Paramedic Application - August 2017
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The Williston Fire Department is a combination of career and on-call firefighters and EMTs. We are committed to our core values of dedication, honor and service. Protecting a daytime population of 20,000 people living and working in a 30+ square mile area, the Williston Fire Department is proud to provide high quality fire and EMS services. We are excited for the potential to reach the pinnacle of fire-based EMS in the form of a paramedic level service.
Table of Contents
Commitment to Provide Sustained and Consistent Coverage
The Need for Paramedicine
Supplies and Equipment
QA/QI Standard Operating Procedure
Background check policy
Drug and alcohol policy
Letters of Support
Commitment to Provide Sustained and Consistent Coverage
The Williston Fire Department (WFD) currently employs eight career shift personnel, along with a full-time Fire Chief, Captain and Administrative Assistant during the week. All career shift personnel are minimally certified at the AEMT level, and one of our current career shift personnel is licensed at the paramedic level. We are currently in the hiring process to add one additional career shift Firefighter/EMT, who will be licensed at the paramedic level.
All career shift personnel work 24 hours on, followed by 48 hours off. This allows for three shifts of three personnel. To start, we will have one shift with paramedic coverage immediately, and another shift will have coverage with our new hire by the end of the summer. We are prepared to send a third career shift Firefighter/EMT to paramedic school this year, thereby providing paramedic level coverage for all three shifts. This would not only ensure paramedic-level care to our community at all times, but it would also make us available for paramedic intercepts 24/7.
A copy of a Resolution of Support letter, signed by the Williston Town Manager, is in the appendix.
The Williston Fire Department prides itself on its ability to manage a $2.0 million budget. Paramedicine ranks as our Department’s number one focus, meaning both resources and finances are being allocated in whatever fashion is needed to make it happen, providing it is both feasible and fiscally responsible.
Early this spring, a Williston resident (who wishes to remain anonymous) approached the Fire Chief stating she wished to help the Fire Department in the form of a donation. The Chief was shocked to discover that the generous amount this woman wished to donate would cover the entirety of the paramedic equipment up-fit cost, and even assist with some of the paramedic training as well. All of the proceeds from this donation have been set aside for this very purpose.
While our budget can and will sustain a paramedic service, the donation not only made it easier, but also allowed for the purchase of equipment to facilitate a paramedic engine company. This greatly assists in our efforts to provide paramedic-level service, both on our ambulances and with our engine company.
Currently, the more expensive items involved in paramedicine, such as cardiac monitors, are under a capital replacement plan. Our six AED units are on a 7-year replacement plan, and our two 12-lead units (costing $27,500 each) are on an 8-year replacement schedule. These budgets have been funded the past five years, and will continue as a guarantee for both up-to-date and timely replacement of critical equipment.
The District 3 protocol change in 2015 helped prompt Williston to purchase some of the advanced drugs and equipment ahead of our potential move to paramedicine. With additional funds in our budget at the end of FY17, we were able to make additional purchases for our paramedicine program (i.e. a Med-Vault safe, paramedic bags, etc.). The less expensive, yet equally important, equipment and supplies have been built into our current operating budget (FY18). We are well positioned to transition into paramedicine in this fiscal year.
Overall, with a responsible and budget conscious Fire Chief, a supportive Town Manager, and an enthusiastic paramedic equipment manager, the Williston Fire Department is proud to be able to initiate and sustain a paramedic level service.
Need for Paramedic Care
The Town of Williston is comprised of several different districts including: a large industrial district, commercial districts, residential districts, and rural farmland. A long stretch of Interstate 89 runs through Williston, as does Lake Iroquois (along with its recreational park and fishing access sites). In addition to its geographic diversity, Williston’s population has been steadily growing over the past several years, with an estimated daytime population of 20,000 and a residential population just under 10,000. In 2016, the Williston Fire Department responded to a total of 1,805 calls, with 1,010 of them being requests for emergency medical care. The combination of the population and geography of our service area results in a wide variety of calls that would benefit from paramedic level interventions and assessment.
The number of paramedic intercept requests to Williston has increased 500% since FY15, with 1 request in FY15, 2 requests in FY16, and 5 requests in FY17. This is due to both an increase in the availability of paramedics in neighboring towns, Department education on the benefits of paramedic interventions, and the ever-increasing elderly population we serve.
A large number of our EMS calls are cardiac in nature. Having a trained paramedic available to provide advanced interventions will mean less of a delay in receiving potentially beneficial drugs and treatment, leading to a positive outcome.
The Williston Fire Department regularly responds to the rural areas of our Town, with some areas up to 7 miles away from the station. We also assist Richmond Rescue in transporting patients from the Bolton Valley Ski Area and from the Town of Huntington, which is over 15 miles from the station, plus another 23 miles back to the hospital. Transport times are estimated at over 30 minutes, which can be especially painful for trauma victims. Paramedic interventions for pain management have proven to provide a more safe and relaxing transport for both the patient and the crew. With the ultimate goal of how to best serve our patient population, the simple easing of pain and/or nausea will make a world of difference.
Due to our location in Chittenden County and our close proximity to the Interstate, a paramedic intercept has often been impractical due to timing and where the intercept would occur. Many intercepts would have to occur on the Interstate, which is very dangerous for all involved. If we staffed our own paramedic, there would be no need for a potential time delay or dangerous location intercept. Medic intercepts have occurred successfully in this town, however, when critical calls come in, timing is everything.
Dan Wolfson, MD, FACEP is an emergency medicine physician who has been serving at the University of Vermont Medical Center, as well as Copley Hospital. Dr. Wolfson currently serves as the Vermont State EMS Director.
Due to the retirement of our previous medical advisor, Dr. Wolfson has generously offered to assume the position as Williston’s Medical Advisor. Through the years, Department members have seen Dr. Wolfson either in training classes, conferences, or in the UVMMC Emergency Department, and they are familiar with his calm and encouraging demeanor. When he found out about Williston’s desire to move to paramedicine, his first response was, “It’s about time!” We look forward to developing our relationship with Dr. Wolfson as our Medical Advisor, and with someone who has always been supportive of not just our agency, but of EMS as a whole.
Provide Sufficient Supplies and Equipment
The Williston Fire Department currently staffs one ambulance and one engine company full time, with an additional ambulance available for second calls if staffing provides. Both of our ambulances are currently equipped at the AEMT level, including one ZOLL X-series cardiac EKG monitor on both apparatus. We are prepared to equip both ambulances with all of the required paramedic equipment and medications, including a District 3 approved secured medical vault (Knox MedVault 2) with wireless audit capability. In addition to our two ambulances, we are outfitting our first response engine with paramedic equipment. This will include a refurbished E-series cardiac EKG monitor, a medical vault, and all required paramedic medications and supplies.
In terms of medication ordering and resupply, we have established a UVMMC Pharmacy account and plan to obtain our paramedic medications through their Pyxis system. The Williston Fire Department will adopt the District 3 Controlled Medication Policy (see appendix), and store all of our controlled medications in accordance with this policy. Additionally, we are creating an internal standard operating guideline (SOG) pertaining to our own schedule of auditing the medication safes, outlining who has access to the controlled medication safes, and the procedure for attempted unauthorized access.
Quality Improvement Program
The Williston Fire Department currently has a quality improvement (QA/QI) committee comprised of five members from varying backgrounds and ranks. We review over 50% of our EMS calls each month, and include a “case study” component as well. We recently appointed our new paramedic as one of the committee leads. His charge is to take a meaningful look at our current process and to incorporate paramedic-level QA/QI into our reviews. We have also entered into discussions with neighboring paramedic agencies to inquire about their program, to help ensure our highest level of understanding and review procedure. Richmond Rescue has given a firm commitment that our agencies can work together towards this goal.
To ensure the current QA/QI program only improves from this point on, we have also created a Departmental standard operating guideline (SOG) regarding quality improvement. Please see the attachment in the appendix.
The Williston Fire Department has every intention of actively participating in the District 3 intercept program as set forth by the District 3 Paramedic Committee. A major catalyst for moving forward with a paramedic program was both our geographic location and our staffing potential.
Located between Lake Champlain and the Green Mountains, Williston is strategically positioned to provide intercepts to numerous surrounding agencies in a short amount of time. Having two busy state highways (US Route 2 and 2A), and a significant portion of Interstate 89 within minutes of our station, increases the intercept potential for not just our neighboring communities, but any agency responding along our travel corridor. Our distance from the University of Vermont Medical Center also allows us time to provide an intercept that would deliver definitive care and interventions prior to arrival.
While our current level of paramedic staffing is only 33%, we are positioned to hire another paramedic within the next 1-2 months, which will bring us to 66% staffing. Between future grants, current donations, and existing budget money, we intend on sending at least one additional career shift employee to paramedic school within a year. With this, the potential to provide 24-hour paramedic staffing becomes more of a reality. With a District goal of 24-hour paramedic coverage looming, Williston is setting itself up to be an integral part of the equation.
We currently respond with an ambulance and a first due engine to all EMS and fire-related calls. This would allow us to staff an intercept vehicle for our paramedic should they be requested out of town, while leaving a staffed ambulance in town to respond to calls. Williston understands that the goal of a paramedic level service is to ensure that our town is made the priority and that this higher level of care is at our disposal when needed. As such, we will work towards having two paramedics on shift, having a paramedic call back system, or hiring per-diem paramedics to ensure continued coverage in town.
Williston Fire Department paramedics will adhere to District 3 paramedic credentialing guidelines, as well as all District 3 training attendance requirements. We are in the process of outlining quarterly and yearly paramedic competency programs to ensure our paramedics are proficient in their assessments and skills (see outline below).
We are planning joint paramedic trainings with our mutual aid partners, allowing us to build working relationships with neighboring paramedics and increase the frequency of paramedic level trainings available to our own medics. The Williston Fire Department will support its paramedics furthering their education through outside trainings and certification programs, as well as supporting them in refresher courses for their certifications. In addition, the Williston Fire Department will encourage our paramedics to stay-up-to date on new evidence-based research and literature.
Paramedic Continuing Education Outline
All Williston Fire Department paramedics will initially be credentialed through the Vermont District 3 process, as outlined in the VT EMS District 3 paramedic manual.
This process includes:
- Williston Fire Department Orientation
- Meeting with a WFD training officer and lead paramedic
- Meet/greet with the WFD Medical Advisor
- Equipment checklist/paramedic bag
- IV Pump training
- ZOLL monitor training
- Pyxis training
- Secure narcotic storage SOP and best practices.
- Initial meeting with preceptor, District Paramedic Medical Advisor (DPMA), and training officer.
- District Orientation
- Review of VT EMS protocols
- Review of District 3 restrictions and clarifications of state protocols
- Satisfactory performance of skills on VT EMS District 3 checklist
- IV/IO placement
- Percutaneous cricothyrotomy
- OG tube placement
- Advanced airway suctioning
- Tracheostomy maintenance
- Needle decompression
- IV pump use.
- Precepted field experience with a minimum of ten calls, to allow the new paramedic to be evaluated by the training officer and DPMA.
- Granting of probationary status by DPMA to act as a paramedic with the Williston Fire Department
- Probationary medic must call medical direction for all paramedic medication and interventions, excluding those used in a cardiac arrest scenario.
- After completing probation, probationary medic granted full credentials by DPMA.
- Williston Fire Department paramedics will adhere to the district continuing education requirements
- District paramedic trainings
- Published prior to January first of each year.
- All credentialed and probationary paramedics must attend four monthly district paramedic trainings each calendar year.
- Annual demonstration of District 3 paramedic skill competency.
- District paramedic trainings
Williston Fire Department requirements
In addition to District 3 required trainings, the Williston Fire Department will have its own monthly and quarterly training requirements:
- The Department training officer and lead paramedic will create a monthly Centre Learn online lecture schedule for paramedics, in addition to the current monthly training requirement for all license levels.
- Quarterly, Williston Fire Department paramedics will demonstrate competency in all skills included in the District 3 protocol to another certified paramedic. This will be done as part of the quarterly airway process. Competency will be tested with skill sheets based off the ones created by District 3.
Town of Williston Fire Department
Standard Operating Procedures
EMS Quality Assurance and Improvement
Date Created: June 2017
Date Revised: July 2017
Scope and Purpose: To ensure the highest level of reporting is performed by members of the Williston Fire Department, specifically regarding the field of Emergency Medical Services patient care reports.
Procedure: Please email:
firstname.lastname@example.org for the procedure
END OF OPERATIONAL PROCEDURE
Background Check Policy
Sections 5 and 19 of the Williston Fire Department’s standard operating guidelines (SOG) manual outline the Department’s alcohol and drug policy, as well as the background check process (in accordance with VCIC) for all employees and call members of the Department.
SECTION 5: PRE-EMPLOYMENT SCREENING AND BACKGROUND CHECKS
SCOPE AND PURPOSE:
To outline the pre-employment screening and background checks required for applicants to the Department.
The Department qualifies under the Title 20 of VSA: Vulnerable Populations Program, to conduct background record checks on all applicants for employment with the Department. These checks include a search of the records with the Vermont Criminal Information Center (VCIC), the Vermont Agency of Human Services (VAHS) Adult Abuse and Child Protection Automated Registry Check, and the Department of Motor Vehicles (DMV), for any criminal, registry or driving history.
POLICY / PROCEDURE:
Once an applicant has been given a Conditional Offer of Employment, they will be asked if they have a criminal or driving record. If the applicant confirms that they have a prior record, they will be given the opportunity to either withdraw from the application process, or request that the process continue knowing that their history will be reviewed by the Fire Chief and Town Manager for clearance. Depending on the circumstances surrounding the conviction(s), the Fire Chief may, at his discretion, deny the applicant to continue and request that they withdraw from the application process at this point.
If the applicant does not have a prior criminal record, or does but is allowed to continue with the process, release forms for the VCIC, VAHS and DMV must be completed and then witnessed by a Notary Public. A criminal records check will be processed by the Department through the VCIC, and a registry check through the VAHS. The DMV National Driver Register (NDR) will be checked first, which will indicate if the NDR has a probable identification (match) from one state (or more) which will be named on the report. If a match is found, a separate check will be made with the state(s) listed from the NDR.
The results of these checks are confidential and are processed by the Department’s Administrative Assistant, then presented to the Fire Chief for review. All applicants have the right to receive a copy of any results provided by the aforementioned agencies. The contents of the record checks will NOT be disclosed to any person other than the applicant, the Fire Chief, the Assistant Fire Chief , the Town Manager (if needed), or a designated employee who has the documented need to know the result of the record check, unless permission is otherwise granted by the applicant.
If there are no records present, the applicant will continue through the employment process. If there is a record history, the Fire Chief and Town Manager will review the record and make a decision regarding what effect the conviction has on the applicant’s ability to continue with the employment process. The review will include, but is not limited to: the number of convictions, how recent the conviction(s), the nature of the conviction(s), the relevancy of the conviction(s) to employment with the Department, and whether there is evidence of a criminal pattern. The Fire Chief and Town Manager reserve the right to place special conditions on the applicant’s employment, including but not limited to immediate dismissal if future convictions are obtained, an extended probationary period, etc.
The Department may, on occasion, update existing staff member’s background checks. The original release forms signed at the time of hire are extended to these future checks, and allow the Department to update their records as needed. Record checks will normally occur no more than once bi-annually, however, more frequent checks may be required depending on the applicant’s history and/or future convictions.
Drug and alcohol policy
SECTION 19: ALCOHOL AND DRUG USE
SCOPE AND PURPOSE:
To define the Department’s policy towards its member’s use of alcohol, alcoholic beverages, illegal and non-prescribed drugs in regards to participation in assigned duty, the on-call program, and the sleep-in program, stand-by assignments, training drill sessions, meetings, and Department events,.
POLICY / PROCEDURE:
The Department intends to provide a safe drug- and alcohol-free environment and to promote the health, well-being, and productivity of its members by practicing “zero tolerance” to maintain such an environment. The Department firmly states that illegal activities will not be tolerated and will be dealt with to the full extent of the law.
No staff member shall report for any assigned duty shifts, drive any Department apparatus, attend training drills, events or meetings, or respond to calls, under the influence of alcohol or drugs, or with the smell of alcohol on their breath. No staff member shall drive or ride in the ambulance, or come into contact with any EMS patient, under the influence of alcohol or drugs, or with the smell of alcohol on their breath.
If, in the judgment of an Officer, a staff member appears to be under the influence of alcohol or any type of non-prescribed drug(s), they may at any time request the staff member to halt all activity and leave the scene. If an Officer feels that allowing the staff member to leave the scene would be a danger to themselves or others, the Officer may notify the police and ask that the staff member be escorted off the scene.
No member shall respond to any type of incident or event if they have consumed any alcohol within the past eight (8) hours or longer if, in the judgment of an Officer, the member’s faculties appear to be impaired as a result of alcohol or drugs.
No member shall consume, serve or obtain any alcoholic beverages in public (including a restaurant, tavern, bar, etc.) while wearing official Department issued clothing, while carrying a Department pager, or while carrying a portable radio containing Department frequencies.
No member shall possess or consume alcoholic beverages in the Department Station or on its grounds. No open alcoholic beverage containers shall be on the premises, including Department facilities, vehicles, or any other area or property of the Department.
The Williston Fire Department shall abide by the District 3 Controlled Substance Policy below.
Vermont Emergency Medical Services District #3 Policy - Controlled Substance Policy
Approved November 13, 2014
Vermont Emergency Medical Services District #3
Policy - Controlled Substance Policy
Last revised: 11/4/2016
This policy describes the use, storage, and return of controlled substances.
Controlled substances will be used in accordance with Vermont Statewide Emergency Medical Services Protocols. Controlled substances shall be stored within a medication safe approved by the District Paramedic Medical Advisor (DPMA) Safes will meet the following performance specifications:
- Electronic lock with key override
- Electronic audit trail
Use of Medication Safes
Each paramedic shall have an individualized code for entry into a medication safe. Routine use of keys to access controlled substances is prohibited unless there is a failure of the medication safe electronic keypad. In this case, the failure must be corrected as soon as possible, allowing paramedics to return to using electronic access. The DPMA shall be notified of an electronic keypad failure and that a key will be used for safe access.
In the case where a service head is not a paramedic:
- The service head will submit a plan to the DPMA that declares who has access to the medication safe and who holds the keys.
- Services will re-submit the plan within 10 days to the DPMA when named individuals vacate positions within the service.
Medication Safe Access Auditing
- In January of each year, the DPMA will designate a month from the previous year for an access audit from each service to be submitted at the February paramedic committee meeting.
- Services will maintain records for review at any time (i.e., spot checks) by the DPMA.
Receiving & Storage of Controlled Substances
- All controlled substances shall be acquired through the pharmacy at the University of Vermont Medical Center and stored in a medication safe. Controlled substances must never be left unattended.
- Each paramedic service is issued an agreed upon number of sealed controlled substance boxes. Controlled substance boxes will be stocked with DPMA approved controlled substances for VT EMS District #3 paramedics (including an inventory sheet with expiration dates).
- When a service has a vehicle out for maintenance, the controlled substances box must be moved to another medication safe.
Checking Controlled Substances
- At the beginning of a paramedic’s shift, he/she will open the medication safe(s), check that the controlled substance boxes are present, that the tag and box are intact, and complete the log accordingly. All medication safes shall be checked and logged each shift.
- If a paramedic is not on duty, it shall be documented daily that the medication safe is present and locked on the service’s daily vehicle/rig check form.
- Expired controlled substances will be returned to the pharmacy drop box located next to the paramedic Pyxis.
Returning Used Controlled Substance Boxes
- When a controlled substance is used, the rest of the controlled substance box will be returned to the pharmacy drop box, and a new box signed out from the Pyxis.
- The controlled substance use will be documented on the inventory sheet that is included. In the case where the remainder of the controlled substance needs to be “wasted,” it will be witnessed and documented by a RN or another paramedic.
- A new red tag (supplied by the paramedic service), with the manufacturer’s pre-stamped code, will be attached to the used box, securing it. The new tag number shall be recorded on the inventory sheet.
Discrepancies in Controlled Substance Boxes
- If a properly tagged/sealed controlled substance box is opened and the paramedic finds that the proper number of each medication is not present, he/she must have another individual document the count of each medication present.
- When that box is returned to the pharmacy drop box, the inventory sheet must clearly document the initial discrepancy in addition to medications used, and the individual who confirmed the starting count must sign the appropriate section of form.
- The paramedic must inform both their head of service and the DPMA immediately following the call, preferably via email, describing the circumstances of the discrepancy.
Controlled Substance Administration Audits
- Service heads or their designee should regularly conduct an audit comparing administered doses (documented in SIREN) to documented waste of medications in the controlled substance box (from the yellow sheet attached to the controlled substance box). Spot checks by the DPMA will occur.
Signature on File Signature on File
Laurel Plante, MD Kate Soons, RN AEMT
VTEMSD#3 Medical Advisor VTEMSD#3 Chair