rpi ambulance attendant class last updated by m. o’donnell, 10/2011

RPI AMBULANCE

ATTENDANT CLASS

Last Updated by M. O’Donnell, 10/2011

Attendant Class

• Module I: Introduction to RPI Ambulance• Module II: RPI Ambulance and the Law• Module III: Safety• Module IV: Radio Communications• Module V: Lifting and Moving• Module VI: Vital Signs & Diagnostic Equipment• Module VII: Airway• Module VIII: Breathing• Module IX: Circulation• Module X: Splinting and Spinal Immobilization

Class Topics

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Module I:

Introduction to RPI Ambulance

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RPI AmbulanceAttendant Class

Introduction to RPI Ambulance

• Service: Volunteer, Student Run

• Level of Care: Basic Life Support (BLS)

• Office: 92 College Avenue

• Garage: Behind the Armory

• Service Period: In service 24/7 during the Fall and Spring Semesters

• Call Volume: ~150 per year

• Primary Coverage Area: RPI Troy campus

• Secondary Coverage Area: Troy, Brunswick, North Greenbush, etc.

• Special Events: Stand-bys for Hockey, Football, Commencement, etc.

Agency Information

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Introduction to RPI Ambulance

• Standard Operating Procedures – Agency Document

• RPIA Constitution– Union Document

• New York State Department of Health– Part 800, Minimum Requirements for an Ambulance

– Part 18, Requirements for large events

• Documents can be found online at www.ambulance.union.rpi.edu

Rules and Regulations

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Introduction to RPI Ambulance

• Crew Chief

• Driver

• Attendant

• Observer

Crew Positions

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Introduction to RPI Ambulance

A. Hold a Professional Rescuer CPR certification.B. Take the Attendant class (recommended).C. Complete the Attendant checklist.D. Complete and submit a copy of a Rig Check.E. Complete one real or two simulated calls, and take vitals and

submit an attendant evaluation.F. Request and receive approval by the Training Committee to be

promoted to Attendant.

Attendant Training Requirements

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Introduction to RPI Ambulance

• Sign up on the website for:– Night Crew– Stand-bys (Hockey, Football, etc.)– Training Drills, Meetings, Banquets, etc.

• Signing up:– Go to the Scheduling page on the website:

http://ambulance.union.rpi.edu/scheduling/index.php– Click “Login”, and enter your username and password.– Go to the Night Crews or Games and Events schedule, and click “Sign

up”, and “Confirm”.– You’ll get an email confirming that you are signed up.

Scheduling Website

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Introduction to RPI Ambulance

• Events:– Hockey– Commencement– Concerts

• Personnel:– Field Crews, EES

Field House and ECAV Operations

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• Locations:– HFH PCF– ECAV EMS Room

• Sign up on website, report to appropriate PCF or the garage 15 minutes prior to start time

Introduction to RPI Ambulance

• Always maintain a professional attitude and appearance– You represent RPI Ambulance and

RPI.– Assures the patient they are in

competent hands

• Don’t dress or act in a manner unbecoming a member of the agency

Professionalism

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Module II:

RPI Ambulance and The Law

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RPI Ambulance And The Law

• State Emergency Medical Services Code (Part 800) Defines:

– General Emergency Medical Services rules

– Certification of EMS personnel

– Certification of EMS agencies

– Requirements for equipment and ambulances

– Pre-hospital DNR orders

NYS Department of Health

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RPI Ambulance And The Law

• Patient’s medical and personal information is private– Name, address, medical conditions, condition, treatment etc.

• State and federal laws forbid disclosure of patient information– NYS Part 800.15, Health Insurance Portability and Accountability Act

(HIPAA)

• Only those who “Need to Know” may have access to patient information– Doctors, nurses, crew members in charge of caring for patient– Your friends, bystanders, Public Safety, the public DO NOT need to know

• When in doubt, ask your crew chief. Do not share information!

Patient Confidentiality

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Module III:

Safety

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Safety

• Crew safety is the primary concern during all operations. You can not help the patient, if something happens to you.

• Unsafe scenes:– Substance abusers– Assaults, weapons on scene– Hazmat incidents– MVAs– Emotionally disturbed persons, attempted suicide.– Fires, collapses, animal bites, CO poisoning.

• Do not enter a scene that is not safe. Wait for fire, rescue or law enforcement personnel to secure the scene.

Scene Safety

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Safety

• If its wet and sticky and not yours, don’t touch it. If you have to, wear gloves!

• Gloves are worn during every patient contact.

• Other PPE includes:– N95 respirator masks– Goggles– Gowns

• The best way to prevent infection is to wash your hands!

• If you come into contact with someone else’s bodily fluids, tell the crew chief!

Infection Control

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Module IV:

Radio Communications

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Radio Communications

• Frequency: 155.200 MHz

• Use of RPIA Radios:– Receiving tones and dispatches from Rensselaer

County Emergency Communications Center (ECC)– Amassing a crew for day calls– Tactical Communications during stand-bys (hockey

games, etc.)

• Crew Chiefs, Drivers, and actively training attendants carry portable radios

RPIA Portable Radios

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Radio Communications

• Frequency: 46.04 MHz

• Uses of County Radios:– Communicating with Rensselaer County ECC

(dispatcher).– NYS Interagency and Mass Casualty Incident

channel.– Used by crew chiefs and drivers.

• Three Portables, – Duty Supervisor, Office, Rig

• One Mobile Unit in the Ambulance

The “800” System

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Radio Communications

• Call Signs– Ambulance is A-39 internally, 5939 to the county– Members are assigned “900” Numbers– Line Officers have Car Numbers (Car 1, etc.)

• Communicating on the Radio– State who you are speaking to, then you.

• “Car 1, this is 944.” – Always be professional; never know who is listening.

• Public Safety, County, General Public

Communication Guidelines

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Radio Communications

• RPI Ambulance is dispatched on Channel 1 on RPI Ambulance’s Radios:

– Dispatcher: “Stand By RPI Ambulance”– Tones– Dispatcher: “RPI Ambulance for a <determinant>

determinant EMS call for <Demographics> <Chief Complaint> at <Location>”

• Example: “ RPI Ambulance. Delta determinant EMS call for a seizure, RPI Crockett Hall, 72 Griswold Road. Cross Streets are Sage Ave and Bouton Road.”

The Dispatch

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Determinants – Alpha: BLS Priority II

• Non-Emergency

– Bravo: BLS Priority I• Emergency, Not Imminently life threatening

– Charlie: ALS & BLS Priority I• Emergency, Possibly life threatening

– Delta: ALS & BLS Priority I• Emergency, Actively life threatening

– Echo: ALS & BLS Priority I (anyone with an AED)• Cardiac or Respiratory Arrest/ Unknown life status

Dispatch Determinants

Radio Communications

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Charlie Chespans

• During the call, the following radio transmissions are made to dispatch over the 800 by the driver:– Confirm crew / en route to the scene– Arriving on scene– En route to the hospital– Arriving at the hospital– Back in service– Back in quarters

• The receiving facility will be notified of patient information and arrival time over the BLS channel (a “med patch”) by the crew chief.

Call Communications

Radio Communications

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Module V:

Lifting and Moving

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• Proper lifting technique:– Lift with your legs,

not your back!– Bend at the knees.– Keep your back straight

and shoulders square.– Do not twist or bend your

back. If you need to turn, use your whole body.

• If a patient is too large for your crew to safely move:– Re-dispatch for additional crew members.– Request Troy Fire Department for a lift assist.

Proper Lifting Technique

Lifting and Moving

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Stretcher

Lifting and Moving

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• Indications: General EMS calls

• Considerations: A backboard is needed in addition for a suspected spinal injury.

• Example: Patient with abdominal pain

Stair Chair

Lifting and Moving

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• Indications: Conscious patient who can’t walk, found upstairs or in areas where the stretcher will not fit.

• Contraindications: Suspected neck or back injury, unconsciousness.

• Example: Conscious patient on a second floor without an elevator, with shortness of breath

Backboard

Lifting and Moving

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• Indications: Suspected neck or back injury, CPR. Can also be used to move patients.

• Contraindications: None

• Examples: Patient who fell from a 20’ ladder. Spear tackle during a rugby game.

Other Moving Devices

Lifting and Moving

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• Reeves – Patient who is upstairs or in a small area who cannot sit up

• Orthopedic Stretcher (Scoop) – Pelvic fracture or hip dislocation

• KED – Immobilization of a seated patient with a neck or back injury

Module VI:

Vital Signs and Diagnostic Equipment

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Overview of Vital Signs

Vital Signs and Diagnostic Equipment

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• A full set of Vitals consists of:– Heart Rate– Respiratory Rate– Blood Pressure

• Additional diagnostic measurements:– Skin color and condition– Pupil size and reactivity– Lung sounds– Pulse oximetry– Temperature– Glucometry

Heart/Pulse Rate

Vital Signs and Diagnostic Equipment

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• Measure by palpation at the radial artery.

• Report the Rate and Quality:– Rate: Beats per minute– Strength: Strong or Thready (weak)– Regularity: Regular or Irregular

• Normal range: 60-100 beats per minute• Dangerous range: Less than 60 or greater

than 120 (sustained)

Respiratory Rate

Vital Signs and Diagnostic Equipment

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• Watch patient’s chest rise and fall.

• Report the Rate and Quality:– Rate: Breaths per minute– Depth: Normal, Shallow or Deep– Regularity: Regular or Irregular

• Normal range: 12-20 respirations per minute• Dangerous range: Less than 8 or greater

than 24

Blood Pressure

Vital Signs and Diagnostic Equipment

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• Measure with a sphygmomanometer (BP Cuff) and stethoscope.

• Two pieces of information:– Systolic BP: Pressure when the heart

is contracting, pumping blood.– Diastolic BP: Pressure when the heart

is relaxed

• Normal range:– Systolic: 100 – 140 mmHg– Diastolic: 60 – 90 mmHg

• Dangerous range:– Systolic: Less than 90 or greater than 180 mmHg– Diastolic: Less than 50 or greater than 100 mmHg

Skin Color and Condition

Vital Signs and Diagnostic Equipment

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• Observe:– Color: Normal, Flushed, Pale, Cyanotic (blue), Mottled (grey), Jaundiced

(yellow).– Condition: Warm, Dry, Cool, Diaphoretic (sweaty).

Pupil Size and Reactivity

Vital Signs and Diagnostic Equipment

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• Observe both pupils and report the:– Shape: Round or Oblong (oval)– Size: Pinpoint, Constricted, Dilated, Blown.– Reaction to light: Pupils should constrict, but may be unreactive.

• PEARRL: Pupils Equal And Round, Reactive to Light.

Pulse-Oximeter

Vital Signs and Diagnostic Equipment

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• Function:– Checks oxygenation of the patients blood– Checks the pulse rate of the patient

• Use:– Place on patient’s finger– Remove any nail polish

• Oxygenation:– 97-99%- Normal– 94-96%- Mild Hypoxia– 91-93%- Moderate Hypoxia

Glucometer

Vital Signs and Diagnostic Equipment

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• Function– Checks level of glucose in patient’s blood– Normal range is 80-120 ml/dl

• Indications– Altered mental status, diabetic issues

• Contraindications– Bleeding/Clotting disorders

• Note:– Used only by the Crew Chief, a special in-

service training is required for EMTs

Module VII:

Airway

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Manual Airway Maneuvers

Airway

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• It is vital to maintain an open airway!

• Head Tilt–Chin Lift:– Indications: Unconscious / unresponsive– Contraindications: Suspected neck or

back injury

• Jaw Thrust:– Indications: Unconscious / unresponsive

with suspected neck or back trauma– Contraindications: None

Airway Adjuncts

Airway

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• Used to keep the airway open.

• Oropharyngeal Airway (OPA):– Indications:

Unconscious / unresponsive– Contraindications:

Gag reflex present

• Nasopharyngeal Airway (NPA):– Indications:

Suspected loss of airway control, OPA not tolerated

– Contraindications: Facial trauma

Airway Suction

Airway

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• Types of suction units:– Ambulance– Portable– Handheld

• Types of Catheters:– Yankaeur (Hard Tip)– French (Soft Tip)

• Suction for no more than 15 seconds!

Module VIII:

Breathing

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Oxygen Tanks

Breathing

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• Medical Oxygen Tanks Are Green • Oxygen Tanks have the following Components

– Tank– O-Ring– Regulator

• Sizes– D, Portable (In the jump bag)– E, Portable (In the rig)– M, On-board Oxygen

• Before Using, Check– Stat Date– Pressure in the tank– Flow Regulator Seal

Non-Rebreather (NRB)

Breathing

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• Indications: Sick or injured patients requiring high-flow oxygen

• Contraindications: Respiratory arrest

• Use with an oxygen flow rate of 10-15 LPM.

Nasal Cannula (NC)

Breathing

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• Indications: Sick or injured patients who do not require high-flow oxygen, or cannot tolerate a NRB

• Contraindications: Respiratory arrest, significant respiratory distress.

• Use with an oxygen flow rate of 4-6 LPM.

Bag Valve Mask (BVM)

Breathing

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• Indications: A patient who is having difficulty maintaining adequate ventilations on their own.

• Contraindications: None

• Rate:– Adults: 12-20 / min– Children: 20 / min– Infants: 20 / min

• Use with supplemental oxygen, 15-25 LPM.

Module IX:

Circulation

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Bleeding Control

Circulation

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• 3 Types of Bleeding:– Capillary: Blood is dark red, and oozes.– Venous: Blood is dark red, and flows steadily.– Arterial: Blood is bright red, and spurts.

• Bleeding Control:

1. Direct Pressure

2. Elevation

3. Pressure Dressing

4. Direct Pressure

5. Pressure Point

6. Tourniquet

Hypoperfusion (Shock)

Circulation

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• Hypoperfusion:– the inadequate supply of oxygen and nutrients to the tissues of the body due

to pathophysiological processes.

• Signs of Hypoperfusion:– Hypotension (low blood pressure)– Tachycardia (rapid pulse)– Tachypnea (rapid breathing)

Hypoperfusion (Shock)

Circulation

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• Treatment of hypoperfusion:– Maintain airway and support patient’s breathing– Control serious bleeding.– Position the patient with their feet elevated (Trendelenburg Position). – Keep the patient warm.– Transport rapidly.

Module X:

Splinting and Spinal Immobilization

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Splinting

Splinting and Spinal Immobilization

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• Function– Splints are used to immobilize and protect an injured

body part.• Types

– Board splints, “Frac-Pak”, Traction splints• General guidelines for use:

– Begin by checking CSM x4.– Hold the extremity above and below the injury.– Gently align the injured extremity, and place it in the

splint. – Make sure that the extremity is immobilized above

and below the site of the injury.

Spinal Immobilization

Splinting and Spinal Immobilization

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• Equipment– Backboard: A long, rigid board used to

immobilize a patient– Cervical Collar: A stiff neck brace used to

immobilize the seven cervical vertebrae– Kendrick Extrication Device (KED): Vest

type immobilization device for seated patients.

• Indications for spinal immobilization:– Head, neck or spine pain, altered mental status

or spinal deformity, that is associated with a traumatic injury.

– Significant mechanism of injury

Kendrick Extrication Device

Splinting and Spinal Immobilization

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• Kendrick Extrication Device (K.E.D.):– Used to immobilize a seated,

non-critical patient.– Check CSM x4 before and after

application.– Requires supplemental use

of a cervical collar.– The patient must still be

placed on a backboard.

Questions?

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