Transport operations

Transport Operations
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National EMS Education
Standard Competencies
EMS Operations
Knowledge of operational roles and
responsibilities to ensure patient, public,
and personnel safety.

Principles of Safely Operating a Ground
Ambulance
• Risks and responsibilities of emergency
response
• Risks and responsibilities of transport

Medicine
Integrates assessment findings with principles
of epidemiology and pathophysiology to
formulate a field impression and implement
a comprehensive treatment/disposition plan
for a patient with a medical complaint.

Infectious Diseases
Awareness and management of
• A patient who may have an infectious
disease
• How to decontaminate equipment after
treating a patient

Infectious Diseases
Assessment and management of
• A patient who may have an infectious
disease
• How to decontaminate the ambulance and
equipment after treating a patient

Infectious Diseases
Assessment and management of
• A patient who may be infected with a
bloodborne pathogen
− Human immunodeficiency virus (HIV)
− Hepatitis B
• Antibiotic-resistant infections
• Current infectious disease prevalent in the
community

Introduction
• Today’s ambulances are equipped with
state-of-the-art technology.
• Driving an ambulance requires good
technique and judgment.

Emergency Vehicle Design
• US General Services Administration
determines ambulance standards.
• Design and manufacturing guidelines are
reviewed and updated every 5 years.
− Outlined by the DOT KKK 1822

Emergency Vehicle Design
• Type I:
Conventional
• Type II:
Standard van
• Type III:
Specialty van
© Tom Carter/PhotoEdit, Inc.
Courtesy of Captain David
Jackson, Saginaw Township
Fire Department
Courtesy of Captain David Jackson, Saginaw
Township Fire DepartmentThe Nurses and attendants staff we provide for your healthy

Ambulance Equipment
• Every inch of space on an ambulance
stores and secures equipment.
• Organizations influence the list of supplies
and equipment that should be carried.
− OSHA
− ACS
− NFPA

Checking the Ambulance
• Crew members are
responsible for
ensuring:
− Unit is capable of
responding
− Proper equipment
and supplies are
available

• A daily check of
the ambulance
should ensure that
it can:
− Start
− Steer
− Stop
− Stay running

• Warning signs
− Belt noise
− Break fade
− Brake pull
− Drift
− Steering pull
− Pulsating brake
− Steering play
− Tire squeal
− Wheel bounce
− Wheel wobble

Ambulance Staffing and
Development
• Maximize productivity and minimize
response times by analyzing:
− Response times
− Productivity
− Unit costs
− Taxpayer subsidies

Ambulance and EMS Systems
• In US, most first-response EMS and
ambulance service is delivered by the fire
department.
− Other models include:
• Private, for-profit agencies
• Public agency
• Public-private partnerships

System Status Management
(SSM)
• Goals:
− Maximize efficiency
− Reduce response time
• Considers:
− Peak loads
− Strategic deployment

Ambulance Stationing
• Goals:
− Maximize
efficiency
− Minimize response
times
• Factors include:
− Distance vs. call
volume
− Special facilities
− Need for
maintenance
− Storage
− Classrooms
− Sleeping quarters

En Route to Scene
• As you prepare to respond:
− Fasten seatbelts and shoulder harnesses.
− Inform dispatch you are responding.
− Confirm nature and location of call.
− Ask for other information.

En Route to Scene
• While on route:
− Prepare to assess and care for the patient.
− Review dispatch information.
− Assign duties and tasks.
− Decide which equipment to take.
− Decide which stretcher to take.

Arrival at the Scene
• Look for safety hazards.
• Evaluate the need for additional units.
• Determine the mechanism of injury or
nature of the illness.

Arrival at the Scene
• Evaluate the need to stabilize the spine.
• Follow standard precautions.
• If you are the first at a multiple-casualty
incident, estimate the number of patients.

Traffic Control
• Ensure orderly traffic flow, and prevent
another crash.
• Place reflectors and other warning devices
on both sides of crash.

Securing Equipment
• Make sure all equipment is secured before
placing a vehicle in motion.
− Some equipment can become lethal projectiles
if not secured properly.

Safe Patient Transfer
• Excessive speed is unnecessary and
dangerous.
− Common sense and good driving techniques
are required.
• Secure the patient with at least three straps
across the body.

Postrun Activities: Restocking,
Cleaning, and Disinfection
• Clean and disinfect
ambulance and
equipment used.
• Restock supplies.
• Perform routine
inspections.
• Decontaminate the
ambulance.

Defensive Ambulance Driving
Techniques
• More than 6,000
crashes per year
• Knowledge of
vehicle operation is
critical.
© Robert Brenner/PhotoEdit, Inc.

Driver Characteristics
• Diligence and caution
• Positive attitude about your ability
• Tolerance of other drivers
• Physical fitness
• Emotional fitness
• Proper attitude
• Good judgment and knowledge

Safe Driving Practices
• Route planning and navigation
− Have access to street and area maps
− Become familiar with the roads and traffic
patterns in your area.
• Avoid heavy traffic areas.
• Know your way around.

• Fatigue
− Don’t be ashamed
to admit when you
are fatigued.
− Place yourself out
of service until
fatigue has
passed.
• Distractions
− Never attempt to:
• Type
• Text
• Operate personal
data devices
• Listen to music
• Eat or drink

• Use of safety restraints
− All passengers should wear seatbelts.
• Speed
− Always drive with caution.
• Siren risk-benefit analysis
− Never use to transport a nonemergency patient.

• Driver anticipation
− All other drivers are unpredictable.
− Maintain a safe travel distance behind vehicles.
− Do not respond aggressively to drivers.
− Do not accelerate through intersections.

• Driver anticipation (cont’d)
− Make eye contact with fellow drivers.
− Use turn signals.
− Never force a vehicle into oncoming traffic.

• Cushion of safety
− Maintain a safe distance from vehicles.
− Avoiding being tailgated.
− Be aware of blind spots.
• View ahead
• Rear of vehicle
• Side of vehicle

• Vehicle size and distance judgment
− Vehicle length and width are critical when:
• Maneuvering
• Driving
• Parking
• Braking and passing

• Backing up the
emergency vehicle
− Use a spotter.
− Agree with the
spotter before
moving.
− Keep your spotter
in view at all times.

• Backing up the emergency vehicle (cont’d)
− Agree on hand signals before moving.
− Keep your window cracked open.
− Do a walk-around before getting in the vehicle.
− Use audible warning devices.
− Do not rely on a back-up camera.

• Parking at an emergency scene
− Allow for efficient traffic control and flow.
− Do not block other emergency vehicles.
− Park uphill or upwind.
− Stay away from structures that might collapse.
− Always use your parking brake.

• Parking at an
emergency scene
(cont’d)
− Park as close to
the scene as
possible.
− Park where your
departure will not
be hampered.
− Be aware of
terrain.

• Parking at an emergency scene (cont’d)
− Turn off headlights to avoid blinding oncoming
traffic at night.
− Always wear visible protective clothing.

Emergency Vehicle Control
• Two ways to control a vehicle:
− Changing directions
− Changing speed
• Drivers must constantly evaluate the road
surface.
Brought to you by

Emergency Vehicle Control
• Road positioning
and cornering
− Take corners at the
speed that will put
you in the proper
road position

Braking
• Getting a feel for brake pressure comes
with experience and practice.
• Get to know each vehicle you drive.
Brought to you by

Controlled Braking
• Weather and road conditions
− Weight distribution should be taken into
consideration during inclement weather.
• Hydroplaning
− Gradually slow down without slamming on the
brakes.

Controlled Braking
• Water on the roadway
− Lightly tap the brakes several times after driving
through water to dry them.
• Decreased visibility
− During fog, smog, snow, or heavy rain, use low
headlights.
− Use headlights during the day.

Controlled Braking
• Ice and slippery surfaces
− All-weather tires and appropriate speed will
reduce traction problems.
− Be especially careful on bridges and
overpasses.

Laws and Regulations
• Vary from state to state and city to city
• Emergency vehicle drivers have certain
limited privileges.
− Privileges don’t lessen liability in a crash.

• Use of warning lights and sirens
− Unit must be on a true emergency call.
− Audible and visual warning devices must be
used simultaneously.
− Unit must be operated with due regard for the
safety of others.

• Right-of-way
privileges
− Only use when
necessary.
− Know your local
right-of-way
privileges.
• Use of escorts
− Generally not a
good idea
− Leave space
between vehicles.
− Instruct family
members not to
drive closely
behind you.

• Intersection hazards
− Look for other motorists and pedestrians before
proceeding into the intersection.
• Unpaved roadways and rural settings
− Operate the vehicle at a lower speed.
− Maintain a firm grip on the steering wheel.

• School buses
− Never pass a
school bus that
has stopped.
• School zones
− In many states it is
illegal to exceed
the speed limit in
school zones.
• Funeral
processions
− Most states offer
no exemption.
− Out of respect,
most drivers turn
off audible
devices.

Air Medical Transports
• Can speed up transfer of patients
• Factors to consider:
− Does the patient’s condition warrant the risk of
using air transport?
− Will the use of air transport truly save time?

Rotor-Wing Versus Fixed-Wing
Air Ambulances
• Rotor-wing aircraft
− Standard of care
for transportation
of critically injured
• Fixed-wing aircraft
− Used mainly for
long-distance
transportation
© Hermann J. Knipperatz/AP Photos
Courtesy of Brian Denlinger and STAT MedEvac

Advantages of Using Air
Ambulances

Disadvantages of Using Air
Ambulances

Helicopter Medical Evacuation
Operations
• Why call for a medevac?
− Ground transportation will take too long.
− Conditions limit or prohibit the use of ground
transportation.
− Patient requires advanced care.
− Multiple patients will overwhelm a hospital.

Operations
• Who receives a medevac?
− Patients with time-dependent injuries or
illnesses
− Patients with serious conditions
− Trauma patients
• Who do you call?
− Notify dispatcher

Operations
• Medevac issues
− Weather
− Environment/terrain
− Altitude
− Airspeed limitations
− Cabin size
− Cost

Establishing a Landing Zone
• Should be a hard or a grassy level surface
• Should be cleared of loose debris
• Should be clear of overhead or tall hazards
• Should be marked with weighted cones or
emergency vehicles

Landing Zone Safety and
Patient Transfer
• Be familiar with capabilities, protocols, and
methods for accessing helicopters.
• Go only where the pilot and crew directs
you.
• Keep a safe distance from the aircraft
whenever it’s on the ground and “hot.”

Patient Transfer
• The proper
approach is
between nine-o’-
clock and three-o’-
clock.
• Walk in a crouched
position when
approaching.

Patient Transfer
• When operating at a landing zone:
− Pay attention to the flight crew.
− Become familiar with hand signals.
− Do not approach unless instructed by flight
crew.

Patient Transfer

Patient Transfer
• When operating at a landing zone (cont’d):
− Make sure all equipment/patients are secured.
− Always approach from the front.
− Smoking, open lights or flames, and flares are
prohibited within 50 ft of the aircraft.

Communicating with Other
Agencies
• When requesting a medevac response,
always include:
− Ground contact radio channel
− Call sign of the unit

Special Considerations
• Night landings
− Do not shine lights in the air to help the pilot.
− Direct light toward the ground.
− Smoking, open lights or flames, and flares are
prohibited within 50 ft of the aircraft.

• Landing on uneven ground
− Approach from downhill side only.
− Do not move the patient until signaled.

• Medevacs at hazardous materials incidents
− Flight crew should be notified immediately.
− Landing zone should be established upwind and
uphill from the scene.
− Exposed patients must be decontaminated
before being loaded into the aircraft.

Summary
• DOT KKK 1822 sets the standards for
ambulance design and manufacturing
specifications.
• Three body styles: Type I, Type II, Type III
• Check the ambulance at the beginning of
every shift to ensure that all equipment is
available and in good working order.
• Preventative maintenance is as important
as operating skills.

Summary
• Perform routine inspection after each call.
• Learning how to properly operate your
vehicle is just as important as learning how
to care for patients.
• Drivers must be qualified to drive an
ambulance, must be physically and
emotionally fit, and must have the proper
attitude.

Summary
• All drivers and passengers should use
appropriate safety restraints while vehicles
are in motion.
• Make sure all equipment is secure before
leaving the scene.
• Lights and sirens should be used sparingly.
• Avoid backing up vehicle if possible. When
unavoidable, always use a spotter.

Summary
• Use extreme caution when driving in heavy
traffic areas or in rural areas.
• Slow down in inclement weather.
• Any specific exemption from traffic laws
does not negate your responsibility to
proceed with due regard.
• Escorts should not be used.
• Air ambulances are used to evacuate
medical and trauma patients.

Summary
• A medical evacuation is commonly known
as a medevac.
• You must follow certain safety rules when
you are working around landing zones and
helicopters.

Credits
• Backgrounds: Purple—Courtesy of Rhonda Beck;
Blue—Jones & Bartlett Learning. Courtesy of
MIEMSS; Red—© Margo Harrison/ShutterStock, Inc.;
Green—Courtesy of Rhonda Beck.
• Unless otherwise indicated, all photographs and
illustrations are under copyright of Jones & Bartlett
Learning, courtesy of Maryland Institute for
Emergency Medical Services Systems, or have been
provided by the American Academy of Orthopaedic
Surgeons.

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