FOREST SERVICE MANUAL NORTHERN REGION (R1) MISSOULA, MONTANA FSM 6700 SAFETY AND HEALTH PROGRAM CHAPTER 6720 OCCUPATIONAL HEALTH PROGRAM Supplement No.: R1 6700-2016-1 Effective Date: 9/26/2016 Duration: This supplement is effective until superseded or removed. Approved: Jane D. Darnell, Deputy Regional Forester Date Approved: 9/31/2016 Posting Instructions: Manual supplements are numbered consecutively by Manual number and calendar year. Post by document; remove the entire document and replace it with this supplement. Retain this transmittal as the first page(s) of this document. Last Change: 6710 (6700-2012-1) New Document: 6720 Superseded Document(s): 6720-2005-1 (8/15/2005) 3, Pages Digest: 6724 Changes to new format. Updates direction for the Region 1 Health and Wellness Program. 6725 - Clarifies language for employees that serve as Emergency Medical Providers while performing their Forest Service duties, either on Forest project work or incident support. Incorporates and clarifies direction for emergency medical protocols, training and rules regarding requirements for employees to be licensed or certified in the Northern Region (R-1). Trained employee(s) may render emergency medical care to another employee or the public, when they come upon a member of the public in need and provide medical care until the
responsible agency (state, county, municipal fire department, and or law enforcement) arrives on scene. The responsible agency should assume patient treatment care and transportation. The term Emergency Medical Provider is used to define the full spectrum of national and state recognized certifications beyond the Basic First Aid/CPR level. While generally similar, there are differences in the titles and skills allowed to be practiced depending on the state or national curriculum in question. Recognized certifications that fall under the term Emergency Medical Provider include but are not limited to National Ski Patrol Outdoor Emergency Care Provider, First Responder/Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), Intermediate EMT, Advanced EMT, and Paramedic. For wilderness training programs such as Wilderness First Responder (WFR), Wilderness EMT (WEMT), and other Wilderness Advanced Life Support (WALS) programs, contact the Regional EMS coordinator for accredited programs. The key component to all of these levels of Emergency Medical Provider (EMP) is that the employee is designated as an EMP in the Unit s Emergency Medical Response Plan and that the employee is current with regards to a state certification (or licensure) at the listed level of qualification. All qualified Emergency Medical Providers will meet these two standards. 6724 AUTHORIZED EMPLOYEE HEALTH SERVICES The purpose of the Regional Wellness Program is to create an environment that encourages employees to be positive, energetic, and mutually supportive of healthy lifestyles and work habits. The Wellness Program shall consist of both physical and mental health activities that will promote active lifestyles, enhance an individual's ability to lead a satisfying and productive life, and reduce Forest Service costs through increased productivity and reduce illnesses and injuries. The Wellness Program shall be continuous and ongoing process and consists of four major components. 1. Health Wellness Assessment Screening Prevention. Units may sponsor and/or pay for activities such as cholesterol screening, blood pressure monitoring, blood testing, health risk appraisals, glaucoma checks, body composition: BMI, Skinfold testing for % body fat, cardiovascular fitness level, health risk appraisals, or other health assessments for all employees who wish to participate. Employee test results from medical examinations or blood tests shall not be kept in unit files. Employees may not be reimbursed for these services if obtained from their own physician or other private entities. 2. Educational Programs. Units may include informational sessions or presentations by guest speakers on such subjects as nutrition, weight management, cancer risks and prevention, blood pressure reduction, cardiac risks, stroke, smoking cessation, mental health and stress reduction. Lifestyles, alcoholism, drug addiction, work life balance and so forth. 3. Encouragement of Active Lifestyles. Employees are to be encouraged to participate in physical fitness activities that promote mental and physical health and well-being. Examples of such activities include personal or group exercise programs, physical conditioning training, sports competition functions, and the use of incentives for employees who reach their fitness goals. Activities may be conducted during lunch or after work hours, at other times through use of variable work schedules; or, if included as part of a formal unit Wellness Plan, up to 1-1/2 hours per employee per week of official time may be granted for approved activities. Persons filling P a g e 2
positions, such as those designated as primary firefighters under the provisions of 5 USC 8336(c), that have a unique work requirement for maintaining a high level of physical fitness (as set forth in the applicable position description, X-118 qualifications standards or Forest Service policy) may also be granted official time for approved physical fitness activities in lieu of a formal unit Wellness Plan. If delegated by the local line officer, first line supervisors may approve use of official time for those employees with unique fitness requirements as described above. Participation in any approved unit Wellness Program by employees shall be strictly on a voluntary basis. Participation should be made available to employee spouses to the extent there is not additional expense to the government. Forest and Grassland Supervisors are delegated authority to approve Wellness Plans that are consistent with National direction and Regional policy for their respective units. Forest and Grassland Supervisors may re-delegate such authority to District Rangers. As provided in the Master Agreement with NFFE, the specific provisions of unit Wellness Plans and their implementation on individual units are a proper subject for labor-management negotiations. Unit managers should evaluate the effectiveness of their programs at least annually. 6725 - EMERGENCY MEDICAL SERVICES Unit Managers shall ensure that Administratively Determined (AD) personnel has attained current EMTB licensure prior to employment or sponsorship. Objectives: 1. To provide support to our employees in the event of accidents and injuries by establishing and maintaining Emergency Medical Response preparedness and capability for all units in the Northern Region. 2. To provide clear direction for the training and certification standard of Emergency Medical Providers and a contract Medical Standards program within the Northern Region. 3. To document for Forest Service EMP s that they are acting within the scope of their employment when they are providing emergency medical care consistent with this direction. Policy - Basic First Aid/Cardiopulmonary Resuscitation (CPR) training requirement for field going crews and office groups are defined in FSH 6709.11 Health and Safety Code Handbook. Emergency Medical Response (EMR) - Every unit in the Northern Region shall plan and prepare to respond to a wide range of medical emergencies. To accomplish this, all units shall take the following actions: P a g e 3
1. Prepare a Unit Emergency Medical Response Plan that defines protocols and resources necessary to provide for emergency medical response to reasonably foreseeable medical emergencies. All of the unit s emergency medical providers should be listed either by name or by position and training within this plan. This Plan shall be updated annually. 2. Units shall comply with state and federal laws for minimal first aid medical kits. Any additional or advanced medical supplies/medication(s) will have Medical Direction concurrence. 3. Each unit shall test or practice emergency medical events, exercising a sufficient portion of the Emergency Medical Response Plan to assess communications, notifications, and other essential elements of the Plan. Afterword, the unit shall evaluate the drill through an after action review and make adjustments to the Emergency Medical Response Plan as necessary. 4. Typically the county, city, or state is responsible for emergency medical response, even on National Forest System lands. In instances where a trained employee must render emergency medical care to another employee or the public, the responsible agency (state, county, or municipal fire department) should be notified. Upon arrival at scene, the responsible agency should assume patient treatment and care as a higher level of care. 5. Units shall not fund additional forest and grasslands EMP s beyond what is identified in the forest s Emergency Response Plan without first providing justification to the Forest and Grasslands Supervisor. Responsibility: Regional Forester The Regional shall ensure that units establish and maintain Emergency Medical Response programs under appropriate medical direction Forest Supervisors The Forest Supervisor is responsible to provide resources to establish an Emergency Medical Response program and ensure the Forest Emergency Medical Response Plan is in compliance with Forest Service policy. Forest Supervisors must approve the Forest Emergency Medical Response Plan and appropriate agreements with cooperating agencies to support emergency medical needs for their Forest. The Emergency Medical Response Plan shall include an assessment of the actual needs of the forest as to the number of medically trained employees that need to be supported on the forest. It should also include a succession plan so that these numbers are maintained as licensed or certified EMPs enter or leave the workforce. The Forest Emergency Medical Response Plan will provide for all agency employees and volunteers and agency cooperators when working in the field and remote locations. The Forest Supervisor shall be responsible for determining if additional licensed or certified EMPs need to be added to the units Emergency Response Plan as conditions change or upon a request from the districts. Annual review and approval of Forest Emergency Response Plans shall be performed at the Forest level. Each unit shall establish a reliable point of contact who will know and have documentation of training and capability to implement this emergency medical response. 1. Regional EMS/IMS Program Manager- Shall annually ensure the units are reviewed and make recommendations for compliancy regarding Forest Emergency Response Plans. P a g e 4
2. District Rangers District Rangers shall ensure employees required to meet the Forest s minimum capability, as identified in the forest s Emergency Medical Response Plan, are trained and equipped as needed. Guidelines: District Rangers will ensure all documentation (training records, certifications, and so forth) for their Emergency Medical Providers is properly recorded. District Rangers will ensure that EMPs under their supervision receive time and funding for certification training, their skills and education are maintained, and necessary equipment for patient care is properly maintained and readily available. 1. Liability a. Those Emergency Medical Providers that are listed in the Unit s Emergency Medical Response Plan and are current in their licensure or certification are acting within the scope of their employment when they provide emergency medical care regardless of the jurisdiction of the medical emergency. These duties are generally collateral duties to an employee s primary position. b. Employees providing Emergency Medical Provider services in connection with Forest Service or cooperating agency operations and working under their state medical direction within the region may perform these duties at locations outside of their certifying state with approved state reciprocity (FSM 6725). c. Forest Service employees certified or licensed to provide emergency medical care must be certified/licensed in their home state. On out of state assignments, individuals are to operate at the basic life support level in providing care to fellow workers, unless state reciprocity has been obtained. 2. Training a. A unit will follow the rules of the individual states in which the Forest Service operates. Examples include use of the various titles and the scope of practice, including initial and refresher training, for each level of Emergency Medical Provider, such as Emergency Medical Responder, Emergency Medical Technician Basic, etc. b. Unit Emergency Medical Response Plans will identify what level of care and training is desired for each unit. c. The cost of training Forest Service personnel as Emergency Medical Providers as identified by the Agency Administrator may be borne by the unit. This may include the cost of State or National Registry of Emergency Medical Technicians certification and recertification. This does not include Administratively Determined (AD) personnel. d. Units may deem it necessary to have employees with skills/certification above the Basic Emergency Medical Technician level. Should this be necessary the Forest Supervisor will approve this need and ensure that it is documented in the forest s Emergency Medical Response Plan. The unit may cover the cost of certification for these identified individuals. More advanced training will vary from forest to forest depending upon complexity, risk of missions, remoteness of environments and resource capabilities. 3. Project Specific Emergency Medical Response Planning and Emergency Medical Provider Staffing Levels - Each project that requires an approved Job Hazard Analysis or P a g e 5
Risk Assessment (JHA/RA) shall include in the mitigations the minimum training level, if any, of Emergency Medical Providers and the Emergency Medical Response protocols. 4. Agency Licensure a. Individual units are not required to obtain a state EMS license in order to provide emergency medical services in conjunction with Forest Service authorized activities. The Northern Region will provide a licensed Medical Provider (M.D.) in each state in the Region to provide training, support and oversight for all agency Emergency Care Providers. This Medical Provider will provide oversight and guidance of all Basic and Advanced Life Support skills in support of the Program of Work, including Incident Management. This may be at the EMTB, EMTA, or Paramedic level. b. Regional Medical Provider/ Director will also provide oversight to the Incident Management Specialist Program in the Region. P a g e 6
6725 - Exhibit 01 Project Specific Emergency Medical Response Planning and Emergency Medical Provider Staffing Levels EXAMPLE(S): EMT NEEDS ANALYSIS 1. A trail restoration project is being planned that involves a large number of employees and volunteers clearing a section of trail from 10 to 30 miles from the trailhead. The JHA/RA for this project must provide for mitigating the risks associated with a difficult, and long, emergency medical rescue and the large number of people involved. This would include the crew composition and desired Emergency Medical Providers on the crew (as an example). In addition, the JHA/RA should display the recommended procedures to activate an emergency medical rescue for a time critical medical emergency. 2. Another example is a watershed project next to an accessible road with 3 personnel may only require a First Aid/CPR provider. Where a trail restoration crew may need more medically trained personnel or higher level medical provider (Advanced EMT/ EMTA). P a g e 7