RPI AMBULANCE ATTENDANT CLASS Last Updated by M. O’Donnell, June 2012

1. RPI AMBULANCE ATTENDANT CLASS Last Updated by M. O’Donnell, June 2012

2. Attendant Class Class Topics • Module I: Introduction to RPI Ambulance • Module II: RPI Ambulance and the Law • Module III: Safety • Module IV: Radio Communications • Module V: Lifting and Moving • Module VI: Vital Signs & Diagnostic Equipment • Module VII: Airway • Module VIII: Breathing • Module IX: Circulation • Module X: Splinting and Spinal Immobilization RPI Ambulance Attendant Class

3. Introduction to RPI Ambulance Agency Information • Service: Volunteer, Student Run • Level of Care: Basic Life Support (BLS) • Office: 92 College Avenue • Garage: Behind the Armory • Service Period: In service 24/7 during the Fall and Spring Semesters • Call Volume: ~150 per year • Primary Coverage Area: RPI Troy campus • Secondary Coverage Area: Troy, Brunswick, North Greenbush, etc. • Special Events: Stand-bys for Hockey, Football, Commencement, etc. RPI Ambulance Attendant Class

4. Introduction to RPI Ambulance Rules and Regulations • Standard Operating Procedures • Agency Document • RPIA Constitution • Union Document • New York State Department of Health • Part 800, Minimum Requirements for an Ambulance • Part 18, Requirements for large events • Documents can be found online at www.ambulance.union.rpi.edu RPI Ambulance Attendant Class

5. Introduction to RPI Ambulance Crew Positions • Crew Chief • Driver • Attendant • Observer RPI Ambulance Attendant Class

6. Introduction to RPI Ambulance Attendant Training Requirements A. Hold a Professional Rescuer CPR certification. B. Take the Attendant class (recommended). C. Complete the Attendant checklist. D. Complete and submit a copy of a Rig Check. E. Complete one real or two simulated calls, and take vitals and submit an attendant evaluation. F. Request and receive approval by the Training Committee to be promoted to Attendant. RPI Ambulance Attendant Class

7. Introduction to RPI Ambulance Scheduling Website • Sign up on the website for: • Night Crew • Stand-bys (Hockey, Football, etc.) • Training Drills, Meetings, Banquets, etc. • Signing up: • Go to the Scheduling page on the website:http://ambulance.union.rpi.edu/scheduling/index.php • Click “Login”, and enter your username and password. • Go to the Night Crews or Games and Events schedule, and click “Sign up”, and “Confirm”. • You’ll get an email confirming that you are signed up. RPI Ambulance Attendant Class

8. Introduction to RPI Ambulance Field House and ECAV Operations • Events: • Hockey • Commencement • Concerts • Personnel: • Field Crews, EES • Locations: • HFH PCF • ECAV EMS Room • Sign up on website, report to appropriate PCF or the garage 15 minutes prior to start time RPI Ambulance Attendant Class

9. Introduction to RPI Ambulance Professionalism • Always maintain a professional attitude and appearance • You represent RPI Ambulance and RPI. • Assures the patient they are in competent hands • Don’t dress or act in a manner unbecoming a member of the agency RPI Ambulance Attendant Class

10. RPI Ambulance And The Law NYS Department of Health • State Emergency Medical Services Code (Part 800) Defines: • General Emergency Medical Services rules • Certification of EMS personnel • Certification of EMS agencies • Requirements for equipment and ambulances • Pre-hospital DNR orders RPI Ambulance Attendant Class

11. RPI Ambulance And The Law Patient Confidentiality • Patient’s medical and personal information is private • Name, address, medical conditions, condition, treatment etc. • State and federal laws forbid disclosure of patient information • NYS Part 800.15, Health Insurance Portability and Accountability Act (HIPAA) • Only those who “Need to Know” may have access to patient information • Doctors, nurses, crew members in charge of caring for patient • Your friends, bystanders, Public Safety, the public DO NOT need to know • When in doubt, ask your crew chief. Do not share information! RPI Ambulance Attendant Class

12. Safety Scene Safety • Crew safety is the primary concern during all operations. You can not help the patient, if something happens to you. • Unsafe scenes: • Substance abusers • Assaults, weapons on scene • Hazmat incidents • MVAs • Emotionally disturbed persons, attempted suicide. • Fires, collapses, animal bites, CO poisoning. • Do not enter a scene that is not safe. Wait for fire, rescue or law enforcement personnel to secure the scene. RPI Ambulance Attendant Class

13. Safety Infection Control • If its wet and sticky and not yours, don’t touch it. If you have to, wear gloves! • Gloves are worn during every patient contact. • Other PPE includes: • N95 respirator masks • Goggles • Gowns • The best way to prevent infection is to wash your hands! • If you come into contact with someone else’s bodily fluids, tell the crew chief! RPI Ambulance Attendant Class

14. Radio Communications RPIA Portable Radios • Frequency: 155.200 MHz • Use of RPIA Radios: • Receiving tones and dispatches from Rensselaer County Emergency Communications Center (ECC) • Amassing a crew for day calls • Tactical Communications during stand-bys (hockey games, etc.) • Crew Chiefs, Drivers, and actively training attendants carry portable radios RPI Ambulance Attendant Class

15. Radio Communications The “800” System • Frequency: 46.04 MHz • Uses of County Radios: • Communicating with Rensselaer County ECC (dispatcher). • NYS Interagency and Mass Casualty Incident channel. • Used by crew chiefs and drivers. • Three Portables, • Duty Supervisor, Office, Rig • One Mobile Unit in the Ambulance RPI Ambulance Attendant Class

16. Radio Communications Communication Guidelines • Call Signs • Ambulance is A-39 internally, 5939 to the county • Members are assigned “900” Numbers • Line Officers have Car Numbers (Car 1, etc.) • Communicating on the Radio • State who you are speaking to, then you. • “Car 1, this is 944.” • Always be professional; never know who is listening. • Public Safety, County, General Public RPI Ambulance Attendant Class

17. Radio Communications RPI Ambulance is dispatched on Channel 1 on RPI Ambulance’s Radios: Dispatcher: “Stand By RPI Ambulance” Tones Dispatcher: “RPI Ambulance for a <determinant> determinant EMS call for <Demographics> <Chief Complaint> at <Location>” Example: “ RPI Ambulance. Delta determinant EMS call for a seizure, RPI Crockett Hall, 72 Griswold Road. Cross Streets are Sage Ave and Bouton Road.” The Dispatch RPI Ambulance Attendant Class

18. Determinants Alpha: BLS Priority II Non-Emergency Bravo: BLS Priority I Emergency, Not Imminently life threatening Charlie: ALS & BLS Priority I Emergency, Possibly life threatening Delta: ALS & BLS Priority I Emergency, Actively life threatening Echo: ALS & BLS Priority I (anyone with an AED) Cardiac or Respiratory Arrest/ Unknown life status Radio Communications Dispatch Determinants Charlie Chespans RPI Ambulance Attendant Class

19. During the call, the following radio transmissions are made to dispatch over the 800 by the driver: Confirm crew / en route to the scene Arriving on scene En route to the hospital Arriving at the hospital Back in service Back in quarters The receiving facility will be notified of patient information and arrival time over the BLS channel (a “med patch”) by the crew chief. Radio Communications Call Communications RPI Ambulance Attendant Class

20. Proper lifting technique: Lift with your legs, not your back! Bend at the knees. Keep your back straight and shoulders square. Do not twist or bend your back. If you need to turn, use your whole body. If a patient is too large for your crew to safely move: Re-dispatch for additional crew members. Request Troy Fire Department for a lift assist. Lifting and Moving Proper Lifting Technique RPI Ambulance Attendant Class

21. Indications: General EMS calls Considerations: A backboard is needed in addition for a suspected spinal injury. Example: Patient with abdominal pain Lifting and Moving Stretcher RPI Ambulance Attendant Class

22. Indications: Conscious patient who can’t walk, found upstairs or in areas where the stretcher will not fit. Contraindications: Suspected neck or back injury, unconsciousness. Example: Conscious patient on a second floor without an elevator, with shortness of breath Lifting and Moving Stair Chair RPI Ambulance Attendant Class

23. Indications: Suspected neck or back injury, CPR. Can also be used to move patients. Contraindications: None Examples: Patient who fell from a 20’ ladder. Spear tackle during a rugby game. Lifting and Moving Backboard RPI Ambulance Attendant Class

24. Reeves – Patient who is upstairs or in a small area who cannot sit up Orthopedic Stretcher (Scoop) – Pelvic fracture or hip dislocation KED – Immobilization of a seated patient with a neck or back injury Lifting and Moving Other Moving Devices RPI Ambulance Attendant Class

25. A full set of Vitals consists of: Heart Rate Respiratory Rate Blood Pressure Additional diagnostic measurements: Skin color and condition Pupil size and reactivity Lung sounds Pulse oximetry Temperature Glucometry Vital Signs and Diagnostic Equipment Overview of Vital Signs RPI Ambulance Attendant Class

26. Measure by palpation at the radial artery. Report the Rate and Quality: Rate: Beats per minute Strength: Strong or Thready (weak) Regularity: Regular or Irregular Normal range: 60-100 beats per minute Dangerous range: Less than 60 or greater than 120 (sustained) Vital Signs and Diagnostic Equipment Heart/Pulse Rate RPI Ambulance Attendant Class

27. Watch patient’s chest rise and fall. Report the Rate and Quality: Rate: Breaths per minute Depth: Normal, Shallow or Deep Regularity: Regular or Irregular Normal range: 12-20 respirations per minute Dangerous range: Less than 8 or greater than 24 Vital Signs and Diagnostic Equipment Respiratory Rate RPI Ambulance Attendant Class

28. Measure with a sphygmomanometer (BP Cuff) and stethoscope. Two pieces of information: Systolic BP: Pressure when the heart is contracting, pumping blood. Diastolic BP: Pressure when the heart is relaxed Normal range: Systolic: 100 – 140 mmHg Diastolic: 60 – 90 mmHg Dangerous range: Systolic: Less than 90 or greater than 180 mmHg Diastolic: Less than 50 or greater than 100 mmHg Vital Signs and Diagnostic Equipment Blood Pressure RPI Ambulance Attendant Class

29. Observe: Color: Normal, Flushed, Pale, Cyanotic (blue), Mottled (grey), Jaundiced (yellow). Condition: Warm, Dry, Cool, Diaphoretic (sweaty). Vital Signs and Diagnostic Equipment Skin Color and Condition RPI Ambulance Attendant Class

30. Observe both pupils and report the: Shape: Round or Oblong (oval) Size: Pinpoint, Constricted, Dilated, Blown. Reaction to light: Pupils should constrict, but may be unreactive. PEARRL:Pupils Equal And Round, Reactive to Light. Vital Signs and Diagnostic Equipment Pupil Size and Reactivity RPI Ambulance Attendant Class

31. Function: Checks oxygenation of the patients blood Checks the pulse rate of the patient Use: Place on patient’s finger Remove any nail polish Oxygenation: 97-99%- Normal 94-96%- Mild Hypoxia 91-93%- Moderate Hypoxia Vital Signs and Diagnostic Equipment Pulse-Oximeter RPI Ambulance Attendant Class

32. Function Checks level of glucose in patient’s blood Normal range is 80-120 ml/dl Indications Altered mental status, diabetic issues Contraindications Bleeding/Clotting disorders Note: Used only by the Crew Chief, a special in-service training is required for EMTs Vital Signs and Diagnostic Equipment Glucometer RPI Ambulance Attendant Class

33. It is vital to maintain an open airway! Head Tilt–Chin Lift: Indications: Unconscious / unresponsive Contraindications: Suspected neck or back injury Jaw Thrust: Indications: Unconscious / unresponsive with suspected neck or back trauma Contraindications: None Airway Manual Airway Maneuvers RPI Ambulance Attendant Class

34. Used to keep the airway open. Oropharyngeal Airway (OPA): Indications:Unconscious / unresponsive Contraindications:Gag reflex present Nasopharyngeal Airway (NPA): Indications:Suspected loss of airway control, OPA not tolerated Contraindications:Facial trauma Airway Airway Adjuncts RPI Ambulance Attendant Class

35. Types of suction units: Ambulance Portable Handheld Types of Catheters: Yankaeur (Hard Tip) French (Soft Tip) Suction for no more than 15 seconds! Airway Airway Suction RPI Ambulance Attendant Class

36. Medical Oxygen Tanks Are Green Oxygen Tanks have the following Components Tank O-Ring Regulator Sizes D, Portable (In the jump bag) E, Portable (In the rig) M, On-board Oxygen Before Using, Check Stat Date Pressure in the tank Flow Regulator Seal Breathing Oxygen Tanks RPI Ambulance Attendant Class

37. Indications: Sick or injured patients requiring high-flow oxygen Contraindications: Respiratory arrest Use with an oxygen flow rate of 10-15 LPM. Breathing Non-Rebreather (NRB) RPI Ambulance Attendant Class

38. Indications: Sick or injured patients who do not require high-flow oxygen, or cannot tolerate a NRB Contraindications: Respiratory arrest, significant respiratory distress. Use with an oxygen flow rate of 4-6 LPM. Breathing Nasal Cannula (NC) RPI Ambulance Attendant Class

39. Indications: A patient who is having difficulty maintaining adequate ventilations on their own. Contraindications: None Rate: Adults: 12-20 / min Children: 20 / min Infants: 20 / min Use with supplemental oxygen, 15-25 LPM. Breathing Bag Valve Mask (BVM) RPI Ambulance Attendant Class

40. 3 Types of Bleeding: Capillary: Blood is dark red, and oozes. Venous: Blood is dark red, and flows steadily. Arterial: Blood is bright red, and spurts. Bleeding Control: Direct Pressure Elevation Pressure Dressing Direct Pressure Pressure Point Tourniquet Circulation Bleeding Control RPI Ambulance Attendant Class

41. Hypoperfusion: the inadequate supply of oxygen and nutrients to the tissues of the body due to pathophysiological processes. Signs of Hypoperfusion: Hypotension (low blood pressure) Tachycardia (rapid pulse) Tachypnea (rapid breathing) Circulation Hypoperfusion (Shock) RPI Ambulance Attendant Class

42. Treatment of hypoperfusion: Maintain airway and support patient’s breathing Control serious bleeding. Position the patient with their feet elevated (Trendelenburg Position). Keep the patient warm. Transport rapidly. Circulation Hypoperfusion (Shock) RPI Ambulance Attendant Class

43. Module X: Splinting and Spinal Immobilization RPI AmbulanceAttendant Class RPI Ambulance Attendant Class

44. Function Splints are used to immobilize and protect an injured body part. Types Board splints, “Frac-Pak”, Traction splints General guidelines for use: Begin by checking CSM x4. Hold the extremity above and below the injury. Gently align the injured extremity, and place it in the splint. Make sure that the extremity is immobilized above and below the site of the injury. Splinting and Spinal Immobilization Splinting RPI Ambulance Attendant Class

45. Equipment Backboard: A long, rigid board used to immobilize a patient Cervical Collar: A stiff neck brace used to immobilize the seven cervical vertebrae Kendrick Extrication Device (KED): Vest type immobilization device for seated patients. Indications for spinal immobilization: Head, neck or spine pain, altered mental status or spinal deformity, that is associated with a traumatic injury. Significant mechanism of injury Splinting and Spinal Immobilization Spinal Immobilization RPI Ambulance Attendant Class

46. Kendrick Extrication Device (K.E.D.): Used to immobilize a seated, non-critical patient. Check CSM x4 before and after application. Requires supplemental use of a cervical collar. The patient must still be placed on a backboard. Splinting and Spinal Immobilization Kendrick Extrication Device RPI Ambulance Attendant Class

47. Questions? RPI AmbulanceAttendant Class RPI Ambulance Attendant Class