BUCKS COUNTY EHS ANNUAL REPORT ANNEX FISCAL YEAR 2019-2020

Authority Report are due within 30 calendar days of the end of each state fiscal year (June 30th)

Jeryl L. DeGideo, Director [email protected]

Ver 1. 06 Jun 2020 TABLE OF CONTENTS

Other Reportable Areas of Interest

ANNEX A – Regional Council Position Descriptions

ANNEX B – Conflict of Interest Policy

ANNEX C – Comprehensive Regional EMS System Plan Comprehensive Regional EMS System Plan

ANNEX D – Meeting and Minutes

ANNEX E – Continuity of Operations Plan (COOP)

ANNEX F – Regional Mass Casualty Plan

ANNEX G – Cumulative Equipment Inventory

Ver 1. 06 Jun 2020 OTHER REPORTABLE AREAS OF INTEREST

Work Force Development - NIMS

Percentage of staff completing NIMS Training (ICS) 90%

Indicate the number of staff members who completed the following NIMS Courses 5.5 total staff

IS-100 5.5

IS-700 5.5

IS-800 5.5

IS-200 5.5

IS-703 5.

ICS-300 4.

ICS-400 3.

Workforce Development Narrative: Currently looking for an ICS-400 for one staff member.

EMS Agency Mergers or Acquisitions

Number of EMS Agency Mergers or Acquisitions 0

Mergers or Acquisitions Narrative: We had no mergers or acquisitions nor is there any talk of any in the works.

‐ 1 ‐ ANNEX A

Regional Council Position Descriptions

Position Descriptions shall include:

• Position Title • Responsibilities/Duties • Number of Hours per Week Worked • Percentage of Work Time Allocated to the Contract • Line of Supervision • Education/Training Requirements • Work Experience/Qualifications

‐ 2 ‐ COUNTY OF BUCKS

JOB TITLE: Director of Emergency Health JOB CODE: 0038 Services

DEPARTMENT: Emergency Health Services UNION: 11

FLSA STATUS: Exempt GRADE:

REVISION 08/2019 DATE:

POSITION SUMMARY: Responsible for planning, organizing, implementing and directing an emergency medical services system through the County Office of Emergency Health Services. Also responsible for planning, organizing and directing the operation of the Bucks County Emergency Health Advisory Council that is recognized by the Board of Commissioners as the advisory body to the County’s Emergency Health Services Department. Operation is guided by the requirements existing within the County and in accordance with general guidelines established by the Federal, State and County government relative to systems and programs for improved emergency medical care. In addition, responsible for attending and participating in the Southeast Regional Task Force, Bucks County Healthcare Coalition and the Regional Healthcare Coalition. Reports to the Emergency Services Division Leader.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:  Responsible to prepare, submit and administer the awarded state contract/grant.  Plans programs to inform, educate and/or train the general public and members of organizations in the use of the emergency medical system and to improve the level of expertise in the initial treatment of persons requiring emergency pre‐hospital care.  Promote recruitment and retention in conjunction with the needs of the Emergency Medical System and guidance from PA Dept. of Health, Bur. of emergency Medical Services.  Promote organization and training of personnel as well as the activities of the Bucks County Emergency Health Advisory Council through presentations to community groups, hospitals and industry.  Promotes a working relationship with all agencies, hospitals, skilled nursing facilities, Bucks County Community College and PA Dept. Of Health, Bur. of Emergency Medical Services as well as various standing committees at the commonwealth level in the provision of emergency medical care to develop plans and programs for improved systems, facilities and equipment.  Prepares necessary reports, grant applications/contracts, state and county budgets and other documents as required by the County, State and/or Federal governments.  Maintains the ability to establish and control effective working relationships with public officials, hospitals, agencies, governmental entities and the general public.  Provides staffing for Emergency Operations Center activation during drills and actual emergency events.  During emergencies must work with Emergency Management. Duties include but are not limited to: staffing Emergency Operations Center, Performing damage assessments in the field, processing unmet needs, providing assistance at any scene when requested and assist in staffing Disaster Recovery Center.  Responsible for all Emergency Health Services staff in completing assignments, offering assistance along with encouragement and discipline.  Reports to the Emergency Services Division Leader.  Other duties may be assigned.

QUALIFICATIONS REQUIRED: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  Bachelor's Degree; three years of administrative experience in a public or private organization; in-depth knowledge of emergency medical services system with minimum five years’ experience, and/or any equivalent combination of experience or training  Ability to address groups, conduct formal meetings and have rapport with all affiliated agencies.  Possess proven ability to work with, train, manage and motivate personnel.  Possess proven ability to relate to and work with other County departments, local government agencies, volunteer agencies and related State and Federal agencies.  Possess current Pennsylvania Emergency Medical Technician and/or NREMT or higher prior to application and maintain certification. ‐ 3 ‐  Possess current PA Dept. of Health, Bur. of EMS approved Cardiopulmonary Resuscitation Instructor Certification prior and maintain certification.  Possess ICS 100, 200, 700, 800 prior to application  PA Driver’s license in good standing  PA Child Abuse – current within one year prior to application  PA State Police Criminal Record check – current within one year prior to application  FBI Background – current within one year prior to application  Complete ICS300, 400, G191, IS703 within one year of hire.  PA EMS Instructor, preferred not required  Position is classified as Essential Personnel. Essential Personnel must report to work when the county is closed due to any conditions if requested. Normal working hours may change.  Position is on call 24/7/365 to the Emergency Services Division Leader.  Position has additional rotating on call requirement.  Must be able to work in austere environments. Cold/hot, rain/snow, flooding, hurricane, etc..

Position: Director Emergency Health Services

FUNCTIONAL REQUIREMENTS:

Physical Demands: (Check all that apply)

Balancing X Stooping X Pushing X

Climbing X Crouching X Pulling X

Crawling X Kneeling X Handling X

Standing X Sitting X Talking X

Turning X Reaching X Hearing X

Seeing X Color Vision X Depth Perception X

Mobility X

Lifting: (Check one) Carrying: (Check one)

Sedentary (0-10 lbs) Sedentary (<10 lbs)

Light (0-20 lbs) Light (0-10 lbs)

X Medium (0-50 lbs) X Medium (0-25 lbs)

Heavy (0- 100 lbs) Heavy (0- 50 lbs)

Very Heavy (over 100 lbs)_ Very Heavy (over 50 lbs)

‐ 4 ‐ Aptitudes: (Check all that apply)

Form perception X Problem solving X

Motor coordination X Working speed (ex.wpm)

Finger dexterity X Manual dexterity X

Computer/VDT ability X General learning ability X

Clerical perception X

Environmental Conditions: (Check all that apply)

Extreme cold X Extreme heat X

Temperature changes X Wet conditions X

Humid conditions X Exposure to fumes X

Exposure to blood and body fluids X Noise and vibration X

Exposure to chemicals Poor ventilation X

Inclement weather conditions; X Inside/outside weather conditions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

I certify I am able to perform each and every essential function of the job for which I have applied, with or without a reasonable accommodation.

Signature: ______Date: ______

‐ 5 ‐ COUNTY OF BUCKS

JOB TITLE: EMS Quality Assurance JOB CODE: 0646 Coordinator

DEPARTMENT: Emergency Health Services UNION: 00

FLSA STATUS: Non-Exempt GRADE:

REVISION 08/2019 DATE:

POSITION SUMMARY: : Functions as a liaison between Pennsylvania Department of Health, Bureau of Emergency Medical Services, Bucks County providers, agencies, hospitals and physicians.

 Monitors the delivery of basic, intermediate and advanced pre‐hospital emergency medical services to include system activation; dispatch; response; time spent in the pre‐hospital phase; procedures performed; interaction with medical command; interaction with support services; interaction with patient/family; transportation; articulation with hospital emergency department personnel; closure; and debriefing.  Determines compliance of pre‐hospital EMS activities in relationship to standards established by Federal, State and local authorities, nationally recognized medical standards and/or administrative and medical standards of Bucks County Emergency Health Council, its Medical Director or representative committee.  Works closely with the hospital Emergency Department physicians, nurses and staff; hospital medical records personnel; agency chiefs; providers; Emergency Health Council Board of Directors and Medical Director; Quality Assurance personnel; personnel at tertiary care centers; office personnel, etc., in the administration and supervision of policies and decisions designed to strengthen the overall quality of emergency medical services.  Responsible to the Director of Emergency Health Services in the execution of all duties.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:  Supervises the collection of data in order to obtain data elements for quality assurance purposes.  Create and provide quality assurance data reports based on collected data.  Analyzes quality assurance data to determine system trends, activities and developments; and reports this analysis to appropriate personnel, committees and agencies.  Matches dispatched ALS calls to the digital voice recordings at the command facility, listens to/reviews tapes for the purpose of quality assurance and peer review.  Obtains communication records and patient data of a given category as directed by the Regional Medical Director and/or EHS Director, i.e., trauma cases, helicopter transports, cardiac arrests etc.  Presents screened cases, data summaries, etc., to the Quality Assurance Committee or other appropriate peer review committee without bias, opinion or recommendation. Records recommendation and/or decisions of the peer review body and/or Regional Medical Director and assist in executing the administrative aspects associated with the peer review recommendation/decision.  Maintains all records associated with the Quality Assurance process in a confidential manner.  Maintains skill maintenance records of all Paramedic personnel and reports deficiencies to the Quality Assurance Committee or other appropriate personnel.  Ex‐officio to MAC (Medical Advisory Committee). Records recommendations/decision of MAC and assists Regional Medical Director in execution of the administrative aspects associated with MAC.  Maintains a close working relationship with Regional Medical Director and all members of MAC.  Executes other assignments in support of the Emergency Health Services office and/or Emergency Medical Services System as may be assigned by the EHS Director.  Other duties may be assigned.

QUALIFICATIONS REQUIRED: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  High School Diploma; Bachelor’s Degree preferred but not required.  Possess PA Paramedic and/or National Registry EMT-P or higher, prior to application and maintain certification.

‐ 6 ‐  Minimum 5 years’ experience in Advanced life Support certification, with a minimum of 1 year in the County of Bucks Emergency Medical Services System.  Possess ICS 100, 200, 700, 800 prior to application  PA State Police Criminal Record Check – current within one year prior to application  PA Child Background Check – current within one year prior to application.  FBI Background Check – current within one year prior to application  Must complete ICS 300, 400, G191 and iS703 within one year of hire.  Must complete a PA Emergency medical Service Instructor certification course within one year of hire and maintain certification.  Position is classified as Essential Personnel. Essential Personnel must report to work when the county is closed due to any conditions, if requested.  Must be able to work in austere environments. Cold/hot, rain/snow, flooding etc.  Basic knowledge of the Bucks County Emergency Medical Services system.  Ability to speak and write English clearly and professionally.  Capable of participating in and/or conducting meetings.  Background in peer review activities or other related area requiring extensive confidentiality.  Possess considerable diplomatic attributes to include easy establishment of rapport, maintenance of strict confidence, capability of working on a one-to-one basis, etc.  Knowledge of computer systems and operations.  Ability to drive large trucks (non-CDL), not required  Ability to tow trailers, not required  Must have the ability to travel overnight, when needed.

OTHER REQUIREMENTS:  Due to the extreme sensitivity and confidential nature of the position activity, the QA Coordinator must:  Maintain confidentiality of records at all times.  Avoid discussion of sensitive quality assurance documents with any party other than the Quality Assurance Committee or those directly involved in the care of the patient.  Maintain complete objectivity and reporting, without bias, any quality assurance occurrence/infraction regardless of person, agency, hospital, facility, patient or any other factor.  Represents Bucks County at State MAC (Medical Advisory Committee) meetings with Bucks County Regional Medical Director. Infraction of any of the above requirements will be considered extreme and may result in disciplinary action and/or termination

Position: EMS Quality Assurance Coordinator

FUNCTIONAL REQUIREMENTS:

Physical Demands: (Check all that apply)

Balancing X Stooping X Pushing X

Climbing X Crouching X Pulling X

Crawling X Kneeling X Handling X

Standing X Sitting X Talking X

Turning X Reaching X Hearing X

‐ 7 ‐ Seeing X Color Vision X Depth Perception X

Mobility X

Lifting: (Check one) Carrying: (Check one)

Sedentary (0-10 lbs) Sedentary (<10 lbs)

Light (0-20 lbs) Light (0-10 lbs)

X Medium (0-50 lbs) Medium (0-25 lbs)

Heavy (0- 100 lbs) X Heavy (0- 50 lbs)

Very Heavy (over 100 lbs)_ Very Heavy (over 50 lbs)

Aptitudes: (Check all that apply)

Form perception X Problem solving X

Motor coordination X Working speed (ex.wpm)

Finger dexterity X Manual dexterity X

Computer/VDT ability X General learning ability X

Clerical perception X

Environmental Conditions: (Check all that apply)

Extreme cold X Extreme heat X

Temperature changes X Wet conditions X

Humid conditions X Exposure to fumes X

Exposure to blood and body fluids X Noise and vibration X

Exposure to chemicals Poor ventilation X

Inclement weather conditions; X Inside/outside weather conditions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

I certify I am able to perform each and every essential function of the job for which I have applied, with or without a reasonable accommodation.

Signature: ______Date: ______

‐ 8 ‐ COUNTY OF BUCKS

JOB TITLE: Emergency Health JOB CODE: 0060 Coordinator

DEPARTMENT: Emergency Health Services UNION: 00

FLSA STATUS: Non-Exempt GRADE:

REVISION 8/19 DATE:

POSITION SUMMARY: Coordinates various Emergency Medical Services continuing education and certification training programs that include; Emergency Medical Responder, Emergency Medical Technician, Paramedic, Pre‐hospital Registered Nurse, Health Professional and any other programs assigned by the EHS Director.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:  Coordinates all administrative EMS course requirements as required by PA Dept. of Health, Bur. Of EMS (BEMS) to include but not limited to: Course registration, schedules, assists students with registering, instructor assignments and course facility.  Insures availability of required course materials and equipment for each course offered.  Schedules required clinical experience of all programs offered.  Maintains EMS instructor records to include but not limited to: hours, types of lessons, reviews materials, counseling etc.  Prepares and maintains PA Dept. of Health, BEMS generated written examinations for all Emergency Medical Services and Vehicle Rescue classes as necessary.  Monitors training programs as necessary  Prepares a written review at the end of each EMS program for inclusion in the class files.  Conducts all student counseling sessions as deemed necessary along with preparing documentation and maintaining all said records.  Schedules and conducts all examinations for PA state certification  Oversee, review, inspect and spot inspect all Education Institutes licensed within Bucks County  Oversee, maintain and provide technical support of PA Dept. of Health, BEMS databases in regards to con‐ed, certification, training and reports.  Process and issue all PA Dept. of Health, BEMS certification materials and re‐registration processes.  Approve/disapprove of all continuing education courses and classes submitted by continuing education sponsors.  Approve/disapprove all student accounts within the National Registry.  Coordinates with Emergency Health Service’s Field Representative in areas affecting course/programs assigned to that position.  Oversees the inventory, maintenance and records of all equipment and materials required for Emergency Medical Services course requirements.  Oversee the CPR Education Coordinator position with the Bucks County Emergency Health Services office.  Acts as ex‐officio liaison to committees pertinent to Emergency Medical Services as assigned by the EHS Director.  Participate with Bucks County Health Council, when needed.  Assist in filling the Emergency Service Function 8 position within Bucks County Emergency Operations Center as needed/requested.  Assist with any equipment requests of ESF8 position as needed/requested.  Assist Bucks County Emergency Management as needed/requested.  Executes other assignments in support of the Emergency Health Services Office as assigned by the EHS Director.  Other duties may be assigned.

QUALIFICATIONS REQUIRED: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  High school diploma or equivalent; Bachelor’s Degree preferred but not required.  Possess current PA and/or National Registry Emergency Medical Technician or higher in good standing, prior to application and maintain certification.  Possess current PA Dept. of Health, BEMS approved CPR Instructor Certification prior to application and maintain certification. ‐ 9 ‐  Possess ICS 100, 200, 700, 800 prior to application.  PA Driver’s license in good standing.  PA Child Abuse – current within one year prior to application.  PA State Police Criminal Record Check – current within one year prior to application.  FBI Background Check – current within one year prior to application.  Complete ICS 300, 400, G191, STRIKE Team Leader and IS 703 within one year of hire.  Complete a PA Instructor certification course within one year of hire.  Position is classified as Essential Personnel. Essential Personnel must report to work when the county is closed due to any conditions, when requested.  Must be able to work changing assigned schedules during weather, manmade and other events when the Emergency Operations Center is open. Nights/Days.  Position has revolving on call requirements.  Must be able to work in austere environments. Cold/hot, rain/snow, flooding etc.  Knowledge of the Emergency Medical Services training programs.  Knowledge of record keeping and general office operations.  Proficient in skills as instructed in the Emergency Medical Services training programs.  Capable of formulating lesson plans and conducting classes.  Ability to establish and maintain effective working relationships with other staff, county department, other emergency services agencies, municipal/county/state/federal leaders along with the general public. position: Emergency Health Coordinator

FUNCTIONAL REQUIREMENTS:

Physical Demands: (Check all that apply)

Balancing X Stooping X Pushing X

Climbing X Crouching X Pulling X

Crawling X Kneeling X Handling X

Standing X Sitting X Talking X

Turning X Reaching X Hearing X

Seeing X Color Vision Depth Perception

Mobility

‐ 10 ‐ Lifting: (Check one) Carrying: (Check one)

Sedentary (0-10 lbs) Sedentary (<10 lbs)

Light (0-20 lbs) Light (0-10 lbs)

X Medium (0-50 lbs) Medium (0-25 lbs)

Heavy (0- 100 lbs) X Heavy (0- 50 lbs)

Very Heavy (over 100 lbs)_ Very Heavy (over 50 lbs)

Aptitudes: (Check all that apply)

Form perception X Problem solving X

Motor coordination X Working speed (ex.wpm)

Finger dexterity X Manual dexterity X

Computer/VDT ability X General learning ability X

Clerical perception X

Environmental Conditions: (Check all that apply)

Extreme cold X Extreme heat X

Temperature changes X Wet conditions X

Humid conditions X Exposure to fumes

Exposure to blood and body fluids X Noise and vibration X

Exposure to chemicals Poor ventilation

Inclement weather conditions; X Inside/outside weather conditions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

I certify I am able to perform each and every essential function of the job for which I have applied, with or without a reasonable accommodation.

Signature: ______Date: ______

‐ 11 ‐ COUNTY OF BUCKS

JOB TITLE: EHS Field Representative JOB CODE: 0023

DEPARTMENT: Emergency Health Services UNION: 00

FLSA STATUS: Non-Exempt GRADE:

REVISION 08/2019 DATE:

POSITION SUMMARY: Functions as a liaison between Pennsylvania Department of Health, Bureau of EMS, Bucks County Emergency Health Services and all Emergency Medical Services agencies. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:  Process all EMS agency licensure/re‐licensure application requests working in conjunction with applying agencies and PA DoH, Bur. Of EMS. This includes all required documentation for PA licensure.  Inspect/re‐inspect all vehicles listed on said licensure applications for PA DoH, Bur. Of EMS.  Distribute licensure certificate along with decals to applying agency after PA DoH, Bur. Of EMS approves the application and inspection documentation.  Assists, develops and prepares information concerning Bucks County EMS licensed unit response, working in conjunction with EMS agency, municipal leaders and Bucks County 911 Center.  Assist with any requests for response type data from EMS agencies, municipal, county and state leaders.  Develop, maintain and support special operations projects including training and equipment. Including but not limited to; Mass Casualty Incident planning, Rescue Task Force, Bucks County STRIKE Teams and the Bucks County POD truck.  Coordinates facilities and instructors for all special operations project classes.  Participate with Bucks County Health Council, when needed.  Provide assistance and supervision to instructors participating in the Bucks County training institute programs as needed/assigned.  Coordinates the availability and use of audiovisual materials and equipment.  Facilitate mass notifications regarding; education, weather closings, EMS Code changes and any other needed communication to Bucks County agencies, chiefs, and or providers.  Assist with Certification Testing.  Distribute and account for all Regional/State/Federal assets when needed.  Support and maintain Regional ePCR application. This includes being the liaison for EHS office/EMS agencies/providers and the ePCR vendor.  Acts as ex‐officio liaison to committees pertinent to EMS as assigned by the EHS Director.  Assist in filling the Emergency Service Function 8 position within Bucks County Emergency Operations Center as needed/requested.  Facilitate any equipment requests as needed/requested.  Deliver equipment as needed/requested.  Assist Bucks County Emergency management as needed/requested.  Other duties may be assigned.

QUALIFICATIONS REQUIRED: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  High school diploma or equivalent.  Possess current PA paramedic and/or NREMTP, or higher prior to application.  Minimum of two years’ experience as a PA paramedic/NREMT, or higher in good standing.  Possess ICS 100, 200, 700, 800 prior to application  Possess PA driver’s license in good standing.  PA Child Abuse – current within one year prior to application  PA State Police Criminal Record Check – current within one year prior to application  FBI Background check – current within one year prior to application  Must complete a PA EMS Instructor certification course within one year of hire and maintain certification. ‐ 12 ‐  Must complete a PA EMS approved CPR Instructor certification course within one year of hire and maintain certification.  Must complete ICS 300, 400 G191, STRIKE Team Leader and IS 703 within one year of hire.  Must complete a PA EMS Instructor certification course within one year of hire and maintain certification.  Knowledge of EMS training programs along with knowledge of record keeping and general office operations.  Ability to establish and maintain effective working relationships with other staff, county departments, other emergency services agencies, municipal/county/state/ federal leaders along with the general public.  Ability to travel overnight, when needed.  Ability to drive large trucks (non-CDL).  Ability to tow trailers.  Position is classified as Essential Personnel. Essential Personnel must report to work when the county is closed due to any conditions, requested.  Must be able to work changing assigned schedule during weather, manmade and other events when the Emergency Operation Center is open. Nights/Days.  Position has revolving on call requirements.  Must be able to work in austere environments. Cold/hot, rain/snow, flooding etc. Position: EHS Field Representative

FUNCTIONAL REQUIREMENTS:

Physical Demands: (Check all that apply)

Balancing X Stooping X Pushing X

Climbing X Crouching X Pulling X

Crawling X Kneeling X Handling X

Standing X Sitting X Talking X

Turning X Reaching X Hearing X

Seeing X Color Vision Depth Perception X

Mobility X

Lifting: (Check one) Carrying: (Check one)

Sedentary (0-10 lbs) Sedentary (<10 lbs)

Light (0-20 lbs) Light (0-10 lbs)

X Medium (0-50 lbs) Medium (0-25 lbs)

Heavy (0- 100 lbs) X Heavy (0- 50 lbs)

Very Heavy (over 100 lbs)_ Very Heavy (over 50 lbs)

‐ 13 ‐ Aptitudes: (Check all that apply)

Form perception X Problem solving X

Motor coordination X Working speed (ex.wpm)

Finger dexterity X Manual dexterity X

Computer/VDT ability X General learning ability X

Clerical perception X

Environmental Conditions: (Check all that apply)

Extreme cold X Extreme heat X

Temperature changes X Wet conditions X

Humid conditions X Exposure to fumes X

Exposure to blood and body fluids X Noise and vibration X

Exposure to chemicals Poor ventilation

Inclement weather conditions; X Inside/outside weather conditions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

I certify I am able to perform each and every essential function of the job for which I have applied, with or without a reasonable accommodation.

Signature: ______Date: ______

‐ 14 ‐ COUNTY OF BUCKS

JOB TITLE: ADMINISTRATVIE JOB CODE: 0306 ASSISTANT/5

DEPARTMENT: Emergency Health Services UNION: AFSCME

FLSA STATUS: Non‐Exempt GRADE:

REVISION 8/2019 DATE:

POSITION SUMMARY: Performs varied clerical and secretarial duties including communication with EMS providers and agencies along with general public.

Candidate must be able to work independently, performing with minimal supervision along with being self-motivated.

ESSENTIAL DUTIES AND RESPONSIBILITIES:  Screens and refers phone calls and visitors to proper people giving or searching for answers to routine questions.  Maintains various files.  Meets and deals effectively with public and staff.  Assists in the solution of problems.  Accumulate and input payroll data  Performs all purchases for the department  Assist in the county budget preparation.  Assist in the state budget preparation  Prepare and submit electronically Monthly Business Analysis  Prepare and submit electronically state contract/grant report/invoice, monthly  Communicate with vendors  Prepare monthly and annual county status reports  Schedules appointments and meetings.  Composes letters, reports, etc., as directed by the EHS Director.  May be required to perform additional work that follows prescribed or well-established procedures that can be learned within a reasonable time by training on the job. More detailed instructions as to the nature of their duties will be given to employees at the beginning of work. QUALIFICATION REQUIRED: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  High diploma or equivalent with emphasis on business courses.  Skill in typing (minimum 45 wpm).  Knowledge of Business English, spelling and arithmetic.  Must complete ICS 100, 200, 700, 800 and IS703 within one year of hire.  Ability to work without direction.  Ability to work effectively with the public and other agencies.

‐ 15 ‐ FUNCTIONAL REQUIREMENTS:

Physical Demands: (Check all that apply)

Balancing X Stooping X Pushing X

Climbing Crouching X Pulling X

Crawling Kneeling X Handling X

Standing Sitting X Talking X

Turning X Reaching X Hearing X

Seeing X Color Vision Depth Perception

Mobility

Lifting: (Check one) Carrying: (Check one)

X Sedentary (0‐10 lbs) X Sedentary (<10 lbs)

Light (0‐20 lbs) Light (0‐10 lbs)

Medium (0‐50 lbs) Medium (0‐25 lbs)

Heavy (0‐ 100 lbs) Heavy (0‐ 50 lbs)

Very Heavy (over 100 lbs)_ Very Heavy (over 50 lbs)

Aptitudes: (Check all that apply)

Form perception Problem solving X

Motor coordination X Working speed – 45 wpm X

Finger dexterity X Manual dexterity

Computer/VDT ability X General learning ability X

Clerical perception X

‐ 16 ‐ Environmental Conditions: (Check all that apply)

Extreme cold Extreme heat

Temperature changes Wet conditions

Humid conditions Exposure to fumes

Exposure to blood and body fluids Noise and vibration

Exposure to chemicals Poor ventilation

Inclement weather conditions;

Inside/outside weather conditions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

I certify I am able to perform each and every essential function of the job for which I have applied, with or without a reasonable accommodation.

Signature: ______Date: ______

‐ 17 ‐ COUNTY OF BUCKS

JOB TITLE: CPR Education Coordinator – JOB CODE: 0760 Per

DEPARTMENT: Emergency Health Services UNION: 00

FLSA STATUS: Non-Exempt GRADE:

REVISION 8/2019 DATE:

POSITION SUMMARY: Develops, prepares, coordinates and delivers various types of cardiopulmonary resuscitation (CPR) education programs. Programs will be presented to County of Bucks departments, community organizations and schools throughout Bucks County. Minimum travel would be required as well as work in the evenings and weekends. Will also perform additional tasks or activities to assist in the overall operation of the Bucks County EHS Office and system.

Must be capable of working independently, performing with minimal supervision, be self‐motivated and experienced in the handling of multiple projects and changing priorities while still meeting critical project deadlines.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:  Teach CPR and 1st Aid classes as needed/determined.  Develops lesson plans, curriculum, strategies and support materials  Ability to use web based programs utilized both for the classroom setting and for completion and submission of all paperwork for certification of students.  Analyzes CPR education needs for the County of Bucks.  Ability to work with all age groups.  Classes are scheduled and held throughout all of Bucks County.  Schedules programs/events, staff, facilities and other resources to facilitate delivery of programs/events.  Coordinates and conducts programs/courses related to the mission of Bucks County and PA Department of Health, Bureau of Emergency Medical Services (BEMS).  Attend professional development training programs and maintains an awareness of changes and issues affecting CPR education.  Conduct inventory and maintain records in reference to training equipment and materials required for CPR, Continuing Education and Emergency Medical Services courses.  Participate in Bucks County Health Council: scheduling meetings and all correspondence.  Reviews new material and programs for use.  Assist Bucks County Emergency management as needed/requested.  Performs other duties as assigned by the Emergency Health Coordinator or the EHS Director.

QUALIFICATIONS REQUIRED: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Any combination of experience and training that affords the applicant an opportunity to gain the above listed knowledge, skill and ability.  High school diploma or equivalent.  Possess current PA Dept. of Health, Bureau of EMS (BEMS) approved CPR Instructor Certification in all levels of CPR education prior to application and maintain certification. Go to BCEHS.com to see a list of approved course.  Excellent verbal and written communication skills.  Must be proficient in public speaking as it is an integral part of the position.  Excellent knowledge of Power Point and Excel programs.  Knowledge of the Bucks County Emergency Services system.

‐ 18 ‐ Position: CPR Education Coordinator – Per Diem

FUNCTIONAL REQUIREMENTS:

Physical Demands: (Check all that apply)

Balancing X Stooping X Pushing X

Climbing X Crouching X Pulling X

Crawling X Kneeling X Handling X

Standing X Sitting X Talking X

Turning X Reaching X Hearing X

Seeing X Color Vision Depth Perception

Mobility X

Lifting: (Check one) Carrying: (Check one)

Sedentary (0-10 lbs) Sedentary (<10 lbs)

Light (0-20 lbs) Light (0-10 lbs)

X Medium (0-50 lbs) Medium (0-25 lbs)

Heavy (0- 100 lbs) X Heavy (0- 50 lbs)

Very Heavy (over 100 lbs)_ Very Heavy (over 50 lbs)

Aptitudes: (Check all that apply)

Form perception Problem solving X

Motor coordination X Working speed (ex.wpm)

Finger dexterity X Manual dexterity X

Computer/VDT ability X General learning ability X

Clerical perception X

Environmental Conditions: (Check all that apply)

Extreme cold Extreme heat

‐ 19 ‐ Temperature changes Wet conditions

Humid conditions X Exposure to fumes

Exposure to blood and body fluids Noise and vibration

Exposure to chemicals Poor ventilation

Inclement weather conditions;

Inside/outside weather conditions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

I certify I am able to perform each and every essential function of the job for which I have applied, with or without a reasonable accommodation.

Signature: ______Date: ______

‐ 20 ‐ Bucks County EHS staff salaries are only partially funded by this contract, the balance is funded by the County of Bucks. Please see below: State % County % Weekly Funded Funded % worked for BEMS Director - salary 40 hours .04% 99.96% 90% Quality Assurance 40 hours 48% 52% 90% Health Coordinator 40 hours 48% 52% 90% Field Representative 40 hours 48% 52% 90% Admin. Assist./5 40 hours 48% 52% 90% CPR Coordinator 20 hours 64% 36% 90%

EHS Director reports to the Bucks County Emergency Services Division Leader and the Bucks County Commissioners, the full time staff report directly to the EHS Director with our part time CPR Coordinator reporting to our Health Coordinator.

‐ 21 ‐ ANNEX B

Conflict of Interest Policy

‐ 22 ‐ BUCKS COUNTY EMERGENCY HEALTH SERVICES

CODE OF CONDUCT

No Code of Conduct can be cover every question or situation and neither the provisions of the Code nor its examples should be seen as the only types of issues that can arise or for which you are responsible. As an employee of Bucks County Emergency Health Services, you are required to adhere to the highest ethical standards in all your dealings, regardless of whether specifically covered in the Code.

Emergency Health Services holds us to a high standard, abiding by this Code of Conduct will set our standards even higher. Working together, setting priorities, and doing so with respect to our department and the EMS community as a whole is very important. Rules of conduct are needed to help everyone work together effectively and efficiently.

By accepting this Code of Conduct, you have a responsibility to the County of Bucks, this department and to your fellow employees to adhere to certain rules of behavior and conduct. The purpose of this code is not to restrict your rights, but rather to be certain that you understand what conduct is expected and necessary. When each person is aware that he or she can fully depend upon fellow workers to follow the rules of conduct, then our department will be a better place to work for everyone.

Generally speaking, we expect each person to act in a mature, professional and responsible way at all times. However, to avoid any possible confusion, we have outlined a few practices that must be adhered to on a daily basis. Adhering to this policy will be to your benefit as well as the benefit of the department.

 If, at any time, these is a conflict of interest, or a conflict that could be construed as a conflict of interest, another member of our staff will handle the situation. This includes quality assurance, licensure and training.  At all times you will act in accordance with any/all EMS State and County laws, guidelines and protocols.  The spreading of rumors or gossip will not be tolerated in any form. Information obtained by this office stays in the office unless otherwise instructed by the EHS Director.  Giving confidential county/patient/agency information to other individuals/organizations or to unauthorized County employees is prohibited unless requested by a court of law.  Engaging in behavior designed to create discord and lack of harmony; interfering with another employee on the job; willfully restricting work output or encouraging others to do the same will not be tolerated.

If your performance is unsatisfactory due to lack of ability, failure to abide by County/Department rules or failure to fulfill the requirements of your job, you will be notified of the problem either verbally or in writing. If satisfactory change does not occur, you may be disciplined or dismissed. Some incidents may result in immediate dismissal.

Signature of Employee Print name Date Title at time of signature

Signature of EHS Director Print name Date

‐ 23 ‐ ANNEX C

Meeting and Minutes

Including but not limited to:  Board of Director Meetings – We are county based, we have a Health Advisory Council no B.O.D.

 Medical Advisory Committee

 Continuous Quality Improvement Committee

‐ 24 ‐ Bucks County Emergency Health Services Advisory Council Council Minutes

‐ 25 ‐

Medical Advisory Committee Minutes

Note: Due to the COVID-19 pandemic. The May 2020 was a joint Web conference call with the the Continuous Quality Improvement Commitee.

Due to the learning curve of Web meeting we were unable to have an attendance sheet

‐ 26 ‐ Bucks County Emergency Health Services Medical Advisory Committee September 11, 2019 Minutes

Attendance: Dr. Wydro Regional Medical Director, Penndel Middletown Emergency Squad Dr. Lavellle Central Bucks EMS Dr. Geracimos St. Mary EMS, St. Mary Medical Center Dr. Wang Bensalem SWAT, Bucks County QA Dr. Yeh Temple Med Flight, Tri-Hampton Rescue Squad Dr. Blackstone St. Mary Trauma Dr. Postupack Holy Redeemer Hospital Jim Glessner Temple University Hospital, Penndel Middletown Emergency Squad Ryan Egan St. Mary EMS Scott Donohue Capital Health EMS Mike DelRossi Warrington EMS Russ Leets Chal-Brit Regional EMS Evan Resnikoff Newtown Ambulance Ray George Tri-Hampton Rescue Squad Chris McLarnon Bensalem EMS Antony Logue Levittown Fairless Hills Rescue Corey Matthews Tri-Hampton Rescue Squad Ed Copper Bensalem EMS Larry Loose Regional EMS Office

1. Meeting Called to order 1005hrs

2. Review of Meeting Minutes May 2019- Approved as written

3. Subcommittee Report a) QA- Attached b) Cardiac Arrest-Attached- Extensive discussion regarding the preference of supraglottic devices over intubation

4. Old Business a) Ketamine SAI Update- Dr. Wang gave a brief updated. Continued progress b) Regional Medical Command / Credentialing Update- Discussion on the continuation of the regional credentialing process. Larry reports challenges with filling sessions and providers not attending sessions with no accountability. c) Leave Behind Naloxone Update – Larry gave a brief updates 5. New Business a) 2019 Protocol Rollout- Dr. Wydro presented highlights of the protocol updates b) Ketamine for Ex Del request – Sq 143- Dr. Jaslow presented. Bucks County Rescue Squad Approved c) Focused Protocol Review – Pain Management i. MSK Trauma #6003- Reviewed ii. Non Trauma #7003-Reviewed

6. General Information / Good and Welfare a) Next meeting November 6, 2019 b) Naloxone Day (Sept 18 and 25)

7. Adjournment 1130 Bucks County Emergency Health Services Medical Advisory Committee November 6, 2019 Minutes

Attendance: Dr. Wydro Regional Medical Director, Penndel Middletown Emergency Squad Dr. Jaslow Bucks County Rescue Squad Dr. Baptista Capital Health EMS Dr. Wang Bensalem SWAT, Jefferson Northeast Dr. Yeh Temple Med Flight, Tri-Hampton Rescue Squad Dr. Lavelle Central Bucks EMS Larry Loose Regional EMS office Dr. Posturpack Holy Redeemer Hospital Jim Glessner Temple University, Penndel Middletown Emergency Squad Tom Mazzo Jefferson Charles Kleinschmidt Jeff Stat Flight Chris McLarnon Bensalem EMS Colleen Campbell St. Mary EMS Chris Zukowski St Lukes Emergency & Transport Greg Gordon St Lukes Emergency & Transport Joe Cervenka Central Bucks EMS Ed Copper Bensalem EMS Chris Adams Yardley Makefield EMS Scot Donohue Capital Health EMS Anthony Logue Levittown Fairless Hills Rescue Squad

1. Meeting Called to order 1003hrs

2. Review of Meeting Minutes September 2019 Approved as written

3. Subcommittee Report a) QA-Attached b) Cardiac Arrest-Attached c) Leave Behind Naloxone- Larry Loose reported year to date 40 boxes of Naloxone were left behind.

4. Old Business a) Ketamine SAI Update- Dr. Wang gave a brief summary of the pilot b) Regional Medical Command / Credentialing Update- Larry Loose gave a brief update on this credentialing. Dr. Wydro led a discussion about the future of regional credentialing past 2020. Need more agency and physician participation throughout the process.

5. New Business a) Con Ed Requirements – Agency Medical Director- Michele Rymdeika gave an overview of the requirements for con-ed including agency medical must be in the state EMS registry. b) HB 1862 Discussion / Advocacy- (handout) Brief discussion c) Ketamine request – St Lukes EMS request approval use Ketamine for excited delirium. St. Lukes Emergency & Transport were granted approval. d) mRACE Regional Training- Dr. Wydro would like to have Regional mRACE. Contact Larry Loose if interested e) DEA 222 Update (handout) Dr. Wydro summarized the updated f) Focused Protocol Review – Refusal and Non-Transport i. #111 – Refusal of Treatment- Reviewed ii. #112 – Non Transport of Patient- Reviewed- Extensive discussion. Committee believes there should more clarity on the definition of “patient” i.e. third party calls

6. General Information / Good and Welfare a) Next meeting January TBD

7. Adjournment-11:37am

Regional QA Report November 6, 2019

Time: July 1-September 30,2019

Advanced Airway Attempts-112 (Patients) 95% success rate Goal 85% first pass

1st =71%(80) 2nd= 6%(7) 3rd = % King LT 18%(20) note 14 patients went direct to Supraglottic Device. 11 are September protocol change

ETCO2 Compliance 99% (goal 95%)

Cardiac Arrest- 94patients 37 had mechanical CPR(2 ped cases omitted)

Initial rhythm Asystole- 44% 1 omitted no initial EKG

Last rhythm Asystole – 11% 0 omitted no end EKG

Initial & Last Asystole- 20% --65% were terminated

Shockable – 20% 1 omitted no initial EKG- 31% defib prior to EMS

PEA= 30% 1 omitted no initial EKG

Witness by EMS= 4%

ROSC- 37patients 39% QTR Initial Rhythm: Asystole- 35% (13) PEA- 27%(10) VF/VT- 35% (13) Witness by EMS-3% (1) 9 patients (25%) had mechanical CPR omitted 1 Ped

Transport L & S w/o ROSC- 18% (4)transported emergently Bucks County Emergency Health Services Medical Advisory Committee January 22, 2020 Minutes

Attendance Dr. Wydro Regional Medical Director, Penndel Middletown Emergency Squad Dr. Brabazon Chal-Brit Regional EMS, Abington Lansdale Dr. Baptista Capital Health EMS Dr. Jaslow Bucks County Rescue Squad Dr. Yeh Temple Med Flight, TriHampton Rescue Squad Dr. Blackstone St. Mary Trauma Antony Logue Levittown Fairless Hills Rescue Squad Jim Glessner Temple University Hospital, Penndel Middletown Emergency Squad Ryan Egan St. Mary EMS Joseph Cervenka Central Bucks EMS Ed Golden St Lukes Emergency & Transport Greg Gordon St. Lukes Emergency & Transport Jessica Huber Levittown Fairless Hills Rescue Squad Joseph Saloma Capital Health EMS Scott Donohue Capital Health EMS Ed Copper Bensalem EMS Chris Mclarnon Bensalem EMS Larry Loose Bucks County Emergency Health Services

1. Meeting Called to order 1010

2. Review of Meeting Minutes November 2019- Approved as written

3. Subcommittee Report a) QA-Attached b) Cardiac Arrest- Attached c) Leave Behind Naloxone- Larry Loose reported a total of 54 Leave Behind Naloxone

4. Old Business a) Ketamine SAI Update- Dr. Wydro gave a brief update. The Bureau of EMS has approved the pilot to continue for one more year. b) Regional Medical Command / Credentialing Update- Dr. Wydro reminded committee to encourage providers to sign up early. Larry Loose: Physician help is still needed. c) Hospital Radio Update- Dr. Wydro reported the transition is still moving forward. 5. New Business a) EMS Information Bulletin 2019-07 (handout) Dr. Wydro gave brief overview regarding minor changes to the 2019 ALS Protocols b) Focused Protocol Review i. #1000/#4091 / #8002- No comments c) Imagetrend: “All Normal Assessment Tab” Update- A recommendation from multiple QA coordinators to remove the “All Normal Assessment Tab” in the regional data collection system due to inaccurate documentation d) Network of Victim Assistance (SANE)- Handout- Brief discussion

6. General Information / Good and Welfare a) Updates i. Approved Medication List / Scope of Practice- Handout b) OLMC Survey i. https://redcap.einstein.edu/surveys/?s=AYE4TM47M3 c) Hugh Cooperman Benefit Beef and Beer- Handout d) Next meeting March 11, 2020 e) Temple University Hospital EMS Con-ed Day May 22, 2020

7. Adjournment 11:00am Regional QA Report January 22, 2020

Time: October 1- December 31, 2019

Advanced Airway Attempts- 123(Patients) 93% success rate Goal 85% first pass

1st =75%(58) 2nd = 10% (8) 3rd = 0% King LT 9%(7) Not include intubation 42 patients went direct to King LT

ETCO2 Compliance 95% QTRX (goal 95%)

Cardiac Arrest- 117patients 48 had mechanical CPR omitted 2 ped cases

Initial rhythm Asystole- 49%(57) 1 omitted no initial EKG

Last rhythm Asystole – 47%(55)

Initial & Last Asystole- 39%(46) 78% were terminated 4 patient did not meet Termination criteria

Shockable – 18%(21) 38% were shocked prior to EMS

PEA= 22%(26) 1 omitted no initial EKG

Witness by EMS= XX%

ROSC- 27 patients 23% Initial Rhythm: Asystole- 15% PEA- 33% VF/VT- 33% Witness by EMS-19% 6 patients (22%) had mechanical CPR

Transport L & S w/o ROSC- 43 transported without 12% transported emergently • COVID Update

• QA review / Cardiac Arrest

• Review Data Scheduled Febrile Resp Illness Report

• Review Protocol 932 Report

Agenda • Discussion of 2019 CARES Data

• Commonwealth Update • Recent EMSIB (13, 17, 18, 19, 21) • Cardiac Arrest Updates BUCKS COUNTY MAC UPDATES • Updates Protocol 931 May 20, 2020 • Good and Welfare

COVID-19 Update

Bucks Bucks County Dept County EHS of Health

Quality Leave Cardiac Behind Assurance Arrest Update Naloxone

Leave Behind Naloxone- 21 were left behind in this quarter. Compared to 1st quarter 2019 “7”

1 Febrile Respiratory Illness Daily Report Febrile Respiratory Illness Report Focused Data Protocol 932 Report Review 2019 CARES Data

Protocol 932 – COVID Refusal Report 2019 CARES DATA

EMS Information Bulletin

• 13: Alternatives to Nebulized Bronchodilators • 17: BLS Non-transport suspected COVID-19 • 18: Cardiac Arrest Treatment • 19: Revised Cardiac Arrest • 21: Interim COVID Updates and Changes

2 EMSIB-13 EMSIB-17

• Albuterol MDI with Spacer • Protocol 932

• IM Epinephrine • Criteria Based

• IM Terbutaline • Agency Medical Director involved

EMSIB-18 EMSIB-19

• PPE Review • Updated airway management

• Drape Application • Better define COVID cases

• HEPA Filter • Further clarity on Termination

• Early Termination

EMSIB-21 Protocol 931 Suspected Influenza Like Illness

• Update on protocols • Focus on hand hygiene

• Cautions on aerosol generating procedures • Medication Updates

• PPE information • Steroid avoidance for COVID

• Limit providers in patient compartment

3 GOOD AND WELFARE

4 Regional QA Report May 20, 2020

Time: January 1 to March 31quarter 1

Advanced Airway Attempts- (116 Patients) 97% success rate 61% (71) had an intubation attempt Goal 85% first pass

1st =75%(53) 2nd= 15%(14) 3rd = 0% 4th =1%(1) King LT 3%(2) Protocol Violation

46 patients went direct to King LT 93% success- noted there were three incidents unable to ventilate and patients were successfully intubated

ETCO2 Compliance 97% (goal 95%) 4 incidents no documented ETCO2

Cardiac Arrest- 104 patients 42 had mechanical CPR – Omitted 2 Pediatric casess

CPR Prior to EMS arrival-Bystander 22% PD/FD 19% NH/HC 9%

Initial rhythm Asystole- 51% 1 omitted no initial EKG

Last rhythm Asystole – 45% 1 omitted no initial EKG

Shockable – 17% 1 omitted no initial EKG- 39% defib prior to EMS arrival

PEA= 23% 1 omitted no initial EKG

Witness by EMS= 7%

Termination- 28=26%

ROSC- 25 patients 24% Initial Rhythm: Asystole- 32% PEA- 32% VF/VT- 28%

7 patients (28%) had mechanical CPR

Transport L & S w/o ROSC- 22% transported emergently who did not meet lights & Siren transport criteria

Leave Behind Naloxone- 21 were left behind in this quarter. Compared to 1st quarter 2019 “7” Protocol Review- Temporary BLS Protocol 932 Non-Transport of Patients with Suspected COVID-19

Enrollment for review – All non-transports were required to answer the following question Was this a Non-transport of a patient with suspected COVID-19, BLS-932?

Timeline: March 15 –May 17th Cases Reviewed- 55 Cases Met Protocol 932: 9 (16%) and 1 Protocol 932 Violation Most Cases Followed Protocol 111- Refusal of care Regional QA Report Minutes

Note: Due to the COVID-19 pandemic. The May 2020 was a joint Web conference call the the Medical Advisory Commitee.

Due to the learning curve of Web meeting we were unable to have an attendance sheet

‐ 27 ‐ Continuous Performance Improvement Committee

September 11, 2019

Minutes

Attendance Larry Loose Regional EMS Office Mike DelRossi Warrington Ambulance Ryan Egan St. Mary EMS Jim Glessner Temple University Hospital, Penndel Middletown Emergency Squad Corey Matthews Tri-Hampton Rescue Squad Anthony Logue Levittown Fairless Hills Rescue Squad Ed Copper Bensalem EMS Ray George Tri-Hampton Rescue Squad

1. Meeting Called to order 0906hrs

2. Review and approve minutes from May 15, 2019- Approved as written

3. Regional QA report- Attached

4. Trends & concerns: Documentation Mismatch –i.e. EKG- Discussion Removal of supraglottic devices- Discussion Statewide Protocol Implementation- Discussion Refusal /No Patient found- Discussion Extended discussion about regarding advance airway preference

5. Adjournment-0950hrs Regional QA Report September 10, 2019

Time: 2019 Quarter 2 (April-June)

Advanced Airway Attempts- (147 Patients) 95% success rate Goal 85% first pass

1st =67%(93) 2nd= 11%(15) 3rd =4%(6) King LT 15%(21) note 4(3%) patients went direct to King LT

SAI- 18 patients 83% first pass rate 10 patients received Ketamine 8 Etomidate

ETCO2 Compliance 100% (goal 95%)

Cardiac Arrest- 129 patients 39%(50)had mechanical CPR

Initial rhythm Asystole- 47% 1 omitted no initial EKG

Last rhythm Asystole – 37% 1 omitted no initial EKG

Initial & Last Asystole- 29% 2 omitted no EKG 70% were terminated 4 Transported L & S 1 Reoccurring VF, 1 Police Officer

Shockable – 18 % 1 omitted no initial EKG

PEA= 24% 1 omitted no initial EKG

Witness by EMS= 7%

ROSC- 35 patients 27% QTR Initial Rhythm: 1 omitted no initial EKG Asystole- 29% (10) PEA- 26% (9) All but 2 had a documented rate less 60 VF/VT- 34% (12) Witness by EMS- 9%(3) 12 patients (34%) had mechanical CPR

Transport L & S w/o ROSC- 57patients transported w/o ROSC. 12%(7) transported emergently with L & S.

Concerns: Supraglottic Devices inserted and removed without documentation. All patients who had alternative airway removed was successfully intubated.

Documentation conflicts: Continued EKG interpretation mismatch between the narrative and the flow chart Continuous Performance Improvement Committee

November 6, 2019

Minutes Attendance: Larry Loose Regional EMS Office Chris McLarnon Bensalem EMS Antony Logue Levittown Fairless Hills Rescue Squad Colleen Campbell St. Mary EMS Jim Glessner Temple University Hospital, Penndel Middletown Emergency Squad Chris Adams Yardley Makefield EMS Ed Copper Bensalem EMS Joe Cervenka Central Bucks EMS Greg Gordon St. Luke’s Emergency & Transport Chris Zukowski St. Luke’s Emergency & Transport Charles Kleinschmidt JeffStat Flight

1. Meeting Called to order 0911hrs

2. Review and approve minutes from September 10, 2019- Approved as written

3. Regional QA report-Attached

4. Trends & concerns: - Protocol 3031 Cardiac Arrest (Adult)- Extensive discussion regarding advance airway in cardiac arrest. - AEMT- Triage & Skills- Discussion about the increase in AEMT’s in the region. What they can and can’t do in the state.

5. Adjournment: 0940hrs Regional QA Report November 6, 2019

Time: July 1-September 30,2019

Advanced Airway Attempts-112 (Patients) 95% success rate Goal 85% first pass

1st =71%(80) 2nd= 6%(7) 3rd = % King LT 18%(20) note 14 patients went direct to Supraglottic Device. 11 are September protocol change

ETCO2 Compliance 99% (goal 95%)

Cardiac Arrest- 94patients 37 had mechanical CPR(2 ped cases omitted)

Initial rhythm Asystole- 44% 1 omitted no initial EKG

Last rhythm Asystole – 11% 0 omitted no end EKG

Initial & Last Asystole- 20% --65% were terminated

Shockable – 20% 1 omitted no initial EKG- 31% defib prior to EMS

PEA= 30% 1 omitted no initial EKG

Witness by EMS= 4%

ROSC- 37patients 39% QTR Initial Rhythm: Asystole- 35% (13) PEA- 27%(10) VF/VT- 35% (13) Witness by EMS-3% (1) 9 patients (25%) had mechanical CPR omitted 1 Ped

Transport L & S w/o ROSC- 18% (4)transported emergently Continuous Performance Improvement Committee January 22, 2020 Minutes

Attendance: Larry Loose Regional Quality Assurance Coordinator Joseph Cervenka Central Bucks EMS Ryan Egan St. Mary EMS Brian Beecher Newtown Ambulance Anthony Logue Levittown Fairless Hills Rescue Squad Jessica Huber Levittown Fairless Hills Rescue Squad Jim Glessner Temple University, Penndel Middletown Emergency Squad Chris Adams Yardley Makefield EMS Ed Copper Bensalem EMS Chris Mclarnon Bensalem EMS Joe Saloma Capital Health EMS (Morrisville) Greg Gordon St. Lukes Emergency & Transport Ed Golden St. Lukes Emergency & Transport

1. Meeting Called to order 0905 hours

2. Review and approve minutes from November 6, 2019- Approved as written

3. Regional QA report- Attached

4. Trends & concerns: Data Collection “All Normal” button on assessment tab- Larry Loose reports the “All Normal button is causes practitioners to document inaccurate physical examines. Example “Heart tones”. Recommendation to disable button. All agreed with disabling the button Ketamine for pain- recommend adding- Ketamine 0.2mg/kg/100ml /10minutes- Agreed Documentation- “Followed ACLS Guidelines”- Larry Loose practitioners continue to document. Providers need to understand our care is guided by the statewide protocols. Regional Strategic Emergency Medicine Cache- Larry Loose recommends agencies or a creation regional cache of emergency medications in the event hospitals are unable to provide Mobile Stroke Unit: Bensalem EMS gave brief update since the unit going in to service.

Good & Welfare: St. Luke’s Emergency & Transport and Penndel Middletown Emergency Squad are planning to do EMT challenge this is similar to the ALS credentialing competency.

5. Adjournment: 1003hrs Regional QA Report January 22, 2020

Time: October 1- December 31, 2019

Advanced Airway Attempts- 123(Patients) 93% success rate Goal 85% first pass

1st =75%(58) 2nd = 10% (8) 3rd = 0% King LT 9%(7) Not include intubation 42 patients went direct to King LT

ETCO2 Compliance 95% QTRX (goal 95%)

Cardiac Arrest- 117patients 48 had mechanical CPR omitted 2 ped cases

Initial rhythm Asystole- 49%(57) 1 omitted no initial EKG

Last rhythm Asystole – 47%(55)

Initial & Last Asystole- 39%(46) 78% were terminated 4 patient did not meet Termination criteria

Shockable – 18%(21) 38% were shocked prior to EMS

PEA= 22%(26) 1 omitted no initial EKG

Witness by EMS= XX%

ROSC- 27 patients 23% Initial Rhythm: Asystole- 15% PEA- 33% VF/VT- 33% Witness by EMS-19% 6 patients (22%) had mechanical CPR

Transport L & S w/o ROSC- 43 transported without 12% transported emergently ANNEX D

Comprehensive Regional EMS System Plan

 An inventory of all EMS resources available in the region;  An assessment of the effectiveness of the existing regional EMS system and a determination of the need for enhancement of the regional EMS system;  A statement of goals and specific measurable objectives for delivery of EMS to persons in need of EMS in the region;  Identification of inter-regional problems and recommended measures to resolve those problems;  Methods to be used in achieving stated performance measures;  A schedule for achievement of the stated performance measures;  A method for evaluating progress toward achievement of performance measures;  Estimated costs for achieving the stated performance measures;  Other information as requested by the Department.

‐ 28 ‐ INVENTORY

UNIT # PHYSICAL TEM/UNIT RADIO FUNDED EXTERIOR LOCATION DESCRIPTION ID SOURCE MAKE MODEL / YEAR COLOR NAME BUCKS DARK COUNTY EHS BC EHS OFFICE CAR EHS1 BEMS CHEVY CHEVY / 2009 BLUE OFFICE MASS CASUALTY BREAD ST. LUKES UNIT MCI108 SEPA TF TRUCK/2006 WHITE QUAKERTOWN MASS CASUALTY BREAD CHAL‐BRIT UNIT MCI134 SEPA TF TRUCK/2006 WHITE EMS MASS CASUALTY BREAD MIDDLETOWN UNIT MCI244 SEPA TF TRUCK/2006 WHITE FIRE MARSHAL MASS CASUALTY BREAD TRI‐HAMPTON UNIT MCI115 SEPA TF TRUCK/2006 WHITE RESCUE BUCKS COUNTY EHS POD TRUCK SS800 SEPA TF GMC 2008 WHITE OFFICE BUCKS SS800‐ TERRARSTAR COUNTY EHS POD TRUCK 1 SEPA TF INTERNATIONAL SFA WHITE OFFICE BENSALEM POD TRUCK SS188 SEPA TF 2018 WHITE EMS

PODS 1‐5 MCI/STRIKE/TENTS/ PODS ‐ EMS LIGHTS/ BENSALEM EQUIPMENT (5) SEPA TF GENERATOR SEAGRAVE WHITE EMS

PODS 6‐10 MCI/STRIKE/TENTS/ BUCKS PODS ‐ EMS LIGHTS/ COUNTY EHS EQUIPMENT (5) SEPA TF GENERATOR SEAGRAVE WHITE OFFICE

BEDS/POTTY CHAIRS/ BUCKS PODS ‐ MASS CARE WHEELCHAIRS COUNTY EHS (4) SEPA TF LIGHTS WHITE OFFICE FLATBED FOR POD BENSALEM TRUCK SEPA TF SEAGRAVE BLACK EMS BUCKS FLATBED FOR POD COUNTY EHS TRUCK SEPA TF SEAGRAVE BLACK OFFICE

‐ 29 ‐ BUCKS IN POD COUNTY EHS TENT 19' X 21' SS800 SEPA TF ZUMRO YELLOW OFFICE IN POD WHITE/ TENT 19' X 21' SS800 SEPA TF ZUMRO BLUE EHS OFFICE IN POD WHITE/ BENSALEM TENT 19' X 21' SS188 SEPA TF ZUMRO BLUE EMS IN POD WHITE/ BENSALEM TENT 19' X 21' SS188 SEPA TF ZUMRO BLUE EMS WITH WHITE/ TENT 19' X 21' MCI108 SEPA TF ZUMRO BLUE ST. LUKE'S WITH WHITE/ CHAL/BRIT TENT 19' X 21' MCI134 SEPA TF ZUMRO BLUE EMS WITH WHITE/ MIDDLETOWN TENT 19' X 21' MCI244 SEPA TF ZUMRO BLUE FIRE MARSHAL WITH WHITE/ TRI HAMPTON TENT 19' X 21' MCI115 SEPA TF ZUMRO BLUE RESCUE GENERATORS ‐TOW BEHIND (6) MULTIPLE SIZE KW's SEPA TF GENERAC WHITE EHS OFFICE SVU ENCLOSED 5 PERSON W/ LITTER MOUNT AND RANGER CREW STOKES SEPA TF POLARIS 900EPS RED EHS OFFICE TRAILER ‐ 18' ‐ SVU TRANSPORT SEPA TF INTEGRITY HL8 X 18T WHITE EHS OFFICE PENNDEL / TOWED MIDDLETOWN BY RESCUE MSEC TRAILER SS168 BEMS / HPP WHITE SQUAD RESCUE TRUCK SS168 AGENCY 148 AMBULANCES AGENCY

78 QRS UNITS 60 EMR 1,318 EMT 2 AEMT 279 Paramedic 53 PHRN 1 PHPE 6 PHP 117 MCP

PENNDEL/ MIDDLETOWN BARIATRIC SE PA Task RESCUE AMBULANCE Force SQUAD

‐ 30 ‐ BARIATRIC SE PA Task NEWTOWN AMBULANCE Force AMBULANCE STATE EBOLA BENSALEM TRANSPORT M185 EMS RADIO ‐ PORTABLES ‐ OPEN SKY (34) ‐ STRIKE TEAMS SEPA TF EHS OFFICE CASES (3) BUCKS PORTABLE RADIOS COUNTY PELICAN 1610 BLACK EHS OFFICE RADIO ‐ PORTABLES ‐ OPEN SKY (2) BEMS EHS OFFICE RADIO ‐ MOBILE OPEN SKY (1) BEMS EHS1 RADIO ‐ MOBILE OPEN SKY (1) BEMS SS188 RADIO CHARGER BANK‐ OPEN SKY (5) SEPA TF EHS OFFICE RADIO CHARGER INDIVIDUAL ‐ OPEN SKY ‐ (34) SEPA TF EHS OFFICE

SE PA TF REGIONAL DATA PURCHASED/ COLLECTION ‐ MAINTENCE IMAGE TREND BY BEMS IN THE CLOUD TRIAGE TAGS (5,000 PLUS) SE PA TF SMART TRIAGE EHS OFFICE MCI, QRS,ALS,BLS TRIAGE TAGS (5,000 ACROSS PLUS) SE PA TF SMART TRIAGE REGION TRIAGE DECON TAGS SE PA TF SMART TRIAGE EHS OFFICE MCI, QRS,ALS,BLS TRIAGE DECON ACROSS TAGS SE PA TF SMART TRIAGE REGION MCI, QRS,ALS,BLS TRIAGE COMMAND ACROSS BOARDS SE PA TF SMART TRIAGE REGION TRIAGE COMMAND BOARDS SE PA TF SMART TRIAGE EHS OFFICE

‐ 31 ‐ TRIAGE HIP PACKS SE PA TF SMART TRIAGE EHS OFFICE EVERY AMBULANCE, TRIAGE HIP PACKS SE PA TF SMART TRIAGE MCI, QRS DATA CARDS ‐ 4 DIFFERENT COLORS ‐ MULTI DAY MCI ‐ ID TO ALLOW ON SITE SE PA TF DATA CARD EHS OFFICE DATA CARD PRINTER ‐ MULTI DAY MCI ‐ ID TO ALLOW ON SITE SE PA TF DATA CARD EHS OFFICE

CPR DEVICES SEPA TF LUCAS

BALLISTIC VESTS SE PA TF POINT BLANK GNX111AN1J06 TAN

BALLISTIC HELMETS SE PA TF POINT BLANK TAN

RTF BAGS SE PA TF ARK EVAC BAG TAN MANIKIN/TRAILERS PRIVATE BENSALEM SIMULATOR GRANT SIM‐MAN EMS CPR MANIKINS ‐ INTELLIGENT BEMS EHS OFFICE PERSONAL FLOATATION DEVICES W HELMETS AND WHISTLES ‐ STRIKE BENSALEM TEAM BEMS/ BPHP EMS

BUCKS IMAGE MULTIPLE MOULAGE/MAKEUP COUNTY PERSPECTIVES TYPES EHS OFFICE BUCKS COUNTY PUBLIC SAFETY SUCTION UNITS ‐ BUCKS TRAINING PORTABLE (12) COUNTY BUILDING ‐ 32 ‐ BUCKS COUNTY PUBLIC SAFETY BUCKS TRAINING REEVES COUNTY BUILDING

‐ 33 ‐ EMERGENCY HEALTH SERVICES

Freedom Way, Ivyland, PA 18974 (215) 340-8735 Fax (215) 957-0765 [email protected]

Board of Commissioners Robert G. Loughery, Chairman Jeryl L. DeGideo Charles H. Martin, Vice-Chairman Director Diane M Ellis-Marseglia, LCSW

June 6, 2020

RE: Effectiveness Evaluation

Dear Dylan,

Bucks County has evaluated our EMS system, in regard to available inventory of assets. The past few years we have reported a bariatric truck deficiency. We are proud to announce we were able to secure SE PA Task Force funding to purchase 2 used bariatric ambulances. We took delivery of both vehicles and immediately gave them to Newtown Ambulance and Penndel Middletown EMS. Currently both vehicles are out having radios installed, engines looked over and lettering to the outside. We hope to have both of these bariatric ambulances licensed and serving Bucks County by the end of June.

Respectfully,

Jeryl L. DeGideo Director

‐ 34 ‐ Statement of Goals

 Opioid Pandemic – Bucks County supports the PA DoH endeavor on Leave Behind Naloxone. Our region has assembled Leave Behind Naloxone kits for each agency who chooses to participate. In the box we supply the Naloxone, an envelope with services available to the family and person along with a magnet (supplied by PA DoH) which has instructions for administering the Naloxone. Our goal with this project is to get more agencies in Bucks County on board. This does not have a real cost except the $10.00 box as we utilize the PCCD grant through our Bucks County Drug and Alcohol to provide the Naloxone. This has been a great project and we hope to be able to provide this service across Bucks County. We continue to attend the Opioid Warm Handoff conferences in the SE. Having our own data collection system assists us in being able to customize the program to ask providers questions so we can build more data. We share our Bucks County opioid scrubbed data with Bucks County Drug and Alcohol and our District Attorney’s office. They utilize our data for their meetings with their counterparts. We have an amazing relationship with both offices since joining this fight against opioids.  Healthcare Coalition – Our office attends the Bucks County Healthcare Coalition and we are a member of the group. This year we will be building new relationships with the new company taking over for HAP. We are able to have direct contact with the facilities, getting to know each other and exchanging best practices prior to any emergency. The facilities have grown to trust our office, calling whenever they have a problem. We did experience problems in the past with the facilities calling HAP directly in an emergency instead of following PA Title 35, which states it is a local problem, then a county problem, and then it goes to the state then federal if needed. Our office has been appointed by Bucks County Emergency Services Division Leader as the liaison between and the facilities. There is really no cost to this project as the Director attends most of these meetings and is mostly funded by the county.  Physician Response – We have secured most of the medical equipment requested/needed to further our abilities in Bucks County. We have a few more things to purchase, however this year we will be attempting to secure funding for a vehicle dedicated to this project. Our Physician Response Team will be able to assist in much more complicated scenes than they have in the past. This team is just another addition to the resources we like to be able to afford to our providers without any cost. This project will not cost PA DoH, BEMS anything as we are attempting to secure SE PA Task Force dollars to fund this entire project.  Active Shooter –Now, Rescue Task Force (RTF) following the NIMS categorization. We designed a 3 tier course that is designed to teach EMS personnel what to do, how to react, how to respond, how to treat in that type of environment along with how to move the patients out safely. Our overall goal is to train as many providers as we can in conjunction with police and fire so that we can save as many lives as possible in a short amount of time, all while keeping providers as safe as possible. We have trained over 200 providers through all 3 levels with an additional 75 trained through levels 1 and 2. Our providers are still very excited about this training, and it been going on for 3 years. We have distributed additional helmets and vest to the participating RTF Teams, along with distributing a second ARK bags to every licensed 911 agency in Bucks County. This is the hottest class going in Bucks, it is physically hard, mind numbing with stress and every provider at the end of the day says this is the best way to get con-eds – working hard, physically doing it and not sitting in front of a computer. We are thrilled to see the feedback we receive from providers, EMS chiefs, police chiefs and my own staff. Everyone working together for a common goal, it’s amazing to see the teamwork created by this project. We will be continuing this project after COVID restrictions are lifted. This past year we utilized some of our Provider Equipment monies to keep up with the demand by our providers for this class (pre COVID). We have utilized SE PA Task Force monies for the most part for this project, approximately $500,000.00 along with $10,000.00 of our 19/20 BEMS contract monies.  EMT Classes – Currently Bucks County only has one Educational Institute in addition to our Bucks County EHS Educational Institute. We continue to offer EMT classes in an attempt to assist our local 911 and inter-facility agencies with staffing problems. We only utilize county dollars and Bucks County Community College dollars for this entire endeavor including staffing, equipment, and facilities for each class. We will continue to assist our agencies the best we can with providing them with certified providers so they can continue to stay in service and provide a much-needed service.

‐ 35 ‐  Regional Paramedic Skill Verification – Our office, working with the MAC, coordinates regional skill testing so our paramedics only have to attend one verification day. We ask each of the physicians on MAC to attend and assist in one or two of the dates so their providers can participate. The doctors have agreed that as long as one of the MAC physicians approve the skills, they will accept that physician’s signature for the command form. We started this program because we noticed that most Agency Medical Directors were just signing off on skills and not really watching the paramedic perform the skill. Our MAC decided that going this way would not only save them some time, but it would ensure verification of skills. When we started this program most paramedics were very intimidated to attend and perform skill in front of doctors, however after 10 years of this project our paramedics walk in confident. They now know our physicians are here to help them, teach them and have them feel and be proficient in their skills. They now ask the physicians questions; they are confident and that is what they need to feel when they are performing skills on true patients. This project costs man hours from my department and we usually utilize approximately $2,500.00 of BEMS contract monies for equipment to keep this program fresh and useful to the paramedics attending yearly.  Treatment goals - Our MAC has set goals for our providers to meet regarding their skills. These can be found in the MAC meeting minutes, along with where we are currently for reaching our goals. We continue to strive to have providers be not only proficient in skills but also in calculations and destination correctness for the patient.  Computer Aided Dispatch (CAD) – Bucks County is finally purchased a new CAD. Our current CAD is from 1983 and though it has received all of the needed/required updates and functions absolutely fine for dispatch, it is very difficult for it to interact with anything else. Once we have the new CAD up and operational (COVID delayed), we will be able to run side by side reports with our data collection system. This will tell us how our documentation in patient charts is with actual times from the new CAD. We will also be able to run additional reports for our agencies, municipal/county/state leaders. This project will not cost BEMS any monies.  Critical Incident Stress Management (CISM) – The Bucks County CISM Team is organized through our office for all emergency disciplines within Bucks County. We utilize the discipline to same discipline approach utilizing EMS, Fire, Police, Dispatch, and anyone else that fits emergency services. We find it very difficult to find funding to train new members let alone training for our current members to keep them up to date but to also keep them involved and feeling needed. We usually can secure funding from SE PA Task Force for a two-day class every two years; however, we feel we are leaving them down not being able to get them the training they are looking for. Every year we ask if there are any monies available for training that we would be permitted to apply for those funds. The team is more active than we would care to admit, however we are very glad to have them have our backs. We would be looking for at least $7,500.00 as this is the average cost for a two-day class.  Bariatric Ambulances – We have taken delivery of 2 used bariatric ambulances. We secured funding through SE PA Task Force for both of the ambulances. This project saves individual agencies from having to each purchase their own bariatric ambulance. Currently, the agencies that have the units are preparing them with lettering, radios, and equipment for inspection. We hope to have both units on the road serving Bucks County by the end of June.

‐ 36 ‐ Inter-regional problems

Bucks County has not experienced any inter-regional problems this past year. I believe all of the regional councils are headed in one direction, as a team. It is quite refreshing to see the fairness there is now as I believe this is why we are all working towards the same goal instead of 13 different ideas/goals with no real communication between us. We enjoy working together once again which includes working with the staff at BEMS.

‐ 37 ‐ ANNEX E

Continuity of Operations Plan (COOP)

‐ 38 ‐ COOP

Bucks County EHS, being government based, is included within the County of Bucks COOP. We have the ability to be moved anywhere within Bucks County government buildings with ease. The county has an integrated telephone system, meaning we can go to any county desk phone and “bring in” our normal desk phone number. We also have the ability to forward all desk phone lines to our cell phones, meaning we never will miss a phone call coming into the office during a relocation or even working from home if need be. Our computers are laptops and Dell Pads, so we do not necessarily have to be at a desk with a docking station.

We will not incur any expenses if the COOP is enacted, being county-based means Bucks County General Services will do all the work of moving offices to another location.

Since the Bureau of EMS went with the new Registry, everything is web based, making relocation of any office almost painless. We will have no problem working with our providers and agencies during or after relocation.

Bucks County COOP is too large a document to attach as it includes a COOP for each department and also each building.

‐ 39 ‐ ANNEX F

Regional Disaster Plan

‐ 40 ‐ Bucks County Emergency Medical Services Mass Casualty Response Guidelines Bucks County Emergency Medical Services Mass Casualty Response Guidelines

Acknowledgements

The Bucks County Emergency Health Council Advisory Committee and Bucks County EMS Chiefs’ Association wish to thank the Montgomery County Emergency Services Council, and the Eastern Pennsylvania Emergency Medical Services Council for their assistance and guidance in forming this guideline. Some portions of these Guidelines were reprinted with permission from each of those regions. The Chiefs’ Association also thanks those past and present members of the Emergency Preparedness Committee under the Bucks County EMS Chiefs’ Association as well as the EMS community for their assistance in forming this guideline.

Rev. May 2016 Bucks County Mass Casualty Guideline Page 1 of 51 Bucks County Emergency Medical Services Mass Casualty Response Guidelines

Table of Contents

Introduction 3 Activation 4 MCI Response Levels 5 MCI Job Aid (checklist) 8 EMS System Condition Levels 9 Bucks County Resource Table 15 National Incident Management System 16 Definitions 24 Officer Positions and Responsibilities 29 SALT / SMART Triage 35 Demobilization 37 Appendix A)School Bus Accidents B) MCI Mass Trauma Response (Pending Updates) C) Resource equipment list (updates in progress) C-1) MCI equipment List 48 C-2) MCI 108, 134, 115, 143 – equipment layout 49 C-3) POD 1 (185s) – equipment layout 50 C-4) POD 4 (EHS Office) – equipment layout 51 C-5) 5 Patient Treatment Bag Equipment and layout 52 C-6) SS168 Equipment List 53 C-7) MSEC Trailer Equipment List

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Introduction

These emergency incident-operating guidelines are designed to assist Bucks County Emergency Medical Services agencies in properly organizing and controlling resources at the scene of an emergency incident. These guidelines will serve as a basic framework upon which each local jurisdiction can, and should, build a more specific plan. Such a plan may address other areas of concern and use of resources not referenced to in this document. These guidelines are not intended to replace any established county, municipal, or local emergency response plan. Rather, they are intended to serve as the central core for emergency medical services operations at an emergency incident. All EMS services must refer to their municipality’s emergency management plan and understand how EMS is to interface within that structure.

These operating guidelines are also intended to identify the basic working relationships which should exist between EMS, fire, rescue, police and other agencies at a large-scale incident. As such, these emergency incident-operating guidelines fully support and utilize the National Incident Management System (NIMS) as prescribed by FEMA. It is strongly advised that all EMS personnel follow the FEMA guidelines and complete the required NIMS training. It is also strongly encouraged that these skills and this guideline be reviewed and practiced periodically by all EMS providers within Bucks County.

It is advisable that all Bucks County EMS organizations meet with their local emergency public service agencies, municipal officials, and emergency management officials who might be involved in a large-scale incident to develop or review a specific emergency response plan and familiarize their municipal officials on use of this guideline.

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Activation

MCI Guideline Implementation

A Mass Casualty Incident is any emergency incident where there are multiple patients and local resources become overwhelmed. This guideline must be implemented as soon as the initial scene survey reveals that there are multiple patients.

Initial Actions

The first arriving unit to the scene of a mass casualty event will have the initial command and control of the scene. The responsibilities of the first arriving EMS unit are as follows:

1. Assess the scene and identify any life and safety hazards. 2. Notify the communications center that you have an MCI, and what level response you will need. 3. Request alternative radio channel for the incident from BCRR. 4. Notify the communications center of an initial estimated patient count. 5. Establish a command post in a safe area and notify the communications center of that location. This shall be the unified command post, and the law enforcement and fire officers in command shall operate from your location. The first arriving unit to take command shall stay in command of the scene until relieved. 6. Designate a triage officer and initiate SALT/SMART triage. 7. Prepare and plan to designate sectors and operational officer positions as more help arrives. 8. Any patients found to be deceased should be covered (if possible) and left where they are found until the Coroner and Law Enforcement officials complete their investigation.

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MCI Response Levels

The following terminology and response levels are effective for the Bucks County EMS Region:

MCI LEVEL I - 5-14 patients (approximately) A suddenly occurring event that overwhelms the routine first response assignment. The number of patients is greater than can be handled by the usual initial response. Depending on the severity of the injuries the system may have adequate resources to respond and transport the patients. Duration of the incident is expected to be less than 1 hour. Examples: Motor vehicle accident, active shooter.

MCI LEVEL II - 15-50 patients (approximately) A suddenly occurring event that overwhelms the first response assignment and, potentially, additional resources requested within the Operational Area and neighboring counties. Regional medical mutual aid system is activated. An adequate number of additional ambulances are not likely to be immediately available, creating a delay in transporting patients. The duration of incident is expected to be greater than an hour. Examples: Bus crash, train accident, active shooter, improvised explosive device (IED).

MCI LEVEL III - 50 + patients (approximately) A suddenly occurring event that overwhelms the first response assignment, additional resources requested within the Operational Area, and mutual aid from neighboring counties (approximately 50+ victims). It is not possible to respond with an adequate number of ambulances to the incident and promptly respond to other requests for ambulance service. Regional medical mutual aid system is activated. Air and ground ambulance and other resources from outside the county will need to be requested. Not only will ambulance service be inadequate but receiving hospitals will be overwhelmed. In an incident of this size the operational area EOC and disaster plan may be activated. Examples: Bus crash, commercial airline crash, building collapse, active shooter.

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Automatic CAD Dispatched units per level

Level 1: 5 Ambulances, 1 QRS, 1 Engine, and 1 Helicopter on stand-by Physician response team on standby, Regional Medical Director notified. County to code ORANGE.

Level 2: 15 Ambulances, 1 MCI unit, 2 QRS, 1 Engine, 1 Rescue,1 Helicopters on stand-by, BUCKS1 or other local command vehicle physician response team on standby, Regional Medical Director notified. Bucks County MCI pod dispatched, Five County Pod Task force placed on standby. County Corner advised. County to code RED.

Level 3: 25 Ambulances 3 MCI units, 3 QRS, 4 Engines (assigned to EMS), 2 Ladder, 2 Rescue, 3 Helicopter services notified of the incident and to prepare for deployment if needed, Five County Pod task force dispatched to scene, BUCKS1, physician response team dispatched, Regional Medical Director notified. Notification to PEMA VIA BCEMA for possible STRIKE response. County Corner advised. County to code Red.

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Initial Calculation of the required number of Ambulances

This guideline is meant to provide general guidance to determine the initial estimate for the number of transport ambulance units required to respond to an MCI based on the number of immediate patients. As a determination of the number of delayed and minor patients is made, additional ambulances or other transport vehicles, such as a bus, may be required. The request for additional transport vehicles, such as ambulance, bus, etc. should be made as early as possible.

A general rule-of-thumb for determining how many ambulances should initially be requested by first-arriving personnel can be calculated using the following formula:

REQUIRED AMBULANCES = NUMBER OF IMMEDIATE PATIENTS DIVIDED BY TWO (2) + PLUS ONE (1)

Example: Ten (10) Immediate Patients + 1 = six (6) ALS Ambulances 2

The number of required ambulances should be adjusted based upon the following considerations: • Distance from the receiving hospitals and back to scene o See Pt flow excel sheet for formula calculator • Number of critical patients • Hospital “turn-around” time • Total number of patients • Availability of alternative transport vehicles • BCRR should keep all units assign to incident until incident is complete • When crews are cleared from hospital should be placed back in staging

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MCI Job Aid

First arriving unit size-up

Assess the scene identify any life and safety hazards Self , Responders, Victims, Public Initial estimated of patients and MCI level request Level 1 5—14 Patients Level 2 15—50 Patients Level 3 50 + Patients

Notify BCRR of the MCI Level Request Alternative Channel Request hospital capabilities Determine if any additional resources are needed:

Fire , EMA ,Law enforcement / Bomb Squad , EMS Office Hazmat / DECON Unit , Public Works , Public Health Establish estimated outer and inner perimeter, if applicable

As Additional resource arrive

Establish a Command Post

Designate a Triage Officer Initiate Triage SALT/ SMART Establish a staging area Establish a secondary staging area for MCI level 2 or 3

Consider a Decon area if needed Prepare and plan for sectors Establish a transportation Officer if needed

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EMS System Condition Levels

EMS system condition levels are utilized in Bucks County to provide early warning and notification to EMS personnel when there is an anticipated need for additional personnel, or immediate need for personnel and resources. EMS Condition level changes are authorized either automatically as a result of a declared MCI, or through the authorization of Bucks County Emergency Health Services for reasons described below:

Code Green: Normal Operations

Code Yellow: (Preparatory Period) – Pending inclement weather (code changes will be automatic with winter weather warnings), Pre Mass gatherings/Events, Severe Federal Terror Risk.

EMS Agencies: • Start planning to bring crews in-house, establish on call/extra availability pool as deemed necessary by EMS Agency Management. • Contact Bucks County EHS with any unmet needs. Dispatch Center: • Send Printout to agencies, Send Everbridge message if not done by EHS • Situational awareness upgrade code status to Orange or Red if deemed necessary by call volume and availability of units. • Create special contact of code status in CAD – under BCFR (or other designated identifier). • Broadcast on Dispatch and EMS Channels at time of status change and on morning and evening announcements.

MCI Units: • On Notice for possible deployment. EHS Office: • Notify Department of Communication for activation of Code Yellow and send EverBridge Notification using code change template.

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EMS System Condition Levels, Cont.

Code Orange: (Operation Period) Inclement weather in place and affecting the county, MCI, mass gathering or any incident(s) taxing/potentially taxing the region beyond available resources

EMS Agencies: • Call crews in-house as deemed necessary by EMS Agency Management and begin putting additional ambulances into service. • Patient Transport - follow statewide BLS Protocol 170 (Weather & MCI exception). • Contact Bucks County EHS with any unmet needs. • Document code status and if incident was related to reason for code change in regional ePCR system. EMS Agencies not using regional ePCR system submit number of incidents, including incident number, incident related (yes/no), call type, and disposition. Report due fifteen (15) days after returning to code green. Dispatch Center: • Situational awareness upgrade/downgrade code status if deemed necessary by call volume and available units. • Notify EHS Office (On call Person after normal business hours, weekends or holidays), if change initiated by Dispatch Center. • SEND EverBridge notification; upgrades and downgrades (use code change template). • Create special contact of code status in CAD – under BCFR (or other designated identifier). • Broadcast on Dispatch and EMS Channels at time of status change and on morning and evening announcements. • Re-broadcast on EMS and Dispatch channels and resend EverBridge every four (4) hours (use code change template). • Start moving up units not affected by the condition into the affected area, if not county wide event. • Consider use of regional staging location. • Contact adjacent PSAPs for available units – utilize on incident and/or covers.

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EMS System Condition Levels, Cont.

Code Orange, Cont. Dispatch Center: • Alert all hospitals and trauma centers of status change and hospital diversions are cancelled until code status change is lowered. • Consider use of TAC channel for isolated incidents.

MCI Units: • On Notice for possible deployment.

EHS Office: • Confirm EverBridge notification sent. • Assist with unmet needs. • Staff Bucks County EOC if activated. • Complete after action report .

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EMS System Condition Levels, Cont.

Code Red: Weather affecting the County, major MCI or incident(s) that have exhausted system resources, evacuation of hospital or nursing home, riots or major police action.

EMS Agencies: • Call crews in-house as deemed necessary by EMS Agency Management and begin putting additional ambulances into service • Patient Transport - follow statewide BLS protocol 170 (Weather & MCI exception). • Contact Bucks County EHS with any unmet needs • Document code status and if incident was related to reason for code change in regional ePCR system. EMS Agencies not using regional ePCR system submit number of incidents, including incident number, incident related (Yes/No), call type, and disposition. Report due fifteen (15) days after returning to code green.

Dispatch Center: • Situational awareness downgrade code status if deemed necessary by call volume and available units. • Notify EMS Offices (On call Person after normal business hours, weekends or holidays), if change initiated by Dispatch Center. • SEND EverBridge notification; upgrades and downgrades (use code change template). • Create special contact of code status in CAD – under BCFR (or other designated identifier). • Broadcast on Dispatch and EMS Channels at time of status change and on morning and evening announcements • Re-broadcast on EMS and Dispatch channels and resend EverBridge every four (4) hours (use code change template). • Confer with EMA/EHS as needed

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EMS System Condition Levels, Cont.

Code Red, Cont. Dispatch Center: • Start moving up units not affected by the condition into the affected area, if not county wide event. • Contact adjacent PSAPs for available units – utilize on incident and for covers. • Alert all hospitals and trauma centers of status change and hospital diversions are cancelled until code status change is lowered. • Consider use of TAC channel for isolated incidents. MCI Units: • Staff units and deploy per directions from Bucks County Radio Room.

EHS Office: • Confirm EverBridge notification sent. • Staff Bucks County EOC if activated. • Assist with unmet needs. • Complete after action report.

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EMS System Condition Levels, Cont.

PROCESS:

Default Code level will be Green. As events and/or conditions change, the Communications Center will announce and send updated EverBridge notifications with information provided by the EMA/EMS Office or information from the field units. Downgrades would be conducted with the same information and cooperation. • Code status changes will be announced on Dispatch and EMS Channels along with the affected police zones. • EverBridge notifications will be sent for all code status changes; upgrades and downgrades (use code change template). • Printout sent to all squads, fire companies, police departments, and hospitals.

Bucks County Squads will be divided into three (3) regions for code status changes. • Northern Squads: 108, 124, 134, 141, 142, 151 • Central Squads: 113, 115, 122, 125, 129, 134, 135, 145, 172 • Southern Squads: 100, 114, 139, 143, 154, 155, 167, 168, 185, 186

Code status changes can include one (1) or all of the regions.

• Examples: o “Southern Bucks County is Operating under a Code Red in Bristol Township” o “Bucks County is operating under Code Orange County Wide due to inclement weather”.

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Bucks County Resource Table

Unit ID Location Capabilities MCI-115 Squad 115 Medical, some fire rehab MCI-134 Squad 134 Medical, Fire Rehab MCI-108 Squad 108 Medical, heated tents, some fire rehab MCI-143 Squad 143 Medical, fire rehab, heated tents POD1 (MCI) Squad 185 Point of Distribution – For up to 100 patients POD4 (MCI) EHS Ivyland Point of Distribution – For up to 100 patients, heated tent UTV1 EHS Ivyland 4 wheel drive, 4 seat Polaris with medical skid/litter POD10 Squad 185 Shelter Tents POD 6 Squad 185 Flatbed POD 7 EHS Ivyland Flatbed SS168 Squad 168 Fire Rehab/MCI/Tents SS175 Squad 175 Medical, Heated Tents, Fire Rehab SS115 Squad 115 Fire Rehab Bucks1 EHS Ivyland Command vehicle C.O.W. EHS Ivyland Communications support vehicle

EMS Services with Extra Capabilities

Service Capabilities Available 108 Wheelchair vans, transport units 114 Medic Responder 122 Bicycle team 125 Wheelchair vans, transport units, bicycle team, medic responder 142 Medic Responder, Bicycle Team 143 Bicycle team 145 Wheelchair vans, transport units, bariatric unit 151 Wheelchair vans, transport units, bariatric unit 168 Bariatric unit, MSEC Trailer 175 Marine unit 185 (2)ATV unit, rescue & Hazmat technicians, some rope & trench equipment

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Incident Management System

In an effort to provide effective patient care and a safe incident scene, the first arriving unit shall implement the National Incident Management System (N.I.M.S.) unless it is an incident where a representative from the fire service has already initiated the N.I.M.S. plan. In that situation, the highest trained individual will establish an Emergency Medical Service Branch (EMS)*.

Within this branch the following tasks will be assigned and shall be in the order listed, from the onset of the incident in order to provide a manageable span of control:

Triage Treatment Transportation

The individual who will undertake the Incident Commander’s Role (IC) or who will be the EMS Branch Director will be required to assess the scene (scene size up), establish incident objectives; identify the immediate incident priorities, and request resources.

When the incident commander is a representative from another Emergency Services organization, this will be dependent on the operation; the representatives from the on scene organizations will establish a Unified command with a Modular Organizational Structure. Within this structure a Consolidated Incident Action Plan (IAP) will be developed along with a comprehensive resource management plan, as well as an established Incident Command Post (ICP).

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Incident Management System Cont.

All individuals on the incident scene will remember that the Incident Priorities, no matter the type of the incident, will always be the same:

Life Safety Incident Stabilization Property Conservation

Command Staff:

Incident Commander Safety Officer (must be filled/assigned during a hazardous Material incident) Public Information Officer (P.I.O.) Liaison

General Staff Positions

Operations Planning Logistics Finaniance

Any position not assigned by the incident commander will, by default, be his or her direct responsibility.

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Incident Management System Cont.

Divisions & Groups

• Groups define tactical-level management positions. • Divisions represent geographic responsibilities, such as Division C (rear of the facility) or Division 3 (3rd floor). • Groups represent a functional (job) responsibility, such as Rescue Group, Multicasualty Group, etc. • Divisions established to provide resources and coordination for a specific geographical area • Division Supervisor reports to a higher level of Command and Responsible for all tactical activities in that area

RESPONSIBILITIES OF DIVISION AND GROUP SUPERVISORS

• Ensure responder safety • Implement their portion of the IAP • Keep next level of Command informed of its status and location • Coordinate activities • Maintain an effective span of control • Determine need for assistance • Release unneeded resources to IC or next level of Command

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Incident Management System Cont. Organizational Element Leadership Position Title Support Positions Incident Command Incident Commander Deputy Command Staff Officer Assistant Section Section Chief Deputy Branch Branch Director Deputy Divisions and Groups Supervisors N/A Unit Unit Leader Manager, Coordinator Strike Team/Task Force Leader Single Resource Boss, Companies/Crews Single Resource Boss Boss N/A Technical Specialist Specialist

• A safe location where resources report until given an assignment. • Resources in Staging are ready for immediate assignment. • If Operations is not staffed, Staging reports directly to IC. • Once Operations is staffed staging reports to Operations. • Check-in resources • Respond to requests for resources • Keep IC or Operations informed of status of resources in Staging • Maintain status of resources in Staging

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Incident Management System Cont.

Branches

• Used when the number of Divisions and Groups create a span-of-control problem • Valuable when large numbers of resources are committed to varying functional activities – e.g., Incident with numerous injuries • Can be geographic, functional, or jurisdictional • Implements the portion of the IAP appropriate to the function • Coordinates activities of subordinate Units • Determines if assigned objectives are being met • Requests additional resources • Keeps immediate supervisor advised of Branch status

Unified Command: • Allows multiple agencies to set common objectives and strategies. • Agencies do not lose authority, responsibility, or accountability. • All agencies with responsibility manage the incident together • One key official from each jurisdiction's responsible agencies • Representatives from departments in a single jurisdiction • Generally, the agency with the greatest jurisdictional involvement is assigned to the Operations function. • It is important to recognize prior training and experience

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Command Staff Positions

Safety Officer Responsibilities • Reason for implementation • Authority to stop unsafe acts • Requisite background

Incident and Personnel Accountability • Personnel holding positions within the Command organization are responsible for the welfare and accurate accountability of all assigned personnel. The system must be able to locate every responder within a small geographic work area within the hazard zone at any moment in time.

Operations Responsibilities

• Responsible for management of all tactical actions at the incident. • Operations should be implemented when necessary to maintain the IC's span of control. • Develop operations portion of the Incident Action Plan (IAP) (strategies and tactics) • Brief and assign Operations Section personnel in accordance with the IAP • Supervise Operations Section, ensuring safety and welfare of all personnel • The Operations Section is responsible for the direct management of: • All incident tactical activities • Tactical priorities • The safety of personnel working in the Operations Section

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Command Staff Positions, Cont.

Planning Responsibilities Responsible for the collection, evaluation, dissemination, and use of information about the development of the incident and the status of resources. • Gather and display information. • Supervise preparation of the IAP. • Determine the need for specialized resources in support of the incident. • Assemble information on alternative strategies. • Report any significant changes in incident status. • Oversee preparation and implementation of Incident Demobilization Plan Planning Section components; • Resources Unit • Situation Unit • Documentation Unit • Demobilization Unit • Technical specialists

Logistics Responsibilities Responsible for providing facilities, services, and materials for the incident. • Participate in preparation of the IAP. • Identify service and support requirements for planned and expected operations. • Coordinate and process requests for additional resources. • Estimate future service and support requirements. • Act as "supply sergeant" for the incident.

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Command Staff Positions, Cont.

Support Branch Responsibilities • Responsible for providing resources, equipment, and supplies in support of incident operations. • Managed by a Branch Director • Components: – Supply Unit – Facilities Unit – Ground Support Unit

Finance Responsibilities Responsible for all financial, administrative, and cost analysis aspects of the incident. Components: • Manage all financial aspects of an incident • Provide financial cost analysis information as requested • Ensure that all personnel time records are completed accurately and transmitted to home agencies, according to policy • Time Unit • Procurement Unit • Compensation/Claims Unit • Cost Unit

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Definitions

BRANCH: The organizational level having functional or geographic responsibility for major parts of incident operations. Branch is organizationally between Section and Division/Group in the Operations Section. Branches may be identified by the use of a functional name (e.g., medical, security, fire, rescue, etc.).

CHIEF: The ICS title for individuals responsible for management of Functional Sections: Operations, Planning, Logistics, and Finance/Administration.

COMMAND POST: The position where agencies will function on-site to support the Incident Commander. The Command Post is located at one location for all agencies.

BRANCH DIRECTOR: The ICS title for individual responsible for supervision of a branch.

FUNNEL POINT: A center point designated by the Triage Team Leader in which every patient filters through prior to movement into the Treatment Area, usually located at the entrance to the Treatment Area. Patients will be numbered for tracking and Triage Tagged (if not already done).

GROUP: Established to divide the incident management structure into functional areas of operation. Groups are composed of resources assembled to perform a special function not necessarily within a single geographic division. Groups are located between Branches and resources in the Operations Section.

IC (Incident Commander): The individual responsible for all incident responsibilities and activities, having overall authority and responsibility for the management of all incident operations at the incident site.

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Definitions (cont.)

ICS (Incident Command System): A standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries.

INCIDENT MANAGEMENT TEAM (IMT) DESIGNATED TYPE I NATIONAL LEVEL, TYPE II REGIONAL & STATE, TYPE III LOCAL TEAMS: An IC and the appropriate Command and General Staff personnel assigned to an incident.

LITTER BEARERS: Individuals assigned by the Medical Group Supervisor, usually will be Firefighters, to assist in movement of injured patients to designated

Triage, Treatment, and Transport Areas.

MANAGERS: Individuals within ICS organizational units that are assigned specific managerial responsibilities (e.g., Staging Area Manager or Camp Manager).

NATIONAL INICIDENT MANAGEMENT SYSTEM (NIMS): A federally mandated program for the standardizing of command terminology and procedures. This standardizes communications between fire departments and other agencies. It is based upon simple terms that will be used nationwide.

PUBLIC INFORMATION OFFICER (PIO): A member of the Command Staff responsible for interfacing with the public and media and/or with other agencies with incident-related information requests.

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Definitions (cont.)

REHABILITATION AREA: A designated area where rescue personnel can be assessed, treated and receive care. Rescue personnel will be evaluated, nourished, and rested in the Rehab Area.

SALT TRIAGE: Immediate treatment and transportation and very limited care; Triage will be based on ventilation, perfusion, and mental status; Emergency care will be restricted to opening airways, controlling severe hemorrhage, elevating patient’s feet, chest decompression and auto injector antidotes

STAGING AREA: Any location in which resources such as personnel, supplies, and equipment can be temporarily housed or parked while awaiting operational assignment.

SUPERVISOR: The ICS title for an individual responsible for a Division or Group.

SUPPLY UNIT: The unit responsible for the ordering, storing and maintaining of incident-related equipment and tools, such as backboards, trauma kits, oxygen, etc.

TRANSPORT AREA: A designated area where patients are moved following treatment, as they await transport to a medical facility.

TRANSPORT UNIT: Any vehicle capable of transporting patients, including an ambulance, aid unit, bus, command unit, etc.

TREATMENT AREA: A designated area for the stabilization of patients.

TREATMENT TAG: A tag that will be affixed to each patient in the Treatment Area. The patient’s number, and outline of their injuries and each set of vital signs taken shall be documented on the tag. This tag will accompany the patient to the designated receiving medical facility.

TRIAGE: A categorization system used to medically prioritize/sort patients.

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Definitions (cont.)

TRIAGE AREA: A designated area where the patients are sorted. This may be the area where the patients are initially found, or a designated point where the patients are transported for appropriate sorting.

TRIAGE TAG: A tag used by triage personnel to identify and document the patient’s medical condition.

TRIAGE TAPE: Red, yellow, green, or black colored surveyors tape is used to medically prioritize each patient. A piece of this tape will be affixed/tied to each patient prior to movement into the Treatment Area.

UNIFIED COMMAND: When multiple agencies have either geographic or functional jurisdiction at an incident. Unified Command should be implemented to jointly establish incident objectives and select strategies.

UNIT LEADER: The individual in charge of managing Units within an ICS functional section. The Unit can be staffed with a number of support personnel providing a wide range of services.

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Officer Positions & Responsibilities

The first arriving agency (EMS/Police/Fire) must be alert to include incident size up, estimated number of patients and initiate action to set up an MCI scene, call for assistance, and initiate the Incident Command structure to assure all pertinent incident information in obtained and managed (e.g. hazmat, hazards, etc.). On scene operations will be structured under the Incident Command System.

INCIDENT COMMAND: (radio call sign “COMMAND”) The Incident Commander will assume overall scene operations pertaining to the emergency incident.

• Command is responsible for: o Firefighting, EMS, Law enforcement, rescue, and or extrication, as needed. o Notifying the Communications Center of an MCI (if this has not been done). o Requesting an appropriate response to handle the incident. o Appointing an Operations Section Chief, as needed. o Appointing a Safety Officer, as needed. o Establishing a Safety Zone. o Identifying a Staging Area, and a Manager, and notifying all incoming units via the Communications Center of its location. o Securing access and egress routes into the area for Emergency vehicles. o Coordinating operations through Unified Command with participating agencies (i.e. Fire, EMS, Law, FBI, Coroner, Hazmat Teams, and Health Dept). o Coordinating with County EMA.

OPERATIONS SECTION CHIEF: (radio call sign “OPERATIONS”) Responsible for all operations at the scene of an incident. May assign Groups or Divisions as needed.

STAGING AREA MANAGER: (radio call sign “STAGING”) Responsible for staging. Will assign companies to the operation as requested by Operations. STAGING will request additional resources as needed.

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Officer Positions & Responsibilities Cont.

MEDICAL GROUP SUPERVISOR: (radio call sign “MEDICAL”) If established, is in charge of all EMS operations as assigned by the Operations Section Chief and responsible for the control of Medical Triage, Treatment, and Transport.

• MEDICAL is responsible for: o Sizing up medical needs, estimating numbers and severity of patients, and informing OPERATIONS/COMMAND. o Designate Triage, Treatment and Transport Areas, and request staffing as needed. o Request and update OPERATIONS/COMMAND regarding status and needs of the Medical Group. o Supervising the Treatment, Triage and Transport Areas.

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Officer Positions & Responsibilities Cont.

TRIAGE UNIT LEADER: (radio call sign “TRIAGE”) should be assigned to the highest medically qualified, first-arriving individual.

• TRIAGE is responsible for: o Surveying the incident scene, establishing Triage Areas, Funnel Points, and triaging patients according to their injuries at the scene or designated Funnel Points. o Patients will be evaluated using the SALT/SMART System, numbered, and placed in the appropriate Treatment or Transport Area. o Numbering each patient with a permanent marking pen for tracking purposes, and affixing/tying Triage Tag (if not completed). In larger MCI events, additional staff may be needed for field triaging. In events where more than one Triage Area or Funnel Points exists, the primary Funnel Point will start numbering patients with the number one (1). The other Triage Area or Funnel Points will start with the number 100; if an additional Triage Area or Funnel Point is needed, numbering will start at 200, and so forth. o If transport units are available, Triage Unit Leader may be responsible for moving patients from the Triage Areas directly to waiting transport units for rapid transport to appropriate emergency departments and bypassing the Treatment Area.

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Officer Positions & Responsibilities Cont.

TREATMENT UNIT LEADER: (radio call “TREATMENT”) should be assigned to the highest medically qualified person to arrive next on scene

• TREATMENT is responsible for: o The treatment of all patients. o Setting up Treatment Areas, equipment and prepare to receive triaged patients. o Requesting personnel and coordinating patient care areas designated as Red, Yellow, and Green. In a major MCI, the Treatment Unit Leader may need to assign additional personnel for each treatment section. o Assure Triage Tags are completed for all patients and affixed/tied to the patient prior to transport. Outline injuries, records vital signs, and identifies patient’s name (when possible). o Keeping the Transport Unit Leader advised to the number of patients, severity, and their availability to be transported. o Requesting additional resources for the Treatment Unit through Medical Group/Operations.

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Officer Positions & Responsibilities Cont.

TRANSPORT UNIT LEADER: (radio call sign “TRANSPORT”) Responsible for the transfer of patients to receiving hospitals. o TRANSPORT is responsible for: o Identify access and egress routes. o Coordinate loading, transporting, and registering of all patients. o Coordinating with the Treatment Unit Leader for patients available for transport. o Maintaining radio communications with the Communications Center to determine receiving facilities capabilities and capacities. o Maintaining a record/log of each patient’s identification, hospital destination, and transporting agency. o Maintain removable stub from Triage Tag for reconciliation with patient transport record/log. o Requesting transport units, equipment, and personnel as needed through the Staging Area Manager.

Litter Bearers will move through the incident scene placing patients on backboards, stretchers, wheelchairs, and assist the walking wounded. They will assist in processing patients through the Funnel Point, and into appropriate designated Treatment and Transport Areas. Litter bearers will be assigned to the most appropriate ICS level established.

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INCIDENT NOMENCLATURE

Division C

Division STRUCTURE Division B D

Division A

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SALT/SMART Triage

• Step 1 Gobal Sorting • Action: • “Everyone who can hear me please move to [designated area] and we will help you” • Use loud speaker if available • Goal: • Group ambulatory patients using voice commands • Result: • Those who follow this command - last priority for individual assessment

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SALT/SMART Triage, Cont.

• Step 2 Gobal Sorting

• Action: • “If you need help, wave your arm or move your leg and we will be there to help you in a few minutes” • Goal: • Identify non-ambulatory patients who can follow commands or make purposeful movements • Result: • Those who follow this command - second priority for individual assessment

• Gobal Sorting Resualts

• Casualties are now prioritized for individual assessment • Priority 1: Still, and those with obvious life threat • Priority 2: Waving/purposeful movements • Priority 3: Walking

• Next step: • Assess all non-ambulatory victims where they lie and provide the four LSIs as needed • Only if within your Scope of Practice, training, authorization • Only if you have the equipment readily available (e.g., you would not return to the rig to get an NPA) • Triage as quickly as possible

Traige Catagories

 Immediate (red) Priority 1)  Delayed (yellow) Priority 2)  Minimal (green) Priority 3)  Dead (Ribbon/Tag)

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Demobilization Plan

General Information

The purpose of the Demobilization plan is to restore resources to their original state, and allow mutual aid services to be released. The following process should be used when releasing resources from the incident.

Guideline

Upon the determination by unified command to de-escalate the incident, each sector chief shall re-inventory resources and determine what is no longer needed. The sector chief shall report to operations the status of each resource. Operations will recommend the release of resources to the incident commander who will direct the release of resources.

Release Priorities

1. Federal Resources 2. PEMA Resources 3. Regional Resources 4. In-County Mutual Aid Resources

Upon termination of command, it will be the discretion of the Emergency Health Services office to change the code status of the system based on available resources returning to service.

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ACCIDENTS INVOLVING SCHOOL BUSES PURPOSE: To establish a standard means of triaging, treating, and transporting children involved in an accident while riding the school bus. To avoid over taxing local emergency service resources and hospital personnel during minor accidents involving many children whose parents cannot be contacted. Also to establish criteria where children who are not injured can be released to school district authorities to reduce the emotional, logistical, and financial impact of the incident for all involved.

POLICY: Upon the arrival of the first unit to the scene, incident command should be established and the member of the team with the highest level of training should initiate triage.

Patients who are minors and do not require treatment in the emergency room may then be left in the care of school district authorities with permission from a command physician. If at any time EMS personnel are unsure of a minor’s health status, the patient’s well being is to be kept in the best interest and the patient should be transported to the emergency department.

PROCEDURE: The detailed procedure for this policy is as follows:

Upon receipt of a call reporting a motor vehicle accident involving a school bus, the dispatch center should dispatch two ambulances or a minimum of an ambulance and a QRS (downgrade/upgrade as indicated by call intake and zone information).

Upon the arrival, the first unit to the scene, incident command should be established and the member with the highest level of training should initiate triage. A few facts must immediately be established. First, the mechanism of the accident; Second, are there any complaints of injuries; and finally, how many people are involved in the incident. Additional EMS units may be dispatched, or their response or cancelled as the IC deems fit. Patients with obvious injuries are to be triaged and transported as in any other incident. Adults involved in the incident may refuse care or transportation according to local protocol.

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ACCIDENTS INVOLVING SCHOOL BUSES, Cont.

Minors who were on the school bus and have no complaints or very minor complaints should be left on the bus if it is safe or directed to the holding area. These minors are then to be individually spoken to and assessed by EMS personnel. As the minors are assessed a log will be completed stating the following information:

Minors Name Minors Age Level of Consciousness Complaints (none if there is no complaint) Position on Bus Triage and transportation Status

As these remaining patients are assessed, they will be divided into two categories: those that require evaluation in the Emergency Department and those who EMS personnel feel do not require Emergency Department evaluation.

Any minor patients that do require evaluation in the emergency department at this point shall be transported to one facility by means, at the discretion of the triage Officer or IC. EMS personnel are to keep in mind that continuity of care must be kept intact and if large numbers of patients with minor injuries are transported by alternate means such as a bus or van, an EMS responder must accompany those patients to the receiving facility.

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ACCIDENTS INVOLVING SCHOOL BUSES, Cont.

Any minor patients that do not require further evaluation may be released to school district authorities after contacting a medical command and receiving permission to release the minors. The EMS personnel on scene must contact medical command and receive permission to release the minors. A school district authority is defined as principal, vice principal, or other administrative district personnel with authority to take charge of the students. It is not advisable to release students to school nurses, teachers, parents, neighbors, etc. Allow the school district to release any minors to their parents. The name of the medical command physician must be documented as well as the name, position and signature of the school district official receiving the children. The command physician reserves the right to require the children be transported to the emergency department. Should the command physician deny permission to release the minors on scene, the minors are to be transported to one facility for evaluation. This may be done by alternate means so long as the continuity of care is not broken.

All patients with no complaints or very minor injuries are to be transported to one facility. This will allow for better accountability of the patients and ease the problems of the school district and parents locating their children. The IC will be responsible to inform the receiving facility of the situation prior to transportation of the injured patients.

Patients with significant complaints or injuries will be transported as directed by the IC or designee, keeping in mind trauma protocol and not to overtax one facility with patients who may require definitive care.

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ACCIDENTS INVOLVING SCHOOL BUSES, Cont.

ALTERNATE MEANS OF TRANSPORTATION

If there are a large number of patients that require transportation to a medical facility, and their injuries do not necessarily require transportation in an ambulance, an alternate means of transportation may be sought. Alternate means of transportation may include a bus, a mini-bus, or a passenger van. The school district involved will usually have a representative on scene and may be able to provide one of these alternate means of transportation.

When one of these means is used, continuity of care must be adhered to and at least one EMS responder must ride to the receiving facility with the patients.

Examples of patients who may be considered for transportation by alternate means include patients with no complaints that are to be evaluated and patients with minor soft tissue injuries.

SPECIAL SITUATIONS:

Although this policy allows for EMS personnel to make a determination whether a patient requires transportation to the emergency department or not, EMS personnel are reminded to always error on the side of caution. If there is a doubt, transport the patient.

EMS personnel are also cautioned to look at mechanism of injury when evaluating patients. Minors who were on a bus that suffered severe damage or that rolled over should be evaluated in the emergency department regardless of complaints or not.

Minors triaged to be released will be transported to the hospital at the request of the school district representative on scene if he/she deems fit.

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ACCIDENTS INVOLVING SCHOOL BUSES, Cont.

OTHER APPLICATIONS OF THIS POLICY:

The concepts of this policy may be applied to any accident involving any school district vehicle.

Various school districts own and operate a wide variety of vehicles at various times throughout the day. If a school district vehicle is involved in a minor accident and there are no complaints or obvious injuries, any minors involved may be released to the school district representative on scene, providing that a command physician has given permission for the patient(s) to be released.

WHERE THIS POLICY CANNOT BE APPLIED:

This policy is solely intended for minors who are riding in school district vehicles. This policy cannot be applied to minors involved in accidents in private vehicles whose parents cannot be contacted, or minors in private vehicles who are in the care of non-related adults, or minors who are riding on publicly or privately owned vehicles such as SEPTA busses and etc.

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Appendix C1 MCI Equipment List

MCI 108 , 134, 115, POD1 (185s) & POD4 (EHS Item 145 - 50 Office) - 100 Patients Patients 40 80 Cervical collars (adjustable – adult ) 40 80 Cervical collars (adjustable – pediatric) 72 100 Blankets (disposable) 58 x 90, insulated 52 102 Blankets (space type) 40 80 Burn sheets (sterile, disposable) 100 200 Multi-trauma dressing (sterile, size 12” x 30”) 100 200 Olaes modular Bandage 4” rolls 100 200 Olaes Modular Bandage 6” rolls 50 100 Abdo dressing, sterile, 8” x 10” 50 100 Blast bandage (tactical Medical) shring wrapped 300 500 Kling 4” rolls (control Wrap) 1600 2000 4 x 4 dressing 150 300 Cravats (triangular bandage 100 200 Cloth Tape 2" 50 100 NP airway kit, latex free, set of 6, sizes 26 to 34 French 50 100 Soft Tourniquet (soft Tactical Tourniquet) 80 Mega Mover (used number of back boards from FEMA 40 list) 60 120 towels cloth 20x40 or 24x48 25 50 chest seals must be vented 25 50 Chest needle decompression 6 6 traffic cones 10 20 Duct Tape (gorilla brand) 10 20 Scissors Trauma 10 20 penlights 10 20 Adult stethoscope 10 20 Adult BP cuff 6 6 permanent markers (box) 6 9 clipboard 6 6 Ball point pens (box) 1 2 triage flag kits 1 2 Triage colored tarps (Red, Yellow, Green, Black) 1 2 triage flag kits (Red, Yellow, Green) 1 1 Mega phone 1 2 Smart Triage CMD Pack 0 50 Nassal Cannulas 0 50 Non Rebreather

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Appendix C-2 – MCI 108, 134, 115, 143 Layout of Equipment (Drivers Side)

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Appendix C-3 – POD1 (185s) Layout of Equipment Passenger Side

Drivers Side

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Appendix C-4 – POD4 (EHS Office) Layout of Equipment (Drivers Side)

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Appendix C-5 –5 Patient Treatment Bags

5 Bags in each unit (MCI 108, 134, 115, 143) 10 Bags in each unit (POD1 & POD4) 1. 5 patient bag Top of bag 1 NP airway kit, latex free, set of 6, sizes 26 to 34 French 1 Oral airway kit 2 Chest Needles 1 Trauma Shear 6 Cravats (triangular bandage Main Bag 12 Kling 4” rolls 2 BSI Kits 1 Gloves Box XL 2 Chest Seals 4 Abdominal Dressings 8x10s 200 4x4 Dressings 5 Triage Tags 2 Blast Bandages (Tactical Medical) Shrink wrapped 7 6" Olaes Bandages 2 rolls 2" tape 5 Tourniquets 1 Roll Duct Tape 5 Space Blankets

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Appendix C-6 – SS168

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Appendix C-7 – MSEC

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Record of Change

This Bucks County Emergency Medical Services Mass Casualty Response Guidelines manual is subject to information updates and changes. The use of this Record of Change helps manage modifications throughout the life of this document.

Change Date Description Signature No. 001 April 2016 Updates to outdated manual

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ANNEX G

Cumulative Equipment Inventory

Include phones and computer hardware valued at $500 or more, purchased with state EMSOF funds

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Item Name Laptop/Docking station/accessories Date of Purchase November 2018 Model Serial Number Item Location EHS Office/Loose Cost 1,935.08 Contract Number SAF4100080321

Item Name Laptop/Docking station/accessories Date of Purchase November 2018 Model Serial Number Item Location EHS Office/Diefenderfer Cost Contract Number SAF4100080321

Item Name Projector Date of Purchase May 2019 Model Serial Number Item Location EHS Office/shared equipment Cost $669.99 Contract Number SAF4100080321

Item Name Intubation Head Date of Purchase April 2019 Model Serial Number Item Location EHS Office/shared equipment Cost $938.00 Contract Number SAF100080321

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In closing, I would like to thank all of the BEMS staff for their teamwork with all of the regional councils. We ask that BEMS continues to move EMS forward as a group. As we work together more, the providers hear the same answer no matter what regional council is asked. Thanks for a great 2019/20 contract period. Wash your hands

Respectfully submitted,

Jeryl L. DeGideo Director

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