1. Transport operation Dr. Miada Mahmoud Rady

2. Introduction What is the single piece of equipment that is used in every paramedic call allover the world?

3. The Ambulance

4. That the rate EMS deaths in car crashes is more than deaths of firefighters and low enforcement officers combined¡¡¡¡. Did you know ……?

5. That is why knowing how to safely and properly drive your ambulance in emergency mode, how to keep your ambulance always ready and how to care for your ambulance is crucial, It means the difference between life and death for you and your patient

6. Emergency Vehicle Design The US General Services Administration is responsible for determining ambulance standards. Design and manufacturing guidelines, outlined by the DOT KKK 1822, are reviewed and updated every 5 years. There are 3 types of ambulances.

7. A.Type I: Box shaped passenger compartment Mounted on truck style chassis B.Type II: Van style vehicle Raised roof Extended rear compartment TYPE 1 TYPE 2 Ambulance type

8. C.Type III: Modular box like a Type I Mounted on a van chassis TYPE 3 Ambulance type

9. Improvements made to emergency vehicles over the years include: 1.Enlargement of the patient compartment. 2.Safety nets on the squad bench. 3.Padded cabinet corners. Improvement of the ambulance structure :

10. Many organizations control the list of supplies and equipment that should be carried on ambulances : 1.The Occupational Safety and Health Administration (OSHA). 2.The American College of Surgeons (ACS). 3.The National Fire Protection Association (NFPA). Ambulance Equipment

11. Every inch of space on an ambulance is dedicated to storing and securing equipment. These equipments are divided broadly into : A.Basic medical equipments. B.Non- medical equipments. Ambulance Equipment

12. 1. Patient transfer equipment. 2.Airways and suction equipment. 3.Artificial Ventilation and oxygen inhalation devices. 4.Cardiac compression equipment and AED. 5.Basic wound care and splinting supplies. 6.Childbirth supplies. 7.Medications. Medical equipments

13. 1.Personal Safety Equipment. 2.Street maps. 3.Global positioning systems (GPS) 4.Computer-aided dispatch consoles. Non - Medical Equipments

14. Ambulance staffing has been a major source of controversy due to increased costs. So in an effort to maximize productivity and minimize response times, high-performance EMS systems should analyze : 1.Response times : A significant fraction (usually 90%) of all responses must be achieved in an established time. 2.Productivity : how many patient transports per hour each ambulance achieves. Ambulance Staffing and Development

15. 3.Unit costs : determined by the cost to respond to calls as well as number of hours units were active. 4.Taxpayer subsidies : because in most western countries, EMS is sometimes provided by private sector. Ambulance Staffing and Development

16. Ambulance and EMS systems  EMS and ambulance service is delivered by : 1.Fire department whose personnel are cross-trained in EMS, most commonly used method in USA. 2.Private for profit organization. 3. public agencies other than fire department. 4.public-private partnerships. ………………… In each type ambulance staffing differs.

17. Developed by Jack Stout in 1983. In SSM data is collected and used to determine ambulance service demands, taking into consideration peak loads. Goal : to maximize efficiency and reduce response time of the ambulance service. Peak loads is increased demand during certain hours. SSM helps organize peak demand staffing by applying Shift schedules. System Status Management (SSM).

18. Before responding to a call, crew members are responsible for ensuring the ambulance is capable of responding and that the proper equipment and supplies are available. A daily check of the ambulance should ensure that it can: 1.Start 2.Steer 3.Stop 4.Stay running Checking the Ambulance 4 S

19. How to make sure that the ambulance is always ready to respond ? 1.Each time supplies and equipment are used, they should be properly cleaned or replaced. 2.Medication expiration dates must be checked regularly. 3.Diagnostic equipment must be tested or calibrated regularly. 4.Daily inspection. Checking the Ambulance

20. 1. Walk-around. 2. Mechanical/fluids. 3.Communications. 4. Life-sustaining. 5. Safety. 6. Other medical. Is it there?Does it work?Will it fail? Checking the Ambulance

21.  Start the engine, Turn on the lighting equipment, walk around the vehicle, looking and listening. 1.New body damage. 2. Fluid leaks. 3. Tire wear. 4. Warning signs. Checking the Ambulance Walk around

22. 1.Under the hood. 2.Engine on / engine off. 3.Make sure that the car is able to start, steer, stop and stay running. 4.Look for warning signs. Checking the Ambulance Mechanical/fluids

23. 1.Belt noise. 2.Break fade. 3.Brake pull. 4.Drift. 5.Steering pull. 6.Pulsating brake. 7.Steering play. Warning signs

24. Communications 1. Dispatch. 2. Handheld. 3. Medical control. Life sustaining 1. Suction. 2. Oxygen/resuscitation. 3. Medication. 4. Defibrillation.

25. Safety 1. Standard Precautions equipment. 2. Binoculars. 3. Scene wear Other medical 1. Carry-in kits 2. Maps 3. Personal gear

26. Phases Of The Call As you prepare to respond En route to the scene Arrival at the scene Traffic control Transferring patient to the ambulance Transporting patient to the hospital The delivery phase Post call activities

27.  As you receive the call, you should: 1.Fasten seatbelts and shoulder harnesses. 2.Inform dispatch that your unit is responding. 3.Confirm nature and location of call and ask for other available information. As you prepare to respond

28.  The most dangerous phase as most ambulance crashes occur in this phase  In this phase you should prepare to assess and care for the patient so the following steps should be followed: 1.Review dispatch information. 2.Assign specific duties and scene management tasks. 3.Decide which equipment and which stretcher to take. En Route To The Scene (Route Phase)

29. 1.Look for safety hazards and Do not enter the scene if there are any hazards to you. 2.If there are hazards, the patient should be moved before you begin care. 3.Evaluate the need for additional units or other assistance. 4.Determine the mechanism of injury in trauma patients or the nature of the illness in medical patients. 5.Evaluate the need to stabilize the spine. Arrival at the scene

30.  Goal : ensure orderly traffic flow and prevent another crash.  Place reflectors and other warning devices on both sides of crash. Traffic control

31. 1.Package the patient for transfer 2.Secure the patient with at least three straps across the body. 3.Use stopping straps over the shoulders to prevent the patient from continuing to move forward in case the ambulance suddenly slows or stops. 4.Properly lift the patient to the ambulance. 5.Continue to care for patient, This Your First Priority. Transferring The Patient To The Hospital

32. 1.Inform dispatch when you are ready to leave the scene. 2.Report the number of patients and the name of the receiving hospital to the dispatch. 3.Inform medical control about your patient(s) and the nature of the problem(s). 4.Conduct ongoing assessments and address any new problem( you first priority ). Transporting patient to the hospital

33. 1.Inform dispatch as soon as you arrive at the hospital and. 2.Report your arrival to the triage or arrival personnel. 3.Physically transfer the patient from the stretcher to the bed directed for the patient. 4.Present a complete verbal report at the bedside to physician who is taking over the patient’s care. 5.Complete a detailed written report and leave a copy with an appropriate staff member. Delivery phase

34. 1.Complete and file additional written reports. 2.Inform dispatch of your status, location, and availability. 3.Clean and decontaminate the inside of the ambulance, according to state and local regulations. 4.Dispose of any contaminated waste in the manner prescribed by your agency. 5.Clean the outside of the ambulance as needed. Post call activities

35. 6.Replace or repair broken or damaged equipment without delay. 7.Replace any other equipment or supplies that were used. 8.Refuel the vehicle if the fuel tank is below required reserves.

36. Defensive Ambulance Driving Techniques

37. defensive ambulance driving course  More than 6000 ambulance crashes every year.  An ambulance involved in a crash causes: 1.Delays patient care 2.Take the lives of EMS providers, motorists, or pedestrians  That is why participation in a certified defensive driving course is mandatory in certain countries.

38. 1.Diligence and caution. 2.Proper attitude and tolerance to other drivers. 3.Good judgment and knowledge. 4.Physical and emotional fitness. 5.Never drive or provide medical care if you are taking medications that may cause drowsiness Driver characteristics

39. 1.Even if you use GPS, make sure you have easy access to detailed street and area maps. 2.Become familiar with the roads and traffic patterns in your area so you can plan alternative routes. 3.Never drive if you feel fatigued. 4.Avoid distractions ( never type, text, eat, drink or operate any data devices while driving) Safe driving practices

40. 6.All passengers, including EMS personnel (unless critical for patient care), should wear seatbelts and shoulder restrains. 7.Speed does not save lives; Good Care does. (this is the single most important rule). 8.Know your ambulance its length and width and Learn how it accelerates, corners, sways, and stops. Safe driving practices

41. 1.Keep safe following distance (4-5 seconds). 2.Avoid being tailgated. 3.Be aware of blind spots ( mirrors, back and sides of the ambulance). 4.Recognize that all other drivers are unpredictable. 5.Do not assume that motorists and pedestrians will do the right thing when an ambulance is passing. Driver anticipation and Cushion of safety

42.  Three basic principles govern the use of warning lights and siren on an ambulance: 1.The unit must be on a true emergency call to the best of your knowledge. 2.Both audible and visual warning devices must be used simultaneously. 3.The unit must be operated with due regard for the safety of all others, on and off the roadway. Use of warning lights and sirens

43. Who decides whether the case is true emergency or not? Paramedic riding in the rear (with the patient ). If you decide to use the siren : 1.Warn patient before use. 2.Do not increase speed just because siren is on. 3.Do not assume lights and sirens will allow you to drive through congested areas without stopping or slowing down.

44.  The use of warning lights and sirens allows EMS driver to do the following: 1.Park or stand in otherwise illegal location. 2.Proceed through red light or stop sign after stopping. 3.Drive faster than posted speed limit. 4.Drive against the flow of traffic on a one-way street or make an illegal turn. 5.Travel left of center to make an illegal pass Laws and regulations

45. Air Medical Transports

46. Air ambulances  Two basic types of air ambulances : A.Fixed-wing : generally used for interhospital patient transfers over distances greater than 100 to 150 miles. B.Rotary-wing (helicopters) : used for shorter distances

48. Advantages of air ambulances 1.Reduces transport time if distance is extreme. 2.Provides less injury to patients with spinal injury over rough terrain. 3.Can provide access to remote areas, specialized hospitals or equipments. 4.Availability of medical crew with advanced skills.

49. Disadvantages of air ambulances 1.Condition of the patient e.g. Cardiac arrest patients need to be transported by ground due to space limitations in the aircraft. 2.Cost. 3.Restrictions on number of caregivers. 4.Altitude and Airspeed limitations 5.Weather/terrain can prevent use. CRAW

50. Helicopter medical evacuation operations  Also known as MEDEVAC.  Things we should know about medevac : 1.When or why to call for medevac? 2.Who gets medevac? 3.Establishing helicopter landing zone. 4.Proper way of approaching helicopter.

51. Why Call For A Medevac? 1.Time factor : Ground transportation will take too long, given the patient’s condition. 2.Weather /terrain factor : Road, traffic, or environmental conditions limit or prohibit the use of ground transportation. 3.Patient factor : Patient requires advanced care. 4.Hospital factor : Multiple patients will overwhelm a hospital if reached by ground transport.

52. Who Gets A Medevac (Patient Factor)? 1.Patients with time-dependent injuries or illnesses, such as stroke, heart attack, or spinal cord injury. 2.Patients with serious conditions, such as diving accident, near drowning, or skiing or wilderness accidents. 3.Trauma patients who are candidates for ( limb replantation,Burn center,Hyperbaric chamber and Venomous bite center ).

53. Establishing Helicopter Landing Zone 1.Requires 100’ x 100’ area. 2.Less than 8° slope. 3.Free of wires, trees, people, and loose objects. 4.should be a hard or a grassy level surface.

54. Helicopter landing zone

55. Proper way of approaching helicopter Follow directions of crew. Crew will direct patient loading. Stay clear of tail rotor. No smoking, traffic, vehicles within 100’ of helicopter Never shine a light in the pilot face.

56. Safe helicopter approach

57. Approach from downhill side. Main Rotor DANGER AREA: Do not approach.

58. Any question?

59. Thank you