Chapter 46 Transport Operations. National EMS Education Standard Competencies EMS Operations...
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Transcript of Chapter 46 Transport Operations. National EMS Education Standard Competencies EMS Operations...
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Chapter 46Chapter 46
Transport Operations
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National EMS Education Standard CompetenciesNational EMS Education Standard Competencies
EMS Operations
Knowledge of operational roles and responsibilities to ensure patient, public, and personnel safety.
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National EMS Education Standard CompetenciesNational EMS Education Standard Competencies
Principles of Safely Operating a Ground Ambulance
• Risks and responsibilities of emergency response
• Risks and responsibilities of transport
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National EMS Education Standard CompetenciesNational EMS Education Standard Competencies
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.
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National EMS Education Standard CompetenciesNational EMS Education Standard Competencies
Infectious Diseases
Awareness and management of
• A patient who may have an infectious disease
• How to decontaminate equipment after treating a patient
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National EMS Education Standard CompetenciesNational EMS Education Standard Competencies
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
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National EMS Education Standard CompetenciesNational EMS Education Standard Competencies
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
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IntroductionIntroduction
• Today’s ambulances are equipped with state-of-the-art technology.
• Driving an ambulance requires good technique and judgment.
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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
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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
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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
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Checking the AmbulanceChecking the Ambulance
• Crew members are responsible for ensuring: − Unit is capable of
responding
− Proper equipment and supplies are available
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Checking the AmbulanceChecking the Ambulance
• A daily check of the ambulance should ensure that it can: − Start
− Steer
− Stop
− Stay running
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Checking the AmbulanceChecking the Ambulance
• Warning signs− Belt noise
− Break fade
− Brake pull
− Drift
− Steering pull
− Pulsating brake
− Steering play
− Tire squeal
− Wheel bounce
− Wheel wobble
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Ambulance Staffing and Development
Ambulance Staffing and Development
• Maximize productivity and minimize response times by analyzing:− Response times
− Productivity
− Unit costs
− Taxpayer subsidies
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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
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System Status Management (SSM)
System Status Management (SSM)
• Goals:− Maximize efficiency
− Reduce response time
• Considers:− Peak loads
− Strategic deployment
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Ambulance StationingAmbulance Stationing
• Goals: − Maximize
efficiency
− Minimize response times
• Factors include:− Distance vs. call
volume
− Special facilities
− Need for maintenance
− Storage
− Classrooms
− Sleeping quarters
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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.
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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.
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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.
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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.
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Traffic ControlTraffic Control
• Ensure orderly traffic flow, and prevent another crash.
• Place reflectors and other warning devices on both sides of crash.
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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.
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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.
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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.
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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.
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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
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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.
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Safe Driving PracticesSafe Driving Practices
• 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
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Safe Driving PracticesSafe Driving Practices
• 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.
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Safe Driving PracticesSafe Driving Practices
• 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.
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Safe Driving PracticesSafe Driving Practices
• Driver anticipation (cont’d)− Make eye contact with fellow drivers.
− Use turn signals.
− Never force a vehicle into oncoming traffic.
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Safe Driving PracticesSafe Driving Practices
• 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
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Safe Driving PracticesSafe Driving Practices
• Vehicle size and distance judgment− Vehicle length and width are critical when:
• Maneuvering
• Driving
• Parking
• Braking and passing
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Safe Driving PracticesSafe Driving Practices
• Backing up the emergency vehicle − Use a spotter.
− Agree with the spotter before moving.
− Keep your spotter in view at all times.
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Safe Driving PracticesSafe Driving Practices
• 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.
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Safe Driving PracticesSafe Driving Practices
• 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.
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Safe Driving PracticesSafe Driving Practices
• 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.
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Safe Driving PracticesSafe Driving Practices
• Parking at an emergency scene (cont’d)− Turn off headlights to avoid blinding oncoming
traffic at night.
− Always wear visible protective clothing.
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Emergency Vehicle ControlEmergency Vehicle Control
• Two ways to control a vehicle: − Changing directions
− Changing speed
• Drivers must constantly evaluate the road surface.
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Emergency Vehicle ControlEmergency Vehicle Control
• Road positioning and cornering− Take corners at the
speed that will put you in the proper road position
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BrakingBraking
• Getting a feel for brake pressure comes with experience and practice.
• Get to know each vehicle you drive.
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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.
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Controlled BrakingControlled Braking
• 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.
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Controlled BrakingControlled Braking
• Ice and slippery surfaces− All-weather tires and appropriate speed will
reduce traction problems.
− Be especially careful on bridges and overpasses.
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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.
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Laws and RegulationsLaws and Regulations
• 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.
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Laws and RegulationsLaws and Regulations
• 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.
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Laws and RegulationsLaws and Regulations
• 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.
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Laws and RegulationsLaws and Regulations
• 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.
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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?
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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
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Advantages of Using Air Ambulances
Advantages of Using Air Ambulances
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Disadvantages of Using Air Ambulances
Disadvantages of Using Air Ambulances
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Helicopter Medical Evacuation Operations
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.
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Helicopter Medical Evacuation Operations
Helicopter Medical Evacuation Operations
• Who receives a medevac?− Patients with time-dependent injuries or
illnesses
− Patients with serious conditions
− Trauma patients
• Who do you call?− Notify dispatcher
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Helicopter Medical Evacuation Operations
Helicopter Medical Evacuation Operations
• Medevac issues− Weather
− Environment/terrain
− Altitude
− Airspeed limitations
− Cabin size
− Cost
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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
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Landing Zone Safety and Patient Transfer
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.”
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Landing Zone Safety and Patient Transfer
Landing Zone Safety and Patient Transfer
• The proper approach is between nine-o’-clock and three-o’-clock.
• Walk in a crouched position when approaching.
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Landing Zone Safety and Patient Transfer
Landing Zone Safety and Patient Transfer
• 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.
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Landing Zone Safety and Patient Transfer
Landing Zone Safety and Patient Transfer
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Landing Zone Safety and Patient Transfer
Landing Zone Safety and Patient Transfer
• 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.
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Communicating with Other Agencies
Communicating with Other Agencies
• When requesting a medevac response, always include:− Ground contact radio channel
− Call sign of the unit
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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.
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Special ConsiderationsSpecial Considerations
• Landing on uneven ground− Approach from downhill side only.
− Do not move the patient until signaled.
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Special ConsiderationsSpecial Considerations
• 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.
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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.
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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.
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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.
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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.
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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.
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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.