Virginia Beach Department of Emergency Medical Services CAAS # 103.01.01 Index # Operations SPECIAL OPERATIONS - SQUAD TRUCK OPERATING POLICY PURPOSE: The purpose of this policy is to establish minimum guidelines for the operations of the EMS Squad Truck Team for the City of Virginia Beach. APPLICABILITY: PROCEDURE: The policy shall apply to all personnel as well as squad trucks insured by and under the auspices of the Department of Emergency Medical Services. SECTION I: CHAIN OF COMMAND AND STAFFING PROCEDURES A. SQUAD TRUCK TEAM OFFICERS: 1. The Virginia Beach Department of EMS squad truck team chain of command shall consist of a Squad Truck Team Captain, an Operations Lieutenant, and Squad Truck Lieutenants appointed by home station Squad Commanders. The Squad Truck Team Captain, Operations Lieutenant or other appointed staff officers shall not hold a position as a Station Squad Lieutenant or designee. 2. Special Operations Captain (Special Ops 30) Squad Truck Team: a) Manages and directs the Squad Truck Team and associated resources for the Department of Emergency Medical Services; does related work as required. Refer to Rescue Captain Job Description for further details. b) Maintains adequate communications via Department of EMS assigned e-mail and phone with supervisor, peers, and subordinates. c) This appointment will have no time limit and will serve to the discretion of the Special Operations Brigade Chief. Prerequisites: In addition to the qualifications of Operations Lieutenant the Squad Truck Team Captain shall have 2 years on the Department of EMS Squad Truck Team. 3. Operations Lieutenant (Special Ops 31): a) Manages and directs the Squad Truck Operations, ensures all departmental rules, regulations and policies are understood and adhered to by all squad truck team personnel; meets and confers with Squad Truck Team Captain, Squad Truck Team Sergeants and Squad Truck Supervisors on a regular basis to discuss activities, operations, concerns and procedures. b) Ensures that staffing remains commensurate with manpower requirements and acts as the primary point of contact for all scheduling / staffing issues. c) Coordinate with Department of EMS training center to schedule required classes for squad truck personnel; conferring with the chain of command. d) Track the status and qualifications of all squad truck team trainees through the Squad Truck Supervisors.
Page 2 e) Ensure Squad Truck Supervisors conduct training for trainees on duty shifts. f) Shall hold the rank of Lieutenant and have operational field authority. g) Reports directly to the Squad Truck Team Captain. h) Act as Squad Truck Team Captain in his/her absence i) Shall be a released Squad Truck Attendant-in-Charge/Driver Operator. j) This appointment will have no time limit and will serve to the discretion of the Special Operations Brigade Chief and the Squad Truck Team Captain. k) Refer to Assistant Rescue Captain Job Description for further details Prerequisites: In addition to the qualifications of Squad Truck Supervisor, the Operations Lieutenant shall have 2 years on the Department of EMS Squad Truck Team. 4. Administrative Lieutenant (Special Ops 32) a) Shall be responsible for personnel accountability for the Squad Truck Team. b) Shall be responsible for Squad Truck Team training issues. c) Shall ensure that trainees meet the minimum requirements as outlined in the city Squad Truck training packages. d) Coordinate with EMS training center to schedule required classes for squad truck personnel; conferring with the chain of command. e) Track the status and qualifications of all Squad Truck Team trainees through Squad Truck Supervisors. f) Reports directly to the Squad Truck Team Captain. g) This appointment will have no time limit and will serve to the discretion of the Special Operations Brigade Chief and the Squad Truck Team Captain. Prerequisites: In addition to the qualifications of Squad Truck Supervisor, the Administrative Lieutenant shall have 2 years on the Department of EMS Squad Truck Team. 5. Station Squad Truck Lieutenant (XX30): a) Shall be responsible to the Squad Truck Team Operations Lieutenant in matters regarding Squad Truck Team issues. b) Shall ensure that squad truck trainees meet the minimum requirements as outlined in the city squad truck training packages. c) Ensure that all heavy and special rescue equipment is operational to provide prompt and safe delivery of patient care. d) Shall be a qualified candidate appointed by the respective home station squad commanders. If no decision can be made, the home squad commander may ask the Squad Truck Team Captain to make the appointment. These appointments may or may not have a time limit depending on the home station and will serve to the discretion of the Special Operations Brigade Chief and the Squad Truck Team Captain. e) Shall have operational field authority. Prerequisites: In addition to the qualifications of the Attendant Level II, the Squad Truck Lieutenant must have completed ICS 300. - 2 -
Page 3 B. MINIMUM MANNING REQUIREMENTS: 1. A duty squad truck shall be manned 24 hours a day, unless otherwise directed by the Special Operations Brigade Chief. The following squad trucks currently support city staffing; 6, 9, 14 and 16. 2. Squad Truck personnel (including trainees) will submit their duty availabilities via two methods: a) OSCAR submission to home rescue station. Upon completion of the ambulance schedule, the scheduling officer will forward remaining submissions to the Squad Truck Team Operations Lieutenant. b) OSCAR submission to EMS / Special Ops. This will not supersede regular ambulance submissions. c) All submissions must be made by the 10 th of the month. Failure to do so will result in an additional duty. 3. A minimum of (1) Driver / Operator and (1) Attendant Level I will be required for a squad truck to be manned. A three-member crew would be preferable. C. PROTECTIVE CLOTHING: Each member of a Squad Truck crew shall wear Personal Protective Equipment (PPE) issued by home Squad Truck station. If the station does not have a Squad Truck, PPE will be issued by the city. PPE must adhere to the following: a) All PPE should meet NFPA, OSHA, NIOSH standards b) White or blue hard helmet c) Safety glasses that must provide side protection and contain the Z87 marking. d) Pair of layered gloves with recommended 2 cuff. e) Boots, steel toe and steel shanks. f) Bunker gear or equivalent, as determined by the Director of EMS, to protect against flash fire and debris. 1. All personnel in and around the Hot Zone, as designated by the extrication officer, shall be dressed in PPE or adequately covered while engaging in on-scene extrication and rescue. The Hot Zone is defined as follows: a) No fluids on the ground 50 foot radius from the center of the incident. b) Fluids on the ground 100 foot radius from the center of the incident. 2. In the event there is a need to perform therapeutic life saving procedures by the medical personnel attending the patient, medical personnel may be given permission by the extrication officer to temporarily remove necessary protective apparel to carry out such techniques. It shall be the responsibility of the extrication officer to minimize the risk to medical personnel during this period of time. D. OPERATIONAL PROCEDURES: 1. The following procedures will be followed by all squad trucks operated by department personnel: - 3 -
Page 4 a) Driver/Operators shall be trained in the proper operation of the squad truck. Each driver of a squad truck must have successfully completed a Heavy EVOC class and Squad Truck Driver / Operator training package. b) A manned squad truck shall be defined as a truck manned with 2 qualified personnel, in station (not on pagers). c) The Duty Squad is defined as the squad assigned the duty and is manned. d) Duty Squad Dispatching The dispatcher shall dispatch the Duty Squad and the closest extrication vehicle (another squad truck or ladder) to the reported entrapment. If there is no Duty Squad, then the two closest extrication vehicles should be dispatched. e) No extrication vehicle shall be canceled until Incident Command determines that their services are no longer required. Once the Incident Commander or any EMS supervisor (EMS-5/6-10) has cleared the unit, they will not continue to the scene. In addition to normal equipment, EMS squad trucks shall be started on a Priority One response (unless otherwise indicated by any EMS supervisor) to the following incidents: 1) Vehicle over-turned, on its side, in a ditch, or in the water 2) Bus accidents 3) Accidents involving farm equipment 4) Bay Bridge Tunnel accidents 5) Aircraft Mishaps. 6) Mass Casualty Incidents 7) Vehicular fire with victim still inside 8) Any other life-threatening emergency as indicated by any EMS supervisor, where rescue equipment and/or manpower is required. f) The Incident Commander or an EMS supervisory designee may modify extrication vehicle response (Emergency/non-emergency) as necessary. g) A Pre-Hospital Patient Care Report (PPCR) shall be completed and a copy forwarded to the EMS Administration office upon completion of each squad truck call. h) The Duty Squad truck will sign on with the dispatcher indicating the highest certification level of the Attendant-in-Charge (Shock Trauma and above only). i) Any squad truck (including first due squad truck) other than the Duty Squad Truck shall check with the EMS supervisor on the assigned TAC channel, prior to responding to any squad truck call. j) If call volume dictates, a supervisory designee may remove an Attendant-in- Charge from the Duty Squad Truck to staff additional resources. All efforts should be made to keep the Driver/Operator with the Duty Squad Truck. E. ADDITIONAL SQUAD TRUCK RESPONSES: 1. If there is a delay in an ambulance response to a Priority One call (time/distance), the manned EMS Squad (if in the first due area of the call) may (at the discretion of the squad truck crew) replace the fire apparatus in assisting the responding ambulance. - 4 -
Page 5 SECTION II: SQUAD TRUCK EQUIPMENT REQUIREMENTS A. Duty squad truck equipment requirement: (minimum) MEDICAL EQUIPMENT All Squad Trucks shall be equipped to meet the Virginia Office of EMS standards for Class A (ALS Non-Transport) Vehicle. Patient treatment supply: Trauma kits (4) stocked Portable oxygen units (2) and spare bottles Oxygen manifold system for 14 patients with 02 supplies for same Semi-automatic Defibrillator Burn treatment kit Cervical collars (8) Blankets (8) may be disposable type OB kits Traction splints Stokes Basket LBB s (8) Board splints KED's or equivalent (2) CID's or equivalent (8) Securing devices for spinal immobilization equipment Triage Tarp Set Triage Ribbon Kit (2) Triage Tags (50) Incident Command vests Basic Tools: Hand tools and cutting tools: Air or cascade system for air tools Air chisel, air nibbler, Para Tec chisel, die grinders, etc. Reciprocating type power hacksaw Chain saw Shovels (2) Picks (2) Pry-Bars 48 to 60 inches. (2) Crash axe, flat head axe, and rescue type axe (3) Sledge hammers (2) Bolt cutters 18 and 36 inch Stabilization Equipment: Cable lug-alls 2 tons (2) Cable slings or chains 15 ft. (2) Holdfast pickets (8) 24 inches Truck mounted winch 15,000 lbs. 4 High Lift Jacks 2 each 6ft 4x4's 2 each 8ft 4x4's 1 set of Tensioned Buttress stabilization device - 5 -
Page 6 Fire extinguishes: 15 lb. dry chemical 15 lb. carbon dioxide Generator 12KW Power cords (400 ft.) Portable floodlights (6) 500 watts each Assorted adapters Vehicle mounted floodlights (4) 500 watts each Ladders: Ladders extension 20 ft. Ladder wall 12 ft. SCBA: Self contained breathing apparatus (4) Spare SCBA bottles (4) General Tools: Complete Tool Box: (1) Minimum Claw hammers Aircraft snips Cold chisel set Machinist hammer Channel locking pliers Needle nose pliers Assorted Phillips and straight blade screwdrivers 2 regular hacksaws with (extra blades 10) Adjustable wrenches (metric and standard) /Assorted open-end wrenches Assorted socket wrenches (metric and standard) Safety Equipment: Safety traffic cones (6) Flares or warning triangles Fire retardant blankets (2) Safety vest (2) Battery operated hand lights (4) Barrier Tape (1) Cribbing / Wood: Wood or rubber cone-shaped pugs 6x6 (20) hardwood 18 inches. 4x4 (40) hardwood 18 inches 4x4 wedges (8) hardwood Step-chocks hardwood (1 set) Hydraulic tools: Power units (2) Spreaders 32 inch (1) 16,000 lbs. "0" type cutters (1) Second tools of each type or combination tool 200 ft. hose Rams 30's (2), 60's (2) Manifold block (1) - 6 -
Page 7 Air bags: 136-ton combination Hoses (4) Controllers (2) Rope rescue gear: Rescue harness, set's (3) Ascenders set (2) Assorted single, double, triple, pulleys (6) Rappelling racks, 8 plates (6) Prussicks and 2 inch, webbing for rigging (15) Carabineers (15) Edge protectors (1) Rescue quality rope 250 ft. 2 inch. (2) Rescue quality rope 250 ft. 5/8 inch. (1) SECTION III: EXTRICATION DISPATCH PROCEDURES: In all cases of extrication, the primary concern is for life safety. Patient condition, their situation, hazard control and the available resources will influence the methods and speed at which the operation will need to be accomplished. An Ambulance, supervisory designee, ALS provider, Engine Company and Extrication Equipment shall be dispatched. 1. The Squad Truck Team and the Duty Squad shall be included on the initial dispatch to all calls requiring any form of extrication of a patient. 2. If there is a staffed EMS Squad Truck closer to the scene than the responding Duty Squad Truck, it shall be responded and the Duty Squad Truck cancelled at the discretion of any EMS supervisor. 3. If there is a Fire Department Ladder OR EMS Squad Truck closer than the responding EMS Squad Truck, the Ladder OR Fire Squad shall be dispatched as a supplement. 4. Only one EMS Squad Truck is necessary for a vehicle extrication call, unless modified by the on-scene incident commander or an EMS Supervisor. 5. Only one Fire extrication unit is necessary to augment a vehicle extrication call. They shall only be dispatched when closer by time/distance unless modified by the onscene incident commander or an EMS Supervisor. The first arriving unit on scene should establish command and shall perform the following procedures: 1. Confirm that the required extrication resources for this call are responding or have been requested. (A minimum of one EMS Squad Truck if available) 2. Ensure that all resources necessary to control hazards are responding. 3. Establish an Extrication Group Leader, Medical Group Leader and a Safety Officer as appropriate. 4. Ensure that the responding Squad Truck has immediate access to the accident scene (within 25 feet of the vehicles involved). - 7 -
Page 8 Once appointed the Extrication Group Leader shall: 1. Ensure that the vehicle is properly stabilized prior to beginning extrication (Refer to Appendices A, B and C). Verify lock-out/tag-out of all machinery. 2. Perform controlled movement and/or removal of all metal and/or obstructions in order to properly package and remove the patient without further aggravating the patient's injuries. 3. Ensure that the patients and patient care providers are properly protected throughout the entire extrication, covered with fire retardant blankets at the minimum. 4. Will work closely with the patient care providers / ALS to assist where needed while transferring the patient out of the vehicle, at this point, the Medical Group Leader will assume complete control over the patient. Once appointed the Safety Officer shall: 1. Ensure that the Hot, Warm and Cold zones have been identified and being observed. 2. Ensure that the patients and patient care providers are properly protected throughout the entire extrication, covered with fire retardant blankets at the minimum. 3. Ensure that all hazards are under control and no danger to rescuers exists at the incident. 4. Ensure that a charged and attended hose line is in place. Once appointed the Medical Group Leader shall: 1. Ensure that a primary patient survey has been completed, and that there is adequate c- spine immobilization and BLS care. ALS providers should be used when possible and work in conjunction with the extrication group. During the Demobilization phase, the Incident Commander, Extrication Group Leader, Medical Group Leader and a Safety Officer will continue to work closely together to secure the scene in a safe manner. SECTION IV: VEHICLE & MACHINERY EXTRICATION PROCEDURES DEFINITION: All types of extrications are the responsibility of the Department of Emergency Medical Services (DEMS). These procedures will cover in-detail the proper methods of Vehicle Extrication that are acceptable under the DEMS standards. Vehicle Extrication is the procedure used to remove accident victims who are entrapped in wreckage by either the nature of their injuries and/or the entanglement of themselves in the vehicle wreckage. While these procedures apply to simple vehicle extrication scenarios, they may also be applied to more complex situations. For Clarification purposes, an EMS Squad Truck is defined as one of the Volunteer Squad Trucks. A fire extrication vehicle is defined as a Ladder Truck or Fire Squad. - 8 -
Page 9 A. GUIDELINES FOR VEHICLE EXTRICATION/STABILIZATION PROCEDURE: 1. Turn off ignition and disconnect battery, if accessible 2. Place vehicle in park and apply parking brake, if possible. 3. Use step chocks on both sides of the vehicle as close to the back tires as Possible but in front of them, add two more step chocks close to but behind the front tires. The air in the tires at this point must be removed for proper stabilization. 4. Another method that may be used for multiple vehicles or highly elevated trucks or cars is to use a box crib build up under four corners of the vehicle in the areas described. Remove all necessary glass to properly perform door and roof removal. 5. At this point the door or doors should be removed by one of the following methods: vertical door to roof rail spread; hinge side first; or striker bolt side first These methods will depend on the condition of the door. 6. The roof should be removed for access to the patient and to provide additional operating space for the patient care providers. This may involve flapping or total removal of the roof. If only one door is to be forced open, the roof post cuts should be performed at the same time on the opposite side of the door being forced to decrease the extrication time 7. At this point a dash roll-up may need to be performed to push the dash off the patient. A relief cut should be made at the kick panel and then a proper ram or rams placed to perform the dash roll-up. Only push the needed side of the dash. B. GUIDELINES FOR VEHICLES ON THEIR ROOFS PROCEDURE: 1. Use step chocks, high level jacks or tensioned buttress stabilization device to keep the vehicle from moving. 2. If the vehicle needs to be raised, insert lifting device in the allowable space. 3. Stabilization should be enough that no moderate rocking or movement should take place. 4. At this point, hydraulic spreaders may be used to open the needed doors to gain entry. 5. All lifting devices and cribbing should be removed in reverse order to maintain safety of the personnel C. GUIDELINES FOR VEHICLES ON THEIR SIDES PROCEDURE: 1. When a vehicle is found on its side, consider this vehicle unstable. Do not rock test prior to entry. 2. The main objective is to increase ground contact between the vehicles and to widen the base of stability 3. It is acceptable to use wood blocking, step cribbing, and high-level jacks as initial stabilization procedures - 9 -
Page 10 4. Prior to beginning the extrication, secondary stabilization procedures must be performed. A two or four point anchor system attached to the accident vehicle must be employed. Rescue chains to cable or chain lug-alls anchored to a strong ground anchor point, pickets, and rescue vehicles, guardrails. A tensioned buttress stabilization device or rescue vehicle mounted winches may be used to complete this requirement. Rope is not considered an acceptable stabilization device. 5. The extrication from this point forward may include cutting the top roof post and folding the roof down to the ground, or the possible removal of the entire roof for proper access, removal and transfer of the patient. SECTION V: TRAINING AND CERTIFICATION A. Identification In order to readily identify personnel on an extraction scene the following color schemes have been adopted for use. BLUE HELMET WITH YELLOW STRIPES BLUE HELMET WITH GREEN STRIPES WHITE HELMET Trainee Driver/Operator Attendant Level I and II Officer All Squad Trucks will carry one white helmet with squad number to be utilized by the senior team member of that Squad Truck in the absence of a Squad Truck Supervisor on duty. Squad Truck personnel must re-certify their qualifications at least every 5 years to remain proficient. B. SQUAD TRUCK MEMBER QUALIFICATIONS Squad Truck Trainee 1. In order to obtain the qualification of Squad Truck Trainee, an individual must have successfully completed the following: a. Approval from Special Operations Brigade Chief b. Released AIC/Driver on ambulance for 90 days c. A member that is scheduled at least 24 hours a month on an ambulance, EMS SWAT Medic, or as otherwise approved by the Deputy EMS Chief d. Passage of physical agility test (5 minute time limit) 1) In full squad truck gear, carry spreader to extent of cord reel and back without setting it down, and return it to its tray. 2) Carry 4--6X6's around the truck and stack in box crib. Then, carry a second set of 4--6X6's around the truck and stack in a second box crib. 3) Hold cutters at waist level for one minute and then return them to their tray. e. IS 100 f. IS 200 g. IS 700-10 -
Page 11 Trainees shall have 120 days to complete the training package upon joining Squad Truck Team. Trainees must be released as Attendant Level I within one year of joining Squad Truck Team, or be re-evaluated to establish viability for the Squad Truck Team. Attendant Level I Driver/Operator 1. In order to obtain the qualification of an Attendant Level I, an individual must have successfully completed the following: a. Completion of an approved Vehicle Extrication Course b. MCI II c. Public Safety Response to Terrorism Awareness d. Completed Squad Truck Attendant training package 1. In order to obtain the qualification of a Driver/Operator, an individual must have successfully completed the following: Attendant Level II a. Requirements for Attendant Level I b. Heavy Emergency Vehicle Operators Course (EVOC) Class III c. Completed Driver/Operator Training Package d. Completed at least one Squad Truck Specific Addendum 1. In order to obtain the qualification of an Attendant Level II, an individual must have successfully completed the following: a. Requirements for Driver/Operator b. One year released as an Attendant Level I c. Completion of all Squad Truck Specific Addendums This policy shall become effective upon the approval of the Chief of Emergency Medical Services. APPROVED: EMS Chief Date 3/2/2007 LEGAL REVIEW Signature on File 3/2/2007 City Attorney s Office Date Originated Revised 3/2/2007-11 -