Blog

December 29, 2010

To: All Fire Department Members, Staff, Dr. Mayberry

Fm: Chief Waldron

Re: Fire Chief, Medical Director and EMS Bureau Direction

As the Service Director, as defined by the EMS Bureau, I have the responsibility to make sure we are providing care within the scope of our license and medical direction. As you are aware, we met with Ken Threet, Montana EMS Bureau, a couple of months ago and Irene and I met with Dr. Mayberry a couple of weeks ago. This is a compilation of those discussion and my direction and comments, noted by *.

From our discussion with Dr. Mayberry and Ken Threet:

1. Should we carry Adavan? Mayberry stated it’s up to us but feels we don’t need it, due to the fact we already have Valium, Haldol and Versed.

*If the paramedics feel we need to change any of these let me know.

2. Rectal Valium? Dr. Mayberry will get back to us on his decision.

*I have not heard from Dr. Mayberry but will discuss this with him next week.

3. Transmitting 12 lead to hospitals? Need to research the cost and if we can do that from West

*Dr. Mayberry thought this had some value. Chief will check into the cost and function of that addition to our defibs/ambulances. Let me know what you think the value is.

4. Treat and release? Strongly against it on any patient, if you choose to head down this road make MD contact.

*We/You /Hebgen Basin Fire District will not treat patients that we do not transport. Both Dr. Mayberry and Ken Threet were against this practice. Calling medical control is not a release from this. If they need treatment, then transport them. That will save all of us a lot of liability and licensing issues. Ken Threet was very adamant that we should have very few refusals and we should be encouraging transports not refusals.

5. How we contact with MD Mayberry? His cell phone will be programmed in the ambulance and recommended in each of our cell phones. He will be available 24/7

*Dr. Mayberry said we may contact him at any time on his cell 1-208-351-5527

6. Training of new hires or students? Chief will call Mayberry and go over person’s experience.

*We will look at the training requirements, with Dr. Mayberry, on a case by case basis.

7. Vasopressin vs Epi? Vasopressin 20units will be our first line in Cardiac Codes

*Paramedic stuff, no comment

8. IM Morphine auto injectors for EMT? Mayberry has no problem with this after proper training

*I will look into how we move forward with this and set up a time line with the Dr.

9. Lidocaine infusion for IO? Will get back to us on this

*I’ll check for some feedback from Dr. Mayberry

10. RSI? Dr. Mayberry feels we need this in the system but wants to look into how Rexburg Fire and Idaho Falls Fire maintain their training and how we can get some OR time to maintain Intubation skills.

*I’ll check with Dr. Mayberry

11. Pronouncing of death? Call Emergency Room and speak to the MD on duty, document time of death and pronouncing MD. If patient shows obvious signs of death no phone call is needed.

*If we have an obvious death, not a working code, we’ll use the coroner and I’ll advise Dr. Mayberry.

Additional Info:

We are not responsible if we are not dispatched. The question has arisen about whether we should be on an incident where law enforcement makes the call that there are no injuries. If we are not dispatched it is not our responsibility. That may not be in the best interest of the patient, but we can’t inject ourselves if we are not dispatched. The current dispatch protocols call for us to be dispatched on all rollovers so that should take care of most of our concerns.
On diabetic calls where a patient has been provide food or glucose by family we call medical control and get confirmation that it is appropriate to not transport.
When we pick up patients at the West Yellowstone clinic we need to get some transfer paperwork if there is a PA on staff. We have a draft form and will look for your input to make it better
Our two online medical controls are MMH with Dr. Mayberry or Bozeman Deaconess. If you contact another physician you are only getting a consult because other Dr’s at MMH or EIRMC are not licensed in Montana. Kind of a technicality but an important one to remember.

Patti attended the ambulance conference and training in November. The following are things we need to make sure are taken care of on our Patient Care Reports.

LOCATION: Physical address where the patient is picked up. If it is an MVC, the Highway number and the Mile Marker.
The mileage on the ambulance at the pickup location. The mileage on the ambulance at the drop off location.
CAREGIVER SIGNATURE: Sign on the bottom where it says Caregiver Signature, not up above under the narrative. Your name and your State License number, not your Fire Department number.
PATIENT SIGNATURE: Always get a patient signature, if you can’t get a patient signature be sure and document in your report the reason the patient could not sign the PCR. If patient is less than 18 yrs of age or is mentally deficient have a parent or guardian sign.
For all patients especially those on Medicare or Medicaid we must have an Ambulance Billing/ Privacy Acknowledgement Form signed. (yellow sheet)
FACE SHEET: Get the patient face sheet from the receiving hospital if possible.
CALL FOR SERVICE: Put the call for service in with the patient care report

January Newsletter

From the Chief

I wanted to send out an information letter for the end of the year. We have the website up and running, thanks to AJ. She is doing a great job and we are working to try and make it better. Kudos to AJ for the good work.

Make sure you check out the website regularly it can be found at www.hbrfd.com

2010 in Review

As usual it is hard to believe that another year has passed. They really go fast the older you get. This has been a great year with a number of accomplishments for many of you individually and for the Fire District. We started off the year with the EMT class with 6 new EMTs completing the course. We held our first Ice Rescue course; Lindsay Crissinger showed us her courage when she went in the water without the protective suit on. We completed most of the new training building and nearly every firefighter, staff, and volunteer in the District participated in the Firefighter 1 tactics tests. This proved very beneficial when we responded to the structure fires we have had this fall. You have done an exceptional job on the structure fires we have had and proven to yourselves and many others that the consolidation and joining of forces makes us all better.

We have put a lot of new and/or improved equipment in service this year. New defibrillators on the ambulances and thanks to a generous donation we just ordered this week three new AED that will be added to stations 2 and 3. In addition to the AED, the new autopulse for CPR and new suction units round out the EMS equipment. A water tender has been added to our fleet at station 2 and we picked up a 6X6 that will be built into a tanker/pumper that will probably be placed in the Horse Butte area. Some new SCBA’s and additional spare bottles have also been added. We were fortunate to get a service truck from Central Valley Fire that will be used for rehab and has a cascade system for air on it also.

Training

We have a 2011 training calendar put together and it is on the wall in station 1 and AJ has added the information to the website for the upcoming months. In January we have the following training scheduled:

January 6 EMS Training

January 13 Fire Training Command/ICS and a live fire (burning a small building in town)

January 20 EMS Training

January 25 EMS Practical Skills Training

January 27 Station Training at your closest station

Training starts at 18:00 (6:00 pm) but if you can’t come until a little later come anyway. Your participation is essential!

Anyone can attend all of the training. You do not need to be an EMT to attend EMS training. Station training is your opportunity to improve your skills and knowledge about the fire apparatus in your individual station. In order for us to improve training we need good participation. We are also going to have a new member class in January. If you know of anyone who we can recruit let them know and let us know so we can contact them.

EMS Jane is available on line for continuing education training. Contact Patti for your password.

Personnel

There have been a number of personnel issues in the past couple of months. There have been a number of inaccurate rumors about laying off staff so we can hire an assistant chief. They were not accurate. We had some issues with the vacation relief position and how that was structured with the Union. That has been resolved and we have made that a half time position for the purpose of covering vacation and sick leave and for use of special projects/events etc. Steve Roy has been filling that position for the past few months but resigned to take another job. We will be announcing that position in the next couple of weeks, get your resumes updated. The District did announce an Asst. Chief position to be the Fire Marshal and to supervise day to day operations. On January 1, 2011 the District will take over the Fire Marshal responsibilities of Town as well as the outlying areas. In addition this position will supervise the maintenance and construction projects for both stations and fire apparatus. We announced the position internally and received one application from Shane Grube. I will be making a recommendation to the Board at the January Board meeting.

Cassandra is back at work after having her baby. The staff have been working on some projects this year including the training building, apparatus updates (John just installed new flashlights on engines), ISO hose testing, Richard and Bernie did most of it. Ryan has been busy keeping our hydrants tested and clear of snow and John did nice job of our preplan visits to buildings. Irene has been keeping our medical supplies squared away, and keeping all of us on our toes with a clean station (and flipping her hair). In addition to numerous transports to all of our hospitals.

Volunteers

Your response and participation is critical to the success of the Fire District. You are the foundation and it has been a great year. Just a few short years ago the Town lost it ISO rating and one reason was they could not maintain a minimum of 4 people on an initial response. The recent fires we have had a much better response and it was critical on all of the incidents that you were there. The duty crew has done a great job on all of the fires getting there and initiating a fire attack. However, they can’t do it alone and as all of you know there is lots of work after the fire is knocked down.

We are going to have some new members and please make them welcome. We’ll get their names out as soon as we get them through the new member training.

Apparatus

The chassis for the new engine has arrived at the factory. It is still on schedule for delivery in February/March. It is a 6X6 2500 gallon tanker pumper. It should be a great addition to our fleet. The station 2 water tender is a very large, very heavy (60,000#), very fast (70mph) piece of equipment. Not everyone is capable of driving that unit and we will be holding training before allowing individuals to drive it. We have some work to get done on it in the next few weeks. An emergency lighting package, radio, plumbing and some paint will be completed by staff and volunteers. The service truck at station 2 is a great piece of equipment for our extended incidents. It has inside seating for rehab, an onboard generator and a cascade for filling air bottles. It also carries hazardous materials absorbents, pads, tank plug and booms for surrounding a spill. It will be our supply vehicle with additional tarps and flashlights etc.

The “new” excess property 6X6 is a 1987 International with only 2,800 miles on it. It is in excellent condition and the plan is to put on a tanks and a pump so that it can be used for both structural and wildland fires. We do not have a specific home for it yet but it would be a great vehicle for use on Horse Butte. It may take a while to get everything in place for that to be a year around situation.

Volunteer reimbursement receipts are due. Please get them to Patti in the next few days or you will miss the opportunity. The Board has also asked me to research and look for funding to help with addition reimbursements, like insurance, I am working on that.

Search and Rescue

Questions have arisen about our participation with Search and Rescue. Over the past couple of years we have looked at some options with SAR. There are some issues with workers compensation and our staff responding and taking our staff out of town for several hours. We have attempted to get a mutual aid agreement or memorandum of understanding with the Gallatin County Sheriff’s Office but have not been able to get that done. So our staff will not be responding on the SAR calls except for ambulance transport. We will support them when necessary any major type of incidents and we encourage you to participate with SAR.

Annual Fire District Party

Our annual party is scheduled for January 14th. Please plan on attending and enjoy good food, entertainment and fun.

Location: Povah Center

Time: 7:00 pm

Menu:

Prime Rib Chicken Garlic Mashed Potatoes

Veggie Desert

Please R.S.V.P to Patti by noon January 6^th.

Some Operational Stuff F.Y.I.

On structure fire the duty crew is responsible for getting Engine 1-1 out and initiating fire attack. Responding volunteers need to take care of supporting their attack with additional crew members and bringing the second engine, laying supply line and getting the ladder truck to the scene. We’ll do some practicing on this at fire training in January.

Fires that are in the attic are best attacked from below. Pull the ceiling and put water into the attic space from below. If time permits lay down some tarps before pulling the ceiling this can reduce water and fire damage to the home.

The automatic tire chains we have some limitations. They are not designed for use in extreme deep snow and they should not be run over about 25 miles per hour. They will help in driveways and for short distances but are not designed for high speeds or long distance driving. Around town they will probably help but out on the highways they should be turned off.

Ventilation should be done in conjunction with fire attack. Ventilate as close as possible to the fire to manage where the fire goes. Fight the fire from the unburned to the burned.

Motor vehicle accidents pose a huge risk to us. Having adequate personnel and equipment at the scene is a must for extrication, patient care and traffic control. Even when it sounds like a minor incident please respond you are needed.

Happy New Year

2011 will be a great year and I look forward to working, training and responding with you this year. Thanks for your help and support and be safe and have a Happy New Year. ---- Scott

Dear Volunteer Emergency Services Supporter,

An important tax exemption for volunteer firefighters and volunteer EMS personnel is set to expire at the end of the year unless Congress takes action in the next few weeks. This exemption, the Volunteer Responder Incentive Protection Act (VRIPA), was enacted in December 2007 and exempts from income taxation all property tax benefits and up to $360 per year of any other type of benefit that a volunteer emergency responder receives in recognition of their service.

Recently, the NVFC sent a letter to key members of Congress asking them to extend VRIPA through 2011 before adjourning for the year. Follow this link to find a draft letter that you can send to your U.S. Representative and Senators telling them that you support extending VRIPA and oppose increasing taxes on volunteer emergency responders.

Thank you for taking action on behalf of the volunteer fire and emergency services!