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Ambulance OperationsAmbulance OperationsChapter 31Chapter 31

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Case HistoryCase History

You arrive at your assigned work location at the start You arrive at your assigned work location at the start of your tour of duty and begin an inspection of of your tour of duty and begin an inspection of equipment, including communications, airway and equipment, including communications, airway and ventilation, splinting, spinal immobilization, AED, and ventilation, splinting, spinal immobilization, AED, and transport devices.transport devices.

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Phases of an Ambulance CallPhases of an Ambulance Call

Preparation for the callPreparation for the call DispatchDispatch En routeEn route Arrival at the sceneArrival at the scene Transferring the patient to the ambulanceTransferring the patient to the ambulance En route to the receiving facilityEn route to the receiving facility At receiving facilityAt receiving facility In service and postrun issuesIn service and postrun issues

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Preparation for a CallPreparation for a Call

Preparation is essential to ensurePreparation is essential to ensure Adequate equipmentAdequate equipment Readiness of the vehicleReadiness of the vehicle Readiness of communication equipmentReadiness of communication equipment

Check vehicle and equipment using checklists.Check vehicle and equipment using checklists.

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Medical EquipmentMedical Equipment

Artificial ventilation devicesArtificial ventilation devices

Oxygen inhalation equipmentOxygen inhalation equipment

Cardiac compression equipmentCardiac compression equipment

Basic wound care suppliesBasic wound care supplies

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Medical EquipmentMedical Equipment

Basic suppliesBasic supplies

Patient transfer equipmentPatient transfer equipment

AirwaysAirways

Suction equipmentSuction equipment

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Medical EquipmentMedical Equipment

Splinting suppliesSplinting supplies

Childbirth suppliesChildbirth supplies

MedicationsMedications

AEDAED

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Nonmedical EquipmentNonmedical Equipment

Personal safety equipmentPersonal safety equipment Per local, state, and federal Per local, state, and federal

standardsstandards

Preplanned routesPreplanned routes

Comprehensive street mapsComprehensive street maps

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PersonnelPersonnel

Available for responseAvailable for response

At least one EMT-Basic in patient At least one EMT-Basic in patient compartmentcompartment

Minimum staffing for an ambulanceMinimum staffing for an ambulance

Two EMT-Basics are preferred.Two EMT-Basics are preferred.

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Type I AmbulanceType I Ambulance

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Type II AmbulanceType II Ambulance

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Type III AmbulanceType III Ambulance

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Daily InspectionDaily Inspection

Engine checkEngine check

Outside inspectionOutside inspection

Cab inspectionCab inspection

Patient compartmentPatient compartment

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Daily InspectionDaily Inspection

Ventilation, airway, and oxygen equipmentVentilation, airway, and oxygen equipment Bandage and sterile suppliesBandage and sterile supplies Stretchers and immobilization equipmentStretchers and immobilization equipment Safety equipmentSafety equipment Other equipmentOther equipment

DiagnosticDiagnostic PASGPASG Specialized equipmentSpecialized equipment

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DispatchDispatch

Dispatch modelsDispatch models Direct dispatch from quartersDirect dispatch from quarters Central access dispatchCentral access dispatch

Enhanced 911Enhanced 911

Ambulance to hospital dispatchAmbulance to hospital dispatch

Emergency medical dispatchEmergency medical dispatch Professionally trained dispatchersProfessionally trained dispatchers Provide triage and categorizationProvide triage and categorization Telephone-directed first aid instructionsTelephone-directed first aid instructions

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Information Collected Information Collected at Dispatch Centerat Dispatch Center

Nature of callNature of call

Name, location, and call-back numberName, location, and call-back number

Location of the patientLocation of the patient

Number of patientsNumber of patients

Special problemsSpecial problems HazardsHazards Access problemsAccess problems

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En Route to the CallEn Route to the Call

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Arch of Driver SafetyArch of Driver Safety

Physical fitnessPhysical fitness

Mental awarenessMental awareness

Ability to perform under stressAbility to perform under stress

Positive attitude about abilitiesPositive attitude about abilities

Tolerance of other driversTolerance of other drivers

Knowledge of handling characteristics of vehicleKnowledge of handling characteristics of vehicle

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Safe DrivingSafe Driving Important phase in the emergency medical care of the ill or Important phase in the emergency medical care of the ill or

injured patientinjured patient

The driver and all passengers should wear safety belts.The driver and all passengers should wear safety belts.

Become familiar with the characteristics of your vehicle.Become familiar with the characteristics of your vehicle.

Be alert to changes in weather and road conditions.Be alert to changes in weather and road conditions.

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Safe DrivingSafe Driving Exercise caution in use of red lights and siren.Exercise caution in use of red lights and siren.

Know appropriate use.Know appropriate use.

Headlights are the most visible warning device on an Headlights are the most visible warning device on an emergency vehicle.emergency vehicle.

Select appropriate route.Select appropriate route.

Maintain safe following distance.Maintain safe following distance.

Drive with due regard for safety of all others.Drive with due regard for safety of all others.

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Factors Affecting Directional Factors Affecting Directional ControlControl

Mechanical condition of the vehicleMechanical condition of the vehicle

Road conditionsRoad conditions

Physical condition of the driverPhysical condition of the driver

Driver’s hand positionsDriver’s hand positions Drive with two hands on the wheelDrive with two hands on the wheel Radio and siren operation should be done by second EMTRadio and siren operation should be done by second EMT Use 9-o’clock and 3-o’clock hand positionsUse 9-o’clock and 3-o’clock hand positions Ambulance is more difficult to control than a car.Ambulance is more difficult to control than a car.

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Factors Affecting Speed ControlFactors Affecting Speed Control

Modern ambulances — weight four times more than Modern ambulances — weight four times more than passenger vehiclespassenger vehicles Average type III ambulance weight 10,450 pounds without Average type III ambulance weight 10,450 pounds without

patient and crewpatient and crew

Considerably different handling characteristicsConsiderably different handling characteristics

Longer stopping distancesLonger stopping distances

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SeatbeltsSeatbelts

Simplest device to help maintain control of Simplest device to help maintain control of vehiclevehicle Keep operators inside the vehicle.Keep operators inside the vehicle. Keep operators in position to control vehicle.Keep operators in position to control vehicle.

Seatbelts have limited likelihood of causing Seatbelts have limited likelihood of causing injury.injury. Only 1 of every 200 people is injured by Only 1 of every 200 people is injured by

seatbelts when worn correctly.seatbelts when worn correctly.

All occupants of the ambulance should wear All occupants of the ambulance should wear seatbelts.seatbelts.

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Laws, Regulations, and Laws, Regulations, and Ordinances – State and Local Ordinances – State and Local

Vehicle parking or standingVehicle parking or standing

Procedures at red lights, stop signs, and intersectionsProcedures at red lights, stop signs, and intersections

Regulations regarding speed limitsRegulations regarding speed limits

Direction of flow or specified turnsDirection of flow or specified turns

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Laws, Regulations, and Laws, Regulations, and Ordinances – State and Local Ordinances – State and Local

Emergency or disaster routesEmergency or disaster routes

Use of audible warning devicesUse of audible warning devices

Use of visual warning devicesUse of visual warning devices

School busesSchool buses

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Laws, Regulations, and Laws, Regulations, and Ordinances – State and Local Ordinances – State and Local

Escorts and multiple-vehicle responseEscorts and multiple-vehicle response Extremely dangerousExtremely dangerous Used only if unfamiliar with location of patient or Used only if unfamiliar with location of patient or

receiving facilityreceiving facility No vehicle should use lights or siren.No vehicle should use lights or siren. Provide a safe following distance.Provide a safe following distance. Recognize hazards of multiple-vehicle response.Recognize hazards of multiple-vehicle response.

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Siren Decibels by LocationSiren Decibels by Location

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Proper Hand SignalsProper Hand Signals

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Proper Hand SignalsProper Hand Signals

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Proper Hand SignalsProper Hand Signals

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En Route to the CallEn Route to the Call

Obtain additional information from dispatch.Obtain additional information from dispatch.

Assign personnel to specific duties.Assign personnel to specific duties.

Assess specific equipment needs.Assess specific equipment needs.

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Arrival at SceneArrival at Scene

Notify dispatch.Notify dispatch.

Size up the scene.Size up the scene. Body substance isolation should be a consideration before Body substance isolation should be a consideration before

patient contact.patient contact.• Use gloves, gowns, and eyewear when appropriate.Use gloves, gowns, and eyewear when appropriate.

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Scene SafetyScene Safety

Assess the scene for hazards.Assess the scene for hazards.

Is the emergency vehicle parked in a safe location?Is the emergency vehicle parked in a safe location?

Is it safe to approach the patient?Is it safe to approach the patient?

Does the victim require immediate movement Does the victim require immediate movement because of hazards?because of hazards?

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Transferring the Patient Transferring the Patient to the Ambulanceto the Ambulance

Patient should be prepared in a timely manner.Patient should be prepared in a timely manner.

Critical interventions should be completed.Critical interventions should be completed.

Dressings and splints should be checked.Dressings and splints should be checked.

Patient should be covered according to environmental conditions.Patient should be covered according to environmental conditions.

Patient should be securely attached to a transfer device.Patient should be securely attached to a transfer device. Transfer device should be selected on the basis of patient position, Transfer device should be selected on the basis of patient position,

immobilization, and type of terrain.immobilization, and type of terrain.

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En Route to Receiving FacilityEn Route to Receiving Facility Notify dispatch.Notify dispatch.

Ongoing assessment should be continued.Ongoing assessment should be continued.

Obtain serial vital signs.Obtain serial vital signs.

Notify receiving facility.Notify receiving facility.

Reassure patient.Reassure patient.

Complete prehospital care reports.Complete prehospital care reports.

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Returning to ServiceReturning to Service

At station or receiving facility, notify dispatch.At station or receiving facility, notify dispatch.

Prepare for the next call.Prepare for the next call.

Clean and disinfect the ambulance and equipment, Clean and disinfect the ambulance and equipment, as needed.as needed.

Restock the disposable supplies.Restock the disposable supplies.

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After RunAfter Run

Refuel unit.Refuel unit.

File reports.File reports.

Complete cleaning and disinfection procedures.Complete cleaning and disinfection procedures.

Notify dispatch.Notify dispatch.

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Aeromedical ConsiderationsAeromedical Considerations

Modern helicopters are equipped with ALS Modern helicopters are equipped with ALS capabilities.capabilities.

Primary benefit is decreasing time from injury to Primary benefit is decreasing time from injury to arrival at definitive care.arrival at definitive care.

EMS providers are encouraged to call for a helicopter EMS providers are encouraged to call for a helicopter in some systems.in some systems.

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Decision to Call HelicopterDecision to Call Helicopter

Proximity to hospitalProximity to hospital

Nature of terrainNature of terrain

Location of the patientLocation of the patient

Estimated extrication timeEstimated extrication time

Clinical status of the patientClinical status of the patient

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Decision to Call HelicopterDecision to Call Helicopter How long will ground transport take?How long will ground transport take?

What will be the expected time of arrival of the helicopter?What will be the expected time of arrival of the helicopter?

Can helicopter land at site?Can helicopter land at site?

Will transport to additional site be needed to meet helicopter?Will transport to additional site be needed to meet helicopter?

Warm up time for helicopter before responseWarm up time for helicopter before response

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Locating Landing ZoneLocating Landing Zone Larger than 100 feet Larger than 100 feet 100 feet 100 feet

Relatively flat groundRelatively flat ground No greater than 10 degrees slopeNo greater than 10 degrees slope

Clear of debrisClear of debris

No major vertical structures impeding landingNo major vertical structures impeding landing Telephone polesTelephone poles TowersTowers Tall grassesTall grasses Tall treesTall trees

As close to the scene as possibleAs close to the scene as possible

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Landing Zone Hand SignalsLanding Zone Hand Signals

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Safety Around HelicopterSafety Around Helicopter

Rotor wash can spray bystanders with debris.Rotor wash can spray bystanders with debris.

Bystanders may be struck by rotor.Bystanders may be struck by rotor. Never approach from the rear.Never approach from the rear. Take directions from pilot from the front.Take directions from pilot from the front. If helicopter is on slope, never approach from uphill side.If helicopter is on slope, never approach from uphill side. Assume a crouching position when approaching helicopter.Assume a crouching position when approaching helicopter.

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Safety Around HelicopterSafety Around Helicopter