EMS Operations Study Guide for the EMT Test

Transport Operations

Ambulances have evolved since the first horse-drawn ambulances in the 1800s. There are many unique aspects of operating an ambulance that need to be understood.

Vehicle Design

Ambulances are vehicles designed for treating and transporting patients. They include a driver’s compartment, a patient compartment, warning systems, and communication systems. Increasing the amount of technology for communication and navigation can distract the driver from safe operations.

Terms/Concepts to Know: ambulance, first-responder vehicles, Star of Life, NFPA 1917 Standard for Automotive Ambulances, Type I, II, III ambulance

Phases of a Call

An ambulance call is considered to have nine distinct phases, starting at preparation and ending with post-run cleaning and completion of paperwork. The nine phases involve the ambulance, as a vehicle, and the crew that will be using it.

Preparation

An ambulance is a large piece of equipment, stocked with hundreds of pieces of equipment and supplies. The vehicle should be inspected daily to assure it is mechanically ready to be operated and that all supplies are present and equipment is in functioning order prior to a call.

Dispatch

Dispatch may be operated by the local EMS or shared with other agencies. It must be accessible 24 hours a day and staffed with trained personnel. Basic information regarding location of the call, the nature of the emergency, and the number of patients needs to be gathered and relayed to responders.

En Route

During the en route phase, the crew faces the danger of a crash and seat belts should always be worn. Information known about the call should be reviewed and clarified with dispatch as necessary. Roles and responsibilities of team members can be clarified prior to scene arrival.

Arrival at Scene

This is when initial scene-size up will occur to identify hazards, assess scene safety, and assess the need for more resources. The vehicle needs to be parked in a safe manner while considering patient access and traffic considerations along with the ability to egress safely for the transport phase.

Transfer of Patient

Transfer of the patient from where they are found to the ambulance can require specialized equipment. Ultimately, the patient needs to be safely secured to the stretcher in the ambulance. When to begin transfer can be a dynamic process, requiring interaction between assessment and treatment.

Transport

Dispatch needs to be informed of the intended destination and what time transport begins. A patient report needs to be given to the receiving hospital and the patient needs to be reassessed as needed. Transport needs to be done efficiently, but without undue risk of emergency transport, unless warranted.

Delivery

Again, dispatch needs to be informed upon arrival at the receiving facility. The patient needs to be brought inside and physically transferred to the hospital bed. A verbal report and transfer of care to hospital personnel is necessary. Charting can then be completed, as well as cleaning of the ambulance.

En Route to Station

Dispatch may be informed of your status upon leaving the hospital and, depending on local protocol, when arriving at the station or post. Refuel as necessary and obtain food if it is a long shift.

Postrun

The postrun phase includes completion of anything necessary to return the ambulance to its pre-run status. Paperwork should be completed and filed. Any equipment or ambulance maintenance issues should be resolved or reported, as necessary.

Terms/Concepts to Know: decontaminated, CPR board, jump kit, cleaning, disinfection, high-level disinfection, sterilization

Defensive Driving

Ambulances must be operated following common defensive driving techniques. Exemptions from normal traffic laws are allowed in emergency mode, but the liability still exists. Ambulances are large vehicles with their own handling characteristics. Transport with lights and siren is usually unnecessary.

Terms/Concepts to Know: blind spots, driver characteristics, cushion of safety, excessive speed, siren syndrome, hydroplaning

Air Operations

Fixed-wing and helicopter aircraft are used as ambulances. Helicopters can be called directly to scenes; the decision to do so must be based on patient condition and transport considerations. Once called, a landing zone will need to be secured and safety around the helicopter ensured.

Terms/Concepts to Know: air ambulances, medevac

A Team Approach

Modern healthcare is based on a team approach. Care will be transferred to other members of the broader healthcare team. Effective communication and collaboration are essential.

Team Types

Different types of teams can exist. They can include regular teams, temporary teams, and speciality teams, such as for special events. Teams are typically multidisciplinary and need to focus on a common goal.

Terms/Concepts to Know: continuum of care, community paramedicine, mobile integrated healthcare (MIH)

Group Versus Team

A group is made up of individual healthcare providers who all are working to take care of a patient, but typically do so independently. A modern approach to healthcare consists of a team of healthcare providers who are interdependent on each other and have clear roles.

Terms/Concepts to Know: groups, teams, team leader

Types of Groups

Different types of groups can exist. Common types can include dependent groups which rely on one leader for direction. In independent groups, each member has an area of responsibility, and interdependent groups represent true teams. Groups can also be organized according to the Incident Command System (ICS).

Terms/Concepts to Know: dependent group, independent group, interdependent group

Team Performance

Effective teams have a shared goal, with clear roles and responsibilities. The team leader monitors and facilitates team performance, and all team members are encouraged to provide input and speak up if they recognize a problem.

Terms/Concepts to Know: crew resource management

Transferring Patient Care

Transfers of care present a point for critical errors to occur. Transfers should be minimized and conducted in a standardized format to ensure proper transfer of care. Critical information needs to be passed on to the next team member and responsibilities clearly transferred.

Terms/Concepts to Know: minimal interference, uninterrupted critical care, common priorities, common terminology

ALS and BLS Care

Basic Life Support (BLS) and Advanced Life Support (ALS) care exist together, and often BLS care continues as part of the addition of ALS care. In some states, BLS care may be blended with some ALS procedures. EMTs may still need to assist with ALS skills, such as vascular access and advanced airways.

Terms/Concepts to Know: endotracheal intubation, oxygenation, preoxygenation, apneic oxygenation, direct laryngoscopy, video laryngoscopy, gum elastic bougie, esophageal intubation, vascular access, saline locks

Team Conflict Troubleshooting

While effective teams have minimized conflicts, conflict will still occur. When conflict occurs, the patient must always come first. Other troubleshooting techniques can include keeping calm, waiting until after the incident to address, focusing on the behavior, and choosing your battles.