Ambulance Operations and Standards Guide

1. Ambulance Operations

2. Ambulance Standards • State administrative rules • Minimum standard vs. Gold standard

3. Ambulance Standards • Vehicle Design • GSA KKK 1822D specs • Type I: truck-cab chassis/modular body • Type II: standard van, integral cab/body • Type III: specialty van, integral cab/body • Medium duty ambulance/rescue

4. Ambulance Standards • Medical Equipment Standards • OSHA • NFPA • Local medical direction

5. Ambulance Standards • Additional Guidelines • Commission on Accreditation of Ambulance Services (CAA) • American College of Surgeons “Essential Equipment”

6. Checking Ambulances • Vehicle/Equipment Checklist • Stretcher Days • Medication Expiration Dates • Vehicle Cleaning/Disinfecting • Medical Equipment Tests/Calibration

7. Ambulance Deployment • Deployment = Strategy used to: • Position ambulances, personnel • Reduce response times • Factors influencing • Location of EMS stations • Location of hospitals • Anticipated call volume • Geographic, traffic considerations

8. Ambulance Deployment • Peak load staffing • Fluid deployment (Primary areas of responsibility, Posting) • System Status Management • Computer Assisted Dispatch

9. Ambulance Deployment • Tiered Responses • Fire/Police First Response • BLS Units • ALS Units • Paramedic Quick Response Units • System Reserve Capacity

10. Emergency Vehicle Laws • The driver of an authorized emergency vehicle may: • Park or stand irrespective of the provisions of this chapter; • Proceed past a red light or stop signal, but only after slowing down as may be necessary for safe operation; • Exceed the maximum speed limits so long as he does not endanger life or property • Disregard regulations governing direction of movement or turning in specified directions.

11. Emergency Vehicle Laws • The exemptions herein granted to an authorized emergency vehicle shall apply only when such vehicle is making use of audible and visual signals meeting the requirements of this Act.

12. Emergency Vehicle Laws • The foregoing provisions shall not relieve the driver of an authorized emergency vehicle from the duty to drive with due regard for the safety of all persons.

13. Driving Excellence

14. Good Driving Basics • Wear seat belts • Practice; Become familiar with: • Acceleration • Deceleration • Braking • Cornering • Fender and bumper clearance

15. Good Driving Basics • Hand position • 9-3 o’clock positions • One hand pulls; the other slides • Neither hand should pass 6 o’clock • Keep to the left (other traffic should be to the right) • Never rely on what another motorist will do

16. Maintaining Control • Braking • Pump brakes slowly, smoothly • NEVER brake on curve • Brake going into curves; accelerate moving out of them

17. Maintaining Control • Railroads • Plan alternate routes for grade crossings • Wait out long trains if there is no over or underpass in a reasonable distance

18. Maintaining Control • School buses • There is NO emergency vehicle exemption from laws pertaining to school buses • If red lights are flashing, stop and wait until driver motions you on.

19. Maintaining Control • Bridges and Tunnels • Ability to pass may be limited • Consider alternative routes if traffic is heavy • Be sure height of roadway will accommodate ambulance

20. Maintaining Control • Traffic Patterns • Learn traffic flow patterns in your area based on time of day, day of week, locations • Plan for alternative routes through or past specific problem areas

21. Maintaining Control • Road Surface • Pay attention to irregularities in road surface (bumps, potholes) • Inner lanes of multi-lane highways usually are smoothest

22. Maintaining Control • Hydroplaning • Occurs on wet roads at speeds >35mph • Water causes loss of contact between tire and road surface • If you can’t see tread marks of car ahead of you in water on highway, there is risk of hydroplaning • Slow down; lightly tap brakes to ensure dryness

23. Maintaining Control • Backing Up • ALWAYS have someone spot for driver while ambulance is backing • Move slowly, carefully

24. Maintaining Control • Escorts • Extremely dangerous • Use only when unfamiliar with location of patient or hospital • Allow safe distance between escort vehicle and ambulance

25. Intersection Collisions • Most common form of ambulance collision • Causes: • Other drivers “timing” lights • Emergency vehicles following each other • Multiple emergency vehicles converging on same location • Motorists going around stopped traffic • Vision of pedestrians in crosswalk obstructed by other vehicles

26. Intersection Collisions Slow down at intersections. Ensure other drivers have seen you and stopped before you proceed.

27. Parking and Loading • At least 50 feet from wrecked vehicles if no fire, other hazards • 100 feet uphill, upwind if fire, other hazards present • Park 100 feet in front of wreck if first unit on scene • Park 100 feet beyond wreck if police already have control of scene • Shut off headlights unless needed to illuminate scene

28. Operator qualification Handling, reporting collisions Investigating, reviewing collisions QA in collision aftermath Backing vehicles, spotters Seat belt use; child transport Emergency response procedures Prudent speed, use of oncoming lanes, intersection negotiation Use of police escort Drug, alcohol policy Standard Operating Procedures

29. Warning Devices

30. Warning Lights • Use at all times when responding to emergency calls • Also, turn on headlights during daylight hours • Use minimal lighting in heavy fog or when parked

31. Siren • Usually not audible until 50 to 100 ft from vehicles • Motorists less inclined to yield when sirens sound continuously • Motorists feel units with sirens are abusing right-of-way privileges • Drivers increase speed 10 to 15 mph • Sirens increase patient anxiety • Drivers develop anxiety, hearing problems

32. Give other drivers time to notice, react to warning devices.