POLICIES & PROCEDURES INDEX COMMACK VOLUNTEER AMBULANCE

GENERAL POLICY DATE 0001 Member personal injury policy 8/26/01 0002 In-house availability policy 10/16/01 0003 Animal / Pet Policy 11/01/01 0004 9/16 Violence Progress call 01/01/90 0005 Chain of Command 04/20/02 0006 Sexual Harassment Policy 04/20/02 0007 Response Policy 01/01/01 0008 Stand-by Policy (in-house) 01/01/01 0009 Privacy Policy 01/01/90 0010 Incident Management System 04/20/02 0012 Public Access Defib notification 01/01/90 0013 overnight hour restriction 01/01/90 0015 Physical exams 01/01/95 0016 Computer Etiquette 03/01/02 0017 Length of Service Award System 00/00/02 0018 Educational Sponsorship 09/15/03 0019 Minimum passing grade 01/01/04 0020 Firefighter Driver 01/01/02 0021 Social Suspension 06/15/08 0022 Good Standing 06/15/08 0023 Honor Guard 01/01/10 0024 Electronic Information 09/16/11 RADIO POLICY 0001 CVAC IDENTIFIER 01/01/95 0002 Portable radio usage policy 01/01/95 0003 Auxiliary phone panel 08/30/02 0005 Telephone Conference Procedure 05/06/04 MEDICAL COMMITTEE POLICY 0001 Ambulance clean-up / Decon 04/17/02 0002 Ambulance Checks 04/17/02 0004 ALS medications and supply checks 10/13/05 0005 Conference selection criteria 01/01/03 MUTUAL AID POLICY 0001 CVAC Mutual aid policy 01/01/90 0003 Greenlawn conditional Policy 01/01/01 0004 East Brentwood / LIE M/A policy 01/01/01 UNIFORM POLICY 0001 Citation Bars / Collar Brass 02/01/02 0002 Uniform distribution policy 05/01/05 80 CAR POLICY 0001 80 car policy 01/01/90 0002 80 car tracking policy 02/01/02 MOTOR VEHICLE POLICY 0001 Ambulance Checks 04/20/02 0002 Driver Trainer Qualifications 08/30/02

DISPATCHER POLICY 0001 FRES phone numbers 01/01/01 0002 Subpoenas 01/01/90 0003 Maximum occupancy 01/01/90 0004 Direct calls for assistance 01/01/01 0005 Alphamate policy 01/01/90 0006 Servicemen and deliveries 01/01/90 0007 Suspected false alarms 01/01/90 0008 Dispatch Office Coverage Policy 01/01/90 0010 Beginning of tour 01/01/90 0011 End of tour 01/01/90 0012 Power failure 01/01/90 0013 Paging procedure 04/01/03 0014 Weather Notifications 05/01/03 0015 Paging with brevity 06/04/04 OPERATNG POLICY 0001 Pt. In Policy Custody 04/20/02 0002 Unable to access/locate pt. 04/20/02 0003 Unattended Death 04/20/02 0004 Sexual Assault 04/20/02 0005 Crime Scene 04/20/02 0006 Child Abuse reporting 04/20/02 0007 DOH Reporting 04/20/02 0008 Refusal of Medical Aid 04/20/02 0009 Designated Receiving Hospitals/tx 01/01/90 0010 Gurwin Center 04/20/02 0011 Cellular phone / pager use on call 08/30/02 0013 Crew Configuration 06/17/04 0014 Diversion enroute 06/17/04 0015 EMT Crew Chief 07/20/06 0016 Crew Chief Training 07/20/06 0017 High Visibility Vests 04/01/09 0018 Probie Response Guidelines 04/07/10 0019 Incident Action Plan 06/05/10 0020 Senior Corps / YS Interaction 04/07/10 0021 Probationary Member 04/15/11 0022 Probie Plus 04/15/11 0023 Bike Team 09/16/11 BUILDING POLICY 0001 Parking 04/20/02 CREW ASSIGNMENT POLICY 0001 Assignment Policy 07/01/03 YOUTH SQUAD POLICY 0001 Participation 06/01/03 0002 Overnights 06/01/03 MEMBERSHIP COMMITTEE 0001 Date of Membership 01/01/94 MCI 0001 MCI Trailer 04/07/10

MEMBER PERSONAL INJURY COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 08/26/01 General 0001

This policy was created to guide officers, Captains, EMT-Crew Chiefs, and Members in the appropriate actions to take in treating and reporting any accident or injury to a Corps Member while on duty and/or acting as a member of the CVAC. MEMBER SHOULD : Immediately report injury / accident to the Chief, Captain, EMT-Crew Chief, or EMT in charge Report the incident to dispatch Seek appropriate emergency medical treatment (ie: ambulance transport or ER visit, Drs Office) The Corps address (PO Box 819) is to be used when registering for treatment. All charges are to be billed (private billing) to Commack Volunteer Ambulance C orps. This prevents billing to the member’s home. The incident is NOT to be reported as a Worker’s Compensation case. Complete CVAC INCIDENT REPORT and VAW-1 forms upon return to the building (or as soon as possible thereafter). Both forms are available i n the Atrium forms rack. Forms are completed even if emergency medical attention is not immediately sought . ** do not forget the VAW-1** DISPATCHER SHALL: Log the Incident in the Miscellaneous Log book AND ambulance log only if treated/transported Alphamate Officers and advise of the particulars. Who was injured – how, when, actions taken. OFFICERS WILL: The Chief and the Board of Director Representative will review the incident and make appropriate recommendations to the Board and the Officers. Appropriate changes will be made to procedure and policy to avoid future occurrences. NOTE: Most injuries, thankfully, are minimal and the Corps opts to pay these expenses out of pocket rather than filing for worker’s compensation and raising our rates. T his is legal. By completing the VAW-1 the member is protecting his/her rights should the injury later prove substantial. It is important that the paperwork at the ER or Doctor’s Office NOT read worker’s compensation.

IN-HOUSE AVAILABILITY COMMACK VOLUNTEER AMBULANCE OPERATING PROCEDURE

Effective 08/26/01 General 0002 Updated 10/16/01

This policy was created to guide the Dispatcher and Members in appropriate conduct for when a call is received. It includes expected behavior should a member become unavailable to participate as an Operational/Dispatching Member while in the building. For the purposes of this policy ‘in the building’ Shall be considered to include: physically in the build ing, on Corps property, and /or participating in a Corps event. DISPATCHER Often members come in and out of the building without checking in with dispatch. The dispatcher should consider persons that may be out back washing vehicles, in the garages, or i n the basement. When a call is received an overhead page should be done requesting available personnel to contact dispatch. “Anyone available for a signal 16 intercom dispatch” MEMBERS are: Expected to be free of disability and ready for service when i n the building Expected to be alcohol/drug free for at least six (6) hours Expected to have appropriate clothing and footwear to prevent injury on call Expected to report their availability to dispatch upon receipt of an alarm RESPONDING FROM THE BUILDING. Personnel utilizing a responder vehicle from the building , in response to an alarm, must first insure the adequate staffing of the ambulance.. UNAVAILABILITY Should a member in the building be unavailable he/she is to leave the building immediat ely upon receipt of the ambulance call and MAY NOT RETURN until the end of the duty shift, or until such time as they become available. Unavailability of a member includes deferring/refusing to go on a call pending the response of another member. (ie: I have work to do…but if you can’t get anyone else) Members are encouraged to do work, study, relax, and utilize the corps facilities for personal use. However, it is to be understood that the primary responsibility of handling ambulance calls supercedes these activities and does not constitute a valid reason to refuse active ambulance service.

ANIMAL / PET POLICY COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 11/01/2001 General 0003

Updated; 01/01/2009

This policy is designed to guide members in the expected behavior for themselves and their pet guests while in the building. It is a compromise that will allow members to share equally and equitably our facility. AMBULANCES Under no circumstance shall any pet be allowed in any part of the ambulance(s) and or responder vehicle(s), this includes both the patient and driver compartments where applicable. BUILDING Pets are not permitted in the lounge or bunk rooms at anytime. Pets are permitted in the meeting room, provided that they are attended and controlled. A member retains full responsibility for the actions of their pet guest at all times. A suitable cage or leash must be on hand to secure the pet. GROUNDS Members may bring their pets onto Corps ground provided that they have a method for securing the pet ie: leash or cage. They are responsible for the conduct of the pet and for appropriate cleaning up of animal waste. SERVICE ANIMALS The American’s with Disability Act and NYS DOH Policy Statement 07 -01 Service Animals allows Service animals to accompany their masters anywhere, including hosp itals and ambulances. This is an exception to our pet policy. These animals will be given appropriate access to CVAC facilities and transported with the patient. Service animal: Any dog that has been trained to do work or perform tasks for the benefit of a person with disability provided that the dog is owned by such person or that person’s guardian.

9/16 VIOLENCE IN PROGRESS COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 01/01/90 General 0004 Updated 11/20/01

Updated: 01/01/09

This policy is designed to guide dispatchers, operating members, and operational offi cers in the appropriate safe handling of (VIP) violence in progress calls. All are reminded that common sense and protection of CVAC personnel and equipment are the paramount concern here and not adherence to a policy. INITIAL NOTIFICATION The dispatcher and only the dispatcher shall contact MEDCOM and request the specifics for a 9/16 violence call when activated. An EMD priority code is available for these calls and should be obtained. DISPATCHER 1) Notify in-house crew of alarm particulars 2) Page for crew members as needed (no specifics over the radio). All crew to HQ. 3) Alphamate officers with particulars – make sure VIP or 9/16 status is noted clearly 4) Maintain crew on stand-by in-house until requested or cancelled 2ND Alarms Standard dispatching procedure applies here. If a second alarm of equal or higher priority is received the ambulance crew should respond immediately and the dispatcher shall page for a second crew to cover the 9/16 violence call. If the second call is of a lower priority alarm the dispatcher shall page for the second alarm and keep the stand -by crew signal 9 until requested or cancelled. If sufficient personnel exist on the stand-by crew the dispatcher may split the crew to cover both assignments. MEDCOM FOLLOW UP REQUESTS / INFORMATION If no request or cancellation is received within the first ten (10) minutes the MEDCOM operator will follow up with the PD dispatcher. They will recheck every ten (10) minutes thereafter until there is a resolution. NOTE: Status updates that are entered by the Medcom dispatcher, at any time, will appear as an event notification on Netdispatcher and as an added comment on I/Mobile.

CHAIN OF COMMAND COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 01/01/90 General 0005

OPERATIONAL OFFICERS

The Operational Officers, Chief Officers, are elected and authorized by the By -Laws to govern the organization on a day-to-day basis including the establishment of operating procedures such as this. The ultimate authority for governing the day-to-day operation rests with these officers. CAPTAINS Duly appointed and authorized by the Officers of the Corps to act on their behalf at all times. The Captains duties and responsibilities extend through the operational and administrative branches of the Corps EMT-CREW CHIEF Article 9 of the Rules and Regulations provides for the operational authority of a non -crew Chief EMT when one is not available or required. Particulars on the definition of such personnel can be found in that article. HEIRARCHY It is expected that all members of the ambulance crew shall work together as a team to provide the best in patient care/transport to the hospital. Where necessary and only when necessary to establish such authority the following hierarchy shall be adhered to: The Senior EMT, that is the provider of highest training, with the most time (seniority) in CVAC shall be the EMT-Crew Chief. This is a voluntary position and by mutual agreement, when in the best interest of the patient, other arrangements are acceptable. (ie: If the Senior AEMT wishes to be in charge it is his prerogative, if the Senior AEMT is satisfie d with another member running the alarm this is acceptable as well). It is not the intention of this policy to force a chain of command, but rather to provide a guideline where required. COMMAND For the continuity of care and operation on scene it is n ecessary for the ambulance crew to determine someone in charge. Lack of an Incident Commander on any alarm will quickly lead to lack of coordination on the simplest of alarms…and anarchy on the larger incidents.

SEXUAL HARASSMENT POLICY COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 01/01/90 General 0006

It is the policy of Commack Volunteer Ambulance Corps to prohibit harassment of its members and employees in the workp lace. Harassment on the basis of sex is a violation of Sec. 703 of Title VII of the Equal Employment Opportunity Commission Regulations. Unwelcome sexual advances, request for sexual favors, and other verbal or physical conduct of a sexual nature constitute sexual harassment when; (1) submission to such conduct is made either explicitly or implicitly a term or condition of an individual’s membership or employment; (2) submission to or rejection of such conduct by an individual is used as the basis for membership or employment decisions affecting such individual; or (3) such condition has the purpose or effect of unreasonably interfering with an individual’s work performance or creating an intimidating, hostile, or offensive working environment. CVAC will not condone any sexual harassment of its members or employees. All Officers, Members, and employees, will be subject to severe discipline, including termination, for engaging in behavior determined to constitute sexual harassment. A member or employee, who feels victimized by sexual harassment should report the alleged harassment to the President or Vice President (Chief/Assistant Chief) immediately. No member or employee will be subject to any form of retaliation or discipline for pursuing a sexual harass ment complaint. POLICY: 1. Purpose: To provide CVAC members and employees with a work environment free of

harassment, thus encouraging efficient, productive and creative work. 2. Scope: All members and employees. Probationary members, Support Personnel, and members of

any other ancillary organization including seasonal and intern members are also covered by this policy.

3. Policy Definitions:

A. Member/employee conduct: CVAC will not tolerate verbal or physical conduct by any member or employee which harasses, disrupts, or interferes with another member’s or employee’s work performance or which creates an intimidating , offensive, or hostile environment.

B. Basis of harassment: While all forms of harassment are prohibited, it is CVAC’s policy

to emphasize that harassment on the basis of sex, race, religion, age, national origin, or other illegal or immoral basis is specifically prohibited. Each Officer or crew chief has the responsibility to maintain a workplace free of any form of harassment. No officer or crew chief shall threaten or imply, either explicitly or implicitely , that a member or employee’s refusal to submit to such harassment will impact assigned duties, shifts, or other conditions of membership or employment.

C. Other types of harassment: Other harassing conduct in the workplace, whether committed

by officers, crew chiefs, other members or employee’s is prohibited. D. Such conduct includes: 1) Sexual innuendo, jokes, touching, advances, or propositions 2) Racial or religious s lurs 3) Ethnic or age jokes 4. PROCEDURE A. Reporting of Harassment

1) Any member or employee who believes that the actions or words of an Officer, Board Member, Crew Chief, or fellow member/employee constitutes harassment, has a responsibility to report or complain as soon as possible to the President or Vice President.

2) Once an Officer, Board Member, or Crew Chief is aware of any harassing

behavior, CVAC can be held liable if management is aware of such harassment and no action is taken. EEOC gui delines hold a company responsible for the acts of its agents and supervisory personnel with respect to harassment. The Officer, Crew Chief, or Board member can be held personally liable for any proven charge of harassment.

B. Investigation of harassme nt charges

All complaints of harassment must be investigated within ten (10) days in a confidential manner by the President and/or Vice President. The President or Vice President must provide a written report of findings to the Officers of the Board of Di rectors. If any member or employee is not satisfied with the handling of a complaint or the action taken by the President or Vice President, then he/she should bring the complaint to the attention of the Officers of the Board of Directors. In all cases, th e member or employee is to be advised of the findings of the President, Vice President, or Board of Directors. C. Disciplinary Action Any member or employee, Officer, Crew Chief, or Board of Director who is found after appropriate investigation to have e ngaged in harassment of another member or employee will be subject to appropriate disciplinary action, depending upon the circumstance, up to and including termination. No member or employee will be subject to any form of retaliation or discipline for pursuing any harassment complaint.

RESPONSE POLICY COMMACK VOLUNTEER AMBULANCE OPERATING PROCEDURE

Effective 01/01/01 General 0007 The following shall define CVAC’s response policies and supercedes any previous document contrary to the information provided herein. Any changes to the current procedures become effective immediately. AMBULANCE RESPONSE The ambulance shall respond COLD to the scene of all calls received and determined to be ALPHA responses in accordance with the correct use of the MPDS dispatch protocol system version currently in use. The ambulance shall respond HOT to all other alarms (BRAVO, CHARLIE, DELTA, ECHO, and UNDETERMINED). CREW CHIEF REPONSE A crew chief should be requested to respond to all CHARLIE, DELTA, and ECHO level calls, fire stand-bys and ALL MVAs. A crew Chief in the 80 vehicle can satisfy this requirement as the intention is to provide on-scene management and turn patient care over to the EMT for transport to the hospital. ALS RESPONSE Advanced life support personnel should be requested to respond to all CHARLIE, DELTA, AND ECHO level calls. An ALS provider in 80 can satisfy this requirement if necessary although the intention is to keep the 80 responder available whenever possible. PERSONAL VEHICLES Operating and/or Dispatching members responding to an alarm should radio or call into dispatch for effective coordination of responding resources. These members may utilize a green light for the purposes of responding to the scene and/or headquarters for all level of ambulance response as the utilization of such a device does not allow the operator of the vehicle to disregard normal traffic laws . It is a courtesy light requesting other vehicle operators to yield the right of way. RESPONDER VEHICLE(S) Will be activated and respond to all CHARLIE, DELTA, AND ECHO level responses as well as fire stand -bys, ALL MVAs, and signal 3’s for any integral personnel (driver/emt) regardless of priority. Neither the 80 car nor it’s operator shall be ut ilized to respond on mutual aid requests ever. At his own discretion the 80 car operator may respond to lower priority calls (attendant, crew chief) in an appropriate response manor.

STAND-BY POLICY (IN-HOUSE) COMMACK VOLUNTEER AMBULANCE OPERATING PROCEDURE

Effective 01/01/01 General 0008 POLICY: CVAC Officers shall have the power to place CVAC Headquarters and grounds off limits during an in-house stand-by. (ie: Installation Dinner, picnic). The neighboring department should be made to feel as at home as possible. This includes free and unrestricted access to the lounge…. Etc… without CVAC members wandering through the building . Stand-by Crew members are to handle all alarms. CVAC personnel are not to respond on alarms without the expressed verbal consent of the officer in charge at that time. (ie: jumping in an ambulance and beating the stand -by crew out the door). OFFICERS: The CAO shall make arrangements for the stand -by crew and he or his designee shall be present to great the crew when they arrive. The MVO shall insure the presence of a working vehicle and he or his designee shall be on hand to familiarize the stand-by crew. The MO shall insure the provided ambulance is stocked and he or his designee shall be on hand to familiarize the stand-by crew. The SAA shall provide adequate signal 8, or arrangements thereof. With the appropriate sanctions one member may handle greeting and familiarizing the stand by crew.

PRIVACY POLICY COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 01/01/90 General 0009

CORPS MEMBERS CVAC maintains a policy of complete privacy for all information regarding the active membership and

It’s support organizations.

Information on Corps Members is available only to other Corps Members. All care should be given to protect the integrity of CVAC membership information, lists, etc… Only other Corps Members are entitled to information on Corps Membe rs. As a rule of thumb the dispatcher should only give out such information if they can find the calling party on the active CVAC Roster (roll-a-dex). The dispatcher should consult an Officer, the Duty Crew Chief, or the EMT in Charge if a question exists. Dispatchers are instructed to err on the side of caution at all times. CVAC shall not make public its membership list except where required by law. PATIENT CARE DOCUMENTS (PCRS) - CALL INFORMATION Patient care documents are protected by patient co nfidentiality laws. No information on patients, their medical condition, or treatment is to be given out by any member of the organization. All requests for such information should be forwarded to either the Chief of Department or the Record Keeper of record for the department. Documents are released by notarized letter to 1 st party requestors and by subpoenas only to all other interested parties. This includes law enforcement officers. It is acceptable to provide generalized information, where appropriate, to assist patient family in finding their loved ones etc…. confirming an alarm or the hospital of transport. Great care must be given not to break confidentiality laws by providing patient information. (A) EMT STUDENTS No member of the CVAC is authorized to make a copy of a patient care document for ANY reason. Those requiring copies of PCRs for Suffolk County (A) EMT training shall submit a request for copies of such records to the CVAC Record Keeper. Only the Record Keeper shall be authorized t o copy such documents.

INCIDENT MANAGEMENT (IMS) COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 01/01/90 General 0010

INCIDENT MANAGEMENT (IMS) is a modular system of coordination nationally recognized as the standard for emergency operat ions. It has been adopted, almost universally, by fire, police, and ems agencies around the world. CVAC has adopted the IMS system, in it’s most current version, for use at all incidents. INFORMAL COMMAND is acceptable for operating at one ambulance / one patient incidents involving only CVAC. It requires only the designation of an Incident Commander (Captain or EMT in charge) who operates as the defacto commander for all operations. FORMAL COMMAND must be utilized at all multi-patient, multi-ambulance, and/or multi-jurisdictional incidents. (multi patient is 3 or more ambulances or mutual aids).

A. COMMAND

The Chief, Captain or EMT-Crew Chief in charge shall assume command, designate a command post, don the EMS COMMAND vest, and give an initial situa tion report to base.

1. Situation report: a. Individual assuming command b. Scene size up c. Initial request for apparatus and personnel d. Location of command post and staging area B. STAGING The Driver of the first ambulance shall assume the role of staging / transport officer And shall determine the proper positioning for arriving vehicles, staging area etc… 1. In-formal staging. Smaller incidents where ambulances are positioned at on-set for the duration of their presence. 2 -3 ambulances only. 2. Formal staging. Establishment of actual staging area, listing of equipment and personnel on site, tracking of vehicular transports. 4 + ambulances. C. TRIAGE / TREATMENT Highest ranking member of the crew remaining or next qualifie d responder shall assume

the role of Triage Officer and/or Treatment area officer. Incident size will determine if this is one or two separate sectors.

D. OTHER SECTORS Determined by the size and scope of the incident. Appointed by the Incident Commander

and serving until terminated. Sectors may include: logistics, safety, public information, supply, planning, and administration.

E. OPERATIONAL OFFICERS Shall assist Incident Commander as Support Personnel. Large scale incidents may

necessitate Operational Officers replacing lesser trained personnel as Sector commanders where appropriate.

F. PRACTICE In order to remain proficient all members are expected to utilize the IMS System as

outlined above. Practice makes perfect. A complete explanation and delineation of the CVAC plan can be found in the latest

revision of the CVAC Mass Casualty Incident Plan.

PUBLIC ACCESS DEFIBRILLLATION COMMACK VOLUNTEER AMBULANCE

AUTHORIZED SITES OPERATING PROCEDURE Effective 01/01/90 General 0012

Suffolk County Department of Health, in conjunction with NYS DOH, and based upon the public access defibrillation law makes routine notification of agencies within the primary EMS agency district that have obtained licensure for public access defibrillation (PAD) use. All members are reminded of the importance of continuity and continued care. Arriving amb ulance personnel may replace the AED equipment with their own AED or ALS equipment and continue care to the hospital, or if unable to do so, transport the patient with the PAD equipment and PAD provider. ALS personnel should consider the shocks that may have already been delivered to the patient in determining the appropriate place in the cardiac arrest algorithm to assume patient care. Each PAD entity in Suffolk County is required to report AED use in a manner consistent with the EMS agencies. Commack Volunteer Ambulance Corps and Commack Union Free School District have identical LIFEPAK 500 equipment. CVAC has agreed to allow CUFSD permission to use our software should an upload be necessary – The Medical Officer should be contacted for more informatio n. CURRENT PAD LICENSEES WITHIN CVAC DISTRICT: Commack Union Free School District Commack Fire Department Commack Multiplex / National Amusements Hamlet Country Club Pathmark 6070 E. Jericho Tpke Commack NY Gurwin Nursing Home (not assisted living facility) Elwood Union Free School District (updated 4/26/02) Hauppauge Central School District (updated 6/30/02) Christ Lutheran Church (updated 2/9/08) Forest Laboratories 49 Mall Drive (updated 6/18/08) Girl Scouts of America 442 Moreland (updated 6/18/08) Additional agencies will be added to the list and appropriate notification made to the membership as it occurs.

OVERNITE HOURS RESTRICTION COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 11/12/93 General 0013

POLICY: Persons not assigned to the overnight shift shall not enter the CVAC Headquarters building between the hours of 01:00 and 05:00 without prior permission of the Captain on Duty or in his absence, the EMT -Crew Chief.. Officers and persons responding to or from an alarm are exempt from this restriction.

PHYSICAL EXAMS COMMACK VOLUNTEER AMBULANCE

IMMUNIZATION RECORDS OPERATING PROCEDURE Effective 04/20/02 General 0015

Updated: 01/01/09 SCHEDULE OF PHYSICALS ALL NEW MEMBERS - PRIOR TO INITIAL AMBULANCE/DISPATCH DUTY MEMBERS 14-29 EVERY THREE YEARS MEMBERS 30-39 EVERY TWO YEARS MEMBERS 40 AND OLDER ANNUALLY IMMUNIZATION RECORDS

The member shall provide immunization records. In the absence of such records the CVAC medical authority conducting the physical exam shall require titers to insure immunization and administer boosters as needed. Immunization records must include, but are not limited to: diphtheria, tetanus, polio, measles, mumps, rubella, hepatitis b, and chicken pox. HEPATITIS ‘B’ VACCINATION Shall be provided to all members at their initial physical examination/clearance. Those refusing administration of the vaccine shall be required to sign a waiver to that effect . DRUG TESTING Shall be part of the new member physical for all categories of adult membership. Youth Squad members shall not be subject to drug testing. YOUTH SQUAD MEMBERS A parent is responsible to accompany their minor child for their physical examination. PPD TESTING Shall be conducted at least annually and in accordance with DOH procedures. RESPONSIBILITY The CVAC bookkeeper is charged with maintaining records of those individuals who are due for physicals and are compliant. The 1st Assistant Chief / Vice President shall be the authority to insure compliance of all members with the physical exam policies. MEDICAL PROVIDER CVAC shall maintain only pass/fail and compliance notifications of member physicals. All documentation shall remain with the contracted provider. Records shall be maintained off -site by that providing agency. NOTE: The current provider is Sound Medical Systems of Islandia NY

COMPUTER ETIQUETTE COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE

Effective 01/01/90 General 0016 Updated 03/01/10 Purpose: To provide a comprehensive policy to govern a member’s use of CVAC computers, peripherals, and network. General CVAC provides computer and internet access for the use of its membership to conduct corps and personal business. Members are at all times responsible for the appropriateness of their computer use. All software on the CVAC Network shall be approved by the Officers and installed by the Technical Committee or their designee. No member shall be authorized to download software of any kind. Inappropriate subject matter As a family and quasi-public organization we expect all members to be free from exposure to potentially offensive information and/or pictures. Sexually explicit materials can be construed as harassing in nature and inappropriate for a business environment. Security The CVAC Network contains information protected by law and proprietary in nature. All efforts to protect the integrity of this data should be taken and are the responsibility of every member. Members are responsible for maintaining the integrity of the CVAC Computer System through their actions. Websites of a questionable nature should be avoided. Members are responsible to maintain the ssecrecy of their password and responsible for the materials / actions produced by their account. Each member should be issued their own access, there is no reason to allow another access to your account. Violations Any member found in violation of this policy shall be subject to the full disciplinary weight of the corps and reported for any violation of state or local law.

Length of Service Award Plan COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Volunteer Ambulance Worker’s Benefit Law

Effective 2002 General 0017

This Length of Service Award Program (LOSAP) is written in accordance with the New York State Law governing pension plan systems in voluntary EMS agencies. It has been adopted through resolution and referendum by the residents of Smithtown and Huntington. It is not subject to arbitrary change.

A. REQUIREMENTS

1. A Member must make fif ty (50) points during the calendar year (January through December). To meet the requirements of the point system and earn one (1) year of service award credit.

2. Participation in LOSAP is voluntary. 3. You must be 18 years old to participate in LOSAP.

B. CATEGORIZATION / MAXIMUM POINTS

1. Tour of Duty/Duty Hours Maximum of 20 Points 2. Back-up responses/Alternate participation “ 25 Points 3. Elected or appointed positions “ 24 Points 4. Training sessions “ 20 points 5. Drills/Seminars “ 20 points 6. Miscellaneous activities “ 15 points 7. Meetings “ 20 points

C. TOUR OF DUTY / DUTY HOURS (Max 20 points)

1. “Tour of Duty Hours” shall be consistent with CVAC Duty Hours. Members shall earn 1/11 of a point for every hour of riding time to a maximum of 20 points / 216 hours per year.

2. Members must sign in the sign- in log indicating T/D for all hours for which they claim credit.

3. All log entries are subject to verification of documentation.

D. ALTERNATIVE PARTICPATION / BACK-UP RESPONSES (Max 25 points)

1. Members may earn 1/8 point for every alarm responded to while on tour of duty. (in house)

2. Members may earn 1/15 point for every back -up alarm responded to /on. (responding to a page from out of the building.

3. All log entries are subject to verification of documentation.

E. ELECTED OF APPOINTED POSITIONS

1. Points are earned for the completion of a one -year term (January – December)

a. Chief Officers 24 Points b. Administrative Officers 18 Points c. Board Member 12 Points d. Coordinator / Advisor 12 Points

2. A Member who is elected to serve as a delegate to an ambulance worker’s convention shall also

be eligible to receive one point per meeting.

3. A Member who is appointed to serve on a NYS Emergency Medical Services Council, The State Emergency Medical Advisory Committee, a regional EMS council, or a regional MAC, established pursuant to Article 30 of the Public Health Law shall also be eligible to receive one point per meeting.

F. TRAINING SESSIONS (max 20 points)

1. A maximum of twenty points can be earned in this category per year.

2. Training courses must be approved by the CVAC and shall consist of courses that further the objectives pf the department. Ie: AEMT, EMT, CFR.

3. The member must successfully complete the course, and pr ovide such documentation for credit.

4. Points will be awarded in the calendar year in which the course is completed.

5. Points are awarded as follows:

i. Less than 20 hours in duration – 1 point per hour , max 5 per course

ii. 20-45 hours in duration – 5 points +1 point per hour over first 20 – max 10 iii. Greater than 45 in duration – 1 pt per hour over first 45 – max 15.

6. A list of acceptable training classes shall be approved by the officers and posted regularly

G. DRILLS / SEMINARS

1. A maximum of ten (10) points s hall be awarded in this category per year.

2. One (1) point will be awarded per drill or seminar (minimum of two hours)

3. Drills indicate skills practice while seminars indicate lectures

4. CVAC sponsored sessions shall be approved by the Officers

5. All outside attendance shall be approved by the Officers

6. A list of acceptable drills/Seminars shall be posted regularly

H. MISCELLANEOUS ACTIVITIES

1. A maximum of fifteen points (15) can be earned in this category.

2. Participation in other activities covered by the volunteer worker’s benefit law and not otherwise listed are worth one (1) point.

3. A member shall earn one (1) point for attendance at officially recognized emergency services

meetings for which they are instructed to attended (authority of Chiefs/Officers)

4. The list shall be approved by the officers and shall included but not be limited to:

i. Parades ii. Funeral details iii. Work details iv. Demonstrations/classes v. Ad hoc meetings/non-standing committee meetings vi. Community service activity

Length of Service Award Plan COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Volunteer Ambulance Worker’s Benefit Law

Effective 2002 General 0017-add

GUIDELINES Tour of Duty hours: Credit is based upon the successful comple tion of 216 hours for the year

to earn the 20 points for this category. There is no partial credit and no provision for leaves of absence. (All or nothing).

Alternative Participation: Fraction of a point per call for every call you dispatch or respond on.

Dispatcher must enter you on dispatch worksheet, or Crew Chief on PCR for credit. Must be entered into Redalert by dispatch when activated.

Meetings: Credit earned for attendance at scheduled meetings of your committees

and General Meetings of the Department. Also credit for representatives to county and state councils. Officers, Board Members, Coordinators, Committee members are all entitled to points for their meetings.

Elected / Appointed: Officers, Board Members, Coordinators, Advisors receive full year, all or

nothing credit, for their responsibilities as listed above. Training Sessions: Credit, 5-10-15 points, based upon length of course. Credit awarded in the

year in which course is completed. Certification is a requirement for points. Points in this category are for classes in which you are registered for the entire class ie: CFR, EMT, EMT-CC, probies in probie class.

Drills/Seminars: CVAC offered or approved practical or lecture sessions (in-house or out

of house). 1 point per ses sion (minimum of two hours). Drill night, Stonybrook lecture series, a member attending an evening of probie or dispatch class for credit as instructor or student (not enrolled).

Example 1: Members should carefully consider the type of credit for whi ch they are applying based upon past points earned and intentions for future attendance at events. As an example is a member of the training committee using a probie class as a meeting point, or are they already maxed out in meetings for the year and can use drill points. They could not use Training session points as they are not enrolled in the course. Example 2: A Board of Director receives 12 points for their service and responsibilities as a Board Member. They are also eligible to receive up t o 12 points a year if they make all Board Meetings. Example 3: A member who is a board member and holds two coordinator positions can only earn 24 points in this Category as that is the max, despite the fact that his/her points total 36.

NYS EMT REIMBURSEMENT COMMACK VOLUNTEER AMBULANCE

GENERAL PROCEDURE

Effective 09/15/03 General 0018 Updated 03/07/11 Reimbursement of personal expense – Suffolk County EMT sponsored course Members registering in Suffolk County EMS sponsored classes must submit a check for the required enrollment fee made out to “Suffolk County EMS”. Upon proof of successful completion the member should submit a signed purchase order, AND a LOSAP form, with a copy of certification attached. Reimbursement is only available for those who meet the following requirements:

• A member (any appropriate category: (OPR, YS, PRO etcc) when registering, throughout course, and upon course completion

• Probationary members and Youth Squaders will not be reimbursed until such time as they are sworn into • Registered through CVAC

Those who receive their certification through employment, without personal expense, or enrolled through another agency are not eligible for reimbursement. Sponsorship through an educational institution - SCCC, Suny Stonybrook etc.. Members who avail themselves of the opportunity to earn college credit for their EMT/CC certification *MUST* follow the following procedure to receive reimbursement through NYS. The individual must be a member (any appropriate category: (OPR, YS etc..) of CVAC when registering, throughout course, and upon course completion. Probationary members and Youth Squaders will not be reimbursed until such time as they are sworn into the department. The member shall pay CVAC the amount currently eligible for reimbursement from NYS DOH and CVAC will in turn write a check to the institution. NYS will not longer reimburse students directly, the enrolling organization must receive the money. Upon successful completion of the course, and immediately upon receipt of card, the member *must* submit for reimbursement. NYS requires this to be processed within two weeks of receipt of the card. Upon receipt of tuition reimbursement from the State, CVAC will issue a check back to the member in the amount of funds returned.

Sponsorship for a Paramedic Program Members who are interested in reimbursement for a paramedic program will submit a letter of intent to the officers for their review at the next scheduled officers meeting. If approved by he Officers;

- The member will be responsible for the entire cost of the class upfront. - After successful completion of the class, CVAC will reimburse the member a total amount of $6500.00

or the price of the class (whatever is less), quarterly over a period of three years. - At the end of each CVAC quarter, if the member is in good standing, they will receive a check for the

set amount. This will continue over the three-year period. - If a member is not in good standing for the quarter, they will NOT receive reimbursement for that

quarter. A contract will be signed between the members and the board of directors.

MINIMUM PASSING GRADE COMMACK VOLUNTEER AMBULANCE OPERATING PROCEDURE

Effective 01/01/04 General 0019

This statement reaffirms CVAC’s long standing position on a minimum passing grade. The minimum passing grade on any CVAC examination is 80 %

FIREFIGHTER DRIVER CO MMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE

Effective 2002 General 0020 Updated 10/10/08 Pre Requisites:

• Be twenty (20) years of age or older • Be a CFD / HFD qualified driver on a truck or an engine (vans/cars/SUV’s do not qualify)

CVAC Training Requirements:

• Must have CEVO • Valid CPR / First Aid Card • Rig / Oxygen Orientation Class • Take and pass CVAC drivers training program

Requirements to maintain FFD status:

• Keep a valid CPR / First Aid Card • Meet all mandatory drill requirements • Must respond to at least one (1) call per quarter

SOCIAL SUSPENSION CO MMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE

Effective 06/15/2008 General 0021 Updated Purpose: To provide a uniform understanding of what a social suspension is and its ramifications to the member.. General: Members under social suspension shall:

• continue to enjoy voting rights and a voice at meetings • be required to make their duty hours requirements • Appear weekly for their scheduled shifts (not be unassigned) • Make their drill requirements

Members under a social suspension MAY:

• Be in the building for their scheduled shifts • May attend meeting and drills, departing immediately after the function ends • May respond on back-up calls, departing immediately after the call ends

Members under social suspension MAY NOT:

• Be in the building for any reason other than what is listed above • Attend any CVAC social functions (on or off site) • Avail themselves of any privileges connected with membership (movie passes, gym use, etc…)

GOOD STANDING COMM ACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE

Effective 06/15/2008 General 0022 Updated Purpose: To provide clarification for, and a definition of “good standing” as defined in the Rules and Regulations General:

A Member in good standing shall be: • In compliance with the mandatory drill requirements of the department • Be current in all drill requirements • Not in receipt of a letter from the membership committee for hours requirement shortage • Not be receipt of a letter from the membership committee for a period of unassignment • Not under any suspension as defined by the rules and regulations of the department

A member who meets any one, multiple , or all of the above conditions shall be considered in poor standing.

HONOR GUARD COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 1/1/2010 General 0023

PURPOSE: TO HAVE AN HONOR GUARD TO REPRESENT CVAC AT FUNERALS, WEDDINGS, PARADES, OR ANY OTHER FUNCTION DEEMED NECESSARY BY THE CHIEF OF DEPARTMENT. REQUIREMENTS: THE HONOR GUARD WILL CONSIST OF MINIMUM OF CHIEFS, CAPTAINS AND 15 SENIOR CORPS MEMBERS. THE HONOR GUARD WILL HAVE QUARTERLY MEETINGS / UNIFORM INSPECTIONS. THEY WILL KEEP THEIR UNIFORMS SERVICEABLE AND READY TO GO AT ALL TIMES. UNIFORM: UNIFORM WILL CONSIST OF THE CVAC CLASS A (AS PRESCRIBED IN THE DEPARTMENT BY-LAWS AND RULES AND REGULATIONS) WITH COVER, WHITE GLOVES, AND BLACK PATTEN LEATHER SHOES. MOURNING BAND WILL BE WORN WHEN APPROPRIATE. ROLES: HONOR GUARD COORDINATOR: ACT AS LIASON BETWEEN THE HONOR GUARD AND THE CHIEFS OFFICE. RUN ALL MEETINGS AND ENSURE THE HONOR GUARD IS READY TO GO AT ALL TIMES. HE SHALL APPOINT SOMEONE AS ACTING COORDINATOR IN HIS ABSENCE. FUNERALS: THERE WILL BE TWO MEMBERS POSTED AT ALL ENTRA NCES TO THE FUNERAL HOME DURING THE HOURS OF THE WAKE AND FUNERAL. THESE MEMBERS WILL OPEN THE DOOR AND ASSIST ANYONE COMING TO PAY THERE RESPECTS TO THE FAMILY. ONE MEMBER WILL STAY INSIDE TO ASSIST THE FAMILY. THE HONOR GUARD WILL LINE UP IN TWO ROWS FROM THE DOOR TO THE HEARSE. THEY WILL RENDER A PROPER HAND SALUTE WHILE THE DECEASED IS BEING MOVED TO AND FROM THE HEARSE. AT THE FAMILY’S REQUEST THE HONOR GUARD CAN BE USED AS PAL L BEARERS. WEDDINGS: HONOR GUARD SHALL BE USED AS REQUESTED BY THE MEMBER WITH APPROVAL OF THE CHIEF OF DEPARTMENT. PARADES: THE PARADE DETAIL WILL CONSIST OF FOUR MEMBERS. ONE WILL CARRY THE AMERICAN FLAG, ONE WILL CARRY THE DEPARTMENT FLAG, AND TWO WILL BE USED TO MARCH ALONG SIDE OF THE COLORS. HONOR GUARD WILL MARCH 5 PACES IN FRONT OF THE REST OF THE FORMATION OTHER FUNTIONS: HONOR GUARD WILL BE PUT TOGETHER AS NEEDED AT THE RQUEST OF THE CHIEF OF DEPARTMENT.

COMMACK VOLUNTEER AMBULANCE

ELECTRONIC INFORMATION OPERATING PROCEDURE Effective 9/14/11 General 0024

Purpose: To manage the authorized release of electronic information including photographic film used to

create digital images, digital images and all forms of electronic voice recordings taken by Commack Vol. Amb. Corps personnel. *Nothing may be posted without authorization.

Procedure: Authorized Release

a) Authorized release of electronic information including photographic film used to create digital images, digital images and all forms of electronic voice recordings are limited to the performance of official duties of the Chiefs or Public Information Officer, and shall be for clinical presentations, department training, public relation, or at the discretion of the Chief of Department.

b) All On Scene Photography, images and information; must be approved by the Chief of Department of the Public Information Officer prior to releasing.

c) All photographs containing individually identifiable patient information are covered by HIPAA privacy laws and must be protected in the same manner as patient care reports and documentation.

Unauthorized Release a) Unauthorized release of electronic information includes but is not limited to: photographic

film used to create digital voice and images taken by a member of the department using personal voice and image technology of any kind in any format without prior approval. The use of current and future voice and photographic technologies, representing or portraying as official information or logos is strictly prohibited.

b) Unauthorized release includes but is not limited to: printing, copying, scanning, transmission via electronic mail (e-mail), shared social networking or with any public safety agency or website for a fee, for free or as a form of political comment.

c) The department has a zero tolerance policy for electronic information used to harass or intimidate a member of the department. Personnel will be subject to discipline and/or dismissal.

Request for Authorized Release a) Members wanting to record and use electronic imaging and voice information devices in

advance of a specific event other than a sanctioned department social event, must submit a written request to the Chief of Department.

b) Violation of this policy, or failure to permit inspection of any device covered in this policy may result in disciplinary action.

CVAC STANDARDIZED IDS COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 11/12/93 Radio 0001

The following shall be considered authorized radio identifiers for use by CVAC personnel: EMERGENCY VEHICLES : 2-16-17 Ambulance 2-16-18 Ambulance 2-16-19 Ambulance 2-16-20 Ambulance 2-16-80 Responder vehicle* 2-16-81 Responder vehicle 2-16-82 Responder vehicle NON-EMERGENCY VEHICLES 2-16-16 Cadillac ambulance 2-16-22 Transport vehicle / van BASE STATION OPERATIONS 2-16-0 CVAC BASE 2-11-0 CVAC BACK-UP BASE BOARD OF DIRECTORS 2-16-90 Chairman of the board 2-16-91 Vice Chairman 2-16-92 Secretary of the Board 2-16-96 Head houseman

PERSONNEL: 2-16-30 Chief 2-16-31 Assistant Chief 2-16-32 2nd Assistant Chief 2-16-33 3rd Assistant Chief 2-16-34 4th Assistant Chief 2-16-71 Treasurer 2-16-72 Secretary 2-16-73 Sergeant @ Arms 2-16-51 Duty Crew Chief 2-16-52 2nd Ambulance Crew Chief 2-16-53 3rd Ambulance Crew Chief 2-16-54 4th Ambulance Crew Chief 2-16-61 Duty Driver 2-16-62 2nd Ambulance Driver 2-16-63 3rd Ambulance Driver 2-16-64 4th Ambulance Driver INDIVIDUAL MEMBERS Individual members, with authorization from the chief may utilize privately owned portable radio devices. They shall identify themselves by pager # “2-16-0, this is Pager #71”

PORTABLE RADIO USAGE COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 01/01/95 Radio 0002

CORPS OWNED PORTABLES

Any portable radios that are available for sign-out shall be kept in the communications center and under the control of the dispatcher of record. The Driver and the Crew Chief of the assigned back-up crew may sign out any available portable radios for their use. These members must be the Driver or Crew Chief of record (on the back -up sheet). The member is committing their availability for any response necessary. The member is to return the radio at the end of the assigned back-up shift. Any portable radio designated as 2-16-0 or Dispatcher’s Portable is for the dispatcher’s use in an emergency and may not be signed out. MEMBER OWNED PORTABLES Members with personally owned portable radios may request permission from the Chief of the Department to utilize such radios on CVAC licensed frequencies for emergency / alarm purposes. As per Part 90 of the FCC rules and regulations such an authorization should be in writing and available for inspection by an authorized agent of the FCC. The Officers reserve the right to limit/refuse use of such portables on CVAC authorized frequencies if in their determination such limiting or refusal is in the best interest of the agency and its functionality.

AUXILIARY PHONE PORTS/ Power Failure phone system COMMACK VOLUNTEER AMBULANCE OPERATING PROCEDURE

Effective 08/30/02 RADIO 0003 Updated 8/23/04

In the case of a complete power failure or telephone system failure Headquarters is equipped with POTS (plain old telephone sets) that can be accessed from two locations. In the event of a power or system failure the POTS phones are routed automatically. Location #1 Communications Center

Emergency lines are provided for the following lines. They are permanently affixed to the East wall in The communications center. The dispatcher must remember to turn the ringers up on the side of each. All the phones ring the same, the easiest way to see which is ringing is to place your hand on it. BLACK 499-9342 MAIN BUSINESS LINE WHITE 499-0884 DISPATCHER’S LINE RED ----------- INTERAGENCY LINE BLUE ----------- MEDCOM LINE

Location #2 Meeting Room Emergency ports are provided on the South wall of the General Meeting Room. The emergency telephone sets are kept locked in the Radio Room for safe keeping. In the event they are required the dispatcher will have an Officer or Radio Committee Member access and install. 6 additional POTS lines are accessible in the meeting room. #1 499-9827 #2 499-9828 #3 499-7390 #4 499-8318 #5 493-1414 #6 462-2822 System phone jacks Two system phone jacks are available for use in the meeting room attached to the main telephone access panel on the South wall. Any standard 12 button set (atrium, lounge, downstairs offices) can be plugged into these ports. DO NOT ATTEMPT TO USE BUNK ROOM OR DISPATCH OFFICE PHONES. They will not work. MEETING ROOM PANEL

AUX 1 AUX 4 SYSTEM 1 X 22 AUX 2 AUX 5 SYSTEM 2 X28 AUX 3 AUX 6

TELEPHONE CONFERENCE PROCEDURE COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective: 5/6/04 Radio: 0005

The following details the proper procedure for conferencing in any third party from a CVAC System phone:

1. DO NOT PLACE THE CALLER ON HOLD 2. Tell the Caller to hold on that you are connecting them with…..

3. Press the CONF button

4. Dial the desired phone number. Both the Language Line and Poison Control are on the telephone

speed dial system

5. When the 3rd party answers press the CONF button again to connect all parties.

PROCEDURE FOR COMMACK VOLUNTEER AMBULANCE

DECONTAMINATION AND CLEAN-UP OPERATING PROCEDURE OF AMBULANCES

Effective 04/17/02 Medical 0001 Updated: 01/01/09

POLICY: The Captain or EMT-Crew Chief in charge , shall be responsible for assuring that an ambulance is properly cleaned/disinfected at the completion of an ambulance call. SUPPLIES: Gloves

Cleaning agent Disinfectant solution (household bleach diluted with water 1:100, ¼ cup bleach per gallon of water, or equivalent commercial agent) Should be prepared at the time of use. Disposable toweling Plastic bags (red biohazard bags, household garbage bags)

CLEAN-UP PROCEDURE FOR AFTER EVERY CALL:

1. Prepare ambulance for cleaning/decontamination. a) Always wear gloves throughout cle an-up procedures. b) Remove used or soiled linen and place in designated receptacle at hospital or in Bay 1 at CVAC. Soiled linen shall be cleaned using warm water, detergent and bleach as necessary. c) Discard any soiled dressings, bloody materials, and o ther contaminated non-sharps waste in a red biohazard bag and leave at hospital or in designated receptacle in Bay 1 at CVAC. d) Clean reusable equipment in designated area at hospital or place reusable equipment in a plastic bag (other than a biohazard ba g) for transport back to CVAC for cleaning. e) Check the vehicle for needles or other sharps that may have been left and carefully dispose of them in a sharps container.

2. Check for areas soiled with blood or other body substances and clean. a) Clean moist blood and other body substances with disposable toweling and discard in red bag. b) Spray cleaning agent on affected area and remove any remaining blood or body substance.

Dispose of toweling in red bag. c) Spray disinfectant solution on affect ed area. Wipe over area and allow to air dry. Dispose of toweling in red bag.

3. Spray cleaning agent on remaining surfaces that the patient came in contact with, as well as

surfaces used in providing patient care. Wipe the surfaces with toweling and all ow to air dry. Dispose of toweling in normal garbage.

PERIODIC CLEANING OF AMBULANCES:

CVAC shall maintain a contract with a professional cleaning service that shall clean and sanitize all ambulances at CVAC Headquarters on a quarterly basis, or more fr equently, if deemed necessary. This service shall clean the floors, walls, interior and exterior of cabinets, benches and other surfaces.

CVAC shall maintain a contract with a sharps removal service that shall replace sharps containers on

CVAC ambulances on a quarterly basis, or more frequently, if deemed necessary.

POLICY FOR AMBULANCE COMMACK VOLUNTEER AMBULANCE

& RESPONDER VEHICLE OPERATING PROCEDURE CHECKOUTS

Effective 04/17/02 Medical 0002

EACH DAY

The Crew Chief, or EMT in charge, shall be responsible for assuring that the duty and b ack-up ambulances are in compliance with Article 30, Part 800 requirements at the beginning of each duty shift. The crew shall use a “CVAC Ambulance Checkout Form” to complete the ambulance checkouts. Any missing equipment or supplies shall be replaced fro m the lockers located in Bay 1. Any discrepancies that can not be corrected must be reported to the Medical Officer immediately. Additionally, the Crew Chief, or EMT in charge, shall be responsible for assuring that used equipment and supplies are replaced at the completion of each ambulance call.

EACH WEEK The Medical Committee shall be responsible for assuring that all four ambulances and 2 -16-80 are in

compliance with Article 30, Part 800 requirements. A “CVAC Ambulance Checkout Form” or “CVAC Responder Checkout Form” shall be used to complete the checkouts. Any missing equipment or supplies shall be replaced from the lockers located in Bay 1. Any discrepancies that can not be corrected must be reported to the Medical Officer immediately.

EACH MONTH

2-16-81 and 2-16-82: The Chief who drives each vehicle shall be responsible for assuring that it is in compliance with Article 30, Part 800 requirements by completing a “CVAC Responder Checkout Form”, and correcting any discrepancies. 2-16-22: The Medical Committee shall be responsible for assuring that 2-16-22 is in compliance with Article 30, Part 800 requirements by completing a “CVAC Responder Checkout Form”, and correcting any discrepancies.

SELECTION CRITERIA / MEMBERSHIP COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE

Effective 01/01/90 Medical 0005 1. Member in Good standing 2. No disciplinary actions/suspensions past 12 months 3. Assigned 4. Highest point accumulation on matrix 1PT 2PT 3PT 4PT 5PT LONGEVITY: >1 yr 1-5 6-10 11-15 15+ HOURS: short making exceed exceed + outstanding ATTITUDE poor better good great exceptional COMMITTEES: none some multiple chairman x – chairman

CVAC MUTUAL AID POLICY COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 01/01/01 Mutual 0001 Updated 5/21/04

The changes in this policy will become effective 5/27/04 This policy is designed to guide the dispatcher in properly handling alarms and their mutual aid when necessary. MINIMUM TIME There is no minimum time that an ambulance call should be held for. If a ‘no available ambulance’ condition exists OR if the dispatcher is reasonably certain based upon available personnel that no adequate crew will become available within the allotted time frame the call should be mutual aided immediately. The dispatcher must however continue to page for a crew as prescribed below. MAXIMUM TIME The dispatcher must confirm a minimum responding crew compliment, based upon the response level of the alarm, within the time frame indicated Response Determinant Maximum Time to confirm Minimum Crew Compliment Alpha & Bravo Alarms 4 minutes Driver & EMT Charlie, Delta, & Echo Alarms 2 minutes Driver & ALS provider In the event that only a BLS crew is available for an ALS level call (C,D,E) the dispatcher will immediately send the BLS crew and request a mutual aid for ALS to the scene. The dispatcher will continue to page every two minutes, to a maximum of ten (10) minutes for all calls on which a mutual aid response is required. If at any time CVAC’s crew status changes during that ten minutes the dispatcher shall immediately send the ambulance and must ascertain from MedCom if another ambulance is on scene (21). DETERMINATION OF MUTUAL AID AGENCY It is the policy of Commack Volunteer Ambulance Corps to mutual aid (24) all calls that CVAC cannot handle to the Department of Fire, Rescue, and Emergency Services Dispatch Center (MEDCOM). They will be instructed to mutual aid the call to the closest appropriate district for handling.

AUTO-24 POLICY GREENLAWN FD COMMACK VOLUNTEER AMBULANCE

WEEKDAY 9/13 OPERATING PROCEDURE Effective 01/01/90 Mutual 0003

MONDAY – FRIDAY 6:00AM – 6:00PM AUTOMATIC 24 ONE (1) AMBULANCE TO STAND-BY AT THE SCENE FOR ANY SIGNAL 13 (STRUCTURE FIRE) AT EITHER: STATE DEVELOPMENTAL CTR ST. JOSEPH’S NURSING HOME 115 LITTLE PLAINS ROAD 350 CUBA HILLS ROAD (LITTLE PLAINS SHELTER) DISPATCHER: 1) MONITOR ALARM ACTIVATION FROM GREENLAWN FD, This is a monitored alarm

meaning that t he dispatcher ‘monitors’ the alarm off the fire radio and acts. 2) DISPATCH CREW AND/OR PAGE FOR CREW COMPENTS TO COMPLETE ALARM. This is a 9/13 alarm and as such requires paging for a Captain 3) ALPHAMATE OUT TO OFFICERS IMMEDIATELY 4) MONITOR FIRE BAND RADIO 46.42 FOR ADDITIONAL PERTINENT INFORMATION This may include: 5/25 for all units or staging area information CREW: 1) GIVE APPROPRIATE SIGNALS TO BASE 2) Give 2-7-0 GREENLAWN DISPATCH A SIGNAL 2 ON THEIR FREQUENCY AND

CONTINUE TO MONITOR THIS BAND FOR INFORMATION FROM THE OFFICER IN CHARGE.

3) FOLLOW INSTRUCTIONS OF OIC.

SIMULTANEOUS ACTIVATION / LIE COMMACK VOLUNTEER AMBULANCE OPERATING PROCEDURE

Auto 24 policy for LIE with East Brentwood Fire Department Effective 01/01/01 Mutual Aid 0004 Effective 1/1/2001 MEDCOM will simultaneously activate East Brentwood Fire Department for (1) ambulance to respond to all calls received on the Long Island Expressway Local and Express lanes, service roads, and on/off ramps within the CVAC District. CVAC has limited access and extended response times to much of these areas. East Brentwood has immediate and swift access to all LIE areas in question. DISPATCHER 1) Monitor Fire Radio (46.46) and insure EBFD activation 2) Apprise CVAC units of EB response and updates, if any 3) Log call has usual. Note EBFD response. 20:00 Auto/24 East Brentwood 1 ambulance MVA W/B Long Island Expressway at Exit 53 (3-3 unit) disposition - our alarm number CREW CHIEF / EMT IN CHARGE

The first arriving unit on scene, whether CVAC or EBFD will notify county control of the condition upon arrival (situation report) and indicate whether the other department is needed to continue responding. CVAC and/or EBFD units will take their direction from whatever office r / crew chief is on scene first.

FIRE DEPARTMENT RESPONSE

Commack Fire Department retains exclusive rights to all fire / rescue related incidents in this area and will be activated as appropriate. Should extrication or fuel spill request be necessary by CVAC personnel the request should be made through our dispatcher for CFD to respond .

CITATION BARS / COLLAR BRASS COMMACK VOLUNTEER AMBULANCE

CLASS A UNIFORM OPERATING PROCEDURE

Effective 01/01/01 Uniform 0001 BADGES Corps provided badge in either Gold or Silver is to be worn with the class A uniform at all times. The General Membership shall be issued Silver badges and Chiefs/Ex Chiefs (30s) and Officers shall be issued Gold badges. CITATION BARS A maximum of five (5) commendation bars may be worn on a black badge attachment (optional): American flag bar - May be worn by any member. If worn it must be the top bar. Solid Gold bar - Reserved for Jack Cotter Service Award Winners, if worn can only be topped by the an American flag. 9/11 bar - Reserved for MOS who participated in 9/11 /2001 WTC service Stork bar - may be worn, in appropriate colors, (maximum of one) pink, blue or pink & blue as

appropriate for members who have delivered/assisted delivery of a baby(s) Bars allow for the placement of a number indicating multiple birt hs, this may be worn as

appropriate. Level of training - member may wear (1) bar to designate level of EMS or EMD training Gold/Red/Gold - reserved for members who are recipients of dispatcher of the year Gold/Blue/Gold - reserved for members who are r ecipients of EMT/Rescuer of the year Gold/Gray/Gold - reserved for members who are recipients of Probie of the year COLLAR BRASS (worn as a pair) Shirt collar 5 horns gold - reserved for active chief of the department 4 horns gold - reserved for active assistant chief of the department 3 horns gold - reserved for active 2nd assistant chief of the department 2 horns gold - reserved for active 3rd assistant chief of the department 2 horns gold - reserved for active 4 th assistant chief of the department 2 horns silver - reserved for administrative officers // parallel horns 5 horns gold –ex - reserved for past Chief of the Department Cpts Bars Silver - reserved for active Crew Chiefs

UNIFORM DISTRIBUTION COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 05/01/05 Uniform 0002

The following change to the distribution of uniform materials shall be effective immediately. This policy is intended to: - Streamline the request and approval process for uniform items - Develop a pay for performance procedure based upon activity level of the member - reduce unnecessary uniform expense BASIC UNIFORM: Probationary members shall be issued a “TRAINING” jumpsuit from CVAC stock. Upon swearing in as an Operating, or Fire Fighter driving member the individual shall be issued a regular CVAC jumpsuit. A jumpsuit meets the basic uniform requirements and provides the member with a readily available uniform for duty and back-up purposes. Upon swearing in a Dispatching only member shall be issued a dispatching shirt. Additional uniform items above and beyond the jumpsuit will be earned by the member through service riding and dispatching –or- can be purchased through the department at cost. Members begin to earn points towards uniform items on their date of membership. Probationary hours do not count towards uniform items. Youth Squad members may apply active duty hours as a dispatcher towards uniform items upon entry into the Senior Corps. Items that are damaged or worn out may be presented back to the Uniform Coordinator for replacement. All issued items are to be returned to CVAC upon resignation, termination, or retirement CVAC reserves the right to limit the number of uniform items issued on a point basis to members. Hours/points per uniform item: Polo Shirt: $25.00 25 points Sweat Shirt: $40.00 40 points Tech Pants: $50.00 50 points Class A Uniform: $200.00 200 points (in its entirety) License Plate $15.00 15 points

RESPONDER VEHICLE USE COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 07/01/98 Responder 0001 Updated 11/16/09

A. GENERAL 1. The CVAC 1st responder vehicle sha ll be radio & county identified. 2. The vehicle shall a t all times be equipped and stocked to New York State minimum standards as outlined in Article 30, Part 800 of the Public Health L aw, and CVAC policy and practice. 3. Only Corps certified drivers, cleared on it’s operation, may drive the responder vehicle. 4. Corps certified Operating Members (EMT or Higher) are eligible to sign out the responder on a per shift basis.

5. The responder may be signed out by any qualified member, not assigned to the duty crew, for the purposes of first responding

A spot will be provided on EMS Planner for advanced sign up. An individual signed up for a

particular time slot shall have precedence over other members for use of the vehicle. The use of the vehicle shall at all times be reserved for the individual with the highest medical

training available. Ie: Paramedic over CC, CC or EMT. 6. The responder will be signed out in the ambulance log book; with dispatcher approval. The

operator of the vehicle will give a signal 28 with their operator number to the disp atcher via radio upon signing out the vehicle and a Signal 6 when returning the vehicle.

7. A member signing out the responder vehicle does so with the understanding that they must be

within the boundary lines established by Section 11 of this article, and available to respond at all times when directed by the on-duty dispatcher. Any request for exception will be approved on a per case basis by the Chief.

8. The responder is to be returned to headquarters at the end of the shift or immediately upon the

direction of the on-duty dispatcher 9. Only Corps Members are allowed to ride in the responder vehicle. Family members, friends,

etc… are prohibited from traveling in the vehicle. 10. Personnel making up an ambulance crew may not take the responder. They should be available

in the ambulance as a crew for alarms.

B. OPERATIONS

1. 2-16-80 upon activation by the dispatcher shall respond directly to an alarm for the purposes of

stabilization, providing advanced life support care, and /or captain administration. 2. Use of the MDT is mandatory. If MDT is non -operational, inform the dispatcher and advise

them to track your times manually. 2. When necessitated by the patient’s condition or when requested by the operator will accompany

the ambulance to the hospital. Bearing in mind that the objective of the 1 st responder is to keep such individuals available whenever possible.

3. If required to roll the ambulance, the dispatcher may direct, divert, or instruct the 1 st responder to

respond to the building. 4. ALS personnel may relinquish care to BLS providers when deemed the patient’s presenting

problem and present condition warrant a BLS transfer. Any question on the patient’s status shall require the ALS provider to accompany the ambulance to the hospital.

5. The 80 vehicle responds only on the expressed verbal consent of the on-duty dispatcher 6. Anytime the vehicle is left unattended it shall be parked in a safe location and secured. It shall be

picked up and returned to service at the earliest possible moment. C. MUTUAL AID APPLICATIONS

1. The responder shall respond to requests for mutual aid from neighboring departments for ALS. The primary purpose of the responder is to provide 1st responder service to the CVAC community. The CVAC distric t must have a full crew in house in order for the responder to leave the district.

2. In the event of a mutual aid t o CVAC by another district the responder car may respond to the

scene and stabilize the patient while he/she awaits transport from a neighb oring department. D. COMMAND APPLICATIONS

1. The responder may be utilized as the Command Post at large scale incidents . It shall eliminate the necessity of placing the 1st due ambulance out of service for command post operations.

2. The duty captain may relinquish his seat on the duty ambulance to respond in the responder, if

there is there is a crew for the ambulance.

E. 2-16-89 1. Will be reserved for the district at all times. 2. Will only respond on mutual aids with the permission of a C hief.

RESPONDER CAR TRACKING COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 2/15/02 Responder 0002

Revised 2/09/08

The responder car operators are required to transmit a Signal 28 when leaving the building with the

vehicle and a ‘6’ when returning to quarters. Dispatchers are required to log the responder vehicle in and out of the ambulance log book. The log book should contain one (1) entry, logged in a fashion similar to that used for the tracking of other Corps vehicles. (example below). 21:00 2-16-80 signal 28 W/ (member name); returned at 23:00 This procedure will allow better tracking of the responder vehicle and its use by members.

AMBULANCE CHECKS / MVO COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 04/20/02 MVO 0001

The Motor Vehicle Officer shall be responsible for contracting with and maintaining a relationship with a vehicle service provider who can insure compliance with Section 800.21 (p)(8) regarding the preventive maintenance of all vehicles. It shall include: 2,500 mile check 1. Change oil and filter 2. Lubricate all chassis fittings, king pins, and inspect front inspection 3. Lubricate all universal joints 4. Check level of steering fluid, transmission, and differential 5. Check the battery (gravity per cell) and clean terminals 6. Inspect emission control system canister (for damage) 7. Check return lines from carburetor to canister and fuel tank 8. Check pump and belt drive 9. Check the fuel filter cap (must be original equipment) 10. Inspect fuel lines for leak 11. Turn on air conditioning system on for 10 minutes and prevent freeze -up 12. Check coolant system and hoses 13. Inspect back-up alarm system 14. Check operation of wipers and blades 15. Inspect all lights on the vehicle, horn, sirens 16. Inspect radio, antenna 17. Road test by Motor Vehicle Officer 18. Set wheel nuts to proper torque 5,000 mile check 1. Inspect, clean, and lubricate face cam of fuel injector pump 2. Check engine idle speed, throttle operations and return spring 3. Inspect and lubricate body mechanisms 4. Drain water hose from fuel filter bowl (diesel vehicles) 10,000 mile check 1. Change the air filter, fuel filter, and PCV filter 2. Change the automatic transmission fluid and filter 3. Check the battery switch and isolator system 4. Replace the spark plugs 5. Check the distributor cap, rotor and spark plug wiring 6. Check the operating temperatures both front and rear for the air and heater 7. Check the condition of the coolant fluid, freon, and all parts of the air conditioner system. 8. Adjust all doors

9. Inspect and lubricate the weather stripping, latches, door positioners, hood latch, and spare tire

door 10. Inspect all cabinets , tighten and adjust screws 11. Inspect and repair all upholstery 12. Polish all paint and chrome 13. Inspect disc brake system and lubricate caliper slide rails 14. Inspect parking brake system for damage and operation 15. Inspect drum brake linings, and hoses 20,000 mile check 1. Replace battery cables 2. Test battery and starter voltage draw 3. Check radiator thermostat 4. Check radiator cap, inspect radiator for leaks, and replace hoses as needed 5. Steam clean the engine compartments (not diesel engines) 6. Check brake master cylinder fluid level SERVICE PROVIDER The contracted CVAC service provider is responsible to maintain all records and insure compliance with

State DOH standards.

DRIVER TRAINER QUALIFICATIONS COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 08/30/02 MVO 0002

ALL DRIVER TRAINERS MUST HAVE A CURRENT C.E.V.O. II CERTIFICATE ALL DRIVER TRAINEES MUST HAVE THEIR DRIVING TRAINING SHEET WITH THEM.

CATEGORY I – SIGNAL 8/5s Must be a CVAC Driver for a minimum of one year. NOTE: In order to drive back from Good Sam Hospital or drive on the highway the trainee must have highway driving signed off. CATEGORY II – LIGHTS/SIREN RUNS Must be a CVAC Driver for a minimum of two years. CATEGORY III-DRIVER TRAINER Must be a CVAC Driver for a minimum of three years. CATEGORY IV- DRIVER TESTERS Must be a CVAC Driver for a minimum of four years. All of the above categories must have the ap proval of the Third Assistant Chief / MVO All of the above must also attend a class given by the Third Assistant Chief to ensure all categories are taught the same way. All of the above will take place beginning January 1, 2003

F.R.E.S. (MEDCOM) PHONE NUMBERS COMMACK VOLUNTEER AMBULANCE OPERATING PROCEDURE

Effective 8/26/01 Dispatcher 0001 FRES (MEDCOM) phone numbers have been programmed into the speed dial. Two different numb ers are provided. Specifics on when to use each of the two numbers are detailed below. Use of the wrong number slows down the process.

MED DSP This speed dial button should be used to contact the MEDCOM DISPATCHER Directly and is reserved for calls pertaining to specific alarm information or radio Issues. 1) To confirm information on a call 2) To get times for an alarm 3) To request a signal 19 MED PH This speed dial button should be used to contact the MEDCOM PHONE OPERATORS Directly and is for all issues not covered directly with the medcom dispatcher. 1) To mutual aid an alarm 2) To request mutual aid from a department 3) Other MEDCOM business

SUBPEONAS COMMACK VOLUNTEER AMBULANCE OPERATING PROCEDURE

Effective 01/01/90 Dispatch 0002

Updated 01/01/09

Often the process servers will deliver subpoenas (requests for appearance of personnel or records at a deposition or court hearing) to CVAC. The dispatcher is authorized to accept subpoenas addressed to: COMMACK VOLUNTEER AMBULANCE CORPS or any variation thereof including listing the President/Board/Chairman etc… and the agency title A process server must personally ha nd over a subpoenas to an individual, if so named, on the paperwork and cannot and should not leave such papers with the duty dispatcher. No information such as personal phone numbers, names, or addresses are given out to these individuals. In the event an appropriately addressed subpoenas is received the dispatcher shall: 1) immediately place the unopened subpoenas in the Chief’s box 2) Log receipt of the document in the Miscellaneous log book 3) Insure that the Chief is notified. This should include alphamate, voice mail, phoning. Subpoenas are often timely documents and dispatchers are encouraged to make every reasonable effort to insure that the Chief acknowledge notification of it’s receipt.

DISPATCHER’S OFFICE MAXIMUM OCCUPANCY COMMACK VOLUNTEER AMBULANCE OPERATING PROCEDURE

Effective 01/01/90 Dispatch 0003

POLICY: 1) The Communications Center shall be limited to a maximum of two (2) members 2) Only members of the CVAC should be in the Communications Center 3) The Communications Center must be manned at all times when an ambulance is on the road REASON: The Communications Center and the dispatcher play an integral role in the operations of CVAC. It is imperative that the dispatcher and the communications center be positioned to handle the events as they occur. The above policy has been created to assist the dispatcher in maintaining control of the center and assures swift response to radio and telephone co mmunications.

DIRECT CALLS FOR ASSISTANCE COMMACK VOLUNTEER AMBULANCE OPERATING PROCEDURE

Effective 11/20/01 Dispatch 0004 This policy is intended to guide the dispatch in the proper handling of calls for assistance t hat are received direct at CVAC. PD RESPONSE

9-1-1 should be called and notified of all requests for assistance received direct to CVAC. The dispatcher should have the following information available: 1) Callers phone # 2) Location of alarm and cross street 3) Nature of alarm 4) Dispatch operator # (member #)

** The 9-1-1 dispatcher’s primary means of accessing records is by telephone # ** EMD DETERMINENT All dispatchers, regardless of training are encouraged to ask the appropriate questions on the current version of the MPDS priority dispatch cards and develop an appropriate response determinant. All calls that are undetermined are BRAVO responses (third party calls) and treated as such for consideration of all CVAC policies and procedures. INTER-AGENCY ALARMS Several of our surrounding agencies do EMD the calls, but do not dispatch by the determinants, the dispatcher should question the other agency dispatcher, as the information may be available .

ALPHAMATE PAGING SYSTEM COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 02/01/97 Dispatch 0005 Updated 11/10/03, 2/1/2004

POLICY: It shall be the responsibility of the on-duty dispatcher to page the appropriate group of individuals as outlined below. ‘ALARM GROUP’ ALL CVAC alarm notifications, updates, and mutual aid notifications ‘OFFICERS’ Messages specifically for viewing by CVAC Chiefs & Officers only “VEHICLES” Notifications of vehicles in/out of service, accide nt, or breakdowns “RADIOS” Notifications of immediate radio/communications problems “ADVISORS” Notifications to the Youth Squad Advisors “ALL” Notifications to all alphamate holders. This is NOT to be used for alarm

notification. The text of ANY group message should first indicate the name of the group being paged, to eliminate confusion amongst the recipients as to who received the page . (ie: RADIOS, Repeater is down) ALARM NOTIFICATIONS

- Should include the following information: METHOD RCVD, TIME RCVD, SIGNAL (9,16,24,59), NATURE, LOCATION, AND CROSS STREET, STATUS OF AMBULANCE OR NEEDED PERSONNEL FOR ALARM, DISP # * Victim of violence calls are paged out on OFFICER group with alarm information *

ALARM UPDATES - Should include information of relevance to the alarm: Call 24’d no crew, 2 nd ambulance needed, ambulance responding ALS still needed to the scene, call unfounded. OFFICER NOTIFICATIONS

Any Injury / Death to a Corps Member or Family Member reported Any activation of the Inclimate Weather Policy (G0013) Any system effecting power failure or equipment failure All hospital diversionary notifications

All major incidents occurring in surrounding agencies that may require immediate or short notice mutua l aid from our agency. (ie: plane crash, bus accident, major incident, bio incident) Any other unusual occurrence deemed of importance by the dispatcher

SERVICE MEN / DELIVERIES COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 02/01/97 Dispatch 0006

Updated: 01/01/09

It shall be the responsibility of the dispatcher to keep accurate records, and make appropriate notifications on the arrival and departure of service providers as well as deliveries and pick ups that occur at Headquarters. As the 24/7 entity the dispatcher is relied upon heavily upon the dispatchers to act as the eyes and ears of the organization. SERVICEMEN Servicemen will be scheduled by either the houseman, appropriate officer, or coordinator to perform needed service at CVAC. Notification of the impending arrival of a serviceman shouldbe made to the dispatcher (leave a note so we know he’s coming). The individual officer, coordinator, or houseman is responsible for insuring that required access, materials, and arrangements are made so that the scheduled work can be performed. The dispatcher shall: 1) Note the arrival and departure time of the company and their purpose in the Misc Log 2) Make notification to the appropriate officer, coordinator, or houseman 3) Insure that someone escorts the serviceman to the appropriate area 4) The dispatcher may sign off on work performed and shall place the work ord er in the appropriate

officer/coordinator box DELIVERIES Deliveries will arrive throughout the day and through a variety of carriers. When a delivery is received

the dispatcher shall: 1) Take due caution to insure delivery is for CVAC 2) Sign for the items , checking to make sure appropriate number of items is received 3) Log the delivery in the Misc Log noting what, who, when, where 4) Notify the appropriate officer , coordinator, or member that the delivery has occurred

SUSPECTED FALSE ALARM COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 01/01/90 dispatcher 0007

POLICY: In the event the Dispatcher receives an alarm that he/she suspects is false the following shall occur: 1. The ambulance will be dispatched immediately 2. The Crew Chief/ EMT shall be notified of the dispatcher’s suspicions 3. The Dispatcher shall notify Signal 10 (direct calls only) 4. Attempt to recontact on the call back number provided (direct calls only) 5. Verify call back number and address through the reverse directory (Coles) REASON: The Dispatcher may believe an alarm request is false, however it is impossible to be absolutely certain.

The ambulance must respond in normal fashion. The dispatcher should make every attempt to verify the alarm and the information provided.

DISPATCHING OFFICE COVERAGE COMMACK VOLUNTEER AMBULANCE OPERATING PROCEDURE

Effective 04/15/02 Dispatch 0008

Reiteration of CVAC policy for dispatching office coverage when there is no assigned dispatche r

The Dispatcher’s Office is to be covered at all times. The Crew Chief as per Article 8 of the Rules and Regulations shall “assign a member of the crew to dispatch as necessary/when necessary rotating such duty so that all members remain familiar with all aspects of the ambulance operation”. The Crew Chief is responsible to make sure that the crew is properly trained for the task to which he has assigned them. He shall report members deficient in such tasks to the medical/training committee for remediation/review.

The Dispatcher / Member assigned to dispatch is expected to cover the office – and be in the office at all times. The portable telephone is available for the dispatcher to take short respites such as eating with the crew, bathroom, etc…

The houseman on duty is allowed to cover the office for an ambulance call when necessary. At all other times the crew is expected to monitor the office and radio. The dispatcher’s office is to be manned at all times when ambulance is on the road.

COMING ON DUTY COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 01/01/90 Dispatch 0010

Dispatching tours of duty: CVAC dispatching shifts are defined as 0000-0700, 0700-1000, 1000-1300, 1300-1600, 1600-1900, and 1900-2400 hours daily. “First seven (7) things you do when coming on duty” When taking over the dispatcher’s office the dispatcher shall: 1) Sign in the duty log indicating name/operator number and start time (in military time) 2) Check the status of the duty crew and personnel available for duty in house 3) Check the status of all CVAC vehicles including the responder car 4) Check the status of assigned back-up personnel 5) Confirm replacement dispatcher for end of tour 6) Check white board, console, and under glass for new information/postings 7) Complete communications center check list (form available in atrium rack)

Communications Center Checklist shall consist of: 1) Dispatcher’s worksheets & continuation forms 2) PCRS Trauma/Medical & continuation forms 3) Fax machine ready in-service 4) Console review for function 5) Generator function / service indicators 6) Fire Alarm function / service indicators 7) Weather eagle turned on 8) Portable radio inventory / log

END OF TOUR COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 01/01/90 Dispatch 0011

Dispatching tours of duty: CVAC dispatching shifts are defined as 0000-0700, 0700-1000, 1000-1300, 1300-1600, 1600-1900, and 1900-2400 hours daily. Four responsibilities at the end of shift: 1) Sign out of the log book 2) Confirm replacement dispatcher is available and briefed 3) Clean up after yourself Leave the office in the condition you would like to find it 4) Turn in communications center check list

POWER FAILURE PROCEDURE COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 01/01/90 Dispatch 0012

CVAC Headquarters has redundant protection from a power failure adversely affecting the operation of the Communication’s Center. A naturally gas powered generator and battery back -up provide dual protection. These systems switch automatically in the event of power failure. The degree of involvement necessary by the dispatcher is directly related to the severity of the pow er failure and the circumstances under which it occurs . As an example: if neighborhood power failure fails during a lightening store, the entire block loses power, and the generator provides power without a glitch – no action other than proper documentation is required. Conversely a power failure that causes the use of the limited battery power and effects only CVAC Headquarters is a serious emergency that requires swift and effectual action on the part of the dispatcher. POWER FAILURE – GENERATOR FUNCTIONS The Generator switches automatically in the event of power failure and will return to street power when its internal sensors register ‘clean power’ coming from the street service. It can operate indefinetly. The dispatcher should pay particular attention to any change in the ‘status’ lights on communications position #1 and report them to the Officer in Charge. The dispatcher should report the power failure to LIPA at 755 -7600 and request emergency service based on the nature of our operations. Note all communications with LIPA including names/operator numbers, times, and conversations. POWER FAILURE – NO GENERATOR – BATTERY POWER ONLY True emergency. The batteries provide limited power, for a limited time, to only the essential systems in the communications center. The dispatcher should make immediate notification to both LIPA and the Generator Company requesting emergency service based on the nature of our organization. Notification must be made, by whatever means necessary to the operati onal officers, the sergeant @ Arms, and the Board Building Representative immediately. The dispatcher should pay particular attention to any change in the ‘status’ lights on the communications center console position #1 and report them to the officer in c harge. Garage bays will need to be opened manually to facilitate rig deployment and response.

POWER FAILURE – COMPLETE FAILURE – NO POWER True Emergency. A complete systems failure severely hinders the operations of the CVAC. The following steps are mandated: 1) Turn ringers on for power failure phones in dispatch (colored phones on wall) 2) Turn on portable radio to CVAC RPTR 3) Call MEDCOM and advise to send all alarms by telephone 4) CALL Commack Fire Department and advise that they will need to monito r the repeater channel

and possibly page out if necessary for an alarm 5) Have crew / available personnel manually open garage bays 6) Notify LIPA of failure and request emergency service 7) Notify Generator company and request emergency service 8) Notify, through wha tever means possible, the operational officers, Sgt @ Arms, and the Board

Building Representative 9) Canvas available membership by phone to get in -house crews for duration of the emergency 10) Instruct CFD dispatcher to page for all available personnel to respond to HQ on General Tones

CONSIDERATIONS:

- Each vehicle at CVAC is equipped with radios and cellular phone equipment - Console batteries will last no more than two (2) hours - Power failure phones are not electricity dependent

OFF SITE BACK-UP / COMMACK FIRE DEPARTMENT CVAC maintains an off-site back-up system at CFD for use in emergency situations only. These situations shall be considered to be: system failures, unrecoverable power failures, and forced evacuation of Headquarters. It is not maintain ed to allow vacancy of the building for personnel issues at any time. Any member attempting to utilize the fire department in such fashion will find the full disciplinary weight of the CVAC against them. This service is a ‘good neighbor agreement’ and is dependent upon the appropriate use and good neighbor policy that exists between the organizations. Return to CVAC Dispatch should be made as soon as reasonably possible. DOCUMENTATION / NOTIFICATION Documentation in the Business Log Book of all power failures is required along with actions taken by the dispatcher. Notification should be made , by whatever means necessary (alpha mate, corps page, telephone) to the operational officers and building representative of the Board of Directors of all power f ailure issues.

PAGING PROCEDURES COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 04/01/03 Dispatching 0013

Updated 01/01/09

PROCEDURE:

1) Receive call for assistance. (reset plectron if applicable) 2) Attach the necessary vehicles through Netdispatcher 3) Immediately page out as required below. 4) Alpha-mate alarm

REMINDER: Dispatchers should know what personnel are scheduled and/or available before an alarm is received. This should NOT be done when a call come in, this should be done when coming on shift. Dispatchers will be guided by the following: GENERAL TONES: Any time personnel are needed for alarms: Crew Chief, Driver, EMT ALS TONES: ALS personnel needed, regardless of paid medic status STILL TONES: When a full crew compliment is staffing the ambulance * REMINDER: Dispatchers are not to voice any incident type or location information when voicing a violence in progress alarm. All personnel must 34 for the information.

PAGING OUT FOR

AN ALARM

GENERAL ALARM

ALL PERSONNEL

ALS ALARM

ALS PERSONNEL

ONLY

STILL ALARM

MEDIC/OFFICER

S ONLY

ANY COMBINATION OF PERSONNEL

IS NEEDED: DRIVER, EMT,

USED ONLY IF THE ONLY

PERSONNEL REQUIRED ARE ALS PROVIDERS

USD ONLY WHEN A FULL CREW IS RESPONDING.

WEATHER NOTIFICATIONS COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 05/01/03 Dispatch 0014

The Weather Eagle in dispatch will notify the dispatcher of the following: :

- Severe thunder storm warnings - Blizzard Warnings - Hurricane Warnings - Tornado Warnings - High Wind Warnings (>35 mpt)

The Dispatcher is alphapage the Officers with the particulars. It may notify several times as the information is posted and re -posted by the national weather service. In the event of se vere weather the dispatcher is encouraged to:

- Insure the weather eagle is powered up for alert activations - Monitor the Weather channel for updated information - Provide the Officers with updates as necessary

PAGING WITH BREVITY COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 06/04/04 Dispatching 0015

Policy: Effective immediately dispatchers shall only announce the relevant information for the alarm

once on each page or when signing on. Dispatchers should be concise and speak at a conversation rate to minimize air time. (No more repeats)

Reason: The new paging requirements force the dispatcher to spend more time on the Dispatch (F16) channel causing more times to be missed. This coupled with the dispatcher’s attention to shortening, reasonably their pages, should minimize this problem. Example: “2-16-0 on the air with a signal 3 on a 16 Crew Chief needed for MVA Larkfield Road &

Jericho Tpke available personnel 34 the base”

NO MORE REPEATING INFORMATION WHEN PAGING

PATIENT IN POLICE CUSTODY COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 04/20/02 Operating 0001

In the cases where an individual has been placed under arrest (custodial cases), regardless of the injury potential or mechanism of injury, the police become the legal surrogate decision makers for that individual. If an individual in police custody has injuries that require transport by ambulance, the police should accompany the patient in the ambulance. The individual will either be restrained, or remain unrestrained depending on medical necessity, threat potential, crew safety, etc. If, in the opinion of the arresting office, the individual requires hospital evaluation, but does not require transport by ambulance, the police will transport the individual to the hospital. 1. Assess the patient to determine if a Prehospital medical intervention is needed. If not, follow

Refusal of Medical Assistance (RMA) procedures. Every effort to use the Police Officer as a witness should be made.

2. Carefully and accurately document all events leading to the patient contact or the refusal of

access to the patient by Police on the PCR. 3. Contact medical control for consultation where appropriate. 4. Avoid public confrontation with Police Officers, patients, and by-standers when attempting to

resolve the situation. 5. Fully document on a CVAC Incident report any untoward problems encountered on the call.

INABILITY TO ACCESS PATIENT COMMACK VOLUNTEER AMBULANCE

UNABLE TO LOCATE PATIENT OPERATING PROCEDURE

Effective 04/20/02 Operating 0002

If you arrive at the reported scene of a medical emergency and are unable to locate or gain acce ss to the patient, take the following actions: 1. Confirm, through the dispatcher, that you have the correct address 2. Confirm, through the dispatcher, that a telephone call back was made to verify the alarm loc. 3. Sound the siren/horn for fifteen (15 ) second intervals for no less than one (1) minute 4. Confirm, or if necessary, request Police Department response to the scene 5. You must confirm that the patient is in a secured building/area or in a locked or inaccessible private residence before forcible entry is attempted. 6. If you are unable to confirm that the patient is present in a secured, locked, or inaccessible

location, the Police Department is to assume responsibility for the forcible entry decision. 7. If a call is determined to be un founded, a PCR must be completed with all actions taken at the scene documented and all times noted. Note #1 In the event of a fire or suspected fire at the location in question the fire dept shall assume responsibility for the forcible entry decsion Note #2 The EMS agency and/or police department may request the fire department assistance in forcible entry if those agencies are not equipped to provide it.

UNATTENDED DEATH COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE

Effective 04/20/02 Operating 0003

1. Any location at which an unattended death victim is found, and where there are no family members or witnesses present, it is to be considered a crime scene until otherwise designated by proper authority.

2. If the Police Department is not present at the scene of the unattended death upon arrival of the

first EMS unit, a sector car response is to be requested before the EMS u nit transports the patient or leave the scene following the determination that pre -hospital care and transport are not required. Do not delay transport if the police department is not on scene.

3. In unattended death situations certified EMS providers are obligated to perform CPR or other

prescribed resuscitative measures , unless a valid New York State “Do not Resuscitate” DNR form is presented, or there are signs of obvious death present.

4. In instances where bystander CPR is initiated prior to the arr ival of the EMS unit and it is

determined by the arriving EMS personnel that there are signs of obvious death present, the EMS personnel may elect to refrain from continuing resuscitative measures.

5. Potential Crime scene considerations should be followed as per CVAC operating procedure #2

SEXUAL ASSAULT PATIENT COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE

Effective 04/20/02 Operating 0004 CREW: 1. Avoid unnecessary disturbance of the patient or physical evidence. Limit physical patient contact to the treatment of injuries only. Do not cleans or cover wounds unless absolutely

necessary. Discourage the patient from rinsing, showering, combing hair, changing clothes, or brushing teeth.

2. Notify the Police Department immediately upon determination that a crime as occurred. You do not need the patient’s permission to make such notification. 3. Limit your patient interview to pre -hospital medical care questioning pertinent to visible injuries

or those claimed by the patient. Reenactment of the assault/incident may not be conducive to a good patient care outcome.

4. If the patient must be transported prior to arrival of the Police Department, advise the patient not

to wash or discard clothing worn during the incident. If possible and where appropriate, t ransport the patient with a female technician in attendance.

5. The patient is not only a victim or physical trauma, but also a victim of emotional/psychological trauma. Treat the patient accordingly.

6. All ambulance shall transport the patient to the hospital designated by the Suffolk County transport protocol. If a request is made to deviate from protocol ie: to a SANE Center, contact Medical Control at 689-1430. Where possible, try to honor the patient’s request concerning the destination hospital.

7. Prepare a PCR. Keep accurate records of the times, your findings and observations and

treatments rendered. 8. Avoid discussing the patient or the incident within hearing range of the patient or patient’s

family

DISPATCHER: 1. All consideration is to be given to having a female member of the department available for transport with the patient to the hospital. Pages should be done as necessary.

CRIME SCENE COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE

Effective 04/20/02 Operating 0005

CRIME SCENE: Any location at which evidence of a crime or suspected crime is found including, but not limited to homicide, suicid e, sexual assault, vehicle pedestrian accidents, or other MVAs involving serious injury or death. Any location at which a deceased is found is to be considered a crime scene until otherwise designated by the proper authority. EMS PROVIDER RESPONSIBILITY: The primary responsibility of EMS personnel operating at the crime scene or suspected crime scene is rendering proper emergency care to those persons in need of such care. Patient care shall not be compromised in order to protect the crime scene or evidenc e. However, every attempt should be made not to disturb any physical evidence at the scene if possible. EMS providers should be aware of the responsibilities of other agencies operating at crimes scenes. The actions and observations of EMS providers at crime scenes are frequently an important part of court testimony, requiring accurate documentation at the time of the incident. After evaluating the scene for potential hazards, the following steps should be taken: 1. Consider the entire location as being involved in the crime scene. 2. Upon entering or leaving the scene, use a single path of travel if possible and have all personnel entering or leaving the scene use the same path 3. Limit the number of EMS providers entering the scene to only those neces sary to evaluate, treat,

and/or remove patients. All non-essential EMS providers are to remain outside the crime scene. 4. If a presumptive diagnosis of obvious death is made, refrain from otherwise moving or

disturbing the victim’s remains. 5. Refrain from using sinks, toilets, or telephones within the immediate area of the crime scene. 6. Remove clothing from the crime scene and restrict the handling of any objects found on the

scene. 7. Offer information on observations pertinent to the incident to t he proper authority. Do not offer

information or observations to those who do not have a legal need for such information or observations.

8. Restrict comments and opinions to known facts when speaking to other authorities.

Interdepartmental communications regarding the incident shall be directed to the proper authority at the scene. Do not offer any information to unauthorized parties such as the media, civilians, or other agencies as this may impede the investigation.

9. Complete all PCR and related documents pertaining to the incident accurately, using specific

language to indicate the position in which the patient was found, the presence of visible wounds and other pertinent data including the clinical information that led to your decision to withhold resuscitative measures. PCRs area legal documents subject to subpoena and must be complete, legible, and accurate.

POLICY FOR REPORTING COMMACK VOLUNTEER AMBULANCE

SUSPECTED CHILD ABUSE OPERATING PROCEDURE OR MALTREATMENT

Effective 04/30/02 Operating 0006 POLICY:

All CVAC EMTs are required to report suspected cases of child abuse or malt reatment to the New York State Central Child Abuse and Maltreatment Registry in accordance with NYS DOH Policy Statement No. 02-01.

RESPONSIBILITY: If there are multiple CVAC EMTs responding to a call, it is only necessary for the EMT in charge of patient care to submit the required form. If there are EMTs from multiple agencies responding on a call to treat the same patient, the EMT in charge of patient care from each agency must file a separate report, regardless of which agency transports the patient.

REPORTING PROCEDURES:

1) An oral report must be made immediately to the NYS Child Abuse and Maltreatment Registry by calling 1-800-635-1522.

2) The oral report must be followed by a written report, using Form DSS -2221-A, within 48 hours.

This report must be mailed to the local child protective services for where the child resides. (There is no provision for faxing the report.) In Suffolk County, the address would be:

C.P.S. REGISTER/INTAKE UNIT Suffolk County Dept. of Social Services P.O. Box 18100 Hauppauge, NY 11788-8900 If the child does not reside in Suffolk County, submit the form to the Suffolk County C.P.S.

office because that is where the incident occurred. If the child resides in a Residential Institution, the r eport shall be mailed within 48 hours to: STATE CENTRAL REGISTER 40 N. Pearl Street Albany, NY 12243 3) It is understood that EMTs will need to complete the DSS -2221-A form after an emergency

situation. EMTs are not expected to have the form filled out in its entirety. EMTs should fill out as much information as possible, and submit the form to the Child Protective Service, who will obtain the rest of the information on the form.

4) A copy of the completed and submitted DSS-2221-A form shall be attached to the CVAC copy

of the Prehospital Care Report. The report shall be kept for a period of three (3) years past the child’s eighteenth birthday, as per NYS-DOH Policy Statement No. 96-01.

NYS DOH REPORTING CRITERIA COMMACK VOLUNTEER AMBULANCE

INJURY / DEATH OPERATING PROCEDURE EQUIPMENT FAILURE REPORTING

Effective 01/01/90 Operating 0007 1) Patient death, injury or other harm due to actions of commission or omission by a member of The CVAC 2) An EMS response vehicle (ambulance, responder, and van) is involved in a motor vehicle accident in which a patient, crew member, or other person is injured or killed to the extent requiring hospitalization or care by a physician 3) Any member of CVAC is killed or injured to the extent requiring hospitalization or care by a Physician while on duty 4) Patient care equipment fails while in use, causing patient harm; 5) It is alleged that any member of the ambulanc e service has responded to an incident or treated a patient while under the influence of alcohol or drugs; MEMBER: 1) Immediate notification to the Officer of CVAC 2) Immediate completion of CVAC Incident report (and where necessary VAW -1) in compliance with member injury/accident reporting OFFICERS: 1) Immediate notification to the Chairman of the Board of Directors 2) Phone call to the NYS DOH no later than the next business day 3) Written follow up within five (5) days of the incident to NYS DOH EQUIPMENT FAILURE REPORTING 1) Immediate notification to the Officers of the Corps 2) Immediate completion of CVAC Incident Report (Atrium forms Rack) 3) Officers will maintain a record of all unexpected authorized EMS response vehicles and patient care equipment failures that could have resulted in harm to a patient and

the corrective action taken. A copy of this record shall be submitted to the Department with the EMS service’s biennial recertification application.

REFUSAL OF MEDICAL AID (RMA) COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 01/01/99 Operating 0008

NO PATIENT

In the event that an ambulance service responds to a reported medical emergency where both the individuals at the scene and the EMS personnel believe that no injuries or illness exist and that there are no individuals requiring EMS assistance a PCR shall be prepared using the following disposition code: 008 GONE ON ARRIVAL or 009 UNFOUNDED / NO PATIENT FOUND. A physical assessment may be necessary to make the determination that there are no patients at the scene. Consider the high -risk criteria identified below before determining that there are no patients at the scene. The names of the individuals at the scene may be noted on the PCR. An RMA signature is not required, but may be obtained for the purposes of documentation. PATIENT EXISTS If in the judgment of EMS personnel there is a patient at the scene who requires treatment and/or ambulance transport, but who refuses such services, Medical Control must be contacted in an attempt to convince the patient to consent to appropriate care. The Medical Control Physician will assess the patient’s capability to refuse treatment, encourage the patient to allow ap propriate care as indicated, and offer advice and guidance to EMS personnel. If the Medical Control Physician determines that the patient warrants treatment and/or transport, every effort should be made, using all available resources at the scene, to encourage the patient to consent to treatment and/or transport to the hospital. If all efforts are unsuccessful the refusal should be thoroughly documented on the PCR, signed by the patient, and witnessed, preferably by the police officer. In the event that a patient receives treatment but refuses transportation by ambulance, and the EMS provider agrees that ambulance transportation is not warranted, Medical Control need not be contacted. This decision, and any recommended follow-up by the patient, should not be contracted. This decision, and any recommended follow=up by the patient, refused transportation. If an EMS provider believes that ambulance transport is indicated, Medical Control must be contacted. In all cases where there is no transport to a hospital, the yellow copy of the PCR must be sent to Medical Control by the ambulance service. RMA HIGH RISK CRITERIA: An RMA should not be considered without contacting Medical Control if any of the following high-risk criteria are present. A physical assessment may be necessary to rule out these criteria. - The patient has an altered mental status or suspected head injury - The patient is less than 18 or older than 70 years of age - The patient has neurological, cardiac, or respiratory symptoms - The patient’s Glasgow Coma Scale is less than 15 - The patient’s vital signs are outside of normal limits - There is alcohol or drug use involved - There is Carbon Monoxide exposure Phone patch is to be used by EMS providers to maintain privacy of patient

DESIGNATED RECEVING HOSPITALS COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE TRANSPORT TO OTHER FACILITIES

Effective 01/01/90 Operating 0009

CVAC by- laws allow for ambulances to transport to any of the five (5) hospitals list ed below at any time. The decision as to which hospital the patient is transported is entirely up to the Crew Chief, or EMT-Crew Chief running the call. The decision will be made based upon the patient’s condition at the time, and NYS and County protocols . Where possible and when allowed patient’s request should be considered. - St. Catherine’s of Sienna Medical Center Smithtown NY - Northport Veteran’s Administration Northport NY - Huntington Hospital Huntington NY - Southside Hospital Bayshore, NY - Good Samaritan Hospital West Islip NY TRANSPORT TO ANOTHER HEALTH FACILITY: Transport to another health facility is allowed when deemed necessary by the Crew Chief. The Crew Chief is the only one who may make this decision. The ambulance wil l transport immediately on the Crew Chief’s standing authority. All transports in this category are defined as ‘emergency transports’ The Dispatcher is responsible to notify an officer that the emergency transport is taking place and to which facility the y are transporting to. Every attempt should be made to find an in -house back-up crew for the duration of the alarm. With the advent of trauma, burn, and other protocols and decontamination procedures it is expected that more patients will be emergency tran sported to other facilities - University Hospital @ StonyBrook (Regional Trauma Center) - Brunswick Hospital, Amityville (Decontamination Center) - Good Samaritan Hospital (SANE Center) DIVERSION Section 405.19 (e) (4) of the NYS Hospital Code authorizes hospitals to request diversion of ambulances to other facilities when the acceptance of another critical patient might endanger the life of that patient or another. A request for diversion does not require that the ambulance divert from that fac ility. EMS Personnel are not obligated to honor such a request if they believe that a critically ill or inured patient’s condition warrants doing so. However, if it is determined that the patient is stable, the diversion request may be honored. Medical control may be contacted to assist in transport decisions. Personnel should document fully the reason(s) for their decision on the PCR.

THE GURWIN CENTER COMMACK VOLUNTEER AMBULANCE

Gurwin Nursing Home OPERATING PROCEDURE Gurwin Assisted Living Facility

Effective 01/01/90 Operating 0010

CVAC provides primary 9-1-1 coverage for the Gurwin Campus of Commack includ ing : The Gurwin Nursing Center and Weinberg Pavilion @ 68 Hauppauge Road, and, The Jay Linder Assisted Living Facility @ 50 Hauppauge Road All calls for assistance at the Gurwin Campus should come through the County 9 -1-1 system and be properly dispatched as per the current version of the Medical Priority Dispatch System. Dispatcher’s should refer to Direct Call Policy General 0001 for the proper handling of all calls received directly at CVAC. TREATMENT POLICY All members of the CVAC are expected to conduct themselves in the utmost polite manner when dealing with Gurwin Staff and Patients. Each and every patient is entitled to the most professional and expedient service CVAC has to offer. All patients are to be treated with the same respect one would afford their own relative. TRANSPORT POLICY CVAC provides emergency care and transportation of emergency patients to St. Catherine’s Hospital in Smithtown except where transport to a specific alternative facility is required by protocol (ie: burn patient, or multi-trauma patient). Crew Chiefs and/or The patient care provider in charge do not have the authority to select an alternate facility except as noted above. It is expected that the facility will triage those patients who are requesting transport to another facility for stability and utilize proprietary transport services as warranted. Upon return to Headquarters the crew is to submit a Medical Facility Report form, available in the Atrium forms rack. Notification of any significant patient care issue should be flagged and reported to the Chief of Department immediately.

ACCESSING THE PATIENT (NURSING HOME) Agreed procedure requires CVAC to enter through the main (awning) entrance to the nursing home for all patients in the main facility. Security will direct the crew to the appropriate wing/room. (WEINBERG PAVILION) While not particularly effective, the agreed upon procedure for accessing all patients in the Weinberg Pavilion requires entry / exit through the main (awing) ent rance of the main nursing home. CVAC has expressed concern over the extended patient contact time that occurs through this procedure and it is under review. The policy will be adjusted as warranted by future agreement. (LINDNER ASSISTED LIVING FACILITY) The most appropriate entrance and exit to facilitate patient care shall be used at this facility. This may require compliance or defiance of the security guard request at the facility. Crews are expected to conduct themselves politely and professionally at all times. Assistance of the responding Police Officer should be used where necessary to facilitate treatment/transport. REVIEW PROCEDURE

All calls will be reviewed by The Corps Medical Director, and presented at the quarterly QA/QI meeting conducted internally. The Corps physician shall, where appropriate, dialog with the facility and the County Medical Director regarding patient care issues. QUARTERLY REVIEW It shall be incumbent upon the operational officers to meet quarterly with the Gurwin Facility to maintain an open communication between organizations with the ultimate goal of such meetings to be the facilitation of appropriate treatment and transport of all patients. Results of these reviews, along with any changes in policy, shall be di stributed to the membership.

CELLULAR PHONE USE ON CALL COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 08/30/02 Operating 0011

The use of cellular phones, two -way phone devices, and audible pagers while on call is prohibited. Cell-phones and pagers that must be worn on call should be placed in the silent or vibrate position. It is inappropriate for members of the crew to take or receive calls during the patient oriented portions of an ambulance call (on scene/enroute to the hospital). Reason: The undivided attention of the ambulance crew belongs with the patient, the patient’s

family, by-standers, and fellow crew members NOT on personal phone calls.

Crew Configuration COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 6/17/04 Operating 0013

In an effort to maximize existing crew resources the following changes are being implemented effective immediately. The following applies to the ambulance compliment only, not the responder vehicle:

- No crew will respond with more than four (4) members of the department (any category) - No crew will respond with more than three (3) ‘certified’ members of the department - When possible personnel should be split when responding to or returning from calls to maintain a pool

of available responders. Definitions: - Certified Members: Crew Chiefs, Drivers, EMTs, ALS Providers -Non Certified Members: Youth Squad, Probationary Members, Observers, students Examples: A crew could consist of: Crew Chief, Driver, EMT, and Probie EMT, Driver, and 2 Youth Squaders ALS provider, Driver, probie

DIVERSION ENROUTE COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 6/17/04 Operating 0014

Effective immediately and until further notice the ambulance crew will be considered committed to their patient upon taking a signal 2. The responder can divert provided that there is a confirmed crew responding on the initial alarm. Exception: If more than one crew is available the dispatcher should still send the closest appropriate unit to the alarm.

EMT / Crew Chief COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 7/20/06 Operating 0015

Members: (sworn in dispatcher and riding

Any individual who receives their certification and is a member of CVAC will have no re strictions.

They may be assigned to a shift as the provider and may roll the ambulance immediately. Probationary Member: (If they have a valid certification when they start probie class OR receive a certification while in probie class.)

1. Will be on a 6 month riding evaluation (must complete and turn in training reports) 2. May not be assigned to a shift as the sole provider. 3. May roll the ambulance immediately, but the dispatcher must page (max 3 times) to find a cleared

provider with the same le vel of training. 4. Once a member, a request may be made to the medical committee for review of their progress. The

medical committee will determine whether the individual may be cleared as a sole provider prior to the completion of their six month evalua tion period

Crew Chief Training COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 7/20/06 Operating 0016

Pre Requisites:

1. Must be a member in good standing, not under corps suspension. Upon r eturn from corps suspension a members Crew Chief status must be approved by the majority vote of the officers.

2. 2 years as an operating member / 2 years as an EMT or higher. 3. Must be up to date with all CVAC drill requirements. (OSHA, START TRIAGE, MARK I KITS, CPC

TRAINING, MCI, etc.) 4. IS-100, IS-200, IS-241, IS-242, IS-700 5. Confined Space Rescue Certification (Awareness Level or Better) 6. HazMat Certification (Awareness Level or Better)

Crew Chief Class: (6 week class)

1. Dispatching – must show knowledge of dispatch procedures, equipment operations and pass a dispatch competency exam.

2. Back to Basics, surrounding depts., # of rigs, als / bls, borders, etc 3. CVAC Policy and Procedures 4. Operating with other agencies (ems / fire / police ) 5. Radio procedure and operations 6. Class Final 7. Field Training

Maintain Certification:

1. Regular submission of probationary training reports and rig checks 2. Attend 2 of 4 quarterly crew chief meetings each year 3. Complete 2 of 4 table to exercises conducted at CVAC 4. Maintain drill quota, make all mandatory drills. 5. Written test every 2 years.

Issued Upon Completion:

1. Red Crew Chief Helmet 2. Crew Chief (EMS Command) Vest

Will Respond To:

1. MVA’s 2. MCI’s (will be sector commanders) 3. HazMat / Carbon Monoxide 4. Confined Space 5. Fire Stand By’s (9/13/35, 9/12) 6. VIP’s (9/16)

Officers hold the right to modify the above to allow for updates in training and certification as deemed necessary by CVAC, New York State , and the Federal Government. After completion of all requirements a majority vote of the officers is required to appoint a member as a Crew Ch ief. 2/3 vote of the officers is required to remove a members Crew Chief status, except failure to meet and maintain above requirements will result in termination of member’s Crew Chief status. Grandfather Clause: All existing CVAC Crew Chiefs will have until January 1, 2007 to comply with the new Standard Operating Procedure. Failure to comply will result in termination of their Crew Chief status.

HIGH VISIBILITY VESTS COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE

Effective 3/31/2009 Operating 0017 Members operating on a roadway, shoulder, right-of-way to a roadway, parking lot, or adjacent roadway surfaces (shoulders etc..) are required to wear the ANSI approved reflective vests supplied by the department. Each operating member has been supplied with their own vest. A small number of vests, for probationary members, youth squaders, and other providers on scene are available on each ambulance. This policy applies to all operations on or near a roadway as defined above NOT only motor vehicle accidents. 23 CFR 634 // November 24, 2008

PROBATIONARY MEMBER COMMACK VOLUNTEER AMBULANCE

RESPONSE GUIDELINES OPERATING PROCEDURE

Effective 04/07/10 Operating 0018 Updated General: - If you respond on an alarm, you MUST be available to transport to the hospital with the crew. - Make sure your jumpsuit is always in your car and ready to go. You are required to be in uniform on all calls. Responding: - You may, and are encouraged to respond whenever the dispatcher pages for attendants. - You are to call the dispatcher and advise them of the following; YOUR NAME, you’re a PROBIE, and you are responding to the BUILDING. **You may only respond to the scene under the direction of the dispatcher. For your safety, if you are the first on scene, wait in your vehicle until the first unit arrives (medic, chief, ambulance, etc.)** Green Light: - The department will issue a green light to you. - May only be used when responding to an alarm. - Is a courteously light only. You MUST obey all traffic laws at all times. Pager: - Will activate for Medcom Tones as well at all pages from the CVAC dispatcher. - You may only call in for a call when the CVAC dispatcher pages for attendants. - The rubber button on the side of the pager is the squelch and will reset the pager after an alarm. - The button on top of the A,B,C,D switch will replay the stored messages. - Button Layout: A: Medcom and CVAC (tones) B: Medcom and CVAC (vibrate) – must push the squelch to hear the alarm C: CVAC Only (vibrate) – must push the squelch to hear the alarm D: CVAC Only (tones) I, ___________________________, understand that being able to respond to alarms as a probationary member is a privilege, and may be revoked at any time. The equipment issued is the property of the Commack Volunteer Ambulance Corps and must be returned upon request. Signature:_____________________________

INCIDENT ACTION PLANNING (IAP) COMMACK VOLUNTEER AMBULANCE OPERATING PROCEDURE

Effective 6/5/2010 Operating 0019 Updated POLICY STATEMENT Effective immediately, an Incident Action Plan (IAP) is required for ALL CVAC events. This includes, but is not limited to: Standbys, social events, parades, and fund raising events. The purpose of this plan shall be two fold. First, to help members maintain familiarity with the IAP process and its use. Second, to formalize CVAC events, eliminating confusion and providing written documentation that can be utilized to plan future such events. INCIDENT ACTION PLANS An Incident Action Plan formally documents incident (event) goals (objectives). It will contain general tactics for achieving these goals while providing important information on the event and its parameters. Equally important the IAP facilitates dissemination of important information about the event to all concerned parties. The intricacy of the plan, the number of operational periods, and the required documentation will be sufficient as to properly reflect the event. The IAP shall include, but not be limited to:

• Goals (what is the ultimate mission) • Operational period objectives (for multiple period incidents • Strategies for the incident • Tactics for the incident • Organizational list with ICS chart showing primary roles and relationships • Assignment list with specific tasks • Critical need/situation assessments • Health and Safety plan for responders* Mandatory section • Communications plan (functional exchange of information) • Logistics plan (supporting the operation, supplies, equipment) • Incident map

SENIOR CORPS / YOUTH SQUAD COMMACK VOLUNTEER AMBULANCE INTERACTION OPERATING PROCEDURE

Effective 04/07/10 Operating 0020 Updated POLICY STATEMENT The Commack Volunteer Ambulance Corps (CVAC) Youth Squad is a critical resource for CVAC. In addition to allowing parents who may be adult members of the Corps to share an activity and be close to their children, the youth squad serves as a feeder and training ground for the development of new members. The Youth Squad is a vital part of CVAC’s success. It is the responsibility of every member to protect the health, safety and welfare of members of the youth squad. Adult members of CVAC, even those who may be only a little older than some members of the youth squad must keep in mind that members of the youth squad look up to them and respond to their mentoring and guidance. It is, therefore, essential to assure the comfort of the members of the youth squad and to avoid even the appearance of a member of CVAC taking advantage of a member of the Youth Squad. This policy is issued as guidance for senior members of CVAC with respect to how to behave toward Youth Squad members and to avoid the appearance of any impropriety. The objective is to avoid circumstances that are potentially coercive or subject to misinterpretation. Generally speaking there is safety in numbers and the greatest danger both of actual abuse or simple misinterpretation is when senior members are alone with junior members. This is to be avoided.

COMMACK VOLUNTEER AMBULANCE

PROBATIONARY MEMBERS OPERATING PROCEDURE o MANDATORY GENERAL MTGS o COMMITTEE WORK

Effective 3/15/11 Operating 0021 Purpose: Define minimum participation requirements, beyond hours and training, for probationary

members. Meetings: While on probation, the monthly general membership meetings are mandatory. Probationary

members unable to make a meeting for any reason; you must submit a request for excusal letter to the Asst. Chief prior to the night of the meeting.

Committee: Once a probationary member has completed their dispatching and/or riding training; they will be assigned to a committee by the Chief of the Department for the duration of the year.

COMMACK VOLUNTEER AMBULANCE

PROBIE PLUS OPERATING PROCEDURE Effective 3/15/11 Operating 0022

Purpose: To facilitate, and formalize, the training of newer members Reason: Upon completion of probationary training members are left to their own devices, expected to

integrate to “full member” on their own. The Probie Plus program is designed to Shepard through the critical period from probie through full member.

Policy: Within one (1) year of swear in, new members will be required to complete the “probie plus”

program. Those found to be remiss will be referred to the Membership Committee for failure to meet the requirements of membership.

Probie plus classes will be offered at various times/dates throughout the year. It is the members

responsibility to schedule themselves to complete the requirements within the 1 year time period. classes: 1 – Incident Command / Scene Awareness 2 – FEMA Courses; IS-100, IS-200, IS-700, IS-800 3 – PCR Writing 4 - Communications

COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 09/01/11 Operating 0023

Purpose When requested, to provide rapid first aid response, in district and out of district, for large-scale

events. Requirements As follows:

• Must be an operating member in good standing as deemed by the Rules and Regulations. • Current health physical on file with CVAC physician. • Completed Bike Safety Course as required by Bike Team Coordinator. • Minimum NYS EMT-Basic certification.

Deployment The CVAC Bike Team must be requested through the Bike Team Coordinator and the Chief of

the Department for all in district and out of district standbys. Each team will consist of two (2) members deemed eligible by the Bike Team Coordinator. The team will act to provide quick-access care to aided persons while ambulance treatment and transportation is delayed by a difficult-to-access location.

Equipment Each team of bicycles will be issued all the equipment and supplies required by the Commack

Volunteer Ambulance Corps Bicycle Checkout Form. No bicycle will be permitted to leave CVAC Headquarters without the required supplies, verified by completed checkout form; including its complementary team member and bicycle. Each bicycle will be equipped with forward and rear lights, and a siren.

Uniform Members operating on the CVAC bicycle team will wear only the approved and issued uniform

of a neon yellow and black reflective shirt, black shorts or tech pants. Members will be required to supply their own closed toe sneaker or slip-resistant work shoe for use while riding. Members must is always wear a helmet while operating any CVAC bicycle.

Identification The bicycles will be hailed as “Bike One, Bike Two, etc.” while operating within the Commack

Volunteer Ambulance Corps District. They will be assigned an identifier by the event coordinator while operating out of district.

Bicycle Team

PARKING COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 01/01/90 Building 0001

AMBULANCE BAYS No vehicles shall be parked in such a manner as to block access to any ambulance bay either front or rear entrance. Free and unrestricted access to the ambulances and emergency ambulance response vehicles is of primary importance. PARKING SPACES Parking spaces are provided on a first come first serve basis for the membership. It is expected that all members shall park in designated parking spots. Select spots, available on a first come first serve basis, are available towards the building as a courtesy to on-duty crew members. Members are expected to act courteously in the use of these spaces. NO-PARKING AREAS In addition to the areas mentioned above members are prohibited from parking their vehicles in any fashion that would block access to the adjoining property or directly to the rear of the atrium. This space is reserved wholly for the Emergency Ambulance Service Vehicles of the Corps and the Chief Officers. (responder vehicles). ADDITIONAL PARKING Additional parking spaces are available on the adjoining school property. CVAC maintains a standing mutual aid agreement with the maintenance department to share parking facilities while maintaining the integrity of access to all facilities. FRONT APRON / CURB No vehicle shall be left or allowed to park or stand on the front apron as this is contrary to the quick response of the duty ambulance. The front curb spaces are reserved, as a courtesy, for members responding on back -up.

CREW ASSIGNMENT POLICY COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE

Effective 07/1/03 CAO 0001 Updated 01/01/09

The Constitution and By-Laws, Rules and Regulations, and Officer’s Policy of the CVAC in various articles clearly give the Crew Assignment Officer the power to enforce a schedule on all Operating and Dispatching Personnel. In an effort to improve the efficacy of service provided to our community, the following is put into effect:

1) All Members, not on an authoriz ed leave of absence, will immediately become assigned. 2) All Members are expected to remain assigned weekly, it is the responsibility of the member to notify

the CAO or his designee of any necessary changes to the schedule. 3) Any member who fails to appear f or duty will be charged with an unexcused absence. 4) Any member who calls in for his shift with less than 48 hours notice, without due cause and/or

without finding his own coverage will be charged with an unexcused absence.

5) The member is responsible to sub mit any additions, scheduled absences, and changes on the prescribed form, via the current scheduling software, to the Crew Assignment Officer

6) Any member who accumulates more than (1) one unexcused absence in a month, or more than three

(3) unexcused absences in total shall receive a suspension of social privileges.

7) Members who continue to be unexcused for their absences will receive a Corps Suspension after the 4th unexcused absence. Continued infractions will result in referral to the Membership Commi ttee for further action.

CHANGES TO THE SCHEDULE MORE THAN 48 HOURS IN ADVANCE

1) Must be submitted through the current scheduling software CHANGES TO THE SCHEDULE LESS THAN 48 HOURS IN ADVANCE

1) Must be submitted on the prescribed form, via email, to the CAO 2) Must be phoned into the dispatcher, the dispatcher will log in the daily log 3) The Dispatcher must immediately page the CAO .

YOUTH SQUAD PARTICIPATION COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Delineates Youth Squad Members responsibilities For active ambulance service/dispatching Effective 6/1/03 Youth 0001 Effective immediately Youth Squad members riding/dispatching at Commack Volunteer Ambulance Corps will be subject to the following policy. This policy is in addition to any rule, regulation, or procedure extent in the CVAC by-laws governing such participation. YOUTH SQUAD DISPATCHERS

1) Must be regularly assigned to a dispatching shift as prescribed by the CAO. 2) Are required to make twenty-seven (27) hours per CVAC quarter. 3) YS Dispatchers must comply with continuing dispatch education as prescribed by Medical Officer

YOUTH SQUAD RIDERS

1) Must be certified CVAC Dispatchers 2) Must maintain their active dispatcher status (assignment/hours) 3) Must complete a probationary riding class prior to assignment 4) Must be permanently assigned to a riding shift by the CAO 5) Youth Squad Riders are expected to have continuing riding education.

Riding for a Youth Squad Member is a privilege of membership extended by the Senior Corps in exchange for the invaluable service provided as dispatcher. This procedure will also allow Youth Squad Members to avoid probation time upon their eighteenth birthday, they will be eligible for membership having completed all training requirements.

YS OVERNIGHTS COMMACK VOLUNTEER AMBULANCE OPERATING PROCEDURE

Effective 06/01/03 Youth 0002

EFFECTIVE IMMEDIATELY YOUTH SQUAD MEMBERS MAY RIDE / DISPATCH THE OVERNIGHTS UNDER THE FOLLOWING CONDITIONS AND THE FOLLOWING CONDITIONS ONLY: 1) Parental approval – presigned and confirmed overnight permission slip 2) YS Coordinator approval – presigned on overnight permission slip 3) Crew Assignment Officer approval – presigned on overnight permission slip

• CAO is to maintain a copy of the permission slip on file at all times.

4) Youth Squad Members are limited to one (1) riding and one (1) dispatching per overnight shift 5) Crew Chief must approve Youth Squad Member to ride dispatch 6) No ad-hoc (weekly assignment) of Youth Squad Personnel to overnight shift 7) Quarterly report to the Officers of YS attendance on overnights by CAO

Date of Membership COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE Effective 01/01/94 Membership 0001

To eliminate the confusion and subjectivity surrounding the official date of Membership the following shall apply. Senior Corps The bylaws allow for the return of six months of probationary time towards a member’s overall time upon the completion of the fifth year of service. Therefore the date of membership for anyone with under five years of service shall be their date of swearing in and for anyone with more than five years of service it shall be the date of start for probation to a maximum of six months. Youth Squad A former Youth Squad Members official date of membership shall be the date they were sworn in to the Youth Squad. SENIOR CORPS > FIVE YEARS Swear in date SENIOR CORPS < FIVE YEARS Swear in date – maximum of six months probationary time YOUTH SQUAD Youth Squad swear in date

MCI TRAILER COMMACK VOLUNTEER AMBULANCE

OPERATING PROCEDURE

Effective 04/07/10 MCI 0001 Updated Purpose: This policy is to outline the operations of the MCI Trailer hereafter referred to as MCI-1. It will

include the training, equipment, operations, and response guide. General:

The Disaster Preparedness Committee will maintain the trailer, and its contents.

The trailer is to remain locked at all times when not in use. The key hanging in the dispatch office or any CVAC “master” key can open the locks.

The trailer may be pulled by any of the responder vehicles or the van. Under no

circumstances is an ambulance to pull the trailer. Identifier: 2-16-MCI1 Requests:

In District: 2-16-MCI1 will respond as per the Special Operations Plan or at the request of the Incident Commander.

Mutual Aid: The trailer will respond if requested for mutual aid.

Training: The MVO will be responsible for training those members interested in becoming a driver for the

trailer. ONLY those member qualified by the MVO will be able to tow the trailer.* Cleared drivers will be noted on the pager list under the glass in the dispatch office with a (T) next to their qualifications.

Response: The vehicle pulling the trailer will respond Code2 (no lights/sirens) to an incident. A 2-person

crew is ideal and the maximum number of people to be dedicated to the trailer. The member(s) responsible for the trailer are to remain with the trailer at all times They are responsible for tracking all equipment removed and returned to the trailer.

Note: * These incidents are over a long period of time. You cannot respond with the trailer and expect

relief in a short amount of time. You must be available to say with the trailer as the number and probability of getting another trailer driver to relief you is very low.