Ambulance Operations Manual

Ambulance Operations Manual Standard Operating Procedures

AMBULANCE SERVICES, MINISTRY PUBLIC HEALTH, SOCIAL DEVELOPMENT & LABOUR, GOVERNMENT OF SINT MAARTEN November 1st 2010 Compiled by: drs.Cylred Richardson, Head Ambulance Services

Ambulance Operations Manual Table of Contents

Ambulance Operations Manual | 8/1/2010

1. PREFACE .................................................................................................................. 4 2. INTRODUCTION ....................................................................................................... 5 3. THE ORGANIZATION/CHAIN OF COMMAND ..................................................................... 6 3.1 MISSION &VISION:................................................................................................. 7 3.2 THE OBJECTIVES................................................................................................... 7 3.3 PERSONNEL MANAGEMENT PHILOSOPHY ......................................................................... 7 3.4 PERSONNEL ORIENTATION .......................................................................................... 8 4. BASIC WORK POLICIES ............................................................................................... 9 4.0 BASIC PRINCIPLES: .................................................................................................... 9 4.1 HOUSE RULES ........................................................................................................ 10 4.2 VEHICLE USE .......................................................................................................... 11 4.3 NON –SMOKING POLICY:...................................................................................... 12 4.4 RECORDING OF WORKING HOURS: ............................................................................... 12 4.5 PERSONAL BUSINESS: ................................................................................................ 12 4.6 ENGAGING IN OTHER ACTIVITIES: ................................................................................. 13 4.7 TARDINESS ......................................................................................................... 13 4.8 ABSENTEEISM & SICK LEAVE: ....................................................................................... 13 4.9 FUNCTIONING & JOB EVALUATION ............................................................................... 13 4.10 DISCIPLINARY PROCEDURES .............................................................................. 14 5. AMBULANCE VEHICLE OPERATION POLICY: ................................................................ 15 5.0 PURPOSE ............................................................................................................ 15 5.1 SPEED RESTRICTIONS ........................................................................................... 15 5.2 USE OF WARNING SIGNALS ................................................................................... 15 5.3 EMERGENCY AND NON-EMERGENCY RESPONSE GUIDELINES ................................... 15 5.4 THE TWO SECOND RULE ...................................................................................... 16 5.5 INTERSECTIONS .................................................................................................. 16 5.6 EXCESSIVE SPEED ................................................................................................. 16 5.7 SIRENCIDE .......................................................................................................... 16 5.8 IRRATIONAL BEHAVIOR ....................................................................................... 16 5.9 LIABILITY............................................................................................................ 16 5.10 POLICIES WHILE ON DUTY .................................................................................. 17 6.DUTIES & RESPONSIBILITIES ........................................................................................ 18 6.0 UNIFORMS AND APPEARANCE ..................................................................................... 18 6.1 REPORTING FOR DUTY AND SCHEDULING ............................................................. 18 6.2 WORK SCHEDULES .............................................................................................. 19 6.3 DAILY ASSIGNMENTS............................................................................................ 19 6.4 AMBULANCE CHECK LIST ..................................................................................... 19

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6.5 AMBULANCE TRIP (SHEETS) FORMS (PRE-HOSPITAL CARE REPORTS) ................................. 20 6.6 AMBULANCE DISPATCH PROCEDURES ............................................................................ 20 6.7 RADIO COMMUNICATIONS ......................................................................................... 22 7. GENERAL POLICIES & RESPONSIBILITIES....................................................................... 24 7.0 PROPER USE OF EQUIPMENT ................................................................................. 24 7.1 MAINTENANCE OF VEHICLES ................................................................................ 24 7.2 TRANSPORTATION OF DECEASED PERSON ............................................................. 24 7.3 DEAD ON ARRIVAL (D.O.A) POLICIES ..................................................................... 24 7.4 ALCOHOL AND OTHER DRUG USE BY AMBULANCE CREW...................................................... 25 7.5 USE OF CELLULAR WHILE OPERATING AMBULANCE DEPARTMENT’S VEHICLES ............................ 25 7.6 MAINTENANCE OF PATIENT CARE EQUIPMENT ................................................................. 25 7.7 USE OF MEDICATION ON THE AMBULANCE ...................................................................... 26 I STAKEHOLDERS ......................................................................................................... 26 II OBJECTIVE ............................................................................................................... 26 III PHASE 1 ................................................................................................................... 26 V MANAGEMENT OF MEDICATION SUPPLY...................................................................... 27 VI STORAGE ................................................................................................................ 27 7.8 VEHICLE ACCIDENT PROCEDURES ................................................................................ 28 7.9 INJURY ON DUTY-CREW ............................................................................................ 28 7.10 RELEASE OF INFORMATION AND NOTIFICATIONS ............................................................. 29 8.SPECIAL CIRCUMSTANCES .......................................................................................... 30 8.0 TREATMENT/TRANSPORT OF MINORS ........................................................................... 30 8.1 EMOTIONALLY DISTURBED PATIENTS ............................................................................ 30 8.2 PATIENT OR LOCATION NOT FOUND/UNABLE TO GAIN ENTRY ............................................ 30 8.3 CRIME SCENE OPERATIONS ........................................................................................ 31 8.4 MASS CASUALTY INCIDENTS (MCI) ............................................................................... 31 8.5 FIRE/HAZARDOUS MATERIALS (HAZMAT) CALLS ............................................................ 32 ATTACHMENT 1: PROCESS DESCRIPTIONS PATIENT BILLING .......................................................... 33 INTRODUCTION ............................................................................................................... 35 PROCESS # 3.1 – AMBULANCE ASSISTANCE ............................................................................... 36 RELEVANT MANAGEMENT INFORMATION .......................................................................... 36 FORMS AND SYSTEMS ................................................................................................. 36 PROCESS # 3.2 – REGISTRATION OF AMBULANCE ASSISTANCE ......................................................... 44 RELEVANT MANAGEMENT INFORMATION .......................................................................... 44 FORMS AND SYSTEMS ................................................................................................. 44 PROCESS # 3.3 – CASH CONTROL .......................................................................................... 48 RELEVANT MANAGEMENT INFORMATION .......................................................................... 48 ATTENTION POINTS & RECOMMENDATIONS .............................................................................. 54 ATTACHMENT 2: DISASTER MANAGEMENT ESF-6 ...................................................................... 56 RESPONSIBILITIES & FUNCTIONS ....................................................................................... 61 FUNCTIONS OF THE SUPPORT AGENCIES .............................................................................. 62 SLS, LABORATORY .......................................................................................................... 62 FUNCTIONS OF ESF 6 .......................................................................................................... 63

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2. ESF 6’S TASKS & ACTIONS ........................................................................................ 64 MITIGATION: ACTIONS OF ACTIVITIES WHICH REDUCE OR ELIMINATE HAZARDS ............................... 65 ATTACHMENT 3: ALARM DIAGRAM CODE BLUE, YELLOW & RED ................................................... 67 ATTACHMENT 4:WORK INSTRUCTIONS & ALARM DIAGRAM CODE BLUE .......................................... 68 ATTACHMENT 5:WORK INSTRUCTIONS & ALARM DIAGRAM CODE YELLOW...................................... 80 ATTACHMENT 6:WORK INSTRUCTIONS & ALARM DIAGRAM CODE RED ......................................... 100 ATTACHMENT 7: INWERKPLAN AMBULANCE- VERPLEEGKUNDIGE ..................................... 118 INLEIDING: .............................................................................................................. 119 OPBOUW INWERKSCHEMA: ........................................................................................... 120 KENNISMAKINGS-/ INTRODUCTIEDAG. ............................................................................. 121 EVALUATIE VAN DE EERSTE DAG: .................................................................................... 122 WEEK 1 .................................................................................................................. 122 WEEK 2. ................................................................................................................. 123 WEEK 3. ................................................................................................................. 124 WEEK 4 .................................................................................................................. 125 EVALUATIEGESPREK MET NIEUWE MEDEWERKER WEEK 1. ...................................................... 126 EVALUATIE GESPREK MET NIEUWE MEDEWERKER WEEK 2. ...................................................... 127 EVALUATIEGESPREK MET NIEUWE MEDEWERKER WEEK 3. ...................................................... 128 EVALUATIEGESPREK MET NIEUWE MEDEWERKER WEEK 4: ...................................................... 129 EVALUATIEOVERZICHT VAN NIEUWE MEDEWERKER WEEK 1 T/M 4. .......................................... 130 CHECKLIST T.B.V. HET INWERKPROGRAMMA VAN NIEUWE MEDEWERKER:................................... 132 ALGEMENE KENNIS EN KENNIS VAN DE INVENTARIS VAN DE AMBULANCE ...................................... 132 DAGEVALUATIE INWERKPLAN NIEUWE MEDEWERKER: .......................................................... 143 VÓÓR EERSTE OPKOMST VAN NIEUWE MEDEWERKER TE REGELEN. ............................................ 144 UITREIKEN DIVERSE ARTIKELEN OP DE EERSTE WERKDAG VAN NIEUWE MEDEWERKER (VPK.) ............. 145 ATTACHMENT 8: INWERKPLAN AMBULANCE CHAUFFEURS................................................ 146 OPLEIDINGSAANDACHTSPUNTEN AMBULANCECHAUFFEURS: ..................................... 148 GEBRUIK VAN HET VOERTUIG ................................................................................. 150 GEDRAG OP DE WEG: ............................................................................................. 151 RIJDEN MET BLAUW ZWAAI/ KNIPPERLICHT EN 2 OF 3 TONIGE HOORN: ....................... 153 AANKOMST POST: .................................................................................................. 154 EINDE DIENST: ....................................................................................................... 154 BLOK-INDELING INWERKPLAN AMBULANCECHAUFFEUR ........................................... 155 PHTLS ................................................................................................................... 166 CHECKLIST INWERKPLAN ....................................................................................... 169 DAGVERSLAG INWERKEN .............................................................................................. 172 PERIODIEK EVALUATIEFORMULIER INWERKEN ......................................................... 173 EVALUATIEFORMULIER EINDE INWERKPERIODE (NA DE 6E BLOK!) ............................. 174 EVALUATIEFORMULIER ZELFSTANDIG FUNCTIONEREN .............................................. 176 UITREIKEN DIVERSE ARTIKELEN OP EERSTE WERKDAG VAN (CH.) .............................................. 179

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1. PREFACE This manual is a compilation of Standard Operating Procedures (SOPs) and guidelines as a result of research based in the field of Emergency Medical Services. Despite the many challenges over the last year of rewriting and editing in an effort to finalize this manual, it could not have been realized without the valuable input of management support and specifically the many suggestions received from staff members of the Ambulance Service.


In addition to other resources available to staff members, the goal of this manual will serve as a resource tool for questions and answers that the ambulance nurses and assistants may be faced with.

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2. INTRODUCTION The purpose of this Policies and Procedures Manual is to familiarize each staff member working at the Ambulance Department with his or her responsibilities and duties, so that all staff may be better able to perform a job vital to the community of St. Maarten in which we all live. This document is the Standard Operating Procedures (SOP’s) of the Ambulance Service of Ministry Public Health, Social Development & Labour. It is not presented as a Book of Law, but rather as a Book of Reference with guidelines for everyone to follow and adhere to. Management realizes that rules or agreements can be forgotten over time, interpreted differently and that in the course of time new guidelines or work policies needs to be developed and decided upon by management of the Ambulance Services, Ministry of Public Health, Social Development & Labour or the government of St. Maarten. The majority of these SOP’s that were introduced in 2007 has been revised. Where possible, the logic behind each policy/procedure or guideline will be explained, in order to make clear to the Ambulance personnel the intent and reasons for implementation. As an employee of the Ambulance Service of the Government of St. Maarten you have a variety of responsibilities and obligations; these responsibilities and obligations are laid down in several regulations and policies related to the legal position of civil servants in general. In this manual the focus will be on standard operating procedures for the Ambulance Service. For any further details, which are not explained in these chapters, you are advised to read your LMA and other laws regulating personnel matters such as the Employee-Handbook and “Introduction Package” with the various laws and policies given to every department by the Personnel Department.


These standard operating procedures or guidelines will assist in maintaining a harmonious relationship between all personnel and the community. The medical protocols of the Netherlands will be adhered too as was taught during the SOSA certified training for ambulance nurses and ambulance drivers/assistants.

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3. THE ORGANIZATION/Chain of Command The Ambulance Department up until June of 2010 is one of four departments of Sector Public Health that has an executing task of providing ambulance services to the community of St. Maarten, 24 hours a day 7 days a week. In transition to County St. Maarten that will go into effect on October 10th 2010, the name will be changed to “Dienst Ambulancehulpverlening” (Ambulance Services) and will form part of the Ministry of Sector Public Health, Social Development and Labour. The department has an FTE of 24.2 that consist of a department head, operational leader, administrative assistant, certified ambulance nurses, certified ambulance assistants/drivers, a part time medical advisor and dispatchers. The operational team consisting of an ambulance nurse and an ambulance assistant works 8-hour shifts aboard the ambulance. This includes day, evening and night shifts. The ambulance nurses also functions as shift leaders and therefore are ultimately responsible for the shift in the execution of their daily tasks whether this is at the ambulance h e a d q u a r t e r s o r a b o a r d t h e a m b u l a n c e . The operational leader (manager) forms part of the first line contact with all operational staff members such as the ambulance nurses, ambulance drivers/assistants and the ambulance dispatchers. The operational leader reports directly to the department head with regards to operational matters of the department. The operational leader is responsible for the execution of operational matters within the department and the head of the Ambulance Services is ultimately responsible for the overall management. The head reports directly to the Secretary General of the Ministry Public Health, Social Development & Labour and the Secretary General will report to the Minister of Public Health, Social Development & Labour.


3.0 Organizational Structure:

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3.1 MISSION &VISION: Mission To provide effective, timely and quality emergency medical services at Accidents, Sickness and Injury transport at large scale accidents and disasters.

Vision Provide optimal, efficient and professional pre-hospital care for the general public and visitors of St. Maarten.

3.2 THE OBJECTIVES The objectives of the Ambulance Service is to guarantee ambulance services 24 hours a day; to guarantee the carrying out of necessary and permitted paramedical and ambulance nursing care that facilitates transportation required due to sickness or accident; to promote realization and maintenance of sufficient qualitative and quantitative facilities for ambulance services. The Ambulance Services deals primarily with the general public, visitors and calamities. Although everyone is familiar with ambulances, very few people are familiar with the details of ambulance care. Ambulances were associated with transport; they were seen as a means of transporting patients to hospital as quickly as possible. These days, very high quality care is provided at the scene. Ambulance care is high-quality care provided by professionals receiving life-long training. In this way, the quality to which every patient is entitled too is assured. This is the specific objective of every ambulance organization and every ambulance dispatch center.

3.3 Personnel Management Philosophy The Ambulance Services is managed by certain guidelines, policies and procedures to ensure that all personnel conduct themselves in the best interest of patients, peers, and Ministry Public Health, Social Development & Labour. Ambulance Operations Manual | 8/1/2010

Our strength depends directly on the contributions made by each of our staff members. Optimal service and efficiency result from individual participation and satisfaction. Personnel will find an organizational arena that is open, frank and honest in regards to personnel management. To work together successfully, each staff member must realize that good working relationships are not only a matter of rules, but are the result of daily decisions, mutual understanding, friendly attitudes, and team spirit.

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3.4 Personnel orientation Introduction and Orientation: The introduction and orientation is not limited only to the role of the ambulance and transport service, role of the new staff member in the organization, and reinforcement of commitment required by the new staff member to be successful but also to get an understanding of the organization of the ministry of Ministry Public Health, Social Development and Labour in general. New staff: Orientation for new personnel is provided at a series of orientation sessions planned within the first weeks after employment. These sessions are mandatory.

Orientation to ride-outs: Prior to orientation to ride-outs, Basic Life Support (BLS) Assist Class will be provided if necessary to provide training on the different equipment used on the ambulances. Teach the proper usage and set-up of specialized equipment if needed.


Following the successful attendance and completion of requirements of the orientation sessions, the new staff member is permitted to begin orientation on board the ambulance.

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4. BASIC WORK POLICIES 4.0 Basic Principles: The regulation is based on 7 principles.

1. Everyone is paid to work a minimum of 8 hours. It is now mandatory to register everyone’s attendance for the purpose of dealing with ‘absence without leave’ and to generate data for future policy development. 2. Department heads are ultimately responsible for registration and for providing correct data. 3. It is imperative for the success of any policy that it is executed, as much as possible, in the same way in every department. 4. Hours of absence without leave will be deducted from one’s salary and can lead to disciplinary measures. Therefore it is imperative to register all forms of absence both with and without permission for leave. 5. Where possible some flexibility in the working-hours can be observed as long as a normal working day remains 8 hours. 6. Lunch break, in principle, is 1 hour and should be taken between 12.00 and 14.00 hrs. Some flexibility is possible, if the service permits. In both the moment and duration as long as point 5 is being honored. The lunch break is a minimum of 30 minutes, or is assumed to have been, even if the worker doesn’t leave his or her desk.


7. It is up to the secretary general, together with the head, to determine whether a department or a section of a department or service can have flexible working-hours or not. Arguments not to have flexible workinghours can be of a functional nature. For instance to be able to guarantee the public opening hours, shift work, or the special responsibilities of certain public servants. A practical inability to register the working hours can also be an argument (for instance if workers do their work out in the field).

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4.1 House Rules 1. The ambulance crew room or lounge is open to any staff member or invited visitors during business hours only. 2. Volunteer staff members are permitted to have visitors between 10:00 am – 12:00 noon and/or between 14:00 pm – 16:00 pm. Duty student/trainee employee staff should not have visitors in the workplace. 3. Staff members are not permitted to be in or around the Ambulance Headquarters after consumption of alcohol or drugs. 4. All departmental equipment and supplies remain at Headquarters for departmental use only and unless otherwise approved by management. 5. The dispatch area and supervisors’ offices are off limits except for authorized personnel and use of the supervisors’ office is limited to Supervisory staff only. 6. The Ambulance Services related work takes priority in the supervisors’ office and personal use of the supervisor’s office/computer is authorized only after Ambulance Services related work has been completed. 7. All other staff and non-supervisory staff members are to use the computers in other designated areas.

9. Any supplies, equipment, or personal items used during the shift are to be cleaned thoroughly and/or put away prior to the end of the scheduled shift. 10. A special effort by management will be made to provide coffee or tea as a courtesy of the ambulance services. If coffee/tea or additional kitchen supplies are needed, please inform a supervisor. 11. Cable TV will be provided as a courtesy and as a means of recreation for the personnel of the Ambulance Services. 12. Video games are allowed at night, but should not disrupt operations in any way.


8. Any dishes used in the kitchen are to be washed, dried and put away prior to the ending of each shift and all trash and cans/bottles must be placed in trash bin.

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13. Ambulance Crew jackets are to be hung up when not in use, and personal belongings should be kept locked in lockers assigned to each staff member or in the bunkrooms during the day. Book bags and coats should be kept neatly hung and NEVER in offices or the ambulance crew (lounge) recreational room. 14. A Telephone is provided as a courtesy; however this is not an answering service. It is expected that all calls will be brief, so as not to tie up phone lines. 15. All mechanical problems encountered with the ambulances or equipment is to be reported directly to the operational leader.

4.2 Vehicle use


It is the policy of the Government and in particular for the Ambulance Services of the Ministry of Public Health, Social Development & Labour that vehicle are used only for officially authorized business. In recognizing the need to meet the standards of this policy, and provide for optimal response to medical emergencies/routine transportation while meeting administrative needs, please note:

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1. Vehicles will be used first and foremost for the service for which they are intended; Ambulances will be dispatched first to emergencies and non-emergency requests for transportation before all other uses. 2. The ambulances and on-duty response vehicles will not leave without the assigned crew/driver on board, and only for official authorized business. 3. The ambulance crew may use the ambulance for the completion of personal details relating to the job but are always to be available for calls. It is the responsibility of the shift leader to ensure that the ambulance is in the compound area and available for emergency & non emergency calls. 4. Use of other vehicles is permissible during the evening and on weekends only for authorized business. The use of this vehicle will be logged on the computer automated dispatch (CAD) as appropriate (such as detail), with the person using the vehicle and the reason for use included in the comments section. 5. Dispatch will be notified each time a vehicle leaves the ambulance headquarters and when drivers return to headquarters. This alerts the dispatcher to the location of the driver at all times. 6. The ambulances are to remain in the parking area of headquarters at all times unless on runs as dispatched, approved details when assigned to supervisor and when the vehicle is out of service for repair. Personal errands and details are never appropriate. 7. The keys to all vehicles are kept in the key box. Keys should never leave the building with anyone who is not on-duty. 8. It is the ambulance driver/assistant’s responsibility to make sure that all keys are accounted for at the beginning and the end of his/her shift. 9. Any unit/ambulance that is “out of service” for maintenance or other problem should be marked on the bulletin board as Out of Service (OOS). Vehicles that are taken in and out of service by the supervisory personnel should not be on the road. If there are questions, contact should be made with the supervisor who marked the unit OOS. 10. Ambulances are intentionally “rotated” to spread out vehicle use. The supervisor determines this rotation, and all crews need to follow the information posted on the shift board to determine which unit is first due, second due etc. 11. If you have any question about the appropriateness of using one of the vehicles, contact must be made with the on-duty supervisor before using the vehicle.

4.3 NON –SMOKING POLICY: 1. All decisions regarding smoking policy of the federal government reflects adherence to the Ambulance Department smoking policy. 2. In accordance with legislation (P.B. 1996, nr.55), smoking is prohibited inside all government buildings, at the Ambulance Department and also in the ambulance and response vehicles. We ask each staff member to contribute to a smoke free and healthy environment. 3. Smoking is only allowed outside of the ambulance building. 4. Use designated smoking areas if applicable at SMMC if needed after the completion of calls.

4.4 Recording of working hours: The new working-hours regulation for the entire government civil service went in effect on August 1st 2007. The most important elements of the new regulation are the obligation to register attendance as well as absenteeism in a uniform way throughout the organization of government and the introduction of flexible working hours where possible. Registering will generate accurate data for future policy development.

Absenteeism and the so called ‘No Show’ have been deemed major organizational problems by both the government and management. In the past years several instruments have been put into place to deal with the problem such as the sick-leave policy. The No Show committee came to the conclusion that often both management and workers were part of the problem of long-term absenteeism. Fixing this problem required implementation of several policies. Next to a new sick-leave policy and procedures for transfers a working-hours regulation will be put in place as a final instrument.

4.5 Personal Business: During working hours, you are not to engage in any business not directly related to our service. This includes the use of telephones, supplies, or equipment, without specific approval of management. We expect you to use your professional discretion in conducting personal business during office hours. If personal telephone calls are necessary during working hours, they should be kept as short as possible.


The regulation also provides management with the necessary tools to effectively deal with ‘absence without leave’ when it occurs. Taking appropriate corrective measures is now largely regulated. Similar to the sick-leave policy the department head has a key role in the enforcement of the regulation. The disciplinary measure of giving an official reprimand is mandated to the sector directors/secretary generals.

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4.6 Engaging in other activities: As a Civil Servant you need specific approval from the government to engage in other activities, such as:   

Starting a business Working a second job Working as a freelancer

When a conflict of interest is expected, you need to request permission before you start any of these activities. Not adhering to this policy can have consequences.

4.7 TARDINESS Arriving ten (10) minutes or more after the shift change is tardy and will be dealt with seriously as per services policy.

4.8 Absenteeism & Sick Leave: The successful operation of the Ambulance Services to the community depends on Civil Servants’ commitment and productivity. Any circumstance, which causes you to be absent from work must be reported to operational manager or head immediately and no later than three hours before start of duty. Only extreme circumstances can justify exception to the rule.


In order to establish justifiable absenteeism and to insure you are being paid during sick leave, the service requires a doctor’s statement regarding your disability to work in the case you have been sick for three days or longer. This statement should be produced on the fourth day of absenteeism at the latest.

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Failure to follow these rules can have repercussions. Illicit absenteeism from work is grounds for deduction of salary or dismissal. If the head sees ground for deduction of salaries due to absenteeism, the individual staff member will be informed. This subject, together with frequent tardiness is considered a very important behavioural trait in the organization. Therefore, it can be listed as a subject in your yearly job evaluation.

4.9 Functioning & Job Evaluation At least once a year every employee will have an evaluation meeting. This should be regarded as an opportunity for an active dialogue between you and the organization. Your Section Head and Department head are responsible for this. They will prepare this meeting, by inviting you and providing you with a standard Evaluation form. Based on the conversation a written evaluation of your performance together with a statement of goals for the next12 months is prepared. The final Evaluation report will be submitted to the Department Head and can have several consequences.

In cases of excellent performance, one can be recommended for a promotion, “graficatie”. In case of insufficient performance, certain goals will be set for your performance within a certain period. In such cases the evaluation period will be much shorter than 12 months, and can vary from one week to 6 months. Possibilities for training, further education or study assignments are also part of the discussion and decision making during these evaluation meetings.

4.10

DISCIPLINARY PROCEDURES

Violations of Standard Operational Procedures: In the event that an apparent violation of operational procedures occurs, a process will be followed to enable an orderly review of the circumstances surrounding the situation. Except in serious cases of violation requiring immediate action, the following procedures will be followed: A. First offense: The person will be informed of the situation and that the occasion is his/her first verbal warning. B. Second offense: A written warning letter will be given and Personnel Affairs will also be informed of the situation. C. Third offense: The person will be suspended, with or without payment, until the government (Council of Ministers) take a decision on the matter.

In addition to the guidelines for conduct and performance stated previously, the department maintains other reasonable (LMA) standards such as, but not limited to, those that prohibit staff from fighting, refusing to perform a reasonable assignment, being under the influence of alcohol or drugs, engaging in disorderly conduct which threatens the safety of others, tampering with or falsifying departmental documentation, and actions which jeopardize the image of the Ministry of Public Health, Social Development & Labour and the Ambulance Services in particular. A violation of any of the above listed or the LMA identified actions will result in immediate suspension of privileges and referral to the Council of Ministers for further action.


Staff with a history of tardiness, unexcused or excessive absenteeism, or other forms of unacceptable behaviour should be written up and counselled with proper documentation to maintain the standards of the ambulance services, and to keep the person informed of the need for corrective action on his/her part.

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5. AMBULANCE VEHICLE OPERATION POL ICY: 5.0 PURPOSE The appearance and operation of all ambulances must reflect to the community that these vehicles are operated in a careful manner, a manner that instils confidence to the patient and ensures the safety of life and property.

5.1 SPEED REST RICTIONS There is no need for excessive speed. The purpose of using the red or blue lights and the siren is to keep the ambulance moving at a constant, safe speed and not to allow the ambulance to exceed the posted speed limits in any area.

5.2 USE OF WARNING SIGNALS An ambulance operator shall not display warning lights and/or sirens except when: a. Responding to an emergency call b. Engaged in lifesaving services c. Transporting emergency patients who are classified as “emergent” by the ambulance nurse (paramedic) on the ambulance trip report form to a medical facility.


It is acceptable to drive with the headlights on when operating an ambulance or response vehicle when responding to a medical emergency. This increases the general public’s awareness of the emergency vehicle.

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5.3 EMERGENCY AND NON -EMERGENCY RESPONSE GUIDELINES Sufficient information should be obtained from the dispatcher prior to responding to give the ambulance driver/assistant a good idea of where the incident occurred. The dispatcher should give clear, definitive directions to the driver as to the exact incident location, utilizing the area mapping system.

The ambulance nurse shall operate the communication system en route to the accident, leaving the driver free to drive with as little distraction as possible. While responding to the scene the nurse should also watch for approaching traffic from the right at all intersections and advise the driver. The driver must ensure, at all times that traffic is clear from all directions before proceeding. Good judgment should be used by the driver at all times. An ambulance is heavier than a passenger car and will take a greater distance to stop. It is also top-heavy and will react differently when rounding curves or cornering.

The posted speed limit may be exceeded when responding to an emergency incident with emergency lights and siren, only if weather, traffic and road conditions permit the increased speed. An exception will be any school zone with a posted speed limit, which will be obeyed.

5.4 THE TWO SECOND RULE Always maintain a safe distance between the ambulance and the vehicles in front of it. Use the two second rule to gauge this distance.

5.5 INTERSECTIONS Most serious ambulance and other emergency vehicle accidents happen in an intersection. Remember, using the lights and siren is merely asking for the right of way. It is essential that the driver approaches all intersections with caution. It is important to realize that many people, while driving, may be day dreaming or talking, with the air conditioning on and the radio or stereo blaring; emergency vehicles are the last thing they are expecting.

5.6 EXCESSIVE SPEED The majority of documented emergency vehicle accidents occur because the vehicles are travelling too fast. The ambulance driver/assistant must drive defensively and have the vehicle under control at all times. Never let the vehicle or your emotions control you. Ambulances are heavy and take much longer to stop than ordinary vehicles. An ambulance will be also corner differently than a passenger type vehicle. It is much safer to maintain a constant speed, in which traffic is clearing a pathway, than to continually speed up and slow down. The result will be to outrun the effect of the siren and emergency lights. This is also extremely hard on the vehicle and gives the crew and patient a very uncomfortable and dangerous ride.

5.7 SIRENCIDE Be aware of this phenomenon. Due to the noise of the siren, the ambulance driver/assistant may be lulled into a false sense of security, believing that everyone hears the siren and sees the lights, and therefore will yield the right of way for the ambulance. At the same time there will be a tendency to increase the speed of the ambulance.

Watch for the unexpected. The sight of flashing lights and the sound of a siren tends to cause people to panic. At times they may speed up, slow down, pull to the left, stop short in front of the ambulance, etc. The ambulance driver/assistant must remain calm and alert. The safety and well being of many people rests with the judgment and the reactions of the ambulance driver/assistant.

5.9 LIABILITY 1.1.

Whenever an ambulance is damaged through the negligence or misconduct of an ambulance assistant/operator or through the negligence or misconduct of any other official or employee of the department, all cost incurred in the removal and repair, or in the case of total loss will be for the person(s) account.


5.8 IRRATIONAL BEHAVIOR

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1.2.

While the driver of an emergency vehicle giving audible signals should be given the right-of-way, this provision does not operate to relieve the ambulance operator from the duty to drive with reasonable care for the safety of all persons using the public streets, nor shall it protect such driver of any emergency vehicle from the consequence of an arbitrary exercise of such right-of- away.

1.3.

The basis for determining responsibility for the negligence or misconduct which caused or precipitated the damage to the vehicle shall be the findings of the Service Investigation Team (SIT). The Department of Support Services shall affix responsibility in accordance with its established procedures and orders.

5.10 POLICIES WHILE ON DUTY MEALS AND BREAKS There are no formal meals and break periods for operational staff scheduled during shift time. The emergency nature of the job necessitates a flexible approach to taking breaks and obtaining meals when not engaged in an emergency run or training. Meals and breaks shall be taken when possible and shall not in any way ever conflict with the system’s immediate response capability. Crews are welcome to work on homework, obtain meals or watch television. Ambulance crews are only welcome to nap during night shifts. TELEPHONES


Telephone calls are to be limited. If personal telephone calls are necessary during working hours, they should be kept as short as possible.

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6.DUTIES & RESPONSIBILITIES 6.0 Uniforms and Appearance One should place the patient at ease by presenting a reassuring appearance. The ambulance personnel should wear clothing that is neat and clean, providing a hygienic as well as professional appearance. Uniforms are to be worn by all on-duty shifts or as approved by the department head. UNIFORM AND GROOMING REQUIREMENTS ARE AS FOLLOWS: 1.1 The new uniforms are to be worn in its entirety during regular shifts while on duty. 1.2 Jeans are not acceptable in combination with regular uniform while on duty for regular shifts 1.3 The uniform code for the “piketdienst” is exceptional however a combination should be made for easy identification of an ambulance staff member. 1.4 Excessive jewelry is discouraged due to the inherent problems associated with small children and convulsive patients. Wedding bands are acceptable. 1.5 Excessive hair is discouraged. Men: Above the collar, medium afros are acceptable. Beards and sideburns must be well trimmed. Women: Hairstyles are to be neat and clean with little adornment and should be pinned if necessary not to interfere while carryout work. Needs to ensure that long hair does not become a safety hazard (entanglement or assault) and that finger nails are kept short.

6.1 REPORTING FOR DUTY AND SCHEDULING It is most necessary that ambulance nurses/ ambulance assistants and dispatchers coming on shift are on time so they may orient themselves to the conditions with which they must work. A minimum of 15 minutes prior to changing of shifts is required and is acceptable. Shifts hour are from 07:00 AM to 15:00 PM, 15:00 PM to 23:00 PM and 23:00 PM to 07:00 AM. Once the ambulance nurses, assistants and dispatchers have reported for duty, he/she may not leave the department without first notifying the operational leader or ambulance nurse in charge. The Ambulance teams is not allowed to take a nap (sleep) during the various shifts except for night shifts however must at all time be ready to respond immediately to any emergency call. Regular and administrative staff working hours ranges from 08:00 AM – 17:00PM.


1.6 Shoes should be black. Steel toes are highly recommended for ambulance teams aboard the ambulance. Clogs, sandals and athletic shoes are not acceptable. 1.7 Name tags shall be worn over the left breast pocket. 1.8 All ambulance nurses and assistants are required to carry their own watch with second hand, as well as a penlight and stethoscope.

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Note: No staff member may leave their duty station without appropriate coverage as approved by the operational manager or department head.

6.2 WORK SCHEDULES a. Work schedules are prepared at least two (2) weeks in advance by the operational leader (manager) and posted on the bulletin board. Every schedule covers a period of one month. It is your own responsibility to check your working schedule for the coming weeks. When you are not present at a specific time, you should call in prior to your absence or delay. b. Any and all requests for schedule changes should be presented in writing at least two (2) weeks in advance of the time the schedule is to be prepared. Emergency requests may be honored at the discretion of the operational leader (manager) after consultation with the head of the service. c. Only the operational leader and/or the head are authorized to make schedule changes. Any such changes must be initialled. d. All scheduled operational staff is to remain on duty until relieved by the on-coming shift. Ambulance nurses, assistants and dispatchers are considered relieved only after they report to the on-coming shift on amongst other things the condition of vehicle (s) and inventory and any other pertinent information and after completion of all reports for his or her shift.

6.3 DAILY ASSIGNMENTS


The operational leader (manager) will indicate on the weekly time sheet which ambulance nurse is “in charge” of each shift. The ambulance nurse “in charge” will prepare daily assignments for each shift. Any medical technician refusing to accept his or her assignment shall be disciplined in accordance with the Ambulance Services policy.

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6.4 AMBULANCE CHECK LIST The Ambulance check lists have been designed with patient care, safety and legal back-up in mind. Each list should be completed by the on-coming ambulance crew at the change of shift, so the off-going and on-coming crew may discuss any discrepancies. The ambulance driver/assistant, at the completion of a run, is responsible for replacement/replenishment of supplies and cleaning of the ambulance patient compartment. Any missing equipment should be indicated on the check lists and reported to the ambulance nurse/shift leader. The Ambulance Nurse/shift leader will review and submit completed ambulance check lists to the operational leader for review and filling. Periodic checks of the ambulance may be made by the operational leader or Head.

6.5 AMBULANCE TRIP (SHEETS) FORMS (Pre-hospital care reports) The ambulance nurse must complete an Ambulance Trip Form in its entirety each time an ambulance call is answered. This form become part of the patient’s permanent record, and is an important legal document; therefore, it is important that they are filled out thoroughly and clearly. They must be completed where possible when handing over of patient to ER and prior to the end of each shift. There are three (3) copies of the Ambulance Trip Form. The top copy (white) is to be handed over to dispatch for data entry, reviewed by the operational leader and filed at administration of Ambulance Services. The middle copy (yellow) is to be attached to the patient’s record at the (ER) hospital. The pink copy is to be given to the patient if requested. Once the ambulance fee is collected, a copy of the receipt should be attached to the trip form of the patient. Note: Make sure all copies are legible.

The ambulance nurse shall make sure that all procedures/materials they provide to patients are noted on the Ambulance Trip Form. This shall include: -

Times Ambulance Calls and Transports EKGs Obstetrical assistance outside of hospital CPR Intravenous Infusion Oxygen Therapy Splinting Slings Adaptive Devices e.g. collars Dressings Medications

All calls must be assumed to be emergent and should be answered with lights and siren unless reliable medical evaluation from the scene indicates otherwise. Upon receiving a call for an ambulance, it is essential to record the following information and dispatch an ambulance immediately.

A. Maintain contact with the caller until all relevant information is collected. B. Essential telephone information: a. Caller’s phone number b. Caller’s name c. Exact location of incident d. Directions to incident and prominent landmarks e. Nature of incident


6.6 Ambulance Dispatch Procedures

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It is important that the following times be accurately recorded: a. b. c. d. e.

Time call is received Dispatch time (time ambulance responds to the incident) Arrival time (time the ambulance arrives at the incident) Departure time (time ambulance departs incident location) Hospital arrival time (time the ambulance arrives at the hospital or appropriate destination)

Answer all calls on the emergency line promptly: a. b. c. d. e.

Try to answer within three (3) rings Expect each call to be an emergency until proved otherwise Answer emergency lines first; administrative lines later Identify yourself and department Record all information

TELEPHONE PROCEDURES 1. All incoming calls must be answered promptly. When multiple phone lines are ringing, callers can be asked to stay on hold once it has been determined that they do not have an emergency. 2. All incoming requests for ambulance and/or medical transport must be entered in the CAD immediately even if only partial information is available (the dispatcher can always return and enter information more completely after units have been dispatched). 3. All ambulance phone lines (912) and (5422111/5206262) are to be answered, “Ambulance Services Medical Dispatch this is (your name)”. All calls should be handled in a professional, friendly and helpful manner. 4. Non business phone lines (5429291, 5429292) are to be answered, “Ambulance Service this is (your name)”.


TAKING AND RECEIVING MESSAGES

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1. Business calls should be directed to the appropriate person; if that person is not available, a message including day/date/time, name of caller, and call back number should be taken. 2. Personal calls received in dispatch (calls for personnel) should be referred to the crew room phone. The dispatcher is under no obligation to take personal messages (this is not an answering service); be certain that if the caller is calling on a business related matter that a message is left. 3. If appropriate, business messages should be left in individual mailboxes. 4. Personal home telephone numbers and cellular phone numbers are never to be given out. Offer to take a message, or forward the caller to the number of the person they would like to speak with. This includes not giving out numbers of supervisory staff. RADIO PROCEDURES 1. Always use a clear, calm voice. There is no place for sarcasm, opinion, or rebuttal over the air. 2. Keep all messages brief and to the point. 3. NEVER use someone’s name over the air (ambulance team or patient). If necessary, use initials or ambulance team medic number only. 4. After you end a radio conversation, state the military time “10-4”. 5. Dispatch is always to make the last transmission.

STATUS CHECKS 1. If the ambulance has been on the scene for more than 15 minutes, and the dispatcher has had no communication with them, the dispatcher should request a status check as follows: “Control to Unit 1 or 2, with a status check” A status update can be requested by the dispatcher sooner than 15 minutes, if the dispatcher deems it appropriate. 2. The ambulance unit in question should respond with either: Unit 1 or 2 Status OK, through continue Status Checks” in situations where there is a question as to the safety of the ambulance crew. With this response, dispatch will continue status checks each 10 minutes until crew clears the scene (or) “Unit 1 or 2 All Set, discontinue Status Checks” in situations where the ambulance crew is comfortable with their safety and does not request additional checks. 3. If no response to a status check is received, contact the Police and ask them to contact their unit on scene. VEHICLE STATUS It will be the responsibility of all Ambulance Dispatcher (AMD) to be aware of the vehicle and crew status of all onduty personnel. Enroute Assignment The responding ambulance team will notify the AMD over the air that Unit #.....is enroute to ........(location) code ......”. The AMD will respond with the time. Arrival on scene Upon arrival at the scene, the responding ambulance team will notify that “Unit.....is on the scene”. The AMD will respond with the time.

Arrival at the hospital Upon arrival at the hospital, the responding ambulance team will notify that “Unit.....is at ER, SMMC”. The AMD will respond with the time.

6.7 Radio Communications The conduct of all persons using an EMS radio must be professional at all times, both on dispatch, police coordination and medical channels. All messages must be as brief as possible. There should be no inappropriate, profane or personal remarks at any time. The following order of steps is recommended for the ambulance crew to use when notifying the hospital of patient information: 1. Patient’s age and sex 2. Chief Complaint – The reason why the patient called for help 3. Present Illness


Departure from the scene Upon departure from the scene, the responding ambulance team will notify that “Unit .....is enroute/available” The AMD will respond with the time.

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An elaboration of the chief complaint (e.g.What was the pain like, Where does it radiate? How long has it been present? Has patient ever had symptoms like these before? Are there any other related symptoms? Etc) 4. Past Medical History Other significant illnesses or injuries, medications or allergies 5. Physical Examination a. General Appearance - Comfortable or in distress - Level of consciousness b. Vital Signs -

Pulse Respirations Blood pressure Temperature

To enhance radio communication, the ambulance crew should keep in mind the following points: 1. 2. 3. 4. 5.

Use common language only. Use medical terms whenever possible. Be aware of the rate of speech with which you speak….do not speak too fast or too slowly. Emphasize important terms, but do not overemphasize by stressing everything. Do not speak too loudly or too softly. Speak decisively, deliberately and in a calm manner. Avoid angry comments at all costs. Do not editorialize.


Do not allow your voice to trail off at the end of words and sentences

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7. GENERAL POLICIES & RESPONSIBILITIES 7.0 PROPER USE OF EQUIPMENT 7.1 MAINTENANCE OF VEHICLES Vehicle Maintenance is essential to the provision of appropriate EMS care in any environment. All operational staff should routinely do up-keep and preventative maintenance of both the interior and exterior of all vehicles. Driver check sheets are to be completed by the driver, or driver progression at the beginning of each shift. Vehicles are to be washed, both interior and exterior, and fuelled daily and as otherwise necessary. Any deficiencies should be documented on the driver check sheet, and an equipment failure report completed. The fleet coordinator and onduty Operational Leader/supervisor needs to be notified as well. The vehicle also needs to be tagged out of service as well. The vehicle service entity needs to be notified in the appropriate time frame. Additionally, all vehicles in service at the ambulance department are subject to annual inspections and routine preventative maintenance. If vehicles are tagged out of service by the facilities supervisor, they can only be returned to service after the specific problem is rectified.

7.2 TRANSPORTATION OF DECEASED PERSON Upon receipt of a call for a deceased person, an ambulance will be dispatched to a “possible cardiac arrest”. Notification of the Police Department should be made by dispatch to request their response. The Ambulance crew upon arrival at the scene will evaluate the condition of the patient. A patient who is found to have rigor mortis, decapitation and or perhaps dependent lividity may not receive resuscitative measures. This patient will be left at the scene under the jurisdiction of the Police Department. The Police Department will notify the Medical Examiner for pronouncement and removal of the body. The Ambulance Service will not engage in transporting of any deceased person.

D.O.A. cases are classified legally as exclusively under the jurisdiction of the Medical Examiner or designee. In order to process these cases legally and efficiently, these guidelines must be followed: a. Immediately notify the Police Department. The Police Department will then determine if the Medical Examiner should be called. b. Record the name, age, date, time, condition of the body and known circumstances of death. c. If the patient is not declared a D.O.A. or death has not been pronounced at the scene of the call, all resuscitative measures shall be taken in accordance with the protocol. If death is pronounced on the scene, all actions of the ambulance crew prior to the declaration of death shall be recorded on the PCR. The Medical Examiner shall be notified as soon as possible through the Ambulance Dispatcher. Law enforcement officers shall be requested to respond if not already on the scene.


7.3 DEAD ON ARRIVAL (D.O.A) POLICIES

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d. If the patient is deemed irretrievable and foul play is suspected or in question, every effort should be made not to disturb the “crime scene” and law enforcement should secure the scene upon their arrival. EMS personnel shall remain on scene until released by a law enforcement supervisor or by the Medical Examiner.

7.4 Alcohol and other drug use by ambulance crew Any crewmember accused of responding to, transporting or treating a patient while under the influence of drugs or alcohol may be: ●

temporarily suspended from the job

●

subjected to testing for alcohol or other drugs if the allegation involves operation of an ambulance department vehicle.

●

referred to police department for investigation

The Ministry of Public Health, Social Development & Labour, specifically the Ambulance Services, takes a strong stance on the use of alcohol or drugs in the workplace. It is expected that staff report when assigned or scheduled, in a condition ready to work. Compounding factors such as the previous night’s activities, or even the use of some prescription medications can cause a staff member to be unfit for work/duty. It is the responsibility of the staff member to be in a condition ready for duty when scheduled. Drinking or use of judgment impairing medications (prescription or recreational) is not permitted within 10 hours before a scheduled shift. Also, on-duty personnel are not allowed to enter establishments that serve alcohol, unless for brief meal pick-ups. Remember that at all times the Ambulance Services uniform is very visible to the general public, and positive examples are to be set without exception. This includes any capacity when personnel are on duty for service.

7.5 Use of cellular while operating Ambulance Department’s Vehicles


It is prohibited by law to use a cellular phone without an appropriate hands-free device when driving.

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Cellular phone use is to be limited when driving vehicles in non-emergency medical transport modes, and must have a hands-free device to be used as well. Cellular phones are not to be used for any reason by anyone driving a vehicle in an emergency response mode. Minimize the use of the cellular phone while you are in the Dispatch Center. If you have to use your cellular phone while you are on duty try to make it as short as possible.

7.6 Maintenance of Pati ent Care Equipment The proper operation of all patient care equipment is essential to the provision of EMS care as a whole. It is of the utmost importance that all equipment be maintained appropriately. All on-duty Ambulance personnel are to complete ambulance check-lists at the beginning of their shifts. Any equipment that isn’t in proper working order must be taken out of service immediately and replaced with spare equipment from the storage room. An equipment failure report must also be completed and handed over to the operational leader/supervisor or placed in mailbox.

Additionally, all durable medical equipment is subject to preventative maintenance, which is done by an external entity. All repairs of equipment are done by that entity as well. Irreparable items will be replaced as needed.

7.7 Use of medication on the Ambulance

I STAKEHOLDERS The stakeholders in this protocol are: 1. The Government of St. Maarten, represented by Ministry of Public Health, Social Development & Labour 2. The St. Maarten Medical Center Foundation

II OBJECTIVE To administer medication aboard the ambulance by the ambulance nurses according to fixed protocols under the final supervision by the emergency room physicians of the SMMC. The emergency room physician will also conduct case management and carry out workshops with the ambulance teams in order to improve pre-hospital care on St. Maarten.

III PHASE 1 Only medications mentioned in the intervention protocols of SOSA-trained ambulance –nurses will be placed on the ambulance. For the first three months only the cardiac-arrest protocol will be applied and therefore in that period, the available medications are: • Atropine

These medications will be administered according to the SOSA protocol manual to patients who are in cardiac arrest without prior consultation with the emergency room physician. The ambulance nurse must contact the emergency room physician for approval when attending to a patient who is not in cardiac arrest but with life threatening arrhythmias. The ambulance nurse must submit at all times a copy of the run form (“rittenformulier”) to the emergency room physician for review after administering above listed medication. Thereafter, the administering of other necessary medication will be considered.


• Epinephrine

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IV PHASE 2 After the three months period, it will be decided to expand the medication on the ambulance according to the skills of the ambulance-staff. To improve the skills the nurses will receive at least an additional 400 hours per year of continuous education including additional classes by the staff of the ambulance department at the emergency room and the intensive care unit of SMMC. (For specifications see appendix “Clinical Program”)

V MANAGEMENT OF MEDICATION SUPPLY The Head of the Ambulance Department will be responsible for the selection and purchase of the medication, once authorized by an appointed doctor. The medication will be purchased from the pharmacist of SMMC, who will monitor the storage and distribution of the medication by the Ambulance Department.

VI STORAGE The medicine will be stored in medicine storage cases in the advance life support kits on the ambulances. The ambulance nurses will be responsible for daily inspections of the medicines for expiration dates and replacement making use of a log book.

VII COMMUNICATION The Ambulance Nurse will contact the Emergency Room Physician by use of the radio communication system or the cellular telephone of the Ambulance Department, in the event of necessary medical supervision prior to administering of medication.

VIII CONTROL MECHANISM


Inventory and periodical control of the medications will be done by the operational leader at the Ambulance Service and a report will be forwarded to the Head of the Department.

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Once medicines are used the ambulance nurse in charge of his or her shift need to document and sign off on the medicine box form and also have to guarantee that the ER doctor who authorizes afterwards the use of the medicine and sign off in the run form (“rittenformulier”). The Government of St. Maarten will replenish the medicines that are used.

Version 2007, Revised 2010.

7.8 Vehicle Accident Procedures This procedure is used in the event an ambulance, transport, or support/response vehicle is involved in any type of accident (with another vehicle, with fixed property, etc): 1. Immediately notify dispatch. 2. In all cases STOP and return to the scene of the accident. In cases involving personal injury, or damage to another vehicle, dispatch will send another vehicle to cover any call that you may be responding to, and/or will send another ambulance to transport a patient on board. 3. Determine if anyone is injured. Request ambulance(s) as needed. Initiate BLS for injured persons. 4. Dispatch will notify the police to respond to the scene and take a report. 5. Obtain the names, addresses and telephone numbers of all involved parties and witnesses. 6. Do not make any statement concerning the assumption of liability. Give out only the information that is requested and required by the Police Traffic Department. 7. The On-duty Supervisor/OL will be notified immediately of any accident, regardless of the severity. 8. The OL will notify the EMS head immediately of any accident involving personal injury to any involved parties. 9. Within (12) hours following the accident, the driver (as able) should fill out an Occurrence Report detailing the circumstances surrounding the accident. 10. Within (24) hours of the accident, the OL and EMS head will review the reports and forward these to NC Wathey Insurances. 11. The Driver involved will refrain from driving immediately following an accident until a supervisory personnel review the situation. The Secretary General of Ministry VSA (Public Health, Social Development & Labour) will be informed if an ambulance driver/assistant fails to report any accident or if he or she has a record showing a high accident frequency, or shows an abnormally high accident cost. This will be accompanied by a statement that such failures or poor performance record is considered to be sufficient justification for the Service to suspend the right of the ambulance assistant to operate an ambulance.

7.9 Injury on duty-crew 1. 2. 3. 4.

Immediately notify the on-duty supervisor (shift leader). Any injuries will be treated according to protocol Dispatch should be notified as soon as is practical. The on-duty supervisor, operational leader (manager), EMS head, Secretary General of VSA and other appropriate department heads will be notified of any incident involving personal injury or death. 5. The injured person should be transported to SMMC as appropriate, for evacuation and initiation of documentation. 6. Within 12 hours following the incident, the staff involved (as able) should fill out an Occurrence Report detailing the circumstances surrounding the incident. 7. Within 24 hours of the incident, the operational manager and EMS head will review the reports and forward to the Secretary General of VSA. 8. The staff person injured will refrain from handling calls immediately following an on the-job injury until the supervisory personnel review the situation. On-the-job injuries and or death are covered under BZV medical insurance. As a result, it is important that all steps above be completed as outlined to ensure timely medical care, and the filling of appropriate documentation.


This procedure is used in the event of an injury or death to on-duty staff:

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7.10 Release of Information and Notifications This procedure defines the procedures for the release of information to outside agencies, as related to operational and/or patient information, in meeting the needs of the administrative functions of the Ambulance Services while maintaining patient confidentiality. Under no circumstances shall ambulance personnel divulge any information to newspapers, radio, or television personnel. Any request for information should be referred to the EMS head.


1. All releases of information will be made through the EMS head. Release of any and all protected health information will be executed in accordance with the policies and procedures of Sector Public Health, Social Development & Labour. 2. The ONLY exception is when other law enforcement agencies are involved that can be advised of patient information such as name and address. This can be done from ambulance nurse to law enforcement officer, or over the direct line to dispatch police service (DPS) dispatcher, including the general condition of the patient. 3. All other releases of information (such as to the press, any legal service or risk management) should be directed to the EMS head. 4. At no time should originals or copies of any documentation (run logs, cards, PCRs, etc.) be distributed to anyone other than authorized ambulance service personnel. 5. Any extraordinary situations should be documented on an occurrence report for follow-up.

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8.SPECIAL CIRCUMSTANCES 8.0 Treatment/Transport of Minors A minor is defined as a person under the age of 18 years who is not emancipated or mature. Emancipated or mature minors may consent to treatment on their own behalf. If a parent or legal guardian is available to consent to treatment on the minor’s behalf, the minor and the parent may be transported to the medical facility should the patient’s condition permit. If a patient or legal guardian refuses treatment and if the medical problem or injury is life threatening and any delay of care will jeopardize the life of the minor, the Ambulance Services may transport the patient without the consent of the parent or guardian if authorized by Medical Control. The circumstances shall be documented in the PCR, and a complete report shall be filed immediately following the call. The Operational Manager should be contacted during or after the call. The parent or guardian shall be notified of the destination decision. If the parent or legal guardian refuses treatment and if the medical problem or injury is not life threatening, the ambulance team shall make an appropriate effort to attempt to convince the parent or guardian to consent. The policy for refusing medical assistance shall be followed. If a parent or guardian is not available on a scene to provide consent for a minor, emergency medical care may be rendered. The minor shall be transported to the appropriate receiving facility. The Police Department shall be notified of the destination decision. Ambulance crew shall not delay patient care or transport is a parent or guardian is unavailable.

8.1 Emotionally Disturbed Patients

If a patient displays violent tendencies or violence towards crew members, bystanders, or other personnel on scene, the ambulance crew shall retreat, if able, and stage until the scene is secured. Restraints may be deployed or used per protocol under the following conditions: • The patient has indicated a high potential for violence • The police and police doctor has taken charge Use of restraints shall follow the applicable restraints protocols.

8.2 Patient or Location Not Found/Unable to Gain Entry Upon arrival on a scene, it is the responsibility of the Ambulance Nurse/shift leader to attempt to locate the patient. If the patient/location is not immediately found, the Ambulance Nurse must contact AMD (Ambulance Dispatch) or


The Ambulance Nurse or shift leader is responsible for determining scene safety. The Ambulance Nurse may choose to stage the ambulance away from the scene until the police has secured the area. If an emotionally disturbed patient voluntarily requests transport to a psychiatric facility, the Ambulance Services may transport without the police or patient restraint if the Ambulance Nurse deems it to be safe. If an emotionally disturbed patient refuses treatment or transport, a Mental Health officer and a police officer should be dispatched. Medical control may be contacted to determine the patient’s ability to decline treatment.

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Police Department to attempt to determine a better location. A search of the immediate area should be performed. If no further information can be discerned, a Patient Care Report (PCR) must be filled out, and any significant findings must be documented. If the ambulance crew is unable to gain entry to a scene, the Ambulance Nurse shall notify AMD and Police Dispatch and shall document the circumstances in the PCR.

8.3 Crime Scene Operations A scene shall be considered a crime scene if evidence of a crime or suspected crime is found, including but not limited to: • Homicide • Suicide • Rape • MVA involving serious injury or death • Assault • Drugs Upon the discovery of a crime scene, the police or law enforcement shall be contacted if not already present, and only personnel necessary to the treatment of the patient shall enter the scene. On a crime scene, EMS personnel shall work in close communication with law enforcement while performing up to their standard of care. Care shall be taken to preserve evidence on the scene if possible while providing patient care. The scene and all actions taken by EMS shall be thoroughly documented in the PCR. Preservation of evidence shall not take priority over patient care. Once patient care has been completed, or if the scene is deemed unsafe, law enforcement personnel assume command of the scene.


8.4 Mass Casualty Incidents (MCI)

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For the operational purposes of the Ambulance Services, a Mass Casualty Incidents shall be defined as scene potentially requiring extraordinary resources. An Operational Leader/manager or Ambulance Services Chief may declare an MCI if additional resources are required that exceed the capacity of the Ambulance Services. This does not include single patient situations requiring an ALS provider. Upon declaration of an MCI, the first Ambulance Services personnel on scene shall set up an Incident Command System until the Operational Leader arrives on scene. The first arriving ambulance team/medic is responsible for initial triage and the request of additional resources, including, but not limited to a command officer. The Incident Commander/Operational Leader or designated Communication Officer may request the use of a dedicated radio frequency through the AMD dispatcher. The Ambulance Services Channel will be used for internal radio communication and the Emergency Channel for the incident. Upon arrival, the Ambulance Services Operational Leader (MCO) may take over the Incident Command and shall continue to maintain an Incident Command System until the incident has been managed. All aspects of incident management shall follow the “opschalings” guidelines and procedures.

8.5 Fire/Hazardous Materials (HAZMAT) Calls The ambulance will automatically be dispatched to all confirmed structural fires or any situations where injury or entrapment may occur. The Ambulance Services will also be dispatched to all hazardous material situations for which the Fire Department is dispatched. The Ambulance crew for a Fire or Hazmat stand by, shall remain on the scene, out of service, until released by the Senior Fire Officer in command. Upon arrival at any major incident where Command has previously been established, the Ambulance Nurse/Medic must report to the command post and advise the Senior Officers (Fire & or police agencies) of the location of the ambulance in case EMS assistance is needed. The ambulance driver/assistant is responsible for staging of the ambulance, keeping lanes clear for additional Fire Apparatus and allowing exit for all emergency vehicles. The Ambulance Nurse shall contact AMD requesting additional ambulance teams to be on alert or to respond to the scene, as necessary, and AMD must make sure that the Operational Leader/MCO and AMBCHIEF has been notified of the incident.


The Fire Department will automatically be dispatched to all calls for Motor Vehicle Accidents with a confirmation that people are trapped.

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MINISTRY OF PUBLIC HEALTH, SOCIAL DEVELOPMENT AND LABOR


Attachment 1: Process Descriptions Patient Billing

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Version 1, SOAB 2011

TABLE OF CONTENTS


INTRODUCTION .................................................................................................................................. 35 PROCESS # 3.1 – AMBULANCE ASSISTANCE ............................................................................................ 36 PROCESS # 3.2 – REGISTRATION OF AMBULANCE ASSISTANCE ................................................................... 44 PROCESS # 3.3 – CASH CONTROL.......................................................................................................... 48 ATTENTION POINTS & RECOMMENDATIONS ............................................................................................ 54

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Introduction


   

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Goal and tasks of the department Goal and explanation of the handbook Maintaining the handbook Procedure for maintaining the handbook

Process # 3.1 – Ambul ance Assistance I.

Process Definition

Goal To provide ambulance assistance, receive payments for the assistance and register the assistance accurately on the ‘ritformulieren’. Risks  The ‘ritformulier’ is not filled-in accurately or completely.  The basic information needed to receive payment is not registered on the ‘ritformulier’.  All the ‘ritformulieren’ are not submitted or not submitted in a timely manner (within 3 days).  All the collected payments are not submitted on the date of receipt. Internal controls a. Periodic controls of the completeness of the ‘ritformulieren’. b. A match between the Dispatchers Logbook entries and submitted ‘ritformulieren’ in order to verify that all ‘ritformulieren’ have been submitted. c. A match between the Deposit Logbook, payment information on the ‘ritformulieren’, receipts and submitted payments in order to verify the completeness of collected payments.

Responsibilities  The ‘Diensthoofd Ambulance Hulpverlening’ and the ‘Operationele Leider Ambulance Hulpverlening’ are responsible for maintaining and updating this process description.  All Personnel of ‘Dienst Ambulance Hulpverlening’ are required to understand and follow this process description.

Functions Involved ‘Ambulance Verpleegkundige’

‘Centralist’ Rel ev an t M an ag em en t I n fo r m a ti o n Monthly overview of:   

Number of calls for ambulance assistance received Number of calls for ambulance assistance dispatched Average time between call and arrival of the ambulance

For m s a n d s ys tem s Dispatcher logbook ‘Ritformulier’ Receipt (credit/debit card) Deposit Logbook


‘Ambulance Chauffeur’

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II. Process Diagram

Function

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III. Process Description

Nr.

Department

Activity

Description

1.

- Function ‘Dienst Ambulance Hulpverlening’

Receive call for ambulance assistance

The ‘Centralist’ receives the call for ambulance assistance.

- ‘Centralist’ The ‘Centralist’ notes the time of the call, the address and a short description of the mishap in the Dispatcher Logbook. Subsequently the ‘Ambulance Verpleegkundige’ on call is notified.

N.B.

2.

‘Dienst Ambulance Hulpverlening’ - ‘Ambulance Verpleegkundige’ - ‘Centralist’

Report on ambulance assistance

The ‘Ambulance Verpleegkundige’ accepts the call from the ‘Centralist’ and reports back to the ‘Centralist’ about the call for ambulance assistance once at the location.

The urgency of the call and the time of arrival are reported to the ‘Centralist’. The ‘Ambulance Verpleegkundige’ determines the urgency of the call.

The ‘Centralist’ registers the time of arrival in the Dispatcher Logbook.


- The data in the logbook will be entered into the CAVIS system in a later stage, together with the data on the ‘ritformulier’. - A team consists of an ‘Ambulance Verpleegkundige’ and an ‘Ambulance Chauffeur’ (assistant ‘Verpleegkundige’). - A ‘Centralist’ has a medical background and if needed, will provide medical support through the telephone to the caller.

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Nr.

Department -

3.

Activity

Description

Provide treatment

The ‘Ambulance Verpleegkundige’ provides treatment to the patient.

Function

‘Dienst Ambulance Hulpverlening’ - ‘Ambulance Verpleegkundige’

Subsequently the ‘Ambulance Verpleegkundige’ decides whether transportation is required. If the patient requires transportation, the ‘Ambulance Chaffeur’ and ‘Ambulance Verpleegkundige’ transport the patient to the hospital. The ‘Ambulance Verpleegkundige’ fills in the ‘ritformulier’ en route to the hospital. Once the patient has been handed over to the hospital the ‘Ambulance Verpleegkundige’ proceeds to seek payments (step 4). If the patient does not require transportation, the ‘Ambulance Verpleegkundige’ fills in the ‘ritformulier’ and proceeds to seek payment (step 4).


N.B.

39

The ‘ritformulier’ contains the medical information of the patient treated by the ‘Ambulance Verpleegkundige’. It also consists of the following personal details: -

Full name; Date of birth; Gender; Address; Telephone number; Type of ID; ID number; Country that issued ID; General practitioner.


Request payment

After the treatment and transport, if required, the ‘Ambulance Verpleegkundige’ inquirers if the patient will pay via local insurance or fulfill the payment themselves.

If the patient is locally insured and can present a valid proof of insurance (card or letter), the ‘Ambulance Verpleegkundige’ notes the following information on the ‘ritformulier’: Insurance company name; Policy number; Insurance expiration date. The ‘Ambulance Verpleegkundige’ then proceeds with step 6.

If the patient will fulfill the payments themselves or if the patient cannot provide a valid proof of local insurance, the ‘Ambulance Verpleegkundiger inquires if the patient is able to fulfill the payment at present.

If the patient is able to fulfill the payment, the ‘Ambulance Verpleegkundige’ continues with step 5.

If the patient is not able to fulfill the payment, the ‘Ambulance Verpleegkundige’ informs the patient of the cost of treatment and tells the patient that a bill will be sent concerning the treatment. Subsequently the ‘Ambulance Verpleegkundige’ proceeds with step 6.


4.

40


Receive payment

The ‘Ambulance Verpleegkundige’ receives full payment from the patient.

The patient can either pay by: -

Cash; Check; Credit Card; and/or Debit Card.

For credit and debit card payments, the machine prints out a receipt. For other payments, a written receipt is made. The ‘Ambulance Verpleegkundige’ writes up a receipt and hands it to the patient as proof of payment. The ‘Ambulance Verpleegkundiger’ keeps a print of the receipts.


In case of a cash payment, the ‘Ambulance Verpleegkundige’ will secure the cash in an envelope with the ‘ritnummer’ on it. The envelopes of the day must be kept secure until they are deposited at the Ambulance Office.

41

- ‘Ambulance Verpleegkundige’

Handover copy of ‘ritformulier’

The ‘Ambulance Verpleegkundige’ completes the ‘ritformulier’ with the necessary information and dates and signs it.

If the patient was transported to the hospital a print of the ‘ritformulier’ is handed over to the hospital to be included in the patient’s medical records.

The patient also receives a print of the ‘ritformulier’ if requested.

N.B. If the ‘ritformulier’ cannot be completed, the form is left at the hospital to be retrieved in a later stadium by the ‘Ambulance Verpleegkundige’ in the case of transportation to the hospital.


‘Dienst Ambulance Hulpverlening’

42


Deposit ‘ritformulier’ and payment

On return to the Ambulance Office, the ‘Ambulance Verpleegkundige’ makes a copy of the ‘ritformulier’ if payment was received.

The ‘Ambulance Verpleegkundige’ puts the copy of the ‘ritformulier’ in an envelope with the receipt and the payment received if applicable, seals the envelope and deposits it in the drop box safe at the Ambulance Office.

The ‘Ambulance Verpleegkundige’ then makes a note in the Deposit Logbook about the deposit: -

current date; ‘ritformulier’ number; name of the patient; and amount in the envelope.

Subsequently, the ‘Ambulance Verpleegkundige’ hand the original ‘Ritformulier’ to the ‘Centralist’ for data entry in the CAVIS system.


N.B.

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CAVIS stands for ‘Caribische Ambulance Verzorging Informatie Systeem’.

Process # 3.2 – Registration of Ambulance Assistance I.

Process Definition

Goal To register the ambulance assistance given in the system in an accurately and timely manner.

Risks  The ‘ritformulier’ is not filled-in accurately or completely.  The ‘ritformulier’ is not registered in CAVIS accurately  All the ‘ritformulieren’ are not submitted or not submitted in a timely manner (within 3 days).

Internal controls a. Periodic controls of the completeness and accuracy of the ‘ritformulieren’. b. Periodic controls of the accuracy of the registration of the ‘ritformulieren’ in the system. c. A match between the Dispatchers Logbook entries and submitted ‘ritformulieren’ in order to verify that all ‘ritformulieren’ have been submitted.


Functions Involved ‘Centralist’ ‘Administratief Medewerker’

   

Number of calls for ambulance assistance recorded in the logbook as compared to the ‘ritformulieren’ received Number of ‘Ritformulier’ received including length of time taken to submit it Number of incomplete ‘Ritformulieren’ received including explanation Number of entries in the Dispatcher Logbook with no ‘Ritformulieren’ including explanation (incomplete ‘ritten’/ ‘loze ritten’)

For m s an d s ys tem s ‘Ritformulier’ Dispatcher Logbook CAVIS system


Rel ev an t M an ag em en t I n fo r m a ti o n Monthly overview of:

44


Process Diagram

Function

‘Centralist’

45

II. Process Description

Nr.

Department

Activity

Description

1.


Receive copy of ‘Ritformulier’

The ‘Centralist’ receives the original ‘Ritformulier’ from the ‘Ambulance Verpleegkunidge’.

- ‘Centralist’

The ‘Centralist’ matches the entry in the Dispatcher Logbook with the corresponding ‘Ritformulier’. The ‘Centralist’ then checks if the ‘ritformulier’ is complete.

If the ‘ritformulier’ is not complete, the ‘Centralist’ makes a note hereof and asks the applicable ‘Ambulance Verpleegkundige’ to complete the ‘ritformulier’.

If the ‘ritformulier’ is complete, the ‘Centralist’ proceeds with data entry.

The ‘Centralis’ verifies that each entry in the Dispatcher Logbook is matched with a ‘ritformulier’. Dispatcher Logbook entries that are not matched are reported to the ‘Operationele Leider Ambulance Hulpverlening’.

2.

‘Dienst Ambulance Hulpverlening’ - ‘Centralist’

Data entry in CAVIS

The ‘Centralist’ enters the data on the ‘ritformulier’ and the Dispatcher Logbook in CAVIS.

The ‘Centralist’ then initials and dates the ‘ritformulier’ and hands it to the


N.B.

46

Nr.

Department -

Activity

Description

Function ‘Administratief Medewerker’ for archiving. The ‘Centralist’ also initials and dates the Dispatcher Logbook.

N.B. CAVIS stands for ‘Caribische Ambulance Verzorging Informatie Systeem’.

3.



- ‘Administratief Medewerker’

47

Archive documents

The ‘Administratief Medewerker’ archives the ‘ritformulieren’ per month in number order.

Process # 3.3 – Cash Contr ol I.

Process Definition

Goal To verify the accuracy and completeness of the funds collected and to transfer the funds to the Receivers Office in a complete and a timely manner. Risks  The funds collected are not completely accounted for.  The funds collected are not completely transferred to the Receivers Department.

Internal controls a. At least two persons have to be present when the safe is cleared and the funds are subsequently counted and recorded. b. Random dossier reviews of the cash control process by the ‘Diensthoofd Ambulance Hulpverlening’ and/or the ‘Controller’ (from Deposit Logbook to Receivers receipt). c. Monitor the collection behavior of the ‘Ambulance Verleegkundiges’, and be aware of irregularities.


Rel ev an t M an ag em en t I n fo r m a ti o n Monthly overview of:   

Total amount of funds collected categorized according to type of payment. Total amount of funds transferred to the Receiver Department. Discrepancies in the cash control.

-

‘Ritformulier’ ‘Proces Verbaal’ (‘Afdrachtsformulier’) Deposit Logbook Receivers Receipt


Functions Involved ‘Diensthoofd Ambulance Hulpverlening’ ‘Operationele Leider Ambulance Hulpverlening’ ‘Administratief Medewerker’

48


II. Process Diagram

Function

49

III. Process Description

Nr.

Department

Activity

Description

1.


Empty safe and count funds

The ‘Operationele Leider Ambulance Hulpverlening’ reviews the Deposit Logbook in order to note the number and amount of payments deposited in the safe.

The ‘Operationele Leider Ambulance Hulpverlening’ and the ‘Administratief Medewerker’ proceed to empty the safe and count the funds together.

The ‘Operationele Leider Ambulance Hulpverlening’ and the ‘Administratief Medewerker’ verify that the amount noted on the ‘ritformulier’ corresponds with the amount in the envelope and/or the receipts.

If all the funds are not in accordance with the ‘ritformulier’ and ‘receipt’, the ‘Operationele Leider Ambulance Hulpverlening’ makes a note of the discrepancy and reports it to the ‘Diensthoofd Ambulance Hulpverlening’. The ‘Administratief Medewerker’ signs the report as verification. The ‘Administratief Medewerker’ then proceeds to record the funds.

If all the funds are in accordance with the ‘ritformulier’ and ‘receipt’, the ‘Administratief Medewerker’ proceeds to record the funds.


- ‘Operationele Leider Ambulance Hulpverlening’ - ‘Administratief Medewerker’

50

Nr.

Department

Activity

Description

2.


Fill in ‘Proces-verbaal’

The ‘Administratief Medewerker’ fills in a ‘Proces-verbaal’ for each ‘ritformulier’ where payment (cash or cheque) was received.

- ‘Operationele Leider Ambulance Hulpverlening’ - ‘Administratief Medewerker’

The following information is noted on the ‘Proces-verbaal’: -

-

Period Current date Name of ‘Ambulance Verpleegkundige’ that collected the funds; Currency; Details of funds; ‘Ritformulier’ number; Date to be sent to Receivers Office.

The ‘Operationele Leider Ambulance Hulpverlening’ and the ‘Administratief Medewerker’ both initial and date the ‘Proces-verbaal’ and send it to the ‘Diensthoofd Ambulance Hulpverlening’ for authorization.


Hulpverlening’ and the ‘Administratief Medewerker’ both initial and date the ‘Proces-verbaal’ and send it to the ‘Diensthoofd Ambulance Hulpverlening’ for authorization.

51

3.


Authorize ‘Procesverbaal’

- ‘Diensthoofd Ambulance Hulpverlening’

The ‘Diensthoofd Ambulance Hulpverlening’ reviews if the ‘Procesverbaal’ is filled in completely and the relevant signatures are present.

If the ‘Proces-verbaal’ is not complete, the ‘Diensthoofd Ambulance Hulpverlening’ notes the discrepancies on the ‘Proces-verbaal’ and returns it to the ‘Administratief Medewerker’ to be adjusted.

If the ‘Proces-verbaal’ is complete, the ‘Diensthoofd Ambulance Hulpverlening’ signs, dates and stamps the ‘procesverbaal’ and returns it to the ‘Operationele Leider Ambulance Hulpverlening’.

‘Dienst Ambulance Hulpverlening’ - ‘Operationele Leider Ambulance Hulpverlening’

Transfer funds to Receivers Department

The ‘Operationele Leider Ambulance Hulpverlening’ receives the authorized ‘Proces-verbaal’ and attaches the funds to it.

The ‘Operationele Leider Ambulance Hulpverlening’ then transfers the funds to the Receivers Department.

The Receivers Department collects the funds, signs the ‘Proces-verbaal’ and hands over a receipt for the amount received.

The ‘Operationele Leider Ambulance Hulpverlening’ verifies that the receipt is correct and attaches it to the ‘Procesverbaal’.


4.

52

The ‘Operationele Leider Ambulance Hulpverlening’ then hands over the documents to the ‘Administratief Medewerker’ to be archived.

N.B. Every month the ‘Operationele Leider Ambulance Hulpverlening’ presents a report to the ‘Diensthoofd Ambulance hulverlening’ on: -

5.

‘Dienst Ambulance Hulpverlening’ - ‘Administratief Medewerker’

Transfer and archive documents

total amount of money collected; total amount of money transferred to the Receivers Department; remarks on discrepancies in the cash control.

After the payment to the Receivers the ‘Administratief Medewker’ receives the ‘Proces-verbaal’ and Receivers receipt from the ‘Operationele Leider Ambulance Hulpverlening’.


The ‘Administratief Medewerker’ copies the ‘Proces-verbaal’ and the debit and credit card receipts. The copies of the ‘Proces-verbaal’ and the original debit and creidtcard receipts are transferred to ‘Sectie FA/IV’ of the ‘Ministerie van Financiën’ for processing.

53

The ‘Administratief Medewerker’ files the original ‘Proces-verbaal’, the copies of the debit and credit card receipts and Receivers receipt according to date.

Attenti on poi nts & Recommendati ons Attentions points/ Risks/ Recommendations ‘DIENST AMBULANCE HULPVERLENING’ 3.1

Ambulance Assistance

(the number refers to the process step in the related process description) 1. Attention point: Immediate entry in the CAVIS system is preferable. It saves time and can functions as a control of the complete handling of all calls (‘ritformulier’).

‘Dienst Ambulance Hulpverlening’ indicated that the Dispatcher module of CAVIS is not yet in use. They are currently concentrating on establishing a well working dispatcher’s operation.

3. Attention point: The current ‘ritformulier’ does not include key information needed for the collection process, such as the type of ID and the issue country of the ID. It is advisable to adapt the ‘Ritformulier’ to include this information. This should be done in collaboration with the Ministry of Finance as it concerns the collection of funds.

It is noted that a sign-off for cash is not practical due to the shifts. And as for the four-eye principle, only the ‘Ambulance Verpleegkundige’ is ‘rekenplichtig’ and receives a ‘toeslag’ for handling cash. So the ‘Ambulance Chauffeur’ cannot (currently) be the second pair of eyes.

3.2

Registration of Ambulance Service

1. It is important to continuously control the timeliness of the transfer of the ‘ritformulieren’.

3.3

Cash Control

1. It is advisable to establish a set frequency for clearing the safe; based on a fixed amount for example.


5. Attention point: There is no four-eye principle applied to the deposit of payments in the safe. In addition, the money is not check immediately and there is no sign off for the transfer of money. This present a risk that the ‘Ambulance Verpleegkundige’ is not indemnified against discrepancies in the cash.

54

2. It is advisable to adjust the way the funds are recorded and transferred to the Receivers department. There should be a record per each envelope/‘rit’ internally, on a spreadsheet or in CAVIS, however the funds sent to the Receivers department should be a total amount booked on the Ambulance CRIB account and not linked to a certain ‘Ambulance Verpleegkundige’.

3. If possible in the system, it is advisable to reconcile the funds collected with the registration thereof in CAVIS from the ‘ritformulier’ by the ‘Centralist’. This is an additional way to control the funds collected.

4. Attention point: The credit card and debit card payments receipt are currently not being transferred to ‘Sectie FA’ of the Ministry of Finance. This is important to verify the completeness of bank transfers through credit and debit card transaction. And to register funds received on the right CRIB account/department.

General. In order to eliminate the risks associated with the collection of cash, ‘Dienst Ambulance Hulpverlening’ has to make proper agreements with the Receivers department concerning the billing and collection process. This is needed to mitigate the negative effect it will have on the collection process.


A copy of identification can serve as proof that services were rendered.

55

General. Cash collection is not noted as an official task of ‘Dienst Ambulance Hulpverlening’. In addition, the Performance Contract and the Formation Plan also do not reflect this task, for example in the form of a KPI or a Financial Administration Office respectively. It is important that the goals and tasks of the organization are aligned with the formation structure and performance indicators.

Attachment 2: Disaster Management ESF-6

MEDICAL RELIEF AND PUBLIC HEALTH -Scenario for disaster management-

Ministry of Public Health, Social Development & Labour

Government of St. Maarten


August 2003, Revised 2010

56

CONTENTS

1. Concept of operations 1.1 General 1.2 Organization 1.3 Notification 1.4 Direction and control 1.5 ESF-6 Responsibilities & functions

4 4 5 6 6 7

2. ESF 6’s tasks and actions 2.1 General

11 11

2.2 Preparedness

11

2.3 Response

11

2.4 Recovery

12

2.5 Mitigation

12

3. Partial Plans (draft) Deelplan 9: Ontsmetting mens en dier


Deelplan: 11: Besmette waren

57

Deelplan 12: preventieve volksgezondheid Deelplan:13: Geneeskundige hulpverlening Deelplan 24: Geestelijke gezondheid Deelplan 29: Milieu

13

1.

CONCEPT OF OPERATIONS

Primary / Lead agency: Ministry of Public Health, Social Development & Labour (VSA) Support agencies members ESF-6:            

Sint Maarten Medical Center White Yellow Cross Foundation WIMA, General practitioners SLS Laboratory Red Cross Foundation WIEMS (Windward Islands Emergency Medical Services) Melmik, Air Ambulance services VSA, ambulance services VSA, Hygiene & veterinary affairs department VSA, section ambulatory mental health VSA, Preventive health department

1.1 General Each organization has their specific responsibility and task for medical relief and public health in the event of a disaster. Therefore, these organizations prepare their own plans that enable them to respond to a disaster and continue to provide care for their patients.

Key in this operational structure is ESF (Emergency Support Function) Group 6: Medical Relief and Public Health (= in Dutch: Geneeskundige Hulpverlening en Public Health (see attachment). This ESF Group is installed by the Prime Minister and is the coordinating body that consists of experts/coordinators of the organizations listed at the beginning of this chapter. ESF 6 has a supporting task to the Office of Disaster management and the EOC. In ESF-6 operational organizational structure, there is a Disaster Management team (DMT) consisting of 3 persons of VSA. The operational coordinator/leader is responsible for the control and management of the emergency or emerging disaster situation. The medical advisor/leader is responsible for any supporting medical advisory task. This person will be the medical leader and member of CoPI (Commando Plaats Incident). The Secretary General of VSA (also ESF-6 coordinator) is ultimately responsible for all actions taken by VSA and ESF6 during and following any emergency situation and in that capacity will organize activities that ensure and improve disaster preparedness.


In the event of a possible disaster or threat of a hurricane an operational organizational structure is put in place (see appendix) that enable organizations to work together in the joint interest of the health and well being of the community. This structure will remain in place until the normalization (recovery) of medical services and public health following a disaster.

58

The Secretary General of VSA is also part of the island disaster team of the Island Government, participates in meetings of the Emergency Operation Center (EOC, see attachment) making decisions relevant to health issues. 1.2 Organization The EOC consists of the following persons (see attachment):    

The Prime Minister The Government Information Service (GIS) The Disaster Coordinator The Secretary Generals

The Office of Disaster management will act as the coordinating and control facility in the event of e.g. a hurricane, and for the coordination of resources in times of an emergency or disaster. The Emergency Operation Center (EOC) is the management body for disaster management of St. Maarten, chaired and led by the Prime Minister. The Disaster management plan of Country St. Maarten is formalized and functions as the (legal) framework to clarify command, organization and coordination of activities.

1.3 Notification The Emergency Operation Center (EOC) will notify the Secretary General of VSA as ESF 6 coordinator in the event of a possible disaster. This notification will usually be made via telephone or radio communication. Such notification could be to advise of the potential for a disaster and normally a meeting of the EOC is called.


Upon receipt of the notification, the director will inform the operational coordinator and medical leader, who will alert all ESF 6 members and inform them of a (potential) disaster. A meeting will be called by the operational leader to discuss response issues (see Chapter 2) once the call to scale up (GRIP- system) is given.

59

1.4 Direction and control Direction and Control: In order to effectively manage any type of emergency event, a system must be established so that everyone is familiar with how to make things happen quickly, efficiently and effectively. The ESF group Medical Relief and Public Health functions as the official body for activities in terms of disaster response, preparedness, recovery and mitigation organization. Each member organization of ESF6 designates a coordinator that is responsible for and will organize the execution of the disaster plans of their respective organizations. These coordinators also participate in ESF6 and all communication from the operational leader of ESF6 will be handled through them. Based on the (expected) magnitude and scope of the expected disaster, all or selected ESF members will be requested to attend the meetings in which decisions are made and activities are coordinated and discussed.


The DMT (Disaster Management Team) of the Ministry of VSA consisting of the Secretary General VSA , Operational Leader and Medical Advisor /Leader, will function as a small key liaison unit between ESF6 and the EOC. In this capacity they will assist the Prime Minister in carrying out her task to maintain order, safety and secure the well being of the community. The Prime Minister can give orders to the Secretary General of VSA to prioritize certain health areas of concern. These will be prepared and executed through the operational leader, medical leader and ESF 6 coordinators.

60

Responsibilities & Functions

Functions of the primary agency (Ministry of Public Health, Social Development & Labour (VSA) 1.

Provide leadership in directing, coordinating and integrating the overall efforts to provide health, medical, public health assistance.

2.

Staff and operate a command and control structure to assure that services and staff is provided to areas of need.

3.

Coordinate and direct the activation and deployment of federal agencies, volunteer health/medical personnel, supplies, equipment and provide certain direct resources that are under the control VSA.

4.

Assure that the following personnel or services are available for any event, such as: Human resources:     

Emergency technicians Physicians Mental health workers Nurses/RN’s/LPN’s Hygiene inspectors

Supplies and equipment:


   

61

Medical equipment and supplies Advanced Life Support/Basic Life Support Vehicles Vaccins Shelter

Services:      5.

Pharmacy and laboratory services Surveillance Immunizations Hygiene and environmental health inspections Public information and education

Take measures to provide response to public health issues such as food safety, crisis mental health, drinking water quality, vaccinations, disease control.

Functions of the support agencies : St. Maarten Medical Center: 1. 2.

To ensure continuity of essential services of the hospital, safety of their clients and the treatment of any casualties at the emergency room department. To organize the evacuation of persons from the hospital whose life and well-being may be threatened due to the impact of the hurricane to the hospital.

White & Yellow Cross Foundation: 1. 2.

To ensure continuity of services and safety to the clients of the White and Yellow Cross Foundation. To provide continuity of care and to give medical assistance to the elderly in the districts.

WIMA, General Practitioners: 1. 2. 3. 4.

To ensure that clinics and poli-clinics are opened as soon as possible. To ensure medical assistance through telephone consultations by emergency on call system. To render medical expertise in case of large scale casualties or other events. To provide medical assistance in the various districts to secure continuity and accessibility of Emergency Medical Services.

Red Cross Foundation: The Red Cross has a fundamental role to bring humanitarian relief to the victims of disaster. It does not assume the responsibility for Government functions but supports and works in co-ordination with Government and other organizations to avoid duplication. To assist Government in search and rescue efforts. To assist with the distribution of clothing, food, blankets, and other relief supplies. To assist shelter management with the provision of First Aid trained volunteers wherever possible. To respond to international tracing inquiry and assist government with information dissemination.

WIEMS (Windward Islands Emergency Medical Services): To provide trained volunteers, equipment to assist where necessary in providing medical assistance and to assist in search and rescue operations if needed.

SLS, Laboratory To provide advice and a variety of laboratory testing services to protect the public health

Ministry of VSA, Ambulance Services: 1. To provide and coordinate medical assistance in search and rescue operations. 2. To provide leadership in case of coordinated medical assistance by the Red cross, WIEMS and Emergency 24.


1. 2. 3. 4.

62

Ministry of VSA, Preventive health To provide control, response and surveillance activities for infectious diseases

Ministry of VAS, Hygiene & Veterinary Services: 1. 2. 3. 4.

To provide vigorous food inspections in supermarkets, with food vendors and in restaurants. To provide vector control and water treatment. To secure safe drinking water for the population. To make district assessment to monitor risk areas and environmental health issues.

Mental Health Foundation: To provide mental health services to the affected populations and coordination of critical incident stress management to personnel of support responders. Air Ambulance Services: To provide, emergency transportation if necessary by air prior and post hurricane.

Functions of ESF 6


The joint effort that is coordinated in ESF6 encompasses a full realm of tasks from education to provision of field services. The following tasks provide the framework upon which actions will occur:

63

a. b. c. d. e. f. g. h. i. j. k. l. m. n. o.

Management, Command and Control of assets Assessment of health and medical needs Disease control/epidemiology Availability of Health/medical care personnel Availability of Health/medical equipment and supplies Patient care & evacuation Emergency Medical Services (pre-hospital) Coordinated in hospital and nursing home care Emergency responder health and safety Food and drug safety and availability of drugs and certain foods Mental health and crisis counseling (individual and community) Public health information Vector control/monitoring Quality of (drinking) water, waste water and solid waste Victim identification/mortuary services.

2. ESF 6’s TASKS & ACTIONS 2.1

General

Actions carried out by ESF6 fall into the four categories of emergency management: preparedness, response, recovery and mitigation. Each category requires specific skills and knowledge to accomplish and requires significant cooperation and collaboration with all supporting agencies and the intended recipients of service. 2.2 Preparedness Preparedness: Actions and activities that develop health and medical response capabilities. Tasks: a. Conduct orientation and risk analyses on preparedness for various disaster scenario’s b. Conduct planning and activities with ESF6 members to refine the concept of operations c. Refine and update Public Information Guidelines for all hazards d. Maintain liaison with health and medical (volunteer) organizations e. Develop rapid response mechanisms for medical relief, public health and mental health.. To ensure that all aspects of the response to a hurricane event are planned for and that designated organizations within ESF6 are prepared to carry out appropriate actions. 2.3

Response

Response: Actions and activities that are focused on saving lives, protecting the public health and stabilizing health and medical systems affected by the hurricane.

a. b. c. d. e. f. g. h. i. j. k. l. m. n. o. p.

Coordinate operations of ESF6 and advice and inform the EOC Coordinate response and resources with other ESF groups Provide team players for the Rapid Impact Assessments Coordinate communications for deployed health and medical personnel Provide staff and services for monitoring public health conditions Conduct rapid assessments for immediate response objectives Determine need for health surveillance programs in communities Arrange for the provision of medical personnel, equipment and supplies as needed to health and medical facilities. Assist with patient evacuation and relocation (post event) Identify hospital and nursing home bed vacancies Operate the Ministry of VSA Operations Center Perform water and food inspection. Arrange for emergency mental health services to individuals and communities Support response personnel with Critical Incident Stress Debriefing resources Arrange for disaster mortuary response or identification services Provide emergency pharmacy/laboratory services, if needed.


Tasks:

64

2.4

Recovery

Recovery: Activities to assist systems in returning to normal pre-event status Tasks: a. b. c. d. e. f.

Restoration of essential health and medical components of delivery systems Restore permanent medical facilities to operational status Restore pharmacy services to operational status Monitor hygiene and epidemiological surveillance and organize response Support emergency services staff and operations until the local system or services is self-supporting Continue provision of long-term emergency environmental activities

2.5

Mitigation

Mitigation: Actions of activities which reduce or eliminate hazards Tasks:


a. b. c. d. e.

65

Identify and seek funds for e.g. hurricane proofing critical facilities Identify locations of all vulnerable sites or populations Stockpile critical medical supplies in strategic locations Develop ESF6 readiness levels to higher capability Identify and seek auxiliary power for critical facilities


3. PARTIAL PLANS (draft)

66

Attachment 3: Alarm diagram Code Blue, Yellow & Red

Ambulance Alarm Diagram Code Blue, Yellow & Red

Melding ongeval


Centralist bepaal alarm code en inzetplan

67

Tot 6 slachtoffers

6-10

>12 slachtoffers

Code Blauw

Code Geel

Code Rood

Afhandelen door Ambulance Dienst Sint Maarten en zonodig OL(OVDG)

Zie verder protocol 1.1

Zie Verder protocol 1.2

Code Geel

Code Rood

Attachment 4:Work Instructions & Alarm Diagram Code Blue

Werkinstructie Rampenbestrijding

CODE BLAUW < 6 slachtoffers

Ambulancehulpverlening St. Maarten kan dit alleen afhandelen.


Aard en omvang van de ramp zijn van dien aard dat de te verwachten schade beperkt is tot maximaal 5 slachtoffers.

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Inhoudsopgave code blauw:

1.


2. 3. 4.

69

Pagina

MKA Centralist…………………………………………......B-03 Ambulance verpleegkundige 1e ambulance(1e Avp)..............B-05 Ambulance chauffeur 1e Ambulance(1e Ach)………………….. B-08 Operationeel Leider………………………………………….B-10

B-2 Meldkamer Centralist (MKA Centralist)

1.

Alarmering en inzet Als u een melding krijgt Als u een melding krijgt van een incident stelt u de volgende vragen: ●

Aard van het incident (ongeval/gevaarlijke stoffen/rellen)

●

Aantal slachtoffers

●

Aard van de verwondingen

●

Plaats van het incident (aanrijroute)

●

Gevaren

●

Gealarmeerde operationele diensten

●

Tijdstip (hoelang bestaat de situatie)

Techniek en hulpmiddelen ●

Ambulance dienst Sint Maarten interne alarmering en communicatie

●

Landelijk protocol ambulancezorg

●


Werkt samen met: ●

Chauffeur 1e ambulance

●

Ambulance bemanningen

●

Operationeel Leider

●

Overige hulpdiensten

Taken ●

Alarmeer de geneeskundige keten (volgens alarmeringsschema)

●

Informeer gealarmeerde functionarissen over de situatie


Samenwerking

70

●

Voer inzetplan uit

●

Communiceer met Operationeel Leider

●

Communiceer met ambulance bemanning

●

Registeer slachtoffers die afgevoerd zijn naar het ziekenhuis

●

Plot informatie (actuele operationele situatie bijhouden o.a door logboek)

●

Signaleer knelpunten en doorgeven aan de Operationeel Leider

Opschaling ●

De Centralist MKA alarmeert volgens het alarmeringsschema

●

1e ambulance geeft opdracht tot verdere opschaling

●

De brandweer maakt bij de opschaling gebruik van de termen: “GRIP 1,-2,-3 en 4 indien sprake is van een incident waarbij gecoördineerde inzet van de hulpverleningsdiensten noodzakelijk is (vergelijkbaar met code blauw, geel en rood)

Afschaling ●

De Centralist MKA schaalt indien verdere medische inzet niet meer nodig is


af in opdracht van hoogst leidinggevende op plaats incident.

71

B-3

B-4

Ambulance verpleegkundige 1e ambulance(1e Avp)

1.

Alarmering en inzet Als u wordt gealarmeerd Als u wordt gealarmeerd stelt u de volgende vragen: ●


●

Aantal slachtoffers

●


●

Plaats van incident (houd rekening met de aanrijroute)

●

Gevaren

●


●

Tijdstip Hoelang bestaat de situatie)

●

Draag herkenbare kleding

●

Test portofoonverbinding met chauffeur

●

Voer na sein “veilig” een snelle (15-30 sec per slachtoffer) triage uit met chauffeur, Gebruikmakend van slachtofferkaarten

●

Rapporteer aan chauffeur (locatie en aantal slachtoffers per triage klasse)

●

Geeft MKA via chauffeur indicatie van in te zetten ambulance


ambulance dienst Sint Maarten interne alarmering en communicatie

●

Landelijk protocol ambulancezorg (protocol: Grootschalig incident)

●


●

Maak bij communicatie gebruik van uw portofoon


Aankomst plaats incident

72

B-5 Samenwerking


Werkt samen met:

73

●

Centralisten MKA

●


●


●

Operationeel Leider

●


B-6

Taken tot komst Operationeel Leider ●

Bevestig alarmeringscode

●

Coordineren inzet

●

Triage

●

Laat informatie omtrent triageklasse, aantallen slcachtoffers en locatie registreren

●

Motorkapoverlegoverige operationele diensten

●

Verricht kortdurende levensreddende handelingen

●

Heeft overzicht na triage-ronde en stemt dit af in motorkapoverleg

●

Rapporteert aan 1e Ambulance chauffeur

●

Rapporteert aan Operationeel Leider

●

Na overdracht coördinatie aan Operationeel Leider: trek groene hes uit/zet groene Helm af

Taken na komst Operationeel Leider ●

Draag coördinatie over aan Operationeel Leider

●

Ga verder als Ambulanceverpleegkundige

●


●

De brandweer maakt bij de opschaling gebruik van de termen: “Grip 1,-2,-3 en 4 indien sprake is van een incident waarbij gecoördineerde inzet van de hulpverleningsdiensten noodzakelijk is (vergelijkbaar met code blauw/geel en rood)

●

Na 1e triage wordt verdere opschaling/inzet bepaald door 1e Avp tot komst OL

Afschaling ●

De Centralist MKA schaalt indien verdere medische inzet niet meer nodig is af in opdracht van hoogst leidinggevende op plaats incident


Opschaling

74

B-7

2.

Ambulance Chauffeur 1e ambulance (1e Ach)



●

Aantal slachtoffers

●

Aard van verwondingen

●


●

Gevaren

●


●




75

●

Stel de ambulance goed zichtbaar op , rekening houdend met de aan- en afvoerroute

●

Meld aankomst via portofoon bij MKA

●


●

Registreer n.a.v. triageronde van 1e Avp informatie over triageklasse, aantallen en Locatie van slacktoffers

●

Na 1e triage: Blijf bij de ambulance

●

Test portofoonverbinding met 1e Avp



●

Landelijk protocol ambulancezorg (protocol grootschalig incident)

●


●


B-8 Samenwerking Werkt samen met: ●

Avp 1e ambulance

●

Operationeel Leider

●

Centralisten MKA

Taken ●

Registreren van gegevens omtrent slachtoffers op aangegeven van 1e Avp

●

Communicatie met de MKA

●

Opstellen sitrap n.a.v. de informatie van de 1e Avp

●

Opschalen op verzoek van Avp via MKA

●

Opstellen inzetplan n.a.v. de informatie van de Avp

Opschaling ●

De Centralist MKA alarmeert volgens het alarmregelingsschema

●

De brandweer maakt bij de opschaling gebruik van de termen: “Grip 1,-2,-3 en 4 Indien sprake is van een incident waarbij gecoördineerde inzet van de hulpveleningsAmbulance Operations Manual | 8/1/2010

diensten noodzakelijk is (vergelijkbaar met code blauw/geel/rood)

76

B-9

3.

Operationeel Leider



●

Aantal slachtoffers

●


●


●

Gevaren

●


●




77

●

Stel voertuig goed zichtbaar op, rekening houdend met de aan- en afvoerroute

●


●

Zoek 1e Avp/ 1e Ach om sitrap

●

Vraag 1e Avp/ 1e Ach op

●

Neem coördinatie over van 1e Avp

●


●

Mogelijke slachtoffers op afstand (effectgebied) en spontane hulpverlening

●

Vaststellen opvang, behandelplaats en morgue

●

Belemmeringen bereik van slachtoffers

●

Bepaal inzetplan

●

Stem af met aanwezige leidinggevende van de operationele diensten en spreek tijdstip van overleg

B-10 Techniek en hulpmiddelen ●


●


●


●


Samenwerking ●

Centralisten MKA

●

1e Avp

●

1e Ach

●


●



Werkt samen met:

78

B-11 Taken ●

Bewaak de gewondenregistratie

●

Geef leiding aan geneeskundige hulpverlening ter plaatse

●

Geef relevante informatie door aan de MKA

●

Opschalen extra ambulances en personeel

●

Bepaal prioriteiten m.b.t. gewonden afvoer

●

Wijs transport coördinator aan

●

Signaleer knelpunten m.b.t. de medische capaciteiten

●

Signaleer knelpunten m.b.t. de gewondenafvoer

●

Let op dehydratie medisch personeel/gewonden

●

Voer intercollegiaal overleg met brandweer en politie (COPI)

●

Maak inzetplan medisch personeel (incl. trauma team S.M.M.C.)

●

Bewaak opschaling

●

Bewaak aflossing functionarissen

●

Neem deel aan evaluatie met betrokken deelnemers


Opschaling

79

●


●

De brandweer maakt bij de opschaling gebruik van de termen: “Grip 1,-2,-3 en 4 Indien sprake is van een incident waarbij gecoördineerde inzet van de hulpveleningsdiensten noodzakelijk is (vergelijkbaar met code blauw/geel/rood)

●

Na overnemen van de coördinatie van de Avp 1e ambulance bepaald u verdere medisch opschaling/inzet

●

Laat de functionarissen altijd alarmeren via de MKA

Afschaling ●


B-12

Attachment 5:Work Instructions & Alarm Diagram Code Yellow

Work Instructions & Alarm Diagram Code Yellow


CODE GEEL


< 10 slachtoffers Aard en omvang van de ramp zijn van dien aard dat de te verwachten schade in het brongebied en omgeving de behandelen transportcapaciteit van de Ambulancehulpverlening St. Maarten binnen 24 uur zullen overschrijden.

80

Inhoudsopgave code Geel:


1. MKA Centralist………………………………………….......G-03 2. Ambulance verpleegkundige 1e ambulance(1e Avp)……........G-04 3. Ambulance chauffeur 1e Ambulance(1e Ach)……………………G-06 4. Operationeel Leider…………………………………………..G-08 5. Vertegenwoordiger Meldkamer………………………………. G-10 6. Transport coördinator…………………………………………G-11 7. Hoofd Ambulancedienst(CVDG)………………………………G-12

81

G-2

2. Meldkamer Centralist (MKA Centralist) Alarmering en inzet Als u een melding krijgt Als u een melding krijgt van een incident stelt u de volgende vragen: ●


●

Aantal slachtoffers

●


●


●

Gevaren

●


●


●

EMS Sint Maarten interne alarmering en communicatie

●


●


Samenwerking Werkt samen met: ●


●


●

Vertegenwoordiger Meldkamer

●

Operationeel Leider

●


G-3


Techniek en hulpmiddelen

82

Taken ●

Alarmeer de geneeskundige keten (volgens alarmeringsschema)

●


●

Voer inzetplan uit

●


●


●

Registreer slachtoffers die afgevoerd zijn naar het ziekenhuis

●


●


Opschaling ●


●

1e Avp laat verder opschaling

●

De brandweer maakt bij de opschaling gebruik van de termen: “GRIP 1,-2,-3 en 4 indien sprake is van een incident waarbij gecoördineerde inzet van de hulpverleningsdiensten noodzakelijk is (vergelijkbaar met code blauw, geel


en rood)

83

Afschaling ●

De Centralist MKA schaalt indien verdere medische inzet niet meer nodig is Af in opdracht van hoogst leidinggevende op plaats incident.

G-4

3. Ambulance verpleegkundige 1e ambulance(1e Avp) Alarmering en inzet Als u wordt gealarmeerd Als u wordt gealarmeerd stelt u de volgende vragen: ●


●

Aantal slachtoffers

●


●


●

Gevaren

●


●

Tijdstip Hoelang bestaat de situatie)

Aankomst plaats incident ●


●


●

Voer na sein “veilig” een snelle (15-30 sec per slachtoffer) triage uit met chauffeur,

●


●




●


●


●


G-5


Gebruikmakend van slachtofferkaarten

84

Samenwerking


Werkt samen met:

85

●

Centralisten MKA

●


●


●

Operationeel Leider

●


G-6



●

Coordineren inzet

●

Triage

●


●

Bepaal inzet locatie 2e en verdere ambulances

●


●


●


●


●

Rapporteert aan Operationeel Leider

●




●


●


●


●


Afschaling ●

De Centralist MKA schaalt indien verdere medische inzet niet meer nodig is af in opdracht Van hoogst leidinggevende op plaats incident

G-7


Opschaling

86


4.



●

Aantal slachtoffers

●


●


●

Gevaren

●


●



Stel de ambulance goed zichtbaar op , rekening houdend met de aan- en afvoerroute

●


●


●

Registreer n.a.v. triageronde van 1e Avp informatie over triageklasse, aantallen en


Locatie van slacktoffers

87

●


●


●

Stem af op juiste portofoonkanaal



●


●


●


G-8


Avp 1e ambulance

●

Operationeel Leider

●

Centralisten MKA

●


●


●


●


●

Opschalen op verzoek van 1e Avp via MKA

●

Opstellen inzetplan n.a.v. de informatie van de 1e Avp

G-9


Taken

88

Opschaling ●


●


●

Na 1e triage wordt verdere opschaling/inzet bepaald door de 1e Avp tot komst van de Operationeel Leider

Afschaling ●

De centralist MKA schaalt indien verdere medische inzet niet meer nodig is af in


opdracht van hoogst leidinggevende van EMS Sint Maarten op plaats incident.

89

G-10

5.Operationeel Leider Alarmering en inzet Als u wordt gealarmeerd Als u wordt gealarmeerd stelt u de volgende vragen: ●


●

Aantal slachtoffers

●


●


●

Gevaren

●


●


●


●


●

Zoek 1e Avp/ 1e Ach op

●

Vraag 1e Avp/ 1e Ach om sitrap

●


●


●


●


●


●

Bepaal inzetplan

●


●

Stem af op juist portofoonkanaal

G-11



90



●


●


●


Samenwerking


Werkt samen met:

91

●

Centralisten MKA

●

1e Avp

●

1e Ach

●


●

Transport coördinator

●


G-12

Taken ●

Bepaal verdere opschaling en medische inzet

●


●


●


●


●

Voer intercollegiaal overleg met brandweer en politie

●


●


●

Bewaak opschaling

●


●


●


●

Neem deel in COPI

●

Denk aan eventueel op te starten deelprocessen rampenbestrijding

●


●


●


●


●


●


G-13


Opschaling

92

Afschaling ●

De Centralist MKA schaalt indien verdere medische inzet niet meer nodig is af in opdracht


van hoogst leidinggevende op plaats incident

93

G-14

6.Vertegenwoordiger Meldkamer Centralist Alarmering en inzet Als u een melding krijgt Als u een melding krijgt van een incident stelt u de volgende vragen: ●


●

Aantal slachtoffers

●


●


●

Gevaren

●


●




●


●



Centralisten

●

1e Avp

●

chauffeur 1e ambulance(tot komst OVDG)

●

OVDG(OL)

●


●

Ziekenhuizen

G-15


Samenwerking

94

Taken ●

Geef leiding aan de meldkamer

●

Alarmeer de geneeskundige keten volgens alarmeringsschema

●


●


●


●

Signaleer knelpunten en doorgeven aan de Operationeel Leider(OVDG)

●

Voer opdrachten OVDG(OL)

●

Stem af met ziekenhuis

●

Stem af met Rode Kruis en WIEMS

●

Neem deel aan de evaluatie aan het eind van de inzet

Opschaling ●

De vertegenwoordiger MKA alarmeert volgens het alarmeringsschema

●



●

95

Opschaling verloopt uitsluitend via de MKA

Afschaling ●


G-16

7.Transport Coördinator Alarmering en inzet Als u een melding krijgt Als u een melding krijgt van een incident stelt u de volgende vragen: ●


●

Aantal slachtoffers

●


●


●

Gevaren

●


●




●


●



Centralist

●

OVDG(OL)

●

Ambulancebemanning

●

Ziekenhuis(zonodig)

●


G-17


Samenwerking

96

Taken ●


●

Laat slachtoffers transporteren in opdracht van OVDG(OL)

●


●


●

Signaleer knelpunten en doorgeven aan de Operationeel Leider(OVDG)

●

Stem af met centralisten

●

Stem af met Operationeel Leider(OVDG)

●

Voer opdrachten OL(OVDG)

●

Stem af op juist portofoonkanaal

●

Verdeel de slachtoffers over de beschikbare ambulances

●

Neem deel aan evaluatie aan het eind van de inzet

Opschaling ●



●

97

Opschaling verloop uitsluitend via de MKA

Afschaling ●


G-18

8. Hoofd ambulancedienst(CVDG) Alarmering en inzet Als u een melding krijgt Als u een melding krijgt van een incident stelt u de volgende vragen: ●


●

Aantal slachtoffers

●


●


●

Gevaren

●


●


●

Vraag of het een voorwarschuwing betref



●


●


●

Bel directrice VSA

●

Informeer Coördinator ESF-6

●

Activeer zonodig COPI

●

Vervul; z.n. taak Medisch Leider COPI

●

Neem zonodig zitting in EOC

G-19


Taken

98

Melding Code Geel 6-10 slachtoffers

Centralist: Ambulance(s) naar plaats incident Volg LPA 1e Ambulance geeft SITRAP en bevestigd code

Centralist

1 Bel OL(Ovd)


OVD: gaat naat plaats incident

99

2 Bel Hoofd van Dienst(Cvd)

CVD: informer coordinator ESF6 z.n COPI activeren

CVD neemt contact met directeur VSA

OVD ter plaatse; Neemt coordinatie over, geeft SITRAP en verdure inzetplan

3 Begin met opschaling(extra personeel en ambulance ter plaatse)

5 Bel en activeer S.M.M.C

1e AVP zorg voor opschaling, opvang en coordinatie

4 Bel voor standby Rode Kruis en W.I.E.M.S

Attachment 6:Work Instructions & Alarm Diagram Code Red

Work Instructions & Alarm Diagram Code Red


CODE ROOD

Aard en omvang van de ramp zijn van dien aard dat de met zekerheid te verwachte schade in het brongebied en omgeving ruimschoots de behandelen transport capaciteit van Ambulance Dienst Sint Maarten overschrijden. Er is sprake van ernstige letsels en potentiële psychotrauma.


> 10 slachtoffers

100

Inhoudsopgave code rood:

Pagina


1. MKA Centralist…………………………………………...R-3 2. Ambulance verpleegkundige 1e ambulance(1e Avp)...........R-4 3. Ambulance chauffeur 1e Ambulance(1e Ach)……………......R-5 4. Operationeel Leider…………………………………....... R-6 5. Transport Coördinator.................................................R-7 6. Hoofd van dienst(C.V.D.G).......................................... R-8

101

R-2

1.Meldkamer Centralist (MKA Centralist) Alarmering en inzet Als u een melding krijgt Als u een melding krijgt van een incident stelt u de volgende vragen: ●


●

Aantal slachtoffers

●


●


●

Gevaren

●


●




●


●


●


●


●

Operationeel Leider

●

CVDG

●

CoPI

●

Transport Coördinator

●


R-3


Samenwerking; Werkt samen met:

102

Taken ●

Alarmeer de geneeskundige keten - Volgens schema - Alarmeer en activeer SMMC - Alarmeer en activeer Rode Kruis en WIEMS

●


●

Voer inzetplan uit

●


●


●


●

Plot informatie (actuele operationele situatie bijhouden o.a. door logboek)

●


Opschaling ●


●

1e ambulance geeft opdracht tot verdere opschaling

●

De brandweer maakt bij de opschaling gebruik van de termen: “GRIP 1,-2,-3 en 4 indien sprake is van een incident waarbij gecoördineerde inzet van de


hulpverleningsdiensten noodzakelijk is (vergelijkbaar met code blauw, geel en rood)

103

Afschaling ●

De Centralist MKA schaalt indien verdere medische inzet niet meer nodig is af in opdracht van hoogst leidinggevende op plaats incident.

R-4

2.Ambulance verpleegkundige 1e ambulance(1e Avp)



●

Aantal slachtoffers

●


●


●

Gevaren

●


●




●


●

Voer na sein “veilig” een snelle (15-30 sec per slachtoffer) triage uit met chauffeur,

●


●



ambulance dienst Sint Maarten interne alarmering en communicatie

●


●


●


R-5


Gebruikmakend van slachtofferkaarten

104

Samenwerking


Werkt samen met:

105

●

Centralisten MKA

●


●


●

Operationeel Leider

●


R-6



●

Coordineer inzet

●

Triage

●


●

Bepaald inzet locatie 2e en verdere ambulances

●


●


●


●


●

Rapporteer aan Operationeel Leider

●




●


●


●


●


Afschaling ●



Opschaling

R-7

106

3.




●

Aantal slachtoffers

●


●


●

Gevaren

●


●



Stel de ambulance goed zichtbaar op, rekening houdend met de aan- en afvoerroute

●


●


●

Registreer n.a.v. triageronde van 1e Avp informatie over triageklasse, aantallen en


Locatie van slacktoffers

107

●


●




●


●


R-8


Avp 1e ambulance

●

Operationeel Leider

●

Centralisten MKA

●


Taken ●


●


●


●

Opschalen op verzoek van Avp via MKA

●

Opstellen inzetplan n.a.v. de informatie van de Avp

Opschaling ●


●

De brandweer maakt bij de opschaling gebruik van de termen: “Grip 1,-2,-3 en 4

diensten noodzakelijk is (vergelijkbaar met code blauw/geel/rood)

R-9


Indien sprake is van een incident waarbij gecoördineerde inzet van de hulpvelenings-

108

4.

Operationeel Leider



●

Aantal slachtoffers

●


●


●

Gevaren

●


●




109

●


●


●

Zoek 1e Avp/ 1e Ach om sitrap

●

Vraag 1e Avp om sitrap

●


●


●


●


●


●

Bepaal inzetplan

●


R-10



●


●


●


Samenwerking ●

Centralisten MKA

●

1e Avp

●

1e Ach

●


●

COPI

●

Hoofd van dienst (CVDG)

●

Transport coördinator

●


R-11


Werkt samen met:

110

Taken ●

Bepaal verdere opschaling en medische inzet

●


●


●


●


●


●


●


●


●


●


●

Voer intercollegiaal overleg met brandweer en politie (COPI)

●


●

Bewaak opschaling

●

Bewaak aflossing functionarissen

●

Neem deel aan motorkapoverleg

●

Denk aan eventueel op te starten deelprocessen rampenbestrijding

●



Opschaling

111

●


●

De brandweer maakt bij de opschaling gebruik van de termen: “Grip 1,-2,-3 en 4 Indien sprake is van een incident waarbij gecoördineerde inzet van de hulpveleningdiensten noodzakelijk is (vergelijkbaar met code blauw/geel/rood)

●


●


R-12

Afschaling De Centralist MKA schaalt indien verdere medische inzet niet meer nodig is af in opdracht van hoogst leidinggevende op plaats incident

R-13


●

112

5.Transport coördinator(TC) Alarmering en inzet Als u wordt gealarmeerd Als u wordt gealarmeerd stelt u de volgende vragen: ●


●

Aantal slachtoffers

●


●

Plaats van incident ( aanrijroute)

●

Gevaren

●


●



Techniek en hulpmiddelen

113

●


●


●


●



Centralisten

●

Operationeel Leider

●


●

Ziekenhuizen(zonodig)

●


R-14

Taken ●


●

Laat slachtoffers transporteren en registreer de slachtoffers die afgevoerd zijn

●

Plot informatie(actuele operationele situatie bijhouden o.a. door logboek

●

Signaleer knelpunten en geef door aan OL (OvDG)

●

Stem af met centralisten

●

Stem af met OL (OvDG)

●

Voer opdrachten van de OL (OvDG)

●

Stem af op het juiste portofoonkanaal

●

Verdeel de slachtoffers over de beschikbare ambulances

●

Meen deel aan de evaluatie aan het eind van de inzet

Opschaling ●

De brandweer maakt bij de opschaling gebruik van de termen: “Grip 1,-2,-3 en 4 Indien sprake is van een incident waarbij gecoördineerde inzet van de hulpverleningdiensten noodzakelijk is (vergelijkbaar met code blauw/geel/rood) Opschalin verloop uitsluitend via de MKA

Afschaling ●


R-15


●

114

6. Hoofd Ambulancedienst(C.VDG) Alarmering en inzet Als u wordt gealarmeerd Als u wordt gealarmeerd stelt u de volgende vragen: ●


●

Aantal slachtoffers

●


●

Plaats van incident

●

Gevaren

●


●


●

Vraag of het een voorwaarschuwing betreft



●



Samenwerking

115


Eilandelijke Rampenstaf (ERS)

●

Eilandelijk Tactisch Team (ETT)

●

CoPI

R-16

Taken ●

Neem zitting in ETT

●

Geef leiding aan de geneeskundige hulpverlening op beleidsniveau

●

Neem beslissingen inzake de ambulance inzet

●

Vertaal multidisciplinaire aandachtspunten en prioriteiten naar de geneeskundige inzet

●

Adviseer in EOC betreffende te nemen beslissingen

●

Vertaal tactische informatie naar strategische informatie

●

Adviseer vanuit geneeskundig perspectief over de multidisciplinaire hulpverlening

●

Bewaak gewondenregistratie

●

Dien verzoek bijstandsaanvrage in

●

Maak een gevaarinschatting

●

Bewaak reguliere ambulance dekking

●

Bepaal lange termijn planning

●

Adviseer betreffende knelpunten

●

Verstrek informatie t.b.v. pers betreffende de geneeskundige hulpverlening

●

Start deelprocessen rampenbestrijding op

●

Neem deel aan de evaluatie aan het eind van de inzet

●

De centralist MKA alarmeert volgens het alarmeringsschema

●

De brandweer maakt bij de opschaling gebruik van de termen: “Grip 1,-2,-3 en 4 Indien sprake is van een incident waarbij gecoördineerde inzet van de hulpverleningdiensten noodzakelijk is (vergelijkbaar met code blauw/geel/rood)

●


Afschaling ●


R-17


Opschaling

116

Melding Code Rood > 10 slachtoffers

Centralist: Ambulance(s) naar plaats incident; volg LPA 1e Ambulance geeft 1e SITRAP en bevestigd Code. CENTRALIST

1 Bel OL (OVD)

OL(OVD) gaat naar plaats incident OVD ter plaatse neem coördinatie over, Geef 2e SITRAP en inzet OVD en CVD stemmen af: Aantal T1, T2, T3 en capaciteiten 2 Bel Hoofd van Dienst(CVD)

CVD bel SG VSA


SG VSA gaat in EOC

117

CVD Activeer coordinatie ESF6 CVD Rapporteer aan SG VSA in EOC 3 Bel en activeer S.M.M.C

4 Bel en activeer Rode Kruis en W.I.E.M.S 5 Zorg voor opschaling en opvang

Attachment 7: INWERKPLAN AMBULANCE- VERPLEEGKUNDIGE

Ambulancehulpverlening St. Maarten

Februari 2009


Aangepast door A.Cristina

118

Inleiding: Dit inwerkschema is bedoeld om nieuwe medewerkers methodisch en eenduidig in te werken. Het geeft structuur en continuïteit in het inwerkproces voor de nieuwe medewerker, de begeleider en de leiding van Ambulance dienst Sint Maarten . Tevens heeft het tot doel het kennismakingsproces met het bedrijf en het werk op de ambulance te stroomlijnen en is het een hulpmiddel bij het toetsen van beroepsinhoudelijke kennis en vaardigheden. Steeds wordt daarbij de vraag gesteld: "wat wordt beheerst", en "wat moet nog geleerd worden?". Het inwerkschema is tevens een stappenplan in aanloop naar de SOSA opleiding. Het methodisch handelen en het werken volgens de protocollen zijn hierin de hoofdzaken. Van de voortgang en de evaluaties worden schriftelijke rapportages bijgehouden. Het inwerkschema beslaat vier weken of 20 werkdagen. Aan het einde hiervan wordt bepaald of de nieuwe medewerker zelfstandig verder gaat, dan wel een vervolg krijgt op het inwerkschema. In het vervolgschema worden de aandachtspunten en de verdere aanpak expliciet benoemd. Aan het einde van iedere week vindt een evaluatie plaats. De nieuwe medewerker wordt gedurende de inwerkperiode gekoppeld aan een mentor. Dit is een collega ambulanceverpleegkundige. Hij of zij bewaakt het proces en woont ook de evaluaties bij. Het inwerken zelf wordt verzorgd door verschillende praktijkbegeleiders. Ook de mentor kan als praktijkbegeleider fungeren. De nieuwe medewerker, de mentor, de praktijkbegeleiders en de Operationele leiders (OL) zijn samen verantwoordelijk voor de voortgang van het inwerkproces. Het Hoofd van dienst van EMS heeft de eindverantwoordelijkheid. Bij voortgangsproblemen kan de afdeling hoofd tot bijstelling van het programma besluiten,


of aan de andere kant ingrijpen.

119

N.B. Na de 4e week kopieen van alle evaluatieformulieren en Checklist geven aan het hoofd van dienst. Na controle worden deze bewaard in het persoonlijke dossier van de nieuwe medewerker.

Opbouw inwerkschema:

* Per week is een aantal aandachtspunten benoemd. * Aan het einde van iedere week vindt een evaluatie plaats. * De weekevaluatie vindt plaats aan de hand van de bij dit inwerkschema behorende evaluatieformulieren. De formulieren geven richting aan het gesprek en brengen de wel- of niet halen van de gestelde doelen in kaart. Evaluaties worden afgesloten met het maken van nieuwe afspraken. * Per dag wordt een dagevaluatieformulier ingevuld door de nieuwe medewerker en bijgehouden. Doel is overzicht te krijgen in de verrichte werkzaamheden. Bovendien kan het dienen als overdracht aan een volgende praktijkbegeleider. * In het schema zijn checklists opgenomen. Hierop worden de meest voorkomende vaardigheden in een drietrapsmodel (demonstratie, onder toezicht, zelfstandig) afgetekend. De checklists worden afgetekend door de praktijkbegeleider. De laatste (derde) handtekening wordt uitsluitend gezet met instemming van de nieuwe medewerker, die daarna zelf verantwoording draagt voor deze handeling. * De inwerkperiode wordt afgesloten met een eind-evaluatie. De eindevaluatie geeft een beeld van het gelopen traject. Er vindt samen-

medewerker, de begeleider en de leidinggevende (OL). 

Ook tijdens het zelfstandig functioneren zullen er op afgesproken momenten evaluatie gesprekken plaatsvinden.


vattende verslaglegging plaats. De eindevaluatie wordt ondertekend door de

120

Kennismakings-/ introductiedag. Tijdens deze eerste dag komen onder andere de volgende punten aan de orde: - Kennismaking met collega's, leidinggevenden enz. - Uitleg van het inwerkprogramma, de functie praktijkbegeleider, het begeleidingsproces. - Opleidingsachtergrond en werkervaring van de nieuwe medewerker. - Uitspreken van verwachtingen van nieuwe medewerker en praktijkbegeleider. - Uitleg/rondleiding organisatie . - Uitleg diensten, dienstrooster, vakantieplanning en diensten ruilen. - Informatie structuur ambulancedienst. - Invullen overwerkformulier. - Informatie huisregels. - Aanvragen vrije dagen. - Ziek en herstelt melding. - Zorgen voor dienstkleding. - Zorgen voor garderobekast. - Uitreiken tensiemeter, stetoscoop, glucometer, holster, pupillampje,


verbandschaar .

121

Evaluatie van de eerste dag: Week 1 Vooral gericht op de organisatie van het ambulancevervoer. Tijdens de eerste dagen gaat de aandacht vooral uit naar: - Kennismaking interieur ambulance middels een dagelijkse contrôlebeurt. N.B. Controle voor aanvang van de diensttijd. - Uitleg organisatie ambulancevervoer, communicatie mogelijkheden, werking meldkamer. - Uitleg mobilofoon, portofoon, telefoon. - Uitleg soorten vervoer, ritformulier. - Meelopen met voorkomend vervoer, met vooral aandacht voor B-vervoeren, en mobilofooncommunicatie en dergelijke. -

Kennismaking ziekenhuis/Eerste Hulp * Aandacht voor de andere instellingen. - Uitleg/kennismaking collega hulpverleners, waaronder Brandweer en Politie. - Wijze van vervoer, tiltechnieken en zorg voor interieur van de ambulance. - Aandacht voor kwaliteit van basiszorg, met name:

* op gemak stellen van patiënt * zorg voor comfortabel transport * aandacht voor thuissituatie - Aandacht voor: * individuele beroepsverantwoordelijkheid * belang van goede registratie hulpverleningsproces op het ritformulier

NB. In de eerste week een rondleiding in de CPA (meldkamer) plannen.


* gastheerschap

122

Week 2. Vooral gericht op medisch-technische en verpleegkundige zorg. Aandachtspunten: - Soorten vervoer - Ritformulier - Kennis en gebruik van apparatuur/ materialen - Eerste-Hulp technieken - Begeleiding van patiënten en familie/ naasten - Attitude en privacy - Kennismaking/ uitleg Landelijk Protocol, met name: * Protocollen algemeen * Protocollen traumatologie * Protocollen cardiologie - Kennismaking met methodisch handelen in de ambulance-hulpverlening: * Afnemen anamnese * Top tot teen onderzoek en specifiek lichamelijk onderzoek * Formuleren werkdiagnoses


* Formuleren behandeldoelen

123

* Toepassing conditiescores * Gebruik medicatie

Week 3. Deze week vooral aandacht voor: - Samenwerking met de chauffeur en andere disciplines (huisarts, verloskundige, politie en brandweer) - Onderlinge taakverdeling. - Toepassing protocollenboek (na vervoer van een patiënt moet het bijpassende protocol besproken worden). - Zelfstandig invullen van het Rit Formulier. - Zelfstandig afnemen anamnese - Zelfstandig uitvoeren lichamelijk onderzoek. - Zelfstandig formuleren werkdiagnoses/ behandeldoelen - Principe van de PHTLS, bijwonen traumatologietraining. - Toepassing paraatkoffer. - Zelfstandig uitvoeren van: * Spalken (extremiteiten/ nek) * Wondverzorging - Advanced Life Support


* Indien mogelijk bijwonen ALS training

124

Week 4 Deze week vooral aandacht voor: - Transportcouveuse en zorg voor pasgeborene - Psychiatrisch vervoer (KZ-verklaring) - Hulpverlening bij grootschalige incidenten: * Rampenplan * Airport * Opschaling * Organisatie rampgebied * Rampenmateriaal - Hulpverlening door derden: * Rode kruis en WIEMS * Artsen en Verpleegkundigen

- Hulpverlening overige activiteiten - Stand-by ritten - Procedure vervoer overledenen op straat en thuis - Hygiënische aspecten met betrekking tot:


* MRSA

125

* TBC * Hepatitis - IC-transporten - Juridische aspecten - Uitbreiden zelfstandig functioneren, terugtrekken inbreng praktijkbegeleider

Evaluatiegesprek met Nieuwe medewerker week 1. Datum :

Tijd:

Naam Medewerker:

Naam praktijkbegeleider: Naam Operationeel Leider: Overige aanwezigen:

- Hoe is de eerste kennismaking met de ambulancehulpverlening ervaren?

- Wat heeft de medewerker gemist/ wat was juist goed?

- Hoe is de eerste week verlopen?

- Zijn de aandachtspunten van week 1 voldoende aan bod gekomen, zo niet, welke punten verdienen nog de aandacht?

-

Heeft de nieuwe medewerker nog vragen/opmerkingen: * A. algemeen:

- Heeft de praktijkbegeleider nog opmerkingen? - Samenvatting van het gesprek:

N.B. Aandachtspunten voor de volgende week doornemen, eventueel niet behaalde doelstellingen/ aandachtspunten van week 1 toevoegen. S.V.P. Kopie van dit verslag naar het hoofd van dienst.


* B. ten aanzien van het inwerkprogramma:

126

Evaluatie gesprek met Nieuwe medewerker week 2. Datum:

Tijd:

Naam Medewerker:

Naam praktijkbegeleider: Naam Operationeel Leider: Overige aanwezigen: - Hoe heeft Nieuwe medewerker de tweede week ervaren?

- Zijn alle aandachtspunten voldoende aan bod gekomen? Wat heeft volgens Nieuwe medewerker onvoldoende aandacht gekregen?

- Hoe verlopen contacten met patiënten en familie?

- Heeft de nieuwe medewerker inzicht in het methodisch handelen, en kan hij/zij dit toepassen?

- Heeft de nieuwe medewerker inzicht in het Landelijk Protocol, en kan hij dit toepassen?


- Heeft de nieuwe medewerker nog vragen/ opmerkingen?

127

- Heeft de praktijkbegeleider nog opmerkingen?

- Samenvatting van het gesprek:

N.B. Aandachtspunten voor de volgende week doornemen, eventueel niet behaalde aandachtspunten/ doelstellingen van week 2 toevoegen. S.V.P. Kopie van dit verslag naar het hoofd van dienst.

Evaluatiegesprek met Nieuwe medewerker week 3. Datum:

Tijd:

Naam Medewerker:

Praktijkbegeleider: Operationeel Leider: Overige aanwezigen: - Hoe heeft de nieuwe medewerker de derde week ervaren?

- Zijn alle aandachtspunten voldoende aan bod gekomen?

Wat heeft volgens hem/haar onvoldoende aandacht gekregen?

- Hoe verloopt de samenwerking met collega's en andere disciplines?

- Hoe verloopt het functioneren met betrekking tot de overige aandachtspunten?

- Heeft de nieuwe medewerker nog vragen/opmerkingen?


N.B. Aandachtspunten voor de volgende week doornemen, eventueel niet behaalde aandachtspunten/doelstellingen van week 3 toevoegen. S.V.P. Kopie van dit verslag naar het hoofd van dienst.



128

Evaluatiegesprek met Nieuwe medewerker week 4: Datum:

Tijd:

Naam medewerker:

Naam praktijkbegeleider: Naam Operationeel Leider: Overige aanwezigen: - Hoe heeft de nieuwe medewerker de vierde week ervaren?

- Zijn alle aandachtspunten voldoende aan bod gekomen? Wat heeft volgens hem/haar onvoldoende aandacht gekregen?

- Heeft de medewerker voldoende ruimte gekregen om zelfstandig te functioneren?





129

N.B. Afspraken worden gemaakt naar aanleiding van de eindevaluatie. S.V.P. Kopie van dit verslag naar het hoofd van dienst.

Evaluatieoverzicht van Nieuwe medewerker week 1 t/m 4. Datum:

Naam medewerker:

Naam praktijkbegeleider: Naam leidinggevende (OL): Overige aanwezigen:

Onderwerp

onvold.

vold.

goed

Attitude Samenwerking met de chauffeur Is in staat feed-back te geven en te ontvangen Basiszorg verlenen aan de patient Zorg voor psycho-sociale aspecten in hulpverlening (patient en familie) Beoordeling hulpvraag en inspelen hierop Is in staat volgens methodisch handelen hulp te verlenen. Is in staat protocollair hulp te verlenen Is in staat het Landelijk Protocol in de hulpverlening te integreren Kan vitale functie’s beoordelen en ingrijpen bij stoornissen Afnemen van anamnese Uitvoeren lichamelijk onderzoek

Instrumenteel-technisch handelen Is in staat om adequaat te handelen in acute situatie’s Is in staat om prioriteiten te stellen


Vaststellen werkdiagnose’s

130

Aan de hand van het evaluatieoverzicht: Wat is de algemene indruk ten aanzien van de geschiktheid voor deze functie:

Eindevaluatie: A. Verpleegkundige kan zelfstandig functioneren B. Verpleegkundige heeft vervolg inwerktraject nodig

- Aan welke aspecten moet in het vervolgtraject aandacht worden besteed?

- Welke vorm moet het vervolgtraject krijgen?



- Heeft de leidinggevende nog opmerkingen?

Samenvatting van het gesprek:


Gemaakte afspraken:

131

Handtekening:

………………..

leidinggevende

…………….

Begeleider

S.V.P. Kopie van dit verslag naar het hoofd van dienst.

……………………

Nieuwe medewerker

Checklist t.b.v. het inwerkprogramma van Nieuwe medewerker: De taak van een ambulance-verpleegkundige omvat een groot aantal vaardig-heden en instrumenteel-technische handelingen.

De bedoeling van deze checklist is om het leerproces te volgen, en helder te maken wat hij/zij reeds beheerst, of niet- of onvoldoende beheerst. Tevens is het een hulpmiddel om er voor te zorgen dat het inwerkprogramma zo volledig mogelijk is. Elke vaardigheid/ handeling moet drie maal afgetekend worden. De eerste maal (1) als demonstratie, de tweede maal bij uitvoering onder begeleiding (2), de derde handtekening (3) wordt gezet met instemming van Nieuwe medewerker Hiermee verklaart hij/zij zich bekwaam tot het uitvoeren van de vaardigheid of handeling. Een kopie van de Checklist naar de Bedrijfsmanager sturen. De taken van de ambulance-verpleegkundige zijn te onderscheiden in een aantal rubrieken: 1. Algemene kennis en kennis van de inventaris van de ambulance 2. Zorg voor de patiënt 3. Instrumenteel-technisch handelen en specifieke taken t.a.v.: - Algemeen - Cardiologie - Traumatologie

- Verloskunde - Neurologie - Pediatrie 4. Coördinatie van zorg

Checklist

Algemene kennis en kennis van de inventaris van de ambulance


- Interne ziekten

132

A. Hanteren van communicatiemiddelen

1

2

3

1

2

3

1

2

3

1

2

3

1

2

3

Mobilofoon Portofoon Telefoon regels m.b.t. communicatie met C.P.A. voorwaarschuwing urgentie aan EHBO

B. Hanteren van geografische gegevens lezen van wegenkaart

C. Inventaris van de ambulance controle van inventaris bij aanvang dienst hygiene t.a.v. inventaris/ achtercompartiment

D. Het kunnen bedienen van


monitor/ defibrillator

133

pulse/ oxymeter Beademingsapparaat* afzuigapparaat (twee stuks)

E. Het gebruik kennen van: Brancardmateriaal Brancardrijder

brancard/ fixatieband Vouwbrancard Schepbrancard

Spalk- en verbandmateriaal

1

2

3

1

2

3

metalline lakens/ doeken vette (synthetische) watten* Nekspalken Spalken KED immobilisatie Hoofdsteunen

Beschermende materialen Gasmasker * TBC masker groene rampenjas* Veiligheidshelm*


* = nog niet aanwezig

134

Overige materialen

1

2

3

2

3

Sterilium Lijkenhoes Zuurstofbril Zuurstofcatheter Zuurstofmasker Afzuigcatheter Yankauer zuurstof cylinders Reduceerventielen Snelkoppelingen beademingsballon bufferzak “

“

peepventiel

“

“

barrierbag filter

Reanimatiebord bedieningspaneel en schakelaars 110 volt mogelijkheid monteren tweede brancard


vacuum matras *

135

Kennis van inhoud/ materialen diverse koffers Paraatkoffer* Verband koffer Kinder*- en partus koffer

* = nog niet aanwezig

1

Zorg voor de patient F. Basiszorg

1

2

3

2

3

2

3

heeft aandacht voor de patient draagt zorg voor de privacy heeft aandacht voor de psycho- sociale aspecten tijdens het vervoer informeert de patient over uit te voeren handelingen informeert de patient zo nodig wat deze te wachten staat heeft aandacht voor de familie en informeert deze voldoende weet correct om te gaan met agressie en/of weerstand v.d. patient heeft aandacht voor de benodigde rijstijl

G. Tiltechnieken

1

Rautekgreep met brancard de trap af en –op Schepbrancard div. technieken van bed naar brancard v.v./rolstoel/vliegtuig assistentie Brandweer

H. Lichaamshouding

1

stabiele zijligging (half) zittende houding Trendelenburg houding


Rugligging

136

J. Zorg voor temperatuur

1

2

3

1

2

3

1

2

3

1

2

3

snelheid van werken vermijden van wind en tocht gebruik van dekens en folie gebruik van air-conditioning

K. Hygiene maatregelen gebruik van handschoenen kennis van protocol MRSA gebruik van TBC maskers zorg voor gebruikte naalden en andere verontreinigde materialen

L. Zorg voor veiligheid in- uitstappen ambulance ongeval met gevaarlijke stoffen afschermen ongeval ongevallen met geweld

M. Zorg voor overledene


kent procedure m.b.t. overledene thuis, elders, onnatuurlijke dood

137

opbaren van overleden thuis draagt zorg voor oproepen huisarts draagt (indien gewenst) zorg voor oproepen van familie draagt zorg voor opvang van aanwezige familie

Instrumenteel-technisch handelen N. Algemeen

1

2

3

1

2

3

2

3

is in staat methodischte handelen is in staat een anamnese af te nemen is in staat een volledig top tot teen onderzoek af te nemen is in staat conditiescore’s af te nemen (RTS/GCS) is in staat werkdiagnose’s te stellen is in staat behandeldoelen te formuleren

O. Bewaking controle vitale functies Monitorbewaking pulse-oxymetrie inbrengen waaknaald/ aanleggen infuus gebruik spuitenpomp *

P. Ademhaling

1

vrijmaken ademweg

uitzuigen mond- keelholte toepassen mayo-tube toedienen zuurstof per catheter, bril of kapje gebruik Ambu-ballon gebruik beademingsapparaat* endotracheale intubatie vernevelen Ventolin is op de hoogte van de relevante protocollen


methode van Heimlich

138

R. Cardiologie

1

2

3

1

2

3

zorg voor patient met angina pectoris zorg voor patient met myocard infarct zorg voor patient met asthma cardiale herkennen van ritmestoornissen en hierop kunnen ingrijpen beheersen reanimatie technieken BLS en ALS is op de hoogte van relevante protocollen

S. Traumatologie stelpen van bloedingen (afdrukpunten) aanleggen van wondverbanden aanleggen van drukverbanden aanleggen mitella/ brede das heeft kennis van hulpverlening bij schedel-/ hersentrauma, halswervelletsel Fracturen whip-lash


* = niet aanwezig

139

1

2

3

1

2

3

1

2

3

thorax trauma (rib frakturen en (spanning pneumothorax)) (stomp) buiktrauma bekken fraktuur frakturen/ luxatie’s Wervelletsel Oogletsel brandwonden (inhalatie trauma) chemische verbranding koolmonoxyde intoxicatie Bevriezing Onderkoeling Drenkeling elektriciteit/ bliksem ongeval repositioneren luxatie’s en de indicatie’s repositioneren/ spalken van nek, arm, boven- en onderbeen

is op de hoogte van het PHTLS principe en kan dit toepassen

zorg voor stellen van indicatie en oproepen van 2e amb. is op de hoogte van relevante protocollen

T. Interne ziekten: zorg voor patient met diabetes mellitis/ bloedsuiker bepalen / oraal,intraveneus reguleren anafylactische shock septische shock gastro-intestinale bloedingen


kennis van methode Kusters en samenwerking met brandweer

140

intoxicaties van medicijnen,alcohol,opiaten en overige Hyperventilatie Longembolie COPD patienten is op de hoogte van relevante protocollen

U. Verloskunde: zorgt voor patient

1

2

1

2

1

2

3

in partu met spontane abortus met extra uteriene graviditeit met bloedverlies tijdens graviditeit met bloedverlies post-partum met niet vorderende baring/ foetale nood is op de hoogte van relevante protocollen

V. Neurologie: zorgt voor patient met

3

Bewustzijnsstoornissen TIA/ CVA


Epilepsie

141

is op de hoogte van relevante protocollen

W. Pediatrie: zorgt voor kind met koortsconvulsie’s Trauma Meningitis circulatie-/ ventilatiestilstand is op de hoogte van relevante protocollen

3

Coordinatie van zorg 1

2

3

het bepalen van de hulpvraag het bepalen van de zorgbehoefte het bepalen van de vervoersindicatie het bepalen van de vervoersurgentie zorgt voor goede mondelinge overdracht naar ziekenhuis zorgt voor goede schriftelijke overdracht naar ziekenhuis kan hulpverleningsproces goed op CRF weergeven overlegt (indien nodig) met andere hulpverleners is in staat functioneel leiding te geven aan chauffeur en derden


is in staat (medische) verpleegkundige hulpverlening te coordineren

142

Dagevaluatie inwerkplan Nieuwe medewerker: Naam medewerker

:

Naam begeleider : ………………………..

Datum

: ………………………..

Dienst

: ………………………..

Ongeval

A

B

C

Aantal

:

…….

……

…… ……

Waarvan zelf

:

…….

……

…… ……

Kort verslag / Opmerkingen Nieuwe medewerker:


Opmerkingen praktijkbegeleider:

143

Naam en opmerkingen chauffeur:

Vóór eerste opkomst van Nieuwe medewerker te regelen. Aktie

gedaan

datum

Persoonlijk medisch/ver pleegkundig mater iaal klaar leggen Rooster klaarleggen Inwer kmap maken Map interne huisregels klaar leggen Kopie rijbewijs vragen/ maken Uniform regelen Werkschoen regelen Regenjas regelen Telefoonlijst afdeling a mbulance Persoonlijk kastje + slot regelen Sleutels regelen Protocollenboekje Funktieomschrijvingen klaarleggen Kopie exemplaar vakantieaanvraag en over wer kformulier

Identiteitspas (kopie) vragen Vakantie afspra ken laten noter en/ r egelen op aa nvraaglijst en formulier


Vragen of telefoon nummer in algemene klapper mag

144

Uitreiken diverse artikelen op de eerste werkdag van Nieuwe medewerker (vpk.)


Aktie

145

Gedaan

Datum

Attachment 8: INWERKPLAN AMBULANCE CHAUFFEURS

January 2009


DIENST AMBULANCEHULPVERLENING SINT MAARTEN

146

Dit inwerkplan is bedoeld om een nieuwe ambulancechauffeur gestructureerd op te leiden tot zelfstandig functionerend ambulancehulpverlener. Daartoe is dit inwerkplan verdeeld in blokken. De nieuwe medewerker zal niet aan een nieuw blok beginnen voordat het voorliggende blok succesvol is doorlopen. Er is hier dus geen sprake van een vooraf ingesteld tijdspad.

De nieuwe medewerker zal een mentor/begeleider toegewezen krijgen. Deze is verantwoordelijk voor het juist doorlopen van het inwerkplan. Het inwerken zal veelal geschieden door begeleiders. Evaluatie zal gebeuren volgens schema.


Aangezien het zal voorkomen dat er tussen het zelfstandig functioneren van de nieuwe medewerker en het behalen van het SOSA-diploma enige tijd verloopt, kan er na het goed doorlopen hebben van dit inwerkplan een “Basisbekwaamheidsverklaring” afgegeven worden. Wanneer dit inwerkplan ook gebruikt zou worden voor collega’s die problemen hebben met het behalen van het SOSA-diploma, zullen er geen ongecertificeerde chauffeurs meer werkzaam zijn.

147

N.B. Van alle dagverslagen, periodieke(blok)evaluaties en de eindevaluatie een kopie naar de bedrijfsmanager ter informatie en “filen” in het dossier van de medewerker.

OPLEIDINGSAANDACHTSPUNTEN AMBULANCECHAUFF EURS:

A: VOERTUIGKENNIS AMBULANCE:

Van de chauffeur wordt verwacht dat hij/ zij geheel vertrouwd is met het type voertuig en de inrichting daarvan:

1. bekend zijn met de communicatie apparatuur, de werking en procedures.

2. blindelings de schakelaars kunnen vinden van: stadslicht/ dimlicht/ grootlicht waarschuwingslichten/ zij- en achterkant werklichten blauw zwaailicht/ knipperlicht 2/3 tonige hoorn ruitenwisser/ -sproeier

hoofdschakelaar

achtercompartiment

airconditioning voor/ achter alle andere schakelaars in de chauffeurscabine en achtercompartment handrem weten waar de autopapieren zich bevinden

3. plaats weten van het reservewiel, krik en ander hulpgereed


binnenverlichting

148

schap

4. in staat zijn een wiel te wisselen of een lamp te vervangen en storingen adequaat te melden

5. weten waar de peilstok van de motorolie zit en waar eventueel olie moet worden bijgevuld

6. weten wanneer en hoe koelvloeistof moet worden bijgevuld

7. weten waar de peilstok van de automatische versnellingsbak


zit, hoe gepeild en zo nodig bijgevuld moet worden

149

B: GEBRUIK VAN HET VOERTUIG - Werkzaamheden vòòr aanvang dienst. N.B. Controle dient plaats te vinden vòòr aanvang dienst. 1. oliepeil + transmissiepeil controleren 2. koelvloeistof niveau controleren 3. ruitensproeiervloeistof niveau controleren 4. bandenspanning controleren 5. verlichting controleren 6. visuele controle op schades en de melding daarvan 7. uitrij mogelijkheid verzorgen 8. spiegels juist afstellen 9. juiste zit/ werking chauffeursstoel 10. sleutelbos controleren op aanwezigheid 11. mobilofoon controleren op instelling

13. autopapieren controleren 14. Serene controleren + externe luidsprekers

- Juiste houding achter het stuur.

15. goede zithouding, hoofdsteun afstellen, autogordels 16. beide handen aan het stuur 17. gebruik van rechtervoet voor rem en gaspedaal 18. blik op de weg tijdens gesprek met inzittenden


12. portofoon controleren op instelling (knop op 1)

150

C: GEDRAG OP DE WEG: - Starten en wegrijden. 1. gebruik hoofdschakelaar 2. op de juiste wijze starten (voorgloeien) 3. gebruik 2e en/of 3e accu 4. handrem 5. juiste wijze van gebruik buitenspiegels tijdens het wegrijden 6. inmelden CPA.

- Rijden algemeen. 7. rechts houden 8. snelheid aanpassen aan het overige verkeer, de toestand van de patiënt en de weersomstandigheden 9. afstand houden


10. regelmatig in de buitenspiegels kijken

151

11. duidelijk in de rijstrook rijden: rechterrijstrook rechts linkerrijstrook links 12. stuurvast rijden (geen onnodige stuurbewegingen)

- Optrekken en remmen speciaal tijdens patiënten vervoer

13. Het optrekken en remmen vereist een speciale techniek welke veel oefening vereist. LET ER SPECIAAL OP EN VER-

ZUIM NIET DE LEERLING ER OP TE WIJZEN.!!!!!!!!!!!!

- Inhalen. 14. tijdig en goed beoordelen van ander verkeer voor, achter, links, rechts 15. keuze moment en plaats van inhalen 16. gebruik richtingaanwijzer bij rijstrook wisseling 17. vlot inhalen en vloeiend weer terug naar de rechterrij strook

- Rijden op verkeerspleinen en verdeelpleinen (klaverblad). 18. tijdig voorsorteren 19. tijdig richting aangeven 20. op de juiste wijze weven 21. verdrijvingsstrepen en -vlakken in acht nemen

- Achteruitrijden. 22. op de juiste wijze kijken (buitenspiegels) 23. ondergeschikt aan ander verkeer

25. regelmatig en stapvoets rijden

- Anticiperen. 26. rekening houden met te verwachten verkeerssituaties 27. vooruitzien 28. reactie op waarnemingen 29. zien van verkeerstekens 30. opvolgen van verkeerstekens -

Tijdens patienten vervoer.


24. niemand hinderen

152

31. vroegtijdig zien en zoveel mogelijk vermijden van gaten op het wegdek. Let op olievlekken (duiden op gaten en

gladheid)

D: RIJDEN MET BLAUW ZWAAI/ KNIPPERLICHT EN 2 of 3 TONIGE HOORN: 1. aanpassen van de snelheid aan de verkeerssituatie 2. gebruik zwaailicht en triofoon 3. stapvoets over de kruising, desnoods in onoverzichtelijke situaties geheel tot stilstand komen 4. de plaats van het voertuig bij een ongeval 5. denk aan de veiligheid van u en uw collega op de plaats van het ongeval 6. gebruik zo nodig een veiligheidshelm (bouwplaats) 7. gebruik van reflecterende kleding en waarschuwingslampen bij invallende duisternis, slecht weer


NB. zie bijlage “Ontheffingen voor de ambulancechauffeur”

153

E: AANKOMST POST:

1. auto "paraat" parkeren 2. afval verwijderen 3. uitmelden bij CPA. 4. eventuele storingen melden

EINDE DIENST: 5. auto opruimen in en parkeren in “paraat rijvak” 6. samen met verpleegkundige aanvullen van gebruikte materialen en ziekenruimte “moppen”, waardoor auto weer “uitrukgereed” is 7. portofoon (onder lading plaatsen) 8. autosleutels in sleutelkast

dienstdoende persoon en je collega.

N.B. Je mag pas weg als de diensttijd is voltooid en je aflossing er is.


9. eventuele defecten aan het voertuig rapporteren aan de

154

BLOK-INDELING INWERKPLAN AMBULANCECHAUFFEUR BLOK 1 a meerijden (stage) b stadskennis/ oriëntatie c voertuigkennis d verbindingsapparatuur e CPA f EMS regels en richtlijnen g huisregels BLOK 2

a begin maken met L.L. te laten rijden (GEEN SPOED) b oriëntatie/ stadskennis c inventaris ambulance (globaal) d tiltechnieken e afspraak plannen met operationeel leider (OL) f herhalen blok 1


BLOK 3

155

a uitleg apparatuur en andere attributen ziekenruimte b medisch assisterende handelingen (verpleegkundige) c oefenen vaardigheden medisch assisterende handelingen d “parat” koffer verpleegkundige e extra koffers (infant, partus, verband koffer) f externe rijvaardigheidstraining . g herhalen blok 1 en 2

BLOK 4

a start rijden met spoed (gedoseerd) b stadskennis/ oriëntatie c hoe te handelen bij brand en andere calamiteiten d de patiënt, de taak van de chauffeur hierbij (chauffeur en verpleegkundige) e afspraak plannen met OL f herhalen blok 2 en 3

BLOK 5

a rijden spoed/ geen spoed b medisch assisterende handelingen (leslokaal) c stadskennis d herhalen blok 2, 3 en 4 BLOK 6

a zelfstandig alle voorkomende ritten kunnen doen

uitvoeren


b zelfstandig alle medisch assisterende handelingen kunnen

156

BLOK 1. a: MEERIJDEN:

1 kijken 2 indruk van het werk opdoen 3 rondleiding ziekenhuis E.H.B.O. ambulanceingangen regels en gewoontes diverse instellingen. 4 rondleiding Sector VSA.

b: STADSKENNIS/ ORIENTATIE:

1 L.L. straten laten opzoeken event. uitleg aanrijroutes ziekenhuizen/klinieken/instellingen 2 testen oriëntatie districten. 3 speciale benamingen zoals b.v. oproepnummers ambulances, enz.

c: VOERTUIGKENNIS:


1 zie opleidingsaandachtspunten A en B

157

d: VERBINDINGSAPPARATUUR:

1 werking mobilofoon + externe luidsprekers 2 werking portofoon 3 etherdiscipline 4 meldingsprocedure vertrek/aankomst, enz.

e: C.P.A :

1 globale uitleg meldkamer 2 werkwijze

f: EMS.

REGELS EN RICHTLIJNEN: 1 geheimhouding/confrontatie media 2 ambulanceritformulier (summier) 3 vervoer afspraken 4 samenwerking politie 5 samenwerking brandweer, Airambulance, begravenisonderneming. 6 begrip 1e,2e- en volgende auto

g: huisregels en organisatiestructuur EMS: 1 aanvraag vrije dagen 2 aanvraag vakantie 3 ziek- en hersteld melden 4 dagindeling (dienstplanning)

ambulanceinspectieformulier. 6 uniform 7 bereikbaarheid voor thuis 8 schademeldingen 9 bekeuringen 10 procedure onderlinge dienstruil 11 interne huisregels 12 organigram uitleggen met diverse funkties 13 direct leidinggevende (operationeel leider)


5 invullen formulieren; vakantie, overwerk,

158

BLOK 2

a: ZELF RIJDEN: 1 aanvang maken met de L.L. zelf te laten rijden GEEN SPOED 2 zie opleidingsaandachtspunten C en E

b: STADSKENNIS EN BUITEN REGIOKENNIS ORIENTATIE: 1 kaartlezen 2 zelf op laten zoeken kortste route nabespreken het hoe en waarom

c: INVENTARIS AMBULANCE: 1 inventaris ambulance

d: TILTECHNIEKEN: 1 van bed op brancard v.v 2 van stoel op brancard v.v 3 van de grond op brancard v.v Ambulance Operations Manual | 8/1/2010

4 de bewusteloze patiënt

159

5 manoeuvreren in huis, airambulance, vliegtuig, schepen. 6 op de trap 7 omgaan met brandcard c.q. til/druk methode

e: AFSPRAAK MAKEN met OL voor blok 3a+3b+3c

f: HERHALEN BLOK 1

BLOK 3 De start van dit blok is één dag in het leslokaal c.q. garage, o.l.v. een ambulanceverpleegkundige/ instructeur.

a: UITLEG APPARATUUR EN ANDERE ATTRIBUTEN ZIEKENRUIMTE: 1 hartapparatuur Life-Pack 2 beademingsautomaat* n.v.t. (toekomst) 3 accutor* n.v.t. (toekomst) 4 beademingsballon 5 uitzuigapparatuur 6 vacuumspalken 7 KED Kit 8 nekspalken 9 Fast Strap 10 zuurstofflessen 11 zuurstoftoedieningssystemen 12 schepbrancard

1 waaknaald helpen plaatsen 2 infuus helpen inbrengen 3 helpen intuberen 4 pat. aansluiten op hartbewakingsapparaat 5 pat. aansluiten op bloeddruk-/saturatiemeter 6 pat. zuurstof toedienen 7 creëren van optimale werkruimte en hygiëne Onder direkt toezicht van verpleegkundige


b: MEDISCH ASSISTERENDE HANDELINGEN:

160

c: OEFENEN VAARDIGHEDEN MEDISCH ASSISTERENDE HANDELINGEN: 1 opzuigen medicamenten,dextrose + NaCl 0,9% 2 infuussysteem klaarmaken + Haemacell 3 laryngoscoop klaarmaken 4 endo-tracheaal tube klaarmaken en fixeren 5 defibrilleren

d: “PARAT” KOFFER VERPLEEGKUNDIGE: 1 juist gebruik, open maken en dicht doen 2 waar zit wat 3 juiste benamingen

e: EXTRA KOFFERS: 1 waar dient verband koffer voor 2 wat zit er in oranje koffer 3 infant koffer (toekomst)


4 partus koffer

161

f: HERHALEN BLOK 1 EN 2

BLOK 4

a: RIJDEN MET SPOED:

1 zie opleidingsaandachtspunt D 2 uitleg geven rijden met spoed onder bijzondere omstandigheden -extreme verkeersdrukte -slechte weersomstandigheden -begeleidend spoed aan b.v. 2e amb. reanimatie -slachtoffer met schedel/CWK letsel, hartinfarct

b: STADSKENNIS/ORIëNTATIE:

1 straten opzoeken bij ongeval 2 oriëntatie bij ongeval

c: HOE TE HANDELEN BIJ BRAND, CALAMITEITEN, DELICTEN EN ANDERE SPECIFIEKE GEVALLEN:

1 aanspreekpunt (communicatie met andere disciplines)en aanrijroute bij brand, drenkeling op het strand, schiet/steek-partijen 2 gedragsregels bij bijzondere opdrachten b.v. voorwaarde scheppend, overweging vervoer van overledene op straat (openbare orde)


3 hoe zet je je auto neer

162

3 procedure 1e ambulance

d: DE PATIëNT (de taak van de chauffeur hierbij):

1 onder leiding van een ambulanceverpleegkundige realiteit nabootsen. Waar ligt wat in de auto en wanneer gebruik je dat?

e: AFSPRAAK MAKEN bij OL voor blok 5B


f: HERHALEN BLOK 2 en 3

163

BLOK 5

a: RIJDEN MET- EN ZONDER SPOED: 1 zelfstandig laten uitvoeren van alle voorkomende ritten ( let op dat het niet te zwaar wordt in het begin ) 2 speciale aandacht voor stratenkennis en oriëntatie tijdens spoedritten 3 uitleg spoedvervoer met begeleiding van de politie (b.v. gewonde gevangene)

b: MEDISCH ASSISTERENDE HANDELINGEN: de in dit blok genoemde handelingen/ vaardigheden zullen o.l.v. een verpleegkundige/ instructeur gedurende een dag in het instructielokaal geoefend worden 1 kennis nemen van de bijlagen A en B A = werkwijze volgens PHTLS principe B = werkwijze volgens ACLS principe 2 oefenen volgens de protocollen PHTLS en ACLS

Roger methode (helm afnemen) Chin lift Jaw thrust Aanleggen Stiff neck Aanbrengen Oregon Spine Splint Gebruik Bak Pak Uitvoeren Log Roll Methode Kusters


3 oefenen PHTLS vaardigheden:

164

4 oefenen van reanimeren van Polsloze Ventrikulaire Tachycardie, Elektro Mechanische Dissociatie en Asystolie.

c: STADSKENNIS/BUITEN REGIOKENNIS:

1 leerling kent doorgaande routes in gehele stad en verdwaalt niet meer 2 kan met behulp van stratenboekje snel naar onbekende locatie


d: HERHALEN BLOK 2,3 EN 4

165

Bijlage A.

PHTLS Primary survey (= waar kijk je in eerste instantie naar)

Airway 0205

Breathing 0209

Circulation

: is er sprake van obstruktie in de mond/keelholte of luchtpijp? Immobilisatie cervicale wervelkolom: manueel of met Stiffneck

: is er werkelijk sprake van gaswisseling in de longen of zijn er ademhalingsproblemen

: is de bloedsomloop van de patient in orde

0212

Disability

: neurologische score, waarbij amb.personeel niet kan behandelen. Bestaat uit

0215

1. Pupilcontrole 2. Alert

: = goed reagerend op aanspreken

Verbal

: = mompelen, kreunen op aanspreken

Pain

: = alleen reaktie op pijnprikkels

Exposure

: klaarmaken voor lichamelijk onderzoek

environment

: beschermende maatregelen (afkoeling)

0216

: schouwen plaats incident ( toedracht)

Secundary survey (=waar kijk je in tweede instantie naar)

Deze begint met het afnemen van de anamnese met behulp van:


Unresponsive : = onbeantwoord, comateus

166

A

: allergieën

M

: medicijngebruik

P

: past illness (= doorgemaakte ziekten in het verleden)

L

: last meal (= wanneer is de laatste maaltijd genuttigd)

E

: events (= zaken die geleid hebben tot de gebeurtenis)

Top tot teen onderzoek.

Hierbij wordt de patient systematisch onderzocht in de volgorde: hoofd en gelaat nek en cervicale wervelkolom borstkas buik bekken schouders/ armen/ benen rug, mits gecontraïndiceerd


Met behulp van al deze informatie kan een behandelplan opgesteld worden en zal de patient vervoersklaar gemaakt worden.

167

BLOK 6

a: ZELFSTANDIG ALLE VOORKOMENDE RITTEN KUNNEN DOEN:

1 speciale aandacht voor alle in de voorgaande blokken aan de orde gekomen opleidingsaandachtspunten 2 laatste puntjes op de i zetten 3 overtuig u er van dat de l.l. na dit blok zelfstandig kan functioneren

b: ZELFSTANDIG ALLE MEDISCH-ASSISTERENDE HANDELINGEN KUNNEN UITVOEREN:

1 laatste controle van zowel de verpleeg-

2 als naar de mening van de mentor, de leidinggevende (OL) en de bedrijfsmanager de kandidaat aan de normen van het inwerkprogramma voldoet, volgt uitreiking van de“Basisvaardigheidsverklaring”.


kundigen als uzelf, dat alle in de voorgaande blokken aan de orde gekomen medisch assisterende taken zelfstandig uitgevoerd kunnen worden

168

CHECKLIST INWERKPLAN Naam medewerker:................................................

Gezien

Onderwerp Hoofdstuk A 1 t/m

7

“

B 1 t/m 18

“

C 1 t/m 31

“

D 1 t/m

7

“

E 1 t/m

9

Opmerkingen hoofdstukken At/m E

Blok 1 a “

1 b

“

1 d

“

1 e

“

1 f

“

1 g


Opmerkingen blok 1

169

Blok 2 a 2 “

2 b

“

2 c

“

2 d

“

2 e(datum……………………)

gedaan

zelfstandig

accoord

Opmerkingen blok 2

Blok 3 a “

3 b

“

3 c

“

3 d

“

3 e

“

3 f(datum………………………)

Opmerkingen blok 3

Blok 4 a 2 “

4 b

“

4 c

“

4 d

“

4 e(datum………………………)


Opmerkingen blok 4

170

Onderwerp

Gezien

gedaan

zelfstandig

Blok 5 a “

5 b

“

5 c

Opmerkingen blok 5

Blok 6 a “

6 b

Opmerkingen blok 6

Gezien, gedaan en zelfstandig: aftekenen door begeleider Accoord: aftekenen door nieuwe medewerker.


Kopie naar hoofd van dienst.

171

akkoord

Dagverslag inwerken NAAM MEDEWERKER:............................

BEGELEIDER:...................VERPLEEGKUNDIGE.................

DATUM:.../.../20..

DIENST......TOT.......

Ongeval

A1

A2

B

AMB..........

BV

A.Amb.

AANTAL:

...

...

...

...

...

...

WAARVAN ZELF:

...

...

...

...

...

...

--------------------------------------------------------------

SPECIALE AANDACHT VOOR:

OPMERKINGEN BEGELEIDER:

OPMERKINGEN VERPLEEGKUNDIGE:


KORT VERSLAG:

172

PERIODIEK EVALUATIEFORMULIER INWERKEN ( Na elke blok !) Naam Medewerker:…………………………………………………………………………………

Datum: ……………………………

Aanwezig: ………………………………………………………… ………………………………………………………… ………………………………………………………… …………………………………………………………

Hoe heeft de nieuwe medewerker deze periode ervaren?

Wat zijn de op-/ aanmerkingen van de OL/ begeleider over deze periode?

Zijn de leerdoelen van de afgelopen periode bereikt?


Wat zijn de aandachtspunten voor de komende periode?

173

voor accoord:

………………………………

…………………………………

………………………………………

nieuwe medewerker

Operationeel Leider/ Begeleider

EVALUATIEFORMULIER EINDE INWERKPERIODE (Na de 6 e blok!) Datum

: ………………………………………………

Naam Medewerker Aanwezige Begeleider

: …………………………… : ………………………………………………

Aanwezige leidinggevende (OL) : ………………………………………………

Hoe heeft de nieuwe medewerker het hele inwerktraject ervaren?

Zijn er nog aspecten niet- of onvoldoende belicht?

Zijn alle medisch-assisterende aspecten(kennis en vaardigheden) voldoende belicht en geoefend?

Denkt de nieuwe medewerker klaar te zijn voor zelfstandig functioneren o.l.v. een ervaren verpleegkundige?


Zijn alle chauffeurs-technische aspekten (hoofdstukken A t/m E) voldoende voldoende belicht?

174

Denken de overige aanwezigen dat de nieuwe medewerker zelfstandig kan functioneren o.l.v. een ervaren verpleegkundige?

Is het gewenst om het inwerktraject te verlengen en welke punten verdienen dan bijzondere aandacht?

Evaluatie momenten zullen zijn nà bovengenoemde datum omstreeks:

…………………… ………………………

…………………… …………………………


Voor accoord tekenen:

175

……………………………

……………………

Nieuwe medewerker Begeleider

……………………

Leidinggevende (OL)

EVALUATIEFORMULIER ZELFSTANDIG FUNCTIONEREN (4 weken na inwerkperiode)

Datum :……………………………………………… Naam Medewerker:…………………………………… Aanwezig :……………………………………………………… ……………………………………………………… ……………………………………………………… ………………………………………………………

Hoe is de afgelopen periode verlopen?

Welke onderwerpen behoeven nadere uitleg?

Hoe moet vorm gegeven worden aan de nadere uitleg?

Opmerkingen mentor/pb-er:

Opmerkingen leidinggevende:

Voor accoord:

…………………………

Nieuwe medewerker

……………………………………

Leidinggevende(OL)

……………………………

Begeleider


Opmerkingen :

176

Vóór eerste opkomst van (ch)te regelen.

Aktie

Stratengids

Rooster klaarleggen Inwerkmap maken

Kopie rijbewijs vragen/ maken Protocollenboekje Personeelskastje + sleutel regelen Telefoonlijst afdeling ambulance

Kopie exemplaar ontheffingen ambulancechauffeur Pen Functieomschrijvingen Kopie exemplaar vakantie, overwerk, schade formulier


Telefoon nieuwe medewerker opnemen in bestand. Vragen bekend aan iedereen?

177

Map interne huisregels voor personeel

Uniform regelen Werkschoen regelen

Regenjas ? Regenlaars? Sleutels

gedaan

Datum

Mag-lite + lader en riemhouder* Holster, verbandschaar, pupillamp Vakantie afspraken laten noteren o p wensenlijst

aanmelden

voor Gedaan

datum

datum lesdag Ambulance Operations Manual | 8/1/2010

Nieuwe chauffeur rijvaardigheidstraining

178

Uitreiken diverse artikelen op eerste werkdag van (ch.)


Aktie

179

Gedaan

Datum

Ambulance Operations Manual

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