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AMBULANCE PROTOCOLS

► AMBULANCE TRANSPORTATION : It is described as the critical care transport based on certain standing orders and protocols to be used by AMBULANCE TEAM while transporting the patient from home to health care facility or from hospital to hospital. ► TYPES OF AMBULANCE : ACLS , BCLS. ► GENERAL GUIDELINES : 1) The patient’s history should not be obtained at the expense of the patient’s life; life-threatening emergencies should be treated first. 2) Trauma patients should be transported promptly with C.P.R control of external bleeding, and cervical spine immobilization. Other indicated procedures should be attempted en route. (on the way) 3) In patients with non-life threatening emergencies, who require I.V cannulas, only two attempts of I.V insertions should be tried on the peripheral veins. Try to keep two large bored I.V cannulas in-situ. 4) Patient transport, or other needed treatments should not be delayed for multiple attempts at E.T intubations. 5) Verbally repeat all orders received prior to their initiation. 6) Any patient with a cardiac history, irregular pulse, unstable B.P., dyspnoea, or chest pain should be placed on cardiac monitor. 7) Never hesitate to contact medical control team at the base station for any problem, question, or for any additional information. ► ROUTINE CARE : The following assessment has to be performed and the information to be obtained on all patients. 1) Always assure safety for yourself, your fellow rescuer, and the patient.
2)

PRIMARY SURVEY : A→ Airway with cervical spine control. B→ Breathing C→ Circulation with control of bleeding.

D→ Disability determination : ► A→ Alert and conscious. ► V→ Response to verbal stimuli. ► P→ Response to painful stimuli. ► U→ Un-responsive. 3. SECONDARY SURVEY : ● Obtain vitals signs, and perform objective head to toe assessment. ● Obtain history. ● Sex, Age, Approximate weight. ● Chief complaint. ● Precipitating factors. ● Significant past medical history. ● Allergies. ● Current medication.
4)

Place the monitoring equipment i.e ECG monitor, pulse oxymeter, etc.

5) Apply appropriate SOP based on assessment. 6) Contact medical team as designated in protocol or for any problems or questions. 7) Position the patient in comfortable position. 8) Re-assure and calm the patient. 9) Loosen any restrictive clothing or remove as indicated. 10)Transport as soon as feasible.

THERAPY :
1)

All trauma patients should receive one, and preferably two I.V. R.L; via large bored I.V cannulas. Trauma patients with systolic B.P of < 90 mmHg, should receive I.V fluids fast until the systolic B.P is > 90 mmHg. Trauma patients with systolic B.P < 90 mmHg should receive I.V fluids at a ‘To keep the vein open’ rate.

2) All pediatric peripheral I.Vs should be started with a microburrette administration set. 3) All I.V attempts are to be peripheral.
4)

In children less than 6 years of age with life threatening emergencies, who require immediate I.V medication or fluids – an intraosseous needle can be inserted by a trained doctor.

5) Access of indwelling central lines is permitted only in patients, where peripheral I.V attempts have been unsuccessful and the needs of intended therapy out weights the risks. 6) Each I.V bag should be labeled as follows : ● Time and date of IV start. ● Size of IV cannula used. ● Initials of paramedic who started the IV.