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Hospital Transport Services, like ambulancy and other emergency services

Hospital Transport Services, like ambulancy and other emergency services

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  • 1. HOSPITAL TRANSPORT SERVICES DR.N.C.DAS
  • 2. TYPE OF TRANSPORT
    • The hospital uses various types of transports to carry out different types of functions.
    • - The transport system can broadly be divided into two parts.
    TRANSPORT STAFF & MATERIAL TRANSPORT PATIENT TRANSPORT SERVICE HEARSE VAN AMBULANCES ACUTE LIFE SUPPORT BASIC LIFE SUPPORT PATIENT TRANSPORT STAFF CARS STORE VAN
  • 3. HOSPITAL TRANSPORT SERVICES The hospital transport services can broadly be divided into four parts. TRANSPORT SERVICE AVAILABILITY OF VEHICLES MANPOWER MAINTENANCE & CONDEMNATION INFRASTRUCTURE
  • 4. INFRASTRUCTURE INFRASTRUCTURE TRANSPORT BAY WORKSHOP ADMINISTRATIVE OFFICE
  • 5. TRANSPORT BAY
    • There should be a designated area for parking of hospital vehicles near to Emergency.
    • The size depends on the number of vehicles.
    • Provision of water supply and Electrical points.
    • Patient loading and unloading Area.
    • The area must be properly secured and have adequate light and power points for charging of ambulance equipments.
    • The mechanics must inspect the vehicles daily and do preventive maintenance.
    • The cleaners must clean the vehicles daily, washing and neat & clean.
    • The O.T technician to maintain the equipments installed in ALS/ BLS ambulances and test them each morning.
    • The in charge transport must make it sure, that the vehicles are properly fueled and greased and ready to take up any time.
  • 6. WORKSHOP
    • The transport service must have a maintenance workshop, having facilities for minor repairs.
    • The minor repair to be done by trained mechanics, recruitment by the hospital.
    • The size of the workshop depends on vehicles load, however an area of 20 ft x 12 ft will suffice.
    • The work shop must have adequate light, vehicle washing system, welding and cutting facilities.
    • Major repair to be done on authorized work shops.
  • 7. ADMN AREA The administrative area must comprises of:-
    • Office of CMO I/c TPT
    • Office of Transport Supervisor
    • Record Room
    • Rest area for drivers and other staff
    • Store
  • 8. ORGANIZATION MEDICAL SUPERINTENDENT ADDITIONAL MEDICAL SUPERINTENDENT (TPT) CMO I/C TPT TRANSPORT SUPERVISOR STRETCHER BEARER MECHANIC DRIVERS CLEANER TECH. STAFF
    • The total number of staff depends on number of vehicles.
    • However each vehicle will have one driver on each shift.
    • Each ambulance per shift will have one O.T Tech and 02 stretcher bearers and one driver.
    • Transport Supervisor will be responsible for deployment of staff roaster and
    • detailment of vehicles on requisition.
  • 9. STAFFING
      • Service to be given 24x7x365
      • Driver -1 ,stretcher bearer-1
      • To be run in 3 shifts with relief duty for Sundays and holidays .
    Ambulance Drivers Paramedic 02 07 10 03 12 15 04 16 20 05 20 24 Doctors-need depends upon the type of emergency, accident or the disaster. CCM trained nurse in each ambulance desirable for ideal optimal mgt. The paramedic should be trained in CPR ,lifting ,tpt of pts Regular training on Up dates. (CCM- Cardiac Care Monitoring)
  • 10. STAFFING
    • TR manager/supervisor
      • Co-ordinator controller of services
      • Supervise the maintenance of log book( dt. of procurement , warranty pd ,break don pd , type of break down, cost of repair, pol filling ,mileage recording, daily km run)
    • STORE KEEPER
    • RECORD OF SPARES USED
    • LOG BOOK-STORE BOOK SHOULD TALLY
    • POL CONSUMPTION
    • SERVICING RECORD OF VEHICLE
    • MILEAGE RECORD
    • MILEAGE AVERAGE
    • CONDEMNED PARTS RECORD
  • 11. MAINTENANCE
    • Daily maintenance
    • Annual Maintenance contract
    • Minor repair in workshop.
    • Breakdown maintenance in authorised Garage.
    • Wash area for ambulance should be defined along with water and drain facility
    • Daily inspection of vehicle
    • Daily inspection and checking of equipment
  • 12. COMMUNICATION
      • Communication with Hospital
      • Communication with CATS (State)
      • Communication with EMR (centre)
      • Mobile ph /wireless sets be provided
      • Keep a record of tel no of fellow colleagues /hospitals.
      • Keep a map of city /area for faster and accurate movement.
  • 13. CONDEMNATION OF VEHICLE There should be a Condemnation Committee, who will be comprising of Senior Officer - Chairman CMO (TPT) - Member TPT Supervisor - Member Secretary Representative of Transport Authority - Member DDA - Member Mechanic - Member
    • The committee will frame the guidelines for condemnation of vehicles as per government norms.
    • The mechanic after examining the condition of vehicle, kilometer covered and amount spent on repair, recommends for condemnation, looking into financial viability.
    • - The committee on proposal of the mechanique examines the vehicle condition and road worthiness and if found unfit, recommend for condemnation of the vehicle.
  • 14. PATIENT TRANSPORT SERVICE PATIENT TRANSPORT BY ROAD BY AIR BY RAIL BY WATER
  • 15. PATIENT TRANSPORT SERVICE
    • Transport of sick/injured from periphery to the health centre .
    • The most vital part of health Care delivery system .
    • Vital link of the health care system.
    • It is the initial golden time which if utilized and given priority helps in saving the life of a pt.
    • To take care of casualties during natural/man made calamities.
    • Effective medical care delivery by qualified competent medical, nursing and para-medical staff.
    • An efficient ambulance service is considered to be an essential of well organized segment of emergency and critical care service .
  • 16. HISTORY
    • In earlier times patients were left to die during calamities
    • With the progress of time, carts (horse, bullock) were used as early as 1762 AD in France.
    • The term “Hospital Ambulant” was used to describe the mobile hospital.
    • 1880 - Wheeled trolleys used in England .
    • 1903- Motorized ambulance introduced.
    • World wars I and II - though a disaster for the world but opened new avenues services in the health sector.
    • The system encompasses a scientific synthesis of biomedical eng.
    • High tech ambulance services have been in operation in the west
    • Gradually making in roads into the India.
  • 17. PATIENT TRANSPORT SERVICE Two types of hospital transport is provided for patients . PATIENT TRANSPORT AMBULANCES HEARSE VAN
    • ALS/ BLS ambulances are used for
    • transportation of seriously ill patient to
    • & from the hospital under doctor’s
    • supervision.
    • -These ambulances are fitted with ventilator,
    • defibrillators, gas pipelines and first aid
    • equipments.
    • -The transport ambulances are used for taking
    • patient after care to home or patients from home to hospital, in whom transit medical intervention is not required.
    • Free for insured patients, but general patient to pay per km subsidized.
    • For carrying dead bodies
    • from hospital.
  • 18. AMBULANCE SERVICES
    • As per dictionary the word ambulance means an organization for rendering first aid.
    • An efficient ambulance service is considered to be an essential of well organized segment of emergency and critical care service .
    • The ever changing concept of Emergency care
    • -on the spot
    • -during tpt.
    • -ICU protocols
    • Has brought a revolution in Ambulance Services.
  • 19. AMBULANCE SERVICES IN INDIA
    • VARIOUS COMMITTEE RECOMMENDATION
    • Mudaliar committee (1961 )
      • Existing system deficient
      • Lack of close cooperation between hospital and ambulance authorities.
    • B. K N Rao committee(1968)-
      • Deficient services
      • Majority of ambulances off road
      • Insufficient staff to run 24 hr service
      • Only primitive type of ambulances are in use.
            • C . Rao committee recommendations
    • Hospital beds No of ambulancces
    • 100-200 3
    • 200-300 4
    • >300 6
    • At least 1-2 ambulance will always be off road for preventive maintenance.
  • 20. Organisation of Ambulance. Services ORGANISATION HOSPITAL CENTRE STATE
  • 21. STATE LEVEL
  • 22. CENTRALISED ACCIDENT & TRAUMA SERVICES (C.A.T.S.)
    • MEDICAL emergency team on call 24 hours - 365 days a year
    • Right medical equipment with-
      • Trained / qualified personnel.
      • Proper transportation of a patient In critical state.
      • Prevention of further deterioration of the patient's condition.
      • Transportation to a location where proper medical attention/care can be provided Immediately.
      • Fastest time frame
      • Availability to the masses.
  • 23. DEVELOPMENT
    • Conceptualised as a plan scheme In 1984 (6th Five Year Plan)
    • The scheme was to be implemented under the aegis AllMS.
    • In April, 1988, ambulance service transferred to Delhi Fire Service (DFS)
    • Multi sectorial coordination needed,
    • -A scheme implemented by a society registered for the purpose.
    • -Consequently, CATS society was formed by Delhi Administration as a registered society in June, 1989 .
  • 24. OBJECTIVES OF CATS-
      • To reach accident site as quickly as possible,
      • To give first-aid to the patient
      • Quick and safe transportation of the patient to the hospital
      • Liaison with other organization as Delhi Police, Delhi Fire Service and any other governmental agencies for the benefit and the care of the accident victims.
  • 25. CENTRAL CONTROL ROOM
    • At Deen Dayal Upadhya Hospital at Hari Nagar,
    • N Delhi.
    • Calls No. "1099" (10 lines)
    • OTHER CALL RECEICING NO-
    • (Delhi Police) ‘100’
    • Delhi Fire Service ‘101’ through wireless sets
    • At present 35 ambulances are standing at 35 location points (plan to increase to 150)
  • 26. STAFFING AND EQUIPMENTS
    • Basic life support system type of ambulance.
    • Each ambulance is manned with two interchangeable Asstt. Junior ambulance Officer (AJAO),
    • AJAOs are graduates who are
    • Trained in multi disciplinary skill of first-aid emergency management
    • Wireless communication and driving.
    • On receiving, a call of accident, proceeds to the sight.
  • 27. NATIONAL LEVEL
    • To give care to accident victims on highways-
    • National Highways Authority of India has arranged ambulances, manned by critical care personnel, on these connectivities.
    • The provision of providing ambulances is part of the contract for the Golden Quadrilateral (GQ) and the North-South East-West (NSEW) corridors
    • Contractor's responsibility to make available an ambulance and a crane for evey 50 km of the road after completion.
    • Currently, there are about 90 ambulances operational on highways
    • To increase up to 300 once the GQ and NSEW projects are completed.
  • 28. NATIONAL LEVEL
    • Golden Quadrilateral is 5,846 km long
    • Connects Delhi- Mumbai- Kolkata and Chennai,
    • The NSEW corridors aims at connecting Silchar with Porbandar and Srinagar with Kanyakumari covering 7,150 km road.
    • Common emergency number across the country.
    • The proposed helpline will apply to
    • Road accidents
    • Snake bites
    • Injuries
    • Theft on the highways.
    • The helpline and ambulance services are part of the integrated trauma care system to be implemented on the GQ and later on the NSEW corridors.
  • 29. BASIC AND ADVANCE LIFE SUPPORT (CARDIO PULMONARY RESUSCITATION)
    • BASIC LIFE SUPPORT
    • Given 1to 4 minutes
    • A - Airway
    • B - Breathing
    • C - Circulation
    • ADVANCE LIFE SUPPORT
    • Given 5to 8 minutes
    • D - Defibrillator
    • E - ECG
    • F - Fluid and drugs
    • G - Gauze parameters
    • H - Human and Machine function
  • 30. HIGHTEC AMBULANCES There are presently Two hitech. Life Support ambulances are in use. i). Basic Life Support (BLS) ii). Advance Life Support(ALS) BLS - manned by paramedics-with min basic equipment. ALS - Manned by CCM EXPERT DOCTOR with all the ICU equipments
  • 31. BASIC LIFE SUPPORT USE
    • Provides transportation of the pt needed for such basic services as:-
    • control of bleeding,
    • splinting fractures,
    • treatment for shock-
    • Airway/Respiration
    • TPR
    • First Aid
    • These ambulances carry necessary equipments and trained Technical staff. equipment and staff .
  • 32. EQUIPMENTS
    • Stretcher,
    • Linens,
    • Emergency medical supplies,
    • Oxygen equipment,
    • Other lifesaving emergency medical equipment and be equipped with emergency warning lights sirens,
    • Telecommunications equipment.
    • This would include at a minimum, one two- day voice radio or wireless telephone .
  • 33. USES
    • Non-emergency patient transport.
    • Transport to local hospital for Radiology and Radiation
    • Specialist appointment.
    • On discharges from Hospital
    • Visit to physiotherapy and Dialysis Unit.
    • Transfer to other Hospital.
    • BLS - manned by paramedics-with minimum basic equipment.
  • 34. ADVANCED LIFE SUPPORT (ALS)
    • These ambulances are recommended for transporting:
    • Critically ill patients: These patients are usually
    • ventilator supported,
    • septicemic,
    • In multiorgan failure on various life support equipment.
    • Transported for investigations such as CT scan, MRI scan,
    • Requiring life saving surgeries to tertiary cares centers or specialized centers.
    • These kinds of transport facilities are provided on bedside-to-bedside transport basic.
    • This can be within the city ICU's or from one city to the other, where better/advanced facilities are available.
    • These ambulances are fitted with the state of the art pre hospital medical equipment almost identical to the Hospital ICU's.
    • These ambulance can transport ventilator- supported patients on long distances.
    • Manned by CCM expert doctor with all the ICU equipments.
  • 35. EQUIPMENTS
    • Doctors trained in CCM (Cardiac care Monitoring) ,adequately experienced to handle all kinds of Emergencies.
    • Portable Aspirator (Suction Machine) HoseVacuum Adjustable (0-550mm Hg) Capacity (900 ml) Should be operated at 12 V DC.
    • Scoop Stretcher
    • Should be tabular aluminum construction with extended aluminum blades includes 3 nylon restraint straps (CE marked).
    • Portable Transport Ventilator .
    • Should have Non Invasive / Invasive ventilator for Neonates, Pediatric & Adults.
    • Ventilator should have Control mode of ventilation.
    • Cardiac Patient Monitor Patient Monitor should have facility to display ECG, HR, SPO2, NIBP, Respiration & Temperature with built in rechargeable battery back up of atleast 2 hrs. operation.
    • Defibrillator Monitor
    • Syringe Infusion Pump:
    • Accepts 10, 20, 30 and 50/60ml, Syringe
    • 0.1 ml/hr to 500 ml/hr flow rate
    • Programmable to accept any brand of syringe
    • :
  • 36. ELIGIBILITY FOR USE OF TRANSPORT AMBULANCE
    • A patient who has to be transported on a stretcher or wheel chair.
    • A patient who is mentally visually or orthopaedically handicap and cannot use public transport.
    • Require oxygen during transport.
    • Suffering from infectious, where is chance of spread in public transport.
    • Require an attendant to move around.
    • The ambulance is booked by filling a requisition form and depositing requisite payments if any.
  • 37. DONTS IN USE
    • Never allow the ambulance for carrying dead bodies as it may spread infection , may cause psychological trauma to the pt.
    • Speed of vehicle should be optimum on the road.
    • All ways use exclusively for patient transportation only.
    • Never Use ambulances for carrying stores, diet or Hospital Staff.
  • 38. Hospital Administration Made Easy http//hospiad.blogspot.com An effort solely to help students and aspirants in their attempt to become a successful Hospital Administrator. hospi ad DR. N. C. DAS