1. RPI AMBULANCE
ATTENDANT CLASS
Last Updated by M. O’Donnell, June 2012

2. RPI Ambulance Attendant Class
Class Topics
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
Updated 10/2011
RPI Ambulance Attendant Class

3. Introduction to RPI Ambulance
Agency Information
Service: Volunteer, Student Run
Level of Care: Basic Life Support (BLS)
Office: 92 College Avenue
Garage: Behind the Armory
Service Period: In service 24/7 during the Fall and Spring Semesters
Call Volume: ~150 per year
Primary Coverage Area: RPI Troy campus
Secondary Coverage Area: Troy, Brunswick, North Greenbush, etc.
Special Events: Stand-bys for Hockey, Football, Commencement, etc.
Updated 10/2011
RPI Ambulance Attendant Class

4. Introduction to RPI Ambulance
Rules and Regulations
Standard Operating Procedures
Agency Document
RPIA Constitution
Union Document
New York State Department of Health
Part 800, Minimum Requirements for an Ambulance
Part 18, Requirements for large events
Documents can be found online at
Updated 10/2011
RPI Ambulance Attendant Class

5. Introduction to RPI Ambulance
Crew Positions
Crew Chief
Driver
Attendant
Observer
Updated 10/2011
RPI Ambulance Attendant Class

6. Introduction to RPI Ambulance
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 and submit an attendant evaluation.
F. Request and receive approval by the Training Committee to be promoted to Attendant.
Updated 10/2011
RPI Ambulance Attendant Class

7. Introduction to RPI Ambulance
Scheduling Website
Sign up on the website for:
Night Crew
Stand-bys (Hockey, Football, etc.)
Training Drills, Meetings, Banquets, etc.
Signing up:
Go to the Scheduling page on the website:
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 confirming that you are signed up.
Updated 10/2011
RPI Ambulance Attendant Class

8. Introduction to RPI Ambulance
Field House and ECAV Operations
Events:
Hockey
Commencement
Concerts
Personnel:
Field Crews, EES
Locations:
HFH PCF
ECAV EMS Room
Sign up on website, report to appropriate PCF or the garage 15 minutes prior to start time
Updated 10/2011
RPI Ambulance Attendant Class

9. Introduction to RPI Ambulance
Professionalism
Always maintain a professional attitude and appearance
You represent RPI Ambulance and RPI.
Assures the patient they are in competent hands
Don’t dress or act in a manner unbecoming a member of the agency
Updated 10/2011
RPI Ambulance Attendant Class

10. RPI Ambulance And The Law
NYS Department of Health
State Emergency Medical Services Code (Part 800) Defines:
General Emergency Medical Services rules
Certification of EMS personnel
Certification of EMS agencies
Requirements for equipment and ambulances
Pre-hospital DNR orders
Updated 10/2011
RPI Ambulance Attendant Class

11. RPI Ambulance And The Law
Patient Confidentiality
Patient’s medical and personal information is private
Name, address, medical conditions, condition, treatment etc.
State and federal laws forbid disclosure of patient information
NYS Part , Health Insurance Portability and Accountability Act (HIPAA)
Only those who “Need to Know” may have access to patient information
Doctors, nurses, crew members in charge of caring for patient
Your friends, bystanders, Public Safety, the public DO NOT need to know
When in doubt, ask your crew chief. Do not share information!
Updated 10/2011
RPI Ambulance Attendant Class

12. RPI Ambulance Attendant Class
Safety
Scene Safety
Crew safety is the primary concern during all operations. You can not help the patient, if something happens to you.
Unsafe scenes:
Substance abusers
Assaults, weapons on scene
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.
Updated 10/2011
RPI Ambulance Attendant Class

13. RPI Ambulance Attendant Class
Safety
Infection Control
If its wet and sticky and not yours, don’t touch it. If you have to, wear gloves!
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!
If you come into contact with someone else’s bodily fluids, tell the crew chief!
Updated 10/2011
RPI Ambulance Attendant Class

14. RPI Ambulance Attendant Class
Radio Communications
RPIA Portable Radios
Frequency: MHz
Use of RPIA Radios:
Receiving tones and dispatches from Rensselaer County Emergency Communications Center (ECC)
Amassing a crew for day calls
Tactical Communications during stand-bys (hockey games, etc.)
Crew Chiefs, Drivers, and actively training attendants carry portable radios
Updated 10/2011
RPI Ambulance Attendant Class

15. RPI Ambulance Attendant Class
Radio Communications
The “800” System
Frequency: MHz
Uses of County Radios:
Communicating with Rensselaer County ECC (dispatcher).
NYS Interagency and Mass Casualty Incident channel.
Used by crew chiefs and drivers.
Three Portables,
Duty Supervisor, Office, Rig
One Mobile Unit in the Ambulance
Updated 10/2011
RPI Ambulance Attendant Class

16. RPI Ambulance Attendant Class
Radio Communications
Communication Guidelines
Call Signs
Ambulance is A-39 internally, 5939 to the county
Members are assigned “900” Numbers
Line Officers have Car Numbers (Car 1, etc.)
Communicating on the Radio
State who you are speaking to, then you.
“Car 1, this is 944.”
Always be professional; never know who is listening.
Public Safety, County, General Public
Updated 10/2011
RPI Ambulance Attendant Class

17. RPI Ambulance Attendant Class
Radio Communications
The Dispatch
RPI Ambulance is dispatched on Channel 1 on RPI Ambulance’s Radios:
Dispatcher: “Stand By RPI Ambulance”
Tones
Dispatcher: “RPI Ambulance for a <determinant> determinant EMS call for <Demographics> <Chief Complaint> at <Location>”
Example: “ RPI Ambulance. Delta determinant EMS call for a seizure, RPI Crockett Hall, 72 Griswold Road. Cross Streets are Sage Ave and Bouton Road.”
Updated 10/2011
RPI Ambulance Attendant Class

18. RPI Ambulance Attendant Class
Radio Communications
Dispatch Determinants
Determinants
Alpha: BLS Priority II
Non-Emergency
Bravo: BLS Priority I
Emergency, Not Imminently life threatening
Charlie: ALS & BLS Priority I
Emergency, Possibly life threatening
Delta: ALS & BLS Priority I
Emergency, Actively life threatening
Echo: ALS & BLS Priority I (anyone with an AED)
Cardiac or Respiratory Arrest/ Unknown life status
Charlie Chespans
Updated 10/2011
RPI Ambulance Attendant Class

19. RPI Ambulance Attendant Class
Radio Communications
Call Communications
During the call, the following radio transmissions are made to dispatch over the 800 by the driver:
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”) by the crew chief.
Updated 10/2011
RPI Ambulance Attendant Class

20. RPI Ambulance Attendant Class
Lifting and Moving
Proper Lifting Technique
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:
Re-dispatch for additional crew members.
Request Troy Fire Department for a lift assist.
Updated 10/2011
RPI Ambulance Attendant Class

21. RPI Ambulance Attendant Class
Lifting and Moving
Stretcher
Indications: General EMS calls
Considerations: A backboard is needed in addition for a suspected spinal injury.
Example: Patient with abdominal pain
Updated 10/2011
RPI Ambulance Attendant Class

22. RPI Ambulance Attendant Class
Lifting and Moving
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
Updated 10/2011
RPI Ambulance Attendant Class

23. RPI Ambulance Attendant Class
Lifting and Moving
Backboard
Indications: Suspected neck or back injury, CPR. Can also be used to move patients.
Contraindications: None
Examples: Patient who fell from a 20’ ladder Spear tackle during a rugby game.
Updated 10/2011
RPI Ambulance Attendant Class

24. RPI Ambulance Attendant Class
Lifting and Moving
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
Updated 10/2011
RPI Ambulance Attendant Class

25. RPI Ambulance Attendant Class
Vital Signs and
Diagnostic Equipment
Overview of Vital Signs
A full set of Vitals consists of:
Heart Rate
Respiratory Rate
Blood Pressure
Additional diagnostic measurements:
Skin color and condition
Pupil size and reactivity
Lung sounds
Pulse oximetry
Temperature
Glucometry
Updated 10/2011
RPI Ambulance Attendant Class

26. RPI Ambulance Attendant Class
Vital Signs and
Diagnostic Equipment
Heart/Pulse Rate
Measure by palpation at the radial artery.
Report the Rate and Quality:
Rate: Beats per minute
Strength: Strong or Thready (weak)
Regularity: Regular or Irregular
Normal range: beats per minute
Dangerous range: Less than 60 or greater than 120 (sustained)
Updated 10/2011
RPI Ambulance Attendant Class

27. RPI Ambulance Attendant Class
Vital Signs and
Diagnostic Equipment
Respiratory Rate
Watch patient’s chest rise and fall.
Report the Rate and Quality:
Rate: Breaths per minute
Depth: Normal, Shallow or Deep
Regularity: Regular or Irregular
Normal range: respirations per minute
Dangerous range: Less than 8 or greater than 24
Updated 10/2011
RPI Ambulance Attendant Class

28. RPI Ambulance Attendant Class
Vital Signs and
Diagnostic Equipment
Blood Pressure
Measure with a sphygmomanometer (BP Cuff) and stethoscope.
Two pieces of information:
Systolic BP: Pressure when the heart is contracting, pumping blood.
Diastolic BP: Pressure when the heart is relaxed
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
Updated 10/2011
RPI Ambulance Attendant Class

29. RPI Ambulance Attendant Class
Vital Signs and
Diagnostic Equipment
Skin Color and Condition
Observe:
Color: Normal, Flushed, Pale, Cyanotic (blue), Mottled (grey), Jaundiced (yellow).
Condition: Warm, Dry, Cool, Diaphoretic (sweaty).
Updated 10/2011
RPI Ambulance Attendant Class

30. RPI Ambulance Attendant Class
Vital Signs and
Diagnostic Equipment
Pupil Size and Reactivity
Observe both pupils and report the:
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.
Updated 10/2011
RPI Ambulance Attendant Class

31. RPI Ambulance Attendant Class
Vital Signs and
Diagnostic Equipment
Pulse-Oximeter
Function:
Checks oxygenation of the patients blood
Checks the pulse rate of the patient
Use:
Place on patient’s finger
Remove any nail polish
Oxygenation:
97-99%- Normal
94-96%- Mild Hypoxia
91-93%- Moderate Hypoxia
Updated 10/2011
RPI Ambulance Attendant Class

32. RPI Ambulance Attendant Class
Vital Signs and
Diagnostic Equipment
Glucometer
Function
Checks level of glucose in patient’s blood
Normal range is ml/dl
Indications
Altered mental status, diabetic issues
Contraindications
Bleeding/Clotting disorders
Note:
Used only by the Crew Chief, a special in-service training is required for EMTs
Updated 10/2011
RPI Ambulance Attendant Class

33. RPI Ambulance Attendant Class
Airway
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
Updated 10/2011
RPI Ambulance Attendant Class

34. RPI Ambulance Attendant Class
Airway
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
Updated 10/2011
RPI Ambulance Attendant Class

35. RPI Ambulance Attendant Class
Airway
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!
Updated 10/2011
RPI Ambulance Attendant Class

36. RPI Ambulance Attendant Class
Breathing
Oxygen Tanks
Medical Oxygen Tanks Are Green
Oxygen Tanks have the following Components
Tank
O-Ring
Regulator
Sizes
D, Portable (In the jump bag)
E, Portable (In the rig)
M, On-board Oxygen
Before Using, Check
Stat Date
Pressure in the tank
Flow Regulator Seal
Updated 10/2011
RPI Ambulance Attendant Class

37. RPI Ambulance Attendant Class
Breathing
Non-Rebreather (NRB)
Indications: Sick or injured patients requiring high-flow oxygen
Contraindications: Respiratory arrest
Use with an oxygen flow rate of LPM.
Updated 10/2011
RPI Ambulance Attendant Class

38. RPI Ambulance Attendant Class
Breathing
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 4-6 LPM.
Updated 10/2011
RPI Ambulance Attendant Class

39. RPI Ambulance Attendant Class
Breathing
Bag Valve Mask (BVM)
Indications: A patient who is having difficulty maintaining adequate ventilations on their own.
Contraindications: None
Rate:
Adults: / min
Children: 20 / min
Infants: 20 / min
Use with supplemental oxygen, LPM.
Updated 10/2011
RPI Ambulance Attendant Class

40. RPI Ambulance Attendant Class
Circulation
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:
Direct Pressure
Elevation
Pressure Dressing
Pressure Point
Tourniquet
Updated 10/2011
RPI Ambulance Attendant Class

41. RPI Ambulance Attendant Class
Circulation
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)
Updated 10/2011
RPI Ambulance Attendant Class

42. RPI Ambulance Attendant Class
Circulation
Hypoperfusion (Shock)
Treatment of hypoperfusion:
Maintain airway and support patient’s breathing
Control serious bleeding.
Position the patient with their feet elevated (Trendelenburg Position).
Keep the patient warm.
Transport rapidly.
Updated 10/2011
RPI Ambulance Attendant Class

43. RPI Ambulance Attendant Class
Module X:
Splinting and Spinal Immobilization
RPI Ambulance Attendant Class
Updated 10/2011
RPI Ambulance Attendant Class

44. Spinal Immobilization
Splinting and
Spinal Immobilization
Splinting
Function
Splints are used to immobilize and protect an injured body part.
Types
Board splints, “Frac-Pak”, Traction splints
General guidelines for use:
Begin by checking CSM x4.
Hold the extremity above and below the injury.
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.
Updated 10/2011
RPI Ambulance Attendant Class

45. Spinal Immobilization
Splinting and
Spinal Immobilization
Spinal Immobilization
Equipment
Backboard: A long, rigid board used to immobilize a patient
Cervical Collar: A stiff neck brace used to immobilize the seven cervical vertebrae
Kendrick Extrication Device (KED): Vest type immobilization device for seated patients.
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
Updated 10/2011
RPI Ambulance Attendant Class

46. Spinal Immobilization
Splinting and
Spinal Immobilization
Kendrick Extrication Device
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.
Updated 10/2011
RPI Ambulance Attendant Class

47. RPI Ambulance Attendant Class
Questions?
RPI Ambulance Attendant Class
Updated 10/2011
RPI Ambulance Attendant Class