STANDARD OPERATING PROCEDURES

1.1 MISSION STATEMENT

Emergency Medical Services (EMS) believes truly and wholeheartedly in accomplishing what is expected by not only its administration but the community as a whole. EMS lives and serves by the following statement:

“To provide compassionate, efficient, and effective healthcare built around the needs of the patients and communities that we serve through blood, sweat, and tears.”

1.2 VISION AND VALUES OF EMS

For utmost efficiency and professionalism, following the missions and values of the department is a must for all employees, dedicating their lives to the citizens of Los Santos while working unbiasedly in solidarity with the public. Clearly following the vision and the values of the Hospital is the first step to being a valuable asset to the city:

“Together, we will provide an effective and constant service to the city while in cooperation with law enforcement and other city services. Through continuous efforts, we shall maintain the following values: Respect, Ethics, Discipline, Understanding, and Safety.”

The EMS Staff Commits To:

• Be the stellar example of a law-abiding citizen, following the city’s laws at all times.

• Keep the standards of the hospital to the highest by any means necessary.

• Respond to every and each call, facing danger in cooperation with law enforcement.

• Be aware of what happens within the community and the city.

• Have exceptional decision-making skills during crises and disasters.

• Keep communication skills to a high standard. 

• Never judge anyone based on skin tone, religion, sexual orientation,  background, or gender. 

2.1 CODE OF CONDUCT

Active Members Of The EMS Must:

• Follow the city’s laws at all times.

• Be polite, respectful, and professional in all situations.

• Keep radio communications as clear as possible.

• Pay attention to dispatch, never muting the radio unless strictly necessary.

• Respond to 311 + 911 calls efficiently and effectively.

• Stay alert during scenarios and be aware if a call is safe to go to or not. For example, an officer-down-call or a call with multiple LEOs on scene requires communication with the respective LEO department first to make sure the scene is Code 4.

• Avoid dangerous situations unless backed or permitted by Law Enforcement.

• Provide their call sign if requested, but they are not obligated to provide your name unless asked by an LEO.

• Always wear the appropriate uniform provided to them unless stated differently by the Chief or Deputy Chief.

• Return their ambulance/emergency vehicle to the garage when they are done with their shift.

• Clock in for at least 3-4 hours a week

• Remember that equipment is not for fun

• Wheelchairs should be for people who actually need them due to injury not just so they can have one.

• Always bring patients back to the beds (ER), no matter the injury.

Active Members Of EMS Must Remember To Never:

• Be clocked in while not performing your duties as a Medical Team Member.

• Take part in ANY kind of criminal activity.

• Take possessions from any individual, be it a patient or not.

• Get involved in any unnecessary confrontations with the public or other services.

• Use the MDT or Dispatch to tell people/friends of any police activity/knowledge.

• Carry a firearm or dangerous weapon on duty unless qualified and approved by High Command.

• Give out prescription medication without the necessary rank and protocol.

• Use tasers or handcuffs without having proper training.

When an injury is caused that may keep you from working at your 100% please keep these in mind before clocking on duty:

• After being checked up by a Nurse+ and you are not cleared for duty you are not allowed to clock in. A report will be made about your injuries as well as why you are not allowed to be on duty and when you can come back.

• If you are cleared for light duty but have restrictions then you can only clock on with someone else so they can do what you cannot. EMTs can be in place of yourself as long as they are ready to treat patients. If no one is on duty then you cannot clock in.

• Take care of yourself before you take care of others, it is ok if you need to take a few days off to heal. We need you at your 100% so you can give your 100%.

**Everyone is to follow the rules and regulations of HIPAA.**

2.2 USE OF FORCE

As an employee of EMS, it is essential that we cause as little harm as possible - even if our hands are forced to do so. We have the right to defend ourselves as a last resort, but doing so in an excessive manner would go against our mission and vision. Employees are permitted to defend the patient, yourself, or others with a blunt object such as a Flashlight, but nothing that would cause too much damage. The use of Tasers and handcuffs is permitted by LEO training only, after training can patients be defended.

In no case at all, unless specifically authorized by Command or High Command are EMS Staff allowed to carry firearms or other lethal weapons on duty. Carrying/showing off any of those weapons while on duty will result in but are not limited to possible penalties such as strikes, suspensions, or terminations.

For Search & Rescue calls, the Fire Department needs to be contacted since they are trained for S&R. If they are not available the Coast Guard (USCG) or the Fish and Wildlife Department (USFW) should be called for assistance before responding to the call as a qualified Medical Staff member (typically pilots). Those who have a VALID weapons license, and are S&R cross-trained are allowed to conceal carry a registered pistol for self-defense against wildlife only when out in the woods. Once they return to their appropriate station from the call, they must put the weapon back in their locker. At any other time, Medical Service employees must only have a taser on them for self-defense and/or radio LEOs for assistance when dealing with locals/citizens.

Notice: Do not engage in gunfights anywhere at all. Move to a safe location and request 78s if you hear any gunfire that has not already been noticed by PD.

Disclaimer

Any reports of active Medical Team members getting involved in police situations, exhibiting excessive harm or force, or causing unnecessary confrontations may result in disciplinary actions including, but not limited to, strikes to their employee record and/or removal from their respective departments. Getting involved in active police situations without permittance not only risks your life but also the lives of the officers and citizens as well.

2.3 DISCIPLINARY ACTIONS

The EMS Team utilizes a three-strike system. Should you be found violating any portion of the Standard Operating Procedures, you may face disciplinary actions varying on the severity of the violation. These can include, but are not limited to:

• A strike on your record.

• A ‘Verbal Warning’ by your Department Head, Chief of Staff, Deputy Chief, or Chief.

• Immediate removal from the department.

If you are spoken to and given a strike, you should contemplate what you have done and correct your behavior for the future. Once you receive your third strike, the Command Team will review your record and will decide whether or not you will be removed from the Department.

Each strike expires automatically after 1 month or can be removed if it was determined unjust, only if the striked staff member shows signs of improvement.

If you are deported from the city, be it on your Medical Services/LEO character or criminal cousin, your deportations do not go unpunished. You will face consequences that could lead to dismissal from the department depending on the following:

• Number of deportations

• Severity of the deportation

2.4 LEAVE OF ABSENCE

If you are going to be leaving the city for an amount of time that will cause your minimum weekly hours not to be affected, it is required to post a Leave of Absence in the appropriate channel in Discordia. Please make known the dates including your departure and estimated return, and the reason(s) for your leave (If you want it publicly known if not then tell Command or put in “Private Reasons”).

This Format Shall Be Used:

Name:

Date(From-To):

Reason (IC):

Reason (OOC):

Your return will be expected after the return date ASAP. Should you not return in an appropriate amount of time after your stated return date, someone on the Command Team will reach out to you. 

You may have a maximum of two calendar weeks for your LOA in one request. If you are going to be gone from the department for longer than that time limit, you MUST notify the chief or deputy chief with a valid reason. These reasons will not be made public to the rest of the team as privacy will be protected during your time away. Regular check-ins are required for leaves longer than two weeks.

Failure to update or communicate an LOA status could result in disciplinary action. If it is deemed that you are abusing the LOA system by taking too many long-term departures, you may be requested to leave the department. Depending on the terms of your departure, you may be hired back at your previous rank.

2.5 LIVE STREAMING BODY CAM "TWITCHY EYES”

Medical Team members are recommended to have their live body cameras turned on. Information from any type of Body Cam (Medal, obs, twitch) may be used in cases of violence, breaking government rules, or reporting any First Responders for not following SOPs or similar.

3.1 RADIO PROTOCOL

While on duty, it is crucial to be on an appropriate radio channel. Dispatch is used for radio communications only, it is not a chatroom to talk with people casually, so stay professional at all times. 

If you catch anyone from Law Enforcement being rude or unprofessional towards another service member, report the incident to your immediate superior.

Highway Patrol & LSSD - Radio 1

LSPD - Radio 3

EMS & FIRE - Radio 5

USPR (Park Rangers) - Radio 6

Coast Guard - Radio 7

DOC - Radio 8

Federal - Radio 9

Towing - Radio 10

Important: The highest ranking staff On Duty answers phone calls and radios unless busy or asking someone else to do it. However, If any EMTs are clocked in they will answer radio calls (and go assist) unless it's requesting a higher ranking.

3.2 10-CODES & COLOR CODES

Make sure you know and understand the proper 10 Codes. Make sure to use the respected color code for the proper scenarios. Respect 10-3s, 10-33s, 10-99s, and Signal 100 (priority information only), if they call a Signal 100 you do not speak unless STRICTLY necessary or spoken to (extremely valuable information to the ongoing scene, etc). Also, make sure in emergency scenarios to make sure the law enforcement calls out Code 4 before going into the scenarios.

4.1 LAW ENFORCEMENT & ACTIVE SCENES

Contacting LSPD: On some calls, you will need to request Law Enforcement assistance over the radio/dispatch (for example M-01 can I get a 10-78 to my 20 (10-20)). 

Listed below are a few instances where Law Enforcement assistance is recommended:

• When attending to a call at a known dangerous location.

• If you’re going to a call with gunshots reported.

• Suspicious or criminal activity happening at Pillbox Hill General Hospital or other medical locations

On rare occasions, you may feel like your life is at risk. Your radio is equipped with a Panic/Emergency Button in the F1  Work Menu - it will ALERT all other service members to your location, or think /panic. 

Only use this in extremely serious emergencies.

4.2 HANDLING ACTIVE LAW ENFORCEMENT SCENES

On calls that involve active scenes, Law Enforcement members will take the lead role in assessing and diffusing the situation. Listed below are a few instances of Active Scenes.

• A civilian down is surrounded by LEOs.

• A robbery [10-90] is taking place.

• A gunfight is occurring.

• A hostage situation is ongoing.

• Officer/Trooper down calls

A few notes to remember during Active Scenes:

• Do NOT enter the scene of a situation that you are not involved in until you get a Code 4 from any Law Enforcement.

• You should be no closer than 2-4 blocks from a situation.

• You MUST be Code 2 (Lights Only) when you are waiting on a scene.

• You can only enter a scene when told the situation is Code 4 (Scene Secured) or otherwise given permission by on-scene Law Enforcement.

• If a First Responder is down, you MUST ALWAYS respond to the First Responder before anyone else.

• Do NOT revive someone who is a part of a situation without permission from on-scene Law Enforcement.

• Stabilize ALL criminals on the scene before moving them into the ambulance/EMS vehicle for transport.

At no time can you respond to a situation where all officers have been downed on the scene and/or there aren't any officers to deem the scene code 4.

4.3 WORKING WITH OFFICERS STATIONED AT A MEDICAL FACILITY

To tackle possible harm caused by violent activities near or inside medical facilities to EMS staff members, LEOs will be stationed more often at Medical Facilities. All LEOs are to be treated kindly and with respect (offer drinks and food, be polite, etc.).

LEOs will be able to deal with any kind of disturbances around the Medical Facilities. This includes but is not limited to:

• Handling violent situations

• Enforcing trespassing orders

• Enforcing parking violations

5.1 HANDLING ACTIVE SCENES

When you arrive at the scene:

If the Patient is conscious:

• Greet them and ask them what happened and how they are feeling, treat the patient as normal.

• If the patient is not a suspect, release them at your own discretion.

• If the patient is a suspect, release them into police custody.

• Do not release a detained suspect without an officer present.

If the Patient is seemingly unconscious (not flat-backed but if the patient is in their head etc.):

• Announce you’re there, and ask if they can hear you.

• If there is no response, proceed to check their pulse.

• If there is still no response, treat any injuries present.

If there’s no response, then check their pulse and use an IFAK to stabilize them. If a patient appears dead, proceed to bring them to the hospital for appropriate treatment or procedures.

“Scuffed”

Sometimes when we get on scene people can be "scuffed", those who were stuck in trunks or just having a tornado effect. If these are happening to your patients here's what to do:

• If possible move them to a safe area, out of the middle of the streets

• Treat them with a first aid kit with the understanding that they will be coming back with you to the hospital

• Once standing help them to the ambulance and bring them to the hospital

• Guide them to the bed and treat them as you normally would

• If they have a tornado effect, treat them on the scene as normal to a hospital after requesting them to fly out to fix their injuries.

5.2 DO NOT RESPOND TO

Calls in the prison unless escorted by Law Enforcement Officers who make sure it's clear. Any calls that show active police presence around, reach out to officers first for a code 4. Paramedics may be standing by a few blocks away (see 4.2)

5.3 HANDLING END OF LIFE

It is recommended that patients first reach out to Doctors+ first when wanting to perma.

If the patient is dead and wants to perma/morgue:

• Bring the patient to a private room upstairs

• Contact next of kin if possible

• If family or friends came with them let them know and let them see the patient 

• Escort the patient to the coroner's office at postal 836.
  Doctor (or above) is around, they can /morgue next to the patient.

• If none are available, the patient will just have to fly out or schedule a morgue later

If the patient is in critical condition:

• Bring the patient to surgery rooms and attempt emergency surgery
  Bring the patient to a private room upstairs

• Contact next of kin if possible

• If family or friends came with them let them know and let them see the patient 

• Escort the patient to the coroner's office at postal 836.
  Doctor (or above) is around, they can /morgue next to the patient.

• If none are available, the patient will just have to fly out or schedule a morgue later.

5.4 HANDLING AUTOPSIES

A person who has passed in our arms is never a good experience, then having to prepare their loved ones and get their bodies ready to morgue them. During this time people can pass, by unnatural means like being murdered. So to prepare for such a need for a forensic autopsy below are some processes we and LEOs must go through. They are the ones who can request forensics from us. We will respond to the scene as normal, with an ambulance. If possible please bring another Doctor+ as one can handle the body while the other writes the report. Below is the process in which we must follow:

• PD must be on site and must clear the area by blocking it off with barriers or their cars.

• No one should touch the scene or the body until you have

• Move over to the body and make sure it is DOA, dead on arrival, once that is said you may start looking over the body

• Make notes of everything on the body, unnatural markings, anything on the wrist or neck, bruising on the hands, etc

• Based on their injuries and the location you can then determine how they died (stab wounds, GSWs, etc.)

• Once you have determined that it was not an accident, you will give the police your field report before moving the body to the morgue

• Again you will look over the body and perform the normal actions for pre-morgue the body

• Once your report is finished and you are done with the body you must give your report to the police

IF ANY OFFICER ISN’T STAYING PLEASE REPORT THEM TO HIGH COMMAND ASAP

6.1 RANK-BASED VEHICLE PERMISSIONS

There are certain ranks associated with the vehicles that EMS has access to. It is crucial for medical staff members to be aware of which vehicles they are allowed to pull out in regard to their rank. Listed below are each vehicle that EMS has in the garage as well as the rank correlated to each respective vehicle’s access.

Ambulance- In order to pull out an EMS ambulance and operate it, you must possess the rank of Advanced EMT. EMTs are permitted to pull ambulances out and operate them ONLY if there is an FTO clocked in and riding with them.

Medical Cars and Trucks- In order to pull out medical cars and trucks, you must be an Advanced EMT. This vehicle is ONLY to be used:

• To run EMS-related errands when having the rank of Paramedic or higher.

For your own transportation to a call in Sandy or Paleto (Must switch to an Ambulance in Sandy or Paleto if going to end up transporting a patient),

• When EMS is requested for events. 

• As for high-ranking staff, you are allowed to respond to a scene when requested by lower-ranking SAMS members, LSPD, or any citizens who have valid reasons to speak to a supervisor.

Helicopter- In order to pull out and operate an Angel Flight helicopter (Callsign Angel Flight 1), you must be; A) ranked at least FTO, B) legally licensed to operate a rotary-winged aircraft. (To request flight school within the Hospital, contact a member of the command team to discuss details.) C) Finished a check-up flight training with one selected command member.

6.2 DRIVING ETIQUETTE

When driving an EMS vehicle within the state of San Andreas certain rules must be followed at all times as part of the city’s emergency services. Below is a list of the main outlines that are expected of every member of the Hospital (EMS) when on the road.

• When on the way to any call, your lights and sirens MUST be on.

• When lights and sirens are on, you are allowed to drive at speeds that exceed the posted speed limits, as well as run any stop signs or red lights that you encounter.

• Citizens who make a valid attempt to get out of the way of EMS vehicles are NOT liable for being hit by our vehicles, no matter when or where they may be. If we hit them and it’s proven that the Hospital (EMS) is at fault, then we run the risk of having a lawsuit filed against us. Consequences will follow for whoever is at fault within the department.

• If you go to a call with an ambulance, or to a hospital call with a marked vehicle, ALWAYS use your lights and sirens. This indicates an emergency situation and is the best way to warn pedestrians and drivers.

• Always be aware of your surroundings, even when having lights and sirens some people might be listening to music and are not able to hear you or simply ignore signs of you approaching. Make sure to drive safely to avoid any accidents. Be incredibly careful around intersections as they can be particularly prone to accidents.

• If you transfer from one hospital to another, you may still use reasonable speed over the posted limit to get to the location quickly as assistance is needed there, however, the lights need to be active to show other drivers that this is a duty-related action. This includes driving back to Pillbox after finishing a call in Sandy/Paleto or 10-19.

• If you are on a non-emergency call, this includes ambulance patrol, picking up food orders, picking up EMS staff that had a Code 0, changing outfits, etc. do NOT use lights or sirens. If no emergency is going on and you are not heading to a hospital you must drive the speed limit and obey traffic laws. Do not abuse the privilege of lights and sirens to help ensure that public trust and safety are guaranteed.

• Communication with team members is key. Accidents can happen to anyone, but make sure to communicate over the radio if you have a heavy crash, your vehicle flipped, you need a repair kit, etc.

• Be polite. If you accidentally caused a crash with a civilian, make sure to apologize to them if you are able to and make sure they are okay - offering on-site treatment if necessary.

7.1 EMT'S

EMTs have a two-week period from when they are hired to receive proper training in order to get promoted to Advanced EMT. All EMTs must be accompanied by an FTO when on duty to receive training. EMTs cannot clock in by themselves for any reason, they need an FTO or higher.

7.2 FIELD TRAINING OFFICERS

Field Training Officers (FTO) are experienced Paramedics who have been entrusted with training trainees and supervising probationers.

All EMTs must be accompanied by an FTO when on duty to receive training. (EMTs are allowed to go on a ride-along with Paramedics who are not FTOs but are NOT allowed to do treatments. The ruling stands on Paramedics who are offering ride-alongs. 

Once you have been deemed ready to receive a promotion, Command will contact you about becoming an FTO. 

• FTO in Training can have 1 EMT on duty with them, but no more.

• FTOs can have up to 2 per FTO on duty (3 if first spoken with command).

7.3 RIDE-ALONG

We are more than happy to bring civilians in on a ride-along. It's a good way to show them how we do our job and better interest them in applying to be EMS. Below are some rules to follow:

• Ride-alongs must be approved by High Command before being taken on one

• Ride-alongs must have their records checked, we can't hire felons so they can't have ride-along unless signed by a judge

• Weapons must be removed by them

• While responding to calls ride-alongs must stay in the vehicles at all times, for their safety

• Ride-alongs must be respectful to the patients while you are treating them

• If a patient requests the ride-along to leave the treatment room, they must comply

• Anything the ride-along does falls on you, you are held responsible for their actions

7.4 EMS COMMAND

Oversees all operations and administration within the department. Responsible for representing and advancing the interests of the department with outside agencies.

Responsibilities:

• Keeping Standard Operating Procedures up to date.

• Improving Medical Services with new systems.

• Organising Medical Services Divisions.

• Includes all Supervisor's Responsibilities.