VBOC Ambulance Operations Module

Transcription

1 VBOC Ambulance Operations Module

2 Goals & Objectives Know the types of Ambulances used in Montgomery County Fleet Understand the types of calls they respond to Know the roles and responsibilities of each riding assignment Learn the inventory carried on the unit and how to do a checkout Understand the different specialized bags and uses for them Understand how to use the stretcher and proper lifting techniques Learn about other patient mobilization devices and how to use them March

3 Montgomery County Ambulance Fleet (ALS & BLS) There are currently 2 types of ambulances in the fleet: Collins Wheeled Coach (Prior to 2007) Freightliner/International Wheeled Coach (After 2007) March

4 Types of Calls Respond Too Medical Calls Personal Injury Collisions Service Calls (assist citizens) House Fires (for transport of injured individuals or crew and for rehab of FFs on scene). March

5 Crew Positions/Riding Assignments & Responsibilities Driver- person responsible to operate the unit and get the crew to the scene safely. Is responsible for daily mechanical checkout of unit to ensure safety for operations. (Is qualified OIC of unit and has completed EVOC-B class and all emergency driving requirements.) Officer- responsible for the crew and the plans of mitigating emergencies and overall patient care. The officer is also responsible for completing medical report for hospital and a report in the computer system after every call to document actions taken. (Is certified EMT-B and OIC of unit.) A3/A4 assists with patient care and does as instructed by OIC. May be an EMT-B or EMS Intern in process of taking EMT-B Class. March

6 Freightliner/International March

7 Freightliner/International Wheeled Coach Inventory The inventories on the Montgomery county units meet the minimum for Maryland Ambulance Seal of Excellence Program. Montgomery County Inventory list is for both ALS and BLS units. All units must have the same basic minimum inventory. Depending on the units, there might be some minor differences in location of equipment. Each day the crew is responsible for ensuring that they have adequate supplies on the unit and that everything is operational. Weekly they need to go through complete inventory checklist. March

8 Exterior of Units Officer s Side March

9 Exterior of Units Officer s Side Inventory March

10 Right Rear Outside Compartment 1 Extrication Kit 2 Triage Kits (Fanny Packs) 2 Backboards - Plastic 2 KEDs 1 Pediatric Immobilization Device 1 Half Backboard - Plastic 1 Orthopedic Frame (Scoop) 1 Stair Chair (or in Left Middle Lower Compartment on units manufactured after 6/07) March

11 Right Rear Outside Compartment Behind Wheel 1 Fire Extinguisher - 10lb. ABC Minimum 1 Hazardous Reflector Triangle Set (3) 5 Flares 1 Toolbox 1 Bolt Cutter (In tool box on units placed in service after 9/07) March

12 Right Front Upper Outside Compartment Can be accessed from inside as well. Depending on type of unit (ALS or BLS) that will determine which bags are in here. Jump Bag or O2 bag can be here or in compartment below. March

13 Right Front Lower Outside Can be accessed from inside as well. Depending on type of unit (ALS or BLS) that will determine which bags are in here. Jump Bag or O2 bag can be here or in compartment above. Can also be used for gear storage. Compartment March

14 Exterior of Units Driver s Side March

15 Exterior of Units Driver s Side March

16 Left Rear Outside Compartment 1 Convertible Safety Seat (Infant/Child) (or in Left Front Compartment on units placed in service after 9/07) Stair Chair (if not in right rear compartment) March

17 Left Middle Lower Outside Compartment 2 Portable Battery Chargers with Batteries (units pre 9/07 only) 2 Rechargeable Handlight or with SCBA unit 1 Ea. Trash Can and 4.7 Qt. Sharps Container 1 Stair Chair on units manufactured after 9/07) Can also be driver gear storage March

18 Left Middle Upper Outside Compartment This is the electrical compartment that is kept locked. This is accessed for maintenance by shop personnel. March

19 Left Front Outside Compartment 1 M Bottle (To Remain Off When Not In Use) 2 45 minute SCBA (or in Left Middle Lower or Left Rear Comp. on units placed in service after 9/07) 3 SCBA face pieces (1 each Small, Large, X-Large) locate with SCBA 1 Oxygen Duffel Bag (or in Compartment N on BLS Units) 2 Spare Oxygen Cylinders 1 Bolt Cutters (In tool box on units after 9/07) 1 Reeves Type Stretcher 2 54" Board Splints March

20 Inside Patient Care Area 1 Stretcher (with pillow, sheets & blanket 1 IV Pole (BLS Optional) 1 Stretcher Net 1 EA. Latex Free Gloves - Box of Sm., Med., Lg. and X-Lg. (Mounted on Wall over Door in 9/07 units) 2 Traffic Safety Vests - Rear Attendants March

21 Interior of Unit On Driver s Side March

22 Interior of Unit on Driver s Side March

23 Compartment A Good way to remember this is A is for Accident 2 Head Immobilization Device 2 Spider Type Back Board Straps 2 Adult Adjustable Extrication Collars 2 Pediatric Adjustable Extrication Collars 4 Towels 2 9' Straps March

24 Compartment B Good way to remember this is B is for Bleeding or Boo Boo 6 Trauma Dressings 6 8 X 10's (or similar size) 1 Box 4 x 4's (24 min.) 12 3" Kling or equivalent 6 6" Kling or equivalent 12 Triangular Bandages 5 1" Tape (Hypo-Allergenic Type) 5 2" Tape (Hypo-Allergenic Type) 5 Cold Packs 5 Heat Packs (<140 Degrees) 1 Box of 1" Band-Aids 1 Non Adherent Material for Occlusive Dressing March

25 Compartment C Good way to remember this is C is for Childbirth and Contamination 2 Chux Type Pads 2 OB Kits (Commercial Kits) 2 Newborn Hat 2 Silver Swaddler or Baby Bunting Type Material 4 Burn Sheets 4 EA. N-95 Masks - Uni-size 1 EA. B/P Cuffs (Adult, Child, Obese, Infant) 1 Stethoscope 4 Eye Protection 4 Bio-Hazard Protection Kits 5 Red Hazardous Waste Bags - Sealable with Biohazard Label (For contaminated items) 1EA. Latex Free Gloves - 1Box Ea. Small, Medium, Large, X-Large March

26 Compartment D Good way to remember this is D is for Drugs or Doing IVs This compartment contains all items necessary for IV Administration. On a BLS unit you will only be touching this if instructed by a paramedic. March

27 Compartment E Good way to remember this is E is for Everything Airway This compartment contains all items necessary for Airway maintenance, including: O2 masks and connection tubing, Nebulizers, Suction Catheters and tubing, Bag Valve Masks, and bulb syringes. March

28 Airway Station This area is where the onboard oxygen hooks up and where oral and nasal airways are kept as well as onboard suction and IV Bag warmer. March

29 CPR Seat This seat is used for Patient care or can be used for CPR as the name suggests because of its location next to top part of cot. The seat also has a flip down backrest that can be used as workspace. March

30 Compartment K This compartment is located under the CPR Seat. 1 Set of Leather Restraints (2ea. Wrist and Ankle) 2 Soft Restraints (Wrist and Ankle) 2 Body Bags March

31 Compartment G This compartment is located behind the jump seat. This compartment contains extra cot supplies (pillows, sheets, etc.) Also holds unit disinfectant supplies for cleaning. March

32 Front of Patient Compartment March

33 Front of Patient Compartment March

34 Compartment I This compartment is located above the jump seat. 5 Benzoin Swabs or 1 Can of Spray 3 Instant Glucose ( 15 grams per) 2 Activated Charcoal (100 gm) 5 Waxed Paper/Plastic Cups 2 Sterile Water/ Saline (1000 cc per) 1 Ring Cutter 2 AED/LP12 Pads - Adult Remote Disposable - Medtronic 1 AED Pads - Pediatric Reduced Energy - Medtronic (Pink connector on front) (Amb. Only) 1 LP12 - Pediatric Pads (Medic Unit Only) March

35 Compartment H This compartment is located at the top by side door. 10 Cabinet Seals & 1 Felt Tip Marker 1 State Protocol Book 31 Daily Check-Out Sheets 1 FRC Note Book 5 Spare Patient Information Sheets 5 Fire Casualty Reports 1 Rehab Clip Board 10 Rehab Vital Forms 5 Rehab Control Forms 2 Grease Pencils. 1 Complete 2007 Ambulance / Medic Unit Inventory Book March

36 Compartment L This compartment is second from top next to side door. 1 Portable Suction Unit (BLS Unit Only) 1 BLS First Aid Bag Inventory (Jump Bag) or combined with O2 Bag may also be stored here. (Depends upon unit.) 1 AED (BLS and Back-up ALS Units) (If converted for Pediatric Use then 1 Ped AED Pad) 2 Adult Combo Defib Pads 1 Razor March

37 Compartment M This compartment is small drawer in middle next to side door. Good way to remember this is M is for Medic Only - Do Not Touch This is the Drug Drawer on ALS Units that is locked. March

38 Compartment N This compartment is bottom compartment next to side door. 1 Oxygen Bag / First Aid Bag can be stored in this compartment on Ambulances or can also be used for turnout gear storage. Most of the time the O2 and First Aid Jump Bags are kept secured to the stretcher. March

39 Bench Seat in Patient Care Area This is bench next to cot across from CPR Seat. This is used for patient care and also as storage. 1 Set of Padded Board Splints (2-15", 2-36") (2-54" in left front compartment) 1 Adult Traction Splint with Ankle Strap 1 Pediatric Traction Splint with Ankle Strap 1 Needle Box and Trash Can under Front End of Bench Seat At end of Bench Seat is also where EPCR portable computer is attached. March

40 Front Cab of Ambulance 2 Portable Radios 1 12v Spotlight Pre- Connected to Unit 2 Hearing Protectors 1 Vehicle Registration 1 PAS Ring with Proper Unit Designation 2 Traffic Safety Vests - Driver & Officer 1 Latex Free Gloves - Sizes vary depending on the on duty OIC and Driver (1 Each) 1 Wheel Chock March

41 Front Cab of Ambulance 1 Incident Report Clipboard 1 Community Resource Guide 1 Set of Door and/or Light Controls (Station Specific) 1 Set of Metro Maps 1 MDT and back up County maps 1 ADC Maps - Montgomery County and Others as Needed 1 Haz-Mat Guide - DOT Emergency Response Guide (Latest Edition) March

42 Specialized Bags Jump Bag (BLS First Aid Bag) O2 Bag Extrication Bag Trauma (Triage) Kit Portable Suction Medic Bag Drug Bag March

43 Jump Bag (Portable BLS First Aid Bag) 8 - C r a v a ts 2 - E y e P r o te c t io n 2 T r a u m a S c is s o r s ( 4 ) P a i r s o f L a te x F r e e G lo v e s 1 In s ta n t G lu c o s e 1 - P e n lig h t 6-3 K l in g T y p e 2-6 K l in g T y p e 4 N 9 5 M a s k s U n i - s iz e E p i P e n E p i P e n J r. 1 - H a n d C le a n e r o r 5 - A n t is e p t ic T o w e le t te s 1 - C h i ld B /P C u f f 1 - In fa n t B /P C u f f 1 - A d u l t B P C u f f 1 - O b e s e B P C u f f 4-8 X 1 0 s X T r a u m a D r e s s in g 1 - S e t N a s a l A i rw a y s 1 - S te th o s c o p e March

44 Basic Configuration of Most County Jump Bags ** Will vary by unit and type of bag used. In some instances Jump Bag and O2 bag are combined. March

45 O2 Bag March

46 O2 Bag 1 Oxygen Bottle with Regulator and Liter Flow or Grab-n-go O2 bottle 1 Nasal Cannula 1 Pediatric Nasal Cannula 1 Adult Non-Rebreather Mask 1 Pediatric Non-Rebreather Mask 1 Oxygen Connecting Tubing 6 Oral Airways (0,1,2,3,4,5) 1 Bite Stick (Tongue Depressor) 1Set Nasal Airways and Lubricant (20fr (4.0mm) to 36fr (8.0mm)) (1 Set is 5 sizes) 1 Adult Bag Valve with #5 Cuffed Face Mask (Single Use) 1 Pediatric Bag Valve with #2 Cuffed Face Mask (Single Use) 1 Infant Bag-Valve with #0 Cuffed Face Mask (Single Use Only) 1 Nebulizer Setup 1 Nebulizer Mask - Adult & Ped. 1ea. Transparent Face Mask (size 00, 1, 3, 4) March

47 Basic Configuration of Most County O2 Bags ** Will vary by unit and type of bag used. In some instances Jump Bag and O2 bag are combined. March

48 Extrication Bag (Found in Outside Right Rear Compartment 2 2" Tape 2 3" Kling 2 6" Kling 5 4x4s 3 Triangular Bandages 1 Pair Trauma Scissors 1 Pair of Eye Protection 1 Center Punch 2 9' Strap 2 Pairs of Gloves 2 Adjustable Extrication Collars (Adult) 2 Adjustable Extrication Collars (Pediatric) 1 Head Immobilizer Blocks or Rolls 1 Complete Sets of Spider Straps for Backboard 2 Towels, Sheets or Padding March

49 Basic Configuration of Most County Extrication Bags ** Will vary by unit and type of bag used. March

50 Portable Suction Bag (Found in Inside Compartment L 1 Tubing with Yankauer Wand Type 1 10 fr Suction Catheter 1 14 fr Suction Catheter 1 Bottle of Water 1 Charging Cord March

51 Basic Configuration of Most Portable Suction Bags ** Will vary by unit and type of bag used. March

52 Stretcher Operations Goals & Objectives Know the types of Stretchers Used in the county Understand weight requirements Proper lifting techniques (watch video) Understand parts and positions of cot Understand proper maintenance of cots Understand how to lock stretcher into ambulance March

53 Ferno Stretchers Length Max 79 in 201 cm Length Min 64 in 163 cm Loading Height 34 in 86 cm Weight 89 lbs 40.5 Kg Load Limit 700 lbs 318 Kg Width 24 in 61 cm March

54 Stretcher Features STABLE A Longer, Fixed Front Leg in the X-frame, and a rigid C- channel running the length of the cot, stiffens the cot and reduces side-to-side flexing. Lower center of gravity offers greater stability for patient transfers or while rolling. MANEUVERABLE 5 Position Load Frame provides superior maneuverability and multiple lift positions for different size operators. 6 wheels (two with swivel-lock and rolling-lock) feature U- tread tires with increased surface area for better rolling and longer life 7 height positions, with true 360 turning radius in the lowest position March

55 Stretcher Features DURABLE All Metal Frame Construction means no plastic parts to wear out or fail Innovative L-Castings technology increases durability and reduces maintenance costs Increased scuff strips for loading and unloading Cast aluminum housing on load wheels prevents bending under heavy loads Powder coated frame available in red or blue COMFORTABLE Wider Bed Surface for comfort and support of any size patient. Wide head frame for large patients and extra elbow room during intubation & CPR Gas assist back rest and shock position for rapid patient positioning March

56 Stretcher Features SAFE No Pinch Points along the lifting mainframe Smooth, clear-coat-finish side rails keep hands clean, are impervious to blood and pathogens, and prevent unsightly wear and tear Heat sealed mattress is impervious to blood and pathogens Swing down side arms have no pinch points and can be used to tuck patient in Safety bar and hook provide safety while unloading from ambulance Conforms to the Federal Specification for the Star-of-Life Ambulance KKK-A-1822E March

57 General Guidelines for Use It is the users responsibility to ensure safe practices for the patient and themselves. A minimum of two trained operators is required. Follow standard emergency patient-handling procedures when operating the cot. Operators work together at all times. Operators communicate with one another and use coordinated movements to operate the cot. Lift only the weight you can safely handle. Use additional help when working with heavy loads (patient and equipment). Stay with the patient at all times. Always use patient restraints to secure the patient on the cot. Keep the cot folded when the load exceeds the standard Load Limit. March

58 Cot Components March

59 Cot Restrictions The patient weight limit on the cots is 700 lbs. There are 2 areas in the county where you can get bariatric cots that can hold 1100 lbs. (R4 and FC) March

60 Cot Loading Positions March

61 Cot Loading Positions March

62 Transferring Patient to the Cot To transfer a patient onto the cot: 1. Unfasten the restraints and arrange the straps so they will not interfere with transferring the patient onto the cot. 2. Place the cot beside the patient and adjust it to the patient s level. 3. Lower or fold the sidearms and retract the side lift handles. 4. Transfer the patient onto the cot using approved EMS procedures and your local protocols. 5. Raise the sidearms. Adjust the backrest and shock frame as needed. 6. Fasten and adjust the patient restraints. 7. Before moving the cot or changing its position, make sure sheets and other articles will not interfere with cot operation. March

63 Using Additional Help Operating the cot requires a minimum of two trained operators. They may need additional help when working with heavy loads (patient plus equipment). Operators should do the following: Position themselves at the head and foot ends of the cot Maintain control of the cot at all times Operate the controls Direct all helpers March

64 Using Additional Help Suggestions March

65 Securing Cot in Unit When loading stretcher into Ambulance, there are 2 safety devices that ensure you lock the stretcher in place. (Antler and Rail) Do not begin transport of patient if the stretcher is not locked into place. March

66 Engaging Safety Hook and Using Rear Mounting Antler Block This is the rear safety hook that the stretcher must be secured to before loading. This is the rail that the stretcher locks into. This is the antler that the back wheels need to be guided into. March

67 Other Patient Transport Devices Stair Chair Reeves Stretcher Scoop Stretcher Backboards March

68 Stair Chair The EZ Glide Evacuation Stair chair glides patient loads up to 500 lbs. down stairs without carrying or lifting March

69 Summary Now you should: Have a better understanding of the types of Ambulances used in the Montgomery County Fleet Understand the types of calls they respond to Know the roles and responsibilities of each riding assignment Have a better understanding of the inventory carried on the unit Understand the different specialized bags and uses for them Understand how to use the stretcher and proper lifting techniques Know what some other patient mobilization devices are and how they are used March

70 What s Next Now we are going to split you into groups. The evolutions will be: Ambulance Inventory on a unit. Stretcher Operations Stair Chair Operations March