EMS Operations

5 phases of an ambulance call

Every ambulance call passes through the same five phases, and each has work of its own:

1. Preparation for the call.
2. Receiving and responding to a call.
3. Transferring the patient to the ambulance.
4. Transporting the patient to the hospital.
5. Terminating the call.

The first of them takes place before any call comes in; the other four follow in order once it does.

Ensuring ambulance readiness

The ambulance is inspected every shift, and the inspection is tracked on a checklist rather than left to memory. Begin by taking a shift report from the crew going off duty.

The inspection itself runs in a sequence. With the engine off, check the body of the vehicle, the tires, the fluid levels and the battery, and look over the cleanliness of the interior. With the engine running, check the dash indicators, the brakes, the lights and the communications equipment. Finish in the patient compartment with an item-by-item inventory, checking the oxygen (O2) pressure and testing the automated external defibrillator (AED).

If a call comes in while the check is half done, respond to the call and finish the check afterward. The exception is essential equipment that is missing, in which case the unit is declared out of service until the equipment is replaced.

Receiving & responding to a call — the EMD

A call reaches the crew through an emergency medical dispatcher (EMD), who is certified through a medical priority dispatch system. The EMD questions the caller and assigns the call a priority from the answers, gives the caller prearrival instructions, and dispatches and coordinates the resources that respond.

The questioning follows a set pattern. The EMD establishes the exact location, a callback number, the chief complaint, and the patient's age and sex, and then asks whether the patient is conscious and whether the patient is breathing. If the patient is not breathing, the EMD sends the maximum response the system can give and talks the caller through CPR over the telephone.

The law & warning devices

The exemptions from traffic law that an emergency vehicle enjoys apply only while you are responding to an emergency or transporting a sick or injured patient; they do not apply during nonemergency operations. They also depend on the proper use of the warning devices, and they never grant immunity from reckless driving. After a collision the law asks two questions: whether you used due regard for the safety of others, and whether this was, to the best of your knowledge, a true emergency.

The siren is the most misused device on the ambulance. Drivers often neither see nor hear an ambulance until it is within 100 feet of them, so never assume that a motorist has heard the siren or will yield to it. The visual devices are used continuously: headlights on by day and by night, and the full emergency lighting package whenever the vehicle is in emergency mode.

Safety at highway incidents

If you are not the first-arriving unit at a highway incident, stay off the highway and stage near an on-ramp until you are called in. The first unit blocks the incident. Whichever unit you are, keep the ambulance on the same side of the road as the incident, and avoid driving over debris and skid marks.

The personal protective equipment (PPE) you wear depends on the work going on around you. Where there is no extrication, wear an American National Standards Institute (ANSI) safety vest and a helmet; where extrication is in progress, wear full turnout gear.

Transferring & transporting the patient

Packaging a patient takes a minimum of 3 straps: one across the chest, one across the hip or waist, and one across the lower extremities. Every patient is secured before being transferred to the ambulance, including a patient receiving CPR.

En route, a minimum of 1 EMT rides in the patient compartment, and 2 is preferable. Notify the hospital by radio, and reassess vital signs every 5 minutes if the patient is unstable and every 15 minutes if the patient is stable. Lights and siren are used far more often than they are needed: less than 5% of transports genuinely require them, so ask on each call whether this one does.

The call ends with a formal transfer of responsibility. Wheeling a nonemergency patient in, placing them in a bed and leaving without handing over care to hospital staff is abandonment.

Air rescue

Air rescue is reserved for high-priority patients, and the clinical criteria for requesting it are:

• Shock.
• A Glasgow Coma Scale (GCS) score of less than 10.
• Head injury with altered mental status.
• Chest trauma with respiratory distress.
• Penetrating injury to a body cavity.
• Amputation proximal to the hand or foot.
• Extensive burns.
• Return of a pulse after cardiac arrest.

The landing zone (LZ) measures roughly 100 feet by 100 feet, sits on a slope of less than 8 degrees, and is clear of wires, towers, vehicles and loose objects. Mark it with one flare placed upwind.

Approach the helicopter only when a member of the flight crew escorts you, and stay clear of the tail rotor at all times. Keep traffic at least 100 feet away from the aircraft, and allow no smoking within 200 feet of it.