EMS Operations
EMS operations are interconnected with multiple key areas, including patient assessment, scene safety, communication, and incident management.
Understanding the well-being of the EMT, proper lifting and moving techniques, and thorough patient assessments (scene size-up, primary, and secondary assessments) are essential for effective EMS response.
Effective communication and documentation are critical components for successful EMS operations and coordination with other emergency services.
Specialized topics such as hazardous materials, multiple-casualty incidents, incident management, highway safety, vehicle extrication, and response to terrorism are integral to comprehensive EMS operations and require additional knowledge and preparedness.
Standard
Understanding operational roles and responsibilities is essential for ensuring the safety of patients, the public, and EMS personnel during ground and air medical operations.
Safe operation of ground ambulances requires adherence to established principles, including proper vehicle handling, awareness of road conditions, and compliance with traffic laws.
Air medical operations involve additional considerations such as coordination with flight crews, understanding landing zone safety, and recognizing the unique risks associated with air transport.
Effective communication and teamwork among EMS providers and with other emergency services are critical to maintaining safety and operational efficiency.
Core Concepts
Ambulance calls involve several key phases: preparation, operating the ambulance, transferring and transporting the patient, handing off to emergency department staff, and terminating the call.
Preparation includes ensuring the ambulance and equipment are ready for immediate response.
Operating the ambulance safely and efficiently is crucial during response and transport.
Transferring and transporting the patient requires proper handling to maintain patient safety and care.
Patient handoff to emergency department staff involves clear communication and transfer of responsibility.
Terminating the call includes restocking, exchanging equipment, and thorough cleaning and disinfection of the ambulance and equipment to maintain readiness and infection control.
Air rescue should be considered when rapid transport is needed or ground transport is impractical, and proper procedures must be followed for its use.
Learning Objectives
Ambulance preparation requires ensuring the vehicle is fully stocked with required equipment and supplies, which can be found on official lists, and performing daily inspections of both the vehicle and patient compartment.
The type of ambulance affects readiness and the ability to respond effectively to different emergencies.
Receiving and responding to EMS calls involves obtaining key information from dispatch, acknowledging receipt, and confirming response.
Professional emergency vehicle operations demand safe driving attitudes, adherence to laws, proper use of warning devices, and awareness of factors affecting safety and efficiency; GPS use has both advantages and disadvantages.
Highway incident safety requires recognizing hazards and taking specific actions to protect responders and patients at the scene.
Patient preparation and transport includes assessing the patient and scene, selecting appropriate transport methods, packaging the patient, and ensuring safe and effective care during transport.
Terminating the call involves transferring the patient to hospital staff, restocking and cleaning the ambulance, and ensuring readiness for the next call both en route and upon return to quarters.
Air rescue considerations include knowing when to request air medical support, providing necessary information, preparing safe landing zones, and following correct procedures when approaching helicopters.
The five main operational phases for EMTs are: preparing for the call, receiving/responding, transferring the patient, transporting to the hospital, and terminating the call.
Preparing for the Ambulance Call
Modern ambulances function as mobile prehospital emergency departments and communications units, providing much more than just patient transport.
Ambulances are classified into Type I, Type II, Type III, and medium-duty types based on U.S. Department of Transportation specifications, with each type designed for specific operational needs and equipment loads.
Increasing equipment for specialty rescue, advanced life support, and hazardous materials has led to the use of medium-duty truck chassis to accommodate greater weight and provide larger storage and work areas.
Ambulance standards are evolving, with some states using the Federal Specification KKK-A-1822(F) ("K-Specs") and others adopting the National Fire Protection Association Standard 1917, reflecting ongoing debate and revision among EMS authorities.
Ambulance Supplies and Equipment
Ambulances must be properly equipped according to state and national guidelines to avoid regulatory penalties and ensure effective emergency care.
Ventilation and airway equipment includes portable and fixed suction devices (with wide-bore tubing and various suction catheters), portable oxygen apparatus with metered flow, oxygen masks and nasal cannulas in adult and child sizes, bag-valve masks (BVMs) for adults () and children (), nasopharyngeal airways (), oropharyngeal airways (sizes ), pulse oximeters with pediatric and adult probes, and infant suction devices.
Monitoring and defibrillation requires an automated external defibrillator (AED) with pediatric capabilities unless advanced life support personnel are present.
Immobilization devices include cervical collars (child and adult sizes), head immobilization devices, lower extremity traction devices, upper and lower extremity splints, and impervious backboards (short and long) with appropriate restraint straps and padding.
Bandages and dressings must cover a range of needs: sterile burn sheets, triangular bandages, sterile multitrauma dressings, abdominal pads ( or larger), gauze sponges (), gauze rolls, occlusive dressings ( or larger), adhesive tape ( and ), and arterial tourniquets.
Communication equipment is essential, requiring a two-way device for contact between EMS, dispatch, and medical direction.
Obstetric kits should include sterile towels, dressings (), umbilical tape, scissors, bulb suction, cord clamps, gloves, blankets, and thermal materials for newborns.
Miscellaneous equipment includes blood pressure cuffs (pediatric and adult), stethoscopes, pediatric reference tapes, thermometers, trauma scissors, cold packs, sterile saline, flashlights, blankets, sheets, towels, triage tags, emesis bags, bedpans, urinals, wheeled cots, folding stretchers, stair chairs, patient care forms, and lubricating jelly.
Infection control supplies must be latex-free and include eye and face protection, gloves (meeting NFPA 1999), gowns, shoe covers, hand cleansers, disinfectants, sharps containers, biohazard bags, and respiratory protection (N-95/N-100 masks).
Injury-prevention equipment includes restraints for all occupants, protective helmets, fire extinguishers (ABC), hazardous material guides, traffic signaling devices, and reflective safety wear (meeting ANSI/ISEA Class II or III standards).
Optional equipment may include glucose meters, elastic bandages, mobile phones, infant oxygen masks and resuscitation bags, alternative airway devices (e.g., King Airway, LMA), pediatric immobilization devices, topical hemostatic agents, CBRNE PPE, CPAP devices, and chemical antidote autoinjectors.
Optional basic life support medications can include albuterol, epinephrine autoinjectors, oral glucose, nitroglycerin, aspirin, naloxone, and other medications per protocol.
Interfacility transport may require additional or specialized equipment and personnel, especially for pediatric and neonatal patients.
Extrication equipment (often on rescue vehicles) includes disassembly tools (wrenches, screwdrivers, pliers, bolt cutters, axes, rams), spreading tools (hydraulic jack/spreader, saws, air-cutting guns), pulling devices (ropes, chains, come-along, hydraulic jacks, air bags), protective gear (reflectors, hard hats, goggles, fireproof blankets, gloves, jackets), and miscellaneous items (shovels, oil, wedges, generators, floodlights).
Local needs may require additional equipment for specialized rescues (water, aerial, mountain).
Ensuring Ambulance Readiness for Service
Readiness for emergencies requires you, your vehicle, and your equipment to be prepared at all times.
A vehicle and equipment inspection is required at the start of every shift, typically using a checklist to ensure nothing is missed.
The inspection process is important for recordkeeping and may be essential during investigations.
A brief shift report with the off-going crew helps identify any problems experienced during the previous shift; any issues should be communicated to a supervisor and thoroughly documented.
A thorough bumper-to-bumper inspection of the ambulance should be performed, covering both vehicle and equipment components.
Usually, the EMT assigned as the driver checks the vehicle, while the EMT crew leader checks the medical equipment.
SCAN 38-1
Inspect the ambulance body, wheels, tires, windows, and mirrors for damage, cleanliness, and proper adjustment; ensure all doors, latches, and locks function correctly.
Check fluid levels (oil, coolant, windshield wiper, brake, DEF, transmission) only after the engine has cooled, and inspect the battery for secure, corrosion-free connections.
Clean and inspect interior surfaces and upholstery, test window operation, horn, siren, emergency lights, and ensure driver’s seat and seat belts are functional.
Verify fuel level meets agency minimums and refuel as needed.
With the engine on, monitor dash indicators and gauges for warning lights or abnormal readings, test brake pedal travel, parking brake, steering, windshield wipers, and all vehicle lights (including warning, headlights, turn signals, flashers, brake, reverse, scene, and marker lights).
Check heating, air conditioning, on-board suction, and communications equipment (radios, cellular phones); ensure backup camera and alarm (if equipped) are operational.
Inspect and inventory all patient compartment and exterior cabinet equipment and supplies for completeness, condition, and operation, including oxygen cylinders, ventilation equipment, rescue tools, and battery-powered devices.
Record findings on the inspection report, correct deficiencies, replace missing items, and notify a supervisor of any unresolved issues.
Clean and disinfect the ambulance using approved materials to maintain infection control and professional appearance.
If essential equipment is missing, report the ambulance as out of service until deficiencies are corrected; always prioritize readiness for emergency calls.
Receiving and Responding to a Call
Dialing 911 provides immediate access to ambulance, fire, or police services at any time of day.
An Emergency Medical Dispatcher (EMD) is responsible for gathering information from callers, determining the appropriate emergency service, and notifying that service to respond.
When instructing others, especially children, always say "nine-one-one" instead of "nine-eleven" to avoid confusion, as there is no "eleven" button on phones.
Role of the Emergency Medical Dispatcher
Emergency Medical Dispatchers (EMDs) use a medical priority system to assign call priorities, provide prearrival instructions, dispatch and coordinate EMS resources, and work with other public safety agencies.
Key questions EMDs ask include: exact location (with detailed address information), callback number, chief complaint, patient’s age and sex, consciousness, and breathing status. These questions help determine the urgency and type of response needed.
Prearrival instructions are provided for life-threatening situations, such as guiding callers through CPR if the patient is not breathing or pulseless, and callers are instructed to stay on the line for further assistance or clarification.
Patient age and sex are important for determining the appropriate medical equipment and instructions, especially for pediatric cases.
Assessment of consciousness and breathing directly impacts response priority; unconscious or nonbreathing patients trigger maximum response and immediate instructions.
Traffic collision calls require additional questions to assess the need for multiple units, determine if there is entrapment or fire risk, and decide which units respond “hot” (emergency) or “cold” (non-emergency).
Clear and repeated communication of dispatch information ensures accuracy, with crews often required to repeat the address or acknowledge the call via computer systems, sometimes aided by GPS for navigation.
Operating the Ambulance
Safe ambulance operation requires both physical and mental fitness, including being free from impairments, controlling emotions, performing under stress, maintaining a positive but cautious attitude, and tolerating the unpredictable behavior of other drivers.
Never drive under the influence of substances or medications that impair ability, and always comply with agency policies regarding medication use, license status, and corrective lenses if required.
Evaluate your readiness to drive based on stress, illness, fatigue, or sleepiness, and use energy drinks with caution as they may not fully counteract fatigue’s effects on reaction time.
Emergency vehicle operators are subject to specific laws and exemptions, such as exceeding speed limits, passing through red lights, and parking as needed, but only during true emergencies and with due regard for the safety of others.
Privileges for emergency driving do not grant immunity for reckless or unsafe behavior; operators can face legal consequences if they fail to drive responsibly, even during emergencies.
Exemptions apply only when warning devices (lights and siren) are used as prescribed by law, and only for true emergencies where life or limb is at risk.
The use of sirens and horns should be judicious and situation-appropriate; overuse can increase patient anxiety, cause operators to drive faster, and may not always alert other drivers due to environmental factors or vehicle soundproofing.
Visual warning devices, including headlights and emergency lights, increase ambulance visibility; use all emergency lights during high-priority responses, but avoid using four-way flashers or directional signals as emergency lights.
Excessive speed increases collision risk and stopping distance, and can negatively affect patient care; drive at a pace appropriate to the situation, obeying traffic laws except during true emergencies.
Seat belts must be worn by all occupants whenever the ambulance is in motion to maximize safety.
Escorted and multiple-vehicle responses introduce additional hazards, such as following too closely or confusion at intersections; communication and caution are essential in these situations.
Ambulance collisions often occur in good weather and daylight, especially at intersections, and are influenced by factors like traffic patterns, time of day, weather, road construction, and railroad crossings.
Always slow down and check for trains at railroad crossings, as not all crossings have lights or gates, and blocked crossings may require alternate response plans.* Half of railroad crossings lack gates and only have lights and signs, so you must always stop and look before crossing tracks to ensure safety.
Bridges and tunnels experience slower traffic during rush hours, and bridges freeze before roadways, increasing collision risk, including for ambulances.
Reduced speed limits near schools and school buses slow traffic; never pass a stopped school bus with flashing red lights, and wait for the driver’s signal before proceeding.
Children may be attracted to emergency vehicles near schools or playgrounds, so always slow down and follow school crossing guards’ directions.
GPS navigation is helpful for reaching emergency scenes and hospitals, but knowing the local area is crucial since GPS routes may be inaccurate due to construction or changes.
Operating GPS or mapping devices while driving can be distracting and increase crash risk; secure your device in a mount or have your partner provide directions to keep both hands on the wheel.
Point of View: EMT
Driving in hazardous conditions, such as snow, significantly increases risk for EMS responders; careful, slow driving and situational awareness are essential to avoid becoming part of the incident.
Familiarity with your service area is crucial; always check detailed maps and GPS before responding, and if lost, stop safely to reorient and seek additional instructions.
Minimize the use of lights-and-siren responses, as they carry high risk; always wear seat belts and avoid distractions such as eating, drinking, using mobile devices, or listening to music while driving.
At highway incidents, only necessary units should be on the highway to reduce risk; additional units should stage off the highway until needed.
Avoid crossovers on limited-access highways unless it is safe to do so without obstructing traffic; it may be safer to use the next off-ramp to change direction.
The first arriving unit should position their vehicle to protect the scene, ideally using a fire truck as a barrier, and ambulances should be parked in a safe loading area out of traffic flow.
Scene size-up and communication are important; cancel unnecessary resources to prevent overcrowding and increased risk.
Always wear appropriate personal protective equipment (PPE): ANSI-approved safety vests and helmets for general scenes, and full turnout gear if extrication is required.
Use cones or flares to warn and direct traffic, but avoid flares if there are fuel leaks; reduce emergency lighting to prevent blinding oncoming drivers.
When placing vehicles at the scene, avoid disturbing evidence such as debris and skid marks, and ensure ambulances are positioned for safe patient loading and egress, ideally on the same side of the road as the incident.
Never carry stretchers or have personnel cross active lanes of traffic; keep all ambulances facing the same direction and prevent blocking of ambulance exits.
Avoid backing up emergency vehicles whenever possible due to blind spots; if backing up is necessary, always use a spotter to guide the process safely.
Transferring the Patient to the Ambulance
You must follow four main steps when transferring a patient to the ambulance: select the proper patient-carrying device, package the patient, move the patient to the ambulance, and load the patient into the ambulance.
The wheeled ambulance stretcher is the most commonly used device for patient transfer.
Packaging involves preparing the patient and the carrying device as a single unit, ensuring all wounds are cared for, impaled objects are stabilized, and dressings and splints are checked before transfer.
Proper packaging balances speed and safety—patients must be secured to prevent falls or worsening injuries, but the process should be efficient to ensure prompt hospital transport.
Covering the patient helps maintain body temperature, protects from weather, and provides privacy; use appropriate coverings for the weather, and ensure sheets and blankets are tucked in securely.
In cold or wet conditions, cover the patient’s head (leaving the face exposed) to reduce heat loss, and use a plastic cover over blankets during transfer if necessary.
Patient-carrying devices should have at least three straps: one at the chest, one at the hips or waist, and one at the lower extremities; straps should be snug but not so tight as to cause discomfort or breathing difficulty.
Some stretchers have harness-style straps for additional upper body restraint, which should always be used if available to prevent patient movement during a collision.
All patients, including those receiving CPR, must be secured to the carrying device before transfer; some states require shoulder harnesses to prevent sliding during sudden stops.
The EMT should remain seated and wear a seat belt or harness during transport to minimize injury risk, as unsecured EMTs are more vulnerable in collisions.
All equipment in the patient compartment must be secured to prevent it from becoming a projectile during a collision, which could injure both the patient and EMT.
Think Like an EMT
Proper vehicle placement is essential for safety and accessibility—you must ensure both your safety and that of your vehicle, while keeping equipment conveniently accessible.
At a railroad car derailment, park the ambulance a safe distance away from the tracks and any potential hazards, such as leaking chemicals or unstable cars, to avoid secondary incidents.
For a collision on the interstate where emergency vehicles are already blocking oncoming traffic, park the ambulance behind the blocking vehicles, using them as a barrier, and position your vehicle to protect the scene and provide easy access to equipment.
At a domestic violence scene where police have not yet arrived, do not approach the scene directly; instead, park at a safe distance and wait for law enforcement to secure the area before proceeding, prioritizing your personal safety.
Transporting the Patient to the Hospital
Transport in emergency care includes all activities from patient loading into the ambulance to the transfer of care at the hospital, not just the act of driving.
Multiple tasks are required during transport, emphasizing the importance of continuous patient management and communication until hospital personnel assume responsibility.
Preparing the Patient for Transport
Continue patient assessment during transport, ensuring conscious patients are breathing comfortably and unconscious patients have adequate airway and air exchange.
Secure the stretcher in the ambulance using the locking device at both ends to prevent movement and ensure patient safety during transit.
Position and secure the patient according to their condition: use the recovery position for unconscious patients without spine injury, a sitting position for those with breathing difficulty (if no spinal injury), and keep trauma or cardiac arrest patients supine, possibly on a backboard.
Adjust security straps after loading to ensure they are snug but not so tight as to restrict circulation, breathing, or cause pain.
Prepare for possible respiratory or cardiac complications by placing a spine or CPR board under the mattress if cardiac arrest is likely, to allow for immediate resuscitation if needed.
Loosen constricting clothing to improve circulation and breathing, and explain any actions to the patient before adjusting their clothing.
Manage accompanying relatives or friends by encouraging alternative transportation, or if necessary, seating them in the operator’s compartment with a seat belt; use a child car seat for uninjured children.
Secure personal effects in the ambulance and follow local policies for documenting and safeguarding these items, especially at accident scenes.
Communicate with the patient to reduce anxiety, build rapport, and provide reassurance during transport.
Keep patients on the stretcher rather than on benches or seats, unless special circumstances exist, for maximum safety and control.
For high-priority patients, essential preparation steps can be completed en route to avoid delaying transport.
Caring for the Patient en Route
At least one EMT must be in the patient compartment during ambulance transport, but having two is preferred for optimal care.
You are responsible for multiple tasks en route, including notifying the hospital with a patient report, which can be done via radio, phone, or electronic apps.
Emergency care must continue during transport, such as maintaining an open airway, resuscitation, addressing patient needs, providing emotional support, and updating assessments as needed.
Safe transport practices are essential: complete patient packaging before loading, repeat vital signs as necessary, and keep the hospital informed.
Always remain seat-belted when possible to reduce injury risk in case of a crash, and secure all equipment to prevent it from becoming a projectile.
Use lights and sirens only in true life-or-death emergencies, as their use greatly increases the risk of a crash and is rarely necessary (less than 5% of transports).
Pediatric Note
Providing comfort to frightened children is crucial; using sanitized, soft, brightly colored toys like teddy bears can help calm them during emergencies.
Children may be especially distressed due to the chaotic environment, absence of parents, and unfamiliarity with responders, making it harder to obtain information.
Female EMTs or police officers may help children feel more at ease, as some children are more comfortable talking to women.
A calm, reassuring demeanor and a friendly tone are essential in gaining a child's trust and providing emotional support.
Gather patient information if the child is conscious and it does not interfere with care; this helps with reporting and can distract the child from distress.
Ask questions in a friendly, professional manner, avoiding an interrogative approach.
Monitor and record vital signs regularly; changes, such as an increased pulse rate, may indicate worsening conditions like shock.
Reassess vital signs every 5 minutes for unstable patients and every 15 minutes for stable patients to detect any changes in condition.
Communicate patient assessment, management details, and estimated time of arrival to the receiving facility to ensure continuity of care.
Transferring the Patient to the Emergency Department Staff
Ensure a smooth and incident-free transfer of the patient to emergency department personnel.
Prioritize the continuation of patient-care activities during the transfer process.
Follow specific steps to facilitate an effective handoff, maintaining clear communication and patient safety.
SCAN 38-2
Always ensure direct transfer of patient care to hospital staff—never leave a nonemergency patient unattended or without formally handing over responsibility, as this could be considered abandonment.
If the emergency department is busy, it may be better to keep the patient in the ambulance with an EMT until hospital staff are ready to receive them, to avoid unnecessary distress or exposure to chaotic environments.
Continue emergency care measures until hospital staff can assume responsibility, and do not demand immediate attention if staff are occupied with more critical cases.
When transferring the patient, assist with moving them to a hospital stretcher and provide a thorough verbal report, emphasizing any changes in the patient’s condition.
Complete all required documentation, including the prehospital care report (PCR), in a quiet area after patient care is finished, ensuring all necessary information is included.
Transfer any patient valuables or personal effects to a responsible staff member, following service policies such as obtaining a written receipt, and document the transfer of belongings.
Before leaving the hospital, confirm with the emergency department nurse or physician that your services are no longer needed to avoid premature departure, especially in rural settings where further transfer may be required.
Terminating the Call
You are responsible for ensuring that both personnel and equipment are fully prepared for the next emergency response after completing a call.
Your duties include more than just changing stretcher linen and cleaning the ambulance; you must also complete several tasks at the hospital, during the return trip, and upon arrival at the station.
Key tasks involve terminating the call, replacing and exchanging used equipment, and thoroughly cleaning and disinfecting both the unit and all equipment.
At the Hospital
Ambulance crews should start preparing the ambulance for the next call while still at the hospital.
Time, equipment, and space constraints may limit how thoroughly the ambulance can be cleaned at the hospital.
Despite these limitations, you should prioritize getting the vehicle ready as quickly as possible for the next patient.
SCAN 38-3
Quickly clean the patient compartment using Standard Precautions and follow biohazard-disposal procedures for contaminated items like dressings and suction catheters, in accordance with OSHA exposure-control plans.
Thoroughly clean up blood, vomitus, and other body fluids from the floor and equipment, placing used towels and contaminated materials directly into red biohazard bags; remove trash and sweep or mop as needed, and bag dirty linens for laundering.
Use deodorizer and ventilation to neutralize odors, but rely primarily on natural ventilation and the ambulance’s exhaust vent for odor removal.
Prepare and disinfect respiratory equipment by cleaning nondisposable, reusable parts of respiratory-assist and inhalation-therapy devices, and disinfecting the suction unit; replace used disposable items with new ones.
Replace expendable items (such as sterile dressings, bandages, towels, disposable oxygen masks, gloves, sterile water, and oral airways) according to your agency’s supply-replacement policy or hospital agreement, ensuring a one-for-one exchange and avoiding abuse of the program.
Exchange equipment (like splints and spine boards) per local policy, inspecting exchanged items for completeness and operability, and reporting any broken or incomplete equipment for repair or replacement.
Make up the ambulance cot by raising the stretcher, removing soiled linens, cleaning the mattress with an EPA-approved disinfectant or a 1:100 bleach/water solution for blood, and neatly arranging sheets, blankets, and pillows according to procedure, ensuring all linens are contained within the stretcher frame.
Ensure the stretcher is presentable and ready for the next patient, using only unstained linens and maintaining a neat appearance to inspire confidence.
Store all linens, blankets, and pillows neatly, fold or tuck them within the stretcher frame, and return the stretcher to the ambulance.
Replace any nondisposable patient-care items and check for any equipment left behind in the hospital before leaving.
En Route to Quarters
Defensive driving and safety must be maintained at all times, including the return to quarters; all occupants must wear seat belts.
You should notify the Emergency Medical Dispatcher (EMD) when returning to quarters and indicate your availability for service; also inform the EMD if you leave the ambulance unattended during the return.
Ventilate the ambulance if necessary, especially after transporting a patient with an airborne communicable disease or if there are lingering odors, by opening windows or using the ventilation system (not on recirculate).
Refuel the ambulance according to local policy, ensuring there is always enough fuel to respond to emergencies and reach the hospital without risk of running out.
In Quarters
After returning to quarters, several tasks must be completed to prepare the ambulance for the next call and to place it back in service.
SCAN 38-4
Always follow OSHA exposure-control plans and wear gloves when handling contaminated materials, cleaning equipment, or disinfecting the ambulance to prevent exposure to infectious diseases.
Separate contaminated and noncontaminated linens by placing contaminated linens in a biohazard container and noncontaminated linens in a regular hamper.
Clean and disinfect all equipment that contacted the patient, including stretcher covers and respiratory equipment, using appropriate brushes and cleaning solutions as specified by your agency’s infection control plan.
Disassemble and thoroughly clean respiratory-assist and inhalation therapy equipment, ensuring all surfaces are exposed, scrubbed, rinsed, and soaked in an EPA-approved germicidal solution for the recommended time, then air-dried for 12–24 hours.
Sanitize the patient compartment and any fixed equipment or surfaces that may have been exposed to body fluids using an EPA-approved germicide.
Practice personal hygiene by washing thoroughly, especially under fingernails, changing soiled clothes promptly, and never taking contaminated clothing home for washing; bring a spare uniform and use on-site laundry facilities.
Restock expendable items and replace or refill oxygen cylinders according to your service’s procedures.
Replace patient-care equipment and perform any required postoperation vehicle maintenance, reporting or correcting any issues found.
Clean the vehicle’s exterior and check for damage or needed repairs to maintain a professional appearance and operational readiness.
Complete all required documentation and report the unit ready for service as soon as possible after returning to quarters.
Air Medical Transport
Air rescue transport, such as helicopters or fixed-wing aircraft, is used when it is the best option for patient care due to specific circumstances.
Decisions to use air transport depend on factors like geography, the patient's condition, and the availability of air rescue services.
Local protocols should always be followed when determining whether to use air rescue for patient transport.
When to Call for Air Medical Transport
Air medical transport is used for both operational and clinical reasons. Operational reasons include speeding transport to distant trauma centers, facilitating rapid evacuation when ground extrication is delayed, and accessing remote locations only reachable by helicopter.
Clinical reasons focus on high-priority patients needing rapid transport. These include patients in shock, with a Glasgow Coma Scale score less than 10, head injuries with altered mental status, chest trauma with respiratory distress, penetrating body cavity injuries, proximal amputations, extensive burns, serious mechanisms of injury, or post-cardiac arrest with a pulse.
Certain medical conditions also warrant air transport. Examples are cardiac patients needing catheterization or surgery, stroke patients, and those requiring hyperbaric oxygen therapy (such as after carbon monoxide poisoning). Typically, these patients are stabilized at a local hospital before being transferred by helicopter to specialized facilities.
Cardiac-arrest patients are generally not flown unless hypothermic. Local protocols should always be followed when determining the need for air medical transport.
How to Call for Air Medical Transport
Air rescue can be requested by law enforcement, fire, or EMS command officers at an incident scene, and as an EMT, you may also request air rescue through dispatch or medical direction if needed.
When requesting air rescue, you must provide your name, callback number, agency name, details of the situation, precise location (including crossroads and landmarks), and the location of a safe landing zone; include GPS coordinates if possible.
Always follow local protocols when initiating an air rescue request.
How to Set up a Landing Zone
A helicopter landing zone (LZ) should be at least 100 feet by 100 feet (about 30 meters by 30 meters) on ground with a slope less than 8 degrees.
The LZ and approach/departure paths must be free of obstacles such as wires, towers, vehicles, people, and loose objects.
Mark the LZ with one flare placed upwind; during night operations, avoid shining lights into the pilot’s eyes and keep emergency lights on.
Some aeromedical systems may require a larger LZ, such as 125 feet by 125 feet (38 meters by 38 meters).
Ground safety courses and landing zone coordinator training are available, and assistance from law enforcement or fire agencies may be requested.
When communicating with air rescue, describe the terrain (e.g., hilltop, valley), major landmarks (e.g., river, highway, factory), estimated distance to the nearest town, and any hazards (e.g., wires, ditches, wind direction and speed).
How to Approach a Helicopter
Only approach a helicopter when escorted by flight personnel to ensure safety and proper procedures.
Let the helicopter crew manage patient loading and follow their instructions at all times.
Stay away from the tail rotor, as it is extremely dangerous and can cause severe injury.
Keep all vehicles and foot traffic at least 100 feet (30 meters) from the helicopter to maintain a safe perimeter.
Do not smoke within 200 feet (60 meters) of the aircraft to prevent fire hazards.
Always be aware of designated danger areas around helicopters and never walk near the tail rotor.
SCAN 38-5
Helicopters have specific approach and danger zones: The main rotor is located on top, and the tail rotor is at the back; both present significant hazards.
Safe approach areas are at the front and sides near the cockpit: You should always approach a helicopter from these areas, never from the rear or near the tail rotor.
Terrain affects safe approach: When a helicopter is landed on a slope, always approach from the uphill (flatter) side, never from the downhill (steep) side, to avoid the danger of the rotor blades being closer to the ground.
Proper posture is important: When approaching, you should crouch to stay below the level of the main rotor blades.