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
 Cognitive Objectives (2 of 4)

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 (3 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 (4 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.
 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
2. 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 • En route to receiving
• Dispatch facility
• En route • At the receiving facility
• Arrival at scene • En route to station
• Patient transfer • 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 • Childbirth supplies
devices • AED
• Suction unit • Patient transfer
• Oxygen delivery equipment
• CPR equipment • Medications
• Basic wound care • Jump kit
• Splinting supplies
 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