Cataldo Ambulance Service, Inc. Policy and Procedures Manual

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1 Cataldo Ambulance Service, Inc. Policy and Procedures Manual Revised September 1, 2008

2 FORWARD The following policies and procedures are not intended to be an inclusive record of all company policies, procedures, rules and regulations: others may be implemented at various times and in various forms, at the company s sole discretion. Cataldo Ambulance Service, Inc. is an at-will employer. These policies and procedures should not be considered or construed as a contract or promise of employment, and do not give rise to contractual rights and/or obligations. Neither the employee nor company is obligated to continue their relationship if either party does not wish to do so for any reason, with or without notice. Company operations, business needs, government regulations and environments are continually changing. Therefore, the company reserves the right to alter, amend or discontinue a policy or procedure without advance notice as appropriate in conducting its business. To the extent that any policies or procedures are superseded by applicable law, it is the intent of the company to comply with the Law. Cataldo Ambulance Service, Inc. generally will inform employees of any changes in policies and procedures as soon as possible. Any violation of or failure to comply with these and other company policies will subject the employee to disciplinary action, up to and including dismissal.

3 Cataldo Ambulance Service, Inc Clinical and Educational Services Policy and Procedures Manual Table of Contents Policy CS 100 CS 101 CS 102 CS 103 CS 104 CS 105 CS 106 CS 107 CS 108 CS 109 CS 110 CS 111 CS 112 CS 113 CS 114 CS 115 CS 116 CS 117 CS 118 CS 119 CS 120 CS 121 CS 122 CS 123 CS 124 CS 125 CS 126 CS 127 CS 128 CS 129 CS 130 CS 131 CS 132 CS 133 CS 134 CS 135 CS 136 Subject Hospital Entry Notifications Patient Care Documentation Patient Refusal and Examine / Treat & Release BLS Request for ALS Response Cardiac Monitors Protecting Patients from the Elements Schedule II-IV Medication Accounting and Security Zoll Battery Maintenance Patient Confidentiality/Protected Health Information (HIPAA) Comfort Care/DNR Order Verification Forms Medication Exchanges Medical Control Training Plans Malfunctioning or Failed Patient Care Equipment Statewide Emergency Medical Services Pre-Hospital Treatment Protocols Clinical Practitioner Senior/Junior Policy ALS Inter-Facility Transfers Clinical Investigations ALS to BLS Triage ALS Operations at Special Events/Standbys Hospital Diversions 3 rd Rider Program Transportation of Chair Car Patients / Customers Scene Management of Sudden Deaths Sexual Assault Patients Physio-Control Suction Unit Battery Maintenance Patient Safety Protect-a-caths ALS interventions with Patient Refusal State or Regional Paramedic/Basic Wavier Activating Aero-Medical Response Consent Splitting of Paramedic Crews Transfer of Patient Care Deviation from Protocols MD or RN on Scene Needle/Sharps Safety

4 Policy Subject CS 137 LSP Ventilator-Auto Vent 3000 CS 138 Exposure Control Plan CS 139 Patient Identification CS 140 Attending the Patient CS 141 Patient Point of Entry CS 142 Patient Transportation Screening CS 143 Medication Box Security CS 144 Employee Exposure/Infection Control Medical Records Assess CS 145 Protection from Contaminated Paperwork/Patient Care Reports CS 146 Hazardous Communications Program CS 147 Major Incident Response/Health & Safety Guideline CS 148 Morbidity & Mortality Rounds (M & M s) CS 149 IV Warmer Rotation

5 Cataldo Ambulance Service Inc. Communication Center Policies and Procedures Table of Contents Policy Subject CM 101 AS/ 400 Computer CM 102 Air Ambulance Transports CM 103 Ambulance and Chair Car Rate Schedule CM 104 Chair Car Services CM 105 Municipal Contracts 105 A City of Chelsea 105 B City of Everett 105 C City of Lynn 105 D City of Malden 105 E City of Revere 105 F Town of Saugus 105 G City of Somerville 105 H City of Melrose 105 I City of Peabody CM 106 Clinics & Urgent Care Centers CM 107 Cash on Delivery (COD) Pre-Payment Transports CM 108 Computer Access and Security CM 109 Computer Failures and Troubleshooting CM 110 Customer Service and Interactions CM 111 Incident Support Unit (ISU) CM 112 DPH Hospital Capacity Website CM 113 Hospital Turn Around Time CM 114 Mass Casualty Incidents (MCI s) CM 115 Med Access Program CM 116 Paper Work Processing CM 117 Power or Electric Failure CM 118 Radio Procedures CM 119 Satellite Locations CM 120 Psychiatric Patient Transfer (Section 12 & 303BB) CM 121 Supervisor Responses CM 122 Shift Responsibilities CM 123 Special Trips and Services CM 124 Telephone Procedures CM 125 Vehicle and Fleet Maintenance CM 126 Out of Chute Time CM 127 Paramedic Basic Waiver CM 128 Nursing Care Facilities CM 129 Children s Hospital Boston - Transportation Services CM 130 Communications Security Appendix 1 Emergency ALS & BLS Response Guidelines

6 Policy Subject Appendix 2 Emergency Response by Call Type

7 Cataldo Ambulance Service Inc. Human Resources Policy and Procedures Manual Table of Contents Policy HR 100 HR 101 HR 102 HR 103 HR 104 HR 105 HR 106 HR 107 HR 108 HR HR 109 HR 110 HR 111 HR 112 HR 113 HR 114 HR 115 HR 116 HR 117 HR 118 HR 119 HR 120 HR 121 HR 122 HR 123 HR 124 HR 125 HR 126 HR 127 HR 128 HR 129 HR 130 HR 131 HR 132 HR 133 HR 134 HR 135 Subject Equal Employment Opportunity Harassment Sexual Harassment Employee Records Performance Evaluations Promotions Open Door Policy Compensation & Pay Overtime Allocation of Available Overtime Hours Employment Separation from Employment Standards of Conduct Confidential and Proprietary Information Telecommunications Systems & Equipment Personal Telephone Calls Workplace Security Dress Code Bulletin Boards/Employee Notifications Drug & Alcohol Policy Work Place Safety Company Vehicle Driving Privileges Paid Time-Off (PTO) Taking Time Off Time-Off Requests Holiday Pay Bereavement Pay Tuition Assistance Worker s Compensation Personal Property Family Medical Leave (FMLA) Small Necessities Leave Attendance & Punctuality Employment Status Crew Scheduler / Payroll Processing Shift Assignments and Bidding Violence Prevention

8 Cataldo Ambulance Service, Inc. Operations Division Policy and Procedure Manual Table of Contents Policy OP 100 OP 101 OP 102 OP 103 OP 104 OP 105 OP 106 OP 107 OP 108 OP 109 OP 110 OP 111 OP 112 OP 113 OP 114 OP 115 OP 116 OP 117 OP 118 OP 119 OP 120 OP 121 OP 122 OP 123 OP 124 OP 125 OP 126 OP 127 OP 128 OP 129 OP 130 OP 131 OP 132 OP 133 OP 134 OP 135 OP 136 OP 137 OP 138 Subject Company Vehicle Operations Checklists Cleaning of Quarters Securing of Quarters Smoking in Vehicles and Bases Reporting use of Medications While on Duty Securing Vehicle Keys Removing Equipment from Vehicles Unusual Event Forms/Reports Retrieving Equipment Left on Scene or at a Hospital Equipment Failures Reporting a Vehicle Out of Service Company Vehicles Involved in Motor Vehicle Accident Oxygen Tanks Equipment Requisition Responsibility to Respond, Treat, and Transport Transport of a Dead Body Major Incident Response Guide (Mass Casualty Incidents - MCI) On-Site Accidents/Incidents Crime Scenes Parental Rights to Accompany a Child During Transport Patient Restraint Sanitary Conditions Inspection Authority Staffing of Ambulances Mandated Reporting Child Abuse and Neglect Mandated Reporting Elder Abuse and Neglect Back-up Services and Their Use Stocking of Supplies Hospital/Destination Turn Around Time Patients Transported Under Police Custody Authorized Personnel in Company Bases Uniforms and Personal Appearance Sleeping Key Security & Accountability Use of Cellular Phones Replacing Medical Equipment for Fire Departments Use of Non-Sanctioned products in the Workplace TD BankNorth Garden Event Eligibility

9 CLINICAL and EDUCATIONAL SERVICES Policy #: CS 100 Title: Level: Definitions: Hospital Entry Notifications EMTs and Paramedics To inform all EMS providers of Company, Regional and State Regulations regarding hospital entry notifications. Hospitals will be notified of incoming patients and their medical conditions in a timely and organized manner. Per OEMS Regulations 105 CMR et al, Medical Control contact should be over a recorded line. Entry note: A radio or telephone communication with a hospital emergency department informing the receiving facility of a patient s medical condition and estimated time of arrival. Emergency Response: A request for emergency care and transportation of a sick or ill individual is made via the 911 systems or directly to the dispatch center necessitating a priority response. These are priority 1. Non-Emergency Response: A pre-scheduled transport request for a stable patient that will not require emergent or urgent care on route or upon arrival at the hospital. These are non-priority responses. Procedural Guidelines and Responsibility: I. Entry notification requirements for emergency responses: NOTE: The below refers to Patient Condition as opposed to dispatch response criteria a. Priority 1 Transports: Entry notifications will be made to all hospital for patients transported priority 1 regardless of the dispatch priority. b. Priority 2 Transports: Entry notification will be made to all hospitals (EXCEPT for Mass. General, Children s Hospital in Boston, Beth Israel Deaconess and Brigham and Women s) for priority 2 patients regardless of the dispatch priority c. Priority 3 Transports: Entry notifications will be made to all hospital (EXCEPT for Mass. General, Children s Hospital in Boston, Beth Israel Deaconess and Brigham and Women s) for priority 3 patients II. Entry notification requirements for non-emergency responses:

10 Entry notifications are generally not required for non-emergency prescheduled transports (priority 4) EXCEPT WHEN: The patient s condition has deteriorated en-route necessitating upgrading of the transport priority. Upon arrival at a location for a pre-scheduled transport, the patient s medical condition is determined to require emergent care and transportation. A psychiatric patient has become violent or a psychiatric patient being transported with a section 12 committal in force is a flight risk. III. Contents of an entry notification The contents of an entry notification will vary according to the acuity of the patient, the time available to the EMS provider to make an entry note and the level of certification of the EMS provider. Entry notes should rarely exceed seconds in duration. a. All entry notes shall contain the following elements: Age Sex Chief Complaint(s) Vital Signs, Lung Sounds, SaO2 readings, Blood Glucose readings, and other pertinent physical findings A brief description of treatment provided Estimated time of arrival at the hospital The following additional information shall be included in all entry notes when applicable: If the patient is a minor, whether or not a parent is onboard or has been notified. The patient has a potentially communicable disease that requires hospital staff to take precautions to protect themselves. The patient is originating from the scene of a Hazardous Materials Incident. The patient is chronically ventilator dependent. Hospital Security is needed to contain and control the patient. b. BLS entry notifications of priority 1 patients shall include a short history of the present illness and pertinent past medical history in addition to the standard entry note elements. c. BLS entry notes of priority 2 and 3 patients generally require only the standard information.

11 d. ALS entry notes shall include the standard elements of all entry notes and the following, when applicable: Past Medical History Medications Medication allergies ECG interpretation ALS treatments that have been administered e. Following an entry note, the hospital may have questions regarding the patient s condition. Be prepared to answer them as completely as possible. IV. Radio Entry Note The C-Med radio should be your primary means of entry notifications for priority 1 and 2 transports/patients. All radio traffic is recorded for your protection. Within our operating area we utilize two C-Med systems: a. Northeast C-Med under Region III. This system comprises all the hospitals located north of Boston and includes the cities of Everett, Lynn, Malden, and Saugus. b. Boston C-Med under Region IV. This system comprises all the hospitals in the metro Boston Area and includes the cities of Cambridge, Chelsea, Revere, Somerville, and Winthrop. c. The following is a list of the hospitals that we frequently transport to and their respective C-Med system: Northeast C-Med: Whidden Memorial Hospital - Everett, Northshore Medical Center Lynn & Salem, Lawrence Memorial Hospital Medford, Melrose Wakefield Hospital Melrose, and North Shore Children s Hospital Salem, Beverly Hospital Beverly and Anna Jacques Hospital Newburyport. Boston C-Med: Somerville Hospital Somerville, The Cambridge Hospital Cambridge, Mount Auburn Hospital Cambridge and the following Boston Hospitals; Mass. General Hospital, Children s Hospital, Beth Israel -Deaconess Medical Center Boston Medical Center, and Brigham & Women s Hospital. d. To hail one of the two C-Meds select the proper channel on the radio & state: Northeast or Boston C-Med Cataldo Ambulance 9 Give the C-Med operator at least 15 seconds to answer the radio. If the C-Med operator does not answer repeat this process at least two more times before giving up.

12 d. When un-able to raise C-Med you will contact the dispatcher and inform them that you were unable to contact C-Med and will need to give an entry note through the dispatch center. Keep the entry note brief. Also as soon as practically feasible please complete an Unusual Event Form regarding this situation. V. Telephone Entry Notes. Telephone entry notifications are acceptable as a back up to radio entry notifications for priority 1 and 2 patients or for low acuity (priority 3) patients. REMEMBER: OEMS requires Medical Control and Patient Care notifications to be over a recorded line! Region III prohibits direct telephone entry notifications to hospitals for priority 1 and 2 patients. This restriction does not apply to priority 3 patients. A crew that elects to utilize this method shall contact Northeast CMED at one of the following numbers and request a phone patch: or Region IV does not prohibit direct telephone entry notes; however, few if any hospitals record the entry notes. The information provided via telephone shall be the same information required for radio notifications. Some hospitals require that only a nurse or physician receive an entry notification. Preface your notification with the statement: This is Cataldo Ambulance (unit#) with an ALS or BLS priority 1/2/3 entry notification. The hospital will then ask you to wait while a nurse is summoned or they will simply take the information. (Return to Clinical and Education Table of Contents)

13 CLINICAL and EDUCATIONAL SERVICES Policy #: CS 101 Title: Level: Patient Care Documentation All Field Staff To establish a standard for patient care documentation Employees who are required to document patient care activities and/or patient billing activities will do so in a complete, accurate, and legible fashion using blue or black ink pen only as described in this policy and procedure. Definitions: Contemporaneous Statement means a legal statement signed by one ambulance employee present during the transport to the receiving facility, that, at the time the service was provided, the patient was physically or mentally incapable of signing the PCR and that none of the individuals allowed by Medicare Regulations were available or willing to sign the PCR on behalf of the patient. Med Nec means Medical Necessity Form PCR means Patient Care Report PCS means Physician Certification Statement Associated Policies & Procedures: CS 102 Patient Refusal & Examine/Treat & Release CS 108 Patient Confidentiality / Protected Health Information CS 131 Consent Procedural Guidelines & Responsibility: GENERAL: All documentation should be in black or blue ink and will be legible and any abbreviations will be in accordance with currently accepted medical terminology meaning the abbreviation or term must be published in a legitimate medical dictionary, i.e. Tabors, Mosby s, etc. All PCR s will be filled out completely and accurately including but not limited to all demographic, billing data, and time notations with correlating assessments, treatments, and outcomes. The goal of the narrative section is to Paint a Picture meaning a person who was not involved with the call who reads the narrative should be able to picture in their mind the events, observations, treatments, and outcomes

14 associated with the call, as it is documented on the PCR. This documentation should also be in a chronological order from beginning to end. It MUST be legible! Once the narrative is complete, if there is additional space for medical documentation, the author should line out the remaining spaces so that additions can not be made after completion. All blank or unused medical documentation portions of the PCR should be filled in with the abbreviation N/A indicating Not Applicable. If an error is made while documenting, simply line out the error with a single line and write the correction as close to it as possible and the author shall initial the correction. Do not block out or white out an error. If additional space is required to complete the narrative, use the secondary PCR which has a modified patient information section and remember to fill in the PAGE OF section accordingly. The appropriate copy (Pink Sheet) of the PCR will be left at the receiving hospital/facility (location where the patient was transported to). NOTE this is in compliance with OEMS Regulations: 105 CMR (C)(2) BILLING: All billing information will be filled completed thoroughly and accurately at the time of service and a signature of patient or responsible party obtained. EMERGENCY AMBULANCE SERVICES o If the patient is unable to sign the form then one of the following persons must sign the form: The patient s legal guardian. A relative or other person who receives social security or other governmental benefits on the patient s behalf. A relative or other person who arranges for the patient s treatments or exercises other responsibilities for his/her affairs. A representative of an agency or institution that did not furnish the services for which payment is claimed but furnishes other care, services, or assistance to the patient. If you are unable to obtain a signature from any one of the above, you may get a Contemporaneous Statement signed see Contemporaneous Statement at end of this policy NON EMERGENCY AMBULANCE SERVICES o The Physician Certification Statement / Medical Necessity Form should be completed and signed by the appropriate individual at time of service. For BLS patients, the PCS demographic lines may be completed by the EMT. Sections 1 through 4 must be completed and signed by either a Physician, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Registered Nurse, or Discharge Planner NOTE: Circle the correct designation of the person signing the form.

15 For Chair Car Patients, the Medical Necessity may be signed by a Physician, Physician Designee, Physician Assistant, Nurse Midwife, Dentist, Nurse Practitioner, or Managed-Care Representative. However, the Chair Car Operator must specify the Physician s Name for any Physician Designee signatures. The Advanced Life Support Medical Necessity Form Demographic lines, Section 1, 2, and 3 may be completed by the Paramedic. However, Section 4 must be completed and signed by a Physician. If a patient or responsible party refuses to sign any of the forms, the crew shall document such refusal on the form. PATIENT REFUSAL: Patient Refusals shall be documented in a complete, accurate, and legible fashion including the Risk and Benefits of the refused aspects of care or transport. In the event that treatment was rendered including but not limited to medication administration, Medical Control should be contacted and such contact shall be documented on the PCR including the Physician s name, medical control number, and the name of the Hospital where the Physician was contacted. Refer to CS-102: Patient Refusal and Exam / Treat & Release Contemporaneous Statement MM/DD/YY at : AM/PM patient was picked up at and transported to. Origin of Call Destination I am signing to verify that the above information is accurate to the best of my knowledge. Signature EMT: OEMS #: Facility Representative: Title: Date: (Return to Clinical and Education Table of Contents)

16 CLINICAL and EDUCATIONAL SERVICES Policy #: CS 102 Title: Level: Patient Refusal and Examine/Treat & Release EMT s and Paramedics 1) To define the terms associated with patient refusals and treat/release situations. 2) To specify the documentation necessary for each type of no patient transport call in order to comply with EMS Healthcare Practice Standards and the Commonwealth of Massachusetts Regulations. Every patient contact shall be offered a medical examination, treatment and transport to an appropriate acute care hospital. Should the patient refuse examination, treatment or transport all facts shall be thoroughly documented on the patient care report form including appropriate signatures. Related Policies: CS 101: Patient Care Documentation CS 131: Consent Definitions: Patient Refusal: All persons who are of legal age (at least 18 yrs. of age) or are an Emancipated Minor, or who is the legal responsible party for a patient may refuse all or any portion of medical examination, treatment, or transport. This refusal must be made using the informed consent standard. If at all possible/practical, the refusal should be done using On-line Medical Control. Informed Consent: The patient must comprehend the risks and benefits of his/her decision and agree to accept them. You must explain all the potential benefits of any medical examination, treatment, and transport offered to the patient or his/her responsible party. You must also explain all potential risks of any medical examination, treatment, and transport offered to the patient or his/her responsible party. Against Medical Advice (AMA) Refusal: This phrase is used to describe a patient who presents with signs/symptoms of illness/injury or who experienced

17 an event which has significant mechanism of injury and is refusing all or portions of the medical examination, treatment, or transport AND after the EMT/Paramedic has made efforts to convince the patient of the need for medical examination, treatment, or transport which includes explanation of all risks and benefits AND if possible/practical using On-line Medical Control still refuses such services/procedures. No Need for EMS: This statement is used to describe an unfounded call specifically patient gone prior to arrival of EMS (patient elopement); No patient found. Examine/Treat and Release: This is a situation where the patient was provided a medical examination and treatment but now refuses transportation to an acute care facility for further evaluation and/or treatment. This may be an ALS or BLS patient. Documentation of all findings and treatments shall be done as well as documentation of any risk/benefit discussions and On-line Medical Control conversations. Patient Contact: Whenever you make contact with a potential patient you must document the contact. Patient contact includes any verbal or physical evaluation. Patient Assists: EMS providers are often called upon to assist an individual to their feet or back to bed. This constitutes patient contact and any examination or interventions must be documented on the appropriate patient care report form with appropriate signatures for refusal of further interventions and transport. Procedural Guidelines and Responsibility: Every patient contact shall include an attempt to provide a medical examination, appropriate treatment based on medical examination according to the corresponding Statewide Treatment Protocol, and transport to an acute care facility. Patient Care Documentation will be in compliance with the Statewide Treatment Protocols and CAS Policy CS 101. If a patient refuses any or all medical care, but accepts transportation the following statement shall be included in the narrative: Patient refused (treatment(s) refused) and was advised of the risk of refusal and the benefits of the treatments. If a patient refuses treatment and transportation the following statement shall be included in the narrative:

18 Patient advised to call for assistance should they change their mind or their symptoms return or increase in severity and the patient is further advised to seek medical care through their own healthcare provider. If a patient refuses transportation but has accepted evaluation and treatment (implied or informed consent) and is of appropriate cognitive capacity, the following statement shall be included: The patient has accepted (the above) evaluation and treatment but refuses the recommended transport. The risks and benefits of this decision have been explained to the patient and the patient acknowledges understanding of these risks/benefits. The patient is further advised to seek medical care through their own healthcare provide or call 911 should they change their mind or symptoms return or worsen. Furthermore in the above situation Medical Control should be contacted especially if Medications or evasive procedures were provided to the patient i.e. Albuterol, D50, Glucagon, IV s, etc. (Return to Clinical and Education Table of Contents)

19 Policy #: CS 103 CLINICAL and EDUCATIONAL SERVICES Title: Level: Definitions: BLS Request for ALS EMT s and Paramedics To define Policy and Procedure for Basic Life Support Providers to request Advanced Life Support Services. The patient s need for potential ALS intervention shall be the ONLY factor that is utilized by on-scene Cataldo EMS personnel in determining whether or not to request ALS services. Advanced Life Support (ALS) means the pre-hospital use of medical techniques and skills by qualified personnel who are specially trained and shall include such functions as advanced airway and circulatory maintenance and the management of cardiac disorders. Basic Life Support (BLS) means the pre-hospital use of those techniques and skills included in an EMT-Basic training course which meets the minimum training requirements defined in 105 CMR Procedural Guidelines and Responsibility: Upon assessment of a patient the BLS crew shall determine whether or not the patient may benefit from ALS intervention. Once a determination is made that the patient may benefit from ALS a request for ALS response shall be made by the most expedient means available. The request should usually be made via company radio, however, telephone or through the police or fire department is acceptable. The following information shall be included in the request for ALS: Age and sex of the patient Patient s chief complaint or presenting sign or symptom that may require ALS evaluation. Requested hospital destination. If there will be an extended extrication. Any other pertinent information. (Be brief). Chief Complaints and presenting signs and/or symptoms that typically require ALS evaluation and intervention include but are NOT limited to the following:

20 Active seizure Airway compromise or obstruction Anaphylaxis Cardiac Arrest Chest pain Entrapped patients Heat exhaustion and heat stroke Hypoglycemia (low blood sugar or insulin shock) Impending childbirth / Out of hospital births Multi - system trauma Respiratory arrest Respiratory distress Shock/hypotension Significant burns Unconsciousness or altered mental status BLS crews shall not await the arrival of ALS. Appropriate patient assessment, interventions and packaging shall be completed and transport initiated. It is the responsibility of the dispatcher to determine whether or not ALS resources are available and to allocate those resources. On scene EMS providers are not to determine whether ALS resources are available or not. (Return to Clinical and Education Table of Contents)

21 Policy #: CS 104 CLINICAL and EDUCATIONAL SERVICES Title: Level: Cardiac Monitors EMTs & Paramedics To ensure that the proper preventative maintenance checks are completed and that all paramedic personnel are knowledgeable in the use of cardiac monitors. All paramedics shall have a strong working knowledge of any cardiac monitor that is carried in their assigned vehicle. Related Policies: CS-107: Zoll Battery Maintenance CS-113: Malfunctioning or Failed Patient Care Equipment Procedural Guidelines and Responsibility: Each oncoming paramedic crew shall complete a daily check of the cardiac monitor s functionality and required supplies in accordance with the manufacturers recommendation and the Cataldo Ambulance Service, Inc. checklist. Batteries shall be rotated though the monitor in compliance with the particular manufacturer s recommendations and abilities. (See CS 107). Universal Daily checks shall include inspection of the monitor for foreign substances, obvious damage to monitor, case or cables. Report damage as per CS 113. LifePak 12 s - turn power on and press the options button and select the User test. The user test will automatically check the monitor/ defibrillator and print a Pass/Fail report. Zoll E-Series Monitors turn on the power, connect the defibrillation (Therapy) Cable to the tester turn unit over to Defib, charge the unit to 30 joules, and discharge. You should see a message: Defib Test Ok. If you do not then contact the On-duty Clinical Field Supervisor immediately. (Return to Clinical and Education Table of Contents)

22 CLINICAL and EDUCATIONAL SERVICES Policy #: CS 105 Title: Level: Protecting Patients from the Elements All Field Staff To ensure the protection of our patients/clients from adverse environmental conditions. Every patient/client shall be appropriately covered and removed from elements in a timely manner, with due regard for patient and crew safety. Procedural Guidelines and Responsibility: En route to each call, the ambulance/ chair car shall be prewarmed/cooled as appropriate. Appropriate linen, and other specialty equipment, will accompany the stretcher, stair chair or wheelchair to pick-up or deliver each patient. Additional coverings (such as a towel) shall be used for severe weather (such as rain, sleet, snow, heavy winds) to protect the patients/clients head. The patients/ client s subjective statements of comfort will dictate the level of coverings. Stretchers shall be covered with the transfer sheet to prevent exposure to adverse conditions prior to patient contact. (i.e. stand-bys or prolonged extrication). (Return to Clinical and Education Table of Contents)

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