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San Mateo County Operations

POLICY #: 001STARCARE

DATE 17 Aug 2011 APPROVED BY: Brad WhiteGeneral Manager

AMR STARCARE Values

In order to meet our service goals and operate in an effective and harmonious manner,certain rules of individual performance and behavior must be established and followed by allemployees. By and large, these are included in this manual. Certain additional unstatedvalues, which are dictated by reasonable judgment and behavior, must also be followed. .

S Safe: Were the actions safe-for me, my colleagues, for other professionals andthe public?

T Team-based: Were actions taken with due regard for the opinions and feelingsof my co-workers, including those from other agencies?

A Attentive to Human needs: Did I treat my customer as a person? Were theykept warm? Did I use their name throughout the call? Did I tell them what toexpect in advance? Did the family receive similar respect?

R Respectful: Did I act toward the customer, colleagues, co-responders, hospitalstaff and the public with the kind of respect that I would want to receive myself?

C Customer accountable: If I were face to face right now with the customers Idealt with in this response, could I look them in the eye and say, “I did my verybest for you?”

A Appropriate: Was my care appropriate-medically, professionally, legally, andpractically, considering the circumstances I faced?

R Reasonable:Did my actions make sense? Would a reasonable colleague of myexperience have acted similarly, under the same circumstances?

E Ethical: Were my actions fair and honest in every way? Are my answers tothese questions honest?

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San Mateo County Operations

Policy #: 002Communications Protocols;Cell Phones and Landlines(Company and Personal)Portable Radios, Pagers

Approved By:Brad White

General Manager

Updated: 17 Aug 2011

I. PURPOSE

To establish and define a standard policy for the use of company ownedtelecommunications equipment. It is the paramount duty of the crew to keepthe communications dispatcher informed of the correct unit status at alltimes. Providing incorrect information to the communications dispatchercould be deemed as intentional placing the general public at risk, whichcould fall under the classification of “willful” and “gross” misconduct.

Employees shall not question the appropriateness of any dispatchdirective and shall not delay complying with said directive. However,when a crew believes they are significantly closer to a response addressthan the unit originally dispatched, they will advise communicationstactfully and respectfully of the situation and then comply with thedispatchers further instructions without delay. Should a situation ofabove nature occur the crew shall submit an incident report validating theevent and submit within twenty four (24) hours. Contact the on-duty FieldSupervisor and or submit a System Status Feedback form on the websitewww.smco-ems.com.

In order to meet performance criteria, it is expected that each crew respondto instructions of the dispatcher with gestures of courtesy and professionalverbalization. All radio traffic will be free of unprofessional comments andconducted in strict accordance with FCC regulations, local government andcompany policies.

Some examples of professional conduct guidelines:

1. Listen before keying the microphone for other traffic.

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2. Keep your tone of voice constructive.

3. Use secondary channels only when necessary for facilitatingcommunication during exceptional scenes.

4. DO NOT intentionally key up the microphone while anyone else istransmitting, regardless of your opinion of their transmission.

5. DO NOT make strange sounds or extraneous microphone-clicks at anytime.

6. Professional radio conduct is required at all times. Use of slang and/orunconstructive methods of communication on the air or via phone is notacceptable.

7. Use of profanity, obscenities, slurs, slang, disparaging remarks, or anyother unprofessional verbiage is strictly prohibited.

8. Contacting dispatch with complaints is prohibited. All disputes shall bedirected to the on duty Field Supervisor

II. PORTABLE RADIOS/PAGERS

It is the responsibility of both the crewmembers to keep their assigned

portables with them at all times, turned on and functioning when the

crews are out of the unit, including the station.

Each crewmember will have their pager with them at all times while onduty. Pager must remain turned on and functioning throughout the shift.Immediately report any malfunction or damaged pagers or portables tothe duty supervisor.

III. FIRE RADIOS

The crew shall make certain that it is in working order. Crews areprohibited from removing or altering the equipment (microphones, etc.)in any way. Crews are responsible for operating fire radios inaccordance with the MCI policy.

IV. RADIO USE PROTOCOL:

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Secondary channels are for official use only.

All units will identify themselves by the proper unit ID at everytransmission.

Any time a unit moves from operations, station, hospital, post, scene,etc., the crew will notify dispatch of their status.

All units are required to report when they go en route, arrive on-scene,transport, arrive at destination, and when the call is completed.

Crews will advise dispatch when possible prior to entering and clearingany known “dead zone area”.

If crew experiences any radio coverage “dead zone”, radiomalfunction, or other problem they must utilize other available meansto communicate. These may include:

Landline, if available;

Message relay via an allied agency on scene with your unit;

Cell phones.

Units should advise dispatch that they are “on-scene”.

Unit actually arrives at the scene, or arrives at a staging orstandby location

Unit is having difficulty in locating correct address or housenumbers should advise dispatch “on-scene in the area”.

Units delayed for any reason should notify dispatchimmediately. Advise nature of the delay (train, heavy traffic,road closure, detour, off-road, or severe weather) and whenclear of the obstacle or delay.

If the unit will be extended on-scene or at the destination, theunit must contact dispatch to notify of status.

Units will advise dispatch upon arrival at destination, which isdefined as wheels stopped. If delayed due to hospital (no EDbed available, etc) the crew must notify dispatch of the delay as

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soon as possible. The System Status Plan will be adhered toby all employees.

V. CORRECTIVE ACTION

Employees covered under the Paramedic Collective BargainingAgreement; refer to Article 6.

Employees covered under the Northern California CollectiveBargaining Agreement; refer to Article 5.

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San Mateo County Operations

Policy #: 003Controlled Substance UseDocumentationRe-Supply

Approved By:Brad White

General Manager

Updated:17Aug2011

I. PURPOSE

To establish the expectations of employees and supervisors regarding the use,documentation, and restock of controlled substances, so that AMR San MateoCounty is in compliance with various Federal, State, and local regulations.

II. DEFINITION AND USE

The controlled substances currently being used in San Mateo County are Morphineand Versed.

Controlled substances will be administered as directed by San Mateo County EMSpolicy and protocol. Any usage outside the parameters of the San Mateo CountyEMS policy or protocol must be approved by a physician via base contact anddocumented as such.

Each ALS unit will be stocked with Morphine Sulfate and Versed when in service; toinclude all ALS system units, ALS standby units, ALS surge units, SMART, and theALS supervisor.

The par levels for each unit in regards to controlled substances are: Morphine Sulfate: 50 mg (5-10mg preload vials)

Versed: 8mg (4-2mg vials)

The minimum amounts of controlled substances a unit must possess in order toremain in service are:

Morphine Sulfate: 20 mg (2-10mg preload vials)

Versed: 2mg (1-2mg vial)

No AMR personnel shall use or administer Fire Department controlled substances,and subsequently no Fire Department personnel shall use or administer AMRcontrolled substances.

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III. DOCUMENTATION

When administering controlled substance, employees and supervisors will followestablished documentation standards when completing the corresponding patientcare report (PCR). This includes, but is not limited to:

Chief complaint of the patient

Indication for controlled substance use

Baseline patient assessment

Dosages administered

Route administered

Time of administration

Reassessment of the patient after each medication dose

Patient response to the controlled substance

Use of controlled substance in a manner outside the parameters of San MateoCounty EMS policy and protocol, requires contact with a base physician and thencan only be done with their approval. When administering controlled substances bya base physician order, make sure to document pertinent information to the orderincluding, but not limited to:

Facility contacted

Base physician name

Time of contact

Orders given

When administering a controlled substance, employees and supervisors will alsocomplete a Controlled Substances Administration and Re-Supply Form. (CSA&RS)A CSA&RS form must be completed for EACH vial or preload used. Completion ofthe Controlled Substances Administration section of the CSA&RS form requires thefollowing mandatory pieces of information:

Type of medication

Whether the medication was Administered, Expired, or Not Intact

Unit #

Date of Administration

Incident #

Patient name

Chief Complaint

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Amount Administered

Amount Wasted

Name of paramedic administering the controlled substance

Signature of paramedic administering the controlled substance

ID # ( Paramedic License #) of the Paramedic administering thecontrolled substance

If any amount of controlled substance is disposed of, completion of theControlled Substances Administration section requires additional mandatorypieces of information.

Name of Paramedic / RN witnessing the disposal of the

controlled substances

Signature of Paramedic / RN witnessing the disposal of the

controlled substance

ID # of Paramedic / RN witnessing the disposal of the controlledsubstance

If medication is found to be broken, damaged, or was prepared but not given,document in the comments section as to the events surrounding the above listedcircumstances under the administration of controlled substance section of theCSA&RS form.

The Re-Supply of Controlled Substances section of the CSA&RS form will becompleted by the ALS supervisor overseeing the controlled substance cachewhen units, including the ALS Supervisor’s supply, are restocked from the cache.

IV. RE-SUPPLY

Re-supplying of the Controlled Substances section of the (CSA&RS form) will becompleted by the ALS Supervisor who oversees the controlled substance cachein order to limit the number of people with access to the cache; this includes therestocking of the ALS Supervisor’s controlled substance supply.

Re-supply will take place on a regular basis during which all units will be returnedto their par level of controlled substances as noted.

If a unit reaches the minimum levels of controlled substances necessary toremain in service, they will notify the on-duty ALS Supervisor for re-supply.

The on duty ALS Supervisor, when not the ALS Supervisor overseeing thecontrolled substance cache, will only re-supply units when they fall below theminimum levels to remain in service. The on-duty ALS Supervisor will re-supplythe unit which has fallen below minimum levels from their supply by swapping

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one vial or preload for a completed Controlled Substances Administration andRe-Supply Form. The ALS Supervisor supply will then be restocked by the ALSSupervisor overseeing the controlled substance cache.

Under emergency situations an on-duty licensed paramedic supervisor/managermay access the cache for restock to keep a unit in service.

At no time will AMR personnel restock Fire Department controlled substances,and subsequently at no time will Fire Department personnel restock AMRcontrolled substances, unless the re-supply is from the ALS Supervisoroverseeing the controlled substance cache to the JPA Coordinator.

V. CORRECTIVE ACTION

Employees covered under the Paramedic Collective Bargaining Agreement;refer to Article 6.

Employees covered under the Northern California Collective BargainingAgreement; refer to Article 5.

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San Mateo County Operations

Policy #: 004End Of Shift RequirementsDate: 17 Aug 2011

Approved By:Brad White

General Manager

I. PURPOSE

To establish expectations of the employee for end of shift requirements.

II. POLICY

When a crew is cleared for off-duty status (ODS), the crew is to make certainthe following steps are completed:

The vehicle should be left with a full tank of fuel, but never less than ¾of a tank.

The main oxygen tank must be at or above 500 psi. If the amount isless, then the crew is responsible to notify support and makearrangements to change out the tank. For 24-hour posts the crewsare responsible for changing out their own tanks.

24-hour units must physically hand over all keys. In addition if anysets of keys are missing the crew will report the discrepancy to the on-duty Field Supervisor immediately.

Any mechanical or equipment issues that were noticed during a shiftwill be submitted in writing to request repairs or replacement.

All paperwork will be completed and checked for thoroughness andcompleteness. This must be turned in prior to employee leaving work.This includes:

PCRs / Billing forms.

Daily Reports, including ending count for controlledsubstances, time cards, and any incident reports thatmay be required.

Advise the appropriate dispatch center that the unit has arrived at themain.

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Thoroughly check the vehicle for any personal items. (crew’s orpatient’s)

Notify the on-duty Field Supervisor of any patient belongings andinclude the patient’s name and the facility he / she was transported to.

Remove all trash from the cab area of the vehicle.

Check in all durable equipment, (e.g. monitors, laptops, radios, cellphones etc.) with a support services technician. This must be done inperson.

III. CORRECTIVE ACTION

Employees covered under the Paramedic Collective BargainingAgreement; refer to Article 6.

Employees covered under the Northern California CollectiveBargaining Agreement; refer to Article 5.

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San Mateo County Operations

Policy #: 005Float PolicyDate: 17 Aug 2011

Approved By:Brad White

General Manager

I. PURPOSE

To establish the roles and responsibilities of each EMT and / or Paramedicassigned to a float position.

II. DESCRIPTION

Float personnel will be available to cover openings due to illness, injury, or asotherwise assigned by the scheduling department or supervisory staff. Inaccordance with respective CBA’s.

III. POLICY

Designated positions referred to as “floats” shall be staffed by full timeParamedics or by full time Advanced EMT. Positions will be determinedduring the shift bid process.

It is the responsibility of all float position personnel to contact thescheduling department or the on duty supervisor the day before your floatshift assignment to ascertain if a shift has been assigned.

If you are not assigned a shift ahead of time, you are to report to theOperations Office (Main) at the start of your designated shift time inuniform and ready to log on. It will be required that you will be within atwenty (20) minute response time to the main if not immediately assigneda shift.

It will be required that you carry your pager and have it in the “on” positionwith an alert you can audibly hear or in a vibrate mode while on yourperson, during your scheduled float shift.

Floats are responsible for 24 hour station duties.

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As defined by established policy, an accurate record of time worked mustbe personally completed and submitted by the employee assigned to floatduty upon completion of their shift.

As a float you will be held to the same policies and guidelines for status oremergency holds while on active system unit.

Due to the nature of this position, refusal of any assignment during thefloat shift or failure to comply with any of the requirements specified abovemay result in corrective action.

Floats shifts are 12 hours. During that time management has the right tomove or re-assign the float to another unit for operational needs. Anexample of this would be, but not limited to, if a float is assigned to a 9.5hour shift and finishes that shift but is needed to hold over to coveranother unit, (if 2-1/2 hours or less), he / she will be required to completethe assignment.

IV. CORRECTIVE ACTIONS

Employees covered under the Paramedic Collective BargainingAgreement; refer to Article 6.

Employees covered under the Northern California Collective BargainingAgreement; refer to Article 5.

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San Mateo County Operations

Policy #: 006Fueling PolicyDate:17 Aug 2011

Approved By:Brad White

General Manager

I. PURPOSE

To establish standards and guidelines for fueling of the vehicles, establishingadequate and required fuel levels, and to assure that AMR maintainsemergency response capabilities among the fleet to facilitate a rapid andreliable responses to our patients.

II. POLICY

No vehicle shall be deployed at BOS with a fuel level below ¾ of a tank.

No vehicle shall be left at EOS with a fuel level below ¾ of a tank.

Fueling is required whenever the fuel level in an ambulance is at or belowone-half (1/2) of a tank.

III. RESPONSIBILITY

Each employee will be responsible to refuel the vehicle well in advance. It isthe crew’s responsibility to never run out of fuel at any time.

It is the responsibility of the Supervisor to make arrangements for the crew tofuel the vehicle should it run below ¼ of a tank or be deployed with less than¾ of a tank of fuel.

It is the responsibility of the support team (VST’s) to check the fuel levelswhen detailing a vehicle.

Ambulances required for rig exchange shall be refueled (if needed under theguidelines stated above) prior to making the exchange.

Unauthorized use of gas card cards for any personal purchases can result incorrective action up to and including immediate termination of employment.

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IV. PROCEDURE

At the beginning of each shift the crew shall make sure that their assignedvehicle is deployed at a ¾ to full level of fuel. If the vehicle is found to bebelow ¾ of a tank of fuel, the crew shall immediately inform the on dutysupervisor so that they can make arrangements to allow the crew to refuel.

At the end of each shift the crew shall make sure that their assigned vehicle isreturned to quarters with a minimum of ¾ of a tank, unless authorized by theon duty supervisor.

Should the crew run below ¼ tank of fuel, the crew shall make immediatenotification to the on duty supervisor so arrangements can be made to takethe unit out of service to refuel.

Should the vehicle be returned under ¾ tank of fuel an incident report shall beturned into the on duty supervisor by support personnel, which will include thevehicle’s physical ID number and the unit number of the previous crewassigned to that vehicle.

Fuel cards are matched to each numbered ambulance. (e.g. 5-7901, etc.)They can be found on or above the driver’s side visor. They are to remain inthe vehicle at all times; cards should never leave the vehicle except whenfueling. Crews are responsible for assuring their card is in the vehicle prior tothe start of their shift. If a card is missing, the on duty supervisor must becontacted immediately.

Each employee will be issued their own fuel pin number. These numbers willnot be shared between employees. In the rare instances where an employeeforgot the pin number or the number malfunctions at the pump, crews are tonotify the on duty supervisor immediately.

Employees will use the vehicles actual mileage when initiating refueling.

IV. CORRECTIVE ACTION

Employees covered under the Paramedic Collective BargainingAgreement; refer to Article 6.

Employees covered under the Northern California Collective BargainingAgreement; refer to Article 5.

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San Mateo County Operations

Policy #: 007Response RequirementsDated: 17 Aug 2011

Approved By:Brad White

General Manager

I. PURPOSE

To provide rapid and reliable emergency and non-emergency responseambulance services for our patients and other customers. This policy willestablish and define a standard policy for responding to calls and post move-ups.

II. POLICY

All personal are expected to respond to calls and move-ups in a safe andtimely manner and in full compliance with all laws, regulations, SystemStatus Plan and AMR policies pertaining to the operations of ambulances.

Personnel on 24-hour units are expected to be in their vehicle, in properuniform, and provide notification on the radio that they are responding,within a maximum of ninety (90) seconds from the time of dispatch for acall or unit movement between the hours of 0700 and 2200, and withinone hundred and twenty (120) seconds between the hours of 2200 and0700.

Personnel on non 24 – hour units shall be in their vehicles, in properuniform within ninety (90) seconds from the time of dispatch for a call andninety (90) seconds from time of dispatch for move-ups, regardless of thetime of day.

Personnel on Surge units on non-emergency responses are expected tobe in their vehicles, in proper uniform, and provide notification on the radiothat they are responding within a maximum of within ninety (90) secondsfrom the time of dispatch for a call or unit movement, regardless of thetime of day.

Personnel will avoid any activities that compromise their ability to achievethe shortest response time possible. At no time will personal businessjustify a delay in response.

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Each crew member shall know the location of the other at all times.

ALS crew members are expected to be available for service no more thanthirty (30) minutes after arrival at the receiving facility. If more time isrequired, crew members shall notify the communication center within ten(10) minutes of arrival that they will be extended.

Computer Aided Dispatch (CAD) and automated geotracking device(Airtrak) or similar device will be utilized for tracking delay chuteresponses, exceptions, location of units and velocity.

III. Corrective Action

Employees covered under the Paramedic Collective BargainingAgreement; refer to Article 6.

Employees covered under the Northern California Collective BargainingAgreement; refer to Article 5.

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San Mateo County Operations

Policy #: 008Rig ExchangesDate: 17 Aug 2011

Approved By:Brad White

General Manager

I. PURPOSE

All vehicles in the AMR fleet are maintained in a professional manner that does notdifferentiate between front line and reserve units. Each vehicle is important as itcould be called into duty at any time. Crews are required to treat all vehicles withthe same respect level.

IV. PROCEDURE

When directed by the Fleet Staff, Supervisor, or designee, crews will report thecorrect mileage displayed on their odometer.

When directed, crews will come to the main and change out into the reserve unitassigned by the VST on duty. All durable equipment that is part of the normalinventory of each unit shall not be removed to stock the reserve unit. All missingitems will be brought to the attention of the VST or the Supervisor for replacement.

All gas cards and keys have been issued to each ambulance and shall remain withthe, ambulance it was assigned to. Under no circumstances are the gas cardsto be removed from units unless authorized.

Make sure all personal items are removed from vehicle that is being taken out ofservice.

Garage door openers for outlying posts shall be removed from the vehicle beingtaken out of service and moved into the reserve vehicle.

Abuse, neglect, failure to report mechanical problems, or not bringing in a vehiclewhen directed, may result in corrective action.

V. Corrective Action

Employees covered under the Paramedic Collective Bargaining Agreement;refer to Article 6.

Employees covered under the Northern California Collective BargainingAgreement; refer to Article 5.

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San Mateo County Operations

Policy #: 009Shift ReadinessDate: 17 Aug 2011

Approved By:Brad White

General Manager

I. PURPOSE

The following procedures have been designed to facilitate the mostexpeditious and concise method for the successful daily readiness and startof shift procedures.

II. PROCEDURE

Employees are expected to report for duty at their assigned time and station inproper uniform and response ready. Crews will receive their vehicle assignmentand check out their portable equipment prior to logging on for duty.

Crews will be issued their own jump bags and pedi bags; these will be kept in thelocker cages identified with the corresponding unit number.

Crews will be responsible for their assigned equipment and their content.

Crews will be responsible for keeping their bags fully stocked and theirequipment in good working condition. Bags will be restocked immediately aftersupplies are used from each bag and sealed with ties after being restocked. Atthe end of each month medics are required to check and replace outdatedmedications and supplies and reseal their med bags. Medics will be required tosign and date the monthly drug bag check off form that is attached to eachspecific locker by the last day of the month to assure all medications have a validdate.

Crews will remove their assigned equipment from their vehicle at end of shift andplace it back into their assigned locker. (The exception to this rule will be for 24hour units.)

Crews will keep their assigned locker secured by lock and key at all times whileequipment is stored.

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Crews will notify a VST or Supervisor immediately if any equipment is in need ofrepair, replacing, or is missing.

Crews will insure that they have all the required paperwork (PCR’s, Billing Forms,Trip Tickets, Controlled Substance Restock Forms, Incident Reports, PatientInformation Sheets, Signature Sheets, etc.) prior to beginning of each shift.

Crews will receive their Cardiac Monitors, Lap Tops, Portable Radios and keysthrough support services. All equipment will be documented and signed out atbeginning of the shift and signed in at end of shift. Any damaged equipment willimmediately be brought to the attention of the VST on duty.

ALS crews are required to check the status of the monitor / defibrillator,glucometer, and suction units at the beginning of their shift. The crew memberswill assure that the equipment has fresh batteries. All monitors / defibrillators willbe checked for proper operation, adequate EKG paper, modem, and accessoriesprior to leaving for their assigned shift.

Employees are responsible at the start of their shift to check the vehicle’s lights.With the engine running, check all exterior and interior lights, including all code 3warning lights, and the siren before leaving the main.

Employees are required to log on with the appropriate dispatch center withinfifteen (15) minutes of their scheduled shift.

If there will be a delay in going in service for any reason the crew will notify theirOn Duty Field Supervisor and the dispatch center at the earliest possible time,but in no case later than fifteen (15) minutes past their scheduled start time.

All 24 hour units are to be considered “in-service” at all times unless specificallydeclared “out of service” by the communications center or On Duty FieldSupervisor.

All 24 hour units are expected to do face-to-face pass downs and log on with nointerruption in status, remaining in service. The crew is required to contact theOn Duty Field Supervisor for approval if there is a sufficient reason to go out ofservice.

All 24 hour units are required to complete a daily check out of their vehicleequipment and supplies at the beginning of their shift. If a call for service delaysthis task it shall be done at the earliest possible time.

Day and Flex units may be released to the deployment center thirty (30) minutesprior to their scheduled off duty time, as outlined in the System Status Plan. Thistime must be used to refuel the vehicle to the appropriate fuel levels. These

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personnel must remain on duty and in an available status until the end of theirshift.

The responsibility for logging on and checking out the unit is a joint one; bothcrew members are responsible and will be accountable for these daily duties.

III. CORRECTIVE ACTION

Employees covered under the Paramedic Collective Bargaining Agreement; referto Article 6.

Employees covered under the Northern California Collective BargainingAgreement; refer to Article 5.