Transport operation Dr. Miada Mahmoud Rady

Introduction

What is the single piece of

equipment that is used in every

paramedic call allover the world?

TheAmbulance

• That the rate EMS deaths in car crashes is

more than deaths of firefighters and low

enforcement officers combined¡¡¡¡.

Did you know ……?

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

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 .

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

C. Type III:

• Modular box like a Type I

• Mounted on a van chassis

TYPE 3

Ambulance type

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 :

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

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

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

1.Personal Safety Equipment.

2.Street maps.

3.Global positioning systems (GPS)

4.Computer-aided dispatch consoles.

Non - Medical Equipments

• 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

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

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 .

• 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).

• 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

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

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

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

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

1.Belt noise.

2.Break fade .

3.Brake pull .

4.Drift .

5.Steering pull .

6.Pulsating brake.

7.Steering play.

Warning signs

Communications

1. Dispatch.

2. Handheld.

3. Medical control.

Life sustaining

1. Suction.

2. Oxygen/resuscitation .

3. Medication.

4. Defibrillation.

Safety

1. Standard Precautions

equipment.

2. Binoculars.

3. Scene wear

Other medical

1. Carry-in kits

2. Maps

3. Personal gear

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

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

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)

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

Goal : ensure orderly traffic

flow and prevent another

crash.

Place reflectors and other

warning devices on both

sides of crash.

Traffic control

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

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

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

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

Post call activities

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.

Defensive Ambulance Driving Techniques

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.

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

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

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

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

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

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.

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

Air Medical Transports

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

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.

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

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.

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.

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 ).

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.

Helicopter landing zone

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.

Safe helicopter approach

Safe helicopter approach

Approach from downhill side.

Main Rotor

DANGER AREA: Do not

approach.

Any question?

Thank you