2 Chapter 33 Ambulance Operations

3 Objectives (1 of 2) Describe GSA/KKK Ambulance standards Define the American College of Surgeons Essential Equipment List and how it relates to local State laws Discuss replacement of equipment and supplies.

4 Objectives (2 of 2) Describe the benefits and complications of lights and sirens and when they should be used. The following slides list noncurriculum objectives.

5 Cognitive Objectives (1 of 6) 1.Discuss the medical and nonmedical equipment needed to respond to a call. 2.List the phases of an ambulance call.

6 Cognitive Objectives (2 of 6) 3.Describe the general provisions of state laws relating to the operation of the ambulance and privileges in any or all of the following categories: –speed –warning lights –sirens –right-of-way –parking –turning

7 Cognitive Objectives (3 of 6) 4.List contributing factors to unsafe driving conditions. 5.Describe the considerations that should be given to: –request for escorts –following an escort vehicle –intersections 6.Discuss “Due Regard for Safety of All Others” while operating an emergency vehicle.

8 Cognitive Objectives (4 of 6) 7.State what information is essential in order to respond to a call. 8.Discuss various situations that may affect response to a call. 9.Differentiate between the various methods of moving a patient to the unit based upon injury or illness. 10.Apply the components of the essential patient information in a written report.

9 Cognitive Objectives (5 of 6) 11.Discuss the elements that dictate the use of lights and siren to the scene and to the hospital. 12.Summarize the importance of preparing the unit for the next response. 13.Identify what is essential for completion of a call.

10 Cognitive Objectives (6 of 6) 14.Distinguish among the terms cleaning, disinfection, high-level disinfection, and sterilization. 15.Describe how to clean or disinfect items following patient care.

11 Affective Objectives 16.Explain the rationale for appropriate reporting of patient information. 17.Explain the rationale for having the unit prepared to respond. There are no psychomotor objectives for this chapter.

12 Ambulance Operations Ambulance –Vehicle used for treating and transporting patients who need emergency medical care. –Most ambulances follow federal specifications (KKK- A-1822C, 1990).

13 Type I Conventional, truck cab-chassis Modular ambulance body that can be transferred to a newer chassis

14 Type II Standard van Forward-control integral cab-body ambulance

15 Type III Specialty van Forward-control integral cab-body ambulance

16 Phases of an Ambulance Call Preparation Dispatch En route Arrival at scene Patient transfer En route to receiving facility (transport) At the receiving facility (delivery) En route to station Postrun

17 Preparation Phase Medical equipment and supplies check Personal safety equipment Equipment for work areas Preplanning and navigation Extrication equipment Daily inspections

18 Medical Equipment Medications AED Jump kit Patient transfer equipment Ventilation devices Suctioning unit Oxygen delivery CPR equipment Basic wound care supplies Splinting supplies Childbirth supplies

19 Suction Unit

20 Oxygen Delivery

21 CPR Equipment

22 Splinting Supplies

23 Childbirth Supplies

24 Automated External Defibrillator

25 Jump Kit

26 Patient Transfer Equipment

27 Personal Safety Equipment Face shields Gowns, shoe covers, caps Turnout gear Helmets with face shields or safety goggles Safety shoes or boots

28 Equipment for Work Areas Warning devices that flash intermittently or have reflectors Two high-intensity halogen flashlights Fire extinguisher Hard hats or helmets with face shields Portable floodlights

29 Preplanning and Navigation Carry detailed street and area maps in the driver’s compartment. Carry directions to key locations. Be familiar with special facilities and locations within your region.

30 Personnel Every ambulance must be staffed with at least one EMT-I in the patient compartment.

31 Extrication Equipment Carry equipment needed for simple, light extrication. If rescue and extrication services are not readily available, additional equipment may be needed.

32 Daily Ambulance Inspections Check medical equipment and supplies at least daily. Ensure daily that everything is in proper working order.

33 Safety Precautions Review safety precautions, including traffic safety rules and regulations, to ensure compliance. Check to make sure that safety devices, such as seat belts, are in proper working order.

34 Dispatch Phase The dispatcher should gather and record the following minimum information: –Nature of the call –Name, present location, and call-back number of the caller –Location of the patient(s) –Number of patients and idea of the severity of their conditions –Special problems or other pertinent information

35 En Route to the Scene (1 of 8) Driver characteristics –May need to complete a driving course Safe driving practices –Speed does not save lives; good care does

36 En Route to the Scene (2 of 8) Use of excessive speed –Lack of expertise –Inadequate equipment –Inadequate training of the EMT –Inadequate driving ability –Siren syndrome

37 En Route to the Scene (3 of 8) Emergency vehicle control –Only two ways to control the vehicle Steering techniques –The way you hold and move the steering wheel Chassis set –Acceleration and deceleration transfers weight from one point to another

38 En Route to the Scene (4 of 8) Vehicle size and distance judgment –Use a spotter when backing up. Road positioning and cornering –Be aware of position in the roadway. Controlled acceleration –Use of acceleration to control the vehicle.

39 En Route to the Scene (5 of 8) Controlled braking –Use of brakes to control vehicle. Weather and road conditions –Be alert for changing conditions. Hydroplaning –Water “piles up” under tire.

40 En Route to the Scene (6 of 8) Water on the roadway –Wet brakes will slow the vehicle. Decreased visibility –Use headlights properly. Ice and slippery surfaces –Use appropriate tires.

41 En Route to the Scene (7 of 8) Laws and regulations –Vary from state to state. Use of warning lights and sirens –Use care even when using lights and sirens. Right-of-way –Right-of-way is a privilege.

42 En Route to the Scene (8 of 8) Use of escorts –A dangerous practice Intersection hazards –Most common place for collisions

43 Arrival at the Scene Scene safety Safe parking Traffic control

44 Transfer Phase Provide lifesaving treatment. Package patient for transport. Be sure to secure the patient with at least three straps across the body.

45 Transport Phase Inform dispatch when you are ready to leave the scene. Report the number of patients and the name of receiving hospital. Conduct ongoing assessments. Contact medical control. –Report the number of patients. –Nature of problems.

46 Delivery Phase Report arrival to dispatch. Give report to staff. Physically transfer the patient. Complete written report. Leave a copy with an appropriate staff member.

47 En Route to the Station Inform dispatch whether or not you are in service and where you are going. Clean and disinfect the ambulance and any equipment used. Restock supplies.

48 Postrun Phase Complete and file any additional written reports. Inform dispatch of your status, location, and availability. Clean and restock the ambulance.

49 Air Ambulances Fixed-wing –Interhospital transfers Rotary-wing (helicopters) –Used for shorter distances

50 Safety Precautions Do nothing near the helicopter and only go to where the crew or pilot directs you. Keep a safe distance away from the aircraft. Stay away from the tail rotor. Never approach the helicopter from the rear.

51 Landing Sites