EMT-Basic Exam: The Basics of Operations - Ambulance Operations

Operational skills, which do not involve the treatment of a patient, are a vital part of every EMT-Basic’s job. They involve skills such as taking inventory of ambulance supplies, preparing to gain access to a patient in the event of an emergency, and the management of major incidents, such as hazardous materials situations. Although cleaning and taking inventory are often tedious tasks, remember that these are important parts of the EMT-Basic’s job.
This guide (series) covers ambulance operations, rescue operations, special operations, tactical emergency support, and weapons of mass destruction. It is important for you to familiarize yourself with and review these skills to prepare for the EMT-Basic exam. Approximately 16 percent of the questions that you will encounter on the NREMT cognitive exam are related to operational skills.

Ambulance Operations
This particular guide will help you understand all of the phases of an ambulance call as well as your responsibilities when preparing a patient for air medical transport.

1. Phases of an Ambulance Call
There are nine steps in a typical ambulance call: preparation for the call, dispatch, en route to the scene, arrival at the scene, transferring the patient to the ambulance, en route to the receiving facility, arrival at the receiving facility, en route to the station, and the postrun phase. Although it may seem difficult to distinguish between these phases in the middle of a call, you should understand your responsibilities during each phase.

a. Preparation for the Call
During this phase, EMT-Basics prepare for calls by ensuring that they have everything they need to respond to an emergency situation. One of the most important parts of this phase is to make sure that you are mentally and physically prepared for a call. EMT-Basics who are physically or emotionally stressed could put themselves, their partners, and their patients at risk. Eating well, getting enough sleep, and exercising are important to the physical and emotional well-being of the EMT-Basic. Taking care of yourself will enable you to perform your job in an effective and efficient manner.
You can also prepare yourself for the challenges of the day by arriving at the station about 15 to 20 minutes before your shift starts. Arriving early provides sufficient time to organize your thoughts and inspect your EMS unit. As an EMT-Basic, you need to ensure that your vehicle is in good working condition before you take it out on a call. Check that the vehicle has fuel, motor oil, and engine coolant. Examine the tires for signs of wear and tear. The driver should also test all lights and sirens at the beginning of the shift before going out on a call.
Taking inventory of your vehicle’s supplies is another important part of preparing for a call. Your vehicle should be equipped to handle most medical emergencies. Your specific EMS agency, along with state and local regulations, will determine the medical supplies that your ambulance must carry at all times.
Ambulances also carry safety equipment to protect the EMT-Basics and patients. This includes body substance isolation (BSI) gear such as gowns, gloves, masks, and protective eyewear. Additional safety equipment may include helmets, bunker pants, tarps and blankets, and leather gloves. Other important supplies found on most ambulances include local maps, preplanned routes, and report forms. Check to ensure that your unit has all the necessary supplies before responding to a call.

b. Dispatch
Dispatch centers have a general access number, usually 911, which people can contact in an emergency. Employees at the dispatch center often provide friends, family, or witnesses with medical instructions that allow them to start treating the patient before EMT-Basics arrive on the scene.
In most cases, the dispatcher will provide the EMS unit with information regarding the nature of the emergency and the location of the incident, as well as a brief description of the patient, including age and gender. Additional information may become available while en route to the emergency. Make sure that you understand all information provided by dispatch. Repeat any confusing information back to the dispatcher and request clarification.

c. En Route to the Scene
Remember, you can’t help anyone if you don’t arrive at the scene safely. Always wear your safety belt when riding to an emergency. When you’re leaving the station, notify dispatch that you are responding to the call and record the time.
If you are acting as the ambulance operator, it is important that you use caution when driving the vehicle. Ambulances can roll over easily, so drive quickly but carefully to the scene of any emergency. Ambulance operators must consider a number of factors when traveling to a scene. Traffic, weather, and road conditions will affect the route you take and the speed at which you travel.

Tip: Some states and EMS agencies require EMT-Basics to take a special course on operating emergency vehicles.
As the driver of an emergency response vehicle, it’s your responsibility to know and follow all state and local regulations when using sirens or flashing lights. Not every call is necessarily a true emergency. Use the information you’ve received from dispatch to determine if the use of such devices is necessary.
When driving an ambulance, it is important to have due regard for other drivers and pedestrians while en route to the scene. Due regard describes the way that a responsible person would act in a similar situation. For instance, if you see a red light ahead, due regard calls for you to make a complete stop at the light. You must always provide other drivers with sufficient notice of your approach to avoid an accident. When operating an ambulance, follow state and local regulations concerning potentially dangerous situations, such as maneuvering through traffic and stopping at red lights.
Calls that require the response of multiple emergency vehicles can be particularly dangerous. To avoid an accident and protect the safety of other drivers, radio other units to notify them of your approach at points where your vehicles might converge. Communication between all responders will ensure that everyone arrives at the scene safely.
If you aren’t driving the ambulance, you can contact dispatch for additional information about the emergency. This will help you determine what equipment will be necessary at the scene and if additional support from other EMS units is needed.
Once you get closer to the scene, help your partner determine the best place to position the vehicle. Park the ambulance in a safe place that will allow an easy departure from the scene. Careful positioning is especially important at the scene of a car accident where traffic may still be moving.

d. Arrival at the Scene
When you arrive at the scene, notify dispatch and record the time of your arrival. Remember, you need to size up the scene before attempting to assess or treat the patient. If the scene seems dangerous, wait for police to arrive. Before approaching, you must outfit yourself with the proper BSI gear for the situation. You must also determine if any patients should be removed from the scene to avoid further injury.
When you determine that the scene is safe, take note of the mechanism of injury or the nature of illness if possible. If there is only one patient, you can begin your assessment. If there is more than one patient, you may need to call dispatch for additional support. You must also alert dispatch when you arrive at the patient’s side, noting the time.
Finally, you should provide all necessary care for the situation and arrange for transport to the nearest medical facility. Ensure that all dressings or splints are secure before transferring the patient to the ambulance.

e. Transferring the Patient to the Ambulance
The patient’s safety is of upmost importance, especially during transfer to the ambulance. When using a stretcher, make sure that the patient is secure before moving him or her to the ambulance. Use a blanket or tarp to protect the patient from inclement weather.
Patients’ family members will sometimes ask to ride in the ambulance. Consult your EMS agency’s policies regarding this situation. Ensure that all passengers are wearing their seat belts before leaving the scene.

f. En Route to the Receiving Facility
After all passengers are secure in the ambulance, the driver should inform dispatch of your departure from the scene, noting the time of departure and your destination. The severity of the patient’s condition will determine the mode of transport to the hospital.
During transport, the EMT-Basic treating the patient will continue assessing the patient and evaluating any interventions that were performed in the field. This person should also keep a constant record of the patient’s vital signs, noting any changes in the patient’s condition. If the patient is stable, the EMT-Basic may also begin the prehospital care report.

g. At the Receiving Facility
Notify dispatch as soon as you arrive at the receiving facility, noting the time of your arrival. Transfer the patient to the appropriate department and provide the staff with a brief report on the patient’s condition, noting all pertinent information that could aid in the patient’s treatment.
All crew members should wash their hands and take any other additional infection prevention measures at this time. After this, the prehospital care report should be completed. Leave a copy of this report with the receiving facility staff as a part of the patient’s permanent medical record.
Before notifying dispatch of your ability to take another call, you must clean and disinfect the vehicle and restock the ambulance with necessary supplies. One person can focus on restocking while the other decontaminates the vehicle. Decontamination is the use of chemical agents to destroy blood-borne pathogens that could potentially transmit disease or infection. It is important to decontaminate all equipment used on the previous call.
Sterilization, which is the destruction of microorganisms, is used on instruments that penetrate skin and on devices that come in contact with normally sterile parts of the body. It is important for you to follow the cleaning and disinfecting policies established by your EMS agency.

h. En Route to the Station
Once your vehicle is cleaned and disinfected, notify dispatch of your departure from the receiving facility. As you travel, discuss the previous call with your coworkers. Think about what went well and consider areas that could use improvement. In a positive manner, discuss the steps you and the crew can take to help the next call run more smoothly.

i. Postrun
When you arrive back at the station, you should inspect the vehicle once again. Make sure that the ambulance has enough fuel and oil. Restock any supplies that weren’t available at the receiving facility. At this time, you should also complete any paperwork that is required by your agency. Additional disinfection procedures that could not be completed at the receiving facility should be taken care of at this time.
Once these tasks are complete, take a moment to prepare yourself for the challenges you may face on the next call.

2. Air Medical Transport
In certain emergencies, air medical transport is necessary to ensure the survival of the patient. Air medical transport is often considered in cases of severe trauma or when the patient needs to be transported to a care facility, such as a neonatal unit or a burn center. Some situations that may necessitate air medical transport include a vehicle rollover in which the passengers were unrestrained, motorcycle accidents, ejection of the patient from a vehicle, and a fall of more than 15 feet. Other considerations include the length of time ground transportation will take, the amount of time it takes to extricate the patient, and the severity of the patient’s injuries or illness. Air medical transport may also be necessary if local EMS resources are limited.

Tip: Remember, air medical transport may not always be available when it is needed. It is important to have a backup plan when air medical transport is unavailable.

a. When to Request Air Medical Transport
Certain EMS agencies will provide guidelines for requesting air medical transport. EMT-Basics always consider the specific circumstances of a situation before placing a call to air medical transport. Many EMT-Basics also consult with medical direction before calling in a request for air medical transport.

b. Establishing a Landing Zone
After calling for air medical transport, you must establish a safe landing zone for the helicopter. Designate one person to handle communications with the air medical transport dispatcher. This communications officer, who is not involved in the care of the patient, will provide the dispatcher with pertinent information, including the number of aircraft needed, the location of the emergency, and any local landmarks that will help the pilot locate the scene.
Choose another person who is not involved in the patient’s care to establish a safe landing zone. Ideally, the landing zone should measure 100 feet by 100 feet. If this space is unavailable, a minimum area of 60 feet by 60 feet is needed for safe landing. The landing zone should also be clear of trees, power lines, fences, buildings, and other objects. Mark each corner of the landing zone with secured cones, flares, or light sticks.
The communications officer should listen carefully for the sound of the helicopter. When the helicopter can be heard, the communications officer should supply the pilot with any pertinent landmark information. After this, the communications officer should provide a brief, detailed description of the landing zone and note any nearby hazards, such as buildings, towers, poles, and power lines.

Tip: When providing the helicopter pilot with information, remember that the pilot is always facing the 12 o’clock position.

c. Safety
Safety is a primary concern when the helicopter is preparing to land. Use a common sense approach to protecting yourself, your partner, and the patient. Shield your eyes from any debris that may be kicked up during landing. Ensure that everyone maintains a safe distance from the helicopter as it lands and while the blades are still turning.

Tip: Always avoid the tail section of the helicopter. The tail rotor is very difficult to see and it may still be turning even after the blades have stopped spinning.
Once the blades have stopped turning, keep bystanders at least 100 feet away from the helicopter. Wait for directions from the pilot or flight crew before approaching the helicopter. After the crew gives you directions, approach the helicopter from the 9 o’clock to 3 o’clock positions, which keep you in the pilot’s field of vision. Always keep low when approaching the helicopter. Don’t carry equipment over your head as you approach the helicopter. Loose hats and clothing should also be avoided.

Air medical transport helicopter.

If the pilot lands on a hill, always approach from the downhill side. The main rotor blade will be closer to the ground on the uphill side, so it is best to avoid this area.
Follow the flight crew’s directions when departing the landing zone. Ensure that all crew members and equipment are out of the landing zone before the pilot prepares for departure.
Your EMS agency can provide additional information on safety procedures to follow when preparing for air medical transport.

Related Topics You Should Review:
- Emergency medical equipment basic supplies
- Factors contributing to emergency vehicle crashes
- Levels of decontamination