Procedure: 1. The Crew Lead (Crew Member II or Crew Chief) will have ultimate responsibility for the Pre- Departure Checklist / Procedure.
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1 Page 1 of 8 Purpose: To define the required Pre-Departure Procedure that will involve each team member, utilize crew coordination, delegate roles and assign specific responsibilities to ensure the prevention of avoidable logistical and operational errors that affect our team s ability to deliver safe and efficient service to our customers. Examples of these preventable errors include leaving at the base, scene or a facility the REACH equipment bags, REACH medical equipment, patient documentation and/or patient belongings. This policy and procedure will help ensure the safety of our patients and decrease the chance of creating a negative impact on our company s ability to provide service delivery. Procedure: 1. The Crew Lead (Crew Member II or Crew Chief) will have ultimate responsibility for the Pre- Departure Checklist / Procedure. 2. All team members will participate in the procedure. 3. The crew will utilize a standardized checklist to provide a visual reference and a systematic process to aid in the completion of the Pre-Departure Procedure. 4. The team will utilize a challenge and response technique for each step of the procedure. 5. There will be a physical confirmation of each item is complete and/or present. This will create a very brief pause at each step of the procedure to prevent team members from only repeating a phrase instead of completing the actual physical confirmation. 6. This procedure and checklist will be utilized during all of the critical phases on every transport. These critical phases are listed below: A. Prior to take off from base, airport, hospital, scene or IFT location. B. Prior to leaving the hospital unit/room with a patient. C. Prior to leaving the aircraft when getting into a ground ambulance with or without the patient. 7. This procedure and checklist is not to interfere with the Pilot s pre-flight procedure and checklist. Pilot preflight checks take priority.
2 Page 2 of 8 Responsibilities: Primary Responsibilities: 1. Crew Lead (Crew Member II or Crew Chief) A. Ultimate responsibility for proper completion of the Pre-Departure and Checklist for each leg of the mission. B. Having the checklist available on each leg of the mission. C. Initiating the procedure on each leg. D. Utilize challenge and response for each step of the procedure. E. Physically confirm/perform each step of the procedure. F. Successful completion of the procedure/checklist on each leg of the mission. 2. Patient Person A. Participation in the Pre-Departure Procedure. B. Utilize challenge and response for each step of the procedure. C. Physically confirm/perform each step of the procedure. 3. Pilot A. Ultimate responsibility is the operation of the aircraft. B. Participation in the Pre-Departure Procedure. C. Utilize challenge and response for each step of the procedure. D. Physically confirm/perform each step of the procedure. Examples of procedure: In the aircraft departing the base for a scene call request in an A109 aircraft: 1. Crew Lead utilizes laminated version of Pre-Departure Procedure Checklist. 2. Crew Lead initiates procedure. 3. Example application of the procedure and checklist: Confirm chocks are in the cabin and secured. Confirms by touching chocks. Then states; We have chocks pulled and secured in the cabin. Pilot copies chocks are secured in cabin. Confirms door is closed, secured and locked. Then states; Door is secured on left. Confirms door is closed, secured and locked. Then states; Door is secured on right Confirms door is closed, secured and locked. Then states; Cabin doors are secured in the cockpit
3 Page 3 of 8 Physically confirms personal seatbelt, partner s seatbelt and any rider s seatbelt are secured. Then states; Belts secured on left. Physically confirms personal seatbelt, partner s seatbelt and any rider s seatbelt are secured. Then states; Belts secured on right. Physically confirms personal seatbelt. Then states; Belts secured in cockpit. Physically confirms blue CCT bag and Stat Pack are present in the cabin and secured with belts. Then states; Confirm we have 2 bags and the 2 bags are secure? Physically confirms blue CCT bag and Stat Pack are present in the cabin. Physically confirms the two bags are secured. Then states; 2 bags are in the cabin and all are secured with belts. Copy 2 bags are in the cabin and all are secured with belts. Confirm we have narcotics. Physically confirms narcotics are in flightsuit pocket. Then states; I have narcotics secured in my flightsuit. Pilot copies narcotics are present and secured. Confirm checklist is complete, items present and team is ready for departure. I am ready on the left for departure. Physically reviews checklist. Then states; Checklist is complete, we have no items missing and I am ready on the right for departure. Physically reviews checklist. Then states; Checklist is complete, we have no items missing and I am ready in the cockpit for departure. Pilot states departure plan.
4 Page 4 of 8 Departing an emergency room on an inter-facility transport: 1. Crew Lead utilizes laminated version of Pre-Departure Procedure Checklist. 2. Crew Lead initiates procedure by following checklist sequence. 3. Example application and communication for the procedure and checklist: Adjust based on patient type and required equipment. Adjust based on Pilot with team or standing by at AC. Physically confirms blue CCT bag and Stat Pack are present in the cabin and secured with belts. Then states; Confirm we have 2 bags and the 2 bags are secure. Physically confirms blue CCT bag and Stat Pack are present in the cabin. Physically confirms 2 bags are secured. Then states; 2 bags are with us. Copy the 2 bags are accounted for. Confirm we have the monitor, pump, vent and portable oxygen. Physically confirms the monitor, pump, vent and portable oxygen are present on the crew or on the gurney. Then states; We have all four with us. Physically confirms the monitor, pump, vent and portable oxygen are present on the crew or on the gurney. Then states; We have all present and ready to go with us. Physically confirms the paperwork is with the patient and complete. Then states; Confirm a complete transfer paperwork packet is ready to go and with us. Physically confirms the paperwork is with the patient and complete. Then states; We have a complete transfer paperwork packet and it is ready to go with us.
5 Page 5 of 8 Physically confirms the paperwork is with the patient and complete. Then states; The transfer paperwork packet is complete and ready to go with us. Confirm we have no patient belongings going with the patient. Physically confirms no patient belongings are coming. Then states; Correct, no patient belongings coming on the transport. Physically confirms no patient belongings are coming. Then states; Copy, there are no patient belongings coming on board the aircraft. Confirm the Services Signature Form has been completed and signed by the patient. Presents the signed copy of the form. Then states; The patient has signed the form and I have it separate from the transfer paperwork. Physically confirms the signed form. Then states; The Services Signature Form is signed and with us. Confirm we have narcotics. Physically confirms narcotics are in flightsuit pocket. Then states; I have narcotics secured in my flightsuit. Pilot copies narcotics are present and secured. Confirm the checklist is complete and we are not missing any items. Physically reviews the checklist. Then states; The checklist is complete and there are no missing items. I am ready to go. Physically reviews the checklist. Then states; The checklist is complete and there are no missing items. I am ready to go. Copy. We are ready to depart.
6 Page 6 of 8 Checklists: These checklists will be kept in the aircraft and with the flight crew for quick reference. The forms should also be memorized. Regardless of method utilized, these checklists must be verbalized and physically confirmed with your partner and pilot prior to departure. The responsibility of proper completion of the pre-take off checklist and procedure will be with the Crew Lead (Crew Member II or Crew Chief). Related Policies: Authorized Signature: Signature on File Original Date: 3/10 Reviewed: 01/13
7 Page 7 of 8 Flight Crew Pre-Departure Checklist Prior to take-off from base / scene checklist: Chocks or Skids Doors Belts Bags (include current REACH standardized bag count: ) Narcotics Prior to taking off from hospital: Chocks or Skids Doors Belts Bags (include current REACH standardized bag count: ) Narcotics Paperwork (X-rays, DVD/CD, Films) Clipboard (if used) Services Signature Form (Consent and Cobra forms) Patient belongings Prior to departing the patients room or utilizing an ambulance: Bags (include current REACH standardized bag count: ) Equipment (Monitor/Defibrillator, Pump, Vent, Portable Oxygen) Paperwork (X-rays, DVD/CD, Films) Patient belongings Services Signature Form signed Narcotics
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