EMS Policy Manual - Contra Costa Health Services
EMS Policy Manual - Contra Costa Health Services EMS Policy Manual - Contra Costa Health Services
Name: Employer: Employer address: CONTRA COSTA HEALTH SERVICES-PUBLIC HEALTH NOTIFICATION OF POSSIBLE COMMUNICABLE DISEASE EXPOSURE (Complete all information below – PLEASE PRINT) PERSON POTENTIALLY EXPOSED Work Phone ( ) Home Phone ( ) □ Completed hepatitis B vaccination series: □ Partial hepatitis B series: □ No hepatitis B vaccinations SOURCE PERSON FOR POTENTIAL EXPOSURE: Name: Address: Location of Incident: Person transported to: Home phone: ( ) INCIDENT REPORT: Date of Incident: Time of Incident: Ambulance # Incident # TYPE OF EXPOSURE: □ Mouth to Mouth resuscitation – without protective device □ Needle stick injury - with a used/non sterile needle □ Blood or secretions splashed into → □ Eyes □ Mouth □ Wound □ Meningitis □ Close exposure to a person with TB → □ Known TB □ Suspected TB □ Other risk exposure → Please describe ________________________________________________________________________ ______________________________________________________________________________________________________________ Notify Public Health (925) 313-6740 during work hours M-F 8a-5p and Fax a copy of this form to (925) 313-6465. After hours and holidays leave a voice mail message at this same number. Public Heath will follow-up with the designated officer and/or employee during normal work hours. For urgent consults phone (925) 313-6740 to connect with the on-call Health Officer. Precautions/equipment used during this exposure: □ Gloves □ Gown □ Face shield □ Eye protection □ N95 mask □ Other: _____________________________________________________ How soon after the potential exposure were you able to cleanse the exposure site? ________________________________________ Other information regarding exposure: ____________________________________________________________________________ Occupational Health Provider: Address: Name of person completing this form: PRINT Phone PUBLIC HEALTH FOLLOW UP: □ No reportable communicable disease identified in source person □ Recommendations given to: □ Employee Date: □ Employer Date: Actions taken by Public Health: □ EMS-7 mailed to: _______________________________________ By: __________________________ Date:__________________ □ Other actions: ______________________________________________________________________________________________ Public Health follow up by: Name: Phone: ( ) ▲ □ Original to Public Health ▲ □ Copy to health facility receiving patient ▲ □ Copy to employee ▲ □ Copy to Infection Control Officer EMS – 6 (11/12)
Contra Costa Emergency Medical Services ABUSE/ASSAULT REPORTING POLICY #: 23 PAGE: 1 of 2 EFFECTIVE: 1/13 REVIEWED: 12/12 PURPOSE To describe reporting requirements for prehospital personnel when child or elder abuse, sexual assault, or domestic violence is observed or is reasonably suspected. II. CHILD ABUSE, ELDER/DEPENDENT ADULT ABUSE, AND DOMESTIC VIOLENCE EMS personnel faced with a situation where s/he has reason to suspect child abuse, elder/dependent adult abuse (physical/sexual/financial) or neglect, or domestic violence shall: A. Notify the appropriate law enforcement agency immediately if the scene is unsafe or it is suspected that a crime has been committed. B. Make reasonable efforts to transport the patient to a receiving hospital for evaluation, and provide the receiving hospital staff of abuse/neglect suspicions. C. Document observations and findings on the patient care report. D. Contact the appropriate reporting agency by telephoning immediately or as soon as reasonably possible to provide a verbal report. E. File a written report with the appropriate reporting agency within two (2) working days. III. REPORTING A. To Report Child Abuse: Complete a Suspected Child Abuse Report Form (SS8572) (available online at http://oag.ca.gov/sites/all/files/pdfs/childabuse/ss_8572.pdf?) Call Children & Family Services Screening Unit: Within 2 working days and submit to: (all numbers are 24-hours/day) Employment & Human Services Department 1-877-881-1116 Children & Family Services Screening Unit 400 Ellinwood Way Pleasant Hill CA 94523 B. To Report Elder Abuse: If the alleged abuse has occurred in a long-term care facility Complete a Suspected Dependent Adult/Elder Abuse Form (SOC 341) Call Ombudsman Services of Contra (available online at Costa (925) 685-2070 to make a http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/SOC341.pdf) verbal report within 2 working days and submit to: Ombudsman Services of Contra Costa 24-Hour Crisis Line: 1601 Sutter Street, Suite A 1-800-231-4024 Concord CA 94520 If the alleged abuse has occurred anywhere else Complete a Suspected Dependent Adult/Elder Abuse Form (SOC 341) (available online at Call Adult Protective Services http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/SOC341.pdf) (925) 602-4179 within 2 working days and submit to: 1-877-839-4347 Employment & Human Services Department to make a verbal report Adult Protective Services 500 Ellinwood Way, 3 rd Floor Pleasant Hill CA 94523
- Page 5 and 6: Contra Costa Emergency Medical Serv
- Page 7 and 8: Contra Costa Emergency Medical Serv
- Page 9 and 10: Contra Costa Emergency Medical Serv
- Page 11 and 12: Contra Costa Emergency Medical Serv
- Page 13 and 14: Contra Costa Emergency Medical Serv
- Page 15 and 16: Contra Costa Emergency Medical Serv
- Page 17 and 18: Contra Costa Emergency Medical Serv
- Page 19 and 20: Contra Costa Emergency Medical Serv
- Page 21 and 22: Contra Costa Emergency Medical Serv
- Page 23 and 24: Contra Costa Emergency Medical Serv
- Page 25 and 26: Contra Costa Emergency Medical Serv
- Page 27 and 28: Contra Costa Emergency Medical Serv
- Page 29 and 30: Contra Costa Emergency Medical Serv
- Page 31 and 32: Contra Costa Emergency Medical Serv
- Page 33 and 34: Contra Costa Emergency Medical Serv
- Page 35 and 36: Contra Costa Emergency Medical Serv
- Page 37 and 38: Contra Costa Emergency Medical Serv
- Page 39 and 40: INTERFACILITY EMERGENCY RESPONSE -
- Page 41 and 42: Contra Costa Emergency Medical Serv
- Page 43 and 44: Contra Costa Emergency Medical Serv
- Page 45 and 46: Contra Costa Emergency Medical Serv
- Page 47 and 48: Contra Costa Emergency Medical Serv
- Page 49 and 50: Contra Costa Emergency Medical Serv
- Page 51 and 52: Contra Costa Emergency Medical Serv
- Page 53 and 54: Contra Costa Emergency Medical Serv
- Page 55: Contra Costa Emergency Medical Serv
- Page 59 and 60: Contra Costa Emergency Medical Serv
- Page 61 and 62: Contra Costa Emergency Medical Serv
- Page 63 and 64: Contra Costa Emergency Medical Serv
- Page 65 and 66: Contra Costa Emergency Medical Serv
- Page 67 and 68: Contra Costa Emergency Medical Serv
- Page 69 and 70: Contra Costa Emergency Medical Serv
- Page 71 and 72: Contra Costa Emergency Medical Serv
- Page 73 and 74: Contra Costa Emergency Medical Serv
- Page 75 and 76: Contra Costa Emergency Medical Serv
- Page 77 and 78: Contra Costa Emergency Medical Serv
- Page 79 and 80: Contra Costa Emergency Medical Serv
- Page 81 and 82: Contra Costa Emergency Medical Serv
- Page 83 and 84: Contra Costa Emergency Medical Serv
- Page 85 and 86: Contra Costa Emergency Medical Serv
- Page 87 and 88: Contra Costa Emergency Medical Serv
- Page 89 and 90: Contra Costa Emergency Medical Serv
- Page 91 and 92: EMS Personnel Recognition of a Haza
- Page 93 and 94: Contra Costa Emergency Medical Serv
- Page 95 and 96: Contra Costa Emergency Medical Serv
<strong>Contra</strong> <strong>Costa</strong><br />
Emergency Medical <strong>Services</strong><br />
ABUSE/ASSAULT REPORTING<br />
POLICY #: 23<br />
PAGE: 1 of 2<br />
EFFECTIVE: 1/13<br />
REVIEWED: 12/12<br />
PURPOSE<br />
To describe reporting requirements for prehospital personnel when child or elder abuse, sexual<br />
assault, or domestic violence is observed or is reasonably suspected.<br />
II. CHILD ABUSE, ELDER/DEPENDENT ADULT ABUSE, AND DOMESTIC VIOLENCE<br />
<strong>EMS</strong> personnel faced with a situation where s/he has reason to suspect child abuse, elder/dependent<br />
adult abuse (physical/sexual/financial) or neglect, or domestic violence shall:<br />
A. Notify the appropriate law enforcement agency immediately if the scene is unsafe or it is<br />
suspected that a crime has been committed.<br />
B. Make reasonable efforts to transport the patient to a receiving hospital for evaluation, and<br />
provide the receiving hospital staff of abuse/neglect suspicions.<br />
C. Document observations and findings on the patient care report.<br />
D. Contact the appropriate reporting agency by telephoning immediately or as soon as reasonably<br />
possible to provide a verbal report.<br />
E. File a written report with the appropriate reporting agency within two (2) working days.<br />
III. REPORTING<br />
A. To Report Child Abuse:<br />
Complete a Suspected Child Abuse Report Form (SS8572)<br />
(available online at<br />
http://oag.ca.gov/sites/all/files/pdfs/childabuse/ss_8572.pdf?)<br />
Call Children & Family <strong>Services</strong> Screening Unit:<br />
Within 2 working days and submit to:<br />
(all numbers are 24-hours/day)<br />
Employment & Human <strong>Services</strong> Department<br />
1-877-881-1116<br />
Children & Family <strong>Services</strong> Screening Unit<br />
400 Ellinwood Way<br />
Pleasant Hill CA 94523<br />
B. To Report Elder Abuse:<br />
If the alleged abuse has occurred in a long-term care facility<br />
Complete a Suspected Dependent Adult/Elder Abuse Form (SOC 341)<br />
Call Ombudsman <strong>Services</strong> of <strong>Contra</strong><br />
(available online at<br />
<strong>Costa</strong> (925) 685-2070 to make a<br />
http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/SOC341.pdf)<br />
verbal report<br />
within 2 working days and submit to:<br />
Ombudsman <strong>Services</strong> of <strong>Contra</strong> <strong>Costa</strong><br />
24-Hour Crisis Line:<br />
1601 Sutter Street, Suite A<br />
1-800-231-4024<br />
Concord CA 94520<br />
If the alleged abuse has occurred anywhere else<br />
Complete a Suspected Dependent Adult/Elder Abuse Form (SOC 341)<br />
(available online at<br />
Call Adult Protective <strong>Services</strong> http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/SOC341.pdf)<br />
(925) 602-4179<br />
within 2 working days and submit to:<br />
1-877-839-4347<br />
Employment & Human <strong>Services</strong> Department<br />
to make a verbal report<br />
Adult Protective <strong>Services</strong><br />
500 Ellinwood Way, 3 rd Floor<br />
Pleasant Hill CA 94523