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ATTENDANT CLASS Fall 2008

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Title: Attendant Class Author: student Last modified by: student Created Date: 8/21/2008 10:32:24 PM Document presentation format: On-screen Show Company – PowerPoint PPT presentation

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Title: ATTENDANT CLASS Fall 2008


1
ATTENDANT CLASS Fall 2008
RPI AMBULANCE
2
Overview
  • Module I Introduction to RPI Ambulance
  • Module II RPI Ambulance and the Law
  • Module III Safety
  • Module IV Radio Communications
  • Module V Lifting and Moving
  • Module VI Vital Signs Diagnostic Equipment
  • Module VII Airway
  • Module VIII Breathing
  • Module IX Circulation
  • Module X Splinting and Spinal Immobilization

3
RPI Ambulance Attendant Class
Module I Introduction to RPI Ambulance
4
Introduction to RPI Ambulance
  • Service All volunteer, student-run
  • Level of Care Basic Life Support
  • Office 92 College Avenue
  • Garage Behind the Armory
  • Service Period In service 24/7 during the Fall
    and Spring Academic
    Sessions.
  • Call Volume 150 per year
  • Primary Coverage Area RPI Troy campus
  • Secondary Coverage Area Troy, Brunswick,
    Rensselaer, etc.
  • Special Events Stand-bys for Hockey, Football,
    Commencement, and other
    requested events.

5
Standard Operating Procedures
  • Standard Operating Procedures (SOPs)
  • An outline of all of RPI Ambulances field
    procedures, training programs and requirements,
    and rules and regulations.
  • Can be found online at http//ambulance.union.rpi
    .edu/About.php

6
Crew Positions
  • Crew Chief
  • Driver
  • Attendant
  • Observer

7
Attendant Training
  • Attendant Training Requirements
  • A. 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.
  • F. Request and receive approval by the Captain
    and Training Lieutenant to be promoted to
    Attendant.
  • Can be found online at http//ambulance.union.rpi
    .edu/training.php

8
Crews and Events
  • Duty crews, stand-bys
  • General meetings, training drills
  • Meals, trips, banquet
  • Signing up
  • Go to the Scheduling page on the
    website http//ambulance.union.rpi.edu/scheduling
    /index.php
  • Click 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.

9
Crews and Events
10
Field House Operations
  • Hockey games, Commencement
  • Patient Care Facility
  • EES, field crews
  • Dedicated stand-bys
  • Report to the PCF, or the rig 10-15 minutes
    prior to the scheduled time.

11
Professionalism
  • A note on professionalism
  • You are a medical care provider, and are
    operating in an official capacity.
  • You represent RPI Ambulance, and RPI.
  • It is very important to maintain a professional
    appearance and attitude, to assure the patient
    they are in competent hands.

12
RPI Ambulance Attendant Class
Module II RPI Ambulance and the Law
13
NYS Dept. of Health
  • State Emergency Medical Services Code (Part 800)
  • General Emergency Medical Services rules
  • Certification of EMS personnel
  • Certification of EMS agencies
  • Requirements for equipment and ambulances
  • Prehospital DNR orders
  • Can be found online at http//www.health.state.ny
    .us/nysdoh/ems/main.htm

14
Patient Confidentiality
  • Part 800.15, HIPAA
  • It is a crime to break patient confidentiality,
    punishable by fines or imprisonment.
  • Confidential information
  • Patients name and information, condition,
    treatment, etc.
  • Need to know
  • Crew, nurses, physicians and staff in charge of
    caring for the patient have a need to know.
  • Friends, other RPI Ambulance members, the public,
    etc. do not have a need to know.
  • Can be found online at http//www.health.state.ny
    .us/nysdoh/ems/policy/08-02.htm http//www.hss.gov
    /ocr/hipaa/

15
RPI Ambulance Attendant Class
Module III Safety
16
Scene Safety
  • Crew safety is the primary concern during all
    operations.
  • Unsafe scenes
  • Substance abusers
  • Assaults
  • Hazmat incidents
  • MVAs
  • Emotionally 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.

17
Infection Control
  • Crew safety is the primary concern during all
    operations.
  • Gloves are worn during every patient contact.
  • Other PPE includes
  • N95 respirator masks
  • Goggles
  • Gowns
  • The best way to prevent infection is to wash your
    hands!

18
RPI Ambulance Attendant Class
Module IV Radio Communications
19
RPIA Portable Radios
  • Frequency 155.200 MHz
  • Uses of RPIA Radios
  • Receiving tones and dispatches from Rensselaer
    County Emergency Communications Center (ECC)
  • Amassing a crew for day calls
  • Communication during stand-bys (hockey games,
    etc.)
  • All officers, crew chiefs, and drivers carry
    assigned radios.

20
Rensselaer Co. Radios
  • Frequency 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.
  • One handheld unit, kept at the office
  • One mobile unit in the ambulance

21
Dispatch Determinants
  • Calls are assigned a determinant based on the
    seriousness
  • Alpha BLS, Priority II
  • Bravo BLS, Priority I
  • Charlie ALS, Priority I
  • Delta ALS, Priority I
  • Echo ALS, Priority I Cardiac or respiratory
    arrest, all local units respond.

22
The Dispatch
  • Dispatches are received on Channel 1 on RPIA
    radios.
  • Dispatch
  • Dispatcher Stand by RPI Ambulance.
  • Tones will sound.
  • Dispatcher Stand by RPI Ambulance, for a
    (Determinant) EMS call for a (Demographics),
    (Chief complaint), at (Location).
  • Dispatch is repeated, and time stamp and
    dispatcher ID are given.
  • Example
  • Dispatcher Stand by RPI Ambulance, for a Bravo
    determinant EMS call, for a 20 year old male with
    a traumatic injury, at the Houston Field House.

23
Call Communications
  • During the call, the following radio
    transmissions are made to dispatch over the 800
  • Confirm crew / en route to the scene
  • Arriving on scene
  • En route to the hospital
  • Arriving at the hospital
  • Back in service
  • Back in quarters
  • The receiving facility will be notified of
    patient information and arrival time over the BLS
    channel (a med patch).

24
Communication Guidelines
  • The ambulances call sign is A39 for internal
    communications, 5939 for county communications.
  • Attendants and above are assigned car numbers.
  • State who you are talking to, and then identify
    yourself.
  • For example, Car 1, this is Car 2.
  • Always be professional communications are
    monitored by Public Safety and County.

25
RPI Ambulance Attendant Class
Module V Lifting and Moving
26
Lifting
  • Proper 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
  • Redispatch for additional crew members.
  • Request Troy Fire Department for a lift assist.

27
Moving Devices - Stretcher
  • Indications General EMS calls
  • Considerations A backboard is needed in addition
    for a suspected spinal injury.
  • Example Patient with abdominal pain

28
Moving Devices Stair Chair
  • Indications 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

29
Moving Devices Backboard
  • Indications Suspected neck or back injury, CPR.
  • Contraindications None
  • Example Patient who fell from a 20 ladder

30
Other Moving Devices
  • Reeves 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

31
RPI Ambulance Attendant Class
Module VI Vital Signs and Diagnostic Equipment
32
Overview of Vital Signs
  • Three prehospital vital signs
  • Heart Rate
  • Respiratory Rate
  • Blood Pressure
  • Additional diagnostic measurements
  • Skin color and condition
  • Pupil size and reactivity
  • Lung sounds
  • Pulse oximetry
  • Temperature

33
Heart Rate
  • Measure by palpation at the radial artery.
  • Three pieces of information
  • Rate Beats per minute
  • Strength Strong or Thready (weak)
  • Regularity Regular or Irregular
  • Normal range 60-100 beats per minute
  • Dangerous range Less than 60 or greater than
    120 (sustained)

34
Respiratory Rate
  • Measure by visualization.
  • Three pieces of information
  • Rate Breaths per minute
  • Depth Normal, Shallow or Deep
  • Regularity Regular or Irregular
  • Normal range 12-20 respirations per minute
  • Dangerous range Less than 8 or greater than 24

35
Blood Pressure
  • Measure with a sphygmomanometer (BP Cuff).
  • Two pieces of information
  • Systolic BP Pressure when the heart is
    contracting
  • Diastolic BP Pressure when the heart is not
    contracting
  • Normal range
  • Systolic 100 140 mmHg
  • Diastolic 60 90 mmHg
  • Dangerous range
  • Systolic Less than 90 or greater than 180 mmHg
  • Diastolic Less than 50 or greater than 100 mmHg

36
How to Take a Blood Pressure
  • Have the patient extend their arm palm up.
  • Place the BP cuff around the patients bicep,
    such that the artery marker is centered.
  • Turn the BP cuffs valve clockwise, all the way
    open.
  • Place your stethoscope, with the large bell down,
    right below the artery marker on the BP cuff.
  • Inflate the BP cuff to 200 mmHg by squeezing the
    bulb.
  • Slowly turn the valve counterclockwise, letting
    the air out slowly.
  • Note at what reading on the gauge you begin
    hearing thumps - this is the systolic blood
    pressure.
  • Note at what reading on the gauge you stop
    hearing distinct thumps - this is the diastolic
    blood pressure.

37
Skin Color and Condition
  • Observe
  • Color Normal, Flushed, Pale, Cyanotic (blue),
    Mottled (grey), Jaundiced (yellow).
  • Condition Warm, Dry, Cool, Diaphoretic (sweaty).

38
Pupil Size and Reactivity
  • Observe
  • 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.

39
RPI Ambulance Attendant Class
Module VII Airway
40
Manual Airway Maneuvers
  • It is vital to maintain an open airway!
  • Head TiltChin Lift
  • Indications Unconscious / unresponsive
  • Contraindications Suspected neck or back
    injury
  • Jaw Thrust
  • Indications Unconscious / unresponsive with
    suspected neck or back trauma
  • Contraindications None

41
Airway Adjuncts
  • Used to keep the airway open.
  • Oropharyngeal Airway (OPA)
  • Indications Unconscious / unresponsive
  • Contraindications Gag reflex present
  • Nasopharyngeal Airway (NPA)
  • Indications Suspected loss of airway control,
    OPA not tolerated
  • Contraindications Facial trauma

42
Airway Suction
  • Types of suction units
  • Ambulance
  • Portable
  • Handheld
  • Types of Catheters
  • Yankaeur (Hard Tip)
  • French (Soft Tip)
  • Suction for no more than 15 seconds!

43
RPI Ambulance Attendant Class
Module VIII Breathing
44
Oxygen Tanks
  • Components
  • Tank
  • O-Ring
  • Regulator
  • Sizes
  • D
  • E
  • M
  • Stat Date
  • Pressure Gauge
  • Flow Valve

45
Non-Rebreather Mask (NRB)
  • Indications Sick or injured patients requiring
    high-flow oxygen
  • Contraindications Respiratory arrest
  • Use with an oxygen flow rate of 10-15 LPM.

46
Nasal Cannula (NC)
  • Indications 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 0-6 LPM.

47
Bag Valve Mask (BVM)
  • A.K.A Ambu-Bags
  • Indications A patient who is having difficulty
    maintaining adequate ventilations on their own.
  • Contraindications None
  • Rate
  • Adults 12-20 / min
  • Children 20 / min
  • Infants 20 / min
  • Use with supplemental oxygen, 15-25 LPM.

48
Humidifier
  • Indications Used in conjunction with another
    oxygen administration device for pneumonia,
    bronchitis, asthma, Adult Respiratory Distress
    Syndrome (ARDS), Neonatal Respiratory Distress
    Syndrome (NNRDS).
  • Contraindications Pulmonary edema

49
RPI Ambulance Attendant Class
Module IX Circulation
50
Bleeding Control
  • 3 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 Pressure
  • Elevation
  • Pressure Dressing
  • Direct Pressure
  • Pressure Point
  • Tourniquet

51
Hypoperfusion (Shock)
  • Hypoperfusion 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)

52
Hypoperfusion (Shock)
  • Treatment of hypoperfusion
  • Support the airway and breathing.
  • Control any external bleeding.
  • Position the patient with their feet elevated
    (Trendelenburg).
  • Keep the patient warm.
  • Rapidly transport.

53
RPI Ambulance Attendant Class
Module X Splinting and Immobilization
54
Splinting
  • Splints are used to immobilize and protect an
    injured body part.
  • Board splints, Frac-Pak, Traction splints
  • In general, when applying a splint
  • Begin by checking CSM x4.
  • 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.
  • Recheck CSM x4.

55
Spinal Immobilization
  • Backboard A long, rigid board used to immobilize
    a patient
  • Cervical Collar A stiff neck brace used to
    immobilize the seven cervical vertebrae
  • 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

56
Spinal Immobilization
  • To immobilize a supine patient (Log Roll)
  • Hold manual C-Spine stabilization.
  • Check CSM x4.
  • Size and apply a cervical collar.
  • Roll the patient on to their side, moving the
    head and body as a unit.
  • Place the backboard next to the patient.
  • Roll the patient on to the backboard, moving the
    head and body as a unit.
  • Secure straps across the body.
  • Put the head blocks in place.
  • Secure straps across the head.
  • Recheck CSM x4.

57
Spinal Immobilization
  • To immobilize a standing patient (Standing Take
    Down)
  • Hold manual C-Spine stabilization.
  • Check CSM x4.
  • Size and apply a cervical collar.
  • Place the backboard behind the patient.
  • Two people, on either side of and facing the
    patient, grab the board under the patients
    armpits with their innermost hands.
  • Supporting the patient, lower the board to a
    horizontal position.
  • Secure straps across the body.
  • Put the head blocks in place.
  • Secure straps across the head.
  • Recheck CSM x4.

58
Spinal Immobilization
  • Kendrick 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.

59
Alright, its over.
Any questions?
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