel is monitored by radio in the front office at all times.
• MOSWIN radio
• Telephones (VOIP & Century Link)
• Computers with texting

Ambulances

• Motor Turbo Digital Radio with ACAD Channels
• Analog Radio with county channels

Handhelds

• Motor Turbo Digital Radio with ACAD Channels
• Digital Radios for direct communications with Mosaic Life Care Radio

Internal Communications

Methods of communicating with Administrator:

• In person
• Cell Phone (573) 760-6257 Call or Text
• Email (acadrudel@gmail.com) Also retrieved by phone
• Mail
• Mailbox outside office

IOps360 system

• Status Board
• Management may contact staff via memos, emails, and postings.

Hearing Impaired / Non-English Speaking Patients

Hearing Impaired

If you encounter a hearing impaired patient use the following steps to attempt communications:

1. Find someone on scene that knows sign language and can act as an interpreter.
2. Use Paper and pen to communicate with the patient.

Non-English Speaking Patient

If you encounter a Non-English Speaking patient use the following steps to attempt communications:

1. Find someone on scene that knows the language and can act as an interpreter.
2. Use Google Translate on a phone
3. Contact the Administrator or other staff member with a phone and advise to bring a google translate phone

Scheduling

Monthly Schedule

Introduction The ultimate goal of the schedule is to have 2 staffed ambulances on at all times.  The following sections describe the base outline of how scheduling and bidding will be performed generally.  These are considered guidelines to try to make it as fair as possible the majority of the time.  Management will always reserve its right to make judgment calls to serve the best interests of the District. 

Monthly Scheduling will be done on a month-by-month basis.  This does not affect the pay periods of 2 weeks long.PRN days and vacation days are due on the scheduling system by the 15th of the month for the following month.

• Full Time: If you request a day off, ATO may have to be used.  You must to have 36 hours each week.  This can be any combination of hours and ATO.  If you do not have the ATO time for a request day, it will not be granted.

The scheduler will use the following general guidelines when making the next schedule. 

Full-time staff scheduling:

• Days off are granted on a first come first serve basis. With the follow exceptions:
  • Generally, 1 full time staff member will be granted the day off
    • Full time can request but there is no guarantee of holidays.
  • Anyone denied days off are still free to trade shifts, trade time, or find their own coverage with a non-overtime staff member.
  • Any call out on a denied day will result in a request for a doctor’s note.
  • Any call out for a scheduled holiday will be handled by policy manual.
  • Scheduler may still try to accommodate additional requests if not a hardship to the District.
• General scheduling consists of:
  • Full time will receive a minimum (except for vacation) of 36 hours per week. (Per ACAD Policy)
  • Full time may be scheduled to work 48 hours in any week.
  • Full time may be schedule an extra 24 hours in a week in times of low staffing due to emergencies or illnesses
  • Approved vacations could be rescinded in emergency situations.

Additional Staff Scheduling:

• For this section ‘Additional Staff” Include Part-Time, PRN, and Reserve generally in that order.
• Scheduler may utilize Additional Staff to fill openings in the schedule.
• Scheduler will use many factors when utilizing Additional Staff:
  • Consistency of Additional Staff reliability
  • Consistency of Additional Staff availability
  • Number of Available days
  • Patterns of available days
  • Seniority
  • Dedication to the District
• Scheduler will not schedule outside the availability of the Additional Staff member.

Filling Emergency Openings

• Emergency Fill Shifts are shifts that occur with 3 hours of the start of shift.
  • Emergency Coverage removes the responsibility of calling down the overtime list, but it still may be followed at caller’s discretion.
  • Staff currently on duty may elect to cover emergency coverage
• Shifts greater than 3 days away will be filled when Resource Officers are available to fill the shift.

Scheduling after the monthly schedule is posted

This process is only applicable when the new schedule is posted. Unless special circumstances, the schedule should be out on or before the 20th of the Month.  To leave time for calling for shifts un-bid bidding on shifts awards will occur after the 23rd at noon. Bids can be accepted up until the actual time the shift is awarded.  Bids will be awarded based on the following guidelines.

1. Personnel without overtime who submitted availability during that week
2. Personnel without overtime who submitted availability during the month but not in that week
3. Personnel without overtime who did not submit any time for that schedule
4. Personnel with overtime

Since it is conceivable that multiple people bid on the same shifts that fall into the same categories above, there will be times when decisions must be made.  The goal is to spread the days out over those who bid on them.  There will have to be some leeway given to the scheduler.  If there are multiple people from the same category bidding on 1 spot, then generally the award will go to who bid first. As always the Administrator reserves the right to make schedule decisions based on what he feels is best for the ambulance district.

Miscellaneous

Miscellaneous

These are miscellaneous items for day to day operations:

• A/C should remain on 72 degrees
• All official communication to or from the District will be done on recorded lines within the District.
• When you are last out of the building, all doors and windows should be secured.

Emergency Operations

• Must be declared by the Administrator.
• Any situation where large amounts of calls but there are few to no patients.  Example would be snow storm and many non-injury MVC’s
• During Emergency Operations we will not provide non emergency routine Services.  Exception is a return and we are already at the hospital from another call and the other crew is available.
• During Emergency Operation, only when a patient is encountered will a trip sheet be written.

Orientation/Probation Program

It is the duty of every staff member to help other staff members succeed!

New staff members will undergo an orientation to the District.  Once a new staff member has been cleared for orientation by the Administrator, their orientation begins.New staff members will generally ride 4 orientation shifts.After those 4 rides the new staff member will meet with Administrator and then will be released or additional rides may be scheduled.This program will also include remediation of current staff when directed by the Administrator and in a method specified by the Administrator. These procedures are in place as guidelines and not meant the tie the hands of the Administrator when orientating new staff.

Orientation

• When a person if undergoing their orientation they are to act as a member of the crew under the direction of the lead paramedic.
• New staff members are to complete their orientation books during the orientation process and will not be removed from orientation until the book is complete and reviewed by the Administrator.
• It is the responsibility of the veteran staff that are orientating the new staff as well as the the new staff member to make sure the new staff member not only completes their orientation book, but understands everything in the book.
• An Orietnation/Probation Review form will be filled out by a member of the staff who helped orientate the new staff member for that day
  • and placed in the Administrator’s mailbox at the conclusion of the shift and placed in the Administrator’s mailbox at the conclusion of the shift.

Probationary Paramedics

• May function as a paramedic as long as they are accompanied by another paramedic of the ambulance district.
• The senior paramedic is ultimately responsible for the care provided on the ambulance.
• The probationary paramedic will alert the senior paramedic:
  • When intending to provide controlled substances
  • Any other conditions requested by the senior paramedic.
• An Orientation/Probation Review form will be filled out by the senior paramedic for that day and placed in the Administrator’s mailbox at the conclusion of the shift.

Note: Any concerns that senior or veteran staff have with a new orientation staff member or probationary Paramedics need to be placed onto the Orientation/Probation Review Form or discussed with the Administrator if needed.Note: Any concerns that new orientation staff member or probationary Paramedics have with senior or veteran staff needs to be discussed with the Administrator if needed.

Ambulance Parking And Garage Operations

Backing the ambulance

• Anytime the ambulance is moving backwards, there shall be a spotter present outside the vehicle on the driver’s side in the rear of the vehicle.
• If a spotter is not used and any damage occurs from backing of the ambulance, both crew members will be subject to drug testing and disciplinary action.
• If a spotter can not be outside the vehicle due to only 2 crew members and patient care being being performed, the attendant should if possible look out the rear window to direct the driver.
• If not spotter is able to be used, then the driver will exit the vehicle and ensure the path they intend to reverse is clear of all obstacles.

Exiting the ACAD Building

• The garage doors are on timers due to safety reasons.
• When preparing to leave, do not open the garage door until both crew members are inside the vehicle and ready to proceed out of the building.
• If you have not exited the building for 30 second after the doors reach there top most position, the passenger will exit the vehicle and ensure the sensors are blocked so the ambulance can exit safely.
• When exiting the building, the driver window should be cracked open and the driver should not proceed until they are certain the door is at its utmost top position.

Entering the ACAD Building

• Upon preparation to enter the ACAD building, the ambulance shall be aligned with the garage door and spotter in place before the door is opened to enter the building.
• Once door is open, ambulance may proceed to back in.

Mosaic

• Doors are on timers.  Driver will be in place with motor running before door is opened.
• Passenger will immediately press open door button and ambulance must exit within 20 sec.  
• If ambulance does not roll in 20 sec, passenger will exit vehicle and manually watch door with button in hand to ensure door stays open while ambulance exits building.

General Note:

• These type of accidents are nearly 100% avoidable.
• Crews shall maintain good situational awareness at all times while operating the ambulances.
• Avoidable accidents shall be met with disciplinary action.

Fire Extinguisher Monthly Checks

Each month the Fire extinguishers will be routinely checked and Initialed off when they meet the following criteria:

• Mounted in an easily accessible place, no debris or material stacked in front of it.
• Safety pin is in place and intact. Nothing else should be used in place of the pin.
• Label is clear and extinguisher type and instructions can be read easily.
• Handle is intact and not bent or broken.
• Pressure gauge is in the green and is not damaged or showing “recharge”
• Discharge hoses/nozzle is in good shape and not clogged, cracked, or broken
• Extinguisher was turned upside down at least three times (shaken)

If any extinguisher does not pass inspection for any reason alert your supervisor.

Snow Parking

When there is a need or potential need for the parking lot to be snow plowed or salted, all cars need to be parked away from the building so it can be plowed or salted.

Maintenance Procedures

Maintenance Reports – Maintenance Form

Anytime you have a piece of equipment, a vehicle, or any other item that needs maintenance, you need to fill out a Maintenance Report.If the needed repair in your judgement places the item out of service, please indicate that on the maintenance report and notify the Administrator. 

Vehicle Fluid Additions – Maintenance Form

Staff shall record:All fluids added except fuel.Airing of low tires. 

Tracking

• Master Maintenance Log will be maintained by Management

Preventive Maintenance

Preventive Maintenance will be performed by the following on an annual basis.

• Cardiac Monitors – Mosaic Life Care
• Suction Units – Mosaic Life Care
• Stretchers – EMSAR
• *Ventilators – BIO One *Currently No Ventilators on the Ambulances

Safe Haven Procedures

Procedures are as follows:

Note: This may be a stressful situation and professionalism will need to be at its highest standards.  Always protect the anonymity of the surrender process.  

Note: The safe Haven law protects parent for the 45 days after birth.  We will accept any infant presented no matter how many days after birth.

1. Download the Safe Haven packet
2. Confirm the individual is the parent
3. Confirm the parent is acting on their own behalf
4. Confirm parent know they are terminating their parental rights
5. Take newborn into your custody
6. Attempt top give parent “Getting Help” Letter
7. Attempt to get information on questionaire
8. Offer needed medical attention for parent or call someone if they would like you to
9. Check for signs of abuse or neglect
   1. if found contact law enforcement and DFS
10. Take infant to Mosaic Life Carea. This will be an “Other Emergency” and details will not be given out on the radio at all.
11. Contact Administrator or Office Manager

Covid-19 Procedures

Based on CDC guidelines for Contingency capacity strategies for healthcare facilities actually a little above. With 25 active staff 6 people out would account for almost 1/4 of the staff. With that we will use this guideline to proceed. Added 10/13/2020.Close ContactIf you have been identified as a close contact per health department, by self determination, or by District administration the following will be observed:

• Facemask will be worn anytime you are in the ambulance or same room as other staff.
• N95 will be worn when contact with all patients.
• Continuously watch for covid symptoms
• Check temperature ever 6 hours while on duty.
• Limit surfaces touched… examples .. use same chairs, computer, etc.
• Wipe down shared surfaces touched after use.

Covid SymptomsIf you have Covid symptoms you will need to be tested for Covid-19.  

Return to work after positive covid TestHCP with mild to moderate illness who are not severely immunocompromised:

• At least 10 days have passed since symptoms first appeared and
• At least 24 hours have passed since last fever without the use of fever-reducing medications and
• Symptoms (e.g., cough, shortness of breath) have improved

Note:  HCP who are not severely immunocompromised and were asymptomatic throughout their infection may return to work when at least 10 days have passed since the date of their first positive viral diagnostic test.

Covid-19 Patient Procedures

• Staff are encouraged to wear surgical masks during all patient encounters.

• Staff should immediately don N95 or PAPR once a patient that is Covid positive or exhibits Covid signs and/or symptoms is discovered.

• Patients who are Covid positive or showing signs or symptoms of Covid shall have a surgical mask placed onto them, unless it is unsafe for the paitent to do so.

• If the patient is unable to tolerate or there are other reasons a mask can not safely be placed on the patient, the crew shall contact the hospital prior to arrival and inquire if there are any special procedures for a patient who cannot wear a mask into the ER. The crew will work with Hospital to ensure safety is met for all involved.