Ride Along: Student - Emergency Medical Services Charlotte NC

MEDIC'S STUDENT RIDE ALONG GUIDELINES + FORM

The purpose of this guideline is to establish a procedure to be followed by students and riders affiliated with our partners, who will ride along in Medic Emergency vehicles.

To participate in the student ride along program, your coordinator will send your information to our scheduling department. The next step in the process will be to complete the Student Ride Along form for the day of your ride with us.

You may NOT ride along until your request has been accepted and approved.

Medic reserves the right to disapprove any request without cause.

**If you would like to ride along with MEDIC, but you are not in an affiliated program, contact: Diamond Durham, HR Coordinator, at DiamondD@Medic911.com.

RIDER EXPECTATIONS

What To Wear:

White-collared, button-down shirt or department/agency/school uniform shirt. Current certification patches are permitted.

Black/Dark Blue slacks/EMS pants. Black athletic shoes or black EMS-style boots.
School uniform ID is desirable but not required.
Photo ID must be carried with you during your ride along.
Clean, neat appearance.
- Facial hair policy: Must be clean shaven or goatee style beards and mustaches only.
- Piercings:
  - No eyebrow, lip, and visible transdermal piercings are allowed.
  - You may wear a nose piercing with a stud-style insert up to 1 mm or a nasal septum piercing that is not visible.
Consider having appropriate gear for inclement weatherv as we are often outside for long periods of time.

Please arrive 15 minutes prior to the start of your shift.

Riders who do not comply with the clothing requirements will not be allowed to ride their scheduled shift.

You must wear seat belts at all times when the vehicle is in motion, unless it is impossible to do so. You may not drive the ambulance at any time for any reason. Individuals who are not riding as part of a field preceptor experience are not permitted to treat patients and are only permitted to observe and perform limited tasks as instructed by the crew.

You are expected to observe courteous, common sense behavior towards our patients, crews, facility staff and any other people you may come into contact with while on our ambulance.

You must be at least 18 years old in order to participate in the ride along program.

Riders are expected to follow all direction from the crew at all times and to adhere to all safety rules, including wearing of any personal protective equipment as directed by the crew.

Riders who do not comply with these rules will be asked to leave and will not be allowed to ride again.

These rules are subject to change and/or revision at any time with/without notice.

STUDENT RIDE ALONG APPLICATION

We look forward to your ride along with us! Your coordinator has sent us your information for your ride along. For the next step in the student and affiliated rider process, please complete this form for the day of your ride time.

Today's date: *

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone *

Home Phone

EMERGENCY CONTACT

Name *

First

Last

Phone *

ADDITIONAL INFO

Affiliation (agency, school, business, self) *

Current Certification Level *

ID Upload *

Click or drag a file to this area to upload.

For you to ride with us, we will require a copy of a valid photo ID. A student ID is acceptable, a driver's license is preferred. ****You must have your ID with you the day you ride with us.

CONFIDENTIALITY AND DISSEMINATION OF PATIENT INFORMATION

Given the nature of our work, it is imperative that we maintain the confidentiality of patient information that we receive in the course of our work. Mecklenburg EMS Agency prohibits the release of any patient information to anyone outside the organization unless required for purpose of treatment, payment, or healthcare operations and discussions of Protected Health Information (PHI)within the organization.
Acceptable uses of PHI within the organization include, but are not limited to, exchange of patient information needed for treatment of the patient, billing, and other essentials healthcare operations, peer review, internal audits, and quality assurance activities.
I understand that Mecklenburg EMS Agency provides services to patients that are private and confidential and that I am a crucial step in respecting the privacy rights of patients. I understand that it is necessary in the rendering of services, that patients provide personal information and that such information may exist in a variety of forms such as electronic, oral, written, or photographic and all such information is strictly confidential and protected by federal and state laws.
I agree that I will comply with all confidentiality policies and procedures set in place by Mecklenburg EMS Agency during my entire association with Medic. If I, at any time, knowingly or inadvertently breach the patient confidentiality policies and procedures, I agree to notify Medic immediately by sending an email to MadisonK@medic911.com. In addition, I understand that a breach of patient confidentiality may result in suspension or termination of my association with Mecklenburg EMS Agency.
I understand that I may never take pictures or patients or scenes, write down patient information, or in any way use or release patient information during or after my ride time with Medic. This includes patient names, date of birth, dates of transport, pickup or drop off locations, medical status or any other information associated with any patient I encounter during my association with Medic.

ACKNOWLEDGEMENT

I, the undersigned, hereby request to accompany the Mecklenburg EMS Agency personnel on emergency and routine medical calls for the purpose of expanding my personal and professional interests and abilities. I am fully aware of the potential risks and dangers involved, the possibility of witnessing emotionally traumatic situations and that unexpected dangers may arise during such activities. I assume all risks of injury to my person, both mental and physical, or property that may be sustained in connection with the stated and associated activities.

In consideration that permission is granted to me to ride on a Mecklenburg EMS Agency ambulance, I do hereby, for myself, my heirs, administrators and assigns release, remise and discharge the Mecklenburg EMS Agency from all claims, demands, action and causes of action of any sort, for injuries sustained by my person, both mental and physical and/or property during my presence on said premises and participation of the stated activities.

I represent myself and certify that my true age is stated below. I certify that my attendance and participation in the above stated activities is voluntary and that I am of sound body and mind.

I certify that I fully read the waiver and release, confidentiality forms and guidelines. I certify that I fully understand all that has been written as it applies to me.

Lastly, I understand that any rider - at any time or reason shall be subject to removal and/or rejection from this program without explanation.

AGREEMENT *

By checking this box, all riders have read and fully understand the guidelines, release, and confidentiality policies above, including those required to have a parental signature. I agree to strictly adhere to all confidentiality guidelines that prohibit the dissemination of any patient information including but not limited to social media platforms.