Standards apply to each transport mode unless specifically designated as Rotorwing (RW), Fixed Wing (FW), or Ground (G)

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1 Apprved 9 th Editin published Octber 2012 New standards are highlighted 9 th EDITION ACCREDITATION STANDARDS f the Cmmissin n Accreditatin f Medical Transprt System Althugh the FAA and ther U.S. authrities are referenced in the standards, equivalent regulatins utside f the U.S. are referenced when reviewing internatinal medical transprt services. Standards apply t each transprt mde unless specifically designated as Rtrwing (RW), Fixed Wing (FW), r Grund (G) MANAGEMENT AND QUALITY MISSION STATEMENT AND SCOPE OF CARE There is a Missin Statement written in the present tense that describes the purpse f the service, mde(s) f transprt prvided and its cnstituents. The Missin Statement directs emplyees tward the values the service was funded upn There is a written scpe f care that describes the types f patients accepted. The scpe f care is cmmensurate with the qualificatins and level f initial and nging educatin required fr medical persnnel. Examples f evidence t meet cmpliance: The Missin Statement describes what yu d. The scpe f care describes what type f services yu perfrm, what patients yu transprt and what type f medical teams yu prvide, etc. Bth are clear, cncise and understd by all. The visin and missin are strategic statements develped by and unique t each rganizatin. Values statements are separate but key underpinnings f these statements. The mdes f transprt and cnstituents are nt, and must nt be part f these statements but, rather, must be included under a scpe f service and care statement FINANCIAL COMMITMENT There must be evidence f financial cmmitment t the prgram by the administrative structure and thrugh financial resurces that prvide excellence in patient care and safety f the transprt envirnment. Examples f evidence t meet cmpliance: Transprt vehicle is well kept equipment and supplies are well maintained, accessible and adequate fr patient ppulatin(s)/vlume. Physical surrundings are well maintained. There are adequate management and staff persnnel fr transprt vlume. Educatin apprpriate t the scpe f care and t all aspects f the rganizatin (cmmunicatins, flight crew, medical crew, etc.) is prvided Insurance - The transprt service must have and maintain insurance against lss r damage f the kinds custmarily insured against and in such types and amunts as are custmarily carried under similar circumstances by 1

2 9 th Editin Accreditatin Standards Management and Quality Insurance similar businesses. The insurers must be financially sund and reputable, and they must be qualified t d business in the state(s) r cuntry in which the transprt service is lcated. The types f insurance must include but are nt limited t the fllwing: 1. Hull insurance fr each perating aircraft. Aircraft liability prvides cverage with a single limit that must cmply with the fllwing minimums that are required fr accreditatin applicants: a. Fixed Wing (U.S. dllars) $5 millin fr twin engine aircraft $25 millin fr turb prps and light jets* $30millin fr heavy jets* *(See Glssary fr definitins f light jets and heavy jets) b. Rtrwing $30 millin (U.S. dllars) 2. Aut insurance (fr grund vehicles and ambulances wned by the service)-$1 millin (U.S. dllars) and includes accidental death and disability. 3. Medical malpractice- $1 millin (U.S. dllars) 4. Wrker s cmpensatin per state r equivalent gvernment guidelines 5. Grup life insurance r accidental death and disability must be ffered whether paid fr by the emplyer r emplyee MARKETING AND EDUCATION FOR THE PUBLIC There is a prfessinal and cmmunity educatin prgram and/r printed infrmatin with the target audience t be defined by the medical transprt service. 1. Clear identificatin f the FAA Part 135 Certificate Hlder (r pertinent natinal aviatin authrity) as the identity that is perating the aircraft is n the prgram s website, in marketing materials and n the aircraft. (RW/FW) 2. Must prvide evidence f state licensure fr each transprt vehicle as apprpriate t state r lcal guidelines 3. State r lcal license fr each transprt vehicle is accessible t the public 4. Hurs f peratin, phne number, and access prcedure 5. Capabilities f medical transprt persnnel 6. Type f aircraft/grund interfacility ambulance(s) used and peratinal prtcls specific t type 7. Cverage area fr the transprt service 8. Preparatin and stabilizatin f the patient 2

3 9 th Editin Accreditatin Standards Management and Quality Ethical Business Practices 9. Patients cnsidered apprpriate fr transprt by the medical transprt service. Generally, an apprpriate transprt is ne that enhances patient utcme, safety and cst effectiveness ver ther mdes f transprt. Examples f evidence t meet cmpliance: Marketing materials are up t date, cnsistent with missin and scpe, depict actual types f aircraft/ambulances etc. and d nt exaggerate the scpe f care r aircraft/ambulance capabilities ETHICAL BUSINESS PRACTICES The transprt service develps and demnstrates use f a written cde f ethical cnduct in all areas f business that demnstrate ethical practices in business, marketing and prfessinal cnduct. 1. The cde f cnduct guides the service when cnfrnted with ptential cmpliance r ethical issues. 2. The cde f cnduct utlines the service s standards fr ethical behavir as well as cntact infrmatin and reprting prtcls if a standard has been vilated. 3. The cde f cnduct utlines ethical billing practices. Examples f evidence t meet cmpliance: Plicies may address such issues as prper/imprper behavir tward ther prgrams marketing materials, hnesty in reprting data, persnal cell phne use, use f scial netwrking sites, hw ethical issues are addressed, cnflicts f interest, phne etiquette, acceptable and unacceptable behavirs n the wrksite/n transprt, acceptance f gifts frm patients/vendrs, etc Ethical business practices must be maintained in plicy and practice and includes specific guidelines fr transprt requests that are nt perfrmed directly by the CAMTS accredited service/service seeking accreditatin as fllws: (RW/FW/G) 1. Referring transprt requests Referring is defined as transferring the transprt request t anther prgram r service. There is n further invlvement n the part f the riginal services and there is n mnetary exchange fr the referral. If an accredited prgram refers a transprt t anther service, the accredited service/service seeking accreditatin will attempt t refer a transprt t anther CAMTS accredited service whenever pssible if unable t perfrm the transprt. 2. Subcntracted transprt requests Subcntracted is defined as the ccasin when anther service is used t supply a prtin f the transprt, such as the vehicle r the medical team if the service s vehicle r medical team is nt available r is nt apprpriate. 3. Outsurcing transprt requests Outsurcing is defined as transferring a request t anther service but retaining cntrl f the crdinatin thrughut the transprt (that may include flight fllwing, arranging fr grund transprt, htels, medical directin etc. The service may add a fee fr crdinating the transprt, but full disclsure f the name f bth the medical prvider and the vehicle prvider must be made t the patient, his/her advcate and the payer surce(s). Less than 5% f the dmestic requests (transprts within the Nrth American cntinent) may be utsurced. 4. Brkering transprt requests - Brkering is defined as arranging fr transprt and cllecting a fee but nt actually perfrming the transprt. This is nt an acceptable practice f an accredited service. If the accredited service/service seeking accreditatin cannt fulfill a request fr transprt, the service may elect t subcntract r refer the request. 3

4 9 th Editin Accreditatin Standards Management and Quality Ethical Business Practices If an accredited service subcntracts r utsurces a request fr transprt, the fllwing cnditins are maintained in practice and plicy: (RW/FW/G) 1. The ther service will be CAMTS accredited whenever pssible unless there is nt ne in the service range, r the CAMTS accredited service is nt available within an apprpriate respnse time based n patient cnditin and needs. 2. If unable t subcntract r utsurce t a CAMTS accredited service, the service must have written cntracts with aviatin services and ther medical prgrams that are utsurced t r subcntracted. The cntract must state that the service subcntracted r utsurced t is nt CAMTS accredited. a. Attempts t cntact a CAMTS accredited service will be dcumented (which service and date and time f cntact) alng with reasns fr nt cntracting with a CAMTS accredited service. b. Transprt requests that are utsurced t r subcntracted will be tracked and trended as part f the Utilizatin Review prcess. 3. If an unfamiliar aircraft/ambulance is used (either by the riginating team r the ther team), a medical team member familiar with the peratin f medical systems, cmmunicatins and emergency prcedures must accmpany the transprt team. 4. The accredited prgram will disclse thrugh a signed agreement (that may be signed n site, faxed r electrnically transmitted) with the requesting agent, patient and payer surce whenever the transprt is nt perfrmed by their prgram, medical teams and/r aircraft. (This des nt apply t specialty teams that are listed as part f an accredited service.) Examples f evidence t meet cmpliance: Signed agreements reflect when part f the service is nt prvided by a CAMTS accredited entity such as a subcntracted aircraft r medical team. All referred, subcntracted and/r utsurced requests are tracked and trended in the QM review prcess The transprt service will knw the capabilities and resurces f receiving facilities and will transprt patients t apprpriate facilities within the service regin based n direct referral, apprved EMS plan, r services available when n directin is prvided. 1. Whenever pssible, services that respnd directly t the scene will transprt patients t the nearest apprpriate hspital (i.e., majr trauma t the nearest Level I r II Trauma Center, strke patients t a hspital with specialized strke care, acute mycardial infarctin patients t a hspital with a staffed cardiac catheterizatin lab, majr burns t a Level I r II burn center, high-risk OB patients t a hspital with OB services and a Level II r III NICU, etc.). See References fr Centers fr Disease Cntrl trauma triage guidelines. 2. Management ensures, thrugh plicy, that all transfers f patient care ccur frm a lwer level f care t an equal r higher level f care except fr elective transfers fr patient cnvenience r returning a patient t a referring facility/residence. 3. Accurate estimated time f arrivals (ETA s) are always prvided regarding arrival f the service t the patient fr emergency requests. 4. Cntractual relatinships with public services r health care agencies d nt reflect implied referrals. 4

5 9 th Editin Accreditatin Standards Management and Quality Cmpliance 5. Subscriptin services d nt reflect implied referrals that culd negatively impact expeditius transprt f patients t the mst apprpriate facility. Examples f evidence t meet cmpliance: Cntracts d nt exceed current market value fr gds and/r services with the intent t influence requests r referral patterns All patient care resurces, including persnnel and equipment, necessary t the prgram's missin must be readily available in the aircraft/grund transprt ambulance r available t place in the aircraft/grund transprt ambulance, and they must be peratinal prir t initiating the missin. This includes resurces, persnnel, and equipment prvided by Specialty Care Prviders COMPLIANCE There is a crprate cmpliance fficer r designated persn respnsible fr ensuring that the service is in cmpliance with external laws and regulatins, payer requirements and internal plicies and prcedures Cmpliance issues may include but are nt limited t: 1. Health Insurance Prtability and Accuntability Act (HIPAA)* 2. Federal civil statutes (False Claim Act)* 3. Balanced Budget Act f 1997* 4. Office f Inspectr General (OIG) Cmpliance Prgram Guidance* 5. OIG annual wrk plans (hspital affiliated)* 6. Anti-kickback and Stark laws* 7. Emergency Medical Treatment and Active Labr Act (EMTALA)* 8. Red Flag Rules (Identity Theft Preventin Prgram) * 9. Federal sentencing guidelines 10. Or applicable internatinal regulatins * (See References) The cmpliance prgram includes: 1. Written plicies and prcedures 2. Designatin f a cmpliance fficer r assignment f respnsibility t a specific individual r individuals 3. Cnducting effective training and educatin fr staff that dcuments bth initial and cntinuing cmpetency 4. Develping effective lines f cmmunicatin 5

6 9 th Editin Accreditatin Standards Management and Quality Management/Plicies 5. Enfrcing standards thrugh published disciplinary guidelines 6. Auditing and mnitring 7. Respnding t detected ffenses and develping crrective actin Examples f evidence t meet cmpliance: Staff is knwledgeable abut current cmpliance issues MANAGEMENT/POLICIES There is a well-defined line f authrity. 1. There is a clear reprting mechanism t upper level management. An rganizatinal chart defines hw the medical transprt service fits int the gverning/spnsring institutin, agency r crpratin. 2. Fr public r private institutins and agencies that cntract with an aviatin r ambulance cmpany fr transprt, there must be a plicy that specifies the lines f authrity between the medical management team and the aviatin/ambulance management team. 3. All persnnel understand the chain f cmmand. Medical persnnel understand that the pilt in cmmand has ultimate authrity fr the aircraft and safe peratins. (RW/FW) 4. Managers are riented t natinal aviatin regulatins, Federal Aviatin Regulatins,(FAR s)in the U.S. that are pertinent t the medical service, including the names and titles f each persn authrized by the aviatin regulatr t exercise peratinal cntrl.(rw/fw) 5. Managers are trained t recgnize real and perceived pressures that may influence unsafe acts by staff. 6. The prgram adheres t state/prvincial, natinal and/r lcal ambulance (air and grund) rules and regulatins, including licensure requirements. 7. A plicy must be in place that dcuments the emplyer's disciplinary prcess and prtects emplyees frm capricius actins. 8. Management: a. Demnstrates strategic planning that aligns with the missin, values and visin f the service. b. Sets written guidelines fr press-related issues and marketing activities. c. Sets an Emergency Respnse Plan that includes a PAIP and respnses t unexpected ccurrences invlving persnnel, vehicles and facilities t include helipads as apprpriate t the base f peratins. d. Requires shift briefings cnducted at the beginning f each shift t assure cntinuity between shifts. e. Requires a pst flight debrief is cnducted after each flight, that includes the cmmunicatins specialist. (RW/FW) f. Requires a pst transprt debrief is cnducted after each transprt r grups f transprts as respnse readiness permits. (G) 6

7 9 th Editin Accreditatin Standards Management and Quality Missin Types and Prfessinal Licensure g. Has a plicy and a mechanism t track, investigate, disclse and clse the lp n any medical adverse event. Examples f evidence t meet cmpliance: Business plans demnstrate a needs and risk assessment when expanding the service r adding bases that includes staffing, training and management restructuring fr added respnsibilities. Examples f evidence t exceed cmpliance: Management is educated t Just Culture and applies Just Culture principles thrughut the rganizatin MISSION TYPES AND PROFESSIONAL LICENSURE THERE WILL BE AN ADDENDUM TO THIS SECTION IN 2013 THAT WILL COMPLETELY REVISE TO ORGANIZE AS LEVELS OF CARE (SEE DRAFTS POSTED ON THE CAMTS WEBSITE) Missin Types Staffing must be cmmensurate with the missin statement and scpe f care f the medical transprt service. The aircraft r ambulance, by virtue f medical staffing and retrfitting f medical equipment becmes a patient care unit specific t the needs f the patient. A well-develped psitin descriptin fr each discipline is written Critical Care - A critical care missin is defined as the transprt f a patient, frm a scene r a clinical setting, whse cnditin warrants care cmmensurate with the scpe f practice f critical care transprt prfessinals. (i.e., physician r registered nurse) 1. The medical team must, at a minimum, cnsist f a specially trained physician r a registered nurse as the primary care prvider. 2. A physician r registered nurse may be designated as the primary care prvider if he/she meets the fllwing criteria: a. There are adequate persnnel t prvide full cverage with physicians r RNs wh are primarily assigned t the medical transprt service and are readily available within the respnse time determined by the service. b. The physician r RN must have apprpriate state licensure. c. Pre-hire qualificatins require a minimum f three years critical care experience fr RN s and a plan t assess and dcument the cmpetency and prficiency f the prvider t perfrm in the critical care medical transprt envirnment. d. A plicy addresses pre-hire backgrund checks that include, at a minimum, criminal backgrund, license verificatin, and previus emplyer. Examples f evidence t exceed cmpliance: Fur r mre years critical care experience is required pre-hire. Nursing certificatins such as CEN, CFRN, CPEN, r CCRN are required pre-hire. 3. Critical care missins require an additinal team member, fr a minimum f 2 medical attendants (fr example, but nt limited t, RN/RN, RN/RT, RN/MD, RN/Paramedic (r alternative team cmpsitin), while a patient(s) is n bard. Persnnel must be available fr each transprt within a respnse time determined by the service. 7

8 9 th Editin Accreditatin Standards Management and Quality Missin Types and Prfessinal Licensure a. Regularly scheduled persnnel must be assigned t the service as his/her primary respnsibility, and must meet all apprpriate and current licensing, certificatin r permitting requirements fr Respiratry Care Practitiners r EMT-Paramedic, r higher level. They must meet educatinal requirements specific t the medical transprt service envirnment assigned. b. Pre-hire qualificatins require a minimum f three years ALS experience fr flight paramedics and three years clinical experience fr an RT and a plan t assess and dcument the cmpetency and prficiency f the prvider t perfrm in the critical care medical transprt envirnment. c. On an emergency/unanticipated/infrequent basis, nn-scheduled persnnel can be added as the secnd team member accrding t the prtcls f the medical transprt service as lng as rientatin includes in-transprt treatment prtcls, general aircraft and ambulance safety, emergency prcedures, peratinal plicies and infectin cntrl. d. Under certain infrequent cnditins, the weight f the secnd medical attendant r equipment culd ptentially cmprmise the perfrmance f the aircraft and the safety f the missin. Under these cnditins, if nly ne medical attendant can accmpany the patient, the fllwing must ccur: A written plicy exists defining the cnditins f density altitude and weight, and it supprts the pilt's authrity t make these decisins. A single medical attendant must have the knwledge and medical equipment t adequately perfrm ne-persn CPR. Quality management activities are in place that regularly review the patient care prvided by nly ne medical attendant and the patient's status at the time f arrival at the arranged destinatin facility. N ther transprt team is available in that regin at the time f the transprt that wuld be mre apprpriate fr delivering the level f care the patient requires. 4. An Alternative t Current Critical Care Team Cmpsitin Requirements*: As an alternative t the team cmpsitin (fr example: paramedic-led teams) requirement abve, the fllwing standard and criteria describe a new way t meet cmpliance with the accreditatin standards as a critical care team. *(See Alternative Team Cmpsitin Requirements - Addendum A) Advanced Life Supprt - An advanced life supprt (ALS) missin is defined as the transprt f a patient frm an emergency department, critical care unit r scene wh receives care cmmensurate with the scpe f practice f an EMT- Paramedic. (See ALS-BLS Grund Sectin as applicable.) 1. The medical team must at a minimum cnsist f ne certified EMT-Paramedic as the primary care prvider. a. There are adequate persnnel t prvide full cverage with EMT-Paramedics wh are primarily assigned t the medical service and are readily available within the respnse time determined by the service (if the majrity f transprts are ALS missins). 8

9 9 th Editin Accreditatin Standards Management and Quality Missin Types and Prfessinal Licensure 2. The EMT-Paramedic prviders must be licensed, certified, r permitted accrding t the apprpriate state regulatins and current relicensing, recertificatin, r re-permitting status. a. Pre-hire qualificatins require a minimum f three years ALS experience fr flight paramedics. b. Pre-hire backgrund checks include criminal backgrund, licensing, and previus emplyer are utlined in a plicy. Examples f evidence t exceed cmpliance: Fur r mre years ALS experience is required pre-hire. 3. Advanced life supprt missins require an additinal team member, fr a minimum f tw medical attendants while a patient(s) is n bard. Persnnel must be available fr each transprt within a respnse time determined by the service. a. Regularly scheduled persnnel must be assigned t the service as his/her primary respnsibility and must meet all apprpriate and current licensing, certificatin, r permitting requirements fr a Respiratry Therapist, EMT-Paramedic, r higher level. b. They must meet educatinal requirements specific t the medical transprt service envirnment assigned. c. On an emergency/unanticipated/infrequent basis, nn-scheduled persnnel can be added as the secnd medical team member accrding t the prtcls f the medical service as lng as rientatin includes in-flight treatment prtcls, general aircraft safety, emergency prcedures, peratinal plicies, and infectin cntrl. d. Under certain cnditins, the weight f the secnd medical persn r equipment culd ptentially cmprmise the perfrmance f the aircraft and safety f the missin. Under these cnditins, if nly ne medical persn can accmpany the patient, the fllwing must ccur: A plicy exists defining the cnditins f density altitude and weight, and it supprts the pilt's authrity t make these decisins. A single medical attendant must have knwledge and medical equipment t adequately perfrm ne persn CPR. Quality management activities are in place that regularly review the patient care prvided by nly ne medical attendant and the patient's status at the time f arrival at the arranged destinatin facility. N ther transprt team is available in that regin at the time f transprt that wuld be mre apprpriate fr delivering the level f care the patient requires ALS/BLS Transprts refer t the ALS/BLS Grund standards. BLS n lnger applies t air transprts as a dedicated service althugh ne care prvider is acceptable fr BLS fixed wing transprts r medical escrt requests. Examples f evidence t meet cmpliance: The prgram has guidelines fr accepting a single prvider transprt (versus the regularly scheduled critical care r ALS team), and these transprts are reviewed in the QM prcess. 9

10 9 th Editin Accreditatin Standards Management and Quality Staffing Medical Escrt Transprts Refer t Medical Escrt Standards t be published as a separate dcument (draft is n the website - camts.rg) Independent Specialty Care Teams Specialty transprt teams that are specifically trained fr air and/r grund transprt and are nt accmpanied by a transprt team r team member must fllw the criteria listed under critical care. Examples f evidence t meet cmpliance: Independent specialty care teams have dcumented evidence f annual educatin in in-flight and ambulance treatment mdalities, altitude physilgy, general aircraft and ambulance safety, and emergency prcedures. Fr RW/FW, they must meet educatinal requirements fr in-flight envirnment (reference p. 44, educatin specific t the in-flight and grund transprt envirnment) Specialty persnnel wh are added t the regularly scheduled transprt team (as fr nenatal, pediatric, perinatal r IABP transprts) must fllw the criteria listed belw: 1. Specialty care persnnel must have apprpriate licensure r certificatin requirements by apprpriate agencies r gverning bdies and have relevant specialty experience as described by prgram plicy. 2. Liaisn rles with the hst medical transprt service ensure chesive and safe peratinal relatinships, and well-defined rles and plicies. 3. Specialty care persnnel must be accmpanied by ne regularly scheduled medical persnnel. 4. Pre-transprt safety briefings are perfrmed prir t each transprt. 5. Specialty care persnnel are familiar with the prgram s plicies, safety and survival techniques as they relate t the specific aircraft r ambulance Specialty persnnel wh cntract with a transprt service but are nt accmpanied by regularly scheduled team members must fllw the criteria listed belw. Training is dcumented and verified n an annual basis. 1. Specialty care persnnel must be educated in in-flight and ambulance treatment mdalities, altitude physilgy, general aircraft and ambulance safety, and emergency prcedures. 2. Specialty care persnnel must cmplete the educatin specific t in-flight and grund transprt envirnment as listed in Accreditatin Standard STAFFING The service must have written peratinal plicies t address each f the areas listed belw: Scheduling and individual wrk schedules demnstrate strategies t minimize duty-time fatigue, length f shift, number f shifts per week and day-t-night rtatin. (See References fr circadian rhythm and ther fatigue studies.) 1. On-site shifts scheduled fr a perid t exceed 24 hurs are nt acceptable. Twenty-fur hur shifts are acceptable if: a. Medical persnnel are nt required t rutinely perfrm any duties beynd thse assciated with the transprt service. 10

11 9 th Editin Accreditatin Standards Management and Quality Physical Well-Being b. Medical persnnel are prvided with access t and permissin fr uninterrupted rest after daily medical persnnel duties are met. c. The physical base f peratins includes an apprpriate place fr uninterrupted rest. d. Medical persnnel must have the right t call "time ut" and be granted a reasnable rest perid if the team member (r fellw team member) determines that he r she is unfit r unsafe t cntinue duty, n matter what the shift length. There must be n adverse persnnel actin r undue pressure t cntinue in this circumstance. e. Management must mnitr transprt vlumes and persnnel s use f a time ut plicy. 2. Scheduling f n-call shifts must be evaluated t address fatigue in a written plicy based n mnitring f duty times by managers, QM tracking and fatigue risk management. 3. Plicies fr lng range transprts address rest during transprt, after patient is at the destinatin and acceptance f back-haul missins. Medical persnnel must have 10 hurs free frm all cmpany assigned duties befre accepting anther missin r crews need t be swapped ut. 4. Persnnel (including cmmunicatins specialists) must have at least ten hurs f rest (pilts must have ten hurs f rest as cnsistent with Part 135 regulatins) with n wrk-related interruptins prir t any scheduled shift f twelve hurs r mre r prir t any n-call shift f greater than 12 hurs. The intent is t preclude backt-back shifts with ther emplyment, cmmercial r military flying, r significant fatigue-causing activity prir t a shift. 5. The number f cnsecutive shifts and day t night rtatin must be clsely mnitred by management fr pilts, medical crews, cmmunicatin specialists, grund ambulance drivers and aircraft maintenance persnnel. 6. Plicies must address minimum rest/duty time requirements fr transprts that are internatinal r invlve vernight stays, nt t exceed mre than 16 hurs n duty in a 24-hur perid OR a minimum f tw medical team members t allw ne member rest during the transprt and insure anther attends the patient. (FW) 7. Plicies that address preparatin fr transprt based n an available patient reprt and distance f transprt (including internatinal transprts) t apprpriately assess staffing and equipment/supplies needs. 8. Plicies address crew interface s that team members are expected t stay alert n all legs f the transprt, including at least ne team member n empty legs, t assist the pilt in staying alert (especially in ne-pilt peratins) and the driver t stay alert fr grund transprts. Examples f evidence t meet cmpliance: Management mnitrs fatigue in terms f staffing patterns, patient utcmes and incidents r accidents PHYSICAL WELL-BEING Physical well-being is prmted thrugh: 1. Wellness prgrams that prmte healthy lifestyles (e.g. balanced diet, weight cntrl, n smking) 2. Evidence f an injury preventin prgram and ergnmic strategies t reduce emplyee injuries 3. Prtective clthing and dress cde pertinent t: 11

12 9 th Editin Accreditatin Standards Management and Quality Meeting, Recrds and Plicies a. Missin prfile such as turn-ut gear available at scene fr medical persnnel wh assist with heavy extricatin (RW) b. Safe peratins, which may include the fllwing, unless specified as required belw: Bts r sturdy ftwear (required) Wearing reflective material r striping n unifrms fr night peratins High visibility reflective vests r apprpriate Department f Transprtatin (DOT) apprved clthing must be wrn by flight and grund crews accrding t the ANSI-SEA 107 standard r equivalent natinal standard (required fr medical crews and pilts/drivers respnding t night scene requests) Flame retardant clthing Apprpriate uterwear pertinent t survival in the envirnment (required) 4. Infectin cntrl - dress cdes address jewelry, hair and ther persnal items f medical persnnel that may interfere with patient care. Refer t Occupatinal Safety and Health Administratin (OSHA) standards. 5. Written plicies addressing: a. Hearing prtectin requirements b. Duty status during pregnancy c. Duty status during acute illnesses such as sinusitis r titis d. Duty status while taking medicatins that may cause drwsiness e. Weight/height and/r lifting ability as specified in pre-hire requirements Examples f evidence t meet cmpliance: Persnnel are bserved fllwing the prgram s dress cdes and are knwledgeable abut plicies regarding physical wellbeing. Pregnancy plicies are cnsistent with current natinal laws and may address ntificatin t emplyer requirement, written dcumentatin requirements t cntinue n duty, pssible alternative duty assignments if team member is restricted frm transprt duty MEETINGS, RECORDS AND POLICIES Meetings 1. There are frmal, peridic staff meetings fr which minutes are kept n file. Minutes will include wh attended, base identificatin (if multiple bases), wh is presiding and discussin (versus agenda/tpics nly). There are defined methds, such as a staff ntebk r electrnic mechanisms fr disseminating infrmatin between meetings. 12

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