D-63

Philadelphia Fire Department Return-To-Service Program

• Directive #63 was introduced in July 2015
• This program sets policy and guidelines for the Philadelphia Fire Department (PFD)

Purpose

• To ensure Fire Suppression Personnel (FF), Fire Service Paramedics (FSP), and Fire Service Emergency Medical Technicians (FSE) are ready to return to service
• Applies to personnel who have been off full active duty for a set amount of consecutive calendar days
• Ensures personnel return with no work restrictions

Personnel Definitions

• "FF" includes Fire Officers up to and including the rank of Captain
• "FSP" includes EMS Officers up to and including the rank of Captain

RTS Program Requirements Based on Time Away

• FSEs and FSPs absent for more than 90 consecutive calendar days must complete the RTS Program before returning to full duty
• FFs absent for more than 120 consecutive days must complete the RTS Program
• Chief Officers absent for more than 120 consecutive calendar days must contact specific offices before returning to full duty
• The Deputy Commissioner of Operations, Personnel, the Safety Office, and the Hazardous Material Administrative Unit (HMAU) must be contacted
• Chief Officers are exempt from the RTS Program due to their job description

Competency Evaluation

• A key component of the RTS program

ALS Skills Assessment

• Members showcase the ability to perform ALS skills
• Performance must align with paramedic scope of practice under Act 37 and Title 28 of the PA Code and its Rules and Regulations
• Regulations are published annually in the PA Bulletin

BLS Skills Assessment

• Members demonstrate the ability to perform BLS skills within their scope of practice
• Performance aligns with Act 37 and Title 28 of the PA Code and its Rules and Regulations
• Regulations are published annually in the PA Bulletin

Firefighter Skill Assessment

• FFs demonstrate the ability to perform Basic Firefighter skills
• Skills align with NFPA 1001 Standard for Professional Firefighter Qualifications and specific Philadelphia Fire Department Job Performance Requirements

Knowledge Assessment

• Members demonstrate understanding of Basic Life Support (BLS), Advanced Life Support (ALS), Directives, Operational Procedures, and General Knowledge
• Knowledge should be related to firefighting and/or medical procedures appropriate for their certification and job classification.

Practical Assessment

• Members complete physical skills similar to the Firefighter Skills Proficiency and/or EMS Skills Proficiency Course along with other job related tasks
• The Skills Proficiency Course combines job related physical evolutions and endurance capabilities

Field Evaluation

• Final step in the EMS RTS process
• Members ride as a third crew member under the direct observation of a Preceptor for a field evaluation
• Abilities to effectively interact with patients, perform patient assessments, perform medical interventions, and complete patient care documentation will be evaluated
• Duration of the field evaluation depends on time away and performance during knowledge and skills assessment, and has a minimum of 1 full tour in duration
• One full tour constitutes a work week from Saturday through Saturday

PA Statewide EMS Protocols

• Philadelphia Fire Department EMS providers must follow Pennsylvania Department of Health (PA DOH) Basic Life Support (BLS) and/or Advanced Life Support (ALS) treatment protocols
• Refer to EMS Procedure #13 and #21

Preceptor Definition

• A Philadelphia Fire Department FSP with full medical command authorization, approved preceptor status, and authorization from EMS Training, the EMS Administrative Chief and the Medical Director

Member Responsibilities

• Each member is responsible for exercising appropriate control as dictated by their rank in the implementation of the RTS Procedure

Fire Suppression Personnel, FSPs, and FSEs Responsibilities

• Notify their company officer or Battalion Chief immediately upon being returned to duty
• Notification by their personal physician, by the Medical Evaluation Unit at 19th and Fairmount, or after returning from any leave of absence
• Inform their company officer or Battalion Chief how long they have been off
• Review protocols, Directives, Operational Procedures and other departmental documents in anticipation of, and in preparation for, attending the RTS program
• Report to the Philadelphia Fire Academy at 0800 Hrs with all sets of assigned Personal Protective Equipment (PPE) and SCBA mask
• FSP and/or FSE will also report with the current edition of the PA Statewide EMS Protocols (ALS protocols, BLS Protocols)
• Certified Hazardous Material Technicians must contact the HMAU to determine if their “HazMat Physical Status” is up-to-date; a HazMat physical exam will be scheduled if needed

Company Officers Responsibilities

• Notify their Battalion Chief and Personnel of the RTS status of the member
• Carry the member “P D to RTS/TRG” on the roll call

Personnel Officer or Designee Responsibilities

• When notified that a member is returned to active duty, determine how long the member has been absent from duty
• Instruct FSE or FSP members off over 90 days to report to PFA EMS Training, and FF members off over 120 days to report to PFA Fire Training
• Advise the member to report with proper protocols, PPE, and SCBA mask
• Notify the Fire Academy that a member is returning to service and how long they have been off

EMS Training Officer Responsibilities

• Evaluate a member’s knowledge and skill competency to identify areas of weakness
• Develop an individual-specific education and training program to address demonstrated weaknesses
• Provide any relevant Medical Director’s Communiqués, Chiefs’ Staff Notes, and Departmental General Memorandums for review
• Schedule a field evaluation after a member demonstrates knowledge and skill competence in the classroom setting
• Inform ES-3 of the status of a member in the RTS program to maintain quotas
• Ensure members report to HMAU and the Safety Office for updates/training and PPE evaluation

Additional EMS Training Officer Responsibilities

• Refer a member to PFD Personnel based on concerns about willingness, ability, or risk of injury during physical evolutions, or if the readiness or capability of a member is in question

PFA Training Staff Responsibilities

• Evaluate the FF’s knowledge, skills, competencies, and physical readiness to determine areas of weakness
• Have FFs report to EMS Training to evaluate their EMT status, including CPR, and provide training, updates, and reviews
• Have members report to HMAU and the Safety Office for updates/training and PPE evaluation
• Develop individual-specific education and training programs to address demonstrated weaknesses
• Provide relevant Communiqués, Chiefs’ Staff Notes, and Departmental General Memorandums for review
• Inform the Deputy Commissioner of Operations of the status of any FF in the RTS Program
• Refer members to PFD Personnel based on concerns about willingness, ability, or risk of injury during physical evolutions, or if the training officer has doubts about readiness or capability

Safety Office Staff Responsibilities

• Evaluate all PPE belonging to the member returning to service
• Require members returning after a 180 day absence to complete the Driver Simulation Awareness course
• Require members returning after a 1 year absence to undergo Driver/Operator Qualifications per Directive #32
• Notify the company officer if a member has been off for over 1 year and needs to undergo Driver/Operator Qualifications prior to driving a Philadelphia Fire Department apparatus/vehicle

RTS Procedures: Day One

• A member of the PFA Training Staff or the EMS Training Staff will explain the purpose of the RTS program, outline objectives, and the department's expectations
• The staff member verifies that members have the current edition of protocols and PPE
• RTS members begin reviewing all protocols in preparation for knowledge assessment
• The EMS Training Officer will familiarize FSPs and/or FSEs with the Human Patient Simulator (HPS)

RTS Procedures: Days Two through Four

• Activities include knowledge and practical skill competency evaluations, which utilize written assessment tools like multiple choice questions
• Evaluations cover EMS protocols, EKG rhythms, listing treatment, firefighter skills competency, and physical readiness. FSEs and/or FSPs must score at least 80% on all evaluations

RTS Procedures: Day Five

• FSP/FSE members who demonstrate knowledge and skill competency will begin the field evaluation
• Field evaluation will occur as soon as practical, depending on Preceptor availability and/or platoon schedule
• If members do not demonstrate competency, the training staff will develop a specific and individual remediation program to address any areas of weakness

RTS Procedures: Days Six and Beyond (FSE and FSP Only)

• Following remediation, members repeat the competency evaluation
• If members fail to demonstrate sufficient skill or knowledge, they will consult with the Medical Director
• The Medical Director may arrange for additional outside education, such as Advanced Cardiac Life Support (ACLS) or Basic Trauma Life Support (BTLS)

Guidelines for Absences of 90-120 Days (FSE and FSP Only)

• Members returning after this absence attend the RTS program before returning to their assignment and must report to the Fire Academy at 0800 Hrs
• The member will review Chief Staff Notes, General Memorandums, Operational Procedures, Directives, EMS Procedures, training-related materials, and the PA Statewide EMS Protocols
• EMS Training will administer competency evaluations including assessments of CPR, oxygen therapy, trauma care, lifting and moving, EMS skills proficiency, patient assessment, IV access, airway management, EKG interpretation, pharmacology, mega-code scenarios, and triage

Absences of 90-120 Days: Field Evaluation

• Members must complete a field evaluation under the direct observation of an approved Preceptor
• Duration of the field evaluation is generally 1 full tour, but may vary based upon performance and length of absence
• One full tour constitutes a work week from Saturday through Saturday

Absences of 120 Days to 1 Year

• FSE/FSP members will ride as third crew members for up to 3 full tours under the supervision of a Preceptor, and during this time, an EMS Officer will also evaluate the member
• FFs returning after this absence attend the RTS program, reporting to the Fire Academy at 0800 Hrs to review materials
• Fire Training Staff will administer competency evaluations consistent with NFPA 1001, Standard for Professional Firefighter Qualifications

Absences of 120 Days to 1 Year: Firefighter Competency Evaluation Topics

• FF Re-entry Portable Radio Review
• FF Re-entry Rapid Intervention Team Review
• FF Re-entry Ladder & Forcible Entry Practical Review
• FF Re-entry Engine Practices Review
• FF Re-entry NFIRS related Software Review
• FF Re-entry Mayday Review
• FF Re-entry Fireground Operations
• National Incident Management System (NIMS)

Mandatory Employee Professional Training

• Re-entry Sexual Harassment Review
• Re-entry EEOC Training
• Re-entry Ethics Training
• Re-entry Fraternization Policy

Additional Requirements

• FFs will attend a minimum of 2 full weeks of training under a PFA Training Officer, who will evaluate the member, with the duration varying based on performance

Absences of More Than 1 Year

• FSPs/FSEs separated for MORE than 1 year and/or NOT functioning as an EMS Provider in the PFD for more than 1 year may be required to complete a refresher course approved by the Pennsylvania Department of Health, along with the RTS Program
• The EMS RTS program covers BLS and ALS skills
• FSPs/FSEs returning after this absence complete a field internship riding as a third crew member for up to 4 full tours under a Preceptor, and during this, an EMS Officer will also evaluate the member

Absences of More Than 1 Year: Firefighter Requirements

• FFs separated for more than 1 year and/or NOT functioning as a firefighter in the PFD, attend the RTS Program for a minimum of 4 weeks of training with a PFA Training Officer, with the evaluation period varying based on performance. The Training Director may reduce the length of the RTS training based upon member competence

Return to Duty

• FSPs/FSEs in the EMS RTS process return to Medic Unit duty when they demonstrate knowledge and skill competency in the classroom and field
• FFs in the RTS Program return to an available assignment when they successfully complete all training, evaluation, and tests under a PFA Training Officer's supervision
• The are given three attempts to successfully pass this program in order to be returned to fire duty status

Unsuccessful Return to Service Program

• The Medical Director interviews any FSP/FSE who was unsuccessful in demonstrating competency, to identify reasons for failure and determine a course of action
• The Director of Training interviews any FF who was unsuccessful in demonstrating competency, to identify reasons for failure and determine a course of action with assistance from the Executive Chief, Strategic Services

Key References

• National Fire Protection Association (NFPA) 1001, Standard for Professional Firefighter Qualifications
• Act 37 and Title 28 of Pennsylvania Code, Department of Health and Safety, Emergency Medical Services
• EMS Procedures # 10, # 13, # 21
• Directives # 3, # 6, # 13, # 18, # 19A, # 19B, # 25, # 28, # 32, # 34, # 39, # 42, # 54, # 58, # 62
• Operational Procedures # 2, # 19, # 21, # 23, # 33, # 37, # 38
• IFSTA Supplement