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Ambulancias equipamiento
Ambulancias equipamiento
Ambulancias equipamiento
Ambulancias equipamiento
Ambulancias equipamiento
Ambulancias equipamiento
Ambulancias equipamiento
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Ambulancias equipamiento

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  • 1. s Ambu lance r uipm ent fo Eq Almost four decades ago, the For purposes of this document, the Committee on Trauma (COT) following definitions have been of the American College of used: a neonate is 0–28 days old, Surgeons (ACS) developed a list an infant is 29 days to 1 year old, of standardized equipment for and a child is >1 year through 11 ambulances. Beginning in 1988, the years old with delineation into the American College of Emergency following developmental stages: Physicians (ACEP) published a similar list. The two organizations Toddlers (1–3 years old) collaborated on a joint document Preschoolers (3–5 years old) published in 2000, and the National Middle Childhood (6–11 years old) Association of EMS Physicians (NAEMSP) participated in the 2005 Adolescents (12–18 years old)American College of Surgeons revision. The 2005 revision included These standard definitions are age Committee on Trauma resources needed on ambulances for based. Length-based systems have appropriate homeland security. All been developed to more accurately three organizations adhere to the estimate the weight of children and principle that Emergency Medical predict appropriate equipment sizes, American College of Services (EMS) providers at all medication doses, and guidelines Emergency Physicians levels must have the appropriate for fluid volume administration. equipment and supplies to optimize prehospital delivery of care. The National Association document was written to serve as a Principles of of EMS Physicians standard for the equipment needs of Prehospital Care emergency ambulance services both in the United States and Canada. The goal of prehospital care is to minimize further systemic EMS providers care for patients of insult or injury and manage life- Pediatric Equipment Guidelines all ages, who have a wide variety of threatening conditions through Committee—Emergency medical and traumatic conditions. a series of well defined and Medical Services for Children With permission from the ACS COT, appropriate interventions, and to(EMSC) Partnership for Children ACEP, and NAEMSP, the current embrace principles that ensure Stakeholder Group revision includes updated pediatric patient safety. High-quality, recommendations developed by consistent emergency care demands members of the federal Emergency continuous quality improvement Medical Services for Children and is directly dependent on the American Academy (EMSC) Stakeholder Group. The effective monitoring, integration, of Pediatrics EMSC Program has developed and evaluation of all components several performance measures for of the patient’s care. the Program’s State Partnership grantees. One of the performance Integral to this process is medical measures evaluates the availability oversight of prehospital care by of essential pediatric equipment using preexisting protocols (indirect and supplies for Basic Life Support medical oversight), which are and Advanced Life Support patient evidence-based when possible, or care units. This document will by medical control via voice and/or be used as the standard for this video communication (direct medical performance measure. The American oversight). The protocols that guide Academy of Pediatrics (AAP) has patient care should be established also officially endorsed this list. collaboratively by medical directors
  • 2. s Ambu lance r uipm ent fo Eqfor ambulance services, adult and Required Equipment: 6. Airwayspediatric emergency medicinephysicians, adult and pediatric trauma Basic Life Support • Nasopharyngeal (16F–34F; adult and child sizes)surgeons, and appropriately trained (BLS) Ambulancesbasic and advanced emergency • Oropharyngeal (sizes 0–5;medical personnel. Current Institute A. Ventilation and Airway Equipment adult, child, and infant sizes)of Medicine (IOM) recommendations 1. Portable and fixed suction 7. Pulse oximeter withencourage each EMS agency to have apparatus with a regulator pediatric and adult probesa pediatric coordinator to specifically (per Federal specifications; 8. Saline drops and bulbcoordinate the capability of the see Federal Specification suction for infantsservice to care for nonadult patients. KKK-A-1822F reference) B. Monitoring and Defibrillation • Wide-bore tubing, rigidEquipment and Supplies pharyngeal curved suction All ambulances should be tip; tonsillar and flexible equipped with an automatedThe guidelines list the supplies and suction catheters, 6F–16F are external defibrillator (AED)equipment that should be stocked on commercially available (have unless staffed by advanced lifeambulances to provide the accepted one between 6F and 10F and support personnel who arestandards of patient care. Previous one between 12F and 16F) carrying a monitor/defibrillator.documents regarding ambulance The AED should have pediatric 2. Portable oxygen apparatus,equipment referred to essential or capabilities, including child- capable of metered flowminimal equipment necessary to sized pads and cables. with adequate tubing adequately equip an ambulance.Equipment requirements will vary, 3. Portable and fixed oxygen C. Immobilization Devicesdepending on the certification levels supply equipment 1. Cervical collarsof the providers, population densities, • Variable flow regulatorgeographic and economic conditions • Rigid for children ages 4. Oxygen administration 2 years or older; childof the region, and other factors. equipment and adult sizes (small,The following list is divided into • Adequate length tubing; medium, large, andequipment for basic life support transparent mask (adult other available sizes)(BLS) and advanced life support and child sizes), both 2. Head immobilization(ALS) ambulances. ALS ambulances non-rebreathing and device (not sandbags)must have all of the equipment valveless; nasal cannulason the required BLS list as well as • Firm padding or (adult, child) equipment on the required ALS list. commercial deviceThis list represents a consensus of 5. Bag-valve mask (manual 3. Lower extremity (femur)recommendations for equipment and resuscitator) traction devicessupplies that will facilitate patient • Hand-operated, self-care in the out-of-hospital setting. • Lower extremity, limb- reexpanding bag; adult support slings, padded (>1000 ml) and child (450– ankle hitch, padded pelvic 750 ml) sizes, with oxygen support, traction strap reservoir/accumulator; (adult and child sizes) valve (clear, disposable, operable in cold weather); and mask (adult, child, infant, and neonate sizes)
  • 3. s Ambu lance r uipm ent fo Eq 4. Upper and lower extremity 6. Adhesive tape 7. Sterile saline solution immobilization devices • Various sizes (including 1” for irrigation (1-liter • Joint-above and joint-below and 2”) hypoallergenic bottles or bags) fracture (sizes appropriate • Various sizes (including 8. Flashlights (2) with extra for adults and children), 1” and 2”) adhesive batteries and bulbs rigid-support constructed 9. Blankets with appropriate material 7. Arterial tourniquet (cardboard, metal, (commercial preferred) 10. Sheets (minimum 4), linen pneumatic, vacuum, or paper, and pillows E. Communication wood, or plastic) 11. Towels Two-way communication 5. Impervious backboards (long, 12. Triage tags device between EMS provider, short; radiolucent preferred) 13. Disposable emesis dispatcher, and medical control and extrication device bags or basins • Short (extrication, head- F. Obstetrical Kit (commercially 14. Disposable bedpan to-pelvis length) and long packaged is available) (transport, head-to–feet 15. Disposable urinal 1. Kit (separate sterile kit) length) with at least three 16. Wheeled cot (conforming appropriate restraint • Towels, 4”x4” dressing, to national standard at the straps (chin strap alone umbilical tape, sterile time of manufacture) should not be used for scissors or other cutting 17. Folding stretcher head immobilization) utensil, bulb suction, and with padding for clamps for cord, sterile 18. Stair chair or carry chair children and handholds gloves, blanket 19. Patient care charts/forms for moving patients 2. Thermal absorbent blanket 20. Lubricating jelly and head cover, aluminum (water soluble)D. Bandages foil roll, or appropriate 1. Commercially-packaged or heat-reflective material H. Infection Control* sterile burn sheets (enough to cover newborn) *Latex-free equipment should be available 2. Triangular bandages G. Miscellaneous 1. Eye protection (full peripheral • Minimum two glasses or goggles, face shield) 1. Sphygmomanometer safety pins each (pediatric and adult 2. Face protection (for example, 3. Dressings regular and large surgical masks per applicable • Sterile multitrauma size cuffs) local or state guidance) dressings (various large 2. Adult stethoscope 3. Gloves, nonsterile (must meet and small sizes) NFPA 1999 requirements 3. Length/weight-based tape or • ABDs, 10”x12” or larger appropriate reference material found at http://www.nfpa.org/) • 4”x4” gauze sponges for pediatric equipment sizing 4. Coveralls or gowns or suitable size and drug dosing based on 5. Shoe covers estimated or known weight 4. Gauze rolls 6. Waterless hand cleanser, 4. Thermometer with low • Various sizes commercial antimicrobial temperature capability (towelette, spray, liquid) 5. Occlusive dressing 5. Heavy bandage or paramedic or equivalent 7. Disinfectant solution for scissors for cutting clothing, cleaning equipment • Sterile, 3”x8” or larger belts, and boots 8. Standard sharps containers, 6. Cold packs fixed and portable
  • 4. s Ambu lance r uipm ent fo Eq B. Vascular Access 9. Disposable trash Required Equipment: bags for disposing of 1. Crystalloid solutions, such biohazardous waste Advanced Life Support as Ringer’s lactate or normal 10. Respiratory protection (ALS) Ambulances saline solution (1,000-mL (for example, N95 or N100 For EMT-Paramedic services, include bags x 4); fluid must be in mask—per applicable all of the required equipment listed bags, not bottles; type of fluid local or state guidance) for the basic level provider, plus the may vary depending on state following additional equipment and and local requirementsI. Injury Prevention Equipment supplies. For EMT-Intermediate 2. Antiseptic solution (alcohol 1. All individuals in an services (and other nonparamedic wipes and povidone- ambulance need to advanced levels), include all of the iodine wipes preferred) be restrained (there is equipment for the basic level provider 3. IV pole or roof hook currently no national and selected equipment and supplies standard for transport of from the following list, based on local 4. Intravenous catheters 14G–24G uninjured children) need and consideration of prehospital 5. Intraosseous needles or 2. Protective helmet characteristics and budget. devices appropriate for children and adults 3. Fire extinguisher A. Airway and Ventilation Equipment 6. Venous tourniquet, 4. Hazardous material 1. Laryngoscope handle with rubber bands reference guide extra batteries and bulbs 7. Syringes of various sizes, 5. Traffic signaling devices 2. Laryngoscope blades, sizes including tuberculin (reflective material 0–4, straight (Miller); sizes triangles or other reflective, 8. Needles, various sizes (one at 2–4, curved, (MacIntosh) nonigniting devices) least 1 ½” for IM injections) 3. Endotracheal tubes, sizes 6. Reflective safety wear for 9. Intravenous administration 2.5–5.5 mm uncuffed and each crewmember (must sets (microdrip and 6–8 mm cuffed (2 each), meet or exceed ANSI/ISEA macrodrip) other sizes optional performance class II or III if 10. Intravenous arm boards, 4. Meconium aspirator adaptor working within the right of adult and pediatric way of any federal-aid highway. 5. 10-mL non-Luerlock syringes Visit http://www.reflectivevest. C. Cardiac 6. Stylettes for endotracheal com/federalhighwayruling.html tubes, adult and pediatric 1. Portable, battery-operated for more information.) monitor/defibrillator 7. Magill (Rovenstein) forceps, adult and pediatric • With tape write-out/ recorder, defibrillator 8. Lubricating jelly pads, quick-look paddles (water soluble) or electrode, or hands- 9. End-tidal CO2 detection free patches, ECG leads, capability adult and pediatric chest • Colorimetric (adult and attachment electrodes, adult pediatric) or quantitative and pediatric paddles capnometry 2. Transcutaneous cardiac pacemaker, including pediatric pads and cables • Either stand-alone unit or integrated into monitor/defibrillator
  • 5. s Ambu lance r uipm ent fo EqD. Other Advanced Equipment • Analgesics, narcotic approved have been studied in 1. Nebulizer and nonnarcotic children. Those that have been • Antiepileptic medications, such studied, such as the LMA, have 2. Glucometer or blood not been adequately evaluated glucose measuring device as diazepam or midazolam in the prehospital setting). • With reagent strips • Sodium bicarbonate, magnesium sulfate, glucagon, naloxone 9. Neonatal blood pressure cuff 3. Large bore needle (should hydrochloride, calcium chloride 10. Infant blood pressure cuff be at least 3.25” in length for needle chest decompression • Bacteriostatic water and 11. Pediatric stethoscope in large adults) sodium chloride for injection 12. Infant cervical • Additional medications as immobilization deviceE. Medications (pre-loaded per local medical director 13. Pediatric backboard syringes when available) and extremity splints Medications used on advanced Optional Basic Equipment 14. Topical hemostatic agent level ambulances should be compatible with current guidelines This section is intended to assist EMS 15. Appropriate CBRNE PPE as published by the American providers in choosing equipment (chemical, biological, Heart Association’s Committee that can be used to ensure delivery radiological, nuclear, on Emergency Cardiovascular of quality prehospital care. Use explosive personal Care, as reflected in the should be based on local resources. protective equipment), Advanced Cardiac Life Support The equipment in this section including respiratory and Pediatric Advanced Life is not mandated or required. and body protection Support Courses, or other such 16. Applicable chemical antidote A. Optional Equipment organizations and publications autoinjectors (at a minimum (ACEP, ACS, NAEMSP, and so on). 1. Glucometer (per for crew members’ protection; Medications may vary depending state protocol) additional for victim treatment on state requirements. Drug based on local or regional 2. Elastic bandages dosing in children should use protocol; appropriate for processes minimizing the need • Nonsterile (various sizes) adults and children) for calculations, preferably a 3. Cellular phone length-based system. In general, B. Optional Advanced Equipment 4. Infant oxygen mask medications may include: 1. Respirator 5. Infant self-inflating • Cardiovascular medication, resuscitation bag • Volume-cycled, on/off such as 1:10,000 epinephrine, operation, 100% oxygen, 6. Airways atropine, antidysrhythmics 40–50 psi pressure (child/ (for example, adenosine and • asopharyngeal (12, 14 Fr) N infant capabilities) amiodarone), calcium channel • Oropharyngeal (size 00) 2. Blood sample tubes, blockers, beta-blockers, adult and pediatric 7. Alternative airway devices nitroglycerin tablets, aspirin, (for example, a rescue airway 3. Automatic blood vasopressor for infusion device such as the ETDLA pressure device • Cardiopulmonary/respiratory [esophageal-tracheal double medications, such as albuterol 4. Nasogastric tubes, pediatric lumen airway], laryngeal (or other inhaled beta agonist) feeding tube sizes 5F and tube, or laryngeal mask and ipratropium bromide, 8F, sump tube sizes 8F–16F airway) as approved by 1:1,000 epinephrine, furosemide local medical direction. 5. Pediatric laryngoscope handle • 50% dextrose solution (and 8. Alternative airway devices 6. Size 1 curved (MacIntosh) sterile diluent or 25% dextrose for children (few alternative laryngoscope blade solution for pediatrics) airway devices that are FDA
  • 6. s Ambu lance r uipm ent fo Eq 7. 3.5–5.5 mm cuffed such as the American Academy of Pulling Tools/Devices endotracheal tubes Pediatrics Guidelines for Air and • Ropes/chains 8. Needle cricothyrotomy Ground Transport of Neonatal and Pediatric Patients. • Come-along capability and/or cricothyrotomy capability • Hydraulic truck jack (surgical cricothyrotomy Appendix • Air bags can be performed in older children in whom the Protective Devices Extrication Equipment cricothyroid membrane • Reflectors/flares Adequate extrication equipment is easily palpable, usually • Hard hats must be readily available to the by the age of 12 years) emergency medical services • Safety goggles responders, but is more often found • Fireproof blanketOptional Medications on heavy rescue vehicles than on the primary responding ambulance. • Leather glovesA. Optional Basic Life Support Medications • Jackets/coats/boots In general, the devices or tools used for extrication fall into several Patient-Related Devices 1. Albuterol broad categories: disassembly, 2. Epi pens • Stokes basket spreading, cutting, pulling, 3. Oral glucose protective, and patient-related. Miscellaneous 4. Nitroglycerin (sublingual The following is necessary equipment • Shovel tablet or paste) that should be available either • Lubricating oil on the primary response vehicleB. Optional Advanced Life or on a heavy rescue vehicle. • Wood/wedges Support Medications • Generator 1. Anxiolytics Disassembly Tools • Floodlights 2. Intubation adjuncts including • Wrenches (adjustable) Local extrication needs may neuromuscular blockers • Screwdrivers (flat and Phillips head) necessitate additional equipment for • Pliers water, aerial, or mountain rescue.Interfacility Transport • Bolt cutterAdditional equipment may be needed • Tin snipsby ALS and BLS prehospital careproviders who transport patients • Hammerbetween facilities. Transfers may be • Spring-loaded center punchdone to a lower or higher level of • Axes (pry, fire)care, depending on the specific need.Specialty transport teams, including • Bars (wrecking, crow)pediatric and neonatal teams, may • Ram (4 ton)include other personnel such asrespiratory therapists, nurses, and Spreading Toolsphysicians. Training and equipment • Hydraulic jack/spreader/needs may be different depending cutter combinationon the skills needed duringtransport of these patients. There Cutting Toolsare excellent resources available that • Saws (hacksaw, fire, windshield,provide detailed lists of equipment pruning, reciprocating)needed for interfacility transfer • Air-cutting gun kit
  • 7. s Ambu lance r uipm ent fo EqSelected References Orliaguet G, Renaud E, Lejay M, et al. Postal survey of cuffed or Footnote: The evidence in children for selected prehospital care interventionsAmerican Academy of Pediatrics Section uncuffed tracheal tubes used for or topics was reviewed in preparation foron Transport Medicine. Guidelines for paediatric tracheal intubation. Paediatr finalizing this ambulance equipment list.Air and Ground Transport of Neonatal and Anaesth. 2001;11(3):277–281. These topics included: (a) child safetyPediatric Patients, 3rd edition. George A. and booster seats approved for EMS Federal Highway Administration, DOT use; (b) alternative airway devices; (c)Woodward, MD, MBA, FAAP (ed). 2007. CFR-634.2 and 634.3 – Worker Visibility spinal immobilization devices includingAmerican College of Surgeons Committee Use of High-Visibility Apparel When collars; and (d) prehospital use of cuffedon Trauma, Advanced Trauma Life Support Working on Federal-Aid Highways endotracheal tubes. The results ofStudent Course Manual (8th Edition). 2008. Available at: http://www.reflectivevest. this evidence evaluation including full com/federalhighwayruling.html. citations will be provided in a companionAmerican Heart Association, article authored by the primary reviewersPediatric Advanced Life Support Resources for Optimal Care of the topics and the EMSC StakeholdersProvider Manual. 2006. of the Injured Patient Group. The evidence in all ages for use of American College of Surgeons arterial tourniquets and hemostatic agentsBrennan JA, Krohmer J (eds), Principles Committee on Trauma was also reviewed and will be providedof EMS Systems. Sudbury, MA: Jones Chicago 1999, 2006. in separate consensus review articles.and Bartlett Publishers, 2005. Rumball CJ, MacDonald D. The PTL,Brown MA, Daya MR, Worley JA. combitube, laryngeal mask, and oralExperience with chitosan dressings airway: a randomized prehospitalin a civilian EMS system. J Emerg comparative study of ventilatory deviceMed. 2007:Nov 14 (doi:10.1016/j. effectiveness and cost-effectiveness injemermed.2007.05.043). 470 cases of cardiorespiratory arrest. Prehosp Emerg Care. 1997;1(1):1–10.Cervical spine immobilizationbefore admission to the hospital. Salomone JP, Pons PT, McSwain NE.Neurosurgery. 2002;50(3 Suppl):S7–17. Prehospital Trauma Life Support, 6th edition. Saint Louis, MO: Elsevier, 2007.Doyle GS, Taillac PP. Tourniquets: areview of current use with proposals Treloar OJ. Nypaver M. Angulationfor expanded prehospital use. Prehosp of the pediatric cervical spine withEmerg Care. 2008;12(2):241–256. and without cervical collar. Prehosp Emerg Care. 1997;13(1):5–8.Equipment for AmbulancesACEP Policy Statement, American College Wedmore I, McManus JG, Pusateri AE,of Emergency Physicians and Medical Holcomb JB. A special report on theDirection of Emergency Medical Services. chitosan-based hemostatic dressing:Available at: http://www.acep.org. experience in current combat operations. J Trauma. 2006;60(3):655–658.Federal Specifications for the Star-of-LifeAmbulance KKK-A-1822F. August 1, 2007. Youngquist S, Gausche-Hill M, Burbulys D. Alternative airway devices for use inFuture of EMS in the US children requiring prehospital airwayHealth Care System management: Update and case discussion.Institute of Medicine, May 17, 2007 Pediatr Emerg Care. 2007;23:1–10.Available at: www.iom.edu.James I. Cuffed tubes in children(editorial). Paediatr Anaesth.2001;11(3):259–263.Kwan I, Bunn F. Effects of prehospitalspinal immobilization: a systematic reviewof randomized trials on healthy subjects.Prehosp Disaster Med. 2005;20(1):47–53. REVISED April 2009

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