ambulance operations
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Chapter 31. Ambulance Operations. Case History. You arrive at your assigned work location at the start of your tour of duty and begin an inspection of equipment, including communications, airway and ventilation, splinting, spinal immobilization, AED, and transport devices. - PowerPoint PPT PresentationTRANSCRIPT
Slide 1Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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.
Slide 3Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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