2018-0803/19/2018
RESOLUTION NO. 2018 - 08
A RESOLUTION APPROVING NORTHWEST COMMUNITY HEALTHCARE
PARAMEDIC PROGRAM FIELD TRAINING SERVICES AGREEMENT
WHEREAS, the Village of Buffalo Grove is a Home Rule Unit pursuant to the Illinois
Constitution of 1970; and
WHEREAS, the Buffalo Grove Fire Department has been a paramedic preceptor with
the Northwest Community Hospital, and
WHEREAS, the attached preceptor program agreement (Exhibit A) has been revised and
requires Village Board approval.
NOW THEREFORE BE IT RESOLVED BY THE PRESIDENT AND
BOARD OF TRUSTEES OF THE VILLAGE OF BUFFALO GROVE, COOK AND
LAKE COUNTIES, ILLINOIS, that the Village President and Village Clerk are hereby
authorized and directed to execute the attached Northwest Community Healthcare Paramedic
Program Field Training Services Agreement (Exhibit A).
AYES: 5 —Stein Ottenheimer m Weidenfeld, Johnson Smith
NAYES: 0 - None
ABSENT: 1 - Berman
PASSED: March 19. 2018.
APPROVED: March 19 2018.
ATTEST:
w
I .IXa
Jane't-M. Sirabian, Village Clerk
#696576
1
APPROVED:
NORTHWEST COMMUNITY HEALTHCARE
PARAMEDIC PROGRAM
FIELD TRAINING SERVICES AGREEMENT
THIS NORTHWEST COMMUNITY HEALTHCARE PARAMEDIC PROGRAM FIELDTRAINING
SERVICES AGREEMENT (the "Agreement") is made as of this 19t' day of Marche 2018 and
effective as of March 20, 2018 (the "Effective Date") by and between the Village of Buffalo
Grove ("Village "), a home rule Municipality, and NORTHWEST COMMUNITY HOSPITAL
("NCH"), an Illinois not -for -profit corporation that operates a hospital at 800 West Central Road,
Arlington Heights, Illinois ("Hospital").
WHEREAS, NCH, as part of its mission to promote the health of the community, arranges for the
provision of a variety of services including operation of the Northwest Community EMS System
(the "System");
WHEREAS, NCH, through the System and together with William Rainey Harper College
("Harper College"), offers a program of paramedic education and training services (the "Training
Program") to Harper College paramedic students (the "Students");
WHEREAS, under Illinois law, 210 ILCS 50/3.55, the Students must fulfill clinical training and in-
field supervised experience requirements mandated for licensing and approval by the System
and the Illinois Department of Health;
WHEREAS, a critical component of the NCH Training Program requires Students to participate
in a field internship in which Students receive training on certain EMS operations and functions
at various participating fire departments and ambulance services in townships and villages within
the System ("Field Internship"), as more fully described in Exhibit A.
WHEREAS, NCH and Village wish to work together to provide the Field Internship opportunity to
Students.
NOW, THEREFORE, in consideration of the mutual promises, covenants and agreements
hereinafter described, NCH and Village agree asfollows:
1. RESPONSIBILITIES OF NCH
1.1 NCH will provide its paramedic training and education services (the "Training Services") to
the Students in a manner that meets or exceeds the National EMS Standards. NCH
represents that the Training Services provided through NCH's Training Program meets all
requirements of the Committee on Accreditation of Educational Programs for the
Emergency Medical Services Professions (CoAEMSP) and is approved by the Illinois
Department of Public Health.
1.2 NCH shall only permit Students to participate in the Field Internship who meet Field
Internship program criteria and have completed the requisite course work and/or training
as described in Exhibit B. Paramedic Student/ProviderAgency Memo of Understanding.
1.3 The parties acknowledge that a stipend of $1,500 (One thousand five hundred dollars)
("Stipend") shall be assessed to the Student and collected by Harper College to
compensate the Village for providing preceptor oversight during the Field Internship.
Upon request of Village, NCH will distribute the Stipend to Village by: (1) issuing a
check directly to the preceptor identified more fully in Section 2.1 of this Agreement; (2)
issuing a check to Village; or (3) holding the funds in escrow for Village to offset future
EMS System billing (for example, In -station costs, Image Trend fees).
1.4 NCH shall designate an employee of NCH as the Program Director of the Training
Program.
II. RESPONSIBILITIES OF VILLAGE
2.1 Village shall permit Students, the number of which shall be mutually agreed upon
between NCH and Village, the opportunity to participate in the Field Internship provided
by NCH working together with the Village's Fire Department. Specifically, Students will
be permitted to observe and participate in certain EMS operations and functions under
the supervision of a preceptor, as described more fully in and in accordance with
Northwest Community EMS Preceptor Agreement attached as Exhibit C. Under the
supervision of a preceptor, Students will be permitted to ride in a Village ambulance and
learn critical paramedic skills, in accordance with the Field Internship Services listed in
Exhibit A. Village agrees to provide a minimum of three hundred (300) hours and/or 3.5
months of Field Internship supervision during the time of each Student's Field Internship.
2.2 In the event Village elects for any one or more of its Village employees to participate as
Students in the Training Program, Village agrees that all such employees shall meet the
Student criteria for participation in the Training Program and comply with all applicable
policies and procedures, attached as Group Exhibit D.
2.3 Village shall designate an employee of Village as its coordinator for the Training
Program and as such, to represent Village to the NCH in the day-to-day activities and
contacts regarding the Training Program, the Training Services and the Field Internships.
III. TERM AND TERMINATION
The term of this Agreement shall begin on the Effective Date stated hereinabove and shall expire
one calendar year thereafter. Notwithstanding the foregoing or any other provision of this
Agreement to the contrary, either party may terminate this Agreement for any reason, with or
without cause, by giving 30 calendar days written notice to the otherparty.
IV. CONFIDENTIALITY
Both parties, their elected officials, officers, employees, subcontractors, representatives and/or
agents, including the Students, shall treat and maintain as confidential information, any
information regarding the other party's programs, processes, costs, equipment, operations or
customers which may be disclosed to or come within the knowledge of the parties, their elected
officials, officers, employees, subcontractors, representatives and/or agents, including the
Students, in the performance of this Agreement, and shall not use or disclose its confidential
information to the other party except as is necessary to perform the Training Program, the
Training Services and Field Internships. For purposes of this Section IV, the Students are the
agents of NCH.
The provisions of this Section IV shall not apply to any information referred to in this Section which
either party establishes (1) has been published and has become part of the public domain other
than by acts or omissions of the other party, its employees, representatives or agents; (2) has
been furnished or made known to the other party by third parties as matter of legal right and
without restriction on disclosure or use; (3) was in the other party's possession prior to disclosure
by such parties and was not acquired by the other party, its employees and agents directly or
indirectly from the other party; or (4) is required to be disclosed under the Freedom of Information
Act (5 ILCS 140/1 et seq.) or other law, rule or order mandating disclosure.
Except as otherwise permitted by the Health Insurance Portability and Accountability Act of 1996
("HIPAA") and the rules promulgated thereunder, neither party nor any of its employees,
representatives, or agents, including the Students, may use or disclose any individually identifiable
health information ("PHI") acquired in the performance of this Agreement, including the Training
Program, the Training Services and the Field Internships. "Individually identifiable health
information" means "information, including demographic data that relates to an individual's past,
present or future physical or mental health condition, the provision of health care to the individual,
where that information identifies the individual being treated or for which there is a reasonable
basis to believe it can be used to identify the individual," for example, name, address, date of birth
and social security number. http://www.hhs.gov/ocr/privacy/index.html
V. NOTICES
Except as otherwise specifically provided in this Agreement, any notice required or permitted to be
given under this Agreement shall be in writing and (1) delivered in person, which delivery the
recipient agrees to acknowledge in writing; (2) deposited with the United States Postal Service,
having first-class, registered or certified mail return receipt requested postage fee prepaid; or (3)
sent via a nationally recognized overnight courier service. Such notice must be addressed as
follows, or to such other address or individual as either party may specify from time to time by
written notice given by such party.
If to Village, it shall be addressed to:
Village of Buffalo Grove
Attention: Chief Michael Baker
Address: 1051 Highland Grove Drive; Buffalo Grove IL 60089.7026
Telephone Number: 847.537.0995
Email: wbakerCa?vbq.org
Copy to:
Village Attorney
Attention: William Raysa
Address: 233 S. Wacker, Chicago,
IL. 60606
Telephone Number: 312-627-4025
Email: wraysa _tresslerlip.com
If to NCH, it shall be addressed to:
Northwest Community Healthcare
Attn: Connie J. Mattera, MS, RN, EMT-P, TNS
EMS Administrative Director and Paramedic Program Director
901 W. Kirchoff — EMS Offices
Arlington Heights, IL 60005
Phone: 847-618-4485
Fax: 847-618-4489
Pager: 708-999-0141
cmattera(a�nch.org
Copy to:
General Counsel
800 W. Central Road
Arlington Heights, IL 60005
VI. ASSIGNMENT/NO THIRD PARTY BENEFICIARIES
Neither party may assign, subcontract, delegate or otherwise transfer this Agreement orany
obligations or responsibilities hereunder without the other party's prior written consent. This
Agreement is not intended to confer upon any person other than the parties to this Agreementany
rights or remedies hereunder.
VII. ENTIRE AGREEMENT
This Agreement and each of its Exhibits incorporated as though fully set forth herein sets forth the
entire agreement between Village and NCH with respect to the subject matter hereof. All prior
negotiations and dealings regarding this Agreement and the subject matter hereof, whether oral or
written, shall be deemed superseded by and merged into this Agreement.
Vill. INSURANCE REQUIREMENTS
The NCH shall procure and maintain for the duration of the Agreement insurance against claims
for injuries to persons or damages to property that may arise from or in connection with the
performance of the Training Program, the Training Services and/or the Field Internships by the
NCH, its agents, representatives, employees or subcontractors, including Students and
preceptors.
8.1. Minimum Scope of Insurance. Coverage shall be at least as broad as:
(1) Commercial General Liability - Occurrence form;
(2) Automobile Liability;
(3) Professional Liability/ Errors and Omissions policy; and
(4) Worker's Compensation as required by the Labor Code of the State of Illinois and
Employers' Liability Insurance.
8.2 Minimum Limits of Insurance. The NCH shall maintain limits no less than:
(1) Commercial General Liability: $3,000,000 combined, single limit per occurrence
and in the aggregate for bodily injury, personal injury, and property damage.
(2) Automobile Liability: $1,000,000 combined, single limit per accident for bodily
injury and property damage.
(3) Professional Liability: $3,000,000 per occurrence and in the aggregate liability
limit for errors and omissions, professional/malpractice liability, including the
Students.
(4) Workers' Compensation and Employers' Liability: Workers' Compensation
statutory limits as required by the Labor Code of the State of Illinois, and
Employers' Liability limits of $1,000,000 per accident.
8.3 Deductibles and Self -Insured Retentions. NCH's obligation hereunder maybe
satisfied through a self-insurance trust maintained by NCH or its affiliates.
8.4 Other Insurance Provisions. The policies are to contain, or be endorsed to
contain, the following provisions:
(1) Commercial General Liability and Automobile Liability Coverages:
a. Village, its officials, employees and volunteers are to be covered as
named insureds with respect to liability arising out of preceptor services,
the Training Program, the Training Services or the Field Internships
performed by or on behalf of the NCH, including its Students and
preceptors, as well as equipment procured, owned, leased, hired or
borrowed by the NCH in the Training Program. The coverage shall
contain no special limits on the scope of the protection afforded to
Village, its elected officials, officers, employees, subcontractors,
representatives and/or agents.
The NCH's insurance coverage shall be primary insurance as respects
Village, its elected officials, officers, employees, subcontractors,
representatives and/or agents. Any insurance or self-insurance
maintained by Village, its elected officials, officers, employees,
subcontractors, representatives and/or agents shall be in excess of the
NCH's insurance and shall not contribute with it.
Any failure to comply with reporting provisions of the policies shall not
affect coverage provided to Village, its elected officials, officers,
employees, subcontractors, representatives and/or agents.
4
d. Coverage shall expressly state that the NCH's insurance shall apply
separately to each insured against whom claim is made or suit is brought,
except with respect to the limits of the insurer's liability.
(2) Workers' Compensation and Employers' Liability Coverage:
The NCH insurer shall agree to waive all rights of subrogation against Village, its
elected officials, officers, employees, subcontractors and/or agents for losses
arising from the Training Program, the Training Services or Field Internships
performed by the NCH forVillage.
(3) All Coverages
Each insurance policy required by this clause shall be endorsed to state that the
coverage shall not be suspended, voided, canceled, reduced in coverage or in
limits except after thirty (30) days' prior written notice by certified mail, return
receipt requested, has been given to Village.
(4) Certificate of Insurance
NCH shall furnish Village with Certificates of Insurance naming Village, its
officials, agents, employees and volunteers as additional insureds, and with
original endorsements affecting coverage required by this clause. The certificates
and endorsements for each insurance policy, including the Certificates of
Insurance evidencing coverage in favor of each Student, are to be signed by a
person authorized by that insurer to bind coverage on its behalf. THE
CERTIFICATES AND ENDORSEMENTS, INCLUDING THOSE EVIDENCING
THE STUDENTS' INSURANCE COVERAGE, MUST BE RECEIVED AND
APPROVED BY VILLAGE BEFORE ANY STUDENT BEGINS ANY TRAINING
SERVICES OR FIELD INTERNSHIP. These Certificates and endorsements may
be on forms provided by the Village. Village reserves the right to request full,
certified copies of the insurance policies.
In the event of the expiration of the policy period for any one or more of the NCH
insurance policies on which the Village, its officials, agents, employees and
volunteers has been named pursuant to this Agreement, NCH shall promptly
furnish Village with current Certificates of Insurance evidencing the continued
coverage of the Village, its officials, agents, employees and volunteers as
required by this Agreement.
IX. REPRESENTATIONS AND WARRANTIES
9.1 NCH represents and warrants that NCH, and its officers and directors are:
9.1.1 Not delinquent in the payment of taxes to the Illinois Department of Revenue in
accordance with 65 ILCS 5/11-42.1-1;
9.1.2 Not barred from contracting as a result of a violation of either Section 33E-3 (bid -
rigging) or 33E-4 (bid -totaling) of the Criminal Code of 1961 (720 ILCS 5/33E-3
and 5/33E-4); and
9.1.3 Not in default, as defined in 5 ILCS 385/2, on an educational loan, as defined in 5
ILCS 385/1.
X. EQUAL EMPLOYMENT OPPORTUNITY During the performance of this Agreement, the
NCH shall.
10.1 Not discriminate against any employee or applicant for employment because of race,
color, religion, sex, sexual orientation, marital status, national origin or ancestry, age,
physical or mental handicap unrelated to ability, an unfavorable discharge from military
service, or on the basis of genetic information; and further that it will examine all job
classifications to determine if minority persons or women are underutilized and will take
appropriate affirmative action to rectify any such underutilization.
5
10.2 If NCH hires additional employees in order to perform this contract or any portion hereof, it
will determine the availability of minorities and women in the area(s) from which it may
reasonably recruit and it will hire for each job classification for which employees are hired
in such a way that minorities and women are not underutilized.
10.3 In all solicitations or advertisements for employees placed by it or on its behalf, it will state
that all applicants will be afforded equal opportunity without discrimination because of
race, color, religion, sex, sexual orientation, marital status, national origin or ancestry,
age, physical or mental handicap unrelated to ability, an unfavorable discharge from
military service or on the basis of genetic information.
10.4 Send to each labor organization or representative of workers with which it has or is
bound by a collective bargaining or other agreement or understanding, a notice advising
such labor organization or representative of the NCH's obligations under the IllinoisHuman
Rights Act and the Illinois Department of Human Rights Rules and Regulations. If any
such labor organization or representative fails or refuses to cooperate with the NCH in
its efforts to comply with such Act and Rules and Regulations, the NCH will
promptly so notify the Illinois Department of Human Rights; and the contracting agency
and will recruit employees from other sources when necessary to fulfill its obligations
thereunder.
10.6 Submit reports as required by the Illinois Department of Human Rights Rules and
Regulations, furnish all relevant information as may from time to time be requested by the
Department or Village, and in all respects comply with the Illinois Human Rights Act and
the Department's Rules and Regulations.
10.6 Permit access to all relevant books, records, accounts and work sites by personnel of the
Village and the Illinois Department of Human Rights for purposes of investigation to
ascertain compliance with the Illinois Human Rights Act and the Department's Rules and
Regulations.
10.7 Include verbatim or by reference provisions of this clause in every subcontract it awards
under which any portion of the contract obligations are undertaken or assumed so that
such or provisions of this contract will be binding upon such subcontractor. In the same
manner as with other provisions of this contract, the NCH will be liable for compliance with
applicable provisions of this clause by such subcontractor; and further it will promptly
notify Village and the Illinois Department of Human Rights in the event any subcontractor
fails or refuses to comply therewith. In addition, the NCH will not utilize any subcontractor
declared by the Illinois Human Rights Commission to be ineligible for contracts or
subcontracts with the State of Illinois or any of its political subdivisions or municipal
corporations.
In the event of the NCH's non-compliance with the provisions of this section X the Illinois Human
Rights Act or the Illinois Department of Human Rights Rules and Regulations, the NCH may be
declared ineligible for future contracts or subcontracts with Village, and this Agreement may be
cancelled or voided in whole or in part; and such other sanctions or penalties may be imposed or
remedies invoked as provided by statute orregulation.
XI. NON -SEGREGATED FACILITIES
The NCH shall not maintain or provide for its employees any segregated facilities at any of its
establishments, and not permit its employees to perform their services at any location, under its
control, where segregated facilities are maintained. As used in this subparagraph, the term
"segregated facilities" means any waiting rooms, work areas, restrooms and washrooms,
cafeterias and other eating areas, time clocks, locker rooms and other storage or dressing areas,
parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing
facilities provided for employees which are segregated by explicit directive or are in fact
segregated on the basis of race, creed, color, or national origin, because of habit, local custom, or
otherwise.
XII. SEXUAL HARASSMENT POLICY
The NCH has and will have in place and will enforce a written sexual harassment policy
in compliance with 775 ILCS 5/2-105(A)(4).
XIII. RECORDS RETENTION
The NCH and all subcontractors shall maintain books and records relating to the performance of
this Agreement in compliance with the requirements of the Local Records Act (50 ILCS 205/1 et
seq.) and the Freedom of Information Act (5 ILCS 140/1 et seq.) until written approval for the
disposal of such records is obtained from the Local Records Commission. All books and records
required to be maintained by the NCH shall be available for review and audit by Village. The NCH
shall comply (a) with any request for public records made pursuant to the Freedom of Information
Act (5 ILCS 140/1 et seq.); (b) with any request for public records made pursuant to any audit; and
(c) by providing full access to and copying of all relevant books and records within a time period
which allows Village to timely comply with the time limits imposed on it by the Freedom of
Information Act (5 ILCS 140/1 et seq.). Failure by the NCH to maintain the books, records and
supporting documents required by this section or the failure by the NCH to provide full access to
and copying of all relevant books and records within a time period which allows Village to comply
timely with the time limits imposed by the Freedom of Information Act (5 ILCS 140/1 et seq.) shall
establish a presumption in favor of Village for the recovery from NCH of any funds that the Village
may be required to pay for any penalties or attorney's fees imposed by the Freedom of Information
Act (5 ILCS 140/1 et seq.). The obligations imposed by this section shall survive the termination of
all other obligations imposed by this Agreement.
XIV. INDEMNIFICATION
The NCH shall defend, indemnify and hold harmless Village, its elected officials, officers,
employees, subcontractors, representatives and/or agents against all injuries, deaths, loss,
damages, claims, suits, liabilities, judgments, costs and expenses whatsoever which may in any
way accrue against Village, its elected officials, officers, employees, subcontractors,
representatives and/or agents, arising in whole or in part in consequence of the negligent or willful
misconduct by the NCH, its employees and its agents, including the Students and the preceptors,
in performance of the Training Program, the Training Services or the Field Internships or which
may in any way result therefrom, except for that arising out of the sole negligence or willful act of
Village, its elected officials, officers, employees other than those acting as preceptors,
subcontractors, representatives and/oragents
XV. LAWS TO BE OBSERVED
The NCH shall at all times observe and comply with all federal and state laws, local laws,
ordinances, and regulations which in any manner may affect the performance of this Agreement
including, but not limited to, all such enactments as exist at the present and those which may be
enacted later by legislative bodies or tribunals having legal jurisdiction or which may have effect
over the performance of this Agreement. The NCH shall indemnify and save harmless Village and
all of its elected officials, officers, employees, subcontractors, representatives and agents against
any claim or liability arising from or based on the violation of such law, ordinance, regulation, order
or enactment, whether by the NCH or anyone subject to the control of the NCH.
XVI. SEVERABILITY
If any term, covenant, or condition of this Agreement or the application thereof to any person or
circumstance shall, to any extent, be declared by a court of competent jurisdiction to be invalid,
void or unenforceable, the remainder of this Agreement or such other documents, or the
applications of such term, covenant or condition, to persons or circumstances other than those as
to which it held invalid or unenforceable shall not be affected thereby; and each term, covenant or
condition of this Agreement or such other document shall be valid and shall be enforced to the
fullest extent permitted by law.
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XVII. WAIVER
No failure or delay in exercising any right, power or privilege under this Agreement shall
operate as a waiver or estoppel thereof or with respect to any subsequent violation or
breach of any of the provisions hereof, and no waiver or modification hereof shall be
effective, unless in writing and signed by the Village.
XVIII. APPLICABLE STATE LAW
This Agreement shall be construed under and governed by the laws of the State of
Illinois, and all actions brought to enforce any item of this Agreement shall be so brought
in the Circuit Court of Cook County, Illinois.
XIX. CORPORATE AUTHORITY
Each party represents and warrants that the person whose name appears on the
signature page below has or has been delegated the lawful and corporate authority to
enter into this Agreement on behalf of that party.
NORTHWEST COMMUNITY HOSPITAL
BY:
ITS:
Date: 3112o�a0/R
ITS: V) Ilag Q cA-e,-\--
3/01 /2018
DM# 660559 - Clean
XVII. WAIVER
No failure or delay in exercising any right, power or privilege under this Agreement shall
operate as a waiver or estoppel thereof or with respect to any subsequent violation or
breach of any of the provisions hereof, and no waiver or modification hereof shall be
effective, unless in writing and signed by the Village.
XVIII. APPLICABLE STATE LAW
This Agreement shall be construed under and governed by the laws of the State of
Illinois, and all actions brought to enforce any item of this Agreement shall be so brought
in the Circuit Court of Cook County, Illinois.
XIX. CORPORATE AUTHORITY
Each party represents and warrants that the person whose name appears on the
signature page below has or has been delegated the lawful and corporate authority to
enter into this Agreement on behalf of that party.
ITS: V i Ibag o TregICA e,�+
3/01 /2018
DM# 660559 - Clean
Date: S- �, � -.z a/ Y
Date: 3199424/2
8
EXHIBIT A
WILLIAM RAINEY HARPER COLLEGE
HEALTH CAREERS DIVISION
NORTHWEST COMMUNITY HEALTHCARE PARAMEDIC PROGRAM
COURSE SYLLABUS
EMS 215 PARAMEDIC: FIELD INTERNSHIP 0 / 20 4
Course Course Course Title (Lec-Lab) Credit
Prefix Number Connie J. Mattera, M.S., R.N., EMT-P Hours
Program Director
Northwest Community Hospital
901 Kirchoff; EMS Office
Arlington Heights, IL 60005
Office hours: M-F 0900-1700
Phone:847.618.4480 Pager:708.999.0141
cmattera@nch.org
Dates: March 2- May 18, 2018 and/or until all objectives and patient care contacts are achieved; no later than
June 13, 2018 unless an extension is granted
Time & location of classes: EMS agencies within the Northwest Community EMS System
Class days: Dates and times variable depending on preceptor schedules and agency policies
COURSE DESCRIPTION
This course integrates the theoretical concepts and practical skills acquired during EMS 210, 211, 212, 213, 217,
and 218 and requires students to use higher order thinking and critical reasoning to safely care for patients in the
out of hospital environment under the direct supervision of an approved paramedic preceptor. The internship is
divided into two phases of ascending mastery and accountability with each having a minimum number of patient
care contacts and competencies. A full description of the objectives and expectations is contained in the NCH
Paramedic Program Student Handbook and on the internship forms. (NOTE: This course has an additional fee of
$1500 to cover the cost of preceptor supervision.)
Prerequisites for release to Field Internship:
• Successful completion of EMS 213
• All initial Hospital clinical rotations (EMS 217 & 218) done except for the elective and paperwork submitted to J. Dyer
• "All Fisdap entries for labs and EMS 217 and 218 entered by student and approved by J. Dyer
• All class -required simulated runs completed by student, submitted to and approved by J. Albert
• Eligible preceptor(s) identified by agency, approved by hospital educator, & paperwork submitted to C. Mattera
• Agency agreement to host students signed by authorized administrator and submitted to C. Mattera
• Hold harmless statement signed by student and forwarded to agency
TOPICAL OUTLINE
Students shall complete a minimum of the following:
I. Orientation to the internship
II. Phase 1; Team member with an emphasis on enhancing assessment and intervention skills.
III. Phase 2: "Capstone" experience, where students, in an end -of -program sequence field internship, do work
that gets assessed against the desired overall course outcomes. They are expected to demonstrate
competency as a team leader.
IV. Mandatory actual and/or simulated skills/patient care contacts
METHODS OF PRESENTATION
• Progression of learning typically sequences from didactic/theory to laboratory practice followed by hospital clinical
experience, followed by the field internship.
• While in the field, students are awarded temporary ALS privileges and will perform to that scope of practice as a
team member and then leader under the direct supervision of an approved preceptor for a minimum of 300
hours.
• Each phase of the internship has specific objectives, expected outcomes, and forms on which to evaluate the
learning experience. A complete description of the Internship is found in the NCH Paramedic Student Handbook.
• Students use independent inquiry to research pathophysiology and drug profiles for patient contacts.
Learning Goal: To develop contextual, integrative, and adaptive competencies using higher order critical thinking skills
and demonstrate competent entry-level Paramedic performance in the cognitive (knowledge), psychomotor (skills),
and affective (behavior) learning domains.
Syllabus EMS 215 Paramedic Field Internship
page 2
STUDENT OUTCOMES: (The student will...)
1. during EMS 210, 211, 212, 213, 215, 217 and 218 (combined), complete the following minimum patient care
contacts and demonstrate skill competency at the precision level or higher for assessments and interventions
included in the National EMS Scope of Practice model, The Illinois Scope of Practice Model, National EMS
Education Standards, those approved by the Program MD as specified in the System SOPs, Policy and
Procedure Manuals and as approved by the Paramedic Program Advisory Committee:
Assessments Minimum number
Adult (18-64 yrs)..........................................................
50 _.
Geriatric (65 or older) ......................................................
30
Pediatric total................................................................
18
Newborn (0-1 month) ....................................................
2
Infant (1-12 mos).........................................................
2
Toddler (2-3 yrs)..........................................................
2
Preschooler.............................................................
2
Schoolage................................................................
2
Adolescent..................................................................
2
Trauma patients total .....................................................
30
Trauma in peds...........................................................
6
Traumain elderly.........................................................
6
Medical patients total .....................................................
60
Medicalpeds..............................................................
12
Medical geriatrics........................................................
12
Stroke/T IA..................................................................
2
Acute coronary syndromelchest pain ..............................
2
Cardiac dysrhythmias...................................................
2
Respiratory distress/failure.............................................
2
Hypog lycem ia/D KA/H H N S.............................................
2
Sepsis.......................................................................
2
Shock (may fall under trauma) .........................................
2
Toxicology emergencies/OK...........................................
2
Psych/Behavioral emergency .........................................
6
Altered Mental Status ...................................................
2
Skills
Obtain Hx from A&O pt (total) ..........................................
10
Comprehensive normal phys assess adult .........................
2
Comprehensive normal phys assess peds..........................
6
Trauma assessment adult ................................................
16
Medical assessment (cardiac) adult ...................................
54
Direct tracheal intubation adult (5 live)* ................................
24
Trauma intubation (inline adult) .........................................
6
Nasotracheal intubation adult ...........................................
2
Supraglottic airway.........................................................
20
Cdcothyrotomy (needle/surgical)......................................
8
CPAP..........................................................................
5
Pleural decompression...................................................
6
Vascular access(IV)......................................................
47
Vascular access(10)......................................................
8
IV/10 Medication administration .......................................
16
IVPB Medication administration ........................................
4
IM or subcutaneous medication admin ...............................
6
Inhaled medication (nebulized) ..........................................
2
Synchronized cardioversion.............................................
16
Defibrillation..................................................................
16
Transcutaneous pacing ....................................................
15
Normal delivery and newborn care .....................................
7
Abnormal delivery and newborn care ..................................
7
Neonatal resuscitation.....................................................
7
Syllabus EMS 215 Paramedic Field Internship page 3
Serve effectively as the team leader 20 runs (15 ALS)
SKILLS Minimum #
BLS skills to be competencied in lab before live patient encounters
Spine motion restriction (adult supine)
3
Spine motion restriction (adult seated)
3
Joint splinting
3
Long bone splinting
3
Traction splinting
3
Hemorrhage control
3
IN med administration
4
Inhaled med administration
4
Glucose check
2
12 L ECG electrode placement
4
CPR equivalent to AHA BLS for HCP
1 & 2 rescuer CPR for adults, children, infant
3
BVM ventilations adult and child
2
Use of AED
1
Obstructed airway technique 1 yr & older
2
2. characterize the professional behaviors stated in the program affective objectives.
METHODS OF EVALUATION
1. Formative evaluations are conducted by the Field Preceptor using forms prepared by the Program to rate
student achievement of cognitive, psychomotor and affective objectives after each call. These are
discussed with the student, Field Preceptor and hospital EMS Coordinator/educator (EMSC) during Phase I
and II meetings
2. The program uses a computer based tracking system (FISDAP) that incorporates the program -defined
minimum numbers of encounters/competencies required for each of the defined exposure groups and
patient ages (pediatric subgroups include newborn, infant, toddler, preschooler, school-ager, and
adolescent), pathologies, complaints, and interventions. The tracking system clearly identifies those
students not meeting the program minimum numbers.
3. The program evaluates at least annually that the established minimums are adequate to achieve
competency. Terminal competency is validated by the Program Medical Director's signature.
4. Student evaluations of preceptors and internship process
5. Employer evaluations of student readiness to work completed six months after graduation
COMPLETION OPTIONS: To successfully pass EMS 215, students must demonstrate entry-level mastery of EMS
knowledge, skills, and behaviors as measured by satisfactorily completed all objectives in the Field Internship
instruction plan. A summative evaluation is conducted with the student, their primary Field Preceptor, PEMSC and
hospital EMSC/educator when all objectives have been achieved. They may select from three options at the end of
the first 300 field internship hours:
1. Objectives fully achieved: Graduate; recommend for terminal certifying exam and licensure without restriction.
2. Objectives minimally achieved: Graduate; recommend for terminal certifying exam; and licensure with restriction
in the form of a probationary status where the new licensee shall continue providing ALS care under the direct
supervision of an approved preceptor with periodic meetings with the EMSC/educator for an agreed -upon period of
time. If this option is selected, the hospital EMSC/educator must specify in detail the rationale and objectives for the
probationary status in an education action plan (EAP) and the EMS agency chief/administrator and EMS Medical
Director must agree to the plan. A copy shall be forwarded to the Course Coordinator for the student's file.
3. Objectives not achieved: The student is given an incomplete at the end of the regularly scheduled Field
Internship. If this option is selected, the hospital EMSC/educator must specify the cause in detail and an EAP must
be established between the student, the primary preceptor, the PEMSC and the hospital EMSC/Educator. A copy
shall be forwarded to the Course Coordinator for the student's file. The student may continue in EMS 215 with an
incomplete for a maximum of one month after the class graduation date unless alternative provisions are made.
If licensure cannot be recommended at the end of one month, the hospital EMSC/educator must specify in detail
the student's inability to meet the objectives and the EMS agency PEMSC and chief/administrator must be
informed of the determination. The EMS MD must be consulted about the final assessment and agree with the
findings. A copy of the final report shall be forwarded to the Course Coordinator for the student's file. The student
will be given an F for EMS 215 and may attempt to re -enroll the next time EMS 215 is offered.
Syllabus EMS 215 Paramedic Field Internship page 4
GRADING: Students receive a pass/fail grade for this course based on accomplishment of the objectives.
TIME REQUIREMENTS: Varies from student to student as each phase is competency rather than time -based.
Students are required to ride a minimum of 300 state -required hours, but may extend to 768 hours as there are 32
possible 24 hour shift days within the full internship time. Eight additional hours are allowed for phase or coaching
meetings. Internship time may be extended a maximum of 45 days after the scheduled end of EMS 215 based on
limited patient contact opportunities and slow but steady student progress. It will not be extended due to irresponsible
student behavior or lack of progress in meeting an IEP. Specific internship attendance requirements and
consequences of failing to meet those requirements are specified in the NCH Paramedic Student Handbook.
ATTENDANCE POLICY: Students are to be present, duty ready, and have reported to the shift commander/
preceptor at least 15 minutes prior to the start of a shift. At a minimum, students are expected to ride an entire day
and evening shift extending until the time set by the EMS agency on days that coincide with their preceptor's work
schedule. Optimally, this includes a 24 hour shift every three days. Students shall not leave in the middle of a shift
except for illness or an emergency, and their early departure must be approved in advance by the Course Coordinator
or Clinical Coordinator. No more than one third of the total hours may be completed from 11 pm to 7 am.
STUDENT BEHAVIOR
Information relative to civil, courteous and professional behaviors including, but not limited to, integrity, honesty,
empathy, self -motivation, appearance and personal hygiene, self-confidence, communication, time management,
teamwork, diplomacy, attitude, respect, patient advocacy, and use of electronic and social media, is specified in the
NCH Paramedic Program Student Handbook at www.nwcemss.org and Harper College Student Handbook at
hfps:flmyharper harpereollege edu/pis/portaVurVITEM/937272F78B81316DE0402EOAOA2A3059.
Information relative to guided study, corrective coaching, disciplinary procedures, and student resources is also
included in the NCH Paramedic Student Handbook.
INSTRUCTIONAL MATERIALS: Northwest Community EMS System Standards of Practice: Standard Operating
Procedures (SOPs), Policy Manual, Procedure Manual, and Drug and Supply List; NCH Paramedic Program Field
Internship paperwork.
EQUAL OPPORTUNITY
The Paramedic Program does not discriminate on the basis of race, color, religion, sex, national origin, ancestry,
age, marital status, sexual orientation, disability, or unfavorable discharge from military service as long as the
candidate meets statutory requirements of licensure as a paramedic and is able to perform all the essential
functions of the paramedic profession during the course with or without reasonable accommodation.
STUDENTS WITH DISABILITIES and Academic Accommodations
If you have a disability (learning, ADHD, physical, psychological or other) and may require any accommodation
during this course, please contact the Course Coordinator at the beginning of the course to discuss. Students with
disabilities must contact Access and Disability Services (ADS) to discuss approval of reasonable accommodations.
Any student already connected with ADS should provide the Course Coordinator a copy of your approved
Accommodation Plan if you would like to use any accommodations during the course. Access and Disability
Services is located in Building D, D119; on the Harper College campus; 847.925.6266 (voice) or 224.836.5048
(videophone for deaf and hard of hearing callers only).
STUDENT E-MAIL NOTIFICATIONS
All notifications related to student registration or other Harper College business activities are sent to students via G-
mail account that is assigned to students upon registration. Students access the G-mail account via an icon in the
student portal (where you registered for classes). Please check this e-mail frequently. To forward a -mails from this
account to a personal e-mail account please follow the instructions for forwarding Harper e-mail available to
http://harper.blackboard.com/. Students must provide the NWC EMSS office with an e-mail address to be used for
all direct correspondence relative to class academic and clinical activities.
Rev. CJM 9/14/17
EXHIBIT B
Paramedic Student/Provider Agency
Memo of Understanding
EMS 216 Field Internship Student Attestations
Student name (PRINT):
Provider Agency:
The NCH Paramedic Program student agrees to abide by the following requirements while
riding with the hosting provider agency during EMS 215 (Field Internship):
Adhere to provider agency rules and regulations regarding appearance, dress, hair style,
body art and jewelry requirements/restrictions.
Comply with provider agency criminal background check requirements.
Comply with provider agency behavior/conduct rules and regulations.
Comply with provider agency student performance expectations throughout each phase
of the internship. The student shall not drive nor operate an agency vehicle unless an
employee of the agency.
Comply with provider agency procedures and policy related to preceptor assignment and
intern sponsorship acceptance/denial criteria.
Comply with provider agency restrictions regarding ride time/visitor hours. Note:
provider agency may restrict hours available to student based on station visitor policy,
preceptor availability, special details, holidays, etc. The student intern may be restricted
to riding between normal working hours or specific time slots.
Comply with any and all "Hold Harmless" agreements/contracts or liability waivers in
place between NCH and the Provider Agency and others as required by the agency.
Review and comply with provider agency's Paramedic Job Description parameters.
Student initials indicate that requirements have been explained by the Provider Agency and
understood by the student.
Student signature:
Agency representative name (PRINT)
Agency rep signature
Title:
Date:
WK S18
Northwest Community Healthcare Paramedic Program Exhibit C
PRECEPTOR AGREEMENT - 2018
Qualifications
1. 1 have been a licensed paramedic in the Northwest Community EMS System for a minimum of two years, am
currently in good standing, and fully meet the preceptor qualifications as specified in System policy.
2. 1 understand that I must complete a Preceptor orientation class given by the Resource Hospital prior to the first
preceptor assignment and again at least every two years or more often if changes in practice or field internship
processes have occurred.
3. 1 affirm that I meet the required characteristics of an effective preceptor: Skilled in EMS care; communicates
effectively; maintains positive working relationships; makes effective decisions; skilled in peer evaluation; shows
genuine interest in others; displays sincere interest in professional development for self and others; able to articulate
reasons for actions while performing them; and provides constructive criticism in an effective manner.
...... _._._..
Prior to the onset of the internship
4. 1 have consulted with my (Provider) EMS Coordinator regarding the Paramedic student assigned to me. I am familiar
with the student objectives and my role as a Preceptor as outlined in the NWC EMSS Policy P-1 (E-7) and preceptor
education materials. I have reviewed the guidelines for preceptors and agree to comply with them.
5. 1 have a co or have access to the cu .n�. ............. mmmm cop .................�IT..... Trentt NWC EMSS SOPs, Policy Manual and Procedure (Lab) manual. It is my;--
responsibility to understand and perform in compliance with these documents when providing patient care and when
providing direct oversight and mentoring of the student.
... uuu
During the internship
6. 1 understand that by law, a Paramedic student is considered to be an EMT and that all Advanced Life Support
assessments and skills performed by the student must be done under my direct supervision or the supervision of
another System -approved Preceptor to ensure patient and responder safety. I further understand that it my
responsibility to ensure that all patient care reports completed by the student are factual, accurate, complete, and.
timely. I further understand that I am responsible for cross-checking all ambulance/equipment cleaning and
restocking performed by the student to ensure an appropriate environment of care and duty readiness.
7. 1 understand that the student must submit mandatory paperwork and formative evaluations completed by me and
other approved preceptors during the internship. I understand that I am responsible for completing an evaluation of
the student's knowledge, skills and achievement of affective objectives on each of the submitted runs in a timely
manner as defined in the field internship requirements.
_. _.._.......
8. 1 understand that I must meet with the designed Hospital EMSC/Educator for a minimum of two Phase meetings
during the internship to discuss the student's progress in achieving the objectives for each Phase
9. 1 further agree to ensure that the student is well -coached and prepared to discuss all calls and/or simulations
completed; including the patient's history, significant assessment findings, all treatments rendered including
medication profiles for EMS delivered and prescription drugs the patient is taking, interventions that were or should
have been instituted per SOPs, the paramedic impression and the general pathophysiology of that disease or injury.
10. 1 further agree to actively participate in the creation and execution of any Individual Education Plan that may be
necessary to help the student succeed.
_-__..._...............------
.. .........
11. 1 further understand that I must complete a summative final evaluation of the student's achievement of the objectives
and make a determination as to whether it is my opinion based on direct evaluation that the student has
demonstrated competency as a safe, entry level paramedic. These documents shall be submitted to the Hospital
EMSC/Educator who facilitates the performance reviews at least one week in advance of the meetings.
I affirm that the information attested to above is true and agree to comply with the above conditions and
provisions and understand that any deviations from the stated preceptor expectations may result in the
termination of my Preceptor status in the Northwest Community EMS System pending a review and
communication with my Chief/Supervisor or his/her designee.
Preceptor name: Please print Signature of Preceptor
Signature of Hospital EMSC/ Educator fin vM+e$i Date
cc: Provider EMS Coordinator (PEMSC); Hospital EMS Coordinator/educator
Preceptor file CJM: 5/99; Rev. 12117
My initials and signature on this learning contract acknowledge that I have received, read, understand, and agree to comply with the
expectations and restrictions specified in the NCH Paramedic Program student policies and procedures and guidelines of Harper
College. The terms of this agreement extend from September 11, 2017 until my date of graduation.
Initials Required Policy compliance to retain student status includes but may not be limited to the following:
• Maintaining required CPR credentials
• Maintaining an active EMT, AEMT, or EMT -I license until licensed as a paramedic
• Completing health requirements, immunizations, and providing required documentation on time
• Satisfying required criminal background and urine drug screening clearance
• Verifying personal health insurance that remains in full faith and force throughout the student tenure
• Completing and documenting required hospital clinical and field internship assignments and patient care
contacts in compliance with Program instruction plans
• Completing all evaluations on time in compliance with Program instruction throughout scheduled course and
up to 6 months post -graduation.
Maintaining HIPAA and confidentiality standards and universal standard precautions at all times, plus
contact and/or droplet precautions as indicated during class labs as well as in the clinical settings
Student behavior and conduct:
• Demonstrating principles of professionalism and complying with the codes of conduct in achieving the
affective objectives as defined by the program.
• Complying with principles of ethical behavior as defined by the Harper College Code of Conduct, NWC
EMSS Ethics policy, program guidelines and course syllabus.
• Assuming an active role for learning through engagement and compliance with course requirements.
• Being respectful of hospital property and adhering to rules of use for them.
• Refraining from recording or photographing lectures or class activities without the instructor's permission.
I affirm that I have received a copy or have been directed to electronic access to the NCH Paramedic Program
Student Handbook, NWC EMSS Standard Operating Procedures, Policy Manual, Procedure Manual and Standard
Drug & Supply list. I understand that I am accountable for fully reading each and acting in compliance with the
standards and requirements set forth in each.
I affirm that I have received a class academic calendar as currently planned. I understand that it may change for
cause and it is my responsibility to check the System website for updates and to attend all classes, labs,
examinations, and clinical experiences and to complete all assignments in compliance with Program policies.
I understand that failure to comply with Program policies in compliance with quality and time standards will trigger
corrective action and disciplinary consequences as specified in the student handbook.
I understand that if my behavior results in a clinical agency refusing to allow me to return, the program/college
are not obligated to find an alternate site, which will affect my continued participation in the program.
I understand that under the Family Educational Rights and Privacy Act (FERPA) I have access to my student
records and that the Program will hold my records confidential under the Act unless I consent to their release.
I affirm that I have been informed my IDPH EMT license number will be required on every quiz and exam Scantron
sheet as it will serve as my unique identifier for the grading software. Furthermore, I am aware that failure to provide
this number WILL NOT be considered an extenuating circumstance that would allow a make-up exam.
Furthermore, l also understand that.
• The Program reserves the right to change class policies or requirements without prior notification and that the
Program will inform me of those changes.
• This signed document will be placed in my student records.
• My social security number may be disclosed as required for regulatory and licensure requirements.
I release and fully discharge NCH, and it employees, agents, and representatives, from any claim, damages, liability, and causes of action which I, my
heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this
agreement. I represent and certify that my true age is at least 18 years old and am competent to contract in my own name. I have read this entire
Student Agreement. I fully understand the contents, meaning, and impact and agree to be bound by it.
Student name (PLEASE PRINT)
Student signature
NCH Paramedic Program representative Date