Chapter 46 Transport Operations. National EMS Education Standard Competencies EMS Operations Knowledge of operational roles and responsibilities to ensure

Chapter 46Chapter 46

Transport Operations

National EMS Education Standard CompetenciesNational EMS Education Standard Competencies

EMS Operations

Knowledge of operational roles and responsibilities to ensure patient, public, and personnel safety.


Principles of Safely Operating a Ground Ambulance

• Risks and responsibilities of emergency response

• Risks and responsibilities of transport


Medicine

Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint.


Infectious Diseases

Awareness and management of

• A patient who may have an infectious disease

• How to decontaminate equipment after treating a patient


Infectious Diseases

Assessment and management of

• A patient who may have an infectious disease

• How to decontaminate the ambulance and equipment after treating a patient


Infectious Diseases

Assessment and management of

• A patient who may be infected with a bloodborne pathogen− Human immunodeficiency virus (HIV)

− Hepatitis B

• Antibiotic-resistant infections

• Current infectious disease prevalent in the community

IntroductionIntroduction

• Today’s ambulances are equipped with state-of-the-art technology.

• Driving an ambulance requires good technique and judgment.

Emergency Vehicle DesignEmergency Vehicle Design

• US General Services Administration determines ambulance standards.

• Design and manufacturing guidelines are reviewed and updated every 5 years.− Outlined by the DOT KKK 1822

Emergency Vehicle DesignEmergency Vehicle Design

• Type I: Conventional

• Type II: Standard van

• Type III: Specialty van

© Tom Carter/PhotoEdit, Inc.

Courtesy of Captain David Jackson, Saginaw Township Fire Department

Courtesy of Captain David Jackson, Saginaw Township Fire Department

Ambulance EquipmentAmbulance Equipment

• Every inch of space on an ambulance stores and secures equipment.

• Organizations influence the list of supplies and equipment that should be carried. − OSHA

− ACS

− NFPA

Checking the AmbulanceChecking the Ambulance

• Crew members are responsible for ensuring: − Unit is capable of

responding

− Proper equipment and supplies are available


• A daily check of the ambulance should ensure that it can: − Start

− Steer

− Stop

− Stay running


• Warning signs− Belt noise

− Break fade

− Brake pull

− Drift

− Steering pull

− Pulsating brake

− Steering play

− Tire squeal

− Wheel bounce

− Wheel wobble

Ambulance Staffing and Development

Ambulance Staffing and Development

• Maximize productivity and minimize response times by analyzing:− Response times

− Productivity

− Unit costs

− Taxpayer subsidies

Ambulance and EMS SystemsAmbulance and EMS Systems

• In US, most first-response EMS and ambulance service is delivered by the fire department.− Other models include:

• Private, for-profit agencies

• Public agency

• Public-private partnerships

System Status Management (SSM)

System Status Management (SSM)

• Goals:− Maximize efficiency

− Reduce response time

• Considers:− Peak loads

− Strategic deployment

Ambulance StationingAmbulance Stationing

• Goals: − Maximize

efficiency

− Minimize response times

• Factors include:− Distance vs. call

volume

− Special facilities

− Need for maintenance

− Storage

− Classrooms

− Sleeping quarters

En Route to SceneEn Route to Scene

• As you prepare to respond: − Fasten seatbelts and shoulder harnesses.

− Inform dispatch you are responding.

− Confirm nature and location of call.

− Ask for other information.

En Route to SceneEn Route to Scene

• While on route:− Prepare to assess and care for the patient.

− Review dispatch information.

− Assign duties and tasks.

− Decide which equipment to take.

− Decide which stretcher to take.

Arrival at the SceneArrival at the Scene

• Look for safety hazards.

• Evaluate the need for additional units.

• Determine the mechanism of injury or nature of the illness.

Arrival at the SceneArrival at the Scene

• Evaluate the need to stabilize the spine.

• Follow standard precautions.

• If you are the first at a multiple-casualty incident, estimate the number of patients.

Traffic ControlTraffic Control

• Ensure orderly traffic flow, and prevent another crash.

• Place reflectors and other warning devices on both sides of crash.

Securing EquipmentSecuring Equipment

• Make sure all equipment is secured before placing a vehicle in motion. − Some equipment can become lethal projectiles

if not secured properly.

Safe Patient TransferSafe Patient Transfer

• Excessive speed is unnecessary and dangerous.− Common sense and good driving techniques

are required.

• Secure the patient with at least three straps across the body.

Postrun Activities: Restocking, Cleaning, and Disinfection

Postrun Activities: Restocking, Cleaning, and Disinfection

• Clean and disinfect ambulance and equipment used.

• Restock supplies.

• Perform routine inspections.

• Decontaminate the ambulance.

Defensive Ambulance Driving Techniques

Defensive Ambulance Driving Techniques

• More than 6,000 crashes per year

• Knowledge of vehicle operation is critical.

© Robert Brenner/PhotoEdit, Inc.

Driver CharacteristicsDriver Characteristics

• Diligence and caution

• Positive attitude about your ability

• Tolerance of other drivers

• Physical fitness

• Emotional fitness

• Proper attitude

• Good judgment and knowledge

Safe Driving PracticesSafe Driving Practices

• Route planning and navigation− Have access to street and area maps

− Become familiar with the roads and traffic patterns in your area.• Avoid heavy traffic areas.

• Know your way around.


• Fatigue − Don’t be ashamed

to admit when you are fatigued.

− Place yourself out of service until fatigue has passed.

• Distractions − Never attempt to:

• Type

• Text

• Operate personal data devices

• Listen to music

• Eat or drink


• Use of safety restraints− All passengers should wear seatbelts.

• Speed− Always drive with caution.

• Siren risk-benefit analysis− Never use to transport a nonemergency patient.


• Driver anticipation− All other drivers are unpredictable.

− Maintain a safe travel distance behind vehicles.

− Do not respond aggressively to drivers.

− Do not accelerate through intersections.


• Driver anticipation (cont’d)− Make eye contact with fellow drivers.

− Use turn signals.

− Never force a vehicle into oncoming traffic.


• Cushion of safety− Maintain a safe distance from vehicles.

− Avoiding being tailgated.

− Be aware of blind spots.• View ahead

• Rear of vehicle

• Side of vehicle


• Vehicle size and distance judgment− Vehicle length and width are critical when:

• Maneuvering

• Driving

• Parking

• Braking and passing


• Backing up the emergency vehicle − Use a spotter.

− Agree with the spotter before moving.

− Keep your spotter in view at all times.


• Backing up the emergency vehicle (cont’d)− Agree on hand signals before moving.

− Keep your window cracked open.

− Do a walk-around before getting in the vehicle.

− Use audible warning devices.

− Do not rely on a back-up camera.


• Parking at an emergency scene− Allow for efficient traffic control and flow.

− Do not block other emergency vehicles.

− Park uphill or upwind.

− Stay away from structures that might collapse.

− Always use your parking brake.


• Parking at an emergency scene (cont’d)− Park as close to

the scene as possible.

− Park where your departure will not be hampered.

− Be aware of terrain.


• Parking at an emergency scene (cont’d)− Turn off headlights to avoid blinding oncoming

traffic at night.

− Always wear visible protective clothing.

Emergency Vehicle ControlEmergency Vehicle Control

• Two ways to control a vehicle: − Changing directions

− Changing speed

• Drivers must constantly evaluate the road surface.

Emergency Vehicle ControlEmergency Vehicle Control

• Road positioning and cornering− Take corners at the

speed that will put you in the proper road position

BrakingBraking

• Getting a feel for brake pressure comes with experience and practice.

• Get to know each vehicle you drive.

Controlled BrakingControlled Braking

• Weather and road conditions− Weight distribution should be taken into

consideration during inclement weather.

• Hydroplaning− Gradually slow down without slamming on the

brakes.


• Water on the roadway− Lightly tap the brakes several times after driving

through water to dry them.

• Decreased visibility− During fog, smog, snow, or heavy rain, use low

headlights.

− Use headlights during the day.


• Ice and slippery surfaces− All-weather tires and appropriate speed will

reduce traction problems.

− Be especially careful on bridges and overpasses.

Laws and RegulationsLaws and Regulations

• Vary from state to state and city to city

• Emergency vehicle drivers have certain limited privileges.− Privileges don’t lessen liability in a crash.


• Use of warning lights and sirens− Unit must be on a true emergency call.

− Audible and visual warning devices must be used simultaneously.

− Unit must be operated with due regard for the safety of others.


• Right-of-way privileges− Only use when

necessary.

− Know your local right-of-way privileges.

• Use of escorts− Generally not a

good idea

− Leave space between vehicles.

− Instruct family members not to drive closely behind you.


• Intersection hazards− Look for other motorists and pedestrians before

proceeding into the intersection.

• Unpaved roadways and rural settings− Operate the vehicle at a lower speed.

− Maintain a firm grip on the steering wheel.


• School buses− Never pass a

school bus that has stopped.

• School zones− In many states it is

illegal to exceed the speed limit in school zones.

• Funeral processions− Most states offer

no exemption.

− Out of respect, most drivers turn off audible devices.

Air Medical TransportsAir Medical Transports

• Can speed up transfer of patients

• Factors to consider:− Does the patient’s condition warrant the risk of

using air transport?

− Will the use of air transport truly save time?

Rotor-Wing Versus Fixed-Wing Air Ambulances

Rotor-Wing Versus Fixed-Wing Air Ambulances

• Rotor-wing aircraft − Standard of care

for transportation of critically injured

• Fixed-wing aircraft − Used mainly for

long-distance transportation

© Hermann J. Knipperatz/AP Photos

Courtesy of Brian Denlinger and STAT MedEvac

Advantages of Using Air Ambulances

Advantages of Using Air Ambulances

Disadvantages of Using Air Ambulances

Disadvantages of Using Air Ambulances

Helicopter Medical Evacuation Operations


• Why call for a medevac?− Ground transportation will take too long.

− Conditions limit or prohibit the use of ground transportation.

− Patient requires advanced care.

− Multiple patients will overwhelm a hospital.



• Who receives a medevac?− Patients with time-dependent injuries or

illnesses

− Patients with serious conditions

− Trauma patients

• Who do you call?− Notify dispatcher



• Medevac issues− Weather

− Environment/terrain

− Altitude

− Airspeed limitations

− Cabin size

− Cost

Establishing a Landing ZoneEstablishing a Landing Zone

• Should be a hard or a grassy level surface

• Should be cleared of loose debris

• Should be clear of overhead or tall hazards

• Should be marked with weighted cones or emergency vehicles

Landing Zone Safety and Patient Transfer


• Be familiar with capabilities, protocols, and methods for accessing helicopters.

• Go only where the pilot and crew directs you.

• Keep a safe distance from the aircraft whenever it’s on the ground and “hot.”



• The proper approach is between nine-o’-clock and three-o’-clock.

• Walk in a crouched position when approaching.



• When operating at a landing zone:− Pay attention to the flight crew.

− Become familiar with hand signals.

− Do not approach unless instructed by flight crew.





• When operating at a landing zone (cont’d):− Make sure all equipment/patients are secured.

− Always approach from the front.

− Smoking, open lights or flames, and flares are prohibited within 50 ft of the aircraft.

Communicating with Other Agencies

Communicating with Other Agencies

• When requesting a medevac response, always include:− Ground contact radio channel

− Call sign of the unit

Special ConsiderationsSpecial Considerations

• Night landings− Do not shine lights in the air to help the pilot.

− Direct light toward the ground.

− Smoking, open lights or flames, and flares are prohibited within 50 ft of the aircraft.


• Landing on uneven ground− Approach from downhill side only.

− Do not move the patient until signaled.


• Medevacs at hazardous materials incidents− Flight crew should be notified immediately.

− Landing zone should be established upwind and uphill from the scene.

− Exposed patients must be decontaminated before being loaded into the aircraft.

SummarySummary

• DOT KKK 1822 sets the standards for ambulance design and manufacturing specifications.

• Three body styles: Type I, Type II, Type III

• Check the ambulance at the beginning of every shift to ensure that all equipment is available and in good working order.

• Preventative maintenance is as important as operating skills.

SummarySummary

• Perform routine inspection after each call.

• Learning how to properly operate your vehicle is just as important as learning how to care for patients.

• Drivers must be qualified to drive an ambulance, must be physically and emotionally fit, and must have the proper attitude.

SummarySummary

• All drivers and passengers should use appropriate safety restraints while vehicles are in motion.

• Make sure all equipment is secure before leaving the scene.

• Lights and sirens should be used sparingly.

• Avoid backing up vehicle if possible. When unavoidable, always use a spotter.

SummarySummary

• Use extreme caution when driving in heavy traffic areas or in rural areas.

• Slow down in inclement weather.

• Any specific exemption from traffic laws does not negate your responsibility to proceed with due regard.

• Escorts should not be used.

• Air ambulances are used to evacuate medical and trauma patients.

SummarySummary

• A medical evacuation is commonly known as a medevac.

• You must follow certain safety rules when you are working around landing zones and helicopters.

CreditsCredits

• Backgrounds: Purple—Courtesy of Rhonda Beck; Blue—Jones & Bartlett Learning. Courtesy of MIEMSS; Red—© Margo Harrison/ShutterStock, Inc.; Green—Courtesy of Rhonda Beck.

• Unless otherwise indicated, all photographs and illustrations are under copyright of Jones & Bartlett Learning, courtesy of Maryland Institute for Emergency Medical Services Systems, or have been provided by the American Academy of Orthopaedic Surgeons.

Documents

Chapter 46 Transport Operations. National EMS Education Standard Competencies EMS Operations Knowledge of operational roles and responsibilities to ensure