Chapter 5



Chapter 19

Transport Operations

Unit Summary

After students complete this chapter and the related coursework, they will understand the concept of preparing for a call, the phases of response, and guidelines for safe helicopter operations.

National EMS Education Standard Competencies

EMS Operations

Knowledge of operational roles and responsibilities to ensure safe patient, public, and personnel safety.

Principles of Safely Operating a Ground Ambulance

• Risks and responsibilities of emergency response (pp 403-405)

Air Medical

• Safe air medical operations (pp 407-408)

• Criteria for utilizing air medical response (p 405)

Knowledge Objectives

1. Summarize the different phases of an emergency response. (pp 404-405)

2. Explain the importance of preparing for an emergency call. (p 403)

3. List the medical and nonmedical equipment needed to respond to a call. (p 403)

4. Explain the importance of reviewing dispatch information. (p 404)

5. Explain the safety precautions needed to ensure a safe emergency response. (p 404)

6. Describe the actions Emergency Medical Responders (EMRs) should take on arrival at an emergency scene. (pp 404-405)

7. Describe the importance of transferring care to other emergency medical services (EMS) personnel. (p 407)

8. Explain the postrun tasks that follow the completion of an emergency response. (p 405)

9. Describe the guidelines for safe helicopter operations. (pp 407-408)

10. Describe the steps of setting up a helicopter landing zone. (p 407)

11. Describe the steps of loading patients into a helicopter. (pp 407-408)

Skills Objectives

1. Demonstrate how to set up a helicopter landing zone. (p 407)

2. Demonstrate how to assist with loading a patient into a helicopter. (pp 407-408)

Readings and Preparation

Review all instructional materials, including Emergency Medical Responder, Sixth Edition, Chapter 19, and all related presentation support materials.

• Review local protocol for the use of air ambulances.

Support Materials

• Lecture PowerPoint presentation

• Handouts summarizing hand signals used for helicopter operations

Enhancements

• Direct students to visit Navigate 2.

Teaching Tips

• Discuss the use of helicopters in transport operations. Present scenarios based on physiologic parameters versus distance. Ask students to choose a course of action, and ask them to support their decisions.

• Offer some examples of blocking traffic with an emergency vehicle, and describe how to position apparatus safely in the following situations:

o Highways

o Intersections

o Interstates

o Firegrounds

o Hazardous materials incidents

o Mass-casualty incidents

Unit Activities

Writing assignments: Have each student find an article on a recent ambulance crash or crew member fatality to illustrate the dangers involved in transport.

Student presentations: Have students find statistics on emergency vehicle crashes in the past five years. Ask them to present these to the class as lessons learned.

Group activities: Assign a specific phase of an emergency call to each group with instructions to create an in-class presentation. Each group should be given the same guidelines and questions to be answered within the presentation. Have students discuss the elements of each phase and explain why each is important. Consider asking the following questions:

• What supplies do we carry and why?

• Are there any specific pieces of equipment that are carried for this region or particular to this system?

• What are some of the policies for calling a helicopter?

Medical terminology review: Create flashcards with terminology relevant to EMS transport operations. Divide the class into groups of three or four students and have the students quiz one another using the flashcards.

Visual thinking: Project an image of an emergency vehicle crash, and present the story of the incident to the class. Discuss what went wrong and which safe driving practices could have been followed to prevent the accident.

Pre-Lecture

You are the Provider

“You are the Provider” is a progressive case study that encourages critical-thinking skills.

Instructor Directions

1. Direct students to read the “You are the Provider” scenario found throughout Chapter 19.

2. You may wish to assign students to a partner or a group. Direct them to review the discussion questions at the end of the scenario and prepare a response to each question. Facilitate a class dialogue centered on the discussion questions.

3. You may also use this exercise as an individual activity and ask students to turn in their comments on a separate piece of paper.

Lecture

I. Introduction

A. To be an effective EMR, you need to

1. Prepare for the call.

2. Review dispatch information.

3. Respond safely to the scene.

4. Perform a scene size-up.

5. Perform initial patient assessment and provide emergency care

6. Update other responding units and transfer care to other emergency medical services (EMS) personnel.

7. Complete postrun activities.

II. Preparing for a Call

A. You may respond using a fire department vehicle, a law enforcement vehicle, your private vehicle, or on foot.

1. You must ensure that these vehicles are ready to respond at all times.

2. Follow a regular schedule to inspect and maintain all vehicles.

3. Check tire pressures, fluid levels, and fuel levels.

B. Be prepared to respond promptly using the most direct route available.

C. Make sure you have the proper equipment to perform your job, including

1. Patient examination equipment

2. Personal safety equipment

3. Resuscitation equipment

4. Bandaging and dressing equipment

5. Patient immobilization equipment

6. Extrication equipment

D. The equipment must be stocked and maintained on a regular basis according to the schedule specified by your agency.

III. Phases of an EMR Call

A. Dispatch

1. The dispatch facility is a center that citizens can call to request emergency medical care.

2. Most centers are part of a 9-1-1 system that is responsible for dispatching fire, police, and EMS responders.

3. Dispatchers should obtain proper information from the caller and instruct callers on how to perform lifesaving techniques such as CPR until you arrive.

4. You may receive your dispatch information by telephone, radio, pager, computer terminal, or written printout.

5. Information from dispatch should include

a. Nature of the call

b. Name and location of the patient

c. Number of patients

d. Any special problems

e. Call-back number from the caller

B. Response to the scene

1. Your first priority is to get to the scene quickly and safely.

2. Consider traffic patterns and the time of day before you select the best route.

3. Be sure you know how to get to the location of the call.

4. Follow safety procedures.

a. Be certain that all personnel are properly seated and secured with approved seatbelts.

b. Keep all equipment secured.

c. Use warning devices according to your state laws and according to the regulations specified by your agency.

i. Emergency warning devices allow you to request the right of way; they do not guarantee it.

ii. Be especially careful at intersections and railroad crossings.

d. Do not exceed a safe speed for the vehicle you are operating.

e. Drive defensively so you are not involved in a crash.

C. Arrival at the scene

1. Place your vehicle in a safe location to minimize the chance of injury.

2. Consider how best to use your vehicle warning lights.

3. Perform a scene size-up as outlined in the patient assessment sequence.

4. Look for hazards:

a. Downed electrical lines

b. Leaking fuel

c. Broken glass

d. Fire

5. Control the flow of traffic to ensure the safety of rescuers, patients, and bystanders.

6. Determine the number of patients and identify whether you need additional resources.

7. Provide patient care using the knowledge and skills you have learned in this course.

D. Perform patient assessment and provide emergency care

E. Transferring the care of the patient to other EMS personnel

1. Transfer care to more highly trained personnel.

a. Give them a brief report of the situation as you initially observed it and tell them what care you have provided.

b. Ask them if they have any questions for you.

c. Offer to assist them in caring for the patient.

F. Postrun activities

1. Your job is not done until you have completed the paperwork.

2. You must also clean your equipment and replace needed supplies.

3. Only after you have completed these activities should you resume regular duties or notify your dispatcher that you are ready for another call.

IV. Helicopter Operations

A. Helicopters are used by EMS systems to

1. Reach patients

2. Transport patients to medical facilities

3. Remove patients from inaccessible areas

B. Helicopters have several advantages.

1. They can respond quickly above traffic congestion and wilderness areas.

2. They usually carry specialized equipment.

3. Their personnel may be able to perform some advanced skills not available through personnel staffing ground ambulances.

C. Helicopters are limited by bad weather, and they are unable to fly under conditions of limited visibility.

D. If your EMS system uses a helicopter

1. Obtain a copy of the ground operations procedures.

2. Schedule an orientation session with helicopter personnel.

3. Know how to request a helicopter response as well as what the criteria for calling a helicopter for trauma patients, medical patients, and wilderness response are.

E. Helicopter safety guidelines

1. Helicopters can provide lifesaving transport for patients with serious injuries to an appropriate medical facility.

2. Helicopters are dangerous to untrained personnel.

a. The main rotor spins at more than 300 revolutions per minute (rpm) and may be just 4′ above the ground.

b. The tail rotor spins at more than 3,000 rpm, and may be invisible to an unwary person.

c. The rotors can generate a “wash” equivalent to winds of 60 to 80 mph.

3. Setting up landing zones

a. Pilots usually land and take off into the wind.

b. The size of a landing zone depends on the size of the helicopter.

i. Most civilian helicopters need a landing zone of at least 100′ ( 100′ (10,000 square feet).

ii. Military aircraft may need a larger area.

c. The landing zone should be as flat as possible and free of debris.

d. Check for any nearby wires.

e. If the site slopes or has any obstacles, notify the pilot.

f. Check with the helicopter service to see how you should secure and mark the perimeter of the site.

i. Avoid using flags or other objects that can be blown away.

ii. Fusees (red signal flares) can create a fire hazard and should not be used.

iii. White lights and flashing emergency lights can interfere with the pilot’s vision.

g. Keep vehicles clear of the landing zone.

h. Close the windows and doors of any nearby vehicles.

i. Some helicopter services request that a charged hose line be available for fire emergencies.

4. Loading patients into helicopters

a. Secure all loose clothing, sheets, and instruments.

b. Use eye protection to prevent debris from getting into your eyes.

c. Approach a helicopter from the front and only after the pilot or crew member signals that it is safe.

d. Follow the helicopter crew’s instructions.

e. Give the patient report to the crew, away from the helicopter’s noise, and offer your assistance.

f. Patients need to be packaged properly and securely.

g. If you will be working with a helicopter ambulance, arrange an orientation session with helicopter personnel so you will be prepared in an emergency.

VI. Summary

A. In preparing yourself for a call, you must understand your role as a member of the emergency medical system and be prepared to respond promptly.

B. As an EMR, you need the proper equipment on an emergency call, including the medical equipment in your life support kit, your personal safety equipment, and equipment to safeguard the accident scene.

C. The six phases of an emergency call are preparation, dispatch, response to the scene, arrival at the scene, transferring care of the patient to other EMS personnel, and postrun activities.

D. If you will be working with a medical helicopter, you need to know proper safety precautions and loading procedures for helicopter transport.

E. By learning the simple but important skills involving EMS operations, you can become an effective member of the EMS system in your community.

Post-Lecture

This section contains various student-centered end-of-chapter activities designed as enhancements to the instructor’s presentation. As time permits, these activities may be presented in class. They are also designed to be used as homework activities.

Assessment in Action

This activity allows the student an opportunity to analyze an emergency care scenario and develop responses to critical-thinking questions. This scenario is designed to help students understand the phases of an EMS response.

Instructor Directions

1. Direct students to read the “Assessment in Action” scenario located in the Prep Kit at the end of Chapter 19.

2. Direct students to read and individually answer the quiz questions at the end of the scenario. Facilitate a class review and discussion of the answers, allowing students to correct their responses as needed. Use the quiz question answers noted here to assist in building this review.

3. You may wish to ask students to complete the activity on their own and turn in their answers on a separate piece of paper.

Answers to Assessment in Action Questions

1. Answer: B Keep the caller on the line until the incident is over.

2. Answer: D Each phase presents different hazards depending on the type of call. Any phase can be hazardous.

3. Answer: D Hemorrhaging

4. Answer: A Your partner’s family problems

5. Answer: A 6, 3, 1, 4, 2, 5

6. Answer: Many dispatch centers use Emergency Medical Dispatch (EMD), a system that allows dispatchers to provide medical instructions over the phone and to classify the type of emergency response. This tiered system allows emergency units to use judgment in their response. On calls classified as non-emergency response, units have the discretion not to use lights and sirens when proceeding to the calls. This allows for better safety when responding to incidents. Calls classified as emergencies let responders know that a true emergency is taking place. Follow your local protocols and guidelines regarding the use of lights and sirens.

7. Answer: This patient is experiencing chest pain and is located in the boiler room. Because it is likely that the boiler room will be located a great distance from your unit, you should have all of the equipment necessary to perform resuscitation if necessary. At the very least you should have oxygen, a medical kit (including a bag-valve mask or cardiopulmonary resuscitation mask), and an automated external defibrillator. You also need to consider the location of this patient and the means for extrication. Equipment such as a stair chair may be necessary to remove the patient from the boiler room.

8. Answer: Because this patient is reporting chest pain, advanced life support should be dispatched. Work with the school administration to keep students away from the incident and the access point so as to maintain a clear path for emergency workers and to preserve the privacy of the patient. Depending on your location, the closest appropriate facility to treat cardiac emergencies may be quite a distance away. Follow your local protocols and guidelines regarding the use of aeromedical services.

9. Answer: Depending on the condition of the patient, EMS personnel at the scene may still require your assistance on the call. In fact, they may need you to assist with patient care all the way to the hospital. Do not assume that your job is finished because additional EMS personnel have arrived at the scene. Remember that patient care is a team effort. Check with the EMS crew to see if they need your help. If nothing else is required of you, then continue with the transfer of care.

10. Answer: After you have initiated patient care, you must maintain patient care until a higher-trained provider assumes responsibility for the patient. Leaving the scene or discontinuing patient care before a formal transfer of care has occurred is considered patient abandonment. After the transfer of care has taken place, complete all of the necessary paperwork required for an EMS response as an EMR. In addition, make sure your equipment is cleaned and restocked before you make yourself available to respond to another medical incident.

Lesson Review

A. List the phases of an EMR call. (Lecture II)

B. Which information should the dispatcher obtain from the caller? (Lecture II-B)

C. Which hazards should you look for upon arrival at the scene? (Lecture II-D)

D. What are the advantages of using helicopters for EMR response? (Lecture III-B)

E. Which dangers exist in approaching a medical helicopter? Which precautions should be taken? (Lecture III-E)

Assignments

A. Complete all the Student Workbook activities for Chapter 19.

B. Review all materials from this lesson and be prepared for a lesson quiz to be administered (date to be determined by the instructor).

C. Read Chapter 20: Vehicle Extrication and Special Rescue for the next class session.

Unit Assessment Keyed for Instructors

1. Place the following steps of response in the correct order:

A. postrun activities

B. arrival at the scene

C. response to the scene

D. dispatch

E. transferring care of the patient to other EMS personnel

Answer: D, C, B, E, A

pp 404-405

2. When preparing for a call, which of the following equipment should be included in your EMR life support kit?

A. patient examination equipment

B. bandaging and dressing equipment

C. extrication equipment

D. all of the above

Answer: D

P 403

3. What is the minimum information that should be gathered by dispatch?

Answer: The nature of the call; the name, call-back number, and present location of the patient; the number of patients; and any special problems

p 404

4. What should you remember about emergency warning devices during your response to the scene?

A. They guarantee the right of way.

B. They request the right of way.

C. They should be used for every emergency response.

D. None of the above

Answer: B

p 404

5. When parking your emergency vehicle at the scene of a crash, you should

A. park as far from the crash as possible.

B. position your vehicle against a crash vehicle to provide stabilization.

C. position your vehicle in a safe location.

D. position your vehicle to block all traffic on the road.

Answer: C

p 404

6. When transferring care of the patient to other EMS personnel, you should

A. tell them what care you have already provided.

B. ask them if they have any questions for you.

C. offer to assist them in caring for the patient.

D. all of the above.

Answer: D

p 405

7. Which postrun activities must be completed before you can resume your regular duties?

Answer: Complete the paperwork, clean your equipment, and replace needed supplies.

p 405

8. Helicopters can respond quickly above traffic congestion and wilderness areas.

A. True

B. False

Answer: A

p 405

9. The main rotor of the helicopter spins at more than ______ and may be just ______ above the ground.

A. 200 rpm; 3′

B. 300 rpm; 3′

C. 200 rpm; 4′

D. 300 rpm; 4′

Answer: D

p 407

10. Most civilian helicopters need a landing zone of at least

A. 25′ ( 25′.

B. 50′ ( 50′.

C. 100′ ( 100′.

D. 150′ ( 150′.

Answer: C

p 407

Unit Assessment

1. Place the following steps of response in the correct order:

____ A. postrun activities

____ B. arrival at the scene

____ C. response to the scene

____ D. dispatch

____ E. transferring care of the patient to other EMS personnel

2. When preparing for a call, which of the following equipment should be included in your EMR life support kit?

A. patient examination equipment

B. bandaging and dressing equipment

C. extrication equipment

D. all of the above

3. What is the minimum information that should be gathered by dispatch?

4. What should you remember about emergency warning devices during your response to the scene?

A. They guarantee the right of way.

B. They request the right of way.

C. They should be used for every emergency response.

D. None of the above

5. When parking your emergency vehicle at the scene of a crash, you should

A. park as far from the crash as possible.

B. position your vehicle against a crash vehicle to provide stabilization.

C. position your vehicle in a safe location.

D. position your vehicle to block all traffic on the road.

6. When transferring care of the patient to other EMS personnel, you should

A. tell them what care you have already provided.

B. ask them if they have any questions for you.

C. offer to assist them in caring for the patient.

D. all of the above.

7. Which postrun activities must be completed before you can resume your regular duties?

8. Helicopters can respond quickly above traffic congestion and wilderness areas.

A. True

B. False

9. The main rotor of the helicopter spins at more than ______ and may be just ______ above the ground.

A. 200 rpm; 3′

B. 300 rpm; 3′

C. 200 rpm; 4′

D. 300 rpm; 4′

10. Most civilian helicopters need a landing zone of at least

A. 25′ ( 25′.

B. 50′ ( 50′.

C. 100′ ( 100′.

D. 150′ ( 150′.

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