Transcript Chapter_031 621KB Jan 14 2015 08:21:50 AM

Chapter 31
Ambulance Operations
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 1
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.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 2
Phases of an Ambulance Call
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Preparation for the call
Dispatch
En route
Arrival at the scene
Transferring the patient to the ambulance
En route to the receiving facility
At receiving facility
In service and postrun issues
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 3
Preparation for a Call
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Preparation is essential to ensure
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Adequate equipment
Readiness of the vehicle
Readiness of communication equipment
Check vehicle and equipment using checklists.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 4
Medical Equipment
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Artificial ventilation devices
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Oxygen inhalation equipment
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Cardiac compression equipment
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Basic wound care supplies
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 5
Medical Equipment
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Basic supplies
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Patient transfer equipment
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Airways
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Suction equipment
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 6
Medical Equipment
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Splinting supplies
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Childbirth supplies
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Medications
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AED
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 7
Nonmedical Equipment
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Personal safety equipment
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Per local, state, and federal
standards
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Preplanned routes
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Comprehensive street maps
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 8
Personnel
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Available for response
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At least one EMT-Basic in patient
compartment
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Minimum staffing for an ambulance
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Two EMT-Basics are preferred.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 9
Type I Ambulance
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Type II Ambulance
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Type III Ambulance
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Daily Inspection
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Engine check
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Outside inspection
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Cab inspection
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Patient compartment
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 13
Daily Inspection
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Ventilation, airway, and oxygen equipment
Bandage and sterile supplies
Stretchers and immobilization equipment
Safety equipment
Other equipment
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Diagnostic
PASG
Specialized equipment
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Dispatch
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Dispatch models
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Direct dispatch from quarters
 Central access dispatch
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Enhanced 911
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Ambulance to hospital dispatch
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Emergency medical dispatch
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Professionally trained dispatchers
 Provide triage and categorization
 Telephone-directed first aid instructions
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 15
Information Collected
at Dispatch Center
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Nature of call
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Name, location, and call-back number
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Location of the patient
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Number of patients
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Special problems
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Hazards
 Access problems
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 16
En Route to the Call
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Arch of Driver Safety
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Physical fitness
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Mental awareness
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Ability to perform under stress
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Positive attitude about abilities
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Tolerance of other drivers
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Knowledge of handling characteristics of vehicle
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 18
Safe Driving
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Important phase in the emergency medical care of the ill or
injured patient
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The driver and all passengers should wear safety belts.
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Become familiar with the characteristics of your vehicle.
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Be alert to changes in weather and road conditions.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 19
Safe Driving
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Exercise caution in use of red lights and siren.
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Know appropriate use.
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Headlights are the most visible warning device on an
emergency vehicle.
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Select appropriate route.
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Maintain safe following distance.
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Drive with due regard for safety of all others.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 20
Factors Affecting Directional
Control
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Mechanical condition of the vehicle
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Road conditions
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Physical condition of the driver
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Driver’s hand positions
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Drive with two hands on the wheel
 Radio and siren operation should be done by second EMT
 Use 9-o’clock and 3-o’clock hand positions
 Ambulance is more difficult to control than a car.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 21
Factors Affecting Speed Control
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Modern ambulances — weight four times more than
passenger vehicles
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Average type III ambulance weight 10,450 pounds without
patient and crew
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Considerably different handling characteristics
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Longer stopping distances
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 22
Seatbelts
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Simplest device to help maintain control of
vehicle
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Seatbelts have limited likelihood of causing
injury.
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Keep operators inside the vehicle.
Keep operators in position to control vehicle.
Only 1 of every 200 people is injured by
seatbelts when worn correctly.
All occupants of the ambulance should wear
seatbelts.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 23
Laws, Regulations, and
Ordinances – State and Local
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Vehicle parking or standing
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Procedures at red lights, stop signs, and intersections
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Regulations regarding speed limits
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Direction of flow or specified turns
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 24
Laws, Regulations, and
Ordinances – State and Local
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Emergency or disaster routes
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Use of audible warning devices
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Use of visual warning devices
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School buses
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 25
Laws, Regulations, and
Ordinances – State and Local
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Escorts and multiple-vehicle response
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Extremely dangerous
 Used only if unfamiliar with location of patient or
receiving facility
 No vehicle should use lights or siren.
 Provide a safe following distance.
 Recognize hazards of multiple-vehicle response.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 26
Siren Decibels by Location
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Proper Hand Signals
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Proper Hand Signals
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Proper Hand Signals
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En Route to the Call
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Obtain additional information from dispatch.
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Assign personnel to specific duties.
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Assess specific equipment needs.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 31
Arrival at Scene
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Notify dispatch.
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Size up the scene.
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Body substance isolation should be a consideration before
patient contact.
• Use gloves, gowns, and eyewear when appropriate.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 32
Scene Safety
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Assess the scene for hazards.
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Is the emergency vehicle parked in a safe location?
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Is it safe to approach the patient?
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Does the victim require immediate movement
because of hazards?
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 33
Transferring the Patient
to the Ambulance
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Patient should be prepared in a timely manner.
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Critical interventions should be completed.
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Dressings and splints should be checked.
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Patient should be covered according to environmental conditions.
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Patient should be securely attached to a transfer device.
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Transfer device should be selected on the basis of patient position,
immobilization, and type of terrain.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 34
En Route to Receiving Facility
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Notify dispatch.
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Ongoing assessment should be continued.
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Obtain serial vital signs.
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Notify receiving facility.
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Reassure patient.
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Complete prehospital care reports.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 35
Returning to Service
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At station or receiving facility, notify dispatch.
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Prepare for the next call.
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Clean and disinfect the ambulance and equipment,
as needed.
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Restock the disposable supplies.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 36
After Run
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Refuel unit.
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File reports.
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Complete cleaning and disinfection procedures.
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Notify dispatch.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 37
Aeromedical Considerations
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Modern helicopters are equipped with ALS
capabilities.
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Primary benefit is decreasing time from injury to
arrival at definitive care.
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EMS providers are encouraged to call for a helicopter
in some systems.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 38
Decision to Call Helicopter
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Proximity to hospital
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Nature of terrain
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Location of the patient
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Estimated extrication time
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Clinical status of the patient
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Decision to Call Helicopter
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How long will ground transport take?
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What will be the expected time of arrival of the helicopter?
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Can helicopter land at site?
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Will transport to additional site be needed to meet helicopter?
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Warm up time for helicopter before response
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 40
Locating Landing Zone
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Larger than 100 feet  100 feet
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Relatively flat ground
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No greater than 10 degrees slope
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Clear of debris
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No major vertical structures impeding landing
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Telephone poles
Towers
Tall grasses
Tall trees
As close to the scene as possible
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 41
Landing Zone Hand Signals
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Safety Around Helicopter
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Rotor wash can spray bystanders with debris.
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Bystanders may be struck by rotor.
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Never approach from the rear.
Take directions from pilot from the front.
If helicopter is on slope, never approach from uphill side.
Assume a crouching position when approaching helicopter.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 43
Safety Around Helicopter
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