Ride Along Training EMS - Fire for Univ. of Iowa Healthcare
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MEMORANDUM
July 6,2005
TO:
The Honorable Mayor and City Council Members
FROM:
Michael C. Van Milligen, City Manager
SUBJECT: Contract for Ride-Along Training for University of Iowa Healthcare
Fire Chief Dan Brown recommends City Council approval of a contract with University of
Iowa Healthcare for the Fire Department to provide preceptorships for students in the
college's EMS training programs.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
(J,tl ~7 j7Jv~
Michael C. Van Milligen
MCVM/jh
Attachment
cc: Barry Lindahl, Corporation Counsel
Cindy Steinhauser, Assistant City Manager
Dan Brown, Fire Chief
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QPUBUQUE.~
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City of Dubuque, Iowa
Memorandum
June 30, 2005
TO: Michael C. Van Milligen, City Manager
FROM: Dan Brown, Fire Chief $DfJ
PREPARED BY: Ric Jones, Fire Department Emergency Medical Services
Supervisor N-
SUBJECT: Contract for ride-along training for University of Iowa Healthcare
The attached contract is an extension of one that has been in place for several
years with University of Iowa Healthcare for the Fire Department to provide
preceptorships for students in the college's EMS training programs.
The only change in the contract since we last had Barry Lindahl review it in 1999,
is that the duration is longer. This change was made at our request.
Requested Action:
The City Manager is requested to sign the tabbed area of the contract, and return
it to the EMS office.
".
THE UNIVERSITY OF lOW A HOSPITALS AND CLINICS
EMERGENCY MEDICAL SERVICES LEARNING RESOURCES CENTER
200 Hawkins Drive, S608-1 GH
Iowa City, Iowa 52242-1009
Clinical/Field Affiliation Agreement
The University of Iowa Hospitals and Clinics
EMS Learning Resources Center
(Hereinafter called the "School'~
Dubuque Fire Department
Dubuque, Iowa
(Hereinafter called the "Cooperating Agency'~
PURPOSE OF AGREEMENT:
This is a mutual Agreement between the School offering programs in Paramedic Training and
the Cooperating Agency providing clinical or field experience for selected student learning. The
basic purpose of this Agreement is to establish cooperative relationships and to outline
responsibilities of the two cooperating parties as they contribute to the education, training and
experience for the students of the School's Paramedic Training Program.
I. Both parties agree that:
A. This agreement shall commence on the 151 day of June, 2005, and shall remain in full
force and effect for a period of three (3) years.
B. They shall establish a channel of communication for the purpose of continuing feedback.
C. They shall provide evidence of non-discrimination with respect to race, religion, sex,
creed, disability or national origin by ongoing practices.
D. Either party shall have the right, for good cause shown and upon prior notification to the
other party, to dismiss a participant from the clinical or field portion of the Paramedic
Training Program.
E. They shall not use students in lieu of professional or non-professional staff.
F. They shall provide schedules, including the number of students, types of students
according to their skill level, and the availability of the facility.
G. Each shall be responsible only for activities in its own patient care setting. Nothing in
this agreement shall be construed to impose an obligation or liability on either party for
medical care or services provided to patients of the other party.
H. They have the right to unilaterally terminate the Agreement, upon thirty (30) days written
notice, the autonomy of each being recognized.
Rev. 12/04 Page I of 4
The School and Cooperating Agency agree that:
II. The School Shall:
A. Assume full responsibility for planning and execution of the educational phase
of the Paramedic Training Program.
B. Be responsible for the planning, implementation and administration ofthe
curriculum.
C. Identify students by name to the Cooperating Agency four (4) weeks prior to the
scheduled clinical or field rotations.
D. Advise the Cooperating Agency and students in writing of the starting and
ending dates of the clinical and field experience.
E. Verify and document that the students have professional liability insurance
(minimum coverage of one million dollars per occurrence and three million
aggregate).
F. Ensure that each student has been fitted with an N-95 Particulate Respirator
mask and has had appropriate training in bloodborne, airborne pathogens and
infection control according the OSHA standards, prior to having contact with
patients.
G. Ensure that each student will have had appropriate training in Hazardous
Materials Awareness and in recognizing Child and Dependent Adult Abuse.
H. Ensure that each student has completed the School's HIPAA training session.
1. Recognize the Cooperating Agency as an affiliated hospital and/or ambulance
serVIce.
J. Provide preceptor orientation materials to the cooperating agency.
K. The student shall be responsible for all medical costs associated with an illness
or injury that occurs while participating in clinical/field experience.
L. Ensure that the student shall have current vaccinations, including Hepatitis B (or
sign a declination form), rubella, MMR, and has had a yearly TB skin test with
positive results requiring a chest x-ray before beginning the clinical/field
expenence.
M. With the consent of the Student, the School will provide the Cooperating Agency
with relevant information as set forth in this agreement, including but not limited
to the results of the Student's criminal background check, adult abuse registry
check, child abuse registry check, and sex offender registry.
Rev. 12/04 Page 2 of 4
III. The Cooperating Agency Shall:
A. Designate a primary preceptor for responsibility in teaching, coordinating, and
directing the student's clinical or field experience. This individual shall be
involved in the planning with the School's faculty and has reviewed the
preceptor orientation materials.
B. Make available clinical or field resources and related experiences for the
educational program of students of the Paramedic Training Program.
C. Have clinical or field instruction planned, organized and taught by designated
clinicians it employs. Persons assuming this educational responsibility for the
Cooperating Agency shall be selected by mutual agreement.
D. Provide a thorough orientation to include the physical environment, safety,
infectious control, confidentiality and pertinent policies/procedures.
E. Review the Clinical/Field Evaluation Forms and guidelines for the clinical or
field training of the students.
F. Inform the School regarding the scheduling of students for the clinical or field
expenence.
G. Schedule students for clinical or field experience time to assure appropriate
experIence.
H. Assure that while engaged in patient care, no student shall be left without the
continuous on-site presence and supervision of a licensed physician, nurse or
paramedic provided by the Cooperating Agency.
1. Provide the preceptors who are to provide the School with an evaluation of each
student throughout the clinical or field experience.
J. Shall not be responsible for lost or damaged personal property of the student.
Rev. 12/04 Page 3 of 4
This agreement will be reviewed every year by both parties.
The renewal date shall be in the fall, on or before January 1 st.
THE UNIVERSITY OF IOWA
HOSPIT ALS AND CLINICS
COOPERATING AGENCY
BY:
BY:
Douglas K. York
Print
TITLE: Director, EMSLRC
TITLE:
DATE:
DATE:
BY:
BY:
Donna Katen-Bahensky
Print
TITLE: Director and Chief
Executive Officer
TITLE:
DATE:
DATE:
CONTACT INFORMATION:
University of Iowa. EMSLRC
Lee Ridge, Program Assistant
200 Hawkins Drive, S 608-1 GH
319-353-8434
ridge1@uihc.uiowa.edu
Coo1Jeratinf! Af!encv
Name:
Address:
Phone:
emai1 :
Rev. 12/04
Page 4 of 4