HomeMy WebLinkAbout1982-08-03 Council Packet - Work SessionKenai City Council
Work Session
August 3, 1982
CIP
EMT Contract with Hospital
Ordinance 791-82 Improvement
Districts
HEA Board Reply to Council
Water & Sewer West of Forest Drive
COUNCIL PACKETS
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AUGUST
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CITY OF KENAI
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/. O. SOX SIC KIMAI. ALASKA 99611
TILE/NONE 483 • INS
NOTICE OF WORK SESSION
There will be a City Council work session on
August 3, 1982 at 7:00 PM in the Council Chambers.
To be discussed:
1. Capital Improvement Projects and $250 per capita.
2. Proposed contract with hospital for EMT's.
3. Ordinance 791-82, Improvement Districts.
4. HEA Board reply to Council.
5. Possibility of water, sewer west of Forest Dr. and
north of Spur Highway.
Janet Whelan
City Clerk
Dated: July 27, 1982
i
i
CITY OF KENAI
►. O. SOX $00 KENAI. ALAEKA 99611
TELEINONE 2$3 • 7635
July 28, 1982
MEMORANDDMs
TO: Kenai City Council
FROMs Charles A. Brown, Finance Director etiQ
REs Capital Project Money
The following applications have been received recently from the
State of Alaska relating to entitlements or grants for capital
improvement moneys
Municipal Aid Entitlement $l,1131433.92
Municipal Grants:
Parks 6 Recreation 100000.00
Boat Ramp 300,000.00
Youth Center Phase II 800,000.00
Streets $2.690.000.00
Total $5,003,433.92
s
To be used for capital projects or social services. The project
must be approved by the voters if !.t is a DP.Ist capital project
costing $1,000,000 or more. That limit is increased to
85,000,000 if it is used to improve or rehabilitate an existing
facility.
The City Council must pass a resolution accepting the
entitlement. That resolution must identify the projects and
amounts relating to each project. These decisions need to be
made Rrier to returning the agreement to the State. After the
State signs the returned agreement, we formally have the money
available to use.
I have not placed such a resolution on the 8-4-82 agenda. I hope
that the decisions concerning projects will be made on 8-3-82,
and a resolution can be on the 8-18-82 agenda.
1
Municipal Grants:
I have given pertinent parts of each application form to the
Department Head (or City Manager in the case of the Boat Ramp)
responsible for the projects. The Street Grant will be of a
general nature (road improvements, to include water, sewer,
lighting, etc.). The Parks and Recreation Grant will be the
Ryan's Creek project and the Fort Renay Restoration project. The
Youth Center Phase II will be the Gym.
`- A resolution is required accepting these grants$ but it is less
specific than the Municipal Aid resolution. It is on the 8-4-82
agenda.
1 CAB/dc
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CITY OF KENAI
FIRE DEPARTMENT
BOX 598 • KENAI. ALASKA 99611
July 12, 1982
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TO: Wm. J. Brighton, City Manager
FROM: mkw-W. A. Winston, Fire Chief
SUBJECT: Contract Agreement with Hospital for EMT Training
The Central Peninsula General Hospital has offered the three
major EMS/Ambulance service providers the cooperation and use
of their facilities for the continual and on -going training of
EMT personnel. In order to do this, they have also offered a
written contract that must be signed and lived up to by all
parties involved. Some of the language and stipulations in
this contract make me a bit nervous or apprehensive at least.
As you are quite -aware, I am not at all comfortable with our
EMT III program as it stands and I can't help but feel that
we are just getting ourselves in deeper and deeper with no
concrete solutions to providing the service.
We have further received a new, revised set of Standing Orders
which the sponsoring physicians have agreed to, that, if we
sign, will lock us into a level of service delivery that we
may not be able to live up to at all times. I.e., hav4ng a
qualified EMT III on duty at all times to administer up to 15
different drugs, including morphine. This means that we must
have at least one (1) EMT III on duty 24 hours a day, 7 days
a week - or when we do not have the EMT III on duty, off come
the drugs, out go the Standing Orders for the EMT III level for
however long we are without the EMT III on duty. This not only
becomes frusterating for the EMT's, it means the Community would
have to try and pick the right day to get hurt or have a heart
attack.
WAW/kh
CONTRACT FOR
NIKISKI FIRE DEPARTMENT
KENAI FIRE DEPARTMENT
CENTRAL PENINSULA AMBULANCE
SERVICE AREA
This agreement is made this I day of (} 64-LST- , 1982, by and between
the Nikiski Fire Department, Kenai Fire Department and the Central Peninsula
Ambulance Service Area, hereinafter called the Departments, and Central
Peninsula General Hospital, hereinafter called the Consultant.
The three Departments are in need of a hospital setting in which to
conduct a practical education program for their Emergency Medical Technicians
and Paramedics, and
Whereas the Consultant is willing to offer that facility to the three
Departments for educational purposes and to supervise such an educational
program;
Now, therefore the parties agree that:
SECTION 1. SCOPE OF WORK
A. The Hospital shall provide an appropriate setting in which a pratical
educational program may be conducted for the Emergency Medical Technicians
and Paramedics of each Department. Educational training needs will be
scheduled by the Medical Training Coordinator for each Department through
the Hospital In Service Director. No student shall be considered an
employee of the Hospital and will not be included within the Hospital's
Workmen's Compensation or Professional Liabilities Programs.
B. The educational experience shall be limited to the areas of:
1. The Emergency Department. Each Student shall be assessed for
his/her level of knowledge. The educational program will be
designed on the basis of the student's skills and knowledge.
He/she will be supervised and directed individually in the
delivery of patient care by a Registered Nurse or Physcian.
Xe/she shall wear a name tag with his current level of training.
2. Operating Room, Coronary Care Unit and Delivery Room. The
student will be supervised and directed individually in the
delivery of patient care by a Registered Nurse or Physcian
to increase practical knowledge and skills.
1
page 2
III`
SECTION 2. TERMS..
I
The terms of this Contract shall be f rom At,IGt�S i , Iq� -to
Agf,� , t483. The Contract may be renewed upon written agree -
went of all parties concerned.
'
SECTION 3. TERMINATION AGREEMENT:
Either the Consultant or the Departments shall have the right to
terminate this agreement by notifying the other in writing of such
termination. The agreement shall be terminated at the end of 30 days
following the receipt of such notification by any party by registered
.---- '
mail.
-
SECTION 4. ASSIGNMENT:
No party shall assign or transfer any interest ar any part thereof
In this agreement without the other party's written consent. Any such
attempts without consent shall give the other party the option of
terminating this agreement without any further liability.
SECTION 5. INDEMNITY:
`
In view of the nature of the services to be provided to the Departments
and the lack of control by the Consultant over the operations of the
Departments, it is hereby agreed that the Departments shall defend, indemnify,
and hold the Consultant harmless from all liability,loss, damage, cost,
and expense, including attorney's fees which may arise from any claims
of third parties related to the performance, abscence of performance, or
breach of this agreement.
- — -
In addition, in the abscence of gross negligence or willful injury,
`?
the Departments hereby waives all claims and discharges all liability which
the Consultant may have to the Departments which may arise out of the
I
performance or abscence of performance of this agreement.
Each Department shall provide proof of medical malpractice insurance
-- -
to the Consultant.
s:.
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page 3
SECTION 6. JURISDICTION:
Any civil action brought by any party under this agreement shall be
commenced and maintained according to the laws of the State of Alaska.
IN WITNESS THEREOF, the parties hereto have executed this agreement
on the date and place indicated above.
ALFRED B. WILLIS
FIRE CHIEF
NIKISKI FIRE DEPARTMENT
STEVEN D. O'CONNOR
DIRECTOR PARAMEDIC OPERATIONS
NIKISKI FIRE DEPARTMENT
WALTER A. WINSTON
FIRE CHIEF
KENAI FIRE DEPARTMENT
DENNIS A. LOVETT
DIRECTOR EMERGENCY MEDICAL SERVICES
KENAI FIRE DEPARTMENT
JIM MATTI
PRESIDENT, BOARD OF DIRECTORS
CENTRAL PENINSULA EMERGENCY
MEDICAL SERVICE AND AMBULANCE
SERVICE AREA
JAMES DUNN
•DIRECTOR EMERGENCY MEDICAL SERVICES
CENTRAL PENINSULA EtMCENCY
MEDICAL SERVICE AND MOUIXICE
SERVICE AREA
MICHAEL J. LOCKU'OOD
ADMINISTRATOR
CENTRAL PENINSULA GENERAL HOSPITAL
ROBERT'A. ANDERSON
•PRESIDENT
LUTHERAN HOSPITALS A HOIfES SOCIETY
OF AMERICA
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page 4
CLINICAL INTERNSHIP OBJECTIVES FOR EMERGENCY F.0011
A. EMT I. During his/her experience in the emergency room, the Et.T I should have
the opportunity to practice under the direct supervision of a registered
nurse or physician, and demonstrate proficiency for each of the following;
1. Obtain histories
2. Do physical assessments including vital signs
3. Oxygen therapy via nasal cannula, mask or bag mask
4. Airway management with oral airways or nasopharyngeal airways
S. CPR
6. Control bleeding and wound care
1. Bandage and dressing applications
8. Administer Ipecac
9. Assist in the use of MAST trousers
B. EKT II. During his/her experience in the emergency room, the EMT II should have
the opportunity to practice under the direct supervision of a registered
nurse or physician, and demonstrate proficiency for each of the following;
1. Obtain histories
2. Do physical assessments including vital signs
3. IV rate calculation
4. Drug dosage calculation
5. Draw up medications;
a. amps .
b. vials ~
c. preloads
6. Administer the following medications under the direct supervision of a
registered nurse or physician;
a. Ipecac
b. Sodium Bicarbonate
c. Dextrose 50%
d. Narcan
e. Nitroglycerin
1. Oxygen therapy via nasal cannula, mask, bag mask, EOA. EGTA, nasopharyngeal
and oropharyngeal airways.
8. Suctioning
9. CPR
10. Control bleeding and wound care
11. Dressing and bandage application
12. Start peripheral IVs and draw blood for analysis
13. Assist in the use of MAST trousers.
14. Administer medications IM, IV and Sub Q.
0
page S
C. EMT III. During his/her experience in the emergency room, the E24T III
should have the opportunity to practice under the direct supervision
of a registered nurse or physician, and demonstrate proficiency for
each of the following;
1. Obtain histories
2. Do physical assessments including vital signs
3. IV rate calculations
4. Drug dosage calculations
5. Draw up medications
a. amps
b. vials
c. preloads
6. Administer the following medications under the direct supervision
of a physician or registered nurse;
a. Ipecac
b. Narean
c. Dextrose 50%
d. Sodium Bicarbonate
e. Nitroglycerin
f. Epinephrine 1:10,000
g. Epinephrine 1:1,000
h. Lidocaine
7. EMT III's that are ACLS qualified may administer the following
medications;
a. Lidocaine drip
b. Morphine Sulfate
c. Calcium Chloride
d. Bretylium Tosylate
e. Atropine Sulfate
f. Benadryl
S. Oxygen therapy via nasal cannula, mask, bag mask, EOA. EGTA, oropharyngeal,
and.aabopharyageal airways.
9. Suctioning
10. Administer medications IM, IV, Sub Q
11. EKG lead placement
12. EKG interpretations of V-tach, V-fib, and asystole.
13. EXT III ACLS qualified, EKG interpretations of all other dysrhythmias.
14. CPA including defibrillation
15. Control bleeding and wound care
16. Dressing and bandage applications
17. Start peripheral IVs and draw blood for analysis
18. Assist in the use of MST trousers
19. Assist with gastric lavages
20. Apply rotating tourniquets when indicated
21. Assist in triaging patients.
page 6
i
`` D. PARAMEDICS. During his/her experience in the emergency room, the Paramedic
should have the opportunity to practice under the direct supervision of a
registered nurse or physician, and demonstrate proficiency for each of the
following;
1. Obtain histories
2. Do physical assessments including vital signs
3. IV rate calculations
4. Drug dosage calculations
5. Draw up medications
a. amps
b. vials
c. preloads
6. Administer all medications, all routes
7. Oxygen therapy via nasal cannula, mask, bag mask, EOA, EGTA, ET tube,
oropharyngeal and nasopharyngeal airways.
8. Suctioning
9. Assist with gastric lavages
10. Pass naso-gastric tubes with supervision when indicated
11. EKG lead placement
12. Do 12 lead EKG
13. EKG interpretations of all dysrhythmias
14. CPR including Defibrillation
15. Start peripheral Ws and draw blood for analysis
16.'Start central venous Us (external jugular and femoral only)
17. Apply rotating tourniquets when indicated
18. Control bleeding and wound care
19. Dressing and bandage applications
20. Assist in the use of MAST trousers
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21. Assist in triaging patients
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page 7
CLINICAL INTERNSHIP OBJECTIVES FOR LABOR AND DELIVERY SUITE
A. During the experience in the delivery and labor suite, the Et4T III and
Paramedic should have the opportunity to practice under the direct
supervision of a registered nurse or physician and demonstrate proficiency
for each of the following;
1. Identify and label the three stages of labor and complications
and abnormal deliveries.
2. Assist or abserve in one normal cephalic delivery
3. Observe and assist, if possible, in abnormal deliveries
4. Assist, if possible, in the control of postpartum hemorrhage by
uterine massage and by infusion of oxytocin.
5. Assist, if possible, in the management of the newborn, including
severing the cord, suctioning, etc..
6. Assist, if possible, in the resuscitiation of the newborn.
CLINICAL INTERNSHIP OBJECTIVES FOR THE CARDIAC CASE UNIT
A. During the experience in the cardiac care unit, the W III and Paramedic
should have the opportunity to practice under the direct supervision of a
registered nurse or physician and demonstrate proficiency for each of the
following;
1.Perfora patient assessment including vital signs
2. Review patient's charts, diagnosis and treatment
3. Apply EKG leads
4. Monitor and interpret EKG's
S. Perform endotracheal suctioning
6. Assist in cardiac arrest management
7. Be familiar with the location and operation of equipment in the
coronary care unit
8. Observe placement of pacemakers
9. Evaluate blood gas measurements
10. Apply rotating tourniquets as indicated
11. Assist in dressing changes
12. Perform peripheral IVs and draw blood for analysis
13. Prepare and administer intramuscular, subcutaneous and IV medications
Pape 8
CLINICAL INTERNSHIP FOR OPERATING ROOM AND RECOVERY ROOM
hj A. EMT II. During the experience in the operating room and the recovery room,
the Dfr II should have the opportunity to practice under the direct
supervision of a registered nurse or physician and demonstrate proficiency
for each of the following;
1. Start peripheral IVa and draw blood for analysis
2. Maintain an airway in an unconscious patient using manipulations
and position of head, oropharyngeal airways and esophageal airways.
3. Observe aseptic endotracheal and orotracheal suctioning
4. Monitor vitals signs of an unconscious patient
B. EMT III and Paramedic. During the experience in the operating room and
the recovery room, the EMT III and the Paramedic should have the opportunity
to practice under the direct supervision of a registered nurse or physiciaa
and demonstrate proficiency for each of the following;
1. Observe endotracheal intubation
2. Start peripheral We and draw blood for analysis
3. Perform aseptic endotracheal and orotracheal suctioning
4. Prepare and administer IV medications and observe the effects of
pharmacological agents
S. Maintain an airway in an unconscious patient using manipulations and
positioning of bead,oropharyngeal airways, esophageal airways and
endotracheal tubes.
b. Monitor vital signs of an unconscious patient
7. Monitor the cardioscope and interpret EKGs, noting any changes or
Irregularities
S. Operate oxygen equipment and assist in the operation of the
mechanical respirators
9. Observe and assist in the treatment of various soft —tissue and
muscuoskeletal injuries.
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KENAI
FIRE DEPARTMENT
PREHOSPITAL PROTOCOLS
for
EMT
EMT 11
EMT Ill
and
PARAMEDIC .
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STANDING ORDER PROTOCOLS FOR EMT I THROUGH PARAMEDIC
The following protocols are for use by the Nikiski, Kenai and
Central Peninsula Ambulance Services medical personnel from
EMT I through Paramedic.
These protocols supercede all previous protocols and were
established under the auspices and authorization of
Dr. Peter 0. Hansen, M.D., and Dr. George Garnett, M.D.,
Physicial Advisors.
The development of these protocols was further aided by the
following people, Steven D. O'Connor. Nikiski Fire Department,
Dennis Lovett, Kenai Fire Department, and Randy Willis, Soldotna
Fire Department.
These protocols assume that a reasonable chance of resuscitation
exists and that transportation to the hospital should procede
without undue delay.
These protocols were accepted for use on July 1, 1982.
s
EMERGENCY MEDICAL TECHNICIAN
F= I
STANDING ORDERS
A. Patient Assessment
1. Primary survey/airway management
2. Secondary survey/vital signs
B. Airway Management
1. Oropharyngeal or Nasopharyngeal airway
2. Suction as needed
3. Oxygen
a. 10-15LPM via bagmask for arrest (cardiac or respiratory)
b. 3-BLPM via nasal cannula or mask for general or trauma
c. 1-2LPM via nasal cannula or mask with patients with COPD by history
4. Nasopharyngeal airways should be lubricated before insertion
C. Cardiac Arrest
1. American Heart Association Basic Life Support protocols
2. Oxygen 10-15LPM via bag or pocket mask
3. Suction as needed
D. Suspected Overdose/Poisoning
1. Airway protocol
2. If the patient is conscious with a gag -reflex, Ipecac 30cc by mouth for adults
with suspected or known overdose/poisoning. -Child dose is 15cc by mouth.
E. Trauma
1. General Trauma
a. airway management protocols
b. control severe bleeding (arterial or major venous)
c. immobilize head, neck and spine as indicated
d. control other bleeding with direct pressure or elevation as indicated
e. splint/traction as indicated. Check neurovascular status
f. hypotension - see MAST protocol
2. MAST Protocol
a. primary survey
1. maintain adequate ABC's
2. control external hemorrhage
b. Secondary Survey
1. assess all injuries
2. obtain vital signs and assess chest sounds bilaterally
3. record vital signs and pertinent information as soon as patient.•
care permits
c. Airway Protocol
J
page 2 EMT I
d. BAST Indications
1. pelvic or multiple leg fractures exist
a. if patient is normotensive, inflate only until fractures are
immobilized
2, signs of shock are present (rapid, weak pulse, pale, clammy skin,
altered level of consciousness, etc.) AIM systolic blood pressure
is less than 1O0mmHg
3. systolic blood pressure -is less than 80 mmHg in any adult patient
4. in the normotensive patient who presents with a history or
mechanism of injury suggesting the potential for the development
of shock. Garment should be applied as soon as patient care permits
with inflation occuring according to d., 2 b 3 above
e. Application and Inflation Procedures
1. before application, remove shoes, belt, and pants if time and
patient care permit. (empty pockets if pants are not removed)
2. inflate leg sections until easily dented with finger or until
systolic blood pressure is 100mmHg
3. recheck'blood pressure
4. if systolic blood pressure is less than 1O0mm!ig, inflate the
abdominal section until easily dented with finger or systolic
blood pressure is 10O=Hg
S. recheck blood pressure
6. if further pressure is needed, inflate.the legs and then the
abdominal section until one of the following occur:
a. patient's blood pressure is 1O0mmHg
b. pop off valves release
c. velcro fasteners begin to slip
f. Special Points
1. MAST should be Inflated on the basis of the patient's blood
pressure and not the pressure within the suit
2. DO NOT DEFLATE the MAST in the field except in the patient in
cardiogenic shock who develops pulmonary edema and"/or
worsening vital signs. In this case, seek advice from the
receiving physician
3. be alert for pressure changes caused by altitude and temperature:
variations J ,
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pipe 3 EMT I
- - g. Contraindications
lP 1. pulmonary edema
1
3. Burns
a. Airway protocol
b. Remove clothing and jewelry as needed
j c. Cool with irrigation solution
d. Cover with clean sheet or use burn pack
e. Estimate percentage of total body surface area involvement
f. Estimate thickness of burn(s)
i
g. Treat for shock
jh. Apply cold packs for localized burns
DRUG APPENDIX:
IPECAC - Supplies in liquid form, various sizes
Adult dose is 30cc
Pediatric dose is 15cc
Route of administration - orally followed by large
amounts of waters
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EMERGENCY MEDICAL TECHNICIAN
LEVEL 11
STANDING ORDERS
A. Patient Assessment
1. Primary survey/airway management
2. Secondary survey/vital signs
B. Airway Management
1. EOA or EGTA
2. Oropharyngeal or nasopharyngeal airway
3. Suction as needed
4. Oxygen
a. 10-15LPM via bagmask for arrest (cardiac or respiratory)
b. 3-8LPM via nasal cannula or mask for general medical or trauma
c. 1-2LPM via nasal cannula or mask with patients with COPD by history
5. EOA and EGTA cuff should be inflated to a maximum of 35cc of air
6. EOA, EGTA and nasopharyngeal airways should be lubricated before insertion
7. CPR should not be interrupted for more than 15 seconds for the placement
of EOA or EGTA. The patient should be hyperventilated prior to placement
attemp
S. In cases of suspected narcotics overdose 0.4mg Narcan preferably I.V, should
be administered prior to the placement of EOA or EGTA
C. Medical Emergencies
1. Airway management protocols
2. Coma or unknown etiology or suspected drug overdose/poisoning
a. airway protocols
b. IV D5W TKO with micro -drip tubing (draw 20 cc's blood for two red tops
and one purple top vaccutainer before starting I.V.)
c. D50 50cc I.V.
d. Narcan 0.4mg to 1.2mg I.V. Titrate to effect. In unable to establish
I.V., narcan may be administered IM or Sub-Q
e. if the patient is conscious with a gag -reflex, Ipecac 30cc by mouth for
adults with suspected or known overdose, Child dose is 15ce by mouth
3. insulin Shock or Diabetic Coma
a. I.V. D59 TKO with micro -drip tubing (draw 20 cc's blood for two red tops
and one purple top vaccutainer before starting I.V.) 1
b. check blood sugar levels with dextrostix
1. if loss blood sugar is indicated, less than 90 by dextrostix, administer
V50 at 0.5 grams/kg up to 25 grams I.V.
2. if dextrostix measurement is 90 or greater, do not administer D50
page 2 f`ST lI
c. treat for shock
D. Cardiac
1. Suspected Myocardial Infarction
a. airway protocol
b. attach EKG monitor leads for LEAD 2 if available
c. IV DSW TKO with micro -drip tubing (draw 20 cc's for two red tops
and one purple top vaccutainers before starting IV)
d. alert patient with mild to moderate discomfort with no previous
nitroglycerin, patient may be given nitroglycerin X 3 at 5 minute
intervals sublingual from patient's own prescription.
2. Cardiac Arrest
a. verify arrest
b. American Heart Association Basic Life Support Protocols
c. airway protocols
d. IV DSW TKO with micro -drip tubing (draw 20 cc's blood for two red
tops and one purple top vaccutainers before starting IV)
e. Sodium Bicarbonate at I.OmEq/KG initial dose up to 10O.0mEq. Repeat
at tea minute intervals at one half initial dose
f. attach EKG monitor leads for LEAD 2 if available
E. Trauma
1. .General Trauma
a. airway management protocol
b. control severe bleeding (arterial or major venous)
c., immobilize head, neck,and spine as indicated
d. IV lactated ringers with macro -drip tubing and large bore needle
(draw 20 cc's blood for two red tops and one purple top vaccutainer
before starting IV) Titrate to maintain blood pressure of 90-100mmR g
systolic. More than one IV may be necessary
e. control other bleeding with direct pressure or elevation as indicated ,
f. splint/traction as indicated. Check neurovascular status
g. hypotension - see MAST protocol
2. HAST Protocol
a. primary survey
1. maintain adequate ABC's !
2, control external hemorrhage •
d
v. ge 3 EHT 11
b. secondary survey
1. assess all injuries
2. obtain vital signs and assess chest sounds bilaterally
3. record vital signs and pertinent information as soon as patient
care permits
c. airway protocol
d. MAST indications
I. pelvic or multiple leg fractures exist
a. if patient is normotensive, inflate only until fractures are
Immobilized
2. signs of shock are present (rapid, weak pulse, pale, clammy skin,
altered levels of consciousness, etc.) AND systolic blood pressure
is less than 100mmHg
.3. systolic blood pressure less than 80mmHg in any adult patient
4. in the normotensive patient who presents with a history or mechanism
of injury suggesting the potential for the development of shock.
Garment should be applied as soon as patient care permits with
inflation occuring according to d., 2 6 3 above.
e. application and inflation procedures
1. before application, remove shoes, belt and pants if time and patijent
care permits. (empty pockets if pants are not removed)
2. inflate leg sections until easily dented with finger or until systolic
blood pressure is 100mmHg
3. recheck blood pressure
4. if systolic blood pressure is less than 100mmHg, inflate the abdominal
section until easily dented with finger or systolic blood pressure is
100mag
S. recheck blood pressure
6. if further pressure is needed, inflate the legs and then the abdominal
section until one of the following occurs:
a. patient's blood pressure is 100mmHg
b. pop off valves release
c. velcro fasteners begin to slip j
J
page 4 EMT II
h
f. special points
1. MAST should be inflated on the basis of the patient's blood pressure
and not the pressure within the suit
2. DO NOT DEFLATE the MAST in the field except in the patient in
cardiogenic shock who develops pulmonary edema and/or worsening
vital signs. In this case, seek advice from the receiving physician
3. be alert for pressure changes caused by altitude and temperature
variations
T; S. contraindications
I. pulmonary edema
3. Burns
a. airway protocol
b. remove clothing and jewelry as needed
C. cool with irrigation solution
d. cover with clean sheet or use burn pack
e*
apply cold packs for localized burns
f. estimate percentage of total body surface area
g. estimate thickness
h. IV lactated ringers with macro -drip tubing and large bore needle with
burns over 20% total body surface area on adults and 10% total body
surface area or more on children. More than one IV may be necessary.
(draw 20 cc's blood for two red tops and one purple top vaccutainer
f before starting IV)
L. treat for shock
t
DRUG APPENDIX
Supplied
Adult
Dose
Pediatric
Route Of
Dose
Administration
Dextrose 50Z
Preloaded Syringe
O-5gram/kg
O-5gram/kS
I.V. only
25 grams in 50ce
Ipecac
Liquid-Vari
size bottle
amounts of wate.i
Subcutaneous
Nitroglycerin
Tablets
may repeat at
five minute
Sodium Bicarbonate
Preloaded Syringe
1-OmE/kg
I-OmEq/kg
intervals X 3
I.V. only
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1
EMERGENCY MEDICAL TECHNICIAN
LEVEL III
STANDING ORDERS
A. Patient Assessment
1. Primary survey/airway management
2. Secondary survey/vital signs
B. Airway Management
1. Oropharyngeal or nasopharyngeal
2. EOA or EGTA
3. Endotracheal intubation is an option for those EMT III's who have
successfully passed an American Heart Association Advanced Cardiac
Life Support Class and are approved by their physician advisor.
4. Suction as needed
5. Oxygen
a. 10-15 LPM via bagmask for arrest (cardiac or respiratory)
b. 3-8 LPM via nasal cannula or mask for general medical or trauma
c. 1-2 LPM via nasal cannula or mask for patients with COPD history
6. EOA and EGTA cuff should be inflated to a maximum of 35cc of air
7. E-T tube should be inflated until no air is heard to escape around
the tube or to a maximum of lOcc of air
S. WA, EGTA, E-T tube, and nasopharyngeal airways should be lubricated
before insertion
9. CPR should not be interrupted for more than 15 seconds for the placement
of EOA. EGTA, or E-T tube. The patient should be hyperventilated prior
to placement attempts.
10. In cases of suspected narcotics overdose, 0.4mg Narcan preferably I.V.,
should be administered prior to the placement of EOA, EGTA, or E-T tube
C. Medical Emergencies
1. Coma of unknown etiology or suspected drug overdose/poisoning
a. airway protocol
b. I.V. D5W TKO with micro -drip tubing (draw 20 cc's blood for two
red tops and one p purple top vaccutainer before starting I.V.)
c. D50 - 50cc I.V.
d. Narcan 0.4 to 1.2mg I.V., titrate to effect. If unable to establish
I.V., Narcan may be administered I.M. or Sub-Q
EMT III page 2
e. if the patient is conscious with a gag -reflex, Ipecac 30cc by mouth
for adults with suspected or known overdose/poisoning. Pediatric
dose is 15cc by mouth
2. Insulin Shock or Diabetic Coma
a. airway protocol
b. I.V. D5W TKO with micro -drip tubing (draw 20 cc's blood for two
red tops and one purple top vaccutainer before starting I.V.)
c. check blood sugar levels wiih dextrostix
1. if low blood sugar is indicated, less than 90 by dextrostix,
administer D5O at 0.5grams/kg up to 25 grams
2. if dextrostix measurement is 90 or greater, do not administer D50
d. treat for shock
3. Asthma
a. airway protocol
b. I.V. D5W TKO with micro -drip tubing (draw 20 cc's blood for two red
tops and one purple top vaccutainer before starting I.V.)
c. cardiac monitor
d. Epinephrine 1:1,000 0.3mg sub-Q for adults
e. Epinephrine 1:1,000 O.lmg sub-Q for pediatric
4. Seizures
a. airway protocol
b. protect patient from injury - do not restrain
c. I.V. D5W TKO with micro-drXp tubing (draw 20 cc's blood for two red
tops and one purple top vaccutainer before starting I.V.)
5. Anaphylaxis
a. airway protocol
b. Epinephrine 1:1.000 0.3mg Sub-Q if no shock or respiratory distress
.present. Pediatric dose is O.lmg Sub-Q
c. if shock and/or respiratory distress is present:
1. Epinephrine 1:1,000 0.3mg IM or I.V. Pediatric dose is O.lini IM
or I.V.
2. apply loose tourniquet proximal to sting with 0.3mg 1:1,000 i
Epinephrine Sub-Q at sting site to be massaged in. Pediatric --
dose is O.lmg Sub-Q.
EMT III page 3
d. I.V. lactated ringers with macro -drip tubing and large bore needle,
titrate for shock (draw 10 cc's blood for two red tops and one
purple top vaccutainer before starting I.V.)
e. Benadryl 50mg I.M. for adults
f. cardiac monitor
g. treat for shock
6. Acute Pulmonary Edema/Congestive Heart Failure
a. airway protocol
b. patient in position of comfort
c. I.V. D5W TKO with micro -drip tubing (draw 20 cc's blood for two
red tops and one purple top vaccutainer before starting I.V.)
d. Morphine Sulfate 2.0 to 4.Omg I.V. slowly, titrated to effect. May
be repeated at five minute intervals as needed to 15mg I.V.
e. rotating tourniquets
1. to be placed on three extremities at a time and rotated every
10-15 minutes. They are to be placed on the most proximal
portion of the extremity and tightened to occlude venous but
not arterial flow.
f. NOTE: NARCAN MUST BE AVAILABLE ANY TIME MORPHINE SULFATE IS
AD14INISTERED
D. Trauma
1. General Trauma
a. airway protocol
b. control severe bleeding (arterial or major venous)
c. immobilize head, neck, and spine as indicated .
d. I.V. lactated ringers with macro -drip tubing and large bore needle
3 (draw 20 cc's blood for two red tops and one purple top vaccutainer
4, before starting I.V.) Titrate to maintain blood pressure of 90-100mmHg
a systolic. More than one I.V. may be necessary
-y e. control other bleeding with direct pressure and/or elevation as indicated
f.. splint/traction as indicated - check neurovascular status
g. hypotension - see MAST protocol i
s_
h. if unable to obtain a peripheral I.V. an external jugular or femoral
I.V. is an option if:
t:
i
EMT III page 4
1. severe shock, blood loss, and/or significant hypotension exists
AND:
2. the EMT III has successfully passed an American Heart Association
Advanced Cardiac Life Support Class and is approved by their
physician advisor
L. Morphine Sulfate 2-5mg I.V. at five minute intervals titrated to
pain relief for extremity trauma
J. NOTE: NARCAN MUST BE AVAILABLY ANYTIME MORPHINE SULFATE IS...
ADMINISTERED
2. MAST Protocol
a. primary survey
1. maintain adequate ABC's
2. control external hemorrhage
b. secondary survey
1. assess all injuries
2. obtain vital signs and assess chest sounds bilaterally
3. record vital signs and pertinent information as soon as patient
care permits
c. airway protocol
d. MAST Indications
1. pelvic or muliple leg fractures exist
S. if patient is normotensive, inflate only until fractures are
immobilized
'2. signs of shock are present (rapid, weak pulse, pale, clammy skin,
altered levels of consciousness, etc.) AND systolic blood pressure
is less than 100mmHg
3. systolic blood pressure less than 80mmHg in any adult patient
4. in the normotensive patient who presents with a history or
mechanism of injury suggesting the potential for the development
of shock. Garment should be applied as soon as patient care permits
with inflation occuring according to d., 2 b 3 above
e. application and inflation procedures* i
1. before application, remove shoes, belt,and pants if time and patient
care permits. (empty pockets if pants are not removed)
-
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page �
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2. inflate leg sections until easily dented with finger or until
systolic blood pressure is 100mMHg
3. recheck blood pressure r
4. if systolic blood pressure is less than 100=Hg, inflate the
I
abdominal section until easily dented with finger or systolic
blood pressure is 100mmHg
S. recheck blood pressure
i
6. if further pressure is needed, inflate the legs and then the
abdominal section until one of the following occurs:
a. patient's blood pressure is 100mmHg j
b. pop off valves release -
•
c. velcro fasteners begin to slip ;
f.
Special points
1. MAST should be inflated on the basis of the patient's blood pressure
and not the pressure within the suit
2. DO NOT DEFLATE the WT in the field except in the patient in
cardlogenic shock who develops pulmonary edema and/or worsening `.
vital signs. In this case, seek advice from the receiving physician
3. be alert for pressure changes caused by altitude and temperature I,
variations
i.
g.
contraindications
-
1. pulmonary edema
�
3. Burns
a.
1
airway protocol
b.
remove clothing and jewelry as needed
'
C.
cool with irrigation solution
I.:
d.
coves with clean sheet or use burn pack
e,
apply cold packs to localized burns
f.
estimate percentage of total body surface area involvement and thickness
_..i:
of burn if possible i
---"
g.
I.V. lactated ringers with macro -drip tubing and large bore needle with
I
burns over 20% total body surface area on adults and 102 total body
surface area on children (draw 20 cc's blood for two red tops and one
purple top vaccutainer before starting I.V.) More than one I.V. may.
be necessaty
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1
EMT III page b
h. treat for shock/maintain body temperature
I. Morphine Sulfate 2-5mg I.V. at five minute intervals titrated to
pain relief
J. NOTtt NARCAN MUST BE AVAILABLE ANYTIME MORPHINE SULFATE IS
ADMINISTERED
4. Cricothyrotomy - for airway obstruction
a. American Heart Association protocol for airway obstruction
b. airway protocol
c- palpate cricothyroid membrane
d. prep site for puncture
e. use 14 gauge over -the -needle catheter and insert through membrane
f. confirm bilateral breath sounds
g. secure in place with tape
5. Tension Pneumothorax
a. airway protocol
b. I.Y. lactated ringers with macro -drip tubing and large bore needle
(draw 20 cc's blood for two red tops and one purple top vaccutainer
before starting I.V.)
e. auscultate lungs thoroughly to ascertain any diminished lung sounds,
absence of lung sounds, or hyper -resonance of affected side
d. observe trachea for shifting to unaffected side
e. splint any flail segments to prevent paradoxical movement
f. if tracheal deviation is apparent or patient exhibits increasing
respiratory distress, a weak pulse, fall in blood pressure, distention
of neck veins, and bulging of upper intercostal tissue use either
14 gauge over -the -needle catheter or McSwain Dart as follows.
1. prep chest wall for puncture
2. palpate second intercostal space, mid -clavicular line, on the
affected side
3. insert either 14 gauge needle or McSwain Dart through the chest
wall over the top of the second rib
4. if using a 14 gauge needle attach a finger of a rubber glove 'to
the hub to create a one-way flutter valve or if using the
McSwain Dart attach the heimlich valve
Em !I! page 7
5. secure needle catheter or McSwain Dart to chest wall
6. ascultate lung sounds and observe patient for reduction of
tension pneumothorax
E. OB/M
1. airway protocol
2. I.V. lactated ringer with macro -drip tubing and large bore needle
(draw 10 cc's blood for two red tops and one purple top vaccutainer
before starting I.V.) More than one I.V. may be necessary
MAST, protocol if indicated
THE FOLLOWING CARDIAC PROTOCOLS ARE FOR THOSE EMT III's
WHO HAVE NOT SUCCESSFULLY PASSED AN AMERICAN HEART
ASSOCIATION ADVANCED CARDIAC LIFE SUPPORT PROGRAM
F. Cardiac - NON ACLS
1. SUSPECTED myocardial infarction
a. airway protocol
b. cardiac monitor
c. I.V. D5W TKO with micro -drip tubing (draw 20 cc's blood for two
red tops and one purple top vaccutainer before starting I.V.)
d. for alert patient with mild to moderate discomfort who has had no
Nitroglycerin, the patient may be given Nitroglycerin X 3 at five
minute intervals sublingual
e. for ventricular tachycardia, PVC's at six or more per minute, multi -
focal PVC's, administer VidbcaineL-t 1.Omg/kg up to 100.Omg I.V.
May repeat in fifteen minutes for a maximum dose of 200mg Z.V.
2. UNMONITORED ventricular fibrillation
a. confirm arrest
f
b. American Heart Association Basic Life Support
c. quick -look with paddles to confirm V-fib
r
d. if not V-fib, procede to appropriate algorithm
"- - e. if V-fib, continue with Basic Life Support, charge paddles to 200 watt
seconds and defibrillate
--s f. if there is a change in rhythm. go to the appropriate algorithm -
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EMT III page 8
g. if there is no change in rhythm, continue CPR, recharge the paddles
to 200 watt seconds and defibrillate
h. if there is a change in rhythm, go to the appropriate algorithm
I. if there is no change, continue CPR, start I.V. of D5W TKO with
micro -drip tubing (draw 20 cc's blood for two red tops and one
purple top vaccutainer before starting I.V.) Secure the airway
with EOA or ECTA if not already done
J. administer Epinephrine 0.5 to 1.0mg I.V.
k. administer Sodium Bicarbonate 1.OmEq/kg initial dose I.V. up to
IOOmEq
1. continue CPR, recharge paddles to 360 watt seconds or maximum output
and defibrillate
m. if there is a change in the rhythm, go to the appropriate algorithm
a. if there is no change, recharge paddles to 360 watt seconds or maximum
output and defibrillate
o. if there is a change in the rhythm, go to the appropriate algorithm
P. if there is no change, repeat Epinephrine 0.5mg I.V. at five minute
intervals and Sodium Bicarbonate at one half the initial dose at ten
minute intervals
q. transport may occur during any phase of the procedure
r. do not interrupt CPR more than fifteen seconds at any one time
3. Monitored Ventricular Fibrillation
a. confirm arrest, confirm V-fib. If not V-fib, go to appropriate
algorithm
b. if V-fib confirmed, use precordial thump
C. if change in rhythm, go to appropriate algorithm
d. if no change in rhythm, initiate Basic Life Support, charge paddles
to 200 watt seconds, and defibrillate
e. if change in rhythm, go to appropriate algorithm
f. if no change in rhythm, recharge paddles to 200 watt seconds and'
defibrillate
g. if change in rhythm, go to appropriate algorithm �
h. if no change in rhythm, continue CPR, start I.V. D5W TKO with micro -drip
tubing (draw 20 cc's blood for two red tops and one purple top vaccutainer
before starting I.V.) Secure the airway with EOA or ECTAjif not already
done
r
EMT III page 9 '
I. administer Epinephrine 0.5mg I.V. i
J. administer Sodium Bicarbonate 1.OmEq/kg I.V. up to 100mEq
k. refer to unmonitored V-fib algorithm letter "L" and procede
4. Asystole
a. American Heart Association Basic Life Support
b. secure airway with EOA or EGTA
c. start I.V. D5W TKO with micro -drip tubing (draw 20 cc's blood for two
red tops and one purple top vaccutainer before starting I.V.)
d. administer Epinephrine 0.5 to I.Omg I.V. and repeat at five minute j
intervals j
i
e. administer Sodium Bicarbonate at 1.OmEq/kg up to 100mEq as initial ;
dose and repeat at one half the initial dose at ten minute intervals
f. continue CPR
g. if change in rhythm, go to appropriate algorithm
b. if no change in rhythm, continue CPR and medications as above'
I. may defibrillate once at maximum output n
j. transport may occur during any phase of the procedure
k. do not interrupt CPR more than fifteen seconds at any one time
5. Electra -Mechanical Dissociation
a. confirm arrest
b. American Heart Association Basic Life Support
c. secure airway with EOA or EGTA
-- d. cardiac monitor
j, e. start I.V.,D5W TKO with micro -drip tubing (draw 20 cc's blood for two
red tops,and one purple top vaccutainer before starting I.V.)
f. administer Epinephrine 0.5 to 1.0mg I.V.
g. administer Sodium Bicarbonate at 1.OmEq/kg up to 100mEq as an
initial dose
h. if change in rhythm, go to appropriate algorithm
I. if no change in rhythm, continue CPR, repeat •epinephrine at 0.5mg I.V.
at five minute intervals and Sodium Bicarbonate at one half the initial
dose every ten minutes i
Frans ort may occur during an -
j• p y g y phase of the procedure
' 1
k. do not interrupt CPR more than fifteen seconds at any one time. ;
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EST III page 10
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6. Ventricular Tachycardia
a. confirm V-tach with cardiac monitor
b. check for pulse, check level of consciousness, CPR as indicated
c. administer precordial thump
d. if change in rhythm, go to appropriate algorithm
e. if no change in rhythm, start I.V., if not already done, of D514 TKO
with micro -drip tubing (draw 20 cc's blood for two red tops and one
purple top vaccutainer before starting I.V.)
f. administer Lidocaine at 1.Omg/kg up to 100mg. May repeat in fifteen
minutes for a maximum dose of 200mg I.V.
g. if change in rhythm, go to appropriate algorithm
h. in the unconscious patient with no change in rhythm, cardiovent at
200 watt seconds, synchronized if available
I. transport may occur at any phase of the procedure
j. if CPR is indicated it should not be interrupted more than fifteen
seconds at any one time
THE FOLLOWING CARDIAC PROTOCOLS ARE FOR THOSE EMT III'S WHO
HAVE SUCCESSFULLY PASSED AN XZRICAN HEART ASSOCIATION ADVANCED
° CARDIAC LIFE SUPPORT CLASS AND WHO ARE APPROVED BY -THEIR PHYSICIAN
ADVISOR TO OPERATE UNDER THESE PROTOCOLS
t
G. Cardiac - ACLS
1. Suspected myocardial infarction
a. airway protocol
b. cardiac monitor
} C. I.V. D5W TKO With micro -drip tubing (draw 20 cc's blood for two red
tops and one purple top vaccutainer before starting I.V.)
s d. for alert patient with mild to moderate discomfort who has had no
f f'
Nitroglycerin, the patient may be given Nitroglycerin X 3 at five-minute
Intervals sublingual
`T e. for patients with severe discomfort not relieved by ..,itroglycerin,j
Morphine Sulfate 2.0 to 5.0 mg I.V., t1trated to pain relief at
five minute intervals to a maximum dose of 15mg.
i
EMT III page 11
f. NOTE: NARCAN MUST BE AVAILABLE ANYTIME MORPHINE SULFATE IS
ADMINISTERED
g. for ventricular tachycardia, PVC's at six or more per minute, or
multi -focal PVC's'idocaine at 1.Omg/kg up to 100mg I.V.
h. if ectopics are not alleviated Lidbeaine may be repeated in fifteen
minutes to a maximum dose of 200mg or a Lidocaine drip may be
established as follows:
2 grams of Lidocaine in 500cc of D5W to give a concentration
of 4.Omg/cc. Start drip at 15uggts/min. Drip may be
increased to 60uggts/min.
2. Unmonitored Ventricular Fibrillation
a. confirm arrest
b. American Heart Association Basic Life Support
c. quick -look with paddles to confirm V=fib
d. if not V-fib, procede to appropriate algorithm
e. if V-fib, continue with basic life support, charge paddles to 200 watt
seconds and defibrillate
f. if change in rhythm, go to appropriate' algorithm
S. if no change in rhythm, continue CPR, recharge paddles to 200 watt
seconds and defibrillate
h. if change in rhythm, go to appropriate algorithm
I. if no change in rhythm, continue CPR, start I.V. of D5W TKO with micro -drip
tubing (draw 20 cc's blood for two red tops and one purple top vaccutainer
before starting I.V.) Secure the airway with E-T tube, EOA, or EGTA
if not already done
J. administer Epinephrine 0.5 to 1.0mg I.V.
k. administer Sodium Bicarbonate at 1.OmEq/kg up to 100mEq as an initial
dose.
1. continue CPR, recharge paddles to 360 watt seconds or maximum output
and defibrillate '
m. if change in rhythm, go to appropriate algorithm
n. if no change in rhythm, recharge paddles to 360 watt seconds or i
maximum output and defibrillate
o. if change in rhythm, go to appropriate algorithm
p. if no change in rhythm, administer Bretylium Tosylate S.OmVkg I.V.
up to 5O0mg
EMT III page 12
1
q. continue CPR for two minutes
r. defibrillate at 360 watt seconds or maximum output
s. if change in rhythm, go to appropriate algorithm
t. if no change in rhythm, administer Bretylium Tosylate lO.Omg/kg IV.
u. continue CPR and administer Sodium Bicarbonate at one half the initial
dose at ten minute intervals
v. defibrillate at 360 watt seconds or maximum output
w. if change in rhythm, go to appropriate algorithm
x. if no change in rhythm, repeat Epinephrine at 0.5mg I.V. at five
minute intervals, Sodium Bicarbonate at one half the initial dose at
ten minute intervals and Bretylium '.osylate at 10.Omg/kg I.V. at fifteen
minute intervals
y. transport may occur during any phase of the procedure
z. do not interrupt CPR more than fifteen seconds at any one time
3. Monitored Ventricular Fibrillation
a. confirm arrest, confirm V-fib. If not V-fib go to appropriate algorithm
b. if V-fib confirmed, administer precordial thump
c. if change in rhythm, go to appropriate algorithm
d. if no change in rhythm, initiate basic life support, charge paddles
to 200 watt seconds and defibrillate
e. if change in rhythm, go to appropriate algorithm
f. if no change in rhythm, recharge paddles to 200 watt seconds and
defibrillate
g. if change in rhythm, go to appropriate algorithm
h. if no change in rhythm, continue CPR, start I.V. D5W TKO with micro -drip
tubing (draw 20 cc`s blood for two red tops and one purple top
vaccutainer before starting I.V.) Secure airway with E-T tube, EOA
or EGTA if not already done
I. administer Epinephrine 0.5mg I.V.
J. administer Sodium Bicarbonate at 1.OmEq/kg I.V. up to IOOmEq
k. refer to unmonitored V-fib algorithm letter "L" and procede
' i
EMT III page 13
4,' :Asystole
a. American Heart Association Basic Life Support
b. secure airway with EOA, ECTA, or E-T tube
c. start I.V. of D5W TKO with micro -drip tubing (draw 20 cc's blood for
two red tops and one purple top vaccutainer before starting I.V.)
d. administer Epinephrine 0.5 to 1.Omg I.V.
e. administer Sodium Bicarbonate at 1.OmEq/Kg up to 100mEq as an initial dose
f. if change in rhythm, go to appropriate algorithm
g. if no change in rhythm, administer 1.0mg Atropine I.V. This may be
repeated in five minutes for a total dose of 2.Omg I.V.
h, if change in rhythm, go to appropriate algorithm
i. if no change in rhythm, administer Calcium Chloride 500mg, ten percent
solution I.V.
J.
if change in rhythm, go to appropriate algorithm
k. if no change in rhythm, continue CPR, repeat Epinephrine 0:5mg I.V.
at five minute intervals, Sodium Bicarbonate at one half the initial
dose at ten minute intervals, and Calcium Chloride 500mg, ten percent
solution I.V. at ten minute intervals
1. may defibrillate once at maximum output
m. transport may occur at any phase of the procedure
n. do not interrupt CPR more than fifteen seconds at any one time
5. Electro-Mechanical Dissociation
a. American Heart Association Basic Life Support
b. secure airway with EOA, ECTA, or E-T tube
c- cardiac monitor
d. start.I.V, of D5W TKO with micro -drip tubing (draw 20 cc's blood for
two red tops and one purple top vaccutainer before starting I.V.)
e. administer Epinephrine 0.5 to 1.0mg I.V.
f. administer Sodium Bicarbonate at 1.OmEq/Kg up to 100mEq as an initial dose
g. if change in rhythm, go to appropriate algorithm
h. if no change in rhythm, continue CPR, administer Calcium Chloride 500mg,
ten percent solution I.V. `r
I. if change in rhythm, go to appropriate algorithm
J. if no change in rhythm, continue CPR, repeat Epinephrine 0.5mg I.V.1at
five minute intervals, Sodium Bicarbonate at one half the initial dose
at ten minute intervals, and Calcium Chloride 500mg, ten percent solution
I.V. at ten minute intervals j
11
EMT III page 14
f .I
k. transport may occur at any phase of the procedure
1. do not interrupt CPR more than fifteen seconds at any one time
6. Ventricular Tachycardia
a. confirm V-Tach with cardiac monitor
b. check for pulse, check level of consciousness, CPR as indicated
c. administer precordial thump
d. if change in rhythm, go to appropriate algorithm
e, if no change in rhythm, start Z.V. if not already done, of DSW TKO
with micro -drip tubing (draw 20 cc's blood for two red tops and one purple
top vaccutainer before starting I.V.)
f. administer Lidocaine at 1.Omg/kg I.V. up to 100mg
g. if change in rhythm, go to appropriate algorithm
h. if no change in rhythm:
1. in the unconscious patient, cardiovert at 200 watt seconds,
synchronized if available
2. in the rapidly deteriorating conscious patient, cardiovert at 50 watt
seconds, synchronized if available
i. if change in rhythm, go to appropriate algorithm
J. if no change in rhythm, administer Bretylium Tosylate at 5.Omg/kg I.V.
up to 500mg over a ten minute period
k. if change in rhythm, go to appropriate algorithm
1. if no change in rhythm in the unconscious patient cardiovert again
at 200 watt seconds, synchronized if available
m. if change in rhythm, go to appropriate algorithm
n. if no change in rhythm, repeat Bretylium Tosylate at 5.Omg/kg I.V.
at fifteen minute intervals'
o. if change to a stable rhythm occurs at any phase of the procedure
establish a Lidocaine drip as follows:
2 grams of Lidocaine in 500cc of DSW to give a concentration of
4.0mg/cc. Start drip at 15uggts/min. Drip may be increased to.
60uggts/min.
p. transport may occur at any phase of the procedure
q. if CPR is indicated it should not be interrupted more than fifteen
seconds at any one time
J
,EiKT III page 15
• s
4
7. Bradycardia
`
a.
confirm bradycardia with pulse check and/or cardiac monitor
b.
airway protocol
c.
start I.V. of D5W TKO with micro -drip tubing (draw 20 cc's blood
for two red tops and one purple top vaccutainer before starting I.V.)
d.
check blood pressure. If less than 90mmRg systolic, pulse less than
60/minute, and the patient is symptomatic administer Atropine
O.15mg I.V.
J
j
e.
if there is no change, repeat Atropine at 0.75mg I.V. at five
--
minute interval to a total dose of 2.25mg I.V.
f.
CPR as indicated
g.
transport may occur at any phase of the procedure
c1
h.
do not interrupt CPR more than fifteen seconds at any one time
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EMT I I I
DRUG APPENDIX
Supplied
Adult
Dose
Pediatric
Dose
Route of
Administration
Atropine
Preloaded Syringe
0.75mg
.4.Olmg/kg
I.V. only
1.0mg in lOcc
2.25mg max
0.5mg maximum
Benadryl
Preloaded Syringe
50mg
1.Omg/kg
I.H.
50mg in ice
"Bretylium
Glass Ampule
5m R/k8
None
I.V. only
Tosylate
500mg in IOcc
{ ,Calcium
Preloaded Syringe
500mg
20mg/kg
I.V. only
'Chloride
1,O00mg in lOcc
Dextrose 50Z Preloaded Syringe 0.5mg/kg 0.5mg/kg
25 grams in 50cc
Epinephrine Preloaded Tubex 0.3mg O.lmg
'1:1,000 1.0mg in ice
Epinephrine Preloaded Tubex 0.5mg to O.lmg/kg
1:10000 l.Omg in lOcc 1.Omg
Ipecac Liquid - Various 30cc 15cc
size bottle
-;.idocaine 22 Preloaded Syringe 1.Omg/kg 1.0mg/kg
100mg in 5cc
a ,
y
k
I.V. only
I
Z.V., I.M.jSub-Q
Z.V. or Endotrachea
i
Orally with large
amounts of water
a
B
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Supplied
Adult pediatric
Dose Dose
Route of
Administration
Lidocaine
2
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1.0-4.0mg/min 0.03mg/kg/min
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grams
grams in 50cc
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NOTE:
ADULT LIDOCAINE DRIP
IS:
2 grams in SOOcc DSW
to give a concentration of 4.Omg/cc.
Start
drip at l5uggts/min.
Drip may be increased to 60uggts/min.
PEDIATRIC LIDOCAINE DRIP IS:
100mg in SOOcc D5V! to
give a concentration of 0.2mg/cc.
Start
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drip at lOuggts/min.
to yield 0.03mg/kg/min.
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2.Omg - 15mg 0.1 mg
Imp• -
Sulfate
15mg in lcc
titrated to
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pain relief
Narcan
Glass Ampule
0.4mg in lcc
0.4m g - 1.2mg O.Olmg/kg
I.V., I.H., Sub-Q
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Nitroglycerin
Tablets
0.4mg/tablet
1 tablet none
Sublingually - may
repeat at five
minute intervals
R 3
Sodium
Preloaded Syringe
'50mEq
1.OmEq/kg 1.OmEq/kg
I.V. only
Bicarbonate
in 50cc
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1
i
CITY OF KENAI
ORDINANCE NO, 791-82
AN ORDINANCE OF THE COUNCIL OF THE CITY OF KENAI, ALASKA, TO
REPEAL AND RE-ENACT KHC 16 TO CORRECT, CLARIFY, AfM MAKE MORE
EFFICIENT PROCEDURES CONCERNING IMPROVEMENT DISTRICTS.
WHEREAS, Title 16 of the Kenai Municipal Code provides for public
improvement districts including initiation by petition or by
Council resolution, procedures under each method of initiation
which while substantially similar, have minor variations which
could cause confusion, in one instance does not follow Charter
provisions, and in other provisions are either w.biguous or set
forth in terms that in some instances would prevent any
possibility of providing an improvement district with a portion
of the costs paid for by property owners, and
WHEP.EAS, attempting to amend this ordinance to straighten out all
of the problems would be so complicated as to completely confuse
the issues so that it is much simpler to repeal and re-enact the
entire title, and
WHEREAS, collections of, and foreclosures on, parcels in
assessment districts already in effect should not be placed in
jeopardy by this repeal and re-enactment.
NOW, THEREFORE, BE IT ORDAINED BY THE COUNCIL OF THE CITY OF
KENAI, ALASKA, as follows:
Sggtign is No improvement districts established prior to
the effective date of this ordinance shall be affected in any
way, and particularly as to interest, penalty, collections, and
foreclosures by the repeal and re-enactment of Title 16 contained
herein, but all properties in said improvement districts on which
assessments are still due and unpaid shall continue to be subject
to Title 16 as it existed prior to the effective date of this
ordinance.
GggtJQU_2: Subject to the provisions of Section 1 above,
KLIC 16 is hereby repealed and re-enacted to read as follows:
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PUBLZ�IkIP$QYP�B�_&PP�I8L..88.&P&&bY�
Chas,:
SOU Oserty OutAif€-2isui0t
atio.�. n of Aaajang=
SICUM s
16.05.010 Assessment authority,
16.05.020 Now improvement proposal initiated.
16.05.030 Requirements of petition.
16.05#040 Contents of resolution,
16.05.050 Permissible methods for financing
local improvement districts,
16.05.060 Authorized capital improvements.
16,05.070 Property assessed.
16.05,080 Amount assessed.
16.05.090 Costs.
16,05,100 Method of assessment,
16,05,010 Assessment Authoritys (a) The City Council may
assess against the property of a governmental unit and private
real property benefited all or a portion of the cost of
constructing or improving capital improvements. Any such special
assessment shall be in proportion to, and shall not exceed, the
value of the benefit from the improvement,
(b) All benefited real property, including that which is
exempt from taxation in accordance with law, shall be liable for
the cost of public improvements assessed unless specifically
2
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exempted from assessments for public improvements by law. No
assessments shall be levied in excess of 25% of the fair market
value of the property after giving effect to the benefit accruing
from the work or action for which assessed.
16#05.020 �Qy�.,�g�QYg n g�Q$Q6�]_Ini ia�€�t (a) An
improvement proposal may be initiated bys
(1) Petition to the City Council filed with the City Clerk,
by the owners of property in the proposed improvement
district, or,
(2) Resolution of the City Council.
i 16.05,030 $Cgyil�gp��Q�g �j,Qas The petition shall
include a description of the proposed improvement. The petition
shall be signed by the owners of 50% or more of the properties
which will be benefited by the proposed improvement. No property
- owner may withdraw his approval of the proposed improvement for a
period of six months after the petition has been filed, unless
authorized by Council.
1�;
16.05.040 �4AD�0..4�$€iiQ],BQIIs The resolution of the
City Council initiating an improvement proposal shall include a
description of the proposed improvement and direct the City
Manager to make an investigation and report thereon.
16.05.050 permissible Method"Inanaing LoQ61
1=rQvement DiOtLjQt&s (a) By general obligation bonds: e
(1) Local improvement districts for capital improvements
may be financed by use of funds obtained from the sale of
general obligation bonds approved by the voters of the City
of Kenai for such capital improvements.
(2) The principal and interest of general obligation bonds
so issued shall be payable from the levy of assessments
against the property benefited, but any deficiency in
meeting payments of principal and interest shall be made up
by an appropriation from the general fund. The assessments
shall constitute a sinking furd for the payment of principal
and interest on the bonds.
(3) interest or funds borrowed to finance the capital
improvement prior to the sale of general obligation bonds
shall be a cost of the improvement district.
(b) By special assessment bonds%
(1) The City Council may, by ordinance, authorize the
3
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issuance and sale of special assessment bonds to pay all or
part of the cost of an improvement in a local improvement
district. The principal and interest of bonds so issued
shall be payable solely from the levy of special assessments
against property to be benefited. The assessments shall
constitute a sinking fund for the payment of principal and
interest on the bonds. The property benefited may be
pledged by the Council to secure a payment.
(2) Interest on funds borrowed to finance the capital
improvement prior to the sale of special assessment bonds
shall be a cost of the improvement district.
(c) By City funds (with or without subsequent recovery by
assessment against benefited property).
(d) By any combination of two or more of the above.
16-05,060 allth=iaed CaPA&AI_IMpL2YQIDPQ31tA (a) A special
assessment district for a public improvement may be initiated for
any one or more of the following improvementss
(1) Streets, roads, parkways, street lighting, curbs,
gutters, driveways, curb cuts, and sidewalks;
(2) Storm sewers, drains, or settling basins;
(3) Sanitary sewers, including interceptors, collectors,
laterals, and sewer service connections;
(4) Parks or playgrounds;
(5) Off-street parking facilities;
(6) Changes in channels of streams or watercourses;
(7) Bridges, culverts, bulkheads, embankments, or dikes for
stream or watercourses;
(8) Water supply systems, including water mains, water
distribution lines, water service connections, and fire
hydrants;
(9) Public shelters; or
(10) Street, road, parkway and sidewalk drainage, dust
control, or snow removal.
16.05.070 ftQMt"fiSQBW; The Council may assess for an
improvement any real property benefited or any interest in real
property benefited, and the property benefited may include
abutting, adjoining, adjacent, contiguous, non-contiguous, or
other property or interest in property benefited directly or
indirectly by the improvement. The property to be assessed may
include any property which is otherwise for any reason exempt
from taxation by law. A benefited property may be included in
whole or in part in more than one local improvement district.
4
16.05.080 amauat-Aaaaaaads The Council may assess 100% of
any or all costs of a public improvement against the parcels of
property benefited by the improvement. Unless a specific method
of computation of the benefit to the property is expressly
provided in this chapter for ascertaining the amount to be
assessed against the property benefited by a designated
improvement, the Council shall assess each parcel of property in
a local assessment district in proportion to the value of the
benefits received from the improvements.
16,05,090 Qat&s The costs of an improvement shall be the
actual costs of the improvement, including acquisition of
interest in land for the improvement, design, engineering,
administration, overhead, professional services, bond costs, and
interest incurred as a result of the improvement, and all other
costs resulting from the construction of the improvement. Bond
r interest shall be calculated from the first date when actual
costs are incurred by the City.
16.05.100 =hQd_Q"ftaCaML1Ls The provisions of this
chapter shall not prevent or be construed to prevent the
collection of assessments or payment in lieu of assessments for
improvements in any other manner as provided by law. The methods
of assessment are described in general herein and will require
decisions of policy by the Council to meet current needs. In
general, the assessment rate for any special assessment district
is computed by dividing the total assessable cost of such
improvement by the total number of assessment units. The entire
project is considered as a whole when computing the assessment
rate and applying it to all properties. The cost of installing
the improvement in front of or past any particular parcel of
property is only one method permitted of assessment. Except as
otherwise provided by law, ordinance, or by Council -approved
policy for a particular local improvement district, costs will be
allocated on a square footage basis extending one lot deep
adjacent to improvements in subdivided areas, midway between
streets up to 150 feet of depth in unsubdivided residential
areas, and up to 300 feet of depth in unsubdivided commerical and
industrial areas. Greater area may be included when assessing
costs for interceptor sewers or water mains providing fire
protection.
5
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16.10.010 City manager action.
16.10.020 Preliminary assessment roll.
16.10.030 Setting of public hearing on improvement
district.
16.10.040 Notice of public hearing on improvement district.
16.10.050 Written objections.
16.10.060 Public hearing on improvement district.
16.10.070 Council action.
16.10.080 Assessment roll.
16.10.090 Setting hearing on assessment roll.
16.10.100 Notice of public hearing on assessment roll.
16.10.110 Public hearing on assessment roll.
16.10.120 Correction and determination of
assessment roll.
16.10.130 Resolution confirming assessment roll and
fixing payment.
16.10.140 Payment.
.- 16.10.150 Notice of payment.
16.10.160 Objection and appeal.
16.10.170 Reassessment.
16 #10,010 My,,,dager Amos (a) The City Manager
shall, within 60 days after the filing of the petition or passage
of the resolution, make a survey of, and report on, the proposed
improvement to the City Council concerning the need for, the
desirable scope of, and the estimated cost of the proposed
improvement, prospective grants that might be secured to assist
in payment for the improvement, recommendation as to grant
application, and the recommended percentage of the improvement
plan cost to be assessed against the property benefited. The
report shall contain a description defining the district and the
properties to be assessed and showing the desirable scope of the
proposed improvement. The proposed improvement district may be
defined bys
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(1) metes and bounds descriptionf or
(2) by a designation of the benefited properties to be
assessed by lot, block, and subdivision.
16,10.020 ELrJJmJaar."aargffMCnt_R211s Within 30 days
after consideration by the Council of the survey and report, the
City Manager will prepare and file with the City Clerk a
preliminary assessment roll for the proposed improvement. This
preliminary assessment roll will include the name of the record
owner, a brief description or designation of the property, and
the estimated amount to be assessed against the property.
16 ,10 , 030 $ il1S_Q�P1i�27.j.0�(iSa�it1S�1_III{ELQYaIDa33�
PlatrUt,s within 30 days after the presentation of the
preliminary assessment roll by the City Manager, the Council
shall by resolution set a date within 60 days after the date of
setting for a public hearing on the proposed improvement.
16.10.040 =ige o" hlic i"XJn"a_UPt.QY.eMga"JAtL Jgt s
Prior to the date of hearing the City Clerk shall publish a
notice at least once a week for four consecutive weeks in a
newspaper of general circulation distributed within the
municipality. This notice shall include a summary of the
improvement, the designation of the properties to be assessed in
the local improvement district, the purpose of the public
hearing, the time and place fixed for the public hearing, the
fact that a preliminary assessment roll is on file with the City
Clerk, and information as to the manner and method of making
written protest or objection to the action to be taken. The City
Clerk shall also send notice by mail to every record owner of
property within the proposed local improvement district at least
15 days prior to the public hearing which, in addition to the
information contained in the published notice, shall include a
designation of the addressee's property to be assessed and the
estimated cost to be assessed against such property.
16.10.050 VxJtt€0_QkJSgtionss Objection to the improvement
plan may be filed in writing with the City Clerk until, but not
on, the date of public hearing. The City Clerk shall present to
Council at the time of the hearing all objections filed in
writing.
16.20.060 Public Agaring on IMRLg ent nistri&,: At the
i
time and place noticed, the Council shall hold a public hearing
upon the necessity for the proposed improvement. The Council
shall hear all interested persons favoring or opposing the
proposed improvements and shall consider all written objections
filed.
16,10,070 COURGil-A0t1Qns After the public hearing is
closed, the Council may increase or decrease the scope or value
of the improvement, or may delete from the proposed improvement
district properties not benefited by the improvement or add
properties which would be benefited and shall adopt a resolution
directing continuation or termination of the modified improvement
district. No change may be made resulting in an improvement
district objected to by owners of properties bearing 50% or more
of the estimated cost to be borne by the property owners except
with the approval of at least six members of the Council. The
resolution directing continuation shall find that the improvement
is necessary and of benefit to the properties to be assessed, and
that it is not objected to by owners of properties bearing 50% or
more of the estimated costs to be borne by property owners or, in
the alternative, that it has been approved by at least six
members of the Council. The findings of the Council are
conclusive. The resolution shall further require that an account
be kept of all costs of the improvement and that after all costs
are known the City Manager shall prepare an assessment roll for
the improvement. The resolution shall state the estimated
percentage of the costs of the improvement to be assessed against
the benefited properties.
26.10,080 A90902man"alls After the improvement has been
completed and the costs of the improvement computed, the City
Manager shall prepare and file with the City Clerk an assessment
roil for the assessment district. The assessment roll shall
contain, as to each property to be assessed, a brief description
or designation of the property, the name of the record owner of
the property to be assessed, and the amount to be assessed
against the property. The person in whose name property is
listed on the municipal property tax roll as owner is
conclusively presumed to be the legal owner of record. if the
owner is unknown, the assessment may be made against the "unknown
owner."
26.10 # 090 getting_ Ug"Ung on Aaagagmantgoll s After the
assessment roll is filed, the Council shall fix the time and
place for a public hearing on objections to the assessment roll.
16.10.100 �Q�S,CQ_Q�_Pul@lSg_�iQdfSaC_Qt���fi8f30E�£��_t3@l1s
Notice shall be given for the public hearing on the assessment
roll as proscribed in KMC 16,10.040 above. The notice to be
published shall include a summary of the improvement, the
designation of the properties to be aasosced in the assessment
district, the purpose of the public hearing, and the time and
place fixed for the public hearing. The notice by mail, in
addition to the information contained in the published notice,
shall include the amount of the actual assessment a ainst the
property owned by the addressee. Each notice by mail shall
generally inform the property owner of the manner and method of
protesting or objecting to the action to be taken at the public
hearing,
16.10.110 Pu�3�S0_gCDLSi�S_Qa�00Q0t�ID0ll�..BQ�Is At the public
hearing, an owner of the property to be assessed shall have the
right to present his objections to the assessment roll by showing
errors and inequalities in the assessment roll and by submitting
any reason for amendment and correction of the assessment roll.
16.10.120 CQ1�4g�SQII.Aa�f3�QfAt1Dfi�SQi1_Qg.,ilOO�i�i0DL3O�..8Q11=
After the public hearing, the Council may correct any error or
inequality in the assessment roll, when the roll is finally
determined, the City Clerk shall so certify and the roil shall be
officially recorded,
16 ,10.130 BQOQlY�1g3i_���1�tAll.tla�l�@QOt�IDfd��..8Q3��tille�ig�8
ZgyMgnts After the public hearingg and detormination of the
assessment roil, Council, by rosolution, shall confirm the
assessment roll of the local improvement district, The
resolution shall provide for the levying of the assessment
against the property included within the district and may
establish a sinking fund for payment of principal and interest on
i any bonds which may be sold to finance the improvement, Tho
resolution shall also fix times of payment, schedule of payments,
rate of interest on unpaid installments, the date of delinquency
of assessments, and the penalty and interest to be paid on
_ delinquent assessments. On delinquent assessments, penalty and
interest shall be in accordance with the provisions of KNC
1.75.0100
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16,10,140 RQyMUUts Payment may not be required sooner than
60 days after assessment, Payment may be in a lump sum or by
installments,
16-10.150 (a) Within 30 days after the
time of payment has been fixed, the City Clerk shall mail a
statement to each owner of record designating the property, the
assessment amount, the time of delinquency, and penalties,
(b) Within five days after the statements are mailed, the
City Clerk shall publish notice that the statements have been
mailed,
16,10,160 Qh10G11Q0_And.rB2BQaIs (a) The regularity or
validity of an assessment may not be contested by a person who
did not file with the City Clerk a written objection to the
assessment roll before its confirmation,
(b) The decision of the City Council upon an objection may
be appealed to the Superior Court within 30 days of confirmation
of the assessment roll,
(a) if no objection is filed or an appeal taken within the
time provided in this section, the assessment procedures shall be
considered regular and valid in all respects,
16,10.170 (a) The City Council shall within
one year correct any deficiency found by a court in an
assessment.
(b) Procedure for notice and public hearing for
reassessment muut conform to that utilizied for the initial
assessment procedures,
(a) Payments on the initial assessments are credited to the
property upon reassessment,
(d) The reassessment becomes a charge upon the property
notwithstanding failure to comply with any provision of the
assessment procedure,
t#�l�S��$QP.ESTY..4uT,�IpY..gI�TRIQT
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16.15.010 Receipt of services.
16.15,020 In -lieu payment credited on subsequent
assessment.
16,15,030 Liens for in -lieu payments.
16.15.040 Initiation of benefits and "in -lieu payments".
16.15.050 Establishment of amount.
16.15.060 "In -lieu payment" rate determination.
16.15.010 BSQBiQ�_Q�_8SAYIQC@s Real property contiguous to
or adjoining local improvement districts may receive the services
from said contiguous improvement districts if a payment is made
in lieu of assessments which is at least equal to the rate of
assessments within the district. Such a payment may be referred
to as an "in -lieu payment".
16 ,15 , 020 :Sa-1S81�.PdYIDt3Dh L�$ S�QiL�1i�tB8S11SG�
80aggOMWts If an "in -lieu payment" has been made for a public
improvement to a property, then the amount of that payment may be
credited to the amount due for payment of any later assessment if
said property is included in a local improvement district
established in the future for the same service.
16.25.030 Any lien created
by an "in -lieu payment" shall have the same priority and
characteristics as a counterpart assessment and may be collected
in the same manner.
26.15.040 jpj, ��, ..Q BSIIS�i�&�O�.:SD:1iIIlLPaYmSD�S=s
(a) Receipt of the benefits by paying an "in -lieu payment" for
benefits of public improvements may be initiated by eithers
(1) The initiative of the Council in the event benefits are
being received for which no payment has been made; or
(2) upon the application of the owner of a property to be
benefited by a public improvement which will be paid for by
"in -lieu payments".
16.15.050 HBtAhJ"bMCnt_Qf..Bmounts if the Council deems it
necessary, the establishment of the amount of the "in -lieu
payment" may be processed as required by KMC 16.10.070 through
16,20,130 of this Code.
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16.15.060 �Zp`liBY_g$Xm�il:���€_pS�£YIItia6�iQ31s (a) After
determination that services from a public improvement should be
paid for by an "in -lieu payment" procedure rather than by
assessment of benefited property, then the Council shall
establish rates for such improvements as follows:
(1) For benefits from connection to the water distribution
system, an "in -lieu payment" shall be computed at the same
rate per square foot of property to be benefited as was
applied in the improvement district;
(2) For benefits from connection to the sewer distribution
system an "in -lieu payment" shall be computed at the same
rate per square foot of property to be benefited as was
applied in the improvement district; or
(3) Other public services other than those enumerated in
this section shall be paid for at a rate to be determined at
the time of application for the requested service.
maQtieraa.zn
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16.20.010 Use of improvements.
16.20.020 Foreclosure of assessment liens.
16.20.030 Cumulative enforcement.
16.20.040 Penalty and interest.
16.20.050 Payment of assessments upon transfer
of title.
16,20.060 Penalty,
26.20.010 212mantas Whenever public
improvements have been constructed by the City of Kenai in any of
the public streets, alleys, or other places of the City and
whenever assessments or charges of any portion of the cost of
such improvements have been made upon the properties specifically
benefited by such improvements, no permit shall be issued by any
City official or employee for any private connection to the
;,. public improvement from any property so assessed and benefited
unless the amount of the assessment or the charges placed against
1 said parcel of property have been paid, or if the assessment or
charges are due in installments, unless all payments due at the
12
time of application is made for the �--
PP permit have been paid. This
provision shall apply to all cases in which assessments have been
levied, whether void or otherwise, and which are uncollected or
on which installments are due and unpaid, and all cases where
charges have been made and have not been paid. Nor shall a
permit for any connection to the public improvement be issued by
any City officer or employee for parcels of property owned by the
United States or the State of Alaska without having said
governments pay an equal amount to the assessment otherwise
levied.
16.20,020 =297,Mn of.�BsgessmSat�_Ugnas Assessments are
liens upon the property assessed and are prior and paramount to
all liens except municipal tax liens. They may be enforced as
provided in Alaska Statutes, Section 29.53.200 through Section
29.53.390. Upon default in a payment due on an assessment
district financed by general obligation bonds, the City Council
may enforce payment of principal and interest, and cost of
collection in a civil action in the same manner and with the same
effect as actions for the foreclosures of mortgages on real
property. Foreclosure shall be against all property on which
assessments are in default. The period of redemption shall be
the same as in the case of mortgage foreclosures on real
property. Monies received from actions taken against property
for non-payment of assessment shall be credited to the Sinking
Fund. Upon default in a payment due on an assesssment district
financed by special assessment bonds, a bond holder or the City
Council may also enforce payment of principal and interest and
costs of collection in a civil action as herein above outlined.
16.20.030 CUMU"tive p�nforgements The collection,
foreclosure, or enforcement of any installment or any part of a
special assessment shall not bar, prevent, or otherwise
extinguish the right of the City to collect, foreclose, or
enforce the payments of any other installment or part of the same
or any other special assessment.
26.20.040 $gpalty and In�tgrggts Failure to pay an
assessment before delinquency shall result in imposition on such
assessment payment of a penalty charge of 10% of the amount due
and the assessment and penalty shall draw interest at the rate of
8% per annum.
13
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16 , 20 , 050 8axmsn_Qf��&easmsn���iltaa_Tran&fCL_Qf�i�la s
All past due installments on any special assessments levied on
property in any improvement district within the City of Kenai
shall be paid in full with applicable interest and penalty prior
to the time any transfer of title to that property is duly
recorded in accordance with statute. The transferor of the
property shall be responsible for ensuring that the provisions of
this section are complied with.
16.20.060 8snaltys Any person who violates the provisions
of KMC 16.20.050 is guilty of a misdemeanor and punishable by a
fine not to exceed $300. The penalty provided for herein may be
assessed for each parcel to which title is transferred and shall
not bar regular foreclosure proceedings provided for herein nor
be applied on, or as a set-off to, any assessments or charges
against said properties.
16.20.070 gtQration of_eSaga=snts (a) where any property
on the approved assessment roil or for which in -lieu payments
have been established is subsequently subdivided or resubdivided,
then the amount of principal and interest due on such property at
the time of such subdivision or resubdivision shall be prorated
between or among the subdivided or resubdivided lots in
proportion to the benefited area contained
subdivided or resubdivided to
(b) In the event that ahy ations of the pra rty sAject
to assessment is dedicated for public street or other public
purpose, then the entire unpaid amount of principal and interest
assessed against the original property will be prorated between
or among the lots resulting from the subdivision or resubdivision
in proportion to the benefited area contained in each such lot.
14
PASSED BY THE COUNCIL OF THE CITY OF KENAI, ALASKA, this 4th day
of August, 1982,
VINCEA�T O'REILLY, 21AYOR�
ATTESTS
Janet Whelan, City Clerk
15
First Readings July 21, 1982
Second Reading: August 4, 1982
Effective Date: September 4, 1982
�` Homer Electric Association, Znc.
M /WM P.O. BOX 429 ■ HOMER. ALASKA 99603 ■ (907) 235-8551
I ' r
July 14, 1982
Mr. William J. Brighton, City Manager
City of Kenai
P. O. Box 580
Kenai, Alaska 99611
Ref: Pole Relocation Costs
Dear Bill:
The Homer Electric Board of Directors met officially July 13,
1982. At that meeting quite extensive discussion was held
concerning the pole relocation problem. The Board, again,
restated its hope that this can be settled outside of court.
The proposal suggested by the Kenai City Council of July 7
was not accepted by our Board. A counter proposal was passed
by the Board which is as follows:
"Homer Electric will not bill the City of Kenai for
any unpaid relocation costs incurred prior to January 1,
1982. The City of Kenai will agree to pay all reasonable
and proper costs incurred after January 1, 1982, for re-
location of Homer Electric facilities, including KCL
facilities, whenever the City of Kenai requests those
facilities to be relocated."
It is the intent that the relocation costs the City should pay
would be the same types that are paid by the Cities of Soldotna,
Homer and Seldovia, the Kenai Peninsula Borough, and the State
of Alaska. I would recommend the methodology of billing and
the components therein to be very similar to that utilized by
the State. That formula has been a tried and proven formula.
We would appreciate your bringing this counter proposal to the
City Council for their consideration. Thank you for your
cooperation.
Sincerely yours,
H0' 2E4ECTR1jCASSOCIATION, INC.
en lick
General Manager
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CITY OF KENAI
%0d G'ari%l of 4"
/. O. BOX SBO KENAI. ALASKA 99611
TELEPHONE 283 • 733S
July 91 1982
Mr. B. Kent Wick
General Manager
Homer Electric Association
P. 0. Box 429
Homer, Alaska 99603
Dear Mr, Wicks
This is a follow—up on the telephone conversation I had with your
secretary on July 8 concerning Council's action at their regular
meeting on July 7 in regards to HEA and the City of Kenai's
controversy over relocation of utility lines.
The Council passed a motion, and I quote *BEA will make no claims
for relocation work done prior to January 1, 1983, The City of
Kenai will pay 50% of all relocation costs requested by the City
of Kenai which were necessitated by road improvement projects by
the City of Kenai after January 1, 1983. It is the City's
contention that even if HEA is moving their utility lines because
of the City's request to do so, the City will pay no costs
incurred by HEA's upgrading of said lines".
I would assume after you and your board have had time to digest
the City Council's action that you will get in touch with me.
Sincerely,
t"A.
Wm. 411.3 BrigWton
City Manager
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