1. 35: Ambulance Operations

2. Cognitive Objectives (1 of 4)
7-1.1 Discuss the medical and nonmedical equipment needed to respond to a call.
7-1.2 List the phases of an ambulance call.
7-1.3 Describe the general provision of state laws relating to the operation of the ambulance and privileges in any or all of the following areas:
speed • right-of-way
warning lights • parking
sirens • turning

3. Cognitive Objectives (2 of 4)
7-1.4 List factors that contribute to unsafe driving conditions.
7-1.5 Describe the considerations that should be given to:
request for escorts
following an escort vehicle
intersections
7-1.6 Discuss “Due Regard for Safety of All Others” while operating an emergency vehicle.

4. Cognitive Objectives (3 of 4)
7-1.7 State what information is essential in order to respond to a call.
7-1.8 Discuss various situations that may affect response to a call.
7-1.9 Differentiate between the various methods of moving a patient to the unit based upon injury or illness.
Apply the components of the essential patient information in a written report.

5. Cognitive Objectives (4 of 4)
Summarize the importance of preparing the unit for the next response.
Identify what is essential for the completion of a call.
Distinguish among the terms cleaning, disinfection, high-level disinfection, and sterilization.
Describe how to clean and disinfect items following patient care.

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

7. Additional Objectives*
Cognitive
Discuss the elements that dictate the use of lights and siren to the scene and to the hospital.
*This is a noncurriculum objective.

8. Ambulance Operations
Emphasis on rapid response places the EMT-B in great danger while driving to calls.
EMT-Bs should know:
How to equip and maintain an ambulance
Techniques for the safe operation of an ambulance
How to work safely with air ambulances

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

10. Type I

11. Type II

12. Type III
© Photodisc/Getty Images

13. Phases of an Ambulance Call
Preparation
Dispatch
En route
Arrival at scene
Patient transfer
En route to receiving facility
At the receiving facility
En route to station
Postrun

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

15. Medical Equipment Airway and ventilation devices Suction unit
Oxygen delivery
CPR equipment
Basic wound care
Splinting supplies
Childbirth supplies
AED
Patient transfer equipment
Medications
Jump kit

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

17. 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

18. Other Preparations Preplanning and navigation
Carry detailed maps and directions.
Be familiar with local area.
Extrication equipment
Equipment needed for simple, light extrication

19. Personnel
Every ambulance must be staffed with at least one EMT-B in the patient compartment during patient transport.
Two EMTs are strongly recommended.
Some services may operate with a non-EMT driver.

20. Inspections and Safety Precautions
Being fully prepared means inspecting the ambulance and equipment daily.
Check medical equipment and supplies at least daily.
Review standard traffic safety rules and regulations.
Make sure seat belts work and that oxygen tanks are secured.

21. Dispatch Phase The dispatcher should gather minimum information.
Nature of the call
Name, person, location, and call-back number
Location of the patient(s)
Number of patients and idea of the severity of their conditions
Special problems or other pertinent information

22. En Route to the Scene Fasten your seat belt.
Confirm response and location.
Prepare for arrival.
Decide what equipment to take initially.

23. Arrival at the Scene Scene safety Safe parking Traffic control
© Comstock Images/Alamy Images

24. Look for safety hazards. Evaluate need for additional units.
Scene Size-up
Look for safety hazards.
Evaluate need for additional units.
Determine MOI/NOI.
Evaluate spinal precautions.
Follow BSI precautions.

25. Safe Parking and Traffic Control
Park away from hazards and out of flow of traffic.
Do not block other responding EMS vehicles.
Place appropriate warning devices on both sides of the accident.

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

27. 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 number of patients
Nature of problems

28. 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.

29. 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.

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

31. Defensive Driving 6,000 ambulances involved in crashes every year
300 fatalities between 1991 and 2001
Properly operating the ambulance is as important as taking care of patients.
Courtesy of District Chief Chris E. Mickal, New Orleans Fire Department, Photo Unit.

32. Driver Characteristics
Physical fitness
Effects of medication
Fatigue
Emotional fitness
Maturity and stability
Proper attitude
Your actions will be scrutinized.

33. Safe Driving Practices
Speed does not save lives; good care does.
Seat belts must be worn.
Learn how your vehicle accelerates, corners, sways, and stops.

34. Driver Anticipation
Anticipate the actions of other motorists and pedestrians.
Assume actions of other drivers will cause a collision.
Use of PA system may add to confusion.

35. Cushion of Safety Keep safe following distance. Watch for tailgaters.
Be aware of blind spots.
Use a spotter when backing up.
© AbleStock

36. Excessive Speed
Speeding is unnecessary if patient is properly assessed and stabilized.
Decreases reaction time
Increases stopping time and distance

37. Vehicle Size and Cornering
Vehicle length and width are critical factors in maneuvering.
Vehicle size and weight greatly influence braking and stopping distances.
Always be aware of your position on the roadway.
Take corners at the speed that will put you in the proper road position as you exit the curve.

38. Weather and Road Conditions
Be alert to changing conditions.
Decrease speed and increase distance in poor conditions.
Hydroplaning
Water on roadway
Decreased visibility
Ice and slippery surfaces

39. Laws and Regulations Vary from state to state
EMS drivers have certain limited privileges.
These privileges do not lessen drivers’ liability.

40. Warning Lights and Sirens
Must be responding to an emergency
Use both audible and visual devices.
Operate with due regard.

41. Right-of-Way Privileges
You must not endanger people or property under any circumstances.
Know your local right-of-way privileges.
Exercise them only when necessary for the patient’s well-being.

42. Escorts and Intersection Hazards
Use of escorts
A dangerous practice
Follow escorts at a safe distance.
Intersection hazards
Most common place for collisions
Even on urgent calls, come to a momentary stop at the light.

43. Air Ambulances Fixed wing Interhospital transfers Rotary-wing
Used for shorter distances
Courtesy of Duke Life Flight.

44. Medivac Operations Become familiar with local capabilities.
Calling for a medivac
Ground transport would take too long.
Spinal cord injuries, amputations, burns, diving emergencies, venomous bites
Notify your dispatcher first.

45. Establishing a Landing Zone
Area should be hard or grassy level surface that measures 100' x 100' (recommended)
Clear area of loose debris and survey for overhead or tall hazards.
Mark landing site with weighted cones or headlights.

46. 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.

47. Special Considerations
Nighttime landings
Considerably more dangerous than daytime operations
Landing on uneven ground
Main rotor blade will be closer to the ground on uphill side.
Hazardous materials incidents
Land zone should be upwind and uphill.

48. Landing on Uneven Ground

49. Review
Upon arrival at a scene where hazardous materials are involved, you should park the ambulance:
A. upwind from the scene.
B. with the warning lights off.
C. downhill from the scene.
D. at least 50’ from the scene.

50. Review
Answer: A
Rationale: At the scene of a hazardous materials incident, the ambulance should be parked uphill and upwind from the scene. Other locations may expose the ambulance to any escaping hazardous material. Be prepared to quickly move the ambulance if the wind shifts in your direction.

51. Review
Upon arrival at a scene where hazardous materials are involved, you should park the ambulance:
upwind from the scene.
Rationale: Correct answer
B. with the warning lights off.
Rationale: Parking upwind is your most important concern. Using the warning lights is based upon departmental guidelines.
C. downhill from the scene.
Rationale: You should park uphill and upwind.
D. at least 50’ from the scene.
Rationale: Parking upwind is your first priority. The distance from the hot zone should be at least 100 feet.

52. Review
2. You have been dispatched to a call for an unconscious patient. What is the MOST important information that you should obtain from the dispatcher initially?
A. The callback number of the caller
B. The severity of the patient’s problem
C. Whether or not the patient is breathing
D. The exact physical location of the patient

53. Review
Answer: D
Rationale: All of the choices listed in this question are important questions to ask the dispatcher. However, you must first determine the exact location of the patient. You cannot help the patient if you cannot find him or her. While en route, you should try to ascertain more specific patient information (ie, whether or not he or she is breathing).

54. Review
2. You have been dispatched to a call for an unconscious patient. What is the MOST important information that you should obtain from the dispatcher initially?
The callback number of the caller
Rationale: This is important, but not the most important piece of information.
B. The severity of the patient’s problem
C. Whether or not the patient is breathing
D. The exact physical location of the patient
Rationale: Correct answer

55. Review
3. The MOST appropriate place to park your ambulance at the scene of a motor-vehicle accident is:
A. alongside the accident, blocking traffic.
B. 100 feet behind the accident on the same side of the road.
C. 100 feet in front of the accident on the same side of the road.
D. 100 feet in front of the accident on the opposite side of the road.

56. Review
Answer: C
Rationale: Parking the ambulance 100 feet in front of the accident, on the same side of the road, will protect you from being struck by oncoming traffic as you are loading the patient. Positioning your ambulance in an area that places barriers between you and oncoming traffic will maximize your safety.

57. Review
3. The MOST appropriate place to park your ambulance at the scene of a motor-vehicle accident is:
alongside the accident, blocking traffic.
Rationale: This may block the movement of other emergency vehicles.
B. 100 feet behind the accident on the same side of the road.
Rationale: Always provide a cushion of space between your vehicle and the operations at the scene.
C. 100 feet in front of the accident on the same side of the road.
Rationale: Correct answer
D. 100 feet in front of the accident on the opposite side of the road.
Rationale: 100 feet is the appropriate distance, but you should park on the same side of the roadway.

58. Review
4. The most common and often most serious ambulance crashes occur at or on:
A. stop lights.
B. intersections.
C. a highway.
D. stop signs.

59. Review
Answer: B
Rationale: Most serious ambulance crashes occur at intersections. Always be alert and careful when approaching an intersection. Whether at an intersection with stop lights or stop signs, you should momentarily come to a complete stop, look in both directions for other motorists or pedestrians, and then carefully proceed through the intersection.

60. Review
4. The most common and often most serious ambulance crashes occur at or on:
stop lights.
Rationale: Stop lights are associated with an intersection. The ambulance must come to a complete stop, since most accidents occur at intersections.
B. intersections.
Rationale: Correct answer
C. a highway.
Rationale: This is not the most common area where crashes occur.
D. stop signs.
Rationale: Stop signs are associated with an intersection. The ambulance must come to a complete stop, since most accidents occur at intersections.

61. Review
5. While en route to a call for a major motor-vehicle crash, the MOST important safety precaution(s) that you and your partner can take is/are:
A. adhering to body substance isolation precautions.
B. ensuring that the fire department arrives before you.
C. using lights and siren and being aware of other drivers.
D. wearing seat belts and shoulder harnesses at all times.

62. Review
Answer: D
Rationale: The “en route to the scene” phase of a call is the most dangerous. Regardless of the nature of the call that you are responding to, wearing seat belts and shoulder harnesses is the most important safety precaution that you and your partner must take. Furthermore, you must drive defensively and remain aware of the traffic around you.

63. Review
5. While en route to a call for a major motor-vehicle crash, the MOST important safety precaution(s) that you and your partner can take is/are:
adhering to body substance isolation precautions.
Rationale: This takes place once the providers arrive at the scene.
B. ensuring that the fire department arrives before you.
Rationale: it is important to know if the fire department is responding, but this is not the most important safety precaution.
C. using lights and siren and being aware of other drivers.
Rationale: The use of lights and sirens adds to the risk potential, but the use of safety devices is the most important precaution that you can take.
D. wearing seat belts and shoulder harnesses at all times.
Rationale: Correct answer

64. Review
6. The minimum recommended dimensions for a helicopter landing zone are:
A. 50’ × 50’
B. 75’ × 75’
C. 100’ × 100’
D. 150’ × 150’

65. Review
Answer: C
Rationale: The dimensions for a helicopter landing zone (LZ) should be, at a minimum, 100' × 100' on a hard or grassy surface that is level. The LZ should be clear of loose debris and power lines.

66. Review
6. The minimum recommended dimensions for a helicopter landing zone are:
50’ × 50’
Rationale: This is below the minimum recommended dimensions.
B. 75’ × 75’
C. 100’ × 100’
Rationale: Correct answer
D. 150’ × 150’
Rationale: This is well above the minimum recommendations, but this may not be a practical size in many emergency operations.

67. Review
7. At what speed will the ambulance begin to hydroplane when there is water present on the roadway?
A. 25 mph
B. 30 mph
C. 40 mph
D. 50 mph

68. Review
Answer: B
Rationale: At speeds of 30 mph or greater, the tires can be lifted off the pavement as the water “piles up” under the tires. This takes the control out of the driver's hands. If hydroplaning occurs, you should gradually slow down instead of jamming on the brakes to avoid losing control of the vehicle.

69. Review
7. At what speed will the ambulance begin to hydroplane when there is water present on the roadway?
25 mph
Rationale: This is below the speed where the risk of hydroplaning exists.
B. 30 mph
Rationale: Correct answer
C. 40 mph
Rationale: This exceeds the speed at which hydroplaning can occur.
D. 50 mph

70. Review
8. All of the following are examples of standard patient transfer equipment, EXCEPT:
A. stokes baskets.
B. long backboards.
C. wheeled stair chairs.
D. wheeled ambulance stretchers.

71. Review
Answer: A
Rationale: A stokes basket—also called a basket stretcher—is a specialized piece of equipment that is used for moving patients up or down rough terrain. Most ambulances do not carry stokes baskets; they are usually carried by rescue vehicles or fire apparatus.

72. Review
8. All of the following are examples of standard patient transfer equipment, EXCEPT:
stokes baskets.
Rationale: Correct answer
B. long backboards.
Rationale: This is a standard piece of patient transfer equipment.
C. wheeled stair chairs.
D. wheeled ambulance stretchers.

73. Review 9. The primary purpose of a “jump kit” is to:
A. ensure that you have immediate access to the AED.
B. have all of the equipment available that you will use in the entire call.
C. have easy access to manage patients with severe uncontrolled bleeding.
D. have all of the equipment available that will be used in the first five minutes.

74. Review
Answer: D
Rationale: Think of a jump kit as the “5 minute kit,” containing anything you might need in the first 5 minutes with the patient. It is during this 5 minute period that you will find and manage immediate life threats.

75. Review 9. The primary purpose of a “jump kit” is to:
ensure that you have immediate access to the AED.
Rationale: A “jump kit” should have the basic equipment to treat immediate life threats. BLS care can be initiated until an AED arrives.
B. have all of the equipment available that you will use in the entire call.
Rationale: You only need that equipment to manage immediate life threats during the first five minutes. Afterwards, additional equipment can be brought to the scene.
C. have easy access to manage patients with severe uncontrolled bleeding.
Rationale: A “jump kit” should have the basic equipment to manage all immediate life threats — including airway and breathing.
D. have all of the equipment available that will be used in the first five minutes.
Rationale: Correct answer

76. Review
10. Which of the following statements about helicopters is true?
A. It is possible that the main rotor blade will dip to within 4' of the ground
B. A helicopter is considered “hot” when it is on the ground and the rotors are still
C. If the helicopter must land on a grade, you should approach it from the uphill side
D. If you must go from one side of the helicopter to the other, the best way is to duck under the body.

77. Review
Answer: A
Rationale: Because the main rotor blade of a helicopter is flexible, it can dip as low as 4' from the ground. Use extreme caution when approaching a helicopter with the rotors on. If the helicopter must land on a grade, approach it from the downhill side. When moving from one side of the helicopter to the other, move around the front of the aircraft—not under it and certainly not behind it!

78. Review
10. Which of the following statements about helicopters is true?
It is possible that the main rotor blade will dip to within 4' of the ground
Rationale: Correct answer
B. A helicopter is considered “hot” when it is on the ground and the rotors are still
Rationale: It is considered “hot” when the rotors are turning.
C. If the helicopter must land on a grade, you should approach it from the uphill side
Rationale: You must approach the helicopter from the downhill side.
D. If you must go from one side of the helicopter to the other, the best way is to duck under the body.
Rationale: You must go from one side to the other around the front of the helicopter — never go behind it.