HomeMy WebLinkAbout2016-697 Emergency Svc - First Choice Medical Transport - Application for Service Franchise lo%T$T CHO jch,
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800-380-7909
"Our#1 Priority is Patient Care"
Orange County Emergency Services
APPLICATION FOR SERVICE FRANCHISE
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Franchise Application Category
(A separate pplication must be completed for each general category of service.)
Convalescent Transport Services Rescue Services
❑ ALS Transport ❑ Confined Space
❑ BLS Transport ❑ Extrication (For OCES use only)
Emergency Services ❑ Heavy Rescue
❑ BLS Supplemental Transport ❑ High/Low Angle Date Received:
❑ BLS System Surge Tansport 0 Swift Water
❑ BLS Special Event Transport ❑ Trench Collapse
❑ Medical Responder Non-transport ❑ Underwater
❑ EMT Non-transport ❑ Wilderness Search & Rescue
Name of Applying Organization: First Choice Medical Transport, LLC
Primary Local Business Address: 123 SUMMER LAKE DR.
Local Address City/State/Zip: CARY, NC 27513
Telephone number at local base of operations: 1-800-380-7909
Name of Owner/Contact erson: CAROL VARSANO
Contact Email Address:
Main Office/Owner/Conta1 t Person Address: 123 SUMMER LAKES DR.
Main Office City/State/Zip: CARY, NC 27513
Telephone number at maih office: 1-800-380-7909
Operating Business/Trade Name: FIRST CHOICE MEDICAL TRANSPORT, LLC
1
Application Attachments Required
(See Orange County Franchise Ordinance for Additional Details)
*Place a check mark in the check-box to indicate that the attachment has been included in the application.
1. ❑ N/A Certified copy of an assumed name certificate if applicant does business under a trade
name AND trade name does not appear on the Articles of Incorporation or Charter.
2. ❑ Certiiied copy of Articles of Incorporation and/or Charter.
3. gl Applicant's resume' of training and experience for the applicable service.
4. Li A full description of the type and level of service to be provided including the location
of the place or places from which it is intended to operate, the manner in which the public will be able to
obtain assistance and how the vehicle will be dispatched.
5. E Financial statement pertaining to (proposed) operations in Orange County.
6. ❑ A I st of radio frequencies the applicant is authorized to operate on, and a copy of the
FCC license(s) in the na lie of the person providing the service.
7. ❑ A cescription of the applicant's capability to provide twenty-four hour coverage, seven
days per week for the di trict covered by the franchise applied for.
8. ❑ An accurate estimate of the minimum and maximum times for a response to calls
within the district covere by the franchise applied.
9. ❑ A vyritten plan detailing how the applicant will furnish credentialed personnel and a
current roster of all credentialed personnel with a list of their credentials.
10.❑ A copy of the applicant's written standard operating procedures including but not
limited to the manageme t of equipment, supplies, and medications.
11.0 N/A Co y of organization by-laws (if applicable).
12. ❑ Ro ter of all members and employees, including name, address, and NCDL number.
13. ❑ Lis all vehicles owned and operated by applicant.
14. ❑ Proposed fee schedule for service in Orange County.
CERTIFICATIONS
*Provide initials in each Certification blank to indicate agreement to each statement
I certify on behalf of the nIrmed franchise applicant the following:
( ,1 1. That the information contained within and any attachments provided is true and correct and
//�� / to the best of my knowledge;
C12.2. That the fr nchise applicant is compliance with North Carolina General Statutes 131E, Article
7;
LA; 3. That the applicant shall provide notices to Orange County Emergency Services of any
changes to the information provided in this Application within five (5) days of any changes
and/or any relinquishment of the franchise;
..0 / 4. That I am the duly authorized agent of the Board and have been authorized to submit this
application and certification to the Orange County; and
5. That any in ormation found to be false or
misleading may be grounds for termination of the
franchise and the franchise agreement.
1''
Authorizing Name/Title: Cl \f,)q ScZI� Q ��.����,( � a�� �L c e )- _ CU Ot,Uf iar
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Authorizing Signature:
Date: e/r)
-';' s Ta l etude Owned a d,0•+gate• • A. I
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Vehicle# Year n Make Model VIN #
Lic. # Mileage
1 2007 I FORD E-350 1FDSS34P07DA47245 DR-8659 273000
2 2008 ( FORD AM 1 FDSS34P08DB38360 CMX-7875 201000
3 2005 FORD E-350 1 FDSS34P75HA60731 BKW-6682 239000
4 2006 FORD E-350 1 FDSS34P66DA83460 CLM-2806 174000;
5 2007 FORD E-350 1FDSS34P27DA59304 DAX-1653 196000;
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VIN Model Year Unit Name Permit Expiration Permit Type Level Status
1FDSS34P89DA80368 2009 3 NC 000483 2/28/2018 Permanent EMT In Service
1FD5534P27DA59304 2008 5 NC 05487 12/31/2016 Permanent EMT In Service
1FDSS34P08DB3860 2008 2 NCO01702 10/31/2018 Permanent EMT In Service
1FDSS3EP8ADA23266 2010 6 NC 07755 9/30/2017 Permanent EMT In Service
1FDSS34P59DA26364 2009 8 NC 001586 7/31/2018 Permanent EMT In Service
1FDSS34P39DA80360 2009 7 NC 000573 5/31/2018 Permanent EMT In Service
1FDSS3EP4ADA12703 2010 9 NC 001860 10/31/2018 Permanent EMT In Service
1FDSS34P07DA47345 2007 1 NC 000512 3/31/2018 Permanent EMT In Service
1F3SS34P66DA83460 2010 4 NC 001774 8/31/2018 Permanent EMT In Service
APPLICATION ATTACHMENT 2
7 , NORTH CAROLINA
y! : � � ��� , Department of The Secretary of State
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To all whom these presents shall come, Greetings:
I, ELAINE F. MARSHALL, Secretary of State of the State of North Carolina, do
hereby certify the following and hereto attached to be a true copy of
ARTICLES OF AMENDMENT
OF
ADVANCED MEDICAL TRANSPORT LLC
WINCH CHANGED ITS NAME TO
FIRST CHOICE MEDICAL TRANSPORT LLC
the original of which was filed in this office on the 12th day of April, 2011.
), . "" "� , IN WITNESS WHEREOF,I have hereunto
a �' ° �`� set my hand and affixed my official seal at the
t ' ._ , a
s Y - = 't City of Raleigh,this 12th day of April, 2011...4- fa,caola-ee
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Secretary of State
Document Id: C201108300260
oena%� E-Filed Annual Report
LIMITED LIABILITY COMPANY 9704049
i Do not data enter manually
Q�; ANNUAL REPORT
TAME OF LIMITED LIABILITY COMPANY: First Choice Medical Transport LLC
REPORT FOR THE YEAR:2015 STATE OF INCORPORATION: NC
SECRETARY OF STATE L.L.C.ID NUMBER: 1192552
NATURE OF BUSINESS: Basic Life Support Medical Transportation
REGISTERED AGENT: Varsano. Carol
REGISTERED OFFICE MAILING ADDRESS: 123 Summer Lakes Drive
Cart/NC 27513-3419
REGISTERED OFFICE STREET ADDRESS: 123 Summer Lakes Drive
Cary NC 27513-3419 Wake County
PRINCIPAL OFFICE TELEPHONE NUMBER: (800)380-7909
PRINCIPAL OFFICE MAILING ADDRESS: 123 Summer Lakes Drive
Cary NC 27513-3419
PRINCIPAL OFFICE STREET ADDRESS: 123 Summer Lakes Drive
Cary NC 27513-3419
Company Officials:
Name: Carol Varsano Name:Ronald Varsano
Title:Member Title:Member
Address: Address:
123 Summer Lakes Drive 123 Summer Lakes Drive
Cary,NC 27513 Cary,NC 2751:
CERTIFICATION OF ANNUAL REPORT MUST BE COMPLETED BY ALL LIMITED LIABILITY COMPANIES
Carol Varsano 4/6/2015
FORM MUST BE SIGNED BY A MANAGER/MEMBER DATE
Carol Varsano Member
TYPE OR PRINT NAME TYPE OR PRINT TITLE
ANNUAL REPORT FEE:E-Paid MAIL TO: Secretary of State•Corporations Division•Post Office Box 29525•Raleigh,NC 27626-0525
. 3ST CHO fC4,
First Choice Medical Transport
123 Summer Lakes Drive
DiCAL TI S% Cary, NC 27513
800-380-7909
Application attachment#3
First Choice Medical Transport LLC is a BLS ambulance transport company based and licensed in Wake
County North Carolina. We have been in business since 2011 and have completed over 6000 BLS
transports. These transports consist of hospital discharges from Rex Hospital, Wakemed Raleigh,
Wakemed Cary and Duke Raleigh Hospitals where we are on their list of approved providers. Our
services include transporting dialysis patients on a regular basis and we also offer BLS transports for
doctor appointments.
Our EMT team is made up of numerous Raleigh Firefighters, Pre-Med/PA/RN students accumulating
clinical hours for their college admission as well as full time dedicated EMTs.
First Choice Medical Transport includes medical professionals as well as a management team with over
50 year's business experience not only in healthcare but also in technology,finance, and banking as well
as other industries.
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800-380-7909
"Our#1 Priority is Patient Care"
Application Attachment #4
First Choice Medical Transport is a non-emergency BLS (Basic Life Support)
ambulance medical transport company and therefore all of our EMT's no matter
what their degree of credentialing may only function as an EMT-B and within their
scope of practice which has been carefully reviewed by our medical director and
management team.
We have an 800# available 24hrs a day and website for public assistance. Also, we
have an FCC license for our radio which is included as part of our application, all
drivers will have cell phones with push to talk capabilities as well, and dispatch
will be handled from our Business Office by our management team.
Vehicles and EMT staff are located at our Apex location where we maintain
parking area, maintenance for our vehicles and a separate office for our EMT's
and supplies.
BUSINESS OFFICE LOCATION
123 Summer Lakes Drive
Cary, NC 27513
AMBULANCE PARKING AND EMT STAFF OFFICE:
1800 North Salem St
Apex, NC 27523
First Choice Medical Transport, LLC
0312315 Balance Sheet
Accrual As of December 31,2014 APPLICATION ATTACHMENT 5
Dec 31,14 Dec 31,13 $Change
ASSETS
Current Assets
Checking/Savings
Vantage South 22,019.20 35,360.93 -13,341.73
Total Checking/Savings 22,019.20 35,360.93 -13,341.73
Accounts Receivable
Accounts Receivable 43,523.32 3,661.63 39,861.69
Total Accounts Receivable 43,523.32 3,661.63 39,861.69
Other Current Assets
Due From Medicare 54,000.00 60,000.00 -6,000.00
Due From Other Insurance 36,000.00 20,000.00 16,000.00
Total Other Current Assets 90,000.00 80,000.00 10,000.00
Total Current Assets 155,542.52 119,022.56 36,519.96
Fixed Assets
Accumulated Depreciation -15,145.25 -15,219.56 74.31
Ambulances 64,250.00 39,900.00 24,350.00
Computer Equipment 3,899.31 3,090.16 809.15
Total Fixed Assets 53,004.06 27,770.60 25,233.46
TOTAL ASSETS 208,546.58 146,793.16 61,753.42
LIABILITIES&EQUITY
Liabilities
Current Liabilities
Other Current Liabilities
Accrued Wages and Taxes 7,049.95 3,413.39 3,636.56
Capital -Credit Card Payable 2,335.24 1,091.70 1,243.54
Capital 1 SPARK CARD-Credit C 4,147.87 0.00 4,147.87
Carol Advances to First Choice 0.00 8,543.04 -8,543.04
Total Other Current Liabilities 13,533.06 13,048.13 484.93
Total Current Liabilities 13,533.06 13,048.13 484.93
Total Liabilities 13,533.06 13,048.13 484.93
Equity
Equity-Carol 68,209.97 20,041.86 48,168.11
Equity-Ron 65,535.06 19,255.90 46,279.16
Net Income 61,268.49 94,447.27 -33,178.78
fott"l Equity 195,013.52 133,745.03 61,268.49
t er!�•l IABILITIES&EQUITY 208,546.58 146,793.16 61,753.42
Page 1
12:03 PM First Choice Medical Transport, LLC
03123115 Profit & Loss
Accrual Basis January through December 2014
Jan-Dec 14 Jan-Dec 13 $Change
Ordinary Income/Expense
Income
Income-Due Patient 87,126.98 6,135.35 80,991.63
MedicarelMedicaid Claim Income 386,678.03 422,174.16 -35,496.13
Non Medicare/Medicaid Income
Bad Debt Patient/Secondary Ins -34,428.44 -14,159.54 -20,268.90
Non Medicare/Medicaid Income-Other 347,938.32 167,380.20 180,558.12
Total Non Medicare/Medicaid Income 313,509.88 153,220.66 160,289.22
Refunds -4,961.81 -2,904.26 -2,057.55
Uncategorized Income 200.94 0.00 200.94
Total Income 782,554.02 578,625.91 203,928.11
Expense
Advertising and Promotion 969.14 2,209.39 -1,240.25
Ambulance Expense 87,823.55 46,910.00 40,913.55
Bank Service Charges 25.49 24.14 1.35
Continuing Education 558.95 0.00 558.95
Depreciation Expense 11,272.36 7,842.54 3,429.82
Dues and Subscriptions 200.00 200.00 0.00
Fees/Licenses 589.18 427.00 162.18
Health Insurance-Carol 5,585.31 4,356.95 1,228.36
Health Insurance-Ron 5,366.28 4,186.09 1,180.19
Insurance Claim Processing Fees 0.00 1,125.00 -1,125.00
Insurance Expense
Worker's Compensation 13,483.00 2,162.00 11,321.00
Insurance Expense-Other 21,485.25 16,929.75 4,555.50
Total Insurance Expense 34,968.25 19,091.75 15,876.50
Meals and Entertainment 2,943.52 1,561.64 1,381.88
Medical Records and Supplies
Medical Supplies 9,013.32 6,136.25 2,877.07
Total Medical Records and Supplies 9,013.32 6,136.25 2,877.07
Meeting Expense 3,395.45 0.00 3,395.45
Office Supplies 5,707.36 2,232.54 3,474.82
Outside Services _ 12,800.00 9,625.00 3,175.00
Payroll Expenses 185,446.98 97,586.85 87,860.13
Payroll Service Fees 1,429.18 1,245.27 183.91
Payroll Tax Expense 18,635.95 9,116.99 9,518.96
Postage and Delivery 0.00 111.36 -111.36
Professional Fees 2,326.54 4,620.00 -2,293.46
Rent Expense 4,250.00 1,530.00 2,720.00
Repairs and Maintenance 0.00 379.00 -379.00
Tax-Vehicle 0.00 1,958.71 -1,958.71
Telephone Expense 8,033.52 4,971.67 3,061.85
Travel Expense 10,627.20 8,378.04 2,249.16
Pagel
12:03 PM First Choice Medical Transport, LLC
03/23/15 Profit & Loss
Accrual Basis January through December 2014
Jan-Dec 14 Jan-Dec 13 $Change
Uniforms 86.50 130.69 -44.19
Total Expense 412,054.03 235,956.87 176,097.16
Net Ordinary Income 370,499.99 342,669.04 27,830.95
Other Income/Expense
Other Income
Gain(Loss)Sale of Equipment -53.33 0.00 -53.33
interest Income 21.83 28.23 -6.40
Total Other Income -31.50 28.23 -59.73
Other Expense
Guaranteed Payments-Carol 143,320.00 126,607.50 16,712.50
Guaranteed Payments-Ron 138,680.00 121,642.50 17,037.50
Guaranteed Payments-Marcus 27,200.00 0.00 27,200.00
Total Other Expense 309,200.00 248,250.00 60,950.00
Net Other Income -309,231.50 -248,221.77 -61,009.73
Net Income 61,268.49 94,447.27 -33,178.78
Page 2
APPLICATION ATTACHMENT 6
TEL(919)856-5215
FAX(9191856-6880
WAKE..R information Services
COUNTY "_radio System Management P.O.BOX 550'Raleigh,NC 27601
,roh l 19{:Akoi INA
To Whom It May Concern:
Under provision of Federal Communications Commission Rules 47 CFR Part 90.421,Wake County, as
Licensee, hereby grants authorization to First Choice Medical Transport, LLC to operate a mobile
unit(s)on these radio system(s)and to install radio equipment and frequencies to communicate within
these systems(s)as required in connection with the activities for which we are licensed. All radio
operation shall be in compliance with the activities for which we are licensed. All radio operation shall be
in compliance with the Federal Communications Commission Rules and Regulations. All communication
shall be only for official activities of the licensee and the State, The granting agency is responsible for all
operation and control.This authorization may be withdrawn at any time by furnishing written notification to
First Choice Medical Transport, LLC. This authorization is valid for the term of the radio license and all
renewals. This radio license has sufficient capacity for the number of mobile units authorized. This
authorization is signed in accordance with FCC Part 90.125.
NAME OF AUTHORIZING AGENCY:Wake, County of
Mailing Address: PO Box 550
City: Raleigh State: NC Zip: 27602
FCC CALLSIGN: KUZ732 Expiration Date: 12/27/2020
RADIO SERVICE: PW—Public Safety Pool,Conventional
NUMBER OF MOBILE UNITS AUTHORIZED TO Wake, County of by this authorization(s): 25
MOBILE TRANSMIT FREQUENCY: 155.280 MHz
155.340 MHz
RECEIVE FREQUENCY: 155.280 MHz
155.340 MHz
SQUELCH tone: Mobile Transmit: 192.8 Hz Mobile Receive Tone: 192.8 Hz
Sincerely,
Frank Hal
Wake County Radio System Manage-
01/13/2012 11:15 9198329757 COMMUNICATION SPECIA PAGE 02
cZ- . Specialists
Raleigh • VMlmington . Jacksonville
January 12,2(112
Thomas Borck
First Choice Medical Transport,LLC
123 Summer Lakes Drive
Cary,NC 27513
Re:UHF Repeater Service
Mr.Borck;
This letter is confirmation of First Choice Medical Transport's enrollment in our UHF
two way radio repeater service. Our tower is located on Chapel i-1i11 road in Raleigh and
should give your firm the Triangle area coverage that is desires.
The UHF frequency/channel pair you will be operating on is TX-'469.125 RX
464,125. We will assign a CTCSS tone for your company at the time of radio
programming,
Let me know if you have any questions. Thank you for choosing Communication
Specialists for your wireless communication needs,
Sincerely,
Tyler Glover
Communication Specialists
3533-B Neil Street Raleigh, NC 27607 ' (919)632-9121 • Fax(919) 832-9757
{ gT C.Ho j„,
1 First Choice Medical Transport
21 123 Summer Lakes Drive
'°ICALTRANSVAC Cary, NC 27513
800-380-7909
Application attachment# 7
First Choice Medical Transport offers BLS ambulance transportation from 7 AM to 7 PM seven days a
week. The companies 800#is manned 24 hours a day seven days week.
,ASST CHOjjt
EJjJCAI,TRANS"PCt
800-380-7909
"four#z Priority is Patient Cara„
Application Attachment #8
First Choice Medical Transport provides BLS non-emergent ambulance
transportation to hospital discharges including the emergency department,
dialysis centers, nursing/rehabilitation facilities and cancer treatment centers.
For requests for service not scheduled in advance, either immediate or as soon as
possible, the average response time of the ambulance at the curb side of the
building for which the request was made is 8 minutes minimum and 28 minutes
maximum.
00f €110/ce
ICAI,TRANSS'
800-380-7909
"Our#1 Priority is Patient care"
Application Attachment #9
First Choice Medical Transport will furnish credentialed personnel through our
multi-phase pre-screening application process. This includes verifying their EMT
and CPR credentials through Credentialing Information System website as well as
several step interview process including meeting with our management team
followed up by an additional face to face interview with our Medical Director.
Once the credentials of each candidate have been verified, a thorough
background check is conducted by a third party company. All background checks
verify criminal records, North Carolina and statewide, employment verification,
professional references, motor vehicle report and Federal fraud history.
Application Attachment 9:
First Choice Medical Transport Employee Roster
State Id First Name Last Name Job Titles) Certifications gn Date
P093726 Nicholas Banister EMS Technician EMT-Basic 4/30/2017
P104783 Justin Beaudin EMS Technician EMT-Basic 1/31/2019
P100583 Timothy Caldwell EMS Technician EMT-Basic 5/31/2018
P100579 Caleb Creech EMS Technician EMT-Basic 5/31/2018
P100587 Aaron Dickson EMS Technician EMT-Basic 5/31/2018
P095647 Thomas George EMS Technician EMT-Basic 8/31/2017
P098694 Tyler Harris EMS Technician EMT-Basic 3/31/2018
P088270 Mark Mancini EMS Technician EMT-Basic 6/30/2016
P102042 Eric Murbach EMS Technician EMT-Basic 8/31/2018
P095386 Addison Newman EMS Technician EMT-Intermediate 3/31/2019
P099994 Duran Pardue EMS Technician EMT-Basic 4/30/2018
P063368 Aaron Parker EMS Technician EMT-Basic 11/30/2016
P093739 Zachariah Reynolds EMS Technician EMT-Basic 4/30/2017
P093738 Samuel Scott EMS Technician EMT-Basic 4/30/2017
P102992 Matthew Tolley EMS Technician EMT-Basic 2/28/2019
P083481 Carol Varsano Member,Agency Primary Contact, EMS Technician EMT-Basic 2/28/2019
P102231 Marcus Varsano Member, EMS Technician EMT-Basic 9/30/2018
P085620 Ronald Varsano Member, Dispatch Center Contact, EMS Technician EMT-Basic 3/31/2016
P075341 Chris Yoo EMS Technician EMT-Paramedic 11/30/2018
Application Attachment # 10
FIRST CHOICE MEDICAL TRANSPORT
EMT-B JOB DESCRIPTION/PRIVILEGES
SOP & Employee Handbook
FCMT SOP & EMPLOYEE HANDBOOK
FIRST CHOICE Medical Transport Standard Operating Procedures& Employee Handbook
INTRODUCTION
First Choice Medical Transport, LLC is managed and operated as a non-emergency BLS (Basic Life
Support)transport company in North Carolina.This document contains the standard operating
procedures set forth by FIRST CHOICE Medical Transport for all personnel. These standards are in
relationship to the responsibilities for which those employees have been delegated or assigned. FIRST
CHOICE Medical Transport provides these standards in conjunction with standards and protocols already
set forth by other governing agencies. These standards are set forth in conjunction with existing
company policies, procedures, protocols and guidelines for our Emergency Medical Technicians(EMT's)
and Paramedics. FIRST CHOICE Medical Transport believes that standards set forth in hiring and training
play a major role in the patient care realm;these standards are incorporated as well. These standards
are subject to change by FIRST CHOICE Medical Transport and can be changed without notice based on
changes in the North Carolina Emergency Medical Services(EMS) office and the Medical Director
recommendations. It shall be up to the individual possessing this standard to maintain and verify that
this is accurate and up to date. You are encouraged to familiarize yourself with the contents of this
manual, and to seek necessary clarification from your supervisor or management if needed.
This manual is not an employment contract and is not intended to create contractual obligations of any
kind. FIRST CHOICE Medical Transport may terminate with or without cause at any time by either party.
Additionally, other terms and conditions of employment such as compensation, benefits,title, duties,
and corrective action may be modified at the discretion of FIRST CHOICE Medical Transport.
Company Structure
The Field personnel (EMTs and Paramedics) are what make FIRST CHOICE Medical Transport run and
function.Without your dedicated work and support, First Choice Medical Transport would not be where
it is today. First Choice Medical Transport has many people in the background to help the field personnel
work and provide great patient care.
To help you direct any questions or concerns, please use this list:
Carol Varsano—General Manager
carol@ firstchoicemedicaltransport.com (919)454-4653
Ronald Varsano—Director of Operations
Ron@ firstchoicemedicaltransport.com (919)454-4652
Marcus Varsano—Director of Business Operations(919)434-1227
Dr.Vincent Nacouzi-Medical Director(919)414-9214
Health Insurance Portability and Accountability Act(HIPAA)
In response to growing concerns about keeping health information private, Congress passed the Health
Insurance Portability and Accountability Act of 1996 (HIPAA).This act includes a privacy act that creates
Page 1of15
FCMT SOP & EMPLOYEE HANDBOOK
national standards to protect individuals' personal health information. We are required to implement
these standards. Our role as a health care provider is to protect the privacy of patients' health
information. FIRST CHOICE Medical Transport is a HIPAA-compliant company and any further questions
should be directed to your supervisor.A HIPAA training acknowledgment agreement according to UNC
Health Care System Privacy and Information Security Policies will be signed by all employees and kept in
their personnel file. Training website: http://www.unchealthcare.org/site/hippa internet
Smoking and Use of Tobacco Products
FIRST CHOICE Medical Transport prohibits smoking inside all of its vehicles and buildings. If you must
smoke,we ask that you remain 15 feet away from buildings and vehicles. Remember ambulances carry
oxygen and OXYGEN IS AN OXYDIZER WHICH AIDS IN COMBUSTION! Use of Tobacco Products,such as
chew, snuff, etc. is not permitted in or around any of FIRST CHOICE Medical Transport's vehicles.
Drug-Free Workplace
FIRST CHOICE Medical Transport is committed to providing a drug-free, healthful, and safe workplace.
To promote this goal, all employees are required to report to work fit to perform their jobs in a
satisfactory manner. While on FIRST CHOICE Medical Transport premises and while conducting business-
related activities, no employee may use, possess, distribute, sell, or be under the influence of alcohol or
engage in the unlawful manufacture, sale, purchase, distribution, dispensation, possession, or use of
illegal drugs.
Violations of this policy may lead to corrective action, up to and including immediate termination of
employment.
Equal Employment Opportunity
First Choice Medical Transport is an Equal Employment Opportunity Employer. Employment practices
will not be influenced or affected by an applicant's or employee's sex, sexual orientation, race,color,
religion, marital status, national origin, ancestry, medical condition,veteran status, or any characteristic
as protected by applicable law. First Choice Medical Transport expects the relationships of people with
First Choice Medical Transport to be impartial and based on respect for the opinions and feelings of
others.
Prohibited Harassment
First Choice Medical Transport is committed to providing all of its employees with a workplace free of
harassment.
First Choice Medical Transport maintains a strict policy prohibiting sexual harassment and harassment
on the basis of sex(including same gender), sexual orientation, race, color, religion, marital status,
national origin, ancestry, medical condition, age, physical/mental disability, denial of PDL(Pregnancy
Disability Leave) or reasonable accommodation,veteran status, or any characteristic as protected by
applicable law.
This prohibition applies to all persons involved in the operation of First Choice Medical Transport,
including employees,vendors, and clients of First Choice Medical Transport. No employee is expected to
Page 2 of 15
FCMT SOP & EMPLOYEE HANDBOOK
tolerate any conduct prohibited by this policy from anyone while at work or engaged in Company
business.
Sexual Harassment Defined
Sexual harassment prohibited by this policy includes any unwanted sexual advances, requests for sexual
favors or visual, verbal or physical conduct of a sexual nature when:
Submission to such conduct is made a term or condition of employment; or submission to or rejection
of such conduct is used as a basis for employment decisions affecting the individual; or such conduct has
the purpose or effect of unreasonably interfering with an employee's work performance or creating an
intimidating, hostile or offensive working environment.
The three most common types of sexual harassment complaints are those in which:
• An employee is fired or denied a job or an employment benefit because he/she refused to grant
sexual favors or because he/she complained about harassment. Retaliation for complaining
about harassment is illegal, even if it cannot be demonstrated that the harassment actually
occurred.
• An employee quits because he/she can no longer tolerate an offensive work environment,
referred to as a "constructive discharge." If it is proven that a reasonable person in the victim's
position, under like conditions, would resign to escape the harassment,the employer may be
held responsible for the resignation as if the employee had been discharged.
• An employee is exposed to an offensive work environment. Exposure to various kinds of
behavior or to unwanted sexual advances alone may constitute harassment.
The following is a partial list of conduct that would be considered sexual harassment:
• Unwanted sexual advances.
• Offering employment benefits in exchange for sexual favors.
• Making or threatening retaliation after a negative response to sexual advances
• Visual conduct such as leering, making sexual gestures, displaying offensive, derogatory,
obscene or sexually suggestive objects, e-mails, computer graphics or images, unwelcome notes
or letters, photographs, cards, drawings,gestures, pictures, cartoons, calendars or posters
placed on walls, bulletin boards, or elsewhere on company premises or circulated in the
workplace
• Verbal conduct such as making or using derogatory sexual comments, epithets, slurs, sexually
explicit jokes, negative stereotyping, comments about an employee's body or dress.
• Written communications of a sexual nature distributed in hard copy or via a computer network.
• Verbal sexual advances or propositions.
• Verbal abuse of a sexual nature, graphic verbal commentary about an individual's body, sexually
degrading words to describe an individual, suggestive or obscene letters, notes or invitations.
• Physical conduct such as touching, assaults, impeding or blocking movements, unwelcome
physical contact or staring at a person's body.
• Retaliation for making harassment reports or threatening to report harassment.
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• Sexual harassment can occur between employees of the same sex. It is unlawful for males to
sexually harass females or other males, and for females to sexually harass males or other
females.
Other Types of Harassment
First Choice Medical Transport also prohibits harassment on the basis of race, color, national origin,
religion, gender, ancestry, pregnancy, childbirth, physical or mental disability, medical condition, age,
veteran status or any other characteristic protected by applicable law.Such prohibited harassment
includes but is not limited to the following examples of offensive conduct:
• Verbal conduct such as threats, epithets, derogatory comments or slurs.
• Visual conduct such as derogatory posters, photographs, cartoons, drawings or gestures.
• Written communications containing statements that may be offensive to individuals in a
particular protected group,such as racial or ethnic stereotypes or caricatures.
• Physical conduct such as assault, unwanted touching or blocking of normal movement.
• Retaliation for making or threatening to make harassment reports to First Choice Medical
Transport, or for participating in an investigation into harassment allegations.
First Choice Medical Transport Complaint Procedure
If you believe that you have been subjected to harassment,whether or not specifically noted as an
inappropriate behavior as described in this policy,you should immediately tell the harasser to stop
his/her unwanted behavior.
You are required to immediately report the offensive behavior, preferably in writing, to your own
supervisor, the General Manager's, Operations Manager or the Client Services Manager of First Choice
Medical Transport.
If you become aware of harassing conduct engaged in or suffered by another First Choice Medical
Transport employee, regardless of whether such harassment directly affects you,you should
immediately report that information, preferably in writing, to your own supervisor, General Manager,
Operations Manager or Client Services Manager of First Choice Medical Transport. Complaints should
include details of the incident(s), names of individuals involved, and the names of any witnesses. No
adverse action will be taken against an employee who makes a report or cooperates in the investigation
of a report of harassment.Supervisors and managers must immediately refer all harassment complaints
to the owners/members of First Choice Medical Transport.
First Choice Medical Transport policy is to conduct an immediate, thorough and objective investigation
of any harassment claims through an interactive process with the employee.
First Choice Medical Transport will protect the confidentiality of the harassment allegations to the
extent possible. However, First Choice Medical Transport cannot guarantee complete confidentiality,
since we cannot conduct an investigation without revealing certain information to the alleged harasser
and potential witnesses. At the conclusion of our investigation,we will attempt to determine whether
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unlawful harassment has occurred. First Choice Medical Transport will look at the totality of the
circumstances, including the nature of the conduct and the context in which it occurred. If appropriate,
First Choice Medical Transport will, as promptly as possible, communicate our findings and the remedial
action (if any)to be taken,to the accused,to the complainant, and, when appropriate, to other persons
who are directly concerned.
If we determine that harassment has occurred, First Choice Medical Transport will take remedial action
commensurate with the severity of the offense.This action may include corrective action against the
harasser, up to and including termination. Steps will be taken, as necessary, to prevent any further
harassment.
No Retaliation
First Choice Medical Transport strictly prohibits retaliation against any person by another employee or
by First Choice Medical Transport or using this complaint procedure, reporting harassment, or for filing,
testifying, assisting or participating in any manner in any investigation, proceeding or hearing conducted
by First Choice Medical Transport or a governmental enforcement agency. Prohibited retaliation
includes, but is not limited to: termination, demotion,suspension, failure to hire or consider for hire,
failure to give equal consideration in making employment decisions,failure to make employment
recommendations impartially, adversely affecting working conditions or otherwise denying any
employment benefit to the person participating in an investigation.
First Choice Medical Transport does not consider conduct in violation of this policy to be within the
course and scope of employment and does not sanction such conduct on the part of any employee,
including management employees.
Employee Hiring Standards
Nondiscrimination
We are required to give service to all regardless of their race, sex, creed, skin color, national origin, age,
disability or medical condition of the patient.This includes patients with any communicable diseases
such as AIDS,TB, or Hepatitis.
The following criteria must be met before an EMT/Paramedic candidate is considered for
employment:
1. Candidate must be a credentialed North Carolina Emergency Medical Technician Basic/
Intermediate or Paramedic (EMTs/Paramedics).
2. Candidate must be qualified to work as set forth by the Department of Labor(all employees).
3. Candidate must possess a valid driver's license; have five (5)years of driving experience, and
present their driving record prior to being hired.
4. Candidate must present original training certification cards and driver's license to our office as
soon as we present an offer of employment
5. Candidate will be subject to a criminal background check prior to employment (all employees).
6. Candidate must be formally interviewed and qualified to continue the employment process.
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7. At FIRST CHOICE Medical Transport's discretion candidates are required to undergo random
drug screening and criminal background checks at any time.
8. All employees must be BCLS (Basic Cardiac Life Support) credentialed by the American Heart
Association or the American Red Cross.
9. Employees undergo a three (3) month, six(6) month and yearly evaluation.
Emergency Medical Technician (EMT)/Paramedic Orientation and Training
All EMTs and Paramedics must undergo a training and evaluation program as set forth by FIRST CHOICE
Medical Transport, approved by Wake County EMS.
1. EMTs/Paramedics must undergo a strict in-house training program before they are allowed to
perform care duties.
2. EMTs/Paramedics must meet all the requirements set forth by FIRST CHOICE Medical Transport
and can only be cleared by the officers of the company.
3. Hiring and training process:
• Application interview process
• Orientation; OSHA, HIPPA Compliance,AED and Standards of Care training
• Review and acknowledge FCMT Roles and Responsibilities/Job Description
• Field training
• EMTs/Paramedics are required to pass a basic ambulance operation &driving skills road
test
4. Complaints regarding professionalism will be investigated thoroughly by FIRST CHOICE Medical
Transport Management and may lead to corrective action, up to and including immediate
termination of employment.
FIRST CHOICE Medical Transport's policy requires all Emergency Medical Technicians and Paramedics to
maintain North Carolina's adopted standard of care.
As maintained by the County's Emergency Medical Service's (NC Office of EMS) policy, First Choice
Medical Transport requires EMTs/Paramedics to perform:
• Patient care at the level our service is licensed to provide
• Patient care at the level of your own certification
• Physical exams
• Necessary treatment
• Transportation without delay to the appropriate facility
• When necessary, call 911 emergency systems
• All patients will receive care that includes respect for the individual privacy, dignity, religious
and cultural beliefs
• At all times be respectful and avoid over-familiarity with patients
• Always address the patient by name when possible
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• Patient's condition must never be discussed with an unauthorized person (see HIPPA
Compliance) Always show respect for patients' customs, values and beliefs, which may be
different than their own.
Dispatcher Orientation and Training
1. Dispatchers are trained in the following areas:
• Computer operations
• Automated Dispatching
• Transportation Coordination
• Communication Skills
• Customer Service
2. Dispatchers are required to maintain accurate records reflecting the time line of each transport.
3. Dispatchers shall set the standard for client relations.
4. Dispatchers will be available during established office work hours.
Beginning of the Shift
The following items must be completed and accomplished at the beginning of each shift. Upon punching
in you will be expected to immediately begin your daily duties as follows:
1. Determine ambulance assignment; pick up keys&AED from dispatcher.
2. Complete Daily Vehicle Inspection Report(DVI)on assigned ambulance.
3. Complete Daily Patient Care Report(PCR)
4.Sanitation
• The inside of all our vehicles and all equipment used shall be cleaned every day
• After transporting patients known to have AIDS, Hepatitis,TB or any other communicable
disease,our vehicles shall be temporarily removed from service. Anything touched by the
patient or patient's body fluids shall be disinfected as per OEMS standards.
• UNIVERSAL PRECAUTIONS-gloves-(plus additional protection depending on specific situation)
will be worn for all patient contacts.
5. Make sure that all equipment is cleaned and working properly.
6. Inspect and restock if needed paperwork(PCRs, DVIs and PCS Forms) in clipboard.
7. Inspect crew cab for Map books and other required material.
Daily Vehicle Inspections Reports(DVI)
Anything outside of the ordinary, missing and/or broken equipment, on an ambulance needs to be
documented on a Daily Vehicle Inspection Report(DVI) and reported to a supervisor. Not advising a
supervisor of missing, faulty, and/or broken equipment means that when the need arises for that
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particularly item to be used it is either gone, not working properly or just not working at all.The policies
below are in place to facilitate maintaining the equipment that we rely on:
• Vehicles must be inspected thoroughly each day that they operate, and have a proper vehicle
inspection form completed.This includes any driving of the vehicle (example—picking unit up
from service).
• Sirens are not to be tested in quarters.Siren and light bar test should be performed at the time
of picking up a unit from service or at a location isolated from large population or homes. The
siren has a diagnostic feature that allows testing without making noise.
• When equipment is not functioning properly, a supervisor and/or dispatch should be advised
immediately.The determination will then be made as to switch out the item, or in extreme
cases,take the vehicle out of service.
Sharps Disposal Procedure
Sharps containers shall be maintained upright throughout use, replaced routinely and not be allowed to
overfill.When removing and disposing sharps containers from the area of use, the containers shall be:
Closed immediately before removal or replacement to prevent spillage or protrusion of contents during
handling, storage, transport, or shipping;
Place in a secondary container if leakage is possible.The second container shall be:
Closable;
Constructed to contain all contents and prevent leakage during handling, storage,transport, or shipping;
and Labeled or color-coded.
Reusable containers shall not be opened, emptied, or cleaned manually or in any other manner which
would expose employees to the risk of percutaneous injury.
Upon closure, duct tape may be used to secure the lid of a sharps container as long as the tape does not
serve as the lid itself.
Sharps containers must be easily accessible to employees and located as close as feasible to the
immediate area where sharps are used (e.g. Ambulance) or can be reasonably anticipated to be found.
Disposal of all regulated waste shall be in accordance with applicable regulations of the United States,
States and Territories, and Wake County Waste Management Services.
Recapping of contaminated sharps should only occur if there is no Sharp container available. If
recapping is the only option, please use the one handed technique as described below:
• Hold IV with one hand
• Place sheath on the ground or flat surface
• Keep second hand clear and manipulate IV into sheath.
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FCMT SOP & EMPLOYEE HANDBOOK
Needlestick Policy and Procedure
The needlestick procedure is to provide a comprehensive infection control procedure, which maximizes
protection against communicable diseases for all FCMT employees, and for the public, they serve. This
policy and procedure applies to all FCMT employees, part-time and full time;field and office staff.The
goal is to provide all employees with the best available protection, from occupationally acquired
communicable disease.
It is the policy of this organization:
• To provide medical transport services to the public without regard to known or suspected
diagnoses of communicable disease to any patient.
• To regard all patient contacts as potentially infectious. Universal Precautions will be observed at
all times and will be expanded to include all body fluids and other potentially infectious
materials(body substance isolation).
• To provide all members with the necessary training, immunizations, and personal protective
equipment (PPE) needed for protection from communicable diseases.
• To recognize the need for work restriction based on infection control concerns.
• To regard all medical information as strictly confidential. No employee health information will
be released without the signed written consent of the employee.
Contaminated needle stick/blood borne pathogen exposure
• The employee will wash the exposed area immediately with soap and water. If an eye/mucous
membrane exposure,flush with copious amounts of water.
• The FCMT employee will notify the on duty supervisor immediately.
• The FCMT supervisor will meet with the exposed employee to gather information and
determine validity. If it is warranted,the supervisor will consult the medical facility to which the
patient was transported.
• FCMT Employee Accident Form &Worker's Compensation form will be completed.
• Supervisor& Medical Facility will obtain consent to test blood from a Source Patient.The
Medical Facility must gather information and report findings to your designated supervisor
within 48 hours and the FCMT employee will be advised immediately.
• With consent and without injury, supervisor will arrange for evaluation and followed up by an
emergency room (ED)doctor or other appropriate health care professional.
• If Employee is injured he/she will be treated directly in the ED.
• Source HIV results will be available to the FCMT Medical Director or designated staff within
three hours after being received by the Blood Bank and/or treating Medical Facility. FCMT
Medical Director will notify the exposed employee immediately of these results.
• The FCMT Medical Director or designated staff will follow up with N.C. Department of Health
and Human Services and Center for Decease Control (CDC) of HIV, Hepatitis B and C results
within three to five days.The FCMT Medical Director or designated staff will contact the
employee after receiving all test results.
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• Prophylactic treatment: If appropriate, prophylactic treatment will be initiated at the direction
the emergency room physician, FCMT Medical Director and/or Infectious Disease Specialist. If
needed the FCMT Medical Director or designated staff will coordinate counseling and follow-up
appointments.
BLS Medication Kit
All approved BLS medications shall be kept in a FCMT BLS Medication portable kit case and stored in a
controlled climate office at the end of every shift day. During operation hours,the medication kit will be
stored in the ambulance with a "Medication Content and Replacement log" for each EMT to complete if
opened or used as prescribed. All personnel must initial and date medications after opening.
Vehicle Breakdown
If your vehicle breaks down for any cause,you shall call our office immediately and another vehicle will
be dispatched to pick up the patient(s). While this is happening, the patient(s) SHALL NOT be left alone.
Vehicle Driving and Conduct
1. Drivers shall operate their vehicles with due regard at all times and not place themselves, their
partners or the patient in any immediate danger of risk of injury.
2. Drivers shall adhere to all local, state and federal laws and regulations governing the operation
of a vehicle.
3. Drivers shall not utilize lights, sirens or any other device that can be construed as an emergency
device unless the situation warrants.
4. Drivers shall refer to the Company Policy and Procedures for guidelines regarding an accident.
5. In an emergency situation requiring lights and sirens, ambulance drivers are required to operate
the ambulance with due regard to all applicable laws.
6. Drivers shall not text while operating any vehicle
7. Drivers must have access to cell phone communication during operation of all company vehicles
and during work shift hours (see Communication/Information Systems standards)
8. Drivers shall carry official training certification cards and driver's license at all times while on-
duty and during work hours.
9. Drivers can only wear patches, which indicate the certifications you have obtained.
Parking and Backing of Ambulances
General rules for drivers and spotters:
1. A backer/spotter shall be used at all times when no patient is being transported. NO
EXCEPECTIONS!
2. Never be in a rush when backing or parking!
3. Do not start to back or park when unsure of the area.
4. Do not put the ambulance into reverse gear until it has come to a complete stop.
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5. When it is dark outside use the side and rear spotlights when backing to light the area.
6. If the vehicle has a backup alarm that can be disengaged, it should always be in the "on"
position before backing the vehicle.
Backing the Ambulance:
1. Backing of the ambulance should be avoided whenever possible. Where backing is unavoidable,
a spotter or an assistant outside the vehicle should be used.
• In addition, a spotter should be used when vehicles must negotiate forward turns with
restrictive side clearances and where height clearances are uncertain.
• The purpose of the spotter is to expand the driver's sense for the right, left,front and rear
space cushions.
2. Under circumstances where the ambulance is staffed by only the driver(e.g., all other personnel
are inside the residence with the patient),the driver should attempt to utilize any available
emergency services personnel to act as spotters.
Where no personnel are available to assist,the driver shall park the vehicle, get out, and
make a complete survey of the space cushion around all four sides of the vehicle to
determine if any obstructions are present before proceeding to back the ambulance.
3. Spotters are never permitted to ride the tailboard or running boards while the vehicle is in
motion.
4. The spotter should be in a visible safe zone positioning him/her ten (10)to fifteen (15)feet at
the left rear of the ambulance.
5. The vehicle should not be backed until the spotter is in position in the safe zone and has
communicated his/her approval to begin backing by way of a hand signal, and voice,when
possible.
6. Spotters should remain visible to the driver in the safe zone.
• Anytime the driver loses sight of the spotter,the vehicle should be stopped immediately
until the spotter is again visible and the communication to continue backing is processed.
7. This is definitely not a high-speed maneuver. It should be done very slowly and cautiously.
Parking the Ambulance:
1. Always park the ambulance in a hazard-free area to protect the crew, patient and the
ambulance.
2. When parking to the driver's blind side a spotter should be used.
3. When parking in a parking space or driveway, back into the parking area so that you have a safe
and efficient exit.
Standard Signals for Spotters:
1. Straight Back-One hand above the head with palm toward face,waving back; other hand at
your side.Turn - both arms pointing the same direction with index fingers extended.
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2. Stop- both arms crossed with hands in fists. Be sure to reinforce the signal by yelling the stop
order loud enough so the driver can hear.
3. Night Backing-Signals are the same.The spotter should assure that the spotlights on the rear of
the ambulance are turned on before allowing the vehicle to be backed. A flashlight, wand type is
useful, maybe carried but at no time will it be directed towards the mirrors.
Passenger Ride-A-Longs/Patient Assistance
We do allow riders with our patients if there are extenuating circumstances.These circumstances
include:
• A parent riding with a child
• If a patient is very upset, in physical pain,or otherwise unstable and the passenger's presence
will positively impact the comfort level of the patient.
• Passenger must sit in front compartment of the ambulance with seat belt buckled.
Information/Communication Systems
Cell Phones–Drivers should complete calls while the vehicle is parked and/or use the phone in a "hands
free" mode via a headset or speaker. While driving, attention to the road and safety should always take
precedence over using the phone.
Personal cell phone use is prohibited during the following situations:
1. During the transport of a patient, in either the role of the driver or attendant.
2. En route to a call or assignment.
3. Exception: Use of company cell phone for patient information and/or supervisor/management
communications.
Any use of a cell phone, company or personal,should be used with the utmost precautions during the
operations of an ambulance.
Personal Communication Devices–The use of personal cellular phones, PDAs, pagers, ear pods,Text
Messaging, etc. can be a problem while working. Such use is distracting and can portray a negative
image to any individual who may see employees using such devices while at work. You are asked to
minimize the personal use of such devices while at work so that business needs are not compromised. If
such devices are used during non-work time (breaks/meals) please do so in a way that does not
interfere with coworkers and other business needs.
Computer, Email, Internet,&Voicemail Use — some employees are provided access to FIRST CHOICE
Medical Transport's information and communication systems for business reasons.These systems are to
be used solely for business purposes. Inappropriate use of FIRST CHOICE Medical Transport information
systems will result in corrective action up to and including termination.
Telephone and Radio Use — Incoming phone calls are an important and essential part of our business.
FIRST CHOICE Medical Transport must use both telephones and radios to accomplish its various
communications.
Employees must always be aware that these communications are never private and cannot be secure;
therefore, professional conduct dictates these communications shall be succinct and to the point and
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absent of any profanity, abusive language, and slurs of any kind. If your job requires you to answer the
phone, remember that the caller's entire impression of FIRST CHOICE Medical Transport will be based on
how you sound. Be courteous and friendly, and whenever possible refer to the caller by name. Personal
phone calls placed or received should be kept to a minimum to ensure that our clients can effectively
communicate with us. Necessary phone calls should be made during breaks or meal periods whenever
possible. If it is necessary to make a personal, long distance telephone call, please keep them to a
minimum and charge any toll calls to a personal calling card.
Attendance and Punctuality
To maintain a safe and productive work environment, FIRST CHOICE Medical Transport expects you to
be reliable and to be punctual in reporting for scheduled work and to start work at the assigned time.
Absenteeism and tardiness disrupt the orderly operations of the company and place a burden on other
employees and on working operations.
Employees are required to arrive no more than 15 minutes prior, in uniform,to the scheduled start of
their shift and are required to be on time for their shift.
If you are unable to report for work due to illness, injury or other emergencies,you are required to
notify your supervisor at least four(4) hours before the start of your shift. Under some circumstances
you may be asked to provide written verification of your illness or emergency. In addition, written
verification from your attending physical or health care provider is required for absences of more than
three (3)consecutive work shifts.
If you are late for your scheduled work shift and call in less than one hour before your scheduled time to
begin work,you will be considered tardy for that day. Excessive absenteeism and tardiness (excused or
not) may result in counseling or corrective action up to and including termination of employment. Each
situation of excessive absenteeism or tardiness shall be evaluated on a case-by-case basis; however,
even one unexcused absence may be considered excessive, depending on the circumstances. Employees
who fail to report for work without any notification to management for a period of two (2) consecutive
work shifts will be considered to have abandoned his/her employment and have voluntarily resigned.
Appearance and Dress Code
Every employee is a representative of our company and thereby becomes a part of our public image.
Personal cleanliness, neatness, and appropriate adherence to the dress code enhance your professional
appearance and inspire confidence in your ability. Good judgment in grooming should be exercised at all
times and appropriate attire should be worn. Please use your best judgment.
Grooming and Hygiene:
1. Hair must be clean, neatly groomed and of a natural color. Due to safety and health code issues,
employees with long hair need to wear their hair up or pulled back into a ponytail during a call.
2. Beards, Mustaches, and Goatees are permitted, but must be neatly trimmed &groomed
3. Sideburns must be neatly trimmed and groomed, cannot extend more than Yz inch below the ear lobe.
4. Perfume or aftershave is not allowed. Use of deodorant and breath fresheners is highly
recommended.
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5. Makeup, if worn, should be subtle.
6. NO jewelry may be worn at any time with the following exceptions:
Watches, wedding bands, approved necklaces(must be worn inside shirt), and Medic Alert Bracelets.
The following are the uniform guidelines for ALL employees:
EMTs/Paramedics:
You are expected to be in uniform at start of your shift and throughout the shift while on calls and/or in
the ambulance.
Dispatchers:
• You are to use good judgment in your professional appearance.
• Unacceptable attire includes sweatpants,tank tops, cut-offs,or any other inappropriate
clothing.
Employees are responsible for the maintenance and care of their individual uniforms.
All employees required to wear a uniform will be issued logo polo shirts. Preferred pants will be khaki,
tan, blue or black color for daily work attire.
Equipment Training and Maintenance
1. Employees receive in-service training on all company equipment.
2. Employees are required to ensure that equipment placed in their care is in proper working
order.
3. Employees are required to report equipment malfunctions.
4. All vehicles are inspected daily at the start of each shift (refer to DAILY VEHICLE INSPECTION
REPORT under Pre-Trip Vehicle Checklist)
5. All vehicles are inspected at the end of each shift (refer to DAILY VEHICLE INSPECTION REPORT
under Post-Trip Vehicle Checklist)
6. All vehicles are routinely maintained by a certified mechanic and records will be maintained by
FIRST CHOICE Medical Transport.
ELDER OR CHILD ABUSE
1. You shall take note of any signs of elder or child abuse to the patient that you observe by
completing company Incident Report.
2. You shall immediately report any abuse to the medical staff at the medical facility and/or
Department of Social Services (USS) or equivalent in the county.
PHYSICAL BEHAVIOUR RESTRAINTS
1. You cannot put a patient into, or transport a patient with, physical behavior restraints unless:
a. A physician or court has authorized the placement of the restraints; or
b. The patient is in the custody of a police or corrections officer and the officer
accompanies the patient within the patient compartment; or
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c. The medical condition of the patient mandates transportation to, and from treatment
at, a health care facility; or
d. The patient shows such a degree of behavior that he or she:
• Poses serious physical danger to themselves or to others; or
• Causes serious disruption to ongoing medical treatment which is necessary to
sustain their lives or to prevent disability.
2. You shall clearly note the reason(s)for placing and or transporting a patient in behavior
restraints on the PCR report.You shall give a copy of the report to the appropriate personnel at
the medical facility receiving the patient.
3. The above mentioned physical behavior restraints do not apply to automotive safety belts,
stretcher patient safety restraints or other safety restraints.
PATIENTS RIGHTS
1. Do not leave a patient alone
2. Do not give out any information on the patients' conditions or medical status to anyone except
the appropriate authorities.
3. Treat all patients properly and in a most professional manner.
4. Respect the patient's privacy(when changing clothes, etc.)
Acknowledgement of Receipt of Employee Handbook
This is to acknowledge that I have received a copy of the Employee Handbook and understand that it
contains important information on many of FIRST CHOICE Medical Transport general personnel policies
and on my privileges and obligations as an employee.The policies contained in this Employee Handbook
apply to all employees and supersede and replace all previously communicated policies both in written
and verbal form. I acknowledge that I am expected to read, understand, and adhere to these policies
and will familiarize myself with the material in the handbook.Additionally, I agree to abide by any new
or revised policy. I have been given an opportunity to ask questions about policies I do not understand.
I also understand that, because FIRST CHOICE Medical Transport cannot anticipate every issue that may
arise during my employment, if I have any questions regarding any of FIRST CHOICE Medical Transport's
policies or procedures, I should contact my supervisor, the Operations Manager or any Officer
In addition, I commit to engaging in an ongoing, meaningful dialog with FIRST CHOICE Medical Transport
regarding all matters of employment, before discussing such matters with persons outside of FIRST
CHOICE Medical Transport.
I understand it is my responsibility to read, understand, and comply with the provisions contained in
FIRST CHOICE Medical Transport SOP and Employee Handbook.
Employee Signature:
Print or Type Name: Date:
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FCMT Job Description/Privileges
First Choice Medical Transport (FCMT) Job Description/Privileges
EMT-B & Paramedic Job Description
First Choice Medical Transport(FCMT) is managed and operated as a non-emergency Basic Life
Support(BLS)transport company in North Carolina. EMT-Bs and Paramedics will provide non-
emergency BLS ambulance services by administering medical assistance at level of EMT-Basic in the
transfer of ill, rehabilitation and convalescent patients to and from assigned location and medical
facility for routine physician appointments or procedures.Accurately complete billing,documentation
and clerical duties related to the position. Perform daily cleaning and general maintenance for the
vehicles and equipment plus restock supplies.
Scope of Care for Basic Life Support (BLS)
EMTs and Paramedics will only provide basic medical care and transportation to patients assigned to
First Choice Medical Transport.The interventions provided by the EMTs and Paramedics include basic
airway,ventilation,and oxygen therapy devices found on the ambulance;takes patient vital signs;
and provides stabilization of the spine and suspected extremity injuries,eye irrigation, bleeding
control, CPR and automated external defibrillation (AED). EMTs and Paramedics may use advanced
oxygen therapy and ventilation equipment, pulse oximetry and use of automatic blood pressure
monitoring equipment.
FCMT Roles and Responsibilities Summary
• Maintain vehicle and equipment readiness
• Ensure safety of the crew,the patient and bystanders
• Operate the ambulance in safe &professional manner
• Assess the patient
• Provide care within the scope of care as defined by Medical Director, management,state,
regional and local regulatory agencies
• Safely lift and move the patient
• Prepare oral and written reports
• Safely transport the patient
• Transfer patient care
• Perform record keeping and data collection
• Serve as the patient's advocate
• Provide compassionate support to the patient, relatives and others
• Maintain medical and legal standards
• Provide administrative support
• Enhance professional development
• Request additional help from 911 or medical direction, if necessary.
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FCMT Job Description/Privileges
EMT-B/Paramedic Privileges for:
Name of Employee(printed)
Privileges authorized by Medical Director of FCMT:
o opening& maintaining an airway(blind insertion devices not allowed);
o ventilating patients;
o administering cardiopulmonary resuscitation, including use of automated external
defibrillators;
o manage general medical complaints of altered mental status, respiratory,cardiac,diabetic,
allergic reaction,seizures and psychological crises.Additional care is provided based upon
assessment of the patient and obtaining historical information;
o searching for medical identification emblems as a guide to appropriate medical care;
o assisting patients with prescribed medications, including sublingual nitroglycerin,epinephrine
auto-injectors and hand-held aerosol inhalers;
o administration of oxygen;
o reassuring patients, relatives and bystanders by working in a confident,efficient manner;
o avoiding mishandling and undue haste while working expeditiously to accomplish the task.
The EMT-B and/or Paramedic is responsible for:
o driving ambulance in a safe manner even in traffic or adverse weather conditions and
complies with traffic ordinances and regulations concerning emergency vehicle operation
o lifting the stretcher or handling stair chair(be able to lift and carry 125 pounds); must be able
to use proper body mechanics while lifting and/or moving a patient
o placing stretcher in the ambulance and seeing that the patient and stretcher are secured;
o continuing medical care while enroute to the medical facility,administers additional care as
indicated by medical direction;
o assists in lifting and carrying the patient out of the ambulance and into the receiving medical
facility;
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FCMT Job Description/Privileges
o reports verbally and in writing,their observation and medical care of the patient at the
dispatched location and in transit,to the receiving medical facility staff for purposes of
records and diagnostics;
o upon request provides assistance to the receiving medical facility staff.
After each call,the EMT-B and/or Paramedic:
o restocks and replaces used linens, blankets and other supplies;
o cleans all equipment following appropriate disinfecting procedures;
o makes careful check of all equipment so that the ambulance is ready for the next run;
o communicate to management if ambulance is not in efficient operating condition;
o ensures that the ambulance is clean and washed and kept in a neat orderly condition;
o in accordance with local,state or federal regulations decontaminates the interior of the
vehicle after transport of patient with contagious infection or hazardous materials exposure.
Additionally the EMT-B and/or Paramedic:
o determines that vehicle is in proper mechanical condition by checking items required by
management;
o attends continuing education and refresher training programs as required by management,
Medical Director for FCMT, licensing or certifying agency.
Acknowledgement
EMT-B/Paramedic Name (printed) Signature Date
FCMT Manager Name(printed) Signature Date
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.t%%STCfIOICw,
1LlblfLl,TRANSVOS6
800-380-7909
"Our 91 Priority it Ponrnr Cana" 123 Summer Lakes Drive,Cary,NC 27513
PHONE:(919)454-4652
FAX: (800)380-7909 Transport Type: Ambulance BLS
TRANSPORT REQUEST FORM Please call Ahead to schedule & confirm your request
Transport Date: Requestor: Phone:
Patient Name: SSN: DOB:
Medicare#: Medicaid #:
Other Insurance Name: Policy#:
Ambulance 1. Does this patient occupy a Medicare Bed? Yes or No
Transport
Only 2. Is this transport related to the Patient's Plan of Care? Yes or No
3.Transport paid by: Medicare Medicaid Facility Private Other
Pickup Time: AM/PM Appointment Time: AM/PM
Pickup Location: Room#:
Receiving Location Address: Suite#:
Receiving Doctor's Name: Phone#:
Reason for Transport/Patients Diagnosis:
Special Instructions:
Approximate weight of patient: lbs. Oxygen Required? Yes or No If yes, LPM
Will this Patient need to be returned? Yes or No Return time: AM/PM
Does this Patient require an escort? Yes or No Escort Type: Staff Ride Along Family to Meet
Family Member Name: Phone#:
A valid Certificate of Medical Necessity is required by Medicare/Medicaid for ambulance transports.
PRIOR TO FAXING TRANSPORT REQUEST FORM,CALL THE SCHEDULING OFFICE AT 800-380-7909 OR(919)454-4652 TO
VERIFY AND CONFIRM AVAILABILITY FOR THE REQUESTED TRANSPORT DATE/TIME. VERBAL CONFIRMATIONS ARE REQUIRED
TO GUARANTEE TRANSPORT. REQUESTS FAXED PRIOR TO CONFIRMING ARE NOT GUARANTEED.
FCMT Use Only: Received/entered by Date:
Daily Vehicle Inspection Report
First Choice Medical Transport,LLC
Date: Check-in Time: Unit#:
Crew Members:
Pre-Trip Vehicle Checklist:
Starting Odometer Mileage: Gas Gauge: E - - 1/4 - - 1/2 - - 3/4 - - F
02 tanks (E) Lrg PSI: , 02 tanks (D) Sm PSI:
1. Check tires for inflation,wear or danger spots. good see comments
2. Look under the vehicle for puddles and/or leaks. good see comments
3. Check belts and hoses. good see comments
4. Check fluid levels. good see comments
5. Ensure that all lights are functioning. good see comments
6. Check siren/horn. good see comments
7. Confirm that PPE gear is available/adequate. good see comments
8. Check AED and Suction for proper charge. good see comments
9. Check medical supply inventory good see comments
(confirm that required items are present and functioning)
Comments:
Post-Trip Vehicle Checklist:
Ending Odometer Mileage: Gas Gauge: E - - 1/4 - - 1/2 - - 3/4 - - F
02 tanks (E) Lrg PSI: , 02 tanks (D) Sm PSI:
1. Dispose used PPE items. [
2. Clean and disinfect the patient compartment& all used equipment [ ]
3. Dispose all contaminated single-use medical supplies and disposable cleaning supplies. [ ]
4. Ensure that all equipment is returned to its proper location. [ ]
5. Prepare the wheeled stretcher for the next patient and lock into place. [ ]
6. Bag or Exchange dirty linens. [ ]
7. Complete end-day inventory and list supplies needed in comments below [ ]
8. Place all patient paperwork in expanding file folder - private information [ ]
Comments/Supplies needed:
Signature: Print: Check-out Time:
Signature: Print: Check-out Time:
FIRST CHOICE MEDICAL TRANSPORT
INCIDENT REPORT
WHAT
Was this an actual or near miss event Actual_Near Miss/Close Call
What happened?
Anything else we should know about the event?
WHEN/WHERE
Date of Occurrence:_/_/ _Date unknown
Time: Time unknown
Where did this occur?&Whom was Present?
WHO
Patient Staff Both
Name of person involved:Last ,First
Gender: M F
DOB: / /
Telephone#:( ) -
Mailing Street Address 1:
Mailing Street Address 2:
City: State: Zip:
Page 1 of 2
What actions were taken as a result of this event? (Please check)
_911 Called Vital Signs: P R BP
_Admitted to Acute Care Unit(Hospital)
Condition:
Admitted to ER for treatment
Disposition of Patient:
Admitted to isolation unit
Admitted to observation Time:
_ Advanced Cardiac Life Support(ACLS)initiated
_Airway established/patient ventilated
_CPR performed
Cardiac defibrillation
First aid administered
Minor first aid administered
_Oxygen administered
_Refused treatment required
Other action taken;
Was treatment provided? _yes_no if YES specify:
Reporter Information
Reporter name:Last ,First
Reporter title:
How often do you think events like this happen?_frequently,_occasionally,_remotely,_uncommonly
In your opinion,could this event have been prevented? _yes_no
Who was this reported to&on what date?
Medical Director Recommendations:
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FIRST CHOICE MEDICAL TRANSPORT = Patient Care Report(PCR) < TRIP# = PREMIS#
DATE OF TRANSPORT / / SERVICE TYPE BLS,Non-Emergency UNIT#
PT.NAME,LAST,FIRST,MI DOB / / AGE
ADDRESS:ST CITY STATE ZIP PHONE(
Gender Race Weight Physician Certification Statement Present(PCS)
❑Male ❑White ❑Black ❑Hispanic ❑American IndianlAlaska Native ❑lbs ❑ YES ❑ NO
❑Female ❑Asian Pacific!Pacific Islander ❑Other ❑kg
SS# MEDICARE MEDICAID
OTHER INSURANCE POLICY# GROUP#
ADV DIRECTIVE DURING TRANSPORT: ❑State DNR Form ❑Other Healthcare DNR ❑Family Request DNR (no form) ❑None ❑ Other
TRIP INFO HRS:DISPATCHED: ENROUTE ON SCENE DEPART SCENE ARRIVAL DEST
REASON FOR TRANSPORT(per PCS):
PICK-UP LOCATION ST CITY STATE ZIP
DROP-OFF LOCATION ST CITY STATE ZIP
STARTING MILEAGE ENDING MILEAGE TOTAL MILES
TYPE TRANSPORT: ❑Dialysis ❑Inter-facility Transfer ❑Hospital Admission ❑Hospital Discharge OMedical Appointment ❑Other:
APPT.ARRIVAL TIME: APPT.DEPARTURE TIME: TOTAL WAIT TIME:
ALLERGIES: ❑NKDA MEDICATIONS:DNA
ISOLATION: [None [Contact [Airborne[Droplet
(Type Isolation): PATIENT MEDICAL HX:DNA
PATIENT VITALS&OBSERVATIONS:
AT FACILITY: TIME HRS P R BP I ; 002 LPM SPO2 RA:
ENROUTE: TIME HRS P R BP I ; 002 LPM SPO2 RA:
2ND SET(if applicable): TIME HRS P R BP I ; 002 LPM SPO2 RA:
LOC=A&O X RESPIRATORY EFFORT EYESNISION VERBAL NEUROLOGICAL MENTAL STATUSIBEHAVIOR
❑Normal❑Person OPERRL Illegally Blind ❑A PPro riate ❑Moving all Ext DAppropriate/Coherent riate/Coherent
OLabored ONon-Reactive OCataracts
❑Incomprehensible OSensory Intact ❑Incoherent
flume ❑Fatigued ❑Constricted OGlaucoma OBaseline ❑Baseline ❑Intermittent Consciousness
❑Situation ❑Absent ODilated ❑None ❑Other ❑Combative
ONot Assessed
INITIAL POSITION OF PT AT SCENE: OSEMI-FOWLER'S; OFOWLER'S; OSUPINE; ❑PRONE; OTRENDELENGBURG; OSITTING; ❑OTHER
PT FOUND IN: OBED; OGERI CHAIR; OMEDICAL RECLINER; ❑FLOOR; ❑CHAIR; ❑OTHER
PATIENT CONDITION AT ARRIVAL STATUS: ❑UNCHANGED(NO COMPLICATIONS) ❑IMPROVED [NORSE OUNKNOWN
EQUIPMENT USED TO INITIATE TRANSPORT: [STRETCHER; ❑STAIRCHAIR; 002; ❑NR; ❑NC; ❑SUCTION;❑OTHER
PPE USED: ❑ GLOVES ❑GOWN ❑MASK ❑GOGGLES ❑ OTHER
NARRATIVE:[Transport Uneventful OPT Stable During Transport
CAREGIVER SIGN PRINT TITLE EMT DATE I 1
DRIVER SIGN PRINT TITLE EMT DATE 1 /
FACILITY REP SIGN PRINT TITLE DATE i 1
AUTHORIZATION TO RELEASE INFORMATION AND PAYMENT REQUEST:I certify that the transportation services)listed above were received and request that payment for these services be made on my behal
authorize any pertinent medical or other information about me to be released to the Division of Medical Assistance and Healthcare Services andlor the Social Security Administration and Financing Administrath
andlor its authorized agents,Intermediates or carriers,and/or the billing agent First Choice Medical Transport LLC any information needed for this claim or a related Medicare I Medicaid I Private Insurance I Priv
Claim now and in the future. I permit a copy of this authorization to be:used in place of the original and request payment of medical insurance benefits to either myself or the party who accepts assignment. I
REQUEST THAT MY PHYSICIAN PROVIDE A LETTER OF MEDICAL NECESSITY. I hereby acknowledge services rendered. I authorize use of this original or a copy and permit payment for same via assignment i
medical insurance to First Choice Medical Transport LLC. Responsible party agrees to pay collection cost and if a suit is filed,reasonable attorney fees,and court costs.
Patient SignaturelMark- DATE / 1
❑Patient Unable to Sign;Reason Patient is physically or mentally incapable of signing:.
Representative/Witness Signature Print Relationship
Application Attachment 12:
First Choice Medical Transport Employee Roster
I ate Id First Name Last Name Job Titles) TechlD Certifications Exp Date Drivers License# Address
93726 Nicholas Banister EMS Technician 8417 EMT-Basic 4/30/2017 22087737 8301 Yaxley Hall Drive Raleigh,NC 27616
04783 Justin Beaudin EMS Technician 4581 EMT-Basic 1/31/2019 34219733 406 Sherwood Forest PI.Cary,NC 27519
00583 Timothy Caldwell EMS Technician 4484 EMT-Basic 5/31/2018 38820033 5005 Windy hill Dr Unit B Raleigh,NC 27609
00579 Caleb Creech EMS Technician 1275 EMT-Basic 5/31/2018 29598258 P.O.Box 1362 Wendell,NC 27591
00587 Aaron Dickson EMS Technician 3930 EMT-Basic 5/31/2018 38720024 4116 lodge Allen ct raleigh,NC 27606
P095647 Thomas George JEMSTechnician 5432 EMT-Basic 8/31/2017 39220071 612 Brent Road Raleigh,NC 27606
P098694 Tyler Harris EMS Technician 4665 EMT-Basic 3/31/2018 38157396 617 texanna way Holly springs,NC 27540
P088270 Mark Mancini EMSTechnician 4848 EMT-Basic 6/30/2016 25699922 202 Windjammer South Emerald Isle,NC28594
P107259 Joseph McDougall IT Personnel 9174 37046775 104 Hedspeth Lane cary,NC 27519
P102042 Eric Murbach EMS Technician 7004 EMT-Basic 8/31/2018 31067358 211 Ridgewood Dr.Apt.914 Raleigh,NC 27609
P095386 Addison Newman EMS Technician 3543 EMT-Intermediate 3/31/2019 39003648 1101 Hillsborough St Apt A6 Raleigh,NC 27603
P099994 Duran Pardue EMS Technician 7873 EMT-Basic 4/30/2018 23777175 1636 MacAlpine Cir Morrisville,NC 27560
P063368 Aaron Parker EMS Technician 2216 EMT-Basic 11/30/2016 33930563 3901 hylton dr raleigh,NC 27616
P093739 Zachariah Reynolds EMS Technician 7586 EMT-Basic 4/30/2017 24290783 2315-A Van Dyke Ave Raleigh,NC 27607
P093738 Samuel Scott EMS Technician 7145 EMT-Basic 4/30/2017 23985532 3528 Oneonta Ave Raleigh,NC 27604
P102992 Matthew Tolley EMS Technician 5978 EMT-Basic 2/28/2019 36929846 10638 Cardington Lane Raleigh,NC 27614
P083481 Carol Varsano Member,Agency Primary Contact,EMS Technician 8885 EMT-Basic 2/28/2019 22240621 123 Summer Lakes Drive Cary,NC 27513
P102231 Marcus_ Varsano Member,EMS Technician 9237 EMT-Basic 9/30/2018 35819337 123 Summer Lakes Drive Cary,NC 27513
P085620 Ronal*i Varsano Member,Dispatch Center Contact,EMS Technician 2328 EMT-Basic 3/31/2016 25941062 123 Summer Lakes Drive Cary,NC 27513
P075341 Chris Yoo EMS Technician 7574 EMT-Paramedic 11/30/2018 32757334 512 Dyersville Drive Morrisville,NC 27560
LucBc Varsano lAdministrator 1 31728821 123 Summer Lakes Drive Cary,NC 27513
Application Attachment#13:
is - 1 ehic es0 nedan O®Ve
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Vehicle# Year
ae _
Make Model VIN # Lic. # Mileage
1 2007 FORD E-350 1 FDSS34P07DA47245 DR-8659 273000
2 2008 FORD AM 1 FDSS34P08DB38360 CMX-7875 201000
3 2005 FORD E-350 1 FDSS34P75HA60731 BKW-6682 239000
4 2006 FORD E-350 1 FDSS34P66DA83460 CLM-2806 174000
5 2007 FORD E-350 1FDSS34P27DA59304 DAX-1653 196000
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800-380-7909
"Our#1 Priority is Patient Care„
Application Attachment #14
At the present time, First Choice Medical Transport is only providing non-
emergency BLS transportation. Our current fees will coincide with the fee
schedules provided by Medicare and/or insurance companies with whom we
are approved. No additional fees, beyond those covered by Medicare and/or
insurance, will be charged to the patient. For those individual with no coverage,
our fees will follow the Medicare fee schedule for North Carolina.
FCMT 2015 Fee Schedule
Charges Ambulance
Load Charge $214.99
Mileage $7.27/mile
Wait Time (medical appts) $1/minute