welcome back uh today we're going to talk about chapter 38 and that's transport operations within transport operations we're going to talk about operating a ground ambulance safely we're going to talk about air medical care we're also going to talk about infectious diseases and how we need to decontaminate our equipment and our ambulance after each run so we're ambulances are stocked with standard medical supplies but some of those supplies are really truly state-of-the-art in that they are able to transmit images and data directly to the emergency department directly to the eyes if you will of the physicians we're also have we have this huge emphasis on rapid response uh the faster we get to our patients the faster they get care but in that rapid response we're putting all of our emts and the public in danger so ambulances um the design it's a vehicle for treating and transporting patients okay but do you realize there's actually a national fire protection nfpa national fire protection agency standard for automotive ambulances there's there's an actual standard that they actually have to follow for the design of ambulances with the the modern ambulances we're talking the the kinds that you see every day there's a driver's compartment there's a patient compartment big enough that they actually to have two emts and two patients that can lie supine in the back there's equipment supplies radios phones all kinds of stuff and they are designed for safety efficiency and comfort safety as long as we follow the rules so there's a type 1 that's where it's like a truck cab with an ambulance behind it a type 2 is a van and type 3 that's the typical ambulance that we see most of the time where you have kind of like the van front end and the modular box in the back realizing also that the star of life actually has to be affixed to the ambulance although some places take a little bit of liberty on how they put it some states require special colors there's all kinds of different standards if you will across the country state by state so the type 1 ambulance is a b is the standard van type ambulance you don't see a whole lot of those unless it's a a private transport company and type c is the one that you see most of the time you see that ambulance with a van front end and a box in the back so there's phases for the ambulance call so number one sitting at the station actually you're preparing for the call and how do we prepare for the call well it kind of varies where you are because that preparation can involve classes education physical preparedness up with your body the making sure the ambulance is stocked and ready to go then we have the dispatch and then we go in route to the call we get to the scene we get the patient to the ambulance we get them to the hospital we go back to the station and then post run involves a lot of other aspects as well like restocking the ambulance making sure we're ready for the next call so the preparation again equipment is what we're talking about that we store new equipment only after proper instruction on its use in consulting with the medical director an ambulance just can't say hey i want this piece of equipment they have to make sure that it's okayed by the medical director for you to carry it or if it's a new piece of equipment that nobody's ever seen before we have to make sure it's been okayed again we want to make sure that we store our equipment and supplies according to how urgently and how often they're used so like we speak thinking about the head of your patient laying on the cot we want to make sure that all that equipment that we're going to need to work on the head is near the head if that makes sense cardiac equipment bleeding equipment blood pressure those should be at the side of the ambulance because that's when or the side of the patient because that's going to come in on the side and it's not going to be obstructed by the airway on the head you have cabinets and they should be labeled or they should be transparent so you can see what's stored within there or better yet both right so this one is transparent and it's labeled you should have suction equipment a cpr board all these pieces of equipment are going to be standardized on your ambulances splinting supplies that ob kit that we talked about recently that has to be there an aed the cot itself or the wheeled ambulance stretcher as they call it should be locked and again these have changed over the years so much that they're power cots now they lift and um retract on their own with a push of a button they call this a jump kit or a jump bag or a trauma bag or your first in bag and that's really all the equipment that you need when you go into the house and like it says the everything that you would need within the first five minutes of contact with your patient we're not going to take all the big stuff in with this uh we just don't have the the space for that so we have these compartments on the outside of the ambulance that are that are waterproof and they're going to hold supplies that we don't usually need for patient care it might be personal protective equipment uh some ambulances will have their emts where fire gear if they're at a motor vehicle crash uh this might be the flashlights the the the safety equipment some of the uh operations equipment are navigation equipment computers uh that are gonna navigate us to the call so that we don't have to be looking at maps and such we can actually bring it up on a computer and it's going to tell us how to get to our patient we might even have extrication equipment some ambulances will have their own extrication equipment some will rely on the fire department but in some areas that might be the job of the emts personnel so at least one emt in the patient compartment during transport it would be nice to have two emts especially with bad patients or unstable patients if you will um some services have a non-emt driver like a first responder emergency medical responder and a single emt in the back so again it depends on who you work for depends on where you work how they staff their ambulances so one of the things we do with preparation we always do our daily inspections every ambulance is inspected uh inside and out at the beginning of every shift doesn't matter if you trust your your friend who was on the ship before you or not we do it you have to because you are responsible for everything in that ambulance for your shift we look at the cleanliness we look at the quantity and function of our equipment and supplies some of the other safety precautions that we have to do is we have to review traffic safety rules and regulations every emt has to know traffic safety rules and regulations before they drive that ambulance we need to ensure that we have all of our safety devices are in working order our lights our siren headlights tail lights turn signals so we have a properly secured oxygen tank we usually have a really big one on the outside in the compartment with and it's piped so that we can use that oxygen on the inside of the ambulance but we also have the smaller portable oxygen tank so we want to make sure they're secured and then make sure everything is secured in that ambulance um because of turns and bumps in the road and such we don't want equipment flying around and the dispatch phase again on an ambulance you you are in service 24 hours a day so dispatch is going to notify us and it might be operated by local ems it might be a shared dispatch center it might be the if you work for a private company it might be the company itself and then again they may only serve one jurisdiction or maybe an area might be a regional thing uh it really does kind of depend the dispatcher is going to try to get as much information for you as possible the nature of the call name uh location and call back number in case they get hung up or we lose the contact with them where the patient is located which could be different than where they're located a number of patients see they're getting a lot of your patient information before you even get there anything else that's pertinent you know because even still sometimes we get dispatched to like a ground level fault somebody tripped and felt and we get there and we end up with the person in cardiac arrest uh dispatch is trying to gather as much information as possible going to the scene again this is where the danger part comes in motor vehicle crashes that's what we're talking about running lights and sirens you know you think everybody can hear you and see you but in in reality they don't care most don't really care most don't even pull over for you anymore even though it's a state law but again make sure you're wearing your seat belt anytime you're in a moving ambulance you should be seat belted in even in the back you're gonna you and your partner are gonna review dispatch information and you're gonna make a plan and that plan is hey partner uh we've got a patient who is experiencing this i'm gonna do this you do that and you kind of work out this battle plan if you will in route to the call so you get to the call and what you're doing is as you're arriving to the call you're looking for hazards you don't just look at the scene you're looking uh you have to can't have tunnel vision we talked about tunnel vision before you can't have that you need to have a wide view up up your scene as you arrive and you're kind of taking things in as the ambulance pulls up and stops we're looking do we need additional help we're thinking about the mechanism of injury uh you know if it's a motor vehicle crash or a motorcycle crash are we thinking about spinal mobilization in a backboard and the last thing that you need to think about before you step out of that ambulance is making sure that you have standard ppe on you or with you if nobody's ever told you this think about this always always always throw an extra pair of gloves in your pants pocket when you go to work there's going to be times where somebody forgot him a pair of gloves gets torn but you always have to have extra gloves when you go on calls mass casualty incident okay so now we're thinking about how many patients do we have and and who do we have as incident commander at the scene additional resources and again we want to make sure that we have a central person in charge of this scene and we don't have multiple people in charge safe parking there's actually safe parking rules we want to park up about a hundred feet before or past the crash scene don't park alongside it you want to park uphill and upwind of hazmat situations we want to make sure we leave our warning lights and devices on turn the siren off but leave your flashing lights on and again you want to keep a safe distance between any emergency vehicle and what's going on at the scene hopefully uh most of you are going to be taking that tim's or national traffic incident management system class i believe it is if i got the the wording correct there is an entire class that you'll take online that talks about scenes and how to direct traffic around accidents and this is kind of what we're talking about here this this diagram and how to protect the scene and how to protect you as you're working at this motor vehicle collision stay away from fires explosive hazards downed wires anything that's unstable structure wise like house where a car ran into the house we want to make sure we set the parking brake on the ambulance so it doesn't roll away we want to facilitate emergency care and rapid transport from the scene and if it's necessary to block traffic we do it quickly and safely because the longer the traffic is actually blocked the more at risk we are for having additional accidents because of that blocked traffic so we want to clear it as quickly as possible traffic control that's not necessarily our job but we have to think about it until we get help there to take over for us the police officers the the fire department that's who are typically typically going to direct traffic for us uh and and the big thing is we want to get it uh so that we have an orderly traffic flow to again to keep down additional accidents transfer phase now we're gonna package our trans our patient to be transported to the hospital we want to make sure that they're seat belted to that cot so that if the ambulance comes to an abrupt stop they're not going to be thrown off the cod god forbid it gets into a bad record it gets rolled over and we want to make sure our patient is secure in the back and then when you get ready to leave you tell dispatch you know your number of patients what hospital you're going to and sometimes you even tell them the beginning mileage of your ambulance why well if somebody says makes a claim that you drove out of the way and sexually assaulted the patient in the back of the ambulance and they you can kind of prove what my mileage was when i started the transport to the hospital and what it was when i got to the hospital it's kind of a protecting a protection layer in there monitor your patient's condition and we talked about that at nauseum do not abandon the patient emotionally okay what i i've seen this before i've seen emts and paramedics in the back of an ambulance more worried about writing a report than talking to their patient that's that's crazy your time is with that patient you can write the report after you're done delivery so we notify dispatch we get to the hospital we probably tell them the ending mileage you talk to the nurse you physically transfer the patient to the hospital bed you complete a verbal report to the physician or nurse or whoever's taking the report a lot of hospitals will have an area for you to go sit down and do your run report and then it also as you're doing the run report this gives your partner time to restock the ambulance and make sure it's clean before you even leave the hospital because you might be dispatched to another call before you even leave the hospital so you want to make sure you have equipment you want to make sure it's clean and ready for the next patient so going back to the station you tell dispatch you're going back to your station you might even do a bigger deeper clean once you get back to the station maybe there's some supplies you couldn't restock at the hospital so now you can restock them but again your ambulance should always be ready to respond to an emergency post run reports there's even more reports to write sometimes um again you you might want to tell dispatch you're back at your station and you're available for the next call uh routine inspections tires gas oil you want to refuel your vehicle because you might be stuck at a scene and it's your ambulance is left idling for hours you want to make sure you have enough fuel some key terms are cleaning disinfection high level disinfection and sterilization i know for a fact that on emt tests they'll ask you some of these questions about how deep of cleaning this these are we always take off the linens off our stretcher you leave them at the hospital you discard medical waste there and then wash contaminated areas of soap and water disinfect all non-disposable equipment and get it ready for patient care then we clean the stretcher with this germicidal uh varicidal solution or one cup of bleach uh or one to 100 bleach dilution so if i got a cup of bleach to a gallon of water basically we clean spillage or other contaminants with the same solution so not just a stretcher but the floor of your ambulance anywhere that patient could have touched so uh yesterday i marked the three-year anniversary of the death of one of my paramedic students in an ambulance wreck and so i always always think about this and and people think that anybody can drive an ambulance it takes training and education on how to drive an ambulance not everybody can just hop in an ambulance and drive so again you have to be careful when you drive you have to have knowledge and education before you drive an ambulance for the driver of the ambulance you want to make sure that they're physically fit and alert emotionally mature and stable have they had the proper rest huge issues uh in ems is proper rest speed does not save lives good care does uh there's a there's a kind of an old joke that the best cpr is done in an ambulance at 40 miles an hour not 60 miles an hour which is true uh because the the less movement in the back of that ambulance the better cpr you can do make sure you wear your seat belts oh my gosh this is why my student died he wasn't seat belted in and he was thrown out of the ambulance when it rolled his patient survived his patient wasn't even hurt why because they were secured properly thankfully he did that a really good job with that be familiar how the vehicle accelerates corners sways and stops and that comes through practice driving and again stay in the extreme left hand on a multi-lane highway we don't want people cutting over in front of us we want to be in the far left lane sirens hmm so the decision to activate lights and siren are really going to depend on your protocols i think we run lights and sirens too many times and and you may not like my answer to that but that's true we run lights and siren too many times to minor incidents and we put a lot of people at risk now the standard argument is always going to be well we don't know exactly what we're going to 99 of the time you know exactly what you're going to and we don't need to run lights and sirens to someone who has a broken leg but we do we always do patient condition now i understand where we have to run license siren to somebody who's injured very badly or they're have a severe medical case anticipated clinical outcome of the patient is going to dictate whether we have lights and siren so again getting them to the hospital is one thing getting them to the hospital safely is another thing as a driver you have to drive defensively what that means is you have to drive that everybody else is an idiot on the road and they're going to run you off the road or run into you they're going to blow their stop sign they're they're not going to hear your uh siren they're not going to see your lights so again we don't drive like we own the road with lights and sirens everybody wants to drive lights and siren everybody everybody it's still fun absolutely it's fun but you have to drive defensively and carefully with due regard is what most states will require legally that you drove with due regard for the public cushion of safety safe following we want to avoid being tailgated from behind but what that is is that a lot of times is if i'm transporting a patient and the husband or the wife wants to follow the ambulance to the hospital a lot of time they'll they'll be right on your tail and you're running lights and siren and they're not but they're speeding and they're doing everything that you do because they think they need to get to the hospital the the problem is when an ambulance blows through an intersection people think that's it and they pull out and they get hit by this person that's tailgating you blind spots do not prevent you from or we want to make sure that they put we want to make sure that we see in our blind spots if we can you have to be good at using mirrors outside mirrors on an ambulance and i know it for a lot of people that's a learning curve in itself being able to use your mirrors to back up being able to use your mirrors to to see to change lanes you can't look over your shoulder you're going to see your partner in the back of the ambulance you can't look over your shoulder you have to use your mirrors never get out of an ambulance to confront a driver okay that's road rage and the blind spots blind spots blind spots happen all the time excessive speed it's unnecessary dangerous and does not increase your patience chance or survival it does not good patient care does again it's difficult for for me in the back of the ambulance to provide care if you're speeding down the road and you're switching lanes and you're going over railroad tracks and hitting potholes it's really difficult and again if you're going very fast in these ambulances number one you have poor reaction time number two these ambulances don't stop like your car does or your pickup it that just does not happen it's gonna take time for this ambulance to stop siren syndrome so true causes drivers to drive faster when they have the siren on you get jazzed up you get worked up and that siren on and and that feeling with those lights flashing and the next thing you know you're going faster than you should be crashes occur when the vehicle is backing up so what use a spotter and what a spotter is is uh if my partner's driving and we need to back the ambulance up i'll get out and i'll step behind the ambulance and i will direct him back the size and weight influence breaking and stopping obviously you kind of know that already think about defensive driving techniques taking a corner these ambulances don't corner like your car either and so you have to slow down and take the corners at correct speeds if not you're going to roll that ambulance right over on its side weather conditions have a huge effect on your driving your ambulance longer braking time stopping time those of you in the in the winter with snow and ice i come from indiana and wisconsin you have to know how to drive an ambulance on those those wet and icy roads even in florida i never realized how many accidents occur on wet roads until i moved to florida and i'm thinking why it's just wet but in florida people drive like people in wisconsin when it snows uh it's like the first time they've ever driven on snow well it's like the first time they've ever driven on rain-soaked roads you have to be alert you have to be planning for the conditions of the road laws and regulations yep if you are on an emergency call and you're using lights and siren you may be allowed to park or stand in an illegal location proceed through a red light or stop sign drive faster than the speed limit drive against the flow of traffic and travel left of center to make an illegal pass you're never allowed to pass a school bus especially when it's uh unloading patience excuse me unloading children obviously and when we use the light and siren it must be on a true emergency call you can't just run lights or you can't just run siren they have to be used both to be considered an emergency vehicle if you run through a stop sign and you just have your red lights on and no siren you're going to go to jail because you violated the law you have to know what each state's individual rules and regulations are as it pertains to driving safely right away privileges emergency vehicles have the right of right to disregard the rules of the road when responding to an emergency do not endanger people or property and get to know your local right-of-way privileges again state of indiana we have different laws about ambulances than we had in wisconsin i don't know what your laws are going to be wherever you work you need to be made aware of that and that's typically something that is going to be an educational component when you go to work for an agency use of escorts oh my gosh so what we're talking about with escorts is is having the police car drive in front of you to lead you to the hospital to clear the path for you the problem with escorts is this that squad car is going to blast through that that stop sign or that stop light people think okay cop's gone time to pull up and they're going to pull out right in front of your ambulance that's the problem with escorts you may need to use them but again that's one of those things we have to be very cautious of if we're going to use them intersections that's the number one location for motor vehicle collisions with ambulances if you cannot wait for the lights to change come to a brief stop look for pedestrians or other hazards and proceed with caution highways shut down emergency lights and siren when you've reached the far left lane uh i drive interstate 95 every day and i swear to god there's there's no ambulance that'll drive fast enough on that interstate there's there's just no way people drive way faster than ambulances so your lights and sirens aren't going to do you any good unpaved roads again you got to slow down on those dirt and gravel roads school zones it is unlawful to exceed the speed limit in school zones distractions there's a lot of distractions when you're driving an ambulance you've got this radio going you have maybe you have this laptop up with information on your call you might have a gps heck my partner love to jam out on a rock station as we're responding to calls lights and siren their cell phone is dinging heck you're an ems you're probably driving with one hand on the coffee cup uh you know there's so many things that are distracting you and this is why people get in accidents distractions driving alone again it's your responsibility to focus on figuring out the safest route while getting ready for this call again the safest route might not be the shortest route you all know the the times a day that are bad in your city that you live in uh that the workers that are getting out um the different roads where the factories are letting out and you know to avoid those between three o'clock and four o'clock in the afternoon whatever again you need to figure out the safest route maybe there's road construction and you have to find a different route this is why my student was killed the driver was fatigued they had done this was their third four hour transport uh in uh in a 12 hour shift it was their third one they were halfway through their third four hour transport without a break and again you are also responsible for your partner and if you want to make sure excuse me and you want to make sure that that partner that's driving is alert hazard had rest so it's safe for you and your patient if you don't if you don't feel safe that service that i was that these people were working for actually implemented a time out system if you will and if you didn't feel like that you were alert enough to drive you could actually say hey time out i'm not ready send somebody else air medical these are these are some really cool jobs and and 90 of everybody that takes paramedic class says i want to be on a flight uh helicopter a paramedic on a helicopter well there's other uh actual air ambulances that people don't think about like the fixed wing units so like the top one the airplanes those do longer transports uh they're used a lot like in hawaii i have a friend of mine who went to work in hawaii as a as a flight medic but typically when we think about uh flight medics we talk about helicopters again that's probably the biggest thing that we think about they're specially trained yep they're not going to have emts on helicopters they'll have paramedics they'll have nurses and in some places they'll actually have physicians but emts on helicopters are not going to happen because they need that special care that only nurses and paramedics can provide um so why do we call a helicopter well number one because it takes too long to drive them by ambulance number two the the road the traffic environmental conditions prohibit the use of a ground transport i know a paramedic in chicago who said i could see the hospital from my accident scene i could physically see the hospital but there's no way i could get them to the hospital in chicago traffic and so we used helicopters even when we could see the hospital maybe this patient requires advanced care something that you can't provide and again multiple patients with will overwhelm the resources at the hospital reachable by ground maybe we need to take them a little bit further away to another hospital then [Music] who gets the the medivac if you will patients with time-dependent injuries or illness major trauma is really typically what we're talking about the faster you get them to a trauma center the better that their chance of survival is you could have medical conditions like a stroke or a heart attack spinal cord injury as flying them by helicopter might be better for them because they're not bouncing down the road on a backboard in your ambulance they're flying smoothly and softly in a helicopter scuba diving accidents near drowning skiing wilderness maybe that's that's a very remote location trauma obviously candidates for limb replantation burn centers hyperbaric chambers or venomous bite centers you can see where a helicopter is going to make the rapid transport better for these patients so who do you call [Music] well dispatch we tell dispatch we need a helicopter and again they'll communicate with the flight crew after initiating the the helicopter request fire department will typically be responsible for establishing a landing zone i have seen this on the national registry test what is the recommended surface area for establishing a landing zone between 60 and 60 feet and 100 and 100 feet we want to make sure it's clear of loose debris clear of overhead or tall hazards telephone poles lights power lines cell phone towers that's the things that we think about mark the landing zone using cones or vehicles and never use caution tape again or people to mark the site that doesn't work and don't use flares because the helicopter blades and and the downwash from the blades could spread those flares and you start a fire we want to make sure non-essential persons and vehicles are out of the landing zone and then we want to communicate the direction of strong wind with the flight crew that's what the landing zone coordinators job is going to be they're going to be on the radio talking to the helicopter telling them about the landing zone so we want to keep away from the helicopter whenever it's on the ground and hot hot meaning the blades are turning the the big area that kills people all the time is that tail rotor that that blade is spinning at the back of the helicopter it's spinning so fast you can't even see it but you know it's there always always always approach the helicopter from the front at the command of the pilot he'll motion you forward towards the helicopter but you always come from the front that way they can see you the blades do dip a little bit so you always crouch when you're going towards that helicopter if the blades are turning i haven't loaded a patient in a helicopter with the blades turning in 10 or 15 years it's a safety issue they'll shut those blades down they'll shut the helicopter down it's a much safer environment then so you want to have an education on how the helicopter operates in your service area they'll they'll come to your your ambulance station they'll come talk to you put on an education so that you're familiar with their hand signals uh you'll get to meet the flight crews go to the helicopter and have a class and they'll show you the equipment that they carry on the helicopter that's huge and we want to keep anything with a flame away from it uh because of the fuel for safety reasons and if they blow that cigarette out of your hand and it goes into tall grass and it starts a fire eye protection around helicopters is huge because of the dust and debris so we can go through this this chart here if you will but a lot of this is going to be done by the fire department and not us our job at at this scene is patient care our job is not to direct a helicopter that's somebody who doesn't have the medical knowledge that you have night landings number one don't shine your flashlight at the helicopter they wear night vision goggles that blinds them put lanterns on the ground to kind of mark the site for them to land they're going to be wearing night vision goggles so they're going to be able to see a lot of these hazards but we want to point these hazards out to them so they're aware of them you never land on uneven ground because again if they land on uneven ground we're not really sure where those blades are and they may actually be lower than you think so that's a danger area we don't want to approach from going down the hill to the helicopter we want to go up the hill to the helicopter if needed hazmat we want to tell the helicopter if there's a possible hazmat situation because they're not going to put that patient in their helicopter then um landing zones should be uphill and upwind just like an ambulance we park our ambulance uphill and upwind and then decontaminate patients before you put them in the helicopter and they're going to be have to be decontaminated really well think about medevacs and severe weather again they may not fly because the weather's bad you may have to go by ambulance some helicopters are limited to flying below 10 000 feet okay the other thing is they can fly up to 130 150 miles an hour here faster with some of these helicopters so getting them to the right place might take a fraction of the time it would take you to drive there's really depending on the helicopter design the type of helicopter it is there's a lot of and i shouldn't say a lot there's a very little space actually in the back of that ambulance for the crew and the patient so again they can't take more than one patient yeah you look at the helicopters and military uses they'll they'll take multiple patients but that's not in the civilian world these helicopters are extremely expensive the flight compared to your ambulance your ambulance bill might be like you know five or six hundred dollars uh that by using a helicopter uh it's gonna be you know ten thousand dollars maybe so there's a huge cost effect now i realize don't lecture me i realize that there's gonna the better higher level of care the they're going to be taken to the hospital faster i understand all that and it's not about money but realize that it that's going to happen so as a review all the following are examples of standard patient transfer equipment except a stokes basket a long backboard wheeled stair chairs or wheeled ambulance stretcher which one is not a standard patient transfer equipment yep the stokes basket again it's a specialized piece of equipment for moving a patient it's kind of like a basket of wire that you put your patient in that's not standard all the others are standard on your ambulance the stokes basket is typically carried by the fire department primary purpose of the jump kit make sure you have immediate access to the aed available uh all has available all the equipment you need to use in the entire call have easy access to manage patients with severe uncontrolled bleeding have available all the equipment that will be used in the first five minutes i know i said it yep indeed it is d it's that first five minutes everything you're going to need to treat your patient in the first five minutes you have been dispatched to a call for an unresponsive patient what is the most important information that you should obtain from the dispatcher callback number severity of the patient's problem whether the patient is breathing and the exact physical location of the patient this is a good one you've been dispatched for an unresponsive patient what is the most important information dispatcher should tell you d the exact location of your partner we don't care if they're breathing or not it's not going to make a difference but it does make a difference if we go to the wrong place where the patient is and route to a call for a major motor vehicle collision the most important safety precautions that you and your partner can take is are are adhering to standard precautions ensuring the fire department gets there before you use lights and sirens and be aware of other drivers wear seat belts and shoulder harnesses at all times what is the most important safety precaution you can take yes indeed wear your seatbelt uh it's amazing that people still don't wear seat belts which of the following is not a guideline for safe ambulance driving use your always use your siren if you have emergency lights on always exercise due regard for a person and property use one-way streets whenever possible or go with the flow of the traffic what is not a guideline for safe ambulance driving i agree it's c avoiding one-way streets because they can become easily clogged and and you if you you drive down one-way streets all the time and they can be clogged just with normal traffic now we added in our lights and siren and people don't know what to do where to go it's crazy at what speed will the ambulance begin to hydroplane when there is water present on the roadway ah that's a good question 25 30 40 50. what speed can you hydroplane at have you ever hydroplaned then you probably know 30 miles per hour or greater the tires lift off the pavement you get water underneath there and your your car gets squirrely it doesn't stop all kinds of craziness can happen so at 30 you can begin to hydroplane the most common and most and often most serious ambulance crashes occur at or on stop lights intersections highways or stop signs most common and often most serious crashes occur at absolutely intersections people aren't looking you have to drive defensively you have to drive thinking that person is going to run the stop light or stop sign and smash into you and kill you drive defensively anticipate what somebody else is going to do recommended dimensions for a helicopter landing zone good question 50 by 50 75 by 75 hundred by 100 or 150 by 150. i know the in the lecture we talked about a range 100 by 100 grassy day or night that would be the uh appropriate size i know the the presentation said 60 by 60 to 100 by 100 100 by 100 is really truly the the size we want it to be what statement about helicopters is true it's possible that the rotor will dip to within four feet of the ground which is bad for me i'm six foot the helicopter is considered hot when it's on the ground and the rotors are still if the helicopter must land on a grade you should approach it from the uphill side if you must go from one side of the helicopter to the other it's best to duck under the body i'm making a face about that last one yeah it's a again those blades can dip and and again we're certainly not going to walk behind the helicopter that's where that tail rotor is we're not going to duck underneath it we're not going to go behind the helicopter but again typically the helicopters will shut their blades down and make it safe for everybody it only takes a few minutes for it to get turning and taking off again anyway so upon arrival at a scene where hazardous materials are involved you should park the ambulance upwind with the warning lights off downhill or at least 50 feet from the scene you better pick a uphill and up wind uh it says be prepared to quickly move the ambulance if the wind shifts uh you should be taking mental note of which way the wind is blowing so that's ambulance operations