EMT Ch. 38- Transport Operations

type I ambulance

conventional, truck cab-chassis w/ modular ambulance body that can be transferred to newer chassis as needed

type II ambulance

standard van, forward-control integral cab-body ambulance

type III ambulance

specialty van cab w/ modular ambulance body that is mounted on cutaway van chassis

phases of ambulance call

1. preparation for call

2. dispatch

3. enroute

4. arrival at scene

5. transfer of pt to ambulance

6. enroute to receiving facility (transport)

7. at receiving facility (delivery)

8. enroute to station

9. postrun

airway/ventilation equipment

• OPAs (adult, child, infant)

• NPA (adult, child)

• CPAP equipment

• equipment for advanced airway procedures (if authorized)

• two portable artificial ventilation devices operating independently of O₂ supply (pocket masks, BVM)

• portable & mounted suctioning units

• 2+ O₂ supply units (portable & installed)

• single-use humidifier

basic wound care supplies

• trauma shears

• sterile sheets

• sterile burn sheets

• adhesive tape (multiple widths)

• self-adhering, soft roller bandages

• sterile dressings

• gauze

• abdominal/laparotomy pads

• sterile universal trauma dressings

• sterile, occlusive, nonadherent dressings (sterilized aluminium foil)

• assortment of adhesive bandages

• tourniquets

splinting supplies

• traction splint (adult, child)

• arm/leg splints (inflatable, vacuum, cardboard, plastic, foam wire-ladder, padded board)

• triangular bandages

• roller bandages

• short backboard

• long backboard

• head immobilization devices

• cervical collars

childbirth supplies

1+ sterile emergency obstetric kit

• surgical scissors

• hemostats/special cord clamps

• umbilical tape/sterilized cord

• smaller rubber bulb syringe

• towels

• gauze sponges

• pair of sterile gloves

• plastic wrap

• sanitary napkins

• plastic bag

• baby stocking cap

• baby blanket

pt transfer equipment

• primary wheeled ambulance stretcher

• wheeled stair chair for use in narrow spaces

• long backboard

• short backboard/immobilization device

• scoop stretcher

• vacuum mattress

• portable/folding stretcher

• flexible stretcher

• basket stretcher

• binder lift

safety/operations equipment

• PPE

• equipment for work areas

• preplanning/navigation guides

• face shields

• N95 masks

• gowns, shoe covers, caps

• turnout gear

• hard hats/helmets w/ face shields/safety goggles

• safety shoes/boots

• tactical vest

• flashing/reflective warning devices

• 2 high-intensity halogen flashlights

• fire extinguisher (ABC, dry chemical)

• portable flood lights

• GPS/MDTs

• maps

dispatch information

• nature of call

• name, current location, call-back number of caller

• location of pt

• number of pts, severity of conditions

• any other special problems/pertinent info about hazards/weather conditions

fend-off parking position

ambulance parked at diagonal angle w/ front wheels turned away from scene

cleaning

process of removing dirt, dust, blood, other visible contaminants from surface/equipment

disinfection

killing of pathogenic agents by directly applying chemical made for that purpose to surface/equipment

high-level disinfection

killing of pathogenic agents by using potent means of disinfection & use of thorough application processes

sterilization

process (use of heat) removing all microbial contamination

guidelines for safe ambulance driving

1. select shortest/least congested route to scene at time of dispatch

2. avoid routes w/ heavy traffic congestion; know alternate routes to each hospital during rush hours

3. avoid one-way streets; do not go against flow of traffic unless absolutely necessary

4. watch carefully for bystanders when approaching scene

5. park ambulance in safe place upon arrival; if parked facing traffic-turn off headlights unless necessary to illuminate scene; if parked blocking part of road-keep warning lights on

6. drive within speed limit during transport, except in rare extreme emergencies

7. go w/ flow of traffic

8. always drive defensively

9. always maintain safe following distance (4 sec rule)

10. maintain open space/cushion in adjacent lane as an escape route in case vehicle in front stops

11. use sirens if emergency lights are used

12. always assume other drivers will not hear siren/see emergency lights

13. always exercise due regard for person/property

possible permitted actions during emergency call w/ lights/sirens on

• park/stand in an otherwise illegal location

• proceed through red traffic light/stop sign but never w/o stopping first

• drive above posted speed limit

• drive against flow of traffic on one-way street, make turn that is normally illegal

• travel left of center to make an otherwise illegal pass

true/false: in many states, it is unlawful for an emergency vehicle to exceed the speed limit in school zones

true

reasons to call for a medevac:

• ground transport time is too long considering pt’s condition

• pt requires urgent initiation of specialized treatment not locally available; road/traffic/environmental conditions limit/completely prohibit use of ground ambulance

• pt requires advanced care that cannot be provided

pts who receive a medevac:

• pts w/ time-dependent injuries/illnesses (stroke, heart attack, serious traumatic injuries)

• serious conditions occurring in remote areas (scuba diving accidents, near drownings, skiing/wilderness)

• high-risk obstetric pts, candidates for limb replantation, pts requiring air transport to burn center, hyperbaric chamber center, venomous bite center

who to call for a medevac

• dispatcher

• flight crew

establishing a medevac landing zone

• ensure area is hard/grassy

• 60×60 ft-100×100 ft

• slope of site should be <5-7°

• ensure area is clear of loose debris

• ensure immediate area does not have overhead/tall hazards

• use weighted cones/position emergency vehicles at corners of landing zone to mark site

• move all nonessential people/vehicles to safe distance outside of landing zone

• create a wind directional device to aid approach/departure if requested

safety guidelines for operating at landing zone

• familiarize self w/ helicopter hand signals used within jurisdiction

• do not approach helicopter unless instructed by flight crew

• ensure all equipment/pt is properly secured to stretcher

• remove all loose articles/belongings from person

• always approach aircraft from front unless instructed otherwise

• smoking, open flames, flares are prohibited

• wear eye protection during approach/departure