Emergency Care Textbook Professional Responders-part-20 PDF

20 Transportation Key Content Emergency Vehicle Maintenance and Safety Check................. 350 Removing a Vehicle from Service............................... 351 Beginning and Ending a Shift................................... 351 Safe Vehicle Operation........... 351 Air Medical Transportation......

20 Transportation Key Content Emergency Vehicle Maintenance and Safety Check................. 350 Removing a Vehicle from Service............................... 351 Beginning and Ending a Shift................................... 351 Safe Vehicle Operation........... 351 Air Medical Transportation.... 353 Patient Considerations........ 353 Landing Site Preparation..... 353 Ground Safety Precautions........................ 353 Medical Evacuation from a Ship....................................... 355 Preparing the Patient for Transfer............................. 355 Introduction TRANSPORTATION If your scope of practice includes the transportation of patients, you must be prepared to transport them safely and effectively. This means driving in a safe manner and ensuring that both the vehicle and its onboard equipment are inspected and maintained regularly. Most often, the vehicle used by responders to transport patients is an ambulance, though other vehicles are sometimes also used (e.g., helicopters). 349 EMERGENCY VEHICLE MAINTENANCE AND SAFETY CHECK Completing an ambulance equipment and supply checklist at the beginning of every work shift is important for safety, patient care, and risk management. Daily checks help ensure that the vehicle is functioning properly and prepared for use in both emergency and non-emergency responses. Some equipment on the ambulance (e.g., defibrillators) requires specific routine maintenance and testing to ensure safe and effective operation when needed. All supplies must be fully stocked and easily accessible (Figure 20–1). For a list of equipment commonly found on an ambulance, see Appendix B: Sample Ambulance Equipment List. The vehicle and equipment must be disinfected and cleaned regularly, both inside and out, to ensure that pathogens have been removed and that the vehicle maintains a professional appearance. Most organizations have specific protocols for vehicle maintenance and routine care. The procedure for vehicle checks is often legislated by a government body. Specific services may develop their own equipment checklists as well. All checks need to be documented and all Figure 20–1: Supplies in an ambulance are in easily accessible cabinets and must be fully checked and stocked at the beginning of each shift. problems or deficiencies brought to the attention of the responsible individual: Your organization should have clear procedures for reporting vehicle problems. You should check the components listed in Table 20–1 as part of your daily vehicle safety check (pre-trip inspection). TRANSPORTATION TABLE 20–1: VEHICLE SAFETY CHECK COMPONENTS 350 UNDER HOOD EXTERIOR INTERIOR Engine oil/leaks Coolant levels/ leaks Power-steering fluid Drive belts Windshieldwasher fluid Battery clean/ secure Leaks, hoses Lights Mud flaps Body damage/rust perforation Fluid leaks under vehicle Wheels, hubs, lugs, nuts Tire condition/ pressure (psi) Suspension, springs, shocks Exhaust system Licence plate— clean/valid sticker Exterior vehicle clean Steering—excessive play/looseness Brake booster operation Brake pedal reserve and fade All gauges Fuel level Windshield wipers and washers Clean windows and mirrors H  eater and defroster Horn Seatbelt operation Parking brake operation Clean inside cab/no damage Mirror adjustment and condition Patient compartment clean and sanitary EMERGENCY EQUIPMENT DOCUMENTATION Emergency warning lights Side floodlights Rear floodlight Interior lights Siren and PA system Backup alarm Flares Fire extinguisher Radio 2 helmets, 2 traffic safety vests, and 2 level C haz-mat suits Ownership Insurance Collision report booklet Annual inspection sticker and/or certificate Removing a Vehicle from Service When checking vehicles, equipment, and supplies, it is important to note and record any problems or deficiencies found. If any vehicle or piece of onboard equipment is damaged or malfunctioning in such a way that it could pose a safety hazard, the vehicle must be removed from service or the equipment repaired/replaced prior to use. If a vehicle is out of service, affix a sign to the steering wheel to prevent another responder from using it without knowing. Organizations should specify how and when to remove a vehicle from service. Beginning and Ending a Shift At the beginning of a shift, your duties include: 1. Checking in with your partner and discussing expectations and roles for the shift. 2. Checking with the outgoing crew for the status of emergency vehicle and equipment. 3. Performing a thorough vehicle safety check. At the end of each shift, your duties include: 1. Refueling the vehicle, if required. 2. Restocking all kits as required. 3. Replenishing and replacing used supplies. 4. Cleaning the interior and exterior of the vehicle. 5. Decontaminating or replacing any soiled equipment. 6. Completing all documentation. 7. Debriefing and discussing all calls with your partner: What went well? What could have gone better? sometimes cause collisions because they fail to drive safely. Defensive driving skills are taught as a component of EVO courses for professional responders. Always pay attention to your driving, and take extra precautions to ensure that there are no hazards in your path. When backing up your vehicle, remember to use your backup signals, as backing up can sometimes be dangerous. Wherever possible, use a spotter to decrease the risks. When operating an emergency vehicle, follow these guidelines: Follow all laws and acts with respect to the operation of an emergency vehicle in your province or territory. Follow all operational guidelines for your jurisdiction. Be observant and aware of other motorists and pedestrians. Always wear your seatbelt. Be familiar with the characteristics of the emergency vehicle. Be alert to changes in weather and road conditions. Exercise caution in the use of audible and visible warning devices. Drive within the speed limit, except in circumstances allowed by law. Maintain a safe following distance. Drive defensively, with due regard for the safety of others. Adjust your driving to balance the needs of timely transportation, patient comfort, and road safety. Attitude Safe vehicle operation is important for the safety of patients, responders, and the public. Any responder who is required to transport patients is strongly advised to complete an Emergency Vehicle Operator (EVO) course and maintain that certification throughout his or her career. Never drive a private vehicle as if it were an emergency vehicle. Even if you have lights and sirens, people do not always see you, hear you, or yield the right-of-way. Professional responders who are travelling to an emergency or a hospital Attitude is the mental framework that structures your day-to-day driving performance. It is the way you see yourself as a driver and how you view other drivers. Attitudes are influenced by experiences, emotions, values, feelings, prejudices, and personality. Being a safe driver requires an open mind, a willingness to learn, and a desire to improve. Safe drivers are courteous and considerate. They are willing to yield the right-of-way, they monitor traffic, and they adapt to changing conditions. A positive attitude will help you drive amicably with others and maintain the safe operation of your vehicle. TRANSPORTATION SAFE VEHICLE OPERATION 351 Environmental Conditions Environmental conditions can pose significant dangers to drivers. Factors that can affect safe vehicle operation include decreased visibility from fog or heavy rain and slippery conditions caused by snow, ice, or water. When hazardous environmental conditions are present, the driver should maintain a speed and following distance that is appropriate to the conditions. Appropriate Use of Warning Devices When responding to an emergency incident, the driver must use audible and visual warning devices according to local protocols and based on provincial/ territorial motor vehicle laws. During patient transportation, the use of warning devices should be based on patient assessment and appropriate protocol for treatment and transportation. When using warning devices, keep in mind that motorists who drive with car windows rolled up or who are using a radio, air conditioning, or heating system may not be able to hear the warning devices. It is important that you proceed with caution and never assume that the warning devices provide an absolute right-of-way to proceed. addition, position the vehicle so that it protects you and the patient from other motorists and hazards. When parking or positioning your vehicle, keep the following potential hazards in mind: Vehicle exhaust fumes Downed electrical wires Poor lighting Blocking extrication vehicles and equipment The possibility of collapse of surrounding buildings due to fire or explosion Proceeding Safely Through Intersections When you are positioning the emergency vehicle, another responder should act as a spotter, especially when you are reversing (Figure 20–2). Most provinces and territories require all emergency vehicles to come to a complete stop at all controlled intersections (i.e., red light, stop sign) and proceed through the intersection when safe to do so. Even with lights and sirens, you cannot trust that all motorists will stop and yield the right-ofway. Take precautions when proceeding through controlled intersections to gain the attention of surrounding motorists—for example, change the mode of the siren or use your air horn. TRANSPORTATION Parking at the Emergency Scene 352 Figure 20–2: Have another responder act as a spotter when you are positioning the vehicle. Before parking and securing the emergency vehicle at the scene, consider potential hazards, such as leaking fuel or gas, or hazardous materials. If any of these conditions are present, position the vehicle uphill, upwind, and at a safe distance. In Operating With Due Regard for the Safety of All Others Most provinces and territories allow special privileges for drivers of emergency vehicles that include driving slightly above the speed limit and proceeding through controlled intersections (after a complete stop) during an emergency response. These exceptions to the rule are privileges, not rights. Due regard for the safety of all others carries legal responsibility. If you operate a vehicle without this due diligence, it can result in liability for you and the agency you represent if damage, injury, or death results. As a responder, you must be familiar with all applicable laws and regulations pertaining to the operation of an emergency vehicle. In certain situations, it is sometimes best for a patient to be transported to a medical facility by a helicopter or a fixed-wing aircraft. This type of transport enables severely injured or ill patients to be transported quickly to specialized medical centres or larger (but more distant) treatment facilities. Geography and other circumstances can play an integral role in this type of transport decision, and specific protocols must be followed by emergency personnel. Air ambulance services throughout the country typically use fixed-wing and/or rotary-wing (helicopter) aircraft. Fixed-wing aircraft are particularly useful for long-distance (i.e., greater than 200 km [124 mi.]) and inter-hospital transfers of patients or vital organs. Fixed-wing aircraft can also operate in weather conditions that may restrict rotary-wing aircraft. When coordinating with air medical transportation organizations, be aware that their protocols may vary: Follow the directions of the pilot and crew. Patient Considerations When preparing a patient for air medical transport, consider the requirements of the aircraft. While most modern aircraft used for medical evacuation allow full monitoring of patients during flight, some may offer fewer options, so the patient should be positioned in the safest manner for his or her condition. If the patient’s airway is compromised, this is often a lateral position, as this helps to keep the airway clear. Other positions may be better suited, depending on the nature of the injury or illness. Landing Site Preparation If a patient is to be transported by helicopter, a safe landing zone must be established at or near the scene. A helicopter landing zone should be approximately 46 by 46 metres (151 by 151 feet). It should have no vertical structures that can impair landing or takeoff and should be relatively flat and free of high grass, crops, or other factors that can conceal uneven terrain or hinder access. The landing site should also be free of debris that could injure people or damage the aircraft. Personnel close to the landing site should wear protective eyewear and helmets. Given the time of day, the landing site may need lighting (e.g., portable lights and traffic cones with reflectors). In some cases, this may be accomplished by positioning emergency vehicles around the perimeter of the landing zone with their warning lights on. If white lights are used, point them toward the centre of the landing zone and not directly at the aircraft. Flares should not be used to illuminate the landing site. If conditions are very dry, you may need to wet the landing zone to prevent the pilot and drivers on the ground from being blinded by clouds of dust. It may also be helpful to use radio communications with the pilot to advise him or her of conditions such as wind direction or any hazards or obstructions that may be relevant. In some cases, such as when the helicopter is landing, it may be appropriate for you to use hand signals to guide the pilot. Ground Safety Precautions Keep the landing zone clear during takeoffs and landings. Maintain a distance of at least 60 metres (200 feet). In addition, adhere to the following guidelines: Never allow ground personnel to approach the helicopter unless requested to do so by the pilot or flight crew. Stay in view of the flight crew at all times. Stay away from propellers. Allow only necessary personnel to help load or unload patients. Secure any loose objects or clothing that could be blown by rotors (e.g., stretcher, sheets, or blankets). After the aircraft is parked, wait for a signal from the pilot to approach. Approach the helicopter in a crouched position, staying within view of the pilot or other crew members (Figure 20–3). Never approach the aircraft (rotary- or fixedwing) from the rear (Figure 20–4). The tail rotors on most aircraft are near the ground and spin at a high rotation per minute, which makes them virtually invisible. TRANSPORTATION AIR MEDICAL TRANSPORTATION 353 Main rotor DANGER AREA Do NOT approach Approach from this side Ground Figure 20–3: Approach a helicopter in a crouched position. Tail rotor Main rotor DANGER ZONE Prohibited area TRANSPORTATION Figure 20–4: Never approach a helicopter from the rear. 354 Acceptable area Approach area MEDICAL EVACUATION FROM A SHIP A helicopter should not be requested for evacuation from a ship unless the patient is in serious condition. In many cases, the decision to use aeromedical evacuation is made in consultation with the medical advisor, based on the medical information provided by the attendant. Preparing the Patient for Transfer To prepare a patient for transfer, follow these steps: Ensure that the patient’s airway, respiration, and circulation are under control. If indicated, strap the patient into the stretcher to prevent him or her from slipping or falling out. Place the patient’s medical records (if any) with all necessary papers (including passport, if available, and notes of any treatment given) in a plastic envelope to be sent along with him or her. If possible, ensure that the patient is wearing a PFD/lifejacket before moving him or her to the stretcher. Relay all pertinent information directly to one of the flight crew members: Describe any bandaged or covered injury, along with any other information about the patient’s condition and a concise history of the event. Ship-to-Ship Transfer Ship-to-ship transfer involves difficult manoeuvring for two vessels. It is a seamanship problem demanding high standards of competence for its safe and efficient performance. Light (unloaded) ships must be approached slowly and with caution. Ships with the higher freeboard should provide the illumination and boarding facilities. The transfer should be performed quickly, and ships should not linger alongside each other for any reason. TRANSPORTATION Carry long objects horizontally and no higher than waist height. Approach or depart the helicopter from the downhill side if it has landed on an incline. 355 SUMMARY BEGINNING AND ENDING A SHIFT At the beginning of a shift 1. C  heck in with your partner and discuss expectations and roles for the shift. 2. Check with the outgoing crew for the status of the emergency vehicle and equipment. 3. Perform a thorough vehicle safety check. At the end of a shift 1. 2. 3. 4. 5. 6. 7.  efuel the vehicle if required. R Restock all kits as required. Replenish and replace used supplies. Clean the interior and exterior of the vehicle. Decontaminate or replace any soiled equipment. Complete all documentation. Debrief and discuss all calls with your partner. Guidelines to Safely Operate an Emergency Vehicle Follow all laws and acts with respect to the operation of an emergency vehicle in  your province or territory. Follow all operational guidelines for your jurisdiction. Be observant and aware of other motorists and pedestrians. Always wear your seatbelt. Be familiar with the characteristics of the emergency vehicle. Be alert to changes in weather and road conditions. Exercise caution in the use of audible and visible warning devices. Drive within the speed limit except in circumstances allowed by law. Maintain a safe following distance. Drive with due regard for the safety of others. Adjust your driving to balance the needs of timely transportation, patient c omfort, and road safety. Air Medical Transportation—Guidelines for Grounding Safely Never allow ground personnel to approach until the pilot or flight crew says so. Stay in view of the flight crew at all times. Stay away from propellers. Allow only necessary personnel to help load or unload patients. Secure any loose objects or clothing that could be blown by rotors. After the aircraft is parked, wait for a signal from the pilot to approach. Approach the helicopter in a crouched position, staying within view of the pilot or other crew members. Never approach the aircraft from the rear. Carry long objects horizontally and no higher than waist height. Approach or depart the helicopter from the downhill side if it has landed on an incline. TRANSPORTATION Medical Evacuation from a Ship—Preparing the Patient 356 Ensure that the patient’s airway, respiration, and circulation are under control. If indicated, strap the patient in a stretcher. Place any patient medical records and all necessary papers (e.g. passport) in a plastic  envelope to be sent with the patient. If possible, ensure that the patient is wearing a PFD/lifejacket before moving him or  her to the stretcher. Relay all pertinent information directly to one of the flight crew members.