Ambulance Vehicle Operators Course Basic

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Ambulance Vehicle Operators Course - Basic

• Revised May 2009

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Ambulance Vehicle Operators Course - Basic

• AVOC Instructor

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Ambulance Vehicle Operators Course

• The Best Ambulance Drivers Need Not Be Fast
• And They Dont Have Crashes,
• EVER!!

4
Welcome Introductions

• Introduction of Instructors
• Introduction of Students

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Course Objectives

• To Improve Driver Abilities and Vehicle Safety
  By
• 1. Identifying the problems facing ambulance
  vehicle operators.
• 2. Motivating emergency vehicle operators to
  recognize the importance of AVOC training and
  utilization of safety precautions.
• 3. Identifying the importance of seatbelt usage.
• 4. Identifying the importance of route
  preplanning.

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Course Objectives

• To Improve Driver Abilities and Vehicle Safety
  By
• 5. Reviewing the legal responsibilities of
  emergency vehicle operations.
• 6. Discussing the physical forces involved in
  the operations of emergency vehicles.
• 7. Discussing the importance of a good
  preventative maintenance program.
• 8. Discussing the appropriate use of emergency
  signaling devices and emergency responses.

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Course Objectives

• To Improve Driver Abilities and Vehicle Safety
  By
• 9. Identifying procedures for controlling the
  emergency vehicle under adverse conditions, and
  proper crash avoidance techniques.
• 10. Providing the participant the opportunity to
  perform hands-on operation through the designated
  driving course.

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Material Included in AVOC

• Didactic Information
• Slow Cone Course (Basic)

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Disclosure Statement

• The material I present here today is accurate to
  the best of my knowledge, but parts of it are
  based on expected interpretation of the law and
  personal experience and judgement in ambulance
  operations.
• The materials used are accurate to the best of my
  knowledge, but this is a rapidly changing field
  with new information and standards being
  presented everyday.

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Disclosure Statement

• This information therefore, is not considered to
  be infallible, but is the best information that
  is available at this time.
• Likewise, please remember that any information
  you have to share is also not infallible, and is
  open to discussion, clarification, and possible
  correction by the instructor.

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Test

• Who said anything about a test???
• Do you all know your numbers from 1-60?
• Can you all draw a circle?

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Seat Belt Usage, Air Bag Safety, Box Safety

• Unrestrained objects MOVE

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Seat Belt Usage, Air Bag Safety, Box Safety

• How many ALWAYS wear your seatbelts?
• In you car?
• In the front of the ambulance?
• In the back of the ambulance?

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Seat Belt Usage, Air Bag Safety, Box Safety

• Unrestrained People MOVE

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Seat Belt Usage, Air Bag Safety, Box Safety
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Seat Belt Usage, Air Bag Safety, Box Safety

• Drivers responsibility
• Family members
• Support staff
• Others

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Seat Belt Usage, Air Bag Safety, Box Safety

• Child Safety Seat
• Children need to be secured
• http//www.maine.gov/dps/bhs/restraints/child-seat
  s/index.html

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Seat Belt Usage, Air Bag Safety, Box Safety
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Seat Belt Usage, Air Bag Safety, Box Safety

• For air bags to operate effectively safely
• You must wear seatbelts - lap shoulder.
• Infant car seats and children should be in the
  rear seat.
• Never place an infant in a rear facing car seat
  in the front passenger seat of an ambulance.

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Seat Belt Usage, Air Bag Safety, Box Safety
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Vehicle Checks Common Vehicle Problems

• Read the Owners Manuals!!
• Vehicle Check Sheets
• Check sheets are important to maintain top notch
  functioning of an ambulance.
• Ambulances should be checked daily

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Ambulance Check Sheets Should Include

• Oil
• Radiator Fluid
• Power Steering Fluid
• Batteries Connections
• Belts Hoses
• Tire Condition Pressure
• Service Due Date

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Ambulance Check Sheets Should Include

• Inspection Due Date
• Street Directories and/or maps
• Amp Volt Meters
• Fuel Levels
• Interior Lights - Cab Pt. Compartment
• Mobile Portable Radios
• Heater/Air Conditioner/defroster

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Ambulance Check Sheets Should Include

• Windshield Wipers Washer
• All Emergency Lights Siren
• Running Lights
• Scene Lights
• Directional Signals
• Pt Compartment Heater/AC
• Transmission Fluid

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Vehicle Service Check Sheets Should

• Be performed by your own mechanic or regular
  garage.
• Be more extensive than daily check sheets.
• Usually performed with routine services (Ex
  2000miles/200 hours).

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Vehicle Service Check Sheets Should Include

• Oil/Filter/Grease
• Bearings
• Tune-up (as needed)
• Shocks
• Lug Nuts
• Front End Parts
• Tires

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Vehicle Service Check Sheets Should Include

• Radiator Coolant Temperature Range
• Drive Train/Rear End Parts
• Repair Any Problems, Noises, Whines, Clunks, etc.

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Symptoms of Common Problems

• In-Operational Lights
• Electrical Batteries
• Engine Won't Start or Runs Poorly
• Transmission - Pending Failure

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Symptoms of Common Problems

• Gauges - What they mean
• Water
• Oil Pressure
• Voltmeter
• Ammeter
• Radio
• Steering

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Symptoms of Common ProblemsSafety

• Causes of brake problems
• Brake problems usually happen at the most
  inopportune times but are usually easily
  predicted and prevented.
• 1. Water When brakes are wet they tend not to
  "grab" as well. After driving through a puddle,
  apply the brakes lightly to warm and dry them.
  If there is no pulling or lurching when applied
  normally, the brakes are probably O.K.
• 2. Heat The BIG ONE! Causes
• a. Riding the brakes NO two footers (except to
  dry the brakes). Two footing causes excessive
  brake and transmission wear.

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Symptoms of Common ProblemsSafety

• b. Excessive hard repeated braking Often seen
  in "city" emergency driving. Reduce speed in
  situations which would require hard braking.
• c. Overly tightly adjusted emergency brake
  Causes the rear brakes to overheat as you drive,
  forcing all the braking action onto the front
  brakes, causing rapid front brake overheating and
  fade.

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Symptoms of Common ProblemsSafety

• 3. Mechanical
• a. Fluid Fluid levels need to be checked and
  maintained on a daily basis.
• b. Brake lines Should be inspected when
  vehicle service checks are performed.
• c. Worn condition Worn brakes do not work
  well. Brakes should be visually inspected with
  each service, and replaced when they are 50
  worn. Early signs of brake wear should be
  reported and checked.

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Symptoms of Common ProblemsSafety

• Just a few notes on antilock brakes
• They DO NOT stop the vehicle in a shorter
  distance, but DO allow you to steer.
• The 3 Ss of antilock brakes Stomp on them,
  Stay on them, and Steer.
• They make a grinding noise, the pedal pulsate,
  and the front of the vehicle shudder.
• Practice in an empty parking lot on wet or snowy
  pavement.

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Symptoms of Common ProblemsSafety

• Traction - 3 types
• 1. Static traction The tire has its best grip
  on the road surface, with 100 coefficient of
  friction
• 2. Rolling traction When a wheel is in
  controlled motion, it is less efficient than
  static traction, but the only type of traction
  that allows controlled motion. Coefficient of
  traction drops to about 60 depending on road
  condition, tire condition, and environmental
  conditions.
• 3. Sliding traction When the coefficient of
  traction drops to almost 0. Braking and
  steering efficiency are lost, and the vehicle now
  controls you. Sliding traction MUST be avoided
  and rolling traction maintained to remain in
  control of the ambulance.

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Symptoms of Common ProblemsSafety

• Tire condition
• Tire condition plays an important roll in
  maintaining rolling traction, especially under
  poor driving conditions.
• 1. Tire pressure A tire inflated to the
  manufacturers recommended pressure has a
  widespread bond with the road surface.
• a. An over-inflated tire bulges in the center,
  loses part of its contact with the road, and
  quickly wears down the center tread.
• b. An under inflated tire cups upward in the
  center, an especially dangerous condition on wet
  roadways, as it traps water under the tire
  causing ideal hydroplaning conditions. It also
  quickly wears outside tread.

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Symptoms of Common ProblemsSafety

• 2. Tread depth A tire with good tread depth
  and good horizontal cuts channels the water out
  of the tire to prevent hydroplaning. If the
  horizontal cuts are worn, or if the tread depth
  is poor, the tire will ride on top of the water
  as soon as the water depth exceeds the tread
  depth.
• 3. Environmental conditions Snow, ice, mud,
  dirt, and rain all cause a tire to lose some of
  its efficiency of traction.

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Ambulance Type 1

• Modular box built on pickup truck chassis.
• Exterior cabinets for equipment.
• Ford most common manufacturer.

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Ambulance Type 2

• Built on standard van chassis.
• Raised roof for additional headroom.
• Limited outside cabinets
• Ford most common manufacturer

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Ambulance Type 3

• Modular box built on van chassis with dual rear
  wheels.
• Exterior cabinets for additional equipment.
• Ford only current manufacturer of Type III
  chassis.

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AmbulanceHeavy-Duty

• Modular body built on medium duty truck chassis.
• Greater GVW for additional equipment.
• International and Freightliner common chassis
  used.

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Route Selection

• Residential Districts
• Children
• Business Districts
• Traffic Congestion
• School Zones
• Children, School Buses
• Hospital Zones
• Quiet

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Route Selection

• Time of Day
• Beginning or End of School or Work Day
• Day of Week
• Weekends Around Malls, Amusements Areas, Scenic
  Areas, etc.
• Large Employment Areas
• Mills, Industry
• Train Tracks
• Know Easily Accessible Alternate Routes

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Route Selection

• Draw Bridges
• Know Any Alternate Routes
• Construction Areas
• Road Closures, Detours, etc.
• One Way Roads
• Interstate as well as Local
• Poorly Cleared Winter Roads, or Areas Prone to
  Flooding
• Common Fire Department Response Routes

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Street Directories

• 1) tells where the designated street runs "from"
  and "to"
• 2) gives specific direction from base to scene
• 3) lists all side and cross streets with street
• 4) based on knowing locations of a minimal number
  of major streets and landmarks

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Good Radio Communications

• Whenever possible, the dispatcher must keep you
  advised of other responding equipment.
• You must keep the dispatcher aware of your
  location status.
• Good radio communications is essential to
  effectively communicate.
• Use plain language

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Good Radio Communications

• Important information for dispatcher to relay
• Nature of call and response code
• Other responding units - police, fire, rescue
  what code they are responding, and from where
• Destination of transport for preplanning of
  transport route to hospital

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Emergency Medical Dispatch (EMD)

• Development of a Priority Dispatch System in Maine

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Maine EMD Timeline

• January 2007 - Statewide EMD Implemented in Maine
• Three systems used in Maine
• Medical Priority Dispatch
• PowerPhone
• National Emergency Communications Institute
  (NECI)
• January 2009 State Contract Signed for Single
  Statewide EMD Protocol and Training Program.
• Priority Dispatch Inc and the National Academies
  of Emergency Chosen as sole vendor and protocol
  for Maines EMD system
• Training begins on the Medical Priority Dispatch
  System (MPDS)
• July 2010 Deadline for All Maine EMD Centers to
  Transition to the MPDS

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Principles of Priority Dispatch

• Send the right response
• At the right time
• In the right mode
• Provides appropriate response to the call
• Provides risk management limiting hot responses
  to only those where time will make a difference
  in the outcome.

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Why Prioritize Response
EMS Misconception Its always better
to send more units and more personnel.
While its true that sufficient emergency
medical assistance must be dispatched, a standard
policy of sending the cavalry on every call is
unjustifiably dangerous and legally
indefensible. Richard Lazar, Esq., 1989
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Misconceptions of EMD
Misconception Its dangerous not to respond
with lights and-siren!
What is the purpose of running with
lights-and-siren?
Average time saved with lights-and-siren
Greenville, NC 43.5 seconds St. Petersburg, FL
33.0 seconds
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Misconceptions of EMD
Misconception Dispatch Centers will be
telling EMS how to Respond!
EMD Centers will provide EMS Providers with a
Determinant Code that describes the type of
illness or injury and the seriousness based upon
the Case Entry and Key Questions asked by the
Dispatcher
EMS System Providers and Planners will determine
response and response mode, not EMD Centers
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Principles of Priority Dispatch

• 4 priority symptoms
• Chest pain
• Difficulty breathing
• Change in mental status
• Serious hemorrhage

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Determinant Descriptors
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Determinant Coding Example
Formula
Chief Complaint Protocol number
Determinant level
Determinant Descriptor number
Suffix (if applicable)
Determinant Code
27
-D
-4
-S
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The Future of Priority Responsein Maine

• Before Priority Response Becomes a Reality in
  Maine
• Transition training to the MPDS for all Maine
  Emergency Medical Dispatchers
• Implementation of a Quality Assurance Program to
  ensure compliance with the EMD Protocol
• Preplanning by EMS agencies, providers,
  administrators and physicians to determine what
  type of response will be sent based upon the
  Determinant Code determined through the EMD
  process.

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For More Information About EMD

• Drexell White, EMD Coordinator
• Maine Emergency Medical Services
• 207-626-3864
• drexell.r.white_at_maine.gov
• www.maine.gov/dps/ems

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• Chapter 19 Rules of the Road
• 2054 Emergency Auxiliary Lights sirens
  privileges
• 1. Definitions
• Authorized Emergency Vehicle means any of the
  following vehicles
• An ambulance
• An emergency medical service vehicle
• A fire department vehicle

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• A hazardous material response vehicle, including
  a vehicle designed to respond to a weapon of mass
  destruction
• A vehicle operated by a chief of police, a
  sheriff or a deputy sheriff when authorized by
  the sheriff
• A vehicle operated by a municipal fire inspector,
  a municipal fire chief, an assistant or deputy
  chief or a town forest fire warden
• A vehicle operated by a municipal rescue chief,
  deputy chief, or assistant chief.
• "Emergency Light" means an auxiliary light
  displayed and used on an authorized vehicle to
  distinguish it and make it recognizable as an
  authorized emergency vehicle.
• "Emergency Medical Service Vehicle" means a
  vehicle equipped and used to transport emergency
  medical personnel or equipment to ill or injured
  persons and authorized by Maine Emergency Medical
  Services.

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• 2. Authorized lights are governed as follows
• A. Only an ambulance an emergency medical
  service vehicle...may be equipped with a device
  that provides for the alternate flashing of the
  vehicle's headlights.
• B. Only a police vehicle may be equipped with a
  device that provides for alternate flashing of
  the vehicle's brake or rear directional lights
  and back up lights or strobe lights behind the
  rear brake lenses.
• C. The use of amber lights on vehicles is
  governed by the following.
• (1) A vehicle engaged in ...emergency rescue
  operations ... public safety agenciesmay be
  equipped with auxiliary lights that emit an amber
  light.

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• 2. Authorized lights are governed as follows
• (2) Emergency lights used on an ambulance, an
  emergency medical service vehicle, a fire
  department vehicle or a hazardous material
  response vehicle may include one blue light
  mounted facing toward the rear of the vehicle so
  that the light is primarily visible to
  approaching traffic from the rear only.

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• F. Only vehicles listed in this paragraph...may
  be equipped with, display or use a red auxiliary
  or emergency light.
• (1) Emergency lights used on an ambulance, an
  emergency medical service vehicle, a fire
  department vehicle, a fire vehicle, a rescue
  vehicle or a hazardous material response vehicle
  must emit a red light or a combination of red and
  white light.

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• (2) The municipal officers or a municipal
  official designated by the municipal officers,
  with the approval of the fire chief, may
  authorize an active member of a municipal or
  volunteer fire department to use one red or
  combination red and white flashing auxiliary
  light mounted as near as practicable above the
  front registration plate on the front of the
  vehicle, behind the rearview mirror OR on the
  dashboard OR 2 flashing red OR combination red
  and white auxiliary lights mounted on the front
  of the vehicle above the front bumper and below
  the hood

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• (2) CONTINUED
• The light or lights may be displayed but may be
  used only while the member is en route to or at
  the scene of a fire or other emergency. A light
  mounted on the dashboard or behind the rearview
  mirror must be shielded so that the emitted light
  does not interfere with the operator's vision.
  The use of lights may be revoked at any time by
  the fire chief.

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• (3) Members of an emergency medical service
  licensed by Maine Emergency Medical Services may
  display and use on a vehicle red or red and white
  combination flashing auxiliary lights of the same
  proportion, in the same location and under the
  same conditions as those permitted municipal and
  volunteer firefighters, when authorized by the
  chief official of the emergency medical service.
  The use of lights may be revoked at any time by
  the chief official of the emergency medical
  service.

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• G. A vehicle may equipped with a spotlight.
  Only spotlights on authorized emergency vehicles,
  highway maintenance vehicles and public utility
  vehicles may be used on a public way, except any
  vehicle may use a spotlight in cases of necessity
  when other lights required by law fail to operate.

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• 3. Sirens A bell or siren may not be installed
  or used on any vehicle, except an authorized
  emergency vehicle.

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• 4. Right-of-way. An authorized emergency vehicle
  operated in response to, but not returning from,
  a call or fire alarm or operated in pursuit of an
  actual or suspected violator of the law has the
  right-of-way when emitting a visual signal using
  an emergency light and an audible signal using a
  bell or siren. On the approach of any such
  vehicle, the operator of every other vehicle
  shall immediately draw that vehicle as near as
  practicable to the right-hand curb, parallel to
  the curb and clear of any intersection and bring
  it to a standstill until the authorized emergency
  vehicle has passed.

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• 4-A. Registered owners liability for vehicle
  failing to yield right-of-way.
• A. The operator of an authorized emergency
  vehicle who observes a violation of subsection 4
  may report the violation to a law enforcement
  officer...The officer shall initiate an
  investigation of the reported violation and, if
  possible, contact the registered owner of the
  motor vehicle involved and request that the
  registered owner supply information identifying
  the operator of the registered owner's motor
  vehicle.
• B. The investigating officer may cause the
  registered owner of the vehicle to be served with
  a summons for a violation of this subsection.

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• 5. Exercise of privileges. The operator of an
  authorized emergency vehicle when responding to,
  but not upon returning from, an emergency call or
  fire alarm or when in pursuit of an actual or
  suspected violator of the law may exercise the
  privileges set forth in this subsection. The
  operator of an authorized vehicle may
• A. Park or stand, not withstanding the
  provisions of this chapter
• B. Proceed past a red signal, stop signal or stop
  sign, but only after slowing down as necessary
  for safe operation

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• C. Exceed the maximum speed limits as long as
  life or property is not endangered, except that
  capital security officers and employees of the
  Department of Corrections may not exercise this
  privilege
• D. Disregard regulations governing direction
  of movement or turning in specified directions
  and
• E. Proceed with caution past a stopped school
  bus that has red lights flashing only
• (1) After coming to a complete stop and
• (2) When signaled by the school bus operator
  to proceed.

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• 6. Emergency lights and audible signals. The
  operator of an authorized emergency vehicle who
  is exercising the privileges granted under
  subsection 5 shall use an emergency light
  authorized by subsection 2. The operator of an
  authorized emergency vehicle who is exercising
  the privileges granted under subsection 5,
  paragraphs B, C, D, and E shall sound a bell or
  siren when reasonably necessary to warn
  pedestrians and other operators of the emergency
  vehicle's approach.

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• 7. Duty to drive with due regard for safety.
  Subsections 4, 5, and 6 do not relieve the
  operator of an authorized emergency vehicle from
  the duty to drive with due regard for the safety
  of all persons, nor do these subsections protect
  the operator from the consequences of the
  operator's reckless disregard for the safety of
  others.

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• 9. Stationary vehicles. The operator of a
  vehicle passing a stationary authorized emergency
  vehicle using an emergency light or a stationary
  wrecker using its authorized lights, with due
  regard to the safety and traffic conditions,
  shall
• A. Pass in a lane not adjacent to that of the
  authorized emergency vehicle or wrecker, if
  possible or
• B. If passing in a nonadjacent lane is impossible
  or unsafe, pass the emergency vehicle or wrecker
  at a careful and prudent speed reasonable for
  passing the authorized emergency vehicle or
  wrecker safely

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• 2065. Driving over fire hose An operator of a
  motor vehicle may not drive over an unprotected
  hose of a fire department laid down on a way for
  a fire alarm without the consent of the police or
  fire department official in command.

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• 2066. Following too closely
• 1. Prohibition. An operator of a vehicle may
  not follow another vehicle more closely than is
  reasonable and prudent, having due regard for the
  speed of the vehicles, the traffic, and of the
  way.
• 2. Trucks. A truck operator when traveling
  outside of a business district or residential
  district, may not follow within 150' of another
  truck. This subsection does not prohibit one
  truck overtaking or passing another.

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• 5. Following fire apparatus. An operator may
  not follow within 500 feet of fire apparatus
  traveling in response to a fire alarm.
• 2067. Lights
• 3. Parking. Unless a municipal ordinance
  specifically provides otherwise, a vehicle may
  not be parked on or beside the left-hand side of
  a way during the times when lighted lamps are
  required in a manner that its lights project in
  the direction of oncoming traffic.

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• 2078. Emergency Rule
• For public safety or convenience, during a fire,
  accident, emergency, or special event, a law
  enforcement officer may temporarily close a way
  to vehicular traffic or to vehicles of a certain
  description, or divert pedestrian or vehicular
  traffic.
• An operator commits a Class E crime if that
  operator refuses to follow the directions for the
  movement of vehicles on request or signal of a
  law enforcement officer.

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• 2091. Control of vehicular traffic at emergency
  scenes
• 1. Definition. For the purpose of this section,
  public safety traffic flagger means a municipal
  firefighter, a volunteer firefighter, or a member
  of an emergency medical service licensed by the
  Department of Public Safety, Maine Emergency
  Medical Services who is trained in accordance
  with subsection 2 and authorized by the chief
  official of the fire department or emergency
  medical service to control vehicular traffic.

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• 2. Training. All public safety traffic flaggers
  must receive training approved by the Department
  of Labor, Bureau of Labor Standards in
  controlling traffic on public ways. Training may
  consist of video instruction, instruction in a
  classroom setting, distribution of informational
  handbooks or other educational materials or other
  training activities
• http//www.maine.gov/labor/workplace_safety/traffi
  ccontrol.html

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• 3. Authority. Not withstanding any other
  provision of this Title, a public safety traffic
  flagger shall wear a reflective traffic vest or
  protective clothing as defined by Title 26,
  section 2103, subsection 3 and has the authority
  to control vehicular traffic on a public way at
  or to reroute vehicular traffic around a public
  safety emergency, including a medical emergency,
  motor vehicle accident, fire, hazardous materials
  incident, or other natural or man-made disaster
  or a training operation, unless otherwise
  directed by a law enforcement officer.

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Legal Aspects of Ambulance Operations - Maine
Title 29-A

• 4. Obeying public safety traffic flagger. An
  operator of a motor vehicle on a public way shall
  obey a request or signal of a person who is
  reasonably identifiable as a public safety
  traffic flagger. A violation of this subsection
  is a traffic infraction.
• 5. Register owners liability.

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Fatal Crash Scenarios
84
Fatal Crash Scenarios

• WHY??
• Sunny Day
• Dry Pavement
• Noon to 6pm
• 65 of Ambulance crashes result in SEVERE damage

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Emergency Vehicle Crashes

• Ambulances are "prone" to crashes
• Vehicles are relatively unstable as compared to
  passenger cars.
• Drivers are frequently inexperienced in driving
  vehicles of this size, and in emergency
  conditions.
• Ambulances are on the road in all weather
  conditions.

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Crash ScenariosAmbulance

• May 2001
• 2 Lane Roadway Straight
• BLS Transfer
• 83yo Patient Lap Belt and Leg Belt Only
• EMT on Squad Bench Unbelted
• Paramedic Driver Unbelted
• Speed 55mph

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Crash ScenariosPickup Truck

• Weather Sunny
• Speed 70MPH
• Drifts Left of Center
• Paramedic attempts to miss accident

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Crash Scenarios
89
Crash Scenarios
90
Crash Scenarios
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(No Transcript)
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Crash Scenarios

• 26 yo EMT dies of blunt head and chest trauma
• 83 yo patient dies of trauma (Ejected from cot)
• 37 yo Paramedic hospitalized with serious injuries

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Crash Scenarios

• Factors
• Driver was unbelted (Against Company Regulations)
• EMT unbelted (in back)
• Patient Belted w/o chest straps
• Equipment unsecured

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Maine Ambulance Crash - Example

• Factors Leading up to crash
• Role of seatbelts in minimizing injury

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Driver Fatigue
Mdd 46
96
Fatigued Driving

• The driver is the leading cause (85) of traffic
  accidents.
• Our bodies have a circadian rhythm and are
  typically more fatigued from 1500-1700 and from
  2400-0600.
• The cure is a 15-30 minute nap, more than that
  puts us into REM sleep and requires 8 hours to
  recover.
• Some services now send 3 people on long transfers
  so 1 can rest while 1 drives and 1 performs
  patient care.

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YOUR REAR VIEW (INSIDE) MIRROR IS NOT ENOUGH
what you see with rear view mirror only
gives you good information about the traffic
behind you
BUT
you cannot see traffic on your left and right
until it gets very close
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NORMAL SIDE MIRROR POSITION -(YOU CAN SEE THE
SIDE OF YOUR CAR)
using your side mirrors plus rear view mirror
CLEAR VIEW
the blind zones are smaller
AND
other traffic stays in your view for longer
99
NEW SIDE MIRROR POSITIONYOU LOOK ALONG THE ROAD,
NOT THE SIDE OF YOUR CAR
Turn your mirrors out - make sure you see the
road, not the side of your car.
CLEAR VIEW
You get only 4 small blind zones.
clear view
clear view
You can see other traffic sooner and for longer!
100
Important Physical Forces and Ambulance Control

• Terminology
• 1. Velocity The speed with which you are
  traveling. The greater the velocity, the longer
  it takes to decrease the velocity. Also, the
  greater the velocity the harder and less safe it
  is to change from going in a straight line.
• 2. Centrifugal force Force that tends to expel
  things outward from a center of rotation. In a
  corner centrifugal force tries to force you out
  of a corner into a straight line. Generally, the
  greater your speed the more your centrifugal
  force.

101
Important Physical Forces and Ambulance Control

• Terminology

102
Important Physical Forces and Ambulance Control

• 3. Inertia A body at rest remains at rest and
  a body in motion remains in motion, going in a
  straight line, unless acted upon by an outside
  force. For our purposes, as the coefficient of
  friction decreases, it is harder to stop a body
  that is in motion.
• 4. Friction Resistance to relative motion
  between 2 bodies that are in contact. The less
  friction the easier the motion.

103
Important Physical Forces and Ambulance Control

• Vehicle weight distribution
• A vehicle is designed to have its weight divided
  so that there is a certain percentage of weight
  over the front and rear axles. Generally,
  ambulances do NOT have a good weight
  distribution. Due to their height they raise the
  center of gravity, making them more top heavy and
  apt to "lean" in corners. The following 3 simple
  acts, over which you have some control, have a
  significant effect on the center of gravity and
  weight distribution.

104
Important Physical Forces and Ambulance Control

• 1. Acceleration
• a. Shifts the weight to the rear wheels.
• b. Increases rear wheel traction
• c. Decreases steering control
• d. Increases centrifugal force in a corner.
• 2. Deceleration
• a. Shifts the weight to the front wheels
• b. Decreases the rear wheel traction
• c. Increases steering control
• d. With increased force of braking will decrease
  steering control due to brake lockup
• 3. Turning
• a. Shifts the weight to the side
• b. Increases centrifugal force

105
Important Physical Forces and Ambulance Control

• Stopping distances
• 1. Ambulances take longer to stop than private
  cars, and stopping distances increase with
  increased weight (people), speed, and brake fade.
• AMBULANCE EXTRA FEET NEEDED BEYOND
• SPEED CAR STOPPING DISTANCE
• 20 mph 5 feet more than passenger car
• 30 mph 12 feet more than passenger car
• 40 mph 20 feet more than passenger car
• 50 mph 37 feet more than passenger car
• 60 mph 60 feet more than passenger car

106
Important Physical Forces and Ambulance Control

• 2. An ambulance going 40 mph needs 69 feet
  further to stop than one going 30 mph. An
  ambulance going 50 mph needs 111 feet further to
  stop than one going 40 mph. An ambulance going
  60 mph needs 146 feet further to stop than one
  going 50 mph.
• a. On a 6 mile run going 60 mph saves 1 min. 12
  seconds over going 50 mph, but it takes an extra
  146 feet to stop the ambulance.

107
Defensive Driving Techniques

• SIPDE
• Scan
• Identify
• Predict
• Decide
• Execute

108
Defensive Driving Techniques

• Four second following rule
• When the rear bumper of the vehicle in front of
  you passes a stationary object count 1000 and 1,
  1000 and 2, 1000 and 3, 1000 and 4 before your
  front bumper reaches the same object.
• Good at any speed 1-100mph
• More reliable than methods using car lengths.

109
Defensive Driving Techniques

• Crash Prevention Formula
• 1. Recognize the hazard
• 2. Understand the defense
• 3. Act in time

110
Defensive Driving Techniques

• Identify situations that may require evasive
  action
• Crash with the vehicle ahead
• a. Watch for signs that indicate a drivers
  intentions
• b. Don't believe the signs you see!
• c. Make visual contact with the driver ahead
• d. Use extreme caution with a vehicle that sees
  you, pulls right, but maintains his speed 1/2
  off the roadway

111
Defensive Driving Techniques

• e. Watch farther ahead than just 1 vehicle
• f. Maintain the 4 second interval between you
  and the vehicle ahead until you are SURE you are
  seen and the driver is reacting appropriately
• Closing in on a vehicle which suddenly hears you
  and panic brakes is an avoidable crash.
• g. When you see a hazard developing ahead, slow
  down cover your brake
• h. Watch out for a vehicle that slows down but
  does not stop is approaching the turn you need.

112
Defensive Driving Techniques

• Crash with the vehicle behind. "A motorist who
  tailgates is asking for trouble, one who
  tailgates an ambulance is inviting disaster.
• If on a non-emergency response
• Slow down and pull right
• Increase the distance between your vehicle and
  any vehicles ahead of you
• If on an emergency response
• Use proper directional signals
• Brake slowly smoothly
• Keep the driver behind you aware of your
  intentions.

113
Defensive Driving Techniques

• Family members tailgating the ambulance to the
  hospital
• Talk with the family before leaving the
  residence.
• If you request a local police department stop a
  tailgating family member, they may or may not
  wish to comply.

114
Defensive Driving Techniques

• Crash with an approaching vehicle the most
  deadly of crashes, even at low speeds.
• If caught in traffic slow down, stay in your own
  lane, let openings develop.
• May occur with an approaching vehicle attempting
  an off road recovery.

115
Defensive Driving Techniques

• In curves, centrifugal force causes the vehicle
  on the inside to drift out.
• Slow down before entering a curve.
• If on the inside of the curve, hug the road edge.
• If on the outside of the curve stay toward the
  middle but be alert for oncoming traffic drifting
  into your lane.

116
Defensive Driving Techniques

• Crash at an intersection 1/2 of all crashes
  are at intersections!! DON'T ASSUME - Make sure
  you are seen.
• Know where you are going, avoid sudden stops and
  turns.
• Slow down and cover your brake.
• Watch for other emergency vehicles, they may be
  going to unrelated calls.

117
Defensive Driving Techniques

• Scan the street as you approach the intersection.
• Mentally note pedestrians, children, bikes, etc.
• Learn two words to tell your partner
• "CLEAR"
• "TRAFFIC"
• Look 1st left (1st danger), then right, then left
  again.

118
Defensive Driving Techniques

• Crash with the vehicle being passed
• You and a vehicle approaching from 1/2 mile away
  are both traveling at 55 mph, you will meet in 15
  seconds.
• If you are passing a vehicle going 40mph, and you
  are going 60 mph, you will need 17 seconds to
  safely pass. (1500', 1/4 mile)
• Be sure there is space ahead to reenter your
  lane.
• Always signal your intentions.
• Pull back into your lane as soon as safe.
• Before passing, get a "running start" to spend as
  little time in the left lane as possible.

119
Defensive Driving Techniques

• Crash with a passing vehicle
• Usually occurs when the ambulance is returning
  from a call.
• A competent defensive driver helps other
  motorists pass.
• If necessary, slow down to allow the other person
  plenty of room to pass and reenter your lane.

120
Defensive Driving Techniques

• Obstruction partially in either lane
• An obstruction in the opposing lane will force
  traffic into your lane.
• An obstruction in your lane will edge you into
  oncoming traffic.
• Best defense - Be ALERT and Slow Down.

121
Defensive Driving Techniques

• Four Steps to avoid a head-on collision
• 1. Read the road ahead
• a. Be alert for the problems we have just
  discussed.
• b. Driving is a full time job, don't get too
  relaxed.
• 2. Ride to the right
• a. When in doubt always hug the right side.
• b. When trouble presents, head right.

122
Defensive Driving Techniques

• 3. Reduce speed
• a. As soon as you see brake lights, swerving
  traffic, or anything to indicate a disturbance in
  traffic flow - reduce speed.
• b. May just remove foot from accelerator, may do
  heavy braking.
• 4. DRIVE off the road.

123
Defensive Driving Techniques

• Six steps to properly drive off the road
• 1. Go to your right (their left)
• a. If they "awaken" they will most always go
  right.
• b. If you can avoid them, don't sound your horn
  cause an inappropriate action.
• c. Going to your right does not put you into
  oncoming traffic.
• 2. DRIVE off the road, don't skid off.
• a. Always keep your vehicle under control as
  long as possible.

124
Defensive Driving Techniques

• 3. Hit something soft.
• a. Large clump of bushes, swamp, water, sand,
  gravel, etc.
• b. AVOID big trees.
• 4. Hit something moving in the same direction as
  you, rather than stationary.
• a. Helps absorb the energy of the crash.
• b. Total speed of the impact is less.

125
Defensive Driving Techniques

• 5. Hit something stationary rather than
  something moving towards you.
• 6. Hit a glancing blow, rather than a head-on.
• a. Better dispersion of energy.
• b. Less total speed.

126
Defensive Driving Techniques

• People to avoid
• 1. Old
• a. Deaf or hard of hearing
• b. Fall or trip easily
• c. Not aware of their surroundings
• 2. Young
• a. Unpredictable
• b. Unaware of dangers
• c. Not knowledgeable of "laws" governing traffic

127
Battle of the Ages
128
Defensive Driving Techniques

• 3. Bicyclists
• Young (or elderly) riders may be unsteady and
  swerving.
• Taught to ride 1 foot inside the outside line.
• Bicyclists must obey the rules of the road,
  including yielding to an emergency vehicle.
• Bicyclists under 16 y/o must wear a helmet.
• Dont use your air horn right behind the
  bicyclist.

129
BICYCLES
130
Defensive Driving Techniques

• 4. Drunk
• a. Staggering, unstable
• b. Unaware of dangers
• c. Unaware of location - sidewalk or middle of
  street
• 5. Any pedestrian at night
• a. Difficult to see anyone not in reflective
  clothing
• b. Difficult to see anyone due to flashing
  emergency lights.

131
Defensive Driving Techniques

• Animals to avoid
• Moose
• a. Moose are tall and heavy enough that there is
  significant risk of serious injury or death from
  striking a moose.
• b. DO NOT swerve to avoid anything smaller than
  a moose, including deer, dogs, skunk, squirrels,
  etc.
• Your risk of a crash, injury, and possible death
  is greater when you swerve to miss any animal
  smaller than a moose.

132
Moose Collisions
133
Aggressive Driving Road Rage

• Aggressive Driving
• Tailgating
• Excessive Lane Changes
• Speeding
• Unsafe Passes

134
Aggressive Driving Road Rage

• Road Rage is the act of violence that accompanies
  individuals who feel they are right and want to
  punish those that have wronged them.
• Increasing 7 each year
• Most commonly used weapon is a gun, knife, or
  fist
• Second most commonly used weapon is the vehicle
  itself.

135
Aggressive Driving Road Rage

• How do you prevent road rage in others?
• Be courteous
• Drive with care
• Do not do things that irritate others
• Excessive use of yelp. Causes the most erratic
  behavior in yourself and others.
• Excessive use of air horns. Can be very
  startling to other drivers.

136
Aggressive Driving Road Rage

• How do you prevent road rage in yourself?
• Allow plenty of time
• Realize that it is not personal
• When responding RLS in an ambulance
• Realize people truly will not hear your siren
  until you are much closer than you realize.
• Most people will try to react appropriately, as
  long as they have not been startled.

137
Aggressive Driving Road Rage

• Why do people get angry?
• They are trying to control the actions of others.
• We can only control our own behavior, not others,
  even when we try to do so through the use of
  emergency lights and sirens.

138
Operations of an Ambulance - Part I

• Types of emergency lighting
• Strobe lights
• a. Powered by an electronic power supply
• b. Strobes are more "attention getting" than