Policies & Procedures Manual Document Title: Ambulance policy

Originating Entity :ACC

Page 1-9 :.Document No
:Date Originated :Date Revised :.Rev. No
:Approved By : Next Revision Date

1-PURPOSE
1.1-To assure that all ambulance transfers between acute care hospitals and other facilities as approved
by the EMS Medical Director are arranged in a manner that maximizes patient safety.
1.2- Requests for ambulance service from all other facilities, e.g., physician's offices, urgent care
centers, clinics (except for those approved by the EMS Medical Director), nursing homes, convalescent
hospitals, or other facilities not equipped or licensed to provide acute inpatient care are considered
either “emergency” or “routine transport” calls rather than inter facility transfers
1.3-The 01 619010 system should be activated by these other (non-acute care) facilities for patients
requiring emergency transport and care.
1.4-Private ambulance service providers should be contacted for routine transport needs.
2-POLICY :
2.1-The transfer equipment must be checked daily and after use by the ER staff on
48M.H & by theatre staff on the 48H site It must be kept fully charged, clean and where relevant, spare
batteries must be available.
Checklist to be completed and date/signed each day.
2.2-The staff carrying out the transfer must ensure that all equipment including plugs and cables
are returned
. Any use of equipment from the emergency bag should be reported so that it can be replaced. They
should also ensure that the equipment is plugged in immediately on return so that charging can start in
readiness for next transfer (especially portable ventilator and monitor).
2.3-As soon as possible:, the relevant staff in the area where the transfer equipment is kept must
ensure that the transfer equipment is cleaned and left in readiness for the next transfer.
2.4-Any department which uses the equipment: for transferring patients around the hospital,
must ensure that the equipment is kept in working order. Any problems or breakages of equipment
during transfer must be reported immediately on return so that appropriate action may be taken.
2.5-All External require: a ‘Preparation of critically ill patient for transfer’ form to be completed
and external transfers require a ‘Final checklist for transfer of critically ill patients to another hospital’
form also (Copies attached to this policy). These forms should then be filed in the patient’s case notes.
Forms can be obtained from A&E.
2.6-CRITICAL CARE AMBULANCE (CCT) with RN or MD staffing .
6.1-For transfer of any patient for whom the sending physician/hospital determines CCT level of care
is appropriate. RN/Physician-staffed CCT units are the appropriate mode for unstable patients requiring
advanced life support level care.
2.6.1-Equipped/staffed to transfer critically ill patients.
2.6.2- Staffing levels, standards, quality activities are NOT regulated or overseen by the County.

3-RESPONSIBILITY
The sending facility is responsible for assuring safe inter facility patient transfer. This means that the
sending facility is responsible for selecting the appropriately staffed ambulance for each patient.
4-SCOPE
4.1-The scopes of practice of EMT-It's, ER staff are limited and regulated by state regulation and local
EMS guidelines and comprehensive listing of scope of practice.
Policies & Procedures Manual Document Title: Ambulance policy
Originating Entity :ACC
Page 1-9 :.Document No
:Date Originated :Date Revised :.Rev. No
:Approved By : Next Revision Date

4.2-SCOPE
EMERGENCY AMBULANCE
SKILL EMT-I SCOPE OF PRACTICE
PARAMEDIC SCOPE OF PRACTICE
(Includes EMT-I scope)

LIFE SUPPORT CPR CPR plus ACLS within scope

Oropharyngeal airway
AIRWAY End tracheal intubation
Nasopharyngeal airway
MANAGEMENT Esophageal/tracheal airway Airway
Suction devices
visualization with laryngoscope and
Oxygen delivery via nasal cannula or simple mask
foreign body removal with forceps
only
Bag-valve-mask

IV FLUIDS AND May monitor peripheral lines containing plain
MANAGEMENT isotonic or glucose solutions with no medications
added.. EMT-I’s are restricted to monitoring,
maintaining present rate, or turning off flow of IV
fluid
MONITORING Cannot provide cardiac monitoring. May monitor NG
and gastrostom y tubes, saline or heparin locks, Foley
catheters or established tracheostomy tubes. Central
venous access lines may be present but no infusions
except if via patient-controlled device. Cannot
transport patients with arterial lines or chest tubes
Administer and adjust rate of glucose or
isotonic balanced saline solutions. May
monitor and adjust IV solutions containing
potassium (20 mEq/L or less).
Continuous ECG monitoring
Chest tube monitoring
Pulse oximetry
IV line monitoring, not including arterial lines

BASIC First aid CPR Defibrillation

PROCEDURES
Obtain vital signs, pupillary status, assess level of Synchronized
consciousness cardioversion Valsalva
maneuver Cardiac
Use stretchers and immobilization devices May
pacing Venous blood
assist patient in use of patient-operated, physician
sample draws Blood
prescribed devices
glucose monitoring

INVASIVE None Needle

PROCEDURES thoracostomy
Needle
cricothyrotomy
Activated Charcoal
MEDICATIONS Glucose paste only Furosemide
Adenosine
Glucagon
Albuterol
Glucose paste
Atropine
Lidocaine
Calcium Chloride
Midazolam
Dextrose (25% or 50%)
Morphine
Diazepam
sulfate
Diphenhydramine
Naloxone
Dopamine
Epinephrine Nitroglycerin
(sublingual)
Sodium
Bicarbonate
 Policies & Procedures Manual Document Title: Ambulance policy
Originating Entity :ACC
Page 1-9 :.Document No
:Date Originated :Date Revised :.Rev. No
:Approved By : Next Revision Date

Scope4 -3
Degree of VEHICLE Ambulance Nursing Medical Other Carer Extra equipment Urgency
illness
Intensive Single cot accident Driver-porter Trained nurse ICU trained Occasionally Advanced 20 minutes but
& or technician critical care doctor of at intensive care Life Support _10 if immediate
emergency experience least specialist technician or kit intervention
ambulance with from registrar level operating Ventilator required in
Stretcher sending or department Monitor receiving area
Siren receiving unit practitioner Syringe
Speed pump
Suction Extra drugs
Critical Oxygen Advanced Life Support Occasional If necessary Advanced 10 minutes
Basic Life practitioner (paramedic or according to for Life Support
Support kit enhanced nurse) with driver- perceived risk safety or to kit
Ill unstable Defibrillator porter or technician. Nurse prevent Monitor 30 minutes
from sending unit if no other distress, Syringe
nurse in team primary carer pump
from own
home, nursing
Basic Life Support home
Ill-stable Often 60 minutes
practitioner (technician or or institution
trained nurse) with driver- monitor
porter. Nurse from sending Occasional
unit if no other nurse in team syringe
pump
Unwell Patient transport First-Aide and other attendant First aid kit 120 minutes
(PTS) vehicle including Driver Oxygen
Pocket
mask
Well PTS vehicle or taxi Driver As available
or car
 Policies & Procedures Manual Document Title: Ambulance policy
Originating Entity :ACC
Page 1-9 :.Document No
:Date Originated :Date Revised :.Rev. No
:Approved By : Next Revision Date

4.4TRANSFER TYPES
4.4.1- EMT-I AMBULANCE TRANSFER
4.4.1.1-For transfer of a stable patient requiring en route care within the EMT-I scope of practice, or for the transfer of any patient
when accompanied by hospital personnel and equipment to provide care beyond the EMT-I scope of practice.
4.4.1.2-Ambulance staffed with two (2) EMT-I's.
4.4.1.3-Care provided includes patient observation and basic life support skills.
4.4.1.4-If patient may require care beyond EMT-I scope of practice, transferring facility must send appropriate personnel supplied
with necessary equipment/medications for transfer.

5-Procedure:
5.1-a. Telephone County-designated emergency ambulance provider dispatch center directly and
request an immediate response ER ambulance for an emergency transfer.
5.2-Prepare to send appropriate personnel and equipment if patient care required enroute is beyond
the scope of practice of ambulance personnel who respond.
5.3-Prepare copies of medical records, x-rays, etc., for transfer.
d. An emergency staff ambulance should not be expected to wait at the hospital for more than 10 minutes while a patient is being
prepared for transport, and after 10 minutes, the crew may contact their dispatch and return to 2217 EMS service. (Patient records
not available within the 10-minute time frame may be faxed to the receiving hospital.
5.4-ERstaff function under EMS Field Treatment Guidelines, and will contact their base hospital if necessary to obtain additional
patient orders.
5.5-Procedure for Obtaining: Contact private ambulance provider offering CCT level service to arrange for transfer:
5.6-Medical Oversight: Transferring physician is responsible.
5.7-Some private ambulance services provide CCT ambulances for transfer. These services are not provided under the auspices of
the County Emergency Medical Services Agency.
5.8-Inter facility Transfer Matrix (attached) outlines the various types and capabilities of ambulances that may be available for
patient transfer.
Note: EMT-It's are generally utilized for routine (scheduled or unscheduled) transfers. In some cases, EMT-I ambulance may
represent the only promptly available level of care based on 2217-system activity.
5.9-Consideration of available modes of transport upon deciding that an emergency transfer is required, consideration of the
transport to be used needs to be made.
5.10-During this period of time the clinicians should think about the many variables to discuss with the Ambulance Service who will
assist in making the final decision. For the most part this will be land ambulance, but occasions where aircraft are required will
present and therefore items for consideration should include:
5.10.1-Patient's condition
5. 10.2-Length of time before the patient will be ready for transfer
5. 10.3-Availability of preferred mode of transport
5. 10.4-Time of day
5. 10.5-Weather conditions
5. 10.6-Estimated arrival time of transport to the patient
5. 10.7-Length of journey
5. 10.8-Ongoing care required during the transfer
5. 10.9-Number of people required during the journey
5. 10.10-Facilities available during the journey
5.10.11-The patient environment during the journey
5. 10.12-Mode of communication with patient:
5. 10, 13-Equipment required for the journey (including consumable)
 Policies & Procedures Manual Document Title: Ambulance policy
Originating Entity :ACC
Page 1-9 :.Document No
:Date Originated :Date Revised :.Rev. No
:Approved By : Next Revision Date

5. 10.14-Refreshment of equipment en-route

5. 10.15-Will the transport need to be refueled en-route
5. 10.16-How will equipment and staff be returned to their base hospital
5. 10.17-Who else needs to be involved,.
5.11-Contact is made with the Ambulance Service Command & Control Centre upon deciding that an emergency transfer is required,
contact should be made with the Ambulance Service Command & Control Centre to discuss the needs of the transfer.
5.12-Where the clinician may be required all areas for consideration will need to be discussed with a Senior Ambulance Control Officer
on duty.
5.13-Upon completion of this discussion, an agreement on the most appropriate mode of transport will be made between the Clinician
and the Senior Ambulance Control Officer.
5.14-Should a failure to agree take place, the Director of Nursing or nominated representative will be asked to arbitrate.
:DOCUMENTATION-7
7.1-Ambulance chick list.
7.2-Patient transfer form.

8-Refrences :
48 Modal Hospital ,
Policies & Procedures Manual Document Title: Ambulance policy
Originating Entity :ACC
Page 1-9 :.Document No
:Date Originated :Date Revised :.Rev. No
:Approved By : Next Revision Date