Philadelphia Fire Department: Alternative Response Units

Policy

• The Philadelphia Fire Department (PFD) is creating Alternative Response Units (ARU) that will respond to specific incidents
• ARUs provide specific care and reduce ambulance transports
• ARUs collaborate with the PFD, healthcare organizations, and social service agencies
• Each ARU has its policy and staff details in an appendix
• The PFD, with the University of Pennsylvania (Penn), has created an ARU
• Penn's ARU, call sign AR1, operates within the University's boundaries
• AR1 offers courtesy rides to students medically cleared for non-EMS transport
• Low acuity care during AR1's hours is managed by local hospital emergency rooms
• Students need to be assessed by the FPL, meet strict guidelines, and be authorized by the PFD Medical Director for release from EMS care
• The program aims to ensure the safety of UPenn students while conforming to privacy, supporting their amnesty program, and reducing non-emergency medic unit calls

Responsibility

• Each member is responsible for implementing procedures according to their rank

EMS Administrative Chief

• The EMS CRR Office is overseen by the EMS Administrative Chief
• They report to the Assistant Deputy Commissioner of EMS

EMS CRR Unit Head

• The EMS CRR Unit Head offers direct administrative and operational oversight for all ARUs and members
• The EMS CRR Unit Head reports to the EMS Administrative Chief, they also complete administrative duties like roll calls and overtime for EMS CRR personnel
• The narcotics locker, and other FAB supplies are checked daily for tampering, regardless of ARU status.

ARU Fire Paramedic Lieutenant (FPL)

• The FPL leads the ARU and oversees administrative duties and medical care during operational hours
• The FPL reports to the EMS CRR Unit Head for administrative and operational needs
• The FPL confirms the safe operation of the ARU vehicle, as per the Safe Operation of Fire Vehicles policy
• The FPL gathers equipment from the EMS CRR office's secured storage area and is responsible for all unit equipment
• Equipment storage and lock procedure details are kept in the EMS CRR office
• Controlled drugs and logs must be maintained according to the Controlled Drug policy
• Verify that there is a minimum level of EMS supplies for ALS Squads, according to the PA Dept of Health
• The FPL performs administrative duties like roll calls, overtime, for ARU personnel
• The FPL ensures proper documentation for all incidents, following the EMS Documentation policy

AR1 Fire Service EMT

• The ARU EMT supports the ARU within their rank, as stated in the EMS Fire Service Emergency Medical Technicians’ policy
• The ARU EMT reports to the ARU FPL and helps with administrative and operational tasks
• The EMT assists the FPL in gathering equipment, preparing AR1 for duty, maintaining supplies, and returning equipment at the end of the service period
• They respond to dispatched incidents according to the dispatch criteria, ensure the ARU vehicle operates safely, and monitor the PENNCOMM radio
• The EMT assists the FPL in assessing and treating patients
• Effective relationships with other fire units, police, medical personnel, and the public must be established

EMS Providers

• EMTs and Paramedics must understand the procedure and AR1 functions
• During AR1's hours, all incidents in UPenn's area get both a Medic Unit and AR1 dispatched
• When operating in UPenn's area during AR1's hours, request AR1 for verified UPenn students, if not already dispatched and they meet AR1 Decision Tree criteria
• AR1 can be recalled if a patient does not meet the AR1 Decision Tree criteria
• Patients that are ineligible based on the AR1 Decision Tree, or at the ARU FPL’s discretion, will be transported to hospital by medic unit
• UPenn students transported by medic unit go to the Hospital of the University of Pennsylvania unless protocol says otherwise
• The student will be taken to Presbyterian Hospital if the Hospital of the University of Pennsylvania is on diversion, otherwise, if both are on diversion, the student is transported to the Hospital of the University of Pennsylvania
• EMTs and Paramedics will not collect insurance when transporting UPenn students during AR1 hours
• "Penn Student on Campus" is selected in the ARU Directive drop box in the incident tab's response section, all other patients will be documented as normal
• UPenn students are documented as normal outside of AR1's hours, with demographics and insurance collected

First Responder Companies (FRC)

• FRC officers in UPenn's area know the AR1 procedure and presence
• When dispatched with AR1, FRCs help with patient care as directed by the AR1 FPL, FRCs will not recall AR1
• First responder companies will continue to follow the First Responder Company chapter.

General Information

• FCC logs AR1 on/off at scheduled times per the PFD and UPenn agreement
• During service, the FCC dispatches AR1 to incidents within the Penn Patrol Zone
• AR1 is dispatched by the FCC to these incident types in the Penn Patrol Zone: ALS, BLS, Code Blue, and BLS Cold
• FCC dispatches AR1 with a Medic unit and FRC, if needed
• AR1 does not replace a First Responder Company; if a FRC is needed, it is dispatched with AR1 and a medic unit
• AR1 reports to the Penn Patrol Zone at its designated time, they can stage anywhere in the zone, and has access to the UPenn Public Safety Office at 4040 Chestnut St
• The unit monitors the south medic band for dispatches and has a UPenn radio
• They monitor PENNCOMM radio’s MERT Digital channel during operation
• Respond to dispatched incidents according to criteria and in the Penn Patrol Zone
• Initial assessment and proper treatment on patient contact must be performed, according to Pennsylvania Statewide Advanced Life Support Protocols
• A verified UPenn student that has a low-acuitty complaint, is alert and oriented x4, denies suicidal/homicidal thoughts, and meets the ARU decision tree criteria is eligible for a courtesy non-EMS ride to the Hospital of the University of Pennsylvania, following assessment by the FPL and documentation of a treat and release
• The student goes to Presbyterian Hospital if the Hospital of the University of Pennsylvania is on diversion, otherwise, if both are on diversion, the student is transported to The Hospital of the University of Pennsylvania
• Students will be seat-belted in the rear of AR1

Additional Information

• Patients with priority conditions from PA Statewide BLS Protocol #201 cannot have an ARU courtesy ride and will be transported by the responding PFD medic unit
• Also, patients with any abnormality, apart from mild intoxication, will be transported to the hospital by the responding medic unit
• FPL will ensure that students will be transported to the Hospital of the University of Pennsylvania, unless otherwise dictated by protocol.
• If the Hospital of the University of Pennsylvania is on diversion, then student will be transported to Presbyterian Hospital. If both hospitals are on diversion, then the Hospital of the University of Pennsylvania will be the receiving facility
• The FPL needs to ensure that medic documentation is completed correctly
• Patients who refuse medical treatment are handled per PA DOH BLS and ALS Protocols for refusals; medical command contact is required, and documented as per the EMS Documentation
• FCC and PENNCOMM need to be notified of status changes such as responding or on scene
• AR1 may be notified of incidents by either FCC or PENNCOMM, depending on how emergency calls are received
• If AR1 is notified by PENNCOMM, the unit informs FCC, and vice versa if notified by FCC
• All incidents are documented per the EMS Documentation policy and policy.
• At the end of a shift, the unit is placed out of service and returned to the designated parking area
• Equipment must be secured back in locked locations and the AR1 vehicle parked, locked, with the key secured in the EMS CRR office
• An electronic patient care report (ePCR) will be generated for all ARU responses, AR1 members follow the EMS Documentation policy
• Students receiving a courtesy ride will be documented as: Treated, Released (per protocol), this is to allow for full documentation: assessment, and completion of all fields in ePCR
• The narrative will reflect that the patient is being released per AR1 protocol and given a courtesy ride as a non-patient to the hospital facility for treatment
• Patients transported by medic unit are documented as: Treated, Transferred to another EMS Unit and the FPL ensures EMTs and paramedics follow this when documenting UPenn transports
• For any UPenn students, the FPL selects “Penn Student on Campus” option in the ARU directive drop box located in the incident tab's response section, regardless of their disposition
• Insurance will not be collected for UPenn students transported by AR1

Alternative Response Unit (AR1) Decision Tree

• Initial Patient Assessment
• First, check if Time Sensitive/Life Threatening and/or Abnormality on EMS Patient Refusal Checklist
• If yes, provide care according to PA Statewide BLS and ALS protocols, then request Medic Unit to continue to incident, remain with patient until care is transferred to medic unit
• If no, check if Patient is ambulatory and able to sit up unassisted
• If no, provide care according to PA Statewide BLS and ALS protocols, then request Medic Unit to continue to incident, remain with patient until care is transferred to medic unit
• If yes, check if University of Pennsylvania Student
• If no, provide care according to PA Statewide BLS and ALS protocols, then request Medic Unit to continue to incident, remain with patient until care is transferred to medic unit
• If yes, Courtesy Ride via Alternative Response Unit

Life Threatening And Time Sensitive (See Chief Complaint And History Of Present Illness)

• Abdominal Pain: Poor/abnormal general impression/vitals, hyper-emesis, GI bleeding, potential aortic aneurysm
• Abdominal Pain/Female: Female of child-bearing age, potential ectopic pregnancy
• Allergic Reaction: Difficulty breathing, swelling, rash
• Altered Mental Status/Unable to Follow Commands: Any cause except for diabetic hypoglycemia
• Chest Pain: Patient over 30, abnormal EKG/vitals or cardiac history, poor general impression
• CVA: Stroke-like symptoms
• Diabetic Hypoglycemia: Follow DM protocol
• Drug Overdose: Onset less than 3-4 hours, poor general impression.
• Hyperglycemia: Symptomatic Hyperglycemia
• Hypertension: Symptomatic Hypertension
• Seizure: No seizure history, multiple seizures, alcohol abuse/withdrawal, prolonged post-ictal period, abnormal vitals, traumatic injury, benzodiazepine withdrawal.
• Sexual Assault: Occurring < 3 hours ago
• Syncope: With or without return to baseline mental status, abnormal EKG or abnormal vital signs, traumatic injury to dangerous body area, poor general impression.
• Traumatic Injury: Onset less than 1 hour, dangerous body part, active bleeding, significant blood loss, abnormal vital signs, deformities or suspected fractures

List of forms required

• N/A

List of references

• FIRST RESPONDER COMPANIES CHAPTER
• CONTROLLED DRUG CHAPTER
• EMS COMMUNITY RISK REDUCTION
• PHILADELPHIA ADVANCED LIFE SUPPORT PROTOCOLS
• EMS DOCUMENTATION
• FIRE SERVICE EMERGENCY MEDICAL TECHNICIANS
• SAFE OPERATION OF FIRE VEHICLES
• PA Dept of Health ALS Squad Inspection Checklist
• PA Dept of Health Vehicle Inspection Checklists
• PA Dept of Health ALS and BLS Protocols
• PA Dept of Health Resource Page