THE EMS HANDBOOK - WELCOME TO EMS

MEETING YOUR FTO

As a new member of the EMS Team, you can only clock in when there is a Field Training Officer clocked in. Field Training Officers (FTOs) are members of the EMS Team who have experience and knowledge they are willing to share with new staff members. The FTOs will be responsible for all aspects of your EMS training, they are there to teach, lead by example, and answer any questions you might have about EMS. They should be your first point of contact if you read anything in this document that you don't understand or need help with. 

FTOs can be contacted via the Emergency Services emails (Discord).  You can use the '#┃ems-general ' channel and @• EMS FTO • to reach out and ask if one is available for training. Any available FTO will then contact you, and let you know they are available. 

TOUR OF THE HOSPITAL

One of the first things your FTO will do is give you a tour of the Pillbox Hospital, which will be your main place of work. EMS can be stationed at Sandy Hospital and Paleto Hospital, but Pillbox is the primary center for medical care in Los Santos. As a new EMS Team member you should be familiar with the following locations:

• Reception (Nancy, Cash Register & Plastic Surgeon Location)

• ICU (Main Treatment Area)

• Staff/Break Room (Uniform Location, Lockers, Fridge & Medical Supplies)

• Examination Rooms (X-Ray, MRI, Doctor Rooms)

• Upstairs Pharmacy Location

•  Upstairs Treatment (Locked Suspect Treatment, Surgery, Therapy & Treatment Rooms)

• Staff Meeting Room 

• Office Locations (Payment Terminal)

Some of these areas you will use every shift, and some will be used rarely, but it is important to know your work environment. Explore post-FTO tour until you feel confident finding different locations.

THE BREAK/STAFF ROOM 

The Break/Staff Room contains several important locations; staff lockers, uniform changing location, medical supplies, and the fridge. Please keep the door to the Break/Staff Room LOCKED at ALL times. 

Lockers - Each EMS Team member has a personal locker, which can be used to store items. It is particularly useful for storing firearms and other melee weapons that cannot be carried on duty as per EMS SOP.  The locker is only accessible while clocked in and can be accessed by using your third eye on the lockers in the back room accessed through the main staff room. 

Uniform Changing - Uniforms are mandatory and each EMS Team member has access to a variety of uniforms, depending on their current rank. As an EMT the uniform selection is limited. Uniforms can be modified and saved to an outfit bag, but these uniforms should be approved by one of the Command or High Command Team.  As a general rule, all uniforms should have medical gloves, rank identification (EMS, Paramedic, etc.) a radio, a stethoscope, or other medical items. 

Medical Supplies - Upon entering the Break/Staff Room you will see a burly individual (the Armory) who is ready to sell you medical supplies at a very reasonable price. Most of these items are used for more specialist purposes, or they are covered in the EMS SOP & SUPPLIES & PRICING GUIDE. As an EMT there are three items you will need to purchase and use regularly; Ifak, Medical Kits, and Bandages. At the start of each shift, you should ensure you have 20-30 of each of these in your pockets. Ifak (Individual First Aid Kits) are used to stabilize patients, Medical Kits are used to restore a patient to full health and Bandage can be used for treating smaller injuries. We also sell bandages to patients. The Armory can be accessed using your third eye.  Never take prescription medication for personal use, or other items just to supply friends with free medical items. 

Fridge - EMS High Command feeds us well and all EMS Team members have access to the staff fridge, while you are on duty you can take food and drink from this fridge as needed. The only stipulation about this fridge is; to use it respectfully. The food and drink items that are placed in this fridge have been paid for out of EMS funding, or they have been donated by fellow EMS and businesses who support EMS. Handing out free food to your friends, taking way more than you can eat, etc. is frowned upon. Giving someone a couple of drinks who is about to pass out from dehydration is fine, but it should not be the person's main source of food. 

THE MDT (MOBILE DATA TERMINAL) 

The MDT is where we store pertinent patient information, details of treatments performed, and other important information (like allergies). The MDT also shows a list of who is on duty, what department they are clocked into, and what radio channel they are on. This information can be incredibly useful, but it SHOULD NEVER BE SHARED WITH ANYONE OUTSIDE OF EMS.  At the beginning of every EMS shift you MUST OPEN THE MDT so your details will be visible to others who are on duty. If you go 10-7 for a break and clock out, you must re-open the MDT when you return 10-8. To open your MDT the command is /mdt

SETTING UP A CALLSIGN - All EMS Team members are assigned a callsign, one will have been assigned to you when you were hired. This callsign will mainly be used for communication over the radio. You also need to update both your email (Discord) name and your MDT callsign. To update your MDT profile; open the MDT (use /mdt), find your name in the list, and right-click it. Select 'callsign' and a pop-up window should open. Type in your callsign including the - (For Example M-05). Close and re-open your MDT and your new callsign should be visible in the list. Your callsign will need updating after each promotion when a new callsign is assigned to you. 

GOING ON DUTY

All of the above information is most pertinent when going on duty (at the beginning of each shift at EMS), the checklist to ensure you have completed all tasks is:

• Flex J & Go On Duty

• Change Into Uniform

• Store Weapons & Items

• Get Medical Supplies (If Running Low)

• Open MDT

• Connect To Radio Channel 5 (For More Information See Below)

You MUST do all these things at the start of every EMS shift.

SETTING UP YOUR RADIO

While on duty ALL EMS staff must have a radio in their pockets, this radio should be on and set to CHANNEL FIVE (5), unless communication with other departments is required. To set up the radio, place it in one of your one-five muscle slots and flex that muscle. Type '5' in the frequency space and flex enter, this should automatically connect you to the channel. The radio has a volume control located on the left-hand side. Radio volume should be adjusted if you are having trouble hearing patients, or local conversations. To change frequency you can manually adjust (using the same method used to connect), or set muscle binds to cycle up/down through channels. At the top of the radio, on the right-hand side, there is a disconnect option that can be used at the end of an EMS shift.

REMEMBER: Being On 'Tac' (The Radio Channel) Is Mandatory While On-Duty

COMMUNICATING VIA THE RADIO

To ensure effective communication within the EMS team, we utilize a system of numeric codes known as 10 codes. These codes are essential tools for conveying information quickly and succinctly, especially during critical situations where clear communication is paramount. 

Why Are The 10 Codes Important?

• Clarity & Efficiency: In emergencies, clarity and efficiency are crucial. 10 codes provide a standardized way to communicate essential information without the need for lengthy explanations, ensuring that messages are conveyed quickly and accurately.

• Professionalism: Utilizing 10 codes demonstrates professionalism and proficiency in emergency communication protocols. It reflects our commitment to maintaining high standards of communication within EMS.

• 
  

A list of commonly used 10 Codes can be found HERE.  If, after reading the remainder of this section, you have any questions regarding the 10 Codes and their use, please direct them to your FTO during training. 

COMMUNICATING WITH 10 CODES

Using 10 Codes is often the most daunting aspect of EMS training. We have all been there; learning a whole new way to communicate, the fear of making mistakes, and forgetting our call-sign. First and foremost, EMS is a supportive environment. Each of us had to learn the 10 Codes and most of us still mess them up occasionally. No one will laugh (excessively) and everyone will help if you have questions, or want to practice. 

So, what are they and what do they mean? Each code corresponds to a predefined meaning. For instance, "10-4" typically signifies acknowledgment or understanding, while "10-20" denotes location.  The 10 Codes streamline communication by condensing information into numerical sequences, reducing the time it takes to explain what you are doing. This standardized approach to communication is particularly beneficial in fast-paced environments like the hospital. 

COMMON EXAMPLES OF 10 CODE USE 

These are a few common examples of 10 Code usage with some tips, tricks, and notes we hope will help.  Any questions regarding these examples should be directed to your FTO during training.

• Going On Duty

[Callsign] 10-41 

EXAMPLE: M05 10-41 

MEANING: Bailey Vance Coming On Duty

• Going Off Duty

[Callsign] 10-42 

EXAMPLE: M05 10-42

MEANING: Bailey Vance Going Off Duty

• Taking A Break

[Callsign] 10-7

EXAMPLE: M05 10-7

MEANING: Bailey Vance Out Of Service

• Returning From Break

[Callsign] 10-8

EXAMPLE: M05 10-8

MEANING: Bailey Vance Available To Take Calls

• Enroute To A Call - Answering Dispatch Calls, Requests For EMS Assistance, Etc.

[Callsign] 10-76  Latest 10-69

EXAMPLE: M05 10-76 Latest 10-69

MEANING: Bailey Vance En Route Latest Civilian Down

10-76 can be used when you are en route to a variety of situations, generally speaking, use it when you are heading somewhere and not returning. If you are moving from one hospital to another you are en route, if you are returning from a call you would use 10-15 or 10-19. 

MOVING BETWEEN HOSPITALS: M05 is 10-76 to Sandy Hospital

• Returning From Calls - Returning From Dispatch Calls, Requests For EMS Assistance, Etc.

[Callsign] 10-15  Pillbox

EXAMPLE: M05 10-15 Pillbox

MEANING: Bailey Vance En Route Hospital With Patient Pillbox

[Callsign] 10-19  Pillbox

EXAMPLE: M05 10-19 Pillbox

MEANING: Bailey Vance Back To Hospital (No Patient) Pillbox

10-15 is used when transporting a patient, and 10-19 is used when there is no patient to be transported. For example: If you answer a call and the patient is missing from the scene (Code 4), or treated on-site (minor injury).

+1 & OTHER NUMBERS

Above are the most commonly used codes and some examples of their use, there are, however, some variations and additions that need mentioning. When multiple EMS attend a call, or more than one patient is being transported the use of codes will vary slightly. Additional EMS/patients are denoted by a +1, or other appropriate number. For example, if you and your FTO are heading en route to a civilian down call, the correct 10 Code use would be; [Callsign]+1 10-76 Latest 10-69. This translates to You (Callsign) +1 En Route Latest Civilian Down.

If more than one patient is being transported in the ambulance, this also changes the use of 10 Codes. For example, if you are transporting three patients back to Pillbox, the correct 10 Code use would be; [Callsign] 10-15+2 Pillbox. This translates to You (Callsign) En Route To Hospital +2 Additional Patients, Pillbox.  Why +2 and not +3 if there are three patients? The first patient is the 10-15, each additional patient is a + patient. 

RADIO CHANNELS - OTHER DEPARTMENTS

Radio channels one (1) to ten (10) are reserved for law enforcement agencies and other government organizations/contractors. While working for EMS contacting other agencies/contractors will be necessary.  It is therefore important to know the channels each department uses, the radio channels are allocated as follows:

Channel 1 - County Dispatch (LSSD & SAHP)

Channel 2 - County Tac (LSSD & SAHP)

Channel 3 - City Dispatch (LSPD)

Channel 4 - City Tac (LSPD)

Channel 5 - Medical Dispatch (EMS and Fire)

Channel 6 - SAPR Dispatch

Channel 7 - Federal Dispatch ( FIB / Coastguard)

Channel 8 - Department Of Correction Dispatch (Prison)

Channel 9 - Internal Affairs (IA)

Channel 10 - Tow Dispatch

NOTE: During active law enforcement scenes, scenes that are Code 6 (Not Secure), or when handling requests for assistance from law enforcement officers it can be useful to switch TAC to the active LEO channel, (usually TAC 3, but it can vary). To see what channel/TAC an officer is on; open your MDT and look at the TAC/channel number displayed to the right of their name. 

When switching TAC and contacting LEO or other government agencies/contractors always contact them and wait for an acknowledgment before relaying any message, for example, "EMS to PD"  or "EMS to Tow". When the other department/contractor responds, use 10 Codes where possible to relay what needs to be relayed as succinctly as possible; "EMS 10-78 at Postal 988, 10-13 with multiple 10-69" If you do not feel comfortable using 10 Codes, relay the information as swiftly as possible with words, "EMS requesting assistance at Postal 988, shots fired with multiple civ downs." Handling non-secure scenes is covered in more detail HERE, your FTO will also cover this information in more depth.

THE LISTS OF THINGS YOU SHOULD AND SHOULD NOT DO AS A MEMBER OF THE EMS TEAM

The code of conduct we expect all EMS Team members to follow is outlined in detail in the EMS Standard Operating Procedures, every EMS Team member should take the time to read through these thoroughly. To get our new EMT started, the important rules are included here, with handy hints. 

ALL EMS MUST:

1) Follow The City Rules - All EMS MUST remain felony free, a conviction for any type of felony will unfortunately mean dismissal from the EMS Department.

2) Be Polite, Respectful & Professional In ALL Situations - While on duty you represent the hospital and your actions can have ramifications. All visitors to the hospital should be treated with respect, even the problematic ones. Any EMS Staff member who experiences disruptive, rude, or visitors/patients who choose not to treat the hospital and its staff with the level of respect it requires can be asked to cease their behavior. This should be done in a polite, but firm manner.  If the visitor/patient chooses to ignore this request, EMS Staff can ask them to leave the hospital. If they still refuse and their behavior continues, contact an LEO and request assistance. 

3) Keep Radio Communications As Clear As Possible - Pay attention to the radio,  only mute it when it is necessary. Always inform fellow on-duty EMS  before going off TAC, and include a reason for your absence. Avoid idle chatter and use the appropriate 10 Codes when communicating your actions.  

4) Respond To 311 & 911 Calls Efficiently - More information on answering these calls can be found in the below section 'Dispatch/Attending Scenes/Responding To Emergency Calls' Each 311 call and 911 call is a potential injured citizen who may have life-threatening injuries, with this in mind these calls must be answered as swiftly and as efficiently as possible. Always communicate your intent to respond to a call via the radio. 

5) Safety First - Stay alert while on duty, when responding to calls approach the scene with caution, we often attend active LEO scenes, shootouts, etc. where gunfights may still be in progress. Always follow the correct protocol, stay safe, and follow the correct protocols outlined below. 

6) Wear Your Uniform - Uniforms are mandatory and each EMS Team member has access to a variety of uniforms, depending on their current rank. As an EMT the uniform selection is limited. Uniforms can be modified and saved to an outfit bag, but these uniforms should be approved by one of the Command or High Command Team.  As a general rule, all uniforms should have medical gloves, rank identification (EMS, Paramedic, etc.) a radio, a stethoscope, or other medical items.  Uniforms should NOT be worn when you are clocked out unless you are in transport to your home, the garage, or a clothing store.    

7) Return Ambulances - When you've finished driving them, put them away. Abandoned ambulances block entrances/exits and potentially cause accidents.

8) Minimum Hours - All EMS are expected to work a minimum of three (3) hours per week. 

9) Treat At The Hospital - Patients with very minor injuries who are still walking about can be treated on-site (at the location they contacted us from), cuts, scrapes, minor bruises, etc. Patients who are curled and twitching, or flatbacked should ALWAYS be transported to a hospital before treatment can commence.  If a patient is flatbacked they should be stabilized before transportation, but treated fully at the hospital. 

10) Equipment For Treatment - Wheelchairs, walking sticks, medication, etc. These items are for people who need them, due to injury, they are not for fun, or friends.  The hospital has strict prescribing guidelines regarding some items and medication, these MUST be followed a ALL times, more information regarding these items and who can/cannot prescribe them can be found HERE.  

ALL EMS MUST NEVER:

1) Pay Cheque Farm - EMS Staff members who clock in MUST be ready and available to work. Clocking in, when you have no intention of performing medical duties,  just to collect a pay cheque, will result in removal from the EMS Department.  

2) Engage In Illegal Activity - All EMS must refrain from engaging in illegal activity. Any EMS that is arrested and charged with a felony will be removed from the EMS Department. 

3) Take Possessions - EMS Staff should not search patients/visitors, or take items from patients/visitors. 

4) Share Information - Police activity and other information that can be gained via dispatch and the MDT is confidential, sharing this information with friends, family, hospital visitors, or patients is strictly forbidden, 

5) Carry A Firearm - All guns and other weapons must remain stored in personal storage lockers while EMS staff are on duty. High Command, may on occasion, raise the status of the hospital and put us on high alert. At such times, weapons may be permitted. Any weapon must remain holstered. To carry any weapon you must adhere to the law; a weapons license will be required and any gun must be registered. 

6) Prescribe Medication - EMS Staff should never prescribe medication without reason, or rank. A list of medications and who can prescribe them can be found HERE. 

7) Carry A Taser/Handcuffs - EMS Staff members should not carry, or use a taser/handcuffs unless they have been certified to do so.  Regular training sessions will be scheduled to provide training to new EMTs.

ll EMS Staff members are expected to adhere to the above, failure to follow these rules can lead to disciplinary measures (strikes) or dismissal from the EMS Department. If you have any questions regarding these rules, please ask your FTO during training. 

SETTING UP MUSCLE BINDS

Muscle binds are invaluable, one muscle ((keyboard key)) can be bound to multiple actions, so you can set a muscle up to emote some text, play an animation, and perform a medical action. Using these muscle binds reduces the time it takes to perform the 'mechanics' of healing and allows us to focus on the patient. 

These are the starter muscles, they can be changed - be as unique as you like, we love to see uniqueness in the workplace, but please keep them professional. 

To enter muscle bings in-city, you’ll need to flex the F8 muscle first. This is where you can copy & paste the binds below.

Your first muscle is for when you check a patient for injuries. This will allow you to see the patient's health status; if they have injuries, and where they are located.

“Checks For Injuries”

Bind keyboard numpad1 “do checks for injuries”

Bind keyboard numpad1 “e mechanic”

Bind keyboard numpad1 “status”

Your second muscle is for when you disinfect and clean a patient's injuries.  This will apply a bandage and can be utilized for smaller injuries. 

“Disinfect Wounds & Clean Area”

Bind keyboard numpad2 “do disinfect wounds and clean area”

Bind keyboard numpad2 “e clean”

Bind keyboard numpad2 “heal”

Your third muscle is for when you use a first aid kit to bandage a patient’s injuries. This is used at the end of medical treatment as it will bring the patient back to full health. 

"Wraps Injury With A Bandage”.

Bind keyboard numpad3 “do wraps injury with a bandage”

Bind keyboard numpad3 “e bandage1”

Bind keyboard numpad3 “revivep”

Your final muscle is for when you need to carry a patient, this can also be used to pull someone from their vehicle or the ambulance.

Bind keyboard numpad7 “escort”

To change which key a muscle is bound to, edit the 'numpad' part of each line, Remember to alter all three parts or the binds will not work properly.  If you have any problems setting up your muscle binds your FTO is available to help, alternatively ask a fellow EMS Team member via the '#┃ems-ooc ' channel in the emails.

ADDITIONAL EMOTES YOU CAN USE TO SET UP MUSCLE BINDS

Additional binds can be added to increase your options during treatment, below you will find some useful medical emotes.  The animation name you need for the muscle bind is the part in brackets. 

Bandage 2 (bandage2) 

Animation of wrapping your arm with a bandage.

Bandage 3 (bandage3) 

Dubious animation, looks like you are wrapping a bandage around something.

Medic Box (medbox) 

Animation of you holding a toolbox.

Look Radiography (radio_look) 

Animation of you looking at x-ray results.

Surgery  (surgery) 

Animation of you holding/using a scalpel. 

Injection (syringe) 

Animation of you using a syringe on someone 

Injection Self (syringe2) 

Animation of you using a syringe on yourself.

Take Temperature (thermo) 

Animation of you using a digital thermometer to take a temperature.

These are the most commonly used medical animations, there are others. Flex F4 to see all available animations and be creative.

DIFFERENT CALL TYPES & HANDLING THEM

EMS receives calls for emergency and non-emergency assistance via phone, radio, and dispatch. Civilian Down (911) calls are sent to dispatch when a downed civilian flexes their 'G' muscle to request assistance. Alternatively, they can do /911 or /311 to contact emergency/non-emergency services and relay a message. Injured civilians will often contact EMS if they are injured and need transportation to a hospital. Civilians can also use the Services App on their phones to call us directly and request assistance. LEO will switch to radio channel five (5), to request EMS attend a scene with either injured civilians or LEO. If an LEO goes down (is incapacitated and starts to bleed out) during a scene an 'Officer Down' alert will appear in the dispatch. All dispatch, radio, and phone requests for medical assistance should be answered, there are a few things to consider, however, when deciding which call should take priority, etc.

DISPATCH CALLS - These are the most common type of call. When a new call is received it will appear on Dispatch (in the top right-hand corner of your screen) and will be visible for a few moments. To open Dispatch and review recent calls, flex your 'Insert' muscle. Any available EMS (Advanced EMT+) can answer Dispatch calls. As an EMT you should only answer calls with your FTO. 

ATTACHING TO DISPATCH CALLS - To attach to a Dispatch call you can flex your 'E' muscle, this can be rebound as the same muscle opens and closes doors, etc. Alternatively, you can open Dispatch, select the call by clicking on it and manually attach, or detach from the call by clicking the appropriate option at the bottom of that call. 

INFORM OTHERS WHEN YOU RESPOND TO A DISPATCH CALL - You should always notify fellow on-duty EMS and FD members of your intention to respond to a call. Use the radio to tell them you are 10-76 to the latest civilian down, 911, etc. 

LEO/FD DOWN CALLS - Law Enforcement Officer (LEO), or Firefighter (FD) down calls are the HIGHEST PRIORITY type of call EMS receive. These should be handled as swiftly as possible. If Dispatch displays an Officer Down call, EMS staff should switch to TAC 3 and ask LEO if they require assistance. ALWAYS contact LEO before heading to the scene of the Officer Down, these scenes are often Code 6 (Scene Not Secure), LEO can be involved in gun fights, car chases, etc. EMS interference could potentially hinder LEO investigations or ongoing operations. When multiple Officer Down calls are received, EMS will often station near the location of the call (a minimum of two blocks from an active scene). EMS should wait until officers inform them the scene is Code 4 (Scene Secure) before approaching to provide medical assistance. 

STEP-BY-STEP HANDLING

• Officer Down Dispatch Notification Received

• Switch Tac 3 & Contact LEO - Ask If They Need Assistance

• If Assistance Needed - Station 2-3 Blocks From Scene (Multiple Ambulances If Necessary)

• Wait For LEO To Call Code 4

• Approach & Transport (LEO First)

• 
  

NOTE: If there are multiple people down, LEO, and civilians, ALWAYS treat LEO, EMS, and FD before treating injured civilians. LEO, EMS, and FD calls ALWAYS take priority over Civilian Down calls. 

LEO REQUEST FOR ASSISTANCE CALLS - At times, LEO will switch TAC to TAC 5 and request EMS assistance. In these situations, it is usually suspects who require medical attention. LEO will provide a postal address. The EMS responding to the call should notify other EMS of their intention to take the call "10-76 to latest request for EMS assistance", etc. These patients/suspects can be transported to Pillbox, they should then be taken upstairs. As a general rule, we always treat suspects behind the locked doors, upstairs in Pillbox.

NOTE: Suspects can be stabilized, but are not to be treated fully unless LEOs are on the scene at the hospital.  

DANGEROUS SCENES - EMS can be called to a variety of dangerous scenes and situations, with this in mind; always approach with caution. Slow down as you approach and listen for gunshots, or other sounds that might indicate an altercation is in process. If you see, or hear anything that gives you cause for concern, move to a safe location, switch TAC to TAC 3, and ask for LEO assistance. "EMS requesting assistance at postal ___, gunshots heard." Wait for LEO to arrive and inform you the scene is secure before returning to the scene of the call. 

All this information will be covered in training, if you have any questions or concerns, please ask your FTO. 

HOW TO TREAT MINOR INJURIES & WHEN TO ASK FOR ASSISTANCE

As a new EMT joining the EMS team, you will encounter a diverse array of medical complaints during your shifts, ranging from minor cuts and scrapes to severe injuries like bullet wounds. While shadowing your Field Training Officer (FTO), you will have the opportunity to witness and learn how to address each of these situations effectively. The information provided below is meant to serve as a reference guide, aiding you when you're ready to take on the responsibility of treating patients independently. If you have any questions regarding this information, please ask your FTO during training.

CUTS & SCRAPES  - Dealing with minor cuts and scrapes requires a few simple steps to ensure proper care and prevent infection. Begin by cleaning the wound to remove any dirt or debris. Pat the area dry with a clean cloth or sterile gauze. Apply antiseptic or antibiotic ointment to help prevent infection and promote healing. Cover the cut or scrape with a sterile adhesive bandage or gauze pad to protect it from further irritation or contamination. Advise the patient to change the bandage daily and monitor the wound for signs of infection such as increased redness, swelling, or pus. If the wound shows signs of infection or does not heal properly, advise them to seek further medical attention.

FIST FIGHT INJURIES/SMALL FALLS - Dealing with bruises and minor damage to the body caused by fist fights or small falls involves a few key steps to promote healing and alleviate discomfort. Initially, apply a cold compress or ice pack wrapped in a cloth to the affected area to reduce swelling and numb the pain. Elevating the injured area can also help minimize swelling. Pain relievers such as ibuprofen or acetaminophen can be taken to manage pain and inflammation. Advise the patient to rest the injured area and avoid activities that may aggravate the injury, this will allow the body time to heal. If the patient is experiencing severe pain, significant swelling, or difficulty moving the injured area additional tests to rule out serious injuries will be required.

ROAD RASH - Dealing with road rash (a type of abrasion caused by friction against the skin during a fall or slide on pavement) requires proper care to prevent infection and promote healing. Start by gently washing the affected area to remove any dirt or debris. Avoid scrubbing the wound, as this can further irritate the skin. Pat the area dry with a clean cloth or sterile gauze. Apply antiseptic or antibiotic ointment to help prevent infection and keep the wound moist. Cover the road rash with a sterile non-adherent dressing or gauze pad, secured with medical tape or an adhesive bandage. Advise the patient to change the bandage daily and monitor the wound for signs of infection such as increased redness, swelling, or pus. If the wound shows signs of infection or does not heal properly, advise them to seek further medical attention. Additionally, you can ensure tetanus vaccinations are up to date, especially if the wound is contaminated with dirt or debris from the road.

BROKEN BONES - Handling broken bones requires careful assessment, immobilization, and referral for further treatment if necessary. Start by assessing the injury; check for signs of deformity, swelling, bruising, and open wounds. Ask the patient about the location and severity of pain and any movement limitations (slowly rotate/move joints if possible and assess the patient's response). If, after the initial assessment, you believe the bone is broken, immobilization will be required to prevent further injury during additional assessments. Use splints, and slings, to ensure the limb is supported in a position that minimizes movement and discomfort. If there are any open wounds or bleeding, apply gentle pressure with a clean cloth or sterile dressing to control bleeding while maintaining immobilization. If possible, elevate the injured limb above the level of the heart to reduce swelling and minimize pain. A patient will typically undergo an X-ray examination of the injured area to confirm the presence and extent of the fracture. Minor breaks can be handled by EMTs, in more severe cases a Doctor, or Surgeon should be contacted. 

Once diagnosed, treatment for minor breaks usually involves immobilization of the affected bone to allow for proper healing. This can be achieved through the application of splints, casts, or braces. The aim is to stabilize the bone, prevent further injury, and promote optimal healing. Painkillers can be used to manage discomfort during the healing process. Follow-up appointments should be scheduled to monitor progress and ensure the fracture is healing correctly. 

HEAD INJURIES - When assessing and treating minor head injuries, we follow a systematic approach to ensure proper evaluation and management. Start by assessing the injury, is the patient conscious? If they are, ask them questions; how did they acquire the injury, are they experiencing any nausea, dizziness, or blurred vision? How well do they respond, are they displaying signs of confusion, having trouble speaking, or remembering? Next, perform a physical examination, examine the site of the injury, pupil dilation (shine a light into their eyes to see if they dilate), and motor strength (ask them to squeeze your hand as hard as they can). If responses seem normal the patient may still have a concussion but can be released into the care of others who can assist in monitoring symptoms. Unconcious patients, those flitting between states of consciousness, or those displaying worrying symptoms (confusion, lack of pupil dilation, loss of motor strength, etc.) should be referred, to a doctor, or surgeon immediately, for further assessment and a CT Scan/MRI. For minor head injuries without significant findings, treatment typically involves observation, rest, and treatment of the injury site. Patients should be advised to manage any pain associated with the injury with painkillers and monitor for worsening symptoms. If their headache worsens, or they experience confusion vomiting, or passing out then they should return to the hospital immediately, for further diagnostic tests. 

BURN INJURIES - Burns are assessed based on the severity and extent of the injury, considering factors such as location, depth, and size of the affected area. EMTs can handle minor burns, severe burns will require a doctor or surgeon's assistance. Clean the wound gently with cool water to remove any debris and reduce heat. They then apply burn cream and a sterile, non-adhesive dressing to cover the burn and protect it from further irritation. Painkillers can be used to manage discomfort. Patients should be advised on proper wound care and to avoid popping any blisters that might appear. The burn area should be kept clean and dry and dressings should be changed daily until the wound is fully healed.

DROWNING - The EMT should focus on stabilizing the patient's condition while addressing potential complications from submersion. Prioritize assessing the patient's airway, breathing, and circulation (ABCs), and initiate CPR if the patient's heart has stopped, or they are not breathing. If the patient is conscious, they can be placed in the recovery position and monitored closely for signs of respiratory distress (trouble breathing) or hypoxia (low oxygen levels in the blood). Oxygen can be administered via a face mask to raise blood oxygen levels. Patients should be assessed for signs of secondary drowning or water in the lungs, such as coughing, or wheezing; ask them to take a deep breath and listen to their chest. Once stabilized the patient's temperature should be taken, remove all clothing and take steps to raise low temperatures if necessary; wrapping them in warmed blankets, warmed IV fluids, and humidified oxygen. Patients should be advised to rest during recovery. 

STARVATION/DEHYDRATION - Patients who are dehydrated or have not eaten, require treatment to rehydrate and nourish them while monitoring for any complications. Assess the severity of the dehydration or malnutrition. Does the patient have a dry mouth, nose, or eyes?  Is their blood pressure low? Is their heart rate elevated? Are they showing any signs of weakness or confusion? Conscious patients can be given a drink of glucose electrolyte solution. Unconscious patients or those displaying numerous symptoms can be treated with an IV. Reintroduce food gradually, starting with light and easily digestible foods to prevent refeeding syndrome (a dangerous shift in fluids and electrolytes). Continue to monitor the patient's vital signs, electrolyte levels, and overall well-being until they return to a state of hydration and nutritional balance. 

BULLET WOUNDS/STAB WOUNDS - Bullet wounds can be deadly, a bullet can puncture organs, break bones, and cause severe blood loss. Similarly, knives and other sharp objects are capable of damaging internal organs and causing blood loss. When dealing with either of these injuries it is important to first control the blood loss and stabilize the patient. Use gauze or towels to absorb blood, and apply pressure to minor wounds. Clamps can be used for more serious injuries to stem blood flow. Check the patient's vitals, and use an ECG, life support machine, and ventilator as necessary to stabilize breathing and heart rate. When the patient is stable you can fully assess the injury. Has the bullet grazed the patient, has it passed through the body, or is it still lodged inside the wound tract? Is there any internal damage? For stabbing injuries; how deep is the wound? Has the patient sustained any internal damage? Is the wound dirty or clean? An IV can be set up to replace fluids and blood and administer pain relief and antibiotics. EMTs will need their FTO to approve the use of morphine, or other strong painkillers. If necessary, remove the bullet and repair internal damage, clean and stitch the wound. For serious gunshot wounds or knife wounds, you should contact a doctor, or surgeon and ask for assistance. After treatment, the patient should be advised to rest, keep their bandages clean and dry, change their bandages regularly, and refrain from activities that might cause any stitches to split open. 

These are some of the more common injuries you will encounter as an EMT and throughout your career at EMS. As part of your training, you will gain practical experience, in handling these situations. We want you to feel both competent and confident. If you have any questions or concerns, or have anything you would like to discuss regarding the above, please speak with your FTO during training.  

HANDLING DISRUPTIVE VISITORS & PATIENTS 

Dealing with difficult visitors and patients can be challenging but it's essential to maintain a professional, safe, and secure environment. The protocol in place for handling these situations is as follows. 

1. Approach the individual calmly and politely and communicate any concerns, or issues with their behavior. Politely, but firmly ask them to stop. Do not joke, or make light of the situation, the patient/visitor must be aware of what they are doing, or how they are behaving is disturbing the peace of the hospital. 

2. If the individual continues to behave disruptively, ask them to leave the premises. Clearly explain the consequences of their refusal to leave, such as the potential involvement of law enforcement.

3. If the individual persists in their disruptive behavior and refuses to leave voluntarily, contact LEO and ask for assistance. Provide them with all necessary information about the situation and the individual involved.

NOTES: Throughout the interaction, EMS personnel should remain calm, polite, and professional. Avoid escalating the situation unnecessarily and prioritize the safety and well-being of everyone involved.

USE OF FORCE 

If the visitor becomes physically violent or poses a threat to others, EMS Staff may need to intervene to protect themselves and others. Only EMS Staff who are trained and certified in the use of Tasers and handcuffs should consider using them as a means of restraint. Use /911 to alert LEO and never put yourself in unnecessary danger, especially if the individual is armed or poses a significant threat.

DOCUMENTATION 

After the incident has been resolved, document all relevant details, including the date, time, nature of the incident, actions taken, and any injuries sustained. This information should be forwarded to Command or High Command. 

Dealing with problem visitors and patients requires a combination of assertiveness, diplomacy, and adherence to established protocols. By following these guidelines and prioritizing the safety and well-being of everyone involved, EMS Staff can effectively manage challenging situations while maintaining a safe and secure environment.

WHEN TO SUBMIT AN LOA

A Leave Of Absence (LOA) is required if any EMS Staff member will be absent from the department and unable to fulfill their weekly hour requirement (three hours minimum). These LOAs should be posted in the '#┃loa ' section of the emails (Discord). Please include your departure and estimated return dates, and the reason(s) for your leave, you can put 'Private Reason' if you do not wish to share that information. 

This Format To Be Used:

Name:

Date(From-To):

Reason (IC):

Reason (OOC):

LOA can be submitted to cover a maximum of TWO calendar weeks. If you are going to be gone from the department for longer than two weeks you MUST notify either the Chief or the Deputy Chief and provide a valid reason for the LOA. This reason will not be made public, your privacy will be protected during your time away. Regular check-ins are required for LOA lasting longer than two weeks.  

Failure to update or communicate an LOA status could result in disciplinary action. Abuse of the LOA system; taking multiple long-term LOAs without good reason, submitting an LOA back to back with few work periods, etc. may result in your removal from the department. Depending on the terms of your departure, you may be hired back at your previous rank. Long absences from the department regularly result in the necessity for retraining.