ATTENDANT CLASSFall 2008

RPI AMBULANCE

Overview

Module I: Introduction to RPI AmbulanceModule II: RPI Ambulance and the LawModule III: SafetyModule IV: Radio CommunicationsModule V: Lifting and MovingModule VI: Vital Signs & Diagnostic EquipmentModule VII: AirwayModule VIII: BreathingModule IX: CirculationModule X: Splinting and Spinal Immobilization

RPI AmbulanceAttendant Class

Module I:

Introduction to RPI Ambulance

Introduction to RPI Ambulance

• Service: All volunteer, student-run

• Level of Care: Basic Life Support

• Office: 92 College Avenue

• Garage: Behind the Armory

• Service Period: In service 24/7 during the Fall and Spring Academic Sessions.

• Call Volume: ~150 per year

• Primary Coverage Area: RPI Troy campus

• Secondary Coverage Area: Troy, Brunswick, Rensselaer, etc.

• Special Events: Stand-bys for Hockey, Football, Commencement, and other requested events.

Standard Operating Procedures

• Standard Operating Procedures (SOPs):

– An outline of all of RPI Ambulance’s field procedures, training programs and requirements, and rules and regulations.

– Can be found online at:http://ambulance.union.rpi.edu/About.php

Crew Positions

• Crew Chief

• Driver

• Attendant

• Observer

Attendant Training

• Attendant Training Requirements:

– A. Hold a Professional Rescuer CPR certification.– B. Take the Attendant class (recommended).– C. Complete the Attendant checklist.– D. Complete and submit a copy of a Rig Check.– E. Complete one real or two simulated calls, and take vitals.– F. Request and receive approval by the Captain and Training

Lieutenant to be promoted to Attendant.

– Can be found online at:http://ambulance.union.rpi.edu/training.php

Crews and Events

• Duty crews, stand-bys

• General meetings, training drills

• Meals, trips, banquet

• Signing up:– Go to the Scheduling page on the website:

http://ambulance.union.rpi.edu/scheduling/index.php– Click “Login”, and enter your username and password.

– Go to the Night Crews or Games and Events schedule, and click “Sign up”, and “Confirm”.

– You’ll get an email confirming that you are signed up.

Crews and Events

Field House Operations

• Hockey games, Commencement

• Patient Care Facility

• EES, field crews

• Dedicated stand-bys

• Report to the PCF, or the rig 10-15 minutes prior to the scheduled time.

Professionalism

• A note on professionalism:– You are a medical care provider, and are operating in an official

capacity.

– You represent RPI Ambulance, and RPI.

– It is very important to maintain a professional appearance and attitude, to assure the patient they are in competent hands.

RPI AmbulanceAttendant Class

Module II:

RPI Ambulance and the Law

NYS Dept. of Health

• State Emergency Medical Services Code (Part 800):

– General Emergency Medical Services rules

– Certification of EMS personnel

– Certification of EMS agencies

– Requirements for equipment and ambulances

– Prehospital DNR orders

– Can be found online at:http://www.health.state.ny.us/nysdoh/ems/main.htm

Patient Confidentiality

• Part 800.15, HIPAA– It is a crime to break patient confidentiality, punishable by fines or

imprisonment.• Confidential information:

– Patient’s name and information, condition, treatment, etc.

• “Need to know”:– Crew, nurses, physicians and staff in charge of caring for the patient

have a need to know.– Friends, other RPI Ambulance members, the public, etc. do not have a

need to know.

– Can be found online at:http://www.health.state.ny.us/nysdoh/ems/policy/08-02.htmhttp://www.hss.gov/ocr/hipaa/

RPI AmbulanceAttendant Class

Module III:

Safety

Scene Safety

• Crew safety is the primary concern during all operations.

• Unsafe scenes:– Substance abusers

– Assaults

– Hazmat incidents

– MVAs

– Emotionally disturbed persons, attempted suicide.

– Fires, collapses, animal bites, CO poisoning.

• Do not enter a scene that is not safe. Wait for fire, rescue or law enforcement personnel to secure the scene.

• Crew safety is the primary concern during all operations.

• Gloves are worn during every patient contact.

• Other PPE includes:– N95 respirator masks

– Goggles

– Gowns

• The best way to prevent infection is to wash your hands!

Infection Control

RPI AmbulanceAttendant Class

Module IV:

Radio Communications

RPIA Portable Radios

• Frequency: 155.200 MHz

• Uses of RPIA Radios:– Receiving tones and dispatches from Rensselaer County

Emergency Communications Center (ECC)

– Amassing a crew for day calls

– Communication during stand-bys (hockey games, etc.)

• All officers, crew chiefs, and drivers carry assigned radios.

Rensselaer Co. Radios

• Frequency: 46.04 MHz

• Uses of County Radios:– Communicating with Rensselaer County ECC (dispatcher).

– NYS Interagency and Mass Casualty Incident channel.

– Used by crew chiefs and drivers.

• One handheld unit, kept at the office

• One mobile unit in the ambulance

Dispatch Determinants

• Calls are assigned a determinant based on the seriousness:

– Alpha: BLS, Priority II

– Bravo: BLS, Priority I

– Charlie: ALS, Priority I

– Delta: ALS, Priority I– Echo: ALS, Priority I*

*Cardiac or respiratory arrest, all local units respond.

The Dispatch

• Dispatches are received on Channel 1 on RPIA radios.

• Dispatch:– Dispatcher: Stand by RPI Ambulance.

– Tones will sound.

– Dispatcher: Stand by RPI Ambulance, for a (Determinant) EMS call for a (Demographics), (Chief complaint), at (Location).

– Dispatch is repeated, and time stamp and dispatcher ID are given.

• Example:– Dispatcher: Stand by RPI Ambulance, for a Bravo determinant EMS

call, for a 20 year old male with a traumatic injury, at the Houston Field House.

Call Communications

• During the call, the following radio transmissions are made to dispatch over the 800:– Confirm crew / en route to the scene

– Arriving on scene

– En route to the hospital

– Arriving at the hospital

– Back in service

– Back in quarters

• The receiving facility will be notified of patient information and arrival time over the BLS channel (a “med patch”).

Communication Guidelines

• The ambulance’s call sign is A39 for internal communications, 5939 for county communications.

• Attendants and above are assigned car numbers.

• State who you are talking to, and then identify yourself.

• For example, “Car 1, this is Car 2”.

• Always be professional; communications are monitored by Public Safety and County.

RPI AmbulanceAttendant Class

Module V:

Lifting and Moving

Lifting

• Proper lifting technique:– Lift with your legs,

not your back!– Bend at the knees.– Keep your back straight

and shoulders square.– Do not twist or bend your

back. If you need to turn, use your whole body.

• If a patient is too large for your crew to safely move:– Redispatch for additional crew members.– Request Troy Fire Department for a lift assist.

Moving Devices - Stretcher

• Indications: General EMS calls

• Considerations: A backboard is needed in addition for a suspected spinal injury.

• Example: Patient with abdominal pain

Moving Devices – Stair Chair

• Indications: Conscious patient who can’t walk, found upstairs or in areas where the stretcher will not fit.

• Contraindications: Suspected neck or back injury, unconsciousness.

• Example: Conscious patient on a second floorwithout an elevator, with shortness of breath

Moving Devices – Backboard

• Indications: Suspected neck or back injury, CPR.

• Contraindications: None

• Example: Patient who fell from a 20’ ladder

Other Moving Devices

• Reeves – patient who is upstairs or in a small area who cannot sit up

• Orthopedic Stretcher (Scoop) – pelvic fracture or hip dislocation

• KED – immobilization of a seated patient with a neck or back injury

RPI AmbulanceAttendant Class

Module VI:

Vital Signs and Diagnostic Equipment

Overview of Vital Signs

• Three prehospital vital signs:

– Heart Rate– Respiratory Rate– Blood Pressure

• Additional diagnostic measurements:– Skin color and condition– Pupil size and reactivity– Lung sounds– Pulse oximetry– Temperature

Heart Rate

• Measure by palpation at the radial artery.

• Three pieces of information:– Rate: Beats per minute

– Strength: Strong or Thready (weak)

– Regularity: Regular or Irregular

• Normal range: 60-100 beats per minute

• Dangerous range: Less than 60 or greater than 120 (sustained)

Respiratory Rate

• Measure by visualization.

• Three pieces of information:– Rate: Breaths per minute

– Depth: Normal, Shallow or Deep

– Regularity: Regular or Irregular

• Normal range: 12-20 respirations per minute

• Dangerous range: Less than 8 or greater than 24

Blood Pressure

• Measure with a sphygmomanometer (BP Cuff).

• Two pieces of information:– Systolic BP: Pressure when the heart

is contracting– Diastolic BP: Pressure when the heart

is not contracting

• Normal range:– Systolic: 100 – 140 mmHg– Diastolic: 60 – 90 mmHg

• Dangerous range:– Systolic: Less than 90 or greater than 180 mmHg– Diastolic: Less than 50 or greater than 100 mmHg

How to Take a Blood Pressure

1. Have the patient extend their arm palm up.2. Place the BP cuff around the patient’s bicep, such that the

artery marker is centered.3. Turn the BP cuff’s valve clockwise, all the way open.4. Place your stethoscope, with the large bell down, right below

the artery marker on the BP cuff.5. Inflate the BP cuff to 200 mmHg by squeezing the bulb.6. Slowly turn the valve counterclockwise, letting the air out

slowly.7. Note at what reading on the gauge you begin hearing thumps -

this is the systolic blood pressure.8. Note at what reading on the gauge you stop hearing distinct

thumps - this is the diastolic blood pressure.

Skin Color and Condition

• Observe:– Color: Normal, Flushed, Pale, Cyanotic (blue), Mottled (grey),

Jaundiced (yellow).

– Condition: Warm, Dry, Cool, Diaphoretic (sweaty).

Pupil Size and Reactivity

• Observe:– Shape: Round or Oblong (oval)

– Size: Pinpoint, Constricted, Dilated, Blown.

– Reaction to light: Pupils should constrict, but may be unreactive.

• PEARRL: Pupils Equal And Round, Reactive to Light.

RPI AmbulanceAttendant Class

Module VII:

Airway

Manual Airway Maneuvers

• It is vital to maintain an open airway!

• Head Tilt–Chin Lift:– Indications: Unconscious / unresponsive

– Contraindications: Suspected neck or back injury

• Jaw Thrust:– Indications: Unconscious / unresponsive

with suspected neck or back trauma

– Contraindications: None

Airway Adjuncts

• Used to keep the airway open.

• Oropharyngeal Airway (OPA):– Indications:

Unconscious / unresponsive– Contraindications:

Gag reflex present

• Nasopharyngeal Airway (NPA):– Indications:

Suspected loss of airway control, OPA not tolerated

– Contraindications: Facial trauma

Airway Suction

• Types of suction units:– Ambulance

– Portable

– Handheld

• Types of Catheters:– Yankaeur (Hard Tip)

– French (Soft Tip)

• Suction for no more than 15 seconds!

RPI AmbulanceAttendant Class

Module VIII:

Breathing

Oxygen Tanks

• Components:– Tank

– O-Ring

– Regulator

• Sizes– D

– E

– M

• Stat Date

• Pressure Gauge

• Flow Valve

Non-Rebreather Mask (NRB)

• Indications: Sick or injured patients requiring high-flow oxygen

• Contraindications: Respiratory arrest

• Use with an oxygen flow rate of 10-15 LPM.

Nasal Cannula (NC)

• Indications: Sick or injured patients who do not require high-flow oxygen, or cannot tolerate a NRB

• Contraindications: Respiratory arrest, significant respiratory distress.

• Use with an oxygen flow rate of 0-6 LPM.

Bag Valve Mask (BVM)

• A.K.A Ambu-Bags

• Indications: A patient who is having difficulty maintaining adequate ventilations on their own.

• Contraindications: None

• Rate:– Adults: 12-20 / min

– Children: 20 / min

– Infants: 20 / min

• Use with supplemental oxygen, 15-25 LPM.

Humidifier

• Indications: Used in conjunction with another oxygen administration device for pneumonia, bronchitis, asthma, Adult Respiratory Distress Syndrome (ARDS), Neonatal Respiratory Distress Syndrome (NNRDS).

• Contraindications: Pulmonary edema

RPI AmbulanceAttendant Class

Module IX:

Circulation

Bleeding Control

• 3 Types of Bleeding:– Capillary: Blood is dark red, and oozes.

– Venous: Blood is dark red, and flows steadily.

– Arterial: Blood is bright red, and spurts.

• Bleeding Control:1. Direct Pressure

2. Elevation

3. Pressure Dressing

4. Direct Pressure

5. Pressure Point

6. Tourniquet

Hypoperfusion (Shock)

• Hypoperfusion – the inadequate supply of oxygen and nutrients to the tissues of the body due to pathophysiological processes.

• Signs of Hypoperfusion:– Hypotension (low blood pressure)

– Tachycardia (rapid pulse)

– Tachypnea (rapid breathing)

Hypoperfusion (Shock)

• Treatment of hypoperfusion:

– Support the airway and breathing.

– Control any external bleeding.

– Position the patient with their feet elevated (Trendelenburg).

– Keep the patient warm.

– Rapidly transport.

RPI AmbulanceAttendant Class

Module X:

Splinting and Immobilization

Splinting

• Splints are used to immobilize and protect an injured body part.

• Board splints, “Frac-Pak”, Traction splints

• In general, when applying a splint:– Begin by checking CSM x4.

– Gently align the injured extremity, and place it in the splint.

– Make sure that the extremity is immobilized above and below the site of the injury.

– Recheck CSM x4.

• Backboard: A long, rigid board used to immobilize a patient

• Cervical Collar: A stiff neck brace used to immobilize the seven cervical vertebrae

• Indications for spinal immobilization:– Head, neck or spine pain, altered mental status or spinal deformity, that

is associated with a traumatic injury.

– Significant mechanism of injury

Spinal Immobilization

• To immobilize a supine patient (Log Roll):

1. Hold manual C-Spine stabilization.2. Check CSM x4.3. Size and apply a cervical collar.4. Roll the patient on to their side,

moving the head and body as a unit.5. Place the backboard next to the patient.6. Roll the patient on to the backboard,

moving the head and body as a unit.7. Secure straps across the body.8. Put the head blocks in place.9. Secure straps across the head.10. Recheck CSM x4.

Spinal Immobilization

• To immobilize a standing patient (Standing Take Down):

1. Hold manual C-Spine stabilization.2. Check CSM x4.3. Size and apply a cervical collar.4. Place the backboard behind the patient.5. Two people, on either side of and facing

the patient, grab the board under the patient’s armpits with their innermost hands.

6. Supporting the patient, lower the board to a horizontal position.

7. Secure straps across the body.8. Put the head blocks in place.9. Secure straps across the head.10. Recheck CSM x4.

Spinal Immobilization

• Kendrick Extrication Device (K.E.D.):– Used to immobilize a seated,

non-critical patient.

– Check CSM x4 before and after application.

– Requires supplemental use of a cervical collar.

– The patient must still be placed on a backboard.

Spinal Immobilization

Alright, it’s over.

Any questions?