Seattle/King County EMT-B Class
Topics
1
Ambulance Operations: Chapter 35
2
Gaining Access: Chapter 36
3
Special Operations: Chapter 37
1
Ambulance Operations
1
Ambulance Operations
Emphasis on rapid response places the
EMT-B in great danger while driving to calls.
EMT-Bs should know:
• How to equip and maintain an
ambulance
• Techniques for the safe operation of an
ambulance
• How to work safely with air ambulances
1
Type I
1
Type II
1
Type III
1
Phases of an Ambulance Call
• Preparation
• Dispatch
• En route
• Arrival at scene
• Patient transfer
• En route to receiving
facility
• At the receiving
facility
• En route to station
• Post-run
1
Preparation Phase
• Medical equipment and supplies check
• Personal safety equipment
• Equipment for work areas
• Preplanning and navigation
• Extrication equipment
• Daily inspections
1
Medical Equipment
• Airway and
ventilation devices
• Childbirth supplies
• Suction unit
• Oxygen delivery
• Patient transfer
equipment
• CPR equipment
• Medications
• Basic wound care
• Jump kit
• Splinting supplies
• AED
1
Personal Safety Equipment
•
•
•
•
Face shields
Gowns, shoe covers, caps
Turnout gear
Helmets with face shields or safety
goggles
• Safety shoes or boots
1
Equipment for Work Areas
• Warning devices that flash
intermittently or have reflectors
• Two high-intensity halogen flashlights
• Fire extinguisher
• Hard hats or helmets with face shields
• Portable floodlights
1
Other Preparations
Preplanning and navigation
• Carry detailed maps and directions.
• Be familiar with local area.
Extrication equipment
• Equipment needed for simple, light
extrication
1
Personnel
• Every ambulance must be staffed with at
least one EMT-B in the patient
compartment during patient transport.
• Two EMTs are strongly recommended.
• Some services may operate with a nonEMT driver.
1
Inspections and Safety Precautions
• Being fully prepared means inspecting the
ambulance and equipment daily.
• Check medical equipment and supplies at
least daily.
• Review standard traffic safety rules and
regulations.
• Make sure seat belts work and that oxygen
tanks are secured.
1
Dispatch Phase
The dispatcher should gather minimum
information such as:
• Nature of the call
• Name, person, location, and call-back
number
• Location of the patient(s)
• Number of patients and idea of the
severity of their conditions
• Special problems or other pertinent
information
1
En Route to the Scene
• Fasten your seat belt.
• Confirm response and location.
• Prepare for arrival.
• Decide what equipment to take initially.
1
Arrival at the Scene
• Scene safety
• Safe parking
• Traffic control
1
Scene Size-up
•
•
•
•
•
Look for safety hazards.
Evaluate need for additional units.
Determine MOI/NOI.
Evaluate spinal precautions.
Follow BSI precautions.
1
Safe Parking and Traffic Control
• Park away from hazards and out of flow
of traffic.
• Do not block other responding EMS
vehicles.
• Place appropriate warning devices on
both sides of the accident.
1
Transfer Phase
• Provide lifesaving treatment.
• Package patient for transport.
• Be sure to secure the patient with at
least three straps across the body.
1
Transport Phase
• Inform dispatch when you are ready to
leave the scene.
• Report the number of patients and the
name of receiving hospital.
• Conduct ongoing assessments.
• Contact medical control.
– Report number of patients
– Nature of problems
1
Delivery Phase
• Report arrival to dispatch.
• Give report to staff.
• Physically transfer the patient.
• Complete written report.
• Leave a copy with an appropriate staff
member.
1
En Route to the Station
• Inform dispatch
whether or not
you are in service
and where you are
going.
• Clean and disinfect
the ambulance
and any
equipment used.
• Restock supplies.
1
Postrun Phase
• Complete and file any additional
written reports.
• Inform dispatch of your status,
location, and availability.
• Clean and restock the ambulance.
1
Defensive Driving
• 6,000 ambulances involved in crashes
every year
• 300 fatalities between 1991 and 2001
• Properly operating the ambulance is as
important as taking care of patients.
1
Driver Characteristics
Physical fitness
• Effects of medication
• Fatigue
Emotional fitness
• Maturity and stability
• Proper attitude
As a public servant, your actions will
be scrutinized.
1
Safe Driving Practices
• Speed does not save lives; good care
does.
• Seat belts must be worn.
• Learn how your vehicle accelerates,
corners, sways, and stops.
1
Driver Anticipation
• Anticipate the actions of other
motorists and pedestrians.
• Assume actions of other drivers will
cause a collision.
• Use of PA system may add to
confusion.
1
Cushion of Safety
•
•
•
•
Keep safe following distance.
Watch for tailgaters.
Be aware of blind spots.
Use a spotter when backing up.
1
Excessive Speed
• Speeding is unnecessary if patient is
properly assessed and stabilized.
• Decreases reaction time
• Increases stopping time and distance
1
Vehicle Size and Cornering
• Vehicle length and width are critical
factors in maneuvering.
• Vehicle size and weight greatly
influence braking and stopping
distances.
• Always be aware of your position on
the roadway.
• Take corners at the speed that will put
you in the proper road position as you
exit the curve.
1
Weather and Road Conditions
Be alert to changing conditions.
Decrease speed and increase distance in
poor conditions, such as:
• Hydroplaning
• Water on roadway
• Decreased visibility
• Ice and slippery surfaces
1
Laws and Regulations
• Vary from state to state
• EMS drivers have certain limited
privileges.
• These privileges do not lessen drivers’
liability.
1
Warning Lights and Sirens
• Must be responding to an emergency
• Use both audible and visual devices.
• Operate with due regard.
1
Right-of-Way Privileges
• You must not endanger people or property
under any circumstances.
• Know your local right-of-way privileges.
• Exercise them only when necessary for
the patient’s well-being.
1
Escorts and Intersection Hazards
Use of escorts
• A dangerous practice
• Follow escorts at a safe distance.
Intersection hazards
• Most common place for collisions
• Even on urgent calls, come to a
momentary stop at the light.
1
Air Ambulances
Fixed wing
• Interhospital
transfers
Rotary-wing
• Used for
shorter
distances
1
Medivac Operations
Become familiar with local capabilities.
Calling for a medivac:
• Ground transport would take too long.
• Spinal cord injuries, amputations,
burns, diving emergencies, venomous
bites
Notify your dispatcher first.
1
Establishing a Landing Zone
• Area should be hard or grassy level
surface that measures 100' x 100'
(recommended)
• Clear area of loose debris and survey
for overhead or tall hazards.
• Mark landing site with weighted cones
or headlights.
1
Safety Precautions
• Do nothing near the helicopter and only
go to where the crew or pilot directs
you.
• Keep a safe distance away from the
aircraft.
• Stay away from the tail rotor.
• Never approach the helicopter from the
rear.
1
Special Considerations
Nighttime landings
• Considerably more dangerous than
daytime operations
Landing on uneven ground
• Main rotor blade will be closer to the
ground on uphill side.
Hazardous materials incidents
• Land zone should be upwind and uphill.
1
Landing on Uneven Ground
2
Gaining Access
2
Safety
Preparation
• Mental
• Physical
2
Vehicle Safety Systems
• Shock-absorbing bumpers
• Airbags
2
Fundamentals of Extrication
Extrication
• Removal from entrapment or a
dangerous situation or position
Entrapment
• To be caught within a closed area with
no way out
2
10 Phases of Extrication
1.
2.
3.
4.
5.
Preparation
En route to the scene
Arrival and scene size-up
Hazard control
Support operations
2
10 Phases of Extrication, cont'd
6.
7.
8.
9.
10.
Gaining access
Emergency care
Disentanglement
Removal and transfer
Termination
2
Preparation
• Training
• Equipment maintenance
2
En Route to the Scene
•
•
•
•
•
•
Safe driving practices
Good steering techniques
Road positioning and cornering
Controlled acceleration
Controlled braking
Laws and regulations
2
Arrival and Scene Size-up
•
•
•
•
•
Traffic hazards
Additional resources
Coordination within ICS
Rescue team responsibilities
EMS responsibilities
2
Hazard Control
Law enforcement
• Traffic control
• Investigation
• Scene control
Fire fighters
• Extinguishment
• Spill control
Rescue team
• Extrication
2
Hazards
•
•
•
•
•
•
Downed power lines
Sharp metal
Broken glass
Toxic substances
Hazardous substance ignition
Unstable vehicles
2
Support Operations
• Lighting
• Tool and equipment
staging areas
• Helicopter landing
zones
2
Gaining Access
• Is the patient in a vehicle or other
structure?
• Is the vehicle or structure severely
damaged?
• What hazards exist that pose risk to the
patient and rescuers?
• What is the position of the vehicle?
• What type of surface is it on?
• Is it stable?
2
Gaining Access, continued
Simple access
• Access without
the use of tools
or force
Complex access
• Requires the use
of tools and force
2
Emergency Care
• Provide manual immobilization to protect the
cervical spine.
• Open the airway.
• Provide high-flow oxygen.
• Assist or provide for adequate ventilation.
• Control any significant external bleeding.
• Treat all critical injuries.
2
Disentanglement
Removal of the motor vehicle from
around the patient.
Techniques include:
• Brake and gas pedal displacement
• Dash roll-up
• Door removal
• Roof opening and removal
• Seat displacement
• Steering column displacement
• Steering wheel cutting
2
Removal and Transfer
• Determine urgency of move.
• Plan moves and communicate with the team.
• Once patient is freed, rapidly reassess and
recheck vital signs.
• Make certain spine is immobilized.
2
Removal and Transfer, cont'd
• Move the patient in slow, controlled
steps.
• Choose a path that requires the least
manipulation of the patient and
equipment.
• Move the patient as a unit.
• If the patient’s condition is critical,
perform remaining steps en route.
2
Termination
• Check tools and equipment.
• Replace used supplies.
• Clean unit and conform to bloodborne
pathogen standards.
• Complete all necessary reports.
2
Specialized Rescue Situations
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•
•
•
•
•
•
Cave rescue
Confined space rescue
Cross-field and trail rescue
Dive rescue
Lost person search and rescue
Mine rescue
Mountain, rock, and ice-climbing rescue
2
Specialized Rescue Situations
• Ski slope and cross-country or trail snow
rescue (ski patrol)
• Structural collapse rescue
• Tactical emergency medical support (SWAT)
• Technical rope rescue (low- and high-angle
rescue)
• Trench rescue
• Water and small craft rescue
• White-water rescue
2
Lost Person Search and Rescue
• Primary role will be to take care of
patient when found.
• Prepare equipment and stand by in area
designated by incident command.
• Only incident command should deliver
information to the family unless someone
else is designated to do so.
2
Trench Rescue
•
•
•
•
Poor outcome for victims
Risk of secondary collapse
Proper safety reduces potential for injury.
Stage response vehicles.
2
Tactical Emergency Medical Support
• EMT-Bs, paramedics, nurses, and physicians
with specialized tactical and medical training
• Nonstandard medical procedures similar to
battlefield medicine
• Examples of tactical situations
– Hostage situations
– Snipers
– Barricaded suspects
2
Tactical Emergency Medical Support
Response procedures
• Shut off lights and siren when approaching
the scene
• Report to the command post
Planning
• Specific location of the incident
• Rally point with tactical EMS providers
• Helicopter landing zones
• Hospital locations and route of travel
2
Structure Fires
• Ask incident command where the
ambulance should be positioned.
• Do not block arriving equipment or
become blocked.
• Only leave the scene if transporting a
patient or cleared by incident command.
3
Special Operations
3
Incident Command System
• ICS is used to help control, direct, and
coordinate resources.
• It ensures clear lines of responsibility and
authority.
• Incident commander has overall responsibility
for the scene.
• Safety officer is designated to circulate
among responders.
3
Incident Command System
3
Information Officer
All information to the public and
news media originates at the
command post.
3
Safety Officer
• Circulates through incident scene to
ensure safety of responders and victims.
• Orders by the safety officer have full
authority of the incident commander.
3
Sector Commanders
Coordinate activities of specialty groups
• EMS
• Rescue
• Fire
3
Sectors of Typical IC Structure
•
•
•
•
Operations
Planning
Logistics
Finance
3
Incident Command
• Command structure must be established
early and expanded as needed.
• Incident command may vary in different
communities.
• An EMT-B must not deviate from the
directions and orders given by command.
3
Key Components of ICS at an MCI
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•
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•
•
•
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•
•
Command center
Staging area
Extrication area
Decontamination area
Triage area
Treatment area
Supply area
Transportation area
Rehabilitation area
3
NIMS
National Incident Management System
Nationwide model to enable federal, state,
and local governments and private-sector
and non-governmental organizations to
work together in an emergency.
3
NIMS, continued
•
•
•
•
Applicable to all jurisdictions
Utilized by a variety of disciplines
Improves coordination and cooperation
Built on existing incident management
systems
3
Mass-Casualty Incidents
• Incidents involving
three or more
patients
• Places high demand
on available
resources
• May require mutual
aid response
3
Triage
• Triage is the sorting of two or more
patients based on the severity of their
conditions.
• Patients are ranked in the order of the
severity of their conditions.
• Treatment priority is determined by
rank.
3
Triage, continued
Triage is an essential component of operations
at a mass-casualty incident.
3
Triage Categories
3
Triage Priorities
• Patients should be color coded early.
• Patients tagged red should be assessed in
the treatment area.
• Patients in dangerous areas should be
removed to a non-hazardous environment
prior to triage.
3
Triage Procedures
• Rotate hospital
destinations.
• Trauma center
should receive the
most critical
patients.
• Utilize a transport
officer to evenly
distribute patients.
3
Disaster Management
• The role of the EMT-B is to respond
when requested and report to incident
command.
• A casualty collection area may be set up
and staffed by nursing and medical staff
with equipment.
• You may have to bring patients to this
area.
3
Introduction to HazMat
• Any substance that is toxic, poisonous,
radioactive, flammable, or explosive and
can cause injury or death with exposure
• Responders must have special training
before becoming involved with
hazardous materials.
3
Hazardous Materials Situations
• A train or truck with a leaking substance
• A leak, fire, or other emergency at an
industrial plant, refinery, or other
storage facility
• A gas pipe leak or rupture
• Deterioration of underground fuel tanks
• Buildup of methane in sewers
• Car crash involving a ruptured gas tank
3
Recognizing Hazardous Materials
• Warning signs
• Placards
• Labels
3
Recognizing Hazardous Materials
• Visible cloud or odd-looking smoke
coming from an escaping substance
• A leak or spill from a tank, container,
truck, or railroad car
• An unusually strong, noxious, acrid
odor
3
HazMat Placards
The four-digit number on the warning
placard identifies the hazardous material.
3
First Arrival
•
•
•
•
•
•
Stop at safe distance.
Call for a HazMat team.
Stay out of danger zone.
Gather information.
Do not reenter the scene.
Do not leave until cleared by HazMat.
3
Identifying Hazardous Materials
• Safety perimeters
• Uphill and upwind
• Efforts to ensure safety and survival of
the masses.
3
HazMat Scene Safety
Approach a hazardous incident cautiously from
upwind.
3
HazMat Scene Operations
• HazMat will determine the specific
hazardous material involved.
• Only those trained in HazMat and
wearing protective gear should enter
the zone.
• As an EMT-B, your job is to remain in
the designated treatment area.
• HazMat will bring patients to you.
3
Decontamination Area
• Designated area where contaminates
are removed.
• Anyone who leaves the hazard zone
must pass through this area.
• Wait for the patients to be brought to
you.
3
Treating Patients at a HazMat Incident
• Only essential treatment will take place
in the hazard zone and decontamination
area.
• Injuries should be treated as any other
patient.
• Treatment for exposure will be mainly
supportive.
• Initiate transport.
3
Special Care
• Some patients may need to be treated
without full decontamination.
• Protect yourself with proper gear.
• Ensure the receiving hospital is aware
patient has not been fully
decontaminated.
• Ambulance will need to be
decontaminated after transport.
3
Resources
• Emergency Response
Guidebook
• Chemical
Transportation
Emergency Center
(CHEMTREC)
• 1-800-424-9300
3
PPE Levels
• Level A—Fully encapsulated, chemicalresistant protective clothing
• Level B—Non-encapsulated protective
clothing with respiratory protection
• Level C —Non-permeable clothing, eye
protection, filtering face mask
• Level D —Work uniform; minimal
protection
3
Four Levels of Protection
Level A
Level B
Level C
Level D
Questions
• What questions do you have?
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