POLICY AND PROCEDURE ON AMBULANCE SERVICES

 

                            POLICY AND PROCEDURE ON AMBULANCE SERVICES

Purpose:

To provide appropriate means for the transporting of patients who must be sent to other         designated areas for special tests, procedures or advanced care.

·            The ambulance services available with the hospital are to be commensurate with the scope of services offered at all times. The ambulances shall comprise general ambulance and ambulance with basic life support facility and shall be deployed according to the patient’s condition.

·            The access, entrance and exits to and from the emergency service department shall be kept unobstructed to facilitate easy and smooth movement of ambulance vehicles.

·            Ambulance vehicles which are not engaged in patient related duties are to be kept in the designated parking areas under the control of Security Incharge who will authorize necessary movement.

·            The ambulance bay of the emergency department shall be kept unobstructed at all times to facilitate easy movement of ambulance while handling emergencies.

·            The ambulance is to be equipped appropriately and the equipment is to be checked for serviceability and readiness with each shift and record maintained to that effect. The check shall include that of emergency medications also.

·            The personnel manning the ambulance shall comprise a team of medical, nursing, technical / paramedical, driver, and ward boy. The team members shall be deployed as per the circumstances faced in transporting patient, on the instructions of the casualty medical officer.

·            All the ambulance team members shall be deployed in shifts and the duty roster shall be intimated in advance.

·            All the ambulance team members shall be trained in advanced life support and / or basic life support and handling of emergencies as per their responsibilities. They shall receive periodic refresher and competency training.

·            All ambulance vehicles shall carry a cell phone / suitable wireless communication device for       communication with the base casualty station. The communication device is to be checked      for serviceability with each shift.

 

v Procedure:

 

A.                 The treating physician shall be responsible for:

1. Writing an order for transportation
2. Designating what portion of patient’s medical record / clinical information is to be sent with the patient.
3. Scheduling the test or procedure to be performed
4. Ordering IV to be changed to IV lock prior to transfer
5. Medical / nursing / Paramedical / Attendant to accompany the patient

 

B.                 Nursing staff will be responsible for:

1.        Making the necessary arrangements for transportation as follows

a.       Identification information and ordering physician, location (unit, room and bed number) Name of facility and department to which patient is to be transported

b.      Test or procedure to be performed

c.       Date and time for scheduled test or procedure and

d.      Mode of transport – wheelchair / stretcher / ambulance / special requirements if any.

2.        Notifying the concerned personnel where necessary

3.        Patient shall be identified as per procedure for patient identification prior to transfer

 

C.     Emergency department will be responsible for making the arrangements for external transportation from casualty.

Objective: The ambulance service provides the first point of access to health care for a wide variety of patient conditions, ranging from life-threatening emergencies to chronic illness and social care. An ambulance, being designed as a vehicle equipped for carrying the sick or wounded and being used as an extension service of the hospital

Purpose: To establish a standard for Emergency Medical Transportation Service response vehicle emergency operations

Policy: It is the policy of the hospital  that the ambulance is maintained properly and be used with specific rules for the benefit of the patients and the hospital personnel involved in the transport.

 

ATTACHMENT:

 

a.                               Request for ambulance use (ambulance slip/receipt) (2 copies)

One to be given to the relative and second one brought back by the driver for hospital records

2. A permit form – for employees request to use the ambulance in permitted states
3. Inventory form (logbook) for drugs and medicines, supplies and equipment
4. Logbook for outside calls containing the following data: name of patient, destination, time of dispatch of ambulance, time of return of ambulance and trip costing

 

                        TIMINGS- Available 24hrs, all weekday\

 

v  PROCEDURES

 

Types of Responses

 

Ø  Non-emergency Operations - anytime an EMS response vehicle is out of the station on an assignment other than an emergency run shall be considered to be a non-emergency operation.

Ø  Emergency Operations- shall be limited to any response to a scene, which is perceived to be a true emergency situation. True emergencies are defined by a response to any situation in which there is a high probability of death or life threatening illness or injury.

v  TRANSPORTATION

• Transport of In-Patients

Ø   Every use of the hospital ambulance should be supported with duly accomplished receipts.

Ø  An ambulance slip/receipt will be prepared in 2 copies, the ambulance driver on duty will keep one and the other copy will be given to the patient’s relatives.

v  ER PATIENT TRANSFER

Ø             The anesthetist or scheduled consulting physician will accompany critical patients who are transferred for diagnostic examination outside the hospital. In such cases, the ambulance can be availed for free of cost.

Ø             The ambulatory ER patient if desires to be shifted to another hospital can avail the ambulance facility, but has to pay in full for the same.

Ø             Every use of the hospital ambulance carrying a patient should be equipped with necessary facilities.

v    Outside Call

Ø  In any ambulance call, the ER medical transcriptionist must take down the name of the caller, reason for calling, place and address of the patient. Also the patient’s current state is inquired to know whether to consider the call as routine call or emergency call.

Ø   The caller must be informed about the charges after accessing or asking his requirement. After confirmation only the call must be responded.

Ø  The patient’s consulting doctor or family physician or any other specific doctor that the patient wants to consult, his name & contact number should be taken down & he must be informed.

Ø  During the request for the use of ambulance, the ER nurse together with the scheduled ER anaesthetist / physician will answer the ambulance call. An attendant will accompany to assist the medicos.

Ø  The HOD will be consulted for any decision making related to the staffing of the hospital during ambulance call.

v    Ambulance regular team composition for outside call:

1.      For seriously ill patient in ICU on Wheels – one physician, one nurse, one attendant, one driver

2.      For less seriously ill patient in ambulance – one nurse, one attendant & one driver

3.      For routine call in one ambulance - one attendant & one driver

4.      For a call at distance more than 250kms in ICU on Wheels & ambulance – one attendant, Two Drivers & medico staff as per requirement & patient condition.

5.      Schedule of ambulance physician and nurse shall be available at time (to be plotted by ER head)

• Ambulance call must be answered within 5 minutes

·         Nurse Administrator on duty will take charge in the area/ward if nurse on duty answers ambulance call

v    Use of Ambulance for transfer of patient

·                                             Order for transfer of patient by the attending physician/ sister in charge

·         Coordinate with the receiving hospital, if it is a transfer to other hospital, attending physician or medical officer must call to synchronize the transfer.

·         Filling out request for ambulance by Sr Nurse

·         If patient is to be transferred to other hospital, he must be informed about the charges.

·         When the destination is reached the driver must take the sign of the patient’s relative accompanying him on the trip on the ambulance trip receipts

·         Notify the ER registration counter upon arrival of the ambulance - driver

v    UNAVAILABILITY OF AMBULANCE

In situations where both ICU on wheels & the ambulance have gone to attend calls & new calls are received then the ER medical transcriptionist who attends the call should redirect the call to any other agency who provides the service with which the hospital shares its goodwill i.e. Nilgiri Agency, Shivam Agency- see the contact details in Department- Emergency.

 

 

v    AMBULANCE CHARGES

·         Emergency pick up is free from home or hospital or any other site within 20kms radius or AUDA limits, this does not include the staff, instrument or oxygen charges.

·                                 ICU on Wheels

            The charges includes ambulance + oxygen + monitor + ventilator + doctor’s fee + nurse’s fee + cost         of medicine used during the trip (attached)

·                                 Ambulance

The charges includes ambulance + oxygen + nurse’s fee +cost of medicine used + charges of any other optional service availed (instrument / nurse/ doctor) during the trip. (Attached)

·         For the ambulance or ICU on wheels going for a pick up or dropping the patient beyond city limits will be charged according to the distance to & fro covered.

v    BASIC EQUIPMENT REQUIRED IN THE AMBULANCE

a.       Stethoscope

b.      Sphygmomanometer

c.       Emergency drugs and supplies

d.      Flashlight

e.       Portable oxygen tank with regulator

f.       Wheel type stretcher with straps

g.       Cervical collar (adult/pediatric)

h.      Resuscitator bags

 

v    AMBULANCE EQUIPMENT

Sister Incharge of ER must periodically inspect & check the stock of ambulance equipments, medicine & oxygen.

 

Stock of Equipments & medicines should be as follows:

 

a)                              Equipment for multiple uses

·         Airway, three sizes for adults 6 pcs

·         Pocket mask for artificial breathing 1 pc

·         Thermometer 1 pc

·         A pair of scissors, large 1 pc

·         Stretchers, collapsible 1 pc

·         Crammer’s splints, for lower limbs 2 pcs

·         Crammer’s splints, for upper limbs 2 pcs

·         Collar for neck-spine immobilization 1 pc

 

b)                              Bandage and other expandable material

·         First bandage, standard, type 1 10 pcs

·         First bandage, abdominal, type 4 5 pcs

·         Second bandage (calico), 10 cm wide 5 pcs

·         Bandage for burns 3 pcs

·         Elastic bandage 3 pcs

·         Three-cornered bandanna 10 pcs

·         Sterile gauze, pads 15 x 15 cm 15 pcs

·         Sticky tape; 2,5 and 5 cm wide 1+1 pc

·         Tampon with disinfection agent 5 pc

·         Antiseptic solution 100 ml

·         Rubber gloves 2 pairs

·         Adhesive plaster strip, various dimensions 20 pcs

·         Braunila (IV catheter) dimensions G 18 to 22 10 pcs

·         Intravenous sets 5 pcs

·         Infusion (Saludex, Ringer) 500 ml 2 pcs

·         Auto injector for mophia 5 pcs

·         Analgesics, non-opiates, tablets 20 pcs

·         Bag, notebook, pencil 1 pc

·         Plastic bag, big 3 pcs

·         Plastic bag, small 3 pcs

v    Physician/Ambulance Equipment

 

a)                           Equipment for multiple uses

·         Balloon AMBU, self-distensible with valve and mask 1 pc

·         Suction pump, foot-operated 1 pc

·         Bottle of oxygen with Valve min. 200 atm 1 pc

·         Stethoscope 1 pc

·         Sphygmomanometer 1 pc

·         Laryngoscope with three spatulas (and spared batteries) 1 pc

·         Metal spatula 3 pcs

·         Otoscope with the kit 1 pc

·         Set of surgical instruments, sterile 2 kpl

·         Thermometer 2 pcs

·         A pair of scissors, large (sharp) 2 pcs.12

·         A pair of scissors, small (sharp) 2 pcs

·         Stretchers, fixed 1 pc

·         Stretchers, collapsible 2 pcs

·         Crammer’s splints, various dimensions 10 pcs

·         Immobilization kit, for upper and lower limbs 2 kpl

·         Collar for neck-spine immobilization 3 pcs

·         Plates for spin immobilization 1 pc

·         Flashlight 1 pc

 

 

b)                          Bandage and other expandable material

·         First bandage, standard, type 1 15 pcs

·         First bandage, abdominal, type 4 10 pcs

·         Second bandage (calico); 10,15 and 20 cm 10 pcs

·         Bandage for burns 5 pcs

·         Elastic bandage 5 pcs

·         Three-cornered bandanna 20 pcs

·         Sterile gauze, pads 15 x 15 cm 25 pcs

·         Sticky tape; 2,5 and 5 cm wide 2 pcs

·         Tampons with disinfection agent 15 pcs

·         Antiseptic solution 3x100 ml

·         Alcohol 70% 1 l

·         Hydrogen peroxide 3% 500 ml

·         One tincture solution 200 ml

·         Cotton wool 500 g

·         Syringes, sterile, type Luer 2 ml, 5 ml, 10 ml and 20 ml 30 pcs

·         Sterile needles, various sizes 50 pcs

·         Rubber gloves 5 pairs

·         Adhesive plaster strip, various dimensions 20 pcs

·         Braumila (IV catheter), dimensions G 18 to 22 15 pcs

·         Intravenous sets 10 pcs

·         Spatulas, wooden 30 pcs

·         Suction catheter 5 pcs