Revised July 2018

LIBERTY COUNTY AMBULANCE

POLICY AND PROCEDURE MANUAL

Liberty County Emergency Services 710 W. Monroe Ave.

PO Box 459 406-759-5746

Tara Hendrickson – Director 406-899-4508 (Cell)

406-759-5947 (Home)

James Dahlen – Co-director 406-265-0883 (Cell)

406-759-5015 (Home)

TABLE OF CONTENTS Page 3: GENERAL STATEMENT Page 4: PATIENT TRANSPORT Page 5: CHARGE FOR SERVICE AND BILLING / DISPATCH Page 6: AMBULANCE SUPPORT FOR FIRE / RESCUE TRUCK Page 7: SANITATION Page 8: MAINTENANCE Page 9: EQUIPMENT / DOCUMENTATION Page 10: CRITICAL INCIDENT STRESS DEBRIEFING Page 11 : REPORTING EXPOSURE TO INFECTIOUS DISEASE Page 12: VACCIANTIONS AND IMMUNIZATIONS Page 13: CONFIDENTUALITY / DONATIONS Page14: TRAINING / AGENCY AFFILIATION Page 15: REPORTING REQUIREMENTS Page 16: DRUG AND ALCOHOL Page 17: SEXUAL AND OTHER UNLAWFUL HARASSMENT Page 18: REIMBURSEMENT / DISCIPLINE / BECOMING A MEMBER OF LIBERTY COUNTY AMBULANCE Page 19: ACKNOWLEDGEMNT AND RECEIPT OF HANDBOOK Page 20: LIBERTY COUNTY EMERGENCY SERVICES POLICY AND PROCEDURE MANUAL ADOPTION

Resources and references: EMS and Trauma Systems: http://dphhs.mt.gov/publichealth/EMSTS Montana Board of Medical Examiners for Emergency Care Providers (ECP): http://boards.bsd.dli.mt.gov/med/ecp#0 Montana Department of Labor & Industry for ECP licensing: https://ebiz.mt.gov/POL/Welcome.aspx National Registry of Emergency Medical Technicians (NRETM): https://www.nremt.org/

GENERAL STATEMENT

Purpose: This policy is intended to cover specific concerns related to the Liberty County Emergency Services departments. This policy does not super-cede the Liberty County Personnel & Policy Handbook (last revision April 2018). Refer to the Liberty County Personnel & Policy Handbook for items not covered in this policy. As a volunteer for Liberty County, members of the emergency service team are subject to the Liberty County Personnel & Policy Handbook as well.

Liberty County Emergency Services is comprised of medical and fire services. Liberty County Ambulance service as the medical component of this team. There are three fire departments in Liberty County: Joplin District, Chester West Rural District and the Town of Chester Fire Department. Members of the Chester West Rural District also serve for the Town of Chester. All members of the medical and fire services are volunteer or part-time.

The Liberty County Ambulance is licensed by Montana State Department of Public Health and Human Services (License #: 452) as a basic life support (BLS) ground transporting unit and quick response unit (QRU). Many policies and responsibilities for the ambulance service are stated in Montana Code Annotated (MCA) and Administrative Rules of Montana. MCA will be referenced in this manual.

Emergency Medical Providers (ECP) are licensed by Montana Department of Labor and Industry: Medical Examiners. ECP’s must be in compliance with state and/or national standards and work within their scope of practice at all times.

Liberty County Ambulance personnel are trained and certified by the National Registry of EMT’s standards and/or licensed by the state of Montana’s standards and also perform in accordance with national and state protocols. It is mandatory to have a current Montana license and be in good standing; however, it is not mandatory to be certified nationally as a responder. Certified drivers are the exception to the license and certification rule.

Liberty County Ambulance will adhere to NIMS/ICS guidelines for all planning, training, and responses. It is recommended that all responders will be certified in IS100 and IS700. It is recommended that supervisors be certified to the level required by national guidelines. It is recommended that new responders complete the NIMS/ICS certification within 30 days of receiving their responder certification/licensure.

State and local policy requires that an ambulance response must have a minimum of two certified/licensed responders on board, with at least one being at an EMT level of above. The only exception to this policy is if additional responders are responding directly to the scene of the emergency and one responder brings the ambulance to the scene.

Ambulance drivers must be members of Liberty County Ambulance or fire departments and must be on the county roster. Ambulance and rescue truck drivers must hold a valid driver’s license as well.

PATIENT TRANSPORT

The base hospital for Liberty County Ambulance is the Liberty Medical Center. On occasion, patients request transport to a different hospital, usually Havre, Shelby, Cut Bank, Conrad or Great Falls. It is the policy of the ambulance service to try to accommodate the wishes of the patient, unless the ambulance health care providers feel that the situation demands transport to Liberty Medical Center. The situation could depend on the patient’s condition, weather, distances, or other factors.

There are also occasions and conditions when the ambulance crew might request advanced air medical services to come directly to the scene or intercept with the ambulance before reaching the hospital.

Liberty County Ambulance is sometimes requested to transport patients to air medical transport (fixed wing or helicopter) for definitive treatment at another facility. Ambulance crew members will retrieve air medical providers and their equipment at Liberty County Airport and transport them to Liberty Medical Center. Once the patient is ready for transport, the patient and medical team will be transferred back to the airport via ambulance.

In cases of severe weather, hazardous road conditions, natural disasters, or acts of terrorism, the ambulance will attempt to respond to emergency calls if at all possible. Transferring patients in inter-facility transfers may not be possible during these conditions or when sufficient crew members are not available. The final decision on these calls is left to the crew and service directors.

Ambulance personnel are reimbursed for patient transfers to other facilities or destinations at a rate of $150 per transfer (revised 1/1/18). Personnel are reimbursed for transfers monthly.

Nurses riding with the ambulance on transfers are under the employment of the hospital.

Montana code annotated also states that registered nurses with supplemental training (and authorized by ambulance’s medical director) can function on the ambulance in the prehospital setting as an emergency medical provider. When a nurse functions in this role, they function under the ambulance license and Liberty County.

Only nurses on the ambulance roster are certified to ride with the ambulance on emergency calls. Doctors are included on the ambulance roster. Both grandfathered nurses and doctors ride as employees of the medical center.

CHARGE FOR SERVICE and BILLING

Ambulance billing is done by a third party individual. The rate for basic life support service is a base rate of $500 and $12/loaded mile (revised 1/1/18).

Charge for service deposits are made at Liberty County Treasurer regularly. Copies of checks, deposits and explanations of benefits are then given to third party biller to reconcile accounts receivables.

When a member of Liberty County Emergency Services or a member of their immediate family use Liberty County Ambulance, the member’s insurance will be billed but the member will not receive a bill for remaining charges.

DISPATCH

The Liberty County Public Safety Answering Point (PSAP), located in the Sheriff’s Office, serves as the dispatch center for ambulance services.

The ambulance is paged out with a toned page on the EMS Repeater. A siren can also be activated for ambulance personnel (two rings).

Responders that live out of town and serve as a quick response unit are can be called by landline or radio by dispatch or by neighbors in their area.

Firemen are paged out with their corresponding toned pages on the EMS Repeater. They may also communicate on the Liberty County fire repeater, or on the Joplin Fire frequency. Chester Fire can also be contacted with the fire phone or by the siren (three rings).

In addition to the above methods, eDispatching can be set up on responder’s cellular phones to receive notification of an emergency. This application can be set up by supervisors.

Responders must communicate to dispatch they are responding to an emergency via telephone or radio.

AMBULANCE SUPPORT FOR FIRE

The Liberty County Ambulance responds with Liberty County Fire departments when there is a structure fire anywhere in the county or through mutual aid with other county fire departments.

The Liberty County Ambulance responds with Liberty County Fire departments when there are known hazardous materials or the potential for hazardous materials. The fire departments are charged with the responsibility for hazardous materials response and the decontamination of patients. The ambulance responds to guarantee the safety of the firemen prior to and after a hazardous materials response. The ambulance is then responsible for the continued care and treatment of the patients.

Ambulance personnel are required to wear the proper Personal Protective Equipment (PPE) at hazardous materials scenes and in transporting patients that have been decontaminated at the scene.

RESCUE TRUCK

The Liberty County Ambulance department is responsible for the rescue truck (48RESQ).

Firemen and ambulance personnel, trained and certified in extrication, respond with the rescue truck to all vehicle accidents, some structure fires, search and rescue operations, hazardous material scenes and any other call that is deemed necessary.

SANITATION

The purpose of this policy is to reduce the risk and exposure of infectious or communicable diseases to emergency service members, patients and the public by requiring the following sanitation and cleanliness procedures associated with all emergency medical responses.

Members will limit their exposure to patient body fluids (saliva, sputum, mucus, semen, vaginal secretion, amniotic fluid, feces, urine, vomit, wound drainage, blood or cerebral spinal fluid) by:

1. Wearing disposable, non-latex exam gloves when examining and treating patients.

2. Wearing eye protection, a face mask (N-95), safety glasses or goggles and protective clothing when subject to the possibility of splashing or soiling by a patient’s body fluids.

3. Using a pocket mask with a one way valve or a bag valve mask whenever performing CPR or ventilations on a patient.

4. Using bleach or similar recognized germicidal agent to clean any equipment used on a patient.

5. Disposable equipment is for one time use and must be disposed of after its use.

6. Oxygen humidification must be single use and disposable.

7. Linen must be changed and the cot mattress disinfected after each use.

8. Complete cleaning and decontamination of vehicle after a hazardous materials response.

9. Needles must not be recapped, bent, or broken and must be disposed of in a labeled container provided exclusively for such disposal.

10. In cleaning after a response, all sharp items must be disposed of in a puncture proof container. All body fluid contaminated items must be placed in leak-proof RED bio-hazard bags for transport to Liberty Medical Center for proper disposal or cleaning.

11. The interior of the ambulance, including all storage areas, must be kept clean and free of dirt, grease, and other offensive matter.

12. Germicidal spray or germicidal towels must be used to wipe down the surfaces of the ambulance counter, stethoscope heads, blood pressure cuffs, pulse oximeter clips, backboards and straps, and any equipment in contact with the patient.

13. The ambulance floor should be swept and mopped as needed after each use and all garbage removed.

MAINTENANCE

Regular inspection and maintenance shall be done on all emergency vehicles weekly and recorded in each vehicle log book. A chart in each log book lists all maintenance procedures and items to be inspected.

Automatic External Defibrillators (AEDs) are checked monthly. AED maintenance records are kept in vehicle log book or with the crew member in charge of the AED.

Any deficiency found during inspection or during a run must be reported to the directors as soon as possible.

At regular meetings, ambulance crew kits will be inspected to make sure that they are clean and complete. Oxygen bottles and regulators will be tested as required.

Radios and pagers will be tested with the county test page each day.

EQUIPMENT

All equipment used by service members, unless purchased by the member, remains the property of the ambulance. Members are responsible for the care and maintenance of this equipment and any loss or damage must be reported to the directors as soon as possible.

QRU members are required to carry a basic kit with a required list of items (list available from supervisor), a portable radio (minimum of 16 channel with required channels) and a portable oxygen kit. These items are subject to inspection by the State EMS bureau.

Upon leaving the service, all department equipment must be returned to the department as soon as possible. This equipment includes radios/pager and chargers, oxygen units, building keys, ID cards and any other equipment and supplies furnished by the department.

DOCUMENTATION

As of January 1, 2018, Liberty County Ambulance uses the state of Montana’s ImageTrend electronic documentation system to document patient care reports (PCRs). A PCR is created anytime ambulance personnel are requested by dispatch; PCR’s are created for all patient transports, transfers, patient refusals, and canceled calls.

Patient care reports are supposed to be submitted within 24 hours of call per state guidelines. Patient care reports need to be very thorough and include all aspects of call. The rule of “if it is not documented, it did not happen” applies to Liberty County Ambulance.

Liberty County Ambulance provides a half page, carbon copy patient information form to crew members as tool to gather patient information on scene and during transport. This form is part of the patient’s medical record; the carbon copy of this completed form is to be left at facility that the patient was transported to.

If a patient refuses transport, a refusal form must be filled out to the best of the crew member’s ability.

When in doubt, document events when summoned as an emergency medical provider.

CRITICAL INCIDENT STRESS DEBRIEFING

The Liberty County Ambulance recognizes the potential for certain calls to create increased stress and emotion for responders.

Every effort will be made to recognize the calls that have this potential and to follow up with responders with the appropriate level of defusing or debriefing. All members of the service are encouraged to also be aware of this potential in themselves and their fellow crew members. Anyone feeling in need to defuse or debrief should contact the service directors or the medical director as soon as possible and the appropriate process will be initiated.

Individual mental health services are also available through the Liberty County Employee Assistance Program. Individuals should contact the service directors or the medical director for information on these services.

REPORTING EXPOSURE TO INFECTIOUS DISEASE

Ambulance crew members are also subject to county procedures for reporting exposure.

Infectious diseases recognized as having the potential of being transmitted to EMS providers through unprotected exposure are: HIV/AIDS, Hepatitus B, Hepatius C, Communicable Pulmonary Tuberculosis, MRSA, Rabies, Chicken Pox, Anthrax, Bioterrorism exposures, Pertussis, Influenza, etc.

Types of exposure that may be reported are:

1. Any person to person contact in which co-mingling or spray of respiratory secretions (saliva or sputum) of the patient and the EMS provider may have taken place.

2. Transmittal of blood or body fluids from the patient onto the mucus membranes of the EMS provider (mouth, nose, eyes) and/or into the breaks in the skin of the EMS provider.

3. Any non-barrier protected contact of the EMS provider with the mucus membranes or non-intact skin of the patient.

4. Any puncture wound to the EMS provider with a needle, scalpel, or other sharp object that is contaminated with blood or body fluids.

5. Body fluids include saliva, sputum, mucus, semen, vaginal secretions, amniotic fluid, feces, urine, vomit, wound drainage, blood, or cerebral spinal fluid.

Liberty County Ambulance will adhere to MCA 50-16-702 “Notification of exposure to infectious disease – report of exposure to disease.”

A report of an unprotected exposure may be filled out by any Liberty County Ambulance member on a Montana Department of Emergency Medical Services Bureau form entitled: “Report of Unprotected Exposure”. This form may be obtained from the EMS directors, Designated Officer (or alternate) for infectious disease, or from the Liberty Medical Center. The completed form is then returned to one of the above listed for the appropriate action.

VACINNATIONS AND IMMUNIZATIONS

The ambulance supervisor has a list of vaccinations and immunizations that Liberty County Public Health nurse suggestions for healthcare professionals.

The ambulance department will make available to all service members the recommended list of vaccinations and immunizations at the department’s expense. Those electing not to receive the recommended vaccinations and immunizations for healthcare professionals run the risk of contacting the illness/disease at the member’s expense.

The ambulance department will arrange, each fall, to have a nurse provide the current influenza shots to ambulance and fire department members at the department’s expense. Historically, Liberty Medical Center has provided influenza shots to ambulance and fire department members free of charge. If this means becomes extinct, the department will fund the immunization from a different source.

INJURY DURING AN EMERGENCY CALL OR TRAINING

In the event of an injury to yourself or a crew member happens during an ambulance sanctioned event, an ambulance supervisor needs to be informed immediately. Depending on the severity of injury, make sure the individual is cared for and transported to closest medical facility if need be. Once the injured safety is secured, the ambulance supervisor will contact and advise county administration of event and circumstance.

The ambulance director submits worker compensation reports to Liberty County Clerk and Recorder of a monthly biases. Response, transfer, training, and volunteer hours are part of report that is submitted.

CONFIDENTIALITY

All members of the Liberty County Emergency Services are required to complete confidentiality and HIPPA training and sign a “Statement of Confidentiality” which will be kept on file with the department. All information learned at a scene, at the hospital, during a transfer, or as part of a debriefing or quality improvement process is to remain strictly confidential.

If and when confidentiality has been compromised, a supervisor must be notified.

Crew members breaking confidentiality policy will be interviewed by supervisor. Depending on circumstance, crew members will be verbal warned, issued a written warning for their file, or be terminated from the department.

DONATIONS

Monetary donations may be given to Liberty County Ambulance. These donations are deposited with the Liberty County Treasurer. The ambulance supervisor will ensure a written thank you is given to the donator. A public thank you in the local paper may also be done if the ambulance director deems necessary.

If donations are made in memorial of an individual, after approximately three months, the ambulance director will notify the family of who made donations in the family member’s name. The letter to the family includes donator’s name and address; the letter does not include amount donated to the agency.

Most donations given to the ambulance are to be used at the discretion of the ambulance director and the ambulance members. Donations usually are used for crew member training and necessary equipment. Occasionally donations are given for certain things; in this case, the ambulance directors will do the best to carry out that obligation.

TRAINING

Continued education and training are vitally important to emergency service responders.

All ambulance responders are required to attend a reasonable number of monthly meetings in order to stay familiar with equipment, policies and training. All ambulance certified personnel are required by law to obtain CE (continuing education) credits for recertification/relicense. Failure to keep up with training, certification, or licensing may result in dismissal from the service. Responders who do not recertify/relicense in a time or are on probation cannot be dispatched for calls or respond with the ambulance. All ambulance personnel are required to be current in Health Care Provider CPR and AED.

A good amount of training is provided locally within the unit. Responders can also attend other regional and state sponsored training whenever possible. The department will reimburse responders for registration fees, mileage and motels (State Rates) when approved by director in advance. Every effort should be made to car pool to out of the area training sites. Crew members that do not attend local training regularly, may have to pay for out-of-area training personally.

AGENCY AFFILIATON

Individuals must have a current emergency medical provider state of Montana license and/or a NREMT certification to become an active member on Liberty County Ambulance’s roster. An active member is responsible to maintain these requirements.

The Liberty County Ambulance training director is responsible to observe training and the skills of individuals on the agency’s roster. The ambulance director will sign off on state licensure and NREMT recertification paperwork if the requesting individual primarily trains and responds to calls in Liberty County.

Occasionally, licensed and certified emergency medical providers reside and or visit Liberty County but do a majority of their training and response outside of Liberty County. In this situation, as long as the individual meets the requirements of the agency, they are able to be on the roster for Liberty County Ambulance at the supervisor’s discretion. These individuals are responsible for having their state and national paperwork completed by the agency in which they do a majority of training and response.

COMMON REPORTING REQUIREMENTS

Emergency services personnel are required by Montana State Law to report certain situations.

At a criminal scene, every effort should be taken to protect and secure evidence, as well as treat the injured patient. Disturbing the scene as little as possible, keeping notes or diagrams of the scene for law, cutting around and preserving knife cuts and bullet holes in clothing, placing a sheet under a patient to collect trace evidence and to wrap clothing up in, not handling weapons if at all possible, are all actions that can help the law investigation and still allow EMS to care for the patient in a timely manner.

Scenes that suggest the possibility of child abuse, domestic abuse or elder abuse, must be documented and reported to the nurse or doctor in the ER. Emergency medical personnel should not judge or make accusatory decisions or remarks at the scene or to those involved.

DRUG AND ALCOHOL

When a member of the Liberty County Emergency Service personnel, plans to be involved in a period of relaxation and using alcoholic beverages, they should shut off or remove their radio or pager. This avoids any temptation to respond and perception that they will be responding.

Liberty County Ambulance has a zero tolerance policy for responding to an emergency under the influence.

Anyone consuming multiple alcoholic beverages should not respond to any call until sober.

Use of recreational drugs, as well as some prescription medications, will also affect one’s ability to respond appropriately. Anyone taking these drugs or medications should not respond to any call.

In the situation that a member responds and other crew members express concern as to the possibility of their drug or alcohol consumption, a supervisor should be contacted immediately.

Crew members breaking drug and alcohol policy will be interviewed by supervisor. Depending on circumstance, crew members will be verbal warned, issued a written warning for their file, or be terminated from the department.

SEXUAL AND OTHER UNLAWFUL HARASSMENT

The Emergency Services department is committed to providing a work environment that is free from all forms of discrimination and conduct that can be considered harassing, coercive, or disruptive, including sexual harassment. Actions, words, jokes, or comments based on an individual’s sex, race, color, national origin, age, religion, disability, sexual orientation or any other legally protected characteristic will not be tolerated.

Sexual harassment is defined as unwanted sexual advances, or visual, verbal, or physical conduct of a sexual nature. This definition includes many forms of offensive behavior and includes gender-based harassment of a person of the same sex as the harasser. The following is a partial list of sexual harassment examples:

Unwanted sexual advances

Offering employment benefits in exchange for sexual favors

Making of threatening reprisals after a negative response to sexual advances

Visual conduct that includes leering, making sexual gestures, or displaying of sexually suggestive objects or pictures, cartoons or posters

Verbal conduct that includes making or using derogatory comments, epithets, slurs, or jokes

Verbal sexual advances of propositions

Verbal abuse of a sexual nature, graphic verbal commentaries about an individual’s body, sexually degrading words to describe an individual, or suggestive or obscene letters, notes, or invitations

Physical conduct that includes touching, assaulting, or impeding or blocking movements

In the Emergency Services department, the policy against harassment applies to both members of the department and to the patients and families that are being treated and transported.

It must be recognized that in treating patients, responders have to touch patients, remove clothing, ask personal and medical questions, and sometimes conduct procedures that other’s might construe as personal or harassing. Responders must take care with comments and questions to patients, joking, subjecting patients to unnecessary touching or exposure. Every effort should be made to protect a patient’s modesty and feelings when examining, treating and transporting them.

It is equally important that all treatment and procedures be fully documented on the run report.

REIMBURSEMENT

Liberty County Ambulance personnel will be reimbursed by the county for Montana state licensure and

NREMT certification; these fees apply every two years. Personnel must submit receipts and/or proof of

licensure and certification to supervisor in a timely manner for reimbursement.

Personnel may also be reimbursed for items or supplies for the ambulance. Arrangements must be made

with supervisor prior to purchase and reimbursement. This is also true for attending training outside of

the county. Again, receipts and proof of purchase or training must be given to supervisor in a timely

manner.

Liberty County Ambulance personnel will be reimbursed for patient transfers to facilities outside of

Liberty County at a rate of $150 per transfer. Exceptions to this rule include long duration transfers which

may be paid at a higher rate per supervisor’s discretion.

Liberty County pays claims monthly. Claims are due by the supervisor to Liberty County Clerk & Recorder

the first Tuesday of the month.

DISCIPLINE

In the event that an ambulance crew member commits an act that breaks the policy and procedure

manual or state statues, the supervisor must be notified immediately. Depending on the circumstance,

the ambulance crew member may be given a verbal warning, a written warning or be asked to terminate

their relationship with the agency.

Written warnings must be kept in personnel files. Depending on circumstances and offenses, three verbal

and or written warnings may result in termination of relationship and duties to the agency.

BECOMING A MEMBER OF LIBERTY COUNTY AMBULANCE

To become an emergency medical provider for Liberty County Ambulance you must possess a valid

Montana emergency medical provider license. NREMT certification is recommended but not mandatory.

Responders must have current training in Healthcare CPR/AED.

Responders may gain their initial training in emergency medicine from Liberty County Ambulance or

elsewhere. Despite where potential new individuals received their training, they must go through a

thorough orientation with ambulance supervisor and be released to service per supervisor’s

recommendation. An orientation check list is available from the supervisor.

Certified drivers for Liberty County Ambulance are not licensed by the state of certified by NREMT.

Certified drivers function under MCA 50.6.322 and MCA 37.104.316. Certified drivers must have current

training CPR/AED/1st aid and be on the ambulance roster.

Ambulance personnel must have a valid driver’s license to operate the ambulance and rescue truck.

ACKNOWLEDGEMNT AND RECEIPT OF HANDBOOK

ACKNOWLEDGEMENT AND RECEIPT OF LIBERTY COUNTY EMERGENCY SERVICES POLICY AND PROCEDURE

I acknowledge receipt of a copy of the Liberty County Emergency Services Policy and Procedure Manual.

I understand that I will be responsible for complying with the terms and conditions contained in the

manual.

Name and title: _____________________________________

Signature: __________________________________________

Date: ______________________________________________

LIBERTY COUNTY EMERGENCY SERVICES POLICY AND PROCEDURE MANUAL ADOPTION

Date adopted

________________________________________

Adopted by

_________________________________________________

Liberty County Ambulance Director

_____________________________________________________

Liberty County Commissioner