Chapter 38

Summarize the tasks EMTs must complete in the post-run phase (1442-3)

- complete and file any additional reports - perform routine inspections - i.e strip linens, discard appropriate materials, wash contaminated areas with soap and water, clean the stretcher with bleach and water, and any other spillage with bleach and water.

Name the medical equipment carried on an ambulance; include examples of supplies that are included in each main category of the ambulance equipment checklist (1428)

---> Basic Supplies - PPE: equipment for work areas, extrication equipment, ANSI class 2 vest, turnout gear, tactical vest... - Sharps containers - airway and ventilation equipment: OPAs, NPAs, CPAPs, and advanced airway procedures if authorized; oxygen equipment; suctioning equipment; - basic wound care and bleeding control supplies - splinting supplies - childbirth supplies - an AED - patient transfer equipment - medications - communications equipment - regionally appropriate supplies ---> CPR Equipment - CPR board ---> Safety and Operations Equipment

Describe the capabilities, protocols, and methods for accessing air ambulances (1453-7)

---> Capabilities: can rapidly transport patients to far away, advanced, medical facilities ---> Protocols: - Why to call: 1. Long transport time, where decrease in transport time ==> increased survival 2. Ground conditions prohibit the use of an ambulance 3. Need ALS you cannot deliver - Who receives a Medevac? 1. Patients with time dependent injuries 2. Patients in Remote Areas 3. Specific regional criteria (i.e a snake bite) - Whom do you call 1. Dispatcher 2. Flight crew in some regions once connected ---> Methods: - usually helicopters, but can be jets as well, though typically used for transporting stable patients between hospitals

Define the terms cleaning, disinfection, high-level disinfection, and sterilization (1442)

---> Cleaning: the process of removing dirt, dust, or blood, or other visible contaminants from a surface or equipment ---> 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 using potent means of disinfection and use of through application process ---> Sterilization: a process, such as the use of heat, which removes all microbial contamination

Discuss the guidelines for safely and defensively driving an ambulance (1443-5)

---> Do not be impaired ---> Be emotionally fit to drive ---> Be certified/approved to drive ---> speed does not save lives, good care does ---> drivers and passengers should wear a seatbelt - only remove the seat-belt for direct patient care

Identify key steps EMTs should take to improve safety while en route to the scene, the hospital, and the station (1443-53)

---> Drive safely and defensively ---> Do not be impaired ---> Be emotionally fit to drive ---> Be certified/approved to drive ---> speed does not save lives, good care does ---> drivers and passengers should wear a seatbelt - only remove the seat-belt for direct patient care

How to Establish a Landing Zone for a Medevac Helicopter

---> Hard or grassy area that measures 100 ft by 100 ft (ideal) and no less than 60 ft by 60 ft ---> notify flight crew if the site isn't level, slope should not vary by more than 5-7 degrees ---> ensure area is clear of debris ---> examine the area for overhead hazards ---> mark the landing site with weight cones or emergency vehicles, with headlights forming an X ---> move non-essential people and vehicles to a safe distance outside the landing zone ---> communicate wind strength to flight crew

Describe some high-risk situations and hazards during both pre-transport and transport that may affect the safety of the ambulance and its passengers (1436-41, 1443-53)

---> Hazardous road conditions ---> Unsafe scenes ---> Unprepared ambulances ---> people trying to enter the scene ---> rubber-necking

Explain the additional risks and special considerations posed by the use of police escorts, and the hazards and special considerations posed by crossing intersections (1451-2)

---> Many jurisdictional issues with crossing intersections, so be safe. ---> Police escorts can be dangerous as people may assume there is only one emergency vehicle - only use if you need a guide in an unfamiliar area

Special Considerations of Medevac

---> Mark landing site at night ---> Approach helicopter from downhill side ---> Consult with flight-crew for hazmat landings ---> Medevac issue - weather, environment/terrain, altitude, airspeed limitations, cabin size, and cost

Describe the specific, limited privileges that are provided to emergency vehicle operators by most state laws and regulations (1450)

---> Park or stand in an otherwise illegal location ---> Proceed through a red traffic light or stop sign, but never without stopping first ---> drive above the posted speed limit ---> drive agains the flow of traffic in a one-way street or make illegal turns ---> travel left of center to make an otherwise illegal pass (except for school busses with lights on)

Discuss the specific safety considerations required to ensure scene safety; include personal safety, patient safety and traffic control (1437-40)

---> Scene Safety, BSI, MOI/NOI, additional resources?, and the # of patients - park appropriately based on resources on scene - Traffic Control: 1. Warn other drivers to prevent secondary crashes 1. Maintain an orderly flow of traffic so injury care is not inerrupted - map out scene with hazard flags

Landing Zone Safety and Patient Transfer

---> The most important rule is to keep a safe distance from the aircraft whenever it is on the ground and "hot" (when the helicopter blades are spinning). ---> The rotor blades will usually remain running because the flight crew does not expect to remain on the ground for long. ---> All EMTs should stay outside the landing zone perimeter unless directed to come to the aircraft by the pilot or a member of the flight crew. ---> Usually, the flight crew will come to the EMTs carrying their own equipment and do not require any assistance inside the landing zone. ---> If you are asked to enter the landing zone, stay away from the tail rotor; the tips of its blades move so rapidly that they appear invisible. ---> With the possible exception of a rear-loading aircraft, always approach a helicopter from the front, even if it is not running, and approach only after the pilot signals it is clear to do so. ---> If you imagine the front of the helicopter as the number 12 on a clock, then you should enter only the area between the 10 o'clock and 2 o'clock positions. ---> If you must move from one side of the helicopter to another, go around the front. ---> Never duck under the body, the tail boom, or the rear section of the helicopter because the pilot cannot see you in these areas. ---> On many aircraft, the main rotor blade is flexible and may dip as low as 4 feet off the ground. ---> When you approach the aircraft, walk in a crouched position.Wind gusts can alter the blade height without warning, so protect your equipment as you carry it under the blades. Air turbulence created by the rotor blades can blow off hats and loose equipment. These objects can become a danger to the aircraft and personnel in the area. ---> When accompanying a flight crew member, follow directions exactly. Never open any aircraft door or move equipment unless instructed by a crew member. When told to approach the aircraft, use extreme caution and pay constant attention to hazards.

List the minimum dispatch information required by EMS to respond to an emergency call (1436)

---> The nature of the call ---> The name current location and call-back telephone number of the caller ---> The location of the patient or patients ---> The number of patients and some idea of the severity of their conditions ---> Any other special problems or pertinent information about the weather and or conditions

List the three factors that dictate the use of lights and siren to the scene and to the hospital; include the risk-versus-benefit factors regarding their use (1450-1)

---> The unit, to the best of your knowledge, must be responding to a true emergency ---> Audible and visual warned devices must be used simultaneously ---> The unit myst be operate with due regard of all others, on and off the roadway. ---> The benefit of speeding in non-emergency scenarios are outweighed by the cons, only consider use in true emergency situations where the patient can remain calm

When parking an ambulance...

---> always use the parking break ---> If you are a second responding vehicle, park 100 ft down form the scene; if you are the first responding vehicle park 100 feet upwind of the scene in the fend-off position

Components of an ambulance

---> driver's compartment ---> a patient compartment large enough to accommodate two EMTs, and at least one patient in the supine position ---> equipment and supplies to provide emergency care, safeguard personnel and patients from hazardous conditions, and to carry out light extrication procedures ---> two way radio communication ---> safe design and construction

Describe the key elements that must be included in the written PCR upon patient delivery to the hospital (1441)

---> summary of patient history with current illness or injury - pertinent positives and negatives - MOIs - arrival findings ---> vitals, pertinent past medical history and allergies/medications ---> documentation of treatments and responses

List the nine phases of an ambulance call; include examples of key tasks EMTs perform during each phase (1426-1443)

1. Preparation for the Call - check to make sure equipment is functional and the appropriate supplies are in the appropriate places 2. Dispatch - Process and comprehend the dispatch information 3. En Route - follow standard precautions - review appropriate route and go - inform dispatch you are responding - ask for additional information - brainstorm care 4. Arrival at the Scene - perform scene size-up 5. Transfer of the Patient to the Ambulance - package and secure the patient for transport. 6. En Route to the Receiving facility (Transport) - inform dispatch you are leaving, report the # of patients you have, the name of the receiving hospital, and in some jurisdictions, the beginning mileage of the ambulance - continue patient care 7. At the Receiving Facility (Delivery) - Report your arrival to the triage nurse or other arrival personnel - physically transfer the patient from the stretcher to the bed directed for your patient - present a complete verbal report at the bedside to the nurse or physician who is taking over the patient's care. - complete a detailed written report, obtain the required signatures, and leave a copy with an appropriate staff member. 8. En Route to the Station - inform dispatch when you leave. - @ the station clean and disinfect used equpiment - restock supplies 9. Post-Run - complete and file any additional reports - perform routine inspections - i.e strip linens, discard appropriate materials, wash contaminated areas with soap and water, clean the stretcher with bleach and water, and any other spillage with bleach and water.

CPR board

A device that provides a firm surface under the patient's torso.

Hydroplaning

A driving condition where the tires lose traction on a wet road, and float on a layer of water or slush.

spotter

A person who assists a driver in backing up an ambulance to compensate for blind spots at the back of the vehicle.

jump kit

A portable kit containing items that are used in the initial care of the patient.

ambulance

A specialized vehicle for treating and transporting sick and injured patients.

blind spots

Areas of the road that are blocked from your sight by your own vehicle or mirrors.

Discuss the importance of performing regular vehicle inspections; include the specific parts of an ambulance that should be inspected daily (1435)

Daily Inspection Items: ---> fuel and oil level ---> transmission fluid level ---> engine cooling system and fluid levels ---> batteris ---> brake fluids ---> 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 fluids ---> horn ---> siren ---> air conditioners and heaters ---> ventilating systems ---> doors (make sure they work) ---> communications systems, vehicle and portable ---> all windows, mirrors (cleanliness and position) ---> As well as all medical and trauma equipment

air ambulances

Fixed-wing and rotary-wing (known as helicopters) aircrafts that have been modified for medical care; used to evacuate and transport patients with life-threatening injuries to treatment facilities.

cushion of safety

Keeping a safe distance between your vehicle and any vehicles around you.

Size of Oxygen Tanks for Ambulances

On Ambulance: 3000 L Portable: 425 L, or 500 L

Name the safety and operations equipment carried on an ambulance; include examples of how each item might be used by EMTs in an emergency (1433-4)

PPE, Equipment for Work Areas, Preplanning/Navigation Guides, and Extrication equipment (pretty straightforward how each is used)

first-responder vehicles

Specialized vehicles used to transport EMS equipment and personnel to the scenes of medical emergencies.

Disinfection

The killing of pathogenic agents by direct application of chemicals.

High-level disinfection

The killing of pathogenic agents by using potent means of disinfection.

cleaning

The process of removing dirt, dust, blood, or other visible contaminants from a surface.

star of life

The six-pointed star emblem that identifies vehicles that meet federal specifications as licensed or certified ambulances.

Decontamination

To remove or neutralize radiation, chemical, or other hazardous material from clothing, equipment, vehicles, and personnel

Types of ambulances

Type 1: Cab + modular box comp. separate from front - modular ambulance can be transferred to a newer chassis as needed. Type 2: Van types Type 3: Like type one but altogether (conjoined mounting of compartments)

medevac

a helicopter for transporting wounded people

Sterilization

a process that destroys all microorganisms, including spores and viruses