Objectives. Chapter 41. Objectives. Objectives. Multimedia Directory. Topics 3/24/2011. Ambulance Operations and Air Medical Response

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1 Objectives Chapter 41 Ambulance Operations and Air Medical Response Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Copyright 2010 by Pearson Education, Inc. All rights reserved. 1. Describe the privileges afforded to EMTs operating emergency vehicles and the precautions that must be observed while using these privileges (slides 12-15). 2. Give examples of habits and behaviors that improve driving safety (slides 16-17). 3. Discuss factors that can affect your ability to maintain control while driving an ambulance (slides 18-23). 4. Explain precautions that should be taken when driving an ambulance in inclement weather (slides 24-27). 5. Explain precautions that should be taken when driving an ambulance at night (slides 28-30). 6. Describe the appropriate use of emergency warning devices, such as lights and sirens (slides 31-39). Objectives Objectives 7. Describe the safety precautions to be taken when working at scenes on and near roadways (slides 40-44). 8. Give examples of the EMT s responsibilities during each of the major phases of an ambulance call (slides 45-66). 9. Describe post-run actions that should be taken to reduce the spread of infection to you, your coworkers, and patients (slides 67-72). 10. Discuss situations in which air medical transport should be considered, potential disadvantages of air medical transport, and guidelines for setting up a landing zone (slides 74-85). 11. Describe the recommendations of the National Association of Emergency Medical Technicians with respect to EMT security and safety (slides 86-91). 12. Explain precautions to avoid exposing yourself or others to increased levels of carbon monoxide associated with ambulance operations (slides 92-94). Multimedia Directory Topics Slide 73 Standard Precautions and Equipment Video Driving the Ambulance Warning Devices Roadway Incident Scene Safety Phases of an Ambulance Call Air Medical Transport Security and Safety 1

2 3/24/2011 Medic One Dispatch Respond to the rest area at Interstate 80 and the Black Canyon Exit. You have a 33-year-old female patient with labor pains. Time out 1511 En Route You move quickly; your partner is driving You fasten your seat belt; the unit proceeds Dispatch information crackles over the radio You inhale deeply and tell yourself, Relax You begin to picture in your mind what you need to do and how you should perform throughout the ambulance call Driving the Ambulance Back to Topics Get to the scene SAFELY. Laws, Regulations, and Ordinances 2

3 You may: You must: Exceed the speed limit Drive the wrong way down a one-way street Turn in any direction at any intersection Park anywhere Cautiously proceed through red stoplights or stop signs Pass in a no passing zone Have a valid driver s license Be responding to an emergency Use lights, sirens, and horns as prescribed by law Follow the rules and regulations specific to your service Driving Excellence Always exercise DUE REGARD for the safety of others. Basics of Good Driving Always wear your seat belt Place hands at three and nine o clock on wheel Be familiar with how your vehicle operates in all weather conditions Pick the safest route Maintain a safe following distance Driving Excellence Maintaining Control 3

4 Go the posted speed limit unless situation is critical Brake smoothly Reduce distractions Arrive for your shift well rested Avoid railroad tracks if possible Be especially cautious around school buses Do not try to pass inside tunnels or congested bridges Consider traffic patterns when planning a route Watch the road surface for potholes or bumps Use all of your resources when backing up Be careful on curves that lead to population pockets Brake before entering a curve Accelerate gradually Exit from curves slowly and steadily Use a lower gear when going downhill Brake smoothly At higher speeds: Aggressive drivers will remain aggressive Avoid escorts and multiple-vehicle responses due to a large increase in risk Intersection Collision Causes Driving Excellence Motorist sails through intersection to avoid red light An unexpected second emergency vehicle enters intersection Stopped vehicles block view of pedestrians (Courtesy Canandaigua Fire and Rescue. Permission on file for all Brady EMS books.) Driving in Inclement Weather 4

5 Rain / Wet Roads Winter Driving Keep mirrors clear Avoid sudden braking or movement Slow down before puddles If hydroplaning, release accelerator, keep wheel straight, and pump brake Ensure ambulance is functioning properly Carry emergency weather equipment Use snow tires Remain aware of the temperature Avoid sudden movements and sudden braking Slow down Watch the road carefully Use headlights Consider using four-way flashers Use defroster Tap brakes prior to slowing down Remember fog can come and go quickly Reduced Visibility Driving Excellence Driving at Night Use quartzhalogen headlights Keep headlights clean Replace burnedout bulbs Dim high beams when passing Never look at high beams Do not flick high beams at others Driving at Night Dim high beams on curves Keep windshield clean Keep instrument panel dim Keep your eyes moving Replace worn wipers Be weary of tired or intoxicated drivers Driving at Night 5

6 3/24/2011 Warning Devices Colors and Markings Back to Topics Colors and Markings Warning Lights and Emergency Lights Quick identification Star of Life symbol Standard colors should be used Design should be unique to ambulances Warning and Emergency Lights Using Your Siren Be sure lights are placed above traffic Always use headlights Use spotlight briefly Use minimal lighting in fog 6

7 Using Your Siren Using Your Air Horn Drivers may not hear sirens Don t use siren directly behind a car May create stress in your patient May create stress in the EMT Always follow state law and protocol Using Your Air Horn Roadway Incident Scene Safety Avoid overuse Use it to clear traffic quickly Don t use close to other vehicles Don t assume it will be heard Back to Topics High Visibility Apparel ANSI/ISEA High-Visibility Apparel Class 1: Parking lots and traffic flow less than 25 mph Class 2: Traffic flow greater than 25 mph Class 3: High-risk personnel where attention is diverted from roadway 7

8 Safety Benchmarks Safety Benchmarks Do not trust approaching traffic Do not turn your back to traffic Use the first emergency vehicle on scene to create a barrier Wear highly visible clothing Use other vehicles to slow and redirect traffic Use advance warning devices Use traffic cones Assign a person to monitor oncoming traffic Remain uphill and upwind of potential hazards Daily Prerun Preparation Phases of an Ambulance Call Ambulance Maintenance and Daily Inspection of Vehicle Back to Topics Ambulance Maintenance Decreased down time Improved response times Safer response Improved transport times Safer transport Daily Prerun Preparation Ambulance Equipment 8

9 3/24/2011 Ambulance Equipment Daily Prerun Preparation Ensure all equipment is present and secure Check cab as well as patient compartment Personnel Ambulance Personnel Daily Prerun Preparation Dispatch Minimum of one EMT in patient compartment Two preferred Follow state and local protocol Location of call Nature of call Name, location, and callback number of caller Patient location Number of patients Any other special problems or considerations En Route to the Scene 9

10 Quickly check vehicle before departing Fasten seat belts Copy and confirm dispatch information Listen for status reports Prepare crew and equipment Call for advanced life support, if necessary At the Scene Notify dispatch of arrival Park in a safe place Perform 360-degree scene size-up Park in front of or behind accident but never next to it Put on safety vest prior to exiting truck Take Standard Precautions Determine scene safety Notify dispatcher of additional needs Be prepared to shift perspectives quickly Observe complete incident on approach Determine the mechanism of injury Determine number of patients Determine priority of care Gain access to patient If stable, properly immobilize and splint prior to moving patient Carefully extricate patient Move patient to the ambulance En Route to the Receiving Facility 10

11 Ensure hazards are managed and equipment is stowed Properly secure patient Check unit exterior Begin reassessment Notify dispatch Check interventions Follow local guidelines when transporting nonpatient passengers Focus on the patient Drive prudently Inform driver if patient s condition changes Notify receiving facility early Continually reassess patient At the Receiving Facility Notify dispatch of arrival Make an official transfer of care Transfer records and information Deliver a complete oral report Assist moving patient to bed Transfer valuables Exchange linen and equipment Complete prehospital care report Check for further needs before leaving En Route to the Station or Response Area Completely clean ambulance at hospital Wash your hands Notify dispatch Wear seat belts while returning to station Refuel according to protocol 11

12 Post Run Fill out and file reports Check fuel Complete inventory of equipment Change soiled uniforms Notify dispatch when in service Infection Control Post Run Infection Control Procedures Dispose of sharps Wash hands Clean, disinfect, or sterilize contaminated equipment Launder dirty linens and uniforms per manufacturer directions Dispose of infectious wastes Disinfectant Levels Sterilization Low-level 1:100 water to bleach Some bacteria; no spores Intermediate 1:10 water to bleach Most bacteria; no spores High-level Hot water pasteurization or chemical sterilant No spores Sterilize all equipment that will be used invasively Sterilization will destroy all forms of microbial life 12

13 Personal Protective Equipment Air Medical Transport Click here to view a video with information about personal protective equipment. Return to Directory Back to Topics Operational Guidelines When to Request Air Medical Transport Long distance to trauma center or specialty care Prolonged extrication Significantly reduced transport time Cannot reach scene by ground Ground transport is blocked Specialty skills needed Medical Guidelines Acute stroke Head injury with signs of herniation Chest or abdominal trauma with signs of respiratory distress or shock Serious mechanism of injury with unstable patient Penetrating injury with unstable patient Requesting Air Medical Transport 13

14 Requesting Air Medical Transport Your name Department name Callback number Nature of incident Exact location of incident Exact location of landing zone Radio frequency Additional Considerations for Air Medical Transport Weather/environment Altitude Air speed Cabin size Terrain Cost Patient preparation Setting Up a Landing Zone Landing Zone Guidelines Landing Zone Guidelines Make sure flat square is large enough for helicopter responding (larger at night) Choose site 150 feet away from vehicles involved in collision Stop traffic going both ways if landing zone is a divided highway Consider wind direction Mark each corner of landing zone Place a fifth marker on upwind side Wet area down if dry or dusty Keep downwash area clear Assign one person to guide the pilot in Follow the crew s instructions exactly Use extreme caution around the rotor blades 14

15 Landing Zone Guidelines Never approach until pilot indicates it is safe Secure all loose items Do not smoke near aircraft Always approach from downhill side Never point a light at the aircraft Consider a rendezvous at a helipad Security and Safety Back to Topics Personnel Operational Security Measures Security briefings, such as meetings, postings, information sheets, or supervisor briefings EMS crews should be well informed and take part in the development of operational security measures and situation awareness Vehicle Tracking of Vehicle Access All EMS vehicles should be tracked at all times Even out-of-service vehicles should be tracked EMS vehicles should never be left running or unattended with the keys in the ignition or in the vehicle All off-service vehicles must be secured A key log should account for who has accessed the vehicle Be sure security measures are strongly enforced when vehicle is off-premise for maintenance or repair Any vehicle retired from service must have its markings removed 15

16 Uniforms and Identification Items EMS patches and identification items must be safeguarded against access Identification cards should be safeguarded against counterfeit Uniform stores must verify the identity of anyone purchasing EMS-related uniform items Carbon Monoxide in Ambulances Causes Prevention Ambulance exhaust Gas-powered equipment Exhaust of vehicles near ambulance Greater outside air pressure, forcing CO into ambulance Have frequent engine tune-ups Have adequate exhaust system Keep windows shut Shut doors tightly Cover openings to outside Don t use vents Keep heater/air conditioner on Don t use gas-powered equipment in the truck Follow-Up En Route 33-year-old female Highway rest area OB kit is stocked Baby delivered prior to your arrival It s a girl! 16

17 At the Scene Notify dispatch Park vehicle so you won t have to back up into traffic Put on personal protective equipment Turn on heat Bring OB kit in to scene At the Scene Find mother and daughter; begin initial care and assessment Father would like to ride with, and he is informed he will ride in front passenger seat One Emergency Medical Responder will assist in back En Route to Receiving Facility Complete secondary assessment Police stops traffic Notify dispatch Reassess interventions Inform father that mother and daughter are doing fine En Route to Receiving Facility Continue driving normal speed limit Notify facility via radio At the Receiving Facility Notify dispatch Bring patient into room Give oral report to physician and nurse Partner has begun cleaning ambulance At the Receiving Facility Finish prehospital care report Leave copy with ED No further assistance needed at ED 17

18 En Route to the Station Dispose of contaminated linens and supplies Disinfect reusable supplies Wash hands Advise dispatch Refuel ambulance Post Run Recheck supplies Clean ambulance fully Hospital called; the baby s name is Sandra Notify dispatch Critical Thinking Scenario Dispatched to a motor vehicle crash on a busy highway It s raining and the roadways are slippery Dispatch reports there are two vehicles and four patients Police already on scene indicate the patients appear to be critically injured You know this highway to be especially busy at this time of day Critical Thinking Questions 1. What emergency vehicle driving practices would you use to ensure a safe response to the scene? 2. What other resources may you request to respond to the scene? 3. What specific steps would you take to improve your safety while on the scene of the crash? Critical Thinking Questions Reinforce and Review 4. What personal protective equipment should you wear while on scene? 5. If a helicopter is requested, how would you prepare a landing zone? Please visit and follow the mybradykit links to access content for the text. 18