AmbulanceOperationalManual 110811 Final

Ambulance Operations Manual
Standard Operating Procedures
AMBULANCE SERVICES, MINISTRY PUBLIC HEALTH, SOCIAL DEVELOPMENT & LABOUR,

GOVERNMENT OF SINT MAARTEN
November 1st 2010
Compiled by: drs.Cylred Richardson, Head Ambulance Services
Ambulance Operations Manual

Table of Contents
Ambulance Operations Manual | 8/1/2010
1. PREFACE .................................................................................................................. 4
2. INTRODUCTION ....................................................................................................... 5
3. THE ORGANIZATION/CHAIN OF COMMAND ..................................................................... 6
3.1 MISSION &VISION:................................................................................................. 7
3.2 THE OBJECTIVES................................................................................................... 7
3.3 PERSONNEL MANAGEMENT PHILOSOPHY ......................................................................... 7
3.4 PERSONNEL ORIENTATION .......................................................................................... 8
4. BASIC WORK POLICIES ............................................................................................... 9
4.0 BASIC PRINCIPLES: .................................................................................................... 9
4.1 HOUSE RULES ........................................................................................................ 10
4.2 VEHICLE USE .......................................................................................................... 11
4.3 NON SMOKING POLICY:...................................................................................... 12
4.4 RECORDING OF WORKING HOURS: ............................................................................... 12
4.5 PERSONAL BUSINESS: ................................................................................................ 12
4.6 ENGAGING IN OTHER ACTIVITIES: ................................................................................. 13
4.7 TARDINESS ......................................................................................................... 13
4.8 ABSENTEEISM & SICK LEAVE: ....................................................................................... 13
4.9 FUNCTIONING & JOB EVALUATION ............................................................................... 13
4.10 DISCIPLINARY PROCEDURES .............................................................................. 14
5. AMBULANCE VEHICLE OPERATION POLICY: ................................................................ 15
5.0 PURPOSE ............................................................................................................ 15
5.1 SPEED RESTRICTIONS ........................................................................................... 15
5.2 USE OF WARNING SIGNALS ................................................................................... 15
5.3 EMERGENCY AND NON-EMERGENCY RESPONSE GUIDELINES ................................... 15
5.4 THE TWO SECOND RULE ...................................................................................... 16
5.5 INTERSECTIONS .................................................................................................. 16
5.6 EXCESSIVE SPEED ................................................................................................. 16
5.7 SIRENCIDE .......................................................................................................... 16
5.8 IRRATIONAL BEHAVIOR ....................................................................................... 16
5.9 LIABILITY............................................................................................................ 16
5.10 POLICIES WHILE ON DUTY .................................................................................. 17
6.DUTIES & RESPONSIBILITIES ........................................................................................ 18
6.0 UNIFORMS AND APPEARANCE ..................................................................................... 18
6.1 REPORTING FOR DUTY AND SCHEDULING ............................................................. 18
6.2 WORK SCHEDULES .............................................................................................. 19
6.3 DAILY ASSIGNMENTS............................................................................................ 19
6.4 AMBULANCE CHECK LIST ..................................................................................... 19
6.5 AMBULANCE TRIP (SHEETS) FORMS (PRE-HOSPITAL CARE REPORTS) ................................. 20

6.6 AMBULANCE DISPATCH PROCEDURES ............................................................................ 20
6.7 RADIO COMMUNICATIONS ......................................................................................... 22
7. GENERAL POLICIES & RESPONSIBILITIES....................................................................... 24
7.0 PROPER USE OF EQUIPMENT ................................................................................. 24
7.1 MAINTENANCE OF VEHICLES ................................................................................ 24
7.2 TRANSPORTATION OF DECEASED PERSON ............................................................. 24
7.3 DEAD ON ARRIVAL (D.O.A) POLICIES ..................................................................... 24
7.4 ALCOHOL AND OTHER DRUG USE BY AMBULANCE CREW...................................................... 25
7.5 USE OF CELLULAR WHILE OPERATING AMBULANCE DEPARTMENTS VEHICLES ............................ 25
7.6 MAINTENANCE OF PATIENT CARE EQUIPMENT ................................................................. 25
7.7 USE OF MEDICATION ON THE AMBULANCE ...................................................................... 26
I STAKEHOLDERS ......................................................................................................... 26
II OBJECTIVE ............................................................................................................... 26
III PHASE 1 ................................................................................................................... 26
V MANAGEMENT OF MEDICATION SUPPLY...................................................................... 27
VI STORAGE ................................................................................................................ 27
7.8 VEHICLE ACCIDENT PROCEDURES ................................................................................ 28
7.9 INJURY ON DUTY-CREW ............................................................................................ 28
7.10 RELEASE OF INFORMATION AND NOTIFICATIONS ............................................................. 29
8.SPECIAL CIRCUMSTANCES .......................................................................................... 30
8.0 TREATMENT/TRANSPORT OF MINORS ........................................................................... 30
8.1 EMOTIONALLY DISTURBED PATIENTS ............................................................................ 30
8.2 PATIENT OR LOCATION NOT FOUND/UNABLE TO GAIN ENTRY ............................................ 30
8.3 CRIME SCENE OPERATIONS ........................................................................................ 31
8.4 MASS CASUALTY INCIDENTS (MCI) ............................................................................... 31
8.5 FIRE/HAZARDOUS MATERIALS (HAZMAT) CALLS ............................................................ 32
ATTACHMENT 1: PROCESS DESCRIPTIONS PATIENT BILLING .......................................................... 33
INTRODUCTION ............................................................................................................... 35
PROCESS # 3.1 AMBULANCE ASSISTANCE ............................................................................... 36
RELEVANT MANAGEMENT INFORMATION .......................................................................... 36
FORMS AND SYSTEMS ................................................................................................. 36
PROCESS # 3.2 REGISTRATION OF AMBULANCE ASSISTANCE ......................................................... 44
FORMS AND SYSTEMS ................................................................................................. 44
PROCESS # 3.3 CASH CONTROL .......................................................................................... 48
ATTENTION POINTS & RECOMMENDATIONS .............................................................................. 54
ATTACHMENT 2: DISASTER MANAGEMENT ESF-6 ...................................................................... 56
RESPONSIBILITIES & FUNCTIONS ....................................................................................... 61
FUNCTIONS OF THE SUPPORT AGENCIES .............................................................................. 62
SLS, LABORATORY .......................................................................................................... 62
FUNCTIONS OF ESF 6 .......................................................................................................... 63
2. ESF 6S TASKS & ACTIONS ........................................................................................ 64

MITIGATION: ACTIONS OF ACTIVITIES WHICH REDUCE OR ELIMINATE HAZARDS ............................... 65
ATTACHMENT 3: ALARM DIAGRAM CODE BLUE, YELLOW & RED ................................................... 67
ATTACHMENT 4:WORK INSTRUCTIONS & ALARM DIAGRAM CODE BLUE .......................................... 68
ATTACHMENT 5:WORK INSTRUCTIONS & ALARM DIAGRAM CODE YELLOW...................................... 80
ATTACHMENT 6:WORK INSTRUCTIONS & ALARM DIAGRAM CODE RED ......................................... 100
ATTACHMENT 7: INWERKPLAN AMBULANCE- VERPLEEGKUNDIGE ..................................... 118
INLEIDING: .............................................................................................................. 119
OPBOUW INWERKSCHEMA: ........................................................................................... 120
KENNISMAKINGS-/ INTRODUCTIEDAG. ............................................................................. 121
EVALUATIE VAN DE EERSTE DAG: .................................................................................... 122
WEEK 1 .................................................................................................................. 122
WEEK 2. ................................................................................................................. 123
WEEK 3. ................................................................................................................. 124
WEEK 4 .................................................................................................................. 125
EVALUATIEGESPREK MET NIEUWE MEDEWERKER WEEK 1. ...................................................... 126
EVALUATIE GESPREK MET NIEUWE MEDEWERKER WEEK 2. ...................................................... 127
EVALUATIEGESPREK MET NIEUWE MEDEWERKER WEEK 3. ...................................................... 128
EVALUATIEGESPREK MET NIEUWE MEDEWERKER WEEK 4: ...................................................... 129
EVALUATIEOVERZICHT VAN NIEUWE MEDEWERKER WEEK 1 T/M 4. .......................................... 130
CHECKLIST T.B.V. HET INWERKPROGRAMMA VAN NIEUWE MEDEWERKER:................................... 132
ALGEMENE KENNIS EN KENNIS VAN DE INVENTARIS VAN DE AMBULANCE ...................................... 132
DAGEVALUATIE INWERKPLAN NIEUWE MEDEWERKER: .......................................................... 143
VR EERSTE OPKOMST VAN NIEUWE MEDEWERKER TE REGELEN. ............................................ 144
UITREIKEN DIVERSE ARTIKELEN OP DE EERSTE WERKDAG VAN NIEUWE MEDEWERKER (VPK.) ............. 145
ATTACHMENT 8: INWERKPLAN AMBULANCE CHAUFFEURS................................................ 146
OPLEIDINGSAANDACHTSPUNTEN AMBULANCECHAUFFEURS: ..................................... 148
GEBRUIK VAN HET VOERTUIG ................................................................................. 150
GEDRAG OP DE WEG: ............................................................................................. 151
RIJDEN MET BLAUW ZWAAI/ KNIPPERLICHT EN 2 OF 3 TONIGE HOORN: ....................... 153
AANKOMST POST: .................................................................................................. 154
EINDE DIENST: ....................................................................................................... 154
BLOK-INDELING INWERKPLAN AMBULANCECHAUFFEUR ........................................... 155
PHTLS ................................................................................................................... 166
CHECKLIST INWERKPLAN ....................................................................................... 169
DAGVERSLAG INWERKEN .............................................................................................. 172
PERIODIEK EVALUATIEFORMULIER INWERKEN ......................................................... 173
EVALUATIEFORMULIER EINDE INWERKPERIODE (NA DE 6E BLOK!) ............................. 174
EVALUATIEFORMULIER ZELFSTANDIG FUNCTIONEREN .............................................. 176
UITREIKEN DIVERSE ARTIKELEN OP EERSTE WERKDAG VAN (CH.) .............................................. 179
1. PREFACE
This manual is a compilation of Standard Operating Procedures (SOPs) and guidelines as a result of research based in
the field of Emergency Medical Services.
Despite the many challenges over the last year of rewriting and editing in an effort to finalize this manual, it could not
have been realized without the valuable input of management support and specifically the many suggestions received
from staff members of the Ambulance Service.
In addition to other resources available to staff members, the goal of this manual will serve as a resource tool for
questions and answers that the ambulance nurses and assistants may be faced with.
2. INTRODUCTION
The purpose of this Policies and Procedures Manual is to familiarize each staff member working at the Ambulance
Department with his or her responsibilities and duties, so that all staff may be better able to perform a job vital to the
community of St. Maarten in which we all live. This document is the Standard Operating Procedures (SOPs) of the
Ambulance Service of Ministry Public Health, Social Development & Labour. It is not presented as a Book of Law,
but rather as a Book of Reference with guidelines for everyone to follow and adhere to.
Management realizes that rules or agreements can be forgotten over time, interpreted differently and that in the
course of time new guidelines or work policies needs to be developed and decided upon by management of the
Ambulance Services, Ministry of Public Health, Social Development & Labour or the government of St. Maarten.
The majority of these SOPs that were introduced in 2007 has been revised.
Where possible, the logic behind each policy/procedure or guideline will be explained, in order to make clear to the
Ambulance personnel the intent and reasons for implementation.
As an employee of the Ambulance Service of the Government of St. Maarten you have a variety of responsibilities and
obligations; these responsibilities and obligations are laid down in several regulations and policies related to the legal
position of civil servants in general.
In this manual the focus will be on standard operating procedures for the Ambulance Service. For any further details,
which are not explained in these chapters, you are advised to read your LMA and other laws regulating personnel
matters such as the Employee-Handbook and Introduction Package with the various laws and policies given to every
department by the Personnel Department.
These standard operating procedures or guidelines will assist in maintaining a harmonious relationship between all
personnel and the community. The medical protocols of the Netherlands will be adhered too as was taught during the
SOSA certified training for ambulance nurses and ambulance drivers/assistants.
3. THE ORGANIZATION/Chain of Command

The Ambulance Department up until June of 2010 is one of four departments of Sector Public Health that has an
executing task of providing ambulance services to the community of St. Maarten, 24 hours a day 7 days a week. In
transition to County St. Maarten that will go into effect on October 10th 2010, the name will be changed to Dienst
Ambulancehulpverlening (Ambulance Services) and will form part of the Ministry of Sector Public Health, Social
Development and Labour.
The department has an FTE of 24.2 that consist of a department head, operational leader, administrative assistant,
certified ambulance nurses, certified ambulance assistants/drivers, a part time medical advisor and dispatchers. The
operational team consisting of an ambulance nurse and an ambulance assistant works 8-hour shifts aboard the
ambulance. This includes day, evening and night shifts. The ambulance nurses also functions as shift leaders and
therefore are ultimately responsible for the shift in the execution of their daily tasks whether this is at the ambulance
h e a d q u a r t e r s
o r
a b o a r d
t h e
a m b u l a n c e .
The operational leader (manager) forms part of the first line contact with all operational staff members such as the
ambulance nurses, ambulance drivers/assistants and the ambulance dispatchers. The operational leader reports
directly to the department head with regards to operational matters of the department. The operational leader is
responsible for the execution of operational matters within the department and the head of the Ambulance Services is
ultimately responsible for the overall management. The head reports directly to the Secretary General of the Ministry
Public Health, Social Development & Labour and the Secretary General will report to the Minister of Public Health,
Social Development & Labour.
3.0 Organizational Structure:
3.1 MISSION &VISION:

Mission
To provide effective, timely and quality emergency medical services at Accidents, Sickness and Injury transport at
large scale accidents and disasters.
Vision
Provide optimal, efficient and professional pre-hospital care for the general public and visitors of St. Maarten.
3.2 THE OBJECTIVES

The objectives of the Ambulance Service is to guarantee ambulance services 24 hours a day; to guarantee the carrying
out of necessary and permitted paramedical and ambulance nursing care that facilitates transportation required due to
sickness or accident; to promote realization and maintenance of sufficient qualitative and quantitative facilities for
ambulance services.
The Ambulance Services deals primarily with the general public, visitors and calamities. Although everyone is familiar
with ambulances, very few people are familiar with the details of ambulance care. Ambulances were associated with
transport; they were seen as a means of transporting patients to hospital as quickly as possible. These days, very high
quality care is provided at the scene.
Ambulance care is high-quality care provided by professionals receiving life-long training. In this way, the quality to
which every patient is entitled too is assured. This is the specific objective of every ambulance organization and every
ambulance dispatch center.
3.3 Personnel Management Philosophy

The Ambulance Services is managed by certain guidelines, policies and procedures to ensure that all personnel
conduct themselves in the best interest of patients, peers, and Ministry Public Health, Social Development & Labour.
Our strength depends directly on the contributions made by each of our staff members. Optimal service and
efficiency result from individual participation and satisfaction.
Personnel will find an organizational arena that is open, frank and honest in regards to personnel management. To
work together successfully, each staff member must realize that good working relationships are not only a matter of
rules, but are the result of daily decisions, mutual understanding, friendly attitudes, and team spirit.
3.4 Personnel orientation

Introduction and Orientation:
The introduction and orientation is not limited only to the role of the ambulance and transport service, role of the
new staff member in the organization, and reinforcement of commitment required by the new staff member to be
successful but also to get an understanding of the organization of the ministry of Ministry Public Health, Social
Development and Labour in general.
New staff:
Orientation for new personnel is provided at a series of orientation sessions planned within the first weeks after
employment. These sessions are mandatory.
Orientation to ride-outs:
Prior to orientation to ride-outs, Basic Life Support (BLS) Assist Class will be provided if necessary to provide
training on the different equipment used on the ambulances. Teach the proper usage and set-up of specialized
equipment if needed.
Following the successful attendance and completion of requirements of the orientation sessions, the new staff
member is permitted to begin orientation on board the ambulance.
4. BASIC WORK POLICIES

4.0 Basic Principles:
The regulation is based on 7 principles.
1. Everyone is paid to work a minimum of 8 hours. It is now mandatory to register everyones attendance for
the purpose of dealing with absence without leave and to generate data for future policy development.
2. Department heads are ultimately responsible for registration and for providing correct data.
3. It is imperative for the success of any policy that it is executed, as much as possible, in the same way in every
department.
4. Hours of absence without leave will be deducted from ones salary and can lead to disciplinary measures.
Therefore it is imperative to register all forms of absence both with and without permission for leave.
5. Where possible some flexibility in the working-hours can be observed as long as a normal working day
remains 8 hours.
6. Lunch break, in principle, is 1 hour and should be taken between 12.00 and 14.00 hrs. Some flexibility is
possible, if the service permits. In both the moment and duration as long as point 5 is being honored. The
lunch break is a minimum of 30 minutes, or is assumed to have been, even if the worker doesnt leave his or
her desk.
7. It is up to the secretary general, together with the head, to determine whether a department or a section of a
department or service can have flexible working-hours or not. Arguments not to have flexible workinghours can be of a functional nature. For instance to be able to guarantee the public opening hours, shift
work, or the special responsibilities of certain public servants. A practical inability to register the working
hours can also be an argument (for instance if workers do their work out in the field).
4.1 House Rules

1. The ambulance crew room or lounge is open to any staff member or invited visitors during business hours
only.
2. Volunteer staff members are permitted to have visitors between 10:00 am 12:00 noon and/or between
14:00 pm 16:00 pm. Duty student/trainee employee staff should not have visitors in the workplace.
3. Staff members are not permitted to be in or around the Ambulance Headquarters after consumption of
alcohol or drugs.
4. All departmental equipment and supplies remain at Headquarters for departmental use only and unless
otherwise approved by management.
5. The dispatch area and supervisors offices are off limits except for authorized personnel and use of the
supervisors office is limited to Supervisory staff only.
6. The Ambulance Services related work takes priority in the supervisors office and personal use of the
supervisors office/computer is authorized only after Ambulance Services related work has been completed.
7. All other staff and non-supervisory staff members are to use the computers in other designated areas.
9. Any supplies, equipment, or personal items used during the shift are to be cleaned thoroughly and/or put
away prior to the end of the scheduled shift.
10. A special effort by management will be made to provide coffee or tea as a courtesy of the ambulance
services. If coffee/tea or additional kitchen supplies are needed, please inform a supervisor.
11. Cable TV will be provided as a courtesy and as a means of recreation for the personnel of the Ambulance
Services.
12. Video games are allowed at night, but should not disrupt operations in any way.
8. Any dishes used in the kitchen are to be washed, dried and put away prior to the ending of each shift and all
trash and cans/bottles must be placed in trash bin.
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13. Ambulance Crew jackets are to be hung up when not in use, and personal belongings should be kept locked
in lockers assigned to each staff member or in the bunkrooms during the day. Book bags and coats should be
kept neatly hung and NEVER in offices or the ambulance crew (lounge) recreational room.
14. A Telephone is provided as a courtesy; however this is not an answering service. It is expected that all calls
will be brief, so as not to tie up phone lines.
15. All mechanical problems encountered with the ambulances or equipment is to be reported directly to the
operational leader.
4.2 Vehicle use
It is the policy of the Government and in particular for the Ambulance Services of the Ministry of Public Health,
Social Development & Labour that vehicle are used only for officially authorized business. In recognizing the need to
meet the standards of this policy, and provide for optimal response to medical emergencies/routine transportation
while meeting administrative needs, please note:
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1. Vehicles will be used first and foremost for the service for which they are intended; Ambulances will be
dispatched first to emergencies and non-emergency requests for transportation before all other uses.
2. The ambulances and on-duty response vehicles will not leave without the assigned crew/driver on board,
and only for official authorized business.
3. The ambulance crew may use the ambulance for the completion of personal details relating to the job but are
always to be available for calls. It is the responsibility of the shift leader to ensure that the ambulance is in the
compound area and available for emergency & non emergency calls.
4. Use of other vehicles is permissible during the evening and on weekends only for authorized business. The
use of this vehicle will be logged on the computer automated dispatch (CAD) as appropriate (such as detail),
with the person using the vehicle and the reason for use included in the comments section.
5. Dispatch will be notified each time a vehicle leaves the ambulance headquarters and when drivers return to
headquarters. This alerts the dispatcher to the location of the driver at all times.
6. The ambulances are to remain in the parking area of headquarters at all times unless on runs as dispatched,
approved details when assigned to supervisor and when the vehicle is out of service for repair. Personal
errands and details are never appropriate.
7. The keys to all vehicles are kept in the key box. Keys should never leave the building with anyone who is not
on-duty.
8. It is the ambulance driver/assistants responsibility to make sure that all keys are accounted for at the
beginning and the end of his/her shift.
9. Any unit/ambulance that is out of service for maintenance or other problem should be marked on the
bulletin board as Out of Service (OOS). Vehicles that are taken in and out of service by the supervisory
personnel should not be on the road. If there are questions, contact should be made with the supervisor who
marked the unit OOS.
10. Ambulances are intentionally rotated to spread out vehicle use. The supervisor determines this rotation,
and all crews need to follow the information posted on the shift board to determine which unit is first due,
second due etc.
11. If you have any question about the appropriateness of using one of the vehicles, contact must be made with
the on-duty supervisor before using the vehicle.
4.3 NON SMOKING POLICY:

1. All decisions regarding smoking policy of the federal government reflects adherence to the Ambulance
Department smoking policy.
2. In accordance with legislation (P.B. 1996, nr.55), smoking is prohibited inside all government buildings, at
the Ambulance Department and also in the ambulance and response vehicles. We ask each staff member to
contribute to a smoke free and healthy environment.
3. Smoking is only allowed outside of the ambulance building.
4. Use designated smoking areas if applicable at SMMC if needed after the completion of calls.
4.4 Recording of working hours:

The new working-hours regulation for the entire government civil service went in effect on August 1st 2007.
The most important elements of the new regulation are the obligation to register attendance as well as absenteeism in
a uniform way throughout the organization of government and the introduction of flexible working hours where
possible. Registering will generate accurate data for future policy development.
Absenteeism and the so called No Show have been deemed major organizational problems by both the government
and management. In the past years several instruments have been put into place to deal with the problem such as the
sick-leave policy. The No Show committee came to the conclusion that often both management and workers were
part of the problem of long-term absenteeism. Fixing this problem required implementation of several policies. Next
to a new sick-leave policy and procedures for transfers a working-hours regulation will be put in place as a final
instrument.
4.5 Personal Business:

During working hours, you are not to engage in any business not directly related to our service. This includes the use
of telephones, supplies, or equipment, without specific approval of management. We expect you to use your
professional discretion in conducting personal business during office hours. If personal telephone calls are necessary
during working hours, they should be kept as short as possible.
The regulation also provides management with the necessary tools to effectively deal with absence without leave
when it occurs. Taking appropriate corrective measures is now largely regulated. Similar to the sick-leave policy the
department head has a key role in the enforcement of the regulation. The disciplinary measure of giving an official
reprimand is mandated to the sector directors/secretary generals.
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4.6 Engaging in other activities:

As a Civil Servant you need specific approval from the government to engage in other activities, such as:
Starting a business
Working a second job
Working as a freelancer
When a conflict of interest is expected, you need to request permission before you start any of these activities. Not
adhering to this policy can have consequences.
4.7 TARDINESS
Arriving ten (10) minutes or more after the shift change is tardy and will be dealt with seriously as per services policy.
4.8 Absenteeism & Sick Leave:

The successful operation of the Ambulance Services to the community depends on Civil Servants commitment and
productivity. Any circumstance, which causes you to be absent from work must be reported to operational manager
or head immediately and no later than three hours before start of duty. Only extreme circumstances can justify
exception to the rule.
In order to establish justifiable absenteeism and to insure you are being paid during sick leave, the service requires a
doctors statement regarding your disability to work in the case you have been sick for three days or longer. This
statement should be produced on the fourth day of absenteeism at the latest.
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Failure to follow these rules can have repercussions. Illicit absenteeism from work is grounds for deduction of salary
or dismissal. If the head sees ground for deduction of salaries due to absenteeism, the individual staff member will be
informed. This subject, together with frequent tardiness is considered a very important behavioural trait in the
organization. Therefore, it can be listed as a subject in your yearly job evaluation.
4.9 Functioning & Job Evaluation

At least once a year every employee will have an evaluation meeting. This should be regarded as an opportunity for an
active dialogue between you and the organization. Your Section Head and Department head are responsible for this.
They will prepare this meeting, by inviting you and providing you with a standard Evaluation form.
Based on the conversation a written evaluation of your performance together with a statement of goals for the next12
months is prepared. The final Evaluation report will be submitted to the Department Head and can have several
consequences.
In cases of excellent performance, one can be recommended for a promotion, graficatie. In case of insufficient
performance, certain goals will be set for your performance within a certain period. In such cases the evaluation
period will be much shorter than 12 months, and can vary from one week to 6 months.
Possibilities for training, further education or study assignments are also part of the discussion and decision making
during these evaluation meetings.
4.10
DISCIPLINARY PROCEDURES
Violations of Standard Operational Procedures:

In the event that an apparent violation of operational procedures occurs, a process will be followed to enable an
orderly review of the circumstances surrounding the situation.
Except in serious cases of violation requiring immediate action, the following procedures will be followed:
A. First offense: The person will be informed of the situation and that the occasion is his/her first verbal
warning.
B. Second offense: A written warning letter will be given and Personnel Affairs will also be informed of the
situation.
C. Third offense: The person will be suspended, with or without payment, until the government (Council of
Ministers) take a decision on the matter.
In addition to the guidelines for conduct and performance stated previously, the department maintains other
reasonable (LMA) standards such as, but not limited to, those that prohibit staff from fighting, refusing to perform a
reasonable assignment, being under the influence of alcohol or drugs, engaging in disorderly conduct which threatens
the safety of others, tampering with or falsifying departmental documentation, and actions which jeopardize the
image of the Ministry of Public Health, Social Development & Labour and the Ambulance Services in particular.
A violation of any of the above listed or the LMA identified actions will result in immediate suspension of privileges
and referral to the Council of Ministers for further action.
Staff with a history of tardiness, unexcused or excessive absenteeism, or other forms of unacceptable behaviour
should be written up and counselled with proper documentation to maintain the standards of the ambulance services,
and to keep the person informed of the need for corrective action on his/her part.
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5. AMBULANCE VEHICLE OPERATION POL ICY:

5.0 PURPOSE
The appearance and operation of all ambulances must reflect to the community that these vehicles are operated in a
careful manner, a manner that instils confidence to the patient and ensures the safety of life and property.
5.1 SPEED REST RICTIONS

There is no need for excessive speed. The purpose of using the red or blue lights and the siren is to keep the
ambulance moving at a constant, safe speed and not to allow the ambulance to exceed the posted speed limits in any
area.
5.2 USE OF WARNING SIGNALS

An ambulance operator shall not display warning lights and/or sirens except when:
a. Responding to an emergency call
b. Engaged in lifesaving services
c. Transporting emergency patients who are classified as emergent by the ambulance nurse (paramedic) on
the ambulance trip report form to a medical facility.
It is acceptable to drive with the headlights on when operating an ambulance or response vehicle when responding to
a medical emergency. This increases the general publics awareness of the emergency vehicle.
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5.3 EMERGENCY AND NON -EMERGENCY RESPONSE GUIDELINES

Sufficient information should be obtained from the dispatcher prior to responding to give the ambulance
driver/assistant a good idea of where the incident occurred. The dispatcher should give clear, definitive directions to
the driver as to the exact incident location, utilizing the area mapping system.
The ambulance nurse shall operate the communication system en route to the accident, leaving the driver free to
drive with as little distraction as possible. While responding to the scene the nurse should also watch for approaching
traffic from the right at all intersections and advise the driver. The driver must ensure, at all times that traffic is clear
from all directions before proceeding.
Good judgment should be used by the driver at all times. An ambulance is heavier than a passenger car and will take a
greater distance to stop. It is also top-heavy and will react differently when rounding curves or cornering.
The posted speed limit may be exceeded when responding to an emergency incident with emergency lights and siren,
only if weather, traffic and road conditions permit the increased speed. An exception will be any school zone with a
posted speed limit, which will be obeyed.
5.4 THE TWO SECOND RULE

Always maintain a safe distance between the ambulance and the vehicles in front of it. Use the two second rule to
gauge this distance.
5.5 INTERSECTIONS
Most serious ambulance and other emergency vehicle accidents happen in an intersection. Remember, using the lights
and siren is merely asking for the right of way. It is essential that the driver approaches all intersections with caution.
It is important to realize that many people, while driving, may be day dreaming or talking, with the air conditioning
on and the radio or stereo blaring; emergency vehicles are the last thing they are expecting.
5.6 EXCESSIVE SPEED

The majority of documented emergency vehicle accidents occur because the vehicles are travelling too fast. The
ambulance driver/assistant must drive defensively and have the vehicle under control at all times. Never let the
vehicle or your emotions control you. Ambulances are heavy and take much longer to stop than ordinary vehicles. An
ambulance will be also corner differently than a passenger type vehicle. It is much safer to maintain a constant speed,
in which traffic is clearing a pathway, than to continually speed up and slow down. The result will be to outrun the
effect of the siren and emergency lights. This is also extremely hard on the vehicle and gives the crew and patient a
very uncomfortable and dangerous ride.
5.7 SIRENCIDE
Be aware of this phenomenon. Due to the noise of the siren, the ambulance driver/assistant may be lulled into a false
sense of security, believing that everyone hears the siren and sees the lights, and therefore will yield the right of way
for the ambulance. At the same time there will be a tendency to increase the speed of the ambulance.
Watch for the unexpected. The sight of flashing lights and the sound of a siren tends to cause people to panic. At
times they may speed up, slow down, pull to the left, stop short in front of the ambulance, etc.
The ambulance driver/assistant must remain calm and alert. The safety and well being of many people rests with the
judgment and the reactions of the ambulance driver/assistant.
5.9 LIABILITY
1.1.
Whenever an ambulance is damaged through the negligence or misconduct of an ambulance

assistant/operator or through the negligence or misconduct of any other official or employee of the
department, all cost incurred in the removal and repair, or in the case of total loss will be for the person(s)
account.
5.8 IRRATIONAL BEHAVIOR
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1.2.
While the driver of an emergency vehicle giving audible signals should be given the right-of-way, this
provision does not operate to relieve the ambulance operator from the duty to drive with reasonable care for
the safety of all persons using the public streets, nor shall it protect such driver of any emergency vehicle
from the consequence of an arbitrary exercise of such right-of- away.
1.3.
The basis for determining responsibility for the negligence or misconduct which caused or precipitated the
damage to the vehicle shall be the findings of the Service Investigation Team (SIT). The Department of
Support Services shall affix responsibility in accordance with its established procedures and orders.
5.10 POLICIES WHILE ON DUTY

MEALS AND BREAKS
There are no formal meals and break periods for operational staff scheduled during shift time. The emergency nature
of the job necessitates a flexible approach to taking breaks and obtaining meals when not engaged in an emergency run
or training.
Meals and breaks shall be taken when possible and shall not in any way ever conflict with the systems immediate
response capability.
Crews are welcome to work on homework, obtain meals or watch television. Ambulance crews are only welcome to
nap during night shifts.
TELEPHONES
Telephone calls are to be limited. If personal telephone calls are necessary during working hours, they should be kept
as short as possible.
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6.DUTIES & RESPONSIBILITIES

6.0 Uniforms and Appearance
One should place the patient at ease by presenting a reassuring appearance. The ambulance personnel should wear
clothing that is neat and clean, providing a hygienic as well as professional appearance. Uniforms are to be worn by all
on-duty shifts or as approved by the department head.
UNIFORM AND GROOMING REQUIREMENTS ARE AS FOLLOWS:
1.1 The new uniforms are to be worn in its entirety during regular shifts while on duty.
1.2 Jeans are not acceptable in combination with regular uniform while on duty for regular shifts
1.3 The uniform code for the piketdienst is exceptional however a combination should be made for easy
identification of an ambulance staff member.
1.4 Excessive jewelry is discouraged due to the inherent problems associated with small children and convulsive
patients. Wedding bands are acceptable.
1.5 Excessive hair is discouraged.
Men: Above the collar, medium afros are acceptable. Beards and sideburns must be well trimmed.
Women: Hairstyles are to be neat and clean with little adornment and should be pinned if necessary not to interfere
while carryout work. Needs to ensure that long hair does not become a safety hazard (entanglement or assault) and
that finger nails are kept short.
6.1 REPORTING FOR DUTY AND SCHEDULING

It is most necessary that ambulance nurses/ ambulance assistants and dispatchers coming on shift are on time so they
may orient themselves to the conditions with which they must work. A minimum of 15 minutes prior to changing of
shifts is required and is acceptable.
Shifts hour are from 07:00 AM to 15:00 PM, 15:00 PM to 23:00 PM and 23:00 PM to 07:00 AM. Once the
ambulance nurses, assistants and dispatchers have reported for duty, he/she may not leave the department without
first notifying the operational leader or ambulance nurse in charge.
The Ambulance teams is not allowed to take a nap (sleep) during the various shifts except for night shifts however
must at all time be ready to respond immediately to any emergency call.
Regular and administrative staff working hours ranges from 08:00 AM 17:00PM.
1.6 Shoes should be black. Steel toes are highly recommended for ambulance teams aboard the ambulance.
Clogs, sandals and athletic shoes are not acceptable.
1.7 Name tags shall be worn over the left breast pocket.
1.8 All ambulance nurses and assistants are required to carry their own watch with second hand, as well as a penlight
and stethoscope.
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Note: No staff member may leave their duty station without appropriate coverage as approved by the operational
manager or department head.
6.2 WORK SCHEDULES

a. Work schedules are prepared at least two (2) weeks in advance by the operational leader (manager) and
posted on the bulletin board. Every schedule covers a period of one month. It is your own responsibility to
check your working schedule for the coming weeks. When you are not present at a specific time, you should
call in prior to your absence or delay.
b. Any and all requests for schedule changes should be presented in writing at least two (2) weeks in advance of
the time the schedule is to be prepared. Emergency requests may be honored at the discretion of the
operational leader (manager) after consultation with the head of the service.
c. Only the operational leader and/or the head are authorized to make schedule changes. Any such changes
must be initialled.
d. All scheduled operational staff is to remain on duty until relieved by the on-coming shift. Ambulance nurses,
assistants and dispatchers are considered relieved only after they report to the on-coming shift on amongst
other things the condition of vehicle (s) and inventory and any other pertinent information and after
completion of all reports for his or her shift.
6.3 DAILY ASSIGNMENTS
The operational leader (manager) will indicate on the weekly time sheet which ambulance nurse is in charge of each
shift. The ambulance nurse in charge will prepare daily assignments for each shift. Any medical technician refusing
to accept his or her assignment shall be disciplined in accordance with the Ambulance Services policy.
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6.4 AMBULANCE CHECK LIST

The Ambulance check lists have been designed with patient care, safety and legal back-up in mind. Each list should be
completed by the on-coming ambulance crew at the change of shift, so the off-going and on-coming crew may discuss
any discrepancies.
The ambulance driver/assistant, at the completion of a run, is responsible for replacement/replenishment of supplies
and cleaning of the ambulance patient compartment. Any missing equipment should be indicated on the check lists
and reported to the ambulance nurse/shift leader.
The Ambulance Nurse/shift leader will review and submit completed ambulance check lists to the operational leader
for review and filling.
Periodic checks of the ambulance may be made by the operational leader or Head.
6.5 AMBULANCE TRIP (SHEETS) FORMS (Pre-hospital care reports)

The ambulance nurse must complete an Ambulance Trip Form in its entirety each time an ambulance call is
answered. This form become part of the patients permanent record, and is an important legal document; therefore,
it is important that they are filled out thoroughly and clearly. They must be completed where possible when handing
over of patient to ER and prior to the end of each shift.
There are three (3) copies of the Ambulance Trip Form. The top copy (white) is to be handed over to dispatch for
data entry, reviewed by the operational leader and filed at administration of Ambulance Services. The middle copy
(yellow) is to be attached to the patients record at the (ER) hospital. The pink copy is to be given to the patient if
requested.
Once the ambulance fee is collected, a copy of the receipt should be attached to the trip form of the patient.
Note: Make sure all copies are legible.
The ambulance nurse shall make sure that all procedures/materials they provide to patients are noted on the
Ambulance Trip Form. This shall include:
-
Times Ambulance Calls and Transports

EKGs
Obstetrical assistance outside of hospital
CPR
Intravenous Infusion
Oxygen Therapy
Splinting
Slings
Adaptive Devices e.g. collars
Dressings
Medications
All calls must be assumed to be emergent and should be answered with lights and siren unless reliable medical
evaluation from the scene indicates otherwise. Upon receiving a call for an ambulance, it is essential to record the
following information and dispatch an ambulance immediately.
A. Maintain contact with the caller until all relevant information is collected.
B. Essential telephone information:
a. Callers phone number
b. Callers name
c. Exact location of incident
d. Directions to incident and prominent landmarks
e. Nature of incident
6.6 Ambulance Dispatch Procedures
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It is important that the following times be accurately recorded:

a.
b.
c.
d.
e.
Time call is received

Dispatch time (time ambulance responds to the incident)
Arrival time (time the ambulance arrives at the incident)
Departure time (time ambulance departs incident location)
Hospital arrival time (time the ambulance arrives at the hospital or appropriate destination)
Answer all calls on the emergency line promptly:

a.
b.
c.
d.
e.
Try to answer within three (3) rings

Expect each call to be an emergency until proved otherwise
Answer emergency lines first; administrative lines later
Identify yourself and department
Record all information
TELEPHONE PROCEDURES
1. All incoming calls must be answered promptly. When multiple phone lines are ringing, callers can be asked
to stay on hold once it has been determined that they do not have an emergency.
2. All incoming requests for ambulance and/or medical transport must be entered in the CAD immediately
even if only partial information is available (the dispatcher can always return and enter information more
completely after units have been dispatched).
3. All ambulance phone lines (912) and (5422111/5206262) are to be answered, Ambulance Services Medical
Dispatch this is (your name). All calls should be handled in a professional, friendly and helpful manner.
4. Non business phone lines (5429291, 5429292) are to be answered, Ambulance Service this is (your name).
TAKING AND RECEIVING MESSAGES
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1. Business calls should be directed to the appropriate person; if that person is not available, a message
including day/date/time, name of caller, and call back number should be taken.
2. Personal calls received in dispatch (calls for personnel) should be referred to the crew room phone.
The dispatcher is under no obligation to take personal messages (this is not an answering service); be certain
that if the caller is calling on a business related matter that a message is left.
3. If appropriate, business messages should be left in individual mailboxes.
4. Personal home telephone numbers and cellular phone numbers are never to be given out. Offer to take a
message, or forward the caller to the number of the person they would like to speak with. This includes not
giving out numbers of supervisory staff.
RADIO PROCEDURES
1. Always use a clear, calm voice. There is no place for sarcasm, opinion, or rebuttal over the air.
2. Keep all messages brief and to the point.
3. NEVER use someones name over the air (ambulance team or patient). If necessary, use initials or
ambulance team medic number only.
4. After you end a radio conversation, state the military time 10-4.
5. Dispatch is always to make the last transmission.
STATUS CHECKS
1. If the ambulance has been on the scene for more than 15 minutes, and the dispatcher has had no
communication with them, the dispatcher should request a status check as follows: Control to Unit 1 or 2,
with a status check A status update can be requested by the dispatcher sooner than 15 minutes, if the
dispatcher deems it appropriate.
2. The ambulance unit in question should respond with either: Unit 1 or 2 Status OK, through continue Status
Checks in situations where there is a question as to the safety of the ambulance crew. With this response,
dispatch will continue status checks each 10 minutes until crew clears the scene (or) Unit 1 or 2 All Set,
discontinue Status Checks in situations where the ambulance crew is comfortable with their safety and does
not request additional checks.
3. If no response to a status check is received, contact the Police and ask them to contact their unit on scene.
VEHICLE STATUS
It will be the responsibility of all Ambulance Dispatcher (AMD) to be aware of the vehicle and crew status of all onduty personnel.
Enroute Assignment
The responding ambulance team will notify the AMD over the air that Unit #.....is enroute to ........(location) code
....... The AMD will respond with the time.
Arrival on scene
Upon arrival at the scene, the responding ambulance team will notify that Unit.....is on the scene. The AMD will
respond with the time.
Arrival at the hospital

Upon arrival at the hospital, the responding ambulance team will notify that Unit.....is at ER, SMMC. The AMD
will respond with the time.
6.7 Radio Communications

The conduct of all persons using an EMS radio must be professional at all times, both on dispatch, police coordination
and medical channels. All messages must be as brief as possible. There should be no inappropriate, profane or
personal remarks at any time.
The following order of steps is recommended for the ambulance crew to use when notifying the hospital of patient
information:
1. Patients age and sex
2. Chief Complaint The reason why the patient called for help
3. Present Illness
Departure from the scene

Upon departure from the scene, the responding ambulance team will notify that Unit .....is enroute/available The
AMD will respond with the time.
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An elaboration of the chief complaint (e.g.What was the pain like, Where does it radiate? How long has it
been present? Has patient ever had symptoms like these before? Are there any other related symptoms? Etc)
4. Past Medical History
Other significant illnesses or injuries, medications or allergies
5. Physical Examination
a. General Appearance
- Comfortable or in distress
- Level of consciousness
b. Vital Signs
-
Pulse
Respirations
Blood pressure
Temperature
To enhance radio communication, the ambulance crew should keep in mind the following points:
1.
2.
3.
4.
5.
Use common language only. Use medical terms whenever possible.

Be aware of the rate of speech with which you speak.do not speak too fast or too slowly.
Emphasize important terms, but do not overemphasize by stressing everything.
Do not speak too loudly or too softly. Speak decisively, deliberately and in a calm manner.
Avoid angry comments at all costs. Do not editorialize.
Do not allow your voice to trail off at the end of words and sentences
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7. GENERAL POLICIES & RESPONSIBILITIES

7.0 PROPER USE OF EQUIPMENT
7.1 MAINTENANCE OF VEHICLES
Vehicle Maintenance is essential to the provision of appropriate EMS care in any environment. All operational staff
should routinely do up-keep and preventative maintenance of both the interior and exterior of all vehicles.
Driver check sheets are to be completed by the driver, or driver progression at the beginning of each shift. Vehicles
are to be washed, both interior and exterior, and fuelled daily and as otherwise necessary. Any deficiencies should be
documented on the driver check sheet, and an equipment failure report completed. The fleet coordinator and onduty Operational Leader/supervisor needs to be notified as well. The vehicle also needs to be tagged out of service as
well. The vehicle service entity needs to be notified in the appropriate time frame.
Additionally, all vehicles in service at the ambulance department are subject to annual inspections and routine
preventative maintenance.
If vehicles are tagged out of service by the facilities supervisor, they can only be returned to service after the specific
problem is rectified.
7.2 TRANSPORTATION OF DECEASED PERSON

Upon receipt of a call for a deceased person, an ambulance will be dispatched to a possible cardiac arrest.
Notification of the Police Department should be made by dispatch to request their response. The Ambulance crew
upon arrival at the scene will evaluate the condition of the patient.
A patient who is found to have rigor mortis, decapitation and or perhaps dependent lividity may not receive
resuscitative measures. This patient will be left at the scene under the jurisdiction of the Police Department. The
Police Department will notify the Medical Examiner for pronouncement and removal of the body. The Ambulance
Service will not engage in transporting of any deceased person.
D.O.A. cases are classified legally as exclusively under the jurisdiction of the Medical Examiner or designee. In order
to process these cases legally and efficiently, these guidelines must be followed:
a. Immediately notify the Police Department. The Police Department will then determine if the Medical Examiner
should be called.
b. Record the name, age, date, time, condition of the body and known circumstances of death.
c. If the patient is not declared a D.O.A. or death has not been pronounced at the scene of the call, all resuscitative
measures shall be taken in accordance with the protocol. If death is pronounced on the scene, all actions of the
ambulance crew prior to the declaration of death shall be recorded on the PCR. The Medical Examiner shall be
notified as soon as possible through the Ambulance Dispatcher. Law enforcement officers shall be requested to
respond if not already on the scene.
7.3 DEAD ON ARRIVAL (D.O.A) POLICIES
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d. If the patient is deemed irretrievable and foul play is suspected or in question, every effort should be made not to
disturb the crime scene and law enforcement should secure the scene upon their arrival. EMS personnel shall
remain on scene until released by a law enforcement supervisor or by the Medical Examiner.
7.4 Alcohol and other drug use by ambulance crew

Any crewmember accused of responding to, transporting or treating a patient while under the influence of drugs or
alcohol may be:
temporarily suspended from the job
subjected to testing for alcohol or other drugs if the allegation involves operation of an ambulance
department vehicle.
referred to police department for investigation
The Ministry of Public Health, Social Development & Labour, specifically the Ambulance Services, takes a strong
stance on the use of alcohol or drugs in the workplace.
It is expected that staff report when assigned or scheduled, in a condition ready to work. Compounding factors such
as the previous nights activities, or even the use of some prescription medications can cause a staff member to be
unfit for work/duty. It is the responsibility of the staff member to be in a condition ready for duty when scheduled.
Drinking or use of judgment impairing medications (prescription or recreational) is not permitted within 10 hours
before a scheduled shift.
Also, on-duty personnel are not allowed to enter establishments that serve alcohol, unless for brief meal pick-ups.
Remember that at all times the Ambulance Services uniform is very visible to the general public, and positive
examples are to be set without exception. This includes any capacity when personnel are on duty for service.
7.5 Use of cellular while operating Ambulance Departments Vehicles
It is prohibited by law to use a cellular phone without an appropriate hands-free device when driving.
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Cellular phone use is to be limited when driving vehicles in non-emergency medical transport modes, and must have
a hands-free device to be used as well. Cellular phones are not to be used for any reason by anyone driving a vehicle
in an emergency response mode. Minimize the use of the cellular phone while you are in the Dispatch Center. If you
have to use your cellular phone while you are on duty try to make it as short as possible.
7.6 Maintenance of Pati ent Care Equipment

The proper operation of all patient care equipment is essential to the provision of EMS care as a whole. It is of the
utmost importance that all equipment be maintained appropriately.
All on-duty Ambulance personnel are to complete ambulance check-lists at the beginning of their shifts. Any
equipment that isnt in proper working order must be taken out of service immediately and replaced with spare
equipment from the storage room. An equipment failure report must also be completed and handed over to the
operational leader/supervisor or placed in mailbox.
Additionally, all durable medical equipment is subject to preventative maintenance, which is done by an external
entity. All repairs of equipment are done by that entity as well. Irreparable items will be replaced as needed.
7.7 Use of medication on the Ambulance
I STAKEHOLDERS
The stakeholders in this protocol are:
1. The Government of St. Maarten, represented by Ministry of Public Health, Social Development & Labour
2. The St. Maarten Medical Center Foundation
II OBJECTIVE
To administer medication aboard the ambulance by the ambulance nurses according to fixed protocols under the final
supervision by the emergency room physicians of the SMMC.
The emergency room physician will also conduct case management and carry out workshops with the ambulance
teams in order to improve pre-hospital care on St. Maarten.
III PHASE 1
Only medications mentioned in the intervention protocols of SOSA-trained ambulance nurses will be placed on the
ambulance. For the first three months only the cardiac-arrest protocol will be applied and therefore in that period,
the available medications are:
Atropine
These medications will be administered according to the SOSA protocol manual to patients who are in cardiac arrest
without prior consultation with the emergency room physician.
The ambulance nurse must contact the emergency room physician for approval when attending to a patient who is
not in cardiac arrest but with life threatening arrhythmias. The ambulance nurse must submit at all times a copy of
the run form (rittenformulier) to the emergency room physician for review after administering above listed
medication. Thereafter, the administering of other necessary medication will be considered.
Epinephrine
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IV PHASE 2
After the three months period, it will be decided to expand the medication on the ambulance according to the skills
of the ambulance-staff. To improve the skills the nurses will receive at least an additional 400 hours per year of
continuous education including additional classes by the staff of the ambulance department at the emergency room
and the intensive care unit of SMMC. (For specifications see appendix Clinical Program)
V MANAGEMENT OF MEDICATION SUPPLY

The Head of the Ambulance Department will be responsible for the selection and purchase of the medication, once
authorized by an appointed doctor. The medication will be purchased from the pharmacist of SMMC, who will
monitor the storage and distribution of the medication by the Ambulance Department.
VI STORAGE
The medicine will be stored in medicine storage cases in the advance life support kits on the ambulances. The
ambulance nurses will be responsible for daily inspections of the medicines for expiration dates and replacement
making use of a log book.
VII COMMUNICATION
The Ambulance Nurse will contact the Emergency Room Physician by use of the radio communication system or the
cellular telephone of the Ambulance Department, in the event of necessary medical supervision prior to
administering of medication.
VIII CONTROL MECHANISM
Inventory and periodical control of the medications will be done by the operational leader at the Ambulance Service
and a report will be forwarded to the Head of the Department.
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Once medicines are used the ambulance nurse in charge of his or her shift need to document and sign off on the
medicine box form and also have to guarantee that the ER doctor who authorizes afterwards the use of the medicine
and sign off in the run form (rittenformulier).
The Government of St. Maarten will replenish the medicines that are used.
Version 2007, Revised 2010.
7.8 Vehicle Accident Procedures

This procedure is used in the event an ambulance, transport, or support/response vehicle is involved in any type of
accident (with another vehicle, with fixed property, etc):
1. Immediately notify dispatch.
2. In all cases STOP and return to the scene of the accident. In cases involving personal injury, or damage to
another vehicle, dispatch will send another vehicle to cover any call that you may be responding to, and/or
will send another ambulance to transport a patient on board.
3. Determine if anyone is injured. Request ambulance(s) as needed. Initiate BLS for injured persons.
4. Dispatch will notify the police to respond to the scene and take a report.
5. Obtain the names, addresses and telephone numbers of all involved parties and witnesses.
6. Do not make any statement concerning the assumption of liability. Give out only the information that is
requested and required by the Police Traffic Department.
7. The On-duty Supervisor/OL will be notified immediately of any accident, regardless of the severity.
8. The OL will notify the EMS head immediately of any accident involving personal injury to any involved
parties.
9. Within (12) hours following the accident, the driver (as able) should fill out an Occurrence Report detailing
the circumstances surrounding the accident.
10. Within (24) hours of the accident, the OL and EMS head will review the reports and forward these to NC
Wathey Insurances.
11. The Driver involved will refrain from driving immediately following an accident until a supervisory
personnel review the situation.
The Secretary General of Ministry VSA (Public Health, Social Development & Labour) will be informed if an
ambulance driver/assistant fails to report any accident or if he or she has a record showing a high accident frequency,
or shows an abnormally high accident cost. This will be accompanied by a statement that such failures or poor
performance record is considered to be sufficient justification for the Service to suspend the right of the ambulance
assistant to operate an ambulance.
7.9 Injury on duty-crew

1.
2.
3.
4.
Immediately notify the on-duty supervisor (shift leader).

Any injuries will be treated according to protocol
Dispatch should be notified as soon as is practical.
The on-duty supervisor, operational leader (manager), EMS head, Secretary General of VSA and other
appropriate department heads will be notified of any incident involving personal injury or death.
5. The injured person should be transported to SMMC as appropriate, for evacuation and initiation of
documentation.
6. Within 12 hours following the incident, the staff involved (as able) should fill out an Occurrence Report
detailing the circumstances surrounding the incident.
7. Within 24 hours of the incident, the operational manager and EMS head will review the reports and forward
to the Secretary General of VSA.
8. The staff person injured will refrain from handling calls immediately following an on the-job injury until the
supervisory personnel review the situation.
On-the-job injuries and or death are covered under BZV medical insurance. As a result, it is important that all steps
above be completed as outlined to ensure timely medical care, and the filling of appropriate documentation.
This procedure is used in the event of an injury or death to on-duty staff:
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7.10 Release of Information and Notifications

This procedure defines the procedures for the release of information to outside agencies, as related to operational
and/or patient information, in meeting the needs of the administrative functions of the Ambulance Services while
maintaining patient confidentiality.
Under no circumstances shall ambulance personnel divulge any information to newspapers, radio, or television
personnel. Any request for information should be referred to the EMS head.
1. All releases of information will be made through the EMS head. Release of any and all protected health
information will be executed in accordance with the policies and procedures of Sector Public Health, Social
Development & Labour.
2. The ONLY exception is when other law enforcement agencies are involved that can be advised of patient
information such as name and address. This can be done from ambulance nurse to law enforcement officer,
or over the direct line to dispatch police service (DPS) dispatcher, including the general condition of the
patient.
3. All other releases of information (such as to the press, any legal service or risk management) should be
directed to the EMS head.
4. At no time should originals or copies of any documentation (run logs, cards, PCRs, etc.) be distributed to
anyone other than authorized ambulance service personnel.
5. Any extraordinary situations should be documented on an occurrence report for follow-up.
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8.SPECIAL CIRCUMSTANCES
8.0 Treatment/Transport of Minors
A minor is defined as a person under the age of 18 years who is not emancipated or mature. Emancipated or mature
minors may consent to treatment on their own behalf.
If a parent or legal guardian is available to consent to treatment on the minors behalf, the minor and the parent may
be transported to the medical facility should the patients condition permit.
If a patient or legal guardian refuses treatment and if the medical problem or injury is life threatening and any delay of
care will jeopardize the life of the minor, the Ambulance Services may transport the patient without the consent of
the parent or guardian if authorized by Medical Control. The circumstances shall be documented in the PCR, and a
complete report shall be filed immediately following the call. The Operational Manager should be contacted during
or after the call. The parent or guardian shall be notified of the destination decision.
If the parent or legal guardian refuses treatment and if the medical problem or injury is not life threatening, the
ambulance team shall make an appropriate effort to attempt to convince the parent or guardian to consent. The policy
for refusing medical assistance shall be followed.
If a parent or guardian is not available on a scene to provide consent for a minor, emergency medical care may be
rendered. The minor shall be transported to the appropriate receiving facility. The Police Department shall be
notified of the destination decision. Ambulance crew shall not delay patient care or transport is a parent or guardian is
unavailable.
8.1 Emotionally Disturbed Patients
If a patient displays violent tendencies or violence towards crew members, bystanders, or other personnel on scene,
the ambulance crew shall retreat, if able, and stage until the scene is secured. Restraints may be deployed or used per
protocol under the following conditions:
The patient has indicated a high potential for violence
The police and police doctor has taken charge
Use of restraints shall follow the applicable restraints protocols.
8.2 Patient or Location Not Found/Unable to Gain Entry

Upon arrival on a scene, it is the responsibility of the Ambulance Nurse/shift leader to attempt to locate the patient.
If the patient/location is not immediately found, the Ambulance Nurse must contact AMD (Ambulance Dispatch) or
The Ambulance Nurse or shift leader is responsible for determining scene safety. The Ambulance Nurse may choose
to stage the ambulance away from the scene until the police has secured the area.
If an emotionally disturbed patient voluntarily requests transport to a psychiatric facility, the Ambulance Services may
transport without the police or patient restraint if the Ambulance Nurse deems it to be safe.
If an emotionally disturbed patient refuses treatment or transport, a Mental Health officer and a police officer should
be dispatched. Medical control may be contacted to determine the patients ability to decline treatment.
30
Police Department to attempt to determine a better location. A search of the immediate area should be performed. If
no further information can be discerned, a Patient Care Report (PCR) must be filled out, and any significant findings
must be documented.
If the ambulance crew is unable to gain entry to a scene, the Ambulance Nurse shall notify AMD and Police Dispatch
and shall document the circumstances in the PCR.
8.3 Crime Scene Operations

A scene shall be considered a crime scene if evidence of a crime or suspected crime is found, including but not limited
to:
Homicide
Suicide
Rape
MVA involving serious injury or death
Assault
Drugs
Upon the discovery of a crime scene, the police or law enforcement shall be contacted if not already present, and
only personnel necessary to the treatment of the patient shall enter the scene.
On a crime scene, EMS personnel shall work in close communication with law enforcement while performing up to
their standard of care. Care shall be taken to preserve evidence on the scene if possible while providing patient care.
The scene and all actions taken by EMS shall be thoroughly documented in the PCR. Preservation of evidence shall
not take priority over patient care.
Once patient care has been completed, or if the scene is deemed unsafe, law enforcement personnel assume
command of the scene.
8.4 Mass Casualty Incidents (MCI)
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For the operational purposes of the Ambulance Services, a Mass Casualty Incidents shall be defined as scene
potentially requiring extraordinary resources. An Operational Leader/manager or Ambulance Services Chief may
declare an MCI if additional resources are required that exceed the capacity of the Ambulance Services. This does not
include single patient situations requiring an ALS provider.
Upon declaration of an MCI, the first Ambulance Services personnel on scene shall set up an Incident Command
System until the Operational Leader arrives on scene. The first arriving ambulance team/medic is responsible for
initial triage and the request of additional resources, including, but not limited to a command officer.
The Incident Commander/Operational Leader or designated Communication Officer may request the use of a
dedicated radio frequency through the AMD dispatcher. The Ambulance Services Channel will be used for internal
radio communication and the Emergency Channel for the incident.
Upon arrival, the Ambulance Services Operational Leader (MCO) may take over the Incident Command and shall
continue to maintain an Incident Command System until the incident has been managed.
All aspects of incident management shall follow the opschalings guidelines and procedures.
8.5 Fire/Hazardous Materials (HAZMAT) Calls

The ambulance will automatically be dispatched to all confirmed structural fires or any situations where injury or
entrapment may occur. The Ambulance Services will also be dispatched to all hazardous material situations for which
the Fire Department is dispatched.
The Ambulance crew for a Fire or Hazmat stand by, shall remain on the scene, out of service, until released by the
Senior Fire Officer in command.
Upon arrival at any major incident where Command has previously been established, the Ambulance Nurse/Medic
must report to the command post and advise the Senior Officers (Fire & or police agencies) of the location of the
ambulance in case EMS assistance is needed. The ambulance driver/assistant is responsible for staging of the
ambulance, keeping lanes clear for additional Fire Apparatus and allowing exit for all emergency vehicles. The
Ambulance Nurse shall contact AMD requesting additional ambulance teams to be on alert or to respond to the
scene, as necessary, and AMD must make sure that the Operational Leader/MCO and AMBCHIEF has been notified
of the incident.
The Fire Department will automatically be dispatched to all calls for Motor Vehicle Accidents with a confirmation
that people are trapped.
32
MINISTRY OF PUBLIC HEALTH, SOCIAL DEVELOPMENT AND LABOR
Attachment 1: Process Descriptions Patient Billing
33
Version 1, SOAB 2011
TABLE OF CONTENTS
INTRODUCTION .................................................................................................................................. 35
PROCESS # 3.1 AMBULANCE ASSISTANCE ............................................................................................ 36
PROCESS # 3.2 REGISTRATION OF AMBULANCE ASSISTANCE ................................................................... 44
PROCESS # 3.3 CASH CONTROL.......................................................................................................... 48
ATTENTION POINTS & RECOMMENDATIONS ............................................................................................ 54
34
Introduction
35
Goal and tasks of the department

Goal and explanation of the handbook
Maintaining the handbook
Procedure for maintaining the handbook
Process # 3.1 Ambul ance Assistance

I.
Process Definition
Goal
To provide ambulance assistance, receive payments for the assistance and register the assistance accurately on the
ritformulieren.
Risks
The ritformulier is not filled-in accurately or completely.
The basic information needed to receive payment is not registered on the ritformulier.
All the ritformulieren are not submitted or not submitted in a timely manner (within 3 days).
All the collected payments are not submitted on the date of receipt.
Internal controls
a. Periodic controls of the completeness of the ritformulieren.
b. A match between the Dispatchers Logbook entries and submitted ritformulieren in order to verify that all
ritformulieren have been submitted.
c. A match between the Deposit Logbook, payment information on the ritformulieren, receipts and submitted
payments in order to verify the completeness of collected payments.
Responsibilities
The Diensthoofd Ambulance Hulpverlening and the Operationele Leider Ambulance Hulpverlening are
responsible for maintaining and updating this process description.
All Personnel of Dienst Ambulance Hulpverlening are required to understand and follow this process
description.
Functions Involved
Ambulance Verpleegkundige
Centralist
Rel ev an t M an ag em en t I n fo r m a ti o n
Monthly overview of:
Number of calls for ambulance assistance received

Number of calls for ambulance assistance dispatched
Average time between call and arrival of the ambulance
For m s a n d s ys tem s
Dispatcher logbook
Ritformulier
Receipt (credit/debit card)
Deposit Logbook
Ambulance Chauffeur
36
II. Process Diagram
Function
37
III. Process Description
Nr.
Department
Activity
Description
1.
- Function
Dienst Ambulance
Hulpverlening
Receive call for

ambulance assistance
The Centralist receives the call for

ambulance assistance.
- Centralist
The Centralist notes the time of the
call, the address and a short description
of the mishap in the Dispatcher Logbook.
Subsequently the Ambulance
Verpleegkundige on call is notified.
N.B.
2.
Dienst Ambulance
Hulpverlening
- Ambulance
Verpleegkundige
- Centralist
Report on ambulance
assistance
The Ambulance Verpleegkundige

accepts the call from the Centralist and
reports back to the Centralist about the
call for ambulance assistance once at the
location.
The urgency of the call and the time of

arrival are reported to the Centralist.
determines the urgency of the call.
The Centralist registers the time of

arrival in the Dispatcher Logbook.
- The data in the logbook will be

entered into the CAVIS system in a
later stage, together with the data on
the ritformulier.
- A team consists of an Ambulance
Verpleegkundige and an Ambulance
Chauffeur (assistant
Verpleegkundige).
- A Centralist has a medical
background and if needed, will
provide medical support through the
telephone to the caller.
38
Nr.
Department
-
3.
Activity
Description
Provide treatment

provides treatment to the patient.
Function
Dienst Ambulance
Hulpverlening
- Ambulance
Verpleegkundige
Subsequently the Ambulance

Verpleegkundige decides whether
transportation is required.
If the patient requires transportation,
the Ambulance Chaffeur and
Ambulance Verpleegkundige transport
the patient to the hospital. The
Ambulance Verpleegkundige fills in the
ritformulier en route to the hospital.
Once the patient has been handed over
to the hospital the Ambulance
Verpleegkundige proceeds to seek
payments (step 4).
If the patient does not require
transportation, the Ambulance
Verpleegkundige fills in the
ritformulier and proceeds to seek
payment (step 4).
N.B.
39
The ritformulier contains the medical

information of the patient treated by the
Ambulance Verpleegkundige. It also
consists of the following personal
details:
-
Full name;
Date of birth;
Gender;
Address;
Telephone number;
Type of ID;
ID number;
Country that issued ID;
General practitioner.
Dienst Ambulance
Hulpverlening
- Ambulance
Verpleegkundige
Request payment
After the treatment and transport, if

required, the Ambulance
Verpleegkundige inquirers if the patient
will pay via local insurance or fulfill the
payment themselves.
If the patient is locally insured and can

present a valid proof of insurance (card
or letter), the Ambulance
Verpleegkundige notes the following
information on the ritformulier:
Insurance company name;
Policy number;
Insurance expiration date.
The Ambulance Verpleegkundige then
proceeds with step 6.
If the patient will fulfill the payments

themselves or if the patient cannot
provide a valid proof of local insurance,
the Ambulance Verpleegkundiger
inquires if the patient is able to fulfill the
payment at present.
If the patient is able to fulfill the

payment, the Ambulance
Verpleegkundige continues with step 5.
If the patient is not able to fulfill the

payment, the Ambulance
Verpleegkundige informs the patient of
the cost of treatment and tells the
patient that a bill will be sent concerning
the treatment. Subsequently the
Ambulance Verpleegkundige proceeds
with step 6.
4.
40
Dienst Ambulance
Hulpverlening
- Ambulance
Verpleegkundige
Receive payment
The Ambulance Verpleegkundige receives

full payment from the patient.
The patient can either pay by:

-
Cash;
Check;
Credit Card; and/or
Debit Card.
For credit and debit card payments, the

machine prints out a receipt. For other
payments, a written receipt is made. The
Ambulance Verpleegkundige writes up a
receipt and hands it to the patient as proof
of payment. The Ambulance
Verpleegkundiger keeps a print of the
receipts.
In case of a cash payment, the Ambulance

Verpleegkundige will secure the cash in an
envelope with the ritnummer on it. The
envelopes of the day must be kept secure
until they are deposited at the Ambulance
Office.
41
- Ambulance
Verpleegkundige
Handover copy of
ritformulier

completes the ritformulier with the
necessary information and dates and signs
it.
If the patient was transported to the

hospital a print of the ritformulier is
handed over to the hospital to be included
in the patients medical records.
The patient also receives a print of the

ritformulier if requested.
N.B.
If the ritformulier cannot be completed,
the form is left at the hospital to be
retrieved in a later stadium by the
Ambulance Verpleegkundige in the case
of transportation to the hospital.
Dienst Ambulance
Hulpverlening
42
Dienst Ambulance
Hulpverlening
- Ambulance
Verpleegkundige
Deposit ritformulier and

payment
On return to the Ambulance Office, the

Ambulance Verpleegkundige makes a
copy of the ritformulier if payment was
received.
The Ambulance Verpleegkundige puts the

copy of the ritformulier in an envelope
with the receipt and the payment received
if applicable, seals the envelope and
deposits it in the drop box safe at the
Ambulance Office.
The Ambulance Verpleegkundige then

makes a note in the Deposit Logbook about
the deposit:
-
current date;
ritformulier number;
name of the patient; and
amount in the envelope.
Subsequently, the Ambulance

Verpleegkundige hand the original
Ritformulier to the Centralist for data
entry in the CAVIS system.
N.B.
43
CAVIS stands for Caribische Ambulance

Verzorging Informatie Systeem.
Process # 3.2 Registration of Ambulance Assistance

I.
Process Definition
Goal
To register the ambulance assistance given in the system in an accurately and timely manner.
Risks
The ritformulier is not filled-in accurately or completely.
The ritformulier is not registered in CAVIS accurately
All the ritformulieren are not submitted or not submitted in a timely manner (within 3 days).
Internal controls
a. Periodic controls of the completeness and accuracy of the ritformulieren.
b. Periodic controls of the accuracy of the registration of the ritformulieren in the system.
c. A match between the Dispatchers Logbook entries and submitted ritformulieren in order to verify that all
ritformulieren have been submitted.
Responsibilities
description.
Functions Involved
Centralist
Administratief Medewerker
Number of calls for ambulance assistance recorded in the logbook as compared to the ritformulieren
received
Number of Ritformulier received including length of time taken to submit it
Number of incomplete Ritformulieren received including explanation
Number of entries in the Dispatcher Logbook with no Ritformulieren including explanation (incomplete
ritten/ loze ritten)
For m s an d s ys tem s
Ritformulier
Dispatcher Logbook
CAVIS system
44
Process Diagram
Function
Centralist
45
II. Process Description
Nr.
Department
Activity
Description
1.
- Function
Dienst Ambulance
Hulpverlening
Receive copy of
Ritformulier
The Centralist receives the original

Ritformulier from the Ambulance
Verpleegkunidge.
- Centralist
The Centralist matches the entry in the

Dispatcher Logbook with the
corresponding Ritformulier. The
Centralist then checks if the
ritformulier is complete.
If the ritformulier is not complete, the

Centralist makes a note hereof and asks
the applicable Ambulance
Verpleegkundige to complete the
ritformulier.
If the ritformulier is complete, the

Centralist proceeds with data entry.
The Centralis verifies that each entry in

the Dispatcher Logbook is matched with
a ritformulier. Dispatcher Logbook
entries that are not matched are
reported to the Operationele Leider
Ambulance Hulpverlening.
2.
Dienst Ambulance
Hulpverlening
- Centralist
Data entry in CAVIS
The Centralist enters the data on the

ritformulier and the Dispatcher
Logbook in CAVIS.
The Centralist then initials and dates

the ritformulier and hands it to the
N.B.
46
Nr.
Department
-
Activity
Description
Function
Administratief Medewerker for
archiving. The Centralist also initials
and dates the Dispatcher Logbook.
N.B.
CAVIS stands for Caribische Ambulance
Verzorging Informatie Systeem.
3.
Dienst Ambulance
Hulpverlening
- Administratief
Medewerker
47
Archive documents
The Administratief Medewerker

archives the ritformulieren per month
in number order.
Process # 3.3 Cash Contr ol

I.
Process Definition
Goal
To verify the accuracy and completeness of the funds collected and to transfer the funds to the Receivers Office in
a complete and a timely manner.
Risks
The funds collected are not completely accounted for.
The funds collected are not completely transferred to the Receivers Department.
Internal controls
a. At least two persons have to be present when the safe is cleared and the funds are subsequently counted and
recorded.
b. Random dossier reviews of the cash control process by the Diensthoofd Ambulance Hulpverlening and/or the
Controller (from Deposit Logbook to Receivers receipt).
c. Monitor the collection behavior of the Ambulance Verleegkundiges, and be aware of irregularities.
Responsibilities
description.
Total amount of funds collected categorized according to type of payment.

Total amount of funds transferred to the Receiver Department.
Discrepancies in the cash control.
Ritformulier
Proces Verbaal (Afdrachtsformulier)
Deposit Logbook
Receivers Receipt
Functions Involved
Diensthoofd Ambulance Hulpverlening
Operationele Leider Ambulance Hulpverlening
Administratief Medewerker
48
II. Process Diagram
Function
49
III. Process Description
Nr.
Department
Activity
Description
1.
- Function
Dienst Ambulance
Hulpverlening
Empty safe and count

funds
The Operationele Leider Ambulance

Hulpverlening reviews the Deposit
Logbook in order to note the number and
amount of payments deposited in the
safe.

Hulpverlening and the Administratief
Medewerker proceed to empty the safe
and count the funds together.

Medewerker verify that the amount
noted on the ritformulier corresponds
with the amount in the envelope and/or
the receipts.
If all the funds are not in accordance with

the ritformulier and receipt, the
Operationele Leider Ambulance
Hulpverlening makes a note of the
discrepancy and reports it to the
Diensthoofd Ambulance Hulpverlening.
The Administratief Medewerker signs
the report as verification. The
Administratief Medewerker then
proceeds to record the funds.
If all the funds are in accordance with the

ritformulier and receipt, the
Administratief Medewerker proceeds to
record the funds.
- Operationele Leider
Ambulance Hulpverlening
- Administratief
Medewerker
50
Nr.
Department
Activity
Description
2.
- Function
Dienst Ambulance
Hulpverlening
Fill in Proces-verbaal
The Administratief Medewerker fills in a

Proces-verbaal for each ritformulier
where payment (cash or cheque) was
received.
- Administratief
Medewerker
The following information is noted on the

Proces-verbaal:
-
Period
Current date
Name of Ambulance
Verpleegkundige that collected the
funds;
Currency;
Details of funds;
Ritformulier number;
Date to be sent to Receivers Office.

Medewerker both initial and date the
Proces-verbaal and send it to the
for authorization.

Medewerker both initial and date the
Proces-verbaal and send it to the
for authorization.
51
3.
Dienst Ambulance
Hulpverlening
Authorize Procesverbaal
- Diensthoofd Ambulance
Hulpverlening
The Diensthoofd Ambulance

Hulpverlening reviews if the Procesverbaal is filled in completely and the
relevant signatures are present.
If the Proces-verbaal is not complete,

the Diensthoofd Ambulance
Hulpverlening notes the discrepancies on
the Proces-verbaal and returns it to the
Administratief Medewerker to be
adjusted.
If the Proces-verbaal is complete, the

signs, dates and stamps the procesverbaal and returns it to the
Operationele Leider Ambulance
Hulpverlening.
Dienst Ambulance
Hulpverlening
Transfer funds to
Receivers Department

Hulpverlening receives the authorized
Proces-verbaal and attaches the funds
to it.

Hulpverlening then transfers the funds
to the Receivers Department.
The Receivers Department collects the

funds, signs the Proces-verbaal and
hands over a receipt for the amount
received.

Hulpverlening verifies that the receipt is
correct and attaches it to the Procesverbaal.
4.
52

Hulpverlening then hands over the
documents to the Administratief
Medewerker to be archived.
N.B.
Every month the Operationele Leider
Ambulance Hulpverlening presents a
report to the Diensthoofd Ambulance
hulverlening on:
-
5.
Dienst Ambulance
Hulpverlening
- Administratief
Medewerker
Transfer and archive

documents
total amount of money collected;

total amount of money transferred
to the Receivers Department;
remarks on discrepancies in the cash
control.
After the payment to the Receivers the

Administratief Medewker receives the
Proces-verbaal and Receivers receipt
from the Operationele Leider Ambulance
Hulpverlening.
The Administratief Medewerker copies

the Proces-verbaal and the debit and
credit card receipts. The copies of the
Proces-verbaal and the original debit
and creidtcard receipts are transferred to
Sectie FA/IV of the Ministerie van
Financin for processing.
53
The Administratief Medewerker files the

original Proces-verbaal, the copies of
the debit and credit card receipts and
Receivers receipt according to date.
Attenti on poi nts & Recommendati ons

Attentions points/ Risks/ Recommendations
DIENST AMBULANCE
HULPVERLENING
3.1
Ambulance Assistance
(the number refers to the process step in the related process

description)
1. Attention point: Immediate entry in the CAVIS system is
preferable. It saves time and can functions as a control of the
complete handling of all calls (ritformulier).
Dienst Ambulance Hulpverlening indicated that the Dispatcher

module of CAVIS is not yet in use. They are currently concentrating
on establishing a well working dispatchers operation.
3. Attention point: The current ritformulier does not include key

information needed for the collection process, such as the type of
ID and the issue country of the ID. It is advisable to adapt the
Ritformulier to include this information. This should be done in
collaboration with the Ministry of Finance as it concerns the
collection of funds.
It is noted that a sign-off for cash is not practical due to the shifts.
And as for the four-eye principle, only the Ambulance
Verpleegkundige is rekenplichtig and receives a toeslag for
handling cash. So the Ambulance Chauffeur cannot (currently) be
the second pair of eyes.
3.2
Registration of Ambulance
Service
1. It is important to continuously control the timeliness of the

transfer of the ritformulieren.
3.3
Cash Control
1. It is advisable to establish a set frequency for clearing the safe;

based on a fixed amount for example.
5. Attention point: There is no four-eye principle applied to the

deposit of payments in the safe. In addition, the money is not check
immediately and there is no sign off for the transfer of money. This
present a risk that the Ambulance Verpleegkundige is not
indemnified against discrepancies in the cash.
54
2. It is advisable to adjust the way the funds are recorded and

transferred to the Receivers department. There should be a record
per each envelope/rit internally, on a spreadsheet or in CAVIS,
however the funds sent to the Receivers department should be a
total amount booked on the Ambulance CRIB account and not
linked to a certain Ambulance Verpleegkundige.
3. If possible in the system, it is advisable to reconcile the funds

collected with the registration thereof in CAVIS from the
ritformulier by the Centralist. This is an additional way to control
the funds collected.
4. Attention point: The credit card and debit card payments receipt
are currently not being transferred to Sectie FA of the Ministry of
Finance. This is important to verify the completeness of bank
transfers through credit and debit card transaction. And to register
funds received on the right CRIB account/department.
General. In order to eliminate the risks associated with the

collection of cash, Dienst Ambulance Hulpverlening has to make
proper agreements with the Receivers department concerning the
billing and collection process. This is needed to mitigate the
negative effect it will have on the collection process.
A copy of identification can serve as proof that services were

rendered.
55
General. Cash collection is not noted as an official task of Dienst

Ambulance Hulpverlening. In addition, the Performance Contract
and the Formation Plan also do not reflect this task, for example in
the form of a KPI or a Financial Administration Office respectively. It
is important that the goals and tasks of the organization are aligned
with the formation structure and performance indicators.
Attachment 2: Disaster Management ESF-6
MEDICAL RELIEF AND PUBLIC HEALTH

-Scenario for disaster management-
Ministry of Public Health, Social Development & Labour
Government of St. Maarten
August 2003, Revised 2010
56
CONTENTS
1. Concept of operations
1.1
General
1.2
Organization
1.3
Notification
1.4
Direction and control
1.5
ESF-6 Responsibilities & functions
4
4
5
6
6
7
2. ESF 6s tasks and actions

2.1 General
11
11
2.2 Preparedness
11
2.3 Response
11
2.4 Recovery
12
2.5 Mitigation
12
3. Partial Plans (draft)

Deelplan 9: Ontsmetting mens en dier
Deelplan: 11: Besmette waren
57
Deelplan 12: preventieve volksgezondheid

Deelplan:13: Geneeskundige hulpverlening
Deelplan 24: Geestelijke gezondheid
Deelplan 29: Milieu
13
1.
CONCEPT OF OPERATIONS
Primary / Lead agency:

Ministry of Public Health, Social Development & Labour (VSA)
Support agencies members ESF-6:
Sint Maarten Medical Center

White Yellow Cross Foundation
WIMA, General practitioners
SLS Laboratory
Red Cross Foundation
WIEMS (Windward Islands Emergency Medical Services)
Melmik, Air Ambulance services
VSA, ambulance services
VSA, Hygiene & veterinary affairs department
VSA, section ambulatory mental health
VSA, Preventive health department
1.1 General
Each organization has their specific responsibility and task for medical relief and public health in the event of a
disaster. Therefore, these organizations prepare their own plans that enable them to respond to a disaster and
continue to provide care for their patients.
Key in this operational structure is ESF (Emergency Support Function) Group 6: Medical Relief and Public Health (=
in Dutch: Geneeskundige Hulpverlening en Public Health (see attachment). This ESF Group is installed by the Prime
Minister and is the coordinating body that consists of experts/coordinators of the organizations listed at the beginning
of this chapter. ESF 6 has a supporting task to the Office of Disaster management and the EOC.
In ESF-6 operational organizational structure, there is a Disaster Management team (DMT) consisting of 3 persons of
VSA. The operational coordinator/leader is responsible for the control and management of the emergency or
emerging disaster situation.
The medical advisor/leader is responsible for any supporting medical advisory task. This person will be the medical
leader and member of CoPI (Commando Plaats Incident).
The Secretary General of VSA (also ESF-6 coordinator) is ultimately responsible for all actions taken by VSA and ESF6 during and following any emergency situation and in that capacity will organize activities that ensure and improve
disaster preparedness.
In the event of a possible disaster or threat of a hurricane an operational organizational structure is put in place (see
appendix) that enable organizations to work together in the joint interest of the health and well being of the
community. This structure will remain in place until the normalization (recovery) of medical services and public
health following a disaster.
58
The Secretary General of VSA is also part of the island disaster team of the Island Government, participates in
meetings of the Emergency Operation Center (EOC, see attachment) making decisions relevant to health issues.
1.2 Organization
The EOC consists of the following persons (see attachment):
The Prime Minister

The Government Information Service (GIS)
The Disaster Coordinator
The Secretary Generals
The Office of Disaster management will act as the coordinating and control facility in the event of e.g. a hurricane,
and for the coordination of resources in times of an emergency or disaster.
The Emergency Operation Center (EOC) is the management body for disaster management of St. Maarten, chaired
and led by the Prime Minister. The Disaster management plan of Country St. Maarten is formalized and functions as
the (legal) framework to clarify command, organization and coordination of activities.
1.3 Notification
The Emergency Operation Center (EOC) will notify the Secretary General of VSA as ESF 6 coordinator in the event
of a possible disaster.
This notification will usually be made via telephone or radio communication. Such notification could be to advise of
the potential for a disaster and normally a meeting of the EOC is called.
Upon receipt of the notification, the director will inform the operational coordinator and medical leader, who will
alert all ESF 6 members and inform them of a (potential) disaster. A meeting will be called by the operational leader
to discuss response issues (see Chapter 2) once the call to scale up (GRIP- system) is given.
59
1.4 Direction and control

Direction and Control: In order to effectively manage any type of emergency event, a system must be established so
that everyone is familiar with how to make things happen quickly, efficiently and effectively.
The ESF group Medical Relief and Public Health functions as the official body for activities in terms of disaster
response, preparedness, recovery and mitigation organization. Each member organization of ESF6 designates a
coordinator that is responsible for and will organize the execution of the disaster plans of their respective
organizations. These coordinators also participate in ESF6 and all communication from the operational leader of ESF6
will be handled through them.
Based on the (expected) magnitude and scope of the expected disaster, all or selected ESF members will be requested
to attend the meetings in which decisions are made and activities are coordinated and discussed.
The DMT (Disaster Management Team) of the Ministry of VSA consisting of the Secretary General VSA ,
Operational Leader and Medical Advisor /Leader, will function as a small key liaison unit between ESF6 and the
EOC. In this capacity they will assist the Prime Minister in carrying out her task to maintain order, safety and secure
the well being of the community. The Prime Minister can give orders to the Secretary General of VSA to prioritize
certain health areas of concern. These will be prepared and executed through the operational leader, medical leader
and ESF 6 coordinators.
60
Responsibilities & Functions
Functions of the primary agency (Ministry of Public Health, Social Development & Labour (VSA)
1.
Provide leadership in directing, coordinating and integrating the overall efforts to provide health,
medical, public health assistance.
2.
Staff and operate a command and control structure to assure that services and staff is provided to areas
of need.
3.
Coordinate and direct the activation and deployment of federal agencies, volunteer health/medical
personnel, supplies, equipment and provide certain direct resources that are under the control VSA.
4.
Assure that the following personnel or services are available for any event, such as:
Human resources:
Emergency technicians
Physicians
Mental health workers
Nurses/RNs/LPNs
Hygiene inspectors
Supplies and equipment:
61
Medical equipment and supplies

Advanced Life Support/Basic Life Support Vehicles
Vaccins
Shelter
Services:
5.
Pharmacy and laboratory services

Surveillance
Immunizations
Hygiene and environmental health inspections
Public information and education
Take measures to provide response to public health issues such as food safety, crisis mental health,
drinking water quality, vaccinations, disease control.
Functions of the support agencies :

St. Maarten Medical Center:
1.
2.
To ensure continuity of essential services of the hospital, safety of their clients and the treatment of any
casualties at the emergency room department.
To organize the evacuation of persons from the hospital whose life and well-being may be threatened
due to the impact of the hurricane to the hospital.
White & Yellow Cross Foundation:

1.
2.
To ensure continuity of services and safety to the clients of the White and Yellow Cross Foundation.
To provide continuity of care and to give medical assistance to the elderly in the districts.
WIMA, General Practitioners:

1.
2.
3.
4.
To ensure that clinics and poli-clinics are opened as soon as possible.

To ensure medical assistance through telephone consultations by emergency on call system.
To render medical expertise in case of large scale casualties or other events.
To provide medical assistance in the various districts to secure continuity and accessibility of Emergency
Medical Services.
Red Cross Foundation:

The Red Cross has a fundamental role to bring humanitarian relief to the victims of disaster. It does not assume
the responsibility for Government functions but supports and works in co-ordination with Government and
other organizations to avoid duplication.
To assist Government in search and rescue efforts.
To assist with the distribution of clothing, food, blankets, and other relief supplies.
To assist shelter management with the provision of First Aid trained volunteers wherever possible.
To respond to international tracing inquiry and assist government with information dissemination.
WIEMS (Windward Islands Emergency Medical Services):

To provide trained volunteers, equipment to assist where necessary in providing medical assistance and to assist
in search and rescue operations if needed.
SLS, Laboratory
To provide advice and a variety of laboratory testing services to protect the public health
Ministry of VSA, Ambulance Services:

1. To provide and coordinate medical assistance in search and rescue operations.
2. To provide leadership in case of coordinated medical assistance by the Red cross, WIEMS and
Emergency 24.
1.
2.
3.
4.
62
Ministry of VSA, Preventive health

To provide control, response and surveillance activities for infectious diseases
Ministry of VAS, Hygiene & Veterinary Services:

1.
2.
3.
4.
To provide vigorous food inspections in supermarkets, with food vendors and in restaurants.
To provide vector control and water treatment.
To secure safe drinking water for the population.
To make district assessment to monitor risk areas and environmental health issues.
Mental Health Foundation:

To provide mental health services to the affected populations and coordination of critical incident stress
management to personnel of support responders.
Air Ambulance Services:
To provide, emergency transportation if necessary by air prior and post hurricane.
Functions of ESF 6
The joint effort that is coordinated in ESF6 encompasses a full realm of tasks from education to provision of field
services. The following tasks provide the framework upon which actions will occur:
63
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
Management, Command and Control of assets

Assessment of health and medical needs
Disease control/epidemiology
Availability of Health/medical care personnel
Availability of Health/medical equipment and supplies
Patient care & evacuation
Emergency Medical Services (pre-hospital)
Coordinated in hospital and nursing home care
Emergency responder health and safety
Food and drug safety and availability of drugs and certain foods
Mental health and crisis counseling (individual and community)
Public health information
Vector control/monitoring
Quality of (drinking) water, waste water and solid waste
Victim identification/mortuary services.
2. ESF 6s TASKS & ACTIONS

2.1
General
Actions carried out by ESF6 fall into the four categories of emergency management: preparedness, response,
recovery and mitigation.
Each category requires specific skills and knowledge to accomplish and requires significant cooperation and
collaboration with all supporting agencies and the intended recipients of service.
2.2 Preparedness
Preparedness: Actions and activities that develop health and medical response capabilities.
Tasks:
a.
Conduct orientation and risk analyses on preparedness for various disaster scenarios
b.
Conduct planning and activities with ESF6 members to refine the concept of operations
c.
Refine and update Public Information Guidelines for all hazards
d.
Maintain liaison with health and medical (volunteer) organizations
e.
Develop rapid response mechanisms for medical relief, public health and mental health..
To ensure that all aspects of the response to a hurricane event are planned for and that designated organizations within
ESF6 are prepared to carry out appropriate actions.
2.3
Response
Response: Actions and activities that are focused on saving lives, protecting the public health and
stabilizing health and medical systems affected by the hurricane.
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
Coordinate operations of ESF6 and advice and inform the EOC

Coordinate response and resources with other ESF groups
Provide team players for the Rapid Impact Assessments
Coordinate communications for deployed health and medical personnel
Provide staff and services for monitoring public health conditions
Conduct rapid assessments for immediate response objectives
Determine need for health surveillance programs in communities
Arrange for the provision of medical personnel, equipment and supplies as needed to health and medical facilities.
Assist with patient evacuation and relocation (post event)
Identify hospital and nursing home bed vacancies
Operate the Ministry of VSA Operations Center
Perform water and food inspection.
Arrange for emergency mental health services to individuals and communities
Support response personnel with Critical Incident Stress Debriefing resources
Arrange for disaster mortuary response or identification services
Provide emergency pharmacy/laboratory services, if needed.
Tasks:
64
2.4
Recovery
Recovery: Activities to assist systems in returning to normal pre-event status

Tasks:
a.
b.
c.
d.
e.
f.
Restoration of essential health and medical components of delivery systems

Restore permanent medical facilities to operational status
Restore pharmacy services to operational status
Monitor hygiene and epidemiological surveillance and organize response
Support emergency services staff and operations until the local system or services is self-supporting
Continue provision of long-term emergency environmental activities
2.5
Mitigation
Mitigation: Actions of activities which reduce or eliminate hazards

Tasks:
a.
b.
c.
d.
e.
65
Identify and seek funds for e.g. hurricane proofing critical facilities
Identify locations of all vulnerable sites or populations
Stockpile critical medical supplies in strategic locations
Develop ESF6 readiness levels to higher capability
Identify and seek auxiliary power for critical facilities
3.
PARTIAL PLANS (draft)
66
Attachment 3: Alarm diagram Code Blue, Yellow & Red
Ambulance Alarm Diagram Code Blue, Yellow & Red
Melding ongeval
Centralist bepaal
alarm code en
inzetplan
67
Tot 6 slachtoffers
6-10
>12 slachtoffers
Code Blauw
Code Geel
Code Rood
Afhandelen door
Ambulance Dienst
Sint Maarten en
zonodig
OL(OVDG)
Zie verder
protocol 1.1
Zie Verder
protocol 1.2
Code Geel
Code Rood
Attachment 4:Work Instructions & Alarm Diagram Code Blue
Werkinstructie Rampenbestrijding
CODE BLAUW
< 6 slachtoffers
Ambulancehulpverlening St. Maarten kan dit alleen afhandelen.
Aard en omvang van de ramp zijn van dien aard dat de te

verwachten schade beperkt is tot maximaal 5 slachtoffers.
68
Inhoudsopgave code blauw:
1.
2.
3.
4.
69
Pagina
MKA Centralist......B-03
Ambulance verpleegkundige 1e ambulance(1e Avp)..............B-05
Ambulance chauffeur 1e Ambulance(1e Ach).. B-08
Operationeel Leider.B-10
B-2
Meldkamer Centralist (MKA Centralist)
1.
Alarmering en inzet
Als u een melding krijgt
Als u een melding krijgt van een incident stelt u de volgende vragen:
Aard van het incident (ongeval/gevaarlijke stoffen/rellen)
Aantal slachtoffers
Aard van de verwondingen
Plaats van het incident (aanrijroute)
Gevaren
Gealarmeerde operationele diensten
Tijdstip (hoelang bestaat de situatie)
Techniek en hulpmiddelen
Ambulance dienst Sint Maarten interne alarmering en communicatie
Landelijk protocol ambulancezorg
Werkt samen met:
Chauffeur 1e ambulance
Ambulance bemanningen
Operationeel Leider
Overige hulpdiensten
Taken
Alarmeer de geneeskundige keten (volgens alarmeringsschema)
Informeer gealarmeerde functionarissen over de situatie
Samenwerking
70
Voer inzetplan uit
Communiceer met Operationeel Leider
Communiceer met ambulance bemanning
Registeer slachtoffers die afgevoerd zijn naar het ziekenhuis
Plot informatie (actuele operationele situatie bijhouden o.a door logboek)
Signaleer knelpunten en doorgeven aan de Operationeel Leider
Opschaling
De Centralist MKA alarmeert volgens het alarmeringsschema
1e ambulance geeft opdracht tot verdere opschaling
De brandweer maakt bij de opschaling gebruik van de termen: GRIP 1,-2,-3

en 4 indien sprake is van een incident waarbij gecordineerde inzet van de
hulpverleningsdiensten noodzakelijk is (vergelijkbaar met code blauw, geel
en rood)
Afschaling
De Centralist MKA schaalt indien verdere medische inzet niet meer nodig is
af in opdracht van hoogst leidinggevende op plaats incident.
71
B-3
B-4
Ambulance verpleegkundige 1e ambulance(1e Avp)
1.
Alarmering en inzet
Als u wordt gealarmeerd
Als u wordt gealarmeerd stelt u de volgende vragen:
Aantal slachtoffers
Plaats van incident (houd rekening met de aanrijroute)
Gevaren
Tijdstip Hoelang bestaat de situatie)
Draag herkenbare kleding
Test portofoonverbinding met chauffeur
Voer na sein veilig een snelle (15-30 sec per slachtoffer) triage uit met chauffeur,
Gebruikmakend van slachtofferkaarten
Rapporteer aan chauffeur (locatie en aantal slachtoffers per triage klasse)
Geeft MKA via chauffeur indicatie van in te zetten ambulance
ambulance dienst Sint Maarten interne alarmering en communicatie
Landelijk protocol ambulancezorg (protocol: Grootschalig incident)
Maak bij communicatie gebruik van uw portofoon
Aankomst plaats incident
72
B-5
Samenwerking
Werkt samen met:
73
Centralisten MKA
Operationeel Leider
B-6
Taken tot komst Operationeel Leider
Bevestig alarmeringscode
Coordineren inzet
Triage
Laat informatie omtrent triageklasse, aantallen slcachtoffers en locatie registreren
Motorkapoverlegoverige operationele diensten
Verricht kortdurende levensreddende handelingen
Heeft overzicht na triage-ronde en stemt dit af in motorkapoverleg
Rapporteert aan 1e Ambulance chauffeur
Rapporteert aan Operationeel Leider
Na overdracht cordinatie aan Operationeel Leider: trek groene hes uit/zet groene
Helm af
Taken na komst Operationeel Leider
Draag cordinatie over aan Operationeel Leider
Ga verder als Ambulanceverpleegkundige
De brandweer maakt bij de opschaling gebruik van de termen: Grip 1,-2,-3 en 4 indien
sprake is van een incident waarbij gecordineerde inzet van de hulpverleningsdiensten
noodzakelijk is (vergelijkbaar met code blauw/geel en rood)
Na 1e triage wordt verdere opschaling/inzet bepaald door 1e Avp tot komst OL
Afschaling
De Centralist MKA schaalt indien verdere medische inzet niet meer nodig is af in opdracht
van hoogst leidinggevende op plaats incident
Opschaling
74
B-7
2.
Ambulance Chauffeur 1e ambulance (1e Ach)
Alarmering en inzet
Aantal slachtoffers
Aard van verwondingen
Gevaren
75
Stel de ambulance goed zichtbaar op , rekening houdend met de aan- en afvoerroute
Meld aankomst via portofoon bij MKA
Registreer n.a.v. triageronde van 1e Avp informatie over triageklasse, aantallen en

Locatie van slacktoffers
Na 1e triage: Blijf bij de ambulance
Test portofoonverbinding met 1e Avp
Landelijk protocol ambulancezorg (protocol grootschalig incident)
B-8
Samenwerking
Werkt samen met:
Avp 1e ambulance
Operationeel Leider
Centralisten MKA
Taken
Registreren van gegevens omtrent slachtoffers op aangegeven van 1e Avp
Communicatie met de MKA
Opstellen sitrap n.a.v. de informatie van de 1e Avp
Opschalen op verzoek van Avp via MKA
Opstellen inzetplan n.a.v. de informatie van de Avp
Opschaling
De Centralist MKA alarmeert volgens het alarmregelingsschema
De brandweer maakt bij de opschaling gebruik van de termen: Grip 1,-2,-3 en 4

Indien sprake is van een incident waarbij gecordineerde inzet van de hulpveleningsAmbulance Operations Manual | 8/1/2010
diensten noodzakelijk is (vergelijkbaar met code blauw/geel/rood)
76
B-9
3.
Operationeel Leider
Alarmering en inzet
Aantal slachtoffers
Gevaren
77
Stel voertuig goed zichtbaar op, rekening houdend met de aan- en afvoerroute
Zoek 1e Avp/ 1e Ach om sitrap
Vraag 1e Avp/ 1e Ach op
Neem cordinatie over van 1e Avp
Mogelijke slachtoffers op afstand (effectgebied) en spontane hulpverlening
Vaststellen opvang, behandelplaats en morgue
Belemmeringen bereik van slachtoffers
Bepaal inzetplan
Stem af met aanwezige leidinggevende van de operationele diensten en spreek tijdstip

van overleg
B-10
Samenwerking
Centralisten MKA
1e Avp
1e Ach
Werkt samen met:
78
B-11
Taken
Bewaak de gewondenregistratie
Geef leiding aan geneeskundige hulpverlening ter plaatse
Geef relevante informatie door aan de MKA
Opschalen extra ambulances en personeel
Bepaal prioriteiten m.b.t. gewonden afvoer
Wijs transport cordinator aan
Signaleer knelpunten m.b.t. de medische capaciteiten
Signaleer knelpunten m.b.t. de gewondenafvoer
Let op dehydratie medisch personeel/gewonden
Voer intercollegiaal overleg met brandweer en politie (COPI)
Maak inzetplan medisch personeel (incl. trauma team S.M.M.C.)
Bewaak opschaling
Bewaak aflossing functionarissen
Neem deel aan evaluatie met betrokken deelnemers
Opschaling
79

Indien sprake is van een incident waarbij gecordineerde inzet van de hulpveleningsdiensten noodzakelijk is (vergelijkbaar met code blauw/geel/rood)
Na overnemen van de cordinatie van de Avp 1e ambulance bepaald u verdere medisch

opschaling/inzet
Laat de functionarissen altijd alarmeren via de MKA
Afschaling
B-12
Attachment 5:Work Instructions & Alarm Diagram Code Yellow
Work Instructions & Alarm Diagram Code Yellow
CODE GEEL
< 10 slachtoffers
Aard en omvang van de ramp zijn van dien aard dat de te verwachten
schade in het brongebied en omgeving de behandelen
transportcapaciteit van de Ambulancehulpverlening St. Maarten
binnen 24 uur zullen overschrijden.
80
Inhoudsopgave code Geel:
1. MKA Centralist.......G-03
2. Ambulance verpleegkundige 1e ambulance(1e Avp)........G-04
3. Ambulance chauffeur 1e Ambulance(1e Ach)G-06
4. Operationeel Leider..G-08
5. Vertegenwoordiger Meldkamer. G-10
6. Transport cordinatorG-11
7. Hoofd Ambulancedienst(CVDG)G-12
81
G-2
2. Meldkamer Centralist (MKA Centralist)

Alarmering en inzet
Aantal slachtoffers
Gevaren
EMS Sint Maarten interne alarmering en communicatie
Samenwerking
Werkt samen met:
Vertegenwoordiger Meldkamer
Operationeel Leider
G-3
82
Taken
Alarmeer de geneeskundige keten (volgens alarmeringsschema)
Voer inzetplan uit
Registreer slachtoffers die afgevoerd zijn naar het ziekenhuis
Opschaling
1e Avp laat verder opschaling

en rood)
83
Afschaling
Af in opdracht van hoogst leidinggevende op plaats incident.
G-4
3. Ambulance verpleegkundige 1e ambulance(1e Avp)

Alarmering en inzet
Aantal slachtoffers
Gevaren
Tijdstip Hoelang bestaat de situatie)
G-5
84
Samenwerking
Werkt samen met:
85
Centralisten MKA
Operationeel Leider
G-6
Coordineren inzet
Triage
Bepaal inzet locatie 2e en verdere ambulances
Rapporteert aan Operationeel Leider
Helm af
Afschaling
Van hoogst leidinggevende op plaats incident
G-7
Opschaling
86
4.
Alarmering en inzet
Aantal slachtoffers
Gevaren
Stel de ambulance goed zichtbaar op , rekening houdend met de aan- en afvoerroute
87
Stem af op juiste portofoonkanaal
G-8
Samenwerking
Werkt samen met:
Avp 1e ambulance
Operationeel Leider
Centralisten MKA
Opschalen op verzoek van 1e Avp via MKA
Opstellen inzetplan n.a.v. de informatie van de 1e Avp
G-9
Taken
88
Opschaling

Na 1e triage wordt verdere opschaling/inzet bepaald door de 1e Avp tot komst van de
Operationeel Leider
Afschaling
De centralist MKA schaalt indien verdere medische inzet niet meer nodig is af in
opdracht van hoogst leidinggevende van EMS Sint Maarten op plaats incident.
89
G-10
5.Operationeel Leider
Alarmering en inzet
Aantal slachtoffers
Gevaren
Zoek 1e Avp/ 1e Ach op
Vraag 1e Avp/ 1e Ach om sitrap
Bepaal inzetplan

van overleg
Stem af op juist portofoonkanaal
G-11
90
Samenwerking
Werkt samen met:
91
Centralisten MKA
1e Avp
1e Ach
Transport cordinator
G-12
Taken
Bepaal verdere opschaling en medische inzet
Voer intercollegiaal overleg met brandweer en politie
Bewaak opschaling
Neem deel in COPI
Denk aan eventueel op te starten deelprocessen rampenbestrijding


opschaling/inzet
G-13
Opschaling
92
Afschaling
93
G-14
6.Vertegenwoordiger Meldkamer Centralist

Alarmering en inzet
Aantal slachtoffers
Gevaren
Werkt samen met:
Centralisten
1e Avp
chauffeur 1e ambulance(tot komst OVDG)
OVDG(OL)
Ziekenhuizen
G-15
Samenwerking
94
Taken
Geef leiding aan de meldkamer
Alarmeer de geneeskundige keten volgens alarmeringsschema
Signaleer knelpunten en doorgeven aan de Operationeel Leider(OVDG)
Voer opdrachten OVDG(OL)
Stem af met ziekenhuis
Stem af met Rode Kruis en WIEMS
Neem deel aan de evaluatie aan het eind van de inzet
Opschaling
De vertegenwoordiger MKA alarmeert volgens het alarmeringsschema

en rood)
95
Opschaling verloopt uitsluitend via de MKA
Afschaling
G-16
7.Transport Cordinator
Alarmering en inzet
Aantal slachtoffers
Gevaren
Werkt samen met:
Centralist
OVDG(OL)
Ambulancebemanning
Ziekenhuis(zonodig)
G-17
Samenwerking
96
Taken
Laat slachtoffers transporteren in opdracht van OVDG(OL)
Signaleer knelpunten en doorgeven aan de Operationeel Leider(OVDG)
Stem af met centralisten
Stem af met Operationeel Leider(OVDG)
Voer opdrachten OL(OVDG)
Stem af op juist portofoonkanaal
Verdeel de slachtoffers over de beschikbare ambulances
Neem deel aan evaluatie aan het eind van de inzet
Opschaling

en rood)
97
Opschaling verloop uitsluitend via de MKA
Afschaling
G-18
8. Hoofd ambulancedienst(CVDG)
Alarmering en inzet
Aantal slachtoffers
Gevaren
Vraag of het een voorwarschuwing betref
Bel directrice VSA
Informeer Cordinator ESF-6
Activeer zonodig COPI
Vervul; z.n. taak Medisch Leider COPI
Neem zonodig zitting in EOC
G-19
Taken
98
Melding Code Geel

6-10 slachtoffers
Centralist:
Ambulance(s) naar
plaats incident
Volg LPA
1e Ambulance geeft
SITRAP en bevestigd
code
Centralist
1 Bel OL(Ovd)
OVD: gaat naat plaats

incident
99
2 Bel Hoofd van

Dienst(Cvd)
CVD: informer
coordinator ESF6 z.n
COPI activeren
CVD neemt contact

met directeur VSA
OVD ter plaatse; Neemt

coordinatie over, geeft
SITRAP en verdure
inzetplan
3 Begin met
opschaling(extra
personeel en
ambulance ter plaatse)
5 Bel en activeer
S.M.M.C
1e AVP zorg voor

opschaling, opvang en
coordinatie
4 Bel voor standby

Rode Kruis en
W.I.E.M.S
Attachment 6:Work Instructions & Alarm Diagram Code Red
Work Instructions & Alarm Diagram Code Red
CODE ROOD
Aard en omvang van de ramp zijn van dien aard dat de met
zekerheid te verwachte schade in het brongebied en omgeving
ruimschoots de behandelen transport capaciteit van Ambulance
Dienst Sint Maarten overschrijden. Er is sprake van ernstige letsels
en potentile psychotrauma.
> 10 slachtoffers
100
Inhoudsopgave code rood:
Pagina
1. MKA Centralist...R-3
2. Ambulance verpleegkundige 1e ambulance(1e Avp)...........R-4
3. Ambulance chauffeur 1e Ambulance(1e Ach)......R-5
4. Operationeel Leider....... R-6
5. Transport Cordinator.................................................R-7
6. Hoofd van dienst(C.V.D.G).......................................... R-8
101
R-2
1.Meldkamer Centralist (MKA Centralist)

Alarmering en inzet
Aantal slachtoffers
Gevaren
Operationeel Leider
CVDG
CoPI
Transport Cordinator
R-3
Samenwerking; Werkt samen met:
102
Taken
Alarmeer de geneeskundige keten

- Volgens schema
- Alarmeer en activeer SMMC
- Alarmeer en activeer Rode Kruis en WIEMS
Voer inzetplan uit
Plot informatie (actuele operationele situatie bijhouden o.a. door logboek)
Opschaling
1e ambulance geeft opdracht tot verdere opschaling

hulpverleningsdiensten noodzakelijk is (vergelijkbaar met code blauw, geel en rood)
103
Afschaling
af in opdracht van hoogst leidinggevende op plaats incident.
R-4
2.Ambulance verpleegkundige 1e ambulance(1e Avp)
Alarmering en inzet
Aantal slachtoffers
Gevaren
ambulance dienst Sint Maarten interne alarmering en communicatie
R-5
104
Samenwerking
Werkt samen met:
105
Centralisten MKA
Operationeel Leider
R-6
Coordineer inzet
Triage
Bepaald inzet locatie 2e en verdere ambulances
Rapporteer aan Operationeel Leider
Helm af
Afschaling
Opschaling
R-7
106
3.
Alarmering en inzet
Aantal slachtoffers
Gevaren
Stel de ambulance goed zichtbaar op, rekening houdend met de aan- en afvoerroute
107
R-8
Samenwerking
Werkt samen met:
Avp 1e ambulance
Operationeel Leider
Centralisten MKA
Taken
Opschalen op verzoek van Avp via MKA
Opstellen inzetplan n.a.v. de informatie van de Avp
Opschaling
diensten noodzakelijk is (vergelijkbaar met code blauw/geel/rood)
R-9
Indien sprake is van een incident waarbij gecordineerde inzet van de hulpvelenings-
108
4.
Operationeel Leider
Alarmering en inzet
Aantal slachtoffers
Gevaren
109
Zoek 1e Avp/ 1e Ach om sitrap
Vraag 1e Avp om sitrap
Bepaal inzetplan

van overleg
R-10
Samenwerking
Centralisten MKA
1e Avp
1e Ach
COPI
Hoofd van dienst (CVDG)
Transport cordinator
R-11
Werkt samen met:
110
Taken
Bepaal verdere opschaling en medische inzet
Voer intercollegiaal overleg met brandweer en politie (COPI)
Bewaak opschaling
Bewaak aflossing functionarissen
Neem deel aan motorkapoverleg
Denk aan eventueel op te starten deelprocessen rampenbestrijding
Opschaling
111

Indien sprake is van een incident waarbij gecordineerde inzet van de hulpveleningdiensten noodzakelijk is (vergelijkbaar met code blauw/geel/rood)

opschaling/inzet
R-12
Afschaling
R-13
112
5.Transport cordinator(TC)
Alarmering en inzet
Aantal slachtoffers
Plaats van incident ( aanrijroute)
Gevaren
113
Samenwerking
Werkt samen met:
Centralisten
Operationeel Leider
Ziekenhuizen(zonodig)
R-14
Taken
Laat slachtoffers transporteren en registreer de slachtoffers die afgevoerd zijn
Plot informatie(actuele operationele situatie bijhouden o.a. door logboek
Signaleer knelpunten en geef door aan OL (OvDG)
Stem af met centralisten
Stem af met OL (OvDG)
Voer opdrachten van de OL (OvDG)
Stem af op het juiste portofoonkanaal
Verdeel de slachtoffers over de beschikbare ambulances
Meen deel aan de evaluatie aan het eind van de inzet
Opschaling

Indien sprake is van een incident waarbij gecordineerde inzet van de hulpverleningdiensten noodzakelijk is (vergelijkbaar met code blauw/geel/rood)
Opschalin verloop uitsluitend via de MKA
Afschaling
R-15
114
6. Hoofd Ambulancedienst(C.VDG)
Alarmering en inzet
Aantal slachtoffers
Plaats van incident
Gevaren
Vraag of het een voorwaarschuwing betreft
Samenwerking
115
Werkt samen met:
Eilandelijke Rampenstaf (ERS)
Eilandelijk Tactisch Team (ETT)
CoPI
R-16
Taken
Neem zitting in ETT
Geef leiding aan de geneeskundige hulpverlening op beleidsniveau
Neem beslissingen inzake de ambulance inzet
Vertaal multidisciplinaire aandachtspunten en prioriteiten naar de geneeskundige inzet
Adviseer in EOC betreffende te nemen beslissingen
Vertaal tactische informatie naar strategische informatie
Adviseer vanuit geneeskundig perspectief over de multidisciplinaire hulpverlening
Bewaak gewondenregistratie
Dien verzoek bijstandsaanvrage in
Maak een gevaarinschatting
Bewaak reguliere ambulance dekking
Bepaal lange termijn planning
Adviseer betreffende knelpunten
Verstrek informatie t.b.v. pers betreffende de geneeskundige hulpverlening
Start deelprocessen rampenbestrijding op
Neem deel aan de evaluatie aan het eind van de inzet
De centralist MKA alarmeert volgens het alarmeringsschema

Indien sprake is van een incident waarbij gecordineerde inzet van de hulpverleningdiensten noodzakelijk is (vergelijkbaar met code blauw/geel/rood)
Afschaling
R-17
Opschaling
116
Melding Code Rood

> 10 slachtoffers
Centralist: Ambulance(s)
naar plaats incident; volg
LPA
1e Ambulance geeft 1e
SITRAP en bevestigd Code.
CENTRALIST
1 Bel OL (OVD)
OL(OVD) gaat naar plaats

incident
OVD ter plaatse neem
cordinatie over, Geef 2e
SITRAP en inzet
OVD en CVD stemmen af:
Aantal T1, T2, T3 en
capaciteiten
2 Bel Hoofd van Dienst(CVD)
CVD bel SG VSA
SG VSA gaat in EOC
117
CVD Activeer coordinatie

ESF6
CVD Rapporteer aan SG VSA
in EOC
3 Bel en activeer S.M.M.C
4 Bel en activeer Rode Kruis

en W.I.E.M.S
5 Zorg voor opschaling en
opvang
Attachment 7: INWERKPLAN AMBULANCE- VERPLEEGKUNDIGE
Ambulancehulpverlening St. Maarten
Februari 2009
Aangepast door A.Cristina
118
Inleiding:
Dit inwerkschema is bedoeld om nieuwe medewerkers methodisch en eenduidig in te werken. Het geeft structuur en
continuteit in het inwerkproces voor de nieuwe medewerker, de begeleider en de leiding van Ambulance dienst Sint
Maarten . Tevens heeft het tot doel het kennismakingsproces met het bedrijf en het werk op de ambulance te
stroomlijnen en is het een hulpmiddel bij het toetsen van beroepsinhoudelijke kennis en vaardigheden. Steeds wordt
daarbij de vraag gesteld: "wat wordt beheerst", en "wat moet nog geleerd worden?".
Het inwerkschema is tevens een stappenplan in aanloop naar de SOSA opleiding.
Het methodisch handelen en het werken volgens de protocollen zijn hierin de hoofdzaken. Van de voortgang en de
evaluaties worden schriftelijke rapportages bijgehouden.
Het inwerkschema beslaat vier weken of 20 werkdagen.
Aan het einde hiervan wordt bepaald of de nieuwe medewerker zelfstandig verder gaat, dan wel een vervolg krijgt op
het inwerkschema. In het vervolgschema worden de aandachtspunten en de verdere aanpak expliciet benoemd. Aan het
einde van iedere week vindt een evaluatie plaats.
De nieuwe medewerker wordt gedurende de inwerkperiode gekoppeld aan een mentor.
Dit is een collega ambulanceverpleegkundige. Hij of zij bewaakt het proces en woont ook de evaluaties bij.
Het inwerken zelf wordt verzorgd door verschillende praktijkbegeleiders. Ook de mentor
kan als praktijkbegeleider fungeren.
De nieuwe medewerker, de mentor, de praktijkbegeleiders en de Operationele leiders (OL) zijn samen
verantwoordelijk voor de voortgang van het inwerkproces. Het Hoofd van dienst van EMS heeft de
eindverantwoordelijkheid. Bij voortgangsproblemen kan de afdeling hoofd tot bijstelling van het programma besluiten,
of aan de andere kant ingrijpen.
119
N.B. Na de 4e week kopieen van alle evaluatieformulieren en Checklist geven aan het hoofd van dienst.
Na controle worden deze bewaard in het persoonlijke dossier van de nieuwe medewerker.
Opbouw inwerkschema:
* Per week is een aantal aandachtspunten benoemd.

* Aan het einde van iedere week vindt een evaluatie plaats.
* De weekevaluatie vindt plaats aan de hand van de bij dit inwerkschema
behorende evaluatieformulieren. De formulieren geven richting aan het gesprek en brengen de wel- of niet
halen van de gestelde doelen in kaart.
Evaluaties worden afgesloten met het maken van nieuwe afspraken.
* Per dag wordt een dagevaluatieformulier ingevuld door de nieuwe medewerker
en bijgehouden. Doel is overzicht te krijgen in de verrichte werkzaamheden.
Bovendien kan het dienen als overdracht aan een volgende praktijkbegeleider.
* In het schema zijn checklists opgenomen. Hierop worden de meest
voorkomende vaardigheden in een drietrapsmodel (demonstratie, onder toezicht, zelfstandig)
afgetekend.
De checklists worden afgetekend door de praktijkbegeleider.
De laatste (derde) handtekening wordt uitsluitend gezet met instemming van de nieuwe medewerker,
die daarna zelf verantwoording draagt voor deze handeling.
* De inwerkperiode wordt afgesloten met een eind-evaluatie.
De eindevaluatie geeft een beeld van het gelopen traject. Er vindt samen-
medewerker, de begeleider en de leidinggevende (OL).
Ook tijdens het zelfstandig functioneren zullen er op afgesproken momenten evaluatie gesprekken
plaatsvinden.
vattende verslaglegging plaats. De eindevaluatie wordt ondertekend door de
120
Kennismakings-/ introductiedag.
Tijdens deze eerste dag komen onder andere de volgende punten aan de orde:
- Kennismaking met collega's, leidinggevenden enz.
- Uitleg van het inwerkprogramma, de functie praktijkbegeleider, het
begeleidingsproces.
- Opleidingsachtergrond en werkervaring van de nieuwe medewerker.
- Uitspreken van verwachtingen van nieuwe medewerker en praktijkbegeleider.
- Uitleg/rondleiding organisatie .
- Uitleg diensten, dienstrooster, vakantieplanning en diensten ruilen.
- Informatie structuur ambulancedienst.
- Invullen overwerkformulier.
- Informatie huisregels.
- Aanvragen vrije dagen.
- Ziek en herstelt melding.
- Zorgen voor dienstkleding.
- Zorgen voor garderobekast.
- Uitreiken tensiemeter, stetoscoop, glucometer, holster, pupillampje,
verbandschaar .
121
Evaluatie van de eerste dag:

Week 1
Vooral gericht op de organisatie van het ambulancevervoer.
Tijdens de eerste dagen gaat de aandacht vooral uit naar:
- Kennismaking interieur ambulance middels een dagelijkse contrlebeurt. N.B. Controle voor aanvang van de diensttijd.
- Uitleg organisatie ambulancevervoer, communicatie mogelijkheden,
werking meldkamer.
- Uitleg mobilofoon, portofoon, telefoon.
- Uitleg soorten vervoer, ritformulier.
- Meelopen met voorkomend vervoer, met vooral aandacht voor B-vervoeren,
en mobilofooncommunicatie en dergelijke.
-
Kennismaking ziekenhuis/Eerste Hulp

* Aandacht voor de andere instellingen.
- Uitleg/kennismaking collega hulpverleners, waaronder Brandweer en Politie.
- Wijze van vervoer, tiltechnieken en zorg voor interieur van de
ambulance.
- Aandacht voor kwaliteit van basiszorg, met name:
* op gemak stellen van patint

* zorg voor comfortabel transport
* aandacht voor thuissituatie
- Aandacht voor:
* individuele beroepsverantwoordelijkheid
* belang van goede registratie hulpverleningsproces op het ritformulier
NB. In de eerste week een rondleiding in de CPA (meldkamer) plannen.
* gastheerschap
122
Week 2.
Vooral gericht op medisch-technische en verpleegkundige zorg.
Aandachtspunten:
- Soorten vervoer
- Ritformulier
- Kennis en gebruik van apparatuur/ materialen
- Eerste-Hulp technieken
- Begeleiding van patinten en familie/ naasten
- Attitude en privacy
- Kennismaking/ uitleg Landelijk Protocol, met name:
* Protocollen algemeen
* Protocollen traumatologie
* Protocollen cardiologie
- Kennismaking met methodisch handelen in de ambulance-hulpverlening:
* Afnemen anamnese
* Top tot teen onderzoek en specifiek lichamelijk onderzoek
* Formuleren werkdiagnoses
* Formuleren behandeldoelen
123
* Toepassing conditiescores
* Gebruik medicatie
Week 3.
Deze week vooral aandacht voor:
- Samenwerking met de chauffeur en andere disciplines (huisarts, verloskundige, politie en brandweer)
- Onderlinge taakverdeling.
- Toepassing protocollenboek (na vervoer van een patint moet het bijpassende protocol besproken worden).
- Zelfstandig invullen van het Rit Formulier.
- Zelfstandig afnemen anamnese
- Zelfstandig uitvoeren lichamelijk onderzoek.
- Zelfstandig formuleren werkdiagnoses/ behandeldoelen
- Principe van de PHTLS, bijwonen traumatologietraining.
- Toepassing paraatkoffer.
- Zelfstandig uitvoeren van:
* Spalken (extremiteiten/ nek)
* Wondverzorging
- Advanced Life Support
* Indien mogelijk bijwonen ALS training
124
Week 4
Deze week vooral aandacht voor:
- Transportcouveuse en zorg voor pasgeborene
- Psychiatrisch vervoer (KZ-verklaring)
- Hulpverlening bij grootschalige incidenten:
* Rampenplan
* Airport
* Opschaling
* Organisatie rampgebied
* Rampenmateriaal
- Hulpverlening door derden:
* Rode kruis en WIEMS
* Artsen en Verpleegkundigen
- Hulpverlening overige activiteiten

- Stand-by ritten
- Procedure vervoer overledenen op straat en thuis
- Hyginische aspecten met betrekking tot:
* MRSA
125
* TBC
* Hepatitis
- IC-transporten
- Juridische aspecten
- Uitbreiden zelfstandig functioneren, terugtrekken inbreng praktijkbegeleider
Evaluatiegesprek met Nieuwe medewerker week 1.

Datum :
Tijd:
Naam Medewerker:
Naam praktijkbegeleider:
Naam Operationeel Leider:
Overige aanwezigen:
- Hoe is de eerste kennismaking met de ambulancehulpverlening ervaren?
- Wat heeft de medewerker gemist/ wat was juist goed?
- Hoe is de eerste week verlopen?
- Zijn de aandachtspunten van week 1 voldoende aan bod gekomen,

zo niet, welke punten verdienen nog de aandacht?
Heeft de nieuwe medewerker nog vragen/opmerkingen:

* A. algemeen:
- Heeft de praktijkbegeleider nog opmerkingen?

- Samenvatting van het gesprek:
N.B. Aandachtspunten voor de volgende week doornemen, eventueel niet

behaalde doelstellingen/ aandachtspunten van week 1 toevoegen.
S.V.P. Kopie van dit verslag naar het hoofd van dienst.
* B. ten aanzien van het inwerkprogramma:
126
Evaluatie gesprek met Nieuwe medewerker week 2.

Datum:
Tijd:
Naam Medewerker:
Overige aanwezigen:
- Hoe heeft Nieuwe medewerker de tweede week ervaren?
- Zijn alle aandachtspunten voldoende aan bod gekomen?

Wat heeft volgens Nieuwe medewerker onvoldoende aandacht gekregen?
- Hoe verlopen contacten met patinten en familie?
- Heeft de nieuwe medewerker inzicht in het methodisch handelen, en kan hij/zij

dit toepassen?
- Heeft de nieuwe medewerker inzicht in het Landelijk Protocol, en kan hij dit
toepassen?
- Heeft de nieuwe medewerker nog vragen/ opmerkingen?
127

behaalde aandachtspunten/ doelstellingen van week 2 toevoegen.
Evaluatiegesprek met Nieuwe medewerker week 3.

Datum:
Tijd:
Naam Medewerker:
Praktijkbegeleider:
Operationeel Leider:
Overige aanwezigen:
- Hoe heeft de nieuwe medewerker de derde week ervaren?
Wat heeft volgens hem/haar onvoldoende aandacht gekregen?
- Hoe verloopt de samenwerking met collega's en andere disciplines?
- Hoe verloopt het functioneren met betrekking tot de overige aandachtspunten?
- Heeft de nieuwe medewerker nog vragen/opmerkingen?

behaalde aandachtspunten/doelstellingen van week 3 toevoegen.
128
Evaluatiegesprek met Nieuwe medewerker week 4:

Datum:
Tijd:
Naam medewerker:
Overige aanwezigen:
- Hoe heeft de nieuwe medewerker de vierde week ervaren?

Wat heeft volgens hem/haar onvoldoende aandacht gekregen?
- Heeft de medewerker voldoende ruimte gekregen om zelfstandig

te functioneren?
129
N.B. Afspraken worden gemaakt naar aanleiding van de eindevaluatie.

Evaluatieoverzicht van Nieuwe medewerker week 1 t/m 4.

Datum:
Naam medewerker:
Naam leidinggevende (OL):
Overige aanwezigen:
Onderwerp
onvold.
vold.
goed
Attitude
Samenwerking met de chauffeur
Is in staat feed-back te geven en te ontvangen
Basiszorg verlenen aan de patient
Zorg voor psycho-sociale aspecten in hulpverlening (patient en familie)
Beoordeling hulpvraag en inspelen hierop
Is in staat volgens methodisch handelen hulp te verlenen.
Is in staat protocollair hulp te verlenen
Is in staat het Landelijk Protocol in de hulpverlening te integreren
Kan vitale functies beoordelen en ingrijpen bij stoornissen
Afnemen van anamnese
Uitvoeren lichamelijk onderzoek
Instrumenteel-technisch handelen
Is in staat om adequaat te handelen in acute situaties
Is in staat om prioriteiten te stellen
Vaststellen werkdiagnoses
130
Aan de hand van het evaluatieoverzicht:

Wat is de algemene indruk ten aanzien van de geschiktheid voor deze functie:
Eindevaluatie:
A. Verpleegkundige kan zelfstandig functioneren
B. Verpleegkundige heeft vervolg inwerktraject nodig
- Aan welke aspecten moet in het vervolgtraject aandacht worden besteed?
- Welke vorm moet het vervolgtraject krijgen?
- Heeft de leidinggevende nog opmerkingen?
Samenvatting van het gesprek:
Gemaakte afspraken:
131
Handtekening:
..
leidinggevende
Begeleider
Nieuwe medewerker
Checklist t.b.v. het inwerkprogramma van Nieuwe medewerker:

De taak van een ambulance-verpleegkundige omvat een groot aantal vaardig-heden en instrumenteel-technische
handelingen.
De bedoeling van deze checklist is om het leerproces te volgen, en helder te maken wat hij/zij reeds beheerst, of niet- of
onvoldoende beheerst.
Tevens is het een hulpmiddel om er voor te zorgen dat het inwerkprogramma zo volledig mogelijk is.
Elke vaardigheid/ handeling moet drie maal afgetekend worden.
De eerste maal (1) als demonstratie, de tweede maal bij uitvoering onder begeleiding (2), de derde handtekening (3)
wordt gezet met instemming van Nieuwe medewerker Hiermee verklaart hij/zij zich bekwaam tot het uitvoeren van de
vaardigheid of handeling. Een kopie van de Checklist naar de Bedrijfsmanager sturen.
De taken van de ambulance-verpleegkundige zijn te onderscheiden in een aantal rubrieken:
1. Algemene kennis en kennis van de inventaris van de ambulance
2. Zorg voor de patint
3. Instrumenteel-technisch handelen en specifieke taken t.a.v.:
- Algemeen
- Cardiologie
- Traumatologie
- Verloskunde
- Neurologie
- Pediatrie
4. Cordinatie van zorg
Checklist
Algemene kennis en kennis van de inventaris van de ambulance
- Interne ziekten
132
A. Hanteren van communicatiemiddelen
Mobilofoon
Portofoon
Telefoon
regels m.b.t. communicatie met C.P.A.
voorwaarschuwing urgentie aan EHBO
B. Hanteren van geografische gegevens

lezen van wegenkaart
C. Inventaris van de ambulance

controle van inventaris bij aanvang dienst
hygiene t.a.v. inventaris/ achtercompartiment
D. Het kunnen bedienen van
monitor/ defibrillator
133
pulse/ oxymeter
Beademingsapparaat*
afzuigapparaat (twee stuks)
E. Het gebruik kennen van: Brancardmateriaal

Brancardrijder
brancard/ fixatieband
Vouwbrancard
Schepbrancard
Spalk- en verbandmateriaal
metalline lakens/ doeken

vette (synthetische) watten*
Nekspalken
Spalken
KED immobilisatie
Hoofdsteunen
Beschermende materialen
Gasmasker *
TBC masker
groene rampenjas*
Veiligheidshelm*
* = nog niet aanwezig
134
Overige materialen
Sterilium
Lijkenhoes
Zuurstofbril
Zuurstofcatheter
Zuurstofmasker
Afzuigcatheter
Yankauer
zuurstof cylinders
Reduceerventielen
Snelkoppelingen
beademingsballon bufferzak
peepventiel
barrierbag filter
Reanimatiebord
bedieningspaneel en schakelaars
110 volt mogelijkheid
monteren tweede brancard
vacuum matras *
135
Kennis van inhoud/ materialen diverse koffers

Paraatkoffer*
Verband koffer
Kinder*- en partus koffer
* = nog niet aanwezig
Zorg voor de patient

F. Basiszorg
heeft aandacht voor de patient

draagt zorg voor de privacy
heeft aandacht voor de psycho- sociale aspecten tijdens het vervoer
informeert de patient over uit te voeren handelingen
informeert de patient zo nodig wat deze te wachten staat
heeft aandacht voor de familie en informeert deze voldoende
weet correct om te gaan met agressie en/of weerstand v.d. patient
heeft aandacht voor de benodigde rijstijl
G. Tiltechnieken
Rautekgreep
met brancard de trap af en op
Schepbrancard
div. technieken van bed naar brancard v.v./rolstoel/vliegtuig
assistentie Brandweer
H. Lichaamshouding
stabiele zijligging
(half) zittende houding
Trendelenburg houding
Rugligging
136
J. Zorg voor temperatuur
snelheid van werken

vermijden van wind en tocht
gebruik van dekens en folie
gebruik van air-conditioning
K. Hygiene maatregelen
gebruik van handschoenen
kennis van protocol MRSA
gebruik van TBC maskers
zorg voor gebruikte naalden en andere verontreinigde materialen
L. Zorg voor veiligheid

in- uitstappen ambulance
ongeval met gevaarlijke stoffen
afschermen ongeval
ongevallen met geweld
M. Zorg voor overledene
kent procedure m.b.t. overledene thuis, elders, onnatuurlijke dood
137
opbaren van overleden thuis

draagt zorg voor oproepen huisarts
draagt (indien gewenst) zorg voor oproepen van familie
draagt zorg voor opvang van aanwezige familie
Instrumenteel-technisch handelen
N. Algemeen
is in staat methodischte handelen

is in staat een anamnese af te nemen
is in staat een volledig top tot teen onderzoek af te nemen
is in staat conditiescores af te nemen (RTS/GCS)
is in staat werkdiagnoses te stellen
is in staat behandeldoelen te formuleren
O. Bewaking
controle vitale functies
Monitorbewaking
pulse-oxymetrie
inbrengen waaknaald/ aanleggen infuus
gebruik spuitenpomp *
P. Ademhaling
vrijmaken ademweg
uitzuigen mond- keelholte

toepassen mayo-tube
toedienen zuurstof per catheter, bril of kapje
gebruik Ambu-ballon
gebruik beademingsapparaat*
endotracheale intubatie
vernevelen Ventolin
is op de hoogte van de relevante protocollen
methode van Heimlich
138
R. Cardiologie
zorg voor patient met angina pectoris

zorg voor patient met myocard infarct
zorg voor patient met asthma cardiale
herkennen van ritmestoornissen en hierop kunnen ingrijpen
beheersen reanimatie technieken BLS en ALS
is op de hoogte van relevante protocollen
S. Traumatologie
stelpen van bloedingen (afdrukpunten)
aanleggen van wondverbanden
aanleggen van drukverbanden
aanleggen mitella/ brede das
heeft kennis van hulpverlening bij schedel-/ hersentrauma, halswervelletsel
Fracturen
whip-lash
* = niet aanwezig
139
thorax trauma (rib frakturen en (spanning pneumothorax))

(stomp) buiktrauma
bekken fraktuur
frakturen/ luxaties
Wervelletsel
Oogletsel
brandwonden (inhalatie trauma)
chemische verbranding
koolmonoxyde intoxicatie
Bevriezing
Onderkoeling
Drenkeling
elektriciteit/ bliksem ongeval
repositioneren luxaties en de indicaties
repositioneren/ spalken van nek, arm, boven- en onderbeen
is op de hoogte van het PHTLS principe en kan dit toepassen
zorg voor stellen van indicatie en oproepen van 2e amb.

T. Interne ziekten: zorg voor patient met

diabetes mellitis/ bloedsuiker bepalen / oraal,intraveneus reguleren
anafylactische shock
septische shock
gastro-intestinale bloedingen
kennis van methode Kusters en samenwerking met brandweer
140
intoxicaties van medicijnen,alcohol,opiaten en overige

Hyperventilatie
Longembolie
COPD patienten
U. Verloskunde: zorgt voor patient
in partu
met spontane abortus
met extra uteriene graviditeit
met bloedverlies tijdens graviditeit
met bloedverlies post-partum
met niet vorderende baring/ foetale nood
V. Neurologie: zorgt voor patient met
Bewustzijnsstoornissen
TIA/ CVA
Epilepsie
141
W. Pediatrie: zorgt voor kind met

koortsconvulsies
Trauma
Meningitis
circulatie-/ ventilatiestilstand
Coordinatie van zorg

1
het bepalen van de hulpvraag

het bepalen van de zorgbehoefte
het bepalen van de vervoersindicatie
het bepalen van de vervoersurgentie
zorgt voor goede mondelinge overdracht naar ziekenhuis
zorgt voor goede schriftelijke overdracht naar ziekenhuis
kan hulpverleningsproces goed op CRF weergeven
overlegt (indien nodig) met andere hulpverleners
is in staat functioneel leiding te geven aan chauffeur en derden
is in staat (medische) verpleegkundige hulpverlening te coordineren
142
Dagevaluatie inwerkplan Nieuwe medewerker:

Naam medewerker
Naam begeleider : ..
Datum
: ..
Dienst
: ..
Ongeval
Aantal
Waarvan zelf
Kort verslag / Opmerkingen Nieuwe medewerker:
Opmerkingen praktijkbegeleider:
143
Naam en opmerkingen chauffeur:
Vr eerste opkomst van Nieuwe medewerker te regelen.

Aktie
gedaan
datum
Persoonlijk medisch/ver pleegkundig mater iaal klaar leggen

Rooster klaarleggen
Inwer kmap maken
Map interne huisregels klaar leggen
Kopie rijbewijs vragen/ maken
Uniform regelen
Werkschoen regelen
Regenjas regelen
Telefoonlijst afdeling a mbulance
Persoonlijk kastje + slot regelen
Sleutels regelen
Protocollenboekje
Funktieomschrijvingen klaarleggen
Kopie exemplaar vakantieaanvraag en over wer kformulier
Identiteitspas (kopie) vragen

Vakantie afspra ken laten noter en/ r egelen op aa nvraaglijst en
formulier
Vragen of telefoon nummer in algemene klapper mag
144
Uitreiken diverse artikelen op de eerste werkdag van Nieuwe medewerker

(vpk.)
Aktie
145
Gedaan
Datum
Attachment 8: INWERKPLAN AMBULANCE CHAUFFEURS
January 2009
DIENST AMBULANCEHULPVERLENING
SINT MAARTEN
146
Dit inwerkplan is bedoeld om een nieuwe ambulancechauffeur

gestructureerd op te leiden tot zelfstandig functionerend
ambulancehulpverlener. Daartoe is dit inwerkplan verdeeld in
blokken. De nieuwe medewerker zal niet aan een nieuw blok
beginnen voordat het voorliggende blok succesvol is doorlopen.
Er is hier dus geen sprake van een vooraf ingesteld tijdspad.
De nieuwe medewerker zal een mentor/begeleider toegewezen

krijgen. Deze is verantwoordelijk voor het juist doorlopen van
het inwerkplan. Het inwerken zal veelal geschieden door
begeleiders. Evaluatie zal gebeuren volgens schema.
Aangezien het zal voorkomen dat er tussen het zelfstandig

functioneren van de nieuwe medewerker en het behalen van het
SOSA-diploma enige tijd verloopt, kan er na het goed doorlopen
hebben van dit inwerkplan een Basisbekwaamheidsverklaring
afgegeven worden. Wanneer dit inwerkplan ook gebruikt zou worden
voor collegas die problemen hebben met het behalen van het
SOSA-diploma, zullen er geen ongecertificeerde chauffeurs meer
werkzaam zijn.
147
N.B. Van alle dagverslagen, periodieke(blok)evaluaties en de

eindevaluatie een kopie naar de bedrijfsmanager ter informatie
en filen in het dossier van de medewerker.
OPLEIDINGSAANDACHTSPUNTEN AMBULANCECHAUFF EURS:
A:
VOERTUIGKENNIS AMBULANCE:
Van de chauffeur wordt verwacht dat hij/ zij geheel vertrouwd is met
het type voertuig en de inrichting daarvan:
1. bekend zijn met de communicatie apparatuur, de werking en

procedures.
2. blindelings de schakelaars kunnen vinden van:

stadslicht/ dimlicht/ grootlicht
waarschuwingslichten/ zij- en achterkant werklichten
blauw zwaailicht/ knipperlicht
2/3 tonige hoorn
ruitenwisser/ -sproeier
hoofdschakelaar
achtercompartiment
airconditioning voor/ achter

alle andere schakelaars in de chauffeurscabine en achtercompartment
handrem
weten waar de autopapieren zich bevinden
3. plaats weten van het reservewiel, krik en ander hulpgereed
binnenverlichting
148
schap
4. in staat zijn een wiel te wisselen of een lamp te vervangen

en storingen adequaat te melden
5. weten waar de peilstok van de motorolie zit en waar

eventueel olie moet worden bijgevuld
6. weten wanneer en hoe koelvloeistof moet worden bijgevuld
7. weten waar de peilstok van de automatische versnellingsbak
zit, hoe gepeild en zo nodig bijgevuld moet worden
149
B:
GEBRUIK VAN HET VOERTUIG
- Werkzaamheden vr aanvang dienst.
N.B. Controle dient plaats te vinden vr aanvang dienst.
1. oliepeil + transmissiepeil controleren
2. koelvloeistof niveau controleren
3. ruitensproeiervloeistof niveau controleren
4. bandenspanning controleren
5. verlichting controleren
6. visuele controle op schades en de melding daarvan
7. uitrij mogelijkheid verzorgen
8. spiegels juist afstellen
9. juiste zit/ werking chauffeursstoel
10. sleutelbos controleren op aanwezigheid
11. mobilofoon controleren op instelling
13. autopapieren controleren

14. Serene controleren + externe luidsprekers
- Juiste houding achter het stuur.
15. goede zithouding, hoofdsteun afstellen, autogordels

16. beide handen aan het stuur
17. gebruik van rechtervoet voor rem en gaspedaal
18. blik op de weg tijdens gesprek met inzittenden
12. portofoon controleren op instelling (knop op 1)
150
C:
GEDRAG OP DE WEG:
- Starten en wegrijden.
1. gebruik hoofdschakelaar
2. op de juiste wijze starten (voorgloeien)
3. gebruik 2e en/of 3e accu
4. handrem
5. juiste wijze van gebruik buitenspiegels tijdens het
wegrijden
6. inmelden CPA.
- Rijden algemeen.
7. rechts houden
8. snelheid aanpassen aan het overige verkeer, de toestand
van de patint en de weersomstandigheden
9. afstand houden
10. regelmatig in de buitenspiegels kijken
151
11. duidelijk in de rijstrook rijden:

rechterrijstrook rechts
linkerrijstrook links
12. stuurvast rijden (geen onnodige stuurbewegingen)
- Optrekken en remmen speciaal tijdens patinten vervoer
13. Het optrekken en remmen vereist een speciale techniek

welke veel oefening vereist. LET ER SPECIAAL OP EN VER-
ZUIM NIET DE LEERLING ER OP TE WIJZEN.!!!!!!!!!!!!
- Inhalen.
14. tijdig en goed beoordelen van ander verkeer voor, achter,
links, rechts
15. keuze moment en plaats van inhalen
16. gebruik richtingaanwijzer bij rijstrook wisseling
17. vlot inhalen en vloeiend weer terug naar de rechterrij
strook
- Rijden op verkeerspleinen en verdeelpleinen (klaverblad).

18. tijdig voorsorteren
19. tijdig richting aangeven
20. op de juiste wijze weven
21. verdrijvingsstrepen en -vlakken in acht nemen
- Achteruitrijden.
22. op de juiste wijze kijken (buitenspiegels)
23. ondergeschikt aan ander verkeer
25. regelmatig en stapvoets rijden
- Anticiperen.
26. rekening houden met te verwachten verkeerssituaties
27. vooruitzien
28. reactie op waarnemingen
29. zien van verkeerstekens
30. opvolgen van verkeerstekens
-
Tijdens patienten vervoer.
24. niemand hinderen
152
31. vroegtijdig zien en zoveel mogelijk vermijden van gaten

op het wegdek. Let op olievlekken (duiden op gaten en
gladheid)
D:
RIJDEN MET BLAUW ZWAAI/ KNIPPERLICHT EN 2 of 3 TONIGE HOORN:
1. aanpassen van de snelheid aan de verkeerssituatie
2. gebruik zwaailicht en triofoon
3. stapvoets over de kruising, desnoods in onoverzichtelijke
situaties geheel tot stilstand komen
4. de plaats van het voertuig bij een ongeval
5. denk aan de veiligheid van u en uw collega op de plaats
van het ongeval
6. gebruik zo nodig een veiligheidshelm (bouwplaats)
7. gebruik van reflecterende kleding en waarschuwingslampen
bij invallende duisternis, slecht weer
NB. zie bijlage Ontheffingen voor de ambulancechauffeur
153
E:
AANKOMST POST:
1. auto "paraat" parkeren

2. afval verwijderen
3. uitmelden bij CPA.
4. eventuele storingen melden
EINDE DIENST:
5. auto opruimen in en parkeren in paraat rijvak
6. samen met verpleegkundige aanvullen van gebruikte materialen en ziekenruimte moppen, waardoor auto weer uitrukgereed is
7. portofoon (onder lading plaatsen)
8. autosleutels in sleutelkast
dienstdoende persoon en je collega.
N.B. Je mag pas weg als de diensttijd is voltooid en je

aflossing er is.
9. eventuele defecten aan het voertuig rapporteren aan de
154
BLOK-INDELING INWERKPLAN AMBULANCECHAUFFEUR

BLOK 1
a meerijden (stage)
b stadskennis/ orintatie
c voertuigkennis
d verbindingsapparatuur
e CPA
f EMS regels en richtlijnen
g huisregels
BLOK 2
a begin maken met L.L. te laten rijden (GEEN SPOED)

b orintatie/ stadskennis
c inventaris ambulance (globaal)
d tiltechnieken
e afspraak plannen met operationeel leider (OL)
f herhalen blok 1
BLOK 3
155
a uitleg apparatuur en andere attributen ziekenruimte

b medisch assisterende handelingen (verpleegkundige)
c oefenen vaardigheden medisch assisterende handelingen
d parat koffer verpleegkundige
e extra koffers (infant, partus, verband koffer)
f externe rijvaardigheidstraining .
g herhalen blok 1 en 2
BLOK 4
a start rijden met spoed (gedoseerd)

b stadskennis/ orintatie
c hoe te handelen bij brand en andere calamiteiten
d de patint, de taak van de chauffeur hierbij (chauffeur
en verpleegkundige)
e afspraak plannen met OL
f herhalen blok 2 en 3
BLOK 5
a rijden spoed/ geen spoed

b medisch assisterende handelingen (leslokaal)
c stadskennis
d herhalen blok 2, 3 en 4
BLOK 6
a zelfstandig alle voorkomende ritten kunnen doen
uitvoeren
b zelfstandig alle medisch assisterende handelingen kunnen
156
BLOK 1.
a: MEERIJDEN:
1 kijken
2 indruk van het werk opdoen
3 rondleiding ziekenhuis E.H.B.O.
ambulanceingangen regels en gewoontes
diverse instellingen.
4 rondleiding Sector VSA.
b: STADSKENNIS/ ORIENTATIE:
1 L.L. straten laten opzoeken event. uitleg

aanrijroutes ziekenhuizen/klinieken/instellingen
2 testen orintatie districten.
3 speciale benamingen zoals b.v. oproepnummers
ambulances, enz.
c: VOERTUIGKENNIS:
1 zie opleidingsaandachtspunten A en B
157
d: VERBINDINGSAPPARATUUR:
1 werking mobilofoon + externe luidsprekers

2 werking portofoon
3 etherdiscipline
4 meldingsprocedure vertrek/aankomst, enz.
e: C.P.A :
1 globale uitleg meldkamer

2 werkwijze
f: EMS.
REGELS EN RICHTLIJNEN:
1 geheimhouding/confrontatie media
2 ambulanceritformulier (summier)
3 vervoer afspraken
4 samenwerking politie
5 samenwerking brandweer, Airambulance,
begravenisonderneming.
6 begrip 1e,2e- en volgende auto
g: huisregels en organisatiestructuur EMS:

1 aanvraag vrije dagen
2 aanvraag vakantie
3 ziek- en hersteld melden
4 dagindeling (dienstplanning)
ambulanceinspectieformulier.
6 uniform
7 bereikbaarheid voor thuis
8 schademeldingen
9 bekeuringen
10 procedure onderlinge dienstruil
11 interne huisregels
12 organigram uitleggen met diverse funkties
13 direct leidinggevende (operationeel leider)
5 invullen formulieren; vakantie, overwerk,
158
BLOK 2
a: ZELF RIJDEN:
1 aanvang maken met de L.L. zelf te laten rijden
GEEN SPOED
2 zie opleidingsaandachtspunten C en E
b: STADSKENNIS EN BUITEN REGIOKENNIS ORIENTATIE:

1 kaartlezen
2 zelf op laten zoeken kortste route
nabespreken het hoe en waarom
c: INVENTARIS AMBULANCE:
1 inventaris ambulance
d: TILTECHNIEKEN:
1 van bed op brancard v.v
2 van stoel op brancard v.v
3 van de grond op brancard v.v
4 de bewusteloze patint
159
5 manoeuvreren in huis, airambulance, vliegtuig, schepen.

6 op de trap
7 omgaan met brandcard c.q. til/druk methode
e: AFSPRAAK MAKEN met OL voor blok 3a+3b+3c
f: HERHALEN BLOK 1
BLOK 3
De start van dit blok is n dag in het leslokaal c.q. garage, o.l.v.
een ambulanceverpleegkundige/ instructeur.
a: UITLEG APPARATUUR EN ANDERE ATTRIBUTEN ZIEKENRUIMTE:

1 hartapparatuur Life-Pack
2 beademingsautomaat* n.v.t. (toekomst)
3 accutor* n.v.t. (toekomst)
4 beademingsballon
5 uitzuigapparatuur
6 vacuumspalken
7 KED Kit
8 nekspalken
9 Fast Strap
10 zuurstofflessen
11 zuurstoftoedieningssystemen
12 schepbrancard
1 waaknaald helpen plaatsen

2 infuus helpen inbrengen
3 helpen intuberen
4 pat. aansluiten op hartbewakingsapparaat
5 pat. aansluiten op bloeddruk-/saturatiemeter
6 pat. zuurstof toedienen
7 creren van optimale werkruimte en hygine
Onder direkt toezicht van verpleegkundige
b: MEDISCH ASSISTERENDE HANDELINGEN:
160
c: OEFENEN VAARDIGHEDEN MEDISCH ASSISTERENDE HANDELINGEN:

1 opzuigen medicamenten,dextrose + NaCl 0,9%
2 infuussysteem klaarmaken + Haemacell
3 laryngoscoop klaarmaken
4 endo-tracheaal tube klaarmaken en fixeren
5 defibrilleren
d: PARAT KOFFER VERPLEEGKUNDIGE:

1 juist gebruik, open maken en dicht doen
2 waar zit wat
3 juiste benamingen
e: EXTRA KOFFERS:
1 waar dient verband koffer voor
2 wat zit er in oranje koffer
3 infant koffer (toekomst)
4 partus koffer
161
f: HERHALEN BLOK 1 EN 2
BLOK 4
a: RIJDEN MET SPOED:
1 zie opleidingsaandachtspunt D
2 uitleg geven rijden met spoed onder
bijzondere omstandigheden
-extreme verkeersdrukte
-slechte weersomstandigheden
-begeleidend spoed aan b.v. 2e amb. reanimatie
-slachtoffer met schedel/CWK letsel, hartinfarct
b: STADSKENNIS/ORINTATIE:
1 straten opzoeken bij ongeval

2 orintatie bij ongeval
c: HOE TE HANDELEN BIJ BRAND, CALAMITEITEN, DELICTEN EN ANDERE

SPECIFIEKE GEVALLEN:
1 aanspreekpunt (communicatie met andere

disciplines)en aanrijroute bij brand, drenkeling op het
strand, schiet/steek-partijen
2 gedragsregels bij bijzondere opdrachten
b.v. voorwaarde scheppend, overweging vervoer van
overledene op straat (openbare orde)
3 hoe zet je je auto neer
162
3 procedure 1e ambulance
d: DE PATINT (de taak van de chauffeur hierbij):
1 onder leiding van een ambulanceverpleegkundige

realiteit nabootsen. Waar ligt wat in de auto en
wanneer gebruik je dat?
e: AFSPRAAK MAKEN bij OL voor blok 5B
f: HERHALEN BLOK 2 en 3
163
BLOK 5
a: RIJDEN MET- EN ZONDER SPOED:

1 zelfstandig laten uitvoeren van alle
voorkomende ritten ( let op dat het niet
te zwaar wordt in het begin )
2 speciale aandacht voor stratenkennis en
orintatie tijdens spoedritten
3 uitleg spoedvervoer met begeleiding van
de politie (b.v. gewonde gevangene)
b: MEDISCH ASSISTERENDE HANDELINGEN: de in dit blok genoemde

handelingen/ vaardigheden zullen o.l.v. een
verpleegkundige/ instructeur gedurende een dag in
het instructielokaal geoefend worden
1 kennis nemen van de bijlagen A en B
A = werkwijze volgens PHTLS principe
B = werkwijze volgens ACLS principe
2 oefenen volgens de protocollen PHTLS en ACLS
Roger methode (helm afnemen)

Chin lift
Jaw thrust
Aanleggen Stiff neck
Aanbrengen Oregon Spine Splint
Gebruik Bak Pak
Uitvoeren Log Roll
Methode Kusters
3 oefenen PHTLS vaardigheden:
164
4 oefenen van reanimeren van Polsloze Ventrikulaire

Tachycardie, Elektro Mechanische Dissociatie en
Asystolie.
c: STADSKENNIS/BUITEN REGIOKENNIS:
1 leerling kent doorgaande routes in gehele

stad en verdwaalt niet meer
2 kan met behulp van stratenboekje snel naar
onbekende locatie
d: HERHALEN BLOK 2,3 EN 4
165
Bijlage A.
PHTLS
Primary survey (= waar kijk je in eerste instantie naar)
Airway
0205
Breathing
0209
Circulation
: is er sprake van obstruktie in de mond/keelholte of luchtpijp?

Immobilisatie cervicale wervelkolom: manueel of met Stiffneck
: is er werkelijk sprake van gaswisseling in de longen of zijn er

ademhalingsproblemen
: is de bloedsomloop van de patient in orde
0212
Disability
: neurologische score, waarbij amb.personeel niet kan behandelen. Bestaat uit
0215
1. Pupilcontrole
2. Alert
: = goed reagerend op aanspreken
Verbal
: = mompelen, kreunen op aanspreken
Pain
: = alleen reaktie op pijnprikkels
Exposure
: klaarmaken voor lichamelijk onderzoek
environment
: beschermende maatregelen (afkoeling)
0216
: schouwen plaats incident ( toedracht)
Secundary survey (=waar kijk je in tweede instantie naar)
Deze begint met het afnemen van de anamnese met behulp van:
Unresponsive : = onbeantwoord, comateus
166
: allergien
: medicijngebruik
: past illness (= doorgemaakte ziekten in het verleden)
: last meal (= wanneer is de laatste maaltijd genuttigd)
: events (= zaken die geleid hebben tot de gebeurtenis)
Top tot teen onderzoek.
Hierbij wordt de patient systematisch onderzocht in de volgorde:

hoofd en gelaat
nek en cervicale wervelkolom
borstkas
buik
bekken
schouders/ armen/ benen
rug, mits gecontrandiceerd
Met behulp van al deze informatie kan een behandelplan opgesteld worden en zal de patient vervoersklaar gemaakt
worden.
167
BLOK 6
a: ZELFSTANDIG ALLE VOORKOMENDE RITTEN KUNNEN DOEN:
1 speciale aandacht voor alle in de voorgaande

blokken aan de orde gekomen opleidingsaandachtspunten
2 laatste puntjes op de i zetten
3 overtuig u er van dat de l.l. na dit blok
zelfstandig kan functioneren
b: ZELFSTANDIG ALLE MEDISCH-ASSISTERENDE HANDELINGEN KUNNEN

UITVOEREN:
1 laatste controle van zowel de verpleeg-
2 als naar de mening van de mentor, de

leidinggevende (OL) en de bedrijfsmanager de kandidaat aan
de normen van het inwerkprogramma voldoet, volgt uitreiking
van deBasisvaardigheidsverklaring.
kundigen als uzelf, dat alle in de voorgaande blokken aan

de orde gekomen medisch assisterende taken zelfstandig
uitgevoerd kunnen worden
168
CHECKLIST INWERKPLAN
Naam medewerker:................................................
Gezien
Onderwerp
Hoofdstuk A 1 t/m
B 1 t/m 18
C 1 t/m 31
D 1 t/m
E 1 t/m
Opmerkingen hoofdstukken At/m E
Blok 1 a
1 b
1 d
1 e
1 f
1 g
Opmerkingen blok 1
169
Blok 2 a 2
2 b
2 c
2 d
2 e(datum)
gedaan
zelfstandig
accoord
Opmerkingen blok 2
Blok 3 a
3 b
3 c
3 d
3 e
3 f(datum)
Opmerkingen blok 3
Blok 4 a 2
4 b
4 c
4 d
4 e(datum)
Opmerkingen blok 4
170
Onderwerp
Gezien
gedaan
zelfstandig
Blok 5 a
5 b
5 c
Opmerkingen blok 5
Blok 6 a
6 b
Opmerkingen blok 6
Gezien, gedaan en zelfstandig: aftekenen door begeleider

Accoord: aftekenen door nieuwe medewerker.
Kopie naar hoofd van dienst.
171
akkoord
Dagverslag inwerken
NAAM MEDEWERKER:............................
BEGELEIDER:...................VERPLEEGKUNDIGE.................
DATUM:.../.../20..
DIENST......TOT.......
Ongeval
A1
A2
AMB..........
BV
A.Amb.
AANTAL:
...
...
...
...
...
...
WAARVAN ZELF:
...
...
...
...
...
...
--------------------------------------------------------------
SPECIALE AANDACHT VOOR:
OPMERKINGEN BEGELEIDER:
OPMERKINGEN VERPLEEGKUNDIGE:
KORT VERSLAG:
172
PERIODIEK EVALUATIEFORMULIER INWERKEN ( Na elke blok !)

Naam Medewerker:
Datum:
Aanwezig:
Hoe heeft de nieuwe medewerker deze periode ervaren?
Wat zijn de op-/ aanmerkingen van de OL/ begeleider over deze periode?
Zijn de leerdoelen van de afgelopen periode bereikt?
Wat zijn de aandachtspunten voor de komende periode?
173
voor accoord:
nieuwe medewerker
Operationeel Leider/ Begeleider
EVALUATIEFORMULIER EINDE INWERKPERIODE (Na de 6 e blok!)

Datum
Naam Medewerker
Aanwezige Begeleider
:
:
Aanwezige leidinggevende (OL) :
Hoe heeft de nieuwe medewerker het hele inwerktraject ervaren?
Zijn er nog aspecten niet- of onvoldoende belicht?
Zijn alle medisch-assisterende aspecten(kennis en vaardigheden)

voldoende belicht en geoefend?
Denkt de nieuwe medewerker klaar te zijn voor zelfstandig functioneren

o.l.v. een ervaren verpleegkundige?
Zijn alle chauffeurs-technische aspekten (hoofdstukken A t/m E)

voldoende voldoende belicht?
174
Denken de overige aanwezigen dat de nieuwe medewerker zelfstandig kan

functioneren o.l.v. een ervaren verpleegkundige?
Is het gewenst om het inwerktraject te verlengen en welke punten

verdienen dan bijzondere aandacht?
Evaluatie momenten zullen zijn n bovengenoemde datum omstreeks:
Voor accoord tekenen:
175
Nieuwe medewerker Begeleider
Leidinggevende (OL)
EVALUATIEFORMULIER ZELFSTANDIG FUNCTIONEREN

(4 weken na inwerkperiode)
Datum :
Naam Medewerker:
Aanwezig :
Hoe is de afgelopen periode verlopen?
Welke onderwerpen behoeven nadere uitleg?
Hoe moet vorm gegeven worden aan de nadere uitleg?
Opmerkingen mentor/pb-er:
Opmerkingen leidinggevende:
Voor accoord:
Nieuwe medewerker
Leidinggevende(OL)
Begeleider
Opmerkingen :
176
Vr eerste opkomst van (ch)te regelen.
Aktie
Stratengids
Rooster klaarleggen
Inwerkmap maken
Kopie rijbewijs vragen/ maken

Protocollenboekje
Personeelskastje + sleutel regelen
Telefoonlijst afdeling ambulance
Kopie exemplaar ontheffingen ambulancechauffeur

Pen
Functieomschrijvingen
Kopie exemplaar vakantie, overwerk, schade formulier
Telefoon nieuwe medewerker opnemen in bestand.

Vragen bekend aan iedereen?
177
Map interne huisregels voor personeel
Uniform regelen
Werkschoen regelen
Regenjas ?
Regenlaars?
Sleutels
gedaan
Datum
Mag-lite + lader en riemhouder*

Holster, verbandschaar, pupillamp
Vakantie afspraken laten noteren o p wensenlijst
aanmelden
voor Gedaan
datum
datum lesdag
Nieuwe
chauffeur
rijvaardigheidstraining
178
Uitreiken diverse artikelen op eerste werkdag van (ch.)
Aktie
179
Gedaan
Datum

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Ambulance Operations Manual

Standard Operating Procedures

AMBULANCE SERVICES, MINISTRY PUBLIC HEALTH, SOCIAL DEVELOPMENT & LABOUR,

Ambulance Operations Manual

Ambulance Operations Manual | 8/1/2010

Ambulance Operations Manual | 8/1/2010

6.5 AMBULANCE TRIP (SHEETS) FORMS (PRE-HOSPITAL CARE REPORTS) ................................. 20

Ambulance Operations Manual | 8/1/2010

2. ESF 6S TASKS & ACTIONS ........................................................................................ 64

Ambulance Operations Manual | 8/1/2010

Ambulance Operations Manual | 8/1/2010

3. THE ORGANIZATION/Chain of Command

Ambulance Operations Manual | 8/1/2010

3.0 Organizational Structure:

3.1 MISSION &VISION:

3.2 THE OBJECTIVES

3.3 Personnel Management Philosophy

3.4 Personnel orientation

Ambulance Operations Manual | 8/1/2010

4. BASIC WORK POLICIES

Ambulance Operations Manual | 8/1/2010

4.1 House Rules

Ambulance Operations Manual | 8/1/2010

4.2 Vehicle use

Ambulance Operations Manual | 8/1/2010

4.3 NON SMOKING POLICY:

4.4 Recording of working hours:

4.5 Personal Business:

Ambulance Operations Manual | 8/1/2010

4.6 Engaging in other activities:

4.8 Absenteeism & Sick Leave:

Ambulance Operations Manual | 8/1/2010

4.9 Functioning & Job Evaluation

Violations of Standard Operational Procedures:

Ambulance Operations Manual | 8/1/2010

5. AMBULANCE VEHICLE OPERATION POL ICY:

5.1 SPEED REST RICTIONS

5.2 USE OF WARNING SIGNALS

Ambulance Operations Manual | 8/1/2010

5.3 EMERGENCY AND NON -EMERGENCY RESPONSE GUIDELINES

5.4 THE TWO SECOND RULE

5.6 EXCESSIVE SPEED

Whenever an ambulance is damaged through the negligence or misconduct of an ambulance

Ambulance Operations Manual | 8/1/2010

5.8 IRRATIONAL BEHAVIOR

5.10 POLICIES WHILE ON DUTY

Ambulance Operations Manual | 8/1/2010

6.DUTIES & RESPONSIBILITIES

6.1 REPORTING FOR DUTY AND SCHEDULING

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6.2 WORK SCHEDULES

6.3 DAILY ASSIGNMENTS

Ambulance Operations Manual | 8/1/2010

6.4 AMBULANCE CHECK LIST

6.5 AMBULANCE TRIP (SHEETS) FORMS (Pre-hospital care reports)

Times Ambulance Calls and Transports

Ambulance Operations Manual | 8/1/2010

6.6 Ambulance Dispatch Procedures

It is important that the following times be accurately recorded:

Time call is received

Answer all calls on the emergency line promptly:

Try to answer within three (3) rings

Ambulance Operations Manual | 8/1/2010

TAKING AND RECEIVING MESSAGES