Chapter 36 - EMT (Transport Operations)
Sterilization
A process, such as the use of heat, that removes all microbial contamination
To care for the patients -only when all the patients have been treated and the emergency situation in under control should you be concerned with restoring the flow of traffic -if police are slow to arrive on scene, you may need to take action in controlling/restoring traffic -as soon as possible, place appropriate warning devices such as reflectors, on both sides of the crash
After ensuring your own safety, what is your first responsibility at a crash scene?
-oropharyngeal airways for adults, children, and infants -nasopharyngeal airways for adults and children -Two sets of equipment for advanced airway procedures if you service is authorized by state regulation and the medical director to perform these: one in the ambulance and one in the jump kit that you carry to patient -two portable artificial ventilation devices that operate independently of an oxygen supply (i.e. disposable pocket masks and bag-mask devices) -Bag-mask devices that are capable being attached to oxygen to deliver near 100% oxygen and associated mask sizes -portable and mounted suctioning units that can generate vacuum of 300 mmHg when tube is clamped; large-bore nonkinking suction tubing with semirigid pharyngeal tip(s); easily accessible at the head of the stretcher; all components must be disposable or made of material that is easily cleaned and decontaminated -two oxygen supply units, one portable (and one extra) and one installed --> portable should have at least 500 L oxygen, be equipped with yoke, pressure gauge, flowmeter, oxygen supply tubing, NRB mask, and nasal cannula, able to deliver oxygen at variable rate between 1-15 L/min --> mounted/installed should have 3,000 L oxygen, equipped with flowmeters capable of delivering 1-15 L/min when you are at head of stretcher -Oxygen and nonrebreather masks in adult, children, and infant sizes -ambulance services that often transport patients on runs for longer than 1 hour should consider using a disposable single-use humidifier for the mounted oxygen system -on runs less than 1 hour, humidification is not necessary and may increase patient's risk of infection unless equipment is rigorously maintained
Airway management and ventilation equipment that should be carried on ambulance
-Not everyone who drives an automobile is qualified to drive an emergency vehicle (in some states you must complete an EVOC course before you are allowed to drive the ambulance on emergency calls) Driver Characteristics 1. Physical Fitness -you should not be driving if you're taking medications that cause drowsiness/slowed reactions such as cold remedies, analgesics, and tranquilizers 2. Emotional Fitness -in addition to knowing exactly what to do, you must be able to do it under difficult conditions 3. Having the proper attitude -good judgment needed to drive an ambulance requires practice
Ambulance Driver Characteristics
blind spots There are 3 blind spots around the ambulance that you cannot see with the mirrors--> mirror itself, rear of vehicle, and side of vehicle: 1. The large mirror itself creates a blind spot, obstructing the view ahead and preventing the driver from seeing objects such as a pedestrian or car -To eliminate, lean forward in your seat so that the mirror does not obstruct the view, especially when making turns at intersections 2. The rear of the vehicle cannot be seen fully through the mirror and is therefore a blind spot, causes many accidents to occur when ambulance is being backed up -rearview mirror gives driver view of patient compartment and is not intended to be used for seeing vehicle behind ambulance -Therefore, a spotter should be used to help you back up the vehicle (rear-facing cameras are also helpful but do not replace a spotter) and use predetermined hand signals when backing up the ambulance 3. The side of the vehicle often cannot be seen through the driver and passenger mirrors at a certain angle --> entire cars may not be seen in the mirror, even though they are right next to ambulance -To eliminate, many EMS services place small rounded mirrors on the side mirrors to assist you in visualizing this blind spot -if these are not available, you need to learn forward or backward in the seat to help eliminate blind spot (esp. impt. when shifting lanes or making turns)
Areas of the road that are blocked from your sight by your own vehicle or mirrors
incident commander -if you are the first EMT to arrive at scene of MCI, quickly estimate # of patients and communicate with incident commander -inform dispatch that additional units are needed at scene
At a MCI, follow instructions from ______, who assigns your roles.
Park ~100' past scene on same side of road -parking 100' before the scene to create a barrier between you and oncoming traffic may also be a good idea -if hazardous materials or smoke are present, park uphill and/or upwind of scene -always leave warning lights or devices on -always park so as to provide a cushion of space between your vehicle and operations at the scene -assume that someone may collide with your vehicle and strike personnel on the scene -if your vehicle is blocking part of roadway, leave your warning lights on (only flashing yellow lights if your vehicle has them)
At scene, where should you park ambulance?
-fuel level -oil level -transmission fluid level -engine cooling system and fluid levels -batteries -brake fluid -engine belts -wheels and tires, including the spare if there is one --> check inflation pressure and look for signs of unusual or uneven wear -all interior and exterior lights -windshield wipers and fluid -horn and siren -air conditioners and heaters -ventilating system -doors --> make sure they open, close, latch, and lock properly -communication systems, vehicle and portable -all windows and mirrors --> check for cleanliness and position -check all medical equipment and supplies at least daily, including all the oxygen supplies, jump kit, splints, dressings and bandages, backboards and other stabilization equipment, and emergency OB kit --> is equipment functioning properly? are supplies clean? are there enough of them? -all battery-operated equipment including the defibrillator, should be operated and checked each day -rotate the batteries according to an established schedule **always check the defibrillator at the beginning of each day
Being fully prepared means that you and your team must inspect both the ambulance and equipment daily to ensure that all items are in proper working order. What all should the ambulance inspection include?
-medivac interacts with many services on a multitude of different radio frequencies because they respond to service requests throughout a large area with numerous jurisdictions (whereas EMS has a specific well-defined jurisdiction) -to prevent any miscommunication, when request is made for medivac response, request should include a ground contact radio channel (usually a pre-established mutual aid channel) as well as a call sign of the unit that the medivac should make contact with
Communication Issues with medivacs
Always assume that motorists around your vehicle have not heard your siren/PA system or seen you until proven otherwise by their actions -whenever a motorist yields the right-of-way, the emergency vehicle operator should attempt to establish eye contact with the other driver -When anticipating how motorists may respond to your lights and sirens, always assume that they will react in a manner that may cause a collision -You can also look at the direction of the other vehicle's front tires to get an early indication of which way the vehicle will turn -the ambulance's PA system should not be used often, if at all, during emergency driving because it can cause more problems and takes attention away from driver because driver has to also concentrate on using microphone *most important, YOU MUST ALWAYS DRIVE DEFENSIVELY; never rely on what another motorist will do unless you get a clear visual signal -even then, you must be prepared to take defensive action in the case of a misunderstanding, panic, or careless driving on the part of the other driver -most ambulance collisions occur on clear days with dry roads
Driver Anticipation/reaction to lights and sirens of ambulance
Type 1 -conventional truck cab-chassis with a modular ambulance body that can be transferred to a newer chassis as needed Type II -Standard van, forward-control integral cab-body ambulance Type III -Specialty van, forward-control integral cab-body ambulance
Each state establishes its own standards for licensing or certifying ambulances. Many agencies use the federal specifications that cover 3 types of ambulances. What are the three types of ambulances?
-landing/taking off at slight angle for helicopters (rather than straight up and down) is safer -need to choose best location to land --> this is the responsibility of the ground EMS crew Things to consider: -Area should be a hard or grassy level surface that measures 100'x 100' (recommended) and no less than 60'x 60' -if landing site is not level, flight crew must be notified of the steepness and direction of the slope -area must be cleared of any loose debris that could become airborne (i.e. branches, trash bins, flares, accident tape, and medical equipment) -survey area for any overhead or tall hazards such as power lines, telephone cables, antennas, or tall/leaning trees --> presence of these must be relayed to flight crew because an alternative landing site may be required or these hazards may need to be marked/illuminated -to mark the landing site, use weighted cones or position emergency vehicles at the corners of the landing zone with headlights facing inward to form an X --> never use accident tape or people to mark the site, nor use flares (they can become airborne or cause fire/expolosion) -all nonessential persons and vehicles should be moved a safe distance outside landing zone -if wind is strong, radio the direction of wind to the flight crew; they may request you improvise some sort of wind directional device to aid their approach (i.e. a bed sheet tightly secured to tree/pole may be used to help crew determine wind direction and strength) *never use tape
Establishing a landing zone for medivac What are some things to consider?
On arrival, you will perform a scene size-up, after which you will report to dispatch the nature of the incident if this is part of your local protocol -if you are first to arrive on the scene of a mass-casualty incident, you should inform dispatch that you have arrived and give a brief report of what you see. Also report any unexpected situations, such as need for additional units, heavy rescue unit, or a HazMat team. Additionally, quickly estimate number of patients and communicate with incident commander -do not enter scene if there are any hazards to you; patient may have to be moved by others if you are not appropriately equipped -at a MCI, follow instructions from the incident commander assigning your roles, which may include assisting with triage, treating patients, or loading patients for transportation to hospital Immediately size-up scene using the following: -look for safety hazards to yourself, partner, and patient(s) -evaluate need for additional units or other assistance -determine MOI in trauma patients or NOI on medical calls -evaluate need to stabilize the spine -make sure you follow standard precautions -in assessing the situation, you must decide where to park the ambulance (park 100' past the scene on the same side of the road) -perform traffic control if necessary
Facts about Arrival at Scene Phase
*most dangerous for you (could get in MVA, etc.) -make sure you fasten your seatbelts and shoulder harnesses before moving ambulance -inform dispatch that your unit is responding and confirm the nature and location of the call, also ask for any other available information about the location (e.g. patient on 3rd floor, or use side door to house) -team should prepare to assess and care for patient --> review dispatch information, assign specific initial duties and scene management tasks, decide what type of equipment to take initially, decide what stretcher to take to patient
Facts about En Route to Scene (Response) Phase
-Once you leave hospital, inform dispatch whether you are in service and where you are going As soon as you are back at the station, you should do the following: -clean and disinfect the ambulance and any equipment that was used if you did not do so before leaving hospital -restock any supplies you did not get at the hospital
Facts about En Route to Station Phase
-making sure equipment and supplies are in proper place and ready for use -store equipment and supplies in ambulance according to how urgently and how often they are used -place equipment for airway management, artificial ventilation, and oxygen delivery at head of primary stretcher -place items for cardiac care, control of external bleeding, and monitoring blood pressure at side of stretcher -containers should be placed in cabinets and drawers with transparent fronts for quick identification or labeled -certain items must be available on the ambulance at all times, as dictated by state and jurisdictional requirements (e.g. basic supplies such as gloves and sharps, airway and ventilation equipment, basic wound care supplies, splinting supplies, childbirth supplies, AED, patient transfer equipment, medications and other supplies such as snakebite kit or regional supplies) -perform daily inspections (such as fuel level, wheels and tires, communication systems, medical equipment, battery-powered equipment, etc.) -a final part of preparation phase = reviewing safety precautions (check seatbelts, are portable oxygen tanks secured, make sure all equipment is secured properly)
Facts about Preparatory Phase
-inform dispatch as soon as you arrive at the hospital (and depending on your jurisdiction, your ending mileage) Follow these steps to transfer patient to receiving hospital: 1. Report your arrival to the triage nurse/arrival personnel 2. Physically transfer the patient from the stretcher to the bed directed for your patient 3. Present a complete verbal report at the bedside to the nurse or physician who is taking over patient's care 4. Complete a detailed written report, obtain the required signatures, and leave a copy with an appropriate staff member -while at hospital, you may be able to restock any items that were used during the call/run, such as oxygen masks or dressings and bandages
Facts about the Delivery Phase
-dispatch must be easy to access and in service 24 hours a day -the dispatcher is the key communications link throughout all phases of the ambulance run For every emergency request, the dispatcher should gather and record the following minimum information: -nature of call -name, present location, and call-back phone # of caller -location of patient(s) -number of patients and some idea of the severity of their conditions -any other special problems or pertinent information about hazards or weather conditions -many areas implement emergency medical dispatching, which provides the caller with instructions for patient care before ambulance arrives
Facts about the Dispatch Phase What information should dispatcher gather and record for every emergency request?
-complete and file any additional written reports -again inform dispatch of your status, location, and availability -you are also responsible for maintaining the ambulance so it is safe and available on a moment's notice --> perform routine inspections and refuel the vehicle -use a written checklist to document needed repairs or replacement of equipment and supplies After every call, you should do 8 things: 1. Strip linens from stretcher and place in plastic bag or in designated receptacle in ED 2. Discard all disposable equipment used for care of the patient that meets your state's definition of medical waste (most items will be considered general trash) 3. Wash contaminated areas with soap and water. For disinfection to be effective, cleaning must be done first 4. Disinfect all nondisposable equipment used in care (e.g. disassemble BVM device and place components in a liquid sterilization solution as recommended by manufacturer) 5. Clean the stretcher with an EPA-registered germicidal/virucidal solution or bleach and water at 1:100 dilution 6. If any spillage or other contamination occurred in the ambulance, clean it up with same germicidal/virucidal or bleach/water solution 7. Create a schedule for routine full cleaning for the vehicle 8. Have a written policy/procedure for cleaning each piece of equipment. Refer to manufacturer's recommendations as a guide
Facts about the Postrun Phase What 8 things should you do after every call?
-in almost every case, you will provide lifesaving care right where you find patient, before moving the patient to the ambulance -next you must package the patient for transport, securing him or her to a device such as a backboard, scoop stretcher, or the wheeled ambulance stretcher -then move to the ambulance and properly lift the patient into the patient compartment -secure patient with at least 3 straps across the body when on the ambulance -use deceleration or stopping straps over the shoulders to prevent the patient from continuing to move forward in case ambulance suddenly slows or stops
Facts about the Transfer Phase
-inform dispatch when you are ready to leave with the patient, report # of patients you have, name of receiving hospital (and in some jurisdictions, the beginning mileage of the ambulance) -continue to monitor patient en route, recheck vitals every 15 min (stable patient) or every 5 min (unstable -at this time, also contact receiving hospital -inform online medical control about your patient(s) and the nature of their problem(s) -depending on # of EMTs on your team and how much care the patient needs, you might also want to begin working on your written report while en route -do NOT abandon your patient emotionally
Facts about the Transport Phase
air ambulances (accompanied by specially trained medical flight crews) -used to evacuate medical and trauma patients -land at or near scene and transport patients to trauma facilities every day in many areas -two types = fixed-wing aircraft and rotary-wing (helicopters) -fixed-wing aircraft --> used for interhospital patient transfers over distances greater than 100-150 miles (transport patient from one hospital to another) -rotary-wing/ground transport --> used for shorter distances (more efficient for shorter distances), used to help provide emergency medical care to patients who need to be transported quickly over shorter distances -rotary-wing typically travel faster than 100mph in a straight line
Fixed-wing aircraft and helicopters that have been modified for medical care; used to evacuate and transport patients with life-threatening injuries to treatment facilities
When school bus has stopped to load or unload children and is displaying its flashing lights or extended "stop arm" -stop before reaching bus, turn off your siren, wait for driver to make sure kids are safe and closes the door/turns off lights --> only then can you proceed past stopped school bus -also, in many states it is unlawful for an emergency vehicle to exceed the speed limit in school zones regardless of the condition of the patient --> if you have your emergency lights and siren activated, this tends to attract children to roadway and create potential hazard
In what situation can you NOT pass a vehicle when on an emergency call with warning lights and sirens?
considered maintaining a "cushion of safety" -cushion of safety = keeping a safe distance between your vehicle and other vehicles on any side of you To safely operate an emergency vehicle... -maintain safe following distance and try to avoid being tailgated (drive about 4-5 seconds behind a vehicle traveling at an average speed) -ensure the blind spots in your vehicle's mirrors do not prevent you from seeing vehicles or pedestrians on either side of the ambulance -if you are being tailgated, then slow down (impatient driver will usually go around you). If not, you can have your dispatcher contact local police and let them know that someone is driving recklessly behind you -NEVER get out of the ambulance to confront a driver -excessive speeds do NOT increase a patient's chance of survival. Instead, they cause more deadly accidents, decrease care EMT in patient compartment can provide, decrease cushion of safety, cuts down on driver's reaction time, and increases the time and distance needed to stop the ambulance -excessive speed is not indicated, even in extreme life-and-death emergencies
Keeping a safe distance between your vehicle and the one in front of you, checking for tailgaters behind your ambulance, and keeping aware of vehicles potentially hiding in your blind spots
-most important rule = keep a safe distance from the aircraft whenever it is on the ground and "hot" (which means when the helicopter blades are spinning) -all EMTs should stay outside the landing zone perimeter unless directed to come to the aircraft by the pilot or members of the flight crew -if you are asked to come inside landing zone, stay away from the tail rotor (tips of its blades move so rapidly that they are invisible) and never approach helicopter from the rear, even if it's not running because pilot cannot see you (instead, go around front) -The main rotor blade of the helicopter is flexible and may dip as low as 4' off the ground --> when you approach the aircraft, walk in a crouched position -When accompanying a flight crew member, follow directions exactly and only do what flight crew member tells you to do
Landing zone safety and patient transfer with medivacs
-regulations regarding vehicle operations vary from state to state and from city to state, but some regulations are same regardless of location -MVAs (esp. at intersections) = single largest source of lawsuits against EMS personnel and services While on an emergency call, these are some privileges you may be allowed to do if using your warning lights and sirens (vary by state and local jurisdiction): -park/stand in an otherwise illegal location -proceed through a red traffic light or stop sign (but you still must stop first) -drive faster than posted speed limit -drive against flow of traffic in a one-way street or make a turn that is normally illegal -travel left of center to make an otherwise illegal pass -state motor vehicle statutes or codes often grant an emergency vehicle (i.e. ambulance) the right to disregard the rules of the road when responding to an emergency, BUT the driver must not endanger people or property under any circumstances -right-of-way privileges vary from state to state (some say stop at red light then go, others say proceed with "due regard")
Laws and Regulations of Ambulance Operation What are some privileges you may have while on an emergency call using warning lights and sirens?
medivac -most EMS jurisdictions/systems have capability to perform helicopter medivacs or have a mutual aid agreement with another agency such as police or hospital-based medivac service to provide such service
Medical evacuation of a patient by helicopter
1. weather -helicopters can't operate in thunderstorms, blizzards, and heavy rain 2. environment/terrain -helicopters typically can't land in moutainous or desert terrain (too many hazards) 3. altitude -most helicopter services are limited to flying at 10,000' feet above sea level (this could create a problem if your patient is at 13,500' above sea level) 4. airspeed limitations -medivac helicopters fly between 130-150 mph 5. cabin size -helicopters are limited in the number of patients that can be safely transported and by the size of the patient that they can safely transport 6. cost -typical medivac flights cost between $8,000-$10,000, whereas the typical ambulance transport costs $400-$1,000 *the decision to request a medivac should not be based on the perceived ability of the patient to pay the bill but rather on the medical necessity (however cost should be considered)
Medivac Issues --> while making the decision to request medivac, what factors need to be taken into consideration?
Siren may have a psychological effect on other drivers (drivers tend to get anxious and drive faster in presence of sirens)
Recognition of Siren Syndrome
-Road position means the position of the vehicle on the roadway relative to the inside or outside edge of the paved surface -To corner efficiently, you must know the vehicle's present position and its projected path -the aim is to take the corner at the speed that will put you in the proper road position as you exit the curve *To keep the ambulance in the proper lane on a curve, you must know the vehicle's present position and projected path and take the corner at the correct speed *the safest path is to enter high in the lane (to the outside), and exit low (to the inside). This allows room for error if you enter the turn too fast -the fastest path through a curve is to enter high in the lane (positioned to the outside of the lane), apex low in the lane (to the inside of the lane), and exit high --> this can result in misjudgment of speed and position, creating the danger of ending up in the opposing lane or off the road if you are traveling too fast
Road Positioning and Cornering
Rule 1 of safe driving = speed does not save lives; good care does Rule 2 = driver and all passengers must wear seatbelts and shoulder restraints at all times. EMTs should wear restraints en route to scene and whenever they are not performing direct patient care. All equipment and cabinets (i.e. oxygen tanks, etc.) must be secured, as well as the patient and any passengers accompanying patient -get a feel for the proper brake pressures of your vehicle and best down-shifting techniques; each vehicle has a different braking action e.g. brakes on types I and III vehicles have a heavier feel than the brakes on type II vehicles -when you are driving on a multilane highway, you should usually stay in the extreme left-hand (fast) lane, which allows other motorists to move over to the right when they see or hear you approach -avoid one-way streets because they can become clogged and do not go against flow of traffic unless absolutely necessary -drive within the speed limit while transporting patients except in the rare extreme emergency -always drive defensively -always maintain a safe following distance; use the "4-second rule" --> stay at least 4 seconds behind another vehicle in the same lane -use your siren if you turn on emergency lights, except when you are on a freeway -always assume other drivers will not hear siren or see your emergency lights
Safe Driving Practices/Defensive Ambulance Driving Techniques
In assessing the situation, you must decide where to park ambulance -pick a position that will allow for efficient traffic control and flow around a crash scene -do NOT park alongside scene as you may block the movement of other emergency vehicles -park ~100 feet past scene on same side of the road -if hazardous materials or smoke are present, park uphill and/or upwind of scene -always leave warning lights or devices on, use parking brake -if your vehicle is blocking part of roadway, leave your warning lights on (only flashing yellow lights if your vehicle has them) -if necessary, you can temporarily block traffic to unload equipment and to load patients quickly and safely
Safe Parking during Arrival at Scene Phase
YES = semiautomated defibrillation equipment -every ambulance should carry an automated external defibrillator
Should an automated external defibrillator be carried on ambulance?
-use of sirens and emergency lights depends on local protocols, patient condition, and the anticipated clinical outcome of the patient -regardless of your jurisdictional requirements, as the driver of the ambulance, you need to evaluate the risk vs. benefit of your response mode, taking into account patient's condition e.g. patient who had a seizure may experience another as a result of the rapid flash pattern of the emergency lighting
Siren and Emergency Lights Risk-Benefit Analysis
1. Night Landings -direct low-intensity headlights or lanterns toward the ground at the landing site from opposite corners to form an X at center of landing zone; do not shine lights in air to help pilot (may temporarily blind pilot) -after helicopter has landed, you should not aim lights near the aircraft -always make sure that the flight crew is aware of any overhead hazards or obstructions, and illuminate these if possible 2. Landing on Uneven Ground -If helicopter must land on a grade (uneven surface), approach from the downhill side only; the main rotor blade will be closer to the ground on the uphill side 3. Medivacs at Hazardous Materials Incidents -flight crew must be notified immediately of the presence of HazMat at the scene -the aircraft generates wind and therefore may spread any hazardous materials and vapors present -landing zone should be established upwind and uphill from the HazMat scene -any patients who have been exposed to a HazMat must be properly decontaminated before they can be loaded into the aircraft
Special Considerations with medivacs
Types I and III vehicles Type II *types I and III are wider than they look from behind the steering wheel -to brake and pass effectively, you must know the length and width of your vehicle
The brakes on _____ vehicles have a heavier feel than the brakes on _____ vehicle.
National Research Council of the National Academy of Sciences
The features found in a modern ambulance are defined by what agency?
-check to make sure safety devices (such as seatbelts) are in proper working order -portable oxygen tanks must be secured by fixed clasps or housings --> never attempt to secure a tank to the stretcher or bench because tanks may become projectiles if ambulance is involved in MVA -all equipment in cab, rear, and in compartments needs to be secured appropriately
The final part of preparation phase = reviewing safety precautions. What does this entail?
Disinfection
The killing of pathogenic agents by directly applying a chemical made for that purpose to a surface or equipment
High-level disinfection
The killing of pathogenic agents by the use of potent means of disinfection
4' -Therefore, when you approach the aircraft, walk in a crouched position and protect equipment as you carry it under the blades because air turbulence by rotor blades can blow loose equipment
The main rotor blade of the helicopter is flexible and may dip as low as ____ off the ground.
Cleaning
The process of removing dirt, dust, blood, or other visible contaminants from a surface or equipment
centrifugal force
The tendency for objects to be pulled outward when rotating around a center (i.e. driving around a turn)
siren -always tell patient before you turn siren on -other motorists most likely won't hear it if they have windows up and radio/air conditioning on -make sure you don't increase your speed just because siren is on -the siren is requesting other motorists to give you the right-of-way *some ambulances headlights are equipped with a high-beam flasher unit --> these are the most visible, effective warning devices for clearing traffic in front in front of the vehicle
This is probably the most overused piece of equipment on an ambulance
Decontamination
To remove or neutralize radiation, chemical, or other hazardous material from clothing, equipment, vehicles, and personnel
decontaminate
To remove or neutralize radiation, chemical, or other hazardous material from clothing, equipment, vehicles, and personnel
False --> ambulances do NOT handle the same as cars -ambulances have longer braking time and stopping distance -weight of ambulance is unevenly distributed, making it prone to roll over -therefore, you must modify your speed according to changing weather, road, and driving conditions -if you run into unexpected traffic congestion, notify the dispatcher so that other emergency vehicles can select alternative routes (during major disaster, all public safety and emergency services should be coordinated)
True or False: Ambulances handle the same as cars.
-CPR board --> provides a firm surface under patient's torso so that you can give effective chest compressions; also establishes an appropriate degree of head tilt ^^only carried in a few ambulances across country -a patient on a CPR board has the appropriate degree of head tilt for effective artificial ventilation -instead, a long or short backboard may be placed under patient on stretcher (or mechanical CPR device such as LUCAS) -use tightly rolled sheet or towel to raise the patient's shoulders 3-4" which will help keep patient's head in a position of max backward tilt and keep shoulders and chest in straight position **do NOT use this roll to hyperextend the neck if you suspect a spinal injury
What CPR equipment is carried on some ambulances?
1. Hydroplaning -at speeds greater than 30mph on a wet road, the tire may be lifted off the road as water "piles up" under it; the vehicle may then feel as if it is floating = hydroplaning -at higher speeds on wet roadways, the front tires may actually be riding on a sheet of water, robbing the driver of control of the vehicle -gradually slow down without jamming on the brakes 2. Water on the roadway -driving through moving water should be avoided at all times, and if possible, also avoid driving through standing water -if you must drive through standing water, slow down and turn on windshield wipers -after driving out of water, lightly tap the brakes several times until they are dry -if the vehicle is equipped with antilock brakes, apply a steady, light pressure to dry the brakes 3. Decreased Visibility -at night, use only low headlight beams for maximum visibility without reflection -you should always use headlights during the day to increase your visibility to other drivers 4. Ice and Slippery Surfaces -a light mist on an oily, dusty road can be just as slippery as a patch of ice -if your area often has snowy or icy conditions, consider using studded snow tires or tire chains, if they are permitted by law -although four-wheel drive vehicles have better traction for acceleration in slippery conditions, they do not stop any faster than two-wheel drive vehicles
What are conditions that require the ambulance driver to decrease speed, increase following distance, and be alert?
1. Why call for a medivac? -transport time by ground is too long -road, traffic, or environmental conditions prohibit use of ground ambulance -patient requires advanced care you cannot give (i.e. advanced airway) -there are multiple patients that will overwhelm resources at hospital reachable by ground 2. Who receives a medivac? -patients with time-dependent injuries or illnesses i.e. stroke, heart attack, or serious spinal cord injury (e.g. injuries sustained in MVA, diving into pool, horseback riding, etc.) -Serious conditions in remote areas such as scuba-diving accidents, near-drownings, skiing and wildnerness accidents -trauma patients and candidates for limb replantation (for amputations), burn center, a hyperbaric chamber, or a venomous bite center (specific criteria vary between services) 3. Whom do you call? -notify dispatch first -in some regions after medivac has been initiated, ground EMS crew may be able to communicate with flight crew via specially designated radio frequency -flight crew may want a brief presentation/update on patient's condition or where to land helicopter -keep information clear and concise *the most dangerous phases of air transport are take off and landing --> it's imperative that at least one person be dedicated to these tasks and not have any patient care responsibilities
What are some guidelines you should be familiar with when considering whether to initiate a medivac operation?
-activated charcoal -drinkable water and cups -oral glucose -oxygen -supplies for irrigating eyes and skin -snakebite kit or other regional equipment depending on area and local protocol ^^make sure they have not expired -make sure you have telephone number and radio frequency of online medical control or local poison control center with you on ambulance (e.g. on back of clipboard)
What are some medications should be included on ambulance?
1. Preparation for the call (preparation phase) 2. Dispatch 3. En route 4. Arrival at scene 5. Transfer of patient to the ambulance 6. En route to receiving facility (transport) 7. At the receiving facility (delivery) 8. En route to station 9. Postrun
What are the 9 phases of an ambulance call?
1. The unit must be on a true emergency call to the best of your knowledge 2. Both audible and visual warning devices must be used simultaneously 3. The unit must be operated with due regard for the safety of all others, on and off the roadway -when you are responding to an emergency call and must travel on the highway, you should shut down your emergency lights and sirens until you have reached the far left lane to minimize possible motorist confusion and then remain in the far left lane -when you exit highway, same procedures should be followed as when you entered highway --> deactivate all emergency devices, move onto off-ramp, and then reactivate the emergency lights and sirens if necessary
What are the three basic principles that govern the use of warning lights and sirens?
-when a motorist "times the traffic lights" -when the driver of one emergency vehicle follows another emergency vehicle through an intersection without assessing situation carefully (motorist who yielded right of way for first emergency vehicle may not be expecting a second, causing an accident) ^^to avoid this, use a siren tone that is different than that of the first vehicle
What are two common intersection hazards?
1. Enlargement of patient compartment 2. Use of first-responder vehicles, which respond initially to the scene with personnel and equipment to treat the sick and injured until an ambulance can arrive (i.e. firefighters and law enforcement)
What are two important developments in ambulance design and operation?
-arriving at scene safely and transporting the patient safely
What are two of the most challenging aspects of being an EMT?
-pair of trauma shears -sterile sheets, sterile burn sheets -adhesive tape in several widths -self-adhering soft roller bandages -sterile dressings -gauze -abdominal or laparotomy pads -sterile universal dressigns -sterile occlusive nonadherent dressings (aluminum foil sterilized in its original package) -assortment of adhesive bandages -tourniquet -adult-size pneumatic antishock garment (PASG) ^^basic supplies for dressing open wounds
What basic wound care supplies are carried on ambulance?
At least one sterile OB kit that includes: -surgical scissors -hemostats or special cord clamps -umbilical tape or sterilized cord -small rubber bulb syringe -towels -gauze sponges -pairs of sterile gloves -sanitary napkins -plastic bag -baby stocking cap and baby blanket
What childbirth supplies should be carried on ambulance?
-driver's compartment -patient compartment that can accommodate 2 EMTs and 2 supine patients (one on bench, one on stretcher) positioned so that at least one of the patients can receive CPR during transport -Equipment and supplies to provide emergency medical care at the scene and during transport, to safeguard personnel and patients from hazardous conditions, and to carry out light extrication procedures -Two-way radio communication so that ambulance personnel can speak with the dispatcher, hospital, public safety authorities, and online medical control -Design and construction that ensure maximum safety and comfort
What features does the modern ambulance have?
-become familiar with helicopter hand signals used within your jurisdiction -do not approach helicopter unless instructed and accompanied by flight crew -ensure that all patient care equipment is properly secured to the stretcher and patient is fastened (this includes oxygen tanks, cervical collars, and head immobilizers) -any loose articles or belongings of patient should not be brought to landing zone and will likely need to be transported to hospital by ground -regardless of where patient is being loaded onto helicopter, always approach helicopter from front unless otherwise instructed by flight crew and always take same path when exiting; move patient headfirst -smoking, open lights or flames, and flares are prohibited within 50' of the aircraft at all times
What guidelines should you keep in mind when operating at a landing zone for a medivac?
6-pointed Star of Life emblem -affixed to sides, rear, and roof of ambulances -warning lights and public address (PA) systems are necessary on licensed and certified ambulances
What identifies vehicles as ambulances?
Ambulance must have jump kit = portable, durable, waterproof kit that you can carry to patient; think of it as the "5-minute kit" containing anything you might need in the first 5 minutes with the patient (except for oxygen cylinder, AED, and suctioning unit) Items carried in jump kit: -disposable gloves -triangular bandages -trauma shears -adhesive tape in various widths -universal trauma dressings -self-adhering soft roller bandages 4"x 5 yd. and 2" x 5 yd -oral airways in adult, child, and infant sizes -BVM device with masks for adult, child, and infants -BP cuff -stethoscope -pen light -sterile gauze dressings, 4"x 4" -sterile dressings (abdominal pads), 6"x 9" or 8"x 10" -adhesive strips -oral glucose -activated charcoal
What is a jump kit and what items should be carried in it?
-primary wheeled ambulance stretcher capable of being tilted up at least 60 degrees (semisitting position) and entire stretcher tilted into a 10-15 degree Trendelenburg's position (feet elevated 6-10") ^^stretchers must have fasteners to secure them to floor/side of ambulance during transport as well as three restraining devices for patient (such as deceleration or stopping straps over the shoulders) -wheeled stair chair for use in narrow spaces -long backboard -short backboard or short immobilization device -other devices that can be used = scoop stretcher, portable/folding stretcher, flexible stretcher, basket stretcher
What patient transfer equipment should be carried on ambulance?
Every medivac contains a flight nurse and a paramedic
What personnel are included on medivacs? (from class)
1. personal protective equipment: -face shields -gowns, shoe covers, caps -turnout gear -helmets with face shields or safety goggles -safety shoes or boots 2. equipment for work areas -a weatherproof compartment that you can reach from outside the patient compartment should hold equipment for safeguarding patients and EMTs, controlling traffic and bystanders, and illuminating work areas -warning devices that flash intermittently or have reflectors -2 high-intensity halogen 20,000 candlepower flashlights of the recharging battery-powered stand0up type -fire extinguisher (type BC, dry powder, 5 lb minimum) -hard hats or helmets with face shields or safety goggles -portable floodlights 3. preplanning/navigation guides -have detailed street and area maps in driver's compartment, along with directions to key locations such as hospitals 4. extrication equipment --> a weatherproof compartment outside the patient compartment should contain equipment that is needed for simple, light extrication (even if extrication and rescue unit is readily available) -includes things such as wrench, screwdriver, hacksaw, pliers, hammer, fire ax, wrecking bar, crowbar, bolt cutter, folding shovel, tin snips, gauntlets (gloves), rescue blanket, ropes, mastic knife able to cut seatbelt webbing, spring-load center punch, roll of duct tape (for window application prior to center punch use), pruning saw, heavy duty shoring (cribbing) blocks -see Table 36-5 for specifics ^^in addition to medical equipment, ambulance should carry several kinds of equipment for responder safety, rescue operations, and locating emergency scenes
What safety and operations equipment should be carried on ambulance?
-summary of the history of the patient's current illness or injury with pertinent positives and negatives -MOI -findings on your arrival -list vital signs -briefly mention relevant past medical or surgical history, as well as information regarding medication and allergies -include any treatment and its effect during prehospital setting
What should be included in your written report?
you say "we can't go until you are safely secured" -if patient then chooses to refuse care, let them and have them sign a form
What should you do if patient refuses to wear seatbelt on ambulance? (from class)
-one portable unit with at least 500 L (at least one extra should be kept on ambulance), kept near door or in jump kit -one mounted/installed unit with 3,000 L, located near head of stretcher -portable oxygen tanks must always be secured by fixed clasps or housings to prevent accidental damage and the cylinder potentially becoming a projectile
What size oxygen tanks should be carried on ambulance?
-adult-size and child-size traction splint -variety of arm and leg splints such as inflatable, vacuum, cardboard, plastic, foam, wire-ladder, or padded board -variety of triangular bandages and roller bandages -short backboard device -long backboard -head immobilization devices -cervical collars in adjustable sizes or variety of sizes
What splinting supplies should be carried on ambulance?
-road conditions -construction -detours -closures -traffic conditions -local special needs patients
What you should you stay current/updated on in your area of service?
When you are in unfamiliar territory and truly need a guide more than an escort -in such cases, neither vehicle should use warning lights or sirens
When is it justified to have a police escort you?
