VBOC Ambulance Operations Module

March 2010 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

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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)

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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).

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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 2010 6

Freightliner/International

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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 2010 8

Exterior of Units – Officer’s Side

March 2010 9

Exterior of Units – Officer’s Side Inventory

March 2010 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 2010 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 2010 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.

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Right Front Lower 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 above.

• Can also be used for gear storage.

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Exterior of Units – Driver’s Side

March 2010 15

Exterior of Units – Driver’s Side

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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)

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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 2010 18

Left Middle Upper Outside Compartment

• This is the electrical compartment that is kept locked.

• This is accessed for maintenance by shop personnel.

March 2010 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 2010 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 2010 21

Interior of Unit On Driver’s Side

March 2010 22

Interior of Unit on Driver’s Side

March 2010 23

Compartment AGood 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 2010 24

Compartment BGood 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 2010 25

Compartment CGood 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 2010 26

Compartment DGood 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 2010 27

Compartment EGood 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 2010 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 2010 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 2010 30

Compartment KThis 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 2010 31

Compartment GThis compartment is located behind the jump

seat.

• This compartment contains extra cot supplies (pillows, sheets, etc.)

• Also holds unit disinfectant supplies for cleaning.

March 2010 32

Front of Patient Compartment

March 2010 33

Front of Patient Compartment

March 2010 34

Compartment IThis 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 2010 35

Compartment HThis compartment is located at the top by side

door.

10 Cabinet Seals & 1 Felt Tip Marker 1 State Protocol Book31 Daily Check-Out Sheets 1 FRC Note Book5 Spare Patient Information Sheets 5 Fire Casualty Reports1 Rehab Clip Board 10 Rehab Vital Forms5 Rehab Control Forms 2 Grease Pencils.

1 Complete 2007 Ambulance / Medic Unit Inventory Book

March 2010 36

Compartment LThis 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 2010 37

Compartment MThis 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 2010 38

Compartment NThis 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 2010 39

Bench Seat in Patient Care AreaThis 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 2010 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 2010 41

Front Cab of Ambulance

1 Incident Report Clipboard 1 Community Resource Guide1 Set of Door and/or Light Controls (Station Specific)1 Set of Metro Maps 1 MDT and back up County maps1 ADC Maps - Montgomery County and Others as Needed1 Haz-Mat Guide - DOT Emergency Response Guide (Latest Edition)

March 2010 42

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

March 2010 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 e1 - 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 e4 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 s1 - 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 f1 - O b e s e B P C u f f 4 - 8 X 1 0 s2 4 - 4 X 4 1 - 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 s1 - S te th o s c o p e

March 2010 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 2010 45

O2 Bag

March 2010 46

O2 Bag

1 Oxygen Bottle with Regulator and Liter Flow or Grab-n-go O2 bottle1 Nasal Cannula 1 Pediatric Nasal Cannula1 Adult Non-Rebreather Mask 1 Pediatric Non-Rebreather Mask1 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 2010 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 2010 48

Extrication Bag (Found in Outside Right Rear Compartment

2 2" Tape 2 3" Kling 2 6" Kling5 4x4s 3 Triangular Bandages1 Pair Trauma Scissors 1 Pair of Eye Protection1 Center Punch 2 9' Strap 2 Pairs of Gloves2 Adjustable Extrication Collars (Adult)2 Adjustable Extrication Collars (Pediatric)1 Head Immobilizer Blocks or Rolls1 Complete Sets of Spider Straps for Backboard2 Towels, Sheets or Padding

March 2010 49

Basic Configuration of Most County Extrication Bags

** Will vary by unit and type of bag used.

March 2010 50

Portable Suction Bag (Found in Inside Compartment L

1 Tubing with Yankauer Wand Type1 10 fr Suction Catheter1 14 fr Suction Catheter1 Bottle of Water1 Charging Cord

March 2010 51

Basic Configuration of Most Portable Suction Bags

** Will vary by unit and type of bag used.

March 2010 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 2010 53

Ferno StretchersLength Max

79 in 201 cm

Length Min

64 in 163 cm

Loading Height

34 in 86 cmWeight

89 lbs 40.5 Kg

Load Limit

700 lbs 318 Kg

Width24 in 61 cm

March 2010 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 2010 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 2010 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 2010 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 2010 58

Cot Components

March 2010 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 2010 60

Cot Loading Positions

March 2010 61

Cot Loading Positions

March 2010 62

Transferring Patient to the CotTo 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 2010 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 2010 64

Using Additional Help Suggestions

March 2010 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 2010 66

Engaging Safety Hook and Using Rear Mounting Antler Block

This is the rail that the stretcher locks into.

This is the antler that the back wheels need to be

guided into.

This is the rear safety hook that the stretcher must be secured to

before loading.

March 2010 67

Other Patient Transport Devices

• Stair Chair• Reeves Stretcher• Scoop Stretcher• Backboards

March 2010 68

Stair Chair

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

March 2010 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 2010 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