Ch 35, 36, and 37 Objectives

36.3 Describe the components of the vehicle and equipment checks done at the start of every shift. (pp. 1026-1028)

1) Check the ambulance body, wheels, tires, and windshield wipers. 2) Check the windows, doors, and mirrors. 3) Check under the hood. 4) Check the interior surfaces and upholstery. 5) Check the dash instruments and communications equipment. 6) Check the fuel level and fill up. Inspection of the vehicle and equipment are typically tracked by a checklist. The checklist and inspection process are an important part of recordkeeping for many different EMS services and may be a critical component of an investigation process if needed.

37.3 Describe the roles in hazardous materials response of providers trained at each of the four levels of hazardous materials training specified by OSHA. (pp. 1055-1056)

1) First Responder Awareness: Rescuers at this level are likely to witness or discover a hazardous substance release. They are trained only to recognize the problem and initiate a response from the proper organizations. There are no minimum training hours required. 2) First Responder Operations: This level of training is for those who initially respond to releases or potential releases of hazardous materials to protect people, property, and the environment. They stay at a safe distance, keep the incident from spreading, and protect others from any exposures. A minimum of 8 hours of training is required. 3) Hazardous Materials Technician: This level is for rescuers who actually pug, patch, or stop the release of a hazardous material. A minimum of 24 hours of training is required. 4) Hazardous Materials Specialist: This level of rescuer is expected to have advanced knowledge and skills and to command and support activities at the incident site. A minimum of 24 hours of additional training is required.

36.11 Describe the EMT's responsibilities in terminating the call and readying the vehicle for the next response after a call and returning to quarters. (pp. 1042-1048)

1) Quickly clean the patient compartment while taking appropriate Standard Precautions. 2) Prepare respiratory equipment for service. 3) Replace expendable items. 4) Exchange equipment according to your local policy. 5) Make up the ambulance cot.

36.8 Describe the steps necessary for transferring the patient to the ambulance. (pp. 1036-1038)

1) Select the proper patient-carrying device. 2) Package the patient for transfer. 3) Move the patient to the ambulance. 4) Load the patient into the ambulance.

37.6 Explain how to identify specific hazardous materials using the NFPA 704 and Department of Transportation placard systems, packaging labels, invoices, bills of lading, shipping manifests, and safety data sheets. (pp. 1057-1060)

A commonly used placarding system is the National Fire Protection Association (NFPA) 704 System. It uses numerical and color coding to show the type and degree of health hazard, fire hazard, reactivity, and specific hazard contained within a fixed facility. Diamond-shaped placards used in the transportation of dangerous goods not only show the hazard class, such as "explosives," " flammable gas," "poison," or other; they also bear a division number that provides more specific information on the material. In addition, a four-digit identification number may appear on the placard itself or on a panel near the placard. Older placards are usually orange and have an identification number preceded by the letters UN or UA. Your dispatcher may have access to the name of the material through this identification number. The U.S. Department of Transportation requires that packages, storage containers, and vehicles containing hazardous materials bear labels or placards with markings that identify the nature of the contents. Pictograms are required as of June 1, 2015. These are part of the new Hazard Communication Standard and align labels with the UN Globally Harmonized System (GHS) for labeling dangerous chemicals. You may also see the signal word "WARNING" or "DANGER." Warning is used for less severe hazards, and Danger is used for more severe hazards. Check invoices, bills of lading (trucks), and shipping manifests (trains). If you can safely obtain them, these documents will identify the exact substance being transported, the exact quantity, its place of origin, and its destination. Review safety data sheets (SDS). Safety data sheets (SDS), formerly called material safety data sheets (MSDS), must be provided on hazardous materials by all manufacturers. These sheets must be maintained at the work site by the employer and available to all employees on the grounds that employees working with hazardous materials have a right to know about them. If you can safely obtain these sheets, they generally name the substance, its physical properties, fire and explosion hazard information, health hazard information, and emergency first-aid treatment.

37.8 Discuss how to establish a treatment area and decontamination and care for patients at a hazardous materials incident. (pp. 1062-1067)

All EMS personnel and equipment must be staged in the cold zone. EMS personnel have two responsibilities at a hazmat incident: to monitor and rehabilitate the hazmat team members and to take care of the injured. Although the rehab area supervisor may not be an EMS provider, all rehab operations must include EMTs or advanced-level EMTs. The characteristics of the rehab area must include the following: located in the cold zone, protected from weather (shielded from rain or snow, a warm area in a cold environment, a cool area in a warm environment), large enough to accommodate multiple rescue crews, easily accessible to EMS units, free from exhaust fumes, and allow for rapid reentry into the emergency operation.

37.13 Recognize the psychological aspects of multiple-casualty incidents for patients and responders. (pp. 1082-1083)

Although patients may outwardly exhibit few signs of injury or emotional stress, people involved in MCIs have been subjected to devastating circumstances with which they are normally unprepared to cope. Proper early management of the psychologically stressed patient can support later treatment and help ensure a faster recovery. You should not attempt to engage in psychoanalysis and should not say things that are untrue in an attempt to calm a patient. However, a caring, honest demeanor can reassure a patient, as will listening to the patient and acknowledging his fears and problems. It is very important that you understand that large-scale or horrific MCIs may affect rescuers as much as, if not more than, nonrescuers. Many jurisdictions have stress debriefing counselors available for responders after the event. It is important for the responder to be vigilant for unhealthy behaviors brought about by stressful events. EMTs who become emotionally incapacitated should be treated as patients and removed to an area where they can rest without viewing the scene.

36.4 Describe the roles and responsibilities of the Emergency Medical Dispatcher. (pp. 1028-1029)

An EMT is trained to perform the following tasks: Ask question of the caller and assign a priority to the call. Provide prearrival medical instructions to callers and information to crews. Dispatch and coordinate EMS resources. Coordinate with other public safety agencies.

36.6 Explain laws that typically apply to ambulance operations. (pp. 1030-1031)

An ambulance operator must have a valid driver's license and may be required to complete a training program and/or an additional endorsement of their driver's license. Privileges granted under the law to the operators of ambulances apply ONLY when the vehicle is responding to an emergency OR is involved in the emergency transport of a sick or injured person. However, the exemptions granted do not provide immunity to the operator in cases of reckless driving or disregard for the safety of others. Privileges granted during emergency situations apply only if the operator uses warning devices in the manner prescribed by law. Typically this means operation of the warning/emergency lighting systems as well as the siren. Most statutes allow emergency vehicle operators to: park the vehicle anywhere if it does not damage personal property or endanger lives, proceed past red stop signals, flashing red stop signals, and stop signs ( or come to a full stop then proceed with caution), exceed the posted speed limit as long as life and property are not endangered, pass other vehicles in no-passing zones, and disregard regulations that govern direction of travel and turning in specific directions.

35.3 Describe general considerations in responding to patients with special challenges. (pp. 1004-1007)

As an EMT, you should take the time to become familiar with any special health care settings in your community so you can be better prepared for calls of this nature. In addition to identifying the locations of such facilities, EMTs should meet and develop plans with facility representatives to minimize confusion that could occur during an emergency call. Facility representatives may be able to arrange for you to see various medical devices in operation prior to any problems or medical distress. Because family members have a vested interest in being competent with the devices, they are very thorough and deliberate with their understanding and application of the devices and their features. Therefore, it is advisable to seek their input on any problem that may be occurring with devices the patient has and to ask if they have been in a similar situation before. Some general questions should include: Has this problem ever occurred before? If so, what fixed it? Have you (or other family members/caregivers) been taught how to fix this problem? Have you tried to fix the problem? If so, what happened? In addition, asking questions such as "How do you normally move him?" or "Has she ever been transported by ambulance, and what worked well for the transfer?" will allow family members to be part of the solution.

36.5 Discuss the principles of safe ambulance operation while responding to the scene. (pp. 1030-1034)

Be physically fit. Be mentally fit with your emotions under control. Be able to perform unde stress. Have a positive attitude about your ability as a driver but not be an overly confident risk taker. Be tolerant of other drivers. Never drive while under the influence of alcohol, illicit or "recreational" drugs, antihistamines, "pep pills," or tranquilizers. Never drive with a restricted license. Always wear your glasses or contact lenses is required for driving. Evaluate your ability to drive based on personal stress, illness, fatigue, or sleepiness. Energy drinks should be used with caution; you could still have reduced reaction times and other negative consequences of prolonged fatigue. Minimize lights-and-sirin "hot responses. Wear your seat belts. Know where you are going before you respond. Use the GPS and check the maps. Be familiar with your response area. Approach intersections with caution. Come to a complete stop at intersections. Avoid sudden turns and always properly signal lane changes and turns. Don't be a distracted driver. Have the crew leader operate the radio, siren, GPS, computer, and other devices. Don't eat or drink when responding under emergency conditions. Pay complete attention to the task at hand. Don't listen to music, text, talk on mobile phones, or indulge in any other distracting activities. Pay 100 percent attention to safe driving.

36.9 Describe the EMT's responsibilities while transporting a patient to the hospital. (pp. 1038-1040)

Continue your assessment. Secure the stretcher in place in the ambulance. Position and secure the patient. Adjust the security straps. Prepare for respiratory or cardiac complications. Loosen constricting clothing. Load a relative or friend who must accompany the patient. Load personal effects. Talk to your patient. Avoid letting patients sit on the bench or airway seat. Notify the hospital. Continue to provide emergency care as required. Use safe practices during transport. Compile additional patient information. Continue assessment and monitor vital signs. Notify the receiving facility.

35.4 Recognize physical impairments and common medical devices used in the home care of patients with special challenges, including respiratory devices, cardiac devices, gastrourinary devices, and central IV catheters, and discuss EMT assessment and transport considerations for each. (pp. 1007-1015)

Continuous positive airway pressure (CPAP) is a form of noninvasive positive pressure ventilation (NPPV) provided by a device that blows oxygen or air under constant low pressure through a tube and mask to prevent alveoli in the lungs from collapsing at the end of a breath. It is often prescribed to patients who suffer sleep apnea (periods when breathing stops during sleep) to help keep airway passages open as the patient sleeps. A tracheostomy is a surgical opening through the neck into the trachea. When the opening created is permanent, it is called a stoma. A tracheostomy is usually created near the second to fourth tracheal ring. A tracheostomy tube (a short breathing tube and flange) is inserted into the airway to allow the patient to breathe through the stoma instead of through the nose and mouth. A ventilator is a device that breathes for a patient. It is programmed to take over the functions of inhalation, exhalation, timing, and rate of breathing. In the case of a pacemaker, a small device is implanted under the skin and wires are implanted into the heart. The pacemaker is designed to prevent the heart rate from becoming too slow. Like a pacemaker, an automatic implanted cardiac defibrillator (AICD) is placed under the skin with wires inserted into the heart. The implanted defibrillator is designed to detect life-threatening cardiac rhythms (ventricular fibrillation and ventricular tachycardia). The left ventricle is the cardiac chamber that pumps blood through the aorta to the body. When there is severe left ventricular heart failure, a heart transplant may be required. While the patient is waiting for a suitable donor, the LVAD serves as a "bridge to transplant." The LVAD moves blood from the left ventricle through an inserted tube to a pump implanted in the abdomen where the blood is pressurized and sent to the aorta for transport to the body. A tube extends from the LVAD through the abdominal wall to an external pump battery and control panel. A feeding tube is used in a patient who is unable to feed himself or can't swallow. It may be used short term (during recovery from surgery) or long term (for chronic conditions). A nasogastric tube (NG-tube) is a long tube inserted through the nose into the stomach that can be used to deliver nutrients. In addition, the device can be used in emergency departments and by some ALS providers to suction out the stomach's contents; for example, in the case of certain overdoses. A gastrostomy tube (G-tube) is a feeding tube surgically implanted through the abdominal wall and into the stomach. Some feeding tubes are placed through the abdominal wall, directly into the small intestine. For example, a J-tube is placed into the jejunum section of the small intestine. A urinary catheter is used for a patient who has lost the ability to urinate or the ability to control when he urinates. An ostomy bag is connected to the site of a colostomy or an ileostomy. A colostomy or ileostomy is the result of a surgery that brings a section of the intestine through the abdominal wall to divert the flow of stool away from the normal path to the rectum. An ostomy may be necessary because of a medical condition such as Crohn's disease or ulcerative colitis or cancer, especially colon cancer. A patient who requires dialysis has renal failure. Hemodialysis is performed by attaching the patient to an external machine called a dialyzer. The procedure is usually performed at a dialysis center, although home units do exist. Hemodialysis requires the use of large needles and tubing to remove and return the blood. Peritoneal dialysis requires a permanent catheter that is implanted through the patient's abdominal wall and into the peritoneal cavity. A patient who receives frequent IV therapy, such as with chemotherapy or total parenteral nutrition, may have one of a variety of central IV catheters. One of the easiest ways to communicate with a patient with hearing loss is to write your questions and explain your actions on a piece of paper. Many dispatch centers and communities also have TDD/TTY phones and may be able to relay information through these devices. It is good practice for the EMT to always carry a small flashlight, even during the day because blind patients w may not use lights in their home or may not notice lights that have burned out. A patient who is unable to speak (aphasic) may need to write answers to your questions, use a TDD/TTY phone, or have a computer that speaks the words he types.

37.2 Anticipate situations in which hazardous materials may be involved. (pp. 1054-1055)

Hazardous material incidents are especially likely to take place at factories; along railroads; and on local, state, and federal highways.

36.10 Describe the EMT's responsibilities when transferring care of patients to the emergency department staff. (pp. 1040-1042)

In a routine admissions situation or when an illness or injury is not life threatening, check first to see what is to be done with the patient. Assist emergency department staff as required, and provide a verbal report. As soon as you are free from patient-care activities, prepare the prehospital care report. Transfer the patient's personal effects. Obtain your release from the hospital.

37.12 Discuss transportation and staging logistics at a multiple-casualty incident. (pp. 1081-1082)

It is advisable to have a staging area from which ambulances can be called to transport patients. The staging area will be the responsibility of the staging supervisor, who must keep track of the ambulance vehicles and personnel. In large-scale incidents, the staging supervisor may need to arrange for certain human needs, such as rest rooms, meals, and rotation of crews. No ambulance should proceed to a treatment area unless requested by the transportation supervisor and directed by the staging supervisor. The staging supervisor is responsible for communicating with each treatment area regarding the number and priority of the patients in that area. This information can then be used by the transportation supervisor to arrange for transport of patients from the scene to the hospital in the most efficient way. It is vital that no ambulance transport any patient without approval of the transportation supervisor since the transportation supervisor is responsible for maintaining a list of patients and the hospitals to which they are transported. The information is relayed from the transportation supervisor to each receiving hospital. In this way the hospitals know what to expect and receive only the patients they are capable of handling. It is critical that the EMTs on the ambulance comply with the instructions of the transportation supervisor. Failure to do so may result in patient's being transported to the wrong facilities. During an MCI, it is very important that the transportation officer know local hospital capabilities. Taking too many patients to one hospital could overwhelm that hospital's capability to treat them. Overwhelming a hospital's surge capacity could bring about poor outcomes. Once an ambulance has completed its run to a hospital, it will probably be directed to return to the staging area, perhaps bringing needed supplies, to await its next instructions from the staging supervisor. Crew rest rotations, as possible, will be very important for long-duration MCI events. Crew rest periods will both decrease the incidence of mistakes and assist in maintaining the long-term psychological health of crew members.

35.5 Explain why patients with special challenges are often especially vulnerable to abuse and neglect and what the EMT's obligations are in such situations. (p. 1015)

Keep in mind that patients with special challenges can be more vulnerable to physical or sexual abuse, exploitation, and neglect because of their dependence on others.

36.7 Discuss how to maintain safety at highway incidents. (pp. 1035-1036)

Keep unnecessary units and people off the highway. Avoid crossovers unless a turn can be completed without obstructing traffic. If yours is the first unit on scene, block the incident by parking the apparatus "upstream" from the incident. Conduct a scene size-up then transmit an arrival report. Cancel or request additional resources as needed. To avoid overcrowding the site, cancel anything that is not absolutely needed. Wear your PPE. Place cones/flares and reduce emergency lighting. Remember that unit placement is important! Avoid backing up if possible, especially during emergencies because there are large blind spots in your mirrors and a danger of striking a pedestrian, an object, or another vehicle.

35.2 Describe special challenges patients may have, including various disabilities, terminal illness, obesity, homelessness/poverty, and autism. (pp. 998-1004)

Many patients with disabilities can live independently, often with some type of assistive equipment or accommodations. Some patients with more severe disabilities live at home but require special assistance, such as ventilators, feeding tubes, and home health care services. Terminally ill patients, such as patients with end-stage cancer, heart failure, or kidney failure, or those with progressive fatal diseases such as Huntington's disease or Lou Gehrig's disease, may prefer to stay at home under the care of family, possibly with assistance from hospice or home health care providers. Alternatively, they may spend the final weeks or days of their lives in a specially designated hospice facility. Terminally ill patients may be depending on technology to sustain life or relieve pain. Terminally ill patients and their families also have special emotional needs. Obesity increases the risk of some cancers, type 2 diabetes, hypertension, heart attack, stroke, liver and gallbladder disease, arthritis, sleep apnea, and respiratory problems. Several serious health problems are related to homelessness: mental health problems, malnutrition, substance abuse problems, HIV/AIDS, tuberculosis, bronchitis and pneumonia, environmental emergencies, wounds, and skin infections. The lack of access to health care also means that conditions that begin as minor problems can go untreated until they become emergencies. Autism spectrum disorders (ASD) are developmental disorders that affect, among other things, the ability to communicate, report medical conditions, self-regulate behaviors, and interact with others to get needs met.

36.12 Identify when and how to call for air rescue, how to set up a landing zone, ad how to approach a helicopter when assisting with an air rescue. (pp. 1048-1050)

Operational reasons for air rescue include: to speed transport to a distance trauma center or other special facility, when extrication of a high-priority patient is prolonged and air rescue can speed transport, or when a patient must be rescued from a remote location that can be reached by helicopter only. Medical reasons for air rescue primarily affect patients who are high priority for rapid transport, for example, a patient: in shock, with a Glasgow Coma Scale total of less than 10, with a head injury with altered mental status, with chest trauma and respiratory distress, with penetrating injuries to the body cavity, with an amputation proximal to the hand or foot, with extensive burns, with a serious mechanism of injury, and who is post-cardiac arrest with a pulse.

37.11 Describe the principles of primary triage, secondary triage, and the START triage system. (pp. 1075-1081)

Priority 1: Treatable Life-Threatening Illness or Injuries, Priority 2: Serious but Not Life-Threatening Illnesses or Injuries, Priority 3: "Walking Wounded," Priority 4 (sometimes called Priority 0): Dead or Fatally Injured START stands for Simple Triage and Rapid Treatment. The foundation of the system is the speed, simplicity, and consistency of its application. It relies on some simple commands the following physiologic parameters tat can be remembered by the mnemonic RPM: Respiration, Pulse, Mental Status. Begin by asking all patients who can walk to get up and go to a collection point such as an ambulance or a building. Since those who can do this are: conscious, able to follow commands, and able to walk... they obviously are perfusing their brain, are breathing, have a pulse, and have a nervous system that is currently working. All of these patients are considered to be Priority 3 (green tag) patients for right now. Assess in the following sequence: respiration, radial pulse, level of consciousness (mental status), and then retriage the priority 3 patients. The only three treatments provided during START triage are to: open an airway and insert an oropharyngeal airway, apply pressure to bleeding, and elevate an extremity. Priority 1 (red) are patients who have: altered mental status or... absent radial pulse or... respirations of greater than 30/minute. Priority 2 (yellow) are patients who: are alert and... have radial pulses present and... have respirations less than 30/minute. Priority 0 (black) are patients who: are not breathing (after an attempt to open the airway) or... have no pulse and are not breathing.

37.4 Describe the responsibilities of the EMT at a hazardous materials incident. (pp. 1056-1062)

Recognize a hazmat incident. Control the scene. Identify the substance. Isolate the hot zone. Establish a decontamination corridor (area where patients will be decontaminated) in the warm zone, an area immediately adjacent to the hot zone. Equipment and other emergency rescuers should be staged in the next adjacent area--the cold zone. Station yourself in the cold zone. Identify the substance. Use binoculars to look for identifying signs, labels, or placards from a safe distance. Search for placards. Check invoices, bills of lading (trucks), and shipping manifests (trains). Review safety data sheets (SDS). Interview workers or others leaving the hot zone. Yu can obtain advice about what initial actions should be taken at the scene from your dispatcher, a hazardous material expert, or one of the following sources: Emergency Response Guidebook Chemical Transportation Emergency Center (CHEMTREC), CHEM-TEL, Inc., a current list of state and federal radiation authorities, and regional poison control centers. Establish a treatment area. EMS personnel have two responsibilities at a hazmat incident: to monitor and rehabilitate the hazmat team members and to take care of the injured.

36.2 Describe the types of equipment required to be carried by EMS response units. (pp. 1021-1025)

The 2009 required equipment for BLS ambulances include devices for: ventilation and airways (suction, BVMs, pulse oximeters), monitoring and defibrillation (AED), immobilization (cervical collars, backboards, etc.), bandages, communication, obstetrics (thermal absorbent blanket, towels, sterile scissors, bulb suction, clamps for cord, etc.), miscellaneous items (cold packs, flashlights, towels, sterile saline for irrigation, triage tags, etc), infection control (eye protection, gloves, shoe covers, etc.), injury prevention (fire extinguisher, protective helmet, reflective safety wear), disassembly tools (wrenches, screwdrivers, pliers, bolt cutters, etc.), spreading tools (hydraulic jack, saw, air-cutting gun kit, etc.), pulling tools/devices (ropes/chains, come-along, hydraulic truck jack, air bags, etc.), protection (hard hats, reflectors/flares, safety goggles, fireproof blankets, etc.), pulling tools/devices, protection, and miscellaneous (shovel, lubricating oil, wood/wedges, generator, and floodlights, etc).

37.10 Describe the principles and features of the Incident Command System. (pp. 1069-1075)

The basic elements of the Incident Management System--with sections such as Operations being subordinate to Command--are: operations, planning logistics, and finance. In single incident command a single agency controls all resources and operations. In unified command several agencies work independently but cooperatively rather than one agency exercising control over the others. Initially Incident Command is assumed by the most senior member of the first service on the scene. Very often this will be an EMS unit. Depending on jurisdiction, laws, or protocols, Incident Command may be later transferred to another individual or may be continued by whoever established it. First Command and the crew do an initial scene size-up, start the triage process, and call for backup. While waiting for help, initial triage is completed and Command gets ready for arriving resources, beginning to construct a plan of action. When reinforcements arrive, there are two options for the person who initially assumed Command: Continue to be in Command or transfer Command to someone of higher rank. In a unified system, Incident Command would be assumed cooperatively by the Command of each service. In a single incident command mode, one person acts as Command, and EMS would typically be a group under the Operations section.

37.9 Describe multiple-casualty incident operations. (pp. 1067-1069)

The disaster plan should be: written to address the events that are conceivable for a particular location, well publicized, realistic, and rehearsed.

37.7 Identify sources of information on initial actions to take once the hazardous material has been identified, including the Emergency Response Guidebook, hotlines, and poison control centers. (pp. 1060-1062)

The essential booklet, Emergency Response Guidebook, published by the U.S. Department of Transportation, Transport Canada, and the Secretariat of Communications and Transportation of Mexico, provides the names of chemicals and concise but thorough descriptions of the actions that should be taken in case of a hazmat emergency. Be sure to have the latest edition in your vehicle at all times. The Chemical Transportation Emergency Center (CHEMTREC) is a group that has been established in Washington, D.C., as a service of the Chemical Manufacturers Association. They can provide your dispatcher or you with information about the hazardous material through a twenty-four-hour toll-free telephone number for the United States and Canada, which is 800-424-9300. For calls originating elsewhere and for collect calls, the number is 703-57-3887. When you call, keep the line open so changes at the scene can be reported to CHEMTREC and the center can confirm that they have contacted the shipper or manufacturer. CHEMTREC will be able to direct you as to your initial course of action. CHEM-TEL, INC is an emergency response communication service that can be reached twenty-four hours a day at 800-255-3924 in the United States and Canada. For calls originating elsewhere or collect calls, use 813-979-0626. Regional poison control centers is an often overlooked source during a hazardous material situation. Using their reference and medical resources, they can provide essential guidance in the decontamination and treatment of patients affected by hazardous materials.

37.5 Given a description of a hazardous materials incident, identify the safe and danger zones and the hot, warm, and cold zones. (p. 1057)

The hot zone is the area of contamination or the area of danger. A decontamination corridor (area where patients will be decontaminated) in the warm zone, an area immediately adjacent to the hot zone. Equipment and other emergency rescuers should be staged in the next adjacent area--the cold zone (where the EMT should be stationed).

36.1 Identify this type of ambulance as currently specified by the U.S. Department of Transportation. (pp. 1021, 1022)

Type I

36.1 Identify this type of ambulance as currently specified by the U.S. Department of Transportation. (pp. 1021, 1022)

Type II

36.1 Identify this type of ambulance as currently specified by the U.S. Department of Transportation. (pp. 1021, 1022)

Type III

35.1 Key Terms

autism spectrum disorder automatic implanted cardiac defib bariatrics central IV cath cpap dialysis disability feeding tube left ventricular assist device obesity ostomy bag pacemaker stoma tracheostomy urinary cath ventilator

37.1 Key Terms

cold zone command decontamination disaster plan hazardous material hot zone incident command incident command system multiple causality incident National Incident Management System Single incident command staging area staging superviors surge capacity transportation supervior treatment area treatment supervior triage triage area triage supervior triage tag unfiled command warm zone

36.1 Identify this type of ambulance as currently specified by the U.S. Department of Transportation. (pp. 1021, 1022)

medium duty