1. ATTENDANT CLASS Fall 2008 RPI AMBULANCE

2. Overview Module I: Introduction to RPI Ambulance Module II:RPI Ambulance and the Law Module III: Safety Module IV: Radio Communications Module V: Lifting and Moving Module VI: Vital Signs & Diagnostic Equipment Module VII: Airway Module VIII: Breathing Module IX: Circulation Module X: Splinting and Spinal Immobilization

3. RPI Ambulance Attendant Class Module I: Introduction to RPI Ambulance

4. 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.

5. 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

6. Crew Positions Crew Chief Driver Attendant Observer

7. 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

8. 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.

9. Crews and Events

10. 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.

11. 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.

12. RPI Ambulance Attendant Class Module II: RPI Ambulance and the Law

13. 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

14. 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.htm http://www.hss.gov/ocr/hipaa/

15. RPI Ambulance Attendant Class Module III: Safety

16. 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.

17. 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

18. RPI Ambulance Attendant Class Module IV: Radio Communications

19. 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.

20. 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

21. 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.

22. 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.

23. 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”).

24. 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.

25. RPI Ambulance Attendant Class Module V: Lifting and Moving

26. 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.

27. Moving Devices - Stretcher Indications: General EMS calls Considerations: A backboard is needed in addition for a suspected spinal injury. Example: Patient with abdominal pain

28. 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 floor without an elevator, with shortness of breath

29. Moving Devices – Backboard Indications: Suspected neck or back injury, CPR. Contraindications: None Example: Patient who fell from a 20’ ladder

30. 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

31. RPI Ambulance Attendant Class Module VI: Vital Signs and Diagnostic Equipment

32. 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

33. 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)

34. 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

35. 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

36. 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.

37. Skin Color and Condition Observe: –Color: Normal, Flushed, Pale, Cyanotic (blue), Mottled (grey), Jaundiced (yellow). –Condition: Warm, Dry, Cool, Diaphoretic (sweaty).

38. 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.

39. RPI Ambulance Attendant Class Module VII: Airway

40. 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

41. 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

42. 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!

43. RPI Ambulance Attendant Class Module VIII: Breathing

44. Oxygen Tanks Components: –Tank –O-Ring –Regulator Sizes –D –E –M Stat Date Pressure Gauge Flow Valve

45. 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.

46. 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.

47. 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.

48. 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

49. RPI Ambulance Attendant Class Module IX: Circulation

50. 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

51. 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)

52. 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.

53. RPI Ambulance Attendant Class Module X: Splinting and Immobilization

54. 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.

55. 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

56. 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

57. 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

58. 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

59. Alright, it’s over. Any questions?