LOA/ROA TERMS

• LOA & ROA Form are 100% Confidential. Only HR and Command Team has access to the document. LOA/ROA forms are located in EMS Emails under Human Resource Wing. Notice: There is a 2 month maximum on LOA's. If you need an LOA that exceeds the 2 month limit. You will be removed from Active duty and placed on reserves. Where you will you will retain your rank for the duration. At that point can remain there for a Maximum of 3 months 

LOA

• Leave of Absents

  • At anytime you can't make a shift within 7 Days, Please submit a LOA Form. 

ROH

• Redcution Of Hours

  • At any time you feel unable to make your full hours, Please Submit a ROH Form

EMS Radio Codes

10 Codes

• 10-04 Affirmative

• 10-06 Busy

• 10-07 Out of Service

• 10-08 In service

• 10-09 Repeat last message

• 10-12 Additional person(s)will be riding in the ambulance

• 10-19 Return to HQ

• 10-20 what is your location/Postal

• 10-23 arrived on scene

• 10-26 ETA

• 10-41 On duty

• 10-42 Off Duty

• 10-50 Vehicle Accident

• 10-76 en route to hospital/location

• 10-99 Medic Down

When arriving on Duty

When arriving On To/Out Of service with that we are using In-City Radio channel 8, it is always a good idea to announce yourself.

ie: 501 to control <pause for response> Show me 10-41 and ask for any active call outs - and then 10-42 when leaving the city

Code Calls

• Code 0 = Game Crashed / Your head exploded

• Code 1 = Non emergency/routine/Patient transfer between facilities

• Code 2 = Patient Transfer / Non Urgent

• Code 3 = Urgent Response - Lights & Siren

• Code 4 = Scene Clear

• Code 5 = DOA

• Code 8 = City Police Attending

• Code 10 = Unit in collision

• Code 12 = Errand

Straight talk - If you find yourself struggling with the codes, just say what you are doing, not everyone is fluent in the code system

RP in our City

We want to have great RP within EMS. It does sometimes get repetitive with trap call after trap call at times, so we want to extend the RP when outside of these situations! Try and have a conversation with the patient after revive to ask them what happened. Ask if they need any further treatment. Build relationships with these people so that you can have better interactions over time!

Think about what you will say, think about how you will conduct yourself, and think about how you want it to play out. Create stories and relationships with people. Spend time getting to know people while you are doing your job.

Arriving on Scene / Scene behavior do’s and don’t

When arriving on scene, you must do the following things when applicable.

• Always announce yourself.

• If at a gang headquarters, wait to be invited in.

• If you are told to leave – LEAVE!!!!

• If you are told to just revive a specific gang/person, only do that.

• If they run away after you have revived them, take their name and report it to The Command Team (Fail RP)

• Be polite and keep your cool, you are a professional.

• NEVER enter an active scene (Shots still going)

• Wait for PD to give you the all clear to enter a scene if they are there.

Medical Information

Intravenous Cannula SIZES [G for gauge, smaller the gauge the bigger the needle]

• 24G IVC - BABY Cannula

• 22G IVC - Small Cannula

• 20G IVC - Good for everyone but can be used in massive resus of bleeding

• 18G IVC - Any car related accidents / episodes should use this

• 16G IVC - MASSIVE IVC for bleeding patients

• 14G IVC - EVEN BIGGER IVC - ONLY TO BE USED IN SURGERY SITUATIONS OR MASSIVE BLEEDS

Pain Medications

• Ketamine - Horse Tranquiliser [Great for pain releif and when PD need people to stay]

• Midazolam - Amnesic medicine that makes people forget the last 10 mins

• Fentanyl - Very quick acting medicine that relieves pain

• Methadone - For people who have been selling drugs and need help withdrawing

• Methoxyflurane - Green whistle, that helps with pain - ONLY GIVE 1 PER DAY to a person (As it fucks their kidneys)

• Methocarbamo - Muscle relaxant

Anti-biotics available for EMS use

• Cephazolin - Antibiotic that can be used for anything to cover them

Other Information

• Research some medical things, drugs and terms.

• Have a little thing you do or say that makes you unique. (please stop with fingers in buttholes)

• The better the RP you have the more you will find people calling us out.

• “Ok Sir/Mam, I have slowed your bleeding and I have stabilized you.” If they were 10bpm, you have said they are stable and you can take your time to RP healing them, if they drop below 5bpm(non-revivable), you can still revive them, so long as you have clearly stated that they are now “Stable” when they were within the revive range 6bpm and above.

• Keep it as real as you can, doing non-EMS things during your RP and on duty is just silly, people will give you less RP if they find you just muck around with them.

• Don’t copy how other people do their revives, try and come up with your own ways and how you do it.

Phases of Training

• Interview process and recruitment training at south hospital fire/med academy

• Go through everything and they tag along and just observe.

• FTO tags along and just observes the recruit.

• FTO Recommends the Recruit to FTO Unit Supervisors for an Exit Evaluation.

• FTO Unit Supervisor performs Exit Evaluation and either Passes or Fails the Recruit.

• If the Recruit Passes they will be cleared to ride solo.

• If the recruit Fails the FTO Unit Supervisor will Inform the Recruit and FTO's on what needs to be worked on.

• Recruits will NOT take off the vest until promoted to EMT (400)

Promotions

Please do not ask for a promotion, you wont get it.

• Promotions are not based on time you spend in the city, it is based on RP and service.

• Promotions will also be based on merit and the effort that you give to the department.

• The Command Team Constantly Reviews Employee Performance and will Recommend Employees For Promotion.

RADIO CHANNELS

1- POLICE

8- FIRE/EMS

Emergency Driving

All apparatus shall adhere to the rules of Defensive Driving:

Clearing Intersections:

When an apparatus is approaching a controlled intersection, they shall slow down to a rolling stop and only proceed when it is clear or all traffic has yielded the right of way.

Speed Limit:

All apparatus may travel at speeds that can be operated in a safe and controlled manner at all times.  

 Arrive alive, don’t become another patient due to your driving.

When transporting, take corners slowly and keep in mind you have a patient

Radio Operations

Radio Operations consist of everything transmitted over the radio from when calling in service as your apparatus until you call out of service as the apparatus. Plain speech or appropriate ten code is acceptable. There are many reasons that you would have to call over the radio to dispatchers. Some of these include, but are not limited to:

"FIRE/EMS DISPATCH (APPARATUS NAME) APPARATUS NAME IS” in service

“FIRE/EMS DISPATCH (APPARATUS NAME) APPARATUS NAME IS” responding

“FIRE/EMS DISPATCH (APPARATUS NAME) APPARATUS NAME IS” arrived

“FIRE/EMS DISPATCH (APPARATUS NAME) APPARATUS NAME IS” clearing

“FIRE/EMS DISPATCH (APPARATUS NAME) APPARATUS NAME IS” transporting 

“FIRE/EMS DISPATCH (APPARATUS NAME) APPARATUS NAME IS” out of service

Whenever calling into dispatch, you are to use your unit number. 

• Firefighters/Medics can not respond to any tweets or any text from anyone. We only responded to 911 calls, witnessed emergencies (seeing an MVA, etc.), or LEO request 

Scene Size Up

Scene size up is the initial evaluation of an incident, in particular an immediate evaluation of hazards to responders, other lives, and property, and what additional resources may be needed. The first arriving unit should paint a picture of the scene to any other responding units and provide the Dispatcher with as much information as possible about the current incident. If hazards are on scene making it unsafe (downed powerline, live RailRoad tracks, leaking gas or water lines, etc.) then the necessary utilities or agencies should be contacted to make the scene dangers neutralized. This is most often done using “/ooc calls power company to shut power lines off” and then you can proceed on scene.

Incident Command System (ICS) 

The Incident Command System (ICS) is an organization system used on any emergency scene to distribute resources to work on multiple jobs at once and to separate responsibilities between all units on-scene. When arriving on-scene, The first unit on-scene performs a size up and takes command, and remains as command until on-duty command staff in another apparatus arrives on-scene or when the Command vehicle arrives on-scene; they will take command. Ex: “Engine 50 on-scene of a 2-story residential structure with flames showing from the roof. Engine 50 will have Panorama Command”.   

Boat Operations 

There may be a potential for Fire and EMS to use a boat to reach injured persons that are out to sea or in the middle of a lake - not easily accessible from the shore. It is at this point that we can deploy our water rescue unit and or the Game Warden vessel, as we have a contract with them to utilize their vessel. FD/EMS personnel must wear a personal flotation device at all times. If there is a need to transport a patient to shore to an awaiting ambulance. If the vessel  is going to be used to transport a patient to an awaiting ambulance on shore, it is up to the driver to take into consideration the patient when determining the speed and roughness of seas.  

Motor Vehicle Accidents

There should be a minimum of 1 ambulance and 1 fire apparatus, if a fire apparatus is not available an ambulance must respond. Proper placement of your vehicle at a traffic accident is at a 45-degree angle, taking up the initial lane of the accident plus 1 lane to ensure safety of all personnel on scene.  The ambulance should be parked downstream of the incident where the back of the ambulance is facing the incident for ease of patient loading. If the MVA is not blocking the flow of traffic and there is room to work. We shouldn’t attempt to block traffic.

Critical care unit

Designation: Critical care (unit #). The critical care unit is an ALS unit designed to offer ALS care by paramedics to scenes where there is: an ambulance already on-scene without a paramedic or to offer first responder assistance with an ambulance already on the way. They can also do intercepts with an ambulance carrying a BLS crew to offer ALS assistance on a call/transport. If the patient requires ALS care with a 2-manned EMT crew, then one of the EMTs may switch with the medic and FOLLOW the ambulance to the hospital while the medic is handling patient care in the back of the ambulance. When responding in the critical care unit, the ambulance has a single EMT on it. If necessary, you may leave the critical care unit on-scene and go with the patient and treat them while en-route to the hospital, or you may ask law enforcement to secure the vehicle at the sheriff's office. If there are multiple victims needing priority transport, the critical care unit should be avoided and an ambulance should respond in lieu of.

Airmed

Airmed must only be operated by paramedics and said operators must have shown proficiency in flying the medical helicopter. Airmed is a valuable resource to the medical team in being able to render aid by arriving on scene rapidly. The pilot shall coordinate with ground law enforcement units to ensure a safe and clear landing zone is created 

Levels of care

Level I: A Level I Trauma center is typically a teaching hospital with a major trauma center. Usually take things that are serious and life-threatening here. Will have all doctors needed to handle all body systems on call and stationed at the facility ready to treat.  

Level II: A level II trauma center can do the same things as a Level one but isn’t a teaching hospital. Most likely will not have a psych ward or neurological doctor on call.   

Level III: A Level III Trauma Center can provide prompt assessment, resuscitation, surgery, intensive care and stabilization of injured patients and emergency operations.

Level IV: A Level IV Trauma Center can provide advanced trauma life support (ATLS) prior to transfer of patients to a higher level trauma center.  It provides evaluation, stabilization, and diagnostic capabilities for injured patients.

Level V: A level V trauma center can provide immediate stabilization and transportation to a higher level of care facility (clinic)

Patient refusal 

A patient, at any point, can refuse treatment if they are alert, oriented, are able to make sound decisions, and are not impaired. Depending on the patient’s presentation and complaint; it is the job of you, the Medic or EMT, to give your best advice to the patient. This means if a patient does refuse, you are required to get paperwork showing they do not want to go to the hospital against your advice.  

Death Declarations

Paramedics and EMTs can be called out to a scene to declare a Patient dead. This is done by checking for a pulse on the wrist and neck, then connecting a monitor/ 12 lead ECG (for paramedics) to check for any sign of cardiac activity (if activity is found, start CPR), and lastly stating TOD and calling for the county coroner to confirm and take the body. The patient is obviously dead if: they have started Rigor Mortis, they have started the decomposition process, or their injuries can in no way support life.

Crime scene care

When found in a position of providing care after a criminal act has occurred, be sure to preserve as much evidence as possible.  What this means:

1). If a patient appears to be deceased, check vitals and nature of injuries; if their injuries aren't conducive to life and they don't have any life signs, leave them be.

2). If a patient is shot or stabbed, cut the clothing in a way to avoid the injuries made by the weapon to get access to the working area.

3). Do not touch anything that isn't necessary to care for the patient.

4). Do not walk through fluids unless necessary to get to a patient.

5). Any one-use items you used on a patient that becomes deceased should be left with them and not removed.

Patients in Custody

If a patient is in custody, ensure you inform law enforcement which hospital you are transporting to. If the patient is a minor all attempts shall be made to contact a legal parent or guardian, if no contact can be made the patient shall be released to law enforcement custody..

Taser prong removal 

Should be conducted by EMS personnel only. 

Procedure for removal is:

1. Hold the skin around the barb,

2. Swiftly pull it out, if bleeding use 4x4 to clean, and

3. Place bandaid over the affected area

Scene of Violence

Staging

Units shall stage 2 blocks away from an active law enforcement scene until notified it is safe to respond. Under no circumstance should you respond to an active scene of violence.

Public Danger/Threat Policy

In the course of your duty, if you witness a person doing something that could endanger the public or if you witness someone acting in a threatening manner to a member of the public; then you are to notify law enforcement and not intervene. You are not to intervene, detain, or citizen’s arrest a person. We are not law enforcement; therefore, we don’t enforce the laws. If a fire/ems unit attempts a traffic stop on any citizen you will be removed from the department immediately and authorities will be notified and you will be charged criminally.