Ambulance Operations

Phases of a Call

• Preparation • Dispatch• En route• Arrival at Scene• Pt contact• Movement of pt to unit• En route to hospital• Arrive at hospital• Transfer of pt care• Clear/Return to service

Ambulance Type

• Type I• Box shaped passenger compartment• Mounted on truck style chassis

• Type II• Van style vehicle• Raised roof • Extended rear compartment

• Type III• Modular box like a Type I• Mounted on a van chassis

TYPE 1

TYPE 2

TYPE 3

Equipment

• Basic Medical Supplies• Pt transfer equipment• Airways• Suction equipment• Artificial Ventilation devices• Oxygen inhalation devices• Cardiac compression equipment• Basic wound care supplies• Splinting supplies• Childbirth supplies• Medications• AED

• Non-medical • Personal Safety Equipment• Street maps, etc

Daily Truck Inspection

• Fuel• Oil• Engine Cooling System• Battery• Brakes• Wheels/tires• Headlights• Stoplights• Turn signals• Emergency lights• Wipers• Horn• Siren• Doors closing/latching• Communication systems• AC/Heat• Ventilation system• Seat belts• Equipment

• Checked/maintained• Restocked/repaired• Batteries for –AED –Suction – O2, etc

Dispatch Centers

• Central Access• Coordinates numerous EMS units in a region

• Enhanced 911• Automatically identifies a callers location

• Emergency Medical dispatch• National method of training for dispatchers• Triage and provide basic 1st aid instruction

• Typical information collected• Nature of call• Name• Location• Name• Location• # of pts• Severity of injury • Call back number• Other special problems

ConsiderationsEn Route

• Considerations• Seat belts• Notify dispatch• Obtain additional info from

dispatch• Assign personnel specific

duties• Assess specific

equipment needs

• Essential info• Nature of call• Location of call

Ambulance OperationsVehicle Operations

• EVOC• Emergency Vehicle Operation Course

• Characteristic of ambulance operator• Physically fit• Mentally fit• Able to perform under stress• Tolerant of other drivers

• Safe driving• Driver/passengers ware seat belts• Become familiar with your ambulance• Alert to weather/road conditions• Caution in use of emergency lights/siren

• LIGHTS/SIRENS DO NOT RELIEVE THE DRIVER FROM LIABILITY IN A CRASH

• Select appropriate route• Maintain safe following distance• DUE REGARD TO SAFETY OF OTHERS• Know appropriateness of lights/siren use

• Increased speed = decrease time to hear siren• Siren @ 60mph barely precedes ambulance

• Headlights are most visible part on an ambulance

Vehicle OperationsMultiple Units, Crashes

• Escorts/Multiple Vehicle Responses

• Extremely dangerous• Use only if unfamiliar:

• Location of pt• Location of receiving facility

• No vehicle should use lights/siren

• Safe following distance• Recognize hazards

• Intersection Crashes• Motorists at intersections as light

changes DON’T STOP• Motorists expect 1 ambulance

not multiple vehicle responses • Vision is obstructed by vehicles

Vehicle Positioning

• For Safety• Uphill from leaking hazards• 100 ft from wreckage

• In front of wreckage, OR• Beyond the wreckage

• Set parking break• Use warning lights• Shut off headlights (unless

illumination is needed)

• Exiting scene• Avoid parking in locations that

will hamper leaving scene

Arrival at Scene

• Notify dispatch• Size-up

• BSI• Scene safety

• -Parked in safe location – Immediate pt removal – Safety

• MOI• Medical Pt

• MCI• # of pt• Obtain additional help• Begin triage

• C-spine stabilization if needed• Trauma Pt

• MCI• # of pt• Obtain additional help• Begin triage

• C-spine stabilization if needed• Total # of pt• Need for additional help

Transfer to Unit

• Action at scene• Organized• Rapid/efficient• Goal of transport in mind

• “Platinum 10 minutes”

• Transfer of pt to unit• Preparing pt for transport

• Completion of critical interventions

• Check dressings/splints• Pt covered and secured to

moving device• Refer to lifting/immobilization

presentation

En Route and Arrival at Hospital

• En route to hospital• Notify dispatch• On going assessment• Additional vitals assessed• Notify receiving facility• Reassure pt• Complete PPRC

• Arrival at hospital• Notify dispatch• Transfer pt • Lift/move as previous

presentation• Reports

• Verbal report at bedside• Complete PPCR and leave

copy

Clear/Return to Service

• En route to station• Notify dispatch• Prepare for next call

• Clean/disinfect unit• Clean/disinfect equipment• Restock disposable items

• Post Run• Refuel unit• File reports• Complete cleaning/disinfecting

• 1:100 bleach:water solution if commercial cleaner is not available

Air Medical Considerations

• Landing Zone (LZ)• At least 100ft X 100 ft• Relatively flat ground

• No greater than 10 degrees• Clear of debris

• Trash• Rocks• Sand

• No major vertical structures• Trees• Buildings• Telephone poles• Towers

• As close as possible to scene of call

• Approach• Assume crouching position• NEVER approach from behind

• Pilot blind spot