Chapter 46
Transport Operations
National EMS Education
Standard Competencies
EMS Operations
Knowledge of operational roles and
responsibilities to ensure patient, public, and
personnel safety.
National EMS Education
Standard Competencies
Principles of Safely Operating a Ground
Ambulance
• Risks and responsibilities of emergency
response
• Risks and responsibilities of transport
National EMS Education
Standard Competencies
Medicine
Integrates assessment findings with principles
of epidemiology and pathophysiology to
formulate a field impression and implement a
comprehensive treatment/disposition plan for
a patient with a medical complaint.
National EMS Education
Standard Competencies
Infectious Diseases
Awareness and management of
• A patient who may have an infectious
disease
• How to decontaminate equipment after
treating a patient
National EMS Education
Standard Competencies
Infectious Diseases
Assessment and management of
• A patient who may have an infectious
disease
• How to decontaminate the ambulance and
equipment after treating a patient
National EMS Education
Standard Competencies
Infectious Diseases
Assessment and management of
• A patient who may be infected with a
bloodborne pathogen
− Human immunodeficiency virus (HIV)
− Hepatitis B
• Antibiotic-resistant infections
• Current infectious disease prevalent in the
community
Introduction
• Today’s ambulances are equipped with
state-of-the-art technology.
• Driving an ambulance requires good
technique and judgment.
Emergency Vehicle Design
• US General Services Administration
determines ambulance standards.
• Design and manufacturing guidelines are
reviewed and updated every 5 years.
− Outlined by the DOT KKK 1822
Emergency Vehicle Design
• Type I:
Conventional
• Type II:
Standard van
© Tom Carter/PhotoEdit, Inc.
• Type III:
Specialty van
Courtesy of Captain David
Jackson, Saginaw Township
Fire Department
Courtesy of Captain David Jackson, Saginaw
Township Fire Department
Ambulance Equipment
• Every inch of space on an ambulance
stores and secures equipment.
• Organizations influence the list of supplies
and equipment that should be carried.
− OSHA
− ACS
− NFPA
Checking the Ambulance
• Crew members are
responsible for
ensuring:
− Unit is capable of
responding
− Proper equipment
and supplies are
available
Checking the Ambulance
• A daily check of the
ambulance should
ensure that it can:
− Start
− Steer
− Stop
− Stay running
Checking the Ambulance
• Warning signs
− Belt noise
− Break fade
− Brake pull
− Drift
− Steering pull
−
−
−
−
Pulsating brake
Steering play
Tire squeal
Wheel bounce
− Wheel wobble
Ambulance Staffing and
Development
• Maximize productivity and minimize
response times by analyzing:
− Response times
− Productivity
− Unit costs
− Taxpayer subsidies
Ambulance and EMS Systems
• In US, most first-response EMS and
ambulance service is delivered by the fire
department.
− Other models include:
• Private, for-profit agencies
• Public agency
• Public-private partnerships
System Status Management
(SSM)
• Goals:
− Maximize efficiency
− Reduce response time
• Considers:
− Peak loads
− Strategic deployment
Ambulance Stationing
• Goals:
− Maximize
efficiency
− Minimize response
times
• Factors include:
− Distance vs. call
volume
− Special facilities
− Need for
maintenance
− Storage
− Classrooms
− Sleeping quarters
En Route to Scene
• As you prepare to respond:
− Fasten seatbelts and shoulder harnesses.
− Inform dispatch you are responding.
− Confirm nature and location of call.
− Ask for other information.
En Route to Scene
• While on route:
− Prepare to assess and care for the patient.
− Review dispatch information.
− Assign duties and tasks.
− Decide which equipment to take.
− Decide which stretcher to take.
Arrival at the Scene
• Look for safety hazards.
• Evaluate the need for additional units.
• Determine the mechanism of injury or
nature of the illness.
Arrival at the Scene
• Evaluate the need to stabilize the spine.
• Follow standard precautions.
• If you are the first at a multiple-casualty
incident, estimate the number of patients.
Traffic Control
• Ensure orderly traffic flow, and prevent
another crash.
• Place reflectors and other warning devices
on both sides of crash.
Securing Equipment
• Make sure all equipment is secured before
placing a vehicle in motion.
− Some equipment can become lethal projectiles
if not secured properly.
Safe Patient Transfer
• Excessive speed is unnecessary and
dangerous.
− Common sense and good driving techniques
are required.
• Secure the patient with at least three straps
across the body.
Postrun Activities: Restocking,
Cleaning, and Disinfection
• Clean and disinfect
ambulance and
equipment used.
• Restock supplies.
• Perform routine
inspections.
• Decontaminate the
ambulance.
Defensive Ambulance Driving
Techniques
• More than 6,000
crashes per year
• Knowledge of
vehicle operation is
critical.
© Robert Brenner/PhotoEdit, Inc.
Driver Characteristics
• Diligence and caution
• Positive attitude about your ability
• Tolerance of other drivers
• Physical fitness
• Emotional fitness
• Proper attitude
• Good judgment and knowledge
Safe Driving Practices
• Route planning and navigation
− Have access to street and area maps
− Become familiar with the roads and traffic
patterns in your area.
• Avoid heavy traffic areas.
• Know your way around.
Safe Driving Practices
• Fatigue
− Don’t be
ashamed to admit
when you are
fatigued.
− Place yourself out
of service until
fatigue has
passed.
• Distractions
− Never attempt to:
• Type
• Text
• Operate personal
data devices
• Listen to music
• Eat or drink
Safe Driving Practices
• Use of safety restraints
− All passengers should wear seatbelts.
• Speed
− Always drive with caution.
• Siren risk-benefit analysis
− Never use to transport a nonemergency patient.
Safe Driving Practices
• Driver anticipation
− All other drivers are unpredictable.
− Maintain a safe travel distance behind vehicles.
− Do not respond aggressively to drivers.
− Do not accelerate through intersections.
Safe Driving Practices
• Driver anticipation (cont’d)
− Make eye contact with fellow drivers.
− Use turn signals.
− Never force a vehicle into oncoming traffic.
Safe Driving Practices
• Cushion of safety
− Maintain a safe distance from vehicles.
− Avoiding being tailgated.
− Be aware of blind spots.
• View ahead
• Rear of vehicle
• Side of vehicle
Safe Driving Practices
• Vehicle size and distance judgment
− Vehicle length and width are critical when:
• Maneuvering
• Driving
• Parking
• Braking and passing
Safe Driving Practices
• Backing up the
emergency vehicle
− Use a spotter.
− Agree with the
spotter before
moving.
− Keep your spotter
in view at all times.
Safe Driving Practices
• Backing up the emergency vehicle (cont’d)
− Agree on hand signals before moving.
− Keep your window cracked open.
− Do a walk-around before getting in the vehicle.
− Use audible warning devices.
− Do not rely on a back-up camera.
Safe Driving Practices
• Parking at an emergency scene
− Allow for efficient traffic control and flow.
− Do not block other emergency vehicles.
− Park uphill or upwind.
− Stay away from structures that might collapse.
− Always use your parking brake.
Safe Driving Practices
• Parking at an
emergency scene
(cont’d)
− Park as close to
the scene as
possible.
− Park where your
departure will not
be hampered.
− Be aware of
terrain.
Safe Driving Practices
• Parking at an emergency scene (cont’d)
− Turn off headlights to avoid blinding oncoming
traffic at night.
− Always wear visible protective clothing.
Emergency Vehicle Control
• Two ways to control a vehicle:
− Changing directions
− Changing speed
• Drivers must constantly evaluate the road
surface.
Emergency Vehicle Control
• Road positioning
and cornering
− Take corners at the
speed that will put
you in the proper
road position
Braking
• Getting a feel for brake pressure comes
with experience and practice.
• Get to know each vehicle you drive.
Controlled Braking
• Weather and road conditions
− Weight distribution should be taken into
consideration during inclement weather.
• Hydroplaning
− Gradually slow down without slamming on the
brakes.
Controlled Braking
• Water on the roadway
− Lightly tap the brakes several times after driving
through water to dry them.
• Decreased visibility
− During fog, smog, snow, or heavy rain, use low
headlights.
− Use headlights during the day.
Controlled Braking
• Ice and slippery surfaces
− All-weather tires and appropriate speed will
reduce traction problems.
− Be especially careful on bridges and
overpasses.
Laws and Regulations
• Vary from state to state and city to city
• Emergency vehicle drivers have certain
limited privileges.
− Privileges don’t lessen liability in a crash.
Laws and Regulations
• Use of warning lights and sirens
− Unit must be on a true emergency call.
− Audible and visual warning devices must be
used simultaneously.
− Unit must be operated with due regard for the
safety of others.
Laws and Regulations
• Right-of-way
privileges
− Only use when
necessary.
− Know your local
right-of-way
privileges.
• Use of escorts
− Generally not a
good idea
− Leave space
between vehicles.
− Instruct family
members not to
drive closely
behind you.
Laws and Regulations
• Intersection hazards
− Look for other motorists and pedestrians before
proceeding into the intersection.
• Unpaved roadways and rural settings
− Operate the vehicle at a lower speed.
− Maintain a firm grip on the steering wheel.
Laws and Regulations
• School buses
− Never pass a
school bus that
has stopped.
• School zones
− In many states it is
illegal to exceed
the speed limit in
school zones.
• Funeral
processions
− Most states offer
no exemption.
− Out of respect,
most drivers turn
off audible
devices.
Air Medical Transports
• Can speed up transfer of patients
• Factors to consider:
− Does the patient’s condition warrant the risk of
using air transport?
− Will the use of air transport truly save time?
Rotor-Wing Versus Fixed-Wing
Air Ambulances
• Rotor-wing aircraft
− Standard of care
for transportation
of critically injured
• Fixed-wing aircraft
Courtesy of Brian Denlinger and STAT MedEvac
− Used mainly for
long-distance
transportation
© Hermann J. Knipperatz/AP Photos
Advantages of Using Air
Ambulances
Disadvantages of Using Air
Ambulances
Helicopter Medical Evacuation
Operations
• Why call for a medevac?
− Ground transportation will take too long.
− Conditions limit or prohibit the use of ground
transportation.
− Patient requires advanced care.
− Multiple patients will overwhelm a hospital.
Helicopter Medical Evacuation
Operations
• Who receives a medevac?
− Patients with time-dependent injuries or
illnesses
− Patients with serious conditions
− Trauma patients
• Who do you call?
− Notify dispatcher
Helicopter Medical Evacuation
Operations
• Medevac issues
− Weather
− Environment/terrain
− Altitude
− Airspeed limitations
− Cabin size
− Cost
Establishing a Landing Zone
• Should be a hard or a grassy level surface
• Should be cleared of loose debris
• Should be clear of overhead or tall hazards
• Should be marked with weighted cones or
emergency vehicles
Landing Zone Safety and
Patient Transfer
• Be familiar with capabilities, protocols, and
methods for accessing helicopters.
• Go only where the pilot and crew directs
you.
• Keep a safe distance from the aircraft
whenever it’s on the ground and “hot.”
Landing Zone Safety and
Patient Transfer
• The proper
approach is
between nine-o’clock and three-o’clock.
• Walk in a crouched
position when
approaching.
Landing Zone Safety and
Patient Transfer
• When operating at a landing zone:
− Pay attention to the flight crew.
− Become familiar with hand signals.
− Do not approach unless instructed by flight
crew.
Landing Zone Safety and
Patient Transfer
Landing Zone Safety and
Patient Transfer
• When operating at a landing zone (cont’d):
− Make sure all equipment/patients are secured.
− Always approach from the front.
− Smoking, open lights or flames, and flares are
prohibited within 50 ft of the aircraft.
Communicating with Other
Agencies
• When requesting a medevac response,
always include:
− Ground contact radio channel
− Call sign of the unit
Special Considerations
• Night landings
− Do not shine lights in the air to help the pilot.
− Direct light toward the ground.
− Smoking, open lights or flames, and flares are
prohibited within 50 ft of the aircraft.
Special Considerations
• Landing on uneven ground
− Approach from downhill side only.
− Do not move the patient until signaled.
Special Considerations
• Medevacs at hazardous materials incidents
− Flight crew should be notified immediately.
− Landing zone should be established upwind
and uphill from the scene.
− Exposed patients must be decontaminated
before being loaded into the aircraft.
Summary
• DOT KKK 1822 sets the standards for
ambulance design and manufacturing
specifications.
• Three body styles: Type I, Type II, Type III
• Check the ambulance at the beginning of
every shift to ensure that all equipment is
available and in good working order.
• Preventative maintenance is as important
as operating skills.
Summary
• Perform routine inspection after each call.
• Learning how to properly operate your
vehicle is just as important as learning how
to care for patients.
• Drivers must be qualified to drive an
ambulance, must be physically and
emotionally fit, and must have the proper
attitude.
Summary
• All drivers and passengers should use
appropriate safety restraints while vehicles
are in motion.
• Make sure all equipment is secure before
leaving the scene.
• Lights and sirens should be used sparingly.
• Avoid backing up vehicle if possible. When
unavoidable, always use a spotter.
Summary
• Use extreme caution when driving in heavy
traffic areas or in rural areas.
• Slow down in inclement weather.
• Any specific exemption from traffic laws
does not negate your responsibility to
proceed with due regard.
• Escorts should not be used.
• Air ambulances are used to evacuate
medical and trauma patients.
Summary
• A medical evacuation is commonly known
as a medevac.
• You must follow certain safety rules when
you are working around landing zones and
helicopters.
Credits
• Backgrounds: Purple—Courtesy of Rhonda Beck;
Blue—Jones & Bartlett Learning. Courtesy of
MIEMSS; Red—© Margo Harrison/ShutterStock, Inc.;
Green—Courtesy of Rhonda Beck.
• Unless otherwise indicated, all photographs and
illustrations are under copyright of Jones & Bartlett
Learning, courtesy of Maryland Institute for
Emergency Medical Services Systems, or have been
provided by the American Academy of Orthopaedic
Surgeons.