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HomeMy WebLinkAbout2018-574-E Emergency Svc - South Orange Rescue Squad operational agreement Page1of4 Version:September2018  OrangeCountyOperationalAgreementforSouthOrangeRescueSquad   Š‹•’‡”ƒ–‹‘ƒŽ‰”‡‡‡–ƒ••‹‰•ƒ—–Š‘”‹–›ˆ‘”‘—–Š”ƒ‰‡‡•…—‡“—ƒ†ȋȌ–‘‘’‡”ƒ–‡ ’‘‹–Ǧ–‘Ǧ’‘‹–ǡǦƒ•‹…Ž‡˜‡Ž’ƒ–‹‡–…ƒ”‡ƒ†–”ƒ•’‘”–ƒ–‹‘•‡”˜‹…‡•™‹–Š‹–Š‡…‘”’‘”ƒ–‡Ž‹‹–• ‘ˆ”ƒ‰‡‘—–›Ǥ  ‘—–Š”ƒ‰‡‡•…—‡“—ƒ†•ŠƒŽŽǣ  ͳȌ‡‘•–”ƒ–‡–‘–Š‡”ƒ‰‡‘—–›‡’ƒ”–‡–‘ˆ‡”‰‡…›‡”˜‹…‡•Ǧ‹˜‹•‹‘ǡ Š‡”‡‹ƒˆ–‡””‡ˆ‡””‡†–‘ƒ•̶̶ǡƒ†–Š‡”ƒ‰‡‘—–›‹•ƒƒ‰‡”̵•ˆˆ‹…‡–Šƒ–ƒŽŽ ”‡“—‹”‡†‹•—”ƒ…‡…‘˜‡”ƒ‰‡ƒ•‹–’‡”–ƒ‹•–‘™‘”‡”̵•…‘’‡•ƒ–‹‘ǡŽ‹ƒ„‹Ž‹–›ǡƒ†’”‘’‡”–› †ƒƒ‰‡…‘˜‡”ƒ‰‡‹•‹’Žƒ…‡ƒ†…‘–‹—‘—•Ž›˜ƒŽ‹†„›’”‘˜‹†‹‰ƒ…‡”–‹ˆ‹…ƒ–‡‘ˆ‹•—”ƒ…‡–‘ –Š‡”ƒ‰‡‘—–›‹”‡…–‘”‘ˆ‡”‰‡…›‡”˜‹…‡•‘”Š‹•ȀŠ‡”†‡•‹‰‡‡Ǥ‡“—‹”‡†‹•—”ƒ…‡ —•–„‡ƒ‹–ƒ‹‡†ƒ–ƒŽŽ–‹‡•Ǥ•ŠƒŽŽ‘–‹ˆ›–Š‡”ƒ‰‡‘—–›‹”‡…–‘”‘ˆ ‡”‰‡…›‡”˜‹…‡•‘”Š‹•ȀŠ‡”†‡•‹‰‡‡ǡ‘ˆƒ›…Šƒ‰‡‹–Š‡•–ƒ–—•‘ˆ”‡“—‹”‡†‹•—”ƒ…‡ …‘˜‡”ƒ‰‡ǡ‹…Ž—†‹‰’‘Ž‹…›…Šƒ‰‡•ǡ™‹–Š‹–Š”‡‡ȋ͵Ȍ„—•‹‡••†ƒ›•‘ˆ•ƒ‹†…Šƒ‰‡Ǥ  ʹȌ‡…”‡†‡–‹ƒŽ‡†‹ƒ……‘”†ƒ…‡™‹–ŠͳͲͳ͵ǦͲˆˆ‹…‡‘ˆ‡”‰‡…›‡†‹…ƒŽ‡”˜‹…‡• ‡‰—Žƒ–‹‘•ǡ‡…–‹‘ǤʹͲ͹Ǧ ”‘—†„—Žƒ…‡ǣ‡Š‹…Ž‡ƒ†“—‹’‡–‡“—‹”‡‡–•Ǥ  ͵Ȍ —…–‹‘‹ƒ……‘”†ƒ…‡™‹–Š–Š‡”ƒ‰‡‘—–››•–‡ŽƒǤ  ͶȌ”‘˜‹†‡–‘–Š‡”ƒ‰‡‘—–›‹”‡…–‘”‘ˆ‡”‰‡…›‡”˜‹…‡•ǡ‘”Š‹•ȀŠ‡”†‡•‹‰‡‡ǡ™”‹––‡ ‘–‹…‡‘ˆ†‡‹ƒŽǡ•—•’‡•‹‘‘””‡˜‘…ƒ–‹‘‘ˆƒ†Ȁ‘””‡•–”‹…–‹‘•–‘ƒ›Ž‹…‡•‡•ǡ’‡”‹–•ǡ ƒ†Ȁ‘”…”‡†‡–‹ƒŽ•’‡”–ƒ‹‹‰–‘ͳͲͳ͵ǦͲˆˆ‹…‡‘ˆ‡”‰‡…›‡†‹…ƒŽ‡”˜‹…‡• ‡‰—Žƒ–‹‘•™‹–Š‹–Š”‡‡ȋ͵Ȍ„—•‹‡••†ƒ›•‘ˆ”‡…‡‹˜‹‰‘–‹…‡‘ˆ•ƒ‡Ǥ  ͷȌ‡•’‘†–‘”‡“—‡•–•ˆ‘”‹ˆ‘”ƒ–‹‘’‡”–ƒ‹‹‰–‘‹˜‡•–‹‰ƒ–‹‘•™‹–Š‹–Š”‡‡ȋ͵Ȍ„—•‹‡•• †ƒ›•Ǥ  ͸Ȍƒ‰”‡‡•–‘•–ƒˆˆƒ‘™‡†ƒ„—Žƒ…‡™‹–Š•›•–‡”‡Ž‡ƒ•‡†•‡˜‡‹‰Š–•’‡” ™‡‡Ǥ›…Šƒ‰‡•–‘–Š‡‘’‡”ƒ–‹‘•‘ˆ–Š‹•—‹–ˆ”‘‡‹–Š‡”‘”•ŠƒŽŽ„‡ †‹•…—••‡†ƒ†ƒ‰”‡‡†—’‘„›„‘–Š’ƒ”–‹‡•Ǥ  ͹Ȍƒ‰”‡‡•–‘ƒ••‹•–„›”‡•’‘†‹‰™‹–Šƒ„—Žƒ…‡•ƒ†’‡”•‘‡Žǡ™Š‡•‘ ”‡“—‡•–‡†„›ǡ–‘‡‡”‰‡…›…ƒŽŽ•ǡ†‹•ƒ•–‡”•ǡ—Ž–‹’Ž‡ƒ•—ƒŽ–› …‹†‡–•ȋŽ•Ȍ ƒ†Ȁ‘”‹…ƒ•‡‘ˆ•›•–‡‘˜‡”Ž‘ƒ†Ǥ ƒǤŠ‡”‡•’‘†‹‰–‘ƒ›…ƒŽŽˆ‘”•‡”˜‹…‡‘”‹…‹†‡–‹ƒ…ƒ’ƒ…‹–›ǡƒ‰”‡‡• –Šƒ–—’‘‡˜ƒŽ—ƒ–‹‘‘ˆ–Š‡’ƒ–‹‡–ȋ•Ȍ„›–Š‡‹”’‡”•‘‡Žǡ‹ˆ‹–‹•†‡–‡”‹‡†–Šƒ– ‘”‡‡”‰‡…›…ƒ”‡ƒ†–”ƒ•’‘”–‹•‹–Š‡„‡•–‹–‡”‡•–‘ˆ–Š‡’ƒ–‹‡–ȋ•Ȍǡ‹‡†‹ƒ–‡ …‘–ƒ…–™‹–Š”ƒ‰‡‘—–›‘—‹…ƒ–‹‘•™‹ŽŽ„‡‡•–ƒ„Ž‹•Š‡†˜‹ƒ”ƒ†‹‘–‘ …‘‘”†‹ƒ–‡–Š‡ƒ’’”‘’”‹ƒ–‡”‡•’‘•‡‘ˆ”‡•‘—”…‡•Ǥ ˆƒ–ƒ›–‹‡ ”‘˜‹†‡”•ƒ”‡—…‡”–ƒ‹ƒ„‘—––Š‡‡‡†ˆ‘”…ƒ”‡ƒ†–”ƒ•’‘”–ƒ–‹‘ǡ’‡”•‘‡Ž •ŠƒŽŽ‹‡†‹ƒ–‡Ž›‡•–ƒ„Ž‹•Š…‘—‹…ƒ–‹‘•˜‹ƒ”ƒ†‹‘™‹–Š–Š‡‘Ǧ†—–› —’‡”˜‹•‘”ˆ‘”†‹”‡…–‹‘Ǥ „Ǥ—•–”‡•’‘†‹ƒ–‹‡Ž›ƒ‡”–‘ƒŽŽ”‡“—‡•–•ˆ‘”•‡”˜‹…‡™‹–Š‹”ƒ‰‡ ‘—–›ǡƒ†ƒ‹–ƒ‹•—ˆˆ‹…‹‡–”‡•‘—”…‡•‹…Ž—†‹‰’‡”•‘‡Žƒ†ƒ’’ƒ”ƒ–—•™‹–Š‹ DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD  Page2of4 Version:September2018 ”ƒ‰‡‘—–›–‘‡•—”‡ƒ–‹‡Ž›”‡•’‘•‡Ǥ  ͺȌ‹•”‡•’‘•‹„Ž‡ˆ‘”—’†ƒ–‹‰’‡”•‘‡Ž”‘•–‡”•ǡ˜‡Š‹…Ž‡‹ˆ‘”ƒ–‹‘ƒ†’”‘˜‹†‡” ‹ˆ‘”ƒ–‹‘‹–Š‡‘”–Šƒ”‘Ž‹ƒˆˆ‹…‡‘ˆ‘–‹——›•–‡Ǥ ƒǤ‡™’‡”•‘‡Ž•ŠƒŽŽ„‡ƒ††‡†‹‘–‹——’”‹‘”–‘™‘”‹‰–Š‡‹”ˆ‹”•–•Š‹ˆ–ƒ† •‡’ƒ”ƒ–‡†‡„‡”••ŠƒŽŽ„‡”‡‘˜‡†ˆ”‘‘–‹——™‹–Š‹•‡˜‡ȋ͹Ȍ†ƒ›•‘ˆ ‘ˆˆ‹…‹ƒŽ•‡’ƒ”ƒ–‹‘Ǥ „Ǥ™‹ŽŽƒ†˜‹•‡•‹—Ž–ƒ‡‘—•Ž›™‹–ŠƒŽŽ—’†ƒ–‡•–‘‘–‹——ˆ‘”…Šƒ‰‡• ƒˆˆ‡…–‹‰ǯ•†‹˜‹•‹‘ǤŠ‹•™‹ŽŽƒŽŽ‘™–‘—’†ƒ–‡–Š‡‡Ž‡…–”‘‹…’ƒ–‹‡– …ƒ”‡”‡’‘”–‹‰ȋ‡Ȍ•›•–‡–‘‡•—”‡–Šƒ–‡„‡”•…‘’Ž‡–‹‰’ƒ–‹‡–…ƒ”‡ ”‡’‘”–•ƒ”‡ƒ††‡†–‘–Š‡‘–‹——”‘•–‡”–‘ƒ˜‘‹††ƒ–ƒ‡””‘”•‹–ƒ–‡ ”‡’‘”–‹‰Ǥ …Ǥ‡™‡„‡”••ŠƒŽŽ‘–’ƒ”–‹…‹’ƒ–‡‹†‘…—‡–ƒ–‹‘—–‹Ž–Š‡›Šƒ˜‡ „‡‡ƒ††‡†–‘–Š‡ ”‘•–‡”ƒ†–Š‡‡•›•–‡Ǥ †Ǥˆ–‡”–‹‡Ž›ƒ†’”‘’‡”‘–‹ˆ‹…ƒ–‹‘‘ˆ•‡’ƒ”ƒ–‡†‡„‡”•„›–‘ǡ‹• ˆ”‡‡ˆ”‘ˆ—”–Š‡”‘„Ž‹‰ƒ–‹‘–‘‡•—”‡–Šƒ–•‡’ƒ”ƒ–‡†‡„‡”•Šƒ˜‡„‡‡”‡‘˜‡† ˆ”‘–Š‡‡•›•–‡Ǥ  ͻȌ—•–ƒ‹–ƒ‹‘–‹—‹‰†—…ƒ–‹‘”‡’‘”–•ˆ‘”ƒŽŽ’‡”•‘‡Žƒ†ƒ‡”‡…‘”†• ‡Ž‡…–”‘‹…ƒŽŽ›ƒ˜ƒ‹Žƒ„Ž‡™‹–Š‹•‡˜‡ȋ͹Ȍ„—•‹‡••†ƒ›•–‘—’‘”‡“—‡•–Ǥ  ͳͲȌƒ‰”‡‡•–‘…‘’Ž›™‹–Š–Š‡…—””‡–‰‡…›”‡†‡–‹ƒŽ‹‰ —‹†‡Ž‹‡•ˆ‘”’”‘˜‹†‡”•ǡ ‘”ƒ•ƒ›„‡ƒ‡†‡†ˆ”‘–‹‡–‘–‹‡ǡ„›–Š‡‡†‹…ƒŽ‹”‡…–‘”ǤȋSeeAttachmentA, OrangeCountyCredentialingGuidelinesforEMTProvidersȌ ƒǤ‘–‹—‹‰†—…ƒ–‹‘–”ƒ‹‹‰–‘™ƒ”†•”‡…‡”–‹ˆ‹…ƒ–‹‘Ǥ  ‹Ǥ™‹ŽŽ’”‘˜‹†‡ƒ…‘–‹—‹‰‡†—…ƒ–‹‘’Žƒ–Šƒ–†‡–ƒ‹Ž•–Š‡‡–Š‘†„› ™Š‹…Š’”‘˜‹†‡”•™‹ŽŽƒ‹–ƒ‹–Š‡‹”…‡”–‹ˆ‹…ƒ–‹‘ƒ†Š‘™™‹ŽŽ‡•—”‡ –”ƒ‹‹‰‡‡†•ƒ”‡‡–ǤŠ‡’Žƒ™‹ŽŽ‹…Ž—†‡–Š‡ˆ‘ŽŽ‘™‹‰ ͳǤ‘…—‡–ƒ–‹‘‘ˆ‡†—…ƒ–‹‘ƒŽŠ‘—”•ƒ†‘„Œ‡…–‹˜‡•ˆ‘”…”‡†‡–‹ƒŽ‹‰ …›…Ž‡ ʹǤ‘…—‡–ƒ–‹‘‘ˆ•‹ŽŽ•’”‘…‡†—”‡• ͵Ǥ††‹–‹‘ƒŽ†‘…—‡–ƒ–‹‘‘ˆŠ‘™–‘ƒŽ–‡”–Š‡’Žƒ™Š‡…”‹–‹…ƒŽ ‹••—‡•ƒ”‡‹†‡–‹ˆ‹‡†‹–Š‡‡‡”‡˜‹‡™’”‘…‡••Ǥ ͶǤ ’Ž‡‡–ƒ–‹‘‘ˆ‡™’”‘…‡†—”‡•Ȁ‡“—‹’‡–Ǥ  ‹‹Ǥ”‘˜‹†‡”•ƒ›ƒ‹–ƒ‹…”‡†‡–‹ƒŽ•„›ƒ––‡†‹‰ƒ”‡ˆ”‡•Š‡”…‘—”•‡ˆ‘”–Š‡‹” Ž‡˜‡Ž™‹–Š‹–Š‡‹”…”‡†‡–‹ƒŽ‹‰’‡”‹‘†‘”ƒ›ƒ––‡†‘–ŠŽ›–”ƒ‹‹‰–‘ ‡‡––Š‡”‡“—‹”‡†–‘’‹…•Ǥ ͳǤ—ƒŽ–”ƒ‹‹‰ˆ‘”Ž‘‘†‘”‡ƒ–Š‘‰‡•ƒ† –”ƒ‹‹‰‹•–‘ „‡‹…Ž—†‡†ƒ—ƒŽŽ›‹–Š‡–”ƒ‹‹‰’ŽƒǤ ʹǤ—•–„‡”‡…‡”–‹ˆ‹‡†‡˜‡”›–™‘›‡ƒ”•ˆ‘”ƒŽŽ”‘˜‹†‡”•Ǥ  ‹‹‹ǤŽŽ…”‡†‡–‹ƒŽ‡†’”‘˜‹†‡”•ƒ”‡”‡“—‹”‡†–‘ƒ––‡†…‘–‹—‹‰‡†—…ƒ–‹‘ƒ† ”‡…‡‹˜‡ƒ’”‡Ǧ•‡–—„‡”‘ˆŠ‘—”•’‡”›‡ƒ”‹•’‡…‹ˆ‹‡†ƒ”‡ƒ•‘ˆ‡†—…ƒ–‹‘–‘ „‡†‡ˆ‹‡†‹–Š‡”ƒ‰‡‘—–››•–‡ŽƒǤ  DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD  Page3of4 Version:September2018 ‹˜Ǥ™‹ŽŽƒ‹–ƒ‹ƒŽŽ”‘•–‡”•ˆ‘”…‘–‹—‹‰‡†—…ƒ–‹‘ǤŽŽ–”ƒ‹‹‰”‡…‘”†• ƒ”‡”‡“—‹”‡†–‘„‡ƒ‹–ƒ‹‡†ˆ‘”‡ƒ…Š’”‘˜‹†‡”ˆ‘”ƒ’‡”‹‘†‘ˆƒ–Ž‡ƒ•–͸ ›‡ƒ”•  ˜Ǥ‘–‹—‹‰‡†—…ƒ–‹‘‘ˆˆ‡”‡†„›—•–„‡‘˜‡”•‡‡„›ƒ‡˜‡Ž  ‹•–”—…–‘”Ǥ  ˜‹Ǥ—•–†‡•‹‰ƒ–‡ƒ–”ƒ‹‹‰‘ˆˆ‹…‡”ƒ†’”‘˜‹†‡–Š‡–”ƒ‹‹‰‘ˆˆ‹…‡” –Š‡‹†‹˜‹†—ƒŽ̵•ƒ‡ƒ†’”‡ˆ‡””‡†…‘–ƒ…–‹ˆ‘”ƒ–‹‘ƒ•™‡ŽŽƒ•–Š‡‹” …”‡†‡–‹ƒŽ•Ȁ“—ƒŽ‹ˆ‹…ƒ–‹‘•–‘‡•—”‡–Š‡–ƒ–‡̵•…‘–‹—‹‰‡†—…ƒ–‹‘ ”‡“—‹”‡‡–•ƒ”‡‡–Ǥ  ˜‹‹Ǥ ‘”†‡”ˆ‘”–‘…‘†—…–‹ǦŠ‘—•‡…‘–‹—‹‰‡†—…ƒ–‹‘‹•–”—…–‹‘‹ …‘’Ž‹ƒ…‡™‹–Š”ƒ‰‡‘—–›†—…ƒ–‹‘ƒŽ •–‹–—–‹‘ǡ”ƒ‹‹‰ˆˆ‹…‡”• —•–’‘••‡••ƒ‡˜‡Ž  •–”—…–‘”…”‡†‡–‹ƒŽˆ”‘–ƒ–‡Ǥ  ͳͳȌ™‹ŽŽ†‡•‹‰ƒ–‡ƒ”‡’”‡•‡–ƒ–‹˜‡™Š‘•‡ƒ––‡†ƒ…‡ƒ––Š‡•–ƒ–—–‘”‹Ž›”‡“—‹”‡†‡‡” ‡˜‹‡™‘‹––‡‡‡‡–‹‰•™‹ŽŽƒ†Š‡”‡–‘–Š‡‡‡”‡˜‹‡™‘‹––‡‡›•–‡Žƒ‘Ž‹…› ƒ•†‡•…”‹„‡†‹ͳͲͳ͵ǤͲͶͲͺȋͳͲȌǤ  ͳʹȌ –Š‡’”‘˜‹•‹‘‘ˆ’ƒ–‹‡–…ƒ”‡ƒ†–”ƒ•’‘”–•‡”˜‹…‡•ǡ”‘˜‹†‡”••ŠƒŽŽƒ†Š‡”‡–‘–Š‡ ”ƒ‰‡‘—–›‡”‰‡…›‡†‹…ƒŽ‡”˜‹…‡•”ƒ…–‹…‡”‘–‘…‘Ž•Ǥ  ͳ͵Ȍƒ†ƒ‰”‡‡–‘ƒ‹‹—‘ˆ‘Ž‡••–Šƒƒƒ—ƒŽ‡‡–‹‰–‘”‡˜‹‡™ƒ†—’†ƒ–‡ –Š‹•ƒ‰”‡‡‡–ƒ†’”‘…‡†—”‡•Ǥ††‹–‹‘ƒŽ‰”‘—’‡‡–‹‰•ƒ›„‡”‡“—‡•–‡†„›ƒ›’ƒ”–› ‹ˆ‡‡†•ƒ”‹•‡Ǥ  ͳͶȌƒ‰”‡‡•–Š‡”‡•ŠƒŽŽ„‡ƒ‹‹—‘ˆ‹‡–›ȋͻͲȌ†ƒ›•™”‹––‡‘–‹…‡’”‹‘”–‘–Š‡ –‡”‹ƒ–‹‘‘ˆ–Š‹•ƒ‰”‡‡‡–„›–Š‡”‹˜ƒ–‡ ”ƒ…Š‹•‡”‘˜‹†‡”Ǥ  ͳͷȌ™‹ŽŽ’”‘˜‹†‡ƒŽŽ‡“—‹’‡–ƒ†‡†‹…ƒŽ•—’’Ž‹‡•‡…‡••ƒ”›–‘‘—–ˆ‹––Š‡‹”ƒ„—Žƒ…‡• ‹‹–‹ƒŽŽ›Ǥƒ‰”‡‡•–Šƒ–ƒ‹–ƒ‹•–Š‡ƒ„‹Ž‹–›–‘”‡•–‘…ˆ”‘•—’’Ž‹‡•ƒ• ‡‡†‡†ƒˆ–‡”–Š‡…‘’Ž‡–‹‘‘ˆ’ƒ–‹‡–…ƒ”‡Ǥ  ͳ͸Ȍ™‹ŽŽ’”‘˜‹†‡™‹–Šˆ—‡Ž…ƒ”†•–‘ƒŽŽ‘™–‘ˆ—‡Ž–Š‡‹”‡‡”‰‡…›”‡•’‘•‡ ˜‡Š‹…Ž‡•ˆ‘”–Š‡’—”’‘•‡•‘ˆƒ••‹•–‹‰™‹–Š”‡•’‘•‡Ǥ  ͳ͹Ȍƒ‰”‡‡•–‘ˆ‘ŽŽ‘™–Š‡”ƒ‰‡‘—–›ƒ•• ƒ–Š‡”‹‰Žƒ‹–Š‡’Žƒ‹‰‘ˆƒ•• ‰ƒ–Š‡”‹‰•’‡…‹ƒŽ‡˜‡–•ƒ†–‘‘–‹ˆ›‘ˆƒ›ƒ†ƒŽŽ•’‡…‹ƒŽ‡˜‡–…‘˜‡”ƒ‰‡ •‡˜‡ȋ͹Ȍ†ƒ›•’”‹‘”–‘–Š‡‡˜‡–ǤȋSeeAttachmentB,OrangeCountyMassGatheringPlanȌ  –Š‡‡˜‡––Šƒ––Š‡ƒ•• ƒ–Š‡”‹‰’Žƒ”‡“—‹”‡•ƒ†˜ƒ…‡†Ž‹ˆ‡•—’’‘”–…‘˜‡”ƒ‰‡ǡ™‹ŽŽ ƒ‡–Š‡”‡“—‡•–‘Ž‡••–Šƒˆ‘—”–‡‡ȋͳͶȌ†ƒ›•’”‹‘”–‘–Š‡‡˜‡–Ǥ™‹ŽŽ‹˜‘‹…‡ –Š‡‡˜‡–’Žƒ‡”•‡’ƒ”ƒ–‡Ž›ˆ”‘Ǥƒ‰”‡‡•–‘’”‘˜‹†‡™‹–Š‘Ž‡••–Šƒ ˆ‘—”–‡‡ȋͳͶȌ†ƒ›•™”‹––‡ƒ†˜ƒ…‡‘–‹…‡ˆ‘””‡“—‡•–•ˆ‘”…‘˜‡”ƒ‰‡ˆ‘”Ǧ…‘‘”†‹ƒ–‡† •’‡…‹ƒŽ‡˜‡–•Ǥ  ͳͺȌƒ–ƒ…‘ŽŽ‡…–‹‘Šƒ”†™ƒ”‡•ŠƒŽŽ„‡’—”…Šƒ•‡†„›–Šƒ–ƒŽŽ‘™•–‘—–‹Ž‹œ‡–Š‡†ƒ–ƒ ”‡•‘—”…‡•ƒ•’”‡•…”‹„‡†ƒ†’”‘˜‹†‡†„›–Š‡‘—–›ˆ‘”–Š‡ƒ…“—‹•‹–‹‘ǡ–”ƒ•‹••‹‘ƒ† ”‡’‘”–‹‰‘ˆ’ƒ–‹‡–…ƒ”‡”‡’‘”–•ƒ†‘–Š‡”†ƒ–ƒƒ••‘…‹ƒ–‡†™‹–Š”ƒ•’‘”–ƒ† DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Page4of4 Version:September2018 ‘Ǧ”ƒ•’‘”–Ǥ ͳͻȌƒ‰”‡‡•–‘—–‹Ž‹œ‡ƒ†…‘’Ž›™‹–Š–Š‡”ƒ‰‡‘—–› ˆ‡…–‹‘‘–”‘ŽŽƒǤȋSee AttachmentC,OrangeCountyInfectionControlPlanȌŠ‡‹ˆ‡…–‹‘…‘–”‘Ž‘ˆˆ‹…‡”ˆ‘””ƒ‰‡ ‘—–›‹•ChrisPope™Š‘…ƒ„‡”‡ƒ…Š‡†ƒ–919Ǧ886Ǧ7673Ǥ ʹͲȌ—”‹‰–Š‡…‘—”•‡‘ˆ†ƒ‹Ž›‘’‡”ƒ–‹‘•ǡ•—’‡”˜‹•‘”•™‹ŽŽ…‘—‹…ƒ–‡†‹”‡…–Ž›™‹–Š–Š‡ •—’‡”˜‹•‘”‘…ƒŽŽƒ†˜‹…‡˜‡”•ƒ˜‹ƒ’Š‘‡ƒ–ͻͳͻǦͻ͸͹Ǧͳͷͳͷ‡š–ǤͺͺǤ —–Š‘”‹œ‡†‹‰ƒ–—”‡•ǣ    ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴  ”‡†–‹’‡ǡŠƒ‹”ƒƒ–‡     ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴ ‹ƒŠ ‡ˆˆ”‹‡•ǡ‡”‰‡…›‡”˜‹…‡•‹”‡…–‘”ƒ–‡ DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD   Rev. 8/8/2018 - 1 - Orange County Emergency Services Agency Credentialing Guidelines Introduction Orange County Emergency Services is committed to excellent and timely patient care for our citizens and to partnering with organizations with a similar commitment. Thus, OCES is interested in providing structure, assistance, and guidelines for Orange County Agencies interested in advancing their EMS service levels. This document provides such guidance and structure. OCES personnel are prepared to provide assistance and mentoring to move the process of advancing EMS service to the fullest extent desired by local agencies. Orange County Emergency Services Agency Credentialing Process Every Orange County Agency providing EMS services in Orange County must maintain a credentialing level of Medical Responder as a base certification level. All Agencies who wish to increase their EMS service level must follow the established guidelines below. It would be helpful for Agencies wishing to move to advanced levels of service to have an initial conversation with both the Orange County Operations Manager and the Training Coordinator prior to initiating the process to ensure full understanding of the requirements. Credentialing Requirements The credentialing process requires the submission of the following documents (detailed below): 1.Initial Application (Attachment 1) 2.Agency CONTINUUM Roster Attestation 3.Agency Service Description 4.Agency Service Provision Attestation 5.Agency Training Coordinator Designation 6.Agency Provider Initial Credentialing Process 7.Agency Continuing Education Plan 8.Agency Documentation Process/Policy "UUBDINFOU"DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Rev. 8/8/2018 - 2 - 9. Agency Quality Assurance Plan 10. Agency Equipment Attestation 11. Agency Infection Control Plan/Policy 12. Agency Medical Treatment Agreement Required Document Description 1. Agency CONTINUUM Roster Attestation: Completed Attestation (Attachment 2) that the Agency is maintaining an active and up to date roster in the North Carolina Office of EMS Credentialing Information System. a. CONTINUUM - "Credentialing Information System" is a database of all credentialed providers in the North Carolina EMS system. It is a mechanism for agencies to verify an individual's credential and date of expiration. b. All EMS Response Agencies in Orange County are currently listed in the CONTINUUM. c. As a credentialed provider joins or leaves an Agency, Agencies will update their CONTINUUM roster. d. The North Carolina Office of EMS will update provider’s credentials as they change including expiration dates. The EMS system administrator, training Coordinator, and Agency representative receive notification of all expired credentials automatically through the CONTINUUM system. e. Providers receive email notification at thirty days prior to expiration and new credentials are mailed through CONTINUUM to the provider’s listed address; therefore it is critical that providers ensure their contact information is current in CONTINUUM. 2. Agency Service Description: Orange County Emergency Services requires a full description of the type and level of EMS service to be provided by the applying Agency, including the location(s) from which it is intended to operate. a. Agencies should define the type and level of service to be provided (e.g. Emergency Medical Technician, Advanced EMT, Paramedic). b. Agencies applying for Advanced EMT or Paramedic Level upgrade to service must obtain Provider License with the North Carolina State Office of EMS as defined in 10A NCAC 13P .0204. Applications to State OEMS must occur at least 30 days prior to projected implementation date. c. Agencies should provide their defined service area and any mutual aid areas for EMS response. d. Agencies should describe the vehicles routinely used for responding to medical calls with the vehicle’s staging location. (i.e. If an Agency utilizes a 1st Responder Vehicle for all calls.) DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Rev. 8/8/2018 - 3 - 3. Agency Service Provision Attestation (Attachment 3): Attestation to the ability to provide at least one certified person at the established level of service on each first due apparatus. A description of the Agency’s capability to provide twenty-four hour coverage, seven days per week for the requested level of service in the first due area covered by the Agency. a. For example, if an Agency were going to initiate an Advanced EMT service, a description of how the Agency’s Advanced EMT's would be staffed to ensure the first-out unit for medical calls is available 24/7. b. This only applies to the Agency’s first due unit. If the first unit is dedicated and a second unit for the same service area is dispatched to a second call, the second unit would not be required to have an A-EMT on the apparatus. 4. Agency Training Coordinator Designation: a. Each Agency must designate a training Coordinator. b. This form (Attachment 4) will include the individual's name and preferred contact information as well as their credentials / qualifications to ensure the State's continuing education requirements are met. c. This individual will be the "go to" person if the State or County request access to provider’s continuing education records for auditing purpose. d. The agency training Coordinator should work closely with the OCEMS training Coordinator for mentorship and assistance with training. e. Agencies have the option of naming a backup individual who will serve in the instance that the primary training Coordinator is unable to provide the service. f. In order for agencies to conduct in-house continuing education instruction in compliance with Orange County Educational Institution, Training Coordinators must possess a Level I EMS Instructor credential from State OEMS. 5. Agency Provider Initial Credentialing Process: Agency’s Plan for initial credentialing a. Agency selecting EMT upgrade will: i. Ensure all Agency EMT’s pass EMT protocol and medication testing. ii. Ensure that providers document all Phase I core competency requirements as described in attachment 5. iii. Ensure completed initial Orange County Emergency Services Credentialing TSOP at EMT level. iv. Ensure completed documentation of process and submission the OCES Training Coordinator for evaluation and Orange County credentialing. b. Agency selecting Advanced EMT upgrade will: i. Ensure that providers meet all Phase II core competency requirements as described in attachment 5.Ensure that all Agency DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Rev. 8/8/2018 - 4 - AEMT’s pass OCES Advanced EMT Protocol and medication testing. ii. Ensure completed initial Orange County Emergency Services Credentialing Technical Scope of Practice Examination (TSOP) at Advanced EMT level. iii. Pass oral board examination with Orange County Emergency Services Medical Direction and Training staff.** c. Agency selecting Paramedic upgrade will: i. Ensure that providers meet all Phase III core competency requirements as described in attachment 5. Ensure that all Agency Paramedics pass Paramedic Protocol and medication testing. ii. Ensure completed initial Orange County Emergency Services Credentialing TSOP at Paramedic level iii. Pass oral board examination with Orange County Emergency Services Medical Direction and Training staff. ** *Field precepting may be concurrent with initial certification course. However, documentation must be retained and all field precepting must occur in Orange County **All Precepting evaluation paperwork must be completed and submitted to the OCES Training Coordinator prior to scheduling board examinations. 6. Agency Continuing Education Plan: Agency’s continuing education and skill maintenance plan a. This plan should detail the method by which Agency providers will maintain their certification and how the Agency will ensure training needs are met. i. Documentation of educational hours and objectives for credentialing cycle ii. Documentation of skills procedures iii. Additional documentation of how to alter the plan when critical issues identified in the Peer Review process arise or implementation of new procedures/equipment. b. Providers may maintain credentials by attending a refresher course for their level within their credentialing period or may attend monthly training to meet the required topics. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Rev. 8/8/2018 - 5 - i. Annual training for Blood Borne Pathogens and HIPPA training is to be included annually in the training plan. ii. CPR must be recertified every two years for all EMS Providers. iii. Advanced EMT: all EMT requirements plus ITLS or PHTLS every four years. iv. Paramedic: all EMT and A-EMT requirements plus ACLS every two years, PALS or PEPP every two years. c. All credentialed providers are required to attend continuing education and receive a pre-set number of hours per year in specified areas of education to be defined in the Orange County EMS System Plan. (See attached refresher guidelines from NCOEMS) d. ALS Providers will be expected to adhere to OCEMS training standards. The OCEMS Training Coordinator will assist Agencies as much as possible. e. ALS providers are required to obtain an additional 24 hours over their four year recertification period. f. All training records are required to be maintained for each provider for a period of at least 6 years (even if the provider leaves the Agency). 7. Agency Documentation Process/Policy: Provide a written plan of the Agency’s patient care documentation capability, retention of patient care documentation policy, and transfer of information process. a. All patient contact by Agency personnel should be documented thoroughly including findings, initial assessment, secondary assessment, all care provided by the Agency prior to EMS arrival. b. Orange County EMS protocol requires the "C.H.A.R.T." method of narrative documentation. c. Included in this plan is the Agency’s method of retaining the records in accordance with HIPPA regulations. d. Include how "Pre-EMS" arrival information will be shared with Emergency Medical Services ambulance crew and the hospital receiving facility. 8. Agency Equipment Attestation: Attestation that the Agency has the appropriate equipment to operate at the requested level of service (See attached "Minimum Required Equipment List", Attachment 6 ) a. Pursuant to proposed North Carolina EMS Rule, Agencies seeking AEMT and/or Paramedic level credentialing shall apply to the OEMS for an EMS Non-transporting Vehicle Permit prior to placing the vehicle in service. b. EMS Nontransporting Vehicle Permits shall not be transferred. c. The EMS Nontransporting Vehicle Permit shall be posted as designated by the OEMS inspector. d. Vehicles that are not owned or leased by the EMS Provider are ineligible for permitting. e. The Orange County System Medical Director may choose to require systems to carry equipment and medication beyond the minimum State DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Rev. 8/8/2018 - 6 - OEMS requirement. Attachment 7 meets the minimum State and County requirements of equipment to be carried by an Agency’s service based on the selected credential level. f. Agencies may choose to carry more than what is on the list, as long as the equipment, medication, or supply is approved by the System medical director in advance and is only utilized by appropriately credentialed providers. g. Agencies will determine the amount of equipment necessary to carry in inventory to ensure availability. h. Orange County will continue to restock equipment on scene as they are utilized; however Orange County is not responsible for initial stocking, unintentional opening, or expired stock. (with the exception of glucometer supplies) i. Agencies must provide a copy of their operational procedures for the management of equipment, supplies and medications. Medications must be stored in "Climate Controlled" Areas. j. Written plans for inventorying supplies should be provided. k. A daily vehicle equipment inventory sheet should be provided. 9. Agency Quality Assurance Plan: QA Designation and responsibilities. a. All Agencies will be required to conduct QA activity. b. The QA designee will ensure the providers are following the protocols adequately and not performing above their scope of practice. c. The QA designee is responsible for auditing skills procedures for competency for all practicing providers in the Agency. d. The QA designee will be required to attend Orange County EMS Peer Review sessions and will be responsible for collaborating on required Peer Review audits with the Orange County EMS QA Coordinator. Agency QA representatives should be able to offer insight and offer suggestions to protocols, procedures, etc. e. Agencies may designate the training Coordinator to maintain QA responsibilities or may select an independent QA Coordinator. 10. Agency Infection Control Plan/Policy: Provide a copy of the Agency’s Infection Control Policy (a written infectious Disease Control Policy includes written procedures which are approved by the EMS System Medical Director addressing the cleansing and disinfecting of vehicles and equipment used to treat patients) or attestation of the agency's commitment to follow OCEMS System Infection Control Policy. a. The Agency may write their own plan or provide copies of existing plans to Orange County. b. The Agency may adopt and implement Orange County Emergency Services Infection Control Policy. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Rev. 8/8/2018 - 7 - 11. Agency Medical Treatment Agreement: (Attachment 7) Orange County EMS Treatment Protocols must be followed by all providers functioning within this county. All providers function at the discretion and permission of the Orange County Emergency Services Medical Director and under his/her supervision. a. The Orange County Emergency Services Medical Director participates actively in training. b. The Medical Director has final authority on provider practice privileges. c. The Medical Directory also has the right and responsibility to suspend any provider he/she deems unfit or unqualified to perform to set standards. d. The Medical Director or Designee will be present at oral boards to determine provider’s capability to practice independently. e. Agencies must agree to adhere to the Orange County EMS System Plan medical disciplinary procedure (Attachment 8) Application Completion and Submission Completed Applications should be submitted directly to the Orange County Emergency Services EMS Operations Manager. The Operations Manager will be available by phone or email to discuss submitted applications. Individual Site Visits will be scheduled upon application acceptance. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD ORANGE COUNTY EMERGENCY SERVICES APPLICATION FOR Fire Department Level EMS Credentialing Please Mark Category: Level of Agency Credentialing EMT EMT Intermediate Paramedic Department Name:______________________________________________________________________ Primary Department Address:_____________________________________________________________ (If different) Physical Address City/State/Zip:_________________________________________________ Telephone number at local base of operations:________________________________________________ Name of Primary Contact Person___________________________________________________________ Telephone number for Primary Contact Person: _______________________________________________ Required Application Attachments 1. Completed attestation that department is maintaining active and up to date roster in the State Office of EMS, Credentialing information system. 2. 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. 3. Department attests to the ability to provide at least one certified person on each first due apparatus. A description of the applicant’s capability to provide twenty-four hour coverage, seven days per week for the request level of service in the first due area covered by the department. 4. Attestation that the department has the appropriate equipment to operate at the requested level of service (see attached equipment lists) 5. A copy of the applicant’s written operational protocols for the management of equipment, supplies, and medications 6. Attach the department’s continuing education plan (including skill maintenance plan) 7. Attach the Training Officer designation form. 8. Provide a written explanation of the department’s patient care documentation capability, retention of patient care documentation policy, and transfer of information process. 9. Provide a copy of the Department’s Infection Control Policy (a written Infectious Disease Control Policy as defined in Rule .0102(33) of this Subchapter and written procedures which are approved by the EMS System medical director that address the cleansing and disinfecting of vehicles and equipment that are used to treat or transport patients) or completed attestation that the department will follow the Orange County EMS System Infection control policy. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD I attest that the information provided is accurate and I have the authority to submit this application. Authorizing Signature: __________________________________________ Date: __________________ FOR OCES USE ONLY Reviewed by: ______________________________________ Date Filed:___________________________ Approved by Orange County EMS Medical Director:_________________________________ DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Attestation of Credentialing Information System Compliance _______________________________ Department attests that our Agency is maintaining an active and up to date roster in the North Carolina Office of EMS Credentialing Information System. Department Chief: ________________________________ ________________ (Signature) (Date) ________________________________ (Printed Name) FOR OCES USE ONLY Received by: ______________________________________ Date: ___________________________ Approved by Orange County EMS Training Officer: _________________________Date:_________________ DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD (Attachment 3) Agency Service Provision Attestation _______________________________ Department attests that our Agency will provide at least one ___________________ (certification level) on each first due apparatus to ensure consistent service is available to all areas covered by our Agency. I. Please attach a description of your Department’s capability to provide twenty-four hour coverage, seven days per week at the requested EMS service level. II.Agency Approval Department Chief: ________________________________ ________________ (Signature) (Date) ________________________________ (Printed Name) FOR OCES USE ONLY Received by: ______________________________________ Date: ___________________________ Approved by Orange County EMS Training Officer: _________________________Date:_________________ DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD (Attachment 2) DESIGNATION OF TRAINING OFFICER Agency Credentialing Guidelines require that the Agency indicate their designation of the EMS Training Officer. Agency Name: ________________________________________________ Date: _____/_____/________ The individual(s) who will provide EMS Training Officer services under the Agency Credentialing Guidelines shall be as follows: I. Agency EMS Training Officer: ______________________________ Contact Information ______________________________ ______________________________ ______________________________ ______________________________ Preferred Method of Contact: ______________________________ II. Back-Up Training Officer: ______________________________ (Optional) Contact Information ______________________________ ______________________________ ______________________________ ______________________________ Preferred Method of Contact: ______________________________ III. If applicable, please attach EMS Level I Instructor Certificate and any other Instructor certificates IV. Agency Approval Department Chief: ________________________________ ________________ (Signature) (Date) ________________________________ (Printed Name) FOR OCES USE ONLY Received by: ______________________________________ Date: ___________________________ DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD (Attachment 2) Approved by Orange County EMS Training Officer: _________________________Date:_________________ DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD 1.Phase 1 Training - (EMT) a.Field precepting with an assigned Field Preceptor and/or Field Training Officer. i.Primary focus is to demonstrate that the candidate is able to operate in the field in all settings, and is able to medically manage a basic level call appropriately with confidence and requiring no intervention from the field preceptor. ii.The field preceptor will check off the candidate’s skills and knowledge. iii.Components on the task check off booklet and document the candidate’s ability to demonstrate the Core Competency Criteria. Once all components have been signed off, and the daily precepting forms reflect that candidate has demonstrated all competencies the field preceptor will complete and sign a Phase 1 Release Form. iv.Once a Phase One Release Form is completed and signed by all required parties (Field Training Officer, Supervisor, Candidate), a candidate will then be required to attend Simulation Lab #1 (Phase 1 concentrates on EMT-B level complexity and treatment modalities) that includes an EMT-B protocol test, patient care simulation, and oral board examination. (A simulation case sample is posted later in this manual.) v.For EMTs only, successful completion of Phase One field precepting and successfully passing the Simulation Lab #1, oral board, and the protocol test officially allows an EMT-B to eligible for release to independent practice. The Training Officer’s signature will signify verification of all required training has been accomplished. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD 1.Phase 2 – (AEMT/Intermediate & Paramedic) a.While not required for all components Orange County will accommodate up to 32 shifts with a Paramedic Field Preceptor outside of initial certification requirements to accomplish these goals. i.The candidate demonstrates competency to care for patients in the field in all settings and is able to medically manage advanced level (AEMT/Intermediate) calls appropriately with confidence requiring no intervention from the field preceptor. ii.The field preceptor will check off the attendant skills and knowledge. iii.Components on the task check off booklet and document the candidate’s ability to demonstrate the Core Competency Criteria. Once all components have been signed off, and the daily precepting forms reflect that candidate has demonstrated all competencies the field preceptor will complete and sign a Phase 2 Release Form. iv.Once a Phase 2 Release Form is completed and signed by all required parties, a candidate will then be required to attend Simulation Lab #2. The candidate will also complete a AEMT/Intermediate protocol test, EKG rhythm test, and Pharmacology test. b.In the case where the candidate fails the Medication Test the candidate will be given a two week remediation period and then allowed to retest. c.In the case where the candidate fails the field precepting or the Simulation Lab#2, the candidate will be allotted 1 full remediation period that adheres to the same criteria as the original precepting period (32 shifts). d.For those departments that AEMT/Intermediate is the highest level of certification the completion of field precepting and the simulation Lab testing will allow the candidate to sit for Oral boards with members of Medical Direction and Training staff. **It is the discretion of the Medical Direction Staff to be considered for reentry back into the precepting process.** DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD 1.Phase 3 – (Paramedic Only) a.While not required for all components Orange County will accommodate up to 48 shifts with a Paramedic Field Preceptor outside of initial certification requirements to accomplish these goals. i.The candidate demonstrates competency to care for patients in the field in all settings and is able to medically manage advanced level (Paramedic) calls appropriately with confidence requiring no intervention from the field preceptor. ii.The field preceptor will check off the attendant skills and knowledge. iii.Components on the task check off booklet and document the candidate’s ability to demonstrate the Core Competency Criteria. Once all components have been signed off, and the daily precepting forms reflect that candidate has demonstrated all competencies the field preceptor will complete and sign a Phase 3 Release Form. iv.Once a Phase 3 Release Form is completed and signed by all required parties, the candidate will then be required to attend Simulation Lab #3 (the phase 3 lab concentrates on Paramedic level complexity and treatment modalities.) The candidate will also complete a Paramedic level protocol test, 12 Lead test, and Pharmacology test. b.With successful completion of Phase 3 field precepting, Simulation Lab #3, and an audit of precepting documentation with appropriate signatures the candidate will then sit for Oral Medical Board. The Medical Board shall consist of a minimum of four personnel with one representative from the Medical Director’s office, OCES EMS Training, the OCES EMS operations manager, and First Responder Department Training Officer. c.Successful completion of Medical Board officially concludes Phase 3. The Paramedic will be released from the precepting phase and will be eligible for release to independent practice. Released Paramedics enter a Quality Assurance phase for no less than six months. i.In the case where the candidate fails the field precepting, or Simulation Lab#3, testing, the candidate will be allotted 1 full remediation period (48 shifts) which adhere to the same criteria as the original precepting period. In the case where the candidate fails the Medical Board only the Medical Board will decide via consensus the appropriate remediation period/criteria. ii.If the candidate fails either the field precepting, or the Simulation Lab #3, or required testing the Second time, the candidate is denied the ability to obtain Paramedic credentials in Orange County. **It is the discretion of the Medical Direction Staff to be considered for reentry back into the precepting process.** DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD   10|Page  CoreCompetencyRequirements Toestablishcontinuityinevaluationoftheprecepteethefollowingrepresentsasetof guidelinesthatoutlinethecorecompetencythataprecepteeshouldpossess.Thesecore competencypointsshouldbereflectedinthedailyevaluationforms.   PatientCare:Assessesandappliesappropriatecareinemergencysituations •Assessneedformorepersonneland/orequipment •Assesschiefcomplaint/problemaccurately •Assessneedforimmediatevs.transportinterventions •Useshistoryandexamfindingstoaccuratelydiagnosethepatient •Assessownneedformoreinformationregardingapatientproblem/medicalprocedure •Demonstrateadequateknowledgeofanatomy,physiology,andpathophysiology •Useappropriateterminology,symbols,andabbreviationsinoralandwrittenreports •Demonstrateappropriateknowledgeofpharmacology •Demonstrateabilitytodeterminewhichprotocol(s)areappropriateforagivenpatient •Demonstrateknowledgeoftreatmentprotocolsandprocedures  CallManagement:Planpatientcare/sceneactionsappropriately •Planasystematicapproachtopatientcareusingassessmentinformation •Adheretoappropriatescenetimes •Demonstratereasonableandsafeprioritiesofcare/action •Obtainappropriatetreatmentorderswhichareappropriateforthepatient'sproblem(s)whennot specifiedbystandingprotocols •Demonstrateabilitytoadapttoadynamicworkingenvironment  Communication:Showabilitytoeffectivelycommunicatewithcoworkers,patient,andfamily •Demonstrateabilitytoeffectivelytransmitandreceiveinformationviaappropriatecommunications mediums(i.e.Radio,cellphone,Lifepakmodem,etc.) •Interactcourteouslywithcrew,firstresponders,patients,families,dispatch,others •Giveorganized,clear,andaccuratereportstohospitalviaradioand/orphone •Giveorganized,clear,andaccuratereporttoreceivingpersonnel •Shareplanofcare/actionwithcrewmembersandotherresponders •Displayprofessionalbehavioratalltimesonduty  Equipment&Supplies:Demonstrateappropriateuseandcareofequipment •Showworkingknowledgeofequipmentforfielduse •Participateincareandmaintenanceofequipment •Properlydocumentsallrequiredinformationandreportsproblemstosupervisorinatimelyfashion    DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD   11|Page  SceneSafety:Monitorsandlooksoutforthesafetyofscene •Ensuresscenesafetyatalltimesforself •Ensuresscenesafetyforothercrewmembers •Ensuresscenesafetyforpatient •Effectivelycommunicateswillallparties(PD,FD,ect.) •Identifiesneedsandimplementssolutionswithoutpromptingtoensurescenesafety.  Skills/Procedures:Demonstrateadequatelevelofskill(s)performance •Showsproperusesofallequipment •Selectsproperproceduresforappropriatepatients •PerformsinterventionswithoutremedialassistancefromPreceptors  TeamIntegration/Teamwork: •Effectivelyusesateambasedapproachtopatientcare •Providesfeedbacktootherteammembersforbettercommunication •Makessuggestionstosuperiorsaboutsolutionstoproblems •Communicateswithotherteammemberswithoutprompting •Acceptsfeedbackfromotherteammembersandappliesinaconstructivemanner •Activelyparticipatesinactivitiestobuildteamdynamic •Participatesindailyactivitiesandchoreswithoutprompting  Documentation:Maintainappropriaterecords •PCRcontainsanaccuratesummaryofpatientassessmentandtreatment •PCRcontainsallotherpertinentinformationandsignatures •PCRutilizesgoodspelling,grammar,andappropriatemedicalabbreviations •PCRisfiledinacceptabletimeframe  PersonalEvaluation:Abilitytoevaluatehis/herownperformance •Identifyareasinwhichskillimprovementisneeded •Identifyareasinwhichknowledgedeficitsareapparent •Identifystrengthsintermsofskillsandknowledge •Acceptcriticismorsuggestions •Usesuggestionsorcriticismstoimproveone’sself.  Navigation:Appropriatelylocateandnavigatetodestinations •Locatingandnavigatingtodestinationsusingmapswhenappropriate •Identifyingmajorandsecondarylandmarksforkeylocations •Correctlyidentifiesaddressandothercalllocationswithoutprompting •Correctlyuseslightsandsirensaccordingtocallcodesandlocallaws  DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD ORANGECOUNTYEMERGENCYSERVICES PreceptingShiftPerformanceRecord TRAINEE: STATION# PRECEPTOR:DATE: Instructions:Section1 Thetraineeshouldcompletethesectionbelowlistingeachpatientcareskillperformedforeachcall.Thepreceptorshouldrateeachskill performedanddiscusstheevaluationwiththetrainee.ALSassistanceskillscanberatedbythemediconthecall. Ratings:123 1=Needs Remediation 2=Needs Improvement 3=Demonstrates Proficiency CFS#CHIEFCOMPLAINT: SKILLSRATING Expectations: PrecepteeComments: PreceptorComments: CFS#CHIEFCOMPLAINT: SKILLSRATING Expectations: PrecepteeComments: PreceptorComments: DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD CFS#CHIEFCOMPLAINT: SKILLSRATING Expectations: PrecepteeComments: PreceptorComments: CFS#CHIEFCOMPLAINT: SKILLSRATING Expectations: PrecepteeComments: PreceptorComments: CFS#CHIEFCOMPLAINT: SKILLSRATING Expectations: PrecepteeComments: PreceptorComments: DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD ORANGECOUNTY EMERGENCYSERVICES End of Shift Performance Record Preceptee Name: Preceptor Name: Instructions : Section 2 At the conclusion of each shift preceptors should evaluatethetrainee'sperformanceforthedayand develop a planforthefuture. **Preceptors should document rating in a fashion that can reflect the true fashion of how well a preceptee progresses. Ratings:12345678910N/A 1=Needs remediation: Competency not demonstratedtothepointofdidacticalremediationisnecessary. 3=Needs improvement: Very basic components aredemonstratedbutneedsimprovement. 5=Demonstrates basic profiency but may periodicallyrequireprompting. 7= Demonstrates profenicy and meets all current standards. 10=Superior performance Overall Assessment of Evaluation Factors EVALUATION FACTOR RATING EVALUATION FACTOR RATING Patient Care: BLS Communications Patient Care: ALS Documentation: Duty PreparednessEquipment and Supplies Scene Safety Interpersonal/Teamwork Vehicle OperationsCall Management Navigation Teamwork Comments Overall Performance: Indicate how the trainee performedoverallonallevaluationfactorsduringthisshift. Development Plan: Identify specific competencies whichneedtobeimprovedor learnedandspecificactions to achieve this. Preceptor Signature: Date: I have read and understand this evaluation.Trainee Signature: Date: DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD a. Portable b. Main Oxygen Cylinder c. Locate Spare Tanks a. High School Football b. Public School Athletic Field Access c. UNC Special Events d. UNC Athletics Locations (See List) e. Franklin St. Celebrations f. Orange Co. Speedway Operations a. Location of equipment/supplies Orange County Preceptee Task Book Name: Phase 1 Skill/Task Date Trained Preceptee FTO Initials O2 Tank maintenance: Portable Suction Unit a. Turning on the device b. Locations of different suction catheters c. Proper use of suction unit d. Charging the Suction Unit Thomas Pack Yellow Medication Bag a. Locate medications b. Locate and assemble bristojets c. Know brand and generic name for all medications Decontamination a. location of equipment b. Infection Control Procedure Pediatric Bag a. Location of equipment/supplies Mass Casualty Triage a. START Triage b. JumpSTART Triage c. Smart Triage Pack Miscellaneous a. Mass Casualty Plan b. Infection Control Plan c. CERT Program d. Injury Prevention Programs e. Falls Prevention Campaign f. Continuing Education Special Events DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD a. Equipment location b. Indications c. Contraindications d. Procedure a. Equipment location b. Indications c. Procedure a. Location of OB kit b. Procedure Documentation a. Documentation Completion/Submission b. Signature Collection c. CHARTE Method d. Refusals/Referral e. Discontinuation of Resuscitation e. Zoll ePCR Procedures f. QA/QI process g. Dispositions BIAD: King Airways Airway Suctioning Basic Adult and Pediatric Assessment a. Adult Procedure b. Pediatric Procedure Cardiac Monitor a. Turning on the monitor b. Recording a strip c. Changing the battery d. Changing EKG paper e. Apply limb leads f. Apply 12\lead g. Apply Defib/Pacer pads h. Apply Pulse Oximeter i. Transmitting data\Computer and j. Storing Cables k. CO2, CO, Met HgB Child Birth Pain Assessment and Documentation a. Procedure b. 0\10 Scale c.Wong\Bakerfacesscale Spinal Immobilization a. Location of equipment b. Indications c. Procedure: Long Board KED Pediatric Immobilizer DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD a. Location of equipment b. Indications c. Procedure d. Padded Board e. Hare traction f. Sling and Swathe g. Miscellaneous: Pillow, Blanket, Ladder Splinting Venous Access: IV Line Assembly a. Location of equipment b. Procedure Wound Care a. Location of equipment b. Hemorrhage control procedure Defibrillation Automated a. Indications b. Contraindications c. Procedure Orthostatic Blood Pressure Measurement a. Indication b. Contraindication c. Procedure Verification of all Phase 1 Skills/Tasks completed with proficiency: Preceptee __________________ (sign) ___/___/____ (date) FTO/Preceptor __________________ ___/___/____ Supervisor (1520) __________________ ___/___/____ DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD PHASE 2 Skills/Tasks Skill/Task Date Trained Preceptee Initials FTO Initials Airway Nebulizer Inhalation Therapy a. Equipment location b. Indications c. Assemble Device d. T-tube adapter/inline neb set up e. Procedure Airway Suctioning Advanced a. Equipment location b. Indications c. Procedure Capnography (ETCO2) a. Indications b. Procedures Restraints a. Indications b. Procedure Stroke Scale: LAPSS Documentation a. Indications b. Procedure c. Appropriate scene time d. Early ED Notifications e. Stroke Centers/ Triage Destination Plan Venous Access External Jugular a. Indications b. Contraindications c. Procedure Venous Access Extremity a. Indications b. Procedure Triage Destination Plans and Procedures a. Trauma b. Pediatric c. Burns d. STEMI e. Stroke Centers f. Alert Procedures (ICC Express, Bat Phone, RACE Hotline, Trauma Notification) DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD CPAP a. Location of equipment b. Indications c. Contraindications d. Assembling the device e. Procedure Injections a. Location of equipment b. SQ and IM procedure Intranasal Medication Administration a. Location of equipment b. Indication c. Contraindications d. Procedure Nasogastric Tube Insertion a. Indications b. Contraindications c. Procedure Medications (indication, dose, route, and contraindications) a. Acetaminophen b. Adenosine c. Afrin (Oxymetazoline) d. Albuterol e. Amiodarone f. Ammonia capsules g. Aspirin h. Atropine i. Diazepam j. Diphenhydramine k. Calcium Chloride l. Dextrose 5% Water m. Dextrose 10% Solution n. Diltiazem o. Dopamine p. Epinephrine 1:1,000 q. Epinephrine 1:10,000 r. Glucagon s. Haloperidol t. Lidocaine u. Magnesium Sulfate v. Midazolam w. Methylprednisolone x. Morphine y. Naloxone z. Nitroglycerine Aa . Normal Saline Bb. Ondansetron Cc. Sodium Bicarbonate DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Verification of all Phase 2 Skills/Tasks and Medications completed with proficiency: Preceptee __________________ (sign) ___/___/____ (date) FTO/Preceptor __________________ ___/___/____ Supervisor (1520) __________________ ___/___/____ DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD PHASE 3 Skills/Tasks Orange County Preceptee Task Book Name __________________ Skill/Task Date Trained Preceptee Initials FTO Initials Airway Surgical Cricothyrotomy a. Equipment location b. Indications c. Contraindications d. Procedure Induced Hypothermia a. Equipment location b. Indications c. Contraindications d. Procedure Cardioversion a. Indications b. Contraindications c. Procedure Chest Decompression: a. Location of equipment b. Indications c. Procedure Intravenous Drip Administration a. EPI drips b. Dopamine drips c. Amiodarone drips Venous Catheters Accessing Existing a. Indications b. Procedure c. Specialty Equipment Defibrillation Manual a. Indications b. Contraindications c. Procedure External Cardiac Pacing a. Indications b. Contraindications c. Procedure Verification of all Phase 3 Skills/Tasks completed with proficiency: Preceptee __________________ (sign) ___/___/____ (date) FTO/Preceptor __________________ ___/___/____ Supervisor (1520) __________________ ___/___/____ DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD   29|Page     Recommendation for Release Phase ________  The trainee Recommendation for Release should be completed with Precepting Shift Performance Records. If the trainee is recommended for release, complete Part 1. If the preceptor recommends thatthe trainee continues precepting, complete Part 2.  Areas of competency that have been addressed and are critical to the success ofemployment of Orange County Emergency Services:  •Patient Care •Communications •Documentation •Navigation •Call Management •Team Integration •Scene Safety •Vehicle Operations •Interpersonal/Team work •Skills/Procedures •Professionalism  Trainee Recommended for Release: ___ YES or ____ NO  Part 1: The trainee has completed all requirements to be released and has passed the written map and knowledge test. The trainee has demonstrated capability in all competency areas as indicated on the attached Periodic Progress Report.  Trainee Signature:  Date: Preceptor Signature:  Date: Training Officer:    Date: Supervisor Signature:    Date: MedicalDirector:    Date:  ForTrainingOfficeruse # of Shifts Drug Test Medical Boards Protocol Test #of Patients Skills Check off Precepting Sheets 12 Lead test SOG Test Sim-Lab Map Test   DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD   30|Page   Part 2: The trainee is recommended for extended field shifts due to the following factor(s): Inability to consistently perform patient care skills  Inability to demonstrate capability in all competency areas  Inability to demonstrate adequate communication skills  Inability to independently complete adequate PCRs  Inability to demonstrate assertiveness/proactive behavior  Inadequate number of patient contacts  Inadequate coverage of competencies during precepting shifts  Other  Areas needing further development and plans for improvement are indicated on the attached Period Progress Report.  Number of additional shifts recommended:    Preceptor Signature:  Date: Trainee Signature:  Date: 1525 Signature:  Date: Supervisor Signature:  Date: Training Officer:  Date: Medical Director:  Date:       ForTrainingOfficeruse # of Shifts Drug Test Medical Boards Protocol Test #of Patients  Skills Check off  Precepting Sheets  12 Lead test SOG Test Sim-Lab Map Test                 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD   34|Page  Phase1:OralBoardExamination GuidanceforCandidatesandPreceptors  Oneofthekeystepsindemonstratingcompetencyandreadinesstofunctionasaprovider(EMTͲBorParamedic)with OrangeCountyEmergencyMedicalServicesispassingthePhase1OralBoardExamination.Eachproviderisexpectedtosit fortheexaminationandmustbeabletodemonstratecompetencytoallmembersoftheexaminingboardinordertopass theexamination.TheexaminerswillconsistofatleastonephysicianrepresentativefromTheOfficeoftheMedical DirectorplusadditionalproviderswithintheOCEMSsystem.Theexaminationusuallylasts15to30minutes,howeverit mayrunlonger. Theoralboardisbroadinscopeandfocusesonmultiplecontentareas.ItisfirmlyexpectedthateachPhase1candidate bewellpreparedinadvancehavingmasteredallEMTͲBlevelprotocolsandprocedurespriortotakingthePhase1oral boardexamination.CandidatesmustprovesatisfactoryknowledgeofmedicalpracticeswithintheOCEMSsystemtoall membersoftheexaminingboardinordertopass. Theoralboard’scontentisgenerallycasebasedwithanemphasisonprotocolknowledge,medicationknowledge,scene management,resourceutilization,andoperationalcompetency. Forexample,thequestionsbelowaresimilartothosequestionsusedinpriororalboardexaminations: ˜“A65yearsoldmaledevelopssuddenshortnessofbreathduringawalk.Whataresomeofthepossiblecausesofhis shortnessofbreath(i.e.differentialdiagnosis)?” ˜“YouandyourpartnerrespondtoaparkinChapelHill.Thesceneissafe.Youfinda23yearoldmalewhois unconscious,butbreathing.Hisrespiratoryrateis6andhisradialpulseisweakatabout120beatsperminute.What stepdoyouwanttoperformnext?” ˜“Howtoyouperforma12ͲleadEKG?HowisittransmittedontheLifePak12?”(PleasenotethisisnotaskingforEKG interpretation.ThisisaskinghowtoperformanEKGandthentransmitittothereceivinghospital.) ˜“WhencananEMTͲBadministeroralglucose?” ˜“Whatistheprocedureforconductingaprehospitalstrokescreen?” ˜“Whathospitalsinourserviceareaaretraumacenters?” ThePhase1OralBoardExaminationisdesignedtobeachallengingexamthatwillonlybepassedifthecandidatecan demonstratemasteryoftheOCEMSprotocols,procedures,andpolicies. PleasedirectquestionsaboutpreparationfortheoralexaminationtotheTrainingOfficer.   Sincerely,    JaneBrice,MDMarkQuale,MDRyanGrebe,EMTͲP MedicalDirectorAssistantMedicalDirectorTrainingOfficer DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD   35|Page  Orange County Emergency Services  Sample Oral Board Examination   Basic Medic   (Candidate) Passed: Yes No Date: / / Thought Process: (Organized/Disorganized, Deductive Reasoning)      Scene Management: (Resources Management, Scene Times)      Protocol Knowledge:      Medication Knowledge:      Technical Skills Knowledge:       S A M P L E DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD   36|Page  Confidence/Appearance:         Comments:           Evaluator Signatures: Name: Position: Signature: Name: Position: Signature: Name: Position: Signature: Name: Position: Signature: Name: Position: Signature: Name: Position: Signature:                     S A M P L E DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD   37|Page  SIMULATION CASE SAMPLE Candidate: Date of Eval:  PHASE1 SIMULATIONLABEXAMINATION CARDIACARREST  ExaminationGoals 1.Performallcriticalactionscompetentlytopass(denotedby“C*”) and 2.Obtainaminimum70%orhigherindividualpointscoretopass  Summary:Sickcall(nausea),afebrile,normotensiveandnonͲorthostatic,whilebeingtransporteddevelopschestpain,12Ͳlead showsMI,cardiacarrest(fib),defibrillation,ROSCwithGCS15.Continuetotransportwithoutcomplicationsorfurtherincidents.  Scene: Summer–Dry–Night(20:00hours) Singlestoryresidence–easyaccesstopatient–notriphazards–sceneiscleanandsafe  DispatchInformation: 26ͲAͲ06,SickPerson(nausea).Patientisa63yearoldmale,consciousandbreathing,complainingofnausea.Thewifehascalled911 statingthatshefeelssomethingiswrongwithherhusband.  Presentonscene/GeneralImpression: HusbandandWifecouple–nofamily–nootherpersons–noanimals Patientlocation:Patientreclininginchairreclinerinthelivingroomandhashishandsoverhisupperabdomen.  AVPUͲPatientisALERTandorientedtoperson,place,time,andevent Skinpale,cool,andclammy.Approximateweight:220lbsͲNoapparentdistress  PatientComplaint: Patientcomplainsofslightnauseawithoneepisodeofvomiting.  /1SAMPLEHistoryObtained S:Nausea,clammy A:NoKnownDrugAllergies M:Simvastatin,Omeprazole,Nitroglycerintabs P:Hyperlipidemia,cholecystectomy,heartproblem Familialhistory:Brotherdiedfromaheartattackatage62.Fatherdiedfromaheartattackattheageof60. L:3ͲdayͲoldChickenCasseroleapprox.30minutespriortocalling911 E:Thepatienthadjustfinishedeatinga3Ͳdayoldchickencasserolewhenhebegantofeel“slightlynauseated”.Patient wenttothebathroomandvomitedonce.ThepatientapologizestoEMSforbeingcalledtohishouseandstatesthathe “feelsfine”.Thewifeofthepatientlooksatyouandstates,“Iknowmyhusbandandsomethingisjustnotright.Henever getssick.Maybeitwasthecasserole.Pleasehelphim.”  /1OPQRSTHistoryObtained O:19:30–suddenonset–nosignsorsymptomspriortoacuteonset P:Patientwassittingandrestingatonsetofnausea.Nothingmakesitbetter. Q:Patienthasasenseofbeingfull,evenaftervomitingonce. R:Gastric/Epigastricregion,nausea S:Patientisnotexperiencinganypainorpressure T:Onsetofnauseais19:30.EMSdispatchedat20:00. S A M P L E DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD   38|Page   SIMULATION CASE SAMPLE Candidate: Date of Eval:     PHASE1 SIMULATIONLABEXAMINATION CARDIACARREST  ExaminationFindings: /C*ObtainFullSetofVitalSignsCorrectly BP:110/70insittingposition.P:100ͲstrongͲregularRR:15 Temp:98.0oralO2:–99%OnRoomAir Glucose:110(Glucosemeasurementnotrequired)  /1Performphysicalexam(toincludecardiac,resp,andGIatminimum) Respiratory:Lungsoundsclearinallfieldswithequalchestriseandfall. Cardiovascular:Nochestpainorpressure.Regularpulse.LeadIIunremarkable. Gastrointestinal:Soft,tendertopalpationepigastricregiononly,nodistention,nodiscoloration.Vomitingx1without blood.NormalBMandUrine Musculoskeletal:Notenderness,Nopain.Nosignsoftrauma Neurological:Alert.Nomotororsensorydeficitsnoted.LAStrokeScale=Neg Integumentary:Nosignsoftrauma.Skinispale,cool,andclammytotouch.  Orthostatics: BP:105/68instandingposition.P:104–strong–regularRR:15 O2:–99%OnRoomAir  ͲͲͲPatientplacedinunitandenroutetoUNCͲͲͲ  Patientsuddenlydevelopschestpainwhileenroutetohospital.Painissubsternal,squeezing10/10,radiatingtotheleft chest/shoulder/arm  RepeatVitals: BP:100/60P:115–weakͲregularRR:20O2:–99%  /1FollowsCHESTPAINProtocol:  Patientinterventions: /1Oxygen /C*12ͲLeadPerformedCorrectly(***AcuteMISuspected***) /C*Aspiringiven /1NitroglycerinSLgiven /1Demonstrateshowtotransmit12Ͳlead        SeePage3 S A M P L E DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD   39|Page   Candidate: Date of Eval:  ͲͲͲVFIBARRESTͲͲͲ  Patientstates“Idon’tfeelsogood.Ifeeldizzy.”ThepatientproceedsintoVͲFibArrestwithagonalrespirations.   /1FollowsCARDIACARRESTProtocol(includingCPR/defibrillation):  Patientinterventions: /C*AutomatedDefibrillationProcedure(CPRasrequired,placepads,turnonmonitor,utilizeAEDmodeappropriately)  ͲͲͲPatientROSCpostdefibrillationandisALERTwithaGCSof15ͲͲͲ  /1Reassesspatientvitalsigns/exam BP:100/60P:70ͲweakͲregularRR:15O2:94%  Respiratory:Lungsoundsclearinallfieldswithequalchestriseandfall. Cardiovascular:ChestPain,Pulseregular Gastrointestinal:Soft,tendertopalpationepigastric/gastricregiononly,nodistention,nodiscoloration. Musculoskeletal:Milddiscomforttochestsecondarytodefibrillation Neurological:Alert.Nomotororsensorydeficitsnoted.LAStrokeScale=Neg Integumentary:Nosignsoftrauma.Skinispale,cool,andclammytotouch   /1Callinappropriatereporttoreceivinghospital       ScoreSummary CriticalActionsCompleted:of4  IndividualPointsTotal:of10  Finaloutcome(pass/fail): ExaminerSignature:   S A M P L E DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD SAMPLE Do c u S i g n E n v e l o p e I D : 7 9 C 5 D 1 6 7 - B 6 C A - 4 E 5 9 - B 4 A C - A A 3 8 C C 1 B 2 0 B D (Attachment 6) Attestation of EMS Equipment and Supplies Management _______________________________ Department attests that our Agency has the appropriate EMS equipment, supplies and pharmaceuticals to operate at the ______________ level of service a. Please attach a copy of your operational procedures for the management of equipment, supplies and medications. b. Please attach written plans for the inventorying of supplies. c. Please provide a copy of the daily EMS vehicle equipment inventory sheet should be provided. Department Chief: ________________________________ ________________ (Signature) (Date) ________________________________ (Printed Name) FOR OCES USE ONLY Received by: ______________________________________ Date: ___________________________ Approved by Orange County EMS Training Officer: _________________________Date:_________________ DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Attachment 7 Rev. 11/21/2013 - 1 - Minimum Equipment to be Carried by Non-Transport Emergency Medical Provider Vehicles. (All items pertain to the level of certification the provider is intending to function as.) The Following Will be Required on all BLS Vehicles: x Appropriate Restraints o Crew o Non-patient passengers x Warning devices (lights and sirens) x Two-way radio mounted in front of vehicle x O2 cylinder with regulator x Suction apparatus x BVMs o Adult with mask o Child with masks Child Infant Neonatal x AED with adult and pediatric pads x Sphygmomanometers o Adult o Large Adult o Pediatric x Stethoscope x Tourniquet (Hemorrhage Control) x Blind Insertion Airway Devices with syringes (BIADS) x Medications at discretion of department with the Medical Directors approval and proof of proper knowledge by providers: o Acetaminophen o Albuterol o Ibuprofen o Benadryl PO o Oxymetazoline (Nasal Spray) o Nerve Agent Kit o Nebulizer o Aspirin o Epinephrine Auto Injector (Adult and Ped) o Nitroglycerin o Naloxone DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Attachment 7 Rev. 11/21/2013 - 2 - x Nasal Mucosal Administration Device x Cervical Immobilization Collars (S, M, L, Pediatric) x Upper and Lower Extremity Immobilization Devices x Oropharyngeal Airways (3 adult & 3 Pediatric sizes) x Nasopharyngeal Airways (3 adult & 3 Pediatric Sizes) x Nasal Cannula Adult & PED x Non-rebreather with tubing (Adult and Pediatric) x Suction Catheters o One between 6 & 10 F. o One between 12 & 16 F. x Rigid Pharyngeal Suction Device x Wide Bore Suction Tubing x Thermometer (with Low Temp. capability) x Glucometer x Pulse Oximeter (adult and pediatric sizes) x Gloves (Latex Free) x Gloves (Non-sterile) x Mounted Fire Extinguisher x Flashlight with extra batteries x Infectious Control Kit (Mask, Gowns, Jumpsuits, eye protection,& shoe covers) x Disposable Biohazard Trash Bags x N-95 or HEPA masks x Disinfectant hand wash x Disinfectant for cleaning equipment x Sharps containers (2 sources) x Emesis Collection Device x Thermal Blanket (or other heat conserving device) x Sterile OB Kit (scissors, bulb suction, cord clamps) x Bulb syringe (Separate from OB Kit) x Length/weight-based pediatric tape x Dressing, bandages, roll gauze x Triangular Bandages (2) x Occlusive Dressing x Adhesive Tape x Heavy Duty Scissors x Alcohol Wipes x Lubricating Jelly x Triage system x Sterile Irrigation Solution x Burn Sheet DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Attachment 7 Rev. 11/21/2013 - 3 - x Cold Packs x Medications and fluid kept in climate controlled environment x Provider name displayed on each side x Reflective tape on all sides x Equipment secured in compartment x Copy of Protocols x Exterior Cleanliness x Interior Cleanliness In Addition to The Above, The Following Will be Required on all EMT-Intermediate Vehicles: x ET Blades (3 adults & 3 Pediatric sizes) x ET handles with extra batteries & Bulbs x ET Tubes (3 adult & 3 pediatric sizes) x ET Stylettes (adult and pediatric) x ET Tube Holder x McGill Forceps (adult & pediatric sizes) x IV Administration Sets Micro and Macro x IV Catheters in at least 4 sizes x Needles of various sizes, one must be at least 1.5 in. for IM injections x Syringes (In at least 3 sizes) x IV arm board x Color Metric/Waveform/Numeric End Tidal CO2 Detector x Medications at discretion of department, approval of Medical Director and proof of proper knowledge by providers, in addition to those in EMT-Basic List: o Crystalloid Solution o Diphenhydramine o Epinephrine 1:1000, 1:10,000, & 1:100,000 o Glucagon o Glucose solution o Ketorolac o Vasopressin* o Nitroglycerin Paste o D10% x Meconium Aspirator Adaptor In Addition to all of The Above, The Following Will be Required on all EMT-Parmedic Vehicles: DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Attachment 7 Rev. 11/21/2013 - 4 - x Monitor/Defibrillator with Electrodes & 2 sizes of Pads/Paddles with 12-Lead Capabilities x Waveform Capnography x Pacemaker (external) x Intraosseous Needles (Adult and Pediatric Sizes) x Advanced airway kit for Cricothyrodomy x Chest Decompression equipment (3” 14 ga angiocath) x Medications at discretion of department, approval of Medical Director and proof of proper knowledge by providers, in addition to those in EMT-Basic and EMT-Intermediate List: o Adenosine o Antiarrhythmic o Antiemetic o Atropine o Calcium Chloride/Gluconate o Beta Blocker o Narcotic Analgesic o Sodium Bicarbonate o Steroid Preparation o Versed o Ativan* o Haloperidol o Morphine o Fentanyl* o Dopamine o Diltiazem o Magnesium Sulfate o Amiodarone o Lidocaine o Vecuronium o Ondasteron o Sodium Bicarbonate o Diazepam o Pralidoxime North Carolina OEMS recognizes the above equipment as the MINIMUM required equipment for the respective provider level, it does not negate the responsibility of the providing service to maintain a minimum level of equipment sufficient to function per the protocols of the provider level responding to a call. * Items are alternatively approved medications in the event there is a shortage, these may be substituted for continuation of care. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD (Attachment 8) Agency Medical Treatment Attestation ________________________ Department understands that Orange County EMS Treatment Protocols must be followed by all providers functioning within the County. We understand that all EMS providers function at the discretion and permission of the Orange County Emergency Services Medical Director and under his/her supervision. a.The Medical Director has final authority on provider practice privileges. b.The Medical Directory also has the right and responsibility to suspend any provider he/she deems unfit or unqualified to perform to set standards. c.The Medical Director or Designee will be present at oral boards to determine provider’s capability to practice independently. Department Chief: ________________________________ ________________ (Signature) (Date) ________________________________ (Printed Name) FOR OCES USE ONLY Received by: ______________________________________ Date: ___________________________ Approved by Orange County EMS Training Officer: _________________________Date:_________________ DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD A Prepared, Coordinated, and Integrated Emergency Services System Twitter @ocncemergency Orange County Emergency Services 510 Meadowlands Drive Hillsborough, NC 27278 919.245.6100 Policy 21: Peer Review Committee Objective: x To clearly state and define the purpose, function, and structure of the Peer Review Committee. Definition: x The Peer Review Committee is a panel composed of EMS program representatives to be responsible for analyzing patient care data and outcome measures to evaluate the ongoing quality of patient care, system performance, and medical direction within the OCES System. Meeting Schedule: x The OCEMS Peer Review Committee meets quarterly, at UNC Hospitals, in the months of March, June, September, and December, on the second Thursday of the month at 9:00 AM. Function of Committee: x The OCEMS Peer Review Committee is tasked with quality assurance oversight functions. The committee collects, analyzes, and evaluates data from all aspects of the OCES System, including the Emergency Communications Center, the EMS Transportation Division, the various First Responder Programs including law enforcement, and the UNC Hospitals Emergency Department, and makes system recommendations designed to improve patient outcomes, continuing education programs, and the quality of the system. x The committee is also charged with reviewing and supporting the practice standards established by the Director and Medical Director, and with providing suggestions to medical staff for areas of focus in programmatic, educational, and operational aspects of the EMS System DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD - 2 - Guarantee of Due Process: x Each individual that temporarily or permanently has their practice privileges suspended will be given due process as required by G.S. 10A NCAC 13P.0408 (7). x The Peer Review Committee has delegated the responsibility for review of situations involving medical discipline to the Medical Review Panel. (See Medical Disciplinary Procedure) Minutes: x The secretary of the Peer Review Committee maintains minutes for the Peer Review meetings and publishes minutes for all participants. x Minutes are reviewed and approved at each meeting. x Minutes will remain on file throughout the duration of the OCES System Approval Duration. Committee Structure Membership: x The membership of the OCEMS Peer Review Committee will consist of representatives from at least the following categories or agencies: o OCES System Medical Director (Core) o OCES Director (Core) o OCES Training Coordinator (Core) o OCES System Assistant Medical Director o OCES System Administrator (Core) o OCES EMS Quality Assurance Coordinator (Core) o OCES Communications Quality Assurance Coordinator (Core) o OCES System Training Coordinator (Core) o South Orange Rescue Squad Representative o JAS Representative o North State Representative o Carolina Air Care Representative o Municipal Fire Representative o Volunteer Fire Representative o Law Enforcement Representative o UNC Hospitals EMS Nurse Liaison o UNC Hospitals ED Nurse Manager o NCOEMS Official. o UNC Trauma Coordinator o UNC STEMI/Chest Pain Coordinator o UNC Comprehensive Stroke Coordinator DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD - 3 - Officers: x The OCES System Medical Director will serve as the chairperson of the Peer Review Committee. x Two OCES System Assistant Medical Directors will serve as the vice chairs. x The OCES Quality Assurance Coordinator will serve as the Peer Review Secretary. The secretary will be responsible for sending notification of meetings, will keep and distribute minutes, and shall maintain an attendance roster. Appointment of Members: x At the December meeting, the chairperson will ask the general membership for recommendations for additional or replacement members. x The appointment of members to the Peer Review Committee will be by the EMS Core Committee, defined above. x The EMS Core Committee will either appoint the person(s) recommended by the Peer Review Committee, or report back to the Peer Review Committee with the reason that the recommended individual is not appointed. Terms of Membership: x The term for general membership is for two years, at which time the EMS Core Committee may re-appoint the member or seek recommendation from the Peer Review Committee for other members. Meeting Attendance and Quorum for Business: x Peer Review Committee Members are encouraged to attend all meetings. x Members who are absent from two consecutive meetings will be sent a letter by the Peer Review Committee Secretary reminding them of the importance of the Peer Review Function. x Members who are absent from four consecutive meetings will be suspended from the Committee pending review by the EMS Core Committee. x A quorum of the members for meeting purposes is at least five members present. Confidential Documents and Records: x In the course of its business, the Peer Review Committee will review both the medical records of identifiable patients and the personnel records of identifiable EMS or Hospital personnel. x All these documents and records are confidential and not to be circulated or released outside of committee meetings. x Other materials submitted for the review of the Peer Review Committee which do not clearly identify either patients or personnel may become public record as noted by G.S. 143-518. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD - 4 - Responsibility x The Peer Review Committee Chair is responsible for enforcing the confidentiality of the records reviewed during Peer Review meetings. Penalty for Release: x The inappropriate release of confidential records by a member of the Peer Review Committee will result in their immediate suspension from the Peer Review Committee pending a review of the situation by the EMS Core Committee. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD - 5 - Orange County EMS System Peer Review Committee OrganizationNameTitleRole UNC Joseph Grover, MD OCES System Medical Director (Core)Chair UNCIrfan Husain, MD OCES Assistant Medical Director Vice- Chair UNCGlen Burket, MD OCES Assistant Medical Director Vice-Chair UNCDiana Miller, MD OCES Assistant Medical Director OCES Thomas R. Griggs, MD OCES Assistant Medical Director OCESDinah Jeffries OCES Director OCES Kim Woodward, EMT P OCES System Administrator (Core) OCES Kyle Ronn, EMT P OCES Quality Assurance Coordinator Secretary OCES Laura Piche, EMD OCES Communications Quality Assurance (Core) OCES Chris Pope, EMT-P OCES System Deputy EMS Operations Manager (Core) OCES James Gusler, EMT -P Training Coordinator (Core) SORS Spencer Lindgren, EMT-P South Orange Rescue Squad (Core) SORS Matthew Mauzy, EMT South Orange Rescue Squad Representative First Choice Mark Varsano First Choice Representative North State Brian Pearce North State Representative CAC Jennifer Haynes, MSN, MHA, RN, CMTE, CPEN Carolina Air Care Representative Chapel Hill Fire Department Jacob Sinkiewicz, EMT Municipal Fire Representative Chief’s Council Philip Nasseri, EMT Volunteer Fire Representative UNCGary Barker, RN UNC Hospitals EMS Nurse Liaison UNCJeff Phillips , RN ED Nurse Manager NCOEMS Doug Calhoun State Office of EMS Representative Police Department Chris Atack Field Operations Commander UNC Trauma Tricia B. Harrison. RN, BSN Trauma Coordinator UNC STEMI Katy Strauss, BSN, RN, PCCN,STEMI/Chest Pain Coordinator UNC Comprehensive Stroke Nicole Burnett BSN, RN, CNRN, SCRN, CCRN-K Comprehensive Stroke Coordinator DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD NCCEPStandards NCCEPStandardsfor EMSPerformance Improvement Performance Standards2009 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD No r t h C a r o l i n a C o l l e g e o f E m e r g e n c y P h y s i c i a n s St a n d a r d s f o r t h e S e l e c t i o n a n d P e r f o r m a n c e o f EM S P e r f o r m a n c e I m p r o v e m e n t Pe r f o r m a n c e S t a n d a r d s ( P a g e 1 o f 1 1 ) 2 0 0 9 No r t h C a r o l i n a E M S P e r f o r m a n c e I m p r o v e m e n t G u i d e l i n e s Th e p u r p o s e o f t h i s g u i d e l i n e i s t o p r o v i d e d i r e c t i o n t o E M S A g e n c i e s w i t h r e s p e c t t o p a t i e n t c a r e b a s e d q u a l i t y m a n a g e m e n t a n d performance im p r o v e m e n t . E a c h o f t h e s e t o p i c s a d d r e s s e i t h e r a n E M S S e r v i ce D e l i v e r y , P e r s o n n e l P e r f o r m a n c e , o r P a t i e n t C a r e i s s u e w h i c h i s either im p o r t a n t t o q u a l i t y o r h a s b e e n i d e n t i f i e d a s a h i g h r i s k o r h i g h l i a b i l i t y a r e a f o r E m e r g e n c y M e d i c a l S e r v i c e s . Pl e a s e r e f e r t o t h e N o r t h C a r o l i n a C o l l e g e o f E m e r g e n c y P h y s i c ia n s S t a n d a r d s f o r M e d i c a l O v e r s i g h t a n d D a t a C o l l e c t i o n F r e q u e n t ly As k e d Q u e s t i o n s ( F A Q s ) fo r i n f o r m a t i o n o n h o w e a c h E M S S y s t e m ’ s P e e r R e v i e w C o m m i t t e e m u s t a d d r e s s t h i s d o c u m e n t . Th e i t e m s l i s t e d i n t h i s g u i d e l i n e a r e o f m o r e v a l u e w h e n t r e n d e d ( m o n t h l y o r q u a r t e r l y a s n o t e d ) a n d t h e n d i v i d e d u p a m o n g t h e yearly peer review me e t in g s f o r r e v i e w a n d d i s c u s s i o n . H o w f r e q u e n t l y e a c h i t e m i s p r e s e n t e d a n d d i s c u s s e d w i t h i n t h e P e e r R e v i e w C o m m i t t e e s h o u l d b e de t e r m i n e d b y t h e E M S S y s t e m s c a l l v o l u m e a n d r e s o u r c e s . E v e r y i t e m i n t h i s g u i d e l i n e i s d e s i g n e d t o b e r e v i e w e d a n d d i s c u s s e d at a minimum of on c e e a c h y e a r w i t h t h e e x c e p t i o n o f t h e 6 E M S T o o l k i t s w h i c h a r e d e s i g n e d t o b e r e v i e w e d a n d d i s c u s s e d t w i c e p e r y e a r . To p i c s a r e g r o u p e d i n t o t h e f o l l o w i n g a r e a s : ¿¿ Se r v i c e D e l i v e r y : R e s o u r c e s a n d E q u i p m e n t ¿ Se r v i c e D e l i v e r y : T i m e P a r a m e t e r s ¿ Se r v i c e D e l i v e r y : C o m p l a i n t s a n d I n v e s t i g a t i o n s ¿ Pe r s o n n e l P e r f o r m a n c e ¿ Pa t i e n t C a r e : T r e a t m e n t ¿ Pa t i e n t C a r e : H i g h R i s k P a t i e n t s ¿ Pa t i e n t C a r e : H i g h R i s k E v e n t s DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD No r t h C a r o l i n a C o l l e g e o f E m e r g e n c y P h y s i c i a n s St a n d a r d s f o r t h e S e l e c t i o n a n d P e r f o r m a n c e o f EM S P e r f o r m a n c e I m p r o v e m e n t Pe r f o r m a n c e S t a n d a r d s ( P a g e 2 o f 1 1 ) 2 0 0 9 To p i c Re c o r d Se l e c t i o n Tr e n d i n g Fr e q u e n c y Ma n d a t o r y Pe r c e n t a g e of E v e n t s Re v i e w e d De f i n i t i o n Da t a So u r c e Loop Closure Se r v i c e D e l i v e r y : R e s o u r c e s a n d E q u i p m e n t 1. V e h i c l e F a i l u r e s Al l O n D u t y Oc c u r r e n c e s Mo n t h l y Ye s 10 0 % Nu m b e r o f V e h i c l e Fa i l u r e s w h i l e i n S e r v i c e EM S Ag e n c y Im p l e m e n t o r e v a l u a t e Ve h i c l e M a i n t e n a n c e P l a n 2. V e h i c l e C r a s h e s Al l O n D u t y Oc c u r r e n c e s Mo n t h l y Ye s 10 0 % Ve h i c l e C r a s h e s w h i l e i n Se r v i c e EM S Ag e n c y Ev a l u a t e a n d D i s c u s s Crash etiology from ve h i c l e , p e r s o n n e l , pa t i e n t , a n d a n y o t h e r pe r s p e c t i v e s . 3. P a t i e n t C a r e Eq u i p m e n t Al l O n D u t y Oc c u r r e n c e s Mo n t h l y Op t i o n a l 10 0 % Nu m b e r a n d t y p e o f re q u i r e d E M S e q u i p m e n t mi s s i n g f r o m d a i l y E M S Ag e n c y a n d S t at e Re g u l a t o r y I n s p e c t i o n s EM S Ag e n c y an d C I S In s p e c t i o n R e p o r t Ev a l u a t e a n d e s t a b l i s h method to assure all eq u i p m e n t i s p r e s e n t o n al l a c t i v e E M S u n i t s . 4. P a t i e n t C a r e D e v i c e Fa i l u r e s Al l O n D u t y Oc c u r r e n c e s wh i l e i n u s e Mo n t h l y Ye s 10 0 % Nu m b e r a n d t y p e o f pa t i e n t c a r e o r m e d i c a l de v i c e f a i l u r e s w h i l e i n us e . EM S Ag e n c y Es t a b l i s h o r m o n i t o r p l a n to a s s u r e a l l a c t i v e E M S un i t s h a v e p r o p e r l y working equipment. 5. F i r s t R e s p o n d e r O n Sc e n e % Al l 9 1 1 ev e n t s w i t h FR D i s p a t c h Mo n t h l y Ye s 10 0 % % o f e v e n t s F R o n Sc e n e wh e r e t h e y w e r e di s p a t c h e d EM S Ag e n c y an d Pr e M I S Re p o r t Es t a b l i s h t a r g e t a n d w o r k fo r 9 5 % c o m p l i a n c e Se r v i c e D e l i v e r y : T i m e P a r a m e t e r s 6. D i s p a t c h C e n t e r Ti m e 91 1 E v e n t s Mo n t h l y Ye s 10 0 % o f Em e r g e n t Di s p a t c h e s 91 1 C a l l t i m e u n t i l E M S No t i f i c a t i o n T i m e Pr e M I S Re p o r t Es t a b l i s h t a r g e t a n d w o r k fo r 9 5 % C o m p l i a n c e 7. T u r n - o u t ( W h e e l s - Ro l l i n g T i m e ) 91 1 E v e n t s Mo n t h l y Ye s 10 0 % o f Em e r g e n t Di s p a t c h e s EM S N o t i f i c a t i o n u n t i l EM S E n R o u t e T i m e Pr e M I S Re p o r t Es t a b l i s h t a r g e t a n d w o r k fo r 9 5 % C o m p l i a n c e DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD No r t h C a r o l i n a C o l l e g e o f E m e r g e n c y P h y s i c i a n s St a n d a r d s f o r t h e S e l e c t i o n a n d P e r f o r m a n c e o f EM S P e r f o r m a n c e I m p r o v e m e n t To p i c Re c o r d Se l e c t i o n Tr e n d i n g Fr e q u e n c y Ma n d a t o r y Pe r c e n t a g e o f Ev e n t s Re v i e w e d De f i n i t i o n Da t a So u r c e Loop Closure 8. R e s p o n s e T i m e t o Sc e n e Al l E v e n t s Mo n t h l y Ye s 10 0 % o f Di s p a t c h e s b y gr o u p : Em e r g e n t 9 1 1 , No n -Em e r g e n t 91 1 , N o n - Sc h e d u l e d Me d i c a l Tr a n s p o r t s , a n d SC T P Tr a n s p o r t s EM S E n R o u t e T i m e un t i l A r r i v a l a t S c e n e or P a t i e n t L o c a t i o n Pr e M I S Re p o r t Establish target and work for 95% Compliance 9. R e s p o n s e T i m e t o Pa t i e n t 91 1 E v e n t s Mo n t h l y Op t i o n a l 10 0 % o f Em e r g e n t Di s p a t c h e s EM S A r r i v a l E M S Ar r i v a l O n S c e n e u n t i l Ar r i v a l a t P a t i e n t T i m e Pr e M I S Re p o r t Establish target and work for 95% Compliance 10 . S c e n e T i m e Al l E v e n t s Mo n t h l y Ye s 10 0 % o f Di s p a t c h e s b y gr o u p : Em e r g e n t 9 1 1 , No n -Em e r g e n t 91 1 , N o n - Sc h e d u l e d Me d i c a l Tr a n s p o r t s , a n d SC T P Tr a n s p o r t s EM S A r r i v a l o n S c e n e un t i l D e p a r t S c e n e Ti m e Pr e M I S Re p o r t Establish target and work for 95% Compliance 11 . T r a n s p o r t T i m e Al l E v e n t s Mo n t h l y Ye s 10 0 % o f Di s p a t c h e s b y gr o u p : Em e r g e n t 9 1 1 , No n -Em e r g e n t 91 1 , N o n - Sc h e d u l e d Me d i c a l Tr a n s p o r t s , a n d SC T P Tr a n s p o r t s De p a r t S c e n e u n t i l Ar r i v e a t D e s t i n a t i o n Ti m e Pr e M I S Re p o r t Establish target and work for 95% Compliance Pe r f o r m a n c e S t a n d a r d s ( P a g e 3 o f 1 1 ) 2 0 0 9 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD To p i c Re c o r d Se l e c t i o n Tr e n d i n g Fr e q u e n c y Ma n d a t o r y Pe r c e n t a g e o f Ev e n t s Re v i e w e d De f i n i t i o n Da t a So u r c e Loop Closure 12 . B a c k i n S e r v i c e Ti m e Al l E v e n t s Mo n t h l y Ye s 10 0 % o f Di s p a t c h e s b y gr o u p : Em e r g e n t 9 1 1 , No n -Em e r g e n t 91 1 , N o n - Sc h e d u l e d Me d i c a l Tr a n s p o r t s , a n d SC T P Tr a n s p o r t s Ar r i v e a t D e s t i n a t i o n un t i l B a c k i n S e r v i c e Ti m e Pr e M I S Re p o r t Establish target and work for 95% Compliance 13 . D i s p a t c h C e n t e r De l a y s 91 1 a n d SC T P Ev e n t s Mo n t h l y Ye s 10 0 % Do c u m e n t e d D e l a y s fr o m P C R Pr e M I S Re p o r t Identify and address noted trends 14 . R e s p o n s e T i m e De l a y s 91 1 a n d SC T P Ev e n t s Mo n t h l y Ye s 10 0 % Do c u m e n t e d D e l a y s fr o m P C R Pr e M I S Re p o r t Identify and address noted trends 15 . S c e n e T i m e D e l a y s 91 1 a n d SC T P Ev e n t s Mo n t h l y Ye s 10 0 % Do c u m e n t e d D e l a y s fr o m P C R Pr e M I S Re p o r t Identify and address noted trends 16 . T r a n s p o r t T i m e De l a y s 91 1 a n d SC T P Ev e n t s Mo n t h l y Ye s 10 0 % Do c u m e n t e d D e l a y s fr o m P C R Pr e M I S Re p o r t Identify and address noted trends 17 . T u r n - A r o u n d T i m e De l a y s Al l E v e n t s Mo n t h l y Ye s 10 0 % Do c u m e n t e d D e l a y s fr o m P C R Pr e M I S Re p o r t Identify and address noted trends 18 . F r e q u e n c y o f E D Of f - L o a d D e l a y s Al l E v e n t s Mo n t h l y Op t i o n a l 10 0 % No t a c u r r e n t P r e M I S Da t a E l e m e n t . M u s t b e do c u m e n t e d l o c a l l y . EM S Ag e n c y Identify and address noted trends No r t h C a r o l i n a C o l l e g e o f E m e r g e n c y P h y s i c i a n s St a n d a r d s f o r t h e S e l e c t i o n a n d P e r f o r m a n c e o f EM S P e r f o r m a n c e I m p r o v e m e n t Pe r f o r m a n c e S t a n d a r d s ( P a g e 4 o f 1 1 ) 2 0 0 9 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD To p i c Re c o r d Se l e c t i o n Tr e n d i n g Fr e q u e n c y Ma n d a t o r y Pe r c e n t a g e o f Ev e n t s Re v i e w e d De f i n i t i o n Da t a So u r c e Loop Closure 19 . F i r s t R e s p o n d e r Re s p o n s e T i m e 91 1 E v e n t s Mo n t h l y Ye s 10 0 % o f A l l Ev e n t s w i t h Fi r s t R e s p o n d e r Re s p o n s e 90 % F r a c t i l e T i m e o f FR Re s p o n s e T i m e (D i s p a t c h u n t i l A r r i v a l on S c e n e ) f o r a l l em e rg e n t e v e n t s wh e r e FR w a s di s p a t c h e d . EM S Ag e n c y Da t a o r Pr e M I S Re p o r t Es t a b l i s h a t a r g e t a n d work for 95% compliance Se r v i c e D e l i v e r y : C o m p l a i n t s a n d I n v e s t i g a t i o n s 20 . I n t e r n a l S e r v i c e De l i v e r y , P e r s on n e l , or P a t i e n t C a r e Co m p l a i n t s Al l Co m p l a i n t s Mo n t h l y Ye s 10 0 % Fo r m a l w r i t t e n o r v e r b a l co m p l a i n t s a s d e f i n e d by E M S A g e n c y EM S Ag e n c y Ev a l u a t e m e r i t a n d a d d r e s s 21 . E x t e r n a l S e r v i c e De l i v e r y , P e r s on n e l , or P a t i e n t C a r e Co m p l a i n t s Al l Co m p l a i n t s Mo n t h l y Ye s 10 0 % Fo r m a l w r i t t e n o r v e r b a l co m p l a i n t s a s d e f i n e d by E M S A g e n c y EM S Ag e n c y Ev a l u a t e m e r i t a n d a d d r e s s Pe r s o n n e l P e r f o r m a n c e 22 . G e n e r a l P C R Do c u m e n t a t i o n Al l E v e n t s Mo n t h l y Ye s 10 % M a n u a l Re v i e w b y Su p e r v i s o r an d 10 0 % Re v i e w u s i n g Da t a Q u a l i t y Sc o r e Da t a Q u a l i t y S c o r e a n d % C o m p l e t e b y Su p e r v i s o r M a n u a l Re v i ew EM S Ag e n c y an d Pr e M I S Re p o r t Se t t a r g e t a n d w o r k f o r 90 % c o m p l i a n c e 23 . P r o t o c o l Do c u m e n t a t i o n Al l E v e n t s Mo n t h l y Ye s 10 0 % % o f P C R s w i t h Do c u m e n t a t i o n o f t h e Pr o t o c o l Us e d Pr e M I S Re p o r t Se t t a r g e t a n d w o r k f o r 10 0 % c o m p l i a n c e 24 . V i t a l S i g n Do c u m e n t a t i o n Al l E v e n t s Mo n t h l y Ye s 10 0 % % o f P C R s w i t h t h e do c u m e n t a t i o n o f a mi n i m u m o f o n e S y s t o l i c BP , D i a s t o l i c B P , P u l s e , Re s p i r a t o r y R a t e , P a i n Sc o r e ( i f a p p r o p r i a t e ) , an d G C S ( i f i n j u r y ) . Pr e M I S Re p o r t Se t t a r g e t a n d w o r k f o r 10 0 % c o m p l i a n c e No r t h C a r o l i n a C o l l e g e o f E m e r g e n c y P h y s i c i a n s St a n d a r d s f o r t h e S e l e c t i o n a n d P e r f o r m a n c e o f EM S P e r f o r m a n c e I m p r o v e m e n t Pe r f o r m a n c e S t a n d a r d s ( P a g e 5 o f 1 1 ) 2 0 0 9 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD To p i c Re c o r d Se l e c t i o n Tr e n d i n g Fr e q u e n c y Ma n d a t o r y Pe r c e n t a g e of E v e n t s Re v i e w e d De f i n i t i o n Da t a So u r c e Loop Closure 25 . S k i l l s P e r f o r m e d Al l E v e n t s Mo n t h l y Ye s 10 0 % Nu m b e r o f S k i l l s pe r f o r m e d b y e a c h pr o f e s s i o n a l Pr e M I S Re p o r t Id e n t i f y i n d i v i d u a l s w i t h o u t sk i l l within a 6 month in t e r v a l and address th r o u g h t r a i n i n g / e d u c a t i o n 26 . S k i l l P r o f i c i e n c y Al l E v e n t s Mo n t h l y Ye s 10 0 % Su c c e s s R a t e u s i n g Pr e M I S P e r s o n n e l Pe r f o r m a n c e R e p o r t f o r ea c h E M S p r o f e s s i o n a l Pr e M I S Re p o r t Use PreMIS report to id e n t i f y a n d a d d r e s s in d i v i d u a l s i n n e e d o f s k i l l tr a i n i n g 27 . P r o t o c o l Co m p l i a n c e Al l 9 1 1 a n d SC T P Ev e n t s Mo n t h l y Ye s 10 0 % 10 0 % R e v i e w b y Su p e r v i s o r a n d a v a i l a b l e Pr e M I S a n d E M S T o o l k i t Re p o r t s i d e n t i f y i n g a n y de v i a t i o n ( m i s s i n g o r ad d i t i o n a l t r e a t m e n t ) b y th e P r i m a r y C a r e g i v e r EM S Ag e n c y , Pr e M I S , an d To o l k i t Re p o r t s Se t T a r g e t a n d w o r k f o r 95 % c o m p l i a n c e . In v e s t i g a t e d e v i a t i ons as s o c i a t e d w i t h a c a r e is s u e 28 . P a t i e n t C o n t a c t Nu m b e r s ( C r e w ) Al l E v e n t s Mo n t h l y Ye s 10 0 % Nu m b e r o f P C R ’ s wh e r e EM S p e r s o n n e l a r e li s t e d a s a n y c r e w me m b e r Pr e M I S Re p o r t Id e n t i f y i n d i v i d u a l s w i t h o u t EM S p a t i e n t c o n t a c t within a 6 m o n t h interval and ad d r e s s through tr a i n i n g / e d u c a t i o n 29 . P a t i e n t C o n t a c t Nu m b e r s ( 1 q Ca r e g i v e r ) Al l E v e n t s Mo n t h l y Ye s 10 0 % Nu m b e r o f P C R ’ s wh e r e EM S p e r so n n e l a r e li s t e d a s t h e P r i m a r y Ca r e g i v e r Pr e M I S Re p o r t Id e n t i f y i n d i v i d u a l s n o t fu n c t i o n i n g a s p r i m a r y pa t i e n t c a r e g i v e r s w i t h i n a 6 m o n t h interval and ad d r e s s through tr a i n i n g / e d u c a t i o n 30 . PC R ’ s C o m p l e t e d Al l E v e n t s Mo n t h l y Ye s 10 0 % Nu m b e r o f P C R ’ s en t e r e d b y ea c h E M S pr o f e s s i o n a l Pr e M I S Re p o r t Monitor to assure all staff on r o s t e r a r e i n v o l v e d i n pa t i e n t c a r e d o c u m e n t a t i o n an d maintain skills 31 . E d u c a t i o n / C M E Al l Pe r s o n n e l Qu a r t e r l y Ye s 10 0 % CM E h o u r s a n d li c e n s u r e s t a t u s EM S Ag e n c y an d C I S Re p o r t s Id e n t i f y a n d a d d r e s s a n y in d i v i d u a l n o t c u r r e n t o r o n tr a c k t o m a i n t a i n c r e d e n t i a l No r t h C a r o l i n a C o l l e g e o f E m e r g e n c y P h y s i c i a n s St a n d a r d s f o r t h e S e l e c t i o n a n d P e r f o r m a n c e o f EM S P e r f o r m a n c e I m p r o v e m e n t Pe r f o r m a n c e S t a n d a r d s ( P a g e 6 o f 1 1 ) 2 0 0 9 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD To p i c Re c o r d Se l e c t i o n Tr e n d i n g Fr e q u e n c y Ma n d a t o r y Pe r c e n t a g e of Ev e n t s Re v i e w e d De f i n i t i o n Da t a So u r c e Loop Closure 32 . E M D I n d i v i d u a l Di s p a t c h T i m e s Al l 9 1 1 Ev e n t s Mo n t h l y Ye s , i f E M D Us e d 10 0 % o f A l l Di s p a t c h e s gr o u p e d b y Em e r g e n t a n d No n -Em e r g e n t 91 1 C a l l t i m e u n t i l Di s p a t c h o f E M S U n i t f o r ea c h E M D p r o f e s s i o n a l EM S Ag e n c y Establish target and work fo r 9 5 % c o m p l i a n c e 33 . E M D P r o t o c o l Co m p l i a n c e Al l 9 1 1 Ev e n t s Mo n t h l y Ye s , i f E M D Us e d Ba s e d o n C a l l Vo l u m e u s i n g Pr i o r i t y Di s p a t c h Re v i e w Gu i d e l i n e EM D C o m p l i a n c e p e r EM D Ve n d o r Q u a l i t y Ma n a g e m e n t Re c o m m e n d a t i o n EM S Ag e n c y Establish target and work fo r 9 5 % c o m p l i a n c e 34 . C o n t r o l l e d Su b s t a n c e C o u n t s Al l E v e n t s wi t h Na r c o t i c U s e Mo n t h l y Ye s 10 0 % % o f n a r c o t i c u s e s w i t h si g n -o u t a n d c o u n t s ap p r o p r i a t e EM S Ag e n c y 100% of narcotic uses should be accounted for or deviation logged Pa t i e n t C a r e : T r e a t m e n t 35 . N o P r o t o c o l Do c u m e n t e d Al l 9 1 1 a n d SC T P Ev e n t s Mo n t h l y Ye s 10 0 % PC R ’ s w h e r e n o pr o t o c o l ( o r o n l y Un i v e r s a l P a t i e n t C a r e Pr ot o c o l ) i s l i s t e d Pr e M I S Re p o r t Set target and work for 95% compliance for protocol documentation 36 . N o P a t i e n t C a t e g o r y Do c u m e n t e d Al l E v e n t s Mo n t h l y Ye s 10 0 % PC R ’ s w i t h no ( E 0 9 _ 1 1 ) Ch i e f C o m p l a i n t An a t o m i c L o c a t i o n , (E 0 9 _ 1 2 ) C h i e f Co m p l a i n t O r g a n Sy s t e m , ( 0 9 _ 1 3 ) P r i m a r y Sy m p t o m , a n d ( E 0 9 _ 1 5 ) Pr o v i d e r ’ s P r i m a r y Im p r e s s i o n D o c u m e n t e d Pr e M I S Re p o r t Set target and work for 95% compliance for documentation of these re q u i r e d d a t a e l e m e n t s . 37 . M e d i c a t i o n Co m p l i c a t i o n s Al l E v e n t s Mo n t h l y Ye s 10 0 % Me d i c a t i o n Co m p l i c a t io n s Do c u m e n t e d in P C R Pr e M I S Re p o r t Discuss and address if preventable care issue. 38 . S k i l l C o m p l i c a t i o n s Al l E v e n t s Mo n t h l y Ye s 10 0 % Pr o c e d u r e Co m p l i c a t i o n s Do c u m e n t e d in P C R Pr e M I S Re p o r t Discuss and address if preventable care issue. No r t h C a r o l i n a C o l l e g e o f E m e r g e n c y P h y s i c i a n s St a n d a r d s f o r t h e S e l e c t i o n a n d P e r f o r m a n c e o f EM S P e r f o r m a n c e I m p r o v e m e n t Pe r f o r m a n c e S t a n d a r d s ( P a g e 7 o f 1 1 ) 2 0 0 9 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD 41 . F r e q u e n t F l y e r s Al l 9 1 1 Ev e n t s Qu a r t e r l y Op t i o n a l 10 0 % Pa t i e n t s a c c e s s i n g E M S > 4 t i m e s p e r m o n t h ? Pr e M I S Re p o r t Di s c u s s a p p r o p r i a t e n e s s o f EM S u s e f r o m a p a t i e n t ca r e p e r s p e c t i v e . I f in a p p r o p r i a t e i d e n t i f y p l a n to a d d r e s s 42 . R e p e a t p a t i e n t s wi t h i n 4 8 h o u r s Al l 9 1 1 Ev e n t s Mo n t h l y Ye s 10 0 % Pa t i e n t s w i t h r e p e a t EM S u s e i n a n y 4 8 h o u r ti m e p e r i o d Pr e M I S Re p o r t Ev a l u a t e p a t i e n t c a r e e v e n t an d d i s c u s s a n y E M S c a r e re l a t e d i s s u e t h a t m a y h a v e co n t r i b u t e d . D e v e l o p a n d im p l e m e n t p l a n t o a d d r e s s an y i d e n t i f i e d i s s u e s . To p i c Re c o r d Se l e c t i o n Tr e n d i n g Fr e q u e n c y Ma n d a t o r y Pe r c e n t a g e of E v e n t s Re v i e w e d De f i n i t i o n Da t a So u r c e Loop Closure 39 . S y s t e m T r i a g e a n d De s t i n a t i o n Pl a n Co m p l i a n c e Al l 9 1 1 Ev e n t s Qu a r t e r l y Ye s 10 0 % Tr i a g e a n d D e s t i n a t i o n ba s e d o n E M S S y s t e m Pl a n s f o r P e d i a t r i c , ST E M I , S t r o k e a n d Tr a u m a Pr e M I S Re p o r t s an d EM S To o l k i t s Discuss findings and ad j u s t p l a n a s n e e d e d . Work with your RAC. 40 . P a i n C o n t r o l Al l E v e n t s Mo n t h l y Op t i o n a l 10 0 % Pa i n r e c o r d e d a s V S a n d ad d r e s s e d w i t h p a i n me d i c a t i o n i f p a i n s c o r e is g r e a t e r t h a n 6 on a sc a l e o f 1 0 Pr e M I S Re p o r t Set Target and work for 90 % compliance Pa t i e n t C a r e : H i g h R i s k P a t i e n t s No r t h C a r o l i n a C o l l e g e o f E m e r g e n c y P h y s i c i a n s St a n d a r d s f o r t h e S e l e c t i o n a n d P e r f o r m a n c e o f EM S P e r f o r m a n c e I m p r o v e m e n t Pe r f o r m a n c e S t a n d a r d s ( P a g e 8 o f 1 1 ) 2 0 0 9 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD To p i c Re c o r d Se l e c t i o n Tr e n d i n g Fr e q u e n c y Ma n d a t o r y Pe r c e n t a g e of Ev e n t s Re v i e w e d De f i n i t i o n Da t a So u r c e Loop Closure 43 . D e a t h s Al l E v e n t s Mo n t h l y Ye s 10 0 % Al l D e a t h s w i l l u n d e r EM S C a r e EM S Ag e n c y an d Pr e M I S Re p o r t s Discussion and address identified issues 44 . R e s t r a i n t U s e Al l E v e n t s Mo n t h l y Ye s 10 0 % Al l R e s t r a i n t u s e EM S Ag e n c y an d Pr e M I S Re p o r t s Review and Discussion of appropriateness and care associated with procedure and event. Address any identified issues or trends. 45 . R e f u s a l s Al l E v e n t s Mo n t h l y Ye s 10 0 % r e v i e w by S u p e r v i s o r wi t h c o n c e r n s re f e r r e d t o Co m m i t t e e Al l P C R s w i t h p a t i e n t co n t a c t b u t no n - tr a n s p o r t EM S Ag e n c y an d Pr e M I S Re p o r t Discussion and address identified issues or trends 46 . C a n c e l b y F R Al l E v e n t s Mo n t h l y Ye s 10 0 % Al l D i s p a t c h e s c a n c e l l e d by a F i r s t R e s p o n d e r wi t h N O E M S A r r i v a l O n Sc e n e EM S Ag e n c y an d Pr e M I S Re p o r t Discussion and address identified issues or trends 47 . O b s t e t r i c a l De l i v e r i e s Al l E v e n t s Mo n t h l y Ye s  10 0 %  Al l D e l i v e r i e s do c u m e n t e d i n P C R Pr e M I S Re p o r t Discussion and address identified issues or trends 48 . A s s i s t e d V e n t i l a t i o n or I n v a s i v e A i r w a y Us e Al l E v e n t s Mo n t h l y Ye s  10 0 %  Al l B V M a n d I n v a s i v e Ai r w a y s d o c u m e n t e d i n PC R a n d A i r w a y Ev a l u a t i o n F o r m Pr e M I S Re p o r t an d Ai r w a y Fo r m  Review and Discussion of appropriateness and care associated with procedure and event. Address any identified issues or trends. 49 . D r u g A s s i s t e d In t u b a t i o n Al l E v e n t s Mo n t h l y Ye s  10 0 %  Do c u m e n t e d i n P C R a n d Ai r w a y E v a l u a t i o n F o r m Pr e M I S Re p o r t an d Ai r w a y Fo r m  Review and Discussion of appropriateness and care associated with RSI event. Address any identified issues or trends. No r t h C a r o l i n a C o l l e g e o f E m e r g e n c y P h y s i c i a n s St a n d a r d s f o r t h e S e l e c t i o n a n d P e r f o r m a n c e o f EM S P e r f o r m a n c e I m p r o v e m e n t Pe r f o r m a n c e S t a n d a r d s ( P a g e 9 o f 1 1 ) 2 0 0 9 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD 52 . T o o l k i t R e s u l t s Al l 9 1 1 Ev e n t s ba s e d o n EM S T o o l k i t To p i c s Tw i c e e a c h ye a r Ye s 10 0 % u s i n g a l l 6 EM S To o l k i t s Pa t i e n t C a r e E v a l u a t i o n us i n g : -S y s t e m R e s p o n s e T i m e -T r a u m a C a r e -C a r d i a c A r r e s t C a r e -S T E M I C a r e -S t r o k e C a r e -P e d i a t r i c C a r e ¿¿EM S To o l k i t Re p o r t s Review, Discuss, Identify, and implement 1 in t e r v e n t i o n p e r T o o l k i t use (2 interventions per year) To p i c Re c o r d Se l e c t i o n Tr e n d i n g Fr e q u e n c y Ma n d a t o r y Pe r c e n t a g e of E v e n t s Re v i e w e d De f i n i t i o n Da t a So u r c e Loop Closure 50 . C h e s t De c o m p r e s s i o n Al l E v e n t s Mo n t h l y Ye s  10 0 % Do c u m e n t e d i n P C R Pr e M I S Re p o r t  Review and Discussion of appropriateness and care associated with procedure and event. Address any id e n t i f i e d i s s u e s o r tr e n d s . 51 . C a r d i o v e r s i o n Al l E v e n t s Mo n t h l y Ye s  10 0 %  Do c u m e n t e d i n P C R Pr e M I S Re p o r t Review and Discussion of appropriateness and care associated with procedure and event. Address any id e n t i f i e d i s s u e s o r tr e n d s . No r t h C a r o l i n a C o l l e g e o f E m e r g e n c y P h y s i c i a n s St a n d a r d s f o r t h e S e l e c t i o n a n d P e r f o r m a n c e o f EM S P e r f o r m a n c e I m p r o v e m e n t Pe r f o r m a n c e S t a n d a r d s ( P a g e 1 0 o f 1 1 ) 2 0 0 9 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD To p i c Re c o r d Se l e c t i o n Tr e n d i n g Fr e q u e n c y Ma n d a t o r y Pe r c e n t a g e of Ev e n t s Re v i e w e d De f i n i t i o n Da t a So u r c e Loop Closure 53 . G C S < 9 Al l E v e n t s Mo n t h l y Ye s  10 0 %  Do c u m e n t e d i n P C R Pr e M I S Re p o r t Review and Discussion of care associated with event. Address any identified issues or trends. 54 . A b n o r m a l V i t a l Si g n s Al l E v e n t s Mo n t h l y Ye s  10 0 %  Ab n o r m a l V i t a l S i g n s i n Ag e > 1 2 y e a r s a s de f i n e d b y : -S y s t o l i c B P < 9 0 -S y s t o l i c B P > 2 0 0 -H e a r t R a t e < 4 0 -H e a r t R a t e > 1 3 0 -R e s p i r a t o r y R a t e < 8 -R e s p i r a t o r y R a t e > 2 8 (P e d i a t r i c V S e v a l u a t e d th r o u g h t h e P e d i a t r i c To o l k i t ) Pr e M I S Re p o r t Discussion and address identified issues or trends Pa t i e n t C a r e : H i g h R i s k E v e n t s 55 . P h y s i c i a n o n S c e n e Al l 9 1 1 Ev e n t s  Mo n t h l y Ye s  10 0 %  EM S E v e n t s w i t h a n o n - EM S P h y s i c i a n o n S c e n e EM S Ag e n c y Discussion and address identified issues 56 . M u l t i - P a t i e n t E v e n t Al l E v e n t s Mo n t h l y Ye s  10 0 %  EM S E v e n t s Do c u m e n t e d a s m u l t i - pa t i e n t Pr e M I S Re p o r t Discussion and address identified issues 57 . M a s s G a t h e r i n g s Al l E v e n t s  Mo n t h l y Ye s  10 0 %  Ma s s G a t h e r i n g s w i t h i n th e E M S S y s t e m EM S Ag e n c y Discussion and address identified issues post event. Adjust plan 58 . P o l i c e C u s t o d y Al l E v e n t s  Mo n t h l y Ye s  10 0 % EM S E v e n t s w i t h p a t i e n t un d e r p o l i c e c u s t o d y EM S Ag e n c y Discussion and address identified issues 59 . T a c t i c a l E M S Al l E v e n t s  Mo n t h l y Ye s 10 0 % EM S T a c t i c a l A c t i v a t i o n s wi t h P a t i e n t C o n t a c t EM S Ag e n c y Discussion and address identified issues 60 . W i l d e r n e s s E M S Re s c u e Al l E v e n t s Mo n t h l y Ye s 10 0 % Wi l d e r n e s s E M S R e s c u e Pa t i e n t C o n t a c t s EM S Ag e n c y Discussion and address identified issues No r t h C a r o l i n a C o l l e g e o f E m e r g e n c y P h y s i c i a n s St a n d a r d s f o r t h e S e l e c t i o n a n d P e r f o r m a n c e o f EM S P e r f o r m a n c e I m p r o v e m e n t Pe r f o r m a n c e S t a n d a r d s ( P a g e 1 1 o f 1 1 ) 2 0 0 9 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised September, 2018 Orange County Emergency Services System Plan M A S S G A T H E R I N G P L A N Guide to an Effective Emergency Response to Planned or Impromptu Mass Gathering Incidents September, 2018 Prepared By: ___________ Kim Woodward Operations Manager, Emergency Medical Services Branch "UUBDINFOU#DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Orange County Emergency Services System Plan Mass Gathering Plan Revised September, 2018 Objective: x To provide guidance to Orange County emergency response agencies to establish minimum medical services so that inter-agency planning and response to a mass gathering incident is managed effectively. Introduction: x To establish the capabilities to respond effectively to a planned or impromptu mass gathering incident, this plan defines the responsibilities of both the event planners and Orange County Emergency Services (OCES) personnel. x A mass gathering incident is defined as any incident involving the expected or actual presence of people in a venue or area for a specific purpose or time that by the nature of the gathering poses a threat to the health, safety, and welfare of the community or participants. x Mass gatherings include planned events like street fairs and festivals, sporting and entertainment events, and political rallies, and impromptu events, such as post-sporting-event street celebrations. x The North Carolina Fire Code requires that appropriate plans be developed for the safety and medical care of persons at mass gathering incidents. x This plan defines the responsibilities of the OCES system in providing the safety and medical care for people at mass gatherings. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Orange County Emergency Services System Plan Mass Gathering Plan Revised September, 2018 Responsibilities: x Event Planner(s): o The Event Planner(s) will be responsible for notifying OCES of planned mass gathering events. o For private events, the event planner is responsible for notifying OCES. o For public events, the law enforcement authority having jurisdiction should coordinate with OCES to provide the requisite medical coverage. o Notification of OCES must occur no later than 60 days prior to the scheduled event. o The event planner(s) are responsible for the following: Involving OCES, Fire, and Law Enforcement in early planning efforts. Providing ground plans, building plans, or site plans to response agencies. Providing accurate estimates of the possible attendance at the gathering and all activities expected. Clearly identifying any special hazards that may be present at the gathering such as pyrotechnics, mechanical / vehicle competitions, etc. Maintaining a copy of the approved medical plan that shall be retained by the event planner and OCES. x Emergency Services Staff: o OCES personnel will provide medical coverage for mass gathering incidents. o Based on the anticipated attendance and special hazards, OCES staff will develop an incident-specific operation plan with clear definitions of appropriate dedicated event-specific response, triage, treatment, and transport capabilities. o Participate in the Incident Action Plan (IAP) planning process. (See Appendix) o Submit a medical plan (ICS 206) that has been crafted in collaboration with OCES and approved by both the OCES Operations Manager and the OCES Medical Director. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Orange County Emergency Services System Plan Mass Gathering Plan Revised September, 2018 Emergency Services Staff (Continued): o Based on the size of the event, the following tasks may be assigned to separate individuals, separate teams, or grouped and assigned to a single individual: Event Medical Operations - This function oversees all aspects of the medical operation at the event. x Event Triage. o This function directs and conducts medical assessment of casualties in a designated treatment area or while roving through the mass gathering area. o If the triage function is conducted while moving around the venue, then transport of the injured to a central treatment area is also a component part of this responsibility. x Event Treatment. o This function directs the treatment of sick and injured people in the mass gathering area. x Event Transportation Officer. o This function directs the transport of severely injured or ill persons to facilities for further treatment. o This function may also involve liaison with the normal OCES operations through the OCES Operations Manager. x Event Logistics Officer. o This function provides for the necessary support of OCES personnel providing coverage at the event. x Other anticipated Functions. o Based on the type and venue of the event, there may be a need to include specialty teams, such as haz-mat, decontamination, wilderness medicine, or amateur radio groups in the OCES event plan. x Communications Plan x Ingress/Egress Plan DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Orange County Emergency Services System Plan Mass Gathering Plan Revised September, 2018 Responsibilities (Continued): x Interface with Routine OCES Operation o Depending on the size of the mass gathering, some of the medical functions may be provided by on-duty EMS resources (hospital transport, for example). o If dedicated units are used to provide medical support at the mass gathering, those units are unavailable for other tasks unless released by IC/Med Ops. o Units may only be diverted from a mass gathering assignment by the on-duty EMS Supervisor, the OCES Operations Manager, or the OCES Director. The Plan: x Mass gathering or special event medical plans shall include, but are not limited to the following considerations: o Event description, including event name and expected attendance o Participant safety o Non-participant (Spectator, Bystander) safety x Direct communications, using wireless means when possible, shall be included in medical plans as follows: o Between venue staff and/or security personnel, event coordinator, and medical personnel o Between medical personnel located at a first aid station and mobile teams and/or satellite stations o Between medical personnel and Emergency Communications Department o Between medical personnel and ambulances o Between medical staff and receiving hospitals x If the mass gathering is a protest registered with the Police Department, organizers are encouraged to provide CPR and 911 access by gathering personnel. x Medical resources will be employed for the mass gathering or special event based on the following template: DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Orange County Emergency Services System Plan Mass Gathering Plan Revised September, 2018 X =REQUIRED * = RECOMMENDED #=MULTIPLE UNITS MAY BE REQUIRED depending on history and size of event. A reasonable planning guide is 1 unit per 10,000 participants or spectators. ^=If a parade or sporting event takes place over 1 mile or more, more than 1 first aid station is recommended @=AED access recommended Event TypeCrowd Size (anticipated) CPR & 911 Access@ 1 st Aid Station w/ EMT 1 st Aid Station w/ Paramedic 1 st Aid Station w/ Physician BLS or ALS Ambulance Mobile Teams Concert/ Music Festival < 2,500 X X * 2500-15,500 X X BLS* * 15,500- 80,000 X X ALS (X)# X >80,000 X X ALS (X)# X Athletic/Sporting Event^ < 2,500 X X * 2500-15,500 X X BLS X 15,500- 80,000 X X ALS (X)# X >80,000 X X ALS (X)# X Parade^/ Block party/Street fair/ Outside Venue < 2,500 X * * 2500-15,500 X X * BLS* X 15,500- 80,000 X X ALS (X)# X >80,000 X X ALS (X)# X Conference or Convention < 2,500 X * 2500-15,500 X X * BLS* * 15,500- 80,000 X X ALS (X)# X >80,000 X X ALS (X)# X DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Orange County Emergency Services System Plan Mass Gathering Plan Revised September, 2018 Definitions / Background: x CPR & 911 Access: o Event staff and/or safety personnel have the capability to notify 911 of any medical emergency and to provide CPR/AED access (within 5 minutes, 90% of occurrences). x Medical Aid Station with EMT: o A fixed or mobile facility with the ability to provide first aid level care staffed by at least one Emergency Medical Technician or higher skill level personnel. o First Aid level care is defined as treatment of minor medical conditions and injuries by care providers that have received training in First Aid. Examples of First Aid are: x Cleaning x Bandaging simple wounds such as scrapes and shallow cuts x Providing cold packs for musculoskeletal strains and bruises x Giving drinking water and providing a place to rest for mildly dehydrated patients Examples of a First Aid Station are: x Tent x Clinic x Ambulance or vehicle of some type First Aid stations must have 911 Communications capability. o EMTs must be fully credentialed with an Orange County franchised ambulance provider agency. o First Aid Stations must notify the Orange County 911 Center once their operations begin and again when they are concluded. x Medical Aid Station with Paramedic: o A similar facility to the one listed above, but staffed by at least one Paramedic. Paramedics must be fully credentialed with an Orange County franchised ambulance provider agency. o The First Aid Station must notify the Orange County 911 Center once their operations begin and again when they conclude. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Orange County Emergency Services System Plan Mass Gathering Plan Revised September, 2018 Definitions / Background (Continued): x Medical Aid Station with Physician: o A similar facility to the one listed above, but staffed by at least one Physician holding a current North Carolina license. It is preferred that the physician be experienced in emergency medical care and triage of seriously ill or injured patients to higher levels of care. x Examples would be physicians with Emergency Medicine, Family Practice, Sports Medicine, Internal Medicine, or Trauma Care Specialization. x BLS (Basic Life Support) or ALS (Advanced Life Support) Ambulance: o An ambulance staffed by 2 EMTs (BLS) or at least one Paramedic and one EMT (ALS). o ALS units may be used to substitute for BLS units. o At least one unit must remain on-site at all times. o In cases where a patient is in extremis, the unit may transport if the ETA to the closest receiving hospital is less than the ETA of responding ALS personnel. o BLS units may substitute for a fixed First Aid Station with an EMT. x Mobile Teams: o Mobile teams consist of two or more personnel, one of whom must be an EMT or higher-level provider, with treatment supplies necessary for the provider’s skill level, and communications capability with at least the Medical Aid Station. o Mobile teams will be classified as either BLS Mobile Team x Includes at least one EMT. ALS Mobile Team x Includes at least one Paramedic. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Orange County Emergency Services System Plan Mass Gathering Plan Revised September, 2018 Procedure: x Event medical plans shall be submitted to Orange County Emergency Services no later than 60 days prior to the proposed event. x The Orange County Emergency Services Operation Officer and the Orange County Emergency Services Medical Director shall review the medical plan within 15 days and respond to both the event sponsor and the permitting agency as follows: o Recommended without modification o Recommended, contingent upon acceptance of modifications o Not recommended x Those plans not recommended shall be returned and will include an explanation of the decision. x The applicant may appeal the decision by resubmitting the plan to the Orange County Emergency Services Director and requesting review of the decision within 5 working days. x The point of contact for questions regarding this policy is the Orange County Emergency Services Operations Manager. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Orange County Emergency Services System Plan Mass Gathering Plan Revised September, 2018 Appendix DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Orange County Emergency Services System Plan Mass Gathering Plan Revised September, 2018 Incident Action Plan (IAP) Documentation DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Orange County Emergency Services System Plan Mass Gathering Plan Revised September, 2018 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Orange County Emergency Services System Plan Mass Gathering Plan Revised September, 2018 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD 919-245-6100 (office) 919-732-5063 (24-hour) 919-732-8130 (fax) PO Box 8181, Hillsborough, North Carolina 27278 Exposure Control Policy Date of Preparation: May, 1992 Dates of Update: March, 1995 May, 1998 March, 2001 June, 2002 February, 2010 February, 2013 -XO\ Annual Review Dates Reviewed By February 15, 2013 Crystal Gualdoni, James Lunsford, Erin Ray Department Director: 'LQDK-HIIULHV Infection Control officer: &KULV3RSH Revised February, 201 Orange County Emergency Services +VMZ ,JN8PPEXBSE &.40QFSBUJPOT.BOBHFS "UUBDINFOU$ DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\, 201 Index Policy Statement Definitions Exposure Control Plan Roles and Responsibilities Standard Operating Procedures: EC 1: Health Maintenance EC 2: Exposure Control Training EC 3: Workplace Environment EC 4: Personal Protective Equipment EC 5: Scene Operations EC 6: Post Response EC 7: Post Exposure Protocols EC 8: Compliance / Quality Monitoring EC 9: Annual Review Exposure Control Plan EC 10: Engineered Sharps and Needle-less Systems EC 11: Hepatitis B Vaccine and Post Exposure Evaluation Appendices: Appendix 1: Approved Disinfectants Appendix 2: Laundry Procedure Appendix 3: Report of Occupational Exposure Appendix 4: Respirator Use Evaluation Form Appendix 5: Treatment Declination Appendix 6: Hepatitis B Vaccination Declination Appendix 7: 29 CFR 1910.1030 Orange County Emergency Services Exposure Control Policy Index DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ Goal: •Orange County Emergency Services is committed to providing a safe and healthy work environment for our entire staff. In pursuit of this endeavor, the following policies and procedures have been adopted. Objective: •To provide a comprehensive exposure control program that maximizes protection against communicable diseases for all personnel, and for the public, which they serve. •To provide emergency medical services to the public without regard to known or suspected communicable infection in any patient. •To regard all patient contacts as potentially infectious. Responders will observe universal precautions at all times. •To provide all personnel with the training, immunizations and personal protective equipment (PPE) necessary for protection from communicable diseases. •To recognize the need for responder work restrictions based on infection control concerns. •To prohibit discrimination against personnel for health reasons including infection and/or seroconversion with HIV, HBV or HCV. •To regard all medical information as strictly confidential. No personal health information will be released without the signed written consent of the personnel involved. • Scope: •This policy applies to all personnel, career and volunteer that provide emergency medical services within Orange County. •This department recognizes that communicable disease exposure is an occupational health hazard. Communicable disease transmission is possible during any aspect of emergency response, including workplace operations. The health and welfare of each personnel is a joint concern of the personnel and of management. While each person is ultimately responsible for their own health, the department recognizes a responsibility to provide as safe of a workplace as possible. The goal of this program is to provide all personnel with the best available protection from identified occupationally acquirable communicable disease. Orange County Emergency Services Exposure Control Program Policy Statement DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised February, 2013 Objective: •To identify a standard definition of personnel, equipment, statements and procedures. Definitions: •AIRBORNE PATHOGENS: pathogenic microorganisms or compounds which may be carried in the air and which when inhaled into the lungs may cause disease in humans. •BLOOD: human blood, human blood components, and products made from human blood. •BLOODBORNE PATHOGENS: pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV). •BODY SUBSTANCE ISOLATION: procedures used to protect emergency workers from ALL blood, blood products and body fluids. •CONTAMINATED: the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface. •CONTAMINATED LAUNDRY: laundry, which has been soiled with blood or other potentially infectious materials or may contain sharps. •CONTAMINATED SHARPS: any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires. •DECONTAMINATION: the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal. •ENGINEERING CONTROLS: controls (e.g., sharps disposal containers, self- sheathing needles) that isolate or remove the bloodborne pathogens hazard from the workplace. •EXPOSURE INCIDENT: a specific eye, mouth, or other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee's duties. •HBV: Hepatitis B virus. •HCV: Hepatitis C virus. •HIV: Human immunodeficiency virus. •HEPA MASK: a high efficiency particulate air respirator as defined by NIOSH, which is used as PPE to provide respiratory protection from airborne pathogens. •OCCUPATIONAL EXPOSURE: a reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's duties. Orange County Emergency Services Exposure Control Program Definitions DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised February, 2013 Definitions (Continued): •OTHER POTENTIALLY INFECTIOUS MATERIALS (OPIM): 1) The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, and all body fluids in situations contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; 2) Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and 3) HIV-containing cell or tissue cultures, organ cultures, and HIB- or HBV- containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV. Also includes the following if there is visible blood: feces, nasal secretions, sputum, sweat, tears, urine, vomitus and saliva (other than dental procedures). •PARENTERAL: piercing mucous membranes or the skin barrier through such events as needlesticks, human bites, cuts, and abrasions. •PERSONAL PROTECTIVE EQUIPMENT (PPE): specialized clothing or equipment worn by an employee for protection against a hazard. General work clothes (e.g., uniforms, pants, shirts, or blouses) not intended to function as protection against a hazard is not considered to be personal protective equipment. •REGULATED WASTE: liquid or semi-liquid blood or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or other potentially infectious materials. •SHARPS: items that may puncture the skin (e.g. needles, broken glass). •SOURCE INDIVIDUAL: any individual, living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to the employee. Examples include, but are not limited to, hospital and clinic patients, clients in institutions for the developmentally disabled, trauma victims, clients of drug and alcohol treatment facilities, residents of hospices and nursing homes, human remains, an individuals who donate or sell blood or blood components. •STERILIZE: the use of a physical or chemical procedure to destroy all microbial life including highly resistant bacterial endospores. •SUPERVISOR: an employee who oversees the work of another employee (e.g. EMS Lieutenant). The responsibilities of the Supervisor are listed in the “Responsibilities” section of this plan. •TUBERCULOSIS (TB): an infectious airborne pathogen. •UNIVERSAL PRECAUTIONS: an approach to infection control. According to the concept of universal precautions, all human blood and blood components including serum; other body fluids such as semen, vaginal secretions, cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids are treated as if they are infectious for HIV, HBV, and other bloodborne pathogens. •WORK PRACTICE CONTROLS: controls that reduce the likelihood of exposure by altering the manner in which a task is performed (e.g. prohibiting recapping of needles by a two-handed technique). DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ Objective: •To identify those tasks and corresponding job classifications for which it can be reasonably anticipated that an exposure to blood, body fluids or other potentially infectious materials (OPIM) may occur; To minimize or eliminate the occupational exposure to blood or OPIM and to comply with the OSHA BBP Standard, 29 CFR 1910.1030 and the Needlestick Safety and Prevention Act (Pub. L. 106-430). Exposure Determination: •All aspects of emergency medical care to medical and or trauma patients are reasonably anticipated to involve exposure to blood, body fluids or other potentially infectious materials. •The following job classifications are reasonably anticipated to involve exposure to blood, body fluids, or other potentially infectious substances in the performance of their duties relating to emergency medical services: o Firefighter o First Responder o EMS Field Supervisor o Emergency Medical Technician o Paramedic o Rescue Team Member o Fire Marshal / Assistant Fire Marshal o Medical Director and Staff o Telecommunicators o Emergency Services Director / Deputy Director o Training Coordinator Implementation: •The Exposure Control Program is applicable to all personnel, career and volunteer that provide emergency medical services through Orange County agencies. This policy was effective immediately on its implementation in 1992. The plan will be reviewed annually and updates / revisions will be made as needed. Orange County Emergency Services Exposure Control Program Exposure Control Plan DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ Implementation (Continued): •The Exposure Control Program consists of specific program components that are identified as follows: o Exposure Control Policy Statement o Exposure Control Plan o Exposure Control Roles and Responsibilities o Standard Operating Procedures: EC 1: Health Maintenance EC 2: Exposure Control Training EC 3: Station/Work Area Environment EC 4: Personal Protective Equipment EC 5: Scene Operations EC 6: Post-Response EC 7: Post-Exposure Protocols EC 8: Compliance and Quality Monitoring EC 9: Annual Review of Exposure Plan EC 10: Engineered Sharps / Needle less System EC 11: Hepatitis B Vaccine / Post Exposure Evaluation o Appendix: 1: Definitions 2: Approved disinfectants 3: Laundry Procedure 4: Report of Occupational Exposure 5: Respirator Use Form 6: Treatment Declination Form 7: Hepatitis B Vaccine Declination Form 8: OSHA 29 CFR 1910.1030 Evaluation of Exposure Incidents: •The procedure for the evaluation / investigation of circumstances surrounding incidents of potential exposure to blood, body fluids, or other potentially infectious materials is detailed in SOP EC 7: Post Exposure Protocols. This SOP also identifies medical follow-up, documentation, recordkeeping and confidentiality requirements. Compliance Methods: •Universal precautions will be observed at this facility in order to prevent contact with blood or other potentially infectious materials. All blood or other potentially infectious material will be considered infectious regardless of the perceived status of the source individual. •Engineering and work practice controls will be utilized to eliminate or minimize exposure to employees at this facility. Engineering controls are the primary means of eliminating or minimizing employee exposure and include the use of safer medical devices, such as needle-less devices, shielded needle devices, and plastic capillary tubes. Medical devices with engineered sharps injury protections and needle-less systems constitute an effective engineering control and must be used where feasible. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ Compliance Methods (Continued): •Where occupational exposure remains after institution of these controls, personal protective equipment shall also be utilized. These controls will be examined and maintained on a regular schedule. Appendix (B) includes the schedule for reviewing the effectiveness of the control for this department/establishment. •Hand washing facilities shall be made available to the employees who incur exposure to blood or other potentially infectious materials. These facilities are to be readily accessible after incurring exposure. If there is a case where a hand washing facility is not accessible, an antiseptic cleanser in conjunction with clean cloth/paper towels or antiseptic towelettes is to be provided. If this alternative is used, then the employee is to wash their hands with soap and running water as soon as possible after the occupational exposure. The location(s) of the nearest hand washing facility should be readily available to employees that are using the alternative method. •Supervisors shall ensure that after the removal of personal protective gloves, employees shall wash hands and any other potentially contaminated skin area immediately or as soon as feasible with soap and water. •Supervisors shall ensure that if employees incur exposure to their skin or mucous membranes then those areas shall be washed or flushed with water as soon as feasible following contact. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ Department Director: •The tasks of managing the department Occupational Health and Safety and Exposure Control Programs are delegated to appropriate staff as noted below. The ultimate responsibility for the health and welfare of all personnel remains that of the Department Director. Designated Exposure Control Officer: •The Exposure Control Officer is the Staff Officer in Life Safety Management for Orange County Emergency Services. The designated officer shall: o Develop a schedule and method of implementation for the various requirements of the OSHA BBP Standard. o Identify training needs for all OCES related personnel regarding OSHA standards for bloodborne pathogens and PPE. o Evaluate possible personnel exposures to communicable diseases and coordinate communications between the Department Director, the Medical Director, area hospitals, UNC Hospital Occupational Health Services, Local and State Health Departments. o Collect quality assurance data on the Exposure Control Program. o Notify the EMS Operations Manager and Medical Director if quality assurance data indicate a safety hazard requiring immediate attention. o Conduct spot inspections of on-scene and workplace operations to assure compliance with department Exposure Control policy. o Coordinate the immunization program and maintain immunization records. o Maintain a confidential database of exposure incidents and follow-up treatment visits, in conjunction with the UNC Hospital Occupational Health Services. o Provide technical expertise in the revision of the Exposure Control Plan. o Keep abreast of new developments in the field of Exposure Control and make appropriate recommendations to the EMS Director and revisions to the Exposure Control Plan as needed. o Enforce compliance of the Exposure Control Plan, polices and procedures. o Develop and deliver a comprehensive exposure control educational program, which complies with OSHA Regulation 29 CFR Part 1910.1030. o Not allow new personnel to assume emergency response duties until initial medical evaluation, immunizations, and Exposure Control training has been completed. Orange County Emergency Services Exposure Control Plan Roles and Responsibilities DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ Department Managers and Supervisors: •Managers and Supervisors will: o Support and enforce compliance with the Exposure Control Program. o Correct any unsafe acts, and refer personnel for remedial exposure control training if required. o Assure safe operating practices on-scene and in the workplace. o Refer for medical evaluation any personnel possibly unfit for work for Exposure Control or other reasons. o Conduct formal workplace tours and document the results monthly. Personnel: •All personnel will: o Assume responsibility for their health and safety. o Always utilize appropriate personal protective equipment as the situation and current protocol dictates. o Assure personal compliance with Exposure Control Program SOPs. o Immediately report any incident of suspected occupational exposure to communicable diseases to their supervisor and to the Exposure Control Officer. o Immediately Report any diagnosis of communicable disease to the Department’s Exposure Control Officer. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ EC 1: Health Maintenance: •No new personnel will be assigned to emergency response duties until an entrance physical assessment has been performed and has been certified as fit for duty. •The Exposure Control Officer may initiate work restrictions for reasons of Exposure Control. These may be temporary or permanent. For example, personnel with extensive dermatitis or open skin lesions on exposed areas may be restricted from providing patient care or handling and / or decontamination of patient care equipment. •All personnel will be offered a TB Skin Test, immunization against hepatitis B, and will be required to show proof of immunization against influenza, measles, mumps, rubella, poliomyelitis (polio), tetanus, and diphtheria. The risks and benefits of hepatitis B immunization will be explained to all personnel and informed consent obtained prior to immunization. •Personnel who refuse immunization will be counseled on the occupational risks of communicable disease, and required to sign a refusal of immunization form. Personnel who initially refuse immunization may later receive immunization upon request. •All personnel will be offered initial and yearly screening for tuberculosis exposure. •All personnel will receive annual health evaluations. •Any personnel returning to work following injury, illness or communicable disease, (occupational or not) will be released by the Exposure Control Officer prior to resuming emergency response duties. •All personnel will receive an exit health evaluation upon being reassigned to non- response duties or upon termination of employment of the department. •The Department Exposure Control Officer will maintain records in accordance with OSHA CFR 29, Part 1910.1030. Personnel participation in the Exposure Control Program will be documented, including: o Name and SSN of personnel. o Immunization records. o Annual medical evaluation records as needed. o Infection control / exposure control plan training participation. o PPE training and fitting. o Incidents of potential exposure to communicable diseases and incident investigation results. o Post-exposure medical evaluation, treatment, and follow-up. •Exposure Control records will become a part of the personnel's personal health file and will be maintained for duration of employment plus thirty (30) years. Orange County Emergency Services Exposure Control Program Standard Operating Procedures DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ EC 1: Health Maintenance (Continued): •Medical records are strictly confidential. Medical records will be maintained by the department, and will not be kept in the personnel records. Medical records will not be released without the signed written consent of the personnel. There will be no exceptions to this policy for Department Administration, Government Administrators, insurance companies or any other persons. •Records of participation in personnel assistance programs or critical incident stress debriefing are considered medical records and kept as strictly confidential. •Personnel may examine their own medical records, and may obtain one copy for personal use. Abstracts of medical records without personal identifiers may be made for quality assurance, compliance monitoring, or program evaluation purposes, so long as the identity of individual personnel cannot be determined from the abstract. •Communications between medical and personnel sections will focus on fitness to work or restrictions, and not on diagnoses. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ EC 2: Exposure Control Training: •All personnel providing emergency services will be required to complete: o Initial Exposure Control training at the time of assignment to tasks where occupational exposure may occur. Personnel shall not be assigned to such tasks until they have received such training. o Refresher and updated exposure control training at least annually thereafter. •All Exposure Control training materials will be appropriate in content and vocabulary to the educational level, literacy, and language of personnel being trained. •Training will be in compliance with OSHA Regulation 29 CFR Part 1910.1030 and shall include: o An accessible copy of 29 CFR Part 1910.1030 and an explanation of its contents. o A general explanation of the epidemiology and symptoms of bloodborne / airborne diseases. o An explanation of the modes of transmission of bloodborne / airborne pathogens. o An explanation of the department exposure control plan including the location of an accessible copy for personnel to examine at any time. o An explanation of the appropriate methods for recognizing tasks and other activities that may involve exposure to blood and other potentially infectious materials. o Information on the types, proper uses, location, removal, handling, decontamination and disposal of personal protective equipment. o An explanation of the basis for selection of personal protective equipment. o Information on the hepatitis B vaccination program provided to all personnel at no cost, including information regarding its efficacy, safety, and benefits. o Information on the appropriate actions to take and persons to contact in an emergency involving blood or other potentially infectious materials. o An explanation of the procedure to follow if an exposure incident occurs, including the method of reporting the incident, exposure determination, and the medical follow-up that will be made available o Information on the post-exposure evaluation and follow-up that the department is required to provide following an exposure incident. o An explanation of the signs, labels and / or color-coding required for biohazard materials including the proper storage and disposal of materials. o Opportunity for interactive questions and answers. Orange County Emergency Services Exposure Control Program Standard Operating Procedures DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ EC 2: Exposure Control Training (Continued): •Exposure Control trainers shall be knowledgeable in all of the program elements listed above, particularly as they relate to emergency services provided by this department. •Written records of all training sessions will be maintained for three years after the date on which the training occurs. Training records will include: o The dates of the training sessions. o The contents or a summary of the training sessions. o The names and qualifications of persons conducting the training. o The names and job titles of all persons attending the training sessions. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ EC 3: Workplace Environment: •STORAGE, DECONTAMINATION, AND DISPOSAL AREAS: o All workplaces will designate separate areas for: •Equipment decontamination and disinfection. •Storage of clean patient care equipment and infection control personal protective equipment. •Storage of bio-hazardous waste. •Under no circumstances will kitchen, bathrooms, or living areas be used for decontamination or storage of patient care equipment or infectious waste. •Decontamination areas will be marked with biohazard signs and will be equipped with: o A sink, constructed of nonporous materials, equipped with a single hot / cold faucet and connected to a sanitary sewer system. o Proper lighting and adequate ventilation. o Adequate counter areas constructed of nonporous materials. o Adequate rack space to allow air-drying of equipment. o Appropriate containers for disposal of biohazard waste. o Facilities for the safe storage, use, and disposal of cleansing and disinfecting solutions. o Appropriate PPE for the use of disinfecting solutions. o Material safety data sheets (MSDS) for cleansing and disinfecting solutions. All personnel using these solutions will be familiar with the MSDS and will use the recommended PPE. o Instructions for routine cleaning and decontamination of patient care equipment and clothing. Infectious waste storage areas will be marked with biohazard signs. •Contaminated sharps will be stored in closed, puncture resistant containers (sharps boxes) with appropriate Biohazard markings and color-coding. •Contaminated materials will be stored in leak proof bags with appropriate biohazard markings and color-coding. o If outside contamination of a disposal bag is a possibility, a second bag with identical markings will be placed over the first. o Reusable bins and containers used to store biohazard waste will be inspected, cleaned, and disinfected weekly, and immediately if outside contamination is present. •All disposal of biohazard waste will be in accordance with UNC Hospitals regulations. Orange County Emergency Services Exposure Control Policy Standard Operating Procedures DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\, 201 EC 3: Workplace Environment (Continued): •LAUNDRY AREA: o Personnel will have access to a clean laundry area with washer, dryer, and wash sink. o All contaminated work uniforms will be washed in-station before being taken home. Under no circumstances will personnel, due to the possibility of family contamination, wash contaminated work clothes at home by infectious or chemical agents. o All personnel will maintain extra clean work uniforms in the station, so that potentially contaminated uniforms can be exchanged and washed upon return to the station. o All linen used for patient transport is considered contaminated. Linen will be exchanged by the medical facility receiving the patient, if possible. If not, the linen will be secured in a linen bag in the ambulance or at the station. Contaminated linen will not be washed in station laundry facilities. Contaminated linen will be transported to UNC hospital for decontamination. Appropriate PPE for handling of potentially contaminated linen will consist of a minimum of disposable gloves. •KITCHEN AREA: o Kitchens will be equipped with double sinks constructed of nonporous materials. o Food preparation areas, counter tops, and cutting boards will be constructed of nonporous materials. o Under no circumstances will any kitchen facility be used for the purpose of cleaning, sterilizing, disinfecting, storing, or disposal of any infectious material or waste. o Food will be properly prepared and cooked. Hands will be washed before and after preparing food. Food will be returned to the refrigerator before leaving the station if a meal is interrupted by a call. Consumption of food or drink will not be allowed in the patient care areas of ambulances. •BATHROOM AREAS: o Bathrooms will have push-to-open doors without handles. o Disposable hand-drying materials will be used. Cloth towels will not be used. o Personnel will have access to shower facilities for use in the event of blood or OPIM soak through the person’s uniform and grossly contaminate the skin. Soiled towels will be placed with other used linen in contaminated linen containers for transport to UNC Hospital. •SLEEPING AREAS: o Suitable sleeping quarters will be furnished for on-duty personnel to accommodate downtime while on duty. o Adequate ventilation will be provided and HVAC system will be maintained and in a safe working condition. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ EC 4: Personal Protective Equipment: •PPE PROVISION: o Supervisors are responsible for ensuring that required PPE is available in all ambulances as well as the stations. o All PPE used will be provided without cost to the employee. o PPE will be chosen based on the anticipated exposure to blood or other potentially infectious materials (OPIM). o The PPE will be considered appropriate if it does not permit blood or OPIM to pass through or reach the employees’ clothing, skin, eyes, mouth or other mucous membranes under normal conditions of use and for the duration of time that the PPE will be used. •PPE USE: o Supervisors shall ensure and enforce employee use of appropriate PPE. •PPE ACCESSIBILITY: o Supervisors shall ensure that appropriate PPE in the appropriate sizes is readily accessible at the work site or is issued without cost to employees. Hypoallergenic gloves, glove liners, powderless gloves, or other similar alternatives shall be readily accessible to those employees who are allergic to the gloves normally provided. •PPE CLEANING, LAUNDERING and DISPOSAL: o All personal protective equipment will be cleaned, laundered, or disposed of by the employer at no cost to the employees. The employer makes all repairs and replacements with no cost to employees. o All garments that are penetrated by blood shall be removed immediately or as soon as feasible. All PPE will be removed prior to leaving the work area. o When PPE is removed, it shall be placed in an appropriately designated area or container for storage, washing, decontamination, or disposal. Orange County Emergency Services Exposure Control Policy Standard Operating Procedures DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ EC 4: Personal Protective Equipment (Continued): •GLOVES: o Gloves shall be worn where it is reasonably anticipated that employees will have hand contact with blood, other potentially infectious materials, non-intact skin, and mucous membranes; when performing vascular access procedures and when handling or touching contaminated items or surfaces. o Disposable gloves used at this facility are not to be washed or decontaminated for re-use and are to be replaced as soon as practical when they become contaminated or as soon as feasible if they are torn, punctured, or when their ability to function as a barrier is compromised. o Where possible, gloves should be changed between patients in multiple casualty situations. o Heavy-duty utility gloves will be used for the handling, cleaning, decontamination, or disinfection of potentially contaminated patient care equipment. •EYE and FACE PROTECTION: o Masks in combination with eye protection devices, such as goggles or glasses with solid side shield, or chin length face shields, are required to be worn whenever splashes, spray, splatter, or droplets of blood or other potentially infectious materials may be generated and eye, nose, or mouth contamination can reasonably be anticipated. •ADDITIONAL PPE PROTECTION: o Fluid-resistant gowns and coveralls are designed to protect clothing from splashes. Turnout gear also protects clothing from splashes and is preferable in fire, rescue, or vehicle extrication activities. Gowns may interfere with, or present a hazard to the personnel in these circumstances. The decision to use barrier protection to protect clothing and the type of barrier protection to be used will depend on the type call (See SOP EC 5). o Under certain circumstances, head covers and/or shoe covers will be required to protect these areas from potential contamination. Structural firefighting gear (impervious boots, helmets) also may be used for barrier protection. o In general, personnel should select PPE appropriate to the potential spill, splash, or exposure to body fluids. No standard operating procedure or PPE ensemble can cover all situations. Common sense must be used. When in doubt, select maximal rather than minimal PPE. Guidelines for use of PPE on scene are found in SOP EC 5. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ EC 5: Scene Operations: •The blood, body fluids, and tissues of all patients are considered potentially infectious and Universal Precautions / Body Substance Isolation procedures will be used for all patient contact. Recommended PPE (minimum required) for use while performing specific tasks includes: All Patient Contact Requires Gloves! Task Gown or Coveralls Mask DQG eye protection Bleeding control, spurting blood Yes Yes Bleeding control, minimal bleeding No No Childbirth Yes Yes IV insertion No No ET Tube placement No Yes Suctioning, splashing likely No Yes Suctioning, splashing unlikely No No Medication administration No No Other tasks require personnel to utilize PPE based on the risk of exposure to potentially infectious materials. •Personnel are encouraged to use maximal rather than minimal PPE for each situation. •While complete control of the emergency scene is not possible, scene operations as much as possible will attempt to limit splashing, spraying, or aerosolization of body fluids. •The minimum number of personnel required to complete the task safely will be used for all on-scene operations. Personnel not immediately needed, will remain a safe distance from operations so that possible communicable disease exposure for extra personnel is reduced. •Hand washing is the most important Exposure Control procedure. •Members will wash hands: o After removing PPE. o After each patient contact. o After handling potentially infectious materials. o After cleaning or decontaminating equipment. o After using the bathroom. o Before eating. o Before and after handling or preparing food. Orange County Emergency Services Exposure Control Policy Standard Operating Procedures DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ EC 5: Scene Operations (Continued): •Hand washing with soap and water will be performed for ten to fifteen seconds. If soap and water is not available at the scene, a waterless hand wash will be used, provided that a soap and water wash is performed immediately upon return to the station of arrival at the hospital. •Eating, drinking, smoking, handling contact lenses, or applying cosmetics or lip balm is prohibited at the scene of operations or in the potentially contaminated area of the emergency vehicle. •Heads will be protected with covers as specified in this policy and additionally hair lengths longer than the collar will be secured so that it does not come in contact with patients or equipment. •Used needles and other sharps shall be disposed of by the technician performing the procedure in approved sharps containers. Sharps will not be handled by any other person for any reason. •Needles will not be recapped, resheathed, bent, broken, or separated from disposable syringes. The most common occupational blood exposure occurs when needles are recapped. •Used sharps will not be temporarily laid down or stuck in any seat, bench or elsewhere for any reason. •All instruments used for starting IVs, drawing blood, injecting medication and all other skills that require penetration of the skin of patients will be properly disposed of at the completion of the procedure. The container used to hold or store blood or body fluids will be the responsibility of the technician performing the procedure. •Sharps containers will be easily accessible. •Lost sharps will be reported in writing to the Supervisor immediately and a search of the unit and scene will be conducted to find the item. When found document location and dispose of properly. •Disposable resuscitation equipment will be used whenever possible. For CPR, the order of preference is: o Disposable bag-valve mask. o Reusable bag-valve mask. o Disposable pocket mask with one-way valve. •Patients with suspected airborne communicable diseases will be transported wearing a facemask whenever possible. Ambulance windows will be open and ventilation systems turned on whenever possible. •Fluid spills and broken containers will be cleaned up immediately. Fluid spills will be adsorbed using bandaging material and broken containers will be cleaned up using mechanical means, such as a brush and dustpan, tongs, or forceps. •At conclusion of on-scene operations, all potentially contaminated patient care equipment will be removed for appropriate disposal or decontamination and reuse. This includes, but is not limited to sharps, dressing materials, etc. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ EC 6: Post Response: •HOUSEKEEPING: o All vehicles, equipment, environmental and working surfaces (fixed and non-fixed) will be cleaned as soon as possible at the conclusion of each call. This will include but not be limited to, wiping down the floor, walls, stretcher, and squad bench with an approved disinfectant. (See definitions.) o All contaminated work surfaces will be decontaminated after completion of procedures and immediately, or as soon as feasible after any spill of blood or other potentially infectious materials, as well as at the end of the work shift if the surface may have become contaminated since the last cleaning. o All bins, pails, and similar receptacles shall be inspected and decontaminated on a regular scheduled basis. o Any broken glassware that may be contaminated will not be picked up directly with the hands. Dustpans and hand-brooms or forceps are to be used. o Contaminated equipment will be stored only in the decontamination area. Cleaning and decontamination will be performed immediately. o Disposable equipment (such as endotracheal tubes, suction catheters, suction tubing, plastic oral airways, respiratory supplies, linen soiled with blood, vomitus, blood/soiled bandages, etc.) and other biohazard waste generated during on-scene operations will be handled as infectious waste. Sharps containers, when 3/4 full, will be closed and disposed of in accordance with the UNC Hospitals policy. o Gloves will be worn for all contact with contaminated equipment or materials. Other PPE will be used depending on splash or spill potential. Heavy-duty utility gloves will be used for cleaning, disinfection, or decontamination procedures. o Blood and body fluid spills will receive priority cleaning: •Heavy-duty rubber, utility (nondisposable), or doubled disposable (if clean up is done at the hospital) gloves will be worn when cleaning blood and body fluid spills. •Wipe up all blood and body fluids using a clean towel or absorbent material. Dispose of these towels as infectious waste. Reusable towels are to be bagged with linen. Disposable materials will be treated as infectious waste. •Saturate the contaminated area with approved cleaning solution. Soak up this solution with towels or other absorbent material and dispose of as infectious waste. Reusable towels will be treated as infectious waste. Orange County Emergency Services Exposure Control Policy Standard Operating Procedures DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ EC 6: Post Response (Continued): HOUSEKEEPING o Eating, drinking, smoking, handling contact lenses, or applying cosmetics or lip balm is prohibited during cleaning or decontamination procedures. o Disinfection will be performed with a department-approved disinfectant. All disinfectants will be tuberculocidal and EPA approved and registered. o Any damaged equipment will be cleaned and disinfected before being sent out for repair. o The manufacturer's guidelines will be used for the cleaning and decontamination of all equipment. Unless otherwise specified: •Stretcher linen must be changed after each use and exchanged as per SOP EC 3. The stretcher parts and mattress will be cleaned and disinfected with an approved disinfectant. •Portable suction equipment, laryngoscope blades, and bag-valve- masks will be soaked for thirty minutes in approved disinfectant, thoroughly rinsed with clean water, and air-dried after use. Fixed suction bags will be properly disposed of and the contained cleaned with an approved disinfectant. Remember, suction is an aerosol; meaning particles of the contained material may be released into the air. •Durable equipment (backboards, splints, cervical collars, MAST, etc.) will be washed with hot soapy water, rinsed with clean water, and disinfected with an approved disinfectant. Equipment will be allowed to air dry. •Delicate equipment (radios, cardiac monitors, stethoscopes, BP cuffs, etc.) will be wiped clean of any debris using hot soapy water (if available), wiped with clean water (if available), and then wiped with disinfectant. If water is not available, wipe with disinfectant. Equipment will be allowed to air dry. •Work surfaces will be decontaminated with an appropriate disinfectant after completion of procedures, and after spillage or contamination with blood or potentially infectious materials. Seats on response vehicles contaminated with body fluids from soiled PPE also will be disinfected upon return to station. •Contaminated turnout coats / bunker pants will be cleaned according to manufacturer's recommendations found on attached labels. Normally, this will consist of a wash with hot soapy water followed by a rinse with clean water. Turnout gear will be air-dried. Chlorine bleach may impair the fire-retardant properties of structural firefighting gear and will not be used. •Contaminated boots will be brush-scrubbed with a hot solution of soapy water, rinsed with clean water, and allowed to air dry. •Contaminated uniforms will be removed and exchanged for clean clothes. The personnel will shower if body fluids were in contact with skin under work clothes. •Contaminated work clothes will be laundered at the station using hot water. Under no circumstances will any personnel launder contaminated work clothes or PPE at home. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ •Infectious wastes generated during cleaning and decontamination operations will be properly bagged and placed in the biohazard disposal area. EC 6: Post Response (Continued): •REGULATED WASTE DISPOSAL: o A list of disposable sharps containers and other regulated waste containers used by OCES is included in the Appendix. o Disposable Sharps: •Contaminated sharps shall be discarded immediately, or as soon as feasible in containers that are closable, puncture resistant, leak proof on sides and bottom, and labeled or color-coded. •During use, containers for contaminated sharps shall be easily accessible to personnel and located as close as feasible to the immediate area where sharps are used or can be reasonably anticipated to be found. •The containers shall be maintained upright throughout use and replaced routinely and not be allowed to overfill. •When moving containers of contaminated sharps from the area of use, the containers shall be closed immediately prior to removal or replacement to prevent spillage or protrusion of contents during handling, storage, transport, or shipping. •The container shall be placed in a secondary container if leakage of the primary container is possible. The second container shall be closable, constructed to contain all contents and prevent leakage during handling, storage, transport or shipping. The second container shall be labeled or color-coded to identify its contents. •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 o Other Regulated Waste: •Other regulated waste shall be placed in containers, which are closable, constructed to contain all contents, and prevent leakage of fluids during handling, storage, transportation, or shipping. •The waste must be labeled or color-coded and closed prior to removal to prevent spillage or protrusion of contents during handling, storage, transport, or shipping. •Disposal of all regulated waste shall be in accordance with applicable United States, state, and local regulations. •LAUNDRY PROCEDURES: o Laundry contaminated with blood or other potentially infectious materials will be handled as little as possible. Such laundry will be placed in appropriately marked (biohazard labeled, or color-coded red) bags at the location where it was used. Such laundry will not be sorted or rinsed in the area of use. o Whenever Body Substance Isolation or Universal Precautions are used in the handling of all soiled laundry (i.e. all laundry is assumed to be contaminated), no labeling or color-coding is necessary as long as all DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ employees recognize the hazards associated with the handling of this material. EC 6: Post Response (Continued): LAUNDRY PROCEDURES o The appendix identifies where laundry at this facility will be cleaned and the procedures to follow. o Whenever contaminated laundry is shipped off-site to a second facility, which does not utilize Universal Precautions in the handling of all laundry, contaminated laundry must be placed in bags or containers, which are labeled or color-coded. One possible solution would be to include a requirement in the laundry facility contract requiring the laundry to utilize the equivalent of Universal Precautions. o See Appendix 9: Laundry Procedures for further information DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ EC 7: Post Exposure Protocols: •Any personnel exposed to potentially infectious material will immediately wash the exposed area with soap and water or saline eyewash (if the eyes are involved) and contact the supervisor. •Any personnel having an occupational communicable disease exposure will immediately report the exposure to his or her supervisor. Needlestick injuries (whether used or not) will be reported to the supervisors and Exposure Control officers immediately. After proper notification to supervisors, call the Needlestick Hotline @ 966-4480 and answer all appropriate questions. •The personnel will fill out an exposure report form immediately following exposures: o Needlestick injury o Break in skin caused by a potentially contaminated object o Splash of blood or other potentially infectious material onto eyes, mucous membranes, or non-intact skin. o Other exposure that the personnel may feel is significant. •The report will include details as requested on the form. •The supervisor will review the exposure report and forward it to the Exposure Control Officer. •If volunteer fire personnel are involved, they should complete the same paperwork as EMS personnel, as well as any internal paperwork required. Copies of this documentation should be forwarded to the on-duty EMS supervisor immediately and Exposure Control Officer within 12 hours. Orange County Emergency Services Exposure Control Policy Standard Operating Procedures DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ EC 8: Compliance and Quality Monitoring / Program Evaluation: •Compliance and Quality Monitoring: o All personnel are responsible for following standard operating procedures while performing job duties. Spot scene monitoring will be conducted. Supervisors will also conduct, at a minimum, formal workplace tours and document the results monthly to assure safe work practices such as: o Hand washing provisions and technique; o Disposal of contaminated needles and other sharps; o Availability and use of PPE; o Housekeeping, including cleaning, handling of contaminated laundry, decontamination, and labeling and disposing of regulated waste. o Inspection of personnel and equipment (including vehicles). •Formal monitoring will be done monthly and no later than the 5th day of the following month. A Bloodborne/Airborne Pathogens Surveillance and Monitoring Manual will be maintained that will contain: o The monthly Bloodborne/Airborne Pathogens Monitoring Form o Recommendations for corrective actions; o Documentation of personnel counseling, retraining, or education; and o A record of monitoring personnel's work practices and personnel disciplinary actions related to personal compliance on the Bloodborne/Airborne Pathogens Monitoring Log. •Monitoring and its documentation on the Monitoring Log will include all personnel and procedures observed. Personnel whose practices are satisfactory will be noted for positive feedback and incorporation with personal job performance evaluations. When monitoring reveals a personnel's noncompliance with standard operating procedures, the need for procedural revision or update, or modification to the work environment or equipment, it will be documented on the Monitoring Log. Recommendations for corrective action, such as personnel discipline, retraining, etc. or purchasing new equipment, will be recorded. The expected outcome of the recommendation and its date of completion will be noted. •Corrective action that involves personnel work practice improvement(s) and any observed work practice improvement will be documented within two weeks. Continued personnel noncompliance will be documented in permanent personnel records and disciplinary action instituted according to personnel policies. •The Exposure Control Officer and the EMS Operations Manager will review each Bloodborne/Airborne Pathogens Surveillance Monitoring Manual quarterly. Orange County Emergency Services Exposure Control Policy Standard Operating Procedures DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ EC 9: Annual Review Exposure Control Plan: •An annual review and update will be conducted to reflect changes in technology that eliminate or reduce exposure to bloodborne pathogens. Medical devices with engineered sharps injury protections and needle-less systems constitute an effective engineering control and will be considered during our review. These devices will be used where feasible to ensure employee safety. Refer to Appendix (E). •This review will: o Take into account innovations in medical procedure and technological developments that reduce the risk of exposure (e.g., newly available medical devices designed to reduce needlesticks); and o Document consideration and use of appropriate, commercially available, and effective safer devices (e.g., describe the devices identified as candidates for use, the method(s) used to evaluate those devices, and justification for the eventual selection). •Since no one medical device is considered appropriate or effective for all circumstances, we will select devices that, based on reasonable judgment: o Will not jeopardize client or employee safety or be medically inadvisable; o Will make an exposure incident less likely to occur OSHA States: (During your annual review of devices, you must inquire about new or prospective safer options and document this fact in your written Exposure Control Plan. This would include, but would not be limited to, newly available medical devices designed to reduce the risk of percutaneous exposure to bloodborne pathogens. Consideration and implementation of safer medical devices could be documented in the Exposure Control Plan by describing the safer devices identified as candidates for adoption; the method or methods used to evaluate devices and the results of evaluations; and justification for selection decisions. This information must be updated at least annually. The revised Exposure Control Plan requirements make clear that employers must implement the safer medical devices that are appropriate, commercially available, and effective. No one medical device is appropriate in all circumstances of use. For purposes of this standard, an "appropriate" safer medical device includes only devices whose use, based on reasonable judgment in individual cases, will not jeopardize patient or employee safety or be medically contraindicated. Although new devices are being continually introduced, OSHA recognizes that a safer device may not be available for every situation. If a safer device is not available in the marketplace, the employer is not required to develop any such device. Furthermore, the revised requirements are limited to the safer medical devices that are considered to be Orange County Emergency Services Exposure Control Policy Standard Operating Procedures DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ "effective." EC 9: Annual Review Exposure Control Plan (Continued): For purposes of this standard, an "effective" safer medical device is a device that, based on reasonable judgment, will make an exposure incident involving a contaminated sharp less likely to occur in the application in which it is used. If no engineering control is available, work practice controls shall be used and, if occupational exposure still remains, personal protective equipment must also be used.) •Employee Input: o Input will be solicited from non-managerial employees responsible for direct patient care regarding the identification, evaluation, and selection of effective engineering controls, including safer medical devices. o The employees providing input will represent the range of exposure situations encountered in the workplace, such as those in the health department, substance abuse, or EMS, along with others involved in direct care of patients. (OSHA will check for compliance with this provision during inspections by questioning a representative number of employees to determine if and how their input was requested. No specific procedures for obtaining employee input are prescribed. This provides the employer with flexibility to solicit employee input in any manner appropriate to the circumstances of the workplace. A dental office employing two hygienists, for example, may choose to conduct periodic conversations to discuss identification, evaluation, and selection of controls. A large hospital, on the other hand, would likely find that an effective process for soliciting employee input requires the implementation of more formal procedures. The solicitation of input required by the standard requires employers to take reasonable steps to obtain employee input in the identification, evaluation, and selection of controls. Methods for soliciting employee input may include involvement in informal problem-solving groups; participation in safety audits, worksite inspections, or exposure incident investigations; participation in analysis of exposure incident data or in job or process hazard analysis; participation in the evaluation of devices through pilot testing.) •Documentation of Employee Input: o Employers are required to document, in the Exposure Control Plan, how they received input from employees. This obligation will be met by: Listing the employees involved and describing the process by which input was requested; or Presenting other documentation, including references to the minutes of meetings, copies of documents used to request employee participation, or records of responses received from employees. (Small medical offices may want to seek input from all employees when making their decisions. Larger facilities are not required to request input from all exposed employees; however, the employees selected should represent the range of exposure situations DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ encountered in the workplace (e.g., pediatrics, emergency department, etc.). The solicitation of employees who have been involved in the input and evaluation process must be documented in the Exposure Control Plan.) DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised February, 2013 EC 10: Engineered Sharps & Needle-less Systems: •Sharps with Engineered Sharps Injury Protections: o Non-needle sharps or needle devices containing built-in safety features that are used for collecting fluids or administering medications or other fluids, or other procedures involving the risk of sharps injury will be used where feasible. During our annual review, these devices will be discussed, reviewed as to their effectiveness with our procedures, and used where feasible. This covers a broad array of devices, including: Syringes with a sliding sheath that shields the attached needle after use; Needles that retract into a syringe after use; Shielded or retracting catheters Intravenous medication (IV) delivery systems that use a catheter port with a needle housed in a protective covering. (Safety equipment must be available at all times. If for some reason an engineering control is not available due to supply shortages, back orders, shipping delays, etc.), this must be documented in your Exposure Control Plan. You would then be responsible to implement the chosen control(s) as soon as it becomes available and adjust your exposure control plan to illustrate such. In the meantime, work practice controls must be used and, if occupational exposure still remains, personal protective equipment must also be used.) •Needleless Systems o Needleless Systems is defined as devices, which provide an alternative to needles for various procedures to reduce the risk of injury involving contaminated sharps. During our annual review, these devices will be discussed, reviewed as to their effectiveness with our procedures, and used where feasible. Types of needle-less systems include: IV medication systems which administer medication or fluids through a catheter port using non-needle connections; and Jet injection systems, which deliver liquid medication beneath the skin or through a muscle. (A key element in choosing a safer medical device, other than its appropriateness to the procedure and effectiveness, is its availability on the market. If there is no safer option for a particular medical device used where there is exposure to blood or OPIM, you are not required to use something other than the device that is normally used. ) Orange County Emergency Services Exposure Control Policy Standard Operating Procedures DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ EC 10: Engineered Sharps & Needle-less Systems (Continued): •Needles o Contaminated needles and other contaminated sharps will not be bent, recapped, removed, sheared, or purposely broken. An exception to this is allowed if the procedure would require that the contaminated needle be recapped or removed and no alternative is feasible and the action is required by the medical procedure. If such action is required, then the recapping or removal of the needle must be done by the use of a mechanical device or a one-handed technique. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ EC 11: Hepatitis B Vaccine and Post-Exposure Evaluation and Follow Up: •General: o Orange County Emergency Services will make available the Hepatitis B vaccine and vaccination series to all employees who have occupational exposure, and post exposure follow-up to employees who have had an exposure incident. o Orange County Emergency Services will ensure that all medical evaluations and procedures, including the Hepatitis B vaccine and vaccination series and post exposure follow-up (including prophylaxis), are: Made available at no cost to employee; Made available to the employee at a reasonable time and place; Performed by or under the supervision of a licensed physician or by or under the supervision of another licensed healthcare professional; and Provided according to the recommendations of the U.S. Public Health Service. o An accredited laboratory at no cost to the employee shall conduct all laboratory tests. •Hepatitis B Vaccination: o The Infection Control Officer is in charge of the Hepatitis B vaccination program. Vaccinations will be administered by the County Health Department or other identified facility. o Hepatitis B vaccination will be made available after the employee has received the training in occupational exposure (see information and training) and within 10 working days of initial assignment to all employees who have occupational exposure unless the employee has previously received the complete Hepatitis B vaccination series, antibody testing has revealed that the employee is immune, or the vaccine is contraindicated for medical reasons. o Participation in a pre-screening program is not a prerequisite for receiving Hepatitis B vaccination. o If the employee initially declines Hepatitis B vaccination but at a later date, while still covered under the standard, decides to accept the vaccination, the vaccination shall then be made available. o Each employee who declines the Hepatitis B vaccination offered shall sign a waiver indicating his or her refusal. Appendix (C) includes the OSHA declination statement to be used for this purpose. o If a routine booster dose of Hepatitis B vaccine is recommended by the U.S. Public Health Service at a future date, such booster doses shall be made available by Orange County Emergency Services at no cost the employee. Orange County Emergency Services Exposure Control Policy Standard Operating Procedures DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ EC 11: Hepatitis B Vaccine and Post-Exposure Evaluation and Follow Up (Continued): •Post-Exposure Evaluation and Follow-Up: o All exposure incidents shall be reported, investigated, and documented. When the employee incurs an exposure incident, it shall be reported to the Infection Control Officer for investigation. o Following a report of an exposure incident, the exposed employee shall immediately receive a confidential medical evaluation and follow-up, including at least the following elements: Documentation of the route of exposure, and the circumstances under which the exposure incident occurred; Identification and documentation of the source individual, unless it can be established that identification is infeasible or prohibited by state of local law. The source individual's blood shall be tested as soon as feasible and after consent is obtained in order to determine HBV and HIV infectivity. If consent is not obtained, the Infection Control Officer shall establish that legally required consent cannot be obtained. When law does not require the source individual’s consent, the source individual's blood, if available, shall be tested and the results documented. When the source individual is already known to be infected with HBV or HIV, testing for the source individual's known HBV or HIV status need not be repeated. Results of the source individual's testing shall be made available to the exposed employee, and the employee shall be informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source individual. Collection and testing of blood for HBV and HIV serological status will comply with the following: •The exposed employee's blood shall be collected as soon as feasible and tested after consent is obtained; •The employee will be offered the option of having their blood collected for testing of the employee's HIV/HBV serological status. The blood sample will be preserved for up to 90 days to allow the employee to decide if the blood should be tested for HIV serological status. Each employee who incurs an exposure incident will be offered post-exposure evaluation and follow-up in accordance with the OSHA standard. All post exposure follow-up will be performed by the County/Entity Health Department or other identified healthcare provider. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ EC 11: Hepatitis B Vaccine and Post-Exposure Evaluation and Follow Up (Continued): •Information Provided To The Healthcare Professional: o The County/Entity Bloodborne Pathogens Coordinator shall ensure that the healthcare professional responsible for the employee's Hepatitis B vaccination is provided with the following: A copy of the OSHA Bloodborne Pathogens Standard, 29 CFR 1910.1030; (While the standard outlines the confidentiality requirements of the healthcare professional, the County/Entity Bloodborne Pathogens Coordinator is to remind the healthcare professional of these requirements) A written description of the exposed employee's duties as they relate to the exposure incident; Written documentation of the route of exposure and circumstances under which exposure occurred; Results of the source individual's blood testing, if available; and All medical records relevant to the appropriate treatment of the employee including vaccination status. •Healthcare Professional's Written Opinion: o The County/Entity Bloodborne Pathogens Coordinator shall obtain and provide the employee with a copy of the evaluating healthcare professional's written opinion within 15 days of the completion of the evaluation. o The healthcare professional's written opinion for HBV vaccination shall be limited to whether HBV vaccination is indicated for an employee, and if the employee has received such vaccination. o The healthcare professional's written opinion for post exposure follow-up shall be limited to the following information: A statement that the employee has been informed of the results of the evaluation; and A statement that the employee has been told about any medical conditions resulting from exposure to blood or other potentially infectious materials which require further evaluation or treatment. NOTE: All other findings or diagnosis shall remain confidential and shall not be included in the written report. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ APPENDICES Orange County Emergency Services ([SRVXUH&RQWURO3ROLF\ DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ APPENDIX 1 Orange County Emergency Services System Plan DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ Department Recommendations: •4XDW3OXV7%DQG6$1,&/27+3OXV will be used to disinfect surfaces, clean blood spills, and fordisinfection of medical equipment such as laryngoscope blades or portablesuction equipment. Equipment will be soaked for 30 minutes, rinsed, andallowed to air dry. •Spray bottles containing 4XDW3OXV7%DQGFRQWDLQHUVRI6$1,&/27+3OXV will be kept on each unit (EMS and Fire) foruse away from the stations. •The manufacturers recommended guidelines will be used for mixing, storing and usage. •The appropriate MSDS will be on hand for all personnel. Orange County Emergency Services Exposure Control Policy Approved Disinfectants DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ APPENDIX 2 Orange County Emergency Services System Plan DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ Department Policy: •Laundry contaminated with blood or OPIM shall be handled as little as possible. •Personnel should remove clothing as soon as possible after contamination occurs. For this reason, all personnel are required to bring a second uniform to work. •Contaminated clothing should be placed into a labeled, leak-proof container for transport to the unit’s primary station. A biohazard bag is preferred for this activity. •All contaminated laundry can be washed at either EMS station 1 or 2. Under no circumstance should contaminated clothing be taken to a private residence and washed. •Contaminated clothing and bunker gear may be washed at the individual fire departments, per individual protocol. Care should be taken to follow all manufacturers recommendations regarding decontaminating bunker gear. Certain common cleaning chemicals may degrade bunker gear and not damage other clothing. •Personnel shall utilize appropriate PPE and remove the contaminated clothing from the container. Gross contaminates shall be removed and placed in a biohazard container along with the transport container used. •Care shall be given in assessing the type of clothing fabric and recommended washing procedures. Do Not wash any type of fabric against the manufacturers’ recommendation / cleaning guidelines. •The contaminated clothing shall be placed in the washing machine with care given so as not to contaminate the outside of the washing machine. •Personnel should remove any contaminated PPE and dispose of in a biohazard container. •Personnel should add the appropriate type and amount of laundry detergent to the wash based on the manufacturer’s directions. Care shall be taken to avoid contact with the contaminated clothing at this time. Non-chlorine bleach may also be added if desired. •Personnel should close and start the washing machine as per manufacturer’s instructions for the load size and amount of clothing. The heavy soil setting is preferred with a warm water wash and cold rinse. •Once the wash cycle is complete, the clothing can be removed and placed in a dryer and dried according to the type of fabric and size of load. •If the exterior of the washing machine was contaminated, it should be decontaminated using standard decontamination procedures during the wash cycle so as not to re-contaminate the clothing on removal. Orange County Emergency Services Exposure Control Policy Laundry Procedure DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised February, 2013 APPENDIX 3 Orange County Emergency Services System Plan DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\, 2011 Employee Name______________________________________________________ Division / Department __________________________________________________ Job Title_________________________ Supervisor__________________________ Date of Exposure_____________________ Time of Exposure ______:______am / pm Type of Exposure: Needlestick Splash Other (explain)___________________________ Type of Fluid________________________ Amount of Fluid_____________________ Severity (depth of injury)_________________________________________________________ Part of Body Exposed____________________________________________________________ Location of Exposure (address of incident)___________________________________________ Please describe how / why the exposure occurred. Include job duties being performed at time of exposure, extent and duration of exposure: Personal Protective Equipment Used: Gloves Face Mask Face / Eye Shield Goggles Gown Other (explain)_________________________________________________ Date and Time Reported to Supervisor______/______/______ ______:______ am / pm Time Needle Stick Hotline Called______:______ am / pm Date and Time Reported to EC Officer______/______/______ ______:______ am / pm Preliminary Instructions to the Employee Date Employee Seen at UNC______/______/______ By__________________________ Report Received By EC Officer______/______/______ Orange County Emergency Services Exposure Control Policy Report of Occupational Exposure DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\2 Signed__________________ DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ APPENDIX 4 Orange County Emergency Services System Plan DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ Date: ____________________ Name: ____________________ Affiliation: ____________________ Birthdate: __________________ Social Security #: ______________ Address: ________________________________________________________ City: ______________________ State: ______ Zip:______________ ______________________________________________________________________ A Questionnaire similar to the one below will be completed online through EI Assessor Health. This Questionnaire is confidential and an important component of our assessment for your potential respirator use. The only information received will be whether or not you are able to be fit tested. DO YOU HAVE OR HAVE YOU HAD THE FOLLOWING IN THE PAST TWO (2) YEARS? 1.Uncontrolled high blood pressure?YES NO 2.Respiratory Condition or disease?YES NO Chest pain or tightness Severe shortness of breath or a chronic cough Asthma or wheezing 3.Allergies that would interfere with you wearing a respirator?YES NO 4.Fainting spells, dizziness, or seizures?YES NO 5.Anxiety attack due to being in enclosed places?YES NO 6.Heart condition (heart attack, heart failure)YES NO 7.Severe medical condition/medications that may interfereYES NO with mask/respirator wearing? If yes, please explain:_________________________ ___________________________________________________________________ 8.Do you smoke more than 4 cigarettes per day?YES NO If yes, how many per day?__________________ How long have you smoked?________________ THE ABOVE NAMED PERSON IS APPROVED TO WEAR THE HEPA / N95 RESPIRATOR. ___________________________________________________________________ Fit Tester Signature ____________________________________________________________________ Fit Tester Name Date Orange County Emergency Services Exposure Control Policy Respirator Use Form DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ If person named above is not able to wear the HEPA / N95 respirator, he/she will be referred to a physician for further evaluation. DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ Date: ____________________ Name: ____________________ Affiliation: ____________________ Birthdate: __________________ Social Security #: ______________ Address: _____________________________________________________ City: ______________________ State: ______ Zip:__________ Respirator Size: _____________ Manufacturer: __________________ NIOSH Approval #: ___________ Model: ________________________ Fit Testing: Quantitative Saccharin Solution Qualitative Fit: Pass Fail Comments: ______________________________________________________ ________________________________________________________________ Employee Acknowledgement of Test Results: Employee Signature: _____________________________ Date: ___________ Test Conducted By: ______________________________ Date: ____________ Orange County Emergency Services Fit Test Report DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ Date: ____________________ Name: ____________________ Affiliation: ____________________ Birthdate: __________________ Social Security #: ______________ Pre-Fit Test Evaluation: Evaluator: _____________________________________________________ Blood Pressure: _____________ Respirations: ___________________ Pulse: _____________________ Pulse Oximitry: __________________ Post-Fit Test Evaluation: Evaluator: _______________________________________________________ Blood Pressure: _____________ Respirations: ___________________ Pulse: _____________________ Pulse Oximitry: __________________ Orange County Emergency Services Medical Screening Pre / Post Fit Testing DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ APPENDIX 5 Orange County Emergency Services System Plan DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring hepatitis B virus (HBV) infection, hepatitis C virus (HCV) infection or any other bloodborne disease. I have been given the opportunity to be evaluated and treated as necessary, at no charge to my self. However, I decline such treatment at this time. I understand that by declining this treatment, I could be at risk of acquiring any known bloodborne disease or any potential complication from this injury / exposure. By signing below I release Orange County Emergency Services and its personnel from any responsibility whatsoever, should I contract any disease, infection or disability from this injury / exposure. ___________________________________ Signature ___________________________________ Date Orange County Emergency Services Exposure Control Policy Treatment Declination Form DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\ APPENDIX 6 Orange County Emergency Services System Plan DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Orange County Emergency Services Hepatitis B Vaccination Declination I understand that due to my occupational exposure to blood or other potentially infectious materials that I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to myself. However, I decline hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with hepatitis B vaccine, I can receive the vaccination series. ________________________________ _____ _________________ Print Name Date ______________________________________ __________________ Signature Date ______________________________________ __________________ Name of Witness Date _______________________________________ __________________ Signature of Witness Date Revised -XO\ DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Revised -XO\,  APPENDIX 7 Orange County Emergency Services ,QIHFWLRQ&RQWURO Plan DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD 265 Occupational Safety and Health Admin., Labor §1910.1030 APPENDIX B TO §1910.1029—INDUSTRIAL HY- GIENEAND MEDICAL SURVEILLANCE GUIDE- LINES I. INDUSTRIALHYGIENEGUIDELINES A. Sampling (Benzene-Soluble Fraction Total Particulate Matter). Samples collected should be full shift (at least 7-hour) samples. Sampling should be done using a personal sampling pump with pulsation damper at a flow rate of 2 liters per minute. Samples should be collected on 0.8 micrometer pore size silver membrane fil- ters (37 mm diameter) preceded by Gelman glass fiber type A-E filters encased in three- piece plastic (polystyrene) field monitor cas- settes. The cassette face cap should be on and the plug removed. The rotameter should be checked every hour to ensure that proper flow rates are maintained. A minimum of three full-shift samples should be collected for each job classifica- tion on each battery, at least one from each shift. If disparate results are obtained for particular job classification, sampling should be repeated. It is advisable to sample each shift on more than one day to account for environmental variables (wind, precipita- tion, etc.) which may affect sampling. Dif- ferences in exposures among different work shifts may indicate a need to improve work practices on a particular shift. Sampling re- sults from different shifts for each job classi- fication should not be averaged. Multiple samples from same shift on each battery may be used to calculate an average expo- sure for a particular job classification. B. Analysis. 1.All extraction glassware is cleaned with dichromic acid cleaning solution, rinsed with tap water, then dionized water, acetone, and allowed to dry completely. The glassware is rinsed with nanograde benzene before use. The Teflon cups are cleaned with benzene then with acetone. 2.Pre-weigh the 2 ml Teflon cups to one hundredth of a milligram (0.01 mg) on an autobalance AD 2 Tare weight of the cups is about 50 mg. 3.Place the silver membrane filter and glass fiber filter into a 15 ml test tube. 4.Extract with 5 ml of benzene for five minutes in an ultrasonic cleaner. 5.Filter the extract in 15 ml medium glass fritted funnels. 6.Rinse test tube and filters with two 1.5 ml aliquots of benzene and filter through the fritted glass funnel. 7.Collect the extract and two rinses in a 10 ml Kontes graduated evaporative concen- trator. 8.Evaporate down to 1 ml while rinsing the sides with benzene. 9.Pipet 0.5 ml into the Teflon cup and evaporate to dryness in a vacuum oven at 40 °C for 3 hours. 10.Weigh the Teflon cup and the weight gain is due to the benzene soluble residue in half the Sample. II.MEDICALSURVEILLANCEGUIDELINES A. General. The minimum requirements for the medical examination for coke oven workers are given in paragraph (j) of the standard. The initial examination is to be provided to all coke oven workers who work at least 30 days in the regulated area. The examination includes a 14″ × 17″ posterior-an- terior chest x-ray reading, pulmonary func- tion tests (FVC and FEV 1.0), weight, urinal- ysis, skin examination, and a urinary cytologic examination. These tests are need- ed to serve as the baseline for comparing the employee’s future test results. Periodic exams include all the elements of the initial exam, except that the urine cytologic test is to be performed only on those employees who are 45 years or older or who have worked for 5 or more years in the regulated area; periodic exams, with the exception of x-rays, are to be performed semiannually for this group instead of annually; for this group, x- rays will continue to be given at least annu- ally. The examination contents are min- imum requirements; additional tests such as lateral and oblique x-rays or additional pul- monary function tests may be performed if deemed necessary. B. Pulmonary function tests. Pulmonary function tests should be per- formed in a manner which minimizes subject and operator bias. There has been shown to be learning effects with regard to the results obtained from certain tests, such as FEV 1.0. Best results can be obtained by multiple trials for each subject. The best of three trials or the average of the last three of five trials may be used in obtaining reliable re- sults. The type of equipment used (manufac- turer, model, etc.) should be recorded with the results as reliability and accuracy varies and such information may be important in the evaluation of test results. Care should be exercised to obtain the best possible testing equipment. [39 FR 23502, June 27, 1974, 41 FR 46784, Oct. 22, 1976, as amended at 42 FR 3304, Jan. 18, 1977; 45 FR 35283, May 23, 1980; 50 FR 37353, 37354, Sept. 13, 1985; 54 FR 24334, June 7, 1989; 61 FR 5508, Feb. 13, 1996; 63 FR 1290, Jan. 8, 1998; 63 FR 33468, June 18, 1998; 70 FR 1142, Jan. 5, 2005; 71 FR 16672, 16673, Apr. 3, 2006; 71 FR 50189, Aug. 24, 2006; 73 FR 75585, Dec. 12, 2008] §1910.1030Bloodborne pathogens. (a) Scope and Application. This section applies to all occupational exposure to blood or other potentially infectious materials as defined by paragraph (b) of this section. VerDate Mar<15>2010 09:17 Aug 04, 2010Jkt 220114PO 00000Frm 00275Fmt 8010Sfmt 8010Q:\29\29V6.TXTofr150PsN: PC150 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD 266 29 CFR Ch. XVII (7–1–10 Edition) §1910.1030 (b) Definitions. For purposes of this section, the following shall apply: Assistant Secretary means the Assist- ant Secretary of Labor for Occupa- tional Safety and Health, or designated representative. Blood means human blood, human blood components, and products made from human blood. Bloodborne Pathogens means patho- genic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immuno- deficiency virus (HIV). Clinical Laboratory means a work- place where diagnostic or other screen- ing procedures are performed on blood or other potentially infectious mate- rials. Contaminated means the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface. Contaminated Laundry means laundry which has been soiled with blood or other potentially infectious materials or may contain sharps. Contaminated Sharps means any con- taminated object that can penetrate the skin including, but not limited to, needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires. Decontamination means the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal. Director means the Director of the National Institute for Occupational Safety and Health, U.S. Department of Health and Human Services, or des- ignated representative. Engineering controls means controls (e.g., sharps disposal containers, self- sheathing needles, safer medical de- vices, such as sharps with engineered sharps injury protections and needleless systems) that isolate or re- move the bloodborne pathogens hazard from the workplace. Exposure Incident means a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infec- tious materials that results from the performance of an employee’s duties. Handwashing Facilities means a facil- ity providing an adequate supply of running potable water, soap and single use towels or hot air drying machines. Licensed Healthcare Professional is a person whose legally permitted scope of practice allows him or her to inde- pendently perform the activities re- quired by paragraph (f) Hepatitis B Vaccination and Post-exposure Evalua- tion and Follow-up. HBV means hepatitis B virus. HIV means human immunodeficiency virus. Needleless systems means a device that does not use needles for: (1) The collection of bodily fluids or withdrawal of body fluids after initial venous or arterial access is established; (2) The administration of medication or fluids; or (3) Any other procedure involving the potential for occupational exposure to bloodborne pathogens due to percutaneous injuries from contami- nated sharps. Occupational Exposure means reason- ably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties. Other Potentially Infectious Materials means (1) The following human body fluids: semen, vaginal secretions, cerebro- spinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental proce- dures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; (2) Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and (3) HIV-containing cell or tissue cul- tures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental ani- mals infected with HIV or HBV. Parenteral means piercing mucous membranes or the skin barrier through VerDate Mar<15>2010 09:17 Aug 04, 2010Jkt 220114PO 00000Frm 00276Fmt 8010Sfmt 8010Q:\29\29V6.TXTofr150PsN: PC150 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD 267 Occupational Safety and Health Admin., Labor §1910.1030 such events as needlesticks, human bites, cuts, and abrasions. Personal Protective Equipment is spe- cialized clothing or equipment worn by an employee for protection against a hazard. General work clothes (e.g., uni- forms, pants, shirts or blouses) not in- tended to function as protection against a hazard are not considered to be personal protective equipment. Production Facility means a facility engaged in industrial-scale, large-vol- ume or high concentration production of HIV or HBV. Regulated Waste means liquid or semi-liquid blood or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if com- pressed; items that are caked with dried blood or other potentially infec- tious materials and are capable of re- leasing these materials during han- dling; contaminated sharps; and patho- logical and microbiological wastes con- taining blood or other potentially in- fectious materials. Research Laboratory means a labora- tory producing or using research-lab- oratory-scale amounts of HIV or HBV. Research laboratories may produce high concentrations of HIV or HBV but not in the volume found in production facilities. Sharps with engineered sharps injury protections means a nonneedle sharp or a needle device used for withdrawing body fluids, accessing a vein or artery, or administering medications or other fluids, with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident. Source Individual means any indi- vidual, living or dead, whose blood or other potentially infectious materials may be a source of occupational expo- sure to the employee. Examples in- clude, but are not limited to, hospital and clinic patients; clients in institu- tions for the developmentally disabled; trauma victims; clients of drug and al- cohol treatment facilities; residents of hospices and nursing homes; human re- mains; and individuals who donate or sell blood or blood components. Sterilize means the use of a physical or chemical procedure to destroy all microbial life including highly resist- ant bacterial endospores. Universal Precautions is an approach to infection control. According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if known to be in- fectious for HIV, HBV, and other bloodborne pathogens. Work Practice Controls means controls that reduce the likelihood of exposure by altering the manner in which a task is performed (e.g., prohibiting recap- ping of needles by a two-handed tech- nique). (c) Exposure control—(1) Exposure Con- trol Plan. (i) Each employer having an employee(s) with occupational expo- sure as defined by paragraph (b) of this section shall establish a written Expo- sure Control Plan designed to elimi- nate or minimize employee exposure. (ii) The Exposure Control Plan shall contain at least the following ele- ments: (A) The exposure determination re- quired by paragraph (c)(2), (B) The schedule and method of im- plementation for paragraphs (d) Meth- ods of Compliance, (e) HIV and HBV Research Laboratories and Production Facilities, (f) Hepatitis B Vaccination and Post-Exposure Evaluation and Fol- low-up, (g) Communication of Hazards to Employees, and (h) Recordkeeping, of this standard, and (C) The procedure for the evaluation of circumstances surrounding exposure incidents as required by paragraph (f)(3)(i) of this standard. (iii) Each employer shall ensure that a copy of the Exposure Control Plan is accessible to employees in accordance with 29 CFR 1910.20(e). (iv) The Exposure Control Plan shall be reviewed and updated at least annu- ally and whenever necessary to reflect new or modified tasks and procedures which affect occupational exposure and to reflect new or revised employee po- sitions with occupational exposure. The review and update of such plans shall also: (A) Reflect changes in technology that eliminate or reduce exposure to bloodborne pathogens; and (B) Document annually consideration and implementation of appropriate commercially available and effective VerDate Mar<15>2010 09:17 Aug 04, 2010Jkt 220114PO 00000Frm 00277Fmt 8010Sfmt 8010Q:\29\29V6.TXTofr150PsN: PC150 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD 268 29 CFR Ch. XVII (7–1–10 Edition) §1910.1030 safer medical devices designed to elimi- nate or minimize occupational expo- sure. (v) An employer, who is required to establish an Exposure Control Plan shall solicit input from non-managerial employees responsible for direct pa- tient care who are potentially exposed to injuries from contaminated sharps in the identification, evaluation, and selection of effective engineering and work practice controls and shall docu- ment the solicitation in the Exposure Control Plan. (vi) The Exposure Control Plan shall be made available to the Assistant Sec- retary and the Director upon request for examination and copying. (2) Exposure determination. (i) Each employer who has an employee(s) with occupational exposure as defined by paragraph (b) of this section shall pre- pare an exposure determination. This exposure determination shall contain the following: (A) A list of all job classifications in which all employees in those job classi- fications have occupational exposure; (B) A list of job classifications in which some employees have occupa- tional exposure, and (C) A list of all tasks and procedures or groups of closely related task and procedures in which occupational expo- sure occurs and that are performed by employees in job classifications listed in accordance with the provisions of paragraph (c)(2)(i)(B) of this standard. (ii) This exposure determination shall be made without regard to the use of personal protective equipment. (d) Methods of compliance—(1) General. Universal precautions shall be observed to prevent contact with blood or other potentially infectious materials. Under circumstances in which differentiation between body fluid types is difficult or impossible, all body fluids shall be con- sidered potentially infectious mate- rials. (2) Engineering and work practice con- trols. (i) Engineering and work practice controls shall be used to eliminate or minimize employee exposure. Where occupational exposure remains after institution of these controls, personal protective equipment shall also be used. (ii) Engineering controls shall be ex- amined and maintained or replaced on a regular schedule to ensure their ef- fectiveness. (iii) Employers shall provide handwashing facilities which are read- ily accessible to employees. (iv) When provision of handwashing facilities is not feasible, the employer shall provide either an appropriate an- tiseptic hand cleanser in conjunction with clean cloth/paper towels or anti- septic towelettes. When antiseptic hand cleansers or towelettes are used, hands shall be washed with soap and running water as soon as feasible. (v) Employers shall ensure that em- ployees wash their hands immediately or as soon as feasible after removal of gloves or other personal protective equipment. (vi) Employers shall ensure that em- ployees wash hands and any other skin with soap and water, or flush mucous membranes with water immediately or as soon as feasible following contact of such body areas with blood or other po- tentially infectious materials. (vii) Contaminated needles and other contaminated sharps shall not be bent, recapped, or removed except as noted in paragraphs (d)(2)(vii)(A) and (d)(2)(vii)(B) below. Shearing or break- ing of contaminated needles is prohib- ited. (A) Contaminated needles and other contaminated sharps shall not be bent, recapped or removed unless the em- ployer can demonstrate that no alter- native is feasible or that such action is required by a specific medical or dental procedure. (B) Such bending, recapping or needle removal must be accomplished through the use of a mechanical device or a one-handed technique. (viii) Immediately or as soon as pos- sible after use, contaminated reusable sharps shall be placed in appropriate containers until properly reprocessed. These containers shall be: (A) Puncture resistant; (B) Labeled or color-coded in accord- ance with this standard; (C) Leakproof on the sides and bot- tom; and (D) In accordance with the require- ments set forth in paragraph (d)(4)(ii)(E) for reusable sharps. VerDate Mar<15>2010 09:17 Aug 04, 2010Jkt 220114PO 00000Frm 00278Fmt 8010Sfmt 8010Q:\29\29V6.TXTofr150PsN: PC150 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD 269 Occupational Safety and Health Admin., Labor §1910.1030 (ix) Eating, drinking, smoking, ap- plying cosmetics or lip balm, and han- dling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure. (x) Food and drink shall not be kept in refrigerators, freezers, shelves, cabi- nets or on countertops or benchtops where blood or other potentially infec- tious materials are present. (xi) All procedures involving blood or other potentially infectious materials shall be performed in such a manner as to minimize splashing, spraying, spat- tering, and generation of droplets of these substances. (xii) Mouth pipetting/suctioning of blood or other potentially infectious materials is prohibited. (xiii) Specimens of blood or other po- tentially infectious materials shall be placed in a container which prevents leakage during collection, handling, processing, storage, transport, or ship- ping. (A) The container for storage, trans- port, or shipping shall be labeled or color-coded according to paragraph (g)(1)(i) and closed prior to being stored, transported, or shipped. When a facility utilizes Universal Precautions in the handling of all specimens, the labeling/color-coding of specimens is not necessary provided containers are recognizable as containing specimens. This exemption only applies while such specimens/containers remain within the facility. Labeling or color-coding in accordance with paragraph (g)(1)(i) is required when such specimens/con- tainers leave the facility. (B) If outside contamination of the primary container occurs, the primary container shall be placed within a sec- ond container which prevents leakage during handling, processing, storage, transport, or shipping and is labeled or color-coded according to the require- ments of this standard. (C) If the specimen could puncture the primary container, the primary container shall be placed within a sec- ondary container which is puncture-re- sistant in addition to the above charac- teristics. (xiv) Equipment which may become contaminated with blood or other po- tentially infectious materials shall be examined prior to servicing or shipping and shall be decontaminated as nec- essary, unless the employer can dem- onstrate that decontamination of such equipment or portions of such equip- ment is not feasible. (A) A readily observable label in ac- cordance with paragraph (g)(1)(i)(H) shall be attached to the equipment stating which portions remain con- taminated. (B) The employer shall ensure that this information is conveyed to all af- fected employees, the servicing rep- resentative, and/or the manufacturer, as appropriate, prior to handling, serv- icing, or shipping so that appropriate precautions will be taken. (3) Personal protective equipment—(i) Provision. When there is occupational exposure, the employer shall provide, at no cost to the employee, appropriate personal protective equipment such as, but not limited to, gloves, gowns, lab- oratory coats, face shields or masks and eye protection, and mouthpieces, resuscitation bags, pocket masks, or other ventilation devices. Personal protective equipment will be consid- ered ‘‘appropriate’’ only if it does not permit blood or other potentially infec- tious materials to pass through to or reach the employee’s work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous mem- branes under normal conditions of use and for the duration of time which the protective equipment will be used. (ii) Use. The employer shall ensure that the employee uses appropriate personal protective equipment unless the employer shows that the employee temporarily and briefly declined to use personal protective equipment when, under rare and extraordinary cir- cumstances, it was the employee’s pro- fessional judgment that in the specific instance its use would have prevented the delivery of health care or public safety services or would have posed an increased hazard to the safety of the worker or co-worker. When the em- ployee makes this judgement, the cir- cumstances shall be investigated and documented in order to determine whether changes can be instituted to prevent such occurences in the future. (iii) Accessibility. The employer shall ensure that appropriate personal pro- tective equipment in the appropriate VerDate Mar<15>2010 09:17 Aug 04, 2010Jkt 220114PO 00000Frm 00279Fmt 8010Sfmt 8010Q:\29\29V6.TXTofr150PsN: PC150 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD 270 29 CFR Ch. XVII (7–1–10 Edition) §1910.1030 sizes is readily accessible at the work- site or is issued to employees. Hypoallergenic gloves, glove liners, powderless gloves, or other similar al- ternatives shall be readily accessible to those employees who are allergic to the gloves normally provided. (iv) Cleaning, Laundering, and Dis- posal. The employer shall clean, laun- der, and dispose of personal protective equipment required by paragraphs (d) and (e) of this standard, at no cost to the employee. (v) Repair and Replacement. The em- ployer shall repair or replace personal protective equipment as needed to maintain its effectiveness, at no cost to the employee. (vi) If a garment(s) is penetrated by blood or other potentially infectious materials, the garment(s) shall be re- moved immediately or as soon as fea- sible. (vii) All personal protective equip- ment shall be removed prior to leaving the work area. (viii) When personal protective equip- ment is removed it shall be placed in an appropriately designated area or container for storage, washing, decon- tamination or disposal. (ix) Gloves. Gloves shall be worn when it can be reasonably anticipated that the employee may have hand contact with blood, other potentially infectious materials, mucous membranes, and non-intact skin; when performing vas- cular access procedures except as speci- fied in paragraph (d)(3)(ix)(D); and when handling or touching contami- nated items or surfaces. (A) Disposable (single use) gloves such as surgical or examination gloves, shall be replaced as soon as practical when contaminated or as soon as fea- sible if they are torn, punctured, or when their ability to function as a bar- rier is compromised. (B) Disposable (single use) gloves shall not be washed or decontaminated for re-use. (C) Utility gloves may be decontami- nated for re-use if the integrity of the glove is not compromised. However, they must be discarded if they are cracked, peeling, torn, punctured, or exhibit other signs of deterioration or when their ability to function as a bar- rier is compromised. (D) If an employer in a volunteer blood donation center judges that rou- tine gloving for all phlebotomies is not necessary then the employer shall: (1) Periodically reevaluate this pol- icy; (2) Make gloves available to all em- ployees who wish to use them for phle- botomy; (3) Not discourage the use of gloves for phlebotomy; and (4) Require that gloves be used for phlebotomy in the following cir- cumstances: (i) When the employee has cuts, scratches, or other breaks in his or her skin; (ii) When the employee judges that hand contamination with blood may occur, for example, when performing phlebotomy on an uncooperative source individual; and (iii) When the employee is receiving training in phlebotomy. (x) Masks, Eye Protection, and Face Shields. Masks in combination with eye protection devices, such as goggles or glasses with solid side shields, or chin- length face shields, shall be worn when- ever splashes, spray, spatter, or drop- lets of blood or other potentially infec- tious materials may be generated and eye, nose, or mouth contamination can be reasonably anticipated. (xi) Gowns, Aprons, and Other Protec- tive Body Clothing. Appropriate protec- tive clothing such as, but not limited to, gowns, aprons, lab coats, clinic jackets, or similar outer garments shall be worn in occupational exposure situations. The type and characteris- tics will depend upon the task and de- gree of exposure anticipated. (xii) Surgical caps or hoods and/or shoe covers or boots shall be worn in instances when gross contamination can reasonably be anticipated (e.g., au- topsies, orthopaedic surgery). (4) Housekeeping—(i) General. Employ- ers shall ensure that the worksite is maintained in a clean and sanitary condition. The employer shall deter- mine and implement an appropriate written schedule for cleaning and method of decontamination based upon the location within the facility, type of surface to be cleaned, type of soil present, and tasks or procedures being performed in the area. VerDate Mar<15>2010 09:17 Aug 04, 2010Jkt 220114PO 00000Frm 00280Fmt 8010Sfmt 8010Q:\29\29V6.TXTofr150PsN: PC150 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD 271 Occupational Safety and Health Admin., Labor §1910.1030 (ii) All equipment and environmental and working surfaces shall be cleaned and decontaminated after contact with blood or other potentially infectious materials. (A) Contaminated work surfaces shall be decontaminated with an appropriate disinfectant after completion of proce- dures; immediately or as soon as fea- sible when surfaces are overtly con- taminated or after any spill of blood or other potentially infectious materials; and at the end of the work shift if the surface may have become contami- nated since the last cleaning. (B) Protective coverings, such as plastic wrap, aluminum foil, or imper- viously-backed absorbent paper used to cover equipment and environmental surfaces, shall be removed and replaced as soon as feasible when they become overtly contaminated or at the end of the workshift if they may have become contaminated during the shift. (C) All bins, pails, cans, and similar receptacles intended for reuse which have a reasonable likelihood for be- coming contaminated with blood or other potentially infectious materials shall be inspected and decontaminated on a regularly scheduled basis and cleaned and decontaminated imme- diately or as soon as feasible upon visi- ble contamination. (D) Broken glassware which may be contaminated shall not be picked up directly with the hands. It shall be cleaned up using mechanical means, such as a brush and dust pan, tongs, or forceps. (E) Reusable sharps that are con- taminated with blood or other poten- tially infectious materials shall not be stored or processed in a manner that requires employees to reach by hand into the containers where these sharps have been placed. (iii) Regulated Waste—(A) Contami- nated Sharps Discarding and Contain- ment. (1) Contaminated sharps shall be discarded immediately or as soon as feasible in containers that are: (i) Closable; (ii) Puncture resistant; (iii) Leakproof on sides and bottom; and (iv) Labeled or color-coded in accord- ance with paragraph (g)(1)(i) of this standard. (2) During use, containers for con- taminated sharps shall be: (i) Easily accessible to personnel and located as close as is feasible to the im- mediate area where sharps are used or can be reasonably anticipated to be found (e.g., laundries); (ii) Maintained upright throughout use; and (iii) Replaced routinely and not be al- lowed to overfill. (3) When moving containers of con- taminated sharps from the area of use, the containers shall be: (i) Closed immediately prior to re- moval or replacement to prevent spill- age or protrusion of contents during handling, storage, transport, or ship- ping; (ii) Placed in a secondary container if leakage is possible. The second con- tainer shall be: (A) Closable; (B) Constructed to contain all con- tents and prevent leakage during han- dling, storage, transport, or shipping; and (C) Labeled or color-coded according to paragraph (g)(1)(i) of this standard. (4) 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. (B) Other Regulated Waste Contain- ment—(1) Regulated waste shall be placed in containers which are: (i) Closable; (ii) Constructed to contain all con- tents and prevent leakage of fluids dur- ing handling, storage, transport or shipping; (iii) Labeled or color-coded in accord- ance with paragraph (g)(1)(i) this standard; and (iv) Closed prior to removal to pre- vent spillage or protrusion of contents during handling, storage, transport, or shipping. (2) If outside contamination of the regulated waste container occurs, it shall be placed in a second container. The second container shall be: (i) Closable; (ii) Constructed to contain all con- tents and prevent leakage of fluids dur- ing handling, storage, transport or shipping; VerDate Mar<15>2010 09:17 Aug 04, 2010Jkt 220114PO 00000Frm 00281Fmt 8010Sfmt 8010Q:\29\29V6.TXTofr150PsN: PC150 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD 272 29 CFR Ch. XVII (7–1–10 Edition) §1910.1030 (iii) Labeled or color-coded in accord- ance with paragraph (g)(1)(i) of this standard; and (iv) Closed prior to removal to pre- vent spillage or protrusion of contents during handling, storage, transport, or shipping. (C) Disposal of all regulated waste shall be in accordance with applicable regulations of the United States, States and Territories, and political subdivisions of States and Territories. (iv) Laundry. (A) Contaminated laun- dry shall be handled as little as pos- sible with a minimum of agitation. (1) Contaminated laundry shall be bagged or containerized at the location where it was used and shall not be sorted or rinsed in the location of use. (2) Contaminated laundry shall be placed and transported in bags or con- tainers labeled or color-coded in ac- cordance with paragraph (g)(1)(i) of this standard. When a facility utilizes Universal Precautions in the handling of all soiled laundry, alternative label- ing or color-coding is sufficient if it permits all employees to recognize the containers as requiring compliance with Universal Precautions. (3) Whenever contaminated laundry is wet and presents a reasonable likeli- hood of soak-through of or leakage from the bag or container, the laundry shall be placed and transported in bags or containers which prevent soak- through and/or leakage of fluids to the exterior. (B) The employer shall ensure that employees who have contact with con- taminated laundry wear protective gloves and other appropriate personal protective equipment. (C) When a facility ships contami- nated laundry off-site to a second facil- ity which does not utilize Universal Precautions in the handling of all laun- dry, the facility generating the con- taminated laundry must place such laundry in bags or containers which are labeled or color-coded in accord- ance with paragraph (g)(1)(i). (e) HIV and HBV Research Labora- tories and Production Facilities. (1) This paragraph applies to research labora- tories and production facilities en- gaged in the culture, production, con- centration, experimentation, and ma- nipulation of HIV and HBV. It does not apply to clinical or diagnostic labora- tories engaged solely in the analysis of blood, tissues, or organs. These re- quirements apply in addition to the other requirements of the standard. (2) Research laboratories and produc- tion facilities shall meet the following criteria: (i) Standard microbiological practices. All regulated waste shall either be in- cinerated or decontaminated by a method such as autoclaving known to effectively destroy bloodborne patho- gens. (ii) Special practices. (A) Laboratory doors shall be kept closed when work involving HIV or HBV is in progress. (B) Contaminated materials that are to be decontaminated at a site away from the work area shall be placed in a durable, leakproof, labeled or color- coded container that is closed before being removed from the work area. (C) Access to the work area shall be limited to authorized persons. Written policies and procedures shall be estab- lished whereby only persons who have been advised of the potential bio- hazard, who meet any specific entry re- quirements, and who comply with all entry and exit procedures shall be al- lowed to enter the work areas and ani- mal rooms. (D) When other potentially infectious materials or infected animals are present in the work area or contain- ment module, a hazard warning sign in- corporating the universal biohazard symbol shall be posted on all access doors. The hazard warning sign shall comply with paragraph (g)(1)(ii) of this standard. (E) All activities involving other po- tentially infectious materials shall be conducted in biological safety cabinets or other physical-containment devices within the containment module. No work with these other potentially in- fectious materials shall be conducted on the open bench. (F) Laboratory coats, gowns, smocks, uniforms, or other appropriate protec- tive clothing shall be used in the work area and animal rooms. Protective clothing shall not be worn outside of the work area and shall be decontami- nated before being laundered. VerDate Mar<15>2010 09:17 Aug 04, 2010Jkt 220114PO 00000Frm 00282Fmt 8010Sfmt 8010Q:\29\29V6.TXTofr150PsN: PC150 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD 273 Occupational Safety and Health Admin., Labor §1910.1030 (G) Special care shall be taken to avoid skin contact with other poten- tially infectious materials. Gloves shall be worn when handling infected animals and when making hand con- tact with other potentially infectious materials is unavoidable. (H) Before disposal all waste from work areas and from animal rooms shall either be incinerated or decon- taminated by a method such as autoclaving known to effectively de- stroy bloodborne pathogens. (I) Vacuum lines shall be protected with liquid disinfectant traps and high- efficiency particulate air (HEPA) fil- ters or filters of equivalent or superior efficiency and which are checked rou- tinely and maintained or replaced as necessary. (J) Hypodermic needles and syringes shall be used only for parenteral injec- tion and aspiration of fluids from lab- oratory animals and diaphragm bot- tles. Only needle-locking syringes or disposable syringe-needle units (i.e., the needle is integral to the syringe) shall be used for the injection or aspi- ration of other potentially infectious materials. Extreme caution shall be used when handling needles and sy- ringes. A needle shall not be bent, sheared, replaced in the sheath or guard, or removed from the syringe fol- lowing use. The needle and syringe shall be promptly placed in a puncture- resistant container and autoclaved or decontaminated before reuse or dis- posal. (K) All spills shall be immediately contained and cleaned up by appro- priate professional staff or others prop- erly trained and equipped to work with potentially concentrated infectious materials. (L) A spill or accident that results in an exposure incident shall be imme- diately reported to the laboratory di- rector or other responsible person. (M) A biosafety manual shall be pre- pared or adopted and periodically re- viewed and updated at least annually or more often if necessary. Personnel shall be advised of potential hazards, shall be required to read instructions on practices and procedures, and shall be required to follow them. (iii) Containment equipment. (A) Cer- tified biological safety cabinets (Class I, II, or III) or other appropriate com- binations of personal protection or physical containment devices, such as special protective clothing, respirators, centrifuge safety cups, sealed cen- trifuge rotors, and containment caging for animals, shall be used for all activi- ties with other potentially infectious materials that pose a threat of expo- sure to droplets, splashes, spills, or aerosols. (B) Biological safety cabinets shall be certified when installed, whenever they are moved and at least annually. (3) HIV and HBV research labora- tories shall meet the following criteria: (i) Each laboratory shall contain a facility for hand washing and an eye wash facility which is readily available within the work area. (ii) An autoclave for decontamina- tion of regulated waste shall be avail- able. (4) HIV and HBV production facilities shall meet the following criteria: (i) The work areas shall be separated from areas that are open to unre- stricted traffic flow within the build- ing. Passage through two sets of doors shall be the basic requirement for entry into the work area from access corridors or other contiguous areas. Physical separation of the high-con- tainment work area from access cor- ridors or other areas or activities may also be provided by a double-doored clothes-change room (showers may be included), airlock, or other access fa- cility that requires passing through two sets of doors before entering the work area. (ii) The surfaces of doors, walls, floors and ceilings in the work area shall be water resistant so that they can be easily cleaned. Penetrations in these surfaces shall be sealed or capa- ble of being sealed to facilitate decon- tamination. (iii) Each work area shall contain a sink for washing hands and a readily available eye wash facility. The sink shall be foot, elbow, or automatically operated and shall be located near the exit door of the work area. (iv) Access doors to the work area or containment module shall be self-clos- ing. (v) An autoclave for decontamination of regulated waste shall be available VerDate Mar<15>2010 09:17 Aug 04, 2010Jkt 220114PO 00000Frm 00283Fmt 8010Sfmt 8010Q:\29\29V6.TXTofr150PsN: PC150 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD 274 29 CFR Ch. XVII (7–1–10 Edition) §1910.1030 within or as near as possible to the work area. (vi) A ducted exhaust-air ventilation system shall be provided. This system shall create directional airflow that draws air into the work area through the entry area. The exhaust air shall not be recirculated to any other area of the building, shall be discharged to the outside, and shall be dispersed away from occupied areas and air intakes. The proper direction of the airflow shall be verified (i.e., into the work area). (5) Training Requirements. Additional training requirements for employees in HIV and HBV research laboratories and HIV and HBV production facilities are specified in paragraph (g)(2)(ix). (f) Hepatitis B vaccination and post-ex- posure evaluation and follow-up—(1) General. (i) The employer shall make available the hepatitis B vaccine and vaccination series to all employees who have occupational exposure, and post-exposure evaluation and follow-up to all employees who have had an expo- sure incident. (ii) The employer shall ensure that all medical evaluations and procedures including the hepatitis B vaccine and vaccination series and post-exposure evaluation and follow-up, including prophylaxis, are: (A) Made available at no cost to the employee; (B) Made available to the employee at a reasonable time and place; (C) Performed by or under the super- vision of a licensed physician or by or under the supervision of another li- censed healthcare professional; and (D) Provided according to rec- ommendations of the U.S. Public Health Service current at the time these evaluations and procedures take place, except as specified by this para- graph (f). (iii) The employer shall ensure that all laboratory tests are conducted by an accredited laboratory at no cost to the employee. (2) Hepatitis B Vaccination. (i) Hepa- titis B vaccination shall be made avail- able after the employee has received the training required in paragraph (g)(2)(vii)(I) and within 10 working days of initial assignment to all employees who have occupational exposure unless the employee has previously received the complete hepatitis B vaccination series, antibody testing has revealed that the employee is immune, or the vaccine is contraindicated for medical reasons. (ii) The employer shall not make par- ticipation in a prescreening program a prerequisite for receiving hepatitis B vaccination. (iii) If the employee initially declines hepatitis B vaccination but at a later date while still covered under the standard decides to accept the vaccina- tion, the employer shall make avail- able hepatitis B vaccination at that time. (iv) The employer shall assure that employees who decline to accept hepa- titis B vaccination offered by the em- ployer sign the statement in appendix A. (v) If a routine booster dose(s) of hep- atitis B vaccine is recommended by the U.S. Public Health Service at a future date, such booster dose(s) shall be made available in accordance with sec- tion (f)(1)(ii). (3) Post-exposure Evaluation and Fol- low-up. Following a report of an expo- sure incident, the employer shall make immediately available to the exposed employee a confidential medical eval- uation and follow-up, including at least the following elements: (i) Documentation of the route(s) of exposure, and the circumstances under which the exposure incident occurred; (ii) Identification and documentation of the source individual, unless the em- ployer can establish that identification is infeasible or prohibited by state or local law; (A) The source individual’s blood shall be tested as soon as feasible and after consent is obtained in order to de- termine HBV and HIV infectivity. If consent is not obtained, the employer shall establish that legally required consent cannot be obtained. When the source individual’s consent is not re- quired by law, the source individual’s blood, if available, shall be tested and the results documented. (B) When the source individual is al- ready known to be infected with HBV or HIV, testing for the source individ- ual’s known HBV or HIV status need not be repeated. VerDate Mar<15>2010 09:17 Aug 04, 2010Jkt 220114PO 00000Frm 00284Fmt 8010Sfmt 8010Q:\29\29V6.TXTofr150PsN: PC150 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD 275 Occupational Safety and Health Admin., Labor §1910.1030 (C) Results of the source individual’s testing shall be made available to the exposed employee, and the employee shall be informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source individual. (iii) Collection and testing of blood for HBV and HIV serological status; (A) The exposed employee’s blood shall be collected as soon as feasible and tested after consent is obtained. (B) If the employee consents to base- line blood collection, but does not give consent at that time for HIV serologic testing, the sample shall be preserved for at least 90 days. If, within 90 days of the exposure incident, the employee elects to have the baseline sample test- ed, such testing shall be done as soon as feasible. (iv) Post-exposure prophylaxis, when medically indicated, as recommended by the U.S. Public Health Service; (v) Counseling; and (vi) Evaluation of reported illnesses. (4) Information Provided to the Healthcare Professional. (i) The em- ployer shall ensure that the healthcare professional responsible for the em- ployee’s Hepatitis B vaccination is pro- vided a copy of this regulation. (ii) The employer shall ensure that the healthcare professional evaluating an employee after an exposure incident is provided the following information: (A) A copy of this regulation; (B) A description of the exposed em- ployee’s duties as they relate to the ex- posure incident; (C) Documentation of the route(s) of exposure and circumstances under which exposure occurred; (D) Results of the source individual’s blood testing, if available; and (E) All medical records relevant to the appropriate treatment of the em- ployee including vaccination status which are the employer’s responsibility to maintain. (5) Healthcare Professional’s Written Opinion. The employer shall obtain and provide the employee with a copy of the evaluating healthcare profes- sional’s written opinion within 15 days of the completion of the evaluation. (i) The healthcare professional’s writ- ten opinion for Hepatitis B vaccination shall be limited to whether Hepatitis B vaccination is indicated for an em- ployee, and if the employee has re- ceived such vaccination. (ii) The healthcare professional’s written opinion for post-exposure eval- uation and follow-up shall be limited to the following information: (A) That the employee has been in- formed of the results of the evaluation; and (B) That the employee has been told about any medical conditions resulting from exposure to blood or other poten- tially infectious materials which re- quire further evaluation or treatment. (iii) All other findings or diagnoses shall remain confidential and shall not be included in the written report. (6) Medical recordkeeping. Medical records required by this standard shall be maintained in accordance with para- graph (h)(1) of this section. (g) Communication of hazards to em- ployees—(1) Labels and signs—(i) Labels. (A) Warning labels shall be affixed to containers of regulated waste, refrig- erators and freezers containing blood or other potentially infectious mate- rial; and other containers used to store, transport or ship blood or other potentially infectious materials, ex- cept as provided in paragraph (g)(1)(i)(E), (F) and (G). (B) Labels required by this section shall include the following legend: (C) These labels shall be fluorescent orange or orange-red or predominantly so, with lettering and symbols in a con- trasting color. (D) Labels shall be affixed as close as feasible to the container by string, wire, adhesive, or other method that prevents their loss or unintentional re- moval. VerDate Mar<15>2010 09:17 Aug 04, 2010Jkt 220114PO 00000Frm 00285Fmt 8010Sfmt 8010Q:\29\29V6.TXTofr150PsN: PC150 EC 2 8 O C 9 1 . 0 1 8 < / G P H > DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD 276 29 CFR Ch. XVII (7–1–10 Edition) §1910.1030 (E) Red bags or red containers may be substituted for labels. (F) Containers of blood, blood compo- nents, or blood products that are la- beled as to their contents and have been released for transfusion or other clinical use are exempted from the la- beling requirements of paragraph (g). (G) Individual containers of blood or other potentially infectious materials that are placed in a labeled container during storage, transport, shipment or disposal are exempted from the label- ing requirement. (H) Labels required for contaminated equipment shall be in accordance with this paragraph and shall also state which portions of the equipment re- main contaminated. (I) Regulated waste that has been de- contaminated need not be labeled or color-coded. (ii) Signs. (A) The employer shall post signs at the entrance to work areas specified in paragraph (e), HIV and HBV Research Laboratory and Produc- tion Facilities, which shall bear the following legend: (Name of the Infectious Agent) (Special requirements for entering the area) (Name, telephone number of the laboratory director or other responsible person.) (B) These signs shall be fluorescent orange-red or predominantly so, with lettering and symbols in a contrasting color. (2) Information and Training. (i) The employer shall train each employee with occupational exposure in accord- ance with the requirements of this sec- tion. Such training must be provided at no cost to the employee and during working hours. The employer shall in- stitute a training program and ensure employee participation in the program. (ii) Training shall be provided as fol- lows: (A) At the time of initial assignment to tasks where occupational exposure may take place; (B) At least annually thereafter. (iii) [Reserved] (iv) Annual training for all employ- ees shall be provided within one year of their previous training. (v) Employers shall provide addi- tional training when changes such as modification of tasks or procedures or institution of new tasks or procedures affect the employee’s occupational ex- posure. The additional training may be limited to addressing the new expo- sures created. (vi) Material appropriate in content and vocabulary to educational level, literacy, and language of employees shall be used. (vii) The training program shall con- tain at a minimum the following ele- ments: (A) An accessible copy of the regu- latory text of this standard and an ex- planation of its contents; (B) A general explanation of the epi- demiology and symptoms of bloodborne diseases; (C) An explanation of the modes of transmission of bloodborne pathogens; (D) An explanation of the employer’s exposure control plan and the means by which the employee can obtain a copy of the written plan; (E) An explanation of the appropriate methods for recognizing tasks and other activities that may involve expo- sure to blood and other potentially in- fectious materials; (F) An explanation of the use and limitations of methods that will pre- vent or reduce exposure including ap- propriate engineering controls, work practices, and personal protective equipment; (G) Information on the types, proper use, location, removal, handling, de- contamination and disposal of personal protective equipment; (H) An explanation of the basis for selection of personal protective equip- ment; (I) Information on the hepatitis B vaccine, including information on its efficacy, safety, method of administra- tion, the benefits of being vaccinated, and that the vaccine and vaccination will be offered free of charge; VerDate Mar<15>2010 09:17 Aug 04, 2010Jkt 220114PO 00000Frm 00286Fmt 8010Sfmt 8010Q:\29\29V6.TXTofr150PsN: PC150 EC 2 8 O C 9 1 . 0 1 9 < / G P H > DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD 277 Occupational Safety and Health Admin., Labor §1910.1030 (J) Information on the appropriate actions to take and persons to contact in an emergency involving blood or other potentially infectious materials; (K) An explanation of the procedure to follow if an exposure incident oc- curs, including the method of reporting the incident and the medical follow-up that will be made available; (L) Information on the post-exposure evaluation and follow-up that the em- ployer is required to provide for the employee following an exposure inci- dent; (M) An explanation of the signs and labels and/or color coding required by paragraph (g)(1); and (N) An opportunity for interactive questions and answers with the person conducting the training session. (viii) The person conducting the training shall be knowledgeable in the subject matter covered by the elements contained in the training program as it relates to the workplace that the train- ing will address. (ix) Additional Initial Training for Employees in HIV and HBV Labora- tories and Production Facilities. Em- ployees in HIV or HBV research labora- tories and HIV or HBV production fa- cilities shall receive the following ini- tial training in addition to the above training requirements. (A) The employer shall assure that employees demonstrate proficiency in standard microbiological practices and techniques and in the practices and op- erations specific to the facility before being allowed to work with HIV or HBV. (B) The employer shall assure that employees have prior experience in the handling of human pathogens or tissue cultures before working with HIV or HBV. (C) The employer shall provide a training program to employees who have no prior experience in handling human pathogens. Initial work activi- ties shall not include the handling of infectious agents. A progression of work activities shall be assigned as techniques are learned and proficiency is developed. The employer shall assure that employees participate in work ac- tivities involving infectious agents only after proficiency has been dem- onstrated. (h) Recordkeeping—(1) Medical Records. (i) The employer shall estab- lish and maintain an accurate record for each employee with occupational exposure, in accordance with 29 CFR 1910.1020. (ii) This record shall include: (A) The name and social security number of the employee; (B) A copy of the employee’s hepa- titis B vaccination status including the dates of all the hepatitis B vaccina- tions and any medical records relative to the employee’s ability to receive vaccination as required by paragraph (f)(2); (C) A copy of all results of examina- tions, medical testing, and follow-up procedures as required by paragraph (f)(3); (D) The employer’s copy of the healthcare professional’s written opin- ion as required by paragraph (f)(5); and (E) A copy of the information pro- vided to the healthcare professional as required by paragraphs (f)(4)(ii)(B)(C) and (D). (iii) Confidentiality. The employer shall ensure that employee medical records required by paragraph (h)(1) are: (A) Kept confidential; and (B) Not disclosed or reported without the employee’s express written consent to any person within or outside the workplace except as required by this section or as may be required by law. (iv) The employer shall maintain the records required by paragraph (h) for at least the duration of employment plus 30 years in accordance with 29 CFR 1910.1020. (2) Training Records. (i) Training records shall include the following in- formation: (A) The dates of the training ses- sions; (B) The contents or a summary of the training sessions; (C) The names and qualifications of persons conducting the training; and (D) The names and job titles of all persons attending the training ses- sions. (ii) Training records shall be main- tained for 3 years from the date on which the training occurred. (3) Availability. (i) The employer shall ensure that all records required to be VerDate Mar<15>2010 09:17 Aug 04, 2010Jkt 220114PO 00000Frm 00287Fmt 8010Sfmt 8010Q:\29\29V6.TXTofr150PsN: PC150 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD 278 29 CFR Ch. XVII (7–1–10 Edition) §1910.1043 maintained by this section shall be made available upon request to the As- sistant Secretary and the Director for examination and copying. (ii) Employee training records re- quired by this paragraph shall be pro- vided upon request for examination and copying to employees, to employee rep- resentatives, to the Director, and to the Assistant Secretary. (iii) Employee medical records re- quired by this paragraph shall be pro- vided upon request for examination and copying to the subject employee, to anyone having written consent of the subject employee, to the Director, and to the Assistant Secretary in accord- ance with 29 CFR 1910.1020. (4) Transfer of Records. (i) The em- ployer shall comply with the require- ments involving transfer of records set forth in 29 CFR 1910.1020(h). (ii) If the employer ceases to do busi- ness and there is no successor employer to receive and retain the records for the prescribed period, the employer shall notify the Director, at least three months prior to their disposal and transmit them to the Director, if re- quired by the Director to do so, within that three month period. (i) Dates—(1) Effective Date. The standard shall become effective on March 6, 1992. (2) The Exposure Control Plan re- quired by paragraph (c) of this section shall be completed on or before May 5, 1992. (3) Paragraph (g)(2) Information and Training and (h) Recordkeeping shall take effect on or before June 4, 1992. (4) Paragraphs (d)(2) Engineering and Work Practice Controls, (d)(3) Personal Protective Equipment, (d)(4) House- keeping, (e) HIV and HBV Research Laboratories and Production Facili- ties, (f) Hepatitis B Vaccination and Post-Exposure Evaluation and Follow- up, and (g) (1) Labels and Signs, shall take effect July 6, 1992. (5) Sharps injury log. (i) The employer shall establish and maintain a sharps injury log for the recording of percutaneous injuries from contami- nated sharps. The information in the sharps injury log shall be recorded and maintained in such manner as to pro- tect the confidentiality of the injured employee. The sharps injury log shall contain, at a minimum: (A) The type and brand of device in- volved in the incident, (B) The department or work area where the exposure incident occurred, and (C) An explanation of how the inci- dent occurred. (ii) The requirement to establish and maintain a sharps injury log shall apply to any employer who is required to maintain a log of occupational inju- ries and illnesses under 29 CFR 1904. (iii) The sharps injury log shall be maintained for the period required by 29 CFR 1904.6. APPENDIX A TO SECTION 1910.1030—HEPATITIS B VACCINE DECLINATION (MANDATORY) I understand that due to my occupational exposure to blood or other potentially infec- tious materials I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to my- self. However, I decline hepatitis B vaccina- tion at this time. I understand that by de- clining this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infec- tious materials and I want to be vaccinated with hepatitis B vaccine, I can receive the vaccination series at no charge to me. [56 FR 64175, Dec. 6, 1991, as amended at 57 FR 12717, Apr. 13, 1992; 57 FR 29206, July 1, 1992; 61 FR 5508, Feb. 13, 1996; 66 FR 5325, Jan. 18, 2001; 71 FR 16672, 16673, Apr. 3, 2006; 73 FR 75586, Dec. 12, 2008] §1910.1043Cotton dust. (a) Scope and application. (1) This sec- tion, in its entirety, applies to the con- trol of employee exposure to cotton dust in all workplaces where employees engage in yarn manufacturing, engage in slashing and weaving operations, or work in waste houses for textile oper- ations. (2) This section does not apply to the handling or processing of woven or knitted materials; to maritime oper- ations covered by 29 CFR Parts 1915 and 1918; to harvesting or ginning of cotton; or to the construction industry. (3) Only paragraphs (h) Medical sur- veillance, (k)(2) through (4) Record- keeping—Medical Records, and Appen- dices B, C and D of this section apply VerDate Mar<15>2010 09:17 Aug 04, 2010Jkt 220114PO 00000Frm 00288Fmt 8010Sfmt 8010Q:\29\29V6.TXTofr150PsN: PC150 DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD