Ambulance Operations

Ambulance Operations Basic Principles
dr. Corona Rintawan Disaster Medical Committee of Lamongan Hospital of Muhammadiyah

Copyright TKM Lakesma 2012
Ambulance Classification
Basic Life support Advanced Life support
Safe Ambulance Operations

Many EMS agencies require:
Emergency driving course Periodic evaluations of emergency driving skills
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Copyright TKM Lakesma 2012
Safe Ambulance Operations

Factors affecting safe ambulance operations:
Size and weight of emergency vehicle Drivers experience Use of escorts Environmental conditions Lights, sirens, air horns Safety at intersections Parking at emergency scene Due regard for safety of all others
Guidelines for Safe Ambulance Driving

Be tolerant and observant of motorists and pedestrians Use occupant safety restraints
Be familiar with emergency vehicle

Be alert to weather and road conditions Use caution with audible and visual warning devices
Guidelines for Safe Ambulance Driving

Drive at speed limit except as allowed by law Use most appropriate route to scene
Maintain safe following distance

Drive with regard for safety of others Drive managing acceptable levels of risk
Appropriate Use of Escorts

Police escorts can be dangerous
Should be used sparingly
Police escorts are used when EMS crew is responding to scene in unfamiliar area
Observe safe distance between ambulance and police escort
Appropriate Use of Escorts

If audible and visual warning devices are used, ambulance and police escort should use different siren tones
Per protocol
Alerts motorists that second emergency vehicle is in the area
Environmental Conditions
Bad weather poses significant dangers when responding to emergency calls
Can affect safe vehicle operation
Environmental Conditions
When adverse environmental conditions are present, proceed at safe speeds appropriate for road and weather conditions Use low-beam headlights during emergency responses
Appropriate Use of Warning Devices

Use of audible and visual warning devices during an emergency response and patient transport:
Guided by protocol Based on state motor vehicle laws
CODE 1 -ROUTINE TRANSFER for example from hosptial to nursing home or private residence CODE 2 - Non emergency call. Transport to hospital with very minor injuries CODE 3 - Emergency call. Possible life threatening situation CODE 4 - HIGH PRIORITY CALL. Life and death situation. This is the highest call. Usually the call orginates from fire or police who are already at the scene. CODE 5 - Patient is deceased. Depending on where death has occurred paramedic in charge will transport in ambulance if it is in a public place and the death was accidental - ie; struck by car. IF IT IS BY CRIME AMBULANCE IS NOT USED. Removal service is called. CODE 1 -NO LIGHTS AND OR SIREN CODE 2- NO LIGHT OS SIREN - PERHAPS A LITTLE OVER SPEED LIMIT CODE 3- LIGHTS AND SIREN - SPEED LIMIT NOT FOLLOWED CODE 4- LIGHTS AND SIREN - HIGHEST PRIORITY - SOMETIMES WITH POLICE ESCORT CODE 5 - NOT FULL LIGHTS AND NO SIREN. SMALL FLASHING RED LIGHTS AT FRONT AND BACK ARE USED TO TRANSPORT TO HOSPITAL MORGUE. AMBULANCES NEVER EVER TRANSPORT TO FUNERAL HOMES ALWAYS TO THE HOSPITAL
Appropriate Use of Warning Devices

Motorists may not hear audible devices
Proceed with caution Never assume lights, sirens, and air horns provide absolute right-of-way or privileged immunity to proceed
Proceeding through Intersections

Driver of emergency vehicle should:
Stop at controlled intersections Attempt to make eye contact with drivers before proceeding through intersection
Other safety precautions

Stop before crossing intersection Use sirens yelp mode or air horn to alert nearby traffic
Parking at an Emergency Scene

Make sure vehicles location allows for traffic flow around area If law enforcement and fire service have secured scene, ambulance should:
Park about 100 ft past scene
Same side of road
Uphill (about 2 feet) and upwind if hazardous materials suspected
If scene is not secured, ambulance should:

Park about 50 ft before scene in fend-off position
Fend-Off Position
Parking at an Emergency Scene

Other safety precautions
Leave emergency warning devices on (particularly at night) Set parking brake
Operating with Due Regard for All Others

Most states allow emergency drivers to:
Drive slightly above the speed limit Proceed through controlled intersections (after a stop) during emergency response
Consider the safety of all using the roadway

Legal responsibility Paramedic and EMS agency may be liable if damage, injury, or death results
The Two-Second Rule

Used to gauge distance
Look at object by road that will soon be passed by vehicle ahead Count one thousand and one, one thousand and two If you reach object before one thousand and two, you are traveling too close to vehicle in front of you
If bad road and weather conditions

Increase following distance to a 4- or 5-sec count
Braking Distance
Based on:
Average reaction time Average vehicle weight Average road conditions Average brakes
Braking Distance
Adversely affected by:
Wet roadways Poor brakes Poor tires Heavy vehicle weight Poor reaction time
Phases of an Ambulance Call

Daily preparation Dispatch En route to the scene At the scene En route to the receiving facility At the receiving facility En route to the station Post run
Daily Pre-Run Preparation

Ambulance maintainance Daily inspection of vehicle Ambulance equipment Personnel
Dispatch
Location of call Nature of call Name,location, and callback number of caller Number of patients Special problems or circumstances
En Route to the Scene

Make sure all doors are closed and secured on ambulance Fasten seat belt Confirm and document dispatch information Listen to status reports Think about equipment needed Remain calm Drive responsibly
En Route Cont
Determine responsibility of each team member CallALS if necessary
At the Scene
Notify dispatch Position the ambulance accordingly Take BSI precautions Scene safety Determine MOI Form general impression of scene Determine number of patients Determine priority of care
At Scene Cont
On MVAs, gain access to patients and extricate Remove patient(s) from vehicle(s) Obtain vitals, assess patient(s) RLH if RBS or stay and play
En Route to the Receiving Facility

Make sure all doors are closed and secure
Begin your ongoing assessment Notify dispatch you are en route Check any patient interventions Focus on the patient, not a third rider Drive prudently. If in back, keep driver informed on the patients status Report to the receiving facility as soon as patient permits Continue assessments on your patient
Care of Patient in Ambulance

Employ safe lifting practices Proper positioning/securing of patient
Stow away unnecessary equipment

Secure equipment Monitor patient closely during transport
At the Receiving Facility

Notify dispatch Transfer all records and information to appropriate people both written and verbal Transfer all valuables , or personal effects of patient Turn patient over to receiving facility Change all linens, spine boards, and other equipment. Complete prehospital care reports and ask if you are needed any further
En Route to the Station

At the hospital or station, clean and inspect the ambulance and everything in it Wash your hands Radio dispatch Wear your safety belt Refuel as needed
Post Run
Fill out and file any reports required by local protocol Complete inventory of equipment and supplies Complete cleaning the ambulance Wash outside of ambulance if necassary Change soiled uniforms Notify dispatch you are back in service
Infection Control Procedures

Dispose of sharps in proper container Wash hands after run and after cleaning ambulance Clean, disinfect, and sterilize contaminated equipment Launder soiled clothing and linens Dispose of infectious wastes
Questions?

Ambulance Operations

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Ambulance Operations Basic Principles

dr. Corona Rintawan Disaster Medical Committee of Lamongan Hospital of Muhammadiyah

Copyright TKM Lakesma 2012

Safe Ambulance Operations

Safe Ambulance Operations

Guidelines for Safe Ambulance Driving

Be familiar with emergency vehicle

Guidelines for Safe Ambulance Driving

Maintain safe following distance

Appropriate Use of Escorts

Appropriate Use of Escorts

Alerts motorists that second emergency vehicle is in the area

Can affect safe vehicle operation

Appropriate Use of Warning Devices

Appropriate Use of Warning Devices

Proceeding through Intersections

Other safety precautions

Parking at an Emergency Scene

Uphill (about 2 feet) and upwind if hazardous materials suspected

If scene is not secured, ambulance should:

Parking at an Emergency Scene

Operating with Due Regard for All Others

Consider the safety of all using the roadway

The Two-Second Rule

If bad road and weather conditions

Copyright TKM Lakesma 2012

Phases of an Ambulance Call

Daily Pre-Run Preparation

Copyright TKM Lakesma 2012

Copyright TKM Lakesma 2012

En Route to the Scene

Copyright TKM Lakesma 2012

Copyright TKM Lakesma 2012

En Route to the Receiving Facility

Care of Patient in Ambulance

Stow away unnecessary equipment

At the Receiving Facility

En Route to the Station

Copyright TKM Lakesma 2012

Infection Control Procedures

Copyright TKM Lakesma 2012

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