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Lisbon Fire Department Standard Operating Guidelines and Policies

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To define guidelines for response to, operations during, and documentation of inter-facility EMS transports and ensure that the Lisbon Fire Department provides timely, quality service while maintaining availability for emergency responses.
Company Assignment
Requests for inter-facility transports will be made through the Dispatch office. The requesting facility shall use the proper code information to activate the Lisbon Fire Department through Waukesha County Communications. An Ambulance company will be assigned to the call using the following guidelines:

  • The on-call group will be responsible to activate the proper EMS crew per the requested level of response and answer the call in the expected time frames.

  • If Lisbon is unable to comply with the request as a result of all ambulances being in service, a call to the requesting facility shall be made from the on-duty officer to either officially deny the transport or to negotiate a alternate time.

  • The on-call officer will arrange for a callback of ALS personnel if needed to cover the Town for additional calls.

A company assigned to a transport shall react / respond in the same parameters as emergency alarm priorities with the following exceptions:

  • In circumstances when a specific transport time is requested that is later in the day.

  • If the company receives an emergency call while enroute on an alpha transport, they are to take the emergency call. On-call officer will be responsible for ensuring another ambulance is assigned to the non-emergency call.

  • All radio communications with dispatch will used in the same manner as a 9-1-1 call, enroute, arrival 1st facility, enroute, arrival 2nd facility, clearing, availability, in quarters.

Transport Procedures
Upon arrival at the facility check in at the nurse’s station. The nurses, facility staff, and patients are to be treated with the utmost respect at all times. Obtain the following information:

  1. Specific patient destination information.

  1. Determine if there are any specific patient care or patient needs required for or during transport. Ensure that there are no treatments that are going to continue during transport that are beyond your scope of practice.

  2. Fill out the top portion of the Physicians Certification Statement (PCS) and obtain a signature on it.

    • A PCS shall be filled out on all transports. Fill out the top portion only, “Medical Necessity Information” must be filled out by the facility staff.

    • Obtain a physician’s signature on the PCS. If the physician is unavailable to sign the form, a facility staff nurse can sign it.

    • Make sure the entire form is completely filled out.

    • The PCS is to be sent to Administration with the incident report, do not leave the PCS at the hospital.

  1. Obtain any patient belongings that need to be transported with the patient. Document what was transported and who the items were left on arrival at the receiving facility.

  2. Obtain any discharge orders or patient records required for the receiving facility.

  3. Obtain any nurse’s notes to assist in writing the incident report. Whenever possible, obtain or make a copy of the face sheet and include it with the report.

Patient Transport
The procedure for transporting patients during transports shall be the same as transporting

a patient for a 9-1-1 call. Except for the driver, Lisbon Fire Department personnel shall be in the patient module with the patient. Baseline vital signs must be obtained on all patients. Monitor the patient throughout the transport, if complications or an emergency situation arises treat the patient in accordance with Lisbon Fire Department and Waukesha County EMS protocols.

Delivering the Patient to the Receiving Facility
On arrival at the receiving facility proceed to and enter at designated entrance if a specific entrance was

Identified, or to the normal ambulance entrance if no specific entry point was designated. Check in at the

nurse’s station. The nurses, facility staff, and patients are to be treated with the utmost respect at all times.
Give the facility staff the patient’s name and any appropriate documents, and determine where the patient

needs to go. Deliver the patient to the appropriate room / area, be sure any of the patient’s belongings that

were brought with the patient are left with them, and the facility staff is aware of this. Complete the

required Lisbon Fire Department incident reports and leave a copy with the facility staff.

Returning to Service
The apparatus should be returned to service in the same manner as a 9-1-1 incident (Sanitized, linens

changed, etc).

File a written EMS incident report and enter a report in the Lisbon Fire Department call log system.
The written report is filed using the same report forms and following the same procedures used for

emergency incidents.

The PCS is to be filed with the packet of paper work and placed in the HIPPA box.


The Lisbon Fire Department has created this guideline to ensure adequate response times to all emergency incidents within the Town of Lisbon and any other municipalities requesting the aid of the fire department. If any situations arise that would be contrary to this guideline, it will be left to the discretion of the OIC (officer in charge) to decide on a resolution.
All personnel that are on duty will remain within a five minute response to the fire station they are assigned to. The five minute response time is measured from time of alarm to the moment when personnel are at the station ready to respond to the incident. This will be accomplished while complying with all state laws regarding vehicle operation. All members are also required to comply with all Lisbon SOG’s related to personal vehicle response to the station.

If personnel are found to not be able to comply within the five minute response as they currently respond, it is expected that they will make arrangements to ensure they will be able to meet this requirement. The preferred arrangements would be staying at the station that they are assigned to. As mentioned the final discretion will be left to the OIC.

Any questions or concerns that can not be resolved between the member and the OIC regarding this SOG, shall be directed to the Fire Chief for further review.




Drug-Free Workplace Policy

It is the policy of the Town of Lisbon to provide a drug-free workplace for all of its employees. The Town requires that employees neither use, nor be under the influence of, a controlled substance(s), and that a zero tolerance standard shall prevail in the workplace. The Town recognizes the importance of maintaining a safe, efficient, and healthful workplace, as well as the social responsibility to provide assistance to it’s employees to the extent possible. Therefore, employees are expected to report for work free from the influence of substances that could inhibit their ability to perform their duties.

Reporting of Drug Conviction

All Town employees are hereby notified that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is strictly prohibited in the workplace. Furthermore, this law makes it a condition of employment that all Town employees abide by the “Drug-Free Workplace Policy” and notify the Town (your immediate supervisor) of any criminal drug statute conviction for a violation occurring in the workplace no later than five (5) days after such conviction. Within ten (10) days of receiving such notice of conviction, the Town will notify the appropriate Federal contracting or granting agency as required. Within thirty (30) days of learning of a workplace drug conviction, the Town will:

1. Require the employee to satisfactorily participate in a Drug Assistance or Rehabilitation Program that is approved by the Town; or
2. Take appropriate personnel action as identified below.

An employee’s failure to abide by the terms of the above paragraph will result in disciplinary action up to, and including, termination of employment. The actual action taken will be based upon the seriousness of the offence, the employee’s past employment record, and the employee’s willingness to participate in drug abuse assistance or rehabilitation.

Prevention and Rehabilitation

The goals of this policy are prevention and rehabilitation whenever possible, rather than discipline or termination. The Town provides access to drug and alcohol counseling, rehabilitation, and the Employee Assistance Program for all of its regular employees. The Town’s group health insurance provides benefits for rehabilitation services, and the Town treats drug addiction the same as other illnesses and provides for a leave of absence under the provisions of the Family and Medical Leave Act for treatment of drug related illnesses. The Town also recognizes drug abuse as a potential health and safety problem. Employees needing help dealing with such problems are encouraged to use the Employee Assistance Program and health insurance plans as appropriate. Employees may telephone the Town EAP provider, for additional information. Conscientious efforts to seek such help will not jeopardize any employee’s job, and contacts with the EAP, initiated only by the employee, will not be known nor noted in any personnel record.

Leave of Absence Prior to Testing

An employee shall be permitted to take a leave of absence for the purpose of undergoing treatment pursuant to a Drug Assistance or Rehabilitation Program approved by the Town for drug use. The leave of absence must be requested prior to the commission of any act subject to disciplinary action.

Because drug use can seriously jeopardize the health and safety of employees and the public, it is the responsibility of the Town to maintain a drug-free workplace at all times. As part of this effort, the Town will continue to provide access to an Employee Assistance Program for current regular Town employees, will administer appropriate pre-employment drug testing in conjunction with the pre-employment physical examination to assure that new Town employees are not drug abusers, and will provide training and education to inform employees of the dangers of drug abuse in the workplace. It is the responsibility of all Town employees to abide by the terms of this policy as a condition of employment.

Town of Lisbon

Drug and Alcohol Testing Policy

The Department of Transportation (DOT) and the Federal Highway Administration (FHWA) have issued a rule (49 CFR Parts 40 and 382) requiring alcohol and controlled substance testing of drivers who are required to have a Commercial Drivers License. These rules include procedures for urine testing and breath alcohol testing. The purpose of this policy, then, is to establish an alcohol and controlled substances testing program to help prevent accidents and injuries resulting from the misuse of these substances by drivers of commercial motor vehicles. Consequently the Town of Lisbon has established the following alcohol misuses prevention program and anti-drug program, as well as the subsequent enforcement of violations for its employees conducting safety-sensitive job functions. (Employees should also refer to the Town’s “Drug-Free Workplace Policy” which addresses the strict enforcement of workplace controlled substance usage.)


For purposes of this policy, The Town of Lisbon and the DOT strictly prohibit the use of alcohol and/or controlled substances by its employees and volunteers who are performing, or ceasing to perform the following safety-sensitive job functions:

1. Operation of commercial motor vehicle;

2. Repair and maintenance of a commercial motor vehicle;

3. Control the movement of commercial motor vehicles (i.e., dispatcher)

4. Directly supervising employees who perform safety-sensitive job functions.


Safety-sensitive employees may not consume alcohol:

1. Four (4) hours before performing a safety-sensitive function;

2. While performing a safety-sensitive function;

3. After a fatal accident, unless the employee has been tested or eight (8) hours have elapsed from the actual time of the accident; or
4. After a non-fatal accident unless the employee’s involvement can be completely discounted as a contributing factor to the accident the employee has been tested, or eight (8) hours have elapsed from the actual time of the accident.
The unauthorized use of any controlled substance is strictly prohibited in all situations.
Required Conditions of Testing

Refusal to take a required test will result in removal of that employee from their assignment(s) which in turn, may result in discipline up to, and including, discharge.

Testing must be conducted in the following situations:
1. Pre-employment: Prior to the first time an employee performs safety-sensitive functions for the Department (i.e., new employment, job transfer, etc.), the employee shall be screened for alcohol and controlled substances. A positive result will result in a disqualification from further consideration for the vacancy or eligibility list.

2. Probable Cause:

a. In a situation where an employee is either acting in an impaired manner and/or the supervisor has probable cause to believe the employee is using, in possession of, or is under the influence of alcohol or drugs (i.e., smell of alcohol), the supervisor should seek a corroborating opinion from another supervisor or manager prior to immediately removing the employee from the job.

NOTE: Probable cause means a suspicion based on a specific personal observation by a supervisor or another, that can be described regarding the appearance, behavior, job performance, speech or breath odor of an employee. It also means receipt of information about an employee’s suspected drug use from a reliable source.

b. Once the employee has been removed from the job the supervisor is to contact the Department Liaison. If contact cannot be made at that time, the supervisor is to proceed through the next step of this procedure and make contact with the Department Liaison as soon as possible thereafter.
c. The supervisor is to then transport the employee to the collection site for drug testing immediately, or no later than two (2) hours of having observed the behavior. The supervisor is to wait at the clinic with the employee until the breath test has been completed or the urine sample has been taken.
d. Once the drug testing has been completed and a positive confirmatory test result has been received (0.02 percent or above), the employee will not be permitted to drive his/her own vehicle home at that time. The employee must make alternative arrangements in order to leave the collection site.
e. The employee is to be advised not to report for work as she/he will be placed on administrative leave without pay. If a blood alcohol test has been administered, the Town will contact the employee once the test results are known (this normally takes 24-48 hours) and a decision has been made as to the employee’s status.
f. The results of the drug testing will be sent directly to the supervisor. When the results are obtained, the employee’s supervisor and department head will meet with the person to determine the appropriate course of action to be taken. This is a confidential process. Test results will be held strictly confidential and are not to be discussed or shared with anyone who does not need to know. Likewise, a supervisor must not discuss the suspected reason for a referral or termination with anyone who does not need to know.
g. Once the test has been completed and the employee has been sent home, the supervisor must submit a written report to the Department Liaison outlining, in detail, the event and the behavior observed that led the supervisor to believe the employee was under the influence of alcohol and/or drugs. This report is to be done within twenty-four (24) hours of the testing.
3. Random: This test is used in order to eliminate risks associated with illegal or unauthorized drug and alcohol use. Random alcohol and drug testing will be conducted just before, during, or just after an employee’s performance of safety-sensitive duties. The employee will be randomly selected for testing from a “pool” of employees subject to testing. The testing dates and times are unannounced and are with unpredictable frequency throughout the year.

The minimum annual percentage rate for random alcohol and drug testing shall be a twenty-five percent (25%) and fifty percent (50%) respectfully, of the average number of safety-sensitive positions. The FHWA will annually publish its decision to increase or decrease the minimum annual percentage rate for random alcohol and drug testing based upon the reported violation rate for the entire commercial vehicle industry. For example, if the Town has one hundred twenty (120) employees who are required to submit to testing, the DOT regulations specify that random testing will be performed at a rate of fifty (50%), then sixty (60) employees must be tested each year - which translates to five (5) employees per month.

The selection of employees for random testing shall be administered by Marshfield Laboratories using a scientifically-valid method. This method will be a computer software-based random selection program that is matched with employee social security numbers. A monthly list of confidential numbers will be generated and forwarded to the supervisor in order that they may make arrangements for testing. Under this selection process, each employee will have an equal chance of being tested each time selections are made.

In the event an employee tests positive for either alcohol or controlled substances, the employee will be subject disciplinary action up to, and including, discharge.

4. Post-Accident: As soon as practical following an accident involving a commercial motor vehicle, the Town shall test an employee driver for alcohol and controlled substances. This testing will be required if:
a. The accident involved the loss of human life; or

b. The employee receives a citation under State or local law for a moving traffic violation arising from an accident.

The alcohol breath test is required to be administered within two (2) hours following the accident, and the drug test is to be administered within thirty-two (32) hours of the accident.

An employee who is subject to post-accident testing shall remain readily available for such testing or may be deemed by the department to have refused to submit to testing.

5. Return to Duty/Follow-up: This test is used to maintain abstinence and to prevent relapse by employees during and after drug treatment. The Town will ensure that before an employee returns to duty, requiring the performance of a safety-sensitive job function, after engaging in conduct prohibited in this policy, the driver shall undergo a return-to-duty alcohol and/or controlled substance test with a result indicating an alcohol concentration of less than 0.02 percent and a verified negative result for controlled substance use. In any event, an employee will not be allowed to return to duty without first having been evaluated by the Town EAP provider in order to determine the employee’s fitness for duty.

Following a determination that an employee is in need of assistance in resolving problems associated with alcohol misuse and/or use of controlled substances, the Town will ensure that the employee is subject to unannounced follow-up alcohol and/or controlled substances testing in consultation with a substance abuse professional. Consequently, the employee will be given at least six (6) random tests during the next year with the possibility of follow-up testing for up to sixty (60) months.

6. Voluntary: This testing provides an opportunity for all employee( management, supervisory and non-supervisory) not part of the random pool to demonstrate a commitment to the goal of a drug-free workplace.

Test Procedures

NOTE: The Town has entered into an alcohol and drug testing agreement with the Marshfield Clinic. Testing will be done on both urine and breath (blood alcohol may be required when necessary). Marshfield Clinic will handle taking the sample (in standard collection kits) from the hours of 9:00 a.m. until 5:00 p.m. and Marshfield Clinic will handle taking the sample at all other non-regular business hours. The health provider will be responsible for sseing that the samples are sent to Marshfield Laboratory for screening and assisting in the interpretation of the results. Drug testing is not to be done anywhere but at Marshfield Clinic, unless specifically authorized by the supervisor.


Employees will be required to submit to breath testing using an Evidential Breath Testing (“EBT”) device. A State-certified Breath Alcohol Technician (“BAT”) will administer an initial screening test, unless the employee tests positive for alcohol, then the BAT will conduct a confirmation test (the Town will take action based only upon the positive results of the confirmation test, 0.04 percent or greater).

Preparation For Breath Alcohol Testing

1. When the employee enters the collection site, the BAT will require him/her to provide positive identification (i.e., photo I.D. or Employee Identification.)

2. The BAT will explain the test procedure.

3. Employees will be required to complete and sign various forms used to document the testing process. Refusal to sign the test form(s) will be regarded as a refusal to take the test.

4. Employees will be instructed to blow forcefully into the mouthpiece for at least six (6) seconds or until the EBT indicates that an adequate amount of breath has been obtained..
5. If an employee tests positive during the screening test, she/he shall not eat, drink, put any object or substance into their mouth and, to the extent possible, not belch during the twenty (20) minute waiting period before the confirmation test.
6. Refusal of an employee to complete and sign the test form, to provide breath, to provide adequate amount of breath, or failure to cooperate with the testing process in a way that prevents the completion of the test, will be considered a disciplinable offence up to, and including, termination.
If a confirmation alcohol test measures 0.04 percent or greater, the Town is required to:

1. Remove the employee from the safety-sensitive position;

2. Refer the employee to the Town EAP for assessment, participation, and a subsequent determination of an alcohol problem; and

3. The employee will subsequently be given at least six (6) random tests during the next year with the possibility of follow-up testing for up to sixty (60) months.

If the confirmation test level is between 0.02 and 0.039 percent, the employee will be removed from the safety-sensitive position and either be re-tested or removed for a minimum of 24 hours.

In the event that an employee is required to comply with breath testing as a result of a law enforcement investigation, the employee will submit to the examination. The test will be considered enforceable for purposes of this policy, if the testing officer is a qualified BAT and that the EBT that was used for the test has been certified by the State of Wisconsin or the Town of Lisbon.

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