1. Slide 1 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Ambulance Operations Chapter 31

2. Slide 2 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. 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. Slide 3 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. Slide 4 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. Slide 5 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Medical Equipment  Artificial ventilation devices  Oxygen inhalation equipment  Cardiac compression equipment  Basic wound care supplies

6. Slide 6 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Medical Equipment  Basic supplies  Patient transfer equipment  Airways  Suction equipment

7. Slide 7 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Medical Equipment  Splinting supplies  Childbirth supplies  Medications  AED

8. Slide 8 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Nonmedical Equipment  Personal safety equipment  Per local, state, and federal standards  Preplanned routes  Comprehensive street maps

9. Slide 9 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Personnel  Available for response  At least one EMT-Basic in patient compartment  Minimum staffing for an ambulance  Two EMT-Basics are preferred.

10. Slide 10 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Type I Ambulance

11. Slide 11 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Type II Ambulance

12. Slide 12 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Type III Ambulance

13. Slide 13 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Daily Inspection  Engine check  Outside inspection  Cab inspection  Patient compartment

14. Slide 14 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Daily Inspection  Ventilation, airway, and oxygen equipment  Bandage and sterile supplies  Stretchers and immobilization equipment  Safety equipment  Other equipment  Diagnostic  PASG  Specialized equipment

15. Slide 15 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. Slide 16 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. Slide 17 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. En Route to the Call

18. Slide 18 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. Slide 19 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. Slide 20 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. Slide 21 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. Slide 22 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. Slide 23 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. Slide 24 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. Slide 25 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Laws, Regulations, and Ordinances – State and Local  Emergency or disaster routes  Use of audible warning devices  Use of visual warning devices  School buses

26. Slide 26 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. Slide 27 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Siren Decibels by Location

28. Slide 28 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Proper Hand Signals

29. Slide 29 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Proper Hand Signals

30. Slide 30 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Proper Hand Signals

31. Slide 31 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. En Route to the Call  Obtain additional information from dispatch.  Assign personnel to specific duties.  Assess specific equipment needs.

32. Slide 32 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. Use gloves, gowns, and eyewear when appropriate.

33. Slide 33 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. Slide 34 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. Slide 35 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. Slide 36 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. Slide 37 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. After Run  Refuel unit.  File reports.  Complete cleaning and disinfection procedures.  Notify dispatch.

38. Slide 38 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. Slide 39 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Decision to Call Helicopter  Proximity to hospital  Nature of terrain  Location of the patient  Estimated extrication time  Clinical status of the patient

40. Slide 40 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. Slide 41 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. Slide 42 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Landing Zone Hand Signals

43. Slide 43 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. Slide 44 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Safety Around Helicopter