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
March 2010 3
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)
March 2010 4
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).
March 2010 5
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 7
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 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.
March 2010 13
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.
March 2010 16
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)
March 2010 17
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 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 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 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 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 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 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