Chapter 40 – Principles of Emergency Response and Transportation 1

Chapter 40 – Principles of Emergency Response and Transportation

  1. Objectives

Knowledge Objectives /
  1. Discuss the medical and nonmedical equipment needed to respond to a call.
  2. Differentiate among the various methods of moving a patient to the unit on the basis of injury or illness.
  3. Discuss the measures necessary to ensure safe operation of an emergency vehicle.
  4. State what information is essential in order to respond to a call.
  5. Describe the general provisions of state laws relating to the operation of the ambulance and privileges in any or all of the following categories: speed, warning lights, sirens, right of way, parking, and turning.
  6. Discuss "due regard for the safety of others" while operating an emergency vehicle.
  7. List contributing factors to unsafe driving conditions.
  8. Give examples of possible driver distractions.
  9. Describe the considerations that should be given to request for escorts, following an escort vehicle, and intersections.
  10. Determine if the scene is safe to enter.
  11. Describe the important factors to consider when placing an emergency vehicle at the emergency scene.
  12. Summarize the importance of preparing the unit for the next response.
  13. Distinguish among the terms cleaning, low-level disinfection, intermediate-level disinfection, high-level disinfection, and sterilization.
  14. Describe how to clean or disinfect items following patient care.

Attitude Objectives /
  1. Explain the rationale for appropriate report of patient information.
  2. Explain the rationale for having the unit prepared to respond.

Skill Objectives / There are no skill objectives for this lesson.
  1. Preparation

Corresponding textbook pages: /
  • 665-681

Audiovisual equipment: /
  • Chapter 40 PowerPoint presentation
  • Computer
  • Multimedia projector

EMS equipment: /
  • Ideally, a fully stocked first response emergency vehicle

Course administration materials: /
  • Attendance sign-in sheet

Research before class: /
  • Check with your local and state regulatory agencies for the specific equipment requirements for emergency vehicles in your area.
  • Check your agency’s policy regarding the use of siren and/or lights in multiple vehicle responses.

  1. Personnel

Primary instructor qualifications: /
  • One EMR instructor knowledgeable in emergency vehicle operations.

Assistant instructor qualifications: /
  • None required

  1. Key Terms Presented in This Lesson
  • Decontamination The use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point at which it is no longer capable of transmitting infectious particles and the surface or item is considered safe for handling, use, or disposal.
  • Emergency Response Operation of an emergency vehicle while responding to a medical emergency.
  • High-Level Disinfection A method of decontamination that destroys all microorganisms except large numbers of bacterial spores. It is used for reusable equipment that has been in contact with mucous membranes, such as laryngoscope blades.
  • Intermediate-Level Disinfection A method of decontamination that destroys tuberculosis bacteria, vegetative bacteria, and most viruses and fungi, but not bacterial spores. It is used for surfaces that contact intact skin and have been visibly contaminated with body fluids, such as blood pressure cuffs, stethoscopes, backboards, and splints.
  • Low-Level Disinfection A method of decontamination that destroys most bacteria, and some viruses and fungi, but not tuberculosis bacteria or bacterial spores. It is used for routine cleaning of surfaces, such as floors, countertops, and ambulance seats, when no body fluids are visible.
  • Safe Zone An identified safety zone at a hazardous materials incident that is an area safe from the exposure or the threat of exposure and that serves as the staging area for personnel and equipment; also called the cold zone or support zone.
  • Sterilization A method of decontamination that destroys all microorganisms including highly resistant bacterial spores. It is used for instruments that penetrate the skin or contact normally sterile areas of the body during invasive procedures.
  • True Emergency A situation in which there is a high possibility of death or serious injury and the rapid response of an emergency vehicle may lessen the risk of death or injury.

V.Skills Presented in This Lesson

  • There are no skills identified for this lesson.

VI. Lesson Outline

Slide # / Instructor Notes
1 / A.Principles of Emergency Response and Transportation
2 / B.Objectives
3 / C.Principles of Emergency Response
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Objective 1 / 1.Preparation phase
a.Personnel and basic supplies
1)Preparation for an EMS call requires ensuring that appropriately trained personnel are available to respond.
2)Minimum staffing requirements for an ambulance include at least one EMT in the patient compartment.
3)To be “certified” as ambulances, emergency transport vehicles are required to carry specific types and quantities of medical equipment.
4)Local and state regulatory agencies mandate specific equipment that must be carried on an emergency vehicle.
5)Additional supplies may be needed to address the specific needs of individual EMS agencies or the type of calls that are common in your area.
b.Non-medical supplies
1)Personal safety equipment as required by local, state, and federal standards
2)Pre-planned routes or comprehensive street maps
3)Communications equipment
a)A ground ambulance must be equipped to provide voice communication between:
i)The ambulance attendant and the dispatch center,
ii)The ambulance attendant and the ground ambulance service’s assigned medical direction authority, and
iii)The ambulance attendant in the patient compartment and the ground ambulance service’s assigned medical direction authority.
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Objective 2 / c.Patient transfer equipment
1)Generally, each patient transport vehicle will have the following basic patient transfer equipment:
a)Wheeled stretcher
b)Collapsible stretcher
c)Long backboard or “Stokes” basket
2)Some EMS agencies will also have a bariatric stretcher available for use.
→Care should be taken to ensure that your patient is properly secured to the stretcher before moving. This includes 2 straps applied over the patient’s shoulders, 1 strap at the chest, 1 at the hips, and 1 at the legs.
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Objective 3 / d.Daily inspections
1)Inspection of vehicle systems
a)Fuel
b)Oil
c)Engine cooling system
d)Battery
e)Brakes
f)Wheels and tires
g)Headlights
h)Stoplights
i)Turn signals
j)Emergency warning lights
k)Wipers
l)Horn
m)Siren
n)Doors closing and latching
o)Communication system
p)Air conditioning/heating system
q)Ventilation system
2)Equipment
a)Checked and maintained
b)Restocked and repaired
c)Batteries for defibrillator, suction, oxygen, and other equipment and devices
7 / e.Vehicle inspection
1)Exterior
a)Begin your vehicle inspection with a conversation with the crew that used the apparatus during the previous shift. They should be able to inform you about any needs or deficits in the apparatus.
b)Next, visually inspect your vehicle for any obvious damage or deficits.
c)Note any breakage or damage on the appropriate “check-off sheet.” Decide if the vehicle needs immediate repair or is safe for operation.
d)All glass should be inspected and free of breakage and the windshield wipers should function properly.
e)Tires should have no visible damage to the rims or sidewalls.
i)The tread depth should be no less than the state accepted minimum.
ii)The nationally recognized minimum is about 1/8” and tire pressure should be appropriate to manufacturer’s guidelines.
iii)In addition, all tire lugs should be inspected for tightness and to ensure that none are missing.
f)All doors and compartments should open and close with ease.
i)The latching mechanisms should be intact and in working order.
ii)External mirrors should be intact and moved to the proper position for vehicle operation.
8 / g)All external lights should function properly and have no damage to the external housing.
i)This inspection must include the activation of all lighting devices.
9 / h)When inspecting the engine, make sure the motor is off.
i)Gloves should be worn to protect your hands from any damage or contamination.
i)Start with a visual inspection of the entire engine compartment, looking for any obviously loose or damaged components.
j)All hoses should be intact and not have any visible cracks or abrasions.
k)Inspect the radiator for leaks or damage and verify that the fluid reservoir is at the appropriate level.
i)If fluid must be added, contact the maintenance division or consult your local policies to determine the proper type and amount of fluid to add.
l)All belts should be inspected for cracks or unusual wear.
i)The appropriate personnel should immediately replace any damaged belt.
m)Inspect the battery and cables to confirm that they are intact and that the cables are tightly connected to the battery.
i)Pay particular attention to any visible corrosion as this may interfere with the proper connection of the cables to the battery.
n)Check all fluid levels as detailed by the operator’s guide.
i)Oil levels should be appropriate to the manufacturer’s specifications and generally must be clear or tan in color.
ii)Transmission fluid levels are generally checked after the vehicle has been “warmed up.” The vehicle operator’s guide should be consulted for the proper method of inspection.
iii)Windshield washer fluid should be checked as a standard part of all vehicle inspections. This fluid may be of critical importance during winter driving conditions.
10 / 2)Patient area
a)Begin inspection of the patient compartment by looking at the general cleanliness of the area.
b)Next, confirm that all safety equipment and seat belts are in good repair and function properly.
c)All patient care equipment must be checked to ensure appropriate stock levels and that each item functions as required.
i)This includes cardiac monitors, suction devices, sharps containers, and your response bag or box.
ii)The inspection of any battery-powered device must include verification of proper battery levels and the availability of additional batteries for extended responses.
iii)The equipment must then be properly stowed and secured in preparation for a response.
d)Continued inspection of the patient area should confirm the proper functioning of the heating, cooling, and exhaust system.
e)All oxygen storage devices should be checked to confirm appropriate levels and that the regulators function properly.
f)Most transport vehicles have communications equipment available in the patient area. This equipment must also be checked to confirm that it functions as required.
11 / 3)Operator area
a)The operator’s area requires not only inspection but also the adjustment of some equipment to your specifications.
b)Check and adjust the operator’s seat.
i)It should be placed at a safe and comfortable distance from the steering wheel and operator’s floor pedals.
ii)Most new apparatus will allow the operator to change the angle and distance of the steering wheel in relation to the operator’s console.
c)Inspect all warning and fluid gauges on the instrument panel to confirm that all are functioning and indicating safe operational levels.
d)Activate and then verify that the turn signals function properly. Note any deficiencies for immediate follow-up and repair before using the vehicle on a call.
e)Although it is important to verify the proper functioning of the horn and siren, in many instances this is prohibited by the placement of the station and the apparatus.
f)Adjust all mirrors as needed.
g)Adjust safety belts and restraint devices as needed.
h)Confirm that all interior lights function appropriately.
i)Parking brakes should be checked for proper operation.
j)Communications equipment will also need to be checked.
i)Follow local protocol for the safe and proper method to verify the operation of this equipment.
 Many of the inspections required in the operator’s area require the vehicle to be started and kept running. This check of equipment while the vehicle is running must be performed outside of any structure or in an area where appropriate exhaust handling systems are in place. Failure to follow this guideline can lead to the potential exposure to carbon monoxide.
 Remember to warn all personnel in the area before activating the horn or sirens for testing purposes. Inappropriate use of the horn or siren during vehicle inspection has the potential to cause hearing damage in any nearby personnel that are not wearing the proper protective devices. Always wear hearing protection before and during this testing.
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Objective4 / 2.Dispatch Phase
a.In the dispatch phase, the patient or a witness reports the emergency by calling 911 or another emergency number.
b.The call to 911 goes to a central communications system that is available 24 hours a day.
1)This system links police, fire, and EMS resources.
c.An Emergency Medical Dispatcher (EMD) receives the call and gathers information from the caller.
d.The dispatcher then activates (dispatches) an appropriate EMS response based on the information received.
e.The EMD will attempt to gather important information from the caller, including:
1)The nature of the call
2)The name, location, and callback number of the caller
3)The location of the patient
4)The number of patients and the severity of their illness or injury
5)Other special problems that can be identified by the caller
f.The EMD is also responsible for coordinating logistics.
1)An EMD is knowledgeable about the geography of the area, the EMS’s capabilities, and the activities of other public service agencies.
2)In most EMS systems, the EMD is trained to relay instructions to the caller for life-saving procedures that can be performed, if necessary, while waiting for trained medical personnel to arrive.
13 / g.When to notify dispatch
1)Receiving the call
2)Responding to the call
3)Arriving at the scene
4)Leaving the scene for the receiving facility
5)Arriving at the receiving facility
6)Leaving the hospital for the station
7)Arriving at the station
14 / 3.En Route or Response Phase
a.As you respond to the reported emergency, begin to anticipate the knowledge, equipment, and skills you may need to provide appropriate patient care.
b.Notify dispatch that you are responding to the call.
c.Write down the essential information from the dispatcher, including the nature and location of the call.
d.Determine the responsibilities of the crewmembers before arriving on the scene.
1)For example, while you and your partner are en route to the scene, decide who will assess the patient and who will document the call.
2)In most agencies, these responsibilities are determined at the start of a shift instead of on the way to a call.
15 / e.Most states and many companies encourage or even require all emergency vehicle operators to attend and successfully complete an approved driver-training course.
f.Characteristics of good emergency vehicle operators include the following:
1)Being physically and mentally fit
2)Being able to perform under stress
3)Having a positive attitude about their skills
4)Being tolerant of other drivers
16 / g.As you begin your response to the reported emergency, use preplanned routes and street maps.
1)Verify location and type of call
2)Select the best route on the basis of weather, traffic patterns, and road conditions.
a)You may need to use a different route depending on the time of day, day of the week, detours, road closings, bridges, railroad crossings, tunnels, schools, heavy traffic areas, weather, or local construction.
b)Plan an alternate route if unforeseen conditions are encountered.
3)Apply safety restraint devices
4)Notify dispatch agency of your response
5)Understand appropriate use of lights and siren
6)Drive with due regard for the safety of others
7)Maintain a safe following distance
8)Consider the need for additional resources if the call is a large incident with multiple patients.
9)Other factors to consider may include checking the wind direction as you approach the scene to confirm that you are upwind from a possible hazardous materials exposure.
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Objective 5 / h.Emergency response
1)The general definition of an emergency response is the operation of an emergency vehicle while responding to a medical emergency.
a)Laws pertaining to the proper methods of responding to an emergency vary from state to state.
b)These laws also govern the use of emergency signaling devices, such as lights and sirens.
2)In general, most states require emergency vehicle operators to obey all traffic regulations unless a specific exemption has been made and documented in statute.
a)Most states allow for these exemptions unless their use endangers life or property.
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Objective 6 / 3)When driving in emergency mode, the operator of an emergency vehicle must drive with due regard for the safety of others on the roadway.
a)Due regard means that, in similar circumstances, a reasonable and responsible person would act in a way that is safe and considerate of others.
b)Speed and speed limits
i)The posted speed limit on any road or highway is determined by many factors such as the type of road surface and the normal driving conditions.
ii)Most states allow for the increase of your emergency response speed to a maximum of 10 miles an hour over the posted speed limit. This increase is also based on weather and road conditions.