FIRE COMPANY ORGANIZATION-OPERATORS
DRIVERS AND OPERATORS:
All fire company employees who drive and operate fire company vehicles and equipment, shall be physically able to perform the duty and shall be trained by certified instructors following nationally and state accepted guidelines, in a safe manner, at all times.
All apparatus and motorized equipment shall be operated in compliance with all New York State Vehicle and Traffic Laws, all Federal Department of Transportation Regulations, and all National Fire Protection Association Standards. The NFPA standards in regards to traffic control devices, railroad crossings, stopped school buses, and intersections will be strictly adhered to by operators and/or their officers.
The driver and officer have the ultimate responsibility to ensure safe operations of the vehicle and ensure that all passengers are securely positioned/restrained on the apparatus. All passengers shall be seated and passenger restraint devices used. All vehicles will be equipped with a back up warning device. No vehicle shall be backed without a spotter and an operable warning device.
All units shall be inspected and tested on a regular basis for routine maintenance items and evaluations. Vehicle maintenance will be in accordance with the manufacturers recommendations and all NFPA standards. Unsafe or non-serviceable equipment shall be removed from service until repaired.
FIRE COMPANY ANNUAL MANDATORY TRAINING TOPICS
Annual OSHA fire and EMS mandatory training will consist of the following (minimum time allotted):
General Hazard Recognition 30 minutes
Station Safety 30 minutes
Response Safety 45 minutes
Scene Safety 75 minutes
Protective Clothing 60 minutes
Respiratory Program/SCBA 120 minutes
Tools and Equipment Safety 60 minutes
Blood Born Pathogens 60 minutes
TB Infection Control Program 60 minutes
Right to Know 30 minutes
Hazardous Materials Awareness 60 minutes
Confined Space Awareness 60 minutes
Additional training for various positions and qualifications for apparatus operators are outlined in department policies and standard operating procedures.
Personal Protective Equipment (PPE) Training
The Fly Creek Fire Company shall provide training to each employee who is required by OSHA 29, CFR 1910.132(f) (1) to know at least the following:
Each affected employee shall demonstrate an understanding of the training specified in the above section and the ability to use PPE properly, before being allowed to perform work requiring the use of PPE.
When the Fire Chief or a Fire Captain/Line Officer has reason to believe that any affected employee who has been trained, but does not have the understanding and skill required by the above mentioned, that officer shall retrain, or cause to be retained said employee.
Circumstances where retraining include, but are not limited to the following:
The Fire Chief or Fire Captain/Line Officer shall verify that each affected employee has received and understood the required training through a written certification that contains the name of each employee trained, the date(s) of training and identifies the subject of the certification/training.
Mutual Aid Calls
Go to station, acknowledge call and find out what’s needed from the requesting department:
1A. Standby – At Station
-Stay in station until called to go somewhere by control center
1B. Standby at other Department/Station
-Find out what equipment and/or manpower is needed
-Call (en route to other station) with equipment and number of personnel
-Stay there until called to scene by control or relieved from standby
1C. Mutual Aided directly to a scen
-Esablish someone as the Incident Commander (I/C)
-Put together materials (trucks, hoses, etc) and personnel needed for mutual aid
-Call (en route to scene/incident) with equipment/truck and type/qualifications of onboard personnel
-Arrive on scene
-Fly Creek I/C to report to I/C running the scene (find out what they want you to do)
-Do task, then report back to scene I/C on status of tasks
-DO NOT DO ANYTHING THAT YOU WERE NOT TOLD TO DO. Stay in contact with Fly Creek I/C who will be in contact with I/C of scene.
-When released by I/C of scene:
-Call control to tell them Fly Creek clear of the scene
-Call en route, back to station
-Call back in station and service
-Make sure equipment is ready to go (air bottles, etc)
Now that we are in the information age, privacy is becoming more and more of a concern. In order to protect privacy and curtail privacy infringements, the Federal Government enacted the "Health Insurance Portability and Accountability Act of 1996." The HIPAA regulations covered more then privacy, but for our purposes the privacy issues are what matters.
In the 1950s, the some newspapers used to list every admission to the hospital and their illness. Now you cannot even go to the hospital without signing a HIPAA form, and you should sign one for every EMS call also.
HIPAA at its most basic says that the patient has a right to privacy and that we respect that right. The patient has the right to determine the amount of information to be given out, and to whom it is given. The only exceptions are for patient care, billing, research, and quality assurance/improvement.
HIPPA created the term “protected health information” or PHI. PHI can be any medical information, but specifically the issue is any information that can connect the patient with the condition. This includes the patient’s name, location, and hospital transported to. The patient can also ask you to keep private any and all information, which you have to comply with.
This includes talking about the patient to the patient’s family and friends, police, press, and anyone not directly responsible for patient care. We as caregivers are responsible for maintaining the patient’s privacy. This includes not interviewing the patient in front of bystanders, family, and non-EMS personnel. The challenge is to treat the patient, with what looks like our hands tied behind our back.
So the question is, how do we treat our patients? Patient’s privacy needs to be worked into all aspects of patient care, and the best way to describe it is to go step by step through a ‘normal’ call. (I will use the example of a transporting EMS service, but it goes the same for EMS support or non-transporting.)
Privacy starts with the dispatch. In many areas, calls are still dispatched as “123 Main St, the Jones Residence for chest pain”. While it may be convenient, and easier to find, the patient’s name should be omitted from radio transmissions. Anyone can buy a scanner, and with the address and name, figure out who the patient is. Ideally even the address wouldn’t be given over the radio, but it is necessary for patient care, and therefore exempt from HIPAA.
When you approach the patient, you should introduce yourself, your company, ask for permission to treat, and ask if it is ok to talk in front of the patient’s family/friends. This may sound odd, but it is important and the permission to treat and privacy questions will save you and your company in the future.
Now that you have permission to treat and speak freely, you should limit the amount of personnel interacting with the patient. HIPAA allows you to share information to achieve effective patient care, but limiting personnel not only is a privacy issue but also provides better patient care.
That being said, there is a limitation. The Ryan White act specifically states that you cannot discriminate or share information about a patient’s HIV status. In this case, you can ask the patient to disclose the information to your partner, but you are not allowed to disclose it.
HIPAA does not make provisions for sharing information with police or other authorities not directly doing patient care. That means that we cannot tell the police that the patient smelled like a brewery or was found with a needle in their arm. In order to get that information, they would need to subpoena the report or ask you to testify in court.
Where HIPPA becomes a big issue in a volunteer department is after the call. We all have gone back to the house and discussed calls, and it’s a good and natural part of the process. HIPAA allows for review of calls, but PHI needs to be protected.
In our small communities, it is easy for people to talk. If you go home and talk to your wife about the call, and talk about the location, hospital transported to, or patient’s name, you are violating HIPAA. This violation can cost you personally $5k or more.
Finally, the last concern as far as HIPAA is involved is record keeping. HIPAA regulations spend quite a bit of time talking about security of records. Any records must be secure and if used for QA/QI or research must have no patient demographics. Patients are allowed to ask to see their file at any time and may ask to have it changed. You should also have on file a document signed by the patient stating that you informed them of their HIPAA rights and they understand.
If you keep your records on a computer, the security concerns double. All data must be password protected, encrypted, and meet stringent security requirements. These requirements are such that it is best to bring someone in to help.
HIPAA legislation may make our lives difficult, but it is for the best. In 10 years, we will all be amazed at the lack of privacy patients had 10 years ago. Keep your members informed, and their adherence to HIPAA regulations with help to show that they are true professionals.