Ambulance Operations


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Ambulance Operations

  1. 1. Chapter Ambulance Operations Twenty-Six
  2. 2. <ul><li>Equipment carried on ambulance and importance of shift checks </li></ul><ul><li>Basics of most states’ emergency driving laws and regulations </li></ul><ul><li>Proper emergency vehicle operation </li></ul><ul><li>Proper transfer of patient to the ED staff </li></ul><ul><li>Usefulness of aeromedical evacuation where available </li></ul>CORE CONCEPTS Chapter Twenty-Six
  3. 3. <ul><li>Walk-around </li></ul><ul><li>Communications </li></ul><ul><li>Mechanical/fluids </li></ul><ul><li>Life-sustaining </li></ul><ul><li>Safety </li></ul><ul><li>Other medical </li></ul>Check Equipment <ul><li>Is it there? </li></ul><ul><li>Does it work? </li></ul><ul><li>Will it fail? </li></ul>(Continued) Preparation for the Call
  4. 4. Check Equipment <ul><li>New body damage </li></ul><ul><li>Fluid leaks </li></ul><ul><li>Tire wear </li></ul><ul><li>Warning equipment </li></ul><ul><li>Walk-around </li></ul>(Continued) Preparation for the Call
  5. 5. Walk-Around Inspection Start the engine. Turn on the lighting equipment. Walk around the vehicle, looking and listening. What is your equipment telling you?
  6. 6. Check Equipment <ul><li>Dispatch </li></ul><ul><li>Handheld </li></ul><ul><li>Medical control </li></ul><ul><li>Walk-around </li></ul><ul><li>Communications </li></ul>(Continued) Preparation for the Call
  7. 7. Check Equipment <ul><li>Starts </li></ul><ul><li>Steers </li></ul><ul><li>Stops </li></ul><ul><li>Stays running </li></ul><ul><li>Walk-around </li></ul><ul><li>Communications </li></ul><ul><li>Mechanical/fluids </li></ul>(Follow Agency Checklist) (Continued) Preparation for the Call
  8. 8. Mechanical Inspection Follow your agency’s checklist through a careful mechanical inspection. Be as sure as you can about your safety — and the public’s.
  9. 9. Check Equipment <ul><li>Suction </li></ul><ul><li>Oxygen/resuscitation </li></ul><ul><li>(Medication) </li></ul><ul><li>(Defibrillation) </li></ul><ul><li>Walk-around </li></ul><ul><li>Communications </li></ul><ul><li>Mechanical/fluids </li></ul><ul><li>Life-sustaining </li></ul>(Continued) Preparation for the Call
  10. 10. <ul><li>BSI gear </li></ul><ul><li>Binoculars </li></ul><ul><li>Scene wear </li></ul>Check Equipment <ul><li>Walk-around </li></ul><ul><li>Communications </li></ul><ul><li>Mechanical/fluids </li></ul><ul><li>Life-sustaining </li></ul><ul><li>Safety </li></ul>(Continued) Preparation for the Call
  11. 11. Communications Checks Your radio equipment — and your warning equipment — are vital to your medicine and your safety. They need to work perfectly.
  12. 12. Check Equipment <ul><li>Carry-in kits </li></ul><ul><li>Cabinet stock </li></ul><ul><li>Personal gear </li></ul>Preparation for the Call <ul><li>Walk-around </li></ul><ul><li>Communications </li></ul><ul><li>Mechanical/fluids </li></ul><ul><li>Life-sustaining </li></ul><ul><li>Safety </li></ul><ul><li>Other medical </li></ul>(Continued)
  13. 13. Ensure Cleanliness <ul><li>Carry-in gear </li></ul><ul><li>Ambulance interior </li></ul><ul><li>Ambulance exterior </li></ul>Preparation for the Call (Continued) <ul><li>Disease prevention </li></ul><ul><li>Public perception </li></ul><ul><li>Personal pride </li></ul>
  14. 14. Not Good Enough Your equipment talks about you, all the time. Make sure it refers to you as a professional.
  15. 15. Check Equipment <ul><li>Medical </li></ul><ul><li>Nonmedical </li></ul><ul><li>Personal safety </li></ul><ul><li>Maps </li></ul>Preparation for the Call (Continued)
  16. 16. Personnel Available for Response <ul><li>At least one EMT-B in patient compartment (minimum staffing) </li></ul><ul><li>Two EMT-Bs preferred </li></ul>Preparation for the Call (Continued)
  17. 17. Vehicle Inspection Preparation for the Call <ul><li>Engine, belts, hoses, fluids, tires </li></ul><ul><li>All lights, sirens </li></ul><ul><li>Communication </li></ul>equipment
  18. 18. The new EMT-B must realize that the most modern, well-equipped ambulance is not worth the room it takes in the garage if it’s not ready to respond. A state of readiness results from a planned preventive maintenance program, periodic servicing of the vehicle, and serious daily shift checks. P RECEPTOR P EARL
  19. 19. <ul><li>Central access (911) </li></ul><ul><li>24-hour availability </li></ul><ul><li>Trained personnel (emergency </li></ul>(Continued) Dispatch medical dispatchers)
  20. 20. Information <ul><li>Nature of call </li></ul><ul><li>Name, location, callback number </li></ul><ul><li>Location of patient </li></ul><ul><li>Number of patients and severity </li></ul><ul><li>Special problems </li></ul>Dispatch
  21. 21. Procedures <ul><li>Wear safety belts. </li></ul><ul><li>Notify dispatch. </li></ul>(Continued) En Route to Call
  22. 22. Driving the Ambulance <ul><li>Emergency vehicle operations course is recommended. </li></ul><ul><li>Course is mandated in some areas. </li></ul>(Continued) En Route to Call
  23. 23. Driving the Ambulance <ul><li>Good operators: </li></ul><ul><li>Mentally/physically fit </li></ul><ul><li>Positive attitude </li></ul><ul><li>Capable of performing under stress </li></ul><ul><li>Tolerant of other drivers </li></ul>(Continued) En Route to Call
  24. 24. Driving the Ambulance <ul><li>Wear safety belts: </li></ul><ul><li>Driver and passengers </li></ul><ul><li>Become familiar with vehicle. </li></ul><ul><li>Be alert to road and weather conditions. </li></ul>(Continued) En Route to Call
  25. 25. Driving the Ambulance <ul><li>Use caution when using red lights/siren. </li></ul><ul><li>Select appropriate route. </li></ul><ul><li>Maintain safe following distance. </li></ul><ul><li>Have regard for safety of others. </li></ul>(Continued) En Route to Call
  26. 26. Driving Hazards <ul><li>Intersection most common collision type (72%) </li></ul><ul><li>Escorts and multiple-vehicle responses. (Motorists don’t </li></ul>expect second emergency vehicle.) (Continued) En Route to Call
  27. 27. Other Procedures <ul><li>Obtain additional info from dispatch. </li></ul><ul><li>Assign personnel specific duties. </li></ul><ul><li>Assess equipment needs. </li></ul>En Route to Call
  28. 28. Parking the Ambulance <ul><li>Park uphill from leaking hazards. </li></ul><ul><li>Park 100 feet from wreckage. </li></ul><ul><li>Set parking brake. </li></ul>(Continued) Arrival at Scene
  29. 29. Parking the Ambulance <ul><li>Use warning lights. </li></ul><ul><li>Avoid parking where exit will be hampered. </li></ul>(Continued) Arrival at Scene
  30. 30. Procedures <ul><li>Notify dispatch. </li></ul><ul><li>Size up the scene: </li></ul><ul><li>Safety </li></ul><ul><li>Body substance isolation </li></ul><ul><li>Number of patients </li></ul>(Continued) Arrival at Scene
  31. 31. Studies have shown that red revolving beacons attract intoxicated or tired drivers. Remind new EMT-Bs to consider pulling off the road, turning off headlights, and using just amber rear-sealed beam blinkers that blink in tandem or unison to identify the size of their vehicles. P RECEPTOR P EARL
  32. 32. Actions <ul><li>Organized </li></ul><ul><li>Rapid/efficient </li></ul><ul><li>Toward goal of transportation </li></ul>Arrival at Scene
  33. 33. Procedures <ul><li>Prepare patient for transport. </li></ul><ul><li>Complete critical interventions. </li></ul><ul><li>Check dressings and splints. </li></ul><ul><li>Secure patient to moving device. </li></ul>Transferring to the Ambulance
  34. 34. Tell new EMT-Bs that under NO circumstances should they simply wheel a nonemergency patient into a hospital, place him or her in a bed, and leave! Unless the EMT-B transfers care of the patient directly to a member of the hospital staff, the EMT-B may be open to a charge of abandonment. P RECEPTOR P EARL
  35. 35. <ul><li>Notify dispatch. </li></ul><ul><li>Continue ongoing assessment. </li></ul><ul><li>Notify receiving facility. </li></ul><ul><li>Reassure patient. </li></ul><ul><li>Complete reports. </li></ul>En Route to Receiving Facility
  36. 36. <ul><li>Notify dispatch. </li></ul><ul><li>Use caution backing </li></ul>into facility. At Receiving Facility
  37. 37. <ul><li>Verbal and written reports </li></ul><ul><li>Transfer of care to </li></ul>hospital personnel Patient Transfer at Facility
  38. 38. En Route to Station <ul><li>Notify dispatch. </li></ul><ul><li>Prepare for next call. </li></ul>
  39. 39. After the Call <ul><li>Refuel unit. </li></ul><ul><li>Complete and file reports. </li></ul><ul><li>Complete cleaning and disinfection. </li></ul><ul><li>Notify dispatch. </li></ul>
  40. 40. Using Air Medical Service <ul><li>Medical reasons </li></ul><ul><li>Operational/rescue reasons </li></ul><ul><li>Know local protocols. </li></ul>
  41. 41. <ul><li>Requires 100 foot x 100 foot area </li></ul><ul><li>Less than 8 degree slope </li></ul><ul><li>Free of wires, trees, people, and </li></ul>loose objects (Continued) Helicopter Landing Zone
  42. 42. Helicopter Landing Zone
  43. 43. Main Rotor Approach Area Approach Areas Tail Rotor Helicopter Danger Area DANGER AREA DANGER AREA
  44. 44. Approach crouched. Ground Approach to Helicopter
  45. 45. DANGER AREA: Do Not Approach Main Rotor Approach from downhill side Approach to Helicopter on Hillside
  46. 46. <ul><li>Follow directions of crew. </li></ul><ul><li>Crew will direct patient loading. </li></ul><ul><li>Stay clear of tail rotor. </li></ul><ul><li>No smoking, traffic, vehicles </li></ul>within 100 feet of copter. Approach to Helicopter
  47. 47. 1. What are the phases of a call? 2. What is the danger of an escort? 3. How big should an LZ be? 4. Give five examples of patients who could R EVIEW QUESTIONS benefit from aeromedical transportation.