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This document is the property of the University of Pennsylvania Medical Emergency Response Team. No portion of it may be redistributed or

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Procedures and Protocols

University of Pennsylvania

Medical Emergency Response Team

Last Revision Date 04-08-2013


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Standard Operating Procedures

University of Pennsylvania Medical Emergency Response Team

Table of Contents

General Membership

100.10 Mission Statement

100.20 Membership

100.30 Functional Position Description

100.40 Member in Good Standing

100.50 Leave of Absence

Member Expectations and Conduct

200.10 Member Code of Conduct

200.11 Harassment

200.12 Alcohol and Controlled Substances

200.13 Disciplinary Policy

200.14 Off-Duty Membership

200.15 Influenza Vaccination

200.20 Membership Meetings

200.30 Member Appearance

200.40 Public Information

200.50 Squad Room Management

200.60 Property and Equipment

200.61 Placement of Bikes

200.62 Drug Security

200.70 Identification and Building Access

200.80 Minimum Duty Requirements

200.90 Shift Exchanges and Cancelations

Operations and Response

300.10 Shift Changes

300.20 Crew Configuration

300.21 Clinical Chain of Command

300.30 Dispatch and Response

300.31 Radio Communication


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300.32 Atypical Dispatch

300.33 Special Event Procedure

300.40 Scene Safety

300.41 Transport Safety

300.50 Jurisdiction

300.60 Patient Transport300.70 Reporting of Accident or Injury to a MERT Member

Clinical Advancement

400.10 Crew Chief Advancement

400.20 Lead EMT Advancement

400.30 EMT Advancement

400.40 Accommodations for Prior EMS Experience

Provisions of Care

500.10 HIPAA Compliance and Patient Confidentiality

500.20 Patient Consent for Medical Treatment

500.30 Patient Refusal of Medical Treatment

500.40 Transfer of Care

500.50 Patient Care Report

500.60 Supplemental Incident Report

500.70 Infection Control

500.80 Critical Incident Stress Management

Administrative Management

600.10 Executive Structure

600.11 Chief - Basic Functions and Responsibilities

600.12 Operations Captain - Basic Functions and Responsibilities

600.13 Operations Lieutenant - Basic Functions and Responsibilities

600.14 Administrative Director - Basic Functions and Responsibilities

600.15 Scheduling Officer - Basic Functions and Responsibilities600.16 Training Officer - Basic Functions and Responsibilities

600.17 Equipment Officer - Basic Functions and Responsibilities

600.18 Disaster Response Team Officer - Basic Functions and Responsibilities

600.19 Internal Communications Officer - Basic Functions and Responsibilities

600.20 BLS Officer - Basic Functions and Responsibilities

600.21 Community Outreach Officer - Basic Functions and Responsibilities


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600.30 Chain of Command

600.40 Internal Investigations

600.50 Quality Assurance / Quality Improvement


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Standard Operating ProcedureUniversity of Pennsylvania Medical Emergency Response Team

Mission Statement

Protocol Number: 100.10

Effective Date: 09-12-2007

Revised Date: 08-10-2008

100.10.1

The University of Pennsylvania Medical Emergency Response Team (MERT) is a student-run, volunteer

organization with the primary purpose of providing professional, timely, and high-quality emergency

medical services to the University community. The secondary purpose of the organization is to provide

valuable educational opportunities for its members as well as the community.


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Membership




100.20.1

All members of MERT must be currently enrolled students of the University of Pennsylvania. All

members must be certified by the Commonwealth of Pennsylvania at a level of EMT Basic or higher and

possess a current CPR for the Healthcare Provider/Professional Rescuer certification.

100.20.2

A member will be considered Active once they have successfully completed new member orientation

and all required prerequisite trainings. An Active member may be placed on Inactive status for anapproved leave of absence.

100.20.3

All members must be able to fulfill the requirements outlined in the Functional Position Description SOP.


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Functional Position Description




100.30.1

All members of MERT acting as emergency care providers must be able to meet the following position

requirements:

1. Ability to read, write and speak the English language2. Ability to communicate verbally3. Ability to interpret written and oral instructions4. Ability to exercise good judgment and remain calm in high-stress situations5. Ability to lift, carry and balance up to 50 pounds


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Member in Good Standing




100.40.1

Requirements for Member in Good Standing:

1. Fulfills requirements of Active member2. Hold a valid certification of EMT Basic or higher in the Commonwealth of Pennsylvania3. Hold a valid American Heart Association CPR for the Healthcare Provider or American Red Cross

CPR for the Professional Rescuer card

4. Fulfill the requirements outlined in the Minimum Duty SOP (200.80)5. Fulfill all mandatory training requirements6.

Attend all required meetings outlined in the Membership Meetings SOP (200.20)

100.40.2

Exceptions to Requirements:

1. A member may be excused from a required meeting with a valid reason submitted to andapproved by the Chief prior to the start of the meeting.

2. A member may be excused from Minimum Duty if an illness or injury prevents the member fromriding.

100.40.3

Members who fail to maintain the requirements for a Member in Good Standing may be placed on

inactive status at the discretion of the Board. A member who fails to regain Good Standing within one

semester may be removed from the organization. Inactive members are not eligible to hold Board

positions.


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Leave of Absence




100.50.1

Certain circumstances may permit a member to take a leave of absence from MERT for up to one year. A

valid reason for a leave of absence includes extended illness, study abroad, or a family emergency. All

other forms of time away from MERT will require the member to resign from the organization and

reapply for membership if he or she chooses to return. In the event that an individual takes a leave of

absence or reapplies for membership, he or she will be demoted one clinical rank and may seek

expedited promotion at the discretion of the Operations Lieutenant.

100.50.2

If the member currently holds a position on the Board and will be absent for the duration of one

semester or longer, the individual may not retain the Board position and will be replaced. If the member

will be absent for less than a full semester, it will be left up to the discretion of the Board.


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Member Code of Conduct




200.10.1

All members are expected to conduct themselves in a professional manner at all times both on-duty and

off-duty. Any member who violates the SOPs, University policy or engages in unethical conduct will be

subject to disciplinary action.

200.10.2

Examples of violations of the Member Code of Conduct:

1. Failure to follow the Chain of Command2. Falsifying information on membership application, patient care report, incident report, etc.3. Unauthorized use of MERT equipment or office space4. Dishonesty or false representation5. Operating outside of the EMT Basic Scope of Practice6. Failure to maintain proper certifications

200.10.3

MERT personnel are not permitted to carry weapons of any type while on duty.


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Harassment



Revised Date:

200.11.1

In accordance with federal law, MERT has adopted and maintains strict enforcement of this policy

against unlawful harassment. Unlawful harassment is behavior which creates an environment that is

hostile, offensive, demeaning or intimidating to a member and is done on the basis of their gender,

sexual orientation, marital status, age, race, color, religion, national or ethnic origin, or disability. Any

discrepancies in adherence to this policy should be reported to the Operations Captain.


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Alcohol and Controlled Substances



Revised Date:

200.12.1

No member may consume or be under the influence of alcohol or controlled substances while on duty.

No member may consume alcohol within twelve hours prior to duty.

200.12.2

Members receiving a prescription for a medication should inquire with the prescribing physician about

possible impairment to judgment or motion as a result of medication use and forward such information

to the Medical Director who will make a determination whether or not a member is able to work.Members using an over-the-counter medication which indicates possible impairment of judgment or

motion as a potential side effect should forward such information to the Medical Director, who will

make a determination whether or not a member is able to work or must be placed on medical leave.

200.12.3

If any member has reason to suspect another member is under the influence of alcohol or a controlled

substance that member must immediately contact the Operations Captain and UPPD Supervisor. A

member who is suspected to be under the influence of alcohol or a controlled substance while on dutymay be asked to consent to medical testing. Refusing consent to the medical tests will be interpreted as

a positive result. A positive result will result in the expulsion of the member.


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Disciplinary Policy




200.13.1

Internal discipline is the responsibility of the Chief in conjunction with the Board of Directors. The

Medical Director and Department of Public Safety Liaison will be involved as needed.

200.13.2

The disciplinary process may be initiated by any Crew Chief, Supervisor or Board Member. That member

will document the incident using an incident report and notify the Chief within twenty-four hours of the

incident. If a member feels that disciplinary action is necessary against another member, they may ask aCrew Chief, Supervisor or Board Member to initiate disciplinary action. The Chief, or appointed

designee, will conduct an investigation into the incident in a timely manner. Upon completion of the

investigation, the Chief can either determine no violation has occurred or forward his/her findings of the

violation to the Board. Disciplinary matters are assessed and determined to be of one of three levels.

Level one violations are considered the most severe offences, level two violations are considered mid-

level offences and level three violations are considered the most minor offences. For confirmed level

one and level two violations, the Board will decide on the appropriate consequences for the members

actions. All confirmed violations will be documented in the members record. It is the ultimate goal of

the disciplinary policy to provide fair and timely warning to members who have violated expected

conduct so they understand how their actions have negatively affected the organization as well as

prevent future offences.

A members disciplinary history may be taken into account when a member is up for promotion.

Members who are removed from the organization as a result of disciplinary action may at no point in

the future reapply for membership.


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Examples of each type of offence and possible consequences are provided below, though it is the

ultimate decision and interpretation of the Board as to what constitutes an offence and what a

reasonable consequence of that offense will be.

200.13.3

Examples of Level One Violations:

1. Negligence resulting in the harm or death of a patient, crew member or bystander2. Deliberate violation of the SOPs3. Acting outside the definition of ones current rank4. Theft or deliberate damage of MERT property5. Having detectable amounts of alcohol or illicit drugs in ones body while on duty6. Falsification of documentation7. Repeat level two violations for the same offence8. Six or more of any level offences

Confirmed level one violations may result in reduction in rank, suspension or removal from MERT.

200.13.4

Examples of Level Two Violations:

1. Missing shifts without prior notification2. Missing General Body meetings or required training without authorization3. Failure to follow the Chain of Command4. Inappropriate actions towards a patient, crew member or bystander5. Failure to meet minimum duty6. Repeat level three violations for the same offence

Confirmed level two Violations may result in written warning or suspension of member privileges.

200.13.5

Examples of Level Three Violations:

1. Arriving late to shift2. Violations of the Member Appearance SOP3. Misuse of MERT property

Confirmed level three violations may result in a verbal warning from the Chief.


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Off-Duty Membership




200.14.1

All members, when they are not on shift with MERT, are not active members of MERT. As such, if an

emergency arises, an off-duty member should immediately follow the appropriate emergency

notification procedures by calling 911 (nine- one-one) or the University of Pennsylvanias emergency

notification system.

200.14.2

If an off-duty member of MERT has followed the appropriate emergency response procedures, the

member may assist the patient in question, as covered by the Good Samaritan law. However, the

member must be cognizant of the facts that:

1. They are not affiliated with MERT when off-duty

2. They may not operate outside the EMTs Scope of Practice

A MERT member should not attempt to assist a patient if the member is:

1. Under the influence of alcohol or other drugs

2. Not in their full mental capacity

200.14.3

An off-duty member may not wear his or her MERT uniform under any circumstances. Additionally,

MERT members are not allowed to wear any MERT apparel when alcohol is present. Violation of this

policy will result in a level one violation, and the Board will review the offenders membership.


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Influenza Vaccination



Revised Date:

200.15.1

In accordance with Joint Commission Standard IC.02.04.01 for staff in healthcare, it is recommended for

all members to be immunized against the flu every year.

200.15.2

Every member is required to have received the influenza vaccination by the first day back from winter

break of every year. All members are also required to complete and turn in the MERT Influenza

Vaccination Declaration form to the Administrative Director. Members who are not in accordance will

be ineligible to take shifts.

200.15.3

A member may decline the influenza vaccination requirement if it conflicts with religious beliefs, or is

medically contraindicated. In the event a member declines to receive the influenza vaccination, they will

be required to wear a mask when working within 6 feet of a patient until April 1st of that year.


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MERT Influenza Vaccination Declaration

Fall 2013 Winter 2014

INFLUENZA FACTS

Influenza is a serious respiratory disease that kills, on average, 36,000 Americans every year. Influenza can be transmitted up to 48 hours before symptoms begin. Up to 30% of people with

influenza have no symptoms but are still contagious to others.

Influenza virus changes often, making annual vaccination necessary. Immunity followingvaccination is strongest for 2 to 6 months. For more influenza information go to

www.cdc.gov\flu.

Influenza vaccine cannot transmit influenza. It does, however, prevent disease. Influenza vaccination is recommended by the Centers for Disease Control and Prevention (CDC)for all health care employees to prevent infection from and transmission of influenza and its

complications, including death, to patients, coworkers, family and community. In order to

protect our vulnerable patients, and fellow members, we ask all MERT members to be

immunized against flu every year.

The MERT members flu vaccine practice meets Joint Commission Standard IC 02.04.01.As per MERT protocol 200.15, all MERT members are required to have annual flu vaccine.

Please choose one of the following statements:

I have had an influenza vaccination this year.

Location Date__________

Knowing the facts set forth above, I choose to decline vaccination at this time for the followingreason: ____________________________________________________________

MERT Member: I have read and fully understand the information on this declaration form.

Print Name ____________________________________

Signature Date

Healthcare Provider: As state above I confirm that the said person has received the influenza

vaccination.

Print Name ____________________________________

Signature Date ______Your participation in this process is required. The protection of our members and patients is important toour organization.

The University of Pennsylvania

Medical Emergency Response Team


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Membership Meetings




200.20.1

All members are required to attend a minimum of two-thirds of scheduled General Body meetings.

200.20.2

A member may be excused from a required meeting with a valid reason submitted to and approved by

the Chief prior to the start of the meeting.


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Member Appearance




200.30.1

MERT members are expected to take pride in themselves and their uniform. Accordingly, all members

will maintain high standards of physical appearance, hygiene, grooming, and uniform. Members will

wear the designated uniform only when on duty, while attending an approved function or in transit to

and from their residence to any of the above. Members may not loan or give MERT uniforms to anyone

except other members without the permission of the Chief. While some articles bearing the MERT logo

are property of the private purchaser, members displaying the MERT logo are expected to act in a

professional manner.

200.30.2

Members will wear their uniform within the following guidelines:

1. Red MERT polo shirt neatly tucked in. If a long sleeved shirt is worn under the MERT polo, thesleeves must be a solid color that is free of design.

2. Red MERT Jacket. Personal sweatshirts, jackets or other MERT apparel may not be worn on calls.During extremely cold weather however, it is permissible to wear a personal fleece, design free

sweatshirt, sweater or jacket provided that they are covered by a MERT polo or MERT jacket at

all times when on a call or visible in public.

3. Navy blue or black pants including khaki, cargo or EMS style. No scrub pants, sweat pants,jeans, shorts or athletic pants may be worn unless completely covered by approved pants.

4. Dark colored belt5. Black shoes, boots or dark colored sneakers6. Functional digital watch or watch with second hand7. Dangling or hoop earrings or other piercings will not be allowed8. Long hair must be secured in a bun or pony tail9. Members are not permitted to wear clothing from other EMS, Fire or Public Safety agencies

while on duty.


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Public Information




200.40.1

MERT members are not to speak to any member(s) of the press or other related individuals about MERT

without permission from the Chief. In the event that the press asks for information regarding a specific

incident, they are to be directed to the Chief for public informational purposes.


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Office Management




200.50.1

The MERT office in shared by many people, and as such, everyone must do their part to keep the office

clean. It is the responsibility of the Crew Chief to ensure the office is clean at the end of his/her shift.

Examples of office maintenance include:

1. Vacuum carpet2. Clean tables/desks3. Straighten up equipment4. Take out trash

200.50.2

The on-duty crew has priority use of the office and office equipment. The Crew Chief may ask members

not on-duty to leave the office if it interferes with the usage by the on-duty crew. A Board member may

supersede the authority of the Crew Chief over office use for official business. No non-members may be

in the office unaccompanied without approval from a Board member.


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Squad Room Management




200.50.1

The MERT squad room is shared by many people, and, as such, everyone must do their part to keep the

squad room clean. It is the responsibility of the Crew Chief to ensure the rooms are clean at the end of

his/her shift. Examples of squad room maintenance include:

1. Vacuuming carpets2. Cleaning tables/desks3. Straightening up equipment4. Taking out trash

200.50.2

The on-duty crew has priority use of the squad room and equipment. The Crew Chief may ask members

not on-duty to leave if it interferes with the usage by the on-duty crew. A Board member may supersede

the authority of the Crew Chief over squad room use for official business. No non-members may be in

the squad room unaccompanied without approval from a Board member.


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Property and Equipment




200.60.1

It is the responsibility of the on-duty crew to ensure the security of all the equipment necessary for a

shift. At the beginning and end of each shift it is the responsibility of the Crew Chief to check the

equipment and ensure that it is present and functioning properly. To ensure the readiness at the start of

the shift, members must arrive for duty 15 minutes prior to the start of the scheduled shift.

200.60.2

The crew will utilize the appropriate check sheet when inspecting equipment. The Crew Chief isultimately responsible for the completion of the check sheet however all members are expected to take

part in checking the equipment. If any equipment is found to be missing or damaged an incident report

should be filed and if necessary the Equipment Officer notified. If damage or loss is due to grossly

negligent conduct, the member will be responsible for repair or replacement. No equipment may be

used by members other than the on-duty crew without prior approval from the Operations Captain.


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Placement of Bikes



Revised Date:

200.61.1

While MERT is not in service, MERT bikes are to be kept in the bike room at the Lower Quad Gate.

200.61.2

While MERT is in service, MERT bikes will be kept in a protected area where they will not be exposed to

the elements, including but not limited to rain, snow, ice, and heavy winds. MERT personnel will ensure

that the bikes are kept within eyesight of themselves, Penn Security, or Penn Police officers at all times.


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Identification and Building Access



Revised Date:

200.70.1

MERT members are required to carry their University of Pennsylvania identification card (Penn Card),

Commonwealth of Pennsylvania EMT Basic card, and CPR card at all times while on duty.

200.70.2

MERT members will have their Penn Cards encoded to provide twenty-four hour access to all University

of Pennsylvania residence halls. Should the crew be dispatched to a building with restricted access, the

crew will notify dispatch of the situation. Each member is liable for his/her own access card. Misuse ofthis privilege will result in disciplinary action.


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Minimum Duty Requirements




200.80.1

All members are expected to perform twenty-four hours of regular duty per month during the academic

year. Additionally each member is expected to fulfill one athletic shift per semester during the academic

year. Any duty hours that a member receives compensation for such as teaching do not count towards

minimum duty hours. Furthermore it is expected that all members attend at least 2/3 of GBMs each

month unless a valid excuse is presented.

200.80.2

In order to facilitate compliance with the minimum duty requirement, all members must submit a

minimum of thirty-six hours availability each month. The total availability submitted may not fall within

seven consecutive days.

200.80.3

The Scheduling Officer has the authority to modify or suspend minimum duty requirements for months

where MERT service is not continuous.


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Shift Exchanges and Cancellations




200.90.1

If a member needs to cancel a shift due to medical and/or personal reasons forty-eight hours or more

prior to the shift, they must notify the Scheduling Officer via e-mail and attempt to find coverage for

their shift. If the Scheduling Officer cannot be contacted, the member must notify the Chief. If the

cancellation is less than forty-eight hours before the shift, they must call the Scheduling Officer. If no

contact has been made, and the member does not show up for his/her shift, he/she will face disciplinary

action. If a member needs to switch a shift with someone, they may do so with another member of

equal or higher rank. Both members must then notify the Scheduling Officer via e-mail.


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Shift Changes




300.10.1

MERT will operate from 17:00 07:00 seven days a week during the academic year. Shifts will operate

on the following schedule:

A Shift: 17:00 23:00 (6 hours)

B Shift: 23:00 07:00 (8 hours)

300.10.2

The shift change will occur 15 minutes prior to the start of the shift. Lateness is defined as arriving more

than 5 minutes after the shift change without notifying the Crew Chief on the shift. Members who are

late to shift may face disciplinary action.


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Crew Configuration




300.20.1

The on-duty crew will consist of a Crew Chief and at least one other member. Two members with the

designation of Lead EMT may function in lieu of a Crew Chief. At no time will a responding crew consist

of more than three members without prior approval of the Operations Captain or Chief. The Crew Chief

has the overall responsibility and authority over the crew. At no time will an EMT or Probationary EMT

respond without a Crew Chief or Lead EMT on-duty.

300.20.3

At no time should an off-duty member present or represent themselves as MERT personnel.


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Clinical Chain of Command




300.21.1

The Clinical Chain of Command is a fixed hierarchy independent of crew configuration.

The Chief is the highest-ranked clinical officer on MERT.

The Operations Captain is the second highest-ranked clinical officer on MERT.

The Operations Lieutenant is the third highest-ranked clinical officer on MERT.

300.21.2

The Clinical Chain of Command should be utilized during any of the following circumstances:

1. Confusion by the on-call crew regarding the correct treatment or procedure to follow during acall.

2. Unresolved conflict with another agency3. Problems that affect the crew's ability to respond or deliver care4. Treatment of a patient with a serious illness/injury (e.g. major trauma, respiratory or cardiac

arrest)

5. Large volume of calls

300.21.3

The officers included in the Clinical Chain of Command should be contacted in order (first through third)

by cellular telephone during any of the aforementioned circumstances. In the unlikely event that the

Chief, Operations Captain, and Operations Lieutenant are unable to be reached, any other crew chief

should be contacted for additional assistance.


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On-Duty Supervisor




300.21.1

The on-duty Supervisor will be designated by the Operations Lieutenant.

300.21.2

The on-duty Supervisor should be notified for any of the following circumstances:

1. Member fails to report for duty and is unreachable by the Crew Chief2. Unresolved conflict with another agency3. Problems that effects the crew's ability to respond or deliver care4. Treatment of a patient with serious illness/injury (e.g. major trauma, respiratory or cardiac

arrest)

5. Large volume of calls

300.21.3

The on-duty Supervisor must be able to be contacted by cellular telephone at all times when a crew is

in-service.


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Dispatch and Response



Revised Date:

300.30.1

When PennComm receives a request for emergency medical assistance, PennComm will gather vital

information and dispatch MERT using the radio. PennComm will inform MERT of vital information

including location, nature of call and dispatch time. The Crew Chief or designee should acknowledge the

dispatch and inform PennComm that MERT is in route to the scene. Once responding, the crew will

travel to the location of the incident by taking the safest and most direct route. PennComm should be

notified upon the crews arrival on scene. The crew should be familiar enough with the service area so

they can modify their route as needed without the use of maps or directions.

300.30.2

Lead patient care will be delegated by the Crew Chief. Refer to the MERT Medical Treatment Protocols

for patient care procedures. If the patient requires transport by ambulance, the crew is to notify

PennComm to dispatch PFD. Patient contact will be maintained until patient care and patient

information has been transferred to the transporting agency or receiving facility (See Transfer of Care).

If the patient does not want to be treated or transported a Refusal of Medical Assistance (RMA) should

be completed and signed before leaving the scene (See Patient Refusal of Medical Treatment). Upon

completion of the incident, the crew should confirm that all equipment is secured and nothing is left on

the scene. When the crew becomes available, they should notify PennComm that the crew is clear of the

scene and available for response.

300.30.3

In the event the crew is dispatched to a second incident while on scene, the Crew Chief will respond at

his/her discretion provided a member of the crew with the rank of EMT or higher remains on scene with

the first patient. If the crew is unable to respond, PennComm must be notified to dispatch PFD to the

second scene.


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300.30.4

All crew members must remain within MERTs jurisdictional boundaries at all times and be able to

respond within two minutes.

300.30.5

In the event the crew is in an accident or an equipment malfunction prevents or delays the arrival of the

crew to the scene, the Crew Chief or highest ranking able member is to notify PennComm of the crew's

inability to respond and request any assistance required by the crew. The on-duty Supervisor should be

contacted and an incident report filed as soon as possible.


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Radio Communication



Revised Date:

300.31.1

All information transmitted over the radio should be kept professional and concise. No patient

identifying information should be transmitted over the radio. Each crew member is responsible for

his/her own radio and carrying it with them at all times.

300.31.2

MERT members should utilize the following designations when communicating over the radio:

Supervisor MERT Command

Crew Chief MERT 1a

EMT MERT 1b

Probationary MERT 1c

The crew may collectively refer to themselves as MERT 1 when on a scene. If multiple crews are in

service, crew numbers will be assigned sequentially by the Supervisor. The designation for PennComm is

Radio.

300.31.3

The Crew Chief should inform PennComm via the radio at the start of the shift that MERT is in service.


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Procedures for Atypical Dispatch



Revised Date:

300.32.1

When MERT is requested by a party other than PennComm, such as a Resident Advisor an individual, a

bystander, or other person to evaluate an individual, the Crew Chief or designee will inform PennComm

of the nature of the call, location of the call, and dispatch time. PennComm will acknowledge the receipt

of this information. Both PennComm and MERT will follow their usual Dispatch/Treatment protocols

after this exchange of information.

300.32.2

In the event that MERT crew comes upon a potential patient without being dispatched by PennComm or

flagged down by another individual, the Crew Chief or designee will inform PennComm of the nature of

the call and the location of the call and then proceed to provide care. If no Penn Security or Penn Police

officers are near the scene, the MERT crew will request their presence on the call. PennComm will

acknowledge the receipt of this information. Both PennComm and MERT will follow their usual

Dispatch/Treatment protocols after this exchange.


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Special Event Protocol




300.33.1

MERT provides on-site medical coverage at special events, such as Spring Fling, Hey Day, sporting

events, and other large scale events. The number of EMTs and crews staffing these events will be

determined by the size and nature of the event. At the start of such events, MERT will inform

PennComm of the number of crews that are in service and the expected duration of the event.

300.33.2

If MERT is working stand-by at a special event, MERT will notify PennComm of any emergencies in which

a patient requests or requires transport to a hospital. MERT will inform PennComm of the nature of the

call, location, and dispatch time. PennComm will acknowledge the receipt of this information.

PennComm and MERT will then adhere to their usual Dispatch/Treatment protocol.

300.33.3

In the event that MERT is working a special event in which individuals unaffiliated with the University of

Pennsylvania are present, MERT will treat individuals regardless of their university affiliation if they

request care or care is deemed appropriate.

300.33.4

In the event that MERT is providing standby coverage at a pool event, MERT personnel will not operateoutside of the Scope of Practice of an EMT and will not perform any water rescue. All water rescue

should be performed by qualified lifeguard personnel. If an individual must be rescued from the water,

MERT personnel will begin treatment once the patient has been safely removed to dry land.


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Scene Safety




300.40.1

MERT members must use extreme caution whenever responding to a scene that is potentially unsecure

or unsafe. The Crew Chief is responsible for ensuring the safety and security of all scenes prior to

assessing the patient and initiating care. If a potential danger is perceived by any member of the crew,

the crew will immediately evacuate the danger zone and move to safe ground. The Crew Chief or

designee will notify PennComm via radio of the perceived danger and request the necessary resources.

Potential dangers include, but are not limited to:

Weapons

Explosives Violent individuals Natural disasters Hazardous materials Roadways Fires Any other potential scenario, which may endanger the crew

The crew will only reenter the scene and begin patient care once the scene has been deemed safe by

police and all other agencies.


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Transport Safety



Revised Date:

300.41.1

The safety of MERT personnel is paramount. Under no circumstances should MERT risk biking or walking

to a scene if conditions may result in the injury of MERT personnel or damage of MERT property. In the

event of inclement weather, such as heavy rain, snow, ice, high winds, flooding, or other circumstances,

the MERT crew on shift will request transportation by Penn Police to all calls. The Crew Chief or designee

will notify PennComm at the beginning of the inclement weather that they will be requesting transport

to all calls for the duration of the adverse conditions. When requesting transport to a call, MERT will

notify PennComm of both the pick-up and drop-off locations.

300.41.2

It is the responsibility of the Crew Chief to ensure that conditions are safe for bike transport, and if any

member of the crew feels uncomfortable biking in the conditions, the Crew Chief shall request transport

for the duration of the adverse conditions.


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Jurisdiction




300.50.1

MERT is responsible to provide emergency medical services to any call which they are dispatched. In

general, MERT will respond to incidents from 30th Street to 43rd Street (east to west) and Market Street

to Baltimore Avenue (north to south).

300.50.2

MERT operates within the jurisdiction of the Philadelphia Fire Department (PFD). When PFD is on scene,

they have primary medical jurisdiction.

300.50.3

MERT will utilize the following Zone designations in documenting locations:

Zone 1 North: Market Street, South - South Street, East: I-76, West: 33rd Street

Zone 2 North: South Street, South: University Avenue, East: I-76, West: Civic Center Boulevard

Zone 3 North: Market Street, South: Walnut Street, East: 33rd Street, West: 38th Street

Zone 4 North: Walnut Street, South: University Avenue, East: 33rd Street, West: 38th Street

Zone 5 North: Market Street, South: Walnut Street, East: 38th Street, West: 42nd Street

Zone 6 North: Walnut Street, South: Baltimore Avenue, East: 38th Street, West: 42nd Street


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Patient Transport



Revised Date:

300.60.1

Any patient who requires ALS treatment, spinal immobilization, oxygen or has potential life threatening

injuries must be transported via PFD ambulance. If a patient requires transport by PFD, confirmation

that PFD is responding should be made with PennComm. Upon arrival of PFD, a complete report of prior

assessment and treatment should be given to the receiving crew.

300.60.2

Non-critical patients with stable vital signs and no signs of immediate distress may be transported viaUPPD. The patient transport must be approved by the UPPD Supervisor and a member of the crew with

the rank of EMT or higher must accompany the patient in the UPPD vehicle with medical equipment.

Patients transported to the University of Pennsylvania Hospital or Penn Presbyterian Medical Center

should be triaged and the name of the triage nurse obtained and recorded on the PCR.


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Reporting of Accident or Injury to a MERT Member



Revised Date:

300.70

In the event that a MERT member is involved in any accident while on shift, which results in member

injury or fatality, the following steps will be adhered to in the order that they are written.

1. The Crew Chief or designee will immediately notify PennComm of the incident andrequest the necessary resources to provide immediate medical treatment to that

member. Fellow crew members will provide emergency care until the arrival of the

Philadelphia Fire Department for transport. If Penn Police is not already on scene, their

presence will be requested. If the injury of the member will prevent the crew from

responding to a call, the Crew Chief or designee will notify PennComm that the MERT

crew will be unable to respond to the previous call.

2. The Crew Chief or designee will notify the Operations Captain and Chief of the incidentas soon as care of the injured member has been transferred to a higher level of medical

care.

3. A Special Report detailing the incident will be written on EMScharts.com by the CrewChief or designee and by the injured member if he or she is capable.

4. The incident will be reviewed by the Chief and Operations Captain, who will consult withthe Department of Public Safety and Student Health Services to ensure that adequate

follow-up is provided to the victim and all other MERT members present at the incident.


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Crew Chief Advancement




400.10.1

In order for a Lead EMT to be promoted to the rank of Crew Chief, the following requirements must be

met:

1. Successful completion of at least one shift review and two reviewed calls by different CrewChiefs

2. Demonstrate competency in MERT operations, SOPs, and campus building locations3. Completion of ICS 200 (NIMS)

After the above requirements have been met, the candidate will be granted an interview with the

Operations Lieutenant.

Any of these individual requirements may be waived by the Operations Lieutenant at his or her

discretion.


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Lead EMT Advancement




400.20.1

In order for an EMT to be promoted to the rank of Lead EMT, the following requirements must be met:

1. Minimum of 8 patient contacts2. Successful completion of three patient care scenarios (medical, trauma and cardiac arrest) with

the Operations Lieutenant held to NREMT standards

3. Demonstrate familiarity of MERT operations, SOPs, and campus building locations4. Successful completion of at least one shift review and one reviewed call by a Crew Chief

After the above requirements have been met, the candidate will be granted an interview with the



discretion.


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EMT Advancement




400.30.1

In order for a Probationary member to be promoted to the rank of EMT, the following requirements

must be met:

1. 24 hours of on-duty time2. Successful completion of the Equipment Location Exam with the Training Officer or Crew Chief

a. This includes that the Training Officer or Crew Chief ensures the zip-tied bags areopened and reviewed

3. Successful completion of the Basic Skills Exam with the Training Officer or Crew Chief4.

Familiarization with radio communication

After the above requirements have been met, the candidate will be granted the rank of EMT.


discretion.


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Accommodations for Prior EMS Experience




400.40.1

Members with significant prior 911 or equivalent EMS experience are eligible to be promoted directly

from EMT to Lead provided after the following requirements have been met:

1. Submit at least one reference of a previous EMS supervisor2. Successful completion of the Equipment Location Exam with a Crew Chief3. Successful completion of the Basic Skills Exam with a Crew Chief4. Successful completion of three patient care scenarios (medical, trauma and cardiac arrest) with

the Operations Lieutenant held to NREMT standards

5.

Successful completion of at least one shift review and one reviewed call by the Chief, OperationsCaptain, or Operations Lieutenant

6. Demonstrate competency in MERT operations, SOPs, and campus building locationsAfter the above requirements have been met, the candidate will be granted an interview with the



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HIPAA Compliance and Patient Confidentiality



Revised Date:

500.10.1

The Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996 and covers

numerous issues in health care. Title II, Subtitle F establishes regulations for the use and disclosure of

Protected Health Information (PHI). PHI is any information about health status, provision of health care,

or payment for health care that can be linked to an individual. In order to protect MERTs professional

integrity, it is imperative that all members strictly adhere to laws regarding confidentiality. Medical

information, including the patients PCR, is considered confidential protected health information and

may only be transferred to the next medical professional caring for the patient. MERT members should

not discuss the specifics of an incident except for the purpose of call review.

500.10.2

The Operations Captain will serve as the privacy officer for MERT. Any suspected privacy violations must

be immediately reported to the Operations Captain.


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Patient Consent for Medical Treatment




500.20.1

The provision of emergency medical care requires the consent of the patient. Any touching of the

patients body without the patients consent could result in charges of assault and battery. Consent may

either by expressed or implied. Expressed consent (or actual consent) is the type of consent in which the

patient speaks or acknowledges that he/she wants care provided. The patient must be informed of the

potential risks, benefits and alternatives to treatment. The patient must be a legal adult and able to

make a rational decision. When a person is unconscious and unable to give consent or when a serious

threat to life or limb exists, the law assumes that the patient would consent to care. Implied consent is

limited to life-threatening emergency situations and is appropriate when the patient is unconscious,

delusional, impaired as a result of drug or alcohol use or otherwise physically unable to give expressedconsent.

500.20.2

In the case of minors or adults who are mentally incompetent, consent must be obtained from the

parent or legal guardian. If the parent or legal guardian is not available, the consent for emergency

treatment is implied.

500.20.3

Persons in the custody of a law enforcement officer may be treated at the request of the officer without

the need to obtain the patients expressed consent.


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Patient Refusal of Medical Treatment



Revised Date:

500.30.1

In order to refuse treatment, the patient must be competent. Competency is defined as being alert,

awake and oriented to person, place, time and event, and not suspected to be under the influence of

any substances such as alcohol or drugs. The patient is not competent when under temporary but

severe stress or depression or having possible temporary psychosis or chronic mental disorder.

500.30.2

If a competent patient states that he/she does not want to be treated, the crew must not initiatetreatment. The crew must explain the consequences of refusing medical care and again offer treatment.

If the patient still refuses treatment, a Refusal of Medical Treatment form should be completed and the

patient should sign the form acknowledging refusal of further treatment. If the patient refuses to sign a

witness or law enforcement official should sign and the incident documented on the PCR. In situations

where the patient is refusing against the medical advice of MERT personnel or there is ambiguity in the

severity of the patients condition, patient care should be transferred to PFD for refusal purposes.


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Transfer of Care



Revised Date:

500.40.1

Patient care may only be transferred to a provider of equal or higher level. Upon transfer of patient

care, a complete verbal report of prior assessment and treatment should be given to the receiving

provider. The unit number and/or name of the accepting agency should be documented on the PCR.


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Patient Care Report




500.50.1

A patient care report (PCR) is completed for every call for which MERT is dispatched. The PCR is a legal

document and part of the patients medical record. PCRs will be completed and signed electronically

using EMSCharts Inc. charting software. Two MERT members are required to sign each chart prior to

locking.


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Supplemental Incident Report




500.60.1

A supplemental incident report is an internal document that explains a deviation from normal

operations. Any member with a rank of EMT or higher can write an incident report. The report should be

a clear and concise narrative that explains the situation, the problem encountered, and any actions

taken in response by the crew. If a report references a specific call, no information should be included

that could identify the patient. The Operations Captain should be notified within twenty-four hours. An

incident report should be filed for any of the following reasons:

1. Violation of MERT SOPs2.

Unusual circumstances in providing patient care

3. Difficulties in interacting with UPPD, PFD or other agencies that regularly work with MERT4. Equipment loss, damage, or malfunction5. Member conduct warranting disciplinary action

500.60.2

Supplemental incident reports will be filed using EMSCharts Inc. charting software Special Reports.


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Infection Control




500.70.1

The following scenarios should be considered an exposure:

1. Patient blood or bodily fluid comes in contact with a providers mucous membrane or skin2. Needle sticks with a used needle or other sharp medical instrument3. Unprotected exposure to a patient with a known or highly suspected airborne pathogen

500.70.2

Immediately following an exposure, the Crew Chief should notify the Operations Captain. The member

should seek medical treatment for the exposure at Student Health Services during operating hours or at

the closest emergency medical facility

500.70.3

MERT members will always take appropriate personal isolation precautions when treating patients. This

may include but is not limited to:

1. Wearing a face mask2. Wearing gloves3. Wearing personal isolation sleeves4. Wearing safety goggles.

500.70.4

If a MERT member treats a patient who is symptomatic of an infectious disease, he/she should report

the incident to the Operations Captain. If the MERT member is concerned that he/she may have been

exposed to the infectious disease, the member should seek medical treatment and testing at Student

Health Services during operating hours or at the closest emergency medical facility and notify the

Operations Captain of the incident.


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Critical Incident Stress Management



Revised Date:

500.80.1

This operational procedure provides guidelines for recognizing and implementing a Critical Incident

Debriefing, thereby attempting to manage and prevent injuries/illnesses to our members from problems

associated with stress.

500.80.2

The following definitions shall apply in this document:

1. Critical Incident A critical incident is one in which a member(s) is experiencing situationswith strong emotional involvements that are generally outside the range of usual humanexperiences.

2. Critical Incident Debriefing Critical Incident Debriefing is an organized approach designedto assist emergency service personnel in understanding and dealing with the effects of

stress.

3. Debriefing Debriefing is a process that provides a format where personnel can discusstheir fears and reactions thereby reducing the stress resulting from exposure to a critical

incident. Debriefing is not a critique of MERT operations that occurred during the incident.

Performance issues will not be discussed during the debriefing. All debriefings are totallyconfidential. Debriefings may be conducted on an individual one-on-one basis or, more

typically, in small groups.

4. Stress Stress is a normal reaction to disaster/emergency operations. It gears our bodiesfor immediate action and sustains us for long periods of intense and strenuous activity.

However, too much stress can be harmful. During and following disaster/emergency


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operations, members may experience the effects of excessive stress.

5. Triggering Events A triggering event is one in which a situation has occurred of suchmagnitude that its occurrence alone has the potential to effect personnel present at the

scene of a disaster/emergency operation. The following have been identified as triggering

events and indicate the need for Critical Incident Debriefing. This is by no means an

exhaustive or comprehensive list.

a. On-duty death of member(s)b. Severe duty related Injuries to member(s)c. Mass casualtiesd. Suicide by a membere. Shooting situationsf. Death or serious injury of civilians during MERT operationsg. Traumatic deaths of childrenh. Traumatic injuries of childreni. Events with excessive media interestj. Incidents when victims or patients are known by or related to MERT membersk. Suspected contamination of members involving toxic materialsl. Dangerous or hazardous environments that MERT is dispatched to, or that

materialize after MERT is on scene

500.80.3

1. Upon any of the above events, or any other situation in which a member of MERT feels adebriefing is necessary, this member or his/her appointee shall approach the Chief with the

request of a debriefing for the member(s) involved.

a. If the Chief is not immediately available, the Operations Captain shall be the nextperson of which to request a debriefing, followed by the Operations Lieutenant, and

finally, the on duty supervisor for the week of which the incident took place. If all of

these resources are unavailable, the request can be made directly as described in

500.80.3.4. If the request is made directly, the Chief must be informed as soon as is

possible after the request is made.

2. If at any point during the QA process, a lead or crew chief finds a call chart that representsan event where a triggering event or critical incident may have occurred, the QA personnel

shall notify the Operations Captain. The Operations Captain shall determine, in conjunction

with the Chief, the need for Critical Incident Debriefing for the affected crewmembers.


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3. The MERT Chief, MERT Operations Captain, DPS Chief of Fire and Emergency Services, andthe DPS Director of Special Services shall have the authority to mandate Critical Incident

Debriefing for MERT members or crews involved in critical incidents at any of their

discretions. Failure to comply can result in disciplinary action, which can include removal

from MERT. The need for follow-up debriefings shall be determined after the initial

debriefing. If Penns Critical Incident Stress Management Team feels that additional

counseling is needed, they shall refer the affected member(s) to Counseling and

Psychological Services. Although this referral cannot be mandated, MERT strongly

recommends affected member(s) to take advantage of any and all referrals given.

4. Once the need for a debriefing is established, the request shall be channeled throughPennComm at the emergency number, 215-573-3333.

500.80.4

MERT members participating in a CID are assured confidentiality. CID records shall not be used

in any matters regarding MERT discipline, advancement, etc., and shall not become a part of any

record that MERT personally maintains. MERT recognizes that there may be times when

documents involved in a CID may be subpoenaed or legally required. Generally speaking,

communications with mental health professionals are privileged and will remain confidential.

There may however, be legal exceptions to this confidentiality over which MERT has no control.


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Executive Structure




600.10.1

MERT receives medical direction from the University of Pennsylvania Student Health Services (SHS) and

operation oversight from the Division of Public Safety (DPS) of the University of Pennsylvania. The Board

will consult with these departments for any major changes within the organization that require their

authorization, signature and/or approval.

600.10.2

The MERT Board of Directors will consist of the Chief, Operations Captain, Operations Lieutenant,Administrative Director, Equipment Officer, Scheduling Officer, Training Officer, Disaster Response Team

Officer, Athletics Scheduling Officer, Bicycle Engineer, Internal Communications Officer, BLS Officer,

Community Outreach Officer, Social Coordinator and CPR Coordinator.

600.10.3

The Chief may choose to add additional staff at his or her discretion after consultation with the Board of

Directors.


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Chief - Basic Functions and Responsibilities




600.11.1

Basic Functions and Responsibilities:

1. The Chief will be the highest-ranked clinical officer2. The Chief will serve as Chairman of the Board3. The Chief will ensure compliance with the SOPs of the organization and review all disciplinary

matters

4. The Chief will communicate concerns or recommendations for improving the delivery ofemergency medical services to the Board

5.

The Chief will meet, as necessary, with the DPS Liaison and Medical Director6. The Chief will organize and oversee the operations for all major University events7. The Chief will be the primary media contact for the organization8. After the term has ended the ex-Chief will be expected fill the role of student advisor by

attending the first half of board meetings in the first semester to provide advice and information

to the new board.

600.11.2

Qualifications:

1. Candidate is a Crew Chief in Good Standing2. Candidate is nominated and elected by the previous Board3. Candidate receives a vote of confidence by the Active Membership4. Candidate has held a previous Board position


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Operations Captain - Basic Functions and Responsibilities




600.12.1


1. The Operations Captain will be the second highest-ranked clinical officer2. The Operations Captain will oversee daily operations and ensure good medical practice3. The Operations Captain will review all Incident Reports4. The Operations Captain will serve as the HIPAA compliance officer5. The Operations Captain will organize, staff, and plan special events6. The Operations Captain will facilitate communication via the Chain of Command

600.12.2

Qualifications:

1. Candidate is a Crew Chief in Good Standing2. Candidate is nominated and elected by the previous Board3. Candidate receives a vote of confidence by the Active Membership4. Candidate has been an Active Member for a minimum of one year


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Operations Lieutenant - Basic Functions and Responsibilities



Revised Date:

600.13.1


7. The Operations Lieutenant will be the third highest-ranked clinical officer8. The Operations Lieutenant shall be responsible for supporting the objectives of the Operations

Captain in absence of that captain

9. The Operations Lieutenant shall identify members in need of advancement10.The Operations Lieutenant is in charge of conducting advancement tests for Probationary, Lead,

and Crew Chief

11.The Operations Lieutenant is responsible for maintaining, revising, and updating alladvancement documents

12.The Operations Lieutenant is in charge of maintain and updating MERT Standard OperationProcedures and Protocols

13.The Operations Lieutenant is in responsible for oversight of the supervisor program14.The Operations Lieutenant will facilitate communication via the Chain of Command

600.13.2

Qualifications:

5.

Candidate is a Crew Chief in Good Standing6. Candidate is nominated and elected by the previous Board7. Candidate receives a vote of confidence by the Active Membership8. Candidate has been an Active Member for a minimum of one year


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Administrative Director - Basic Functions and Responsibilities




600.14.1


15.The Administrative Director will maintain accurate records of all active members16.The Administrative Director will maintain all call statistics17.The Administrative Director will coordinate the new member application process18.The Administrative Director will create the SAC budget and manage non-operational MERT

funds

19.The Administrative Director will attend all SAC meetings20.

The Administrative Director is in charge of applying for all awards and grants

21.The Administrative Director is the NCEMSF liaison22.The Administrative Director will facilitate communication via the Chain of Command

600.14.2

Qualifications:

9. Candidate is nominated and elected by the previous Board10.Candidate receives a vote of confidence by the Active Membership


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Scheduling Officer - Basic Functions and Responsibilities




600.15.1


23.The Scheduling Officer will schedule all duty crews for daily shifts and special events24.The Scheduling Officer will maintain all shift records and duty statistics25.The Scheduling Officer confirms service availability for events26.The Scheduling Officer maintains contacts with MERT clients vital to scheduling tasks27.The Scheduling Officer relays information about delinquent members to Operations Captain28.The Scheduling Officer oversees Athletics Scheduling Coordinator29.

The Scheduling Officer will facilitate communication via the Chain of Command

600.15.2

Qualifications:

11.Candidate is nominated and elected by the previous Board12.Candidate receives a vote of confidence by the Active Membership


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Training Officer - Basic Functions and Responsibilities




600.16.1


30.The Training Officer will schedule and organize all MERT membership meetings, and continuingmedical education training

31.The Training Officer will ensure all new members are familiar with the SOPs and medicalprotocols before certifying them for active duty

32.The Training Officer is in charge of organizing and conducting bicycle-training classes33.The Training Officer will facilitate communication via the Chain of Command

600.16.2

Qualifications:

13.Candidate is nominated and elected by the previous Board14.Candidate receives a vote of confidence by the Active Membership


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Equipment Officer - Basic Functions and Responsibilities




600.17.1


34. The Equipment Officer will be responsible for all equipment and supplies35.The Equipment Officer will administer operational funds36.The Equipment Officer will be responsible for conducting safety reviews of the organization37.The Equipment Officer will be responsible for all bike and equipment maintenance38.The Equipment Officer will advise the Bicycle Engineer39.The Equipment Officer will oversee and maintain Butcher station40.

The Equipment Officer will facilitate communication via the Chain of Command

600.17.2

Qualifications:

15.Candidate is nominated and elected by the previous Board16.Candidate receives a vote of confidence by the A