MED-Star Policies and Procedures-V03 2013

MED-Star Paramedic Ambulance, Inc.
Policies & Procedures
Revision 03.13
3/12/2013
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INTRODUCTORY MATERIAL
This Policies and Procedures Manual is intended to serve as a guide and reference to the policies,
procedures, and practices of MED-Star Paramedic Ambulance, Inc.
MED-Star reserves the right to modify, establish, or terminate any or all of the policies and
procedures contained herein, whenever such action is necessary. As changes in the policies and
procedures occur, or new policies are implemented, you will be notified of these changes in a
timely manner.
NOTICE: THIS POLICIES AND PROCEDURES MANUAL DOES NOT CONSTITUTE

AN EXPRESS OR IMPLIED CONTRACT OF EMPLOYMENT BETWEEN MED-STAR,
YOU, OR ANY OTHER EMPLOYEE.
While we attempt to provide current and valuable information, this Policies and Procedures
Manual may not answer every question concerning employee policies, procedures, benefits and
services. This Policies and Procedures Manual will not replace policy documents or benefit plan
descriptions that are available for review upon request. If the information needed is not
contained in this Policies and Procedures Manual, you may contact a supervisor for further
assistance.
It is your responsibility to read these policies and procedures, keep them conveniently available
as a reference and update them so you are always well informed. This Policies and Procedures
Manual shall remain the property of MED-Star Paramedic Ambulance, Inc., and it must be
returned upon your termination of employment.
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Table of Contents
Policy # Title Page

Section 1: Introduction
1-1 Statement of Policy 1
1-2 Mission Statement 2
1-3 About MED-Star Paramedic Ambulance, Inc. 3
1-4 Equal Employment Opportunities Policy Statement 5
1-4-1 Diversity Plan 6
1-4-2 Positive Employee Relations 7
1-4-3 Non-Harassment Policy 8
1-4-4 Sexual Harassment 9
1-4-5 Safe Work Environment 13
1-5 Patient Rights 14
1-5-1 Confidentiality / Release of Information Policy Statement 15
1-5-2 Care Commitment 16
Section 2: Personnel and Staff
2-1 At-Will Employment 17
2-2 New Employees 18
2-3 Background Investigations 20
2-4 Employee Classifications 21
2-4-1 Other Part-Time Employment 22
2-5 Performance Evaluations 23
2-6 Credentialing / Licensure / Certifications 24
2-7 Employee Personnel Files 25
2-7-1 Employee Medical Files 26
2-7-2 Employee Education Files 27
2-8 Reference Inquiries 28
2-9 Exit Interview 29
2-10 Staffing and Duties, Generally 30
2-11 Regular Pay Procedures 31
2-11-1 Recording Work Hours 32
2-11-2 Paid Time Off (PTO) 33
2-11-3 Work Schedules 34
2-11-4 Emergency Overtime (EOT) Procedures 35
2-11-5 Shift Trades And Coverage 36
2-11-6 Meal Periods And Rest Breaks 37
2-11-7 Absences And Tardiness 38
2-11-8 Leave Of Absence 40
2-12 Conduct Policy, Generally 44
2-13 Insubordination 46
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2-14 Tobacco Use 47
2-14-1 Drug And Alcohol Abuse Policy 48
2-15 Corporate Computers, Technology, Networks, And Internet Use 55
2-16 Gifts, Honoraria, Tipping and Gratuities 56
2-17 Employee Issued Equipment / Supplies 57
2-17-1 Uniform / Dress Code 58
2-17-2 Wearing Uniform When Not On Duty 59
2-17-3 Personal Hygiene And Appearance 60
2-18 Corrective Action 61
Section 3: Safety And Risk Management
3-1 Overview 63
3-2 Duties of Employees 65
3-3 Patient Safety 66
3-4 Vehicle Accidents 67
3.4.1 Ambulance Mechanical Breakdowns 70
3-5 Exposure Control Plan Education 71
3-5-1 Exposure Control Plan 72
Section 4: Operations
4-1 Shift Duties 86
4-2 Sanitary Ambulance Policy-Interior 90
4-2-1 Sanitary Ambulance Policy-Exterior 91
4-3 Post-Transport Duties 92
4-4 Medical Equipment Inspections 93
4-5 Vehicle Inspection-Daily 94
4-5-1 Vehicle Inspection-Monthly 95
4-6 Duty To Treat And Transport/Patient Refusal 96
4-7 Driver's Training 97
4-7-1 Motor Vehicle Policy, Generally 98
4-7-2 Policy And Procedure For Driving 99
4-7-3 Safe Driving Guidelines, Generally 100
4-8 Inclement Weather/Road Conditions Operations 102
4-9 Reflective Vests 103
4-9-1 Cell Phone Usage 104
4-10 Passengers/Seatbelts and Safety Restraints 105
4-11 Patient Confidentiality 106
4-12 Reports And Documentation 107
4-12-1 Approved Acronyms And Abbreviations 109
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Title Statement of Policy
Section Introduction
Policy No. 1-1
Modified March 12, 2013
These policies and procedures establish the minimum standards of conduct for all employees of
MED-Star Paramedic Ambulance, Inc. Employees are encouraged to not only adhere to all of
the policies and procedures contained herein, but also to strive to excel above them.
All MED-Star employees are required to conduct themselves, at all times, in accordance with
these policies and procedures; protocols; Federal, State, and local laws and regulations; requests,
direction, or guidance of MED-Star supervisors;and other applicable guidelines and/or directives.
Because MED-Star supervisors are responsible for enforcing these policies and procedures, other
applicable laws, regulations, and/or guidelines, to ensure the orderly, efficient, and effective
operations of MED-Star, supervisors are held to a much higher standard in that their adherence to
these policies and procedures must be beyond reproach.
If any employee observes any other employee violating any of these policies and procedures, or
any other law, regulation, protocol, guideline, or directive, the employee observing the conduct
or behavior should report it to a supervisor at the soonest available time.
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Title Mission Statement
Policy No. 1-2
Our mission is to make a difference by caring for people in need. At MED-Star Paramedic
Ambulance, Inc. the patient will always come first. Although we treat and transport those who
are injured and ill, we love to see our neighbors healthy and safe.
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Title About MED-Star Paramedic Ambulance, Inc.
Policy No. 1-3
What We Do
MED-Star Paramedic Ambulance, Inc. (“MED-Star”) was founded in 2000, as a privately owned
and operated ground ambulance company in South Dakota. We provide emergency medical
services (EMS) to the City of Brandon and surrounding communities in Southeast Minnehaha
County. We also provide long-distance and local inter-facility ALS and BLS transport services
for local and regional facilities, such as Avera Health Systems and Sanford Health Systems.
Additionally, we provide ALS intercepts and we are the contracted ground transfer provider for
Careflight Emergency Air Transport and Medical Air Rescue Company. MED-Star also
provides standby medical services for community events and sporting events.
MED-Star is a growing company with its mission, goals and objectives looking far into the
future. MED-Star is always looking to expand its services, which may include additional
facilities in other communities throughout the State of South Dakota and the nation.
MED-Star is partnered with Health Education Design Solutions, Inc. and Santa Fe Community
College to provide basic and continuing education classes to the community and healthcare
professionals. MED-Star’s curriculum includes classroom instruction in basic first aid, CPR,
advanced paramedic education, and refresher conferences. Classroom instruction is done in a
full-service training center, with adult, pediatric, and infant PDA STAT manikins.
Objective
MED-Star’s objective is to provide superior emergency medical services from our patient’s point
of view. MED-Star is committed to delivering high-performance ambulance service by
achieving the highest levels of:
 Clinical excellence;
 Response time reliability;
 Economic efficiency;
 Customer satisfaction; and
 Employee satisfaction.
MED-Star will measure all of these system elements from the perspective of our patients,
customers, and employees, while working continuously to improve on each and every one of
these system elements.
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Management
The management team at MED-Star consists of:

 Mr. Jay Masur, Founder, President and Chief Executive Officer;
 Ms. Kristen Johnson, Supervisor;
 Mr. Ken Blocker, Supervisor;
 Mr. Brian Rubin, Supervisor; and
 Ms. Judi Zimmerman, Billing and Collections Manager.
Service Area
MED-Star provides 911 ALS contracted services to Brandon, Valley Springs, and Southeast
Minnehaha County. From its Brandon location, MED-Star provides ALS and BLS transport
services for local and regional facilities, including Avera Health Systems and Sanford Health
Systems. MED-Star regularly provides transport services in the following states:
 South Dakota,
 North Dakota,
 Minnesota,
 Wisconsin,
 Iowa,
 Missouri,
 Nebraska,
 Kansas,
 Oklahoma,
 Colorado,
 Wyoming, and
 Montana.
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Title Equal Employment Opportunities Policy Statement
Policy No. 1-4
MED-Star Paramedic Ambulance, Inc. (“MED-Star”) provides equal employment opportunities

(EEO) to all employees and applicants for employment without regard to race, color, religion,
gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic
information, marital status, amnesty, or status as a covered veteran in accordance with applicable
Federal, State, and local laws. MED-Star complies with applicable State and local laws
governing non-discrimination in employment in every location in which the company has
facilities. This policy applies to all terms and conditions of employment including, but not
limited to, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence,
compensation, and training.
MED-Star expressly prohibits any form or unlawful employee harassment based on race, color,
religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic
information, disability, or veteran status. Improper interference with the ability of MED-Star’s
employees to perform their expected job duties is absolutely not tolerated.
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Title Diversity Plan
Policy No. 1-4-1
As the means to achieve the goal of equal employment opportunity and to ensure that current
practices do not have an undesired discriminatory effect, MED-Star will take steps to:
 Ensure equal employment opportunity to all persons regardless of race, color, religion,
sex, age, national origin, and disabilities, including but not limited to employee selection,
promotion, training and development, compensation, termination, and disciplinary action.
 Ensure that all pre-employment inquiries and qualifying factors do not disproportionately
screen members of one sex and that applicants will be judged fairly on their ability to
perform the job.
 Ensure that promotion decisions are in accordance with principles of equal employment
opportunity by imposing only valid requirements for promotional opportunities.
 Ensure that no such individual be denied participation in, benefits of or be subject to
discrimination under any program or activity authorized by MED-Star.
The success in achieving racial neutrality in employment requires a conscious, deliberate and
total commitment on the part of administrators and employees to eliminate all barriers. The
management of MED-Star is committed to successfully implementing these established
procedures and practices to achieve the goal of equal opportunity employment.
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Title Positive Employee Relations
Policy No. 1-4-2
MED-Star Ambulance believes in and will practice fair employee relations policies. MED-Star
meets its obligations to employees by providing adequate pay, appropriate benefits, and good
working conditions, observing the laws applicable to employment and recognizing the
employees' rights as individuals. We believe that adherence to these principles is the best policy
for our employees and that their best interests are served by our direct, voluntary action in their
behalf and by the direct communication through their manager.
The primary obligation of MED-Star is to make continuously available to the community it

services the best possible care to the sick. This is a continuing, around-the-clock obligation to
which all other obligations are secondary.
We, therefore, believe that the interest of MED-Star's employees, the patients we treat, and
MED-Star itself are best served if our employees deal directly with MED-Star.
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Title Non-Harassment Policy
Policy No. 1-4-3
MED-Star Ambulance affirms the dignity and value of each person, and will not condone
personal harassment of any nature in any area of the organization. This applies to employees,
patients, guests, physicians, volunteers and contractors of services. Submission to personal
harassment shall not be a condition of employment or advancement with MED-Star. It is the
policy of MED-Star to maintain a workplace free of personal harassment and intimidation.
A hostile work environment is defined as comments, actions or objects that unreasonably

interfere with work performance or create an intimidating, hostile or offensive work
environment.
Sexual harassment is legally defined as unwelcome sexual attention. It includes unwelcome

advances of any kind, requests for sexual favors and other verbal, written or physical conduct of
a sexual/personal nature or hostile work environment.
Neither submission to sexual harassment nor acceptance of an intimidating, hostile, or offensive

work environment will be tolerated as a condition of employment or advancement with MED-
Star Ambulance.
Federal and State law protect each employee from sexual harassment in the workplace regardless
of whether the harassment is caused by supervisory personnel, coworkers, volunteers, vendors or
contractors of services. It is the policy of MED-Star to maintain a workplace free of sexual
harassment and intimidation. Sexual harassment is considered a serious offense and will be
treated like other forms of misconduct. Resulting discipline will include written warning,
suspension and/or probation, or termination.
If any employee falsely accuses an individual of harassment, he/she will also be subject to
disciplinary action up to and including termination. Sexual harassment should not be tolerated by
any employee.
If you feel that you have been the victim of harassment or if you notice or suspect possible
harassment of others, you should report such actions immediately to a supervisor.Each complaint
will be fully investigated, reviewed and effectively remedied when an allegation is determined to
be valid. Every effort will be made to keep the complaint and investigation confidential for the
protection of the individual(s) involved without fear of retaliation.
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Title Sexual Harassment
Policy No. 1-4-4
Statement Of Policy
MED-Star is committed to providing a workplace that is free from all forms of discrimination,
including sexual harassment.
ANY EMPLOYEE’S BEHAVIOR THAT FITS THE DEFINITION OF SEXUAL

HARASSMENT IS A FORM OF MISCONDUCT WHICH SHALL RESULT IN
DISCIPLINARY ACTION UP TO AND INCLUDING TERMINATION OF EMPLOYMENT.
MED-Star’s policy on sexual harassment is a part of its overall affirmative action efforts
pursuant to Federal and State laws prohibiting discrimination based on race, color, religion,
gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic
information, marital status, amnesty, or status as a covered veteran. Specifically, sexual
harassment is prohibited by Title VII of the Civil Rights Action of 1964 and South Dakota
Human Rights Act, South Dakota Codified Laws 20-13-1 et seq.
Each employee of this company must refrain from sexual harassment in the workplace. No
employee, male or female, should be subjected to unsolicited or unwelcome sexual overtures or
conduct in the workplace. Furthermore, it is the responsibility of all supervisors, managers,
directors, and officers of MED-Star to make sure that he work environment is free from sexual
harassment. All forms of discrimination and conduct which can be considered harassing,
coercive, or disruptive, or which create a hostile or offensive environment must be eliminated.
Instances of sexual harassment must, and shall, be investigated in a prompt and effective manner.
ALL EMPLOYEES OF MED-STAR, PARTICULARLY THOSE IN A SUPERVISORY OR

MANAGEMENT CAPACITY, ARE EXPECTED TO BECOME FAMILIAR WITH THE
CONTENTS OF THIS POLICY AND TO ABIDE BY THE REQUIREMENTS IT
ESTABLISHES.
Definition Of Sexual Harassment
Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of
a sexual nature constitute sexual harassment when:
 Submission to such conduct is made either explicitly or implicitly a term or condition of
an individual’s employment,
 Submission to or rejection of such conduct by an individual is used as a basis for
employment decisions affecting such individual, or
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 Such conduct has the purpose or effect of unreasonably interfering with an employee’s
job or an intimidating, hostile, or offensive working environment.
A hostile environment can be developed from repeated, offensive physical actions, verbal
comments, hazing, or graphic or written displays which affect an employee’s ability to perform
the job.
Sexual harassment occurs when:

 Employment decisions are based upon acceptance or refusal of sexual advances. For
example, a person is fired for having refused a sexual advance. This is called “quid pro
quo” harassment, meaning “this for that.”
 A working environment is so intimidating, patently offensive, or sexually hostile as to
hinder a person’s ability to do his or her work. A supervisor, co-worker, or someone else
who the victim comes in contact on the job creates an abusive work environment or
interferes with the employee’s work performance through words or deeds because of the
victim’s gender. This is called “hostile environment” harassment.
Conduct which may constitute sexual harassment includes, but is not limited to:
 VERBAL: sexual innuendos, suggestive comments, insults, humor, and jokes about sex,
anatomy or gender-specific traits, sexual positions, threats, repeated requests for dates, or
statements about other employees, even outside of the employee’s presence, of a sexual
nature.
 NON-VERBAL: Suggestive or insulting sounds (e.g. whistling); leering; obscene
gestures; sexually suggestive bodily gestures; “catcalls,” “smacking,” or “kissing” noises.
 VISUAL: Posters, signs, pin-ups or slogans of a sexual nature, viewing pornographic
material or websites.
 PHYSICAL: Touching, unwelcome hugging or kissing, pinching, brushing the body, any
coerced sexual act, or actual assault.
 TEXTUAL/ELECTRONIC: Sexting, electronically sending messages with sexual
content, including text, pictures, and video; the use of sexually explicit language,
harassment, cyber stalking and threats via all forms of electronic communication, such as
e-mail, text, picture, and video messages; intranet and on-line postings, blogs, instant
messages and social network websites such as Facebook and Twitter.
While the most commonly recognized forms of sexual harassment involve the types of conduct
described above, non-sexual conduct can also constitute a violation of applicable laws when that
conduct is directed at the victim because of his or her gender.
The most severe and overt forms of sexual harassment are easier to determine. On the other end
of the spectrum, some sexual harassment is more subtle and depends, to some extent, on
individual perception and interpretation. Courts will assess sexual harassment by a standard of
what would offend a “reasonable person.” For this reason, every employee must remember that
seemingly “harmless” and subtle actions may lead to sexual harassment complaints. The use of
terms such as “honey,” “darling,” and “sweetheart” is objectionable to many women, and men,
who believe that these terms undermine their authority and their ability to deal with men on an
equal and professional level. While the use of these terms by an individual with authority over
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an employee of the opposite sex will rarely constitute an adverse employment action, it may lead
to the creation of a hostile work environment.
SEXUAL HARASSMENT IS UNACCEPTABLE MISCONDUCT, WHICH AFFECTS BOTH

GENDERS.
Responsibility OfIndividual Employees
Each individual employee has the responsibility to refrain from sexual harassment in the
workplace. An individual employee who sexually harasses a fellow worker is, of course, liable
for his or her conduct. The harassing employee will be subject to disciplinary action up to and
including termination of employment.
Responsibility Of Supervisory Personnel
Each supervisor is responsible for maintaining the workplace free of sexual harassment. This is
accomplished by promoting a professional environment and by dealing with sexual harassment
as with all other forms of employee misconduct. It must be remembered that supervisors are the
first line of defense against sexual harassment. By setting the right example, a supervisor may
discourage employees from acting inappropriately. In addition, supervisors will often be the first
to spot objectionable conduct or the first to receive a complaint about conduct which the
supervisor did not observe.
Responsibility Of MED-Star
MED-Star shall, upon being made aware of a sexual harassment situation, shall take action to
correct the situation, no matter how trivial the situation may appear. MED-Star shall:
 Immediately investigate the allegations to find out what happened and take appropriate
action.
 Eliminate the harassing behavior by considering the severity of the alleged conduct and
responding appropriately.
 Conduct follow up interviews with the victim and the alleged harasser to tell each
individual what is happening and why.
 See to it that the work atmosphere remains free from sexual harassment.
MED-Star shall not attempt to resolve the matter by putting the victim and alleged harasser
together in the same room.
Reporting Sexual Harassment
An employee who either observes or believes herself/himself to be the object of sexual

harassment should immediately report the situation to his or her supervisor or the MED-Star
President/CEO.
It is not necessary for sexual harassment to be directed at the person making the complaint.
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All reports of sexual harassment, including anonymous reports, will be accepted and investigated
regardless of how the matter comes to the attention of MED-Star. However, because of the
serious implications of sexual harassment and the difficulties associated with investigating such
reports, cooperation is a vital component to an effective inquiry and an appropriate outcome.
No one making a non-frivolous, good faith report of sexual harassment will be retaliated against,
even if the report is not substantiated. Additionally, any witness will be protected from
retaliation.
False And Frivolous Complaints
False and frivolous charges refer to cases where the accuser is using a sexual harassment
complaint to accomplish some end other than stopping sexual harassment. It does not refer to
charges made in good faith which cannot be proven. Given the seriousness of the consequences
for the accused, a false and frivolous charge is a severe offense that can itself result in
disciplinary action up to termination of employment.
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Title Safe Work Environment
Policy No. 1-4-5
MED-Star Ambulance strives to provide an environment for employees, patients, physicians, and
visitors free from threatening behavior and to provide a formalized process to address any
workplace violence should it occur.
Threatening behavior is a serious offense and will not be tolerated. All employees are
responsible to maintain a safe environment. Therefore, it is incumbent upon each employee to
immediately report any violent or threatening behavior directed against oneself, employee,
patient, physician, visitor, or other individual on MED-Star's premises, or while conducting
business on behalf of the company.
MED-Star will investigate all such reports thoroughly and take appropriate action.
Whenever the safety of the workplace may be threatened, MED-Star reserves the right, without
prior notice to search any and all company property, work areas and personal belongings on the
company's premises. Failure to cooperate in such a search is considered misconduct and may
result in corrective action, up to and including termination.
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Title Patient Rights
Policy No. 1-5
MED-Star has established requirements to assure patient rights are consistently respected.
Including in these is the right to considerate, respectful care, access to complete and current
information regarding medical care, the right to refuse treatment, the right to privacy and access
to communications, and the right to examine medical charges.
The Health Insurance Portability and Accountability Act (HIPAA) privacy rules provide rights to
individuals relative to their protected health information (such as medical records). The
following are the individual rights that must be afforded by covered entities.
 Right to receive a covered entity's Notice of Privacy Practices

 Right to access and copy their protected health information
 Right to request restriction of the uses and disclosures of their protected health
information
 Right to receive confidential communications
 Right to request amendment and correction of their protected health information
 Right to an accounting of the disclosures of their protected health information
 All patients/patient representatives receive a copy of the Notice of Privacy
Practices and Rights/Responsibilities.
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Title Confidentiality / Release of Information Policy Statement
Policy No. 1-5-1
All employees are required, as a condition of employment, to enter into the At-Will
Employment, Confidentiality And Non-Disclosure Agreement.
Employees are prohibited from releasing medical, financial, personal or other information about
patients, patients' family members, MED-Star Paramedic Ambulance Inc. operations or
employees, except where the exchange of such information is required during the performance of
job duties and has been properly authorized.
Because a breach of confidentiality is a violation of the trust placed in our organization and its
employees by other employees, patients, residents and the community, any inappropriate
disclosure or release of confidential information to unauthorized individuals or organizations will
be thought of as a serious incident of misconduct and will be treated accordingly. Violators of
this policy are subject to immediate dismissal and possible legal action.
Original records may not be removed from the office except as designated in policy. Staff may
carry copies of essential patient information necessary to provide care. Such information must be
carried in a confidential manner and returned to the office for destruction upon patient's end of
service.
THE RECORDS OF AND INFORMATION REGARDING PATIENTS AND OR STAFF ARE

STRICTLY CONFIDENTIAL.
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Title Care Commitment
Policy No. 1-5-2
MED-Star Paramedic Ambulance Inc. employees have earned an excellent reputation for
integrity, efficiency and professionalism. As a team member, you have a personal responsibility
to maintain the high professional standards of our organization. This is why your appearance and
attitude, as well as the manner in which you perform your duties, are of utmost importance. By
performing your job in a compassionate, tactful and professional manner, you create a positive
atmosphere and will find your own work more rewarding.
A medical emergency is often a new experience for our patients and their families, and they are
understandably apprehensive. They place their confidence in the MED-Star staff. It is your
professional responsibility not to violate this confidence through indiscriminate discussion
pertaining to patients, their treatment or progress without authorization. Erroneous or non-public
information prematurely released may easily cause embarrassment to the MED-Star relations
with the community.
Our professional family commits to providing our patients and families the highest level of
personal service, embracing the opportunity to serve with respect and compassion.
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Title At-Will Employment
Section Personnel and Staff
Policy No. 2-1
Employment at MED-Star Paramedic Ambulance, Inc., for all employees, is for an unspecified
duration and constitutes “at-will” employment, unless otherwise specifically set forth in writing.
“At-will” employment means that either the employee or MED-Star may terminate the
employment relationship at any time, with or without good cause or for any or no cause, except
as otherwise specifically set forth in writing.
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Title New Employees
Policy No. 2-2
Overview
New employees at MED-Star are in an extremely difficult situation. No matter how much
training or orientation you receive, you will be unavoidably thrust into the world of EMS and
patient care. New employees must always be prepared to deal with situations that they have
never before come across. All employees must also be prepared to acclimate themselves to the
different personalities and procedures that you will encounter.
All employees with a significant amount of time at MED-Star will be expected to assist and train
new employees. The training will include paperwork, procedures, and driving, among other
things. All MED-Star “veterans” and new employees are expected to get along and work
together. Leave all personality conflicts outside. We are a comparatively small company that
does a high volume of work. The employees and staff need to function as a close-knit group.
All new employees will be evaluated on paperwork, attitude, and overall performance. Use this
manual, other resources of information, your training, and your common sense to consistently
improve all aspects of your performance.
Orientation
All new employees will be oriented to the operations of MED-Star by using the New Employee
Orientation Program. Every new employee is continuously encouraged to ask questions. All
personnel and staff members should be willing and able to assist every new employee or to at
least point them in the right direction to have their questions answered.
MED-Star conducts orientation to assure that employees are introduced to the philosophy and
mission of the company, as well as policies and procedures that are required and/or affect their
position, performance and service to our patients / families.
Employee orientation includes but is not limited to the following components:
 Vision, mission, values

 Leadership expectations
 Policies/procedures/protocol testing (written and oral) appropriate to job description
 Lines of communication
 Quality improvement activities
 OSHA blood borne pathogens, as appropriate
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 Exposure control plan, as appropriate
 Safety
 Confidentiality
 Compliance Program
 Health Insurance Portability & Accountability Act (HIPAA) Training
 Joint visits with specific disciplines as appropriate
EMTs and Paramedics will be required to pass their orientation program prior to being released
from probation. Failure to pass the orientation program within ninety (90) may result in
suspension or termination of employment. Questions regarding orientation should be directed to
a supervisor or your manager.
Probationary Period
All new employees shall receive a ninety (90) day probationary period in which the employee
will receive instruction, training, and guidance on all policies, procedures, protocols, and any
other guidance related to the new employee’s duties and expectations. Upon the conclusion of
the new employee’s ninety (90) day probationary period, the new employee’s supervisor shall
conduct an initial performance evaluation.
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Title Background Investigation
Policy No. 2-3
As required by law, MED-Star Ambulance conducts background checks on all candidates who
are offered employment and all volunteer applicants.
If any misrepresentation or omission is discovered as a result of the investigation which was not
properly disclosed on the application form, such misrepresentation or omission will be sufficient
grounds to deny or terminate employment.
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Title Employee Classifications
Policy No. 2-4
For purposes of salary administration, eligibility for overtime payments, and employee benefits,
MED-Star classifies its employees:
Full time employees
Employees hired to work MED-Star’s normal, full-time, minimum 36-hour workweek on a

regular basis.
Part time / PRN employees
Part time and PRN employees are defined as employees who are hired to work fewer than forty
hours per week on a regularly scheduled basis. Such employees are "nonexempt" as defined
below. To stay on as part time or PRN you must work two shifts every thirty days.
Nonexemptemployees
Nonexempt employees receive hourly and salary wages; they are subject to wage and hour laws,
i.e. overtime pay.
Exempt Employees
An exempt employee is an employee who, because of his/her positional duties, responsibilities

and level of decision making authority is exempt from overtime provisions of the Fair Labor Act.
Exempt employees are expected, by organization, to work whatever hours are necessary to
accomplish the goals of the company.
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Title Other Part-Time Employment
Policy No. 2-4-1
Although MED-Star would like you to devote your primary efforts towards your duties and
responsibilities with us, you may engage in outside employment as long as it does not interfere
with our company and prior approval of the President/CEO. Other employment should not
interfere with your obligations with MED-Star.
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Title Performance Evaluations
Policy No. 2-5
Your job performance will be continually appraised and formally evaluated during the course of
your employment with MED-Star Ambulance.
You will receive a formal performance evaluation upon completion of your probationary period
(90 days), at the end of your first year, and annually thereafter. An employee’s 90 day and/or
annual review is not associated with compensation.
If you are promoted or demoted, your performance review date may be adjusted to reflect the
effective date of the job change. Your performance review date may also be adjusted to reflect
any time missed while on a Leave of Absence.
If your job is reclassified your annual review may not be reset. Your manager's evaluation of
your j ob performance will be written on a performance review form. The job description for
your position will be used as the basis for measuring your performance, as well as behavioral
competencies and goals. After reviewing your job performance and progress with your manager,
the appraisal form will be signed by you and your manager and will become a part of your
employment record.
23
Title Credentialing / Licensure / Certifications
Policy No. 2-6
Because MED-Star Ambulance is dedicated to providing the best quality service to our patients
and their families, we will verify that all employees have a current and valid license, registration
and/or certification required by any governing agency. If your position requires licensure by the
State or certification by a professional society or governing agency, you are responsible for
keeping the licensure and certification current and providing a copy to MED-Star.
An employee must notify their supervisor immediately when the employee's license, certification
or registration is suspended, revoked, placed on probationary status, put under investigation or
expires. An employee who does not have a valid license or certificate by the expiration date is
not permitted to work until the new and current license and/or certificate is obtained.
AT A MINIMUM YOU MUST CARRY YOUR DRIVER’S LICENSE ON YOUR PERSON

AT ALL TIMES.
IT IS THE RESPONSIBILITY OF ALL EMPLOYEES TO MAINTAIN CURRENT

CERTIFICATIONS. FAILURE TO MAINTAIN REQUIRED CERTIFICATIONS MAY
RESULT IN IMMEDIATE DISMISSAL.
24
Title Employee Personnel Files
Policy No. 2-7
MED-Star maintains personnel files on each employee. These files contain documentation
regarding all aspects of the employee's tenure with MED-Star, including, but not limited to,
performance reviews, beneficiary designation forms, disciplinary/warning notices, letters of
commendation, and copies of your driving record that MEDSTAR obtains annually. You may
review your personnel file upon request. If you are interested in reviewing your file, contact your
supervisor to schedule an appointment.
To ensure that your personnel file is up to date at all times, you must notify your supervisor of
any changes in your name, telephone number(s), home address, email address, marital status,
number of dependents, beneficiary designations, scholastic achievements, or the individuals to
notify in case of an emergency.
25
Title Employee Medical Files
Policy No. 2-7-1
Employee medical files will be kept in a separate locked cabinet or password protected database
to limit access. These files will contain all medical information pertaining to an employee such
as the results of pre-employment physicals, medical evaluations, and information pertaining to
unprotected exposures.
26
Title Employee Education Files
Policy No. 2-7-2
MED-Star maintains an employment file for each employee. The contents of this file include
copies of all current and past certifications. This file will be updated annually to document that
all of our employees meet or exceed re-certification requirements. As you are aware, re-
certification consists of twenty-four (24) hours of continuing education, renewal of appropriate
CPR certification, and the appropriate refresher program every two years. Copies contained in
employee files include:
 EMT or EMT-P Certification

 Driver's License
 Driving Record
 CPR Certification
 PEPP Certification
 PHTLS Certification
 ACLS Certification (Paramedics)
 Any further continuing education classes
IT IS THE RESPONSIBILITY OF ALL EMPLOYEES TO MAINTAIN CURRENT

CERTIFICATIONS. FAILURE TO MAINTAIN REQUIRED CERTIFICATIONS COULD
RESULT IN IMMEDIATE DISMISSAL.
27
Title Reference Inquiries
Policy No. 2-8
From time to time, MED-Star may receive inquiries from third parties regarding employees, such
as a bank verifying employment for an employee applying for a mortgage or personal loan. All
requests for reference information should be directed to the CEO. Normally, MED-Star will
respond only to written inquiries. If a telephone reference inquiry is received, MED-Star will
require the requesting party to provide the request in writing, including verification that the
affected employee or prior employee has authorized the request. The only exception to this
policy shall be when the telephone request is made by a governmental or law enforcement entity
but, then, only upon verification of the identity of the requesting party.
Generally, information will be released only after a written release has been received from the
employee or former employee, whichever the case may be. However, MED-Star reserves the
right to release any information it deems appropriate in its discretion without authorization.
When employment references are requested from other employers, MED-Star is only obligated
to give dates of employment and rehire information out to requesting party who presents a valid
release of information signed by the employee/former employee.
28
Title Exit Interview
Policy No. 2-9
Employees desiring to terminate their employment relationship with MED-Star are urged to
notify MED-Star at least two weeks in advance of their intended termination. Such notice should
preferably be given in writing to the President or CEO.
Proper notice generally allows MED-Star sufficient time to calculate all accrued overtime (if
applicable) as well as other monies to which you may be entitled and to include such monies in
your final paycheck. Without proper notice, however, you may have to wait until after the end of
the next normal pay period to receive such payments.
ALL EMPLOYMENT RELATIONSHIPS WITH MED-STAR ARE ON AN AT-WILL BASIS.

THUS, ALTHOUGH MED-STAR HOPES THAT OUR RELATIONSHIPS WITH
EMPLOYEES ARE LONG TERM AND MUTUALLY REWARDING, MED-STAR
RESERVES THE RIGHT TO TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY
TIME, WITH OR WITHOUT CAUSE OR NOTICE.
Exit interviews are normally scheduled for outgoing employees after receiving a notice of
resignation or intent to retire or for employees whose termination is initiated by MED-Star. The
purposes of these interviews are to review eligibility for benefit continuation and conversion, to
ensure that all necessary forms are completed, to collect all MED-Star property that may be in
the employee's possession (e.g., MED-Star's pager, uniform items, policy and procedure manual,
and protocol books), and to provide employees with an opportunity to discuss their job-related
experiences.
29
Title Staffing and Duties, Generally
Policy No. 2-10
Staffing of Ambulances
All MED-Star ambulances performing 911 or patient transport duties will be staffed with a
minimum of one (1) Paramedic (EMT-P) and one (1) EMT at all times. All MED-Star
ambulances providing ground transport of a patient to or from an aircraft shall be staffed with a
minimum of one (1) EMT, so long as the Flight Paramedic maintains patient care during the
ground transport of the patient. In the event the Flight Paramedic does not or will not have
patient care during the transport of a patient to or from an aircraft, the MED-Star ambulance
shall be staffed with a minimum of one (1) Paramedic and one (1) EMT.
Duties, Generally
No matter what job or position you are hired for at MED-Star, always remember that there are
times when you will be asked and required to perform duties that you may not like. There may
be times when you are called upon to do transfers, sweep the garage, move ambulances, run
errands, work as a driver, work as an attendant, teach EMS related subjects, and do other tasks as
designated by a supervisor or dispatcher. All personnel will be expected to accept this and
cooperate.
Tasks should be equally divided as much as possible, but you must again realize and accept that
this does not always work out that way. All types of duties are necessary to keep the company
functioning at a high level. Afterward, if you have a reasonable question, by all means, address
it to an appropriate person. MED-Star appreciates your help and understanding regarding this
issue and this aspect of your employment.
30
Title Regular Pay Procedures
Policy No. 2-11
All MED-Star employees are normally paid by check or on a biweekly basis every Friday
afternoon typically not before 1700. The workweek begins at 0800 Sunday and ends at 0759 the
following Sunday. All required deductions, such as for federal, state, and local taxes, and all
authorized voluntary deductions, such as for health insurance contributions, will be withheld
automatically from your paychecks.
Please review your paycheck for errors. If you find a mistake, report it to a supervisor ASAP.
31
Title Recording Work Hours
Policy No. 2-11-1
It is the policy of MED-Star to comply with applicable laws that require records to be maintained
of the hours worked by our employees. To ensure that accurate records are kept of the hours you
actually work (including overtime hours where applicable) and of the accrued leave time you
have taken, and to ensure that you are paid in a timely manner, you will be required to record
your time worked and any paid time off that you request.
Please ensure that your actual hours worked, EOT, details, and paid time off are recorded
accurately. If there is a problem or if you neglect to punch in or out at any point please write in
the appropriate times and hours worked.
FALSIFYING A TIME RECORD OR COMPLETING TIME RECORDS FOR ANOTHER

EMPLOYEE IS A BREACH OF COMPANY POLICY AND IS GROUNDS FOR
DISCIPLINARY ACTION, UP TO TERMINATION.
32
Title Paid Time Off (PTO)
Policy No. 2-11-2
Full time employees are eligible to accrue Paid Time Off (PTO). PTO will be granted at the
discretion of the management pending adequate staffing levels. PTO may be used for vacation,
ill time or approved leave of absences. Vacation requests must be submitted for each month by
the 15th of the previous month. PTO must be used during the calendar year and will not carry
over to the next year. PTO will not be paid out in the event of termination of employment.
ACCRUAL RATES:
24 hour shift employees will accrue 5 shifts (24 hour periods) each year during years 1 and 2,
eligible to use PTO after first year of employment. 10 shifts (24 hour periods) per year will be
accrued after 3 years of employment.
Hourly employees will accrue 40 hours each year during years 1 and 2, eligible to use PTO after
first year of employment. 80 hours per year will be accrued after 3 years of employment.
33
Title Work Schedules
Policy No. 2-11-3
The minimum regular workweek for all full-time employees is thirty-six hours. Often, full time
employees are regularly scheduled for more than forty hours per week. The supervisory staff will
arrange your working hours and schedule. MED-Star will attempt to provide you with reasonable
notice when the need for overtime work arises. Please remember, however, that advance notice
may not always be possible.
If you are a part-time/PRN employee, the supervisory staff will arrange your working hours and
schedule,
As an ambulance service, MED-Star's work hours could be any time 24 hours per day, seven
days per week.
LEAVING THE SHIFT WHEN NOT AUTHORIZED OR REFUSING A CALL WILL

RESULT IN IMMEDIATE TERMINATION.
Daily and weekly work schedules may be changed from time to time at the discretion of the
MED-Star to meet the varying conditions of the company. This includes, but is not limited to,
reporting for work early or being required to stay later than the end of your shift.
Dispatchers and crews coming off shift may not punch out and leave unless there is adequate
coverage available in the service area.
If the only MED-Star ALS unit(s) is on a call. The crew that is coming off shift must remain
until MED-Star ALS unit is available to cover the city.
34
Title Emergency Overtime (EOT) Procedure
Policy No. 2-11-4
MED-Star must always maintain particular staffing levels at given times. Open shifts and
sickouts can occasionally result in personnel being required to stay for one (1) additional shift
(up to 12 hours) to maintain adequate staffing. EOT does not apply to reporting early, late calls,
or extended shifts due to call volume.
All personnel should be willing to work together and make accommodations whenever possible
to make a difficult situation as easy as possible. Everyone must understand that an EMS agency
must always have adequate staff coverage. In an attempt to deal with these scenarios in as fair
and equitable way as possible, this policy will be used as a guide to assign personnel to fill these
shifts.
The last appropriate member to punch in is the "designated member". (i.e.-"First in - first out") If
an appropriate member other than the "designated member" is willing to serve as the designated
member voluntarily, it is always appreciated. If there is a question as to the "designated member"
and one must be assigned it will be determined by a supervisor.
Appropriate is defined as the member who meets the following criteria whenever possible in the
following order of consideration (Again, someone that is not within the following criteria can
volunteer):
The member who is best qualified to fill the open shift - ex. Paramedic to fill an ALS shift,
approved dispatcher, driver when required, etc.
35
Title Shift Trades And Coverage
Policy No. 2-11-5
SHIFT TRADES AND COVERAGE OF STRAIGHT TIME FOR OVERTIME ARE NOT
PERMITTED.
FULL TIME EMPLOYEES REQUESTING TO TRADE SHIFTS MUST TRADE WITH A

FELLOW FULL TIME EMPLOYEE.
MED-Star strives to maintain flexibility in allowing personnel to trade shifts and obtain coverage
for their own shifts with the following stipulations:
Shift trades and coverage must be completed with another staff member who is qualified to fill
the shift(s) (i.e. - dispatcher, driver, ALS, appropriate experience and/or rating). If there is any
question, please consult a supervisor as to qualifications of the staff member you are trading
shifts with.
Management must be notified of all shift trades as soon as possible. Management reserves the
right to void any trade based on scheduling and staffing issues.
Employees must keep track of their own shift trades and paybacks if not trading during the same
week.
36
Title Meal Periods And Rest Breaks
Policy No. 2-11-6
MED-Star Ambulance employees work a variety of shifts and schedules to accommodate the
needs of their patients.
Crews may stop at a restaurant for meals during their shifts. Crews are not out of service when
on breaks. While on duty, all meals will be limited to less than one hour. Whenever possible,
meals should be taken when coming back from a run or other company business. Meals are not
allowed at a private residence. Dispatch must be notified of your location. Crew must have a
portable radio and pager. You may be called out at anytime during a shift. Crews may not eat at
any establishment that serves alcohol as its primary retail good. Crews must stay within their
assigned district while out for meals.
While every effort will be made to allow time for meal periods and rest breaks, the needs of the
patients or workload demands take priority and might not allow for this. In any event, breaks
may not be accumulated or "saved" to provide additional time off work.
MED-Star provides a break room for its employees. The break room should be used for storing
and serving baked items and other food or beverages brought to the office so that the workspace
can be kept clean and professional looking at all times.
To maintain a work environment that promotes good health and safety, breaks and meal periods
are strongly encouraged and should be taken in designated break areas or in other non-work
areas.
37
Title Absences And Tardiness
Policy No. 2-11-7
Excused Absence or Tardiness
Regular attendance on the job is important to you and MED-Star Ambulance, in order to assure
quality patient care. If, for any reason, you are unable to report to work, notify your supervisor as
soon as you know you are going to be absent or tardy. This notification prior to your scheduled
shift is necessary because arrangements must be made to cover your position during your
absence.
“No Call/No Show” Defined
Failure to notify a supervisor that you will be absent or tardy from work shall be deemed a “no
call/no show,” even in the event you subsequently report to work prior to the conclusion of your
scheduled work shift. However, consideration may be given of the fact that you did report to
work prior to the conclusion of your duty shift by your supervisor in determining the appropriate
disciplinary or corrective action.
Habitual Absenteeism / Tardiness
Any employee who demonstrates habitual absenteeism (excluding long~ term illness) or
tardiness will be counseled by their manager as to corrective action.
Habitual absenteeism is considered the unexcused missing of one (1) scheduled work day or
more per pay period for three (3) consecutive pay periods and/or the missing often (10)
scheduled work days in a one-year period.
If you are absent for three (3) consecutive scheduled work days without notifying your
supervisor, this will be treated as a voluntary resignation. In any event, you are required to notify
your supervisor of all absences, and failure to do so may result in disciplinary action up to
termination.
911 Shift and Scheduled Patient Transports
A single “no call/no show” occurrence for a scheduled 911 shift or patient transport shall be
grounds for disciplinary action up to termination of employment, unless excused by a supervisor.
38
On-Call Shifts / 20 Minute Response
Failure to answer your telephone, pager, communication device, or otherwise respond when
required, or failure to report within twenty (20) minutes of notification during an on-call shift
shall be deemed a “no call/no show” and shall be treated in accordance with the Habitual
Absenteeism / Tardiness discuss above, unless excused by a supervisor.
39
Title Leave Of Absence
Policy No. 2-11-8
Leaves of absence for any reason other than those outlined in the following sections are
generally not available at MED-Star personnel. A supervisor will evaluate individual requests for
a leave of absence that do not fall under the following parameters on a case- by-case basis. All
requests for a leave of absence should be presented to your supervisor.
Family and Medical Leave (FMLA)
MED-Star will grant a leave of absence to employees who have completed at least one full year
of service with MED-Star and have worked a minimum of 1,250 hours in the 12-month period
preceding the leave for the care of a child after birth or adoption or placement with the employee
for foster care, the care of a covered family member (spouse, child, or parent) with a serious
health condition, or in the event of an employee's own serious health condition. Leaves will be
granted for a period of up to 12 weeks in any 12-month period.
Child/Family Care Leave
If you request a leave of absence to care for a child after birth, adoption, or placement in your
home for foster care or to care for a covered family member with a serious health condition, you
will be granted unpaid leave under the following conditions:
If the leave is planned in advance, you must provide us with at least 30 days' notice prior to the
anticipated leave date.
If the leave is unexpected, you should notify the supervisor as far in advance of the anticipated
leave date as is practicable.
All MED-Star benefits that operate on an accrual basis (e.g., paid time off hours) will cease to
accrue during any period of FMLA leave that is unpaid.
You will be required to use all accrued, unused paid time off hours during the leave period. Once
such benefits are exhausted, the balance of the leave will be without pay. All group health
benefits (eg., health and dental insurance) will continue during the leave provided you continue
regular employee contributions to these plans.
Employees requesting a leave to care for a covered family member with a serious health
condition may be required to provide medical certification from the family member's physician
attesting to the nature of the serious health condition, probable length of time treatment will be
required, and the reasons that the employee is required to care for this family member.
Employees may also be required to provide additional physician's statements at MED-Star's
40
request at reasonable intervals. Further, the family member may be required to submit to a
medical examination by a physician designated by MED-Star at MED-Star's expense.
Leave for Employee's Serious Health Condition
If you request a leave of absence for your own serious health condition, you will be granted leave
under the following conditions:
If the leave is planned, you must provide at least 30 days notice prior to the anticipated leave
date.
If the leave is unexpected, you should notify your supervisor as far in advance of the anticipated
leave date as is practicable.
Any time that you expect to be absent, or are absent for more than five consecutive workdays
because of your own serious health condition (including pregnancy), you will be required to
submit appropriate medical certification from your physician. Such certification must include, at
a minimum, the date the disability began, a diagnosis, and the probable date of your return to
work.
All MED-Star benefits that operate on an accrual basis (e.g., paid time off hours) will cease to
accrue during any period of unpaid leave. All group health benefits will continue during the
leave provided you pay the entire premium payments to these plans during your leave. (Other
benefits, such as pension, 401 (k), life insurance, and long- term disability, will be governed in
accordance with the terms of each benefit plan.)
During your leave, you may also be required to provide additional physician's statements upon
request from MED-Star or to MED-Star's insurance carriers at reasonable intervals, attesting to
your continued disability and inability to work. You may also be required to submit to medical
examinations by physicians designated by MEDSTAR at its discretion and at MED-Star's
expense, at the beginning of, during, or at the end of your leave period, and to provide MED-Star
with access to your medical records as required.
Before you will be permitted to return from medical leave, you will be required to present MED-
Star with a note from your physician indicating that you are capable of returning to work and
performing the essential functions of your position, with or without reasonable accommodation.
Where required, MED-Star will consider making reasonable accommodation for any disability
you may have in accordance with applicable laws.
Leave Entitlement
Eligible employees are entitled to a leave for up to 12 weeks in any 12-month period. The 12-
month period will be determined on a rolling 12-month period measured backward from the date
an employee seeks FMLA leave.
Leave taken to care for a child after birth, adoption, or placement in your home for foster care
must be taken in consecutive workweeks, Leave taken for the employee's or a covered family
41
member's serious health condition may be taken consecutively, intermittently, or on a reduced
work/leave schedule based on certified medical necessity. In such instances, MED-Star will
follow applicable federal and state laws in reviewing and approving such leave requests.
Reinstatement Rights
Eligible employees are entitled to be reinstated to their former position or an equivalent position
with equivalent employment benefits, pay, and other terms and conditions of employment on
return from leave. Exceptions to this provision may apply if business circumstances have
changed (e.g., if the employee's position is no longer available due to a job elimination).
Exceptions may also apply for certain highly compensated employees under certain conditions.
Bereavement Leave
If you are a full-time employee and a death occurs in your family, you will be compensated for
time lost from your regular work schedule. In the event of the death of your spouse, domestic
partner, child, parent, sibling, grandparent, father-in-law, mother-in-law, son-in- law, daughter-
in-law, step-child, or legal guardian, you will be granted up to three scheduled days off from
work following the death, but not beyond one day after the funeral. You will be paid the day of
the funeral if scheduled that day. Other days may be drawn from your PTO bank. Requests for
bereavement leave should be made to your supervisor.
Jury and Witness Duty- Leave
Employee's who are summoned for jury duty will be granted time off. You may draw from your
PTO bank to cover scheduled hours of worked missed. You are also permitted to retain the
allowance you receive from the court for such service. All employees are allowed unpaid time
off if summoned to appear in court as a witness. Employees may use accrued paid time off hours
during this period or take the time off without pay.
If you are summoned to appear in court as a witness pursuant to a case that arose in the course of
your employment, MED-Star will compensate you for the time spent in court.
To qualify for jury or witness duty leave, you must submit a copy of the summons to serve to
your supervisor as soon as it is received. In addition, proof of service must be submitted to the
supervisor when your period of jury or witness duty is completed. MED-Star will not attempt to
have your service on a jury postponed except when business conditions necessitate such action.
As soon as you are excused from jury service or witness duty you will be required to notify
dispatch and return to work.
Military Leaves of Absence
Leaves of absence without pay for military or Reserve duty are granted to full-time regular and
part-time regular employees. If you are called to active military duty or to Reserve or National
Guard training, or if you volunteer for the same, you should notify your supervisor and submit
copies of your military orders to him or her as soon as is practicable. You will be granted a
military leave of absence without pay for the period of military service, in accordance with
applicable federal and state laws. If you are a reservist or a member of the National Guard, you
42
are granted time off without pay for required military training. Your eligibility for reinstatement
after your military duty or training is completed is determined in accordance with applicable
federal and state laws.
43
Title Conduct Policy, Generally
Policy No. 2-12
As an integral member of the MED-Star team, you are expected to accept certain responsibilities,
adhere to high standards of personal conduct, and exhibit a high degree of personal integrity at
all times. This not only involves showing sincere respect for the rights and feelings of others,
but also demands that you refrain from any behavior that might be harmful to you, your
coworkers, MED-Star, or that might be viewed unfavorably by the people we serve or by the
public at large.
WHETHER YOU ARE ON OR OFF DUTY, YOUR CONDUCT REFLECTS ON MED-STAR.

CONSEQUENTLY, YOU ARE REQUIRED TO OBSERVE THE HIGHEST STANDARDS
OF PROFESSIONALISM AT ALL TIMES.
ANY TYPE OF BEHAVIOR AND/OR CONDUCT THAT MED-STAR CONSIDERS

INAPPROPRIATE COULD LEAD TO DISCIPLINARY ACTION UP TO AND INCLUDING
TERMINATION OF EMPLOYMENT WITHOUT PRIOR WARNING, AT THE SOLE
DISCRETION OF THE COMPANY.
Listed below are some of the rules and regulations of MED-Star. This list should not be viewed
as being all-inclusive. These behaviors and/or conduct include, but are not limited to, the
following:
 Falsifying employment or other MED-Star records;
 Violating MED-Star’s policies and procedures; protocols; or Federal, State, or local laws,
regulations, or administrative rules;
 Refusing or failing to comply with reasonable requests, directives, or guidance of or from
a MED-Star supervisor;
 Soliciting gratuities from patients or the entities that we serve;
 Establishing a pattern of excessive absenteeism or tardiness;
 Reporting to work intoxicated or under the influence of non-prescribed drugs;
 Illegally manufacturing, possessing, using, selling, distributing, or transporting alcohol or
illegal drugs;
 Bringing or using alcoholic beverages on MED-Star property or using alcoholic
beverages while engaged in MED-Star business off MED-Star’s premises, except where
and when specifically authorized;
 Fighting or using obscene, abusive, or threatening language or gestures;
 Stealing property from coworkers, patients, entities that we serve, or MED-Star;
 Having unauthorized firearms, weapons, or restraints such as handcuffs on MED-Star
premises or while conducting MED-Star business;
44
 Disregarding safety or security regulations;
 Engaging in insubordination; and
 Failing to maintain the confidentiality of patient information and/or corporate
confidential information, proprietary information, or trade secrets.
IF YOUR PERFORMANCE, WORK HABITS, OVERALL ATTITUDE, CONDUCT, OR

DEMEANOR BECOMES UNSATISFACTORY IN THE JUDGMENT OF MED-STAR,
BASED ON VIOLATIONS EITHER OF THE ABOVE OR OF ANY OTHER MED-STAR
POLICIES, RULES, OR REGULATIONS, YOU WILL BE SUBJECT TO DISCIPLINARY
ACTION, UP TO AND INCLUDING DISMISSAL.
Courtesy and Politeness
Working in EMS and with patients can be a trying and testing position. When you are on the
job, when you are wearing your uniform, or when you are wearing MED-Star apparel, you are
seen as a representative of MED-Star Paramedic Ambulance, Inc.
As a representative of the company, you must maintain a courteous, polite, and in control
demeanor at all times.
Occasionally, you may be subject to verbal abuse, unsavory duties, and somewhat “difficult”
people. When you find yourself in this position, remember that you are there for a reason. You
are there to help a sick, injured, or infirm person. The people we serve depend on you and
expect you to be neat, clean, courteous, polite, and in control of yourself and the situation.
Always be ready to work in concert with your partner and other people on the scene, not in
conflict. If you lack any one of these attributes or if you disregard them, yourself, your patient,
your coworkers, and MED-Star will suffer. This is an unacceptable situation. You must always
strive to be better and try harder for everyone concerned.
45
Title Insubordination
Policy No. 2-13
Policy
All employees of MED-Star, regardless of job position, are required to obey MED-Star
directives issued by any Corporate Officer, supervisor, and/or the senior Paramedic when on a
911 call or patient transport.
For purposes of this policy, the term “insubordination” means:

 An unwillingness to carry out a directive from a Corporate Officer, supervisor, or the
senior on-scene Paramedic manifest by a verbal refusal, a nonverbal refusal, or an
unreasonable delay in completing work.
 Disrespectful behavior toward a Corporate Officer, supervisor, or the senior on-scene
Paramedic. Disrespectful behavior includes, but is not limited to, cursing at a supervisor
or senior on-scene Paramedic, verbally or physically intimidating the supervisor or senior
on-scene Paramedic, or speaking loudly or argumentatively to or about a supervisor or
senior on-scene Paramedic.
INSUBORDINATION SHALL SUBJECT THE EMPLOYEE TO MED-STAR’S

CORRECTIVE ACTION PROGRAM AND MAY BE THE GROUNDS FOR TERMINATION
OF EMPLOYMENT.
46
Title Tobacco Use
Policy No. 2-14
To maintain a safe and comfortable working environment and to ensure compliance with
applicable laws, tobacco use (smoking or chewing) in MED-Star's offices and facilities is strictly
prohibited. Because MED-Star may be subject to criminal and civil penalties for violations of
applicable smoking laws, we must insist on strict adherence to this policy.
 TOBACCO USE IS NOT PERMITTED IN ANY MED-STAR VEHICLE

 TOBACCO USE IS NOT PERMITTED ANYTIME YOU ARE IN UNIFORM OR IN
PUBLIC
 TOBACCO USE IS NOT PERMITTED IN OR ON MED-STAR PROPERTY
ANY EMPLOYEE NOT ADHERING TO THIS POLICY IS SUBJECT TO DISCIPLINARY

ACTION.
47
Title Drug and Alcohol Abuse Policy
Policy No. 2-14-1
POLICY STATEMENT
MED-Star Paramedic Ambulance, Inc. (hereinafter “MED-Star”) is dedicated to preserving the

lives of the citizens of Brandon and Minnehaha County and all of the patients to whom we
provide care. MED-Star takes great pride in its professionalism and commitment to safety.
Toward that end, we adopt and implement a policy of zero tolerance with regard to any member
of our team being under the influence of alcohol, drugs, or controlled substances while
responding to an emergency, transporting a patient, operating MED-Star vehicles or equipment,
or being at an emergency scene. Any employee who transports a patient, responds to a call,
operates vehicles or equipment, or is at an emergency scene under the influence of alcohol or any
drug poses a serious safety risk and endangers the life and well-being of him or herself, fellow
MED-Star members, our patients, and the public. Further there will be a complete prohibition of
alcohol at any and all facilities occupied by MED-Star. The only exception to the prohibition
will be a special function on or off premises, personnel scheduled for any duty (911, back-up, or
call) shift will be allowed to attend, but are prohibited from consuming any alcohol. All other
personnel will be off duty for the duration of the special event.
ANY EMPLOYEE WHO VIOLATES THIS POLICY WILL BE TERMINATED.
DEFINITIONS
The term “alcohol” means the intoxicating agent in beverage alcohol, ethyl alcohol, or other low
molecular weight alcohols. The terms “alcohol concentration” or “alcohol content” means the
alcohol in a volume of breath expressed in terms of grams of alcohol per 210 liters of breath as
indicated by an evidential breath test. The terms “controlled substances” or “drugs” are defined
as meaning marijuana, cocaine, opiates, amphetamines, and phencyclidine.
DISCHARGEABLE OFFENSE
A violation of any of the following rules will result in termination from MED-Star:
1. An employee shall not report for any duty shift (911, Back-up, or Call), transport
a patient, respond to a call, operate any vehicle or equipment, or be at an emergency
scene while having any alcohol in the employee’s system.
2. An employee shall not report for any duty (911, Back-up, or Call), drive, operate,
load, unload, inspect, service, repair or perform any other safety sensitive function
relating to an ambulance, response unit vehicle, or any other motor vehicle and shall not
use, handle or inspect any equipment within twelve (12) hours after consuming alcohol.
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3. An employee shall not use alcohol after an on-duty accident for twelve (12) hours
or until undergoing an alcohol breath test, whichever first occurs.
4. An employee shall not possess, be under the influence of, or use an illegal
controlled substance or any therapeutic drug while on duty, except for prescription drugs
when the employee provides a supervisor with a written physician’s statement that the
prescription drug will not adversely affect his/her ability to operate vehicles or
equipment.
5. No employee while on duty shall fail or refuse to submit, upon request by or on
behalf of a supervisor, or by a law enforcement officer, to take a urinalysis drug test or an
alcohol breath test.
6. Should any employee suspect anyone operating a MED-Star vehicle or equipment
in violation of this policy, they will immediately notify a MED-Star supervisor who will
then follow the same procedures as outlined in this policy. THERE WILL BE NO
DEVIATION FROM THIS DRUG AND ALCOHOL ABUSE POLICY.
7. Any of the following shall be deemed a refusal to take a test and thus shall be
grounds for discharge.
a. With respect to a urinalysis drug test:
i. Not showing up within a reasonable time at the designate testing
laboratory after being instructed to do so.
ii. Failing to provide an adequate urine sample unless a medical
evaluation shows a genuine inability to do so.
iii. Refusing to have one’s temperature taken if the urine sample falls
outside the normal temperature range.
iv. Altering or contaminating, or attempting to alter or contaminate,
the urine specimen or otherwise not cooperating so as to prevent testing or
materially interfere with the testing process or test results.
b. With respect to an alcohol breath test:
i. Failing or refusing to provide breath, to provide an adequate
amount of breath, to complete and sign a breath alcohol testing form, or
otherwise failing to cooperate with the testing processing in a way that
prevents the completion of the test.
c. Not remaining readily available for drug and alcohol testing after being
involved in a work related accident or a traffic accident, except that the employee
may leave the accident scene to obtain emergency medical attention for
themselves or other injured persons or to notify law enforcement officers. Any
employee involved in such an accident who does not remain readily available for
such testing shall be deemed to have refused to submit to testing.
CIRCUMSTANCES UNDER WHICH AN EMPLOYEE WILL BE TESTED FOR

CONTROLLED SUBSTANCES AND ALCOHOL
POST-ACCIDENT TESTING
An employee operating a MED-Star vehicle or equipment shall be tested for alcohol and
controlled substances as soon as practicable following an accident for which the employee
receives a moving violation citation or involving a fatality, an accident involving any damage to
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public, private, or MED-Star vehicles or property, or an accident involving an injury. Drivers
involved in accidents are to remain readily available for alcohol and/or drug testing and shall not
leave the accident scene until released by law enforcement, except as is necessary to obtain
emergency medical care or to obtain assistance in contacting the police.
Alcohol tests must be conducted within two (2) hours after the accident. Any employee involved
in such an accident while driving a MED-Star vehicle who does not remain readily available for
drug and alcohol testing following such an accident shall be deemed to have refused to submit to
testing and will be subject to discharge.
A post-accident breath or blood test for the use of alcohol or a urine test for the use of controlled
substances may be conducted by or at the direction of Federal, State, or local law enforcement
officials provided that the test conforms to the applicable requirements of the law.
REASONABLE SUSPICION TESTING
An employee may be required to submit to a urinalysis drug test or a breath alcohol test if, based
on objective circumstances, a supervisor has a reasonable suspicion that the employee while on
duty (911, Back-up, Call, transporting a patient, responding to a call, at any emergency scene, at
a training or practice exercise, or operating a MED-Star motor vehicle or equipment) is under the
influence of drugs or alcohol which adversely affects or could adversely affect the employee’s
performance of his/her duties or ability to operate vehicles or equipment.
Such reasonable suspicion must be based on specific observations concerning the appearance,
behavior, speech and/or odors of the employee and the observations must be documented.
Tests based on reasonable suspicion shall be promptly administered. If an alcohol test is not
administered within two (2) hours following a determination of reasonable suspicion, the reasons
for the delay must be documented and in no event shall the alcohol test be administered more
than eight (8) hours after the reasonable suspicion determination.
If a confirmed alcohol breath test shows any level of alcohol, a drug test result is positive, or the
employee fails or refuses to submit to a test or otherwise fully cooperate in the testing, the
reasonableness of the suspicion shall be conclusively presumed.
RECORDS
An employee shall, upon written request, be provided with copies of any records pertaining to
his or her use of alcohol or controlled substances, including any records pertaining to his or her
alcohol or controlled substances tests, contingent upon advance payment of reasonable copying
costs not to exceed $0.50 per page.
NOTIFICATIONS
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An employee whose test confirmed positive for any alcohol or controlled substance shall be
notified of the test results and which controlled substance or substances were confirmed as
positive.
If a medical review officer (doctor) or designee is unable to contact the employee who has tested
positive for alcohol or drugs, MED-Star shall make reasonable efforts to contact the employee
and request him or her to contact and discuss the test results with the medical review officer or
designee within twenty-four (24) hours.
DRUG AND ALCOHOL TESTING PROCEDURES
A summary and overview of the drug and alcohol testing procedures are explained below. These
procedures for the most part are consistent with the DOT Drug and Alcohol Testing Procedures
set forth in 49 CFR, Part 40.
PROCEDURES FOR URINE SPECIMEN DRUG TESTING
The specimen collection and testing procedures for urinalysis tests are designed to insure the
integrity and accuracy of the testing process. Test will be conducted through a designated
laboratory. When the employee arrives at the testing facility, he or she must show photo
identification. If the employee does not have photo identification, he or she must identify him or
herself by Social Security Number, EMT license number, or Paramedic license number,
signature and be verified by a supervisor of MED-Star.
The employee may retain a pocket size wallet, but all coats, jackets, and other outer garments,
and all purses, briefcases and other containers must be left outside the restroom or other urine
specimen collection site.
The employee will be instructed to wash and dry his or her hands. All specimens should be split
specimen collections. The employee will then be supplied with one (or in some instances two)
clean, single-use specimen bottles, each enclosed in wrapper and marked with a unique number.
The bathroom or other collection site will be private and made secure against access by a third
person.
Absent objective evidence of attempted alteration, adulteration, or substitution of the specimen,

the employee will be alone and unobserved when the urine specimen is given. Immediately after
the urine specimen has been collected, the laboratory technician will visually inspect and
measure the temperature of the specimen. The bottle will be promptly sealed with a tamper
proof seal.
The employee must initial the identification label of the specimen bottle and complete the
signature part of a standard printed custody and control form certifying that the identification
documents provided by the employee are accurate. Failure to initial the bottle label or to
complete and sign the certification form will be deemed a refusal of the test and grounds for
termination from MED-Star.
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If the employee being tested is unable to provide the necessary quantity of urine, the employee
will be required to drink up to twenty-four (24) ounces of water and after waiting no more than
two (2) hours; the employee must attempt to provide an adequate urine sample using a fresh
specimen bottle. If the donor is unable to provide a urine specimen of 60 ml, then he/she is
required to drink at least 40 fluid ounces over a three (3) hour period. If the employee is still
unable to provide an adequate urine sample, a medical examination may be required to determine
whether the claimed inability is genuine or contrived. If the inability to provide an adequate
urine sample is determined upon medical examination by a medical professional to be contrived,
the employee shall be deemed to have refused to give a urine specimen and shall be subject to
termination.
If there is any objective reason to believe that the employee giving the urine sample has altered,
contaminated or substituted the specimen, a second specimen shall be collected as soon as
possible thereafter under the direct observation of a same gender laboratory assistant or
technician.
Laboratories where urinalysis drug tests are conduct shall be licensed by the Federal Department
of Health and Human Services. Laboratories shall use chain of custody procedures to maintain
control and accountability of specimens from receipt through completion of testing, and
continuing until the final disposition of specimens. The date and purpose shall be documented
on an appropriate chain of custody form each time a specimen is handled or transferred and
every individual in the chain shall be identified.
The initial controlled substance test shall use an immunoassay. All specimens identified as
positive on the initial test shall be confirmed using gas chromatograph/mass spectrometry
techniques for each drug by quantitative analysis. If the initial test is positive but the
confirmatory test is negative, the test result is considered negative. The laboratory reports the
test results to a licensed physician shall report to MED-Star whether the test is positive or
negative and may report the drug(s) for which there is a positive test, but shall not disclose to
MED-Star the amount of the drug found. The amount of a drug for which a confirmed positive
test was obtained may be disclosed in a grievance, lawsuit, or other proceeding initiated by the
employee.
A positive drug test result does not automatically identify an employee as having used drugs in
violation of this policy or DOT Regulations. A physician will review all positive test results to
determine whether there is a possible alternate medical explanation. The doctor shall also review
the chain of custody documentation to ensure that it is complete and appears to be accurate.
Prior to making a final decision to verify a confirmed positive test result of an individual the
doctor shall attempt to contact the individual directly and give him or her an opportunity to
confidentially discuss the test results. If the doctor is unable to reach the individual, the doctor
will contact a MED-Star supervisor who will attempt to contact the employee for the purpose of
instructing the employee to contact the doctor.
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Any employee who has tested positive for any controlled substance shall be suspended from
participating in all MED-Star activities, until the doctor completes the review process and either
verifies the confirmed test results to be positive or cancels the test results.
If the single sample method of collection was used, the doctor shall notify the employee who has
a confirmed positive test result that the employee has seventy-two (72) hours in which to request
a reanalysis of the original sample by the same or different laboratory. If the reanalysis fails to
reconfirm the presence of the drug or drug metabolite, the doctor shall cancel the test. If the
employee fails to contact the doctor within seventy-two (72) hours because of an illness, injury,
or other legitimate reason, the doctor may order a later reanalysis.
The doctor shall not disclose to any third party medical information provided by the employee as
part of the testing review and verification process, except that the doctor may disclose such
medical information to MED-Star if in the doctor’s reasonable medical judgment, the medical
information indicates that the continued performance by the individual safety-sensitive
emergency services functions could pose a significant safety risk.
Before obtaining medical information as part of the medical test review process, the doctor shall
inform the employee of the circumstances under which such medical information may be
disclosed and to whom.
PROTECTION OF RECORDS
Upon written request, an employee shall have access to any records relating to his or her drug
test. Laboratories shall maintain test records in confidence to the same extent as provided in
DOT Regulations.
ALCOHOL TESTING
Breath alcohol tests shall be conducted only by a breath alcohol technician adequately trained in
the operation of the evidential breath-testing device being utilized.
The triplicate copy breath alcohol testing form prescribed by DOT Regulations is recommended
to be used in connection with all breath alcohol tests. When an employee enters an alcohol
testing location, the breath alcohol technician will require him or her to provide positive
identification. The employee must date and sign the breath alcohol testing form certifying that
the identifying information provided is true and correct.
If the result of the screen test detects, determines, or results in any concentration of alcohol, a
confirmation alcohol breath test shall be performed.
Refusal by an employee to complete and sign the breath alcohol testing form, to provide breath,
to provide an adequate amount of breath, or otherwise cooperate with the testing process in a
way that prevents the completion of tests, shall be grounds for termination of the employee from
MED-Star.
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Except as required by law, or in connection with a grievance claim or lawsuit by the affected
employee, MED-Star shall not disclose information relating to breath alcohol tests.
Upon written request an employee shall be given copies of any records pertaining to the
employee’s use of alcohol, including alcohol test records, provided that the employee pays in
advance the reasonable cost of making such copies.
The specimen collection and testing procedures for urinalysis tests are designed to ensure the
integrity and accuracy of the testing process. Tests will be conducted at a laboratory of choice
by MED-Star Paramedic Ambulance, Inc. All costs associated with the testing will be borne by
MED-Star Paramedic Ambulance, Inc.
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Title Corporate Computers, Technology, Networks, And Internet Use
Section Personnel And Staff
Policy No. 2-15
MED-Star Paramedic Ambulance, Inc. (hereinafter “Company”) provides computers,

technology, networks, and Internet services for the specific and limited purpose of achieving the
Company’s mission, goals, and purposes. Company computers, technology, networks, and
Internet services remain at all times the property of the Company.
Use of Company computers, technology, networks, and Internet services does not create any
expectation of privacy. The Company reserves the right to search and/or monitor any
information created, accessed, sent, received, and/or stored in any format by any Company
employee on Company equipment or any equipment connected to the Company’s network and/or
Internet access.
Passwords, which allow access to networks, data, and hardware, need to be protected at all times.
Employees are not to disclose confidential information to unauthorized individuals.
Users may encounter material they interpret as controversial, inappropriate, or offensive. It is

impossible to completely define such content. It is the user’s responsibility not to access such
material using the Company’s computers and technology. Examples of inappropriate uses that
are prohibited include, but are not necessarily limited to, the following:
 Anything prohibited by law;
 Activities that would subject the Company or the individual to criminal, civil, or
administrative liability;
 Harassing, insulting, or attacking others;
 Sending or displaying intimidating, hostile, offensive, or hate related material;
 Using obscene language or intentionally accessing or possessing obscene or
pornographic material;
 Internet gaming/gambling;
 Possession or use of any tools, programs, or technologies designed for probing,
monitoring, or breaching the security of the network or infecting the network with a
virus;
 Advertising or promoting non-Company commercial endeavors; and
 Participating in non-Company approved forums, chat rooms, or exchanges.
EMPLOYEES IN VIOLATION OF THIS POLICY WILL BE SUBJECT TO DISCIPLINARY

ACTION UP TO AND INCLUDING DISMISSAL.
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Title Gifts, Honoraria, Tipping and Gratuities
Policy No. 2-16
A gift/honorarium received by an employee for services he/she provides to another organization

is to be endorsed over to MED-Star Ambulance if the employee was representing MED-Star or
was issued the invitation because of his / her position with MED-Star.
Tips or gratuities are not to be accepted. Gifts offered to you by patients may be accepted
provided such gifts are nominal in value, such as candy or flowers (not valued in excess of $50).
If you have any questions contact a Supervisor.
SOLICITING GIFTS, HONORARIA, TIPS AND/OR GRATUITIES FROM PATIENTS OR

THE ENTITIES THAT WE SERVE IS STRICTLY PROHIBITED.
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Title Employee Issued Equipment / Supplies
Policy No. 2-17
MED-Star assures that staff members are issued equipment and supplies to accomplish their jobs
in a safe and efficient manner.
Upon receipt of the equipment/supplies, you will be asked to sign and date the checklist.
Employees are responsible for all supplies and equipment issued. If items are lost due to neglect
or damaged due to abuse, you may be required to pay for replacement or repair.
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Title Uniforms / Dress Code
Policy No. 2-17-1
Employee Dress Code
All personnel are to wear their uniforms properly at all times when outside of quarters and in
public when on duty. Your uniform must remain clean, unwrinkled, neat, and in good repair.
Uniform items that are faded, torn, or worn are not acceptable. Please get those items replaced as
soon as possible.
 Only MED-Star uniform items may be worn while on duty.
 A white, gray, or black t-shirt is the only items that may be visible under a
uniform shirt.
 You must wear your assigned radio, pager, and cell phone at all times when on
duty.
Uniform items include:
 Black EMS pants
 Green MED-Star polo shirt
 Any Black shoes or boots with "postal approved" traction, must be clean.
 Appropriate and proper badge and nametag
You are responsible for the care and maintenance of your uniforms. You should always have
spare uniform items available. If for any reason your uniform becomes soiled during your shift,
you are to return to quarters for your own spare uniform. If your uniform is damaged beyond
cleaning or repair while working at a scene, please see your supervisor for assistance in replacing
it.
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Title Wearing Uniform When Not On Duty
Policy No. 2-17-2
No MED-Star employee shall wear an identifiable uniform item when not on duty.
This particularly applies to wearing an identifiable uniform item in an establishment that serves
alcohol. If it is your intention to go out after work you should plan to have a change of clothes.
ANY OFF DUTY EMPLOYEE OBSERVED WEARING AN IDENTIFIABLE UNIFORM
ITEM IN AN ESTABLISHMENT THAT SERVES ALCOHOL WILL BE SEVERELY
DISCIPLINED UP TO AND INCLUDING DISCHARGE.
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Title Personal Hygiene And Appearance
Policy No. 2-17-3
All personnel are required to present themselves at the beginning of their shift as someone proud
to represent this organization and your profession. This presentation includes your personal
hygiene. It is imperative that all employees are clean, showered, and presentable.
If an individual is emitting a malodorous air, from a uniform or his or her person, it is not fair to
patients or partners. The offending party will be requested to shower or wash the uniforms at the
base or asked to leave by the supervisor for the remainder of the shift. There will be no pay for
this time lost. We are a professional organization and must present ourselves as such 24 hours
per day 7 days a week.
Hair must be short and neat at all times. Employees should wear their hair short or pinned back
for their own safety. Unnaturally colored hair is not permitted, i.e. purple, orange, red, etc.
Mustaches must be neat and trimmed. All personnel must be clean-shaven.
Male employees are prohibited form wearing earrings while on duty. Female employees may not
wear earrings that hang down. Facial jewelry of any type is not permitted. MED-Star discourages
the wearing of large rings while on duty.
Employees should not wear heavy cologne or perfume while on duty. Your taste may not be that
of another. Some patients may be allergic or made uncomfortable by these products.
ALL PERSONNEL MUST PRESENT A PROFESSIONAL IMAGE, IN THE DISCRETION

OF THE COMPANY, AT ALL TIMES.
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Title Corrective Action
Policy No. 2-18
Policy
MED-Star Paramedic Ambulance acknowledges that employees can occasionally make bad
decisions or mistakes. MED-Star will utilize a formal Corrective Action Program. In most
instances a three tiered system of Formal Corrective Action will be utilized which is listed
below:
1. Verbal Warning
2. Written Warning
3. Suspension without pay up to Termination
Each Corrective Action will list the infraction, a plan of correction and follow up terms.
Employees will be given the opportunity to comment in writing and will be given a copy of the
Corrective Action Form for their records. Corrective Action Forms will be placed in the
employee’s HR file.
MANAGEMENT DOES RESERVE THE RIGHT TO VARY FROM THIS TIERED SYSTEM
AS IT DEEMS NECESSARY DUE TO THE SEVERITY OF THE CONDUCT, BEHAVIOR,
AND/OR INSUBORDINATION.
MED-STAR, IN ITS SOLE DISCRETION, WILL DETERMINE WHEN TO WARN,

SUSPEND, OTHERWISE DISCIPLINE OR DISCHARGE EMPLOYEES IN THE MANNER
AND DEGREE MED-STAR DEEMS APPROPRIATE.
Progressive Discipline
Generally, MED-Star adheres to a progressive discipline policy; however, MED-Star may begin
the discipline process at any step, or advance to any step at MED-Star’s sole discretion based on
the circumstances.
The levels of discipline are as follows:

1. Verbal Warning
2. Written Warning
3. Suspension
4. Termination of Employment
All levels of discipline shall be documented on an Employee Corrective Action Form. Each
Employee Corrective Action Form will describe the infraction and state a plan of correction and
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follow up terms. Employees will be given the opportunity to comment in writing and will be
given a copy of the Corrective Action Form for their records. Corrective Action Forms will be
placed in the employee’s HR file.
Use of Disciplinary Action
Supervisors and management staff are authorized to use disciplinary action in varying degrees.
 Supervisors are authorized to issue Verbal Warnings, Written Warnings, Suspensions,
and Termination to any employee other than a fellow supervisor.
 The President/CEO is authorized to issue all levels of disciplinary action. The
President/CEO is authorized to discipline any employee, including supervisors.
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Title Overview
Section Safety and Risk Management
Policy No. 3-1
Introduction
Good safety risk management awareness and practice at all levels is a critical success factor for
any EMS organization. Risk is inherent in everything that an EMS organization does: treating
patients, determining service priorities, managing a project, purchasing new medical equipment,
making decisions about future strategies, or even deciding not to take any action at all. The
MED-Star Risk Management Strategy provides the framework for the management of all risks,
including organizational, financial, and clinical risks at every level of the organization. The aim
of the strategy is to create a more coordinated, systematic, and focused approach to the
management of risk.
Strategy objectives
1. Raise the quality of care provided by MED-Star to patients, employees, and others
through the identification, control, and elimination or reduction of all risks to an
acceptable level.
2. Understanding the underlying causes of adverse incidents and ensure that lessons are
learned from the experience.
3. Ensure that managers and staff at all levels in the organization are clear of their personal
responsibilities with regard to risk management.
4. Understand the many risks faced by MED-Star, their causes and cost and to transfer risks
where unacceptable or unavoidable.
5. Provide a safe environment and facilities for patients, employees, and visitors.
6. Minimize the costs diverted to risk funding.
7. Maximize the resources available for patient services and care.
Overview
MED-Star is firmly committed to maintaining a safe and healthy work environment. To achieve
this goal, MED-Star has implemented comprehensive safety policies. These policies are
designed to prevent workplace injuries, accidents, and illnesses.
The success of any safety program depends on the safety consciousness and cooperation of
everyone in the organization. Employees at every level are expected to assist MED-Star in the
prevention of workplace accidents and injuries and are expected to follow all safety and health
rules. It is the duty of each employee to adhere to all safety rules and to report any potential
safety hazards to his or her supervisor immediately.
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ANY INJURY THAT OCCURS ON THE JOB, EVEN A SLIGHT CUT OR STRAIN, MUST
BE REPORTED IMMEDIATELY TO A SUPERVISOR.
Workers’ Compensation insurance is provided according to State law for occupational injuries or
diseases. MED-Star pays for the cost of this insurance.
ALL EMPLOYEES ARE RESPONSIBLE FOR WORKING SAFELY AND MAINTAINING A

SAFE AND HEALTHY WORK ENVIRONMENT.
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Title Duties of Employees
Policy No. 3-2
Duties of Supervisors
All supervisors are responsible for the safety and health of the employees of MED-Star and for
the safety and health of individuals who interact with MED-Star. To fulfill this duty, each
supervisor must:
1. Become familiar with all applicable safety and health laws and regulations and to be
familiar with the organization’s rules and policies relating to workplace safety and health;
2. Ensure that all employees are properly trained in workplace safety and health. This
includes training in general safe work practices, as well as specific instruction with
respect to hazards specific to each employee’s job assignment.
3. Ensure that all employees do, in fact, perform their work in a safe and healthy manner
consistent with the organization’s rules and policies;
4. Take all reasonable steps necessary to avoid unsafe working conditions, accidents,
injuries, and illnesses;
5. Regularly inspect MED-Star offices and its equipment for workplace hazards and submit
a written report to the President/CEO of any unsafe workplace conditions;
6. Ensure that unsafe and unhealthy working conditions are corrected promptly; and
7. Immediately report all workplace accidents, injuries, illnesses, or “near misses,” to the
President/CEO.
Duties of Employees
All employees are required to conduct themselves in a manner consistent with MED-Star’s
safety rules and policies. To fulfill this duty, each employee must:
1. Comply with all organizational safety rules, policies, and procedures;
2. Comply with all organizational operating rules, policies, and procedures;
3. Immediately report all workplace accidents, injuries, or illnesses involving the employee,
or to which the employee is a witness, to a supervisor; and
4. Immediately report all unsafe conditions or hazards to a supervisor or President/CEO.
Employees may report such conditions or hazards anonymously.
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Title Patient Safety
Policy No. 3-3
Transferring
All patients will be transferred to or from the ambulance on the stretcher when necessary.
Patients who are readily ambulatory can be walked under close supervision. Any patient, family
member or passenger must be supervised and assisted by a crew member or other EMS worker
upon ingress/egress from the ambulance.
 STRETCHER PATIENTS WILL ALWAYS BE SECURED TO THE STRETCHER
WITH STRAPS AND SHOULDER HARNESS.
 When transporting a patient on a stretcher the patient will be turned on a level surface and
brought head first to the waiting ambulance.
 When rolling a stretcher patient, the stretcher should be maintained at one-half height and
must be carefully handled by both crew members.
 NEVER LEAVE A STRETCHER PATIENT UNATTENDED.
These precautions serve to prevent patient tipping injuries.
Carrying
When carrying a patient down stairs, the patient always travels feet first when sitting up and feet
first when lying flat.
WHENEVER AN EMPLOYEE DOES NOT BELIEVE THAT HE OR SHE IS ABLE TO

SAFELY LIFT OR CARRY A PATIENT, THE EMPLOYEE IS REQUIRED TO CALL FOR A
LIFT ASSIST. ALWAYS ERR ON THE SIDE OF CAUTION AND CALL FOR A LIFT
ASSIST IF YOU THANK THAT YOU MAY NEED ONE.
NEVER SEEK ASSISTANCE FROM OR ALLOW ANY UNTRAINED BYSTANDER TO

AID IN MOVING ANY PATIENT.
When transporting a patient on a scoop stretcher or backboard, at least three straps must be used
to secure the patient. For patient and employee safety, the patient is transferred to the stretcher
in a lowered position. The restraints from the stretcher are then used to secure the patient and
backboard.
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Title Vehicle Accidents
Policy No. 3-4
Vehicle Accidents
When you consider the amount of time you spend driving, your chance of a vehicle accident
certainly increases by virtue of being on the road so frequently. It is understandable that some
vehicle accidents are avoidable, while others are not.
As an employee of MED-Star, you have been instructed in the safe operation of an emergency
vehicle by supervisors and senior employees. It is imperative to understand exactly what to do if
you find yourself in a company vehicle accident.
General Guidelines
VEHICLE ACCIDENT INFORMATION
If you are involved in a vehicle accident with a company vehicle:

 All vehicle accidents involving company vehicles must be reported immediately to
dispatch. If you are injured and are unable to visually assess the situation notify dispatch
of what kind of help you require. If you are not injured, you are to assess the situation
and instruct dispatch of the help you require. It is important to render medical assistance
to any other party involved.
 All vehicle accidents involving a company vehicle must be reported to a supervisor as
soon as practicable. If a supervisor is the driver, passenger, or crew member of the
company vehicle involved in the accident, that supervisor must report the accident to a
fellow supervisor or President/CEO as soon as possible.
 All accident reports must be completed and submitted by all crew members prior to the
end of the crew members’ shift.
 All employees will document any injuries sustained. Any employee involved in an
accident will not make any statement to anyone on scene, aside from the responding
officer and a supervisor.
At a minimum the following information should be obtained:

 Name and address of the operator of the other vehicle
 Name and address of the owner of the other vehicle
 Make, model, and year of the other vehicle
 Registration number of the other vehicle
 Driver’s license number/state of the operator of the other vehicle
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 Insurance company providing coverage on the other vehicle
 Names and addresses of all passengers in the other vehicle
 Names and addresses of all injured parties
 Location and time of the accident
 Damage sustained to all vehicles
 Name of responding law enforcement officer
If you have a camera or cell phone available, take pictures of:

 All four (4) sides of the ambulance with close up photographs of the damaged areas
 All four (4) sides of the other vehicle(s) involved in the accident with close up
photographs of the damaged areas
 The street behind and ahead of the vehicle accident
 Any stationary objects involved in the vehicle accident
Accident Investigation and Review
All company vehicle accidents will be investigated in a timely manner. Minor incidents and near
misses will be investigated as well as serious accidents. A near miss is an incident that, although
not serious, could have resulted in a serious injury or significant property damage. Investigation
of these instances may avoid serious accidents in the future.
A supervisor, President/CEO, or designate must investigate all company vehicle accidents. After
investigating an accident, a written accident report must be completed. The President/CEO will
ensure that the investigation was thorough and that proper action has been taken to avoid similar
accidents in the future.
NO INDIVIDUAL MAY BE DESIGNATED TO INVESTIGATE A VEHICLE ACCIDENT

WHO WAS THE DRIVER, PASSENGER, OR CREW MEMBER OF THE COMPANY
VEHICLE INVOLVED IN THE ACCIDENT.
All accidents shall be investigated as soon as possible. In conducting an inquiry, the party
investigating the accident, at a minimum, shall:
 Visit the accident scene if possible. This will ensure the facts are still fresh in the
witnesses’ minds.
 The investigator should interview the employee as soon as the employee is physically and
mentally able.
 Interview witnesses to the accident either at the scene or as soon after the accident as
possible.
 Document details graphically, using photographs, sketches, or diagrams wherever
appropriate.
 Submit a written accident report.
 Save or preserve all physical evidence.
All accident reports shall be reviewed by the investigator and the President/CEO. The
investigator shall provide the President/CEO will recommendations as to disciplinary action, if
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any. The President/CEO may accept the investigator’s recommendation or reject the
investigator’s recommendation. In the event the President/CEO rejects the investigator’s
recommendation, the President/CEO shall determine the extent, severity, and level of
disciplinary action. All accidents may subject the employee(s) to disciplinary actions.
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Title Ambulance Mechanical Breakdowns
Policy No. 3-4-1
When transporting a patient, duty crew shall handle the incident in a manner that is in the best
interest of the patient. If unit is transporting a critical patient, duty crew should contact 911 via
cell phone or the appropriate communications center by radio to dispatch the closest available
ambulance. After calling for transport, On Duty Supervisor should be notified. If ALS services
our needed and a BLS service responds, duty medic and ALS equipment will accompany patient
to an appropriate medical facility. If patients condition allows, On Duty Supervisor should be
immediately notified to assist with making patient transportation arrangements.
On Duty Supervisor and/or a member of the management team will be in charge of making tow
and service provider arrangements.
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Title Exposure Control Plan Education
Policy No. 3-5
Employees will review and follow MED-Star Employee Control Plan.
Infection control, Body Substance Isolation and Universal Precautions training shall be done
during new employee orientation prior to employee working in field. Continuing education shall
be done on a yearly basis with all employees who participate in patient care activities.
Records of initial training and annual training shall be kept in the employee's continuing
education file.
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Title Exposure Control Plan
Policy No. 3-5-1
MED-Star Paramedic Ambulance Inc. (MED-Star) is committed to providing a safe and

healthful work environment for our entire staff. In pursuit of this endeavor, the following
Exposure Control Plan (ECP)is provided to eliminate or minimize occupational exposure to
bloodborne pathogens in accordance with OSHA standards.
This ECP is a key document to assist our organization in implementing and ensuring compliance
with the standard, thereby protecting our employees. This ECP includes:
1. Program Administration
2. Determination of employee exposure
3. Implementation of various methods of exposure control including:
a. Universal Precautions
b. Engineering and work practice controls
c. Personal protective equipment
d. Housekeeping
– Ambulance Cleaning Procedure
– Equipment Cleaning Procedure
4. Hepatitis B vaccination and antibody testing when appropriate.
5. Post-exposure evaluation and follow-up
6. Administration for post-exposure evaluation and follow-up
7. Evaluating the circumstances surrounding and exposure
8. Communication of hazards to employees and training.
9. Recordkeeping
10. Tuberculosis Policy
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11. Definitions
The methods of implementation of these elements of the standard are discussed in the subsequent
pages of this ECP.
PROGRAM ADMINISTRATION
ThePresident/CEO and Supervisors are the designated Officers, and are responsible for the
implementation of the ECP. The Officers of the service will maintain, review, and update the
ECP at least annually, and whenever necessary to include new or modified tasks and procedures.
The Operations Manager and Supervisors are classified as “Infectious Control Officers” for
MED-Star. These persons will be responsible to oversee all bloodborne pathogens for the service
and record them appropriately.
All employees who are determined to have occupational exposure to blood or other potentially
infectious materials (OPIM) must comply with the procedures and work practices outlined in this
ECP.
MED-Star will maintain and provide all necessary personal protective equipment (PPE),
engineering controls (e.g. sharps containers), labels, and red bags as required by the standard.
The Operations Manager and Supervisors will ensure that adequate supplies of the
aforementioned equipment are available in the appropriate sizes.
The Officers of MED-Star will be responsible for ensuring that all medical actions required are
performed and that appropriate employee health and OSHA records are maintained.
The Officers will be responsible for training, documentation of training, and making the written
ECP available to employees, OSHA, and NIOSH representatives.
If it is determined that revisions need to be made, the Officers will ensure that appropriate
changes are made to this ECP. (Changes may include an evaluation of safer devices, adding
employees to the exposure determination list, etc.)
EMPLOYEE EXPOSURE DETERMINATION
The following is a list of all job classifications within our organization in which all employees
have occupational exposure:
1. First Responders & EMT-Basics

2. EMT-Intermediates, Paramedics and RN’S
3. Officers of MED-Star
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METHODS OF IMPLEMENTATION AND CONTROL
Universal Precautions
All employees within MED-Star will utilize universal precautions:
1. Uniforms must be worn on every run. Jackets are additional to these.
2. Gloves will be worn on every call prior to attending to a patient.
3. Every attendant will wash their hands after removing gloves, preferably at the location
the patient was delivered.
4. Gloves will be disposed of properly, in a waste receptacle if unsoiled, in a biohazard

bag if possibly soiled with infectious waste.
5. CPR will be performed with a Microshield, pocket mask or bag valve mask.
Exposure Control Plan
All employees covered by the bloodborne pathogens standard receive an explanation of this ECP
during their initial training and orientation session. The plan will also be reviewed in employee’s
annual refresher training. All employees have access to this plan at any time by looking it up in
the organizational book located in each of the ambulances, in the training room and online. A
copy of the ECP will be provided to any employee that requests one. The copy will be submitted
to the employee within 15 working days of the request.
The Officers are responsible for reviewing and updating the ECP annually or more frequently, if
necessary, to reflect any new or modified tasks and procedures, which affect occupational
exposure and to reflect new or revised employee positions with occupational exposure. The
annual update documentation will include:
1. An assessment of technology changes that can reduce exposures.
2. An assessment of appropriate commercially available and effective safer medical

devices designed to eliminate or minimize occupational exposure.
3. Methods used for soliciting the input from non-managerial employees in the
identification, evaluation and selection of effective engineering and work practice
controls.
1. Engineering Controls & Work Practices
1. Engineering controls and work practice controls will be used to prevent or minimize
exposure to bloodborne pathogens. The specific engineering controls and work
practice controls used are listed below:
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1. Protect IV plus needles
2. Needle-less IV system
3. Needle safe syringes
4. Needle safe lancets
Sharps containers are inspected, maintained or replaced by the Director or Operations Supervisor
whenever necessary to prevent overfilling.
MED-Star Ambulance identifies the need for changes in engineering control and work practices
through reviewing past OSHA records, employee interviews and committee activities.
Our service evaluates the need for new products/procedures through open discussion at monthly
meetings and through committee activities. The Officers and all employees are involved in this
process.
The Director will ensure effective implementation of these recommendations.
1. Personal Protective Equipment

PPE is provided to our employees at no cost to them. Training is provided by the Officers in the
use of the appropriate PPE for the tasks or procedures employees will perform.
The types of PPE available to employees are as follows:
1. Non-disposable = Jumpsuits, uniforms and jackets
2. Disposable = gloves, jumpsuits, gowns, booties and eye protection.
The Director issues non-disposable PPE to an employee after the completion of orientation to the
service, but prior to performing any ambulance related job. Any non-disposable PPE that no
longer performs to its standard is to be brought to the attention to the Officers for immediate
replacement/repair. Replacement PPE will be issued by the Director. All non-disposable PPE is
to remain in the ambulance bay to decrease potential contamination of personal items.
All disposable PPE is located inside the ambulances and storage room in the building. The
officers of the service are responsible for ensuring appropriate disposable PPE is available to
employees.
Employees are responsible to notify an officer if they know of a deficiency or problem with any
disposable PPE.
All employees using PPE must observe the following precautions:
1. Wash hands immediately or as soon as feasible after removal of gloves or other

PPE.
2. Never wash or decontaminate disposable gloves for reuse.
3. Remove PPE after it becomes contaminated and before leaving the work area.
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4. Used PPE may be disposed of in the garbage unless contaminated with infectious
substances then they must be disposed of in a red biohazard bag.
5. Wear appropriate gloves when it can be reasonably anticipated that there may be
hand contact with blood or OPIM and when handling or touching contaminated
items or surfaces.
6. Replace gloves if torn, punctured, contaminated, or if their ability to function as a

barrier is compromised.
7. Utility gloves may be decontaminated for reuse if their integrity is not

compromised. Utility gloves must be discarded if there are any signs of cracking,
peeling, tearing, puncturing, or deterioration.
8. Wear appropriate face and eye protection when splashes, sprays, spatters, or
droplets of blood or OPIM pose a hazard to the eye, nose or mouth.
9. Remove immediately or as soon as feasible any garment contaminated by blood or

OPIM, in such a way as to avoid contact with the outer surface of other garments
or your skin.
The procedure for handling used PPE is as follows:
1. Non-Disposable
1. Upon contamination of an ambulance personnel’s clothing/garments, the

contaminated item(s) must be removed as soon as possible and placed into
a biohazard bag. The Infection Control Officer must be notified
immediately so the appropriate actions may be taken.
2. Any other non-disposable PPE may be washed at the ambulance station as

needed.
1. Disposable
1. All disposable PPE is discarded. Non-contaminated PPE may be discarded

in general garbage. All contaminated PPE should be discarded in red
biohazard bags/containers located in each ambulance and at the hospital.
2. Housekeeping
Regulated waste is placed in red biohazard containers, which are closeable, constructed to
contain all contents and prevent leakage. The containers shall be closed prior to removal to
prevent spillage or protrusion of contents during handling.
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Sharps disposal containers should be placed in the red biohazard containers at Area Hospital. No
full sharps containers shall be discarded at the ambulance station.
Contaminated sharps are discarded immediately or as soon as possible in containers that are
designated as sharps containers. The containers should be closable, puncture resistant, leak proof
and labeled as biohazard sharps. Sharps containers are located in each ambulance on the counter
and in the medical kits. If needle recapping is indicated, it should be done with a one handed
technique. The cap should then be taped on to prevent further exposure to the needle.
Emesis basins should be discarded in red biohazard containers at area hospital.
Broken glassware, which may be contaminated, is picked up using mechanical means, such as a
brush and dustpan and disposed of in an appropriate sharps container.
1. Labels
The following labeling methods are used by MED-Star:
EQUIPMENT TO BE LABELED LABEL TYPE

1. Contaminated laundry and specimens Red biohazard bags with biohazard label
2. Contaminated sharps Red biohazard sharps container w/ bio
label
3. All contaminated disposable equipment Red biohazard bags with biohazard label
(suction catheters, containers, etc.)
The Officers will ensure warning labels are affixed or red bags are used as required, if regulated
waste or contaminated equipment is brought into the facility. Employees are to notify the
infectious control officer if they discover regulated waste containers, contaminated equipment,
etc. without proper bags or labels.
Ambulance Cleaning Procedures
1. Adhere to all universal precautions.
2. Wear heavy rubber gloves to clean the ambulance.
3. Check surfaces of the ambulance for blood/body fluids and dispose of properly.
4. Prepare a solution of ¼ cup bleach to 1 gallon water.
5. Wash surfaces inside of the ambulance after each run or as needed. (include gurney)
6. Allow surfaces to air dry.
Potential Exposure Situation Protocol
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2. For potentially infectious body fluids:
A) soak up fluid with a paper towel and dispose of in a biohazard bag.

B) spray all surfaces, except floor, with disinfectant (Cavicide) and wipe clean.
C) scrub floor with bleach solution.
3. For airborne infectious diseases:
A) spray all surfaces, except floor, with disinfectant (Cavicide) and wipe clean.
B) spray the air with a disinfectant spray (e.g. Lysol).
C) scrub floor with bleach solution.
D) open doors to allow the ambulance to become well ventilated.
Equipment Cleaning Procedures
Single Use Equipment
1. All single use equipment will be treated as if contaminated.
2. Dispose of all single use equipment that has been in contact with a patient in biohazard bags or
containers.
Non-Disposable Equipment
1. Wash all non-disposable equipment with either a 4:1 water to bleach solution or a Cavicide
solution.
Potential Exposure Situation Protocol
1. Follow all universal precautions.

2. Dispose of all needles or sharps in a red sharps container immediately after use.
3. Dispose of all fluids in the toilet at the hospital.
4. Wash all non-disposable equipment thoroughly with soap and water to remove fluid.
5. Clean all non-disposable equipment thoroughly with Cavicide or any other approved
disinfectant.
HEPATITUS B VACCINATION
MED-Star Ambulance Service will provide training to employees on hepatitis B vaccinations,

addressing the safety, benefits, efficacy, methods of administration, and availability.
The hepatitis B vaccination series is available at no cost after EMS orientation and within 10
days of initial assignment to employees identified in the exposure determination section of this
plan. Vaccination is encouraged unless:
1. Documentation exists that the employee has previously received the series.
2. Antibody testing reveals that the employee is immune.
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3. Medical evaluation shows that the vaccination is contraindicated.
However, if an employee chooses to decline vaccination, the employee must sign a declination
form. Employees who decline may request and obtain the vaccination at a later date at no cost.
Documentation of refusal of the vaccination is kept in the employee’s medical record file at the
MED-Star Ambulance Station.
.
Following hepatitis B vaccinations, the health care professional’s written opinion will be limited
to whether the employee requires the hepatitis vaccine, and whether the vaccine was
administered.
One to two months following the HBV vaccination series, EMS personnel will be tested for
HBV surface antigens as indicated in MMWR.
Antibody testing for response to hepatitis B surface antigen will be provided.
POST-EXPOSURE EVALUATION & FOLLOW-UP
Should an exposure incident occur, immediately contact an officer of the service. (Preferably the
infectious control officer.)
An immediate and confidential medical evaluation and follow-up will be conducted by a Sioux
Falls Area Hospital. Following the initial first aid of cleaning the wound, flushing the eyes, or
mucus membranes, etc., the following activities will be performed:
Document the routes of exposure and how the exposure occurred.
Identify and document the source individual (unless the identification is

infeasible or prohibited by state or local law).
Obtain consent and make arrangements to have the source individual tested as
soon as possible to determine HIV, HCV, HBV infectivity. Document that
the source individual’s test results were conveyed to the employee’s health
care provider.
If the source individual is already known to be HIV, HCV, and/or HBV

positive, new testing need not be performed.
Assure that the exposed employee is provided with the source individual’s test
results and with information about applicable disclosure laws and
regulations concerning the identity and infectious status of the source
individual (e.g. laws protecting confidentiality)
After obtaining consent, collect exposed employee’s blood as soon as feasible

after exposure incident, and test blood for HBV and HIV serological
status.
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If the employee does not give consent for HIV serological testing during
collection of blood for baseline testing, preserve the baseline blood sample
for at least 90 days. If the exposed employee elects to have the baseline
sample tested during this waiting period, perform testing as soon as
feasible.
ADMINISTRATION OF POST EXPOSURE- EVALUATION & FOLLOW-UP

MED-Star Ambulance ensures that the health care professional(s), which are responsible for
each employee’s hepatitis B vaccination and post-exposure evaluation and follow-up, are given a
copy of OSHA’s bloodborne pathogen standard.
MED-Star Ambulance ensures that the healthcare professional evaluating an employee after an
exposure incident receive the following:
The employee’s job description.
The route(s) of exposure.
The circumstances of exposure.
Results of the source individual’s blood test (if possible)
Relevant employee medical records, including vaccinations.
MED-Star Ambulance will provide the employee with a copy of the evaluating health care
professional’s written opinion within 15 days after completion of the evaluation.
EVALUATING THE CIRCUMSTANCES OF AN EXPOSURE INCIDENT
MED-Star will review the circumstances of all exposure incidents to determine:
Engineering controls in use at the time.
Work practices followed.
A description of the device being used.
Protective equipment or clothing that was used at the time of the exposure
incident. (jumpsuit, uniform, gloves, face mask, etc.)
Location of the incident. (ambulance, residence, hospital, etc.)
Procedure being performed when the incident occurred.
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Employee’s training status.
The Officers shall maintain a sharps injury log for the recording of percutaneous injuries from
contaminated sharps. The information in the sharps injury log shall be recorded and maintained
in such a manner as to protect the confidentiality of the injured employee. The sharps injury log
shall contain, at a minimum:
1. The type and brand of device involved in the incident.
2. The area where the exposure incident occurred (inside ambulance,

residence, hospital, etc.)
3. An explanation of how the incident occurred.
EMPLOYEE TRAINING
All MED-Star Ambulance employees who have occupational exposure to bloodborne pathogens
receive training conducted by the Director or Supervisor of MED-Star Ambulance Service.
MED-Star Ambulance may supply training to employees of outside organizations, which have
exposure to bloodborne pathogens with our organization, as well.
All MED-Star Ambulance employees who have occupational exposure to bloodborne pathogens
receive training on the epidemiology, symptoms, and transmission of bloodborne pathogen
diseases including HIV, HBV and HCV. In addition, the training program covers, at a minimum
the following elements:
A copy and explanation of the standard.
An explanation of this ECP and where to obtain a copy.
An explanation of methods to recognize tasks and other activities that may

involve exposure to blood and OPIM, including what constitutes an
exposure incident.
An explanation of the use and limitations of engineering controls work

practices, and PPE including specific training on the sharps used.
An explanation of the types, uses, location, removal, handling,

decontamination, and disposal of PPE.
An explanation of the basis for PPE selection.
Information on the hepatitis B vaccine, including information on its efficacy,

safety, method of administration, the benefits of being vaccinated, and that
the vaccine will be offered free of charge.
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Information of the appropriate actions to take and persons to contact in an
emergency involving blood or OPIM.
An explanation of the procedures to follow if an exposure incident occurs,

including the method of reporting the incident and the medical follow-up
that will be made available.
Information on the post-exposure evaluation an follow-up that the employer is

required to provide for the employee following an exposure incident.
Information on timely reporting of an exposure indicent so that the chemical

prophylaxis, if appropriate, can be administered in a timely monner in
order to be effective.
An explanation of the signs, labels and/or color-coding required by the

standard and used within this organization.
An opportunity for interactive questions and answers with the person

conducting the training.
Training materials for this organization are located in the storage room and training room.
RECORDKEEPING
1. Training Records
Training records are completed for each employee upon completion of training. These
documents will be kept for at least three years in the MED-Star Ambulance training records.
The training records include:
1. Date of training session.
2. Instructor and qualifications
3. Summary of training session
4. Signatures of employees, which attended the session.

Employee training records are provided upon request to the employee or the employee’s
authorized representative within 15 working days. Such requests should be addressed to
MED-Star Ambulance Service.
2. Medical Records
Medical records are maintained for each employee with occupational exposure in accordance
with 29 CFR 1910.20, “Access to Employee Exposure and Medical Records.”
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The Officers are responsible for maintaining the required medical records. These confidential
records are kept in each employee’s file in the office of the service. They are kept the duration of
employment plus 30 additional years.
Employee medical records are provided upon request of the employee or to anyone having
written consent of the employee within 15 working days. Such requests should be addressed to
the MED-Star Ambulance Service at 916 E Redwood Blvd Brandon, SD 57005.
3. OSHA Recordkeeping
All work related needlestick injuries and cuts from sharp objects that are contaminated with
blood or OPIM are recorded as and injury on the OSHA Injury and Illness log (300) by
MED-Star. In addition, they will be logged on the Needlestick and Sharps Injury Log and also
“Privacy Case” Log as deemed necessary.
A non-sharps exposure incident is evaluated to determine if the case meets OSHA’s
Recordkeeping Requirements (29 CFR 1904). MED-Star does this determination, as well as the
recording activities.
The privacy of employees will be protected by not recording the names of individuals on the
OSHA Injury and Illness log. (OSHA 300) These employees will be logged as “privacy case.”
All other provisions of the OSHA record keeping rules (29 CFR 1904) will be
followed.
TUBERCULOSIS POLICY
Transmission of Disease
Tuberculosis is carried through the air in an infectious droplet nuclei of 1-5 microns in size.
These droplet nuclei may be generated when a person with T.B. coughs, speaks, breathes or
spits.
Workplaces with the greatest incident of T.B. cases:
health care settings / long term facilities for the elderly
correctional institutions
homeless shelters
drug treatment centers
Signs and Symptoms
productive cough that lasts more than 2 weeks
coughing up blood
weight loss
loss of appetite
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weak/lethargic
night sweats or fever
Universal Precautions (In addition to previously listed)
1. All ambulance attendants will wear a T.B. mask or hepa respirator mask.
2. Any bodily fluids from the mouth or nose will be disposed of in a biohazard container.
3. Whenever a patient is coughing, spitting, or being suctioned, a T.B. mask will be worn.
4. Notify the hospital of any patient exhibiting any of the above signs or symptoms.
Significant Exposure Protocol
2. In a known case of T.B. apply a mask to the patient as well as to ambulance personnel.
3. As soon as patient has been delivered to their destination, air out the ambulance.
4. As soon as the exposure is realized, it should be reported to the Infection Control Officer
immediately.
5. The document “Guidelines for Preventing the Transmission of Tuberculosis in the Health-
Care Setting, with Special Focus on HIV-Related Issues” should be read thoroughly.
6. The OSHA 300 log will be completed for the incident.
Medical Surveillance for T.B.

This will include the following:
initial baseline screening at the time of employment.
Bi-annual screening.
Retesting every six months for workers with a significant exposure.
DEFINITIONS
Significant Exposure
1. Any puncture of the skin by a needle or other sharp object that has had any contact with a
patient’s blood or body fluid, or with fluids infused into the patient.
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2. Blood spattered onto mucous membranes or eyes.
3. The contamination of open skin (cuts, abrasions, blisters, open dermatitis) with potentially
infectious body fluids.
4. The transportation of a patient who subsequently is diagnosed with an airborne infectious
disease.
Contaminated
The presence of blood or other potentially infectious materials on an item or surface.
Contaminated Laundry
Laundry that has been soiled with blood or other potentially infectious materials (wet or dry), or
may contain sharps.
Contaminated Sharps
Any contaminated object that can penetrate the skin including, but not limited to needles,
scalpels, broken glass, broken capillary tubing and exposed wires.
Exposure incident
A specific eye, mouth other mucous membrane, non-intact skin, or parental contact with
blood or other potentially infectious materials.
Regulated waste
Liquid or semi-liquid blood or other potentially infectious materials; contaminated items that
would release blood or other potentially infectious materials in a liquid or semi-liquid state if
compressed; items that are caked with dry blood or other potentially infectious materials and are
capable of releasing these materials during handling; and contaminated sharps.
Cleaning
The physical removal of soil from an object, often using a detergent or mild disinfectant.
(Disinfectants are less effective if organic matter, such as blood or feces is present. This needs to
be cleaned up thoroughly with soap and water first.)
Potential Exposure
When contact can reasonably be expected to be made with potentially infectious body fluids, any
unfixed tissue or organ, or a patient with an airborne infectious disease.
High Level Disinfectant
Has a sporicidal capability that is used for a much shorter time than that required for sterilization.
It also kills the same organisms as the intermediate disinfection.
Intermediate Level Disinfectant
Kills vegetative bacteria, lipid viruses, fungi and T.B. A cleaning agent such as a commercial
anti-microbial disinfectant is appropriate.
Low Level Disinfection
Kills vegetative bacteria and lipid viruses. A cleaning agent such as 1:10 solution of bleach/water
is appropriate.
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Title Shift Duties
Section Operations
Policy No. 4-1
911 Duty Shifts
DUTY DAY DEFINED
911 duty shifts commence promptly at 8:00 a.m. and conclude at 8:00 a.m. the following day.
All crews are encouraged to arrive a few minutes prior their 911 duty shift.
The “Duty day” for all 911 duty shifts is from 8:00 a.m. to 4:00 p.m. In addition to responding
to 911 calls, the 911 crew shall complete all necessary duties, details, inspections,
continuation/refresher training, and be available to the supervisors throughout the entire duty
day.
From 4:00 p.m. to 8:00 a.m., the 911 crew shall be signed off the time clock for crew rest, unless
responding to a 911 call or performing a task specified by a supervisor.
It is the responsibility of each employee to ensure he or she is properly rested when reporting to
work for a 911 shift at 8:00 a.m. and to properly rest from 4:00 p.m. to 8:00 a.m. when not
responding to a 911 call. Failure to report to work properly rested and/or properly rest from 4:00
p.m. to 8:00 a.m. when not responding to calls may subject the employee to disciplinary action.
EQUIPMENT
All 911 crew members shall report for duty with two (2) clean and serviceable MED-Star
uniforms; one for wear and the second for wear in the event the first becomes soiled and/or
unserviceable.
In addition to any personal/professional equipment carried by the employee (e.g. flashlight,

scissors, etc.), each 911 crew member shall have on his/her person at all times:
 Radio,
 Pager, and
 Cellular Telephone.
DAILY AND ADDITIONAL DUTIES
From 8:00 a.m. to 4:00 p.m., the 911 crew shall perform the following daily duties:
 Complete truck checks, using the Daily Ambulance Inspection sheet*;
 Clean the quarters;
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 Clean the Laundromat (twice per day, once in the morning and a second time prior to
4:00 p.m.);
 Clean all the basement areas on the grounds;
 Clean all bathrooms (quarters, basements, Laundromat);
 Wipe down rims and doors of ambulances;
 Wash and fold the laundry;
 Wash any ambulances that require cleaning;
 Take out the trash;
 Assist in the cleaning of any ambulances that return from a transfer between the hours of
8:00 a.m. and 4:00 p.m.;
 Snow removal, as needed;
 Police the grounds for trash;
 Training and review of skills; and
 Perform any additional task/duty assigned by a supervisor.
* Truck checks must be completed at the beginning of each 911 shift and shall be
completed prior to any other duty, other than responding to a 911 call.
The 911 shift shall document performance of the Daily Duties using the MED-Star Duty Crew
Checklist. The 911 shift is highly encouraged to complete the MED-Star Duty Crew Checklist
as each item is performed, so that the Back-Up and/or Call crew may continue performing the
daily duties in the event the 911 crew and/or Back-Up shift is/are dispatched.
In addition to the above daily duties, each 911 shift shall complete the following:
 Mondays – fill the DEF in 931 and 936;
 Mondays and Thursdays – take out trash to the outdoors receptacle for trash pick-up;
 Wednesdays – check tire pressure on all tires of every ambulance (All tires must be
pressurized to 70 psi);
 Fridays – battery checks;
 First Friday of the month recondition the battery;
 Detail 931 on the 5th day of the month;
 Detail 936 on the 30th day of the month (28th day for the month of February).
LEAVING MED-STAR PROPERTY
Other than responding to emergency calls, the 911 crew is encouraged to remain on the MED-
Star premises throughout the entire 911 shift. Nevertheless, MED-Star allows the 911 crews to
leave the premises to perform errands, such as grocery shopping, and meal periods, under the
following conditions:
 The 911 crew shall remain on the MED-Star premises from 8:00 a.m. to 4:00 p.m., unless
specifically authorized by a supervisor to leave the premises for meals, errands, etc.;
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 All daily and additional duties must be completed, unless specifically authorized by a
supervisor;
 Both crewmembers must remain together at all times;
 Both crewmembers shall carry on their person a radio, pager, and cellular telephone;
 The 911 crew must take a fully stocked, 911 ambulance whenever leaving the premises;
 The 911 crew shall remain within the city limits of the City of Brandon, South Dakota.
The ability to leave the premises during the 911 shift is a privilege, not a right. Abuse of this
privilege by one or more 911 crews may result in the loss of this privilege for all 911 crews.
Priority shall be given to all 911 calls, not to the errand, meal period, or any other reason for
leaving the premises. DELAYING IN THE RESPONSE TO A 911 CALL MAY SUBJECT
THE EMPLOYEE(S) TO DISCIPLINARY ACTION INCLUDING, BUT NOT
NECESSARILY LIMITED TO, TERMINATION OF EMPLOYMENT.
LEAVING THE MED-STAR PROPERTY IN VIOLATION OF ANY OF THE ABOVE IS

STRICTLY PROHIBITED AND SHALL SUBJECT THE EMPLOYEE(S) TO
DISCIPLINARY ACTION INCLUDING, BUT NOT NECESSARILY LIMITED TO,
TERMINATION OF EMPLOYMENT.
Back-Up and Call Shifts
All Back-Up and Call shifts commence at 8:00 a.m. and conclude at 8:00 a.m. the following day.
It is the responsibility of all employees assigned to Back-Up or Call shifts to be and remain
properly rested for potential duty.
DUTY LOCATION AND REPORTING
The phrase, “within a reasonable time and without delay,” when used in this Policy shall mean
the reasonable amount of time required to drive from the employee’s home to MED-Star without
deviating from the route, in light of road conditions.
Whenever the 911 crew receives a call, those individuals on the Back-Up shift shall
automatically respond by reporting to MED-Star within a reasonable time and without delay,
obeying all traffic laws and regulations. Upon arrival at MED-Star, the Back-Up shift shall
automatically assume the 911 shift duties and shall remain on the MED-Star premises until the
911 crew is physically present within the City of Brandon.
In the event the 911 crew and Back-Up crew are dispatched, the Call shift shall automatically
respond by reporting to MED-Star within a reasonable time and without delay, obeying all traffic
laws and regulations.
The Back-Up and Call shifts may perform their duty, other than 911 response, from any location
that is within a reasonable distance from MED-Star that allows for the crewmember to arrive at
MED-Star within a reasonable time. If an employee chooses to perform all or any part of the
Back-Up or Call shift period at MED-Star, the employee shall not clock-in, shall not interfere
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with or impede other employees in the performance of his or her duties, and shall not be tasked
for any duties and/or responsibilities by a supervisor.
If an employee chooses to perform all or any part of the Back-Up or Call shift period from a
location other than the employee’s home, the employee shall comply with all of the equipment
requirements stated below.
WHEN REPORTING TO MED-STAR DUE TO THE 911 SHIFT AND/OR BACK-UP SHIFT
BEING DISPATCHED, THE EMPLOYEE SHALL REPORT WITHIN A REASONABLE
TIME AND WITHOUT DELAY TO MED-STAR AND SHALL NOT DEVIATE FOR ANY
REASON (E.G. PURCHASING A SODA, ETC.).
FAILURE TO REPORT TO MED-STAR WITHIN A REASONABLE TIME AND WITHOUT

DELAY MAY SUBJECT THE EMPLOYEE TO DISCIPLINARY ACTION INCLUDING,
BUT NOT NECESSARILY LIMITED TO, TERMINATION OF EMPLOYMENT.
ALL BACK-UP AND CALL CREWMEMBERS SHALL OBEY ALL TRAFFIC LAWS AND
REGULATIONS; FAILURE TO DO SO MAY RESULT IN DISCIPLINARY ACTION.
DAILY DUTIES
In the event the 911 crew was dispatched between the hours of 8:00 a.m. and 4:00 p.m., the
Back-Up and/or Call shift, if applicable, shall continue performing the daily duties, using the
MED-Star Duty Crew Checklist as a reference.
EQUIPMENT
All Back-Up and Call shift personnel shall have on their person at all times a pager and cellular
telephone. If the employee has been issued a radio, the employee must have on his or her person
at all time the issued radio, in addition to the pager and cellular telephone.
When reporting to MED-Star, the employee shall report with two (2) clean and serviceable
MED-Star uniforms; one for wear and the second for wear in the event the first becomes soiled
and/or unserviceable.
Patient Transport
Employees assigned to inter-facility, intra-facility, or aircraft transports shall report to MED-Star

within a reasonable time to perform any necessary pre-departure inspections, checks, or other
duties and to arrive at the sending facility prior to pick-up time (pick-up time is “bed side”).
89
Title Sanitary Ambulance Policy - Interior
Section Operations
Policy No. 4-2
Proper infection control standards must be utilized while cleaning and maintaining proper
sanitary practices.
The interior of the ambulances shall remain clean and free of debris at all times. On coming duty
crews shall assure the interior of each ambulance and the equipment on each ambulance is clean
and ready for service during daily checks.
Immediately after an ambulance is utilized to transport a patient, the patient compartment and
any non-disposable equipment used shall be thoroughly cleaned and disinfected prior to reuse.
All equipment labeled single patient use shall not be reused and shall be disposed of in the
proper bio-medical waste container. Oxygen masks, cannulas, humidity containers, suction
catheters, tubing or any airway designed to be places in patient's nose or mouth should be single
use and must be stored and handled properly.
Freshly laundered linens or disposable linens shall be used on cots and pillows. Lines shall be
replaced with clean linens after each patient use. Dirty linens shall be disposed of or bagged
properly for transport to laundry facility. Bagged laundry shall not be transported in patient
compartment.
Supervisors and/or managers shall routinely check the interior cleanliness of vehicles and follow
up crew members as needed.
90
Title Sanitary Ambulance Policy - Exterior
Section Operations
Policy No. 4-2-1
On coming duty crews shall assure that the exterior of all ambulances are clean during their daily
checks. Any vehicle in need of washing should be completed at that time.
When returning to the station after utilizing an ambulance, crew staffing that ambulance shall
assure that the ambulance exterior is clean and ready for service.
Supervisors and/or managers shall routinely check the exterior cleanliness of vehicles and follow
up crew members as needed.
91
Title Post-Transport Duties
Section Operations
Policy No. 4-3
Following each and every patient transport, whether 911, inter-facility, intra-facility, or aircraft
transport, the following duties must be performed upon arrival at the MED-Star premises:
 Clean the interior and exterior of the ambulance;
 Mop the interior of the ambulance;
 Restock and retag the ambulance;
 The individual having patient care must complete and sign the PCS; and
 Add DEF, if 931 or 936 were used for a long distance transfer.
If the crew is unable to restock the ambulance, the crew must provide a list of the items needed
for the ambulance to be placed back in service. The ambulance requiring items must be
identified and identifiable by other crews, so that the ambulance is not inadvertently placed in
service.
92
Title Medical Equipment Inspections
Section Operations
Policy No. 4-4
All medical equipment will be inspected monthly to ensure equipment is in good condition and
functioning properly. All medical equipment will be inspected and have annual maintenance
performed by a biomedical company (currently contracted with Sanford Health Biomed). This
equipment includes, but no limited to, cardiac defibrillators, pulse oximeters, glucometers,
infusion pumps and ETCO2 monitors. Defibrillators will be inspected and a user test will be
performed daily by on duty crew members.
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Title Vehicle Inspection - Daily
Section Operations
Policy No. 4-5
All ambulances will be inspected on a daily basis to ensure all emergency warning lights and
sirens are functioning properly. Fluid levels will be checked and the appropriate fluids will be
added to maintain proper levels. Daily inspection will be noted on daily check sheets.
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Title Vehicle Inspections - Monthly
Section Operations
Policy No. 4-5-1
All ambulances will be inspected on a monthly basis to ensure all vehicles and vehicle
equipment are in good condition and functioning properly. A monthly inspection report will be
completed by the inspecting personnel. Any vehicle or equipment issues will be reported to the
on call supervisor.
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Title Duty To Treat And Transport / Patient Refusal
Section Operations
Policy No. 4-6
Duty to Treat and Transport
At all times and at a minimum, all 911 patients must be transported to the nearest facility. MED-
Star will strive to honor specific patient requests for transport to a more distant facility based on
the condition of the patient and current emergency loads and stresses on the EMS system in the
area. The crew caring for the patient will make this determination with input from dispatch, a
supervisor, and/or medical control if necessary.
Transport of a Deceased Person
No MED-Star vehicle shall transport a dead body, except in special circumstances when it is in
the interest of public health and/or safety to do so or when ordered to do so by an appropriate
authority.
Patient Refusals
TRANSPORT REFUSAL
Occasionally, a 911 patient may refuse transport to a hospital. Patient refusal shall be dealt with
in accordance with the applicable Protocols.
C-COLLAR / BACKBOARD REFUSAL
Occasionally, a 911 patient may refuse the use of a c-collar and/or backboard. Patient refusal
shall be dealt with in accordance with the applicable Protocols.
Patient must sign a c-collar/backboard refusal form; blank copies of this form are located in the
clipboard in the ambulance.
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Title Driver’s Training
Section Operations
Policy No. 4-7
All employees who operate company vehicles must attend and complete the first available
company sponsored EVOC or CEVO training program after beginning employment. All
employees must attend and complete MED-Star's drivers’ initial and continuation training
program. Operations Supervisor will complete a new hire drivers training checklist for each
employee during new employee orientation.
97
Title Motor Vehicle Policy, Generally
Section Operations
Policy No. 4-7-1
The purpose of this policy is to ensure the safety of those individuals who drive company
vehicles. Vehicle accidents are costly to our company, but more importantly, they may result in
injury to you or others. It is the driver's responsibility to operate the vehicle in a sage manner and
to drive defensively to prevent injuries and property damage. MED-Star endorses all applicable
state motor vehicle regulations relating to driver responsibility. MED-Star expects each driver to
drive in a safe and courteous manner and to follow the laws of the state. The attitude you take
when behind the wheel is the single most important factor when driving.
Company vehicles are to be driven by authorized MED-Star employees ONLY. Other employees
and family members are NOT authorized to drive MED-Star vehicles.
Company vehicles are to be driven for company business ONLY. NO unauthorized persons are
allowed to ride in company vehicles.
If a patient has a family member ride with them on a run, the family member must ride in the
front passenger seat and wear a seat belt.
All accidents involving MED-Star vehicles, regardless of the severity, will be reported to the
police and your supervisor. Failing to stop or failure to report an accident may result in
disciplinary action, up to dismissal.
The use of company vehicles while under the influence of intoxicants and other drugs is
prohibited and is sufficient cause for disciplinary action up to dismissal.
All drivers and passengers operating or riding in MED-Star vehicles will wear seat belts. Motor
vehicle records will be obtained periodically to asses driving records. An unfavorable record will
result in loss of driving privileges or employment. Talk to your supervisor for the method used
for driving record evaluation.
Drivers are responsible for the security of MED-Star vehicles used by them. The vehicle engine
must be shut off, ignition keys removed, and vehicle doors locked whenever the vehicle is left
unattended. If the vehicle is left with a parking attendant, only the ignition key will be left.
Report any mechanical problems or repairs needed to the supervisor.
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Title Policy and Procedure For Driving
Section Operations
Policy No. 4-7-2
Code 1 Dispatches or Transports: Units responding to a call or transporting patients to a medical

facility code 1 or non-emergent will travel without utilizing emergency lights and sirens. All
traffic laws must be followed.
Codes 2, 3, or 4 Dispatches or Code 3 Transports: Units responding to a call or transporting a

patient in an emergent fashion will utilize emergency warning lights and sirens. The maximum
speed allowed will be ten (10) miles per hour above the posted speed limit, provided traffic and
road conditions warrant. Before entering the intersection the operator must reduce the speed of
the vehicle to be able to stop the vehicle if necessary to permit such safe passage. The
ambulance must come to a complete stop if the ambulance has a red signal or stop sign.
Driver may proceed through the intersection only after making sure all other traffic and
pedestrians have yielded the right-of-way.
Drivers shall operate the vehicle in a reasonable and prudent manner at all times, taking into
consideration traffic and road conditions.
It will be up to the senior Paramedic to decide what Code is driven to the hospital once receiving
the patient.
 ABSOLUTLY NO EMPLOYEES WILL DRIVE MORE THAN 10 MPH OVER

THE SPEED LIMIT AT ANY GIVEN TIME. NO EXCEPTIONS TO THIS
RULE!
 SEATBELTS NEED TO BE WORN AT ALL TIMES BY EMPLOYEES AND
OTHERS WHILE IN THE AMBULANCES
 ANY OTHER PERSONS 1N THE AMBULANCE NEED TO BE
SEATBELTED 1N THE FRONT SEAT
 ALL PERSONNEL WILL DRIVE WITH DUE REGAURD AT ALL TIMES
 THERE IS TO BE NO USE OF CELL PHONES WHILE DRIVING AT ANY
TIME
 IF YOU ARE BACKING A VEHICLE, SOMEONE MUST SPOT YOU IN
THIS PROCESS
*There are no exceptions to any of these rules while driving. If you choose to not follow the
policy, disciplinary- action will be taken and possible termination of employment.
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Title Safe Driving Guidelines, Generally
Section Operations
Policy No. 4-7-3
THE AMBULANCE OPERATOR’S PRIMARY RESPONSIBILITY IS THE SAFE

TRANSPORT OF THE PATIENT. DO NOT RISK AN ACCIDENT OR INJURY.
Smooth driving refers to driving that will not stress or traumatize the patient, permitting the
attendant to safely provide medical care to the patient.
REMEMBER, YOU ARE THE PERSON WHO IS MOST IN CONTROL OF SAFETY WHEN
RESPONDING OR TRANSPORTING ON A PRIORITY.
No medical emergency, however severe, justifies driving in a manner that risks loss of control of
the vehicle, or that relies on other drivers or pedestrians to react ideally.
A decision to transport emergently must be based upon reasonable cause to believe that the
medical emergency justifies the risks incurred when demanding the right-of-way through traffic.
However, any doubt as to the seriousness of the emergency must be resolved in favor of the
patient.
All personnel should be aware that high-speed transportation of patients is often unnecessary,
and sometimes harmful. A high-speed transport with its associated noise, sudden starts, stops,
and sway can:
 Frighten the patient,
 Put a stabilized patient into shock,
 Disrupt ongoing medical treatment or injure personnel providing treatment,
 Aggravate certain medical conditions sufficient to cause death or permanent disability to
the patient (e.g. spinal injuries, serious fractures, and heart attacks).
“Smooth driving” principles should be observed at all times. Smooth driving refers to driving
that will not stress or traumatize the patient, permitting the attendant to safely provide medical
care.
Sufficient notice of the ambulance’s approach must be given to allow other motorists and
pedestrians to yield the right-of-way. Proper use of signaling equipment is, by itself, not enough.
You should always presume the other drivers do not hear the siren under most conditions,
particularly at an intersection. Be aware that other drivers often have difficulty in locating the
source of the siren.
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NEVER ASSUME THAT THE USE OF LIGHTS AND SIREN WILL CLEAR THE WAY
THROUGH TRAFFIC OR THAT A MOTORIST OR PEDESTRIAN IN THE VICINITY
WILL DO WHAT IS EXPECTED AFTER BECOMING AWARE OF THE AMBULANCE.
WATCH FOR THE REACTION OF OTHER VEHICLES AND PEOPLE TO THE SIREN
AND BE PREPARED TO MANEUVER ACCORDINGLY.
An ambulance operator must anticipate particular hazards during emergency operation, they
include:
 Blind intersections,
 Driveways,
 Motorists with impaired hearing,
 Inattentive drivers, and
 Pedestrians.
An ambulance transporting a stable patient should never travel over the posted speed limit.
Regardless of the patient’s condition, never travel at a speed that does not permit complete
control of the vehicle at all times.
ALL DRIVERS MUST DRIVE WITH “DUE REGARD” FOR THE SAFETY OF OTHERS.
State vehicle statutes provide special privileges to an operator of an emergency vehicle.

However, this does not relieve the operator from the duty and responsibility to drive with due
regard for the safety of others. A driver can be cited or held personally liable for damages if he
or she exercises this privilege without justifiable cause or in an imprudent manner.
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Title Inclement Weather/Road Conditions Operations
Section Operations
Policy No. 4-8
When the National Weather Service has issued a storm warning or winter weather advisory, all
out of town ambulance trips will be approved by a member of the management team.
Management team members will check weather and road conditions throughout the day and will
verify road and weather conditions for the route of travel for each out of town trip. If crew
members on a trip determine that conditions are unsafe, crew members have the right to abort the
trip in the safest manner possible. When a patient is on board, crew members must determine the
safest most appropriate destination for the patient, i.e. return to sending facility, diverting to
closer facility. Crew members must contact a member of the management team as soon as
possible to advise them of the change in status of the trip.
911 calls will be handled in safest manner possible including requesting assistance from
Emergency Management, city, county and state highway departments.
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Title Reflective Vests
Section Operations
Policy No. 4-9
All employees shall wear the supplied DOT approved reflective scene vests when operating on
any roadway, street, county road, highway or interstate. Failure to do so will result in
disciplinary action.
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Title Cell Phone Usage
Section Operations
Policy No. 4-9-1
Cell phone usage and text messaging is prohibited while driving. If driver's must use a cell
phone, find a safe place to pull over and stop to complete the call. Drivers must take into
consideration the necessity of the phone call, response or transport mode and patient condition.
Use radio communications if possible.
104
Title Passengers / Seatbelts and Safety Restraints
Section Operations
Policy No. 4-10
Parent / Guardian / Family Member
Any parent, guardian, or family member requesting to accompany a minor child in the
ambulance shall be allowed to do so, unless it is determined that this would hinder patient care
(i.e. the parent is uncontrollably upset). If a parent is denied the right to accompany a child, the
reason(s) must be completely and thoroughly documented on the trip report.
Third Party Passengers
DURING PATIENT TRANSPORT/TREATMENT
The following individuals are the only persons authorized to travel in a MED-Star ambulance
when a patient is being transported/treated:
 MED-Star personnel;
 Healthcare providers giving care to the patient during the transport;
 Family member of the patient; and
 Interns and EMS students, who are participating in the MED-Star Third Party Rider
Program and have completed the Authorized Rider form.
WITHOUT PATIENT
No individual, other than a MED-Star employee, may be a passenger in a MED-Star ambulance

or response unit, unless specifically authorized by a supervisor or the President/CEO.
Seatbelts and Safety Restraints
ALL EMPLOYEES, THIRD PARTY RIDERS, FAMILY MEMBERS, AND PATIENTS

RIDING IN ANY MED-STAR VEHICLE (AMBULANCE OR RESPONSE UNIT) ARE
REQUIRED TO WEAR THEIR SEATBELTS OR SAFELY RESTRAINTS. THE ONLY
EXCEPTION TO THIS IS THE ATTENDANT WHO MAY BE UNRESTRAINED ONLY TO
ADMINISTER PATIENT CARE.
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Title Patient Confidentiality
Section Operations
Policy No. 4-11
All MED-Star employees, independent contractors, and service providers must be aware of
patient confidentiality issues at all times.
Discussing any information regarding the care or circumstances of any patient’s care is strictly
prohibited.
Do not discuss patient information in any public place, such as a restaurant.
ALWAYS CONSIDER AND RESPECT THE PRIVACY OF EVERY PATIENT, NO

MATTER WHAT HIS OR HER CONDITION. ALWAYS PROTECT A PATIENT’S
MODESTY AS MUCH AS POSSIBLE, KEEP THE PATIENT COVERED, AND BE AWARE
OF THEIR CIRCUMSTANCES AND FEELINGS.
Given the nature of our work, it is imperative that we maintain the confidence of patient
information that we receive in the course of our work. MED-Star prohibits the release of any
patient information to anyone outside the organization, unless required for purposes of treatment,
payment, or health care operations. Additionally, discussions of Protected Health Information
(PHI) within MED-Star should be limited. Acceptable uses of PHI within the organization
include, but are not limited to, exchange of patient information needed for the treatment of the
patient, billing, and other essential health care operations, peer review, internal audits, and
quality assurance activities.
MED-Star provides services to patients that are private and confidential and you are a crucial
step in respecting the privacy rights of MED-Star’s patients. In the rendering of EMS, patients
provide personal information and that such information may exist in a variety of forms, such as
electronic, oral, written, or photographic, and that all such information is strictly confidential and
protected by Federal and State laws.
106
Title Reports And Documentation
Section Operations
Policy No. 4-12
Overview
Documentation is vital to our operation and your duties. The attendant on the call is responsible
for completing the documentation. However, both crewmembers are always responsible for its
content. Please keep in mind that a driver should not sit back, do nothing, and watch the
attendant write up all of the documents. If you have documentation problems or questions, do
not hesitate to ask for help from your partner or the office. Proper documentation is essential for
billing purposes and for proper patient care and follow up.
Your documentation must be completed before the end of your shift. Your documentation
should be completed during or immediately after returning to service after each and every call.
This is the best time to write your narrative and document what occurred on the call.
REMEMBER, IF YOU DO NOT DOCUMENT IT; IT DID NOT HAPPEN OR YOU DID NOT
DO IT AT ALL.
Documentation, Generally
The following provides the basic instructions necessary to complete the various forms that you
will encounter at MED-Star.
Proper documentation will clearly explain what you did for the patient and why. It will also
include pertinent negatives to show that you looked for and did not find certain things. Your
documentation serves as the justification for the services provided and not provided by you.
Properly documenting a call can discourage or defeat claims, allegations, or charges made
against you before they begin. It is your first line of defense if issues or questions arise at a later
date.
Complete, precise documentation is essential in order for MED-Star to be paid for the quality
services that we provide. Insurance companies, Medicare, and other third-party payers are
setting stringent policies regarding reimbursement for ambulance transportation, making
documentation that much more important. The determination of whether an ambulance was
medically necessary is predominately based on your documentation.
When completing any documentation by hand, please print the information clearly and take an
extra minute to double check the spelling. Use common and simple abbreviations. You are
expected to complete all of the appropriate documentation. If you cannot obtain certain
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information, be sure to explain why on the document. It is just as important to document what
you did not do as it is to document what you did do.
Most of the documents you complete become legal medical records. Document facts only, do
not add assumptions, personal beliefs, or editorial comments.
DOCUMENT EVERYTHING EXACTLY AS IT HAPPENED ON THE CALL.
ALL INFORMATION CONTAINED IN THESE RECORDS IS STRICTLY CONFIDENTIAL.
Any requests by outside sources for release of any information shall be referred to a supervisor
or the President/CEO.
The completion of documentation is the responsibility of both crewmembers, regardless of who

was driving. All documentation must be completed and turned in at the end of your shift or
whenever requested by a supervisor.
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Title Approved Acronyms And Abbreviations
Section Operations
Policy No. 4-12-1
Medical EMS Abbreviations & Acronyms

Definitions
[Aa]
@ At
AAA Abdominal Aortic Aneurysm
AAOx Awake, Alert, Oriented (times [insert number])
abd Abdomen
ABC Airway, Breathing, Circulation
AC Antecubital
ACLS Advanced Cardiac Life Support
A&D Admission and Discharge
AED Automatic External Defibrillator
A-fib Atrial Fibrillation
AIDS Acquired Immune Deficiency Syndrome
ALS Advanced Life Support
AKA Also Known As / Above the Knee Amputation
AM Morning
A.M.A., AMA Against Medical Advice
AMI Acute Myocardial Infarction
AMT Amount
AOS Arrived On Scene
APAP Acetaminophen
APGAR Infant Assessment Scale
APPROX Approximate / Approximately
ASA Aspirin
ASHD Arterioscierotic Heart Disease
[Bb]
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BBB Bundle Branch Block
bilat Bilateral Breath Sounds
BKA Below Knee Amputation
BLS Basic Life Support
BM Bowel Movement
BP Blood Pressure
BG Blood Glucose
BS Breath sounds
BVM Bag Valve Mask
[Cc]
ć With or Change
C/2 Code 2/ nonemergent
C/3 Code 3/ emergent
C/4 Code 4/ scene is secure
CABG Coronary Artery Bypass Graft
CAD Coronary Artery Disease
CAOx3 Conscious, Alert, Oriented to Person, Place, and Time
CA Cancer
Cath Catheterization
C/C Chief Complaint
CCU Coronary Care Unit / Critical Care Unit
CHF Congestive Heart Failure
CMS Circulation, Movement, Sensation
CNS Central Nervous System
C/O Complains Of
CO2 Carbon Dioxide
COD Cause of Death
COPD Chronic Obstructive Pulmonary Disease
CP Chest Pain
CPR Cardiopulmonary Resuscitation
CQI Continuous Quality Improvement
CSF Cerebral Spinal Fluid
CT Scan Computerized Axial Tomography
CVA Cerebral Vascular Accident
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[Dd]
DA Drug Abuse
D/C Discontinue / Discharge
Deformities, Contusions, Punctures & Penetrations,
DCAP-BTLS Burns, Tenderness, Lacerations
DNR Do Not Resuscitate
DOA Dead On Arrival
DOB Date Of Birth
DT's Delirium Tremens
DVT Deep Vein Thrombosis
D5W Dextrose 5% in Water
Dx Diagnosis
[Ee]
ea Each
ECG Electrocardiogram
EEG Electroencephalogram
EENT Eyes, Ears, Nose, Throat
EJ External Jugular
EMS Emergency Medical Services
EMT Emergency Medical Technician
EMT-B Emergency Medical Technician-Basic
EMT-P Emergency Medical Technician-Paramedic
EOA Esophageal Obturator Airway
ETA Estimated Time of Arrival
ETOH Ethyl Alcohol
ET Endotracheal Tube
EXT External / Extension
[Ff]
F Female
FLEX Flexion
FROM Full Range of Motion
Fx Fracture
[Gg]
111
g Gram(s)
GCS Glasgow Coma Scale
GI Gastrointestinal
GSW Gunshot Wound
gtts Drops
GU Genitourinary
GYN Gynecology
[Hh]
HEENT Head, Ears, Eyes, Nose, Throat
HIV Human Immune Deficiency Virus
HR Heart Rate
HTN Hypertension
Hx History
Hyper Above or High
Hypo Below or Low
[Ii]
ICF Intracellular Fluid
ICP Intracranial Pressure
ICS Intercostals Space
ICU Intensive Care Unit
IM Intramuscular
IO Intraosseous
IV Intravenous
IVP Intravenous Push
IVPB Intravenous Piggy Back
[Jj]
J Joules
JVD Jugular Vein Distension
[Kk]
Kg Kilogram
KVO Keep Vein Open
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[ll]
(L) Left
L&D Labor and Delivery
LAT Lateral
LBBB Left Bundle Branch Block
lb(s) Pound(s)
lg Large
LLQ left Lower Quadrant
LMP Last Menstrual Period
LOC Loss Of Consciousness
LR Lactated Ringers
L-Spine Lumbar Spine
LSB Long Spine Board
LUQ Left Upper Quadrant
[Mm]
M Male
MAE Moves All Extremities
mcg microgram
MCI Mass Casualty Incident
MDI Metered Dose Inhaler
ME Medical Examiner
mEq Millequivalent
MED Medication / Medium
mg milligram
MICU Medical Intensive Care Unit
MI Myocardial Infarction
MOI Mechanism Of Injury
MRI Magnetic Resonance Imaging
MS Morphine Sulfate / Multiple Sclerosis
MVA Motor Vehicle Accident
MVC Motor Vehicle Crash
[Nn]
N/A Not Applicable
NaCL Sodium Chloride
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NAD No Acute Distress
N/C Nasal Cannula
NEB Nebulizer
NKA No Known Allergies
NKDA No Known Drug Allergies
NRM Non-Rebreather Mask
NRB Non-Rebreather Mask
NS Normal Saline
NSR Normal Sinus Rhythm
NT Non-tender
NTI Nasotracheal Intubation
NTG Nitroglycerine (Nitro)
[Oo]
O None
O2 Oxygen
O2Sat Oxygen Saturation by pulse oximeter
OB Obstetrics
OD Overdose
OPA Oralpharyngeal Airway
Onset, Provoking Factors, Quality, Radiation, Severity,
OPQRST Time
OTC Over The Counter
(OU) Both Eyes
[Pp]
ṕ After
P Pulse
PAC Premature Atrial Contraction
PALP Palpation
PALS Pediatric Advanced Life Support
PASG Pneumatic Antishock Garment
PCN Penicillin
Physical Examination / Pulmonary Embolism / Pulmonary
PE Edema
PEA Pulseless Electrical Activity
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PEEP Positive End Expiratory Pressure
PEARL/PERL/PERLA Pupils Equal and Reactive to Light

PJC Premature Junctional Contraction
PMHx Past Medical History
PO Orally
POV Privately Owned Vehicle
PRN, prn As Needed
PSVT Paroxysmal Supraventricular Tachycardia
PT Patient
PTA Prior To Arrival
PVC Premature Ventricular Contraction
[Qq]
q Every
QAM, qam Every Morning
qd Every Day
Qh Every Hour
q2h Every Two Hours
q3h Every Three Hours
q4h Every Four Hours
QHS, qhs Every Night at Bedtime
qid, QID Four Times a Day
qod, QOD Every Other Day
[Rr]
R/O Rule Out
ROM Range Of Motion / Range Of Movement
(R) Right
RLQ Right Lower Quadrant
RR Respiratory Rate
RUQ Right Upper Quadrant
Rx Prescription Therapy
[Ss]
SaO2 Systemic Arterial Oxygen Saturation (%)
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SB Sinus Bradycardia
SIDS Sudden Infant Death Syndrome
SL Sublingual
SOB Short Of Breath
SpO2 Oxygen Saturation by Pulse Oximeter
ST Sinus Tachycardia
STAT At Once
STD Sexually Transmitted Disease
SQ Subcutaneous
SR Sinus Rhythm
START Simple Triage & Rapid Treatment
SVT Supraventricular Tachycardia
[Tt]
T Temperature
TCP Transcutaneous Pacing
TIA Transient Ischemic Attack
TKO To Keep Open
Tx Treatment / Transport
[Uu]
unk Unknown
URI Upper Respiratory Infection
UTI Urinary Tract Infection
[Vv]
via By Way Of
V-fib Ventricular Fibrillation
V/S Vital Signs
VT Ventricular Tachycardia
[Ww]
W&D Warm and Dry
WNL Within Normal Limits
wt Weight
116
[Yy]
YTD Year To Date
Symbols
@ At
+ Positive
- Negative
? Questionable
Ψ Psychiatric
~ Approximately
> Greater Than
< Less Than
= Equal
s Without
Δ Change
ā Before
L Left
R Right
117

MED-Star Policies and Procedures-V03 2013

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MED-Star Paramedic Ambulance, Inc.

Policies & Procedures

NOTICE: THIS POLICIES AND PROCEDURES MANUAL DOES NOT CONSTITUTE

Policy # Title Page

Policy No. 1-1

Modified March 12, 2013

Policy No. 1-2

Modified March 12, 2013

Policy No. 1-3

Modified March 12, 2013

The management team at MED-Star consists of:

Policy No. 1-4

Modified March 12, 2013

MED-Star Paramedic Ambulance, Inc. (“MED-Star”) provides equal employment opportunities

Policy No. 1-4-1

Modified March 12, 2013

Policy No. 1-4-2

Modified March 12, 2013

The primary obligation of MED-Star is to make continuously available to the community it

Policy No. 1-4-3

Modified March 12, 2013

A hostile work environment is defined as comments, actions or objects that unreasonably

Sexual harassment is legally defined as unwelcome sexual attention. It includes unwelcome

Neither submission to sexual harassment nor acceptance of an intimidating, hostile, or offensive

Policy No. 1-4-4

Modified March 12, 2013

ANY EMPLOYEE’S BEHAVIOR THAT FITS THE DEFINITION OF SEXUAL

ALL EMPLOYEES OF MED-STAR, PARTICULARLY THOSE IN A SUPERVISORY OR

Definition Of Sexual Harassment

Sexual harassment occurs when:

SEXUAL HARASSMENT IS UNACCEPTABLE MISCONDUCT, WHICH AFFECTS BOTH

Responsibility OfIndividual Employees

Responsibility Of Supervisory Personnel

Reporting Sexual Harassment

An employee who either observes or believes herself/himself to be the object of sexual

False And Frivolous Complaints

Policy No. 1-4-5

Modified March 12, 2013

Policy No. 1-5

Modified March 12, 2013

 Right to receive a covered entity's Notice of Privacy Practices

Policy No. 1-5-1

Modified March 12, 2013

THE RECORDS OF AND INFORMATION REGARDING PATIENTS AND OR STAFF ARE

Policy No. 1-5-2

Modified March 12, 2013

Section Personnel and Staff

Policy No. 2-1

Modified March 12, 2013

Section Personnel and Staff

Policy No. 2-2

Modified March 12, 2013

Employee orientation includes but is not limited to the following components:

 Vision, mission, values

Section Personnel and Staff

Policy No. 2-3

Modified March 12, 2013

Section Personnel and Staff

Policy No. 2-4

Modified March 12, 2013

Full time employees

Employees hired to work MED-Star’s normal, full-time, minimum 36-hour workweek on a

Part time / PRN employees

An exempt employee is an employee who, because of his/her positional duties, responsibilities