Emergency Care In The Streets: Chapter 46 Ambulance Operations

Front 1

"An Act to Establish Uniform System of Ambulances in the Armies of the US"

Back 1

Enacted in 1864 by congress for an organized ambulance system to transport pt's for the military.

Hint 1

46.5

Front 2

The ambulances in the US were commissioned in the ______.

Back 2

1860s

Hint 2

46.5

Front 3

The first motorized vehicles for ambulances were used in _____.

Back 3

1899

Hint 3

46.5

Front 4

When and where were the first commercial ambulances in the US?

Back 4

In 1937, the Hess & Eisenhardt company.

Hint 4

46.5

Front 5

Who determines current standards for design and manufacturing for ambulances?

Back 5

The US General Services Administration, design and manufacturing specifications are outlined in the DOT KKK 1822 federal guidelines.

Hint 5

46.5

Front 6

OSHA recommendations in the EMS setting

Back 6

The Occupational Safety and Health Administration makes recommendations regarding infection control practices to include all areas of personal protective equipment, sharps containers, and disinfecting equipment.

Hint 6

46.6

Front 7

How to stow equipment and supplies in an ambulance

Back 7

Fit tightly together to prevent injury, yet be accessible.

Hint 7

46.6

Front 8

Equipment that requires calibration

Back 8

Diagnostic equipment, such as defibrillators and pulse oximeters.

Hint 8

46.6

Front 9

When motor oil should be checked

Back 9

At the start of the shift before turning engine on.

Hint 9

46.7

Front 10

When transmission fluid should be check

Back 10

While the engine is running in park.

Hint 10

46.7

Front 11

Equipment found on every ALS ambulance

Back 11

The American College of Surgeons (ACS) developed the first list of equipment to be carried in the 1970s and continues to update these list.
Airway and ventilation equipment, basic wound care supplies, monitoring devices, orthopedic injury stabilizers, Childbirth supplies, pt transfer equipment, and medications.

Hint 11

46.6

Front 12

What does a sewer gas odor mean during daily check of ambulance?

Back 12

May indicate that a battery has been boiling, perhaps because the voltage system is too high or battery resistance has dropped.

Hint 12

46.7

Front 13

Ambulance issues that call for the unit to taken out of service

Back 13

Anything that threatens any of the "four Ss"
Start, steer, stop, and stay running. Also keep in mind adequate visibility, AC, and heat.

Hint 13

46.7

Front 14

Definition and parameters of fractile response time standards

Back 14

A fraction (not average) of an emergency responses for the purpose of setting standards in response time. Meaning usually 90% of all responses must be achieved in 8 minutes or less as recommended by CAAS-Commission of the Accreditation of Ambulances.

Hint 14

46.16

Front 15

DOT KKK 1822

Back 15

Federal standards that regulate the design and manufacturing guidelines of emergency ambulances.

Hint 15

46.16

Front 16

How to measure productivity of an EMS system

Back 16

How many patient transports per hour each ambulance accomplishes (known as "unit-hour utilization").

Hint 16

46.8

Front 17

Parameters of a tiered response system

Back 17

Attempts to assign ALS ambulances only where needed, letting BLS handle the rest.

Hint 17

46.8

Front 18

The goal of system status management

Back 18

Maximize efficiency and reduce response times. Uses historical data to determine demand and locations of calls.

Hint 18

46.8-9

Front 19

Characteristics of most ambulance collisions

Back 19

The most common cause for ambulances collisions was not traveling in the proper lane or the operator was driving to fast.

Hint 19

46.9

Front 20

The meaning of due regard in relation to emergency driving

Back 20

Due regard means you may use lights and sirens as a means to alert other drivers that you are in emergency mode, but it does not exempt you from operating your vehicle safely.

Hint 20

46.10

Front 21

Issues with using an escort

Back 21

Most drivers assume the way is clear after the first vehicle passes. Leave enough space between vehicles to react to drivers pulling out in path.

Hint 21

46.10

Front 22

Responsibility of determining an emergency response to the hospital

Back 22

Determine by attending paramedic/EMT and should be only for critical pts.

Hint 22

46.10

Front 23

Responsibilities of the paramedic when responding to an emergency call

Back 23

Decide the safest route avoiding when possible heavy traffic, school zones, construction zones. Beware of rail road tracks and alternative routes. Help clear intersections and be another pair of eyes for potential hazards.

Hint 23

46.10

Front 24

Placement of critical patients during a multiple patient transport to the hospital

Back 24

Load the most seriously injured last so that they will be unloaded first.

Hint 24

46.11

Front 25

Principles for backing an ambulance

Back 25

-Avoid when possible.
-Use a spotter.
-Communicate with spotter on where your backing, hand signals.
-Keep spotter in view.
-Roll window down, so that you many hear warnings of unseen dangers.
-Do a walk around looking for hazards.
-Use audible warning devices.

Hint 25

46.12

Front 26

Pediatric considerations during transport

Back 26

Use properly restrained children seats, and car seats, and attach to cot. It is not advisable to use adult seatbelts for children.

Hint 26

46.12

Front 27

Rotary wing (helicopters) vs fixed-wing air ambulances

Back 27

Fixed-wing ambulances are generally used for long distances, since they require a much greater area to land and take off.
Rotary wing can land in much smaller areas and have been used many times for areas far from hospitals.

Hint 27

46.13

Front 28

Situations that warrant a helicopter transport

Back 28

Pt in serious condition located far enough from hospital that time is gain by using helicopter. Severe traffic congestion or prolonged extrication times may sometimes make the use of a helicopter appropriate in urban areas. Also consider spinal injury and rough terrain as a helicopter travel is usually much smoother than the bouncy road conditions.

Hint 28

46.14

Front 29

Disadvantages of using an air ambulance

Back 29

Limited space, ie cardiac arrest.
Visual flight rules, difficult terrain to land safely, altitude limitations, airspeed limitations, and cost.

Hint 29

46.14

Front 30

Parameters of a helicopter landing zone

Back 30

Standard dimensions are 100' x 100'
Landing zone mush be firm and level, with no loose objects, and be on the look out of over head wires. Mark the landing site with a light at each corner.

Hint 30

46.14

Front 31

Night landing parameters

Back 31

Do not shine flashlights or spotlights at the aircraft as it can blind the pilot. Turn off headlights, and consider placing emergency vehicles under any overhead wires to signify the hazard.

Hint 31

46.14

Front 32

Parameters of approaching a helicopter

Back 32

If possible the rotors should be stopped before you approach. If loading hot, the tail rotor is the most dangerous so avoid it and load from the front and keep the pilot in view at all times.

Hint 32

46.15

Front 33

Types of ambulances

Back 33

Type I Conventional, truck-cab chassis with a modular ambulance body that can be transferred to a newer chassis as needed.

Type II Standard van, forward control integral cab-body ambulance.

Type III Specialty van, forward-control integral cab-body ambulance.

Hint 33

11-8

Front 34

Notes on belt noise

Back 34

Usually related to a over load on an appliance operated by a drive bet ie. power steering pump, the water pump, the vacuum pump, or the alternator. Does not warrant taking out of service immediately but should be given attention before it leads to major problems.

Hint 34

46.7