1. When possible, no medical responder shall provide care to a minor, or to a patient of the opposite gender, alone in an enclosed room. In a life-threatening incident, as soon as possible the first caregiver shall deputize another person until a second medical assist team member arrives.

2. Multiple Responders: The minimum level of licensure does not prohibit a licensed EMT, Paramedic, RN or physician response during an incident.

3. If a medical responder higher than EMR-level certification is present either as scheduled or last-minute involvement, a higher level of care may be administered to the patient provided the higher level of response is

(a) is consistent with the availability of unexpired medical equipment or supplies, and

(b) is consistent with NDEMS common procedures and practice for the responder’s level of certification.

4. During a medical incident requiring a 911 response (see 8 below), if an unscheduled or visiting medical responder volunteers during the incident, the scheduled Century Medical Assist Team is encouraged to use said volunteer’s expertise related to the specific care of the patient. Said volunteer shall not be given full incident responsibility, but shall be allowed to focus on patient care with the Century responders.

5. When more than one medical responder comes to the aid of a stricken person, the responder with the highest level of medical certification will lead the care plan.

6. Multiple patients: If multiple persons need care at the same time, MCI response shall be followed, with a competent EMR or higher level of training providing medical incident command until relieved by ambulance service incident command. This will allow responders with higher certification to render higher level of care to those stricken.

7. Patient reporting to Ambulance Crew: Once the ambulance service arrives on scene, the Medical Team will give report to the arriving crew and allow the ambulance crew to assume oversight of the incident. The responder with the highest level of certification and who has been an active part of patient care, shall give report to the receiving ambulance crew.

8. Mandatory 911 call: The following incidents shall automatically trigger a 911 request for ambulance response. If a patient or patient’s guardian states no ambulance, an ambulance shall nevertheless be called, with the opportunity for the patient or guardian to sign a refusal of transport provided by the responding ambulance.

   1. • Any life-threatening condition (A-B-Cs)

      • Known or suspected cardiac incident

      • Known or suspected respiratory crisis

      • Altered mental status of any kind

      • Any known or suspected acute allergic reaction or anaphylaxis emergency

      • Head trauma or head strike

      • Loss of consciousness

      • Known or suspected compound fracture

      • Any substantial damage to extremities or sensory organs

      • Any 2^nd degree burns over more than 5% of body, and all 3^rd degree burns

      • OB emergencies

9. If a patient or guardian states for the medical team not to call an ambulance, but one of the conditions listed above exist, 911 will still be called and the patient or guardian will be instructed they can sign a waiver with the ambulance crew. In no case shall the Century medical assist team decline or permit waiver of response. Only the ambulance crew can offer such a waiver to the patient or guardian.

10. Initiation of Care by Unlicensed Person: In the event of a life-threatening health emergency, to the extent allowed by state statute, if a person other than a medical assist team member has initiated care, the responding medical assist team member(s) shall work with the initial caregiver to assure knowledgeable transfer of care into the hands of Century’s medical assist team. If the initial caregiver wishes to continue helping, the Century medical assist team may deputize said person for the remainder of the incident if it is in the best interest of patient care.

11. Who may use AED: To the extent allowed by state statute, no one will be prohibited from initiating CPR or proper use of an AED. As soon as possible, a member of Century’s medical assist team shall assume patient care in such instances, until an ambulance crew arrives and the patient is transferred to their care. It is our desire that anyone performing CPR be current in their CPR certification.

12. Movement of a patient: If a patient is on the ground and the cause is unknown, and if no witness can verify that the fall was not related to a trauma incident, the patient shall not be moved but shall be treated in place until the ambulance crew arrives.

13. If the patient is to be stabilized via longboard or similar device, and in absence of appropriate devices on hand, Century medical team will initiate C-spine protection throughout patient care, and may assist ambulance crew members in placing the patient on long board if the crew desires such assistance.

14. If a patient is conscious and has not suffered a possible trauma, the patient can be assisted to the front foyer, or to the closest numbered doorway for further assistance.

15. If the conscious person is unable to stand but no potential for skeletal injury is present, the patient may be moved to the front foyer or to a numbered doorway via wheelchair. A wheelchair is located in the ushers’ room, right-front door into the main sanctuary.

16. If the patient can stand and walk, the patient may be assisted on his or her own to the front foyer or numbered doorway, and then be seated for further evaluation and treatment.

17. Incident Reporting: For every patient contact a PCR shall be completed by midnight the day of the incident and given to the EMS coordinator, the ERT Director, or the Century Director of Operations (or designate). The church Director of Operations will be guardian of all PCRs, and will work with the ERT Director to provide PCR retrieval for review when legal, ethical, appropriate, and necessary.