Calling Off / Late Arrivals 

Calling Off, Employee;

  1. Speak with a manager. 

  2. Update dispatch. 

  3. Reach out to co-workers to swap and trade days before calling off.

  4. Provide a an alternative person who can cover your shift.

  • Call Off; an unapproved absence from work where you notified a manager and dispatch 8 hours prior to the start of your shift. 

  • No Call No Show; with consideration to state and federal law; this scenario will likely lead to termination; calling off of work within less than 8 hours of your scheduled start time.  All factors will be considered. 

Late Arrival, Employee; 

  1. Contact a supervisor or dispatch. 


  • 3 Late arrivals in a 7 day period OR 8 in Calendar Year ; Final Written Warning 

Dispatch & Supervisor;


  1. Update When2Work.

  2. Ask the employee if they can work a different day in the week, provide them with options.

  3. Adjust the staffing, call in staff early to cover the short shift, AND OR, contact other staff to work the open shift. 

  4. Generate Incident Report.  

Work Injuries


  1. Report to a manager without delay. 

  2. Report to dispatch. 

  3. Initiate self and or partner care.

  4. Injury easily managed with self over the counter self care do not require an urgent care or hospital visit.  

  5. Complete incident report.

  6. Complete CA State Reporting Form.

  • If the employee is going to be seen at a treatment facility or stop working, the employee will clock out and remain off the clock. 

  • The injury will be reported to the state of CA and insurance carrier. 

  • Lost or missing wages and follow up care will be ​discussed between the insurance provider adjuster and employee, and not issued by Horizon Ambulance. 

  • Initial care at urgent care facilities must be authorized by Horizon Ambulance. 

Dispatch or Supervisor - HOW TO MANAGE THE EMPLOYEE; 

  • Manage employee care first; send to clinic, ER, or activate 911

  • then call a Supervisor/Manager, do not stop until you speak with one or the other.

  • If applicable; partners and other employees can drive each other to the urgent care or other treatment facilities 

What to do with the employee; 

  1. Employees do not need to go to the clinic if they feel comfortable self-treating with over the counter medication or first aid.

  2. Serious illness and injuries, life threatening emergencies, and the conditions that threaten the loss of life, limb or eyesight must go to the emergency department, or activate 911

  3. If the employee is not experiencing serious illness or injury, and requires more than over the counter care, or self-care, they should go to an urgent care clinic,

  • Sunrise Multi-Specialist Medical Center

  • 714-771-7420

  • Address: 867 S Tustin St, Orange, CA 92866


  • Immediate Medical Center

  • 714-228-0411

  • Address: 15330 Valley View Ave Ste 1, La Mirada, CA 90638

Accidents & Breakdowns

  • During a vehicle failure or accident it is preferable to exit freeways and busy roads and park in a safe location designated for parking. 

  • Manage incident safety first, then call a Supervisor/Manager; do not stop until you speak with one or the other.

When a crew reports a mechanical failure or accident dispatch and supervision must obtain the following information;


  • Exact location

  • Nature of incident

  • Number of persons on board

  • Patients

  • Status of patients

  • Hazards Present

  • Resources needed

  • Other pertinent information


General provision to crew:


  • If an unstable patient is onboard or at scene during a vehicle breakdown or vital equipment failure; dispatch will request Fire ALS intercept with ambulance response via 911 and provide the public dispatcher with the required/requested information, location of crew.

  • Advise Crew, that when experiencing a vehicle breakdown on a highway or in traffic lane.

    • Do not exit vehicle.

    • Activate hazard or secondary lights.

    • When vehicle is stopped in traffic lane remain seated with belts latched & secondary lights active.  

    • If the vehicle is stopped in a high traffic lane or on a highway or freeway public safety (CHP or PD) must be activated for assistance.  


  • If a stable patient is on board, a separate ambulance must be sent to transfer the patient safely.


  • All equipment failures and breakdowns must be reported via email to GM/Supervision and documented in the pass-down dispatch log.

  • All accidents and injuries must be reported to a supervisor or manager without delay.  

  • The vehicle may be towed to an approved repair shop or station.




Advise crew to


  1. Observe General Provisions

  2. Assess for patients

  3. Contact 911 if needed

  4. Provide you with their location & brief report

  5. Use tablets to take photos

  6. Provide driver with GM Phone  

  7. Advise other driver that, if Horizon is at fault the damages will be covered immediately.

  8. Provide other driver with a copy of the unit registration.

  9. Request a copy of the other vehicle registration.

  10. Obtain other drivers contact information.

  11. Contact GM & CEO do not stop until one is reached.

Towing, requires dispatch and or supervisor approval

  1. Call a Supervisor/Manager; do not stop until you speak with one or the other.

  2. DISPATCH/SUP; Call Two Guys Towing

    • 714-394-394-7279

  3. Ask for Peter

  4. Tow to station if after hours, or tow to approved shop during operational hours; 


Mechanic Shops


  • During day the shops business hours, SUPERVISORS & DISPATCHERS may tow broken down vehicles to;


  • Pep-Boys Address: 215 E Katella Ave, Orange, CA 92867

  • Sunrise Auto Address: 1821 E Katella Ave, Orange, CA 92867


Vehicle Maintenance


  • Is due every 5,500 miles.

  • Is checked by the operations a manger (temp Roshan) daily. They check the miles of each units, this is one reason why we record the start and end of shift reports.

  • A unit must be taken out of service within 250 miles of the PM miles, you typically report it via email with your pass down log/reports.


When is a vehicle Out of Service?


  • Expired Registration

  • Expired Weights and Measure

  • Nonfunctioning lights, any light bar, side rear lights, brake lights

  • Nonfunctioning radios 

  • Nonfunctioning functioning ambulance equipment; gurneys, AC/Heater, suctioning etc…

  • Nonfunctioning gurney, ripped mattresses etc…

  • Missing supplies as defined on the checkout form

  • Unsafe items, broken gurney, backboard etc..


How to report deficient equipment  



    • Dispatch Pass down and AM to PM or PM to AM Dispatch Check off

    • Email to supervisor, 

  1. Remove ambulance/equipment from active vehicles in angel track

  2. Right it on the out of service board

  3. Red tag the equipment


Crew: Replace with station inventory, if none, report to dispatch and document in the unit inspection section of Angel Track 


MED 9 must be on and set to Channel A

Fleet Radio primary channel is Santiago 

Radio Failure 


  • Look for loose wires and connectors

  • Swap mics, it may be a mic issue 

  • Is the power on and volume up

  • Coordinate with dispatch to check different channels 

  • Update dispatch  


  • Call a Supervisor/Manager; do not stop until you speak with one or the other.

  • Move to Hand Held 1 for fleet, Hand Held 2 for Med 9

  • Attempt to have crews and dispatch coordinate a channel switch.

  • Unplug Power; check for loose wires/connectors.


DISPATCH OR SUP: Contact B&W communications for equipment repair: (562) 921-2067.

DISPATCH OR SUP: Contact Henry Radio if the equipment works but multiple channels fail.


Unstable Patient 

  • Deteriorates Transporting

    • Provide Dispatch with an emergency ER Report & ETA to nearest ​
      • 3 Minutes to nearest appropriate ED; 
        • Confirm with dispatch that the ED is open and Divert to Nearest ​
      • Code 2 is safest 
      • Contact communications if you are unsure how to proceed

  • On Scene or Destination

    • Ambulance crews should confer with the sending facility medical staff prior to activating 911. 

    • If the location has no higher level of care medical staff the crew should activate 911 without delay.

    • Contact dispatch for support and guidance.


How To Call 911 

  1. If Driving; provide dispatch with a report and rendezvous location of the ambulance, select safe parking locations.

  2. Dial 911

  3. State ‘’my name is __________ with Horizon Ambulance, I need Fire/Police dispatch for the city of’’

  4. They should transfer you to the correct hub.

  5. State ‘’my name is __________ with Horizon Ambulance, I need Fire/Police at location/address due to’’.


Receiving ER Closed or Diversion -Unstable Patient 



  • The new destination must be a receiving emergency department that is open, within a reasonable amount of transfer time, and provide services required by the patients status at time of diversion.



  1. Contact the planned destination regardless of facilities REDDINET status, even if on diversion.

  2. Obtain a nurses name and verbal confirmation that the receiving facility is closed.

  3. Contact the sending nurse and state,

    1. ‘’Nurse Name’’ at ‘’Hospital name’’ is refusing to take the patient, I spoke Nurse ‘’nurses name’’, and they are stating that they are on diversion and that they cannot accept any additional patients.

    2. Ask the sending nurse, ‘’does the doctor have privileges at any other facilities’’, ‘’we can wait if you would like to take a moment to determine a different facility or we can suggest a destination’’.

    3. Advise the nurse that you will have you crew wait with the patient as long as it takes to contact the doctor, AND that if the sending nurse can elect to allow Horizon Ambulance to select a receiving ER them, if they would like.

  4. Obtain new destination. 

  5. Document names, and notes in the call notes.

  6. Change the destination in the CAD build.


DISPATCH PROCEDURE Due to safety concern, patient deterioration, unstable.

  1. Obtain units exact location.

  2. Determine ETA to nearest open ER.

  3. Advise Operations.

    1. Dispatch will screen call if no operations on site.

  1. Obtain report from crew,

    1. Location.

    2. Concern reason for diversion to determine the receiving facility designation type.

    3. Vital Signs.

    4. Patient needs/interventions.

  2. Direct crew to new destination.

  3. Update CAD notes to explain diversion.

  4. Contact sending facility and politely explain the concern, event, situation and outcome, ALSO, document the name of staff at sending facility in CAD notes.

    1. CCT; The RN may provide the dispatch center with the designation type so that the dispatch center can provide with ambulance crew with the nearest appropriate receiving facility.

  5. Provide ER with report.

    1. CCT; The RN may provide the ER Report directly to the receiving facility ALS Line.

BLS versus 911 

Horizon Ambulance crews cannot be dispatched to patients requiring 911, or emergent ACLS interventions, or to patients that appear unstable, or that require care outside the responding crews level of care. The following values are acceptable for transport via BLS ambulance.

  • Alert & Oriented x’s 4 & GCS: 15, OR lowering scoring that is not baseline.

  • Heart Rate 50-120

  • Resp. 12 to 26 per min. (Adult)

  • BP: Systolic greater than 90 mmHg

AND, vital signs outside those adults ranges listed above may be deem safe for BLS transport if;  


  • A doctor has determined the patient’s vital signs to be a base line value for the patient and the patient is stable;

  • EXAMPLE; LOC less than 4 with dementia or Alzheimer or old CVA

  • The transport is SCT (CCT) with a doctor’s standing order for transport  

  • A public entity dispatcher or ALS (FIRE/County EMS) has; 1. Established via base contact that the patient is BLS, or 2. Has requested a BLS rendezvous with an ALS unit 

Vital Sign Value That Fall outside these Require 911 ALS, unless the stipulations above apply;

  • Alert & Oriented x’s 4 & GCS: 15, OR lowering scoring that is not baseline.

  • Heart Rate 50-120

  • Resp. 12 to 26 per min. (Adult)

  • BP: Systolic greater than 90 mmHg


Think Critically


  • Normal vital signs do not always mean a patient is stable and abnormal vital signs do not always mean a patient is unstable.

  • Treat the patient, presentation and assessment, and not just the number (V.S.)

  • Consider the history

  • Confirm with the sending nurse

  • Confirm with the nurse if the patient is stable or not 

  • Do not act on fear. Fear of getting in trouble for activating 911 or for not activating 911 should not be your concern, nor should these influence you follow scope, protocol and BLS standing orders!

  • Contact a manager if you are unsure or have questions

Patient presentations that fall outside OCEMS Policy 315.00 for BLS treatment; Requires 911 

  • Chest Pain determined to be cardiac in nature, or with an  unknown nature.  

  • Severe Bleeding,

  • SOB, not chronic base line conditions determined to be safe by a physician. 

  • Acute ALOC

  • Recent acute change in mentation or new neurological deficit.  Asymmetric grip strength, slurred speech, arm drift

  • New onset neurological deficit or new seizure activity with no history of seizure

  • Patients who had an AED applied to them

  • Patient who meet Stroke, STEMI, or trauma criteria

  • Still Alarms 

  • OCEMS Policy 315.00, 310.00