Transport Operations (Chapter 37)

What are the nine phases of an ambulance call and the EMTs role in each?

1. Preparation: EMT ensures equipment is clean and ready and fully stocked; vehicle is prepped. 2. Dispatch: 3. En route: EMT confirms dispatch; wear seat belts. assign tasks, decide on equipment to take in. 4. Arrival at scene: scene size up: request additional help, decide on ppe, evaluate MOI/NOI, need for spine immobilization. Safe parking: allow for efficient traffic control/flow. park in front (pref 100 ft beyond) or behind scene (if first on scene). leave warning lights on/headlights off). lock doors and take key. Traffic Control Help restore traffic flow after emergency is under control, if police are not yet there. 5. transfer of patient to ambulance secure patient in ambulance. 6. En round to the receiving facility (transport) inform dispatch you are on the way, # of patients; monitor patient; call hospital and medical control. begin written report if able. support patient 7. at the receiving facility (delivery) inform dispatch Report to triage nurse present complete report to the nurse/physician taking over care. complete report, get signatures and leave copy. restock items used. 8. En route to the station inform dispatch 9. Postrun inform dispatch restock paperwork clean (linens, discard used stuff, wash, disinfect, clean stretcher, clean up spillage,

what are the key scene safety considerations when preparing for a helicopter medivac?

1. establishing landing zone ==hard/grassy, level 100x100 ft. ==clear of loose debris. ==clear of overhead hazards (power lines, trees) ==mark with cones/have emergency vehicles on opposite corners to create a lighted X ==move all nonessential people/vehicles outside zone ==check wind and share with flight crew. 2. stay away from the helicopter unless directed by its crew otherwise. They will come to you to get patient only walk around the front (10-2 o'clock) make sure the patient and all equipment is well secured. no loose belongings. wear eye protection no smoking/flares 3. get a cleared radio channel and call sign. 4. Special concerns --night landings: form X with head beams; illuminate overhead hazards if possible --uneven ground--beware of rotors. --warn crew of HazMat conditions. may need to land far away (uphill upwind) to not exacerbate issue.

What medical equipment is carried on an ambulance? (list on table 37-3 pg. 1356)

Basic supplies (gloves, sharps, meds, communication equipment, blankets; stethoscope, wipes, hot/cold packs) Airway and ventilation equipment (oro/nasopharyngeal airways, advanced if authorized; bvms, suctioning equipment, 02) Basic Wound Care (Trauma sheers, sterile sheets, burn sheets, tape, gauze, occlusive bandages, assorted bandages, tourniquets) Splinting supplies traction splints, padded splint boards, triangular bandages, roller bandages, backboards, cervical collars) Childbirth supplies Surgical scissors, cord clamps, rubber bulb syringe, towels, sponges, sanitary pads, baby blanket/cap) AED Patient transfer equipment (wheeled stretcher, stair chair, other carry devices) Meds activated charcoal, glucose, O2, saline, aspirin, epi, nitro, ibuprofen, Tylenol, benedryl, Jump Kit portable kit to take to patient (stuff you need in the first 5 minutes) PPE triangular bandages trauma shears tape trauma dressings airways bam bp cuff stethoscope penlight meds

What are the guidelines for safe/defensive driving of an ambulance?

Don't drive on meds that make you sleepy Don't drink within 10 hours of your shift Don't drive when working back to back shifts Don't drive when you are emotionally distressed Speed doesn't save lives; good care saves lives. Wear seat belts Secure all equipment so it doesn't fly around Understand your vehicle's quirks--esp braking Stay in left lane if possible.

What are some medivac limitations

Elevation number of patients/combined weight Cost

What parts of an ambulance need to be inspected daily

Fluid check: gas, oil, transmission, brake, Engine cooling, wiper fluid Batteries Engine belts wheels/tires/spare all lights wipers Horn/siren AC/Heat Doors communication systems Windows/mirrors supplies test seat belts, O2 locks, stretchers secured.

What safe and operations equipment is carried on an ambulance?

PPE Equipment for work areas (warning devices, high power flash lights, fire extinguishers, hardhats, portable floodlights) Preplanning and Navigation (GPS and MDTs(tablet) Extrication Equipment (wrench, screwdrivers, hacksaw, pliers, hammer, fire ax, crowbar, bolt cutter, shovel, blanket, ropes duct tape...)

What are the key steps EMTs can take to improve safety while enroute to the hospital/station?

Take shortest/least congested route; know alternatives Avoid one-way streets/ and going wrong way on them. Watch for bystanders Notice the effect of where you park on traffic and adjust lights accordingly. Drive the speed limit when transporting except in rare extreme emergency. Go with the flow of the traffic Stay 4 seconds behind another car ( and Maintain open space around you so you can change lanes by constantly checking mirrors/blindspot (cushion of safety) Use siren/lights together. Assume people can't hear or see you and will do things to cause crashes.--try to make eye contact. Be aware that ambulances are heavy, take corners wide, and slow to stop and easy to roll. adjust speed to wet, icy, foggy road conditions

What are the distinctions between cleaning, disinfection, high-level disinfection and sterilization?

clean=removing dirt or visible contaminants from a surface. disinfection: killing pathogenic agents by applying a chemical for the purpose to a surface High-level disinfection: killing of pathogenic ages by sue of potent disinfectant. Steilization: process of removing all microbial contamination (usually by use of heat)

What three factors determine the use of lights and siren to the scene and to the hospital?

local protocol patient condition anticipated clinical outcome of the patient Studies show lights and sirens save minimal time. contra indicated for people with seizures, etc. peaceful, calm transport may be better for everyone. just because you use lights/sirens doesn't mean you have to speed.

What are the risks and social considerations posed by the use of police escorts and the hazards of crossing intersections?

often cause more trouble than worth. mainly useful when you are in a place you don't know where you are going and truly need a guide. always pause and look at an intersection, esp if following another emergency vehicle.

What are the specific, limited privileges provided drivers of emergency vehicles by most state laws?

on call and using lights/siren: park/stand in illegal location run a red light/stop sign Drive faster than speed limit drive against traffic/make illegal turn make illegal pass NEVER allowed to pass stopped school bus with extended stop arm. be careful in school zones. DOn't turn on siren/lights until you are in the far left lane on the hwy.

What are the capabilities, protocols and methods for accessing air ambulances?

usually helicopter if less than 150 miles to hospital; fixed wing for more. Call medivac if: 1. transport time due to distance, weather, traffic is too long. 2. patient needs advance care 3. multiple patients will overwhelm local/closest hospital, need to distribute EG of patients who need medivac (time sensitive) stroke, heart attack, spinal cord, wilderness/diving accidents trauma patients who need specialized care (burn, spinal, hyperbaric, venom) Call dispatcher first, who may then make a direct connection to flight crew.