Moving Ambulance Scope of Service

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pdc

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Hello,

This is my first post to your fine forum. I hope I am not violating any rules of forum etiquette with this post. I am not an EMT. I am graduate mechanical engineering student working on a PhD dissertation focusing on the remediation of shocks and vibrations in ambulances. It is one of my suspicions that a variety of medical procedures carried out in moving ambulances could be made more effective if the vibrations and shocks from road bumps, etc. could be lessened. It seems it may be possible that some proceedures currently NOT carried out in a moving ambulance may become possible if vibrations were lessened. In general, it is my thesis that the standard of care delivered in a moving ambulance could be improved if there wasn't so much bouncing around going on! I am basing my research on a Type III ambulance built on a Ford E450 chassis with a 168" length and 72" interior headroom.

But, like I said, I am not an EMT, so I need some experts to help me out.
I could not find a scope of service anywhere which defined what kind of procedures were indicated or contraindicated for performance in a moving ambulance.

I found a list of ALS procedures and include it here for reference (I realize scope of services for the various levels of EMTs, Paramedics, etc. vary by state). Perhaps you folks would be kind enough to let me know what kind of procedures are commonly performed in moving ambulances, of those, which could be made more effective if you didn't have to worry about vibrations and bumps, and what, if any, procedures you don't perform in a moving ambulance, you might be able to if the ride was smoother. Any comments along the lines of: "evaluating breath or heart sounds would be easier if the vibrations weren't so bad." would be appreciated as well.

Monitoring of Vital Signs
Application of Tourniquet
Administration of Endotracheal Medications
Administration of Medication via A PVAD
Amputation Management
Combitube
Defibrillation
Endotracheal Intubation: Adult
Feeding Tube Insertion
Intravenous Access: Adult or Pediatric
Jugular Vein Cannulation-External
End-Tidal CO2 Monitoring / Capnography
Needle Thoracostomy
Pulse Oximetry
Saline Lock
Serum Glucose Level Determination
Spinal Immobilization
Synchronized Cardioversion
Valsalva’s Maneuver
Electrodardiography application of leads and monitoring

Thanks in advance for any help you may be able to provide. I am located in Massachusetts. You may contact me directly at **email address removed** if you would like.

Best,

pdc
 
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W/o vibrations 12 lead, 15 lead, 3 lead etc EKG's would be more accurate. With out vibration and noise blood pressure would be more accurate. W/o vibrations starting IV's would be safer. W/o vibration and noise lung and heart sounds would be more accurate. That is just a start.
 
W/o vibration ETT / advanced airways would be a ton safer.
 
Thanks Linuss and Medic. Keep 'em coming.

Paul
 
I could not find a scope of service anywhere which defined what kind of procedures were indicated or contraindicated for performance in a moving ambulance.
Click to expand...

You can't find it because it doesn't exist. Scopes of practice are based on the provider's level, not whether the provider is inside or outside of the ambulance. The simple fact is, everything would be easier and more accurate if the ambulance ride was smoother, including assessment, assessment tools (ECG, pulse ox, d-sticks, etc) and treatments. Furthermore, it would be much more comfortable for patients, especially when they are suffering from a skeletal injury or in spinal restriction.
 
Manufacturers of devices such as Pulse Oximetry, ETCO2 and EKG recording/monitoring have taken into consideration the different environments their equipment will be used in such as flight and ground ambulance.

The manual skills will depend on other factors including the skill level and experience of the provider. As well, the ability of the driver to maintain a safe moving vehicle will be a factor.
 
We can and often perform any or all procedures in the back of a moving ambulance...we have various reasons for getting what we can prior to transport and your vibrations is a big reason...12-lead ECG's are usually done stationary, but with the engine running. Stationary with the engine running causes its own issues...

Generally with experience we learn how work around or with these vibrations or bumps or sometimes craters in the road...

With out vibrations everything we do would be safer with better results...not saying we don't have good/appropriate results now. But as other have said, IV starts, ECG's, etc. would benefit from less vibrations, but until we can get the ambulances to float instead of drive on the roads, the roads will be bumpy.

I am in the northeast...New England now, but was in Buffalo...I have been on some terrible streets...
 
12 LEad would be sooooo much more accurate


Placing IV's

Inserting NAsal Canulas

Pushing Meds
 
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