Ambulance Operations

1. Chapter 31 Ambulance Operations

2. Case History You arrive at your assigned work location at the start of your tour of duty and begin an inspection of equipment, including communications, airway and ventilation, splinting, spinal immobilization, AED, and transport devices.

3. Phases of an Ambulance Call • Preparation for the call • Dispatch • En route • Arrival at the scene • Transferring the patient to the ambulance • En route to the receiving facility • At receiving facility • In service and postrun issues

4. Preparation for a Call • Preparation is essential to ensure • Adequate equipment • Readiness of the vehicle • Readiness of communication equipment • Check vehicle and equipment using checklists.

5. Medical Equipment • Artificial ventilation devices • Oxygen inhalation equipment • Cardiac compression equipment • Basic wound care supplies

6. Medical Equipment • Basic supplies • Patient transfer equipment • Airways • Suction equipment

7. Medical Equipment • Splinting supplies • Childbirth supplies • Medications • AED

8. Nonmedical Equipment • Personal safety equipment • Per local, state, and federal standards • Preplanned routes • Comprehensive street maps

9. Personnel • Available for response • At least one EMT-Basic in patient compartment • Minimum staffing for an ambulance • Two EMT-Basics are preferred.

10. Type I Ambulance

11. Type II Ambulance

12. Type III Ambulance

13. Daily Inspection • Engine check • Outside inspection • Cab inspection • Patient compartment

14. Daily Inspection • Ventilation, airway, and oxygen equipment • Bandage and sterile supplies • Stretchers and immobilization equipment • Safety equipment • Other equipment • Diagnostic • PASG • Specialized equipment

15. Dispatch • Dispatch models • Direct dispatch from quarters • Central access dispatch • Enhanced 911 • Ambulance to hospital dispatch • Emergency medical dispatch • Professionally trained dispatchers • Provide triage and categorization • Telephone-directed first aid instructions

16. Information Collected at Dispatch Center • Nature of call • Name, location, and call-back number • Location of the patient • Number of patients • Special problems • Hazards • Access problems

17. En Route to the Call

18. Arch of Driver Safety • Physical fitness • Mental awareness • Ability to perform under stress • Positive attitude about abilities • Tolerance of other drivers • Knowledge of handling characteristics of vehicle

19. Safe Driving • Important phase in the emergency medical care of the ill or injured patient • The driver and all passengers should wear safety belts. • Become familiar with the characteristics of your vehicle. • Be alert to changes in weather and road conditions.

20. Safe Driving • Exercise caution in use of red lights and siren. • Know appropriate use. • Headlights are the most visible warning device on an emergency vehicle. • Select appropriate route. • Maintain safe following distance. • Drive with due regard for safety of all others.

21. Factors Affecting Directional Control • Mechanical condition of the vehicle • Road conditions • Physical condition of the driver • Driver’s hand positions • Drive with two hands on the wheel • Radio and siren operation should be done by second EMT • Use 9-o’clock and 3-o’clock hand positions • Ambulance is more difficult to control than a car.

22. Factors Affecting Speed Control • Modern ambulances — weight four times more than passenger vehicles • Average type III ambulance weight 10,450 pounds without patient and crew • Considerably different handling characteristics • Longer stopping distances

23. Seatbelts • Simplest device to help maintain control of vehicle • Keep operators inside the vehicle. • Keep operators in position to control vehicle. • Seatbelts have limited likelihood of causing injury. • Only 1 of every 200 people is injured by seatbelts when worn correctly. • All occupants of the ambulance should wear seatbelts.

24. Laws, Regulations, and Ordinances – State and Local • Vehicle parking or standing • Procedures at red lights, stop signs, and intersections • Regulations regarding speed limits • Direction of flow or specified turns

25. Laws, Regulations, and Ordinances – State and Local • Emergency or disaster routes • Use of audible warning devices • Use of visual warning devices • School buses

26. Laws, Regulations, and Ordinances – State and Local • Escorts and multiple-vehicle response • Extremely dangerous • Used only if unfamiliar with location of patient or receiving facility • No vehicle should use lights or siren. • Provide a safe following distance. • Recognize hazards of multiple-vehicle response.

27. Siren Decibels by Location

28. Proper Hand Signals

29. Proper Hand Signals

30. Proper Hand Signals

31. En Route to the Call • Obtain additional information from dispatch. • Assign personnel to specific duties. • Assess specific equipment needs.

32. Arrival at Scene • Notify dispatch. • Size up the scene. • Body substance isolation should be a consideration before patient contact. • Use gloves, gowns, and eyewear when appropriate.

33. Scene Safety • Assess the scene for hazards. • Is the emergency vehicle parked in a safe location? • Is it safe to approach the patient? • Does the victim require immediate movement because of hazards?

34. Transferring the Patient to the Ambulance • Patient should be prepared in a timely manner. • Critical interventions should be completed. • Dressings and splints should be checked. • Patient should be covered according to environmental conditions. • Patient should be securely attached to a transfer device. • Transfer device should be selected on the basis of patient position, immobilization, and type of terrain.

35. En Route to Receiving Facility • Notify dispatch. • Ongoing assessment should be continued. • Obtain serial vital signs. • Notify receiving facility. • Reassure patient. • Complete prehospital care reports.

36. Returning to Service • At station or receiving facility, notify dispatch. • Prepare for the next call. • Clean and disinfect the ambulance and equipment, as needed. • Restock the disposable supplies.

37. After Run • Refuel unit. • File reports. • Complete cleaning and disinfection procedures. • Notify dispatch.

38. Aeromedical Considerations • Modern helicopters are equipped with ALS capabilities. • Primary benefit is decreasing time from injury to arrival at definitive care. • EMS providers are encouraged to call for a helicopter in some systems.

39. Decision to Call Helicopter • Proximity to hospital • Nature of terrain • Location of the patient • Estimated extrication time • Clinical status of the patient

40. Decision to Call Helicopter • How long will ground transport take? • What will be the expected time of arrival of the helicopter? • Can helicopter land at site? • Will transport to additional site be needed to meet helicopter? • Warm up time for helicopter before response

41. Locating Landing Zone • Larger than 100 feet  100 feet • Relatively flat ground • No greater than 10 degrees slope • Clear of debris • No major vertical structures impeding landing • Telephone poles • Towers • Tall grasses • Tall trees • As close to the scene as possible

42. Landing Zone Hand Signals

43. Safety Around Helicopter • Rotor wash can spray bystanders with debris. • Bystanders may be struck by rotor. • Never approach from the rear. • Take directions from pilot from the front. • If helicopter is on slope, never approach from uphill side. • Assume a crouching position when approaching helicopter.

44. Safety Around Helicopter