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Fire/Rescue Print Date: 3/5/2013

Fire/Rescue Fire/Rescue Print Date: 3/5/2013

Table of Contents

CHAPTER 1 - MISSION STATEMENT 1.1 - Mission Statement...... 1 CHAPTER 2 - ORGANIZATION CHART 2.1 - Organization Chart...... 2 2.2 - Combat Chain of Command...... 3 2.6 - Job Descriptions...... 4 2.7 - Personnel Radio Identification Numbers...... 5 CHAPTER 3 - TRAINING 3.1 - Department Training -Target Solutions...... 6 3.2 - Controlled Substance...... 8 3.3 - Field Training and Environmental Conditions...... 10 3.4 - Training Center Facility PAM...... 12 3.5 - Live Fire Training-Conex Training Prop...... 14 CHAPTER 4 - INCIDENT COMMAND 4.2 - Incident Safety Officer...... 18 CHAPTER 5 - HEALTH & SAFETY 5.1 - Wellness & Fitness Program...... 19 5.2 - Infectious Disease/Decontamination...... 20 5.3 - Tuberculosis Exposure Control Plan...... 26 5.4 - Safety...... 29 5.5 - Injury Reporting/Alternate Duty...... 40 5.6 - Biomedical Waste Plan...... 42 5.8 - Influenza Pandemic Personal Protective Guidelines 2009...... 45 CHAPTER 6 - OPERATIONS 6.1 - Emergency Response Plan...... 48 CHAPTER 7 - GENERAL RULES & REGULATIONS 7.1 - Station Duties...... 56 7.2 - Dress Code...... 58 7.3 - Uniforms...... 60 7.4 - Grooming...... 65 7.5 - Station Maintenance Program...... 67 7.6 - General Rules & Regulations...... 69 7.7 - Inspection & Cleaning Program...... 73 7.8 - Apparatus Inspection/Maintenance/Response...... 75 7.9 - Backing Fire Apparatus & Rescue Units...... 79 7.18 - Station/Personnel Inspections...... 81 7.19 - Station Activity Book/Memorandums/Bulletins...... 82 7.20 - Payroll/Scheduling Procedures...... 84 7.21 - Pre-Fire Plans/Inspections...... 92 7.22 - Hydrant Inspections...... 97 7.23 - Departmental Reporting...... 100 7.24 - EMS & Fire Reporting...... 104 7.25 - Ride-Along...... 106 7.26 - Roadway Emergency Traffic Management...... 108 CHAPTER 8 - STANDARD OPERATING GUIDELINES Fire/Rescue Print Date: 3/5/2013

8.1 - Aircraft Crash...... 112 8.3 - Apparatus Response to Brush ...... 114 8.4 - Building Collapse...... 115 8.7 - Building Fire (Residential)...... 116 8.12 - Elevator Stuck...... 120 8.29 - Vehicle Accident with Extrication...... 121 8.35 - On Scene Operations...... 125 8.36 - Bomb Threat...... 132 8.37 - Headquarters Building Security...... 134 8.38 - Headquarters Fire Evacuation...... 136 8.41 - Fire Investigations...... 138 8.42 - Fire Stream Management...... 141 8.57 - Multi-Story Fire Response...... 144 CHAPTER 9 - SPECIAL OPERATIONS 9.1 - Personnel Deployment...... 146 CHAPTER 10 - DEPARTMENTAL EQUIPMENT OPERATING GUIDELINES 10.1 - ...... 149 10.2 - SCBAs & Respiratory Program...... 152 10.3 - IT Support Requests...... 162 CHAPTER 11 - DEPARTMENT TEAMS AND CHARTERS CHAPTER 12 - PUBLIC INFORMATION 12.1 - Public Information...... 163 CHAPTER 13 - PERSONNEL ACCOUNTABILITY SYSTEM 13.1 - Personnel Accountability System...... 166 CHAPTER 14 - STADIUM OPERATIONS 14.1 - Ben Hill Griffin Stadium Medical Operations...... 173 CHAPTER 15 - RAPID INTERVENTION TEAM (R.I.T.) 15.1 - Rapid Intervention Team (R.I.T.)...... 183 CHAPTER 16 - MEDICAL TRANSFERS CHAPTER 17 - PARAMEDIC CLEARANCE PROTOCOL 16.1 - Medical Transfers...... 186 17.1 - Paramedic Clearance Protocol...... 188 CHAPTER 18 - DEPARTMENT CHAPLAIN 18.1 - Department Chaplain...... 190 CHAPTER 19 - MAY DAY EMERGENCY PROCEDURES 19.1 - MAY DAY Emergency Procedures...... 192 CHAPTER 20 - THE TFP PRO/PAK 20.1 - The TFP PRO/PAK...... 195 CHAPTER 21 - EMERGENCY ROOM BUSY STATUS (ERBS) 21.1 - Emergency Room Busy Status (ERBS)...... 197 CHAPTER 22 - KNOX BOX OPERATIONS 22.1 - Knox Box Operations...... 198 CHAPTER 23 - GATOR NATIONALS MEDICAL OPERATIONS PLAN 23.1 - Gator Nationals Medical Operations Plan...... 200 CHAPTER 24.1 - MEDICAL CARE PROTOCOLS 24.1.1 - General Considerations...... 206 24.1.2 - Radio Report...... 208 24.1.3 - Initiation of CPR...... 209 24.1.4 - Determination of Death...... 210 24.1.5 - Suppected Child/Elder Abuse...... 212 24.1.6 - Determination of Hospital Destination...... 213 Fire/Rescue Print Date: 3/5/2013

24.1.7 - Hospital Emergency Dept. EMS Bypass Guidelines...... 214 24.1.8 - Refusal of Service...... 215 24.1.9 - Physician On Scene...... 219 24.1.10 - Universal Precautions...... 220 24.1.11 - Quality Assurance Program...... 221 24.1.12 - Baker/Marchman Act...... 228 24.1.14 - Rapid Extrication...... 231 CHAPTER 24.2 - BASIC MEDICAL CARE PROTOCOLS 24.2.1 - Basic Medical Care Protocol...... 232 24.2.2 - ...... 234 24.2.3 - Therapy...... 235 24.2.4 - Control of External ...... 236 24.2.5 - Shock...... 237 24.2.6 - MCI and Triage System...... 238 CHAPTER 24.3 - CARDIOVASCULAR PROTOCOLS 24.3.1 - Chest Pain-Suspected Cardiac...... 240 24.3.2 - Chest Pain Non-Cardiac...... 242 24.3.3 - Congestive Heart Failure/Pulmonary Edema...... 243 24.3.4 - Cardiac Arrest Management...... 244 24.3.5 - Dysrhythmia-Asystole/Pulseless Electrical Activity(PEA)...... 245 24.3.6 - Dysrhythmia-Atrial Fibrillation/Atrial Flutter...... 247 24.3.7 - Dysrhythmias-Bradycardia...... 248 24.3.9 - Dysrhythmias-Supraventricular Tachycardia...... 249 24.3.10 - Dysrhythmias-Polymorphous Ventricular Tachycardia(Torsades de Pointes)...... 250 24.3.11 - Dysrhythmias Ventricular Wide-Complex Tachycardia...... 251 24.3.12 - Dysrhythmias-Ventricular Fibrillation/Pulseless Ventricular Tachycardia...... 253 24.3.13 - Cerebrovascular Accident (CVA, Stroke)...... 254 24.3.14 - LVAD...... 256 CHAPTER 24.4 - EMERGENCY MEDICAL PROTOCOLS 24.4.1 - Allergic Reactions...... 258 24.4.2 - Abdominal Pain...... 260 24.4.3 - Altered Mental Status...... 262 24.4.4 - Intoxication...... 263 24.4.5 - Diabetic Emergencies...... 264 24.4.6 - Dysbarism-Diving Accidents...... 265 24.4.7 - Gastrointestinal Bleeding...... 266 24.4.8 - Heat Illness...... 267 24.4.9 - Hypertension...... 268 24.4.10 - Hypothermia...... 269 24.4.11 - Nausea & Vomiting...... 270 24.4.12 - Overdose & Poison Ingestion...... 271 24.4.13 - Psychiatric Disturbances/Excited Delirium...... 274 24.4.14 - Respiratory Distress...... 276 24.4.15 - Seizures...... 277 24.4.16 - Shock-ALS...... 278 24.4.17 - Snake Bite...... 280 24.4.18 - Taser Removal...... 281 CHAPTER 24.5 - TRAUMA PROTOCOLS 24.5.1 - Trauma...... 282 24.5.2 - Burns...... 286 24.5.3 - Eye Emergencies...... 288 Fire/Rescue Print Date: 3/5/2013

CHAPTER 24.6 - OB/GYN PROTOCOLS 24.6.1 - Vaginal Bleeding...... 289 24.6.2 - Suspected Ectopic Pregnancy...... 290 24.6.3 - Pre-Eclampsia...... 291 24.6.4 - Eclampsia...... 292 24.6.5 - Prolapsed Umbilical Cord...... 293 24.6.6 - Emergency Delivery...... 294 24.6.7 - Neonatal Resuscitation...... 296 CHAPTER 24.7 - PROCEDURAL PROTOCOLS 24.7.1 - 12 Lead EKG...... 298 24.7.2 - Automatic External Defibrillation...... 299 24.7.3 - Blood Draw...... 300 24.7.4 - Chest Decompression...... 301 24.7.5 - Continuous Positive Airway Pressure(CPAP)...... 302 24.7.6 - Cricothyrotomy...... 304 24.7.7 - Cyanokit (Hydroxocobalamin for injection)...... 305 24.7.8 - End Tidal CO2 Monitoring...... 307 24.7.9 - Endotracheal Intubation (Nasal & Oral)...... 308 24.7.10 - External Cardiac Pacing...... 311 24.7.11 - EZ-IO Infusion System...... 312 24.7.12 - Intravenous Access/Saline Loc...... 314 24.7.13 - Nasogastric Tube Placement...... 315 24.7.14 - Oxygen Saturation Monitoring...... 316 24.7.16 - Ventilator...... 317 24.7.15 - Stemi Alert (St Elevation Myocardial Infarction)...... 319 24.7.17 - ZOLL® E Series™ Reference Guide...... 322 24.7.18 - Sepsis Alert with Lactate Scout...... 325 24.7.19 - ZOLL® Autopulse Battery Conditioning...... 327 24.7.20 - ZOLL® Autopulse® Model 100...... 329 CHAPTER 24.8 - APPENDICIES 24.8.1 - Pediatric Trauma Score...... 334 24.8.2 - Revised Trauma Score...... 335 24.8.3 - Pediatric Trauma Assessment Methodology...... 336 24.8.4 - Adult Trauma Triage Criteria & Methodology...... 337 24.8.5 - Normal Pediatric Vital Signs...... 338 24.8.6 - Alternate Routes Of Drug Administration...... 340 24.8.7 - Apgar Scoring...... 341 24.8.8 - Approved Abbreviations For Documentation...... 342 24.8.9 - Approved Medication List...... 343 CHAPTER 25 - TECHNICAL RESCUE GUIDELINES 25.1 - Technical Rescue Guidelines...... 344 CHAPTER 26 - WILDLAND TASK FORCE/STRIKE TEAM GUIDELINES Fire/Rescue Print Date: 3/5/2013

CHAPTER 1 Mission Statement

Issued: February 2006 Revised:

Submitted By:SOG Team Approved By:

Improve the life, safety and protection of property through preparedness, response, mitigation and recovery.

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Organization Chart

CHAPTER 2.1

Click to view ↓

Department Org Chart

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Chain of Command

CHAPTER 2.2

Issued: January 2006 Revised: Sept. 2009, Feb 2011 Submitted by: Approved by: Director

All personnel are subject to the Department's Chain-of-Command. The highest ranking classification is in-charge when present. When addressing an officer, it will be by the title of their current job classification.

Any directive or order (written or verbal) given to any member by a superior or senior officer shall be carried out without delay. Should an individual be in the act of executing an order and a subsequent order is given to that individual by a different officer, the individual shall make known to the second officer that he/she is in the process of executing an order. In the event the second officer insists that their order be obeyed, the individual shall execute the second order, the second officer then assumes full responsibility for the change in orders and actions thereof.

An order that creates an unsafe situation or that is in contradiction to Department regulations shall be challenged by the receiving party. If after consideration the situation or contradiction persists, the order shall be referred to the issuing individual’s superior for confirmation and direction.

The Chain-of Command identifies levels of authority and responsibility. These levels are subject to the presence of the highest ranking individual present. The Department is organized within a framework similar to the NIMS. The Department is headed by the Department Director.

● In the absence of the Department Director the designated or respective Section Chief is the authority.

● Each Department Section is headed by a Section Chief. In the absence of the Section Chief the designated or respective Branch Director is the authority. Each Section has an identified organizational chain-of-command that is a continumum of the Department's structure.

● Each Section divided into branches. Each branch Is headed by a Branch Director. Each Branch has an identified organizational chain-of-command that is a continumum of the Section's structure.

● The ranking officer present is the authority.

The current hierarchy for the Fire Rescue Section is as follows:

Chief Fire Rescue Assistant Chief District Chief Captain Lieutenant Rescue Lieutenant Driver/Operator

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JOB DESCRIPTONS

Chapter 2.6

Click on link below to view Alachua County job descriptions

Job Classifications

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Personnel Radio Identification

CHAPTER 2.7

Issued: December 2008 Revised:

Submitted by: Chief Bailey Approved by: Will G. May Jr., Director

Click below to view Chart

Personnel Radio ID Numbers

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DEPARTMENT TRAINING TARGET SOLUTIONS

CHAPTER 3.1

Issued: January 15, 2013 Revised:

Submitted By: Technical Services Approved By: Chief of Fire Rescue

Purpose

To ensure personnel are trained to a level that enables them to work safely and effectively during an emergency response. To properly document training hours and show that ACFR is meeting the required training as recommended by ISO, NFPA, and NIOSH. To document and track required certifications pertinent to departmental employees and emergency operations.

Policy

Alachua County Fire Rescue shall utilize the Target Solutions, Inc.® online learning management system and training platform as its sole means of recording, tracking, and maintaining department training records.

All shift personnel shall log into Target Solutions at least once per shift.

Personnel shall check the “Schedule”portion of their home page for any new or pending assignments, activities, or courses that need completion. All “assigned”items must be completed by the due date.

All assignments, activities, or courses that have been assigned to a user shall be completed regardless of applicable CEU and/or ISO hours needed or obtained.

Personnel shall review their credentials to assure they are complete and accurate.

Personnel may assign their own classes utilizing the “Self Assign”tab on the left side of the home screen. These assignments will have no due date and can be completed at the will of the user. These courses are provided by Target Solutions and all requirements are set by the company in accordance with their policies.

Company Officer Responsibilities

The company officer is responsible for ensuring all training is completed and entered in Target Solutions as directed in ACFR SOG’s ,Chapter 7.6. This includes physical fitness, company and individual training.

The company officer is responsible to enter the daily equipment checks and activities.

The company officer is responsible to enter any other completed training, unless training is conducted by the Training Division.

In the case of company or multi-company training done at the station in which two company officers are present, it shall be made the responsibility of the most senior officer to record the training in Target Solutions.

Company officers shall check all their personnel’s progress in Target Solutions on a weekly basis and verify all completed training has been submitted.

To verify that training has been completed and entered, go to Administration tab in Target Solutions and click “generate reports.”Next, click “generate report”on the right side of the page.

All current company officers and out-of-class company officers will have the appropriate supervisor rights granted to them in Target Solutions.

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Out-of-class eligible personnel shall only record training and run reports when acting as the company officer or instructed to do so by an officer.

District Chief Responsibilities

It is the responsibility of the District Chief to verify that the training has been completed and entered at the company level on their shift.

To verify that training has been completed and entered, go to Administration tab in Target Solutions and click “generate reports.”Next, click “generate report”on the right side of the page.

The District Chief shall make every possible effort to get all members through scheduled training. This may require some changes in the schedule developed by the Training Division. The District Chief must coordinate the training around the scheduled leave of personnel on their shift.

The District Chief shall enforce compliance with assigned training deadlines and completed company training.

The District Chief shall update their assigned personnel utilizing the “Manage User”tab under the Administration tab. This will assure users are properly updated with field assignment changes.

All current District Chiefs and out-of-class eligible District Chiefs will have the appropriate supervisor rights granted to them in Target Solutions.

Training Division Responsibilities

The Training Division will assign required training as determined by the ACFR Medical Director and/or the Assistant Chief of Technical Services.

The Training Division will conduct a monthly audit of Completions and Credentials to determine if any personnel have not completed an assigned training task or if any of the required ACFR Credentials are expired/expiring. This will be done the first Monday of each month. A report will be generated and sent to the District Chiefs and the Assistant Chief of Technical Services.

The Training Division shall enter all training activities that are coordinated and delivered by the Technical Services Branch of ACFR. This shall include, but is not limited to, multi-company drills, live fire training, company drills, EMS In-Service and Grand Rounds.

All efforts shall be made to prevent repeat documentation of training. If there are any questions as to whom is to record the training, it shall be discussed amongst the officers present during the training.

Credentials Tracking

The Technical Services Branch of ACFR shall act as the administrator for Target Solutions and shall be responsible for entering and maintaining all department required credentials documentation.

The individual user shall be responsible for ensuring all requirements are met and upheld for all ACFR required credentials within their respective time constraints.

The individual user shall be responsible for creating an electronic copy of the credential and sending it via email to the Technical Services designee prior to its expiration.

The individual user shall review their credentials regularly and assure the accuracy and dates. If there are any discrepancies, the user shall notify the Technical Services designee.

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Controlled Substance

CHAPTER 3.2

Issued: January 2010 Revised: October 2009

Submitted by: Technical Services Approved by:Ed Bailey, Chief

Controlled Substance

● Each ALS permitted Public Safety Unit will maintain a "Narcotics Control Sheet #102" as follows:

● Time, month, day, and year of the inventory will be logged in the "Date" column.

● The name of the substance, weight, volume, or quantity and expiration date will be logged in the respective column.

● During crew change, the off-going and on-going Rescue Lieutenants or Paramedic/Firefighter will sign full signature and ID number for control of the substance in the respective columns.

● Deviation from standard stocking levels of substances will be logged in the "comments" column and reported to the District Chief. ● Each ALS Permitted Public Safety Unit will maintain a "Narcotics Control Sheet #1303-B" as follows:

● Time, month, day, and year will be logged in the "Date" column.

● Total amount of substance available (prior to administration) and expiration date will be logged in the appropriate column.

● The dose ordered by the MCA will be logged in the "Dose" column in mg.

● The balance of the substance (in mg) will be logged in the "waste" column.

● The Paramedic who administers or wastes the substance and a witness will sign with full signature, printed name, and ID number in the respective column.

● The physician that ordered administration of the substance will sign in the "Physician" column.

● The CR number of the incident the substance was ordered on will be logged in the "CR" number column.

● When restocking substances the District Chief issuing the substance will sign in the "Paramedic off-going" column. The Paramedic receiving the restock will sign in the "Paramedic oncoming" column.

● All pages will have to be numbered consecutively.

● The District Chief will carry narcotics to replenish those substances utilized by the individual Public Safety Units.

● The month, day, year and time of issue will be logged in the "Date" column.

● Total amount of substance (in mg) on hand prior to issue will be logged in the respective columns.

● Amount of substance (in mg) issued and CR number substance is intended to replace will be logged in "Comments" column.

● Signature and ID number of Chief issuing substance will be logged in "Chief Issued" column.

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● Signature and ID number of individual receiving substance will be logged in "Paramedic Receiving" column.

● District Chiefs will sign on and off for control of substance during crew change.

● Assistant Chief will sign in "Chief Issued" column when issuing replacement substance.

● District Chief will sign in "Paramedic Receiving" column when receiving substances.

● Completed form will be submitted to the Assistant Chief at the first of each month where it will be kept on file as required.

● All pages will be numbered consecutively.

● DC's monthly count sheet submitted to Assistant Chief at the end of the month.

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Field Training and Environmental Conditions

CHAPTER 3.3

Issued: November 2006 Revised: November 2008

Submitted by: Health & Safety Officer Approved by: Chief Northcutt

PURPOSE

The purpose of this SOG is to establish guidelines and responsibilities for minimizing the effects of environmental conditions to department members during normal field training. Additionally, it will provide guidelines for determining when to cancel or alter outside training exercises based on these environmental conditions.

The Company Officer or Incident Commander must remember that he/she is responsible for the health and safety of these employees.

DESCRIPTION

Normal field training, for this policy, is defined as that training conducted outdoors. This Includes all field training including training being conducted at the company level and formal field training conducted by the Department of Public Safety Training Branch or any other Section or Branch of the Department of Public Safety exposing employees directly to anyone, or all, of the five environmental conditions.

Environmental conditions shall be broken into five areas of concern: heat/humidity, cold, rain, lightning, and wind.

Heat/Humidity

The Heat Index shall be determined by data obtained from the National Weather Service. The Company Officer or Incident Commander on duty will be responsible for obtaining the Heat Index. Whenever the environmental conditions exceed the standard of a Heat Index of 98º F, non-emergency outside training activities shall be curtailed as follows.

● Non-emergency training activities requiring the use of protective gear (bunkercoat/pants) or other heat-retaining garments shall be discontinued.

● Light outdoor activities are permitted, though supervisors shall allow adequate rest periods for proper hydration and cooling. Supervisors shall monitor employees for indications of heat/environmental stress and modify activities accordingly.

● Members shall notify their supervisors any time they feel that they are approaching an unsafe degree of heat/environmental stress.

Other Environmental Conditions

Whenever the environmental conditions meet or exceed the following standards, all non-emergency outside training activities shall be discontinued.

● Rain – When rain creates an unsafe condition.

● Lightning– When visible cloud to ground lightning appears to be in the general area. Elevated training shall be discontinued at the first sighting of lightning by the Officer in charge.

● Wind–Strong gusty winds may affect ground ladder and elevated non- emergency activities.With winds exceeding 25 mph, all outdoor non-emergency training activities should be discontinued.

● Cold-Normal outdoor training activities shall continue with the exception of the use of water as the ambient

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temperature reaches 40ºF. Normal outdoor training activities shall be discontinued as the wind chill reaches 32ºF or below. The Wind Chill shall be determined by data obtained from the National Weather Service. The Company Officer on duty will be responsible for obtaining the Wind Chill.

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TRAINING FACILITY CENTER PAM

CHAPTER 3.4

Issued: December 2012 Revised:

Submitted by: Technical Services Approved by: Chief Fire Rescue

Purpose

To ensure the safety of all persons using the Alachua County Fire Rescue Training Center Facility. To protect the Facility for continued use and assure the security of the area. To provide general building issues for Live Fire Training, in conjunction with the Live Fire Training SOG Chapter 3.5

General

The Training Center is situated on 1.8 acres of land within the property of the Professional Academies Magnet (PAM) at Loften High School located at 3000 East University Avenue, Gainesville, FL. The Training Center consists of a 20’ x 30’ classroom building with a 20’ x 30’ roofed open area; a Training Building constructed of “conex”metal storage containers; and vehicle props for fire and extrication, among other items. A serviceable hydrant is located approximately 200’ north of the facility. An agricultural/horticultural Nursery next to the Training Center has restroom and shower facilities for use by participants. PAM has a Class A engine for use at the Training Center that will be parked at the facility.

Use/Scheduling

Orientation to the facility, grounds, and security must be obtained from the Training Division prior to any use of the facilities. Departments wishing to use the Training Center must have prior approval from the Assistant Chief of Technical Services. Use of the facility must be scheduled a minimum of five (5) days prior to use. All use must be approved by the Assistant Chief of Technical Services or his designee.

All clothing and equipment must be appropriate for the type of training performed.

Security

A Knox Box is affixed to the Training Building with keys to the classroom, Training Building, and a gate to the Nursery. Keys to this knox box are located in the Training Division and with District 5. The Training Division will notify District 5 of any authorized use and the approved dates when necessary. District 5 shall make note of any units/crews making use of the key and facility during times with no Training Division staff present.

After use

Following training sessions the building and grounds must be cleaned up and returned to the original state. Cans, trash, and other items not part of the facility must be removed and disposed of properly. (Unused pallets, hay, and other materials may be stored inside the Training Building for future use).

The building should be swept and/or hosed down after use as needed. All windows and doors shall be secured to prevent weather damage and vagrancy. When leaving the facility the Training Building, classroom and Nursery gate will be locked and all keys returned to the Knox Box. Knox box key is to be returned to the appropriate custodian (who?). If after school hours, the main gate will be locked and secured. Departments that use the facility improperly, cause damage, do not bear the cost of repairs, or fail to clean the buildings or grounds will not be allowed future use of the Facility. In addition, departments that do not adhere to the Facility SOG may not be allowed on the Facility grounds. Any damage to the buildings or grounds during training are to be reported to the Training Division. Repairs and all costs thereof are the responsibility of the damaging agency. Any damage to the Training Center buildings, grounds, props, etc. shall be reported to the on duty District Chief’s immediately and appropriate paperwork completed.

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ACFR crews that use the facility improperly, cause damage (reported or unreported), or fail to clean the buildings or grounds may be subject to disciplinary action(s).

Live Fire

Live Fire exercises at the Fire Training Center shall be conducted under the direct supervision and presence of ACFR Training Division personnel or other personnel approved by the Assistant Chief of Technical Services.

Live Fire SOG’s must be covered with all Instructors and Students.

Pallets, hay, etc. will be placed on the appropriate racks in the burn room and not directly on the floor or against the walls.

Burning shall be done only in designated burn rooms. A machine may be used throughout the building for search and rescue, RIT and other training.

When burning, all windows and doors will be unlocked/unsecured and in a state for immediate opening if needed.

All Live Fire Instructors and Procedures shall adhere to FL Statute 69a-37, NFPA 1403 and ACFR Live Fire Training SOG Chapter 3.5.

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LIVE FIRE TRAINING-CONEX TRAINING PROP

CHAPTER 3.5

Issued: December 2012 Revised:

Submitted By: Technical Services Approved By: Chief Fire Rescue

Purpose:

To ensure that live fire training exercises are conducted professionally and safely in accordance with established laws, rules, and standards. It is the intent for this S.O.G. to supplement, NOT REPLACE, NFPA 1403 and FL Administrative Code 69a-37. We want every participant and instructor to gain the most from these experiences without taking undue risks. Only those instructors who have completed the State approved, 40-hour, Live Fire Instructor Training Program and have received State certification as a Live Fire Instructor will be allowed to function as the Safety Officer or Instructor-in-Charge during live fire training.

The Instructor-in-Charge will ensure that all live fire drills are conducted in accordance with NFPA1403 and FL Administrative Code 69a-37, and that all instructors participating in these drills have been given an opportunity to review this S.O.G.

Pre-Burn prep:

The Instructor-in-Charge will ensure that all pre-burn procedures are completed in accordance with NFPA 1403 and FL Administrative Code 69a-37.

Check all PPE for compliance.

All doors, windows and shutters, roof scuttles and automatic ventilators, mechanical equipment, lighting, manual or automatic sprinklers, and standpipes necessary for the live fire training evolution shall be checked and operated prior to any live fire training evolution to ensure they operate correctly.

All safety devices, such as thermometers, oxygen and toxic and combustible gas monitors, evacuation alarms, and emergency shutdown switches, shall be checked prior to any live fire evolutions to ensure they operate correctly.

The instructors shall run the system prior to exposing students to live flames in order to ensure the correct operation of devices such as the gas valves, flame safeguard units, agent sensors, fans, and ventilation fans. Prior to conducting actual live fire training evolutions, a pre-burn briefing session shall be conducted for all participants.

All facets of each evolution to be conducted shall be discussed in the pre-burn briefing, and assignments shall be made for all crews participating in the training session.

The location of simulated victims shall not be required to be disclosed, providing that the possibility of victims is discussed during the pre-burn briefing.

At no time, shall a victim be dressed in firefighting PPE during live fire training evolutions.

A site plan will be sketched to show the location of Command, Staging/Air Supply, Rehab/Medical, Apparatus, exposures, water supply, hoselines, and hazards.

A building/floor plan will be sketched to provide detail. Burn rooms shall be clearly numbered and recorded on the floor plan. Exits shall be clearly marked.

Communication, Evacuation, and Medical Plans shall be developed and reviewed with participants prior to the burn day.

Set-up and Demobilization Plans for burn day including Company assignments for areas of responsibility shall be developed and reviewed with instructors prior to the burn day.

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All live fire paperwork must be completed, reviewed, and signed off by the Instructor-in-Charge no later than 4:00PM on prep day.

The original documents will be kept on file by ACFR Technical Services. One complete copy will be kept at the Command Post.

Burn Operations

1. All operations will be managed by use of the Incident Command System.

2. All operations will be conducted under Level III Accountability.

3. All radio communications will be consistent with professional fireground radio traffic, using “Clear Text”.

4. “Open-Ended”communications are not acceptable, and must immediately be corrected (closed) by the Instructor-in-Charge.

5. “URGENT”will be the term used to identify urgent communications. “MAY DAY”will be the term used to identify instructors or students in distress. All other radio communication will cease until the Instructor-in-Charge declares a return to “Normal Radio Traffic”.

6. The package used shall be limited to avoid conditions that could cause flashover or . Fuel materials shall be Class A combustibles and used only in the amounts necessary to create the desired fire size.

7. All hose lines (minimum 95 gpm each) will be flowed simultaneously prior to lighting the fuel package. Driver Operators will take this opportunity to set proper engine pressures and ensure the ability to deliver the total fire flow required. The Primary and Secondary Apparatus shall be connected to separate water supply sources and be operated by state certified Pump Operators.

8. The Instructor-in-Charge will conduct a “Go/No-Go”sequence with all assigned divisions/groups prior to lighting the fuel package.

9. This is designed as a “room and contents”exercise. Ordinarily the IC would use a risk/benefit analysis to determine how long to continue interior operations once the fire has grown beyond the control of the fire attack. During this drill that procedure shall be modified as follows:

If the fire extends beyond the room of origin, either horizontally or vertically and any Instructor feels it is not controllable, the Instructor-in- Charge shall be notified and the IIC shall order all personnel out of the structure. The deluge sprinkler system shall be activated. Once all personnel are out and the Entry Officer reports a PAR to Command, an exterior attack will begin to bring the fire under control within the room of origin. The fire will, then, be put “dead out”and an assessment will be made to determine if the room is suitable for continued fire attack operations. Operations will resume at the “Go/No-Go”sequence.

10. The Instructor-in-Charge must consider the potential for heat saturation, heat exhaustion and heat stroke for students and instructors during this drill. It is recommended that each participant be assigned to advance a handline on an interior attack a maximum of three times. This should give every participant an opportunity to handle a nozzle and manage a hoseline during this drill.

11. Attack lines shall be advanced into, and retreated from, an attack position by the attack team.

12. Monitor current weather advisories and conditions throughout the drill.

ASSIGNED POSITIONS:

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Instructors will be assigned to one of two groups (Attack Group and Support Group).

Groups will be rotated at the discretion of the Instructor-in-Charge.

Command Staff shall consist of the Instructor-in-Charge and Safety Officer as follows:

Instructor-in-Charge -has overall responsibility and authority for managing and coordinating this drill.

Safety Officer -has overall responsibility for the safe completion of this drill.Unlike actual emergency scene operations, the Safety Officer has ultimate authority to shut down operations, which is NOT subject to countermand by the Instructor-in-Charge. Inspects PPE of all participants to ensure properly worn,compliant gear. Also monitors interior and exterior conditions that are evident from that vantage point.

Attack Group shall consist of Attack, Back-up, RIT, and Entry as follows:

Attack -supervises the attack team. Directs the fire attack, assuming a position which allows for effective crew management. Monitors all PPE.

Back-up -supervises the back-up team. Also monitors interior conditions that are evident from that vantage point. Monitors all PPE.

RIT - Minimum of three (two?) personnel assigned as the Rapid Intervention Team. Also monitors interior and exterior conditions that are evident from their vantage point. Monitors all PPE.

Entry -controls the entry point to the interior under Level III accountability. Monitors all PPE. Maintains an entry board to hold the PAT’s of students and instructors working inside. No one will be allowed inside without appropriate PPE and PAT. Also monitors exterior conditions that are evident from that vantage point. Monitors all PPE.

Support Group shall consist of the Primary Apparatus, Secondary Apparatus, Rehab/Medical, and Staging/Air Supply as follows:

Primary Apparatus -Establishes and maintains a continuous water supply from the primary water source. Operates to provide required water flow and discharge pressures to the attack line and all other lines as needed. Also monitors exterior conditions that are evident from that vantage point.

Secondary Apparatus -Establishes and maintains a continuous water supply from the secondary water source. Operates to provide required water flow and discharge pressures to the back-up line and all other lines as needed. Also monitors exterior conditions that are evident from that vantage point.

Rehab/Medical -Assess the established location (upwind, uphill, access to EMS). Take baseline vitals for all students and instructors before the drill. Ensure that all students arrive at Rehab from the Attack position for vitals,hydration, cooling, and rest, then,send them to Staging for reassignment. Manage patient care. Contact person with local EMS. Responsible for transfer of patient and patient information to local EMS. Also monitors exterior conditions that are evident from that vantage point.

Staging/Air Supply- Assess the established location (upwind, uphill). Maintain adequate reserve air supply. Maintain at least one team dressed and ready at all times. Monitors all PPE. Also monitors exterior conditions that are evident from that vantage point.

ORDER OF OPERATIONS

Set-up - According to the site plan unless conditions dictate a change.

Building Survey -Check the interior for any tools, equipment, animals or persons.

Briefing -The Instructor-in-Charge will conduct a briefing for all instructors and students to ensure that everyone understands the evolutions.

Safety Review –Safety Officer will conduct a brief safety review to include MAYDAY procedures, T-PASS, accountability, gear checks and evacuation tones/procedures. This shall include an audible demonstration of

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evacuation notifications. The safety officer shall discuss other conditions that may warrant an instructor to stop the training evolution.

Walkthrough – A walkthrough of the building will be done to familiarize participants with the floor plan and layout. This walkthrough shall include the notation of all exits and exit pathways.

Assignments -Assume assigned positions and flow lines.

“Go/No Go”…Run the sequence with all assigned positions in this order: Attack, Back-up, RIT, Entry, Primary Apparatus, Secondary Apparatus, Rehab/Medical, Staging/Air Supply, Safety, Ignition.

Ignition…The Back-up Instructor will have a temporary assignment as Ignition Officer, which will be last in the “Go/No Go”sequence, and with a radio identifier “Ignition”. The order to light the fuel package will be “Ignition, you have a Go”. The Ignition Officer will advise Command when there is “Fire in the hole”. The Safety Officer will personally return the torch to the staging area.

*NOTE: Any time operations are shut down we will resume with the “Go/No Go”Sequence.

POST-BURN OPERATIONS

Shutting down - Begin the demobilization process at the discretion of the Instructor-in-Charge. Leave at least one line in operation until the fire is “dead out”.

Post Incident Analysis -The Instructor-in-Charge will conduct an on-site debriefing for all participants.

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Incident Safety Officer

CHAPTER 4.2

Issued: October 1, 2002 Revised:

Submitted by: Safety Officer/Team Approved by: Will G. May, Jr., Director

Qualifications:

● Completion of Department Safety Officer Course.

● Florida certified minimum fire standards to be Safety at fire scene.

● Have been designated by Incident Command as the Safety Officer (ID will be "Safety").

● Have and maintain a knowledge of potential safety hazards involved in fire fighting and rescue practices.

Authority:

● The Safety Officer shall have the responsibility to identify and cause correction of safety hazards at the station, during training, and emergency operations.

● Safety Officers shall have the authority to cause immediate correction of situations that are an imminent hazard to personnel.

● At an emergency incident, where activities are judged by a Safety Officer to be unsafe and to involve an imminent hazard, the Safety Officer shall have the authority to alter, suspend, or terminate those activities. The Safety Officer shall immediately inform the IC of any actions taken to correct imminent hazards at an emergency scene.

● At an emergency incident where the Safety Officer identifies unsafe conditions that do not present an imminent danger, the Safety Officer shall take appropriate action through the IC to mitigate or eliminate the unsafe condition.

● Where non-imminent hazards are identified, a safety officer shall develop actions to correct the situation within the administrative process of the Department.

Records:

● The assigned Safety Officer will document any unsafe or hazardous actions taken during an event and make recommendations via Department administrative process to avoid similar situations in future if possible.

● In the event of a death and/or injury at an incident, the Safety Officer will participate in the investigation.

Training:

● A Safety Officer will be assigned any time the situation (training activities, emergency incident) warrants.

Incident Safety:

● The Department shall insure that training for safety procedures relating to Department operations and functions is offered to all of the Department members.

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Wellness & Fitness Program

CHAPTER 5.1

Issued: November 1, 2003 Revised: January 2006

Submitted by: SOG Team Approved by: Will G. May Jr, Director

Purpose:

To reduce workplace injuries by inproving muscular development, cardiovascular output, endurance levels, flexibility, reduction of body fat, and empowering the employees with the opportunity for an enhanced quality of life through physical fitness. Fitness testing is not intended to identify employees who are below a physical standard. It is an opportunity to empower people to know more about their health, how it impacts them and provide them with the tools to start, continue, or advance goals to improve physical health.

Responsibility

The Department's Health and Safety Officer is responsible for the Wellness/fitness program. It is each employee's responsibility to ensure that they are physically fit.

General Guidelines

The Wellness/Fitness program is a comprehensive strategy to increase physical health and the examples in the proper methods and techniques of exercise. Nutrition, fitness, wellness and overall physical well being shall be targeted through the following objectives:

● Assessments – Each employee will be assessed per the requirements of the program. Six months from that time, there shall be a subsequent assessment to measure results. One year from the initial assessment, a third assessment will be administered. Assessments shall continue on an annual basis. Each assessment will measure the following: flexibility (sit and reach), muscular strength (arm curl and grip strength), muscular endurance (sit-ups and push-ups), body composition (calipers), and cardio-vascular ability (aerobic capacity).

The assessments will provide baseline information that can be tracked over a long period of time in order to determine increases or decreases in fitness levels.

● Data – A database will be maintained by the Health and Safety Office. All fitness information will be kept confidential. An injury data base has been formulated as a means of determining essential need for exercise prescription.

Equipment – This equipment shall be kept at the assigned station and any defects damage or required shall be reported to the Department Health and Safety Officer. All equipment shall be kept neat, clean and orderly. All weights shall be put away after their use.

● Time – At least one hour should be devoted to fitness training each shift. This time shall not interfere with other assignments or response to calls.

● Responsibility – Each employee shall ensure they are working towards improving their fitness levels. Each supervisor shall ensure that all efforts are made to allow for fitness training in daily routines.

● Exercise - Picture boards illustrating proper techniques shall be posted at all stations with equipment. Employees shall follow manufacturer's recommendations while utilizing exercise equipment.

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Infectious Disease/Decontamination (Exposure Control Plan)

CHAPTER 5.2

Issued: January 1992 & 1996 Revised: Oct. 02, Sept. 06, Oct.07 Sept. 09, May 11, June 12 Submitted by: Health & Safety Officer Approved by: Chief Fire Rescue

SCOPE

This policy describes program components, best practices and post exposure procedures.

PURPOSE

The purpose of this SOG is to establish guidelines and policies to:

● Decrease the risk of an infectious exposure by informing employees about:

● Infection control standards

● Infection control training requirements

● Personal protective equipment (PPE)

● Work practices to decrease exposure risk

● Engineering controls to decrease exposure risk

● Equipment and station cleaning and disinfecting

● Safe disposal of infectious waste

Explain:

● Post exposure procedures

● Each station will be issued current information regarding standard procedures for Post Exposure Prophylaxis (PEP) for documented exposure to HIV.

● Meet the Occupational Health and Safety Administration (OSHA), CFR 1910.1030 Bloodborne Pathogens rule.

● Meet State of Florida Firefighter Occupational Health & Safety Act. FAC 69A-62

● Strive to meet recommendations in NFPA 1581 – Infection Control 1581 – Standard on Infection Control Program for Fire Departments

PROGRAM COMPONENTS

The components of the ACFR Exposure Control SOG include:

● The Exposure Control Plan

● Risk Management assessment

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● Training, work practices and engineering controls

● Health and fitness maintenance programs

● Exposure management procedures

“Significant exposure”Means:

Exposure to blood or body fluids through needle-stick, instruments, or sharps.

Exposure of mucous membranes to visible blood or body fluids, to which universal precautions apply according to the National Centers for Disease Control and Prevention, including, without limitations, the following body fluids: Blood, Semen, Vaginal secretions, Cerebro-spinal fluid, Synovial fluid, Pleural fluid, Peritoneal Fluid, Pericardial Fluid, Amniotic fluid or other body fluid visibly contaminated with blood or exposure was to a body fluid during a circumstance where it was difficult or impossible to differentiate the fluid type involved and is therefore considered potentially hazardous.

Other Special Cases:

If the exposed individual is not satisfied with the determination regarding significant exposure, they should be treated as a significant exposure.

Exposure of skin to visible blood or body fluids when the exposed skin is chapped, abraded, or afflicted with dermatitis

If there has been prolonged contact with intact skin or a massive blood exposure, the exposure should be considered significant.

EXPOSURE CONTROL PLAN

The Exposure Control Plan broadly establishes the need, management of, and policy statement for the program. A copy of this plan is on the Alachua County Intranet and available to all personnel. This document will be revised annually, or as needed to meet any rule changes.

RISK MANAGEMENT ASSESSMENT

Exposure risk, defined as the assessment of the potential risk of an infectious exposure, is determined by job classification and duties. All Department positions are assigned one of three risk classifications; increased, some, minimal.

Risk assessment will be performed when new positions are created or when duties of existing positions change.

TRAINING REQUIREMENTS

Annual infection control training shall be provided to all members who are at an increased risk of having some risk of exposure.

Training will be conducted using a variety of methods including, but not limited to: classroom self-study, internet- based and teleconferencing. Topics will include bloodborne diseases, airborne diseases, principles of disease transmission, proper use of PPE, work practices, use of engineering controls, bio-hazard waste disposal, housekeeping practices, personal and equipment cleaning and disinfecting, and post exposure procedures. The Health & Safety Officer is responsible for tracking training completion.

Training shall be conducted during orientation of newly hired personnel and as needed to meet new or revised regulations, and emergence of new risks.

WORK PRACTICES

It is the responsibility of every member of the Alachua County Fire Rescue Department to report any exposure to infectious disease, utilize all personal protective equipment (PPE) provided, and to clean and disinfect any reusable

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equipment according to the guidelines set forth in this plan

PREVENTION TECHNIQUES

Infection Control has three objectives:

● Reduce the risk of contamination to the responder

● Reduce the risk of contamination to the patient

● Reduce the risk of cross contamination from patient to provider to patient.

The following work practices will decrease the risk of an exposure to blood and other potentially infectious material (OPIM). OPIM includes semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva and any body fluid visibly contaminated with blood.

Members are expected to comply with these standard work practices.

Handling Sharps

● Safety device systems will be used.

● Self-shielding needles shall not be defeated or recapped.

● Sharps will immediately be placed in an approved sharps container.

● Sharps containers will be readily available in transport vehicles and kits at scenes.

Scene Management

● Limit number of members who make direct patient contact when practical.

● Limit exposure time when possible.

Handling Infectious Materials

● Appropriate PPE will be donned before handling infectious materials.

● All contaminated, non-sharp materials shall be isolated and secured in bio-hazard bags.

● Infectious materials collected shall be disposed of in a designated bio-hazard disposal container.

● Refer to Chapter 5.6 – Control of Biomedical Waste

Refer to Chapter 5.3 - Tuberculosis Exposure Control Plan

ENGINEERING CONTROLS

Engineering controls are physical or mechanical processes implemented to improve efficiency and safety while decreasing exposure risk. Examples include portable sharps containers, needless safety systems, red bags, etc. The Health/Safety Officer and Safety Team will work together to research, review and test new engineering control products.

● Contain biomedical waste in red bags.

● Sharps containers for needles, glass, scalpels, etc.

INFECTIOUS DISEASE PREVENTION

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All members are personally responsible for their health and fitness. Members will decrease their risk of acquiring an infectious disease by maintaining high health and fitness levels by:

● Taking advantage of immunizations, vaccinations and tests offered by the Department

● Documenting any exposure per Department regulations.

● Using provided cleaning and disinfecting products.

PERSONAL PROTECTIVE EQUIPMENT

● Gloves (Exam or sterile)

● Eye protection (Safety glasses or fluid shields)

● Masks (surgical or N95)

● Gowns or Bunker gear

DISINFECTION AND DECONTAMINATION

● Non-disposable Medical Equipment will be cleaned and disinfected with provided germicidal agents and appropriate PPE will be worn when performing cleaning and disinfection. ● Surfaces of rescue units will be cleaned and disinfected on a daily basis.

● Insure appropriate stocking cleaning and disinfection products on transport units. Both transport units and fire apparatus should have waterless hand cleaning dispensers filled and readily available.

● Cleaning and decontamination should be done in appropriate areas at stations and away from living, sleeping or food preparation/eating areas. Stations with specific decontamination areas can handle larger equipment items.

● Red bags will be used to contain contaminated equipment during transport to cleaning areas.

● When contaminated uniforms, bunker gear or other items have been washed in station washers, a cleaning cycle shall be done afterward using bleach and hot water or ACFR approved germicidal solution.

EXPOSURE FOLLOW UP

Personnel who receive a significant exposure shall complete the transfer of patient care and notify hospital staff of the exposure. The exposed employee shall then notify their District Chief who will contact Risk Management and the Health/Safety Officer.

ACFR Significant Exposure Protocol Steps

When an employee advises of a potential significant exposure, ensure that the receiving hospital is notified immediately so that blood for testing can be secured at that facility, or that blood drawn in the field is retained.

If blood sample is drawn by ACFR personnel, it is important that the blood tubes are labeled with patient name, ACFR , name of medic drawing blood and the date. If unlabeled tubes are left, they will not be used by the lab.

● Call Health/Safety Officer Cell Phone 352-258-9562 and leave message with Risk Management Office

● Each of the hospitals have a specific person to notify:

● Shands at UF Charge Nurse

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● North Florida Regional PCC

● Veterans Administration PCC

● Present the Source Patient Testing Request Form to the appropriate employee at the hospital. This form requests HIV, Hepatitis B and Hepatitis C testing. Please be sure to obtain the name of the individual who is the facility contact for follow up by the Health/Safety Officer.

● Source Patient Testing will be done at the hospital. North Florida and Shands use the SUDS test which will provide the HIV status on the patient within 60 minutes. Should there be a reason why they are unable to do the SUDS test; the physician at that facility will determine appropriate Post Exposure Prophylaxis (PEP) recommendations.

● If the source patient is diagnosed as HIV positive, the appropriate PEP will be provided at the receiving facility or through EMC via prescription as recommended by the physician at the receiving facility

● The employee shall be referred for baseline testing (if not done at the receiving facility) and follow-up care at one of the Worker’s Compensation clinics:

● Emergency Medical Center

6121 NW 1st Place Phone: 331-4357 ● Hours: Monday – Saturday; 0800-1800

Emergency Physicians Medical Center

2445 SW 76 St. # 110 Phone: 872-5111 Hours: Monday – Friday; 0800-2000 Saturday-Sunday1200-1600

● First Care of Gainesville

4343 W. Newberry Road – West Building; Suite # 10 Phone: 373-2340 Hours: Monday-Friday; 0800-1800

● If the Source Patient’s test results are positive for HIV infection, then the employee must receive immediate treatment according to the guidelines for Post Exposure Prophylaxis (PEP). North Florida, or Shands at UF will dispense a short term does of these medication s from their pharmacy. In some cases, they will provide a prescription for further medications.

● All employees will still need to go for follow-up care at one of the worker’s compensation clinics. If the patient’s HIV status will not be know immediately, the physician at the hospital will decide if PEP administration is warranted until the Source Patient’s status has been confirmed. ● If the exposure is from a non-HIV positive patient, the employee will still need to go for baseline testing to determine their Hepatitis B titer status and Hepatitis C and HIV testing. This testing must be completed within 48 hours of the exposure.

● Treatment for an airborne exposure such as meningitis may be done at the hospital, or one of the worker’s compensation clinics depending on when we receive notification.

● If the Source Patient’s blood cannot be obtained, the employee will have baseline testing done as previously indicated. Examples of these instances are a diabetic patient treated but who refused transport, or a patient who dies on scene and whose body is sent directly to the Medical Examiner’s

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Office. ● Students. If the individual exposed is a student riding with ACFR under the preceptor program at SFCC or City College, they are required to contact their coordinator and proceed with testing at their expense and under their insurance. ● ACFR employees who are riding as students come under the SFCC or City College agreements and are not handled as an employee under our Worker’s Compensation policy.

● Other exposure treatments will be handled according to the specific concern at that time.

Click items below to view forms ↓ Significant Exposure ALG 2012

ICFORMG-Source Patient Testing Request

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Tuberculosis Exposure Control Plan

CHAPTER 5.3

Issued: October 2002 Revised: 08/06, 10/06, 10/07, 09/09 January 2010 Submitted by:Health/Safety Officer Approved by: Ed Bailey, Chief

I. Overview of Control Plan

A. Purpose The purpose of this plan is to establish guidelines and policies for reducing the risk of transmission of TB to employees. The TB Exposure Control Plan is available to all employees at all times on the SOG site. B. Background M. Tuberculosis is carried in airborne particles, or droplet nuclei, that can be generated when persons who have pulmonary or laryngeal TB sneeze, cough, speak, or sing. The particles are an estimated 1-5 Micron in size, and normal air currents can keep them airborne for prolonged time periods and spread them throughout a room or building. Infection occurs when a susceptible person inhales droplet nuclei containing M. tuberculosis, and these droplet nuclei traverse the mouth or nasal passages, upper respiratory tract, and bronchi to reach the alveoli of the lungs.

C. Fundamentals of Tuberculosis Exposure Control Program An effective TB infection control program requires early identification and isolation of persons who have active TB. The primary emphasis of this TB Exposure Control Plan is to achieve these goals by three measures: a) the use of administrative measures to reduce the risk for exposure to persons who have infectious TB; b) the use of engineering controls to prevent the spread of the infectious droplet nuclei; and c) the use of personal respiratory protective equipment (N95 masks) where there is a risk for exposure to M. tuberculosis.

D. Responsibilities of Health/Safety Officer 1. Insure that personal respiratory protection equipment is available in accessible locations, used by personnel when appropriate, and stored properly when not in use. 2. Maintain records regarding PPD testing and compile yearly analysis of conversion rates and exposures. 3. Coordinate and implement all required in services, training and education for respiratory users. Maintain records of all educational In- services received regarding respiratory policies and protocols for all personnel. 4. Upon verification of any news of any staff PPD conversion, of the development of signs/symptoms consistent with suspect TB, or the development of a positive pulmonary MTB culture in a member, the Health/Safety Officer will determine if the policies, protocols or procedures need to be modified. 5. Work with expert medical resources in the community to insure that all policies and protocols meet current Federal and State regulations and appropriate medical policies and procedures.

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E. Student Responsibilities Students must wear N95 Masks as directed by the Officer in Charge.

F. Education and Training of Employees All employees will receive education regarding TB that is relevant to their response protocol. The need for additional training will be reevaluated annually. The training will address the following elements as listed in the Centers for Disease Control and Prevention's Guidelines for Preventing the Transmission of Tuberculosis in Health- Care Facilities, 1994 and other appropriate medical guidelines.

G. Screening and Evaluation Screening and Evaluation of personnel will include the following points: 1. The relationship between TB and HIV infection (or any immunocompromising condition that personnel may have). 2. The need to follow infection control recommendations. Any employee r who has a persistent cough (i.e. a cough lasting >3 weeks), especially in the presence of other signs or symptoms compatible with active TB (e.g. weight loss, night sweats, bloody sputum, anorexia, or fever) should be evaluated promptly for TB. The employee should not return to the work place until diagnosis of TB has been excluded or that individual is on therapy and a determination has been made that that person is non-infectious. All employees with newly recognized positive PPD tests will be evaluated promptly for active TB. 3. Following any significant exposure to M. Tuberculosis, employees will be sent for baseline testing and any follow up test or treatment as recommended by the ACPHU. It should be noted that under the Presumptive Illness legislation, employees who are diagnosed after January 1, 1996 to have TB will be presumed to have become infected while performing duties for ACDPS; however, they may be required to produce baseline testing demonstrating non-infection prior to that exposure.

Baseline PPD testing will be done on all new employees at time of hire.

The Alachua County Public Health Unit will be the designated Medical facility to handle employees diagnosed with TB.

2. Respiratory Protection Program

A. Goal To prevent transmission of infectious airborne agents. As outlined in the introduction, tuberculosis is an infectious airborne disease.

B. N95 Mask Use Indication: The N95 Mask will be worn whenever there is confirmation or a suspicion due to a patient's medical history or physical condition that an airborne infectious disease exists. If a patient has obvious droplet expression due to coughing or sneezing, for example, an N95 mask should be worn. In addition, the attached Patient Medical History Evaluation under D provides assessment criteria which will assist in making the decision of whether or not a mask should be worn. If worn, it should be worn for the duration of patient care and treatment after being donned.

C. Transport Issues

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If a patient is transported who is suspected to have TB, decontamination of airborne particulates will be done by:

1. Allowing circulation of outside air during transport when possible. 2. Opening doors of medic unit when at hospital during transfer of patient. This will allow sufficient air exchange to eliminate airborne contamination. 3. If patient secretions caused any contamination on surfaces of the medic unit or equipment that is non-disposable, clean and disinfect with Department disinfectant.

D. Patient Medical History Evaluation to Determine Respirator Use

The following questions will be asked of any patient presenting with a cough which has persisted for longer than two weeks. Have you experienced any of the following: YES NO

______Coughing up blood?

______Weight Loss?

______Decreased appetite?

______Persistent fever?

______Night Sweats?

______Worked with anyone with symptoms as above?

______Had a positive TB test? ______Been treated for TB?

______Have a condition that could weaken your immune system (i.e. cancer, kidney disease, HIV, AIDS, receiving cortisone or steroid therapy, receiving chemotherapy,diabetes, alcoholism, Silicosis, had stomach surgery or is an organ transplant recipient.

If any of the above are checked "yes" a respirator should be worn for the duration of that patient's treatment and transport.

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Safety

CHAPTER 5.4

Issued: Revised:Feb. 2003, Feb. 2011

Submitted by: Safety Team Approved by: Chief of Fire Rescue

INTRODUCTION

Safety is an issue that every member of the Department must be constantly aware of and consider at all times. The statement that safety is no accident means that safety does not just happen, it is a skill that needs practice. Safety cannot be legislated away nor can it be ignored. Common sense is usually the best approach to safety. However, all employees must remain alert to keep everyone safe and well. Every member of the Department of Public Safety is responsible for ensuring a safe work environment. If an employee is aware of a situation that creates a hazard, he/she has the responsibility to report this to his/her supervisor immediately. Understanding that “on scene” operations are inherently dangerous, everyone needs to be aware of the environment and hazards that surround them. Safety is, however, not limited to “on scene” operations, but to all work places and locations where we respond. It is incumbent upon all of us to become aware of the hazards where we work. The following safety guidelines are not inclusive:

● Keep work and common areas clean and orderly.

● Any Department member taking medications or who has a medical condition which might impair their ability to perform certain tasks shall report this to their supervisor.

● Members shall wear the provided safety equipment when involved in emergency operations.

● Wear gloves or other hand protection when handling rough, sharp-edged or abrasive material or where the work subjects the hands to lacerations, punctures, burns or bruises.

● Follow all additional safety instructions, warnings, signs, procedures, and rules as written, posted, or communicated.

● Upon detection, all foreign substances shall be cleaned/removed from the floor area. Immediately report the problem to your supervisor.

● Eye and hearing protection shall be worn when operating power equipment.

● Determine the emergency vehicle’s readiness prior to start of each shift. If during the shift an equipment failure occurs, report the problem to your supervisor immediately.

● Do not use damaged or defective tools. A tool that is not in working order should be removed from service and reported to the supervisor.

● Ignite torches with friction lighters only.

● Do not use open flame devices or spark producing equipment/tools where flammable liquids are stored or where combustible gasses or vapors may be present.

● Tighten all connections and verify that they are oil free prior to equipment use.

● Wear eye protection, gloves and protective clothing when cutting.

● Store, transport and use gas cylinders in a secured position.

● Do not handle or use chemicals without prior training.

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● Read the MSDS for each chemical prior to its handling or use.

● Do not reuse drums, pails, buckets or any other container that has held a toxic chemical for anything.

● Refer to MSDS before cleaning up any chemical splash or spill.

● Add chemicals to water when diluting chemicals. Do not add water to chemicals or chemical containers.

● Do not enter any known hazardous environment without prior approval from your supervisor or the incident commander.

● Victim(s) should be removed from hazardous areas prior to providing medical treatment.

● All equipment should be used in accordance with manufacturer’s guidelines.

PERSONAL FLOTATION DEVICES (PFDs)

● Each Department of Public Safety transport unit will be equipped with two (2) PFDs. Each Department of Public Safety's fire apparatus will be equipped with four (4) PFDs. (All PFDs utilized shall be Department of Public Safety issued, Coast Guard Approved, Class III devices).

● PFDs shall be inventoried and checked for integrity and cleanliness daily.

● All personnel shall become familiar with the donning of the PFD.

● PFDs shall be worn whenever the incident is on or near water. All operations involving water rescue shall include the PFDs as part of the Personal Protective Equipment Ensemble (i.e., natural disasters, lake, quarry, or river operations, etc.)

AIR LIFT CUSHIONS

Air cushions may be used to extricate persons trapped in vehicles, under overturned vehicles, fallen trees, collapsed scaffolding, in collapsed tunnels, trenches, against walls, in railroad accidents, or construction collapses.

Common Features: Air Lift systems consist of cushions, a hose with quick connect fittings, a control valve, a high pressure valve, a high pressure hose and a regulator assembly.

The system can be operated with an SCBA cylinder. The control valve-assemblies are equipped with safety valves to prevent rupture of the cushions. The control valves provide very precise control of inflation or deflation.

Cribbing shall be used any time the air system is utilized. Cribbing will take the load or secure the space gained as soon as possible for safety, and to gain additional height capabilities. Cribbing may also be needed to stabilize the load.

AIR HAMMER KIT

The Air Hammer Rescue Kit offers many advantages for forcible entry and rescue work. It is easily portable, operates on air so there are no motors to start, goes into operation instantly and the danger of flying sparks are reduced. It is faster and safer to use the Air Hammer for entry into prefabricated steel or aluminum buildings than to use an axe.

Safety Rules:

● For safe operation, make sure that the bit retainer ring is turned all the way to the "close" position. ● Disconnect tool from air supply before changing bits. ● Do not point tool at yourself (feet, etc.) or in the direction of anyone else. ● Start tool only when bit makes contact with work surface.

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● Do not operate tool with barrel or barrel lock nut loose. ● Replace worn or damaged parts. ● Use 90 PSI air pressure at tool inlet bushing. ● Protect yourself from noise. NOTE - the steel tool bit produces varying noise levels dependent on work surface. ● Wear protective gear at all times during operation.

General Use: The air hammer uses approximately 4 CFM of air. This type air consumption will quickly drain a 30 cu. ft. fresh air tank. Therefore, it is essential to operate tools at proper air pressures.

Normal body metal requires only 90 PSI for efficient operation. After familiarization, operators can usually-cut three sides of a roof to extricate a victim in 60-90 seconds. The same 90 PSI setting will also serve to cut through quarter panels and fire-walls to free crash victim's feet.

Holes for Extrication: Holes for extrication should be cut as large as possible for easy access. It is a good procedure to cut three sides and fold the fourth to produce a rounded edge to work across. Edges should be protected with salvage covers, chafing pads or other cushions as necessary to protect emergency personnel and victims.

CRIBBING

Cribbing is a process of arranging material (usually wood blocks) into positions to stabilize and/or support the load imposed.

Cribbing, as used in rescue work, may be done with whatever materials are at hand and in whatever form necessary to accomplish the desired objective; as an example, the tires or wheels of the vehicles may be used as part of the cribbing.

The primary caution in cribbing operations is to form a stable crib of materials that will safely support the load imposed. Otherwise, cribbing operations are limited only by your imagination and the availability of materials.

Factors to Consider:

● Imposed load ● Availability of materials ● Lift causing sideways shift ● Lift in one area crushing victims in another area ● Strength of structure being supported ● Ground conditions under cribbing ● Heat or sharp objects which may cause failure of some air lift cushions. Cribbing between cushion and hazard may provide protection.

EMERGENCY SCENE TACTICAL POSITIONING

Positioning of operating companies can severely effect the safety/survival of such companies. Personnel must use caution when placed in the following positions:

● Above the fire (floors/roof) ● Where fire can move in behind them ● When involved with opposing fire streams ● Combining interior and exterior attack ● When fire fighting tactics cannot control position/retreat ● With limited access - one way in/out ● Operating under involved roof structures ● In areas containing hazardous materials ● Below ground fires (basements, etc.) ● In areas where a back- potential exists

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The safety of personnel represents the major reason for an effective and well-timed offensive/defensive decision and the decision to "write off" by Command. When the rescue of savable victims have been completed, an officer must ask: "Is the risk of my personnel worth the property I can save?"

When operating in a defensive manner, your operating position should be as far from the involved area as possible and still remain effective. Position and operate from behind barriers if available (fences, walls, etc.) The intent is for personnel to utilize safe positioning where possible and available, in an effort to safeguard against sudden hazardous developments such as back-draft explosion, structural collapse, etc. Due to the inherent hazards of the immediate fire or incident scene, efforts will be made by Command personnel to limit the number of personnel on the emergency scene to those assigned to a necessary function. All personnel shall either:

● Be positioned in Staging Area ● Be assigned to a task or position ● Having completed an assignment and no other assignment is available within the area. Crews should be assigned to a Resource, Staging, or Rest Area until such time as they can be either reassigned to an operating area or released to in-service status.

The intent of this procedure is to minimize on scene confusion/congestion and more importantly, to limit the number of personnel exposed to hazards, to only those necessary to successfully control the operation. Individuals or crews shall be restricted from wondering about the scene or congregating in nonfunctional groups.

If you have not been assigned or you do not have a necessary staff function to perform, stay off the emergency scene.

In extremely hazardous situations (large quantities of flammable liquids, LP gas, hazardous materials, difficult marginal rescues, etc.) the Incident Commander will engage personnel that are needed within the scene perimeter. Self-standing master streams will be utilized wherever possible.

In situations where crews must operate from opposing or conflicting positions, such as front vs. interior crews, etc. utilize radio or face-to-face communications to coordinate actions with those of the opposing crew in an effort to prevent needless injuries.

Do not operate exterior streams, whether hand lines, master streams, ladder pipes, etc., into an area where interior crews are operating. This procedure is intended to prevent injuries to Personnel due to stream blast and the driving of fire and/or heavy heat and smoke onto interior crews. Ground crews must be notified and evacuated from interior positions before ladder pipes go into operation.

Offensive interior attack lines will be operated by teams (nozzle and backup). At no time will this line be operated with less than two personnel.

When laddering a roof, the ladder selected shall be one which will extend 2' - 3' above the roof line. This shall be done in an effort to provide personnel operating from the roof with a visible means of egress. Watch for overhead hazards.

If possible, when laddering buildings under fire conditions, place ladders near building corners of fire walls as these areas are generally more stable in the event of a structural failure.

When operating either above or below ground level, establish at least two (2) separate escape routes/means where possible. Such as stairways, ladders, exits, etc., preferably at opposite ends of the building or separated by considerable distance. Many safety principles revolve around action that takes place on the emergency scene.

For the purpose of operations, the emergency scene perimeter can be defined as: The area inside an imaginary boundary that has been determined by safety considerations according to the foreseeable hazards of the particular incident. The flexible boundary that determines the emergency scene can be altered by various safety factors. All Personnel Entering the Perimeter Shall:

● Check-in with Command/Staging ● Wear Protective Ensemble ● Have crew intact ● Be assigned to a specific task/function

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● Maintain Accountability

COMMAND SAFETY FUNCTION

The safety of personnel represents a major reason for scene organization. Officers must maintain the capability to communicate with forces under their command so that they can control both the position and function of their companies and account for crew members.

Officers shall be able to account for the whereabouts and welfare of all crews/crew members. Refer to Chapter 13.1, “Personnel Accountability Procedures.”

Company Officers shall insure that all crew members are operating within their assigned area. Crews will not leave their respective areas unless authorized to do so by the officer in charge of the particular area.

When crews are operating within an area, Company Officers shall keep Command informed of changing conditions within the area, and particularly those which may affect the safety of personnel.

Hazards that will affect only a specific area should be dealt with within that area and not necessarily affect the entire operation.

In an effort to regulate the amount of fatigue suffered by personnel during sustained field operations, Company Officers should frequently assess the physical condition of their crew members. When crew members exhibit signs of serious physical or mental fatigue, the entire crew should be reassigned to a Rehab Area. A guide for rehab assignment is when the individual has exhausted two full SCBA bottles. To be reassigned to a Rehab Area, Company Officers shall request assignment from Command. The Company Officer's request shall indicate the crew's position/condition, etc., and shall advise as to the need for a replacement crew. Individual crews shall not report to the Rehab Area unless assigned to it. It is the ongoing responsibility of the Incident Commander to summon adequate resources to tactical situations to effectively stabilize the situation, and to maintain adequate resources during extended operations to complete all operations phases. The rotation of companies will be utilized by Command during extended operations to provide an effective ongoing level of personnel and personnel performance. It is the intent of this policy to reduce the fatigue and trauma experienced during difficult operations to a reasonable (and recoverable) level and is in no way intended to lessen the individual and collective efforts expected of all members during field operations.

SAFETY OFFICER: See also Chapter 4.2

The recognition of situations which present inordinate hazards to Personnel and the proper response to safeguard personnel from those hazards is of critical importance to all Department operations. Command has the responsibility to recognize situations requiring response of assigned personnel. Upon arrival at a working incident, assigned personnel will report to the Command Post and unless otherwise assigned, will automatically assume assigned responsibilities. A Safety Officer will be assigned in accordance with Department Protocol.

A Safety Area shall be established at those incidents posing a high potential danger to personnel such as:

● Fire complexity; i.e., most multiple alarm fires. ● Hazardous structural conditions, existing or potential. ● Hazardous materials and chemicals, etc. ● Any other situation where a Safety Sector or Area could be advantageous to the safety of the operation.

The establishment of a Safety Area and the presence of a Safety Officer on the scene in no way diminishes the responsibility of all officers for the safety of their assigned personnel and of each and every member to utilize common (safety) sense, and to work within the intent of established safety procedures at all times.

STRUCTURAL COLLAPSE

In recent times, structural collapse has been the leading cause of serious injuries and death to . For this reason the possibility of structural collapse should be a major consideration in the development of any tactical plan.

Structural collapse is always a possibility when a building is subject to intense fire. In fact, if fire is allowed to affect a

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structure long enough some structural failure is inevitable. Regardless of the age and exterior appearance of the building, there is the possibility that a principal structural supporting member is being seriously affected by heat and may collapse suddenly inflicting serious injury to emergency personnel.

In the typical , the roof is the most likely candidate for failure; however, failure of the roof may very likely trigger collapse of one or more wall sections. This is especially true if the roof is a peak or dome type which may exert outward pressure against both the bearing and non-bearing walls upon collapse. In multi story buildings or buildings with basements, the floor section above the fire may collapse if supporting members are directly exposed to heat and flame.

A knowledge of various types of building construction can be invaluable to the Fire Officer from a safety standpoint as certain types of construction can be expected to fail sooner than others. For example: under fire conditions light weight truss and bar joist roof construction can be expected to fail after minimal fire exposure.

Structures have been known to collapse without warning but usually there are signs which may tip off an alert officer. Action might be taken to avert any imminent hazard. Tell Tale Signs:

● Cracks in exterior walls ● Bulges in exterior walls ● Sounds of structural movement - cracking, groaning, snapping, etc. ● Smoke or water leaking through walls ● Flexible movement of any floor or roof where firefighters walk ● Interior or exterior bearing walls or columns - leaning twisting or flexing

The following construction features or conditions have been known to fail prematurely or to contribute to early structural failure when affected by fire.

Contributing Factors:

● Large open (unsupported) areas - supermarkets, warehouses, etc. ● Large signs or marquees-which may pull away from weakened walls. ● Cantilevered canopies - which usually depend on the roof for support and may collapse as the roof fails. ● Ornamental or secondary front (Facades) or sidewalls which may pull away and collapse. ● Buildings with light weight truss, bar joists, or bow string truss, roofs. ● Roofs supported by unprotected metal-beams, columns, etc. ● Look for external signs of wall ties such as stars.

Buildings containing one or more of the above features must be constantly evaluated for potential of collapse. These evaluations should be of major consideration toward determining the tactical mode, i.e., offensive/defensive.

It is a principle Command responsibility to continually evaluate and determine if the fire building is tenable for interior operations. This ongoing evaluation of structural/fire conditions requires the input of Company Officers advising Command of the conditions in their area of operations.

Structures other than fire protected/heavy timber construction are not designed to withstand the effects of fire, and can be expected to fail after approximately twenty minutes of heavy fire involvement. If after 10-15 minutes of interior operations heavy fire conditions still exist, Command should initiate a careful evaluation of structural conditions and should be fully prepared to withdraw interior crews and resort to a defensive position.

If structural failure of a building or section of a building appears likely, a perimeter must be established a safe distance from the area which may collapse. All personnel and apparatus must remain outside this perimeter.

EMERGENCY EVACUATION OF PERSONNEL

Interior firefighting operations should be abandoned when the extent of the fire prohibits or the structure becomes unsafe to operate within. When such conditions become untenable, evacuate, regroup, re-communicate, and redeploy.

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Our primary concern, when a hazard which may affect the safety of personnel becomes apparent, is the welfare of those personnel. In an effort to protect personnel which may suffer the adverse effects of hazards such as structural collapse, explosions, back-draft, etc.. A structured method of area evacuation must be utilized, one which will provide for the rapid effective notification of personnel involved, and one which will be able to accurately account for these personnel.

The method of evacuation selected will vary depending on the following circumstances:

● Imminency of the hazard ● Type and extent of hazard ● Perception of the area affected by the hazard

Upon receipt of the emergency evacuation order, company officers shall assemble their crews and promptly exit to a safe location, where the Company Officer will again account for all crew members and report to Command.

Shortly after the evacuation order, officers shall begin the process of accounting for all evacuated crews. When all affected crews and crew members are accounted for, the evacuation process is complete. At this time a more specific determination as to the reality/extent of the hazard can be made and efforts initiated to redeploy/redirect attack forces.

Building evacuation generally involves a shift from offensive to defensive as an operational strategy. In such cases, Command must develop a corresponding operational plan and must communicate that plan to all operating elements. This can be a difficult shift to complete as units are committed to positions in an offensive manner. It is extremely important that everyone gets the word that a strategic shift has been made.

Hazards noted of a less than imminent nature should usually be handled by a consultation of Command, other Chief Officers, Safety Officer, Company Officers or outside agency authorities. These officers or specialists should make a determination as to the nature and possible effect of the suspected hazard. Then advise Command that he/she can make a more knowledgeable decision as to the proper course of action.

Crews retreating from interior operations often require hose line protection. The personnel protection afforded to firefighting personnel in such situations represents a major function of such back-up lines.

Notification of an Emergency Evacuation shall be initiated in the following manner:

● Apparatus Air Horn shall be sounded with four (4) short blasts and one (1) long blast. The cycle of 4:1 will continue until advised by Command to cease.

● Radio Tone Alert with an emergency evacuation order shall be broadcasted over all radio channels utilized for the incident.

SEARCH AND RESCUE

Search and rescue should be performed according to an efficient, well-planned procedure which has included the safety of the search-crew personnel. The object of the search effort is to locate possible victims, and not to create additional ones by neglecting the safety of the search crew.

Prior to entering the search area, all search team members should be familiar with a specific search plan including the overall objective, a designation of the search area, individual assignments, etc. This may require a brief conference among crew members before entering the search area to develop and communicate the plan.

Individual search activities should be conducted by two or more members where possible.

Company Officers must maintain an awareness of the location and function of all members in their crew during search operations.

A brief look around the floor below the fire may provide good reference for the search team, as floors in multi-story occupancies usually have a similar layout. Whenever a search is conducted that exposes search crews to fire

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conditions (particularly above the fire floor) the search team should be protected as soon as possible with a charged hose line, in order to insure a safe escape route.

If search personnel are operating without a hose line: A life line and tools should be used when encountering conditions of severely limited visibility.

Radio communication with Command must be maintained at all times.

A Rapid Intervention Team (RIT) shall be established and maintained when conditions warrant and personnel are available.

HIGH-RISE SAFETY

Personnel conducting operations in high-rise buildings are faced with many non-typical hazards due to the design, elevation, limited access/egress, etc. inherent in these buildings. High-rise buildings containing a working fire are to be considered a high hazard area.

Stairways/Elevator: If a working fire is suspected in a high-rise building, the following procedures shall be adhered to:

● Utilize stairways if possible. ● Elevators without the firefighter feature shall not be used if a working fire is indicated. ● Elevators may be used provided the following measures have been taken:

● The elevator shaft must be checked to insure that heat/fire have not damaged the hoist mechanism, etc. This can be done by checking the space between the door frame and the elevator car and by shining a light up the shaft. If smoke or fire are visible in the shaft, DO NOT RIDE THE ELEVATOR. However, it may be used for equipment only.

● Before using an elevator, the nearest enclosed stairway should be identified.

● You must verify that the floor you are going to arrive on is uninvolved. This can be done by utilizing the following measures:

● Elevators With Firefighter Service Feature - Engage the firefighter feature and take the elevator two floors below the suspected fire floor. Be prepared to close the elevator door immediately. This is done by removing finger from door control button.

NOTE: Most elevators with complete firefighter service require you to hold close-door button until elevator begins to move and hold open-door button until door is fully opened. Also a person has to be left in elevator to control same for use by other companies, etc.

Do not exceed the maximum load capacity of the elevator.

When operating in high-rise buildings where the potential hazards of falling glass and debris exist, a scene perimeter may be established by Command approximately 200 feet from the building and shall be observed by all personnel as a high hazard area.

Pumpers supplying water should utilize hydrants outside the perimeter area if possible.

All personnel shall have a full safety ensemble on when entering or operating within the perimeter area.

To insure accountability of personnel operating in high-rise buildings, the Accountability Officer shall note the names of all crew members assigned to the incident.

HYDRAULIC EXTRICATION RESCUE TOOLS

Full protective clothing shall be worn by members operating and by those members in the operational perimeter while the Rescue Tool or other tools are in operation.

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The hydraulic fluid used to operate the extrication tool can cause severe burns to the eyes. To provide eye protection in the event of a hose or coupling failure where fluid may be expelled, all members in the area of operation of a hydraulic tool shall place their face shield in position to provide such protection.

The hydraulic tool engine should be kept downwind and away from the injured and the work area.

The engines should never be refilled while the engine is running. If fuel is spilled while refueling, wipe off before starting.

It is the best policy to refill the gas tank after the engine has cooled down.

Do Not restart engine in a small enclosed space after refueling.

Use correct fuel only.

During the operation of the hydraulic tool for extrication, a hose line will be pulled, charged and manned for safety and precautionary measures.

In situations that fire apparatus has not responded and power extrication is imminent, the fire extinguishers will be removed from the EMS unit and placed in close proximity to the operation.

OPERATING POWER SAWS

When operating power equipment under emergency conditions, accident potential is high due to adverse operational conditions. A slight miscalculation or sudden unplanned move can result in a serious accident. Performance skill coupled with the use of common sense and the strict adherence to safety procedures can prevent accidents.

Know your power tool. Read operator's manual carefully. Learn the tool's applications and limitations.

Personal Protection: Full protective clothing shall be worn by members operating, and by those members in close proximity of the operation of power saws.

Operating Guidelines: All saws should be carried with the engine stopped and with the blade and muffler away from the body.

Keep both hands on the control handles when operating the saw. Use a firm grip with thumbs and fingers encircling the saw handles. Make sure of your footing before operating the saw.

Whenever possible, a team of two shall perform cutting operations. The person operating the saw (operator) will be assisted and/or guided by the second person (guide). The guide may use the sling in which the saw is carried as safety harness to guide and assist the operator.

The saw shall always be shut down when unattended. Have a plan of action before putting the saw into operation; your plan should include:

● Location and sequence of cuts and openings. ● Wind direction. Consider its effect on exposures and personnel. ● At preplanned escape routes, your plan should provide for at least two (2) means of egress, if possible.

Whenever possible, an officer should be present to supervise cutting operations and to assure compliance with safety procedures.

Always place the safety guard in the proper position to provide protection for the use intended before operating any saw.

Power saw operations are safest when cutting on horizontal surfaces near ground. Side pressure or twisting of the blade when operating a rescue saw should be avoided. The saw should never be forced. If too much pressure is

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applied to the blade, the hazard of blade breakage (carbide tipped) or blade shattering (aluminum oxide or silicone carbide discs), chain breaking, etc., is increased. A blade which breaks or shatters during cutting operations may cause serious injury to the operator, or to others in the area.

The saw cut should be only as deep as necessary. Deep cuts may weaken supporting beams and lead to collapse. The experienced operator will know when he has reached a beam by the sound and feel of the saw.

If conditions permit, scrape gravel and debris from the path to be cut, in order to reduce the danger of injury from flying chips and loose materials.

When using the rescue saw to open metal buildings, doors, etc., where conditions permit, utilize methods to eliminate the hazards of sharp edges. Consider making your cut in either an X design or a triangular design with the points bent inward.

Fueling and Maintenance Precautions: Observe all safety regulations on the safe handling of fuel. When necessary to refuel, comply with following:

● The saw should never be refueled while the engine is running. ● If fuel is spilled while refueling, wipe off saw before starting. ● Do not operate the saw if there is a fuel leak, send it in for servicing. ● Do not restart the saw in a small enclosed space after refueling.

NOTE: These same safety precautions apply when refueling portable generators used with lights or electrically operated equipment.

Always keep equipment in good clean serviceable condition.

Examine the rescue saw cutting wheel for nicks or defects at the beginning of each shift and after each use.

Clean the wheel (blade) and both wheel washers when installing the wheel. Wheel blotters must be used between washers and wheel to compensate for irregularities in the wheel.

Care must be taken to assure that the abrasive saw blades do not become contaminated with petroleum-based products. Such contamination may dissolve the resin which is used to bond the blade, causing the blade to shatter when used. New blades should be stored in plastic bags to insure cleanliness.

Operating Procedures:

● When cutting, pull the machine toward you and allow the disc to just go through the work piece. ● Do Not race engine when not cutting. ● Do Not turn machine sideways while cutting. ● Make sure no one is in front of the cutting disc while you are working. ● Self contained breathing apparatus shall be used when cutting asbestos material or metal coated with red lead. The same will apply when cutting stone or any material which can produce large quantities of dust. ● When the cutting disc is brought into contact with the material to be cut, the engine is run at low speed and speed is gradually increased as the disc cuts into the material. ● Always allow the carbide to do the cutting - Do Not force the blade into the material.

Equipment

● All personnel of this department and its associated members shall wear all protective equipment as required by Division Procedures, at the order of the Officer-in-Charge, and/or Safety Officer.

● All personnel are to wear proper eye protection when operating any power tools. Fire helmets must be utilized in hazardous or fire situations, with the face shields down.

● Full protective gear shall be worn as specified in this manual during any/all hazardous situations.

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● Protective gear shall also be worn or removed at the direction of the Company Officer (Lieutenant/Rescue Lieutenant) Safety Officer, Chief Officer, or Incident Commander.

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Injury Reporting/Alternate Duty

CHAPTER 5.5

Issued: January 2010 Revised: May 2011 Submitted by: Health & Safety Approved: Chief Fire Rescue

Provisions

This program is established to insure appropriate notifications and treatment of injuries and exposures to personnel on duty and to accommodate employee’s work related illness/injuries by providing alternate duty assignments in accordance with the requirements of the Alachua County Board of County Commissioners Employee Policy.

Intent

To describe the procedure for reporting an injury and assigning temporary alternate duty assignments to employees injured either on the job or off the job, or who become ill as a result of a job-related exposure.

Procedure

Reporting of injuries will comply with existing requirements to comply with Alachua County Employee Policy. In addition, ACDPS personnel will:

1. Notify their immediate supervisor after the injury occurred. The Company Officer will advise the District Chief. 2. The District Chief will immediately notify the Health/Safety Officer and Risk Management at the time of the injury or exposure. 3. If the situation is non-emergent, Risk Management must be contacted prior to the employee receiving outside medical treatment. 4. Treatment will be provided as necessary at an approved facility. Emergency Medical Center (EMC) or First Care of Gainesville will be used unless treatment is required at an emergency room due to the nature of injury and/or time of occurrence. If the injury is a significant exposure other direction may be given for treatment. 5. The immediate supervisor shall complete the supervisor’s Incident/Accident Investigation Report and Department Situation Form. The completed paperwork must be submitted prior to the end of the shift.

Temporary alternate duty assignments are intended to provide employees who have sustained an occupational or non-occupational injury that temporarily limits their ability to perform their regularly assigned duties with the opportunity of returning to work. The duty, if available, will accommodate the needs of Alachua County Department of Public Safety and the employee’s temporary medical limitations respectively.

Fire Rescue personnel who are injured in the line of duty or who become ill as a result of exposure on the job will follow the following guidelines:

1. Upon release to alternate duty from the authorized Worker’s Compensation physician (or private physician if not a duty related injury/illness), the employee shall immediately report to the Health/Safety Officer. A release to alternate duty status means that the employee is no longer being paid under Workers Compensation Coverage and is released to light or alternate duty status with restrictions as noted by the employee’s physician.

a. Personnel assigned to alternate duty must work a minimum of 40 hours per week (pay period). See Employee Policy 5.23 & 5.24. b. Personnel will report the morning of their next working day defined as normal business day as worked by Department Administration. c. Personnel assigned to alternate duty will be permitted to attend injury related appointments and/or therapy. Therapy should be scheduled on a standardized basis and be either early in the morning or the last part of the day. d. Time off for work related and non-work related personal leave will be limited to actual duration of the appointment and travel time. When early or late appointment is not possible, the employee must report to

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alternate duty assignment appointment or take annual leave time for additional time off. e. Personnel assigned to alternate duty must make contact with the Payroll Supervisor to insure all appropriate paperwork is explained and completed. f. Personnel who desire to take leave time (sick, annual, etc.) will be charged the number of time units per hour, commensurate with their normal work hours.

2. The following procedures will be followed when reporting for alternate duty:

a. Employees must complete a 40 hour payroll sheet at the completion of each week and present to the Payroll supervisor. b. Doctor and therapy appointment schedules will be given to the Health/Safety Officer for tracking purposes. c. When reporting back to duty after a doctors/therapy appointment, the employee must provide a doctor’s report to the Health/Safety Officer. d. Personnel on alternate duty will make contact (speak with or visit, no messages) with the Health/Safety Officer, at a minimum, each Monday and Thursday morning between 0730 – 0830. e. Requests for personal leave while assigned to alternate duty shall be made to the Health/Safety Officer. f. Once signed by the Health/Safety Officer all leave requests will be processed the same as for field personnel. g. If the Health/Safety Officer is on leave, employees will report to the Health and Safety Officer designee.

Click on the links below to view Risk Management's Procedures and the form used to report incident and accidents.

Workers Compensation Injury Reporting Procedures

Online Incident/Accident Investigation Report

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BIOMEDICAL WASTE PLAN

CHAPTER 5.6

Issued: January 1997 Revised: October 1, 2002, December 2007, August 2008, August 2009, October 2010

Submitted by: Health/Safety Officer Approved by: Edwin C. Bailey, Director

TABLE OF CONTENTS

I. Directions for completing the biomedical waste plan II. Purpose III. Training for personnel IV. Definition, identification, and segregation of biomedical waste V. Containment VI. Labeling VII. Storage VIII. Transport IX. Procedure for decontaminating biomedical waste spills X. Contingency plan XI. Miscellaneous

I. DIRECTIONS FOR COMPLETING THE BIOMEDICAL WASTE PLAN

All biomedical waste facilities are required to develop and maintain a current operating plan that complies with subsection 64E-16.003(2), Florida Administrative Code.

II. PURPOSE

The purpose of this Biomedical Waste Operating Plan is to provide guidance and describe requirements for the proper management of biomedical waste at ACDPS facilities. Guidelines for management of biomedical waste are found in Chapter 64E-16, Florida Administrative Code (F.A.C.), and in section 381.0098, Florida Statutes.

III. TRAINING FOR PERSONNEL

Biomedical waste training will be scheduled as required by paragraph 64E-16.003(2)(a), F.A.C. Training sessions will detail compliance with this operating plan and with Chapter 64E-16, F.A.C. Training sessions will include all of the following activities that are carried out at ACDPS:

● Definition and Identification of Biomedical Waste ● Segregation ● Storage ● Labeling ● Transport ● Procedure for Decontaminating Biomedical Waste Spills ● Contingency Plan for Emergency Transport ● Procedure for Containment

ACDPS must maintain records of employee training. These records will be kept in the office of the Health/Safety Officer. Training records will be kept for participants in all training sessions for a minimum of three (3) years and will be available for review by Department of Health (DOH) inspectors.

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IV. DEFINITION, IDENTIFICATION, AND SEGREGATION OF BIOMEDICAL WASTE

Biomedical waste is any solid or liquid waste which may present a threat of infection to humans. Biomedical waste is further defined in subsection 64E-16.002(2), F.A.C. Items of sharps and non-sharps biomedical waste generated by ACDPS personnel are:

● IV catheters, needles and scalpels ● Contaminated gauze and bandaging materials ● Any other disposable materials that are contaminated with blood or body fluids.

If biomedical waste is in a liquid or semi-solid form and aerosol formation is minimal, the waste may be disposed into a sanitary sewer system or into another system approved to receive such waste by the Department of Environmental Protection or the DOH.

V. CONTAINMENT

Red bags for containment of biomedical waste will comply with the required physical properties.

ACDPS red bags are manufactured by Moore Medical LLC, 1690 New Britain Avenue, Farmington, CT 06032 (Phone: 800-234-1464). ACDPS documentation of red bag construction standards is kept in office of Health/Safety Officer.

Working staff can quickly get red bags at from their apparatus storage and station storage locations.

Sharps will be placed into sharps containers at the point of origin.

Filled red bags and filled sharps containers will be sealed at the point of origin. Red bags, sharps containers, and outer containers of biomedical waste, when sealed, will not be reopened in this facility. Ruptured or leaking packages of biomedical waste will be placed into a larger container without disturbing the original seal.

VI. LABELING

All sealed biomedical waste red bags and sharps containers will be labeled with ACDPS’s name and address prior to offsite transport. If a sealed red bag or sharps container is placed into a larger red bag prior to transport, placing ACDPS’s name and address only on the exterior bag is sufficient. Outer containers must be labeled with our transporter’s name, address, registration number, and 24-hour phone number.

VII. STORAGE

When sealed, red bags, sharps containers, and outer containers will be stored in areas that are restricted through the use of locks, signs, or location. The 30-day storage time period will commence when the first non-sharps item of biomedical waste is placed into a red bag or sharps container, or when a sharps container that contains only sharps is sealed.

Indoor biomedical waste storage areas will be constructed of smooth, easily cleanable materials that are impervious to liquids. These areas will be regularly maintained in a sanitary condition. The storage area will be vermin/insect free.

Outdoor storage areas also will be conspicuously marked with a six-inch international biological hazard symbol and will be secure from vandalism.

Biomedical waste will be stored and restricted in the following manner:

● Where available, containers will be in separate rooms identified with signage noting storage of biomedical waste. ● Containment boxes will provide primary catchments at the base and a cover on top to restrict access to the contents of the boxes. ● All storage areas will be appropriately identified and labeled.

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VIII. TRANSPORT

ACDPS will negotiate for the transport of biomedical waste only with a DOH-registered company. If ACDPS contracts with such a company, ACDPS will have on file the pick-up receipts provided for the last three (3) years. Transport for ACDPS facilities is provided by:

Biocycle 648 NW Guerdon Street Lake City, FL 32055 386-208-6263 Registration numbers: 51-052-8821 State of Florida ID#: 1402 Place pick-up receipts are kept at CSW, Station 12, 16, 19, 21 and Health/Safety Office

IX. PROCEDURE FOR DECONTAMINATING BIOMEDICAL WASTE SPILLS

Should there be a breach of the red bag containing contaminated materials, the following procedures will be followed:

● Place broken bag in a second red bag ● Clean contaminated area with the germicidal agent provided at all stations in accordance with manufacturer’s instructions for use. ● Properly dispose of in red bag any cleaning cloths, paper towels, etc. used to clean the spill

X. CONTINGENCY PLAN

Healthcare Waste Solutions 12394 SW 128th Street Miami, FL 33186 305-238-2347

XI. MISCELLANEOUS

For easy access by all of ACDPS personnel, a copy of this biomedical waste operating plan will be kept in the following place:

● Office of Health/Safety ● CSW ● Stations 12, 16, 19 and 21 ● On-line at firenet.

The following items will be kept at Station 12, 16, 19, 21 & CSW:

a. Current DOH biomedical waste permit/exemption document b. Current copy of Chapter 64E-16, F.A.C. c. Copies of biomedical waste inspection reports from last three (3) years d. Transport logs from last three years

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Influenza Pandemic Personal Protective Guidelines for Alachua County Department of Public Safety

Chapter 5.8

Issued: October 2009 Revised: Submitted by: Health & Safety Officer Approved by: Medical Director

Purpose: Provide information and guidelines for transportation of patients during Influenza Pandemic Conditions.

All personnel should be aware of the signs and symptoms of infectious respiratory diseases and the procedures necessary for protecting themselves. Influenza transmission can occur from direct or indirect contact via droplet nuclei. Certain procedures can also impact transmission of influenza particulates by producing aerosols: intubation, extubation, deep tracheal suctioning and nebulized respiratory treatments.

Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness onset. Persons who continue to be ill longer than 7 days after illness onset should be considered potentially contagious until symptoms have resolved. Children, especially younger children, might potentially be contagious for longer periods.

Respiratory Precautions:

● Implement the use of surgical masks by personnel during the evaluation of patients with respiratory symptoms which may be influenza related.

● Implement the use of N95 respirators by personnel when performing intubation (oral or nasal), insertion of King Tube, suctioning, and nasal or oral airway placement.

● If not requiring oxygen administration, provide surgical masks to all patients with symptoms of respiratory illness.

● For patients who cannot wear a surgical mask in addition to any medical treatment being provided, provide tissues and instructions on when to use them (i.e., when coughing, sneezing, or controlling nasal secretions).

● Continue to use respiratory precautions to manage patients with respiratory symptoms until it is determined that the cause of symptoms is not an infectious agent that requires precautions beyond standard precautions.

Recommendations:

● Use gown, gloves and eye protection if contact with bodily secretions or if a contaminated environment is anticipated. Use proper procedures for donning and doffing PPE.

● Practice good hand hygiene. Use the provided waterless hand cleaner until you can access soap and water.

● Assure adequate cleaning of equipment and vehicles between transports. (See additional information in separate section on cleaning of transport vehicles)

Patient Assessment

● Step 1: The Centers for Disease Control and Prevention (CDC) suggests that EMS personnel stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza.

● Step 2: Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following: nasal congestion/cold symptoms, sore throat, or cough)

● If no acute febrile respiratory illness, proceed with normal EMS care.

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Personal Protective Equipment (PPE)

● When treating a patient with a suspected case of swine-origin influenza as defined above, the following PPE should be worn: ● Disposable surgical mask and eye protection (e.g., goggles; eye shield), disposable non-sterile gloves, and gown, when coming into close contact with the patient.

● When treating a patient that is not a suspected case of swine-origin influenza, but who has symptoms of acute febrile respiratory illness, the following precautions should be taken: ● Place a standard surgical mask on the patient, if tolerated. If not tolerated, personnel may wear a standard surgical mask.

Use good respiratory hygiene:

● Use non-sterile gloves for contact with patient secretions, or surfaces that may have been contaminated.

● Follow hand hygiene including hand washing or cleansing with alcohol based hand disinfectant after every contact. ● Encourage good patient compartment vehicle airflow/ventilation to reduce the concentration of aerosol accumulation when possible.

Guidance for Cleaning Emergency Medical Service Rescue Vehicles during an Influenza Pandemic

Following are general guidelines for cleaning or maintaining rescue vehicles after transporting a suspected influenza patient during a pandemic. This guidance may be modified or additional procedures may be recommended by the Centers for Disease Control and Prevention (CDC) when an influenza pandemic becomes widespread in the United States, or as new information about a pandemic strain becomes available.

All personnel should consistently practice basic infection control procedures including vehicle/equipment decontamination, hand hygiene, cough and respiratory hygiene, and proper use of PPE.

Influenza viruses can persist on nonporous surfaces for 24 hours or more, but quantities of the virus sufficient for human infection are likely to persist for shorter periods. Although the relative importance of virus transfer from inanimate objects to humans in spreading influenza is not known, hand transfer of the virus to the mucous membranes of the eyes, nose, and mouth resulting in infection is likely to occur. Hand hygiene, cough etiquette and respiratory hygiene are the principal means of interrupting this type of transmission. Routine cleaning and disinfection practices may play a role in minimizing the spread of influenza.

Routine cleaning with soap or detergent and water to remove soil and organic matter, followed by the proper use of provided disinfectants, are the basic components of effective environmental management of influenza. Reducing the number of influenza virus particles on a surface through these steps can reduce the chances of hand transfer of virus. These products must be used in accordance with their label instructions; following label instructions is necessary to achieve adequate efficacy and to avoid unreasonable adverse effects.

After the patient has been removed and prior to cleaning, the air within the vehicle may be exhausted by opening the doors and windows of the vehicle while the ventilation system is running. This should be done outdoors and away from pedestrian traffic.

Some reusable equipment may need to be covered with disposable plastic covers to protect it from contamination if it cannot be decontaminated with disinfectants without the chance of damage to the equipment (per the manufacturers' recommendations). These covers should be changed as appropriate (e.g., after each shift, after every run) or when they are visibly contaminated. Dispose of these covers in a leak proof bag or waste container.

Routine cleaning methods should be employed throughout the vehicle with special attention in certain areas as specified below:

● Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturer's recommendations.

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● Non-patient-care areas of the vehicle, such as the driver's compartment, may become indirectly contaminated, such as by touching the steering wheel with a contaminated glove. Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care (e.g., steering wheels, light switches). If the surfaces in the driver's compartment become contaminated, they should be cleaned and disinfected according to the recommendations in item 4 below. ● Wear non-sterile, disposable gloves while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions. Avoid activities that may generate infectious aerosols. Eye protection, such as a faceshield or goggles, may be required if splashing is expected. Cleaning activities should be supervised and inspected periodically to ensure correct procedures are followed.

● Frequently touched surfaces in patient-care compartments (including stretchers, medical equipment control panels, adjacent flooring, walls, ceilings and work surfaces, door handles, radios, keyboards and cell phones) that become directly contaminated with respiratory secretions and other bodily fluids during patient care, or indirectly by touching the surfaces with gloved hands, should be cleaned first with detergent and water and then disinfected using the provided disinfectant in accordance with the manufacturer's instructions. Ensure that the surface is kept wet with the disinfectant for the full contact time specified by the manufacturer. Adhere to any safety precautions or other recommendations as directed (e.g., allowing adequate ventilation in confined areas, and proper disposal of unused product or used containers).

● Non-porous surfaces in patient-care compartments that are not frequently touched can be cleaned with detergent and water.

● Clean any small spills of bodily fluids (e.g., vomit from an ill patient) by cleaning first with detergent and water followed by disinfection.

● Large spills of bodily fluids (e.g., vomit) should first be managed by removing visible organic matter with absorbent material (e.g., disposable paper towels discarded into a leak-proof properly labeled container). The spill should then be cleaned and disinfected as above.

● Place contaminated reusable patient care devices and equipment in biohazard bags clearly marked for cleaning and disinfection or sterilization as appropriate.

● Clean and disinfect or sterilize reusable devices and equipment according to the manufacturer's recommendations.

● After cleaning, remove and dispose of gloves as instructed in a leak proof bag or waste container. State and local governments should be consulted for appropriate disposal decisions. Barring specific state solid or medical waste regulations to the contrary, these wastes are considered routine solid wastes that can be sent to municipal solid waste landfills without treatment.

Immediately clean hands with soap and water or an alcohol-based hand gel. Avoid touching the face with gloved or unwashed hands.

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Operations - Emergency Response Plan

CHAPTER 6.1

Issued: Revised:

Submitted by: Approved by:

The purpose of this section is to establish a uniform plan for the effective coordination and control of Fire/Rescue actions to be taken in the event of disaster situations.

Disasters or disaster situations are defined as:

Natural Disaster Means any storm, hurricane, tornado or flood resulting in or threatening to cause major damage, hardship and suffering to the public.

Accidental Disaster Means any explosions, fires, transportation accidents, hazardous material accidents or structural collapse resulting in or threatening to cause major damage, hardship and suffering to the public. Civil Disaster Means any local civil disturbance, riot or acts of terrorism or act of war against the United States resulting in or threatening to cause major damage, hardship and suffering to the public.

COMMAND POST AND OPERATING CENTERS

Staff and Service personnel are listed below along with assignments. They will be notified of Level status as the situation develops. Staff and Service personnel will be notified by the Chief or designee, as they do not have the same call-in or reporting procedures listed for shift personnel.

PERSONNEL ASSIGNMENT Chief EOC Overall Responsibility Deputy Chief EOC - Command - Fire/Rescue Operations; ESF 4/9 Assistant Chief EOC - Command - Fire/Rescue Operations; ESF 8 Assistant Director EOC - Command - Fire/Rescue Finance Program Manager/Chief EOC - Command - Fire/Rescue Logistics Emergency Manager EOC - Command - Fire/Rescue Planning Public Information Officer EOC - Command - Fire/Rescue PIO Training Bureau Personnel Emergency Operation Center: Staff Emergency Operation Center: Staff District Chief (duty) Mobile Command Post District Chief (duty) Mobile Command Post District Chief(s) (Call-In) Field Operations Supply Officer Central Supply Warehouse

OPERATIONS DURING NATURAL/ACCIDENTAL DISASTERS

Fire/Rescue has established 5 Levels of operation which initiates the following actions by Department personnel. Levels are cumulative.

Level 0 Normal day-to-day operations

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Level 1 Alert Status, Staff Briefing to be held at Headquarters or designated site. Level 2 Standby Status, off-duty shifts notified of possible recall. Level 3 On-call shift report to duty (on-call shift is the shift that was “on duty”the previous day) Level 4 Reserve shift reports to duty (reserve shift means the off-duty shift which will be on duty the next tour)

When it appears possible that Alachua County may be in the path of an approaching storm, Level 1 will be ordered and the following actions will be initiated.

LEVEL 1

Duty Shift (Shift on duty)

● Drain, flush and fill all apparatus water tanks to provide for emergency drinking water.

● Place all portable radios on charge.

● Test all portable lantern batteries and assure spare battery and bulb supply.

● Test run and service all emergency generators-station and apparatus.

● Check station supplies, first-aid supplies and order if necessary.

● Top off all fuel tanks. Maintain a minimum of ¾ full until return to LEVEL 0.

LEVEL 2 (Includes Level 1 preparations)

Installations that may have to evacuate will develop preparations for evacuating with the following considerations:

● Rescue supplies and equipment

● Employee records

● Department & installation operating records

● Electronic equipment

● Training Aids

● Library

● Apparatus

● Foam

● Utilities, i.e. gas, electric, aux. generator

NOTE:

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After all equipment has been removed to evacuation site, personnel and apparatus will return to station to wait for further direction concerning evacuation of personnel and apparatus.

● Advise on-duty employees and reserve shift to prepare their homes for storm conditions and make arrangements for the safety of their families in the event of later call back to duty.

● The following day at 0800 hours, upon completion of duty tour, off-going (on- call) shift will take their bunker gear home with them. They will prepare their homes for storm conditions, arrange for the safety of their families, in the event of call-back to duty. They are to be on a standby status and are to make sure they can be reached by telephone if necessary. Should they be recalled to duty, they shall report to their duty station or other assembly point as directed. They will bring sufficient clothing and personal items, as necessary, for an extended duty tour.

NOTE: Any personnel who feels for the safety of their family members or needs assistance in securing them in a shelter, should contact the District Chief for assistance.

LEVEL 3 (Includes Levels 1 & 2 preparations)

● Shift Lieutenants will be notified to contact on-call shift and direct them to report to duty station or other assigned assembly point. Lieutenants will log call times. Personnel may be recalled in stages.

● On-call shift will report as directed. They will have bunker gear, spare clothing and personal items with them. They will log in and stand by for duty assignments.

● Executive Staff members will be divided into two teams, each working a 12 hour tour of duty.

LEVEL 4 (Includes Levels 1, 2, & 3 preparations)

● Shift Lieutenants will be notified to call in reserve shift and direct them to report to duty station or other assigned assembly point. Lieutenants will keep logs of staff called in (time of contact, who contacted, time reported, where assigned, when relieved).

● Reserve shift will report as directed. They will have bunker gear, spare clothing and personal items with them. They will log in and stand by for duty assignment.

● After the emergency has passed and there is no further need to maintain the call or reserve shifts, the order will be given to release them from duty. No personnel shall leave their duty assignment without authorization. Each individual working overtime shall be responsible for keeping their own time, preparing the request for overtime pay with proper signatures and submitting same to the Lieutenant or District Chief.

● Any person who fails to return to duty (including from annual and sick) under LEVEL 3 or 4 may be subject to disciplinary action.

● Telephone contact with any adult member living in employee’s household will be considered as contact with the employee.

● Exemptions may be granted on a case by case basis when approved by Command.

NOTE: On-call Reserve District Chiefs, when returning to duty, upon LEVEL 3 conditions will report to headquarters, notify command and stand by for assignment.

OPERATIONS DURING CIVIL DISTURBANCES

This plan of operation and assignment of Fire/Rescue personnel and equipment is designed to cover all levels of Civil Disturbances within the limits of Alachua County.

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MISSION Fire/Rescue’s objective in civil disturbances is the protection of life and property, care and transportation of the sick and injured, rescue of trapped occupants and overall and medical care within the limits of jurisdiction, unless the magnitude of the civil disorder deems it unsafe for personnel to enter the affected area. This is not a matter of tradition or preference of the Department, but a matter of law.

GENERAL

● Fire/Rescue will not use their personnel, apparatus or equipment for crowd control or disbursement of people and will avoid physical contact with persons involved with the disorder.

● At no time will any Fire/Rescue employee, while on duty, carry on their person, have on any Department properties, or on apparatus, firearms or other concealed weapons.

● It is emphasized to Command Officers (Chief Officers), and Company Officers that on-scene time be kept to the necessary minimum and that the protection of personnel and equipment is paramount. Only such overhaul that is operationally practical will be done. No salvage operations will be conducted in civil disturbance areas.

● During fires, use master streams when practical, utilizing large volumes of water to knock down and extinguish the fire as quickly as possible. Retain capability of rapid pick up of hose and equipment to respond to other alarms or to withdraw from area if conditions warrant same. All units will assist each other in preparing to leave the scene and no individual company will be left alone in problem area.

● During EMS calls, the practice of “load and go”will be of priority, keeping on-scene time at a minimum. Retain the capability to rapidly withdraw from the area if conditions warrant.

● As a civil disturbance progresses or intensified, the legal responsibilities may shift from the Gainesville Police Department (City), to the Sheriff’s Department, the State of Florida or even Federal Agencies. However, Fire/Rescue personnel will always stay under the supervision and leadership of Fire/Rescue officers. Fire/Rescue Command Officers (Chiefs), Company Officers, and Supervisors at the scene will be responsible for the operations, safety and conduct of their personnel.

DEFINITIONS

A designated number of reserve vehicles will be manned by on-call personnel at the discretion of the Assistant Chief of the Department or designee.

Fire/Rescue has established five (5) operating conditions (LEVELS) and Condition X to identify the severity and level of operations before, during and after a civil disturbance.

LEVEL 0 Normal day-to-day operations LEVEL 1 Civil disorder operations for Fire/Rescue level of operations - Gainesville Police Department (City), Alachua County Sheriff’s Department (County). LEVEL 2 Civil disorder operations for Fire/Rescue progressive problems - level of operations - Alachua County Sheriff’s Department. LEVEL 3 Civil order operations for Fire/Rescue severe problems - level of operations - National Guard LEVEL 4 Civil disorder operations for Fire/Rescue critical situation - level of operations - Federal Agencies CONDITION X: Uncontrolled situation, unsafe for Fire/Rescue personnel to work in and respond to area.

NOTE: Due to the possible rapid development of severe civil disturbances and time element involved to set up Command Posts and get military personnel on the scene, the level of operations may be in advance of the outside agencies.

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Upon notification that a civil disturbance exists, Fire/Rescue personnel and apparatus will not enter civil disturbance areas unless notified by Law Enforcement that area is secure and safe for Fire/Rescue personnel to respond and work. Fire/Rescue will immediately go to LEVEL 1 and all affected stations and personnel will follow these guidelines. Progression of LEVELs is cumulative.

LEVEL 1

● All personnel will wear full protective clothing for riot conditions.

● All axes, tools, etc., will be placed in compartments or kept under cover. Hose bed covers will remain in place.

● Companies responding will locate apparatus so that they can effect a rapid exit.

● No sirens or red lights will be used within the designated disturbance area.

● If units in disturbed area(s) are attacked or physically threatened, apparatus and personnel will be withdrawn until area is secured.

● Dispatcher will notify all duty staff officers and the situation will be evaluated.

● All installations will be notified, doors will be secured and personnel assigned to stations in riot areas will remain indoors with a minimum of lighting after dark. The Fire/Rescue Mobile Command Post will be activated if needed.

● If the situation appears to be involved and of long duration, command posts and operation centers will be activated. One or more stations may have to be evacuated and relocated to a safe location.

LEVEL 2

● Legal authority now changes to the Alachua County Sheriff. Staff is moved to the EOC at the County Office of Emergency Management.

● The Department will, upon direction from the Chief, initiate shift call-in to staff additional units. These units will be placed in strategic locations and assigned when needed.

● All calls for assistance, in troubled areas, will be verified by GPD and ASO before Fire/Rescue responds.

LEVEL 3

● Florida State National Guard on the scene: The County Administrator and the Governor of Florida has declared Alachua County an area of civil disturbance and unable to cope with the situation. All operation centers will remain in their present location.

● All Fire/Rescue stations operating in areas of civil disturbance will have police and/or National protection. Any threatening action toward Fire Rescue personnel will be cause for the Fire Rescue Command Officer on the scene to order withdrawal of all Fire Rescue resources until situation is controlled and declared safe by law enforcement/guard personnel to operate in.

LEVEL 4

● Federal Law Enforcement Agencies and/or U.S. Armed Forces have now moved in to assist the National Guard with military and police actions. EOC, Emergency Services Department Communication and Command Post will continue to function in the same locations. Emergency Services Department actions and objectives remain the same. The emphasis will be to prevent large sweeping fires or .

CONDITION X

● Will be in-force when conditions are such that it is impossible for Fire/Rescue personnel to safely operate in

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disturbed areas. These conditions will be established by the Chief or designee and all responses to affected areas will cease until Condition X has been rescinded.

● In areas of Condition X, all requests for medical aide will be forwarded to Law Enforcement Agencies. LEA will remove the victim from the area and meet with a medical/rescue unit in a secure area where patient treatment will begin.

SUPPORT DIVISIONS

● Supply Division will furnish all supplies necessary.

● Prevention Division personnel will be used in secured areas for fire detection and fire prevention, also for fire investigation of suspicious fires when possible. They will work under Law Enforcement or Military protection while in disturbed areas.

● Alachua County Public Works will maintain apparatus and supply fuel to needed vehicles. They will not enter an area of unrest unless properly protected.

● Training Bureau will assist at Fire/Rescue Command Post on the scene and at Command Center at the EOC for liaison between various agencies.

● When the all clear is sounded and the civil disturbance is over, the Department will return to LEVEL 0.

Staff and Service personnel are listed below with their duty assignment. They will be notified of Civil disturbance status as the situation develops. Staff and Service personnel will be notified by the Fire/Rescue Chief of Operations, as they do not have the same call-in or reporting procedures previously listed for shift personnel.

OPERATIONS LEVELS LEVEL NUCLEAR ACCIDENT HURRICANES & TORNADOES Level 0 - Normal Operations, NORMAL OPERATIONS HURRICANE SEASON Emergency Management monitors seasonal weather related events Level 1 - Higher state of readiness UNUSUAL EVENT/ALERT STORM FRONTS APPROACH than is normally present (HURRICANES - 72 HOUR ALERT) Level 2 - A term used to describe a SITE AREA EMERGENCY HURRICANE WATCH condition moreserious than (36 HOUR ALERT) Condition 2. A condition which presents a greater threat of emergency than Condition 2 but not an immediate threat to life or property. Level 3/4 - This is a serious GENERAL EMERGENCY HURRICANE WARNING condition which denotes that (24 HOUR ALERT) hazardous conditions are probable or, in fact already occurring in certain areas within Alachua County. A high potential exists for property damage or loss of life. LEVEL EXAMPLES Level 1 Hurricane Season Normal Operations, Emergency Management monitors seasonal weather related events Level 2 1. Forecast for severe weather/watches Higher state of readiness than is normally 2. Potential for local civil unrest present 3. Potential for energy emergency 4. Hurricane with 72 hr forecast within 300 miles 5. Nuclear power plant incident (Alert) Level 3 1. Tornado Warning A term used to describe a condition more 2. Hurricane Watch

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serious than Condition 2. A condition which 3. Civil Unrest with incident presents a greater threat of emergency than 4. Nuclear power plant Site Area Emergency Condition 2 with some threat to life or property. Level 4 1. Hurricane Warning This is a serious condition which denotes that 2. Civil disorder with rather large scale localized violence hazardous conditions are probable, or in fact 3. Nuclear power plant General Emergency already occurring in certain areas within 4. Hazmat Incident Level III involving large scale Alachua County. A high potential exists for evacuations property damage or loss of life.

RESPONSE/RECOVERY LEVEL CLASSIFICATIONS LEVEL EXAMPLES ACTIONS NORMAL RESPONSE AIR-CRASH (SMALL PLANE) MANAGED BY ON SCENE INCIDENT COMMANDER WITH Emergencies that are handled HOUSE FIRE AVAILABLE RESOURCES through normal response without reducing the available response HAZMAT LEVEL I to other incidents. MINOR STORM DAMAGE Level O CIVIL DEMONSTRATIONS LOCALIZED EMERGENCY AIR CRASH(COMMERCIAL MANAGED BY ON SCENE CARRIER) INCIDENT COMMANDER. Emergencies that require major RESPONSE MAY REQUIRE OFF commitment of resources. Low MAJOR FIRE (POTENTIAL FOR DUTY PERSONNEL AND MUTUAL capacity to respond to other MAJOR LOSS OF LIFE) AID. emergencies. FLOODING THE COUNTY EOC MAY BE Level 1 ACTIVATED TO SUPPORT HAZMAT LEVEL 11 OPERATIONS.

MODERATE TO SEVERE A STATE OF EMERGENCY MAY STORM DAMAGE, LIMITED BE DECLARED FOR A LIMITED AREA AREA AND FOR SPECIAL ACTIONS. LOCALIZED CIVIL DISTURBANCE MINOR DISASTER TORNADO WITH AREA WIDE MANAGED BY ON SCENE DAMAGE INCIDENT INCOMMANDER OR A disaster that is likely to be FROM COUNTY EOC within the response capabilities HAZMAT LEVL 111 of local government and to result A STATE OF EMERGENCY MAY in only minimal need for state or WIDE SPREAD CIVIL BE DECLARED WHEN NORMAL federal assistance. DISTURBANCES OPERATING PROCEDURES ARE INAPPROPRIATE OR Level 2 STATE/FEDERAL ASSISTANCE IS REQUIRED. MAJOR DISASTER MAJOR TORNADO DECLARE STATE OF EMERGENCY AS NEEDED. A disaster that will likely exceed HURRICANE CAT 1-2 local capabilities and require a ACTIVATE COUNTY EOC AND ALL broad range of state and federal ESF’S assistance. DIRECT RESPONSE FROM EOC Level 3 REQUEST STATE AND FEDERAL RESPONSE CATASTROPHIC DISASTER HURRICANE CAT 3-5 DECLARE STATE OF EMERGENCY A disaster that will require massive state and federal ACTIVATE COUNTY EOC AND ALL assistance, including the military. ESF’S DIRECT RESPONSE FROM EOC

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Level 4 REQUEST STATE AND FEDERAL RESPONSE

DIVIDE COUNTY INTO OPERATIONAL AREAS.

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RULES & REGULATIONS Station Duties

CHAPTER 7.1

Issued: July 2007 Revised: September 2009

Submitted by: SOG Team Approved by: Director

Purpose:

To maintain the grounds, facility, and apparatus in excellent working order at all times.

Responsibility:

It is the responsibility of the Station Officer that the facility, grounds, and apparatus are kept clean, neat, and in good working order at all times.

It is the responsibility of the off-going Station Officer to ensure that the apparatus, facility, grounds, and equipment are clean, presentable, and operational.

The off-going Officer shall provide a report, review the shift activity and log book with the on-coming Officer.

All off-going personnel shall provide an oral report and review shift activity with their relief.

It is the responsibility of the on-coming Station Officer to ensure that the apparatus, facility, grounds, and equipment are clean, presentable, and operational for the duration of the shift.

The Station Officer has the authority and responsibility for the application, enforcement and compliance of the contents of this Chapter.

The Station Officer is responsible for the proper display of the national Flag, per County Policies and Procedures.

The following shall commence at the beginning of each shift:

● Check Apparatus (Apparatus Daily Checklist and appropriate supply/inventory list)

● Restock apparatus supplies

● Wash and clean apparatus

● Check apparatus for appropriate tools and equipment, making sure that all are operational.

● Complete specific day duties, as listed under Daily Work Schedule.

● Raise Flag at sunrise

● Retire Flag at sunset

The following shall be done no later than 2300 hours on a daily basis:

● All trash cans emptied and cleaned.

● Secure station and vehicle(s).

The following duties shall be completed on the assigned day

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Monday

● Thorough cleaning of kitchen (appliances, cabinets, walls, light fixtures, and replace or clean vent filter, etc...). ● Restock delivered supplies.

Tuesday

● Thorough cleaning of Station exterior and grounds (windows, gutters, cut grass, trim bushes, edging, rake leaves, etc...).

Wednesday

● Thorough cleaning of apparatus. ● Inventory vehicle and medical supply cabinet and fax the order to Supply. ● Sweep down and wash exterior aprons, bay floors.

Thursday

● Thorough cleaning of the Station interior (floors, walls, furniture, window sills, windows, screens ceiling fans, and doors, etc...). ● Restock delivered supplies.

Friday

● Thorough cleaning of restrooms (showers, tubs, toilets , etc...). ● Last Friday of each month inspection of all fire extinguishers. Inspections shall be recorded on the inspection tag and in the station log .

Saturday

● Detailed inspection and maintenance of equipment as directed by Station Officer.

Sunday

● Detailed inspection and maintenance of equipment as directed by Station Officer. ● All stations inventory EMS supplies (vehicle & cabinet) and station supplies and fax the order to Supply.

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RULES & REGULATIONS Dress Code

CHAPTER 7.2

Issued: July 2007 Revised: September 2009

Submitted by: SOG TEAM Approved by: Director

RESPONSIBILITY

Officers have the authority and are responsible for the application and enforcement of this Chapter.

Each individual is accountable and responsible for issued uniforms and safety ensembles.

Each individual is responsible for appropriate representation as Department personnel.

DRESS CODE

● While representing the Department and/or on-duty the Uniform shall be clean and well pressed.

● Shoes/boots will be kept shined while on duty.

● Damaged uniforms will be inspected by the employee's immediate supervisor. The appropriate form must be completed and forwarded to CSW for replacement. Items identified and authorized for replacement must be turned into Supply at the time of their replacement.

● A spare uniform will be kept at the station.

● Uniforms are not to be worn when off duty, except during travel to and from duty assignments and occasions authorized by the Section Chief.

● Whenever a concern exists about personnel visibility, the Department issued safety vest or bunker coat shall be worn.

● Personal Protective gear shall be worn during any/all hazardous situations. Protective gear shall also be worn/removed at the direction of the Company Officer, Safety Officer, Chief Officer, or Incident Commander.

● When wearing the uniform shirt (Class A, B) all buttons will be fastened up to, but not including, the collar button. When a tie is worn with a uniform shirt (Class A) all buttons will be fastened.

● Class A/B uniform will constitute the standard for compliance with the Department Dress Code and Grooming Standard. When inspected, the employee shall assume the traditional military "attention" posture.

● The color of Department uniform shall be determined by the Director of the Department.

● When in uniform (all or part), on or off duty, you are a representative of the Department. As such you are subject to the rules and regulations of the Department, County Employee Policies, and professional codes of conduct.

● Shirt sleeves will not be rolled or turned up.

● Department issued uniform items shall only be used for official Department business.

● Anytime a Department I.D. is used (verbal or visual), you are a representative of the Department.

Jewelry:

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● Necklaces shall not be worn in such a fashion as to present a safety hazard while on duty.

● Wrist watches and identification bracelets may be worn if the article does not interfere with the use of the safety ensemble or personal protective equipment.

● Earrings shall not be worn on duty.

● Rings which interfere with the donning of gloves are not permitted.

● Jewelry that may be visible to the public, other than as specified herein, shall not be worn while representing the Department.

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RULES & REGULATIONS UNIFORMS

CHAPTER 7.3

Issued: November 2008 Revised: March 3, 2013

Submitted By: Fire Rescue Section Approved By: Chief Bailey

Purpose The purpose of this policy is to establish the standard uniform for Alachua County Fire Rescue Operations and to set forth responsibilities governing the use and wear of the uniform and protective ensembles.

Uniforms are an essential component to any Fire Rescue organization. Uniforms provide a degree of safety, identification, and community to the members of the Department. Uniforms by definition provide a consistency in the appearance to the members included in the organization and can provide recognition as emergency responders to members of the community. Items issued for use as part of the official operational uniform shall meet the specifications set forth by the Department. Unauthorized alterations, and or modifications to any part of the uniform or protective ensemble will not be allowed except as authorized in writing from the Chief of the Department. The Chief of the Department is final authority on any alteration.

UNIFORM ARTICLES PROVIDED BY DEPARTMENT

Pant: Uniform Duty and Dress

Shirt: Uniform Duty T, Duty, and Dress Winter Coat

Raincoat

Protective Ensemble

County Identification Badge

Name Tag (worn centered over right breast pocket ¼”from pocket seam)

Badge (worn in designated area over left breast pocket)

Collar Insignia (centered on each collar, bugle facing collar tip, 1 1/18”from collar tip)

Dress Tie

Dress Blazer and Cap (Chief Officers)

UNIFORM ARTICLES PROVIDED BY EMPLOYEE

Belt:

● Black leather or Patent

● Width 1" - 2.25”with Department approved buckle

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Socks:

● Black or White (with boots only)

Shoes:

● Polishable Black leather or Patent

● Lace-up Shoes or Boots

● Oil-resistant soles

Ball Cap:

● As authorized by Department - Dark Blue, Department patch front centered.

● Worn with bill of cap to the front.

T - Shirt Short Sleeve

● Of matching color to uniform no lettering (worn under dress or duty shirt only).

Athletic

● As authorized by the Department

● Shorts (no spandex), no more than eight (8) inches above the knee, navy blue

● Sweat pant navy blue

● Shoes white or black

Uniform Classification

Class A

● Dress Long Sleeve Uniform Shirt

● T-Shirt of matching color

● Dress Trousers with Black Belt

● Black Socks with shoes; White Socks (boots)

● Dress Tie

● Blazer (Chief Officers)

● Badge, Name Tag, Collar Insignia

● Black Boots/Shoes, Polished

● Dress Cap (Officers only, Optional)

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Class B

● Duty Shirt; short sleeve

● T-Shirt or Duty-T Shirt of matching color to uniform shirt

● Duty Trousers with Black Belt

● Black socks (shoes); White Socks (boots)

● Badge, Name Tag, Collar Insignia

● Black Boots/Shoes, Polished

● Department Ball Cap (Opt.)

Class C

● Duty-T Shirt

● Duty Trousers with Black Belt

● Black socks (shoes); White Socks (boots)

● Black Boots/Shoes, Polished

● Department Ball Cap (Opt.)

Class D

● Protective Ensemble (Class B uniform must be worn with protective ensemble.)

Class E

● Dress ensemble as designated by the Chief

Class F

● Athletic shorts or sweats

● Duty T-Shirt

● Socks

● Athletic shoes (white or black)

Note: At no time shall Class “C or F" be worn while away from the assigned duty station unless as provided in this Chapter. Crews must be uniformed the same and maintain a professional appearance at all times. Ball Cap must be worn with bill of cap to the front.

Department Approved Accouterments for Class A Uniform

Fire Rescue service related and Department issued pins/ribbons and medals are authorized for use on Class A uniform shirts. Non-Department issued pins/ribbons/medals must have prior written approval of the Chief.

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Examples of Pins/Ribbons/Medals which are considered appropriate for use include but not limited to years of service pins, fire inspector/ investigator pin, United States/Florida Flag, Firefighter of the year ribbon, Fire campaign ribbon and other job related/department related items.

Pins shall be worn evenly spaced approximately ¼”above name tag. Ribbons /medals should be worn as appropriate to design.

Uniforms shall be worn as follows:

Class A

● Official Presentations

● Funerals

● Court Appearances

● Commission presentations

● As directed

Class B Class B uniform is the Fire Rescue Operations Section Duty Uniform. It is also part of the safety ensemble.

● Duty Uniform

● All times out of Station

● In Station 0800 - 2300

● As directed

Class C

● In Station use only

● Training where there no reasonable chance of encountering hazardous conditions (. i.e. hose evolutions, water rescue, ladder training etc.). Any training such as live fire or other similar training will require Class B uniform to be worn under Class D

● Outside Station duties (mowing the lawn, physical training).

● In Station 2300 - 0800

● As directed by Chief

Class D

● Any Hazardous Incidents (firefighting, extrication, hazardous materials, etc…).As directed

Class E

● Business/Professional Dress as directed by Chief

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Class F

● Physical Training

● Sleep Wear

Uniform Care Procedures

Uniforms are an important part of the safety ensemble for Alachua County Fire Rescue and shall be cared for as such. Manufacturer specifications and directions shall be followed in the routine care and cleaning of the garments.

Uniforms are an important part of the equipment issued to operational personnel and should receive proper care during their lifetime. As garments which are used in emergency operations, there is an expectation that there may be normal wear and damage to uniforms as part of their operational life. However, intentional damage or damage due to neglect or improper care is not part of the expected wear and tear. Employees whose uniforms are damaged due to neglect, improper care, and intentional actions will re-imburse the county for the replacement cost of the garments or face possible disciplinary actions.

Uniforms shall only be washed with other garments of same material

Uniforms shall not be cleaned in extractors.

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RULES & REGULATIONS Grooming CHAPTER 7.4

Issued: June 1, 2002 Revised: April 14, 2007

Submitted by: SOG Team Approved by: Will G. May, Jr., Director

Grooming Standard To facilitate a professional appearance and safe work practices hair and grooming standards must be followed. It is the responsibility of each employee to comply with this regulation and present a neat, clean, and professional appearance at all times while representing the Department. Maintaining a proper public image, personal safety, and use of protective equipment dictate that certain grooming standards shall be required.

It is understood terms such as: neat, clean, well groomed, “professional,”and clean shaven, as used in this Regulation can be subject to many interpretations. For the purposes of enforcement, the interpretation of the Director or his/her designee shall be used and is final.

Violations of this rule constitute a violation of a safety practice(s) and or safety regulations (Alachua County Employee Policies, Policy 9-3).

● Hair shall be clean, neatly groomed, well kept and at all times present a professional image. The length or bulk of the hair shall not be excessive or present a ragged, un-kept or extreme appearance. Hair styles shall not interfere with the proper wearing of Department Headgear, safety ensemble, create a potential safety hazard, fall around the face, interfere with ability to perform procedures, interfere with the use of SCBA, or potentially contaminate a work area.

● Hair color will be of natural tone. No extreme or unnatural colors are acceptable or permitted.

● Hair length shall not, at any point or time, extend beyond the lowest edge of the Department issued personal protective equipment. Hair length shall not or interfere with or potentially interfere with the wearing of the SCBA (2007 Edition NFPA 1500 Chapter 7.13). Long hair must be pulled back (IE ponytail, braid, etc…) for the duration of the shift.

● Sideburns shall be neatly trimmed, at no point extend beyond the lowest portion of the earlobe, not wider than one inch at any point, and shall at no time extend into or under any part of the facepiece seal of the SCBA (2007 Edition NFPA 1500 Chapter 7.13).

● Moustaches shall be neatly trimmed and kept in a professional appearance at all times. At no time shall any part of the moustache extend into or under any part of the facepiece seal of the SCBA (2007 Edition NFPA 1500 Chapter 7.13).

● Unshaven facial hair except as outlined by this policy shall not be permitted.

● Members shall be clean shaven upon reporting for duty and shall remain clean shaven throughout their tour of duty.

● Offensive body odor will not be tolerated.

NFPA 1500 Standard on Occupational Safety and Health Program, 2007 Edition

Chapter 7

7.13 Using Respiratory Protection.

7.13.1 Respirators shall not be worn when a member has any conditions that prevent a good face seal.

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7.13.2 Nothing shall be allowed to enter or pass through the area where the respiratory protection facepiece is designed to seal with the face, regardless of the specific fitting test measurement that can be obtained.

7.13.3* Members who have a beard or facial hair at any point where the facepiece is designed to seal with the face or whose hair could interfere with the operation of the unit shall not be permitted to use respiratory protection at emergency incidents or in hazardous or potentially hazardous .

7.13.3.1 These restrictions shall apply regardless of the specific fitting test measurement that can be obtained under test conditions.

Appendix A.7.13.3 The following is an excerpt from 29 CFR 1910.134(g): “(g) Use of respirators. This paragraph requires employers to establish and implement procedures for the proper use of respirators. These requirements include prohibiting conditions that may result in facepiece seal leakage, preventing employees from removing respirators in hazardous environments, taking actions to ensure continued effective respirator operation throughout the work shift, and establishing procedures for the use of respirators in IDLH atmospheres or in interior structural firefighting situations. (1) Facepiece seal protection. (i) The employer shall not permit respirators with tight-fitting facepieces to be worn by employees who have:

(A) Facial hair that comes between the sealing surface of the facepiece and the face or that interferes with valve function; or

(B) Any condition that interferes with the face-to-facepiece seal or valve function.” This prohibition applies to any negative- or positive-pressure personal respiratory protection device of a design relying on the principle of forming a face seal to perform at maximum effectiveness. A beard growing on the face at points where the seal with the respirator is to occur is a condition that has been shown to prevent a good face seal. This is so regardless of what fit test measurement can be obtained. However, if the beard is styled so no hair underlies the points where the SCBA facepiece is designed to seal with the face, then the employer may use the SCBA to protect the employee.

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Station Maintenance Program

CHAPTER 7.5

Issued: Revised: January 2006, June 2010

Submitted by: Assistant Chief Collins Approved by: Chief Northcutt

Purpose

The purpose of this program is to track, coordinate, and ensure timely maintenance of Fire Rescue stations. In addition this program delegates a contact person for station maintenance and requests for enhancements.

Accountability

For the purpose of complete accountability, each District Chief is assigned to the specific stations noted below, to be responsible for the stations up keep, maintenance and repair process. The list is as follows:

● District 5 A-Shift – 3,10, 25 ● District 5 B-Shift – 9, 23, ● District 5 C-Shift – 2, 8, 12 ● District 6 A-Shift – 15, 19 ● District 6 B-Shift – 16, 20 ● District 6 C-Shift – 17, 21, 27 ● Program Manager – CSW

All lingering problems with Facilities should be directed to the attention of Assistant Chief Collins.

1. The Lieutenant (Rescue or Suppression) shall be responsible for managing the Station Maintenance Program at their assigned station. 2. The District Chief shall be responsible for overall management of the Station Maintenance Program. The District Chief shall have the authority to authorize repairs and maintenance for the station. 3. The Lieutenants will report routine repair and maintenance requests to the Facilities Management "Magic System". The link is as follows: http://facsupport.alachua.fl.us/selfservice/PreLogin.asp?langsettings=1 Your user name is the First name initial and last name. No password is needed to enter the system. Non-routine repairs shall be reported immediately to the duty District Chief and to the District Chief that has Oversite for the station.

Routing 1. A record shall be made of all Station repair and maintenance requests. 2. A station maintenance form will be kept on this clipboard. After station duties are completed each morning any non-emergent repairs and maintenance items will be logged on the form. 3. All emergent repairs will be reported to the station Lieutenant and dealt with immediately. 4. All non-emergent repairs and maintenance will be forwarded to Facilities Management via the established “Magic System”reporting procedures. A record will be maintained at the Station identifying the nature of the request, when the request was made, when the Facilities Department responded, and when the request was resolved.

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Station Tracking

1. The original form will be emailed to facilities management. The form will then be copied, filed and kept at the station.

2. Once the repairs are completed the date of completion and repairs made are documented on the original form. 3. The forms are subsequently filed and retained in the station. 4. The Lieutenant shall prepare a monthly report of all Station repair and maintenance activity. The report shall be forwarded to the District Chief by the tenth of the month for the previous month. This report will encompass : a) Station Number b) Repairs requested c) Repairs completed d) Modifications made

Equipment/Supply Enhancement or Modification

1. In the event that a modification to the station is requisitioned the Lieutenant will poll each shift supervisor (other Lieutenants) assigned to the station. 2. The modification request along with the poll results will be forwarded to the District Chief in charge of the station maintenance program. This request should be emailed and include the following: a) Station Number b) modification requested c) purpose for modification d) potential costs incurred 3. The request will be reviewed and recommendation provided by the District Chief. The completed request shall then be presented to the Assistant Chief for consideration. The originator of the request will be notified as soon as possible of the disposition of the request. 4. No modifications are to be made to a facility prior to receiving approval of the Assistant Chief. Click to view ----> Station Repair and Maintenance Form

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General Rules & Regulations

CHAPTER 7.6

Issued: January 2005 Revised: Sept 11

Submitted by: Deputy Chief Northcutt Approved by: Chief Bailey

Computers, Software, and E-mail

● At the beginning of each shift all personnel shall sign on to the Department computer system to review e-mail, Policy Management System, Telestaf and County postings as provided. Personnel are also encouraged to review their e-mail during their shift. Opening the electronic document constitutes viewing the document.

● The Company Officer shall ensure that the vehicle status page (intranet) is reviewed for accuracy and completeness at the beginning of the shift. Corrections, needed repairs and maintenance will be reported per Department protocol.

● No computer software or programs may be added to Alachua County computer equipment beyond the approved, licensed software supplied by the Department.

● Extraneous software or programs found resident on Departmental equipment will be deleted and employees found responsible for its presence will be subject to disciplinary action.

Firearms/Weapons/Explosives

● Firearms/Weapons/Explosives are not permitted on any County property, at any County work site, or at any County facility. This regulation applies to firearms/weapons/ explosives inside a personal vehicle while on County property.

Lost or misplaced private property

● When information or complaints involving lost or misplaced private property are received, the Officer-in-Charge shall be notified and shall initiate an investigation to resolve the concerns. A permanent record will be made in the Station Log Book, a situation report completed, and the Duty District Chief shall be notified immediately.

Meals

● One meal break will be allowed for each eight (8) hours worked.

● Meals should be eaten in as short a time as is practical and shall at no time require more than one hour per meal.

● Personnel who are on duty prior to 0800 hours and are going to be on duty after 1000 hours may eat breakfast on duty as long as daily housekeeping/vehicle duties are completed prior to eating.

● All stations are authorized one trip per shift to pick up groceries. Grocery pickups will occur in the unit's first run area and must be completed in as short a time as is practical.

● MEALS WILL BE EATEN AT THE STATION

● Variances must have prior approval of the Duty District Chief.

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Media/PIO

● All requests from the media shall be referred to a Chief Officer or if at incident, the Public Information Officer (PIO). Employees shall not comment to the media about any Departmental matters. Any employee contacted by the media concerning Departmental matters shall immediately make verbal contact (one on one communication) with their District Chief.

● Taking photographs shall not be allowed within or at any County Station without prior approval of the Chief of Fire Rescue or designee.

Miscellaneous Directives

● No property of Alachua County shall be loaned, borrowed, sold, given away, or disposed of without prior written authorization of the Chief of Fire Rescue or designee.

● Two hours shall be taken daily (M-F) to study territory, SOG, in-service training, and/or educational materials provided by the Department. Such activities shall be documented in the provided format and on designated training forms.

● All personal business will be transacted on off duty time, unless permission is granted by District Chief.

● Employees should make every effort to preserve evidence when possible, at the scene if a crime is suspected.

● The off-going personnel shall provide pass-on information to the on-coming personnel.

● Employees should make no comment about the following situations except to proper authorities (Officers of ACFR):

Patient information Cause of an accident

Cause of injury Suspected foul play

Department Business Fire cause or origin

Alleged deficiencies in response, dispatch or treatment

Professional Standard

● No member will report for duty under the influence of any intoxicant; alcohol, drug, or compound. Nor shall they appear at the station off duty while under the influence of any of the above-mentioned substances. Any form of physical encounters not compatible with standard of conduct will not be permitted while on duty.

● Profane and abusive language will not be used while on duty or representing the Department.

● Personnel shall be professional, courteous, and respectful at all times.

● Any employee that is placed under criminal or traffic arrest and/or convicted of a criminal or traffic offense shall immediately notify their District Chief.

● All personnel must carry all licenses and certificates as required by Florida Law/Rule and or County Ordinance.

Sleeping/Lying in Beds

● Sleeping is subject to the workload of personnel (e.g. training, emergency calls, station duties, etc.) or at the discretion of the District Chief, Lieutenant, or Rescue Lieutenant.

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● Beds will be made up at the beginning of each shift and remain as such during the shift. Employees that use a sleeping bag will make up their beds with a clean sheet at the beginning of their shift. Prior to ending a tour of duty, beds will be stripped and all linen will be placed in its appropriate place.

Station

● Building repairs and maintenance supplies are to be reported in accordance with the Station Repair and Maintenance Protocol.

● An employee may be allowed to keep personal exercise equipment at a County Station. The employee must have prior authorization and approval from the Chief and Health & Safety Officer.

● Personal vehicle or equipment shall not be worked on at a Station.

● No personal vehicle or equipment shall be parked or stored inside a County Station without prior authorization of the District Chief.

● All operational personnel are to keep the assigned portable radio in their possession, turned on and monitored between the hours of 0700-2200.

● The Station shall be secured when unattended.

● Wake up time for on duty crew is 0700.

● The Station Lieutenant shall ensure that floor watch is maintained between the hours of 0715 and 2200. Personnel on floor watch are responsible for answering the telephone and the proper receipt and relay of all alarms and messages to the members of the station.

● Personnel shall not leave the station except when responding to a call, as specified in this manual, or authorized by the station officer.

Tobacco Products

● The use of any/all tobacco products shall not be permitted inside any facility, in any County vehicle, or when interacting with the public. The use of any/all tobacco products are permitted only outside and in designated areas.

Telephone

● The proper procedure for answering the station telephone is to answer by giving the station number, the answering individual's rank and the individual's surname (Station 8 firefighter Smith, may I help you).

● Every effort will be made to answer the phone by the second ring.

● Personal phone calls shall be brief and will not exceed five (5) minutes.

● When paging is down or during a state-of-emergency, personal business shall not be conducted on Station phones.

● No incoming personal calls are allowed on the station line between 2200 - 0700 hours, except for emergencies.

● No long distance calls charged to the County will be made without the District Chief's prior approval. All long distance calls shall be entered into the station log book.

● If equipped with an answering machine the following guidelines apply:

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● Automated message must be professional and representative of the Department. ● Phone message checked upon return to the Station. ● Appropriate individual(s) notified of message(s).

Television Viewing

● Any hour for Departmental training.

● Monday - Friday: ● Between 1200 and 1300 hours and between 1700 to 0800 provided it does not interfere with assigned duties.

● Saturday, Sunday and recognized Holidays. Provided it does not interfere with assignments.

● After the completion of assigned duties.

● At the discretion of the Station Officer.

Visitors

● All visits will be limited to periods that will not interfere with the work schedule or training periods.

● Visitors shall be greeted, presence made known, and treated with courtesy.

● Visitors are not allowed in the station unattended.

● No visitors permitted in bunk room except on Station tour.

● Visitors may be permitted at the Station between 0900-2100 hours.

● Any visit that is deemed detrimental or upsetting to the routine of the station shall be terminated.

Emergency Personnel Recall

All members of the Department are subject to emergency recall.

Any member of the Division who fails to respond to a special call shall be subject to disciplinay action.

All members of the Operations Division must provide the Department with a means of contact.

Late Procedures

Any employee who will be late for duty must notify the duty District Chief no later than 15 minutes prior to the beginning of the shift. Failure to notify will result in A.W.O.L. and potential disciplinary action.

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Bunker Gear Inspection & Cleaning Program

CHAPTER 7.7

Issued: May 2006 Revised:September 2009 Submitted by:Daniel Shaeffer Approved by: Edwin Bailey, Deputy Chief

Purpose:

To inform employees of the proper cleaning and inspection procedures of their PPE.

To reduce the potential for secondary exposure to the products of combustion and other contaminants which have been scientifically traced to chronic health effects.

Inspection A thorough inspection of bunker gear should be done at least on a semi-annual basis and after any incident where the gear may have become physically damaged or contaminated.

If there is any doubt about the protective condition of your gear you must notify your immediate supervisor immediately. Trained personnel at Station 27 can be contacted to answer questions, and to perform an inspection if needed.

If your gear has become contaminated with a significant amount of blood, or bodily fluids, do not attempt to wash. Gear should be secured in a bio-hazardous bag until a further evaluation can be made by St27 personnel.

If your gear has small amount of contamination of blood or bodily fluids a 3% hydrogen peroxide solution (OTC Typical Solution) will suffice to remove small quantities.

In the event of a hazardous materials contamination, a District Chief should be consulted regarding the degree of decontamination needed to minimize a secondary exposure. Specialized decon cleaning solutions are available for some products. In some cases, the degree of gear compromise can only be determined by destructive testing; in this case PPE may have to be destroyed. Non-disposable PPE suspected to be contaminated by a HAZMAT, will be placed in an appropriately marked hazardous materials container or bag (obtainable from HAZMAT team) until further examination.

Gear Inspection:

● Jacket and Pants (outer shell) - Check for any burns, abrasions, rips, holes, etc. on the outer shell of the gear. Look for any oil, tar or other contaminants. Make sure that all zippers, snap buttons, clips, etc., are working properly and all velcro closures fasten securely. Velcro should be combed free of lint build up to assure secure closure. Note: ST 27 personnel have hat comb for heavy buildup.

● Jacket and Pants (thermal liner) - To complete a thorough inspection of the thermal liner you should remove the liner from the outer shell. You should check for any burns, deterioration, discoloration, UV damage, holes, rips, etc.

● Helmet – Make sure that web harness and straps are not damaged. Check ratchet, chin strap, shield and shield hardware for any damage. Check the outer shell of the helmet for cracks in the fiberglass or any distortion from heat or mechanical damage.

● Hood – Check hood for any holes, burns, discoloration, rips, excessive stretch, etc.

● Gloves – Check gloves for any holes, burns, rips or worn to leather. Inspect inner liner for continuity & integrity. Gloves should be pliable enough to have a degree of expected dexterity.

● Boots – Check boots for any holes or damage to the steel toe and/or metal plate on the bottom of the boot. Make sure pull straps are fastened to the boot securely. For leather boots check sewn seems. Are boots still waterproof when worn – if not this indicates a violation to the protection. Look for excessive heel wear which

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could distort gate and cause a fall.

Cleaning

NFPA 1851 recommends that bunker gear should be professionally cleaned once a year. As per the manufacture; Morning Pride / Total Fire, our fire fighting ensemble may be cleaned in the station household style washing machine with some precautions and procedures. If a detergent is used, it must be specifically formulated for firefighting gear. A mild Bio-cleaning solution can be used on bunker gear to disinfect blood or other bodily fluids. If not sure of approved solution, check with Lieutenant's that are trained at ST27. After cleaning gear in a washing machine you should run one full cycle with one cup of bleach thru the machine. DO NOT USE BLEACH TO CLEAN ANY BUNKER GEAR.

PPE self-cleaning procedures

Jacket and Pants (outer shell) – Separate the liner from the outer shell. Rinse or brush off any obvious debris that is on the outer shell. Pay close attention to assure contents of pockets are removed, including any accumulation of debris. Fasten all zippers, Velcro and snaps before placing into washing machine. Add proper amount of PPE approved detergent and begin washing cycle.

Only wash the outer shells together. Do not add other clothes or gear. Wash only one set of gear at a time.

When gear is done washing you will want to hang it in a dark cool area to dry. A fan blowing across the gear will expedite the drying time. Do not place gear in direct sunlight or a dryer.

Jacket and Pants (thermal liner) – The thermal liner can be placed into a washing machine and wash using the proper amount of PPE approved detergent.

● Only wash the thermal liners together. ● Do not add other clothes or gear. ● When liners are done washing you will want to hang it in a dark cool area to dry. A fan blowing across the gear will expedite the drying time. Do not place thermal liners in the direct sunlight or dryer.

Helmet – Helmet should be cleaned using soap and water only. Hand wash the inside web harness and straps. Hand wash outer shell if needed. Place in a cool dry area for drying.

Hood – Hand wash the hood using turnout gear detergent. Do not wring hoods, squeeze hoods to remove excess water. Lay flat to dry in a cool area.

Gloves – Hand wash gloves using gear detergent and place in a cool dark area to dry.

Boots – Wash with soap and water, turn boots upside down to dry.

After gear is dry and ready to be returned to service, it may be prudent to re-inspect the areas that may have been too soiled to inspect before the cleaning to assure nothing is missed.

REMEMBER THIS GEAR IS YOUR PROTECTION FROM AN IMMEDIATE THREAT OF A HOSTILE ENVIROMENT, AND IF PROPERLY CARED FOR, IT WILL CONTRIBUTE TO THE REDUCTION OF POSSIBLE CHRONIC EFFECTS FROM SECONDARY CONTAMINATION.

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Apparatus Inspection/Maintenance/Response

CHAPTER 7.8

Issued: October 20, 2003 Revised: December 2011

Submitted by: Deputy Chief Northcutt Approved by: Chief Ed Bailey

Responsibilities

● The Station Officer is responsible for the inspection, readiness, repair, and maintenance of vehicles and equipment assigned to the station.

● The supervisor who places an apparatus in service for special detail will sign for the vehicle and document times the vehicle was taken and returned to the station on the Inspection Check list.

● It is the responsibility of the Supervisor and Driver to ensure that the vehicle is operated in a safe and compliant manner.

● Upon completion of each assignment, the supervisor is responsible for the readiness of the apparatus.

● Whenever a reserve apparatus must be used in place of the company's regular apparatus, it shall be the duty of the company using such apparatus to thoroughly clean and check that it is properly serviced. When the reserve apparatus is returned, it shall be returned in clean condition and shall be properly serviced and stocked.

● Members of each company will be directly responsible for the proper care, maintenance, cleaning and upkeep of their respective apparatus, and performing such duties as assigned to them by their Senior Officer and/or as outlined in this manual.

● Any exchange of apparatus requires the updating of the Department's Vehicle Status Board by the Officer in charge.

● The Central Supply Warehouse may assist with the coordination of delivery and pick-up of apparatus for repair and maintenance.

Vehicle Repair/Maintenance

All vehicle maintenance problems will be reported to your supervisor immediately.

Apparatus shall be kept clean and ready for service at all times.

PMs due (within 500 miles), PMs overdue and non-emergent vehicle repairs will be reported on the Vehicle Status CS internet page by the Officer in charge.

Apparatus left at CSW in need of repair shall have a note left on the driver’s seat or steering wheel indicating the problem. In the event the vehicle is towed, an email stating the problem shall be forwarded to the Warehouse Manager as soon as possible.

District Chief 6B who is responsible for Department apparatus will coordinate the preventative maintenance, and non-emergent repairs. DC 5 & 6 will coordinate PMs with Fleet in the absence of the District Chief in charge of apparatus via telephone to the Fleet Supervisor. A follow up email as documentation will be sent to the District 6B who is responsible for apparatus.

A reserve Command vehicle shall be located at CSW. The reserve command vehicle is not to be used or assigned to anyone other than an on duty District Chief. The District Chief is responsible for keeping this vehicle maintained and ready for service.

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Spare apparatus shall be fueled, cleaned, ready for service, and restocked from station supplies when returned to the assigned station from assignment. All spare trucks will be started daily and run for a minimum of 15 minutes and placed on an electrical charging system to maintain charge. Any apparatus defects, inventory issues, and plan of action for remedies and/or corrections, are to be recorded in Station Log/Station Activity Book (Chapter 7.19).

Emergency vehicles will maintain at minimum ¾ fuel capacity. Unless the apparatus is en-route to or being operated at the scene of an emergency, in which case it will be filled as soon as practical.

Vehicle Status Board – See Firenet for instructions.

Vehicles mileages must be updated on the Vehicle Status Board every Wednesday. Spare apparatus will be assigned at the following locations:

Location of Spare Rescues

R41 - ST9 R42 - ST12 R45 - ST16 R43 - ST17 (Secondary Signal 15 unit & all Special Event Equipment) R44 – ST17 (Primary Signal 15 Event unit & all Special Event Equipment) R40 - ST21

Location of Spare Engines

E3412 - ST8 E3425 - ST21 E3415 - ST27

Apparatus Daily Inspection/Check List

● An Apparatus Inspection Checklist is available to be printed at the ACFR Intranet site for every emergency response vehicle, listed by 4 digit Fleet ID#. ● A laminated “Expendables Supply List” will be kept inside every ALS vehicle referencing required items for ALS engines and transports noted on the Apparatus Inspection Checklist. ● Every primary and reserve apparatus will have the current week’s checklist kept on a clipboard, hung at a defined location inside the station’s office, available for LT and DC review. ● All primary and backup apparatus, assigned to a station, will be checked and signed for daily on the appropriate unit’s checklist. Deficiencies will be restocked and any other problems taken care of or documented with the appropriate officer being advised. ● When a reserve vehicle is placed into service as a primary unit, the current checklist will be taken by the new crew and maintained until that reserve vehicle is returned to its assigned, reserve location. All checklists used during the period of time a reserve vehicle is in service as a primary unit will be returned with the truck to the Officer in charge of the assigned, reserve location. ● Completed apparatus checklists will be chronologically filed and maintained at the assigned station for two (2) years. Records over two (2) years old will be destroyed by the Lt in charge. ● Special Event apparatus (specifically R44 at Station 17) will be checked and signed for daily on the appropriate vehicle checklist by the assigned station crew. When placed in service for a Special Event, the Special Event crew will accept the vehicle as already checked and sign and document times taking and returning the vehicle to the station. The truck will be refueled, cleaned and all equipment/supplies restocked after the Special Event, by the Special Event crew, prior to signing it back in at the assigned station and leaving their OT assignment. Any other problems or deficiencies with the vehicle will be relayed to the station Officer upon return of the vehicle. ● Any additions, deletions or changes in equipment or their location on the apparatus or changes in the check sheet itself must be agreed upon by all 3 officers in charge of the specific unit. The C-shift officer in charge of the specific unit will send, via email, the change to their appropriate DC. If approved by that DC, he/she will forward that email to DC5C, who will then forward it to the IT department for change on Firenet.

General

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All apparatus shall be operated in compliance with the Fleet Management Operating Policy and Procedures Manual.

The use of cell phones is prohibited while operating department apparatus (exception: Chief, Command Officers).

Department apparatus, tools, or pieces of equipment carried on County units shall not be used for private or personal use.

There shall be no use of any tobacco products while in or operating apparatus.

Food or liquids are not allowed anywhere in the apparatus that may result in damage to equipment on the apparatus.

All Operators of Department apparatus shall possess a valid Florida Driver’s License in accordance with State Law/requirements.

Any individual who has his/her license suspended or revoked must notify the on duty District Chief immediately.

The number of personnel riding in the apparatus shall be limited to the design of the apparatus and number of safety belts.

All personnel aboard an Alachua County apparatus, are to be positioned properly with seat belts and/or safety harnesses fastened, unless attending to a patient or fighting a brush fire. Personnel are to refrain from donning or doffing bunker gear while vehicle is in motion.

No personnel are to step from any Department apparatus which is moving. Personnel catching hydrants, pulling lines, or removing equipment must allow for the apparatus to stop and receive a signal from the Driver to proceed before executing necessary evolutions.

All vehicle accidents involving Department apparatus will be investigated by the LEA having jurisdiction. NO modifications shall be made to any apparatus without prior authorization from the Chief.

Driving/Response Procedures

The maximum time allowed from the notification of dispatch to the apparatus responding shall be no greater than sixty (60) seconds.

Prior authorization is required from the Duty District Chief for Crews/Units to participate in any activity which would delay the response to an emergency call.

Non-emergency transfer with significant lead time for patient pick-up

● The Rescue Lieutenant must acknowledge the page within one minute. The unit must respond in such a manner to ensure the timely pick-up of the patient.

● Unit move-up is considered as being dispatched.

The driver of an apparatus shall drive to the assigned incident(s) in a safe and expeditious manner.

Apparatus responding from the same station or location will follow the same route if possible and practical.

Water Tankers shall respond non-emergency and not exceed the posted speed limit. In no instance shall a Tanker exceed 60 miles per hour, even if the posted speed limit allows a higher maximum speed.

The driver of an apparatus shall comply with Florida State Law.

There shall be no racing of apparatus nor shall fire suppression apparatus pass another apparatus while responding. Chief, Command, and Rescue apparatus may pass slower fire suppression apparatus when necessary and safe to do so.

All vehicles will come to a complete stop at all red lights or stop signs before proceeding through, even when driving

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with lights and sirens in emergency mode.

The Department has two (2) vehicle response modes: Non-emergency: Without the use of and emergency lights

Emergency: ALL Alachua County Fire Rescue vehicles responding to an emergency will comply with State of Florida Statue Chapter 316 - Uniform Traffic Control, which states:

316.126 -Operation of vehicles and actions of pedestrians on approach of authorized emergency vehicle. ( Section 3) - Any authorized emergency vehicle, when en route to meet an existing emergency, shall warn all other vehicular traffic along the emergency route by an audible signal, siren, exhaust whistle, or other adequate device or by a visible signal by the use of displayed blue or red lights. While en route to such emergency, the emergency vehicle shall otherwise proceed in a manner consistent with the laws regulating vehicular traffic upon the highways of this state.

The Officer of the vehicle will use their discretion in deciding if lights and siren, or lights alone are sufficient to safely respond to an incident or, in the case of an emergency transport to the hospital, from an incident scene.

In all cases, the safety of the crew, patient and citizens will be foremost in the response posture.

School Zone/School Bus (non-emergency or emergency response) School Zone restrictions shall be complied with during the designated time periods. The speed of the apparatus shall be reduced to the lawful limit.

All apparatus will stop for school buses when the school bus has the stop sign displayed. Apparatus shall not proceed until the sign is disengaged and/or the School Bus Driver signals to proceed.

All vehicles must move in the direction of traffic and shall not be driven against traffic in the opposite lane of traffic. (Florida Statues 316.126). Exception: When traffic has stopped or the roadway is blocked for your means of travel.

Vehicle Backing Refer to Chapter 7.9

Vehicle Parking

When emergency vehicles are parked in non-emergency situations, the vehicle will be parked in such a fashion that it can exit the space in an expeditious manner.

Do not park vehicles in marked fire zones unless committed on an emergency incident.

Vehicle Clearance Restrictions When vehicles are required to navigate under any type of overhead hazard such as tree branches, wires, signs, canopies, etc., a spotter shall be used if personnel are available. Both the driver and the spotter need to be aware of the required clearance before proceeding under such obstructions. When navigating under obstructions that are of unknown height, the spotter should take into account the extra height requirements of the vehicle due to radio and GPS antennas that are mounted on top of the vehicle. In the absence of the Company Officer, the Driver is responsible to ensure adequate clearance for the vehicle to pass through without damage.

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BACKING FIRE APPARATUS & RESCUE UNITS

CHAPTER 7.9

ISSUED: October 2009 Revised:

Submitted By:Health& Safety Officer Approved By: Chief Northcutt

Purpose

This policy will provide rules pertinent to safe backing operations for Alachua County Department of Public Safety fire apparatus and rescue units.

Policy

● Backing of Department fire apparatus and rescue units should be avoided whenever possible. Where backing is unavoidable, spotter(s) shall be used. Spotter(s) shall also be used when vehicles must negotiate restrictive side clearances and where height clearances are uncertain. When backing is necessary and or when using a spotter(s) the driver will slowly maneuver the vehicle with the anticipation that something may go wrong.

● The vehicle driver shall make a complete 360°survey of the area around the vehicle prior to moving the vehicle. This includes looking up high and low for potential obstructions.

● Under circumstances where the vehicle is manned by only a driver, the driver will attempt to utilize any available Department or appropriately qualified (I.E.: GFR, law enforcement, security) personnel to act as spotters.

● When apparatus having a crew are backed, members of the crew shall be utilized as spotters. The primary spotter shall be located approximately 10 feet off the left rear corner of the apparatus in plain view of the driver. The secondary spotter, when available shall be located approximately 10 feet off the right rear corner of the apparatus in a position that can be seen by the driver. The secondary spotter should be able to see the right side of the apparatus and the primary spotter. In congested or tight areas all crew members will dismount the apparatus and act as spotters, including the Company Officer who will oversee the safety of the operation. When only a single spotter is available, the spotter shall be located approximately 10 feet off the left rear corner, and will act as the primary spotter.

● There shall be no riding on the tailboard, steps, or any exposed position of the vehicle.

● Spotters shall have portable radios and flashlights (night). A backing plan will be discussed (hand signals, flashlights, radio) with the driver before beginning to back the vehicle. The communication method and warning process will be in accordance with Department Policy.

● The vehicle shall not be moved until all spotters are in position and communicate their readiness. Spotters will remain visible to the driver at all times. Anytime the driver loses sight of the primary spotter, the vehicle shall be stopped immediately and remain stopped until the spotter is visible. The process will continue only after the communication to continue is given by the primary spotter.

● When Department vehicle must be backed where other vehicle traffic exists, day or night, the apparatus emergency lights shall be operating and traffic safety vests shall be worn by all spotters.

The Officers and Drivers

The Company Officer is responsible for the safe operation of the apparatus and its crew.

If at any time the Driver feels that the situation is not safe, he/she should stop the apparatus until the situation is corrected. This may mean getting out and walking around the apparatus and down the road where the apparatus is headed.

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The Spotter(s)

The spotter must not only look at the ground level for obstructions, but also look up for overhead hazards such as tree branches, wires, signs, canopies, ladders, etc.

The spotter shall maintain visual contact with the driver at all times.

At night, the spotter should position one of the rear spotlights on themselves or use a flashlight to help the driver see them. DO NOT point the flashlight directly in the mirror of the driver as it may blind him/her.

Voice communication between the spotter and the Driver is recommended.

The use of portable radios to communicate between the spotter and the Driver may prove beneficial in certain circumstances.

click to view hand signals → Hand Signals

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STATION/PERSONNEL INSPECTIONS

CHAPTER 7.18

Issued: January 2005 Revised: June 09, Nov 09, Jul 11

Submitted by: Operations Approved By: Deputy Chief

Personnel, stations, and equipment shall be inspected to ensure compliance with Policies and Procedures. Inspections will be conducted in two categories:

a. General:

Shall be conducted by the Company Officer of the unit and station they are assigned to. The form will include the names of the duty crew assigned to the apparatus on that day. The completed form shall be forwarded to the Chief of the District.

b. Detailed:

The Company Officer will have prior notice of the inspection and is responsible for preparing his crew, apparatus and station for the inspection. The detailed inspection will be conducted by a Chief Officer at their discretion.

The inspection forms will be used as a performance review reference.

General Inspection Form ← (click to view form)

Detailed Inspection Form ← (click to view form)

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Station Activity Book/Memorandums/Bulletins

CHAPTER 7.19

Issued: January 1, 2007 Revised: December 2009, August 2010

Submitted by: Operations Approved by: Chief Northcutt

Station Activity Book

The Station Activity Book is a communication tool that is used to provide written communication between shifts, officers, and managers. The Station Activity Book is a vital record of daily activity at the station.

It is the responsibility of the Station Officer (highest classification) on-duty to ensure that entries are made in the Station Activity Book and that the book is maintained. It is the responsibility of the Station Officer to request a replacement book prior to exhaustion of their current book. Request for a replacement book shall be made to CSW at least one week prior to requiring the new book.

There shall be one Station Activity Book per station, regardless of number or type of companies assigned.

Activities not entered into the Station Activity Book are items or activities entered into the Department electronic record programs such as, hose records, hydrant records, training records, vehicle status, etc…No medical information shall be entered into the Station Activity Book.

Activities do not have to be entered in chronological sequence. All entries into the Station Activity Book shall be printed and legible. Activities entered into the Station Activity Book are:

● crew changes ● visitors information ● special detail assignments ● station deficiencies ● completion of station duties ● vehicle changes ● initiation or completion of daily assignments ● assigned incidents to include the control number, time of call, and type of call (fire or rescue)

The following is the Department outline for information entered in the Station Activity Book:

● Each twenty four hour shift begins with a new page. ● Date, shift and apparatus number (Fleet and Dept number) listed on the top of the page. ● Crew members on duty (names w/Dept. ID #). ● Any crew changes during the shift. ● Station duties completed. ● Deficiencies with the Station or grounds and action taken to correct deficiencies. ● Apparatus check completed with deficiencies recorded in the Electronic Vehicle Status Page. ● Daily Activities ● Any information that needs to be relayed to oncoming crew. ● Dispatched incidents (CR#, times, type of call [fire or rescue], NO MEDICAL INFORMATION. ● Entries should be thoroughly communicated (what was actually done, what actually happened).

The on-duty Station Officer (highest classification) is the custodian of the station's records. In the absence of the Station Officer the District Chief will serve as custodian of the station's records. All requests by the public or other agencies to view station records shall be forwarded to the records custodian. Custodianship of station records must be maintained at all times. Station records shall be inspected and or examined only under the supervision of the custodian of the records.

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All completed Activity Books are to be sent to Headquarters for storage.

Memorandums - Bulletins

Numbered Memorandums

All memorandums and bulletins will be sent electronically.

Numbered memorandums are official documents/directives of the Department.

Each member shall review their e-mail daily, initially at the beginning of their shift. Employees are required to open and read all Departmental and County issued e-mail. Opened e-mail is read e-mail.

Employees will be notified of amendments to the Rules and Regulations and S.O.G. electronically(via email).

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Payroll/Scheduling Procedures

CHAPTER 7.20

Issued: June 1, 2002 Revised: December 2011

Submitted by: Deputy Chief Northcutt Approved by: Chief Bailey

The Operations Branch of the Department shall utilize PDSI “Telestaff”for the general purposes of documentation of payroll, scheduling work assignments/hours, personal leave time, and special events.

Payroll

Employees will be paid in accordance with County Policy and Collective Bargaining Agreement(s).

It is the employee's responsibility to immediately notify the appropriate District Chief, via email, of any modification to their work schedule that would impact payroll.

A Payroll Adjustment Form must be completed and submitted by employee to correct any errors.

It is the employee's responsibility to initiate, complete, and process a Payroll Adjustment Form for errors that are caused by the employee. This form requires the District Chief (shift that the error occurred), and Chief (or designee) signatures.

Errors shall not be corrected until the authorized Payroll Adjustment Form is submitted to Payroll.

Payroll corrections shall be made in the following pay period after the receipt of the approved Payroll Adjustment Form.

Pay checks are based on actual hours worked and/or leave utilized as recorded in Telestaff.

Employee prints the “Personal History Report” on the first working day of the new pay period for prior period. It is reviewed, signed, and all necessary documentation attached (i.e. doctor notes, pay adjustment requests, attendance awards, etc.).

The employee forwards the original personal history report and attachments to Payroll at Fire Rescue HQ.

Any adjustment made to the Personal History report must be reported on a Payroll Adjustment Form and electronically forwarded to the employee’s District Chief for approval and processing. See the intranet for form and instructions.

Requests to earn Compensatory Time in lieu of overtime shall be submitted by the employee on an electronic Compensatory Time request form, which is located on the ACFR Intranet. The form shall be completed by the employee and forwarded electronically to payroll email:[email protected]. Payroll staff will print and route the request for approval. All requests for Compensatory Time must be delivered to the [email protected] by the end of the last working day of the pay period in which the overtime occurred (0800 on Monday morning).

● See the Intranet for further detail on the Payroll Procedures.

Scheduling/Station Assignments

Most Fire Rescue Section personnel operate on a 24 hour per day basis, utilizing three 24 hour shifts to provide a work schedule of 24 hours on duty and 48 hours off duty. Other schedules may be assigned based on operational needs.

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Crew schedules will be approved by the Branch Director prior to distribution.

It is the responsibility of each employee to check the schedule. Personnel are responsible for hours assigned to them.

When a position becomes vacant or available, voluntary applications for request of transfer to that position may be made in writing on the approved form, addressed to the District Chief.

A current Field Operations Assignment roster will be provided and posted at all stations.

Any employee impacted by an extremely busy shift may request a mid shift rotation to an outlying station through their District Chief.

General Scheduling Procedures

Telestaff (an automated scheduling program) is the program utilized for maintaining all leave of field/operations personnel, filling of any and all vacancies that occur, and documentation of payroll.

District 5 on each shift is responsible for filling vacancies on his/her shift and ensuring that the next day’s roster is complete.

District 5 will outbound vacancies for the next 28 days on a daily basis. This will occur only between the hours of 0900 and 2200.

District Chiefs will enter Trade Time forms, Holdover codes and approve Field Training Officer codes for the employees assigned to their respective region/District.

Each District Chief will finalize their region on the roster by the end of each shift. Note; the District Chief overseeing special events will finalize large scale events in which he/she acts as Operations/Command.

Vacancies that occur after 2200 for the following day will be Out-bounded between the hours of 0600 and 0800 using the “Last Minute On-duty OT”list.

Personnel must supply the Department with a single, working phone number for overtime assignment and messages from Telestaff.

Personnel on-duty will be contacted at their duty assignment while working and at their contact number during off-duty days.

Personnel may elect not to be called at the station, and only at their contact number, by notifying their District Chief via e-mail of such request. (Override on duty phones)

An employee may add the code “Not Available” to any day of their calendar which will prevent Telestaff from contacting them for overtime on that day. This will only stop Telestaff from calling them ON the selected day. It does NOT stop Telestaff from calling them FOR a vacancy on the selected day.

Employees (excluding District Chiefs) shall not work more than forty eight (48) continuous hours. An eight (8) hour break is required prior to returning to work after working forty eight (48) hours straight.

Employees are required to log into Telestaff at the beginning and end of each shift to check notifications, messages, overtime offers, etc.

Telestaff maintains a Seniority list for the department. This list will be the only one used for all scheduling purposes. This list is available to all employees by using the Picklist option.

The Operations Branch Director is the only person that can approve an employee to work overtime in a lower classification. This does not apply to Special Events.

Leave

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The maximum number of personnel permitted off per shift on any combination of approved vacation, floating holiday, or compensatory time is ten percent (10%) of the minimum staffing level. Rounding to a higher whole number will occur at 5 tenths (.5). Minimum staffing level does not include staffing positions (April 22, 2004).

The Operations Branch Director may authorize variance to the above protocol for unusual situation(s) that occur, which are beyond the control of the employee.

Holdover

If an employee is held over for any reason, it is the employee’s responsibility to ensure that the appropriate District Chief is notified via email. This email shall be sent the day the holdover occurred before the employee leaves his/her assigned station. This notification(email). The following steps will be taken by the employee when notifying the on duty District Chief for each of these work codes:

● Holdover – Late Call: Employees must send an email to the District Chief in charge of the unit where the holdover occurred stating they were held over for a late call. The email shall include; 1) How long they were held over, 2) the CR# of the call(s), and 3) the nature of the holdover. ● Holdover – Relief: Employees must send an email to the District Chief in charge of the unit where the holdover occurred stating they were held over while waiting for relief. The email must include; how long they were held over, the Unit they were working on, and the last name of the person they were waiting on. ● Holdover – To complete reports: Employees must send an email to the District Chief in charge of the unit where the holdover occurred stating they were held over to complete reports. This email must include; how long they were held over all CR#’s for the calls related to the reports; and why reports could not be completed before the end of the shift.

Overtime Assignments/Working Opportunities

Shift vacancies shall be filled by the assignment of staffing personnel and/or shift out-of-class assignments. However, in the event that a vacancy results in the assignment of overtime, the overtime assignment will be offered in the classification which the original vacancy occurred. If the original vacancy is not filled within the classification then the overtime will be offered to personnel currently on the promotional list for the classification (OC/OT). If the original vacancy is not filled with OC/OT the overtime assignment will then follow mandatory protocol (See Mandatory Section).

For the purposes of these procedures, Overtime is defined as time an employee works which is not on their normally assigned duty day.

Telestaff maintains a total number of Overtime hours worked by each employee, known as “buckets.” These hours are cumulative for the current calendar year. The cumulative hours are used to determine the sort order for working opportunities. The buckets will “empty”, or reset at 00:00 on January 1st of each year.

Overtime will be offered only to the classification in which the vacancy occurred, with the exception of Out-of-class assignments.

Voluntary Overtime will be offered based on a list that is generated by Telestaff each time a vacancy is to be filled. This list is then sorted by the Voluntary OT Bucket Hours (Ascending) and then Seniority (if the bucket numbers are equal). As employees accept Overtime positions, the hours of the vacancy will be added to their buckets, which will move them down on the next list.

Employees who promote/transfer to a different position will carry over their Voluntary OT Hours to their new position.

Newly hired employees in Telestaff will initially receive hours in their Voluntary OT Bucket equal to the person already in the classification with the highest number of hours plus one hour.

The following lists will be used to fill vacant positions:

Pre-Scheduled List Chain Used to fill vacancies that are greater than 144 hours from the current day.

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Pre-Scheduled 2nd Call List Chain Used to fill vacancies that are less than 144 hours from the current day.

Non Pre-Scheduled List Chain Used to fill vacancies that are less than 72 hours from the current day.

Scorched List Chain Used to fill vacancies that occur on the current day.

Last Minute On Duty OT List Chain Used to fill vacancies that occur on the morning of the current day between 0600 and 0800.

Special Event LW-PM List Chain Used to fill vacancies for large scale special events where a Paramedic only is needed.

Special Event W-EMT List Chain Used to fill vacancies for large scale special events where an EMT only is needed.

Telestaff will reserve the vacancy for each employee for 20 minutes before moving on to the next candidate for these lists: Pre-Scheduled List Chain, Pre-Scheduled 2nd Call List Chain, Special Event LW-PM List Chain, and Special Event W-EMT List Chain.

Telestaff will reserve the vacancy for each employee for 5 minutes before moving on to the next candidate for the Non Pre-Scheduled List Chain.

Telestaff does not reserve the vacancy for each employee when using the Scorched List Chain or the Last Minute On Duty OT List Chain as both of these require rapid succession of phone calls to attempt to fill the vacancy.

Overtime offers accepted by employees will appear on their personal calendar. Once assigned, overtime cannot be cancelled by the employee. However, an employee wishing to un-obligate themselves from his/her hours may do so if a replacement with equal qualifications/classification (including personnel on the promotional list for the classification) can be assigned. The employee is responsible for finding a replacement.

A record of Overtime offers will be maintained by Telestaff for each position.

If Overtime is cancelled for an employee for any reason, no replacement Overtime will be assigned manually. When the Overtime hours are removed from the employee’s bucket they will return to the place in the list they held before receiving the overtime that was cancelled. This process is self-correcting and no action from the District Chiefs is necessary.

An employee may request to be removed from the overtime list by advising their District Chief via e-mail of such request. To be placed back on the list, Chief Harrell must be notified in the same manner. The request to be removed from the overtime list has no effect on mandatory assignments.(OT Do Not Contact Group)

Mandatory Assignments

Mandatory Overtime assignments shall be made in the classification in which the original vacancy occurred.

Telestaff maintains a total number of Mandatory OT Counts worked by each employee in what it calls “buckets.” These counts will be cumulative for the current calendar year and will be used in determining the sort order for working Mandatory OT. The buckets will “empty”, or reset at 00:00 on January 1st of each year.

Mandatory Overtime assignments will be based on a list that is generated by Telestaff each time a vacancy is to be filled. This list is then sorted by the Mandatory OT Bucket Counts (Ascending) and then Seniority (if the bucket numbers are equal). As employees work Mandatory assignments, each count/instance will be added to their buckets, which will move them down on the next list.

Employees who promote/transfer to a different position will carry over their Mandatory OT Counts to their new position.

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Newly hired employees in Telestaff will initially receive counts in their Mandatory OT bucket equal to the person already in the classification with the fewest number of counts.

Employees on approved leave at the time of the vacancy will be excluded from the Mandatory OT list by Telestaff.

If a vacancy occurs greater than one-hundred forty-four (144) hours (six days) before it begins, Telestaff may call candidates up to two (2) times to offer the same position. If/when the vacancy is not filled seventy-two (72) hours before it begins, mandatory overtime is used. This will ensure that the correct person is mandated.

If a vacancy occurs between one-hundred forty-four (144) hours (six days) and seventy-hours (72) hours before it begins, Telestaff will call candidates once to offer the position. If/when the vacancy is not filled seventy-two (72) hours before it begins, mandatory overtime is assigned. This will ensure that the correct person will be mandated.

If a vacancy occurs less than seventy-two (72) hours before it begins. Telestaff will make a minimum of one (1) attempt to fill the vacancy. After which, mandatory overtime will be assigned. This will attempt to ensure that the correct person will be mandated.

Employees will be sent a Notification through Telestaff and contacted via phone by a District Chief for the Mandatory assignment. The Notification will contain the position, the shift, and the time of the assignment.

An employee wishing to un-obligate themselves from his/her assignment may do so if a replacement with equal qualifications/classification (including personnel on the promotional list for the classification) can be assigned. The employee is responsible for finding a replacement.

Out-of-Class Assignments

Out-of-class assignment is utilized to fill vacancy(s) and afford individual experience in a higher job position/classification.

An employee must meet the minimum qualifications for the position/classification that they are working.

Employees who can work Out-of-Class will appear in Telestaff as ‘Can Act As’ in their personal profile. These employees will be called for vacancies in the position they can work Out-of-class at the end of the Pre-Scheduled 2nd Call List Chain, the Non Pre-Scheduled List Chain, and the Scorched List Chain. Employees acting in another classification will be assigned the proper work code by Telestaff.

If shift personnel are scheduled to work out-of-class and someone calls in for leave after 1800 hours for the next day, then everyone shall stay as they are scheduled and the vacant position will be filled. (Example: A Lieutenant vacancy is filled with an out-of-class Driver Operator, the DO is filled with an out-of-class firefighter and the firefighter is filled with staffing. A firefighter calls in sick after 1800 hours the night before his/her shift. Everyone would stay as they are scheduled and the OT would be assigned to the FF vacancy.) However, if a Mandatory assignment is required then all affected personnel will be returned to their regular classification/position and the Mandatory shall be assigned to the original position.

If shift personnel are scheduled to work out-of-class and someone calls in for leave prior to 1800 hours for the next day, all affected personnel will be returned to their regular classification/position and the overtime assigned to the original position.

Non-Bid Leave

Leave requests may be cancelled by the Department due to operational considerations (See the current Collective Bargaining Agreement).

Employees will apply for non-bid leave via their Telestaff calendar. Leave will be approved by Telestaff or a District Chief based on which leave code they are requesting. No paper forms need to be submitted.

The deadline for submitting leave (Attendance Award, Comp Time Used, Floating Holiday, Vacation Leave) is ninety-four hours before the leave will begin.

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The deadline for cancelling leave (Attendance Award, Comp Time Used, Floating Holiday, Vacation Leave) is ninety-six hours before the leave will begin.

Telestaff will approve leave based on maximum number of employees off per shift, and minimum number of hours prior to requesting leave. Alternates to the ‘maximum number off’ rule will be accepted by Telestaff. If another employee cancels their leave, alternates will be approved based on the date/time they requested to be an alternate.

Leave codes that will be approved by Telestaff are:

● Floating Holiday ● Vacation Leave

Leave codes that are requested by employee via Telestaff, but approved by a District Chief:

● Attendance Award ● Bereavement Leave ● Civil Leave ● Military Leave ● All FMLA Codes ● Union Leave ● Workers Comp Leave

Leave codes are available to all employees to view on their personal calendar. Leave codes that are preceded by an asterisk “*”are still pending approval and are NOT YET approved. Employees who see an asterisk in front of a leave code MUST report to their assigned duty station.

Employees wishing to modify leave codes must do so through a District Chief via email.

Employees wishing to cancel leave codes (Attendance Award, Comp Time, Floating Holiday, Vacation) can do so through Telestaff if the vacancy has not yet been filled and it is ninety-six hours prior to when the leave begins. Employees wishing to cancel these types of leave after the vacancy has been filled must contact a District Chief via email to do so.

Employees wishing to cancel other types of leave (other than those stated above) must contact a District Chief, unless the code has not yet been approved.

Bid Leave

See the current applicable Collective Bargaining Agreement.

Alternates to the ‘Maximum Number Off’ rule will be added in order of seniority by the District Chiefs.

Trade Time

See the current applicable Collective Bargaining Agreement.

Sick Leave

Any employee who is ordered to be off work or light duty for medical reasons must provide a medical release before returning to work.

Contact (verbal or in person, no messages) must be made with the District Chief responsible for scheduling by the employee that is requesting the leave. Contact must be made no later than 0630 (effective 09/01/06) of the scheduled duty day. If the employee is unable to contact the District Chief responsible for scheduling by the above methods, then the secondary District Chief must be notified in the same manner.

● Sick Leave Instance:

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See the current Collective Bargaining Agreement.

● Abusive Sick Leave

See the current Collective Bargaining Agreement.

● Critical Attendance Employee

See the current Collective Bargaining Agreement.

Special Event Scheduling

A special event is defined as any activity not related to minimum shift staffing.

The assigned District Chief is responsible for scheduling the special event(s). Requests for special events will be forwarded to the assigned District Chief. The assigned District Chief will communicate with scheduling and the District Chief of the affected shift.

If an event request is received with less than twenty four hours prior to the time of the event any means necessary may be used to fill the vacancies. Mandatory overtime will follow the Union Contract.

Special Events will be posted on the Telestaff daily Roster on the day the event is to occur.

Employees may sign up for events using Telestaff. When signing up for events, employees should include the name of the event they are signing up for in the Note field of the Add window.

Events will be posted on the Telestaff Roster as they are received and will be Outbounded no greater than 28 days in advance of the event.

Vacant positions for events that are not filled with voluntary overtime will be assigned mandatory overtime. Mandatory overtime will be assigned if the vacancy has not been filled seven days from the event date.

Notification for mandatory assignments with greater than 72 hours notice will be via Telestaff and e-mail.

Mandatory assignments with less than 72 hours notice will be followed up with a phone notification via the provided contact number.

In the situation that an event is cancelled the employee will be notified as soon as possible at the contact number listed by the employee.

In the situation that an event is rescheduled the employee(s) that are initially scheduled will be given the first option to work the hours. If the employee(s) cannot work the hours then the event will be deemed as a new event and scheduled accordingly.

An employee wishing to cancel his/her hours may do so if a replacement with equal qualifications/classification can be found. The employee is responsible for finding a replacement. The employee originally assigned the event must notify the special event District Chief of any such changes.

Lead Worker designation will be utilized for FF/Paramedics (non-supervisory classification) who have oversight of one or more personnel when assigned to an Aid Station at Ben Hill Griffin Stadium.

Emergency Personnel Recall

All members of the Department are subject to emergency recall.

Any member of the Division who fails to respond to a special call shall be subject to disciplinary action.

All members of the Operations Division must provide the Department with a means of contact.

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Late Procedures

Any employee who will be late for duty must notify the duty District Chief no later than 15 minutes prior to the beginning of the shift. Failure to notify will result in A.W.O.L. and potential disciplinary action.

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Pre-Fire Plans/Inspections

CHAPTER 7.21

Issued: Revised: January 2006

Submitted by: SOG Team Approved by:

PURPOSE: This is a Pre-fire Planning form to be used by all Alachua County Fire Rescue firefighting companies.To provide a uniform and comprehensive program for preplanning all special and target hazards within the response district of a given fire apparatus.

OBJECTIVES:

● Perform a Pre-fire Plan on all special and target hazards. IE: as identified by ISO, all Commercial, Industrial and Institutional facilities. ● Establish a six (6) month cycle for updating all Pre-fire Plans on file. (see below application time frame). ● Provide a uniform mechanism for all shifts to study and review Pre-fire Plans. ● Standardize filing and placement of completed Pre-fire Plans.

DEFINITIONS:

● Target Hazard: Facility or process which could produce or stimulate a fire that could cause a large loss of life or property (ex. lumberyard, bulk oil storage, hospital, restaurants, ‘Jiffy Marts’, schools, day cares, etc.). ● Special Hazard: A hazard that arises from the operations or process that is peculiar to the individual occupancy. (ex. painting, welding, dust).

RESPONSIBILITIES:

● The Company Officers assigned to ‘B’ shift shall be responsible for the implementation, application, maintenance of this program at their assigned station. ● The Pre-fire Plan shall be performed/completed by the appropriate Fire-Rescue company in their 1st due area as assigned by the ‘B’ shift Company Officer. ● The Company Officers assigned to the Station shall jointly identify ALL applicable hazards and create a Pre- plan Master List. ● Each shift will then be assigned specific targets to Preplan from the Master List for that Station.

APPLICATION:

● The Pre-fire Plan shall be as complete as possible with all information legibly printed on the blank ‘working copy’, while doing the survey, then typed on the computer program back at the Station. ● Actual annual ON-SCENE visits/surveys shall be done on all identified targets during the months of SEPTEMBER & OCTOBER. ● PHONE SURVEYS to update key holder information and any other ‘quick fix’ changes shall be done during the months of MARCH & APRIL. ● Any occupancy change that is discovered during the rest of the year will require an update of that specific target at that time. ● There shall be an original placed in the vehicle PRIMARY RESPONSE PREPLAN BOOK of all units assigned to that station.

● Pre-fire Plans shall be filed alphabetically using the legal business name of the special or target hazard.

PRE-FIRE PLAN INSTRUCTIONS:

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● NOTE: Remember, the facility we are doing a Preplan on is one of our Employers; we serve them. Always Professional demeanor and courtesy.

**This form cannot be changed. Point your mouse on each blank box that you want to fill in with information; do not use ‘TAB’ or ‘ENTER’ as this will move the spacing off on the form. To enter more information than is allowed on the line given, just keep on typing and it will move to additional lines without messing up the rest of the form.

● The following are examples of information for each topic on the form. Remember to keep the information concise and accurate as you will likely be reading this en route to a call.

● INSPECTION DATE: Last actual ‘on-scene’ inspection. (Annually during the months of September & October) BY: Officer in Charge last name. CREW ID’s: crew ● BUSINESS: Name of Business ● PHONE SURVEY DATE: Phone update date. (Annually during the months of February & March) ● LOCATION: Physical address ● MAILING ADDRESS: if different from actual ● OCCUPANCY: Identify approximate # of personnel on site during each period ● TYPE OF BUSINESS: Main function IE: Manufacturing, Cafeteria, School, Daycare, Retail Sales, Hospital, Gas Station, etc. ● HOURS OF OPERATION: Hours where ‘Personnel’ are present on scene or facility is occupied IE: 6am-5pm, etc. ● HAZARDS: Primary hazards to be concerned about IE: Life safety, environmental, personal, security (dogs and razor wire), chemicals or hazardous materials (MSDS & DOT Guide #s, etc. ● EXPOSURE: Any exposure problems. IE: 500 gal. tank rear of building; house on south side of structure 4' away; 2 commercial transformers attached to rear of building; upstairs residential apartments above office complex, etc. ● FIRE FLOW DEMAND: Water demand when 100% involved, 50% & 25%. Depends on overall rough square footage as calculated (L x W x # of floors divided by 3) See in-depth calculation instructions. You can quickly see how much water, how many apparatus and how many personnel will be needed to adequately extinguish the fire. ● NEAREST HYDRANT: Location of hydrant, FLOW and GPM of that specific hydrant. ● NEXT HYDRANT: Same type information as above. ● FD CONNECTION: Size & Location of connection if applicable. IE: 2 2" left front (southwest) corner of structure. SPRINKLERS: Advise if present. ● STAND PIPES: Advise of # of STAND PIPES and locations. IE: Interior stairwells north and south side of structure. ● CONSTRUCTION: Exterior type. IE: Wood frame, masonry, CBS, etc. ● SQUARE FEET: Exterior dimensions ok. Don’t forget to account for # of floors. ● NUMBER OF STORIES: self explanatory ● NUMBER OF STAIRWELLS: Distinguish between interior and exterior stairs and any other unusual features. IE: Exterior enclosed stairwell from 1st to 3rd floor then interior stairs from 3rd to 2nd floor is only access from ground. ● ROOF - TYPE & CONSTRUCTION: Type. IE: Flat, pitched, gable, mansard, etc.

Construction. IE: pre-stressed concrete, shingle, tar & gravel, metal, etc. Be sure to mention type of trusses, if applicable, IE: lightweight truss, laminated bowstring truss, etc. EXAMPLE – ‘Shingle, Mansard style roof with lightweight trusses’ or ‘rolled tar paper over plywood covered laminated bowstring trusses’, etc.

● ROOF ACCESS: Location and type of roof access. IE: locked, interior, drop-down metal ladder access; interior stairwell; No access, Fire Dept. Ladder needed; etc.

NOTE: Be sure to identify location of roof access on floor plan drawing.

● CEILING: State material, type and any unusual features such as double, false or drop ceiling. IE: sheet rock, tongue & groove, insulated drop, etc. ● ATTIC HEIGHT/ACCESS: Describe approximate height so you can anticipate being able to move around in attic; also, any/all attic access locations and BE SURE to locate such access on floor plan drawing. ● VERTICAL OPENINGS: IE: Elevators, escalators, stairwells, skylights, large vents, etc. BE SURE to locate on floor plan drawing.

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● AIR HANDLING SYSTEMS: Note type and if gas is involved in any way. IE: Residential type A/C with natural gas heat; Commercial electric roof top air handlers & compressors; Heavy-duty exhaust fans mounted on sheet metal roof; etc. Paint the picture so crews can be alert for any associated hazards such as gas involved or collapse from roof mounted equipment, etc. ● UTILITY COMPANIES: Note Electric, Gas and Water company names. BE SURE to locate on both floor and plot plans the locations of fuel tanks and controls/shut off for electric, gas and water. ● OWNER/KEY HOLDER/TITLE: Name, Title, Work and Home phone #s of primary key-holder such as Owner, Manager, etc. ● #2 KEY-HOLDER & #3 KEY-HOLDER information also needed so we know who to contact if no response with the Primary person. ● ALARM COMPANY: Name of Alarm Company if applicable and PHONE # and TYPE of alarm. IE: Residential type smoke detectors; Monitored Police & Fire alarms; Panic/Pull Stations only; etc. ● STRATEGIES: Special notes to assist responding crews with desired tactics. IE: No access for Tankers; lay 700' Rural hitch from front gate to yard in front of structure, etc. ● FORCIBLE ENTRY POINTS: Suggested quick points to assist responding crews with forcible entry. IE: Pry bar to front door; K-12 to rear roll-up metal doors; K-12 to front, double dead bolted steel door; Bolt cutters needed for front chained gate; etc ● ANTICIPATED PROBLEMS: Any notes that would help responding crews. IE: 1600' to nearest hydrant; NO hydrants in area, respond 3 Tankers; Limited access to attic; No tower access to structure; Heavy wood fuel load in rear storage shed; History of ?? Problems, respond LEA Code 3; etc. ● SAVED AS: ‘Title’ you saved this preplan as on Pre-fire Plan 3.5" floppy and in MS Word.

Refer to ‘SAVING PLAN’ in instructions.

PLOT & FLOOR PLANS

REMEMBER, you will probably be reading the PLOT and FLOOR PLANS in dim light en route to a call. Keep it clear, concise and neat with important information only. If you are computer literate, you can do the drawings in ‘Paintbrush’ and paste to the appropriate sections. If not, pen and rulers will work fine. WORKABLE INFORMATION is what we need!

PLOT PLAN The Plot plan will reflect the location of the business. Simple drawing showing important features as below. Do not be so detailed that it becomes congested, but so that you can clearly read important items (One plot plan per business, example Oaks Mall, Progress Center).

LOCATE THE FOLLOWING (IF APPLICABLE):

● Hydrants(s) ● Stand Pipe Connection ● Sprinkler System Connection ● Water Support (Pool, Pond, etc.) if in immediate area ● Utility Control (s) ● Hazards ● Blind Access (Back Entrance) ● Exposures ● Staging Area ● Auxiliary Power and Controls

**NOTE: Star the Plot Plan for any additional IMPORTANT information not required by form; Document any information on the bottom of the sheet.

FLOOR PLAN

● Floor plan is to be placed behind front information page in protector sheets. ● May require more than one Floor Plan for a Pre-fire Plan. ● One Floor Plan per story level. ● One Floor Plan per structure within business (i.e. Progress Center, Oaks Mall) ● One Floor Plan for large storage structures or any storage structures containing hazardous materials.

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Locate:

● Ingress/Egress ● Fire Doors ● Fire Walls ● Stand Pipe(s) ● Alarm System Control ● Specific Hazards ● Attic Access ● Vertical Openings ● Auxiliary Power and Controls

QUICK -CALCULATION FIRE GROUND FORMULA

The NFA quick-calculation formula is expressed as:

Fire Flow = (length x width) 3

This formula is most easily applied if the estimated square footage of the entire structure is used to determine an approximate fire flow for the total structure and is then reduced accordingly for various percentages of fire involvement.

The example shown below illustrates how the formula can be used for a typical one story single family dwelling with approximate dimensions of 50 ft. by 30 ft.

(50' x 30') x 1 = 3

FULLY INVOLVED: 500 gpm 50% INVOLVED: 250 gpm 25% INVOLVED: 125 gpm

The quick-calculation formula indicates that if this structure were fully involved, it would require approximately 500 gpm to effectively control the fire. If only half of the building were burning, 250 gpm should suffice, and 125 gpm should be sufficient if one-fourth of the building were involved.

In multi-storied buildings, if more than one floor in the building is involved with fire, the fire flow should be determined based on the area represented by the number of floors that are actually burning. For example, the fire flow for a two- story building of similar dimensions as that used in the previous example would be:

50' x 30') x 2 = 3

FULLY INVOLVED: 1,000 gpm

If other floors in the building are not yet involved, but are being threatened by possible extension of the fire, they should be considered as exposure and 25% of the required fire flow should be added for exposure protection.

Likewise, if adjacent structures are being exposed to fire from the original fire building, 25% of the actual required fire flow for the building on fire should be added to provide protection for each exposure. If the exposure actually becomes involved with fire, either additional floors of a multi-storied building or adjacent structures, the exposure(s) should then be treated as a separate fire area and the required fire for that area determined and added to the required fire flow for the original fire area.

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The example shown below illustrates how the quick-calculation formula is applied to a one-story structure that is fully involved and exposing two adjacent structures:

Fire Building: (50 x 30) =500 gpm 3 Exposure:500gpm x (25% x 2) =250 gpm Total Fire Flow Required =750 gpm

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Hydrant Inspections

Chapter 7.22

Issued:June 2003 Revised:February 2010

Submitted by: H. Theus, District Chief Approved by: Ed Bailey, Chief

PURPOSE

The purpose of annual hydrant inspections is to insure a good operating condition when needed for emergency operations. The inspections also provide personnel the opportunity to familiarize themselves with areas and locations, as well as a degree of confidence in knowing that the inspections have been done to an established standard.

Inspection guidelines will be conducted in accordance with the American Water Works Association Manual M-17 and comply with the Insurance Services Office (ISO).

RESPONSIBILITY

All Operations Branch personnel must be able to complete a standard hydrant inspection.

The Assistant Chief assigned to Operations is responsible for the oversight, implementation, compliance of the Hydrant Inspection/Maintenance Program. The Assistant Chief may delegate authority of the Program to a District Chief.

The District Chief assigned to manage the Hydrant Program shall:

● Be responsible for the overall operation and management of the program.

● Identify Company Officers of a particular shift to supervise the Program.

● Assist in detecting deficiencies in the system and making the appropriate shift District Chief aware of said deficiencies.

● Immediately resolve the validated deficiencies.

District Chiefs are responsible and accountable for the implementation and compliance of this protocol within their district. This includes but is not limited to; monitoring the hydrant inspection activities within their district and insuring that their Company Officers meet established hydrant inspection deadlines.

The Training Division shall conduct periodic training on both the SOP and the modifications to the Hydrant Inspection and Inventory Program.

Company Officers are responsible and accountable for the implementation and compliance of this protocol. This includes but is not limited to; supervision of the completed hydrant inspections in his/her company's assigned areas, insuring that appropriate procedures are followed during inspections, accurate recording of information into the Fire Soft Program and accurate marking of hydrant locations in the mapping system.

PROTOCOL

Hydrant inspections shall begin the first week of October and must be completed by March 31st. All inspection information is to be entered into the Hydrant Inspection and Inventory System by March 31st. The water department having jurisdiction shall be notified the day of the hydrant maintenance so they can handle any water system related issues.

GRU contact: 352-334-2711

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Archer contact: 352-495-2880

Alachua contact: 386-462-1084

Hawthorne contact: 352-562-1589

Waldo contact: 352-468-1001

HYDRANT INSPECTION PROCEDURES

General Instructions:

1. Each hydrant shall be inspected annually. 2. Ten percent of the hydrants shall have a Fire Flow Testing conducted annually, insuring that all hydrants will be flowed at least every 10 years. 3. Each hydrant shall be cleared of all weeds, brush or other obstructions. In the event that a hydrant is obstructed by permanent fixtures, (shrubbery, landscaping, fence etc.) on private property, an e-mail must be sent to the Fire Marshal’s office so appropriate measures can be taken. 4. Each hydrant shall be visually inspected and operated to determine defects e.g. hydrant cracked, main stem nut in place, bonnet secured, discharge caps in place. 5. Hydrant is flushed to insure it is free of debris.(see flushing below) 6. Pressure test the hydrant by attaching a closed gated wye. Open hydrant fully to check for leaks around the bonnet and housing. 7. Lube all caps with provided grease. 8. Insure a blue road marker is placed on the roadway.

HYDRANT FLUSHING

Remove the 2 ½”Hydrant cap away from any personal property and attach a Hydrant stream diffuser. Aim the diffuser away to an acceptable runoff area to minimize any citizen complaints. Tighten all other caps ‘hand tight’ to prevent leaks or blow off of the caps. Open the hydrant fully and let the water flow until clear. Close the hydrant slowly, observing for proper drainage (when water is heard draining from the hydrant). Water standing in hydrant after valve is closed indicates improper drainage. If so, replace cap and submit a repair request.

FIRE FLOW TESTING

Flow testing ten percent of hydrants shall be conducted annually. All hydrants shall be fire flow tested every ten years. To conduct a fire flow test:

● Select the hydrant to be flowed. Remove the 2 ½”cap, and prepare to flow.

● Select another hydrant in the area, preferably closer to the source supply (upstream). Install the cap gauge, and take a static reading. Record this reading as S. This is the static pressure.

● Attach the pitot/diffuser to the previously selected hydrant, open fully and record the reading. Record this reading as P. This is the pitot flow pressure.

● While the hydrant is flowing, record the pressure at the non flowing hydrant. Record this reading as R. This is the residual pressure.

● Slowly close the hydrant and again record the pressure at the non flowing hydrant. This reading should be equal to the previously recorded S. If not, calculate the average the two. If the difference is more than 10 psi, repeat the test.

● Three pressures have now been recorded.

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● Shut down the hydrant and observe for proper drainage.

Record all pressures in the Fire Soft Program, Hydrant Maintenance Log.

HYDRANT MARKER INSTALLATION GUIDELINES

All hydrant markers are blue in color which is the recognized standard color. All markers will be installed with the reflectors facing the main fire routes of travel. They should always be nearest the dividing line as possible for easy visibility.

Special epoxy glue is used for the installation of the hydrant markers. Two tubes are involved – one is epoxy resin and the other is hardener. The tubes must be dispensed equally onto a clean flat surface, (scrap cardboard). Then mix with a putty knife until the color is uniform. Do not mix the glue on the bottom of the marker. The glue that is in direct contact with the surface will not mix and will leave an area under the marker that will not adhere. Place the marker on the pavement and press down firmly. Do not force all the glue from underneath the marker. Leave approximately 1/16”of glue underneath the marker.

GRU HYDRANT MAINTENANCE/REPAIR FORM

Report all hydrant maintenance/repair issues by e-mail utilizing the Hydrant Repair Request form to the GRU email address: [email protected]

Archer email address: [email protected]

Alachua email address: [email protected]

Hawthorne email address: [email protected]

Waldo email address: [email protected]

All other hydrant maintenance/repair issues should be communicated with the authorized water department in your jurisdiction.

Notify dispatch when the service status (in-service/out-of service) of a hydrant changes.

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Departmental Reporting

CHAPTER 7.23

Issued: November 2008 Revised: 11/08, 12/09, January 2010 Submitted by: SOP Review Team Approved by: Ed Bailey, Chief

GENERAL REPORTS/FORMS

Uniform/Safety Ensemble Form (#001)

● Completed when requesting any of the items identified on the Form. Level of authority is the District Chief. It is critical that the completed form be thoroughly communicated.

Station Repair and Maintenance Form (#002)

● Completed for any/all Station repair or maintenance requests. Level of authority is dependant on the type of request (see form). Routine maintenance is handled by the Station Supervisor. Repair items (appliances, station, etc...) are at the District Chief level. All modifications (removal or addition of walls, changes of structures, etc...) are at the Section Chief level. It is critical that the completed form be thoroughly communicated.

Observer Release Form (#003)

● Completed anytime a non-county person (excluding occupational students) rides on any apparatus. It is critical that the completed form be thoroughly communicated.

District Chief Shift Activity Report(#004)

● Completed by the District Chief (permanent or acting) for each shift. It is critical that the completed form be thoroughly communicated.

Duty Assignment Reassignment Request (#005)

● Completed anytime an individual requests a change in station or shift assignment. The processing of the request and level of approval is dependent on the desired duty change (see instructions).It is critical that the completed form be thoroughly communicated.

Incident Report (#006)

● Completed on resolvable service delivery issue/incident. The form is for documentation of the originator's action and resolution. It is critical that the completed form be thoroughly communicated.

Trade Time Report (#007)

● Completed for any request to trade time with another individual. It is critical that the completed form be thoroughly communicated.

Situation Report (#008)

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● Completed on situations such as but not limited to: personal injury, vehicle accident, breakdown, out of service, contamination; patient complaints; loss of equipment; failure of equipment; etc... The situation report provides documentation for a situation that may not have a specific resolution.

Vehicle Repair/Maintenance Form:

● This form shall be completed any time an ACDPS vehicle is sent in for repair or maintenance. Fleet will leave this form in vehicle for purposes of crew review when vehicle is picked up.

● Forms are available at Fleet.

● Operational companies will report apparatus to be left at Fleet for more than a couple hours to the VSB message center.

Incident/Accident Investigation Report

● Completed for all accidents and incidents, including vehicular. Completed by immediate supervisor and confirmed by Chief Officer. Follow the Alachua County Risk Management Reporting Procedures and forward original forms to the Operations Branch at HQ via Department mail.

● Notifications

● Employee is responsible for IMMEDIATELY notifying their supervisor when an incident, accident, crash, or injury occurs involving Department personnel, property, vehicle, or public liability.

● Employee is responsible for contacting the Assistant Chief and Payroll, during normal business hours, immediately following any loss of time incident and or alternate duty assignment.

● The Duty District Chief is responsible to ensure that the following notifications are made in a timely fashion:

● The Assistant Chief of Operations Branch and the Health & Safety Officer (immediately): Vehicular crash involving Department apparatus; Injury or hospitalization of Department personnel; Public Liability incident.

● Notifications per the Alachua County Office of Risk Management protocol.

● Payroll (during/beginning of work day): Incident/injury resulting in any change of work status of an employee.

● Department Health & Safety Officer: Exposure Incident, employee injury.

● GENERAL REQUIREMENTS

● The Health & Safety Officer shall investigate all reported incidents/accidents involving apparatus, property, and/or personnel injury.

● All reports shall be submitted to HQ prior to the end of your shift in which the accident/incident occurred.

● Original reports shall be copied and forwarded to the Office of Risk Management. Appropriate copies shall be distributed to the Health & Safety Officer and Payroll.

● All vehicular accidents shall be investigated by the LEA authority having jurisdiction, (except those that involve the same jurisdiction).

● Medical treatment shall be rendered at the County designated medical care facility. In emergency situations, the patient shall be taken to the closest and appropriate medical care facility.

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Flow Chart Reporting Injury

Seeking Outside Medical Attention

NO YES . Initiate/obtain medical treatment. Complete Supervisor's Incident/Accident Complete Supervisor's Incident/Accident Report. Report. Make appropriate notifications. Make appropriate notifications. Completed forms are forwarded to Supervisor maintains custody of employee Assistant Chief of the Operations Branch, until drug test is complete and employee Health/Safety Officer. returned to duty station (if applicable). . Completed original forms are forwarded to the Operations Branch @ HQ. Then originals to Risk Management and copies forwarded to Assistant Chief of the Operations Branch, Payroll, Health/Safety Officer.

Alternate Duty

NO YES Employee contact Assistant Chief of Employee contacts Assistant Chief of Operations and Payroll Operations and Payroll during normal business hours immediately following the incident.

HAZARDOUS MATERIALS EXPOSURE

● Should an on duty employee become exposed to a hazardous material through inhalation, direct contact, ingestion or injection, she/he shall follow the guidelines outlined below:

● Immediately perform the proper decontamination procedures as may be necessary to remove contaminants.

● Allow required emergency medical treatment to be performed.

Supervisor's Responsibilities are as follows:

● If other than the District Chief, the Supervisor in Charge shall ensure that the appropriate District Chief has been notified of the incident

● The Supervisor in Charge of the scene will complete the Hazardous Materials Incident Exposure Record (Hazfma).

● The District Chief will notify the Health/Safety Officer of the incident and complete all notification/paperwork as required for an employee injury.

The Health/Safety Officer will:

● Ensure that all appropriate medical treatment has been offered to the employee.

● Interview all involved with the incident and complete their report for the Chief of the Department's

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review.

● Review incident with Risk Management and the Department's Safety Committee to discuss recommendations.

● Any questions with regard to immediate treatment should be referred to the Medical Command at the receiving Hospital.

LICENSE AGREEMENT

● A License Agreement ("Hold Harmless") will be completed prior to the Department conducting any type of training on privately owned property.

● Information concerning the property owner, property description, type of training to be conducted will be forwarded to the Technical Services Branch.

● The Technical Services Branch will complete the License Agreement.

● The completed License Agreement will be forwarded to the property owner for signatures and returned to the Technical Services Branch.

● The Technical Services Branch will forward the License Agreement to the County Manager's Office for the appropriate signatures.

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EMS & Fire Reporting

CHAPTER 7.24

Issued: January 1, 2007 Revised: Jany 11, Aug 11, Nov 12

Submitted by: EMS Branch Approved by: Chief Bailey

Purpose

To ensure that a complete and accurate report is completed and submitted for all incidents.

To ensure that appropriate documentation and continuum of patient care are recorded.

To ensure that appropriate documentation of all activities at fire, hazardous materials, and other major incidents are recorded.

General

The Department shall utilize a designated electronic reporting system as the reporting mechanism for all incidents.

The Company Officer (Lieutenant, Rescue Lieutenant) is responsible for the submission of all reports assigned to their respective apparatus. A report shall be completed detailing the actions of each apparatus dispatched. All apparatus dispatched to an event will receive an Incident Number. This number will allow multiple unique reports for each event.

CAD information shall be imported for ALL reports (CAD(F2)/Import Selected CAD Info). This information may be modified after import to improve accuracy.

A request to dispose of a CAD Record may be submitted for verified Incident Number assignment errors.

All reports shall be complete, accurate, and submitted immediately after the incident. All narratives shall include a description of the following:

● Incident the units were dispatched to

● What was found

● What was done

● What happened as a result of what was done

● How the incident was terminated

Should an extenuating circumstance arise where completing the report will be delayed, the District Chief shall be contacted for approval.

EMS Reports

A complete and accurate report shall be completed for all assigned incidents including but not limited to EMS standby, cancellations and diversions (incident reassignment).

An EMS report shall be completed on every patient contact, by each unit making patient contact, regardless of the unit type (first response or rescue) or treatment administered.

A patient is defined as “An individual who presents with a chief complaint or has evidence of a medical condition, injury or who has vital signs outside the normal range”.

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The Company Officer of each unit is responsible for the completion of a patient care report on every patient contact, regardless of treatment administered. Paramedics shall complete ALS reports and EMT’s may complete BLS reports at the discretion of the Company Officer. This will provide documentation of continuum of care and actions taken by the units assigned to the incident.

The NFIRS TAB of the EMS report shall be completed as well by all responding units. This will satisfy the NFIRS reporting requirement, negating the need for a separate fire report for this incident.

The following dispositions are contained in EMS Pro and will require a narrative only for Non-Transport Dispositions:

● Cancel (By Dispatch)- canceled en route, canceled by caller through dispatch.

● Cancel (By EMS Agency) – cancelled en route by another Rescue responding or that has arrived on scene. Canceled while on scene (with no patient contact). Special requests for blood draw. Team/Organ Transports (Must get UNOS ID, organ type, company name, address and phone number)

● Stand By- Special Events

● Cancel (By Fire Agency) – cancelled en route by Fire Apparatus responding or on scene.

● Cancel (By Law Enforcement)- cancelled en route by Law Enforcement.

The following Non-Transport Dispositions will require a full report:

● Pronouncement of Death

● Refused Treatment/Transport – cancelled with waiver obtained, canceled with patient refusing to sign waiver.

● Treated and Refused Transport – patient refuses transport after treatment has been administered (MCP contacted).

● Transfer to Another EMS Agency – An ACFR unit that arrives first on scene, making patient contact and transfers care to the transporting unit. Transfer to outside EMS Agency, (Shandscair).

A report for each patient transported is automatically faxed to the destination hospital by EMS Pro once the report is signed by the Rescue Lieutenant.

Fire Reports

A Fire Report shall be submitted for all events which receive an Incident Number including but not limited to Fire standby, cancellations and diversions (incident reassignment).All ACFR units shall complete the NFIR’s page. The type of fire report completed will be determined by the order of arrival and/or action taken.

The Company Officer from the first arriving ACFR suppression apparatus (excluding Rescue and District Chief) shall ensure that a “primary/detailed”Fire Report, regardless of the incident location, is submitted for all fire suppression related events (alarms, hazardous conditions, fire of any nature, etc.). The Officer from each of the other dispatched suppression apparatus (including District Chief and Rescue Unit) shall submit a supplemental report (Incident Type: 000 Supplemental) detailing their actions. This will provide documentation of all activity at the scene and allow for a better recreation of the incident. In the event of simultaneous arrival, the Officer from the apparatus (excluding Rescue and District Chief) of which the call is in their first due area shall complete the primary/detailed report. In the event that all units are canceled en route, the closest suppression apparatus shall complete a primary report, all others shall complete a supplemental (000).

When multiple fire suppression apparatus from one station are assigned to an incident (i.e. Brush 15 and Tanker 15) an individual report shall be required for each unit. If the tanker or brush units respond to independent calls a primary/detailed report shall be completed for each separate call.

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RULES & REGULATIONS RIDE-ALONG

CHAPTER 7.25

Issued: November 2010 Revised: July 11, Sept 11

Submitted by: Deputy Chief Northcutt Approved by: Chief Bailey

All non-Alachua County Fire Rescue employees riding on ACFR units must comply with the following:

No one is permitted to ride on an Alachua County Fire without proper compliance with these regulations and procedures.

All riders will complete a Ride-Along Release except personnel from the following categories: (Exempt)

● New Alachua Fire Rescue Employees on Orientation.

● Alachua County Sheriff's Office, Cooperative Dispatch Center, Personnel on Orientation, or Radio Module Training.

● Students of a current contracted Clinical Agreement and the Agreement must include the following: ● A liability statement.

● Students of a program without Clinical Agreement with ACFR will need a Ride-Along Form and will comply with all other sections. These students will not have priority over contracted students.

Dress Code

● Navy or Black long pants (pants must be worn at the waist line)

● Black or dark blue socks

● Grey, Blue or White shirt with collar (polo shirts preferred), black belt

● Shirt must be tucked in

● Black polished and laced leather shoes

● Company logos are allowed on shirts (paramedic and EMT student shirts only)

● Minimal jewelry (no facial jewelry, no earrings)

All riders must be at least 18 years of age, except as authorized by the Chief.

Reporters from media must have prior authorization from the Chief or his/her designee.

Representatives from government agencies must have prior authorization from the Chief.

There will only be one rider per Apparatus. No riders of any sort are permitted in vehicles that cannot accommodate the rider in a safe fashion.

All Riders will be coordinated via the Technical Services Branch prior to riding.

When a rider appears for a ride-along the crew will check Telestaff to confirm scheduling. If the rider is not scheduled

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on Telestaff the crew will contact the Duty District Chief to confirm authorization to ride.

No ride will be scheduled between 0000 and 0800 hours without prior approval from the Chief.

All non-program sponsored Ride- Alongs will end at 2100 hours unless it is a part of a clinical ride along.

Prior to anyone riding a unit, a safety orientation session will be conducted by the supervisor with the rider(s). This session will include at least the following:

● Department regulations about seat belt use.

Department safety guidelines.

Crew members in-charge for scene activities.

Ride-Along Forms are available via the Intranet.

The Ride-Along Form is to be kept on file for a period of at least three years at Headquarters.

County Policy dictates that non-employees are not permitted to ride in County Vehicles in a non-authorized capacity. The accompaniment of a patient's family or close friend on an EMS Transport Unit on a bona fide Patient Transport is not required to comply with these guidelines, except for safety components. In an emergency transport situation the family rider should be briefed of this type of situation before or as the ride begins.

Riders not associated with a Department approved program must be authorized by the Chief or his/her designee.

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ROADWAY EMERGENCY TRAFFIC MANAGEMENT

CHAPTER 7.26

Issued: December 2007 Revised:

Submitted By: Approved By: Edwin C. Bailey, Director

IT SHALL BE THE POLICY OF ALACHUA COUNTY DEPARTMENT OF PUBLIC SAFETY TO POSITION APPARATUS AT THE SCENE OF EMERGENCIES IN A MANNER THAT BEST PROTECTS THE WORK AREA AND PERSONNEL FROM VEHICLE TRAFFIC AND OTHER HAZARDS.

Goals:

● Safety of personnel and patients ● Expeditious scene operations ● Rapid termination of incident and reopening of roadway

Purpose:

● Provide a safer work environment when working roadway incidents ● Ensure that emergency operations are performed in the most expeditious manner when working a roadway incident. ● Ensure that the designated safer area is proportioned to the incident.

General: The National Fire Protection Association (NFPA) 1500 Chapter 8.7 provides guidelines for emergency operations at traffic incidents. The components of a Temporary Traffic Control Zone (TTCZ) include:

● Advance warning area ● Approach area ● Transition area ● Fend-off position ● Shielding Apparatus ● Activity area ● Termination area

The first arriving unit shall ensure that traffic is controlled before addressing the emergency operations (NFPA 8.7.7)

A TTCZ shall be established at all roadway incidents where emergency or non-emergency operations are established.

Staging of the first arriving, emergency response apparatus is critical to the development of an effective TTCZ. Since the primary function of this apparatus is firefighting and rescue this position must also compliment the capabilities of the fire rescue team. The staging position of apparatus should:

● provide a shield to the incident with reference to NFPA 1500 (8.7),

● remain firefighting and rescue functional,

● provide immediate advanced warning to the incident, and

Apparatus staging involves an angled parking procedure or fend-off position, in addition to establishing a buffer space and lateral buffer.

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FEND-OFF POSITION To make the best use of fire department vehicles, the “Fend-off”position was developed as shown in Figure 1. To establish the fend-off position, the driver should pull as far to the right or left as possible, then turn sharply back, to position the vehicle at 20 to 30 degrees to the roadway. This recommended method of positioning emergency apparatus provides an initial level of safety to the scene for several reasons: Apparatus not protecting the scene or rescuers shall be parked immediately down-way of the incident site. Their location should not create a traffic hazard or obstruction, or impede other emergency services.

BUFFER SPACE It is recommended that a “Buffer Space”, as shown in Figure 1, be maintained between the incident site and shielding apparatus. This creates a clear area or space between the shielding vehicle and the incident site or potentially hazardous area. The suggested distance is 75–100 feet up way from the accident. Reasons for the buffer space include:

Cones can be used to close off the buffer space to vehicle traffic by placing them along the skip line.

The front bumper of the shielding apparatus should be no closer than 0.6m to the lane divider line as shown in Figure 1. A traffic cone shall be placed on the lane divider line directly in front of the corner of the front bumper.

Traffic cones shall be placed on the lane divider approximately every twenty feet along the buffer area to help prevent vehicle reentry into the area.

Click to view →FIGURE 1 Apparatus Staging

ESTABLISHING A TRAFFIC CONTROL ZONE

Click to view→FIGURE 2 Temporary and Emergency Traffic Control Zones

COMPONENT AREAS OF AN EMERGENCY TRAFFIC CONTROL ZONE A well-designed emergency traffic control zone should reflect five distinct component areas. These areas are described below in the order in which drivers would encounter them.

Advance Warning Area

● It should alert the motorist that there is a traffic situation or difficulty ahead, which will require some action on his or her part.

Approach Area

● It should identify the nature of the equipment or vehicle that he or she is about to encounter and allow them to analyze the situation.

Transition Area

● It should provide some indication as to the actions to be taken by the motorist so they can decide a course of action and execute safe driving techniques before entering the activity area.

Activity Area

Recommended components include:

● Fend-Off Position (Fire Apparatus). ● Buffer Space (scene protection area). ● Incident Site (a restricted area for authorized personnel). ● Traffic Space (where traffic is allowed to pass through the activity area, next to the incident). ● Staging Area: Emergency vehicles performing COMMAND functions or not immediately required for shielding or providing direction, that are unable to park in a safe area off of the roadway, may be directed to STAGE in this area, downstream of the Incident Site. Their location should not create a traffic hazard or obstruction, or

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impede other emergency services.

Termination Area

This area is where traffic returns to its normal path. The termination area extends from the downstream end of the staging area to the point where traffic is able to resume normal driving. Traffic control may be required in this area under emergency conditions when access to off ramps, on ramps and intersections compromises motorist safety.

NOTE: Two or more of the component areas may be combined in emergency situations where traffic volume, speed, visibility and conditions permit.

Establishing a secure emergency traffic control zone takes time and should be a progressive activity defined by the officer in charge, and is based on the manpower available and the critical needs of the incident.

EXAMPLES OF VIEW OBSTRUCTIONS - HORIZONTAL CURVE The following Figures 3 and 4 are examples of horizontal view obstructions. The term Horizontal Curve is used to describe a level section of curved roadway. This type of situation may have trees (as per example) or buildings on the inside of the curve that affects the sight distance of the motorist. Adequate sight distance can be an important factor in these instances, as it allows the driver time to perceive that a hazard is present and react accordingly.

Click to view→FIGURE 3 AND 4 - Examples of VIew Obstructions - Horizontal Curve

When it is determined that a horizontal view obstruction exists, steps should be taken to move the set-up back to a point that allows the oncoming motorist more perception and reaction time.

NOTE: Substitute vehicle headlight illumination for sight distance and this diagram would provide an example of reduced visibility (darkness). Traffic set-ups at night should consider that the driver’s vision might be reduced by a combination of vehicle speed and headlight performance.

EXAMPLES OF VIEW OBSTRUCTIONS - VERTICAL CREST The following illustration is an example of a vertical view obstruction. The vertical crest of a hill reduces the motorist’s visibility of the roadway as shown below. The sight distance in this situation must be adequate for the driver to perceive that a hazard is present and react accordingly.

Click to view→FIGURE 5 View Obstruction - Vertical Crest

SETTING UP TAPER AND TANGENT SECTIONS Tapers and tangents will vary in length. A freeway requires longer tapers and tangents than a local street. Emergency personnel must also consider the conditions affecting cone placement to establish a safer and effective traffic control zone. Longer tapers and tangents allow more time and distance for the motorist to react to a lane closure or change.

If the incident affects more than one lane of traffic each traffic lane should be closed separately.

Click to view →Taper and Tangent Sections

Click to view→TAPERS AND TANGENTS INVOLVING CURVED SECTIONS

SET-UP AND TAKEDOWN OF THE EMERGENCY TRAFFIC CONTROL ZONE

The greatest risk to firefighting personnel occurs during two phases of Traffic Management, set-up and takedown. During the set-up phase, apparatus staging and the placement of equipment establishes an emergency temporary traffic control zone. Until all warning devices are in position, approaching motorists may not be expecting to find firefighters and their equipment on the roadway.

TRAFFIC MANAGEMENT SET-UP CONSIDERATIONS The following example identifies some of the set-up considerations when closing one or more lanes of traffic on a

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high volume, high speed roadway. This scenario may be considered as one of the more complex or as requiring the most apparatus, equipment and manpower to complete. Each situation encountered will require individual assessment and may require periodic re-evaluation to ensure that apparatus position and warning device placement is adequate.

The primary response apparatus is usually the first unit to arrive at an incident, and as Incident Command, should consider the following:

● Establishing a buffer space between the incident site and the apparatus. ● Positioning the apparatus to protect the immediate scene by parking in the fend-off position. Units with arrow boards may park parallel to traffic lanes. ● Maintaining a lateral buffer to reduce apparatus lane encroachment. ● Designate a fire fighter for cone placement. The fire fighter dons the traffic jacket and when safe to do so, places cones on the roadway in the following areas: 1. Lateral Buffer – They place a traffic cone on the skip line adjacent to the corner of the apparatus, next to the traffic flow. 2. Advance Warning - Initial cone placement is initiated on the approach to the emergency vehicle. One of the safest methods for distributing traffic cones is from the shoulder or non- traffic area of the roadway. Cones and are removed from the apparatus and placed on the, curb, sidewalk, roadway shoulder, etc. While facing oncoming traffic and staying in the non- traffic area, a reasonable number of cones are carried adjacent to the intended position of the first cone. When safe to do so, the fire fighter steps onto the roadway, positions the cone and returns to the shoulder. They continue to distribute the remaining cones in the same manner as above, with consideration to the conditions affecting cone placement (as shown in Section 4.2 Securing the Scene), until all of the cones dedicated for advanced warning are in position.

3. Buffer Space – Delineation devices are placed along the skip line between the lateral buffer and the incident to outline the traffic space and secure the incident site.

TRAFFIC MANAGEMENT TAKE-DOWN CONSIDERATIONS Taking-down the emergency traffic set-up needs to be well organized and coordinated by the Incident Commander. The removal of apparatus and equipment from the roadway must be a priority of Command in order to provide the required level of safety to each situation. The following recommendations should be considered when preparing to terminate an incident:

● The law enforcement agency “Officer in Charge”and the Fire Department “Officer in Charge”should liaison to develop a joint procedure for take-down and the re-establishment of traffic flow. ● All apparatus stays in place until the Incident Commander gives the order to start take-down operations. This will ensure that all personnel are aware that the incident is terminating and traffic flow will be resuming. ● Each lane should be opened individually, starting with the lane closest to the centre of the roadway. ● Takedown should follow the same order as the setup, with the last traffic control device removed from the roadway in the advance warning area.

NOTE: Due to the non-emergency status of the takedown operation, the Incident Commander (police and/or fire officer in charge), should arrange to have fire apparatus or police vehicles shield fire fighters when they remove equipment from the roadway.

Vehicles will carry traffic cones as follows:

Engines 4 Rescue 2 Staff vehicles/District Chiefs 2

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STANDARD OPERATING GUIDELINES Aircraft Crash

CHAPTER 8.1

Issued: November 2010 Revised: Submitted by: SOG Team Approved by: Chief Northcutt

PURPOSE

A. To establish guidelines for the handling of emergency incidents with the airport personnel. B. To establish an Incident Command Procedure for emergency incidents at the airport.

POLICY

A. The fire department shall follow these guidelines in working with airport personnel in the handling of emergency incidents at the airport. B. The fire department shall follow these guidelines to insure the safety of personnel while operating on the airport.

PROCEDURE

A. UPON ARRIVAL 1. a. Report on conditions. b. Size up conditions. c. Request additional assistance if needed. d. Establish an operational perimeter. e. Establish a command post. B. SAFETY

1. Full protective clothing and breathing apparatus. 2. Use proper procedures for crossing taxiways and active runways. 3. Beware of the propellers, rotors and jet exhaust. 4. Do not approach military aircraft from the front. They may be loaded with ordinance. 5. Follow the directions of the CFR (Crash-Fire-Rescue) Crew if on scene. 6. Beware of fuel spills and vapor clouds. 7. Be prepared for possible explosions. 8. Keep personnel away from aircraft if not participating with the incident.

C. OPERATIONS

1. Dispatch shall notify the proper support agencies in the event of an alarm for an in-flight emergency. 2. If an aircraft crashes on the airport property or off the exact location and best approach route should be relayed to responding apparatus and agencies. 3. If a command post is established the highest ranking chief officer shall assume the Incident Commanders position. 4. If there is no fire: a. Use foam on spilled fuel and aircraft to minimize ignition potential. b. If foam is not available, flush spilled fuel away from cabin or cockpit and keep fog streams in operation while effecting rescue of occupants. (Remember, keep in mind where the spilled fuel may be running.) c. Take precautions against possible fuel ignition. d. Set up a safety perimeter around the incident site.

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e. Try and determine if there are any hazardous materials on board the aircraft. 5. If there is a fire: a. Approach from windward, if possible. b. Use foam if available. c. If foam is not available, use fog streams to drive away fire from occupants and to cover firefighters on nozzles and those attempting rescue. d. Protect exposures. e. Set up a safety perimeter around the incident site. f. Try and determine if there are any hazardous materials on board the aircraft.

Gainesville Regional Airport Alert Levels are listed below:

Alert 1 – Indicates that an aircraft is approaching the airport in minor difficulty. Fire/Rescue units stand by on the station ramp.

Alert 2 – Indicates that an aircraft is approaching the airport in major difficulty. Fire/Rescue units deploy to pre- determined locations.

Alert 3 – Indicates that an aircraft accident/incident has occurred or is imminent on or near the airport. This definition also includes aircraft fires not involving a crash, aircraft off the runway, etc.

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STANDARD OPERATING GUIDELINES Apparatus Response to Brush Fires

CHAPTER 8.3

General

● If the incident is an extended operational period the Station may be backfilled with overtime personnel to place structural apparatus in-service. ● Water Tanker apparatus are only authorized to respond non-emergency, regardless of staffing. ● staffed with one person shall only respond non-emergency. ● After returning to station place structural apparatus back in service.

Stations staffed with two (2) personnel with a light duty brush truck

● Two persons on the light-duty brush truck. ● Engine is out of service for duration of call or until staffed with back fill.

Stations staffed with three (3) personnel with a light duty brush truck

● Two persons on the light-duty brush truck ● One person follows non-emergency with: ● Engine if hydrant area. ● Tanker if non-hydrant area or Engine if Tanker is out of service. ● If the engine is not used. Place it out of service until you return to station from incident or until staffed with back fill.

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STANDARD OPERATING GUIDELINES Building Collapse

CHAPTER 8.4

Issued: December 2010 Revised:

Submitted by:SOG Team Approved by: Chief Northcutt

PURPOSE

To provide guidelines for the safe handling of building collapse incidents.

POLICY

In the event of a building collapse, be it partial or total, the following guidelines shall be adhered to.

PROCEDURES

A. Give a report on conditions include: type of occupancy, size of building, extent of damage, probable number of victims, etc. and approximate number of ambulances needed.

B. Request notification of Building Services, LEA, County Light Technical Team, also the gas and electric companies to shut off utilities.

C. Request heavy-duty equipment (cranes, bulldozers, loaders, etc.) if needed.

D. Request notification of an experienced demolition contractor if needed.

OPERATIONS

A. Operations must proceed at a pace which will provide for the safety of those trapped as well as those directly involved in rescue efforts.

B. Shoring operations may be necessary to reach trapped victims.

C. Obtain advice of building official as to stability of balance of structure.

D. Request LEA to rope off or barricade the area, to keep spectators away.

E. Call for Medical Examiner, if needed.

F. Provide emergency medical care as needed.

G. Before returning to quarters, see that barricades are placed and signs posted to warn of unsafe conditions.

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STANDARD OPERATING GUIDELINES Building Fire (Residential)

CHAPTER 8.7

Issued: Revised: January 2006

Submitted by: SOG Team Approved by:

GOALS AND OBJECTIVES:

● To mitigate hazards effectively and as efficiently as possible ● To provide a means of suppressing fires when they occur within a residential structure ● To establish guidelines in which all personnel have a clear understanding at all emergency scenes.

EQUIPMENT:

● Two engines company ● One truck company or Tanker ● One squad company ● One rescue company ● One district chief ● Or a second alarm ● Or third alarm

TACTIC/ACTION PLAN:

● Offensive Mode: Interior attack and related support directed towards quickly conducting search for victims and bringing the fire under control ● Defensive Mode: Exterior attack directed to first reduce fire extension and then bring the fire under control, while protecting exposures ● Investigative Mode: Situation which requires investigation by the first arriving unit ● Ventilation Mode: Removal of toxic gases from the structure by mechanical, natural, or hydraulic removal ● Salvage and Overhaul: Stopping loss by limiting smoke and water damage ● Search and Rescue: Searching for victims and removing them from hazardous conditions

ATTACK:

First Engine Company Assignment

● Locate, Confine and Extinguish ● Must use a direct, indirect or combination attack ● Place the first hose line on the unburned side and push to the burn side ● Choose the proper hose size to attack the fire ● Must have at least two personnel on the interior attack hose line ● Prior to making and offensive attack a RIT must be established within RIT guidelines. ● Conduct a primary search ● Must secure a water supply; i.e. forward lay, reverse lay, or rural hitch

Second Engine Company Assignment

● Lay into first engine from the closet stage at hydrant ● Report to IC for the next assignment

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Squad Company Assignment

● Provide lighting at the fire scene ● Fill air bottles ● Any other related duties assign by the IC

Rescue Company Assignment

● Provide Advanced Life Support (ALS) ● Place unit out for tactical advantage ● Bunker out in full PPE gear ● Proceed to the scene command post with the following items. ● Stretcher ● ALS and Airway bag ● Cardiac Monitor ● Backboard and CID ● Check with the IC and await further assignment

VENTILATION:

First Truck Company assignment or second engine if no water supply is needed.

● Must coordinate with first in engine if forcible entry is needed ● Must coordinate the ventilation with the interior attack crews ● Must have two personnel assigned to the primary search and secondary search one man assigned to OVM ( outside vent man) and utilities and gas shut off. ● Two personnel will carry set of irons and other tools needed ● Three types of ventilation: Mechanical, Natural, or Hydraulic ● Must use Vertical, Horizontal, or Positive pressure ● Tools for ventilation; i.e., pike poles, closet hook, pike head axe, smoke fan, chain saw, roof ladder, extension ladder, and other assorted tools. ● All vents holes will be cut as close as possible to the seat of the fire ● All vertical openings must be 4’ x 4’ holes ( square holes) ● Must have two means of egress off of any roof when a vent hole is being cut ● Must work from a roof ladder and have a charged hose line in place when cutting a vent hole ● This is a minimum of three personnel when cutting a vent hole

SALVAGE AND OVERHAUL:

● This will be assigned by the IC. ● To extinguish all hot spots on the fire ground. ● Salvage as much as possible for the owner. ● Tools for the job; i.e., Salvage covers, wash tubs, shovels, pike polls, axes, ladders, chain saws and other tools as needed.

PERSONNEL:

● Two engines; i.e., six personnel One truck company; i.e., three or four personnel ● One squad; i.e., three personnel ● One rescue; i.e., two personnel ● One district chief; i.e., one personnel ● Additional alarms if needed

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SAFETY CONSIDERATIONS:

● Must follow two in and two out rule ● Must have two personnel on a interior attack line ● Must have a RIT established if an interior attack is made unless there is a victim trapped inside then a RIT team must be established as soon as manning permits. ● Must wear all PPE while on fire ground

POST INCIDENT MANAGEMENT:

● Must have a review of all working fires

DISPATCH RESPONSE:

● Follow dispatch protocols

ARRIVAL REPORT/SIZE UP:

● The systematic ( and on going) process of conducting rapid, yet deliberate consideration of all critical fire ground factors including: ● Number of stories ● Type of structure ● Conditions showing ● Side(s) of the building where the hazard is showing ● Assume command of the scene and identify command name ● Mode of operation

FACTORS OF CONSIDERATION

● Location ● Extension possibility and probability ● Life hazard ● Time ● Weather ● Construction ● Height ● Area ● Occupancy ● Access ● Internal protection ● Water supply ● Apparatus ● Personnel ● Terrain ● Good communication and proper coordination are essential at a structure fire ● Incident command must provide a necessary coordination of the various fire ground activities ● The Incident command must communicate all instructions and vital information clearly to those on the fire ground.

REHAB

● Rehab will be established on all working fires. ● Rehab must be anticipated and requested early in the event. ● If the fire is a large scale event the Reserves must be notified to bring all equipment for rehab. ● Pre and Post vitals will be monitored while in rehab and recorded by the rehab officer

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ANCILLARY RESPONSE

● Must request the proper equipment for the job.

VEHICLE PLACEMENT

● The first in engine shall pull past the structure. ● The first in Truck shall have the front side of the building and at least one corner of the structure. ● Second in engine shall stage at the closet hydrant and await orders ● Rescue will stage with access to scene and egress away from scene. ● Squad will be place in a manner is suitable for lighting.

NOTIFICATIONS

● Administration will be notified on all working fires per dispatch SOP’s

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STANDARD OPERATING GUIDELINES Elevator Stuck

CHAPTER 8.12

Issued: December 2010 Revised:

Submitted by:SOG Team Approved by: Chief Northcutt

PURPOSE

To establish guidelines for handling elevator emergencies in the safest way possible.

POLICY

When it has been determined that persons are trapped in an elevator the following guidelines have been established.

PROCEDURE

A. Upon Arrival

1. Request dispatcher to notify elevator mechanic to respond. (Obtain name and phone number from occupant.) 2. Reassure trapped passengers that efforts are underway for their release. Ascertain if any passengers are ill or injured. 3. Locate the position of the stalled car and obtain over-ride keys, if so equipped.

B. SAFETY PRECAUTIONS

1. The safest means of rescue is through elevator doors (hoistway and car). 2. If passengers are being removed from elevator by any means other than the car doors, then the mainline disconnect must be opened. 3. Whenever possible, elevator emergencies should be handled by elevator mechanic with fire department personnel assisting. 4. Barricade any openings into the hoistway. 5. When a car is stalled more than three (3) feet below a landing, it is recommended that passengers be removed through the top escape hatch.

C. PROCEDURE FOR FREEING PASSENGERS

1. Locate the stalled car. 2. Communicate with passengers either by elevator phone or by yelling through the elevator doors. 3. Check the power supply systems. (Mainline disconnect, breakers, fuses, etc.) 4. Have passengers check the Emergency Stop button. 5. Push the landing button and have passenger push "Door Open" or "Floor" button simultaneously. 6. Shake hoistway doors and have passengers shake car doors simultaneously. 7. Attempt to break light beam with thin piece of cardboard or paper. (Power on) 8. Turn power off. 9. Have passenger open car doors. (Rescuer may have to enter through top hatch to perform this.) 10. Have passenger or rescuer open hoistway doors. 11. Trip the interlock using tools available. 12. Cut or pry doors. (Life or death situation only)

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STANDARD OPERATING GUIDELINES Vehicle Accident with Extrication

CHAPTER 8.29

Issued: November 2010 Revised: Submitted by: SOG Team Approved by: Chief Northcutt

Goal

Disentanglement from and/or removal of a vehicle from its occupant/s.

Objectives

Establish Perimeters A “Hot Zone”and a “Cold Zone”will be identified to establish areas of specific tasks and/or functions.

Hazard Assessment Account for all conditions which are potentially hazardous.

Occupant Contact Determination of the number and condition of the vehicle occupants.

Vehicle Stabilization Secure the vehicle in place.

Occupant Access/Preparation Establish physical contact with occupants, protect them from flying glass and remove seatbelts.

Glass Removal Eliminate necessary window panes and/or windshield.

Activator and Pretensioner Assessment Removal of the interior plastic trim to locate airbag and seatbelt components.

Occupant Packaging Provide medical treatment as indicated including cervical spine immobilization, wound care, venous access etc.

Equipment Staging Locate and prepare an area near the vehicle for holding extrication equipment.

Door Removal Open and remove vehicle doors as needed.

Roof Removal Remove or flap vehicle roof as needed.

Seat Displacement Adjust vehicle seat position to maximize occupant legroom.

Dashboard Displacement Make relief cuts in the vehicle body and lift the dashboard.

Seat Removal Remove vehicle seat components as needed.

“Third Door”Technique

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Create a door by breeching sheet metal or enlarge an existing opening by removing the entire “B”post.

Occupant Removal Remove all vehicle occupants.

Safety Considerations

Personal Protective Equipment

The “Class D”uniform ensemble is required for all personnel inside the extrication activities “Hot Zone”. Fire suppression rated gloves may be exchanged for other types of hand protection such as leather work gloves, extrication, technical rescue or “mechanic”gloves or other appropriate hand coverings. The technical rescue helmet with goggles may be substituted for the fire suppression helmet.

Vehicle Traffic

Awareness of vehicles and machinery operating near the extrication site is paramount. Appropriate apparatus placement will reduce but not eliminate the potential for injury to those working the incident. A “spotter”should be assigned if adequate personnel are present. Placement of traffic cones may assist motorists navigating through the area. Ideally, law enforcement personnel should provide traffic control and traffic should be stopped if conditions warrant.

Hazard Recognition

Initial arriving personnel are responsible for identifying potential hazards and relaying this information to other responding apparatus. Low hanging power lines, weakened structures, leaking fluids, downed trees, hazardous materials placards, livestock, swift water, lightning and traffic are just a few. Consideration of these conditions will dictate the approach to the incident and the tactics to be employed.

Personnel Conditioning

Extrication activities are physical and demanding. Prolonged scene times can lead to exhaustion and mental fatigue. All personnel should monitor themselves for signs of weakness and deteriorating performance. A rotation of personnel should be established when extended scene times are suspected. An Incident Safety Officer and Rehabilitation Area should be designated early in the incident.

Dispatch Response

Personnel

The extrication group consists of varied positions dependant upon the type and difficulty of entrapment. Individuals may be assigned multiple positions and/or tasks when necessary. Not all positions will be utilized during every extrication and some incidents will require the creation of positions not listed here.

Extrication Group Supervisor

The Extrication Group Supervisor (EGS) is responsible for the extrication process. This individual develops the strategy and identifies the tactics utilized during the event. A successful EGS will solicit suggestions from the group and act upon the most appropriate. The EGS will report to the Operations Chief or a Branch Director if assigned. On smaller incidents the EGS may report directly to the Incident Commander when the EGS is designated as Operations. The EGS may or may not be located in the “Hot Zone”as conditions warrant.

Tool Staging Manager

The Tool Staging Manager (TSM) is responsible for maintaining inventory and organizing the tools and equipment utilized during the extrication. The EGS may delegate the staging area location to the TSM. Tools and equipment will be brought to the staging area in a proactive timeframe and organized in a logical manner. Tools and equipment that are damaged or rendered unusable during the event will be removed from the staging area and placed out of service until repaired. The TSM will report to the Operations Chief or Incident Commander if an Operations Chief has not been designated.

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Hydraulics Task Force

These Single Unit Resources will work in unison to efficiently expose and dismantle the vehicle. The Hydraulics Task force (HTF) will utilize hydraulic powered tools to spread and peel sheet metal, cut hinges and posts, lift and separate vehicle assemblies and perform other designated tasks. One member of the HTF will be identified as the Leader and will report to the EGS.

Pneumatics Task Force

These Single Unit Resources will work in unison to efficiently lift and stabilize the vehicle or adjacent objects. The Pneumatic Task Force (PTF) will utilize compressed air operated tools to lift and/or stabile vehicles and machinery, move objects impeding the extrication process and cut through sheet metal and/or laminates. One member of the HTF will be identified as the Leader and will report to the EGS.

Ancillary Response

As requested by IC

Notifications

Follow Dispatch SOG’s

Action Plan

Apparatus Placement

Arrival Report

Equipment

Tactics

Vehicle Stabilization

Mechanical

● Engine shut down ● Turn the ignition key to the “off”position and remove the key (consideration given to displacing electric seats prior to key removal). ● Parking Brake ● Fully engage the parking brake ● Engage transmission (first gear or park) ● Place the transmission lever in the “Park”position on automatic transmission vehicles. Place the gear shift lever in the “first”gear position on manual transmission vehicles.

Physical

● Chocks, Struts, Jacks, PLD, Chains,etc. ● Electrical ● Battery/ies isolation.

Rehab

Rehab unit should be paged as soon as possible and should be used on any long term incident.

Post Incident Management

All extrication events shall be reviewed/critiqued post incident.

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Incident Command and Company officers shall evaluate crews for need of CISD.

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On Scene Operations

CHAPTER 8.35

Issued: December 2011

Submitted by: Deputy Chief Northcutt Approved by: Chief Bailey

Arrival Report

When the fire units arrive at the scene of an incident, they must announce their arrival on the operational TAC.

The first unit on scene should announce a description of the scene in the following order:

● Unit ID ● Visual description of the scene ● Visual description of hazard or injury ● Report of operational mode ● Assumption of command

The Dispatcher repeats the arrival report on the operational TAC.

EXAMPLE Situation: Arrival report given by Engine 21. E21: “Alachua County, Engine 21 on scene, two-story wood framed residential structure, smoke and flames showing, we’ll be in Offensive Mode, 29th Street Command” CDC: “E21 on scene, two-story wood framed residential structure, smoke and flames showing, Offensive Mode, assuming 29th Street Command, (time)”

EXAMPLE Situation Arrival report given by Rescue 1 M1 “Alachua County, Rescue 1 on scene, 2 vehicle accident, Investigative Mode” CDC “Rescue 1 on-scene, two vehicle accident, Investigative Mode,(time).

Safety Staging

ACFR is often sent to disturbances where injuries or other hazards are involved. If it is believed that Fire Rescue personnel may be in danger according to the information provided to them by the Fire Rescue Dispatcher and Call Takers, they may elect to stop short of the actual address and wait for law enforcement to secure the scene. The Fire Rescue Dispatcher should attempt to provide as much information as possible regarding the scene and its dangers so that the ACFR crew members can make as informed a decision as possible.

When units advise they are staging, this will be entered in CAD along with their location.

Although requests from law enforcement agencies for ACFR to stage shall be relayed to the responding units, Fire Rescue Dispatch will refrain from ordering them to stage. If ACFR units decide to stage, the appropriate LEA Dispatch Center must be notified of the location of the staging units, for safety purposes.

When LEA secures the scene, the Fire Rescue Dispatcher will be notified by the appropriate LEA Dispatcher that the staging unit(s) can be directed to report to the scene. If the incident is being handled by Gainesville PD or another municipal police agency, the Fire Rescue Dispatcher should expect a phone call from that agency when the scene is secure.

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When the Fire Rescue Dispatcher is notified that the scene is secure and the staging units are advised, this information will be entered in the CAD narrative field.

Placement Effective apparatus placement begins with the arrival of the first units. The placement of the initial arriving apparatus (, Engine, Aerial, Tanker etc.) should be based up initial size-up and general conditions upon arrival. First arriving companies should place themselves to maximum advantage and go to work: later arriving units should place themselves in a manner that builds on the initial plan and allows for expansion of the operation. Upon arrival evaluate and communicate as soon as possible. Let CDC know what you find and what you need.

During your approach watch for victims or survivors that may have been thrown clear of the emergency scene, spectators and debris. You may have to take an alternate route to reach the scene. Company Officers arriving after initial company should report to Command for specific assignment either in person or by radio.

Charge Hydrant (Supply Line)

When the order is given to utilize a supplemental water source the Driver Operator shall signal that he/she is prepared for the supply line to be charged by blowing the apparatus air horn 3 consecutive times.

Size-up

The systematic (and ongoing) process consisting of the rapid, yet deliberate, consideration of all critical fireground factors and leads to the development of a rational attack plan based on these factors.

Factors to consider

Location Extension possibility and probability Life Hazard Time Weather Construction Height Area Occupancy Access Internal protection Water Supply Apparatus Personnel Terrain

Operational Modes Investigative Mode: These situation generally require investigation by the first arriving rescue, engine, or tanker and while holding staged companies at a distance. Normally the officer should go with the company to check for a patient, injuries, hazards, or fire, while utilizing the portable radio for communication. In effect, he creates a “Mobile Command”. Treatment Mode: Giving medical care to patients

Offensive Mode: Actions that involve a direct attack on a fire to directly control and extinguish the fire generally performed in the interior of involved structures. This mode should not last more than a few minutes. Defensive Mode: Conducting an exterior attack, with larger lines, while protecting exposures. Extrication Mode: Person(s) entrapped in vehicle(s), by machinery, in a building collapse, or some other physical confinement are

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being extricated. The extrication process typically involves the use of tools, be they hand tools (axes, halligan bars, sledge hammers, etc.) or power tools (hurt tool, chain saw etc.) Overhaul Mode: Checking the structure to insure that the fire is completely out and securing the scene so that it is safe to leave. Salvage Mode: Conducting activities such as smoke and water removal and covering of furniture to reduce damage from water/smoke. Search/Rescue Mode: Searching for victims and removing them from unsafe areas.

Ventilation Mode: Smoke and heat are being removed from the structure by either natural air flow or forced air through existing or intentionally created openings in the structure. Working Fire: A working fire is a fire where a 1½”attack line (or larger) or building’s built-in extinguishing systems are utilized.

Status Reports

Status Reports are given throughout an incident to keep all command and senior officers, as well as the Dispatcher aware of the situation. Status Reports are usually announced by the Incident Commander and may include information on the progress of the incident, patients involved, operational modes, Benchmarks, and special orders.

The Incident Commander should condense status reports to essential information prior to transmitting to Dispatch.

All Clear Primary search has been completed and all salvable occupants have been removed (when it is impossible to conduct a primary search the Incident Commander shall advise that “No all clear will be given”)

Fire Out The fire has been extinguished.

Loss Stopped Salvage activities have been conducted so that no further damage will occur to the property.

Patient Being Transported Patient is being transported to hospital by Rescue unit.

Secondary Search Completed A thorough search of the structure was completed once the fire was controlled or extinguished.

Task Completed The specific task assigned to a unit or sector has been completed. Examples are the completion of ventilation, triage or evacuation.

Under Control The fire can be contained within its present area and can be extinguished with the resources on the scene.

Patient Status Reports

On medical calls, a status report will include whether a patient has been located and an operational mode. Occasionally, if a Rescue unit is not yet on the scene, the fire unit may provide the patient’s vital information on the operational TAC. Medic units will provide patient status reports to CDC on the operational TAC assigned to the incident. However, if a unit gives this information to GPS, CDC must be notified via the Fire Hotline.

EXAMPLE

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Situation: Engine 19 has located the patient of their medical call. E19: “Alachua County, Engine 19” FRD: “Engine 19” E19: “We’re evaluating a conscious 65 year old male complaining of chest pain, treatment mode” FRD: “Engine 19 evaluating conscious male patient, complaining of chest pain, treatment mode (time).”

The Fire Rescue Dispatcher will document patient status reports and the operational mode in the CAD call Narrative.

Additional Alarms An Incident Commander (or first unit on-scene) may also determine that the resources committed will not be able to sufficiently handle the incident and may require another full complement (2 engines, 1 truck/tower or tanker) to be added to the call. This is called a Second Alarm. Each additional alarm is an exact duplicate of the INITIAL DISPATCH as required by the Response Guide. If still another full complement is needed, the Incident Commander will call for a Third Alarm, and so on. The Fire Dispatcher must be aware that additional units could be required at any time.

EXAMPLE Situation: E25, T25, E30, R25, DC25, Medic 7 and DC5 are all on scene of a confirmed building fire at the Merchants & Southern Bank in Hawthorne. DC5(Merchant Command) decides another full complement is required to combat the fire. DC5: "Alachua County, Merchant Command". FRD: “Merchant Command” DC5: “Alachua County Dispatch a second alarm FD: “Merchant Command requests second alarm, (time)". FRD: (TONES: ST31, ST24) “Station 24, Station 31, Second Alarm, Building Fire, Merchants and Southern Bank in Hawthorne, select TAC-2. Station 24, Station 31, Second Alarm, Building Fire, Merchants and Southern Bank in Hawthorne select TAC-2, (time)”( Activate ST 24 Siren)

Evacuation-It may become necessary to evacuate certain areas surrounding an incident to prevent injury or death. For example, areas surrounding the site of a possible explosion, leak or fire are likely to require evacuation. Areas downwind from toxic materials maybe at risk for exposure. Other areas maybe evacuated as a precaution in case conditions change. The IC must decide early what type of protective measures to take, such as evacuation or protecting in place. The area for initial evacuation must be defined, along with contingency areas to be evacuated if conditions change.

Facilities already identified as potential shelters should be designated as staging areas and ultimate destinations.

In-place protection maybe an alternative to evacuation and should be considered under the following conditions:

● Fire spread potential is minimal

● Vulnerable populations, such as the elderly and the sick, could sustain more injury during evacuation, than by staying in place and taking appropriate protective actions.

American Red Cross

The American Red Cross (ARC) is an agency whose mission is to provide various types of support for people in need. During fire incidents the Red Cross may be called upon to provide any of the following services:

● Firefighter relief – providing drinks and snacks for fatigued firefighters.

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Red Cross will need to know how many persons to provide for.

● Support of the homeless – providing clothing and temporary lodging for families who have lost their homes.

Red Cross will need to know number, age, and sex of all persons needing clothing and will need to know the number and sizes of families displaced.

● Evacuation – Assist in evacuating citizens to a safe place and manage evacuation centers.

Once ARC is requested, the Fire Dispatcher shall immediately do the following:

● If requested during normal business hours (M-F 0800-1700 hours), the Red Cross Office shall be called by telephone.

● Any other time, the Fire Rescue Dispatcher will page Red Cross to contact ACFR Dispatch.

● Document the notification and ETA in the CAD narrative.

Collapse

In recent times structural collapse has been one of the leading cause of serious injuries and death to Firefighters. For this reason the possibility of structure collapse should be a major consideration in the development of any tactical plan.

Structural collapse is always a possibility when a building is subject to intense fire. In fact if fire is allowed to affect a structure long enough some structural failure is inevitable.

Regardless of age and exterior appearance of the building, there is the possibility that a principal structural supporting member is being seriously affected by heat and may collapse suddenly inflicting serious injury to emergency personnel.

In the typical structure fire, the roof is the most likely candidate for failure, however, failure of the roof may very likely trigger collapse of one or more wall sections. This is especially true if the roof is a peak or dome type which may exert outward pressure against both the bearing and on-bearing walls upon collapse. In multi-story buildings or buildings with basement, the floor section above the fire may collapse if supporting members are directly exposed to heat and flames.

A knowledge of various types of building construction can be invaluable to the Fire Officer from a safety standpoint as certain types of construction can be expected to fail sooner than others. For example: under fire conditions light weight truss and bar joist roof construction can be expected to fail after minimal fire exposure.

Structures have been known to collapse without warning but usually there are signs which may tip off an alert officer. Action might be taken to avert any eminent hazard.

Tell Tale Signs:

Cracks to the exterior walls Bulges in exterior walls Sounds of structural movement – cracking, groaning, snapping etc. Smoke or water leaking through walls Flexible movement of any floor or roof where Firefighters walk interior or exterior bearing walls or columns – leaning, twisting or flexing.

The following construction features or conditions have been known to fail prematurely or to contribute to early structural failure when affected by fire.

Contributing Factors:

● Large open (unsupported) areas-supermarkets, warehouses etc. ● Large signs or marquees-which may pull away from weakened walls. ● Cantilevered canopies-which usually depend on the floor for support and may collapse as the roof fails.

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● Ornamental or secondary front or sidewalls which may pull away and collapse. ● Buildings with light weight truss, bar joist, or bow strings truss, roofs. ● Roofs supported by unprotected metal-beams, columns etc. ● Look for external signs of wall ties such as stars.

Buildings containing one or more of the above features must be constantly evaluated for collapse potential. These evaluations should be of major consideration toward determining the tactical mode i.e. offensive/defensive.

Personnel Tracking

Station and Resources

Each and medic units has an assigned area for which it is responsible. The responsibility involves responding to calls for service in addition to various details including hydrant inspections, building surveys and more. Each fire station houses different amounts and types of apparatus. Most stations have an engine company assigned to it; some also have truck/tower companies. Some stations house specialized units. Below is a list of all types of apparatus at ACFR's disposal including a generalized description.

Engine Crew (2-4): 1 Company Officer, 1 Driver-Operator, 1 or 2 Firefighters Primary Responsibilities: Fire Truck and suppression, exposure protection, life safety. Truck Tower Crew (4): Company Officer, 1 Driver-Operator, 2 Firefighters. Primary Responsibilities: Search & Rescue, secure utilities, ventilation, salvage & overhaul, elevated rescue, vehicle extrication, assist engine company as needed. Rescue, Light of Heavy Crew (2): 1 Company Officer, 1 Driver-Operator Primary Responsibilities: Medical Assistance, vehicle extrication. Extrication incidents, Forcible entry tools. Brush Truck Crew (1-2): 1 Driver/Operator, 1 Firefighter Primary Responsibilities: Initiate attacks off-road and minimize fire spread and exposure. Vehicle Specifications: Avg. 250 gal. water, 250 GPM pump. Brush trucks are usually 4-wheel drive. Squads are not.

Tanker Crew (1-2): 1 Driver/Operator, 1 Firefighter Primary Responsibilities: Delivery of water supply to fireground in absence of sustained water supply. Vehicle Specifications: Large vehicle with 1250-4000 gal. water (some have up to 3000 gals), 250-750 GPM pump, some units carry portable dump tanks. District Chief Crew (1): 1 District Chief Primary Responsibilities: Directs fireground and medical operations, oversees all daily vehicle/personnel operations for assigned shifts. Vehicle Specifications: Heavy duty sport utility vehicle, command post operations equipment in rear of truck. Rescue Unit Crew (2): 1 Paramedic Attendant, 1 EMT/Paramedic/Driver Primary Responsibilities: Advanced life support transport vehicle, life safety, fire

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suppression. Vehicle Specifications: Ambulance vehicle with a front truck design cab and a large patient transport compartment. The interior of the patient transport compartment is designed for the storage of medical supplies and equipment as well as stretcher transport for patients. The exterior of the vehicle also contains multiple compartments for equipment storage.

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Bomb Threat - ACFR Headquarters

CHAPTER 8.36

Issued: February 20, 2002 Revised:

Submitted by: Administrative Office, Approved by: Will G. May, Jr., Director Health & Safety Office, County Fire Marshal's Office

Definition:

All Alachua County Departments are charged with the task of developing and/or enhancing plans for assuring the security of their facility(ies). All Alachua County Departments will be working to assure the continued accessability of County facilities for all visitors, balanced with providing a safe work environment for department employees.

Purpose:

The Bomb Threat Plan for ACFR Headquarters is designed to better assure the safety of those personnel working in and visiting the Alachua County Fire Rescue Headquarters building.

General Guidelines:

● The person receiving the threatening call will:

● Complete the Bomb Threat Checklist to obtain information from the caller.

● Immediately dial 9-911 to report the call and provide all the information from the Bomb Threat Checklist exactly as it was received from the caller.

● The Consolidated Communications Center (CCC) will dispatch law enforcement to ACFR Headquarters to investigate. Upon investigation, a determination will then be made as to activation of the alarm and alerting the Bomb Disposal Unit (BDU).

● Any request for a BDU will be made by law enforcement in accordance with their departmental procedures.

● The Department Director, their designee, or the BDU will:

● Immediately assess the situation and, if necessary, will activate the alarm.

● Set up a Command Post in the most appropriate, and safest area.

● All personnel (with the exception of the Department designated contact person) will:

● Upon hearing the bomb threat alarm, scan your work area for anything unusual and evacuate the building utilizing the closest stairway and building exits.

● Do not close or lock office(s) or any other door(s) when evacuating, unless instructed otherwise.

● Report anything unusual found in your work area to the Department -designated contact person. DO NOT TOUCH ANYTHING WITH WHICH YOU ARE NOT FAMILIAR.

● Assemble at the rally point (in the open area on the south side of the building) and remain there until receiving the all clear to re-enter the building.

● Be prepared to move to a secondary location if requested by the Command Post, or law enforcement representative.

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● Turn off, and do not use two-way radios, cordless phones, cellular phones and pagers until receiving the all clear to re-enter the building.

● Prior to evacuation, the Receptionist (or their designee) will print out the status of headquarters personnel and bring it with them .

● The Department-designated contact person will:

● Assure that their area has been searched and completely evacuated. All offices must be checked to insure that all personnel have left the work area.

● Report anything unusual found in your work area to the Command Post. DO NOT TOUCH ANYTHING WITH WHICH YOU ARE NOT FAMILIAR.

● After evacuation is completed, the Department-designated contact person will proceed to the rally point to assist in accounting for all personnel from their respective work area. (NOTE: the Department Director will assure that their personnel are instructed to assemble together at the rally point to determine an accurate accountability).

● The Department-designated contact personnel assigned to monitor entrances will:

● Stand by their assigned entrances until relieved by staff, or law enforcement personnel.

● Ensure that no unauthorized personnel enter the building until receiving the all clear to re-enter the building.

● Instruct everyone to stay clear of the building until instructed otherwise.

● The Bomb Disposal Unit (BDU) will assume command of operations until the hazard has been eliminated.

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Headquarters Building Security

CHAPTER 8.37

Issued: February 20, 2002 Revised: 09/09, January 2010

Submitted by: Administrative Office, Approved by: Ed Bailey, Chief Health & Safety Office County Fire Marshal's Office

Definition:

All Alachua County Departments have been charged with the task of developing and/or enhancing plans for assuring the security of their facility(ies). All Alachua County Departments will be working to assure the continued accessibility of County facilities for all visitors, balanced with providing a safe work environment for department employees.

Purpose:

The Building Security Procedure is designed to better ensure the safety of those personnel working in and visiting the Alachua County Department of Public Safety Headquarters building.

General Guidelines:

Guest Policy

● A Log entry identifying the date, name of the person(s)(printed and signed), organization the person represents, time in and time out. The Guest Pass shall be maintained at the receptionist desk. It is the responsibility of the person receiving the guest to maintain the Log.

● All persons, including ACDPS employees who do not have their Department issued ID card and family members, must sign in at the front desk and receive a Guest Pass.

● When a person arrives, the receptionist shall contact the employee to be seen and that employee shall escort the guest while they are in the building. Persons will not be allowed in unless they have a purpose for being in the building.

● No one will be allowed to enter a door other than via the reception area, unless they have a key card. Family members and friends must sign in as noted above.

Building Security

● All doors from the lobby into the building shall remain secured (locked) at all times.

● Opening and securing the main entrance for normal business hours will be assigned by the Section Chief of Finance and Administration.

● All exterior doors (except the main entrance) shall remain secured at all times. No exterior door shall be propped open at any time.

In the event of a hostile situation, the security alarm shall be armed and activated, and an announcement made on the paging system to advise building occupants of the situation.

● All personnel shall secure their respective areas. The most senior management person will act as the liaison with law enforcement and give the all clear message on the paging system when the event has passed.

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● All offices will be locked when the occupant leaves the building.

● All ACDPS Headquarters personnel must update their status utilizing the computer software program when they enter or leave the building.

● In the event it is necessary to evacuate the building, the Receptionist, or their designee, will print out a copy of the status of all ACDPS Headquarters personnel and bring it with them to the designated meeting area outside the building.

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Department of Public Safety Fire Evacuation Procedures - Headquarters Building

CHAPTER 8.38

Issued: February 20, 2002 Revised: February 9, 2011

Submitted by: Mark V.Smith, Fire Marshal Approved by: Edwin C. Bailey, Director

Definition:

All Alachua County Departments have been charged with the task of developing and/or enhancing plans for assuring the security of their facility(ies). All Alachua County Departments will be working to assure the continued accessibility of County facilities for all visitors, balanced with providing a safe work environment for department employees.

Purpose:

The Fire Evacuation Procedure for ACDPS Headquarters Building is designed to better assure the safety of those personnel working in and visiting the Alachua County Department of Public Safety Headquarters building.

General Guidelines:

Review the attached Emergency Evacuation Plan for the ACDPS Headquarters Building.

In the event of a fire condition, or alarm:

● All personnel will:

● Remove all personnel and visitors from the immediate area of the fire.

● Call 911 to report the fire, or alarm condition and the exact location of the fire. If possible, call 911 after you have evacuated the building. (NOTE: if time permits, give a brief description of the type of fire.)

● Upon being notified of a fire emergency in the building, immediately evacuate the building utilizing the closest exit.

● Assemble at the rally point (North side of the building by the dumpsters) to assure that all personnel are accounted for. Remain at this location until receiving the all clear to re-enter the building by the Evacuation Coordinator.

● Do not lock office(s) or other doors unless you have been instructed otherwise, simply close the door.

● Anyone passing the front lobby should take the visitor’s log with them to the meeting place.

● Be prepared to move to another location if requested by the Fire Department or law enforcement personnel.

● Responding fire services personnel will:

● Immediately, upon arriving at the scene, assume command of operations until the all clear is given.

● Provide written report(s) of any finding or investigations to the ACDPS Director or designee.

Click to view

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↓ Model Emergency Evacuation Plan

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STANDARD OPERATING GUIDELINES FIRE INVESTIGATIONS

CHAPTER 8.41

Issued: February 15, 2010 Revised:

Submitted by: Fire Marshal Approved by: Ed Bailey, Director

PURPOSE

The purpose of the Alachua County Department of Public Safety (ACDPS) fire investigation standard operating guideline is to ensure that a fire investigation is conducted to determine origin and cause of fires within our jurisdiction and areas of responsibility. This guideline is intended to give direction for when a fire investigation should be conducted, not how a fire investigation is to be conducted.

DEFINITIONS

● Arson is the crime of maliciously and intentionally, or recklessly, starting a fire or causing an explosion. ● Classification of fires: ● Accidental ● Natural ● Incendiary fires are those that result from deliberate acts, where fires are ignited or result from deliberate actions in circumstances in which the person knows there should not be a fire. ● Undetermined ● Fire Marshal (FM) is the County Fire Marshal or his/her designee. ● Incident Commander (IC) is the officer on the scene of the incident who is in charge. ● Initial Fire Investigation means a preliminary investigation of the origin and cause of a fire for the purpose of determining whether there is probable cause that the fire was the result of carelessness or design. ● Probable Cause means reasonable cause or reasonable grounds to believe that an unlawful act has been committed or that an unlawful event has occurred. ● State Fire Marshal (SFM) is an officer employed by the State Fire Marshal’s Office whose job is to investigate fires.

RESPONSIBILITIES

1. It is the responsibility of the Incident Commander (IC), District Chief and/or Company Officer, of a fire incident to ensure that an initial fire investigation is conducted as to the origin and cause, as well as the circumstances surrounding all fires which occur in our jurisdiction and areas of responsibility. For fires where the origin and cause are readily apparent, and are non-incendiary in nature, the IC shall ensure that the findings are thoroughly documented in the fire reporting system. These incidents do not require contacting the Fire Marshal (FM) unless one of the criteria in the FM Call-out Matrix is met.

2. The FM is responsible for the origin and cause investigation for incidents within their jurisdiction. If probable cause exists to determine the fire to be incendiary in nature, the FM will immediately contact the State Fire Marshal to conduct an arson investigation. The Fire Marshal (FM) will respond to the scene upon request. The FM will report to the IC for a briefing upon arrival on scene. The FM will respond within a reasonable time period. In the event the FM is not available, the Florida State Fire Marshal (SFM) shall be contacted.

3. If the FM is unavailable for response, the IC shall request that the SFM be notified. The IC shall provide the information required below under the section “SFM Notification”upon making contact with the SFM detective.

APPLICATION

Call-out of the FM:

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The FM shall be contacted for the following types of incidents:

● Fires of incendiary origin ● Estimated dollar loss exceeding $250,000 ● A death or serious injury has occurred to a civilian as a result of a fire ● A death or serious injury to a firefighter has occurred as a result of a fire ● The fire origin and cause is undetermined ● A crime has been determined to have occurred on the property ● Fires started by juveniles of involving juvenile fire setters

FM notification via County email for the following situations:

● Fire code violations contributed to the cause or spread of the fire ● Industrial or construction accidents resulting in severe injury or death ● Fireworks or explosives related incidents ● Activation of a fire suppression system

SFM Notification

The FM will make a determination if a response is needed based on the information provided. The Florida State Fire Marshal’s Office shall be contacted to conduct the arson fire investigation.

● The SFM shall be notified by the FM when: ● Death or injury of a firefighter in the line of duty ● Injured, requiring hospitalization or treatment by a physician at a medical facility; or ● Killed as the result of, during, while combating, or otherwise engaged in any act or action related to fire.

● Presumption for purposes of the SFM: ● Any fire with a projected dollar loss exceeding $1,000,000 (one million dollars); or ● Any fire involving a civilian death, or an injury that is likely to result in death; or ● Any fire in which the cause is not readily determined by an initial investigation; or ● Any fire involving the suspected failure of a fire suppression or fire detection system.

● When notifying the SFM the following information must be relayed either over the phone or in writing: ● The date and time of the fire; ● The address of the property damaged; ● A description of property damaged (ie. single family home, restaurant, etc.), and the extent of the damage; ● The name(s) of the owner(s) of property damaged, if known; ● The name(s) and number of persons injured or killed, if known, and the extent of any injuries; and ● The facts and circumstances considered by the local fire official or law enforcement officer to constitute probable cause to believe that the fire was the result of carelessness or design.

Accidental Fires For fires in which the origin and cause investigation has determined to be accidental in nature, it is the IC/FM’s responsibility to obtain the necessary report information. This information shall be included in the fire or follow-up investigative report on the findings and outcome of the investigation relating to the fire.

Incendiary and Fires involving injury and/or fatality Once the IC/FM has determined that there has been a crime committed and has classified the scene as a crime scene, it shall be their responsibility to request the appropriate law enforcement agency (LEA) to respond to the scene. Upon LEA arrival, a brief overview of the circumstances should be provided. At that time LEA will be given the responsibility of providing scene security.

Chain of Custody Under no circumstances shall chain of custody of the fire scene be broken prior to the FM/SFM arriving on scene.

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The IC and/or company officer shall ensure that nothing in the area of origin (if known) is moved until it has been viewed by the FM/SFM. If objects are moved to extinguish the fire, their location should be noted so the scene can be reconstructed. Preservation of evidence does not preclude the IC and/or company officer from completing extinguishment or initiating overhaul operations, but unnecessary disturbance or destruction of the fire scene shall be minimized.

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STANDARD OPERATING GUIDELINES FIRE STREAM MANAGEMENT

CHAPTER 8.42

Issued: January 2010 Revised

Submitted By: Operations Approved: Ed Bailey, Chief

8.01 PURPOSE

To promote the most effective, efficient deployment and utilization of fire streams possible during fire fighting operations.

8.02 POLICY

Fire stream operations shall be well coordinated and carried out in the most safe, effective and efficient manner possible.

8.03 RESPONSIBILITY

A. The Incident Commander is responsible for overall coordination and management of fire stream operations. B. It is the responsibility of each engine company to provide its own uninterrupted, adequate supply of water. "Provide", in this case, does not mean they must necessarily lay the line or pump the water. It is their responsibility to get water into their pump, by whatever means that are appropriate. C. Company Officers must assume responsibility for the effectiveness of their fire streams. Such officers must maintain an awareness of where fire streams are going and their effect. D. All members involved in fire stream operations are responsible for the safe operation of such streams. 8.04 PROCEDURES

A. FACTORS

1. The factors involved in fire stream selection and deployment are as follows: a. Size. b. Placement. c. Speed. d. Mobility. e. Supply.

2. The fire stream factors must be considered in light of fire stream characteristics and the fire problem in order to effectively manage fire stream operations. B. CHARACTERISTICS Fire control forces must consider the characteristics of fire streams, the fire stream factors, and the fire problem in order to choose the proper nozzle and stream for the task. 1. Solid stream: More penetration, reach and striking power, less steam

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conversion. 2. Fog: More gross heat absorption/expansion, low reach. 3. l ¾" lines: Fast, mobile, moderate to high volume. 4. 2½" lines: Big water, big knockdown, slow/immobile. 5. Master Streams: Mostly stationary, slow to set up, maximum water. 6. Consider that hose lines pump as much air as they pump water (particularly fog streams). Think of them as fans when making line placement judgments and use confinement and reduction of loss. When entering basement fire(s) do not open nozzles until you can see and are near the fire. C. BASIC HOSE LINE PLACEMENT 1. The first stream is placed between the fire and persons endangered by it. 2. When no life is endangered, the first stream is placed between the fire and the most severe exposure. 3. Second line is taken to secondary means of egress (always bear in mind the presence of men opposite the second line). 4. Succeeding lines to cover other critical areas. 5. Whenever possible, position hose lines in a manner and direction that assists rescue activities, supports confinement, and protects exposures. 6. Hose lines should be advanced inside fire buildings in order to control access to halls, stairways, or other vertical and horizontal channels through which people and fire may travel.

D. GENERAL OPERATIONS 1. Use the size of hose line that will eventually be required from the beginning; if you need a big line, provide it from the outset. If there is any doubt from the beginning, go to the next size hose line. 2. When you make a decision on what size fire stream to apply, select the size that is actually required. Beware of automatically going for the size you use most often; or the size that is fastest/easiest - we tend to rely on one size of fire stream. 3. When you change commitment from offensive to defensive and pull hand lines out for the fire building, do not continue to operate them as hand lines - convert them to exterior master streams. Give priority to water supply and application. The operating positions of such streams must also be evaluated. Do not continue to operate into burned property. 4. Do not operate fire streams into smoke - fire location must be determined before water can be effectively applied. 5. Fire streams must deliver an effective rate of flow (GPM) in order to overcome the amount of heat being generated by the fire. In other words, the amount of water and the rate at which it is applied to the fire must be enough to absorb more heat than is being generated by the fire. 6. Hose line judgments generally involve the trade-off of time versus pure tactical placement; if a tactical placement principle is violated, back-up action must be taken. 7. Maintain control of key hydrants - be certain that engines are assigned to such key hydrants to provide most effective stream operation. Beware of numerous unpumped hydrant supply lines instead of fewer pumped lines. 8. As soon as a fire is knocked down, the rate of flow (GPM) should be reduced or discontinued according to the situation in order to hold water damage to a minimum.

E. ATTACK LINES 1. Offensive attack activities must be highly mobile. As their movement slows

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down, they necessarily become more defensive in nature and effect. Many times effective offensive operations are referred to as "aggressive"; fast, active, vigorous, energetic, bold, forward, assertive. 2. Offensive attack positions should achieve an effect on the fire quickly, consequently back-up judgments should also be developed quickly. If you apply water to an offensive attack position and the fire does not go out or improve fireground conditions, then back out. 3. Beware of hose lines that have been operated in the same place for long periods. Fire conditions change during the course of fire operations (most things will only burn for a limited time) and the effect of hose line operation must be continually evaluated. If the operation of such lines becomes ineffective, move, adjust or redeploy them. 4. Beware of the limitations of operating nozzles through holes. The mobility of such streams is necessary limited and it is generally difficult to evaluate the effectiveness of such streams. Sometimes, you must breach walls, floors, etc., to operate - realize the limitations of such situations. 5. Have attack lines ready during forcible entry operations. Attack crews should be fully protected and supervised before forcible entry is effected. 6. If you commit attack crews to inside operations, do not operate exterior streams into the same building-particularly ladder pipes. Do not combine interior and exterior attacks in the same building. It may be necessary to coordinate pulling crews out of the building while an exterior heavy streams knockdown is made. Know when to shut down nozzles. Many times continuing operations of large streams prevents entry and complete extinguishment.

F. AERIAL STREAMS

1. Ladder pipes are particularly useful and effective when operated on large open-type fires. A good general rule is that you have, in effect, written off the building (or portion) when you initiate ladder pipe operations and you are essentially in a defensive mode. 2. Ground crews should be advised before ladder pipes go into operation. 3. Do not apply water to the outside of a roof and think you are extinguishing the fire. Such water application may offer effective exposure protection, but, if part of the roof is intact, it will shed water just like it was built to do and will prevent water from reaching the seat of the fire. This is particularly true of ladder pipe operations. 4. Do not operate fire streams down ventilation holes during offensive operations.

G. WATER SUPPLY

1. During large scale operations, fire officers must be mindful of the fact that when several engines attempt to draw from the same water system, considerably less water is available and at a reduced residual pressure. 2. During alarms in which large quantities of water are required or whenever water supply is anticipated as, or becomes a problem, the Incident Commander may request the response of the Water Department representative and shall establish liaison with same. 3. Fire Department members should have knowledge of those areas in the County in which water supply may be a problem.

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Multi-Story Fire Response

CHAPTER 8.57

Issued: July 2010 Revised:

Submitted by: District Chiefs Approved by: Chief Northcutt

PURPOSE:

To establish a uniform procedure for operations in a multi-story structure involved in fire, smoke, or hazardous conditions. This guideline will also define and standardize specified equipment to be used and carried by operations personnel.

DEFINITIONS:

High Rise Pack- this is comprised of 150 feet of 1 ¾ “hose (or equivalent) folded in a triple layer load. The nozzle shall be a low pressure (50 psi) solid stream nozzle without a stream shaper in place. This pack shall be secured using straps and buckles. An equipment bag shall accompany the hose and shall include at least one gated wye (may be attached to hose), two spanner wrenches, crash axe, 2 ½”to 1 ½”reducer, and four door chocks. Supply Pack - this is comprised of 50 feet of 2 ½”or 3”hose folded in a flat load and secured utilizing straps and buckles. Set of Irons- term used to describe the combination of a flathead axe and halligan tool. Entry Tools- minimum of two tools brought with a crew to perform firefighting, search, or forced entry functions. (i.e. set of irons, TNT tool, Kelly tool, halligan, pike pole, etc.)

Thermal Imaging Camera (TIC)- imaging tool used to locate sources of heat in low visibility conditions.

SAFETY:

Fire/Rescue personnel conducting operations in high-rise buildings are faced with many non-typical hazards due to the design, elevation, limited access/egress, etc. inherent in these buildings. Multi-story buildings containing a working fire are to be considered a high hazard area

EQUIPMENT:

Emergencies involving multi-story structures require precise communication, teamwork, and increased equipment/personnel. Assigned apparatus shall report to the lobby (unless ordered otherwise) with the following equipment:

Fire Apparatus Equipment

● High Rise Pack

● Supply Pack

● Entry tools (set of Irons)

● TIC if available

● One spare PBA bottle

● Any further equipment requested by the Company Officer

Rescue Unit Equipment

● Stretcher

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● ALS and BLS kits

● Spare PBA bottles

ASSIGNMENTS:

First fire unit

● Take Command

● Control the elevators

● Check alarm system

● Contact security

● Start accountability procedures (PAT)

Primary assignments for incoming crews.

● Two units to fire floor

● One unit to floor above the fire

● One unit to the top floor

● Staging two floors below the fire floor

Second fire unit.

● D/O Hook up to the hydrant and supply the stand pipe

● Crew Report to command for assignment

All other units report to command for assignment.

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Personnel Deployment

CHAPTER 9.1

Issued: February 20, 2002 Revised: September 2009 Submitted by: Administrative Office Approved by: Will G. May, Jr. Director

Definition:

Establishes a Department Policy for the out of jurisdiction deployment of Department personnel.

Purpose:

Alachua County Department of Public Safety is occasionally requested to provide personnel who possess specialized training to other jurisdictions during times of emergency operations. Alachua County may provide such assistance under three distinct scenarios:

● Alachua County is statutorily obligated to provide assistance under the Statewide Catastrophic Mutual Aid Agreement (SMAA) when that assistance will not present an operational hardship to Alachua County.

● The State of Florida is statutorily obligated to provide assistance under the Emergency Management Assistance Compact (EMAC) when that assistance will not present an operational hardship to the State. Resources available under the SMAA, are available under the EMAC.

● The Federal government may request resources through the State of Florida. In this case, those resources become "federalized" employees and will be compensated by the Federal Government directly.

This Policy will determine the manner in which Department resources are provided, the manner that Department personnel will be compensated during deployment, and assure that eligible expenses are documented for reimbursement.

General Guidelines for Deployment Under Federal Request:

Bargaining

Department personnel covered by Collective Bargaining Agreements will utilize approved leave during the time of deployment. Approved leave shall be one, or any combination of the following:

● Vacation Leave ● Compensatory Leave ● Floating Holiday(s) ● Leave of Absence (without pay for up to 30 days)

Personnel that are deployed on Federal Request will be compensated by the Requesting Agency according to the Federal Pay Plan. (April 1, 2002)

Non-Bargaining

Department personnel who are not covered by Collective Bargaining Agreements will utilize approved leave during the time of deployment. Approved leave shall be one, or any combination of the following:

● Management Reassignment approved by the County Manager ● Vacation Leave ● Floating Holiday(s) ● Leave of Absence (without pay for up to 30 days)

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General Guidelines for Deployment Under the Statewide Catastrophic Mutual Aid Agreement (SMAA) or Emergency Management Assistance Compact (EMAC):

● Each ACDPS employee who is deployed to an incident will be responsible to assure that the following forms are completed and delivered to ACDPS Headquarters. The Payroll Office will not process any additional hours to be paid until all the required forms have been completed and delivered to ACDPS Headquarters.

● During deployment, personnel will be paid for their regularly scheduled shift(s) and additional actual hours worked on days they would normally be off-duty. All payments shall be in accordance with County Personnel Regulations and Union Contract. (April 1, 2002)

PRIOR to DEPLOYMENT

FFCA Form #3 - Disaster Team Deployment Form

● This Form will be completed by ACDPS Staff and forwarded to the Incident Command Post. The purpose is to document the date and time of deployment of ACDPS personnel, provide qualifications of deployed ACDPS personnel, provide payroll information to the Incident Management Team, and the expected demobilization date.

Alachua County Travel Authorization Form

Alachua County policy stipulates that this form be completed prior to any Alachua County employee traveling outside the County on official business. In the case of emergency deployments, this form will be completed by Staff.

DURING DEPLOYMENT

ACDPS Additional Hours Form

This form will document your hours daily. Will be signed and forwarded to the Team Leader who will contact the District Chief for inclusion in Telestaf.

ICS #214 - Unit Log

● This form documents the daily assignment of ACDPS personnel and equipment during deployment. ACDPS personnel and equipment may be assigned to Strike Teams, Task Forces, or Groups, and completion of the Form may be the responsibility of the Leader. ACDPA personnel should obtain a copy of the completed ICS #214 daily, or complete an ICS #214 daily documenting their hours and the hours our equipment is used.

Emergency Fire Fighter Time Report

● During on-going large scale incidents, the Finance/Administration Section will be activated, and incident personnel will be required to complete an Emergency Fire Fighter Time Report. For those incidents when the Finance/Administration Section is not activated, or if you were deployed during and demobilized prior to activation of that Section, this form may not be available.

Vehicle Mileage Log (Required)

● This form must be completed in order to document the time County vehicles are used on an incident.

● This form must also be completed in the event an employee is required to use their personal vehicle for any reason while on deployment. The County will reimburse the employee for using their private vehicle, and the County will be reimbursed by the State at the same rate.

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Request For Reimbursement Of Traveling Expenses

● This form must be completed if the employee incurs expenses while on deployment so that those expenses can be reimbursed.

UPON RETURN

Completed original County/Department forms and copies of all non-department forms completed during deployment must be submitted to ACDPS Payroll immediately upon return to Alachua County.

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Fire Hose

CHAPTER 10.1

Issued: Revised: November 2008

Submitted by: Approved by:

Fire Hose

Fire hose shall be tested in accordance with the Department's Hose Maintenance program.

Purpose This standard shall apply to the care of all types fire hose while in service, in use and after use, including record keeping, inspecting, and service testing. The purpose of this standard is to provide a reasonable degree of assurance that the hose, coupling assemblies, and nozzles will perform as designed.

Responsibility The Assistant Chief responsible for Operations shall assign the overall management and oversight of the Fire Hose Program (FHP) to a District Chief. The assigned District Chief shall be responsible for all aspects of the FHP. Each station Lieutenant on the same shift as the assigned District Chief shall be responsible for the oversight and application of the FHP at their respective station. The other shift Lieutenants shall be responsible for FHP duties as assigned by the primary shift Lieutenant

Care and Use of Fire Hose

● Hose shall be inspected and service tested within 90 days before being placed in service for the first time and at lease annually thereafter

● Hose shall be removed from the apparatus and reloaded so that the folds occur at different positions. This must be done every 90 days. This practice will be completed during the months of February, May, and August. If it is documented that the hose was removed and reloaded during fire operations this will meet the above requirements.

● After each use, all hose shall be cleaned. If, after use the hose has been exposed to hazardous materials, it shall be decontaminated by the method approved for the contaminate.

Hose Loads

The following hose loads are standard hose configuration for the Department.

5" LDH Fire Town Fold 3" LDH Accordian 1¾ and 2½" "S" Load

Hose Records

● Accurate hose records shall be established and maintained. It shall be the responsibility of the District Chief assigned to the program to ensure that hose testing and record keeping is current.

● The primary shift Lieutenant shall ensure testing is completed as directed. She/he shall ensure that the hose and test pressure are accurately recorded on the hose information sheet. When hose testing is completed the she/he shall record the information into the Department approved software application.

Inspection of Coupling

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● Couplings shall be kept in serviceable condition. After each use, and during each hose service test, they shall be visually inspected for the following:

● Damaged threads ● Corrosion ● Slippage on the hose ● Swivel not rotating freely ● Out-of-Round ● Missing lugs ● Loose external collar ● Other defects that might impair operation.

Hose Service Testing-Procedures

● Hose testing will take place during the month of February and will be completed by May 1st of that year.

● Prior to testing a visual inspection of each section must be made in order to ensure that there are no visual defects.

● A hose testing machine or a stationary pump shall be used. Fire apparatus shall not be used for testing hose.

● Where the pressure supply source is not specifically designed for testing hose, the following procedures shall be utilized:

● A short section of 3" hose shall be attached to the discharge outlet on the apparatus. ● Attached a gated wye to the first section of hose and the sections to be tested. ● After filling to 45 psi the hose shall be checked for leakage at the coupling and tightened with a spanner wrench as necessary. Each length of hose shall then be marked at the end or back of each coupling to determine if the coupling has slipped during the test. ● When increasing the pressure to the specified testing pressure the operator will slowly increase the pressure at a rate no greater than 50 pounds over 15 seconds. ● The total length of hose to be tested at one time shall not exceed 300 feet. ● The District Chief in charge of the Hose program shall assign an Officer to ensure that the gauge used to read the hose test pressure shall have been calibrated within 30 prior to the testing.

● Service test pressure shall be held for five minutes. Service test pressures are as follows:

● 1½" to 4½ " hose 250 PSI ● 5" hose 150 PSI

● When the test hose is at service test pressure the hose shall be inspected for leaks. If the inspecting personnel walk the test layout to inspect for leaks, they shall be at least 15" to the left side of the hose in the test layout. The left side of the hose shall be defined as the side that is to the left when facing the free end from the pressure source.

● If during the test a section of hose leaks or bursts the test will be terminated and the failed section will be marked and returned to supply for replacement. A Fixed Property/Replacement Form will be completed at that time. If failed section(s) of hose will place the apparatus below minimum requirements, the Supply Officer shall be notified immediately to replace the required sections of hose.

● After five minutes at the test pressure the pump shall be shut down and the water drained. The marks on the hose by the couplings will be checked for slippage.

Damaged Hose

● Hose damaged either by testing or in operation shall be marked and returned to the supply division. The

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Lieutenant on duty will be responsible to update the records with special emphasis on recording the nature of the damage. New hose may be requested from supply at this time.

Safety

● The Lieutenant on duty will act as the Safety Officer. Only those individuals testing the hose shall be present in the near vicinity when hose testing.

● All individuals on the test ground must wear the following safety gear:

● Helmet ● Gloves ● Fire Boots

Hose Test Sheet

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SCBAs & Respiratory Program

CHAPTER 10.2

Issued: October 2008 Revised: 09/09, 01/10, Feb 2010

Submitted by: Dan Shaeffer Approved by: Ed Bailey, Chief

SELF CONTAINED BREATHING APPARATUS

● SCBA's are to worn during all initial attack stages of structural or automotive fires as well as during overhaul and salvage operations, and during any operation where hazardous airborne contaminants exist or there is potential for inhalation related injuries. Any personnel not wearing a SCBA are to remain out of the area where hazardous airborne contaminants exist as determined by the O/C and/or air monitoring devices. Driver Operators or any personnel operating down wind from the incident where there may be a potential for exposure will operate in SCBA.

● All SCBA's being worn at any emergency scene will have a PASS (Personal Alert Safety System) Devise attached and activated.

● It is the responsibility of each ACDPS employee and affiliate at the beginning of their duty shift to inspect the SCBA assigned to him/her for the period of that duty shift. All inspections shall be conducted in accordance with the section entitled RESPIRATOR CARE in the Department's RESPIRATORY PROTECTION PROGRAM article. Units with spare SCBA's will inspect these on Friday and exchange the unit if a deficiency is noted. Any problem with a SCBA should be fixed or the unit shall be replaced with a spare from Station or CSW. All units needing repair are to be delivered to Station 21.

● Any SCBA that is dropped from any height, falls from an apparatus, is exposed to excessive heat, covered in a ceiling or wall collapse, exposed to caustics or corrosives, etc... are to be removed from service immediately and sent to station 21 for an extensive inspection.

● Bottles (when not in use at an emergency scene) shall be refilled when the pressure falls below 2700 psig. Composite bottles which must be refilled but exceed the 3 year hydro test date (5 years on Carbon Fiber bottles), must be sent to Station 21 for exchange. No bottles will be exchanged at non ACDPS stations. ACDPS bottles (SCBA) are not to be left at non-ACDPS stations, placed on non-ACDPS apparatus not currently maintained by ACDPS, or otherwise loaned or exchanged with any other agency.

RESPIRATORY PROTECTION PROGRAM Purpose

To meet the guidelines established by the US Department of Labor, OSHA Regulation 29 CFR 1910.134 Respiratory Protection.

To reduce exposure to personnel, acute and chronic, from airborne toxins and to provide breathable air in oxygen deficient atmospheres.

To establish Departmental Guidelines and policies for all personnel required to use Self Contained Breathing Apparatus. This will include training in the proper use, care maintenance and storage of the Department issued SCBA's.

Responsibilities

District Chief, Logistics

● Overall management and support of the Department's Respiratory Protection Program.

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● Work with the Chief of Department, other County Officials, Medical Director, supervisors and other personnel to develop and administer related policies and practices needed to support the effective implementation of this plan.

● Act as Department liaison during compliance inspections.

● Review Respiratory Protection Plan periodically as to assure plan is up-to-date with latest standards and guidelines.

● Conduct spot inspections of on-scene and station operations to ensure compliance with Respiratory Protection Plan.

● Oversee maintenance operations and quality control procedures used in the repair and service of SCBA's, Air filling station, and remote cascade units.

District Chiefs

● Enforce Departments SOG's and policies in regards to the use of Department issued SCBA's.

● Ensure SCBA's are inspected on a daily basis.

● Coordinate the replacement of any SCBA or mask determined unfit for safe use by field personnel.

● Oversee that all cylinders used on shift, found to be below Department acceptable level (2700 psig) are filled by personnel trained in the operations of the filling station or remote cascade unit.

● Conduct spot inspections of on-scene and station operations to ensure compliance with Respiratory Protection Plan.

Health & Safety Officer

● Assigns Department approved mask to new employees.

● Conducts quantitative fit test to assure proper fit.

● Maintains Department records of fit test results.

Lieutenant Assigned Air Program

● Oversees maintenance of department approved SCBA's.

● Maintains records on all repairs. Maintains inventory of all SCBA's and components.

● Oversees training of personnel assigned by the Department to repair SCBA's.

● Provides budget request to assigned SCBA Program Officer/Manager.

● Oversees maintenance and compliance with Breathing Air Purity standards for air compressor and remote air filling stations.

● Maintain records on all service.

● Oversees training of personnel designated by the Department to operate the air compressor and/or remote filling stations.

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Training Division

● Provides detailed information and training specific to the SCBA used by the Department.

● Ensures personnel trained in compliance with Federal and State standards.

● Maintains training records.

Department Personnel

● Attend training sessions.

● Know and adhere to current Department SOG's and policies. ● Conduct daily inspection of SCBA's, and personal assigned mask

● Decontaminate and inspect SCBA's after each use.

● Remove from service units not deemed safe or operable.

● Tag unit for service, with a description of compliant.

Personnel Designated to wear SCBA's

The following Departmental job classification are expected to know and be trained in accordance with the Department Respiratory Protection Plan, as the job requires the use of the SCBA on a regular basis or in the process of supervising an incident a need may arise which requires the use of a SCBA for protection.

Department Chief Lieutenants

Assistant Chief(s) Driver/Operators

Fire Marshal Firefighters Rescue Lieutenants District Chiefs Paramedics EMTS Captains

Personnel Training

Department personnel designated to wear an SCBA will be provided detailed training specific to the Department approved SCBA. This will include, but not be limited to training for:

● Recognition of emergency situations requiring the use of a SCBA.

● Instruction and demonstration for donning the SCBA.

● Handling situations in which the unit may fail to perform.

● Instructions on emergency air sharing.

● Familiarization of SCBA parts and their function.

● Approved methods of inspecting, cleaning and storage of the SCBA and personal assigned mask.

● Review updates of Department's SOG's and policies.

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Training shall be conducted at a minimum, on an annual basis utilizing any of the following:

● Department SOG, Chapter 10.2

● IFSTA manual titled, Self Contained Breathing Apparatus.

● Donning and Field maintenance instructions provided by the manufacturer.

● NFPA Standards: ● 1404 - F.D. SCBA Program ● 1500 - F.D. Occupational Safety & Health Program ● 1981 - SCBA ● 1982 - PASS for firefighters

Medical Examinations

Per OSHA Standard 1910.134, employees assigned to tasks that require the use of a respirator must be physically able to perform the work while using the respirator.

Respirator Selection

The Department has elected to use the SCOTT Fifty 3.0 open-circuit type Self Contained Breathing Apparatus. SCOTT APR (air purifying respirator) adapters and filters are provided for specific uses as noted in this plan.

The approved models supplied are:

● SCOTT Air-Pak Fifty 3.0

Selection of type of SCBA supplied by the Department and its method of use and care will be in accordance with the following:

● Certified by NIOSH (National Institute for Occupational Safety & Health)

● Certified by MSHA (Mine Safety & Health Association)

● Compliant with NFPA 1981 - SCBA Performance (1992)

● Manufacturer instructions for care and use.

● OSHA 29 CFR 1910.134

● NFPA, 1404 - F.D. Self Contained Breathing Apparatus Program (1989) ● ANSI, z88.2 - Practice for Respiratory Protection

● ANSI, z88.5 - Practice for Respiratory Protection for the Fire Service

Mask fit will be as current approved standards for quantitative fit-testing. The Department currently utilizes an appropriate unit for quantitative test.

Air Quality

● Breathable air must meet the minimum requirements for Grade E breathable air as described by the CGA (Compressed Gas Association).

● Breathable air must be supplied to respirators from cylinders or air compressors intended for the sole purpose

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of storing or creating breathable air.

● Such air shall be filtered and monitored for minimum requirements as specified below:

Oxygen - 20 - 22% Water Vapor - 24 ppm

Carbon Dioxide - 500 ppm Oil Mist - 5.0 mg/m3

Carbon Monoxide - 10 ppm Odor - None

The compressor for supplying air shall be equipped with required safety devices and alarms.

● The compressor shall be located to avoid any entry of contaminated air and must be equipped with air purifying filters and dryers. SEE also AIR FILL OPERATIONS.

● The Department will only use air which has been tested and certified to meet or exceed CGA Grade E specifications in the SCBA bottles intended for breathing air purposes.

The Department composite SCBA cylinder shall be as follows:

● Visually inspected prior to filling

● Serviced according to the manufacturers specifications

● Remove from service for hydrostatic testing every 3 years in accord with CFR Title 49, part 173.34. In no case, shall the service life of the composite cylinder exceed 15 years. Note: 2008 still awaiting DOT ruling on Carbon Fiber Cylinders' life of 30 years.

Respirator Care

Purpose

To assure the optimum performance of the SCBA and the protection factor it affords, the individual user must know how the unit is suppose to perform, how to inspect it, and how to care for and maintain it. The Department will provide the training required to inform the user of the Manufacturer recommendations, as well as instructions pertaining to the Departments SOG's and policies.

Use/Inspections/Care/Maintenance

SCOTT AV2000 and AV3000 Facepiece

NOTE: Personnel should only use their assigned mask which has been determined to be of proper fit as a result of quantitative fit-testing. Any significant changes in facial structure, and/or significant weight gain or loss should result in re-testing as per OSHA and NIOSH guidelines. Contact Health & Safety if this is an issue.

● Carefully inspect facepiece and head harness for aging rubber parts, and worn, damaged, missing or loose components. Any mask exposed to a hazardous material where the possibility of degradation of the material is a potential, should be marked CONTAMINATED, bagged and sent in for inspection.

● The lens should be inspected for cracks, severe scratches, and for a seal in the mask housing. If there is any question regarding the integrity of the lens, the mask should be removed from service immediately and sent for evaluation.

● The nosecup does not normally have to be removed, if it is removed; upon reinstallation assure raised rib on top front of nosecup is locked into notch on mask, and bottom is tucked behind chin pocket of faceseal.

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● The KEVLAR head harness should not be removed or serviced in the field.

● Cleaning of the mask is accomplished using warm water and a mild soap solution. NO BLEACH is to be added. Mask can be disinfected with a solution of 70% Isopropyl alcohol, or the Department approved disinfecting solution at its proper dilution rate.

● Eye glass retainers are available upon request.

Electronic Voice Amplifier

This is an intrinsically safe, removable component, it is designed to enhance voice communications while wearing the AV2000 or AV3000 mask.

● 9 volt batteries are replaced on an as need bases. Batteries can be replaced in the field. Care should be taken to see that water tight lid is properly sealed, and exercise caution as to not over tighten retaining screws.

● Care should be taken to assure unit is not accidently activated and left on while not being worn.

● Unit is water resistant, not waterproof, remove before washing mask.

● Mask is still in service if EVA is not working. Replace battery as needed. If unit does not function, send to the Health & Safety Officer for evaluation.

● Do not remove EVA mounting bracket from mask.

Cylinder

● The Department minimum pressure for the 3000 psig carbon-fiber cylinder is 2700 psig. ● The tank gauge and the regulator gauge (with regulator pressurized) should not vary by more than 300 psig, however it is often difficult without additional gauges to determine which one is inaccurate.

● The valve assembly should be tight in the cylinder. If it will move by hand remove from service immediately.

● Inspect the cylinder body for severe damage, gouging or heavy peeling of the fiberglass wrap. If the protective coating on arms of vehicle SCBA brackets are worn or missing, notify St 21. This protective coating is essential to prevent gouging while removing or returning SCBA or cylinder into the vehicle bracket.

Backframe/Harness/Regulators/Alarms

● Inspection of the Backframe should include; the cylinder latching hanger, the cylinder retainer band release, and PASS Sensor Module release to see if they are in working order.

● Inspection of the Harness should include; all screws are tight, and all buckles and latches operate properly. Units with damaged harness straps or buckles should be removed from service. The bottle retainer should lock down on the bottle and hold it firmly in place.

● Inspection of mask mounted regulator should include; sealing gasket in place, donning-doffing switch operable, Vibralert operates as unit reaches low pressure (approx. 700 psig).

● The mask mounted regulator can be washed and sanitized using warm water and the Department approved disinfecting solution at its proper dilution rate.

Methods:

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● With regulator still attached; charge system with air, leaving donning switch off, submerge regulator in cleaning solution, remove and shake dry, shut tank valve and open purge valve to evacuate trapped water in regulator

● With regulator removed at quick-disconnect; completely submerge in cleaning solution, remove and shake dry, reattach regulator, charge system with air and open purge valve to evacuate trapped water from regulator, close tank. NOTE: if using method 2 it is important to return the regulator to the pack it was removed from for future testing purposes.

● Inspect the high pressure hoses for cuts and abrasions.

● The Pak-Alert 1000 is an integrated PASS and distress alarm system. The sensor module located in the lower part of backframe can be removed to change batteries. There is one battery each for sensor & alarm. Low Battery indicator is a continuous audible beep. Only affected battery needs to be changed. Check Red & Green L.E.D. to see if they flash.

● For low pressure air warning, the SCOTT AIR-PAK Fifty is equipped with the audible & vibrating Vibralert system on mask mounted regulator and a redundant low pressure whistle, along with a shoulder mounted pressure gauge. These should be part of the daily SCBA check.

NOTE: activation of the Vibralert without activation of the redundant alarm and more than a 1000 psi in the tank is an indication of possible reducer problem - return for service.

SCOTT SCBA regulators will be flow tested at least bi-annually as per manufacturer recommendation. Date of last test will be affixed to backframe, behind the back pad. This service is via contract with an outside vendor.

Air Fill Station Operations

Alachua County Department of Public Safety currently employs three systems for filling SCBA bottles. The systems are: the cascade air system on SQ16, the air compressor located at Station 21, and the compressor located at Station16. These policies and procedures will establish guidelines for training personnel in the operation of each and hopefully serve as a reminder as to the potential for serious bodily injury or death should safety precautions here be ignored.

Purpose:

To establish Department guidelines and procedures for personnel using a Department Air Filling Station such as a compressor or cascade tank system.

To meet current Federal and State guidelines regarding the use and operation of such stations.

To help insure the safety of the operators and upkeep of the equipment.

Definitions:

CASCADE - the procedure of using a storage system by means of opening one supply cylinder at a time until such time as the pressure in that supply cylinder is below the minimum desired pressure (i.e.; 3000 psig), and then closing that supply cylinder and opening the cylinder with the next lowest quantity, yet with more than the supply cylinder currently being used.

This method provides the greatest number of fills from the system. For an example, a six-tank, 4500 psi storage system will fill from empty about (30) 60 cu. ft. bottles using the cascade method, whereas opening all six valves simultaneously will only result in about (8) bottles being filled from empty.

General Precautions and Procedures

The following applies to filling operations of either the cascade system or compressor. Each operator is responsible for knowing these precautions and procedures in order to assure the safety of him/herself and of those in the area.

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Although rare, accidents do happen, and with the pressures being dealt with they can be extremely unforgiving.

● NO unnecessary personnel should be in the immediate area of the filling operation. Generally it only takes one individual to fill the bottles. Other individuals may transport bottles to and from the filing location and thus have to enter, however they should limit the time in the area to the purpose.

● When filling SCBA bottles, bottles should be placed in the fragmentation tank. The fragmentation tank should be placed remotely from the operator, and at no time should the operator or anyone else stand in such a way as to be over the fragmentation tank during the filling operation.

Before filling any SCBA bottle the following should be observed:

● Hydro date; fiberglass wrapped or aluminum cylinders have a hydro period of 3 years, or 5 years for carbon fiber bottles with a maximum service life of 15 years. (2008 - awaiting DOT ruling of 30 years on Carbon Fiber) Steel bottles have a hydro period of 5 years with a maximum service of 25 years. The original approved service date of the bottle is on the label. The company which does the hydrostatic test is required to mark or label the bottle with an ID number and date. We have found these do not last on fiberglass wrapped bottles, so ACDPS bottles have the last hydro date rewritten at the neck of the bottle. Records are maintained at Station 21 should questions arise. Steel bottles will have the ID and date stamped in the bottle near the neck.

● Bottles with damage or excessive wear such as tank gauges with bent needles or face plates which prohibit gauge operation, damaged bottle threads, and fiberglass tanks that are peeling fiberglass strands should not be filled. Return these to Station 21 for inspection.

In addition to inspecting the SCBA tanks, the charging hoses should also be inspected for damage. Signs of damage would include deep cuts or gouges in the hose. A bulge in the hose may indicate a weakening of the hose. The charging hoses ACDPS employs have what is called a soft seat connector (at SCBA bottle connection), this comes in the form of a plastic tip that screws on the charging hose tip or a rubber o-ring that slips over the charging hose tip. These need to be in place.

Control valves and knobs which operate air flow almost always have some type of soft seat surface for sealing, over tightening these valves/knobs while shutting down leads to damage of the valve and leaks. For a valve with an undamaged seat it takes very little effort to seal and shut off the flow. If after shutting off the system and the air is bled, a small leak is detected, simply tighten with a little more pressure. Any leaking valves should be reported to the air officer.

The filling rate of bottles is a debatable subject, however remember that the faster a bottle fills the more the air heats in the bottle and expands. When the bottle cools, it can have substantially less pressure. A good rule to judge a fill rate for SCBA bottles is to allow about 2.5 minutes per fill (2216 bottle) from empty. Naturally this time period would be adjusted according to what pressure the bottle had when you started. Another condition that might affect filling time is scene demands, it may be necessary to fill the bottles much faster, however crews should be reminded that the gauge readings are inaccurate until the air cools. MSA has tested their bottles at rapid fill rates with no problems and they are approved for such, however we have found rapid fills to damage the gauge and occasionally cause a burst disc to blow, which can be a startling event and puts the bottle out of service until it can be repaired.

Bottles should not be filled above the rated capacity. Currently ACDPS SCBA bottles are 3000 psi carbon fiber cylinders. The cascade tanks on SQ16 fill to 4500 psi. The maximum fill capacity is controlled by the regulator on the compressor or cascade system. Fill 2216 and 3000 psi bottles in separate operations so as not to overcharge the 2216 bottles.

Cascade Operations

Components

The Cascade system on Sq 16 contains the following:

● 6 - Supply Tanks, capacity: 4500 psi, the control valves on these tanks are left open.

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Panel:

● 6 - Bank Gauges, each constantly registers the psi of the supply tank it is connected to. 6 - Bank Valves, these valves control the flow from and to the supply tank. ● 1 - Supply Pressure Gauge, registers the same pressure as the Bank gauge which is being used. ● 1 - Regulator, controls the discharge pressure, cannot create pressure that is not there, (if Bank 1 gauge shows 1500 psi, that is all the regulator can deliver, turning it up further will not increase the pressure), should be bled off when finished.

1 - Regulator Pressure Gauge, pressure regulator is set at (i.e.; 2216) provided the supply pressure is above this range. 2 - SCBA Pressure Gauges, registers the pressure in the SCBA bottle once the valve on the SCBA bottle is open. During the filling process this gauge and the gauge on the SCBA bottle will read differently primarily because the SCBA tank gauge is reading hot expanded air. 2 - SCBA Valves, this controls the flow (rate) of air in to the bottle. 2 - Charging Hoses, also equipped with bleed valves to relieve pressure after filling to help remove charging hoses.

To operate, select a bank with suitable pressure to permit filling.

● Open the corresponding bank valve. The supply pressure gauge will show the pressure available.

● Turn the regulator knob clockwise to set the desired filling pressure, this will register on the regulator pressure gauge (2216 is blue zone, no indicator for 3000 psi).

● After placing tanks to be filled in fragmentation tank, connect fill hose(s) open tank valve(s) and then slowly open the SCBA Valves on the panel to deliver a slow constant pressure.

● When tank has completed filling, shut off the SCBA Valve(s) on the panel, shut the SCBA tank valves and open bleeders. [ note; if bleed does not stop in a few seconds, you have left one or more valves open].

● When bank selected no longer will bring the tanks up to fill pressure it is time to begin cascading. This simply means use the bank you initially selected to bring the tanks up to whatever pressure is available in that bank (ie1800 psi), and then select the bank with the next lowest psi but more than the initial selection (i.e.; 2600 psi), this would then complete a fill for a 2216 psi tank, however for a 3000 psi fill you would have to continue after this second bank fill to yet a third bank (i.e.; 3800 psi). This process continues until the supply tanks can no longer meet the demands.

REMEMBER: Opening more than one bank valve simultaneously will result in those supply tanks equalizing to a reduced pressure and thus decreasing the total number of fills the system can provide.

Air Compressor - STATION 16

The air compressor is also equipped with a cascade tank system. However, it has only 2 banks rather than 6. The procedures for this operation are the same. The Bank Valves are labeled FROM BANK [ONE or TWO].

The valves labeled TO BANK [ONE or TWO] are to fill these banks from the compressor. They are not to be open during the process of filling SCBA bottles from the banks. Like having both FROM valves open simultaneously, both TO valves open will equalize the bank pressures.

Another valve on the compressor is labeled BY-PASS, this valve allows a tank to be filled directly from the compressor motor by-passing the cascade banks. Filling the cascade tanks on Sq16 would be an example of this operation.

To operate the compressor motor:

● Check the oil level, the full level is when a small air bubble is all that is visible in

the sight glass. The sight glass is located on left hand side of the compressor (facing the panel). To add synthetic oil,

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remove cap on stem located above the sight glass, pour slowly and stop occasionally to observe level in glass. Give a minute for oil to settle before taking a reading. DO NOT over fill.

● Turn switch to AUTO, [Do not operate in manual mode]. The motor is set to turn

off when a 4th stage air pressure of 4600 psig is obtained.

● To fill compressor cascade banks, open the TO BANK [ONE or TWO] valve(s).

Note: [It is possible to fill a cascade bank while filling SCBA bottles off of the other bank, it requires a careful manipulation of the valves. The TO BANK valve would be open to which ever bank you are filling and the FROM BANK valve of this same bank should be closed, while the FROM BANK valve would be open on the other bank to fill the SCBA bottles and the TO BANK valve of this bank would be closed].

● To fill using the BY-PASS valve, turn the compressor motor on, after the compressor shuts off because it has reached an air pressure of 4600 psig, set the regulator to the desired fill pressure [i.e.; 4500]. Connect compressor charging hose(s) to tank(s) to be filled (for Sq16 this would be the extension hose which would be connected to the charging port on the panel) an open the charging hose valve(s) on the compressor bank along with tank valve of the bottle being filled, the compressor will cut on automatically and shut off when the pressure designated by the compressor regulator is achieved.

● ADDITIONAL NOTE FOR FILLING Sq16 TANKS: When filling two or more tanks on SQ16, fill each bank individually to capacity of 4500 psi. After finishing fill, allow a short cool down period then open all banks that were just filled simultaneously and allow the compressor to run and top all the banks together. The compressor must register a significant drop in pressure before it will come back on (about 500 psi) opening all these valves at once should allow this drop.

● If the compressor shuts off because; (1) low oil pressure [as indicated by light] - add oil, (2) High CO detected [CO alarm activates], (3) High temperature [as indicated by light], other, or if excessive vibration or an unusual noise is heard, DO NOT resume use - shut off immediately.

The Air Compressor @ Station 21 is a 2 stage compressor motor and should only be used to fill an attached cascade system or individual bottles.

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IT SUPPORT REQUESTS

CHAPTER 10.3

Issued: August 2010 Revised:

Submitted by: Office of Information & Approved by: Chief Northcutt Technology

Purpose

To identify the process for reporting technical problems and projects requests through the Department of Public Safety’s Office of Information Technology. The Office of Information Technology (OIT) is staffed by a Network Analyst and a Network Specialist who are the primary IT support for the Department of Public Safety. The Office of Information Technology is also the liaison between the ACDPS and BOCC Information & Telecommunication Services.

Procedure

General IT related problems and application support.

All IT related issues should be reported using the IT Support Request Form located on http://firenet:9675/portal. The only exceptions are connectivity related issues that prevent access to the County’s intranet. Once a request is submitted, an automated email is sent to the Office of Information and Technology. As the request is assigned and updated you will receive an email updating you on the status of the request.

Other means of contact are as follows:

1. If the intranet is not available to submit a support request then a detailed email addressed to Ron Burchfield [email protected] and Tim Davis [email protected] should be sent. 2. If email is not available because of issues with the email system then a detailed voicemail should be left at the following numbers: a. Ron Burchfield (352) 213-9217 b. Tim Davis (352) 213-7414 3. All after hours support requests should be made via voicemail at the above listed numbers, or through email. Requests are addressed based on the severity of the problem.

When a request is received via email or voicemail, it is addressed in the order of priority and entered into the support request software.

OIT Special Project Requests

OIT special project requests include data requests, enhancements, configuration changes or any new projects that could involve the Office of Information Technology. Requests should be made via the chain of command and submitted using the same form located on Firenet at http://firenet:9675/portal. Consideration should be given to the funding sources required for the project or request.

Should any support or project request require the assistance of BOCC Information & Telecommunication Services, OIT will submit the required ISR (Information & Telecommunication Services Request Form) and liaison with BOCC IS.

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Public Information

CHAPTER 12.1

Issued: Revised:

Submitted by: Approved by:

Introduction:

It is policy of the Alachua County Fire/Rescue Department to establish and maintain a positive operating relationship with the news media.

This directive will establish a standard procedure to provide the news media with information normally requested from the fire department regarding fire, EMS, Emergency Management, and 911 Emergency Reporting information, to control the movements of the media personnel for safety reasons, and to establish an operating framework for Public Information that will effectively integrate into the overall fireground management system.

Procedures

Availability:

The Public Information Officer or his designated representative will be available on a twenty-four basis for the purpose of gathering and relaying pertinent information to Media personnel on any incident which has attracted such media attention.

Notification:

Notification of all significant incidents will be made to the Public Information officer. This will be done on the following manner:

● A separate logon for the CAD system at CDC. This will allow designated personnel access to all information viable for news releases. The new logon is FIRE-PIO. Personnel assigned to the duty of PIO will have the needed password and training for obtaining information.

● A dedicated Fire/Rescue telephone newsline will be established for media purposes. The audix line would contain a brief report of newsworthy incidents and a pager number to contact the designated Public Information Officer for further information. Information services will be responsible for upkeep of this line. The PIO will be responsible for the daily update of information.

● Fire dispatchers shall immediately notify the Public information Officer of any newsworthy incident via alphanumeric, or voice pager.

● Newsworthy incidents would include any of the following:

Accidental Deaths Aircraft Alert 3/Fire Animal Rescues Arson Attempts/Arrest/Fire Boat Accidents/Fires Bombings Drownings Evacuations EOC Activation’s Firefighter Injury/Death Dept Vehicle Accidents Fuel Spills (Large) Harzadous Material Incidents Entrapment Responses Mutual Aid Responses Severe Weather Advisory Structural Fires Structural Collapse Unusual Events Train Accident/Fire

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Vehicle Accident w/Death

Guidelines for on-scene operation:

Command will be responsible for the management of the public information on the incident. As soon as practical, after basic rescue and fire operations are extended, Command will establish a Public Information Officer (PIO). The PIO Officer will relieve Command of the need to deal directly with the media during incidents. The PIO will provide standard information to the media in order to accurately report the situation.

The Department PIO will report to Command upon arrival on the fireground, to determine the status of the PIO Assignment. The PIO will immediately assign or assume the function.

Prior to the arrival of the Public Information Officer, Command may assign an officer to the PIO function. The assigned officer will begin to gather information on the incident. The assigned officer will station himself in a readily visible and accessible location adjacent to the Command Post to meet with and provide information for media personnel.

Radio designation will be "PIO".

Individuals assigned to perform PIO functions should be regulated by the following general guidelines:

If possible, add anything to the basic information on the form that will enhance the story of the situation, such information might include:

● An extremely hazardous situation/rescue

● A person or company that did an outstanding job

● Citizen support

● Extra information that will make a better story for the reporters and tell the citizens how the fire department provides fire and/or EMS services.

● If possible, a personal interview with a Fire Officer, or crew member is encouraged. The interview should be related to the scene and only facts should be given. Fire officers and crews assigned to a specific task should not be interviewed until their jobs are complete.

Usually, during the time you are gathering information, you will have inquiries from reporters seeking information. Give them what you have at that point and emphasize that this information is tentative. If it gets to the point that questions from reporters are keeping you from gathering information, use these alternatives:

● Establish a designated area for all reporters to gather. Tell the reporters to standby in that location and that you will return shortly with more information.

● Request additional manpower from Command to utilize for assistance in gathering information and stay with the reporters.

● Tell the reporters to go ahead and get pictures and film footage without interfering with fireground operations while you are gathering information. Make certain and point out the hazard zone. Arrange to meet them shortly at a location and give them facts.

● If they have deadlines to meet, get a phone number(s) where they can be reached and phone the facts to them as soon as possible.

● Verify that press line is being updated with information regarding the incident.

● DO NOT release names of persons injured or deceased until next of kin has been notified. Notification(s) is/are usually handled by the police and/or hospitals. Ask CDC supervisor to check with the police department or hospital to confirm that next of kin has been notified. DO NOT USE NAMES OF DECEASED OR

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INJURED PERSONS OVER RADIO AT ANY TIME.

The officer assigned to PIO may be required to escort media on an orientation tour of the scene. This must be cleared with Command and coordinated with operating and investigative officers before entering the area.

The PIO will be responsible for requiring that all media personnel maintain a safe distance from the operations on the scene.

If media personnel create a safety problem, or hinder operations, they should be removed in a positive manner – avoiding confrontations.

The Public Information Officer will have access to the Media Line which contacts all news agencies on a closed-loop telephone system.

Press Conferences/News Releases:

The Public Information Officer should be apprised of the need for all press conferences. The public Information Officer is responsible for notifying the media of when and where the press conference will be and what the conference pertains to.

At no time shall an officer/employee hold a press conference without direct approval from the Chief of Alachua County Fire/Rescue.

The decision to hold a press conference will be at the discretion of the Chief of the Alachua County Fire/Rescue Department, and/or the Public Information Officer.

Production/Public Relations:

The Public Information Officer is to be the liaison between any productions companies and Alachua County Fire/Rescue. The requests for production must be passed through the Public Information Office and approved by the Chief of Alachua County Fire/Rescue. If a production company requests a story on a specific incident, releases from the citizen(s) involved in the incident are a must.

All requests from the media shall be referred to a Chief Officer or if at incident, the Public Information Officer (PIO). Employees shall not comment to the media about any Departmental matters. Any employee contacted by the media concerning Departmental matters shall immediately make verbal contact, one to one communication, with their District Chief.

Taking photographs shall not be allowed within or at any County Station without prior approval of the Chief or designee.

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Personnel Accountability System

CHAPTER 13.1

Issued: Dec 2004 Revised: Sept. 2009, Aug. 2010

Submitted by: Health & Safety Officer Approved by:Chief Northcutt

PURPOSE:

To establish a uniform procedure that will account for Department personnel at the scene of emergency incidents.

The Personnel Accountability System (PASS) gives Incident Commanders a fast, effective, and efficient means to account for all Department personnel at any point during an incident in which the system is utilized. In order to ensure the effectiveness of this system and the subsequent safety of all personnel, accountability procedures will be strictly adhered to at all times.

PROCEDURES

T-PASS Every position in ACDPS as assigned to apparatus will be assigned a PASS Device. The PASS devices will be programmed and coded as listed below.

O’s Chief Officers 100's Lieutenants 200’s Driver-Operators 400's Rescue Lieutenants & Firefighters 500's Rescue Driver 700's Safety Officer, Training, Special Assignments

The PASS Device will consist of a GRACE Systems PASS module, a ring/snap fastener with a personal activation key and lanyard with snap hook.

● Each PASS Device shall be equipped with a PASS Activation Key and Lanyard.

● The PASS Activation Key and lanyard will “clip”onto each PASS device to place the unit in an “off”mode.

● The PASS Activation Key and lanyard shall be attached to each PASS device while not activated for use at an incident scene. Upon activation of the PASS device the Activation Key and lanyard will remain affixed to an anchor hook mounted within each apparatus.

● Apparatus

● A fixed-point attaching device shall be fastened to each unit, adjacent to each riding position and the PASS device’s Activation Key Lanyard clip secured to that fixed point. Upon exiting the apparatus, the anchored lanyard will cause the attached Activation Key to pull-free of the PASS device, thereby, turning the unit “on”.

● The PASS Device will remain in the assigned location on each apparatus.

● It will be the responsibility of each position in which a PASS is assigned to monitor the battery status of the assigned PASS Device to ensure that it has an

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adequate charge to fulfill its designed function.

● Each position in which a PASS is assigned shall ensure that the PASS Device is present and placed in appropriate location to facilitate activation upon exiting apparatus.

● Any loss, damage, or destruction of a PASS Device shall be immediately reported to the appropriate supervisor and on-duty District Chief for replacement and Accountability.

● The Health & Safety Officer should be advised of defective or damaged TPass units, and will provide a replacement unit.

● Spare (loaner) units are available through the District Chief and must be reprogrammed into all Command Base modules.

● At the discretion of the District Chief, a “Spare”Pass Device may be temporarily assigned to an individual with immediate notification made to the City/County District Chiefs of the employee’s name and riding position assigned as “Spare”.

Personnel Accountability Tag (PAT)

Every member of ACDPS will be initially issued two (2) PAT’s that will be printed with his/her name and be color coded by rank.

Yellow Firefighters Blue Driver-Operators Red Lieutenants & Rescue Lieutenants White Chief Officers Green Unit Identification Orange PIO, Fire Inspectors, Fire Investigator, Training Captains, Health/Safety Officer and Public Education Specialist Blue/White Riders, Specialists and/or Mutual Aid Companies

● The PAT will consist of a snap fastener with a personnel identification card attached. (Attachment #1)

● Each member shall keep a PAT with his/her protective gear when not on duty or assigned to a unit.

● Replacements are available through the Health & Safety Office.

● Each emergency vehicle will have a collector ring.

● The collector ring will consist of a large ring with a unit Identification tag attached. (Attachment #2)

● The collector ring shall be maintained in the cab of each unit and shall be removable.

● Each response apparatus will maintain a cache of “blank” color coded tags for use in providing temporary replacements. The members name will be scribed onto the temporary replacement PAT with a grease pencil. The Company Officer will insure that a permanent replacement card is immediately requested through the Health & Safety Office.

● Each District Chief vehicle will maintain a cache of “blank” color coded cards for use in providing temporary identification cards for Riders, Specialists and/or Mutual Aid Companies. The individual’s name will be scribed onto the temporary PAT with a grease pencil.

IMPLEMENTATION

Level 1 Accountability

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Level 1 Accountability is the normal day-to-day operations of Alachua County Fire Rescue.

● T-PASS Devices:

● Each member shall attach the PASS device in their apparatus location to the SCBA harness via the clip on left harness strap on the front of the air pack with the Activation Key lanyard, then attach to the designated anchor point within each apparatus.

● The Company Officer shall be responsible for PASS Policy compliance for all personnel riding on the apparatus.

● The Company Officer shall assure that each member has attached his/her PASS device to the anchor point adjacent the employees riding position at the beginning of each shift.

● Post arrival at the scene of an incident each member shall ensure that prior to closing apparatus doors the Activation Key and lanyard are free of impingement.

PAT System

● Each member shall ensure upon exiting the apparatus that their PASS Device is “on”.

● Each member shall attach his/her PAT to the unit collector ring on his/her assigned apparatus at the beginning of the shift. If a member is reassigned to another unit during the shift, he/shall remove the PAT from the original unit and attached it to the collector ring on the next unit.

● The Company Officer shall be responsible for accounting for all personnel riding on the apparatus.

● The Company Officer shall assure that each member has attached his/her PAT to the unit collector ring at the beginning of each shift.

● The Driver-Operator shall collect all PAT’s on the collector ring and place the ring on the fixed point located in the cab of the apparatus.

● At the order of the Incident Commander, the Company Officer will bring or have brought to the command post the collector ring once command set-up is complete. (attachment #3)

● Administrative staff personnel, command officers, and any additional personnel arriving shall report to the command post to have their PAT’s collected. Personnel arriving prior to the command post being established may leave their PAT at the unit that has assumed command and is already on the scene until the command post has been set up for placement on the Command Assignment Board. (attachment #4)

● It shall be the responsibility of each member to ensure that his or her PAT is removed from the collector ring at the completion of the shift.

Level II Accountability

Level II Accountability is used when the Incident Commander has the need for a stricter accountability for personnel operations on a scene; for example, a multi-alarm fire, HazMat incident or confined space rescue. These incidents are typified by the factors of multiple companies, long duration, and multiple tasks.

T-PASS Devices and PAT System:

● At any time during the course of an incident, the Incident Commander (IC) has the option of directing units to account for the personnel operating on the event by calling for a Personnel Accountability Report (PAR). The IC shall announce a PAR check by either calling for a PAR of a single unit or for all units assigned to an incident. The IC shall call for a PAR check at benchmarks (all clear, fire out, fire under control), changes in conditions (offensive to defensive, flash over, collapse) or no more than thirty-minute (30) intervals during a working incident.

● Company Officers shall immediately respond to a PAR check by making an immediate visual

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accountability of their company members/or those members assigned under their command for a task. This PAR will be relayed to the IC, and will include the member’s normal assigned company position.

● In the event a company/or assigned task member can not be immediately accounted for, this will be relayed to the IC to include members name & ID (if known), also last known location/task. Upon notification of an unaccounted for member, the IC will immediately take actions via radio channels and/or visual means to locate individual(s).

● During PAR checks, the IC should be notified (or verified) by CO if the company is to be split up in to separated task. The reassignment location of each member should be announced over the radio, or directly to the IC at the CP.

● At the order of the Incident Commander, all collector rings that have not been collected already (stages, special call), will be brought to and maintained at the command post.

● The collector rings will be organized at the command post by utilizing and Accountability Control Chart and the Command Assignment Board.

● Company Officers shall ensure that all personnel assigned to their unit are accounted for prior to leaving the incident scene.

● Each Driver-Operator shall ensure that the Activator Keys and Lanyards are not in danger of being crushed by closing apparatus doors wile on the scene or before leaving the incident.

● Each Driver-Operator shall ensure that the collector ring is returned to his/her unit at the completion of the incident or before leaving the incident scene.

Level III Accountability

Level III Accountability is used when access to the scene must be controlled; for example, a large multi-story structure fire, level III Haz-Mat incident or significant event.

● T-PASS Devices and PAT System:

● When the Incident Commander determines that the incident requires more stringent accountability, he/she will implement Point of Entry control. A “time benchmark”will be set for the amount of time to be spent in the hazard area (should include time for entry, work and exit).

● To implement Point of Entry control, the designated officer(s) will monitor all points of entry into the structure, confined space, or areas involved. These individuals will be referred to as “Entry Control.”Entry Control will ensure that each member’s name, company name, duration of air supply, time of entry, and assignment shall be recorded on this chart.

● Each member shall leave their second PAT at the Point of Entry.

● Entry Control shall ensure that members are relieved as appropriate.

● As members exit a control point, the time of exit shall be recorded. Members who must exit at a point remote from the control point shall inform Entry Control personnel of their exit from the building.

● Entry Control shall inform the Incident Commander that search and rescue operations are needed for unaccounted personnel.

Firefighter Personal Emergency Alarm Signaling

While the PASS Device is in the “on”mode, the Firefighter may transmit a personal distress or alarm signal to the Incident Commander by manually pressing the alarm button on the front of the PASS Device. When in ALARM, the yellow wig-wag display is replaced by a rapid pulsing of two red LED’s accompanied by a rapid modulated loud

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audio “Alarm signal”and an electronic radio transmission is sent to the Command Base Received. This signal alerts the Incident Commander that a specific Firefighter is in need of assistance.

● Upon receipt of an ALERT Signal; the Incident Commander shall immediately initiate a PAR Check of the specific Firefighter as displayed on the Command Base Screen.

● The Command Base Screen may be cleared of transmitted ALARM signals by pressing “key 1, then key C and then key C again.”

Command Evacuation Signaling

A building evacuation (or an evacuation of any incident location) may be ordered by the Incident Commander.

A building evacuation may be ordered to immediately remove all fire/rescue personnel from a hazardous area. Examples of hazardous conditions would include exposure to extremely toxic fumes, a possible explosion, or deteriorating building conditions, suggesting an imminent collapse.

When the decision to evacuate personnel is made the Incident Commander or the Safety Officer shall do the following:

● Notify dispatch of the order (by radio).

● Utilize the GRACE Command Module to generate electronic PASS Device evacuation notification to all appropriate personnel.

● Notify all personnel of the order (by radio or face to face)

● Designate a person to sound the air horn and make the announcement.

Methods for Signaling Building Evacuation

GRACE COMMAND MODULE

The Evacuation function may be activated by the Incident Commander from the Command Base Module at any time. When the Evacuation signal is received by the firefighter’s PASS Device, both amber LEDs flash rapidly accompanied with a loud chirping audio alarm tone. The Evacuation alarm tone is easily differentiated from other audio tones with minimal training.

To facilitate an “Evacuate All”order, the Incident Commander will access the red star Evacuation Screen by pressing the “red #2" button:

● Evacuate All by pressing the “red star”.

● Individual members may be electronically prompted to evacuate by pressing “red key #9" and selecting desired member.

● When the Evacuation alarm signal is received by the firefighter’s PASS Device, it automatically sends an electronic acknowledgement that the signal was received by the PASS Device. ● The firefighter must manually acknowledge receipt of the Evacuation signal by momentarily pressing both PASS Device side buttons. This manual acknowledgement will cause the flashing LED’s and loud chirping audio tones to cease. The firefighter will then immediately evacuate the area.

● An estimate of the time required for specific Company or member’s “Evacuation” must be determined and their progress monitored to ensure the structure has been cleared. The Incident’s tactical channel may be placed on “Emergency Traffic”with radio calls made to monitor exit progress.

● Post Evacuation of all personnel: The Incident Commander will complete a Personnel Accountability Report (PAR) Check/Assessment.

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● To “Clear” all PASS Device ID’s from Evacuation Screen upon completion of PAR Check, the Incident Commander may press the “red OPER or O key”.

RADIO DISPATCH AND ON-SCENE APPARATUS AIR HORNS

When the order to evacuate a building is given, there are two sets of actions to be taken simultaneously. They are:

● The dispatcher shall be notified of the decision to evacuate the Building. th ● Example: Alachua, 25 Street Command, Inform all personnel to evacuate this building”.

● The dispatcher shall sound Tone 2 (an electronic warble sound) and announce the evacuation. th th ● Example: Tone 2 - “All personnel at 800 Northeast 25 Street, 25 Street Command has ordered an evacuation of the building.”( Repeat tone and announcement.) The tone and order shall be broadcast on all Tactical channels to ensure that any personnel on an incorrect channel will hear the order.

● The address must be included so that the dispatcher does not inadvertently evacuate a different fire location.

● An apparatus air horn shall be sounded with four (4) short blasts and one (1) long blast. The cycle of 4:1 will continue until advised by Command to cease. When possible, the unit that will be used for the air horn should be driven to the nearest entrance so that sound of the air horn projects into the building.

● When a building evacuation is ordered all fire/rescue personnel shall immediately leave the building or indicated location and move to a safe area. “Immediately leave”means that personnel shall stop what they are doing, unless performing a rescue, rapidly exit the building, and leave equipment that cannot be carried out without impeding rapid exit. ● Immediately following an evacuation, each company officer shall account for his/her personnel and shall report, in person, to their division leader, their group leader, or to the Command Post. All division and group leaders shall then report the status of all companies under their command to the Incident Commander. This accounting of personnel shall be the first and only action of officers until all personnel are accounted for.

● At least one additional company shall be immediately assigned by the Incident Commander to assemble near the Command Post or appropriate specified location to serve as a Rapid Intervention Team.

● The Incident Commander (or his/her designee) shall conduct a written roll call following a building evacuation order.

● All on-scene agencies or individuals associated with the response (such as Utilities, LEA, Red Cross, Media, Riders, or requested Specialists) shall be accounted for in the evacuation and written roll call.

● Each apparatus shall have a plate affixed to the dashboard near the driver’s seat with the air horn evacuation signal written on the plate.

Rehabilitation Procedures

At the discretion of the District Chief or Incident Command, a rehab area for responders may be established. Upon reporting to rehab, the CO will notify IC of members of his group reporting (or, if a Rehab officer has been designated, he/she will make notification to IC) to Rehab. PASS units will be disabled while members assigned to Rehab. Rehab will maintain spare lanyards and keys for the PASS units at Rehab.

Prior to reporting for next assignment post completion of Rehab, firefighters will disconnect PASS Device’s Accountability Lanyard and Key from the Rehab tarp and ensure PASS Device is in the “on”function.

Use of Repeaters

Repeaters for enhanced signal processing in large structure will be assigned as the need presents.

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The location of Repeater placement will be identified through pre-incident planning. The determination of locations for repeater placement will be a recognized component of pre-planning efforts.

Each unit assigned a repeater shall be responsible for the retrieval of their Repeater Device post deployment. The use of Repeaters may be requested through Incident Command System to address PASS Device reception difficulties.

Compliance

The PASS Device shall be considered an item of Personnel Protective Equipment.

If a PASS Device is non-functioning, a replacement shall be obtained as soon as possible from the District Chief or Health/Safety Officer. Each device is specifically programmed to a position on the apparatus; therefore it should not be moved to another location.

Each PASS Device shall be inspected upon reporting to duty and after each incident.

Any deficiencies will be reported to the immediate Supervisor; the District Chief shall be contacted to facilitate replacement or resolution of deficiency. Members shall ensure their devices are equipped with a battery with sufficient charge through inspection at the start of each shift. Replacement batteries may be obtained through CSW, Health/Safety Officer or the District Chief. The Department recognized replacement battery shall be a Duracell 9-Volt.

Fire/rescue personnel shall ensure their PASS Devices are attached to the apparatus via the Accountability Lanyard and Key as described in the Level 1 Accountability section of these operational guidelines.

Click each attachment below to view/print

Attachment #1 (Personnel Accountability Tag)

Attachment #2 (Collector Ring)

Attachment #3

Attachment #4

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Stadium Operations Ben Hill Griffin Stadium Medical Operations 2011-2012

CHAPTER 14.1

Issued: August 2003

Revised: April 2011

The following plan will pertain to all Special Events held at Ben Hill Griffin Stadium. These events will include: University of Florida regular season football games, the annual Orange & Blue Football game, Gator Growl, Championship events, Florida High School Football Championship games and any other events agreed upon by both agencies.

This plan has been approved by the following representatives:

1) Mr. J. Foley UF Athletic Director 4/29/11

2) Mr. C Howard UF Director of Operations 4/29/11

3) Dr. M. Dace Chief-UF Stadium Medical Operations 5/10/11

4) Edwin C. Bailey Director-ACDPS 3/31/11

5) Bill Northcutt Chief -ACDPS 4/12/11

6) C. Van Dillen, MD. Medical Director-ACDPS 4/18/11

(*) 2011 season start through 2012 Orange & Blue Game TABLE OF CONTENTS

Section 1 Staffing Requirements

Section 2 General Considerations

Section 3 Game Day Operations

Section 4 Reports and Billing

Section 5 Appendix

SECTION 1 - STAFFING The University of Florida Athletic Association and Alachua County of Public Safety have approved the following staffing requirements. No changes will be made without the consultation, and agreement of both parties.

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U.A.A. ORANGE & BLUE GAME/Championship Celebrations Field Unit 1 Rescue Lt./1 EMT (Not required Championship Celebrations) Field/South End Zone 1 Paramedic/1 EMT (Moves to field if Field Unit committed) West Aid 1 Paramedic/1 EMT West Transport/MERV 1 Rescue Lt/1 EMT (Transport crew mans MERV) East Aid 1 Paramedic/1 EMT North Level 1 1 Paramedic/1 EMT North Level 3 1 Paramedic or 1 EMT with AED North Level 5 1 Paramedic/1 EMT Champions Club 1 Paramedic/1 EMT U.A.A provided Physician West Aid Station Incident Command 1 Chief Officer/1 Ops Chief Total Personnel – 7 Paramedics, 7 EMT’s, 1 Incident Commander, 1 Operations Chief

GATOR GROWL (Student Government Event) West Aid 1 Paramedic/1 EMT West Transport/MERV 1 Rescue Lt/1 EMT East Aid 1 Paramedic/1 EMT North Level 1 1 Paramedic/1 EMT North Level 3 1 Paramedic/1 EMT Champions Club 1 Paramedic/1 EMT Incident Commander 1 Chief Officer Total Personnel - 6 Paramedics, 6 EMT’s, 1 Incident Commander, 1 Operations Chief UNIVERSITY OF FLORIDA (U.A.A.) FOOTBALL GAMES Field Unit 1 Rescue Lt./1 EMT (Remains post-game until relieved by UAA) 1 Field/South End Zone Paramedic/1 EMT (Moves to field if Field Unit committed) West Aid 1 Paramedic./1 EMT West Transport/MERV 1 Rescue Lt/1 EMT East Aid 1 Paramedic/1 EMT East Transport/MERV 1 Rescue Lt./1 EMT South Aid 1 Paramedic/1 EMT North Level 1 1 Paramdeic/1 EMT East Float Team* 1 Paramedic/1 EMT West Float Team* 1 Paramedic/1 EMT North Level 3 1 Paramedic or 1 EMT with AED (ALS team large scale event) (Remains post-game, relieved by UAA) North Level 5 1 Paramedic/1 EMT Champions Club 1 Paramedic/1 EMT(Remains post-game, relieved by UAA) West Level 7 1 Paramedic/1 EMT U.A.A. provided Physician West & East Aid Incident Command 1 Chief Officer/1 Operations Chief *East and West Float Teams as requested by DOC 1 for anticipated heavy call volume game. (*) Wheelchair units

Total Personnel – 12/14 Paramedics, 12/14 EMT’s, 1 Incident Commander, 1 Operations Chief

TV Sports Cast “GAME DAY”event ALS Transport - Assigned to area W University vicinity of event

NOTE: In order to allow for staffing, U.A.A. will notify ACPS as soon as possible when it’s known this event will occur. As with Stadium events, unit will treat patients on site and call for outside transport if need, unless patient is critical. If event assigned unit transports, CCC will move a duty unit “last call”to the event till event unit can return. Duty District Chief’s will be notified.

Spring Practice Events

U.A.A will contact ACPS District Chief responsible for staffing special events, a minimum of two weeks in advance to schedule standby EMS coverage for these events.

HIGH SCHOOL FOOTBALL CHAMPIONSHIPS (FHSAA)

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DAILY LOW AVERAGE ATTENDANCE EVENTS (as determined by both parties): Field Unit 1 Paramedic/1 EMT West Aid 1 Paramedic [OIC]/1 EMT MERV (Eastside) 1 Rescue Lt./1 EMT Total Personnel – 3 Paramedics, 3 EMTs

DAILY HIGH AVERAGE ATTENDANCE EVENTS (as determined by both parties): Field Unit 1 Paramedic/1 EMT West Aid 2 Paramedic/2 EMTs MERV (Eastside) 1 Rescue Lt./1 EMT Total Personnel – 4 Paramedics, 4 EMTs,

INCIDENT COMMANDER NOTE:

MERV will transport non-ambulatory patients to West Aid as determined by the West Aid Supervisor.

STAFFING ADDENDUM:

● Extra personnel (as noted) will be added to those U.A.A. football events, which will have a significantly increased attendance, and thus be categorized as “Big Games”( IE: FSU, Tennessee, etc.). The Game Operations Chief will assign extra personnel as needed throughout the stadium. To allow for appropriate staffing, these games should be identified by the U.A.A. 30 day(s) prior to the start of the season. These staffing requirements can be reduced by the U.A.A., provided that 24 hour notice has been provided before game day.

● In the case of environmental factors (IE: projected high heat index) that the Chief Stadium physician and ACPS determine may significantly increase the need for medical intervention during the event, extra staffing will be added as deemed appropriate. This should be determined 5 days before the event, and can be canceled at anytime if both parties agree conditions will improve by game time (IE: game time changed to later event, significant weather pattern change).

● The UAA will make arrangements for Physician coverage in the West and East Aid Stations during U.A.A sanctioned events (1 Physician in West Aid for Orange & Blue). If the Physician is needed in an area other than the East or West Aid Station, ACPS personnel with radio communications shall accompany the physician to the incident.

● The Chief Stadium Physician will be assigned the call name “DOC 1” and will be available via ACPS radio and UAA Operations radio.

SECTION 2 – GENERAL CONSIDERATIONS

● At U.A.A. events; DOC 1 and the ACPS Operations Chief will be notified via radio of any injuries involving players, U.A.A. staff, dignitaries, ACPS, or LEA staff. In addition; DOC 1 will be notified of any serious medical and trauma incidents that occur within the stadium.

● In the event an attendee or any non-participant is injured significantly, or questionably, within the stadium during any event, a U.A.A. Incident Report will be completed (available in each Aid Station) and turned in to the game- day ACPS Operations Chief post event. These will be forwarded to the U.A.A. for follow up. NOTE: The University of Florida will have a Risk Manager Representative on site to assist investigating and the follow up completion of the Incident Reports if needed. The U.A.A. will provide ACPS with information needed to contact the Risk Management representative during the event. In all cases the Operations Chief will be notified as soon as possible, while the event is in progress, of any incident requiring documentation on the U.A.A. Incident Report.

● Professionalism will be maintained at all times by ACPS employees interacting with anyone at the Stadium. In the event a situation arises that calls in question the ACPS employee(s) mannerisms, quality of medical care, etc., the following should occur; ● At U.A.A. sanctioned event: Operations Chief & DOC 1 should be contacted via radio or phone.

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● At Student Government sanctioned event: Operations Chief should be contacted via radio or phone. ● At F.H.S.A.A. sanctioned event: The most senior PM Att/ or a Lt. should be contacted. If this is not satisfactory, an on-duty District Chief should be contacted via CCC.

● For all Stadium events, outside on-duty transports will be utilized as the primary source of transportation. Transport pickups will occur typically at the safety bollards on west-side of the Stadium, which prevent access to the stadium north and south on Gale Lemerand. MERV’s will deliver patients to the pickup points, or gates (18, 1, 2, 3, 4) if utilized. ● Outside transports arriving at the Stadium will be subject to LEA clearance prior to being allowed to pass the security barricades to designated pick up points.

● In the event Eastside Aid Station access is required; transports best access will be the following; st ● East or North Aid Stations– approach though parking area (1 Right off of Fletcher), follow west to east side of stadium, pickup between gates 14 & 12 ● Field – Stadium Road, SE side of Stadium, follow road (east of ramp) down below Gate 15 to tunnel. ● OPTIONAL pick up: Stadium Road at Gate 17

● All Transports responding to the Stadium will be assigned the Stadium Event assigned tactical channel. At U.A.A. (except Orange & Blue & Championship Celebrations) & Growl events, CCC game day operations will manage incident communications. All Transports from the Stadium Event to the ED will communicate on the assigned medical channel, unless otherwise instructed by CCC.

● Stadium assigned transport units will remain available at the stadium and only be used for transport in the cases of a disaster, or a patient whose medical condition is determined critical or time sensitive. In the event a Stadium assigned Transport does leave with a patient, the Stadium Operations Chief, or senior PM/Att (FHSAA) will be notified immediately. An on-duty rescue will be assigned to stand by. ● Stadium Transports (assigned to MERV’s) must take kits, EKG monitor, etc., from MERV in the event of a transport from the stadium

● The ACFR Special Detail Supplemental form is the medical report for Stadium events. The use of this form will be to document those extra medical details that maybe required at a later date. This would include the obtaining of a waiver from a patient seen inside the Stadium who in the paramedics best medical opinion should be transported to the emergency department or seen relatively soon by a physician of the patients choosing. Paramedics’ will also complete the Department Electronic Rescue report for patients transported from their Aid Stations if they rendered ALS aid before transport.

● The South Aid Station will be the EMS supply depot for U.A.A events, except for Orange & Blue or Championship Celebration events. A stock supply list will be maintained in this station. UNLESS emergent need, all requests for supplies will be called in via phone by other Aid stations (ph # 1897).

● OTC kits will contain oral diphenhydramine HCL which can be administered in accordance with ACPS protocols for anaphylaxis. Pt’s will be informed not to drink or drive for 24hrs after taking Benadryl. If a question should arise regarding the administration of Benadryl by the paramedic, the stadium physicians in East or West Aid should be consulted.

● Any patient tazed by LEA on the premises of Florida Field will be transported by LEA to STH, or by EMS if medically necessary.

● Responses into female restrooms by an all male EMS crew will require LEA to accompany these responders. In addition; ANY UNRESPONSIVE subject in a bathroom stall that has a door secured shut, will be removed from the stall by LEA not EMS personnel.

● Overheated individuals without medical implications, should be directed to RTS heat bus(es) for rehab. A Return Entry pass should be obtained from the physicians in East & West Aid and given to the subject(s) prior to their departure from the stadium. Designated buses will be parked as close to the stadium as possible [IE; at Gate 13 – Eastside, at or about Gate 2 Westside on Gale Lemerand]

● The Operations Chief will be notified anytime the patient count in an Aid Station overwhelms the staff.

● POV patient pick-ups during the event are at security barricades, Westside. A vehicle description, driver’s

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name, and tag (if known) will be communicated to Stadium Dispatch for LEA vehicle clearance down Gale Lemerand. The Operations Chief should be notified when this occurs.

● Patients requiring transport post-event may be transported via stadium assigned transports at the Operations Chief discretion.

● AS the ‘Gators Fans’ Code of Conduct’ prohibits “drunkenness”in the Stadium, this policy will be enforced in the EMS Aid Stations. ● Patrons suspected of being intoxicated will be treated appropriately for any immediate medical need. If the subject is not in control of their basic motor control faculties, or cannot protect their airway, or fails a common mental clarity exam by a paramedic or physician, they will be transported to STH via an ACPS Rescue unit. Assistance by LEA shall be requested if the patient refuses to cooperate with this only option.

● Subjects, who are suspected of being intoxicated but not significantly enough to warrant transport, will be released to LEA, or to a competent adult known to the subject, and that attest he/she is not under the influence of alcohol or drugs and will see the subject safely out of the stadium and to a safe place of refuge. This latter should be documented on a waiver.

SECTION 3 - GAME DAY OPERATIONS

DISTRICT CHIEF RESPONSIBLE FOR SPECIAL EVENT(S)

● Staffs event(s) according to this SOG, SOP Chp. 8E , and current Union Contract

● Completes ICS 204 [Division/Group Plan] & ICS 206 [Medical Plan] prior to each event on WEBEOC. Reviews ICS 202 [Incident Objectives – Response Priorities], ICS 205 [Communications Plan], ICS 223 [Health & Safety Message], prepared on WEBEOC.

● Maintains current copy of ICS205 during event

● Schedules events in advance on Telestaff, and periodically checks to assure all staffing locations at the event are filled prior to the event.

● Post event; completes Department Fire Report to document event, times, and personnel. Notifies ACPS Ambulance Billing Department when report complete [Exception is FHSAA events – this is handled by senior EMS supervisor at event]

● Post event; Updates personnel work hours on Telestaff and finalizes event for Payroll. [Exception: FHSAA].

● Attends post-season U.A.A. event meetings with Chief Stadium Physician and his/her staff. During the season will attend post game follow-up meeting with Chief Stadium Physician and his staff. Also in the absence of, or along with, the event Incident Commander, attends the pre-game security meeting with U.A.A., L.E.A. & GFR Hazmat.

● Conducts inspections of Stadium AID Stations pre-season with Chief Stadium Physician, and/or his staff. Reports any Aid Station deficiency or maintenance issue to Chief Stadium Physician and/or his/her staff during the season.

● During season assures needed event paperwork is on hand (Special Detail Supplemental form, Station Activity Log (Appendix A), U.A.A. Incident reports*, stadium maps*, and Stadium phone list*. Assures Champions Club & Level 6 has box assignment list with phone numbers* for; Bull Gator Deck (Lev 3), Champions Club Suites (Lev 5), Presidents Level Suites (Lev 6), Bull Gator Zone Suites (Lev 7). (*) Provided by UAA staff

● Post U.A.A. games/Gator Growl/Orange & Blue/Championship Celebrations; collects all completed paperwork from Aid Stations

● Submits report to Chief Stadium Physician regarding statistics of numbers & types of patients seen in Aid Stations, number of transports, significant incidents. This information is obtained from Station Activity Logs

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(Appendix A), & medical reports. A copy is also forwarded to the Assistant Chief for EMS review.

● Post season: compiles season’s stats and provides copy to Chief Stadium Physician, Assistant Chief, and the ACPS Department Chief.

● Assures MERV’s, radios, needed medical equipment & supplies are available for all events.

● Maintains inventory list of needed medical equipment and supplies for event. Including; ALS kits & airway bags, BLS kits, special kits (Field Crew, & South EZ/Field crew)

● For U.A.A. & Gator Growl events; conducts pre-event meeting with PM’s/EMT’s to update regarding security risk, environmental issues, EMS event plan, crew transportation plan.

● Assures predetermined event radio (either VHF or 800 MHz) is available for each personnel or location as needed. Radios will be assigned as a minimum as follows:

West Aid – 1 portable, 1 800 MHz mobile base station West Transport/MERV – 2 portable radios with earpieces Champions Club – 1 portable Level 7 – 1 portable North Level 1 – 1 portable, 1 800 MHz mobile based station North Level 3 – 1 portable North Level 5 – 2 portable radios (1 with earpiece in the event crew must go in to stands) East Aid – 1 portable, 1 800 MHz mobile base station East Transport/MERV – 2 portable radios with earpieces Field Crew – 2 portable radios with earpieces Field/SEZ crew – 2 portable radios with earpieces South Aid – 1 portable, 1 800 MHz mobile based station East Float crew – 2 portable radios with earpieces West Float crew – 2 portable radios with earpieces “Doc 1”– 1 portable with earpiece – issued at beginning of season

● Is assigned OPS Chief at U.A.A. events & Gator Growl. [Notifies Stadium Dispatch to assign CR to Operations Id for later documentation on Department Reporting System]

PRIOR TO EVENT(S)

● Pre U.A.A. season, CSW staff shall assist District Chief responsible for Special Events: ● Inspect MERV’s for readiness. Annual PM maintenance is scheduled in June. ● Deliver MERV’s to stadium before first event and secure keys in West/East Aid stations. ● Oversee inventory of ALS/BLS equipment to be used during season. Replace out dated fluids/Rx. Report any problems with required supplies/equipment in a timely manner to District Chief responsible for Special events. ● Stock South Aid supply cabinet as per modified stock list (See ACPS’s ‘SOUTH AID STATION SUPPLY LIST’) ● Deliver EMS kits/airway bags/suctions/ LSB’s to stadium and secure in designated areas (See ACPS’s ‘STADIUM STATION STOCK LIST’)

● Prior to each U.A.A., & Gator Growl event, CSW staff shall assist District Chief responsible for Special Event (s): ● Inspect MERV’s for readiness, and fuel if needed (maintain ½ tank per event) ● Re-stock South Aid supplies as per list provided by previous crew working event in South Aid ● Report issues with required supplies/equipment to Chief responsible for Special events. ● For single U.A.A. events, IE; Orange & Blue, Championship Celebration, - CSW will have all supplies/equipment needed loaded in a supplemental vehicle for transport to the event.

● The Operations Chief will arrive at CSW prior to personnel to review the staffing schedule, transportation, and to make any last minute changes for the event.

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● Crews assigned to West Transport/MERV will report to CSW 4.0 hours prior to the event. After the pre-game meeting with OPS Chief, crew will proceed to stadium; West Transport crew will meet DOC 1 at West Aid 3.0 hours prior to event start with West MERV. Crew will assist DOC 1 in opening and inspecting Aid Stations, and equipment cabinets.

● Other crews will report to CSW 3.0 hours prior to the event. After a pre-game meeting with OPS Chief, crews will proceed to the stadium and be at their assigned station 2 hours pre-event.

GAME OPERATIONS

● Crews responding to the event and working the event will communicate directly with Stadium Dispatch as they would under normal daily operations.

● The Alachua County Sheriff’s Office (ACSO) will operate the “Stadium Dispatch” from CCC. Operational channels as follows: ● See current ICS 205 ‘Communications Plan’ on WEBEOC prior to event ● Stadium telephone system – List in each AID Station. Stadium Dispatch: 846-0227

● The ACSO “Stadium Dispatch”will be responsible for the following: ● Dispatching medical emergencies inside the stadium and the immediate surrounding area. ● Communications with Incident Command (IC) at designated Command Post (ICP) ● Notifying the ICP, OPS Chief, and “ALL CALL”notification to ACPS Aid Stations & MERV units, regarding any fire or HAZMAT incident with in the stadium or surrounding area. ● Communication with CCC regarding any fire / HAZMAT incident within the stadium or surrounding area. ● Communications with all LEA agencies on-site of event ● Communications with U.A.A. ● ACPS will communicate with UAA Operations either through the command post or phone. ● Access to CAD and can operate independently from CCC.

● MERV Units will be notified of needs for assistance in the West and East stands, Sunshine Seats (318 – 329), South EZ seats (47 - 65) and their corridors. MERV’s can transverse sides as needed. ● MERV identifiers (based on primary first run); MERV – WEST MERV - EAST

● MERV units will also be available to assist other Stations, or areas, retrieve patients and should be the 1st choice of transportation for patients going to the designated gates for transport to ED. Exception would be Champions Club or Level 7 Aid Station patients. Arriving off-site transport will take stretcher to LEVEL 5 via the west side elevators located between Gates 2 & 3.

● ALSO, West Aid may elect to have patients picked up at their Station (enter at Gate 2) by off- site transport unit.

● MERV UNITS DO NOT LEAVE THE STADIUM OR IT’s SURROUNDING WALKWAYS WITHOUT CLEARANCE FROM OPERATIONS

● MERV units may assist Aid Stations with retrieval of needed supplies from South Aid.

Note: East and West Float crews can respond to other areas of the stadium as needed

● ALL Aid Stations will be staffed (manned) continuously while event operations are in effect [2 hours pre-game, till cleared by Operations]. The Operations Chief shall be notified if an AID Station’s entire crew must abandon a station for an emergency response. AT NO TIME will patients ever be abandoned in an Aid Station for an emergency response. In such a case, the Station Supervisor will send one of the other personnel in the station and notify “Stadium Dispatch”if additional assistance will be needed for the response.

● The Field crew will be first response to any incident on the playing field (if requested by Team physicians), the sidelines, or the end zones, and the player locker rooms. In the event a patient must be removed from the area of the playing field, the Field crew will make the determination as to the best point of evacuation. Stadium stairs

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are available to be placed at the NE corner of the field.

In the event the Field crew is committed to an incident, or leaves the area of the playing field during the event, Field/South End Zone (or a Float crew in the event this crew is also committed) will be dispatched to the field immediately. Operations Chief will be notified whenever the Field crew is committed to an incident.

Field crew remains post game until relieved by U of F Team physician or his designee. Field crew will then notify CCC of their release from the event if “Stadium Dispatch”has been shut down. The Operations Chief will be notified by crew of time of their release for billing purposes.

Champions Club and North Level 3 crews will be released post event by U.A.A. staff. The crew will then notify CCC of their release from the event if “Stadium Dispatch” has been shut down. The Operations Chief will be notified by crew of time of their release for billing purposes.

● The Stryker Chairs will be used for removing non-ambulatory patients in the stands. They will be available on both MERV’s, at North Level 5, & Champions Club. Stryker Chairs on the MERV’s will be stored in the MERV’s assigned Aid Station post event.

● The U.A.A. will provide a designated area for storage of citizen’s wheel chairs if needed. Typically there is no room in the Aid Stations for storage of these chairs or other mobility devices. The exception would be in South Aid, where a couple of chairs could be stored if need be. ACPS is not responsible for any items left in the designated storage area.

CONCLUSION OF EVENT

● Crews will remain at their assigned stations post event until released by the Operations Chief.

● Aid stations will be cleaned and readied for service prior to departure.

● All completed paperwork will be collected and routed to the Operations Chief before departure from the stadium, unless prior arrangements are made between the Operations Chief and the Aid Station supervisor.

● South Aid crew will provide an inventory of stock supplies dispensed during event.

● EMS kits, airway bags, EKG monitors, suction unit, gloves will be secured in Aid Stations. MERV units will secure equipment in assigned Aid station. Field Crew, South EZ/Field crew secure equipment in East Aid. East Float storage is in East Aid and West Float storage is in West Aid. The OTC boxes will be left out in Aid station for U.A.A. staff to inventory & refill.

● MERV units will be secured at West & EAST Aid; keys will be returned to CSW.

● Drivers will account for all personnel they arrived with before departure from event.

● Upon arrival back at CSW, crews will check in assigned radios

● All trash will be removed from vehicles.

● Operations Chief will release all personnel from event (except Field unit, NL3 and Champions Club), billing time ends at this time for all except crews listed above.

● All remaining crews will notify Stadium Dispatch (or CCC if Stadium Dispatch has gone off air) of time they are released by U.A.A., this is event AVAILABLE time for documentation.

● Remaining crews will secure portable radios and unit keys in Sig15 room in the event upon return the Ops Chief is unavailable.

MAJOR EVENT/DISASTER WITHIN STADIUM DURING EVENT

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● Personnel will immediately report to assigned station and secure (lock down) the station.

● The Stadium MCI Plan will be placed in to effect. A Copy of this plan is to be maintained in each Aid station during the “season”.

● The station supervisor will report “Station Secured”to Stadium Dispatch.

● The station supervisor will maintain accountability of assigned personnel.

● The Station shall remain secured until assigned/dispatched by Stadium Dispatch.

● Field crew will evacuate the field, and report to the field transport on site.

● MERV units will report to the closest Aid Station.

● Field/South End Zone float crew will report to South End Zone Aid Station, with North float crew reporting to North 1.

ALL crews will await further orders from these locations via radio, or telephone

SECTION 4 - REPORTS AND BILLING The following are reports that will be completed when delivering care, first aid supplies, or assistance to patrons at an event. Also, a report for cases of significant trauma, or incidents involving injury, that may be in the U.A.A.’s best interest to follow up on.

STATION LOG (Appendix A) - This form will be used for ALL patrons who visit the Aid Station’s requesting some form of aid or assistance for all events, except; FHSAA event. The Log is to account for the number of patrons assisted in each location, and to track the types of request for aid.

SPECIAL DETAIL SUPPLEMENTAL FORM - This form will be used for ALL patients that are rendered BLS/ALS care [IE: Heat exhaustion, fall, cardiac, seizures, etc] and require, or would ordinarily require transport. ALL signatures of patient, Paramedic and/or Physician MUST be completed on the form.

NOTE: These reports (except electronic) will be submitted to the Operations Chief at the conclusion of the event.

STATISTICS REPORT This letter is completed by the Event Operations Chief for all except; Gator Growl, Championship, & FHSAA events. Statistics are compiled from the Station Log (Appendix A), along with other notable comments, including number of transports, and which ED’s were used.

A copy will be forwarded to the ACPS Chief, Assistant Chief, with oversight of EMS & the U.A.A. Chief of Stadium Medical Operations [FAX: 376-9132, or to his staff e-mail] . ASSIGNMENT / BILLING (Appendix C & D)

● For billing purposes time will be based on units contracted report time, generally 2 hours pre-event and continue to time released by the Operations Chief, including ● West MERV – 3.0 hrs pregame to event end time (U.A.A. events only)

Field Crew – to time released by U.A.A. team physician or his assistant. West Level 7 crew – to time released by U.A.A. staff

U.A.A. Incident Report – are available in all Aid stations and completed as noted in Section 2 of this SOG – General Considerations. ACPS will not retain copies of these; rather all forms will be turned over to the U.A.A. Risk Management Team.

SECTION 5 - APPENDIX DIRECTORY

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Appendix A – EMS Station Log (Designed for "Doc1" by ACPS for infomation he/she determines is necessary to obtain from ACPS staff providing medical care within the Stadium

Appendix B – Emergency Radio Contingency Plan (See WEBEOC - ICS205). Accurent printed copy of this plan will be in the possession of the Operations Chief at each U.A.A. event.

Appendix C - Staff Assignments (See ACPS Telestaff roster). A copy will be provided to "DOC 1" the day of the event.

Appendix D - Billing Report (Electronically submitted via ACPS EMS/Fire reporting system, by Operations Chief at the conclusion of the event.)

Appendix E - Ben Hill Griffin Stadium Mass Decontamination Plan

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Rapid Intervention Team (R.I.T.)

CHAPTER 15.1

Issued:September 30, 2002 Revised:

Submitted by: Safety Team Approved by: Chief of Fire Rescue

Definition: The Two In/Two Out protocol is a safety measure to insure that all fire ground operations that involve entering into an of immediate danger to life or health (IDLH) will have two firefighters in a back-up role (RIT) for immediate rescue of the first two firefighters entering into the IDLH condition.

Purpose:

The purpose of a Rapid Intervention Team (RIT) is to locate and initiate the rescue of firefighters who are lost/missing, or trapped while working in an IDLH (Immediately Dangerous to Life and Health) atmosphere.

General Guidelines:

● RIT shall be established on any incident where firefighters are operating in an IDLH atmosphere and the potential for being lost/missing, or trapped exists. Incident Commanders shall ensure that sufficient equipment/personnel are available to staff a RIT. Depending on incident size, more than one RIT may be assigned. This group may be assigned to peripheral duties and shall perform rescue operations for lost/missing, trapped or injured fire and rescue personnel when deployed.

● If on arrival there are signs of a trapped person or reports of persons in the structure, with life threatening potential. Every attempt shall be made to rescue these individuals without delay and without RIT being present.

● The rapid rescue to save life shall be carefully considered by the first arriving officer on the incident or the IC using proper fire ground indicators (IE: Time of day, accountability of persons present on the scene, type of structure involved, the amount of fire present, etc.).

● Caution should be taken in the event that a hazard may still be present in closed structures.

● To accomplish the above, the minimum response to structure fires will be a combination of four (4) fire rescue apparatus. The responding apparatus will consist of engines, truck, aerial, tanker, rescue, squad and Incident Commander.

Staffing/Location/Equipment:

● Each RIT shall be staffed with a minimum of two (2) firefighters. The Department of Public Safety recommends four (4) firefighters if staffing is available.

● When assigned to a RIT, the team leader shall report to the IC. The team leader will coordinate a staging location with the IC after conducting a reconnaissance.

● RIT members shall be fully bunkered out with SCBA and assigned equipment.

● Equipment (checklist) may consist of but not be limited to the following items: ● Assorted ropes, SCBA and mask. ● Forcible entry tools. ● Access to pre-plans ● Hand lights. ● Charged hand line.

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Rapid Intervention Team Leader Responsibilities:

● The person designated as the Team leader shall obtain a briefing from the IC and maintain radio contact at all times.

● Reconnaissance of the building: ● Where is the fire? Where is it going? How is it going to get there? ● Secondary means of ingress/egress? ● Are there any types of security bars, gates, etc.? ● Roof type? ● Number of doors and windows? Locations? ● Upon completion of Recon, the team leader will relay to the IC any special equipment and/or resource needs, as well as any other pertinent information. ● Develop a plan and ensure all members of the team understand it. ● Maintain control of the team. Do not allow freelancing. ● Monitor location and activities of personnel in structure.

Rapid Intervention Team Member’s Responsibilities:

● Maintain contact with the team leader. NO FREELANCING!

● Recon the situation/building with the team leader or as directed by the RIT leader.

● Remain alert. Look, listen, and try to envision what is going to happen.

● Have assigned tools/equipment in a ready state. Be prepared to get involved.

● Be mentally prepared. You are the firefighters safety net. If assigned to task that may interfere with the RIT, inform the person issuing the task that you are assigned to the RIT. Prior to commitment, inform your Team Leader.

● Know the plan. Understand the plan explained by the RIT leader. Know your part.

● Stay focused on the rescue. The primary responsibility of the RIT, once deployed, is rescue operations.

Secondary Functions of the Rapid Intervention Team (Prior to deployment):

● The team’s primary responsibility is RESCUE. You must maintain contact and readiness at all times.

● Any function, at the direction of the IC, on the outside of the structure that may enhance rescue:

● Placement/positioning of a ventilation fan. ● Secondary egress ladder. ● Opening door(s), etc.

● Secondary tasks will be performed without utilizing their assigned SCBA.

Rapid Intervention Team Deployment Phase:

● The RIT will be activated by the IC when it is determined that a firefighter is lost/missing, or trapped. The IC will use the term “urgent”to announce pertinent radio information.

● When deployed, the RIT will be assigned to the same channel or talk group as the initial attack team. The channel will be placed on emergency traffic.

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● Additional resources shall be considered.

● When the RIT is deployed, a replacement RIT will need to be staffed and staged for deployment. However, the call for a replacement RIT will not delay deployment of initial RIT for rescue purposes.

Training:

● All fire training that has a hazardous atmosphere will utilize a RIT.

● Training evolutions shall include scenarios to train RIT to rescue lost/missing, trapped or injured fire and rescue personnel.

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Medical Transfers

CHAPTER 16.1

Issued:January 1, 2002 Revised: Oct 2002, Sept 2007, Aug 2008, Oct 2009, Feb 2011 Submitted by: Command Staff Approved by: Director

Purpose:

To establish a guideline that will facilitate the timely and appropriate response to requests for medical transfers.

Emergency Transfers

● Emergency transfers are a priority and are dispatched and handled as an emergency incident.

Non-Emergency Transfers

Secured payment in full is required prior to accepting any non-emergency transfer.

Local Transfer:

● Is defined as a transfer that originates and terminates within the boundaries of counties that are contiguous with Alachua County.

● Will be handled on a first scheduled, first served basis, twenty four (24) hours a day, seven (7) days a week.

● Are scheduled during normal business hours through the Department Billing Office (352-384-3150) or after hours directly through CCC (352-955-1819).

● Are assigned to the closest rescue unit (with the exception of R8 & R20) during their operational period.

● At no time will more than one twenty four (24) hour rescue unit be assigned to a local transfer.

Medium Distance Transfer:

● Is defined as a transfer with a one way travel time of approximately two (2) hours). The border of this boundary is approximately: east to the Atlantic; southern borders of Volusia, Seminole, Orange, Lake, Sumter, and Pasco counties; southwest to the Gulf; western borders of Franklin, Wakula, and Leon counties, north to include Georgia counties that are contiguous with Florida to include the city of Valdosta over to the northern border of Nassau County, FL.

● Will be handled on a first scheduled first served basis seven (7) days a week with a pick up time between the hours of 0900-1700.

● Are scheduled during normal business hours through the Department Billing Office or after hours directly through CCC (352-955-1819).

● At no time will more than one twenty four (24) hour rescue unit be assigned to a medium distance or long distance transfer.

● Are assigned to the closest rescue unit (with the exception of R8 & R20) during their operational period.

Long Distance Transfers

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● Is defined as a transfer with a one way travel time of approximately three (3) hours or more.

● Long distance transfers must be scheduled through the Billing Department during normal business hours (Monday thru Thursday,0700-1730). Twenty four (24) hours advance notice is required. Requests will not be accepted at the Dispatch Center.

● Transfers greater than six hours one way require the assignment of a third person. There will be no overnight assignments.

● When a request is received, Billing contacts District 5 for approval. Approved transfers are faxed to the Dispatch Center and the assigned Rescue Unit.

● It is preferred that an additional unit be placed into service for long distance transfers.

● At no time will more than one twenty four (24) hour rescue unit be assigned to a medium distance or long distance transfer.

Click to view → Medium Distance Map

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Paramedic Clearance Protocol

CHAPTER 17.1

Issued:May 1, 2002 Revised: April 18, 2007, October 27, 2007,September 2009, January 2010 Submitted by: Special Services Division, Approved by: Edwin C. Bailey, Medical Director Chief

Purpose:

All paramedics employed by licensed EMS agencies in Alachua County function under the direction and pleasure of the System Medical Director. The purpose of this procedure is to establish a methodology to determine the competency of paramedics to practice medical procedures in the field, under the System Medical Director.

General Guidelines:

All paramedics that wish to obtain medical clearance shall complete an evaluation process to determine competency to perform medical procedures in the field. The process will assure that candidates possess the cognitive knowledge and pyschomotor skills necessary to provide medical services without direct supervision.

1. Submit copy of current State of Florida paramedic license, BTLS or PHTLS, current ACLS, and current BLS card.

2. Send an email request to the Assistant Chief of Technical Services requesting to take the written protocol test. The written protocol test will be set up off duty within ten days of request acceptance.

3. If you pass the written protocol test you may then ride as a paramedic/firefighter in training. This allows you to ride in the back of a Rescue with a Rescue Lieutenant which gives you the opportunity to work on skills while transporting patients. The Rescue Lieutenant is in charge of overall patient care. Any submitted EMS reports must be cosigned by the Rescue Lieutenant.

4. Upon completion of the written protocol test you will have sixty (60) calendar days commencing from that date to complete all clearance requirements.

5. Prior to the clearance lab with the Medical Director, you shall meet with Technical Services personnel to determine your readiness to meet with the Medical Director.

6. Upon successful completion of the Technical Services assessment, you shall be scheduled to complete the clearance lab with the Medical Director. The clearance lab date will be scheduled off duty.

7. Should the clearance candidate fail to complete the Medical Director clearance lab prior to the end of the sixty day period, he/she must restart the clearance process. 8. Once you pass the clearance lab*, paperwork will be submitted for a classification change and you can work out of class until the final pay grade change is made. This normally takes about two weeks for processing.

9. If you fail any step you must start back at step 1 or as directed by the Medical Director.

*During the clearance process, the candidate shall at a minimum show proficiency of the following:

1. Demonstrate a thorough knowledge of ACLS procedures and protocols 2. Demonstrate a thorough knowledge of ACFR’s Medical Care Protocols 3. Demonstrate a thorough knowledge of trauma protocols and trauma transport protocols 4. Demonstrate a thorough knowledge of airway management and vascular access 5. Demonstrate a thorough knowledge of the doses, effects, uses, and contraindications

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of ACFR’s formulary. 6. Demonstrate proficiency in documentation of pertinent information required on approved run reports

Upon successful completion of the clearance lab, the Training Bureau will issue a Certificate of Completion for Medical Clearance and an authorization to perform ALS procedures autonomously in the field.

The medical clearance will allow you to work in the capacity of a cleared paramedic. It does not promote you to the pay class position of a Rescue Lieutenant.

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Department Chaplain

CHAPTER 18.1

Issued:May 1, 2003 Revised: December 2009

Submitted by: Operations/Elmore Approved by: Director

Objective

To provide for the full range of Department personnel needs through the establishment of a comprehensive chaplaincy program within Alachua County Department of Public Safety.

Appointment

Because of the major risks and constant stressors faced by fire and EMS personnel in the line of duty, a chaplain will be appointed to function within Alachua County Department of Public Safety.

The Chaplain will be appointed by written order of the Director.

General Guidelines for the Chaplain

The Chaplain does not replace the home church pastor, but seeks to support the concern of every church for its members who may be in professions with special risks or needs. Moreover, the Chaplain must be for the advantage of every member of the department, regardless of his or her nationality, race, sex, or religion.

Any communication a person makes to the Chaplain is on a strictly confidential basis and will not be released to department members or any other person. Any personnel may go to the Chaplain without having to notify his or her supervisor or anyone else.

Any Department officer or member (including administrative staff) who is made or becomes aware of any situation which may need the response of the Chaplain may contact the Chaplain directly. Department administration will keep current telephone numbers for the Chaplain. The Chaplain may also be contacted through Department administration if desirable. Examples of situations where the Chaplain may be contacted include, but are not limited to:

● Death, injury to, or hospitalization of a department member. ● Death, injury to, or hospitalization of a department member's spouse or child. ● Death in a department member's immediate family (i.e. any family member covered under the department's bereavement leave provisions).

Duties of the Chaplain

The below listed duties constitute a brief summary of what may actually be required in any situation that may be encountered.

Emergency Situation

● The Chaplain may respond when contacted by CCC at the request of a Chief Officer or IC. The Chaplain will report to the ICP and will be under the IC's authority. Chaplain response is as follows:

● Critical injury or death of member of the department or members spouse or children. ● Whenever the IC determines that the services of the Chaplain may be of value in the ongoing operations. This may include situations where:

● The victim or the family requests the services of a chaplain or clergy.

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Hospital

● The Incident Commander or Officer determines that the employee or their immediate family may need support or counsel not provided by the hospital. ● The employee's family needs to be located and notified.

Follow up Actions

● Provide appropriate employee assistance to free operational personnel for on scene duties. ● Comfort and counsel. ● Referral to appropriate agencies for assistance. ● Help contact persons, insurance agents, family members, etc. in all cases, the Chaplain will find out the victim's church or religious preference and attempt to notify the pastor or church. ● Provide appropriate assistance to on scene personnel. ● Watch for signs of emotional and physical stress. ● Assist in providing personnel needs (CISM, Rehab, etc.) ● Work closely with Rehab officers to monitor personnel.

Post B Emergency Duties

● Conduct follow-up to insure personnel are receiving necessary assistance. ● Insure personnel needs are met in the areas of on the job injuries, CISM, etc.

Routine Duties

● Visit with personnel. ● Visit hospitalized department members and members of their immediate family. ● Be available for helping or counseling members of the department when requested. ● Attend Department functions when requested. ● Conduct funeral/memorial services as needed and requested. ● Be an active member of the CISM team. ● Represent the Department goals and concerns to the churches and religious institutions of the community.

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MAY DAY EMERGENCY PROCEDURES

CHAPTER 19.1

ISSUED: October 2011 Revised: Submitted by: Technical Services Approved by: Chief Bailey

PURPOSE:

The purpose of this standard operating procedure is to identify the actions that shall be used by anyone operating within a situation wherein they become lost, trapped, injured or find themselves in any situation that requires rescue.

DEFINITIONS:

● Mayday- Shall be the standard verbal radio transmission used by any firefighter who becomes disorientated, lost, injured, trapped, out of air, or any other instance where he/she or other personnel need immediate assistance. ● Evacuation Order- the immediate termination of interior firefighting operations accompanied by the immediate removal of all firefighters from the structure. ● Priority Traffic-Shall be used to identify all other urgent messages for tactical considerations.

MAYDAY PARAMETERS:

If you become lost or disoriented Then call a MAYDAY If you become trapped, stuck, or entangled Then call a MAYDAY If your low air alarm activates and you are greater than 60 Then call a MAYDAY seconds from an exterior exit If you are caught in a collapse Then call a MAYDAY If you fall from or through something Then call a MAYDAY

MAYDAY PROCEDURES:

Any personnel in need of immediate assistance while performing operations shall initiate a MAYDAY without hesitation.

The steps initiating the MAYDAY shall be prioritized as follows:

1. Activate ECB on portable radio 2. Voice transmission of MAYDAY following voice communications procedures 3. Activate T-Pass and Integrated Pass alarms

Should a higher priority step be unable to be executed, then the next step in priority should be attempted.

This will notify the Incident Commander, RIT Team Leader and all other companies operating at the incident that a firefighter is in need of immediate emergency assistance.

The Incident Commander will then make contact with crew(s) initiating the Mayday, receive the LUNAR Report (see details under “Voice Communications”), and activate the Rapid Intervention Team (RIT) to locate, assist, and remove those in distress.

IC shall direct ALL units to conduct a PAR (Personnel Accountability Report) to insure that their personnel are accounted for.

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The IC shall call for additional resources and an officer shall be appointed as MAYDAY Officer for management of rescue operations (if available).

Firefighting operations must continue unless ordered to cease by the IC.

The Incident Commander, MAYDAY Officer, RIT team leader, RIT crew and firefighter(s) who initiated the Mayday will remain on the originally assigned radio channel for rescue operations. If the ECB is activated and received on an alternate channel, the Fire-Rescue Dispatcher will patch that channel through to the original operations channel.

All other operations and functioning assignments will be directed to an alternate radio channel for operations. The Incident Commander will monitor both the fire ground operations and MADAY rescue operations channels using two separate radios. (mobile and portable)

VOICE COMMUNICATIONS: Firefighter(s) in distress shall first attempt to activate ECB button on portable radio to initiate emergency signal and establish priority traffic on assigned radio channel.

Should the firefighter(s) in distress be unable to activate the ECB, or not in timely manner, then radio transmission should be made to call MAYDAY.

Using a portable radio, firefighter shall call “MAYDAY”three (3) times over the radio and give a situation report.

The emergency situation report will be given to the Incident Commander by the firefighter(s) in distress in L.U.N.A.R. format if possible. The Incident Commander should be prepared to elicit LUNAR information from the downed firefighter, who is likely to be overcome by stress and anxiety, and may be unable to provide LUNAR information without prompting.

1. Location: 2. Unit: 3. Name(s): 4. Assignment/Air remaining: 5. Resources needed for rescue:

*NOTE* It will be likely that personnel will not give information in exact LUNAR form due to the stress, fatigue, fear, etc. In such cases, the minimum information of WHO you are, WHERE you are, and WHAT is your problem should be obtained when possible.

The Fire-Rescue dispatcher shall refrain from any radio traffic unless the MAYDAY call has not been acknowledged by personnel, including the IC, on scene. At that time CCC dispatcher will advise the Incident Commander of the MAYDAY call with unit identification if possible, and then stand by until needed.

The Incident Commander will declare radio silence and place attempt to establish radio contact with the person(s) that declared the “MAYDAY”.

Once communication contact is made with the IC and the LUNAR report has been given, the distressed firefighter(s) shall activate the PASS Alarm devices. The PASS devices should only be silenced when they interfere with radio transmissions, RIT operations (echoing in large open areas), or turned off by RIT crew upon locating distressed firefighter(s).

The Incident Commander will place the RIT in service to locate, assist, and remove those in distress and immediately call for additional resources.

The Incident Commander will then roll call through PAR accountability for on scene units.

IF RADIO COMMUNICATIONS CANNOT BE MADE:

If the firefighter(s) in distress is unable to communicate with the Incident Commander, the ECB should be activated and all efforts to activate the T-PASS device shall be made.

*NOTE* This can be accomplished by remaining still until the T-PASS or Integrated PASS is activated

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automatically

In cases where the ECB is activated, the Fire-Rescue Dispatcher will advise the Incident Commander of the ECB activation, the radio it came from, and the radio channel.

If the ECB is activated on a channel other than the assigned channel, the Fire-Rescue Dispatcher will patch that channel to the original operations channel. The CCC should notify all units operating at the incident that a “MAYDAY” was sounded and to move incident radio traffic to channel XXXX. The MAYDAY channel is on emergency traffic. The Incident Commander shall use the radio designation of the unit in distress to determine their last known assignment and/or location.

The Incident Commander will place the RIT in service to locate, assist, and remove those in distress and call for additional resources.

The Incident Commander will then roll call through PAR accountability for on scene units.

DISTRESSED FIREFIGHTER(S) RESPONSIBILITIES:

1. Activate ECB on portable radio 2. Give three (3) “May-Day”announcements consecutively over the radio 3. Wait for channel to be cleared and “May-Day” acknowledged by Incident Commander, other on scene personnel, or Fire-Rescue Dispatcher 4. Prepare to give LUNAR information 5. Activate PASS device on the SCBA and T-PASS unit 6. Give LUNAR information to Command 7. Relocate to a wall (if possible) and try to orient yourself to your surroundings 8. Point beam of flashlight on the ceiling or straight up 9. Perform “control”breathing or “skip”breathing to conserve air 10. Remain calm and remain in the same location

COMMAND RESPONSIBILITIES:

1. Fire operations during rescue efforts 2. Request additional resources (additional alarms) 3. Expanding ICS 4. Establish/deploy the RIT and assign Secondary RIT 5. Assign an officer to manage the MAYDAY rescue assignment 6. Medical operations 7. Personnel Accountability Reports (PARs) 8. Member support (debriefing, etc) 9. Logistics – specialized equipment 10. Safety 11. Support Activities

FACTORS TO REMEMBER Command shall not be transferred during a “MAYDAY”situation. The firefighter(s) in distress shall provide updates on their status. All other personnel not assigned to the rescue efforts shall carry on with their assigned tasks, DO NOT ABANDON THEM. Radios shall be set on the incident scene channel and the scan feature must be turned off.

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TFT PRO/PAK

CHAPTER 20.1

SAFETY

This portable foam system can be used in potentially dangerous situations. The following must be observed at all times:

WARNING: . Make sure that the foam concentrate in the foam tank is the right type for the situation. Do not use Class A foam on Class B fires or Class B foam on Class A fires. Note: Some foam concentrates are universal and can be used on Class B fires and spills and as a wetting agent on Class A fires. (Refer to foam concentrate manufacturer ’s recommendations for proper foam choice.)

WARNING: . Foam concentrates can be ineffective if not used at the correct percentage. Make sure that the Percentage Knob is set to the correct concentration for the type of foam being used.

CAUTION: . Make sure the Flow Control Valve is off and the correct nozzle and Outlet Hose are securely attached to the Control Block before the hose line is charged.

GENERAL INFORMATION

The PRO/Pak Portable Foam System is a very versatile eductor-type foam application appliance. It can be used with 0.1% -1% Class A foam concentrates for wildland, rural and urban fire suppression on Class A (wood, paper, combustible materials). On Class A materials the PRO/pak is intended to be used for direct extinguishment, overhaul, and wetting of fuels. Some foam concentrates are corrosive, we recommend using only Class A concentrates that have received USDA and USFS approval.

On Class B materials the PRO/pak is primary intended to be used for vapor suppression. It can be used with 1% and 3% AFFF Class B concentrates on flammable liquids that do not contain alcohol. It can be used with 3% and 6% Alcohol Resistant AFFF Class B concentrates on flammable liquids containing polar solvents. It can also be used with 3% X 6% or 6% Class B concentrates. Whenever possible back up the PRO/pak with additional water/foam capabilities for added safety.

The Pro/pak can be used on ignited liquid fuels, but it’s foam application rate is very limited. Based on NFPA 11 this unit should not be used on ignited Class B fuels with an area greater than 120 square feet (10 x 12 feet) or 11 square meters. The PRO/pak should not be used on burning Polar Solvents with an area greater than 60 square feet (6 x 10 feet) or 5.5 square meters.

The PRO/pak is designed for Class A and Class B foam concentrates, but it has been used with other concentrates for other uses.

If you intend to use the Pro/pak for liquids other than Class A and Class B concentrates and water, we urge you to contact the Task Force Tips Engineering Department. The use of other liquids may void the warranty and subject the user to hazards not addressed in this manual. The user assumes all risks for non intended uses. PART IDENTIFICATION← (Click to View)

LEFT or RIGHT HAND OPERATION

The Control Block and Valve Assembly can be mounted on the Foam Tank for right or left hand operation. To switch hands, remove the Shoulder Strap from the Pull Pins. Remove the Circle Cotters from the Pull Pins and remove the Pull Pins themselves. Pull the Control Assembly straight up and out of the tank. Turn the Control Unit around and reinstall the Pull Pins, the Circle Cotters, and the Shoulder Strap.

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FOAM SELECTION

In any eductor type system the accuracy of the foam concentrate to water ratio will depend upon the viscosity (thickness) of the foam concentrate. The more viscous, or thick, the foam concentrate, the greater the amount of energy required to draw the concentrate into the eductor. The viscosity of most foam concentrates changes with temperature, some thickening to a gel at temperatures or 40oF (4o C).

The Pro/pak percentage knob has two sides, the green Class A side was calibrated for 20 Centipoise Class A foam concentrates and the red, Class B, side was calibrated with National Foam’s Universal Gold® AFFF concentrate.

CAUTION: Class A foam concentrates are generally less viscous than Class B foam concentrates. Do not use 1 percent Class B concentrates with the percentage knob set at 1 percent on Class A side of the knob. Using 1% Class B foam on the 1% Class A setting may cause the actual percentage to be less than 1%.

Actual foam concentrations vary with changes in water flow, foam concentrate temperature and viscosity. The user must verify that the concentrate’s performance is suitable for use in their application. In all cases, the manufacturer’s recommendations must be followed.

CLASS A FOAM ←(Click to View)

CLASS B FOAM ←(Click to View

FOAM COMPATABILITY

WARNING: Do not mix different types of foam concentrates or foams of the same type from different manufacturers. Mixing of foam concentrates can cause the contents of the foam tank to gel and produce unpredictable results. Clean tank and foam passages thoroughly when changing foam types

NOZZLE SELECTION

Straight Stream Nozzle – is for Class A foam solutions. Foam Expansion will be negligible. It should be used where maximum reach or penetration is desired.

Reach 50ft @ 100 psi 15m @ 6.8 bar

Low Expansion Nozzle – can be used with wither Class A or B solutions. Reach is slightly less than the smooth bore. It should be used on Class B fires for extinguishment and Class A fuels to soak the fuel with a wet foam solution.

Reach 37ft @ 100 psi 11m @ 6.8 bar

Medium Expansion Nozzle - produces the greatest expansion ratios. It should be used on Class B fuels for vapor suppression and Class A fuels when a longer lasting insulating layer of drier foam is desired.

Reach 9ft @ 100 psi 3m @ 6.8 bar

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Emergency Room Busy Status (ERBS)

CHAPTER 21.1

Issued: October 21, 2005 Revised: July 21, 2008

Submitted by: Operations Approved by: Will G. May, Jr. Director

Emergency Room Busy Status (ERBS) is a recognized event that occurs from time to time when the Emergency Room (ER) is experiencing patient overload. The ERBS guideline has developed, as an immediate yet temporary mechanism to help with the overload.

The ERBS guideline applies to all hospital emergency rooms within Alachua County . When the appropriate hospital designee authorizes ERBS, the hospital official will contact the Combined Communication Center (CCC) Dispatch Center via (352) 955-1819 and request to speak with District 5 (Five) or District 6 (Six) respectively. CCC will contact the appropriate on duty District Chief (DC). The on duty District Chief shall immediately return the hospitals call and verify the request for ERBS with the hospital official. Once ERBS has been verified, the District Chief shall make notification to the on-duty units of the ERBS.

Emergency Room Busy Status will not exceed a two (2) hour time limit; only one (1) ERBS will be established and granted at a time between the four (4)-area hospitals.

Per this revised policy, all non-designated nurses or attending physicians who request busy status will be “denied ERBS " via Alachua County Fire Rescue (ACFR) District Chiefs.

The following designees are authorized to request Emergency Room Busy Status (ERBS):

Shands @ University of Florida (UF) Hospital Administrator on-call Adrian Tyndall, MD Chairman Joel Moll, MD Medical Director Craig Davies, RN Nurse Manager

Shands @ Alachua General Hospital (AGH) Hospital Administrator on-call Dave Roberts, MD Chairman, Emergency Department Matt Shannon, MD Medical Director, Emergency Department

North Florida Regional Medical Center (NFRMC) Hospital Administrator on-call

Malcom Randall Veterans Administration Medical Center (MRVAMC) Hospital Administrator on-call

When notified of ERBS, field personnel shall inform the patient of the ERBS and suggest an alternate Emergency Room (ER). If the patient refuses transport to an alternate ER, the patient will be informed of possible delays due to the ERBS. If the patient still insists on being transported to the originally requested emergency room, the patient will be transported to that ER as demanded.

The Rescue Lieutenant will inform the ER staff of the patients ’ demand to be seen at their facility despite knowledge of ERBS.

Documentation of the ERBS rerouting or patients ’ choice will be noted in the comment section of the Emergency Medical Service (EMS) report.

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Knox Box Operations

CHAPTER 22.1

Issued: 01/06 Revised: January 2010

Submitted By: Fire Prevention Approved By: Ed Bailey, Chief

PURPOSE:

The Knox box program was established in cooperation with businesses and organizations located within ACDPS’s jurisdiction. It was established to aid the Department with gaining access to a business or facility during times when the structure is not occupied. This will allow for a timely and non-destructive means of access to the property or structure by the responding units.

This guideline covers the use and operation of the Knox Box KeySecure3 Master Key Security Units installed on ACDPS’s fire apparatus as well as the operation of the wall mounted Knox Boxes. This guideline is to assure proper operation of the Key Secure3 Security Units and to maintain the highest security for the Knox Master Keys that are in the possession of the Department.

POLICY:

To assure the level of security needed for the success of this program, all Company officers and those that work out- of-class as Company Officers will learn and follow the following guidelines when utilizing the Knox Box system.

GENERAL GUIDELINES:

● The Knox Master Key shall be secured by utilizing the KeySecure3 Master Key Security unit at all times. If the KeySecure3 Key Security Unit is determined to be out-of-service, the Officer assigned to that apparatus will maintain possession of the Master Key until the KeySecure3 Key Security unit is repaired or the key is transferred to the officer reporting for duty to relieve the assigned Officer.

● Operation of the vehicle mounted KeySecure3 Master Key Security units :

a. The KeySecure3 unit is a vehicle mounted key retention unit that allows for the Knox Master Key to be safely secured, but easily accessible by the Company Officer. The unit also allows documentation of all operators accessing the Master Key, when the key is released and returned to the unit.

b. The KeySecure3 unit requires for the operator to enter the pre-assigned access code followed by the “#” symbol to release the key for use.

c. When the Knox Master Key has been released from the unit the blue strobe light located on the top of the unit will display a steady flash until the Master Key has been returned to the locked position.

d. CCC shall be notified each time the Knox Master Key is removed from the unit

e. There are two indicator lights located on the face of the unit which will indicate the following: 1. If the left light(red/green status light) is solid green and the right light(yellow programming light) is off, that indicates that the Master Key is secure and operations are normal 2. The left light blinking red indicates that the release code has activated the release of the Master key. The light remains blinking until the predetermined release time period expires. The right light is off. 3. The left light is red and the strobe located at the top of the unit is flashing indicates that the Master Key is in the unlocked position. The right light is off. 4. The left light is solid green and the right light blinks five times indicates that an error has occurred when entering the access code. 5. Both right and left lights illuminated indicates that the unit is in the programming mode. 6. The right light blinking in sets of three every few seconds indicates that the unit’s internal battery is in

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need of replacement.

f. Any problems with the operation of the unit should be reported to your District Chief. The District Chief will notify the appropriate personnel for repair or troubleshooting.

● Operation of the wall mounted Knox Box:

a. The wall mounted Knox Box will be installed on a participating facility’s structure. The location of the Knox Box will be accessible to the Fire Department. For security reasons, the location of the Knox Box may be elevated and may require the use of a ladder to access it.

b. To gain access, the Company Officer inserts the Knox Master Key into the Knox Box cylinder and rotates it to release the locking pins. This releases the door on the face of the Knox Box to allow access to the facility’s keys or access cards.

c. To re-secure the Knox Box, return the facility’s keys or access cards to the Knox Box and place the door over the opening. Insert the Master Key into the cylinder and rotate it to return the cylinder to the locked position.

● When the wall mounted Knox Box has been accessed to gain entry to a structure, all keys and/or access cards located within the Knox Box shall be secured by the Officer in charge until they can be returned and re-secured in the Knox Box. At no time shall the Knox Box Master Key be left inserted into the wall mounted box.

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National Hot Rod Association Gator Nationals @ Gainesville Florida MEDICAL OPERATIONS PLAN

CHAPTER 23.1

The following plan will pertain to the Gator Nationals at Gainesville, Florida. This event will include occur during the month of March of each year. Specific dates of the event will be transmitted by the NHRA representative one month in advance of the first day of the event.

This plan has been approved by the following:

1) Don Robertson General Manager Gainesville Raceway 3/13/07 2) Dan Brikey EMS Director National Hot Rod Association 3/12/07 3) Chief W. May Chief ACFR 3/12/07 4) Chief E. Bailey Chief of Operations ACFR 3/12/07

TABLE OF CONTENTS

Section 1 Staffing Requirements

Section 2 General Considerations

Section 3 Race Day Operations

Section 4 Reports and Billing

Section 5 Appendix

SECTION 1 - STAFFING

The National Hot Rod Association and Alachua County Fire-Rescue have approved the following staffing requirements. No changes will be made to the staffing requirements without the consultation, and agreement of both parties.

Gator Nationals: Thursday

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Start Line ALS Transport 1 Rescue Lieutenant / 1 EMT Finish Line ALS Transport 1 Rescue Lieutenant / 1 EMT South Stands ALS Transport 1 Rescue Lieutenant / 1 EMT South Division ALS MERV 1 Paramedic / 1 EMT ACFR Reserve Group BLS EMT/Bicycle Teams Incident Command 1 ACFR Command Officer

Total Personnel 11- 4 Paramedics 4 EMT 1 ACFR Command Officer 2 Reservists

Gator Nationals: Friday

Start Line ALS Transport 1 Rescue Lieutenant / 1 EMT Finish Line ALS Transport 1 Rescue Lieutenant / 1 EMT South Stands ALS Transport 1 Rescue Lieutenant / 1 EMT South Division ALS MERV 1 Paramedic / 1 EMT North Division BLS MERV 2 EMTs (Staffed w/Reservists) ACFR Reserve Group BLS EMT/Bicycle Teams Incident Command 1 ACFR Command Officer Total Personnel 13- 4 Paramedics 4 EMT 1 ACFR Command Officer 4 Reservists

Gator Nationals: Saturday

Start Line ALS Transport 1 Rescue Lieutenant / 1 EMT Finish Line ALS Transport 1 Rescue Lieutenant / 1 EMT South Stands ALS Transport 1 Rescue Lieutenant / 1 EMT South Division ALS MERV 1 Paramedic / 1 EMT North Division ALS MERV 1 Paramedic / 1 EMT ACFR Reserve Group BLS EMT/Bicycle Teams Incident Command 1 ACFR Command Officer 1 ACFR Chief Officer

Total Personnel 16- 5 Paramedics 5 EMT 1 Command Officer 1 Chief Officer 4 Reservists

Gator Nationals: Sunday

Start Line ALS Transport 1 Rescue Lieutenant / 1 EMT

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Finish Line ALS Transport 1 Rescue Lieutenant / 1 EMT South Stands ALS Transport 1 Rescue Lieutenant / 1 EMT South Division ALS MERV 1 Paramedic / 1 EMT North Division ALS MERV 1 Paramedic / 1 EMT ACFR Reserve Group BLS EMT/Bicycle Teams Incident Command 1 Fire Rescue Command Officer 1 ACFR Chief Officer

Total Personnel 16- 5 Paramedics 5 EMT 1 Command Officer 1 Chief Officer 4 Reservists

DAILY HIGH AVERAGE ATTENDANCE EVENTS (as determined by NHRA and ACFR):

Additional ALS Transport 1 Paramedic / 1 EMT Additional ALS MERV 1 Paramedic / 1 EMT (Paid or Reserve) Additional Team 1 Paramedic / 1 EMT (Paid or Reserve)

*NOTE: MERV units will transport non-ambulatory patients to designated Aid Stations as determined by the Operations Chief.

STAFFING ADDENDUM:

In the case of environmental factors (IE: heat index) that the NHRA EMS Director and ACFR Command Officer determine may significantly increase the need for medical intervention during the event, extra staffing will be added as deemed appropriate. This should be determined 5 days before the event, and can be canceled at anytime if both parties agree conditions will improve by event time.

SECTION 2 – GENERAL CONSIDERATIONS

INCIDENT COMMAND The National Incident Management System (NIMS) shall be used for the organization and operation of the event. A unified command post shall be established at the ACSO Mobile Communication Vehicle. Agency responsibilities are listed below:

● Gainesville Raceway General Manager; Raceway Operations ● NHRA EMS Director; Coordinator for EMS at NHRA event ● Alachua County Fire Rescue; Fire Rescue/EMS Operations ● Waldo Fire Rescue; Fire Suppression ● Alachua County Sheriff’s Office; Near site traffic control and law enforcement at Event ● Gainesville Police Department; Off site traffic control

● The ACFR Command Officer will monitor all fire rescue radio traffic and direct all fire

rescue units and personnel as needed.

● All incident responses or encounters shall be documented on the Departments Incident Reporting System. A summary of incidents/encounters will be provided to the NHRA EMS Director at the end of the event. The summary will provide the nature of the incident/encounter and other information as permitted by HIPPA.

● Professionalism will be maintained at all times by ACFR employees interacting with anyone at the Track In the event a situation arises the calls in to question the ACFR employee(s) mannerism, quality of medical care, etc., the following shall occur;

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● ACFR Command Officer shall be contacted via radio or phone.

● System on-duty rescue units will be utilized as the primary source of transportation from the event. Best access for responding rescue units is via the main gate of the event. Further directions and channel assignment will be provided from CCC.

● All rescue units responding to the Track will be assigned the NHRA event assigned tactical channel and communicate to “Dispatch”.

● The ACSO Mobile Command Post will be operational and manage incident communications. The mobile command post will be designated “Dispatch.”All rescue units transporting from the NHRA event to the emergency room will communicate on the assigned medical channel, unless otherwise instructed.

● Event assigned rescue units will remain available at the event and only be used for transport in the cases of a disaster, or a patient whose medical condition is determined critical or time sensitive.

● In the event an event assigned rescue unit does transport a patient, the Command Officer will be notified immediately. An on-duty rescue will be assigned to stand by until the assigned rescue returns to the event (Unless determined otherwise by the Command Officer and the Duty District Chief).

● The ACFR Reserves Bike Team may be, at the request of the Command Officer, patrolling and dispatched to calls immediately outside the stands area.

SECTION 3 - EVENT DAY OPERATIONS

CHIEF IN CHARGE OF SPECIAL EVENTS

● Staffs event according to this SOG, SOP Chp 8E, current Union Contract

● Completes Incident Action Plan:

● ICS 202 – Incident Objectives / Response Priorities ● ICS 203 – Organizational Assignment List ● ICS 204 – Division / Group Plan ● ICS 205 – Communications Plan ● ICS 205- 1 – ICS Positions / Phone Numbers ● ICS 206 – Medical Plan ● ICS 223 - Health & Safety Message

(The Department Chief will sign two copies. The Chief will retain one copy; the Event Operations Chief will retain one copy. The later copy will be returned to the Chief post event with any changes that occurred or were noted during the event.)

● Completes an event Assignment Roster (Appendix C). Post Event times are acquired from CCC and a copy of this form (Appendix C) is turned in to Billing.

● Completes Department Additional Hours form and turns into Payroll post event. ● Initiates post-event review with NHRA EMS Director.

● Assures needed paperwork is on hand (Special Detail Supplemental form, DepartmentRescue report, .Situation Report, Event maps, phone list, etc…)

● Post event collects up all completed paperwork.

● Post event submits a report to the NHRA EMS Director identifying statistics of numbers & types of patients seen, number of transports, significant incidents. This information is obtained from station

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Activity Logs (Appendix A), & medical reports.

● Assures MERV’s, radios, and needed medical equipment & supplies are available for all events.

PRIOR TO EVENT

● Pre Gator National Event, CSW staff shall assist District Chief responsible for Special Events: ● Inspect MERV’s. Maintenance issues will be reported to Chief responsible for Special Events ● Deliver MERV’s to event. ● Oversee inventory of ALS/BLS equipment to be used for event. Replace out dated fluids/Rx’s. Report any problems with required supplies/equipment in a timely manner to District Chief responsible for Special events.

● The Command Officer will arrive at CSW prior to personnel to review the staffing schedule, transportation, and to make any last minute changes for the event. The Supply Division shall have all supplies/equipment needed stocked, checked, and loaded in the supply van for transport to the event.

● Crews will report to CSW 1.5 hours prior to the event. After the pre-event meeting with OPS Chief, crews will proceed to the event.

EVENT OPERATIONS

● The Alachua County Sheriff’s Office (ACSO) will operate the “Dispatch”operations from the Mobile Command Vehicle. Operational channels as follows: ● Fire/Rescue/EMS Operations (800mhz) Channel as assigned ● “RED”( VHF) – Contingency back up: [Channel 7 on Motorola HT]

● The ACSO “Dispatch”will be responsible for the following: ● Dispatching medical emergencies within the event and the immediate surrounding area. ● Communications with Incident Commander (IC) at designated Command Post (ICP) ● Notifying the ICP, Command Officer, and “ALL CALL”notification to ACFR units, MERV, and other medical units, regarding any fire or HAZMAT incident with in the event or surrounding area. ● Communication with CCC regarding any fire / HAZMAT incident within the stadium or surrounding area. ● Communications with all LEA agencies on-sight of event ● Communications with NHRA Operations ● Access to CAD and can operate independently from CCC.

CONCLUSION OF EVENT

● Crews will remain at their assigned locations post event until released by Command.

● All completed paperwork will be collected and routed to the Command Officer before departure.

● MERV units will be secured at the event and keys will be given to the Command Officer.

● Officers will account for all personnel they arrived with before departure from event.

● Upon arrival back at CSW, crews will unload LifePaks, Pulse-Ox’s, and any other equipment on carts provided. Radios will be checked in and placed in designated container.

● All trash will be removed from vehicles.

● The Command Officer will then release all personnel from event. Time will end.

MAJOR EVENT/DISASTER WITHIN EVENT AREA DURING THE EVENT

● Personnel will immediately report to their assigned unit/location and remain there until directed by Command.

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● The Chief Officer shall immediately report to “Dispatch”and assign command.

● The Command Officer will respond to the incident and assume “Operations Division.”

● The unit/station Officer will report “Unit Secured”to Dispatch.

● The unit/station Officer will maintain accountability of assigned personnel. ● The Unit/Station shall remain secured until assigned by Dispatch.

● MERV units will report to the closest Aid Station.

SECTION 4 - REPORTS AND BILLING

The following are reports that will be completed when delivering care, first aid supplies, or assistance to patrons at an event.

All paperwork MUST be brought to the Command Officer at the conclusion of the event.

ASSIGNMENT / BILLING – This Assignment portion of this form is completed prior to the event by the Command Officer. A copy will be provided to “Dispatch”, NHRA EMS Director, and each assigned ACFR unit. A copy of this form will be completed with times for billing purposes and will be turned in to ACFR Billing Department as soon after event as possible.

Billing time will be from the contracted time until the time released by NHRA EMS Director. The end billing time will be relayed to “Dispatch”via radio for documentation.

NHRA Incident Report – will be available in all Aid stations and completed as noted in Section 2 of this SOG – General Considerations. ACFR will not retain copies of these, rather all forms will be turned over to the NHRA EMS Director as soon as possible post-event.

SECTION 4 - APPENDIX DIRECTORY

Appendix A - Emergency Radio Contingency Plan

Radio Contingency Plan

In the event of radio failure of the 800 mhz system the following plan shall be implemented.

1. Phone contact will be made immediately between the Command Officer and “Dispatch.”

2. Initially all units will be assigned to Ch15 for Fire/EMS and Ch16 for LEA.

3. VHF would then be transitioned in using the “Dispatch”repeater.

4. LEA would stay on Ch15 and Ch16 for operations.

5. Fire/EMS will use “red”, “white”, and “blue”channels, as assigned.

6. Incoming fire rescue units will report to the staging area and be issued VHF radios for communications from the MAC Radio Contingency.

7. Mutual aid units will report to the staging area to be assigned radios for communications from the MAC Radio Contingency.

8. UHF Med 8 can be used as an alternate for EMS units.

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MEDICAL CARE PROTOCOL GENERAL CONSIDERATIONS

CHAPTER 24.1.1

Issued: May 2010 Revised: July 12

Submitted By: EMS Branch Approved By: Medical Director

The following standards of care shall apply to all patients treated by Alachua County Emergency Medical System

All patients are to be treated with respect.

An individual becomes a patient when presenting with a chief complaint or evidence of a medical condition or injury or upon discovery of vital signs outside normal values.

Consultation with an on-line medical control physician prior to initiation of non-life threatening therapeutic modalities outside the context of these protocols remains the standard. The sole exception is being life-saving care. Life- saving care is defined as any or all measures which having the purpose of immediate preservation of life and/or the establishment of means by which life might be preserved. The Medical Control Physician shall be defined as the emergency department attending physician at Shands Teaching Hospital.

Patient care is by nature unpredictable and patients may require care derived from multiple protocols, or in the absence of these, on-line medical control. The following protocols are written with this reality in mind. Deviations from protocol will be tolerated only when it is intended to further patient care. Such deviations must in no way detract from the high level of patient care expected from pre-hospital care providers associated with Alachua County’s EMS system.

The CAB’s ( circulation, airway, breathing) will always take priority in patient management. Maneuvers required to secure the airway, ensure adequate gas exchange, and establish adequate tissue perfusion should always supersede specific protocol statements.

Orders communicated directly from the on-line Medical Control Physician to the paramedics caring for the patient may supersede established protocol.

The Company Officer of each unit is responsible for the completion of a patient care report on every patient contact, regardless of treatment administered. Paramedics will complete ALS reports and EMT’s may complete BLS reports at the discretion of the Company Officer.

Complications, problems, or requests for additional orders during treatment will be directed to the on-line Medical Control Physician. Additional questions or problems should be directed to the Medical Director after the incident.

Emergency responders functioning at the BLS level will be expected to conform to Alachua County’s BLS Medical protocols to the extent that their training and certifications allow.

Although it is our policy and desire to be of assistance to law enforcement, requests by law enforcement for collection of blood samples to screen for alcohol or drug levels will be honored when, in the best judgment of the paramedic in charge of the patient, assisting law enforcement in such a manner would not delay patient transport, care, nor violate the Citizen’s rights of refusal.

An Alachua County Fire/Rescue ALS unit may cancel their response by any of the following means:

● The requester calls back and advises that they no longer need EMS to respond,

● Another Advanced Life Support (ALS) unit arrives on the scene and determines additional ALS units are not needed,

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● LEA or a Basic Life Support (BLS) unit advises there is no patient.

NOTE: The only recognized reason for cancellation by another Public Safety Agency is for “no patient on the scene”. The Medic unit will continue response for a minor injury or for a patient refusing treatment.

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MEDICAL CARE PROTOCOL RADIO REPORT

CHAPTER 24.1.2

Issued: May 2010 Revised:Mar 12, July 12

Submitted By: EMS Branch Approved By: Medical Director

It is understood that some pre-hospital situations preclude providing a complete report to the destination facility. However, paramedics should strive to furnish a complete report at the earliest possible opportunity with deviations from this standard being for the benefit of the patient.

MEDICAL COMMUNICATIONS

The following information should be communicated on initial contact by the paramedic with the hospital or with the On Line Medical Control Physician (OLMCP).

1. Unit Identification number

2. Patient’s age and gender

3. Patient’s chief complaint/Time of onset

4. Brief history relevant to the chief complaint /illness, medications used, allergies

5. Vital signs (as appropriate for circumstances)

6. Description of the mechanism of injury for traumatized patients

7. General appearance, including the Glasgow coma scale

8. Pertinent physical findings

9. Treatment rendered and the response to treatment

10. Request for orders needed and confirmation of any orders given

11. Estimated time of arrival (ETA)

If transported patient is critical and the paramedic is occupied treating the patient, an abbreviated report may be given by either the paramedic or the driver (Driver’s Report).

If medical radio contact is not available

1. Attempt contact by phone via the use of a recorded line at the Combined Communication Center (CCC)

2. Route a message through CCC via dispatcher

3. Follow protocol as written

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MEDICAL CARE PROTOCOL INITIATION OF CPR

CHAPTER 24.1.3

Issued: May 2010 Revised: July 12

Submitted By: EMS Branch Approved By: Medical Director

All patients found in cardiopulmonary arrest by EMS personnel will receive cardiopulmonary resuscitation (CPR). CPR will be initiated using the American Heart Association standards for adults, children or infants.

Exceptions:

● A patient who has in his or her possession, or at the bedside, a completed, legal, yellow State of Florida Do Not Resuscitate Order (HRS Form 1896). ● If there is any question about the validity of the DNR document, the Paramedic shall contact the on- line medical control physician at Shands. Until there is a clear understanding as to the validity of the order, CPR will be performed. ● Any patient who presents as obviously dead. (See Determination of Death, Chapter 24.1.4)

Cardiopulmonary resuscitation may be halted when:

● Effective spontaneous ventilation and circulation have been restored as per 2010 AHA ECC guidelines

● Resuscitation efforts have been transferred to persons of no less skill than the initial providers

● The rescuer is exhausted and physically unable to continue resuscitation.

All criteria has been met per Protocol 24.1.4

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MEDICAL CARE PROTOCOL DETERMINATION OF DEATH

CHAPTER 24.1.4

Issued: May 2010 Revised: July 12

Submitted By:EMS Branch Approved By: Medical Director

The EMS team does not pronounce death; rather, it is determined to exist.

What to look for: Death is determined to be present if all of the following are evident:

● Unresponsive

● Pulseless

● Apneic

● Absence of electrical activity on cardiac monitor in 2 or more leads

● Additionally, at least one of the following will be present to determine that death has occurred: ● Lividity, rigor mortis, or generalized cyanosis

● Decomposition of body tissue

● Decapitation, incineration

● Destruction of brain or heart

● Once it is determined that death has occurred, the EMS team will request/notify LEA.

● The body will not be left unattended until LEA is present.

● If this may be a crime scene, nothing in and around the immediate area should be disturbed.

● Patients who are in a hypothermic environment may respond to resuscitation measures for a longer period of time. Therefore, hypothermic patients should be resuscitated until normal body temperature is achieved.

● When in doubt, resuscitate and transport.

● The criteria noted herein DO NOT apply in the situation of a mass casualty incident [MCI].

TERMINATION OF CARDIOPULMONARY RESUSCITATION

The Paramedic has the discretion to continue resuscitation efforts in any case despite Termination of Resuscitation criteria being met if scene safety, location, patient’s age, time of arrest, or bystander input compels this decision.

When asystole is seen on the cardiac monitor, verification of the rhythm shall include a printed rhythm strip as well as interpretation of the rhythm in more than one lead. Low amplitude V-Fib or PEA may be difficult to distinguish from asystole when using only the cardiac monitor display for interpretation.

Medical Control Contact Not Required/Asystole

The Paramedic may terminate resuscitative efforts in non-hypothermic adults provided all 5 of the following criteria

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exist after 20 minutes of CPR:

● Initial rhythm is Asystole confirmed in two leads on a printed rhythm strip

● Rhythm remains in Asystole throughout resuscitative efforts

● Secure airway confirmed by digital capnography (ETT or King LTA)

● Medication efforts have been exhausted per protocol 24.3.5

Quantitative ETCO2 value is <10 mmHG with effective CPR

Do not terminate resuscitation efforts if transport has been initiated.

In the case of extenuating circumstances, contact Medical Control for direction.

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MEDICAL CARE PROTOCOL SUSPECTED CHILD/ELDER ABUSE

CHAPTER 24.1.5

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Whenever child or elder abuse is suspected, assess the scene closely.

Record all appropriate information on the patient care report.

Upon arrival at the Emergency Department, a verbal report summarizing your findings should be given to the responsible medical personnel. Complete any appropriate paperwork in compliance with organizational and administrative procedures.

Do not delay transport to obtain the above information.

Do not make accusatory, confrontation, angry, or threatening statements to any parties present.

Any non-transported patient, for whom you have concerns about the possible abuse, will be reported to the appropriate local or state agency (Children and Family Services, LEA). The District Chief/Supervisor will also be notified.

ABUSE REGISTRY 1-800-962-2873

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MEDICAL CARE PROTOCOL DETERMINATION OF HOSPITAL DESTINATION

CHAPTER 24.1.6

Issued: May 2010 Revised: July 1, 2011

Submitted By: Technical Services Approved By: Medical Director

Determine the acuity of the patient’s chief complaint, illness, or injury.

● If potentially life threatening, transport the patient to the closest appropriate facility.

● If non life-threatening: ● Transport the patient to hospital of the patient’s choice ● If the patient is unable to make such a judgment (minors, etc.), transport the patient to the hospital of choice of an appropriate party acting on behalf of the patient (parent, guardian); ● If the patient expresses no choice and if no other appropriate party is available or has reason to act on behalf of the patient, transport the patient to the closest appropriate facility.

● All Rescues carrying pediatric patients inbound to Shands at UF (less than 18 years old in need of emergency services), shall be routed to the Pediatric Emergency Department in the Shands Hospital for Children located on the north side of Archer Road (North Tower-old ER) except for those meeting trauma alert criteria.

● All patients meeting trauma alert criteria, regardless of age, should be transported to the Shands at UF Trauma Center, located on the south side of Archer Road.

● Shands UF Obstetric Patients

● OB patients who are 16 weeks of gestation or greater and experiencing acute labor related emergencies, including pre-hospital deliveries, should be transported to the Pediatric Emergency Department in the Shands Hospital for Children. Patients are to be taken by hospital personnel to the Labor and Delivery Unit in the North Tower. ● OB patients with non-labor related emergencies should be transported to the current Emergency Department in the South Tower.

● When transporting an OB patient, notify the ED as early in the call as possible. When the ED gets the radio call from ACFR stating they have an L&D transport, the ED will notify Labor and Delivery. The OB RN will meet EMS personnel at the designated elevator. The OB RN will then transport the patient to OB triage.

● If the OB patient is unstable, the ED physician will evaluate and stabilize the patient in the ED.

● If the transport is an inter-facility transfer and the OB physician requests EMS to transport the patient to OB triage, the L&D RN will meet EMS personnel at the designated elevator and both personnel will transport the patient to meet the OB physician in OB triage.

No paramedic is to influence the choice of hospital by the patient nor assume that any hospital cannot offer its usual range of services thereby preferentially re-routing patients to select facilities, however, paramedic personnel may educate those requesting information to the appropriate facility for their specific type and acuteness of emergency consistent with recognized local practice.

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MEDICAL CARE PROTOCOL HOSPITAL EMERGENCY DEPT. EMS BYPASS GUIDELINES

CHAPTER 24.1.7

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By:Medical Director

Recognizing that the usual capabilities of a particular department my become acutely and temporally overwhelmed, it may be necessary to temporarily divert patients to other facilities. To promote community cooperation in the delivery of emergency services, we have agreed to the following standards:

The only complete hospital bypass is as a result of a hospital disaster (fire, power failure, HAZMAT incident, flooded ED, etc.) or a security lockdown (armed and dangerous subject in the ED). All patients are subject to hospital bypass.

EMS bypass, as determined only by persons authorized to do so (Hospital designee in cooperation with the ACFR Medical Director), will give the emergency department of that hospital temporary relief from incoming patients via EMS. This status is independent of any temporary change in other hospital capabilities.

Once notified of a hospital's bypass status, EMS crews will make every effort to honor that status. Exceptions to this rule include:

● The patient whose condition is unstable, life threatened, and deteriorating will be taken to the closest appropriate facility, regardless of bypass status. The paramedic attending the patient is the sole arbiter of the patient’s status. ● If the patient (or third party responsible for the patient) insists on patient transport to a facility on bypass for the patient's condition, on-line medical control at the facility requested by the patient (or surrogate) will be contacted for assistance. The directives of the on-line medical control physician will indicate the most appropriate destination for the patient. ● Any hospital placing themselves on EMS bypass status will notify the Combined Communications Center when the ED has been reopened.

Each hospital will develop internal procedures for determining which personnel are authorized to recommend bypass and are authorized to report hospital status to the Alachua County Combined Communications Center (CCC).

Should two or more receiving facilities request bypass status at the same time, all bypasses will be terminated. The administrator’s on-call at each facility will be notified (by their respective ED staffs) in this event and the Combined Communications Center will issue an administrative page to ACFR and the Medical Director. In this event, the hospitals involved, ACFR and the Medical Director will determine status and notify the Combined Communications Center.

These guidelines apply to patients transported by Alachua County Fire/Rescue units only. Extension of these guidelines to patients transported by EMS units of other agencies may be permitted.

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MEDICAL CARE PROTOCOL REFUSAL OF SERVICE

CHAPTER 24.1.8

Issued: May 2010 Revised: February 2012

Submitted By: EMS Division Approved By: Medical Director

A written run report is required for any encounter involving an individual expressing a chief complaint and/or an individual presenting with assessment findings outside of normal established values. The written report must include thorough documentation describing the type of situation found, assessment findings, the suspected chief complaint, treatment or care rendered, reactions noted, and disposition of the patient including any instruction given in a case when care is refused.

Dealing with patients who activate the EMS system (or has the system activated on their behalf by a third party) and then declines or refuses care and/or transport is a difficult problem for the field paramedic. Using an ordered approach in these situations will help expedite a satisfactory resolution. The assumption should ALWAYS be that the patient requires medical care and transport.

Assess the patient and the scene.

● Obtain a history from the patient and/or others in the area, including mechanism of injury (if appropriate).

● Obtain the patient’s vital signs and document on the run report

● Perform the physical examination, paying particular attention to alterations in mental status or vital signs and consider any traumatic injury, mechanism of injury, or medical illness that may represent a threat to the well being of the patient.

● Document clearly if the patient or surrogate refuses assessment.

Assess the competency of the patient.

For our purposes, a competent patient shall be defined as one who is:

● Over 18 years of age, or is an emancipated minor (a pregnant woman, a woman who has given birth, or a married person of either gender) and;

● Awake, alert, and fully oriented to time, person, place, and situation and;

● Has no alterations in vital signs, mental status, or level of consciousness and;

● Has no signs of acute injury or illness, and has no signs of chronic illness, either of which may influence the ability to make an informed decision and; ● Is not exhibiting clinical signs of intoxication by alcohol or drugs, (licit or illicit) and/ or

● Has no history of mental illness that affects their decision-making ability.

If the patient (or parent or guardian) is judged competent to refuse transport:

● Again emphasize the need for care, the risks of refusal of care (including death), and our wish to transport the patient;

● If patient, parent, or guardian declines care, and the EMS personnel do not feel transport by EMS to the hospital is required, patient, parent, or guardian must sign the appropriate written release form in front of two witnesses. The patient, parent, or guardian who is judged competent, declines care, and then refuses to sign the waiver will prompt the EMS crew to reassess the competency of the individual; if still considered competent

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to decline care, a verbal statement MUST be documented on the run report and the verbal waiver form completed.

If the patient (or parent or guardian) is judged not competent to refuse transport:

● Explain to the patient (or parent/guardian) the need for transport; reassure the patient that no harm will result from transport but that complications, up to and including death, may result from a delay in treatment;

● If patient, parent, or guardian continues to refuse care, enlist the MCP or law enforcement personnel to secure patient for transport.

Refusal of treatment/ transport of minors:

● Although care may be refused by a responsible parent or legal guardian if said parent or guardian making the decision qualifies as competent as defined above, every effort will be made to transport minors exhibiting any findings consistent with injury, alteration in mental status, or intoxication. If the parents or guardian are not on scene, they may make the refusal over the telephone. Two witnesses will confirm the telephone conversation by signing the waiver form.

● Where there are historical or physical findings of injury or illness, intoxication, and/or alterations in mental status, level of consciousness, or vital signs, and no parent or guardian is available, the minor will be transported.

● If the minor is a college student, the paramedic will obtain assistance from the MCP prior to obtaining a waiver.

● If the EMS system is summoned to by a third party and either the patient is not found or there is no EMS assistance required, there is “No Patient”and no refusal form is required. ● If patient contact is made a patient care report must be completed.

● If patient, parent, or guardian refuses care, and EMS personnel feel transport to the hospital is required, the patient, parent, or guardian must sign the appropriate written release form in front of two witnesses.

● The patient, parent, or guardian who is judged competent, refuses care, and then refuses to sign the waiver will prompt the EMS crew to reassess the competency if the individual;

● If the person in question is still considered competent to decline care, a verbal statement MUST be documented on the run report and the verbal waiver form completed. It is recommended to contact the medical control physician to help persuade these patients to agree to care and transport.

● Thank patient, parent, or guardian for signing the release. Emphasize that our EMS system WILL RETURN should the patient, parent, or guardian change his or her mind.

All episodes, which involve refusal of care or assessment of competency, must be documented completely on the run report.

● If responding to a call at “The Birthing Center,”please transport all of these patients unless the paramedic is advised by the midwife on scene that she has decided there is no need for transport. In these cases, “The Birthing Center”has taken full responsibility of this patient after our departure. This decision will not be based on our “assessment.” Please document appropriately why you were called and ask the midwife to sign a refusal waiver.

Refusal of Transport After Treatment Given

Bronchospasm Resolved After Nebulizer Treatment

● After treatment of bronchospasm, and return to an asymptomatic state, some patients will refuse transport to the hospital.

● The following items should be accounted for and included in the assessment and documentation: ● The presentation is consistent with a mild exacerbation of asthma

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● No severe dyspnea at onset

● No pain, sputum, fever or hemoptysis

● Not initially hypoxic (oxygen saturation < 90%)

● Significant improvement after a single nebulizer treatment

● Complete resolution of symptoms

● Vital signs within normal limits after treatment given

● (BP, pulse, respiratory rate, oxygenation)

● Additional patient safety measures that should be considered: ● A family member or caregiver should be available to stay with the patient and assist if a relapse occurs

● Assure the patient understands transport has been offered and subsequently refused

Informed the patient to follow-up with their physician as soon as possible and/or to re-contact 911 if symptoms re- occur

Insulin Induced Hypoglycemia-Resolved

● This protocol applies only to insulin dependent diabetic patients who are refusing hospital transport after the resolution of insulin-induced hypoglycemia by the administration of intravenous D50. After treatment of hypoglycemia, and return to an asymptomatic state, some patients will refuse transport to the hospital.

The following items should be accounted for and included in the assessment and documentation:

● The patient is on Insulin only (does not take oral diabetic medications)

● The presentation is consistent with hypoglycemia

● Rapid improvement, and complete resolution of symptoms, after D50

● Vital signs within normal limits after glucose given ● (BP, pulse, respiratory rate, oxygenation, and blood sugar > 70)

● There is no indication of an intentional overdose or dosing error

Additional patient safety measures that should be considered:

● A family member or caregiver should be available to stay with the patient and assist if a relapse occurs

● Assure the patient understands transport has been offered and subsequently refused

● Informed the patient to follow-up with their physician as soon as possible and/or to re-contact 911 if symptoms re-occur

NO REFUSAL OF CARE WILL OCCUR IN THE PATIENT WHO, AFTER EVALUATION BY RESCUE PERSONNEL, IS JUDGED TO BE AT RISK OF OR SUFFERING FROM A SERIOUS ILLNESS OR INJURY, WITHOUT THE INVOLVEMENT OF THE ON-LINE MEDICAL CONTROL PHYSICIAN (OLMCP).

Situations deemed high risk include:

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● Patients <1, >65 ● Trauma Patients ● Intoxicated Patients ● Chest Pain ● Abnormal Vital Signs ● Mental Health Concerns ● Status Post Treatment(seizure, asthma, hypoglycemia)

Termination of Efforts to Obtain Consent –

There are six situations where efforts to obtain consent from the patient may be discontinued: 1) Patient decides to consent

2) Patient's level of consciousness deteriorates to the point that they are no longer able to refuse care -- care may now proceed under implied consent.

3) Patient continues to refuse and the patient is determined to be capable of making an informed refusal and OLMCP consultation was not required

4) Patient continues to refuse, physical restraint with law enforcement assistance is needed, law enforcement refuses to assist (tape document), and OLMCP approves discontinuation of efforts.

5) Patient has left the scene and efforts to detain the patient would be inappropriate or dangerous.

6) Contact with medical direction has occurred.

Many times, patients will decide to consent after they hear the consultation with OLMCP, in spite of the sincere efforts of field crews. Therefore, take advantage of that fact to help persuade a patient to seek care as appropriate. You may ask OLMCP to speak directly with the patient. This has also been helpful in getting the patient to consent. If they still refuse, it puts the patient's own voice on the tape log of the radio system as an additional documentation of the system's sincere efforts to have the patient make an informed decision.

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MEDICAL CARE PROTOCOL PHYSICIAN ON SCENE

CHAPTER 24.1.9

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

If a physician on scene offers to provide assistance/physician-command for a case requiring Advanced Life Support, the paramedic is to do the following, as long as it may be accomplished without putting the patient at risk for further morbidity or mortality. A “physician”is, for the purposes of this protocol, defined as a health care practitioner with either an MD or DO Degree.

Determination of Qualification:

● A valid license to practice medicine is required.

Authorization to Paramedics:

● Paramedics are authorized to proceed under the command of a physician on scene only if the physician has produced a valid license to practice medicine. Any dispute will be referred to the Medical Control Physician [MCP].

Requirements of Physician on Scene:

● Assistance: After determination of qualification, the physician who wishes to assist the Paramedic, but not take physical command, may do so. In this situation, the Paramedic remains in command and the Physician acts as either an extra set of hands or as a resource for selected procedures (i.e., Endotracheal Intubation) or both.

● Command: Physical command may be accepted ONLY if the physician on scene agrees to sign the narrative section at the bottom right corner of the run report AND agrees to accompany the patient to the hospital.

● Any conflicts will be referred to the MCP for resolution.

● The physician who offers assistance at a scene call is doing so for reasons of humanity. A professional and respectful attitude toward the physician-volunteer will be maintained.

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MEDICAL CARE PROTOCOL UNIVERSAL PRECAUTIONS

CHAPTER 24.1.10

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

All blood and bodily fluids will be considered infectious.

Appropriate Personal Protective Equipment (PPE) will be worn when treating patients where blood and/or OPIM (Other Potentially Infectious Materials) are evident or suspected.

Appropriate respiratory protection will be used if it is documented or suspected that the patient may have infectious Tuberculosis or any other respiratory spread infection.

General Practices:

● Sharps will be disposed of in appropriate sharps container(s). ● Sharps will not be recapped. ● Hands will be cleaned, preferably with soap and water after patient contact or contact with OPIM; however, waterless hand cleaners may be used until soap and water are available. ● Contaminated equipment will be cleaned and then disinfected. ● PPE should be used to cover any areas on an employee’s person that could provide a route for contamination.

Universal Precautions Categories:

Mechanical Devices:

● Sharps containers and biomedical waste red bags. ● Sharps Safety Devices.

Personal Protective Equipment (PPE) Gloves, Gowns, Eyewear, Fluid Shields, N95 Respirators.

Housekeeping:

● Cleaning and disinfecting products. ● Waterless hand cleaner.

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MEDICAL CARE PROTOCOL QUALITY ASSURANCE PROGRAM

CHAPTER 24.1.11

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Purpose: To establish the review of field incident reports and on scene care to identify and continually measure the quality of emergency medical care being provided to the citizens of Alachua County. It is the intent of these guidelines to meet, and or exceed the requirements of Florida Statute 401 and 64E (section 8) as well as the current Protocols developed by the Medical Director.

Scope: The guidelines prescribed are applicable to all employees of the Fire-Rescue department and may not be deviated from without the expressed, written permission of the current Medical Director.

General: Information received through the review of medical field incident reports and on-scene observation of care provided will be used in focused studies and education, benchmarking, and performance outcomes which will improve the overall quality of service provided by the Alachua County Department of Public Safety.

Quality Assurance Categories to Be Reviewed Each Shift:

● Cardiac Alert/Cardiac Arrest ● Stroke Alert ● Chest Pain (30%) ● Unconscious Patient GCS <8 ● Pregnancy/OB ● Patient Refusal of Care (30%) ● Alternating Protocol as assigned by Technical Services

Quality Assurance Categories to Be Reviewed Monthly:

● Trauma Alert/Trauma Arrest ● Drowning ● Death Scene ● Airway Techniques including CPAP ● Administration of Medications (All uses of Morphine and Versed)

Components of the EMS Quality Management Program:

● Review of the Standard of Care as set forth in Florida Statute and the current Protocols developed by the Medical Director in the following areas: ● EMS Report Documentation ● Performance Standards and Skill Evaluation ● Patient Outcome

The above areas will be reviewed for:

● Call time date / Completion time date ● Quality of Care Delivered ● Process Improvement Needs ● System-wide Remediation Requirements ● Individual Remediation Requirements

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The following areas of the EMS Run Report document shall be reviewed as basic criteria for all reports:

● Patient Identification on ALL pages ● Biographical and Personal Data ● Paramedic/EMT Identification ● Entry Date ● Identification of Chief Complaint ● Patient History/Pertinent ● Physical Examination Results ● Diagnosis ● Documentation of ALL treatment ● Medically Appropriate Care ● Narrative which documents all pertinent patient care along with any unusual occurrences.

Data Collection: Electronic Reports are completed in the County Reporting Management System (RMS). Upon completion of the incident, the Paramedic/EMT is responsible for the completion of the electronic report. All screens requiring data should be completed as soon as possible so that the most accurate information is collected on each patient.

Each electronic report is reviewed by the Rescue Lieutenant assigned to QA for adherence to protocols and completion of required data. Any discrepancies will be forwarded to Technical Services for review. After review by Technical Services, any discrepancies will be returned to the individual paramedic for correction.

All report data is used to develop future training needs for the Department.

Patient Care Review Process In order to provide consistent and constant review of our procedures, the following steps shall be followed for each patient who receives care according to the QA review categories:

● EMS report is generated by field personnel for any EMS response by Fire and/or Rescue Unit where patient contact is made. ● After the report is completed, it is reviewed by the Rescue Lieutenant assigned to QA for compliance to practice parameters. The goal is to review qualifying EMS reports, based upon the QA categories, by the completion of the next duty shift. (72 hours) ● The Rescue Lieutenants assigned to QA will be the Rescue Lieutenants assigned to Rescue 8 and Rescue 25. They will split the categories and review the reports of the shift prior to their assigned shift. The categories will be split as follows:

Rescue 8

● Cardiac Alert/Cardiac Arrest ● Stroke Alert ● Chest Pain (30%) ● Unconscious Patient GCS <8 ● Trauma Alert/Trauma Arrest ● Drowning ● Death Scene

Rescue 25

● Pregnancy/OB ● Patient Refusal of Care (30%) ● Alternating Protocol as assigned by Technical Services ● Airway Techniques including CPAP ● Administration of Medications (All uses of Morphine and Versed)

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Technical Services will determine when rotation of categories is necessary.

All reports reflecting a high degree of quality in patient care or which may have questions regarding compliance with current protocols will be flagged for further review by the Technical Services Branch.

The Rescue Lieutenant assigned to QA will advise Technical Services via email of the recognition of excellent care, as well as any non-compliance issue.

The Technical Services Branch will track all trends in service to determine future needs for training and or changes in the protocols.

Technical Services will notify the assigned District Chief of trends, need for remedial training, and any issue being removed from the QA process for discipline.

The Technical Services Branch shall prepare a report of data on a quarterly basis. This report shall include all significant responses along with any possible changes in trends.

See EMS Quality Assurance Matrix Attachment

EMS Review Guidelines: The following guidelines shall be used for the review of EMS reports.

Trauma Alert / Cardiac Arrest / Drowning

Treatment Parameters:

● On Scene Time < 10 minutes or documentation of reason for prolonged scene time ● Protocol Adherence ● Advanced Skills Utilized ● Accurate ECG Interpretation

Patient Outcome:

● Restoration of Vital Signs ● Maintenance of Vital Signs ● Improvement in Vital Signs

Patient Transportation:

● Ground transportation used to appropriate facility ● Air-Medical Transportation (requested)

Medical Cardiac Arrest / Cardiac Alert / Stroke Alert / Unconscious Patient

Treatment Parameters:

● On Scene Time < 20 minutes or documentation of reason for prolonged scene time ● Protocol Adherence ● Advanced Skills Utilized ● Accurate ECG Interpretation

Patient Outcome:

● Restoration of Vital Signs ● Maintenance of Vital Signs

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● Improvement in Vital Signs

Patient Transportation:

● Ground transportation used to appropriate facility

Pregnancy / OB

Treatment Parameters:

● On Scene Time < 10 minutes or documentation of reason for prolonged scene time ● Protocol Adherence ● Advanced Skills Utilized ● Accurate ECG Interpretation

Patient Outcome:

● Restoration of Vital Signs ● Maintenance of Vital Signs ● Improvement in Vital Signs

Patient Transportation:

● Ground transportation used to appropriate facility

Pediatric ALS / Cardiac Arrest

Treatment Parameters:

● On Scene Time < 20 minutes or documentation of reason for prolonged scene time ● Protocol Adherence ● Advanced Skills Utilized ● Accurate ECG Interpretation

Patient Outcome:

● Restoration of Vital Signs ● Maintenance of Vital Signs ● Improvement in Vital Signs

Patient Transportation:

● Ground transportation used to appropriate facility

Pediatric Trauma

Treatment Parameters:

● On Scene Time < 10 minutes or documentation of reason for prolonged scene time ● Protocol Adherence ● Advanced Skills Utilized

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● Accurate ECG Interpretation

Patient Outcome:

● Restoration of Vital Signs ● Maintenance of Vital Signs ● Improvement in Vital Signs

Patient Transportation:

● Ground transportation used to appropriate facility ● Air-Medical Transportation (requested)

Death Scenes

Treatment Parameters:

● Determination of Death Parameter adherence ● Documentation of Parameter met ● Documentation of Contact with the Medical Director (IF REQUIRED) ● Documentation of Acceptable DNR form or Order (if applicable) ● Documentation of applicable scene assessment ● Documentation of notification of appropriate agencies / law enforcement ● Accurate ECG interpretation

Patient Refusal

Treatment Parameters:

● Protocol Adherence ● Patient’s Chief Complaint ● Assessment which includes at least one (1) set of Vital Signs ● Working diagnosis, if able to obtain ● Statement of level of consciousness ● Attempts to convince patient to seek treatment if applicable ● Reason given for refusal documented ● Medical Direction if required

Invasive Airway Techniques

Oral, Nasal or Digital Intubation

● Treatment parameters per Standards of Care ● Documentation ● Performed per Standards of Care ● Bilateral breath sounds present ● Oxygen Supplementation ● Changes in Patient after Assessment

Cricothyrotomy

● Performed within Standards of Care ● Documentation ● Performed per Standards of Care

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● Amount of bleeding ● Bilateral Breath sounds present ● Oxygen Supplementation

Patient Disposition

● Patent airway on first attempt ● Patent airway on second attempt ● Patent airway on greater than two (2) attempts ● Patient without successful airway patency

Medication Administration

Treatment Parameters

● Per Standard of Care ● Appropriate medication for working diagnosis

Documentation

● Medication delivered ● Dosage and amount ● Delivery route ● Response of patient to medication ● Any reactions or complications

Patient Disposition

● Expected, positive response to medication ● Untoward reaction

Alternating Protocol

A rotation of all protocol that is not already listed in this SOG will be on a monthly rotation. The rotation will be scheduled by Technical Services. Technical Services will email the QA Rescue Lieutenants by the 1st of the month specifying the protocol to be reviewed.

Probationary Rescue Lieutenants and Newly Cleared Paramedics

All EMS reports for Probationary Rescue Lieutenants and newly cleared Paramedics will be reviewed for completeness and adherence to MCP during their first three months. The need for further review will be determined by Technical Services and the assigned District Chief at the end of the three month period.

Treatment

Exceptional

● A call that exceeds expectations

Acceptable

● Typical call with no deviation from protocol

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Minor

● Deviation from MCP without MC Contract justification or without patient compromise ● Transfer of patient not documented ● No documentation of ETOH, Drugs, or Competency on Refusals

Major

● Missing “alert”notifications per MCP ● Improper rhythm recognition with concurrent treatment or non-treatment ● Incorrect medications or dosage ● Treatment without justification ● Lack of documented treatment that hindered patient care ● Waiver without MC contact or justification ● Failure to obtain waiver without justification

Written

Class 1

● Missing signature ● Grammar and spelling errors ● Times missing from treatment section

Class 2

● Missing EKG ● Incorrect Protocol used

Class 3

● Poorly written narrative

Class 4

● Incomplete Report

Good

● Report is complete and has all required information

Outstanding

● All required information ● Narrative is very clear as to this situation ● All required signatures

click to view → Quality Assurance Matrix

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MEDICAL CARE PROTOCOLS BAKER/MARCHMAN ACT

CHAPTER 24.1.12

Issued: June 2010 Revised: Nov 12

Submitted by: EMS Branch Approved by: Chief Ed Bailey

Purpose

To establish standard guidelines and procedures that will serve to provide a safe working environment for all employees and patients during the treatment and transportation of patients placed under the Baker /Marchman Acts.

Policy

These policies aim to create an understanding of the unique challenges posed by patients confined under these Acts and seek to create a guideline for treatment and transportation of these patients with an emphasis on crew, patient, and citizen safety.

Definitions

Baker Act Florida Statues Chapter 394 Mental Health.

In 1971, the Florida Legislature enacted the Florida Mental Health Act, a comprehensive revision of the state’s mental health commitment laws. The law is widely referred to as the “Baker Act”in honor of Maxine Baker, the former state representative who sponsored the Act. Since the Baker Act became effective in 1972, multiple legislative amendments have been enacted to protect individuals’ civil and due process rights.

The Florida Mental Health Act of 1971 (commonly known as the "Baker Act") allows involuntary examination of an individual who presents with:

A. A mental illness (as defined in the Baker Act) and B. Who is a harm to self, harm to others, or is at risk for self-neglect (as defined in the Baker Act).

This examination must be performed within 72 hours. Can only be initiated by:

● Judges, ● Law Enforcement Officers, ● Physicians or ● Mental Health professionals

The Marchman Act is a part of the Florida statutes that allows for voluntary or involuntary assessment of anyone who is suspected of being under the influence of drugs or alcohol and because of this has lost the power of self-control with respect to substance use and is a danger to themselves or others. This act is filed with the court system.

Procedures

The Florida Mental Health Act, section FSS-394.462(1.) (Transportation) sets out the provision of transportation service of involuntary Baker Act Patients. The “County has designated”the Alachua County Sheriff’s Office (ACSO) as one of the transportation providers for Baker Act patients within Alachua County. The Sheriff’s Office is responsible for transporting to the nearest receiving facility. Thus, this Standard Operating Guideline seeks to provide examples and courses of actions that should be taken for the transportation of these patients to a receiving facility. This same section also states that once at a receiving facility it is unlawful for law enforcement to transport to a medical facility, “County or municipal law enforcement and correctional personnel and equipment shall not be used

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to transport patients adjudicated incapacitated or found by the court to meet the criteria for involuntary placement pursuant to s. 394.467 “. This does not eliminate the need for common sense and a practical approach to handling these individuals.

The ACSO or Law Enforcement Agency (LEA) will transport all Baker Act and Marchman Act patients to the nearest receiving facility unless an exception listed below is present:

1. The patient is undergoing a medical emergency which requires the treatment abilities of an EMS unit.

2. The patient has a physical limitation which precludes the transportation by a law enforcement vehicle such as being confined to a stretcher or unable to sit.

In cases where a patient is under the provision of the involuntary Baker Act/Marchman Act and requires transportation or tranfer to a medical facility by EMS.

1. The cases where the transferring facility is willing to provide a patient advocate, the advocate will be responsible for the enforcement of the Baker /Marchman Act during transport.

2. In cases where the transferring facility does not provide custodial care, should the patient present the crew with an imminent threat or an appearance of violent behavior, the Alachua County Sheriff’s Office will be contacted for assistance with securing the patient and protecting the crew. The sheriff’s Office cannot be used as a regular component of transfers.

A. In the spirit of inter-agency cooperation, should the patient not present the crew with an imminent threat or an appearance of violent behavior, the patient will be transported as any other patient would.

B. The EMS crew is not to enforce the restraint order and should the patient seek to exit the vehicle it will be up to law enforcement to secure the patient. A new evaluation of the patient will have to be conducted by law enforcement to see if the patient still meets the criteria for a Baker Act involuntary examination. If the patient does meet the criteria then they will be taken to the nearest receiving facility with medical care.

C. Should the deputy restrain a patient that is being transported by EMS through the use of handcuffs or other methods, the deputy may need to ride in the EMS unit to provide access to the patient in the event that the patient becomes unstable. EMS providers will not transport patients who have been placed in the “hogtie or hobble position.”This can cause asphyxia and will not be tolerated.

D. Should the Rescue Lieutenant feel threatened or uncomfortable from the patient’s imminent violent behavior, they may request a deputy to ride along with the unit to provide security for the crew. The assisting ACSO Deputy (LEA) on scene will evaluate the patient’s demeanor, and contact their Shift Commander. A determination will be made if it’s necessary for an (LEA) to ride inside or follow the EMS vehicle with the patient to the receiving facility. If the patient should become violent, the EMS vehicle will pull over and the Deputy will contact the ACSO Shift Commander for approval to ride in the EMS vehicle for the remainder of the transport In those instances when other law enforcement agencies are involved, their appropriate Shift Commander should be contacted regarding this request. Should the deputy refuse, the crew should contact their on-duty District Chief for direction.

E. In the rare event of an immediate life threatening condition, where waiting for an appropriate law enforcement officer would cause the injury/death of the patient, the EMS crew will notify their District Chief and request personnel from additional units until there is sufficient manpower to mitigate any possible threat posed by the patient, should they become combative.

In cases where inter-facility transfers are requested for a patient to a facility outside Alachua County.

1. The transferring facility shall provide a bonded law enforcement officer to maintain the Baker/Marchman Act provision. F. In the case where the facility refuses to provide this agent, the EMS crew will contact the on-duty District Chief. If the facility is unable and or unwilling to provide the security agent at the request of the DC, the DC will refuse the transfer. G. In the spirit of professional cooperation, ACFR will provide return transportation for the security agent as

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long as the time constrains are deemed reasonable.

The following state statute pertains to those patients not qualifying for Baker or Marchman Act but are not competent to make rational decision.

401.445 Emergency examination and treatment of incapacitated persons.—

1. No recovery shall be allowed in any court in this state against any emergency medical technician, paramedic, or physician as defined in this chapter, any advanced registered nurse practitioner certified under s. 464.012< or any physician assistant licensed under s. 459.022<, or any person acting under the direct medical supervision of a physician, in an action brought for examining or treating a patient without his or her informed consent if: a. The patient at the time of examination or treatment is intoxicated, under the influence of drugs, or otherwise incapable of providing informed consent as provided in s. 766.103< b. The patient at the time of examination or treatment is experiencing an emergency medical condition; and c. The patient would reasonably, under all the surrounding circumstances, undergo such examination, treatment, or procedure if he or she were advised by the emergency medical technician, paramedic, physician, advanced registered nurse practitioner, or physician assistant in accordance with s. 766.103.

Examination and treatment provided under this subsection shall be limited to reasonable examination of the patient to determine the medical condition of the patient and treatment reasonably necessary to alleviate the emergency medical condition or to stabilize the patient.

2. In examining and treating a person who is apparently intoxicated, under the influence of drugs, or otherwise incapable of providing informed consent, the emergency medical technician, paramedic, physician, advanced registered nurse practitioner, or physician assistant, or any person acting under the direct medical supervision of a physician, shall proceed wherever possible with the consent of the person. If the person reasonably appears to be incapacitated and refuses his or her consent, the person may be examined, treated, or taken to a hospital or other appropriate treatment resource if he or she is in need of emergency attention, without his or her consent, but unreasonable force shall not be used. 3. This section does not limit medical treatment provided pursuant to court order or treatment provided in accordance with chapter 394 or chapter 397..

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MEDICAL CARE PROTOCOL Rapid Extrication

CHAPTER 24.1.14

Issued: January 15, 2013 Revised:

Submitted By: Technical Services Approved by: Medical Director

Purpose:

To establish a written guideline documenting conditions where physical or environmental conditions exist which preclude the initiation of most, if not all other medical care guidelines for the wellbeing of all personnel involved. The scope of the guideline is not to list every possible condition where rapid extrication would be required, but rather to set the parameters which could elicit the use of rapid extrication.

The field of emergency services by its very nature is unpredictable and often times places the lives of patients, caregivers and bystanders in harm’s way. Occasionally, there are incidents where the situation and or conditions are so volatile that it places the wellbeing of the personnel involved at greater risk if basic medical care is provided. These occasions are rare but require definitive action to ensure the safety of all involved.

Examples of Situations and Conditions which may require the use of rapid extrication techniques to lower the risk to all involved.

● Environmental Conditions

Fires, floods, civil unrest, animal/insect and weather all can sometimes present a condition where patients must be moved to a safe location prior to the initiation of basic medical care.

● Physical Situations

Patient position, location and situation have to be measured when decisions regarding the initiation of medical care are considered. Patients in positions where care is not practical or possible must be moved with all expediency to a location where proper medical care can be provided. Examples of such situations may include high angles, confined space rescues, entrapment within burning/sinking vehicles, locations such as the stands during a university of Florida home game where access to the patient is limited. Under these situations dangers to patient, caregivers and bystander may be lessened by moving the patient prior to the initiation of care.

Once the decision is made, that moving the patient to a safe location prior to the initiation of care poses a better treatment option or threat to the patient or caregiver than the dangers of their current location, several considerations are needed.

1. Risk vs. benefit must be weighed to determine if a rescue is possible.

2. If the determination is made that a recue is possible the move needs to be rapidly undertaken and completed as soon as possible to allow for the initiation of needed care.

3. Other injuries such as C-spine and occluded airways may exist and if at all possible these considerations should be addressed.

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BASIC MEDICAL CARE PROTOCOL

CHAPTER 24.2.1

Issued: May 2010 Revised:June 2011

Submitted By: Technical Services Approved By: Medical Director

The phrase “Basic Medical Care”is used throughout the entire protocol as the first direction in patient care. This phrase will encompass all of the following and includes all of the BLS care protocols that are appropriate to the patient.

Scene size up:

● Utilize Personal Protective Equipment ● Assess the scene for hazards ● Park unit in a safe place ● Protect yourself and crew members ● Assess for the number of patients ● Assess the need for additional resources ● Assess the general condition of the patient(s)

Establish responsiveness: If unresponsive;

● Basic Life Support ● Establish patent airway, open airway if necessary protecting cervical spine when indicated ● Supplemental oxygen if any respiratory signs or symptoms present ● Record and monitor vital signs ● Control bleeding when indicated ● Record Blood Glucose Level if any weakness, altered mental status or history of diabetes ● Nothing by mouth, unless patient is a known diabetic with hypoglycemia and is able to self-administer oral Glucose Paste, or a glucose containing beverage ● Advanced Life Support ● When condition warrants (specified as “Full ALS Assessment and Treatment”in individual protocols): ● Advanced airway/ventilatory management as needed ● Perform cardiac monitoring ● Evaluate 12-lead ECG if chest pain, abdominal pain above the umbilicus or ischemic equivalent symptoms (dizziness, weakness, shortness of breath) ● Obtain vital signs ● Obtain history and perform physical exam ● Record & monitor continuous 02 saturation and microstream capnography ● IV 0.9% NaCl KVO or IV lock ● If evidence of dehydration (tachycardia, dry mucous membranes, poor skin turgor) administer boluses of 0.9% NaCl at 250 ml (hold at 500 ml total if no hypotension)

● If BP < 90 mm Hg systolic, administer boluses of 0.9% NaCl at 250 ml until systolic BP > 90 mm Hg ● Contraindicated if evidence of congestive heart failure (e.g. rales)

● If Hypoglycemic (Blood glucose < 70 mg/dL [<50mg/dL if stroke]) with IV access ● Dextrose 50% 25 gm slow IVP •Repeat Dextrose 50% 25 gm once if blood glucose < 70 mg/dl after 10 minutes

● If Hypoglycemic (Blood glucose < 70 mg/dL, [< 50 mg/dL if stroke]) without IV access ● Glucose paste or other oral glucose containing agent (e.g. orange juice) if patient alert enough to self

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administer oral agent ● If unable to take oral glucose administer Glucagon 1 mg IM

● Transport patient to nearest appropriate Emergency Department

● Minimize on scene time when possible

● Frequently reassess patient

● Contact Medical Control for any additional orders or questions

Click to view → BLS for Healthcare Providers' Chart

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BASIC MEDICAL CARE PROTOCOL AIRWAY MANAGEMENT

CHAPTER 24.2.2

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Management of a patient’s airway is paramount to life support.

The management of a patient’s airway shall include the following in order from BLS to ALS:

● Position the head using the head tilt-chin lift method unless trauma is suspected ● The airway of a suspected trauma patient should be opened using the modified jaw thrust maneuver ● Use suction as needed to clear airway ● Use oral or nasal pharyngeal airway adjuncts ● Consider King LT tube ● Request ALS intervention

Assisted Ventilations:

● Adult patients with a respiratory rate less than 12 or greater than 28 breaths per minute and/or exhibiting signs of hypoxemia may require assisted ventilations. This shall include use of any of the following methods: ● Utilizing (BVM) and basic airway maneuvers, with supplemental Oxygen. ● Deliver enough volume to make the chest rise. ● Mouth-to-mouth, mouth-to-nose, mouth-to-stoma (at provider option when adjuncts are not available). If any of these methods are employed an incident report MUST be filled out because of the exposure. ● Pediatric patients with signs of hypoxemia and or respiratory distress (including bradycardia, abnormal breath sounds, increased work of breathing, nasal flaring, retractions, stridor or abnormal positioning) should have ventilations assisted with a mask that covers both mouth and nose, but not eyes. This can be accomplished utilizing: ● Pediatric Bag Valve Mask (BVM) and reservoir with supplemental Oxygen at 10-25 LPM. ● Mouth-to-mouth, mouth-to-nose, mouth-to-stoma (at provider option when adjuncts are not available.) If any of these methods are employed an incident report MUST be filled out because of the exposure.

Advanced Skills Endotracheal Intubation (see protocol) Cricothyrotomy (see protocol)

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BASIC MEDICAL CARE PROTOCOL OXYGEN THERAPY

CHAPTER 24.2.3

Issued: May 2010 Revised: July 12

Submitted By: EMS Branch Approved By: Medical Director

Oxygen should be administered to patients who:

● Display signs and symptoms of hypoxia

● Present in hypotensive states

● Have suffered major trauma

● Present as acutely ill

● Are suspected of carbon monoxide inhalation (regardless of SaO2 reading)

● Are pregnant and may have reason for fetal hypoxia

● Any patient who you suspect may become hypoxic due to mechanism of injury or nature of illness regardless of oxygen saturation level.

● If patient is able to maintain SaO2 greater than 94% you may elect not to administer O2.

Methods of administration include:

● Nasal cannula 1-6 LPM = 24-40%

● Non re-breather mask 12-15 LPM = 90-95%

● Bag Valve Mask with reservoir 10-25 LPM = 90-100%

● Oxygen powered Ventilator N/A = 100%

● Ventilator 40-60 LPM = 21-100%

Oxygen therapy should never be withheld from any patient who displays a need for it.

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BASIC MEDICAL CARE PROTOCOL CONTROL OF EXTERNAL BLEEDING

CHAPTER 24.2.4

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Whenever the term “Control external bleeding”is used throughout these protocols, the following elements must be considered:

● Application of direct pressure with a sterile ● Elevation of the injured part above the level of the heart ● Application of a pressure dressing ● Application of pressure to proper arterial pressure point ● Application of a Tourniquet ● Should be applied early when there is SEVERE arterial bleeding present.

Studies show considerable increase in survival rate when applied prior to the onset of shock.

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BASIC MEDICAL CARE PROTOCOL SHOCK

CHAPTER 24.2.5

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Decompensated Shock:

Any adult patient exhibiting signs of inadequate perfusion, which may include:

● Altered mental status (e.g. lethargy, coma) ● Tachycardia ● Pallor ● Diaphoresis ● Pale conjunctiva ● Delayed capillary refill ● Orthostatic vital sign changes ● Low Blood Pressure ● Thirst

Any pediatric patient having a systolic blood pressure BELOW normal [(patient age x 2) + 70] or the following signs of inadequate central (proximal) perfusion:

● Altered mental status (e.g. lethargy, coma) ● Profound tachycardia or bradycardia ● Delayed capillary refill time (greater than 2 seconds) ● Any of the adult signs listed above

Protocol:

● Place patient in supine position ● Oxygen via NRBM @ 10-25 liters/minute ● Maintain body temperature ● Request ALS assistance

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BASIC MEDICAL CARE PROTOCOL MCI AND TRIAGE SYSTEM

CHAPTER 24.2.6

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Definition:

● A Mass Casualty incident or “MCI”is defined as any event that overwhelms the resources of the EMS system. ● Alachua County’s EMS system resources may very at different times. (IE: such as fall during college football games).

Protocol:

● The need for an organized and orderly approach to an MCI can not be over stressed. ● The Department’s SOG has an established guide for implementation of the incident command system which should be active for any MCI. ● Triage of patients at the scene of an MCI should be accomplished using the START/JUMPSTART triage system as listed below ● Patients injury/illness severity will be identified as one of the following four categories:

● Red – Requires immediate transportation. ● Yellow – Requires transportation but can be delayed. ● Green – Ambulatory “walking wounded”with minor injuries. ● Black – Deceased- not transported ● Coordination of patients with area hospitals must be accomplished through the incident command system. ● The steps of the Start triage systems are as follows.

STEP ONE: Loudly ask anyone within the sound of your voice to move to a designated area if they are able. This will automatically help you sort out the walking wounded and these patients should be tagged green. STEP TWO: In an orderly fashion, move to each patient checking for the status of Airway, Breathing, Circulation and Mental status and tag them using the following rules

Breathing:

● Yes, if respirations less that 30 then check circulation.

● Yes, if respirations greater than 30 =triage RED.

● No, open and clear airway- if breathing begins =triage RED

● No, after clearing airway the patient is not breathing =triage Black

CIRCULATION: (Check pulse)

● Control bleeding

● Weak pulse=triage RED

● Strong Pulse= go to metal status check or check capillary refill time (CRT)

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● CRT: If less than 2 seconds go to mental status check

● CRT: If greater than 2 seconds=triage RED

Mental Status: (Commands “open your eyes, squeeze my hand, etc.)

● Patient follows commands = triage Yellow

● Fails to follow simple commands =triage RED

A simple flow chart below will demonstrate the progression of triage with each individual, including pediatric patients.

Click to view → Triage Algorithm

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CARDIOVASCULAR PROTOCOL CHEST PAIN-SUSPECTED CARDIAC

CHAPTER 24.3.1

Issued: May 2010 Revised: April 12, July 12

Submitted By: EMS Branch Approved By: Medical Director

Protocol:

● Basic Medical Care

● Airway management

● Define pain response using OPQRST: ● Onset, Provocation, Quality, Radiation, Severity, Time

● If patient has a history of Diabetes, consider symptoms other than pain to evaluate for a silent MI

● Cardiac monitor -Treat dysrhythmias as indicated

● Cardiac rhythm and the presence of a blood pressure must be assessed prior to and between each therapeutic measure when treating cardiac dysrhythmias with a pulse.

● Obtain a 12-lead EKG as soon as possible (See 12-lead protocol) ● Repeat 12-lead EKG after treatment or changes in patient condition (as time permits). ● Vascular Access

If chest pain is considered cardiac in origin

● Administer supplemental oxygen if the patient is dypsneic, hypoxemic, or has obvious signs of heart failure. Providers should titrate therapy, based on monitoring of oxy-hemoglobin saturation, to greater than or equal to 94%.

● Administer Nitroglycerin*

● Spray/tablet SL every 5 minutes until pain relieved

● After administration of Nitroglycerin re-check vital signs to ensure the patient is hemodynamically stable ● Apply Nitroglycerin paste, ½”– 2”to the anterior chest wall

● Use Nitroglycerin carefully if evidence of a right ventricular infarct

● In the presence of a right ventricular infarct, a fluid bolus of 250ml Normal Saline may be appropriate prior to the administration of Nitroglycerin.

*Patients who have ingested Viagra or Levitra within the last 24 hours or Cialis within the last 48 hours should not receive nitrates in any form.

● If patient is not allergic and has not consumed aspirin in the past 6 hours ● Administer 4 chewable baby Aspirin (total 324mg)

● Patients on coumadin, plavix or aspirin daily will still benefit from aspirin during their cardiac event. ● If pain persists and systolic BP is greater than 100mmHg

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● Morphine Sulfate 1-5 mg IVP/IO. May repeat in 2 mg increments up to a total 10 mg. For additional pain management contact medical control. ● If hypotensive and lungs are clear ● Refer to Hypotension protocol

If runs of Ventricular Tachycardia occur

● Amiodarone 150mg IV Piggyback over 10 minutes

● Isolated PVC’s do not require treatment

For patients with severe nausea and vomiting

● Zofran 4mg slow IV

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CARDIOVASCULAR PROTOCOL CHEST PAIN NON-CARDIAC

CHAPTER 24.3.2

Issued: May 2010 Revised: July 12 Submitted By: EMS Branch Approved By: Medical Director

Protocol:

● Basic Medical Care

● Airway management

Define pain response using OPQRST:

● Onset, Provocation, Quality, Radiation, Severity, Time

● Cardiac monitor

● Treat dysrhythmias per protocol

Vascular Access Obtain and document a 12-lead EKG to aid in recognition of a cardiac event If chest pain is still considered non-cardiac in origin

● Focused physical exam for chest injury

● Ascertain if movement, drinking fluids, eating, deep inspiration, or other changes pain

● Continually re-evaluate for cardiac or respiratory distress

● If patient develops shortness of breath go to respiratory distress protocol

● Administer oxygen if saturation is less than 94%

Click to view → Chest Pain Differential Diagnosis Chart

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CARDIOVASCULAR PROTOCOL CONGESTIVE HEART FAILURE PULMONARY EDEMA

CHAPTER 24.3.3

Issued: May 2010 Revised: July 12

Submitted By: EMS Branch Approved By: Medical Director

Protocol:

● Basic Medical Care

● Airway management

● Vascular Access

● Administer Nitroglycerin 0.4 mg sublingual

● Administer Nitropaste ½”– 2”on anterior chest ● Remove if systolic B/P drops less than 100

Patients who have ingested Viagra (sildenafil) or other erectile dysfunction medications within 36 hours should not receive nitrates in any form

● Morphine Sulfate 1-5 mg IVP/IO

● May administer Albuterol 2.5 mg in 3 ml Normal Saline via nebulizer if wheezing

● Lasix 20-40 mg IVP over 2 minutes can be given if the following is conditions are present 1. History of CHF and Lasix usage

2. Findings consistent with fluid overload, which consist of JVD, crackles on auscultation and/or pedal edema.

3. Lack of fever and hemoptysis.

● If hypotensive

● Refer to Shock Protocol

● Severe respiratory distress, CPAP in addition to the above

● If respiratory failure is imminent, be prepared to intubate and provide positive pressure ventilation.

MEDICAL CONTROL OPTIONS:

● Repeat any of the above Standing Orders

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CARDIOVASCULAR PROTOCOL CARDIAC ARREST MANAGEMENT

CHAPTER 24.3.4

Issued: May 2010 Revised: June 11, Aug 11

Submitted By: Technical Services Approved By: Medical Director

1. CPR ● Compressions at a rate of 100/min. ● Avoid interruption ● Minimize delays between delivery of shock(s) ● Ratio of 30:2 (15:2 for infants and Children with 2 rescuers). ● Compressions should not be interrupted for any reason not even to give breaths ● Chest compressions are then delivered continuously at 100/ min for 2 minutes intervals. ● Ventilations are provided once every 6-8 seconds. Avoid excessive ventilations ● Ventilate with enough volume to make chest rise. ● Rescuers should switch roles (ventilator and compressor) every two minutes to minimize compressor fatigue and deterioration of quality of compressions. ● Apply pads and monitor as soon as possible to identify a shockable rhythm, then follow protocols according to rhythm

2. Airway management: ● Basic: oral or nasophyngeal airways should be used to maintain a patent airway with BVM ● Advanced: place an advanced airway when needed, minimizing interruptions in CPR during placement. Examples include endotracheal tube, King LT tube, and LMA. ● Continuous ETCO2 Waveform Capnography is required on every patient with and ETT or King LTD in place because this provides the most reliable means of confirming proper tube placement and assuring adequate CPR (i.e. you will see a CO2 waveform and measurements of at least 20 mm/Hg if CPR is adequate)

3. Work flow of the cardiac arrest: ● A team leader should assign roles to each member of the rescue team to make sure everyone knows what tasks they are responsible for completing. ● Team Roles include an airway manager, compressor, IV/Drug administration person and team leader. ● The sequences of tasks that are to be accomplished during a cardiac arrest are demonstrated in the 2 pictures below. The V-Fib/Pulseless VT protocol has the specific details of each two minute segment. For all others follow this sequence as it applies.

Click to view → AHA Circular Cardiac Arrest Algorithm

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CARDIOVASCULAR PROTOCOL DYSRHYTHMIA ASYSTOLE/PULSELESS ELECTRICAL ACTIVITY(PEA)

CHAPTER 24.3.5

Issued: May 2010 Revised: June 11, July 12

Submitted By: EMS Branch Approved By: Medical Director

Protocol Note: When Asystole is seen on the cardiac monitor confirmation of the rhythm shall include a printed rhythm strip, as well as interpretation of the rhythm in more than one lead. Low amplitude V-Fib may be difficult to distinguish from Asystole/PEA when using only the cardiac monitor display for interpretation.

● Advanced Life Support ● Follow Cardiac Arrest Management protocol

● Consider and treat possible causes: ● Epinephrine 1 mg IV/IO every 3-5 min during arrest ● Strong consideration to replacement of 2nd dose of Epi with 40 units Vasopressin. ● Drug overdoses (see specific drug OD/toxicology section) ● Glucagon 3 mg IV/IO for calcium channel and B blocker OD

● Calcium Chloride 1 gram IV/IO for calcium channel blocker OD ● Avoid if patient on Digoxin / Lanoxin ● Bicarbonate 1 mEq/kg IV/IO for Tricyclic antidepressant OD

● Naloxone (Narcan) 2 mg IV/IO for possible narcotic OD ● May be given IM if no IV/IO available ● If no response to resuscitative efforts after 20 minutes refer to Termination of CPR Protocol, 24.1.4.

Potential causes if Asystole Treatment

● Hypovolemia (most common) ● Normal Saline 1-2 liters IV/IO

● Hypoxia ● Secure airway and ventilate

● Hydrogen Ion- acidosis ● Sodium Bicarbonate 1 mEq/kg IV/IO

● Hyperkalemia (end stage renal ● Sodium Bicarbonate 1 mEq/kg IV/IO disease) ● Calcium Chloride 1 Gram IV/IO slow

● Hypothermia ● Active rewarming

● Tablets (drug overdose) ● See above

● Tamponade, cardiac ● Normal Saline 1-2 liters IV/IO

● Tension pneumothorax ● Needle Thoracostomy

● Thrombosis, coronary (MI) ● Expedite transport

● Thrombosis, pulmonary (clot in lung) ● Expedite transport

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Contact Medical Control for any additional orders or questions

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CARDIOVASCULAR PROTOCOL DYRHYTHMIA - ATRIAL FIBRILLATION/ATRIAL FLUTTER

CHAPTER 24.3.6

Issued: May 2010 Revised: June 11, Aug 11

Submitted By: Technical Services Approved By: Medical Director

Protocol

● Advanced Life Support ● Full ALS Assessment and Treatment ● Do not delay treatment if patient is unstable by obtaining 12 lead ECG unless diagnosis is in question ● If rate is less than 130 and patient is asymptomatic ● Treat underlying conditions as per protocol (dehydration, pain, etc.) ● Provide supportive care and expedite transport

● STABLE Atrial Fibrillation/Atrial Flutter with Rapid Ventricular Rate

(Normotensive without dyspnea, chest pain, or decreased level of consciousness):

● Vagal maneuvers (cough, hold breath)

● Administer Diltiazem 0.25 mg/Kg (20 mg in a normal adult) IV over two minutes

● If no response in 15 minutes administer Diltiazem 0.35 mg/Kg IV (25mg in a normal adult) over two minutes

● If patient allergic to Diltiazem; or no response and patient is stable, consider: ● Amiodarone 150 mg over 10-15 minutes. 150 mg in 50 ml NS using a MACRO drip infusion set run at no more than 1 drop/second

(ABOVE TREATMENTS ONLY IF RVR ONSET LESS THAN 48 HOURS)

● UNSTABLE Atrial Fibrillation or Atrial Flutter with Rapid Ventricular Rate

(Including: decreased LOC, chest pain, dyspnea, hypotension, shock, pulmonary congestion, etc.)

● Synchronized Cardiovert at 50-100 joules Biphasic, ● If no change Synchronized Cardiovert at 120 joules Biphasic, ● If no change Synchronized Cardiovert at 150 joules Biphasic, ● If no change Synchronized Cardiovert at 200 joules Biphasic. ● (Peds see Broselow Tape) ● When the rhythm converts, proceed to appropriate protocol. ● Contact Medical Control for any additional orders or questions

**NOTE** Energy Selection based on Zoll Manufacturing Research recommendations and AHA Research based Guidelines.

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CARDIOVASCULAR PROTOCOL DYSRHYTHMIAS-BRADYCARDIA

CHAPTER 24.3.7

Issued: May 2010 Revised: June 11, Aug 11, Sept11

Submitted By: Technical Services Approved By: Medical Director

Protocol:

● Basic Life Support ● Supplemental oxygen

● Advanced Life Support ● Full ALS Assessment and Treatment noted in basic medical care protocol ● Do not delay treatment if patient is unstable by obtaining 12 lead ECG unless diagnosis is in question

● Note: The following therapies are indicated only when serious signs and symptoms are present. If symptoms are mild, provide supportive care and expedite transport.

● Symptomatic (SBP < 90 mm Hg, altered mental status or severe chest pain) ● Atropine 0.5 mg IVP Repeat every 3 minutes as needed ● (Maximum 0.04 mg / kg) ● If symptoms persist after Atropine ● For the treatment of adults with symptomatic and unstable bradycardia, chronotropic drug infusions (dopamine) are recommended as an alternative to pacing. ● Dopamine infusion at 10-20 mcg/kg/min titrated to maintain systolic BP > 90 mm Hg ● Note if there is any delay in establishing an IV can move onto transcutaneous pacing ● If symptoms persist or patient found to be in 2nd or 3rd degree AV block. ● Initiate transcutaneous pacing (do not use Asynchronous Pacing) ● Start at lowest milliampules; increase until electrical capture with pulses achieved ● Start rate at 70 and increase rate to achieve systolic BP ≥ 90 mm Hg (Max 80 beats / minute) ● Sedate if patient condition and time allows (hold if SBP < 90 mmHg) ● Versed 1 mg, slow IV ● If above unsuccessful ● Epinephrine infusion at 2-10 mcg/minute IV

● If drug induced, treat for specific drug overdose ● Calcium Chloride 1 gram IV for calcium channel blocker OD ● Contraindicated if patient on Digoxin / Lanoxin ● Glucagon 3 mg IV for calcium channel blocker OD if no response to Calcium Chloride ● Glucagon 3mg IV for Beta blocker OD ● Naloxone (Narcan) 2 mg IVP every 3 min (Maximum 8 mg) for possible narcotic overdose ● Naloxone (Narcan) can be given in 0.4 mg increments titrated to level of consciousness and respiratory drive ● If IV access has not been established, Naloxone (Narcan) 2 mg IM ● Sodium bicarbonate 1 mEq/kg IV for Tricyclic antidepressant OD

Contact Medical Control for any additional orders or questions

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CARDIOVASCULAR PROTOCOL DYSRHYTHMIAS-SUPRAVENTRICULAR TACHYCARDIA

CHAPTER 24.3.9

Issued: May 2010 Revised: June 11, Aug 11

Submitted By: Technical Services Approved By: Medical Director

Protocol

● Basic Life Support ● Supplemental oxygen

● Advanced Life Support ● Full ALS Assessment and Treatment ● Do not delay treatment if patient is unstable by obtaining 12 lead ECG unless diagnosis is in question

● Stable or borderline (Ventricular rate > 150): ● Vagal maneuvers (Valsalva or cough) ● Ice water contraindicated in patients with ischemic heart disease ● Adenosine phosphate (Adenocard) 6 mg rapid IVP over 1-3 seconds ● If no response in 2 minutes, 12 mg rapid IVP over 1-3 seconds ● If no response, consider synchronized cardioversion

● Unstable with serious signs and symptoms (Ventricular rate > 150):

● Go directly to Synchronized Cardioversion ● First energy level 50J – 100J ● If no response 120J ● If no response 150J ● If no response 200J ● Peds dosing see broselow tape

Contact Medical Control for any additional orders or questions

**NOTE** Energy Selection based on Zoll Manufacturing Research recommendations and AHA guidelines

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CARDIOVASCULAR PROTOCOL DYSRHYTHMIAS-POLYMORPHOUS VENTRICULAR TACHYCARDIA (TORSADES DE POINTES)

CHAPTER 24.3.10

Issued: May 2010 Revised: June 2011

Submitted By: Technical Services Approved By: Medical Director

Protocol:

● Basic Life Support ● Supplemental oxygen ● Advanced Life Support ● Full ALS Assessment and Treatment ● Do not delay treatment if patient is unstable by obtaining 12 lead ECG unless diagnosis is in question

IF THERE IS NO PULSE, PROCEED TO PULSELESS VTACH/VFIB PROTOCOL

● If patient is stable ● Sulfate 2-4 g slow IV in 10 ml NS over 1-2 minutes ● If no response, Amiodarone 150 mg over 10-15 minutes. 150 mg in 50 ml NS using a MACRO drip infusion set run at no more than 1 drop/second ● Repeat Amiodarone 150 mg infusion as above over 10 minutes every 10-15 minutes (Maximum of 450 mg total)

● If Unstable or if no response to the above measures ● Unsynchronized Cardioversion ● 1st energy level 100 Joules ● If no response 120 Joules ● If no response 150 Joules ● If no response 200 Joules ● Contact Medical Control for any additional orders or questions

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CARDIOVASCULAR PROTOCOL DYSRHYTHMIAS VENTRICULAR WIDE-COMPLEX TACHYCARDIA

CHAPTER 24.3.11

Issued: May 2010 Revised: June 11, Aug 11

Submitted By: Technical Services Approved By: Medical Director

Protocol

● Basic Life Support ● Supplemental oxygen

● Advanced Life Support ● Full ALS Assessment and Treatment ● Do not delay treatment by obtaining ECG unless diagnosis is in question ● In general, assume unknown wide complex tachycardias at rates over 150 represent ventricular tachycardia

● Stable and SVT highly likely (rate > 150) ● Adenosine Phosphate (Adenocard) 6 mg rapid IVP over 1-3 seconds ● If no response in 2 minutes, 12 mg rapid IVP over 1-3 seconds ● If no response, consider synchronized cardioversion

● Stable and unknown wide complex or ventricular tachycardia likely (rate > 150) ● Adenosine may be considered in the initial diagnosis of stable, undifferentiated, regular, monomorphic, wide-complex tachycardia. It should not be used if the pattern is irregular. ● If Adenosine is used and unsuccessful consider: ● Amiodarone 150 mg over 10-15 minutes. 150 mg in 50 ml NS using a MACRO drip infusion set run at no more than 1 drop/second ● Repeat Amiodarone 150 mg infusion as above over 10 minutes every 10-15 minutes (Maximum of 450 mg total) ● If Amiodarone is not available Llidocaine can be given ● Lidocaine 1-1.5mg/Kg over 1-2 minutes, if ectopy is suppressed then start an infusion at 2mg/min ● If ectopy continues: Repeat dose of Lidocaine 0.5-0.75mg/Kg IVP every 10 minutes until ectopy suppressed or total dose of 3mg/Kg has been given with each additional bolus increase infusion by 1mg/min up to 4mg/min ● If suspected cocaine toxic patient:

● Administer Versed 1mg IVP if ectopy not suppressed

● Unstable wide complex tachycardia (rate > 150) ● (hypotension, chest pain, dyspnea, pulmonary edema and decreased level of consciousness) ● Synchronized cardioversion ● 1st energy level 100J ● If no response 120J ● if no response 150J ● If no response 200J ● If delays in synchronization occur and clinical condition is critical, go immediately to unsynchronized shocks ● May administer Amiodarone or Lidocaine as described above in stable wide complex tachycardia protocol ● If wide complex tachycardia re-occurs begin therapy at last step which was successful in resolving the dysrhythmias ● If hyperkalemia suspected in any wide complex tachycardia (e.g. renal failure patient) administer the following medications: ● Calcium Chloride 1 gram IV

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● Contraindicated if patient on Digoxin/Lanoxin ● Sodium Bicarbonate 1 mEq/kg IV

**NOTE** Energy Selection based on Zoll Manufacturing Research recommendations

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CARDIOVASCULAR PROTOCOL DYSRHYTHMIAS-VENTRICULAR FIBRILLATION PULSELESS VENTRICULAR TACHYCARDIA

CHAPTER 24.3.12

Issued: May 2010 Revised: June 2011

Submitted By: Technical Services Approved By: Medical Director

Protocol

● Advanced Life Support ● Follow Cardiac Arrest Management protocol ● Assure CPR is initiated and performed effectively ● Assess the rhythm, if shockable, Defibrillate at 200J biphasic ● Peds: see Broselow tape ● CPR should be continued through the charging of the Defibrillator ● Continue CPR immediately after shock (do not stop to check pulse or rhythm) ● Analyze rhythm after 2 minutes of good CPR ● If VF/VT persists: then Defibrillate at 200J biphasic ● Continue CPR immediately after shock (do not stop to check pulse or rhythm) ● Epinephrine 1 mg IV/IO every 3-5 min during arrest ● May replace 1st or 2nd dose of Epi with 40 units Vasopressin IVP. ● Analyze rhythm after 2 minutes of good CPR ● If VF/VT persists: Defibrillate at 200 J biphasic ● Continue CPR immediately after shock (do not stop to check pulse or rhythm) ● Administer Amiodarone 300 mg IV/IO bolus

If Amiodarone unavailable or patient has Amiodarone allergy

● Lidocaine 1-1.5 mg/kg up to 3 mg/kg IVP is an acceptable alternative if amiodarone is not available. ● For persistent VF/VT administer ● Amiodarone 150 mg IV/IO bolus ● Defibrillate for persistent VF/VT at 200J biphasic ● A shock should be delivered about once every 2 minutes if the patient remains in Ventricular Fibrillation. ● Continue cycle of ● CPR and DrugèRhythm CheckèCPRèShockè ● CPR and DrugèRhythm CheckèCPRèShock as needed ● When dysrhythmia resolves, initiate Amiodarone or Lidocaine infusion ● unless contraindicated (i.e.: allergies, bradycardia, etc.). ● Antidysrthymic Infusions ● Amiodarone Infusion ● Administer Amiodarone 150 mg over 10-15 minutes. 150 mg in 50 ml NS using a MACRO drip infusion set run at no more than 1 drop/second ● Lidocaine Infusion ● Use premixed bag that yields 4mg/1ml ● OR mix 200mg (2-100mg prefilled vials) into 50ml bag of NS (4mg/ml) ● Start rate at 2 mg/min using micro drip

● Additional interventions to consider in special circumstances ● Magnesium Sulfate 2-4 gm IV/IO push over 1-2 minutes only if suspected Polymorphous VT (torsades de pointes) or hypomagnesemic state (chronic alcohol, diuretic use) ● Sodium bicarbonate 1 mEq/kg IV/IO if suspected Hyperkalemia (e.g. dialysis patient) or Tricyclic antidepressant OD

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CEREBROVASCULAR PROTOCOL CEREBROVASCULAR ACCIDENT (CVA, STROKE)

CHAPTER 24.3.13

Issued: May 2010 Revised: May 2012

Submitted By: Technical Services Approved By: Medical Director

Protocol

Basic Life Support

● Administer OXYGEN at 2-3 L/min via nasal cannula if oxygen saturation <95%

● Keep head of stretcher 30-45 degrees

● Give nothing by mouth

● Transport expeditiously

Advanced Life Support

● Full ALS Assessment and Treatment

● Obtain Vascular Access

● For hypotension (systolic BP <90 mmHg) not improved by fluid boluses or when fluid boluses are contraindicated* ● Dopamine infusion at 5-20mcg/kg/min titrated to maintain a systolic pressure of 90 mmHg ● Check blood glucose level (BGL) ● Administer Dextrose 50% as needed to maintain a blood glucose between 60 and 200 mg/dl ● Complete Stroke Alert Checklist

● If all of the following criteria are met initiate Stroke Alert: ● The patient has no evidence of trauma

● The stroke symptoms are new and onset less than or equal to 8 hours (this is inclusive of patients who awoke with symptoms as long as they still fall within 8hr window from last time seen normal)

● Initial Glucose is greater than 50

● If patient currently has an abnormal stroke assessment as listed below ● If patient meets stroke alert criteria immediately notify the appropriate receiving facility ● When patients present 0-3.5 hours from onset of symptoms they can be transported to the closest stroke center (NFR or Shands)

● When patients present 3.5-8hours from onset of symptoms they should be transported to Shands ● Obtain a good history from the family or witnesses as to onset of symptoms. Be specific.

● Obtain name and contact number of witnesses if they do not accompany the patient to the hospital.

● Do not treat elevated blood pressure without consultation with MCP control, as this may be a compensatory mechanism for maintaining cerebral perfusion pressure.

● If seizure activity, refer to seizure protocol

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● If patient is intubated, ventilate to CO2 level of 30 mmHg monitored by electronic ETCO2 capnography.

REMEMBER: Even though the patient meets tPa exclusion criteria(taking ASA, Coumadin, past CVA, etc.), he/she is still considered a STROKE ALERT patient if assessment is positive.

STROKE ASSESSMENT

Facial Droop: Have patient show teeth or smile Normal both sides of face move equally Abnormal one side of face does not move as well Arm Drift: Patient closes eyes and holds arms outright for 10 seconds

Normal both arms move the same or both arms do not move at all Abnormal one arm does not move or one arm drifts down compared with other Abnormal Speech: Have the patient say the words: “You can’t teach an old dog new tricks” Normal patient uses correct words with no slurring

Abnormal patient slurs words, uses the wrong words, or is unable to speak

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CARDIOVASCULAR PROTOCOLS LVAD

CHAPTER 24.3.14

Issued: July 2012 Revised:

Submitted By: EMS Branch Approved By: Medical Director

This protocol applies to the management of all patients who have a left ventricular assist device (LVAD) implanted. A ventricular assist device is a mechanical pump that is used to support heart function and blood flow in people who have weakened hearts. The device takes blood from the lower chamber of the heart and helps pump it to the body and vital organs just as a healthy heart would.

Basic Life Support

● Establish patent airway

● Supplemental oxygen if any respiratory signs or symptoms are present

● Listen to heart sounds. In a functioning device you should hear a continuous whirling sound.

● Locate the device usually found at the patient’s waist. Look at the controller and identify which device is in place. Locate the colored sticker and match this to the color coded EMS guide found in the Medical protocol appendices.

● Using this guide, intervene appropriately based on the type of alarm and device.

● Record and monitor vital signs.

Note* In a majority of these patients a pulse will not be palpable. This occurs because the LVAD unloads the ventricle in a continuous fashion and therefore the aortic valve may not open with each contraction.

A manual blood pressure may not be obtainable, but with an automated cuff you will be able to obtain a pressure with a narrow pulse pressure. Your treatment of the patient will be based on the mean arterial pressure. In these patients, the normal range for mean arterial pressure is greater than 60 and less than 90.

Pulse oximetry may not be accurate due to the continuous flow nature of the LVAD.

● If the patient is unconscious, unresponsive to stimuli, and pulseless listen to the patient’s chest. If you hear the whirling sound of the LVAD, DO NOT PERFORM CPR. The LVAD device has been surgically placed into the left ventricle and CPR could dislodge this device, causing death. If you cannot hear the device then CPR should be performed per cardiac arrest protocol.

● Record blood glucose level if any weakness, altered mental status or history of diabetes.

● Nothing by mouth, unless patient is known diabetic with hypoglycemia and is able to self-administer oral glucose paste, or a glucose containing beverage.

● Above all else please remember that these patients, along with their families, have been well trained in the care of themselves and their devices. LISTEN TO THEM!

● Call the number on the device for the LVAD coordinator on call.

● Patients always carry a “backup bag”which contains 2 extra fully charged batteries, and a second controller. Please make sure to always bring this emergency backup equipment with them to the hospital.

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Advanced Life Support

If advanced airway/ventilation management is needed, perform these interventions:

● Perform cardiac monitoring

● Evaluate a 12 lead ECG if chest pain or ischemic equivalent symptoms (i.e. abdominal pain above the umbilicus, nausea, dizziness, chest tightness or shortness of breath.)

● If patient meets Stemi criteria on 12 lead ECG, follow Protocol 24.7.15.

● All dysrhythmia’s should be treated in accordance with appropriate Dysrhythmia Protocol.

● For conscious electrical defibrillation, the patient may be sedated with Versed 1mg if the MAP is greater than 65mmHg.

● Record and monitor continuous O2 saturation, sometimes not obtainable with LVAD patients. In addition you may utilize End Tidal Co2 capnography.

● IV normal saline, KVO or IV lock.

● If evidence of dehydration, bolus 250 ml of Normal Saline with a max of 500 ml of NS until patient is normotensive, (= or > 65 MAP). If patient shows signs of Congestive Heart Failure (crackles on ausculatation of lungs, JVD or peripheral edema) withhold fluid bolus.

● If hypoglycemic follow Protocol 24.4.5

● If patient suffering from severe nausea or vomiting, follow Protocol 24.4.11.

● Transport patient to nearest appropriate Emergency Department

● Minimize on scene time when possible

Transport these patients to the closest LVAD center. Bring the significant other or caretaker if possible to act as an expert on the device, especially if the patient is unconscious or unreliable.

Please refer to the LVAD EMS guide located in the appendix for further information on field care of these devices.

Click below to view

LVAD 2012 FIELD GUIDE

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MEDICAL EMERGENCY PROTOCOL ALLERGIC REACTIONS-ANAPHYLAXIS

CHAPTER 24.4.1

Issued: May 2010 Revised: June 11, Aug 11

Submitted By: Technical Services Approved By: Medical Director

Protocol

● Basic Medical Care ● Airway management ● Vascular Access

● If simple allergic reaction (urticaria): ● Place and transport patient in position of comfort

● If allergic reaction with itching, swelling and urticaria: ● Administer Diphenhydramine 25-50 mg IVP/IM (Peds: 1 mg/kg IVP)

Or Phenergan 12.5 mg diluted in 10ml of Normal Saline slow IV/IO or 25mg IM

● Consider Methylprednisolone 125 mg IVP (Peds: 1 mg/kg IVP)

● If anaphylaxis without hypotension (shortness of breath, wheezing, urticaria): ● Administer Epinephrine 0.3 ml of 1:1,000 IM in the anterolateral thigh** ● Administer Diphenhydramine 25-50 mg IVP/IM (Peds: 1 mg/kg IVP)

Or

● Phenergan 12.5 mg diluted in 10ml of Normal Saline slow IV/IO or 25mg IM

● Consider Methylprednisolone 125 mg IVP (Peds: 1 mg/kg IVP) ● If wheezing, administer Albuterol 2.5 - 5 mg via nebulizer

● If anaphylaxis with hypotension: ● Administer Normal Saline bolus of 20 ml/kg to maintain systolic BP greater than 90 mmhg. Adults may require volumes in excess of 2-3 liters ● Administer Epinephrine 1:10,000-0.5 - 1mg IVP/IO ● If wheezing, administer Albuterol 2.5 - 5 mg via nebulizer and repeat PRN ● If hypotension persists, administer Epinephrine 1:10,000-1 mg IVP q3-5 mins ● Administer Diphenhydramine 25-50 mg IVP/IM (Peds: 1 mg/kg IVP)

Or

● Phenergan 12.5 mg diluted in 10ml of Normal Saline slow IV/IO or 25mg IM

Antihistamines and corticosteroids are second line agents for the treatment of anaphylactic shock. Antihistamines should be administered after the airway is secured and hypotension is resolved

** If the thigh cannot be rapidly accessed, administer epinephrine into the deltoid. Do not administer into the subcutaneous area as we have in the past- absorption may be significantly delayed in shock.

MEDICAL CONTROL OPTIONS

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● Repeat any of the above Standing Orders ● Consider administration of one of the following infusions. Titrate the infusion to maintain a systolic BP greater than 90 mmHg

● Dopamine infusion - 400 mg in 250ml. Normal Saline

OR

● Epinephrine infusion - 1 mg in 250ml Normal Saline

● *Precaution: Epinephrine is relatively contraindicated in patients with known coronary artery disease, angina, or previous MI except in life-threatening circumstances. ● **Promethazine: Unless patients are allergic to diphenhydramine, avoid Promethazine in pediatric patients. Promethazine is not recommended for patients less than 16 years of age.

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MEDICAL EMERGENCY PROTOCOL ABDOMINAL PAIN

CHAPTER 24.4.2

Issued: May 2010 Revised: April 2012

Submitted By: EMS Branch Approved By: Medical Director

Protocol

Basic Medical Care Vascular Access Use a large bore IV Special assessment considerations:

● Assess the patient closely for possible cardiac etiology, as many patients may present with abdominal pain during an acute M.I. This should include a 12 lead ECG if available. Pay close attention to diabetics and the elderly

● Assess for orthostatic blood pressure changes.

Life threatening problems that may present with abdominal pain include:

● Acute Myocardial Infarction (AMI)

● Perforated abdominal organs

● G.I. bleeding ( ask about blood in stool or emesis)

● Diabetic Ketoacidosis (DKA)

● Ruptured Appendicitis

● Dissecting Abdominal Aortic Aneurysm

● Ectopic Pregnancy (ask about menstrual history)

● Certain toxic ingestions (including mushrooms and poisons)

● Abdominal pain emergencies are likely to lead to death through hypovolemic shock (either blood or fluid loss). This may also lead to electrolyte imbalances that can cause dysrhythmias.

If patient presents in Shock refer to Shock protocol.

● Patient should have nothing to eat or drink.

● Consider Toradol 30mg IVP for pain management

● If patient is pregnant, history of renal dysfunction, or concerns for internal bleeding withhold administration of Toradol

If patient presents with severe nausea and vomiting:

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● May administer Zofran 4mg iv or po,

● If symptoms continue at 10 min repeat 4mg iv or po x 1

OR

● May administer Phenergan 12.5 mg diluted in 10ml of Normal Saline slow IV/IO (if patient is 16 years or older)

● Transport patient in position of comfort if not in shock

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MEDICAL EMERGENCY PROTOCOL ALTERED MENTAL STATUS

CHAPTER 24.4.3

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

(SYNCOPE/NEAR SYNCOPE)

Protocol

Basic Medical Care Airway management Vascular Access Spinal immobilization if history is unknown or trauma is suspected Check Blood Glucose Level (BGL)

● If blood glucose level less than 60 mg/dl ● Administer Dextrose 50% IVP ½ - 1 amp (12.5-25 gm) ● May be repeated x2 PRN ● Repeat BGL should be obtained after each Dextrose 50% bolus

If a change in Level Of Consciousness is suspected from narcotic use: (respiratory rate less than 12, pinpoint pupils, history of opiate use/abuse, etc)

● Administer Narcan 0.4 mg IV ● If no effect, may administer Narcan 2 mg IV ● If patient returns to baseline after Narcan, further boluses may be necessary ● Be prepared for a combative patient if reversal of opiate abuse (e.g. heroin addict) ● Be prepared for acute narcotic withdrawal syndrome if patient opiate dependent (as this may precipitate seizures or delirium)

Assess patient for seizure history and medications

Look for underlying causes (e.g. fever, cardiac, stroke, infections, etc.)

If patient presents with hypotension

● Refer to hypotension protocol

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MEDICAL EMERGENCY PROTOCOL CARBON MONOXIDE INTOXICATION

CHAPTER 24.4.4

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Protocol

Basic Medical Care

Airway management

● Give 100% OXYGEN via NRBM irrespective of SaO2

Vascular Access

If Unconscious

● Altered Mental Status Protocol

Minimize patient motion

Transport to hyperbaric facility

● Shands Hospital at the University of Florida ● Baptist Hospital Jacksonville

Consider:

CPAP at 5 cm/H2O

Note: Remember that patients may not experience severe respiratory distress with this disorder. Use CPAP Prophylactic, for patients that have been exposed to carbon monoxide and show signs and symptoms of intoxication (headache, errythemia, slow capillary refill, shortness of breath)

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MEDICAL EMERGENCY PROTOCOL DIABETIC EMERGENCIES

CHAPTER 24.4.5

Issued: May 2010 Revised: June 11, Aug 11

Submitted By: Technical Services Approved By: Medical Director

Protocol

● Basic Medical Care ● Airway management ● Assess Blood Glucose Level (BGL)

● If BGL is between 60-80 mg/dl and patient is verbally responsive ● May administer oral glucose 1 tube. ● If BGL less than 60 mg/dl or patient is unresponsive: ● Vascular Access ● Administer Dextrose 50% 25 gm IVP. ● Dose may be repeated x2 PRN. ● Repeat Blood Glucose Level should be obtained 5 minutes after each Dextrose 50% bolus. ● If vascular access is not available; ● Administer Glucagon 1mg IM. (Preferably in the anterolateral thigh) ● If suspected hyperglycemia (BGL greater than 400 mg/dl) ● Vascular Access ● Administer Normal Saline - fluid bolus (20ml/Kg) and then decrease rate to KVO. ● Monitor closely for fluid overload ● Recheck BGL intermittently

NOTE:

1. If diabetic patient with nausea, diaphoresis, pallor or unspecified pain consider cardiac in origin and refer to the Chest Pain/Cardiac protocol.

2. After treatment with Glucose/Glucagon, the paramedic should investigate the cause of the hypoglycemic episode. This might suggest an underlying medical problem and a need for transport.

3. Once the patient has returned to baseline mental status, is not on oral diabetic medications, and is deemed competent with no underlying medical problem, the patient may refuse further treatment and/or transport (without Medical Control Physician contact). It is advised for patient to be left in the company of another competent adult. If patient admits to usage of oral diabetic medications (metformin/glucophage, glyburide, glipizide, glimepiride/amaryl, pioglitazone or rosiglitazone) and they still refuse transport call medical control to further attempt to change their decision.

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MEDICAL EMERGENCY PROTOCOL DYSBARISM-DIVING ACCIDENTS

CHAPTER 24.4.6

Issued: May 2010 Revised: June 11, Aug 11

Submitted By: Technical Services Approved By: Medical Director

Protocol

Basic Medical Care Airway management Vascular Access Obtain C-spine control if mechanism of injury suggests C-spine injury or if patient is unresponsive

Administer 100% OXYGEN by NRBM

● Caution should be taken with any positive pressure (BVM, intubation) as this may worsen a pneumothorax.

Transport in left lateral position

● Keep patient warm

Transport to the closest appropriate facility ED.

Monitor for possible/developing tension pneumothorax.

Medical Control Options:

● Morphine Sulfate 1-5 mg IVP/IO

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MEDICAL EMERGENCY PROTOCOL GASTROINTESTINAL BLEEDING

CHAPTER 24.4.7

Issued: May 2010 Revised: April 2012

Submitted By: EMS Branch Approved By: Medical Director

Protocol

Basic Medical Care

Airway management

● Monitor airway for emesis

Vascular Access

● 2 large bore IV’s suggested

Transport expeditiously

Refer to shock protocol

If patient is vomiting blood, may place nasogastric tube for suction of stomach contents (see appropriate protocol)

If patient presents with severe nausea and vomiting:

● May administer Zofran 4mg iv or po,

● If symptoms continue at 10 min repeat 4mg iv or po x 1

OR

● May administer Phenergan 12.5 mg diluted in 10ml of Normal Saline slow IV/IO (if patient is 16 years or older)

● Monitor for hypotension

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MEDICAL EMERGENCY PROTOCOL HEAT ILLNESS

CHAPTER 24.4.8

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Protocol

Basic Medical Care

Airway management

Evacuate patient from heat environment

Determine if patient suffers from fever, heat cramps, heat exhaustion, or heat stroke.

If fever:

● May sponge patient with room temperature water or Normal Saline ● If heat cramps or heat exhaustion (skin ambient temperature, diaphoretic): ● Remove outer layers of clothing ● May cool patient with water or Normal Saline ● Vascular Access ● Fluid bolus Normal Saline as needed (20ml/Kg)

● If heat stroke (skin hot and dry, elevated core temperature): ● Remove outer layers of clothing ● Cool patient with water, Normal Saline and/or cold packs to axilla and/or groin ● Vascular Access ● Fluid bolus Normal Saline as needed (20ml/Kg) ● Monitor patient closely ● Rapid Transport

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MEDICAL EMERGENCY PROTOCOL HYPERTENSION

CHAPTER 24.4.9

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

(Hypertensive Crisis/Urgency)

Definition: SBP > 180 mm Hg, DBP > 120 mm Hg

Protocol

Basic Medical Care

● Assess and document severity of hypertension ● Check BP every 5 minutes.

Airway management

● Vascular Access

Asymptomatic:

● Monitor for blood pressure and symptomatic changes

Mildly symptomatic: headache, dizziness, etc., or asymptomatic with diastolic BP > 120 mmHg:

● Administer Nitroglycerin spray/ tablet SL every 5 minutes ● Place 1”Nitroglycerin paste on chest ● Remove Nitroglycerin paste if systolic BP drops to 140-150 mmHg.

Severely symptomatic and /or hypertensive emergency (chest pain, dyspnea, pulmonary edema, mental status change, etc.) and patient’s condition not improving with the above therapy:

● For a 70 Kg adult [bracketed dose is in mg/Kg ideal body weight] administer IV Labetalol as follows: ● 15 mg [0.2 mg/Kg] IV push; ● Re-check blood pressure, if goal not reached within 5 minutes... ● 30 mg [0.4 mg/Kg] IV push; ● Re-check blood pressure, if goal not reached within 5 minutes... ● 60 mg [0.8 mg/Kg] IV push; ● Re-check blood pressure, if goal not reached within 5 minutes... ● 120 mg [1.6 mg/Kg] IV push; ● Re-check blood pressure, if goal not reached within 5 minutes... ● May repeat 120 mg [1.6 mg/Kg] dose 2 more times; ● Observe closely for progression of symptoms. If noted, continue with protocol. ● Hypertension associated with cocaine or other drug use may be difficult to control, consider Versed 1-2 mg SIV. May repeat once. ● In patients suspected of having a CVA/transient ischemic attack/reversible ischemic neurologic deficit, the blood pressure should not be treated unless directed by medical control [i.e., use less drug and/or allow the BP to remain in the high end of Goal BP], as cerebral autoregulation may be impaired.

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MEDICAL EMERGENCY PROTOCOL HYPOTHERMIA

CHAPTER 24.4.10

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Protocol

Basic Medical Care

● Assess vital signs over one minute before declaring them absent.

Airway management Evacuate patient from cold environment. Handle the patient very gently as the hypothermic heart is irritable and ventricular arrhythmias may result from rough treatment. Warm patient compartment

If core temperature > 95 degrees F:

● Vascular Access ● Utilize warm fluids if possible ● Administer Normal Saline at 250ml/hr unless otherwise indicated ● Remove wet or cold clothing; wrap patient in blankets

If core temperature < 95 degrees F:

● Obtain 12 lead if available ● Treat dysrhythmias per cardiac protocols ● Warming is the priority. Maintain core temperature with blankets ● If patient exhibits a decreased level of consciousness, incorporate that protocol into your treatment plan.

If hypothermia injury is local (frostbite):

● Handle injured part gently; leave uncovered. ● Do not allow the injured part to thaw if chance exists for the part to refreeze before arrival at a definitive care facility.

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MEDICAL EMERGENCY PROTOCOL NAUSEA & VOMITING

CHAPTER 24.4.11

Issued: May 2010 Revised: April 2012

Submitted By: EMS Branch Approved By: Medical Director

Protocol

Basic Medical Care Vascular Access

● Use a large bore IV

Special assessment considerations:

● Assess the patient closely for possible cardiac etiology, as many patients may present with sudden nausea and vomiting during an acute M.I. This should include a 12 lead ECG if available. Pay close attention to diabetics and the elderly ● Assess for orthostatic blood pressure changes.

Life threatening problems that may present with nausea and vomiting include:

● Acute Myocardial Infarction(AMI) ● G.I. bleeding ( ask about blood in stool or emesis) ● Diabetic Ketoacidosis (DKA) ● Ruptured Appendicitis ● Certain toxic ingestions ( including mushrooms and poisons) ● Nausea and vomiting can lead to death through hypovolemic shock (either blood or fluid loss) especially in infants and the elderly. This may also lead to electrolyte imbalances that can cause dysrhythmias.

If patient presents in Shock refer to Shock protocol.

● Patient should have nothing to eat or drink.

If patient presents with severe nausea and vomiting:

● May administer Zofran 4mg iv or po ● If symptoms continue at 10 min repeat 4mg iv or po x 1

OR

● May administer Phenergan 12.5mg diluted in 10ml of Normal Saline slow IV/IO (if patient is 16 years or older) ● Monitor for hypotension ● Transport patient in position of comfort if not in shock

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MEDICAL EMERGENCY PROTOCOL OVERDOSE & POISON INGESTION

CHAPTER 24.4.12

Issued: May 2010 Revised: June 11, Aug 11, Sept 11

Submitted By: Technical Services Approved By: Medical Director

Protocol

● Basic Medical Care ● Airway management ● Determine agent, time and amount of ingestion, circumstances of the event, and retain for transport any pill bottles, containers, or other identifying material ● Notify CCC to contact Poison Control and to advise of your destination hospital ● Vascular Access ● For hypotension (systolic BP < 90 mmHg) not improved by fluid boluses, or when fluid boluses are contraindicated: ● Dopamine infusion at 10-20 mcg/kg/min titrated to maintain systolic BP > 90 mm Hg ● If wide QRS complex (≥0.10sec), hypotension, or any arrhythmias: ● Sodium Bicarbonate 1 mEq/kg IV, Repeat Sodium Bicarbonate 1 mEq/kg IV in 5 to 10 minutes ● If any of the following conditions occur, refer to the appropriate protocols: ● Polymorphous Ventricular Tachycardia ● Altered mental status ● Seizures ● If patient awake, alert: ● Transport patient

● If patient with decreased level of consciousness: ● Perform blood glucose check ● Refer to altered mental status protocol

● Several ingestions may have antidotes or effective countermeasures. Consult with Medical Control if you have any questions and concerns.

● Tricyclic Antidepressants: ● Cardiotoxicity may manifest as tachycardia, wide QRS, or hypotension; ● Alkalization may be accomplished with hyperventilation and/or administration of Sodium Bicarb 50-100 mEq IVP, and an infusion of Sodium Bicarb 100 mEq in Normal Saline 1000 ml TRA 150 ml/hour.

● Cholinergic Poisoning (organophosphate or carbamate insecticides): ● Toxicity to crew may result from inhalation or topical exposure. Any patient with dermal exposure MUST be adequately decontaminated prior to transport. Crew should wear protective clothing including masks, gloves, and eye protection; ● Initiate Hazmat alert if indicated ● Remove all patients clothing and contain run off toxic chemicals when flushing ● Use supplemental O2 ● If symptoms severe (blurred vision, nausea, vomiting, diarrhea, salivation, lacrimation, bradycardia, diaphoresis, wheezing, fasciculations, confusion, and seizures, etc): ● Administer Atropine 2 mg IVP every 5 minutes titrate dosing by assessing improvement in respiratory/bronchial secretions. ● For hypotension (systolic bp<90mmHg) not improving by fluid boluses or when contraindicated use Dopamine 10-20mcg/kg/min titrate to maintain sbp >90mmHg.

● Acetaminophen:

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● If patient has a known toxic acetaminophen level or ingestion of potential toxic dose (calculated greater than 140 mg/Kg or 7.5 gm), transport to receiving facility expeditiously.

● Digoxin (symptomatic): ● Administer Magnesium Sulfate 2 gm slow IVP.

● Cyanide (symptomatic): ● Transport expeditiously ● Administer Cyanokit 5 grams IVP

, Ethylene Glycol: ● Transport expeditiously.

● Antipsychotics/Acute dystonic reaction: (common offenders: haloperidol, prolixin, thorazine, prochlorazine/compazine, promethazine/phenergan ● Administer Diphenhydramine 50 mg IVP.

● Calcium Channel Blockers:(examples: amlodipine/norvasc, nifedipine/procardia/adalat, felodipine/pendil/renedil, verapamil/calan, isradipine/dynacirc/, diltiazem/cardizem, nicardipine/cardene) ● Toxicity may manifest as bradycardia, hypotension, bronchospasm, and/or altered mental status;

● For those patients with cardiovascular toxicity, (defined by: sbp< 90mmHg altered mental status and bradycardia) administer the following: ● Atropine 0.5mg IV repeat every 3 min as needed with a max of 3mg ● If no response administer Calcium Chloride 10% solution 1gm IV slow (adults only, contraindicated with digoxin use), this can be repeated x1 ● If no response Glucagon 3mg IV x 1 ● If no response, or patient presenting with 2nd or 3rd degree heart blocks, begin transcutaneous pacing

● Beta Blockers:(examples: propanolol, atenolol/tenormin, metoprolol/lopressor, nadolol/corgard, timolol/blocadren, labetalol/trandate, esmolol/brevibloc) ● Toxicity may manifest as bradycardia, hypotension, bronchospasm, and/or altered mental status; ● For those patients with cardiovascular toxicity, defined by: sbp< 90mmHg, AMS, bradycardia, 2nd or 3rd degree heart blocks administer the following: ● Atropine 0.5mg IV repeat every 3 min as needed with a max of 3mg ● If no response administer Calcium Chloride 10% solution 1gm IV slow (adults only, contraindicated with digoxin use), this can be repeated x1 ● If no response glucagon 3mg IV x 1 ● If no response begin transcutaneous pacing

● Benzodiazepines: ● Support airway and transport.

● Cocaine: ● Toxicity may manifest as tachycardia, hypertension, agitation, and mental status changes; ● Administer Versed 1-2 mg SIV. May repeat once. ● Carbon Monoxide ● Remove patient from the contamination source ● Supplemental 100% oxygen; document time started ● For smoke inhalation patients consider cyanide poisoning ● Opiates: ● Toxicity may manifest as altered mental status, pinpoint pupils, slow respirations, and hypotension; ● Administer Narcan . ● ADULT - 0.4 - 2mg IVP, IO,IM, SQ, or via ETT, repeat as necessary. ● PED- 0.1 mg/Kg IVP,IO,IM every 2 minutes; titrate to respiratory increase or to a maximum dose of 2mg

See “Drug Overdose Chart”on next page for more information.

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MEDICAL CONTROL OPTIONS

● OPTION A: Repeat any of the above Standing Orders ● OPTION B: Administer Activated 50-100 gm P.O. or NG tube ● OPTION C: HAZMAT Unit: Cyanide Ingestion ● Open amyl nitrite pearl under the nose; encourage forceful inhalation. ● Administer Sodium Nitrite 3% 5-10 ml slow IVP (contact MCA for Pediatric dosing). ● Administer Sodium thiosulfate 25% 50 ml slow IVP over 10-15 minutes (contact MCA for Pediatric dosing).

Click to view → Drug Overdose Chart

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MEDICAL EMERGENCY PROTOCOL PSYCHIATRIC DISTURBANCES/EXCITED DELIRIUM

CHAPTER 24.4.13

Issued: May 2010 Revised: Nov 12

Submitted By: EMS Branch Approved By: Medical Director

Purpose

A psychiatric disturbance is defined by an individual who is presenting with acute mental distress or disability not associated with a medical condition.

Excited delirium is defined by any of the following: agitation, anxiety, hallucination, disorientation, violent and bizarre behavior, insensitivity to pain, elevated body temperature and super human strength. Excited delirium arises commonly in male subjects with a history of mental illness, drug abuse (particularly stimulants), alcohol withdrawal and/or head injury.

Left untreated, patients can progress to excited delirium resulting in death from cardiac/respiratory arrest, sometimes associated with the use of physical restraints or tasers.

Protocol

Basic Medical Care

● Safety for both the EMS crew and the patient are of paramount concern. Take no actions that may endanger EMS personnel or the patient.

● Always involve law enforcement if the patient may present a significant danger to him/herself, bystanders, to yourself, or your partner.

● Determine if patient is awake and alert, if possibility of traumatic injury exists, or if underlying medical problems (e.g. hypoglycemia, hypoxia, drug or alcohol intoxication), might cause patient's behavioral difficulties. Refer to appropriate protocol.

● If possible, establish collegial rapport with patient.

● Avoid escalating the situation.

● Remove all loose objects or potential weapons from the patient care area.

● It would be prudent to secure any personal equipment (scissors, etc.) at a distance from the patient.

● If patient becomes violent before transport, enlist assistance of patient's family, friends, and/or law enforcement personnel.

● EMS personnel should not transport the overly hostile patient alone.

● If patient becomes violent at any time during care and becomes a danger to him/herself or the medical team, attempt to control patient using reassurance and, if needed, mechanical restraints.

● If restraints are used the receiving facility shall be notified.

● If unable to restrain, request driver to stop vehicle immediately and notify law enforcement personnel for assistance.

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● Restrain patients in supine or lateral recumbent position only, using no excessive force.

● Never allow patients to be restrained in the “hog-tied”position.

● Versed 1-2 mg SIVP/IM for control of agitated patient. May repeat once.

● Haldol 2.5 - 5 mg IV slowly, for patients exhibiting agitation. May repeat up to total dose of 10 mg.

Any patient who is psychotic or could present a danger to personnel will be transported with 2 personnel in the patient compartment.

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MEDICAL EMERGENCY PROTOCOL RESPIRATORY DISTRESS

CHAPTER 24.4.14

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Protocol

Basic Medical Care Airway management

● Determine site of respiratory impairment ● Allow patient to sit in position of comfort

If infectious upper airway obstruction (croup or epiglottitis):

● Administer 100% Oxygen via NRBM or “blow-by”technique ● Attempt to calm patient; allow to sit in position of comfort ● Parent may be allowed to hold the pediatric patient ● Transport expeditiously ● Vascular Access, if at all, after airway control established ● If suspected epiglottitis, avoid agitation

If lower airway obstruction (Asthma, COPD, Wheezing):

***For severe respiratory distress apply CPAP (see procedural) before continuing treatment

Administer Albuterol 2.5-5 mg in 3ml Normal Saline via nebulizer Albuterol therapy may be repeated as necessary during transport while heart rate remains below 160 Vascular Access

If patient does not improve or has self-administered albuterol prior to requesting EMS:

● Consider a mixed Albuterol 2.5 mg / Atrovent 0.5 mg treatment ● Consider Solumedrol 125 mg IVP ● If bronchospasm worsens despite treatment, respiratory failure may be imminent (as documented by falling oxyhemoglobin saturations, tachycardia, increased work of breathing, lethargy, apnea, etc ;). ● Refer to Advanced Airway Protocol

Patients with chronic obstructive pulmonary disease may have a decrease in respiratory effort and/or mental status when placed on high concentrations of Oxygen. Thus, a SaO2 of 91% to 95% is acceptable.

Medical Control Options

● For Croup/ epiglottitis: If breathing becomes labored and SaO2 consistently decreases below 90% ● Gently assist ventilations with BVM with 100% Oxygen ● Administer Epinephrine .5 mg in 2ml Normal Saline via nebulizer ● Magnesium Sulfate 1-2 gm slow IV push over 5 minutes

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MEDICAL EMERGENCY PROTOCOL SIEZURES

CHAPTER 24.4.15

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Protocol

Basic Medical Care Airway management Immobilize if indicated Protect patient from injuring him/herself Vascular Access Obtain Blood Glucose Level

For repeated seizures or seizures lasting longer than 2 minutes:

● Administer Versed 1-2 mg SIVP , IO or IM ● Repeat dose once every 2 minutes up to 10 mg if seizure activity continues ● Be prepared to support a decreased respiratory status ● If seizure occurs in the setting of poisoning, overdose or eclampsia refer to the appropriate protocol for additional management

MEDICAL CONTROL OPTIONS:

● If seizure is refractory to other therapy, consider Lidocaine up to 3 mg/Kg IVP. ● Consider Versed 1-2 mg IM/IO if unable to obtain vascular.

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MEDICAL EMERGENCY PROTOCOL SHOCK-ALS

CHAPTER 24.4.16

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Protocol

Basic Medical Care Airway management BLS Shock Protocol Vascular Access Determine the etiology of shock Continually reassess

Anaphylaxis: refer to anaphylaxis protocol

Hypovolemia: (i.e. trauma, ruptured aorta, ectopic pregnancy, etc)

● If bleeding is controlled or hypovolemia is from other fluid loss (i.e. vomiting, diarrhea) ● Administer Normal Saline fluid bolus of 20 ml/Kg over 15 minutes ● Reassess lung sounds ● May repeat 20ml/Kg fluid bolus

Hypovolemic from uncontrolled bleeding:

● Initiate 2nd IV ● Titrate fluid administration to maintain peripheral pulses

Septic (sepsis):

● Administer Normal Saline fluid bolus of 20 ml/Kg over15 minutes ● Reassess lung sounds ● May repeat fluid bolus x2 prn

Hypotension refractory to IV fluids, or development of pulmonary edema develop

● Administer Dopamine infusion. ● Titrate to systolic BP greater than 100 mmHg

Cardiogenic (CHF)

● Position patient upright if tolerated ● Manage Airway and support ventilations if needed ● Administer Normal Saline fluid bolus of 100 ml ● Reassess patient ● If systolic BP improves, continue cautious fluid boluses until no further improvement noted or systolic BP 90- 100 mmHg. ● If hypotension refractory to fluids, consider administration of one of the following infusions. Titrate infusion to maintain a systolic BP greater than 90 mmHg

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● Dopamine infusion - 400 mg in 250ml Normal Saline

OR

● Epinephrine infusion - 1 mg in 250ml Normal Saline

Neurogenic (spinal cord injury):

● Secure airway while maintaining cervical spine immobilization ● Administer OXYGEN irrespective of Saturation level ● Keep patient warm ● Administer fluid bolus of Normal Saline 20 ml/Kg

Refractory hypotension:

● Consider administration of one of the following infusions. Titrate infusion to maintain a systolic BP greater than 90 mmHg

● Dopamine infusion - 400 mg in 250ml Normal Saline

OR

● Epinephrine infusion - 1 mg in 250ml Normal Saline

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MEDICAL EMERGENCY PROTOCOL SNAKE BITE

CHAPTER 24.4.17

Issued: May 2010 Revised: June 11, Aug 11

Submitted By: Technical Services Approved By: Medical Director

Protocol:

● Basic Medical Care

● Airway management

● Vascular Access: ● Two IV’s preferred.

● Immobilize area and minimize all movement

● Cardiac monitor ● Treat dysrhythmias per protocol

● Assess degree of envenomation, type of snake, and advise MCP

● Outline edematous, erythremic, ecchymotic area with a pen and note the time

● Follow hypotension/anaphylaxis protocol as needed

MEDICAL CONTROL OPTIONS:

● Morphine Sulfate 1 - 5 mg IVP/IO for pain

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MEDICAL CARE PROTOCOL TASER REMOVAL

CHAPTER 24.4.18

Issued: November 2012 Revised:

Submitted By: EMS Branch Approved by: Medical Director

Protocol

For patients that have been controlled by law enforcement using a Taser Device. All patients should be evaluated for underlying medical, substance abuse and/or psychiatric emergencies. All patients shall either be transported or a waiver obtained.

● Confirm scene safety with LEA and approach the patient with caution.

● Most sworn Law Enforcement personnel have been trained to remove Taser Probes. Probes that have penetrated a “sensitive area”such as the head, neck, spinal column and groin or breast tissue in a female will not be removed by LEA and will require transport.

● If the probes are embedded in an area not specified above and the patient appears stable; they may be removed in the following manner: 1. Place one hand on the patient in the area where the probe is embedded to stabilize the skin around the puncture site.

2. Place second hand firmly around the probe.

3. In one fluid motion, pull the probe straight out of the puncture site, if resistance is met, leave probe in place and transport.

4. Repeat procedure on remaining probe(s).

5. Handle probes as a bio-hazard sharp with the exception that the officer may request that the probe be turned over to him/her for entry as evidence.

Considerations

Do not delay transport if the one or more of the following exist.

● Unconscious patient

● Evidence of progressing excited delirium (Chapter 24.4.13)

● Persistent abnormal vital signs

● History/Physical findings consistent with amphetamine/hallucinogenic drug use

● Altered level of consciousness, aggressive or violent behavior

● Evidence of hyperthermia

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TRAUMA PROTOCOL TRAUMA

CHAPTER 24.5.1

Issued: May 2010 Revised: June 11, Aug 11, Jan 15, 2013 Submitted By: Technical Services Approved By: Medical Director

Protocol

EARLY TRANSPORT OF THE CRITICAL TRAUMA PATIENT OFFERS THE BEST CHANCE OF SURVIVAL. FIELD TIME SHOULD NOT BE PROLONGED IN ORDER TO PERFORM PROCEDURES NOT ABSOLUTELY CRITICAL TO THE WELL-BEING OF THE PATIENT DURING TRANSPORT.

Basic Medical Care

AIRWAY Assess airway patency

● If intact, administer OXYGEN by most appropriate method

If patency in question:

● If patient exhibits increased respiratory compromise perform jaw thrust maneuver to open the airway making sure to maintain cervical spine position and immobilization.

Reassess the respiratory effort:

● If adequate, ensure SaO2 > 95%

If unsuccessful, consider placement of a nasal trumpet or oral airway to maintain airway patency. The individual controlling cervical immobilization must maintain the jaw thrust maneuver until airway is placed.

Assist ventilation with 100% OXYGEN via bag-valve-mask as needed

Perform endotracheal intubation as needed The nasal intubation can be used on the trauma victim. Contraindications to this route include:

● Apnea

● The presence of mid-face fractures

● Significant neck trauma with possible disruption of the airway

● Known bleeding disorders

● Oral intubation may be performed with assistance in maintaining neutral head position

If intubation is unsuccessful (including placement of King LTD airway) or mechanical obstruction prevents intubation and ventilating via bag valve mask, perform surgical cricothyrotomy.

BREATHING

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Assess respiratory exchange If adequacy of ventilation is in question:

● Support ventilation at a rate of 12-14 breaths/minute with 100% oxygen via Bag Valve Mask

● If evidence of herniation such as decerebrate or decorticate posturing, abnormal pupil, seizure, or bradycardia Hyperventilate at 20-22 breaths per minute.

● If patient is intubated, ventilate to CO2 of 30 mmHg utilizing electronic ETCO2 waveform capnography

● Assess for signs of chest trauma

● Open chest wound - cover with a gloved hand, place 4x4 Vaseline gauze dressing over wound, and tape on three sides only.

● Flail chest - Support chest wall with chest wall by taping or manual support.

● Tension pneumothorax - perform chest decompression per protocol

● Oxygen via BVM.

CIRCULATORY Assess circulatory status (pulse, skin temperature, capillary refill, blood pressure as indicated)

● Vascular Access

● The goal is to support a systolic blood pressure of 90-100 mmHg.

● If circulatory status is in question, refer to shock protocol

● Intra Osseous infusions prior to IV attempts are acceptable for patients that are unstable with difficult peripheral access.

DISABILITY Assess neurologic status using AVPU

● Alert

● Responds to voice

● Responds to pain

If unresponsive

● Immobilize patient with backboard and cervical collar as indicated

● Patient should be immobilized as soon as possible; however, immobilization should not take priority over assessment and management of the ABCs.

If patient exhibits decreased level of consciousness, follow altered level of consciousness protocol

SPINAL IMMOBALIZITION Determining the need for spinal immobilization requires a careful assessment of the mechanism of injury, the patient’s complaints, overall condition and the patient’s ability to recognize and convey the presence of spinal injury symptoms. Spinal immobilization should always be applied when any concern exists as to the possibility of spinal

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trauma.

Any patient who has an altered mental status (GCS <15, significant intoxication, Dementia) who is the victim of blunt trauma as listed below shall be immobilized.

● Any mechanism that produces a violent impact to the head, neck, torso or pelvis ● Incidents with sudden acceleration or deceleration. ● Any fall, especially in the elderly ● Ejection ● Shallow-water drowning or diving accidents ● High-voltage electrical injuries

Symptoms such as spinal tenderness, neurological deficits or complaints, paralysis, weakness or anatomical deformities of the spine shall be documented.

For patients who cannot tolerate supine position due to clinical condition:

● Apply all elements of spinal immobilization that the patient will tolerate ● Maintain spinal alignment as best as can be achieved during transport ● Clearly document the clinical condition that interfered with full immobilization.

For patients who refuse spinal immobilization

● Advise the patient of the indication for immobilization and the risks of refusing the intervention ● If the patient allows, apply the cervical collar even if backboard is refused ● Maintain spinal alignment as best as can be achieved during transport ● Clearly document refusal of immobilization

“Clearing”of the spine shall not take place in the pre-hospital setting.

EXPOSURE

● Undress patient completely to facilitate a thorough, focused survey.

● Cover with blankets to prevent loss of body heat and preserve modesty.

● To facilitate rapid transport; the patient should be evacuated to the ambulance for the focused survey.

Assess extremities

● Splint suspected fracture sites in most appropriate fashion after checking pulses, motor function and sensation.

● If the patient is critically injured, utilization of the long spine board as a total body splint is a time and resource efficient procedure.

● Femur fractures may be immobilized with traction splints.

● Fractures may be immobilized with air splints, ladder splints, or board splints in order to immobilize the joint above and below the injured area.

● Place cold pack on suspected fracture sites if time and resources allow.

● If distal vascular deficits noted, reduce fracture in anatomical alignment and splint in most appropriate fashion.

Recheck pulse, motor function and sensation after reduction and immobilization.

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If partial amputation:

● Place in a dressing moistened with Normal Saline and splint in line with associated extremity.

● Avoid torsion or traction of severed part;

If complete amputation:

● Apply direct pressure to bleeding sites.

● Elevate above the level of the heart as able.

● If bleeding profuse despite elevation and direct pressure, place blood pressure cuff just proximal to amputation site and inflate to just above systolic pressure. Maintain cuff pressure during transport. Do not place cuff over joints.

● Consider applying a Tourniquet prior to shock and notify hospital immediately upon arrival.

● Wrap amputated part in a dressing moistened with Normal Saline.

● Secure in watertight container and place container in cool water.

● Transport amputated part with patient to definitive care facility.

● Placing the amputated part on ice or a similar environment may further damage the tissue and prevent its use.

Special considerations in the pregnant trauma victim:

● The most common cause of fetal mortality is maternal mortality. Treatment of the mother ALWAYS comes first.

● Assess patient for uterine contractions, vaginal bleeding, and amniotic rupture.

● Place patient in left lateral recovery position to decrease pressure on the mother’s vena cava and increase blood return to her heart. Support backboard with pillows placed under the right side of the board in the immobilized patient.

● If unable to place mother in recovery position, you may manually displace the uterus to the left to relieve pressure on the vena cava.

Re-assess

● Reassess any of the above critical injuries identified and perform necessary interventions during the focused survey. Treatment of life threatening injuries identified during the initial survey take priority over a complete subsequent survey.

● Notify the receiving hospital early regarding critical patients or those patients meeting trauma alert criteria.

● Report revised trauma score and mechanism of injury.

All Trauma patients should be evaluated using the state trauma scorecard methodology.

Pain Management Options

● Morphine Sulfate 1-5 mg IVP/IO may be administered for isolated extremity pain

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TRAUMA PROTOCOL BURNS

CHAPTER 24.5.2

Issued: May 2010 Revised: June 2011

Submitted By: Technical Services Approved By: Medical Director

Protocol

● Basic Medical Care ● Airway management ● Patients with known inhalation injury or with signs of potential airway burns (singed nasal hair, in the pharynx, etc.) in respiratory distress should be intubated with the largest endotracheal tube possible. ● Remove all clothing from patient and expose all burned areas ● Assess type, depth, and extent of burn ● If indicated cool burn for 1-2 minutes

● If burning agent still in contact with skin ● Remove gently after cooling with sterile water or Normal Saline. ● If burning agent is chemical: ● Brush away loose, dry agent and irrigate burned area with copious amounts (2 or more liters) of Normal Saline or sterile water. ● If an explosion is involved: ● Follow trauma protocol ● For Radiation Burn: decontamination is paramount. ● Utilize bunker gear for protection; remember time, distance, shielding and quantity relating to the exposure. Treat burns the same. ● In all cases avoid recontamination or cross contamination ● If patient has > 5% body surface area (BSA) second degree or any third degree burn: ● Vascular Access ● Avoid starting lines in burned areas if possible ● Run IVF at the rate using the following formula:

(%BSA) (Wt. in KG) = cc per hour IV fluids 4

Formula examples for small, medium and large person: %BSA Wt in CC/hr %BSA Wt in CC/hr %BSA Wt in CC/hr Kgs Kgs Kgs 10 50 125 10 100 250 10 150 375 25 50 313 25 100 625 25 150 938 50 50 625 50 100 1250 50 150 1875 75 50 938 75 100 1875 75 150 2813 100 50 1250 100 100 2500 100 150 3750

Do not delay transport to establish IV

● Dress burns:

● Transport patient in dry non-sterile sheets or regardless of extent of burn

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● Document area involved on chart using "Rule of Nines.”

● Maintain temperature control. ● Keep patient warm ● Wrap in blankets as needed ● DO NOT ALLOW PATIENT TO BECOME HYPOTHERMIC ● For Pain relief: ● Administer Morphine Sulfate 1-5 mg IVP/IO if patient hemodynamically stable ● Dose may be repeated every 5 minutes prn

● Transport to Shands @ UF (Burn Center): ● Partial thickness burn involving > 20% BSA ● Full thickness burn involving > 5% BSA ● Burns of the hands, face, feet, or perineum ● Burns associated with inhalation injuries ● Burns associated with multiple trauma ● Electrical injuries

MEDICAL CONTROL OPTION: Repeat any of the above Standing Orders

Click link to view BURN REVIEW

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TRAUMA PROTOCOL EYE EMERGENCIES

CHAPTER 24.5.3

Issued: May 2010 Revised: June 11, Aug 11

Submitted By: Technical Services Approved By: Medical Director

Protocol

● Basic Medical Care ● Assess the nature of eye emergency - blunt vs. penetrating, chemical, glaucoma (by history), or others ● Briefly check visual fields and visual acuity ● Transport with head of bed elevated at 60 degrees ● Trivial injuries to eyelids may hide significant injury to the globe ● Penetrating Trauma: ● Avoid any pressure on the affected globe ● Carefully secure penetrating objects ● If possible, cover the affected eye with a metal eye shield ● Patch both eyes to prevent conjugate movement ● Explain to the patient why it is necessary to patch both eyes ● If possible, transport patient in supine position ● Blunt Trauma: ● If no contraindications, elevate head of bed. ● Avoid bright lights (Dim compartment lights, allow patient to wear sunglasses, keep eyes closed, etc). In cases of facial trauma, note the ability or loss of ability to move the eyes in any particular direction. ● Chemical trauma: ● Irrigate affected eye with a minimum of 2 liters Normal Saline. ● Continue irrigation throughout transport if the chemical was an alkali agent, or if symptoms persist. ● Dim cabin lights for patient comfort. ● If patient is being transported for treatment of diagnosed central retinal artery occlusion:(This is an Eye emergency that presents as acute painless persistent loss of vision ranging from seeing fingers to only seeing light. Many may describe a prior episode of amaurosis fugax = which is vision loss described as a curtain falling over visual field lasting seconds to minutes then vision returning to normal) ● Administer 100% OXYGEN via NRBM. ● Place patient in supine position. ● Transport emergently to the receiving hospital.

MEDICAL CONTROL OPTIONS:

● Morphine Sulfate 1-5 mg IVP/IO for pain

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OB/GYN PROTOCOL VAGINAL BLEEDING

CHAPTER 24.6.1

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Protocol

Basic Medical Care Airway management Ascertain patient history specifically for:

● Date of Last Menstrual Period (LMP)

● Position patient tilted right side up 10-15 degrees ● Vascular Access ● Attempt to obtain fetal heart tones if pregnancy is estimated greater than 10-12 weeks ● If hypotensive ● See Shock protocol ● If in active labor ● See Emergency Delivery protocol ● Keep accurate count of used perineal pads ● Save any clots or tissue expelled for examination by physician upon arrival at receiving facility

Transport expeditiously

NOTE: Monitor pad usage - Two saturated pads are equivalent to one pint (~ 250ml) of fluid/blood loss.

DO NOT let anyone perform vaginal or rectal examination on the patient. Vaginal bleeding may markedly increase and hypovolemia may result.

MEDICAL CONTROL OPTIONS:

● Morphine Sulfate 1-5 mg IVP/IO. ● Versed 1-2 mg SIVP for anxiety.

Differential Diagnosis: Ruptured ectopic pregnancy ruptured ovarian cyst, abortion, threatened abortion, appendicitis, cholecystitis, diverticulitis, colitis, and kidney stones.

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OB/GYN PROTOCOL SUSPECTED ECTOPIC PREGNANCY

CHAPTER 24.6.2

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Protocol

Basic Medical Care Airway management Vascular Access x 2 Keep accurate count of used perineal pads Save any clots or tissue expelled for examination by physician upon arrival at receiving facility If signs of shock are noted:

● Refer to Shock protocol

Physical Exam:

● Abdominal bruising, distention, tenderness, guarding, rebound tenderness, rigidity, bowel sounds, distension, presence of a pulsating mass ● Are peripheral pulses equal? ● Emesis: amount and type [ingested food, bloody, bilious, feculent (looks and smells like stool)] ● Ruptured Ectopic Pregnancy: ● May present as a pale, diaphoretic, distressed woman with a weak, fast pulse. ● May have orthostatic hypotension ● Refer to shock protocol

Warning signs of an undiagnosed ectopic pregnancy:

● Previous recent visits to the ED or physician’s office with menstrual irregularity and/or mild abdominal pain with no diagnosis being made. ● May complain of abdominal pain and/or vaginal bleeding.

Warning signs of a ruptured ectopic pregnancy:

● Increased abdominal or pelvic pain ● Dizziness, fainting ● Pain radiating to the shoulder from pelvic area

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OB/GYN PROTOCOL PRE-ECLAMPSIA

CHAPTER 24.6.3

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Third Trimester Pregnancy with B/P greater than 140/90 Hg/mm, proteinuria, and peripheral edema. May progress to eclampsia.

Protocol

Basic Medical Care Airway management Position patient tilted right side up 10-15 degrees Vascular Access

Physical Examination:

● Mild hypertension (diastolic BP < 100 mmHg) usually no symptoms ● Severe Hypertension (diastolic BP > 110 mmHg) may cause: ● Headache ● Visual disturbance ● Upper abdominal pain ● Jaundice ● Bruises ● Pulmonary edema

Transport expeditiously

If seizures occur, refer to ECLAMPSIA protocol

MEDICAL CONTROL OPTIONS If hypertensive and symptomatic, contact medical control for possible Magnesium sulfate order.

Monitor blood pressure, fetal heart rate, respiratory rate and, if possible, urine output before and during Magnesium sulfate therapy.

If hypertension (systolic BP > 170 or diastolic BP > 120) and symptoms persists after administration of Magnesium sulfate, refer to hypertension protocol.

NOTE: LOWERING BLOOD PRESSURE TO LESS THAN 150/100 IN SEVERE PRE-ECLAMPSIA MAY COMPROMISE FETOPLACENTAL BLOOD FLOW.

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OB/GYN PROTOCOL ECLAMPSIA

CHAPTER 24.6.4

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Pre-eclampsia with seizure activity

Protocol

Basic Medical Care Airway management Position patient tilted right side up 10-15 degrees Vascular Access

Seizure precautions and attempt to prevent maternal injury

● Administer Magnesium sulfate 2 gm IVP over 5 minutes ● Initiate Magnesium infusion (10 gm in 250ml of Normal Saline) @ 50 ml/hr ● If already receiving Magnesium sulfate infusion when seizure occurs, give an additional 2 gm bolus of Magnesium sulfate. ● If severe hypertension (systolic BP > 170 or diastolic BP > 120) persists after administration of Magnesium sulfate: ● See Hypertension protocol ● If unresponsive to therapy, call MCP.

Transport expeditiously

MEDICAL CONTROL OPTIONS:

● For seizures that continue despite Magnesium sulfate: ● Use Versed 1-2 mg SIVP/IM ● Repeat in 2 minutes if seizures do not resolve.

Lowering diastolic blood pressure to less than 90-100 mm/hg may compromise fetoplacental blood flow.

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OB/GYN PROTOCOL PROLAPSED UMBILICAL CORD

CHAPTER 24.6.5

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Protocol

Basic Medical Care Airway management Shock protocol Monitor Fetal Heart Rate abdominally and indicate time accurately Transport expeditiously

● Position the patient in Shock Position or on left lateral side with knees flexed ● Instruct mother to pant, and not to push during contractions ● Insert sterile gloved hand into vagina and elevate the presenting fetal part to prevent cord compression. Leave hand in place and avoid touching cord. ● Cover exposed cord with sterile saline gauze ● If crowning noted, prepare to assist with vaginal delivery ● If delivery is inevitable prior to arrival at the hospital, attempt gentle manual replacement of cord into the uterus. This should only be done just prior to actual delivery, or on advice of medical control.

MEDICAL CONTROL OPTIONS:

Magnesium sulfate 1-5 gm IVP over 30 minutes

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OB/GYN PROTOCOL EMERGENCY DELIVERY

CHAPTER 24.6.6

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

History

● Time when contractions began ● Has “water broken” ● Obstetrical History ● Number of previous deliveries ● Complications in previous pregnancies, abnormal presentation, multiple pregnancy, hemorrhage ● Known complications in this pregnancy ● Due Date, Date of last period (i.e. is this a premature delivery?) ● Has there been meconium staining of amniotic fluid?

Physical Examination Determine that delivery is imminent by assessing for the following signs:

● Bulging perineum ● Crowning (top of baby’s head visible) ● Contractions less than 2 minutes apart and reported as strong by mother

Delivery

● Prep mother and delivery area with drapes. ● As the infant’s head delivers, use the palm of your hand to gently apply pressure to his/her head preventing a rapid, uncontrolled delivery. ● Support the infant’s head as it emerges from the vagina. ● Allow the head to rotate to one side. ● Aspirate mouth and then nose with bulb syringe. ● Wipe any mucous from the infant’s face with gauze. ● After delivery of the head, examine the neck for a looped umbilical cord. ● If found, gently remove it by slipping it over the head of the infant. ● If wrapped tightly, clamp the cord in two places. ● Using scissors cut between the clamps. ● Begin to deliver the infant’s shoulder. ● Position your hands on either side of the infant’s head. ● Exert gentle downward pressure as you deliver the anterior shoulder, then guide the head upwards and deliver the posterior shoulder. ● Be careful to securely grasp the infant, as he/she will be slippery. ● Keep the baby at a level below or equal to the mother until the umbilical cord is clamped. ● Clamp the cord in two locations (minimum of 6-8 inches from baby). ● Position the clamps one-inch apart. ● Cut cord with scalpel or scissors.

CAUTION: Remember not to cut the cord too close to the infant. It can always be made shorter later.

After the Delivery

Keep the mother and infant warm.

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Evaluate infant. Obtain APGAR score at 1 and 5 minute marks.

Placenta delivery

● The placenta will deliver spontaneously usually within 15 minutes of the infant. Do not force the placenta to deliver. ● Signs of separation include: gush of blood from the vagina, lengthening of the umbilical cord, uterine fundus rising upward in the patient’s abdomen, or uterus becoming firmer. ● Massaging the uterus and/ or allowing baby to nurse may facilitate uterine contractions and delivery of the placenta. ● Massage uterine fundus as soon as it shows signs of relaxing; ● Check the patient’s vaginal and perineal area for excessive bleeding. ● If patient becomes hypotensive, refer to shock protocol

Meconium (fetal fecal material) aspiration:

● When there is thick meconium staining of the amniotic the infants mouth then nose should be suctioned with a meconium aspirator until secretions are cleared or appear thin and watery. ● Suctioning should be preformed after the head emerges but prior to the delivery of the body.

If infant requires resuscitation, refer to NEONATAL RESUSCITATION PROTOCOL

● Indications for neonatal resuscitation include: meconium staining, lack of spontaneous breathing, pulse rate less than 100 BPM after birth despite Oxygen and stimulation.

Document the following:

● Presentation ● Date and time of birth of baby and placenta ● Gender of infant ● Position of cord at delivery ● Appearance of amniotic fluid (brown, green, clear) ● Complications

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OB/GYN PROTOCOL NEONATAL RESUSCITATION

CHAPTER 24.6.7

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Protocol

Deliver infant in method consistent with emergency childbirth protocol Suction mouth and nose of infant with bulb syringe or appropriate suction device

● In the infant with thick, particulate meconium, suctioning should be performed upon delivery of the head, PRIOR TO delivery of the body. ● Upon delivery of the body and prior to ventilation, Infants should be immediately intubated and meconium suctioned through the ET tube until no more meconium is present ● The infant may then be ventilated with positive pressure as indicate. ● Failure to clear the trachea before assisted or spontaneous ventilation will disseminate meconium through airways, severely impairing chances for survival. ● Warm and dry infant ● Apply tactile stimulus to feet and back of infant to stimulate a vigorous respiratory effort ● Assess APGAR

If respiratory effort adequate:

● Place infant in slight Shock position. ● Turn head of infant to side

If respiratory effort inadequate:

● Manage Airway and support ventilations ● Assess heart rate and respiratory status frequently ● If spontaneous respirations return and patient has not been intubated, continue to provide 100% OXYGEN to patient via facemask. ● If infant remains apneic or bradycardic, continue with protocol

If brachial pulse less than 80 bpm:

● Assist ventilations with 100% OXYGEN via BVM or ETT ● If pulse remains less than 80, perform endotracheal intubation and ventilate ● Perform chest compressions at 120/min. ● Follow infant BLS protocols

If heart rate climbs greater than 80 bpm

● Cease compressions, maintain ventilation, and continue to administer 100% Oxygen

If no change in heart rate, continue with protocol.

If heart rate remains less than 80 bpm:

● CPR

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● Vascular Access ● Administer fluid bolus - Normal Saline 20ml/Kg ● Administer Epinephrine 0.01 mg/Kg IV. ● May repeat every 5 minutes at higher dose of 0.1 mg/Kg ● Repeat fluid bolus of 20ml/Kg ● Consider 2 mEq/Kg 4.2% Sodium Bicarb if bradycardia prolonged ● Consider Narcan 0.1 mg/Kg IVP. ● May repeat dose every 2 min as needed to avoid respiratory depression. ● Check BGL. IF less than 40 mg/dl, consider Dextrose 10% solution, 0.25 to 0.50 mg/Kg IVP

Apgar Scoring 0 points 1 point 2 points Heart Rate Absent <100 >100 Respiratory Effort Absent Slow irregular Strong Cry Muscle tone Flaccid Some flexion Action motion Irritability No response Some response Vigorous Color Blue, Pale Body: Pink Ext: blue

● Calculate one and five minute APGAR scores as time permits

Note: The use of the length based measurement device (i.e.: Broslow ®, Pediwheel) is strongly encouraged.

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PROCEDURAL PROTOCOL 12 LEAD EKG

CHAPTER 24.7.1

Issued: May 2010 Revised: October 2010

Submitted By: Technical Services Approved By: Medical Director

Protocol

Indications for performing a 12-lead

● Non-traumatic chest pain/thoracic back pain ● Epigastric pain where no evidence of GI cause ● Sudden onset of SOB, diaphoresis, syncope (non-traumatic) ● CHF/ Acute PE ● Any diabetic with signs/symptoms suggesting cardiac etiology ● Any overdose with potential cardiac effects (tricyclics, Beta blockers, calcium channel blockers, etc.) ● Whenever physician or paramedic deems it necessary ● Obtain rhythm strip prior to 12-lead EKG ● Assess and treat any life threatening conditions or arrythmias ● Perform assesment and obtain baseline vital signs ● If patient meets criteria, clean site and attach chest leads ● Obtain 12 Lead EKG ● Print 2 copies of 12-lead #1) for hospital, #2) for EMS reports

Suspect MI if:

● 1 mm of ST segment elevation is seen in 2 or more contiguous V-leads or limb leads

● If evidence of inferior AMI is present (leads ll, lll, and AVF) obtain right side chest lead EKG utilizing V4R. Treat patient accordingly.

● A 12-lead EKG is not recommended for trauma or unstable patients.

● In patients meeting criteria for STEMI Alert notification, notify the receiving hospital and transmit 12 Lead EKG for verification as soon as possible (see STEMI Alert SOG 24.7.15)

● Deliver radio report to the receiving facility en route and advise them that a 12 Lead EKG has been transmitted.

NOTE: Medications may alter the patients EKG; therefore, it is preferred that a 12 Lead EKG be obtained prior to the administration of medications and/or transport.

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PROCEDURAL PROTOCOL AUTOMATIC EXTERNAL DEFIBRILLATION

CHAPTER 24.7.2

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Protocol

The AED is to be used to treat patients of non-traumatic cardiac arrest who are greater than 8 years old.

The AED operator is in charge of patient care until ALS arrives on scene The sequence of events:

● Establish unresponsiveness ● ABCs and CPR until defibrillator arrives ● If the arrest is not witnessed, perform 5 cycles of CPR prior to having AED analyze rhythm. ● Power on defibrillator and attach electrodes as directed ● State a brief situation report aloud (the AED will be recording sound) ● Analyze the patient’s rhythm ● Do not allow anyone to touch the patient (including yourself) ● If “shock”is advised, state “I’m clear, you’re clear, we’re all clear”as you scan the patient from head to toe, to insure no one is touching the patient ● The AED will deliver a shock then immediately perform CPR for 2 minutes, check for signs of circulation. ● Re-analyze the patient’s rhythm ● Deliver 1 more shock if directed to do so by the AED ● If patient is still pulseless, perform CPR for 2 minutes ● Re-analyze the patient’s rhythm ● The operator may deliver 1 more shock ● If the patient remains pulseless, continue CPR until ALS arrives emphasizing on “Hard and Fast” compressions and enough ventilations to see the chest rise. ● If at any time the patient has a return of spontaneous circulation, but is not breathing, correct ABC’s as needed ● If patient returns to spontaneous circulation, with breathing, place in recovery position and monitor ABC’s until transport arrives.

● If the AED prompts rescuer to deliver shocks consecutively, the AED may be turned off until the end of 5th cycle of CPR or leave AED powered on and be prepared to listen to “motion detected”throughout CPR cycles.

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PROCEDURAL PROTOCOL BLOOD DRAW

CHAPTER 24.7.3

Issued: May 2010 Revised: April 2012

Submitted By: EMS Branch Approved By: Medical Director

Protocol

● Utilize Universal precautions

● Select vein and prep site as you would for IV cannulation

● Gather appropriate drawing devices

● Apply tourniquet

● Clean site with alcohol or betadine (do not use alcohol for cleansing site while drawing for LEA and blood alcohol levels.

● Insert needle or cannula

● Attach blood tubes to vacutainer and draw blood ● All blood draw supplies will be provided by and collected from local receiving hospitals. ● Release tourniquet

● Withdraw needle and vacutainer

site

● Label blood sample ● Patient’s Name

● Date and Time

● Drawer’s initials

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PROCEDURAL PROTOCOL CHEST DECOMPRESSION

CHAPTER 24.7.4

Issued: May 2010 Revised: June 2011

Submitted By: Technical Branch Approved By: Medical Director

Protocol

● Determine need for chest decompression by clinical presentation of the patient (decreased breath sounds with signs and symptoms consistent with tension pneumothorax) ● Identify puncture site

● Second intercostal space on affected side in the midclavicular line (strongly preferred); ● Fourth intercostal space on affected side in midaxillary line

● Prepare skin at puncture site with Betadine or alcohol swabs

● Insert 14-16 gauge catheter perpendicular to the skin and over of inferior rib.

● Remove any parts from the catheter/needle assembly which may occlude the lumen)

● Listen for a rush of air. If noted, the diagnosis of pneumothorax and proper needle placement is confirmed.

● Alert receiving hospital personnel on arrival to the presence of this catheter.

● DO NOT UNDER ANY CIRCUMSTANCES remove this catheter from the patient.

● If Symptoms reoccur, there would be a concern for catheter displacement. In this case, place another catheter adjacent to the first catheter following the steps above.

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PROCEDURAL PROTOCOL CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP)

CHAPTER 24.7.5

Issued: May 2010 Revised: Nov 12

Submitted By: EMS Branch Approved By: Medical Director

Protocol

Indications:

For patients with Acute Bronchospastic Disorders (acute or chronic bronchitis, emphysema, or asthma) or Acute Pulmonary Edema, who have hypoxemia and/or respiratory distress that do not or would not quickly improve with pharmaceutical treatment.

Contraindications:

● Respiratory arrest ● Agonal respirations ● Unconsciousness or obtunded ● Shock associated with cardiac insufficiency ● Trauma ● Persistent nausea and vomiting ● Facial anomalies ● Inability to cooperate with the procedure

Equipment:

● Medical Director approved Continuous Positive Airway Pressure (CPAP) device

Procedure:

● Perform primary and secondary surveys ● Attach cardiac monitor, capnography, and pulse oximetry ● If indications present and systolic blood pressure >100, proceed with CPAP; if systolic blood pressure <100, contact Medical Control prior to beginning CPAP ● Verbally instruct patient (this is a critical item) ● Patient requires “verbal sedation”to use this device effectively ● "You are going to feel some pressure from the mask but this will help you breathe easier.” ● Setup CPAP device as per manufacturer’s instructions ● Instruct patient to slowly breathe in through the nose and exhale through the mouth (exhalation phase should be about 4 seconds) ● For CHF/ACPE use a CPAP setting of 10cm H20

● For COPD use a CPAP setting of 5cm H20 ● Continue treatment throughout transport to the ED ● Record and monitor vital signs, ETCO2, and O2 saturation as needed ● In the event of progressive respiratory and/or consciousness deterioration ● Offer reassurance ● Stop treatment if necessary ● Apply bag valve mask to patient ● Document adverse reactions, and reasons why CPAP was discontinued, in patient care report

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The following items should be documented:

● CPAP level used ● Vital Signs every 5 minutes ● SpO2 every 5 minutes ● Response to treatment

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PROCEDURAL PROTOCOL CRICOTHYROTOMY

CHAPTER 24.7.6

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Protocol

● Surgical Cricothyrotomy (Adults only) ● Identify and prepare cricothyroid area ● Grasp the tracheal cartilage (Adam's apple) with the non-dominant hand to secure it ● Using a #11 scalpel, make a midline vertical incision approximately 3 cm long, centered over the cricothyroid membrane ● Using the blade handle or hemostats, move the strap muscles out of the way ● Once the cricothyroid membrane is reached, make a horizontal stab incision in the inferior third of the membrane ● Open the incision by spreading clamps or by inserting the handle of the scalpel and rotating to the vertical position ● Insert ETT until the balloon is just inside the trachea ● Secure the tube and ventilate the patient ● Follow intubation protocol

● Note: The prefered method for GFR crews will be utilization of the Melker Wire-guided Cricothyrotomy Kit.

Alternate method:

● Make a stab/puncture into the trachea through the cricoid membrane with a #11 blade. ● Extend the incision laterally or use the blunt end of the scalpel to open an area able to place a small ET tube within the trachea. ● Proceed as above to secure the tube

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PROCEDURAL PROTOCOLS CYANOKIT (Hydroxocobalamin for injection)

CHAPTER 24.7.7

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Protocol:

Indication: Cyanokit is indicated for the treatment of known or suspected cyanid poisoning.

Identifying Patients with Cyanide Poisoning: Cyanide poisoning may result from inhalation, ingestion, or dermal exposure to various cyanide-containing compounds, including smoke from closed-space fires. These agents may present with an almond odor yet this cannot be a reliable indicator. Sources of cyanide poisoning include hydrogen cyanide and its salts, cyanogenic plants, aliphatic nitriles, and prolonged exposure to sodium nitroprusside. Most plastics, glues, and fabrics contain cyanide agents.

The presence and extent of cyanide poisoning are often unknown. There is no widely available, rapid, confirmatory cyanide blood test. Treatment decisions must be made on the basis of clinical history and signs and symptoms of cyanide intoxication. If clinical suspicion of cyanide poisoning is high, Cyanokit should be administered without delay.

Symptoms Signs *Headache * Altered Mental Status * Confusion * Seizures or Coma * Dyspnea * Mydriasis (dilated pupils) * Chest discomfort * Tachypnea / Hyperpnea (early) * Nausea * Bradypnea / Apnea (late) * Hypertension (early) / Hypotension (late) * Vomiting

Contraindication: NONE

Warnings and Precautions:

● Emergency Patient Management- In addition to Cyanokit, treatment of cyanide poisoning must include immediate attention to airway patency, adequacy of oxygenation and hydration, cardiovascular support, and management of any seizure activity. Consideration should be given to decontamination measures based on route of exposure. ● Allergic Reaction- Use caution in the management of patients with known anaphylactic reactions to hydroxocobalamin. Consideration should be given to use of alternative therapies if available. Allergic reactions may include anaphylaxis, chest discomfort, edema, urticaria, pruritus, dyspnea, and rash. Always treat any allergic reaction appropriately to the protocol. ● Hypertension- Many patients with cyanide poisoning will be hypotensive; however, elevations in blood pressure have also been observed in known or suspected cyanide poisoning victims. Although there has been no significant studies done on hydroxocobalamin and the affects on cyanide victims, there were elevations in blood pressure >180 mmHg systolic or >110 mmHg diastolic) in approximately 18% of healthy subjects (not exposed to cyanide) receiving hydroxocobalamin 5 g. Most affects were noticed in first 30 minutes of administering hydroxocobalamin. ● Erythemia- Non life threatening, yet a redness of the skin may proceed the administration of hydroxocobalamin along with red tint to urine.

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Dosage and Administration:

● Recommended Dosing- The starting dose of hydroxocobalamin for adults is 5 g (i.e. both 2.5 g vials) administered as an intravenous (IV) infusion over 15 minutes (total 5 g).There can be a second dose of 5g depending on severity of the poisoning. There have been no safety or efficacy studies performed in pediatric patients. Contact medical control for consultation about pediatric administration. ● Preparation of Solution for Infusion- Each 2.5 g vial of hydroxocobalamin for injection is to be reconstituted with 100 ml of Normal Saline (not typically supplied by manufacture) that will be supplied with injection kit. The line on each vial label represents 100 ml volume of diluent. After NS is mixed with lyophilized powder, each vial should be repeatedly inverted or rocked, not shaken, for at least 30 seconds prior to infusion. This solution should be visually inspected for particular matter and color prior to administration. If the reconstituted solution is not dark or if particular matter is seen after the solution has been appropriately mixed, the solution should be discarded. ● Incompatibility Information- DO NOT administer any drug simultaneously through same IV line as hydroxocobalamin.

Click to view → Cyanokit Antidote Administration

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PROCEDURAL PROTOCOLS End Tidal CO2 Monitoring

CHAPTER 24.7.8

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Protocol

ELECTRIC WAVEFORM CAPNOGRAPHY

● Power on the Zoll E Series Cardiac Monitor and assure the ETCO2 cable is attached (The ETCO2 device takes approximately one minute to warm up when the monitor is powered on) ● Secure airway via endotracheal (ET) intubation. Be sure to follow manual confimation techniques (ie. Visualization of tube passing vocal chords, negative sounds over the epigastrium, fogging of the ET tube, etc.) ● Place ETCO2 device with adapter on the end of ET tube between the ET tube and BVM. ● Press the “Wave 2”soft key until the CO2 waveform is displayed. (The default color will be in YELLOW) ● Attach the BVM to the open end of ETC02 device and administer ventilations ● Note the reading of patient CO2 levels on cardiac monitor ● Look for rhythmic and consistent waveform ETCO2 capnography on the display screen. (See examples below of normal and abnormal waveforms) ● If placement of tube is in question, remove the tube, ventilate patient for 30 seconds and attempt to intubate again

● If tube placement confirmed, consider possible causes of low end-tidal CO2 (low cardiac output secondary to hypovolemia or cardiac failure, or cardiac arrest) and treat appropriately

Click to view → NORMAL CAPNOGRAM - ESOPHAGEAL INTUBATION - DISLODGED ET TUBE

DIPOSABLE CO2 DETECTION DEVICE **( intended for use only when there is eletronic equipment failure or early access cannot be made to patient with the Zoll E Series Cardiac Monitor)**

● Secure airway via endotracheal (ET) intubation ● Place CO2 device on adapter end of ET tube ● Attach the BVM to the open end of ETC02 device and administer ventilations ● Complete at least 3 ventilations before the electric ETCO2 device will register a color change or 6 ventilations before the disposable device will register a color change ● If either device turns yellow with exhalation, tube placement is confirmed ● If the device remains purple ● Reconfirm ET tube placement by direct visualization and auscultation ● If placement of tube is in question, remove the tube, ventilate patient for 30 seconds and attempt to intubate again

● If tube placement confirmed, consider possible causes of low end-tidal CO2 (low cardiac output secondary to hypovolemia or cardiac failure, or cardiac arrest) and treat appropriately ● If device changes to Tan, consider low cardiac output from poor CPR or poor patient perfusion. Recheck tube placement by visualization, and correct as neccesary ● If device is yellow, but changes to purple during transport, recheck placement using steps as above ● The disposable devices are ineffective if they become wet ● Recheck placement of tube each time you move the patient or there is a change in his/her condition ● As soon as possible, apply electronic ETCO2 monitoring.

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PROCEDURAL PROTOCOLS ENDOTRACHEAL INTUBATION (NASAL & ORAL)

CHAPTER 24.7.9

Issued: May 2010 Revised: June 11, Aug 11, July 12 Jany 15, 2013

Submitted By: EMS Branch Approved BY: Medical Director

Protocol

● Select route of intubation

● Have all airway supplies and suction nearby

Orotracheal Intubation

● Hyper oxygenate patient with 100% O2 using BVM prior to intubation attempt

● Attempts should be limited to 10 seconds

● Insert laryngoscope blade into oropharynx and visualize vocal cords ● Miller blade (straight) is used to lift the epiglottis

● Macintosh (curved) is placed in the vallecula and used to raise the larynx and therefore the epiglottis ● Remove any obstructing secretions or foreign bodies with suction and/or Magill forceps

● Insert endotracheal tube past vocal cords by visually confirming the placement before removing the laryngoscope

● If a stylet is used, remove it after the tube has passed the cords

● Inflate the cuff

● If no cervical spine injury is suspected, cricoid pressure may be used to reduce the risk of vomiting and to assists in visualization of the cords. ● Cricoid pressure is contraindicated in the placement of the King LTD Airway ● After 2 failed attempts at endotracheal intubation (not 2 attempts per provider) a King LTD airway shall be immediately placed.

● In patients who have sustained trauma after any 2 failed attempts (even if done by a paramedic student) it is required that a King LTD airway then be placed by a cleared paramedic.

● If the King LTD airway is unsuccessful, utilize a BVM with an OPA to oxygenate and ventilate this patient until arrival at the hospital.

● If unable to oxygenate, consider surgical cricothyrotomy.

● If endotracheal intubation or King LTD Airway is unsuccessful, the paramedic shall document and justify the failed attempts.

At any time the paramedic believes the patient would benefit from the King Tube device he/she may elect to not attempt Endotracheal Intubation.

Nasotracheal Intubation

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**Contraindicated in patients with facial fractures and/or a closed head injury**

● Patient must have spontaneous respirations

● Maintain cervical spine immobilization if trauma is known or suspected

● Place patient on high flow OXYGEN via NRB prior to nasal intubation

● Consider use of 4ml of 2% Lidocaine via nebulizer mask. This will result in the complete or near complete loss of the gag reflex and facilitate patient compliance with the passage of the ET tube.

● Anesthesia can also be achieved by the placement of an NPA coated with 4% lidocaine jelly 3-5 minutes prior to intubation. Coat external nares and tip of endotracheal tube with 4% lidocaine jelly

● Apply the Beck Airway Airflow Monitor (BAAM) device on the end of the ET tube

● Insert tube with bevel side facing the septum. The tube should be advanced along the floor of the nose. Endotrol® tubes are helpful in controlling the position of the tip of the tube, stylets cannot be used. As the tube enters the pharynx, listen for breathing sounds to get louder (whistle with the BAAM device) as you advance closer to the trachea

● The patient is likely to cough or gag. Suction must be ready for use

● Listen for patient breathing and/or vocalizations. The vocal cords are widest apart upon inspiration

● Ask patient to take a deep, slow breath or when the patient inhales, advance tube quickly through cords

● Success is noted by an absence of further vocalizations and continued airflow through the tube

● Inflate balloon

● Verify tube placement as you would with oral intubation

● Ventilate patient via ET tube with 100% O2 using BVM

● Secure ET tube in place using locking device or tape

● Reassess and document tube placement after moving patient

● Continue with ventilation during transport with BVM or use a mechanical ventilation device

All intubations will be confirmed by the absence of breath sounds over the epigastrium and the presence of breath sounds over the right and left lung field. This shall be documented in the run report.

Electronic ETCO2 shall be measured continually on all intubations to verify tube placement. This information shall be documented in the run report as a separate intervention and shall include waveform capnography. If electronic ETCO2 is unavailable the use of a colorimetric device is acceptable.

Considerations

It is strongly suggested that the patient’s head and neck be immobilized using a cervical collar and CID to prevent tube dislodgement during patient movement

To manage the airway of a patient with known or suspected trauma who vomits during airway procedures:

● Turn AS A UNIT on side and suction oral cavity. Maintain spinal immobilization throughout the turning maneuver

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● If the patient becomes combative, consider Versed 1-2mg IV push to facilitate intubation. May repeat in 2 minutes. Closely monitor the patient who has received Versed for respiratory depression or arrest

On occasions when a patient has been intubated prior to arrival, confirmation of the airway placement shall be made by the presence of lung sounds and ETCO2 prior to acceptance. It is acceptable to manage airways that have been secured with alternate devices (LMA).

Any airway device shall be removed that is not properly ventilating (i.e. absent breath sounds, cyanosis or loss of waveform capnography) device shall be removed immediately. REMEMBER: The goal of airway management is to VENTILATE and OXYGENATE the patient, not necessarily to intubate the patient.

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PROCEDURAL PROTOCOL EXTERNAL CARDIAC PACING

CHAPTER 24.7.10

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Protocol

● Place cardiac monitor limb leads on the patient

● Place defibrillator pads on patient (anterior and posterior)

● Turn Central Control Knob to PACER (Green)

● Set the Pacer Rate at 20-30 ppm higher than the patient’s intrinsic rate. Default Pacer Rate is 70 ppm. DO NOT EXCEED 80 ppm.

● Turn Pacer Output (mA) until there is a defined “QRS”behind each pacer spike (Electrical Capture).

● Next, confirm mechanical capture by palpating a carotid and/or radial pulse.

● Once electrical and mechanical capture is obtained, increase the current (mA) by 10% to exceed the impedance threshold.

● Turn the Pacer Rate dial to adjust the patient’s heart rate. This should be done to maintain a systolic BP > 100 mmHg. Do not exceed paced rate of 80 ppm

● To view the underlying rhythm , press and hold the 4:1 button (not recommended to prevent loss of mechanical capture)

● Administer Versed 1-2 mg SIV , titrate to patient comfort to a maximum dose of 10 mg and a systolic blood pressure greater than 100 mmHg.

***THINGS TO REMEMBER***

● The Pacer will continue to pace if a limb lead is inadvertantly removed or displaced ● If the monitor is turned off, the pacing function will resume if monitor is turned back on within 10 seconds ● The Zoll Eseries Monitor paces in the “Demand”function unless unsynchronized pacing is selected via the soft key. ● If the pacer stops due to the under lying rhythm rate exceeding that of the pacer (demand mode), be sure to check for presence of a corrolating carotid and/or radial pulse.

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PROCEDURAL PROTOCOL EZ-I0 INFUSION SYSTEM

CHAPTER 24.7.11

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Protocol

If the patient is conscious, advise of EMERGENT NEED for this procedure and obtain verbal consent

● Wear approved Body Substance Isolation Equipment (BSI) ● Determine EZ-IO AD® or EZ-IO PD® Indications ● Rule out Contraindications ● Locate appropriate insertion site, SEE (Location Sites) ● Prepare insertion site using aseptic technique (Alcohol Prep) ● Prepare the EZ-IO® driver and appropriate needle set ● Stabilize site and insert appropriate needle set ● Remove EZ-IO® driver from needle set while stabilizing catheter hub ● Remove stylette from catheter, place stylette in shuttle or approved sharps container ● Confirm placement ● Connect primed tubing ● Slowly administer appropriate dose of Lidocaine 2% (Preservative Free) IO to conscious patients ● Syringe bolus (flush) the EZ-IO® catheter with the appropriate amount of normal saline. ● Rapid syringe bolus (flush) the EZ-IO AD® with 10 ml of normal saline ● Rapid syringe bolus (flush) the EZ-IO AD® with 5 ml of normal saline ● Utilize pressure (pressure bag or infusion pump) for continuous infusions where applicable for hemodynamically unstable adults, repeat flush as needed for pediatrics ● Begin infusion ● Dress site, secure tubing and apply wristband as directed ● Monitor EZ-IO® site and patient condition

APPROVED SITE LOCATIONS:

● Proximal Tibial Tuberosity (preferred site): One index finger (1-2 cm) distal from tip of the medial aspect of tibia tuberosity. ● Distal Tibial Tuberosity: Two fingers (2-4 cm) proximal to the tip of most distal aspect of tibia (medial malleolus), insertion of IO being medial aspect of distal tibial anatomy.

● Proximal Humerus: Locate greater tubercle (flat portion of proximal humerus, 1-2 cm inferior to proximal tip), slightly anterior to humerus lateral midline. Arm is to be adducted with elbow posteriorly placed. Needle set should never enter or be medial to the intertubercular groove.

INDICATIONS:

● EZ-IO AD® (40 kg and over) & EZ-IO PD® (3 -39 kg) ● Intravenous fluids or medications are needed and a peripheral IV cannot be established in 2 attempts or 90 seconds AND the patient exhibits one or more of the following: ● An altered mental status ● Respiratory compromise ● Hemodynamic instability

● EZ-IO AD® & EZ-IO PD® may be considered PRIOR to peripheral IV attempts in the following situations:

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● Cardiac arrest (medical or traumatic) ● Profound hypovolemia with alteration of mental status ● Patient in extremis with immediate need for delivery of medications and/or fluids.

CONTRAINDICATIONS:

● Fracture of the bone selected for IO infusion (consider alternate site) ● Excessive tissue at insertion site with the absence of anatomical landmarks (consider alternate site) ● Previous significant orthopedic procedures (IO within 24 hours, prosthesis -consider alternate site) ● Infection at the site selected for insertion (consider alternate site)

CONSIDERATIONS:

● Flow rate: With the anatomy of the IO space you will note flow rates to be slower than those achieved with IV catheters. ● Ensure the administration of an appropriate rapid syringe bolus (flush) prior to infusion NO FLUSH = NO FLOW ● Rapid syringe bolus (flush) the EZ-IO AD® with 10 ml of normal saline ● Rapid syringe bolus (flush) the EZ-IO PD® with 5 ml of normal saline ● Repeat syringe bolus (flush) as needed ● To improve continuous infusion flow rates always use a syringe, pressure bag (with maximum pressure of 300 mm) or infusion pump if available. ● Pressure Infusion in adults only

● Pain: Insertion of the EZ-IO AD® & EZ-IO PD® in conscious patients has been noted to cause mild to moderate discomfort (usually no more painful than a large bore IV). However, IO infusion for conscious patients has been noted to cause severe discomfort ● Prior to 10 ml syringe bolus (flush) or continuous infusion in alert patients: ● EZ-IO Slowly administer Lidocaine 2% (Preservative Free ie. cardiac Lidocaine) through the hub over 15 - 20 seconds. ● EZ-IO AD® Slowly administer 20 - 40 mg Lidocaine 2% (Preservative Free) ● EZ-IO PD® Slowly administer .5 mg / kg Lidocaine 2% (Preservative Free) ● May use flush after 1 minute.

EQUIPMENT:

● EZ-IO® Driver ● EZ-IO AD® ● EZ-IO PD® Needle Set Alcohol ● Betadine Swab ● EZ-Connect® ● Standard Extension Set 10 ml Syringe Normal Saline (or suitable sterile fluid) ● Pressure Bag ● Infusion Pump ● 2 % Lidocaine (preservative free) ● EZ-IO® Yellow wristband ● 3-way stop clock

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PROCEDURAL PROTOCOL INTRAVENOUS ACCESS/SALINE LOC

CHAPTER 24.7.12

Issued: May 2010 Revised: June 11, Aug 11

Submitted By: Technical Services Approved By: Medical Director

Protocol

● Select site for IV placement ● Select appropriate size catheter for patient, things to consider: ● Patient age/size ● Vein size or integrity ● Location of IV ● Need for fluid replacement (i.e. hypovolemia, trauma, unstable B/P, Cardiac arrest, etc.) ● Only use needle/catheter sizes that are available from ACFR supply ● Apply tourniquet snugly to area just proximal to intended puncture site ● Peripheral catheterization procedure ● Prepare skin with Betadine or alcohol swabs ● Secure vein with fingers ask patient or assistant to secure extremity ● Insert needle and catheter assembly into vein, bevel up; watch for free blood return ● When placement confirmed by blood return, advance catheter into the vein until you reach the hub ● Attach blood collection device and draw blood samples for hospital use as appropriate ● Remove tourniquet

● Saline Loc: ● Attach Saline Loc to catheter hub ● Insure patency by briefly flushing with fluid

● For IV: ● Attach drip solution set to IV catheter and administer a small amount of fluid to ensure patency ● Fluid should then continue to run at a rate indicated by the patient’s condition and related protocol

*Secure catheter/saline loc with tape or occlusive dressing *Do not place an IV on same side as an AV fistula or same side after a mastectomy with lymph node resection.

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PROCEDURAL PROTOCOL NASOGASTRIC TUBE PLACEMENT

CHAPTER 24.7.13

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Protocol

● Explain the procedure to the patient and/or parent if appropriate; ● Select the proper size tube:

● Premature - newborn infant # 8 french

● 1 - 6 months # 8 - # 10 french

● 6 months - 2 years # 10 french

● 2 years - 8 years # 10 - 12 french

● 8 years and older # 14 - # 16 french

● Adults # 16 - # 18 french

Mark the distance the tube should be inserted:

● For pediatric patients, measure the tube by holding distal end of tube at patient's nose and extending tube to the tip of the earlobe and down to the xiphoid process. Mark the point on the tube ● For adult patients, measure the distance from the earlobe to the bridge of the nose and then from the bridge of the nose to below the xiphoid process. ● To aid in tube insertion, curl tube tightly around index finger and then release. Lubricate distal end of tube with water-soluble lubricant ● Place the patient in a semi-upright position if condition permits ● Gently insert tube into nare. When resistance is felt, apply gentle downward pressure to advance tube ● With the tube just above the oropharynx, instruct the patient to swallow (if able) to facilitate advancement of the tube. Offer the patient water to drink if appropriate (Only if the head is not restrained and suction is ready) ● If cervicle spine injury is not suspected, the patient may be asked to flex the neck toward the chin ● If the patient begins to cough, gag, or choke, procedure should be stopped and the patient be given an opportunity to recover. If patient begins to vomit, place in lateral decubitus position ● Continue to pass the tube until the marked spot is reached ● Check tube placement by ascultating over stomach as air is introduced through the tube - or by aspirating gastric contents ● Tape tube in place (Tube may be left open to gravity drainage or may be hooked to suction if ordered) ● Restrain patient as needed to prevent dislocation of the tube ● Document procedure, including tube size, which nare it was placed in, amount of stomach contents aspirated, and the patient's tolerance of the procedure ● The EGTA may be used to facilitate the placement of the NG tube in the unconscious overdose patient. The tube should be passed as above but through the lumen of the EGTA.

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PROCEDURAL PROTOCOL OXYGEN SATURATION MONITORING

CHAPTER 24.7.14

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Protocol

● Switch power to the “on”position of the oxyhemoglobin saturation monitor, (or just clip the unit on the finger using the portable devices)

● Place oxyhemoglobin sensor on digit or earlobe of patient; secure to finger with tape if necessary. Avoid attaching sensor to hand or arm where IV has been initiated

● Allow sensor to “capture”pulse and determine oxyhemoglobin saturation (approximately 15-20 seconds).

● In order to ensure that the saturation reading is correct, the patient’s pulse rate obtained from the Pulse Oximeter MUST match the pulse manually. If these pulse rates do not match within several beats, the saturation reading you have is incorrect

● Continue to monitor O2 saturation during transport

NOTE: Use of the pulse oximeter distal to the blood pressure cuff may give brief inaccuracies when the cuff is inflated.

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PROCEDURAL PROTOCOL VENTILATOR

CHAPTER 24.7.16

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Protocol

Basic Medical Care Review transfer paperwork Meet with Respiratory Therapist and RN in charge of patient Review and document patient’s ventilator settings and flow sheet

Set Ventilator Parameters:

● BPM (Breaths Per Minute)

● Tidal Volume (TV) range 100-1000 ml

● Pressure Control + PEEP 5-20cm/H2O

● Inspiratory Time 1-2 (I:E Expiratory is internally adjusted) example: 1:2-3

● Pressure Support + PEEP 5-20cm/H2O

● Sensitivity 1-3cm/H2O

● Set Pressure Alarms 10 pts. Higher and lower than settings

● Mode ( A/C, CMV, SIMV, CPAP, NPPV)

● FIO2 range 21-100%

● “Low Flow”adjusted by external flow meter 1-25Lpm

● Non Invasive Positive Pressure Ventilation (NPPV)

● CPAP 5cmH2O for COPD, 10cmH2O for Pulmonary Edema “Titrate to Effect”

● Additional Equipment Needed for Ventilator Transfer

● SPO2 monitor with Capnography

● Cardiac monitor

● Full O2 bottle

● Suction

BVM

Many conscious/alert patients that are being transferred from hospital vents to transport vents will experience agitation. It is important to advise patient of the challenge of adjustment and to relax. BE PATIENT!!!! There are physiological reasons for patients to become agitated including: pain, hypoxia, fever, and nervousness about

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transfer.

Rule out hypoxia

Allow 10-15 minutes for patient to acclimate to LTV1150, if no change the Paramedic may administer Versed 1-2mg SIVP. Repeat as needed, after ruling out hypoxia.

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PROCEDURAL PROTOCOL STEMI ALERT (ST MYOCARDIAL INFARCTION)

CHAPTER 24.7.15

Issued: May 2010 Revised: Oct 2010, June 2011

Submitted By: Technical Services Approved By: Medical Director

Protocol:

● ST segment elevation, measured at the J-point, of 1 mm or more is considered an abnormal finding. When that elevation is found in two anatomically contiguous leads, it is considered presumptive evidence of acute myocardial infarction (Injury). Patients who display ST segment elevation in two contiguous leads and display symptoms should be transported to one of the listed facilities: ● Shands at UF ● North Florida Regional Medical Center ● Veterans Administration Medical Center of Gainesville ● Paramedics should group the patient with ST elevation in two contiguous leads into one of the following anatomic groups: ● Leads I,AVL, V5, V6= suspected lateral wall injury ● Leads II,III,AVF =suspected inferior wall injury ● Leads V1 thru V4=suspected anterior or septal wall injury ● If the patient displays injury patterns on the 12 lead EKG, the Combined Communication Center (CCC) shall be contacted by the treating paramedic and a “STEMI ALERT”issued to the receiving facility as soon as possible. ● The 12 Lead EKG(s) shall be transmitted to the receiving facility as soon as possible to allow EKG review by attending physician in the Emergency Department.

Paramedic Recognition/ of “STEMI”in the Field:

● Criteria for “STEMI Alert” ● (+) ACS Symptoms ● (+) Characteristic cardiac presentation ● (+) 12 Lead ECG Printout ● (+) ST Segment elevation >1mm in two or more contiguous leads ● (+) Paramedic interpretation for “STEMI” ● The patient’s 12 Lead EKG shall be transmitted to the receiving facility as soon as available. (This may not be available until Rescue Unit arrives) ● NO NAMES SHALL BE PLACED ON 12 LEAD EKG ● Age and gender are acceptable and needed for accurate interpretation by EKG monitor ● No other identifiers will be used other than Unit ID and Time/Date stamp generated by EKG Monitor ● En route to the ED, the treating paramedic shall assure the following is completed: ● Full patient assessment ● Treatment via appropriate Medical Care Protocol ● 12 Lead EKG transmitted successfully ● Radio report given to receiving facility including the following: ● Notification of EKG transmission ● Patient status/condition ● Treatments rendered ● Current vital signs

Currently there are three hospitals with interventional cath labs

● Shands at UF ● North Florida Regional Medical Center ● Veterans Administration Medical Center of Gainesville

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BYPASS of Emergency Department directly to the Cardiac Cath Lab

● Done only at North Florida Regional Medical Center ● Done only if the Cath Lab is staffed and ready for the patient ● Patient must be seen be the attending ED Physician in order to affirm patient’s stability and ability to Bypass the ED ● Receiving hospital staff (minimum of an RN) must accompany ACFR personnel to the Cath Lab and assume patient care responsibility within the hospital. ● ACFR crews shall assist the hospital staff within their scope of practice should an emergency event take place during the bypass process ● ACFR crews shall notify CCC when bypassing the ED and proceeding directly to the Cardiac Cath Lab. The Rescue Lieutenant shall place their unit on a 10 minute delayed response.

Situations Not Categorized as STEMI ALERTS:

● Conditions and situations exist which may mask or mimic the criteria for EKG categorization of “injury patterns”. Some of these conditions are Left Bundle Branch Block (LBBB), Left Ventricular Hypertrophy (LVH), Pericarditis and Benign Early Repolarization. Examples of these follow:

● Left Bundle Branch Block (LBBB) can produce ST elevation in leads V1, V2, and V3. It will also display a QRS of abnormal duration. (>.12 sec) and a QS complex or negative terminal force in V1. Electrophysiology: LBBB alters depolarization (affects QRS), which alters repolarization (affects ST-T wave). Therefore, LBBB can produce changes in the QRS-ST-T waves that are identical to those produced by injury. A BBB widens the QRS (.12 sec or more). This widening is due to the fact that the ventricles are forced to contract sequentially, thus requiring more time. Therefore, when a QRS of .12 sec or more is produced by a supraventricular rhythm, think BBB. This rule applies in all leads. Differentiation of LBBB from RBBB comes from evaluation of lead V1 on the 12-lead ECG. The “classic”pattern of LBBB in V1 is a QS complex or negative terminal force.

Note: ***New onset LBBB with STEMI characteristics will be classified as a STEMI Alert. If Unknown, consider it new onset.

● Left Ventricular Hypertrophy (LVH) can produce ST elevation in leads V1, V2, and V3. The formula to use to look for LVH is as follows: ● Compare V1 and V2 and determine which lead has the deepest S wave. Then determine the depth of the deepest S wave. ● Compare V5 and V6 and determine which lead has the tallest R wave. Then determine the depth of the R wave. ● Add the height of the R wave and the depth of the S wave. If the number is > 35mm suspect LVH (each box = 1 mm).

Electrophysiology: There are many causes of LVH. Most are the result of either the left ventricle working harder over a long period of time or the result of chronic overfilling. For ACS management, it is NOT critical to determine the cause of the LVH. Simply suspecting the presence of LVH is sufficient. LVH can mimic “injury”patterns on the 12- Lead EKG. Unlike BBB, LVH does NOT usually widen the QRS to .12 sec or more. Instead of abnormally widening the QRS, LVH increases amplitude. LVH can produce ST segment elevation in early V leads.

● Pericarditis -There are numerous causes of pericarditis. These patients often complain of chest pain, which is an indication for a 12-Lead EKG. Pericarditis is capable of producing diffuse ST segment elevation across the EKG. The ST segment elevation of pericarditis is caused by inflammation of the epicardium secondary to inflammation of the pericardium. This process is not related to coronary artery disease and, therefore, ST segment changes do not tend to follow anatomical groups typically seen with AMI. Pericarditis may produce notching of the J-point and a “fish hook”shaped ST and J-Point. The “classic”pericarditis presentation has some distinguishing features. Listed below are the differentiating characteristics of AMI vs. Pericarditis. The purpose is not to rule out AMI, but help the care provider suspect the possibility of pericarditis.

● Benign Early Repolarization can produce ST elevation in the anterior or anteriolateral leads and tall T waves. In some respects it closely resembles pericarditis on the 12 lead EKG with notching of the J point. Electrophysiology: It has been theorized that the cause of Benign Early Repolarization is due to one region of

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myocardium repolarizing early. This produces a difference in electrical potential, and thus causes ST and T wave changes. Changes can occur in any lead. But are more common in the lateral and anterior chest leads. Benign Early Repolarization, like pericarditis, may produce notching of the J-point and a “fish hook”shaped ST and J-Point. Patients with Benign Early Repolarization often meet the voltage criteria for LVH. However, no true hypertrophy may exist. Anyone, male or female, of any ethnic background can have this pattern on his or her EKG. However, this pattern is most commonly seen in young adult African-American males.

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PROCEDURAL PROTOCOL ZOLL® E SERIES™ REFERENCE GUIDE

CHAPTER 24.7.17

Issued: May 2010 Revised: June 11, Aug 11

Submitted By: Technical Services Approved By: Medical Director

Universal Dial (Central Control Knob)

● One universal dial is used for all therapies (defib/monitoring/pacing). Turn the dial to the therapy you wish to use. Additional options will appear at the bottom of the screen. Soft keys will be used often and the options at the bottom of the screen will change based on which therapy you are utilizing.

Defib (ALS) (biphasic is 200J for each shock)

● #1 Turn Central Control knob to DEFIB (Red) ● #2 Press CHARGE ● #3 Press SHOCK st nd ● Pediatric - 2 J/kg 1 Shock -> 4 J/kg 2 and subsequent shocks (See Broselow Tape) ● You will need to manually set the Joule settings for Pediatric patients ● The default setting is 200J

Cardioversion

● Turn Central Control knob to DEFIB (Red) ● Press SYNC ON/OFF soft key ● White arrows will sync on “R-wave” ● Energy Settings are: ● SVT : 50 to 100 à 120 à 150 à 200 Joules ● Atrial fibrillation/Flutter: 50 to 100 à 120 à 150 à 200 Joules ● Wide Complex Tachycardias: 50 to 100 à 200 à 300 à 360 Joules st nd ● Pediatric- 1 J/kg 1 dose -> 2 J/kg 2 dose (See Broselow Tape) ● **You must manually select the energy you wish to use. The energy will not automatically increase once manually changed** ● Press CHARGE à Push and hold SHOCK to shock on “R-wave” ● You must press SYNC ON/OFF key between each cardioversion attempt. It is automatically turned off when charge is delivered in case of rhythm change to VFib

Pacing

● Turn Central Control Knob to PACER (Green) ● Turn Pacer Output (mA) until “QRS”appears after each pacer spike (Electrical Capture). ● Confirm mechanical capture by checking Carotid and/or Radial pulse. ● Once you get mechanical/electrical capture, increase the current by 10% to make sure you don’t lose capture. ● Set the Pacer at 20-30 ppm higher than the patient’s intrinsic rate. Default pacer rate is 70 ppm. Do not exceed 80 ppm ● Turn the Pacer Rate dial to change the patients heart rate ● Press and hold the 4:1 button to view the underlying rhythm (Not recommended)

Blood Pressure (NIBP)

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● Select proper cuff size and apply to patient, making sure that the cuff is tight and properly aligned. ● Press blue NIBP button to take a single pressure. The cuff will inflate to 180, if a pressure is not obtained at 180, the cuff will re-inflate until a pressure is obtained. Push NIBP button again to abort measurement. ● Push and hold NIBP button to Auto inflate every 5 min. Press and hold again to shut off ● Auto NIBP. ● Change interval – Press “Param”à Enter NIBP à select Auto Interval à Increase or Decrease ● To take a single pressure in between Auto Interval, Press the NIBP button again. This will take a single pressure, but not change your Auto Interval. ● To get a list of all your vitals (Trends), press “Summary”à Trend à It will highlight NIBP à Enter à Print ● You will receive trending of all blood pressures, heart rate, SPO2, and EtCO2.

12-Lead ECG

● Turn Central Control to “Monitor”and make sure Lead II not PADS is displayed. ● Prep patients skin as appropriate and attach 4 Lead cable to torso à Press and hold the recorder button to print leads I, II, III, aVR, aVL, aVF à Connect V leads to chest à Plug V lead cable into 4 lead cable block. Press and hold the RECORDER button to obtain a quick look real time 12-lead. ● Press 12 Lead à PT Info à Gender (m/f) à Age à Press arrows on top of monitor & Enter à Return à Return again ● Make sure patient is still for a full 10 seconds when acquiring. à Press Acquire

12 Lead Transmission

● After 12 lead has been performed, monitor will be in EKG Transmission mode ● Select transmission destination ( Hospital Choice or TEST) ● Press “Transmit Now”when in proximity of mobile router located in unit

ETCO2

● Plug the ETCO2 adapter (clear piece) into the ETCO2 module and place airway adapter between ET tube and BVM ● The CO2 module takes about 1 min. to warm-up after you turn on the monitor and should already be zeroed. ● If you have to re-zero, place the sensor into the module à Press Param (soft key) àSelect ETCO2 à Enter à Press Zero. Make sure nothing is attached to the patient when re-zeroing ● Press soft key labeled Wave 2 to view the wave form

Lead Button

● Your monitor will “power up”in Lead II. You may press the “Lead”button to change leads

Recorder Button

● Press “Recorder”button once to print what you see on the screen. Press “Recorder”button again to stop printing. ● Press and hold “Recorder”button with 4 Lead cable and it will print I, II, III, aVR, aVL, aVF in Diagnostic Mode. ● Press and hold “Recorder”button with 12 Lead cable and it will print a Diagnostic 12 lead with no interpretation

Code Markers

● Press the Code Marker button, you will see a list of drugs that follow protocols à Press Enter Marker ● Once you press the Enter Marker it will automatically highlight the next drug in your protocol. To move through the list of drugs use the arrows on top of the monitor. If you deviate from the protocol use the arrows on top of

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the monitor to move through the list. ● If you want to mark a generic event, press the Code Marker button once

Printing a Summary

● There are three main uses in the Summary section ● Trend: (see NIBP above) ● Print Chart à Print Range: allows you to print a range of events. A log of events will appear on screen. Use arrow keys to scroll down to highlight the first event that you want to print. Press “Print Record”. Allow the machine to print off the information you want, press “Record”to stop recorder. ● Printing a complete summary: press “Summary”à Print Call à Select Call with arrows on top of the monitor à Print Record

Shift Check - Do in the following order

● Rotate Batteries 1. Unit to Charger 2. Spare to Unit 3. Charger to Spare (this should be done daily) ● Plug red end of defib cable into the black test port that is attached to the cable. Turn central dial to red (Defib). Select 30 Joules à Press Charge à Press Shock à “Test OK”will appear on screen. If you get an “Error code”contact the Duty Supervisor.

Adjusting the Screen for Bright Light

● Press and hold the button in the lower left that is a half shaded circle

Uploading Data into Tablet PCR

● Information to be released in the future

Battery and Charger Maintenance

● Batteries need to be conditioned once a month ● This should be done on the first day of every month when expired drugs are checked ● Notate battery conditioned with date and initials/id # on the tag on the side of the battery rd ● Charger should be tested every 3 month (quarterly) ● Notate the charger test on the tag on the charger with date and initials/id #

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PROCEDURAL PROTOCOL SEPSIS ALERT WITH LACTATE SCOUT

CHAPTER 24.7.18

Issued: March 2013 Revised:

Submitted By:EMS Branch Approved By:Medical Director

Purpose:

To actively assist in the early identification of SIRS/Sepsis patients to decrease morbidity and mortality.

Background:

Systemic Inflammatory Response Syndrome, (SIRS) refers to the inflammation that is the body’s response to a nonspecific insult, consisting of a complex cascade of events. SIRS can be caused by ischemia, inflammation, infection, trauma or a combination of insults. Sepsis is the systemic response to infection with presence of SIRS, with a documented or presumed infection.

SIRS is defined as two or more of the following criteria:

● Temperature of less than or equal to 96.8 degrees Fahrenheit or greater than or equal to 100.4 degrees Fahrenheit.

● Heart rate of greater than or equal to 90 beats per minute.

● Respiratory rate of greater than or equal to 24 breaths per minute

● White blood cell count of greater than 12,000 or less than 4,000; or greater than 10% bands (if lab result available)

Common infections include pneumonia, urinary tract infection, cellulitis/abscess (skin infection), or bacterium (blood infection).

Patients whom are immunosuppressed are at a higher risk for developing an infection. These patients may include those with cancer, are on steroidal treatments, have recently undergone a surgical procedure, have indwelling foreign body (Foley catheters, IV line, external fixator), or patients who have comorbidities such as diabetes or bed bound.

A Sepsis Alert shall be activated when a patient presents with two or more criteria for SIRS listed above plus a systolic blood pressure less than 90mmhg or signs of end organ damage.

Signs of end organ damage include:

● Neurological changes (altered mental status, coma, agitation or lethargy)

● Respiratory changes (hypoxia, dyspnea)

● Circulatory changes (poor capillary refill, ECG changes, pulmonary edema)

● Renal changes (decreased urination, an acute rise in creatinine)

Procedure:

Basic Life Support

● Perform a full history and physical assessment searching for evidence of infection.

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● Ensure patent airway

● Apply supplemental oxygen if any respiratory signs or symptoms present with an oxygen saturation less than 94%

● Record and monitor vital signs

● BGL

Advanced Life Support

● Advanced airway (if needed)

● 12 Lead ECG

● IV and if evidence of dehydration and hypotension, administer 250 ml bolus. Repeat if necessary, until systolic pressure reaches 100 mm Hg. Withhold bolus in patients who present in CHF (presence of rales, rhonchi or crackles).

● Continuous monitoring of non-invasive ETCO2

A Sepsis Alert may also be called based on Paramedic Discretion.

*** Alachua County Fire Rescue and Shands Health Care have entered into a research partnership in obtaining Lactate Levels for patients that are suspected to be Septic. The Lactate Scout Monitor is not FDA approved, cannot be utilized to diagnose Sepsis and will only be utilized for research purposes. A Lactate Level shall be obtained for all patients who meet the criteria for a Sepsis Alert. This value SHALL NOT be passed onto the receiving facility. It will be documented in the EMS Run Report for research purposes only.

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PROCEDURAL PROTOCOL ZOLL® AUTOPULSE BATTERY CONDITIONING

CHAPTER 24.7.19

Issued: March 2013 Revised:

Submitted By: EMS Branch Approved BY: Medical DIrector

About this Procedure:

The information in this User Guide applies to the ZOLL Circulation AutoPulse® Battery Charger designed for the AutoPulse Resuscitation System Model 100. The AutoPulse Power System consists of two main components: the AutoPulse Battery Charger and the AutoPulse Battery.

Proper use of the AutoPulse Power System requires a thorough understanding of the Power System, and appropriate training and practice using the Power System.

Always charge a stored Battery before placing the Battery in active operation. Battery may self-discharge when not in use. Failure to charge a Battery before use may cause device power failure.

Introduction of the AutoPulse Power System:

The AutoPulse Power System represents a state-of-the-art breakthrough in battery technology and one of the breakthroughs that make the AutoPulse Resuscitation System possible. The AutoPulse Battery communicates with the AutoPulse Battery Charger or with the AutoPulse Platform when it is plugged into each respectively.

The Battery is intended to operate for a minimum of 30 minutes at a rate of 80 compressions per minute.

The Battery uses a lithium ion (Li-Ion) technology because Li-Ion delivers one of the highest power outputs of any battery technology. At the same time, Li-Ion does not have the limiting memory effect inherent with nickel-cadmium (NiCd) batteries or the higher weight associated with the higher mass-to-power ratio of lead-acid batteries. The Battery automatically monitors its readiness state. Finally, the Battery is mechanically keyed to the AutoPulse Platform and Battery Charger to facilitate correct installation.

Checking the Battery’s status allows you to determine the need for a charge to ensure adequate battery capacity (run time). A green LED ensures that the Battery has the capacity for a minimum run time of 30 minutes on a typical patient. Batteries self-discharge when not in use. Recharge the Battery before use if the amber LED illuminates.

Performing a Battery Status Check:

To determine if an AutoPulse Battery needs to be charged, press the white Status Check button on the Battery.

Green LED – Battery charged and ready for use. Amber LED – Battery is partially discharged and remaining runtime is unknown. Red LED – Battery has exceeded its service life or failed a test-cycle.

When a Battery is in the Battery Charger and the READY LED illuminates, leave the Battery in the Battery in the Battery Charger to maintain peak capacity.

Battery Charger Status LEDs:

Yellow LED – Battery is charging. Yellow LED on Charger and Amber on Battery – indicates that battery is in the Test-Cycle mode. Test/Cycle last approximately 12 hours. At completion of the Test-Cycle the Battery Charger will indicate READY or FAIL. Green LED – Battery is charged and ready to use. Red LED – Battery has failed or the Battery Charger is currently unable to charge the Battery. Try reinserting the

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battery again. If Red LED still illuminates then battery has failed and needs to be replaced.

Understanding Test-Cycles:

A test-cycle measures the Battery’s charge holding capability by cycling the Battery through a charge- discharge- recharge sequence. Batteries with a high charge holding capability pass the test cycle and remain available for continued use. Batteries that no longer accept a charge will fail the test-cycle and must be replaced as they can no longer be used in the AutoPulse System.

Note: The AutoPulse Battery Charger will automatically perform a Test-Cycle every 10th charge/discharge cycle or at a minimum of every 30 days. When a battery is placed in the battery charger under those conditions, the Test- Cycle Yellow LED will illuminate and the charger will automatically begin the Test-Cycle. The normal Test-Cycle requires up to 12 hours and the battery cannot be removed during the Test-Cycle. Documentation will be noted on the Battery Test-Cycle attached to the bottom of each Battery.

The Battery Charger will automatically perform a test-cycle: •Every 10th charge/discharge cycle.

•When the Battery Charger detects that the Battery has been severely discharged (no status LEDs will illuminate when you press the Battery’s Status Check button).

Note: Do not remove a Battery during a test-cycle or the Battery’s runtime will be unknown.

Removing a Battery during a test-cycle may cause the Battery Charger to automatically enter a test-cycle mode the next time a Battery is inserted into the Battery Charger.

At the end of one full test-cycle, if the Battery Charger’s TEST (amber) LED remains illuminated, the Battery Charger has determined that the Battery’s charge capacity remains compromised. In an attempt to restore the Battery, the Battery Charger will perform a second test-cycle (another six hours). If the Battery Charger’s TEST LED remains illuminated, the Battery Charger will attempt to perform a third test-cycle (another six hours). Following the third test- cycle, the Battery will either be ready for operation (green READY LED illuminated) or the Battery will have failed the test-cycle and must be replaced (red FAIL LED illuminated).

A Battery will fail a test-cycle following 100 charge-discharge cycles.

Note: Discontinue use of any failed Battery as it will no longer hold an appropriate charge. Notify the appropriate District Chief so that a replacement Battery can be obtained.

Battery Management:

The AutoPulse System is intended to be deployed on emergency vehicles in a state of high-readiness. Therefore, regular AutoPulse System checks should be integrated into Emergency Medical Service (EMS) rig-check procedures. Regular monitoring of AutoPulse Battery status is vital to ensure adequate run time. Discharged Batteries (amber status light-emitting diode (LED) on the Battery or less than four bars seen on the AutoPulse Platform’s display panel screen when the AutoPulse Platform is powered up) will result in shorter Battery run times. Discharged Batteries should be replaced with charged Batteries (green status LED or four bars seen on the AutoPulse Platform’s display panel screen).

The following essential elements of AutoPulse Battery management should be incorporated into a regular routine:

•Leave a fully-charged Battery installed in the AutoPulse Platform at all times.

•Leave a fully-charged spare Battery in the case that carries the AutoPulse System.

•Maintain one fully-charged Battery in the AutoPulse Battery Charger.

The Battery rotation preformed at the beginning of each shift is;

•Battery in Battery Charger becomes the spare. •Battery that is spare in case goes into the AutoPulse platform. •Battery in AutoPulse Platform goes into the Battery Charger.

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PROCEDURAL PROTOCOL ZOLL® AUTOPULSE® MODEL 100

CHAPTER 24.7.20

Issued: March 2013 Revised:

Submitted By: EMS Branch Approved By: Medical Director

Indication for Use:

The AutoPulse is intended to be used as an adjunct to manual CPR, on adult patients (> 18 years of age) only, in cases of non-traumatic cardiopulmonary arrest defined by a lack of spontaneous breathing and pulse.

Description of the System:

The AutoPulse is an automated, portable, battery-powered chest compressor, which provides chest compressions as an adjunct to performing manual CPR. Use of the AutoPulse is intended to reduce the impact of rescuer fatigue and will enable the rescuer to address additional patient needs.

AutoPulse Platform:

The AutoPulse Platform contains the mechanical drive mechanism, control system, and electronics necessary to generate and control the force required to perform mechanical chest compressions. User controls and indicators are contained in the User Control Panel.

LifeBand Load-distributing Band (LDB):

The LifeBand is a load-distributing band (LDB) that consists of a cover plate and two bands integrated with a compression pad with a Velcro® fastener. Attached to the AutoPulse Platform, the LifeBand is automatically adjusted to the patient and provides compressions to the patient's chest in the region of the heart. The latex-free LifeBand is a single-use component that is attached to the AutoPulse Platform before each use.

AutoPulse Power System Battery:

The AutoPulse Battery is a removable component that supplies power for the AutoPulse operation. The Battery is a proprietary, rechargeable, Lithium Ion (Li-Ion) battery that is the exclusive power source for the AutoPulse.

The Battery is mechanically keyed to the AutoPulse Platform and Battery Charger to facilitate correct installation. The Battery’s back end contains connections for power and communications to the Battery Charger and to the AutoPulse Platform. A Battery Status Check button illuminates the Battery’s status light-emitting diodes (LEDs).

Using the AutoPulse:

Before deploying the AutoPulse, note the following warnings and precautions:

Warning:

● The AutoPulse is intended for use on adults, 18 years of age or older. ● The AutoPulse is not intended for patients with traumatic injury (wounds resulting from sudden physical injury or violence). ● When CPR is indicated, manual compressions should be initiated immediately, while AutoPulse is prepared for application. ● The AutoPulse must be used only in cases that manual CPR would normally be initiated. ● Personnel certified in manual CPR must always be present during the AutoPulse operation.

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Caution: Use care while using sharp instruments around the LifeBand.

Caution: Do not block the vents of the AutoPulse Platform.

Deploying the AutoPulse System:

In order to deploy the AutoPulse quickly and with the least interruption in cardiac compressions, a pit crew model - similar to that which is used in auto racing - is suggested for roles and positions of the staff involved in performing defibrillation and using the AutoPulse.

CPR must be initiated and interruptions kept to a minimum when deploying the Auto Pulse.

1. Power up the AutoPulse. The ON/OFF button is located on the top (“head”) edge of the AutoPulse Platform. 2. The AutoPulse illuminates the green Power light-emitting diode (LED) on the User Control Panel and performs a self-test. Refer to the User Control Panel and its display panel during the operation of the AutoPulse. All operating information is available on the User Control Panel.

NOTE: Make sure that no User Advisory, Fault or System Error messages display.

3. The AutoPulse indicates that it is ready for use. 4. After assessing the patient’s condition and monitoring pads are in place, sit the patient up and remove the remainder of the upper torso clothing. 5. Slide the AutoPulse Platform into position behind the sitting patient and lay the patient down onto the Platform. 6. Position the patient so that he/she is centered laterally (from left to right) and that the armpits are aligned with the AutoPulse using the yellow line positioning guides on the platform. 7. Close the LifeBand around the patient's chest.

To properly align the two sides of the LifeBand:

a. Place band with yellow alignment tab on top of patient’s chest. b. Locate mating slot of the other band placing it over the alignment tab. c. Press the bands together to engage and secure the Velcro® fastener d. Lift up the LifeBand to its fullest, ensuring that the side bands are at a 90 degree angle to the platform, that they are not twisted and that there are no obstructions. e. Center the LifeBand on the patient's chest, placing it such that its center is over the area upon which manual compressions are conducted.

NOTE: If the bands cannot be closed or any other difficulty with the device is found, continue with manual CPR.

Starting Chest Compressions:

1. Make sure that the yellow upper edge of the LifeBand is aligned with the patient's armpits, and is directly over the yellow line on the AutoPulse Platform. Also make sure that there are no obstructions, such as clothing or equipment, with the bands. 2. Press and release the Start/Continue button once. The AutoPulse automatically adjusts the bands to the patient's chest. 3. The AutoPulse will pause for 3 seconds to allow you to verify that the patient is properly aligned and that the LifeBand has taken up any slack in the bands. (indicated on the Display Panel Screen)

NOTE: If the patient is not properly aligned, press the Stop/Cancel button, realign the patient, and begin compressions again.

4. After the 3 second pause to verify patient alignment is complete, compressions will automatically begin. You may press the Start/Continue button to immediately initiate compressions ahead of that time. 5. WARNING:

● Do not lean on the patient after pressing the Start/Continue button. ● If you must move or realign the patient, you must press the Stop/Cancel button before adjustment. ● Do not place your hands or any objects on or under the LifeBand while the AutoPulse is analyzing the patient or during active operation.

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6. The pre-set mode compression operation will be Continuous Compressions. In the Continuous Compression mode, it performs compressions with no pauses. In Continuous mode, an audio cue tone for ventilation will sound 8 times per minute.

7. To access the patient or to pause the AutoPulse for any reason, press the Stop/Cancel button. The AutoPulse Platform releases the tension on the LifeBand, allowing the user to pull the bands to the maximum extended position. 10 seconds after the Stop/Cancel button has been pressed a single audio alert tone will sound. Three audio alert tones will sound 20 seconds after the pause was initiated. Audio alert tones will sound continuously after 30 seconds into the pause.

NOTE: Opening the bands during active operation will cause the AutoPulse to stop operation immediately. To restart compressions, re-fasten the Velcro® fastener, clear the Fault by pulling up on the LifeBand and pressing Start/Continue and then follow the normal operating steps.

8. To restart compressions, press the CONTINUE button.

Ending Active Device Use:

1. After either successful resuscitation or termination of activities, press the Stop/Cancel button followed by the ON/OFF button. The Stop/Cancel button action will cease the compression cycles and relax the LifeBand. The ON/OFF button action will power down the AutoPulse.

2. Open the Velcro® fastener and lift or log roll off the patient from the AutoPulse Platform, as necessary.

Preparing the AutoPulse for Its Next Use:

1. Remove the LifeBand from the AutoPulse Platform. 2. Discard the LifeBand as it is a single-use component. Treat the LifeBand as contaminated medical waste and dispose of it accordingly. 3. Clean the AutoPulse Platform before its next use. 4. Replace the LifeBand before returning the AutoPulse to service. 5. Remove the AutoPulse Battery.

NOTE: Ensure that the AutoPulse is powered down before removing and replacing the Battery.

6. Replace the Battery with a fully charged Battery before returning the AutoPulse to service. 7. Recharge the used Battery as necessary for future use.

Periodic Electrocardiogram (ECG) Monitoring and/or Defibrillation/ETCO2:

When the AutoPulse is used in conjunction with defibrillators or with other therapeutic devices that must monitor an ECG signal or to continuously evaluate to determine when ROSC has occurred (ie jump in ETCO2 level ex- 10-20), interruption of the compression cycles may be required to avoid ECG motion artifact associated with mechanical chest compressions, need for defibrillation and/ or determine if ROSC has occurred.

To temporarily interrupt the AutoPulse’s active operation, press the Stop/Cancel button.

To restart the AutoPulse press the Continue button.

Patient Alignment and Securing for Transport:

WARNING: The AutoPulse is not intended for carrying or transporting a patient. The AutoPulse should be placed on the soft stretcher to carry or transport the patient, if necessary. During transport, regular checks of the patient’s alignment should be

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performed.

The AutoPulse does not require any patient restraints to perform compressions while the patient is lying on a flat surface. However, patient restraints should be used to maintain alignment of the patient to the AutoPulse.

● If the AutoPulse cannot be set on a flat level surface

● If the AutoPulse is used during extrication or during transport

The AutoPulse is designed to accept standard restraints to maintain patient alignment. The rescuer can secure a patient of up to 300 pounds, chest circumference not to exceed 51.2 inches or chest depth not to exceed 15 inches.

Caution: Motion can cause the patient to shift and restraints to loosen, so care should be given to the initial strapping for alignment of the patient to the AutoPulse. Regular checks of patient alignment to the AutoPulse and alignment of the LifeBand to the patient's mid-axillary line should be made if the AutoPulse is performing active compressions, or before active compressions are restarted.

When transporting the patient, lift by supporting the patient and the AutoPulse onto the stretcher utilizing the soft stretcher and place the AutoPulse and patient within the vehicle during AutoPulse operation. Secure the AutoPulse and patient to the stretcher.

Caution: Straps or restraints used for transportation purposes must not interfere with the operation of the AutoPulse. Specifically, straps across the patient’s chest may restrict the compression/ decompression of the chest. In general, strapping schemes must not alter the alignment of the patient to the AutoPulse.

Remember to attach the included combination AutoPulse Shoulder Restraint/Head Immobilizer before moving.

1. Attach the Shoulder Restraint to keep the patient properly aligned on the AutoPulse Platform, therefore making for easier transport. 2. The Head Immobilizer assists in keeping the patient's head from moving, especially when combined with a cervical collar. A cloth may also be placed under the patient's head. 3. When lifted, the Soft Stretcher has a cradling effect that helps maintain alignment of the patient on the AutoPulse. Users can also allow the patient's lower legs to bend freely at the knees, facilitating moving around tight corners, elevators, and stairwells.

Always ensure the following:

1. Make sure that the patient's armpits and the upper edge of the LifeBand are aligned with the yellow line on the AutoPulse.

2. Make sure that the LifeBand is not twisted and properly mated with the Velcro®.

3. Maintain the LifeBand at 90 degrees with the AutoPulse Platform. Ensure that the LifeBand is not impeded by anything such as the patient's arms, clothing, straps, and buckles that may interfere with the movement of the LifeBand.

AUTOPULSE DAILY BATTERY ROTATION AND CHECKOFF

Batteries for the AutoPulse will be rotated on a daily basis utilizing the following battery rotation procedure.

● Battery in charger will replace battery in AutoPulse Platform. ● Spare battery in AutoPulse bag will be placed in the Battery Charger. ● Battery that was in AutoPulse will become spare in bag.

Once a new battery from charger is placed in AutoPulse, the AutoPulse needs to be powered on using the ON/OFF button. This allows the AutoPulse to run an analysis of the battery. The screen will advise if the battery needs to be recharged/replaced.

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Cleaning the AutoPulse Platform:

1. Remove and dispose of the LifeBand. 2. Wipe all the surfaces of the AutoPulse Platform free of foreign matter and spills with a disinfectant or bactericidal wipe. Check the vents to ensure that they are free and clear of any obstructive matter. 3. Install new LifeBand and ensure that the AutoPulse is dry before storing.

Click to view Flow Chart below

AUTOPULSE PIT CREW DEPLOYMENT

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APPENDICIES PEDIATRIC TRAUMA SCORE

CHAPTER 24.8.1

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

COMPONENT 2 POINTS 1 POINT -1 POINT Size >20 Kg 10-20 Kg <10 Kg Airway Normal Maintainable Un-maintainable Systolic BP >90 mm HG 90-50 mm Hg <50 mm Hg CNS AWAKE OBTUNDED COMATOSE Open Wound None Minor Major/penetrating Skeletal None Closed FX Open/multiple FX

(If proper size BP cuff not available, BP can be assessed by assigning 2 points for a palpable pulse at the wrist, 1 point for a palpable pulse at the groin, and –1 point if no pulse palpable.)

I. SIZE: When a given amount of energy is imparted to a smaller child (with less reserve), the potential for severe injury is much greater, so smaller children have high injury potential.

II. AIRWAY: Airway management is more difficult in children because of size and anatomy and the greater difficulty in obtaining a surgical airway when needed, requiring the skills which probably only reside at a trauma center.

III. SYSTOLIC BLOOD PRESSURE: Systolic blood pressure is assessed to provide an initial evaluation of cardiovascular status; “low”blood pressure may reflect normal physiology for a small infant, or reflect Decompensated shock with impending arrest in an older child.

IV. CNS: Level of consciousness is the most important factor in determining neurologic status, and any deviation from totally awake and normal with no history of abnormality demands heightened attention.

V. OPEN WOUND: Any abrasion may reflect internal injury or fracture more often than in adults; certainly, any penetrating injury or major avulsion/laceration may reflect such an injury.

VI. SKELETAL: Children with skeletal trauma are more likely than adults to have associated blunt trauma to the trunk area, and this adds greatly to general morbidity.

The score range is -6 (injured worst) to +12 (injured least).

Studies have shown that no children with PTS of greater than 8 died; though they certainly may have been seriously injured. All children with PTS of less than 1 died. 3% of those who had PTS of 7-8 died. Therefore, any child with PTS of 8 or less should be taken to the highest-level trauma center available.

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APPENDICIES REVISED TRAUMA SCORE

CHAPTER 24.8.2

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

The Revised Trauma Score (RTS) is a standardized method of reporting the severity of injury of the trauma patient in the pre-hospital setting, because of it’s reliance solely on objective parameters, it’s use is to be preferred to that of the Trauma Score in patient care conducted by ACFR/GFR/ShandsCair personnel.

Parameter Revised Trauna Score Point

Glasgow Coma Score: 13-15 4 9-12 3 6-8 2 4-5 1 3 0 Systolic Blood Pressure >89 mm Hg 4 76-89 mm Hg 3 50-75 mm Hg 2 1-49 mm Hg 1 None 0 Respiratory Rate 10-29/min 4 >29/min 3 6-9/min 2 1-5/min 0 Total Revised Trauma Score 0-12 ______NOTE: A lower Total Revised Trauma Score reflects an increased severity of injury and mandates consideration of patient transport to a trauma center or the closest appropriate facility.

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APPENDICIES PEDIATRIC TRAUMA ASSESSMENT METHODOLOGY

CHAPTER 24.8.3

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Click to view

Pediatric Trauma Assessment Methodology

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APPENDICIES ADULT TRAUMA TRIAGE CRITERIA & METHODOLOGY

CHAPTER 24.8.4

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Click to view ↓

ADULT TRAUMA TRIAGE CRITERIA & METHODOLOGY

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APPENDICIES NORMAL PEDIATRIC VITAL SIGNS

CHAPTER 24.8.5

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Age Weight (kg) Pulse Respirations B/P

Newborn 3 140 40 80/50 6 months 6 140 30 90/60 1 year 10 120 25 90/60 5 years 20 100 20 100/60 15 years 50 80 14 120/80

(Adult values are applicable from age 15 on)

To estimate pediatric weight: Estimated wt (Kg) = 2 x (age) + 10 Example: For 7 year old child, wt = (2 x 7) + 10 = 24 Kg

To estimate pediatric endotracheal tube size: Use diameter of patient’s little finger as gauge of needed tube size; OR

Tube size = (16 + age) 4

Example: For 7-year-old child, tube size 16 + 7 = 5.75 4 (Approx. a 5.5 or 6.0 ETT)

Pediatric defibrillation dose:

2 joules/Kg, followed by 4 joules/Kg, followed by 4 joules/Kg

Pediatric major ACLS drug doses:

Epinephrine 0.01 mg/Kg Atropine 0.02 mg/Kg (min. dose 0.2 mg) Lidocaine 1 mg/Kg Dextrose 0.5 - 1 gm/Kg Naloxone 0.4 - 2 mg NaHCO3 0.5 - 1 mEq/Kg Versed 0.1 - 0.5 mg/Kg max 5 mg total

Pediatric Blood Sugar Values

0-2 years: 40-60 gm/dl

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2-8 years: 60-80 gm/dl

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APPENDICIES ALTERNATE ROUTES OF DRUG ADMINISTRATION

CHAPTER 24.8.6

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

The preferred route of drug administration shall be intravenous when not otherwise specified in operational protocols. However, providers must be aware of alternate routes of drug administration and make this information available to base station physicians when difficulties arise in giving required fluids and/or medications.

INTRAOSSEOUS Any drug given IV may be given via the intraosseous route:

ENDOTRACHEAL The following drugs may be given via the endotracheal route:

● Naloxone ● Atropine ● Epinephrine ● Lidocaine ● Vasopressin

When drugs are given endotracheally, they should be diluted with 10-15 cc NS prior to administration; administration must be followed by hyper-insufflation of the lungs to promote optimal drug absorption. Use 2-2.5 X recommended dosage, preferably done by administering through IV tubing past the end of the ETT.

SUBLINGUAL The following drugs may be given sublingually (injected into the venous plexus at the base of the tongue):

● Nitroglycerin ● Capoten ● Glucose paste

INTRAMUSCULARLY The following drugs may be administered intramuscularly:

Atropine Morphine sulfate Naloxone Haldol Phenergan Glucagon Toradol Diazepam Diphenhydramine Furosemide Lidocaine

Use of the IM route is to be highly discouraged due to slow and erratic absorption of drugs from deep IM sites.

TRANSCUTANEOUS The following drugs may be administered transcutaneous:

● Nitroglycerin paste

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APPENDICIES APGAR SCORING

CHAPTER 24.8.7

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

The Apgar score provides a measure of the well being of the newly delivered infant. It is composed of the parameters of appearance, pulse, irritability (grimace), muscle tone (activity), and respirations. The scores may be from 0 to 10; higher scores are more indicative of neonatal well being. APGAR scores should be determined both one and five minutes after delivery; the five minute score is most significant.

Parameter 0 points 1 point 2 points

Heart Rate 0 <100 >100

Respirations absent slow, irregular good, crying

Irritability to slap 0 grimace cry

Musle Tone Flaccid some reflex active motion

Color blue/pale body pink all pink

Total score = sum of each parameter score

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APPENDICIES APPROVED ABBREVIATIONS FOR DOCUMENTATION

CHAPTER 24.8.8

Issued: May 2010 Revised:

Submitted By: Technical Services Approved By: Medical Director

Click to view ↓ Approved Abbreviations for documentation

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APPENDICES APPROVED MEDICATION

CHAPTER 24.8.9

Issued: May 2010 Revised: Feb 12, Dec 12

Submitted By: EMS Branch Approved By: Medical Director

Click to view ↓

APPROVED MEDICATION LIST

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TECHNICAL RESCUE GUIDELINES

CHAPTER 25.1

Issued: 04/08 Revised: 09/09, January 2010

Submitted By: Ed Kennedy, District Approved By: Ed Bailey, Chief Chief

Purpose

The purpose of this program is to provide dedicated teams of individuals capable of performing rescue operations requiring specialized equipment and techniques. The areas of specialization include, but are not limited to, high angle rope rescue, confined space, trench rescue, building collapse, vehicle and machinery extrication.

Responsibility and Authority

Alachua County Department of Public Safety maintains a State of Florida recognized Type II Light Technical Rescue Team (LTRT). This team is considered a state wide resource and is deployable as a single unit or in conjunction with Florida Task Force 8 for urban search and rescue (USAR). As a Type II Light Technical Rescue Team the unit is capable of immediate response if needed and can, be deployed as part of a force USAR response within 3 hours.

Organization

The Team Manager is responsible for administration of the Type II Light Technical Rescue Team.

The LTRT vehicles and equipment will be located at Station 16. Every effort will be made to ensure that at least 6 members of the Team are on duty at all times. Requests for the LTRT) to respond to an incident may be made through the State of Florida or through Mutual Aide.

Member Qualifications

All members of the Type ll LTRT will be certified to the Operations Level in the five (5) disciplines as outlined by the State of Florida.

Team members who meet the Technician Level are encouraged to get additional training to the Specialist Level.

The Technical Branch of Alachua County Department of Public Safety will oversee all training and shall keep a separate training folder for each individual in the program.

All members of the LTRT are required to demonstrate proficiency appropriate of technical skills on a yearly basis as mandated by the State of Florida. The Technical Services Branch of ACDPS will assist the Team Manager to accomplish this objective.

Response

Response for a Catastrophic Event with no warning

The Team Manager will be notified of any event that requires a response within 3 hours. Once notified, the Manager will contact the on duty District Chiefs to assist in contacting individuals who are available for response. The response teams will be designated Red, White and Blue and will consist of 6 personnel. In the event that a team member cannot be deployed he/she is responsible for ensuring that an alternate has been selected. The name of the alternate shall be given to the team manager prior to any deployment actions.

The Team Manager will contact the Section Chief of Fire Rescue or designee to secure all necessary pre deployment information including but not limited to: Tasking number from State, names and contact information for

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deployed members.

The Team Manager will ensure that contact is made with the assigned Task Force leader and that an appropriate assembly place for the team is established.

Currently for a deployment north of Gainesville the Task Force assembly point is Station 16; for a deployment south of Gainesville the assembly point is Marion County Station 20.

The Task Force Manager or designee will ensure that the ACDPS component is self sufficient for at least 5 days. Supplies should include water, MRE’s, cots and ATV’s.

During deployment the Team Manager will, when possible, contact the Section Chief of Fire Rescue or designee to provide updates and expected demobilization dates. The Team Manager will have in their possession a Departmental issued phone.

Upon returning from deployment, the Team Manager or designee shall submit within a reasonable period of time the following: payroll records, injury reports if necessary and an after action report documenting all activities of the team during deployment. Team personnell will be paid in accordance with adopted deployment policies and procedures.

Response for an Anticipated Event

Incidents such as hurricanes, political gatherings and sporting events are usually anticipated and require a less urgent response of USAR personnel.

If possible the Team Manager will brief crews prior to the event providing information about the teams anticipated activities. Personnel on call for the event will be updated on the status of the pending event.

Necessary supplies (food, water, ATV’s, transportation) will be inventoried and moved to Station 16.

Upon returning from deployment, the Team Manager or designee will complete all required paperwork as outlined previously.

Immediate Response

When notified of an event requiring the immediate response of the Type II Light Technical Rescue Team. The on duty District Chief shall contact the Team Manager and relay the need for urgent action. If possible the Team Manager will accompany the team to the incident. It will be the responsibility of the on duty District Chief to obtain all information prior to the deployment of the team. This information will include a task number, location of the event, type of event and anticipated length of deployment.

A response of the LTRT requires six (6) Operations Level trained personnel. In the event that ACDPS cannot immediately accommodate this provision, the on duty District Chief will contact the Gainesville Fire Rescue Department (District One) and request assistance. The decision to respond shall be based on the ability to provide the necessary personnel and equipment.

Apparatus utilized to transport the response team may include Squad 16, 16, Rescue 16 and a Command vehicle. On extended operations the District Chief in charge of scheduling will immediately to backfill those personnel and apparatus committed as LTRT.

In the event that a complete response cannot be generated the requesting agency shall be informed of ACDPS’s resources. It is possible that ACDPS’s personnel might still respond if requested.

Equipment Inventory

An inventory of the LTRT equipment cache will be maintained by personnel assigned to Station 16 “B” shift. The operational status and location of this equipment will be determined monthly, commencing on the first “B” shift of each month. All deficiencies will be reported to the Team Manager.

See appendix for equipment inventory.

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Training

All personnel assigned to the LTRT (all personnel certified to Operations Level) will be evaluated annually to ensure that skills are current. The document to be utilized for this review (Operations level only) will be the State “Member Readiness Evaluation“. The Training Officer assigned with the duties will ensure that all members meet or exceed all applicable skills as listed on the form.

At least two hours of technical rescue training will be conducted each week. A Company Officer or designee will supervise and document each session adhering to departmental guidelines. The Team Manager will review the Technical Rescue training documents monthly and report these activities to the Technical Services Branch by the 15th of each month.

Additional training activities may be initiated by the Team Manager.

Appendix 1

Training Calendar for Technical Rescue Team January Collapse

February Vehicle/Machinery Extrication

March Confined Space

April Trench

May Ropes

June Deployment readiness

July USNG

August Equipment Skills

September Assigned by Company Officer

October Field Operation Guide ( FOG )

November Assigned by Company Officer

December Review and make up sessions if applicable

Appendix 2

Equipment Inventory

8-10 Lb Sledge Hammer 2

3-4 Lb. Sledge Hammer 2

Cold Chisel (1’’X 7 ⅞ ”) 2

Pinch Point Pry Bar ( 60”) 4

Claw Wrecking Bar (3’) 2

Hacksaw ( heavy duty Stanley) 2

Carbide Hacksaw Blade pkg. 3

Crosscut Hacksaw (26”) 2

Bolt Cutter (30”) HK Porter 1

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Scoop Shovel “D”Handle 1

Axe (Flat Head) Nupla 1

Axe (Pick Head) Nupia 1

Shovel, Long Handle SQ. Pt. 1

Shovel, Long Handle Rd. Pt. 1

Chain set 1 ea 1’’.w/grab hook on each end Omaha Sling 1

1 ea. ⅜ 5’ w/grab hook & slip hook 1

1 ea. ⅜10’ w/grab hook & slip hook 1

Come Along (3 ton)Little 404 wna 1

Air Bag Set 1

Tape Measure ( 25’) Stanley 33-600 2

Framing Hammer ( 24oz) Estwing 2

Tri or Speed Square Johnson RAS 1 2

Carpenter belts 2

Generator ( 5kw) Honda 1

Floodlight (500wt) Pro Series 6

Extension Cords (50’) 6

Wye Electrical adapter 1

5 ft X 1 in. Tubular Web Blue 6

12 ft X 1 in. Tubular Web Yellow 6

15 ft X 1 in. Tubular Web Orange 6

20 ft. X 1 in. Tubular web Red 6

CMC Rescue Pick-off Strap 1

CMC ProTech Fire-Rescue Harness L/XL 2

150 ft X ½ in CMC Rescue Lifeline Orange 1

150 ft X ½ in CMC Rescue Lifeline Red 1

6 ft X 8mm Prusik cord Teal 6

Ultra-Pro Edge protector 2

CMC Large Steel Carabiner, Gold 12

CMC Large Steel Carabiner,Gold ( stretcher ) 4

CMC Rescue ProSeries Single Pulley 3

CMC Rescue Aluminum 8 w/ears,black 2

CMC Rescue #2 Rope Bag, Orange 1

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CMC Rescue #2 Rope bag, Red 1

CMC Proseries Rescue Harness 1

Traverse titan Rescue Stretcher (tapered) 1

Four Gas meter IST AIM 600 1

Electrical Detection Device 1

Lock Out/ Tag Out Kit 2

Chain Saw Stihl 1

Saw Circular 10 ¼ w/blades 1

Sawsall, Milwaukee 1

Technical Search Device, Snake Eye 1

Sawsall, Dewalt 1

Gibbs Ascenders 2

Ladder Rack 1

Carabiners, Red 2

Etrier 1

Load Release 2

Generator, Honda 1

Welding Kit 1

Replacement Parts for Generator/Welder 1

Appendix 3

Directive on the Usage of Alachua County Department of Public Safety’s All Terrain Vehicles (ATV)

1. ATV’s are to be utilized by members of either the USAR Team or Light Technical Rescue Team.

2. Currently the ATV’s are stationed at Station 16. Maintenance and operational issues will be assigned to “C”Shift. All repairs will be conducted by Alachua County Fleet Management.

3. In the event of a deployment, the ACDPS Team Leader will secure all transportation requirements for the ATV's.

4. The following Safety requirements shall be followed at all times:

a) Helmets will be worn whenever the vehicle is moving.

b) Eye Protection to be worn at all times.

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c) Long pants and boots are required whenever operating an ATV. During deployments a long sleeve shirt/jacket will be worn.

d) Ride within your abilities.

e) One rider per machine.

f) Check weather forecast, if lightening is present seek a safe shelter.

g) Obey all traffic and information signs.

h) If operating in nighttime conditions, a flashlight must be carried in case of an emergency.

i) During emergency operations, a two way radio must be carried by the operator.

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