Penn State Emergency Medical Services

Penn State EMS Standard Operating Procedures and Constitution

University Ambulance Service
Centre County Company 20
Procedures Manual

CURRENT POLICY MEMORANDA

CONTENTS

Patient Refusal/Sign Off

Advanced Directive

Mass Casualty Box Alarm

Uniform Guidelines

Airport Disaster Plan

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PATIENT REFUSAL/SIGN OFF:

38.1 The provider should attempt to obtain a history and physical as permitted by
the patient.

A. Determine that the patient is an adult or emancipated (major) minor
	1. Minor less than 18 years old .
	2. Emancipated (Major) Minor is less than 18 years old 1) is pregnant or has
had a child, 2) graduated from high school, or 3) is or has been married.
	3. Adult is 18 years or older

B. Determine competency of the patient.
	1. Patient is oriented to person, place, time, and event.
  2. Patient does not appear to have mental compromise. (consider alcohol, drugs, or
illness/ head injury)
  3. Patient has not injured self on purpose.

C. Determine medical severity of the illness/injury
	1. Actual or potential life or health-threatening illness or injury
	2. Moderately severe illness or inJury
	3. Minor illness or injury

38.2 The patient is competent.

A. All degrees of medical severity
	1. Potential risks of refusing treatment/transport must be explained to the
patient.
	2. Consider soliciting the help of friends or family to convince the patient to
accept treatment.
	3. Give the patient the refusal form ( on the back of the narrative section of
the state form) to sign and have it witnessed. If no one is available to witness, have
it witnessed by a fellow crew member and document the information.
	4. Advise the patient to seek medical help if symptom develop and offer
alternatives. a. "Consult your family physician" b. "Go to a health care facility by
privately owned vehicle." c. "If you experience any of the following
signs/symptoms, call 91 1."
	5. Give the patient a "Refusal Information Sheet" and have him/her sign and
date a copy to be included with the trip record.

B. Potential life-threatening illness of injury
	1. Law enforcement personnel, family, crisis workers or children's services
should be contacted.
	2. Medical command at the receiving hospital should be contacted. 3. If all of
these are unsuccessful, follow the procedures in section "A".

38.3   The patient is not competent
	1. Health care worker should not jeopardize their safety, but all reasonable
attempts should be made to treat and transport the patient.
	2. Law enforcement personnel, family, crisis workers or children's services
should be contacted.
	3. Medical command at the receiving hospital should be contacted.
	4. If all of these are unsuccessful, follow the procedures in section "A".

38.4   If a patient is an involuntary commitment, the procedures in Section 53.2
should be followed.

38.5   Documentation - The narrative should include:
	1. Criteria used to determine competency.
	2. The symptoms which would suggest need for treatment/transport.
	3. Results of the patient assessment.
	4. Information provided to patient about potential risks of refusal.
     5. The patient's understanding of the consequences of refusal
	6. What alternatives were offered.

38.6 In the event of multiple victim vehicle accidents, the same refusal process
should be completed on uninjured patients if available manpower is present or
patient care will not be compromised.

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CENTRE COMMUNITY HOSPITAL ADVANCED LIFE SUPPORT DEPARTMENT
Policy # 3001S

Title: Advance Directive

Purpose:  The purpose of this policy is to establish uniform guidelines for the
Advanced Life Support personnel when presented with an original Advance
Directive.

Under Pa's Advance Directive for Health Care Act, any individual who is 18 years of
age or older, or has graduated from high school or  married,  may  execute  an 
Advanced  Directive  governing  the initiation,  continuation,  withholding  or 
withdrawing  of  life sustaining treatment.   The  Declaration must be  signed by the
patient or by another on behalf of and at the direction of the patient, and must be
witnessed by two individuals each of whom is 18 years of age or older.  A witness
shall not be the person who signed the Declaration on behalf of the patient.  The
Declaration becomes  operative  when  a  copy  is  provided  to  the  attending
physician and the patient is determined by the attending physician to be
incompetent and in a terminal condition or in a state of permanent
unconsciousness.  This Act specifies circumstances under which ALS personnel can
respond to an Advance Directive if ordered by the Medical Command Physician.

Policy:

A.  In the event that a patient is unable to give informed consent to treatment and
an ORIGINAL (see Appendix) Declaration, signed by the patient or authorized
person and witnessed as indicated above, is presented to the Paramedic, he/she
must immediately notify the Medical Command Physician

B.  The Medical Command Physician, based upon this notification or prior
notification by the attending Physician or other Health Care Provider that a valid
and operative Declaration exists, may direct the Paramedic according to the
provisions of the Declaration.

C.  In the event that no original Advance Directive is supplied or there is some
uncertainty regarding the validity of the Declaration all accepted treatments
protocols and standards will be 	followed.


D.  Paramedics confronted with any conflicting information regarding the patient's
wishes for life-sustaining treatment shall act according to the treatment protocols
and accepted 	standards.

Paramedic Determination of the Existence of an Original Declaration

The Paramedic should consider the following factors in determining whether to
advise the Medical Command Physician that an ORIGINAL DECLARATION has
been presented to ALS personnel:

1.  The document should appear to be signed by the patient (not a photocopy or
document marked "copy") or signed by another person claiming authority to sign
on behalf of the patient;

2.  The Paramedic should reasonably believe the patient is 18 years of age or older. 
This belief may be based upon observation of the patient, information from others
at the scene, patient identification documents or information from the patient;

3.  The document is signed by two (2) individuals as witnesses.   The Paramedic
should presume the witnesses are 18 years of age or older unless they receive
information at the scene to the contrary.

4.  A document is invalid as an original declaration if any of the following
information is determined by the Paramedic:

a.  the document is not signed by the patient or other authorized person on behalf of
the patient;

b.  the patient or authorized person signing the document is less than 18 years of age
and is not married nor has not graduated from high school;

c.  the document is not witnessed by at least two (2) persons;

d.  the authorized person signing the document on behalf of the patient also signs
the document as 1 of witnesses; and

e.  the document is a copy or photocopy of an original document.

E.  The original Declaration will remain with the original State Paramedic Trip
Report and a copy will be made for the Medical Command Physician.

Administrator

Medical Director

Coordinator

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MASS CASUALTY BOX ALARM

SEQUENCE OF DESIRED EVENTS AT A MASS CASUALTY INCIDENT

A.  Activation of Pre-Hospital Phase.

B	.  Concise response system implemented.  First arriving police, fire,
ambulance units establish a Command Post near the disaster scene.  Command
responsibilities are assumed and any additional equipment and manpower
necessary as requested.

C.  First pre-hospital medical personnel at the scene do primary survival scan of
scene.

D.  Notification of EXTENT and NUMBER OF CASUALTIES to communications
center by EMS Official, Communications center then notifies all agencies to be
involved, including medical facilities.

E.  Activation of area hospital disaster plans for external disasters according to level
of disaster which has been reported and number of patients each facility may
receive.

F.  Initiation of critical life-saving treatment techniques during the rapid initial
survey performed by the first arriving pre-hospital EMS personnel. (ABC's)

G.  Patients tagged according to appropriate priorities (TRIAGE) by assigned Triage
Team.

H.  Patients immobilized rapidly on portable transportation devices.

I.  Patient Collection Stations designated and set up in well marked areas by
Transportation Officer.

J.  Patients delivered by priority if possible to Patient Collection Stations

K.  Patients arranged by priority at Patient Collection Stations.

L.  Incoming emergency units report to Vehicle Staging Area designated by EMS
Official; drop off personnel and supplies/equipment; and driver remains with
vehicle, awaiting further assignment.

M.  Patient treatment implemented at Patient Collection Stations.

N.  Prehospital advanced life support personnel and/ar Designated Physician
Disaster Response Team treat patients most in need of advanced care at Patient
Collection Stations.

O. Patients transported in priority sequence, if possible, to designated hospitals as
assigned by Transportation Officer.

P. Detailed scene reports concluded.

Q . Plan Deactivated .

R.  Equipment and supplies returned to agencies involved.

5.  Critique at disaster scene operations conducted by all agencies involved, shortly
apter the disaster incident.

                   CENTRE COUNTY, PENNSYLVANIA
                       EMS BOX ALARM SYSTEM

    Attached is the bop alarm system for EMS response to Mass Casualty Incidents 
(MCI).   Bop alarms are pre-planned response strategies to be used in any incident
that overwhelms the response capabilities of the first arriving EMS units.  Pre-
planning allows for a coordinated response to the incident as well as reducing
anxiety for both the dispatchers and responding units.
    The box alarm is designed around each Centre County ambulance service s
coverage area.   The box was  designed to enable the quickest  response to the
patient(s) possible; but, still allow for EMS coverage within that jurisdiction. 
Response levels have been developed  using  the  number  of  patients  as  the 
criteria  for determining the appropriate response.  The levels are as follows:

Level    No. of Patients*    EMS Units** to respond
	   I           2-10                      6
    II          11-25                   12
   III         over 25                  16

    Initial responders need only advise the county dispatch center of the number of
injured patients and the telecommunicator will dispatch the appropriate EMS
equipment.  After triage is complete, should additional units be needed,  responders
should re-contact county dispatch and update the number of patients.
    This plan was developed assuming all units identified within the  plan are 
available.   Telecommunicators  need to use  their discretion on which units to
dispatch based upon availability, location, environmental conditions and other
appropriate criteria. The bop alarm is only a guideline.
    This plan was developed by the Seven Mountains EMS Council. Council would
like to thank Dave Kirk, EMT-P for his assistance with this project.

*   Response is based upon the number of patients, not the number
    of people involved (which may be much higher).

**  This plan deals solely with EMS response.  Police, Fire,
Rescue, and other public safety agencies should be dispatched as appropriate.

CENTRE COUNTY BOX ALARM PLAN

RESPONDING COMPANY			LEVEL
I				LEVEL II				LEVEL III
																			(< 10 PTS.)	(11-25 PTS.)	(> 25 PTS.)

Logan Ambulance (Co. 1)		l-BLS						2-
BLS						2-BLS
Centre Hall (Co.
4)																	l-BLS*					2-BLS*
Alpha Ambulance (Co. 5)		3-BLS						3-
BLS						3-BLS
Snow Shoe Ambulance (Co. 6)	
Pleasant Gap Amb. (Co. 8)		l-BLS						l-
BLS						2-BLS
Citizens Amb. (Co. 9)
Mountaintop Amb. (Co. 13)
Port Matilda Amb. (Co.
15)												2-
BLS					2-BLS
University Amb. (Co. 20)			l-BLS						l-
BLS						l-BLS
East Centre Amb. (Co. 21)
Moshannon Valley EMS (Co.
23)								2-
MICU					3-MICU
Medic
24														1-ALS							l-ALS					1-ALS
Gregg Twp. QRS (Co. 7)
Howard QRS (Co. 14)
Walker Twp. QRS (Co. 16)
   OUT OF COUNTY UNITS
Helicopters																											2								2
Juniata Valley (Huntington
Cty)																		l-BLS

* If ESCALATION, includes units previously assigned to Move-Up.

MOVE-UP PLAN

RESPONDING COMPANY				LEVEL
I						LEVEL II				LEVEL III
																				(< 10 PTS.)			(11-25 PTS.)		(> 25 PTS.)

Logan (Co. 1)
Centre Hall (Co.
4)																l-BLS to Co 5	1-BLS to Co 5
Alpha (Co. 5)
Snow Shoe (Co.
6)																												l-BLS to Co 1
Pleasant Gap (Co.
8)															l-BLS to Co 5	l-BLS to Co 5	
Citizens (Co. 9)																		
l-BLS to Co 1	2-BLS to Co 5
Mountaintop (Co. 13)
Port Matilda (Co. 15)
University (Co. 20)
East Centre (Co. 21)
Moshannon Valley (Co.
23)																						l-BLS to Co 15
Medic 24
   OUT OF COUNTY UNITS
Tyrone (Blair
Cty)																												1-BLS to Co 15

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UNIFORMS GUIDELINES

The purpose  of a  uniform  is so  we can  be  identified as  EMS professionals.   This
means wearing a  standard uniform that does not  include fashionable  belts,  trendy 
athletic  shoes,  funny hats, or other non-uniforms items.  Trainees that have filled
oui a  UAS  application, have  been approved  by  Wes, and  have been assigned to 
the day or night schedules are acting as part of the crew and may wear all uniform
items below.

Shirts:   White  shirts are worn on duty.  Trainees should try to conform  to these 
requirements, but  may wear  the old blue uniform  shirts if they  do not  wish to 
purchase one.

Do not  wear various colors of  t-shirts or turtlenecks under uniform shirts.  Stick to
white.

Insignia: EMT, EMT-P, or National Registry patch on left sleeve.

University Ambulance Service patch on right sleeve.

Laminated ID badge.

(Optional) Name plate above right pocket.

Trousers: Dark blue long uniform pants.

Belt:     Dark blue or black web belt or black leather belt.

Shoes:    Black shoes or boots with plain dark blue or black socks.

Jacket:   Blue Penn State EMS jacket, plain Penn State jacket, or plain blue or black
jacket.  Penn State EMS sweatshirts or dark blue/black military  style sweaters may
also be worn for cold weather.

Hat:	      (Optional) Blue PSU Ambulance hat or blue Penn State 	hat.  (Worn
with the bill facing front.)

Other:    	The UAS Supervisor may authorize other items and should
	be consulted if there are any questions.

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PENN STATE UNIVERSITY
UNIVERSITY PARK AIRPORT

EMERGENCY RESPONSE PROCEDURE FOR CRASH, FIRE, AND RESCUE

GENERAL INFORMATION

AUTHORIZATION HAS BEEN GIVEN TO CENTRE COUNTY DISPATCH TO
TURN BACK ALL UNWANTED APPARATUS AND EQUIPMENT

AIRPORT PERSONNEL WILL DETERMINE AND REQUEST THE DESIRED LEVEL
OF RESPONSE

ALL CALLS THAT GO DIRECTLY TO UNIVERSITY POLICE SERVICES OR
CENTRE COUNTY DISPATCH BETWEEN THE HOURS OF 11:30 PM AND 6:00
AM, SEVEN DAYS A WEEK, ARE TO BE TREATED AS CALLS REQUIRING A
LEVEL FOUR (4) RESPONSE

Should Centre County Dispatch Or Bellefonte Communications receive the initial
call for an emergency at the airport, they should immediately notify University
Police Services  (863-1111)  after dispatching equipment for the appropriate response
level.

RESPONSE LEVEL ONE (l)

For a Level One response the Police Service Dispatcher is to notify Centre  County 
Dispatch  for  a  medical  response.  Bellefonte Communications ( 355-5441 ) is to be
notified for a response from the Bellefonte Fire Department.

Criteria for a Level One response is for a plane carrying from one (1) to four (4)
passengers and 75 gallons of fuel or less.

EMS RESPONSE:

Two (2) ambulances; One (1) from Ritenour Health Center and one (1) from
Bellefonte

One (l) Advanced Life Support Unit from Centre Community Hospital

FIRE RESPONSE:

One (1) Rescue Truck

All airport firefighting equipment

One (1) Aerial Apparatus at dusk

POLICE RESPONSE:

Bellefonte Fire Police

University Police

RESPONSE LEVEL TWO (2)

For a Level Two response the Police Service Dispatcher is to notify Center  County 
Dispatch  for  a  medical  response.  Bellefonte Communications (355-5441) is to be
notified for a response from the Bellefonte Fire Department.

Criteria for a Level Two response is a plane carrying a maximum of six (6)
passengers and less than 300 gallons of fuel.

EMS RESPONSE:

Two (2) Ambulances; One (1) from Ritenour Health Center and one (1) from
Bellefonte

One (1) Advanced Life Support Unit from Centre Community Hospital

FIRE RESPONSE:

All Airport Firefighting Equipment

One (1) Rescue Truck

One (1) Tanker

One (1) Engine

One (1) Aerial Apparatus at dusk

POLICE RESPONSE:

Bellefonte Fire Police

University Police

RESPONSE LEVEL THREE (3)

For a Level Three (3) response the Police Service Dispatcher is to notify Centre
County Dispatch for a medical response and for a response from the Alpha Fire
Company. Bellefonte Communications (355-5441) is to be notified for a response
from the Bellefonte Fire Department.

Criteria for a Level Three (3) response is for a plane carrying between 6 and 12
passengers and between 300 and 600 gallons of fuel.

EMS RESPONSE:

Three (3) Ambulances; One (l) from Ritenour Health Center, one (1) from
Bellefonte, and one (1) from Alpha Ambulance Service

One (1) Advanced Life Support Unit from Centre Community Hospital

FIRE RESPONSE:

All Airport Firefighting Equipment

Two (2) Rescue Trucks

One (1) Engine

Two (2) Tankers

One (1) Aerial Apparatus at dusk

POLICE RESPONSE:

Bellefonte Fire Police

Alpha Fire Police

University Police

RESPONSE LEVEL FOUR (4)

(THIS LEVEL IS ALSO TO BE USED FOR AN UNKNOWN TYPE AIRCRAFT
RESPONSE)

For a Level Four (4) Response the Police Service Dispatcher is to notify Centre
County Dispatch for a medical response and for a response from the Alpha Fire
Company. Bellefonte Communications (355-5541) is to be notified for a response
from the Bellefonte Fire Department.

Criteria for a Level Four (4) response is for a plane carrying between 12 and 50
passengers and approximately 1,000 gallons of fuel.

EMS RESPONSE:

FIRST RESPONSE:	Six  (6)  Ambulances;  One  (1)  from Ritenour Health Center,
Two (2)  from Bellefonte, Two (2) from Alpha Ambulance Service, and one (1) from
Pleasant Gap

Two (2) Advanced Life Support Units; One (1) from Centre 	Community
Hospital and One  (1) from Philipsburg

SECOND RESPONSE:	Six (6) Ambulances; One (1) from Pleasant Gap, One  (1) 
from Milesburg,  One  (1)  from Port Matilda, One (1) from Centre Hall, and Two (2)
from Philipsburg

FIRE RESPONSE:

All Airport Firefighting Equipment

Four (4) Engines:   2 Bellefonte, 2 Alpha

Three (3) Tankers:  2 Bellefonte, 1 Alpha

Two (2) Rescue Trucks:   1 Bellefonte, 1 Alpha

Two (2) Aerial Apparatus at dusk:  1 Bellefonte, 1 Alpha

POLICE RESPONSE:

Bellefonte Fire Police                Alpha Fire Police
University Police