EMS 4

• Philadelphia Fire Department EMS Procedure #4 is an Emergency Medical Services (EMS) Complaint Policy that went into effect in October 2008.
• The policy establishes procedures to process complaints generated from Philadelphia Fire Department (PFD) Emergency Medical Services (EMS) activities.

Definitions

• A Complaint is an allegation of inappropriate conduct by a Philadelphia Fire Department member(s) on an assignment involving EMS activity.
• Complaints generally fall into four categories: Medical, Attitudinal, Operational, and Other.
• Medical complaints are when the level of medical care provided by members was inadequate or inappropriate for the patient.
• Attitudinal complaints are when behavior/attitude of member(s) wasn't consistent with the level of professionalism PFD members are expected to maintain when interacting with the public.
• Operational complaints are violations of established Directives or Procedures of the Philadelphia Fire Department.
• "Other" complaints are any allegation of misconduct that doesn't meet the criteria for Medical, Attitudinal, or Operational complaints.
• A Complainant is any person who notifies the Philadelphia Fire Department of the alleged inappropriate conduct, including those who have received healthcare service from the PFD, their guardian/advocate, or an observer.
• Observers that can be complainants include bystanders, friends, relatives, PFD members, police officers, or fellow patients or a healthcare facility such as a hospital, clinic, or nursing home, or a person providing healthcare such as a paramedic, doctor, dentist, or nurse, ,or the Philadelphia Fire Department or its agent.

Outcome

• The disposition of a complaint is determined by the Philadelphia Fire Department's Medical Director and the Administrative Chief of Emergency Medical Services with possible outcomes including sustained, not sustained, exonerated, unfounded, frivolous, withdrawn, or referred.
• Sustained: Allegations of misconduct have been admitted to by member(s) or substantiated through the fact-finding process.
• Not Sustained: Allegation(s) that the investigation can neither prove nor disprove
• Exonerated: The allegation is true; the conduct of the members is in accordance with official departmental policy.
• Unfounded: The occurrence of the allegation(s) of misconduct was not substantiated via investigative findings.
• Unfounded, with aggravating circumstances: Issues raised during the investigative process warrant educational follow-up with the medics.
• Frivolous: Investigation shows that the allegation(s) has no merit or was made with malicious intent.
• Withdrawn: Complainant or their agent requests that the complaint be closed/withdrawn without further investigation.
• Referred to: The investigation has been completed by EMS and the information has been referred to another agency (Inter Departmental, City, State, or Federal) for further investigation and completion.

Complaint Intake

• Complaints can be received by telephone, letter, fax, e-mail, or in person, but anonymous complaints will not be taken.
• EMS complaints may be received at telephone #215-685-4209 Monday through Friday, during normal business hours.
• On weekends and evenings, complaints may be received by an on-duty EMS Field Supervisor.
• Any PFD officer or the F.C.C can take EMS complaints and forward them to the EMS Administrative Captain if needed.
• All complainants must provide their name, a return address, and if possible a telephone number.

Responsibility

• The procedure requires each member to exercise the appropriate action and control according to their rank.
• Members will immediately notify a supervisor like a Company Officer, EMS Field Supervisor, ES-8, CQI, or EMS Administrative Captain of a request to lodge a complaint and cooperate fully with the complaint inquiry.
• Company Officers and/or EMS Field Supervisors will assist the investigating officer by providing information/documentation and ensuring members are available for the fact-finding interview process, and forward complaints to the Administrative Captain promptly.
• EMS Administrative Captains will interview all members and witnesses and collect all relative documentation connected to the events surrounding the complaint as needed.
• The EMS Administrative Captain will investigate all aspects of the dispatch generating the complaint, ensure members have the opportunity to give their statement (including placing the medic unit out of service), notify Local 22 if the member requests union representation, maintain records of individual paramedic complaint histories and a database of all EMS system complaints, provide complaint acknowledgment/outcome letters, provide written notification of complaint dispositions, and prepare/forward Trial Board Charge Sheets.
• The Medical Director reviews all paramedic complaints, provides disposition, and makes recommendations for counseling by the EMS Field Supervisor, Administrative Captain, EMS Training, the Operations Chief, or the Medical Director

Procedures

• When an allegation of inappropriate conduct or inadequate medical care meeting the definition of a complaint is received actions will be taken.
• In cases where criminal conduct is alleged, the complainant will be referred to the Philadelphia Police Department.
• Complainants with allegations of a gross or direct violation of Departmental Directives/Operational Procedures will be referred to the Special Investigations Officer (SIO).
• The Officer in receipt of the complaint will document all information pertinent to the case on a Philadelphia Fire Department Emergency Medical Services Complaint Form or a Complaint by City Employee and forward it to the EMS Administrative Captain.
• Once the EMS complaint is forwarded to the Administrative Captain, it will be catalogued utilizing the last two digits of the current calendar year and a sequential number system (i.e. 03-01, 03-02, 03-03, etc.) The complainant is notified in writing with the acknowledgement of their complaint, the complaint number, and a contact telephone number.
• A preliminary fact-finding review of the complaint will be conducted by the EMS Administrative Captain.
• The investigating EMS Officer will visit the complainant(s) and witness(s) in person where possible, gather all pertinent reports, and add these to the complaint package.
• Anyone including Police Officers, PFD members, and Hospital staff who may have information pertinent to the case, will be interviewed and their statement taken.
• All personnel against whom allegations have been made will be contacted, informed of the allegations, and interviewed; they will be advised as to the nature of the complaint and apprised of any evidence gathered to date.
• Interviews conducted at the EMS Administrative Building will be on the member's off duty time without compensation when answering complaints that may lead to charges or charges against themselves; Class “A” uniform is required.
• IAFF Local 22 will be notified of the member's interview date and time by the interviewing office.
• The Investigating EMS Officer will submit a report to the Medical Director and/or the Administrative Chief of EMS, who will review all facts and determine the complaint's outcome.
• The member(s) involved may be summoned to a non-disciplinary conference with the Medical Director/EMS Administrative Chief at the Medical Director's discretion.
• A member may be summoned to meet with the SIO, the Medical Director, the EMS Administrative Chief, or the EMS Training Office if the complaint's outcome is “referred to.”
• The EMS Administrative Captain will contact the complainant and involved member(s) in writing, explaining the investigation details and outcome, after the disposition of the complaint has been determined by the Medical Director.
• The Medical Director may instruct the platoon EMS Field Supervisor, the Administrative Captain, EMS Training Office, or the Continuous Quality Improvement Office to address any specific concerns.
• The Office of the EMS Administrative Captain will maintain all complaint related records for up to three years, unless involved in litigation, then records are maintained up to one year after litigation concludes.
• The EMS Administrative Captain will maintain a database listing all of the complaints that were made.

Trial Board Charge Sheets

• If formal charges are necessary after the complaint disposition, Trial Board Charge Sheets will be prepared and forwarded directly from EMS Administration.
• Trial Board Charge Sheets may be prepared for gross violations of protocols or procedures, or where there is a pattern of violation resulting in successive sustained complaints.
• The EMS Administrative Captain will prepare the Trial Board Charge Sheet and forward all supporting documentation through the EMS Administrative Chief to the SIO.
• The Deputy Chief of the division in which the member is assigned will be copied on the accompanying memorandum to the Commissioner.

Appeal

• Members may appeal the complaint outcome by submitting a memo to the Emergency Medical Services Medical Director with details of the reason for the appeal and justification for any change in the outcome.
• Based on the information presented the Medical Director will schedule an interview with the paramedic, direct the reinvestigation of all/specific portions of the case, direct the outcome be changed, or direct the outcome stand.
• Cases involving disciplinary action may not be appealed through EMS; they will be handled per Philadelphia Fire Department Directive # 25, Discipline.

References include

• Directive # 25 Discipline
• Complaint by City Employee
• Philadelphia Fire Department, Emergency Medical Services Complaint Form