Ch. 37- Transportation Operations

15. Explain the additional risks and special considerations posed by the use of police escorts, and the hazards and special considerations posed by crossing intersections. (pp 1375-1376)

police escorts are extremely dangerous. People might assume pd is only vehicle passing and not see ambulance. If you're being escorted, follow at a safe distance. Police escorts are only justified when you are in an unfamiliar area and truly need a guide. Intersection crashes are the most common. Be alert and careful when approaching intersection. Be aware of motorists who time the lights.

3. Demonstrate how to write a written report that includes all pertinent patient information following patient transfer to the hospital. (pp 1366-1367)

-Complete a detailed report, obtain the required signatures, and leave a copy with an appropriate staff member -complete PCR

6. the Transport phase

-Inform dispatch when you are ready to leave with the patient. -Recheck the patient's vital signs en route. -contact receiving facility -Inform online medical control about the patient(s) and the nature of the problem(s).

4. Demonstrate how to clean and disinfect the ambulance and equipment during the postrun phase. (pp 1367-1368)

-Immediately strip used linens from the stretcher after use and place them in a plastic bag or in the designated receptacle in the ED. -Discard in an appropriate receptacle all disposable equipment used for care of the patient that meets your state's definition of medical waste. -Discard disposable equipment that is bloody or contaminated by body fluids in an OSHA-approved biohazard container. -Discard noncontaminated disposable equipment used for care of the patient following OSHA and local guidelines. -Wash contaminated areas with soap and water. -For disinfection to be effective, cleaning must be done first. -Disinfect all nondisposable equipment used in the care of the patient. -Clean the stretcher with an EPA-registered germicidal/virucidal solution or bleach and water at 1:100 dilution. -Clean up any spillage or other contamination that occurred in the ambulance with the same germicidal/virucidal or bleach/water solution.

9. Summarize the tasks EMTs must complete in the postrun phase. (pp 1367-1368)

-Immediately strip used linens from the stretcher after use and place them in a plastic bag or in the designated receptacle in the ED. -Discard in an appropriate receptacle all disposable equipment used for care of the patient that meets your state's definition of medical waste. -Discard disposable equipment that is bloody or contaminated by body fluids in an OSHA-approved biohazard container. -Discard noncontaminated disposable equipment used for care of the patient following OSHA and local guidelines. -Wash contaminated areas with soap and water. -For disinfection to be effective, cleaning must be done first. -Disinfect all nondisposable equipment used in the care of the patient. -Clean the stretcher with an EPA-registered germicidal/virucidal solution or bleach and water at 1:100 dilution. -Clean up any spillage or other contamination that occurred in the ambulance with the same germicidal/virucidal or bleach/water solution.

5. The Transfer phase

-Package the patient for transport, securing him or her to a device such as a backboard, a scoop stretcher, or the wheeled ambulance stretcher. -Be sure to secure the patient with at least three straps across the body.

12. Identify key steps EMTs should take to improve safety while en route to the scene, the hospital, and the station. (pp 1368-1376)

-Whenever a motorist yields the right-of-way, the emergency vehicle operator should attempt to establish eye contact with the other driver. -Always drive defensively. Never rely on what another motorist will do unless you get a clear visual signal. -Be prepared to take defensive action in the case of a misunderstanding, panic, or careless driving on the part of the other driver. --there are 3 blindspots around the ambulance: the rearview mirror creates a blind spot --the rear of the vehicle cannot be seen fully --The side of the vehicle often cannot be seen through the side view mirrors at a certain angle. -scan mirrors frequently and adjust position in seat -don't tail people, and if someone is tailing you, slow down -

9. Postrun phase

-complete and file any additional reports -clean, disinfect, high-level disinfection, and sterilization -Have a written policy/procedure for cleaning each piece of equipment. Refer to the manufacturer's recommendations as a guide.

11. Discuss the guidelines for safely and defensively driving an ambulance. (pp 1368-1370)

-don't drive after drinking or taking meds that cause fatigue or drowsiness -emotional fitness -rule #1= speed does not save lives, good care does -rule #2 = seat belts for everyone -When driving an ambulance on a multilane highway, you should usually stay in the extreme left-hand (fast) lane. -when cornering, the safest way is to enter high and exit low

2. Demonstrate how to present a verbal report that would be given to receiving personnel at the hospital upon patient transfer. (pp 1366-1367)

-inform dispatch when you arrive at hospital -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.

7. the Delivery phase

-inform dispatch when you arrive at hospital -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 report, obtain the required signatures, and leave a copy with an appropriate staff member -complete PCR

8. En Route to the station

-once back at the station, clean and disinfect the ambulance and equipment -restock supplies

4. Arrival at the Scene

-scene size up -Do not enter the scene if there are any hazards. -Quickly estimate the number of patients and communicate with the incident commander. -determine where to park the ambulance -Pick a position that will allow for efficient traffic control and flow around a crash scene. -park in front or behind scene-- not alongside -Always leave on your warning lights or devices, and use extra caution if you must park on the backside of a hill or curve. -When parking at a scene at night, you should leave on warning lights but turn off your headlights.

1. List the nine phases of an ambulance call; include examples of key tasks EMTs perform during each phase. (pp 1353-1368)

1. preparation phase -You should place items needed to care for life-threatening conditions within easy reach, at the head of the primary stretcher. Place items for cardiac care, control of external bleeding, and monitoring blood pressure at the side of the stretcher. -store equipment and supplies according to priority and how often they are used -check batteries and equipment especially AED -Every ambulance must be staffed with at least one EMT in the patient compartment whenever a patient is being transported. -You and your team must inspect both the ambulance and equipment daily to ensure all items are in proper working order. -Check safety devices, such as seat belts (in the cab and patient compartment), to ensure they are in proper working order.

8. Describe the key elements that must be included in the written patient report upon patient delivery to the hospital. (pp 1366-1367)

The patient care report (PCR) should include: -A summary of the history of the patient's current illness or injury with pertinent positives and negatives, MOI, and findings on your arrival -Vital signs -Relevant past medical or surgical history -Information regarding medication and allergies -Any treatment and its effect during the prehospital setting

2. Name the medical equipment carried on an ambulance; include examples of supplies that are included in each main category of the ambulance equipment checklist. (pp 1354-1360)

Basic supplies: Stretcher items, bp cuffs, stethoscope, gloves, sharps container Airway and ventilation equipment: Infection control kits, OPA/NPA, BVMs, mounted suction, O supply, humidifier CPR equipment: Lucas device Basic Wound care: trauma shears, sterile burn sheets, adhesive tape, roller bandages, gauze pads, occlusive dressings, tourniquets Splinting supplies: Traction splints, variety of other splints, backboards, C collars Childbirth supplies: OB kit and its supplies AED: Semi automated defibrillation equipment Pt transfer equipment: Wheeled stretcher, stair chair, scoop stretcher, basket stretcher, flexible stretcher Meds: Activated charcoal, drinkable water/cups, oral glucose, O, Supplies for irrigating skin and eyes, aspirin, epinephrine Jump Kit: Basic supplies needed in first 5 minutes of reaching pt.

10. Define the terms cleaning, disinfection, high-level disinfection, and sterilization. (p 1367)

Cleaning is the process of removing dirt, dust, blood, or other visible contaminants from a surface or equipment. Disinfection is the killing of pathogenic agents by directly applying a chemical made for that purpose to a surface or equipment. High-level disinfection is the killing of pathogenic agents by the use of potent means of disinfection. Sterilization is a process, such as the use of heat, that removes all microbial contamination.

13. List the three factors that dictate the use of lights and siren to the scene and to the hospital; include the riskversus-benefit factors regarding their use. (pp 1370-1371)

Factors to consider in your siren risk-benefit analysis include: 1. local protocols -Some local protocols require that all responses to the scene use emergency lights and siren, whereas other systems incorporate response modes based on the information received from dispatch. 2. patient condition -Patients who have experienced a seizure may have another seizure as a result of the rapid flash pattern of the emergency lighting. 3. anticipated clinical outcome

17. Describe key scene safety considerations when preparing for a helicopter medivac, including establishing a landing zone, securing loose objects, reducing onsite hazards, and approaching the aircraft. (pp 1378-1381)

Hard or grassy level surface between 100'x100' area. Clear loose debris, alert flight crew of overhead or tall hazards, mark landing site using cones or vehicles. Keep safe distance from aircraft whenever it is on the ground and "hot." Stay away from tail rotor. Never approach from rear. Approach from the front Night landings: do not shine spotlights in the air. Direct low-intensity headlights to the ground. Illuminate overhead hazards or obstructions, if possible. Light up the poles, not the wires.

7. Discuss the specific considerations required to ensure scene safety; include personal safety, patient safety, and traffic control. (pp 1363-1366)

Look for safety hazards to yourself, partner, bystanders, pts. Evaluate need for additional units, other assistance. Determine MOI in trauma pts or NOI on medical calls. Evaluate need to immobilize the spine. Follow standard precautions. Park uphill and up wind. Have ff and PD block traffic if needed.

6. Describe some high-risk situations and hazards during both pretransport and transport that may affect the safety of the ambulance and its passengers. (pp 1363-1366, 1368-1376)

Most dangerous phase for EMS is en route. Collisions cause many serious injuries. Review dispatch info. Excessive speed to H is most often unnecessary. Defensive ambulance driving: speed does not save lives, wear seat belts, be familiar with how vehicle drives, stay in left-most lane on multilane highways.

3. Name the safety and operations equipment carried on an ambulance; include examples of how each item might be used by EMTs in an emergency. (pp 1360-1361)

PPE: face shields, gowns, turnout gear, safety shoes/boots Equipment for work areas: warning devices that flash/reflect, two high-intensity halogen 20,000 candlepower flashlights, fire extinguisher, hard hats/helmets, portable floodlights Preplanning/navigation supplies: GPS, detailed street and area maps Extrication equipment: wrench, screwdriver, hacksaw, pliers, hammer, fire ax, wrecking bar, crowbar, bolt cutters, ropes, knife, duct tape

4. Discuss the importance of performing regular vehicle inspections; include the specific parts of an ambulance that should be inspected daily. (pp 1361-1362)

PPE: face shields, gowns, turnout gear, safety shoes/boots Equipment for work areas: warning devices that flash/reflect, two high-intensity halogen 20,000 candlepower flashlights, fire extinguisher, hard hats/helmets, portable floodlights Preplanning/navigation supplies: GPS, detailed street and area maps Extrication equipment: wrench, screwdriver, hacksaw, pliers, hammer, fire ax, wrecking bar, crowbar, bolt cutters, ropes, knife, duct tape

14. Describe the specific, limited privileges that are provided to emergency vehicle operators by most state laws and regulations. (pp 1374-1376)

Using lights and sirens allows driver to park/stand in an illegal location, proceed through red light or stop sign, drive faster than speed limit, drive against flow of traffic, travel left of center to make illegal pass. *All with "due regard for safety"Still can't pass school bus stopped to un/load, exceed speed in school zone.

16. Describe the capabilities, protocols, and methods for accessing air ambulances. (pp 1376-1380)

Why call? -transport time by ground is too long -road, traffic, or environmental conditions prohibit use of ground transport -pt requires advance care -multiple pts will overwhelm resources at hospital reachable by ground transport.

Skills Objectives 1. Demonstrate how to perform a daily inspection of an ambulance. (pp 1361-1362)

check for the following: fuel level, oil level, transmission fluid levels, batteries, brake fluid, engine belts, wheels and tires, all interior and exterior lights, windshield wipers and fluids, horn, siren, air conditioners and heaters, ventilating system, doors, communication systems. windows and mirrors check all med equipment, oxygen supplies, jump kit, splints, dressings, etc...

5. List the minimum dispatch information required by EMS to respond to an emergency call. (p 1363)

dispatcher should gather at least: -nature of call -The name, present location, and call-back telephone number of the caller -The location of the patient(s) -The number of patients and some idea of the severity of their conditions -Any other special problems or pertinent information about hazards or weather conditions

2. Dispatch phase and 3. En route to scene

dispatcher should gather at least: -nature of call -The name, present location, and call-back telephone number of the caller -The location of the patient(s) -The number of patients and some idea of the severity of their conditions -Any other special problems or pertinent information about hazards or weather conditions -Assign specific initial duties and scene management tasks to each team member, and decide what type of equipment to take initially.