EMT Training: Chapter 42: Ambulance Operations and Air Medical Response

Privileges of Operating Emergency Vehicles and the Precautions That Must Be Observed (1156)
Privileges:
1. Exceed the speed limit as long as you’re not endangering lives or property
2. Drive the wrong way down a one way street or drive down the opposite side of the road
3. Turn in any direction at any intersection
4. Park anywhere as long as you’re not endangering lives or property
5. Leave ambulance standing in the middle of the street or intersection
6. Cautiously proceed through a red light or red flashing signal
7. Pass other vehicles in a no passing zone

Precautions:
1. Need your driver’s license. Most states require a driver safety class
2. Must be responding to a serious emergency
3. Must use warning devices – lights, sirens, horns, so that other vehicles on the road know
4. Exercise due regard for the safety of others.
5. Additional guidance based on EMS service

Examples of Habits and Behaviors That Improve Driver Safety (1157)
1. Wear seatbelt and make sure other team members wear their seatbelt too
2. Hold steering wheel with two hands (mechanics of steering detailed on page 1157)
3. Be familiar with how the ambulance accelerates and decelerates, space required for its fenders and bumpers, how it breaks, and how it corners
4. Adjust your speed in regards to changes in weather and road conditions (i.e for decreased visibility at night and during storms)
5. Select the best route best suited for safe travel (may not be the shortest route)
6. Study a map if you are unfamiliar with an area
7. Select alternative routes during rush hour traffic
8. Maintain a safe following distance

Factors That Can Affect Your Ability to Maintain Control While Driving an Ambulance (1157-1158)
1. Braking – sudden braking may result in loss of control
-older ambulances that don’t have ABS, your brakes cause the wheels to lock, causing you to skid dangerously
-pump your brakes in this case
-newer ambulances that have ABS -> brakes should be applied firmly
-never brake on a curve

2. Driver Distractions
-cell phones, loud music, conversations, eating and drinking, and other stuff
-focus on the road

3. Driving Alone
-partner will be in the patient compartment when transporting the patient
-maintain focus on the safe operation of the ambulance
-don’t get distracted

4. Fatigue

5. Railroads
-keep calm and monitor the patient

6. School Buses
-follow state law
-watch for children

7. Bridges and Tunnels
-be sure the height of bridge/tunnel accommodates the ambulance

8. Day of the Week
-more traffic during the week, less on the weekends
-shopping centers have most traffic on saturdays

9. Time of the Day
-rush hour traffic more congested in urban areas than rural areas
-wach for school zones and industrial plant shift changes

10. Road Surface
-potholes, bumps
-give your patient the smoothest ride possible
-two inner lanes on a 4 lane highway are generally the smoothest

11. Backing Up – use all resources when you do this

12. Higher Speeds (*1158 goes into detail about this*)

13. Aggressive Drivers
-exercise extreme caution when approaching these kinds of vehicles
-slow down, assess the situation, and choose the safest method for continuing to your destination

14. Escorts
-Using police or other emergency escorts should be a last resort

15. Intersection Collisions
-most common accidents with ambulances
*3 main causes*: detailed on page 1158
1. motorist approaches the intersection just as the light is changing; doesn’t want to sit at the red light so they go through it
2. when there’s two emergency vehicles when the motorist only expects one
3. vehicles waiting at an intersection may block your view of pedestrians in the crosswalk; slow down and anticipate people in the crosswalk

Precautions That Should Be Taken When Driving in Inclement Weather
1. Rainy or wet weather
-about 6 times more people are killed on wet roads than on snowy and icy roads combined
-can hydroplane on a wet road (can begin at speeds as low as 35 mph)

Do the following when driving on Rainy or Wet Roads:
A. Keep mirrors clear of water
B. Avoid sudden braking and sudden moves of the steering wheel
C. If you are about to go through a large standing puddle, slow down turn on your wipers before you hit the water
-as you leave the water, pump the brakes
D. If you begin to hydroplane, hold the wheel steady, take your foot from the accelerator, gently pump the brakes

2. Winter Driving
-sleet, freezing rain, packed snow, and ice decrease visibility and increase skidding

Do the following when driving in wintry conditions:
A. Make sure that your engine is tuned, your heater and defroster are in good working condition, battery is charged
B. Carry emergency equipment – chains, shovel, sand booster cables, and towing device
C. Equip ambulance with snow tires
D. Stay aware of the temperature
-wet ice and freezing rain (most hazardous) occur between 28 and 40
E. Avoid sudden movements of the steering wheel and sudden braking

3. Fog, Mist, Dust Storms, Smog: DO THE FOLLOWING:
A. Slow down but avoid decelerating completely
B. Watch the road ahead and hind carefully for other cars that are traveling slowly
C. Turn on lights, regardless of time of day, use your wipers
-never use your high beams
D. If you are traveling 15 mph or more below the speed limit, use 4 way flashers (these may not be legal in some states)
E. Use defroster to keep as much fog as possible off the inside of the windshield
F. Tap brakes to slow down if needed
G. Be alert of vehicles in front of you

Precautions That Must Be Taken When Driving at Night (1158-1159)
-1/2 of all collisions happen at nighttime
-1/3 of all fatalities happen at night
-headlights on low beams illuminate about 150 feet
-headlights on high beams illuminate about 350-400 feet
[email protected] 55 mph, it takes 4.5 seconds to cover 350 feet

TO improve visibility, do these things:
1. make sure the ambulance has quartz-halogen lights
2. have headlights on whenever you are traveling in an emergency
3. keep headlights cleaned and properly aimed; check them before your shift
4. replace burned bulbs immediately
5. dim headlights within 500 feet of an approaching vehicle or 300 feet of someone in front of you
6. never stare into the high beams of another vehicle
7. don’t flick your high beams up and down
8. never use high beams when going into a curve
9. keep your windshield clean inside and out
10. keep instrument panels dim
11. keep eyes moving, avoid focusing on one object
12. replace the blades or use a stronger concentration of washing fluid if the washing fluid under the hood doesn’t leave the glass clean
13. be sure to be rested before a night shift; be alert for intoxicated or drowsy drivers

Discuss Appropriate Use of Emergency Warning Devices, Like Lights and Sirens (1160-1161)
1. Lights
-whenever you’re responding to an emergency call, always use the lights
-when you’re not using the siren, you should still be using the lights
-need the lights to be high enough to cast a beam above the traffic
-lower lights needed to be visible in the rearview mirror of the car ahead of you
-use strobe lights with emergency lights (white lights can be seen from a longer distance than red or blue)
-use headlights always when in an emergency
-use minimal lighting during heavy fog or when you are parked

2. Siren
-do not assume the other drivers know about your siren (look to see that they know, be cautious) -> insulation in newer vehicles can lower decibel level of an approaching siren by 35-40 percent
-internal noises within the car can also prevent them from hearing the siren
-never pull directly behind a car and blast the siren
-siren can elicit an emotional stress on the patient, so use it sparingly
-studies show that ambulance operators speed up 15 mph more when siren is on

3. Air Horn
-avoid overuse
-consider it when you need to clear traffic

Roadway Incident Scene Safety (1161-1162)
1. High-Visibility Apparel
-federal law mandates that EMTs and other rescue personnel wear this to increase visibility during highway and roadway emergencies
3 classes of garments:
A. Class 1: designed for workers in parking lots and other areas with traffic flow moving at less than 25 mph
B. Class 2: designed for personnel whose attention is diverted from traffic or where traffic is moving at more than 25 mph
C. Class 3: designed for personnel whose work greatly diverts their attention from the roadway and where they are at serious risk from hazards created by moving vehicles

2. Safety Benchmarks:
-don’t trust approaching traffic (they may not be aware of the accident or not paying attention)
-do not turn your back to approaching traffic -> position yourself so that you can see the traffic
-position the first arriving emergency vehicle to create a block and a physical barrier between upstream traffic and the scene
-wear appropriate personal protective equipment and ANSI high-visibility vests
-at nighttime, turn off vision-imparing lights, including headlights and spotlights on emergency vehicles that are positioned to oncoming traffic
-use other emergency vehicles, like police and fire, to initially slow down and redirect flow of traffic
-use advance warning signs and other traffic control measures upstream of the scene to reduce the speed of the oncoming traffic
-use traffic cones
-assign a person to monitor oncoming traffic
-uphill/upwind

Phases of an Ambulance Call (1162-1168)
1. Daily Prerun Preparation:

a. Ambulance Maintenance
-oil and filter changes, transmission and differential checks, wheel bearing check, brake check, and tie rod end inspection
-benefits of doing this include:
1. decreased vehicle downtime
2. improved response times to the scene
3. safer emergency and nonemergency responses
4. improved transport times to the medical facility
5. safer patient transport

b. Daily Inspection of Vehicle
-checklist of items you need to make sure are on the ambulance
-clear protocol for reporting problems with vehicles, taking them out of service if they aren’t safe, and performing regular service and maintenance

c. Ambulance Equipment
-tables 42-1 and 42-2 detail all of these items

d. Personnel
-properly trained personnel is essential for making sure that the ambulance has the right equipment and can operate it

2. Dispatch
-will provide you with:
a. location of the call
b. nature of the call
c. name, location, and callback number of the caller
d. number of patients and severity of issue
e. any special problems or circumstances that may be pertinent

3. En Route to the Scene
-before you depart, quickly check the vehicle to make sure the outside compartment doors are closed and secure, external shoreline are disconnected, and any jump kits are retrieved and stored
-fasten seatbelts
-write down info from dispatch on notepad
-confirm dispatch information
-listen for status reports from other units on scene
-think about what equipment you’ll use on scene
-remain relaxed but focused
-drive responsibly maintaining a 3-4 second following distance
-determine what responsibilities of team members will be before arriving on scene and make sure those responsibilities are clear
-call ALS if necessary

4. At the Scene
-notify dispatch when you arrive
-park in safest place that will allow you to load patient and depart from scene
-survey scene, paying attention to any hazards and everything
-park in front or behind a collision, never alongside it
-safety vest if on or near highway or other roadway
-standard BSI
-determine if its safe to approach the patient
-call dispatcher if you need backup or mechanical error occurs

more details, too long to copy…

5. En Route to the Receiving Facility
-ensure all hazards have been controlled
-make sure patient is secure and settled
-seatbelts
-determine necessity of using lights and sirens
-patient reassessment
-notify dispatch
-check any patient interventions
-if a patient’s relative or friend accompanies him, follow guidelines as to where they should sit
-focus on the patient
-driver should drive prudently, use only the necessary speed and be safe
-keep driver informed of the patient’s condition
-during reassessment, if patient’s condition worsens, tell driver so he can proceed as quickly as possible
-notify the receiving medical facility as soon as your patient’s condition permits you to call in a report
-continue to reassess and notify receiving facility if it deteriorates

6. At the Receiving Facility
-notify dispatch of your arrival
-official transfer for care to an appropriate healthcare provider at the receiving facility -> continue care
-transfer all records and information when you are able to
-complete oral report should be given to the receiving facility

7. En Route to the Station
-clean and inspect ambulance
-wash hands
-radio dispatch and tell them you’re coming back
-buckle seatbelts and return
-refuel according to protocol

8. Post Run
-fill out report
-check fuel and fuel according to protocol
-complete an inventory of equipment
-change soiled uniforms
-notify dispatch that you’re in service, available for calls

Infection Control Procedures (1168-1169)
look on page 1168-1169

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