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Home My WebLink About911122.tiff RESOLUTION RE: APPROVAL OF THE EMERGENCY MEDICAL SERVICES PLAN FOR THE COUNTY SUBSIDY PROGRAM OF THE COLORADO DEPARTMENT OF HEALTH AND AUTHORIZE CHAIRMAN TO SIGN WHEREAS, the Board of County Commissioners of Weld County, Colorado, has the duty and responsibility of administering the affairs of Weld County pursuant to Colorado Statute and the Weld County Home Rule Charter, and WHEREAS, Section 23-3.5-605, C.R.S. , references monies in the Colorado State Emergency Medical Services account to be appropriated to counties for planning and coordination of emergency medical services so long as a county satisfies certain criteria set forth in that statute, and WHEREAS, one of the criteria a county must fulfill to access the county subsidy money in the above-referenced Emergency Medical Services account is the development and maintenance of a County Emergency Medical Services Plan which meets the criteria set forth in Section 23-3.5-605(2) , C.R.S. , and WHEREAS, the Director of the Weld County Health Department, the Director of the Weld County Ambulance Service, and interested citizens participated in the drafting of a proposed County Emergency Medical Services Plan to meet the criteria of Section 23-3.5-605, C.R.S. , for Weld County, and WHEREAS, said proposed Plan, attached hereto and incorporated herein by reference, is recommended by the Directors of the Weld County Health Department and the Weld County Ambulance Service together with the interested citizens involved in drafting the Plan for approval by the Board of County Commissioners of Weld County in order that Weld County may access funds in the Colorado State Emergency Medical Services account. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the attached Weld County Emergency Medical Services Plan, incorporated herein by reference as if fully set forth, be, and hereby is, approved. BE IT FUTHER RESOLVED by the Board that the Chairman be, and hereby is, authorized to sign said Plan indicating approval by the Board of County Commissioners. 911122 AMO011 jt�( Q; �1cG�.�1�1 � f-47 � � G/� €� QC Page 2 RE: EMS PLAN The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 25th day of September, A.D. , 1991. �� BOARD OF COUNTY COMMISSIONERS /ATTEST: WELD COUNTY 0 0 Weld County Clerk to the Board /� �/ —y)� �, Gordp ac} , rman By: ‘ C/1Q_Qa, . L 11 Lf�('6-, , Depu y C rk to the Board Geo�dy, Pro-TemPro-Tem APPROVED AS TO FORM: ..I-jC��TBixaJ,/as jahz* Consstttaance L. H.acrbbe�r't n�' ty Attorney C. W. Kirby, / ir,//1 W. H. Webster 911122 ATTACHMENT 1 BUDGET Personnel EMS Advisor $ 7,869 General Support and Travel $ 2,000 TOTAL $ 9,869 Budget Justification Personnel The EMS Advisor salary and fringe was calculated by the following method: 524 hours X $ 15.02 = $ 7,869 The hourly rate was calculated by taking the equivalent of a Paramedic rate of $ 9.16 per hour X 244 hours per month which is equivalent to $ 12.84 per hour at 174 hours per month. Using an estimated 179, fringe rate ($12.84 X 179.) the hourly rate is $ 15.02. Support and Travel Travel costs were calculated by estimating 2 visits to each of the 26 sites in Weld County at $.25/mile. Other support includes printing and postage. 911122 EMERGENCY MEDICAL SERVICES COUNTY SUBSIDY PROGRAM REPORTING FORM L AND INSTRUCTION BOOK COLORADO DEPARTMENT OF HEALTH DIVISION OF EMERGENCY MEDICAL SERVICES APRIL 1991 911142 TABLE OF CONTENTS INTRODUCTION 1 PART I 2 LICENSING INFORMATION Definitions 2 2, 3 PART II 3 COUNTY LAWS, ORDINANCES, OR RESOLUTION 3 PART III 4 COUNTY EMERGENCY MEDICAL SERVICES PLAN 1. Treatment 4 2. Transportation 4 3. Communications 5 4. Training 6 5. Documentation 6 6. Disaster Plan 6 6 PART IV 7 FINANCIAL INFORMATION 7 PART V 7 COUNTY PAYMENT FORM 7 APPENDIX LICENSING INFORMATION FORM LICENSED AMBULANCE SERVICE FORM 1 COUNTY RESOLUTION, LAW OR ORDINANCE COUNTY PLAN FINANCIAL INFORMATION COUNTY SUBSIDY PAYMENT DISTRIBUTION FORM SENATE BILL 34 25-3.5-605 iv COLORADO STATE EMS ADVISORY COUNCIL EVALUATION CRITERIA v . . . . vi 9111 INTRODUCTION Senate Bill 34, enacted in 1989, provided financial assistance for improvement of the EMS system statewide by establishing a one dollar surcharge on motor vehicle registrations. Of the accumulated funds, twenty, percent (20%) will be appropriated for payments to counties for improvement of the county emergency medical service system. The documentation in this booklet is designed to provide assistance and guidance to counties in meeting the eligibility requirements established by statute. As indicated in the statute, this documentation must be submitted to the EMS Division by October 1, 1991. Upon receipt of this information, the Colorado EMS Advisory Council will review the report and if approved, we will process the reimbursement form for payment. The state council will use the evaluation criteria outlined on page vi of the appendix. If the report is not approved, the Division will correspond with your designated representative to explain the deficiencies in the report. You will then be afforded time to correct the deficiencies. The EMS Division encourages the counties to use the money for planning and coordination of emergency medical services to ensure compliance with section 3 of the Colorado EMS rules. The local physicians and the local EMS community should be extensively involved in the EMS plan as outlined in this annual report form. The Division will provide on site technical assistance when requested. Please call (303) 331-8630 to schedule such assistance. - -- Emergency Medical Services is a critical component of your local public safety system and is highly dependent upon local government support. We encourage each county to take an interest and become involved in developing and improving the emergency medical service system within your county. An efficient system not only provides better service to your residents but also aids in promoting tourism and economic development. Send all documentation to: The Colorado Department of Health Emergency Medical Services Division 4210 E. 11th Ave. Denver, Colorado 80220 931123 Following are instructions for completing the annual report form. Each section will reference a page in the appendix that will be used to complete the documentation. Part I, Licensing Information, relates to Senate Bill 34 25-3.5-605(2)(a). This states that: "(2) In order to qualify for moneys under this section, a county shall: (a) Comply with all provisions of part 3 of this article regarding the inspection and licensing of ambulances which are based in the county;" Paee i of appendix Licensing Agency - That agency which the county commissioners have given the authority to inspect, regulate, and/or license the individual agencies or ambulances. This may be a County Health Department, the County Health Nurse, the office of Emergency Preparedness, or even an individual. The phone number, address and a contact person is to be filled in. The contact person is the individual who will be able to answer questions regarding the inspection and licensing of the services within their jurisdiction. Inspector - The actual person who performs the inspections. If there is more than one person who performs this duty in the county, all should be listed. A list of those individuals can be attached to the page. The title of each inspector shall be listed, as well as their phone number and address. Basic Life Support (BLS) Service Requirements - A service that meets the requirements set forth by the County Commissioners to be eligible for a license as a Basic Life Support Service. The requirements should include, but not be limited to the minimum equipment and minimum personnel requirements. If those specifications are stated in the county resolution, ordinance or law, a duplicate need not be sent. Advanced Life Support (ALS) Service Requirements - A service that meets the requirements set forth by the County Commissioners to be eligible for a license as an Advanced Life Support Service. If this does not apply to your county, the requirements will not be sent with this application. The requirements should include,but not be limited to the minimum equipment and minimum personnel requirements. If these requirements are stated in the county resolution, ordinance or law, a duplicate copy need not be sent. Basic Life Support (BLS) Ambulance Requirements - An ambulance that meets the requirements set forth by the Board of County Commissioners to be eligible for a permit as a Basic Life Support Ambulance. 2 911123 Advanced Life Support (ALS) Ambulance Requirements - An ambulance that meets the requirements set forth by the Board of County Commissioners to be eligible for a permit as an Advanced Life Support Ambulance. License application - The form used by the ambulance service to apply for licensure within the county. If all requirements are stated in the county resolution, ordinance or law, a copy of the application need not be attached. Page ii of appendix Ambulance Service Agencies Licensed - List all licensed ambulance agencies. Include both emergent and non-emergent transportation of patients related to ambulance services. Name_of the agency - The legal name of the entity. The contact person is the individual that can be contacted for information regarding the agency. Number of Ambulances - The total number of ambulances licensed to operate from that agency. Please list the year the chassis was manufactured. The type will be a I (truck type chassis with a box attached), type II (van), and type III (van chassis with an attached box), other is any-vehicle owned by an ambulance service and used for patient transportation. Quantity will be the number of each type and year the agency owns. If more space is needed for this documentation page 2 may be copied. Part II, County Laws. Ordinances. or Resolutions, which identifies compliance with Senate Bill 34 25-3:5-605(2)(a)(b). "(2) In order to qualify for moneys under this section, a county shall: (a) Comply with all provisions of part 3 of,this article regarding the inspection and licensing of ambulances which are based in the county; (b) Require .all licensed ambulance services to utili7P the statewide emergency medical services uniform prehospital care reporting system operated by the department; . Page iii of appendix The law, ordinance, or resolution should include but not be limited to the provisions of licensure and inspection of ambulances within the county and should include a statement that provides for the agencies to comply with the emergency medical services uniform prehospital care reporting system operated by the EMS Division of the Colorado Department of Health. 3 311123 PART III, County Emeraencv Medical Services Plan, references Senate Bill 34 25-3.5- 605(c)(1)(II)(IIi). This states the counties will: "(c) Develop and maintain an emergency medical services plan which: (I) Outlines the emergency medical services which are and are not available in particular areas of the county; (II) Identifies ways in which emergency medical service providers can coordinate responses so that such responses are cooperative rather than duplicative; (RI) Promotes mechanisms for the efficient sharing of resources in disasters or multiple casualty incidents such as mutual aid agreements between counties and adjacent emergency medical services entities; Pale iii of appendix Attach a copy of the most current county EMS plan adopted by the board of county commissioners., It is recommended that the plan include the following components; addressing how each are handled in the county, any problems that are evident,and the goals and measurable objectives that would allow the county to correct those problems. An example of the goals and measurable objectives would be: • Problem: Patients from outlying areas of Cloud county are having to wait 30 to 60 minutes before Advanced Life Support (ALS)intervention. Goal: ALS services will be available throughout the county within the next five years. Objective: Cloud county will send 2 personnel to EMT-I training each year for the next 5 years. The personnel will be selected from outlying Fire Districts that provide prehospital care. Below is an outline, with suggestions to.address within your plan. If one of the categories does not pertain to your county, you will need not address the issue. County EMS Plan 1. Treatment Protocols - address how patients enter a specialty referral center, (i.e. Burn Center, Trauma Center, Cardiac Center); list criteria used to refer those patients • to the specialty. center address tertiary care available locally, if there is none available locally where can the patient receive such care; • 911123 Pernn - address the number of EMS personnel within the county; identify if there is high rate of turnover and if so, why; identify what level of training the EMS personnel should obtain within your county;.identify if first response is available in the county and by whom; identify if there is a redundancy of agencies responding to the patient;address how the agency will keep the personnel once they have been recruited; Facilities - identify all hospitals within the county; if there are none, where are the patients transported to; identify the facilities within your county able to accommodate all levels and types of patients; address any interhospital agreements; - Access to care - address how patients enter into the EMS system; identify if the patient has access to appropriate tertiary care; if the patient needs to be sent to a facility that has extended care, how will that patient access that care; Mutual Aid Agreements - address the need of the ambulance services within the county to have a mutual aid agreement with surrounding agencies that will provide back up treatment and transportation of patients; identify the need of the ambulance services to have mutual aid agreements for transporting patients long distances because of lack of manpower or lack of an adequate vehicle; Physician Advisor identify any county requirements for ambulance services to have a physician advisor; identify if there is a physician that is willing to be the physician advisor, and if not, where will that involvement come from; Ouality Assurance-address a quality assurance plan that addresses the care given - to each patient; does the quality assurance plan provide for interaction between the EMS personnel and the physician advisor; do all EMS personnel have a copy of the protocols and the quality assurance plan; does the quality assurance plan meet the guidelines set forth by the Board of Medical Examiners; 2. Transportation Use of public safety agencies - identify if law enforcement responds with the ambulance and in what type of situations they should; address if law enforcement personnel routinely transport patients that have an injury; if so, do they have physician approved protocols to do so; Transfer of patients - identify who provides routine, prearranged transfers to patients within the county; does this place a burden on the system; if so, how can this be overcome; Mutual Aid Agreements - identify mutual aid agreements in place for multiple casualty incidents; do the mutual aid agreements address the need for services in of vehicle_failure or shortage of trained personnel; Ouality assurance - identify protocols which address the destination policies for patients; does the physician advisor review those cases that do not adhere to those policies; address an ongoing maintenance program for each vehicle; 5 911123 3. Communications Citizen Access - identify how citizens access emergency care, what are the deficiencies and how can this be improved; Dispatch - address the deficiencies of the dispatch function and how can dispatch be improved to reduce response times; are there provisions for Emergency Medic Dispatch training; Medical Control - describe the present method for accomplishing ambulance to hospital and/or EMT to physician communications for medical assessment and patient information exchange; assess deficiencies and provide recommendations to overcome those deficiencies; Public Safety Coordination - assess the public coordination capabilities and deficiencies; develop methodology to overcome deficiencies; 4. Training Training of personnel - address the need to train more personnel; is the training adequate within the county; what level of training should the EMS personnel have; Availability of training - assess the adequacy of training available to the EMS personnel in the county; do EMS personnel have to travel a great distance to receive the training; who is providing the training within the county; Level of certification - assess the level of training needed within the county; is there first response capabilities within the county, are ALS capabilities feasible in your county; has a local survey been done to indicate what level of service the community feels should be in place, and what level they are willing to support financially; Continuing Education - identify CE available to the personnel; is the CE linked to the QA program established by the physician advisor; how does the personnel access the CE and is payment for CE a problem; Public Education - assess need for public education regarding accessing the EMS system or a need for bystander CPR education within the county; does the public need to be educated regarding what the ambulance service does and what functions they perform; 5. Documentation Record keeping standards - address the trip report form and its compliance with the required state documentation information; where are the records stored; who has access to those records; EMS prehospital care reporting system - identify in the county resolution ordinance or law, provisions for compliance with the EMS reporting system; is the data being used for budgeting purposes, staffmg purposes, and quality assurance purposes; 6. Disaster Plan Outline of plan for handling man made or natural disasters or mass casualty incidents within the county, include mutual aid agreements. 6 913.E Part IV, Financial Information, references SB 34 25-3.5-605(2)(d)(I)(II) and (3). These sections state: "(2) In order to qualify for moneys under this section, a county shall: - (d) Ensure that all moneys received pursuant to this section shall be expended on developing and updating the emergency medical services plan and other emergency medical services needs of the county such as: (I) Training and certification of emergency medical services providers; (II) Assisting local emergency medical providers in applying for grants under section 25-3.5-604. (e) Beginning October 1, 1991, and each October 1 thereafter, submit to the council an annual report from the board of county commissioners which details the county's emergency medical services plan and any revisions to such plan and which details the expenditure of moneys received. In instances where the council finds such report inadequate, the county shall resubmit the report to the council by December 1. (3) Funds distributed to counties pursuant to this section shall be used in planning the improvement of existing county EMS programs and shall not be used to pay for the emergency medical services available on January 1, 1991." Page iii of appendix County Expenditures for EMS prior to January 1, 1991 - This documentation should include moneys budgeted byy the county for EMS expenditures in FY '90, from January to December. If there is a specific county EMS budget, that may be attached. Expenditures needed to implement the county EMS plan - Outline expenditures that will be needed to implement the goals and objectives outlined in the County EMS plan. This should include both short term and long term expenditures. Description of County Subsidy Expenditures - Itemize the expenditures of funds distributed in January 1991. Part V, County Payment Form, rage iv of appendix. Appendix iv contains the information necessary for payment of the County Subsidy. This form should be completed and signed by the person or persons having authority to accept and distribute funds in accordance with count or state law. If the report is approved the Division will process the payment form. The actual amount of funds distributed to each county will not be determined until the appropriation has been set by the legislature. 7 911123 APPENDIX 911123 I. Licensing Information Licensing Agency: Phone: Agency ( ) _ Contact Person ( ) Address: Inspector: Title: Phone: ( ) Address: ** Attach the licensing requirements for Basic Life Support Service and Advanced Life Support Service if applicable. If these are included in the county resolution a duplicate need not be sent. ** Attach a copy of the license application. ** Documentationrequired with this application. APPENDIX i 911123 List all Ambulance . -rvices licensed below. (You ma, .;opy this page if you need more space): Name of Agency Phone ( 1 Contact Person Address Number of Ambulances Please list years, types (Type I, II, III, or other) and quantity of each: Year Type Quantity Year Type Quantity Name of Agency Phone ( ) Contact Person Address Number of Ambulances Please list years, types (Type I, II, III, or other) and quantity of each: Year Type Quantity Year Type Quantity APPENDIX 911122 II. County Resolution, Law or Ordinance ** Attach a copy of the most current county resolution, ordinance, or laws pertaining to the licensing and inspection of ambulances. III. County Plan ** Attach a copy of the most current county EMS plan adopted by the board of county commissioners. - " IV. Financial Information ** Attach documentation for the budget and expenditures for EMS in the FY '90. ** Attach documentation describing future county expenditures necessary to implement the county EMS plan. ** Attach documentation describing expenditures of county subsidy funds received from the state in calendar year 1990. APPENDIX 911123 COUNTY SUBSIDY PAYMENT DISTRIBUTION FORM COLORADO EMERGENCY MEDICAL SERVICES SUBSIDY PROGRAM FOR COUNTIES In accordance with the provision of CRS 25-3.5-605, the undersigned hereby requests an EMS county subsidy distributio.`.payment for the improvement and expansion of prehospital EMS. It is understood that payment is contingent upon approval of the statutatory reporting requirements by the State Advisory Council on EMS. Payment To: Name of Board of County Commissioners (payee) Address (City) (State) (Zip) Authorizing County Official SIGNATURE: DATE: Printed Name: Title: SIGN AND RETURN THIS FORM ALONG WITH ALL REPORTING DOCUMENTATION For use only by Department of Health Emergency Medical Services Division Amount: $ Approved By: Date: • EMS Director Aeencv Ore. a GBL Source Sub Beginning Date: January 1, 1992 Ending Date: December 30, 1993 APPENDIX iv 911123 25-3.5-605 Improvement of County Emergency Medical Service - Eligibility for County Funding- Manner of Distributing Funds (1) Beginning January 1, 1991, and each January 1 thereafter, moneys in the emergency medical services account which are appropriated for distribution to counties for planning, and, to the extent possible, coordination of emergency medical services in the counties shall be apportioned equally among the counties which satisfy the criteria set forth in subsection (2) of this section. (2) In order to qualify for moneys under this section, a county shall, (a) Comply with all provisions of part 3 of this article regarding the inspection and licensing of ambulances which are based in the county; (b) Require all licensed ambulance services to utilize the statewide emergency medical services uniform prehospital care reporting system operated by the department; (c) Develop and maintain an emergency medical services plan which: (I) Outlines the-emergency medical services which are and are not available in particular areas oche county; (II) Identifies ways in which emergency medical service providers can coordinate responses so that such responses are cooperative rather than duplicative; (III) Promotes mechanisms for the efficient sharing of resources in disasters or multiple casualty incidents, such as mutual aid agreements between counties and adjacent emergency medical services entities; (d) Ensure that all moneys received pursuant to this section shall be expended on developing and updating the emergency medical services pIan and other emergency medical service needs of the county such as: (I) Training and certification of emergency medical service provider; (II) Assisting local emergency medical providers in applying for grants under section 25-3.5-604. (e) Beginning October 1, 1991, and each October 1 thereafter, submit to the council an annual report from the board of county commissioners which details the county's emergency medical services plan and any revisions to such plan and which details the expenditure of moneys received. In instances where the council finds such report inadequate, the county shall resubmit the report to the council by December 1. (3) Funds distributed to counties pursuant to this section shall be used in planning the improvement of existing county EMS programs and shall not be used to pay for the emergency medical service available on January 1, 1991. (4) (a) Failure to comply with the requirements of subsection (2) of this section shall render a county ineligible to receive moneys from the emergency medical service account until the following January. (b) At the end of any fiscal year, moneys which are not distributed to a county shall remain in the emergency medical services account until the following January. APPENDIX 911123 v EVALUATION CRITERIA Emergency Medical Services County Subsidy October 1991 Evaluation is based upon County compliance with: A. Licensure and inspection of ambulances based in the county B. Utilization of statewide emergency medical services uniform prehospital care reporting system operated by the department. C. Submission of a County EMS Plan which demonstrates countywide planning and coordination for emergency medical services and includes the following: 1) a description of the current EMS system and identifies EMS services NOT available in the county 2) identifies how duplication in the county EMS system can be eliminated 3) promotes cooperation and sharing in disaster or mass casualty incidents D. Submission of documentation which verifies that expenditures of the moneys distributed January 1991 were expended for the purpose of planning, coordinating, or upgrading EMS services in the county. APPENDIX vi 911123 pA ;K ; I. Licensing Information Licensing Agency: Weld County Health Department, Environmental Protection Services Phone: Agency ( )303-353-0586/353-0635 Contact Person ( ) Dr. Randy Gordon Address: 1517 16th Avenue Court Greeley, Colorado 80631 Inspectors: Judy Schmidt, Supervisor, Char Davis and Pam Smith Title: Environmental Protection Spec. Phone: ( UO3-353-0635 Address: 1517 16th Avenue Court Greeley, Colorado 80631 ** Attach the licensing requirements for Basic Life Support Service and Advanced Life Support Service if applicable. If these are included in the county resolution a duplicate need not be sent. See Sec. 2. 1-1, 2. 1-2, 2. 1-9 and 4.6 of County Ordinance ** Attach a copy of the license application. See Appendix 2 *• Documentationrequiredwiththisapplication. • APPENDIX i 911123 List all Ambulance r -vices licensed below. (You ma; spy this page if you need N. more space): Name of Agency Weld County Ambulance Phone ( ) 303-353-5700 Contact Person Gary McCabe ext. 2400 or 2401 Address 1658 15th Street Greeley, Colorado 80631 Number of Ambulances 7 Please list years, types (Type I, II, III, or other) and quantity of each: Year Type Quantity Year Type Quantity 1991 Ford E350 III _ 1 1989 Chevy Surburban I 1 1991 Ford E350 III 1 1990 Ford Econoline III 1 1989 Ford Econoline 350XL III 1 1990 Ford Econoline E350 III 1 1985 Ford Econoline 350XL III 1 Name of Agency Tri-Area Ambulance District Phone (303) 833-2825 Contact Person Ed Garbarino Address 350 4th Street/P.O. Box 708 Frederick, Colorado 80530 Number of Ambulances 2 Please list years, types (Type I, II, III, or other) and quantity of each: Year Type Quantity Year Type Quantity 1989 Ford Econoline 350 III 1 1986 Ford Econoline 350 III 1 APPENDIX ii 911123 List all Ambulance Services licensed below. (You may copy this page it you need\ more space): Name of Agency Platte Valley Fire Protection District, a/k/a Kersey Fire Department and Rescue Squad Phone ( 303) 353-3890 Contact Person David Wright Address P.O. sox 16 Kersey, Colorado 80644 Number of Ambulances 2 Please list years, types (Type I, II, III, or other) and quantity of each: Year Type Quantity Year Type Quantity 1970 Chevy Custom 10 II 1 1988 Ford F350XL I I Name of Agency Phone ( ) Contact Person Address Number of Ambulances Please list years, types (Type I, II, III, or other) and quantity of each: Year Type Quantity Year Type Quantity APPENDIX • ii 311123 A �u 1. TREATMENT Protocols: Currently, there are four transporting agencies domiciled in Weld County: 1) Air Life 911 Helicopter (A.L.S.) 2) Platte Valley Fire Protection District (B.L.S.) 3) Tri Area Ambulance Service (A.L.S.) 4) Weld County Ambulance Service (A.L.S.) Each agency utilizes separate physician advisors and protocols with slightly different destination policies. All have on-line physician medical control via radio, landline telephones and/or cellular phone communications. Presently, non-emergent prehospital patients are generally transported to the nearest appropriate hospital or medical center of the patient's choice. A 50 mile radius of the transporting agency's base usually prevails. Emergent patients are generally transported to the nearest appropriate facility for further stabilization, treatment, and possible transfer to a specialty referral center. The patient's attending physician or the emergency department physician makes the determination for specialty or tertiary care needs. Interfacility transfers from North Colorado Medical Center are arranged by those physicians. Personnel: A recent census of Weld County EMS personnel affiliated with service e r v i c e agencies: Level 0f Training, a! First Responder 247 EMT-B 186 EMT-I 3 EMT-P 25 The majority of EMS personnel in Weld County are volunteers who are members of the 26 Fire departments located throughout the county. Most of these fire departments have the majority of their responding personnel trained to the First Responder level. Most also have some trained to the EMT-B level. A minority have a few personnel at the EMT-I or EMT-P level, but these individuals are usually personnel from other paid services who volunteer with their local Fire departments. Some fire departments have had low to moderate turnover, while others report major problems. Most turnover problems seem to be related to local politics and/or perceived poor leadership. 1 91.1123 An informal survey completed in March of 1991 indicated a general consensus that most departments would prefer to have all of their EMS responders trained to the EMT-B level. Some departments also indicated an interest in having IV-Mast and/or EMT-D capabilities. The Problems: Weld County is geographically huge (4000 + square miles) , and (concomitantly) population-poor inmost outlying areas. Consequently, there is a paucity of EMS calls in most Rural areas. This results in the inability to utilize many of the skills necessary to maintain higher levels of training. Also, the relatively small property tax base in the rural areas severely limits funding of the more expensive, sophisticated equipment needed to provide ALS services on a local level. Goals: Increase the number of EMT-B's in each fire department to meet local first- response personnel needs 100% of the time, and provide at least BLS transport capabilities for each fire department within the next five years. Objectives: A Weld County EMS Council should be formed by January 1, 1992 to assist in the planning, coordination, training and funding of rural EMS needs. Consideration will be given to regionalizing these efforts in order to gain some economics of scale. Facilities: North Colorado Medical Center is the only hospital domiciled in Weld County. Other facilities nearby include: 1) McKee Medical Center in Loveland; 2) Poudre Valley Hospital in Ft. Collins; 3) Memorial Hospital and DePaul Hospital in Cheyenne, Wyoming; 4) Logan County Hospital in Sterling;5 ) Morgan County Hospital in Ft. Morgan; 6) Platte Valley Medical Center in Brighton; and 7) Longmont United Hospital in Longmont. North Colorado Medical Center is generally able to accommodate all levels and types of patients. However, interagency transfers to Denver facilities are handled on a case-by-case basis via the attending physician. Access To Care: All of Weld County is under the 911 system with all but four party-line phone systems under Enhanced 911. Tertiary care and extended care access is the responsibility of the attending physician. Interfacility transports are routinely carried out by both air and ground services per physician request. 2 91.21.2e3 Mutual Aid Agreements: Both of the ALS ground transport services (Tri Area Ambulance Service and Weld County Ambulance Service) have mutual aid agreements with each other and with surrounding transport agencies. In addition, Weld County Ambulance Service has attempted to initiate mutual aid agreements with all fire departments having districts in the county. Most of the twenty - six departments have signed agreements with WCAS. Under most circumstances, lack of manpower or adequate vehicles is no longer a transport problem. When demands cannot be met, the requesting party is referred to other services able to accommodate their needs. Physician Advisor: Weld County Ordinance 77C requires that all ambulance services must have a physician advisor. Each of the ambulance services and Air Life currently have physician advisors. Additional physicians have indicated an interest in providing advisory services. Problem: The recent Board of Medical Examiners requirement that all EMT's who are members of service agencies must have physician advisors created an initial negative response by fire departments and physicians in Weld County. The unknown expense factor coupled with the lack of willing, trained physicians caused a temporary impasse. Goal: Weld County recognizes and supports the necessity for physician advisor services for all EMS providers. A county EMS Task Force has been formed to facilitate this goal. Objectives: Weld County has assigned personnel to the EMS Task Force to work in concert with representatives from geographically selected fire department representatives. The objective is to contract the services of a qualified physician advisor(s) by April 1, 1992. Quality Assurance: Two forms of quality assurance are implemented in each of the transporting agencies: 1. Internal Q.A. 2. External Q.A. Trip sheets are reviewed by personnel to ascertain completeness, compliance with protocols, and then coordinated with continuing medical education needs. 3 31 .123 The physician advisors and/or their physician extenders review trip sheets with personnel periodically in M&M/CME group settings as well as on an individual basis. All transporting agency personnel have copies of their protocols. 4 311123 2. TRANSPORTATION: Normal Transportation: Patients in most of Weld County are transported to North Colorado Medical Center by an ambulance from the Weld County Ambulance Service. This is an ALS service. Non-emergent BLS patients in the Kersey area are normally transported to North Colorado Medical Center by an ambulance from The Platte Valley Fire Protection District. ALS patients in the Kersey area are stabilized by their BLS service and then transferred to Weld County Ambulance Service and/or Air Life Helicopter. Tri Area ALS Ambulance Service covers the Southwest corner of Weld County. Air Life 911 covers all of Weld County as well as portions of the surrounding Counties. Their primary function is to transport critical patients. This is a ALS helicopter service. Patients in Weld County Routinely are taken to North Colorado Medical Center in Greeley. Depending on the desires of the patients, location, and special circumstances the patient may be taken to other hospitals within a reasonable area of the incident. Use Of Public Safety Agencies: In Weld County local law enforcement officials routinely respond to any EMS incident in which there is the possibility of violence or unlawful acts. These types of incidents include but are not limited to attempted suicides, suicides, shootings, fights, domestic arguments, DOA's, and traffic accidents. Law enforcement officers may upon occasion be the first one to come upon an EMS scene, however, the only time that they usually transport a patient is when they take an inebriated person to The Island Grove Regional Treatment Center Inc or when they have made an arrest and that person needs to be checked out at the hospital for some thing minor. Law enforcement agencies help indirectly with transportation by following emergency response vehicles and warning/ticketing motorist who fail to yield the right of way. Problems: The size of Weld County is one of the most obvious problems facing the EMS service in Weld County. Weld County has 4,004 square miles and response time from Greeley to the remote areas can be up to 59 minutes. This is much too long for effective EMS service. The Weld County Ambulance Service has manned an ambulance in a station at Ft. Lupton to cut the response time to the southern part of Weld County. Due to the lack of money and the lower volume of incidents in Northern Weld County it has not been possible to place an ambulance in a station in that area. 5 91 .123 Routine long distance transfers of patients presents another problem for the EMS service in Weld County. Whenever possible long distance routine or non-emergency transfers of patients are done by off duty personnel with a reserve ambulance. However many times an in-service crew and ambulance has to be taken out of service to transport local routine patients. With just two ambulances in-service in Greeley taking one of them out of service cuts the available number of front line crews to respond to the Greeley area as well as the Northern Weld County Area. As the volume of transports increases the ability to hire a crew to transport increases. This crew might be used to supplement the in-service crews. Mutual Aid Agreements: Weld County Ambulance Service has through verbal and written mutual aid agreements a tight knit blanket over all of the County. Each and every agency will come to the aid of any other agency in case of a need either large or small. Some of the local fire departments have .the capability of transporting patients in case of a large EMS incident. Depending on the personnel, this would be BLS service. Quality Assurance: Each of the agencies that transport have established routine and non- routine maintenance procedures. They vary with each agency's needs and resources. 6 3?_1223 3. COMMUNICATIONS ANNEX: Assessments Citizens presently access emergency care throughout Weld County by dialing 9-1-1. Weld County has the enhanced version of 911, therefore, the individual's name, telephone number, and address as well as the ambulance service responsible to that address appears on a computer screen for the dispatcher's information. After the emergency is determined by the dispatcher, a county-wide VHF radio system pages the appropriate ambulance service and the information is relayed by radio to the emergency care unit which will be responding. The system works well as designed and is fairly rapid and efficient. The 9-1-1 service is available to every citizen who has a telephone and the emergency radio dispatch system adequately covers the entire 4,004 square miles of Weld County. Problems: The dispatchers for the Weld County Regional Communications Center are not trained in emergency medical dispatch. There currently is no citizen displeasure over the county dispatchers not being medically able to assist; however, as the population grows and the ability for rapid ambulance response becomes strained, the capability to provide adequate medical advice over the telephone should be considered. Goals The emergency medical dispatcher (EMD) training should be a mid-range goal. If the decision is made to designate the Weld County Regional Communications Center as having a responsibility to provide medical advice, it could take as long as two years to have the entire staff adequately trained. Without hiring additional personnel to backfill dispatch positions while current employees are in EMD training, the program could go beyond two years. The requirement for training would then be required on a continuous basis as the normal turnover rate for dispatchers is between 15-207 per year. It is virtually impossible in Weld County to hire experienced dispatchers qualified in EMD, therefore, it is assumed every new employee must start training from the beginning. Objective The need to have all dispatch personnel trained in emergency medical dispatching is an issue the Weld County Commissioners need to decide. There is a legal liability burden that will be assumed by the county when dispatchers start giving medical advice over the telephone. The training of all dispatchers will create a burden on the workforce due to the time required for classroom instruction. It is impossible to obtain adequate training while working shift work at the Dispatch Center, however, to release more than one person at a time to receive training creates a burden on the small workforce in place at the Center. Hiring additional 7 .1.1121 personnel to fill in for the dispatchers in training appears to be the best alternative; however, funds for additional wages are not presently available, so this project should be planned for at least a two-year effort. 8 91.1121 4. TRAINING Training of Personnel ASSESSMENT AND PROBLEMS: 1. Address the need to train more personnel a. There is always a need to train more personnel on the EMT-B level to avoid burnout and ensure an adequate response b. Some fire department's have only a few EMT-B's and more First Responders. There is a need for more EMT-B's to even out the departments, to increase medical care and to have EMT's available to respond at all times c. Very rural areas - fewer people available who want to commit to EMS training due to the time required d. Rural areas - initial EMT-B training is often difficult in extreme rural areas: 1. People don't want to leave their area and travel for training 2. If First Responders - don't want to leave district uncovered 3. It's difficult for Aims Community College to send instructors to teach an EMT-B class for a few people. Aims requires a minimum number of students per class e. The time committment for EMS training is prohibitive for some people. EMT-B training is approximately 160-180 hours, First Responder is approximately 40-46 hours f. The availability of "quality" instructors is a problem. We are very limited with the number of people who either want to teach or with those considered to be at least good instructors. We need an expanded training program to teach people how to teach. 2. Is the training adequate within the county? a. Training on all levels is available throughout the county, although it's not always taken advantage of. b. CME (Continuing Medical Education) is currently free and available to all volunteer fire departments in the form of a tuition waiver or performance contract with Aims Community College (includes CPR, First Responder, First Responder-Refresher, EMT and EMT-P CME) c. There are over 40 EMS classes to choose from along with CME on a monthly basis d. The CME program would benefit by changing from individual departments receiving CME to more regionalized training. The benefits would be: 1. The ability to offer training with higher quality instructors 2. Area departments would have the advantage of training together lie. more interaction and mutual aid.) 3. The amount of hands on training and special topics could be increased where specialty guest lecturers would participate. 4. CME could be offered at various times (ie days, weekends, and for longer periods of time to meet the needs of everyone.) 3. What level of training should the EMS personnel have? a. Weld County Ambulance Service - Paramedics, EMT Intermediate and Basic b. Air Life - EMT-P, and RN 9 91 .123 c. Tri Area Ambulance - EMT-P, Intermediate and Basic d. Greeley Fire Department - EMT-Basic or above, CPR recertification yearly e. Volunteer Fire Departments - EMT-Basic as a minimum Additional classes : IV/MAST, EMT-Intermediate, CPR recertification yearly f. Industry - EMT-B for emergency response teams or First Responder (at lowest level) depending on their location within the county. g. CME should be attended at least quarterly GQ6L: Increase the number of EMS personnel throughout the county and also increase existing training/certification levels of those already in EMS to better serve the extreme rural areas. OBJECTIVES: 1. Aims Community College will: a. Continue to do mailings to all agencies of available and upcoming training. b. The CME coordinator will contact each volunteer fire department at least every other month to encourage training of existing and new EMS personnel. c. Attempt to secure funding within the next two years for rural agencies to contract with Aims to send an instructor to their area for initial training when class numbers are low (to supplement training costs). 2. All volunteer fire departments and EMS personnel should participate in EMS training at least quarterly to maintain skills, starting no late than April 1, 1992. 3. Train 20 new EMT's in rural Weld County within the next two years. • 10 911123 AVAILABILITY OF TRAINING ASSESSMENT AND PROBLEMS: 1. Assess the adequacy of training available to the EMS personnel in the county. a. Aims Community College offers: 1. Over 40 EMS classes to choose from 2. A two year Associate of Arts degree in EMS; Field Specialist or Manager 3. Conferences are available: EMTAC, Heartbeat, Estes Park Conference 4. Free CME at individual departments is available to all volunteer FD's and on a paid or contract basis for other agencies 5. Seminars are occasionally available although lack of attendance has reduced these offerings. b. Available training is adequate for EMS personnel in the county 2. Do EMS personnel have to travel a great distance to receive training? a. Currently there is very little or no travel required of personnel involved in CME with AIMS. b. Departments who have too few numbers to receive individualized CME need to travel to area departments for training. c. Most EMS classes are available regionally if there is an adequate number of people enrolled for the class, otherwise people must travel. 3. Who is providing the training within the county? a. Aims Community College does most of the EMS training within the county. 1 . The program includes four full time EMS instructors as well as approximately 50 part time instructors made up of personnel from WCAS, Volunteer and paid fire departments, and general CPR instructors. Credentials include: physicians, nurses, paramedics, EMT-Intermediates and Basics, First Responders and CPR certified instructors. b. WCAS - provides CME and medical review for all WCAS personnel- is also available to other responding EMS agencies c. NCMC offers in-service/in-hospital classes d. Departments - some departments "do their own training", monthly/quarterly and others take refresher classes before their certificates expire. oak: Offer more extensive classes in extreme rural areas to enable people to take part in training without having to travel extensively. OBJECTIVE: Secure funding within two years to supplement instructor costs for extreme rural classes when class enrollment is below the minimum number required. FINANCIAL IMPLICATION: Approximately $6,000 (for instructor and travel costs) to offer a couple of EMT classes in extreme Weld County 11 S11.1.23 1.1 .23 LEVEL OF CERTIFICATIGI ASSESSMENT AND PROBLEMS: 1. Assess the level of training needed within the county. a. General public - CPR , First Aid, (First Responder or EMT- B if interested) b. Industry and Business - CPR, First Responder EMT for Emergency Response Teams c. Volunteeer fire departments - First Responder, EMT-B (is most desired), EMT-I (for extreme rural areas), IV/MAST, EMT-D. d. Paid fire departments - EMT- due to general quick response of WCAS: could raise level of training to compensate for increased time on scene with WCAS 4th call and increased call volume. e. EMT-I and /or IV/MAST training would enhance EMS capabilities as long as there is quality control and ample opportunity for skill retention through CME and available shifts in the Emergency Department at NCMC. f. EMT-P for Weld County Ambulance Service, Air Life, Tri Area Ambulance 2. Is there First Response capabilities within the county; are ALS capabilities feasible in your county? a. Very good First Response system: most fire departments have at least First Responder Training. Some departments respond with a majority of EMT-B's. b. ALS services provided by WCAS and Tri Area Ambulance 3. Has a local survey been done to indicate what level of service the community feels should be in place and what level they are willing to support financially? a. A survey for the EMS degree program was done of EMS agencies/providers b. EMS survey with local fire departments was done for CME and seminars several years ago. 1. There is interest from local fire departments to raise level of training to EMT-I/IV MAST c. A survey was done on the feasibility of a subscription plan for WCAS several years ago. GOAL: Determine what level of service the community and provider agencies feel should be in place and determine what level they are willing to support. OBJECTIVES: Weld County, WCAS, or the county "EMS coordinator" will create and conduct a survey of the community and provider agencies within two years for their input on the desired level of training and financial implications. FINANCIAL IMPLICATIONS: 1. Cost of survey - depending on how it's done 2. Potential for increased training which could result in increased costs. 12 91.11.23 CONTINUING EDUCATION ASSESSMENT AND PROBLEMS: 1. Identify CE available to the personnel a. Aims Community College offers CE at the First Responder, EMT-B, and EMT-P levels at individual fire departments and at the Greeley campus b. WCAS offers CE to its personnel- also available to local fire departments. c. Conferences and seminars are available throughout the county and state. 2. Is the CE linked to the Quality Assurance program established by the physician advisor? a. Aims Community College currently has a physician advisor and its own QA program but it's not in conjunction with a county QA plan. This shift will be fairly easy to accomplish once a county QA plan goes into effect. 3. How do personnel access the CE and is payment for CE a problem? a. They contact the EMS department at AIMS b. No payment required for volunteer fire departments c. Full time public school teachers in Weld and Larimer counties also get a tuition waiver. (For EMS providers in school district and those serving with fire departments). d. Fire departments - pay for conferences and classes aside from CE. Exception: Volunteer fire departments get free off-campus CPR and First Responder classes. GOAL 1: Establish a county EMS QA program OBJECTIVES: 1. Establish a "County EMS coordinator" position and hire this person to work with the physician advisor in establishing a QA program by January 1, 1992. 2. Determine and contract with a physician advisor immediately to establish a QA program. GOAL 2: Link the CE with the county QA program which is to be established by the physician advisor. OBJECTIVE: 1. The Aims Community College CME coordinator will work closely with the physician advisor and "County EMS coordinator" to incorporate the CE program with the QA program. GOAL 3: Train more instructors for the CE and other training programs. OBJECTIVE: 1. Aims Community College will try to recruit more instructors from local EMS agencies in order to offer more CE at various times. 2. Aims will seek funding next year for training of instructors in order to maintain a quality program. 13 9'$.1123 PUBLIC EDUCATION ASSESSMENT AND PROBLEMS: 1. Assess need for public education regarding accessing the EMS system or a need for bystander CPR education within the county. a. CPR is available through Aims and the American Red Cross. b. Aims has taught CPR and Introduction to Emergency Care (First Aid) to the public, daycare workers, providers, business and industry, teachers and coaches, bus drivers etc. c. WCAS PR training at schools d. Health fairs e. CPR in the public schools needs to be enhanced but is somewhat cost prohibitive at this point. f. Air Life PR 2. Does the public need to be educated regarding what the ambulance service does and what functions they perform? a Yes b. Need more exposure to public through education, although WCAS does a great job with demos and PR through the local school districts. It is difficult though for on-duty crews to be expected to have time for demos. c. Suggest involvement and PR during EMS week d. Public service announcements e. TV show Rescue 911 has made strides in educating the public on what they have come to expect GOAL 1: To establish an ongoing CPR certification program for teachers, coaches, students in the public school system in Weld County. OBJECTIVES: 1. Seek funding for the 92'-93' school year to help defray course costs for bystander CPR. 2. Once funding is secured, establish a schedule for implementation of the CPR program in the school system. GOAL 2: Increase public awareness and education of the ambulance service, the EMS system, and available EMS training. OBJECTIVES: 1. WCAS, Aims Community College and the physician advisor (or EMS coordinator) will work on a joint PR project for EMS week for 1992. 2. Make public service announcements for cable TV. FINANCIAL IMPLICATIONS: 1. CPR in the schools: $500 - $1,000/ High school in Weld County to train the staff and senior high school students. 2. Overtime pay for WCAS personnel for school demos and PR projects 3. Mailings for PR projects 14 9t1123 GOAL 4: Regionalize CE Wing in an attempt to offer more training %among area fire departments and agencies OBJECTIVE: 1. The physician advisor will work with the Aims CE coordinator and area fire departments/agencies to establish a workable schedule and locations for CE offerings. GOAL 5: Integrate call review and other QA programs into the CE program. OBJECTIVE: 1. The Aims CE coordinator will work closely with those involved in the county QA program and instructors to include call review and QA in the CE program. FINANCIAL IMPLICATIONS: 1. The county EMS coordinator position salary - approximately $30,000 per year. 2. A fee for the physician advisor • 3. Approximately $3,600 to train 30 part time instructors on how to teach skills and follow a QA program (to pay instructors for a 10 hour class for attendance). 15 9111.23 5. DOCUMENTATION: In most areas documentation or "report writing" is the most unpopular facet of providing emergency medical services. However, we must all realize that it is necessary in order to continually improve our standard of assessment, treatment and transport of patients in our County. The Weld County Ambulance Services is in the process of making some minor changes in their present trip report forms (Appendix 3) to make them more compatible with the scanable report forms (Appendix 4) . The records are presently stored at the Ambulance Service office. Access to the records is through the Weld County Ambulance Service Director, Supervisors and Secretary and also the Physician Advisor. The Board of County Commissioners of Weld County have enacted Ordinance Number 77-C which addresses the documentation of the transportation and treatment of patients in Section 4.2. The data obtained from these reports is used for budgeting purposes, staffing purposes and quality assurance purposes. At the present time there are different types of pre-hospital care report forms (Appendix 5) being used by the various agencies in the Weld County EMS system. That is to say there is no uniform trip report form used in Weld County to record the initial assessment and treatment of a patient. It should also be pointed out that there is no procedure outlined to allow for the gathering and compiling of trip report forms from agencies other than the Weld County Ambulance Service. Problem: A standard trip form needs to be used by all EMS agencies to document the initial assessment and treatment of a patient prior to the arrival of Weld County Ambulance personnel. Also, a central gathering system where this information can be collected and compiled should be developed. Goal: Within the next year a standardized form needs to be implemented along with a central gathering point for the compilation of pertinent information. Objective: The Director of Weld County Ambulance Service along with the physician advisor and a representative from the fire/rescue will disseminate a standardized form to be used by EMS providers in Weld County. The Weld County Ambulance Service in cooperation with North Colorado Medical Center will look into the funding for and the development of a central gathering point which will provide for the compiling of all information received. Another concern which may need to be addressed under documentation is confidentiality. Throughout the communities in Weld County there are 16 01 1.1.23 several weekly publications and the method of reporting to these newspapers varies widely. Guidelines should be set up for all EMS agencies in Weld County much like the guidelines used by Weld County Ambulance Service (Appendix 6) . Guidelines used by Weld County Ambulance Service are as follows: 1. All medical information is considered confidential and there will be no release of information without patient consent or Court Order in writing. 2. Reports to the newspaper contain only the following information; Date, Time, What ie. traffic accident, General Location ie. 500 block of 29th Street, Age, Sex, Transport or not and Other Responding Agencies. 17 211121 r 6. DISASTER PLAN: Enclosed in Appendixes 7, 8, 9 and 10 are the Health and Medical Annex of the Weld County Emergency Operations Plan, the Disaster Plan from North Colorado Medical Center, the Disaster Emergency Response Plan for Kersey, Colorado and the Fire Department Incident Command Protocol. Much work has been devoted to developing these plans by various entities. However, we still lack a coordinated plan for emergency medical services in case of disaster in the County. As we address the issue of emergency medical services within the County, it will be necessary to develop an overall disaster plan. Problem: Lack of a coordinated emergency services disaster plan Goal: The development and dissemination of an emergency services disaster plan for Weld County. Objective: To have a disaster plan developed by December 31, 1992. Financial Impact: This will require the time and effort of an emergency services coordinator. Part of the time of the coordinator will he devoted to developing and disseminating a plan. 18 TA RI- _JUT - COUNTY EXPENDITURES FOR EMS PRIOR TO JANUARY, 1991: Please find enclosed the final budget message for the Ambulance Service of Weld County for fiscal year 1991. It also includes the 1990 budget expenditures. 91.1123 I 1 BUDGET UNIT SUMMARY IAGENCY/DEPARTMENT NAME: AM U Aury BUDGET UNIT TITLE AND NUMBER: Ambal,”no __ An_,1An I DEPARTMENT DESCRIPTION: Ambulances maintained by the County are housed at North Colorado Medical Center and Ft. Lupton. The ambulance service handles all emergency and routine ambulance calls for the County. ll ACTUAL BUDGETED REQUESTED APPROVED RESOURCES LAST FY CURRENT FY NEXT FY NEXT FY II Personnel $ 751,592 $ 801,700 $ 830,750 $ 830, 750 IIServices/Supplies 721,100 736,079 786 ,710 789 ,561 Capital/Credits 0 0 0 0 llGross County Cost 1,472,692 1,537,779 1,617,460 1,620,311 Revenue 1,637 ,720 1,537,779 1, 617 ,460 1, 620,311 II Net County Cost $ (165,028) $ 0 $ 0 $ 0 lBudget Positions 22 22.5 22.5 22.5 ll SUMMARY OF CHANGES : Budget reflects salary increase of $29,050 for 1991. Operating supplies for medicine, etc. are up $27,500 while motor pool costs are down $15 ,000 along with other purchased services ($800) . Depreciation is up $1,206 and collection expenses are up $4,739. Bad debt is estimated at $332 ,986 , ill up $32 ,986 over 1990. Revenues are estimated at $1,620,311, up 5.4%. Fees are proposed to go up 6%. Capital budget includes $136,000 for two new vehicles . II Final budget adjustments include increased computer charges of $6 ,826, and overhead costs of $9,677. III OBJECTIVES: 1) To provide emergency pre-hospital care to the citizens of Weld County; 2) To continue to keep the ambulance service on a self-sufficient basis (zero subsidy) . IIACTUAL ESTIMATED PROJECTED WORKLOAD MEASURES LAST FY CURRENT FY NEXT FY IIEmergency Transports 3,507 3,300 3,445 Routine Transports 745 830 855 ni Dry Runs 1,216 1,500 1,500 Special Events 44 35 40 M 347 311123 FINANCE/ADMINISTRATION RECOMMENDATION: Recommend approval of funding level and the proposed 6% rate increase to allow service to remain self-sufficient. BOARD ACTION: Board approved rate increases of 6%. t 1 f I i 348 911..1.23 m I x at 0 0 I r VA Z. " .7 A. 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U a a ] V 0 a a O 01 m 1• £ £ ti U ] tI O U 9 LL W OZ W W L C X 2 6 W ] £ J w K £ J 1 N 9 a 1 U Y r ra a O £ S O J .1..I 0 J J 5 V J J LL J J J 'l 5 5 1 y 6 1 r L Z I • A N G '0 O N M J 01- 0 •1000, r 004304 •4000040r V 0 J O -. 01- or N T A r I- - A O J 1 r r N • • • • D r ! N N O -. N n J J ♦ • N 0 b a ANN O0 0 4p4 P P J, T O • O 00 • 0 a N N N N I. �I n n M n n M 11••II n n n n n n n A O1 01 N N 01 O F AI- Jr P '0 •0 V L •0 V a a '0 O V V V V V V V V V V V V V V V V V V V V V V V V V 'O 91.1123 I. � • • a n a I- a 2 w 4. � u o M .. 0 N O P C N x. a 9 .• W • • H • O O 2 U .0 O 'W 1- s w u n .. o f a ' ~ .• _ • • ▪ 1 O 10 M w• F• I I ' K u - u a J 1 I m -. = .. 1 1 1 • O a I-▪ W A in N N W 2 W h O O. 1'I a Ylel y W # 41r 1 Y P• • 1• F a I- J X h W 2 W J O L H W 1 U • Y Ce O O N a t W a K • •1 1 I- 1- O N Ol !.J + ,n ti u 1- m N > > w • 1 o z u a a W a l 1 J N p X to .. I 7 VI il f • it 1 a 2 1 L I W 1 J l a ♦ - • • H u I 12 A I 7 N 1 I J u u u z J t W 2 a la J W in W U O• W u 2 J ii J 2 2 J 11- J J C d. a 2 2 L u 2 J. O N * J J `I •• Q 2 1- J ▪ O Z b ~ ~ 914123 EXPENDITURES NEEDED TO IMPLEMENT THE COUNTY EMS PLAN: The total cost of implementation of all the aspects of this county plan cannot be accurately calculated at this time. For example, the Communication Center anticipates that it would like to train the dispatchers in emergency medical dispatch. The cost to implement this part of the emergency medical plan has not been calculated at this point. However, the most pressing need that the Emergency Medical Services Task Force identified was providing a physician advisor for the EMT's of Weld County to come into compliance with acts allowed regulation promulgated by the Board of Medical Examiners. One solution of this problem has been proposed to provide emergency services coordinator for the county who reports to a physician advisor. The cost of the emergency services coordinator is anticipated to be around $35,000. A physician advisor will be recruited and is estimated to cost around $15,000. However, this is only an estimate and may need to be revised after the advisor makes his/her final report to the EMS Task Force. 3111.23 DESCRIPTION OF COUNTY SUBSIDY EXPENDITURES: The EMS Task Force of Weld County has recommended to the Board of County Commissioners to spend the 1991 county subsidy to hire an emergency medical services advisor. This advisor will have multiple duties which include devising a plan to provide for physician advisors for the EMT's of Weld County. The Weld County Board of Commissioners agreed to spend its county subsidy money for this purpose on September 23, 1991. Please find enclosed the memorandum of agreement which will be signed with the emergency medical services advisor, the budget for the 1991 county subsidy, and a job description of the emergency medical services advisor. 1.123 • MEMORANDUM OF AGREEMENT THIS AGREEMENT, made and entered into this day of , 1991, by and between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, hereinafter referred to as "Weld County," and hereinafter referred to as "Contractor." WITNESSETH WHEREAS, Weld County desires to improve emergency medical services in Weld County; and WHEREAS, Weld County has received funding from the Colorado Department of Health for use in this effort; NOW THEREFORE, for and in consideration of the covenants, conditions, agreements, and stipulations hereinafter expressed do hereby agree to as follows: 1. CONTRACTOR RESPONSIBILITIES: a. The Contractor will serve as emergency medical services advisor for Weld County. b. The Contractor will be responsible to the Weld County Emergency Medical Services (EMS) Task Force. c. The Contractor will accumulate, organize, and present findings regarding the availability, cost, and credentials of potential physician advisors for the emergency medical system of Weld County. d. The Contractor will survey representatives of EMS agencies and their boards on site to determine the needs of each agency and the most effective means of providing physician oversight for their EMT's. e. The Contractor will research potential funding sources for the EMS program. f. The Contractor will manage the EMS Consultant budget and provide a monthly report to the EMS Task Force outlining expenditures. g. The Contractor will assist in the preparation of a county EMS disaster plan. h. The Contractor will review and revise, as necessary, the EMS plan for Weld County. 311123 2. WELD COUNTY RESPONSIBILITIES: a. Weld County will provide office space for the Contractor. b. Weld County will provide administrative support, i.e. , secretarial support, financial management, and supervision of the Contractor. c. Weld County will provide worker's compensation coverage, and fringe benefits (social security taxes, and health and life insurance coverage) for the Contractor. 3. The period of this Agreement will be from October 1, 1991 through December 31, 1991. 4. The Contractor agrees that it is an independent contractor and neither it nor its officers or employees become employees of Weld County, and therefore, are not entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts while performing Contractor's duties as described in this Agreement. The Contractor shall indemnify, defend and hold harmless Weld County, the Board of County Commissioners of Weld County, its officers and employees for any loss occasioned as a result of the performance of this Agreement by the Contractor, its employees, volunteers, and agents. 5. This Agreement may be amended only upon written agreement by both parties. 6. It is agreed that no person shall, on the grounds of race, color, sex, religion, age, national origin, or individual handicap, be excluded form participation in, be denied the benefits of, or be subject to discrimination under any provision of this Agreement. 7. Responsibility for providing unemployment compensation and worker's compensation pursuant to Colorado law shall be the responsibility of Weld County for its staff only. Responsibility for providing unemployment compensation and worker's compensation pursuant to Colorado law for Contractor's staff shall be Contractor's responsibility. 8. Weld County and the Contractor agree that this is a personal services contract and such contract is not assignable without the advance written consent of either Weld County or the Contractor. 9. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties nor their officers or employees may possess, not shall any portion of this agreement be deemed to have created a duty of care with respect to any persons not a party to this Agreement. 10. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year. 11. If any section, subsection, paragraph, sentence, clause or phrase of this Agreement is for any reason held or decided to be unconstitutional, such '3?11.23 decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraph, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 12. This Agreement is expressly made subject to all laws and regulations of the United States and the State of Colorado. Contractual provisions required by such laws and regulations, but not having been set out herein are hereby incorporated by this reference as though expressly set out in full. All parties to this Contract are hereby put on notice, and charged with the responsibility of compliance with such contract provisions as required by law. 13. This Agreement may be terminated upon thirty (30) days written notice, by either party. IN WITNESS WHEREOF, the parties have caused this Agreement to be executed by their duly authorized representatives as of the day and date first hereinabove written. WELD COUNTY BOARD OF COMMISSIONERS CONSULTANT WELD COUNTY, COLORADO Gordon E. Lacy, Chairman ATTEST: Weld County Clerk to the Board By: Deputy Clerk to the Board Approved as to form: WELD COUNTY HEALTH DEPARTMENT Randolph Gordon, M.D. , M.P.H. Director 31 .123 ATTACHMENT 1 BUDGET Personnel EMS Advisor $ 7,869 General Support and Travel $ 2,000 TOTAL $ 9,869 Budget Justification Personnel The EMS Advisor salary and fringe was calculated by the following method: 524 hours X $ 15.02 = $ 7,869 The hourly rate was calculated by taking the equivalent of a Paramedic rate of $ 9.16 per hour X 244 hours per month which is equivalent to $ 12.84 per hour at 174 hours per month. Using an estimated 17% fringe rate ($12.84 X 172) the hourly rate is $ 15.02. Support and Travel Travel costs were calculated by estimating 2 visits to each of the 26 sites in Weld County at $.25/mile. Other support includes printing and postage. 914.1123 WELD COUNTY, COLORADO EMERGENCY MEDICAL SERVICES ADVISOR DESCRIPTION OF WORK General Statement of Duties: Performs duties as outlined in the contractual agreement. Is responsible to the Weld County EMS Task Force. Supervision Received: Works under general supervision of the Director of Weld County Health Department. Supervision Exercised: None EXAMPLES OF DUTIES (any one position may not include all of the duties listed nor do the listed examples include all duties which may be found in positions of this class. ) Serves as advisor to the Weld County EMS Task Force. Researches potential physician advisors for the EMS Task Force and accumulates, organizes, and presents findings regarding availability, cost, and credentials of physician advisors. Surveys representatives of EMS agencies and their boards on site to determine the needs of each agency and the most effective means of providing physician oversight for their EMT's. Researches potential funding sources. Develops a county EMS disaster plan. Reviews and updates the plan as necessary. Completes appropriate documentation for activities. Attends and participates in required and/or approved training sessions. Communicates current and anticipated problems to supervisor. Performs related work as required. MINIMUM QUALIFICATIONS Required Knowledge, Skills and Abilities: Considerable knowledge of advanced medical practices, procedures and equipment. Knowledge of county resources in emergency medical services. Ability to network with community and county emergency medical services. Ability to take verbal and written instructions. Ability to communicate effectively verbally and in writing. Ability to work effectively with the entire medical services community. Ability to establish and maintain effective working relationships with employees, other agencies, and the public. . 111.23 Education: High school graduation or equivalent. Experience: Two years experience as or in a position equivalent to Emergency Medical Technician. OR Any equivalent combination of education and experience. Necessary Special Requirements: Must be a graduate of an approved Paramedic course, possess a Colorado E.M.T.-B, E.M.T.-I, or E.M.T.-P Certificate, an American Heart Association ACLS Certificate, and a valid Colorado driver's license. 91.11.23 -P14:9 1- --2- COUNTY SUBSIDY PAYMENT DISTRIBUTION FORM COLORADO EMERGENCY MEDICAL SERVICES SUBSIDY PROGRAM FOR COUNTIES In accordance with the provision of CRS 25-3.5-605, the undersigned hereby requests an EMS county subsidy distributio' payment for the improvement and expansion of prehospital EMS. It is understood that payment is contingent upon approval of the statutatory reporting requirements by the State Advisory Council on EMS. Payment To: Weld County Board.of Commissioners Name of Board of County Commissioners (payee) 915 10th Street, P.O. Box 758 Address Greeley CO 80631 (City) (State) (ZiP) Authorizing County Official SIGNATURE: DATE: 9 6 9I tit Printed Name: Gordon E. Lacy. Title: Chairman � SIGN AND 1 ; LONG WITH ALL REPORTING DOCUMENTATION � � For use only by Department of Health Emergency Medical Services Division Amount: $ Approved By: Date: EMS Director Aeencv Ore. N GBL - Source Sub Beginning Date: January 1. 1992 Ending Date: December 30. 1993 APPENDIX iv 911123 Appendix One Ambulance Mailing List 911.123 AMBULANCE MAILING LIST Tri-Area Ambulance Division 350 4th Street P.O. Box 708 Frederick, Colorado 80530 Ed Garbarino - Acting Supervisor Phone: 833-2825 (Office) Number of Ambulances: 2 Advisor: Dr. Ron Sarno, Avista Hospital Licensed as: Advanced Life Support Weld County Ambulance Service 1658 15th Street Greeley, Colorado 80631 Gary McCabe Phone: 353-5700 ext. 2400 or 2401 Number of Ambulances: 7 Advisor: Jeffrey Schwartz, M.D. , North Colorado Medical Center Licensed as: Advanced Life Support Platte Valley Fire Protection District a/k/a Kersey Fire Department & Rescue Squad P.O. Box 16 Kersey, Colorado 80644 David Wright - First Captain Rescue Phone: 353-3890 Number o£ Ambulances: 2 Advisor: Stephanie V. Korthuis and Dr. David Jones Boulder Community Hospital Licensed as: Basic Life Support EAMB02.EPS 911123 l Appendix 1w•o Ambulance License Application i i 311123 HELD COUNTY AMBULANCE SERVICE LICENSE APPLICATION Application year: Application for Exempt Status: Yes No 1. Owner: Name: Address: Phone Number: 2. Operations Manager: Name: Address: Phone Number: 3. List all Emergency Vehicles on the attached vehicle list. 4. Location and description of the place(s) from which this ambulance service will operate. * Street Number: City: State Phone Street Number: City: State Phone *If more than two locations, attach separate sheet with the above information. 5. Physician advisor: Name: Address: Phone Number: 91.1123 Weld County Ambulance Service License Application Page Two 6. What area will you be serving? 7. List all emergency personnel who will be responding to an emergency with your ambulance on the attached personnel list. 8. Proof of insurance, as required in Section 4.4 of Ordinance 77-C. 9. Vehicle Maintenance and Safety Inspection Protocol: Describe your vehicle maintenance and safety inspection program including frequency and the facility which performs inspections. 10. Provide a copy of the Colorado Department of Health E.M.S. approval of your quality control program required in Section 3.2, Part B of the Colorado Revised Statutes and Regulations on Emergency Medical Services. 11. Provide as required in Section 3.8-9 of Ordinance 77-C, a current copy of E.M.T. or Paramedic Protocols adopted by the ambulance service in accordance with standards approved by the ambulance service's Physician Advisor. 12. Provide as required in Section 3.8-10 of Ordinance 77-C, a current copy of the Ambulance Service's Training Standards in accordance with the requirements approved by the ambulance service's Physician Advisor. 13. Provide a notarized statement by the person operating the vehicles or the person in charge of operating the vehicles declaring the purpose of the transportation conducted by that person or entity and the reasons by which the person or entity is entitled to an exemption from the ambulance licensing requirements of Ordinance 77-C. PERSONNEL LIST (Also includes driver's that are not EMT's) Name of Ambulance Service : Application Year: Name: Address: Date of Birth: Highest level o£ certification, licensure or training attained: Attach a photo copy of current Colorado Department of Health EMT-B, EMT-I, or Paramedic Certificate; or an Advanced First Aid Card from the American Red Cross; or a First Responder Course Completion Certificate; or a Cardiopulmonary Resuscitation Card issued by the American Heart Association or the American Red Cross. Attach proof of a valid Colorado Driver's License. Attach a statement of criminal complaint or convictions, including Class I and II traffic violations within the previous twelve (12) months. Section 5.3 of Weld County Ordinance Number 77-C States: Before the state certification of an EMT, EMT-B, EMT-I or Paramedic expires, the ambulance service shall provide the Department with a written statement showing the name of EMT, EMT-B, EMT-I or Paramedic, the date the certificate was issued, the date of expiration, and the certificate number of the new State Certificate. Failure to comply with this section disqualifies an EMT, EMT-B, EMT-I or Paramedic from practice in any Weld County Ambulance Service. EAMBS 311123 WELD COUNTY HEALTH DEPARTMENT ENVIRONMENTAL PROTECTION SERVICES Ambulance Service and Vehicle Equipment Survey Report Date of Inspection: Inspected By: Ambulance Service: NAME: ADDRESS: TELEPHONE: CONTACT: Qualification: Advanced Life Support: Basic Life Support: Motor Vehicle Chassis No. Make & Model Year Weld County License Tag No. Date of Expiration Odometer Vehicle Identification No. 2.1.1.1.23 AMBULANCE SURVEY REPORT I. Each ambulance shall contain the following equipment which shall be maintained in good working order: A. Siren operational. YES NO B. Lights operational: Emergency Lights YES NO Headlights YES NO Parking Lights YES NO Tail Lights YES NO Brake Lights YES NO Hazard Lights YES NO Turn Signals YES NO C. Safe tires with snow tires/chains available. YES NO D. Vehicle safety inspection log. YES NO Basic Sanitation. YES NO E. Vehicle preventive maintenance log. YES NO F. Are there always two qualified drivers present on a run who hold valid drivers licenses? YES NO G. Ambulance drivers are: 1. Paramedic 2. Intermediary --EMT 3. Emergency Medical Technician 4. First Responder 5. American Red Cross Advanced First Aid and Cardiopulmonary Resuscitation Card or equivalent. H. When transporting a patient, is there a licensed Emergency Medical Technician present in the patient compartment? YES NO I. Do you have insurance that complies with the latest Colorado requirements? (Ordinance 77-C Section 4.4) YES NO J. The lighting and space are adequate for the performance of cardiopulmonary resuscitation, airway maintenance, suctioning, hemorrhage control, shock care, dressing of wounds and burns, immobilization of fractures, oxygen therapy, and ceiling light sufficient for adequate administration of IV fluids. YES NO K. Safety belts in forward compartment; safety belts or other safety restraining devices available for patients being transported. YES NO 2 211121 L. Two-way Radio Equipment - which provides adequate communications between the ambulance in the field and the hospital, clinic or ambulance service physician advisor or medical control point. YES NO II. Minimum required equipment for Colorado Ambulances. "Each ambulance based and licensed in Colorado shall, at a minimum, be equipped in accordance with the following list of equipment, pursuant to CRS 25-3.5-301 (2) (a) ." Colorado Statutes & Regulations on Emergency Medical Services, January, 1985, pg. C13-14. A. Ventilation and Airway Equipment 1. Portable suction apparatus with wide- bore tubing and pharyngeal suction tip. YES NO 2. Hand-operated bag-mask ventilation unit with adult, child and infant sized masks (clear masks are preferable) . Valves must operate in cold weather, and the unit must be capable of use with an oxygen reservoir. YES NO 3. Oropharyngeal and nasopharyngeal airways in adult, child and infant sizes. YES NO 4. Portable oxygen equipment with a variable flow regulator; adequate length tubing; transparent, non-rebreathing valveless masks in adult and child sizes and transparent valveless infant-sized mask; and nasal canula. YES NO B. Bandages and Dressings 1. Large and small sterile dressings. YES NO 2. Roller bandages, both soft and elastic, 4 inch or larger. YES NO 3. Adhesive tape, 2 inch or larger. YES NO 4. Two clean burn sheets (do not have to be sterile) . YES NO 5. Triangular bandages with safety pins. YES NO 3 1.11.23 C. Immobilization Devices 1. Lower extremity traction splint. YES NO 2. Extremity immobilizing devices, eg. inflatable splints or splinting materials for immobilizing the joint above and the joint below the fracture. YES NO 3. Long spine board and appropriate accessories to immobilize the cervical spine. YES NO 4. Short spine board or equivalent stabilization/immobilization device (eg. "KED" type device) and appropriate accessories to stabilize cervical spine. YES NO D. Sterile Obstetrical Kit, Containing: 1. Sterile Cloves YES NO 2. Scissors YES NO 3. Aspiration Device YES NO 4. Umbilical Clamps or Tapes YES NO 5. Sterile Dressings YES NO 6. Towels YES NO 7. Plastic Bags YES NO E. Miscellaneous 1. Blood Pressure Cuff/Sphygmomanometer YES NO 2. Stethoscope YES NO 3. Sterile Irrigation Solution (eg. normal saline) YES NO 4. Roll of aluminum foil, large enough to cover a newborn infant. YES NO 5. Shears or heavy scissors capable of cutting clothing, bandages, boots, etc. YES NO 6. Flashlight with spare batteries and spare lightbulb. YES NO 7. "ABC" fire extinguisher, minimum 5 pound capacity, with current annual inspection. YES NO 4 2111..23 III. Recommended Optional Equipment It is strongly recommended and encouraged that every ambulance be equipped with, and the ambulance crew be proficient in using, a set of Pneumatic Antishock (Mast) Garments. Such pneumatic antishock garment should be compartmentalized (separate leg and abdomen compartments) and be equipped with control valves (valves to have closed and open position) and an inflation pump. The pneumatic antishock garments should cover the body from the lower legs to the rib cage only: antishock garments which cover the chest area are not permitted. YES NO NOTE: It is important to note that EMT-Basics may use pneumatic antishock garments only if specifically trained in their use through a Departmental approved course of instruction, and only if they are used under the specific direction and authority of a physician advisor, in accordance with the EMS Rules of the Colorado Board of Medical Examiners (the so-called "Acts Allowed") .. Surveyor: Ambulance Service Representative: General Comments and/or Suggestions: Licensed to operate as the following: Advanced Life Support Ambulance YES NO Personnel: EMT-Paramedic EMT-Intermediate RN with Advanced Cardiac Life Support Certificate Physician with Advanced Cardiac Life Support Certificate Drive with valid Colorado Drivers License and current EMT-Basic Basic Life Support Ambulance YES NO Personnel: EMT-Basic Driver with valid Colorado Drivers License and American Red Cross Advanced First Aid Card and CPR Card or equivalent of both. S 2y q 112 f EMERGENCY VEHICLE LIST Name of Ambulance Service: Application Year: Vehicle #1 Make Year of Colorado State Motor Vehicle Manufacture License Number Chassis Number Length of time this vehicle has been in service Location of the Chassis Number Vehicle #2 Make Year of Colorado State Motor Vehicle Manufacture License Number Chassis Number Length of time this vehicle has been in service Location of the Chassis Number Vehicle #3 Make Year of Colorado State Motor Vehicle Manufacture License Number Chassis Number Length of time this vehicle has been in service Location of the Chassis Number Vehicle #4 Make Year of Colorado State Motor Vehicle Manufacture License Number Chassis Number Length of time this vehicle has been in service Location of the Chassis Number Vehicle #5 Make Year of Colorado State Motor Vehicle Manufacture License Number Chassis Number Length of time this vehicle has been in service Location of the Chassis Number 2111.23 Emergency Vehicle List Page Two Vehicle #6 Make Year of Colorado State Motor Vehicle Manufacture License Number Chassis Number Length of time this vehicle has been in service Location of the Chassis Number Vehicle #7 Make Year of Colorado State Motor Vehicle Manufacture License Number Chassis Number Length of time this vehicle has been in service Location of the Chassis Number Section 3.11 of Ordinance Number 77-C States: If a vehicle is replaced or an additional vehicle or vehicles are added to a service's fleet, an application for a vehicle permit shall be filed with the Department WITHIN 30 DAYS of receipt of the new vehicle or vehicles. The completed application shall include a description of the vehicle(s) that were replaced. Upon receipt of a new vehicle permit application, the Department shall inspect the new vehicle and issue the new vehicle permit, if appropriate. 911122 19. Appendix Three Trip Report Forms 911123 I 0' Ilk OUT IN UNIT NO. YEAR MO DAY CR Weld County Ambulance Service ❑ 1639 ❑ ❑ 10.10 El ADDRESS OF INCIDENT CITY ASSISTING AGENCIES TIME. BP= ATTENDANTS PARAMEDIC O EMT❑ PARAMEDIC❑ EMT❑ DRIVER PARAMEDIC ❑ EMT❑ TIME. RESP. DISPATCHED: LOC- ENROUTE: EKG- ARRIVED DEPARTED'. TIME- ARRIVED DESTINATION: BP- AVAILABLE- PULSE= PESP- CANCELLED' LOC= I EKG= • TIME. i } BP. PULSE. RESP. • LOC. EKG- TIME= BP- PULSE. RESP. LOC= 11 ROUT 12 EMER 18 MILES 13 ASST 10 RETURN 17 AL ASST 20 OXY 29 ET 33 PHARYN BELONGINGS LEFT WI TIME MEDICATION DOSAGE ROUTE INT JI SUCTION 35 NG TUBE 36 THORACENT TYPE OF SPLINTING 21 MONITOR • 221V • ❑ BACKBOARD ❑SCOOP ❑KED ❑COLLAR.BAGS B TAPE 231V BPUMP 211V ADD 25 MEDS TIME IV TYPE SITE INT 27 DRESS 26 COLD 301RRIG 3108/BURN 32 MAST 37 CRIC 38C.CONTROL L FLUID INTAKE - 39 FOLEV CATH b SPLINTING LAB BLOODS DRAWN' 26 C-COLLAR PATIENT DESTINATION _ BASE CONTACT PRIVATE PHYSICIAN TREATING PHYSICIAN • PATIENT NAME DOB AGE SEX SOCIAL SECURITY NUMBER `TAILING ADDRESS CITY STATE I21P CODE PHONE I INSURANCE INFO PT❑ KIN❑ AUTO❑ EMPLOYER PHONE • NEXT OF KIN DOB- SOCIAL SECURITY NUMBER EMPLOYER PHONE • OR IGINAL 211123 - _ _ A- P�� Appendix Four State Documentation Form 311123 A, 6 Printed in V.S.A. lin IN Mark Reflsxe by NCS MPft3121 EMS DIVISION COPY Ill C 1989,1990 EMS DATA SYSTEMS r r NCY ID DATE DISPATCH ENROUTE .ARRIVE SCN IDEPART SCNIARRIVE DEST RTN SERVICE INCIDENT LOCATION ( _ ` °Residence °Office ( ari'a)®(iii CDg CID®®®®(SD®®CD(ID®CIDCIDCID!®®(IDCDQ®®®CIDCID(ID®(3?®°Traffic Way≥55 MPH°Industrial ( meaom CE)GI)oomoom0000mQOmoom0000moo®o(Do°Other Traffic Way °Agricultural Area yr BCD(D(®®CID CID(DCDCJmCDC9(D(ID mQJ(DCrmCDmtV la)®(I)®®®C2)Q)CDCD0 Public Place C)Acute Care Facility am. 4J®®0®®(D CD(D® ®CD® cD®CD MOD CD ma)CD a)CD CD®®°Other Recreation Area °Clinic,Dr.'s Office,etc. m®O Oa (®®llI® C4)(1) )® ®MG) O CID O (4)(D @ ®®CID ®CD(1)(D()°Restaurant/Bar °Long Term Care Facility mo®®CDCD©0CU V (..D at)CID $ CD®® 11 ®CID() il Ce(ID® I ®®® g ®CID(D®(ID°Hotel/Motet °Other ro;ri®® IDODPC� ® P ® ® FC5D ® P ® ® P ® (mP ® ®®® , fc ma-roo so ::1 mo o ¢ © o �Q © co ¢ .1 Q o co o m Q Q Q Q Was Incident Work Related? EINM CID® CCU 5i ® CD t XI ® tii C$3 MI5 ® ® �_ ® ® � ® (mom °Yes ONo °Unknown r�:.ID(ID CC •93 CID 1 ® ® 2 `1) CO CID CD 2 ® tom' - ® ® M ® (31) CID ri RESP/TRANSP MODE I TYPE OF CALL I MECHANISM OF INJURY I POSSIBLE CONTRIB.FACTORS To Scene: O Assault .°Fall<20 Ft. O Stabbin g • °MVA-Rear Impact°Alcohol ,r D Self-Infliction O Emergency O Trauma °Bicycle O Fall>20 Ft. O MVA-Ejection O MVA-Rollover O Altitude O Substance n al O Non Emergency O Bite/Sting . O Fire C MVA-Head On O MVA-Other O Extrication>20 Minutes >• From Scene: C Medical °Drowning C Gunshot O MVA-intrusion O Other(l) O Hazardous Materials O Emergency C)Electrical �•=;Motorcycle °MVA-Lateral Imp. O Other(2) VITAL SIGNS me O Non Emergency C Equipment O Recreation Vehicle O MVA-Pedestrian O Other(3) ti SEX INJURY SITE/TYPE PROTECTION I ILLNESS/EMERGENCY (31; n I m I r. rF: m Y Y N c �•Abdom.Pain ODysrhythmia 0 08/Delivery ® S ® y GE y (7'�• cc 'c c � m H $ 1 E � m C'Allergic Reac. °Gen.Weakness i�OD/Poisoning a) , $$! a CD a CS(1. 111 11- 111 Q m oi M a � y = ij < D 2 08ehavioral O G.I.Bleed (✓Rasp.Arrest 62D1' 63)®''V 'Q CD Q *w`Yr:Mir' Head °C(-,'' °0 Driver O CC 0 O O C C Cardiac Arrest O Hyperthermia O,Rasp.Dist/S.O.B. 0.01 O 0'T CD o C4�(e O mil,Q l Eye i_•;C. O CD Pass. ?�O 0:�C 0 C C,Chest Pain :,,Hypothermia °Seizure •'x_43 CC`'is15 �,*ID X®® O rir i I Face .J CD il-D C_C(17:' GLASGOW COMA SCALE CChoking `;Hyperventilate °Syncope (371)a.'.VI)It®0 e _1— ! ;; Neck . C Eyes Verbal Motor OCVA/TIA C,"',Infection ;._Unc./Origin Unk. 44(a(e�*I.,^ate Pupils l= ri 3 '3 Upper Ext.C.:.0 v C.,,C(.7.2.;Ca:Spont. Orient. .1)Obeys C Dehydration °Ingestion ;✓Vaginal Bleed is C3.'' ®'D® L R . I ...RIM a;'a Chest C .('.1,Spch CE O .� _.,,�—• �,g;Confus.;5�Localiz. �Diabetic `Nausea °Vomiting �®•:�(� �®Cf' .L. O C�. I • - -!5 .5 Abdomen • C ,^.(I....)To Pain ,}..Inappr. "4;Wdrws`_,Diarrhea ?'Nosebleed '_Other ISt®.'S(3`,V)®(i z ill ■ 5. Back :C 03 None T Garbled•.Flexion CPR INITIATED BY Itt®.fg 'C,g®M T', —I a max f : Pelvis i� O Cf None `.�Exten. (_,,Bystander .•Reporting Agency le®V a '0)®'fa Nft s ,_, I.0:,'�9 Genitalia C C C._r C. `)No Mtn';First Responder Witnessed. °Yes 0 N EMERGENCY MUD.• m DISPATCH(FMD)USED? ri!�....0.: Lower Ext C_,-,O(: �''^ > ^ C�, Z J`.._' Police/Fire Pulse Restored7�,Yes ONo °Yes `No °Unk 1 r� TREATMENT MEDICATIONS INITIAL EKG !TRANSMIi PT IgOD I RECEEAAfECH y ■ �i Assessm't It a a(.8.• Blood Draw %fit.44 Ct,© Aminophylline 9S A2 A3 Isuprel I.0"RI Al O Normal Sinus I Q �i Airway At 41.2' A'_3'Cli Cardiac Mon. J� A3,.,o Cv, Atropine At AZ 0 Lidocaine 0 A2 a C Asystole ®CO,ID®(ID 0 Cot'g;®® D ° Gm Cntrl Bleed.0':4't '744;V.) Defibrillation 0 O 0'6 Benadryl Al A3 Al Mag.Sulfate 0 O'A3 C Atrai Fib a;i)'-1_;Cf:-,C(I y•a)(j)(i, ill -CPR AAA a"0 C1l EOA/EGTA At 0 0 a Bretylium 0 0 0 Morphine 0 0 A$O Atrial Flutter (..ICE®(1)(z ri.,3z®®® Q I Extrication . ,,o 44 a Nas'trach Int. A.a cs)a Calcium 0 AI A.3 Na Bicarb 0!+p A.3 C EMD/PIVR ®®Chi®®®.o 0..)CD® 0 im MASTApp.43(gt'',4)© Orotracheal Int..A1)A'1 03(IL Decadron AD A)'' Naloxone 0 0 0 O Heart Block CCD(q7 ®®C®®®C ° um MAST Infl. 0 Al OD C)Cardioversion a-a lo e Dextrose 50%0 0 0 Nebulized Rx 00.0°PVC'S ®®CE Chi CID CE X CID®X ° r•Oxygen 0 00 Cgl Chest Decom. A9 Fi,3 p® Diazepam 0 0'0 Nitroglycerine 090 0 O Sinus Brady ®® ®®®CO®®CC ° OS/Deliv. a a a(� Crichothyro. a Al g#0 Dopamine 'Al Ai3 Oxytocin 0 0 Q O Sinus Tach (D(I)o CD CD Cr®CZ)(7)® O Restraints 0 0 0(Z Foley 0 0 0 CID Epinephrine '.WW,K3 Phenobarbital At Ail ilil O SV Tach ®®®iE®®®®®($ ° eta Spin'1lmm.la a al(0 NG Tube 43,a 40(fb Furosemide e V:0 Pronestyl Al AJ'I3 O Vent Tach CID CD CI.)CID CID CE®(I)®a O M Spin't Ext. 0®0 a) Peripheral IV 0 0 0(R) Oral Glucose 400 0 Verapamil 0 0 Q O Vent Fib t}D Suction CO inf i-3(ID Central IV 0 0 0 ig) Ipecac CI)0 0 Other 0 0 0 O Other SIJ ass IVEAII I P N T r_Ventilation At 0 Q(Q) Ext Jug.IV 00 410 QZ IV °D5WO NS O LR °Other In your opinion,the patient's condition was: Wnd Care 0®0 a Interos.IV loco® °Good°Fair °Serious °Critical r_ PAT ZIP CODE I RESPONSE oU ICOME ATTENDANT 1 I ATTENDANT 2 I ATTENDANT 3 to _. I - it olCID®®(Z °Transported (iit(M®®I3DCD®af)aD(SAS(ID®®®CID®(11)OD®08®®COCO®®CO)QDCID (7) I ...^+Ct70Cr) °Care Transferred 41:lC170 IT'00°CDODMt®CD0CD CDCI3ooCDC37alo0CD(1)0ooCD0 "*.`i 1)(-,L ' a)a) C)Cancelled 0C2)GDIMCD(3)C1J®CD®(3)®CDCID®C9®a)GDGD�CDCOCZCDCDC3 CD®C9 'p 1322 �j To®©® °Refused �C7oC'DCVC3)®®®Ci)(�®CDCDC3)(Clala)CD(DC➢1 CID®(D®C,DX(2)a)CD � 7, M � CDa ®®®(�i 0 False Cal (g)(13CD CiD(d)®°CDCD®®(3�®CA)IT® A3 CD®ED®®®ODlaD®CD(1)( ) Z ( os+."ID®ODC'..DC'.D CiPOV dOCDCD(ID CID CTi®®(ID QDdEDCD IO®®®®®®CID+DQ®®(D coma)CID® 3 4-4 I .-...®a)ceDo3® C Dead On Scene/DNA fa61)®(O®($)®oCCMOf Ce al)0)co amp®®®0CIDa?®CID®®ffJ®CID 1 4.4 I 2)CDa)C1)C7Z °Treat/No Transport 46CDCrCDCDCD00CD®ft)CBCD()CDGDCDCDCDCID fig D000CDa)CDC CD a4-1� I .IT® $J®®( °Other eopTanC$ cuce®Com®CD®(ID(pcocea3CDaDeop®®(DCc'CD($3CD® r'I ��1:m3)C�� escLc ,�®Ta)(1)®®(DsC a)cca (m(po .11, ®r�c�(D(voCo®® STATE OF COLORADO EMS TRIP REPORT PATIENT'S HOSPITAL ID* AGENCY TRIP* Appendix Five Pre Hospital Care Report Form 911123 .. LaSalle Fire department ,b- C/ E.M.S. REPORT (tc�f• • f Date C.R.# . Patient's Name Age Sex Address Dr. 2. Medications 3. Allergies 4. Upon observing the patient, the following were suspected or present: ❑ Airway problem ❑ Neck-back injury ❑ Wound longer than 4 inches ❑ Respiratory distress ❑ Chest injury ❑ Suspected fracture ❑ Chest pain ❑ Electrocution ❑ Suspected intemal hemorrhage ❑ Shortness of breath ❑ Pregnant ❑ Gunshot wounds ❑ Diabetic ❑ Abdominal injury ❑ Stab wound ❑ Heart attack ❑ Flowing bleeding ❑ CVA ❑ Cardiac arrest ❑ Spurting bleeding Burns: ❑ Head injury ❑ Deep tissue exposed 1° %2° Mo 3° 1. 2. 3. 5. Time Blood Pressure / Pulse Resp. , 'upil Level of Con. Skin Color 6. Patient's chief complaint: Care rendered: Paramedics: EMS Report by: 111.23 • WESTERN HILLS FIRE PROTECTION D■STRICT MEDICAL REPORT PAGE OF • D # 123-78 TYPE OF MEDICAL PATIENT NAME ❑ Medical Emergency ADDRESS CITY STATE LIP INCIDENT # __ ❑ Traffic Accident CASE REPORT # ❑ Fire Casualty PRONE SEA AGE DATE OF BIOTA ACTION TAKEN NATURE OF INJURY MEDICAL CARE GIVEN DISPOSITION RESCUE ACTION EQUIPMENT USED ❑ Basic Life Support ❑ Medical Problem ❑ CPA ❑ Weld Counry Ambulance ❑ Extrication ❑ Back Board ❑ Assist Paramedic ❑ Trauma ❑ Oxygen @ ❑ Private Vehicle ❑ Forcible Entry ❑ KED ❑ Stand-by ❑ Control Bleeding ❑ Refused Transport ❑ Disentanglement ❑ Scoop ❑ None SEVERITY ❑ Splinting ❑ Released ❑ Other C-Collar ❑ Other ❑ Injury ❑ Immobilization ❑ Other ❑ Death ❑ Rolls @ Tape ❑ Straps ❑ Oxygen ❑ Suction ❑ Ambu-Bag ❑ Oral Ainrvay ❑ B/P Cuff ❑ Stethoscope ❑ MAST Pants ❑ 'Inman Splint ❑ Sam Splint ❑ Rare Traction VITAL SIGNS Time: B/P = Pulse = Resp= LOC= Time. B/P= Pulse -- Resp = LOC= Time: B/P= Pulse = Rasp -- LOC = Time: B/P= Pulse = Resp = LOC= I MARE DESCRIPTION WU • - Q ADDRESS MODEL YEAR AL a 0 Cltt STATE ZIP YIN• LICENSE a ATTENDANT OFFICER fIIIYO REPORT DATE .91.11.2aWhite — Original Yellow— Copy r■l VJ [VANS FIRE DEPARTMENT RUN REPORT '. � CALL NUMEER_ PATE / I CR NUMBER ; SU M T W TH F SA I EVANS PD ON SCENE ADDRESS : CITY DISTRICT (10) EMS (50) MUTUAL AID. . (20) TA (60) HAL' MAT ( 30) FIRE (70) OTHER (40) SMOKE/ODOR. . APPARATUS AND DRIVERS • DRIVERS-> C } ---C J C 1 C ] C J SQUAD 4 ENGINE 6 ENGINE 3 ENGINE 2 SQUAD 5 ALARM IN ENROUTE - ARRIVAL CLEAR SQUAD ON DUTY: A(___) B(___) C(___) D(___) F(___) FIREFIGHTERS RESPONDING TO THE CALL: Notes: 1. C J 11. Ed H C ] 21. Larry R C J 2. Dean G C J 12. Lance H C ] 22. ( ] " 3. Dick M C J 13. C J 23. Shannon C J 4. C ] 14. George Z C J 24. John M C ] 5. Kent W C J 15. C 7 25. Rich H C J 6. Glen S C 7 16. Mike B C ] 26. [ J 7. Al H C 7 17. Alan D C ] 27. Marty S C J 8. Buzzy R C J 18. Charlie R C l 28. Jeff B C l 9. Bob M C 7 19. Jim W C J 29. C J ]O. Garry J C J 20. Doug M C J 30. Eric C C J EMS SECTION RESPONDING PARAMEDIC UNIT: 1 ( ) 2( ) (_ ) PARAMEDICS / PATIENT NAME: AGE: CHIEF COMPLAINT DOCTORS NAME --- --- ---- ALLERGIES: - - MEDICATIONS: HISTORY OF PROBLEM: VITAL SIGNS: BP : ____/____ PULSE: RESP: Time : ILOC. AAO x 1___ 2____ 3____ Transported by Paramedics? Y____N REPORT BY: " EMT (___> 1ST RESPONDER (___) Fill out back side _ - Sept 90/jry 2.111.23 GIL EST FIRE DEPARTMENT RESCUE RSPOW ,.JG# I ' LOCATION OF INCIDENT: DATE: MO DA YR [ 1 [ 1 [ 1 PATIENT NAME: (LAST) (FIRST) (M) 0.0 B. MO DA YR AGE: SEX: I [ 1 [ 1 [ 1 HOME ADDRESS: (CITY) COUNTY: STATE: ZIP: RESPONSIBLE PARTY: HOME PHONE: PHYSICIAN: TIME B/P PULSE •RESP. RESP. PUPILS SKIN NEURO STATUS _normal —responsive s—normal _drowsy _shallow —non-respons. hot _confused —labored _equal _cold _conscious _absent —dilated• —sweaty —unconscious hyperv, _constricted _Lushed _respond to pain _other _p.e.r.l. _pale —respond.to verb. cyanotic AAOX— MOEX— _Cleared Airway —Bandaging —Tourniquet-Time -Admin.02 Ltrs. —Splinting —O.BCase —C.P.R. _Back/Neck Imb. —Heat/Cold Pack -Control Bleeding Burn Treatment -Suction —Mast Pants Inflated CHIEF COMPLAINT: HISTORY: MEDS. ALLERGIES. FINDINGS: F ✓ TREATINENT: t-1 l t r P 1 Was Patient transported by W.C.A.S? Yes— No— Platteville R-1? Yes— No— Patient's Signature if Patient Refuses Treatment. Signature: Witness: Officer in Command: E.M.T.in charge: Report filed by: 911123 ( Appendix Six Weld County Ambulance Daily Log .91..1.1.23 CL /1 W i W C .. U- \ "Sc Z .. N O d N H O W c C 1 X W N O J } J Q O N Q v 3 2 O , rr F Q U O J e O O W S V F- Q CI. N O W F- �( IIII ! IIIIiI ►I III II FP 7 Appendix Seven Weld County Emergency Operations Plan Health and Medical Annex 21.1123 HEALTH AND MEDICAL ANNEX Weld County Emergency Operations Plan Table of Contents Page PURPOSE CONCEPT OF OPERATIONS ORGANIZATION AND ASSIGNMENT OF RESPONSIBILITIES DIRECTION AND CONTROL CONTINUITY OF GOVERNMENT ADMINISTRATION AND LOGISTICS PLAN DEVELOPMENT AND MAINTENANCE AUTHORITIES AND REFERENCES APPENDICES Ambulance and Transportation Communication 3111.23 HEALTH AND MEDICAL ANNEX ANNEX I I. PURPOSE This annex discusses the provision of public health services during emergency situations. Many factors including disease control, sanitation, and mental health are considered. II. SITUATION AND ASSUMPTIONS A. Most emergency situations can lead to public health and medical problems. Depending upon the nature of the incident, complications might include injury, death, disease, sanitation problems, contamination of food and water and community mental health problems. B. Although many health-related problems are associated with disase, there is an adequate local capability to meet the demands of most situations. When necessary, support will be available from state and federal agencies. III. CONCEPT OF OPERATIONS A. General Emergency operations for emergency medical services will be an extension of normal duties. Of primary concern is the coordination of triage, treatment and transportation of the sick and injured. Emergency operations for public health services will be an extension of normal duties. One of the primary concerns of public health personnel is disease control. This involves the detection and control of disease-causing agents, as well as purification of water. Sanitation is a very significant aspect of public health. One of the primary considerations is the continuation of water disposal under disaster conditions. Medical facilities and food establishments need sanitation inspections. Personal health and hygiene education is very important before, during and after an emergence. Personal food and water supplies must be kept free of contamination. B. Phases of Management 1. Mitigation a. Immunization b. Continuous health inspections c. Blood program d. Specialized training 31.11.23 e. Epidemic intelligence, evaluation, prevention and detection of communicable diseases. f. Public awareness programs. 2. Preparedness a. Storage of food and water b. Maintenance of medical supplies c. Emergency plans for water supply d. Emergency plans for water disposal e. Emergency plans for laboratory activities regarding examination of food and water, diagnostic tests, and identification, registration and disposal of the dead. 3. Response a. Public information programs dealing with personal health and hygiene, emergency medical instructions b. Disease control operations c. Sanitation activities d. Potable water supply e. Environmental health activities regarding waste disposal, refuse, food, water control and vector control f. Collection of vital statistics 4. Recovery a. Continuation of response activities, as needed b. Compilation of health reports for state and federal officials IV. ORGANIZATION AND ASSIGNMENT OF RESPONSIBILITIES A. Organization I. The Weld County Health Department is responsible for developing health and medical services plans within the framework of the state health and medical services plan and operationg within the legal authority delegated to the county, including its municipali— ties. 2. Within the framework of "government in emergency," the emergency management organization will include all government services of which health will be known as health and medical services. 9.111.2 3. The county health officer will coordinate triage and transportation with the director of the county emergency health service. (This person/persons need to be identified here) 4. Medical Advisory Council (this needs to be discussed) a. The council is composed of the officers and directors of the Weld County Medical Society. b. This council will assist the medical director in planning and organizing all activities and in training health and medical services personnel. 5. The (identify position) will be in charge of the operations. B. Task Assignments 1 . Administrative Division (County Health Department) : This division will be primarily responsible for directing and coordinating emergency programs; for example: a. Direction of the management, distribution and use of health resources (personnel, material and facilities) under county control and allocated to the county. b. Coordination with other agencies to provide transportation, communication, nonhealth supplies and supporting personnel. c. Prepares and maintains a roster of health and medical personnel both active and inactive (but available for service) . d. Prepare and maintain a list of existing health facilities in the county and of those facilities that could serve as temporary health facilities. e. Establish liaison with other emergency services (i.e. , Law Enforcement, Fire Control, Social Services, etc.) f. Issue to the public instructions on health care, preventive medical care, sanitation, vector and rodent control, first aid, etc. g. Arrange for the procurement of medical supplies and equipment. h. Arrange for the procurement of medical and health personnel. i. Arrange for the conduct of .damage assessment activities. 2. Medical Care Division (appoint a position to this task) a. Coordinates all medical care activities in the county. 3.1-11.2 b. Maintain continuous liaison with the hospitals and other medical facilities. c. Maintain adequate supplies of medical, drug and equipment rations in the county. e. Maintain roster of medical treatment personnel (including physicians, nurses and others) . f. Initiates requests to the Health and Medical Coordinator for medical care support supplies, equipment etc. , as necessary. g. Coordinates the assignment, use and maintenance of ambulances and other emergency medical vehicles with the Ambulance Director. h. Arranges for the transportation and medical care en route for those patients requiring hospitalization outside the county i. Blood program. • Pre-attack/disaster: Whole blood supplies normally on hand in communities will generally be inadequate for meeting the needs of civilian casualties expected to result from a thermonuclear war. In addition, most major blood banks are located in potential target areas and may not survive an attack or may not be able to make their supplies immediately available. Because of the magnitude of the anticipated requirements for blood and because of the technical problems involved in the shortage of blood, it is not feasible to store whole blood in quantities deemed necessary for such a disaster. Serious consideration should be given to : (a) Coordinating efforts with the Red Cross. (b) Training personnel in procedures, such as veinpunctures and other blood collecting techniques. (c) Stockpiling blood substitutes. (d) Post-attack/disaster: The chief, division of medical care, will actively promote blood-collecting programs and coordinate the distribution of available stockpiles of whole blood and blood substitutes. Provisions will be activated for expansion of existing blood collection facilities, including building space, supplies, equipment and administrative procedures. j . Maintains communication with the Health and Medical Coordinator 911123 3. Director of Community Health Services, Weld County Health Department will: a. Assist in the provision of care for the sick and injured, and necessary preventive health services. b. Provide casualty locater information to American Red Cross and Salvation Army representative at the EOC. c. Provide immunization as indicated. d. Maintains a situation status on community health services operations and resources. e. Establish public health nursing services as directed in designated shelters and provide staffing. Shelters will be designated in coordination with other county agencies and the state government. f. Provide other public health personal services as indicated. g. Provides vital statistics services in coordination with the coroner. h. Maintain communication with the Health and Medical Coordinator. 3. Environmental Health Division, Weld County Health Department: This division will: a. Establish procedures for the evaluation, monitoring and investigation of environmental conditions at the scene of the disaster. b. Coordinate the implementation of measures for the protection of the public from disease, toxic agents, contaminants, radiation, hazardous materials and other harmful agents or unhealthy conditions. c. Provide technical laboratory expertise during and after a hazardous materials spill and coordinate needs with the on—scene Incident Commander. Coordinate the cleanup and proper disposal of waste materials from the site of a hazardous spill. d. Conduct sanitary inspections of appropriate food and water supplies and distributions systems and coordinate protective measures to correct sanitary deficiencies. e. Coordinate technical assistance and manpower support on environmental health matters from other county health departments, Colorado Department of Health, U.S. Environmental Protection Agency and other federal and state agencies. 31.1.1.23 f. Collect necessary environmental health samples of water, food, air, soil, and other environmental samples and have them analyzed in an appropriate laboratory and coordinate results and protection measures with the appropriate agencies. g. Provide sanitation inspections at relocation centers and coordinate corrections with the Weld County Department of Social Services. h. Designate solid waste disposal sites. i. Maintains adequate supplies and equipment. j . Initiates requests to the Director, Health Department for supplies and equipment. k. Maintains communication with the Health Department Director. 4. Colorado Department of Health: Provide assistance in all areas of public health services. 5. Federal support: Provide assistance as needed. V. DIRECTION AND CONTROL The Weld County Health Department Director will be responsible for the direction and control of public health activities. The EOC will serve as the coordinating office for the health officer or a representative will be chosen to function with the same authority as the Health Officer and will act as liaison with the medical officer and other related personnel. VI. CONTINUITY OF GOVERNMENT A. Lines of Succession. 1. Director, Weld County Health Department 2. Director, Public Health Division 3. Director, Environmental Health Division B. Indispensable Operating Records 1. The division chiefs will be responsible for determining the records essential for post-attack assignment. 2. The division chiefs will select individuals to fulfill assignments within the division since the chiefs are familiar with qualified personnel and .the objectives of the program. VII. ADMINISTRATIVE AND LOGISTICS A. Administration 1. Organization 2. Personnel 3. Personnel will be trained to perform the function to which they are assigned. B. Health statistics 1. Vital statistics: The health department will continue to collect vital statistics as under normal operating procedures. 2. Disease statistics: Data related to disease outbreaks will be collected and forwarded to appropriate state and federal officials. C. Emergency Medical Statistics 1 . Disaster Welfare Inquiry: The hospital liaison will compile patient roster for the EOC personnel who will relay the information to the appropriate agencies. 2. American Red Cross and the Department of Social Services require this information for damage assessment statistics. D. Testing and Inspections All testing of materials will be accomplished under the normal procedures used by the health department. Inspections will be conducted in a normal fashion but with increased frequency. E. Logistics 1. Clothing and bedding will be provided by the American Red Cross and the Salvation Army, in coordination with the Health Department and the Department of Social Services. Medical supplies will be provided for first aid stations and triage centers from hospital supplies or by requisition form drug stores and drug warehouse supplies or from the State of Colorado resources. 2. Food and water for evacuees and for persons at first aid stations, triage centers, etc. , will be obtained by coordination through the Department of Social Services, the American Red Cross and the Salvation Army, and where appropriate, by requisition from super- markets and food warehouse supplies. Preparation of food, where necessary will be carried out in the kitchen areas of the schools and other locations which have been, designated as shelters. F. Communications and Control 1. Communication a. See Annex B. Basic Plan b. Alarms will be activated, and the sequential warning systems intitiated. (Primarily fanout) c. The Director of the Health Department will assure that communication is maintained between personnel deployed in the field, the EOC and the Health Department. d. Personnel stationed at the EOC will maintain communication with the Colorado Department of Health and adjacent county health departments, hospitals, clinics, and ambulance services as appropriate. Communications will be maintained with Hospital Control and will include the Hospital Emergency Administrative Radio (HEAR) . e. The Director of the Health Department or his representative will: 1) . Maintain communication with personnel deployed in the field. 2) . Maintain communication or be at the EOC at all times. 3) . Maintain communication with the Colorado Department of Health, other appropriate state and federal agencies, hospitals, clinics, and ambulance services. 4) . Maintain communications to Hospital Control which will include Hospital Emergency Administrative Radio (HEAR) . 2. Control a. See Annex A, Basic Plan. b. Control point during a disaster. 1) . Primary - EOC 2) . First Alternate - Weld County Health Department 3) . Second Alternate - c. Hospital Control is NCMC, with Memorial Hospital as alternate. d. A log of operations will be initiated, and requests for follow-up responses, personnel reporting and assignments will be accomplished and confirmed. 3111.21 VIII. PLAN DEVELOPMENT AND MAINTENANCE The Director, Health Department will work with the emergency management director, other medical personnel and the agencies specified in this annex in its development and maintenance. The The plan must be reviewed, tested and updated annually. IX. AUTHORITIES AND REFERENCES A. Legal Authority 1. Federal a. Federal Civil Defense Act of 1950, Pub.L. 81-920, as amended. b. The Disaster Relief Act of 1974, Pub.L. 93-288, as amended. c. Emergency Management and Assistance, 44 U.S. Code 2. 1 (October 1 , 1980) 2. State a. Colorado Disaster Act 3. Local a. Resolution 9.11123 HEALTH AND MEDICAL ANNEX _I_ APPENDICES Page • A. BASIC DIVISIONS B. WELD COUNTY EMERGENCY MEDICAL SERVICES DISASTER PLAN * Ambulance and Transportation Annex * Communications and Emergency Power Annex * EOC Annex * Forward Command Post Annex * Fire Service Annex * Law Enforcement Annex • Morgue Annex * Notification Annex * Weld County Fire Departments * Weld County Medical Facilities * Weld County Law Enforcement Agencies * Local Emergency Management Office * Public Information Annex * Triage Annex C. U.S. DEPARTMENT OF ENERGY: "EMERGENCY HANDLING OF RADIATION ACCIDENT CASES--AMBULANCE/RESCUE SQUADS" HEALTH AND MEDICAL ANNEX I A. BASIC DIVISIONS ADMINISTRATION DIVISION Chief Administrator 1. Establish office services sufficient for the operation of health and medical services. 2. Furnish liaison with transportation, communications and supply. 3. Keep accurate records of all personnel available to accomplish the mission of health and medical services. 4. Prepare and execute plans for training personnel for appropriate duties during an emergency. 5. Gather and publish necessary vital statistics. MEDICAL CARE DIVISION Chief, Hospital Branch 1. Coordinate organization of hospitals within Weld County for emergency service. 2. Maintain and operate the pre-positioned disaster hospital assigned to this area. 3. Organize and operate necessary clinics available in this area for emergency service. Chief, Field Unit Branch 1 . Establish necessary first-aid stations. 2. Organize first-aid teams for emergency operations. 3. Prepare litter-bearer and ambulance teams as required. Chief, Blood Collection Branch 1. Establish blood collecting centers. 2. Store blood for emergency use. PUBLIC HEALTH DIVISION Environmental Health Branch 1. Prepare for proper waste disposal. ey 111.23 2. Prepare to monitor food and water during an emergency. 3. Obtain and store necessary supplies for vector control. 4. Organize the area mortuaries for service during an emergency. Chief, Communicable Disease Branch 1. Prepare for control of epidemics. 2. Study conditions leading to epidemics. Chief, Laboratory Branch 1 . Establish procedures to examine food and water during an emergency. 2. Obtain and store necessary supplies for diagnostic test. 3. Prepare means to identify biological war agents. 2 11.23 B. WELD COUNTY EMERGENCY MEDICAL SERVICES DISASTER PLAN INTRODUCTION Wald County has one major and one minor hospital within its jurisdiction with a total bed capacity of ---- and the ability to effectively treat -- critically injured patients during normal circumstances. The reasonable assumption that an incident could generate casualties exceeding treatment capabilities of any one or more hospitals necessitates the formulation of this health and medical services disaster plan to ensure an orderly approach to coordinating various medical services and support units. This plan was developed to provide a general framework of operations that will be flexible enough to meet any mass casualty situation that may affect the county. BASIC PLAN The operational concept upon which this plan is based is applicable to any incident that causes an extraordinary number of casualties in excess of the emergency treatment capability of any one or more of the medical facilities in Weld County. I. PURPOSE The purpose of this plan is to outline responsibilities and procedures to develop a system of coordinated responses between hospitals (private, public or federal) and local government during emergency/disaster operations. II. DEFINITIONS A. Ambulance Service: Those agencies responsible for transporting and aiding the sick and injured. B. Central Morgue: A facility designated jointly by the coroner and the Weld County health officer to receive and process mass fatalities. C. Chief of Medical Staff: The physician designated by his/her peers to head the medical staff of his/her hospital or medical institution. D. Communications: Those communications systems that include, but are not limited to, established telephone, telegraph, radio and message. E. Emergency Medical Disaster: Any incident that generates an emergency patient load that exceeds the expanded emergency patient treatment capablility of any one or a number of the community's hospitals. F. Emergency Operating Center (EOC) : The facility especially designed and staffed to coordinate support activities. including, but not limited to, communications, public information, personnel and resources beyond that normally needed. 9 .1123 G. EOC Information Officer: Official at the EOC who is responsble for collecting statistics from the medical treatment facilities regarding injured and deceased and for preparing releases to the media regarding casualty and situation summaries. H. Fire Service: Those agencies responsible for preventing, suppressing, or controlling fire; leading search and rescuing of entrapped persons; and assisting in evacuation of affected areas. I. Forward Command Post: That area established by the initial responding fire department or law enforcement officer situated at a location of his/her discretion, taking into accounty the hazard involved, the accessibility and space requirement to marshal and manage the personnel and material to combat the hazard. The forward command post serves as the onsite communications and intelligence link to the EOC. J. Hospital Administrator: The administrator or chief executive of a hospital or his/her designee. K. Hospital Disaster Coordinator: The individual designated by the Weld County council of hospital administrators to report to the EOC and serve as medical community coordinator for disaster/emergency operations. L. Hospital Information Officer: The official at the hospital who is responsible for the rapid collection of statistics concerning disaster victims, the notification of next of kin, and the timely dissemination of information to the EOC. M. Medical Treatment Facilities: 1. North Colorado Medical Center 2. Memorial Hospital N. Law Enforcement: Those agencies responsible for maintaining law and order through traffic and crowd control and for providing security for vital facilities and supplies, controlling access to operating scenes and vacated areas, intial notification of specific agencies and evacuating danger areas if appropriate. 0. Triage Team: A team of paramedics who are organized, trained, and equipped for deployment to disaster areas to sort and route casualties for distribution to medical treatment facilities. P. Triage Coordinator: That person designated by each respective ambulance service to act as the liaison between the triage team and the on—scene commander. III. ORGANIZATIONAL RESPONSIBILITY A. The Weld County hospitals will select an individual and alternate to serve as hospital coordinator. This person is responsible for serving the medical community from the EOC as its medical services coordinator 2.11.2 during disasters and emergencies. The coordinator's primary duty is to ensure the orderly coordination of medically oriented logistics. In addition, the hospital disaster coordinator shall call on the individual disaster coordinator or the chief executive officer of each hospital to provide support in accordance with the provisions of this plan. B. The ambulance services are responsible for transporting casualties as directed by the triage team and shall act as the on-scene triage team. C. The emergency management agency is responsible for the activation /operation of the EOC, and as such, shall coordinate personnel, material, supplies, transportation, hazard mitigation, security, communications, public information and other resources/support as necessary. Additionally, the agency will designate a representative to supply the on-scene authority. D. Fire service is responsible for the containment or removal of a fire or hazardous agent, establishment of the forward command post, and the initial extraction of trapped victims. E. Law enforcement is responsible for dispatching a communications unit to support the forward command post, controlling access to the disaster area, crowd control, and assisting in removal of victims of hazardous areas. In addition, law enforcement is responsible for the initial notification of hospitals and support agencies and evacuation. F. The triage team is responsible for the classification of victims, setting priority for transportation and treatment, and directing the distribution to medical facilities. G. The triage coordinator is responsible to act as liaison between the on-scene medical personnel and the on-scene commander. IV. CONCEPT OF OPERATIONS This plan is designed especially to cope with an emergency medical disaster. A. Emergency management, guided by the hospital disaster coordinator and housed in the EOC of the effected community, will coordinate the support effort. (See EOC and hospital disaster coordinator appendices.) B. The triage officer shall be responsible for the formal declaration of a medical disaster, the classification of victims, setting priority for transportation/treatment, and directing the distribution of casualties to medical facilities. (See triage, medical facility, and transportation appendices.) C. The on—scene senior fire officer may be .responsible for control of the forward command post. (See forward command post, communications and EOC appendices.) 9111.23 D. Law enforcement shall be responsible for the initial notification of hospitals and support agencies and evacuation of the affected area. Fire service shall assist in evacuation. V. PROCEDURES The following procedures will be implemented for an emergency medical disaster. A. Evacuation and Notification The first responding unit shall make a preliminary evacuation (windshield survey) and immediately report the type of incident, location, and approximate number of casualties involved to its respective radio dispatcher. Law enforcement shall be responsible for initial notification. B. Increased Readiness and Response Upon notification of an emergency medical disaster, the official triage team will respond to the site. In the interim, hospitals will begin increased readiness measures as outlined in their respective plans and the ambulance EMT service will commence preliminary triage, emergency treatment and transport. (See ambulance, triage, medical facility and transportation appendices.) C. Emergency Medical Declaration Upon declaration of an emergency medical disaster, the hospitals and support agencies will be notified by the law enforcement dispatcher and the EOC will be activated. (See EOC, notification, and medical facility appendices.) D. Implementation Implementation shall take place as set forth in the appropriate appendices. VI. READINESS All agencies assigned responsibilities in this plan are responsible for developing or updating internal action plans that will ensure a continuing acceptable degree of operational readiness to carry out their responsiblities. Essential to any internal plan is a current listing of responsible individuals and alternates who may be contacted at any time in any emergency. This information is detailed in appropriate appendices. VII. TEST AND EXERCISE In order to keep this plan practicable, there will be an unannounced disaster drill held annually, organized by the emergency management agency and using a sufficient number of mock casualties to ensure calling a cull emergency medical disaster. 2111.2', 1.2 , HEALTH AND MEDICAL ANNEX AMBULANCE AND TRANSPORTATION APPENDIX 1 I. PRE—EMERGENCY A. All ambulances and emergency rescue vehicles in Weld County, both civilian and military, will be equipped with 20 METTAGs (International Field Triage Tags) . B. All ambulances serving Weld County shall contain at all times those essential items as specified by the state board of health, health and medical services division. C. Civilian ambulance services shall designate an individual to serve as triage coordinator for its jurisdiction. II. EMERGENCY A. Upon notification of an emergency situation, the appropriate ambulance shall respond with the necessary units to the scene. The ambulance services whose service does not cover the scene will also be notified and will place personnel on standby status to respond to the scene if the situation warrants. B. The paramedic or senior EMT who first arrives on the scene shall: 1. Survey the disaster scene. 2. Report to the senior fire officer and establish a proper triage area. 3. Institute a preliminary screening of casualties and begin transport of those most critically injured as put in priority in the triage annex. He/she will record the number of casualties transported and their destinations. C. If the disaster warrants, the paramendic will request, through the HEAR net dispatcher or the FOC, that the other ambulance services and/or Air Life begin responding with units to the scene. D. Upon arrival of the triage officer, all ambulance service personnel will place themselves at the disposal of the triage officer and will • follow the directions of the triage officer in regard to casualty movement. E. The paramedic will report to the triage officer and inform the triage officer as to what procedures were begun, location of the triage area, number of casualties and number transported. 311123 F. The triage officer during the disaster will provide ambulance personnel with information in relation to saturation and/or existing capabilities at the various medical treatment facilities. '?.1.121 HEALTH AND MEDICAL ANNEX I EOC Appendix 2 I. PRE—EMERGENCY A. All emergency management personnel are required to become thoroughly familiar with the provisions of this plan. B. Preparations should be made in each emergency management office in the county to ensure proper staffing of the EOC in the event of a medical disaster within the jurisdiction. II. EMERGENCY A. In the event of a medical disaster, the EOC will be activated in the effected community. All the other EOCs will be placed on stanby status to serve as the disaster may warrant. The activated EOC will immediately send an emergency management staff member to the scene to render support, as requested, to the on-scene commandar. B. The activated EOC will serve as the emergency management point of operations management, offering communications and coordinating services. C. The EOC will be commanded by the civil defense director of the jurisdiction. Additional emergency management personnel will be used at the discretion of the director to staff the EOC. D. The county hospital disaster coordinator will respond to the EOC when a disaster bas been declared. The coordinator will serve the madical community from the EOC to ensure the orderly coordination of medically oriented logistics. The coordinator shall call on the individual disaster coordinator and/or the chief executive officer of each hospital to provide support in accordance to this plan. E. The EOC information officer will respond to the EOC upon notification of a disaster to aid in disseminating and collecting information in accordance with the publec information provisions of this plan. F. The EOC staff will coordinate: 1. Personnel. 211.123 2. Materials. 3. Supplies. 4. Transportation. 5. Hazard mitigation. 6. Security. 7. Communications. 8. Public information. 9. Other support and resources, as requested. 31.1.1.2 HEALTH AND MEDICAL ANNEX I FORWARD COMMAND POST APPENDIX, 3 I. As provided in the hazardous material plan, upon occurrence of a medical disaster, control of the situation may be assumed by the initial responding fire department officer, who will become the on—scene commander. II. The on-scene commanding officer will immediately establish a forward command post situated at a location of his/her discretion, taking into account the hazard involved, the accessibility, and space requirement to marshall and manage the personnel and materials to combat the hazard. III. The local on-scene fire officer along with law enforcement within jurisdiction are responsible for the coordination of the forward command post and all support units will report to them and operate under their jointly made decisions from this fixed position. IV. The initial responding fire department officer will remain in charge as on—scene commander of the forward command post until relieved by a senior fire and/or law enforcement official from the appropriate jurisdictional area. V. It is essential that the forward command post management team remain at its established position to coordinate the on-scene combat forces. 91.1.1.24 HEALTH AND MEDICAL ANNEX I TRIAGE APPENDIX 4 I. PRE—EMERGENCY A. All ambulances and emergency rescue vehicles in Weld County will be equipped with 20 METTAGs (International Field Triage Tags) . These tags are to be furnished by the Weld County Ambulance Service. B. All ambulances serving in Weld County shall contain at all times those essential items as specified by the state board of health, emergency medical services division. C. Medical supplies for providing advanced life support to trauma victims will be stored in an emergency management major rescue vehicle. Adequate supplies for treatment of 50 victims requiring advanced life support will be stored in the rescue vehicle and mobilized to the scene of a mass casualty disaster. These supplies will be furnished by area hospitals and the stock rotated through these hospitals to prevent expiration of sterility. D. Each hospital in Weld County with emergency department facilities will have an on-scene triage officer M.D. and an alternative appointed by the chief of staff. Discretion should be used in appointing these physicians to ensure that they have some experience in triage. In the event that neither is available when the disaster occurs, the chief of staff will respond to the disaster scene. II. EMERGENCY A. It is the responsibility of the EMT who first arives on the scene to institute a triage to confer with the nearest emergency room physician and to implement action necessitated by the situation. B. The nearest hospital with emergency facilities will be notified immediately and requested to designate the most available M.D. from the medical community to serve as the on—scene triage officer who will respond promptly to the disaster site. C. The triage officer will be in charge of the overall triage activities. The triage officer shall respond immediately to the scene of a local disaster and is responsible for formal declaration of a medical disaster. D. The triage coordinator shall respond to the scene during medical disasters and shall act as the liaison between the triage officer and the on—scene commander. E. Registered nurses and paramedics employed with local ambulance services and capable of providing advanced life support in the field will respond immediately to the disaster site. They will 2'111.23 work with the triage officer and apply their skills to disaster victims. F. Equipment and medications for administering advanced life support to trauma victims will be transported to the scene by the emergency management rescue unit. Additional -supplies will be abtained from local hospitals upon request. G. Triage Priorities. Patients with certain conditions of injuries have priority for transportation and treatment over others. These priorities are: 0. Lowest priority: Black flap on triage tag. To be transported or treated last. Obviously dead. 1. Highest priority: Red flag on triage tag. Must be transported and treated immediately: a. Airway and breathing difficulties. b. Cardiac arrest. c. Uncontrolled or suspected severe bleeding. d. Shock. e. Open chest or abdominal wounds. f. Severe head injuries. g. Severe medical problems: poisoning, diabetes with complications, cardiac disease. 2. Second priority: Yellow flap on triage tag. Transportation and treatment may be deferred. a. Burns. b. Major or multiple injuries. c. Back injuries with or without spinal damage. 3. Third priority: Green flap on triage tag. Transportation and treatment is required for minor injuries but not necessarily by emergency medical service personnel; minor fractures or other injuries of a minor nature. H. The triage tags should be placed around the patient's neck and the appropriate flap removed to indicate the. priority by the last remaining flap. Any medications admininstered before the patient's arrival at the hospital should be indicated on the triage tag. Should the receiving hospital decide to institute its own disaster tag upon the 21.11.23 patient's arrival, the original triage tag should be retained with the hospital disaster tag. I. A separate category of triage should also be noted, as it supersedes all others. Patients who have undergone radiation contamination and are themselves carrying contaminated particles must be decontaminated as an initial step. They should not be allowed to contaminate other patients, ambulances or hospitals. In • the event of a radiation accident with casualties, trained personnel from the metro hospitals and others identified as resources shall assist with these victims. All ambulance personnel shall ideally have received training on radiological monitoring and handling the contaminated patient. • 31.1121 TRIAGE CHAIN OF COMMAND Triage Officer (First Paramedic on scene) Triage Coord_nator (WCAS Director) Registered Nurse or Paramedic Senior ranking EMT Ambulance driver :3; ;R n`A HEALTH AND MEDICAL ANNEX I MORGUE APPENDIX 5 I. RESPONSIBILITY The ultimate responsibility for the collection, identification, storage, and dispatch of deceased victims will lie with the coroner of Weld County as sit forth by the laws of the state of Colorado. II. DIRECTION AND CONTROL The direction and control of procedures in relation to the care of deceased victims shall follow the chain of command detailed below. A. Coroner of Weld County. B. Director, Weld County Health Department. 1. Collection center director. 2. Collection center personnel. III. GENERAL PROCEDURES A. Collection. 1 . The coroner's office shall be notified immediately in the event of an emergency situation and shall dispatch appropriate staff to the scene. 2. Collection of victims on scene, from hospitals, and other designated collection points shall be accomplished through the use of enclosed vehicles; e.g. , funeral home coaches. 3. Victims will be taken to designated identification points as dispatched by the coroner's office. B. IDENTIFICATION. 1. Identification of victims shall be made by use of accepted forensic methods by the coroner's office as supplemented by: a. Funeral home personnel. b. Other coroners and their staffs. 2. If circumstances warrant, the coroner's office shall also be assisted in the positive identification of victims by: 2. If circumstances warrant, the coroner's office shall also be assisted in the positive identification of victims by: 9 ^1 a. Special agents of the Federal Bureau of Investigation (FBI) . C. Interment. 1 . Upon positive identification of victims, bodies will be released to funeral homes specified by the deceased's family. 2. If no preference is noted, bodies will be released to local funeral homes on a rotation basis. 21.11.2'1 D. U.S. DEPARTMENT OF ENERGY: "EMERGENCY HANDLING OF RADIATION ACCIDENT CASES -- AMBULANCE/RESCUE SQUADS" The U.S. Department of Energy (DOE) has compiled the following information for "Emergency Handling of Radiation Accident Cases -- Ambulance/Rescue Squads." Emergency handling of radiation exposure or radioactive contamination cases should not be feared. Handling these cases involves common sense, cleanliness and good housekeeping. Radiation can be detected and measured by a simple instrument -- a survey meter. Radiation accident problems have parallels in other conditions handled frequently by emergency rooms and rescue squads without concern and following simple rules. Your group, your hospital can be involved. There are a few things you should know. There are four types of radiation accident patients. The individual who has received whole or partial body external radiation may have received a lethal dose of radiation, but he/she is no hazard to attendants, to other patients, or to the environment. This individual is no different from the radiation therapy or diagnostic x-ray patient. Another type is the individual who has received internal contamination by inhalation or ingestion. He/she also is no hazard to attendants, other patients, or the environment. Following cleansing of minor amounts of contaminated material deposited on the body surface during airborne exposure, he/she is similar to the chemical poisoning case. His/her body wastes should be collected and saved for measurements of the amount of nuclides to assist in the determination of appropriate therapy. External contamination of body surface and/or clothing by liquids or by dirt particles presents the third type, with problems similar to vermin infestation. Surgical isolation techniques to protect attendants and cleansing to protect other patients and the hospital environment must take place to confine and remove potential hazard. When external contamination is complicated by a wound, care must be taken not to cross-contaminate surrounding surfaces and the wounds. The wound and surrounding surfaced are cleansed separately and sealed when clean. When crushed dirty tissue is involved, early preliminary wet debridement following wound irrigation may be indicated. Further debridement and more definitive therapy can await sophisticated measurement and consultant guidance. There are a few simple rules (standing orders) to follow. a1.11.21 STANDING ORDERS FOR EMERGENCY HANDLING OF RADIATION ACCIDENT CASES RESCUE SQUADS Ambulance-rescue squad personnel usually see the case of radiation exposure or radioactive contamination before anyone else does. Their first acts will vary in degree whether they evacuate the patient(s) from a nuclear energy plant or from a road transportation accident. Trained, knowledgeable co-workers, supervisors, or health physicists are usually on hand at the plant, but not at the road site. When the accident has occurred at a plant, the health physicist, supervisor, co-workers and the patient(s) should be able to inform the rescue squad of the nature of the accident, number of patients and type of radiation exposure or radioactive contamination involved, and possible body areas that may be affected. A gross measurement of the amount of radiation involved may be available. Such information is most helpful. It is the responsibility of the rescue squad to: For the patient: 1. Give lifesaving emergency assistance, if needed. 2. Secure pertinent information, including rough measurement from those in attendance. 3. Determine if physical injury or open wound is involved. Cover wound with clean dressing; use elastic bandage to hold wound—cover in place; do not use adhesive. 4. Cover stretcher, including pillow, with open blanket; wrap victim in blanket to limit spread of contamination. 5. Notify hosptial of available information by radio or telephone. For rescue squad personnel: 6. Perform survey of clothing, ambulance, etc. , on arrival at hospital before undertaking further activity. 7. If contaminated, discard clothing in container marked "Radioactive--Do Not Discard." Cleanse self by washing and/or showering, as appropriate. 8. If in contaminated area, rescue squad personnel must be surveyed by radiation survey meter and measurements must be recorded. Cleansing must continue until responsible physician indicates person may leave. nil 2`. ,?� .�s.�. a_, i EMERGENCY ROOMS Standing orders for physicians, nurses, and hospital administrators are as follows: It is the responsibility of the senior hospital emergency room person on duty, on receipt of notification of the momentary arrival of a case involving radiation exposure or contamination, to: 1. Notify responsible staff physician or nurse and aides (trained health physcists or trained technicians from x-ray or nuclear medicine departments) , if available. 2. Get appropriate survey meter, if one is available in the hospital. If hospital has no meter, notify hospital administrator or responsible hospital official so he/she may obtain survey meter and other pertinent equipment by calling Office of Emergency Management (Sheriff's Office) . 3. Notify the hospital administrator so he/she may seek expert professional consultation for technical management of the case. 4. If contamination is suspected, prepare separate space, using either isolation room or cubicle, if available. If such is not available, cover floor area immediately adjacent to emergency room entrance-way with absorbant paper--the area to be adequate for stretcher-cart, disposable hampers, and working space for professional attendants. Mark and close off this area. Be prepared to shut off air circulation system. On Ambulance arrival, the physician and/or nurse in the emergency room should: 1. Check patient on stretcher for contamination (as stretcher is moved from ambulance) with survey meter. 2. If seriously injured, give emergency lifesaving assistance immediately. 3. Handle contaminated patient and wound as one would a surgical procedure; i.e. , gown, gloves, cap, mask, etc. 4. If possible external contamination is involved, save all clothing, bedding from ambulance, blood, urine, stool, vomitus, and all metal objects; i.e. , jewelry, belt buckles, dental plates, etc. Label with name, body location, time, and date. Save each in approriately covered containers. Mark containers clearly "Radioactive--Do Not Discard." 5. If medical status permits, decontamination should start with cleansing and scrubbing the area of highest concentration first. If extremity alone is involved, clothing may serve as an effective barrier and the affected limb alone may be scrubbed and cleansed. 01.1..?.23 AI Appendix Eight Disaster Plan North Colorado Medical Center 91./123 NORTH COLORADO MEDICAL CENTER . GREELEY, COLORADO DECEMBER, 1990 DISASTER PLAN Page L PURPOSE 1 II• GENERAL RULES 1,2,3 III. PROCEDURES 3,4 IV. MEDICAL CENTER PERSONNEL ASSIGNMENTS 5,6,7,8 V. TRIAGE DUTIES 8,9 VI. PATIENT TRANSFER PROCEDURE 9 VII. HOSPITAL DISASTER PLAN 9 VIII. DISASTER DRILLS 9 • IX. DUTIES OF OUTSIDE AGENCIES 10 X. GUIDELINES FOR RESUMING NORMAL OPERATIONS DURING DISASTER DRILL 10,11 111 • 91.1 ..23 NORTH COLORADO MEDICAL CENTER Greeley, Colorado "CODE D" MASS CASUALTY/DISASTER PLAN PURPOSE : The Medical Center may be faced with a situation where an unusually large number of patients must be cared for within a very short period of time. The purpose of this plan is to present an orderly and systematic guide of handling such a situation. I • DEFINITIONS : Triage - The term triage is a word of French origin which means sorting. When applied to multiple casualties, it refers to sorting and classifying casualties to establish a priority for emergency care of victims. - Class I priority - Immediate (Red)* - victims whose chances of survival depend on immediate emergency care. Class II priority - Delayed (Yellow)* - victims who need emergency care prior to transportation, but whose survival is not dependent on immediate V care. 11, • Class III priority - Minimal (Green)* - victims who apparently require simple emergency care needs or those who appear injured and only require observation. Class IV priority - Deceased (Black)* - the deceased victims. * Weld County Ambulance and North Colorado Medical Center classification tags. II . GENERAL RULES : A. The Senior Vice President Hospital Operations or, in his/her absence, the On-Call Administrator, after consultation with the Administrative Nursing Supervisor, shall put the plan into effect. B. A "Code D" Standby may be paged in the event of a potential disaster with a verfication of "Code D" or cancel within 30 minutes. In this respect units can assess their situation and be ready if needed to call in staff. No one should be dismissed from work during a "Code D" Standby. C. All department Managers shall have an up-to-date listing of his/her employees, both at work and at home and, when notified, will call the employees to report to work. The PBX operators shall have a list of all administrative staff and department managers and their home telephone Jnumbers. 1111 31.1123 • MASS CASUALTY/DISASTER PLAN • Page Two D. Every employee must know that a "Code D" means the Medical Center's Mass Casualty/Disaster Plan is in effect. E. Thee Dispatch Center will be located in the auditorium (Ext. 6395/6396). All unassigned Medical Center employees and volunteers will report here for duty assignment. This area will be supervised by the Personnel Department. F. Upon learning of a disaster, every employee on duty must return to his/her respective department as soon as possible unless he/she has a predetermined responsibility during a disaster. When possible, employees. should use the stairs rather than elevators. Reassignment or release of employees will be made from their respective departments. Off-duty employees should report to the Dispatch Center. G. All entrances will be closed to unauthorized personnel. Only those individuals with Medical Center identification will be given entrance. Security officers will be stationed at these entrances to enforce this. The doctors' entrance will be open for physicians. The main entrance will be open for Security to admit family. They will be directed to the cafeteria by escorts provided by the Dispatch Center. 110 H. Press representatives may enter the Medical Center through the main • entrance after presenting proper identification. They are to proceed immediately to the Board Room where Marketing personnel (Ext. 6108) will further certify their credentials. I. All admissions, except emergency and obstetric cases, will immediately be deferred until such time as the Senior Vice President Hospital Operations or his/her designee decides that it is possible to resume normal activities. J. Outgoing telephone calls are to be restricted to Medical Center business. Employees should refrain from receiving or placing non-emergency calls. K. No Medical Center personnel will give out any information. The Senior Vice President Hospital Operations or the Administrative Person On-Call will release all information through the Marketing Department. L. Nursing students and instructors assigned to the Medical Center should remain on the unit. They may assist as directed, by the Unit Charge Nurse. Those nursing students or instructors in the building performing non-patient care activities should evacuate the building. M. Relatives and friends of casualty patients will be directed to the cafeteria. The Social Services Department will staff this waiting area. (Pager 95- 452, Pager 95-453 and Ext. 6291). N. The Administrative Office will be used as the Control Center to direct • �- and coordinate activities under the direction of the Senior Vice President Hospital Operations or the Administrative Person On-Call (Ext. 6001). l 1.1 21 MASS CASUALTY/DISASTER PLAN v Page Three O. All clergy will be directed to the cafeteria to assist the Department of Social Services with family members and may be further dispatched to the units, upon request of Social Services or other NCMC staff. Relatives of non-disaster patients should remain in patient's room or go to the cafeteria. P. All disaster {patients" will be tagged with the appropriate Medical Center form immediately after they are triaged. They will also be given a pre- stamped chart corresponding to their disaster tag number. Any subsequent important matters relating to the patient's treatment must be entered on the chart or form, as appropriate. The charge nurse of the triage area • will be responsible for assuring that patients are properly tagged. Q. The Senior Vice President Hospital Operations or, in his/her absence, the On-Call Administrator, shall be the only one to end the "Code D." R. All department managers will be held accountable for developing specific "tail-in" procedures and internal procedures for their departments during a mass casualty disaster. A copy of each department plan call list should be on file in the office of the Disaster Committee chairman and in Administration. S. This plan will be maintained and kept up-to-date by the Emergency Department Nursing Care Coordinator. All changes should be addressed to him/her quarterly. III • PROCEDURE ; Communication Center Inform Emergency Department Law Enforcement Agency of a disaster and relays Ambulance Personnel pertinent information. Emergency Department Obtains all available information concerning disaster. Calls Administrative Nursing Supervisor - Page 95-408. She calls the Senior Vice President Hospital Operations or his/her designee. Senior Vice President/ Puts Disaster Plan into effect. Hospital Operations or Administrator On Call Switchboard Operator - Announces "Attention: Code Plan "D" or Code Plan "D" Drill or Code "D" Standby (number of casualties expected); paged three (3) times in succession and repeated three (3) times at one (1) minute intervals. ni 1.23 MASS CASUALTY/DISASTER PLAN r Page Four . Switchboard Operator - Telephone notification will be made to physicians and key Medical Center personnel by the Scheduling Center (7 a.m.-7 p.m.) or by employees assigned by the Administrative Nursing Supervisor (7 p.m.-7 a.m.). Notify Personnel Director or other ' Personnel Department staff as outlined in Department call-in list. NCMC Employees - Upon learning of "Code Plan "D", unless on duty or have a specified responsibility as outlined in this procedure, return to your depart- ment as soon as possible. Use stairs, when possible. Medical Staff - Reports to Emergency Department conference/waiting room for • assignment. Family Practice Residents - Reports to Ambulatory Care Center to provide care to minor injury patients. Senior Vice President/ - When appropriate, will end "Code Hospital Operations or Plan "D". Administrator On-Call Calls switchboard and notifies them of this decision Switchboard Operator - Announces "Cancel Code Plan D", (ALL CLEAR) pauses three seconds, then repeats, pauses three seconds, then repeats. During a scheduled Disaster Drill, regular service can be resumed in accordance with the "Guidelines for Resuming Regular Services During the Disaster Drill." • 2111.21 40 MASS CASUALTY/DISASTER PLAN Page Five IV. MEDICAL CENTER PERSONNEL ASSIGNMENTS : A. Personnel on duty shall report to their duty stations, prepare to support the treatment effort, and await further instructions. Request for 'additional personnel will come from the Dispatch Center. 1. ADMINISTRATION a) The Senior Vice President Hospital Operations or Administrator On- Call will assume overall coordination of the disaster from the ' Operations Control Center located in Administration (Ext. 6001). b) The Director of Planning and Marketing will serve as the public information officer and will release all information on the nature of the disaster and the status of disaster victims from the Operations Control Center (Ext. 6000). c) The Director of Clinical Services will man the Emergency Department Communications Center (Ext. 6961) to provide information to the Operations Control Center and to coordinate administrative activity in the Emergency Department area, i.e. supplies, personnel, etc. [i.e. Air Life, outside ambulance services, etc.]. d) The Director of Support Services will coordinate and supervise the supportive services, including the set up of needed areas, transportation of supplies, traffic control, and security, transportation to other facilities, as needed, and coordinate services of outside agencies (Ext. 6000). 'Itwo-way walkie talkie will be used for communication between Emergency Department Communication Center, PBX, Operations Control Center and Department of Social Services as needed. 2. ADMINISTRATIVE NURSING SUPERVISOR: a) Shall, in the absence of the Senior Vice President Hospital Operations or his/her designees, determine in any disaster situation the extent to which the disaster notification should proceed. This decision is based on the information as it is available from the scene, the day of the week, and the time of day. 3. NURSING UNITS a) Shall transport stretchers, LV. stands, wheelchairs, bedpans, portable suction machines, sandbags, and shock blocks to the central core of each floor and personnel from the Dispatch Center shall transport items to the Emergency Department, as needed. Supplies shall be • sent only upon the request of the Communication Center. 311123 w MASS CASUALTY/DISASTER PLAN • Page Six b) Shall determine the maximum number of casualties that the unit may absorb and develop a list of patients for possible discharge for -- review by the discharge team. CCU is ,,to notify the Emergency Department off space available. Surgery is to notify the Emergency Department of available suites. c) Upon receipt of disaster victims, shall prepare and send to the Operations Control Center (Administration) every two (2) hours, a report of all disaster casualties received and their condition. i ' 4. PERSONNEL DEPARTMENT a) Shall supervise the employee Dispatch Center located in the auditorium and shall assign four (4) employees from the Dispatch Center to man and operate the elevators. Assigns patient advocates, as needed, to the Emergency Department, giving each patient advocate a sheet of duties. At the direction or request of the Communication Center, may be asked to release personnel from their stations. 5. SOCIAL SERVICES DEPARTMENT a) Shall support and assist family members of the disaster victims who S will be located in the cafeteria (Ext. 6291, Pager 95-453, Pager 95- 452). 6. ADMITTING DEPARTMENT a) Shall suspend all non-emergency admissions until casualty demands are determined. b) Shall be responsible for the collection and storage of disaster victims' valuables. c) Shall keep a tracking log of victims for their location to enable lab and x-ray reports to reach them. d) Shall immediately dispatch PSR's to the Emergency Admitting area to assist with logging in patients in the Emergency Department. 7. SECURITY a) Shall be responsible for visitor and traffic control. 8. ENGINEERING a) Shall be responsible for traffic control on hospital property. b) Maintain power and H2O and 02 supplies. • 21.1123 MASS CASUALTY/DISASTER PLAN Page Seven 9. RADIOLOGY a) Shall send two (2) technicians with a portable x-ray unit to the } Emergency Department. 10. LABORATORY a) Shall send two (2) phlebotomists to the Emergency Department immediately for type and crossmatch and other blood specimens. One (1) phlebotomist will be sent to Day Surgery. • b) The Blood Bank will evaluate blood supply against demand and report available supply to the Emergency Department. c) One runner will be sent to transport specimens back to the lab. 11. RESPIRATORY THERAPY a) Shall send two (2) therapists to the Emergency Department with extra ambu-bags and 02 equipment. 12. EKG tra a) Shall send one (1) technician with an EKG machine to the Emergency Department and one (1) to the delayed treatment area (Day Surgery). 13. INSURANCE BILLING A. Shall complete the discharge process for any disaster victims who may be treated and released. 1• In the event the disaster occurs after hours, the Insurance Billing Department would be called in according to their departmental plan. B. Off-Duty Personnel shall (a) report to the Medical Center as soon as being notified by the Supevisor of a disaster and (b) should park in the North lot and enter the hospital through the Oncology Center entrance wearing their name tag or a large safety pin for identification. 1• Off-duty Nursing Personnel shall report directly to the Dispatch Center located in the auditorium to await further assignment unless their department Manager has specified otherwise. 2. All departments.other off-dut ersonnel shall report directly to their l Ali 31.1123 • r MASS CASUALTY/DISASTER PLAN Page Eight • C. Medical Staff: 1. Family Practice Resident Physician: a) Shall report to the Ambulatory Care Unit. „ b) Shall be responsible for the care of all patients triaged to this area. c) In the event no patients are triaged to this area, these physicians may be requested to assist in the Day Surgery delayed care or the Emergency Department. • d) Information regarding the number of victims and the estimated extent of injury will be available from the Communication Center (Ext. 6961). 2. Private Staff Physicians: a) Physicians should report immediately to the Physician Control Center locatedLall ntheEmergency waiting room. b) Triage be performed by the Emergency Physician on duty until relieved by the first general surgeon on scene. (See Triage Duties • below). c) The first member of the Medical Staff to arrive will be in charge of briefing subsequent physicians upon their arrival. He/she will dispatch physicians to the Emergency Department, Day Surgery delayed care, the AC Unit and the O.R., as needed. All requests for physician help should be directed to this individual - (Ext. 6258). d) In the event discharge of inpatients becomes necessary, a discharge team under the direction of the senior resident on duty, until the arrival of the Department of Medicine Chairman, shall evaluate the patients for discharge in order to provide space for disaster victims. e) Following the triage period, every attempt should be made to have patients choose private physicians. In the absence of patients' preferences, physicians will be assigned on an equal number of diagnosis basis. V• TRIAGE DUTIES : Chief Triage Officer, Emergency Medicine Physician: 1• Oversees all activities in the triage area. '1 2• Assigns patients to treatment areas: • MASS CASUALTY/DISASTER PLAN Page Nine a) Class I priority - Immediate (Red) - triage to Emergency Department. Class II priority - Delayed (Yellow) - triage to Emergency Department or Day Surgery depending on the numbers of Class I victims. c) Class III priority - Minimal (Green) - triage to the Ambulatory Care Unit. • d) Class IV priority - Deceased (Black) - the deceased victims - triage to the garage outside the Emergency Department. *The Emergency Medicine Physician will not triage patients to the Bum/Trauma Complex until he/she has been notified that a surgeon has arrived and assumed responsibility for this area. VI • PATIENT TRANSFER PROCEDURE: a) In the event that the number of disaster victims with neuro/spinal cord traumas exceeds the volume of patients the Medical Center is capable for handling, then arrangements would be made according to i ED transfer policy to evacuate the most stable injuries to other appropriate facilities. b) In the event that the number of bum patients exceeds the Medical Center's capabilities, then the most stable of these victims would be transferred according to ED policy to appropriate facilities. VII • HOSPITAL DISASTER PLAN : a) All departments and services shall develop and review annually detailed plans of action supporting the basic Disaster Plan and the general provisions outlined herein. Departmental plans and instructions shall be coordinated with the Disaster Committee and be added to the Disaster Plan. b) Department Managers and Supervisors shall be responsible for informing their employees of the department's functions in a disaster situation and the employees' individual assignments. Those departments without specific disaster assignments should hold available personnel in their department. They may be called by the Dispatch Center as the need arises. c) Every employee should be familiar with the Medical Center's Disaster Plan and their department's Disaster Plan. 1/40 O11 API MASS CASUALTY/DISASTER PLAN • Page Ten VIII . DISASTER DRILLS : a) Disaster drills will be held at least twice a year. The disaster code will be .paged or all departments nofified by telephone of the drill. All departments should carry through with their disaster assignments with the exception of actually disrupting patient care and calling in off-duty personnel, unless specifically told to do so. IX. DUTIES OF OUTSIDE AGENCIES : A) American Red Cross (352-7212) Upon request from the Senior Vice President Hospital Operations or his/her designee, the Red Cross is available to: 1. Assist in finding shelter for discharged patients. 2. Assist the Department of Social Services in the location of relatives of patients through the Interstate Network. 3. Provide transportation to and from the Medical Center for victims and/or families. • B) Salvation Army (353-1441) Upon request from the Senior Vice President Hospital Operations or his/her designee, the Salvation Army is available to: 1. Provide clothing for disaster victims. C) Department of Social Services (Weld County) 356-4000 Upon request from the Senior Vice President Hospital Operations or his/her designee, the Weld County Department of Social Services is available to: 1. Assist with transportation of discharged patients to their home or to an appropriate facility. D) Other Health Care agencies. X• GUIDELINES FOR RESUMING NORMAL OPERATIONS DURING A DISASIEk MULL : A) After the drill has been in progress approximately one-half hour after arrrival of patients and also depending on the time of day, notification will be given to resume regular operations. B) Notification is made by the Senior Vice President Hospital • • Operations or his/her designee and is announced as: "Code Plan still in operation - resume regular operations" announced. q qq .`�.y q 7.`E..�.2,3 { MASS CASUALTY/DISASTER PLAN Page Eleven . C) Regular operations include the following: 1. Discharging patients - this includes allowing family members to go to patient units to assist with discharge functions. 2., Admitting/patients. 3. Transferring patients to and from diagnostic and treatment departments. 4. Delivering meals to inpatients. 5. Delivering supplies, medications, linen, etc. to inpatients. D) One elevator (far west) if the central bank needs to be held and dedicated for disaster victims. E) When it is determined that the Disaster Plan has been well tested, the Senior Vice President Hospital Operations or his/her designee initiates the page to "cancel Code Plan D." ;Elegk-eir Karl B. Gills, Sr. Vice President Hospital Operations Reviewed/Revised: April, 1988 Reviewed/Revised: July, 1988 Reviewed/Revised: July, 1990 Reviewed/Revised: December, 1990 ----- -- ---- ---- �l 1 121 i MASS CASUALTY/DISASTER PLAN aPage Eleven C) Regular operations include the following: 1. Discharging patients - this includes allowing family members to go to patient units to assist with discharge functions. '2. Admitting patients. 4 3. Transferring patients to and from diagnostic and treatment departments. 4. Delivering meals to inpatients. 5. Delivering supplies, medications, linen, etc. to inpatients. D) One elevator (far west) if the central bank needs to be held and dedicated for disaster victims. • E) When it is determined that the Disaster Plan has been well tested, the Senior Vice President Hospital Operations or his/her designee initiates the page to "cancel Code Plan D." ' Karl B. Gills, Sr. Vice President Hospital Operations Reviewed/Revised: April, 1988 JReviewed/Revised: July, 1988 • Reviewed/Revised: July, 1990 r NORTH COLORADO MEDICAL CENTER • DEPARTMENT DISASTER PLAN ADMINISTRATION L - NO Ur_!CATION: A. During normal d‘ty hours, the Senior Vice President Hospital Operations or the Administrative Person On-Call will be notified of a pending disaster situation by the Administrative Nursing Supervisor on duty. B. During off-duty hours, the Administrative Person On-Call will be notified of a pending disaster situation via telephone or radio pager by the Administrative Nursing Supervisor. Administration not initially notified (President, Senior Vice President Hospital Operations, Vice Presidents and Directors of Clinical Services, Support Services, Cardio Vascular Services) will be contacted by the Medical Center operator upon implementation of the Disaster Plan. The Administrative and Corporate secretaries will be notified via a phone call from the Director of Support Services on holidays and weekends or after 5:00 p.m. on week days. / �IL RESPONSD3ILITIES AND DU'ITES: A. Upon notification by the Administrative_ Nursing Supervisor of a pending disaster situation, the Senior Vice President Hospital Operations (or, in his absence, the Administrative Person On-Call) shall make the decision to implement the Medical Center Disaster Plan. B. Implementation of the Disaster Plan will be ordered by the Senior Vice President Hospital • Operations or the Administrative Person On- Call by: 1. Instruction to the PBX operator to page the disaster code, and; 2. Instruction to the Administrative Nursing Supervisor to notify persons listed on the Disaster Alert Call list. C. Specific Administrative assignments will be as follows: 1. The Senior Vice President Hospital Operations will assume the overall coordination of the disaster from the Operations Control Center located in Administration (Ext. 6001). 2. The Director of Planning & Marketing or On-Call staff will serve as the public information officer. He/she will release • all information on the nature of the disaster and the status of the disaster victims from the Operations Control Center (Ext. 6000). 21.1123 - --- -- 1 AADgMINIISoTRATION - DEPARTMENTAL DISASTER PLAN 3. The Director of Clinical Services will man the Emergency Room Communications Center to provide information to the Operations Control Center and to coordinate administrative activity in the Emergency Department area (Ext. 6961). 4. The Director of Support Services will coordinate and supervise the supportive services, including the set up of needed areas, transportation of supplies, traffic control, and security beeper. In the event the Senior Vice President Hospital Operations is not available, the Administrative Person On-Call will assume overall coordination of the disaster and his/her duties assigned to another administrative or hospital staff. • 21/224, Karl' B. Gills, Senior Vice President Hospital Operations Reviewed/Revised: June, 1985 Reviewed/Revised: July, 1988 Reviewed/Revised: July, 1990 Distribution: President, Senior Vice President, Vice Presidents, Director of Planning & Marketing, Administrative Assistant, Administrative Secretary, Corporate Secretary dl 21.123 M - • F NORTH COLORADO MEDICAL CENTER Section D Greeley, Colorado Class Reg TNTERNAL DISASTER PREPAREDNESS PLAN _ . Purpose of evacuation A. To provide a safe , organized exit for all patients , visitors and staff.. B . To provide information regarding when to escape , where to escape and how to escape . Rgzpnnsihility A. Fire 1 . Ensure the patient 's safety. 2 . Contain the fire (close door) . 3 . PULL FIRE ALARM . If the fire alarm pull station has been activated and there is no visual or audible alarm, to to the nearest phone and dial 77 or 91-911 and state your emergency. 4 . Use an extinguisher on the fire if it is a small one . a) Do not remove any fire damaged equipment . b ) Be sure you report all fires no matter how samll (use manual fire alarm box first) - get help on the way. Call on telephone as back-up . c ) Once the Fire Chief has arrived, he will work with the Administrator on Call . B . Tornado Evacuation Plan The decision to evacuate an area will be made by the Medical Center Administrator on Call . How to evacuate A. Room evacuation 1 . If unit staff suspects fire in a patient ' s room and door is closed , check door and door latch for heat; if hot DO NOT ENTER. If cool, open the door slightly to check ex- tent of fire . DO NOT ENTER IF ROOM IS ENGULFED IN FLAMES . Immediately shut door, pull nearest fire alarm and follow fire procedure . 2 . If Number 1 is not applicable, remove patient from room to a safe area.* 3 . If fire is serious, remove patients from adjoining rooms to safe area.* 4 . Administrative Nursing Supervisor will notify floor above and floor below indicating which room has the fire . These floors should in turn evacuate the rooms below and above the fire and the adjacent rooms to a safe area.* * Safe area is one fire door between fire and people . B . Area evacuatinn (appli s to patients viaitnra , end staff) • 1 . The decision to evacuate an area will be made by the Medical ` Center Administrator on Call (who may confer with the Fire Chief or his designee) . 2 . Upon arrival of a fireman to the involved area, the Nursing Supervisor will brief him on action taken thus far, patientVA census , number of staff and general mobility of the patients . ,r,, ?n case of an evacuation the Nursing Supervisor or designee gel - _-__ ... medical record=_ accompany each patient 11 1TERNAL DISASTER PREPAREDNES" PLAN Ige 2 3 . Once the decision is made to evacuate patients should be evacuated to area behind one fire door . If entire floor needs to be evacuated , use the stairways 4 . BE FAMILIAR WITH YOUR AREA MAP for evacuation and your unit procedure Maps posted on each floor . . 5 . Nursing Supervisor to institute Code E when more help is needed . • C . R1PvatnrS- will be used by the Fire Department, only D . Rvacnate in stap.p 1 . Move to "safe" area of the floor . 2 . Move to "safe" area of building. 3 . Move to exterior . 4 . Hove to Evacuation Center. 5 . Account for everyone at each stage . 6 . Keep everyone together - STAY CALM! ! E . Employees are to remain in safe area until dismissed by Aministrator on Call or his/her designee . F . Modes of Pvsirustion 1 . Ambulatory patients can assist with other . 2 . Sheet drag or fire man life method to safe area. 3 . Immobilized patients a) Move entire bed and equipment only if absolutely necessary. b ) Use scoop boards available on 5 North, ER, and ICCU . G. Gene^m1 Guidelines, 1 . Know evacuation routes . 2 . Keep calm . 3 . Do not endanger shelf . 4 . Practice drills . 5 . Know safe areas.. d--"" C.5/ Richard H . Stenner, President Formulated January 1984 Revised : June 1985 Reviewed : July 1988 Revised : November 1989 NORTH COLORADO MEDICAL CENTER ,y EMERGENCY DEPARTMENT DEPARTMENTAL DISASTER PLAN 1. NOTIFICATION: A. The Emergency Department will be notified of an actual or possible disaster by telephone, radio, or by receipt of casualties at the Emergency entrance, All telephone calls to the hospital concerning a disaster situation shall be directed by the operator to the Emergency Department, Extension 6244. The Emergency Department shall determine, so far as possible, the followino: 1 , The nature of the disaster (fire, explosion, accident, etc) and . location. J --t. Number of casuarities. 3. Type of injuries (burns, fractures, etc) . 4. Time lapse before casualties will be received. 5. Source of the disaster report. Re: official status. I1. .RESPONSIBILITIES AND DUTIES: A. When it has been determined that the receipt of casualties mill likely exceed the normal working capacity of the Emergency Department, the Emergency Department will immediately contact the following people: 1 . The nursing supervisor on duty to initiate Code Plan D. The Emergency Department MD to begin disaster call for Emergency HD'„ J. The NCC, O. It mill be the department responsibility to notify off duty personnel needed for the disaster situation based on the department 's anticipated needs and those employees already on duty, C. The Emergency Department will be used as a treatment area to treat seriously ill and injured casualties as outlined in the basic Disaster Plan. t Red tagged patients and yellow, if necessary. D. Upon implementation of the Disaster Plan by the administrative person on call , Emergency Department shall assume the following functions: 1 . The Emergency Department HD, Charge or designated nurse, ED secretary shall assume initial triage of casualties. The physician will be relieved of triage duty by the first general surgeon on the scene, a. Triage protocol as described in main disaster plan is to be instituted. 2. The Charge Nurse shall assume responsibility for conducting a quick inventory of supplies and medications to determine whether additional supplies will be needed. All such requests should be channeled through Extension 6961, A disaster cart and pharmacy box will be brought directly to the department. The Charge Nurse is also responsible for the clearance of Emergency Department patients, non—emergent. J. The Disaster Communications Center is the responsibility of the VP of Clinical Services , or his/her designee. All requests for personnel, supplies, equipment, bed status, surgery status, etc, should be channeled through this desk. 4. The second member of the Medical Staff to arrive shall be in charge of briefing subsequent physician arrivals on the nature of the disaster and for making duty assignments based on consultation with the triage physician . --- - lq E. Specific Duties of ED f sonnel: '. ED Physician Dutie: a. Shall communicate with the charge nurse to determine if only additional ED staff is required or if the disaster plan need; to be put into effect. b. Shall determine which non—urgent patients may be immediately discharged, , c. The _scheduled ED Physician will be the triage office until the on call physician arrives and assumes responsibility, d. The ED Physician OD duty will be in charge of non—disaster patient; with the ED Physicians that are called in plus other members of the medical staff handling disaster victims. �'. RH Sta;°f a... Shall, be responsi'6Ie for direct patient care as well as assisting in procedures. b, Shall maintain adequate level of _supplies and contact the Communication Center, if more are needed. _. Shall complete the medical records, keep flow sheets and if possible obtain other patient demographics not obtainable at the ' time of admission. d, One RH mill be assigned to delayed care in Day Surgery. e. One RH will be assigned to Ambulatory Care (green) for ambulatory patient:. 7. Emergency Department Admission Secretary a. Take pre—numbered charts and disaster tags to triage area. b. Log field triage tag number, if present, ED tag—charge number , and destination after triage name, is know. Admitting office will assist after their arrival. c. Place ID band on patient with corresponding number to chart and ED triage tag. 4. Emergency Department Back Desk Secretary/financial Counselor a. Begins ED staff disaster call in, as directed. . b. Completes requisitions. c. Handles phone calls. • 5. ED Orderly a. Obtain_ the rolling table/cart from the shover area and take to triage area. b. All equipment will be removed from the shower area in case of a hazardous material incident. c. One Orderly will assigned to the garage for managing the emergency morgue. These patients will be segregated by age, sex, race, and group to facilitate identification. F. Radio Communications will be handled by staff until relieved by HCAS personnel. As additional staff arrive, they will be assigned duties by the charge nurse. t Re wed and Revised: 7/83, 7/90 a ,-,„ IkF . , JL::,, 1DIS.4:TER.ER fmem I , ` 4ORTN COLORADO MEDICAL CENTER Filing T DISASTER PLAN Class. INFORMATION Appendix: Tornadoes �*� 4� p ��c �� I. PURPOSE n1 (J ' ro.PLL/11 O1—v /0 Q. While tornadoes are less common in Colorado than in some other areas, they do present an occasional local threat, particularly from April through June, with some resultant modifications to our basic Disaster Plan. This appendix stresses only those modifications. II. NOTIFICATION 1 . Private Individuals - In the event the initial sighting of a tornado funnel by a private individual is made directly to the hospital, the con- tacted party will pass that information on to the Weld County Communica- tion Center (366-4000) before implementing our internal reaction unless the hospital is imminently threatened. 2. Official Notice - This may come from the Weld County Communication Center or a public radio station. 2A. Internal Notice - On confirmation of private notice or on receipt of official notice, the contacted individual will promptly notify the Administrator on Duty or the Nursing Supervisor. I , I A. "Tornado Watch" - signifies only that weather experts feel that highly favorable conditions exist in the area for the formation of severe thunderstorms and/or tornadoes during a certain time period (generally mid- to late afternoon until early to mid- evening). B. "Tornado Warning" - indicates the actual sighting of a funnel or severe storm front. Specification is usually made of the time and location at which sighted and the apparent direction and speed of travel . Tornadoes in recent years have had mean ground path lengths of over 19 miles and the path can be as wide as a mile. The most common travel direction is from southwest to northeast. C. "Tornado Watch" - The Administrator On Call or the Nursing Supervisor will direct a telephone notification to alert all hospital departments to the potential for severe weather. D. "Tornado Warning" - The Administrator on Call or the Nursing Supervisor will instruct the hospital operator to page a notice such as: "Attention. A tornado warning is now in effect. Please imple- ment Tornado Warning Procedures." III. PREPARATION 1 . Tornado Watch - No reaction other than alertness to further updates with reliance on the alerting agency to contact the hospital . 1.11.23 jnupendix: Tornadoes Page 2 2. Tornado Warning - With any sighting that poses a real or potential threat to the hospital itself, the following precautions are taken with priority given to the parts of the hospital in line with any sighted funnel travel(usually the South and West sides), t A. Patients and personnel should be quickly moved away from exterior walls (especially those with windows) to interior corridors, B. Windows should be opened and drapes should be closed if time permits, C. All cigarettes and any open flames will be extinguished. D. Hospital engineers will monitor and control utilities. IV. ACTUAL DAMAGE OCCURRENCE 1 . Outside Hospital - As information is received of outside damage, Code D Procedures will be followed. 2. Damage to the Hospital Structure - A. The Nursing Care Coordinator of each ward or Department Manager/Supervisor will effect a rapid survey of their area with precedence given to patient or employee injury, and secondarily to damage that might result in rapid progression or further damage and possible injury such as actual fire, breached water, gas or electric lines, or severe structural damage that could result in collapse of a ceiling, floor or wall. Other damage { need not be estimated at this time. 4111 B. Uo not attempt to move injured patients or personnel unless further harm is threatened but do give appropriate first aid. C. Results of area injury survey will be relayed by phone or messenger, if necessary, to the Emergency Department. D. Property and utility line damage information will be similarly provided to the engineer on duty for proper action. E. Fire reports will follow the normal procedure. F. The Orderly Pool and available Weld County Ambulance Service personnel will , with assistance by unit RNs and available physicians, go to dam- aged areas and bring injured patients by usual medical priority to the Emergency Department area for emergency care. The injured will be handled and distributed as per the Disaster Plan with modification by the doctor in charge and/or the Administrator if needed because of des- ignated areas in the plan being damaged. NOTE: For evacuation procedure, refer to Code Echo (Filing "E", Class "Regulation"). Formulated: 4/79 Reviewed: 8/82 4 Reviewed: 8/85 Revised: 11/85 i ,�� Reviewed: 7/88 Mike Bre en ichard H. Stenner Safety 0 icer President i 1,"1� 23 _c_�fleL-Cg Role in Disaster 1. First off duty paramedic to arrive will take control of operation of all radio traffic, and is responsible to charge nurse only. J"-2. All other off duty paramedics will assist R.N. 's and M.D. 's with Advanced Airway control, IV access, etc. according to patient's needs. t J, 2111.23 Air Life ^ Role in Disaster 1. Will not assume Primary Patient Care. a. Will be available to fly at any time. 2. Paramedic will take operation of all radios until - a. Relieved by off duty Air Life paramedic b. Called to fly 3. If—not called to fly, 411 assist in`Emergency Department as determined by the charge nurse, but available to fly at a moments notice. 4. If Air Life is on a flight at the time of disaster — a. Patient is on board, flight will continue to destination as usual. • Air Life will then proceed to disaster area as conditions warrant. b. If flying to get patient, continue at discretion of charge nurse and flight nurse. (Continue or return) C) f 1 2,11.1.23 Charge Nurse Role in Disaster .t n 1. Will be responsible for the coordination of all activities in the Emergency Department during a disaster, in conjunction with the charge physician. Will not assume a patient care position unless relieved by Nursing Care Coordinator. 2. Will notify Nursing Supervisor of disaster or possible disaster after consultation with charge physician. 3. After "Code D" is initiated, the charge nurse and charge physician will decide how and where to discharge remaining Emergency Department patients to makeroom for disaster victims. 4 4. Will assign a secretary or nurse, or Emergency Department tech to start re— call of all Emergency Department personnel. • 5. Will assign Air Life paramedic to handle all radio traffic until relieved by off duty Air Life paramedic, or until a flight is dispatched. If a paramedic is not available to handle radio traffic, a nurse that is experienced with the radio operations will assume radio traffic until an off duty paramedic is. available. 6. On duty Air Life personnel will not assume patient care duties, and will be available to fly at all times. 7. Will assign all personnel appropriate duties. a. ICCU/CCU - critical patients b. Floor nurses - more stable patients c. Emergency Department nurses - to level of ability and to assist any i other RN's not familiar with Emergency Department d. Emergency Department Techs - Assist RN's in Emergency Department 8. During the course of a disaster, if it- is determined that the disaster patient number or severity exceeds the capability of North Colorado Medical Center, patient's will be diverted to an appropriate medical facility by appropriate means of transportation. 9. Will be responsible to inform triage M.D. and triage nurse of number of ICCU beds, Emergency Department beds, or availability when information becomes available. T Stet 1 t < ≤ or" QL (arcto1 1.112 An Overview of Disaster Protocol, Involving Radiation Injuries Contaminated patients enter via shower, and after shower go to following rooms: laser, ENT, eye, dental, psych holding and ortho. Critical contaminated patients may go to Cardiac Trauma. Room sealed off from rest of Emergency Department to prevent spread of contamination. Personnel dealing with contaminated patients should not circulate out of contaminated zones. All others (non-contaminated) triaged at door of Emergency Department: a. Critical to treatment 1 thru 6, and/cardiac trauma room b. Moderate to burn trauma complex or Emergency Room c. Walking wounded to Ambulatory Care (unlimited) Ultimate disposition of RADIATION INJURIES is St. Luke's, Denver Formulated: 3/83 • Reviewed: 4/29/85 Reviewed and Revised: 7/88 • NORTH COLORADO MEDICAL CENTER _ INSTRUCTION SHEET DISASTER VICTIM PATIENT ADVOCATE ^ ' - l During a disaster , one hospital employee say be assigned to each disaster victim in order to assist in recording information about the patient, and to make sure that order. for the patient are carried out. As a disaster victim patient advocate, please be prepared to do the following: 1. Feed together all paperwork on your patient making sure that the patient 's name has been recorded on all forms an matches the name appearing on the disaster tag. If unable to get name, the disaster tag is used. 2. Help record all additional data that may be available (address, nature of injuries-, vital signs , etc.) . J. Help record all order; on the appropriate form: (lab tests, x—rays-, transfer to a holding area, etc.) . 4. Stay with your patient. If your patient is sent to x—ray for example, make :sure you know where the patient is to go when the x—rays have been completed. Report any change of location beyond £.D, to ext 6470. 5. ln=ure that all verbal orders for your .patient have been recorded and carried out, and you have signed ,our name and _status. i.e. RN, LPN, etc. 6. If your patient is Cor,sciazs, reassure his and help keep hia calm. 7. Assist with any other minor tasks as may be assigned (changing linen, transport 4 of your patient with approval and supervision of qualified medical personnel , etc) . 8. Mhen your patient has reached his destination, leave the original copy of the E,D. record with patient. You return with the remainder- of the copy to the E. O. Return to Auditorium for reassignment. Do nor accept any assignment until you have reported back to the auditorium. 9. If patient has valuables: a. Remove them. Have witness sign the outpatient record, and note all items OD the E.O. record and state they were taken to the hospital safe. Reviewed and Revised: 7/88, 7/50 I DikMP4PCLICYlDIEASTER.ER 21.1123 4: Appendix Nine Disaster Emergency Response Plan Kersey, Colorado • Disaster Emergency Response Plan r • Kersey, Colorado Table of Contents Page CONCURRENCE i TABLE OF CONTENTS BASIC PLAN 1 RESPONSIBILITIES ;1 NOTIFICATION 1 ACTION 1 EVACUATION 5 TACTICAL COMMAND POST . 5 STABILIZATION 6 RECOVERY 7 CALL UP LIST_OF THE ACTION AGENCIES g CALL UP LIST_OF ASSISTANCE AGENCTFS g CALL UP LIST OF THE NEWS MEDIA 10 PRELIMINARY PUBLIC INFORMATION_CHEC:K'T.TST 11 TACTICAL CaMMAND POST ORGANIZATION CHART 12 . DISTRIBUTION.LIST 13 MAP 314__ CALL UP LIST 7N•CASE OF TRANSPORTATION INCIDENTS 15 ii 31.1.1.23 I. G<_natal A. This Disaster Emergency Response Plan will ba followed in the event of i) An act of':God. ii) A hazardous material incident. iii) Civil disorder or iv) Bomb threat. • II. Area of Responsibility A. the general area of responsibility for :this plan is limited to the city • limits of the Town of Kersey. III. Mutual Aid Area of Responsibility . A. Mutual aid.will be requested fran the Weld County Sheriffs Office; the Colorado State Patrol, other law enforcement agencies:withindieldT:Itin County, and other fire dep.nrtrrents within Weld Countyg_as_available. , • B. Requests fran other agencies will be made upon need assessment by the... on scene commander, a repersentative of Kersey Police Dept. IV. .Notification- _ A. Notification of a disaster will normally originate -from-one or:rMra.oft-- ;: r;_,_i -- the following agencies: - 1. Colorado Division of Disaster Emergency Services- - 2. Weld County,Emergency Management _ 3. Weld County Sheriff's Office 4. Colorado State Patrol 5. . Kersey Volunteer •Fire Department and Rescue Squad=z _ 6. - Kersey Police Dept. • • B. Advance notice will be given wfien possible, however,. most notification times will be fran zero to twelve hours of anticipated V. Action A. Upon notice of disaster conditions, all action agency heads or their --- - • dociCnccs t:i1 n_h2di.atcl.y mzct at the priwcit} lanand post---.1im_: K rscy Toni Hall; or at a Secondary Command Post---the Kersey Fire Department; or the Third Command Post--the Platte Valley High School Office. In the event that none of the three designated command posts may be utilized, due to the circumstances surrounding the disaster incident, an alternative command post will be selected by the On Scene Supervisor of the Kersey Emergency Services Group. B. The location of the command post will be determined by the type and size of the disaster. C. Responsibilities. and Action Agencies shall include, but may not be limited to the following: 1. The Weld County Commissioners a. Coordinating all efforts in Weld County with Federal, State, and Local agencies involves in the disaster. . 2. Weld County Communications and Emergency Management (Dispatch) a. Coordinating notification and cuuuunications within Weld County, to the State of Colorado, and Emergency Serivices Group of Kersey. b. If disaster is outside the city limits of Kersey or of a large scale, coordinating related disaster emergency function . as outlined in the Weld..County Emergency Operations Plan to . include the establishment of emergency reception and sheltering of persons evacuted from a contaminated to affected area, emergency welfare assistance, Red Cross liaison, etc. 3. Chairman of Kersey Emergency Services Group (Police Commissioner)- a. Coordinating all efforts within the city.c limits of Kersey - with any action agency involved in the disaster. . 4. Kersey-.Fire Department a. Responsible for all fire fighting; search and rescue and other duties as deemed necessary by the command post. a l 12 3 i unco_ U_pL. • • a. (darning or af'fect'ed population. 1. Initiate Disaster Signal - two (2) continuous minutes of sirens. b. Enforcing evacuation orders. c. Maintaining law and order to include security of controlled area. d. Control of traffic. • e. Search and rescue operations. f. Coordinating liaison. .: 6. .Weld County Sheriff's Office a. Warning of affected population. b. .Fhforcing. evacuation orders._ - c. : Maintaining- law- and order to include-security. of controlled.area. d. Control of. traffic.• • e. • Field Command Post. • 7. • Colorado State patrol, a. Respond and assist upon request:in areas not precluded by Statues. • 1. Traffic control 2. Canmmications 3. Hazards materials 8. -Platte-Valley School Districtu,. a. :.Providing.lodging and food .facilities" as deemed necessary:;" _ b. Other assistance as needed-(buses, etc:)_. 9. Kersey- Fire Dept:. Rescue Squad-(E E!s):=: D. General 1. All agencies are assigned specific:responsibilities as follows:- .a. :Developing and:maintaining.dinternal_plans._ - b. Maintaining current alerting.procedures and phone.nunbers required --- - to mobilize their emergency_response_personnelc c. Developing and establishing operating procedures necessary to perform their functions, 21.1123 d. Training their" emergency:respense personnel in the provisions of __.__ this rAnn anlr 1-n n,�l ._^ ...•-rn. ..-,�, _. e. Participalipo in joint training and exercise- Lo Lest the validi.Ly of this plan, and inprove the response of action personnel. E, A call-up list of the action agencies is contained herein as en- closure (1). F. - After the action agencies have assembled, the following agencies shall be.; notified, as deemed necessary by the carmand post. In that instance • an emergency exists and plans for disaster control have begun. • 1. The Colorado Division of Disaster Emergency Services. 2. Weld County Road Department 3. . Colorado•Division of Highways - . 4. `Colorado-State Health Department .:- 5. -Weld County Health Department 6. Weld County-Red Cross - , • 7. Salvation Army:.-y 8. North Colorado Medical Center_ . 9. Memorial Hospital• . . : • 10. _ Weld County_Anbulance Service 11.1 " Poudre Va11ey.Menorial Hospital (Fort Collins) . 12.L St. Tubes. Hospital .(Radioactivei Incident). ! 13. -.Memorial.Hospital_of Laramie_County:(Cheyenne)._ _ 14.: DePaul Hospital (Cheyenne) : 15. -F.E:. Warren:Air`Force Base- _ . 16. i.:Weld County-Ham Radio Association c- • 17.:-Greeley. Gas Conpany-_ • 18,• Public Service Company 19."" Mountain Bell Telephone Campany -7 20.T Weld CoimbjcyCamunications G. A call up list is contained herein as enclosure (2);_- . . 4 • • 21.:_1. 3 • • VI. Evacuation A. Public Alert 1. If the city emergency siren has not already been sounded, it will be activated upon order fran the Emergency Management Director. 2. Depending on advance knowledge of the disaster conditions, the Kersey Police , [field County Sheriff's Office, Colofado State Patrol, Kersey Fire Department ( vthichever is deemed applicable) will attempt to proceed to the specified area and alert the residents of the inpending disaster. 3. -.Ihe:.tactical command post shall appoint a public information officer to deal will all media and request they announce the disaster conditions, order or evacuation or Other special instructions. a. The Public Information Officer will keep- the media updated on the actions and conditions of the disaster, when practical. b. Media Officer will direct media persons to a specified:: area for updated information. c. . A call up list is contained herein as enclosure (3). VII. Tactical-Command-Post A. Location of cancan post herein.contained in-actien;P'hase=df omss plan. B. Responsibilities, 1. : Correlate, evaluate, and estimate the scope .of the disaster. 2. . Onthe basis of the estimate,: the :tactical:conmand..post will de • - termine the precise areas to be evacuate and 'direct the evacuees - to the .proper_shelter. • 3. An estimate of the total population in the evacuation area.will:be . % calculated by the command post based upon reports from personnel in the field (and the Weld County Planning Department.) 4. Appoint as appropriate representative to arrange.for and coordinate 2?.11.1.2`3 r all transportation in the evacuation area. l ^ 5. Appoint as appropriate representative to coordinate food and lodging needs (possibly utilize ARC.) 6. Establish the absolute deadline hour for all persons to evacute the suspected disaster area. a. If possible, after deadline of evacuation, law enforcement, and Fire Department personnel will make a house-to-house check to be sure everyone has left the area. b. Any person found in the area where a disaster is expected will be adviiS.ed to leave immediately. . If the._individual(s) refuse to leave, the officers shall offer assistance and advise -- where they can be reached should said individual decide to leave voluntarily. 7. On the:basisof all available information, determine all access.roads into and out of the area expected to be affected by the disaster. 8. With the assistance of the appropriate highway and road departments, the command post will arrange for barricades and detours. . Traffic Drill-be directed away firom the area expected to be affected by the_disaster. _ a. Upon final deadlir€ for evacuation, access to -the effected areas maybe prohibited.---- 9. Certain keyroadblocks will be manned as appropriate and where directed by the command post: • 10. -As deemed necessary the Emergency Operations-Center_for_ the-State._ of Colorado, is to be kept informed by a situation report (through Weld County OEM). Ia._ Stabilization A. Thy tactical command post will keep a close check on the emergency conditions and keep all concerned parties advised of the expected duration of `;:ccr:or7oncy. 311123 B. The Amarican Re_ Cross, the Mem Radio Opara Lois „ssosiation, and Lh_ Salvation Army will handle all emergency family notification of safe and ._• well messages for stranded persons. IX. Recovery A. The Emergency Management Director willAteclare as end of the disaster and cause the all clear siggal to be sounded after receiving reports from the field that the disaster is over. "ov. 18, 1935 r-. • ENCLOSURE I ' Call up list of the Action Agencies . 1. Kersey Volunteer Fire Department 356-1212 2. Colorado State Patrol 350-2207 3. Platte Valley School District 352-6168 . 4. Kersey Rescue Squad (EMT) • 353-3890 5. Kersey Emergency ServicesGroup (Home) (Work) 356-1212 `. Chairman of Health and Safety (Hone) • (Work) Mayor (Hone) 356-3892 (Work) 330-3080 6. Weld County Ambulance Service 352-5700 7. Weld County__Emergency_Ma-nagement- - 356-4000) ext. 4250 Ed Herring . (Home) 330-6191 8. Weld County Commissioners 356-4000, ext..4200 9. Weld County-Sheriff 356-4000, . ext. 4241 10." Kersey Town Government 353-1681 T. 11. Kersey Police Chief (Home) 353-3677 (Work) 356-1212 • • 21.1123 Nov. 18, 1985 r- • . • ENCLOSURE 2 Call up list of Assistance Agencies I. Medical Facilitied 1. DePau1 Hospital (Cheyenne) (307)632-6411 2. F.E. Warren Air Base (307)775-1110 3. Manorial Hospital (Greeley) 352-3123 . 4. Memorial Hospital of Iaremie County (Cheyenne) (307)634-3341 5. " North Colorado Medical Canter (Greeley) 352-4121 6. ,Poudre Valley Manorial Hospital (Ft. Collins) 482-4111 7. St. Luke's Hospital (Denver) 839-1000 II. Public Utilitied 1. .Greeley Gas Company 352-7171 2. Haile, Light, Poker 454-2191 3. Mom Lain Bell Telephone-(AT&T) 1-555-1621 .. !.II._ .Transportation Agencies I- t. . Colorado Division of Hizhways 353-1151 2. Union_Pacific-Railroad 352-2121 3. . Weld County Engineer 356-4000. ext.4750 _ IV. _.Volunteer Organizations.& Public Health ._ 1. American Red Cross 352-7212 2. Colorado. Dept. of Health 1-388-6111 ' 3. Salvation Army 353-1441/353-0521 4. Weld Cointy Health Dept 353-0540 5. Geld county Ham Radio Association :91.-E1.23 • Nov. 18, 1935 ENCLOSURE 3 Call up list of the News Media • I. Newspapers 1. Associated Press 1-825-0123 " 2. Greeley Tribune 352-0211 3. Platte-Valley Vdice7 351-7241 4. United Press Internationale 1-321-2234 - - II. Radio Stations 1. K03L 1-482-5991 - - 2. KBE. 1=534-5373 3. . KIKA 4. KGRE 356-1452 : 5' 1-266-2611 . . 6' KZZ 1-759-5666 - 7. KTC' 1-493-5330 8. KURD 686-2791 9. KYOU 356-1450 10. KOA 1-861:L/I444._.. III. Television Stations -- 1. KBT/ - 1-266-3601 2. Mai 1-292-3456 3. KClNC 1-861-8111' 4. WO 1-222-9525 5' KYCU (307)632-5842 311123 PRELIMINARY PUBLIC INFORMATION CHECKLIST 1. What kind of disaster control? 2. What day and time did the disaster. occur?. 3. What type of;disaster is it? • 4. - Were there injuries of fatalities?-... f. _•Tyr s of injuries? 6. Who is in charge? • 7. Wi-at area is affect? 8. • Evacuation•necessary? 9. Over Th-lich routes? • 10. • Were-will- evacuees -.be .taken? 11. How long cz11- evac,ation.orders.te in effect?.._ 12. Participating agencies?- :. . • :ZIT g • z v�H H U - � 2 H _ -. H Q • W Z H O Q H U Z �H N - H H . a' �y Q H- o o (U1 IYY. Eft!, N 4H 4 0 p 8 � H � a DISTRIBUTION LIST AGENCY TELEPHONE NUMBERS Town of Kersey 353-1681 Kersey Chairman 853-1681 Kersey Fire Department 356-1212 Platte Valley School District 352-6168 Platte Valley Elementary School 352-6168-- Weld County Sheriff's Office 356-4000 . 356-1212 Weld County Emergency Management 356-4000 . 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(DUMP W/ SNOW BLADE) 24 9. (DUMP TRUCK, TANDEM) 13 10. (DUMP TRUCK, OTHER) 33 P. CATERPILLARS 2 Q. BACKHOES 29 R. FRONT LOADERS 1. (LIGHT DUTY) 22 2. (HEAVY DUTY) 10 S. GRADERS 1. (LIGHT DUTY) 13 2. (HEAVY DUTY) 47 T. TRAILERS 1. (45' FLAT BED) 1 3. (27' FLAT BED) 1 • 4. (20' FLAT BED) 5 31.1123 RE: EQUIPMENT RESOURCE LIST 1990 EDITION 10. (CONVERTER DOLLY JIFF) 1 - 11. (OTHER) 11 U. AIRCRAFT 4 V. HELICOPTER 1 W. BUS 25 R. SNOWMOBILE 10 Y. COMMUNICATION VAN 8 MISCELLANEOUS EQUIPMENT AA. BOAT 14 BB. WATER TRUCK 34 CC. AQUEOUS FILM FOAM 2105 DD. OIL ABSORBANT BOOMS 71 EE. OIL ABSORBANT PADS 332 FF. PROTECTIVE SUITS 180 GG. SPARK PROOF TOOLS 7 HH. PLUGS 5 II. RECOVERY DRUMS 50 JJ. HAZ MAT REF BOOKS 302 KK. OTHER 291 31.t129 1-2 /1/ Appendix Ten Fire Department Incident C^—and Protocol 211123 INTRODUCTION • The majority of Emergency Medical incidents involving between one and five victims are normally handled by initial responding units with subsequent requests for additional assistance depending upon the number of victims involved and the severity of their injuries. Large multi-casualty incidents will overwhelm the initial responding resources. The Incident Commander must have delineated and expandable operational procedures to assure that proper emergency pre-hospital care and the prevention of further injury to victims, the public, and public safety personnel will be provided. These pre-determined emergency medical operational procedures must provide for the effective treatment/transportation of multi-casualties through the principles of "Triage" management. The medical organization structure is designed to utilize all aspects of Emergency Medical Service response resources, including on-scene Physician medical direction. These procedures are tiered into three categories: • 1 . Expanded Medical Emergency 2. Major Medical Emergency 3. Medical Disaster 21.11.2 3 EXPANDED MEDICAL EMERGENCY An Expanded Medical Emergency involves between 5 to 15 casualties, at least five (5) would be considered to be in critical condition. The incident may be handled by the Incident Commander and/or the Medical Division/Treatment Supervisor through direct requests for additional emergency medical and hospital personnel and equipment, depending upon the number of victims, severity of injuries and magnitude of the incident. To determine the amount of additional emergency medical personnel required, the following is recommended: 1 . One Paramedic and one EMT for each critical patient. 2. One EMT for every 3 non-critical patients. 3. One Paramedic as Medical Communications, Transportation leader. A. One Paramedic as Triage Control officer. The Incident Commander shall also assure that: 1 . Sufficient ambulances and/or appropriate transport vehicles have been requested. 2. Sufficient fire suppression support personnel have been requested. 3. Medical Channel 9 is used for communication. The following minimum line positions are recommended: 1 . A Triage Control Officer. 2. A Medical/Transportation Control Officer. MAJOR MEDICAL EMERGENCY A Major Medical Emergency involves between 16 and 50 casualties. the Incident Commander would establish a Medical Division, at a level of support/line personnel as determined by the number of victims and the magnitude of the incident. The need for hospital support teams (Physicians, Nurses) should be anticipated depending upon the severity of patient injuries. To determine that amount of additional emergency medical personnel required, the following is recommended: 1 . A complete Medical Division appropriately staffed pursuant to the number of casualties. 2. One Paramedic per three critical victims. (Note: Patient ratio increased from Expanded Medical Emergency) . 3. One EMT per seven minor injuries. (Note: patient ratio increased from Expanded Medical Emergency) . MEDICAL DISASTER A Medical Disaster involves 51 or more casualties, and the magnitude of the incident can be handled by the resources available. The Incident Commander may establish one or more Medical Divisions at a level of support/line personnel as determined by the number of victims and the magnitude of the incident. Medical Strike Teams, Task Forces, Groups, or Branches may be established . Gutside agency involvement for Paramedic and EMT personnel for use at the scene or to provide Paramedic coverage should be considered . To determine the amount of additional emergency personnel required, the following is recommended: 1 . A minimum of one complete Medical Division. 2. One Paramedic per three critical patients. 3. One EMT per seven minor injuries. 1911.123 • MEDICAL DIVISION The Medical Division (or Group) Organizational structure is designed to provide the Incident Commander with a basic expandable system for handling any number of patients in a multi-casualty incident. A second Medical Division may be established if geographical or incident conditions warrant. A minimum structure is required whenever five or more critical patients are being cared for (see Expanded Medical ) . When the number of victims reaches 16 or more, one or more Medical Divisions are required , however, the degree of implementation will depend upon the number of victims. The chart on the following page depicts the recommended minimum staffing for establishing a complete Medical Division . ..9.1.11.23 MEDICAL DIVISION AND TREATMENT CONTROL OFFICER DEFINITION: Chief/Qualified Officer/Paramedic. COMMANDED B'i ; Incident Commander, Operations Chief or Branch Director. UkurnDINATES: Triage Control Officer; Transportation, Communications and taping Officer; Medical Strike Team; Medical Supply Officer, Morgue Officer. FUNCTION: Establish, command and control the activities within a Medical Division in order to assure the best possible emergency medical care to patients during a multi-casualty incident. AssUme the responsibilities for controlling proper triage management, treatment, and coordination of all casualties in the Treatment units. DUTIES: 1 . Establish and supervise a Medical Division at a level of personnel and other resources sufficient to handle the magnitude of the incident. 2. Implement and assign leaders to Immediate, Delayed and Minor Treatment units. Isolating Minor treatment and the Morgue area=_ . 3. Establish a Medical Strike Team. 4. Determine the amount and types of additional medical resources and supplies, i .e. , Medical Strike Teams, Medical Caches, Ambulances, Helicopters, and other methods of patient transportation. 5. Establish liaisons with on-scene agencies, e.g. , Coroner 's Office, Red Cross, Law Enforcement, Ambulance Companies, Fire Departments, Department of Health Services. 6. Ensure Law Enforcement/Coroner involvement as necessary, 7. Ensure that proper security, traffic control and access has been established for the Medical Division area. 8. Request sufficient Treatment Teams and qualified Emergency Medical personnel as required to staff the Treatment Units. 9. Coordinate casualty requirements with Triage Control and the Transportation Control Officer. 10. Request Medical Caches and supplies as necessary. 11 . Ensure Medical Standing Orders have been obtained. 12. Maintain control and proper triage assessment of patients throughout the Treatment Units. 13. Ensure proper coordination and patient assessment has been established between Immediate and Delayed Treat- ment Units. a1.'A 1 TRIAGE OFFICER DEFINITION: Qualified Officer/Paramedic COMMANDED BY: Incident Commander, Operations Chief, or Medical Division Supervisor. SUBORDINATES: 1 . Triage Team(s) . 2. Hospital Response Team(s) personnel , when applicable. FUNCTION: Assume responsibilities for providing triage management, and coordination of all casualties. May assume the duties of the Treatment Control Officer. DUTIES: 1 . Implement and supervise Triage Teams as necessary. 2. Coordinate the designation of the Triage area. 3. Acquire/coordinate medical supplies from the Medical Supply Officer for Triage areas. Example: backboards, stretchers, triage tags, etc. 4. Coordinate and assure proper victim designation with the Medical Division Officer. 5. Continually review triage procedures. 6. Ensure that Medical Standing Orders for Paramedics have been established. 7. Assume the responsibility for the safety of personnel functioning on the incident. .9 _1:123 • TRIAGE TEAM(S) DEFINITION: Paramedics and medically qualified personnel . Two Paramedics or a minimum of one Paramedic and one EMT. COMMANDED BY: Triage Control Officer FUNCTION: To triage patients on-scene and assign to the appropriate Treatment units. DUTIES: 1 . Report to designated on-scene triage location. 2. Triage and tag the injured as to patient classification, noting injuries and vital signs if taken . 3. Direct personnel teams with patients to the proper Treatment Units. 4. Provide appropriate medical treatment to victims prior to movement to Treatment Units as incident conditions permit. 5. Provide appropriate medical patient treatment as directed by on-scene Physicians. 2.41123 • MEDICAL COMMUNICATIONS, TRANSPORTATION AND STAGING OFFICER DEFINITION: Qualified Personnel COMMANDED BY: Medical Division Supervisor FUNCTION: Coordination of patient transportation and maintaining records relating to patients, injuries, mode of transportation and destination. DUTIES: 1 . Acquire hospital availability. 2. Receive basic patient information and injury status from the Treatment Control Officer. 3. Assure patient information and destination is recorded. 4. Coordinate transportation of patients as determined by the Treatment Control Officer or the Immediate Treatment Unit leader. 5. Request additional ambulances as required . 6. Designate/coordinate Air Operations with the Medical Division Supervisor. 7. Record the Ambulance Agency and identification number of those transporting patients. , Also note destination . IMMEDIATE TREATMENT UNIT LEADER DEFINITION: Qualified Paramedic COMMANDED BY: Treatment Control Officer SUBORDINATES: 1 . Treatment Teams 2. Paramedics 3. EMT 's FUNCTION: Responsible for Treatment/Triage of victims assigned to the Immediate Treatment Unit. DUTIES: 1. Establish Treatment Teams as necessary. 2. Receiving of victims triaged to the Immediate Treatment Unit. 3. Treatment of victims triaged to Unit. 4. Assure that Standing Orders for Advanced Life Support Procedures have been requested. 5. Assure that patients are prioritized for transportation. b. Coordinate transportation of victims through the Medical Communications and Transportation Officer. 7. Assure that appropriate medical and patient information is recorded. • DELAYED TREATMENT UNIT LEADER DEFINITION: Qualified Paramedic COMMANDED BY: Treatment Control Officer SUBORDINATES: 1. Treatment Teams 2. Paramedics 3. EMT 's FUNCTION: Responsible for treatment/triage of the injured assigned to the Delayed Treatment Unit. DUTIES: 1 . Establish Treatment Teams as required. 2. Receiving of victims triaged to the Delayed Unit. 3. Treatment of victims triaged to the Delayed Unit. 4. Assure proper prioritizing/reevaluation of patients for transportation or reassessment to the Immediate Treatment Unit. 5. Coordinate victims for transportation with the Immediate Treatment Unit Leader and the Treatment Control Officer. 6. Assure that appropriate medical and patient information is recorded. 7. Coordinate Paramedic operation as directed by Physicians and Nurses assigned to the Treatment units. 2111.23 MINOR TREATMENT UNIT LEADER DEFINITION: EMT COMMANDED BY: Treatment Control Officer SUBORDINATES: Treatment Teams EMT personnel Red Cross personnel Volunteers FUNCTION: Responsible for treatment/triage of victims triaged to the Minor Treatment Unit. DUTIES: 1 . Establish Treatment Teams as necessary. 2. Receiving of victims triaged to the Minor Treatment Unit. 3. Treatment of victims triaged to the Minor Treatment Unit. 4. Prioritizing of victims for transportation . 5. Coordinate victims with the Delayed Treatment Unit Leader. 6. Record victims information and treatment prior to the victims being released or transported. 7. Assure that proper patient releases are signed. B. Coordinate Red Cross and volunteer personnel through agency liaisons (as appropriate) . TREATMENT TEAM(S) DEFINITION: Paramedic, EMT and volunteer personnel. COMMANDED BY: Treatment Control Officer and the Treatment Unit Leader(s) . DUTIES: I . Assigned to Immediate, Delayed or Minor Treatment Units ` to perform the treatment and triage of victims. <. Record victims information and treatment as necessary. 3. Report changes in victim status to the appropriate Treatment Unit Leader. z1.11.23 MEDICAL SUPPLY OFFICER DEFINITION: Personnel as assigned. COMMANDED BY: Medical Division Supervisor SUBORDINATES: Aides as required. FUNCTION: Acquire and stage appropriate medical equipment and supplies from units assigned to the scene. • DUTIES: 1 . Acquires, distributes and maintains status of medical equipment and supplies within the Medical Division. 2. Request additional medical equipment and supplies as needed through the Medical Division Supervisor. 311123 MEDICAL STRIKE TEAM DEFINITION: Firefighters, EMT 's COMMANDED BY: Triage Officer FUNCTION: To respond to medical emergencies as assigned. MEDICAL STRIKE TEAM APPENDIX A MEDICAL STRIKE TEAM COMPOSITION: Strike Team Leader - Chief/Command Officer Three (3) MICU - Two Paramedics each Two (2) EMT Engines - Staffed with a minimum of 3 EMT's MINIMUM STAFFING (13) : Chief/Command Officer 6 Paramedics 2 Officers (EMT) 4 Firefighters (EMT) PREFERRED STAFFING: 1 Chief/Command Officer and Aide (EMT) 6 Paramedics 2 Officers (EMT) ', Firefighter_ (ENT ) Hello