CH 37: Ambulance Operations

Summarize the tasks EMTs must complete in the postrun phase 1367-1368

Clean, disinfect, sterilize the box. Restock necessary supplies. Throw out trash when needed.

List the 9 phases of an ambulance call; include examples of key tasks EMTs perform during each phase. 1353-1368

1. Preparation for call: Make sure equipment and supplies are in their proper places and ready for use. 2. Dispatch: Must be easy to access and in service 24 hrs a day. 3. En route: Inform dispatch your unit is responding and confirm the nature of call and location. Ask for any other available info about location. 4. Arrival at scene: Perform scene size up. Report to dispatch the nature of incident if part of protocol. Safe parking, traffic control should be part of this step. 5. Transfer of the pt to the ambulance: Excessive speed in most cases is unnecessary. Secure pt with belts on stretcher. 6. En route to the receiving facility (transport): Inform dispatch when you're ready to leave with the pt. Report # of pts you have, name of receiving H, reassess pt along the way, contact receiving H. 7. At the receiving facility (delivery): Inform dispatch as soon as you arrive at H, report arrival to triage nurse, Physically transfer pt from stretcher to H bed, Present a complete verbal report, complete detailed report, obtain required signatures, leave copy with appropriate nursing staff. 8. En route to station: Inform dispatch whether you're in service and where you're going. As soon as you get back to the station you should clean and disinfect the ambulance and equipment that was used if you didn't at the H, restock any supplies you did not get at the H. 9. Postrun: Complete and file any additional reports and inform dispatch of unit status/location/availability. Clean, disinfect, high-level disinfection, sterilization of ambulance.

Name the medical equipment carried on an ambulance; include examples of supplies that are included in each main category of the ambulance equipment checklist 1354-1360

Basic supplies: Stretcher items, bp cuffs, stethoscope, gloves, sharps container Airway and ventilation equipment: Infection control kits, OPA/NPA, BVMs, mounted suction, O supply, humidifier CPR equipment: Lucas device Basic Wound care: trauma shears, sterile burn sheets, adhesive tape, roller bandages, gauze pads, occlusive dressings, tourniquets Splinting supplies: Traction splints, variety of other splints, backboards, C collars Childbirth supplies: OB kit and its supplies AED: Semi automated defibrillation equipment Pt transfer equipment: Wheeled stretcher, stair chair, scoop stretcher, basket stretcher, flexible stretcher Meds: Activated charcoal, drinkable water/cups, oral glucose, O, Supplies for irrigating skin and eyes, aspirin, epinephrine Jump Kit: Basic supplies needed in first 5 minutes of reaching pt.

Define: Cleaning, disinfection, high-level disinfection, sterilization 1367

Cleaning: Process of removing dirt, dust, blood, or other visible contaminants Disinfection: Killing of pathogenic agents by directly applying a chemical made for that purpose High-level disinfection: Killing of pathogenic agents by use of potent means of disinfections Sterilization: Process, such as the use of heat, which removes all microbial contamination

Discuss the importance of performing regular vehicle inspections; include the specific parts of an ambulance that should be inspected daily 1361-1362

Ensure all items are in proper working order. Fuel/oil/transmission/engine-cooling fluid levels, batteries, brake fluid, engine belts, wheels and tires, lights, wipers, horn, siren, AC/heat, ventilating system, doors, comms system, windows, mirrors, medical equipment, supplies.

Describe key scene safety considerations when preparing for a helicopter medivac, including establishing a LZ, securing loose objects, reducing onsite hazards, and approaching the aircraft 1378-1381

Hard or grassy level surface between 100'x100' area. Clear loose debris, alert flight crew of overhead or tall hazards, mark landing site using cones or vehicles. Keep safe distance from aircraft whenever it is on the ground and "hot." Stay away from tail rotor. Never approach from rear. Approach on helicopter's left side. Night landings: do not shine spotlights in the air. Direct low-intensity headlights to the ground. Illuminate overhead hazards or obstructions, if possible. Light up the poles, not the wires.

Discuss specific considerations required to ensure scene safety; include personal safety, patient safety, and traffic control 1363-1366

Look for safety hazards to yourself, partner, bystanders, pts. Evaluate need for additional units, other assistance. Determine MOI in trauma pts or NOI on medical calls. Evaluate need to immobilize the spine. Follow standard precautions. Have ff and PD block traffic if needed.

Describe some high-risk situations and hazards during both pretransport and transport that may affect the safety of the ambulance and its passengers 1363-1366, 1368-1376

Most dangerous phase for EMS is en route. Collisions cause many serious injuries. Review dispatch info. Excessive speed to H is most often unnecessary. Defensive ambulance driving: speed does not save lives, wear seat belts, be familiar with how vehicle drives, stay in left-most lane on multilane highways.

List the minimum dispatch info required by EMS to respond to an emergency call 1363

Nature of call Name, present location, call-back number Location of pts # of pts, severity of conditions Any other special problems or pertinent info about hazards

Name the safety and operations equipment carried on an ambulance; include examples of how each item might be used by EMTs 1360-1361

PPE: face shields, gowns, turnout gear, safety shoes/boots Equipment for work areas: warning devices that flash/reflect, two high-intensity halogen 20,000 candlepower flashlights, fire extinguisher, hard hats/helmets, portable floodlights Preplanning/navigation supplies: GPS, detailed street and area maps Extrication equipment: wrench, screwdriver, hacksaw, pliers, hammer, fire ax, wrecking bar, crowbar, bolt cutters, ropes, knife, duct tape

Explain the additional risks and special considerations posed by the use of police escorts, and the hazards and special considerations posed by crossing intersections 1375-1376

People might assume pd is only vehicle passing and not see ambulance. If you're being escorted, follow at a safe distance. Intersection crashes are the most common. Be alert and careful when approaching intersection. Be aware of motorists who time the lights.

Describe the key elements that must be included in the written pt report upon pt delivery to the hospital 1366-1367

Summary of history of pt's current illness/injury with pertinent + and -. MOI and findings upon arrival. Vital signs, relevant past medical history. Meds, allergies, treatment and its effect during transport.

Describe the specific, limited privileges that are provided to emergency vehicle operators by most state laws and regulations 1374-1376

Using lights and sirens allows driver to park/stand in an illegal location, proceed through red light or stop sign, drive faster than speed limit, drive against flow of traffic, travel left of center to make illegal pass. *All with "due regard for safety" Still can't pass school bus stopped to un/load, exceed speed in school zone.

Describe the capabilities, protocols, and methods for assessing air ambulances 1376-1380

Why call? -transport time by ground is too long -road, traffic, or environmental conditions prohibit use of ground transport -pt requires advance care -multiple pts will overwhelm resources at hospital reachable by ground transport.