Transcript CC_Presentation

Crew Chief Class
The Crew Chief Class
• Introduction to the Position
• Rules & Responsibilities
• Duties of the Crew Chief
• “Good Clinical Judgment”
• Useful Information
• PCR Writing & Documentation
• Written Examination &
Procedures for Advancement
Introduction to the
Position
Who or What is a Crew Chief?
– The person in charge of
a crew
– “Leader” of the Crew
– “Procedurally InCharge”
– In charge of all patient
care given
– Is at least a NY State
EMT-B (Can be an AEMT I,
CC, or P)
– Ensures crew follows
all Agency Procedure
and Protocols
Rules & Responsibilities
• Rules
– RPI Ambulance Standard Operating
Procedures (SOPs)
• 04-04 & 04-07 Describe the Position
• 04-05 Describe the Training Process
– NY State Department of Health
• Public Health Law Article 30
– Defines the Emergency Medical Service System &
Other Associated Requirements
• 10 NYCRR Part 800
– More Laws Governing EMS & Ambulance
Operations
• 10 NYCRR Part 18
– Law About Public Functions and EMS
– US Government
• Health Insurance Portability and Accountability
Act (HIPAA)
– The Privacy Law!
• Rules: Where can I find them?
– RPI Ambulance Standard Operating
Procedures (SOPs)
• http://ambulance.union.rpi.edu/SOPs2004.doc
– NY State Department of Health
• Public Health Law Article 30
– http://www.health.state.ny.us/nysdoh/ems/art3
0.htm
• 10 NYCRR Part 800
– http://www.health.state.ny.us/nysdoh/ems/part
800.htm
• 10 NYCRR Part 18
– http://www.health.state.ny.us/nysdoh/ems/part
18.htm
– US Government
• HIPAA
– http://www.hhs.gov/ocr/hipaa/
• Rules: When Can I start Crew
Chief Training?
“Any individual who acts in the capacity of
Crew Chief must be properly credentialed as
an R.P.I. Ambulance Crew Chief or must be a
valid Crew Chief Trainee with a Crew Chief
Trainer present. As such, any person acting as
the Crew Chief must meet the qualifications
as set forth in Policy # 04-05.”
– Hold a valid NYS EMT-B certification
– Be an Attendant
– Attend and pass the written exam for the
RPI Ambulance Crew Chief Training Class
• Responsibilities
–You’re In Charge
•Of the Crew
•Patient Care rendered by you & your
Crew!
•Crew Morale
•All Appropriate Documentation (Patient
Care Reports (PCRs), Incident Reports,
Training Evaluations, etc)
• Responsibilities
“The position of Ambulance Crew Chief is the
highest credentialed position in the
Ambulance Crew. Becoming an Ambulance
Crew Chief involves not only medical
proficiency, but also thorough knowledge of
all Operating Policies and an ability to lead
the crew effectively. The Crew Chief Trainee
should, while training, act in the capacity of
Crew Chief to the best of his or her ability.
The training period is a time to gain experience
with a trained Crew Chief on board. The Crew
Chief Trainee is encouraged to attend as many
drills as possible as they are a good source
of knowledge and training.”
Duties of the Crew Chief
• Duties During a Crew
–Completion of an Ambulance
Equipment Checklist
–Reporting any discrepancies or
problems to the Duty Supervisor
–Try to fill any vacancies on the crew
–Provide training opportunities if time
allows
–Maintain Crew Morale
–Remember you’re a student first
• Duties During a Call
–Confirm Crew and try to include
trainees
–Advise Driver of appropriate level of
response (Priority I or II)
–Plan usage or resources and
equipment en route
–All radio communications
–Scene Safety
–In charge of Patient Care Given and
ensure Patient receives appropriate
care (BLS Transport, ALS,
Helicopter, etc)
• Duties During a Call (continued)
–Allowing other members to train as
appropriate
–Make appropriate Hospital
Destination Choice
–En Route to Hospital give report
over VHF radio
–Transfer patient to receiving medical
facility with report
–Complete paperwork and verify
ambulance is ready for the next call
–Go back in service as quickly as
possible
“Good Clinical Judgment”
New York State BLS Protocols
“These protocols are not intended to be absolute and ultimate
treatment doctrines, but rather standards which are flexible to
accommodate the complexity of the problems in patient
management presented to Emergency Medical Technicians (EMTs)
and Advanced Emergency Medical Technicians (AEMTs) in the
field. These protocols should be considered as a model or
standard by which all patients should be treated. Since patients
do not always fit into a "cook book" approach, these protocols
are not a substitute for GOOD CLINICAL JUDGMENT, especially
when a situation occurs which does not fit these standards.“
Review of a Few Protocols
• “Adult Major Trauma”
– Mechanisms of Injury
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1. Ejection or partial ejection from an automobile
2. Death in the same passenger compartment
3. Extrication time in excess of 20 minutes
4. Vehicle collision resulting in 12 inches of intrusion
in to the passenger compartment
5. Motorcycle crash >20 MPH or with separation of
rider from motorcycle
6. Falls from greater than 20 feet
7. Vehicle rollover (90 degree vehicle rotation or
more) with unrestrained passenger
8. Vehicle vs pedestrian or bicycle collision above 5
MPH
Review of a Few Protocols
• “Adult Major Trauma” (continued)
– Physical Findings
• 1. Glasgow Coma Scale is less than or equal to 13
• 2. Respiratory rate is less than 10 or more than 29 breaths
per minute
• 3. Pulse rate is less than 50 or more than 120 beats per
minute
• 4. Systolic blood pressure is less than 90 mmHg
• 5. Penetrating injuries to head, neck, torso or proximal
extremities
• 6. Two or more suspected proximal long bone fractures
• 7. Suspected flail chest
• 8. Suspected spinal cord injury or limb paralysis
• 9. Amputation (except digits)
• 10. Suspected pelvic fracture
• 11. Open or depressed skull fracture
Review of a Few Protocols
• “Adult Major Trauma” (continued)
– “High Risk Patients
• 1. Bleeding disorders or patients who are on
anticoagulant medications
• 2. Cardiac disease and/or respiratory disease
• 3. Insulin dependent diabetes, cirrhosis, or morbid
obesity
• 4. Immunosuppressed patients (HIV disease, transplant
patients and patients on
• chemotherapy treatment)
• 5. Age >55
– Treatments?
• ABC’s, Immobilization, Oxygen, Request ALS,
Transport Rapidly to Trauma Center
Review of a Few Protocols
• “Suspected Stroke (CVA)”
– ABC’s, Oxygen, History of Present Illness,
Cincinnati Prehospital Stroke Scale
– Transportation Decision?
• Go to Stroke Center if the total prehospital time
(time from when the patient’s symptoms and/or
signs first began to when the patient is expected
to arrive at the Stroke Center) is less than two
(2) hours.
Review of a Few Protocols
• “Altered Mental Status”
– Scene Safety, ABC’s, Oxygen, Level of
Consciousness, Request ALS, History of Present
Illness
• Treatments of Known Conditions such as Diabetes
• These were only 3 of the NYS BLS Protocols!
You need to know your protocols well, you
should have received them in EMT Class. Now
is the time to make sure you know them
backwards and Forwards!!!
The Area Hospitals
•Samaritan Hospital
•Stroke Center
•Saint Mary's Hospital
2215 Burdett Ave Troy, NY
~4 Minutes
1300 Massachusetts Ave Troy, NY
~5 Minutes
•Albany Medical Center 43 New Scottland Ave Albany, NY
•Trauma, Stroke Center, Cath. Lab ~15 Minutes
•Saint Peter’s Hospital
315 S. Manning Blvd Albany, NY
•Cath. Lab
~20 Minutes
•RPI Student health Center Academy Hall RPI Campus
The Area Hospitals (The Rarer Ones)
•Albany Memorial
600 Northern Blvd Albany, NY
~15 Minutes
•Albany VA Stratton
113 Holland Ave Albany, NY
•VA: Veterans
~15 Minutes
•Ellis Hospital
1101 Nott St. Schenectady, NY
•Stroke Center
~30 Minutes
•Saint Claire’s Hospital 600 McClellan St. Sch’dy, NY
~30 Minutes
•Bellevue Maternity Hospital
2210 Troy-Sch’dy Road Niskayuna, NY
•OB/GYN
~20 Minutes
Useful Information
Radio Communications:
Determinants
–Alpha: BLS Priority II
–Bravo: BLS Priority I
–Charlie: ALS & BLS Priority I
–Delta: ALS & BLS Priority I
–Echo: Cardiac or Respiratory Arrest
ALS & BLS Priority I (anyone with an
AED)
Radio Communications: The dispatch
• RPI Ambulance is dispatched on Channel 1 on
RPI Ambulance’s Radios:
– Dispatcher: “Stand By RPI Ambulance”
– Tones
– Dispatcher: “Stand By RPI Ambulance for a
<determinant> determinant EMS call for
<Demographics> <Chief Complaint> at
<Location>”
• Example: “Stand By RPI Ambulance for a bravo
determinant EMS call for a 18 year old male
patient with a Laceration at the RPI Houston
Field House”
Radio Communications
• “800 Mhz”
– Radioing Dispatch. Call sign 5959
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Acknowledging Call, Confirming Crew
En route to scene
on scene
En route to hospital
Arrive at hospital
In service
In Quarters
• Portables (HT750 155.220)
– Amassing Crew and Communication during operations.
Call sign RPI Ambulance Car xx
Advanced Life Support (ALS)
• How do I Get it?
– Radio Dispatch.
• Who do I get it from?
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Troy Fire Department
Mohawk Ambulance
Empire Ambulance
North Greenbush Ambulance
• Meeting up with ALS
– Choices: Await ALS Intercept or ALS on Scene?
Mutual Aid
• What is it?
• Who may call us for it?
– City of Troy
– North Greenbush
– Poestenkill
– Brunswick
• Who do we call for it?
– Troy Fire Department
– Mohawk Ambulance
– Empire Ambulance
Other Circumstances
• Equipment Failure
• Child or Elder Abuse
• Hospital Diversion
• Field House Operations
• MCI Protocols
• Contacting medical control
• RMA’s
– Rights, Clinical Findings, and Possible
Consequences up to and including death.
– Signature of Patient or Patient’s Guardian
and a Witness are required.
– Completion of a REMO RMA Checklist
Hospital Radio Reports
• Needs the following Information
– Patient’s Age and Gender
– Estimated Time to Arrival (ETA)
– Chief Complaint and History of Present
Condition
– Pertinent Past Medical History
– Treatments and Vital Signs
– “Do you Require anything further?”
Hospital Radio Reports
• Example:
• “Samaritan Hospital, RPI Ambulance. Currently en route to
your facility with an 18 years old male patient with a 5 minute
ETA. Patient twisted his knee earlier this evening playing
soccer. Knee is immobilized, cold applied, on oxygen. Vital
signs within normal limits and the patient is resting
comfortably, do you require anything further?”
• Example:
• “Albany Medical Center, RPI Ambulance. Currently en route
to your facility with a 25 years old male patient with a 15
minute ETA. Patient involved in a head on motor vehicle
accident, approximate speed 30 mph and struck a tree. Pt is
complaining of severe abdominal pain and tenderness in the
Upper Quadrants. Patient is immobilized and on oxygen. Vital
signs as follows BP102/70, Pulse 124 sinus tachycardia on
monitor, Respirations 26, spO2= 93% on Oxygen, Pupils
PEARRL. Troy Fire ALS on board, Patient is IV positive with
two large bore IVs. do you require anything further?”
PCR Writing &
Documentation
• The PCR
– What is it?
• A complete written record of your Patient
Assessment, care given, and Transporting of
the Patient to the hospital
• It is a Legal Document!
• It is a triplicate form with one copy being left
with each of the following organizations
– Receiving Hospital
– Agency
– REMO or the State
1 0 12 05
0 8 13 33
4130
5939
RPI Ambulance
1400
Traumatic Injury
RPI Harkness Field
4102
1.0
1403
0.0
1406
1.0
1424
1427
JOHN
DOE
1445
1445
123 Fake Street
518
123
4567
•
TROY
19
NY 12180
09 17
1986
• 000
00 0000
•
B
RPI DPS, TFD E2
L. Lawrence, MD
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HT
•Twist
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ASA
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1410
1420
22
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20
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Albuterol
1425
22
•
80 130
•
90
84 132
•
•
•
P
80 124
•
P
•
4
5
6/15
4
5
6/15
4
5
6/15
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•
•
•
••
•
••
•
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PtA, V/S, LS, spO2
SAMARITAN HOSPITAL BED 8
412
Crew Chief
Driver
Attendant
Observer
•
300000
•
333333
OBS
OBS
• Chief Complaint and Narrative
– Chief Complaint: I twisted my knee playing soccer
– Narrative: U/A 19 y/o ♂ found lying supine on the
ground I/C/O RPI DPS and TFD E2 c/o while playing
soccer and running and feeling his R knee pop. Pt is
complaining of 5/10 pain from the incident that
happened approximately 15 min /a to EMS arrival. +
Patent, self- maintained airway. Breathing 22/min /s
labor /c +, = chest rise and fall LS clear = ,
bilateral –SOB, diff breathing, JVD, tracheal
deviation. spO2=98% RA. Pt put on O2 via NRB @ 12
LPM ↑ spO2=100%. Circulation 80/min strong and
regular BP= 130/90 skin warm and dry. –Gross
Bleeding, Obvious Deformities –CP, N/V/D,
dizziness, lightheadedness, headache +CSMx4. Pt
AOx3 /c GCS= 15 (4,5,6). Upon P/E R knee swollen
in comparison to L, R leg immobilized /c CSM in R leg
/a & /p splinting. Ice pack applied to R knee. P/E
otherwise unremarkable and within normal limits.
Pt transported to 412 ED /s incident /c ↓ in pain to
3/10. Pt transferred to Bed 8 and left I/C/O RN
/c rails up x2, report, and in possession of
belongings.
REMO Approved Abbreviations
•
Available online http://www.remo-Ems.com/abbrev4.pdf
The Most Important Ones!
c/o: complaining of
♀: female
/c: with
/s: without
♂: Male
/A: before
/p: After
TXF: Transferred
TXP : Transported
CP: chest pain
SOB: Shortness of Breath
ABD: Abdomen
N/V/D: Nausea, Vomiting, Diarrhea
TOT: Turned over to
LS: Lung Sounds
VS: Vital Signs
CSMx4: Circulation, Sensation, Motor x4
Pt : Patient
P/E: Physical Exam
HTN: Hypertension
spO2: Pulse Oximetry
LOC: Loss of Consciousness
U/A: Upon Arrival
Y/O: Years Old
AOx3: Alert & Oriented x3
JVD: Jugular Vein Distension
I/C/O: In Care of
Δ: Changes
Written Examination &
Procedures for
Advancement
• The Requirements
– Backup Crew Chief
– A. Hold a valid NYS EMT-B certification or
higher
– B. Be an Attendant
– C. Attend and pass the written exam for the
RPI Ambulance Crew Chief Training Class
– D. Complete the Crew Chief Checklist
– E. After completing requirements A, B and
C pass a Crew Chief Practical Exam
including Radio Report and PCR as set up
by the Training Lt.
– F. Tek 2 calls with a Crew Chief Trainer in
the patient care compartment of the
Ambulance and submit Crew Chief
Evaluation Forms
– G. Request and receive approval by the
Captain and Training Lt. to be promoted to
Backup Crew Chief
•The Requirements
–Crew Chief
–A. Be a Backup Crew Chief
–B. Tek 1 call as a Backup Crew Chief
and submit a Crew Chief Evaluation
Form
–C. Student Teach 1 Training Drill and
submit Training Drill Instructor
Evaluation Form
–D. Request and receive approval by a
Promotional Board as defined in
SOPs to be promoted to Crew Chief
•The Crew Chief Trainers
–Warren Hayashi, AEMT-CC
–Anthony Richard, EMT-B, CC Student
–Eric Tesoriero, EMT-B, CC Student
–Sarah Toner, EMT-B
Test Time
The End. Go Out and Tek
Some EMS Calls