Crew Chief Class

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Crew Chief Class
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The Crew Chief Class

• Introduction to the Position
• Rules Responsibilities
• Duties of the Crew Chief
• Good Clinical Judgment
• Useful Information
• PCR Writing Documentation
• Written Examination Procedures for Advancement

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Introduction to the Position
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Who or What is a Crew Chief?

• The person in charge of a crew
• Leader of the Crew
• Procedurally In-Charge
• In charge of all patient care given
• Is at least a NY State EMT-B (Can be an AEMT I,
  CC, or P)
• Ensures crew follows all Agency Procedure and
  Protocols

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Rules Responsibilities
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• Rules
• RPI Ambulance Standard Operating Procedures
  (SOPs)
• 04-04 04-07 Describe the Position
• 04-05 Describe the Training Process
• NY State Department of Health
• Public Health Law Article 30
• Defines the Emergency Medical Service System
  Other Associated Requirements
• 10 NYCRR Part 800
• More Laws Governing EMS Ambulance Operations
• 10 NYCRR Part 18
• Law About Public Functions and EMS
• US Government
• Health Insurance Portability and Accountability
  Act (HIPAA)
• The Privacy Law!

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• Rules Where can I find them?
• RPI Ambulance Standard Operating Procedures
  (SOPs)
• http//ambulance.union.rpi.edu/SOPs2004.doc
• NY State Department of Health
• Public Health Law Article 30
• http//www.health.state.ny.us/nysdoh/ems/art30.htm
  
• 10 NYCRR Part 800
• http//www.health.state.ny.us/nysdoh/ems/part800.h
  tm
• 10 NYCRR Part 18
• http//www.health.state.ny.us/nysdoh/ems/part18.ht
  m
• US Government
• HIPAA
• http//www.hhs.gov/ocr/hipaa/

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• Rules When Can I start Crew Chief Training?
• Any individual who acts in the capacity of
  Crew Chief must be properly credentialed as an
  R.P.I. Ambulance Crew Chief or must be a valid
  Crew Chief Trainee with a Crew Chief Trainer
  present. As such, any person acting as the Crew
  Chief must meet the qualifications as set forth
  in Policy 04-05.
• Hold a valid NYS EMT-B certification
• Be an Attendant
• Attend and pass the written exam for the RPI
  Ambulance Crew Chief Training Class

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• Responsibilities
• Youre In Charge
• Of the Crew
• Patient Care rendered by you your Crew!
• Crew Morale
• All Appropriate Documentation (Patient Care
  Reports (PCRs), Incident Reports, Training
  Evaluations, etc)

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• Responsibilities
• The position of Ambulance Crew Chief is the
  highest credentialed position in the Ambulance
  Crew. Becoming an Ambulance Crew Chief involves
  not only medical proficiency, but also thorough
  knowledge of all Operating Policies and an
  ability to lead the crew effectively. The Crew
  Chief Trainee should, while training, act in the
  capacity of Crew Chief to the best of his or her
  ability. The training period is a time to gain
  experience with a trained Crew Chief on board.
  The Crew Chief Trainee is encouraged to attend as
  many drills as possible as they are a good source
  of knowledge and training.

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Duties of the Crew Chief
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• Duties During a Crew
• Completion of an Ambulance Equipment Checklist
• Reporting any discrepancies or problems to the
  Duty Supervisor
• Try to fill any vacancies on the crew
• Provide training opportunities if time allows
• Maintain Crew Morale
• Remember youre a student first

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• Duties During a Call
• Confirm Crew and try to include trainees
• Advise Driver of appropriate level of response
  (Priority I or II)
• Plan usage or resources and equipment en route
• All radio communications
• Scene Safety
• In charge of Patient Care Given and ensure
  Patient receives appropriate care (BLS Transport,
  ALS, Helicopter, etc)

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• Duties During a Call (continued)
• Allowing other members to train as appropriate
• Make appropriate Hospital Destination Choice
• En Route to Hospital give report over VHF radio
• Transfer patient to receiving medical facility
  with report
• Complete paperwork and verify ambulance is ready
  for the next call
• Go back in service as quickly as possible

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Good Clinical Judgment
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New York State BLS Protocols These protocols are
not intended to be absolute and ultimate
treatment doctrines, but rather standards which
are flexible to accommodate the complexity of the
problems in patient management presented to
Emergency Medical Technicians (EMTs) and Advanced
Emergency Medical Technicians (AEMTs) in the
field. These protocols should be considered as a
model or standard by which all patients should be
treated. Since patients do not always fit into a
"cook book" approach, these protocols are not a
substitute for GOOD CLINICAL JUDGMENT, especially
when a situation occurs which does not fit these
standards.
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Review of a Few Protocols

• Adult Major Trauma
• Mechanisms of Injury
• 1. Ejection or partial ejection from an
  automobile
• 2. Death in the same passenger compartment
• 3. Extrication time in excess of 20 minutes
• 4. Vehicle collision resulting in 12 inches of
  intrusion in to the passenger compartment
• 5. Motorcycle crash gt20 MPH or with separation of
  rider from motorcycle
• 6. Falls from greater than 20 feet
• 7. Vehicle rollover (90 degree vehicle rotation
  or more) with unrestrained passenger
• 8. Vehicle vs pedestrian or bicycle collision
  above 5 MPH

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Review of a Few Protocols

• Adult Major Trauma (continued)
• Physical Findings
• 1. Glasgow Coma Scale is less than or equal to 13
• 2. Respiratory rate is less than 10 or more than
  29 breaths per minute
• 3. Pulse rate is less than 50 or more than 120
  beats per minute
• 4. Systolic blood pressure is less than 90 mmHg
• 5. Penetrating injuries to head, neck, torso or
  proximal extremities
• 6. Two or more suspected proximal long bone
  fractures
• 7. Suspected flail chest
• 8. Suspected spinal cord injury or limb paralysis
• 9. Amputation (except digits)
• 10. Suspected pelvic fracture
• 11. Open or depressed skull fracture

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Review of a Few Protocols

• Adult Major Trauma (continued)
• High Risk Patients
• 1. Bleeding disorders or patients who are on
  anticoagulant medications
• 2. Cardiac disease and/or respiratory disease
• 3. Insulin dependent diabetes, cirrhosis, or
  morbid obesity
• 4. Immunosuppressed patients (HIV disease,
  transplant patients and patients on
• chemotherapy treatment)
• 5. Age gt55
• Treatments?
• ABCs, Immobilization, Oxygen, Request ALS,
  Transport Rapidly to Trauma Center

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Review of a Few Protocols

• Suspected Stroke (CVA)
• ABCs, Oxygen, History of Present Illness,
• Cincinnati Prehospital Stroke Scale
• Transportation Decision?
• Go to Stroke Center if the total prehospital time
  (time from when the patients symptoms and/or
  signs first began to when the patient is expected
  to arrive at the Stroke Center) is less than two
  (2) hours.

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Review of a Few Protocols

• Altered Mental Status
• Scene Safety, ABCs, Oxygen, Level of
  Consciousness, Request ALS, History of Present
  Illness
• Treatments of Known Conditions such as Diabetes
• These were only 3 of the NYS BLS Protocols! You
  need to know your protocols well, you should have
  received them in EMT Class. Now is the time to
  make sure you know them backwards and Forwards!!!
  

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• The Area Hospitals
• Samaritan Hospital 2215 Burdett Ave Troy, NY
• Stroke Center 4 Minutes
• Saint Mary's Hospital 1300 Massachusetts Ave
  Troy, NY
• 5 Minutes
• Albany Medical Center 43 New Scottland Ave
  Albany, NY
• Trauma, Stroke Center, Cath. Lab 15 Minutes
• Saint Peters Hospital 315 S. Manning Blvd
  Albany, NY
• Cath. Lab 20 Minutes
• RPI Student health Center Academy Hall RPI Campus

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• The Area Hospitals (The Rarer Ones)
• Albany Memorial 600 Northern Blvd Albany, NY
• 15 Minutes
• Albany VA Stratton 113 Holland Ave Albany, NY
• VA Veterans 15 Minutes
• Ellis Hospital 1101 Nott St. Schenectady, NY
• Stroke Center 30 Minutes
• Saint Claires Hospital 600 McClellan St. Schdy,
  NY
• 30 Minutes
• Bellevue Maternity Hospital
  
  2210 Troy-Schdy Road Niskayuna, NY
• OB/GYN 20 Minutes

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Useful Information
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• Radio Communications Determinants
• Alpha BLS Priority II
• Bravo BLS Priority I
• Charlie ALS BLS Priority I
• Delta ALS BLS Priority I
• Echo Cardiac or Respiratory Arrest ALS BLS
  Priority I (anyone with an AED)

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• Radio Communications The dispatch
• RPI Ambulance is dispatched on Channel 1 on RPI
  Ambulances Radios
• Dispatcher Stand By RPI Ambulance
• Tones
• Dispatcher Stand By RPI Ambulance for a
  ltdeterminantgt determinant EMS call for
  ltDemographicsgt ltChief Complaintgt at ltLocationgt
• Example Stand By RPI Ambulance for a bravo
  determinant EMS call for a 18 year old male
  patient with a Laceration at the RPI Houston
  Field House

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• Radio Communications
• 800 Mhz
• Radioing Dispatch. Call sign 5959
• Acknowledging Call, Confirming Crew
• En route to scene
• on scene
• En route to hospital
• Arrive at hospital
• In service
• In Quarters
• Portables (HT750 155.220)
• Amassing Crew and Communication during
  operations. Call sign RPI Ambulance Car xx

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• Advanced Life Support (ALS)
• How do I Get it?
• Radio Dispatch.
• Who do I get it from?
• Troy Fire Department
• Mohawk Ambulance
• Empire Ambulance
• North Greenbush Ambulance
• Meeting up with ALS
• Choices Await ALS Intercept or ALS on Scene?

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• Mutual Aid
• What is it?
• Who may call us for it?
• City of Troy
• North Greenbush
• Poestenkill
• Brunswick
• Who do we call for it?
• Troy Fire Department
• Mohawk Ambulance
• Empire Ambulance

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• Other Circumstances
• Equipment Failure
• Child or Elder Abuse
• Hospital Diversion
• Field House Operations
• MCI Protocols
• Contacting medical control
• RMAs
• Rights, Clinical Findings, and Possible
  Consequences up to and including death.
• Signature of Patient or Patients Guardian and a
  Witness are required.
• Completion of a REMO RMA Checklist

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• Hospital Radio Reports
• Needs the following Information
• Patients Age and Gender
• Estimated Time to Arrival (ETA)
• Chief Complaint and History of Present Condition
• Pertinent Past Medical History
• Treatments and Vital Signs
• Do you Require anything further?

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• Hospital Radio Reports
• Example
• Samaritan Hospital, RPI Ambulance. Currently en
  route to your facility with an 18 years old male
  patient with a 5 minute ETA. Patient twisted his
  knee earlier this evening playing soccer. Knee
  is immobilized, cold applied, on oxygen. Vital
  signs within normal limits and the patient is
  resting comfortably, do you require anything
  further?
• Example
• Albany Medical Center, RPI Ambulance. Currently
  en route to your facility with a 25 years old
  male patient with a 15 minute ETA. Patient
  involved in a head on motor vehicle accident,
  approximate speed 30 mph and struck a tree. Pt
  is complaining of severe abdominal pain and
  tenderness in the Upper Quadrants. Patient is
  immobilized and on oxygen. Vital signs as
  follows BP102/70, Pulse 124 sinus tachycardia on
  monitor, Respirations 26, spO2 93 on Oxygen,
  Pupils PEARRL. Troy Fire ALS on board, Patient
  is IV positive with two large bore IVs. do you
  require anything further?

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PCR Writing Documentation
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• The PCR
• What is it?
• A complete written record of your Patient
  Assessment, care given, and Transporting of the
  Patient to the hospital
• It is a Legal Document!
• It is a triplicate form with one copy being left
  with each of the following organizations
• Receiving Hospital
• Agency
• REMO or the State

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1 0 12 05 0 8 13 33
4130 5939
RPI Ambulance
1400 1403 1406 1424 1427 1445 1445
1.0 0.0
Traumatic Injury
RPI Harkness Field
4102 1.0
JOHN DOE
123 Fake Street
518 123 4567


B
TROY
NY 12180

19 09 17 1986 000 00 0000
40
RPI DPS, TFD E2
L. Lawrence, MD


HT

Twist






ASA
1410 22 80 130
90


4 5 6/15









1420 20 84 132
P

4 5 6/15




Albuterol



1425 22 80 124
P
4 5 6/15





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PtA, V/S, LS, spO2
SAMARITAN HOSPITAL BED 8 4 1 2
Crew Chief Driver
Attendant Observer


3 0 0 0 0 0 3 3 3 3 3 3
O B S O B S
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• Chief Complaint and Narrative
• Chief Complaint I twisted my knee playing soccer
• Narrative U/A 19 y/o ? found lying supine on the
  ground I/C/O RPI DPS and TFD E2 c/o while playing
  soccer and running and feeling his R knee pop.
  Pt is complaining of 5/10 pain from the incident
  that happened approximately 15 min /a to EMS
  arrival. Patent, self- maintained airway.
  Breathing 22/min /s labor /c , chest rise and
  fall LS clear , bilateral SOB, diff breathing,
  JVD, tracheal deviation. spO298 RA. Pt put on
  O2 via NRB _at_ 12 LPM ? spO2100. Circulation
  80/min strong and regular BP 130/90 skin warm
  and dry. Gross Bleeding, Obvious Deformities
  CP, N/V/D, dizziness, lightheadedness, headache
  CSMx4. Pt AOx3 /c GCS 15 (4,5,6). Upon P/E R
  knee swollen in comparison to L, R leg
  immobilized /c CSM in R leg /a /p splinting.
  Ice pack applied to R knee. P/E otherwise
  unremarkable and within normal limits. Pt
  transported to 412 ED /s incident /c ? in pain to
  3/10. Pt transferred to Bed 8 and left I/C/O RN
  /c rails up x2, report, and in possession of
  belongings.

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• REMO Approved Abbreviations
• Available online http//www.remo-Ems.com/abbrev4.p
  df
• The Most Important Ones!
• c/o complaining of /c with
• ? female /s without
• ? Male /A before
• CP chest pain /p After
• SOB Shortness of Breath TXF Transferred
• ABD Abdomen TXP Transported
• N/V/D Nausea, Vomiting, Diarrhea
• TOT Turned over to
• LS Lung Sounds
• VS Vital Signs
• CSMx4 Circulation, Sensation, Motor x4
• Pt Patient
• P/E Physical Exam
• HTN Hypertension
• spO2 Pulse Oximetry

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Written Examination Procedures for Advancement
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• The Requirements
• Backup Crew Chief
• A. Hold a valid NYS EMT-B certification or higher
• B. Be an Attendant
• C. Attend and pass the written exam for the RPI
  Ambulance Crew Chief Training Class
• D. Complete the Crew Chief Checklist
• E. After completing requirements A, B and C pass
  a Crew Chief Practical Exam including Radio
  Report and PCR as set up by the Training Lt.
• F. Tek 2 calls with a Crew Chief Trainer in the
  patient care compartment of the Ambulance and
  submit Crew Chief Evaluation Forms
• G. Request and receive approval by the Captain
  and Training Lt. to be promoted to Backup Crew
  Chief

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• The Requirements
• Crew Chief
• A. Be a Backup Crew Chief
• B. Tek 1 call as a Backup Crew Chief and submit a
  Crew Chief Evaluation Form
• C. Student Teach 1 Training Drill and submit
  Training Drill Instructor Evaluation Form
• D. Request and receive approval by a Promotional
  Board as defined in SOPs to be promoted to Crew
  Chief

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• The Crew Chief Trainers
• Warren Hayashi, AEMT-CC
• Anthony Richard, EMT-B, CC Student
• Eric Tesoriero, EMT-B, CC Student
• Sarah Toner, EMT-B

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• Test Time

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The End. Go Out and Tek Some EMS Calls