Penn State Emergency Medical Services

Penn State EMS Standard Operating Procedures and Constitution

University Ambulance Service
Centre County Company 20
Procedures Manual

EMS DEPARTMENTAL PROCEDURES

OFFICE OF EMERGENCY MEDICAL SERVICES PROCEDURES

CONTENTS

Accident Reports

Airport Response

Ambulance Service Operations

Ambulance - Vehicle Maintenance

Centre Region Disaster

Communications Equipment Maintenance

Crime Scene/Weapons

Do Not Resuscitate Protocol

EMT Building Support Services

Fire Standby

HIV and Infectious Disease Exposure

Incident Reports

Mutual Aid

Non-Compliant Patients

Pre-Hospital Patient Death

Refusal of Treatment/Transportation

Sexual Assault/Abuse

Special Events

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ACCIDENT REPORTS

Purpose:

To establish guidelines for reporting accidents.

Procedure:

--Should an accident occur involving a University owned vehicle, the following
procedures must be followed:
	A. If the accident is a reportable accident the appropriate Police 		Dept.
must be notified to investigate.
	B. If the accident is a non-reportable accident the following
		information must be obtained:
					Driver of vehicles involved.
		Insurance information.
		Vehicle registration number.
		Damage to vehicle.
		Location of accident
	C. Any accident involving a University vehicle, the driver must complete a
Risk Management accident form, and submit this form to Risk Management within
24 hours.

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AIRPORT RESPONSE

Purpose:

To provide procedures for initial response to an airport incident.

Procedure:

--Any response to the University Park Airport (UPA) involving a confirmed or
possible aircraft crash , the UPA, FAA approved disaster plan will be activated.

--When dispatched for an Airport incident the crew will request that the EMS
supervisor be paged to respond.

--On arrival at the airport the crew will report to the administration building for
information on location of aircraft, any runways still in use, and route to be used by
emergency vehicles.

--On confirmation at scene of an incident the crew supervisor will assume EMS
command.

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AMBULANCE SERVICE OPERATIONS

Purpose:

Establish general guidelines for the overall operations of the University Ambulance
Service.

Procedure:

The overall operations of the University Ambulance Service (UAS) will comply
with the rules and regulations of Act 45 of the PA Dept. of Health.

The UAS will at all times adhere to the PA State Licensure requirements set by Act
45.

The primary response area of UAS consists of University Park Campus, University
owned properties where UAS is the nearest available service, and any request for
Emergency Medical Services (EMS) for a PSU student within a 10 minute response
time.

Treatment of all patients will be within the standards set by the DOT and the PA
Dept. of Health.

Requests for EMS service will be received from the dispatch receiving the request
(Centre Med, University Police Services, Univ. Health Services).

Upon receiving a request for EMS, the duty crew will acknowledge the dispatch via
radio and respond within two minutes. When responding to an incident all the
above (#5) dispatch centers shall be notified.

When en route to an incident the crew will use the best possible route to the scene.
Drivers will adhere to PA Vehicle Code when operating the University ambulance.

While on the scene of an incident the UAS crew will conduct themselves in an
orderly manner. Crew safety will be a priority on any incident.

Transporting to a medical facility shall be to the nearest appropriate facility.

All incidents shall be documented in writing on state trip reports. Documentation
will be reviewed daily under a Quality Insurance Program (QIP).

After completion of an incident the crew will restock any used items. The
ambulance will be cleaned (if ambulance or equipment is exposed to blood borne
pathogens the crew will follow the UAS Infectious Control Policy) as needed and
readied for the next response. The ambulance will be placed available with the
dispatch centers.

Upon returning to station the ambulance log in the ambulance will be completed, (if
fuel is below one half the ambulance will be filled before returning to station and
recorded in the ambulance log) and stock any supplies not restocked at the medical
facility.

Trip reports will be recorded on the Call Log in Room 107 Ritenour and placed into
the closed envelope provided for security.

Prior to beginning of each shift the crew will be given a report from the crew ending
their shift.

At the beginning of each shift the crew will complete an ambulance check and the
check list provided. The EMS supervisor will monitor these check lists daily.

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AMBULANCE - VEHICLE MAINTENANCE

Purpose:

To explain the vehicle maintenance on the ambulance. This section directs the
normal preventive maintenance performed on the vehicle; no medical equipment
will be addressed by this procedure.

Procedure:

Scheduled maintenance is performed at Penn State' s Fleet Service Garage.

Maintenance is scheduled during low call volume periods.

The unit will be taken out of service with dispatch centers for service intervals.

Vehicle maintenance is broken down by time and mileage as indicated on the
attached service interval chart.

In the event of unexpected breakdown, the Office of Physical Plant service garage
will be contacted. County and University dispatch will be notified and EMS calls will
be referred to the next available service.

The EMS supervisor will be notified if the ambulance will be out of service longer
than 1 hour.

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CENTRE REGION DISASTER

Purpose:

To provide procedure for response to disasters in the Centre region.

Procedure:

--In the event of a disaster in the Centre Region, the UAS will be activated by the
County dispatch system within the EMS Box Alarm guidelines.

--The UAS crew will respond to the assigned area as requested by the onscene
Command. 

--If activated to a disaster incident the responding crew feels appropriate EMS
coverage has not been assigned to transfer into the UAS coverage area, the crew
supervisor will request the dispatch center take appropriate action.

--The crew will follow the EMS Operations procedure for response, treatment,
transport and documentation.

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COMMUNICATIONS EQUIPMENT MAINTENANCE

Purpose:

To explain the maintenance procedures for radio or communications equipment.

Procedure:

Routine maintenance and all repairs are performed at the Office of Physical Plant,
Penn State University.

A preventive maintenance check on all equipment is performed on a yearly basis.

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CRIME SCENE/WEAPONS

Purpose:

To provide guidelines for preserving crime scenes and crew safety.

Procedure:

--Never attempt to enter a scene involving a weapon or possible weapon until the
scene is secured by police.

--When involved with an incident that is a possible crime scene every attempt to
preserve the scene should be made.  If disturbance of a scene is made by the EMS
crew, notify police prior to leaving the scene.

--No UAS crew member is permitted to carry a firearm while on duty with UAS.

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DO NOT RESUSCITATE PROTOCOL

Purpose:

To provide guidelines for patients found in cardiac arrest.

Procedure:

--Cardiopulmonary Resuscitation will be initiated on any patient found without
pulse or respiration's.

--Exceptions to the procedure are limited to the guidelines set by the American Heart
Association.
	A. Decapitation
	B. Rigor mortis
	C. Decomposition
	D. Lividity
	E. The patient has been pronounced dead by a licensed physician

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EMT BUILDING SUPPORT SERVICES

Purpose:

To provide guidelines of building support services for evening and weekend crews.

Procedure:

--During the evening and weekend hours of operation the EMS crew will act as the
building support service as requested by the nursing supervisor.

--If a request is made by the nursing supervisor that the crew feels is beyond their
capability, the EMS supervisor will be contacted for instructions.

--The evening and weekend crews will be responsible for building security.

--The evening and weekend crews will be responsible for repairing used crutches.

--During inclement weather the crews will monitor entrances for ice and snow, and
take appropriate action.

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FIRE STANDBY

Purpose:

To establish procedures for responses to fire incidents that will provide coverage
areas, establish guidelines for ambulance placement, mutual aid response, and to
provide crew responsibility.

Procedure:

--The UAS will respond to all fires reported on University owned properties.

--Response will be non-emergencies unless dispatch confirms injuries or
entrapment.

--Upon arrival at the scene of a fire response the ambulance will be staged in an area
that will not hinder fire response or to be obstructed by fire apparatus for transport.

--UAS responsibility at a fire scene is patient care only.  UAS will not be involved in
the suppression of fires.

--If additional ambulances are needed at the scene, dispatch will be advised to
activate the County EMS Box Alarm based on the crews information of estimated
injuries.

--In the event of a multiple patient response the UAS crew will request that dispatch
page the EMS supervisor.

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HIV AND INFECTIOUS DISEASE EXPOSURE

Purpose:

Identify procedures in the event of an exposure to assure proper action is taken.

Procedure:

(Personnel)
--In the event of an HIV or infectious disease exposure the exposed will follow the
University Health Services Exposure procedures. See Section______  Page_____

(Equipment)
--In the event of an exposure to EMS equipment, the crew will follow the UAS
infectious control procedure.

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INCIDENT REPORTS

Purpose:

To identify specific problems and occurrences for the purpose of quality
improvement.

Procedure:

--In the event of any unusual occurrence, the individuals involved will complete a
UHS incident report form.  This form will  be submitted to the UHS risk manager
for processing.

--The incident form should in no way effect the normal documentation of trip
reports.

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MUTUAL AID

Purpose:

Provide procedures for mutual aid requests and reposes.

Procedure:

--Mutual aid response has been predetermined in the Centre Co. EMS Box Alarm
system.

--At no time should a crew respond to a mutual aid request without being
dispatched.

--When requesting mutual aid into the University coverage area, the crew need
only supply the dispatch with the number or possible number of patients.

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NON-COMPLIANT PATIENTS

Purpose:

To provide guidelines that will promote crew safety in handling non-compliant
patients.

Procedure:

--If a patient is in need of medical attention and becomes abusive, the crew will
request Police assistance.

--ONLY in the event that the situation becomes life threatening to the patient , crew
or bystanders will physical restraint be used. 

--Physical restraint should not be attempted without sufficient trained personnel.  If
there is a lack of sufficient personnel the crew will control the scene until help is
available, and avoid any physical confrontation.

--Any use of physical confrontation will require a UHS incident form, and detailed
documentation on the state trip report.

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PRE-HOSPITAL DEATH

Purpose:

To provide procedures already established by local and county governments.

Procedure:

--In the event of a death on the PSU owned properties, after completing the trip the
crew will notify the EMS supervisor. 

--In the event of a death off campus the County Coroner will be notified.

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REFUSAL OF TREATMENT/TRANSPORTATION

Purpose:

To provide guidelines for crews confronted with patients refusing treatment and
transportation.

Procedure:

--In the event a patient refuses treatment and transport, before a signature of refusal
is obtained the crew must determine the following.
	A. Is the patient alert to person , place and time?
	B. Is the patient aware of the seriousness of their injury or illness?
	C. Has the patient been alerted to the possible consequences if he refuses
treatment?
	D. Does the patient have a family or friend he can be released to that will
accept responsibility?

--If a signature of refusal is obtained from a patient a witness signature must also be
obtained.

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SEXUAL ASSAULT/ABUSE

Purpose:

To assure proper handling of sexual assault and abuse patients and scenes.

Procedure:

--When encountering an incident where there is an obvious or possible sexual
assault/abuse the following steps will be followed:
	A. Treat as a crime scene and preserve any evidence.
	B. Notify police.
	C. Special consideration should be given to the patient's 		situation.

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SEXUAL ASSAULT PROCEDURES
UNIVERSITY PARK CAMPUS

Purpose:

This procedure is used when a student presents to University Health Services
stating he/she has been sexually assaulted.

Procedure:

1. The health center staff member to whom the student presented will escort the
student to the nurse in charge, who will elicit a brief history and determine when
assault occurred. Assure privacy at all times.

		a. If the student is female, Monday - Friday 8:00 a.m. - 12 noon, 1:00
p.m. - 5:00 p.m., escort the student to the Women' s Health Department
immediately. (See protocol in place in the Women' s Health Department)

		b. If the student is male, Monday - Friday, 8:00 a.m. - 6:00 p.m., escort
the student to the Out-patient Department. (See protocol for the Out-patient
Department)

		c. During other hours of UHS operation, the student will present to the
Urgent Care Clinic.

2. If the sexual assault occurred within the last 72 hours, explain to the patient that
the preferred service for victims of rape is located at the Centre Community
Hospital Emergency Department for Penn State students and for victims in the
county in general. Be positive in your initial description. Explain that Perm State
wants to support the best treatment for students and will pay the Hospital charges.

		a. A complete examination with lab tests should be done as soon as
possible at Centre Community Hospital for the following reasons:

	Medical

	To treat injuries;
	To test for, prevent and treat infection;
	To test for, prevent and/or treat pregnancy.

	Medical-Legal

	To document injuries that can corroborate the use of force;
	To document sexual contact;
	To perform tests that can identify the offender.

	Reassurance

 To define expected outcomes for the victim; e.g., the degree of injury or probability
of infection;
 To relieve the victim's anxieties and correct any misperceptions;
 To facilitate follow-up care.

		b. Explain the policy of Penn State University payment for the Centre
Community Hospital rape exam and evidence collection, lab work and follow-up
exam at UHS.

		c. Counsel the patient to avoid bathing, urinating, defecating, douching
or washing g ut the mouth until the exam has been completed.

		d. Offer emotional support resources (see Appendix A). Additionally,
Pam Gerber, Penn State' s Victim/Witness Advocate may be available to accompany
female victims to their medical exam. Between 8:00 a.m. and 5:00 p.m., she can be
reached at 865-1864. After hours, she can be contacted through the police dispatcher
at 863-1111.

		e. Offer transportation options and arrange as necessary. If any cost is
involved, Penn State University will pay cost (see Appendix B).

		f. If the patient has agreed to have the exam at Centre Community
Hospital, contact the Emergency Department charge nurse and inform them that the
patient will be coming. Release of further information must be with written consent
of the patient ("Authorization to Release Medical Information" form).

		g. Give the student a Sexual Assault Victim information brochure.

		h. Briefly explain that a follow-up visit to Women' s Health (Out-
patient Department for males) in approximately 4-6 weeks should be made for
repeat STD testing (and pregnancy-testing, if indicated).

3. If the student who was sexually assaulted within the last 72 hours refuses to go to
Centre Community Hospital, follow protocol for "sexual assault more than 72 hours
ago."

		a. Assure that the student understands the medicolegal importance of a
post sexual assault exam, especially if the student plans on pursuing legal action
against assailant. Explain that if exam is not done as soon as possible (and within 72
hours) that evidence crucial to any legal case will be lost.

		b. Discuss need for medical exam, STD and pregnancy testing, even if
complete post sexual assault exam is not done. Discuss risks of STD exposure. Give
appropriate STD handouts.

		c. Inform of University payment policy.

		d. Offer emotional support options including Counseling and
Psychological Services "on-call" crisis worker and psychologist and/or the trained
volunteer from the Women' s Resource Center.

		e. Arrange for any of these options per student' s request. In this case,
emotional support resources are especially important since assault has been recent
and student will not have the immediate evaluation at Centre Community
Hospital.

		f. Give student Sexual Assault Victim information brochure.

		g. Offer and encourage the student to make an appointment for an
exam at the student' s convenience and preferably within 1-2 weeks (Women' s
Health Department - women; Out-patient Department - men). They should specify
that they are sexual assault victims. Most appointments are given immediately.

		h. Follow established protocol regarding filing a report to police
following sexual assault.

4. If the sexual assault occurred more than 72 hours ago, discuss the need for and
availability of medical exam.

		a. Women should make an appointment at their convenience in the
Women' s Health Department, Monday - Friday, 8:00 a.m. - 5:00 p.m.; men in the
Out-patient Department Monday - Friday 8:00 a.m. - 5:00 p.m., preferably within one
- two weeks. They should specify that they are sexual assault victims.

		b. Inform of University payment policy.

	c. Offer emotional support options. Arrange for any of these options as
		requested.

		d. Give the student appropriate informational materials (Sexual
Assault Victim information brochure; STD handouts if appropriate).

		e. File report as appropriate with Police Services (see Appendix D).

5. If the student telephones UHS stating she/he has been sexually assaulted, the
person receiving the call should immediately ask the caller to stay on the line to
speak with a nurse. The caller should not be placed on hold. The health center
employee should immediately inform the nurse in charge of the call. If the nurse in
charge is not immediately available, another nurse on duty would be appropriate.

The nurse will immediately ascertain if the student requires immediate medical
attention and the time of the sexual assault (within previous hour, two days ago,
etc.). The nurse will explain to the student that the nurse can call for an ambulance
to be dispatched to the student' s location for transport to Centre Community
Hospital immediately. Briefly explain payment policy and rationale.

If the assault occurred within the previous 72 hours and the student wishes to have
a medical examination and it is not a medical emergency, the student may go to
Centre Community Emergency Department herself/himself. Options for transport
may include having a friend take her/him, having a taxi take her/him (friend
accompany or person from Rape Crisis Center), or as outlined in transportation
options. (Note - If student directly goes via taxi from her/his location to Centre
Community Hospital, the Emergency Department will issue the taxi driver a
voucher for payment by Penn State).

If the student was assaulted more than 72 hours ago or does not choose to go to
Centre Community Hospital, follow procedure as noted in "sexual assault more
than 72 hours ago.

APPENDIX A
Emotional Support Resources
for Victims of Sexual Assault

1. CAPS (Counseling and Psychological Services) - 217 Ritenour Health Center

a. Immediate Help (If student is in crisis) A CAPS crisis worker or on-call
psychologist is available to see student. Call: 863-0395

b. Delayed Counseling (If student is not in crisis) The availability of counseling
psychological services by appointment through CAPS should be explained to the
student. Assist student in making this appointment, if she/he desires. CAPS phone
number: 863-0395. Hours are Monday - Friday, 8:00 a.m. - 5:00 p.m.

c. Group Counseling - Sexual assault recovery groups are offered periodically.

2. Women' s Resource Center - 140 W. Nittany Avenue, State College, PA

a. Immediate Help - "Hotline" (available 24 hours a day) puts student in touch
(through answering service) with a certified volunteer counselor trained in sexual
assault and domestic violence crisis intervention. This counselor is immediately
available to speak with the student on the phone and/or meet with the student
immediately. Hotline #234-5050

b. Drop-in Counseling - Certified volunteer counselor available at Women' s
Resource Center office weekdays (Monday - Friday) 9:00 a.m. to 7:00 p.m. Phone
#WRC: 234-5222

c. Sexual Assault Support Group - Must first interview with counselor before
joining group. Group meets once per week.

d. Resource Library: Books and magazines available pertaining to women' s issues,
sexual assault, domestic violence, etc. Also has a sexual assault referral file. Lists
referral available within community pertaining to different aspects of sexual assault;
i.e., physicians, psychologists, medical facilities, etc.

3. Center for Women Students - 102D Boucke Building

a. Counseling - Counseling services, including information, referrals, and advocacy,
are provided by a trained rape crisis counselor. An appointment can be made by
calling 863-2027. If the student mentions that she is a rape victim, she will be seen as
soon as possible. Hours are Monday - Friday, 8:00 a.m. - 5:00 p.m.

b. Resource Library: Books are resource files on issues concerning women, including
sexual assault, are available to be checked out.

APPENDIX B
Transportation Options
for Sexual Assault Victims

1. Ambulance to Centre Community Hospital - When the student' s physical or
mental health warrants. Call #865-6556 to arrange for the University Health Services
Ambulance. Make copies of pertinent progress notes to accompany student to Centre
Community Hospital (if time and situation permits and student is able and
agreeable to sign authorization release record). Assure student that cost of
ambulance will be paid by Penn State University. If no female EMT is available,
make effort for female Women' s Health staff member to accompany female student
in ambulance.

2. Ritenour staff car - Usually available 24 hours a day. Female student should be
given the option of being accompanied by a female (preferably the driver should be a
female). Pam Gerber, Victim/Witness Advocate (865-1864), or Patty Johnstone,
Center for Women Students (863-2027) may be available to drive victims. The
student should be assured that there will be no charge to her/him for this
transportation.

a. Call the Business Office to see if the car is available.

b. Determine if car and staff member is available to take student to Centre
Community Hospital.

c. If available, pick up sign out card and keys in Business Office. The driver to
complete date, dept., destination, time out, time in, need, and driver' s signature on
sign out card.

3. Personal friend: Student has the option of arranging her/his own transportation
to Centre Community Hospital by a friend. Assist student with these arrangements
as much as possible.

4. Representative of Women' s Resource Center. Call Hotline #234-5050. A
representative of WRC is available 24 hours a day to either accompany or drive
student from Ritenour to Centre Community Hospital at no charge. Make these
arrangements for student if this option selected.

5. Taxi - A taxi voucher for round trip can be given. Student should be accompanied
by a friend or a WRC representative. Victims should not be sent by taxi when they
are alone. Vouchers will be paid for by the University. Make arrangements for the
student.

a. Arrange paperwork for taxi.

b. Complete name, SS#, and local address.

c. Complete two vouchers if student going to Centre Community Hospital and then
from Centre Community Hospital to home via taxi. One for each direction of travel.
On first voucher check line stating "to the Centre Community Hospital ED." On the
second voucher check stating "from Centre Community Hospital ED to home," if
student plans to use taxi to return home. Give both copies to student to give to taxi
drivers. Explain to student to use one voucher in each direction.

   d. Complete "white charge card"

	1. complete date, name and local address of student.
	2. under description write "taxi to Centre Community Hospital ED to
		home."
	3. send white charge card to Business Office.

APPENDIX C
Police and Legal Resources

University Police Services - Grange Building 863-1111

Police for State College and surrounding communities 911

Victim/Witness Advocate - Grange Building 865-1864

District Attorney - Centre County Courthouse, Bellefonte 355-6735

Attorney, Campus Life Assistance Center - 135 Boucke Building 863-1809

Office of Conduct Standards - 135 Boucke Building 863-3042

APPENDIX D
Guidelines for Filing Report with Police

All services to sexual assault victims are confidential, except physicians and hospital
personnel are required by law to report rapes to the police. It is the victim' s choice,
however, whether or not to talk to the police.

It is the understanding of the University Health Services and Centre Community
Hospital staff that the clinician examining the sexual assault victim bears
responsibility for police reporting.

University Health Services staff will follow these guidelines:

1. All sexual assault victims should be asked if they would like to report the incident
to the police; there should be documentation indicating that this question was asked
with the victim' s response. Send report of this exchange to University Health
Services Director' s office.

2. If physical injuries inflicted through the use of force are present, reporting
requirements under Section 5106 should be followed: the incident should be
reported to the police immediately by telephone and in writing; the police will
contact the victim and follow her wishes as to whether or not they investigate.
Utilize attached form. Location of assault determines whether University Police or
State College Police are notified.

3. In cases of stranger rape, the victim who does not want to report should be
informed that the following information needs to be given to the police: a. date of
incident, b. location of incident, c. brief description of perpetrator if available, d. any
weapons used; however, her/his identity need not be revealed. Utilize attached
form.

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SPECIAL EVENTS

Purpose:

To establish guidelines for special events planning and operations, and promote
consistency in the overall operations.

Procedure:

--Any request for special event EMS coverage will be directed to the EMS supervisor
for review.

--The EMS supervisor will review events with the requesting organization to
establish the role of EMS during the event and is responsible for coordination with
other public safety agencies and health care organizations.    

--The EMS supervisor will at the beginning of each semester appoint a student
coordinator for special events.  The role of the coordinator will be to assist the EMS
supervisor with planning, scheduling, set up, and operations of BLS special events. 
Special events operating at the BLS level only are governed by the internal
University Health Services EMS clinical and administrative supervisory system.

--In the event of a special event that would require ALS,  the OEMS will coordinate
with the medical director from Hershey Medical Center OEMS to establish
guidelines in accordance with Act 45 and will coordinate with Centre Community
Hospital as required. 

--Medical direction for ALS events will be provided from the OEMS at Hershey
when possible.

--In the event that medical direction is not available from Hershey, the Hershey
director will coordinate with local command physicians to provide this service.

--Any special event coordinated by the OEMS will meet or exceed the standards set
by Act 45 for special events.

--Staffing requirements of BLS special events are PA state certified EMT with a
minimum of one year field experience.  BLS providers working with ALS teams
must have a minimum of one year field experience with an ALS service.

--Staffing requirements of ALS events require PA state certified EMT-P, or Health
Professional with a minimum of one year experience.  ALS providers must have
current ACLS certification.

--Medical direction for ALS events requires approved command eligible physicians
in accordance with Act 45.

--The EMS supervisor will be responsible for submitting a special events plan to the
PA Dept. of  Health within the standards set by Act 45.  When submitting a plan for
approval, a copy will be submitted to Centre Community Hospital, SMEMS Council,
and any local ambulance service that may be effected by the event.  All plans will be
approved by the Assistant Director of UHS prior to submitting.

--Continuous quality improvement program and quality assurance issues will be
administered though the Quality Improvement Committee of University Health
Services and the medical director of the Hershey OEMS as required for basic and
advanced life support issues.

--Special events covered by the OEMS are not limited to those whose scope fall
within the guidelines of Act 45.  Many small events are covered by the OEMS staff
under this procedure and are subject to all appropriate provisions of this
procedure.