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Article One
Operational Overview
Section One F.U.E.M.S
Fordham University Emergency Medical Service (F.U.E.M.S) is a New York State Certified Volunteer Ambulance Service (VAS), which primarily services the Rose Hill Campus at Fordham University in the Bronx, New York.
Section Two Service Area and Responsibility
The primary Service Area is the Rose Hill Campus. F.U.E.M.S primary responsibility is providing 24 hour per day coverage when the University is in session or during any special events when F.U.E.M.S assistance is requested by the administration. F.U.E.M.S will operate during the Fordham University’s academic calendar year.
Section Three Vehicles
F.U.E.M.S has at its disposal one 2000 McCoy Miller Ambulance and one 2008 GM Traumahawk K5. These vehicles are Fordham University property and are thus under the supervision of the Captain, Chief of Operation, Director, and Director of Intercampus Transportation.
Section Four Dispatching
The primary dispatcher for F.U.E.M.S is Fordham University Security. University Security Dispatches F.U.E.M.S via alphanumeric pagers and two-way radios. Anyone needing to dispatch F.U.E.M.S shall notify security.
Section Five Communication
F.U.E.M.S utilizes the following communication systems, which can be used in conjunction with Article One, Section Four. The procedures for dispatching F.U.E.M.S and notifying security shall remain in place.
Alphanumeric Pagers
Two Way Radios
Cellular Telephones
Land Line Telephones
Subsection A Mutual Aid Agreement & NYC Mutual Aid Radio System F.U.E.M.S is a member of the NYC Mutual Aid Response System and thus in possession of one MARS Radio.Refer to Article 5 for usage of the MARS Radio)
Subsection B Radio Channel Usage
F.U.E.M.S utilizes the University Security Channel to facilitate in its daily operations. Any communications to this channel us to be strictly professional and at no time shall F.U.E.M.S interfere with Security’s daily operations.
Article Two
Documentation
Section One Personnel Files
Fordham University Emergency Medical Service shall maintain personnel files on all members. These files shale be kept for a period of at least three years after the member has left F.U.E.M.S. Refer to Article Four, section One and Two of the F.U.E.M.S Constitution for delegation/assigning these duties. The Personnel files shall contain information on the following areas:
Subsection A Certifications
Copies of Certifications for American Red Cross (ARC) and/or American Heart Association for the Professional Rescuer (AHA), Certified First Responder (CFR), and Emergency Medical Technician (EMT) shall be kept on file.
Subsection B Health Records
Health Records shall be maintained by the Health Center, including vaccination records for measles, mumps, rubella, polio, tetanus and PPD. Records concerning Hepatitis B and any documentation regarding F.U.E.M.S. “Exposure to Blood Borne Pathogens” policyshall be kept for 30 years after a member has left F.U.E.M.S. –please note the exposure control plan section 11.1 Vaccination against Hepatitis B is strongly encouraged and proof of vaccination or refusal must be kept on file for 30 years. Health Records shall be maintained by the University Health Center, who will provide documentation that the file is complete and student is eligible to join.
Subsection C Driver Status
The Captain and Chief of Operations will provide documentation as to the driver’s completion of the Driver Training Program. This documentation will be kept in the member’s personnel file.
Subsection E Miscellaneous
Awards, letters of reprimand, the sexual harassment policy and any additional documentation deemed appropriate for the personnel file.
Subsection F Review and Updated Information
The requirements set forth shall be reviewed and updated at least twice a year. These Responsibilities shall fall under the responsibilities of the Executive in charge of personnel files..
Section Two Prehospital Care Reports (PCRs) & Non-emergency Transports
Subsection A PCRs
F.U.E.M.S. shall maintain a record of each call on a “Prehospital Care Report.” This form is approved by the Department of Health (DOH) and any other form submitted must be in accord with the DOH Standards. PCRs must be maintained for a period of three calendar years and shall be available upon request to authorized individuals after signing a release (See Appendix). In Refusal of Medical Aid (RMA) Cases, a separate “Fordham University E.M.S Refusal Information Sheet” shall be attached to the respective PCR and will be held for three calendar years. PCRs shall be processed and maintained by the medical staff. See also the FUEMS RMA policy addendum.
Subsection B Non-emergency Transport
F.U.E.M.S provides non-emergency transportation “Pick Up” for patients released from the hospital. Please refer to Article 9 for further explanation and details regarding non-emergency transports. For each and every “Pick Up” done by F.U.E.M.S a “Pick Up” form shall be filled out. See Appendix for sample.
Subsection C Quality Assessment/Quality Improvement Standards
All QA/QI procedures will follow NYC Emergency Management Guidelines and Regulations for the processing of all PCRs. The Chief shall establish additional standards of Operations in conjunction with the QA/QI Board. It is the policy of FUEMS to QA/QI 100% of the PCRs generated by FUEMS EMTs for all calls including those resulting in RMA (Refusal of Medical Aid). This is to be done by the designated QA/QI officer and, when deemed necessary, by the established QA/QI board.
Article Three
Membership
Section One Attendants
In order to ride for F.U.E.M.S. candidates must maintain current certification in AHA Basic Life Support for Health Care Providers or ARC CPR for Professional Rescuers. Members must also attend an OSHA training session determined by the Chief’s Office.
All members must also attend and complete Ambulance Orientation and Training conducted by the Chief’s Office prior to riding as an attendant. The Lieutenant in charge of training shall work closely with the Chief in organizing and implementing these matters. Either the Chief or Director may revoke attendant status at any point.
Section Two Drivers
All F.U.E.M.S. drivers shall have no more then two moving violations or accidents on their record, be in good physical condition to allow for operation of the ambulances, and have all appropriate documentation which includes a Ram Van Physical, Driver Application, and a copy of a current driver’s license. Drivers must also undergo an ambulance orientation program and driver training courses conducted under the supervision of the Captain. Driving privileges and abilities are to be reassessed by the Captain or under his/her supervision. Either the Captain, Chief, Director, or Director of intercampus transportation may revoke driver status at any time.
Section Three Crew Chiefs
All Crew Chiefs must have current EMT Certification and meet all criteria included in the F.U.E.M.S. Crew Chief Handbook and standards established by the Chief of Medical Operations. Crew Chiefs have the responsibility of conducting their own duty tour when they have gained this position. Crew Chiefs fall under the responsibility of the Officer Staff and are thus accountable to line officers in the organization. Either Chief or Director may revoke Crew Chief status at any point.
Section Four Membership Requirements
All F.U.E.M.S. Members shall maintain a level of physical condition that allows them to function as a member of F.U.E.M.S. (i.e. Lifting a patient, CPR, Climbing stairs, etc.). The maintenance of physical condition is left to the discretion of each member.
Section Five Drugs and Alcohol
F.U.E.M.S. shall follow the policy outlined in Article Nine, Section E of the F.U.E.M.S. Constitution.
(See SOP Article 8, Section One, Subsection D for further information)
Section Six Policy violations
Each member of the organization is responsible to document any F.U.E.M.S. policy they believe is/was violated. All policy violations and grievances shall fall under the jurisdiction of the Director and/or the Chief of Operation and the F.U.E.M.S. Constitution.
Article 4
Daily Organization
Section One Officers and Day Staff Members
F.U.E.M.S. Officers and Day Staff members will be on call during the “Day”- from 0800 until 1800 Hours- Monday through Friday. Each Officer and Day Staff member will be issued an alphanumeric pager for the purpose of responding to calls during this time to serve periods when a Primary Duty Crew is not scheduled. Either Chief or Director may revoke a pager from an Officer or a Day Staff member.
Section Two Primary Duty Tours
The period when a set crew is scheduled will be from 1800 to 0800-Monday through Friday. The weekend shifts are divided as the following: 1800 Friday until 1200 Saturday, 1200 Saturday until 2000 Saturday, 2000 Saturday until 1200 Sunday, 1200 Sunday until 2000 Sunday, and 2000 Sunday until 0800 Monday.
Section Three Day and Emergency
As Security is the Primary Dispatcher for F.U.E.M.S., and there are two distinct types of duty tours- Day and Emergency. All F.U.E.M.S. Officers and Day Staff will receive pages sent over “Day”. All Primary Duty Emergency Pagers will receive sent over “Emergency”. Please refer to the Crew Chief Handbook Addendum for further detail in this matter.
Section Four Response
Any page sent out from Security that does not receive a response from F.U.E.M.S. in three minutes during the “Day” Shifts will be re-paged. Either the Chief or Director may personally request a member of service to respond to the re-paged call at this time. It is the responsibility of all available Officers and Day Staff members to respond to the re-paged call at this time. See section 6 and Appendix for maximum time interval before security dispatches to back up EMS service provided by NYC 911 system.
Section Five Simultaneous Calls & Backup Procedures
In the event of simultaneous calls, the second call will be paged out over “Day.” It is the responsibility of all available officers and day staff members to respond to the second call in this event. In the event that additional support is needed for the purpose of backup, this will also be paged over “Day”. It is again the responsibility of all available officers and day staff to respond to the backup page in this event. If at any time the primary duty crew cannot be reached or is unable to respond to a call Security will be instructed to page the call over “Day.”
Section Six 911 and Mutual Aid
The security dispatcher should be told to call 911 and notify the security supervisor on duty in any of the following situations:
1) The Paging System is down and FUEMS personnel cannot be reached.
2) FUEMS is OOS (Out of Service).
3) FUEMS personnel cannot be reached. (see appendix for maximum time interval with out a response.)
4) Additional resources are deemed necessary by the crew on duty (ALS, NYPD, etc.)
5) FUEMS fails to meet the required response times prescribed by the Additional Assistance and Mutual Aid Procedure Addendum for daytime response.
6) FUEMS’ primary mutual aid provider is the FDNY*EMS system and will be utilized in any of the aforementioned situations and/or if the on duty security supervisor deems it necessary.
Section Seven Use of MARS Radio and MARS for Mutual Aid
FUEMS is in the possession of a NYC MARS radio for easy contact with a MARS dispatcher for the request of ALS backup, BLS backup, NYPD response, FDNY response. The procedure for this is as follows:
1) Make sure radio screen says MARS
2) Key the microphone and say “92 David to MARS”
3) Upon recognition from the MARS dispatcher state what additional resources you need and the MARS dispatcher should comply with request.
In the event that the MARS radio is down or inoperable, or the duty crew cannot make sufficient use of it, the following number can be called to reach the MARS dispatch desk via cell phone or land line: (718)-422-7393. Identify yourself with the dispatcher and request additional resources.
Section Eight Campus Security Notification
Security shall be notified for every flag-down, walk in, any time FUEMS is participating in significant patient care, and should a call be received to the primary duty crew by means other than Alphanumeric Pager. When notifying security of your location and nature of the call, you must also request any additional resources needed during this time.
Section Nine Scene Control and Patient Care Standards
At no time shall any member respond to the scene in addition to the scheduled primary duty crew during Primary Duty Crew hours. This does not apply when specifically paged or requested to the scene, or when acting under the direction of either the Chief, Director, or the officer in charge of said scene.
Subsection A Scene Control
The established Chain of Command for scene control will begin with the Director, then the Chief, and then down the chain of command with administrative command holding priority.
Subsection B Patient Care
The patient care chain of command will begin with the Chief, then the Director, and then down the chain of command with the Medical Staff holding priority.
Section Ten Confidentiality
Patient Confidentiality shall be assured by the respective crew not disclosing the patient’s name over the radio, by deleting past calls on the emergency alphanumeric pagers or any other form of wrongful disclosure (refer to FUEMS HIPPA policy). The patient’s name, call location and any specific details regarding the call shall not be disclosed to any member of service or the general public. At the end of each shift the crew chief in charge is responsible for removing all PCR’s, non emergency transport forms, and any other documents for that shift and place them into the PCR drop box inside the office. Only the director and Chief, or anyone of their designees has the right to know the information. Wrongful disclosure of any patient information shall not be permitted and will be met with disciplinary action or suspension.
Article Five
Mutual Aid Procedures
Section One Policy
Upon becoming aware of a disaster, unusual emergency or multiple casualty incident (MCI), in the New York City Region, the Chief or Director shall immediately activate the internal emergency operations plan (EOP) After this initiation, FUEMS shall advise the FDNY whether or not it is able to provide ambulance or personnel resources and if resources are provided FUEMS shall respond to a mobilization point designated by the FDNY.
Section Two Emergency Operations Plan
Upon becoming aware of a disaster, the Officer Staff is directed to immediately report to headquarters and await further instructions. The Chief of Operations and Director shall appraise the situation and inform FUEMS advisors. The Advisors shall then inform the Dean of Student Life of the decision to assist the FDNY based upon the Chief and Directors assessment. The Chief of Operations shall designate a truck and crew of no more than four members to provide assistance to the FDNY. It is the responsibility of the Director to inform University Security of FUEMS’ status
Section Three FDNY RCC
Activation of the MARS system requires the senior officer/member of the responding crew to first log the unit with the FDNY RCC at (718) 999-2952. FUEMS designation for the RCC is 92 David (92D). Inform the RCC of your designation and that you are equipped for BLS service and are requesting to be logged into the RCC. You shall be given a Mobilization Point to report to at this time.
Section Four Use of MARS Radio
During the fall of 1991, Fordham University Emergency Medical Services became a part of the Mutual Aid Radio System (MARS). This will enable FUEMS to utilize New York City’s emergency services. This radio is to be used after contacting the FDNY RCC and logging into the network using the unit designation: 92 David (92D).
Section Five Mobilization and Equipment
The responding unit is to respond to the mobilization point and all members on scene must carry on their person: Current FUEMS ID, NYS DOH EMT certification, valid drivers license. After all transports, the crew is to return to designated mobilization point or any other RCC designated location. FDNY EMS mobilization point representatives should be provided with a copy of the PCR, any triage tag retained with the PCR and if instructed, to return any issued equipment. The crew may not stand down until specifically instructed to do so by the FDNY Operations Officer.
Section Six Participation Guidelines
The Regional Emergency Service Council of New York City (NYC REMSCO) states that ambulance units and/or EMS personnel will not respond to any incident outside of their primary service area without a specific request from FDNY and/or the NYC Office of Emergency Management (OEM). It is therefore the policy of FUEMS that no member shall respond or utilize FUEMS equipment without the consent of the Chief of Operations for this purpose.
Article Six
Ambulance Operations
Section One Drivers and Passengers
FUEMS shall abide by all NYS Vehicle Traffic and Safety Laws. As such, all ambulance drivers and passengers must wear safety belts when not engaged in patient care.
Section Two Coding
“Code” refers to the use of all warning devices to achieve a short transport time. At all times the decision to code shall be at the discretion of the crew chief or any ranking officer on the scene. When advised to code, all lights must be used in conjunction with the siren. At no time shall a driver code without the permission of the crew chief and at no time shall either the driver or the crew chief code outside of the a situation in which the crew chief deems it necessary. This will be met with punishment or suspension of membership and/or driving privileges as it is very dangerous and incurs a large liability upon the university and FUEMS.
The siren is not to be used on campus for any reason. When responding to off campus calls, the siren may be used only after exiting the campus gates. Headlights are to be used at all times, regardless of time of day.
Section Four Ambulance Usage
Please refer to the Fordham University EMS Driver training policy and statements Addendum regarding usage of the ambulance for training purposes. Refer all questions to either the captain of the Chief of Operations.
Subsection A Non-Emergency Usage
In order to move any rig off or around campus at any time for a non emergency reason, permission must be secured from the Chief or Captain.
Subsection B Parking
Please refer to the Crew Chief Handbook addendum for parking spots for on campus emergencies. When not on a call, the ambulance(s) shall be parked in either one of their two designated spots—in back of Alumni Court South or in front of Finlay Hall. In the event the primary rig is unable to be parked in front of Finlay Hall, the rig is to be parked between John Mulcahy Hall and Walsh Hall in the fire lane. The rig at no time shall park in a manner that blocks the main walkway or roadway.
Subsection C Miscellaneous Occurrences and Notification
For any miscellaneous usage of the ambulance or incident that may arise, every attempt must be made to notify either the Chief or Captain. Either the Chief or Captain must be notified as soon as possible regarding events/incidents involving the ambulances.
Section Five Ambulance Inspection & Decontamination
Daily Rig Checks shall be conducted by the crew chief within two hours of the start of a duty tour. All findings shall be documented on a Rig Check Sheet, and submitted to the captain who will maintain these reports. Any equipment failure shall be documented on an equipment failure report and delivered to the Captain. Should the equipment failure be deemed by the crew chief as placing the ambulance outside of Part 800 standards, the crew chief shall notify the Captain or Chief immediately and a decision will be made at that point as to whether or not the ambulance shall be temporarily placed out of service. In addition to these daily rig check sheets, it is the responsibility of the medical staff to assure that the ambulances are in perfect compliance with Part 800 of the New York State DOH regulations.
Subsection A Preventative Maintenance
All preventative maintenance shall fall under the responsibility of the Captain and/or the Captains Aid. Any additional maintenance must be scheduled with the approval of the Chief of Operations or Director. In short, preventative maintenance will include anoverview of the vehicle by the primary duty crew’s driver regarding the systems on board the ambulance and their functionality. It will also include yearly inspections by a NYS certified inspection mechanic as well as regular 3000 mile oil changes. It is among the responsibilities of the Captain to, on his or her own, check the ambulances on a regular basis to reassure the fact that they are in safe and proper working order.
Subsection B Cleaning and Decontamination
Cleaning and decontamination of the ambulance and equipment shall occur on a weekly basis. The regular decontamination shall be conducted as a Phase II decontamination on a schedule set by the Captain. The crew performing this Phase II decontamination must fill out the Decontamination Record and submit it to the captain following the duty tour. In addition to this weekly decontamination, the ambulance is to be decontaminated and not returned into service following every call. This post-call decontamination must occur in the receiving hospitals emergency department ambulance bay. The ambulance is not to leave the ambulance bay until after this decontamination as occurred. At all times, members shall abide by FUEMS exposure control plan, and should any exposures occur, members must fill out an exposure incident report available at headquarters.
Section Six Jurisdiction and Supervision
At all times, FUEMS’ vehicles are under the direct supervision and jurisdiction of the, Chief, Captain, Director, and Director of Intercampus Transportation. The Chief, and Captain have the ability to update and/or establish additional guidelines they deem appropriate to this article. The Captain is responsible for making sure all FUEMS drivers are made aware of existing and updated FUEMS Standard Operating Procedures regarding ambulance operation.
Article Seven
Patient Procedures
*Note- FUEMS follows all REMAC guidelines for patient care and protocols.
Section One Notifications
Please refer to the crew chief handbook addendum for the instances when a notification to the Director or Chief is to be made.
Section Two Treatment of Minors
FUEMS shall treat all minors under the following conditions:
1) If the patient is critically injured or ill, FUEMS assumes implied consent and will provide both treatment and transport with or without parental consent/notification.
2) If the patient is alert and oriented, FUEMS shall contact a parent or guardian through all reasonable means available. In the event one cannot be reached, the Crew Chief must transport according the law and in the interest of the patient and the parent or guardian. The Crew Chief will then notify the proper individuals/officials (Director, Chief, Fordham Preparatory School Administrator, Security Supervisor, NYPD Officer, etc.) to coordinate the decision.
3) NYS Law States that minors (individuals under the age of 18) may not sign a refusal of aid (RMA) form.
Section Three Treatment of Emotionally Disturbed People (EDP)
FUEMS shall treat and transport all EDPs. If the patient is a threat to the crew, Fordham Security and/or NYPD shall be notified and their assistance will be requested on board the transporting ambulance.
Section Four Impaired Patients
FUEMS does not allow any patient impaired by alcohol or drugs to sign a refusal of aid (RMA) form.
Section Five Members of Service
Members of Service can request transport to a particular hospital only after being approved by the Chief of Operations. The request may be denied without explanation.
Section Six Unable to Gain Entry to Patient/Unfounded Calls
In the event that FUEMS is unable to locate a patient the crew chief is to take the following steps:
1) If off campus, sound the siren for the (10) second intervals for a period no longer than one (1) minute. To call attention to the crew so that a patient can make him/herself known. If on campus, use the warning lights and instruct the crew to make themselves known to people in the area etc.
2) Work closely with Fordham Security or NYPD on scene to determine if the patient is indeed there, and if the crew and law enforcement on scene determine that forcible entry is necessary, the law enforcement agency assumes responsibility for the forcible entry.
3) If unable to locate patient and all crew chiefs and law enforcement on scene decide that the call is in fact unfounded, document all actions taken on the PCR and list the names of all law enforcement on scene.
Section seven RMA
1) See Article 21 for updated and amended FUEMS Policy.
Article 8
Notification to the DOH
F.U.E.M.S. operates under the guidelines of NYS DOH. Thus F.U.E.M.S. shall notify the Local Area office of the Department of Health in reference to the below mentioned areas no later than the following day.
Subsection A Patient care
Any incident in which a patient dies or is otherwise harmed due to acts of commission or omission by a member of F.U.E.M.S. and/or patient care equipment fails while in use and causes harm to the patient.
Subsection B Vehicle Accidents
Any accident when an EMS Response vehicle operated by F.U.E.M.S. is involved in a motor vehicle accident in which a patient, member of the crew, or other person is killed or injured to the extent of hospitalization or physician care is needed and/or there is personal damage that equals or exceeds 1000 dollars for each individual party.
Subsection C Mortality
Any time a member of the crew or other person is killed or injured to the extent of hospitalization or care by a physician.
Subsection D Member of service
Any time it is alleged that a member of F.U.E.M.S. has responded to an incident or treated a patient under the influence of alcohol or drugs while on duty.
Article 9
Non-Emergency Transport
Section One Hospital Pick Ups
F.U.E.M.S. provides non-emergency transport service (“Pick Up”) for patients released from the hospital. F.U.E.M.S. may also transport any friend who may be with the patient; however, friends cannot be transported separately.
Article Ten
Scheduling
It is the responsibility of the Officer Staff to assure that F.U.E.M.S. shall have all regular tours of duty covered with both a cleared Crew Chief and Driver. Since the Officer Staff is divided between both the Administrative and Medical Staffs, each staff shall be responsible for covering one month of scheduling at a time. When that month is completed, the other staff shall take over scheduling responsibilities.
Article Eleven
Medical Control
F.U.E.M.S. Medical Director Dr. Leviton shall be notified in cases where medical control is needed. OLM 233rd’s Medical Director has also extended Medical Control via landline at (718-920-6969). These two options shall be exercised if Medical Control is needed. In any situation that requires Medical Control, always act in the best interest of the patient and never delay transport to the nearest medical facility capable of receiving the patient. It is the responsibility of the Crew Chief to inform the Director and/or Chief of any problems in contacting medical control, they also must document all findings on the PCR this includes doctor’s name, job title, their decision and time call was placed.
Article Twelve
Acting Director and Acting Chief
At any time, the Director and Chief of Operations may designate someone to act in their absence to assume their responsibilities within F.U.E.M.S. The Administrative and Medical Chain of Command shall be followed when designating an Acting Director or Chief. The Acting Chief and Director shall still follow the regular chain of command regarding scene control and patient care, and do not have the authority to change the F.U.E.M.S. Constitution or SOPs. The role of the Acting Director and Chief shall be designated and further explained by each respective authority.
Article Thirteen
Field Trainers and Driver Trainers
Section One Field Trainers
The Chief of Operations shall have the authority to interview and appoint anyone whom they deem fit to become Field Trainers for F.U.E.M.S. Their primary function is to act as a teacher for new members seeking to attain Crew Chief status. They shall appraise and instruct EMTs and EMT Students of the proper F.U.E.M.S. Policy and NY State Standards of Care. Field Trainers may also nominate those members whom they feel can fulfill the requirements of becoming a Crew Chief with F.U.E.M.S.
Section Two Driver Trainers
The Chief of Operations and Captain shall have the authority to interview and appoint anyone whom they deem fit to become a Driver Trainer for F.U.E.M.S. Each Driver Trainer shall have the authority to take prospective drivers out on the road. The Captain shall inform Driver Trainers about the specifics.
Section Three Trainer Status Revocation
Any time a trainer has demonstrated they are unable to act as a suitable trainer for the organization, their status as either a Field Trainer or a Driver Trainer shall be revoked by either the Director or Chief of Operations. Reinstatement of ones trainer status is contingent upon the Chief of Operations of the Director’s approval.
Article Fourteen
Behavior as an Agent of F.U.E.M.S.
At no time shall a member of the organization act in a way that is unbecoming and detrimental to F.U.E.M.S. when providing patient care. Any problems that arise should be handled with patience and respect to others involved. Always act in the best interest of the patient. Physical Assault- any agent of the organization providing emergency care to a patient shall not be physically or verbally abusive. If you are unable to handle a patient’s attitude or think they shall become physically abusive to either yourself or others – secure the assistance of Fordham Security, NYPD, another F.U.E.M.S. Officer, or anyone who can offer appropriate assistance. Avoid physical and verbal confrontation when possible.
Article Fifteen
Officer Jurisdiction
The Officer Staff should assist in assuring the guidelines of the organization are maintained. Thus officers have the following authorities/jurisdiction in the organization, which relate only to general members and not to Article 8
Article Sixteen
CISD
CISD are designed to assure that members of a crew who have been subjected to an extraordinary situation are fit both psychologically and physically to again perform their roles within F.U.E.M.S. They are a meeting held with the Director, Chief, Director of Health Services, a medical doctor, and a counselor. They are completely confidential and are placed in their personnel files. The F.U.E.M.S. Chaplain is also available at anytime for those who need counseling.
Article Seventeen
Mass Casualty Incidents (MCI)
Section One Characteristics of and Policies for MCI Operations
1) MCI’s are generally defined as five (5) or more patients with the potential need for extraordinary resources. However, the criteria for the definition of MCI’s are not primarily dependent on the number of patients.
2) The Fire Department of the City of New York (FDNY) is responsible for the coordination of patient care resources at the scene of multiple casualty incidents.
3) Crew arriving on the scene of an internal Fordham University emergency which appears to be an MCI shall quickly survey, size-up and evaluate the incident, call MARS and inform the operator of the situation. Lacking any specific orders from the MARS dispatcher the crew should establish an incident command post and staging are, with the most highly medically qualified member on scene in charge if no officer is present. In the event that an officer is present the Incident Commander will start with the Chief or Director, with the medical staff holding priority. The Incident Commander should maintain contact with the MARS dispatcher, providing updates and requesting additional resources. The FUEMS Incident Commander will remain as such until an FDNY official is there to replace him/her.
Section Two Triage Procedures
In situations where the number of victims greatly exceeds the number of EMTs on scene, the crew on scene must immediately asses the physical status of all victims so that care can be delivered to those most likely to survive. START – Simple Triage and Rapid Treatment enables specialists to quickly evaluate patients’ respiration, circulation and CNS status and triage them quickly and efficiently.
Using START, patients are sorted into four (4) categories: DECEASED/NON SALVAGEABLE, IMMEDIATE, DELAYED, and MINOR:
Deceased/Non Salvageable (Black tag) patients have no ventilations present after one attempt is made at repositioning the airway.
Immediate (Red Tag) patients have ventilations present after repositioning the airway. This category also includes any patients:
-With a respiratory rate greater than 30 per minute, or
-In whom capillary refill exceeds 2 seconds.
-Who is unable to follow simple commands.
Delayed (Yellow Tag) patients do not fall into the IMMEDIATE or MINOR category.
Minor (Green Tag) patients are characterized as the “walking wounded.”
When you enter the area of a Multiple Casualty Incident (MCI), tell all patients who can walk to go to a previously designated Safe Area. You then assess non-walking patients individually as they are encountered using respiration, circulation, and mental status as the evaluation criteria.
Respiration – The EMT makes a rapid estimate of the number of respirations per minute.
When respiration exceeds 30 per minute, the patient is tagged IMMEDIATE
If the patient is not breathing, one (1) attempt is made to reposition the head, and loose dentures and foreign matter are rapidly removed. Cervical spine precautions may not be used if they will delay the assessment. If the patient remains apneic, he is triaged as Deceased/Non-Salvageable. Never start CPR when performing triage during an MCI.
Patients who are placed in the IMMEDIATE category receive no further assessment.
Circulation – For patients who are breathing at a rate of less than 30 breaths per minute, check the patients capillary refill. If capillary refill is delayed longer than two (2) seconds the patient is placed in the IMMEDIATE category.
When capillary refill cannot be assessed (i.e. poor lighting conditions, nail polish) check the radial pulse. If it is absent, you can assume a systolic blood pressure is less an 80 mm Hg, and the patient needs IMMEDIATE care. Apply direct pressure to any significant external bleeding and raise the patient’s legs. The walking wounded, or even the patient himself/herself, if conscious, can help with this procedure. IMMEDIATE patients (delayed capillary refill or no radial pulse) require no further assessment.
Altered Mental Status – is assessed by asking the patient to follow the simple command “squeeze my hands”. If the patient cannot do this he is categorized as IMMEDIATE, if he can he is considered MINOR. If an extremity injury prevents the patient from squeezing your hands, instruct the patient to “open and close your eyes”. No further assessment is performed and no additional care is rendered until all patients have been triaged and moved to the appropriate treatment areas. As more help arrives patients will be re-triaged and appropriate care and/or transportation is provided.
Article Eighteen
Hazardous Materials Operations (HAZMAT)
Section One Policy and Operations
The Following procedure shall be followed in the event of a hazardous materials incident:
1). FDNY shall be responsible for coordination of pre-hospital resources in HAZMAT situations.
2). The crew shall not enter a situation where there may be exposure to HAZMAT situation in which the crew members are untrained in dealing with, or lack the appropriate safety equipment and PPE.
3). Upon arrival at a suspected HAZMAT scene, the crew will contact MARS or 911 and inform the operator of the situation.
4). If the crew opts not to enter the scene, they should attempt to attain as much information as possible so that they can provide the HAZMAT responders with an accurate report.
5). Members should review HAZMAT warnings and procedures regularly.
6). Members must refrain from making direct contact with anyone exposed to a HAZMAT scene until that person has been appropriately decontaminated.
7). Available at headquarters and in both of the ambulances is the 2000 Emergency Response Guidebook provided by the US DOT for the consultation of any crewmembers unsure of a possible hazardous materials effects and/or characteristics and placards.
Article Nineteen
Do Not Resuscitate Orders (DNR)
Section One Policy
Do Not Resuscitate (DNR) orders are authorized under chapter 370 of Article 29-B of the New York State Public Health Law. The law establishes a presumption in favor of the consent of a patient to CPR, but also establishes the lawfulness of a DNR order issued in compliance with the provisions of the law. Chapter 370 of Article 29-B requires pre-hospital personnel to comply with an order no to resuscitate issued by the patients attending physician whenever the patient is being transferred from one institution to another. Such institutions include acute care hospitals, skilled nursing homes, immediate care facilities, hospice beds in hospitals, and psychiatric hospitals. DNR orders are also applicable to adults living at home.
Section Two Procedure
1) If there is a cessation of vital signs during transport of the patient, or if the patient is in cardiac or respiratory arrest upon medical crew arrival, and the crew is in possession of a properly issued DNR order, no life sustaining measures will be undertaken.
2) The only acceptable DNR is the “Department of Health Non-Hospital DNR Order.”
a. Pre-hospital patient care providers should not accept a verbal DNR.
b. Health Care Proxy, Living Will, and Medical “Power of Attorney” are not recognized in the pre-hospital setting.
3) If a medical crew does not begin resuscitative measures because of a DNR, Medical Control and NYPD must be contacted. The Body will not be removed and the crew must remain on scene until NYPD arrival.
Note: A non-hospital order not to resuscitate directs emergency medical services personnel not to attempt cardiopulmonary resuscitation in the event that a patient suffers cardiac or respiratory arrest.
Note: Cardiopulmonary resuscitation means measures to restore cardiac function or to support ventilation in the event of cardiac or respiratory arrest.
Note: Cardiopulmonary resuscitation shall not include measures to improve ventilation and cardiac functions in the absence of arrest. Hence, all appropriate care in compliance with regional protocols is to provide patients who are not experiencing cardiac or respiratory arrest, even if a valid DNR exists.
Article Twenty
Unattended Death
Section One Definitions
A. Private Location – shall be defined as those areas to which the public in general does not have access, such as a home, apartment, hotel room, or private office.
B. Public Location – shall be defined as those areas, which are open to the public or to public view.
Section Two Procedure
When a FUEMS crewmember is to remove the deceased from the scene of an EMS call, the member shall be guided by the following procedures:
A. Prior to the removal of the deceased:
1. The crew chief shall confirm with the police officer in charge that the death has been reported to the Office of the Chief Medical Examiner.
2. Record the M.E. Case number on the PCR
3. Confirm with the police officer in charge that a search has been conducted and personal property removed.
1. Removal from private locations:
1. When police officers are on the scene at a private location, members shall leave the body in the custody of the police officerson scene.
2. If NYPD is not present at a private location, members shall contact the security dispatcher and request police assistance at the scene. Members shall remain on scene until police arrive.
3. A mortuary unit shall perform the removal of the deceased from private locations. (See exceptions below in part c.)
2. Removal from public locations:
1. The removal of the deceased from the scene of public locations shall be performed by ambulance, with the exception of decomposed bodies, which shall be removed by mortuary units only.
i. In cases involving decomposed bodies at the scene of a public location, the members shall contact the security dispatcher to request that a mortuary unit be dispatched to the scene.
ii. In cases involving removal of bodies to the Chief Medical Examiners office (Bronx Borough), members shall notify the security dispatcher to contact the medical examiners office via landline to inform them that the deceased is being transported to their location.
2. When the deceased is to be removed from a public location, if an NYPD ID tag has been placed on the body, the body shall be delivered directly to the medical examiners morgue in the county of occurrence.
i. Prior to the removal of the body to the morgue, members shall inform the security dispatcher to make notification to the communications unit of the Office of the Chief Medical Examiner that the body is being removed from the scene to the morgue.
3. When the deceased is to be removed from the scene of a location, if a PD ID tag has not been placed on the body the members shall:
i. Await the placement of PD ID tag prior to removing the body from the scene. When this is not possible:
ii. The body shall be left in the custody of a police officer. Bodies shall not be removed from the scene without a PD ID tag.
iii. If no officers are present at the scene the members shall contact the security dispatcher to request an NYPD unit to respond to the scene. The members shall remain on scene until the arrival of police officers and conclusion of a search for personal property.
4. The only exceptions to this procedure shall be authorized by the Chief medical Examiner based on special circumstances.
5. At anyscene require the removal of the body of a deceased person; members shall not disturb the body.
6. Where death has been pronounced at the scene of a call, all resuscitative measures and other procedures that have been applied to the deceased by members, shall be recorded on the PCR, and a copy of the PCR shall be submitted to the mortuary supervisor when the body of the deceased is transported to the morgue.
i. When the body of a deceased person is let at the scene in the custody of police officers, a copy of the PCR shall be turned over to the mortuary unit removing the body.
ii. If members transport the body to the morgue, they shall turn a copy of the PCR over to the mortuary supervisor.
Article 21
RMA policy
1. PURPOSE -To set forth the policy and procedures for obtaining and documenting any patient refusal of emergency medical treatment and/or transport (RMA).
2. DEFINITIONS
a. Decisional Capacity – an individual's ability to make an informed decision concerning his or her medical condition or treatment. In order to have decisional capacity, the patient must be alert and demonstrate that they understand:
i. the nature of their acute or presenting medical problem;
ii. the possible risks and consequences of refusing emergency medical treatment and/or transport for their acute or presenting medical problem, including where applicable, the risk of death;
iii. their treatment and transportation alternatives.
b. Emancipated Minors - A minor who is married, is pregnant or is a custodial parent, or who lives apart from and is not supported by their parents, may RMA on their own behalf.
c. High Index of Suspicion – A provider’s concern that an individual may have an acute medical, traumatic, psychiatric or social condition that might result in an untoward patient outcome. Indications for a high index of suspicion may include, but not be limited to:
i. The mechanism of injury to the patient;
ii. A 911 caller, friend, neighbor, co-worker, family member, home health aide expresses concern for the patient’s health, with good cause;
iii. A caller to 911 is reporting expressed or actual suicidal or homicidal behavior by the patient, regardless of whether the caller is on the scene or not;
iv. The request for assistance originated with a physician or other health care provider.
d. Impairment – A condition in which an individual whose decisional capacity, you suspect, may be compromised as a result of diminished, altered or impaired intellect, reasoning, insight, or judgment; including any diminishment, alteration or impairment associated with:
i. Alcohol, drug or toxic substance use or abuse;
ii. Head trauma, dementia, encephalopathy, mental retardation, or other central nervous system (CNS) dysfunction (e.g., Alzheimer's disease);
iii. Acute or chronic psychiatric illness;
iv. Medical illness, including but not limited to metabolic or infectious disorders such as hypoxia, hypotension, hyperglycemia, hypoglycemia, dehydration, and sepsis.
e. Patient – An individual for whom an ambulance was requested for the possible provision of emergency medical treatment and/or transport.
f. Patient Contact – Any instance, in which an emergency medical provider has visualized, approached, communicated with, or initiated history taking and/or a physical exam on an individual for whom the ambulance was requested.
g. Refusal of Medical Aid (RMA) – A refusal of emergency medical treatment and/or transport by a patient with the decisional capacity to do so.
h. Treatment – Any patient care that is provided beyond obtaining a patient history, vital signs, and the performance of a physical examination, including but not limited to: the administration of any medication (via any route).
3. POLICY
i. A patient, who demonstrates decisional capacity to do so, has the right to refuse emergency medical treatment and/or transport.
j. Prior to accepting an RMA from patient, members must perform a complete assessment and offer appropriate treatment to the patient.
k. EMTs must contact Saint Barnabas Hosptial prior to considering and/or accepting an RMA for any patient where:
i. any treatment has been provided to the patient, or who indicates that they has self-administered any prescribed medication, including aspirin for chest pain, prior to the arrival of the EMS personnel or in the presence of such personnel.
ii. Age five and younger, or age sixty-five and older.
iii. Whom the member has determined requires immediate treatment and/or transport to an ambulance destination, based on a high index of suspicion.
iv. When a health care proxy refuses emergency medical treatment and/or transport on behalf of the patient.
l. EMS providers shall make aggressive attempts to persuade patients requiring emergency medical treatment and/or transport to accept such assistance. Under no circumstances shall any patient be encouraged to refuse medical aid.
m. EMS providers shall use all means available to them (radio, telephone, etc.) for required Saint Barnabas contact in an RMA situation.
n. A Pre-Hospital Care Report (PCR) must be completed for every patient contact, including every RMA. NOTE: Every RMA must generate a PCR, including cases of an uncooperative patient who does not provide information or prevents assessment.
4. PROCEDURE
o. If a patient lacks decisional capacity, treat the patient as appropriate and transport to the nearest appropriate ambulance destination.
i. If the patient resists and cannot be safely treated or transported, request the assistance of a Security Officer and the appropriate law enforcement agency to facilitate treatment and transport. NOTE: Members shall attempt to contact Saint Barnabas if the patient is communicative, even if the patient lacks decisional capacity. The Saint Barnabas physician may be able to facilitate transport.
p. If a patient demonstrates decisional capacity and refuses treatment and/or transport to an ambulance destination, members shall attempt to perform a complete patient assessment and shall use all reasonable efforts to convince the patient of the necessity for treatment and/or transport.
q. If a patient demonstrates decisional capacity, members shall accept the RMA without Saint Barnabas contact, only if:
i. the patient does not meet any of the criteria requiring contact with Saint Barnabas; and
ii. All EMS providers at the scene involved in the patient's care are in agreement that the RMA should be accepted.
r. If the patient demonstrates decisional capacity but meets the criteria for calling Saint Barnabas, members shall:
i. Contact Saint Barnabas for assistance in convincing the patient to accept emergency medical treatment and/or transport, and document on the PCR:
ii. The name and identification number of the Saint Barnabas Physician.
s. The appropriate final disposition code.
t. Request the response of a Security Officer, if the patient refuses to speak with Saint Barnabas.
u. Follow the direction of the Saint Barnabas Physician.
v. If Saint Barnabas determines that the patient lacks decisional capacity, treat the patient as appropriate and transport the patient to the nearest appropriate ambulance destination. If the patient resists and cannot be safely treated or transported, request the assistance of a Security Officer and the appropriate law enforcement agency to facilitate treatment and transport.
w. If NYPD or other law enforcement agency will not assist in the transport of the patient, document the names, ranks, shield numbers and the commands of those personnel on the PCR and notify Saint Barnabas.
x. Request that the dispatcher make appropriate documentation into the call history.
y. If a patient lacks decisional capacity, but does not appear to require emergency medical care and/or transport (e.g., a request for lifting assistance for an Alzheimer’s patient), members may contact Saint Barnabas for medical concurrence that no acute medical condition exists requiring emergency medical care and/or transport. Following Saint Barnabas’ concurrence that the patient does not need to be transported from the scene, a final radio disposition 10-93A (Patient Not Found, Disposition Code 008) shall be recorded on the PCR. NOTE: 10-93A is not an RMA, but authorization from Saint Barnabas not to transport. RMA Signatures are not required.
z. If the patient becomes unstable or the patient's condition begins to deteriorate, while enroute (10-82), the unit must divert to the nearest 911 ambulance destination.
aa. An PCR shall be completed for each patient contact and every RMA.
bb. All information relevant to the RMA shall be fully and legibly documented on the PCR.
cc. In situations with an uncooperative patient, obtain all possible information and document the situation fully.
dd. Ensure that the patient signs the back of the PCR indicating the refusal of medical aid and have a witness countersign the PCR.
ee. The witness may be a family member, friend, bystander, police officer, caregiver or other involved individual.
ff. The On-Line Medical Control Physician shall:
i. Prior to making a determination concerning a patient’s decisional capacity to refuse medical aid, ensure that all information needed to make such determination has been received from the members, patient or others.
ii. Communicate directly with the patient, members or any other caregivers (e.g. physician, visiting nurse, family members) present at the scene to determine:
1. The patient's decisional capacity to refuse emergency medical treatment and/or transport.
2. The necessity for emergency medical treatment and/or transport. It may be necessary to evaluate the “normal” health status of the patient and any acute change in that status prior to determining the need for emergency medical treatment or transport (e.g., nursing home patient requesting lifting assistance). NOTE: The use of a translator (e.g., family, friends, bystanders, ATT Language Line) is an acceptable alternative to talking directly to the patient if the patient is non-English speaking. If a translator is used, document the translator’s name, address, and phone number on the ACR.
3. Fully evaluate all information of the call received from the members and document this information on the OLMC RMAWorksheet.
4. Authorize the EMS crew to accept or deny the RMA.
gg. The following dispositions are applicable for Saint Barnabas contacts:
i. 10-82: the patient agrees to treatment and transport following contact with Saint Barnabas, or it is determined that the patient does not demonstrate decisional capacity and requires treatment and/or transport.
ii. 10-93A: the Saint Barnabas physician determines that there is no acute presenting medical condition requiring emergency medical treatment and/or transport. NOTE: Patients for which a 10-93A is being considered do not need to demonstrate decisional capacity to RMA
Article 22
State Laws and Policies
Section A Medical Protocols
Medical Protocols should follow in accordance to Local REMAC rules and regulations and should be maintained and
Updated according to the availability of new protocols
Section B Abandoned Infant Protection Act
Under this provision a parent, guardian or other legally responsible person may leave their infant, as long as they are five days old or less, at a fire or ambulance station as defined as a safe place. Since FUEMS does not operate 24 hours out of their headquarters all matters involving a found child should be directed to Fordham Security who will contact local police.
Section C Volunteer Ambulance response
FUEMS is a Volunteer Ambulance Corp. as defined under NYC DOH article 30, and operates during the “day” as defined by FUEMS SOPs.
Subsection A
All matters where care is being given to a patient must be in observance of a FUEMS EMT cleared as a crew chief.
Subsection B
i. An ambulance may only respond to a scene if it is known that an EMT is also responding by foot.
ii. If when the ambulance has arrived and the EMT is delayed, the driver of the ambulance may only provide care if they are certified by New York State as an Emergency Medical Technician. If the operator of the Ambulance is a CFR they may also begin care but must transfer care upon the immediate arrival of the EMT.
Subsection C
An ambulance must NOT respond to a scene if it is known that EMT is NOT available
i. An ambulance may respond to a scene if it is known that another ambulance agency will provide the EMT
ii. If an ambulance is on scene no EMT is available but another service is immediately available, the patient must be transported by that service.
Subsection D
FUEMS does not allow any members the use of private vehicles as
Emergency Ambulance Service Vehicles.
Section D Sexual Harassment/ Discrimination
FUEMS has a no tolerance policy on Sexual Harassment and Discrimination. FUEMS shall follow policies outlined by Fordham University and all disciplinary action shall be referred to the University.
Section E Smoking
FUEMS follows New York State guidelines and Fordham University
guidelines on smoking and all members are prohibited in smoking in Headquarters, Bunk Room, Supply Closet, Oxygen supply room, and ambulances. Special Disciplinary action will be taken if a member is found smoking in any of these places and will be referred to the University and have their membership revoked.
Article Twenty-Three
Transition of Care PAD/Epi-Pen
Section One Public Access Defibrillation (PAD)
1) When arriving on a scene where the patient is being treated by a “first responder” with an AED, the crew chief should immediately confirm the patients status (unresponsive, responsive, apneic, pulse less, etc.), and determine if a “shock” is advised. Treat the patient appropriately, request ALS, and prepare for immediate transport. The “first responder’s” AED should remain on the patient until a full cycle of the AED has been completed. The AED and/or pads are usually changed when the patient is ready for transport or upon treatment by an ALS provider.
2) For patients where “no shock” is advised, the EMS provider should continue CPR (verify that CPR is being performed correctly) and prepare for immediate transport.
3) For patients where a “shock” is advised, the EMS provider should administer a set of 3 shocks and prepare for immediate transport.
4) If the ambulance does not have an AED or if the AED is not functioning, the “first responder” should accompany the patient to the hospital, follow regional protocols and provide CPR as indicated (the ambulance should pull over and stop when analyzing and shocking the patient).
5) The EMS provider should attempt to gather the following information:
a. how long the patient has been down
b. when was CPR initiated
c. when was the patient first “shocked”
d. how many “shocks” has the patient received
e. any pertinent patient history that is available
Section Two Epinephrine Auto-Injector for Anaphylactic Reactions with Respiratory Distress or Shock.
a. When arriving on the scene of a patient experiencing an anaphylactic reaction, if the patient is being treated by a “first responder” who has administered epinephrine by an auto injector, the EMS provider should immediately confirm the patient’s status. The EMS provider should pay close attention to the patient’s airway, respiratory distress and any signs or symptoms of hypo-perfusion (shock). Treat the patient appropriately, request ALS if available and prepare for immediate transport.
b. The EMS provider should attempt to gather the following information:
a. determine the substance the patient was exposed to
b. how long ago the exposure occurred
c. the initial symptoms the patient reported
d. the time and dosage of the epinephrine administered
e. the name of the individual who administered it
f. the patients response to the treatment.
e. Medical control must be contacted prior to administering a second epinephrine injection.
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