OLFDSOG1100.4MedicCo.Ops(FINAL06.01.22).pdf

MEDIC COMPANY OPERATIONS STANDARD OPERATING GUIDELINES Medic Company Operations Page 1 of 18 1.0 OBJECTIVE To define the roles of the Medic Company at an incident within the Oak Lawn Fire Department (OLFD). 2.0 POLICY It is critical that all members of the OLFD understand the expectations of the...

MEDIC COMPANY OPERATIONS STANDARD OPERATING GUIDELINES Medic Company Operations Page 1 of 18 1.0 OBJECTIVE To define the roles of the Medic Company at an incident within the Oak Lawn Fire Department (OLFD). 2.0 POLICY It is critical that all members of the OLFD understand the expectations of the Medic Company to ensure a coordinated response to all incidents by all responding companies. 3.0 DEFINITIONS None 4.0 RESPONSIBILITY 4.1 Chief Officers and Company Officers will be responsible for ensuring compliance with the provisions of this SOG. 4.2 Chief Officers and Company Officers will conduct company training to ensure that all members under their command understand this SOG. 4.3 It is the responsibility of all members to have a thorough knowledge of this SOG. 5.0 PROCEEDURE 5.1 SOG Quick Briefs 5.1.1 TACTICAL MISSION OF A MEDIC COMPANY The tactical mission of the Medic Company is to rapidly access the patient and then provide a quality assessment. Once patient needs have been assessed the mission becomes providing the correct lifesaving treatments in a timely fashion while preparing for transport to definitive care. Above all, a rapid transition to transport from on scene treatment must be considered. 5.1.2 POSITION / RADIO SIGNATURE / TOOL ASSIGNMENTS Attendant / Medic # / Portable Radio, Cardiac Monitor, Immobilization Equipment Driver / Medic # Driver / Portable Radio, Jump Bag and Airway Equipment, Cot. Medic Company Operations Page 2 of 18 5.1.3 1st, 2nd and 3rd DUE MEDIC COMPANY ASSIGNMENTS AT FIRE INCIDENTS 1st Due Medic. Upon arrival, position the Medic Co. and plan for treatment and transport of initial victims. Additional Medic and Fire Companies can be assigned as needed to manage the volume of patients present. If the initial scene becomes an MCI or MVI, the 1st arriving Medic assumes the roles of the Medical Sector and Triage Sector to manage the scene. 2nd Due Medic. The 2nd Due Medic Co. will join Squad Co. to assist with assigned Fireground tasks such as forcible entry, ventilation, primary search, securing utilities, other duties as assigned by Squad Officer. 3rd Due Medic. The 3rd Due Medic Co. is to report to command in full bunker gear with all EMS equipment for assignment as the RIT EMS Unit or to be assigned for treatment and transport of additional patients from the scene if needed. Note: At the discretion of the Incident Commander the Medic Co. can be reassigned at any time to any fire ground task, however, the above listed Medic Co. assignments need to be filled. If a Medic Co. is assigned to another Fireground task, a replacement Medic Co. shall be requested to fill the vacated assignment. 5.2 Mission of a Medic Company The Medic Company is charged with rendering lifesaving care and transportation of casualties in a timely manner. The purpose of this standard is to provide for an organized, coordinated, safe and efficient plan of operation in accomplishing this goal. 5.3 Medic Company Functions and Responsibilities The mastery of all the functions and responsibilities is challenging and requires continuous training and strong skill sets. These functions include: • Patient Assessments • Airway Management • Cardiac Rhythm Interpretation • Pacing • Defibrillation • Cardioversion • • • • • • Vascular Access Medication Administration Communication CPR Mass Casualty Care Tactical Emergency Casualty Care Medic Company Operations Page 3 of 18 5.4 Shift Roll Call Information as necessary will be passed on daily concerning out-of-service equipment, street closings, apparatus and equipment condition, and any information applicable to the Medic Company that should be checked during the shift. Roll Call is recommended to take place on the apparatus floor near the apparatus according to department policy. Exceptions prohibiting this Roll Call location or time would be responses to incidents, extreme weather, apparatus breakdowns, or any distraction that would prohibit an attentive Roll Call as deemed by the Company Officer running the Roll Call. Teamwork, experience, knowledge, and discipline are the key to successful Medic work. Only through a concerted effort can a Medic Company become a highly efficient unit. It is imperative that everyone is aware of their own duties, the duties of other company members, the overall responsibilities of their company, and how the company operates in the overall strategy of an emergency incident. Recommended topics to be covered during Roll Call: • • • • • • • • • • 5.5 Riding position and assignments per the Daily Field Roster Assure proper helmet shield and passports are in place Scheduled apparatus maintenance Modified response routes Weather and road conditions Road construction or detours Meals House duties Brief officer drill Review guidelines, procedures, SOPs, orders and any other official information Medic Company Roll Call Riding Position Assignments are titled: 5.5.1 Attendant – Responsible for managing patient care and the scene, contact with Online Medical control, and documentation of the call 5.5.2 Driver – Responsible for safely operating the vehicle, navigating to the call and the hospital, conducting patient care interventions such as IVs, medication administration, etc. The riding assignments are placed on a daily field roster for emergency scene accountability. 5.6 Riding Position Medic Company Tools Assignments 5.6.1 5.6.2 Attendant- Portable radio, cardiac monitor, Immobilization equipment Driver- Portable radio, jump bag and airway equipment, cot. Medic Company Operations Page 4 of 18 Tool assignments are only guidelines and may be altered based on nature of call or additional information from dispatch. 5.7 Radio Assignments and Signatures Attendant Driver “MED 1” ”MED 3 Driver” Example ”Command from MED 1” “Engine 2 from MED 2 Driver” The portable radio assignment and signature is for efficient and effective accountability measures. The correlation of the company member to the company name and number will relate to the assigned company functions. 5.8 Medic Company Operations 5.8.1 Medic Company Size-up Size up for Medic companies is different than that of other fire companies. This is due to differences in the mission of the Medic Company. Especially for AFAs or structure fires an Engine Officer is looking to determine the situation as well as how much hose and water is needed. The Medic Company Attendant is looking at the scene for safety issues, a good place to position the Medic Unit and the number of patients visible on initial size up to determine needs. 5.8.2 Size-up – If first on the scene provide an initial size-up indicating (SHOPS): • Size, Height, Occupancy, Problem, Strategy, 360. (See SOG 200.) for Size Up Review and Information. • Size up examples for MVC: “MED 2 is on the scene with a two car MVC, one car in the roadway and one 50 feet off the road. We are investigating and are eastbound past the incident”. 5.8.3 Fireground Frequency Assignments At an incident scene from a Fireground Channel that’s been assigned, the Medic Company Attendant will keep their portable on Fireground White at all times. The Driver of a Medic Company will keep their portable on Fire Main at all times unless directed to switch to Fireground White by their house’s Company Officer or Incident Commander (IC). For EMS incidents, having the Medic Company Attendant on Fireground White allows an officer on an approaching fire apparatus to find out what help or equipment the Medic Company needs on their arrival without creating radio traffic on the main fire frequency. Medic Company Operations Page 5 of 18 5.8.4 Response to routine Medical and Trauma incidents The Medic Company must respond to medical and trauma incidents as though they were requested to a confirmed medical emergency requiring immediate advanced life support. In doing so, the initial actions or Investigation mode will require that all apparatus positioning, PPE, equipment and deployment of personnel to be in preparation for locating a patient in need of initial ALS care. As such, additional companies will presume that they will be assisting in ALS care of critical patients until such time that an Officer or the Attendant determines otherwise and reports such findings. All tools and equipment are to be deployed with personnel. No member of a Medic Company should deploy without their other member and equipment. All response, patient care and transport decisions must be based on Region and System Policies and Procedures as well as specific Departmental Rules and Policies. 5.8.5 Response to Fire incidents There is an assumption that the Medic Company will be available when needed to assist in any given still district. The Medic Company will be able to perform fireground tasks to support the 1st due Suppression Company when needed. These tasks will normally be limited to exterior support operations including securing water supply and assistance in ladder and hose operations. There are however, several tasks that must be completed by a Medic Company at a fire incident as follows: 5.8.5.1 First due Medic Co. will provide initial medical care and transport for any victims found on arrival 5.8.5.2 Second due Medic Co. will join Squad Co. to assist with assigned duties such as forcible entry, ventilation, primary search, securing utilities, other duties as assigned by Squad Officer 5.8.5.3 Third due Medic Co. will dress in PPE and report with equipment to Command Post to be deployed as RIT medic for firefighter safety if needed or to accept any additional victims found 5.8.5.4 All Medic Companies should position ambulances for transport from the scene if possible. If any of these positions are vacated due to a Medic Co. being assigned to fire suppression duties, that assignment must be communicated to the IC so that the Medic Co. can be replaced and their normally assigned tasks completed. Medic Company Operations Page 6 of 18 5.9 Multiple Patient Incident Management 5.9.1 Multiple Victim Incident (MVI) • • A small-scale incident can be managed with resources that can arrive within 15 minutes of the initial dispatch and make normal levels of EMS care achievable for the most seriously injured. Time sensitive patients can be transported within 10 minutes of scene time. A multiple victim incident exists when: • Responding EMS providers can mitigate life-threats using standard operating procedures, and • The responding EMS agency can acquire adequate numbers of responders and ambulances to provide normal levels of care and transportation, and • Hospitals that can be reached within the normally accepted transport time can provide adequate patient stabilization until definitive care can be provided. This may require receiving hospitals to activate their internal disaster plans, even though it is not necessary to implement the mass casualty response in the field. Practical application: • No triage tags necessary (but may be used) • Ambulance transport as usual o Medic Company may transport 1 ALS and 1 BLS or 2 BLS patients without mitigating circumstances • Medical Control radio contact by each transporting ambulance as usual • Patient Care Reports to be completed as usual o Refusals and MPRs documented as per System SOP 5.9.1.1 First EMS Unit on scene: • The Attendant begins scene size-up and calls for additional resources • The Driver begins primary triage using the START or Jump START triage process • Initial contact with Medical Control at the resource hospital and report the nature of the incident and potential number of victims per Systemspecific policy • Identify patients by number and physical location 5.9.1.2 Scene command decision: 5.9.1.2.1 Begin transport of 2 of the most critical (red) patients to each of the nearest hospitals (adhering to trauma triage criteria for Level I and II transports) to help clear the scene 5.9.1.2.2 Transporting EMS providers shall contact the receiving hospital for on- line Medical Control Medic Company Operations Page 7 of 18 5.9.1.3 Remaining patient disposition (Considerations): 5.9.1.3.1 Joint decision with Medical Control: When the number of ill or injured persons exceeds the transport of 2 (of the most critical) patients to each of the nearest hospitals, contact the Resource Hospital to coordinate remaining patient distribution. Inform them about the nature of the incident, the number of patients and their acuity levels. 5.9.1.3.2 The hospital will assess receiving hospital status and relay receiving availability to scene. 5.9.1.3.3 Make all attempts to evenly distribute remaining patients to local hospitals; do not overburden one facility. 5.9.1.3.4 While it is preferable to keep families together, it is not always in the best interest of patient care to do so. 5.9.1.3.5 The hospitals will consider time of day, hospital resources available, patient acuity and trauma triage criteria in determining patient destinations. 5.9.1.3.6 Follow System-specific policy regarding contact of EMS Medical Director and/or EMS System Coordinator. 5.9.1.3.7 Track the patients and their transport destination by assigned patient numbers and transporting medic unit. 5.9.1.4 Documentation 5.9.1.4.1 Per system protocol, complete a patient care report for each patient transported or refusal obtained. 5.10 Mass Casualty Incident (MCI) Mass Casualty Incidents in Regions VII are governed by MABAS Divisions and County or System Mass Casualty Plans. Roles will vary. It is recommended that at least the following are designated for EMS purposes: Triage, Treatment and Transportation Groups. An MCI is a medium to large scale incident that cannot be managed with primary and secondary response companies making normal levels of EMS care unachievable. This may be due to the nature of the incident and/or number of patients. A mass casualty incident exists when the: • number of patients and the nature of their injuries make the normal prehospital level of stabilization and care unachievable; and/or • resources that can be brought to the field within primary and secondary response times are insufficient to manage the scene under normal operating procedures; and/or • stabilization capabilities of area hospitals are insufficient to handle all the patients. Medic Company Operations Page 8 of 18 Practical application: • Triage tags are to be used on all patients • • • May transport more than one patient in each ambulance o 1 stretcher and 3 seated patients or 2 stretcher patients – all must be safely secured with belts/restraints No radio reports to hospitals; treat per SOPs No individual run reports necessary, triage tags function as the run sheet for each patient. A PCR may be generated at the completion of the MCI to document activities performed. A NFIRS report WILL be generated by the individual company as per SOP to document the call for the company. o Refusals may be documented as a running MPR by the Triage Officer as time allows to document the disposition of patients leaving the scene not under medical care. 5.10.1 First EMS unit on scene establishes temporary scene command: • The Attendant begins scene size up and calls for additional resources • The Driver begins primary triage using START or Jump START and SMART Tag™ systems 5.10.2 Scene command / Joint decisions with Online Medical Control (OLMC): • Call Resource Hospital from scene. o Relay nature of incident; number of victims; general acuity; age groups, special needs and estimated time of arrival. o Maintain communications with hospital once established. o Keep line open for updates. • Resource Hospital shall assess receiving hospital status and relay receiving availability to scene. • Transportation officer should determine hospital destinations based on time of day, hospital resources available, and patient acuity. o Make all attempts to evenly distribute remaining patients to area hospitals; do not overburden one facility. o This may mean transports of longer than 25 minutes depending on patient volume. o Preferable, but not necessary, to keep families together. • Trauma triage criteria to Level I and Level II trauma centers no longer apply. • All effort shall be made to remove patients from the scene and transport to the appropriate hospital as quickly as possible. Do not hinder patient transports to complete documentation. 5.10.3 Suspension of normal EMS operations Depending on the nature and magnitude of an incident, the EMS Medical Director or State Medical Director may suspend all EMS operations as usual and direct that all care be conducted by SOP and/or using personnel and resources as available. Medic Company Operations Page 9 of 18 5.10.4 Documentation o The 1st arriving Medic Company will generate a PCR describing the scene and actions taken in general. o Incident Command will generate a NFIRS report to document the scene as per Alliance SOP. o Individual Medic and Fire Companies will only complete NFIRS reports to document their actions on the scene and transports. o Transporting Medic Companies will ensure patient triage tag corner is given to the Transport Officer before leaving the scene to transport patients to the hospital if possible. If unable, the Medic Company will ensure the triage tag number is reported to the Transport Officer as soon as possible following the transport. 5.10.5 5.11 Reassignment of Transporting Medic Companies Medic Companies assigned to an MCI will return to staging after transporting their patients to the hospital and quickly restocking. Companies will remain assigned to the MCI until released by Incident Command or the Staging Officer. Violence Related Calls (Domestic/Psych) Potentially violent calls can be dispatched as many things including abuse, assault and behavioral evaluations. Scene safety is the main priority at such incidents. Provider safety followed by safety of the patient and the public should be considered in that order when responding to any potentially violent situation. Staging for law enforcement to declare the scene safe to enter is a common practice that should be employed based on the situation, as well as department and system specific policies. All calls have the potential to become violent or to escalate. The following are scene safety considerations to keep in mind to operate safely: • Monitor the scene continuously for escalation • Know ways to retreat from unstable situations • Be prepared to request further assistance • Consider use of ballistic protection if available based on department policy 5.12 Active Shooter Incidents/Rescue Task Force Active Shooter Incidents (ASI) utilizing Rescue Task Forces (RTF) are specialized operations in a dangerous environment that require a heightened level of awareness and training to mitigate safely. Medic companies operating at these incidents is remarkably like any other MVI/MCI. The main difference is that even in an outer perimeter operation are taking place in an uncontrolled environment. This requires more attention be paid to outside threats and changing circumstances than in other medical situations. System specific policies for MCI/MVI should be followed at all times. Medic Company Operations Page 10 of 18 Expedient patient care and departure from the scene for the most critical patients is the priority for Medic Companies at an ASI. Much of the on-scene care and scene management will be handled by non-transport companies out of necessity. 5.12.1 First Due Medic at an ASI The first due Medic at an ASI should report to the staging area and contact the Rescue Chief. Expect to take the Medical and Triage positions as on an MCI. • • • • • Determine with the first arriving Chief where in the outer perimeter to set up Triage area Gather the following equipment: o Triage equipment o Trauma equipment o Cot o Cardiac Monitor o Airway and medication equipment o Any available tactical EMS equipment o All patient movement equipment including movement tarps, backboards stair chair Locate RTF deployment area and hand off patient movement equipment Perform Triage in the outer perimeter Establish communications with resource hospital 5.12.2 Additional Medic Companies arriving to an ASI • Report to staging area and position vehicle with other transport vehicles in a manner that facilitates exit from the scene to transport to hospitals • Gather the following equipment: o Triage equipment o Trauma equipment o Cot o Cardiac Monitor o Airway and medication equipment o Any available tactical EMS equipment o All patient movement equipment including movement tarps, backboards stair chair • Be prepared to hand off patient movement equipment to RTF companies. • Wait to be requested to move up. Due to the nature of these incidents there may be multiple casualty collection points and based on transport priorities there may be a substantial distance to travel to get to a patient Medic Company Operations Page 11 of 18 5.13 Rehab Operations This guideline shall apply to all personnel who perform activities including, but not limited to, fire ground operations, EMS operations, and training exercises where strenuous mental and physical activities or exposure to heat or cold exist. Rehab will be established to ensure that the physical and mental condition of members operating at the scene of an emergency, training exercise, or other Fire Department activity does not deteriorate to a level that affects the safety and well-being of each member or that jeopardizes the safety and integrity of the operation. 5.13.1 Rehab Levels Tier 1 Rehab: At the discretion of the Incident Commander, the company should selfrehab (rest with hydration) for at least 10 minutes following the depletion of one 30-min SCBA cylinder or after 20 minutes of intense work without wearing an SCBA. The Company Officer must ensure that all assigned members are fit to return to duty before resuming operations. Tier 2 Rehab: Personnel must enter a formal rehab area, drink appropriate fluids, be medically evaluated, and rest for a minimum of 20 minutes after any of the following: • Depletion of two 30-min SCBA cylinders • Depletion of one 45 or 60 -min SCBA cylinder • Whenever encapsulating chemical protective clothing is worn; • Following 40 minutes of intense work without an SCBA • At the discretion of the incident commander 5.13.2 Establishment of Rehab The IC shall establish rehab when conditions indicate that rest and rehabilitation is needed for personnel working at an incident or training activity. Climactic or environmental conditions that indicate the need to establish rehab are a heat stress index above 90 degrees Fahrenheit or wind-chill index below 10 degrees Fahrenheit. Additional factors that should be considered in the need to establish rehab include: • Time – including extended use of PPE and exposure to weather conditions • Complexity – including crimes scenes, or specialty team operations • Intensity -mental and/or physical stress at incidents such as major extrications, interior search and rescue or fire suppression operations. The rehab group supervisor shall function within the Incident Command system and report to the IC or designee (i.e. Safety Officer). Rehab shall be staffed by a minimum of 1 Paramedic for every 10 persons who are being concurrently rehabbed. For incidents that escalate to a box alarm, a Chief Officer should be assigned to the Rehab Group if possible. Medic Company Operations Page 12 of 18 5.13.3 Site location and characteristics of Rehab The Rehab Group Supervisor shall select an appropriate location that will allow physical rest by allowing personnel to recuperate from the demands and hazards of the emergency incident or training activity. Specific criteria for selecting a rehab site should include: • Be far enough away from the scene that personnel may safely remove PPE and have their vital signs checked while receiving fluids and rest. • • • • • • Provide suitable protection from the prevailing weather conditions. During hot weather, it should be in a cool, shaded area. During cold weather, it should be in a warm, dry area. Large enough to handle the needs to the incident Easily accessible by ambulance Enable personnel to be free from exhaust of apparatus, vehicle or equipment Allow for prompt re-assignment by the rehab manager as determined by the IC. Should be marked using scene tape and signs and provide a single entry/exit point 5.13.3.1 Services provided Rehab Efforts should include the following: • Relief from weather conditions • Rest and recovery • Active and/or passive cooling or warming as needed • Rehydration • Calorie and electrolyte replacement for longer duration incidents • Medical monitoring • Accountability 5.13.3.2 Medical Evaluation criteria for required medical transport of personnel • Complaints of chest pain, dizziness, shortness of breath or weakness • Symptoms of heat or cold related stress • Changes in gait, speech, or behavior • Changes in alertness and orientation to person, place, time 5.13.3.3 Medical Evaluation criteria to recommend medical transport of personnel • Weakness, nausea, or headache. • General complaints such as cramps, aches and pains • Vital signs considered abnormal based on Appendix A (Medical Assessment Criteria) • Final decision to require transport of a member in any case will rest with the Rehab Supervisor or if none has been established, with the Incident Commander or Training Officer. Medic Company Operations Page 13 of 18 5.13.3.4 Accountability – Appendix B – Incident Rehab/ Individual Rehabilitation Report • Assignment to rehab is to be considered an order like any other scene assignment. • Personnel assigned to rehab shall enter and exit the rehab area as a company. The company designation, number of personnel, and the times of entry/ exit shall be documented by the rehab manager. • Companies shall not leave the rehab area unless released by the rehab group supervisor and shall then report to the next assignment issued by the IC, operation, or the IC • At the conclusion of the incident/ training all completed rehab forms will be turned over to the IC/ training officer. The completed forms need to be attached to the NIFRS or training report. • See Appendix B for copies of the OLFD Rehab forms. 5.14 RIT Operations 5.14.1 Assignment A Medic Company can be assigned to a ‘rapid’ intervention operation at any time during a fire. The RIT Medic Company works under the supervision of the RIT Chief or other Chief assigned. A rapid intervention will generally occur within immediate reach of the victim requiring immediate disentanglement, direction out of building, rapid removal out of the building, etc... 5.14.2 Equipment and Staffing The assigned RIT Medic Company is to have all EMS equipment to provide rapid lifesaving treatments and to properly immobilize for spinal protection. The Medic Company shall monitor the RIT channel to identify the exit point of the rescue to receive and start treatment of the victim. Each additional RIT team should be assigned their own Medic Company. 5.14.3 RIT Medic Company Duties The duties of a RIT Medic are to expedite treatment and transport once the member who called a mayday is extricated. When multiple personnel are injured, additional Medic Companies should be assigned to RIT to allow immediate transport. If the RIT Medic Company enters the IDLH atmosphere to assist in rescuing and removing personnel, they are considered a part of the RIT team and should be replaced with another Medic Company. 5.14.4 Tools Cot, jump bag, radios, monitor, airway equipment, immobilization equipment. Medic Company shall gather equipment and report to Incident Commander. 5.14.5 Transport/Apparatus Placement Medic Company shall position itself to successfully transport from scene if needed Medic Company Operations Page 14 of 18 5.14.6 Hazardous Materials Incidents During a Hazmat response, once the RIT is established, consideration should be given to assigning 1 Medic Company per Entry Term member to expedite treatment and transport in the event of mayday incident. Refer to MABAS Division 21 guidelines for rehab. 6.0 EXCEPTIONS None 7.0 REFERENCES None 8.0 APPENDICIES NONE Medic Company Operations Page 15 of 18 Medic Company Operations Page 16 of 18 DEPARTMENT UNIT TYPE CREW SIZE TIME IN TIME OUT DEPARTMENT UNIT TYPE CREW SIZE TIME IN TIME OUT Medic Company Operations Page 17 of 18 Medic Company Operations Page 18 of 18