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Chapter 46 Ambulance Operations

Chapter 46 Ambulance Operations. History of Ground Ambulances. Dr. Dominique-Jean Larrey Horse-drawn wagons (flying ambulances) First ambulances in the US Civilian hospitals . Michael Reese Hospital in Chicago. 1899: First motorized vehicle was used Top speed of 16 mph

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Chapter 46 Ambulance Operations

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  1. Chapter 46 Ambulance Operations

  2. History of Ground Ambulances • Dr. Dominique-Jean Larrey • Horse-drawn wagons (flying ambulances) • First ambulances in the US • Civilian hospitals

  3. Michael Reese Hospital in Chicago • 1899: First motorized vehicle was used • Top speed of 16 mph • 1937: Hess and Eisenhardt Company built first commercial ambulance

  4. Current Standards for Ambulances • Defined by US General Services Administration • Design and manufacturing specifications outlined in DOT KKK 1822 federal guidelines • Improvements • Safer and more comfortable • Easier to perform patient care activities

  5. Ambulance Designs Type II & III Photos Courtesy of Captain David Jackson, Saginaw

  6. Ambulance Equipment • Patient compartment • Storing or securing the equipment it takes to do the job well • Prevent injury • Easily accessible

  7. Organizations Influencing the Development of Supplies and Equipment • OSHA • American College of Surgeons (ACS) • First standardized list of equipment • Updates

  8. Paramedics have a large number of responsibilities, and the list grows with time and experience. Suppose your experience keeps increasing, you keep up your skills and continuing education well, and you take responsibility for yourself, your partner/crew, and the patients you treat and transport. • Is it your responsibility to be concerned about electrical or mechanical problems with the medic truck being used? • Is it your responsibility to be concerned with response times, productivity, and unit costs?

  9. Checking the Ambulance • Ambulance compartments • All compartments should be checked regularly.

  10. Essential Equipment • Airway and ventilation equipment • Basic wound care supplies • Monitoring devices • Orthopedic injury stabilizers • Childbirth supplies • Patient transfer equipment • Medications

  11. Understanding Your Ambulance • The ambulance should • Start • Steer • Stop • Stay running

  12. Threats to the Four Ss • Immediately pull the vehicle out of service. • Extreme weather • Adequate visibility • Internal environmental controls

  13. Check It Before You Drive It • Standard daily checklist • System-by-system inspection

  14. Warning Signs (1 of 2) • Belt noise • Brake fade • Brake noise • Brake pull • Drift

  15. Warning Signs (2 of 2) • Steering pull • Pulsating brake pedal • Steering play • Tire squeal • Wheel bounce • Wheel wobble

  16. Ambulance Staffing and Development • High-performance EMS systems • Key factors • Response times • Productivity • Unit costs • Taxpayer subsidies

  17. Ambulance and EMS Systems • First-response emergency medical • Some trained in BLS • Others have ALS training • May be paid or volunteer • Private, for-profit enterprise • Public agency delivers ambulance service

  18. Ambulance Staffing • May be variable • Two or three paramedics on each ambulance • Other systems staff ambulances with EMT-Bs. • Tiered response system

  19. System Status Management (SSM) • Jack Stout • Maximize efficiency. • Reduce response times. • Historical data to determine ambulance service demands • Peak loads • Strategic deployment • Posting • Peak demand staffing

  20. Ambulance Stationing • Distance and call volume • Urban setting and suburban setting • Rural setting • Other considerations • Maintenance of vehicles and equipment • Storage • Classrooms for training and meeting • Sleeping quarters for personnel who spend the night

  21. The Paramedic as an Emergency Health Care Provider • Responsibility to be professional • Even in times of severe stress or fatigue • Always seek to deliver high-quality care.

  22. (continued) • You just began your shift, and before you could even put your things down, you are dispatched to the scene of a car accident involving three vehicles. • Should you automatically trust the crew that worked before you to have adequately restocked, cleaned, and checked the vehicle? • How could this negatively affect you?

  23. Emergency Vehicle Operation • Collision prevention • Common causes • Ambulance not traveling in the proper lane • Operator driving too fast • EMS system is responsible for hiring safe drivers and training in emergency vehicle operations courses during service.

  24. Due Regard • Use lights and sirens as a means to alert other drivers. • Does not exempt you from due regard for the safety of others

  25. Use of Escorts • Typically not a good idea • Drivers see only the first set of lights and sirens. • Leave enough space between the vehicles.

  26. Use of Lights and Sirens • When responding • When transporting • Paramedic’s decision • Critical patients

  27. Driving to the Scene • Safest approach route • Avoid school zones, construction zones, and railroad crossings. • Type of call affects how you respond. • Children or severe trauma • Another public safety worker • Always drive with caution.

  28. Parking at an Emergency Scene (1 of 2) • Don’t unnecessarily impede traffic flow. • If you need to block a lane for safety concerns, do it. • Off the side of the road • Be aware of the terrain.

  29. Parking at an Emergency Scene (2 of 2) • On a roadway at night • Drivers distracted by the scene • May be safer to use your emergency flashers • Turn off headlights when parked • Always wear visible protective clothing. • Reflective vests • Heavy protective clothing in extrication

  30. Loading and Unloading the Patient • Safely and quickly • Most on a stretcher • Always secure the patient. • Person riding with the patient • Front passenger seat • Patient compartment • Multiple patients • Always load the most severe last.

  31. Skill Drill 46-1: Loading the Patient Step 2 Step 1 Step 3 Step 4

  32. Skill Drill 46-2: Unloading the Patient Step 2 Step 1 Step 3 Step 4

  33. Backing Up the Emergency Vehicle • Most common source of vehicle damage • May result in costly repairs • Rules for backing up • Use of safety restraints • Everyone in the ambulance must use seatbelts. • Pediatric transporting devices

  34. (continued) • Everyone in the US knows what ambulances and fire trucks with flashing lights and sirens mean, even if they don’t speak English or come from a different culture. • Is this statement completely accurate? • How can this error in thinking on the part of any emergency response personnel be a life-threatening issue?

  35. Air Medical Transports (1 of 2) • Fixed-wing air ambulances • Captain George H. R. Gosman and Lieutenant A. L. Rhodes at Fort Barrancas, Florida, in 1910 • Flew 500 yards at a height of 100 feet before crashing • At the end of World War I, a Curtiss JN-4 Jenny biplane was converted to an air ambulance for the evacuation of wounded soldiers.

  36. Air Medical Transports (2 of 2) • First use of a rotary-winged air ambulance was during the Burma Hump Airlift Operation in World War II. • 1943: first “flight nurses” graduated from Bowman Airfield in Kentucky. • Civilian use began in 1973 with St. Anthony’s Hospital in Denver.

  37. Advantages of Using Air Ambulances • Reduce transport time • Decision as early as possible • Spinal injury and rough terrain Courtesy of Brian Denlinger and STAT MedEvac

  38. Disadvantages of Using Air Ambulances • Difficult to treat cardiac arrest patients in limited space • Visual flight rules • Visibility interference can make it dangerous to fly. • Landing terrain

  39. Setting Up the Landing Zone (1 of 2) • Large enough to accommodate a rotary-winged aircraft of any size • Standard dimensions of 100´ by 100´ • Landing field must be firm and level. • No loose objects or debris

  40. Setting Up the Landing Zone (2 of 2) • Mark the landing site. • Mark the side of prevailing winds with an extra strobe light. • Do not shine flashlights or spotlights up at the aircraft. • Turn off headlights. • Place emergency vehicles under any overhead wires to signify the hazard.

  41. Procedures for Landing • Be aware of all hazards. • Agree on communication channels. • Use standard arm signals. • Wear eye protection. • Do not approach until signaled by the pilot. • Always approach a helicopter from the front and keep the pilot in view.

  42. Summary • Although no human being is perfect and mistake-free, each of us has a responsibility as a paramedic or other emergency personnel to anticipate the worst case scenario and be prepared, from being dispatched to a car accident in which the injuries are unknown or the number of patients is not clear, to being responsible for checking supplies, equipment, and the vehicle itself at the beginning and end of each shift. It is somewhat scary, but necessary, to consider the implications of not doing, or partially doing, any of our duties as emergency personnel.

  43. Summary • History of ground ambulances • Ambulance equipment and maintenance • Emergency vehicle operation • Air medical transport

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