35: Ambulance Operations

Cognitive Objectives (1 of 4)

7-1.1 Discuss the medical and nonmedical equipment needed to respond to a call.

7-1.2 List the phases of an ambulance call.

7-1.3 Describe the general provision of state laws relating to the operation of the ambulance and privileges in any or all of the following areas:

• speed • right-of-way

• warning lights • parking

• sirens • turning

7-1.4 List factors that contribute to unsafe driving conditions.

7-1.5 Describe the considerations that should be given to: • request for escorts• following an escort vehicle• intersections

7-1.6 Discuss “Due Regard for Safety of All Others” while operating an emergency vehicle.

Cognitive Objectives (2 of 4)

7-1.7 State what information is essential in order to respond to a call.

7-1.8 Discuss various situations that may affect response to a call.

7-1.9 Differentiate between the various methods of moving a patient to the unit based upon injury or illness.

7-1.10 Apply the components of the essential patient information in a written report.

Cognitive Objectives (3 of 4)

7-1.11 Summarize the importance of preparing the unit for the next response.

7-1.12 Identify what is essential for the completion of a call.

7-1.13 Distinguish among the terms cleaning, disinfection, high-level disinfection, and sterilization.

7-1.14 Describe how to clean and disinfect items following patient care.

Cognitive Objectives (4 of 4)

Affective Objectives

7-1.15 Explain the rationale for appropriate reporting of patient information.

7-1.16 Explain the rationale for having the unit prepared to respond.

• There are no psychomotor objectives for this chapter.

Additional Objectives*

Cognitive 1. Discuss the elements that dictate the use of lights

and siren to the scene and to the hospital.

*This is a noncurriculum objective.

Ambulance Operations

• Emphasis on rapid response places the EMT-B in great danger while driving to calls.

• EMT-Bs should know:– How to equip and maintain an ambulance– Techniques for the safe operation of an

ambulance– How to work safely with air ambulances

Emergency Vehicle Design

• Ambulance– Vehicle used for treating and transporting

patients who need emergency medical care– Most ambulances follow federal

specifications (KKK-A-1822C, 1990)

Type I

Type II

Type III

Phases of an Ambulance Call

• Preparation

• Dispatch

• En route

• Arrival at scene

• Patient transfer

• En route to receiving facility

• At the receiving facility

• En route to station

• Postrun

Preparation Phase

• Medical equipment and supplies check

• Personal safety equipment

• Equipment for work areas

• Preplanning and navigation

• Extrication equipment

• Daily inspections

Medical Equipment

• Airway and ventilation devices

• Suction unit• Oxygen delivery• CPR equipment• Basic wound care• Splinting supplies

• Childbirth supplies• AED• Patient transfer

equipment• Medications• Jump kit

Personal Safety Equipment

• Face shields• Gowns, shoe covers, caps• Turnout gear• Helmets with face shields or safety goggles• Safety shoes or boots

Equipment for Work Areas

• Warning devices that flash intermittently or have reflectors

• Two high-intensity halogen flashlights• Fire extinguisher• Hard hats or helmets with face shields• Portable floodlights

Other Preparations

• Preplanning and navigation– Carry detailed maps and directions.– Be familiar with local area.

• Extrication equipment– Equipment needed for simple, light

extrication

Personnel

• Every ambulance must be staffed with at least one EMT-B in the patient compartment during patient transport.

• Two EMTs are strongly recommended.• Some services may operate with a non-EMT

driver.

Inspections and Safety Precautions

• Being fully prepared means inspecting the ambulance and equipment daily.

• Check medical equipment and supplies at least daily.

• Review standard traffic safety rules and regulations.

• Make sure seat belts work and that oxygen tanks are secured.

Dispatch Phase

• The dispatcher should gather minimum information.– Nature of the call– Name, person, location, and call-back number– Location of the patient(s)– Number of patients and idea of the severity of

their conditions– Special problems or other pertinent information

En Route to the Scene

• Fasten your seat belt.

• Confirm response and location.

• Prepare for arrival.

• Decide what equipment to take initially.

Arrival at the Scene

• Scene safety

• Safe parking

• Traffic control

Scene Size-up

• Look for safety hazards. • Evaluate need for additional units. • Determine MOI/NOI. • Evaluate spinal precautions. • Follow BSI precautions.

Safe Parking and Traffic Control

• Park away from hazards and out of flow of traffic.

• Do not block other responding EMS vehicles.

• Place appropriate warning devices on both sides of the accident.

Transfer Phase

• Provide lifesaving treatment.• Package patient for transport.• Be sure to secure the patient with at

least three straps across the body.

Transport Phase

• Inform dispatch when you are ready to leave the scene.

• Report the number of patients and the name of receiving hospital.

• Conduct ongoing assessments.• Contact medical control.

– Report number of patients– Nature of problems

Delivery Phase

• Report arrival to dispatch.

• Give report to staff.

• Physically transfer the patient.

• Complete written report.

• Leave a copy with an appropriate staff member.

En Route to the Station

• Inform dispatch whether or not you are in service and where you are going.

• Clean and disinfect the ambulance and any equipment used.

• Restock supplies.

Postrun Phase

• Complete and file any additional written reports.

• Inform dispatch of your status, location, and availability.

• Clean and restock the ambulance.

Defensive Driving

• 6,000 ambulances involved in crashes every year • 300 fatalities between 1991 and 2001• Properly operating the ambulance is as important

as taking care of patients.

Driver Characteristics

• Physical fitness– Effects of medication– Fatigue

• Emotional fitness– Maturity and stability– Proper attitude

• Your actions will be scrutinized.

Safe Driving Practices

• Speed does not save lives; good care does.

• Seat belts must be worn.

• Learn how your vehicle accelerates, corners, sways, and stops.

Driver Anticipation

• Anticipate the actions of other motorists and pedestrians.

• Assume actions of other drivers will cause a collision.

• Use of PA system may add to confusion.

Cushion of Safety

• Keep safe following distance. • Watch for tailgaters. • Be aware of blind spots. • Use a spotter when backing up.

Excessive Speed

• Speeding is unnecessary if patient is properly assessed and stabilized.

• Decreases reaction time

• Increases stopping time and distance

Vehicle Size and Cornering

• Vehicle length and width are critical factors in maneuvering.

• Vehicle size and weight greatly influence braking and stopping distances.

• Always be aware of your position on the roadway. • Take corners at the speed that will put you in the

proper road position as you exit the curve.

Weather and Road Conditions

• Be alert to changing conditions. • Decrease speed and increase distance in poor

conditions.– Hydroplaning– Water on roadway– Decreased visibility– Ice and slippery surfaces

Laws and Regulations

• Vary from state to state• EMS drivers have certain limited privileges. • These privileges do not lessen drivers’

liability.

Warning Lights and Sirens

• Must be responding to an emergency

• Use both audible and visual devices.

• Operate with due regard.

Right-of-Way Privileges

• You must not endanger people or property under any circumstances.

• Know your local right-of-way privileges. • Exercise them only when necessary for the

patient’s well-being.

Escorts and Intersection Hazards

• Use of escorts– A dangerous practice– Follow escorts at a safe distance.

• Intersection hazards– Most common place for collisions– Even on urgent calls, come to a momentary stop

at the light.

Air Ambulances

• Fixed wing

– Interhospital transfers

• Rotary-wing

– Used for shorter distances

Medivac Operations

• Become familiar with local capabilities.

• Calling for a medivac

– Ground transport would take too long.

– Spinal cord injuries, amputations, burns, diving emergencies, venomous bites

• Notify your dispatcher first.

Establishing a Landing Zone

• Area should be hard or grassy level surface that measures 100' x 100' (recommended)

• Clear area of loose debris and survey for overhead or tall hazards.

• Mark landing site with weighted cones or headlights.

Safety Precautions

• Do nothing near the helicopter and only go to where the crew or pilot directs you.

• Keep a safe distance away from the aircraft.• Stay away from the tail rotor.• Never approach the helicopter from the rear.

Special Considerations

• Nighttime landings– Considerably more dangerous than daytime

operations• Landing on uneven ground

– Main rotor blade will be closer to the ground on uphill side.

• Hazardous materials incidents– Land zone should be upwind and uphill.

Landing on Uneven Ground

Review1. Upon arrival at a scene where hazardous materials

are involved, you should park the ambulance:

A. upwind from the scene.B. with the warning lights off. C. downhill from the scene. D. at least 50’ from the scene.

ReviewAnswer: A

Rationale: At the scene of a hazardous materials incident, the ambulance should be parked uphill and upwind from the scene. Other locations may expose the ambulance to any escaping hazardous material. Be prepared to quickly move the ambulance if the wind shifts in your direction.

Review1. Upon arrival at a scene where hazardous materials are involved,

you should park the ambulance:

A. upwind from the scene.Rationale: Correct answerB. with the warning lights off. Rationale: Parking upwind is your most important concern. Using the

warning lights is based upon departmental guidelines.C. downhill from the scene. Rationale: You should park uphill and upwind.D. at least 50’ from the scene. Rationale: Parking upwind is your first priority. The distance from the

hot zone should be at least 100 feet.

Review2. You have been dispatched to a call for an

unconscious patient. What is the MOST important information that you should obtain from the dispatcher initially?

A. The callback number of the callerB. The severity of the patient’s problemC. Whether or not the patient is breathingD. The exact physical location of the patient

ReviewAnswer: D

Rationale: All of the choices listed in this question are important questions to ask the dispatcher. However, you must first determine the exact location of the patient. You cannot help the patient if you cannot find him or her. While en route, you should try to ascertain more specific patient information (ie, whether or not he or she is breathing).

Review2. You have been dispatched to a call for an unconscious patient.

What is the MOST important information that you should obtain from the dispatcher initially?

A. The callback number of the callerRationale: This is important, but not the most important piece of

information.B. The severity of the patient’s problemRationale: This is important, but not the most important piece of

information.C. Whether or not the patient is breathingRationale: This is important, but not the most important piece of

information.D. The exact physical location of the patient Rationale: Correct answer

Review3. The MOST appropriate place to park your ambulance

at the scene of a motor-vehicle accident is:

A. alongside the accident, blocking traffic.B. 100 feet behind the accident on the same side of the

road.C. 100 feet in front of the accident on the same side of

the road.D. 100 feet in front of the accident on the opposite side

of the road.

ReviewAnswer: C

Rationale: Parking the ambulance 100 feet in front of the accident, on the same side of the road, will protect you from being struck by oncoming traffic as you are loading the patient. Positioning your ambulance in an area that places barriers between you and oncoming traffic will maximize your safety.

Review3. The MOST appropriate place to park your ambulance at the

scene of a motor-vehicle accident is:

A. alongside the accident, blocking traffic.Rationale: This may block the movement of other emergency

vehicles.B. 100 feet behind the accident on the same side of the road.Rationale: Always provide a cushion of space between your

vehicle and the operations at the scene.C. 100 feet in front of the accident on the same side of the road.Rationale: Correct answerD. 100 feet in front of the accident on the opposite side of the road.Rationale: 100 feet is the appropriate distance, but you should

park on the same side of the roadway.

Review4. The most common and often most serious

ambulance crashes occur at or on:

A. stop lights. B. intersections. C. a highway.D. stop signs.

ReviewAnswer: B

Rationale: Most serious ambulance crashes occur at intersections. Always be alert and careful when approaching an intersection. Whether at an intersection with stop lights or stop signs, you should momentarily come to a complete stop, look in both directions for other motorists or pedestrians, and then carefully proceed through the intersection.

Review4. The most common and often most serious ambulance crashes

occur at or on:

A. stop lights. Rationale: Stop lights are associated with an intersection. The

ambulance must come to a complete stop, since most accidents occur at intersections.

B. intersections. Rationale: Correct answerC. a highway.Rationale: This is not the most common area where crashes

occur.D. stop signs. Rationale: Stop signs are associated with an intersection. The

ambulance must come to a complete stop, since most accidents occur at intersections.

Review5. While en route to a call for a major motor-vehicle

crash, the MOST important safety precaution(s) that you and your partner can take is/are:

A. adhering to body substance isolation precautions. B. ensuring that the fire department arrives before you. C. using lights and siren and being aware of other

drivers.D. wearing seat belts and shoulder harnesses at all

times.

ReviewAnswer: D

Rationale: The “en route to the scene” phase of a call is the most dangerous. Regardless of the nature of the call that you are responding to, wearing seat belts and shoulder harnesses is the most important safety precaution that you and your partner must take. Furthermore, you must drive defensively and remain aware of the traffic around you.

Review5. While en route to a call for a major motor-vehicle crash, the

MOST important safety precaution(s) that you and your partner can take is/are:

A. adhering to body substance isolation precautions. Rationale: This takes place once the providers arrive at the scene.B. ensuring that the fire department arrives before you. Rationale: it is important to know if the fire department is

responding, but this is not the most important safety precaution.

C. using lights and siren and being aware of other drivers.Rationale: The use of lights and sirens adds to the risk potential,

but the use of safety devices is the most important precaution that you can take.

D. wearing seat belts and shoulder harnesses at all times. Rationale: Correct answer

Review6. The minimum recommended dimensions for a

helicopter landing zone are:

A. 50’ × 50’B. 75’ × 75’C. 100’ × 100’D. 150’ × 150’

ReviewAnswer: C

Rationale: The dimensions for a helicopter landing zone (LZ) should be, at a minimum, 100' × 100' on a hard or grassy surface that is level. The LZ should be clear of loose debris and power lines.

Review6. The minimum recommended dimensions for a helicopter landing

zone are:

A. 50’ × 50’Rationale: This is below the minimum recommended dimensions.B. 75’ × 75’Rationale: This is below the minimum recommended dimensions. C. 100’ × 100’Rationale: Correct answerD. 150’ × 150’Rationale: This is well above the minimum recommendations, but

this may not be a practical size in many emergency operations.

Review7. At what speed will the ambulance begin to

hydroplane when there is water present on the roadway?

A. 25 mphB. 30 mphC. 40 mphD. 50 mph

ReviewAnswer: B

Rationale: At speeds of 30 mph or greater, the tires can be lifted off the pavement as the water “piles up” under the tires. This takes the control out of the driver's hands. If hydroplaning occurs, you should gradually slow down instead of jamming on the brakes to avoid losing control of the vehicle.

Review7. At what speed will the ambulance begin to hydroplane when

there is water present on the roadway?

A. 25 mphRationale: This is below the speed where the risk of hydroplaning

exists.B. 30 mphRationale: Correct answerC. 40 mphRationale: This exceeds the speed at which hydroplaning can

occur.D. 50 mphRationale: This exceeds the speed at which hydroplaning can

occur.

Review8. All of the following are examples of standard patient

transfer equipment, EXCEPT:

A. stokes baskets.B. long backboards.C. wheeled stair chairs.D. wheeled ambulance stretchers.

ReviewAnswer: A

Rationale: A stokes basket—also called a basket stretcher—is a specialized piece of equipment that is used for moving patients up or down rough terrain. Most ambulances do not carry stokes baskets; they are usually carried by rescue vehicles or fire apparatus.

Review8. All of the following are examples of standard patient transfer

equipment, EXCEPT:

A. stokes baskets.Rationale: Correct answerB. long backboards.Rationale: This is a standard piece of patient transfer equipment.C. wheeled stair chairs.Rationale: This is a standard piece of patient transfer equipment.D. wheeled ambulance stretchers.Rationale: This is a standard piece of patient transfer equipment.

Review9. The primary purpose of a “jump kit” is to:

A. ensure that you have immediate access to the AED.B. have all of the equipment available that you will use

in the entire call.C. have easy access to manage patients with severe

uncontrolled bleeding.D. have all of the equipment available that will be used

in the first five minutes.

ReviewAnswer: D

Rationale: Think of a jump kit as the “5 minute kit,” containing anything you might need in the first 5 minutes with the patient. It is during this 5 minute period that you will find and manage immediate life threats.

Review9. The primary purpose of a “jump kit” is to:A. ensure that you have immediate access to the AED.Rationale: A “jump kit” should have the basic equipment to treat

immediate life threats. BLS care can be initiated until an AED arrives.

B. have all of the equipment available that you will use in the entire call.

Rationale: You only need that equipment to manage immediate life threats during the first five minutes. Afterwards, additional equipment can be brought to the scene.

C. have easy access to manage patients with severe uncontrolled bleeding.

Rationale: A “jump kit” should have the basic equipment to manage all immediate life threats — including airway and breathing.

D. have all of the equipment available that will be used in the first five minutes.

Rationale: Correct answer

Review10. Which of the following statements about helicopters

is true?

A. It is possible that the main rotor blade will dip to within 4' of the ground

B. A helicopter is considered “hot” when it is on the ground and the rotors are still

C. If the helicopter must land on a grade, you should approach it from the uphill side

D. If you must go from one side of the helicopter to the other, the best way is to duck under the body.

ReviewAnswer: A

Rationale: Because the main rotor blade of a helicopter is flexible, it can dip as low as 4' from the ground. Use extreme caution when approaching a helicopter with the rotors on. If the helicopter must land on a grade, approach it from the downhill side. When moving from one side of the helicopter to the other, move around the front of the aircraft—not under it and certainly not behind it!

Review10. Which of the following statements about helicopters is true?

A. It is possible that the main rotor blade will dip to within 4' of the ground

Rationale: Correct answerB. A helicopter is considered “hot” when it is on the ground and the

rotors are stillRationale: It is considered “hot” when the rotors are turning.C. If the helicopter must land on a grade, you should approach it

from the uphill sideRationale: You must approach the helicopter from the downhill

side.D. If you must go from one side of the helicopter to the other, the

best way is to duck under the body.Rationale: You must go from one side to the other around the front

of the helicopter — never go behind it.