Title 13 - California Code of Regulations

·                Maintain appropriate licensures/certifications (California driver's license, EMT-1 certification or EMT-P license, Ambulance Driver Certificate: on-duty fire department personnel exempt)

·                Provide for safe transport of the patient

·                Use due regard in considering the safety of the public

GOLDEN RULE:  "First, do no harm."

Appropriate Method of Cleaning

·          Remove equipment and wash with bacteriostatic soap

·          Wash down interior including ceiling and floors

·          Allow to air dry before replacing equipment

Wexcide

·          Bacteriocidal; kills viruses, fungi, tuberculosis

·          Surface cleaner and soak; leave on surface or soak for 10 minutes

·          For surface cleaning, use only with Wexcide spray bottles

·          To reconstitute use 1 squirt of Wexcide per gallon of water

·          Shelf life

·          Reconstituted solution - 6 months

·          Concentrated solution - 2 years      

Refer to the following for lists of ambulance equipment required:

·          Prehospital Care Policy Manual, L.A. County DHS: Ref. #702 Mobile Intensive Care Unit Inventory (L.A. County requirement)

·          Ref. #710 Ambulance Equipment Requirements From California Administrative Code: Title 13, Section 1103

Rescue Units

3.10.7.4        Respond to Bravo and Charlie responses Code 3, unless otherwise noted by alarm office

Engine Companies:

2.1.3.1          Freeway Response:  Response ON the freeway shall normally be code 2.  Code 3 may be used at the discretion of the officer in charge of the apparatus.

2.1.1.11        All emergency response shall be driven in accordance with the State of California Motor Vehicle Code governing authorized emergency vehicles.  For clarification, refer to Departmental Driver Training Manual, Section 3 “Code 3 Driving”.

2.1.13.5        First-Alarm Assignments:  if the first on-scene unit reports “nothing showing” or something with similar intent, all other responding units shall go Code 2 and continue in until cancelled.  Caution should be exercised when changing from Code 3 to Code 2 to avoid unsafe effects on traffic.

2.1.1.3          Companies shall NOT use red lights or sirens when “moving up”.

Marine Safety Division:

3.69              Rescue Boats:  Code 3 shall be used for major medical aids, fires, boating accidents involving serious injury, vehicle in water with person inside, vessels going aground, sinking or in some immediate distress or people in the water due to capsizing and threatened with hypothermia.

                     Includes procedures for Code 3 response for rescue boats.

3.51              Response Vehicles:  On emergency calls, the lights and siren shall be used according to the desired response code.

                     Rescue Emergencies:  Rescues involving two or more victims;

                     time consuming or complicated rescues; disabled boats

                     approaching the beach endangering others.

                     Medical Emergencies:  All victims down; fractures or possible

                     fractures; all submersions or possible submersion victims; any    medical aid situation requiring additional medical supplies or     assistance.

                     Includes procedures for Emergency Driving, which covers

                     Code 3 driving on the beach and street.

California Vehicle Code:

·        30:  Red Lights and Siren:  Should be restricted to authorized emergency vehicles engaged in police, fire, and lifesaving services.

·        17001:  Liability of a Public Entity:  A public entity is liable for death or injury to person or property proximately caused by a negligent or wrongful act or omission in the operation of any motor vehicle by an employee of the public entity acting within the scope of his employment.

·        17004:  Authorized Emergency Vehicles:  A public employee is not

      liable for civil damages on account of personal injury to or death             from the operation, in the line of duty, of an authorized emergency          vehicle ... when responding to but not upon returning from a fire             alarm or other emergency call.

·        21055:  Exemption of Authorized Emergency Vehicles:  Drivers of emergency vehicles are exempt from certain traffic laws as long as the vehicle is being driven Code 3 (siren as reasonably necessary and red lights) in response to an emergency call.

·        21056:  Effects of Exemption:  Privileges granted under Section 21055 do not relieve the driver from driving with due regard for the safety of all persons using the highway, nor protect from consequences of an arbitrary exercise of the privileges.

Code 3 is justified only when initially responding to an emergency call or transporting a patient with a life-threatening emergency such as:

·          Uncontrolled hemorrhage

·          Uncontrolled cardiovascular or respiratory status

·          Complicated impending childbirth

Vehicle Code Sections 25268 and 25269 restrict the use of warning lights to conditions of "extreme hazard" and "unusual traffic hazard".  Proper use is as follows:

·          Steady burning red light: shall be displayed when required by VC 21055 or when an extreme hazard exists. 

·          Flashing red light:  may be displayed only during extremely hazardous conditions, i.e., any incident or situation that requires traffic to stop or proceed only as directed, any incident that requires the roadway to be blocked, or other situations in which extreme hazards exists.

·          Flashing amber lights:  may be displayed only when an unusual traffic hazard exists.

Precautions:

·          Warning lights may be ineffective due to low sun or glare, due to confusion with traffic signals or neon lights, or the position of the lights may be out of visual range of the oncoming vehicles.

·          Sirens warn vehicles or pedestrians traveling in the same direction and ahead of the ambulance; lose effectiveness in warning vehicles approaching head on or traveling on converging roads.

·          Never assume the red lights and siren will clear the way through traffic or that the motorists will do what is expected.

Precautions:

·          Visibility is obstructed by buildings, landscaping, or other vehicles

·          Drivers misjudge traffic situations and clearance

·          Motorists don't hear or see the approaching ambulance

·          Two or more emergency vehicles often "meet" at intersections

·          Check for actual or potential hazards well in advance of the intersection

·          Look to left, then right, then left again before entering the intersection

·          Maintain safe following distance, especially if following another emergency vehicle.

•           Station a crew member outside to the left rear of the vehicle

•           Check for pedestrians and obstacles

•           Sound horn before backing

•           Back slowly

•           Check mirrors constantly

Factors to consider:

·          Presence of hazardous materials

·          Traffic flow and pattern

·          Access to victim(s)

·          Number of emergency vehicles

·          Parking Pattern: Engine in at angle, then ambulances or rescues park in front of engine

·          Usually set out ahead of an incident

·          May be set in a straight line to serve as a warning to traffic or may be set in a pattern to route traffic from one lane to another or to completely halt traffic

·          After pattern is established, a single flare should be placed well in advance of pattern to serve as warning to traffic, particularly in areas where road visibility is poor

·          In fire hazard areas, a man should be in attendance of flares at all times

Complete a written test which include the following items:

·          Responsibilities of ambulance driver

·          Locating an address and selecting an appropriate response route using an area map

·          Daily ambulance check

·          Appropriate method of cleaning and decontaminating the interior of an ambulance

·          Equipment required on an ambulance in California

·          Safe ambulance driving

·          Complete an EMS report form

·          (Refer to LBFD Policies and Procedures 3.12.0.0 REPORTING AND DOCUMENTATION)

·          Demonstrate proper radio procedures: 

·          enroute to scene

·          at scene

·          at patient

·          enroute to receiving facility

·          at receiving facility

·          enroute to station

·          at station

·          (Refer to LBFD Policies and Procedure 2.2.0.0 Radio Policies and Procedures - General and Specific and/or for Marine Safety Division Policies and Procedures 3.110.1.0 VHF Radios)

·          Provide an accurate radio report

Rules of Lifting and Carrying

·          Know the weight

·          Know your physical ability and limitations

·          Call for additional help when necessary

·          Keep back locked in lordosis; do not hyperextend or twist

·          Use the leg, back and abdominal muscles

·          Keep the weight to be lifted close to the body

·          Communicate clearly and frequently with your partner

·          Shoulders, feet and hips should face forward at all times

Rules for Reaching

·          Keep your back in a locked-in position

·          When reaching overhead, avoid a hyperextended (sway-back) position

·          Never twist your back when reaching

Rules for Pushing and Pulling

·          Push whenever possible

·          Keep your back in a locked-in position

·          Bend your knees whenever you pull so that the line of pull is through the center of your body

·          Keep the weight close to your body

How to Prevent Back Injuries

·          Improve posture and body mechanics

·          Lose extra weight

·          Reduce stress and fatigue factors

·          Increase general body strength especially belly, back and leg muscles

GOLDEN RULE:  75% of industrial lifting back injuries occur from            lifting below the knuckle level.

Appropriate positions for patients with special illnesses or injuries

·             Semi-Fowlers (head of gurney elevated)

·          Dyspnea

·          Chest pain

·          CVA with hemiplegia (may consider positioning on affected side if problems controlling airway)

·             Supine (on back, flat position)

·          C-spine trauma without shock

·          Pelvic fracture

·          Flail chest

·             Shock position: (supine with legs raised)

·          Patient in shock without spinal trauma

·             Left lateral:  (left side lying position)

·          Unconscious (nontraumatic)

·             Trendelenburg: (supine, head lower than legs on one plane)

·          Spinal trauma with shock

Appropriate devices for patients with special illnesses or injuries

·          Flail Chest:  stabilize flail segment with bulky dressing or gentle hand pressure

·          C-spine trauma:  backboard, rigid cervical collar, head immobilization device, tape on flat gurney

Miscellaneous Devices

·          Foley catheters

·          Keep bag below level of bladder

·          Avoid tension on or kinks in tubing

·          Nasogastric tubes (NGT)

·          Plug end of tubing

·          Avoid tension on or kinks in tubing

·          Gastrostomy tubes (GT)

·          Plug end of tubing

·          Avoid tension on or kinks in tubing

·          Heparin or Saline locks

·          Monitor for bleeding

·          Tracheostomy tubes

·          Suction prn

·          Indwelling Vascular Access Devices

·          EMT-Is may not access these devices

Supplies and equipment necessary for IV therapy

·          alcohol wipes

·          solutions, tubing, needles, cannula

·          IV pole or hook

·          tape

·          armboard

Supplies and equipment necessary for Saline Lock

·          alcohol wipes

·          tourniquet

·          catheters

·          syringe

·          needles

·          normal saline

·          I.V. “plug”

·          tape

Re-establishing IV flow

·          examine site for signs/symptoms of infiltration

·          check to ensure air vent is open

·          reposition arm

·          examine tubing for kinks

·          loosen constricting tape and/or clothing

·          elevate bag

IV site complications:

·          Signs/symptoms

·          infiltration  -  edema around IV site, pain

·          hematoma  -  edema, discoloration, pain

·          thrombosis  - increased skin temperature around IV site,                           reddened area, pain

·          Proper procedure if complications identified

·          turn off flow

·          monitor IV site for bleeding or edema

Monitoring and transporting a patient with an I.V.

·          Identification of solutions

·          glucose solutions

·          isotonic salt solutions

·          Approved additives only

·          folic acid - 1mg/1000 ml.

·          multivitamins - 1 vial/1000ml.

·          potassium chloride - 20mEq/1000 ml. (infusion pump required)

·          thiamine - 100 mg./1000 ml

·          chemotherapeutic agents (infusion pump required)

·          total parenteral nutrition (TPN) (infusion pump required)

·          Assess patency of I.V.

·          Secure I.V. tubing during transport

·          Secure I.V. site

·          Properly position extremity

·          Monitor flow rate frequently

·          Document any incidents

Vascular access devices NOT approved for EMT-I transport

·          Central Venous Monitoring Devices            

·          Arterial lines

·          Swan Ganz catheters

Factors affecting IV flow rate:

•      Height of bag

•      Altitude

•      Patient position

•      Motion of ambulance

Discontinuing IV line flow

·          Procedures

·          turn off IV flow rate regulator

·          leave tubing attached to IV catheter

Supplies and equipment for glucometer

·          alcohol wipes

·          cotton balls

·          retractable lancet device (if doing finger stick)

·          angiogath or I.V. insertion device

·          sterile 4 x 4 gauze

·          band-aid

·          approved reagent strips

Factors affecting glucometer reading

·          timing

·          insufficient blood sample

·          outdated reagents

·          improper wiping

·          reagents have been left open (become moist)

EMT-I responsibilities

·          assemble supplies

·          time accurately if asked 

·          disposal of equipment

·          safe handling of “sharps”

Indications for cardiac monitoring

·          chest pain

·          shortness of breath

·          trauma criteria or guidelines

·          shock

·          symptomatic hypertension

·          altered LOC

·          ingestion of poisonous substances

·          haz-mat exposure with medical complaint

·          major burns

·          elderly patients with weakness, syncope, or vague complaints

·          patients with irregular heart rates or rhythms

Supplies for cardiac monitoring

·          Cardiac monitor and cable with lead wires

·          E.K.G. patches (3)

·          4 x 4 if patient is diaphoretic

Application of cardiac monitor standard lead two placement

·          white electrode on the upper right chest

·          red electrode at the apex of the heart

·          black electrode at the left upper chest

Monitor troubleshooting

·          low batteries

·          loose leads or cable

·          patient is diaphoretic

·          dried electrode pads

·          patient movement

·          monitor malfunction

·          unconsciousness (non trauma)

·          CVA with hemiplegia

·          c-spine trauma

·          pelvic fracture

·          shock

·          Transporting patients with the following:

·          foley catheter

·          nasogastric tube

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