1. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Paramedic Care: Principles & Practice Volume 5 Special Considerations/ Operations

2. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 8 Ambulance Operations

3. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Topics Ambulance Standards Checking Ambulances Ambulance Deployment and Staffing Safe Ambulance Operations Utilizing Air Medical Transport

4. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Introduction Good ambulance operations involve some of the knowledge and skills you have already established as an EMT-Basic Five topics: –Ambulance standards –Maintenance of ambulance equipment and supplies –Ambulance stationing –Safe ambulance operations –Utilization of air medical transport

5. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Ambulance Standards

6. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Ambulance Standards Many of the requirements for ambulance service are written in state statutes or regulations –State laws are broad, while corresponding regulations provide more specific guidelines or rules State standards usually set minimum standards

7. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Ambulance Design DOT KKK 1822E specs –Attempt to influence safety standards as well as standardize the look of ambulances Three basic ambulance designs –Type I - conventional truck cab-chassis with a modular ambulance body –Type II - standard van, forward control integral cab-body ambulance –Type III - specialty van, forward control integral cab-body ambulance

8. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Type I Ambulance Design © Ken Kerr

9. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Type II Ambulance Design © Ken Kerr

10. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Type III Ambulance Design © Ken Kerr

11. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Ambulance Design There is also a medium-duty ambulance rescue vehicle Designed to handle heavier loads © Ken Kerr

12. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Ambulance Design Agencies that influence ambulance design –Federal government –State agencies –Local or regional agencies –National organizations

13. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Medical Equipment Standards The following organizations may set standards for the type and quantity of equipment carried: –OSHA –NFPA –City, county, local authorities –State agencies

14. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Checking Ambulances

15. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Checking Ambulances An equipment checklist should be completed on every shift –Makes the work environment safer Assuring mechanical maintenance Availability of personal protection equipment Proper disinfection © Ken Kerr

16. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Ambulance Deployment and Staffing

17. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Ambulance Deployment and Staffing The strategy used to maneuver ambulances and crews in order to reduce response times is known as deployment Factors affecting deployment include: –Location of ambulances –Location of hospitals –Anticipated call volume –Local geographic and traffic considerations

18. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Ambulance Deployment and Staffing Ideal deployment decisions must take into account two sets of data: –Past community responses –Projected demographic changes Primary areas of responsibility

19. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Traffic Congestion In determining deployment strategies, traffic congestion must be taken into account –Ground-level railroad System status management Response times Tiered response

20. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Operational Staffing Based on particular needs and available resources Ambulance staffing should take into account the peak load of the system Reserve capacity Standards for ambulance operators and for driving the vehicle

21. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Safe Ambulance Operations

22. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Safe Ambulance Operations Educating Providers –Proactive collision prevention program First part is recognition and definition of the problem –There has been a marked increase in the frequency of ground ambulance crashes over the last decade –In a recent study, nearly three quarters (72 %) of all collisions took place at intersections

23. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Routine use of driver qualification checklists and driver’s license checks Demonstrated driver understanding of preventive mechanical maintenance Provision of adequate hands-on driver training Implementation of a slow-speed course © Canandaigua Emergency Squad Reducing Ambulance Collisions

24. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Reducing Ambulance Collisions Training that ensures operators know how to react to emergency situations Demonstrated driver knowledge of both the primary and backup routes to all hospitals Demonstrated driver understanding of the rules, regulations, and laws

25. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Procedure for qualifying as an ambulance operator Procedure for handling and reporting an ambulance collision Process for investigating and reviewing each collision Process for implementing quality assurance in the aftermath of a collision Standard Operating Procedures

26. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Standard Operating Procedures Method for using a spotter when backing up a vehicle Use of seat belts in the ambulance, and the procedure for transporting a child passenger under 40 pounds Guidelines on what constitutes an emergency response and the exemptions that may be taken under state laws

27. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Guidelines on prudent speed; proper travel in, and the circumstances for using, oncoming lanes; and safe negotiation of intersections Circumstances and procedures for use of escorts A zero-tolerance policy for driving the vehicle under the influence of alcohol or any drugs Standard Operating Procedures

28. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ The Due Regard Standard While most state laws exempt drivers of emergency vehicles from certain laws, they also hold them to a higher standard Due regard places the responsibility for deciding when and where these exemptions should be applied squarely on the driver

29. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Lights and Sirens Motorists are less likely to yield when sirens are continually sounded Many motorists feel the right-of-way privileges of ambulances are abused when sirens are used Inexperienced drivers speed up when they hear sirens Sirens can worsen sick or injured patients Ambulance operators may also develop anxiety from sirens—and long-term hearing problems

30. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Siren Guidelines Use the siren sparingly Never assume motorists will hear your siren Assume that some motorists will hear your siren, but choose to ignore it Be prepared for panic and erratic maneuvers Never use the siren to scare someone

31. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Escorts and Multiple-Vehicle Responses Police escort considerations –May be useful in unfamiliar territory –Ambulances and police cars have different braking distances –The two vehicles have different acceleration speeds –Other motorists are not likely to realize that the two emergency vehicles are traveling together

32. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Escorts and Multiple-Vehicle Responses Multiple-vehicle responses –The dangers are the same as for an escort –Multiple vehicles arriving in intersection at the same time –Always negotiate an intersection assuming that you may meet another emergency vehicle

33. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Parking the Ambulance Ambulance is the first to arrive –Park in front of the wreckage If scene secure –Park beyond the wreckage Always be aware of potential traffic hazards

34. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ The Deadly Intersection Exercise extreme caution whenever you approach an intersection Know the rules for negotiating an intersection

35. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Utilizing Air Medical Transport

36. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Utilizing Air Medical Transport Air medical transport involves 2 types of air rescue units –Fixed-wing aircraft –Rotorcraft Missions involving air units are commonly referred to as aeromedical evacuations or medevac

37. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Advantages of Air Transport Rapid transportation Access to rural or remote areas Access to specialty units (NICU) Access to personnel with specialized skills Access to specialty supplies © Dudley Wait

38. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Disadvantages of Air Transport Weather and environment restrictions to flying Altitude limitations Air speed limitations Expense

39. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Activation Ideally there should be a single access point for air medical transport Front-line first responders, EMT-Basics, and paramedics must be willing to consider the need for medevac as early as possible Pilot consideration

40. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Indications for Helicopter Transport Uses –Medical emergencies, trauma emergencies, and search and rescue missions Federal Aviation Agency does not license commercial operators to do rescue missions –May be local or state provisions for highly trained operators

41. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Patient Preparation and Transfer Identify any special considerations that must be taken into account prior to loading the patient –Methods of infection control and intubation –PASG or vacuum splints may be affected by pressure changes Assessment considerations

42. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Scene Safety and the Landing Zone All paramedics should be capable of selecting an appropriate LZ Should be clear of wires, towers, vehicles, people, and loose objects

43. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Scene Safety and the Landing Zone Once the aircraft has landed, approach it with extreme caution and only on approval of the flight crew

44. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Scene Safety and the Landing Zone Allow the flight crew to direct loading of the patient Approach in a crouched position

45. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Scene Safety and the Landing Zone Approach it from the downhill side of the incline Ensure no smoking around the helicopter

46. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Summary Ambulance Standards Checking Ambulances Ambulance Deployment and Staffing Safe Ambulance Operations Utilizing Air Medical Transport