Detailed Lesson Plan
Chapter 41
Ambulance Operations and Air Medical Response
145–180 minutes
Chapter 41 objectives can be found in an accompanying folder.These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes / Content Outline / Master Teaching Notes
5 / I.Introduction
A.During this lesson, students will learn to prepare themselves, their equipment, their medical supplies, and their vehicle for an ambulance run.
B.Case Study
1.Present The Dispatch and En Route information from the chapter.
2.Discuss with students how they would proceed. / Case Study Discussion
- What daily actions can ensure that you and your vehicle are ready to respond when needed?
- What are your responsibilities before, during, and after an EMS call?
5 / II.Driving the Ambulance—Laws, Regulations, and Ordinances
A.Legal privileges in most states
1.Exceed the speed limit, so long as you are not endangering lives or property.
2.Drive the wrong way down a one-way street; drive on the “wrong” side of the road.
3.Turn in any direction at any intersection.
4.Park anywhere as long as you do not endanger lives or property.
5.Leave the ambulance standing in the middle of a street or intersection.
6.Cautiously proceed through a red light or red flashing signal.
7.Pass other vehicles in no-passing zones.
B.Qualifications required by law
1.Have a valid driver’s license.
2.Pass an approved driving course (mandatory in most states).
3.Be responding to an emergency of a serious nature.
4.Use warning devices (emergency lights, horns, sirens).
5.Exercise due regard for the safety of others.
6.Obey any specific rules or requirements of your EMS system. / Teaching Tip
Be prepared to discuss local regulations, policies, and practices regarding emergency vehicle operations.
Discussion Question
What are some of the privileges generally granted to emergency drivers?
25 / III.Driving the Ambulance—Driving Excellence
A.Basics of good driving
- Always wear a seat belt.
- Hold the steering wheel with both hands at all times.
- Practice driving your ambulance until you are familiar and comfortable with its responses.
- Recognize and respond to changes in weather and road conditions.
- When transporting a patient, select the route best suited for safe travel.
- Maintain a safe following distance.
- Exercise caution when using red lights and siren.
1.Braking
- Pump the brakes slowly and smoothly.
- Never brake on a curve.
- Rest your foot lightly on the brake when decelerating.
3.Driver alone—Focus on safe operation of the vehicle.
4.Fatigue—To avoid fatigue, get proper rest and nutrition before your shift.
5.Railroads
- If a long slow-moving train is blocking your path, there may be an underpass or overpass within a reasonable distance.
- Never try to drive across tracks in front of a moving train.
- Always be alert for children.
- Follow state laws regarding passing of school buses.
- Due to difficulty of passing, consider an alternate route.
- If there is no alternate route, try to get control of the situation before entering bridge or tunnel.
- Be sure the height of the bridge or tunnel can accommodate the height of the ambulance.
9.Time of day—Be aware of rush hour, school zones, and industrial plant shift changes.
10.Road surface
- Avoid potholes and bumps.
- Decrease speed on bad or unpaved roads.
12.Higher speeds
- Negotiate curves with extra care.
- Brake to the proper speed before entering a curve.
- Accelerate carefully and gradually as you leave a curve.
- Keep your exit from the curve slow and steady.
- Use a lower gear when going down a long hill.
- Always use a smooth braking motion.
14.Escorts—Use only if you do not know how to find the hospital or the victim.
15.Intersection collisions—Causes
- A motorist speeds up and goes through just as the light is turning red.
- Motorist does not anticipate the presence of a second emergency vehicle.
- Vehicles may block your view of pedestrians in the crosswalk.
- Rainy or wet weather
- Keep mirrors cleared of water.
- Avoid sudden braking and sudden moves of the steering wheel.
- Slow down when approaching a large standing puddle, and turn on your wipers.
- If you begin to hydroplane
- Hold the wheel steady.
- Take your foot from the accelerator.
- Gently pump the brake.
- Winter driving
- Make sure that your engine is tuned, your heater and defroster work, and your battery is charged.
- Carry emergency weather equipment (chains, shovel, sand, and so on).
- Equip the ambulance with studded snow tires.
- Stay aware of the temperature.
- Avoid sudden movements of the steering wheel and sudden braking.
- Fog, mist, dust storms, smog
- Slow down but avoid sudden deceleration.
- Watch the road ahead and behind for other slow-moving cars.
- Turn on your lights (never high beams) and use your wipers.
- Use four-way flashers
- If you are traveling 15 miles or more below the speed limit
- If you pull off the road and stop
- Use the defroster.
- Tap your brake pedal several times if you need to slow down.
- Be alert for vehicles in front of you.
- Make sure that your ambulance has quartz-halogen headlights.
- Have your headlights on whenever traveling in an emergency.
- Keep your headlights clean and properly aimed.
- Replace burned-out bulbs immediately.
- Dim your high beams
- 500 feet of an approaching vehicle
- 300 feet of a vehicle in front of you
- Never stare into the high beams of another car.
- Do not flick your high beams up and down.
- Never use high beams when going into a curve.
- Keep your windshield clean.
- Keep your instrument panels dim.
- Keep your eyes moving.
- If your windshield is not getting properly cleaned
- Replace your window-washer blades.
- Try a stronger washing solution.
- Be sure that you are properly fed and rested before a night driving shift.
- Be alert for intoxicated or drowsy drivers, and use extreme caution in passing.
- What are some considerations in selecting the safest, as opposed to the quickest, route of travel to a destination?
- What are some issues that may cause the driver to lose control of a vehicle?
- What is the proper way to negotiate curves when driving?
Students should be able to apply principles of safe driving, both in personal vehicles and when driving the ambulance.
Critical Thinking Discussion
If you were a policy maker, what would you do to decrease the number of injuries and deaths from ambulance crashes?
Class Activity
If your circumstances (location, liability issues and so on) allow, let students drive the ambulance in a vacant parking lot under the direction of an experienced emergency vehicle operator to get an idea of how an ambulance handles differently from a personal vehicle.
Weblink
Go to
and click on the mykit link for Prehospital EmergencyCare, 9th edition to access a web resource on safe driving tips.
Discussion Question
What are some special considerations for driving in poor weather and at night?
2 / IV.Warning Devices—Colors and Markings
A.Federally mandated
B.Provide quick identification by the public
C.Maximize visibility in traffic
D.White with orange stripe around body
E.Blue lettering and “Star of Life” symbol
3 / V.Warning Devices—Warning Lights and Emergency Lights
A.Activate at all times when responding to emergency calls.
B.Use lights even when not using siren.
C.Turn on headlights at all times to aid in visibility.
D.Lights should cast a beam above traffic and be high enough to be visible in the rearview mirror of the car in front.
E.Use only minimal lighting in heavy fog or when you are parked.
F.Use emergency lights only when needed (such as for rapid transport). / Discussion Question
What are the risks and benefits of using warning devices?
Knowledge Application
Given several scenarios, students should be able to select the appropriate use of warning devices on the ambulance.
5 / VI.Warning Devices—Using Your Siren
A.Do not assume that drivers are aware of you unless they respond to your presence.
B.Never pull directly behind a car and blast your siren.
C.Be aware that the siren may cause physical and emotional stress on the patient.
D.Always let the patient know before you activate the siren.
E.Be aware that the siren may unnerve you or make you tense, which in turn can push you to drive faster and with less care than you should.
F.Follow state laws and local protocol regarding siren use. / Critical Thinking Discussion
Does siren noise pose a risk to the hearing of EMS personnel? If so, how can they minimize that risk?
5 / VII.Warning Devices—Using Your Air Horn
A.Avoid overuse.
B.Use to clear traffic quickly when necessary.
C.Use with or without siren, depending on state laws and local protocol.
D.Do not sound horn when you are close to other vehicles.
E.Do not assume that drivers will hear or heed the horn. / Discussion Question
What are some reasons sirens and air horns may not be effective?
5 / VIII. Roadway Incident Scene Safety—High-Visibility Apparel
A.American National Standards Institute (ANSI) / International Safety Equipment Association (ISEA) 107-2004, American National Standard for High-Visibility Safety Apparel and Headwear
- Class 1: for workers in parking lots and other areas with traffic moving at less than 25 mph
- Class 2: for personnel whose attention is diverted from traffic or where the traffic is moving at 25 mph or greater
- Class 3: for personnel whose work greatly diverts their attention from traffic and where they are at serious risk from moving vehicles
1.Same retro-reflective material as Class 2 vest
2.Nearly the same amount of fluorescent material
3.Breakaway features and specific dimensions to allow fit over gear
4.Color-specific markings (law enforcement, fire, EMS)
- On right-of-way of all federally funded highways, Code of Federal Regulations requires wearing a Class 2 or 3 of ANSI/ISEA 107-2004 or PSV (ANSI/ISEA 207-2006).
Demonstrate the use of safety apparel and other items used to increase safety when working at roadway incidents.
15 / IX.Roadway Incident Scene Safety—Safety Benchmarks
A.Do not trust approaching traffic.
B.Do not turn your back on approaching traffic.
C.Position the first arriving emergency vehicle to create a physical barrier between upstream traffic and the scene.
D.Wear appropriate personal protective equipment and ANSI high-visibility vests.
E.At night, turn off vision-impairing lights on emergency vehicles positioned to oncoming traffic.
F.Use other emergency vehicles to slow down and redirect traffic.
G.Use advance warning signs and other traffic control measures to reduce speed of oncoming traffic.
H.Use traffic cones for traffic control.
I.Assign someone to monitor oncoming traffic.
J.Place your vehicle uphill and upwind from the scene to avoid potential contamination from leaking or airborne chemical or other hazards. / Discussion Questions
- What steps can you take to keep yourself safer at roadway incidents?
- What can cause driver distraction despite the safety measures you may take at roadway scenes?
Given several scenarios, students should be able to identify and manage hazards when responding to roadway incidents.
Critical Thinking Discussion
What can be done to increase EMS provider safety at roadway incidents?
Class Activity
If your circumstances (location, liability issues and so on) allow, use a vacant parking lot to provide students with scenarios in which they must set up a safe roadway response scene.
Weblink
Go to click on the mykit link for Prehospital EmergencyCare, 9th edition to access a web resource from the National Institute for National Safety and Health about the FACE Program.
5 / X.Phases of an Ambulance Call—Daily Prerun Preparation
A.Ambulance maintenance benefits
- Decreased vehicle down time
- Improved response times to scenes
- Safer emergency and nonemergency responses
- Improved transport times to medical facilities
- Safer patient transport to medical facilities
C.Ambulance equipment—Check, restock, clean, maintain, and secure as needed.
D.Personnel—Follow state laws and protocols for staffing.
E.Dispatch: will provide information which you should write down:
- Location of the call
- Nature of the call
- Name, location, and callback number of caller
- Location of patient(s) at the scene
- Number of patients and severity of problem(s)
- Any other pertinent special problems or circumstances
Have students carry out all phases of an ambulance run on mock calls.
Discussion Question
What are the EMT’s responsibilities in the prerun phase?
Knowledge Application
Students should be able to perform their responsibilities in all phases of an EMS call.
Weblinks
Go to click on the mykit link for Prehospital EmergencyCare, 9th edition to access web resources on the American Ambulance Association and the Commission on Accreditation of Ambulance Services.
6 / XI.Phases of an Ambulance Call—En Route to the Scene
A.Before departure
- Check that doors are closed and secure.
- Check that external shoreline cords are disconnected.
- Check that jump kits are retrieved and properly stowed.
C.Write down information from the dispatcher.
D.Confirm the following dispatch information.
- Location of the call
- Nature of the call
- Location of the patient(s)
- Number of patients and severity of problem
- Any other special conditions or problems
- If any other units are en route
F.Think about what equipment you will take into the scene.
G.Remain relaxed, yet focused. Be aware that less than five percent of all ambulance runs involve life-threatening emergencies.
H.Drive responsibly.
I.Determine each team member’s responsibility before arriving on the scene.
J.Call for advanced life support if necessary.
7 / XII.Phases of an Ambulance Call—At the Scene
A.Notify dispatch of arrival.
B.Park in the safest place, one that will allow you to load the patient and depart.
C.Perform a full 360-degree scene survey, looking for risk factors.
- Downed electrical wires
- Leaking fuel or fluid from accident vehicle
- Smoke or fire
- Broken glass
- Trapped or ejected patients
- Mechanism of injury
- If another emergency vehicle is positioned to block the scene, park in front of or behind a collision but never next to it.
- If no other emergency vehicle is present, position to ambulance to provide a safety zone.
- Block a narrow no-parking road completely.
- Park in a driveway or on the shoulder of the road whenever possible.
- Stay at least 100 feet from a burning vehicle.
- Stay at least 2,000 feet from a hazardous materials spill.
F.Take necessary Standard Precautions.
G.Determine whether it is safe to approach the patient.
H.Call the dispatcher immediately for the following.
- Mechanical failure occurs.
- You need backup equipment or personnel.
J.Carefully observe the complete incident or scene as you approach.
K.Determine the mechanism of the patient’s injury.
L.Determine the total number of patients before beginning to treat anyone.
M.Determine the priority of care.
N.Carefully gain access to patient(s) in a crashed motor vehicle and extricate him safely.
O.Splint and immobilize injured extremities before moving the patient unless he is unstable and needs immediate transport.
P.Carefully remove the patient from any wreckage and move him to the ambulance.
Q.Transfer the patient to the ambulance. / Video Clip
Go to
and click on the mykit link for Prehospital EmergencyCare, 9th edition to access a video about Standard Precautions and equipment.
7 / XIII. Phases of an Ambulance Call—En Route to the Receiving Facility
A.Before you leave the scene
- Ensure that all hazards have been controlled.
- Pick up and dispose of equipment properly.
- Turn the scene over to the appropriate agency (police, fire, and so on) if required.
C.Driver should check the unit, making sure that doors, equipment, and supplies are secure.
D.All personnel in the unit should be seated and wearing seat belts.
E.Determine the need for lights and siren during transport.
F.Begin reassessment and conduct at intervals.
- 15 minutes for a stable patient
- Five minutes for an unstable patient
H.Check any patient interventions, oxygen flow, dressings, and splints.
I.If a relative or friend accompanies the patient
- Allow him in the patient compartment only if
- Local protocols permit
- He is under emotional control.
- Keep in mind that it is often helpful to have a parent accompany a juvenile patient.
- Provide adequate safety restraint, including for children.
- Use a car seat to transport a child under 40 pounds, unless the child is immobilized on a backboard.
- Always follow local protocol.