Division 5 Special Considerations/ Operations Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Chapter 48, Operations Part 1 Ambulance Operations Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Topics Ambulance Design Ambulance Equipment and Supplies Safe Ambulance Operations Air Medical Transport Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Introduction Good ambulance operations involve some of the knowledge and skills you have already established as an EMT-Basic. However, it is important for you to review this information regularly so that it becomes second nature. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Ambulance Standards Most guidelines and requirements for ambulance standards and equipment are provided by state law. The United States General Services Administration specifies ambulance design requirements, known as DOT KKK 1822D. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Type I – Conventional truck cab-chassis with a modular ambulance body © Kenneth Kerr Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Type II – Standard van, forward control integral cab-body ambulance © Kenneth Kerr Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Type III – Specialty van, forward control integral cab-body ambulance © Kenneth Kerr Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Medium duty © Kenneth Kerr Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Medical Equipment Standards The following organizations may set standards for the type and quantity of equipment carried: OSHA NFPA City, county, local authorities State agencies Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Checking Ambulances An equipment checklist should be completed on every shift. The checklist makes the work environment safer by assuring mechanical maintenance and the availability of personal protection equipment. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Disinfecting the ambulance is critical to maintaining a safe work environment and meeting OSHA standards. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Ambulance Deployment and Staffing The strategy used to maneuver ambulances and crews in order to reduce response times is known as deployment. Factors affecting deployment include: Location of ambulances Location of hospitals Anticipated call volume Local geographic and traffic considerations Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Safe Ambulance Operations Educating providers is the first part of any proactive education program ensuring safe ambulance operations. The days of “blowing through” intersections with lights and sirens blaring have come and gone! Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Reducing Collisions Programs aimed at reducing ambulance collisions may include: Routine driver’s license checks Demonstrated driver understanding of preventive mechanical maintenance Plenty of hands-on driver training on such topics as the use of mirrors, emergency situations, backing up Demonstrated driver understanding of the motor vehicle regulations and laws Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

A 10,000–24,000 pound ambulance has a much longer stopping distance than the 2,500 pound pickup the operator drove to work. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Standard Operating Procedures Each agency should have standard operating procedures (SOPs) pertaining to the operation of its vehicles. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Due Regard While most state laws exempt drivers of emergency vehicles from certain laws, they also hold them to a higher standard. Due regard places the responsibility for deciding when and where these exemptions should be applied squarely on the driver. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Lights and Sirens Motorists are less likely to yield when sirens are continually sounded. Many motorists feel the right-of-way privileges of ambulances are abused when sirens are used. Inexperienced drivers speed up when they hear sirens. Sirens can worsen sick or injured patients. Ambulance operators may also develop anxiety from sirens—and long-term hearing problems. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Siren Guidelines Use the siren sparingly. Never assume motorists will hear your siren. Assume that some motorists will hear your siren, but choose to ignore it. Be prepared for panic and erratic maneuvers. Never use the siren to scare someone! Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Most EMS agencies no longer suggest the use of a police escort for ambulances—except in those circumstances where the ambulance is providing service in an unfamiliar area. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Parking the ambulance Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

The Deadly Intersection Exercise extreme caution whenever you approach an intersection. Know the rules for negotiating an intersection! Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Air Medical Transport Air medical transport involves 2 types of air rescue units: fixed-wing aircraft and rotorcraft. Missions involving air units are commonly referred to as aeromedical evacuations, or medevac. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Hospital-based helicopter © Mark C. Ide Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Advantages of Air Transport Rapid transportation Access to rural or remote areas Access to specialty units (NICU) Access to personnel with specialized skills Access to specialty supplies Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Disadvantages of Air Transport Weather and environment restrictions to flying Altitude limitations Air speed limitations Expense Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

In order for a helicopter program to be effective, the front-line First Responders, EMT-Basics, and Paramedics must be willing and able to consider the need for air transport and activate as early as possible! Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Indications for Air Transport Clinical criteria—See Table 48-1 in text Difficult access situations Wilderness rescue Ambulance egress or access impeded by road conditions, weather, or traffic Time/Distance factors Transport to a trauma center is >15 minutes by ground Transport time to local hospital by ground is greater than transport time by helicopter Patient extrication time is greater than 20 minutes Using a ground ambulance to transport the patient leaves the local area without ambulance coverage Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Clinical Criteria – Mechanism Trauma score <12 Unstable vital signs Significant trauma in patients <12 or >55 or pregnancy Multisystem injuries Ejection from a vehicle Pedestrian or cyclist struck Death in the same passenger compartment Significant damage to patient’s passenger compartment Penetrating trauma to the abdomen, pelvis, chest, neck, or head Crush injury to the abdomen, chest, or head The National Association of EMS Physicians has written a position paper on the proper criteria for dispatching an air medical transport. The entire position paper can be found on the NAEMSP website or by cutting and pasting the following link in your web browser: http://www.naemsp.org/Position%20Papers/AirMedicalDispatch.pdf Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Clinical Criteria – Systems (1 of 3) Neurological: GCS score <10 Deteriorating mental status Skull fracture Neurological presentation suggestive of a spinal cord injury Thoracic: Major chest wall injury Flail segment Pneumothorax Hemothorax Suspected cardiac injury The National Association of EMS Physicians has written a position paper on the proper criteria for dispatching an air medical transport. The entire position paper can be found on the NAEMSP website or by cutting and pasting the following link in your web browser: http://www.naemsp.org/Position%20Papers/AirMedicalDispatch.pdf Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Clinical Criteria – Systems (2 of 3) Abdominal/Pelvic: Significant abdominal pain following trauma Presence of a seatbelt sign or other abdominal contusion Obvious rib fractures below the nipple line Major pelvic ring fracture Unstable pelvic ring Open pelvic fracture Pelvic fracture with hypotension Orthopedic/Extremity: Partial or total amputation of a limb (excluding digits) Finger/thumb amputation with potential for implantation Fracture or dislocation with vascular compromise Extremity ischemia Open long-bone fractures 2 or more long-bone fractures The National Association of EMS Physicians has written a position paper on the proper criteria for dispatching an air medical transport. The entire position paper can be found on the NAEMSP website or by cutting and pasting the following link in your web browser: http://www.naemsp.org/Position%20Papers/AirMedicalDispatch.pdf Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Clinical Criteria – Systems (3 of 3) Burns: >20% BSA Involvement of face, head, hands, feet, or genitalia Inhalation injuries Electrical burns Chemical burns Burns with associated injuries Immersions: Near-drowning injuries The National Association of EMS Physicians has written a position paper on the proper criteria for dispatching an air medical transport. The entire position paper can be found on the NAEMSP website or by cutting and pasting the following link in your web browser: http://www.naemsp.org/Position%20Papers/AirMedicalDispatch.pdf Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Helicopter landing zone Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

The area around a helicopter’s tail rotor is extremely dangerous. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Always approach a helicopter in a crouch when the rotor is moving. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Approach a helicopter from the downhill side when it is parked on a hillside. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Summary Ambulance Design Ambulance Equipment and Supplies Safe Ambulance Operations Air Medical Transport Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ