Step by Step Medical Care that is provided to the Person On Board in an Ambulance

AOCEmergency healthcare services provide essential medical care to patients aboard in an ambulance that is rerouted to the hospital. They are often regarded as Emergency Medical Services (EMS) or Paramedic Services. EMS provides out-of- hospital medical aid or interim support with definitive care facilities while transporting patients suffering from illness or physical injuries.

EMS has evolved a long way from merely being a transport agent for ailing patients. The primary goal of EMS is to ensure that crucial preliminary medical care for moving patients is dispensed on time. Thus, during health-related emergencies, the present symptoms of the patient are satisfactorily handled during transit before moving them to more sophisticated points of care. This is crucial in life saving situations and for preventing permanent organ damages/impairments.

Today, Ambulance with Medical Facilities are reasonably equipped with healthcare equipment and trained paramedic staff to prevent fatalities. The fundamental medical equipment in ambulances includes stretcher, a first aid kit with antiseptics, sterile wipes, bandages, gloves, syringes and needles, cardiac monitor, oxygen cylinder, basic maternity and burn kits, cold packs and communication devices for interacting with the care points (hospital). Paramedics are professionals who trained in pre-hospital care and cater to the patient’s needs in the ambulance.

Ambulances with dedicated facilities are also available for seniors, pregnant women and children. Specifically, Ambulance services for adults are equipped with state-of-art medical devices to handle any kind of health exigencies and provide optimal stabilization of patients to ensure best outcomes. The levels of care provided may be categorised into

  • Basic Life Support (BLS)
  • Advanced Life Support (ALS)
  • Critical Care Transport (CCT)

The step-wise medical care dispensed to ambulance patients may be enumerated as follows:

  • Evaluating the patient’s medical needs: The first and most important step is the evaluation of the medical needs of the sick or injured person. This must be done accurately, efficiently and quickly by the paramedic staff as it could lead to life and death situations. If the concerned patient requires further treatment, he/she is shifted to the ambulance using a stretcher or wheel chair depending upon their physical condition. The ambulance staff ensures that the patient is comfortable, handled cautiously, strapped up correctly and covered by a blanket.
  • Monitoring the vital parameters: All the vital parameters of the patient, including consciousness levels, respiratory capabilities, pulse rate, blood pressure and sugar levels are examined. Oxygen masks are provided for patients with breathing difficulties and saline drips may be provided for stabilisation.
  • Assessing the patient: The patient is subsequently assessed by the paramedics for nature of treatment required by doing a physical examination and making an appropriate diagnosis. Intermediate medical intervention may be undertaken like monitoring and administering medication, dressing wounds/injuries, doing intravenous infusions and giving pain relief medication.
  • Handling specialist care: In events of health crisis, paramedics may resort to usage of emergency equipment like   ventilators, defibrillators or procedures like cardiac resurrection and tracheotomy to revive the patients.
  • Determining the appropriate healthcare facility or suitable hospital: This is done to ensure further course of treatment is given adequately based on the patient’s condition.
  • Documenting a Patient Report: The paramedics make a detailed patient report based on the patient’s symptoms, history of ailments (if any – using previous medical records or getting information from family members), treatment dispensed in the ambulance and diagnosis made. This helps in easy takeover by concerned staff once the patient is shifted to the hospital.
  • Briefing the hospital staff and patient handover: On arrival at the hospital, the paramedics safely move the patient from the ambulance to the emergency unit. The physicians are updated on health status and treatment given along with patient reports to ensure the safe handover.

 

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Demand for Non-Emergency Ambulance Service

A recent study has revealed that the total population in India would increase at a rapid pace during the period between 2000 and 2033. As a result, the estimated number of senior citizens will increase by 21%. It is a clear indicator, as we need to gear up in offering utmost medical care for them. One of the effective ways in providing adequate medical treatment for the elderly is to schedule regular appointments with the doctor via non-emergency medical transportation or in short NEMT.

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Most of the senior citizens are facing huge challenges in traveling to longer distances through standard vehicles such as private buses and cars. It is during this period of time where non-emergency ambulance services come into the scene. They will be well equipped with ultra modern medical equipments including oxygen cylinders. The senior citizens will be escorted to their desired location by a team of highly skilled health care professionals and paramedics.

What is meant by the term non-emergency medical transportation?

A non-emergency medical transportation is specially designed to provide comfortable means of transportation of those individuals who are suffering from chronic diseases and mobility issues. The customer services include escorting or transporting a patient back and forth from a health care center. The non-emergency ambulance, which is operated by a professional driver, is well equipped with all basic facilities needed for a patient.

What are the hidden challenges for a non-emergency medical transportation?

As the population across the globe is increasing at an alarming rate, the need for non-emergency medical transportation has become a necessity in our daily life. It is very hard to imagine without the presence of such kind of medical transportation in case of non-emergencies. It has emerged as one of must required medical need, especially amongst the senior citizens and those people who are facing severe health issues.

Owing to time constraints, most of the people wish their parents be transported or escorted to a desired location with the help of non-emergency medical transportation. Most of the people who are raising their kids do require the support of non-emergency ambulance services. It is very essential to keep them physically fit, safe and secure.

Types of non-emergency medical transportation

The non-emergency medical transportation comprises of both private as well as municipal operators, which offer transportation via road and air. They are primarily utilized only in non-emergency circumstances. Both these modes of transportation consist of state-of-the-art life saving medical equipments, which is accompanied by a team of highly qualified doctors as well as nurses.It is an ideal mode of transportation for those people who are below the poverty line and have limited access to various health care clinics and hospitals.

At present, the demand for non-emergency medical transportation is increasing due to rise in population and as a result, this kind of medical services has become a necessity in everyday life of an individual. People who are suffering from chronic diseases requires this mode of transport.

The Different Types of Medical Transportation

The role of medical transportation becomes very significant in an emergency situation, but the non-emergency transport services are equally important for certain population like elderly, people who could not take part in log-distant journeys, or people residing in areas where transportation remains a challenge. In a developing country like India, such situations are common.

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What are the modes of medical transportation?
The mode of medical transportation depends upon the type of service required that is emergency or non-emergency.
Below is a look at some of the different options in this wide-ranging service:

Road Ambulance
Road ambulance is used to transport patients in emergency situation who need immediate medical care and patients who have psychiatric conditions. Ambulances are equipped with paramedical staff trained in providing immediate care. It’s used to transport patients to hospitals during emergencies and to transport patients with psychiatric conditions.

Non-Emergency Ground Ambulance
These are the perfect mode for patients who can walk but are not well and also for patients who are physically impaired. Non-Emergency ground services also serve a good medium for people who need some travel assistance/supervision but does not need the care level of any emergency. These vehicles are equipped with all of the necessary tools required to make your ride comfortable and to provide you with a limited amount of medical care to and from the medical facility. Ambulances for transportation are staffed by trained medical professionals that are accustomed to assisting patients with a variety of different ailments and medical conditions.

Wheelchair Accessible Vehicles
These vehicles can be used by people who are wheelchair bound. Having lifts facility, they ensure that you and your wheelchair arrive at your final destination safely. With the use of an electric lift, the patient can be loaded while they are seated in the wheelchair and remain in the wheelchair for the trip.

Air Ambulance
Air medical dispatch is used to move a patient in emergency needs by an aircraft. It acts as a life saver for people seeking immediate medical care residing in remote areas or in urban areas where medical facilities are not adequate. The air ambulance transfer exposes the patient to additional risks besides involving huge expenses. There should be at least two competent care providers with the patient depending upon the critical care need of the patient.

Non-Emergency Air Ambulance
Used for domestic and international travel, this mode is best suited for patients who are in stable condition, but needs fairly involved transportation assistance and cannot for one reason another use ground transport.

Guidelines for Air Ambulance Medical Dispatch

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What is Air Medical Dispatch?

Air medical dispatch is used to move patient in emergency needs by an aircraft. It acts as a life savior for people seeking immediate medical care residing in remote areas or in urban areas where medical facilities are not adequate.
Air medical dispatch involves a number of risks for the patient that may lead to worsening of the patient’s health status; hence, the discretion for air ambulance need should always be justifiable. There are standard International guidelines for air medical dispatch which is quite difficult to be followed in India mainly due to lack of standardization in medical care across the country. Nevertheless, there are some key guidelines that must be followed while implementing air medical dispatch.

Decision for air medical dispatch

As already discussed, the air ambulance transfer exposes the patient to additional risks besides involving huge expenses. This decision is usually done after an in-depth discussion within the hospital team and the family members.

Stabilization of the patient and adequate preparation for transfer

Before prosecuting any air transfer, it is very important to have the patient into a clinically stabilized condition. This reduces chances of any untoward medical event in the course of journey. Adequate preparation should be done to provide all the resuscitation facility required as per the patient’s condition including ABCDE approach or airway, breathing, circulation and disability approach to treat the patient.

Accompanying the patient

There should be atleast two competent care providers with the patient depending upon the critical care need of the patient. The following guidelines have been laid down to ensure complete safety of the patient:
Level 0: These patients are equivalent to hospital ward patients and do not need to be accompanied by any specialized person.
Level 1: These patients have chances of deterioration in their health condition during the transfer. An acute ward setting is required and they must be accompanied by a competent paramedical staff or a nurse.
Level 2: These include those patients who have single organ failure. They should be under complete observation of competent personnel during the transfer.
Level 3: These are highly critical patients requiring respiratory support and have witnessed two organ system failure. Such patient can only be transferred along with a competent doctor, nurse and paramedical staff.

Continuous Monitoring of the patient

It is very important to continuously monitor the patient and keep the craft equipped with the lifesaving drugs and equipment for resuscitation. This includes all patients within level 1, 2 and 3 critical care. A proper monitoring with the provision of all lifesaving drugs is mandatory for transfer of all patients with level 1, 2 and 3 critical care needs.

Patient Record or documentation

Proper record or documentation should be done for each and every step of the process. Since, this document may be required in case of any legal issues related to the air transfer, all details pertaining to the patient’s status and other details like reason for air dispatch, details of the referring doctor, details of the referred doctor or hospital, any adverse event during the transfer and the treatment given for that; all should be clearly documented.

Temperature

The inside of the aircraft is maintained at a low temperature using the air conditioners. This can lead to hypothermia or sudden fall in body temperature of the patient. Neonates are too susceptible for this condition. Hence, it is very important to cover the patients with blanket to keep their body warm during the air transfer.

Height or the level of the air ambulance

The more the altitude of the craft, lesser is the fraction of inspired oxygen level. The flying levels are different for rotor wing (2000-5000 feet above sea levels) and fixed wing (15000-40000 feet above sea level) air ambulances. The guidelines suggest there should be pressurized air cabins for crafts flying above 10,000 feet above the sea level.

 

First Aid and Basic First Aid Procedures

First aid training can be an important asset to everyone as an emergency situation is non-predictable. If you are able to handle an “emergency situation”, and help somebody in need, that will be the greatest moment in one’s life. But you cannot perform first aid unless you take proper first aid training and first aid without proper training may even make the condition of the victim worse.

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There are a few things which you can do until the medical rescue team arrives. These simple procedures would help the patient as well as paramedics who treat the patient.

Abdominal pain – Keep the patient in a position in which he/she is comfortable. Do not to give the patient anything to eat or drink.

Minor burns – Soak the wound area in cold water. Do not put creams, ice or butter in the affected area. Protect the burn by covering it with a non-adhesive bandage.

Chest pain – Rest the patient in a position in which they are comfortable. It is better if you could make the patient sit upright. Aspirin can be given only if the patient is an adult and not allergic to aspirin. Try to keep the patient calm.

Choking – Trouble in breathing, inability to talk or cough are the signs of choking. Ask the person to cough. If coughing doesn’t work, support their upper body with one hand and help to turn forward.  Using the heel of your hands, give five continuous blows between their shoulder blades. Start Heimlich maneuver only if you are trained or else get immediate medical help.

Convulsions/Seizures – Look around if the person is in a dangerous area. Clear the zone to keep the patient from harming themselves. Do not try to hold them still.

Bleeding – Bleeding from cuts and grazes can be controlled by elevating the wound and applying pressure.

Drowning – Check if the person is breathing or not. Perform pulse check for 10 seconds and if there is no pulse then start CPR if you’re trained, or get the immediate assistance of a medical dispatcher.

Suffocating – If the patient is not breathing, you can start CPR. Make sure the airways are clear. Place the individual on his back. If the patient cannot breathe by himself, start to give artificial breathing by mouth to mouth method. Continue it until the patient start to breathe himself. Get immediate medical help.

Electric Shock – Separate the person from an electrical source. Start CPR immediately, if the person is not breathing. Check for other injuries and call for medical help immediately.

Suspected broken bones or disengaged joints – Keep the injured body part from moving until you reach the hospital. This may ease the pain and protect from further damage.

Nosebleed – Keep the head tilted forward. Apply an ice pack to nose or the back of the patient’s neck.

Most of the accidental deaths occur due to the lack of proper first aid or emergency care. It is advisable for everyone to get a medical emergency training and never wait to support the victim to get an immediate medical support.