SOG-11

		Upper Leacock Fire Company SOG's

Upper Leacock Fire Company

SOG's

Section 11 Personal Injury & Exposure Control Guidelines

1. Any Fire Company Member that sustains ANY type of personal injury during ANY type of Fire Company function is REQUIRED to notify the Fire Chief or Officer In Charge immediately.

2. Fire Company Members sustaining a personal injury during a Fire Company function are REQUIRED to fill out a Major Personal Injury Report or a Minor Injury Report depending on the type of injury they may have. These reports should be filled out with in 24 hours of the injury or as soon as the injured Fire Company Member is capable of providing the necessary information to complete the report. All reports are kept in the Fire Company Office.

3. A MAJOR INJURY is one that requires medical attention at a medical facility. A MINOR INJURY is one that may require first aid but no medical attention at a medical facility required. A MINOR INJURY is one that does not require a Workman's Comp claim.

4. The Fire Chief or his designee is responsible to see that the personal injury reports are completed submitted, and kept on file for any member that has sustained a personal injury.

5. The Fire Chief or Officer in Charge may request Fire Company Members or by standers to submit a written statement if they personally witness an incident in which a Fire Company Member sustains a personal injury during a Fire Company function.

6. The Fire Chief or Officer in Charge is responsible to see that the Upper Leacock Township Workman's Comp procedure is followed at all times when a Fire Company related personal injury occurs. The workman's Comp report should be submitted to the Upper Leacock Township Office on the next business day following an injury that required treatment by an approved physician or approved medical facility.

7. The following physicians should be used by Fire Company Members in the event that their injury involves a Workman's Comp claim to ensure that the claim is paid as outlined by the Upper Leacock Township Workman's Comp policy:

Richard H. Niemeyer, MD 146 East Main St. Leola, Pa.
Ken L. Hurst, MD 146 East Main St. Leola, Pa.
Robert L. Good, MD 15 Zimmerman Road Leola, Pa.
Stephen Diamantoni, MD 218 West Main St. Leola, Pa.
Joel Samitt, MD 33 Holly Dr. Leola, Pa.

8. The following hospitals should be used in the event that a Fire Company Member sustains a MAJOR personal injury that will be a Workman's Comp claim to ensure that the claim is paid as outlined by the Upper Leacock Township Workman's Comp Policy.

Community Hospital of Lancaster
Ephrata Community Hospital
Lancaster General Hospital
Lancaster Regional Medical Center

9. Only the Fire Chief, his or her designee, or Officer in Charge is permitted to notify family of an injured Fire Company Member or release any information to the media pertaining to an injured Fire Company Member.

10. Any Fire Company Member is permitted to release the personal medical information contained in the Rehab boxes to EMS crews that are providing care for a Fire Company Member that has sustained a MAJOR injury.

11. The Fire Company Safety Officer is required to obtain and review ALL personal injury reports. The Fire Company Safety Officer is also required to provide a monthly and year end report to the Deputy Fire Chief documenting total injuries per month and year, type of Injuries, and recommendations of ways to prevent or minimize personal injuries in the future.

12. The Local Law Enforcement Agency SHALL be notified immediately anytime that a Fire Company Member sustains a MAJOR personal injury that may result in death or has already resulted in a death during a Fire Company function.

13. In the event that a Fire Company Member sustains a MAJOR injury that requires medical attention, someone shall immediately notify the Fire Chief OR Officer in Charge, so they can notify County Dispatch to have the proper EMS providers dispatched to the scene.

14. When a Fire Company Member sustains a MAJOR injury that requires medical attention, someone shall notify the highest medical trained person available at the scene to give first aid to the injured member until EMS providers arrive on location and take over patient care.

15. Fire Company Members are NOT permitted to perform any duties at a Fire Company function after they have sustained a MAJOR injury that required treatment at a medical facility UNTIL a physician has furnished the Fire Chief with a written medical release stating that the injured Fire Company Member can return to duty.

UPPER LEACOCK FIRE COMPANY

MINOR PERSONAL INJURY REPORT

Name _______________________________________________

Date_______________ Time_______________

Location_____________________________________________

Type/ Location of Injury_____________________________________________________________________________________________________

Describe how the Injury was sustained

_______________________________________________________________________________________________________________________________________________________________

Officer in Charge_______________________________________

In the event that you seek medical attention at a later date for your injury you will be required to fill out a MAJOR injury report and Workman's Comp paperwork. All paperwork should be submitted to the Fire Chief as soon as possible.

UPPER LEACOCOK FIRE COMPANY

Personal Injury/ Illness Investigation Report

Emergency Service Organization _____________________________________________________ Date________

Address______________________________________________________________________________________

Name of Injured_________________________________________________________ Date of Birth____________

Address of Injured______________________________________________________________________________

Phone( )_________________Age________ Sex_________ Height______________ Weight________________

Occupation____________________________________________ Job Title________________________________

Social Security Number_________________________________________________ years with dept.____________

Date of Injury________________________________________ Time of Injury______________________________

Accident Reported To___________________________________________________________________________

Nature of Injury

Fractures	Multiple Injury	Heat Exhaustion, Fatigue
Inflammation	Recurrence	Abrasions, Contusions, Bruises
Infectious Disease	Strain, Sprain, Torn Ligament	Heart Malfunction
Frostbite, Cold Exposure	Cuts, Lacerations, Punctures	Eye Injury
Pinched Nerve, Ruptured Disk	Inhalation, Fumes	Burns
Electric Shock	Inhalation, Fumes	Other___________________
Chemical Injury

Parts of Body Affected

Multiple Parts	Abdomen	Knee(s)
Head	Back	Ankle(s)
Eye(s)	Heart	Foot/Feet
Ear(s)	Groin	Ribs
Neck	Arm	Hip
Shoulder	Hand	Other_____________________
Chest	Finger
Lungs	Leg(s)

Where Injury Occurred

Station Maintenance	Fundraising	Standing By Station for Call
Apparatus Maintenance	Convention	Training
Emergency Scene	Emergency Vehicle to Emergency	Auxiliary Services
Private Auto to Emergency	Emergency Vehicle Non-Emergency	Responding/ Returning to Emeg. (Non Vehicle
Private Auto Non-Emergency	Parades, Picnics, Contests	Other_____________________

Cause of Injury

Fall	Improper Lifting	Inadequate Illumination
Weather	Horseplay	Inadequate Ventilation
Making Safety Devices Inoperative	Structural Collapse	Lack of Knowledge or Skill
Using Defective Equipment	Inadequate Guards or Protection	Irrational Civilian
Using Equipment Improperly	Back Draft	Communication
Failure to Use Personal Protection Equipment	Improper Placement	Abuse or Misuse
Struck by Object	Civil Disturbance	Other_____________________

Injury Occurred - Performing What Task

Forcible Entry	Overhauling	Rescue Operation
Using Ladders	Salvage	Administering Medical Aid
Advancing/Directing Hose Line	Servicing Replacing Equipment	Physical Fitness
Ventilating	Extrication	Other_____________________

Wittness(es) to Injury: _____________________________________________________________________________

Injured Person's Signature __________________________________________________ Date __________________

INVESTIGATION REPORT

Thoroughly describe accident: (What, How, Where, Equipment, Activity, etc. ____________________________________

Hospitalized or Treated, Where? (Include Address) _______________________________________________________

_________________________________________________________________________________________________

Name and Address of Physician: (Include Referral) ________________________________________________________

_________________________________________________________________________________________________

Did the injury individual to perform limited duties, or to be assigned to other duties or positions? YES or NO if yes, what duties or position? __________________________________________________________________________________

And, what period of time? ____________________________________________________________________________

Investigated by __________________________________________ Title_________________________ Date_________

SAFETY OFFICER'S REPORT:

What Acts, Failures to Act And/Or Conditions Contributed Most Directly to This Accident? (Immediate Cause)

What are the Basic or Fundamental Reasons for the Existence of These Acts And/Or Conditions? (Fundamental Cause) ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What Action Has or Will Be Taken to Prevent Recurrence? Place "X" By Items Completed

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________

Reviewed by Safety Officer_______________________________ Title________________ Date____________________

EXPOSURE CONTROL GUIDELINE

1.	The purpose of this guideline is to promote safe work practices, to minimize the incidence of illness and injury, and to reduce occupational exposure to Hepatitis B Virus, HIV, Poisons, hazardous materials, and other blood borne pathogens, etc. that you as emergency responders may encounter.
2.	Risk of exposure to any of the hazards mentioned above should never be underestimated. Incident Commanders and Chief Officers will make every effort to minimize the crewmembers exposure to these hazards.
3.	In Order for all Members to minimize their risk to exposures they need to play their role in prevention by doing the following: Plan and conduct all operations in accordance with Fire Company Policy and Standard Operating Guidelines Develop good personal hygiene habits. (Proper hand washing is your first line of defense against transmission). Know what your limitations are and what equipment you have available. Use all of your prevention equipment available to you when a risk of exposure is present.
4.	Exposure Risks come in many forms and you, as a crewmember, must be able to recognize these risks along with the Incident Commander. You must know your own limitations and your equipment limitations before you compromise yourself to an exposure risk.
5.	When dealing with blood and other bodily fluids you should treat them all as potentially infectious (Universal precautions).
6.	PREVENTION EQUIPMENT ISSUED Turnout gear (pants, coat, gloves, boots, helmet with shield) Latex gloves SCBA Hepatitis B vaccination
7.	It is YOUR RESPONSIBILITY to obtain and use all prevention equipment made available to you. In the event that you are placed in a situation that additional prevention equipment is needed to complete a task, it is recommended that you acquire the needed equipment or notify the Incident Commander immediately of the situation.
8.	It is highly recommended that you wash your hands with soap and water or use an antiseptic wipe prior to eating or drinking anything if you were in any operation that presented an exposure risk to you.
9.	Food, drinks, cosmetics, etc. should never be stored or placed in an area that poses a possible risk of infectious or hazardous materials being in that immediate area.
10.	When assisting EMS crews, always remember to avoid contact with contaminated needles and sharps. Never recap or bend needles for any reason.
11.	When assisting EMS with treatment of a patient that has sustained injury in which blood or bodily fluids are exposed the following prevention measures should be taken; Always wear Latex or rubber gloves Possibly wear your air pack in the event that the patient has a known contagious disease or illness Goggles or eye protection should be worn anytime that the victim's blood may splash or splatter, etc. Acquire needed equipment such as disposable gowns, goggles, etc. from EMS in the event you are needed to assist and do not have the appropriate prevention equipment needed. Notify EMS and the Incident Commander that you do not have the appropriate prevention equipment needed BEFORE you enter an environment that poses exposure risks.
12.	ALL equipment SHALL be decontaminated as soon as possible, if feasible to do so after any equipment has been exposed to blood or other infectious diseases. Latex gloves or rubber gloves should never be decontaminated and used again.
13.	In the event that your turnout gear or clothing has been contaminated, you shall remove it as soon as possible and store it in a red Biohazard or garbage bags UNLESS instructed otherwise. Turnout gear should be decontaminated according to manufacture recommendations.
14.	Any members of the Upper Leacock Fire Company are permitted to obtain a Hepatitis B vaccination from the Leola Family Health Center FREE of charge from Upper Leacock Township. This vaccination involves three inoculations over a six-month period. It is the responsibility of each member to complete this series of inoculations on his/her own. A consent form MUST BE signed by the member requesting the Hepatitis B vaccination and returned to the Deputy Fire Chief prior to receiving the first inoculation. These consent forms are located in the office or can be obtained from the Safety Officer.
15.	ALL Members are required to complete the Upper Leacock Fire Company Infectious Exposure Form and/or the Incident Exposure Record anytime that your health and safety has been compromised by exposure to blood borne pathogens, hazardous materials, poisons, and other infectious materials. Those forms are located in the office or can also be obtained from the Safety Officer. In the event that you have sustained injury due to your exposure, you will also be required to fill out a personal injury report and workman's comp report in case you are transported to a medical facility for evaluation or treatment.
16.	All of the above mentioned reports should be filled out immediately within a 24-hour period of the exposure or injury. All reports should be submitted to the Deputy Chief to be investigated along with the Safety Officer.

UPPER LEACOCK FIRE COMPANY

INCIDENT EXPOSURE RECORD

NAME ___________________________________________________________

DATE OF BIRTH _______________ SOCIAL SECURITY # ________________

INCIDENT # __________________________ INCIDENT DATE _____________

OFFICER IN CHARGE _____________________________________________

LOCATION OF INCIDENT ___________________________________________

DESCRIPTION OF INCIDENT ______________________________________ ________________________________________________________________

TYPE OF EXPOSURE: INHALATION __________________________________

DIRECT CONTENT _____________________________

INGESTION ___________________________________

MATERIALS EXPOSED TO _________________________________________ ________________________________________________________________

TYPE OF DECONTAMINATION ______________________________________

LENGTH OF EXPOSURE (TIME) _____________________________________

SMPTOMS (IF ANY) _______________________________________________ ________________________________________________________________

TREATMENT AT SCENE ___________________________________________ ________________________________________________________________

TREATMENT BY MEDICAL FACILITY _________________________________ ________________________________________________________________

PROTECTIVE CLOTHING USED DURING INCIDENT (LIST) _______________ ________________________________________________________________

ADDITIONAL INFORMATION ________________________________________ ________________________________________________________________

FIREFIGHTERS SIGNATURE ____________________________ DATE______

CHIEF'S SIGNATURE ___________________________________DATE______

SAFETY OFFICER ANALYSIS

WHAT ACTS, FAILURES TO ACT AND.OR CONDITIONS CONTRIBUTED MOST DIRECTLY TO THIS ACCIDENT? (IMMEDIATE CAUSE)

________________________________________________________________________________________________________________________________

WHAT ARE THE BASIC OR FUNDAMENTAL REASONS FOR THE EXISTENCE OF THESE ACTS AND/OR CONDITIONS? (FUNDAMENTAL CAUSE)

WHAT ACTION HAS OR WILL BE TAKEN TO PREVENT RECURRENCE? PLACE "X" BY ITEMS COMPLETED

SAFETY OFFICER COMMENTS

SAFETY OFFICER'S SIGNATURE ___________________ DATE ___________

UPPER LEACOCK FIRE COMPANY

INFECTIOUS EXPOSURE FORM

Exposed Member's Name _______________________ Position _____________

Soc. Sec. # ________________________ Home Phone ___________________

Field Inc # _______________ Shift ______________ Company _____________

Name of Patient __________________________________ Sex _____________

Age ___________ Address __________________________________________

Suspected or Confirmed Disease _____________________________________

Transported to ____________________________________________________

Transported by ____________________________________________________

Date of Exposure ____________________________ Time of Exposure _______

Type of Incident (auto accident, trauma) ________________________________

Type of protective equipment utilized __________________________________

What were you exposed to

Blood ____ Tears____ Feces ____ Urine ____ Saliva ____

Vomitus ____ Sputum ____ Sweat ____ Other ____

What part(s) of your body became exposed? Be specific ___________________ ________________________________________________________________________________________________________________________________

Did you have any open cuts, sores, or rashes that became exposed? Be specific ________________________________________________________________________________________________________________________________

How did exposure occur? Be specific __________________________________ ________________________________________________________________

Did you seek medical attention _______Yes ________No

Where___________________________________________________________

Contact infection Control Supervisor Date ________________ Time __________

Supervisor's Signature _______________________________ Date __________

Member's Signature _________________________________ Date __________

Infection Control Supervisor's Report

Medical facility notified? _______Yes ________No

If Yes:

Name of Facility _____________________________________ Date _________

Address of Facility _________________________________________________

Name of Facility Contact ____________________________________________

Confirmed Exposure________________________________________________

Member Notified _______Yes ________No

Member's Signature __________________________________ Date _________

Medical Follow Up Action ____________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Remarks ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Infection Control Supervisor's Signature ______________________Date _____

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Page last edited: 03/12/06