G.8.14 Ambulance Staging

INTRODUCTION

The personal safety of Manitoulin-Sudbury Paramedics remains the highest priority during any response. The Occupational Health and Safety Act, R.S.O. 1990, c. O.1, limits the right of work refusal for Paramedics in circumstances that are; inherent in the work and/or normal condition of employment and/or if such refusal will endanger the life, health, or safety of another person.
 

APPLICATION

• Paramedics
• Paramedic Superintendents
• Senior Managers
• Joint Health and Safety Committee
   

PROCEDURE

The following procedures must be followed by all Paramedics and/or management team personnel during response to each request for Paramedic service. This is to evaluate and mitigate health and safety risks associated with circumstances that are inherent to the work and/or normal condition of employment.

While responding to a scene the following processes will guide the actions of Paramedics:
 

Call originates with CACC: 

1. Paramedics will respond in accordance with the call prioritization assigned by CACC. 

2. Note: CACC will not advise Paramedics to “approach with caution”, The ACO will advise the call details and it is the requirement of the responding Paramedics to determine if they should approach or stage. This occurs even when Police are the originators and unless they specifically tell ACO to advise crew to stage, CACC are not able to direct.

3. Where Paramedics have been directed by Police or determine they should stage, it will be at a safe distance to the scene and wait stage until police have arrived on scene for the following call type examples, including but not limited to:

• Domestic violence calls where police have no resources to send (i.e. Code 4 to an address for a spousal assault, where the assailant is possibly still on scene)
• Calls related to firearms and/or weapons (i.e. Code 4 to an address for a patient with a hx. of violence that states he has a knife/gun)
• Calls to known flagged (safety based) residences. (i.e. Code 4 to 254 Some Street for a patient that was assaulted. This residence, 254 Some Street, has been flagged due to it being a known drug house)
• Police generated calls where sufficient information has not been provided. (i.e. Code 4 to an address for an unknown call as per police. No further info and they have no one to send at this time)
• CACC will not direct responding personnel to delay response by waiting for police unless the police service has identified an immediate threat and request the Paramedics to stage until police have secured the scene. 

Call originates with Police Dispatch and determines Paramedic presence is required:

Staging: A Medical need has been identified but the scene is not secure. 

• CACC’s communication with the crew will include “Police have advised that you are not to enter the scene until secured. You are directed to stage at a safe location and notify CACC so they can notify poli” If CACC is aware of a hazard or unusual situation, they may instruct all vehicles involved to switch to a tactical frequency until the issue has been resolved or the call completed. 

Standby: A medical need has not been identified but there is a possibility for medical assistance. 

• CACC’s communication with the crew will include “Police have advised that you are not to enter the scene until secured. You are directed to standby (Code 8) at a safe location and notify CACC so they can notify police.” If CACC is aware of a hazard or unusual situation, they will instruct all vehicles not involved to switch to a tactical frequency until the issue has been resolved or the call completed.
• Paramedics may be directed by CACC to stage or standby at a specific location. If no specific location is given, follow the procedures outlined below.

Communications and Location: 

• CACC shall disclose all call information to the responding crew(s) that might assist them in determining that a threat exists from the initial call taking procedure
• CACC shall update all responding units with any new information regarding any Allied Agency response.
• The responding Paramedics will use the information provided to determine scene safety.
• If there is valid uncertainty regarding personal and/or patient safety, the Paramedics shall request assistance from Allied Emergency Services agencies if not already tiered and maintain communication with CACC.
• Staging locations shall be such that Paramedics do not drive by the scene and Paramedics are to stage out of sight from the call location.
• CACC will notify the Paramedics when the police have confirmed arrival/scene safety.
• CACC shall notify the Superintendent on duty of any staging or standby event and Superintendent monitor the situation and respond to the scene if available and as required.

On arrival to any scene:

• Paramedics shall perform assessment of the scene.
• Paramedics shall park the ambulance in a safe location as close to the point of patient contact as personal safety dictates, based on the information provided.
• Paramedics shall identify obvious and potential hazards to the patient(s), Paramedic(s) or other allied agencies as well as routes of entry and exit should be identified and any obvious or potential hazards, including potential violence and or confrontation be noted.
• If Paramedics arrive at a scene and determine it to be unsafe, or the scene becomes unsafe, the Paramedics shall remove themselves immediately and identify a safe staging area and report this to CACC.
• CACC will contact the responding police service for an ETA and relay that information to the Paramedics.

While on scene where Paramedics have staged, and now patient contact has made through Police secured scene and or Paramedics have been approached:

• Paramedics shall contact CACC by portable radio once patient contact has been made; a safe and secure scene has been determined and shall give an initial CTAS of the patient.
• CACC will contact the Paramedics via portable radio if the Paramedics fail to contact CACC within five minutes of arrival at scene.

If unable to establish contact with Paramedics, CACC shall:

1. Call back to the call-back (originator) number
2. If unsuccessful, CACC will immediately notify police communications to send their resources
3. Contact the Superintendent on duty to inform them that they were unable to contact the Paramedics on scene.

Paramedics are to use the 10-codes if they require police assistance. 

1. 10-2000 or activation of the emergency button on the portable radios for urgent police assistance for Paramedic safety 
2. CACC will contact police communications immediately and an ETA will be given (ETA of 10- 2000 is ….)
3. CACC will immediately notify the Superintendent on duty who will respond if they are available to assist.