Table of Contents. Executive Summary 3. Mission 4. Program Overview 5. Proposed Aircraft 5. Dates of Operation 6. Services 6. Equipment Inventory 7

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3 Table of Contents Executive Summary 3 Mission 4 Program Overview 5 Proposed Aircraft 5 Dates of Operation 6 Services 6 Equipment Inventory 7 Staffing 11 Training 11 Dispatch Procedures 11 Communication 12 Documentation 12 Population Served 12 Response Area 13 Quality Assurance/ Quality Improvement 14 Conclusion 14 2

4 Executive Summary Every November a predictable challenge arrives to the desert riding area of California City. It arrives in motorhomes, pick-up trucks and buses. It comes from California, Utah, Texas and Florida. The Thanksgiving weekend alone increases the population of California City to over 100,000. Of course the challenge is due the Off-Highway Vehicle (OHV) enthusiasts who stream out in droves to recreate in the vast desert and mountain regions in and around California City. This influx remains in one form or another until the warm weather returns in June. Unfortunately anytime 100,000 people are condensed into a region, participating in activities as inherently dangerous as dirt bike riding, there is going to be injuries. With these injuries comes a demand on local public safety services. To combat this increase in demand, the California City Fire Department and California City Police Department developed the Desert Incident Response Team (DIRT). The DIRT team is a collection of individuals from each agency who are specially trained for operations in the desert. Since 2001 the DIRT team has responded to over 10,000 calls for service, with the majority being medical aid for traumatic injuries. In 2011 the Police Department began operating a Robinson 44 helicopter for Search & Rescue operations. The helicopter proved incredibly useful in accessing patients quickly and leading responding Fire and EMS units into the scene. During the 2013 riding season Air 44 arrived on scene to multiple calls and was left waiting for up to 60 minutes for ground resources to access its location. The lack of qualified medical personnel on the helicopter meant the patients did not receive early intervention. This is a problem and is identified as a gap in service. The solution to the problem is simple, staff Air 44 with an ALS First Responder. The California City Fire Department already functions in the Kern County EMS system and operates under established policies and procedures. The mechanisms for prompt implementation already exist. CCFD has the personnel, equipment and training to seamlessly transition into this vital increase in service. 3

5 Mission To deliver our region an ALS First Responder Helicopter for rapid response utilizing superior pre-hospital patient care through excellence in training, the latest equipment and advanced technology in conjunction with strong leadership, professionalism and continuous quality improvement. 4

6 Program Overview 1. Proposed Aircraft The proposed aircraft to be used in the program is a Robinson 44. The Robinsonn R44 is a four-seat light helicopter produced by the Robinson Helicopter Company since The R44 is a single- engined helicopter with a semi-rigid two-bladedd main rotor and a two-bladed tail rotor and a skid landing gear. It has an enclosed cabin with two rows of side-by-side seating for a pilot and three passengers. General characteristicss Crew: one or two pilots Capacity: four, including pilot Payload: 748 lb Length: 459" Rotor diameter: 33 ft Tail rotor diameter: 4 ft 10 in Height: 10 ft 9 in (3.33 m) Empty weight: 1,450 lb Loaded weight: 2,500 lb Powerplant: 1 Lycoming IO-540-AE1A5 6 cylinder, flat engine with fuel injection, 245 bhp Fuel: 1000 low lead (100LL) fuel or 100/130. Main tank capacity: 31.6 US gallons Main tank usable fuel: 30.6 US gallons Auxiliary tank capacity: 18.5 US gallons Auxiliary tank usable fuel: 18.3 US gallons Performance Maximumm speed: 130 kn (150 mph) Cruise speed: 110 kn (130 mph) Range: 300 nmi (350 mi) Fuel consumption: 15 US gallons (57 l) of Avgas per hour. Not given in Pilot's Handbook. Altitude restrictions: 14,000 ft density altitude or 9,000 ft above ground level in order to be able to reach ground within 5

7 Dates of Operation The First Responder Helicopter will be placed in service in the same manner as any other piece of equipment which is utilized for DIRT operations. ECC will be notified prior to beginning of shift. Notifications will be made to adjoining resources to include: Hall Ambulance, Mercy Air, Medevac, KCFD, KCSO and San Bernardino County The expected dates of operation are as follows: Thanksgiving Week: Thursday, Friday, Saturday, Sunday New Year s Week: Dec 30 th, Dec 31 st, Jan 1 st President s Day Week: Friday, Saturday, Sunday, Monday Spring Break: Thursday, Friday, Saturday, Sunday Easter Weekend: Friday, Saturday, Sunday The Helibase will be located at the California City Municipal Airport and a Helispot has been established at Borax Bill Station. The Helicopter will be scheduled as a 24 Hour resource, but may become a 12 hour resource in the event a relief pilot becomes unavailable. Should the ship become unavailable, ECC would be immediately advised. Each proposed mission is 3 to go, 1 to say no, meaning that if any member of the crew is uncomfortable with the flight for any reason, the flight is canceled. This is common practice among helicopter crews. Services Incident Command Search Observation Navigation Basic Life Support Advanced Life Support Investigation Law Enforcement The minimum crew will consist of one Law Enforcement Officer and one Fire Department Paramedic. In the event that staffing limitations prohibit the operation of the ALS first responder helicopter, it will be removed from the system as an EMS resource. Fire Department personnel may, in these situations, still fly as a crewmember; however the personnel will not perform patient care but will perform other non-ems roles. 6

8 Equipment Inventory ADVANCED LIFE SUPPORT Medications: 1. Activated Charcoal 50.0 gm 2. Adenosine (Adenocard) 30.0 mg 3. Albuterol Sulfate (pre-dilute 2.5 mg per 3 ml inhalation solution) 10.0 mg 4. Amiodarone 900 mg 5. Aspirin (150 to 325 mg. tablets-chewable preferred) 10 tablets 6. Atropine Sulfate 12.0 mg 7. Calcium Chloride 1.0 gm 8. Dextrose 50% (prefilled) 50.0 gms 9. Diphenhydramine (Benadryl) mg 10. Epinephrine, 1:10, mg 11. Epinephrine, 1:1, mg 12. Glucagon 1.0 mg 14. Ipratropium Bromide (Atrovent) 1000 mcg 15. Intropin (Dopamine) 800 mg 16. Lidocaine, 1% or 2% (IVP) 200 mg 17. Lidocaine, 4% (IVD) 2.0 gm 18. Magnesium Sulfate 5.0 gm 19. Naloxone (Narcan) 8.0 gm 20. Nitroglycerine Ondansetron (Zofran) IV 12.0 mg 22. Oral glucose 15.0 gm 23. Sodium Bicarbonate (prefilled) 100 meq 24. Verapamil Hydrochloride 15.0 mg MICU Narcotics Inventory (mandatory amount to be maintained) 1. Diazepam 30.0 mg 2. Fentanyl 400 mcg 3. Morphine Sulfate 40.0 mg 4. Versed 12.0 mg 5. Lorazepam 4mg/ml single dose vial 8.0 mg Intravenous Access/Administration - Intravenous Solutions 1. 5% Dextrose and Water or NS (50 or 100ml bags) 2 2. Isotonic balanced salt solution (500/1000 ml) 4 Liters 3. Normal Saline 0.9% for Injection Single Dose 10 mg 3 4. Medication label 2 7

9 Intravenous Access/Administration Intravenous Accessories 1. Alcohol Preps 10 preps 2. Betadine Preps 5 preps 3. Hypodermic Needles (18 or 20 ga) 8 4. Mucosal Atomization Device (MAD) 2 5. Intraosseous Needles (EMS approved) 2 6. IV Catheters (14, 16, 18, 20, 22, 24 ga) 4 each 7. IV Flow Regulator 2 9. IV Tubing (3 Macro, 3 Micro) 6 total 10. Saline Locks Syringes (1, 3, 10/12, 20 cc) 2 each 12. Tourniquets (1 x5 ) 4 Airway Maintenance 1. King Airway Kits (sizes 3, 4, 5) 1 each 2. Cricothyrotomy Unit (EMS Approved) 1 sterile set 3. Endotracheal Tubes (2.5, 3, 4, 4.5 mm)(without cuff) 2 each 4. Endotracheal Tubes (5, 6, 6.5, 7, 8 mm)(with cuff) 2 each 5. ET Intubation Tube Stylets (adult and pediatric) 2 each 6. Commercial ET Tube Holder 2 7. Secondary ET Confirmation Device 2 8. Lubricant, water soluble (K-Y) 20ml 9. Naso-Gastric Tubes (14, 16, 18 french) & (1) in range of 22-32french) 1 each 10. Nebulizer set 2 sets 11. Oral Airways Must meet CHP, HPH 82.4 recommendations 2 sets 12. Oxygen Nasal Cannula Adult Oxygen Mask Adult & Pediatric Non-Rebreather 2 each 14. Suction Catheters (10, 18 fr.) 2 each 15. Suction Tubing Rigid suction tubing Bulb Syringe Thoracic Decompression Unit (EMS Approved) Ventilation Bag-Valve unit (Adult, Ped, Infant) Ventilation Bag Mask Semi-open, valveless, transparent( Adult, Ped, Infant) 2 Bandages and Dressings 1. Band-aids (1 x3 ) Dressing, Abdominal (8 x 10 ) 5 sterile 3. Dressing, Oval Eye Pads 4 sterile 4. Dressing, 3 Kling/Kerlix 6 sterile 5. Dressing, 4 x Dressing, 10 x30 (multi-trauma dressing) 1 8

10 7. Petroleum gauze 1 8. Bandage shears 1 9. Tape, 2 Adhesive or Silk 2 rolls 10. Tape, 1 Plastic or Silk 3 rolls Miscellaneous Supplies 1. Burn Pack or Burn Care Supplies 2 sterile 2. Cervical Collars Pediatric & Adult 3 each 3. Cleaning Solution, 10% Bleach in water or other agent 2 bottles 4. Cold Packs (single use disposable) 3 5. Dextrose Sticks/Chemstrips or Blood Glucose Analysis Device 12 strips 6. ECG Recording Paper (extra) 2 rolls 7. ECG Electrodes, Adult 3 multi packs 8. ECG Electrodes, Pediatric 2 multi packs 9. Multi-function pacing/defibrillation pads (adult and pediatric) 2 sets 10. Emesis Basins or Emesis Bags (disposable) Gloves, multi-size, non-permeable and non-sterile 1 box 12. Irrigation Syringe (50 or 60 cc) Laryngoscope Batteries (extra) 1 set 14. Laryngoscope Blade Bulbs (extra for each type of blade carried) 1 each type 15. Non-Permeable Gowns or equivalent, long sleeve, full length protection Non-Permeable plastic bags for infectious medical waste and linen Normal Saline Irrigation Solution 2 liters 18. Obstetrical Kit Shield, transparent or goggles for eye protection Surgical mask (paper, disposable) Triage Tags (EMS Approved) 10 tags 22. DOT Emergency Response Guide Hazardous Materials Length Based Resuscitation Tape 1 Airway Maintenance Reusable 1. Laryngoscope Blades: Straight (sized 0, 1, 2, 3) Curved (sizes 2,3) 1 each 2. Laryngoscope Handle 1 3. Magill Forceps 1 4. Oxygen Tank Extra, Portable (1000 PSI) 1 5. Oxygen Tank Portable with regulator, liter flow control (500PSI) 1 6. Portable Suction Unit, shall meet CHP, HPH 82.4 recommendations 1 unit 1 unit 9

11 Spinal Immobilization 1. Backboard Long, with straps (collapsible) 2 set 2. Backboard Short or KED, with torso and forehead straps 1 set 3. Cervical spine immobilization pads/device (EMS Approved) 2 sets 4. Splints A. Skeletal Traction Device Femur 1 set B. Extremity Splints (Long/leg and Short/arm) 1 set Cardiac and Communications 1. Defibrillation Paddles or Pads (adult and peds) 1 set each 2. Biomedical Radio (Fixed) with voice access into Kern County Medical 1 unit Communications System (Med channels 1-7, 9 and required PLS codes) 3. Biomedical Radio (portable) with voice access to Med-9, PL-7A; Med-9, PL-7Z, 1 unit PL-7A; of the Kern County Medical Radio System 4. Portable Cardiac Monitor/Defibrillator with patient cable and capable of 1 unit synchronization, pacing, 12-Lead EKG Miscellaneous Medical Supplies and Equipment 1. Blood Infusion Pump (manual unit) 1 2. Blood Pressure Cuffs with Gauge Adult 2 3. Blood Pressure Cuffs (infant, pediatric, obese) 1 each 4. Pediatric Dosage Chart and /or copy of valid EMT-P Treatment Protocols 1 5. Puncture proof sharps container 1 6. Stethoscope 2 7. Thermometer, oral 1 8. Pulse Oximetry 1 unit Optional MICU Supplies and Equipment 1. CPAP 1 unit 1 unit 2. Capnography (required for patients on ventilator) 1 unit 1 unit 3. Endotracheal tube introducer 1 1 Restock The proposed helicopter provides minimal space for restock and as such a full complement of on board restock is unrealistic. It is planned to carry a limited restock module on board that has IV sets, NS bags, an additional traction splint, assorted trauma dressings, splints, additional spinal immobilization collars and stay blocks. A full restock will be available at Borax Bill Station, with the station having appropriate climate controlled lock storage. 10

12 Staffing The staffing model for the Air 44 ALS First Responder program will be a crew of three. 1 pilot 1 Law Enforcement Officer 1 Firefighter/Paramedic The helicopter will not operate as an EMS resource if staffing of three crew members is not attained, or if there is no Paramedic to fill the firefighter seat. In the event no qualified Paramedic is available the helicopter may continue to function as an observation platform and assist in locating victims, but will not be authorized to render aid. Training The training requirements and qualifications for eligibility to operate as a fire department helicopter crew member are as follows: Licensed Paramedic Kern County Accreditation ICS 100, 200, 300 NIMS 700, 800 HECM red card within 12 months PHTLS, ACLS, PALS Current member of the California City Fire Department with at least 2 years of continuous service performing Paramedic level Emergency Medical Services Attend annual 4 hour orientation with pilot and aircraft from which crew member will be deployed These are the minimum requirements for fire department members to operate as a fire department helicopter crew member. Dispatch Procedures The dispatch of the first responder helicopter will be made through California City Police Department Control 6 and/or Kern County ECC. The PSAP that initiates original dispatch will depend on which PSAP receives the initial call. When launched the aircraft will flight follow with Kern ECC. The first responder helicopter would, under normal circumstances, be dispatched as a part of an Off-Road Vehicle Accident response. This response configuration would not change and would include ground resources and air ambulance resources normally dispatched for such an incident. For example: should CCPD Control 6 receive a call for an Off-Road Rescue, the dispatcher would advise the Borax Bill Command Post and forward the call to ECC. Units staged at Borax Bill Command Post would begin response and confirm dispatch through ECC. ECC would then start appropriate 11

13 resources and the incident would be managed to its completion by the designated Incident Commander. Communication Each fire department helicopter crew member will be equipped with two radios. A VHF radio will be carried for communication with ECC and adjoining fire resources; and a UHF radio for communication with law enforcement as well as Med 1 through 9. Communication will be plumbed into each crew member s flight helmet and can be disconnected to disembark the aircraft when rendering aid. The pilot will have appropriate radio frequencies to communicate with air-to-air resources. The air-toair communication would allow the aircraft to communicate with all other aircraft on established frequencies. Additionally the aircraft will have the ability to communicate on traffic control channel JOSHUA and the ability to contact SCOUT (Edwards Air Force Base). The aircraft will have the ability to communicate with Medevac 1, Mercy Air 14, Air 5, H408/407, CHP Air 80. All communication will remain consistent with currently used systems throughout county. Documentation EMS reporting will utilize EPCR and will remain within current guidelines set forth for the California City Fire Department ALS First Responder Program. All patient care reports will be completed within 15 hours of end of each call. Population Served The population to be served will be approximately 100,000 individuals. All individuals are from outside of the area and camp at a number of campsites and open areas within the city limits. Additionally large numbers of campers congregate in the areas of Dove Springs and Jawbone Canyon. The first responder helicopter would be available as a mutual aid resource, just as all Fire Department resources are. All mutual aid requests will initiated by Kern ECC. The bio demographics do not generally vary from average populations with regard to medical; however there is a significant increase in trauma. Historically most calls are for trauma with a high mechanism of injury. Long bone fractures and closed head injuries are common. Pediatric patients are naturally very challenging, as they tend to compensate for a long period of time and decompensate quickly. 12

14 Response Area The map on the following page shows areas which will be significantly impacted by increase in out of town campers and OHV enthusiast. 13

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