Ambulance Operations

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					                                                  Types of Ambulances

                                                  • Type I- separate cab and back
Ambulance Operations                              • Type 2- van-style
                                                  • Type 3- ALS-style truck
                                                  • Medium duty- Larger vehicles for the
                                                    transportation of more equipment

Operating an Ambulance

                                                  • 41-1. Describe the privileges afforded to
                                                    EMTs operating emergency vehicles and
                                                    the precautions that must be observed
                                                    while using these privileges.

• Most States allow emergency vehicles to:
 • Park anywhere that is safe during a call       • You must be a licensed driver
 • Proceed through stop lights/signs after a      • Privileges granted during emergency response/
                                                    transport are not in effect when an emergency
   complete stop
                                                    does not exist
 • Exceed posted speed limits                     • You must use warning devices when using any
                                                    of the granted privileges
 • Pass other vehicles at any time- though this
   never applies to off-loading school buses
                                                     • If an injury occurs or property damage
• You must exercise due regard for others
• Drivers are still liable for reckless driving or    • Did you use due regard for the safety of
    disregard of safety
                                                      • Was it a true emergency?

• 41-2. Give examples of habits and behaviors         Improving Driving Safety
    that improve driving safety.
                                                       • Always wear seat belts
•   41-3. Discuss factors that can affect your
    ability to maintain control while driving an       • Have 2 hands on wheel- 3 and 9 o’clock
    ambulance.                                            positions

• 41-4. Explain precautions that should be             • Decrease speed for weather conditions,
    taken when driving an ambulance in                    surface conditions and visibility
    inclement weather.                                    limitations

                                                      Maintaining Vehicle Control

• The shortest route to a destination is not           • Avoid sudden braking- anticipate stops
    always the best route- consider road
    conditions, traffic, lights, construction, etc      • Minimize distractions like eating, texting,
                                                          etc. (driving an ambulance presents its
• Always have headlights on when driving                  own set of distractions)

• Maintain a safe distance from other vehicles         • Minimize fatigue
                                                       • Be patient with school busses/trains
                                                 Escorted/Multiple Vehicle Response
• Remember that road surfaces can affect pt      • Dangers include
  comfort as well as the safety of the crew in
  the pt compartment
                                                  • Following the lead vehicle to closely and
                                                    colliding when is slows/stops
• Back up carefully
• Be especially cautious at intersections         • Drivers pull out behind the lead vehicle
                                                    causing collision

• Avoid escorting other vehicles if possible      • Never use an escort unless unfamiliar with a

                                                  Driving in Inclement Weather and at Night

• 41-5. Explain precautions that should be         • Recognize the risk of hydroplaning at
  taken when driving an ambulance at night.           speeds as low as 35 mph on wet roads

• 41-6. Describe the appropriate use of            • Keep windows and mirrors clear
  emergency warning devices, such as lights
  and sirens.                                      • Avoid sudden braking/turns
                                                   • Tap breaks after going through a puddle

• Carry emergency equipment; e.g., jumper
  cables, sand, etc.
                                                  Warning Devices
• Keep headlights clean
• Use high beams with caution                      • Start with standards for ambulance
                                                      markings- standard color is white with
                                                      orange stripe around body and “Star of
• Replace wiper baldes as needed                      Life” symbol
• Only drive if you are capable- have your
  partner drive if you are fatigued
                                                     • Strobes would be used with, not in place of,
•   Lights                                             rotating lights

    • Must be visible 360 around vehicle
                                                     • Be careful not to blind oncoming drivers
    • Running light should be on whenever the        • Use minimal lighting in fog/snow
      vehcile is in use
                                                     • Wig-wags should be used only if they are
    • Emergency lights should be on whenever           secondary to headlights
      you are running a call, even if the siren is
      not in use                                     • Four way flashers (hazard lights) should never be
                                                       used on a moving vehicle

 Sirens                                               • Sirens can cause stress for your pt- many
                                                         systems avoid using them when transporting
                                                         cardiac pts
    • Do not assume everyone hears your
      siren- cars are well insulated from sound
      and amient internal noise from stereo           • Sirens tend to boost the EMT’s adrenalin level-
                                                         studies show speed increases of 15mph when a
      systems, cell phone ear-sets, rain, etc
                                                         siren is sounding
      block your attempt at warning

    • “Blasting” a driver may cause a reflexive        • Use sirens sparingly, varying their sound output
      emergency braking response- be
      especially careful of air horns                 • Using the horn can sometimes be as effective
                                                         as using the siren

                                                         Roadway Incident Safety

                                                          • Wear high-visibility apparel
• 41-7. Describe the safety precautions to be             • Do not trust/turn your back on
    taken when working at scenes on and near
                                                             approaching traffic
                                                          • First arriving vehicle should be parked so
                                                             as to serve as a barrier to upstream
• Do not blind oncoming traffic with lights               • Park 100’ from wreck (50’ if there are no
                                                           fumes/hazardous liquids)
• Use traffic cones/flares to manage traffic                • Allow room for other emergency vehicles
• Park uphill/upwind if hazardous chemicals              • Don’t allow your vehicle to become
    may be involved; downhill for vapors
                                                           blocked in

                                                              8 Phases of a Call
                                                           1. Prerun/                  6. At Receiving
• 41-8. Give examples of the EMT’s                            Equipment Check             Facility
    responsibilities during each of the major              2. Dispatch                 7. En Route
    phases of an ambulance call.                                                          Returning to
                                                           3. En Route to                 Station
•   41-9. Describe post-run actions that should               Scene
    be taken to reduce the spread of infection                                         8. Post Run
    to you, your coworkers, and patients.                  4. At Scene

                                                           5. En Route to
                                                              Receiving Facility

                                                           2. Dispatch
1. Prerun/Equipment Check

• Vehicle inspection (check tires, fluid levels,           • Emergency Medical Dispatchers (EMDs)
                                                            interrogate caller, assign priority, dispatch
    lights, heating/air conditioning, mirrors, body of
                                                            crews and coordinate other required
    vehicle, communication devices)
• Patient Compartment Supplies (Checklist of all          • Crew needs address, nature of call, location
    required equipment; testing of suctioning
                                                            of pt at scene, number of pts/severity, other
    devices, O2 levels)
                                                            pertinent data
                                                     3. En Route to Scene

 • Priority 1- hot (unstable pt)                    • Conform dispatch information
 • Priority 2- (potentially unstable pt)            • Listen for status reports
 • Priority 3- cold (stable pt)                     • Prepare for scene by considering possible
                                                      issues, equipment needs, etc

     4. At Scene                                   Transferring the Pt to the Ambulance

      • Notify dispatch of arrival                 • Select appropriate transfer device
      • Perform 360o viewing of scene and          • Package the pt

      • Take all standard precautions that apply   • Move pt to ambulance
      • Perform a Scene Survey                     • Load pt into ambulance
      • AT&T- Assess, Treat & Transport            • Secure stretcher

5. En Route to Receiving Facility
                                                    • Loosen constricting clothes
•   Be sure that all gear has been returned to
    ambulance before leaving- dispose of medical    • Check splints and other interventions
    materials used on scene
                                                    • Reassess and perform necessary pt
• Load family member/friend into passenger seat       interventions

• Appropriately position/secure pt                  • Keep receiving hospital aware of ETA and pt
• One EMT drives, one “techs”
  6. At Receiving Facility

 • Check with ED staff as to where they want      • Clean/disinfect pt compartment
   the pt and assist with lifting & moving

 • Provide a verbal report to ED staff            • Restock ambulance
 • Complete the PCR and provide a copy to ED      • Make up cot with replacement linens
 • Be sure to have transferred personal effects   • Return to service
 • Obtain release from hospital

                                                  8. Post Run
7. En Route Returning to Station
                                                   • Complete any required reports
 • Radio dispatch regarding availability
                                                   • Change uniforms if needed
 • Refuel if needed
                                                   • Reinventory truck

                                                            Air Transport

• 41-10. Discuss situations in which air
   medical transport should be considered,
   potential disadvantages of air medical
   transport, and guidelines for setting up a
   landing zone.
Justification of Air Transport: Medical and Operational Reasons
                                                                 Limitations of Air Transport
• Critical Pt
                                                                  • Weather/environmental conditions
• Need for special facility
                                                                  • Terrain
• Extended extrication time
                                                                  • Pt’s weight
• Remote location rescue
                                                                  • Cost
• Traffic delays

     Landing Zones (LZ)

     • Must be 100’ x 100’                                       • Stop traffic going both ways on a divided
     • Provide GPS coordinates if the LZ is not a
        standard one
                                                                 • Mark all 4 corners for pilot
     • Be sure that lights from vehicles do not blind            • Secure all loose items at LZ and pick up any
                                                                   trash/debris before the landing
     • Approach only from front and after being
        directed to do so by pilot/crew

                                                                  NAEMT Security/Safety Recommendations

    • 41-11. Describe the recommendations of                       • Personnel Recommendations
       the National Association of Emergency
       Medical Technicians with respect to EMT                      • Security briefing before shifts to
                                                                        forewarn personnel of dangers
       security and safety.
                                                                     • EMS crews should be actively involved
                                                                        in security/safety matters
• Vehicle Recommendations                            • Uniforms and ID Recommendations
 • All EMS vehicles should be tracked                • Counterfeit-resistant ID cards/badges to
                                                       authorized individuals
 • Should never be left running or                   • Uniform stores must require evidence of
    unattended with keys in ignition
                                                       authorization to purchase uniforms

                                              • Have frequent engine tune-ups
                                              • Adequate exhaust system
• 41-12. Explain precautions to avoid         • Keep rear windows shut
  exposing yourself or others to increased
  levels of carbon monoxide associated with   • Assure proper gasket sealing of doors
  ambulance operations.
                                              • Do not use roof vents/exhaust fans
                                              • Keep heater/AC on for positive pressure
                                              • Do not use gas-powered gear in an ambulance

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