PART 7   Ambulance Operations Gaining Access EMS Operations

False. One must always maintain a safe following distance.

11. True or false: When responding to an emergency, one need not maintain the normal following distance.

This is unsafe practice; every EMT must know when it is appropriate to use lights and sirens.

12. Right out of EMT school, Tim uses lights and sirens any time he gets a call from dispatch, arguing any call might ultimately be an emergency. Comment.

Obtaining additional information from dispatch; assigning personnel to specific duties; assessing specific equipment needs; how to position the vehicle when on scene.

13. Prior to arriving on scene, what additional considerations should the squad leader have considered?

Set the parking brake; utilize warning lights; shut off the headlights unless there is a need to illuminate the scene.

14. What should the driver do before exiting the vehicle?

Vehicle parking or standing; procedures at red lights, stop signs, and intersections; regulations regarding speed limits; direction of flow or specified turns; emergency or disaster routes; use of audible warning devices; use of visual warning devices; school bus safety.

15. What are some of the local laws, regulations, and ordinances relating to the operation of emergency vehicles that you should review?

Escorts and multiple vehicle response.

16. What is the most dangerous mode of emergency response?

No vehicle should use lights or siren; provide a safe following distance; recognize the hazards of multiple vehicle responses.

17. What special precautions should you take if you must utilize a multiple vehicle response?

Intersection crashes.

18. What is the most common type of crash?

Motorists arriving at an intersection as the light changes and not stopping; multiple emergency vehicles following closely and waiting motorists do not expect more than one; vision obstructed by other vehicles.

19. What are some of the causes of intersection crashes?

Notify dispatch.

20. What is the first thing you need to do when arriving on scene and assuring scene safety?

Body substance isolation; scene safety; mechanism of injury/illness; total number of patients; the need for additional assistance.

21. What are the elements of scene size-up?

Glove; gowns; eyewear.

22. What types of body substance isolation should you have available?

Is the emergency vehicle parked in a safe location? Is it safe to approach the patient? Does the victim require immediate movement because of hazards?

23. What are the three primary aspects of scene safety you should consider?

Organized; rapid; efficient.

24. What adjectives would you use to describe appropriate actions at an MCI?

Organized, rapid, efficient transport.

25. To what end should your actions at an MCI be directed?

Notify dispatch; continue an ongoing assessment; obtain additional vital sign measurements; notify the receiving facility; reassure the patient; complete the prehospital care reports.

26. Jonathan has just taken off in the helicopter to transfer a patient from Macon to Atlanta. What six things should he aim to accomplish during the transport?

Verbal report at bedside; written report completed and left prior to returning to service.

27. What two types of reports should be given to the receiving facility?

Clean and disinfect the ambulance and equipment as needed; restock the disposable supplies; refuel the unit; file reports; notify dispatch.

28. What tasks do you need to accomplish to prepare for the next call?

Proper utilization of aircraft; landing zones; safety.

29. What considerations should you take when calling for air transport?

That the nonrescue EMS providers work together with the providers of rescue, but not allow their activities to interfere with patient care.

30. In working with the fire department personnel, what must Mike ensure?

Establish a chain of command to ensure patient care priorities; administer necessary care to the patient before extrication; ensure that the patient is removed in a way to minimize further injury. Patient care precedes extrication unless delayed movement would endanger the life of the patient or the rescuer.

31. You roll up in Medic 86 at a car-versus-pole scene at 9th Avenue, and Middle Elyria Fire radios that the rescue vehicle is at another crash. An engine has been dispatched but has been delayed at a train crossing and will be there in 15 minutes. What principles must you keep in mind as both rescuer and EMT?

Safety.

32. What is the number one priority for all EMS personnel?

The safety of the patient.

33. Following the safety of the EMS responders, what is the next priority?

Broken glass; sharp metal; and other hazards, including the environment.

34. From what should you protect the patient during extrication?

Try opening each door; roll down windows; have patient unlock doors.

35. What can you do to gain vehicle access that does not require equipment?

Trench; high angle; vehicle extrication; confined spaces; SCBA; swift water; SWAT; etc.

36. What are examples of courses that can be taken for learning the techniques of complex access?

His or her own; the crew's; the patient's; the public's.

37. For whose safety is the EMT concerned at a hazardous materials incident?

By knowing the occupancy of the building or vehicle; looking at the size and shape of containers; looking for placards and shipping papers; using your senses.

38. When approaching a scene, how can you find out if hazardous materials are involved?

Park upwind/uphill from the incident at a safe distance; keep unnecessary people away from the area; isolate the area by keeping people out; do not enter without proper equipment; avoid contact with the material; remove patients to a safe zone if no risk to EMT. Do not enter the hazardous materials area unless trained as a hazardous materials tech with proper training and SCBA?

39. What are some general procedures you should use when approaching the scene of a possible hazardous materials incident?

Local hazardous materials response teams; CHEMTREC 800-424-9300; Hazardous Materials, The Emergency Response Handbook, published by the U.S. Department of Transportation.

40. What resources should you be aware of when dealing with a hazardous materials incident?

NFPA 479 and OSHA 1910.120.

41. Where can you find the National Fire Protection Association (NFPA) Hazardous Materials requirements for EMS providers

A system developed to assist with the control, direction, and coordination of emergency response resources; provides an orderly means of communication and information for decision making; makes interactions with other agencies easier because of the single coordination.

42. What is the incident management system?

Extrication; treatment; transportation; staging; supply; triage; mobile command center.

43. After an incident manager is determined, what seven EMS sectors are established as needed?

Complete the task, and then report back to the sector officer.

44. Once assigned your task by the sector officer, what should you do?

An event that places great demand on resources, be it equipment or personnel.

45. What is the definition of a multiple-casualty situation?

Sorting multiple casualties into priorities for emergency care or transportation to definitive care.

46. What is basic triage?

Highest priority; second priority; lowest priority.

47. What are the three triage levels?

Burns without airway problems; major or multiple bone or joint injuries; back injuries with or without spinal cord damage.

48. What complaints are included in the second priority?

Minor painful, swollen, deformed extremities; minor soft-tissue injuries; death.

49. What complaints are included in the lowest priority?

Request additional help; perform initial assessment on all patients; assign available equipment and personnel to priority one patients; prioritize patient transport; remain at the scene to assign and coordinate personnel; supplies, and vehicles.

50. What are the responsibilities of the triage officer?

Equipment should be checked and maintained, restocked and repaired; batteries for the defibrillator charged; suction working; oxygen filled.

In addition to mechanical and electrical systems, what else must you check on the ambulance daily?

In addition to traffic, any changes in weather and road conditions that might affect his driving.

It is Sunday, January 17. Medic 310 hasn't had a call all day, and Mike, who is driving today, has been sacked out on the couch since checking out the vehicle this morning. It is now 1845 hours and he is awakened for a call. As the bay doors open, what is he looking for?

The driver and all passengers.

It is three o'clock in the morning. Lieutenant Lane prepares to depart the hospital to take Mrs. Blum back to her home from the emergency department 2 hours after he brought her in for a headache. Who must wear seatbelts for the ride home?

Physically fit; mentally fit; able to perform under stress; has a positive attitude about his or her abilities; is tolerant of other drivers.

What are the characteristics of a good ambulance operator?

The nature of the call; name; location and callback number of the caller; location of the patient; number of patients and severity; other special problems.

What dispatch information must be obtained from a caller?

The nature and location of the call.

What must the dispatch inform the responding unit?

Central access; 24-hour availability; trained personnel.

What three elements comprise a good dispatch system?

When it is en route.

When is the first call made to dispatch from the ambulance?

Horn; wipers; headlights; stoplights; turn signals; emergency warning lights; siren; communications system.

Which electrical systems are you required to inspect on the ambulance daily?

Fuel; oil; engine-cooling system; brakes; wheels and tires; door closing and latching system; air conditioning/heating system; ventilation system.

Which mechanical items are you required to inspect on the ambulance daily?