INTRODUCTION TO AMBULANCE SERVICE

INTRODUCTION

“ Sick and injured are not cargo to which ordinary rules of

logistics can be applied. They are perishable hence they must
be evacuated in comfort and provided with all the requisite life
saving support, enroute to the medical establishment.”

U.S. Field Ambulance Manual

HISTORICAL DEVELOPMENT OF AMBULANCE

o The first organized attempt to provide for the transport of sick and
wounded soldiers was made by French in 1759.

o Barons Percy and Larcy were two eminent French army surgeons
who originated a modern system for removal of wounded soldiers
from the battle field by trained attendance in conveyances specially
designed for their transport.
Cont..

o In April 1792 Baron Dominique Jean Lary was appointed as Surgeon

major of hospital to the army of Rhine.

o It was there that he introduced system of light weight vehicle for

transport of the wounded.

o Baron Dominique Jean Lary is also known as the “Father of the

Ambulance Service.”

o The civil Ambulance system emerged in the second half of the 19 th

century as an out-growth of military experiences both in Europe and
America.
 Cont..

o Modern ambulance is closer to its ancient meaning – a field hospital.

o A modern ambulance is practically “a hospital on wheels” as it is fully

equipped with latest medical technology.

o Modern day ambulances are equipped to effectively deal with surgical

and medical emergencies.

o In our country, however the ambulance services yet to receive the

requisite consideration in planning, procurement and execution.

o Most ambulances are neither ideally designed nor optimally equipped.

 DEFINITION

o An ambulance is a vehicle equipped for transporting those who are wounded,

injured or sick.

o Committee on Ambulance Design Criteria (1973) has stated that a vehicle

should not be termed as ambulance unless it is designed, built, equipped and
staffed to cope with medical emergencies outside the hospital.

o An Ambulance life support (ALS) unit or a mobile intensive care unit refers to
any vehicle that is staffed and equipped to provide ALS to those patients
needing that level of care, both at the scene of pre-hospital medical
emergency and rout to a hospital.
TYPES OF HOSPITAL AMBULANCES

Various types of ambulance are as follow;

Basic Ambulance
It should be equipped with medical devices and pharmaceutical
products to allow the attendant to provide basic life support as and when
needed.

Advanced life support Ambulance

this ambulance is staffed with physician, emergency medical
technician, nursing staff and attendant facilitate along essential
Equipments and drugs required for preservation or restoration of life or
relieving pain or agony.
TYPES OF HOSPITAL AMBULANCES

Helicopter Ambulance
helicopter air ambulance is best used when pre-hospital ground ambulance
time is expected to be more, when ground ambulances are not available or can not be
used.

Fixed wing air Ambulance

for greater distance or when helicopters are not available fixed wing
ambulance are used.
It is ideal transport for donor organs and evacuation of patient to specialized
institutions such as burn or transplant centers.

Rail ambulance
these are designed for evacuating casualties which occur on rail routes or
for evacuating mass casualties from a rail head to requisite medical establishment.
Ambulance Operations
Phases of a Call

• Preparation
• Dispatch
• route
• Arrival at Scene
• Pt contact
• Movement of pt to unit
• route to hospital
• Arrive at hospital
• Transfer of pt care
• Clear/Return to service
 TYPE 1

Ambulance Designs

Type
I Box shaped passenger TYPE 2
compartment Mounted on truck style
Type chassis
IIVan style vehicle
body and cab form a single
unit
Raised roof TYPE 3
Extended rear compartment
Type
III
Modular box like a Type I
Mounted on a van
chassis
Daily Truck Inspection
• Fuel
• Oil
• Engine Cooling System
• Battery
• Brakes
• Wheels/tires
• Headlights
• Stoplights
• Turn signals
• Emergency lights
• Wipers
• Horn
• Siren
• Doors closing/latching
• Communication systems
• AC/Heat
• Ventilation system
• Seat belts
• Equipment
• Checked/maintained
• Restocked/repaired
• Batteries for –AED –
Suction – O2, etc
Dispatch Centers

• Central Access
• Coordinates numerous EMS units in a region
• Enhanced 911
• Automatically identifies a callers location
• Emergency Medical dispatch
• National method of training for
• dispatchers Triage and provide basic 1st
• Typical information collected
aid instruction
• Nature of
• call Name
• Location
• # of pts
• Severity of injury
• Call back
• number
• Other special
• problems
Considerations Route

• Considerations
• Seat belts
• Notify
• dispatch
Obtain additional info
• from dispatch
Assign
• personnel
specific duties
• Assess specific
Essential info
equipment
• Nature of call
needs
• Location of
call
Ambulance Operations
Vehicle Operations

• EVOC
• Emergency Vehicle Operation Course
• Characteristic of ambulance operator
• Physically
• fit Mentally
• fit
• Able to perform under
• Safe stress
drivingTolerant of other
• drivers
Driver/passengers ware seat belts
• Become familiar with your ambulance
• Alert to weather/road conditions
• Caution in use of emergency
• LIGHTS/SIRENS DO NOT RELIEVE THE
lights/siren
DRIVER FROM LIABILITY IN A CRASH
• Select appropriate route
• Maintain safe following
• distance
• DUE REGARD TO SAFETY OF
OTHERS
• Increased speed = decrease time to hear
Know appropriateness
• siren Siren @ 60mphof barely precedes
• lights/siren
Headlights use most visible part on an
are
ambulance
ambulance
Vehicle Operations
Multiple Units, Crashes

• Escorts/Multiple
Vehicle Responses
• Extremely dangerous
• Use only if unfamiliar:
• Location of pt
• Location of receiving
facility
• No vehicle should
use lights/siren
• Safe following
• distance Recognize
• Intersection
hazards Crashes
• Motorists at intersections as
light changes DON’T STOP
• Motorists expect 1 ambulance
not multiple vehicle responses
• Vision is obstructed by
vehicles
Vehicle Positioning
• For Safety
• Uphill from leaking hazards
• 100 ft from wreckage
• In front of wreckage, OR
• Beyond the wreckage
• Set parking break
• Use warning lights
• Shut off headlights (unless
illumination is needed)
• Exiting scene
• Avoid parking in locations
that will hamper leaving
scene
Arrival at Scene
• Notify dispatch
• Size-up
• BSI(body substance isolation)
• Scene safety
• -Parked in safe location –
Immediate pt removal –
• Safety
MOI (mechanism of injury)
• Medical Pt
• MCI mass casualty incident
• # of pt
• Obtain additional
• help Begin triage
• C-spine stabilization if needed
• Trauma Pt
• MCI
• # of pt
• Obtain additional help
• Begin triage
• C-spine stabilization if needed
• Total # of pt
• Need for additional help
Transfer to Unit
• Action at scene
• Organized
• Rapid/efficient
• Goal of
transport in 10 minutes”
• “Platinum
• Transfer
mind of pt to unit
• Preparing pt for transport
• Completion of critical
interventions
• Check dressings/splints
• Pt covered and secured to
moving device
• Refer to
lifting/immobilization
presentation
 Route and Arrival at Hospital

• route to hospital
• Notify dispatch
• On going assessment
• Additional vitals
• assessed Notify receiving
• facility Reassure pt
• Complete PPCR
• Arrival at hospital
• Notify dispatch
• Transfer pt
• Lift/move as
previous
• presentation
Reports
• Verbal report at bedside
• Complete PPCR and
leave
Copy
*PPCR
(PRE HOSPITAL PATIENT
CARE REPORT)
Clear/Return to Service
• En route to station
• Notify dispatch
• Prepare for next call
• Clean/disinfect unit
• Clean/disinfect equipment
• Restock disposable items
• Post Run
• Refuel unit
• File reports
• Complete
cleaning/disinfecting
• 1:100 bleach:water
solution if commercial
cleaner is not available
Air Medical Considerations
• Landing Zone (LZ)
• At least 100ft X 100
• ft Relatively flat
• No greater than 10
ground
• Cleardegrees
of debris
• Trash
• Rock
• Sand
• No major vertical structures
• Trees
• Buildings
• Telephone polesT
• owers
• As close as possible to scene
call
of
• Approach
• Assume crouching position
• NEVER approach from
• Pilot blind spot
behind
 PLANING
No Happy Hour remaining for ever