Download ASNSW Skill Manual 2011 - Prehospital ambo guides

 excellence in care
Skills Manual
January 2011
Issued by: Manager, Education
Airway
Airway Management
Indication:
Upper airway obstruction.
Cause of upper airway obstruction:
1. Tongue falling back in comatose state especially if supine.
2. Foreign bodies.
• Fluid - saliva, vomit, blood
• Solid - food, false teeth, other foreign bodies
3. Swelling of nasal passages, oral cavity, pharynx and larynx from:• Allergic reactions
• Burns
• Infection
• Trauma
• Tumor
Fig 1
4. Laryngeal spasm.
Diagnosis of upper airway obstruction:
1. Inadequate air moving through nose or mouth.
• “listen and feel”. (Figs 1 & 2)
2. Sound.
• Complete silence with complete obstruction.
• Inspiratory snoring, gurgling or stridor with incomplete
obstruction. Remember “noisy breathing is obstructed
breathing”.
• An expiratory wheeze is only heard with lower airway
obstruction eg. asthma.
Fig 2
3. Chest movement “see-saw” breathing.
• In babies especially, one sees intercostal recession and
inspiratory in-drawing in the supra-clavicular regions.
• With lower airway obstruction the chest is hyperinflated.
Method:
1. Remove foreign bodies.
• Suction for fluids.
• Fingers for solids. (Fig 3)
• Laryngoscope and Magill’s forceps for solids.
• Turn head to side to drain fluid if suction is ineffective.
• Log-roll if neck injury is suspected.
Fig 3
2. Head tilt.
3. Jaw lift.
4. Artificial airway.
• Guedels airway.
• Nasopharyngeal airway.
• Endotracheal
tube.
Laryngeal Mask
airway, Endotracheal Tube.
Approved by:
Medical Director
December 2003
101.1
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Airway
Oropharyngeal Airway
Fig 1
Indications:
Upper airway obstruction due to backward displacement of the
tongue. Can act as a protective “bite block” when other airways are
in place.
Method:
1. Check patient’s level of consciousness.
Fig 2
2. Prepare oropharyngeal airway.
3. Take airway from package.
4. Select correct size (the correct size is the same length as the
distance from the corner of the mouth to where the ear lobe joins
the face). (Fig 1)
Fig 3
Insertion:
1. Hold by the flange. (Fig 2)
2. Natural curve upside down. (Fig 3)
3. Insert into mouth rotating through 180˚ as it passes under
the palate. (Figs 4 and 5)
4. Continue insertion until flange rests against patient’s lips. (Fig 6)
Fig 4
5. Check for gag reflex and remove if retching occurs.
6. Check for unimpeded air entry (supplementary jaw support may
be necessary).
Note:
1. If the airway is too long, the device may impinge on the epiglottis
and bend it over the laryngeal opening.
Fig 5
2. If the airway is too short it may not support the tongue forward.
3. Oropharyngeal airways do not protect the airway from gastric
aspiration.
Fig 6
Approved by:
Medical Director
December 2003
101.2
Ambulance Service of New South Wales
Page 1 of 12
Airway
Nasopharyngeal Airway (NPA)
Indication:
1. Upper airway obstruction. It is especially useful in situations
where an oral airway cannot be used eg:
•
•
•
•
Trismus
Seizures
Severely swollen tongue (Anaphylaxis)
Injuries to the mouth
Method:
1. Select appropriate airway by measuring from the ear lobe
to the tip of the nose. Fig 1
Fig 1
As a guide the following may be applied;
• 3.5 mm
6 mths – 3 yrs
• 4.5 mm
4 yrs – 8 yrs
• 5.5 mm
9 yrs – 15 yrs
• 6.5 mm
Adolescent
• 7.5 mm
Small adult
• 8.5 mm
Large adult
2. Lubricate with water based lubricant.
•
Select the widest nostril
•
Insert perpendicular to the nose with bevel towards the
septum. Fig 2 and 3
•
Do not point the tip upward
•
If resistance is met, attempt gentle rotation of the NPA to
Fig 2
continue progress
•
If obstruction is encountered try other nostril. If this fails
select a smaller airway.
Complications:
•
•
Epistaxis
Nasal injury
•
If base of skull fracture is suspected use with caution
Supporting Information:
•
A ‘Y’ suction catheter can be passed down the airway
lumen to aspirate secretions or blood from the posterior
pharynx. Refer to skill 101.14
•
Tolerated well where a slight gag exists such as drug or
alcohol overdose.
Approved by:
Manager Education
December 2003; Revised January 2011
Fig 3
101.03
Ambulance Service of New South Wales
Page 1 of 1
Airway
Endotracheal Intubation – (ETT)
Quick Step Guide to ETT Insertion
Airway Management throughout
Pre-oxygenate
Position head
Prepare ETT & laryngoscope handle
Laryngoscopy
Insert – Inflate cuff
Confirm placement
Attach Airway filter and CO2 detector
Disposable catheter mount
Secure ETT
Difficult intubation
- Bougie
- LMA
Complications
Supporting information
Approved by:
Manager Education
October 2008; Revised January 2011
101.5
Ambulance Service of New South Wales
Page 1 of 11
Airway
Endotracheal Intubation – (ETT)
Indication:
• Unconscious patients with either:
• Absent cough/ gag reflex
• Hypoventilation
Check Equipment:
• Laryngoscope handle and globe
• Blades
• Endotracheal tubes and stylets
• Magill’s forceps
• Airway kit
• Resuscitator bag (BVM)
• Bougie
• Suction and oxygen
• Colorimetric end tidal CO2 detector
• Airway filter where CO2 detector is
used
• Pulse Oximetry
• LMA
Approved by:
Manager Education
October 2008; Revised January 2011
Endotracheal Tube (ETT) sizes:
Larger males
Females or small males
Small females and teenagers
Formula: (Age ÷ 4) + 4
• 12 years
• 10 years
• 8 years
• 6 years
• 4 years
• 2 years
• 1 year
• 6 month
• Neonate
⇒
⇒
⇒
9mm
8mm
7mm
(cuffed)
(cuffed)
(cuffed)
⇒
⇒
⇒
⇒
⇒
⇒
⇒
⇒
⇒
7mm
6mm
6mm
5.5mm
5mm
4.5mm
4mm
3.5mm
3mm
(cuffed)
(cuffed)
(cuffed)
(uncuffed)
(uncuffed)
(uncuffed)
(uncuffed)
(uncuffed)
(uncuffed)
101.5
Ambulance Service of New South Wales
Page 2 of 11
Airway
Endotracheal Intubation – (ETT)
Method
Procedure
Supporting Information
Airway Management
Perform Basic Airway Management
Assess class of airway.
Pre-oxygenate
Ventilate for 2 minutes between Laryngoscopy
attempts
Avoid Hypoxia.
Position Head
Ensure neutral alignment, consider sniffing
position
Placing patient’s head in sniffing position aligns 3 airway
angles and promotes visualisation of cords.
Adult – smaller head relative to body
Consider padding under occiput
If patient has obstructed airway or is apnoeic in presence of
Cervical spine precautions, remove collar and maintain manual
in-line stabilisation during procedure. Minimise flexion/
extension of cervical spine.
Child – larger head relative to body
Consider padding under shoulders
Prepare ETT and
Laryngoscope handle
Insert stylet and lubricate ETT (adjusting curvature
if required)
Ensure stylet does not protrude beyond tip of ETT, otherwise it
may perforate trachea.
Have one smaller size ETT on hand.
Attach blade to laryngoscope handle
Approved by:
Manager Education
October 2008; Revised January 2011
101.5
Ambulance Service of New South Wales
Page 3 of 11
Airway
Endotracheal Intubation – (ETT)
Method
Laryngoscopy
Procedure
Supporting Information
With left hand, insert laryngoscope
down right side of mouth, moving
tongue with tip of blade across to
midline until epiglottis and cords are
visualised Fig 1, Fig 2 and Fig 3
Aim to intubate within 10 seconds, do
not keep trying beyond 20 seconds
Note: hold breath when attempting
intubation, if failed, re-ventilate for 2
minutes and attempt again.
Adult – place tip of laryngoscope blade
in ‘vallecula’ between tongue and
epiglottis, then lift upwards and
forwards to expose larynx
Caution: Do not apply leverage on
upper front teeth.
Whilst one officer focuses on intubation,
a second officer can provide alerts
pertaining to patient’s perfusion, oxygen
saturation, heart rate and timing of
procedure
Fig 1
Caution: Watch for dysrhythmias.
Infants – insert blade beyond long
floppy epiglottis to visualise larynx
Caution: Do not over extend head tilt
as laryngoscopic view may be lost.
Fig 3
If cords are not readily visualised abort
attempt and ventilate
Apply cricoid pressure. Fig 10
• prevents gastric reflux or emesis by
compressing the oesophagus.
• assists in bringing larynx into view.
Occasionally the blade may
inadvertently go too deep, if this
happens gently withdrawal until cords
are visualised. Fig 3
Fig 2
Intubation should be performed gently
and purposefully with no levering or
force against the teeth. Fig 2
Approved by:
Manager Education
October 2008; Revised January 2011
101.5
Ambulance Service of New South Wales
Page 4 of 11
Airway
Endotracheal Intubation – (ETT)
Method
Insert ETT
Confirm placement
Procedure
Supporting Information
With the right hand, insert ETT down If an assistant is available, it may be useful to
right side of mouth until cuff (second pull the right corner of the mouth outwards
during this manoeuvre
black line on ETT) passes through
the vocal cords Fig 4 and Fig 5
Do not proceed if patient gags or coughs.
This stimulates a gag reflex, which increases
Remove stylet
intra-cranial pressure and intra thoracic
pressure, thus increasing the risk of emesis/
Inflate ETT cuff with the least
aspiration.
amount of air required so as to
minimise pressure within trachea
Check for air leaks around cuff/ tube during
Common methods
ventilations, in paediatrics there should always
• until resistance is felt on syringe
be an audible air leak around uncuffed tube.
• until air leak is removed (whilst
ventilating)
If there is a large air leak the tube should be
• approx 10ml
replaced with a larger size.
Confirm placement. Ventilate and
Oesophageal intubation is always a danger
auscultate epigastrium then lateral
and should be considered if:
lung fields
• CO2 detector remains purple after 6
• gastric intubation
ventilations
immediately remove if bubbling
•
The patient remains hypoxic after
heard in epigastrium
intubation and ventilation with 100%
• right endobronchialoxygen
withdraw slightly
• An air leak persists or excessive inflation
of cuff is necessary
Document ETT measurement by
• Absent breath sounds or inadequate chest
noting depth of insertion at
movement
teeth/lips.
• Gastric distension occurs
• Bag valve head has no expiratory noise
Approved by:
Manager Education
October 2008; Revised January 2011
Fig 4
Fig 5
101.5
Ambulance Service of New South Wales
Page 5 of 11
Airway
Endotracheal Intubation – (ETT)
Method
CO2 Detector
Procedure
Give at least 6 breaths prior to CO2
detector to remove residual stale air Fig 6
Ensure CO2 detector is purple upon
removal from packaging Fig 6
Always connect CO2 detector and ensure
positive colour change
Supporting Information
Ensure colour range changes after 6
ventilations as false reading can be
recorded if patient has consumed
large quantities of carbonated
beverages.
Ensure airway filter is attached to
prevent contamination with gastric
contents.
Ensure airway filter is used between ETT
and CO2 detector to prevent
contamination leading to false readings
Fig 7
Disposable catheter
mount (Flex tube)
Attach disposable catheter mount Fig 7
Fig 6
Keeps weight off top of ETT
minimising potential dislodgement.
Fig 7
Approved by:
Manager Education
October 2008; Revised January 2011
101.5
Ambulance Service of New South Wales
Page 6 of 11
Airway
Endotracheal Intubation – (ETT)
Method
Procedure
Supporting Information
Bite block
Insert bite block for adults Fig 8.
Use an oropharyngeal airway in
paediatrics
Secure ETT
Place tie-in tape under neck prior to
Adult
White tape, place a loop tightly around intubation. Then if there is head movement
inserting the tape does not run the risk of
the back of the neck
causing malposition
Method one. Tie a reef knot between
When tying-in; perform a double turn
the tube and upper teeth. Then pass
(surgeons knot) on the first half of the reef
the tape tightly around the tube and
knot. The extra friction holds the knot in place
tie another reef knot below the tube to
and negates the need for an assistant to put
secure in place
their finger on the tape during the procedure
Method 2. Utilise Larks head knot if
operator familiar with application
Child – use Elastoplast type tape,
trouser leg x2 across the top lip and
over the tube and onto face Fig 9
Note: consider applying a cervical
collar for infants and children to
minimise neck movement and
possible dislodgement. May also be
useful in adult patients
Approved by:
Manager Education
October 2008; Revised January 2011
Place bite block prior to tie in, it can be difficult to insert once tape insitu.
Fig 8
It is mandatory to ask the receiving doctor to
confirm ETT placement prior to removing
patient off ambulance stretcher.
Confirm correct placement and tube security
after every movement, prior to unloading at
hospital and again prior to moving to hospital
bed.
Note the Doctors name on PHCR and have
Doctor sign PHCR if possible.
Fig 9
101.5
Ambulance Service of New South Wales
Page 7 of 11
Airway
Endotracheal Intubation – (ETT)
Method
Difficult Intubations
Procedure
Supporting Information
Ambulance clinicians may at times encounter difficult
intubation attempts or patients with a difficult airway
anatomy.
During these situations and subsequent laryngoscopy
attempts the ambulance clinician must consider the
following:
• Confirm correct technique
• Positioning of patient’s head
• Applying cricoid pressure. Fig 10
• Applying Backwards Upwards Rightwards Pressure
(B.U.R.P.) for anterior airways
• Utilisation of Bougie
• Another experienced clinician
• Insert LMA if the airway is presenting problems for ETT
at this time
• Thick / bull neck patients with nil cervical / spine
indication. Have the assistant straddle the patient,
grasping both of the patients hands pull up and
towards the assistant slowly, place laryngoscope into
oral cavity, the assistant then slowly lower the patient
until laryngoscopic view is achieved.
Fig 10
Approved by:
Manager Education
October 2008; Revised January 2011
101.5
Ambulance Service of New South Wales
Page 8 of 11
Airway
Endotracheal Intubation – (ETT)
Method
Bougie
Procedure
Supporting Information
Ideally this is a two person
technique but can be performed
alone
•
Make an anterior bend on the last
two centimetres of the Bougie to
facilitate it’s passage behind the
epiglottis, and down the trachea.
•
When the Bougie is in the trachea,
you can fell the tracheal rings as
“bumps”, as you pass the Bougie.
This is important when you have a
poor laryngoscopic view, and you
manoeuvre the Bougie behind the
glottis.
Perform Laryngoscopy as detailed
above.
With right hand insert Bougie down
right side of mouth through glottis
Fig 11
Have an assistant insert an
appropriate sized ETT onto end of
Bougie and firmly hold Bougie to
prevent movement Fig 12
Fig 11
While holding laryngoscope with left
hand, slide ETT down Bougie with
right hand and visualise ETT cuff
going beyond cords
Whilst holding laryngoscope and
ETT in place, have assistant gently
remove Bougie whilst ensuring
visually ETT cuff remains beyond
chords
Approved by:
Manager Education
October 2008; Revised January 2011
Fig 12
101.5
Ambulance Service of New South Wales
Page 9 of 11
Airway
Endotracheal Intubation – (ETT)
Complications
1. Dislodgement/ Malposition into oesophagus,
oro-pharynx or right main bronchus
•
•
•
•
•
Tie tube in firmly
Look and listen over epigastrium to exclude gastric
distension and oesophageal intubation
Monitor end tidal CO2
Endobronchial, usually the right, make sure both sides of
chest are being inflated by monitoring chest rise and
auscultating both axillae
Inflation of cuff too high/ between vocal cords, causes great
pain, laryngeal damage and increases potential
dislodgement. Ensure cuff is positioned below larynx.
•
•
•
•
•
Mucous or blood blocking lumen
Kinking in pharynx
External pressure from biting
Herniation of cuff
Impingement of bevel on the carina or side wall of trachea
3. Trauma
•
•
•
Lips
Teeth
Tongue
•
•
•
Pharynx
Larynx and trachea
Cervical cord injury with
spinal fractures
4. Interference with physiological functions
• Filtering
• Warming
• Humidifying
•
•
•
•
Talking
Coughing
Straining
Swallowing
2. Obstruction
Approved by:
Manager Education
October 2008; Revised January 2011
101.5
Ambulance Service of New South Wales
Page 10 of 11
Airway
Supporting
Information and
learning tips
Endotracheal Intubation – (ETT)
•
Maintain a healthy respect for the skill and its many parts.
•
Single clinician on scene not to intubate cardiac arrest until sufficient resources are available.
•
Whilst preparing for intubation ventilations take priority; imagine the patient sliding down a slippery dip unless you
ventilate them every 4-5 seconds. That is your main task, but you can get a lot done between those ventilations if you are
organised.
•
Where only two officers are present the person who will perform the intubation can prepare intubation equipment inbetween ventilations. In a cardiac arrest there is sufficient time to open packets, position tape under the neck etc.
between ventilations at appropriate ratio. If person doing compression quietly counts their compressions before giving
ample warning to prepare for the next ventilation. For example counts down last 5-10 compressions.
•
Visualise pushing laryngoscope away from patients’ nose. This avoids the natural tendency to lever laryngoscope on
teeth.
•
Insert laryngoscope down right hand side of mouth and push tongue to left and out of the way. Gradually insert until cords
are visible. Alternatively insert blade all the way in (too far) and then slowly pull back until cords become visible. Push tip
of laryngoscope into vallecula.
•
If an attempt is not successful within 10-20 secs withdraw and ventilate immediately to minimise apnoea.
•
Holding your breath during laryngoscopy and ETT insertion will give an indication of when the patient requires ventilation.
•
When inserting tube, viewing the cords can become obstructed. This may be exacerbated by having laryngoscope blade
and tube both being central and dominating the view. Try pulling laryngoscope across as far to left as possible whilst
inserting the ETT from as far right as possible to open up view.
•
If left side does not expand assess for other causes such as tension pneumothorax and treat accordingly.
•
Where cardiac arrest is from an obstructed airway be careful of foreign matter remaining within the trachea and being
pushed further down by the tube, Magill’s forceps are recommended.
•
If you are performing effective non-intubated ventilations then you are doing what the patient requires.
•
Prolonged attempts to intubate a patient may result in hypoxic brain damage.
•
Hyperventilation may lead to hypocapnia (reduced carbon dioxide in the blood), also hypotension due to increased
intrathoracic pressure decreasing venous return.
Approved by:
Manager Education
October 2008; Revised January 2011
101.5
Ambulance Service of New South Wales
Page 11 of 11
Airway
Laryngeal Mask Airway – (LMA)
Quick Step Guide to LMA
Airway Management throughout
Pre-oxygenate
Insertion
Removal
Position head
Disconnect Resus Bag
Lube
Cut tape
Insert
Bite block out
Inflate cuff
Suction
Disposable catheter mount
Roll as required
Confirm placement
Remove
Bite block in
Further Airway as required
Tie
Further BVM as required
Complications
Supporting information
Approved by:
Manager Education
October 2008 Revised January 2010
101.6
Ambulance Service of New South Wales
Page 1 of 4
Airway
Laryngeal Mask Airway – (LMA)
Indication:
Unconscious with either;
• absent cough/ gag reflex
• hypoventilation
Fig 1
Prepare the patient:
1. Airway management, refer to skill 101.1
2. Apply Bag Valve Mask (BVM) and pre-oxygenate, refer to skill 102.1.1
Prepare the equipment:
1. Airway kit consisting of flexible catheter mount, 20ml syringe, bite block, lubricating gel, cotton
tape and scissors
2. Select LMA based on patient weight & oral anatomy.
As a guide the following may be applied:
• Size 2
10 kg to 20 kg
• Size 2.5 20 kg to 30 kg
• Size 3
30 kg to 50 kg
• Size 4
50 kg to 70 kg
• Size 5
> 70 kg
3. Liberally lubricate posterior surfaces of the LMA cuff and 5-7
cm of the posterior distal end of the tube with water based
lubricant. Do not lubricate the anterior surface as this may
prevent a good seal Fig 1
4. Ensure blue valve depressor is connected to indicator bulb
Fig 2 - arrow
Fig 2
Insert LMA:
1. Position patient supine with yourself behind patient’s head
where possible
2. Head/neck positioning
• Adults; flex neck and extend head into ‘sniffing position’, consider padding under head
• Paediatrics; consider padding under shoulders
If spinal injury is suspected, remove collar and maintain manual stabilization during
procedure with minimal flexion or extension of patient’s cervical spine
3. Open mouth and support lower jaw to facilitate passage of LMA behind tongue. Consider
having an assistant provide jaw lift
4. Grasp LMA firmly between fingers and thumb with cuff of LMA facing towards tongue. Fig 2
5. Advance LMA over top of tongue while pushing back of LMA against hard palate. Fig 2
Approved by:
Manager Education
October 2008 Revised January 2010
101.6
Ambulance Service of New South Wales
Page 2 of 4
Airway
Laryngeal Mask Airway – (LMA)
6. Occasionally tip of LMA may fold over on insertion preventing a
good seal, withdraw LMA approximately 2 to 3cm and reinsert
7. Ensure LMA is in midline position.
Remove blue valve depressor, attach 20ml syringe, inflate cuff
until resistance is felt on the syringe. Do not exceed maximum
pressure indicated. LMA will adjust position and tube of the
LMA should rise 1-2 cm when it seats. Check cuff pressure is
maintained by compressing inflation bulb. Fig 3 arrow
Fig 3
8. Attach Resuscitator Bag, gently ventilate patient, check visually
that chest has adequate rise and fall. Fig 4
Note: Attaching a flexible disposable catheter mount onto LMA
may help eliminate possible dislodgement. Fig 4 arrow
9. If chest does not rise adjust LMA position slightly. If chest still
does not rise, remove LMA and ventilate before further
attempts. If further attempts are necessary consider altering
insertion technique or inserting LMA with valve depressor off.
Fig 4
10. Auscultate chest to ensure adequate air entry. Fig 4
11. Insert bite block. Fig 5
12. Secure LMA firmly in place. Suggested methods using white
tape;
•
•
Place a loop tightly around neck and tie a reef knot between
tube and upper teeth. Then pass tape tightly around tube and
tie another reef knot below tube to secure in position. Fig 6
Fig 5
Alternatively tie a larks head knot around tube to secure
At hospital have a doctor confirm correct placement of LMA
and record doctors name on PHCR
Fig 6
Approved by:
Manager Education
October 2008 Revised January 2010
101.6
Ambulance Service of New South Wales
Page 3 of 4
Airway
Laryngeal Mask Airway – (LMA)
Complications:
1. Patient has cough or gag reflex and will not tolerate LMA
2. Malposition
3. Inadequate chest expansion
4. Vomiting, regurgitation
5. Over-inflation of cuff which may dislodge LMA
6. Cuff does not inflate or remain inflated
Removal:
1. Remove Resuscitator Bag
2. Cut securing tape
3. Remove bite block
4. Suction oropharynx
5. Posture patient as required – log roll if CPR not required
6. Do not deflate cuff
7. Remove LMA gently
8. Insert oropharyngeal airway if required
9. Continue to ventilate patient as required
10. If required - reinsert LMA
11. If re-insertion fails, continue basic airway management
Approved by:
Manager Education
October 2008 Revised January 2010
101.6
Ambulance Service of New South Wales
Page 4 of 4
Issued by: Manager, Education
Airway
Extubation
Indication:
Fig 1
If the patient’s condition improves and the indications for intubation
are no longer present and the patient is physically trying to remove
the tube then extubation must be considered.
Method:
1. Place the patient in the lateral position breathing 100% oxygen.
2. Suction oropharynx with Yankauer sucker to remove any
secretions. (Fig 1)
Fig 2
3. Deflate the endotracheal tube cuff with a syringe. It is of the
utmost importance to ensure the cuff is fully deflated at the time
of removal. Check the pilot balloon closely to confirm cuff
deflation. (Fig 2)
4. Suction the trachea. (Fig 3)
5. Cut the tie-in tape with scissors. (Fig 4)
6. The tube is gently withdrawn upon full inspiration assisted by
positive pressure on the Laerdal bag. Most importantly the
extubation must be non-traumatic. (Fig 5)
Fig 3
7. Continue oxygen therapy with a high concentration mask.
8. Monitor ECG and respirations at all times during and after this
procedure.
Fig 4
Fig 5
Approved by:
Medical Director
December 2003
101.7
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Airway
Intragastric Tube
Indication:
Gastric distension with air or fluid eg near drowning or poorly
performed EAR which can cause:
1. Increased risk of regurgitation.
2. Fluid absorption and consequent fluid overload.
3. Interference with breathing or IPPV especially in children.
4. All intubated children to receive IPPV.
Fig 1
5. Continuous vomiting.
6. Transport of neonates, spinal injuries, abdominal problems especially by air.
Prepare the equipment
Choose the appropriate sized tube:1). Adults - 14FG
2). Children - 12FG
3). Neonates - 10FG
Prepare the patient
1. Measure the distance from the tip of nose to ear lobe then to
below xiphoid process which gives the appropriate length
required to enter the stomach. (Figs 1 & 2)
Conscious Patient
a water based
lubricant
and passed
The tube is lubricated with lignocaine
jelly
and passed
slowly slowly
through the widest nostril whilst encouraging the patient to
swallow. Sips of water are often useful. To minimise discomfort
and risk epistaxis, the tube should be passed along the floor of
the nose which runs at right angles to the face.
Fig 2
Unconscious Patient
The patient should be intubated first, then the lubricated tube is
passed through the widest nostril and then manipulated down the
oesophagus using a laryngoscope and Magill’s forceps.
2. Check for correct placement
• Aspirate with 50ml syringe to determine if gastric contents are
present.
• Inject 50 ml of air down the tube whilst listening to air entry
over the stomach. (Fig 3)
5. The stomach can be emptied by means of a 50ml syringe with a
catheter tip connected or attached to low pressure suction. The
tube should not be clamped but left on free drainage.
6. The tube should be securely taped to the patient’s nose using the
“Trouser Leg” method.
Contraindication:
Fig 3
With suspected fractured base of skull and facial injuries, the tube
must be inserted through the mouth and not the nose.
Approved by:
Medical
ManagerDirector
Education
December
2003
October 2008
101.8
Ambulance Service of New South Wales
Page
Page 11 of
of 12
Issued by: Manager, Education
Airway
Oral Suction
Indication:
Fluid such as saliva, vomit or blood in the pharynx.
Method:
1. Use a large bore plastic Yankauer sucker inserted gently into the
mouth. Beware of the patient biting the sucker. If necessary it
can be inserted between gaps in the teeth. If a blockage occurs in
an emergency situation, disconnect the Yankauer sucker and use
the wide bore suction tubing instead. (Fig 1)
Fig 1
2. A tracheal suction catheter should be used for oral suction in
infants.
Complications:
1. Trauma to teeth, tongue, pharynx with bleeding.
2. May induce vomiting or laryngospasm.
Check the equipment:
1. Suction equipment must be regularly checked with a suction
gauge. Normally there should be a rapid fall to a pressure of
minus 250mmHg.
2. If the suction falls slowly or does not reach minus 250mmHg look
for the following problems:
Leaks
• Poor fit of suction tubing at connections.
• Cracked vacuum container jar.
• Poor seal in lid due to absent or displaced ‘O’ ring.
Obstruction
Suction tubing too narrow.
Foreign material obstructing the tubing.
A wet filter in the twin-o-vac. ALWAYS remove the filter.
A blocked Venturi jet.
•
•
•
•
Approved by:
Medical Director
December 2003
101.14
Ambulance Service of New South Wales
Page 1 of 12
Breathing
Inspiratory Assistance
Indication
• Hypoventilation
• Severe pulmonary oedema
Diagnosis of Hypoventilation
• Slow respiratory rate and/or
• Low tidal volume
Methods
Apply appropriate airway management procedures and commence
Intermittent Positive Pressure Ventilation (IPPV) via:
• Bag Valve Mask Resuscitation (BVM). Ref skill 102.1.1
• Bag Valve to Laryngeal Mask Airway (LMA). Ref skill 102.1.1
• Bag Valve to Endotracheal Tube (ETT). Ref skill 102.1.1
Checking Effectiveness
Ensure both sides of the chest rise with each inflation and that gastric distension is not
occurring. If no chest rise occurs re-check airway management procedures and equipment
functionality
Recommended ventilation rates:
• Adults 10 -15/minute
• Children 20/minute
• Infants 40/minute
NB During CPR, apply stated cardiac arrest ventilation/compression ratios accordingly
Complications
1. Gastric distension
High pressure ventilation can lead to inflation of the stomach by overcoming the resistance
of the cardiac sphincter. This can cause gastric regurgitation and increase pressure on the
diaphragm
2. Barotrauma
High pressure ventilation can cause pressure injury to the lung leading to subcutaneous
emphysema and pneumothorax. IPPV can convert a simple pneumothorax to a tension
pneumothorax in patients with chest injuries
3. Hypotension
IPPV raises intrathoracic pressure and decreases venous return especially if the patient is
hypovolaemic
Occupational Health and Safety
Compliance with relevant infection control, OH&S and manual handling techniques and
procedures
Approved by:
Manager Education
December 2003. Revised; March 2010
Ambulance Service of New South Wales
102.1
Page 1 of 1
Breathing
Bag Valve Mask Resuscitation
Indication
1. Hypoventilation
2. Severe pulmonary oedema
Refer Skill 102.1 Inspiratory Assistance
Prepare the patient
• Posture the patient according to Skill Sheet 110.1/9
• Use head tilt and jaw thrust to maintain airway, if unconscious
(with caution for the paediatric or spinal injured patient)
Prepare the equipment
Select a single use disposable resuscitator bag according to
patient size;
Bag sizes
Adult
> 45kg
1500 mL - adult
Paediatric
< 45kg
550 mL - paediatric
Neonate
< 6.5kg
280 mL - neonate
1. Connect the oxygen tubing to a regulated oxygen source
2. Adjust the oxygen flow ensuring the reservoir bag does not
collapse
3. Confirm mask is attached to patient valve
4. Ensure pressure relief valve is open – close only to achieve
adequate chest inflation or if higher ventilation pressures are
required
Method
1. Apply mask to cover patient’s nose and mouth to obtain a seal
2. Gently compress the resuscitator bag to deliver a breath.
Observe the chest rise to confirm inspiration
3. Release pressure on the resuscitator bag to allow exhalation.
Observe the chest fall to confirm exhalation
4. Be aware of any gastric distension
5. Do not hyperventilate or hyperinflate
Checking effectiveness
Ensure both sides of the chest rise with each inflation and that
gastric distension is not occurring
Recommended respiratory rates for patients not receiving CPR:
•
adult
- 10 to15 breaths per minute
•
children - 20 breaths per minute
•
infant - 40 breaths per minute
Approved by:
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102.1.1
Ambulance Service of New South Wales
Page 1 of 2
Breathing
Bag Valve Mask Resuscitation
Complications
1. Gastric distension:
High pressure ventilation can lead to inflation of the stomach by
overcoming the resistance of the cardiac sphincter. This can
cause gastric regurgitation and increase pressure on the
diaphragm.
2. Barotrauma:
High pressure ventilation can cause pressure injury to the lung
leading to subcutaneous emphysema and pneumothorax. IPPV
can convert a simple pneumothorax to a tension
pneumothorax.
3. Hypotension:
IPPV raises intrapleural pressure and decreases venous
return. This is of particular importance especially if the patient
is hypovolaemic.
Handy Hints
• All three sizes are supplied with a pressure relief valve that
is to remain un-capped unless higher ventilation pressures are
required.
• Resuscitator diverter cap should be turned away so that
exhaled gases are vented away from the operator.
Should the non-rebreathing valve become contaminated with
vomitus blood or secretion during ventilation, remove from the
patient and clear as follows:
• Rapidly compress the squeeze bag to deliver several sharp
breaths through the non-rebreathing valve
• Rinse the non-rebreathing valve in water before again
rapidly compressing the squeeze bag to deliver several sharp
puffs of air through the non-rebreathing valve to expel any
contaminant
• If this fails, replace resuscitator
Non-rebreathing valve
Diverter cap
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures.
Approved by:
Manager Education
July 2009 v2
102.1.1
Ambulance Service of New South Wales
Page 2 of 2
Breathing
Oxygen Administration
Indications
• Respiratory distress or hypoxia
• Supplement in illness or injury to maintain tissue oxygenation
• Simultaneous administration of other medications e.g. midazolam or morphine
• Obstetric and diving Emergencies
• Drive gas for the administration of nebulised medicines
• Hyperventilation
Fig 1
Methods
Oxygen Therapy
1. Oxygen Therapy Mask
Two sizes - Adult and Child Fig 1
In the majority of patients who are ventilating adequately,
oxygen is given via a therapy mask.
The inspired oxygen concentration depends on the litre flow rate. Average figures for the
performance of these masks are:
- 4 litres per min 35%
- 8 litres per min 50%
- 15 litres per min 65%
However, the actual percentage varies greatly from one patient to another. It is impossible to
give 100% oxygen via an oxygen therapy mask.
NB The choice of flow rate is determined by the clinical condition of the patient. The more
dyspnoeic the patient, the higher the initial flow rate required. “If in doubt, use a high flow”. As
shortness of breath/ respiratory effort improves, the flow rate may be reduced. This can be
useful with chronic air flow patients. For specific flow rate refer to Pharmacology 221 Oxygen
2. Oxygen Therapy Mask with Reservoir Bag (Fig 1)
(also referred to as a Non-Rebreather mask - NRB)
The reservoir decreases the amount of entrainment of room air and with 15 litres inflow, the
inspired oxygen can greatly exceed 65%.
3. Low concentration Oxygen Therapy
In general it is only used in patients with chronic airway limitation with carbon dioxide
retention who have an “hypoxic drive” and would hypoventilate if given higher
concentrations of oxygen. It should only be used if it has been prescribed by the patient’s
respiratory physician. However, if in severe distress or “in extremis” follow the basic rules for
any patient in respiratory distress.
4. 100% Oxygen Therapy (Fig 2 and 3)
Spontaneous breathing by patients who are ventilating adequately through the BVM
Resuscitation bag, provided the oxygen reservoir bag is not allowed to collapse using 15
litres per min inflow and a seal is maintained on the face. The patient can be in any posture.
Approved by:
Manager Education
December 2003. Revised; March 2010
Ambulance Service of New South Wales
102.2
Page 1 of 2
Breathing
Oxygen Administration
Indications for administration of 100% Oxygen Therapy
• Severe hypoxic states, i.e. patient still confused, cyanosed on 15 lpm oxygen by therapy
mask with reservoir bag
• Carbon monoxide poisoning
Fig 2
• Venous air embolism
• Obstetric emergencies
• Diving emergencies
Oxygen by IPPV (Intermittent Positive Pressure
Ventilation)
IPPV will provide up to100% oxygen provided the reservoir bag remains inflated, 15 litres per
min inflow is maintained and a seal kept when using a face mask
1. Bag Valve Mask (BVM) Resuscitation. Ref skill 102.1.1
Used to ventilate the non-intubated patient with a face mask. Fig 3
2. Bag Valve Resuscitation Ref skill 102.1.1
Used for ventilating a patient who is intubated or has an
LMA insitu. It has a distinct advantage in that one can “feel
the patient’s lungs” and thus detect problems such as
obstruction and stiffness. This will provide 100% oxygen
when the reservoir bag remains inflated using 15 litres per
min inflow
Fig 3
3. Mechanical Ventilation Refer to Aero-medical skill sets for particular devices.
Equipment is supplied and used by medical teams to ventilate the sedated patient during
primary and or secondary transfers.
Complications of Oxygen administration in the ambulance situation
1. May cause hypoventilation in CAL patients who are dependent on a hypoxic drive
2. Increases risk of fire and/or explosion
Occupational Health and Safety
Compliance with relevant infection control, OH&S and manual handling techniques and
procedures.
6
Approved by:
Manager Education
December 2003. Revised; March 2010
Ambulance Service of New South Wales
102.2
Page 2 of 2
Breathing
Chest Needle Decompression
Indications:
• Single tension pneumothorax with rapidly deteriorating
cardiovascular and respiratory function and decreasing level of
consciousness
• Chest injuries with major trauma where the patient is in a peri-arrest
state with rapidly deteriorating cardiovascular and respiratory
function and decreasing level of consciousness. If preparing to
ventilate such a patient, urgently perform bi-lateral chest needle
decompressions
Note: Decompression is not indicated for a simple pneumothorax
Method/ Procedure:
• Identify the mid point of the clavicle (Fig 1) and draw the mid
clavicular line (Fig 2)
• Place your finger on the clavicle over the marked mid clavicular line
• Roll your finger down so it sits below the clavicle, this is the first
intercostal space
• Place your next finger below; this is the second rib, below this is the
second intercostal space (Fig 3)
• Mark the insertion point below your finger across the mid clavicular
line (Fig 3)
• Swab the site
• Use the scalpel blade provided with the Dwellcath to make a small
incision prior to inserting the cannula (Fig 4)
• Remove the cap and insert the Dwellcath perpendicular (straight
back) into the upper chest (Fig 5)
• Insert until resistance gives way; air and/or blood may return via the
cannula
• Remove the stylet
Approved by:
Manager Education
December 2003 Revised; March 2010
Ambulance Service of New South Wales
102.4
Page 1 of 2
Breathing
Chest Needle Decompression
• Secure the catheter in-situ (Fig 6)
• Spontaneously breathing patients require a connecting tube and
Heimlich valve
Supporting Information:
• Once inserted DO NOT remove the cannula
• Only use a long 12 gauge Dwellcath; 14g cannulas are too short to
reliably reach the pleura
• Where significant subcutaneous emphysema is present, press down
on skin to move subcutaneous air to locate landmarks
• Placing the cannula packaging over the hub during insertion will
allow the monitoring of escaping air and/or blood into the package
• Diaphoretic patients may benefit from using monitor dots to secure
cannula in place
• Heimlich valve must be used for spontaneous breathing patients as
the negative pressure on inspiration may draw air in through the
needle
• If the catheter occludes and the patient deteriorates, consider redecompressing beside the existing site
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual handling
techniques and procedures
Approved by:
Manager Education
December 2003 Revised; March 2010
Ambulance Service of New South Wales
102.4
Page 2 of 2
Issued by: Manager, Education
Breathing
Expiratory Assistance
Indication:
Asthmatic patients presenting with severe dyspnoea.
• Chest will not deflate.
• Extremely high inflation pressure.
• Little or no air movement.
Fig 1
Method:
External chest compression. (Fig 1)
1. Place hands on both sides of the lower lateral chest wall.
If the patient is supine, face the patient and kneel astride patient’s
hips.
2. Compress medially, synchronising with patient’s expiratory effort
and do not compress during inspiration.
3. With IPPV, compression commences with cessation of each
positive pressure ventilation.
4. Compressions should be slow, rhythmic and sustained to help
force air out.
Complications:
1. Fractured ribs.
2. Hypotension.
Approved by:
Medical Director
December 2003
102.7
Ambulance Service of New South Wales
Page 1 of 12
Haemorrhage Control
Arterial Tourniquet – Mechanical Advantage Tourniquet (MAT)
Indication:
• Arrest haemorrhage in situations where direct pressure is not
possible or is inadequate
Fig 1
•
Haemorrhage area is inaccessible, eg trapped limb
•
Lack of assistance, eg disaster situation
•
Trapped patient with compression immediately prior to release
MAT Tourniquet:
1. Apply proximal to the bleeding site
2. Click buckle into place and tighten strap. Fig 1
3. Turn handle clockwise until haemorrhage is controlled. Fig 2
Fig 2
4. Mark “T” on patients forehead and record time on handle. Fig 3
Removal of MAT Tourniquet
• Press and hold the release button and or lift buckle on the
strap where it attaches to the device. Fig 4
To Reset the MAT Tourniquet
• Push and hold the release button, then turn counter
clockwise to unwind
Sphygmomanometer:
1. Apply proximal to the bleeding site
Fig 3
2. Inflate cuff until haemorrhage is controlled
3. Clamp tubes with artery forceps if necessary
4. Do not cover the sphygmomanometer
5. Mark “T” on patients forehead and record application time
Supporting Information:
• Release of the tourniquet after prolonged application may
Fig 4
produce signs and symptoms similar to the removal of any
compressive force
•
Ensure colleague’s and medical staff are aware of tourniquet
•
The MAT can be applied to a forearm as small as 10 cm up to
a femur of 97cm.
103.9.5
Approved by:
Manager Education
December 2003, Revised January 2011
Page 1 of 1
Ambulance Service of New South Wales
PRINCIPLES
Only two things have evidence for improved outcomes in cardiac arrest:
1. Chest compressions with minimal interruptions
2. Early defibrillation rather than delayed
No other clinical intervention has primacy over chest compressions and defibrillation.
If only one thing can be done, do chest compressions
The basic needs of the patient must be met to allow the next level to be effective
CHEST COMPRESSIONS
• Commence chest compressions immediately upon locating patient
• Second officer to set up for defibrillation & ventilations in an order
that suits the circumstances
• Only interrupt compressions to check pulse, perform analysis and
defibrillate
• Continue chest compressions immediately after each shock
SET-UP DEFIBRILLATOR within two minutes
• Second person concurrently sets up defibrillator and applies pads
• Do not check for a pulse or interpret ECG post shock
• Continue chest compressions immediately after shock
• Check for pulse only after two minutes of compressions
• Deliver shock as required
WITNESSED CARDIAC ARREST
NON-WITNESSED CARDIAC ARREST
No bystander
CPR
• CPR 2 mins
• DC Shock X1
• Repeat cycle as
required
• Where a defibrillator is immediately available,
DC shocks should be delivered in a single
cluster of up to 3 shocks in VF/VT
(Do not check for a pulse between shocks)
• Then 2 min cycles of CPR
• Subsequent DC shocks X1 as required
Effective bystander
CPR
• DC Shock X1
• CPR 2 mins
• Repeat cycle as
required
VENTILATIONS as soon as practicable
• Perform basic airway management
• Commence Bag Valve Mask (BVM) ventilations
• Ventilate on room air initially if attaching O2 causes a delay
ADJUNCTS
•
Perform advanced airway, IV and medications
without interrupting chest compressions
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CHEST COMPRESSIONS
•
Commence chest compressions if patient is unconscious with absent or gasping resps
•
Routinely rotate compressions role to reduce fatigue
•
If only one thing can be done perform chest compressions rather than inserting advanced
airways or IV’s.
AIRWAY
•
Default to oropharyngeal airway (OPA). Suction as required
•
Insert an advanced airway (ETT / LMA) prior to commencing an IV if there are only two
officers. One person CPR is more effective with a tied in airway than BVM
•
Insert advanced airway (ETT / LMA) without interrupting chest compressions.
Oxygenation is dependent upon good circulation
•
Mandatory CO2 detection can help identify malposition or dislodgement of an ETT
IV & PHARMACOLOGY
•
Cannulation and medication administration must not be at the expense of continuing
chest compressions.
•
After peripheral IV administration of medicines, flush to assist venous return
•
Medicines cannot circulate without chest compressions
RETURN OF SPONTANEOUS CIRCULATION (ROSC)
•
Feel for a pulse. The ECG is indicative of electrical activity only, and may appear normal
even in the absence of a pulse e.g. Pulseless Electrical Activity (PEA) / Electro
Mechanical Dissociation (EMD)
•
Continue ventilations as required
•
Continually repeat a primary survey
•
Continually re-assess the CO2 detector in intubated patients
•
If an alarm sounds on a defibrillator, check the patient to determine the need for CPR
and/or defibrillation
•
If unable to obtain BP, commence chest compressions
•
CPR may be required for inadequately perfused bradycardias, particularly in children
•
Skin colour / perfusion may take some minutes to improve
•
Pulse oximetry may take some minutes to indicate a change in the patients’ status
Reference: Australian Resuscitation Council Guidelines
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Issued by: Manager, Education
Circulation
Cardio-Pulmonary Resuscitation - CPR
Indication:
Cardiac arrest.
Diagnosis: Fig 1
1. Unconscious, absent or gasping respirations, absent pulses.
NOTE: If a pulse cannot be felt in 10sec’s or if uncertain whether a pulse
is present, start CPR.
Prepare the patient:
1. Position the patient in the supine posture on a firm, flat surface.
2. In pregnant patients >20 weeks place sufficient padding under right
buttock to give obvious tilt to the left.
3. Check and clear airway
4. Insert appropriate airway (OPA, NPA, LMA)
Fig 1
Method:
1. Deliver 2 rescue ventilations (each over one second sufficient to make
the chest rise).
2. Hand placement for External Chest Compressions;
Adults and
Younger
Infant (< 1)
Older
Children
if
pulse <60
children
(1-8)
(≥9)
if pulse <40
Place both
hands over
lower the half
of the sternum.
Fig 2
Place two fingers over the lower half
of the sternum (equates to centre of
the chest). When two officers are
performing CPR - use two thumbs
over lower half of sternum with
hands encircling thorax. Figs 4 & 5
3. Depress sternum 1/3 depth of chest. Allow for complete recoil of the
chest.
4. Rate 100 compressions per minute (almost 2 per second).
5. Compression to ventilation ratios
Adults and
Younger
Infant (< 1)
Older
Children
if pulse <60
children
(1-8)
(≥9)
if pulse <40
E.A.R.
15 comp’s to 2 vent’s
or
except in Newborns (<48 hrs)
30 comp’s
15 comp’s
Mask to 2 vent’s
to 2 vent’s
use
Vent’s
3 comp’s to 1 vent
ETT
5 comp’s to 1 vent
or
except in Newborns (<48 hrs)
10 comp’s
5 comp’s
LMA
to 1 vent
to 1 vent
use
in situ
3 comp’s to 1 vent
Fig 2
Place one or
both hands
over the lower
half of the
sternum. Fig 3
Fig 3
Fig 4
Each ventilation should be delivered over one second sufficient to make the
chest rise. Interruptions to chest compressions should be minimised.
Checking Effectiveness:
A palpable carotid or femoral pulse should occur with each compression, if
this does not occur, greater sternal depression is required. At 2 minute
intervals palpate for the return of a spontaneous pulse.
Never stop compressions for longer than 10 seconds except for the
defibrillation procedure.
Approved by:
Medical Director
November 2006
Fig 5
10 3.4
Ambulance Service of New South Wales
Page 1 of 1
Circulation
LifePak 12/15 ~ Pre-Shift Check
Indication:
Fig 1
At the commencement of every shift to ensure unit is fully
operational.
Check the unit visually:
•
Life Pak 12. Fig 1
•
Life Pak 15. Fig 1a
1. Inspect unit and accessories for physical damage.
2. Check monitor leads, defibrillation cable and connectors
for damage.
Fig 1a
Check consumables:
•
Two sets of in-date Quick combo defibrillation pads
•
Monitoring electrodes < 30 days since opening
•
Razor and paper towel
•
Spare paper roll
•
Adequate amount of recording paper in the printer
Battery care:
1. Press the soft key on the rear of the battery Fig.3
2. View the LED bars, if three bars or > battery is OK.
3. If < three LED bars remove battery and place in charger,
replace with fully charged battery.
4. READY light on charger indicates fully charged
Fig 2
5. FAILED light on charger indicates battery has failed the
charging process. This battery must be removed from
service and sent to the Medical Equipment Manager at
Regents Park for replacement. Enclose relevant details of
location and failure.
Fig 3
Approved by:
Manager Education
April 2009
103.5.1
Ambulance Service of New South Wales
Page 1 of 2
Circulation
LifePak 12/15 ~ Pre-Shift Check
Check mobile phone: (Specific project areas only)
1. Undamaged.
2. Same unit ID as Lifepak12’s.
3. Fully charged.
Test Unit:
1. Turn the unit on – press and hold the ON button Fig.4
Fig 4
2. Press OPTIONS button Fig. 5, scroll to USER TEST and
press SPEED DIAL
•
USER TEST in progress – displayed on screen, takes
30 seconds
•
Unit prints a test result strip
Attach this strip to daily vehicle check list
•
If USER TEST fails, decommission unit
Fig 5
Check time and date:
1. Make sure the unit time and MDT time correspond
2. Press OPTIONS button, scroll to DATE/TIME Fig. 6 and
press SPEED DIAL, scroll to adjust as required.
Turn unit off:
•
Press and hold the ON button until the unit turns off. Fig. 7
Fig 6
Occupational Health and Safety:
•
Compliance to relevant Infection Control, OH&S and
Manual Handling techniques and procedures
Fig 7
Approved by:
Manager Education
April 2009
103.5.1
Ambulance Service of New South Wales
Page 2 of 2
Circulation
LifePak 12/15 ~ 4 Lead Monitoring
Indication:
Patient requires cardiac monitoring.
Examples include Acute Coronary Syndrome (ACS), SOB, trauma,
decreased LOC, post syncope, dysrhythmias or any patient for whom a
cardiac event cannot be excluded.
Fig 1
Prepare the patient:
1.
2.
3.
4.
Explain to the patient what is about to happen.
Turn the unit on – press ON button.
Swab, abrade and dry electrode sites.
Connect monitoring leads to the unit Fig. 1
Attach the 4 monitoring leads to patient Fig. 2 and Fig. 4
The preferred positioning is:
• anterior aspect of the wrist and lower leg. Fig 3a and 3b
RA
Right wrist
RL
Right lower leg
LA
Left wrist
LL
Left lower leg
Fig 2
• alternate placement on the upper arms and thighs may be used
5. Adjust the volume if required:
• turn the SELECTOR/SPEED DIAL to locate HEART RATE indicator
(top left screen)
• press SELECTOR/SPEED DIAL and scroll to adjust the QRS
volume as required
• press the HOME button to exit menu.
Fig 3a
Mark Event
•
•
Use the functionality of the EVENT button is used to record important
events such as treatment and drug therapy. These events will appear on
the code summary when printed.
To access the function, press the EVENT button and scroll to select the
appropriate event – press more for additional options. Press the
SELECTOR/SPEED DIAL button to lock in event.
Fig 3b
Recording and obtaining a strip
The machine automatically records pre and post shock rhythms.
• to save an ECG as an event to memory – press the PRINT button twice,
or
• to obtain a hard copy- press PRINT button to run a length of ECG strip
and again to stop.
• press CODE SUMMARY button to print all critical event details at the
completion of the case
Always attach an ECG printout to the Medical Review and Hospital/Patient
copy’s of the PHCR and tick the box ECG attached
Fig 4
Occupational Health and Safety:
•
Compliance to relevant Infection Control, OH&S and Manual Handling
techniques and procedures.
Approved by:
Manager Education
April 2009
103.5.2
Ambulance Service of New South Wales
Page 1 of 1
Circulation
LifePak12/15 ~12 Lead Monitoring-Acquisition-Transmission
Fig 1 Lifepak 12
Indication:
Patient requires 12 lead cardiac monitoring.
Prepare the patient:
1.
2.
3.
4.
5.
6.
Explain to the patient what is about to happen.
Swab, abrade and dry electrode site
Ensure monitoring cable is plugged into the unit.
Turn the unit on – press and hold the ON button Fig. 1
Connect the chest leads to the 4 lead monitoring cables. Fig 2
Attach the 12 lead ECG electrodes to the patient. Figs 3 and 4
Limb leads
Chest leads
RA Right wrist
V1
Fourth intercostal space to the right of the
sternum
V2
Fourth intercostal space to the left of the
sternum
V3
Directly between leads V2 & V4
V4
Fifth intercostal space at left midclavicular line
V5
Level with lead V4 at left anterior axillary line
V6
Level with lead V5 at left midaxillary line
LA
Left wrist
RL
Right lower leg
LL
Left lower leg
Fig 1 Lifepak 15
Enter Patient Data:
1. Press the OPTIONS BUTTON
2. Using the SELECTOR/SPEED DIAL, press ‘patient’ enter
• Last name
• Age
• Sex
3. Press HOME screen button
Fig 2
Record patient ECG:
1. Ask patient to remain still during ECG recording
2. Press 12-LEAD BUTTON
3. Unit will acquire the 12 lead ECG and print a copy of the rhythm
strip
4. At the completion of the case, if a comprehensive copy of ECG /
treatment record is required press the CODE SUMMARY button
5. Ensure patients name, date of birth and incident number are on the
ECG strip, and attach a copy of the ECG to both hospital and
medical review copies of the PHCR
Approved by:
Manager Education
April 2009
Fig 3
103.5.3
Ambulance Service of New South Wales
Page 1 of 2
Circulation
LifePak12/15 ~12 Lead Monitoring-Acquisition-Transmission
PROJECT AREAS ONLY – ETAMI and THROMBOLYSIS
Fig 4
1. Press the TRANSMIT button. Fig 5
2. SEND is highlighted on the menu screen. Fig 6
3. Confirm the SITE for appropriate destination, if incorrect scroll to
SITE press the SPEED DIAL and adjust to select appropriate
destination. Fig 7
4. Once appropriate destination is confirmed and SEND is highlighted,
press the SELECTOR/SPEED DIAL. Fig 8
Fig 5
5. Unit will transmit the ECG and display a percentage transmission
rating at the bottom of the screen.
6. If the initial dialling fails to transmit, the unit will automatically re-dial
twice. If transmission failure occurs the machine will print
CALL NOT COMPLETED
In the event of transmission failure, immediately begin preparation
for transport, and attempt another transmission inside the
Ambulance. If this transmission fails proceed to the closest
Fig 6
appropriate hospital.
If transmission was successful, the receiving hospital will contact you.
• Identify yourself and the LP unit number eg. St Ives 2
• Doctor will then advise of the transport decision
• If a decision is made not to transport to the cardiac centre, please
advise the doctor as to where the patient will be transported
Hospital contact (Thrombolysis)
• Doctor will contact you and advise of STEMI pattern
• Proceed with treatment as per specific protocol
Fig 7
Record treatment
1. Press the EVENT button
2. Turn SELECTOR/SPEED DIAL and scroll to treatment screen,
press the selector to save treatment initiated
Handy Hint
At any time to exit a screen and return to main screen press the HOME
SCREEN button
Fig 8
Occupational Health and Safety:
•
Compliance to relevant Infection Control, OH&S and Manual
Handling techniques and procedures.
Approved by:
Manager Education
April 2009
103.5.3
Ambulance Service of New South Wales
Page 2 of 2
LifePak 12
Indication:
•
•
VF -Ventricular Fibrillation
VT -Ventricular Tachycardia
i.
Pulseless
ii.
Where the patient is unconscious and poorly perfused with
impalpable peripheral pulse
LifePak 15
Method:
1. Confirm cardiac arrest - unconscious, pulseless
2. Press GREEN ON button (Fig 1), unit defaults to monitoring mode
3. Press the LEAD button (Fig 2), unit will option to PADDLES, press
HOME button to confirm (Fig 11)
4. Expose chest, shave if necessary, abrade the pad placement sites and
apply defibrillation pads with rolling on motion to ensure complete skin
contact
Pad placement
Sternum pad
Apex pad
9 years or older
Below right clavicle
Lateral to apex of heart
8 years or younger
Anterior left chest
Posterior left chest
5. Energy selection; When switched on, the unit defaults to ADULT Joules
setting of 200 JOULES.
For PAEDIATRIC PATIENTS use ENERGY SELECT button (Fig 3a).
To enter joules selection mode, use either ENERGY SELECT button or
SPEED DIAL (Fig 3b)
Scroll to the required paediatric joule setting- 4 joules/kg (to nearest
machine setting). Do not exceed 200 joules.
Refer to Medication Reference Card to confirm paediatric joules
6. Connect defibrillation cable to pads.
DO NOT PRESS ANALYSE BUTTON.
IF ACTIVATED IN ERROR RESET TO MANUAL MODE BY PRESSING
ENERGY SELECT BUTTON AND CHECK/ RESET JOULE SETTING
7. Stop all patient movement, confirm with partner:
• patient pulseless
• pads and cable connected
• ECG rhythm
• joule setting is correct
!
#
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"% &$
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"
8. If the Unit detects a shockable rhythm;
• VF/VT icon will flash, (Fig 4), &
• check patient message will be displayed on the lower screen
an audible alarm may sound (unless alarm previously silenced)
9. Press CHARGE button (Fig 5)
10. Advise STAND CLEAR during charging and CONFIRM JOULES out loud
11. Press flashing SHOCK button immediately when illuminated (Fig 6a / b)
NOTE: If shock is not required, energy can be ‘dumped’ by pressing
either ENERGY SELECT button or SPEED DIAL.
CHECK/RESET CORRECT JOULE SETTING
12. Following DC shock, immediately commence CPR for 2 minutes without
checking for pulse.
Unit will re-analyse in approx 8-10 seconds and may sound audible alarm
if a shockable rhythm is detected. To silence during 2 minute CPR cycle,
press ALARM button twice (Fig 7)
CPR artefact may mimic a shockable rhythm and cause VF/VT alarm
to sound. If this occurs silence alarm and continue CPR for 2 minute
period
13 Approximately every 2 minutes repeat steps 7 to 12
If patient is in a non shockable rhythm or alarm has been silenced the
unit will NOT give a warning prompt that 2 minutes has elapsed. The
paramedic needs to monitor the time and check for a pulse/ confirm
rhythm at 2 minute intervals
Mark Event
•
Use the full functionality of EVENT button (Fig 8) to record important
events such as patient name, age, treatment and drug therapy. These
events will appear on code summary when printed
•
To access this function, press EVENT button and scroll to select
appropriate event – press more for additional options. Press selector /
speed dial button to lock in event.
Recording and obtaining a strip
Machine will automatically record:
•
initial rhythm
•
pre and post shock rhythm
•
at check patient prompts
!
#
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"% &$
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"
To capture an ECG as an event to memory – press PRINT button twice.
To obtain hard copy of ECG displayed on the screen press PRINT
Press CODE SUMMARY button to print all critical event details at
completion of case, a heart rate trend summary will also be printed.
Always attach an ECG printout to the Medical Review and Hospital/Patient
copy’s of the PHCR and tick box ECG attached
Options
• Lifepak 15 is equipped with a CPR metronome button (Fig 9), which
can be activated to assist with CPR and ventilation timing. When
selected the VF/VT alarm will be deactivated. To deactivate
metronome press CPR button, scroll to ‘stop metronome’, press
Selector/ speed dial button
•
LifePak 15 is equipped with a “sun view” screen. This can be used in
bright sun light conditions. To activate the sun screen press the SUN
button on right above selector dial (Fig 10)
•
If at any point you select a screen that is not required, press HOME
button Fig 11. This will navigate back to the main screen.
Occupational Health and Safety
Compliance to relevant Infection Control, OH&S and Manual Handling
techniques and procedures.
!
#
$
"% &$
'(
"
Issued by: Manager, Education
Circulation
Zoll M Series – Pre-Shift Check
Indication:
At the commencement of every shift to
ensure the unit is fully operational.
Check the unit visually:
Fig 1
Fig 2
The unit must contain the following items;
1. 2 sets of defibrillation pads, monitoring electrodes, recording paper in
tray & two spare packs, razor, paper towel, battery in unit and 1 spare.
Fig 3
1. Inspect the unit and accessories for
physical damage. Fig 1
2. Check monitor leads, defibrillation cable, AC power cord, and
connectors for damage. Fig 2
Check the unit’s consumables:
2. Check expiry date of monitoring electrodes. (30 days after opening
packet)
3. Check expiry date and correct pads for unit. Fig 3
Check unit battery and spares:
1. Remove battery from defibrillator and place in charger.
Fig 4
2. Remove spare battery from the side pocket and place into the
defibrillator. Fig 3
3. Remove spare battery from charger and place into side pocket.
Turn unit on:
1. Turn “POWER SWITCH” to the ON position. Fig 4
2. Confirm 4 self test beeps.
Fig 5
Test recorder, date & time:
1. Press “RECORDER” button. Fig 5
2. Print out a summary with the date and time.
3. Press “RECORDER” button again to turn off.
4. Check time against MDT clock. (printed on top edge of strip) Fig 6
5. Adjust time if necessary by turning power switch off for 10 seconds,
then on again whilst pressing the round soft key at lower right corner of
the screen, until time set functions appear. Fig 7
Fig 6
6. Set time and date by pressing appropriate soft keys.
7. Press “enter & return” soft key to go to main screen. Fig 7
Approved by:
Medical Director
February 2006
103.9.1
Ambulance Service of New South Wales
Page 1 of 2
Issued by: Manager, Education
Circulation
Zoll M Series – Pre-Shift Check
Test defibrillator:
1. Connect the defibrillation cable into the test load device. Fig 8
2. Press “ANALYZE” button. Fig 9
3. Unit will automatically charge to 30 Joules.
Fig 7
4. Press “SHOCK” button. Fig 10
5. Unit will display on screen “TEST OK” if no fault detected.
Erase summary:
1. Press and hold summary button for four seconds.
2. Press “Erase Summary” soft key. Fig 11
3. Unit will display on screen “Erasing Report”.
Fig 8
Turn monitor off:
1. Turn power switch to OFF
Fig 9
Fig 10
Fig 11
Approved by:
Medical Director
February 2006
103.9.1
Ambulance Service of New South Wales
Page 2 of 2
Issued by: Manager, Education
Circulation
Zoll M Series Battery Management
Indication:
This test MUST be conducted on each Zoll M Series battery monthly to
maintain performance and operating time of each battery.
Method:
The “ZOLL M Series Base Power Charger 4x4” (Charger) has four
battery compartments that are able to test and charge batteries
simultaneously and independently of each other.
Fig 1
Procedure to test a battery:
Fig 2
1. Check to see that the Charger is connected to live AC mains. The
POWER indicator light should be lit. Fig. 1
2. Insert a battery into any compartment. Make sure the battery is fully
seated, a click can be heard. Fig. 1
3. Press the TEST button for the appropriate compartment. The
TESTING indicator light will illuminate for the duration of the test
cycle. This test may take up to EIGHT hours “DO NOT REMOVE
THE BATTERY FROM THE CHARGER UNTIL THE TEST
IS COMPLETE” Fig. 2
4. If the battery passes the test, the BATT. READY light will illuminate
while the TESTING light remains lit Fig. 2
5. If a battery fails the test, the FAULT light will illuminate while the
TESTING light remains lit.
Fig 3
6. Repeat test and if the battery still fails again, attach a fault card to the
battery, the faulty battery should be sent to the stores maintenance unit
and a replacement battery ordered.
7. The test date MUST be recorded on the back of each battery. Fig.3
8. The date of the battery test is entered on the audit form (Attachment A)
which will be available on the Intranet forms register.
Responsibilities:
1. Station officers should ensure that staff perform this test each month
and the date of the test is entered on the record form (Attachment A),
then forward the completed forms (electronically or manually) to the
relevant Sector Office.
2. Sector managers are responsible for monitoring the procedure and
should report monthly data and outcomes to their respective Divisional
Manager.
3. Divisional Managers should ensure that quarterly data and information
regarding relevant actions are forwarded to the Patient Safety Manager.
Approved by:
Medical Director
February 2006
103.9.2
Ambulance Service of New South Wales
Page 1 of 1
Issued by: Manager, Education
Circulation
3 lead ECG Monitoring
Indication:
In situations where a patient requires cardiac monitoring, eg chest pain,
SOB, chest injury, decreased LOC, post syncope, abnormal heart rhythm.
Prepare the patient:
1. Explain to the patient what is about to happen.
2. Expose the chest.
3. Avoid placement of electrodes on areas with excessive hair or over a
bony prominence.
4. Shave, dry and abrade the electrode site.
5. Attach electrodes as follows: Figs 1,2 & 3
• Right chest - white lead beneath lateral aspect of clavicle
or right arm.
• Left chest - black lead beneath lateral third of the clavicle
or left arm.
• Left chest - red lead left costal margin, mid-clavicle line
or left leg.
Monitor patient and record:
1.
2.
3.
4.
Instruct patient to remain still.
Press “recorder” button (Zoll M Series illustrated).
Run a minimum of ten second strip. Fig 4
Confirm quality of hard copy.
Record patient details on hard copy:
Record the following:
• Patient surname and initials.
• Incident number. Fig 5
Approved by:
Medical Director
November 2006
103.9.3
Ambulance Service of New South Wales
Page 1 of 1
Circulation
ZOLL M/E Series ADVISORY Manual Defibrillation - Adult & Paediatric
Indications:
1. Cardiac Arrest with VF or VT
2. Wide QRS tachycardia. (VT) with a monitored rate >150, unconscious and
poorly perfused with impalpable peripheral pulse.
Method:
Fig 1
1. Confirm cardiac arrest.
2. Turn the power switch ON and press MANUAL MODE followed by
CONFIRM Figs 1, 2 & 3
3. Expose the chest, shave and abrade if necessary and apply defibrillation
pads with rolling on motion to ensure complete skin contact. Figs 5 & 6
Pad placement
Sternum pad
Apex pad
9 years or older
Below right clavicle
Lateral to apex of heart
Anterior left chest
Posterior left chest
8 years or younger
Fig 2
Fig 3
4. Joule setting for adult is defaulted at 150 joules
5. For paediatric patient use the ENERGY up/down button to select joules at 4
joules/kg to nearest joules setting but not exceeding 150 joules. Fig 4
Fig 4
NB. Refer to drug dose card to confirm paediatric joules
6. Connect pads to the defibrillation cable. Fig 7
7. Stop all patient movement e.g. stop vehicle and CPR
8. Advise “stand clear”, do not touch the patient or anything in contact with the
patient and make a visual scan of the area
9. Press ANALYSE
NB. In manual mode only ICP can press CHARGE when a shockable rhythm
is diagnosed
Fig 5
10. Re-advise everyone to “stand clear”
NB. If the unit diagnoses a shockable rhythm, it will automatically charge up
to the selected joules and prompt “PRESS SHOCK”. If a non-shockable
rhythm is diagnosed the unit will prompt “NO SHOCK ADVISED”
(Commence CPR - 2 min).
11. The SHOCK button will glow red and an audible tone will indicate when
shock is ready for delivery. Fig 8
Fig 6
NB. If the machine is charged and the charge is not required, the shock can
be dumped by changing and then resetting the joule setting.
Approved by:
Manager Education
September 2007
103.9.4
Ambulance Service of New South Wales
Page 1 of 2
Circulation
ZOLL M/E Series ADVISORY Manual Defibrillation - Adult & Paediatric
12. Advise “stand clear”, make a visual scan of the area and press SHOCK Fig 8
13. Immediately commence CPR - 2 minutes, and then check for return of pulse.
NB. If pulse present go to step 15. Fig 9
14. If pulse not present, continue cycle - Steps 7 to 12
15. Activate monitor alarm by pressing ALARM SUSPEND. Fig 10
Fig 7
16. If monitor alarm sounds and / or the machine says “CHECK PATIENT”;
•
Check the patient.
•
Confirm if patient is in cardiac arrest.
•
Follow steps 7 to 15.
•
Turn off monitor alarm by holding down “ALARM SUSPEND” for four
seconds. Fig 10
Fig 8
Record:
The unit automatically records pre and post shock rhythms. To record other
rhythms such as asystole, press the “RECORD” button twice as the event
occurs.
The unit will hold a six-second strip in memory for a summary report or pressing
record and obtaining a strip, or by pressing the code marker soft key once (this
Fig 9
will be recorded as Code-marker Default on the summary).
You are encouraged to use the full functionality of the Code Marker button to
record important events such as drug therapy. To do this press the Code Marker
soft key then select the appropriate soft key that corresponds to the event –
press more for additional options.
Fig 10
Summary:
At the completion of the event, press the “SUMMARY” button, and select soft
keys “print chart” then “print all” (or “print range” for specific periods). The event
will remain in the memory until erased. To erase the memory press and hold the
“SUMMARY” button for four seconds. Then press the “CONFIRM” soft key. An
“ERASING REPORT” message will appear in the display.
Occupational Health and Safety
•
Compliance to relevant Infection Control, OH&S and Manual Handling
techniques and procedures.
Approved by:
Manager Education
September 2007
103.9.4
Ambulance Service of New South Wales
Page 2 of 2
Circulation
Synchronised Cardioversion - Adult & Paediatric
Indications:
•
In the peri-arrest setting if the patient is unstable and deteriorating
with adverse features caused by the tachycardia
•
Patients presenting with signs and symptoms of unstable
tachyarrhythmia as per ASNSW Protocol C8 – DysrhythmiasTachycardia
ZOLL
•
Informed consent must be obtained prior to procedural sedation and
cardioversion being performed on a conscious patient
Sync markers on R waves
Method:
1. Apply monitoring electrodes/leads - If necessary remove clothing, dry
and shave skin
2. Employ strategies to reduce artifact
ZOLL
3. Confirm indications exist – consider sedation
4. Expose the chest, apply defibrillation pads with rolling on motion to
ensure complete skin contact - shave and abrade if necessary
Pad placement
Sternum pad
Apex pad
9 years or older
Below right clavicle
Lateral to apex of heart
Anterior left chest
Posterior left chest
8 years or younger
5. Connect pads to the defibrillation cable
LIFEPAK
6. ZOLL - Press MANUAL MODE followed by CONFIRM soft keys.
7. Press SYNC soft key (Zoll and LIFEPAK) – confirm that screen shows
Sync markers on R waves
SYNC and that a sync marker appears on each ‘R’ wave. If ‘R’ wave
is not detected adjust ECG size until marker is visible
8. Select initial energy setting by using the ENERGY SELECT up/down
button
Patient >16yrs
Patient < 15yrs
1st shock = 100J
1st shock = 0.5-1J/kg
2nd shock = 150J
2nd shock = 2J/kg
3rd shock = 200J
3rd shock = 2J/kg
9. Advise “stand clear”, do not touch the patient or anything in contact
LIFEPAK
with the patient and make a visual scan of the area.
Approved by:
Manager Education
January 2011
103.9.5
Ambulance Service of New South Wales
Page 1 of 2
Circulation
Synchronised Cardioversion - Adult & Paediatric
10. Press CHARGE button
11. The machine will charge up to the selected joules and prompt “PRESS SHOCK”. The SHOCK button
will glow red and an audible tone will indicate when shock is ready for delivery
NB. If the machine is charged and the energy is not required, it can be dumped by changing and then
resetting the joule setting.
12. Press and HOLD the SHOCK button until shock is delivered
13. Immediately following the shock the machine defaults to DEFIB mode. This is so that defibrillation can
occur, if required, without delay if patient goes into VF or pulseless VT, select the correct energy and
proceed with defibrillation skill 103.9.4
14. Reassess patient and if further synchronised cardioversion is required go to point 7 and escalate the
energy as required
Record:
The unit automatically records pre and post shock rhythms. To record other rhythms, print out current
rhythm or press the printer button twice as the event occurs which will save this in the memory.
Summary:
At the completion of the case print a summary and attach report to PHCR.
Approved by:
Manager Education
January 2011
103.9.5
Ambulance Service of New South Wales
Page 2 of 2
Issued by: Manager, Education
Circulation
ZOLL AED Pro
Pre Shift Check:
1. Visual Check unit for damage.
2. Check Green Tick in “Ready Indicator” is activated. Fig 1
3. If a red cross is visible, two causes can be rectified:
• electrode connection - reconnect
• battery charge – change battery
To re-test, turn the unit on allowing a self test to be performed. If the
Green Tick does not re-appear, the unit is to be deemed defective
4. Open unit and check stat-padz II defibrillator pads expiry date. Fig 2
5. Check stat-padz II defibrillator pads are plugged into the unit. Fig 3
6. Check ECG leads and electrodes
7. Repack ECG leads and defibrillator pads and close unit.
ON/OFF
Fig 1
Note: Zoll stat-padz II defibrillator pads are for adult patients only;
DO NOT use adult padz on patients under 8 years of age. Paediatric
pads are only supplied to designated units
Indication:
•
•
Fig 2
Monitoring a patient where no other cardiac monitor is available.
Patient collapsed in cardiac arrest where no other defibrillator is
available.
Resuscitation - AED Mode
NON Witnessed Arrest
1. Expose the patient’s chest and immediately commence CPR.
2. Activate ZOLL AED Pro by pressing green ON/OFF button. Fig 1
3. Follow audible & screen prompts.
4. Apply stat-padz (shave and dry if required).
5. Continue following audible & screen prompts, with a single shock at 2
minute intervals if required.
6. Do not turn off until required information about number of shocks and
elapsed time has been noted.
7. In a non-witnessed arrest with effective CPR in progress, switch unit to
manual mode
A Patient Arrest with effective CPR in progress
1. Activate ZOLL AED Pro by pressing green ON/OFF button.
2. Confirm the Arrest and once the stat-padz are in place (shave and dry
chest if required), Press the right soft key marked “ANALYZE”.
3. Follow audible & screen prompts, with a single shock at 2-minute
intervals if required.
4. Do not turn off until required information about number of shocks and
elapsed time has been noted.
Approved by:
Manager Education
September 2007
Fig 3
Screen
Defib button
Fig 4
Soft Keys
103.9.6
Ambulance Service of New South Wales
Page 1 of 2
Issued by: Manager, Education
Circulation
ZOLL AED Pro
Witnessed Arrest – Manual Mode
1. Expose the patient’s chest.
2. Activate ZOLL AED Pro by pressing green ON/OFF. Apply stat-padz
(shave and dry chest if required). Press and hold both black soft keys for
4 seconds, then select and press “MANUAL” soft key. Unit is now in
MANUAL mode.
3. Ensure the “Check Patient” prompt is on screen (audio prompt should
also be heard). Note that “CHECK PATIENT” prompt will appear
for VF, VT (150+) and Asystole.
4. Unless Asystole, press the CHARGE button (left black soft key) Fig 4
5. If patient remains in a shockable rhythm (ensure “CHECK
PATIENT” prompt on screen and it is not Asystole) deliver up to 3
shocks if required.
6. Press and hold right soft key until voice prompt “Release Right Soft
Key”. This will require you to hold the key for 10 seconds. Unit is now
back in SEMI-AUTO mode.
7. Continue following audible & screen prompts, with a single shock at 2minute intervals if required.
8. Do not turn off until required information about number of shocks and
elapsed time has been noted.
Note: Should a Zoll M-Series become available during the arrest the statpadz II defibrillator pads can be left on the patient and connected to the
Zoll M-Series.
Monitoring a conscious patient:
1. Unplug stat-padz II defibrillator pads from the unit and plug in the
monitoring cable/leads
2. Attach monitoring dots, apply dots to the patient
3. Activate ZOLL AED Pro by pressing green ON/OFF button.
After use:
Turn unit off, replace used items, complete a Pre-shift Check.
•
IMPORTANT
Defibrillator/monitors detect electrical activity only. The attending officers
should manually assess patients for the presence and rate of a pulse.
Defibrillation should only be given to unconscious patients who have no
pulse.
Approved by:
Manager Education
September 2007
103.9.6
Ambulance Service of New South Wales
Page 2 of 2
Issued by: Manager, Education
Circulation
ZOLL AED PLUS
Pre Shift Check:
1. Visual Check unit for damage.
2. Check Green Tick in “Ready Indicator” is activated. Fig 1
3. Open unit and check stat-padz II defibrillator pads expiry date. Fig 2
4. Check stat-padz II defibrillator pads are plugged into the unit. Fig 3
5. Repack and replace lid.
Note: Zoll stat-padz II defibrillator pads are for adult patients only;
DO NOT use them on patients under 8 years of age
Fig 1
Indication:
•
Patient collapsed in cardiac arrest where no other defibrillator is
available.
Resuscitation
Fig 2
NON Witnessed Arrest
1. Expose the patient’s chest and immediately commence CPR for 2
minutes. This step can be excluded if 2 minutes of CPR has been already
performed.
2. Activate ZOLL AED Plus by pressing green ON/OFF button. Fig 4
3. Follow audible & screen prompts, shave and dry if required, apply statpadz.
4. Do not turn off until required information about number of shocks and
elapsed time has been noted.
Fig 3
Witnessed Arrest
1. Expose the patient’s chest.
2. Activate ZOLL AED Plus by pressing green ON/OFF button. Fig 4
3. Follow audible & screen prompts, shave and dry if required, apply statpadz.
4. Do not turn off until required information about number of shocks and
elapsed time has been noted.
Fig 4
After use:
1. Turn unit off
2. Complete a Pre-shift Check
3. Contact the Equipment Support Officers at Rozelle to arrange an
exchange unit which will be sent to your location. Clinical data will be
downloaded from the unit
Note:
Should a Zoll M-Series become available during the arrest the stat-padz II defibrillator pads can be left on the
patient and connected to the Zoll M-Series
103.9.7
Approved by:
Medical Director
November 2006
Page 1 of 1
Ambulance Service of New South Wales
Miscellaneous
Valsalva Manoeuvre
Indication.
Symptomatic supraventricular tachycardia.
Method
The Valsalva manoeuvre is performed by forcibly exhaling against
a closed glottis (a closed airway).
Fig 1
Cannulate patient prior to conducting the Valsalva manoeuvre.
Ideally the patient should be placed on the stretcher.
Record a continuous ECG strip during the procedure and attach to
PHCR.
Option 1
•
Using a 20ml syringe pull the plunger 1/2 way out. Fig 1
•
Have the patient seal their lips around the “Luer Lock “ end
of the syringe and instruct patient to blow against the
resistance for as long as they can comfortably perform Fig 2
Fig 2
Option 2
•
Have patient curl their fingers on both hands and then link
both hands together in front of their chest Fig 3
•
Advise patient to take and hold a deep breath and then try
to forcibly pull their hands apart Fig 4
Fig 3
Do not perform carotid sinus massage due to the risk of cardiac
complications in the field, and the risk of dislodgement of plaque
leading to a stroke.
Occupational Health and Safety:
Fig 4
Compliance with relevant Infection Control, OH&S and Manual
Handling techniques and procedures
103.10
Approved by:
Manager Education
November 2008
Page 1 of 1
Ambulance Service of New South Wales
Patient Assessment
Primary Survey
Indication
ALL patient contacts
Method
The primary survey is a “snap shot” of the patients condition, it takes approximately 90 seconds to
complete, and includes a clinical risk identification tool (Worthing Physiological Scoring System).
•
Adopt a “treat as you go” approach
•
Identify problems found and initiate treatment immediately
1. Initial impression/global overview of patient
• Reaction to greeting from paramedic
• Appropriateness of initial verbal response
• Initial perfusion and posture of patient
• Presence of obvious distress or discomfort
Key Area
2. Airway
+ spinal management if
required
How to assess
9 Check consciousness
9 Assess ability to take a deep
breath
9 Assess ability to speak a full
sentence
(measure in ‘word’, ‘phrase’ or
‘sentence’)
What to look for
•
•
Actual Obstruction
° Complete = silence
° Partial = noisy breathing,
snoring, gurgling, stridor
° Foreign bodies
° Swelling
° Traumatic injury
Potential Obstruction
° Swelling (allergic reactions, burns,
infection, trauma)
Refer to Skill 101.1 Airway Management
3. Breathing
9 Look, listen & feel
9 Accurately count respiratory rate
(15 seconds x 4)
9 Assess work of breathing
(effort & efficacy)
9 Auscultate chest for breath
sounds
•
•
•
•
•
Increased respiratory effort
° Tachypnoea
° Use of accessory muscles
° Intercostal recession
Decreased respiratory effort
Decreased air entry (unilateral/bilateral)
Abnormal (adventitious) breath sounds
° Wheeze (unilateral or bilateral)
° Crackle (unilateral or bilateral)
Fatigue, cyanosis, hypoxia
Refer to Skill 102.1 Inspiratory
Assistance
4. Circulation
+ arrest life threatening
haemorrhage
9 Examine for life-threatening
haemorrhage
9 Accurately count pulse rate
(15 seconds x 4)
9 Assess peripheral & central
perfusion
ƒ Skin temperature
ƒ Skin colour
ƒ Central & peripheral cap refill
ƒ Pulse volume & rhythm
•
•
•
•
•
Uncontrollable haemorrhage
Tachycardia
Bradycardia
Poor brain perfusion
° Restlessness or Altered LOC
Poor Skin perfusion
° Cold, Pale, Sweaty,
° Capillary refill > 2 seconds
Refer to Protocol T10
104.1
Approved by:
Manager Education
July 2009 v3
Page 1 of 3
Ambulance Service of New South Wales
Patient Assessment
Key Area
Primary Survey
How to assess
5.
Disability/Dysfunction
(neurological)
9
9
9
9
Measure LOC (AVPU or GCS)
Check pupil size & function
Assess ability to walk, if
appropriate to do so
Assess ability to move limbs
What to look for
•
•
•
•
•
Altered LOC
History of loss of consciousness
Pain
Poor co-ordination or balance
Unsteady gait
Rash or petechiae
Contusions or discolouration
Signs of injury
6.
Exposure/Environment
9
9
Expose and inspect torso
Expose and inspect limbs
•
•
•
7. Focused History &
Adjuncts
9
9
9
9
9
9
Blood Pressure
BGL
Pulse oximetry
Measure tympanic temperature
ECG
Calculate Worthing Physiological
Score
• Systolic and Diastolic
• < 4 mmol/l or >17mmol/l
• Assess patients condition, respiratory effort,
tidal volume etc
o
o
• <36.0 C or >38.5 C
• Dysrhythmias
• Score > 1 = transport
8. Ask questions
• What is the main problem you have called the ambulance for today?
• Do you currently have chest pain or breathing difficulty?
• With respect to the problem that you called the ambulance for today:
¾ When did it start?
¾ What were you doing when it started?
¾ How severe is it at the moment?
¾ Is it getting better or worse?
Positive and Negative Primary Survey
This survey identifies those patients who require transport for treatment at definitive care
Positive:
If on initial presentation, a problem is identified at A, B, C, D or E which indicates a
patient at risk, irrespective of any pre-existing medical condition.
Negative:
No problem is identified at A, B, C, D or E which indicates the patient is NOT at risk.
Note: If the primary survey is positive patient transport should be strongly recommended.
Clinical Risk Identification Tool
The Worthing Physiological Scoring System is a vital clinical risk assessment tool along with the
primary survey relies on the accurate measurement of specific vital signs. Respiratory rate is the most
sensitive sign of illness and is incorporated in this tool.
Any abnormality leading to a Worthing Score of 2 or more is automatically positive and represents a
patient at risk that requires ongoing care and transport to an Emergency Department.
104.1
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July 2009 v3
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Ambulance Service of New South Wales
Patient Assessment
Cumulative Scoring System
Primary Survey
0, 1 - Well
2, 3, 4 - At Risk
> 5 – Critical
The Worthing Physiological Scoring System is to be routinely applied on scene and during transport.
This is required for ALL patients 16 years of age and over with the initial score to be documented on
the PHCR.
Repeated Examinations
Repeated and documented primary survey examinations and physical observations must occur.
Changing trends in respiratory rate, pulse rate, level of consciousness etc will demonstrate if the patient
is responding to treatment, improving or deteriorating.
The best tool available to all clinicians for assessing and monitoring illness/injury, regardless of the
setting, is repeated, accurate physiological observations.
“Above all, repeat the primary survey, measure observations accurately,
and record them on the PHCR”
Occupational Health and Safety
Compliance with relevant infection control, OH&S and manual handling techniques and procedures
104.1
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July 2009 v3
Page 3 of 3
Ambulance Service of New South Wales
Patient Assessment
Secondary Survey
Indication
ALL patient contacts following the completion of the primary survey
Method
The secondary survey is a comprehensive head to toe assessment which incorporates a look,
listen and feel approach designed to identify and rectify other injuries/illness not identified in the
primary survey.
Do not move the head until you have checked the patient's neck and if necessary immobilise the C Spine
Key Area
Head
How to assess using a
professional teamwork approach
9 Local trauma posteriorly /
laterally
9 Assess pupils using pupil torch
9 Ask patient to bite and to run
the tongue around inside of
teeth
What to look for
•
•
•
•
Neck
9 Local trauma
9 Assess spinal cord function
9 Assess jugular vein for
distension
•
•
•
•
Chest
9 Local trauma
9 Assess chest movement
9 Gently spring the ribs
•
•
•
•
•
•
Abdomen
Pelvis
9 Local trauma
9 Palpate the abdomen across all
regions
9 Local trauma
•
•
•
•
•
Swelling, tenderness, deformity,
contusions, abrasions and
lacerations (STDCAL)
Pupils for size, equal or unequal and
reaction to light (PEARL)
Look in nose and ears for blood,
foreign bodies and CSF leaks
Facial fractures
STDCAL
Ability of patient to squeeze both
hands, wiggle toes
Presence of numbness or tingling or
any altered sensation.
DO NOT CLINICALLY “CLEAR” THE
CERVICAL SPINE
STDCAL
Pneumothorax / Haemothorax
Tension Pneumothorax
Sucking chest wound
Subcutaneous emphysema, tracheal
deviation
‘See-saw’ breathing or paradoxical
segment with a flail chest
Any unequal chest movement
STDCAL
Assess for distension, rigidity,
guarding
Palpate the presence of femoral
pulses
STDCAL
Patient MUST NOT have their pelvis
“sprung” or compressed.
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July 2009 v3
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Ambulance Service of New South Wales
Patient Assessment
Key Area
Upper and
Lower limbs
Secondary Survey
How to assess using a
professional teamwork approach
9 Local trauma
9 Assess distal perfusion and
pulses
What to look for
•
•
STDCAL
If no fracture or dislocation is
suspected confirm by asking the
patient to move each limb
Ensure palpation of all bones is
performed, e.g. upper limb from
clavicle and scapula to fingers
•
Back and Spine
9 Maintain spinal alignment
9 Check in natural hollows for
trauma
9 Palpate carefully along the
spine for tenderness and
deformity
Take the History
9 Record chief complaint
9 Assess pain
9 Ascertain treatment given prior
to your arrival
9 If the patient was unconscious
prior to your arrival, was it
continuous and how long
9 Obtain an AMPLE history
During the physical
examination take a
history from the
patient, relative or
bystander
Patient
Reassessment
The need for regular reassessment and
monitoring of the patient including
repeat observations should be
considered in the light of:
•
•
STDCAL
Log roll patient towards you to look
for trauma, include the back of head
and buttocks
• Assess pain with the PQRST system
P - provoking factors
Q - quality
R - region or radiation
S - severity
T - time of onset and duration
•
•
•
History with the AMPLE system
A - allergies to anything
M - medications currently taken
P - previous illness
L - last meal taken
E- events leading up to this incident
ABCDE reassessed
Observation and recording of vital
signs
9 Clinical interventions
undertaken prior to and during
transport
9 Nature of underlying
illness/injury
9 Time for transport for definitive
diagnosis and management
The best tool available to all clinicians for assessing and monitoring illness/injury, regardless of
the setting, is repetitious and accurate physiological examinations and observations.
Occupational Health and Safety
Compliance with relevant infection control, OH&S and manual handling techniques and
procedures.
104.1
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Manager Education
July 2009 v3
Page 2 of 2
Ambulance Service of New South Wales
Issued by: Manager, Education
Patient Assessment
Patient Handover
Indication:
•
•
Transfer of patient information between members of the public, other emergency agencies,
paramedics and allied health professionals.
Acknowledged transfer and final handover of your patient to another health care professional.
Receiving a handover:
•
•
•
Using active listening allow the person to complete their handover, information from witnesses
can be very useful and otherwise impossible to find out.
If urgent treatment is required, inform bystander of the importance of any information they may
be able to provide and ask them if they can wait at the scene until we can give them our full
attention
Thank the bystander(s) and consider issuing a Trauma Support Brochure.
Handover with Health Professionals:
1. Handover should be performed by the treating officer where possible
2. Consult with the Carer, Nurse, Medical Officer or the Ambulance Release Team (ART) and ensure that
they are ready to receive handover information
3. Communicate handover information incorporating the MIST format
• Introduction – Patient’s name, age and pre-hospital provisional diagnosis
M Medical history or mechanism of injury,
I Illness or injuries
S Signs and symptoms
T Treatment and times
• Other information as relevant, presence of infectious diseases, accompanying medications,
medical notes or imaging results
• Confirm the receivers understanding and ask if they would like any further information
With intubated patients it is a mandatory requirement to have a Doctor confirm ETT
placement immediately following the transfer of the patient to another bed. Note the time and
Doctors name on the PHCR.
4. After arrival at a Health Care Facility, and while the patient remains on the ambulance stretcher,
Paramedics must continue to monitor and record patient observations. Vital signs are to be
completed at frequent intervals according to the patient’s clinical condition.
5. One officer should remain with the patient. If any patient requires ongoing intervention whilst
awaiting a bed, the circumstances of shared care should be negotiated with the hospital staff. All
treatment and vital signs recorded by Paramedics whilst waiting for a bed must be in accordance
with ASNSW protocols and recorded on our Patient Health Care Record.
6. At any stage if there are concerns regarding the condition of the patient immediately notify
hospital staff to allow for re-triage.
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April 2008
104.1.1
Page 1 of 1
Ambulance Service of New South Wales
Patient Assessment
Patient Escorts
Indication:
•
Inter facility transport requiring Medical/ Nurse escort.
Plan the transfer:
•
•
•
•
•
•
•
•
•
Assess information from Operations Centre regarding the patient and transfer
circumstances.
Consider equipment that may be required en-route or for extended time periods. Eg fuel,
O2 levels, power inverter, extra monitor battery, child seat etc
Meet with medical staff to discuss patients condition and on-going clinical treatment/needs
required during transfer, for example :
Medications in TABLETS bag
Advanced care directives.
Ensure all documentation accompanies the patient.
The paramedic confirms a clinical care plan and clarify the individual roles that the
Medical/Nurse escort and the paramedic will play in providing on-going care during the
transfer
Provide orientation to ambulance vehicle and equipment for escort staff.
Explain transfer arrangements to patients’ relatives/ friends.
En-route.
•
•
•
Ensure personnel and equipment is secure.
Take vital signs at a frequency commensurate with patients’ condition. Record at least two
sets of observations and no less frequently than they were receiving prior to departure.
Where a drug is administered by an escort or paramedic, it should be noted on the
Ambulance Services PHCR.
Recognition and management of the rapidly deteriorating patient.
•
Use of Ambulance Service equipment is the responsibility of the paramedic. Medical
equipment and application of skills outside the paramedics’ scope of practice is the
responsibility of the escort.
• The Paramedic always has a responsibility for the patients’ condition whilst they are in
Ambulance care. However, depending on the circumstances of the transfer, the condition
of the patient and the relative training and abilities of the individual Paramedic and escorts,
either can be next to the patient as all are in their immediate presence in the vehicle.
• The paramedic in conjunction with the escort must share information, observe the patient,
monitor and record a full history and vital signs on the Patient Health Care Record as per
a non-escorted case.
• Should a patient deteriorate, the paramedic and escort should work as a team in
accordance with the agreed care plan and within the scope of their clinical practice.
• Consideration should be given to calling for back-up, or diverting to a closer facility. Any
changes to the transport plan must be notified to the Ambulance Operations Centre.
• To rapidly recognise and manage the deteriorating patient, monitoring and resuscitative
equipment must accompany the patient out of and into each hospital particularly in large
institutions and lifts.
Occupational Health & Safety
•
Compliance with relevant infection control, OH&S and manual handling techniques
and procedures.
Approved by:
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November 2008
104.1.2
Page 1 of 1
Ambulance Service of New South Wales
Issued by: Manager, Education
Patient Assessment
Pulse Measurement
Indication:
As part of patient assessment in accordance with Service protocol
and procedure where taking a patient’s pulse is indicated.
Prepare the patient:
1. Explain what you are about to do and reassure the patient.
•
In primary patient assessment it is sufficient to ascertain
whether a carotid pulse is present or absent, its regularity, rate
and volume.
Prepare the equipment:
Fig 1
1. Have a watch or clock in clear view.
Take the patient’s pulse:
1. Locate various pulse points and select the most appropriate.
• A normal pulse is taken at various points when moving down
the body in the secondary assessment.
2. Expose the selected area and place 2-3 fingers on the pulse point.
• Take a precise measurement in secondary patient assessment.
(Fig 1)
• The most common place to palpate for the pulse on an adult
patient is on the wrist, along the radial artery. If you cannot
feel a pulse on either wrist, you should then locate the carotid
artery in the neck. The carotid pulse is easier to locate than the
radial, especially if the patient has a low blood pressure. To find
the carotid pulse, first locate the Adam’s apple in the front of
the neck, then slide your index and middle fingers along the
side of the neck until the pulse is felt.
3. Assess pulse strength i.e. strong or weak.
4. Assess pulse regularity i.e. regular or irregular.
5. Assess pulse rate.
Record pulse information:
1. Record findings on Patient Health Care Record.
Normal Pulse Rates in Infants and Children
Age
Range
Newborn
Infant
1 to 3 years
3 to 5 years
10 to 15 years
Over 15 years
120 to 160/minute
120 to 140/minute
100 to 120/minute
80 to 100/minute
60 to 90/minute
Refer to Protcol 42
Approved by:
Medical Director
December 2003
104.2
Ambulance Service of New South Wales
Issued by: Manager, Education
Patient Assessment
Chest Measurements - Palpation and Auscultation
Indication:
As part of patient assessment in accordance with Service protocol,
where measurement of respiratory status is indicated.
Prepare the patient:
1. Explain what you are about to do and reassure the patient.
2. Posture patient in accordance with Skill Sheet 110.7.
Prepare the equipment:
Fig 1
1. Have a watch or clock in clear view.
Observation of respirations:
1. In primary patient assessment observe that the patient has an
adequate respiratory rate and depth by placing hand/s across the
chest, measuring visually and manually. (Fig 1)
• Respirations should be regular and inaudible.
2. Count respirations for one minute by observing the rise and fall of
chest.
3. Measure the equality of chest movement by placing hands with
thumbs along the right and left midclavicular line observing the
rise and fall of both chest sides. (Fig 2)
4. Assess whether the accessory muscles are being used.
• Overuse of accessory muscles could indicate respiratory
distress.
Fig 2
1
2
3
4
5
6
5. Listen for abnormal breath sounds.
• Document findings on the Patient Health Care Record.
Palpate the chest:
1. Use fingers to feel along the thoracic landmark and assess
whether they are equal in symmetry and firmness.
2. Look and feel for lacerations, swelling, deformity, tenderness or
flail segments.
Auscultate the chest:
Fig 3
1. Ask the patient to breathe through the mouth if possible.
2. Using the diaphragm of the stethoscope, auscultate in the
sequence depicted.
3. Compare the pairs of auscultation points.
• Minimum of two respiratory cycles for each auscultation point.
4. Record any abnormal sounds and identify the lung field in which
they occur. (Fig 3)
Approved by:
Medical Director
December 2003
104.3
Ambulance Service of New South Wales
Issued by: Manager, Education
Patient Assessment
Abdominal Assessment
Indication:
Examination of the abdomen during the secondary assessment.
Fig 1
Prepare the patient:
1. Reassure the patient and explain what you are about to do.
2. Posture the patient supine where possible.
3. Expose the abdomen.
Examine the abdomen:
• Physical examination of the abdomen is only one part of the
patient’s history. Mechanism of injury, bystander information
and physical evidence need to be considered as well. (Fig 1)
Fig 2
1. Lacerations, swelling, deformity, tenderness.
2. Examine for the presence of penetrating injury, impaled objects
and obvious bleeding.
• The most reliable indicator of intra-abdominal bleeding is
unexplained shock.
Palpate the abdomen:
1. Using fingers in a kneading motion, palpate the abdomen across
the quadrants from the top working downwards. (Fig 2)
• Do not test for rebound tenderness as it can antagonise some
underlying conditions.
2. Record any distension, rigidity and tenderness identifying the
quadrant it was detected in.
• Recording of an abdominal defect without stating its location
and nature is an imprecise assessment.
Approved by:
Medical Director
December 2003
104.4
Ambulance Service of New South Wales
Issued by: Manager, Education
Patient Assessment
Blood Pressure Measurement
Indication:
In situations where measurement of the blood pressure of a patient is
required.
Prepare the patient:
1. Explain what you are about to do and reassure the patient.
2. Posture patient according to Skill Sheet 110.1/9.
Fig 1
3. Place the selected arm with the palm of the hand facing forward (up).
4. Keep elbow slightly bent.
5. Remove clothing or restriction from arm.
• Do not take blood pressure on an arm with an arterio/venous
fistula, a mastectomy, or haemophiliac patients.
Application of sphygmomanometer cuff: (Fig 1)
1. Place cuff around arm, slightly above elbow, making sure the
arrows on the cuff are over the brachial artery.
• The width of the cuff should be at least two-thirds the size of
the patient’s upper arm.
2. Fasten the cuff around the arm.
Take patient’s blood pressure:
1. Locate appropriate pulse point i.e. brachial or radial.
Fig 2
Palpation Method:
1. Inflate cuff to 30 mmHg above the cessation of peripheral pulse.
2. Deflate cuff slowly until pulse returns and note pressure.
3. Deflate cuff completely. (Fig 2)
Auscultation Method:
1. Locate and place diaphragm over brachial pulse point.
Check that stethoscope has earpieces facing slightly forward and
ensure listening is via diaphragm.
2. Inflate cuff to 30 mmHg higher than previous systolic reading.
3. Deflate the cuff slowly until pulse sounds begin and note the
systolic pressure at this point.
Fig 3
4. Continue to deflate slowly until pulse sounds cease and note
diastolic pressure at this point.
5. Deflate cuff completely. (Fig 3)
6. Document blood pressure recordings on Patient Health Care
Record.
Approved by:
Medical Director
December 2003
104.5
Ambulance Service of New South Wales
Issued by: Manager, Education
Jugular Vein Assessment
Patient Assessment
Indication:
As required in assessment of patient.
Fig 1
Prepare the patient:
1. Reassure the patient and explain what you are about to do.
2. Posture the patient sitting at approximately a 45˚ angle.
3. Ask the patient to turn their head away from the side to be
examined. (Fig 1)
Determine the jugular vein perfusion:
Fig 2
1. Examine the jugular vein for distention.
• The jugular vein should not be distended in a normal patient
at sitting angles greater than 45˚.
2. When it is not distended - occlude the jugular vein where it
emerges above the patient’s clavicle to cause distention. (Fig 2)
3. Remove finger and examine the jugular vein to see whether or not
it remains distended.
Approved by:
Medical Director
December 2003
104.7
Ambulance Service of New South Wales
Issued by: Manager, Education
Patient Assessment
Temperature Measurement -Tympanic Thermometer
Indication:
In situations where the measurement of a patient’s temperature is required.
Prior to operating the tympanic thermometer
Familiarise yourself with the manufacturer’s instructions. Ensure you
understand the operation of the device and the meaning of the various
display codes.
Prepare the patient:
Explain to the patient what you are about to do and reassure them.
Fig 1
Method:
1. Check that probe tip and lens are clean. If necessary, clean with alcohol
wipe and allow to dry. Fig 1
2. Push probe into new cover and wait for ready signal “beep”. Fig 2
Fig 2
3. Fit the probe snugly into the ear canal.
• Adults – gently pull ear lobe back slightly
• Paeds – gently pull ear lobe up and back slightly
4. Press and release the “start” button and wait a few seconds. After long
“beep” remove probe. Fig 3.
5. Check temperature display and compare against normal tympanic
temperature.
NB. Temperature may vary due to:
• Time of day
• Exercise activity
• Medications
• Patient’s age or gender
6. Press eject button and dispose of probe cover. Fig 5.
Fig 3
Fig 4
Check previous measurements by pressing “I/O mem”.
7. Turn off by pressing “I/O mem” for 3 seconds or wait 60 seconds.
Inaccurate measurement
If error occurs, e.g. “POS” (position error) on display, turn off and start
again. If error continues adjust or replace batteries. Fig 6.
If error still continues check instructions or defect machine.
Reasons for inaccurate measurement may include:
• Low battery power
• Probe not inserted snugly
• Probe cover not attached
• Probe window dirty
• Ear obstructed or containing excessive cerumen
• Ear covered prior to measurement taken
• Machine exposed to excessive vibration, heat or cold
Approved by:
Manager Education
September 2007
Fig 5
Fig 6
104.8
Ambulance Service of New South Wales
Page 1 of 1
Issued by: Manager, Education
Patient Assessment
Pulse Oximetry
Indication:
All patients except “routine cases” but especially
• Respiratory distress.
• Decreased LOC.
• Chest pain.
• Trauma.
• Any patient receiving oxygen therapy.
Prepare the equipment:
Fig 1
1. Ensure that all components are present and undamaged (Fig 1)
Diagnosis:
1. Patient on room air
Sa02 <95% - administer oxygen therapy.
2. Patient on oxygen therapy
Sa02 <95% - high flow therapy mask with reservoir.
Sa02 <90% - 100% oxygen therapy.
Fig 2
Method:
1. Select appropriate site and clean with alcohol swab. (Fig 2)
2. Place and secure appropriate sensor according to patient’s size
and site selected.
3. Protect sensor from ambient light.
4. Turn machine on.
5. Correlate radial pulse with machine derived pulse rate; if the two
do not correlate Sa02 may be inaccurate. (Fig 3)
6. Use regular readings to determine appropriate oxygen
administration.
7. Clean sensor after each use. (Fig 4)
Fig 3
Factors affecting accuracy of readings:
1. Poor perfusion of sensor site.
2. Ambient light interference.
3. Movement.
4. Incorrect application.
5. Nail polish or other material at selected site when sensor placed
on fingers or toes.
Fig 4
6. Oedema at sensor site.
Approved by:
Medical Director
December 2003
104.9
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Patient Assessment
Blood Sugar Measurement MediSence
Indication:
Fig 1
To determine blood glucose level.
Method:
1. Do not turn sensor on.
2. Remove electrode from packaging, carefully tear off lower portion only. (Fig 1)
Insert Sensor Electrode:
Insert electrode firmly with the three “contact bars” facing upward.
• The sensor will turn on automatically.
• The display shows “88.8” followed by “CAL” “3 digit code”
then “rdy”. (Figs 2 & 3)
Fig 2
Gently remove foil sleeve:
Obtain Blood Sample:
Do not swab the skin of the puncture site with an alcohol swab. Position
the lancing device on the side of the finger and activate. (Fig 4)
Fig 3
Apply Blood Sample:
1. Obtain a hanging drop of blood by gently squeezing or “milking”
the patient’s finger.
2. Apply blood to the blue target area whilst the display reads “rdy”.
(Fig 5)
3. Blood is drawn into reaction site in twenty seconds. (Fig 6)
N.B. If test does not start add more blood within thirty seconds
of the initial application. However, do not apply more blood once the
countdown has started.
Fig 4
Recalling results from memory:
Depress and hold blue button until “R” is displayed, then release.
Apply plastic strip to patient’s finger.
Calibration:
Fig 5
Fig 6
The machine must be calibrated each time a
new box of electrodes is opened. To do this,
insert calibrator with “contact bars” facing
upward. Sensor turns on automatically. Turn
sensor off by pressing then releasing the button.
Store calibrator in workstation.
Approved by:
Medical Director
December 2003
104.10
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Patient Assessment
Blood Glucose Measurement – Optium Xceed
Indication:
To measure blood glucose level.
Method:
1. Do not turn sensor on.
2. Remove electrode from packaging, carefully tear off lower portion only.
Insert Sensor Electrode:
Insert the three black lines at the end of the electrode into the electrode port until it
stops. The monitor turns on automatically. The apply blood symbol and lot number
will appear on the display screen.
•
Fig 1
Check that the lot number on the screen matches the batch of the electrodes
being used
Obtain Blood Sample:
• Clean, dry and warm the site.
• Hang patients arm down before obtaining sample to aid blood flow.
• Gently “milk” the patient’s finger – avoid squeezing the puncture site.
• Position the lancing device on the side of the finger and activate.
Apply Blood Sample:
• Touch the blood drop to the white area at the end of the electrode (Fig1).
• Continue to touch the blood to the end of the electrode until the test begins.
• Accurate results in 5 seconds (Fig2).
• Apply plastic strip to patient’s finger.
N.B. If test does not start add more blood within thirty seconds of the initial
application. However, do not apply more blood once the countdown has started.
Fig 2
Recalling results from memory:
Depress the middle on button and memory will be displayed
•
To obtain previous results scroll back using the left < button
Calibration:
The machine must be calibrated each time a new box of electrodes is opened (Fig3).
To do this, insert calibration bar with “contact bars” facing upward, calibration code
is stored and sensor turns off automatically once the calibration bar is removed. Store
calibrator in workstation.
Quality Assurance Check:
Unit must be checked weekly using the High and Low glucose control solutions. To
complete this test, insert electrode and apply a drop of the Low solution and record
results in the log book. Repeat this test using the High solution and record results.
Fig 3
Note: Refer to users guide or website for comprehensive setup instructions.
http://www.abbottdiabetescare.com.au/browse.asp?page=340
104.10.1
Approved by:
Manager Education
September 2007
Page 1 of 1
Ambulance Service of New South Wales
Patient Assessment
Glucometer Control Solution Test
Indication:
Control Solution must be used whenever a new pack of
electrodes are initiated, to ensure that the glucometer
and electrodes are working properly.
Method:
Insert Electrode:
Wash your hands using warm soapy water and dry them
completely.
Remove an electrode from its foil packet.
Insert the three black lines at the end of the electrode
into the electrode port.
Push the electrode into the electrode port fully until it
stops, monitor will turn on automatically.
Display window will open and lot number of the
electrodes will appear.
Ensure that the lot number on the machine and
electrode are the same.
Add Control Test Solution:
Commence control test by pressing and holding the
on/off button on for 2 seconds until the word Control or a
bottle icon appears on the screen.
Test is performed using the high control solution and low
control solution on two separate electrodes.
Turn the control solution bottle upside down three or four
times to mix the solution.
Apply a drop of control solution to the distal end of the
electrode. The control solution is drawn into the
electrode.
Continue to touch the control solution to the electrode until the monitor begins the test.
The monitor begins the test when:
•
•
•
•
you hear the beeper, if the beeper is on
display window shows the status bar
display window shows the countdown.
There is a 20 second countdown before the result is displayed.
104.10.02
Approved by:
Manager Education
July 2009
Page 1 of 2
Ambulance Service of New South Wales
Patient Assessment
Glucometer Control Solution Test
Note: Do not remove the electrode from the monitor or
disturb it during the countdown.
If the countdown does not start you may not have applied
enough control solution to the electrode, if this occurs.
•
Discard the current test electrode, and repeat the
control test with a new electrode.
•
The control result displays on the display window.
Removing the electrode from the port or pushing the
on/off button turns the glucometer off.
Understanding your result:
Compare the control results to the “Expected Results for
Use with Medisense Control Solutions”. These can be
found on the bottom of the front page of the instruction
sheet packaged with the electrodes. These results vary
for each LOT No.
If the control result does Not fall within the range:
Repeat the process with a new electrode. If this fails, remove the glucometer from service and
report the failure as per SOP2009-010 Equipment or consumable defects/failures
Handy Hints:
• DO NOT use the control solution if the expiration date
has passed. Check the expiration date printed on the
control solution bottle.
•
When you open a control solution bottle for the first
time, count forward 90 days and write this date on the
control solution bottle.
•
Discard any remaining solution after this date.
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual handling techniques and
procedures.
104.10.02
Approved by:
Manager Education
July 2009
Page 1 of 2
Ambulance Service of New South Wales
Issued by: Manager, Education
Multiple Victim Situation
Patient Assessment
Summary:
Step
Step
Step
Step
Step
1.
2.
3.
4.
5.
Raise alarm, reconnoitre, report and take command.
Move victims from danger and give basic field treatment.
Move victims to triage point for labelling.
Move patients to treatment area.
Transport patients to hospital.
These five steps MUST be followed in strict chronological order.
Step 1. Raise alarm, reconnoitre, report and take command.
a) Raise the alarm immediately by radio or telephone. Leave one
person permanently attending to the radio or telephone to relay
extra information as it comes to hand.
b) Reconnoitre the whole scene and assess:
• The number, severity and position of the victims.
• The presence of any danger - fire, gas, electricity, collapsing
structures etc that would require mobilisation of special
resources.
• “Use your eyeballs and not your hands” Under no
circumstances stop to treat a victim - no matter how severely
injured.
c) Report by radio or phone and give a detailed account of the
situation. This vital information will allow the appropriate
response to be mounted and will save more lives than spending
time by treating individual victims.
d) Take command of the Ambulance situation, liaise with other
emergency services and direct later arrivals to proceed with steps
2, 3 and 4 until a more senior officer arrives.
Step 2. Move victims from danger and give basic field treatment.
a) Move victims who are in physical danger from fire, gas, explosion,
collapsing structures etc. They should be moved a short distance
to a place of safety irrespective of their injuries.
b) Basic field treatment.
Initial field treatment should be confined to:
• Arrest haemorrhage
- Protective gloves should be worn.
- Direct pressure.
- Laryngeal
Evaluation.Mask airway, Endotracheal Tube.
- Tourniquets occasionally.
•
Basic airway care
- Remove liquids and solids.
- Maximal head tilt.
- Jaw lift.
- Guedels airway.
- Recovery position if unconscious.
- Bystanders should be utilised to help with these simple measures.
Approved by:
Medical
ManagerDirector
Education
December
2003
August 2009
104.11
Ambulance Service of New South Wales
Page 1 of 3
Issued by: Manager, Education
Multiple Victim Situation
Patient Assessment
Early in a disaster situation with multiple casualties, if a patient has
stopped breathing or is pulseless, NO attempt should be made at
resuscitation.
Step 3. Move victims to triage point for labelling.
a) Disaster personnel least skilled in resuscitation and first aid
should act as stretcher bearers. In the early stages of a disaster,
ambulance officers should be involved in direct patient care and
supervising lifting procedures. They should not be employed as
stretcher bearers.
b) Attach an appropriate label: (Fig 1)
• Red - life-threatening injuries.
• Orange - non life-threatening injuries.
• Green - walking wounded.
• White - dead.
Do not waste time by writing on the label at this stage.
Step 4. Move patients to treatment area.
Fig 1
Direct patients with red labels to right side of treatment area and all
other labelled patients to the left.
Red Label Treatment:
All red labels should now be attended by one or more
personnel and appropriate further emergency treatment given:
• Continue airway control.
• Continue haemorrhage control.
• IV fluids.
• Oxygenation.
• Suction.
• Pain relief.
• Splinting, bandaging.
• Cervical collar.
The details of treatment can now be written on the labels and
from this time onwards no red labelled patients should be left
unattended. After all red labelled patients have been treated,
move on to orange labelled patient treatment area.
Orange Label Treatment:
Treat all orange labelled patients. On reassessment some may
have deteriorated, necessitating change to a red label and urgent
resuscitation.
Green Label Treatment:
Treat all green labelled patients. On reassessment some may
have deteriorated, necessitating change to a red or orange label
and urgent resuscitation.
Approved by:
Medical
ManagerDirector
Education
December
2003
August 2009
104.11
Ambulance Service of New South Wales
Page 2 of 3
Issued by: Manager, Education
Multiple Victim Situation
Patient Assessment
Step 5. Transport patients to hospital.
a) At all times red labelled patients have transport priority over
orange or green labelled patients.
b) When patients are to be transported, the corner of the label is
removed and they are carried to the dispatch area for transfer to
hospital. (Fig 2)
c) Walking green labelled patients should be marshalled in a
holding area away from the site. They should be medically
assessed and registered before being allowed to leave or
transported to appropriate medical care.
Paramedic and Advanced Life Support officers.
Fig 2
Apart from the foregoing, the mainstays of paramedic and
advanced life support officer treatment at a disaster site are:
October Suit
2008
• M.A.S.T.
• Cannulation and
of Haemaccel
Page 1administration
of 1
•
Intubation
a water based lubricant and passed slowly
There is little place for E.C.G. monitoring, cardiac drugs etc in
disaster situations.
There is great merit in paramedic pairs splitting up - each officer
being accompanied by an ambulance officer whilst cannulating,
intubating, etc.
Approved by:
Medical
ManagerDirector
Education
December
2003
August 2009
104.11
Ambulance Service of New South Wales
Page 3 of 3
Issued by: Manager, Education
Patient Assessment
Scene Management Procedure (Routine)
Scene assessment commences as soon as visual contact is made with the scene and is as equally important
at medical situations as at trauma scenes.
1. Each officer to don appropriate personal protective equipment eg gloves, safety glasses, safety vests,
helmets. The 2nd (treating) officer should do so enroute. The 1st (driver) officer should do so on arrival.
2. When arriving at the scene of motor vehicle accidents and the like, it can be of assistance to planning
within the Operations Centre if the officers can provide a brief preliminary report once visual contact is
made with the scene. eg. ‘Car ..... approaching scene. I observe a single motor vehicle crash. Car into a
tree’.
3. Park the vehicle in a suitable safe location. At the scene of road traffic crashes, try to place your vehicle
between the passing traffic and your work area - remember the OH& S requirements for a safe
workplace. Leave beacons on.
Considerations concerning vehicle parking should include:
- passing traffic
- the need to have an escape path in situations where violence or other hazards is a real or
potential concern
- direction of travel to hospital
- access to vehicle for equipment
- prevailing weather conditions ie protect the rear of the vehicle from wind, rain or snow in poor
conditions
- wind direction and land slope if hazardous substances are present
- the need to maintain traffic flow on major roads
• At night, leave beacons and parking lights on and headlights off so as not to obscure vision of
oncoming drivers.
• Consider the need to leave vehicle engine running ie interior heating, cooling and maintenance of
battery power.
• Vehicle security:
- both officers should carry a set of vehicle keys on their person
- vehicles should be locked when unattended
- at larger scale/major incidents, vehicles are left unlocked with keys in the ignition
4. Assess the scene for hazards - remove the ‘patient from the danger’ or the ‘danger from the patient’
Remember the ‘1-2-3 of Safety’:
• yourself
• the bystanders
• the casualty
5. Complete a reconnoitre of the scene - ‘use your eyes and not your hands’. This is the responsibility of
the 2nd officer (treating officer).
6. Conduct an initial triage of victims. Triage labels should be used where the ‘number of casualties
outweighs the number of rescuers’. This could include an incident involving as few as two patients
where a double team attends.
Approved by:
Medical Director
December 2003
104.12
Ambulance Service of New South Wales
Page 1 of 2
Issued by: Manager, Education
Scene Management Procedure (Routine)
Patient Assessment
7. Consider the need for and request additional resources as required:
- intra/service (ALS, paramedics, supervisor, rescue, SCAT, aero medical evacuation)
- inter/service (rescue, fire brigade, police, electrical/gas authorities)
- medical retrieval team
• Where a helicopter service is requested, patient condition information as per a ‘code 3’ (see point 9
below) is required plus a global positioning system (GPS) reading of the site is also required with
the initial request.
8. Provide the Operations Centre with an accurate and concise situation report (SITREP) within 3 minutes
of arrival. This is the responsibility of the 1st officer (driver). Remember you are the ‘eyes and ears’ of
the Operations Centre. Communicate clearly and don’t make assumptions.
Use the mnemonic ‘ ETHANE’
E
T
H
A
N
E
-
Exact location if different to initial call details
Type of incident - motor vehicle crash, industrial, domestic or farming incident
Hazards (actual or potential)
Access to location
Number, severity of casualties (assess in terms of triage label colours)
Emergency services (present or required)
• The passing of a situation report on ALL emergency cases is a requirement - this is not optional.
9. Treat and extricate the victims.
10.Alert hospital (via a Code 3) of incoming patients, where appropriate. A Code 3 should contain the
following information Age and sex of patient plus
M
I
S
T
O
-
Mechanism of injury
Injuries/conditions found (include LOC)
Signs and symptoms
Treatments/time to hospital
Other relevant information
ETA at hospital
11.Maintain communications with the Operations Centre. Provide updated SITREPS as required. This is the
responsibility of the 1st officer (driver).
General
• Always consider the need for the senior ranking officer present to take on the role of supervisor /
liaison officer especially once additional resources arrive.
• The 1st officer (driver) must at ALL times carry and monitor a portable radio. They are responsible
for communications from the site to the Operations Centre.
• The officers have a responsibility to ensure that all scenes are left clear of clinical wrappers/rubbish,
sharps and any potentially infectious/dangerous material. Prior to leaving the scene, the 1st officer
(driver) should ensure that clinical waste and all Service equipment has been collected and safely
stowed in the vehicle.
Approved by:
Medical Director
December 2003
104.12
Ambulance Service of New South Wales
Page 2 of 2
Issued by: Manager, Education
Patient Assessment
Mental Health
Indication:
In situations where a patient is suspected of experiencing a mental health
problem and may require mental health care.
Diagnosis:
Mental health problems may present as one or a combination of the
following themes:
1. Aggressive or threatening violence
2. Bizarre behaviour or speech
3. Confused or not making sense
4. Hyperactivity, loud, grandiose or elevated moods
5. Sad, depressed, withdrawn or distressed mood
6. States of nervousness, anxiety, panic or excessive concerns for health
7. Self-harm or suicidal behaviour
8. Physical symptoms in the absence of an identifiable cause
Method:
1. Conduct Scene Safety Assessment
•
•
Fig 1
The Safety of Officers, patients and others is the objective of this
assessment.
Particular attention should be paid to the safety of children in the care of
patients presenting with mental health emergencies.
2. Conduct a Risk of Violence Assessment.
Consider police assistance if any of these criteria are met:
• History of violence
• History of impulsiveness or risk taking behaviour
• Agitated behaviour
• Threats or inappropriate gestures
• Substance abuse, especially alcohol or stimulants such as cocaine
• Current disturbed mental state such as mania, hallucinations, delusions
or paranoia
If the scene appears to be a safety risk or you suspect weapons may be
present, stand off and call for immediate police assistance.
Fig 2
3. Develop trust and rapport with the patient. Fig. 2
•
•
•
•
Calmly and clearly identify yourself to the patient. Talk in a nonjudgmental tone.
Ask the patient to share their main concerns. Paraphrase their
statements back to communicate that their concerns are taken seriously.
Reassure the patient by stating that you want to help them. Do not
contradict their statements or concerns.
Efficiently and effectively communicate with the patient by using simple
words and sentences - this will help reduce misunderstandings.
Approved by:
Medical Director
July 2006
Fig 3
104.13
Ambulance Service of New South Wales
Page 1 of 2
Issued by: Manager, Education
Patient Assessment
Mental Health
4. Conduct a Pre-Hospital Mental Health Assessment
Determine the patient’s state of mental health. NB. This is a preliminary
assessment. Indicators to consider are – S.T.A.T.E. Fig. 3
• Signs and symptoms that indicate an abnormal or unusual state of
mental health including;
• Thoughts that indicate delusions, hallucinations, suicidal ideas, or
illogical thinking.
• Appearance of the patient considered disheveled or indicating poor
coping skills or hygiene.
• Threats or acts by the patient that are potentially harmful to self or
others.
• Emotions of the patient considered to indicate feelings of sadness,
distress, anger or hopelessness.
Based on the assessment of the patient’s state of mental health, determine
the associated risk factors and take appropriate action e.g. reassure and
transport the patient to hospital for a comprehensive mental health
assessment.
5. Conduct a Risk of Self-Harm / Suicide Assessment
Determine the patient’s risk from self-harm / suicide. Risk factors and
questions to consider are - S.U.I.C.I.D.E Fig. 4
• Significant relationship issues - “Are you having difficulties with any
personal relationships in your life?”
• Unfulfilled expectation by self or others - “Have things been so bad
lately that you have thought you would rather not be here?
• Intoxicated or drug use – “Have you been using alcohol or drugs to feel
better?”
• Current harmful thoughts of suicide – “Have you had thoughts of
harming or killing yourself? What plans have you made? Do you have a
weapon?”
• Isolation or feelings of loneliness – “Do you feel lonely or that your
circumstances are hopeless?”
• Deterioration of mental health – “Do you have a mental health problem
that you believe is getting worse?”
• Employment of financial difficulties - “Are you having financial or
employment difficulties?”
Fig 4
Based on the determined self-harm / suicide risk factors, take appropriate
action e.g. reassure and transport the patient to hospital for a comprehensive
mental health assessment. Fig. 5
6. Determine Treatment and Transportation Options
Based on the Risk of Violence, Mental Health and Self-Harm / Suicide
Assessments, determine the combined risk factors and appropriate options
for treating and transporting the patient e.g. transport patient to hospital for
a comprehensive mental health assessment in an ambulance vehicle with
police on-board or in a police vehicle with an ambulance vehicle escort.
Fig 5
Approved by:
Medical Director
July 2006
104.13
Ambulance Service of New South Wales
Page 2 of 2
Issued by: Manager, Education
Patient Assessment
Patient Search
Indication:
Section 81 (4) of the Mental Health Act (NSW) 2007 grants paramedics the
power to carry out an ordinary search or a frisk search of a person, if the
paramedic reasonably suspects the person is carrying anything that could
present a danger, or could assist the person to abscond during transport
NOTE: Any restrictions on the liberty of patients and other people
with a mental illness or mental disorder and any interference with
their rights, dignity or self-respect are to be kept to the minimum
Fig 1
necessary under the circumstances
Procedure:
Ordinary Search
A search of a person or of articles in the possession of the person that may
include:
•
requiring the person to remove only his or her overcoat, coat or jacket
or similar article of clothing and any gloves, shoes, socks and hat and
•
an examination of those items
Frisk Search
A search of a person conducted by:
•
quickly patting over the person’s outer clothing with an open hand,
Fig 7 or
•
an examination of anything worn or carried by the person that is
conveniently and voluntarily removed by the person
Searching
•
If police are available they should always be asked to perform Fig 2
the search
•
Whenever possible, a female paramedic should search a female patient
and a male paramedic should search a male patient
•
Appropriate personal protective equipment should be worn such as
patient examination gloves and eye shields
•
A paramedic, the patient’s carer or a member of the public must be
present during the search procedure. If the witness is not a paramedic
ask them to sign the PHCR as a witness
•
Introduce yourself to the patient and inform them that you are going
to exercise your authority to search them under Section 81 of the Fig 3
Mental Health Act 2007
•
Tell the patient why you are going to conduct the search
•
If the patient refuses the search and you maintain a reasonable
suspicion that the patient is carrying an object that could
present a danger or assist to abscond, call for police assistance
immediately
•
Ask the patient if they are in possession of any object or article that
may pose a danger during the search or that they wish to declare
•
Whenever possible, a second paramedic should adopt a lateral cover
position to observe the search and alert the searching paramedic of
Fig 4
any patient distress or hostility during the procedure, Fig 1
Approved by:
Manager Education
January 2008
104.13.1
Ambulance Service of New South Wales
Page 1 of 2
Issued by: Manager, Education
Patient Assessment
•
•
•
•
•
•
Patient Search
Ideally, the patient should stand facing you with their feet apart and
with the flat palms of your gloved hands, lightly pat down the outer
clothing, Fig 2
Start with the shoulders, Fig 3 & 4 and proceed downwards to one
arm, then
ƒ second arm
ƒ chest
ƒ abdomen
ƒ left flank
ƒ right flank
ƒ hips
ƒ outside and inside of each leg, Fig 5
Ask the patient to turn around and repeat the procedure on the rear
of the patient, Fig 6. Start with the shoulders and proceed downwards
to one arm, then
ƒ second arm
ƒ back
Fig 5
ƒ hips
ƒ outside and inside of each leg
Do not touch the groin of any patient or place fingers inside a
body cavity such as the mouth or ear canal. If you maintain a
reasonable suspicion that the patient is concealing an object in
these areas that could present a danger or assist to abscond, call
for police assistance immediately
Do not place your hands into any area or handle any object that
cannot be seen
Record on the PHCR that a search has been conducted, the type of
search that was conducted and what was found, if anything
When an object is found
•
If any object of concern is found consider asking the patient to
remove the object. If the object can be visually inspected consider
carefully removing it
•
Place the object into a safe location such as a sharps container,
garbage bin or clear plastic bag and inform the patient what you have
done with it
•
If a suspected illegal object is found remove the item or substance Fig 6
from the patient having regard to any personal or patient safety issues
that may arise, make a note of the find, secure the item or substance
(e.g. in a ‘zip lock’ plastic bag) and notify the police
•
If any item that may effect the ongoing clinical management of the
patient is found, such as a suicide note or an unknown substance, it
should be secured and given to the receiving health care facility
Occupational Health and Safety
•
Compliance to relevant OH&S and manual handling techniques
•
Compliance to infection control procedures
Approved by:
Manager Education
January 2008
Fig 7
104.13.1
Ambulance Service of New South Wales
Page 2 of 2
Issued by: Manager, Education
Bandaging
Folding a Triangular Bandage
Indication:
In situations where a folded triangular bandage is necessary, eg limb
immobilisation, bottle/loop knot or bandages.
Folding a triangular bandage to create a broad and narrow fold
bandage:
1. Place an open triangular bandage on a flat, clean surface. (Fig 1)
Fig 1
2. Fold the apex to meet the middle of the base. (Fig 2)
3. Fold again in the same direction, to form a broad fold bandage.
(Fig 3)
4. Fold again in the same direction, to form a narrow fold bandage.
(Fig 4)
Fold a narrow fold bandage in a form suitable for storage:
Fig 2
1. Fold the two ends in to meet at the centre.
2. The bandage is folded towards the centre again.
3. The bandage is now folded in half to form a compact package.
Fig 3
Fig 4
Approved by:
Medical Director
December 2003
105.1
Ambulance Service of New South Wales
Issued by: Manager, Education
Bandaging
Triangular Bandage for the Head
Indication:
In situations where a dressing is required to be secured to the head.
Prepare the patient:
1. Explain to the patient what is about to happen.
2. Administer pain relief if required.
Fig 1
3. If possible, place the patient in the sitting position.
Application of bandage:
1. Fold a hem inwards along the base of an open triangular bandage.
(Fig 1)
2. Stand behind the patient and place the open bandage so that the
hem lies on the forehead just above the eyebrows and the apex
hangs down around the nape of the head. (Fig 2)
Fig 2
3. Take the ends around the head along the ears and cross them
near the nape of the neck. (Fig 3)
4. Tie an over hand knot at the base of the skull. (Fig 4)
5. Bring the ends forward and tie a reef knot in the centre of the
forehead.
6. Steady the patient’s head with one hand and with the other hand
draw the apex of the bandage downwards.
7. Turn up the apex and pin or tape to the bandage on top of the
head. (Fig 5)
Fig 4
Approved by:
Medical Director
December 2003
Fig 3
Fig 5
105.2
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Triangular Stump Bandage
Bandaging
Indication:
In situations where a dressing is required to be secured to an
amputated limb.
Prepare the patient:
1. Explain to the patient what is about to happen.
Fig 1
2. Administer pain relief if required.
Application of triangular stump bandage:
1. Fold hem inwards along the base of an open bandage. (Fig 1)
2. Place the base of the bandage high up on the underside of the
stump with the apex hanging down.
3. Draw the apex up over the stump and cross the ends in front of
the apex. (Fig 2)
Fig 2
4. Carry the ends behind the stump and cross them again, bring
them forward and tie with a reef knot in front. (Figs 3 & 4)
5. Bring the apex down over the knot maintaining pressure and pin
or tape to the bandage over the top of the knot. (Fig 5)
6. Elevate if possible.
Fig 3
Fig 4
Fig 5
Approved by:
Medical Director
December 2003
105.3
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Bandaging
Triangular Bandage for the Hand
Indication:
In situations where a dressing is required to be secured to the hand.
Prepare the patient:
1. Explain to the patient what is about to happen.
2. Administer pain relief if required.
2. Control haemorrhage and dress wound as per Skill Sheet 107.1
and 103.1.
Fig 1
Application of bandage:
1. Fold the hem inward along the base of an open bandage.
2. Place the hand on the bandage in the middle, the arm facing the
point. (Fig 1)
3. Carry the apex of the bandage back over the hand. (Fig 2)
Fig 2
4. Pass the ends around the wrist, cross them and using a reef knot,
tie uppermost. (Figs 3 & 4)
5. Bring the apex over the knot and fix to the bandage over the
hand. (Fig 5)
Elevate limb in sling as per Skill Sheet 106.12.
Fig 3
Fig 4
Fig 5
Approved by:
Medical Director
December 2003
105.4
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Bandaging
Triangular Bandage for the Elbow or Knee
Indication:
In situations where a dressing is required to be secured to an elbow
or knee.
Prepare the patient:
1. Explain to the patient what is about to happen.
2. Administer pain relief if required.
3. Posture patient according to Skill Sheet 110.7 with the limb flexed
at 90° angle.
Fig 1
Application of bandage:
1. Fold a hem inwards along the base of an open bandage.
Application to elbow. (Fig 1)
1. Lay the base on the posterior of the forearm immediately inferior
to the elbow with the apex laying across the elbow joint and
terminating superior to the joint. (Fig 2)
Fig 2
2. Cross the tails of the bandage in front of the elbow, then around
the arm superior to the elbow joint.
3. Tie the tails firmly using a reef knot according to Skill Sheet
105.14 (Fig 3)
4. Bring the apex down across the knot and fix with pin or tape.
(Fig 4)
Fig 3
Fig 4
Approved by:
Medical Director
December 2003
105.5
Ambulance Service of New South Wales
Page 1 of 23
Issued by: Manager, Education
Bandaging
Triangular Bandage for the Elbow or Knee
Application to Knee
1. Lay the base on the leg immediately inferior to the knee with the
apex laying over the knee joint and terminating superior to the
joint. (Fig 5)
2. Cross the tails of the bandage behind the knee and tie superior to
the knee joint. (Fig 6)
3. Tie the tails firmly using a reef knot according to Skill Sheet 110.7.
(Fig 7)
Fig 5
4. Bring the apex down across the knot and fix with pin or tape.
Check distal pulse:
• Where distal pulse/perfusion is absent gently realign limb until
present. (Fig 8)
Fig 6
Fig 7
Fig 8
Approved by:
Medical Director
December 2003
105.5
Ambulance Service of New South Wales
Page 2 of 23
Issued by: Manager, Education
Bandaging
Triangular Bandage for the Foot
Indication:
In situations where a dressing is required to be secured to the foot.
Prepare the patient:
1. Explain to the patient what is about to happen.
2. Administer pain relief if required.
3. Posture limb so as to gain suitable access.
Fig 1
4. Remove footwear.
5. Check distal pulse/perfusion. (Fig 1)
Apply triangular bandage to the foot:
1. Place the foot in the centre of an open triangular bandage with
the apex beyond the toes and the base at shoe top level at the
back of the ankle. (Fig 2)
2. Draw the apex of the bandage over the top of the foot. (Fig 3)
Fig 2
3. Cross bandage ends over the top of the foot. (Fig 4)
4. Pass the ends around the ankle and tie off with a reef knot on
foot. (Fig 5)
5. Draw the apex forward down over the knot and fix bandage over
the foot and secure. (Fig 6)
Check distal pulse and/or capillary refill:
• If distal pulse/perfusion absent slightly loosen bandage until it
returns, whilst maintaining support.
Fig 3
Fig 4
Fig 5
Approved by:
Medical Director
December 2003
Fig 6
105.6
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Bandaging
Preparation of a Ring Pad using a Triangular Bandage
Indication:
In situations where a ring pad is required.
Preparation of a ring pad:
1. With a narrow fold triangular bandage form a loop at one end
around the hand. (Fig 1)
2. Take the remaining bandage and continually wrap around the
loop. (Figs 2 & 3)
Fig 1
3. Tuck in the end.
• Where required, use another narrow fold bandage to increase
the depth and firmness of the ring pad by wrapping it around
the original. (Figs 4 & 5)
Fig 2
Fig 3
Fig 4
Approved by:
Medical Director
December 2003
Fig 5
105.7
Ambulance Service of New South Wales
Issued by: Manager, Education
Bandaging
Compression Bandage
Indication:
In situations when envenomation is suspected.
Prepare the patient:
1. Explain to the patient what is about to happen and in particular
the importance of minimal movement.
2. Administer pain relief if required.
Fig 1
Apply compression bandage:
1. Apply gauze dressing to bite site.
2. Using crepe bandage with roll uppermost and with an adequate
tail, make two locking turns over bite site, working from medial to
lateral aspect. (Fig 1)
3. The bandage should be firm but not tight, such as you would
apply for a sprained ankle. Check distal pulse and/or capillary
refill. (Fig 2)
Fig 2
4. Continue the bandage to the tip of the extremities, then continue
back along the limb until the entire limb is covered. A second
bandage may be required. (Fig 3)
5. Secure bandage.
Immobilise affected limb using appropriate methods and check
distal pulse. (Fig 4)
Fig 3
Fig 4
Approved by:
Medical Director
December 2003
105.9
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Bandaging
Stump using a Crepe Bandage
Indication:
In situations where a dressing is required to be secured to a stump.
Prepare the patient:
1. Explain to the patient what is about to happen.
2. Administer pain relief if required.
Control haemorrhage and dress wound according to condition
of patient.
Fig 1
Application of bandage:
1. Using a crepe bandage with roll uppermost, place end of bandage
approximately 15cm superior to end of stump on anterior aspect
of limb. (Fig 1)
2. With assistant holding the tail of the bandage in place, roll the
bandage across the centre of the stump, then behind and
underneath. Assistant to hold in place. (Figs 2 & 3)
Fig 2
3. Alternate the bandage right then left of the midline ensuring that
two-thirds of the previous run is covered until the end of the
stump is covered. (Fig 4)
4. Bring the bandage forward obliquely from the inner aspect down
toward the lower lateral edge and then horizontally behind the
lower end of the stump.
5. Bring the bandage forward again in an upward direction to cross
the previous turn.
Fig 3
6. Repeat this pattern until stump has been covered.
7. Finish off bandage with two lock-in turns.
8. Remove any excess bandage.
9. Secure bandage. (Fig 5)
Fig 4
10.Elevate if possible.
Fig 5
Approved by:
Medical Director
December 2003
105.10
Ambulance Service of New South Wales
Issued by: Manager, Education
Bandaging
Figure of Eight to Hand or Wrist
Indication:
Where a dressing is needed to be secured to the hand or wrist.
Prepare the patient:
1. Explain to the patient what is about to happen.
2. Administer pain relief if required.
Application of figure of eight to hand or wrist:
Fig 1
1. Posture according to patient’s condition (Fig 1)
2. With crepe bandage, roll uppermost and with an adequate tail,
make two locking turns around the wrist, working from the
medial to the lateral aspect of the limb. (Fig 2)
3. Pass roll obliquely over the back of the hand to the side of the
little finger. (Fig 3)
4. Encircle the fingers with a horizontal turn at the level of the base
of the nail of the little finger. (Fig 4)
Fig 2
5. Pass the bandage across the back of the hand obliquely to the
wrist. (Fig 5)
6. Repeat the figure of eight until the hand is covered.
7. Remove excess bandage if required.
Fig 3
8. Secure bandage. (Fig 6).
Check distal pulse and/or capillary refill:
• If distal pulse/perfusion absent, loosen bandage until it
returns whilst maintaining support.
Fig 4
Fig 5
Approved by:
Medical Director
December 2003
Fig 6
105.11
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Bandaging
Figure of Eight to Knee or Elbow
Indication:
Where a dressing is required to be secured to the knee or elbow.
Prepare the patient:
1. Explain to the patient what is about to happen.
2. Administer pain relief if required.
Application of figure of eight bandage:
1. Posture patient according to Skill Sheet 110.1/9.
Fig 1
2. Position limb to be bandaged with joint at a 90˚ angle.
3. With conforming crepe bandage, roll uppermost and with an
adequate tail, make two fixation turns around the joint working
from the medial to the lateral aspect of the limb. (Fig 1)
4. Covering two-thirds of the previous turn, alternate above and
below the fixation turn. (Fig 2)
Fig 2
5. Finish off bandage with two fixation turns above the elbow or
knee.
6. Remove any excess bandage.
7. Secure bandage. (Fig 3)
Check distal pulse and/or capillary refill:
• If distal pulse/perfusion absent, slightly loosen bandage until it
returns, whilst maintaining support.
Approved by:
Medical Director
December 2003
Fig 3
105.12
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Bandaging
Figure of Eight to Foot and Ankle
Indication:
Where a dressing is required to be secured to a foot or ankle.
Prepare the patient:
1. Explain to the patient what is about to happen.
2. Administer pain relief if required.
Fig 1
Application of figure of eight bandage:
1. Posture according to patient’s condition. (Fig 1)
2. With crepe bandage, roll uppermost and with adequate tail, make
two locking turns around the limb working from the medial to the
lateral aspect of the limb. (Fig 2)
3. Take the roll obliquely across the foot to the base of the little toe.
(Fig 3)
Fig 2
4. Make a horizontal turn around the foot.
5. Carry the bandage back over the foot and take a turn around the
ankle just above the heel. (Fig 4)
6. Repeat figure of eight covering the previous one by two-thirds,
proceed until foot is covered. (Fig 5)
7. Complete with a spiral around the ankle.
8. Remove excess bandage if required.
Fig 3
9. Secure bandage in place. (Fig 6)
Check distal pulse and/or capillary refill:
• If distal pulse/perfusion absent, loosen bandage until it
returns whilst maintaining support.
Fig 4
Fig 5
Approved by:
Medical Director
December 2003
Fig 6
105.13
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Reef Knot Application
Bandaging
Indication:
Tie the Reef Knot:
1. With the tails of a triangular bandage in each hand, pass the right
tail over then under the left tail and pull tight. (Fig 1)
2. With the tails still in the respective hands, pass the left tail over
and under the right tail and pull tight. (Fig 2)
Untie the Reef Knot:
Fig 1
1. Hold both the bandage and tail on the same side. (Fig 3)
2. Pull them steadily apart - the knot should then slide off. (Fig 4)
Fig 2
Fig 3
Fig 4
Approved by:
Medical Director
December 2003
105.14
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Cervical Collar
Immobilisation
Indication:
Fig 1
In situations where cervical spine immobilisation is indicated.
Prepare the patient:
1. Explain to the patient what is about to happen to avoid head or
body movement.
2. Administer pain relief if required.
Manual immobilisation:
Fig 2
1. Instruct assistant to immobilise the head and neck with their
hands.
2. Carefully remove or rearrange any clothing or jewellery that could
impede collar application.
Prepare the equipment:
1. Use your fingers to visually measure the distance between the
trapezius (top of the shoulder) and the lower edge of the
mandible. (Fig 1)
• The measuring hand should always have the wrist posterior to
the patient’s head so as not to obscure the lower edge of the
mandible.
Fig 3
2. Use the number of fingers to select the appropriate size collar,
measuring the distance between the sizing post (black fastener)
and the lower edge of the rigid plastic at the bottom of the collar. (Fig 2)
• Do not measure from the sizing post to the end of the foam
padding.
3. Move the black fastener at the end of the chin piece up the inside
wall of the collar and push the fastener all the way through the
small hole.
Fig 4
4. Pre-form the collar.
Application of collar to patient:
Where the patient is sitting:
1. Hold the collar by the front with your hand near the Velcro
section.
Fig 5
2. Position the chin piece by sliding the collar up the chest wall. (Fig 3)
3. Ensure the chin is well supported and covers the centre fastener.
4. Difficulty positioning the chin piece may indicate the need for an
alternative collar size.
5. Bring the back section around the rear of the patient’s neck and
secure the Velcro. (Figs 4 & 5)
Approved by:
Medical Director
December 2003
106.1
Ambulance Service of New South Wales
Page 1 of 24
Issued by: Manager, Education
Immobilisation
Cervical Collar
Where the patient is supine:
Fig 6
1. Use your fingers to visually measure the distance between the
trapezius (top of the shoulder) and the lower edge of the
mandible. (Fig 6)
• The measuring hand should always have the wrist posterior to
the patient’s head so as not to obscure the lower edge of the
mandible.
2. Begin by sliding the back portion of the collar behind the patient’s
neck.
3. Once the Velcro is visible, position the chin piece in a circular
motion, sliding the chin section up the patient’s chest to their
jaw. (Fig 7)
4. Fasten the Velcro and ensure a firm fit. (Fig 8)
5. Re-tension Velcro fastener if necessary.
Where patient is in a right lateral position:
1. Begin by sliding the back portion of the collar under the patient’s
neck.
2. Once the Velcro is visible, position the chin piece in a circular
motion, sliding the chin section up the patient’s chest.
Fig 7
Fig 8
3. Ensure the chin is well supported and covers the central fastener.
4. Fasten the Velcro and ensure a firm fit.
Where patient is in a left lateral posture:
1. Position yourself behind the patient if possible.
2. Position the chin piece by sliding the collar up the chest wall.
3. Ensure the chin is well supported and covers the central fastener.
4. Bring the back section around under the patient’s neck and secure
the Velcro.
5. Re-tension Velcro fastener if necessary.
Adjunct to Rigid Collar immobilisation:
1. Collars are aids to cervical spine immobilisation - do not rely on
collars alone to adequately immobilise the cervical spine.
2. Support under the head where necessary to ensure neutral
alignment is maintained i.e. hands or packing.
3. Apply support with sand bags to reduce risk of lateral flexion
injury.
Approved by:
Medical Director
December 2003
106.1
Ambulance Service of New South Wales
Page 2 of 24
Issued by: Manager, Education
Immobilisation
Cardboard Splint/Forearm
Indication:
Fig 1
In situations where the forearm is fractured and requires
immobilisation.
Prepare the patient:
1. Explain to the patient what is about to happen.
2. Administer pain relief if required.
• Posture the patient sitting.
3. Instruct assistant to support under the fracture site.
Fig 2
4. Gently move the limb to the normal alignment position. (Fig 1)
5. Expose the limb.
6. Dress the fracture when necessary.
7. Check distal pulse.
Prepare the equipment:
1. Select appropriate size splint.
• Splint should extend from elbow to fingertips.
Fig 3
2. Obtain four triangular bandages, fold three of them into
narrowfold bandages.
• The fourth triangular bandage is for the sling.
• Do not use roller bandages.
Apply the cardboard splint:
1. Place the splint under the injured limb. (Fig 2)
Fig 4
2. Instruct the assistant to hold splint in place.
3. Insert padding in anatomical hollows.
4. Position and tie off triangular bandages in the following sequence.
• Narrowfold - bandage proximal to the fracture site.
• Narrowfold - bandage distal to the fracture site.
• Narrowfold - bandage around the hand. (Fig 3)
Immobilise limb:
1. Secure limb to patient with Large Arm Sling According to
Skill Sheet 106.13.
2. Periodically check splint tension.
3. Regularly monitor distal perfusion. (Fig 4)
Approved by:
Medical Director
December 2003
106.2
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Immobilisation
Cardboard Splint/Hand and Wrist
Indication:
Fig 1
In situations where the forearm, wrist or fingers require splinting.
Prepare the patient:
1. Explain to the patient what is about to happen.
2. Administer pain relief if required.
• Posture the patient in the sitting position.
3. Expose the limb.
4. Instruct assistant to support the fracture site, then gently move the
limb to normal alignment. (Fig 1)
Fig 2
5. Check distal pulse and re-align if necessary.
6. Dress any wound as necessary.
Prepare the equipment:
1. Select hand and wrist splint.
Fig 3
2. Obtain four triangular bandages.
Apply the cardboard splint:
1. Place the splint under the fractured limb. (Fig 2)
2. Instruct assistant to hold splint in place.
• Fill anatomical hollows with padding to limit movement and
avoid pressure points.
3. Position triangular bandages and secure in the following
sequence.
• Narrowfold - proximal to fracture.
• Narrowfold - distal to fracture.
• Broadfold - distal to elbow. (Fig 3)
Fig 4
Immobilise limb:
1. Secure limb to patient with large arm sling according to
Skill Sheet 106.13.
2. Recheck distal pulse/perfusion.
3. Periodically recheck bandage tension and distal perfusion (Fig 4)
Approved by:
Medical Director
December 2003
106.3
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Immobilisation
Cardboard Splint/Lower Leg
Indication:
Indications where the lower leg is fractured and requires
immobilisation.
Prepare the patient:
1. Explain to the patient what is about to happen.
2. Administer pain relief if required.
3. Instruct assistant to support the fracture site.
• Posture according to patient’s condition.
Fig 1
4. Gently move the limb to normal alignment position whilst
maintaining support of the fracture site.
5. Instruct assistant to move hands down to ankle and take over
support.
6. Remove footwear, expose the limb.
7. Check distal pulse.
• Take care never to lift the limb without supporting the fracture
site. (Fig 1)
Fig 2
Prepare the equipment:
1. Select appropriate size splint.
• Splint should extend from the upper thigh to the heel.
2. Obtain five triangular bandages.
• Do not use roller bandages.
Position splint:
1. Inform the patient and assistant of intention to position splint and
what is to occur.
2. Support the fracture from above and below and then instruct the
assistant to raise the limb.
3. Using your top hand, place the splint under the limb against the
crease of the buttock and lower on to patient’s shoe or other likesized object to maintain slight elevation.
4. Insert padding in anatomical hollows. (Fig 2)
Approved by:
Medical Director
December 2003
106.4
Ambulance Service of New South Wales
Page 1 of 24
Issued by: Manager, Education
Immobilisation
Cardboard Splint/Lower Leg
Secure:
1. Place the triangular bandages under the splint in the following
sequence.
• Narrowfold - proximal to fracture.
• Narrowfold - distal to fracture.
• Broadfold - upper proximal aspect of thigh.
• Narrowfold - under ankle and figure of eight around foot.
• Broadfold - around the knee. (Fig 3)
For patella fractures:
1. Place bandages under the splint in the following sequence.
• Narrowfold - just above the knee.
• Narrowfold - just below the knee.
• Broadfold - upper proximal aspect of thigh.
• Narrowfold - under ankle and figure of eight around foot.
The splint may be cut away from the knee to avoid pressure on
the patella.
2. Gently lower the limb on to the bandages.
• Support the fracture site on either side whilst lowering the
limb.
Fig 3
Laryngeal
Mask airway, Endotracheal Tu
Fig 4
3. Ask assistant to hold sides of splint in position firmly against the
patient’s limb.
4. Tie off triangular bandages as per sequence.
• Narrowfold - tie loop bandage around limb.
• Ankle - narrowfold is tied off as figure of eight bandage.
5. Recheck distal perfusion. (Fig 4)
Monitor splint:
1. Periodically check splint tension.
2. Regularly monitor distal circulation.
Approved by:
Medical Director
December 2003
106.4
Ambulance Service of New South Wales
Page 2 of 24
Issued by: Manager, Education
Immobilisation
Loop
Indication:
When securing a patient:
1. Take a narrowfold triangular bandage and fold in half.
2. Place bandage under limb with fold to the medial aspect of limb.
3. Place the second bandage over the top of the limb with the fold
to the lateral aspect as in picture. (Fig 1)
Fig 1
4. Place one end of the bandage through the loop from left to right.
5. Place other end of bandage through the loop from right to left.
(Fig 2)
6. Using even pressure, tension the knot. (Fig 3)
7. Complete the reef knot according to Skill Sheet 105.14.
Fig 2
Fig 3
Approved by:
Medical Director
December 2003
106.6
Ambulance Service of New South Wales
Immobilisation
Hare Traction Splint
Indication:
Suspected mid shaft fractured femur
Prepare the patient:
1.
2.
3.
4.
5.
6.
Explain the procedure
Provide adequate pain management prior to movement of the
limb
Expose the limb and remove any footwear
Check the foot for circulation, sensation & movement
NB. Compound Fractures should be thoroughly rinsed with saline
to remove any debris from the wound site prior to applying
traction. Open wounds should be covered with saline moistened
dressings and bandaged
Apply the manufacturer’s ankle strap (Fig1). If unavailable apply
a combine dressing to protect the ankle prior to using a bottle
knot or ankle loop. Tie off against the sole and to one side of the
foot (Fig2)
Fig 1
Fig 2
Prepare the equipment:
1.
2.
3.
4.
The thigh strap on later models of ‘Hare’ is longer to facilitate the
more ample thigh (Fig3). If patient’s leg is thin, consider
Fig 3
shortening the thigh strap by tying a thumb knot at its attachment
point to the splint, which will enable correct Velcro overlap once
insitu (Fig 4 & 5).
Loosen the lockets and size the splint from the crease of the
buttock to approximately 15cm beyond the sole of the foot then
tighten lockets (Fig1)
Lengthen the traction strap and lower the stand
Position the velcro support straps loosely underneath. Position
the straps as follows;
• Thin top strap – near crease of buttock
• Strap 1 - above the fracture site (as high as possible)
• Strap 2 – below the fracture site and above the patient’s knee
• Strap 3 - below the patient’s knee
• Strap 4 - above the patient’s ankle
Old model
New model
Fig 4
Apply manual traction and position the splint in one movement
1. Officer 1 – Support the fracture site using both hands (Fig 6)
2. Officer 2 – Hold the ankle strap/knot and gently apply firm
traction to realign leg into neutral position. (Fig 6)
3. Working together, gently raise the leg to approximately 10
degrees elevation. While maintaining traction, Officer 2 is to
gently insert and slide the splint up into the crease of the
buttocks. Lower leg onto splint (Fig 7)
4. Fasten thigh strap
5. Connect the traction strap to the ankle strap and tension until
adequate traction or comfort has been achieved (Fig 8)
Approved by:
Manager, Education
November 2008
Fig 5
106.7
Ambulance Service of New South Wales
Page 1 of 2
Immobilisation
Hare Traction Splint
6. Secure the four remaining Velcro support straps (Fig 9) Re-check
circulation, sensation & movement
7. Immobilise splint with sandbags, pillows or rolled blankets
Contraindications
1.
2.
Fractures distal to the femur e.g. knee, lower limb, foot, ankle. In
this situation utilise cardboard splints
Fractured pelvis, as a Hare Traction may twist the pelvis.
Fig 6
Occupational Health & Safety
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures.
Fig 7
Information surrounding the changes
This skill has been amended to simplify the traction splint application procedure
while reducing the amount of pain, movement and subsequent damage at the
fracture site.
•
Clean the bone and wound with saline prior to reducing a compound fracture.
This helps reduce the potential risk for neurological damage, shock and
infection
•
Check circulation, sensation & movement before and after applying traction
•
Do not apply manual traction until pain management is initiated (it might not
be needed or effective in some cases) and the splint is in the process of
being inserted.
•
Measure the length of the splint from the crease of the buttock to
approximately 15cm beyond the sole of the foot (Fig 2). Using the iliac crest
introduces an unnecessary variable.
•
Thigh strap is longer in latest ‘Hare’s Splints to accommodate larger thighs,
this strap may need to be shortened for some patients.
•
Lock the foot stand into the down position prior to insertion.
•
Do not log roll the patient. This creates significant movement without a
commensurate improvement in access for splint insertion
•
Do not tie the ankle bandage around the side rails- this bows the splint and
reduces the longitudinal traction.
•
Apply the 4 Velcro elastic support straps after traction is applied.
Approved by:
Manager, Education
November 2008
Fig 8
Fig 9
106.7
Ambulance Service of New South Wales
Page 2 of 2
Indication
Fractured femur where knee and neck of
femur injuries have been excluded in adult
and paediatric patients
Prepare the patient
• Explain procedure to patient
• Provide adequate pain management prior
to any limb realignment
• Expose limb, remove footwear
• Check distal pulse, capillary refill and
motor-sensory function
Prepare the equipment
• Remove from bag by grabbing the ankle
attachment end and raising it to shoulder
height ensuring tubing interlocks
• Straighten straps
• Measure splint by placing alongside leg.
Splint is to extend just above Ischial crest
and approx 15cm below patients foot
• If adjustment is required, remove the Ischial
cap and either add or subtract tube
sections for larger or smaller patients
Apply splint (Do not apply traction at this
point)
• Apply Ischial strap as high as it will go with
buckle on top of leg ensuring a firm fit
• Apply additional padding prior to application
of the blue ankle hitch
• Tighten foot strap to fit snugly against arch
of foot
!
" #!
$
%
• Apply velcro support straps
o Above fracture site
o Above knee
o Below knee
o Above ankle hitch
• Align splint by pulling cord. Apply
moderate tension (not traction) until
splint seats
• Lock cord into V-jam to hold tension
• Assess splint for correct placement
prior to traction
The splint can be upsized or downsized
at this point if required
Traction the Limb
• Support fracture site as required, particularly when compound fracture present
• Apply traction by removing cord from V-jam and slowly apply traction until fracture is
reduced
• Lock cord into V-jam and tie off excessive cord
• If application of splint is clearly detrimental, reassess and consider removal, particularly
where fracture site close to hip or knee
Bi-lateral fractured femurs
Two CT-6 splints can be applied to bi-lateral femur fractures
Paediatrics
The CT-6 splint can be used on paediatric patients by downsizing the splint prior to application
Transport
Support splinted limb during transport with blankets and/or pillows as required for comfort
Contraindications
•
•
•
Suspected pelvic injuries where pelvic binding is not in place
Fractured hip/ neck of femur
Knee, lower leg and ankle injuries should not have traction applied
!
" #!
$
%
Supporting Information
•
The CT-6 can be applied by a single operator
•
There is no need to lift the limb or log roll the patient
•
Check motor-sensory function, capillary refill & distal pulse pre & post application
•
Rinse and remove all debris from compound fractures and cover with saline moistened
sterile dressing prior to reduction
•
Reduction of a compound fracture is in line with trauma guidelines to reduce
neurological damage, shock and infection risk
•
Prior to reduction, the Ischial strap can be removed from splint and secured onto
patient before reattaching
•
Use caution when applying traction with the 4:1 pulley system to prevent excessive
traction. It is not like starting a lawn mower
•
Footwear should be removed where possible. Consider that applying the splint with
footwear on may later require removal of traction to assess circulation
•
Can be applied to patients ranging in height from 90cm to 200cm
•
Consider padding the Ischial strap and having clips facing outwards for comfort
•
CT-6 can be used to immobolise knee and fractures below the knee without the use of
traction if cardboard box splints are not feasable
Packaging Technique
•
Slide all four leg straps to one end of the splint, keeping straps off tube edges
•
Ensure the orange thigh extension strap is attached to the splint
•
Ensure the splint is folded down from the position of having one tube reduced and
secured by the Ischial cap
•
Allowing the straps to hang, break the splint down by folding each section on top of the
other towards the heel attachment end
•
Fold the ankle hitch and ischial strap alongside tube sections
•
Roll splint tightly within the leg straps but don’t roll around splint to allow Velcro to grab;
this will prevent easy removal from the bag
•
Slide splint into the bag allowing the ankle hitch cord to be visible at the top of the bag
•
Tighten bag closed with the cord fasteners
!
" #!
$
%
Issued by: Manager, Education
Immobilisation
Sling/Collar and Cuff
Indication:
In situations where a collar and cuff sling is required, eg fracture of
the humerus.
Fig 1
Prepare the patient:
1. Explain to the patient what is about to happen.
2. Administer pain relief if required.
3. Expose the limb and apply dressings if necessary.
4. Place patient in a comfortable position, with forearm of the
injured side across the chest with fingers pointing towards the
opposite shoulder. (Fig 1)
Fig 2
Prepare the equipment:
1. Take a narrow fold bandage and make a clove hitch. Fold two
loops over the centre of the bandage with one loop pointing
upwards and the other loop pointing downwards. Bring both
loops together from outside making sure that the free ends are
between the loops. (Fig 2)
Fig 3
Apply the collar and cuff sling:
1. Facing the patient pass the clove hitch over the hand and around
the wrist, ensuring the knot to the clove hitch is on the thumb
side of the wrist.
2. Tension firmly without interfering with distal circulation.
3. Tie the ends of the bandage in a reef knot, in the hollow of the
neck on either side. (Fig 3)
Re-check distal pulse:
•
Adjust sling if pulse is absent.
Approved by:
Medical Director
December 2003
106.11
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Sling/Small Arm
Immobilisation
Indication:
In situations where an injury to the hand or forearm requires support
or elevation.
Prepare the patient:
1. Explain to the patient what is about to happen.
2. Administer pain relief if required.
3. Check pulse distal to injury.
Fig 1
4. Apply dressings if necessary.
5. Place patient in a comfortable position with the forearm of the
injured arm across the chest with fingers touching the opposite
shoulder.
Application of sling:
1. Facing the patient, drape the open bandage over the forearm, the
apex just superior to the elbow and the upper point tucked under
the fingertips forming a trough. (Fig 1)
Fig 2
2. Pass the base of the bandage under the forearm, join the bandage
together at the elbow and give 2-3 twists towards the patient, then
take the lower point of the bandage across the back, under the
scapula.
• Fold the apex back behind the elbow securing with a pin, tape
or twist the end ensuring that it is secured. (Fig 2)
Re-check distal pulse:
•
Adjust sling if pulse is absent.
Approved by:
Medical Director
December 2003
106.12
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Immobilisation
Sling/Large Arm
Indication:
Fig 1
In situations where the forearm is required to be supported i.e. with
fractures to radius/ulna and injuries to hand.
Prepare the patient:
1. Explain to the patient what is about to happen.
2. Administer pain relief if required.
3. Check pulse distal to injury.
Fig 2
4. Expose the limb and apply dressings and splinting if necessary.
Apply large arm sling:
1. Place the patient in a comfortable posture with forearm positioned
horizontally across torso.
2. Facing patient, place the open triangular bandage underneath the
injured arm with the apex at the elbow. (Fig 1)
3. Take the upper point of the triangular bandage over the shoulder
and behind the neck. (Fig 2)
Fig 3
4. Bring the lower point of the triangular bandage over the injured
arm.
5. Tie the two ends with a reef knot on the injured side so that the
knot fits into the hollow of the neck.
• This is the only sling that is tied off on the injured side.
(Fig 3)
6. Fold the apex back behind the elbow securing with a pin, tape or
twist the end ensuring the hand is fully supported and fingernails
exposed. (Fig 4)
Fig 4
Re-check distal pulse:
• Adjust sling if pulse is absent. (Fig 5)
Fig 5
Approved by:
Medical Director
December 2003
106.13
Ambulance Service of New South Wales
Page 1 of 12
Immobilisation
Pelvic Sheeting
Indication:
Any patient who has experienced any mechanism of injury which
has resulted in any degree of pain in the pelvic area must have the
pelvis externally stabilised.
High risk groups include:
• Vehicle v pedestrian / cyclist / motor bike
• Motor vehicle crash
• Crush or compressive force
• Patients > 65 years of age
Fig 1
Patient MUST NOT have their pelvis sprung or compressed.
Procedure:
1. Bring patient’s legs together by internally rotating the legs to
align the feet.
Fig 2
2. Apply padding between their knees and both sides of their
ankles. Secure with triangular bandages ensuring the feet are
aligned together. (Fig 1)
3. Place patient onto a folded sheet between the iliac crest and
the groin (Fig. 2). Use a scoop stretcher to minimise spinal
movement.
4. Remove clothing where feasible, except underwear.
5. Fold each side of the sheet across the patient’s symphysis
pubis region and with an assistant pull the sheet firmly. (Fig 3)
Fig 3
6. While maintain tension and using the forceps from the Pelvic
Sheeting Kit, clamp at the four points shown in figure 4.
7. Keep the forceps away from the groin and lower abdomen to
allow for further clinical examinations and procedures. (Fig. 4)
Handy Hints:
• Pelvic sheeting is not to be used for isolated neck of femur
injuries as it may impact the fracture site, although
preventing the morbidity and mortality from pelvic
fractures outweighs #NOF discomfort in multiple trauma.
•
Traction splinting is not to be applied to fractured femurs
when pelvic fractures are suspected and treated.
•
To secure forceps tape can be used to prevent forceps
from springing open.
Fig 4
Fig 5
Occupational Health and Safety:
Compliance with relevant Infection Control, OH&S and Manual
Handling techniques and procedures
Approved by:
Manager Education
June 2008 - Revised April 2009
Fig 3
Ambulance Service of New South Wales
106.14
Page 1 of 1
Issued by: Manager, Education
Wound Care
Dressings - Dry
Indication:
In situations where an open wound requires haemorrhage control
and protection against infection.
Prepare the patient:
1. Explain to the patient what is about to happen.
2. Administer pain relief if required.
• Ensure personal infection control measures are used.
Fig 1
Prepare the equipment:
1. Select suitable sterile dressing from first aid kit and remove from
package.
• Should extend well beyond wound area on each side.
• Should be adequate to absorb exudate where present. (Fig 1)
Cleaning of wound:
1. For irrigation use only saline or antiseptic solution.
2. For cleaning intact skin surrounding a wound, use sterile gauze
swabs. Swab from wound edge outwards using antiseptic solution.
(Fig 2)
Fig 2
3. Remove foreign bodies if this can be done by gently removing
with forceps or brushing away with a sterile piece of gauze.
4. Place a ring bandage around foreign bodies that are penetrating in
nature.
Dressing of the wound:
1. Remove appropriate sterile dressing from packet making sure that
the fingers do not contaminate the side of the dressing which will
be in contact with the wound. (Fig 3)
Fig 3
2. Secure in place with appropriate bandage or tape.
3. Support and immobilise if appropriate.
4. Apply additional dressings if the original dressing becomes
saturated with exudate. Do not remove initial dressing. Cover first
dressing with another sterile dressing of the same size and secure.
Approved by:
Medical Director
December 2003
107.1
Ambulance Service of New South Wales
Laryngeal
Page 32
of 47 M
Issued by: Manager, Education
Wound Care
Dressings - Wet
Indication:
In situations where a wound requires haemorrhage control,
protection against infection and maintenance of moist environment,
ie wounds with exposed viscera, burns.
Prepare the patient:
1. Explain to the patient what is about to happen.
2. Administer pain relief if required.
3. Ensure personal infection control measures are used.
Fig 1
Prepare the equipment:
1. Select suitable sterile dressings from first aid kit.
2. Dressings should extend well beyond wound area on each side.
3. Dressings should be adequate to absorb exudate where present.
Cleaning of the Wound:
Fig 2
1. Clean area around wound using antiseptic solution applying with
sterile gauze swabs. Swab from wound edge outwards.
2. For wound irrigation, use sterile saline solution only. (Fig 1)
Application of the Wet Dressing:
1. Moisten selected dressing with a sterile saline solution.
2. Make sure that the fingers do not contaminate the side of the
dressing which will be in contact with the wound. (Fig 2)
Extruded Viscera:
1. Place gently over protruding viscera.
2. Do not try in any way to push back any protruding contents.
3. Where necessary, the first dressing may be covered by a second
dry dressing. Lightly secure in place by taping the sides.
• Beware of hypothermia.
Approved by:
Medical Director
December 2003
107.1
Ambulance Service of New South Wales
Manager
Page 53
of 47 Ed
Issued by: Manager, Education
Wound Care
Dressings - Wet
Eye Injuries excluding protruding penetrating foreign bodies:
1. Use appropriate sized sterile dressings.
2. Place dressing lightly over the injured eye.
3. A sterile, dry, light dressing may be placed over the initial first
dressings.
4. Use no pressure over eyes - secure in place by strapping side to
face/forehead/cheeks. (Fig 3)
Fig 3
5. Do not bandage uninjured eye.
Extruded Eyeball:
1. Cover with moist dressing.
2. Do not handle or try to replace eyeball back into socket.
3. Protect by surrounding eyeball with cup or cone. (Fig 4)
Fig 4
Approved by:
Medical Director
December 2003
107.1
Ambulance Service of New South Wales
October
Page 64
of 47 200
Issued by: Manager, Education
Wound Care
Preservation of Severed Parts
Indication:
In situations where traumatic amputation of body parts has occurred.
Administer pain relief if required.
Care of the severed part:
1. Place severed part in an empty, dry, plastic bag, then seal. (Fig 1)
2. Place cold water with some ice (where possible) into a second
bag or container.
Fig 1
3. Place the first bag containing the severed part into the second bag
or container and seal. (Fig 2)
• The severed part must remain with the patient.
Fig 2
Approved by:
Medical Director
December 2003
107.2
Ambulance Service of New South Wales
Page 1 of 12
Wound Care
Burns
Indication
To minimise tissue damage, infection and pain following burn
injuries.
Prepare the patient
• Refer to Burns Protocol T12
Methods
1. Plastic film
• After cooling the Burn Surface Area (BSA) apply plastic film
longitudinally over site
• Do not wrap plastic film circumferentially around any BSA
• Not to be applied to facial burns
2. Hydro gel dressing
• Choose the most suitable size dressing to cover the burn
injury allowing enough dressing to cover the BSA and at
least 50% of the surrounding non-burnt area
• Open pack and remove dressing
• Apply to BSA and surrounding area
• When applied to facial burns the pre cut eye or nose flaps
can be removed if required
Handy Hints
• In all situations, monitor patients temperature to prevent
hypothermia, wrap patient in blanket and apply space blankets
to promote warming
• Dressings may be cut to size if required
• May be used as a nappy wrap for perineum burns in children
and adults
• May be left in situ for extended periods of time including interfacility transfers
• Suitable for friction, abrasion and chemical burns
• Minor burns and small BSA may be treated with a 20ml syringe
with water, saline etc, attached to a MAD and spray onto the
burn for cooling and soothing
• The MAD may also be applied to a pump set with Normal Saline
or Hartmann’s for cooling and soothing
• If the patients clothing is burnt to the skin, the hydro gel
dressing can be applied over the material as the gel will
penetrate.
Occupational Health and Safety
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures.
Approved by:
Manager Education
July 2009
107.3
Ambulance Service of New South Wales
Page 1 of 1
Medications and Fluids
Burette
Indication
Administration of certain IV medications and fluids
Method
•
Ensure that the giving set, medications and fluids to be
administered are intact, without discolouration or sedimentation
and within the expiry date
•
Remove giving set and fluids from packaging
•
Re-position infusion regulator near the drip chamber and close off
Fig 1
•
Turn off the burette filling regulator
•
Remove protective cap from fluid container and perforator
•
Insert perforator into fluid container
Fig 1
If perforator touches non sterile field, discard and prepare another
• Suspend container
•
Ensure burette air vent is open
•
Fill burette chamber to volume required by opening the burette
filling regulator Fig 2. Determine volume of fluid/medication in
burette by measuring from top of swim valve
•
Close the burette filling regulator securely
•
Swab burette injection port with alcohol wipe
•
Add the required additive to the burette via the burette injection
port Fig 3
•
Ensure solution is adequately mixed (gentle swirling motion)
•
Squeeze lower half of the drip chamber until half full
•
Open the infusion regulator and prime the line until all air is
expelled between the drip chamber and the end of the IV tubing
•
Close infusion regulator
•
Remove protective cap from the male luer lock connector
•
Connect and secure IV tubing to reflux valve attached to cannula
If luer lock touches non sterile field, discard and prepare another
•
Elevate fluid to provide optimum flow
•
Control flow rate with infusion regulator
Approved by:
Manager Education
December 2003. Revised; March 2010
Ambulance Service of New South Wales
Fig 2
Fig 3
108.1.1
Page 1 of 2
Medications and Fluids
Burette
Supporting Information
Removing air in the tubing between the drip chamber and the injection port
• Swab the injection port
• Occlude the line immediately beyond the injection port
• Turn on the infusion regulator
• Using a drawing-up needle attached to a 10ml luer lock syringe
• Insert needle into injection port and draw back on the syringe to remove air
• The solution drawn out will contain medication. This must be re-introduced to the burette chamber
via the burette injection port – swab burette injection port prior to adding medication
Drip chamber fills past half way
• Occlude the line immediately below the drip chamber
• Invert the burette chamber
• Squeeze the drip chamber to evacuate fluid into the burette
• Re-establish the drip chamber to half-full
Removing air in the tubing between the injection port and the patient – when secured in place
• Turn off infusion regulator
• Disconnect IV line from the reflux valve – maintain asepsis
• Turn on regulator to allow a small amount of fluid (1-2ml) to flow to push any air out. Contain this
fluid and dispose of appropriately
• This loss of medication needs to recorded on the PHCR as discarded
Caution
Patient movement
The giving set needs to checked for kinks, bends, twists, occlusions and air in the line following any
patient movement where the IV line and fluid container have been laid flat
Occupational Health and Safety
Compliance with relevant infection control, OH&S and manual handling techniques and procedure
Approved by:
Manager Education
December 2003. Revised; March 2010
Ambulance Service of New South Wales
108.1.1
Page 2 of 2
Medications and Fluids
Pump Set
Indications
Administration of IV fluids and medications
Method
•
Ensure that the giving set and fluids to be administered are intact,
without discolouration or sedimentation and within the expiry date
•
Remove giving set and fluids from packaging
•
Re-position regulator near the pump chamber and close off Fig 1
•
Remove protective cap from fluid container and perforator
•
Insert perforator into fluid container
Fig 1
If perforator touches non sterile field, discard and prepare another
•
Suspend container
•
Squeeze lower half of the drip chamber until half full Fig 2
•
Invert the pump chamber and the injection port, open the regulator
and prime the line until all air is expelled between the pump
chamber and the end of the IV tubing Fig 3
•
Close regulator
•
Remove protective cap from the male luer lock connector
•
Connect and secure IV tubing to reflux valve attached to cannula
Fig 2
if luer lock touches non sterile field, discard and prepare another
•
Elevate fluid to provide optimum flow
•
Control flow rate with regulator
Supporting Information
Removing air in the tubing between the drip chamber and the pump
chamber
• Hold fluid container upright
• Bend over the one way valve on the top of the pump chamber
• Pressurise the pump chamber to evacuate air into the drip
chamber and fluid container
Fig 3
Drip chamber fills past half way
• Occlude the line immediately below the drip chamber
• Invert the fluid container and drip chamber
• Squeeze the drip chamber to evacuate fluid into fluid container
• Re-establish the drip chamber to half-full
Approved by:
Manager Education
December 2003 Revised; March 2010
Ambulance Service of New South Wales
108.1.2
Page 1 of 2
Medications and Fluids
Pump Set
Removing air in the tubing between the pump chamber and the injection port
• Occlude the line immediately beyond the injection port
• Swab the injection port and connect a luer lock syringe
• Turn on the regulator and draw back on the syringe to remove air
Removing air in the tubing between the injection port and the patient – when secured in place.
• Turn off regulator
• Disconnect from the reflux valve
• Turn on regulator to allow a small amount of fluid to flow to push any air out. Contain this fluid and
dispose of appropriately
To change the fluid container – do not allow fluid to drain completely from drip chamber
• Turn the regulator off
• Remove the empty container and replace as in initial steps above.
Caution:
Patient movement
The giving set needs to checked for kinks, bends, twists, occlusions and air in the line following any
patient movement where the IV line and fluid container have been laid flat.
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual handling techniques and procedure
Approved by:
Manager Education
December 2003 Revised; March 2010
Ambulance Service of New South Wales
108.1.2
Page 2 of 2
Issued by: Manager, Education
Injections/Intramuscular
Drugs and Fluids
Indication:
Administration of a drug through the intramuscular route.
Prepare the patient:
1. Reassure the patient and explain the purpose of administration
and likely effects of the drug.
2. Determine whether any contraindication exists.
3. Choose appropriate injection site and expose the area.
• The thigh is the preferred IM injection site for paediatrics.
Fig 1
4. Swab the site with an alcohol wipe in a circular motion from the
inside out. (Fig 1)
Prepare the equipment:
1. Obtain the drug.
• Ensure that it is within the expiry date, clear and intact.
2. Assemble the needle and syringe using aseptic technique.
• A 23 gauge needle is generally selected for intramuscular
injections.
Drawing up the drug:
1. Ensure that the full amount of drug is in the vial/ampoule.
Where using a vial
1. Swab top of vial with an alcohol wipe.
2. With a sharp needle draw up drug into syringe, in excess of
required amount where possible.
3. Holding syringe at eye level with needle uppermost, gently tap
the side of the syringe. Expel the air and ensure that the exact
amount of solution required is contained within the syringe. (Fig 2)
Fig 2
Where using an ampoule:
1. Insert neck of ampoule into an opened swab packet or
equivalent and break off at neck.
• If using a plastic ampoule remove top by twisting.
2. Attach blunt needle to syringe, remove cover and insert into
ampoule.
3. Draw up drug into syringe, in excess of required amount
(where possible).
4. Dispose of needle in sharps container and fit with 23 gauge
needle.
Approved by:
Medical Director
December 2003
108.2
Ambulance Service of New South Wales
Page 1 of 612
Issued by: Manager, Education
Drugs and Fluids
Injections/Intramuscular
Administer the drug:
1. Pull the skin to one side or flatten the skin over the injection
site.
2. Insert the needle at an angle of 90˚ to the skin surface for two
thirds the length of the needle. (Fig 3)
Fig 3
3. Withdraw the plunger slightly to ensure no blood is aspirated.
4. If blood is aspirated withdraw the needle and syringe slightly,
rotate 180˚ and inject.
5. Steadily apply pressure to the plunger to administer the drug.
6. Withdraw the needle.
7. Apply direct pressure with gauze or alcohol wipe.
8. Immediately dispose of sharps into sharps container.
• Do not resheath any needle.
• Prior to injection, always confirm with your partner, doctor
or registered nurse the drug, dose and expiry date.
• In the event of a single officer response refer to Standard
Operating Policies & Procedures Manual, Cl 3.2.
Approved by:
Medical Director
December 2003
108.2
Ambulance Service of New South Wales
Page 2 of 612
Issued by: Manager, Education
Drugs and Fluids
Injections/Intravenous Cannulation
Indication:
Fig 1
In situations where a patient requires intravenous access for fluid or
drug administration.
Prepare the patient:
1. Explain to the patient what is about to happen.
2. Place the patient in a comfortable position, with the selected limb
positioned down.
3. Choose suitable cannulation site.
• Avoid areas that run over joints because of increased potential
for dislodgement.
Fig 2
4. Apply a venous tourniquet above the potential cannulation site.
• Can also use blood pressure cuff.
5. Swab the site with an alcohol wipe in a circular motion from the
inside out.
• Shave the area if excessive hair is present. (Figs 1 & 2)
Fig 3
Prepare the equipment:
1. Needle-less injection valve, 10ml syringe, 10ml ampoule 0.9%
NaCl, arm lock or similar splint and appropriate cannula securing
equipment.
2. Select the most appropriate cannula size for the task.
• For major fluid replacement select the largest cannula that can
be confidently inserted.
Fig 4
3. Obtain and set up selected fluid for infusion as per Skill Sheet
108.1.
• Ensure that all items are sterile, intact and within date.
4. Set out equipment near patient in an accessible location.
Cannulate the patient:
1. Tension the vein with the non-cannulation hand.
2. Pointing superiorly, with bevel up, insert cannula at a 25-30˚
angle. (Figs 3 & 4)
Fig 5
3. When flashback observed, lower the cannula and advance about
2mm to stabilise the needle in the vein. (Fig 5)
Approved by:
Medical Director
December 2003
108.2
Ambulance Service of New South Wales
Page 53 of 612
Issued by: Manager, Education
Drugs and Fluids
Injections/Intravenous Cannulation
4. Advance the Teflon into the vein and secure the stylette in the
self-locking sheath. (Fig 6)
Fig 6
5. Occlude the vein with external pressure, remove the self-locking
sheath and attach a needle-less injection valve to the cannula.
(Fig 7)
6. Dispose of self-locking sheath immediately into the sharps
container.
7. Secure the cannula, with Steri-Strips and Opsite. (Figs 8, 9 & 10)
8. Inject 10ml of 0.9% NaCl into the cannula to confirm its
placement. Ensure the site is free of extravasation.
Fig 7
Fig 8
Fig 9
Fig 10
Approved by:
Medical Director
December 2003
108.2
Ambulance Service of New South Wales
Page 64 of 612
Issued by: Manager, Education
Drugs and Fluids
Injections/Subcutaneous
Indication:
Administration of a drug through the subcutaneous route.
Prepare the patient:
1. Reassure the patient and explain the purpose of administration
and likely effects of the drug.
2. Determine whether any contraindications exist.
3. Choose appropriate injection site and expose the area.
4. Swab the site with an alcohol wipe in a circular motion from the
inside out. (Fig 1)
Prepare the equipment:
1. Obtain the drug.
Fig 1
2. Ensure that it is within the expiry date, clear and intact.
3. Assemble the needle and syringe using aseptic technique.
• A 25-gauge needle is generally selected for subcutaneous
injections.
Drawing up of drug:
As per Skill Sheet Drugs and Fluids 108.1.
Administer the drug:
Fig 2
1. Pinch a fold of the patient’s skin.
2. Insert needle at 45˚, bevel uppermost, for two thirds the length of
the needle. (Fig 2)
3. Withdraw the plunger slightly to ensure no blood is aspirated.
• If blood is aspirated, withdraw the needle and syringe and
rotate 180˚ and then inject.
4. Steadily apply pressure to the plunger to administer the drug.
5. Withdraw the needle.
6. Apply direct pressure with gauze or alcohol wipe.
7. Immediately dispose of needle into the sharps container.
• Do not resheath any needle.
• Prior to injection, always confirm with your partner, doctor or
registered nurse, the drug, dose and expiry date.
• In the event of a single officer response refer to Standard
Operating Policies & Procedures Manual, Cl 3.2.
Approved by:
Medical Director
December 2003
108.2
Ambulance Service of New South Wales
Page 85 of 612
Issued by: Manager, Education
Drugs and Fluids
Injection/External Jugular Vein Cannulation
Indication:
In situations where a patient requires intravenous access for fluid or
drug administration where a peripheral vein cannot be cannulated.
Prepare the patient:
1. Explain to the patient what is about to happen.
2. Place patient supine, with legs elevated where possible, with head
turned away from cannulation side.
3. Swab the site with an alcohol wipe in a circular motion from the
inside out. (Fig 1)
Prepare the equipment:
Fig 1
1. Needle-less injection valve, 10ml syringe, 10ml ampoule 0.9%
NaCl and appropriate cannula securing equipment.
2. Select a cannula size.
• Generally the biggest cannula that can be confidently inserted.
3. Obtain and set up selected fluid for infusion as per Skill Sheet
108.1.
• Ensure that all items are sterile, intact and within the expiry date.
4. Set out equipment near patient in an accessible location.
Fig 2
Cannulate the patient:
1. Choose the cannulation site, generally midway from the angle of
the jaw to the clavicle, lateral to the thyroid notch.
2. Tension the vein with the non-cannulating hand.
3. Tensioning the vein will anchor the vein and also create a
tamponade effect making the vein easier to visualise.
Fig 3
4. Pointing inferiorly with bevel up, cannula at 25-30˚ angle.
(Fig 2)
5. When flashback observed - lower cannula and advance
approximately 2mm to stabilise the needle in the vein.
6. Advance the Teflon into the vein and secure the stylette in the
self-locking sheath.
7. Occlude the vein with external pressure and attach a needle-less
injection valve to the cannula. (Fig 3)
8. Dispose of self-locking sheath immediately into the sharps
container.
9. Inject 10ml of 0.9% NaCl into the cannula to confirm its
placement. Ensure site is free of extravasation.
Approved by:
Medical Director
December 2003
108.2
Ambulance Service of New South Wales
Page116 of 612
Issued by: Manager, Education
Drugs and Fluids
Cannula security -Tegaderm
Indication:
For securing IV cannula
Prepare and apply Tegaderm:
1. Check the integrity and expiry date on the package.
Fig 1
2. Separate the backing sheet from the transparent dressing and
securing tape. Fig 1
3. Remove single adhesive strip. Fig 2
4. Secure to cannula with single strip. Fig 3
Fig 2
5. Apply the transparent dressing over cannula with wings distal to
patient. Fig 4
6. Apply second single adhesive strip over cannula site. Fig 5
7. Record and attach the date adhesive strip over dressing. Fig 6
Fig 3
Note: Ensure the injection site is visible through the transparent
dressing
CONTRAINDICATIONS:
•
Known allergies to adhesive tape
Fig 4
Fig 5
Approved by:
Manager Education
September 2007
Fig 6
108.2.4
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Methoxyflurane Inhaler Use
Drugs and Fluids
Indication:
When using the Methoxyflurane inhaler kit to provide analgesia.
Prepare the patient:
1. Reassure the patient and explain the purpose of administration
and likely effects of the drug.
2. Determine whether any contraindication exits.
Fig 1
Prepare the equipment:
1. Obtain Methoxyflurane inhaler equipment and ensure that it is
sealed and within the expiry date.
2. Open inhaler kit and remove contents.
3. Open 3ml bottle of solution and pour into base of inhaler. (Fig 1)
4. Shake inhaler slightly to dispel any excess fluid. Wipe
mouthpiece with gauze if excess fluid is present.
Fig 2
Use equipment:
1. Give inhaler to patient.
2. Instruct patient to inhale through the mouth with the diluter
hole open, and exhale through the nose or remove inhaler from
mouth to exhale. (Fig 2)
3. The wrist band can be used to assist the patient to hold the
inhaler.
Fig 3
4. Explain to patient how to increase concentration by covering
diluter hole. (Fig 3)
5. Record time of administration and effects.
6. A resuscitation mask can be fitted to the inhaler if required. (Fig 4)
7. Add additional Methoxyflurane bottle to inhaler unit.
Disposal:
Fig 4
Dispose of used inhaler by sealing item in a plastic bag so as to limit
release of unwanted Methoxyflurane vapour.
Approved by:
Medical Director
December 2003
108.3
Ambulance Service of New South Wales
Page 1 of 12
Medications and Fluids
Nebuliser
Indication
Fig 1
Administration of medication via a nebuliser
Prepare the equipment
•
Select appropriate sized mask for patient; 2 sizes of
mask/nebuliser kits are available
•
Ensure nebuliser device is complete and assembled
•
Without disassembling nebuliser load medication through
top opening Fig 1
Connect nebuliser to mask and ensure tight fit and seal
to face Fig 2
Adjust O2 flow to 8 litres per minute (unless using 8
L/nipple)
•
•
Fig 2
T piece - Adult / Child resuscitator bag (> 6.5 kg)
•
Attach nebuliser to T-piece between resus mask and
resuscitator bag. Fig 3 NB The multi-directional nebuliser
will vaporise the drug from every angle (except upside
down) Fig 4
•
If patient has an LMA or ETT in situ, attach T-piece to the
airway tube using a flexible catheter mount Fig 5
Fig 3
T piece - Infant resuscitator bag (< 6.5 kg)
•
The T-piece will not connect directly to the supplied
resus mask in this size resuscitator. In this situation use
a flexible catheter mount to attach the T-piece to the
mask
Fig 4
Supporting Information
•
•
•
Patients with severe or extreme asthma present with
difficulty exhaling. These patient’s can often be hyperinflated and have high pressure in their chest
Patients requiring inspiratory assistance often also
require expiratory assistance. If only one can be
performed, apply a mask/nebuliser and perform
expiratory assistance
Consider one officer starting expiratory assistance
immediately upon locating patient while the other officer
prepares and commences oxygen and medication
therapy
Fig 5
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and
manual handling techniques and procedures
Approved by:
Manager Education
September 2007. Revised; March 2010
Ambulance Service of New South Wales
108.4
Page 1 of 1
Issued by: Manager, Education
Drugs and Fluids
Mucosal Atomiser Device
Indication:
The administration of drug therapy via atomised particles through the
nasal mucosa.
Fig 1
Prepare the patient:
1.
Explain to the patient what is about to happen.
2.
Ensure patient is able to breath freely from the nostril(s)
Prepare the equipment:
1.
Open Mucosal Atomiser Device kit consisting of one luer lock
syringe, one drawing up needle, one MAD, two alcohol swabs.
(Fig 1)
2.
Select appropriate medication and cross check with colleague.
(Fig 2)
3.
Swab injection site on vial with alcohol swab.
4.
Draw up prescribed dose of medication required for one
intranasal spray using a blunt drawing up needle. (Fig 3)
Note: Depending on medication being used you may be
required, on FIRST loading dose ONLY, to draw up an
additional 0.1ml to account for dead space. - refer to
Pharmacology.
5.
Fig 2
Fig 3
Remove syringe from drawing up needle, then attach the
Mucosal Atomiser Device ensuring a firm fitting.
Administer the medication:
1.
Place the Device into patients Nare ensuring a firm but gentle
fit. (Fig 4)
2.
Holding the syringe, push the plunger in firmly to create a
misting of the medication.
3.
Withdraw the syringe and remove the Mucosal Atomiser Device
from the syringe.
Fig 4
For further intranasal medication administrations of same drug
1.
Draw up prescribed dose as in steps 2, 3, 4 and 5 of “Prepare
the equipment”.
2.
Then Repeat steps 1, 2 and 3 of “Administer the medication”.
Note: Personal protective equipment must be worn at all times when
administering an atomised medication including gloves, eye
protection and respiratory mask.
Approved by:
Medical Director
July 2005
108.5
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Drugs and Fluids
Intraosseous
Indication:
Situations where intravenous access is not possible on a paediatric patient
who requires active fluid or drug administration
Prepare the patient:
1. Posture patient
2. Select appropriate infusion site. Fig 1
• Proximal tibia - 1 to 2 cm inferior to the tibia tuberosity in the
middle of the flat surface of the medial aspect of the tibia.
• Distal tibia - medial surface of the tibia just above the medial
malleolus.
Fig 1
3. Clean the skin with an alcohol swab.
Prepare the equipment:
1. Obtain the intraosseous needle, needle-less injection valve, 10ml syringe,
arm lock or similar splint and adhesive tape.
Fig 2
2. Obtain and set up selected fluid for infusion and appropriate infusion
set.
Cannulate the patient:
1. Identify the insertion landmarks and insert the needle at a 90˚ angle to
the skin surface. Angle needle away from growth plate.
2. Holding needle in the palm of the insertion hand with fingers extended
to the tip of the needle, use moderate forward pressure and a slight
twisting motion to advance the needle into the bone cortex. Fig 2
•
•
Fig 3
Do not wobble as a “V” shape hole will develop and extravasation
will occur.
Placement is confirmed by a sudden loss of resistance and the
needle independently standing (like a nail in a board). Fig 5
3. Remove needle by rotating counterclockwise, do not pull. Dispose of
needle immediately into a sharps container. Fig 3 & 4
4. Connect primed infusion line to the cannula. Fig 6
Fig 4
5. Secure infusion line with hinged tape technique. Fig 7
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Ambulance Service of New South Wales
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Drugs and Fluids
Intraosseous
Commence infusion:
1. Connect a needle-less injection valve to the injection port of infusion set
if in situ.
2. Connect 10ml syringe to needle-less injection valve.
3. Turn on the infusion set.
4. Crimp the infusion line below the injection port, draw 10ml fluid into
the syringe. Fig 8
5. Releasing the infusion line below to the injection point and crimping the
infusing line above to the injection valve, depress the syringe slowly to
commence infusion of fluid.
Fig 5
• Placement is confirmed by the infusion of 10ml of fluid without
extravasation.
6. Repeat as often as necessary. All fluid to be measured and administered
by a 10ml syringe
7. Secure cannula site, apply appropriate splinting if required. Fig 9
Fig 6
COMPLICATIONS:
•
•
•
•
Extravasation
Infection
Damage to the bone growth plate
Possible fracture of the site if excessive force is applied
Fig 7
CONTRAINDICATIONS:
Defect in the cortex of the chosen tibia
•
•
•
Fracture of that bone or
Previous attempts which penetrated the cortex of that bone
Infected skin overlying insertion site (relative contraindication)
Fig 8
Fig 9
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108.7
Ambulance Service of New South Wales
Page 2 of 2 4
Medications
EpiPen
Indication
For administration of a patient’s own prescribed and supplied
adrenaline (EpiPen) in patients with signs and symptoms of
moderate to severe anaphylactic reactions
Fig 1
Prepare the patient
1. Explain procedure to the patient
2. Expose the preferred site lateral aspect of thigh. Avoid
injecting through clothing to ensure absorbtion
3. Swab injection site with alcohol swab
Fig 2
Fig 2
Prepare the equipment
1. Remove from plastic container (Fig 1). Do not touch the
black tip with your fingers or thumb at any time when
handling the EpiPen
2. Form fist around EpiPen and pull off grey cap
DO NOT touch either end with any part of your fingers or
thumb (Fig 2)
Fig 3
Administer the drug
1. Push black end against lateral aspect of thigh (Fig 3),
(with or without clothing)
Fig 4
2. Push down hard until a click is heard or felt and hold in
place for 10 or more seconds to allow full administration of
the preloaded dose
3. Remove EpiPen and place in sharps container (Fig 4)
4. Massage the injection site for 10 seconds (Fig 5)
Fig 5
Fig 5
Approved by:
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108.8
Ambulance Service of New South Wales
Page 1 of 1
Issued by: Manager, Education
Drugs and Fluids
Pre Administration Check
Indication:
Safe administration of drugs and fluids.
Method:
1. Confirm provisional diagnosis and need to administer medication with
your partner.
2. Check the “5 R’s” with your partner prior to the administration of a
drug or fluid.
The Right:
• Patient
• Drug
• Dose
• Time
• Route
Precautions:
•
•
•
•
Ask the patient if they have any allergies. Also name the drug you are
about to give and whether they have had it previously?
Ensure aseptic technique is used at all times
Use Ampoule opener with all glass ampoules
Draw up drugs with filtered drawing up needle. Discard IM dose syringe
and needle after use. Apply a new capped needle to cover syringe hub
between IV doses to maintain asepsis. Do not re-sheath needles.
Procedure:
Select appropriate drug or fluid to be administered
Read the label carefully and check the following
1. Expiry date, integrity of the packaging and appearance of the drug or
fluid for sediment or cloudiness
2. Hand the drug or fluid to the second officer and without telling them
what is on the label ask them to read out the
• Name of the drug or fluid
• Volume (mls) and weight (grams) of the packaged drug or fluid
• Expiry date and physical appearance of the drug or fluid
• Each officer calculates the dosage. Confirm administration with
‘Drug Dose Reference Card’
3. Draw up required dose into administration device. eg syringe, MAD,
burette, apply appropriate drug label to side of the syringe or burette.
4. Administer drug according to ASNSW pharmacology and where
possible have your work partner witness the administration, especially
S8 drugs
5. Confirm repeat doses with your partner
6. Each incremental dose must be recorded on the PHCR
Approved by:
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September 2007
108.9
Ambulance Service of New South Wales
Page 1 of 24
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Drugs and Fluids
Pre Administration Check
7. Second officer to confirm doses written on PHCR and co-sign each
entry
8. Record the administration/discarding of all drugs in the appropriate
drug register. Both officers must sign the register
9. In the event of a single officer/flight nurse response, the drug is to be
checked and rechecked immediately prior to administration
Occupational Health and Safety:
1. Wearing of approved appropriate personal protective equipment during
procedure.
2. Swab sites, vials and bungs prior to administration.
3. Dispose of sharps into approved sharps containers immediately.
4. Compliance to relevant OH&S, and manual handling techniques
5. Compliance to infection control procedures
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September 2007
108.9
Ambulance Service of New South Wales
Page 2 of 24
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Extrication
Removal of Full Face Helmet
Indication:
In a motorcycle accident where the mechanism of injury suggests
likelihood of spinal damage/compromised airway.
Prepare the patient:
1. Reassure the patient and highlight the importance of minimal head
movement.
2. Manually immobilise the patient’s head.
Fig 1
3. Remove any glasses in situ.
4. Log roll patient into lateral position.
5. Cut helmet head strap. (Fig 1)
Remove helmet from patient:
1. The helmet is adjusted so that the back of the patient’s head and
neck are exposed. Treating officer to manually support the chin
and cervical area whilst second officer removes the helmet.
Fig 2
2. Whilst maintaining neutral head alignment, the helmet is removed
by pushing superiorly on the rear of the helmet. (Fig 2)
Patient is then placed supine:
1. A cervical collar is then sized and applied as per Skill Sheet 106.1
Immobilisation - Cervical Collar. (Fig 3)
2. Take care where potential exists for spinal injury.
Fig 3
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Ambulance Service of New South Wales
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Extrication
Kendrick Extrication Device
Indication:
During the extrication of a patient from difficult circumstances when
spinal immobilisation is required.
Prepare the patient:
1. Explain to the patient and assistant what you are about to do and,
in particular, the importance of minimal spine movement.
• Manual immobilisation of head and spine should be
maintained throughout procedure. (Fig 1)
Fig 1
Prepare the equipment:
1. Remove the extrication device from its bag and assemble head
straps and padding. (Fig 2)
Apply the Kendrick Extrication Device (KED):
1. Whilst maintaining the spine in neutral alignment, gently slide the
device behind the patient so that the centre line of the device is in
line with the patient’s spine and the superior edge of the chest
assembly is at the patient’s axillae. (Figs 3 & 4)
Fig 2
Fig 3
Approved by:
Medical Director
December 2003
Fig 4
109.2
Ambulance Service of New South Wales
Page 1 of 23
Issued by: Manager, Education
Extrication
Kendrick Extrication Device
2. Position the bottom two chest straps and tighten firmly. (Fig 5)
3. Position top chest strap but do not tighten.
4. Position padding to fill the anatomical hollow between the patient
and the KED.
5. Position the leg straps so they cross over the groin area and attach
to the opposite side. Tension firmly.
• When there is a suspected groin injury, pass leg restraints
around and attach on the same side. (Fig 6)
Fig 5
6. Position head strap and fasten.
7. Position chin strap over the point of the chin-piece of the collar
and fasten.
• Cross the head straps over one another.
• Ensure tensioning over straps does not compromise spinal
immobility. (Fig 7)
Monitor integrity of extrication device:
Fig 6
1. Check straps and re-tension if necessary.
2. Release leg straps when placing the patient in the supine position.
3. Tighten top chest strap.
Fig 7
Approved by:
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December 2003
109.2
Ambulance Service of New South Wales
Page 2 of 23
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Extrication
Scoop Stretcher
Indication:
The scoop stretcher is used for moving a patient with spinal or multiple
injuries. A minimum of four people are required for this lift. Bystanders
may be recruited to assist, however they will need to be carefully
instructed.
Fig 1
Prepare the patient:
1. Explain to the patient what is about to happen.
2. Administer pain relief if required.
Prepare to lift:
1. The first step in the use of a scoop stretcher is to adjust its length to
suit the height of the patient. (Fig 1)
Fig 2
2. It can then be separated into its two halves which are gradually eased
under the patient, while two officers on the same side gently pull
taut on the patient’s clothing allowing each half to slide easily under
the patient from each side. (Fig 2) It is easier connecting the head
ends first and then gradually closing the foot end, taking care not to
pinch the patient’s back.
Fig 3
3. When closed and locked the restraining straps are applied in the
following sequence:
• 2 chest straps.
• 2 waist straps.
• 1 ankle strap.
4. When patient is secure, the stretcher can be lifted by four officers
preferably with an additional officer at the patient’s head to keep it
steady. (Fig 3)
5. On the officer’s command “prepare to lift”, officers ready themselves
for the count 1-2-3 “lift”. On the command “lift”, the patient is lifted
from the deep squat position. Once raised, officers assume an upright
posture. Before walking, hold the scoop stretcher close to minimise
the load on the spine and face the direction of travel. (Fig 4)
Fig 4
6. The handles are very low, so a deep squat is required to reach them.
7. In order to load the scoop stretcher with patient onto the raised
stretcher, the officers will have to raise the scoop stretcher still further
with their arms and walk on either side of the stretcher. Gripping the
scoop stretcher with palm up is desirable to optimise elbow flexion
strength for this purpose. (Fig 5)
Fig 6
8. When the scoop stretcher is lifted by two
officers, an officer should go to each end of
the scoop stretcher and get as close to the
load as possible by straddling the scoop. (Fig 6)
9. When some of the lifting team are relatively
short, lifting onto a raised stretcher will be
difficult and it may be preferred to lift onto a
lowered stretcher. However, the stretcher,
scoop stretcher and patient must then all be
lifted together. For this purpose, assistance
should be sought to make up a team of four.
Fig 5
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December 2003
109.4
Ambulance Service of New South Wales
Page 1 of 12
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Spine Board
Extrication
Indication:
During extrication from difficult circumstances and moving patients
from ground to stretcher when spinal immobilisation is required.
Prepare the patient:
• Manual immobilisation of the patient’s spine should be
maintained throughout the procedure when required.
1. Explain to the patient and assistant what you are about to do and,
in particular, the importance of minimal spine movement.
• Use an RED or a KED device if you cannot be certain of
maintaining neutral spine alignment.
Fig 1
Prepare the equipment:
1. Check that the spine board and the patient attachment straps are
clean and intact. (Fig 1)
2. Position the stretcher in an appropriate position nearby.
• Stretcher headrest should be positioned flat and the stretcher
brakes should be applied.
Fig 2
3. Position the spine board in an appropriate position near the
patient. (Fig 2)
4. Organise sufficient personnel to assist with procedure.
Apply the spine board and extricate the patient:
Fig 3
If the patient is supine.
1. Instruct assistants to position themselves along the patient’s side
and outline what is going to occur.
2. Tell the patient what is about to happen, ask that movement is
kept to a minimum and that their hands should be across the
chest.
3. On the officer’s command “prepare to roll”, both officers ready
themselves for the count 1-2-3 “roll”. On the command “roll”, both
officers roll the patient towards them.
• Ensure the patient’s spine and head is kept in constant
alignment. (Fig 3) Also inspect the patient’s back at this time.
Fig 4
4. Place the spine board next to the patient.
5. Log roll the patient onto their side, place the spine board under the
patient, then log roll the patient back onto the spine board.
6. Gently slide the patient to the centre of the spine board. (Fig 4)
7. Secure restraining straps criss crossing the patient’s chest and
pelvis, ensuring that the chest straps are not interfering with the
cervical spine area.
Approved by:
Medical Director
December 2003
109.5
Ambulance Service of New South Wales
Page 1 of 24
Issued by: Manager, Education
Extrication
Spine Board
If the patient is sitting.
Fig 1
1. Instruct assistants to take up position near the patient.
2. Gently insert the spine board under the patient’s buttocks. (Fig 1)
• Patient’s head must be manually immobilised at all times.
3. Rotate patient 90˚.
4. Lower patient onto spine board and, where possible, slide the
patient up the spine board in the same movement. (Fig 2)
• Ensure patient’s spine and head is kept in constant alignment.
5. Secure the patient to the spine board according to Skill Sheet
109.5.
Fig 2
6. Secure spine board to stretcher using attached stretcher restraining
devices.
• Check that restraining straps do not interfere with airway,
breathing or circulation.
Approved by:
Medical Director
December 2003
109.5
Ambulance Service of New South Wales
Page 2 of 24
Issued by: Manager, Education
Extrication
NIEJ Extrication Device
Fig 2
Indication:
• To immobilise the cervical spine and
prevent gross spinal movement to the
thoracic and to a lesser degree the
lumbar area.
Fig 1
Prepare the patient:
Explain the procedure to the patient and the importance of minimal spinal
movement.
• Manual immobilisation of the head and spine must be maintained
throughout the procedure.
• Apply cervical collar.
Fig 3
Prepare the NIEJ:
Remove the NIEJ from its bag and ensure the yellow lumbar support pad,
blue groin pads, red head pads and black velcro head/chin straps are
present. Fig 1
Apply the NIEJ:
1. Remove all bulky items from the patient’s chest and hip pockets.
Fig 4
2. Whilst supporting the upper torso, recline the seat back, or gently lean
the patient forward to allow easy insertion of the NIEJ. Fig 2
3. Insert the NIEJ behind the patient with buckles facing outward.
Straighten the NIEJ and centre behind the patient’s back. Fig 2
4. Insert yellow lumbar support in the natural curve of the lumbar spine
for patient comfort. If this causes pain or discomfort to the patient it
should be removed. Fig 3
5. Lean the patient back against the NIEJ, and ensure the top of the NIEJ
is no higher than the patient’s head.
Fig 5
6. Release black groin straps from the back of the NIEJ, pass both straps
under patients leg to one side. Fig 4
Position the straps under the buttocks and legs, pull straps forward,
ensure they are central and not twisted. Fig 5
Do not connect the leg straps at this stage.
7. Position the chest flaps around the patient. Fig 6
8. Apply the green chest straps, and tighten to prevent the NIEJ sliding
down the body. Fig 7
• Preferred method. Cross the green straps over the shoulders and
connect to the buckle on the opposite chest flap.
• If shoulder injuries or respiratory distress are present.
Place the green straps over the shoulders and connect them to the
buckles on the same side of the chest flap. Fig 11
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September 2007
109.7
Ambulance Service of New South Wales
Page 1 of 2 4
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Extrication
NIEJ Extrication Device
9. Apply yellow and red chest straps and tighten. Fig 7
Over-tightening may result in respiratory compromise and or
pressure on injured abdominal organs.
Fig 6
10. Slide blue padding onto each black groin strap. Fig 8
11. Connect black groin straps to buckles and tension.
• Groin straps can be connected to either buckle.
• Ensure straps are not twisted.
• Ensure padding is situated in the sub pubic groin area.
Fig 7
12. Recheck all straps to confirm comfortable but firm fit.
13. Position red head pads to fill space between the patient’s occiput and
NIEJ. Fig 9
• Ensure patient’s head is in the neutral in-line position before
measuring and inserting the pads.
14. Apply 25 mm collar/chin strap ensuring it is centred on the c-collar,
away from the chin support.
15. Apply 50 mm forehead strap ensuring the strap is aligned with the
patient’s eyebrows. Fig 10
16. Extricate the patient using a spine board/scoop stretcher
17. Position the patient supine on the spine board/scoop stretcher
Fig 8
Fig 9
18. Loosen the groin straps only if increasing tension or discomfort is
experienced by the patient
Note;
Do not transport a patient fitted with a NIEJ on a spine board,
REMOVE THE SPINE BOARD/SCOOP
Contraindications;
•
Urgent transport situations, eg. head
injury with decreased LOC
Approved by:
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September 2007
Fig 10
Fig 11
109.7
Ambulance Service of New South Wales
Page 2 of 2 4
Issued by: Manager, Education
Posture
110.1. Supine: (Fig 1)
• Shocked patients unless dyspnoeic.
• Spinal injuries.
• Diving emergencies.
• Cardiac arrest.
110.2. Supine with legs elevated: (Fig 2)
• Severe hypovolaemic shock.
Fig 1
Fig 2
Fig 3
Fig 4
Fig 5
Fig 6
Fig 7
Fig 8
110.3. Supine with knees up: (Fig 3)
• Abdominal injuries.
110.4. Lateral: (Fig 4)
• Non-intubated unconscious patients.
• Syncope.
• Continuous vomiting or upper airway
bleeding with decreased level of
consciousness.
• Chest injuries with severe flail or
pulmonary haemorrhage with
affected side down.
110.5. Left Lateral: (Fig 5)
• Pregnant females, greater than 20
weeks gestation if hypotensive.
• Venous air embolism from lacerated
major neck veins or dialysis
emergencies.
110.6. Left Lateral with elevation of
buttocks: (Fig 6)
• Prolapsed umbilical cord.
110.7. Sitting: (Fig 7)
• Respiratory distress and conscious.
• Facial and neck injuries unless major
neck veins are lacerated.
• Eye injuries.
• Suspected myocardial ischemia.
• Hypertensive crisis.
• Epistaxis.
• Croup and epiglottitis.
• Vomiting if conscious.
110.8. Sitting with legs dependent: (Fig 8)
• Cardiogenic pulmonary oedema.
110.9. 10˚ upper body elevation: (Fig 9)
• All head injuries.
Fig 9
Approved by:
Medical Director
December 2003
110.1/9
Ambulance Service of New South Wales
Issued by: Manager, Education
Lifting
Chair Lift
Fig 1
Indication:
When transferring a patient between a chair and a raised stretcher, or
for carrying a patient to a stretcher. This lift is not suitable for patients
with chest injuries or conditions which prevent bilateral arm
abduction.
Prepare the patient:
1. Explain to the patient what is about to happen.
Fig 2
2. Administer pain relief if required.
Prepare to lift:
1. Officers are positioned in close on either side of the patient. The
patient’s arms are positioned across the rear of the officers’ backs.
(Fig 1)
2. A donut is placed under the patient’s legs and gripped. When
gripping the donut, palms should be in the upward position for
increased strength. (Fig 2)
Fig 3
3. Both officers start the lift from the semi-squat position. On lifting,
the legs come together to assume a normal standing posture. (Fig 3)
4. On the officer’s command “prepare to lift”, both officers ready
themselves for the count 1-2-3 “lift”. On the command “lift”, both
officers lift the patient.
5. Once standing, hands grip the back of the patient. (Fig 4)
6. Bent knees enable both officers to hold the spine in an upright
posture at the start of the lift. When walking with the patient some
twisting will result, however this can be minimised by supporting
high under the patient’s thighs. (Fig 5)
Fig 4
Approved by:2
Medical Director
December 2003
Fig 5
111.1
Ambulance Service of New South Wales
Page 1 of 232
Issued by: Manager, Education
Lifting
Chair Lift
Considerations:
1. Most chairs in domestic and nursing homes are more like
armchairs. Move the patient forward in the chair to overcome
access problems from padding or armrests. (Fig 6)
Fig 6
2. This lift can be modified to commence with the patient in the
standing position. Twisting of the back can be minimised if the
officers bend their knees slightly. (Fig 7)
3. Instruct the patient not to grab your neck, if this happens, ABORT
the lift to avoid trauma to your neck.
Fig 7
4. When lifting from wheelchairs, remove the arm rests first. Never sit
the patient forward in a wheelchair, it will overbalance.
5. If officers are of different heights, the patient will lean towards the
shorter officer who will bear more weight. (Fig 8)
Fig 8
Approved by:
Medical Director
December 2003
111.1
Ambulance Service of New South Wales
Page 2 of 23
Issued by: Manager, Education
Lifting
Carry Sheet
Indication:
The carry sheet is used for moving non-ambulatory patients who do
not have spinal injuries. It is possible to perform this lift with two
people, however, four people are preferred. Bystanders may be
recruited to assist, however they will need to be carefully instructed.
Prepare the patient:
Fig 1
1. From a kneeling position, officers position themselves close to the
patient. The patient is rolled onto their side. The carry sheet is
placed under the patient who is then rolled back onto the sheet. A
roll to the opposite side is usually required to access the carry
sheet handles. (Figs 1 & 2)
2. To prevent the carry sheet splitting, ensure the plastic and metal
security clips are fastened. ( Fig 3)
3. Lifters should be evenly placed on each side of the carry sheet
before commencing the lift. (Fig 4)
Fig 2
4. The carry sheet is loaded onto a lowered stretcher at groundheight or preferably half-height. (Fig 5)
5. For individual comfort, the hands can grip anywhere along the
wooden or aluminum handles. For maximum comfort when
walking the rear hand should face palm down and the forward
hand should face palm up. (Fig 6)
6. Because the hand grips are fixed below the patient, officers must
start the lift from a full-squat position. A wide base of support is
required to prevent overbalancing. (Fig 7)
Fig 3
7. On the officer’s command “prepare to lift”, officers ready
themselves for the count 1-2-3 “lift”. On the command “lift”, the
patient is lifted from the full squat position. Once raised, officers
assume an upright posture. Before walking, hold the carry sheet
close to minimise the load on the spine and face the direction of
travel.
Fig 4
Fig 6
Fig 7
Fig 5
Approved by:
Medical Director
December 2003
111.2
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Lifting
Carry Chair
Indication:
The carry chair may be used for moving patients up and down
stairs and can also be used as a wheel chair for moving the patient
short distances.
Prepare the patient:
1. Explain to the patient what is about to happen.
Prepare the equipment:
1. Position the carry chair next to the patient.
2. Apply brakes before sitting patient on carry chair.
Fig 1
Chair to chair:
1. Stand the patient up and changing their chair for the carry chair.
Fig 1
2. Secure the patient with all three safety belts. (Upper body, lap, &
feet) Fig 2
Carrying patient down stairs:
1. Wheel the chair to the stairs. One officer at the back facing down the
stairs and one officer at the footplate facing the patient and standing
two or three steps below top stair.
2. The officer behind the patient tilts the chair toward themself while
Fig 2
the officer at the front folds out the handle under the foot plate.
Fig 3 and 4
3. On the officer’s command “prepare to lift”, both officers ready
themselves for the count 1-2-3 “lift”. On the command “lift”, both
officers lift the patient and chair and walk downstairs. The chair can
be set down on the rear wheels if officers need to rest.
Carrying Patient up stairs:
1. Wheel the chair to the stairs. One officer at the rear with their back
to the stairs and one officer at the footplate facing the stairs.
2. The officer at the back tilts the chair raising the footplate from the
ground while the officer in front of the patient folds out the handle
from under the foot plate.
3. On the officer’s command “prepare to lift”, both officers ready
themselves for the count 1-2-3 “lift”. On the command “lift”, both
officers lift the patient and chair and walk upstairs. The chair can be
set down on the rear wheels if officers need to rest. Fig 5
Considerations:
1. The chair must be held by one officer when the patient sits down or
propped against a wall to prevent tipping.
2. The footplates can get in the way when transferring the patient.
3. There is minimal head support.
4. Vision of the stairs can be impeded by the carry chair.
5. The carry chair is rated to take 160kgs, however it is advisable to
utilize a minimum of 4 personal when lifting excessive weight.
Additional resources may be required e.g. Rescue.
Fig 3
Fig 4
Fig 5
Approved by:
Manager Education
September 2007
111.3
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Lifting
Flat Lift
Indication:
The flat lift is used when transferring a patient between two surfaces
of significant height difference. It is also used when it is not possible
to perform a direct transfer between bed and raised stretcher i.e.
insufficient space, significant difference in height between the
stretcher and bed.
Fig 1
Prepare the patient:
1. Explain to the patient what is about to happen.
Fig 2
2. Administer pain relief if required.
Prepare to lift:
1. Officers are positioned in close to the patient, and the patient is
pulled to the edge of the bed or stretcher first. Both officers’
forearms should be positioned under the patient. (Fig 1)
2. One hand should be placed around the patient’s shoulder to steady
the patient’s head during the lift.
3. For stretchers and hospital beds, both officers start the lift from a
semi-squat position. Ensure a wide base of support. (Fig 2)
Fig 3
4. For domestic beds or non-height adjustable beds it may be better
to start the lift with one leg in the kneeling position, very strong
leg muscles are required for this lift.
5. At the commencement of the lift the patient is rolled in close to the
chest of the officers. On the officer’s command “prepare to lift”, both
officers ready themselves for the count 1-2-3 “lift”. On the command
“lift”, both officers lift the patient and then assume an upright
posture while the legs are moved back into a normal stance. (Fig 3)
Fig 4
Considerations:
1. If possible, the patient’s arms should be positioned to slide down
the closest officer’s back i.e. patient should position their lower
arm under the officer’s left arm bringing it up to the shoulder, the
other arm grasps the lower arm at the tip of the shoulder. This is
important in preventing the officers from being knocked in the face
during the lift and, more importantly prevents the patient from
grabbing the officer’s neck during the lift. (Fig 4)
2. It is very important that the officers involved in this manoeuvre talk
through the lift before commencing, especially walking commands
and direction of travel.
3. Your vision will be restricted during this manoeuvre so ensure the
walking area is free of obstruction eg loose mats.
4. In a two person lift, the stronger and/or taller officer should take
the lower position. For a three person lift, they should take the
middle position.
Approved by:
Medical Director
December 2003
111.4
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Lifting
Foot Step
Indication:
Assist a walking patient on or off a stretcher
Prepare the patient:
Explain the procedure to the patient.
Fig 1a
Prepare the equipment:
1. Unfold the legs and engage the leg locking system Figs 1a and 1b
2. Place the step onto a firm and level surface
Procedure:
1. Paramedics position themselves on either side of the patient and assist
patient to step forward onto the step Figs 2a and 2b
Fig 1b
2. One Paramedic to support the patient from the front, while the second
Paramedic positions the stretcher behind the patient Fig. 3
3. Lock stretcher wheels
4. One paramedic standing in front and supporting the patient, while the
other paramedic positions themselves behind the stretcher to support
the patient. Instruct patient to sit onto the stretcher. Fig. 4
5. Re-position patient according to their needs. Fig. 5
6. To assist the patient off the stretcher, reverse the above procedure
Fig 2a
Contraindication
The safe working load rating for the footstep is 160 kg
Occupational Health and Safety:
•
Compliance to relevant Infection Control, OH&S and Manual
Handling techniques and procedures.
Fig 2b
Fig 5
Approved by:
Manager Education
February 2009
Fig 4
Fig 3
111.6
Ambulance Service of New South Wales
Page 1 of 1
Issued by: Manager, Education
Lifting
Patslide
Indication:
The patslide should only be used when the difference in height
between the two surfaces is less than 150mm. It is possible to
perform this manoeuvre with two people, however, four people are
preferred.
Fig 1
Prepare the patient:
1. Explain to the patient what is about to happen.
2. Administer pain relief if required.
Prepare to lift:
1. The patient is rolled onto their side with the sheet supporting the
patient. The sheet is gripped with the palms down. (Fig 1)
Fig 2
2. The patslide is slipped under the patient and the patient is rolled
back onto the patslide.
3. On the officer’s command “prepare to slide”, both officers ready
themselves for the count 1-2-3 “slide”. On the command “slide”,
the patient is then pulled across the patslide on the sheet, palms
facing down. Officers on the side where the manoeuvre
commenced may find it more comfortable to change their grip to
palm up before providing some assistance with the transfer. (Fig 2)
Fig 3
4. The transfer is performed in the standing position. Officers should
position their feet with a good base of support, one leg may need
to be under the bed or stretcher to prevent over balancing. (Fig 3)
5. Officers adopt an upright posture while holding the patient. When
pulling the patient, officers should lean forward from their hips
minimally against the bed or stretcher.
Considerations:
1. Timing is important to achieve a smooth transfer, so talk through
the manoeuvre.
2. The hospital bed or stretcher should be fully raised before the
transfer.
3. In a two officer transfer, one officer is positioned on either side of
the patient. Once the patslide is in place, one officer can move to
the other side to assist in pulling the patient across. This should
only be done when the bed or stretcher is secured to prevent
movement and railings are put in place on the side where the
officer moved from. If you are unsure, get assistance.
Approved by:
Medical Director
December 2003
111.7
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Lifting
Walking Patient
Indication:
Where a patient has to be manually assisted to and from the
ambulance.
Prepare the patient:
1. Explain to the patient what you are about to do.
2. Administer pain relief if required (ensure patient is constantly
monitored).
Fig 1
3. Once you have assessed the patient and provided
emergency care, you and your partner will have to
move the patient to or from the waiting ambulance.
Prepare to get patient out of chair:
1. If the patient is sitting, position the patient’s feet under
the chair. (Fig 1)
2. Ask the patient to push down on the arms of the chair
or on the seat pan. (Fig 2)
3. Ask the patient to move their hips closer to the edge
and help them if necessary. (Fig 3)
Fig 2
Fig 3
4. Hold the patient or walk belt handles.
5. Block the patient’s feet with your own.
6. Tilt the patient forward slightly in the chair.
7. Assist the patient to stand grasping their arm after it has left the
armrest. (Fig 4)
Prepare to walk the patient:
1. If the patient uses a walking stick, stand on the opposite side.
Fig 4
2. If the patient uses a walking frame, stand behind them with hands
lightly on their hips.
3. Hold the patient’s left hand with your left hand, palm to palm or
their right hand with your right hand. (Fig 5)
4. Place your other hand on their elbow or around their waist.
5. Do not intertwine arms.
Contraindications:
1. Suspected cardiac condition.
2. Severe breathlessness.
3. Suspected lower limb fracture.
4. Obstetric emergencies.
5. If patient feels unable to walk, then do not.
Approved by:
Medical Director
December 2003
Fig 5
111.8
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Lifting
Walkbelt
Indication:
Where a patient has to be manually assisted to and from the ambulance.
Walkbelts are extremely useful in confined spaces or outdoors where it is
impossible or impractical to use other appliances to lift or move a patient
eg out of toilets or cars. They provide more stability and security when
walking patients because the patient is held at the trunk rather than by the
hand.
Fig 1
Prepare the patient:
1. Explain to the patient what you are about to do.
2. Administer pain relief if required (ensure constant monitoring).
Fig 2
3. Once you have assessed and provided emergency care, you and your
partner will have to move the patient to or from the waiting ambulance.
4. The correct belt size should be selected or the belt adjusted to fit.
5. The belt is placed around the waist just above the iliac crest, around
the narrowest diameter of the patient. (Fig 1)
6. Tighten the belt firmly.
7. Locate the handles symmetrically around the patient with
two at the front and two at the back. (Fig 2)
Fig 3
Fig 4
Prepare to stand the patient:
1. If the patient is sitting, position the patient’s feet under
the chair.
2. Ask the patient to push down on the arms of the chair
or seat pan.
3. One officer stands in front with their feet and knees
alternately with the patient’s. Two officers stand at the
patient’s side. (Fig 3)
4. You may block the patient’s knees with your own but stay out of the
way of their head. (Fig 4)
Fig 5
5. One officer grasps the handles at the front or for two officers one at
the front and one at the back.
6. One officer leans back pulling the belt forwards. Two officers tilt the
patient forwards and up. (Fig 5)
7. Step back as patient approaches the upright position.
The walkbelt can be used during the following activities:
1. Standing transfer with one officer (from seated position).
2. Standing transfer with two officers (from seated position).
3. Walking the patient from behind or beside.
4. Helping someone out of a confined space or car.
5. Helping someone up from the floor.
6. Walking a patient down stairs or over rough ground.
7. Repositioning the patient in a chair or wheelchair.
Approved by:
Medical Director
December 2003
111.9
Ambulance Service of New South Wales
Page 1 of 24
Issued by: Manager, Education
Lifting
Walkbelt
Transferring the patient from chair to chair:
1. Place the chair as close as possible to the chair you are transferring
from. (Fig 6)
Fig 6
2. Instruct the patient about what you are doing.
3. Position the patient’s feet back under the chair.
4. Position your feet and knees alternately with the patient’s.
5. You may block the patient’s knees with your own but stay out of the
way of their head. (Fig 7)
Fig 7
6. Grasp the handles at the front.
7. Lean back pulling the belt towards you until the patient just clears the
seat. There is no need to stand the patient right up. (Fig 8)
8. Pivot on your feet, rather than twisting your back.
9. Keeping the belt taut, lower yourself while tilting the patient forwards
and then lowering and pushing the patient backwards at the hips until
positioned in the chair. (Fig 9)
Getting the patient up from the floor:
1. Assist the patient into a crawl position, holding them by the handles at
the back. (Fig 10)
Fig 8
2. Assist the patient in kneeling.
Fig 9
3. Place chair beside the patient and instruct them to push
down on it.
4. Instruct the patient to come up and sit into the chair,
assisting them by holding the walkbelt by the handles at
the back. (Fig 11)
Considerations:
1. If belts are not properly fitted or used with people with
large waists and small chests they can ride up during the
transfer especially if the forces are incorrectly applied in a
vertical direction.
2. Narrow belts are better than wide belts.
Fig 10
Fig 11
3. Riding up does not occur when forces are
applied in a horizontal direction. For
example in the sitting to standing transfer,
the patient should be tilted forwards rather
than lifted.
Contraindications:
The walkbelt can be used to assist a patient in
most conditions provided they are not walked if
the following conditions are suspected.
1. Suspected cardiac condition.
2. Severe breathlessness.
3. Suspected lower limb fracture.
4. Obstetric emergencies.
5. If patient feels unable to walk, then do not.
Approved by:
Medical Director
December 2003
111.9
Ambulance Service of New South Wales
Page 2 of 24
Issued by: Manager, Education
Lifting
Reverse Chair Lift
Indication:
The reverse chair lift is also used when transferring a patient between
a chair and a raised stretcher, or for carrying a patient to a stretcher.
This lift is not suitable for patients with chest problems, conditions
which prevent bilateral arm abduction or conditions which require
constant observation of the patient’s face.
Fig 1
Prepare the patient:
1. Explain to the patient what is about to happen.
Fig 2
2. Administer pain relief if required.
Prepare to lift:
1. Officers are positioned in close on either side of the patient. The
officers’ shoulders sit in the patient’s armpit and the patient’s arms
fall down the officers’ backs. (Fig 1)
2. A donut is placed under the patient’s legs and gripped. When
gripping the donut, palms should be in the upwards position for
increased strength.
3. Hands can be placed on the stretcher for support.
4. Both officers start the lift from the semi-squat position. On the
officer’s command “prepare to lift”, both officers ready themselves
for the count 1-2-3 “lift”. On the command “lift”, both officers come
to the upright position. Once upright, their legs need to be repositioned to increase the base of support and accommodate the
backward shift in the load. The leg closest to the stretcher should
be bent slightly. (Fig 2)
5. Bent knees enable both officers to hold the spine in an upright
posture at the start of the lift. When walking with the patient some
twisting will result, however this can be minimised by supporting
high under the patient’s thighs.
6. Avoid twisting the neck.
Considerations:
1. Most chairs in domestic and nursing homes are more like
armchairs. Move the patient forward in the chair to overcome
access problems from padding or armrests.
2. When lifting from wheelchairs, remove the armrests first. Never sit
the patient forward in a wheelchair, it will overbalance.
3. It is not recommended to commence this lift with the patient in the
standing position.
Approved by:
Medical Director
December 2003
111.10
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Lifting
Slide Sheet
Indication:
There are many different types of products made from various
materials which can be used for sliding and rolling patients. As an
ambulance officer, you may see these being used in an emergency
department with a slide board to make the stretcher to bed transfer
even easier. You may see a slide sheet, two slide sheets on top of
one another or a slide tube being used.
The slide sheet is a rectangular thin slippery fabric, which is folded in
half and positioned under the patient to facilitate a patslide transfer.
Fig 1
The slide sheet can be used for sliding and rolling the patient from
side to side or repositioning the patient up the bed.
Prepare the patient:
1. Explain to the patient what is about to happen.
2. Administer pain relief if required.
Fig 2
Prepare to transfer patient:
1. The patient on the ambulance stretcher is rolled onto their side
then the patslide is tucked under the patient with the slide sheet,
two slide sheets or a slide tube on top of the patslide. (Fig 1)
2. The open side of the slide sheet needs to be positioned on the
same side as the empty bed. (Fig 2)
3. The stretcher is positioned at the same height as the adjusted bed
and the patient is rolled back over it.
Fig 3
4. On the officer’s command “prepare to slide”, both officers ready
themselves for the count 1-2-3 “slide”. On the command “slide”, the
assistance on the side of the bed then pull on the sheet or slide the
sheet to slide the patient across the patslide with palms facing down.
Officers on the side where the manoeuvre commenced may find it
more comfortable to change their grip to palm up before providing
assistance with the transfer. (Figs 3 & 4)
5. It is important to make sure the slide sheet covers the heaviest
part of the patient. It must extend from the shoulders to past the
hips. Take the patient’s shoes off first.
Fig 4
Considerations:
1. Bed sliding devices can be unpredictably slippery. Once the
momentum has been gained it can be difficult to stop.
2. Slide sheets and tubes for stretcher to bed transfers should not be
used without a patslide to bridge the gap.
Approved by:
Medical Director
December 2003
111.13
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Lifting
304 Stretcher
Indication:
In situations where a patient requires stretcher transport.
Unload Stretcher:
1. Assess loaded weight to determine need for assistance when
required.
2.
Identify any potential hazards such as sloping or rough terrain.
3.
Ensure patient is appropriately restrained.
4.
Disengage YELLOW stretcher lock release lever (Fig 1) and
slowly remove stretcher from vehicle listening for audible click
as legs lock into position prior to removing head end of stretcher
from floor of vehicle. (Fig 2)
Safety Note:
Removal of front-loading wheels from vehicle before checking
that legs have locked into position may cause stretcher to
collapse.
Fig 1
Fig 2
Load Stretcher:
1. Assess loaded weight, safe working load and need for assistance
when required.
2.
Identify any potential hazards such as sloping or rough terrain.
3.
Ensure patient is appropriately restrained.
4.
Engage front loading wheels with vehicle floor, relieving the
stretchers front legs of weight.
5.
Push the front leg lock (RED lever) down and then pull the
release handle (GREEN lever) below the right hand grip. (Fig 3)
6.
Push the stretcher until the rear legs are about to touch the rear
of the vehicle.
7.
Push the rear leg lock (RED lever) down and then pull the
release handle (BLUE lever) below the left hand grip. (Fig 4)
8.
Push stretcher fully into vehicle until locked onto the floor
bracket.
Adjusting Height of 304 Stretcher:
Full height to ground. (No patient)
1. Release the front leg lock (RED lever) then pull the release
handle (GREEN lever) (Fig 3), and lower head end of stretcher to
ground in a controlled manner. (Fig 5)
2.
Fig 3
Fig 4
Fig 5
Release the rear leg lock (RED lever) then pull the release
handle (BLUE lever) (Fig 4), and lower foot end of stretcher to
ground in a controlled manner. (Fig 6)
Fig 6
Approved by:
Medical Director
July 2005
111.14
Ambulance Service of New South Wales
Page 1 of 35
Issued by: Manager, Education
Lifting
304 Stretcher
Full height to half height. (No patient)
1. Pull the RED release knob on the front left side to release the
front half height legs. (Fig 7)
2.
Pull the RED release on the rear left side to release the rear half
height mechanism. (Fig 8)
3.
Activate rear wheel brakes.
4.
Release the front leg lock (RED lever) the pull the release handle
(GREEN lever) and lower head end of stretcher to half height in
a controlled manner. (Fig 9)
5.
Release the rear leg lock (RED lever) then pull the release
handle (BLUE lever) and lower foot end of stretcher to half
height in a controlled manner. (Fig 10)
Ground to full height. (With or without patient)
1. Raise backrest of stretcher for patient comfort (30% angle or
greater should be maintained during this procedure and apply
restraints).
2.
Pull the RED release knob on the front left side to release the
front half height legs. (Fig 7)
3.
Pull the RED release on the rear left side to release the rear half
height mechanism. (Fig 8)
4.
Lift head end of stretcher to half height followed by foot end to
half height.
5.
Raise to full height by either;
a) lifting head end to full height followed by foot end to full
height or,
b) reverse of (a) above or,
c) flat lift from ground to full height (with assistance when
required).
Half height to full height. (With or without patient)
1. Raise to full height by either;
a) lifting head end to full height followed by foot end to full
height or
b) reverse of (a) above or
c) flat lift from half height to full height with two operators.
Approved by:
Medical Director
July 2005
Fig 7
Fig 8
Fig 9
Fig 10
111.14
Ambulance Service of New South Wales
Page 2 of 35
Issued by: Manager, Education
Lifting
304 Stretcher
Trendelenburg Operation
1. To raise, lift the Trendelenburg release lever (WHITE lever)
and pull the Trendelenburg up until it locks into place. (Fig 11)
2.
To lower, push the Trendelenburg support legs forward and
lower the Trendelenburg until it is level with the main frame of
the stretcher and clicks into place. (Fig 12)
Backrest and Head Extension
1. To raise or lower the backrest pull the Red lever located under
the stretcher tray at the head end.
2.
Fig 11
The head extension is located under the backrest and slides in
and out from underneath the mattress. (Fig 13)
Reduced Length
1. Raise the backrest.
2.
3.
Push the two drop down levers (one each side) while holding
the front end which can now be lowered. (Fig 14)
Fig 12
To lock the front end back to normal length pull the front end
up until both levers lock into place.
IV Pole
1. Locate IV Pole under Trendelenburg diaphragm.
2.
To remove pull RED knob down and pull pole out.
3.
To replace push the pole in until the RED knob locks into the
loop at the end. (Fig 15)
Fig 13
Stretcher Bridge
Purpose designed equipment bridge can be secured to stretcher by
aligning bridge and sliding onto securing mounting posts located on
each side of the stretcher frame near the foot end. (Fig 16)
Safe Working Load
The 304 Stretcher has a safe working load of 220kg.
Fig 14
Fig 15
Approved by:
Medical Director
July 2005
Fig 16
111.14
Ambulance Service of New South Wales
Page 3 of 35
Issued by: Manager, Education
302 Stretcher
Lifting
Indication:
1.
In situations where a patient requires stretcher transport.
Unload Stretcher:
1.
Assess loaded weight to determine need for assistance when
required.
2.
Identify any potential hazards such as sloping or rough terrain.
3.
Ensure patient is appropriately restrained and side rails locked.
4.
Disengage stretcher lock, YELLOW lever, (Fig 1) and slowly remove
stretcher from vehicle listening for audible clicks as rear legs and
then front legs lock into position prior to removing head end of
stretcher from floor of vehicle. (Fig 2)
Fig 1
Safety Note.
Removal of front-loading wheels from vehicle before checking that
legs have locked into position may cause stretcher to collapse.
Load Stretcher:
1.
Assess loaded weight, safe working load and need for assistance
when required.
2.
Identify any potential hazards such as sloping or rough terrain.
3.
Ensure patient is appropriately restrained and side rails locked.
4.
Engage front loading wheels with vehicle floor, relieving the
stretchers front legs of weight.
5.
Pull front leg release lever with right hand as front leg slide blocks
contact vehicle. (Fig 3)
6.
Push the stretcher until the rear legs are about to touch the rear of
the vehicle.
7.
Pull rear leg release lever with left hand as rear leg slide blocks
contact vehicle. (Fig 4)
8.
Push stretcher fully into vehicle until locked onto floor bracket.
Fig 2
Fig 3
Adjusting height of 302 Stretcher:
Full height to ground. (No patient)
1.
Pull the front leg release lever and lower head end of stretcher to
ground in a controlled manner. (Fig 5)
2.
Pull the rear leg release lever and lower foot end of stretcher to
ground in a controlled manner. (Fig 6)
Fig 5
Approved by:
Medical Director
September 2005
Fig 4
Fig 6
111.15
Ambulance Service of New South Wales
Page 1 of 24
Issued by: Manager, Education
302 Stretcher
Lifting
Adjusting height of 302 Stretcher:
Full height to half height. (No patient)
1.
Raise backrest to access release lever and release front half height
legs. (Fig 7)
2.
Pull the RED release on rear left side to release the rear half height
mechanism. (Fig 8)
3.
Activate rear wheel brakes.
4.
Pull the front leg release lever and lower head end of stretcher to
half height in a controlled manner. (Fig 9)
5.
Pull the rear leg release lever and lower foot end of stretcher to half
height in a controlled manner. (Fig 10)
Fig 7
Ground to full height. (with or without patient)
1.
Raise backrest of stretcher for patient comfort. (30o angle or greater
should be maintained during this procedure and apply restraints and
side rails locked.
2.
Release the front and rear leg half height mechanisms.
3.
Lift head end of stretcher to half height followed by foot end to half
height. (Figs 11 and 10)
4.
Raise to full height by either;
a) lifting head end to full height (Fig 12) followed by foot end to
full height or,
b) reverse of a) above or,
c) flat lift from ground to full height (with assistance when
required).
Half height to full height. (with or without patient)
1.
Raise to full height by either;
a) lifting head end to full height (Fig 12) followed by foot end to full
height or,
b) reverse of a) above or,
c) flat lift from ground to full height (with assistance when
required).
Fig 8
Fig 9
Rolling the stretcher:
1.
Ensure that the appropriate patient restraint harness is securely
fastened at all times and side rails locked.
2.
Assess the environment for hazards such as obstructions, rough or
sloping terrain.
3.
Summon additional resources if required after assessing loaded
weight of stretcher, or potential hazards.
Fig 10
Safe Working Load
The 302 Stretcher has a safe
working load of 220kg.
Fig 11
Approved by:
Medical Director
September 2005
Fig 12
111.15
Ambulance Service of New South Wales
Page 2 of 24
Lifting
305 Stretcher
Unload 305 Stretcher from Ambulance
1. Assess loaded weight to determine need for assistance when
required
2. Identify any potential hazards such as sloping or rough terrain
3. Ensure patient is appropriately restrained
Fig 1
4. Disengage YELLOW stretcher lock lever,Fig 1, to release from
floor bracket and utilising both hands, slowly remove stretcher
from vehicle.
Front loading wheels
5. Listen for audible clicks, firstly as rear legs lock into postion,
secondly as front legs lock into position prior to removing front
loading wheels of stretcher from floor of vehicle. Fig 2
Safety Note:
Stretcher will collapse if front loading wheels leave the rear of
the vehicle, prior to either the front or rear legs locking into
position.
Front legs
Fig 2
Load Stretcher
1. Assess loaded weight/safe working load and need for
assistance when required
2. Identify any potential hazards such as sloping or rough terrain
3. Ensure patient is appropriately restrained by applying belts and
locking raised side rails Fig 8
Fig 3
4. Approach straight in from directly behind vehicle.
Do not approach on an angle
5. Push in stretcher to engage front loading wheels with vehicle
floor relieving the stretchers front legs of weight
6. Release the front leg lock (RED lever) and pull the release
handle (GREEN lever) below the right hand grip Fig 3
7. Push the stretcher further in until the rear legs are about to
touch the rear of the vehicle
Fig 4
8. Push the rear leg lock (RED lever) down and then pull the
release handle (BLUE lever) below the left hand grip Fig 4
9. Push stretcher fully into vehicle until locked into the floor
bracket and ensure yellow lever has engaged
Lower/Raise Stretcher
Full Height to Half height
1. Pull the red knob (located front right side of stretcher) to
release the front and rear half height legs Fig 5
Ensure half height legs drop and lock into position
Approved by:
Manager Education
June 2009 Revised March 2010
Fig 5
111.16
Ambulance Service of New South Wales
Page 1 of 3
Lifting
305 Stretcher
2. Release the front leg lock (RED lever) then pull the release
handle (GREEN lever) and lower head end of stretcher to half
height in a controlled manner Fig 6
3. Release the rear leg lock (RED lever) then pull the release
handle (BLUE lever) and lower foot end of stretcher to half
height in a controlled manner Fig 7
Fig 6
4. Activation of rear wheel brakes must occur. This can be
achieved either prior to commencing or at completion of this
process.
Half Height to Full height
1. Assess loaded weight/safe working load and need for
assistance when required and method; either staged
(head/foot) or one movement (flat)
Fig 7
2. Identify any potential hazards such as sloping or rough terrain
3. Ensure patient is appropriately restrained by applying belts and
locking raised side rails Fig 8
4. Ensure brakes are applied and advise patient of lifting
procedure
Fig 8
Staged (head/foot)
•
Operator/s lift simultaneously at the head end of the
stretcher until front legs lock into position
•
Operator/s then move to the foot end and lift simultaneously
until rear legs lock into position
One movement (flat)
•
Operators lift simultaneously from both ends of the stretcher
until front and rear legs lock into position
Extra staff can assist by stabilising and lifting stretcher sides
Fig 9
THIS NEXT STEP MUST ONLY BE DONE WHEN BOTHS ENDS
OF THE STRETCHER ARE AT FULL HEIGHT.
5. Operator pulls the red knob and folds the half height legs up
into the stored position.
Backrest and Head Extension
1. To raise or lower the backrest push the RED lever located
under head of stretcher Fig 9
2. The head extension is located under the backrest and slides in
and out from under the mattress Fig 10
Approved by:
Manager Education
June 2009 Revised March 2010
Fig 10
111.16
Ambulance Service of New South Wales
Page 2 of 3
Lifting
305 Stretcher
Reduce Stretcher Length – for difficult access areas
1. Raise the backrest
2. Removing locking pins on both sides of stretcher and slide off
front end of stretcher Fig 11 and Fig 12
3. When replacing front end of stretcher, ensure pins are replaced
and locked in position
Fig 11
Safety Note:
Ensure front end of stretcher is reassembled as soon as is
practically possible, as the stretcher will not load into vehicle with
the part removed and potentially collapse if attempted.
IV Pole
1. To remove from stored position pull down red knob at foot end
of stretcher, slide pole out and position in either left or right
pole slots as required Fig13 and Fig 14
Fig 12
2. When returning, ensure red knob locks pole into storage
position
Stretcher Bridge
To attach the purpose designed stretcher bridge, remove the black
mounting post covers located on each side of the stretcher frame
near the foot end, Fig 15, align and slide bridge onto securing
mounting posts
Fig 13
Safe Working Load
The 305 stretcher has a safe working load rating of 220kg
Supporting Information
•
Unlike previous model stretchers which had a separate half
mechanism at each end, the 305 has one mechanism to
govern height adjustment for both legs.
•
Stretchers are ONLY to be lowered to half height. Lowering to
the ground requires a strenuous lift and an increased risk of
injury
•
Stretchers are NOT to be lowered with a patient on the
stretcher due to the uncontrolled manner in which lowering may
occur increasing risk of injury
Fig 14
Occupational Health and Safety
Compliance with relevant infection control, OH&S and manual
handling techniques and procedure
Approved by:
Manager Education
June 2009 Revised March 2010
Fig 15
111.16
Ambulance Service of New South Wales
Page 3 of 3
Lifting
Auto Load Stretcher – ALS 6000
In situations where patients requires stretcher transport
Unload and Loading ALS stretcher from Ambulance
Unloading
• Vehicle must be on flat ground
Fig 1
• Clear any obstacles away from the path of the Tyne system
• If patient is on the stretcher advise them of pending movement
• Press the button on the left side of the Tyne system to release
the stretcher locking mechanism (Fig 1)
Fig 2
• Manually pull the stretcher on the Tyne system from the vehicle
until it is full extended from the vehicle and locks (Fig 2)
• On the touch screen press the “up” arrow to lower the legs
(Fig 3). When the legs reach the ground the stretcher will
release from the Tynes
Fig 3
• Pull the stretcher away from the Tynes
• Press the “down” button to lower the stretcher to waist height,
before moving (Fig 3)
• Press the button on the left side of the Tyne system to release
the lock and relocate the Tynes back into the vehicle once the
stretcher has been removed (Fig 4)
Fig 4
Fig 4
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Manager Education
March 2010
111.17
Ambulance Service of New South Wales
Page 1 of 3
Lifting
Auto Load Stretcher – ALS 6000
Loading
• Press the button on the left side of the Tyne system to release
the lock and pull the Tyne out until fully extended and the unit
locks (Fig 1)
Fig 5
• Line the stretcher up between the Tyne’s
• Push the stretcher within the Tyne rails until it reaches the end
of the rails and ensure the locking mechanism is lined up in
position at the head end of the stretcher
• Press the “down” arrow to raise the legs completely (Fig 3)
• Advise the patient that the stretcher is about to move into the
vehicle
Fig 6
• Press the button on the left side of the Tyne system to release
the lock and push the stretcher and the Tyne into the
ambulance (Fig 1)
• Ensure the locking device is engaged to secure the stretcher
(Fig 5)
Brake system
• To operate the brakes, press or lift the red lever located on the
wheels to lock or unlock the brakes (Fig 6)
Fig 7
Front locking mechanism
• Place your foot on the yellow release bar located at the foot end
of the stretcher and press down, this will allow for acute turning
and sideways movement of stretcher (Fig 7)
Fig 8
Reduce Length
• Raise the headrest
• Locate and remove the locking pins on both sides of the
stretcher and slide off the front stretcher end (Fig 8)
• When replacing front end of the stretcher, slide on and ensure
pins are secure and locked in position
Fig 8
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March 2010
111.17
Ambulance Service of New South Wales
Page 2 of 3
Lifting
Auto Load Stretcher – ALS 6000
IV Pole
•
The IV pole is located at the head end of the stretcher
Power and charging
• The battery level indicator is on the touch screen monitor
• Spare battery and charger are located on the passenger side of
the vehicle inside the sliding door
• The stretcher battery is located on the leg assembly of the
stretcher (Fig 9)
Fig 9
Side rails
• Side rails can be raised or lowered by engaging the yellow
release lever located under the top hand rail (Fig 10)
Fig 10
Specifications
Length
Width
2160mm
578mm
Max
Height
Min
Height
Unit
Weight
1150mm
400mm
55kg
Max
Load
Weight
220kg
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual handling
techniques and procedures
Approved by:
Manager Education
March 2010
111.17
Ambulance Service of New South Wales
Page 3 of 3
Issued by: Manager, Education
Stretcher Harness
Restraints
Indication:
All stretcher patients.
Prepare the patient:
1. Explain the procedure.
2. Posture the patient according to Skill Sheet
110.1/9.
Prepare equipment:
1. Place diamond under patient’s shoulder blades.
(Fig 1)
Fig 1
2. Position straps over patient’s shoulders, crossing
over to correspond to appropriate colour marked
locking device. (Fig 2)
3. Secure with lap belt across patient. (Fig 3)
NB
Straps must go over shoulders, do not place
over pillow and shoulders. (Fig 4)
Fig 2
Fig 3
Fig 4
Approved by:
Medical Director
December 2003
112.1
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Restraints
Child capsule seat on 304 stretcher
Indication:
To secure a young child / baby (up to 12 kgs recumbent and 18 kgs sitting)
in an approved capsule for transport.
Method:
1. Disconnect standard adult harness from foot ends and side buckles.
Fig 1
Fig 1
2. Place the harness straps into the tray under the head end of stretcher
securely and lower head rest fully. Fig 2
Rearward facing configuration:
1. Place capsule on centre of stretcher in rearward facing position. Fig 3
2. Adjust capsule back height to
required posture using blue and
yellow leavers under foot end of
capsule. You may require an assist to
hold the base to do this. Fig 3 & 4
Note; there are 3 possible positions,
upright, semi-recumbent (blue lever)
and recumbent (yellow lever).
Fig 2
Fig 3
Fig 4
Fig 5
Fig 6
Fig 7
Fig 8
3. Locate seat restraint belts fitted to
lower rear of the capsule seat. These
belts are fitted with speed clips.
Note; the wide webbing belt passes
through the capsule backrest. Fig 5
4. Locate corresponding attachment
points located adjacent to the top of
the front stretcher legs on each side.
Fig 6
5. Attach speed clips to corresponding
attachment points. Fig 7 & 8
6. For ease of attachment lay the capsule
on its back to connect the clips. Fig 9
7. Bring back to upright position and
move the base towards the foot end
of the stretcher to apply tension to
the now anchored seat restraint belts.
Fig. 10
Approved by:
Manager Education
September 2007
Fig 9
Fig 9
Ambulance Service of New South Wales
Fig 10
112.2
Page 1 of 3
Issued by: Manager, Education
Restraints
Child capsule seat on 304 stretcher
8. Locate seat restraint belts at the foot end of the baby seat (i.e. facing the
foot end of the stretcher). These restraints are fitted with seatbelt
tongues. Fig 11
9. Clip seat belt tongues into foot end stretcher harness buckles. Fig 11
10. Tighten all restraints as firmly as possible.
11. Check for movement there should be a firm fit to the stretcher with
very little movement of the seat. If excessive movement is evident check
tension of the belts – alternatively disconnect buckles, slacken the
tension adjustments, cross the anchor points over to the opposite side
re-connect and re-tension. Fig 12
12. Lift the flap on the front edge of seat to expose the child shoulder
harness tension device.
Note: there are 2 models of seat with differing tensioning system.
a.
Lift the metal release lever and pull on the child shoulder restraint
straps to lengthen in preparation to fit child into restraint. Fig 13
Fig 11
Fig 12
b. Pressing the blue button under this flap and pull on the child
shoulder restraint straps to lengthen in preparation to fit child into
restraint.
13. Unbuckle the centre buckle, place the shoulder restraint straps to one
side and place the child in the capsule seat. Fig 14
14. Bring the shoulder restraint straps over the child’s shoulders and have
arms out each side, then re-buckle the centre buckle between the child’s
legs in the groin
Fig 13
15. When the child is buckled in,
Note: there are 2 models of seat with differing tensioning system.
a. pulling on the single webbing strap coming out of this metal tension
device will tension the shoulder straps onto the child’s shoulders.
Fig 15
Fig 14
b. Pressing the blue button with child in position and buckles secured
activates the automatic tensioner.
Fig 15
16. If the shoulder straps are too high or too low in the seat back, these can
be adjusted for two levels. To do this remove both shoulder harness
restraint webbings from their metal anchor point, located behind the
back of the seat, by threading them through the slots in the metal
anchor. Fig 16
Pass the shoulder restraint webbing through the seat back and
reposition through desired shoulder height slot in seat back. Now
reconnect securely both shoulder harness restraint webbings into their
metal anchor.
17. Readjust shoulder harness tension on front of seat as required.
Fig 16
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Manager Education
September 2007
112.2
Ambulance Service of New South Wales
Page 2 of 3
Issued by: Manager, Education
Restraints
Child capsule seat on 304 stretcher
Forward facing configuration:
Note: the capsule must be in the upright position for forward facing
mounting.
1. Place capsule on foot end of stretcher in forward facing position. Fig 17
2. Adjust back height to required posture using blue and yellow levers
under foot end of capsule. You may require assistance to hold the base
to do this. See Fig 3 & 4 in previous pages.
Fig 17
3. Locate seat restraint belts fitted to lower rear of the capsule seat. These
belts are fitted with speed clips. Fig 18
Note; the wide webbing belt passes through the capsule backrest.
4. Locate speed clip attachment points located adjacent to the foot end of
the stretcher on each side. Fig 18
Fig 18
5. Find restraints at the forward edge of the baby seat (i.e. facing forward
on the stretcher). These restraints are fitted with seatbelt tongues. Fig 19
6. Fit these into the centre mounted buckles on the stretcher as used for
the adult harness. Fig 19
7. Tighten all restraints as firmly as possible.
Fig 19
8. Check for movement, there should be a firm fit to the stretcher with
very little movement of the seat. If excessive movement is evident check
tension of the belts and redo the attachments as detailed above.
9. Fit child into capsule seat as detailed above in rearward facing
configuration from steps 12 to 16.
Occupational Health and Safety:
•
•
Compliance to relevant OH&S and manual handling techniques.
Compliance to infection control procedures
Fig 9
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Manager Education
September 2007
112.2
Ambulance Service of New South Wales
Page 3 of 35
Issued by: Manager, Education
Restraints
Child Harness Application
Indication:
Fig 1
In all cases where a child is transported.
Prepare equipment
1. Remove harness, clip hook to anchor point behind dicky seat.
(Fig 1)
2. Place straps under headrest over back of seat. Place over child’s
head and shoulders. (Fig 2)
3. Apply locking clip to convert lap sash to lap belt at seat anchor
point. (Fig 3)
Fig 2
4. Thread lap belt through loops of harness and secure. (Fig 4)
5. Adjust child harness from rear using adjusting strap, ensure lap
belt is across the pelvis. (Fig 5)
Fig 3
Fig 4
Approved by:
Medical Director
December 2003
Fig 5
112.3
Ambulance Service of New South Wales
Page 1 of 12
Restraints
Mechanical Restraint Device
Indication:
For use with patients in whom control is necessary to facilitate specific treatment and prevent an
injury to themselves or others where other strategies have failed. This particularly refers to
aggressive, combative and violent mental health patients and aggressive, combative head injured
patients without hypoxia that are clinically difficult to manage.
Note:
1. Any restriction on the liberty of patients and other people with a mental illness or mental
disorder and any interference with their rights, dignity and self-respect is to be kept to the
minimum necessary in the circumstances.
2. Restraint should only be used in the best interests of the patient when other means of control
have failed.
3. Once the restraint has been applied, the patient must be supervised at all times by a
paramedic who has been issued with a written authority to exercise the powers granted under
the Mental Health Act 2007.
Prepare the Patient:
1. One person should reassure the patient and inform him/her
that they are about to be restrained for their own welfare.
Explain to them that their cooperation would be beneficial.
Note: Only one officer should communicate with the patient.
Getting direction from more than one person can be confusing for
the patient and can escalate the situation.
2. Ensure the presence of adequate resources for the safe
physical restraint of the patient. Ideally a minimum of four
people who are capable of assisting may be required. Police or
hospital security officers should form part of the team
whenever possible with violent and aggressive mental health
patients.
Fig 1
3. Clarify the individual roles of all personnel during the restraint
procedure.
Prepare the Equipment:
1. Position the stretcher in a practical location and adjust to the
fully lowered position.
2. Attach the ankle mounting strap to the stretcher via the seatbelt
brackets fitted to the underside of the stretcher. Fig 1
3. Position the waist mounting strap around the base of the
headrest or underside of the stretcher, ensuring it does not
impede the mechanical workings of the stretcher. Fig 2
Approved by:
Manager Education
December 2007 Revised; March 2010; August 2010; November 2010
Ambulance Service of New South Wales
Fig 2
112.5
Page 1 of 3
Restraints
Mechanical Restraint Device
4. Position the wrist extension strap to the stretcher as per
stretcher type; e.g: Figure 3 relates to the 305 and newer 304
stretchers. Figure 4 relates to older style 304, 303 and 302
stretchers
Note: In difficult extrications you can mount the MRD to a
spineboard or scoop stretcher. The spineboard/scoop securing
straps must be used in conjunction with the MRD.
Use of the MRD in the management of children and young
people, and in the elderly.
• Decisions to use the MRD in the management of children,
young people, and elderly patients must be based on level of
risk, irrespective of the age of the patient.
Fig 3
• Where possible, use of the device should be discussed with a
parent, guardian, or carer.
Use of the MRD in the management of pregnant women.
• The waist belt component of the MRD must not be used with
women who are, who say they are, or who appear to be
pregnant.
Note: When other components of the MRD are used with women
who are, who say they are, or who appear to be pregnant, the
patient must not be postured supine.
• The positioning of pregnant women in the MRD must be in the
left lateral position.
Fig 4
• Attach the wrist extension strap to one of the wrist cuffs and
attach to the upper part of the stretcher frame. Fig 9. Attach the
other wrist extension strap to the other wrist cuff and attach to
the mid section of the stretcher frame. Fig 9
Use of the MRD in the management of bariatric patients
A modified version of the MRD is located in each Multi-Purpose
Vehicle and is only available for use by paramedics certified to
provide bariatric care. If required please contact the Medical
Retrieval Unit.
Fig 5
Apply the Mechanical Restraint Device:
The patient must never be restrained in the prone position.
1. Attach the waist belt, wrist cuffs and ankle cuffs to the patient. Ensure that the “D” shackles
are facing away from patient. Fig 3
2. Fasten the wrist cuffs to the waist belt. Fig 5
3. Using appropriate manual handling techniques assist or carry the patient to the stretcher
4. Fasten the patient’s waist belt to the waist mounting strap and ankle cuffs to the ankle
mounting strap. Fig 6 & 7
5. Check that all connections are firm and secure
Approved by:
Manager Education
December 2007 Revised; March 2010; August 2010; November 2010
Ambulance Service of New South Wales
112.5
Page 2 of 3
Restraints
Mechanical Restraint Device
Use of the wrist cuffs only
1. The use of wrist cuffs only can be used as limb holders to
prevent patients disrupting clinical treatment such as pulling
their IV lines/ catheters/artificial airway tube. Fig 8
Patients With Decreased Levels of Consciousness:
1. Posture in a lateral position
2. Attach the extension strap to one of the wrist cuffs and attach
to the stretcher frame. If necessary reposition the other wrist
cuff on the waist belt. Fig 9
Fig 6
Note: Ensure that the patient’s airway, breathing and circulation
are not compromised. Once restrained all normal monitoring
procedures must be maintained. The stretcher harness must be
used during transport in addition to the MRD.
Removal of the Mechanical Restraint Device:
1. Ensure adequate staff or security personnel are available
2. Release the waist belt and ankle cuffs from the stretcher
mounting straps before moving the patient onto the hospital
bed
3. Do not remove the other straps until safe to do so
Fig 7
Occupational Health and Safety:
Compliance with relevant Infection Control, OH&S and Manual
Handling techniques and procedures
MRD COMPONENT PARTS
Waist belt
mounting strap
Fig 8
Waist belt
Wrist and Ankle
cuffs
Wrist Extension
straps
Ankle strap
buckles
Fig 9
Ankle mounting strap
MRD stow bag
Buckle
release key
Approved by:
Manager Education
December 2007 Revised; March 2010; August 2010; November 2010
Ambulance Service of New South Wales
112.5
Page 3 of 3
Issued by: Manager, Education
Restraints
302 (modified) & 304 stretcher
Stretcher Harness
Indication:
All stretcher patients.
Prepare the equipment:
1.
With stretcher made up and stretcher harness in situ and all
buckles connected (Fig 1) you will find the harness webbing at
the head and foot anchors has Yellow coded strips to one side
of stretcher and Red coded strips to the other side. The centre
buckles are crossed to opposite sides of the stretcher. The
elastic shoulder webbings should be over the top of the
headrest. (Fig 2)
2.
Lengthen the belts at the foot end adjustments
3.
Disconnect centre buckles only and allow the harness webbing
to hang either side of the stretcher. (Fig 3)
Fig 2
Prepare the Patient:
1.
Place patient on the stretcher.
2.
Explain the procedure of securing safety harness
3.
Posture the patient according to Skill Sheet 110.1/9 (Fig 4)
4.
Cross the centre buckles over the patient and connect on the
opposite side. (Fig 5)
5.
Tighten each side down onto the shoulders of the patient, and
take up any slack using the belt adjusters at the foot end.
(Fig 5 & 6)
6.
To prevent breakage of buckles when not in use :
a) with a patient on the stretcher who is unable to be restrained
for clinical reasons – tuck the buckles and belts under the
mattress
b) with no patient on the stretcher the stretcher should be
made up with clean linen and all buckles connected (Fig 1)
prior to placing stretcher into the Ambulance.
7.
Fig 1
Fig 3
Fig 4
The patient can be placed in the lateral position with the
harness secured as normal. (Fig 7)
Occupational Health and Safety Note:
When a patient is loaded / unloaded from the stretcher, ensure that
the feet of the patient / officers cannot become entangled in the
harness webbing of the centre buckle, by disconnecting the foot
buckle on that side.
Fig 6
Approved by:
Medical Director
September 2005
Fig 5
Fig 7
112.6
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Restraints
302 (modified) & 304 stretcher
Child Harness
Indication:
All child stretcher patients.
Prepare the equipment:
1.
With stretcher made up and stretcher harness in-situ and all
buckles connected, you will find the harness webbing at the
head and foot anchors has Yellow coded strips to one side of
stretcher and Red coded strips to the other side. The centre
buckles are crossed to opposite sides of the stretcher. The
elastic shoulder webbings should be over the top of the
headrest.
2.
3.
Disconnect centre buckles only and allow the harness webbing
to hang either side of the stretcher.
Fig 1
Fig 2
Place the paediatric restraint on the stretcher with straps
underneath and the metal buckles placed beside the centre
buckles of the Stretcher Harness. (Fig 1)
Prepare the Patient:
1.
Explain the procedure and give reassurance as required.
2.
Place the child on the restraint and fasten the waist buckle, and
then thread groin strap through its buckle and tension. (Fig 2)
3.
Posture the patient according to Skill Sheet 110.1/9
4.
Disconnect the buckle at the head end anchor (Fig 3) and
passing it through the blue loop (which is part of the child
restraint harness) under the patients shoulder (Fig 4) and
reconnect it to it’s anchor. (Fig 3)
5.
Repeat Step 4 with the opposite side of the stretcher harness.
6.
Cross the centre buckle of the stretcher harness over the
patient (Fig 5) and
- passing the tongue of it through the slot of the metal buckle
clip of the child restraint
- connect it into the side buckle of the stretcher harness. (Fig 6)
7.
Bring the shoulder flaps
over the shoulders of the
patient and fasten the
black velcro retainers
around the harness
webbing. (Fig 7)
8.
Tighten each side down
onto the patients
shoulders (Fig 8) and
take up any slack using
the adjustment sliders at
the foot end. (Fig 9)
Approved by:
Medical Director
September 2005
Fig 3
Fig 4
Fig 5
Fig 6
Fig 7
Fig 8
Fig 9
112.7
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Pre-Hospital Birth
Miscellaneous
Indication:
In situations where childbirth is imminent in a pre-hospital situation.
Prepare the equipment:
1. Place enclosed sterile dressings under the patient’s buttocks to
maintain a sterile field.
2. Prepare the baby receiving area nearby with two bunny rugs,
neonatal aspiration equipment and paediatric resuscitation
equipment.
Fig 1
3. Remove gloves worn during preparation and reapply fresh gloves:
Prepare the patient:
1. Explain to the patient what is about to happen.
2. Position according to patient’s condition.
3. Administer pain relief if required.
Fig 2
Delivery:
1. When the mother indicates a need to push, visually assess for
crowning.
2. Allow baby’s head to deliver slowly by asking the mother to pant
rapidly through pursed lips, at the same time cupping your hand
over the baby’s head to prevent a rapid expulsion. (Fig 1)
3. Support the baby’s head as it is delivered, checking with fingers
for cord around the baby’s neck.
Fig 3
4. Immediately remove any membrane that may be covering baby’s
face using fingers only.
5. Prior to the delivery of the shoulders, clear airway with the paediatric
mucous extractor and by wiping baby’s face with a sterile dry gauze.
(Fig 2)
6. After the baby’s head has rotated to one side and with the next
contraction, using the flat of the hands on each side of the baby’s
head gently guide baby’s head downwards to deliver the upper
shoulders. (Fig 3)
Fig 4
7. With the hands in the same
position ease the head upwards
freeing the lower shoulder. (Fig 4)
8. Do not use undue force in freeing
of baby’s shoulder.
9. Support and take the weight of the
baby whilst the trunk and
lower limbs are delivered, and
position for drainage. (Figs 5 & 6)
Fig 5
Approved by:
Medical Director
December 2003
Fig 6
113.4
Ambulance Service of New South Wales
Page 1 of 36
Issued by: Manager, Education
Pre-Hospital Birth
Miscellaneous
Airway management:
1. Lay baby across mother’s abdomen with head down to allow
fluids to drain.
2. Wipe baby’s nose and mouth.
5 cm
10 cm
3. Breathing should occur spontaneously within the first minute, if
not, flick soles of feet to stimulate or resuscitate.
5. Cover baby in bunny rug or nappy - leave only face visible.
• Babies are very prone to hypothermia.
Fig 7
6. Apply sterile umbilical clamps - the first 10cm from the baby and
the second 15cm from the baby. (Fig 7)
7. Place a third clamp on the cord near the mother’s perineum, this
is only an indicator for the onset of placental expulsion.
8. Wrap a piece of sterile gauze around the cord between the first
two clamps/ties and cut the umbilical cord.
9. Cover the end of the stump of the umbilical cord of the baby
with a sterile pad.
10.Hand baby, warmly wrapped to mother to put on the breast.
• Breast feeding can stimulate uterine contraction.
Record birth information:
1. Time of birth.
2. Condition of baby and mother.
3. Sex of baby.
4. Complications.
Assess baby for APGAR score:
Assess baby for APGAR score one minute after birth and repeat
after five minutes.
Sign
O
1
2
Appearance
Cyanosed/Pale
Body pink,
cyanosed
extremities
All Pink
Pulse Rate
Absent
<100 per minute
>100 per minute
Grimace
None
Grimace
Cough, sneeze,
crying
Activity
None
Some flexion
Active
Respirations
None
Slow, irregular
Fast, regular
Approved by:
Medical Director
December 2003
113.4
Ambulance Service of New South Wales
Page 2 of 36
Issued by: Manager, Education
Miscellaneous
Pre-Hospital Birth
Delivery of Placenta:
1. When placenta is delivered, place in a suitable container that
should remain with the patient. (Fig 8)
2. Never pull on the cord to force delivery of the placenta.
3. Cover vulva with large dressing or a folded nappy.
4. If placenta has not delivered in fifteen minutes, cover vulva
and cord and transport.
5. Babies are slippery, take care when handling immediately after
delivery.
Fig 8
Where there are loop/s of cord around the baby’s neck:
1. Lift gently over head using gentle pressure.
2. Slip over head using gentle pressure.
3. Clamp in two places on the same loop, cut and unwind if too
tight to slip over baby’s head.
Approved by:
Medical Director
December 2003
113.4
Ambulance Service of New South Wales
Page 3 of 36
Miscellaneous
Slipper Bed Pan
Indication
To facilitate toileting options for all patients
Preparation
•
Apply personal hand hygiene before and after use
•
Apply PPE
•
Protect patients privacy by using a folded sheet or a
towel
Method
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Raise the stretcher head if possible to the sitting position or a position most comfortable
for the patient
Place an absorbent pad beneath patient
Insert bedpan between patients legs
Assist by sliding/inserting the bedpan with the thin end of
the bedpan facing towards the patient
Ensure bedpan is in the correct position with the
patient’s buttocks resting on the rim of the bedpan
Have toilet paper available and ensure privacy
Once complete, remove bedpan by sliding out from
underneath patient being careful not be spill the contents
Place lid over bedpan
Provide patient with hand hygiene product or equipment
after toileting
Dispose of contents into a sluice or toilet
Clean bedpan in a hospital grade pan washer or by
using hot soapy water to clean away any visible soiling
Supporting Information
If the patient requires assistance with hygiene care, log roll patient laterally and part
buttocks to access and clean the area. Wrap toilet tissue around your hand several times
and wipe the patient clean with one stroke front to back. Discard tissue and repeat until
the patient is clean
If the bedpan is used in transit, absorb liquids by placing disposable cloths into the
bedpan before covering with lid and place in a plastic bag until arrival at destination
The Slipper bedpan is also suitable for patients who are restrained in the Mechanical
Restraint Device (MRD) and who have limited movement on the stretcher
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual handling techniques and procedures
Approved by:
Manager Education
December 2003 Revised: March 2010
Ambulance Service of New South Wales
113.9
Page 1 of 1
Issued by: Manager, Education
Miscellaneous
Urinal
Indications:
Male patient who needs to void (urine).
Equipment:
• Urinal.
• Gloves.
• Protective eye wear.
Prepare the Patient:
1. Explain the procedure to the patient.
2. If the patient is able to use the urinal himself;
- place the urinal within reach.
- allow the patient to have privacy, if safe to do so.
3. If the patient is unable to use the urinal on his own;
- fold the blanket back enough to allow for placement of the
urinal.
- the urinal is properly placed between slightly spread legs.
- position the urinal with the base resting on the stretcher mattress.
- assist by placing the penis into the urinal opening. (Fig 1)
Fig 1
4. When removing the urinal, do so in such a way to prevent
spillage of contents.
5. Empty the contents in an appropriate place, e.g. slues, dispose of
gloves in an approved manner and wash hands thoroughly.
6. Record the events on the patient health care record, making mention
of any offensive odours or visual abnormalities of urine contents.
Approved by:
Medical Director
December 2003
113.10
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Miscellaneous
Changing Oxygen Cylinder in Oxygen Supply Pack
Prepare the equipment:
1. Select a “C” size cylinder.
• Black body with white shoulder with pin identification safety
system.
2. Remove plastic seal from neck of cylinder.
• Ensure plastic seal on cylinder neck is in place and heat
indicator is undamaged. (Fig 1)
3. Using oxygen cylinder key wheel, turn slowly in an anti-clockwise
direction half a turn and return to closed position so as to remove
any dust particles. (Fig 2)
• Do not place hand over cylinder opening or direct opening
towards any person.
Fig 1
Removal of redundant cylinder:
1. Close cylinder valve on empty cylinder.
• Ensure oxygen system is depressurised.
2. Rotate the cylinder yoke key in an anti-clockwise direction until
shaft of the cylinder is clear of the cylinder neck.
Fig 2
3. Pull the neck of the cylinder towards the shaft of the cylinder
yoke key to clear the cylinder from the two locating pins of the
cylinder. (Fig 3)
4. Slide empty cylinder from the unit.
Insertion of full cylinder:
1. Ensure that the “Bodok” washer is seated around the yoke.
2. Slide full oxygen into unit and line up the two cylinders locating
holes with the two locating pins on the cylinder yoke.
Fig 3
3. Secure in position by rotating the cylinder yoke key in a clockwise
direction until tight.
• Do not over tighten.
Checking cylinder contents:
1. Using the oxygen key wheel, turn slowly in an anti-clockwise
direction to turn the cylinder on. (Fig 4)
2. Check the pressure gauge to ensure that the cylinder is full.
Fig 4
3. Check that the cylinder yoke is not leaking.
4. Turn the cylinder off by turning the oxygen key wheel in a
clockwise direction.
5. Depressurise system.
Approved by:
Medical Director
December 2003
113.11
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Changing “D” Size Oxygen Cylinder
Miscellaneous
Indication:
Fig 1
When a “D” size cylinder is less than a quarter full.
Prepare the equipment:
1. Select a “D” size cylinder.
• Black body with white shoulder.
2. Remove plastic thread protector from the cylinder.
• Ensure the plastic seal on the cylinder is in place and the heat
indicator is undamaged. (Fig 1)
3. All cylinders found without dust protectors are to be assumed to
be empty and should not be used.
Fig 2
4. Using the oxygen cylinder valve, turn slowly in an anti-clockwise
direction half a turn and quickly return to closed position to
remove any dust particles. (Fig 2)
• Do not place hand over cylinder opening or direct towards
any person.
Removal of redundant cylinder:
1. Close cylinder valve on empty cylinder. (Fig 3)
Fig 3
2. Ensure oxygen system is depressurised.
3. Remove oxygen regulator from the cylinder. (Fig 4)
4. Remove empty cylinder from restraining device.
• Observe correct back care procedures.
5. Re-connect regulator to new oxygen cylinder and secure in
restraining device. (Fig 5)
• Do not over-tighten the oxygen regulator.
Fig 4
Checking cylinder contents:
1. Using oxygen key wheel, turn slowly in an anti-clockwise
direction to turn the cylinder on.
2. Check the pressure gauge to ensure that the cylinder is full.
(Fig 6)
3. Check that the cylinder yoke
is not leaking.
Fig 5
Fig 6
4. Turn cylinder off by turning
oxygen key wheel in a
clockwise direction.
5. Depressurise system.
Approved by:
Medical Director
December 2003
113.12
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Miscellaneous
Oxygen Supply Cleaning Pack
Indication:
In all situations once a month or if contamination has occurred.
Cleaning an oxygen pack:
All non-disposable component parts are cleaned with an approved
disinfectant solution and dried.
• Soft packs can be sponged with warm soapy water.
Cleaning suction components:
1. Unscrew the suction jar and clean.
2. Disconnect the suction tubing from the angled nipple on the
suction jar.
3. Discard used disposable parts.
4. Clean and dry all suction components with approved disinfectant
solution.
5. Replace the suction filter.
6. Reassemble unit.
• Do not use petroleum or chlorine based products on the
oxygen soft pack.
Approved by:
Medical Director
December 2003
113.14
Ambulance Service of New South Wales
Issued by: Manager, Education
Miscellaneous
Blanketing and Securing a Patient in a Nato Type Stretcher
Indication:
Fig 1
In major incident or isolated incident situations where a patient
needs to be moved.
Prepare the patient:
1. Reassure the patient and explain what is about to happen.
2. Check the patient’s clothing and remove any bulky items.
Prepare the equipment:
Fig 2
1. Remove the straps that hold the stretcher together (if present).
2. Using your foot, lock the stretcher spreaders in place.
• Fingers can be injured if used to lock spreaders.
3. Obtain a rope 12mm x 12m for securing the patient to the
stretcher.
4. Apply one or two blankets to the stretcher using the following
methods.
Blanket the stretcher:
Single Blanket Method 1. Lay a blanket on the stretcher with one corner at the top centre of
the stretcher.
2. Place the patient on the stretcher on top of the blanket with their
head level with the top of the stretcher. (Fig 1)
3. Fold the feet end of the blanket in between and around the
patient’s feet.
4. Fold the lower corner over the patient and tuck in.
5. Fold the upper corner over the patient and tuck in. (Fig 2)
Approved by:
Medical Director
December 2003
113.15
Ambulance Service of New South Wales
Page 1 of 24
Issued by: Manager, Education
Miscellaneous
Blanketing and Securing a Patient in a Nato Type Stretcher
Fig 3
Double Blanket Method 1. Lay a blanket on the stretcher lengthwise across the stretcher.
• One quarter over one side and one half over the opposite side.
2. Lay the second blanket with its centre in the middle of the
stretcher, about 44mm from the head end of the stretcher.
3. Flare out the foot end of the second blanket.
4. Place the patient on the stretcher on top of the blanket with their
head level with the top of the stretcher. (Fig 3)
Fig 4
5. Using the end of the second blanket fold in between and around
the patient’s feet.
6. Fold the quarter side over the patient.
7. Fold the half side over the patient and tuck in.
Secure patient in stretcher:
1. Using a 12mm rope, tie a figure of eight loop around the stretcher
handles and through the D at the right hand side on the head end
of the stretcher.
2. Working down the patient, place at least three half hitches around
the patient and the stretcher.
3. The half hitches should be at chest, wrist and just above the knee
levels if possible.
4. Take a round turn around the feet and then apply half hitches on
the opposite side to the first ones working up towards the head.
5. Secure the rope to the handle at the head end with a round
turn and two half hitches. (Fig 4)
Approved by:
Medical Director
December 2003
113.15
Ambulance Service of New South Wales
Page 2 of 24
Miscellaneous
Oxygen Pack – Pre Shift Check
Indication
Pre-Shift check. Check the following:
External
• Check outside surface for tears and cracks
• Inspect seams, joints, hoses and fittings for damage
• Ensure all surfaces are clean
Pressure and therapy equipment
• Slowly turn cylinder on in an anti-clockwise direction; a quarter
turn is sufficient
• If an audible hiss is heard, turn off and check ‘Bodok’ washer
• Visualise cylinder gauge for content (min 10,000kPa)
• Turn flow meter on and ensure to maximum flow
• Ensure spare ‘bodok’ seals are available and have integrity
Suction unit
• Suction tubing X 1
• Yankeur sucker X 1
• ‘Y’ Suction catheters sizes 6-8-10-12-14 X 1ea
• Occlude end of suction tubing, turn unit on and ensure effective
suction occurs
• To disassemble and clean suction unit, refer to skill Infection
Control – Cleaning of Suction Units 114.5.3
Adult Oxygen Equipment
and Oxygen Pack
Adult masks and tubing
• Disposable Bag Valve Mask (BVM) Resuscitator X1
• Oxygen Therapy mask X 1 Adult,
• Oxygen Therapy mask with reservoir bag X 1 Adult
• Nebuliser mask X 1 Adult,
• Oxygen nipple pre set at 8L/min and ‘T’ piece for nebuliser
• Oxygen tubing X 2
Airways
Ensure the following are present:
• Oropharyngeal Adult airways *
Size
Colour
70mm
White
80mm
Green
90mm
Yellow
100mm
Red
* Oropharyngeal airway sizes and colours may vary between manufacturers
• Nasopharyngeal Adult airway sizes 6.5 - 7.5 - 8.5
• Lubricant jelly X 2
• LMA sizes 3 - 4 - 5
Approved by:
Manager Education
December 2003 Revised; April 2010
Ambulance Service of New South Wales
113.16
Page 1 of 2
Miscellaneous
Oxygen Pack – Pre Shift Check
• Airway kit (LMA / ETT) X 2
Sphygmomanometer and cuffs
• Adult size cuff X 1
Paediatric Oxygen Equipment
Pre-Shift check for PAEDIATRIC oxygen equipment . Check the
following:
External
• Check outside surface for tears and cracks
• Inspect seams, joints, hoses and fittings for damage
• Ensure all surfaces are clean
Paediatric Masks and tubing
• Disposable Bag Valve Mask (BVM) Resuscitator - Neonate X 1
• Disposable Bag Valve Mask (BVM) Resuscitator - Paed X 1
• Oxygen Therapy mask X 1
• Oxygen Therapy mask with reservoir bag X 1
• Nebuliser mask X 1
• Oxygen tubing X 2
Paediatric Oxygen
Equipment Kit
Airways
• Oropharyngeal paediatric airway sizes*
Size
Colour
30mm
Clear
40mm
Pink
50mm
Blue
60mm
Black
* Oropharyngeal airway sizes and colours may vary between manufacturers
Sphygmomanometer and cuffs
• Paediatric cuff x 1
Supporting information:
ASNSW has a combination of single adult / paediatric and
combined oxygen packs.
Occupational Health and Safety
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures
Note
No additional equipment or medications are to be stored in the
oxygen kits
Approved by:
Manager Education
December 2003 Revised; April 2010
Ambulance Service of New South Wales
113.16
Page 2 of 2
Issued by: Manager, Education
Miscellaneous
Making up Stretcher
Indication:
At the completion of a shift and post ambulance transport.
Prepare equipment:
1. Obtain a harness if not already in situ.
2. Obtain clean pillowslips, sheets and blankets.
3. Check the integrity of the mattress ie no rips or tears in the
covering.
Fig 1
Apply harness if applicable:
1. In accordance with Skill Sheet 112.1.
Apply linen:
1. Place the folded sheet over the stretcher.
Fig 2
2. Fold the top of the sheet over the diamond
3. Tuck in neatly ensuring no wrinkles. (Fig 1)
Blanket:
1. Fold the blanket in half lengthwise.
2. Fold the blanket in half again leaving a small margin from the
folded edge. (Fig 2)
Fig 3
3. Place the folded blanket on the stretcher. (Fig 3)
4. Fold both ends to the centre leaving a small gap. (Fig 4)
5. Fold the top half over the bottom half and place on the end of the
stretcher. (Fig 5)
Clip harness to leg strap anchor buckle as per Skill Sheet 112.1
1. Apply a clean pillowslip to the pillow and place the pillow on the
head of the stretcher. (Fig 6)
Fig 5
Approved by:
Medical Director
December 2003
Fig 4
Fig 6
113.17
Ambulance Service of New South Wales
Page 1 of 12
Issued by: Manager, Education
Helicopter Procedures
Miscellaneous
Indication:
In situations when a helicopter landing is required.
Select appropriate landing area:
1. Select a clear flat area approximately forty
metres square.
2. Remove any obstructions or loose objects.
3. Determine the wind direction.
• Check for overhead wires.
Mark appropriate landing area:
Fig 1
1. Deploy responsible people to keep the landing
area clear.
2. Ask each person to stand at the corner of the
square area at a distance of only forty metres
apart.
OR
1. Position two ambulance vehicles with beacons
active at an angle of 45˚ so that headlights
intersect, lighting the landing area approximately
forty metres from the vehicles. (Fig 1)
2. Ensure the headlights of the vehicles are facing
towards the wind.
Fig 2
Prepare for helicopter landing:
1. Secure all loose items, sheets etc.
2. When smoke flares are available, the Landing
Zone Coordinator is to position themself with their
back to the wind with the flare held upright.
(Figs 2 & 3)
Fig 3
Approved by:
Medical Director
December 2003
113.18
Ambulance Service of New South Wales
Page 1 of 24
Issued by: Manager, Education
Miscellaneous
Helicopter Procedures
Approaching the aircraft:
1. Remain outside the diameter of the main rotor.
2. Obtain clearance from the pilot before approaching
by facing the helicopter and fully extending one
arm with thumb up - thumbs up response by pilot
is clearance to approach. (Fig 4)
3. Approach helicopter via safe approach areas only.
4. Watch pilot while approaching in case of any
possible change of instruction.
5. Observe the path of the rotor blades.
6. Approach from the low side of the aircraft.
7. Do not lift objects higher than your waist while
under the rotors.
8. Be guided by the crewman as to your position in
the helicopter.
Safety:
• If blinded or disoriented by dust, immediately
sit down and wait for assistance.
•
Fig 4
An aircraft must never be approached without
permission from the pilot or crewman.
Approved by:
Medical Director
December 2003
113.18
Ambulance Service of New South Wales
Page 2 of 24
Miscellaneous
Tazer –Electronic Control Device
Indication:
In situations where Police officers have used a Tazer to incapacitate a
person. Two methods may be used by the Police:
•
•
Firing the Tazer and having the two wired probes imbedded into
the patient. Each probe is 12mm long.
Using the Drive Stun mode. This is where the patient has
received a shock from direct contact with the gun. The probes
have not been fired.
Removal:
The Police may have attended to the initial care of the patient and
removed the probes prior to ambulance arrival.
If probes are still in-situ:
•
•
•
•
•
•
Follow all Police instructions for safety.
Cut wires from probes.
Place one hand to support patient skin away from the probe
NB: DO NOT place probe between fingers.
Using other hand, gently but swiftly pull on the probe to remove.
Ensure the entire probe is removed as it may separate at the
barrel.
Once the probes are removed, as evidence they must remain the
property and responsibility of the NSW police force.
Post Removal Care:
•
•
•
•
•
Treat wound
If patient has a Pacemaker or Internal Cardiac Defibrillator then
the patient should be monitored and transported for assessment.
Placement of the probes and wounds observed must be
documented on the PHCR
Communicate to the Police Officer any specific observations
taken or concerns that you may have.
If transport is required notify Police Officer in charge as Police
escorts may have to be arranged.
If probe/s have penetrated the eye or genitalia
•
•
•
DO NOT ATTEMPT TO REMOVE THE PROBE, CUT THE WIRE
AND LEAVE THE PROBE IN SITU
Transport to hospital as specialist treatment may be required.
Treat as per specific protocols.
Occupational Health & Safety
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures.
Approved by:
Medical Director
November 2008
113.21
Ambulance Service of New South Wales
Page 1 of 1
Miscellaneous
Flares
Indications
• Signalling device
• Visual location for approaching aircraft
• Show prevailing wind speed and direction
Orange Flare
Red Flare
smoke for daylight use
bright light for night (or day)
Fig 1
Prepare the environment
1. Risk analysis should occur during periods of high or extreme bush fire conditions
2. Close attention should be paid to anticipated wind direction and strength
3. Select firm surface like concrete, bitumen, bare earth or
mown green grass:
• away from buildings, vehicles, oil / gas tanks or
cylinders
• free of fire hazards, dry grass, crops or other
vegetation
• away from a patient/emergency service workers/
Fig 2
bystanders
• upwind of the emergency site
• provides a good view of the horizon from which you expect the helicopter to approach
• towards the upwind edge of the proposed landing site
Prepare the flare
1. To prevent burns safety helmet, glasses, goggles, leather
gloves and long sleeves must be worn whilst igniting and
deploying flares
2. Select the appropriate flare Fig 1
3. Read the operating directions on the label
4. Hold the flare away from the face/body and remove cap
Fig 2
Fig 3
Igniting the flare
1. Activation sequence, follow the diagrams printed on the flare canister
2. Ignite the flare by swiftly pulling the tab Fig 3
3. Hold at arms length, and point away from your body. Do not look directly at the flame once
ignited and avoid having the smoke blow over you Fig 4a & 4b and Fig 5
4. After activation, the flare canister will become very hot - hold by the plastic handle only
5. There may be a delay of a second or two before the flare ignites, avoid pointing the flare at
anyone
113.22
Approved by:
Manager Education
March 2010
Page 1 of 2
Ambulance Service of New South Wales
Miscellaneous
Flares
Supporting Information
• Store flares away from ignition sources in rear of vehicle
• Do not inhale smoke, avoid contact with skin and eyes
Fig 4a
• Do not expose flare to shock and friction
• Fire extinguisher on hand when using flares
• Refer to the Product Safety Data Sheet for additional
information
• Ignite flare after visual contact is made with aircraft
Have second flare on hand to allow for failure or longer signalling required
• Orange smoke flare may occasionally produce an orange flame only. If this occurs, the
manufacturer recommends that you immediately tap the
end of the activated flare on the ground, and it should
Fig 4b
convert to producing smoke. A vigorous tap may be
required
• The flare will operate for around 45 to 60 seconds
• After use, the spent flare canister will be very hot and
may pose a fire risk. Place in water if available, place on
a non-combustible surface e.g. concrete, bitumen or
bare earth, and allow too cool
• Dispose of spent flare securely
• Flares should be removed from service on their noted expiry date and returned to local
sector office
Fig 5
• Fig 5 illustrates the effects of the night flare
Occupational Health and Safety
Compliance with relevant Infection Control, OH&S and Manual Handling techniques and
procedures
113.22
Approved by:
Manager Education
March 2010
Page 2 of 2
Ambulance Service of New South Wales
Infection Control
draft
Issued by: Manager, Education
Infection Control Policy Statement
The Service is committed to ensuring the health and safety of all patients in the health care setting (and
particularly the pre-hospital setting) and the provision of a safe and healthy working environment for all
staff. This commitment includes adopting an infection control system and procedures that minimise the
risk of health care consumers and providers acquiring healthcare associated or occupational infection.
The Infection Control System has two tiers;
1. Standard Precautions;
The first tier is called standard precautions and applies to all patients, regardless of their diagnosis or
presumed infection status. These precautions constitute the minimum acceptable level of practice in
infection control.
2. Additional (Transmission Based) Precautions;
The second tier includes precautions that are applicable for the care of specific patients. The
additional tier of precautions is known as additional (or transmission based) precautions. These
precautions are applied to patients known or suspected to have infections spread by the airborne,
droplet or contact route.
Multi Resistant Organisms (MROs)
MROs are bacteria and other organisms that have developed resistance to antimicrobial drugs. MROs are
spread by direct contact with the affected patient or with contaminated objects eg unwashed hands.
Patients may be infected or colonised with MROs such as MRSA (Multiple Drug Resistant Staphylococcus
Aureus) or VRE (Vancomycin Resistant Enterococci). MROs can cause serious illness and avoidable
deaths in patients. The Service is committed to minimising the risk of MRO infection transmission in the
pre-hospital setting.
All health care workers have a common law duty of care to take all reasonable steps to safeguard
patients, staff and the general public from infection.
The Infection Control Policy and System are reflected in the Infection Control Procedures. Assessment of
the Infection Control procedures will occur concurrently with assessment of all procedures.
Reference: NSW Health Policy Directive 2007_036 Infection Control Policy
Approved by:
Manager Education
October 2008
114
Ambulance Service of New South Wales
Page 1 of 1
Infection Control
Standard Precautions
Indication:
Implement Standard Infection Control Precautions for all patients receiving care, regardless of their
diagnosis or presumed infection status.
Procedure:
1. Standard Precautions involve the use of safe work practices and protective barriers including;
•
Hand hygiene
•
Use of personal protective equipment (PPE) when indicated
•
Appropriate device handling
•
Appropriate handling of laundry
•
Incorporation of respiratory hygiene / cough etiquette
2. Implement standard precautions for all patients.
3. Use PPE when touching (or potentially exposed to);
•
Blood (including dried blood)
•
All body substances, secretions and excretions (excluding sweat), regardless of whether or not
they contain visible blood
•
Non-intact skin
•
Mucous membranes including eyes
Approved by:
Manager Education
October 2008
114.1
Ambulance Service of New South Wales
Page 1 of 1
Infection Control
Standard Precautions – Hand Hygiene
Hand Hygiene
Indication:
The frequency, duration and type of hand hygiene are dependent upon the nature, intensity, duration and
sequence of the work activity and guidelines are provided below.
Rationale:
Hand hygiene is the single most important practice to reduce the transmission of infectious agents in
healthcare settings.
Procedure:
1. The term hand hygiene includes both hand washing with running water and soap or the use of waterfree skin cleansers such as alcohol based products.
2. Perform hand hygiene
• When starting and finishing work
• Before and after going to the toilet, smoking and eating
• If skin is contaminated or visibly soiled with body substances
• Following contact with own mucous membranes (eg blowing nose, sneezing or coughing into
hands)
• Following contact with non-intact skin and/or abnormal skin conditions (rashes)
• Before donning gloves and after removing gloves
• Before and after removing facial and eye protection
• After removing a gown
• Before and after patient care procedures
• Between different procedures on the same patient
• Before and after direct patient contact (except where urgent and emergency patient treatment is
necessary and washing facilities are not readily available)
• After touching inanimate objects that are likely to be contaminated
• Prior to food preparation or feeding patients
• After touching animals
3. Types of hand hygiene required
Type
Routine healthcare
interventions /
social
Procedural (non
surgical)
Skin cleaning product
Liquid soap and water
Water-free skin cleanser
Alcohol hand rub with residual affect
(eg chlorhexidine)
Duration
10 -15 seconds
10 -15 seconds and until
dry
30 seconds minimum
4. Drying hands
• Hands must be dried with paper towel after hand washing in clinical and food preparation areas
• Alcohol hand rubs must be allowed to dry
• Hot air hand dryers and reusable cloth towels are not recommended in areas where health care
workers perform hand hygiene
Approved by:
Manager Education
October 2008
114.1.1
Ambulance Service of New South Wales
Page 1 of 2
Infection Control
Standard Precautions – Hand Hygiene
5. Glove use and hand hygiene
• Glove use does not eliminate the requirement for hand hygiene
• If gloves are torn or compromised during patient care, they should be removed and hand hygiene
performed before new gloves are applied
6. Hand wash dispensers
• Liquid hand hygiene dispensers with disposable cartridges and nozzles should be used rather than
reusable dispensers
7. Hand and skin care
• Prior to each shift, check skin integrity visually and with an alcohol hand rub
• Cover cuts and abrasions on exposed skin with a water resistant occlusive dressing, and change
dressing as necessary or if it becomes soiled, loose, damp or damaged
• Seek further advice from a medical practitioner or the infection control officer if non intact exposed
skin cannot be covered by a dressing or gloves
• The regular use of non-oil based hand moisturising creams or lotions is recommended to protect
hands from chafing
8. Hand accessories when in direct patient care
• Artificial fingernails, nail extenders or any nail enhancements (eg painting, varnish or nail art) must
not be worn
• Natural fingernail tips should not be more than 0.5cm long
• Hand and wrist jewellery must be kept to a minimum
• Rings with large or multiple settings or detailed scroll work must not be worn
• Wrist jewellery should be easily removed for hand hygiene or patient activity and should not be
worn for invasive procedures
• Wristbands that cannot be easily cleaned (eg made of leather, wood or cloth) must not be worn
9. Patient or visitor hand hygiene
• Patients and visitors are to be encouraged to perform hand hygiene as possible and appropriate to
the setting
Occupational Health and Safety:
Compliance with relevant Infection Control, OH&S and Manual Handling techniques and procedures
Approved by:
Manager Education
October 2008
114.1.1
Ambulance Service of New South Wales
Page 2 of 2
Infection Control
Standard Precautions - Infection Control PPE
Infection Control Personal Protective Equipment (PPE) for Standard Precautions
Indication:
Infection control personal protective equipment is to be used as a barrier to protect the health care worker
from contamination with blood or body fluids.
Procedure:
Medical Examination Gloves
1. Gloves must be worn
• On both hands
• In situations where there is direct contact anticipated with blood, body fluid, mucous membranes or
non-intact skin
• While handling items or surfaces that have come in to contact with blood or body substances
• When performing an invasive procedure, venipuncture or a finger or heel stick
2. Gloves are not required for subcutaneous, intradermal or intramuscular injections unless exposure to
blood is anticipated
3. Gloves must be removed and discarded
• As soon as the integrity has been altered (eg torn or ruptured)
• After care to a patient is complete and before providing care to another patient
• When performing separate procedures on the same patient
• Before touching environmental items and surfaces
• Before writing in the medical notes, answering phones or using radios or MDTs
Facial Protection
1. Protective eyewear or a fluid resistant mask and face shield must be worn while performing
procedures where there is a likelihood of splashing or splattering of blood or body substances.
2. General prescription eyeglasses do not comply with Australian Standards for protective eyewear and
therefore protective eyewear must be worn in addition to prescription glasses
Gowns
3. A disposable fluid resistant gown must be worn where there is a likelihood of splashing or splattering
of blood or body substances to the uniform.
Donning and Removal of PPE
4. The following sequences are recommended for donning and removal of PPE to reduce the possibility
of cross contamination;
Donning PPE
1. perform hand hygiene
2. gown
3. mask
4. protective eyewear / shield
5. gloves
Removing PPE
1. gloves
2. perform hand hygiene
3. protective eyewear / shield
4. gown
5. mask
6. perform hand hygiene
Contaminated Clothing
5. Clothing contaminated with blood or body substances should be removed as soon as possible and
before attending other patients.
Occupational Health and Safety:
Compliance with relevant Infection Control, OH&S and Manual Handling techniques and procedures
Approved by:
Manager Education
October 2008
114.1.2
Ambulance Service of New South Wales
Page 1 of 1
Infection Control
Standard Precautions - Handling Equipment/Devices
Handling of Contaminated Equipment or Medical Devices
Indication:
Used patient care equipment that is soiled with blood or body fluids is to be handled in a manner which
prevents health care worker contamination as well as transfer of micro-organisms to other patients and the
environment.
Procedure:
1. When handling equipment that is soiled with blood or body fluids, use an appropriate level of PPE
2. When patient care is complete, all single use items are to be discarded
3. When patient care is complete all reusable items are to be cleaned or re-processed
as per Procedure 114.5
4. When medical equipment items require maintenance, they must be cleaned and all visible signs of
soiling removed prior to sending away for maintenance
Occupational Health and Safety:
Compliance with relevant Infection Control, OH&S and Manual Handling techniques and procedures
Approved by:
Manager Education
October 2008
114.1.3
Ambulance Service of New South Wales
Page 1 of 1
Infection Control
Standard Precautions - Linen Handling
Linen Handling
Indication:
Linen should be handled in a manner that reduces the likelihood of contamination of the surrounding
environment and cross infection of patients and health care workers.
Procedure:
1. Use clean linen for every patient
2. Clean linen is to be stored in a clean dry environment that prevents contamination by moisture, dust
and vermin
3. Clean linen is to be stored and transported separately from used linen
4. Clean linen stock is to be stored in a manner that allows stock rotation
5. Handle used linen in a manner that prevents skin and mucous membrane exposure, contamination of
clothing and transfer of micro-organisms to other patients and the environment
6. When handling linen that is soiled with blood or body fluids, use an appropriate level of PPE
7. Linen that is soiled with blood or body substances should be enclosed in to a leak proof bag for
transport
Occupational Health and Safety:
Compliance with relevant Infection Control, OH&S and Manual Handling techniques and procedures
Approved by:
Manager Education
October 2008
114.1.4
Ambulance Service of New South Wales
Page 1 of 1
Infection Control Standard Precautions - Respiratory Hygiene/Cough Etiquette
Respiratory Hygiene / Cough Etiquette
Indication:
All people with signs and symptoms of respiratory infection should practice respiratory hygiene and cough
etiquette.
Procedure:
1. Instruct patients who are coughing and or sneezing (where it is possible and achievable) to;
•
Cover their mouths with a disposable cloth
•
Use the disposable cloth to contain respiratory secretions
•
Spit in to the disposable cloth if spitting is necessary
•
Dispose of the cloth in to the nearest rubbish bin after use
•
Perform hand hygiene after coughing and sneezing and handling used disposable cloths
•
Wear a face mask (if clinically appropriate) when being transported
2. Health care workers who have a persistent cough must practice respiratory hygiene and be medically
assessed by their doctor.
Occupational Health and Safety:
Compliance to relevant Infection Control, OH&S and Manual Handling techniques and procedures.
Approved by:
Manager Education
October 2008
114.1.5
Ambulance Service of New South Wales
Page 1 of 1
Infection Control
Issued by: Manager, Education
Additional (Transmission Based) Precautions
Indication:
Implement Additional Infection Control Precautions when patients are known or suspected to harbour
infectious organisms for which extra measures above Standard Precautions are required.
Procedure:
1. When a specific infectious disease is known or suspected, use the Disease Index (R3 – Protocols &
Pharmacology) to determine if and which type(s) of Additional Precautions are required for each listed
disease.
2. There are three types of Additional Precautions
a. Airborne Precautions
b. Droplet Precautions
c. Contact Precautions
3. A combination of these precautions may be required for diseases that have multiple routes of
transmission
4. Patients requiring Additional Precautions should be transported separately from other patients except
when cohorted with a patient(s) with the same infection
5. Triaging of patients suspected of transmissible infection or disease should occur in a manner that
prevents contamination of the environment and transmission to other patients in the waiting area
Occupational Health and Safety:
Compliance with relevant Infection Control, OH&S and Manual Handling techniques and procedures
Approved by:
Manager Education
October
2008
114.2
Ambulance Service of New South Wales
Page 1 of 1
Issued by: Manager, Education
Infection Control
Additional Precautions - Airborne Precautions
Airborne Precautions
Indication:
Implement Airborne Precautions for patients known or suspected to be infected with organisms that can
be transmitted by small airborne particles. (These particles can remain suspended in the air for long
periods of time.)
Procedure:
Summary of Airborne Precautions
Requirements
Transport
Precautions required
Transport alone or cohorted with another patient with same infection
Patient to wear a mask if clinically tolerated
Notify area receiving patient of requirement for additional
precautions prior to arrival
Hand hygiene
Yes
Gloves
As for standard precautions
Gown
As for standard precautions
Mask
P2 mask to be worn by all occupants of the transport vehicle
Protective Eyewear
As for standard precautions
Special handling of
As for standard precautions
equipment
Avoid contaminating surfaces with used gloves
Cleaning Requirements
Apply clean PPE and implement standard cleaning protocols
Other
Avoid contamination of medical records or PHCR
Occupational Health and Safety:
Compliance to relevant Infection Control, OH&S and Manual Handling techniques and procedures.
Approved by:
Manager Education
October
2008
114.2.1
Ambulance Service of New South Wales
Page 1 of 1
Issued by: Manager, Education
Infection Control
Additional Precautions - Droplet Precautions
Droplet Precautions
Indication:
Apply Droplet Precautions for patients known or suspected to be infected with organisms that can be
transmitted by respiratory droplets. (These particles are usually expelled from the patient and only travel
short distances ie less than one metre from the patient.)
Procedure:
Summary of Droplet Precautions
Requirements
Precautions required
Transport alone or cohorted with another patient with same
infection
Transport
Patient to wear a mask if coughing and if clinically tolerated
Notify area receiving patient of requirement for additional
precautions
Hand hygiene
Yes
Gloves
As for standard precautions
Gown
As for standard precautions
Mask
Yes – when within one metre of the patient
Protective Eyewear
As for standard precautions
Special handling of
As for standard precautions
equipment
Avoid contaminating surfaces with used gloves
Cleaning Requirements
Apply clean PPE and implement standard cleaning protocols
Other
Avoid contamination of medical records or PHCR
Occupational Health and Safety:
Compliance with relevant Infection Control, OH&S and Manual Handling techniques and procedures
Approved by:
Manager Education
October
2008
114.2.2
Ambulance Service of New South Wales
Page 1 of 1
Issued by: Manager, Education
Infection Control
Additional Precautions - Contact Precautions
Contact Precautions
Indication:
Implement Contact Precautions for patients known or suspected to be infected or colonised with
organisms that can be transmitted by direct or indirect contact. (This may involve skin to skin contact from
one person to another or a contaminated intermediate object or person eg patient care equipment.)
Procedure:
Summary of Contact Precautions
Requirements
Precautions required
Transport alone or cohorted with another patient with same
Transport
infection
Notify area receiving patient of requirement for additional
precautions
Hand hygiene
Yes
Gloves
Yes – when in direct contact with the patient or their environment
Gown
Yes – when in direct contact with the patient or their environment
Mask
As for standard precautions
Protective Eyewear
As for standard precautions
Special handling of
As for standard precautions
equipment
Avoid contaminating surfaces with used gloves
Cleaning Requirements
Apply clean PPE and implement standard cleaning protocols
Other
Avoid contamination of medical records or PHCR
Occupational Health and Safety:
Compliance to relevant Infection Control, OH&S and Manual Handling techniques and procedures.
Approved by:
Manager Education
October
2008
114.2.3
Ambulance Service of New South Wales
Page 1 of 1
Issued by: Manager, Education
Infection Control
Additional Precautions - PPE
Infection Control Personal Protective Equipment (PPE) for Additional Precautions
Indication:
Infection control personal protective equipment is to be used as a barrier to protect the health care worker
from contamination with airborne, droplet or contact infections.
Procedure:
Medical Examination Gloves
•
Utilise gloves as appropriate for the type of infection transmission.
•
Avoid contaminating self, the environment and patient care equipment.
Facial Protection
•
Utilise masks and protective eyewear as appropriate to the type of infection transmission.
Gowns
•
Utilise gowns as appropriate to the type of infection transmission.
Donning and Removal of PPE
•
The following sequences are recommended for donning and removal of PPE to reduce the possibility
of cross contamination;
Donning PPE
Removing PPE
1. perform hand hygiene
1. gloves
2. gown
2. perform hand hygiene
3. mask
3. protective eyewear / shield
4. protective eyewear / shield
4. gown
5. gloves
5. mask
6. perform hand hygiene
Occupational Health and Safety:
Compliance with relevant Infection Control, OH&S and Manual Handling techniques and procedures
Approved by:
Manager Education
October
2008
114.2.4
Ambulance Service of New South Wales
Page 1 of 1
Infection Control
Issued by: Manager, Education
Additional Precautions - Multi Resistant Organism
Multi Resistant Organism (MRO) Procedure
Indication:
Implement contact precautions when providing care for patients infected or colonised with MROs.
Procedure:
1.
PPE required
2.
Hand hygiene required
3.
Environmental cleaning required – refer to Procedure 114.5
4.
Patients with MROs are to be transported separately to reduce the risk of cross infection. Patients
with a similar MRO may be transported together (eg 2 patients with MRSA or 2 patients with VRE),
however patients with different types of MROs must never be transported together.
5.
Avoid contamination of patients’ documentation eg transfer letters or PHCRs
Occupational Health and Safety:
Compliance with relevant Infection Control, OH&S and Manual Handling techniques and procedures
Approved by:
Manager Education
October
2008
114.2.5
Ambulance Service of New South Wales
Page 1 of 1
Infection Control
Issued by: Manager, Education
Additional Precautions – Resp Diseases Mask
Respiratory Diseases Mask (Respirator) Donning and Fit Checking
Technique
Indication:
Officers must apply a respiratory diseases mask to themselves when
caring for a patient with signs and symptoms of respiratory infection or
when caring for patients that are confirmed to have infections spread via
the droplet or airborne route (Disease Index R3 – Protocols &
Pharmacology).
Procedure:
1. Remove the respirator from its packaging and hold with straps facing
upward. Pull out the top and bottom panel to form a cup.
2. Turn respirator over to expose headbands.
3. Cup respirator under the chin and pull both straps over the head.
4. Locate the lower strap below the ears and the upper strap across the
crown of the head. Adjust top and bottom panels for a comfortable fit.
5. Using both hands, mould nose clip to the lower part of the nose.
6. Check the fit of the respirator every time it is worn. Cup both hands
over the respirator. Inhale sharply. If air flows around the edges
readjust nosepiece and repeat the fit check until a good fit is
achieved.
7. After use, remove and dispose of the respirator by using the straps,
do not handle the front of the respirator when removing
Occupational Health and Safety:
Compliance to relevant Infection Control, OH&S and Manual Handling
techniques and procedures.
Approved by:
Manager Education
October
2008
114.2.6
Ambulance Service of New South Wales
Page 1 of 1
Issued by: Manager, Education
Infection Control
Safe Handling, Use and Disposal of Sharps
Indication:
Use the following guidelines when managing and using sharp devices.
Rationale:
The potential for transmission of blood borne viruses is greatest when medical devices such as needles
and other sharp instruments are used.
Procedure:
1.
The person using the sharp device is responsible for the management and safe disposal of sharps
2.
Wherever possible minimise the use of sharps
3.
Sharps must be safely managed when used eg
a.
always seek assistance if giving injections or cannulating an unco-operative patient or child and
b.
communicate to all present about the proximity and use of sharps
4.
Do not pass sharps by hand from person to person
5.
Do not re-sheath needles
6.
Do not disconnect needles from syringes prior to disposal
7.
Dispose of sharps using single hand operation, by dropping in to sharps containers as soon as
practical following use, avoiding direct contact with the contaminated tip
8.
Place sharps containers as close as practical to the point of generation and use of the sharp (“point
of use”)
9.
Sharps containers should be located in appropriate places such as within the ambulances and on
mobile kits and not be used when not mounted or restrained in some way. Sharps containers should
not be enclosed within kits
10.
Mobile kit sharps containers with temporary closure mechanisms should be temporarily closed when
not in use
11.
Do not force sharps into sharps containers
12.
Do not overfill sharps containers – replace when three-quarters filled
13.
Securely seal sharps containers with a lid before disposal
14.
Dispose of used sharps containers in to a Clinical Waste bin
15.
In the pre-hospital setting, great care should also be exercised when in proximity to sharp objects
that are contaminated with blood or other body fluids eg broken glass or jagged metal at the scene
of motor vehicle accidents
Occupational Health and Safety:
Compliance to relevant Infection Control, OH&S and Manual Handling techniques and procedures.
Approved by:
Manager Education
October
2008
114. 3
Ambulance Service of New South Wales
Page 1 of 1
Issued by: Manager, Education
Infection Control
Staff Exposure to Blood and/or Body Fluids
Indication:
Use the following procedure when an unprotected exposure to blood or body fluids (excludes sweat)
occurs.
Rationale:
Blood borne viruses may be transmitted by significant exposure to blood or other body substances.
Procedure:
1.
If you have sustained an exposure of blood or body fluids to your skin, wash the affected skin with
soap and water as soon as possible. If soap and water are not available use the alcohol hand rub
and a disposable cloth as an interim measure until the area can be cleaned with soap and water. No
further action is required.
2.
If your uniform has been soiled with blood or body fluids, the uniform must be changed and any
affected skin washed (as above) as soon as possible and before coming in to contact with another
patient
3.
If you have sustained a splash exposure to the eyes, nose, mouth or non intact skin with blood or
body fluid, or sustained a contaminated sharps injury, the following procedures apply:
a.
Institute first aid as per the type of exposure
i.
For a splash of blood / body fluid to the eyes, nose, mouth or non-intact skin, rinse the
affected area with water.
ii.
For a contaminated sharps injury (eg needlestick injury), wash the wound with soap and
water (do not squeeze the wound). If soap and water are not immediately available, wash the
wound with the alcohol hand rub. Cover the wound.
b.
Report the incident to your immediate supervisor and complete a report of the injury (IIMS).
c.
Seek medical advice from a local hospital or doctor. If no other options are immediately
available, then contact the NSW 24 Hour Needlestick Injury Hotline Number for advice on
1800 804 823
d.
Report the incident by phone to the Infection Control Officer within 5 business days of the
incident occurring. Direct phone number (02) 9320 7868
4.
Managers and supervisors should;
a.
Ensure that the employee obtains appropriate management of the injury
b.
Ensure the provision of peer support or counselling as appropriate
c.
Maintain confidentiality about the incident in the workplace
Occupational Health and Safety:
Compliance to relevant Infection Control, OH&S and Manual Handling techniques and procedures.
Approved by:
Manager Education
October
2008
114.4
Ambulance Service of New South Wales
Page 1 of 1
Issued by: Manager, Education
Infection Control
Cleaning of Reusable Medical Equipment
Cleaning of Reusable Medical Equipment
Indication:
Clean reusable patient care equipment between each patient use. Examples include the patient stretcher
(including restraints), stethoscope, thermometer, bedpan and blood pressure cuff.
Rationale:
Reducing the microbial burden on patient care equipment after each use will minimise the possibility of
cross infection.
Procedure:
1.
Prior to cleaning, don the appropriate level of PPE according to the cleaning task
2.
Commence thorough cleaning of items as soon as practical after use
a.
The process of cleaning should involve water and detergent and physical or mechanical action
b.
Use a sink or bowl kept specifically for that purpose
c.
Remove gross soil by rinsing in warm water
d.
Disassemble equipment and immerse in warm water and detergent
e.
Use the amount of detergent according to manufacturer instructions
f.
Clean equipment manually using appropriate tools eg scrubbing brush or cleaning cloth,
ensuring removal of all visible soiling
3.
g.
Rinse equipment in warm water, removing all traces of detergent
h.
Dry the equipment
i.
Check visually that the equipment is clean and functional before returning to use
Due to the different locations in which the cleaning of equipment is required, the full cleaning
process as described above may not be achievable. Interim cleaning options include using detergent
and disposable cleaning cloths. Using thorough physical action, wipe over equipment until visually
clean.
4.
When covers or sheaths are used on equipment, cleaning of that equipment is still required (eg
tympanic thermometers).
5.
When medical equipment has to be sent away for maintenance, the equipment must be cleaned
before being sent off site.
Occupational Health and Safety:
Compliance to relevant Infection Control, OH&S and Manual Handling techniques and procedures.
Approved by:
Manager Education
October
2008
114. 5.1
Ambulance Service of New South Wales
Page 1 of 1
Issued by: Manager, Education
Infection Control
Cleaning of Suction Units
Cleaning of Suction Units
Indication:
Suction Units should be emptied and cleaned or changed after each
patient use.
Twin-o-Vac and Eco-Vac Suction Unit Procedure:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Do not allow liquid in the jar to fill past the maximum level.
Wearing appropriate level of PPE, empty jar (into sluice), refit jar
and flush clear water through unit to clean the head until water runs
clear. Empty jar when flushing complete and dispose of suction
tubing.
Remove the unit from the oxygen source. Fig 1
Disassemble into the various parts. Fig 2
Remove the metal dome and discard the filters. Fig 3
Eco-Vac only – Remove the metal mesh, remove ball bearing and
valve block being careful not to lose the ball bearing.
Clean all parts with detergent and water – do not immerse head of
unit in fluid and ensure that no cleaning solution enters the gas
passages.
Eco-Vac only - refit valve block and ball bearing.
Refit metal mesh
Replace filters - the thin filter is placed against the metal mesh and
the thicker filter is then placed on top of that filter. Ensure the blue
disk that is located between the thin disks is discarded before filter
is used.
Refit the metal dome.
Reassemble and check that the equipment is functioning before
returning to service.
Fig 1
Fig 2
Fig 3
Medi-Vac Suction Unit Procedure:
1.
2.
3.
4.
5.
6.
Do not allow the container to fill past the maximum level.
Wearing appropriate level of PPE, dispose of the suction tubing
and the blue elbow connection, remove the vacuum connection
and close off the suction liner using the two blue caps. Fig 4
Dispose of the entire suction liner into clinical waste Fig 5
Clean the red wall fitting and clear outer canister using detergent
and water.
Wipe over the red vacuum connection with detergent (do not allow
fluid to enter the vacuum connection).
Insert a new suction liner, reassemble the suction unit and check
that the equipment is functioning before returning it to service.
Fig 4
Fig 5
Occupational Health and Safety:
Compliance with relevant Infection Control, OH&S and Manual Handling
techniques and procedures.
Approved by:
Manager Education
October 2008
114.5.3
Ambulance Service of New South Wales
Page 1 of 1
Issued by: Manager, Education
Infection Control
Storage of Sterilised Instruments and Equipment
Storage of Sterilised Instruments and Equipment
Indication:
Sterilised items must be stored and handled in a manner that maintains the integrity of the packaging
material and prevents contamination of the contents.
Procedure:
1.
Sterile storage areas must be
•
Dedicated to that purpose
•
Cleaned to a routine schedule
•
Free from dust, insects and vermin
2.
3.
Sterile items must be stored
•
So that packaging is not crushed, bent, compressed, punctured, exposed to heat or direct sunlight
•
So that they are not held together with rubber bands, staples, or paper clips
•
And stock rotated in a manner that ensures that the nearest “use by date” is used first.
On open shelving, sterile items must be at least 250mm off the floor and at least 440mm from the
ceiling
4.
Once the packaging has been opened and contents partially used, any left over product must be
discarded after that episode of patient care
5.
Contents will be considered contaminated if the packaging is wet or damaged
6.
Stock levels should be kept at appropriate levels according to local requirements.
7.
If a sterile item does not have a use by date, factors such as the purpose of the product and the
condition of the packaging, will determine if the product is safe to use
Occupational Health and Safety:
Compliance to relevant Infection Control, OH&S and Manual Handling techniques and procedures.
Approved by:
Manager Education
October
2008
114.5.4
Ambulance Service of New South Wales
Page 1 of 1
Issued by: Manager, Education
Infection Control
Environmental Cleaning
Environmental Cleaning
Indication:
Health care facilities including transport vehicles, casualty rooms, aircraft and ambulance stations must
undergo a regular cleaning schedule that includes cleaning of visibly soiled surfaces as soon as possible.
Rationale:
Deposits of dust, soil or microbes on surfaces are a potential source of health care associated infection.
Procedure:
Cleaning of Vehicles and Casualty Rooms
1.
2.
3.
4.
5.
6.
7.
8.
9.
Timing of cleaning procedures;
a.
Clean internal flat surfaces of ambulances and patient transport vehicles when visibly soiled and
at the end of each shift
b.
A more detailed clean of the inside of the vehicle should be carried out weekly
c.
“Casualty rooms” should be cleaned when visibly soiled and at least weekly
Prior to cleaning, the appropriate level of PPE should be applied
Thoroughly clean all internal surfaces of vehicles and casualty rooms, including the patient care
area, driver and passenger area, equipment compartments, steering wheel and door handles
Use water and detergent (diluted as per the manufacturer’s instructions) in a cleaning bucket with
disposable cleaning cloths
Start cleaning at the most distant point from the door and clean from high to low, working back
towards the door until all surfaces are cleaned and all visible signs of soiling are gone
Use water and detergent (as above) in a mop bucket and mop to clean floors
If cleaning is undertaken at a location where buckets and mops are not available, use cleaning
cloths and detergent as an interim measure
Avoid the use of cleaning methods which aerosolise or disperse microbes in to the air (sweeping or
spray and wipe cleaning methods)
When cleaning is complete, wash buckets and mops with warm water and detergent and store in a
manner to facilitate drying. Maintain cleaning equipment in a clean and hygienic condition. Replace
mops regularly. Discard cleaning cloths after use.
Heavily Contaminated Vehicles
10.
Cleaning of vehicles that have been heavily contaminated with blood and or body substances
involves a combination of the above procedure and Management of Blood and Body Substance
Spills. While the principles are the same for cleaning the vehicle whatever the level of soiling, for
logistical reasons it is appropriate to temporarily remove a heavily contaminated vehicle from service
until thoroughly cleaned and checked.
Healthcare Worker Personal Items
11.
Staff must ensure that frequently handled personal items such as stethoscopes and pens are
cleaned after being in contact with patients. Other items such as lanyards and mobile phones should
be cleaned on a regular basis.
Station Cleaning
12.
Station cleaning should be managed by Station Managers as appropriate to the individual
requirements of each station, however the following points are provided as a guide.
13. Kitchen;
a.
Surfaces should be cleaned and rubbish removed prior to the completion of each shift
Approved by:
Manager Education
October
2008
114.5.5
Ambulance Service of New South Wales
Page 1 of 2
Issued by: Manager, Education
Infection Control
Environmental Cleaning
b.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
Food placed in the fridge should be labelled with the person’s name and the date it was placed
in the fridge
c.
Fridges should be cleaned regularly and outdated food removed
d.
Ovens and microwaves should be wiped down after each use
Bathroom / toilets;
a.
Bathrooms and toilets should be kept clean at all times
b.
Liquid hand soap should be supplied in a non-refillable dispenser (bladder or cassette style)
c.
Paper towels should be readily available (cloth towels are not to be used for hand drying)
d.
Suitable hand moisturiser should be readily available in a pump pack
e.
Showering facilities should be available for staff in case of unexpected splashing or
contamination
Staff locker areas should be kept clean and tidy at all times’
Office areas should be cleaned regularly
Plant room should be kept clean and tidy and floors cleaned at least weekly. If area is hosed, ensure
that it is done in a manner that minimises potential contamination of the environment, equipment and
clothing
Vehicle cleaning area:
a.
Appropriate cleaning equipment should be readily available (cleaning cloths, detergents,
housekeeping gloves, mops and buckets) and kept in clean and hygienic condition, and in good
working order. Mops should be cleaned after use and hung to dry. Buckets should be cleaned
after use and stored dry. Housekeeping gloves should be washed and dried after each use
b.
Appropriate PPE should always be available
c.
Laundry bags should be available for dirty linen and provision made for regular removal
d.
General waste and clinical waste containers should be readily available, kept in clean condition
and provision made for regular removal
Equipment cleaning area – there should be a designated area for equipment cleaning. This area
should be kept in a clean and hygienic condition. It is recommended that the washing facilities are
made from stainless steel and include a large sink, draining area and hot and cold running water.
The following should be readily available;
a.
Cleaning cloths
b.
Detergent
c.
Liquid measure
d.
Cleaning brushes of appropriate size
e.
PPE
Stock storage area
a.
should be kept clean and hygienic
b.
surfaces should be easily cleanable (eg laminate surfaces encouraged and timber surfaces
discouraged)
c.
Cardboard cartons are to be minimised as they may harbour vermin – decanted items should be
stored in washable containers
d.
Sterile stock should be stored and handled in a manner that maintains the integrity of the
packaging material and prevents contamination of the contents
Cleaners Room and chemical storage areas should be kept clean and hygienic
Lounge and rest areas should be kept clean and tidy. When lounges are soiled, commercial cleaning
is recommended
Reclining quarters
a.
Should be kept clean and tidy
b.
Mattress and pillow protectors should be used at all times and laundered regularly
Occupational Health and Safety:
Compliance to relevant Infection Control, OH&S and Manual Handling techniques and procedures.
Approved by:
Manager Education
October
2008
114.5.5
Ambulance Service of New South Wales
Page 2 of 2
Issued by: Manager, Education
Infection Control
Management of Blood and Body Substance Spills
Management of Blood and Body Substance Spills
Indication:
Blood and body substance spills must be cleaned as soon as possible after the spill occurs.
Procedure:
1.
Apply an appropriate level of PPE according to the amount of the spill
2.
Confine and contain the spill
3.
Cover the spill with disposable material to absorb the bulk of the blood or body substance
4.
Remove the debris and treat as clinical waste
5.
Clean the spill site with detergent
Occupational Health and Safety:
Compliance to relevant Infection Control, OH&S and Manual Handling techniques and procedures.
Approved by:
Manager Education
October
2008
114.5.6
Ambulance Service of New South Wales
Page 1 of 1
Issued by: Manager, Education
Infection Control
Management of Clinical Waste
Management of Clinical Waste
Indication:
Use the following guidelines when handling disposable items contaminated with blood, body fluids or
human tissue.
Procedure:
1. Clinical Waste is defined as “waste which has the potential to cause sharps injury, infection or
offence”
2. Clinical Waste includes the following types of waste
a.
Sharps
b.
Human tissue (excluding hair, teeth and nails
c.
Bulk body fluids and blood
d.
Visibly blood stained body fluids
e.
Visibly blood stained disposable material
3. Place Clinical Waste into yellow plastic bags or containers with the “Biohazard” symbol
4. When handling Clinical Waste:
a.
Wear the appropriate level of PPE
b.
Minimise the chance of splashing or contamination to skin or mucous membranes
5. Clinical Waste and general waste should be segregated at the source of generation.
6. Do not overfill clinical waste bags and containers
7. Store Clinical Waste in a secure location (bin should be locked if not in a secure location)
8. Bulk Clinical Waste (eg multiple sharps containers or clinical waste bags) must not be transported in
ambulance vehicles
Occupational Health and Safety:
Compliance to relevant Infection Control, OH&S and Manual Handling techniques and procedures.
Approved by:
Manager Education
October
2008
114.6
Ambulance Service of New South Wales
Page 1 of 1
Issued by: Manager, Education
Infection Control
Specific Clinical Practices
Specific Clinical Practices - Use of Glucometer
Indication:
This procedure applies when using a glucometer.
Rationale:
This type of equipment has been implicated in the transmission of blood borne viruses between patients.
Procedure:
1. Clean glucometer between each use
2. Dispose of used lancets immediately after each use into a sharps container
3. Wear gloves when performing finger or heel sticks
4. Ensure that the glucometer and protective casing /covering are not contaminated with blood
5. A glucometer that is owned by a patient is for the sole use of that patient
Occupational Health and Safety:
Compliance with relevant Infection Control, OH&S and Manual Handling techniques and procedures
Approved by:
Manager Education
October
2008
114.7.1
Ambulance Service of New South Wales
Page 1 of 1
Issued by: Manager, Education
Infection Control
Specific Clinical Practices
Specific Clinical Practices - Nebuliser Use
Indication:
Use the following procedure when a nebuliser is administered.
Rationale:
Nebulisers are thought to increase the risk of airborne spread for some transmissible diseases.
Procedure:
1. Give strong consideration to the use of PPE (mask) when a nebuliser is in use especially in an
enclosed space eg ambulance or aircraft
2. Ensure the nebuliser is used where other patients will not have exposure to the aerosol
Occupational Health and Safety:
Compliance with relevant Infection Control, OH&S and Manual Handling techniques and procedures
Approved by:
Manager Education
October
2008
114.7.3
Ambulance Service of New South Wales
Page 1 of 1
Issued by: Manager, Education
Infection Control
Specific Clinical Practices
Specific Clinical Practices - Airway Filters
Indication:
Use a bacterial / viral airway filter when ventilating using a mask, laryngeal mask or endotracheal tube and
a reusable resuscitator bag.
Rationale:
Airway filters provide a barrier to cross contamination between patients and respiratory apparatus and vice
versa.
Procedure:
1. Use the filter for a single patient only and discard after use.
2. Replace the filter if during use it becomes contaminated with body substances eg vomitus or blood
Caution:
• For clinical reasons airway filters should not be used for patients under 10kg in weight
•
The white screw cap should be left in place on the filter (the cap covers a monitoring port). If the white
cap is missing, replace the filter otherwise there will be an air leak
Occupational Health and Safety:
Compliance with relevant Infection Control, OH&S and Manual Handling techniques and procedures
Approved by:
Manager Education
October
2008
114.7.4
Ambulance Service of New South Wales
Page 1 of 1
Issued by: Manager, Education
Infection Control
Specific Clinical Practices
Specific Clinical Practices - Sterile medications and solutions
Indication:
Use the following procedure when using medications packaged in multi dose vials.
Rationale:
Where medications are packaged in multi use vials, there is the potential for re-use for more than one
patient and the potential for cross contamination.
Procedure:
1. Injectable products packaged in a multi dose vial or ampoule must not be used for more than one
patient.
Occupational Health and Safety:
Compliance with relevant Infection Control, OH&S and Manual Handling techniques and procedures
Approved by:
Manager Education
October
2008
114.7.5
Ambulance Service of New South Wales
Page 1 of 1
Issued by: Manager, Education
Infection Control
Specific Clinical Practices
Specific Clinical Practices - Single Use Items / Devices
Indication:
This procedure is to be used when equipment in use is marked “Single Use”.
Rationale:
Items labelled “Single Use” are intended by the manufacturer to be used once and then discarded.
Procedure:
1. If an item is marked for single use only, it must be used once only and then discarded
2. If an item is marked for single patient use, it means it has been approved for more than one episode of
use on one patient only.
Occupational Health and Safety:
Compliance with relevant Infection Control, OH&S and Manual Handling techniques and procedures
Approved by:
Manager Education
October
2008
114.7.6
Ambulance Service of New South Wales
Page 1 of 1
Issued by: Manager, Education
Infection Control
Specific Clinical Practices
Specific Clinical Practices - CPR training using a mannequin
Indication:
Use this procedure when providing first aid training using a mannequin and mouth to mouth resuscitation
techniques.
Procedure:
1. When first aid CPR training involves mouth to mouth resuscitation, a resuscitation device or filter
should be provided to each person and discarded after use.
2. Disposable mannequin lungs must be discarded after each training session.
3. Non disposable mannequin lungs must be cleaned and re-processed according to manufacturer
instructions after each training session.
Occupational Health and Safety:
Compliance with relevant Infection Control, OH&S and Manual Handling techniques and procedures
Approved by:
Manager Education
October
2008
114.7.7
Ambulance Service of New South Wales
Page 1 of 1
Bariatric Care
Manual Handling
Indication
When a patients weight/girth width exceeds the safe working load
limit of a standard ambulance stretcher. In some case’s the
patient’s girth rather then their actual weight, is the contributing
factor for a requirement to use a bariatric stretcher.
• Mega Lift Operator is to take command and:
o
Select and brief lifting team (minimum 6 to maximum of 10)
o
Assign lifting positions by balancing height and potential
carrying capacity i.e. do not place individuals of similar
height on the same side
o
Instruct staff to pull lifting handles out
Fig 1
o Instruct team on the lifting commands: stop – lift - lower forward - turn - halt. If an individual feels any strain during
the lifting procedure, .they must call out the word “stop”.
The Mega Lift operator will then determine an appropriate
course of action
o Team is to prepare to lift on the command “1-2-3 lift”. The
patient is then lifted from the full squat position ending in an
upright standing posture
Fig 2
o On the command “forward” team walks in straight line with
first step being left foot for left side of stretcher and right
foot for right side of stretcher
o On the command “turn” individuals on the inside of the
turn take short steps whilst those on the outside of the turn,
take longer steps
o On the command “halt” team comes to a complete stop
o Team is to prepare to lower on the command “1-2-3 lower”.
The patient is then lowered from the upright standing
posture to the full squat position at ground level
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures
Approved by:
Manager Education
July 2009
BC-1
Ambulance Service of New South Wales
Page 1 of 1
Bariatric Care
Non Electric Stretcher Lifting
Indication:
A Bariatric patient who requires lifting and/or lowering whilst on the
Bariatric stretcher
Method:
•
Check the stretcher i.e.
o
Under stretcher tension buckles are secured and tensioned:
Fig 1
o
Vinyl stitching is not frayed at any joining point: Fig 1
o
Friction lifting handles will release: Fig 2
o
Two head release handles are working: Fig 1
o
Four pull straps are attached: Fig 4
o
Brake wheel locks are working: Fig3
Fig 1
Fig 2
NB: The two front wheels are not brakes, they only lock wheel
direction
Procedure
• Reinforce manual handle techniques
•
Explain procedure and reassure patient
•
Refer to Manual Handling Skill BC-1
Fig 3
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures.
Fig 4
Approved by:
Manager Education
July 2009
BC-2
Ambulance Service of New South Wales
Page 1 of 1
Bariatric Care
Stretcher Loading / Unloading
Indication
Transfer from bariatric stretcher to bariatric wheelchair, or bariatric
stretcher to hospital bed
Prepare the team
•
Refer to skill BC-1 Manual Handling
Loading Procedure for Standard Ambulance
(Mercedes 316 / VW LT35 – not for VW T5) Fig 1
•
Mega lift operator will coordinate all movement using
identified commands
•
Open rear doors to their full fold back position Fig 2
•
Position patient on stretcher – Skill BC-1
•
Position one officer in back of vehicle to hold stretcher pull
straps
•
When front wheels touch floor pan the mega lift operator
calls “Halt”
Caution: Beware of hands being jammed up against right
door hinge Fig 3
Fig 1
Fig 2
Note: At this point the front wheels will be resting on the floor
pan and only be 2-3 mm inside the vehicle. The team
member in the vehicle must keep tension on the front pull
straps whilst the remainder of the team maintain forward
pressure on the stretcher at all times Fig 2
•
Front team members push handles in and reposition
themselves at foot of stretcher (if required)
•
When the middle row reaches the door hinge call “Halt”
•
The middle row push handles in and move away
•
When the middle row reaches the door hinge call “Halt”
•
The third row push handles in and moves away
•
Push stretcher firmly into locking mechanism whilst pushing
down on locking plate
•
Pull back on rear straps to ensure that the stretcher has
locked securely
Loading Procedure for Bariatric Ambulance
(with ramp/hoist facility) Fig 4
•
•
Fig 3
Fig 4
Mega lift operator will appoint a safety officer and
coordinate all movement using identified commands
Safety officer to observe from the driver’s side ensuring a 1
metre clearance around the ramp
Approved by:
Manager Education
July 2009
BC-3
Ambulance Service of New South Wales
Page 1 of 4
Bariatric Care
•
•
•
•
•
•
Stretcher Loading / Unloading
Ensure that the rear vehicle ramp leading edge is flat to
ground Fig 5
Place the ramp side security gates into position and ensure
ramp safety stops are functional Fig 6
Using pulling straps ensure stretcher wheels contact the
back of the ramp (minimum 4 people) Fig 7
Position stretcher onto ramp ensuring no backward
movement by applying brakes and ramp safety stops Fig 8
One team member is to remain on the ramp to reassure
patient and stabilise stretcher Fig 9
Mega-lift operator actuates ramp switches on rear side of
vehicle Fig 10
Fig 5
Note: Internal ramp switches are only used in an emergency
when outside switches fail
Caution: Beware that stretcher handles and body parts do
not get caught between the vehicle and the ramp
•
Warn the team and patient that the ramp will move
•
Raise the ramp to the level position Fig 6
•
Raise the ramp to the full height position Fig 11
•
Team member now enters vehicle via side door to assist
with final loading procedure
•
Unlock all stretcher brakes and pull stretcher into vehicle
using pull straps until it locks in
•
Push down on rear stretcher lock and pull back on pull
straps to confirm it is locked in
•
Lock stretcher brakes with higher limit Bariatric patients
Unloading Procedure for Standard Ambulance
(Mercedes 316 / VW LT35 – not for VW T5)
•
Mega lift operator will coordinate all movement using
identified commands
•
Open rear doors to their full fold back position Fig 2
•
Position one officer in back of vehicle to hold stretcher pull
straps while ensuring end handles remain extended
•
Two team members pull handles out and position
themselves at foot of stretcher
•
Unlock and slowly commence removing stretcher ensuring
that tension is maintained on the pull straps
•
When the handles at the foot of the stretcher are outside
the vehicle call “Halt”
Approved by:
Manager Education
July 2009
Fig 6
Fig 7
Fig 8
Fig 9
BC-3
Ambulance Service of New South Wales
Page 2 of 4
Bariatric Care
•
Stretcher Loading / Unloading
As the stretcher is being removed and side handles
become available there is a pause as each team member
takes up their position at lifting points, facing in the direction
of travel
Note: Ultimately the front wheels will be resting on the floor pan
and only be 2-3 mm inside the vehicle. The team member in the
vehicle must keep tension on the front pull straps whilst the
remainder of the team maintain counter pressure on the stretcher
at all times Fig 2
•
From this point onwards, all movement and commands are
as per Skill BC-01
Fig 10
Unloading Procedure for Bariatric Ambulance
(with ramp/hoist facility)
•
•
•
Mega lift operator will appoint a safety officer and
coordinate all movement using identified commands
Safety officer to observe from the driver’s side ensuring a 1
metre clearance around the ramp
Place the ramp side security gates into position and ensure
ramp safety stops are functional Figs 8 & 12
•
Team member now enters vehicle via side door to assist
with final unloading procedure
•
•
Warn the team and patient that the ramp will move
Mega-lift operator actuates ramp switches on rear side of
vehicle Fig 10
•
•
Lower the ramp to the floor level position Fig 6
Position stretcher onto ramp ensuring no forward movement
by applying stretcher brakes and ramp safety stops
One team member is to remain on the ramp to reassure
patient and stabilise stretcher
•
•
Warn the team and patient that the ramp will move
•
Lower the ramp ensuring the leading edge is flat to the
ground Fig 5
•
Hold tension of the stretcher using the 4 pulling straps while
the brakes are unlocked and ramp safety lock is
disengaged Fig 7
•
Turn stretcher 90 degrees parallel to the leading edge of the
ramp and reapply stretcher brakes Fig 6
Approved by:
Manager Education
July 2009
Fig 11
Fig 12
Fig 13
BC-3
Ambulance Service of New South Wales
Page 3 of 4
Bariatric Care
Stretcher Loading / Unloading
•
The co-ordinator now levels the ramp in preparation for
moving the patient Fig 6
•
Assist patient to pivot on the stretcher to the sitting position
by having 2 paramedics support patients arms, another
supporting patients back
•
Adjust ramp allowing patient to stand on the ground and
assist patient to the standing position
•
Assist patient to bariatric wheelchair or hospital bed Fig 13
Handy Hints
•
Team leader must command and co-ordinate all stretcher
movements
•
Ensuring head end handles remain extended during
removal provides a safety feature in the event of an
inadvertent drop
•
Use a ‘standard’ hospital bed (without mattress) to transfer
bariatric stretcher and patient from the rear of the
ambulance to alongside their bariatric bed. The patient can
then be moved off the ASNSW bariatric stretcher
•
Once bariatric stretcher and patient are placed on the
hospital bed, lower the bed to its lowest height to prevent
damage to hydraulics (do not attempt to re-raise this bed
with the patient on it)
Occupational Health and Safety
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures.
Approved by:
Manager Education
July 2009
BC-3
Ambulance Service of New South Wales
Page 4 of 4
Bariatric care
240 Volt Extension Lead (with in-line safety switch)
Indication:
When a 240 volt extension lead with an in-line electrical safety
switch is required
Prepare the team/patient
• Mega Lift operator is to take command and identify potential
hazards i.e. electrocution, extension lead damage. Do not
use in wet areas
Fig 1
Caution: Do not use if any damage noted
•
Prepare equipment to be used in conjunction with extension
lead and ensure electrical supply is maintained
Procedure
One (240 volt fixed outlet)
• Lay extension lead out so it is not coiled
•
Connect the safety extension lead to equipment e.g.
Hovermatt, Hoverjack, home ventilator via 240 volt outlet:
Fig 1
•
Turn power on and when procedure is completed turn off
Fig 2
Two (240 volt vehicle outlet)
•
Lay extension lead out so it is not coiled
Connect the safety extension lead to equipment e.g.
Hovermatt, Hoverjack, home ventilator
•
Start vehicle and turn on main power switch: Figs 2 & 3
•
Connect safety extension lead to inverter and turn on
inverter power switch: Fig 4
Fig 3
Note: If patient is on a ventilator, have manual
resuscitation equipment readily available
•
Load and unload patient refer skill : BC 3
•
Turn all power off when procedure is completed
•
Roll extension lead up and store in protective bag/locker
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures.
Fig 4
Approved by:
Manager Education
July 2009
BC - 4
Ambulance Service of New South Wales
Page 1 of 1
Bariatric Care
240 Volt Inverter
Indication:
When 240 volt power is required
Method:
•
Check power output requirements as each vehicle may
have different inverter size: Figs 1 & 2
1
Fig 1
•
Plug each unit individually into power board restricting
unnecessary loadings to inverter
Appliances may be rated in watts or amps. Use one of the
following power output formulas to determine inverters capability
Watts= 240 volt x amps
Amps = watts / 240 volts
Calculate total amps or watts up on the selected machines that
need to work off the inverter and if this exceeds the maximum
output, then the inverter is not powerful enough to use
(Consider start up current draw of some motors, example: balloon
pump heater)
Fig 2
Examples
3000 watts inverter
Rated amps = 3000 watts / 240 volts
Therefore amps rating = 12.5 amps maximum load or total watts
not to exceed 3000
1200 watts inverter
Rated amps = 1200 watts / 240 volts
Fig 3
Therefore amps rating = 5 amps maximum load or total watts not
to exceed 1200
1800 watts inverter
Rated amps = 1800 watts / 240 volts
Therefore amps rating = 7.5 amps maximum load or total watts not
to exceed 1800
Approved by:
Manager Education
July 2009
Fig 4
BC - 5
Ambulance Service of New South Wales
Page 1 of 2
Bariatric Care
240 Volt Inverter
Prepare the equipment
•
•
•
•
•
•
Check 240 Volt leads for any damage: Fig 4
Start vehicle and turn master power isolator switch on. refer
skill BC-15
Turn 240 volt isolator switch on Fig 5
Plug equipment individually into power board
Plug power board into inverter and turn on: Figs 1 & 2
If the inverter overload switch trips out, reconsider the
power formulas and remove non essential equipment
Fig 5
Post transport
•
•
Turn off inverter power switch followed by inverter isolator
switch
Check for any damage to power board, extension lead and
store in security bag
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures.
Approved by:
Manager Education
July 2009
BC - 5
Ambulance Service of New South Wales
Page 1 of 2
Bariatric Care
Vehicle Tilt cab
Indication:
When a Mega Lift Ambulance needs to have the front cabin Tilted
to access the engine compartment. i.e. check fluid levels, service
vehicle. Minimum of two staff required to perform procedure: Fig 1
Method:
Tilting cabin
• Park vehicle on flat ground, close windows, select and
engage first gear, apply hand brake and chock wheels
• Remove all unsecured items from inside the cabin
• Make sure front of vehicle is clear of obstructions
• Enter back of cabin, slide rear window open, and separate
velcro seal between front and rear cabin
• Position one officer on driver’s side of cabin
• locate cabin release handles on passenger side of vehicle,
drivers side of cabin does not have a handle: Fig 2
• Push safe locking lever down before pulling main release
lever to release cabin Fig 3
• Grab lifting handle on lower section of passenger door and
position cabin forward: Fig 4
• Using established commands, tilt the cabin forward until
cabin support locking arm is straight and locked in place
• Apply safety lock to cabin support arm: Fig 5
Fig 1
Fig 2
Lowering cabin
Caution: If loss of lowering control is experienced during the
lowering procedure do not try to stop it
• Have second officer supporting cabin on driver’s side.
• Both officers take weight of cabin whilst passenger side
officer grabs cabin support handle
• Using established commands, commence lowering of cabin
• Release cabin support arm safety clip and pull cabin
support arm forward to release tension.
• Once cabin starts to fall, drivers side officer take hands
away from cabin
• Passenger side officer guides cabin to locking mechanism
and pushes main cabin lever up
• An audible and visual alarm will indicate if the cabin is not
securely locked in position
• Reseal Velcro between compartments.
Fig 3
Fig 4
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures.
Fig 5
Approved by:
Manager Education
July 2009
BC - 6
Ambulance Service of New South Wales
Page 1 of 1
Bariatric care
Vehicle ramp failure
Indication:
When a manual override is required following an electrical system
ramp failure
Method:
Note: Two styles of mechanical override systems are available
refer figs: 1 & 2
•
•
•
Notify Operation centre , request appropriate resources i.e.
mechanic, back up transport
Appoint safety officer to ramp area and ensure that no
personnel enter ramp working area
Indentify and open door of ramp mechanical override
compartment (rear outside patient cabin lower passenger
side
Hino Model : Fig 2
•
•
•
•
•
Fig 2
Locate two switches inside cabinet: Fig 3
One switch tilts ramp whilst other lowers ramp
Press one button in for 10 secs to identify if it tilts or lowers
Tilt ramp until it is level with vehicle floor
Position stretcher/equipment onto ramp refer skill BC -3 and
lower to ground level ref skill BC - 3
Mercedes Benz Model :Fig 1
•
•
•
•
•
•
Fig 3
Refer to manufacturers instruction manual
Release and remove clips that support internal cover
Locate coloured toggle switches
Yellow and Green / Tilts ramp use first Fig 5
Blue / Lowers ramp Fig 5
Do not touch the green switch Fig 5
Caution: large turns of the toggle switch will cause the
ramp to fall rapidly
•
•
Fig 1
Fig 4
Tilt ramp until it is flat and level with the floor: Fig 4
Position stretcher/equipment onto ramp refer skill BC-3 and
lower to ground level ref skill BC- 3
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures.
Fig 5
Approved by:
Manager Education
July 2009
BC- 7
Ambulance Service of New South Wales
Page 1 of 1
Bariatric Care
Rear Cabin Double Width Chair
Indication:
When a Bariatric patient needs to be seated in the rear cabin
double width chair: Fig 1
Procedure:
•
•
•
Remove excess gear from around double chair and
reposition bariatric wheel chair it into locked position near
oxygen bay Fig 2
Lower Double width chair by unclipping wall locking harness
and lowering chair into floor locking mechanisms: Figs 3 & 4
Pull up on chair to confirm it is locked in
Fig 1
Caution: Ensure body parts do not get caught in locking
mechanisms
•
•
Apply seat belt harness
Consider seat belt extender strap and extra padding to
support patient comfort refer BC- 11
Fig 2
On completion of case:
•
•
•
•
Unlock double width seat floor lever
Raise the double seat until it is in the upright position and
connect the wall safety support line Fig 3
Tension the support strap by pulling on the buckle belt tail
Reposition and secure the bariatric wheel chair into its front
storage position
Fig 3
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures
Fig 4
Approved by:
Manager Education
July 2009
BC – 8
Ambulance Service of New South Wales
Page 1 of 1
Bariatric Care
Rear Cabin Climate Control
Indication:
Incidents where the rear cabin needs to be isolated i.e. CBR
incidents, patient and crew comfort
Note: The rear cabin Air conditioner and heater are completely
independent from the front of the vehicle Figs: 1 & 2
CBR Incidents
Mega Lift Operator is to take command and:
Fig 1
•
•
Undertake a risk analysis and consult with all personnel
involved
Ensure appropriate PPE and remove non essential
personnel and equipment
Note: If in doubt to what PPE level, seek advice from Fire Brigade
Procedure
• Close windows between front and rear cabins
•
Identify and advise team on usage of various control
features
•
Load the patient and refer skill BC- 3
•
If air conditioner fails, open up roof vent.
Fig 2
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures.
Approved by:
Manager Education
July 2009
BC - 9
Ambulance Service of New South Wales
Page 1 of 1
Bariatric care
Arterial line holder
Indication:
Securing arterial lines during transport
Procedure:
•
•
•
•
Position support holders on the side wall to line up with one
of the three positions; FIG 1
Lock Arterial bag into support holder by securing top first
Support central bag by wrapping Velcro support line around
arterial line
Ensure IV lines are not entangled
Fig 1
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures
Approved by:
Manager Education
July 2009
BC - 10
Ambulance Service of New South Wales
Page 1 of 1
Bariatric Care
Seat belt extension strap
Indication:
Patient requiring a seat belt extension strap
Procedure
Vehicle rear cabin single / double seats
•
Belts located in carry sheet bag or in storage locker, check
for damage Fig 1
•
Sit patient on forward facing seat if girth width can be
accommodated Fig 2
•
Attach extender safety seat belt and apply lap/sash belt
across patient Fig 3
•
Lock into apposing buckle
•
Ensure patient not rubbing against any objects, consider
extra pillows/blankets as padding for protection
Fig 1
Stretcher non electric.
Note: Seat belt extension strap only to be used when extra
girth width support is required
•
•
Fig 2
Apply bariatric stretcher harness to patient and
Apply seat belt extension straps to stretcher if required by the
following procedure:
supine/semi supine
•
•
•
Place one strap encompassing stretcher and patient at the
central chest line Fig 4
Place second strap encompassing stretcher and patient at
the lower pelvic region
Ensure seat belt is not tangled underneath stretcher
Fig 3
sitting patients
•
•
Place one strap encompassing stretcher and patient at lower
pelvic region Fig 4
Ensure seat belt is not tangled underneath stretcher
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures
Fig 4
Approved by:
Manager Education
July 2009
BC -11
Ambulance Service of New South Wales
Page 1 of 1
Bariatric Care
Bridge / Retrieval Platform
Indication:
Retrieval patients requiring a Bariatric stretcher coupled with a
medical retrieval bridge
Procedure
Preparing stretcher :
• Perform a physical walk through assessment of access and
egress between patient and Ambulance
• Unlock the two retaining pins of platform by holding pins in
open position: Fig 1
• Slide backwards to release and lift platform away from
brackets: Figs 2 & 3
• Identify platform footplates to join retrieval bridge to adapter
• Place and lock platform onto stretcher utilising the four
stretcher brackets, or Douglass tracking and confirm that it
is locked in
Fig 1
Fig 2
Transferring patient :
• Remove platform from Mega lift stretcher
• Transfer patient onto stretcher
• Connect platform / bridge to stretcher ensuring all leads and
attachments are secure: Fig 4
• Lock platform onto stretcher and confirm locked in position
and move patient to Ambulance
Note: Be mindful of overall Bridge height in lifts and doorways
Fig 5
Fig 3
Loading patient :
• refer skill BC -3
Unloading patient:
• refer skill BC -3
Caution:
• Assembled unit is extremely heavy
• weight is distributed towards the top and may over
balance
Fig 4
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures
Fig 5
Approved by:
Manager Education
July 2009
BC - 12
Ambulance Service of New South Wales
Page 1 of 1
Bariatric care
Energy Storage System Brake
Indication:
Require to use the Energy Storage System (ESS) braking on Hino
style Mega Lift Trucks
The ESS system is an automatic brake holding system similar to a
hand brake being activated
Activation:
•
•
•
•
Locate ESS switching system on dash board at right hand
side of steering wheel column: Fig 1
The ESS system has two switches
o Power on / off
o Slow / fast - indicates system reaction speed, hold
switch down to alter reaction speed
The system automatically activates when brakes are applied
at a complete halt
Can be used on incline starts, not suitable for flat or down
hill sloped starts
Fig 1
Note: When ESS applied, do not get out of the drivers seat as the
door alarms will be activated, It is not a fail safe mechanism
Deactivation:
To deactivate system either:
• Pull hand brake on
• Turn ESS power switch off
• Select first gear and disengage clutch
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures
Approved by:
Manager Education
July 2009
BC -13
Ambulance Service of New South Wales
Page 1 of 1
Bariatric care
Vehicle Remote Engine Throttle
Indication:
To provide constant vehicle high engine power to run the raising of
the rear patient ramp
Prepare the team / patient
•
Warn that engine noise will increase and communications
will be difficult due to increased noise
Fig 1
Procedure
Locate the remote engine throttle:
• Hino: outside face of rear cabin left hand side: Fig 1
• Mercedes Benz 2008 version: front cabin left hand side
Fig 2
• Mercedes Benz 2009 version: not fitted
• Apply hand break and place gear lever into neutral position
• Apply vehicle wheel chocks before starting engine
• Activate remote engine throttle
• Load/unload patient on ramp Refer skill BC - 1
• Disengage remote engine throttle
• Stop engine and engage first gear
Fig 2
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures
Approved by:
Manager Education
July 2009
BC - 14
Ambulance Service of New South Wales
Page 1 of 1
Bariatric care
Battery Isolator Switch
Indication:
To reduce the risk of flattening the master vehicle batteries
Locate isolator switch:
•
•
•
Hino - outside of rear cabin wall lower left hand face Fig 1
Mercedes Benz 2008 - front passenger vehicle left hand side Fig 2
Mercedes Benz 2009 – not fitted
Note: when the master vehicle isolator switches in the above vehicles
are activated, all radio’s are without power
Fig 1
Deactivating Battery Isolation Switch:
•
•
Hino / Mercedes Benz 2008 -Turn the master vehicle isolator
switch ON
Mercedes Benz 2009 - DISCONNECT 240v power lead Fig 3
Activating Battery Isolation Switch:
•
•
Hino / Mercedes Benz 2008 -Turn the master vehicle isolator
switch OFF
Mercedes Benz 2009 - CONNECT 240v power lead
Fig 2
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual handling
techniques and procedures
Fig 3
Approved by:
Manager Education
July 2009
BC - 15
Ambulance Service of New South Wales
Page 1 of 1
Bariatric Care
Motorola XTL 5000 GRN Radio
Indication:
Operation of two way GRN radio communications
Motorola XTL 5000 Quick Reference User’s Guide
XTL 5000 Radio Control Head
The picture demonstrates the
3
7
radio control head for the new
2
6
Motorola Digital XTL5000 GRN
4
radio.
1. Microphone Connector
5
2. Volume Control
8
1
3. Backlight function
Adjusts the level of
backlighting for the display
4. HOME button
This button displays the user
menu with a short press or changes the channel to FAULT RPT for reporting MDT faults to
SSU with a long press. The user then has to manually change the radio back to the original
operating channel
5. ON/OFF button
6. Channel selector
7. DURESS button. Note: Requires long press to activate.
8. Scroll button
XTL 5000 Display
Figure 2 shows the radio display when the 1 NTH OPS talk group is selected in the SYDNEY
zone. It is from this display that the following radio menus can be accessed.
A long press of the HOME button, 4, will take the channel to the 21 FAULT RPT channel used to
report MDT faults to the Systems Support Unit (SSU).
The following menu items are accessed from the radio Display in conjunction with the following
buttons:
9. Call button: CALL menu item. Used for private calling in conjunction with a keypad microphone
where fitted or a call list has been programmed into the radio. Can also be used to confirm the
radio’s ID number.
10. Receive signal strength indicator: RSSI Shows radio site selected and signal strength.
11. Zone button: ZONE. Allows user to change radio zones e.g. ADMIN, SYDNEY NORTHN,
WESTERN etc by rotating Channel Selector 6 (see Figure 1)
12. Channel button: CHAN. Allows user to change radio channels e.g. in the SYDNEY zone, from
1 NTH OPS to 2 STH OPS
ASNSW TELECOMMUNICATIONS
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BC - 16
Ambulance Service of New South Wales
Page 1 of 2
Bariatric Care
Motorola XTL 5000 GRN Radio
Changing Zones and Channels
The radio channels are separated into Zones as per the previous GRN radio.
Each area has a separate Zone that contains the radio channels for that area.
The channel names are the same as they were in the old GRN radios. The Zone names are
longer because the new radios allow the full zone name to be programmed.
To Change Zone
• Press the ZONE Menu button, 11
• The Zone Name, e.g. ASNSW ADMIN will flash.
• Use the Left and Right Scroll Button, 8, to select the desired Zone. For example
ASNSW SYDNEY or ASNSW NORTHN.
• Press the HOME button, 4.
To Change the Channel
• Press the CHAN Menu button,12
• The Channel Name, e.g. 1 NTH OPS (Sydney zone) or 1 NEWC OPS (Northern Zone) will
flash.
• Use the Left and Right Scroll Button, 8, to select the desired channel e.g. 1 NTH OPS
(Sydney zone) or 1 NEWC OPS (Northern Zone).
• Press the HOME button, 4.
Digital and Analogue Radio Channels
The current GRN network is an analogue trunked radio network. This network will be upgraded to
digital operation which will eventually support voice encryption for greater communications
security.
To accommodate the change to digital operation the new XTL5000 radios, and the XTS5000
portables, will be initially programmed with both analogue and digital channels.
The Digital Channels and Zones are identified with a capital D in the name.
For example there is an analogue zone for Sydney, called ASNSW SYDNEY, and a digital zone
for Sydney, called ASNSW D SYDNEY.
Likewise in the Emergency Services zone ESO there are analogue channels, like ESO CHAN 7,
which is analogue and digital channels, like ESO D CHAN 18.
The digital channels wont work until the GRN is migrated to digital operation. These channels
have been highlighted with a light grey background in the channel list to identify them.
Once the migration to digital operation has been completed all radios will be reprogrammed to
remove the redundant analogue channels.
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual handling techniques and
procedures.
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Ambulance Service of New South Wales
Page 2 of 2
Bariatric Care
Patient Slide
Indication:
To transfer patients between stretcher and bed
Two sizes are available; one full Bariatric width / length and two
half lengths Figs 1 & 2
If using half lengths you may require two units Fig 2
Fig 1
Prepare team / patient
•
Reinforce manual handle techniques
•
Explain procedure and reassure patient
• Refer to Manual Handling Skill BC-1
• Consider the use of Hovermatt refer skill BC- 19 or
Hoverjack refer skill BC- 18
• Prepare any IV fluids, IDC bags, ventilation equipment,
monitors and other medical equipment
Note: With bariatric patients, minimise the time that they are
supine due to orthopnoea
Fig 2
Transferring on slide
• Confirm that medical equipment is attached and operable
• Patient is rolled laterally allowing slide to be placed partially
underneath patient refer skill 111.7
• Ensure slide has a surface area that partially covers the
receiving bed and that no major gaps are present between
the two half slides
• Patient is rolled back to supine position and transferred
Transferring off slide
• Patient is rolled laterally allowing slide to be removed before
patient is rolled back to supine position
• Confirm that medical equipment is attached and operable
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures
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BC- 17
Ambulance Service of New South Wales
Page 1 of 1
Bariatric Care
Hoverjack
Indication
To lift patient from ground level to stretcher height Fig 1.
Can be used in conjunction with the HoverMatt
Procedure
Prepare
• Mega Lift Operator is to take command
• Ensure Hoverjack is attached to the motor and plugged in
Fig 2
• Ensure a paramedic is beside the patient at all times
Fig 1
Placing Matt
• Place Hoverjack on floor next to patient ensuring chamber
with “Inflation # 4” is on the top, and chamber with “Inflation
# 1” is on the floor Fig 3
• Ensure all red capped deflation valves are closed
• Roll Hoverjack up from either side
• Log roll patient onto side
• Place rolled up Hoverjack against patient
• Log roll patient to the supine position ensuring patient is
centred on Hoverjack and attach straps
Fig 2
Inflating Matt
• Inflate inlet valve #1 which is the chamber on the floor Fig 4
• When chamber #1 is fully inflated remove the hose. The
valve will automatically close maintaining inflation
• Follow the same process to inflate remaining chambers in
the successive order of 2, 3 and 4
• Turn off air supply and cap valves Fig 5
Fig 3
Deflating Matt
• Deflate the Hoverjack using red deflation valves in the
reverse order of 4, 3, 2 and 1 allowing each chamber to
deflate completely before moving to the next. Do not release
all chambers simultaneously
Fig 4
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures.
Fig 5
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Ambulance Service of New South Wales
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Bariatric Care
Hovermatt
Indication
To transfer patient from stretcher to hospital bed Fig 1.
Can be used in conjunction with the Hoverjack
Procedure
Prepare
• Mega Lift Operator is to take command
• Ensure motor is plugged in with 240 volt safety lead Fig 2
• Ensure a paramedic is beside the patient at all times
Fig 1
Placing Matt
Choice 1
• Place Hovermatt on stretcher prior to loading patient
• Lift patient onto Hovermatt on stretcher
Choice 2
• Roll Hovermatt leaving 300mm extension exposed
• Log roll patient onto their side Refer skill : 111.7
• Place Hovermatt under patient and log roll them onto it
Inflating Matt
• Connect motor to the Hovermatt using the connecting tube
Fig 3
• Place stretcher and Hospital bed close to each other
• Place a patient slide between the two beds refer skill: BC 17
Fig 2
Note: Check to see that the patient slide is rated to take
the patient’s weight. Consider using two patient
slides joined together
• Inflate Hovermatt by turning motor on
• Transfer patient over to other bed
Fig 3
Note: Pull Hovermatt across either head or feet first Fig 4
Deflating Matt
• Deflate the Hovermatt by turning off the motor
Secondary use
• Can be used in conjunction with Hoverjack
Note: Have one Officer holding onto Hovermatt head end
handles at all times
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures.
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Fig 4
BC-19
Ambulance Service of New South Wales
Page 1 of 1
Bariatric Care
Wheelchair
Indication
Where a bariatric patient requires to sit and mobilise (SWL 295kg)
Procedure
It is imperative that the ambulance be positioned safely during this
procedure in relation to oncoming traffic
Ramp style Ambulance
Removing Wheel Chair
• Remove bariatric wheel chair from storage position
Figs 1; 2; 3
• Remove via the rear ramp
• Open chair and ensure top locking arm is secured: Fig 4
Securing Loaded Wheel Chair
• Reposition attendant seat to forward locking position (2
person lift): Fig 5
• Reposition stretcher to side wall mounting (2 person lift)
• Secure front wheelchair straps to floor tracking
• Load patient and secure front straps to wheelchair (must be
through solid frame – not wheel spokes) Fig 6
• Chair is tensioned backwards and brakes applied
• Secure and tension rear straps
• Apply patient seat belt
Non-Ramp style Ambulance
• Ensure PPE (safety vest) worn and place reflective devices
on roadway either side of vehicle
• Open door and undo wheelchair locking support strap
• Raise wheelchair off the floor by activating the “Raise”
button located on the door
• Grasp the wheelchair swinging it clear of the vehicle
• Activate the “Lower” button located on the door
• Once lowered unhook the chair
• Open chair and ensure top locking arm is secured
• Close storage door and remove warning devices
Fig1
Fig 2
Fig3
Fig4
Note: The non-ramp style ambulance
does not cater for transporting
wheelchair patients, they must be
transported on the stretcher
Occupational Health and Safety:
Compliance with relevant infection
control, OH&S and manual handling
techniques and procedures
Fig 6
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Fig 5
BC-20
Ambulance Service of New South Wales
Page 1 of 1
Aeromedical Fixed Wing
Fixed Wing Airside Safety
Indications:
In situations when approaching a parked fixed wing aircraft
Approaching the aircraft:
Ambulance crews:
1. Remain within the ambulance vehicle at entrance to
airside driveway
2. Allow aircraft to park. Ensure aircraft engines are off and
beacon underneath aircraft turned off.
3. Remain parked until the aircraft doors opened (Figure 1) or thumbs up by the pilot
5 A rotating beacon on the underbody of the aircraft indicates the engines are still operating.
NB: the rotating beacon indicates the aircraft is about to start engines or they are shutting
down and the propellers are still rotating and it is unsafe to approach.
6 Turn on ambulance beacon before approaching
7 Approach aircraft from rear and park towards the tail of
the aircraft on the side of the aircraft door (portside).
8 Do not reverse vehicle into position unless guided by the
pilot.
9 Wear safety vests.
10 Leave appropriate distance between the aircraft tail and
wing to manoeuvre both the aircraft and road stretchers.
11 Stand clear of the aircraft wing and doors when assisting
with loading and unloading of the aircraft stretcher.
12 Never move forward of the wing.
13 When departing, drive towards rear of the aircraft. The aircraft engines will not start until the
vehicle is well clear.
14. Do not touch or place anything on the aircraft wing
Air Ambulance and ground crews:
1. Ensure aircraft engines are off
2. If pilot or engineer in the cockpit and the aircraft door is
closed, capture their attention before approaching.
3. Walk towards the rear of the aircraft.
4. If it is unavoidable and approaching from front, ensure
the cockpit crew have signalled for your movement. If
engines off, gently manoeuvre the aerleron, which will
move the steering.
NB: Do not move from safety until signalled.
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Aeromedical Fixed Wing
Fixed Wing Airside Safety
5. Walk in a large semicircle across the front of the wing span
6. When the aircraft is being backed into the hanger at Mascot, ensure the tug operator is
always in view (Figure 3)
7. Ensure all road stretchers and personnel are well clear of the aircraft until the tug operator
comes to a complete stop and then approach
8. Ensure room is left for the cargo door or the air stairs to be opened. (Figure 2)
9. Ensure air stairs are completely down before embarking the aircraft. Only one person on the
stairs at one time.
10. Ensure safety bar is in position on the cargo door before standing beneath the cargo door
Safety:
•
An aircraft must never be approached without the air stairs or the cargo door being opened
•
A closed aircraft that is occupied must never be approached without permission of the pilot or
engineer
•
A rotating beacon on the underbody of the aircraft indicates the engines are still operating.
•
The wing lockers must never be opened without knowledge of the pilot
•
Safety vests must be worn when airside to enhance visibility
•
All relatives must be escorted airside (on and off) under the direction of the flight crew.
NB: All airport tarmacs are restricted security areas.
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Ambulance Service of New South Wales
Page 2 of 2
Patient Monitoring Device
Propaq General
Indication:
To monitor patient vital signs.
Models and Functions:
VITAL SIGN
ECG
Non invasive BP (NIBP)
Invasive Pressure
Pulse oximetry
Mainstream CO2
Apnoea/breath rate
104
1 Channel 3 lead
Yes
Yes
Yes
No
No
106
1 channel 3 lead
Yes
Yes
Yes
Yes
Yes
Power:
1. Battery life ranges from 4 to 30 hours depending how
often NIBP ( non invasive blood pressure) is taken and if
ETCO2 (end tidal carbon dioxide) channel is in use
2. Aircraft 28 volt power can replenish the battery whilst the
aircraft power supply is available
Charging and battery life:
1. Charging from a flat battery takes 16 hours
2. Charging from a partially depleted battery takes less
3. <7.8 volts indicates a low battery and will deliver 1 hour
of 15 minutely BP’s (blood pressures)
4. >7.8 volts will give approximately 5 hours use
Display:
1. Up to three waveforms can be displayed at any one time on the 106 model
2. Other measurement will still be active but will be displayed in numeric form on the right side of
the monitor display
3. The device will automatically display ECG and invasive haemodynamic waveforms as a
priority.
4. To change the display of a hidden waveform press display and turn on/off specific channels.
5. The breath rate can be obtained with the use of the appropriate ECG lead or with ETCO2
measurements, which also displays apnoeas.
Changing mode:
1. Turn on Propaq
2. Machine will automatically self test and display
battery life
3. Will automatically default to adult mode
4. To change mode and alarms:
• Press setup
• Press more: will default to adult on the screen
• Press change
• Press neonatal or paediatric: this machine will ask you to check
• Press yes or no: will default to patient mode confirming your selection and alarms will
default to adult, paediatric or neonatal parameter
• Press main menu to return to display screen
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Ambulance Service of New South Wales
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Patient Monitoring Device
Propaq General
Changing alarms:
1. Press setup
2. Press alarms
3. Press limits: will default to first page.
4. Move cursor on the page by pressing next
5. Press up or down to change parameter
6. To change page on display screen press next page
until the correct menu is display and alter setting
7. Press main menu to return to main screen
Pre use check:
1. Check when disconnected from charging prior to collection in the equipment room
2. Turn on Propaq
3. Battery capacity will be displayed on the screen
4. Automatic default to adult mode and alarm settings
5. Check the standard leads and devices are in the zipper packs
• Adult NIBP cuff
• Child NIBP cuff
• NIBP lead with screw and cuff connector
• ECG cable
• Oximetry cable
• Oximetry probes: adult, paediatric and neonatal
• Temperature skin probe
6. Additional leads and devices gathered
• ETCO2 cable, sensor and disposable connection
• Multilumen invasive lines and cable
Post use check:
1. Returns leads and devices to zipper packs
2. Clean any contaminated leads and devices
3. Restock any standard devices into zipper pack that are being decontaminated or drying
4. Reconnect to power for recharging
Cleaning:
1. The machine and accessories can be cleaned with mild detergent in warm water.
2. Alcohol and solvents are to be avoided.
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Ambulance Service of New South Wales
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Patient Monitoring Device
Propaq Monitoring
Indication:
In situations where a patient’s diagnosis history
requires cardiac monitoring e.g. AMI, post syncope
Prepare the patient:
1. Explain to the patient what is about to happen
2. Switch on Propaq
Procedure:
1. Connect ECG cable to the Propaq
2. Attach monitoring cable to the monitoring electrodes
3. Propaq will default to lead II. ECG waveform will automatically
be displayed. Heart rate digital read out will be displayed
4. To change any settings press ECG/Resp
5. Alter any of the following:
• ECG size
• ECG lead
• Respiratory size
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Ambulance Service of New South Wales
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Patient Monitoring Device
Propaq NIBP
Indication:
1. All adult patients
2. Paediatric patients if indicated by history or symptoms
Prepare the patient:
1. Explain what you are about to do
2. Position patient
3. Remove clothing or restriction from selected arm
• Do not take BP on an arm with an arterio/venous fistula,
mastectomy, lymphoedema or haemophiliac patients
• Limited BP’s on patients with extremely low platelets unless
they are of high acuity
Method:
1. Connect BP hosing to the machine
2. Apply appropriately sized BP cuff
3. Turn on Propaq
4. Press NIBP. Screen will display manual/automatic mode
5. Press start. BP will be taken
6. Press auto/man menu to set mode if further readings required
7. Timed automatic readings can be taken by selecting interval.
Press interval until the correct timing is selected which is
displayed on the screen
8. Press Turbocuf for 5 minutely measurements
9. Remove cuff when completed
Occupational Health and Safety:
1. Soak BP cuff in warm soap water for 1 hour if contaminated or
patient is infectious
2. Ensure solution does not enter the hosing
3. Hang to dry
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Patient Monitoring Device
Propaq Oximetry
Indication:
In all patients in either intermittent or continuous mode.
Continuous SaO2 is indicated for:
• high acuity patients
• all neonates
Intermittent measurements are required:
• baseline on the ground
• top of ascent
• during ascent if the patient has oxygen or condition
alters
Prepare the equipment:
1. Explanation to the patient
2. Turn on machine
Method:
1. Attach oximetry cable to the left side of the Propaq
2. Select appropriate sized probe for the patient
3. Select appropriate sized site and clean if required
4. Use Coband to secure universal, paediatric or neonatal
probes to the patient
5. Waveform will be displayed on the screen depending on how
many waveforms have been activated. This oximetry
waveform is a low priority and may not be displayed.
6. A numerical value is displayed on the right lower corner of
the screen
7. Heart rate numerical value will be displayed in
the upper right corner of the screen
8. Press SpO2/CO2 to enter SaO2 menu
9. Press SpO2 to change waveform size. Several pushes on this button
will alter the size until an audible pulse rate is heard.
10. Press main menu to return to normal screen
11. Press setup to enter
• Alarm
• Waveform selection
• Trends
12. Press main menu to return to normal screen
13. Clean sensor after each use
Factors affecting accuracy of readings:
1. Poor perfusion of sensor site
2. Ambient light interference
3. Movement
4. Incorrect application
5. Nail polish or other material at selected site when sensor placed on digit
6. Vasoconstrictive inotropes
7. Oedema at site
Cleaning: Wipe transducer cable and box if contaminated or patient if an infectious disease or
suspected of same.
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Ambulance Service of New South Wales
Page 1 of 1
Patient Monitoring Device
Propaq- Invasive monitoring
Indication:
• All patients with arterial line in situ
• All patients with a CVP line that warrant an intermittent
measurement e.g.: significant haemorrhage
• Most high acuity patients that are high dependency unit
transfers
• Most intensive care transfers
• Patients on inotropes
Prepare the equipment:
1. Ensure the following equipment is collected
• Propaq 106
• Multilumen transducer cable
• Pressure bag
2. Test the transducer setup to ensure operational prior to
departing from base
Method:
1. For CVP or arterial pressure monitoring Connect transducer to
the transducer cable
2. Plug in the transducer cable into the Propaq machine into P1 or
P2 port if two channels are available.
3. The message NOT ZEROED will appear
4. To zero the transducer, open the stopcock to air and allow a
few seconds for the transducer to settle.
5. The zero menu should appear, if it doesn’t press Sensors, Inv.
Prs, More then Zero.
6. Zeroing should appear in the blood pressure numeric window.
7. A tone will sound and the word zeroed will appear.
8. Close the transducer stopcock.
9. If the transducer will not zero, check the stopcock is open and
that the cable connections are correct.
10. Press cancel and start again
11. To set the pressure channel, press Sensors, Inv. Prs, Label
format and Rescale.
12. Monitor access site and perfusion distal to the site hourly
13. Titrate intravenous fluids according to the patients range as
indicated by diagnosis and clinical condition
Waveforms:
1. The transducer must be zeroed before a
waveform will appear.
2. Once the zero reference has been made the
scales will automatically appear.
3. To display the waveform press Range
4. To see a larger version of the waveform or
reduce the scale press Rescale
Factors affecting readings:
1. Pressure bag deflating
2. Stopcock flow incorrect position
3. Incorrect multilumen transducer cable
selected
4. Access site occluded
Cleaning: Wipe transducer cable and box if contaminated or patient if an infectious disease or
suspected of same.
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Ambulance Service of New South Wales
Page 1 of 1
Patient Monitoring Device
Propaq- Capnography Measurement monitoring
Indication:
In all ventilated patients
Patients in CPAP with well fitting mask optional
This is a mainstream measurement of:
• End tidal CO2 (ETCO)
• Breath rate
• Apnoea
Prepare the equipment:
1. Ensure the following equipment collected
• Propaq 106
• Monitor cable & box
• Disposable inline airway adaptor
2. Test the transducer setup by inserting the cable into the Propaq
which will show CO2 display on the monitor screen.
Method:
1. Remove disposable airway adaptor, inspect the lumen and
window for integrity
2. Align the sensor over the adaptor and place together, the
sensor will snap into place. Do not force sensor into place.
3. To set the sensor into the endotracheal tube (ETT) push and
twist in larger end of the adaptor into the ETT
4. Position the sensor so it sits higher to prevent fluid collecting
within the sensor
5. Push and twist the smaller end of the adaptor onto the
ventilator circuit
6. Ensure no air leaks exist
7. Plug the transducer cable into the Propaq
8. Press:
• SpO2/CO2 button
• Then CO2 button
• Then range button to set desired waveform scale
9. The CO2 waveform is displayed
10. Breath rate and apnoea are also detected from the sensor.
Both settings have alarm limits that can be adjusted
11. At completion of the transfer place ventilator tubing into plastic
bag NEVER YELLOW. Dispose of disposable airway inline
adaptor if incompatible with the hospital equipment.
Waveforms:
• To select the speed of the waveform, press Response
• Select slow, medium or fast settings
Factors affecting readings:
1. Collection of fluid secondary to airway humidity occludes the
light sensor. To correct remove the fluid and place motorized
sensor at the highest point.
2. Poor waveform. Humidifier positioned between ETT and
motorized CO2 sensor. To correct, place CO2 sensor between
ETT and humidifier
Approved by:
Manager Education
September 2009
Cleaning:
• Wipe transducer cable
return to box to prevent
cable fracture
• Send contaminated
ventilator circuit to
rearranged CSSD for
sterilising
AM- 07
Ambulance Service of New South Wales
Page 1 of 1
Circulation Infusion Device
B/Braun Perfusor Compact
Indication:
To administer a continuous intravenous fluid or intravenous drug
infusion
Description of machine:
1. Source of power.
• Internal NiCd battery – operating life 10 hours
• Recharging time 10 hours.
• 4 AA batteries- operating life 80 hours
2. Main delivery system
• Controlled infusion device with built in alarm system.
• Accepts 20 or 50 ml syringes
• Minimum volume extension set 75-150mm
3. Controls
• A handle
• B function key
• C display panel
• D instruction card for use
• E syringe holder
• F locking lever
• Upper surface of case- codes for syringe brands
Method of use:
1. Draw up infusion and prime minimum volume extension set
2. Press on/off button. Machine will perform self test
3. Syringe size will be detected, and displayed as a numerical
code e.g. 54- Terumo 50 ml syringe.
4. To change syringe code, hold down syringe symbol and
simultaneously press C. The display window syringe and –00
will flash. Release all buttons then press C. Insert correct
numerical code for syringe brand and size.
5. Lock in primed syringe.
6. Connect to cannula
7. Press F and enter infusion rate.
8. The flow rate range is from 0.1ml/hr to 99.9 mls/hr.
9. Press start to commence infusion. Round wheel in upper left
corner of display window will rotate to indicate infusion in
progress
10. To alter rate.
• Do not stop infusion.
• Press C and enter new rate
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Ambulance Service of New South Wales
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Circulation Infusion Device
B/Braun Perfusor Compact
• Press F to confirm and new rate will commence
11. To administer bolus
• Press F and hold down simultaneously pressing BOLUS
• An audible signal will sound for each mil administered.
Bolus rate is at 800 mls/hr
• Press start to return to background infusion rate
12.
To cease infusion press stop
13.
To turn off press on/off key for 2 seconds
14. Occlusion.
Possible causes
• If back pressure occurs through a small gauge cannula,
butterfly needle or high infusion rate, the syringe plunger
may move backwards.
• Ensure line is not kinked
• IV may require a n/saline flush at the cannula hub
• IV cannula may need resiting
15. Alarms/ symbols
• ‘Σ’ selected volume has been administered.
• ‘→⏐’ volume preselection will stop when set volume is
reached
• ‘P‘ occlusion pressure the device will stop operating
• Syringe symbol with flashing black fluid level
3 minute before the syringe is empty.
• Battery capacity level flashing lower right corner
in display window. 30 minutes battery time remaining
• Rectangle and downward arrow symbol syringe
catch not engaged correctly
Cleaning:
Moistened gauze. No alcohol or solvents can be used.
Dispose of completed infusion set in contaminated waste or
garbage
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September 2009
AM - 08
Ambulance Service of New South Wales
Page 2 of 2
Infusion Device
Imed Gemini
Indications:
To administer a continuous intravenous infusion or
intravenous drug infusion
Description of machine:
1. Source of power
• Internal battery 5 hours at 125mls/hr
• Recharge time 10 hours on 240 volt
2. Aircraft power source
• 240 volt
3. Main delivery system
• The infusion is driven by peristaltic action against the
infusion set.
• Controller mode senses the pressure created by the height
of the fluid container and uses that pressure as an occlusion
pressure limit.
• Volumetric infusion pump mode the occlusion pressure limit
is internally set and dependent on the infusion rate.
• Delivery rate - micro rate 0.1-99.9 mls/hr
macro rate 1-999 mls/hr
• Requires a Alaris Gemini pump set.
4. Weight
• PC-1 single channel is 5 kg - PC-2 dual channel is 8 kg
Method of use:
1. Connect intravenous fluids to Gemini infusion giving set.
2. Connect Gemini to:
• stretcher bridge by tightening clamp to vertical pole and
secure with red bridge strap or,
• secure to aircraft ceiling Douglas track ensuring maximum
weight for entire track dose not exceed 8 kg.
3. Suspend intravenous fluid from stretcher bridge or ceiling
Douglas track
4. Prime giving set and remove all air and close roller clamp
5. Connect to intravenous cannula
6. Press power on - Machine will conduct self check
7. Open Gemini pump door and Insert primed giving set
• Top connector into recess above pump mechanism
• Place lower Flo-Stop fitment into recess below pump
mechanism with arrow pointing into pump
• Press tubing into air-in-line detector and close door
8. Press the channel select button on the primed side
9. Press rate button
10. Press white clear button to zero rate
11. Insert infusion rate by keying in yellow numeric values to
correct rate required.
• Range is 0.1 to 999mls/hr. Value is displayed on the LED
screen.
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Ambulance Service of New South Wales
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Infusion Device
Imed Gemini
12. Press volume to be infusion (VTBI) to set the volume for entire
infusion or an hourly volume
13. Press white clear button to zero
14. Insert VTBI by keying in yellow numeric values either for the
entire infusion or for the hour. The value will be displayed on
the LED screen
15. Open roller clamp
16. Press green start button to commence infusion
17. Select channel button on multiple infusion pumps.
• to pause infusion, press the orange pause/stop button
once.
• to recommence infusion, press green start button
18. To alter infusion rate, select channel button and press green
rate button
• Yellow rate of titration arrows. This will change infusion rate
by one mil, depending of the direction of the arrow or,
• Press numeric keys, which will alter rate by key select.
The options available are 100, 10 ,1 and 0.1 ml
• Press green start button to commence new infusion rate.
19. To stop infusion select channel button on multiple infusion
pumps press the orange pause/stop button twice.
20. To alter Volume To Be Infused (VTBI) select channel button
then press VTBI button
• Yellow rate of titration arrows. This will change rate by one
ml, depending of the direction of the arrow. or
• Press numeric keys, which will alter rate by key select.
The options available are 100, 10, 1 and 0.1 ml
• Press green start button to commence new VTBI
21. Alarms and error messages
• HELP INTERNAL ERROR. Pause and stop. Reinsert giving
set into machine. If message recurs needs biomedical repair
• INFUSION COMPLETE-KVO. Infusion is complete.
Change intravenous fluids. Re-enter VTBI
• LOW BATTERY. Connect to 240 volt
• LOW FLOW. Flow has slowed due to backpressure.
Check tubing for restriction and/or raise intravenous fluids.
• AIR IN LINE. Clear air from giving set and restart
• OCCLUDED PATIENT SIDE. Due to increased
backpressure, clear occlusion, check roller clamp and
restart unit
• OCCLUDED FLUID SIDE. Upstream occlusion sensed,
replace empty infusion bag and check vacuum in drip
chamber has released
Approved by:
Manager Education
September 2009
Clean Unit:
• Water moistened gauze
• Discard used infusion
sets into contaminated
waste bin
• Do not use alcohol or
solvents to clean unit
AM - 09
Ambulance Service of New South Wales
Page 2 of 2
Circulation Infusion Device
Terumo Syringe Pump STC Series
Indication:
To administer a continuous intravenous fluid or intravenous drug
infusion
Description of machine:
1. Source of power
• Internal battery approximately 2 hours
• Recharging time 15 hours
2. Aircraft power source
• 240 volt
3. Main delivery system
• Microcomputer controlled infusion device with alarm system.
• Accepts any 20, 30 or 50 ml syringe.
• Minimum volume extension set 75-150mm
Method of use:
1. Draw up infusion and prime minimum volume extension set
2. Lock in primed syringe.
3. Connect to cannula
4. Press power. Machine will perform self test
5. Syringe size will automatically be detected.
6. Alarm and digital flow rate display will sound.
7. Press FLOW RATE. Increase/decrease by holding down
up/down cursors. The flow rate range 0.1 ml to 150 mls/hr.
8. Press start to commence infusion.
9. To bolus, press stop. Hold down the purge button. The
machine has an audible indicator for each ml delivered, as well
as a digital numerical value in the flow rate display. Press start
to resume background infusion rate
10. To alter infusion rate, press stop. Increase/ decrease by
altering cursors on flow rate display window.
11. Press start.
Alarms:
1. Occlusion. Possible causes
• If back pressure occurs through a small gauge cannula,
butterfly needle or high infusion rate, the syringe plunger
may move backwards.
• Ensure line is not kinked
• IV may require a n/saline flush at the cannula hub
• IV cannula may need resiting
2. Nearly Empty. A small amount of solution remains in the
syringe.
3. Low battery. 5 minutes of battery life is left.
Approved by:
Manager Education
September 2009
Clean Unit:
• Water moistened gauze
• Discard used infusion
sets into contaminated
waste bin
• Do not use alcohol or
solvents to clean unit
AM - 10
Ambulance Service of New South Wales
Page 1 of 1
Circulation Infusion Device
Terumo Syringe TE Series
Indication:
To administer a continuous intravenous fluid or intravenous drug
infusion
Description of machine:
1. Source of power.
• Internal battery approximately 2 hours
• Recharging time 15 hours.
2. Aircraft power source
• 240 volt
3. Main delivery system
• Microcomputer controlled infusion device with alarm system.
• Accepts any 20, 30 or 50 ml syringe.
• Minimum volume extension set 75-150mm
Method:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Draw up infusion and prime minimum volume extension set
Lock in primed syringe.
Connect to cannula
Press power. Machine will perform self test
Syringe size will automatically be detected.
Alarm and digital flow rate display will sound.
Turn infusion rate dial on right side of syringe pump
The flow rate range is from 0.1ml/hr to 1200 mls/hr.
Press start to commence infusion. Round dial in centre of
machine will illuminate, indicating infusion is being delivered
and rate screen will flash volume remaining
10. Alarms
• Occlusion. Possible causes
• If back pressure occurs through a small gauge cannula,
butterfly needle or high infusion rate, the syringe plunger
may move backwards.
• Ensure line is not kinked
• IV may require a n/saline flush at the cannula hub
• IV cannula may need resiting
• Nearly Empty. A small amount of solution remains in the
syringe.
• Nearly Empty and Occlusion. Infusion complete.
• Low battery. 5 minutes of battery life is left.
• Er.1 or Er.2. Unit malfunction requires biomedical repair.
Clean Unit:
• Water or detergent as
required moistened
gauze
• Discard used infusion
sets into contaminated
waste bin
• Do not use alcohol or
solvents to clean unit
11. To bolus a volume, push stop then hold down purge button.
Audible alarm every ml delivered
Approved by:
Manager Education
September 2009
AM - 11
Ambulance Service of New South Wales
Page 1 of 1
Ventilation Device
Oxylog 2000
Indications:
To administer ventilation for interhospital transfers in the following modes
• IPPV (intermittent positive pressure ventilation) with variable inspiratory and expiratory tidal
volumes. Will deliver timed cycled ventilation 5-40 breaths/minute
• SIMV (synchronised intermittent mandatory Ventilation). A combination of mechanical
ventilation and spontaneous respirations.
Ventilator will deliver preset breaths if the patient makes no respiratory effort. Ventilator will
trigger with patients inspiratory effort
• Spontaneous breathing with either PEEP or CPAP. Can only be used if patient is
spontaneously breathing. Patient must have a minute volume greater than 2 l/minute
Oxylog 2000 is timed cycled, volume constant ventilator designed for transportation use
Description of the machine:
1. Power source- battery
• Internal rechargeable battery
• Batteries viable for two years only
• Batteries will remain charged for 6 hours unused
• Batteries will operate for 4-6 hours
• 10 minutes electrical supply remaining when alarm
displays Charge NiCd or Change Bat.
2. Power source- electrical
• Aircraft supply 28 volt
• Road vehicle 12 volt
• 240 volt recharge time 8 hours if completely
flat window display when charged
• In future retrieval bridges will have a converter
with the ability to charge at 12, 28 or 240 volt.
3. Power Source- oxygen
• Ventilator must be connected to oxygen supply
to function
4. Calculating oxygen requirements
• Calculate tidal volume (TV)
• TV= wt (kg) x 10mls
• Calculate minute volume (MV)
• MV= TV x respiratory rate
• Calculate oxygen requirements per hour
• Volume of gas supply divided by MV
• Divide by 2 if airmix
• Compare this to the length of the transfer time
• Example 70 kg patient at 12 breath/minute on 100%
• 70x 10 = 700mls TV
• 700x 12 = 8400ml or 8.4 L MV
• CD inhalo 630L divided by 8.4 = 75 minutes (1hour 15
minutes)
• Aircraft supply 3277L divided by 8.4 = 390 minute (6.5
hours)
Approved by:
Manager Education
September 2009
AM - 12
Ambulance Service of New South Wales
Page 1 of 3
Ventilation Device
Oxylog 2000
5. Ventilator controls – see diag numbers
1. On/off switch
2. Ventilation mode IPPV or SIMV/CPAP
3. Ventilation ratio left, setting of maximum airway pressures middle and PEEP right
4. Ventilation frequency left and tidal volume right
5. Airway switch
6. Alarm reset button
7. Digital display of expiratory minute volume and message alarms
8. Additional information button when held for 3 seconds. Test displays, light and alarm
9. Inspiratory/expiratory pressure gauge
7
8
6
9
5
4
3
2
1
6. Main delivery tubing
• Wide ventilator circuit connects the ventilator to the ETT
• Two fine flow sensor circuits and alarms runs adjacent to the main ventilator circuit.
Functions:
• Airway pressure
• Expiratory minute volume
• Electrical minute volume
• Electrical power supply
• Gas supply
Approved by:
Manager Education
September 2009
AM - 12
Ambulance Service of New South Wales
Page 2 of 3
Ventilation Device
Oxylog 2000
Method of use:
1. Connect ventilator circuit to machine
2. Dial up settings:
• Frequency in breaths per minute
• Tidal volume (Vt) in litres
• Air mix/no air mix
• Ventilation ratios (Ti:Te) inspiratory/ expiratory in
seconds
• Maximum airway pressures (Pmax) in mbar
• PEEP in mbar
• Select ventilation mode SIMV/CPAP or IPPV
3. Connect test lung to patient end of circuit
4. Turn machine on- will conduct self test and test lung will
ventilate
5. Functional test select the following:
• Frequency 12/minute
• Vt 0.5L
• Ti:Te 1:2
• Pmax 60 mbar
• PEEP 5 mbar
• Ventilation mode IPPV
6. Machine response should show:
• Self test
• SW version XX.XX
• Red alarm will briefly illuminate
• Audible alarm will sound twice
• Green light if on external power supply
• Self test OK after 6 seconds
• Test lung will ventilate
• Test peak airway pressures Paw:
• High Paw compress test lung
• Low Paw remove test lung alarm
should sound after 20 seconds
Decontamination:
After each patient has used the ventilator, the complete
ventilator circuit must be removed and placed in a
contaminated garbage bag and sent to local the
CSSD for sterilising.
Approved by:
Manager Education
September 2009
AM - 12
Ambulance Service of New South Wales
Page 3 of 3
Ventilation Device
Oxylog 3000
Indications:
1. To administer ventilation for interhospital transfers in the following invasive modes
• SIMV/PS (synchronised intermittent mandatory ventilation with pressure support). A
combination of mechanical ventilation and spontaneous respirations. The ventilator will
deliver preset breaths if the patient makes no respiratory effort. Ventilator will trigger with
patients inspiratory effort.
NB: this is the default ventilation mode of the Oxylog 3000.
• CMV Assist (controlled mechanical ventilation) or IPPV (intermittent positive pressure
ventilation).
Volume controlled ventilation with fixed mandatory minute volume (MV), set with tidal
volume and frequency. Indicated for patients with partial spontaneous breathing. Ventilation
will be synchronised with the patient’s spontaneous breaths
• CPAP/PS Continuous Positive Airway Pressure with pressure support. For patients with
adequate spontaneous breathing, provides with increased pressure to increase functional
residual capacity FRC. Pressure support can be added.
• PCV/ PS pressure controlled ventilation BIPAP/PS Biphasic Positive Airway Pressure. Used
for a range of patients without spontaneous respirations to those spontaneous breaths being
weaned before extubation
2. To administer non invasive ventilation during interhospital transfers.
• PCV/PS or BIPAP/PS with pressure support. Pressure controlled ventilation combined with
spontaneous breathing throughout the breathing cycle and variable pressure support. For
patients with mask ventilation
• CPAP/PS with pressure support. For patients with adequate spontaneous breathing
providing increased pressure to increase functional residual capacity FRC.
Pressure support can be added. For patients with mask ventilation
3. Minimum patient weight is 5 kg
Description of the machine:
1. Power source- battery
• Internal rechargeable battery
• Batteries viable for two years only
• Operating time approximately four hours
• Recharge time 4 hours if fully depleted
• Battery capacity displayed on screen in increments of
25%
• Spare battery should be taken from the battery charging
unit to ensure ample battery supply as there is no alternate
aircraft supply
• Battery slot located at the rear of the ventilator
2. Power source- electrical 240 volt
3. Power Source- oxygen
• Ventilator must be connected to oxygen supply to function
4. Weight
• 5 kg Oxylog 3000
• additional battery weight 410gms
Approved by:
Manager Education
September 2009
AM - 13
Ambulance Service of New South Wales
Page 1 of 6
Ventilation Device
Oxylog 3000
5. Main delivery tubing
• Wide ventilator circuit connects the ventilator to the ETT or
tight fitting BPAP/CPAP mask and head holster
Two fine flow sensor circuits and alarms runs adjacent to
the main ventilator circuit.
Functions:
• Airway pressure
• Expiratory minute volume
• Electrical minute volume
• Electrical power supply
• Gas supply
6. Calculating oxygen requirements
• Calculate tidal volume (TV)
• TV= wt (kg) x 10mls
• Calculate minute volume (MV)
• MV= TV x respiratory rate
• Operation time (minutes)
• Operation time = medical gas supply in litres divided
by (MV+0.5) l/min
• 0.5+ the gas consumption of the ventilator
• Gas consumption is displayed bottom left line of
information window in L/min
• The higher the FiO2 the higher the gas consumption
Approved by:
Manager Education
September 2009
AM - 13
Ambulance Service of New South Wales
Page 2 of 6
Ventilation Device
Oxylog 3000
7. Ventilator controls
1. LED screen:
• Row 1 ventilation mode alarm display
• Row 2 constant display of MV O2 %
• Row 3 Paw and auto alarm limits
• Row 4 constant display of gas consumption and battery capacity
2.
Alarm settings button
3. Setting for ventilation parameters on LED
screen
5. IPPV button
7. BIPAP button
9. Alarm silence button (2 minutes)
11. Inspiratory hold button
13. On/off button
15. Rotary dial
17. Pmax dial
19. Vt dial
21. Values display button
4. CPAP button
6. SIMV button
8. Red/yellow visual alarm indicator
10. Alarm reset button
12. O2 inhalation
14. Power supply light
16. O2 concentration dial
18. Freq. Dial
20. Curves display button
Method of use:
1. Connect ventilator circuit to machine
2. Connect white oxygen tubing to oxygen outlet or cylinder
3. Connect test lung to the patient end of the circuit
4. Press on/off button. The ventilator will conduct self test.
5. The default ventilation mode is SIMV/PS ( shown top left screen)
6. To change the ventilation mode, Press and hold down for three seconds the ventilation mode
button right of the LED screen. A yellow light will flash
intermittently, then become fixed once the mode has
altered. The selected ventilation mode will be shown in the
top left hand corner of the LED screen.
7. Select ventilation parameters (Dials below LED screen)
• Tidal volume (Vt) in litres
• Frequency in breaths per minute
• Pmax cm H2O
• Oxygen concentration
Approved by:
Manager Education
September 2009
AM - 13
Ambulance Service of New South Wales
Page 3 of 6
Ventilation Device
Oxylog 3000
8. Select settings button, located right of LED screen to alter LED screen parameters. These
parameters will automatically default for each ventilation
mode selected.
NB: both the values and setting headings will be
different for each of the ventilation modes.
9. Scroll rotary dial to highlight individual parameter. Press in
rotary dial to enter. Rotate dial to change setting clockwise
will increase the setting and anticlockwise will decrease it.
Press rotary dial inwards to confirm.
10. Add HME filter and ETCO2 to the patient end of the
ventilation circuit and connect to the patient
11. To shutdown the ventilator. Press and hold the on/off button for 3
seconds. The LED screen will prompt for confirmation.
To confirm press in the rotary dial button.
Ventilation modes:
1. SIMV/PS
• This is the default ventilation mode
• Will deliver a fixed mandatory MV, Vt and Freq.
• Patient can breathe between mandatory ventilation
strokes. Patient triggered breaths are indicated with an
asterisk on the top line of the LED screen
• Spontaneous breaths can be assisted with pressure
support (PS)
• Set ventilation parameters on the four dials below the LED screen for:
• Vt
• Freq.
• Oxygen concentration
• Pmax
• The following parameters are set on the screen and can be altered.
• Tinsp Inspiration time. 1.7
• Tplat 0
• PEEP 5cm
• PS 10cm
Press setting again for:
• Sensitivity Trigger 3
• Pressure rise time Ramp
Press setting again for:
• screen brightness
NB: reducing the screen brightness will prolong the battery life
2. CMV (IPPV) Assist
• Mandatory ventilation strokes are synchronised with the patient’s spontaneous breathing
efforts when the trigger is activated. An asterisk symbol will appear next to the IPPV Assist
display at the top of the LED screen when the patient breathes
• The trigger can be turned off deactivated if synchronisation with the patient’s respiratory
efforts is not required. To deactivate, press settings, rotate rotary dial.
Approved by:
Manager Education
September 2009
AM - 13
Ambulance Service of New South Wales
Page 4 of 6
Ventilation Device
Oxylog 3000
Default settings are:
• Ventilation mode CMV
• Trigger = 3L/min
• PEEP 5 mbar
• I:E = 1:1.5
• Plateau time Tplat = O%. this is the percentage of the inspiration time
Press settings again for:
• screen brightness
3. BIPAP and BIPAP/PS (PCV)
• Pressure controlled ventilation combined with spontaneous breathing throughout the
breathing cycle and variable pressure support.
• Set ventilation parameters below the LED screen for:
• The default settings are:
• Ventilation mode: PCV
• Tinsp 1.7
• Pinsp= inspiratory pressure 20
• PEEP 5
• PS 10
Press settings again for:
• NIV off. Turn on for patients with a NIV mask
• Trigger 3
• Ramp
Press settings again for:
• Screen brightness
4. CPAP and CPAP/PS
• Is for patients with adequate spontaneous breathing with increased pressure to increase
FRC. Pressure support can be added
• Set ventilation parameters below the LED screen for:
• The default settings are:
• Ventilation mode: CPAP
• Trigger 3
• PEEP 5
• PS 10
• Ramp
Press settings again for:
• NIV on. Turn off for patients for invasive CPAP
Press settings again for:
• Screen brightness
NB; Apnoea ventilation. In the event of apnoea in CPAP mode, this mode will
automatically switch over to SIMV
Approved by:
Manager Education
September 2009
AM - 13
Ambulance Service of New South Wales
Page 5 of 6
Ventilation Device
Oxylog 3000
5. Values
Button is located left of LED screen.
This menu will provide the actual values for a number of functions of the ventilator and the
ventilation mode selected. Not all values are displayed at once. Press the values until all the
readings are displayed. The values are on 5 pages.
Values for all ventilation modes are:
• PEEP
• Pmean
• Ppeak
• Pplateau
• MV spn
• F spn
• MV
• O2
• F
• Vte
NB; gas consumption in L/min and the battery life are continuously displayed at the lower
LED screen
6. Curves
The curves button is located left of the LED screen. When activated, the ventilation cycle will
be displayed as a positive or negative curve on the LED screen.
7. Alarm system
• Alarm button right top menu button will visually flash red or orange when an alarm is
triggered. An audio alarm is also triggered
• The red alarms are high priority
• The yellow alarms are either a caution or advisory
• In the event of multi alarm priorities, the highest priority will be displayed
• The alarm message will be displayed top line of LED screen.
• Correcting the fault will cancel the audio alarm and visual alarm can be cancelled by
pressing alarm reset button
8. 100% Oxygen
• pressing this button until the key lights up will provide 3 minutes of 100% oxygen to the
patient.
• Suggested uses for preoxygenation prior to suctioning and changing ventilators at the
receiving and referral hospitals.
Decontamination:
After each patient has used the ventilator, the complete ventilator circuit must be removed and
placed in a contaminated garbage bag and sent to local the CSSD for sterilising.
Disposable items are to be disposed through the yellow contamination bin
Approved by:
Manager Education
September 2009
AM - 13
Ambulance Service of New South Wales
Page 6 of 6
Aeromedical Fixed Wing
Oxiquant Oxygen Analyser
Indications:
1. Measures the oxygen percentage of the ambient atmosphere
2. Predominantly used for neonatal and preterm infant transfers
with the thermacot
3. To maintain an environment of 25% for all premature infants
that have documented chronic lung disease or required oxygen
for more than two weeks
Description of machine:
1. Source of power.
• Internal sensor compromised of a synthetic membrane and
two oxygen sensor electrolytes
• The measured gas diffuses through the membrane dissolving
through the electrolytes, which creates an electrical current to
produce a readout
• The sensor has a 2 year lifespan. The sensor must be
disposed into the yellow contaminated waste bin as it may
become corrosive
2. Controls
• LCD display shows oxygen concentrations between
• 0-100%
• Calibration buttons.
• On/off button
3. Components
• Oxygen analyser
• Jack plug
• Sensor
• T piece if connected to a ventilator circuit
Method:
1. Connect black jack plug to the oxygen sensor and screw
connection finger tight
2. Depress on button for 2 seconds to operate
3. To calibrate to 21%:
• Hold down 21% button on calibration panel until flashing CAL
occurs.
• It will automatically stop and display a digital readout of the
ambient atmosphere
• The reading should be 20.9% as ambient oxygen is 20.95%,
the analyser rounds down.
• Blue T piece only for calibration at 100% oxygen.
• This function is not required at Air Ambulance Service
4. Depress off button for 2 seconds to turn off.
5. Remove the jack plug from the sensor
6. Store all components in the carry case.
Factors affecting readings:
1. Humidity
2. Temperature
3. Ambient pressure
Approved by:
Manager Education
September 2009
Cleaning:
Wipe with damp cloth only.
Detergent and disinfectant
can be used. Electric shock
may occur if the cloth is
saturated
AM - 14
Ambulance Service of New South Wales
Page 1 of 1
Aeromedical Fixed Wing
IABP Lifting Device
Indication:
To lift the AutoCAT2 Intra Aortic Balloon Pump (IABP) from the
ground onto the stretcher lifting device (SLD)
Limitations:
1. The IABP is to be positioned close to the foot of the patient
stretcher with the cables positioned on the patient’s right side
(aisle side) during installation & removal (Figure 1). The
Retrieval Doctor or the Technician are responsible for
maintaining full view of the IABP cables at all times as the
Flight Nurses (FN’s) view is limited
Figure 1
2. The AutoCAT2 IABP is powered off 28 volt.
3. The patient stretcher is to be installed into the forward stretcher
position only.
4. The IABP-LD is only to be used for lifting AutoCAT2 from the
ground to the Air Ambulance SLD and visa versa.
5. The AutoCAT2 can only operate to a maximum cabin altitude of
10,000ft and flight altitude of 38,000ft.
Figure 2
Procedure:
1. Remove rear stretcher and aircraft chair stored in right hand
wing locker
2. The IABP Lifting Device (IABP-LD) is in three components:
•
the floor restraint (Figure 2)
•
lifting device (Figure 3)
•
inverter (Figure 2)
Figure 3
Install Floor Restraint:
1. Pilot or engineer to install the Floor Restraint into the rear
stretcher position. Install into RH seat track 4.5 holes pitch
forward of the rear stretcher restraint side brace (Figure 4)
2. Ensure that the openings on the latches face forward and the
lugs on the bottom of the floor restraint are correctly engaged
in the seat track.
3. The 2 seat track locking points are locked (Figure 5)
Figure 4
Install Inverter:
1. The inverter is installed onto the rear stretcher restraint.
2. Remove quick release locking pin on the inverter.
3. Push inverter onto existing rear stretcher retention latch and
lock
4. Install quick release locking pin
5. Connect inverter to the rear 28 volt power cable
Approved by:
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September 2009
Figure 5
AM - 15
Ambulance Service of New South Wales
Page 1 of 3
Aeromedical Fixed Wing
IABP Lifting Device
Assemble Lifting Device:
1. Open legs and install locking pins
2. Lock wheels
3. Attach lifting frame
4. Attach to 28 volt aircraft power
5. Unlock ground wheels
Lower lifting device to position lifting arms under the IABP and
load
Figure 6
7. Fasten a black belt around the body of the IABP and a second
black belt through the handle of the IABP.
To Load:
1. Pilot to set up the SLD and IABP-LD
2. Flight Nurse to connect IABP-LD to aircraft 28 volt power.
3. An Ambulance Officer is to embark the aircraft and to position
at the rear of the aircraft to assist with patient loading. The
Flight Nurse will coordinate the lift but will be directed by the
pilot who has full view of the stretcher and wheels. The
technician or doctor will monitor the patient cables.
Figure 7
4. The pilot will reposition the step ladder
5. The patient is loaded in the usual manner only to the mid front
aisle position. NOT FULLY INSTALLED
6. Pilot to lower SLD
7. Raise the IABP-LD to full height (Figure 6)
8. Flight Nurse and Ambulance Officer to slowly load the patient
Figure 8
9. Dr or technician manoeuvre IABP following down side of the
SLD
10. Pilot to raise IABP-LD to position the IABP over and onto the
SLD
11. Pilot to release the 2 black securing straps from around the
IABP
12. Pilot to raise the SLD to elevate IABP to the level of aircraft
floor
13. Ambulance Officer to disembark via airstairs.
14. The Dr or technician to follow IABP into the aircraft
Figure 9
15. Pilot to install IABP into rear stretcher position with lug (Figure
7) and locking pins. Figure 8 shows locking pin in locked
position
16. Connect IABP to the inverter to power off the aircraft 28 volt.
(Figure 9)
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September 2009
AM - 15
Ambulance Service of New South Wales
Page 2 of 3
Aeromedical Fixed Wing
IABP Lifting Device
Unloading:
1. Pilot to set up the SLD and IABP-LD
2. Flight Nurse to connect IABP-LD to aircraft 28 volt power.
3. Dr or technician to disconnect IABP power and disembark from
the aircraft.
4. Pilot to release IABP from the rear stretcher position (Figure10)
5. Pilot to roll IABP onto the SLD platform.
6. The Dr or technician to monitor the patient cables at all times.
7. Ambulance Officer to embark aircraft and remain at the rear of
the aircraft
Figure 10
8. Pilot to move ladder away from the SLD
9. Flight Nurse to unlock patient stretcher and with assistance of
the A/O move the stretcher to mid aisle.
10. Pilot to lower SLD then position the IABP-LD under SLD.
Attach black securing straps around the IABP & remove and
lower the IABP to the ground.
11. Dr or Technician to locate IABP to foot of SLD
12. Pilot to raise SLD
13. FN with the assistance of A/O to move patient stretcher onto
SLD.
14. Pilot to lower SLD
Figure 11
Stowage In Flight:
1. The lifting device is stowed in the RH wing locker for the flight.
Figure 11 shows LH wing locker
Occupational Health and Safety:
1. Compliance to ASNSW manual handling techniques.
2. No solvents are to be used on mechanical components of the
IABP-LD
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September 2009
AM - 15
Ambulance Service of New South Wales
Page 3 of 3
Aeromedical Fixed Wing
Child Seat
Indications:
Paediatrics weighing < 18 kg.
Prepare the equipment:
•
Obtain the child restraint seat.
•
Ensure the restraint is clean and undamaged
•
Check belts and attachments for signs of wear.
•
Ensure Douglas Track attachment is in the rear
pocket of the capsule
NB: Additional Douglas Track attachment is located in the right
lower drawer of the medical cabinet. This is available in the event
of obtaining a capsule at the referral airport, when diverted during
the course of the day.
Figure 1
Method of use:
Secure the car seat to the aircraft stretcher
1. The stretcher bridge can remain in position.
2. Undo the central abdominal aircraft blue stretcher harness
3. Place the capsule on the stretcher, at about the shoulder
position of an adult, so that the child seat is rearward facing.
4. Remove Douglas track black belt (extension set) from
rear pocket of the child seat
5. Attach the two clips of the extension set into the Douglas
track located on the aircraft floor at the front of the aircraft
stretcher.
Figure 2
6. Join the metal anchor hoop located at the rear of the child
seat to the metal clip on the Douglas Track extension belt Fig 3
7. Feed the blue abdominal belt through the base of the child
seat to minimise forward or lateral movement of the child
seat Fig 1
8. Remove slack from the Douglas track extension set
and the blue abdominal belt, ensuring there is minimal
movement of the child seat in all directions Fig 2
Approved by:
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September 2009
Figure 3
AM 16
Ambulance Service of New South Wales
Page 1 of 2
Aeromedical Fixed Wing
Child Seat
Secure car seat to rearward or forward facing aircraft seat:
1. Undo aircraft seatbelt
2. Place capsule on the aircraft seat
3. Remove Douglas track black belt (extension set) from rear
pocket of the child seat
4. Attach the two clips of the extension set into the Douglas
track located on the aircraft floor behind the aircraft seat.
5. Join the metal anchor hoop located at the rear of the child
seat to the metal clip on the Douglas track extension belt
6. Feed the aircraft seat abdominal belt through the base of
the child seat to minimise movement of the child seat.
(alternatively use the red belt to secure the child seat to the
aircraft seat)
7. Remove slack from the extension set and the aircraft
abdominal belt, ensuring there is minimal movement of the
child seat in all directions Fig 4
Figure 4
Secure the patient in the restraint:
1. Position the child seat in sitting, semi reclined or reclined position, by pressing in the blue
recline latch. The latch is located beneath the foot position on child seat.
2. Adjust the child seat restraint system by lifting the metal adjustment lever. The lever is located
in the leg area of the child seat under the padding.
3. Place the patient in the restraint
4. Place harness over the child’s shoulders and hips
5. Place the harness tongue in the buckle. Both harness tongues must be inserted into the
buckles at the same time
6. Adjust the black restraint system by lifting the lever and sizing to accommodate the child
comfortably.
Cleaning:
1.
2.
3.
4.
Clean with approved Ambulance Service of NSW cleaning solution
Contaminated padding can be removed and washed with detergent
Child seat harness can be washed with a liberal amount of approved cleaning solution
Hang out to dry/do not tumble dry
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual handling techniques and
procedures.
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September 2009
AM 16
Ambulance Service of New South Wales
Page 2 of 2
Aeromedical Fixed Wing
Communications and Headsets
Indications:
For communication in all NSW Air Ambulance aircraft
via a headset for a variety of features: Fig 1
• UHF radio linked to ASNSW
• VHF radio frequency 132.75Mhz linked to the MRU
• CDMA phone and Satellite phone
• ICS Intercom system allows communication between the flight
nurse and the pilot
Method of use:
1. Insert headset jacks are located starboard adjacent to the flight
nurses seat or the side panel adjacent to the aft passenger
seat on the port side of the aircraft. The headset plugs are size
dependent, the microphone jack will only go into the micro
phone slot. Fig 2
2. Position the microphone boom close to lips as possible. Boom
pivots 180 degrees, worn either to either left or right side of
head.
3. Hearing protection is not rated on the David Clark headsets
4. Select dial for either: Fig 3
• UHF
• VHF
• Satellite phone
• Next G
• ICS
5. For radio transmissions press PTT (press to talk) button on
panel. Leave a few seconds to open channel then speak.
Release PTT when finished otherwise channel remains open.
6. For phones dial number
7. Intercom converse with pilot
8. Adjust volume dial to suitable level to receive communications
9. Cockpit isolated blue button. If blue light is illuminated the pilot
has turned off the ICS, severing communication via the headset
between the flight nurse and the cockpit
10. Pilot (green) button will activate a light in the cockpit to alert the
pilot that the flight nurse wishes to gain their attention. The pilot
turns on the communication via the ICS, the isolation button will
not be illuminated when ICS open
11. Cockpit/mono switch will allow the flight nurse to hear ATC (Air
Traffic Control) when in cockpit position. In mono position the
flight nurse cannot hear ATC.
12. It is recommended that the flight nurse and pilot be in direct
communication for two critical phases of each sector. The
headset on and in the ICS position from start-up to cruise and
then descent to landing
13. Each flight nurse is issued a headset. In the event of using a
communal headset the boom is to be cleaned at the
completion of each flight with the a sparse amount of approved
cleaning solution
14. Headsets are to be offered an additional medical crew.
Figure 1
Figure 2
Figure 3
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures.
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Ambulance Service of New South Wales
Page 1 of 1
Aeromedical Fixed Wing
Oxygen Cylinders Securing Systems
Indications:
1. When additional oxygen/air (medical gas) is required.
2. When N.E.T.S require the use of the air cylinders
Procedure:
•
Place the O2 and/or air cylinder in the green canvas transport
bag by loosening the adjusters and placing the bottle in the
bag.
•
To secure the cylinder tighten the strap around the neck of the
cylinder.
•
Place the bottle between the seat track ensuring the neck of
the bottle faces aft and the webbing is over the bottle Fig 1
•
Ensure the bottle is positioned to minimise the risk of damage
with the regulator or cylinder neck
•
Lock all four male Douglas track fittings into the female
Douglas track Fig 2
Figure 1
Figure 2
•
After the return of the flight please return the used cylinder to
the relevant oxygen rack.
•
Remove the cylinder bag and store in cupboard.
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures.
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September 2009
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Ambulance Service of New South Wales
Page 1 of 1
Patient Monitoring Device
iSTAT
Indications:
1. Measurement of arterial blood gases (ABG’s) and limited
electrolytes and haematology
2. Venous measurement of blood gases and limited electrolytes
and haematology
Description of machine:
1. Components:
• i-STAT 1 analyser
• Martel Printer
• EG6+ cartridge: provides values of pH PCO2 PO2 Na K Hct
and calculated values of HCO3 TCO2 BE sO2 Hb
• Electronic simulator
2. Power Source
• Two 9 volt lithium batteries.
3. Cartridges
• Store between 2-8C. Keep a single cartridge at room
temperature for 5 minutes before opening the pouch
• Do not use after expiry date
Cartridge can be stored at room temperature for 2 weeks.
then discard
• Cartridge which has been at room temperature cannot be
returned fridge
• Use cartridge immediately after the pouch has been opened
4. Analyser
• Operating temperature range is 16-30 C
• Do not store in direct sunlight
Daily Check:
• Turn on
• Press menu for administration menu
• Press 3 for quality tests
• Press 4 for simulator
• Press Enter for operator ID
• Enter or scan simulator serial number located on the
simulator box
• Remove cap and insert the simulator into the cartridge port.
The simulator will lock and take 2 minutes to read
• View results on the analyser screen
• PASS should be displayed indicating i-STAT ready for use
• If FAIL is displayed, reinsert simulator. If FAIL is displayed a
second time machine needs service.
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Ambulance Service of New South Wales
Page 1 of 2
Patient Monitoring Device
iSTAT
Method of use:
• Handling edges at all times, remove cartridge from pouch
and place on flat surface.
NB: The upper surface of the cartridge contains a
calibration fluid, which can be easily damaged if not
handled from the sides at all times.
• Collect arterial or venous sample
• Slowly apply blood sample into the sample well on the
cartridge until the fill mark is reached
• Remove excess blood with tissue or cotton gauze
• Using the round tab, close the sample well cover until it
snaps into position
• Turn on analyser and place on a flat surface
• Press 2
• Insert cartridge by the base using the finger indentation
when prompted.
• Press enter three times
• Analysis takes approximately 2 minutes.
• NB: do not remove cartridge while in locked position
• as indicated at base of the screen
• Enter sample type (venous or arterial), patient’s
temperature and FiO2.
• Press enter until the parameters is highlighted and enter the
value
• Adjusted results will appear below the initial results
• Remove cartridge when cartridge lock message is no
longer displayed
• To print results point analyser towards the left side of the
Martel printer and press the print symbol on the analyser
• Turn off analyser
Cleaning:
The analyser and Printer case and display window can be cleaned
with a gauze pad moistened with service approved disinfectant.
Dry immediately
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures.
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September 2009
AM - 19
Ambulance Service of New South Wales
Page 2 of 2
Aeromedical Fixed Wing
EVAC Spinal Immobilising
Indication:
• Spinal injuries
• Multi trauma with long bone or pelvic fractures
Note: The application of an Evac mattress may not be appropriate
for all spinal injuries, refer to on call consultant for a final decision.
Description:
The EVAC mattress is a malleable foam filled mattress that can be
moulded around the patient to conform to their exact size,
preventing movement and ensure spinal stability
Figure 1
Contents:
• Carry bag
• EVAC mattress with lifting handles, fastening straps and clips
• Air suction device, hose and male adaptor
• Valve and cap
Method of application:
1. Open mattress and place on a bed with valve near the patient’s
head. Fig 1
2. Ensure all black straps are fully extended prior to the patient’s
placement.
3. Place a sheet on the mattress, as the patient will be easier to
move if the patient is Jordan Framed over. It also reduces
moisture build up, as the patient becomes sweaty secondary to
lack of air circulating once the mattress is suctioned. Fig 2
4. Ensure the patient’s cervical spine is secured with a hard
cervical collar. One person is made responsible for cervical
spine precautions during any movement of the patient.
5. Ideally either a Jordan Frame or scoop stretcher the patient off
and onto the mattress. Ensure only a sheet covers the patient
at this stage, as they often experience overheating due to lack
of air circulating when confined to the mattress. Blankets can
be used over the mattress for patient comfort. Fig 3
6. Apply any monitoring equipment prior to the patient being
confined in the mattress.
7. Ensure all bony prominences such as knees and ankles are
cushioned with pads, towels or a pillow. Ensure the body is
anatomically aligned including feet, which may become
extended during suctioning of the mattress.
8. Close all black straps and ease to size.
9. Ask one person to be responsible from moulding the mattress
around the patient’s head while it is being suctioned, if possible
place a towel halved length ways under the patients head and
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Figure 2
Figure 3
Figure 4
AM - 20
Ambulance Service of New South Wales
Page 1 of 2
Aeromedical Fixed Wing
EVAC Spinal Immobilising
roll the edges up to place around the patient’s ears. This
minimises lateral movement of the neck and protects the
patient’s ears. An alternative option is the use of the Ferno
head immobiliser. Fig 4
10. Remove black cap off the suction valve at the patient’s head.
Connect to wall suction or hand pump. Remove air until the
mattress is firm and the patient’s head and spine is well
secured.
11. Check distal limb circulation.
12. Ease black straps over the patient Fig 4,5,6,7,8
13. Secure the cap over the suction portal.
14. Ensure the hand pump is accessible throughout all stages of
transport.
Figure 5
Method for removal:
1. Position the patient on the bed at the receiving hospital.
2. Undo black straps and remove suction cover and partially
unscrew the suction valve until air enters and softens the
mattress
Figure 6
3. Using full spinal precautions Jordan Frame or scoop stretcher
patient. At least six people are required to manually lift:
•
One person is responsible for the patient’s neck and coordinate the lift
•
Two people on each side of the frame
•
One person to remove the EVAC mattress from the foot of
the bed
4.
Alternatively use a Henry Lifter
5.
Lower the patient
Figure 7
Cleaning:
Moistened cloth with Ambulance Service of NSW approved
disinfectant
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures.
Approved by:
Manager Education
September 2009
Figure 8
AM - 20
Ambulance Service of New South Wales
Page 2 of 2
MRL
Non Invasive Blood Pressure
Indications:
• Patients if indicated by history or symptoms
Prepare the patient:
• Explain procedure
• Position patient
• Remove clothing or restriction from selected arm
• Do not take BP on arm with arterial/venous fistula,
mastectomy or limb trauma
• Limit BP's on patients with extremely low platelets
unless they are of high acuity
Method:
• Apply appropriately sized BP cuff
• Artefact can be minimised by requesting the patient
to keep their arm still
• Start/stop NIBP depress button left of NIBP window.
(Fig 1)
• Mode last used will be displayed in the BP window,
either Auto, Manual or Stat
• To change mode:
• Press NIBP (Fig 2)
• Select mode auto, manual or stat (Fig 3)
• If auto selected, press up or down cursors
until correct time selected
• Press exit to hide sub menu
• Stat setting repeats one NIBP every 5 minutes.
• The reinflation pressures will self adjust to 30 mmHg higher
than the last systolic reading. Press stop to cancel stat
setting. The NIBP will remain in standby mode. Then
change out of stat mode.
• Alarm icon and flashing reading indicates alarm limits
exceeded only if alarms have been set. To alter alarm
settings:
• Press next
• Press alarms
• Select NIBP
• Alter alarm settings
• Press exit to hide sub menu
• When complete clean & loosely coil tubing and place in
storage pocket
Fig 1
Fig 2
Fig 3
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures.
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September 2009
AM - 25
Ambulance Service of New South Wales
Page 1 of 1
MRL
Invasive Monitoring
Indications:
• All patients with arterial line insitu
• All patients with a CVP line that warrants an intermittent
measurement
Prepare the equipment:
1. Ensure the following equipment is collected
• MRL IBP cable
• Multilumen transducer cable
• Pressure bag
2. Test the transducer setup to ensure operational prior to
departing from base
Method:
• The MRL IBP has the ability to measure arterial and
• central venous pressures
• Two invasive monitoring lines are available on the
• LCD display window
• Attach IBP adapter to the MRL
• Attach the transducer to the cable and select correct cable
on the multilumen box
• To set up:
• Press IBP left side of LCD screen Fig 1
• Press IBP1 or IBP2
• Press enable
• Press IBP1 or 2 setup Fig 2
• To zero the transducer
• close transducer to patient
• open venting stopcock
• Press zero 1 or 2 for the channel selected Fig 3
• --- will appear followed by reading of 0
• open transducer stopcock to patient waveform
• and pressure reading should be displayed
• Name the channel ART or CVP
• Titrate intravenous fluids according to the patients
range as indicated by diagnosis and clinical
condition
Waveforms: Fig 4
1. The transducer must be zeroed before a waveform will
appear.
2. Once the zero reference has been made the scales will
automatically appear.
• To alter scale:
• Press scale until correct settings appear
• Press back
• Press exit to hide sub menu
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2009
Fig 1
Fig 2
Fig 3
Fig 4
AM - 27
Ambulance Service of New South Wales
Page 1 of 2
MRL
Invasive Monitoring
Factors affecting readings:
1.
2.
3.
4.
Pressure bag deflating
Stopcock flow incorrect direction
Incorrect multilumen transducer cable selected
Access site occluded
Cleaning:
Wipe transducer cable and box if contaminated or patient if an
infectious disease or suspected of same.
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures.
Approved by:
Manager Education
September
2009
AM - 27
Ambulance Service of New South Wales
Page 2 of 2
MRL
Defibrillation - Paddles
Indications: (manual external paddles)
1. Ventricular Fibrillation (VF)
2. Wide QRS tachycardia (VT) with a monitored rate >180, unconscious and poorly perfused
with impalpable peripheral pulse
Method:
1. Confirm diagnosis
2. Prepare chest, apply conductive defibrillation pads:
Adult and Children >6 years of age
Children < 6 years of age
Below right clavicle
Anterior left chest
Lateral to the apex of the heart
Posterior left chest
3. The defibrillator paddles to be connected.
• Slide the adaptor into the track to install the paddles
• Click release button into place
• For children under 10kg attach paediatric multipurpose paddles over the standard
defibrillator paddles
4. MRL PIC defibrillator joules is set to default to adult mode of 150 joules.
5. Change joules for paediatric patients under 15 years of age:
Age
Shocks
> 15 years of age
150 joules all shocks
< 15 years of age
4 joules/kg
•
Select the correct amount of joules Energy Select 1 on
the front of the MRL by selecting the cursor up or down,
OR
• Select Energy 1 on sternal paddle to dial up the correct joules
6. Charge the defibrillator by selecting:
• Charge button 2 on the front of the MRL, OR
• 2 on the apex paddle
7. An audible tone periodic will sound while charging, changing to
constant when charged. A solid bar graph will be displayed on
the screen in the joules as a visual guide.
8. Confrim shockable rhythm, ensure everyone is clear before the
shock is administered
9. Press both paddle discharge buttons simultaneously to defibrillate.
10. Repeat steps 6-9 to deliver a cluster.
11. The defibrillator will disarm after 1 minute on standby.
Note: Press Disarm button if energy is no longer required
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MRL
Defibrillation - Paddles
Recording
1. Each time the defibrillator is discharged the printer will run for 12 seconds providing
4 seconds pre-shock rhythm and 8 seconds post-shock rhythm
2. Print a summary for the patient record:
• Press next, Press recorder
• Press log, Press print log
• Press clear log at the end of the transfer to clear the MRL memory
• Press exit to hide the sub menu
Testing the Defibrillator
1. Conduct weekly
2. Attach paddles
3. Turn MRL on
4. Charge defibrillator to 200 joules
5. Place paddles against the test wells on the sides of the battery charger unit
6. Discharge the defibrillator when charge complete
7. A red test defibrillator light at the back of the charger should flash indicating that 200 joules
was achieved
8. Cross check the amount of joules delivered on the lower right corner of the LCD screen
9. Initial and date a sticker. Apply to front of MRL
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual handling techniques and
procedures.
Approved by:
Manager Education
September 2009
AM - 28
Ambulance Service of New South Wales
Page 2 of 2
MRL
Defibrillation - Pads
Indications: (manual hands free)
1. Ventricular Fibrillation (VF)
2. Wide QRS tachycardia (VT) with a monitored rate >180,
unconscious and poorly perfused with impalpable peripheral
pulse
Method:
1. Confirm diagnosis
2. Prepare the chest, apply adhesive pads
Adult and Children > 6 years
Children < 6 years of age
of age
Below right clavicle
Anterior left chest
Lateral to the apex of the heart
Posterior left chest
3. Not suitable for children under 10 kgs. Use
paediatric defibrillation paddles instead
4. Connect to hands free adapter, locked at defibrillator
position, by joining the arrows on the leads (Fig 1)
5. Select correct joules by pressing Energy Select button 1
(Fig 2) (MRL is set to default to 150 joules)
6. Change joules for paediatric patients under 15 years
of age:
Age
Shocks
> 15 years of age
150 joules all shocks
< 15 years of age
4 joules/kg
7. Press Charge button 2 (Fig 3)
8. When steady tone heard, warn everyone to stand clear,
visual check
9. Press Red button on hands free adaptor to discharge (Fig 4)
10. Repeat steps 7 - 9 to deliver cluster
11. Commence CPR for two minutes
12. Check carotid pulse and monitor rhythm
13. The defibrillator will disarm after 1 minute on standby.
Note: Press Disarm button if energy is no longer required (Fig 5)
Recording:
1. Each time defibrillator is discharged the printer will run for 12
seconds providing 4 seconds pre-shock and 8 seconds postshock rhythm
2. Print a summary for the patient record:
• Press next, Press recorder
• Press log, Press print log
• Press clear log at the end of the transfer to clear the MRL
memory
• Press exit to hide the sub menu
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures.
Approved by:
Manager Education
September 2009
Fig 1
Fig 2
Fig 3
Fig 4
Fig 5
AM - 29
Ambulance Service of New South Wales
Page 1 of 1
MRL
Transcutaneous Pacing
Indications:
1. Complete heart block with a monitored rate < 50,
decreased level of consciousness, poorly perfused
and not responding to protocol management
2. Transvenous pacing with unresolved
biomedical pacing failure
Method:
1. Monitoring leads must be connected.
• Select a lead which provides the greatest amplitude
QRS complex by adjusting the menu on the right
side of the MRL.
• Adjust the size of the complex to ensure optimal
sensing of the patients heart rate, confirmed by
the heart rate window
2. Expose the chest
3. Apply self adhesive pads below right clavicle and anterior left
chest below the nipple.
4. For paediatric use over 10 kg. Placement of the right
self adhesive pad can be to below the right scapula or
below left scapula.
5. Connect to hands free adapter, locked at defibrillator
position, by joining the arrows on the leads (Fig 1)
6. Turn on pacer by pressing the on/off button, an orange light
illuminates next to the switch indicating the pacer is stopped in
standby. No pacing pulses are being delivered to the
patient (Fig 2)
• The mode of pacing defaults to demand pacing.
The pacer will deliver pulses to maintain heart rate at
preselected rate (Fig 3)
• Press the mode button once to change to asynchronous.
This will deliver pacing pulses at a set rate
7. Press up or down arrows to select the desired pacing rate
(Fig 4)
9. Press start/stop button to initiate pacing (Fig 5)
• The orange light will turn green
• Each time pacing pulse is delivered, the green
light will flash off briefly
10 Press output button (Fig 6)
• Output rate measured in milliamperes (mA).
• The machine will default to the lowest output setting to
prevent a high current being delivered.
• Press arrow up or down
• Up arrow will increase by 10 mA.
• Slowly increase output current while observing the
monitor for electrical capture.
• Verify mechanical capture by monitoring the patients
physiological status, including:
• Skin perfusion
• Palpable pulses
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September 2009
Fig 1
Fig 2
Fig 3
Fig 4
Fig 5
Fig 6
AM - 30
Ambulance Service of New South Wales
Page 1 of 2
MRL
Transcutaneous Pacing
• Improved LOC
• Improved blood pressure
• Down arrow will decrease by 5 mA. Select the lowest output
current that will achieve both electrical and mechanical
capture.
• To pause the delivery of pacing pulses briefly, press the
start/stop button. The rate and output settings keyed in will
remain unchanged. To resume press start/stop button.
8. Consider analgesia or sedation should the pacing
become uncomfortable for the patient
9. In the event of defibrillation, once the defibrillator
is charged, the pacing activity will automatically
turn off for safety reasons.
Occupational Health and Safety:
Compliance with relevant infection control, OH&S and manual
handling techniques and procedures.
Approved by:
Manager Education
September 2009
AM - 30
Ambulance Service of New South Wales
Page 2 of 2