REPUBLIC OF THE PHILIPPINES DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT BUREAU OF FIRE PROTECTION Rm 618, 145 Union Square Condominium, 15th Avenue, Cubao, Quezon City Tel. No.911-7085 Tel Fax: (02) 911-7060 MEMORANDUM CIRCULAR NUMBER 2008-007 SUBJECT: PRESCRIBING POLICIES AND GUIDELINES ON BFP EMS OPERATIONS SECTION I RATIONALE/PURPOSE : To ensure quality standards in the provision of Emergency Medical Services including the proper utilization of BFP medical and rescue ambulances nationwide. SECTION 2 SCOPE AND APPLICATION : This Circular shall apply to all regional offices, FNTI and the National Headquarters with EMS units operating BFP medical and rescue ambulances. SECTION 3 DEFINITION OF TERMS: 1. AMBULANCE - a marked vehicle designed to transport only the critically sick or wounded/injured person to a hospital or medical center and an extension of the hospital. 1.2. Primary Ambulance — a vehicle used to transport critically ill patients 1.b. Secondary Ambulance — a vehicle used to transport patients for diagnostic workup or home conduction. 2, EMERGENCY CASE ~ a serious event or condition which require immediate intervention to keep one from danger or further injury or life- threatening situation. 3, RESCUE — process of moving a victim from danger area to a safer place, 4. RESCUE VAN - a vehicle equipped with rescue tools, medical equipment used in retrieving patients/victims from a life-threatening situation. 5. PREHOSPITAL CARE - medical management given to a Patient/victim from the scene of the accident to the nearest hospital. 6. NON-EMERGENCY CASE - a non life-threatening situation which need not necessitate immediate intervention or transfer. 7. RUNNING CARD - an established S.0.P. relegating specific firefighting personnel and equipment to respond on a certain fire alarm. 8. DISASTER ~ Serious disruption of functioning of society causing widespread human, material, or environmental losses which exce the ability of the affected people to cope using its own resources, ‘9. FIRE GROUND COMMANDER - Highest ranking BFP officer in charge of fire fighting operation in the fire scene. 10. HAZARDOUS MATERIAL — material or substances that are likely to cause fire and explosion which may have an adverse effect on health and even cause death. 11. TRANSFER - moving a victim from safe place to the nearest appropriate hospital or medical facility with complete medical equipment. 12.BASIC LIFE SUPPORT (BLS) — (based on Red Cross definition) refers to emergency procedures which consist of recognizing respiratory or cardiac arrest or both, and the proper application of Cardiopulmonary Resuscitation (CPR) to maintain airway, breathing and circulation until a victim recovers or ACLS (Advance Cardiac Life Support) is available. 13.ADVANCED CARDIAC LIFE SUPPORT (ACLS) - (According. to STOP DEATH-DOH), means a sophisticated level of pre-hospital care and inter-facility emergency care which includes basic life support functions including CPR, cardiac monitoring, defibrillation, telemetered electrocardiography, application of Anti-arrhythmic agents, drugs and solutions, use of adjunctive ventilation devices trauma care and other authorized techniques and procedures. SECTION 4 GENERAL GUIDELINES ON EMS RESPONSE : 4.1, AMBULANCE TEAM COMPOSITION 4.1A Regular Team 4.1.A 1.One (1) medical officer or team leader who will be responsible for the monitoring and management of the patient during the course of the conduction. 4.1.A 2. Two (2) Basic life support trained nurse or personnel to assist the medical officer or team leader, 4.1.A 3. One (1) ambulance driver 4.1.4 4, One aide man 4.2, QUALIFICATIONS OF THE AMBULANCE TEAM 4.2a Medical Officer or Team Leader - Licensed by the Professional Regulations Commission - Preferably trained with first aid/Basic Life Support/ Emergency Medical Technician Course / Medical First Responders Course or Advance Cardiac Life Support Course 4.2.b Nurse - Licensed by the PRC - Must be trained and certified in first aid /BLSIMFRUACLS\ / *4.3 4,2.¢ Paramedic or Allied Medical Professions - Licensed by the PRC or Civil Service eligible - Must be trained and certified in First Aid/BLS/MFR/ACLS 4.2.4 Ambulance Driver - As required by the Civil Service Commission - Preferably trained in Ambulance Driving - A holder of a professional drivers license - Preferably trained and certified in First Aid/BLS **The above qualifications shall be the minimum requirement hence, upgrading is encouraged to best serve the public/patients. All personnel assigned in EMS shall have at least undergone the following training requirement: 1. First Aid and Basic Life support or 2. Medical First Responders Course The Following shall be optional and based on the availability of the training courses: 1. Basic EMT EMT Intermediate EMT Advanced Paramedic . Basic Rescue Techniques a. Air Rescue b. Land Rescue c. Water Rescue Mass Casualty Incident (MCI) Management Incident Command System ( ICS) 2 3 4 5 NO RECOMMENDED BASIC AMBULANCE EQUIPMENT REQUIREMENT Aside from the standard white color specified marking (the word “AMBULANCE” written backwards), light and siren, the following equipment are required in the Ambulance: 4.3.1. Sphygmomanometer 43.2. Stethoscope 4.3.3. Cardiac monitor *** 4.3.4. Defibrillator with ECG *** 4.3.5. Pulse oximeter ** Equipment other than moi de 4.3.6 Portable suction machine*** 4.3.7, Scoop Stretcher with mel’4.3.8 Spine Board with straps™* 4.3.9 Cervical collar (adult/pediatric) 4.3.10 Minor surgical set (Straight and curved forceps, bandage scissors) 4.3.11 Resuscitator/ ambu bag 4.3.12 Portable Oxygen tank with regulator 4.3.13 One Flashlight 4.3.14 Wheel type stretcher with straps 4.3.15 Safety cordon 4.3.16 Safety cones 4.3.17 Triaging Tape Medical Kit 4.3.18 Cotton ball packs 4.3.19 Sterile Gauze 4.3.20 Betadine wound antiseptic solution 4.3.21 Micropore tape 4.3.22 Disposable gloves 10's box 4.3.23 Alcohol 70% 4.3.24 Hydrogen Peroxide 4.3.25 Triangular bandages 4.3.26 Burn ointment 4.3.27 Bulky dressing (5) 4.3.28 Elastic bandages (5) 4.3.29 Roller bandages (5) 4.3.30 Band aid strips 1 box 4.3.31 Face mask box 50's 4.3.32 Penlight (1) 4.3.33 Power scissors 4.3.34 Splints Personal Protective Equipment 4.3.36 Hard hat 4.3.36 Face Mask 4.3.37 Disposable rubber gloves 4.3.38 Protective goggles 4.3.39 Reflectorized vests used during night operation*** Communication system 4.3.40 1 Unit Handheld Radio or Cellphone 4.3.41 1 base radio 4.3.42 1 unit public address communication system*** ***when appropriate ‘\4.4 REQUEST FOR AMBULANCE ASSISTANCE ‘The following may request for ambulance assistance from the BFP: a) All BFP personnel b) BFP Personnel Dependents c) DILG and other Government Agencies d) Referrals from EARnet and PATROL 117 Requirements for Ambulance assistance / Conveyance (Elective): Within AOR, City or Municipality: 1. Formal written request from the requesting party endorsed to the station C, EMS and /or City Fire Marshal Patient's Clinical Abstract Doctor's Recommendation for transport Formal written Approval from the City Fire Marshal and or C,EMS Patient's Waiver gaen Within the District: 1. Formal written request from the requesting party endorsed to the District Director through the District C, EMS Patient's Clinical Abstract Doctor's recommendation for transport Approval from District Fire Marshall Patients Waiver Recipient party or Hospital's approval for transfer Bureau Order and Logistical Requirements c/o requesting party (if travel is outside the region) NOON Outside NCR and or Region - patient conduction / mission 1. Formal written request from the requesting party endorsed to the Fire Chief or RD’s as the case may be thru the C EMS Patient's Clinical Abstract Attending physician's recommendation for transport Written approval from the Fire Chief or Regional Director copy furnished C,EMS-NHQ or C, REMS as the case may be Recipient party or Hospital's approval for transfer Bureau Order Patient's Waiver Logistical requirements to be shouldered by requesting party(Gas, Toll fee and food for ambulance crew) if outside AOR bo PN ow SECTION 5 IMPLEMENTING GUIDELINES : 5.1 PROCEDURAL RESPONSE DURING FIRES 2. EMS UNITS shall respond to : a. FIRST alarm in their AOR b. ALL FIRE ALARMS on specified calls; schools v-dormitories -orphanages -hospitals -places of mass assembly(malls, theaters, hotels, restaurants and the like) -All government offices c. Task Force Alpha on adjacent districts d. All incidents involving potential Mass Casualty and requests for medical assistance in cases of disasters such as train collision, bombing, building collapse, plane crash, landslide, trashslide, earthquake, flash floods, typhoons, volcanic eruptions, lahar and other calamities. e. Task force Bravo for BFP EMS National Headquarters team f In. Mass Casualty Incidents wherein the DOH/Health Emergency Management Staff(HEMS) has arrived, DOH shall assume as lead agency and proper coordination shall be observed. In the event the BFP EMS units happen to be the first responder on scene, transfer of command shall be effected to the DOH - HEMS staff. g. Render first aid treatment to all persons in need h. Provide EMERGENCY ambulance services to the public. EMS ambulances are intended to convey patients on EMERGENCY CASES ONLY within the AOR of the EMS teams. Requests for conveyance in extremely exceptional non emergency cases within ten (10) kilometer from the AOR shall have prior approval of the following: 1. District 1-4 NCR RD 2. EMS SLEX ARDO, NCR 3. EMS Region RD Region 4, EMS NHGQ..... Fire Chief Requests for conveyance beyond 10 kilometers radius of NCR, SLEX and NLEX EMS station shall have clearance from the Fire Chief, BFP thru C, EMS -NHQ i. Perform all other functions as directed by Regional Director, District Director , OFM and Higher Authorities, 5.2 PROCEDURAL RESPONSE ON EMERGENCY CASES 5.2.1. EMERGENCY CASES / SITUATIONS : — serious event(s) or condition(s) which require immediate intervention to keep one from danger or further injury or life-threatening situation such as but not limited to the following v- Fire which includes schools and malls, hospitals, dormitory, hotels, residential area involving potential for MCI (Mass Casualty Incidents), squatters area = Bombing incident * + Sea Mishap * ~ Plane Crash * - Road Traffic Accidents* - Day to day emergencies such as trauma, medical cases and the like = Natural and Man made disasters with MCI * especially those with mass casualty 5.2.2 ON DISPATCH - The Regional Director / District’ CFM/ MFM or the Chief , EMS may dispatch the unit within his AOR on emergency cases. - Bureau / Regional Order is NO longer required in emergency situations except for travels outside the region. 5.2.3 ON RESPONSE - During operations, all EMS Units shall at all times observe the following -Chain of Command -The proper use of uniform and Personal Protective Equipment (PPE) - Scene Safety and Security of EMS personnel -Reporting and coordination with higher authorities -Documentation of medical management -Proper hospital endorsement -Submission of spot and final report. - In the event of a disaster or calamity where protracted operations is expected, a Rapid Assessment Team (RAT.) shall be deployed within 24 hours period to get the necessary information and make appropriate recommendations. -The Team should report the following initial information immediately to the Director for Operations / Regional Director thru channel: Nature of the Incident - Exact / or estimated time of the incident - Exact location of the disaster/incident - Estimated Number of population affected by the disaster - Estimated Number of dead and injured = Type of injuries sustained - Lifelines affected (electricity, water, road access etc.) - Health facilities affected - Level of continuing emergencies threats - Level of response by the community - Access roads/bridges x5.2.4 LATERAL COORDINATION : - In Mass Casualty Incidents , lateral coordination with the Department of Health thru Health Emergency Management Staff (HEMS) is encouraged for the following : -Alert receiving hospitals -Back up medical teams -Preparation of necessary emergency medicines and - ‘supplies 5.3. PROCEDURAL RESPONSE ON NON EMERGENCY CASES With reference to Memorandum Circular No. 107 of the DOH restricting the use of goveriment ambulances, all government officials and employees, particularly with the Dept. of Health, the hospitals under it and the local govemment units with goverment ambulances, all BFP ambulances are hereby prohibited from securing, appropriating or using ambulances for any purpose other than the transport of patients. Transport of cadaver is likewise prohibited. Exceptions to the prohibition against the unauthorized use of BFP government ambulances may only be granted if the user has been confirmed to have no other vehicle including the service of the Regional Director, District Director, City Fire Marshall or his equivalent, Chief, EMS which could be utilized for the purpose of. a. Transport of duty personnel to and from pick-up/dropping points; b. Medical outreach missions provided that transporting patient shall have the priority in the use of the ambulance. 5.3.1 | NON-EMERGENCY CASES / EVENTS - non life-threatening situation, which need not necessitate immediate intervention or transfer such as + Hospital to home patient conduction - Planned mass action or demonstrations / rallies national elections or local elections - Scheduled holidays or celebrations (e.g. New Year's Day, Alll Saint's Day, Labor Day and Independence Day) - Scheduled Individual Activities (e.g. Walk for a cause, Religious Anniversaries, Para-Lympics Sports Activities) - National Activities (e.g. APEC, ASEAN Summit) 5.3.2. ON DISPATCH -A Bureau / Regional Order shall be issued whenever teams arg dispatched on these events / scheduled activities. a