Attendant Class

RPI AMBULANCE

ATTENDANT CLASS

Last Updated by M. ODonnell, June 2012Attendant ClassModule I: Introduction to RPI AmbulanceModule II:RPI Ambulance and the LawModule III: SafetyModule IV: Radio CommunicationsModule V: Lifting and MovingModule VI: Vital Signs & Diagnostic EquipmentModule VII: AirwayModule VIII: BreathingModule IX: CirculationModule X: Splinting and Spinal Immobilization

Class TopicsUpdated 10/2011RPI Ambulance Attendant Class2Introduction to RPI AmbulanceService: Volunteer, Student RunLevel of Care: Basic Life Support (BLS)Office: 92 College AvenueGarage: Behind the ArmoryService Period: In service 24/7 during the Fall and Spring SemestersCall Volume: ~150 per yearPrimary Coverage Area: RPI Troy campusSecondary Coverage Area: Troy, Brunswick, North Greenbush, etc.Special Events: Stand-bys for Hockey, Football, Commencement, etc.

Agency InformationUpdated 10/2011RPI Ambulance Attendant Class3

Introduction to RPI AmbulanceStandard Operating Procedures Agency Document

RPIA ConstitutionUnion Document

New York State Department of HealthPart 800, Minimum Requirements for an AmbulancePart 18, Requirements for large events

Documents can be found online at www.ambulance.union.rpi.edu

Rules and RegulationsUpdated 10/2011RPI Ambulance Attendant Class4

Introduction to RPI AmbulanceCrew ChiefDriverAttendant Observer

Crew PositionsUpdated 10/2011RPI Ambulance Attendant Class5

Introduction to RPI AmbulanceA. Hold a Professional Rescuer CPR certification.B. Take the Attendant class (recommended).C. Complete the Attendant checklist.D. Complete and submit a copy of a Rig Check.E. Complete one real or two simulated calls, and take vitals and submit an attendant evaluation.F. Request and receive approval by the Training Committee to be promoted to Attendant.

Attendant Training RequirementsUpdated 10/2011RPI Ambulance Attendant Class66Introduction to RPI AmbulanceSign up on the website for:Night CrewStand-bys (Hockey, Football, etc.)Training Drills, Meetings, Banquets, etc.

Signing up:Go to the Scheduling page on the website:http://ambulance.union.rpi.edu/scheduling/index.phpClick Login, and enter your username and password.Go to the Night Crews or Games and Events schedule, and click Sign up, and Confirm.Youll get an email confirming that you are signed up.

Scheduling WebsiteUpdated 10/2011RPI Ambulance Attendant Class7

Introduction to RPI AmbulanceEvents:HockeyCommencementConcertsPersonnel:Field Crews, EES

Field House and ECAV OperationsUpdated 10/2011RPI Ambulance Attendant Class8

Locations:HFH PCFECAV EMS RoomSign up on website, report to appropriate PCF or the garage 15 minutes prior to start timeIntroduction to RPI AmbulanceAlways maintain a professional attitude and appearanceYou represent RPI Ambulance and RPI.Assures the patient they are in competent hands

Dont dress or act in a manner unbecoming a member of the agency

ProfessionalismUpdated 10/2011RPI Ambulance Attendant Class9

RPI Ambulance And The LawState Emergency Medical Services Code (Part 800) Defines:

General Emergency Medical Services rulesCertification of EMS personnelCertification of EMS agenciesRequirements for equipment and ambulancesPre-hospital DNR orders

NYS Department of HealthUpdated 10/2011RPI Ambulance Attendant Class10

RPI Ambulance And The LawPatients medical and personal information is privateName, address, medical conditions, condition, treatment etc.

State and federal laws forbid disclosure of patient informationNYS Part 800.15, Health Insurance Portability and Accountability Act (HIPAA)

Only those who Need to Know may have access to patient informationDoctors, nurses, crew members in charge of caring for patientYour friends, bystanders, Public Safety, the public DO NOT need to know

When in doubt, ask your crew chief. Do not share information!

Patient ConfidentialityUpdated 10/2011RPI Ambulance Attendant Class11SafetyCrew safety is the primary concern during all operations. You can not help the patient, if something happens to you.

Unsafe scenes:Substance abusersAssaults, weapons on sceneHazmat incidentsMVAsEmotionally disturbed persons, attempted suicide.Fires, collapses, animal bites, CO poisoning.

Do not enter a scene that is not safe. Wait for fire, rescue or law enforcement personnel to secure the scene.

Scene SafetyUpdated 10/2011RPI Ambulance Attendant Class12

SafetyIf its wet and sticky and not yours, dont touch it. If you have to, wear gloves!

Gloves are worn during every patient contact.

Other PPE includes:N95 respirator masksGogglesGowns

The best way to prevent infection is to wash your hands!

If you come into contact with someone elses bodily fluids, tell the crew chief!

Infection ControlUpdated 10/2011RPI Ambulance Attendant Class13

Radio CommunicationsFrequency: 155.200 MHz

Use of RPIA Radios:Receiving tones and dispatches from Rensselaer County Emergency Communications Center (ECC)Amassing a crew for day callsTactical Communications during stand-bys (hockey games, etc.)

Crew Chiefs, Drivers, and actively training attendants carry portable radios

RPIA Portable RadiosUpdated 10/2011RPI Ambulance Attendant Class14

Radio CommunicationsFrequency: 46.04 MHz

Uses of County Radios:Communicating with Rensselaer County ECC (dispatcher).NYS Interagency and Mass Casualty Incident channel.Used by crew chiefs and drivers.

Three Portables, Duty Supervisor, Office, Rig

One Mobile Unit in the Ambulance

The 800 SystemUpdated 10/2011RPI Ambulance Attendant Class15

Radio CommunicationsCall SignsAmbulance is A-39 internally, 5939 to the countyMembers are assigned 900 NumbersLine Officers have Car Numbers (Car 1, etc.)

Communicating on the RadioState who you are speaking to, then you. Car 1, this is 944. Always be professional; never know who is listening.Public Safety, County, General Public

Communication GuidelinesUpdated 10/2011RPI Ambulance Attendant Class16

Radio CommunicationsRPI Ambulance is dispatched on Channel 1 on RPI Ambulances Radios:Dispatcher: Stand By RPI AmbulanceTonesDispatcher: RPI Ambulance for a determinant EMS call for at

Example: RPI Ambulance. Delta determinant EMS call for a seizure, RPI Crockett Hall, 72 Griswold Road. Cross Streets are Sage Ave and Bouton Road.

The DispatchUpdated 10/2011RPI Ambulance Attendant Class17

Determinants Alpha: BLS Priority IINon-EmergencyBravo: BLS Priority IEmergency, Not Imminently life threatening Charlie: ALS & BLS Priority IEmergency, Possibly life threateningDelta: ALS & BLS Priority IEmergency, Actively life threateningEcho: ALS & BLS Priority I (anyone with an AED)Cardiac or Respiratory Arrest/ Unknown life status

Dispatch DeterminantsRadio CommunicationsUpdated 10/2011RPI Ambulance Attendant Class18

Charlie ChespansDuring the call, the following radio transmissions are made to dispatch over the 800 by the driver:Confirm crew / en route to the sceneArriving on sceneEn route to the hospitalArriving at the hospitalBack in serviceBack in quarters

The receiving facility will be notified of patient information and arrival time over the BLS channel (a med patch) by the crew chief.

Call CommunicationsRadio CommunicationsUpdated 10/2011RPI Ambulance Attendant Class19Proper lifting technique:Lift with your legs, not your back!Bend at the knees.Keep your back straight and shoulders square.Do not twist or bend your back. If you need to turn, use your whole body.

If a patient is too large for your crew to safely move:Re-dispatch for additional crew members.Request Troy Fire Department for a lift assist.

Proper Lifting TechniqueLifting and MovingUpdated 10/2011RPI Ambulance Attendant Class20

StretcherLifting and MovingUpdated 10/2011RPI Ambulance Attendant Class21

Indications: General EMS calls

Considerations: A backboard is needed in addition for a suspected spinal injury.

Example: Patient with abdominal pain

Stair ChairLifting and MovingUpdated 10/2011RPI Ambulance Attendant Class22Indications: Conscious patient who cant walk, found upstairs or in areas where the stretcher will not fit.

Contraindications: Suspected neck or back injury, unconsciousness.

Example: Conscious patient on a second floor without an elevator, with shortness of breath

BackboardLifting and MovingUpdated 10/2011RPI Ambulance Attendant Class23Indications: Suspected neck or back injury, CPR. Can also be used to move patients.

Contraindications: None

Examples: Patient who fell from a 20 ladder. Spear tackle during a rugby game.

Other Moving DevicesLifting and MovingUpdated 10/2011RPI Ambulance Attendant Class24Reeves Patient who is upstairs or in a small area who cannot sit up

Orthopedic Stretcher (Scoop) Pelvic fracture or hip dislocation

KED Immobilization of a seated patient with a neck or back injury

Overview of Vital SignsVital Signs and Diagnostic EquipmentUpdated 10/2011RPI Ambulance Attendant Class25A full set of Vitals consists of:Heart RateRespiratory RateBlood Pressure

Additional diagnostic measurements:Skin color and conditionPupil size and reactivityLung soundsPulse oximetryTemperatureGlucometry

Heart/Pulse RateVital Signs and Diagnostic EquipmentUpdated 10/2011RPI Ambulance Attendant Class26Measure by palpation at the radial artery.

Report the Rate and Quality:Rate: Beats per minuteStrength: Strong or Thready (weak)Regularity: Regular or Irregular

Normal range: 60-100 beats per minuteDangerous range: Less than 60 or greater than 120 (sustained)

Respiratory RateVital Signs and Diagnostic EquipmentUpdated 10/2011RPI Ambulance Attendant Class27Watch patients chest rise and fall.

Report the Rate and Quality:Rate: Breaths per minuteDepth: Normal, Shallow or DeepRegularity: Regular or Irregular

Normal range: 12-20 respirations per minuteDangerous range: Less than 8 or greater than 24

Blood PressureVital Signs and Diagnostic EquipmentUpdated 10/2011RPI Ambulance Attendant Class28Measure with a sphygmomanometer (BP Cuff) and stethoscope.

Two pieces of information:Systolic BP: Pressure when the heart is contracting, pumping blood.Diastolic BP: Pressure when the heart is relaxed

Normal range:Systolic: 100 140 mmHgDiastolic: 60 90 mmHgDangerous range:Systolic: Less than 90 or greater than 180 mmHgDiastolic: Less than 50 or greater than 100 mmHg

Skin Color and ConditionVital Signs and Diagnostic EquipmentUpdated 10/2011RPI Ambulance Attendant Class29Observe:Color: Normal, Flushed, Pale, Cyanotic (blue), Mottled (grey), Jaundiced (yellow).Condition: Warm, Dry, Cool, Diaphoretic (sweaty).

Pupil Size and ReactivityVital Signs and Diagnostic EquipmentUpdated 10/2011RPI Ambulance Attendant Class30Observe both pupils and report the:Shape: Round or Oblong (oval)Size: Pinpoint, Constricted, Dilated, Blown.Reaction to light: Pupils should constrict, but may be unreactive.

PEARRL: Pupils Equal And Round, Reactive to Light.

Pulse-OximeterVital Signs and Diagnostic EquipmentUpdated 10/2011RPI Ambulance Attendant Class31Function:Checks oxygenation of the patients bloodChecks the pulse rate of the patient

Use:Place on patients fingerRemove any nail polish

Oxygenation:97-99%- Normal94-96%- Mild Hypoxia91-93%- Moderate Hypoxia

GlucometerVital Signs and Diagnostic EquipmentUpdated 10/2011RPI Ambulance Attendant Class32FunctionChecks level of glucose in patients bloodNormal range is 80-120 ml/dl

IndicationsAltered mental status, diabetic issues

ContraindicationsBleeding/Clotting disorders

Note:Used only by the Crew Chief, a special in-service training is required for EMTs

Manual Airway ManeuversAirwayUpdated 10/2011RPI Ambulance Attendant Class33It is vital to maintain an open airway!

Head TiltChin Lift:Indications: Unconscious / unresponsiveContraindications: Suspected neck or back injury

Jaw Thrust:Indications: Unconscious / unresponsive with suspected neck or back traumaContraindications: None

Airway AdjunctsAirwayUpdated 10/2011RPI Ambulance Attendant Class34Used to keep the airway open.

Oropharyngeal Airway (OPA):Indications: Unconscious / unresponsiveContraindications: Gag reflex present

Nasopharyngeal Airway (NPA):Indications: Suspected loss of airway control, OPA not toleratedContraindications: Facial trauma

Airway SuctionAirwayUpdated 10/2011RPI Ambulance Attendant Class35Types of suction units:AmbulancePortableHandheld

Types of Catheters:Yankaeur (Hard Tip)French (Soft Tip)

Suction for no more than 15 seconds!

Oxygen TanksBreathingUpdated 10/2011RPI Ambulance Attendant Class36Medical Oxygen Tanks Are Green Oxygen Tanks have the following ComponentsTankO-RingRegulatorSizesD, Portable (In the jump bag)E, Portable (In the rig)M, On-board OxygenBefore Using, CheckStat DatePressure in the tankFlow Regulator Seal

Non-Rebreather (NRB)BreathingUpdated 10/2011RPI Ambulance Attendant Class37Indications: Sick or injured patients requiring high-flow oxygen

Contraindications: Respiratory arrest

Use with an oxygen flow rate of 10-15 LPM.

Nasal Cannula (NC)BreathingUpdated 10/2011RPI Ambulance Attendant Class38Indications: Sick or injured patients who do not require high-flow oxygen, or cannot tolerate a NRB

Contraindications: Respiratory arrest, significant respiratory distress.

Use with an oxygen flow rate of 4-6 LPM.

Bag Valve Mask (BVM)BreathingUpdated 10/2011RPI Ambulance Attendant Class39Indications: A patient who is having difficulty maintaining adequate ventilations on their own.

Contraindications: None

Rate:Adults: 12-20 / minChildren: 20 / minInfants: 20 / min

Use with supplemental oxygen, 15-25 LPM.

Bleeding ControlCirculationUpdated 10/2011RPI Ambulance Attendant Class403 Types of Bleeding:Capillary: Blood is dark red, and oozes.Venous: Blood is dark red, and flows steadily.Arterial: Blood is bright red, and spurts.

Bleeding Control:Direct PressureElevationPressure DressingDirect PressurePressure PointTourniquet

Hypoperfusion (Shock)CirculationUpdated 10/2011RPI Ambulance Attendant Class41Hypoperfusion:the inadequate supply of oxygen and nutrients to the tissues of the body due to pathophysiological processes.

Signs of Hypoperfusion:Hypotension (low blood pressure)Tachycardia (rapid pulse)Tachypnea (rapid breathing)

Hypoperfusion (Shock)CirculationUpdated 10/2011RPI Ambulance Attendant Class42Treatment of hypoperfusion:Maintain airway and support patients breathingControl serious bleeding.Position the patient with their feet elevated (Trendelenburg Position). Keep the patient warm.Transport rapidly.

Module X:Splinting and Spinal Immobilization Updated 10/2011RPI Ambulance Attendant Class43

RPI AmbulanceAttendant Class

SplintingSplinting and Spinal ImmobilizationUpdated 10/2011RPI Ambulance Attendant Class44FunctionSplints are used to immobilize and protect an injured body part.TypesBoard splints, Frac-Pak, Traction splintsGeneral guidelines for use:Begin by checking CSM x4.Hold the extremity above and below the injury.Gently align the injured extremity, and place it in the splint. Make sure that the extremity is immobilized above and below the site of the injury.

Spinal ImmobilizationSplinting and Spinal ImmobilizationUpdated 10/2011RPI Ambulance Attendant Class45EquipmentBackboard: A long, rigid board used to immobilize a patientCervical Collar: A stiff neck brace used to immobilize the seven cervical vertebraeKendrick Extrication Device (KED): Vest type immobilization device for seated patients.

Indications for spinal immobilization:Head, neck or spine pain, altered mental status or spinal deformity, that is associated with a traumatic injury.Significant mechanism of injury

Kendrick Extrication DeviceSplinting and Spinal ImmobilizationUpdated 10/2011RPI Ambulance Attendant Class46Kendrick Extrication Device (K.E.D.):Used to immobilize a seated, non-critical patient.Check CSM x4 before and after application.Requires supplemental use of a cervical collar.The patient must still be placed on a backboard.

Questions?Updated 10/2011RPI Ambulance Attendant Class47

RPI AmbulanceAttendant Class