County EMS Agency Field Operations Guide

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County of Santa ClaraCountywide Medical Response SystemCounty EMS AgencyField Operations GuideAn operational guidance document for EMS Agency Personnel, EMS DutyChief, EMS Commander, and EMS DirectorREFERENCE #817Revised November 2008Santa Clara County Emergency Medical Services Agency976 Lenzen AvenueSan Jose, California 951261

Table of ContentsEmergency Management MissionContact InformationPosition DescriptionsStandard EMS Agency NotificationsAlerting and NotificationEMS Duty Chief CoverageUniform and IdentificationEmergency Vehicle OperationsStill AlarmDocumentationOperational Area Mutual AidRegion II Mutual Aid (Outside of the OA)Medical-Health Command Staff AssignmentsSupervisor/Management AssignmentsExpanded Medical-Health Dispatch OperationsExpanded System Status Management OperationsAvailable (Medical-Health Resources)FAA Alert II & IIL ResponseFAA Alert III & Aircraft DownHospital Internal DisasterMedical-Health Mutual Aid Requests ReceivedPatient Care Facility EvacuationCare Facility Heat EventPolicy Deviation/ComplianceHealth Department/Physicians AlertMPMP Local AlertMPMP Countywide AlertMPMP Level I and II 37404244454647

EMERGENCY MANAGEMENT MISSIONGeneral DescriptionThe Santa Clara County Emergency Medical Services Agency (Agency) shallinsure the sound operation of the Emergency Medical-Health Services Systemwithin the Operational Area as authorized by the California Code of Regulations,Health and Safety Code, Government Code, and County Ordinance Code.The Agency will operate in accordance with the National Incident ManagementSystem and the California Standardized Emergency Management System.In most cases, personnel will serve as an Agency Liaison or AgencyRepresentative when working on the scene of a response. Based on the natureof the event, Agency personnel may be part of a Unified or Area Command.Agency personnel may respond as an agent of the County Health Officer/PublicHealth Department based on the nature of an incident.3

CONTACT INFORMATIONGeneral DescriptionEMS field units (EMS 2-6/Squad1), EMS Duty Chief, EMS Commander, EMSDirector may be contacted as identified below.DescriptionTelephoneDetailSanta Clara County Communications408-998-3438Station Call Sign: Med-91Transmit: 811.4375PL: 210.7Receive:856.4375PL: 192.8RadioStation Call Sign: Command-92Transmit: 812.4375PL: 94.8Receive:857.4375PL: 225.7County Communications may receive requests throughmultiple radio frequencies.Operational AreaMedical HealthBranch (whenactivated)4Medical Health Branch Operations408-808-7740408-808-7741OASIS SatelliteTelephone SystemReceived through the County Emergency Operations CenterCalifornia HealthAlert Network(CAHAN)Notification of any of the following positions: Emergency Management Coordinator Medical Health Operational Area Coordinator Terrorism Coordinator Local Emergency Medical Services Agency

Position DescriptionsGeneral DescriptionIn order to maintain the sound operations of the Santa Clara County MedicalHealth System, the following standardized positions are filled by representativesof the Public Health Department/Emergency Medical Services Agency.Health OfficerThe Health Officer is responsible for the overall health and welfare of the citizensand visitors of the County of Santa Clara and fills the role of the Medical-HealthOperational Area Coordinator (MHOAC), in cooperation with the Director ofEmergency Medical Services. The Health Officer reports administratively to theDirector of the Public Health Department. During significant events, the HealthOfficer may respond to the County Operational Area Emergency OperationsCenter (OA-EOC) and serve as the Medical Health Branch Director or to thePublic Health Department Medical-Health Operations Center (MHOC).The Health Officer or a Deputy Health Officer remain on-call at all times and areavailable by phone. Deputy Health Officers report to the Health Officer fordelegated responsibilities and to a Public Health Division Directoradministratively. Under the majority of circumstances, the Health Officer is notdeployed to the field setting. If a field deployment is necessary, the EMS DutyChief, EMS Commander, or EMS Director will provide response support andcoordination.In the absence of the Health Officer or Deputy Health Officers, the Health Officerof a neighboring County may be consulted until a local representative isidentified. Under most circumstances, this coverage will be pre-arrangedbetween the two physicians. In the event that an arrangement is not in place andthe local Health Officer/Deputy Health Officers are not available, the MedicalHealth Mutual Aid System will be accessed via the Regional Disaster MedicalHealth Specialist/Coordinator, State Operations Center, or DHS/EMSA DutyOfficer.The Health Officer may delegate any appropriate duties to other appropriateCounty staff. In addition to the Deputy Health Officers, various authorities aredelegated to the Director of Emergency Medical Services, EMS Commander,and/or EMS Duty Chiefs. The Health Officer may also provide medical directionto the Santa Clara County Emergency Medical Services System whenappropriate. Whenever possible, this shall be accomplished in conjunction withthe EMS Medical Director.The Health Officer and/or Deputy Health Officers are available through theCounty Communications Center.5

Emergency Medical Services DirectorThe Director of Emergency Medical Services reports to the Director of the PublicHealth Department and also serves cooperatively as the Medical HealthOperational Area Coordinator (MHOAC) with the Health Officer. The Director isresponsible for the executive management of the Santa Clara County EmergencyMedical Services System and Public Health Department Medical-HealthOperations Center (MHOC) oversight.The Director is on-call at all times and remains available for telephone/remoteconsultation. In his/her absence, the Director may appoint a lead Manager tomaintain the daily operations of the Emergency Medical Services Agency.However, in relation to Medical-Health/Disaster Operations, the Senior EMSSpecialist (EMS Commander) shall be the lead operational manager for allemergency operations (EMS/Public Health).In most cases, the Director shall provide public policy-level guidance anddirection to the EMS Commander and consult with other Executive Managers inthe County. The Director responds to either the Operational Area EmergencyOperations Center (OA-EOC) to serve as the Medical-Health Branch Director orto the Public Health Department Medical-Health Operations Center (MHOC).The Director is equipped with an unmarked emergency vehicle and may respondto the field setting to assist in mitigation, response, and/or recovery operations.EMS CommanderThe EMS Commander is normally the Senior EMS Specialist of the EmergencyMedical Services Agency. However, other qualified personnel may fill this role.The EMS Commander reports to the Director and provides council tocommand/Executive Managers as appropriate. The Commander is responsiblefor the operational aspects of the EMS and Public Health Response Systems andis on-call at all times for consultation and supervision of EMS field personnel.The Commander serves as the Medical Health Mutual Aid Coordinator andreports cooperatively to the Medical Health Operational Area Coordinator. In theabsence of the Health Officer and/or the EMS Director, the Commander may fillthis role. The Commander may also fill the role of the Medical-Health BranchDirector at the OA-EOC or as the Director or Operations Chief in the MHOC. Inthe absence of the Commander (out-of-service), the EMS Duty Chief reportsdirectly to the Director of Emergency Medical Services. The Director or the EMSCommander remains available at all times.6

The Commander has the authority to make any necessary modifications to theEMS/Public Health Response Systems as appropriate. This may include policymodifications, issuance of orders, system restrictions, etc. The Commanderconsults with the Director, Health Officer, and other appropriate personnel whenmanaging the operational aspects of the system.The Commander is equipped with an unmarked emergency response vehicleand may respond to the field setting.EMS Duty ChiefThe EMS Duty Chief is the primary manager of the daily operations of the EMSand Public Health System. Staff assigned to EMS Duty Chief/emergencyoperations roles report to the EMS Commander.The EMS Duty Chief primarily serves as a facilitator, technical referencespecialist, and agency representative. They work closely with public and privateresponders and provide council to command as appropriate. The EMS DutyChief may provide transportation and support to Health Department personnel(Health Officers, Outbreak Teams, Public Information, etc.).EMS Duty Chief coverage is accomplished through a standard rotation ofqualified personnel. When assigned to coverage, the EMS Duty Chief is theprimary contact for all EMS/Medical-Health issues that are under the authority ofthe Public Health Department. During this time, the EMS Duty Chief is requiredto be able to respond to inquiries within ten minutes of notification. At least oneEMS Duty Chief is scheduled at all times (should an unforeseen event occur, theEMS Commander and/or Director may fill multiple roles).The EMS Duty Chief is equipped with a marked emergency vehicle and is able torespond to support field operations. The EMS Duty Chief may also staff otheremergency/support vehicles and staff.EMS Field Supervisors/Managers (Private Services)Santa Clara County Accredited EMS Field Supervisors/Managers areresponsible for the management of their individual services daily operations.These supervisors/managers provide council to the EMS Duty Chief and are thekey link to routine operational practices within the Emergency Medical ServicesSystem. These supervisors and managers are not government employees, andtherefore, hold no power or authority of the County. However, they are requiredto adhere to the National Incident Command System (NIMS) and StandardEmergency Management System (SEMS).In some cases, various authorities may be delegated to private service EMSmanagers and/or supervisors in accordance with appropriate authorities.7

EMS/Fire/Law Enforcement Supervisors/Managers (Government)These public service supervisors and managers are responsible for the dailymanagement and mitigation of emergency incidents occurring within theirjurisdiction. Other than regulatory authority, the EMS Agency and Public HealthDepartment most often serve as agency representatives, technical referencespecialists, or fill any assigned appropriate position.In some cases, various authorities may be delegated to other governmentservice managers and/or supervisors in accordance with appropriate authorities.Medical-Health System Operational Area ManagementEmergency/Disaster OperationsMedical Health Operational AreaCoordinatorDeputy Health Officers(Health Officer and/or EMS Director)Public Health DepartmentEmergency Response PersonnelEMS CommanderEMSDuty ChiefApplicable Field Personnel8EMS Agency Emergency ResponsePersonnel

STANDARD NOTIFICATIONSGeneral DescriptionEMS Agency personnel shall be notified of the following events/conditions.StandardDescriptionEMS Duty ChiefNotificationsDetailALRTL, ALRTL2, ALRTL3 events at San Jose InternationalAirport and equivalent events at Moffett Field. Small aircraftevents do not need to be dispatched to the EMDC unless aresponse is requested by a public safety jurisdiction; this doesnot include Code 1000 events.All aircraft crashes (Code 1000).Multiple Patient Management Plan Activations. “Local Alerts”do not require EMDC notification.An “Emergency” status button has been activated (medicalcommunity) and dispatch is unable to confirm status or theemergency is verified.Any traffic collision involving an ambulance (including out-ofcounty ambulances) or a private EMS vehicle of which CountyCommunications is notified when (1) transporting a patient, (2)persons are injured, or (3) the incident may be high profile(damage to property, media interest, etc.).A hospital has advised of an internal emergency (“Black”EMSystem Status).Critically low ambulance system levels when one or more 911calls are holding.A failure of the Base Hospital or other communications system(radio frequency failure, known loss of another PSAPscommunications system, etc.).Requests for Medical-Health/EMS Mutual Aid or for theMedical Health Operational Area Coordinator (MHOAC) fromanother county, state, or federal partner.Two or more units are placed on standby for a 911 incident.9

Any public safety agency requests notification or dispatch ofthe EMS Duty Chief.Multiple responses to the same incident location, in a shortperiod of time, for like signs and symptoms not related to anMPMP event (multiple responses to a school, heat illness,care facility, government institution, custodial facility, etc.)Notification of a “Biowatch” or biological sensor activation by agovernmental or governmental-appointed agency.Notification of Bio Defense System (BDS) activation by agovernmental or governmental-appointed agency.Multiple alarm structure or wildland fires.When two or more Trauma Centers have implemented“Trauma Bypass/Red” status.When Communications personnel request Expanded Dispatchwithin the medical community or when County Fire hasimplemented Expanded Dispatch.Significant law enforcement activity that may result in illnessor injury to citizens or responders (barricade situations, civilunrest/violence, bomb unit operations, etc.). At times it maynot be appropriate to dispatch these events over the air, insuch cases; the EMDC shall be dispatched and advised tocontact Communications for details.Communication with the on-call county health officer (HLTH)has been attempted, but no response has been received byCounty Communications after sixty (60) minutes.Tier 3 or 4 Air Resource requests. (Tier 1 and 2 removed).Unusual or difficult responses to the San Antonio Valley orother remote/wilderness area that may result in extendedresponse of EMS units (air units not able to fly, responsetimes in excess of 45 minutes, multiple patients, etc.). Thisshould include closures of Mount Hamilton Road (snow),Pacheco and Hecker Pass, Highway 35 (Summit/Skyline),Highway 17, etc. when known to County Communications.10

Receipt of a “Tsunami Warning”, “Tsunami Alert”, or “SeaSurge” from a governmental partner (State OES, Region 2,etc.).Anytime that the Watch Commander or CountyCommunications personnel believe notification is warranted orwhen a request to modify system operations occurs.EMS CommanderNotificationsKnown threats to critical infrastructure such as potential/actualdam breech, loss of widespread critical public services (water,power, etc.).Generally, the EMS Duty Chief will advise Communicationswhen contact/notification with the EMS Commander isindicated. However, at times this may not be possible;therefore the following notifications should be made asappropriate:Failure of the EMDC to respond to a dispatch within 20minutes.EMDC or other EMS unit (EMS 2-6/Squad1) are involved in atraffic collision or advises of injury.Level 3 Multiple Patient Management Plan Activations orCountywide Alerts.All aircraft crashes (Code 1000) or ALRTL3.An “Emergency” status button has been activated by theEMDC and dispatch is unable to confirm status or theemergency is verified.Any unresolved issue related to the performance of the EMSDuty Chief at the time of an incident.When requested by the Watch Commander or other publicsafety partner.When the EMS Duty Chief is committed to a response (ie: fireat a skilled nursing facility, etc.), all EMDC notifications shallbe directed to the Commander when the Commander has“Assumed Command of the EMS System”. In such cases, theEMDC will manage the medical-health components of the onscene activities and the Commander will manage EMSSystem operations.11

EMS DirectorNotificationsGenerally, the EMS Commander (CMDR) will adviseCommunications when contact/notification with the EMSDirector is indicated. However, at times this may not bepossible; therefore the following notifications should be madeas appropriate:Failure of the CMDR to respond to a dispatch within 30minutes.CMDR is involved in a traffic collision or advises of injury.An “Emergency” status button has been activated by theCMDR and dispatch is unable to confirm status or theemergency is verified.12

ALERTING AND NOTIFICATIONGeneral DescriptionAll EMS Specialists, Senior EMS Specialists, and the EMS Director maintainvaried degrees of on-call responsibilities. Minimum alerting standards areprovided for standard emergency response assignments. Any variation must beapproved by the Senior EMS Specialist or EMS Director.StandardDescriptionEMS SpecialistsDuty ChiefCommanderDirector13Detail Alphanumeric pager set to alert (may be directedthrough a smart phone such as the County providedBlackberry). Mobile phone with WPS service. Unit logged-on (EMS3-5) with County Communications(unless on authorized time off). CountyCommunications shall be notified when personnel areout of County when the field response time exceedsforty-five (45) minutes. Alphanumeric pager set to alert (may be directedthrough a smart phone such as the County providedBlackberry). Mobile phone with WPS service. Unit logged on (EMDC) with County CommunicationsCounty Communications shall be notified whenpersonnel are out of County when the field responsetime may exceed forty-five (45) minutes. Radio-pager set to alert. Portable EMS Communications System radio. Alphanumeric pager set to alert (may be directedthrough a smart phone such as the County providedBlackberry). Mobile phone with WPS service. Unit logged-on (CMDR) with County Communications.County Communications shall be notified when theCommander is out of County. Alphanumeric pager set to alert (may be directedthrough a smart phone such as the County providedBlackberry). Mobile phone with WPS service. Unit logged-on (DIR) with County Communications.

EMS DUTY CHIEF COVERAGEGeneral DescriptionThe EMS Duty Chief serves as the primary County-level medical-health systemmanager. The EMS Duty Chief remains available for response 24-hours per-day,7-days per-week, 365-days per-year.The EMS Duty Chief reports to the EMS Commander or the EMS Director in theabsence of the Commander.StandardDescriptionRequests for ServiceField ResponseRequesting ServiceAvailability14DetailThe Duty Chief shall respond to all requests for service withinten (10) minutes (this does not include field response).When a response is requested or necessary, the Duty Chiefshall respond within forty-five (45) minutes of the request.Requests for the Duty Chief shall be routed through CountyCommunications. The Duty Chief shall insure the ability to be contactedat anytime. In some situations, this may entailnotifying County Communications of temporaryalternate contact means (radio watch, satellite phone,landlines, etc.). The Duty Chief shall not leave the County whenresponse back into the County is in excess of sixty(60) minutes unless approved by the EMSCommander or Director. The Duty Chief shall be provided with a vehicleequipped to respond with red lights and siren duringscheduled rotations. The vehicle must be maintainedin a ready fashion and be easily access able should afield response be required. In the event that the assigned Duty Chief is unable torespond for a period of time, they shall makeimmediate arrangements with another available DutyChief. If another Duty Chief is not available, the EMSCommander should be contacted for direction.

Variances15 Duty Chiefs may trade hours and shifts as necessary.In the event that a Duty Chief requests time off from ascheduled shift, but is unable to find an appropriatecoverage, the scheduled Duty Chief must cover theshift unless the time off is approved by the EMSCommander. The Director or EMS Commander may elect to placethe Duty Chief out of service as appropriate. In suchcases, County Communications shall be notified of anappropriate contact should a request for the EMS DutyChief be received. In the event that the scheduled Duty Chief becomesincapacitated, the EMS Commander shall assign anyother appropriate person to fill the vacancy. This willnormally be covered by the EMS Commander but mayalso be assigned to other EMS Specialists (EMS DutyChief qualified). In the event that an emergency vacancy occurs, theEMS Commander or the Director may assume the roleof EMS Duty Chief, place the unit out-of-service, orimplement an interim solution. This may includefacilitating coverage through other public safetyofficials or authorized designees. Additional personnel may be placed on-call forsignificant scheduled events and gatherings such asNew Years Eve, Fourth of July, etc. which may resultin an unusual EMS/Medical-Health system occurrence. The EMS Commander will announce additionalstaffing needs as necessary. Filling of vacantpositions will occur first by volunteers and then byseniority (scheduled time off requests will also beconsidered). In the event that an EMS Specialist is assigned to DutyChief Coverage on a County holiday; the Commandermay authorize “holiday worked” hours, based duties tobe performed that exceed routine on-call activities(field presence for scheduled events (IndependenceDay, etc.). Use of “holiday worked” hours must beapproved in advance.

Training Status 16EMS Specialists that are training for independent dutywill be partnered with a qualified EMS Specialist orSenior Specialist.Specific training programs will vary based on theknowledge, experience, and abilities of the EMSSpecialist.An EMS Specialist that has not been released fromtraining status may not cover scheduled rotations,unless approved by the EMS Commander or Director.All EMS Specialists must remain ready for emergencyfield response. This includes having ready access toall equipment and supplies necessary for suchresponse (radios, personal protective equipment, etc.).In most cases, equipment and supplies shall bemaintained at the employees workstation, vehicle, orother appropriate location.Readiness Chain of Command The Commander may assume Medical-Health SystemCommand from the Duty Chief as appropriate. TheDirector may assume Medical-Health SystemCommand from the Commander as appropriate. In the event that multiple Specialists are activated to fillDuty Chief duties at the same time, the Commanderor/Director will assign specific duties and areas ofresponsibility.

UNIFORM AND IDENTIFICATIONGeneral DescriptionEMS Agency personnel don appropriate uniforms and identification asnecessitated by the nature of the Personal ProtectiveEquipmentDetailAll personnel shall display a Santa Clara County EmergencyMedical Services System Identification Card when serving inany official capacity.Personnel shall wear an authorized uniform when respondingto and working on the scene of an incident. Personnel shalldetermine the specific components based on the nature of theevent, time of day, safety, and environmental conditions. Onlyapproved uniform items may be worn.Personnel shall wear the provided personal protectiveequipment as appropriate for the incident. This may includehelmet, jacket, gloves, goggles, and hearing protection.Air Purified Respirators (APRs) and Self Contained BreathingApparatus (SCBA) are provided for personnel that arerequired to work in specialized environments.Ballistic vests are provided for passive protection.All personnel are provided with Level B and C equipment.Level A equipment is available as required.17

EMERGENCY VEHICLE OPERATIONSGeneral DescriptionPublic Health and EMS Agency personnel shall operate emergency vehicles in asafe and prudent fashion at all times.StandardDescriptionReadinessDetailPersonnel assigned a vehicle are responsible to insure thatthe assigned emergency response vehicle is ready forresponse at all times.NotificationAgency staff shall notify and maintain status with CountyCommunications when responding to a call.Emergency Drivingand Use of Lights andSiren18 Qualified and approved EMS Agency personnel mayoperate vehicles with red lights and siren whenappropriate. The Agency staff shall follow all emergency drivingguidelines and adhere to all applicable vehicle lawsrelated to the operation of emergency vehicles. The Agency staff shall discontinue the use of red lightsand siren operation whenever it may create an unduehazard to the general public or the operator. Thisincludes weather, citizen confusion/safety (civilian isfollowing a code-three vehicle, etc.). When responding with red lights and siren, theemergency vehicle shall come to a full and completestop at all red lights prior proceeding through theintersection. This is more restrictive than the vehiclecode. The vehicle operator (and any other passengers) shalldon the provided hearing protection/intercom systemheadset prior to red lights and siren operation. Only authorized County personnel or other authorizedemergency service personnel may operate the EMSAgency emergency vehicles.

VehicleSpecialized Equipmentand SuppliesNon-County EmployeePassengers19 All EMS Agency vehicles shall be secured whenunoccupied. Whenever possible, the vehicle shall be parked infashion that enables rapid response and movement(backing into parking spaces, leaving maneuveringroom, etc.). The public address system shall only be used forproviding emergency directions when appropriate. All equipment and supplies carried in Agencyvehicles shall be maintained and in an operablefashion. Vehicle operators must be able to operate allequipment and supplies carried in Agency vehicles. All vehicles shall be maintained with no less that onehalf tank of fuel at all times. The vehicle shall be clean and free of debris at alltimes. Vehicles shall be serviced in accordance with Countypolicy.Some EMS Agency vehicles carry specialized equipment andsupplies. Only authorized and qualified personnel shall usethese items.If the need to respond to a call arises and another party otherthan a County employee is in the vehicle, the operator mustcause the following to occur: The party must be advised to limit distractions to thevehicle operator during response. The party must remain in the vehicle upon arrival atthe scene of an emergency (unless a safety issuearises requiring evacuation) or it is safe to enter thescene with an escort.

20 The party shall be instructed of the units call sign andhow to call for emergency assistance should theoperator become incapacitated. If the party is a pre-approved ride-along or observer,they may exit the vehicle and enter the scene whenunder direct supervision of the operator. The partyshall be clearly identified by appropriate means. Minors and those who do not wish to respond mustexit the vehicle prior to response.

STILL ALARMStill AlarmA still alarm is any event that may require public safety services, has not beendispatched, and presents to responders.EMS Agency personnel primarily serve in a command and control position, not aprovider of emergency medical care. As such, Agency staff shall insure theappropriate medical-care response to attend to the needs of those who may beill, injured, or in need of assistance.9DescriptionOnce the EMS Agency staff have determined that an incident has occurred, theprimary role shall be to ensure the safety of the general public and those involvedin the incident, with due regard to their own safety.Agency staff shall position in the vehicle in a fashion that provides for the safety ofthe staff and for those involved in the incident (ie: blocking traffic, securing aroadway, etc.). As appropriate for safety, Agency staff may take all appropriateactions while inside the vehicle or until other emergency responders arrive on thescene.Agency staff shall notify County Communications of the incident location andrequest any immediate need resources. As soon as is possible, the Agency staffshall provide a report on conditions to County Communications and make anyadditional resource requests.Agency staff shall don appropriate protective equipment prior to accessing anemergency incident.Agency staff shall direct bystanders, with due regard to their safety, to providebasic first aid as appropriate. Agency staff shall not to provide medical careunless absolutely necessary. The primary role of the Agency staff is to control thescene and insure the response of appropriate emergency services.Upon the arrival of public safety personnel, the Agency staff shall transitionIncident Command, including a face-to-face report on conditions, and then fill anyappropriate role assigned. If the first unit on-scene is a private resource, Agencystaff may retain command and then direct the resource to provide medical care asindicated.21

DOCUMENTATIONGeneral DescriptionSanta Clara County EMS Agency personnel shall complete appropriatedocumentation related to medical-health events within the Operational Area orwhen associated with mutual aid responses.StandardDescriptionEMS Agency IncidentRecordStandardizedEmergencyManagement System(SEMS)/NationalIncident ManagementSystem (NIMS)22Detail An Incident Record must be completed by each unitassigned to a response or incident. Incident Records must be complete and submitted tothe EMS Commander within 72 hours of the closure ofan event. All personnel shall comply with applicable SEMS/NIMSdocumentation requirements. This includes thecompletion of applicable ICS forms such as the ICS214 Unit Log, etc. All documents must be complete and submitted to theEMS Commander within 72 hours of the closure of anevent.Patient Care Records(PCR) EMS Agency personnel should not complete patientcare reports. If a PCR is required, personnel shall dispatchappropriate medical resources. Any firs

County EMS Agency Field Operations Guide An operational guidance document for EMS Agency Personnel, EMS Duty Chief, EMS Commander, and EMS Director REFERENCE #817 Revised November 2008 Santa Clara County Emergency Medical Services Agency 976 Lenzen Avenue San Jose, California 95126 1. . EMS field units (EMS 2-6/Squad1),

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