SOP2011word - Thorne Ambulance Service · the policies and procedures within this manual outline the general principles that are to be followed by thorne ambulance service employees

2011Standard Operating Procedures

Thorne Ambulance Service

THE POLICIES AND PROCEDURES WITHIN THIS MANUAL OUTLINE THE GENERAL PRINCIPLES THAT ARE TO BE FOLLOWED BY THORNE AMBULANCE SERVICE EMPLOYEES.

THIS DOCUMENT, IN NO WAY, REPRESENTS A CONTRACT FOR EMPLOYMENT, OR CONTINUATION OF EMPLOYMENT.

WHILE ALL ATTEMPTS WERE MADE TO GENERATE POLICIES BASED ON COMMONLY ENCOUNTERED ISSUES, IT IS UNDERSTOOD THAT EVERY ISSUE CAN NOT BE COVERED WITHIN THIS DOCUMENT. THE SUPERVISING MEMBERS OF THORNE AMBULANCE SERVICE WILL MAKE ALL EFFORTS TO BASE DECISIONS ON THE STANDARDS SET FORTH BY THIS POLICY MANUAL, ALONG WITH THE ADMINISTRATIVE POLICY AND PROCEDURES MANUAL. IN ALL CIRCUMSTANCES, BEST JUDGMENT AND COMMON SENSE ARE TO BE UTILIZED BY BOTH FIELD AND ADMINISTRATIVE PERSONNEL.

Thorne Ambulance Service Est. 2010 Revised January, 2011

Standard Operating Procedures 2

Objective:

The purpose of the following document is to establish the general principles and practices that are to be observed by all employees of Thorne Ambulance Service. These policies are meant as a general guideline, and not every incident will fall under a specific category. In the event that a policy can not be found regarding a specific incident, or the current policy is unacceptable for a given situation, the Officer In Charge (OIC) may, based upon the general practices of Thorne Ambulance Service, make an executive decision in this instance.

Ownership:

Thorne Ambulance Service was established as a Limited Liability Corporation (LLC) on January 15th of 2010. Ryan Thorne is the primary shareholder of the company, with the remaining ownership belonging to Bart Thorne. The managing parties of Thorne Ambulance Service meet quarterly to review the current state of the organization, and plan for future operations.

Mission Statement:

Thorne Ambulance Service strives to provide the highest quality medical services by demonstrating the highest standard of care to everyone that we encounter. It is our

privilege to assist our community through the utilization of properly trained personnel, quality equipment, and to exhibit a high level of commitment to every one of our

customers. Each member of the Thorne Ambulance Service team provides the essential foundations required in today’s marketplace. The highest moral and ethical standards

will be employed to ensure our commitment to quality and professionalism.



Table of Contents

Section 1: Chain of Command Page 5

Section 2: Codes of Conduct Page 6

Section 3: Uniforms and Appearance Page 9

Section 4: Human Resources Page 12

Section 5: Vehicles Page 22

Section 6: Ambulance Operations Page 25

Section 7: Wheelchair Operations Page 36

Section 8: Dispatch Page 38

Section 9: Safety Page 39



Section 1: Chain of CommandInitial: January 2010Revised: January 2011

Policy 1.1Subject: Organizational Chart

Policy 1.2Subject: Communication• Any problems or complaints will be handled within the proper chain of command. The shift supervisor

should be contacted first (unless the matter involves him/her). From that point, the operational chain of command diagram should be referenced. If the employee initiating the complaint feels there have been no appropriate resolutions made, that employee is then allowed to speak directly to the Director regarding his/her concerns. Again, this is only to occur after speaking to one of the shift supervisors first.

• Any problems or suggestions that an employee encounters should be brought to the attention of the Officer in Charge (OIC) via DOR. This will allow problems to be resolved in a timely manner, and allow Thorne Ambulance to provide the best care possible to our patients.



Section 2: Codes of ConductInitial: October 19th, 2009Revision: January 12th, 2011Purpose: To establish the expectations of Thorne Ambulance Service employees

Policy 2.1Subject: Standards of ConductThorne Ambulance Service recognizes that while working in the healthcare industry, significant legal and ethical responsibilities will emerge. These responsibilities are to the patients we serve, our fellow employees, the agencies we work with, and the public at large. Employees of Thorne Ambulance Service personnel should adhere to the highest level of ethical standards while on duty or anytime representing Thorne Ambulance Service.

Policy 2.2Subject: Conversation • ANY offensive or potentially offensive language will not be tolerated while an employee is on duty or

while representing Thorne Ambulance Service, in a public venue.• ALL employees will at all times be polite and respectful to everyone they encounter on duty.

Disrespect toward ANYONE will not be tolerated, and lead to strict disciplinary action.• Thorne Ambulance employees will be respectful to all other healthcare providers

Policy 2.3Subject: Prohibitions• Thorne Ambulance Service offers a SMOKE FREE environment to all employees and customers. NO

smoking will be tolerated at any time while on duty.• The use of alcoholic beverages ON or within 8 hours of being on-duty will not be tolerated and will

require immediate termination of the employee. Refer to policy 2.6• Personal errands will not be run while on duty and within a Thorne Ambulance. These units are

intended for official business only. Any deviation from this policy will result in disciplinary action. This action could include paying for the mileage that resulted from errand running based on GPS calculation of the deviated mileage.

• No weapons of any kind will be allowed while on duty. The only knives that will be tolerated will be those with folding blades that can be carried in a pocket via a clip. These knives serve as a legitimate rescue tool and should only be displayed when being used as such. If there is a question as to whether an item is allowed or not, the item should not be brought to work. *Thorne issued knives are allowed while on duty.*

• Chewing gum while on scene of a call is considered unprofessional, and should be avoided.• The use of cell phones for personal use while driving a TAS owned vehicle is strictly forbidden. Cell

phone use for TAS-related business should be kept to a minimum, and all efforts should be made to stop the vehicle in a safe location prior to talking on the phone. If the unit phone rings, the employee who is not driving should answer the phone.

• Texting while driving is a serious offense, and will require disciplinary action including revocation of driving privileges up to suspension and/or termination.

• Cell phone use while on scene of a call, or in the presence of a patient, family, or staff member is not allowed. This presents an unprofessional appearance and speaks directly against the TAS mission statement.

Policy 2.4Subject: Visitors and Pets• Visitors are not allowed by any crew member during normal business hours without the prior approval/

consent of the supervisor on duty. 24-hour personnel are allowed to have visitors after normal business hours, but never beyond 2230 hours. Visits should be kept short, as you are on the clock. No visitor will be allowed to spend the night at any Thorne Ambulance station. EMPLOYEES are responsible for the conduct of their visitors at all times. While visitors are present on Thorne Ambulance property, all policies are enforced on the visitor as well, with the potential for disciplinary action falling on the employee.

• Pets are not allowed within Thorne Ambulance Service offices or vehicles by ANY staff member. In the event that a patient requires assistance from a trained animal (I.e.: seeing eye dog, etc.), that animal



is not allowed to be transported within the ambulance, as this may cause a problem for future patient’s with allergies to such animals. In the event that a patient requires the transport of a medical assisting animal, and has no means of obtaining transportation for the animal - Thorne Ambulance administration will make a good-faith effort to find a means of transportation for the patient’s animal.

Procedure:• Patient Care -It is of the utmost importance that all patients be treated with dignity and respect at all times. When treating patients with a high level of respect, we will then begin to engage in providing the highest level of care possible. It is important that we furnish each of our patients with any information regarding their rights and responsibilities, and work to the best of our abilities to ensure these rights are adhered to.• Confidentiality - It is a requirement of Thorne Ambulance Service personnel to ensure that each patient’s right to privacy and confidentiality is upheld. The information shared with personnel is only to be shared with authorized caregivers on a need-to-know basis only. Any questions as to what information can/should be shared can be directed toward the supervisor on duty any time an issue comes into question. The rights of our patients are also expanded to include our fellow employees and other healthcare workers.• Conflicts of Interest -Situations that may make an employee choose between their personal interest and the interest of Thorne Ambulance Service are deemed as conflicts of interest. These situations should be avoided by employees at all times. Examples of conflicts of interests in our particular work environment include:- Working for a convalescent service that is viewed as a direct competitor of Thorne Ambulance Service

(permission may be given in rare circumstances) - This does NOT include hospital-based transportation services at this time.

- Any job/event that would require you to obtain a patient customer base for services similar to those offered by Thorne Ambulance Service

• Employee’s Non-Compete Agreement/Acknowledgement-Employees should respect the business that Thorne Ambulance Service has become. Employees that choose to work for additional services and/or begin their own services should do so outside of Thorne Ambulance Service’s call area. Currently, this call area encompasses Greenville County, and therefore, no employee is to act as a competitor of Thorne Ambulance Service within 30 miles of Greenville County. It is expected that employees (past and present) will not utilize protected patient information to solicit current patient’s of Thorne Ambulance Service. Legal action can and will be taken against any employee who utilizes protected patient information inappropriately and/or for personal gain.• Employee Interactions-All employees shall be treated with dignity and respect. At no time shall an employee have to deal with workplace harassment, and disciplinary action will be taken against the offending employee. Aside from employee to employee interactions, the following should also be observed:- Acknowledge all personnel you come in contact with, in a courteous and respectful way- Always let those around you know how much you care about your job and your patients (your body

language will dictate your feelings toward your job)- Demonstrate initiative - step up to do the right thing- Be reliable and dependable with your promises (including service promises)- Show recognition and appreciation toward your peers for their excellence in service- Strive to build trusting relationships with fellow employees and customers- We should arrive at work when scheduled, and do our best to complete our responsibilities- Our jobs should be performed with enthusiasm and vigor, without our personal lives interfering with

our performance.- We should inform our supervisors of when additional training is required to perform our jobs.

Policy 2.5Subject: Health Insurance Portability and Accountability Act (HIPAA)Thorne Ambulance Service, along with many other facets of the healthcare industry, are required to abide by the rules and regulations set forth by HIPAA. It is important, that we as direct healthcare providers, not only understand HIPAA, but abide by all of the requirements set forth by the policy.



Uses, Requests, and Disclosures:Health information may be used, requested, or disclosed for treatment of a patient if the use, request or disclosure, is consistent with the minimum necessary policy and if one of the following conditions is met:

• Health information is used as appropriate for professional duties; or• Health information is requested from another healthcare provider or health plan; or• Health information is disclosed to another health care provider for the treatment activities of the

provider that receives the information; or• There is an authorized signed by the patient or the patient’s authorized representative; or • Such use, request or disclosure is approved by the supervisor on duty or another member of Thorne

Ambulance Service Administration.• The minimum necessary standard does not apply to requests by a healthcare provider for treatment.

Uses, requests, and disclosure for Payment: (In addition to the above list)• Information that is disclosed to Colleton Software for billing purposes or any other entity that is in

charge of billing

Employees should familiarize themselves with all of the policies set forth by HIPAA by visiting the HIPAA website for more/updated information. Any other information requests should be directed toward a supervisor, who will then furnish the requesting employee with the information they need.• HIPAA policies will be observed and practiced by all employees. Any employee who deviates from

the regulations set forth by the HIPAA will be subject to disciplinary action.

Policy 2.6Subject: Substance AbuseSubstance abuse, the use of unlawful substances, and the misuse of lawful substances will not be tolerated by Thorne Ambulance Service. These substances are a danger to patients, fellow employees, and the employee abusing the substance. The use of such substances will not be utilized while on or off duty by any Thorne Ambulance employee.

In the event that an employee is arrested on any drug or alcohol related charges, a supervisor should be notified as soon as possible, and no later than 24 hours after the arrest. At the time the charges are resolved, or the employee is convicted of wrongdoing, a supervisor will again be notified no later than 24 hours of the verdict. Employees will be suspended from employment from the time of arrest to the date in which the verdict is rendered. It is at the time of the verdict, that future employment will be determined. Employees should expect that an internal investigation by Thorne Ambulance Service administration will also commence following arrest, and pending trial outcomes.

If an employee has a substance abuse problem, it is the goal of Thorne Ambulance Service to provide the required assistance for that employee to seek help in resolving their problem. If reported voluntarily, the opportunity for rehabilitation will be granted once. If at any time after rehabilitation, the employee is found to have a substance abuse problem once again, that employee will be terminated. In the event that a substance abuse problem is discovered by another means (i.e.: drug test), other than from the employee themselves, immediate termination will occur pending the outcome of an internal investigation.

*Employees are subject to drug and/or alcohol testing prior to gaining employment, and/or at any time after employment commences, regardless of reason*

Section 3: Uniforms and AppearanceInitial: October of 2009Revised: Jan. 2011Purpose: To provide employees with the definition of approved uniform attire to be worn on duty, or any time one is acting in the capacity or name of Thorne Ambulance Service, LLC.

Policy 3.1Subject: Uniform Requirements • Employees are required to report to work in uniform and on time. Any deviation from this policy will

result in disciplinary action against the employee.



• Provided uniforms must be worn at all times during an employee’s assigned shift. The only exception to this is for 24-hour crews. After hours (1800 hours and beyond), 24-hour crews may remove their uniform shirt but must have on a service approved t-shirt. The approved colors for undershirts are: Navy Blue, black, or white. Shirts may not contain any offensive wording or art work. If there are any questions as to the appropriateness of a T-shirt, approval should be obtained by the supervisor on duty. Uniform shirts are to be worn at all other times, unless otherwise noted. This includes classes held on/off site, In-Service Training, etc.

• Uniforms and provided accessories (I.e.: nametag) are expected to be kept in good condition at all times. Uniforms are required to be neatly pressed and shoes polished. ANY EMPLOYEE WHO COMES TO WORK WITH A WRINKLED WORK SHIRT WILL BE REQUIRED TO IRON THEIR SHIRT PRIOR TO CLOCKING IN FOR WORK. If the clock-in occurs late due to ironing a uniform, this WILL be counted as a late occurrence.

• No long sleeve shirts will be allowed under short-sleeve uniform shirts. Long sleeve uniform shirts may be purchased through Thorne Ambulance Service by the employee.

• Employees who have full sleeve tattoos, or visible upper extremity tattoos will be required to wear long sleeve uniform shirts year round. These employees will be provided with this uniform type - this type of uniform shirt will take the place of the provided short sleeve uniform shirt. Enforcement is at the discretion of the Director or Officer in Charge (OIC).

• Uniforms will be provided at no cost to the employee provided the employee meets staff meeting requirements outlined later. Additional uniforms may be purchased via payroll deduct. Length of term is negotiable and must be documented prior to TAS supplying additional uniform. Reference policy 4.13 for meeting requirements.

• Uniforms must be kept clean and neat while on duty. It is strongly encouraged that employees retain a spare uniform while on duty to ensure cleanliness.

Policy 3.2Subject: Shirts• Administrative Personnel - Business attire or field personnel uniform should be worn at all times,

along with appropriate collar pins.• Field Personnel - Provided uniform shirt must be worn for the entirety of an employee’s shift. (see

above)• ALL Uniform shirts will include: Patch depicting level of certification on the right sleeve and Thorne

company patch on the left arm. Name plates and EMS badges are approved, but not provided by Thorne Ambulance Service at this time. TAS is willing to share in the cost of badges.

Policy 3.3Subject: Pants• Administrative staff must wear appropriate business attire or field uniform.• 5.11 Pants provided by TAS

Policy 3.4Subject: Shoes• Administrative Personnel must wear appropriate business shoe attire or black boots.• Black laced/pull-on boots and laced shoes are approved - NO OTHER foot coverings will be allowed

on duty. Boots will be kept clean and polished during work hours. A shoe shine kit can be found in quarters.

Policy 3.5Subject: Belts• A black belt at least 1” in width must be worn at all times on duty• Belts should be either plain leather, basket weave leather, or canvas. No “decorative” belts may be

worn.

Policy 3.6Subject: Socks• Only dark sock colors will be allowed on duty. This includes: Navy blue, black, etc. In the event that

any other color of sock is worn, they must not be visible when standing or sitting.



Policy 3.7Subject: Jackets• Only issued jackets will be allowed while on duty. Any other jackets/pullovers that the employee

wishes to wear on duty must be first approved by the supervisor on duty. Upon obtaining approval from a supervisor, the same patches required on the uniform shirt will be required on the approved clothing item. Thorne issued jackets are reversible, and are to be worn as follows: During daylight hours (in good weather), employees are to wear the jacket with the black/navy side facing outward. During evening and inclement weather conditions, employees are to utilize the ANSI2 (yellow/green) reflective jacket as the outer shell.

Policy 3.8Subject: Nametags/Picture ID’s• When name badges are issued to employees, they will contain the employees name and a recent

photograph (that will be taken by Thorne Ambulance administration and kept on file). Once issued, these badges will be required while on-duty. Badges will display the employees current credential level.

• Nametags are to be worn by employees at all times, when provided, with identification information facing outward (not toward the employee).

Policy 3.9Subject: Head Coverings • Ball caps will be allowed during rain and/or snow storms, but must be solid black or Navy blue in

color. These hats are not allowed to depict any images other than EMS logos (Star-of-Life, etc.). If there are any questions to the appropriateness of a logo, a supervisor should be notified.

• Beanies will be allowed in the winter/cold weather months, and must be a solid navy blue or black in color. EMS-type logos are acceptable on these beanies. No head coverings are provided by Thorne Ambulance at this time.

Policy 3.10Subject: Class PinsClass pins are allowed, and must be featured on the left-front pocket of the uniform shirt. These pins will not be provided by Thorne Ambulance Service. The pins currently accepted on uniform shirts are: ACLS, PALS, PHTLS, and BTLS. If there are other pins for classes currently offered, a supervisor’s approval must be obtained prior to displaying the pin.

Policy 3.11Subject: Award PinsAward pins must be worn above the name plate on the right chest of the uniform shirt.

Policy 3.12Subject: Uniform Return

Upon discontinuation of employment, the employee is required to return their uniform (supplied by TAS) in good condition. Failure to return the uniform(s) will result in a deduction of the uniform cost in the employee’s last paycheck. If any uniforms were purchased by the employee during their time with TAS, they have the right to retain those uniforms, but must return the Thorne Ambulance Service patch. This patch was provided by the company, and therefore; must be returned as well. Failure to do this will result in a deduction of $5/patch from the last paycheck.

Policy 3.13Subject: Educational Costs

Employees who choose, or are chosen, to terminate employment, for any reason, within the first ninety (90) days of employment with TAS will have any educational costs deducted from their final paycheck. This includes, but is not limited to: DOT Physical and Drug Test, CPR Heartsaver and/or Healthcare Provider, First Aid, Defensive Driving Course, etc.



Policy: 3.13Subject: Personal Appearance• Professionalism is a vital part of providing outstanding patient care, and personal appearance is often

times the determinant by patients and staff as to the level of one’s professionalism. All employees are required to report to work well-groomed. This terminology refers to the following: excellent “Can Do” attitude, trimmed nails, neat hair (Mohawks and abnormal hair colors not accepted), excellent manners, etc.

• Hair must be clean and neatly trimmed• Beards and mustaches, while allowed, must be neatly trimmed at all times• Finger nails must be clean and NOT excessive in length. Nail polish is allowed on female employees

only, and must be a solid color on all nails• Perfumes/cologne must not be worn in excess due to potential patient allergies.• The wearing of jewelry is discouraged, as lost or broken items are the responsibility of the employee.

Watches with a second hand are required to obtain appropriate vital signs• a. Ear rings may be worn by female employees only, however; only one in each ear (stud

type) will be allowed• b. No other visible piercing will be allowed while on duty• Sunglasses are allowed, but must be removed when in the presence of a patient or within a building• Tattoos must not be visible with the short sleeve uniform. Employees will be required to wear long

sleeve uniform if tattoos are present – Discretion of the Officer in Charge (OIC)

Personal hygiene should be kept in a fashion that is not offensive to patients, facility employees, or co-workers. If an employee that smokes and/or has poor hygiene is offensive to patients, staff, or co-workers, the employee will receive a warning regarding the issue at hand. Additional complaints after the initial warning could lead to termination of employment.

***Employees will not be allowed to clock in without first correcting a violation in any of the above policy***



Section 4: Human ResourcesInitial: October 20th, 2009Revised: January 2011Purpose: To establish the general job requirements for all field employees of Thorne Ambulance Service

Policy 4.1Subject: General Requirements• All employees are required to report to work in FULL uniform 10 minutes prior to the start of their

assigned shift. Personal hygiene and uniform policies will be enforced daily. Failure to clock-in on time will result in disciplinary action. NO employee is to clock in sooner than 10 minutes prior to assigned shift start or clock out later than 10 minutes after the end of a shift without approval from a supervisor or an obvious occurrence (i.e.: late call). In the event that an employee signs off beyond the 10 minute mark, it is required that the reason for late sign off be noted. This can be as simple as emailing the Shift Sergeant the call number that generated the overtime.

• ALL employees must provide a reliable contact number and emergency contact information prior to commencing employment - Any time this information changes, it is the responsibility of the employee to update administration with new information as soon as possible.

• ALL employees eligible to operate Thorne Ambulance units must submit a driving record at the time of hire and each year within the month of original hire.

• ALL employees are required to undergo a criminal background check at the time of hire. It is then possible for the employer to again request a background check at any time during employment

• Personal conduct on and off duty is to be of a nature that reflects the values of Thorne Ambulance Service.

• ALL employees are required to report to work at their required start time. Excessive tardiness will not be tolerated and may lead to disciplinary action. Employees are not to clock in more than 10 minutes prior to a scheduled shift, unless requested at a different time.

• A monthly schedule will be produced each month, and will be available to all employees. Schedules are subject to change, often times with limited notice. In the event of a schedule change, ALL employees affected by the change will be notified as quickly as possible.

• Employee staff meetings are not required, but must be attended to qualify for a uniform allowance. An employee may miss two meetings per year with excused absences documented and will still qualify for uniform allowance. Failure to attend monthly staff meetings will disqualify the employee from the allowance, and the cost of uniforms will be payroll deducted.

• Thorne Ambulance employees will be required to complete a Field Training program administered by the Field Training Officer and/or Training Sergeant. After completion of the program, it is possible for an employee to be re-assigned to a FTO for remediation.

• Any special events covered by Thorne Ambulance Service will be paid to the employee at their regularly calculated hourly rate, unless the hours result in overtime. Overtime will be paid to employees who work more than 80 hours in a pay period.

• Employees are to utilize the “station duties” sheet that can be found on the bulletin board at the back of the office. These duties are to be performed every day (where applicable). This check off should not result in a delay of response to a call. Any major items should be replaced prior to leaving the station, or reported to a supervisor at minimum. Once items are reported, it then becomes the supervisor on duty’s responsibility to resolve the issue. These items of concern should be brought to the attention of the supervisor on duty, no later than two hours after the start of your shift (if time permits). If unable to report discrepancies within the first two hours, then items should be reported at the quickest, most appropriate time.

• Field employees and administration are required, together, to perform station duties daily. Certain duties will be required on specific days, but should be completed earlier if the need arises. It is the supervisor on duty’s responsibility to ensure that all duties are completed accurately prior to the end of their shift. At ANY time a supervisor is likely to assess what duties are/are not being performed - this includes any substations that may be added at a later date. (SEE APPENDIX)

Policy 4.2 Subject: Call Out & Shift Change PolicyIt is understood that there are times where it is acceptable to miss work. However, it is also understood that there is potential to abuse the ability to call out of an assigned shift. When calling out, you must:



• Call the on-duty/call Shift Sergeant two or more hours prior to the start of the assigned shift (the more time the better)

• Provide justification to the on-duty/call Shift Sergeant of your need to be excused.• In the event that the Shift Sergeant does not feel that the employee presents a satisfactory explanation for

calling off, the Shift Sergeant is to inform the employee of this. If the employee decides that he/she would like the shift off regardless of approval, this will result in disciplinary action. It is only acceptable to call off of an assigned shift for the following:

1. Death of an immediate family member2. Emergency medical appointment (requires doctor’s note)3. Illness4. Case-by-case basis for any not covered.

A full time employee is eligible to miss four (4) scheduled shifts in a twelve (12) month period of time. This policy includes any employee who works an average of 30 hours or more per week. For part time employees, or those who work less than an average of 30 hours per week, will be eligible to miss up to two (2) scheduled shifts in a twelve month period of time. Paid Time Off (PTO) will be utilized in the event of a call out.

At no time is a field employee to request early leave of shift. It is expected that the employee is eligible to work the time that was submitted (for part timers) or scheduled (full time). Any request to leave early or refusal of a call during an assigned shift is unacceptable practice, and will result in disciplinary action. Calls for service will be accepted up until shift end (i.e.: shift ends at 1900, calls must be accepted up until 1900). Out of county calls are to be evaluated on a case-by-case basis, but should only be excused if received within the last hour of the assigned shift. Out of country calls will be handled by Thorne Airborne Division.

Policy 4.3Subject: Inclement WeatherAll employees scheduled to work are required to report to their assigned shift, at the assigned time. It is not acceptable for an employee to miss an assigned shift due to weather, unless the weather is unpredicted by local and/or national forecasts. In the event of mass transport cancellations, staffing may be adjusted (added, revised, removed), based on need. The on-duty Sergeant will make the determination as to who may be relieves of a shift. It is acceptable for employees to remain at TAS Headquarters or appropriate assigned station in order to facilitate an employee’s ability to arrive for shift on time.

Administrative staff members (Office Manager, Sergeant, etc.) are required to report to work at the time the inclement weather policy is enacted. These individuals will assist with additional call volume and managerial duties as needed. Night staffing, to assist with 911 transferred calls will be the responsibility of the administrative staff, and all efforts will be made to ensure staffing of an Advanced Life Support (ALS) unit.

Employees failing to comply with this policy will be counted as a “no show.” Disciplinary action will be taken against employees who do not arrive for a scheduled shift, and will receive disciplinary action that corresponds to their current standings with TAS.

Once the Inclement Weather Plan is activated, TAS will first contact all pre-scheduled customers to ensure that transportation is still needed and/or confirm appointments have not been cancelled due to weather. Secondly, TAS will contact local contracted facilities (first priority after patients), and offer transportation for employees to and from work, or to another assigned location. This will take place as needed, and inquiries about work transportation should be delivered via email, and an appropriate route of transportation established. The appropriate email address is [email protected].

Once ALS staffing during a weather event is available, TAS will contact Greenville County Communications to advise number of units available for mutual aid. Once mutual aid is established, The ALS unit will be posted in an area specified by GCEMS dispatch. Communication will flow from GCEMS to TAS dispatch to the responding unit.

Policy 4.4



mailto:[email protected]


Subject: Clocking Procedures• In order for an employee to clock in, the employee must utilize the appropriate desktop application.

This program log will be verified weekly by administrative personnel to ensure compliance. It is essential that employees accurately document times in and out. Shift premiums will be calculated by administrative personnel, but it is in the employee’s best interest to maintain records for verification. It is not necessary to type a “job” into the allotted space, unless the employee is on call time. Then it is appropriate that the employee list the “job” as “on call”. This will ensure that the employee is compensated at the appropriate rate.

• Specialty events/Stand-bys will have calculated in and out times (in most cases). If there is any deviation from the originally scheduled times, it is the employees responsibility to request a change in hours recorded, via email at: [email protected].

• Employees who fail to clock in or out are required to alert administration of the mistake. This correction must be made the Tuesday before a Friday pay date. Failure to alert administrative personnel will result in an incorrect check amount being produced. As this is the employee’s responsibility, these corrections can be made only during the time prior to the effected pay date. No changes or alterations will/can be made after the pay date has passed. If any compensation changes are made, the employee will be responsible for the payroll processing expense. This will be paid via payroll deduct.

Policy 4.5Subject: Certified Personnel***For the purpose of this policy, “EMT” will be utilized as a representative of all three categories of EMT(Basic, Advanced, and Paramedic) unless further specified***• EMTs are required to maintain their credentials - IST will be offered to the employee, but it is the

responsibility of the employee to ensure renewal of certifications. In-Service Training (IST) will be provided to the employee by the employer on a monthly basis. This is a required class in order to maintain certification. With that said, it is not a TAS requirement that employees attend the TAS offered IST program. IST will be provided to the employee at no cost. Employees are not compensated for attending IST.

• EMTs must abide by all National and State regulations regarding their level of certification• EMTs will be required to abide by the protocols set forth by Thorne Ambulance Service with the prior

approval/consent of the Medical Control Physician• EMTs are required to demonstrate proper patient handling (lifting/moving) prior to working in the

field. This will be performed during orientation in the event that 6 months of documented EMS experience are not confirmed.

• Paramedics will be required to possess the following at all times of employment: Current BLS, ACLS, PHTLS/BTLS/ITLS (one of the three), PEPP/PALS (either one is accepted). It is preferred that the employee also possess the following: NRP, AMLS, and ASLS, but is not currently a requirement. If the employee does not hold a pediatric credential at the time of higher, one must be obtained within 3 months of employment.

• EMTs are responsible for knowing/understanding all of the protocols set forth by the Medical Control Physician. Failure to comply with current Thorne Ambulance Service protocols will lead to disciplinary action, and possible termination.

• EMTs must obtain NIMS certification for courses IS-100, -200, -700, and -800. This will ensure proper readiness for situations which tax TAS resources.

Policy 4.6Subject: Scope of Practice TAS adheres to the established guidelines of the South Carolina Department of Health & Environmental Control - Emergency Medical Services division, and to provide a standard for all employees to follow regarding their individual certification level.

The following has been derived from the SC DHEC EMS website regarding scope of practice:•SC EMT-Basic Skills•Updated: July 2009 (Updated 12-21-09)•All EMT-Basic candidates who successfully complete a SC approved EMT-Basic course which uses the 1994 DOT EMT-Basic curriculum, successfully pass the National Registry EMT-Basic (i.e. SC





State basic written and practical examinations) and receive subsequent SC certification as an EMT-Basic are authorized to perform the following skills: (All skills are inclusive of adult and infant unless otherwise stated).•CARDIO - RESPIRATORY SKILLS:•- One and Two person CPR - Conscious and unconscious obstructed airway - Oxygen administration - OPA and NPA airways - One and Two person use of BVM - Oral suction - Combitube - Laryngeal Mask Airway (LMA)* - King Airway* - Sterile Suction* - Use of Automated External Defibrillators (AED)*•BANDAGE AND SPLINT SKILLS:•- Upper and Lower extremities - Spinal Immobilization (Short and Long board) - Pneumatic Anti-Shock Garments* - Hemorrhage control (Direct Pressure, Pressure Point, Tourniquet, etc.)•GENERAL SKILLS:•- Patient Assessment - Vital signs - Patient Lifting•- IV Maintenance* (involves ONLY monitoring and maintenance of previously initiated IV lines as well as calculation and adjustment of flow rates - fluids NOT containing any medications or blood products).•- Monitoring of Blood Glucose with use of automated chem-strip analysis* (Local option - training to be done by the individual EMS provider with Medical Control Supervision).•- EMT Administered Medications (Oxygen, Activated Charcoal,* Ipecac,* Instant Glucose*)•- EMT Patient Assisted Medications* (Nitroglycerin, Epi Auto-injectors, Prescribed Inhalers)•- CPAP* (Local option-training to be done by the individual EMS provider with Medical Control Physician supervision).•- Primary Administration of Epinephrine Auto-Injector for Severe Anaphylaxis* (Local option-training to be done by the individual EMS provider with Medical Control Physician supervision).•* These skills require the EMT-basic to be affiliated with A SC Licensed Ambulance Provider and gain authority (on-line or off-line) from the provider's medical control physician prior to initiating these skills. (Training in all “Local option skills” is to be done by the individual EMS provider with Medical Control Physician supervision).•Approved Skills (revised 02/2009)•SC EMT-Intermediate Skills•All EMT-Intermediate candidates who successfully complete a SC approved EMT-Intermediate course, successfully pass the National Registry EMT-Intermediate/85 (i.e. SC State Intermediate written and practical examinations) and receive subsequent SC certification as an EMT-Intermediate are authorized to perform the following skills: (All skills are inclusive of adult and infant unless otherwise stated).•- All skills listed under SC EMT-Basic - Pharyngeal Tracheal Lumen Airway (PTL) - Intravenous Therapy (peripheral, external jugular, intraosseous, INT – Heploc/PRN adaptor) - Finger Stick for Blood Glucose Monitoring (BGL) - D50 Administration•NOTE: ALL ADDITIONAL SKILLS LISTED ABOVE FOR THE EMT-INTERMEDIATE MAY ONLY BE PERFORMED WHEN THE EMT IS AFFILIATED WITH A SC LICENSED AMBULANCE PROVIDER UNDER THE AUTHORITY (ON-LINE OR OFF-LINE) OF THE PROVIDER'S MEDICAL CONTROL PHYSICIAN.•SC EMT-Paramedic Skills•All EMT-Paramedic candidates who successfully complete a SC approved EMT-Paramedic course which uses the current DOT EMT-Paramedic curriculum, successfully pass the National Registry EMT-Paramedic (i.e. SC State Paramedic written and practical examinations) and receive subsequent SC certification as an EMT-Paramedic are authorized to perform the following skills: (All skills are inclusive of adult and infant unless otherwise stated).•- All skills listed under SC EMT-Basic - All skills listed under SC EMT-Intermediate - Endotracheal Intubation - Medication Administration•- Sub Q Injection - IM Injection - IV Push - IV Drip•- Endotracheal Tube



•- Rectal - Pleural Decompression (Adult & Pediatric) - Gastric Lavage - Vagal maneuvers - EKG Monitoring and Rhythm Identification to include 12-lead (Optional for 12-lead) - Defibrillation - Cardioversion - External Pacing - Rapid Sequence Induction - Monitoring approved interfacility drugs - Managing cardiac patients per current ACLS standards•NOTE: ALL ADDITIONAL SKILLS LISTED ABOVE FOR THE EMT-PARAMEDIC MAY ONLY BE PERFORMED WHEN THE EMT IS AFFILIATED WITH A SC LICENSED AMBULANCE PROVIDER UNDER THE AUTHORITY (ON-LINE OR OFF-LINE) OF THE PROVIDER'S MEDICAL CONTROL PHYSICIAN.Approved Skills (revised 02/2009)

(END OF DHEC LITERATURE)

At Thorne Ambulance Service, it is expected that each employee will understand what it means to work within their “scope”. Any employee who deviates from the above state ordered policy on scope of practice, at any level, will be subject to extreme disciplinary action. This policy will be observed through the QA/QI process along with any complaints we receive from staff members, family members, or other employees of Thorne Ambulance Service. Know your protocols and know your scope of practice and there should be no problem.

Policy 4.7Subject: Part-Time Employee Work Requirements• Part-time employees will be required to undergo the same orientation that is required of full time

employees• Part-time employees are required to turn in an availability sheet for each month, no LATER than the

15th of the current month (i.e.: On October 15th, November availability is due). This availability will be at least 6 days a month.

• ***It is not guaranteed that part-time employees will receive all of the time they have requested***• If a Part-time employee is unable to satisfy the above requirements, a letter will be sent to the

employee concerning their inability to meet the minimum standards. At that time, it is the EMPLOYEES responsibility to schedule a meeting with Thorne Ambulance administration and determine the next appropriate course of action.

• It is encouraged that all part-time employees attend IST monthly, however; this is not a requirement. It is a requirement to maintain all credentials. This is the responsibility of the EMPLOYEE

• Part-time employees must adhere to the same standards of full time employees with the exception of hours worked

Policy 4.8Subject: Full-Time Employee Work Requirements• Full-Time Employee refers to an employee who is regularly scheduled for a minimum of 32 hours per

week.• Full-Time employees are required to sign up for a minimum of six days of call back per month.• Full-Time employees are eligible for healthcare benefits which include the following

- Healthcare- Dental- Vision- Accidental- Short Term Disability- Life

Policy 4.9Subject: Light Duty Job RequirementsIn the event that an employee is placed on “light duty”, the following will be placed into effect:

•Employees on light-duty status will report to work from the hours of 0900-1700 Monday-Friday (regardless of normal shift start)•During this time, there are a number of duties that may be performed by the employee (assuming the employee is cleared to perform the following):

1. Unit check-offs will be completed by the employee on light-duty2. Station duties will be performed by the employee on light-duty



3. Station phone may be answered by employee on light-duty4. Employee on light-duty may be required to act as primary attendant with NO lifting

responsibilities (3-person crew scenario)5. Any other assigned duty is to be performed in a timely manner

Only FULL TIME employees are eligible for light duty assignmentsPhysical Activities Involved:

•Minimal lifting•Minimal Bending•Some Walking•Riding in Ambulance or other company vehicle•Entering Data into Mobile Computer•Carrying Mobile Computer on calls

Policy4.10Subject: Vacation UsageVacation picks will be as follows:

- Vacation will be granted on a first come, first serve basis for eligible employees. It is expected that an employee will give at least one month’s notice on vacation time when possible. If multiple employees request the same time off, the employee with the most seniority with TAS will be awarded the time.

- Administrative staff: Eligibility for time off will be based upon the number of supervisors scheduled. Administrators are able to swap shifts if within the same class (i.e.: Sergeant swap with a Sergeant, etc.). Any time that the Office Manager is out for sickness or vacation, the remainder of the administrative staff shall share these duties.

- If an employee chooses to cancel a vacation day, they will be allowed back on the schedule for that day if there are any availabilities on the schedule.

***Only full time personnel can acquire and use Paid Time Off (PTO)***

Policy 4.11Subject: Leave Without Pay/Shift SwapsEmployees are eligible to take time off without pay IF coverage is found by the employee, that does NOT result in overtime for the employee covering time. Employees may choose this option as often as they would like, however; if done in excess, employee benefits may be effected.

Shift swaps are allowed with prior administrative approval, IF the time for either party does not result in over time. Emails from both parties are to be sent to [email protected]. Once sent, employees must receive approval email prior to official change of schedule.

Policy 4.12Subject: FMLA/Return to Work ProcedureAny employee (full or part-time) who is out of work due to a medical condition/injury, must be cleared by a Thorne Ambulance Service approved physician prior to the employees return to work.

The following types of leave will be honored by Thorne Ambulance Service:A.) Medical leaves including: Family Leave, short/long term disability, worker’s compensation leaveB.) Jury DutyC.) Military Leave

Family Medical Leave Act (FMLA) of 1993:Thorne Ambulance Service complies with all requirements established by the Family Medical Leave Act of 1993. This act entitles employees up to twelve weeks of un-paid, job-protected leave each year for specified family and medical reasons. To be eligible:• Must have been employed one year or longer• Worked 1,250 hours or more in the preceding 12 months (prior to commencement of leave)• Thorne Ambulance Service also complies with the requirements outlined in the Americans with

Disabilities Act, in relation to any employee on FMLA.





Employees while on Family Medical Leave Act are entitled to the following benefits:Employees on FMLA making timely and accurate premium payments may maintain benefits. Premium payments shall be withheld from any Paid Time Off (PTO) or Short Term Disability checks the employee receives. If the employee does not receive PTO or a disability check, payments can be made by the employee no later than the first of the month (of the effected month) via check to the human resources office at Thorne Ambulance Service corporate office, located at: 301 Halton Rd. Ste H, Greenville, SC, 29607.Once an employee is cleared by an approved physician to return to work, the employee will be restored to his/her original job, OR to an equivalent job with equivalent pay, benefits, and other terms and conditions of employment.Jury Duty Leave:Employees are expected to serve on juries when summoned. Employees providing documentation of jury duty service may be compensated by Thorne Ambulance Service if the time of service takes away from the hours an employee would have accrued on the job. This is in addition to any pay accumulated from jury duty. This leave is only applicable to full time employees, as part-time/PRN employees provide availability to TAS and are not automatically scheduled for shifts.It is the employee’s responsibility to: 1.) Contact the supervisor in advance to discuss reporting requirements and scheduling conflicts2.) Submit original receipt or pay voucher reflecting hours of jury duty service to the supervisor upon return to work.It is supervisor’s responsibility to:1.) Administrate scheduling conflicts at his/her discretion2.) Receive original receipt or pay voucher from the employee and input request for payment to Thorne Ambulance Service Human Resources and/or Director.Military Leave:Employees may qualify for two types of military leave - Temporary Military Leave or Extended Military Leave. Employees on temporary military leave and extended military leave are eligible to maintain benefits afforded to other full time Thorne Ambulance Service employees on similar leaves of absence. Thorne Ambulance Service complies with the requirements outlined in the Uniformed Services Employment and Reemployment Act (USERRA) in relation to employees on ANY type of military leave.

Employees on military leave of any type will NEVER be required to search for their own coverage, as long as the appropriate procedures and awareness have been put into place regarding leave of any type.

Employees may utilize Paid Time Off to supplement their military pay up to 100% of their normal pay period earnings (typically 40 hours/week).

Employees complying with the Employee Obligations outlined in the USERRA will have available all other rights available to military personnel under the USERRA.

Policy 4.13Subject: Subpoenaed Witness• Personnel that are subpoenaed as a witness in a job related case will provide notice of such as soon as

received. Efforts will be made with attorneys, etc. involved to schedule the testimony while the employee is ON duty (as to not take away from employees off time). If this type of scheduling is unavailable, and the employee is required to give their testimony on an off day, the employee will be paid their regular wages.

• Personnel who are subpoenaed to testify or appear for non-job related reasons will be charged Paid Time Off or will lose pay (in the event no Paid Time Off is available) for time missed from work.

• Administration/Supervisor is responsible for coverage needed while an employee is away from the job for any of the above reasons.

Policy 4.15Subject: Information TechnologiesEmployees have the right to check work/personal email while on the clock and if time permits. At no time will computer usage result in a late/delayed pick-up of a patient. It is expected that an employee using a computer for personal use has completed ALL assigned tasks/duties for their assigned shift.



When using social networking sites, both on and off duty:Employees are not to make negative comments about Thorne Ambulance Service, its patients, or its competitors. This would negatively impact Thorne Ambulance Service, and speaks directly against our mission and vision statements. At no time will privileged information be allowed on these sites, as it may result in a HIPAA violation or become a legality issue for the employee. Disciplinary action will be taken against any employee who cannot abide by the above standards set forth by Thorne Ambulance Service.

Any websites that may be construed as pornographic in nature, offensive, etc. are NOT at ANY time permitted on Thorne Ambulance Service equipment. This, again, speaks directly against the mission and vision of Thorne Ambulance Service and is a completely inappropriate use of company equipment. This will not be tolerated, and if discovered, will lead to the immediate termination of the employee(s) involved.

Contact Information & Uses:[email protected] - Utilize this email for all HR, office-related inquiries, and as directed by this manual.

[email protected] - Utilize this email to contact Sgt. Alexander regarding shift issues, DOR submission, or other supervisory tasks. Unless specifically for Sgt. Alexander, the on-call Sergeant’s email account should be utilized (see monthly schedule). SEND AVAILABILITY HERE.

[email protected] - Utilize this email to contact Sgt. Goodman regarding shift issues, DOR submission, or other supervisory tasks. Unless specifically for Sgt. Goodman, the on-call Sergeant’s email account should be utilized (see monthly schedule)

[email protected] - This email is utilized to contact Director Thorne. Please utilize the above email addresses prior to submitting any information to this account. This is primarily used by the vendors, customers, etc. of Thorne Ambulance Service.

Policy 4.16Subject: Information Technology (IT) AssistanceIn the event that the MICS program or other computer applications are not properly functioning, it is appropriate to alert the Officer In Charge (OIC) of the computer problem. If the problem does not directly affect the care attendant’s ability to document on the MICS program, then the computer will remain in service for the remainder of the shift. In the event that the MICS program is not working properly, the computer is to be taken out of service, and the documentation completed on a spare computer (when applicable) OR on the PREMIS short version print out (only when no other computers are available). In the event that the PREMIS form is utilized:• The assigned call # must be clearly indicated on the top of the form• The completed PREMIS form must contain call times• The form is to be transferred to the MICS program when possible• Signatures are to be scanned (by administrator) and sent to Colleton Software for processing

Policy 4.17Subject: Corporate Integrity• Legal Compliance-- We shall strive to comply with Federal, State and Local laws, rules and regulations in both a business

and personal sense. Breaking laws not only negatively effects the employee who breaks the law, but impacts the business and co-workers as well. It is your responsibility to not only be aware of the laws, but to ensure compliance with laws.

- We are mandated to comply with requirements set forth by regulatory agencies- We will keep our certifications current and attend continuing education courses to keep current with

healthcare topics- At no time will a Thorne Ambulance Service employee make knowingly false statements to regulatory

or enforcement agencies - nor will any employee speak on behalf of Thorne Ambulance Service. Any company viewpoints shall be shared/expressed by the administrative person in charge of media relations.

- Employees are to cooperate in the event of an audit or any type of internal investigation.• Equal Employment Opportunities-











- Opportunities for advancement will first be open to employees from within the organization. After one business week, these jobs will be open to the public. Minimum job requirements will be posted at the time positions become available and open for applications.

- All employees who qualify with the minimal qualifications are eligible to apply for the open position.- A grievance procedure has been placed into effect in order to assist employees with any problems

associated with the work place.- Disciplinary actions will be administered equally across Thorne Ambulance Service• Asset Protection-- Property of Thorne Ambulance Service should be used in accordance with the policies set forth by this

manual, and Thorne administrative staff.- All property of Thorne Ambulance Service is intended for proper business purposes only. Any other

use must first be approved by the supervisor on duty.- Any equipment that becomes outdated should be taken to the supervisor on duty for proper disposal.- The proper measures shall be taken by all employees to protect the computer systems and patient care

reports of Thorne Ambulance Service.- At no time should employees share computer passwords or fuel card pin numbers.- Employees are mandated to report any suspicious or inappropriate actions or behavior by anyone, to

the supervisor on duty. In the event that the supervisor is the person in question, the next employee in the chain of command shall be contacted.

• Safety, Security, and Environmental Issues-- We shall comply with applicable safety, security, environmental, and infection control laws,

regulations, policies, and procedures.

Policy 4.18Subject: Disciplinary Procedure• South Carolina is an “At Will” state. TAS chooses to provide a “right to work” environment. This acts

as protection to TAs employees from undue discipline, suspension, or termination.• This policy does not guarantee continued employment at TAS, nor represents a contract of

employment.

Automatic DisqualifiersDue to the nature of our industry, there are a few instanced that will require immediate termination. The following list gives examples of automatic disqualifiers for continued employment. The list is not all-inclusive, and circumstances not listed may be cause for termination. All occurrences which may be considered automatic disqualifiers must be reviewed by the Director, who has the final say in termination.• Drug use or other similar impairment on duty• Alcohol use or other similar impairment on duty• Dishonesty (lying, false documentation, etc.)• Industrial Espionage• Deliberate destruction of TAS property• Unprofessional conduct toward any customer (patient, family, staff, etc.)• Gross insubordination

Methods of Disciplinary Action• Documentable Occurrence Report (DOR)

- The DOR is for all employees to document an incident they would like the Shift Sergeant to review. This may range from interpersonal conflicts to accidents involving TAS property. The DOR is confidential, and is reviewed only by Administration. The DOR may not be used as retaliation towards any employee. If the DOR is regarding a shift supervisor, the DOR should be turned in to the next highest officer. The Director reserves the right to review any DOR

• Verbal Counsel (VC)- One-on-one counsel with Shift Sergeant regarding an incident. Physical document will be created

for employee’s file with knowledge of employee(s) involved. A Verbal Counsel cannot result in a suspension. More than two (2) VCs on any one type of incident will result in a Written Counsel (WC)

• Written Counsel (WC)- Written Documentation of an incident regarding an employee’s conduct and/or appearance. WC

may be generated after two (2) VC regarding same incident. WC may be generated if an incident



involves a gross infraction of TAS policy. Employee’s have the right to refuse to sign WC if the employee believes the WC to be falsified in any form including subject matter. An incident occurring a second time after WC is issued will result in Suspension (SUP). Director approval is required prior to placing WC in employee’s file. The issuing officer reserves the right to revoke WC for any reason.

• Suspension (SUP)- Suspension of an employee involves removal of the employee from duties without pay.

Suspension may be from one work day to nine work days depending on severity of infraction. While on SUP, the employee may not attend any official TAS function. SUP is a recommendation from the Shift Sergeant, and must be approved by the Director. SUP may result from infractions noted on any one WC. Serious infractions of policy may result in SUP without prior WC. SUP forfeits on bi-annual pay raise. PTO may not be used while on SUP. If the SUP occurs during scheduled PTO, The SUP will be effective beginning after the scheduled PTO. During the SUP period, continued employment of the employee will be reviewed by Administration.

• Termination- Termination of an employee is a recommendation sent to the Director based on repeat offenses by

employees resulting in one or more SUP. Any gross infraction of policy during New Employee Probation may be grounds for termination. Termination is not a desired resolution to a problem, but rather is a last resort. TAS wishes all conflicts to be resolved in the early stages of disciplinary action to grow an employee’s professionalism and maturity. Once termination is recommended, the Director will make the final decision on employment status.



- Section 5: VehiclesInitial: October 25th, 2009Revised: January 2011

Policy 5.1Subject: Unit Check-offAll Thorne Ambulance Service units should be in a state of readiness at all times. Whether responding to an emergency call or a non-emergency call, all items should be in working order and ready for use. Unit check-offs will be completed daily to ensure the readiness of each unit. Prior to leaving the station, crews shall complete the Daily Check-off Sheet for their particular Unit at the beginning of their shift. Upon completion of Daily Check-off Sheet, crew shall turn in form to the on duty Sergeant for approval. If Sergeant is not available, crew shall turn it in to next available administrator. After shift completion, crew shall check back in all equipment that is documented on their Daily Check-off Sheet. The crew is responsible for all applicable restock, repair DORs, and any additional issues that arose during their shift. Crew must check back in all equipment regardless of log off time. Crew is to leave the completed Daily Check-off Sheet in the provided wall file for review by administration.

Unit fluid levels should be assessed, tires inspected, and damage reported. This is to ensure not only proper care for units, but is also meant as an overall safety check for crew members. Equipment within the unit (and outside compartments where applicable) should be assessed for proper quantities and functionality. These items should be removed/replaced as problems arise. Any item that requires a battery for proper operation (I.e.: cardiac monitor) should be tested prior to leaving the station.

All vehicles have the potential to be used for long-distance transfers. To ensure unit readiness, all vehicles must be topped off prior to end of shift. Fuel cards have been issued for each unit and should be checked out at the start of each shift. At no time during your shift should the fuel level fall below ½ tank, unless call volume prevents refueling. Should fuel levels fall below ¼, the shift supervisor should direct dispatch to allow for the unit to be refueled. The fuel card should be checked back in at the end of each shift.

Oxygen cylinders should be replaced at or below the 500 psi level. Review supplied check-off sheets for further on unit requirements. It is imperative that the M and E cylinders are left in the “off” position when not in use. Failure to do this may result in a leaking of O2. If an employee is found making this mistake often, the employee may be held financially responsible for O2 replacement ($40/tank).

***All units are required to be stocked to the SC DHEC minimum - Any time this is in question, concerns should be brought to a supervisors attention immediately***

Policy 5.2Subject: Supply SwapThorne Ambulance Service units will only swap supplies with other agencies (fire depts., ambulance units, healthcare agencies) that we receive and assume the role of primary care provider. No items will be swapped that have not been utilized on that specific call. Any request for additional supplies should be directed to the supervisor on duty.

In the event that equipment is left at an Emergency Room with/on a patient, the crew should wait for the item (if wait time is expected to be less than 10 minutes). In the event that wait time may exceed ten minutes, the crew should return prior to the end of their shift to obtain the item(s). At no time will taking items belonging to other EMS agencies be tolerated. This is poor practice and should be avoided.

Policy 5.3Subject: Vehicle Backing

· Any time a TAS vehicle is backed into a parking place a TAS employee must spot the driver from outside the vehicle on the driver’s side.

· Driver shall have their window down so they can hear any verbal commands given by backer.· BOTH DRIVER AND BACKER SHALL BE HELD RESPONSIBLE FOR DAMAGE DONE

BY A BACKING ACCIDENT.· Not using a backer will be grounds for disciplinary action against ALL CREW MEMBERS

assigned to ambulance.· If vehicle is single occupied (supervisor truck, Wheelchair Van) a backer does not have to be used



if not available. If TAS employee is available, then all efforts shall be made to have a backer spot driver of single occupied vehicle. Not using an available TAS employee to assist with backing single occupied vehicle may be grounds for disciplinary action against the driver.

· In event of emergent transport of a critical patient all efforts must be made to recruit a qualified backer (Law enforcement, EMS, Fire) to assist with backing out of a scene. If there are no qualified persons available, then the patient care attendant may spot through the back windows of the ambulance. ALL OTHER TIMES TAS EMPLOYEE SHALL SPOT DRIVER FROM BEHIND THE AMBULANCE.

In event of backing accident, TAS employees shall do the following:· Contact Sergeant and advise location of accident, number of vehicles involved and possible

injuries.· Assess all persons involved for injuries/transport priority.· Request additional resources as necessary.· Administer appropriate aid.· Update Sergeant on situation.· Provide all necessary information to Law Enforcement.· Photograph damage done to all vehicles/property.· If backer was not a TAS employee document person’s name, rank and agency.· Complete all appropriate paperwork in a timely manner.· Complete DOR of incident ASAP.

Policy 5.4Subject: Vehicle/Equipment Accident Reporting ANY incident involving a Thorne Ambulance Service unit and another vehicle, OR an incident that

produces damage to property, is to be investigated by the South Carolina Highway Patrol and/or the local authority in the jurisdiction in which the incident occurred. This policy should be enacted regardless of how minor the damage incurred/caused.

Once the local authority has been contacted to investigate the incident, the supervisor on duty is to be contacted, and the Accident Review Committee (ARC) is to respond. The primary purpose of ARC will be to take pictures of the incident, and to possibly relieve crew members as to not disrupt regularly scheduled calls in progress

- The ARC may not be required to respond to the scene if there is no patient on board, the crew was not en route to a patient, and if the crew members are capable of taking photographs of vehicle damage with Thorne Ambulance Service provided cell phone cameras.

All occupants in any vehicles/property involved should be assessed for injuries, and EMS units (and other appropriate resources) requested to facilitate the transportation of the injured persons.

If the vehicle en route has a patient on board OR is en route to a call, the dispatcher should be notified and other arrangements made. Another Thorne Ambulance unit is to be dispatched to assume patient care in the event that a patient is being transported at the time of incident.

Employees on the scene of above incidents should make an attempt to obtain the names and addresses of witnesses to the accident and provide the information to the supervisor upon his/her arrival at the scene.

Remember: It is the employees responsibility to maintain all units in accordance with state/local law and Thorne Ambulance Service policy. Any incident that results in employee negligence (as determined by Thorne Ambulance Service administration/ARC), could result in the employee being charged for damages incurred, up to a maximum of $250 per occurrence.

In the event that an employee is found to be guilty of deliberate or gross negligence, the employee may be held responsible for the full amount of the total repair costs to the item(s) involved. An example of this is an employee damaging an item out of anger or disregarding a vehicle warning light and continuing to operate the vehicle.

Refer to Section 9 for Safety ProgramPost Incident Occurrence: Following any moving accident involving a Thorne Ambulance Service vehicle, where the operator is

deemed at fault and/or injuries occur, the following will commence:1. The operator of the vehicle will be required to take an immediate drug screen through an approved

administrator of drug tests.2. The operator’s driving status will be reviewed, and the appropriate action will be determined.



Appropriate action includes, but is not limited to: Driving suspensions (EMTs may be placed in a patient care role only), Written Counsel, or in extreme cases, Termination.

3. In the event that the employee is required to attend driver remediation, that employee will have up to 30 days to successfully complete any courses. Any employee who fails to complete the required courses will have their employment status reviewed, and the results will determine employment status.

4. Disciplinary action outside of remedial training may be incorporated (see 2)5. If an employee has more than two (2) backing accidents in a twelve month period (or less), that

employee will be removed from any operational position until remediation is successfully completed.

Policy 5.5Subject: Vehicle Parking Units are to be parked in the appropriate assigned spots at the end of each shift (currently spots backing

up to TAS HQ building) Employee vehicles are to be parked in the back parking lot of TAS HQ. At no time will a Thorne Ambulance Service unit be parked in a handicapped parking space OR an

area designated as a fire lane (unless emergent response). Fire Hydrants should not be blocked at any times, and units should use appropriately designated spaces when away from the station.

In the event that covered parking is provided, these spaces will be utilized for unit parking ONLY Personal vehicles are to park in the rear parking lot of TAS HQ. After hours crews may utilize the

spaces in front of the HQ door for safety and security.

Policy 5.6Subject: Vehicle Maintenance• At the start of every shift, proper operation of Thorne Ambulance Service units will be assessed and

confirmed.• The interior AND exterior of ALL units will be kept clean at all times• Any missing equipment should be replaced prior to leaving the station.• All units will furnish a service sticker to indicate the mileage at which service is to be performed, and

the type of service to be completed.• Any problems/concerns with units should immediately be reported to the supervisor on duty• Only equipment found on unit check-off sheets will be allowed - Any suggestions for new equipment

should be submitted to the supervisor on duty.• At all times, vehicles are to retain a minimum of half a tank of fuel. Fuel cards should be utilized for

all fuel purchases.• Vehicles are not to be utilized for personal business• All vehicles are to be locked/secured at all times that Thorne Ambulance personnel are not within the

unit.• At any time during an assigned shift, supervisors/administrators have the ability to inspect a vehicle for

SC DHEC/Thorne Ambulance Service policy compliance.• Any time that a Thorne Ambulance Service unit is to cross 2 or more counties during a transport, the

vehicle should be assessed for any problems (I.e.: Tire inspection, fuel levels, etc.). This extra assessment of equipment is in addition to morning check-offs



Section 6: Ambulance OperationsInitial: October 20th, 2009Revised: January 2011Purpose: To outline the expectations of daily ambulance operations in both the emergent and nonemergent settings.

Policy 6.1Subject: Patient Handling and Transportation• ONLY authorized medical personnel will be allowed in the patient compartment. This includes:

Physicians, nurses and other allied healthcare workers, and any others deemed necessary by sending facility.

• A family member may accompany the patient to the pre-determined destination, but must remain in the front passenger seat of the vehicle, and is required to wear a seatbelt and sign a release form. This form must be signed PRIOR to transporting AND each time the family member rides in the unit.

• In the event that a violent, behaviorally disoriented, or sexually assaulted patient is transported by Thorne Ambulance Service, a crew member of the same sex will act as the primary attendant (if applicable). Law enforcement will accompany this patient-type if necessary/possible.

• Thorne Ambulance personnel are responsible for their patient until appropriate transfer of care (including signatures) has been performed.

• All patient encounters will require lifting. ALL employees are required to utilize proper lifting techniques to lessen the likelihood of an injury. Lifting assistance should be requested anytime deemed necessary by the crew on scene. Staff members at the sending facility should be sought after prior to sending an additional unit. At NO TIME will lifting assistance be DENIED to an employee for any reason.

• The Stair Chair should be utilized anytime patients are moved up/down steps. This will decrease the likelihood of employee injury.

• Patients will be properly secured to all moving devices (stretcher, spine board, stair chair, etc.) utilizing all available straps/safety devices. Failure to comply will result in disciplinary action.

• Patients will not be walked to the ambulance as the patients we transport are sick and require a stretcher. Failure to comply will result in prompt disciplinary action

• The stretcher should be securely fastened to the mounted bracket prior to moving of the ambulance• NO patient will be transported in the cab of the ambulance. If there are more patients than stretchers,

additional resources should be requested. The only exception to this would be in the event of a MCI.• Provide appropriate emotional support to patients and any family member that may accompany patient

Policy 6.2 Subject: Types of Services (Calls Accepted)• Any request for non-emergency services will be accepted and dispatched by the dispatcher on duty, or

by means of after-hours dispatching policies• Any request for mutual aid from an emergency or non-emergency service will be handled by the

dispatcher/supervisor on duty at the time of request. Any request will be granted, assuming resources are available to assist.

• Mutual aid agreements from other services (both emergent and non-emergent) will be handled by Thorne Ambulance Service administration, and the results of any agreements revealed to all field personnel. (to be added to SOP’s at the time of initiation)

• Any request for specialty transport (I.e.: pediatric) will be accepted assuming available resources and personnel confirmed by supervisor on duty.

• At NO time will patients be taken from facilities by employees without a dispatcher giving prior approval (this policy is to discourage inappropriate means of obtaining call volume from other non-emergency services)

• Wheelchair or ambulatory transportation requests must be made through the South Carolina Broker System.



Policy 6.3Subject: Response to Dispatched CallsWhile Thorne Ambulance Service does not provide emergency response services (primarily), it remains of the utmost importance that all calls are handled in a timely manner. Listed below are the standard guidelines in regard to non-emergency responses. These are the goals of the organization, and it is known that these goals will not always be met, however; it is the employee’s responsibility to respond as closely within the posted guidelines as possible.

Though not posted in this section, employees are required to observe state laws in regard to traffic laws. If the employee is unable to locate these laws, copies will be furnished prior to operating any Thorne Ambulance Service unit by administration. This section will also be covered during the employees initial orientation phase.

Definitions within this section:Code 1/Non-Priority - Normal traffic, abiding by ALL traffic lawsCode 3/Priority - Emergent traffic abiding by Thorne Ambulance Service policy, while utilizing LIGHTS AND SIRENS - observing South Carolina traffic laws regarding emergency vehicle response.I. Non-Emergency Response Guidelines• Upon obtaining a call from dispatch (assuming the unit is clear of other calls, and that the call is for

immediate pick up), the responsible unit is required to be en route to the call no later than 5 minutes after receiving the request.

• While responding to calls, vehicle operators will abide by all traffic laws and by the policies set forth by Thorne Ambulance Service.

• It is the goal of Thorne Ambulance Service to be “on scene” 10 to 15 minutes prior to scheduled pick up times.

• Anyone on board of the ambulance is required to wear the proper restraints for their safety (I.e.: seatbelts, stretcher straps, etc.). At no time are these securing devices to be disengaged.

• Each employee will make a good-faith effort to be on scene 10 to 15 minutes prior to the scheduled pick-up time at all calls. Excessive call volume may prevent this from occurring each time, but all efforts to be on time will be made.

II. Emergency Response GuidelinesIn the event of obtaining a call from a 911 or other emergency call source, the following is expected of all Thorne Ambulance Service personnel:• Personnel will be within the emergency vehicle, properly restrained, and en route to the call within 1.5

minutes of receiving the call for service.• All traffic laws will be abided by the operator of the unit while en route/transporting• At no time should the unit operator exceed the posted speed limit by 10 MPH• At no time will the vehicle operator exceed 70 MPH (regardless of posted speed limit) - Any MPH

over this maximum greatly jeopardizes the safety of the patient, the primary attendant, and any personnel in the front of the ambulance cab.

• All personnel shall show due regard to the public while engaging in emergency operations***YOU CAN’T HELP SOMEONE IF YOU ARE INJURED YOURSELF***

Employee License Retention:All Thorne Ambulance Service employees are required to possess and maintain a valid driver’s license. Any employee that has the potential to lose their license MUST notify the supervisor on duty within 24 hours of occurrence. If the matter is pending prior to a trial or any other circumstance, the employee in question will be suspended from driving privileges pending the resolution of the incident. If the offense is serious enough, employees have the potential to be placed on a leave of absence until the incident is resolved.

If the employee in question is solely an Ambulance Operator, then this employee will be offered any light-duty jobs (if any are available at the time of incident), until the incident is resolved. Employees who are operators and patient care attendants, will be mandated to work as a patient care attendant only until all matters are resolved.Driving Record:Employees are required to furnish a driving record prior to commencing employment with Thorne Ambulance Service, and at the hire date each year thereafter. Any incidents resulting in the accumulation



of points on the employee’s record should be reported at the time of the incident - This information should not be discovered at the time of annual driving record review. Disciplinary action could result from any deviation from this or other driving policies.Required Driver Training:Employees that are eligible to operate Thorne Ambulance Service units will be required to complete driver training within 6 months of employment, and annually thereafter. The required courses will be completed online, in the class room, and through practical applications where necessary. Any operator that fails to complete operational requirements will be suspended from ambulance operations.DOT Physical:Employees who work or plan to work on a Thorne Ambulance Service ambulatory or wheelchair van, must pass and retain a DOT physical.

Policy 6.4Subject: Patient Right of RefusalAny patient who is alert and oriented to person, place, time, and event has the right to refuse transport. This applies not only in the emergency setting, but for pre-scheduled transports as well. Any patient who is taken against their will, who is alert and oriented, may seek legal action against Thorne Ambulance Service and the employees involved. It is important that, prior to obtaining a refusal, the patient be made aware of the possible outcomes/complications associated with refusing care/transport (I.e.: if you skip dialysis continuously, life as you know it cannot continue).

The refusal is one of the most important forms of documentation that will ever be completed by pre-hospital personnel. That is why it is of the utmost importance to provide the most detailed documentation possible when allowing a patient to refuse transport. If the call is an emergency call and no patient information is given, assessments (including vital signs) and a narrative should still be included.

If the patient is deemed incompetent to make sound judgment in regard to treatment/transportation, a supervisor should be contacted for further guidance.

Policy 6.5Subject: First-In EquipmentUpon arrival to all TAS calls for service, the crew shall bring in the Oxygen bag and first-in BLS bag. These bags shall be secured to the gurney at all times for to allow for quick access to BLS equipment. It is expected that all TAS employees react to emergency situations within their scope of practice. This policy enables crews to respond immediately, not delaying patient care. Deviation from this policy shall result in disciplinary action for BOTH crew members.

Policy 6.6Subject: Forced EntrySince the primary function of Thorne Ambulance Service is non-emergency transportation, forced entry into a residence should not be a common occurrence. There are a few incidents in which forced entry can be observed as a possible option.

These situations include, but are not limited to, the following:- In the event that the patient/person can be visibly seen within the residence, and appears unresponsive,

entry should be immediately gained to the residence with the attempt of resuscitating the patient.- In the event that the patient cannot be seen, but heard - permission should be requested prior to gaining

entry into the residence.- Any other situation that may call for forced entry into a residence shall be deemed appropriate through

the supervisor on duty.

- When gaining entry to a residence, be sure to inflict the least amount of damage to the residence as possible. After patient care has been performed, and deemed appropriate, a supervisor should be contacted and arrangements made to take photographs of any damage to patient property. Aside from contacting a supervisor, the following should also be done:

1. Explain to the family/bystanders the reason that forced entry was made, and the type of damage done to the property.

2. A report should be completed by the employees involved (and signed), with a



detailed account of the incident.3. The supervisor on duty is to establish a detailed statement of the events in addition to

the one created by the crew involved.

Policy 6.7Subject: When to Stop ResuscitationLast Modified: October 20th, 2009In the event that a patient requires resuscitation by Thorne Ambulance Service personnel, the following guidelines should be followed in regards to the cessation of life saving measures.

If resuscitation has been initiated and effective CPR is being performed on a patient who appears to have injuries incompatible with life, lividity, or rigor, a physician should be contacted while CPR is continued until an order is received to stop resuscitation. This is also the case if ANY advanced procedure has been initiated. Two consecutive EKG strips of Asystole are required prior to contacting physician for orders to terminate efforts. If BLS unit, ALS should be contacted, and the arriving ALS unit shall make this determination.

In the event that CPR has not been initiated on a patient due to injury incompatible with life, lividity, or rigor, then the patient’s family doctor should be contacted. If contacted, a brief synopsis of the event should be presented to the family physician and a request to sign as the pronouncing doctor should be obtained. In the event that the death appears suspicious OR the family doctor refuses to sign as the pronouncing physician, the county coroner should be called.

Any patient who does not have any advanced directives (I.e.: DNR) who is in any rhythm other than asystole must be resuscitated. If there is any doubt by the responding crew, resuscitation SHOULD BE INITIATED. See protocols for further direction.

Policy 6.8Subject: Unattended Death (DOA)A: Discovery

- Upon discovery of an unresponsive patient, an EMT shall immediately check for pulse and respirations. If vital signs are present, follow appropriate protocol according to standing orders. If no vital signs are present, request paramedic for EKG confirmation. The response urgency shall depend on the nature of the on scene unit’s request. If CPR is initiated, the paramedic shall respond emergent. If CPR is not indicated due to obvious signs of death, the paramedic shall respond nonemergent.

- If unsure of down time, begin CPR immediately. Continue CPR according to current protocol until Paramedic assistance arrives and gives further direction. Refer to TAS policy for withholding CPR.

- If obvious signs of death, or injuries incompatible with life, contact TAS dispatch.- TAS administration will be dispatched to represent TAS on scene.

B: Documentation- A paramedic will attach a minimum of three EKG limb leads to the patient and record three

different leads of asystole to confirm death.- The first unit on scene should fill out an Unattended Death report for the arriving deputy coroner

to include: Name, Date of Birth, Social Security Number, Time of Discovery, Known medical history, Next of Kin contact information, and certifying physician (if known).

- All attempts will be made by unit on scene to contact patients physician to certify death certificate. Should the attempts become a time constraint, the transport unit will clear the scene and the Administrator will continue attempts on scene.

- A run report should be generated in MICS documenting the details of the call.

C: Notification- TAS dispatch will be responsible for the notification of Next of Kin of the deceased.



- If time allows, TAS will transport deceased to GMH morgue. If no time, have dispatch contact Biocare for transport.

- TAS administration will follow up with family to offer condolences.- If patient is a common customer with TAS, at least one party of TAS administrative staff will

attend wake and/or funeral.D: Grief Counseling

- It is expected that on occasion, a field employee may discover a familiar patient who has passed away. Due to the rapport field employees build with some patients, there is a natural sense of loss and sadness. Therefore, TAS will offer grief counseling to employees involved in the discovery of a deceased patient, if requested.

Policy 6.9Subject: Hospital Transport ChoicesAny patient who presents to Thorne Ambulance personnel with a complaint will be offered transport to a hospital Emergency Room. In most cases, the patient’s hospital choice will be honored. However, it is the responsibility of the patient care attendant to determine the most appropriate destination. If the facility deemed appropriate for the patient’s complaint is other than that of the patient’s choosing, it is the obligation of the primary attendant to insist that the patient be seen at the appropriate facility. In the event that the patient refuses to be seen at the appropriate facility, contact the supervisor on duty for guidance.

• Any patient that falls under the category of “Major Trauma” should be transported to one of the following (closest facility of those listed is deemed appropriate):

• 1. Spartanburg Regional Medical Center• 2. Greenville Memorial Hospital• *These facilities are the Level I trauma centers within Thorne Ambulance’s primary service area*• In the event that the crew does not feel either of these facilities is within a reasonable distance,

helicopter transportation or transportation to the nearest most appropriate facility should commence.• All critical patients will be transported to the nearest, most appropriate facility that is equipped to

stabilize the patient. In the event of cardiac arrest - the closest hospital of any rating is deemed appropriate.

• STEMI and CVA patient’s that meet the requirements listed in protocols should be transported to the closest facility that can manage these types of patients.

Policy 6.10Subject: Hospital Reporting/Telecommunication OperationsAll units will be supplied with a cellular phone, as to do away with the need for personnel to utilize personal equipment while on duty. These cellular devices are to be used for business operations ONLY. In the event that a hospital report is required (I.e.: anytime a patient is transported to an ER), personnel should utilize this cellular device to call the appropriate receiving facility.

Policy 6.11Subject: Inter-agency Patient TransfersLast Modified: October 20th, 2009Any patient that is moved, whether from a medical facility or other ambulance service, will need to be transferred safely and in a proper manner. When this is done appropriately and according to policy, each agency is given legal protection against any potential abandonment charges. This policy will also allow for appropriate documentation to capture the flow of patient movement.

Employees should make themselves aware of the following:A.) Signing a receipt form does not state that you personally agree with any treatments given/initiated prior to your receiving of the patient.B.) If any other pre-hospital provider refuses to sign for the receipt of the patient, the current patient attendant (a Thorne Ambulance Service employee) is required to remain with the patient for the remainder of transport). In this event, the supervisor on duty should be contacted for further guidance.C.) If no treatments have been initiated and the patient is never placed onto a Thorne Ambulance stretcher, then documentation will not be required for transfer of patient to another service.D.) In the event that the transfer is of a critical patient, receiving signatures may be delayed until after the call has been completed, and the patient has been transferred to the appropriate medical facility’s care.



E.) The above procedure is null and void when transferring a patient between two Thorne Ambulance Service units.

• Be sure to obtain electronic signatures and complete the patient information section on the computer. Let the receiving agency know that a copy of the run report can be faxed to them at a later time.

• Be advised that this is not a policy of Thorne Ambulance Service alone, but is derived from the SC DHEC statewide policy.

Policy 6.12 Subject: Multi-Patient Incidents & Hazardous Materials IncidentsIn the event of a multi-patient incident, or Mass Casualty Incident (MCI), the first responding and highest level medical professional will assume medical command. All units responding, upon arriving on scene, will be under the authority of the medical commander. Upon the arrival of a Thorne Ambulance Supervisor (or other EMS supervisor), medical command will be transferred to that person. The scene commander is still required to participate in patient care activities if the scene is deemed safe.

In an effort to remain organized, the medical commander should make an attempt to keep all ambulance units together on scene - preferably in a staging area.

Notify the Thorne Ambulance dispatcher of the need for more resources and estimated number of patients. At the time an MCI is declared, ALL other non-emergency radio traffic will be suspended until the resolution of the MCI. In this event, all non-emergent traffic (I.e.: clear times) are the responsibility of the crews.

Note any hazards or potential hazards on the scene, and advise dispatch of the need for additional resources

Begin to triage appropriately when the scene is deemed safe

Dispatch will be responsible for alerting other agencies and area hospitals of the MCI as soon as the information is relayed by the medical commander on scene

The above policy is the same for any Hazardous Materials Incident, and the appropriate HAZMAT team will be activated by dispatch

Utilize training from National Incident Management System (NIMS) courses for further direction and reference.

Policy 6.13Subject: Elderly/Child AbuseANY TIME an employee feels that an elder or child is being abused OR the patient directly indicates abuse, it is the responsibility of the employee to notify the supervisor on duty AND the receiving health facility (if applicable)

It is then the responsibility of the employee and supervisor to contact the SC Department of Social Services (SC DSS) between 0800-1700 Monday-Friday at (864) 596-3001 OR (864) 585-1445. In the event that law enforcement is on scene, notify them of the suspected abuse/neglect and document that you have done so (be sure to include the officers name).

For immediate or potentially life-threatening situations, contact law enforcement through dispatch. Remain on scene if deemed safe OR move to a safe location until law enforcement secures the scene.

Policy 6.14Subject: Patient BelongingsIt is preferred that employees refrain from transporting patient belongings. In the event that a patient refuses to leave an item at home, be sure to fully document all items that are transported, and note what was done with the belongings at the time of patient care transfer. At no times will weapons be allowed to be carried on/by a patient OR transported by Thorne Ambulance Service staff. If there are any problems that



arise, law enforcement and a supervisor should be contacted.

Patient medications should be left at residence unless directed otherwise by the sending/receiving facility. The same policy applies to any x-rays, MRI/CT discs, etc. Be sure to make a list of all medications prior to leaving the residence to avoid having to transport medications. In the event that a patient is being taken to an Emergency Room, the dosage of the prescribed medications should be noted. At no other time will it be required that dosages be noted other than emergency-type calls.

Policy 6.15Subject: Cancelled Call ProcedureNon-Emergent Cancellation - Cancellation of a non-emergency call will be recorded by the dispatcher, and will generally require no further documentation by crews. Dispatchers who handle cancelled calls will fill in a “cancelled call” sheet or make adjustments to the call log. In the event of a broker cancellation, the dispatcher is to contact the Medicaid broker and advise them of the cancellation PRIOR to the on scene crew departing.

Emergency/Mutual Aid Cancellation - any time a call for emergency services is made to Thorne Ambulance (code 2 or 3), documentation of the event must occur with all applicable/provided information. If a Thorne Ambulance Service unit arrives on scene and there is no patient, this documentation will need to be completed as a false call. Run numbers will be provided on these call types.

Policy 6.16Subject: Thorne Ambulance Service Flight PolicyIn the event that Thorne Ambulance Service is providing 911 coverage OR mutual aid to a 911 agency, the following flight policy will be initiated.

When considering air transportation, consider the following guidelines:• Is the patient greater than 20 minutes from the appropriate medical facility?• Can immediate transport be initiated, or does wait time designate the need for air transportation?• Are there adequate personnel to handle patient care needs, or is the helicopter faster/more qualified?• Will transportation to an ER lead to admission?• Is the scene inaccessible by ground?• Is this an MCI - and are more resources required?

Communication:All communication will be relayed by the personnel on scene to the dispatcher (including brief patient report if available), who will then alert the appropriate aero medical service. At this time, the local fire department will be contacted to set up an appropriate Landing Zone (LZ) for the helicopter. Law enforcement will be contacted if road closures are required.

*At any time aero medical transport may be cancelled**Patient care will be provided to the best of the ground personnel’s ability until helicopter arrives**Documentation is required on ALL calls*

Policy 6.17Subject: Checking Medications and FluidsIt is the responsibility of the highest level provider on each unit to ensure all fluids and medications are within date, and to remove those that have expired. This is to be done at the first of the month.Medications/fluids should be confirmed/verified at the time they are selected from their appropriate cabinet, when the medication/fluid is being prepared for administration, and prior to the actual administration of the fluid/medication. It is important that we recall and confirm the 6 “rights” of the patient prior to considering any administration. A reminder of these six “rights” follows:1. Right Patient2. Right Dose3. Right Route4. Right Medication



5. Right Time6. Right Documentation

***It is the responsibility of the certified personnel to assure all of the above PRIOR to administration. This person is ultimately responsible for any fluid/medication that is administered***

***ONCE IT IS ADMINISTERED TO THE PATIENT, YOU CAN NOT GET IT BACK***

Policy 6.18Subject: Inter-facility Drug Administration FormAny time a drug/fluid (other than normal saline, lactated ringers, D5W, or any medication currently carried by TAS) is transported with a patient between facilities, an inter-facility drug sheet must be accurately documented, prior to the transport of the patient. If the sending facility is unable to produce such documentation OR refuses to complete the required documentation, the facility must discontinue administration of the drug(s)/fluid(s) in question prior to the patient being transferred onto a Thorne Ambulance Service stretcher. Failure to comply will not only lead to internal disciplinary action, but may lead to disciplinary action by SC DHEC and the National Registry of EMTs.

Policy 6.19Subject: Documentation

· Documentation will be completed by the appropriate employee for each call in which documentation is required (see policy 112). Documentation will be completed to the best of each employee’s ability with factual information gathered from sending facility documents, or from the patient themselves. Crew opinions or assumptions regarding patient care are discouraged, as these are not appropriate for patient care documentation and should have been taught during the employees initial EMT training.

· All patients encountered require a vital sign entry to include: Blood Pressure, Pulse, and Respiratory Rate

· Each call shall be documented factually and as accurately as possible by the patient care attendant. In the event that there is an error in patient care, this too should be documented fully and followed up with a supervisor.

· Any patient document that is not attached to the final Patient Care Report, or is not filed in a secure file, is to be placed into the shred box, as to not accidentally release any private patient information.

· Any application of the cardiac monitor to a patient by a PARAMEDIC must include a rhythm strip with appropriate diagnosis and any pertinent treatments. These strips could potentially be utilized in the future for legal purposes and as part of the QA/QI process.

· ANY patient who is intubated in the field should have a minimum of two (2) documented confirmations. Any patient that is transported to the Emergency Department will be furnished a copy of the run report within 12 hours of the incident upon request. This task will be accomplished through the timely completion of documentation by the crew, and the timely drop off of the report by the supervisor on duty.

· See protocols for further guidance/policies

Policy 6.20Subject: PassengersAny person riding in the ambulance as a third-person (family, student, etc.), MUST sign a release form prior to riding within any Thorne Ambulance vehicle.

Policy 6.21Subject: Billing ChargesA billing charge will be generated for any patient who receives any form of treatment or transport by Thorne Ambulance Service.Non-Emergency - Basic Life Support (BLS) - Billing:• Any call that is determined to be of a pre-scheduled nature, not having been derived from a 911 or

emergent source, will fall under the category of Non-Emergency.• Basic Transportation: No interventions (outside of Oxygen), requiring vital sign assessment and



monitoring of patient condition• Examples: Dialysis transportation, inter-facility transportationNon-Emergency - Advanced Life Support (ALS) - Billing• Any call that is determined to be of a pre-scheduled nature, not having been derived from a 911 or

emergent source, will fall under the category of Non-Emergency.• ALS Transportation: Any transport requiring ANY of the following:• a.) Cardiac Monitoring• b.) IV Supplies• c.) Drugs (2 or less IV drugs) - NOT Oxygen, NTG, or ASA• d.) BGL assessment (even if performed by an EMT or EMT-I)• Examples: Inter-facility transport requiring one of the above interventionsEmergency - Basic Life Support (BLS) - Billing:• Any call that has been derived from a 911 or other emergency source, requiring immediate response to

a potential medical/trauma incident. This may include no lights and sirens response.• BLS Emergency Transport - when immediate assessment of vital signs and patient condition required,

to include Oxygen administration and any other protocol-approved intervention for the BLS attendantEmergency - Advanced Life Support (ALS) I - Billing• Any call that has been derived from a 911 or other emergency source, requiring immediate response to

a potential medical/trauma incident.• ALS I Emergency Transport - When immediate assessment of vital signs and patient condition

required, to include one or more of the following:• a.) Cardiac Monitoring (to include 12-lead EKG)• b.) IV initiation OR maintenance• c.) Drugs (2 or less IV drugs)• d.) BGL assessment• Examples: Any incident that requires activation of approved protocols, and includes one or more of

the above interventions.Emergency - Advanced Life Support (ALS) II - Billing• Any call that has been derived from a 911 or other emergency source, requiring immediate response to

a potential medical/trauma patient.• ALS II Emergency Transport - When immediate assessment of vital signs and patient condition

required, to include one or more of the following:• a.) Any patient that is intubated OR that is transported with an advanced airway • b.) The administration of 3 or more IV medications (to include 3 doses of the same

medication)• c.) Manual defibrillation, cardioversion, or cardiac pacing• d.) Chest decompression• e.) Intraosseous line placement or maintenanceTreat/No Transport - Billing• In the event that a patient is NOT transported, but one of the following is provided - a Treat/No

Transport charge will be applied:• a.) BGL assessment• b.) On-scene treatment of the hypoglycemic patient (refer to protocol)• c.) Any bandaging that is performed• d.) Vital Sign assessment request• Obviously, no transport mileage should be generated for a Treat/No Transport charge.No Transport - Billing• If a call is received from a 911 or other emergency source (and was not called in from a third-party

caller), a No Transport charge will be applied.• In the event that no transport is initiated from a pre-scheduled or other inter-facility type of response,

the billing section of the call documentation is to be left clear of any charges. Further on this policy can be found below.

No Charge - Billing• In the event that a 911 or other emergency source is utilized to dispatch a Thorne Ambulance Service

unit to an MVC (motor vehicle collision), where no patients are transported (even if vitals assessed), a “No Transport/Non-billed” option will be applied as a part of the documentation.

• No charges will be generated for cancelled calls from a pre-scheduled or other type of inter-facility response.



• No charges will be applied to any call that fall under the “assist a citizen” category. These services are provided as a courtesy to the surrounding communities.

Broker Calls:Any time that a Thorne Ambulance Service crew transports a patient under the MTM contract, it shall be documented as a “transport/non-bill”, contract 1 event. Please consult dispatch regarding call classifications prior to completing the billing section of the PCR if you have any questions.Signatures:• A “Responsible Party” signature must be obtained for every call where patient contact has been

initiated - regardless of the outcome (transport, no transport, etc.). These signatures, if unable to be signed by patient, must be signed by a responsible party, and documentation as to why a signature could not be obtained should be supplied. In the event that the patient is unable to sign, someone MUST sign as the responsible party and/or receiving signature. No patient incapable of signing is to be left unattended at a residence or otherwise. This is clearly a situation of abandonment and/or inappropriate transfer of care.

• Any signature that is not of your own (or a member of your crew), MUST be witnessed to ensure accurate documentation procedures are being followed.

Policy 6.22Subject: Regional Medical Assistance Team (R.M.A.T.) ParticipationThe Regional Medical Assistance Team (R.M.A.T.) - Piedmont Region, have extended an opportunity for Thorne Ambulance Service EMTs (B, I, or P) to participate in drills and regional deployment (where applicable). The purpose of R.M.A.T. is to respond to catastrophic incidents (natural or man-made) within the Piedmont Regions, or beyond (when requested), in order to provide immediate aide and relief to those involved. The initial evacuation, triage, and treatment of victims involved in such disasters will be the responsibility of the R.M.A.T. It is possible for the Piedmont Region to be called upon to assist in areas outside of the standard call area.

R.M.A.T. training is typically held on Thursday mornings at 0900 at Spartanburg EMS Headquarters, located at 525 Union St., Spartanburg, SC. Activities typically include familiarization with the establishing of treatment centers and living quarters, use of ATVs for appropriate and safe evacuation/movement of patients, among others.

In order to be eligible to apply to this elite team, a Thorne Ambulance Employee must:• Be an EMT-B, I, or P with a valid CPR card• Be physically and emotionally fit to handle the responsibilities of trainings and deployments• NIMS 100, 200, 700, & 800• Be in good standing with TAS - No Written Counsels (WC) within the previous 6 months• Prefer: HAZMAT, Incident Command System (ICS), Disaster, Rescue, etc. course completion• Obtain a letter of recommendation from a supervisor

Once a candidate meets the above requirements, they will be supplied an official application for team membership. It is to be understood that this is a volunteer activity at the present time, and team eligibility is ultimately at the discretion of Rodney McAbee, Logistics Coordinator of Spartanburg EMS. In the event of a deployment, Thorne Ambulance Service will allow an employee time off to accommodate deployment schedule.

Policy 6.23Subject: Quality Assurance/Quality Improvement & Skills Competencies Urgent and Non-urgent requests for service will often be reviewed by the QA/QI officer to ensure compliance with TAS policies and standing orders. This is a way to improve overall patient care, commend attendants for exceptional patient care, identify problem areas, and to establish grounds for policy and protocol changes. After the QA/QI of a patient care report, it may be required that the employee be ordered to complete skills remediation. National Registry skills check-off sheets will be utilized (where applicable) for this function. These skills are to be observed by the Training Sergeant (when available), Shift Sergeant, or Director. The completed/corrected skills check sheet will be placed in the employees training file. In the event that the skill is not corrected/performed in future indicated circumstances, disciplinary action may be in order.



Skills competencies will be required of all personnel who work more than fifteen (15) hours (on average) per month. Those who do not work at least fifteen (15) hours a month must be employed at a high-volume 911 EMS service in order to be deemed “not applicable”. Every month the “skill(s) of the month” will be posted on the shift calendar. This will allow employees the opportunity to familiarize themselves with the requirements of the station. Anytime during the month, an employee is to complete this skill in the presence of the Training Sergeant. In the event the Training Sergeant is not available, the Shift Sergeant or Director may be consulted to observe the employee. Documentation will be kept in the employee’s training file. If an employee fails to perform, or is unable to successfully perform the skill of the month by the last day of the assigned month, the employee will be ineligible to work any shift in the following month until the skill is performed. This is another measure of Quality Assurance, and is not to be viewed as punishment.



Section 7: Wheelchair OperationsInitial: January 2011

Policy 7.1Subject: Job Functions• Unit Operator: • All drivers are required to be 21 years of age or older. • Two points from traffic violations OR two points from traffic accidents within last three years

maximum. A combination of no more than 3 points will be allowed.• Driving records will be required for review annually (any point accumulation is cause for possible

suspension and/or removal of driving privileges)• Any Thorne Ambulance driver must have a valid S.C. license• All drivers are required to obtain CPR credentials during their first 6 months of employment.• It is recommended that all drivers complete the Medical First Responder course within 1 year of

employment (this does not allow drivers to administer care to patients in the patient compartment. This certification is strictly designed to give the drivers a basic medical knowledge)

• Once CPR and First Responder credentials obtained - employee is responsible for maintaining this certification AND must have both credentials on their person while on duty

• All employees must have a High School Diploma or GED- Each operator must maintain a current DOT physical examination card. - Operators must obtain a CDL license with passenger endorsement for operating a vehicle with twelve

passengers or more. - Driver must be able to safely lift an average size patient with the assistance of their assigned partner.

Currently, TAS requires that each employee be able to lift 150lbs independently or 300lbs with a partner. Patient lifting techniques are covered during orientation for employees with less than 6 months of documented EMS experience, and a physical test will be required to demonstrate proficiency with patient lifting/moving equipment.

Policy 7.2Subject: Documentation• Unit Operator shall utilize a driver manifest to document all customers transported by paratransit

vehicle. This will document the name of the customer, date of transport, times of transport, and mileage of transport.

• Each customer must sign the manifest for EACH trip.• A checkout sheet must be complete each day. This will log equipment, equipment failures, and

maintenance mileage.

Policy 7.3Subject: Operations• Training- The Training Sergeant is responsible for the education, and remediation of all unit operators. - The Training Sergeant must be familiar with all aspects of operating a wheelchair unit including

restraint systems, equipment requirements, certification requirements, and documentation requirements.

- All employees will be trained to operate a wheelchair unit during initial orientation.• Clientele- Ambulatory customers must be secured in standard passenger seating with seatbelts secured.- Wheelchair-bound customers must be restrained via the wheelchair restraint system. The wheelchair

must be restrained utilizing four anchor points. The customer must be restrained to the wheelchair using the seatbelt system with shoulder strap installed on the unit. In the event a unit does not have a seatbelt system in place, the patient must be restrained utilizing a nine foot strap.

- All customers are expected to be respectful of TAS employees and vehicles. Should an incident occur, which causes harm, or the potential for harm to TAS resources, the customer will receive a warning of conduct. Should the same customer require a second warning, the customer will no longer be allowed to employ TAS for transportation.

- Customers are expected to be ready for pick up at the time requested. Due to time requirements, operators will wait only five minutes past scheduled pick up time before having to leave. Should this



occur, the customer is responsible for contacting the Medicaid Broker to reschedule transportation. TAS dispatch will contact the customer to advise them of the attempted pick up.



Section 8: Dispatch OperationsInitial: January 2011

Policy 8.1Subject: Job FunctionsDispatcher:• Dispatcher must be 18 years of age or older• Must possess High School Diploma or GED• Prior EMS/Dispatching experience preferred, however; not required• Will be responsible for answering calls and then distributing assignments to the appropriate crews• Must possess/have the ability to obtain CPR credential at the time of hire or within 6 months of hire

(will be offered in-house)• Responsible for daily office tasks as assigned by Office Supervisor• Optional: Employee may request to be trained at the level of Medical First Responder or higher

Policy 8.2Subject: System Status• Dispatchers are responsible for proper system status management They are responsible for unit

placement through utilization of GPS software where applicable (training provided)• After completion of a call, employees are to inform dispatch of their status, and await additional

assignments/postings. • Further dispatching procedures may be referenced in Administrative Policy XXI.

Section 9: SafetyInitial: January 2010

Policy 9.1



Subject: Employee Safety ProgramPurpose: To establish a policy to enhance the safety standards of Thorne Ambulance Service, while minimizing the potential for injury/accident occurrence. This will be done in three sections:I. Vehicle Accident ReportingII. Personnel Injury ReportingIII. Safety Management & Implementation

I. Vehicle Accident ReportingPurpose: To provide a standardized reporting system for all accidents and/or incidents involving Thorne Ambulance Service, LLC owned and/or operated vehicles. All employees are required to comply with this policy.

Policy Outline:A) Employees involved will immediately contact dispatch, advising of accident location, injuries, and

additional resources needed.B) Dispatch will notify Officer In Charge (OIC) & dispatch additional resources as necessaryC) At scene, employees must:D) 1. Assess safety of crew members and on-board patients firstE) 2. Initiate appropriate care to victimsF) 3. Avoid talking to anyone not involved in the accident except law enforcement, fire, and EMSG) 4. Obtain names and phone numbers of applicable witnessesH) 5. Remain on scene until cleared by law enforcement and the OIC.I) 6. Take a drug screen when feasibleJ) After the incident, employee(s) must completely document the events of the incident on the Accident

Report FormK) 1. MTM form (if incident involved MTM transport)L) 2. TAS form (all accident types)

II. Personnel Injury ReportingIII.Purpose: To provide a standardized system of reporting all injuries involving employees of Thorne

Ambulance Service.

Policy Outline:A) Advise OIC of injuries immediately after incidentB) If the injury sustained is life-threatening, TAS Standing Orders will be utilized to treat the injured

employee. Once transport is initiated, it is imperative that the injured employee be transported to the closest, most appropriate facility.

C) If the injuries sustained are not life-threatening, the involved employee must report the matter to an urgent care center, at which time, the employee(s) involved may be subject to a drug screen.

D) The employee(s) involved must fill out a “Personal Injury Report” or “Incident Report”, whichever is applicable given the circumstances.

III. Safety ManagementIV. Purpose: To establish a program to reduce and/or eliminate work place incidents involving Thorne

Ambulance Service employees.

A) Safety Strategy:1. Maintain a workplace that is mentally and physically fit for the work duties assigned and/or anticipated2. Provide high quality equipment and personal protective equipment (PPE), along with training to ensure

correct operability3. Conduct regular safety inspections of worksites and equipment. This may also include inspections of

employee uniforms and work techniques.4. Keep all department members up to date on safety programs and any potential issues within the

program.5. Ensure effective treatment and rehabilitation programs/services to employees who meet the needed

criteria.6. Collect and analyze accident, injury, and exposure information as soon as possible.



7. Formulate specific action plans to improve overall safety of patients, employees, and bystanders.

It is the goal of Thorne Ambulance Service to maintain the safety of all employees at all times. We will do everything within our power to ensure the prevention of injury. In the event that an injury does occur, Thorne Ambulance Service will assist the employee in receiving appropriate and timely care.

Frequent additions and revisions to this manual should be expected. Any time a policy is changed, all employees will be provided a copy of the revision or new policy via email, handout, or can find it posted on the bulletin board. I want to personally thank you for taking the time to review these policies. Understanding and following the above policies are sure to create a fair and professional work environment. The above policies and procedures are intended to protect the employees and patients of Thorne Ambulance Service.

Sincerely,

Ryan D. Thorne, NREMT-PDirector & Chief Operating OfficerThorne Ambulance Service



Documents

SOP2011word - Thorne Ambulance Service · the policies and procedures within this manual outline the general principles that are to be followed by thorne ambulance service employees