STANDARDS FOR

Ambulsn(eSeruices

New&BrunswickHealth andCommunity Senrices

STAI{DARDS FOR AMBTJLANCE SERVICES

IN

NEW BRTJNSWICK

Departnent of Ilealth & Community Senices

Augrst 1992

MloirrctHcrlth rndCommunit.TScn'iccs

MiolrrrcSrnra ctScn'iccscommunlutttrcs

xo.,fl""X & Brunswick

August 1992

The Department of Health and Conmunity Senrices (DHCS) is pleasedto approve the Standards for Ambulance Serrrices in New Brunswick.

InitialLy developed by a working party with expertise in ambulanceserrrices in the Province, the Standards were presented for approvalby the Ambulance Setrrices Advisory Committee. This DHCS committeeincludes representation fronr St. John Ambulance, the New BrunswickAmbulance operators Association, the New Bnrnswick HealthcareAssociation, the Nurses Association of New Brunswick, the NewBrunswick corlege of physicians and surgeons, the Department ofMunicipali t ies, Culture and Housing, and the Departmentbf AdvancedEducation and Labour.

The introduction of standards for vehicles, equiprnent, personneland cl inical practice wil l help to ensure that quali ty Lmbulanceselrrices are available throughout New Brunswick. tfris i! essentialgiven that ambuLance senrices are considered an integral part ofthe health care systen, and often the f irst poinL of cl ientcontact.

These standards are a new undertaking for the Province and shallcome into effect on January 1, 1993 wilfr the following exceptions:

Vehicres ordered before inplenent,ation that do not meet thespecifications in Part rrr i. of the standards shall be issuedan exemption untit a repracement vehicre is obtained.However, it is expeeted that alr repairs would be incompliance with the St,andards.

Tr{o years following irnplenentation of the standards andavairabirity- of the revised amburance attendant trainingprogram, dt reast one attendant on each carl shalr meet th;prerequisites, responsibil i t ies, and qualif ications asoutr ined in the standards, part r r (sect ions a. , b. & c.) .

z

P.O. Box 5lO0 C.P. SlOOFrcdcricton FrcdcrrcronNeB'Brunswick Nouveau-BrunswickCenrdr E3B 5G8 Canrdu EtB 5GS@t'tlt;iT*Ei

2

Within three years following implementation of the Standardsand availabil ity of the revised ambulance attendant trainingprogram, both attendants on a carr sharl neet th;prerequisites, resPonsibil i t ies and qualif ications outl ined inthe Standards, Part I I (sect ions a. , b & c. ) .

The Department of Health and C-onmunity Senrices is of the opinionthat the Standards for Ambulance Serrrices are reasonablL andattainable and that all Arnbulance Serrrices will take the necessarysteps to iuplernent them. It is recognized that the Standards wilirequire periodic review.

Your cooperation in the interest of quality care is very nuchappreciated.

aL--te-4 lI'; />RUSSELL H.T. KING, U.D.UINISTER

Standards for Ambulance Services in New Bnrnsvick

I N D E X

Paee

P r e a m b l e . . . . . . . 1

Part I:

a.

Part II:

S e r v i c e s . . . . . 2

Ro leandRespons ib i l i t i es . . . .2

P e r s o n n e l . . . . 3

P r e r e q u i s i t e s . . . . . . . 3

R a s p o n s i b i l i t i e s . . . . . 3

Q u a l i f i c a t i o n s . . . . . . . . . 4

P e r s o n n e l R e c o r d s . . . . 5

S t a f f i n g . . . . . 6

I - o c a l P h y s i c i a n l n v o l v e m e n t . . . . . . . 6

V e h i c l e s a n d E q u i o m e n t . . . . . 7

V e h i c l e S p e c i f i c a t i o n s . . . . . . . . . . . 7

D e s i g n a n d T l p e . . . . . . . 7

C o l o u r . . . . . . . . j

M a r k i n g s . . . . . . 9

E x t e r i o r l i g h t i n g . . . . . . . 9

A s r b u l a n c e E m e r g e n c y l i g b t i n g . . . . . . . 9

Opera t ionandPer fo rmance . . . . .9

E l e c t r i c e l S y s t e n a n d C o m p o n e n t s . . . . . . 9

D r i v e r A r e a . . . . l l

D r i v e r a n d P g t i e n t A r a s s . . . . . . 1 1

P a t i e n t A r e a . . . . 1 2

Body 'Genera lConst ruc t ion . . . l4

C o m m u n i c a t i o n s . . . . . . 1 4

08t92

a.

b.

c.

d.

e.

f.

Part III:

a.

a -1 .

a-2.

a-3.

a4.

a-5.

a{ .

a-7.

a-8.

a-9.

a-10.

e- l 1 .

a-12.

lu

Standards for Ambulance Serrices in Nan'Bnrrrswick

I N D E X ( c o n t ' d )

Paeellehicles and Eouioment (cont'd)

E q u i p m e n t . . . . . . . 1 5

C o m m u n i c s t i o n E q u i p m e n t . . . . . . . . . . 1 5

A c c e s s o r y A m b u l a n c e E q u i p m e n t . . . . . . 1 5

P a t i e n t C a r e E q u i p m e n t . . . . . . . 1 5

Transportat ionEquipment . . . . . f5

I m m o b i l i z a t i o n D e v i c e s . . . . . . . 1 6

O x y g e n E q u i p m e n t . . . . 1 6

B a g V a l v e M a s k . . . . . . 1 2

S u c t i o n A p p a r a t u s . . . . . l 7

S u c t i o n A c c e s s o r i e s - . . . l 7

O r o p h a r y n g e a l A i r w a y s . . . . . . . 1 7

P o r t a b l e F i r s t A i d K i t . . . . . . . . 1 7

V e b i c l e S u p p l i e s . : . . . . . . . . . 1 8

Main tcnanccand lnspcc t ionProgram . . . . . .19

Part III:

b.

b-l.

b-2.

b-3.

3 . 1

3.2

3.3

3.4

3.5

3.6

3.7

3 .8

3.9

c.

Part IV:

a.

b.

Part V:

a.

b.

Oualiw Assurance/Risk Manaeement

Quality Management

Risk Management .

20

20

20

Comrnun ica t i on . . . , 21

D i s p a r c h . . . . 2 1

Rad ioCornnun ice t i on . . . . . 21

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iv

Standards for Ambulance Senices in Ne*'Brurswick

I N D E X ( c o n t ' d )

Aopendices

Appendix A: Components of an Emergency Medical Services Model

Appendix B: I-evel I Emergency Medical Technology Educational Program

Appendix C: Immunization of Health Care Workers

Appendix D: Philosophy of Medical Control in Emergency Medical System

Appendix E: Policy on Use of Emeigency Flashing Ligbts end Siren

Appendix F: Anbulance Stretcbers

Appendix G: Requirements for Cervical Collers

Appendix H: Oxygen Cylinder Content

Appendix I: Bag-Valve Devices

Appendix J: Vehicle Service and Maintenance

Appcndix K: Suggested Quality Management Activities

Appendix L: Legal Issues

Appendix M: Basic Dispatch lnformation

Appendix N: Sample Prehospital Communication Record

Appendix O: Selected References

Note: A list of references used in the development of the standards is ettgched as Appendix O. V/ithin tbedocument each quolation or reference is followed by a number which refcrs to the appropriate listed source.

0t/92

WORKING PARTY ON AMBT]LANCE STAIYDARDS FOR THE PROVINCE OF NEW BRI]NSII'ICK

Tbe Standards for Ambulance Services were prepared for and prasented to tbe Advisory Cornmittee on AmbulanccServiccs by the following representative group:

Marilyn Brewer, CbairmanStan&rds Officerlnstirutional Services DivisionDepartment of Health and

Community ServicesFredericton, New Bnrnsvick

Anne Marie Beeulieu, Emergency NurseNursing Consult"ntEdmrurdston Regionai HospitalEdmundston, New Brunsvick

Guy H6bertAdministratiys AssistqnUAmbulance lnspectorDepartment of Health and

eg6prrnily ServicesFredericton, New Brunswick

Marion Norquey (Superintendent)St. John Ambulsnce Div. 865Mouth of Kesrvick, New Brunsvick

Jane Findlater, M.D., F.R.C.P.CEmergency PhysicirnDircctor of Emergency ServicesDr. Everctt Chdmers HospitalFredericton, New Bnrnsvick

Joe NoelAmbulaoce Op€r8torJecquet River Ambulence ServiceJrcquet River, New Bnrnswick

Lloyd Secord, Executive DircctorSussex Heelth Centre Ambulance ServiceSussex, New Brunsrick

Linde Ai&cn, Emergency NurseProject CoordinstorAmbulance Serviccs BrenchDepartment of Hcelth rnd

Connunity ScrviccsFredericton, Ncw Bnrnsvick

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vi

Page I

Deparfnent of Health and Community Senices

Standards for Ambulance Serrices in New Bnurswick

heamble:

Ambulance services prwide pre-hospital emergency care, and tr8$portstion of persons (patients) who need or 11nyneed medical attention.2

The Stan&rds for Ambulance Services in New Brunswick have been developed in accordaace with the A:nbulanceServices -Act and proposed Regulations. The standards sddress seliccs, personnel, vehicles, equipment, andsupplies.2

Based on inforrnation, knowledge and experience relevant to New Bnrnsrvick, the stan&rds are desigoed to assisti! 'the development throughout the Province of a balanced and effective systen of ambulance services'.2 Thestan&rds will be reviewed regularly and revised ss necessary.

These standards apply to tbe use of embulances for the tnnsporration of paticnts only. It is recognized that, undercertain circumstances, ambulutce vehicles may be used for otber purposes such 8s trusportstion of donated organs.2Appendices provide srpponing documentation and are included rs useful references.

As regulated stendsrds for embulance scrvices are a ncw rmdertrking for the province, they bave boen developedwith a future orientation. Tbe stan&rds are designed as reasonable end ettainsble tsrgets ior ambulance servicesto achieve over a phased implemenlation period beginning January l, 1993 unlixs noted differently. To meet thisgoal, everyone involved will need to work together to overcome the many existing challenges.rrr-

08t92

Standards for Ambulance Senices in New Brunswick

Part I: Services

a. Role and Resoonsibilities

Ambulance serviccs shdl cer€ for end transport patients in order tbat they ere maintsined in the bcst conditioupossible under the circumstgnccs. (sec Appendix A)

Ambulance serviccs shall be responsible for:

e-1. 24 bour acccssibility of scrvice;

a-2. provision of quelified ambulence personnel;

u-3. cffectivedispatch;

a-4. efficient communicetion with hospitels;

a-5. being able to establish cornmunicetions with other emergency selices, i.e. police, fire, e!c.;

a{. participatioo 8s Psrt of the emergency response tcgm for cmergency disastcrs/Mass Cespalty Disasters;

e-7. provision of edeqrnte medicel nrpervision end control;

a-8. provision of patient care iD eccordrnce with *an&rds;

g-9. effective mainlenance of rmbulance vchicles, cquipmcnt and nrpplics;

. a-10. reguler evduetion of tbe scrvice.

Page 2Psrt I

0Et92

Standards for Ambulance Senices in Ne$'Bruns\r'ick

Pan [I: Personnel

Ambulance sltead-nt means 'a person who attends patiens being transported by smbulance and includes anambulance driver'.2 Throughout the document the word 'gllgsdrnl' will mean 'ambulance attendlnt".

a. Prerequisites

Prior !o treginning an embulance sttendsnt gigining progrsrn, a cendidate shsll:

a-1. be able to read, write and comprehend a language of the service;

e-2. be between the ages of l8{5 years and physically able to perform all required dutiestt2;

a-3. hsve s currenl standard first aid certificgte (St. John Ambulance, Red Cross, Cansdien Ski Patrol);

s4. bave current Basic Life Support (B.L.S.-C) - Bssic Rescuer ccrtificate;

s-5. for the previous two years, have a driving record witbout five or more points assessed against it under theMotor Vehicle Act:

a{. for the previous two years, not have a driver's license srspension under the Motor Vehicle Act;

a'7. for the previous three years, not have been prohibited under tbe Criminal Code from driving a molorvehicle in Canadat.

b. Resoonsibilities

The ambulanc€ sttendant shall be competent to:

' a) r*oguza a physiological or psycbological human crisis and accurately evaluste e given paticnt's condition;

b) identify and carry out the most sppropriate pbysiological and psychological EtD.rgenent techniques for e. given patient's condition;

c) collect, eveluate urd rcport accurately, orally end in writing, the pertinent informstion concerning ellsspects ofa given patient's condition;

d) use appropriately and csre for dl equipment required to eccomplish his/her job.'rt.

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08t92

Standards for Ambulance Services in Nex'Bnrrrswick

c. Oualifications

Note: This seaion is ubimately efeaivefor all attetdans as of January I, 1996.

A qualified ambulance attendant shall:

c-1. successfully meet tbe following conpetency requirements excerpted from thc l-evel I Educationsl Progremin Emergency Medical Technology!: (s€e Appendix B)

1.1 assess and rnnn'ge tbe health crisis scene;

1.2 perform e primary patie,nt survey;

1.3 maintain the patency of the upper eirway, and if neeessary, use oropheryngeal airway adjuncts andsuctioning;

1.4 perform basic menagemeat of breathing dysfunctions including:- gdmini5l6tion of oxygen using mesk (including pocket mask) or nasal cannula;- use of bag-valve-mask 'nit;

1.5 retognizz' external snd intemal hemorrhage and apply Nssig m'nagement techniques;

1.6 perform cardiopulmonary resuscitation (CPR) on rdult, child or infant;

1,7 perform a secondary patient survey;

1.8 provide appropriate psychological srpport to a patient;

1.9 provide basic care for given wounds end cnvironme,lrtal injuries;

1.10 perform appropriate imrnobilization tcchniques for ectual and srspected frcctur€s;

l.l1 recognize end provide basic mn"gement of Eedic8l cmergencies, including recogtrizing indicetions forrapid transport;

l.l2 rn'n'8e emergency childbirth, including pnstnqtrl, matcrnal aad neonstal cere 8trd trsnsport;

f .l3 demonstntc npid triage skills and ebbrsviatcd clinical asscssmeot and rapid transport in menagement oftrau'I8;atien!:;

1.I't ttse appronriate rnaru;;emeat 'tchniques for e patiart rmdergoing en emotionel end/or possibte mentel he&lthunsis;

l. l5 demonstrete basic rmdersteadbg of crtricrtion principles, ssfe renovrl of e petient end use of approprietepackeging and transport tcchniques;

l.16 use lifting and moving techniques @iomecbanics) esscntial !o approprirte paticat care rad safety of theprehospial care practitioner;

l.l7 op€r8te an smbulsnce in eccordance with patient needs end public safety.

Fage 4Part tr

08t92

Standards for Ambulance Services in Ne*'Bnrrswick

c-2. be competent in the use of, and know the location of all basic equipment in the ambulance;

c-3. be between the ages of l8{5 years and physically eble to perform all required dutiesrs:;

c4. bave a valid driver's license as required by tbe Department of Transportationt;

c-5. for the previous two years, have a driving record without five or more poi-uts assessed against it under tbe

Motor Vehicle Act;

c6. for the previous two years, not bave a driver's license suspension under the Motor Vehicle Act;

c-7. for the previous tbree years, not have been prohibited under the Criminal Code from driving 8 motor

- vehicle in Canadat;

c-8. be knowledgeable of the geography of the area served by the Ambulence Service;

c-9. be knowledgeable of the Provinciel Integrated Rsdio Connr"nication System procedures and competent in

the use of tbe provincial ambulance radio systemr(arqr'

c-10. demonstrate the ability to drive an emergency vehicle using safe and professional driving techniques

including the appropriate use of emergency lights and siren$;

c-l l. during each year of service be ccrtified in cardiopulmonary resuscitation to the Basic Rescuer l-evel by the

Heart and Stroke Foundation of New Brunswick or equivalentro'z;

c-12. be certified in accordance witb the Ambulance Services Act2.

l. Personnel Records

The ambulence service shell msintsin a record for each snbulsnce slteadqnt listing educational qualificetions,

continuing education hours, gnd ccrtificstions for advanced procedures on a form prescribed by the Ministcr.

Fage 5Part tr

0Et92

Standards for Ambulance Senices in New Bnrnnvick

e. Stsffins

e-1. An ambulance sball be staffed with et least two (2) ettendants.

e-2, One attea.l2nt shall remain in the patient compartment with the patient for the duration of the trip.

e-3. y'l11ssdants shall carry an identificstion cerd issued by Ambulance Serviccs Branch, DHCS.

e4. Attenrl-nts sball be neat and clean and u,,ga1 stsrhing or lnifotms tbet readily identify them as smbulancepersonnel.

e-5. Atten&nts shall bave knowledge of the Standards for Arnbulence Services in New Bnrnsrick.

e{. No individual, while functioning gs en snbulaDce atten&trt, shsll conzume, take or be under the influenceof liquor, drugs or any srbst"nce which could interfere with ability to provide ambulance services.rt

e.7 6llsnrlents should rnaintein immunizations st the level appropriarc to the work hazards as currentlyreco--ended by the Department of Health and Comm'nity Services @HCS;tt'to' (see Appendix C)

f. I-ocal Phvsician Involvement

Physician involvement is important to lhe planning, direction and operation of rmbulance scrvices rs well ss liaisonwith tbe emergency care system.s'rrr

f-1. Eacb ambulance scrvice shall heve e medicsl control physician to sssure medical input into patient c8re.If there is no local physician to csrry out this role, it Ery be c8rried out by such e pbysician in the hospitatto which the ambulancc delivers its patiens.

The role of the physician sball be:

1.1 to provide feedbsck to ambulance pcrsonnel/scwices regerding patie,nt care and p8ticnt care issues;

1.2 to assist witb continuing education of ambulance personnel;

1.3 when appropriate, to assist with cenification and recertificstion of ambulance personnel st EMTLevel I;

1.4 when appropriate, to assist with the medical aspects of quality 'ne"ageme,nt rnd risk mgnsgement progrsms;

1.5 to liaise with other physicians when appropriete to assist tbe ambulance scrvice in providing tbe bestpossible patient care (link to formal emergency medicsl system to resolve syst€m problems).

f'2. The sandards are the ninimum level of ambulance services. Medical control in relation to rdvrncedprocedures is discussed in Appcndix D, section d.

Page 5Part tr

08t92

Standards for Ambulance Serrices in New Brurrswick

Part III: Vehides and Equipment

Ambulance rneans I motor vehicle dasigned or adapted to be used for the transportation of patients (persons whoneed or may need medical attention).2

s. Vehicle Specifications

Note: This seaion applies to all new anbulance whicles ordcred afterJanuary 1, 1993 and to allrepairs to otheranbulancus after that date.

Every ambulance sh8ll obr"in a ccrtificste of compliance to N.B. rninilasp standards from tbe conversionmanufacturer Eeeting the following requircnents:

a-1. Desipn and Tvoe

l.l Two or four wheel drive exteuded van.

1.2 Chassis order clearly notes that the vebicle is to be uscd as an ambul8rce. Wbere tbe 'Anbulance optionpackage' is available, lhe vehicle shall be supplied with equal or better components tben those specified.

1.3 Conversion Ecets or surpssscs tbe requircments of thc C"ngdisn Molor Vehicle Safcty Standerds (CMVSS)as issued by Transport Conedq.lll

1.4 One copy of tbe menufccturer's rcferencc handbook/manuel is srpplied providing instructions for theopcration, clrc, end repair of ell embulance relat€d (acccssory, component) cquipment and system(s)furnisbed ss psrt of the ambulancc.

1.5 Weight: rnini6gsl 3,906 kg (t,600 pounds) gross vehicle weight.

1.6 Wheel bsse: minimum 318 cm (127 inches).

1.7 Payload: maximum svsileble from tbe mraufscturer of choicc.

1.8 Suspension: rnsximum heavy duty springs end stabilizer oblique smy bars front end rear.

1.9 Shock absorbcn: double-ecting type, heaviest duty evailable, on fr,ont rnd rear axle. Air bags on frontaxle rccornnended.

l.l0 Bumpers: chrome, aluminum or cquivalent.

l.ll Step wells: coverpd with anti-slip msterial.

l.l2 Rttst inhibitors.

a-2. Colour

Exterior: basic white with e solid unintemrpted international orenge reflective stripe equivalent to 3M-AI5BQ' not less than 15 cm (6 inches) wide nor more than 35 cm (14 inches) wide, encircling tbe entireambulance body (rn"y exclude the front of the hood penel) at the bclt line bclow the bottom edge of cabwindows.D

Page 7Part Itr

0Et92

Standards for Ambulance Senices in New Brunswick Page tPsn m

a-3. Markines

Using contrasting colour rcflective tape, markings shall be epplied es follows:

3.1 Front- Word 'AMBULANCE', mirror imaged, in block, diecut style letters, not less thsn tQ cm (4 inches)

higb, ccntered ebove the grille, clearly visible.- Radio call sigo clearly visible with letters at least l0 cm (4 inches) high on front snd rear of tbe vehicle.

3.2 Side and rear:- Word 'AMBULANCE' iD block, die-cut style letlers minisum 15 cm (6 inches) on both sides and rear

of vehicle body.- Name of service clearly visible in l0 cm (4 inches) lettcrs on both sides.- Emblems, including the 'Star of Life', 8re optionsl but shall not interfere with required markings and

necd not be reflective.

a4. Exterior Liehtins

4.1 Lights end brackets highly corrosive resistant, weterproof and self dreining of condensetion.

4.2 Headlrrnns- Halogen.- Equipped to flash altcraarcly in the high beem position, controlled by a scparate switch.

4.3 Flood end loading ligha - firmly fastened to reinforccd body srrfrces on the left end right sides of thevehiclet- Not less then 188 cm (75 inchcs) above the ground rnd unobstructd by opar doors.- Provide s minimum of 800 bcam condle powert.- Rear facing floodligh(s) shell operate 8utomatically whe,lr the rear doors are opened.- Side doo(s) floodligh(s) shell opcnte automatically when the patient conpertme,nt door is opened.

a-5. Ambulance Emereencv Lishtine

5.1 A light [g1 coataining a rninimum of 2 rd and 2 white lights.

5.2 2 red lights loceted on grill below tbe bottom edge of the windshield.

5.3 lntersection ligha - I fleshing red light instsld rt cech of tbe front feoders, shielded or recessed.

5.4 Rear roof warning lighs - 2 rpd revolving lighs or eguivalcnt installed on the vertic8l plane of the rparroof.el

5.5 Use of sirens and lighs in eccordance with DHCS policy. (sce Appendix E)

ou92

Standards for Ambulance Services in New Brunswick

a{. Ooeration and Performance

6.1 Engine - niaimum V8 or diesel equivalent.

6.2 Block heaters - minimum 500 watts

6.3 Cooling System - marimum size and heaviest duty components to maintein the engine and transmission atsafe operating temperatures gt sll driveable dtitudes and grades encountered during on end off road vehicleuse.D

6.4 Transmission - minimum 3 speed sutomatic with a heavy duty oil cooler.

6.5 Brake system - power brakes, beavy duty linings, antilock brakes where avsilable.

6.6 Steering - power assisted.

6.7 Wheels snd tires - minipg6 40 cm (16 inches) wheels and 4 performance reted preferably "open tread'radial tircs.

Tools - shsll be avsilable for exchanging mounted tire essembly with the spare rssembly and sbell includeat least a jack, jack hurdle, end wheel nut wrench.

Spare Tire- Not mounted in front of the vehicle.- Accessible without moving the patient.- I spare tire (see 6.7) or equivalent.

Electricsl Svstem 8nd Components sbell comply with 8ll Federat Motor Safety Rcgulations end rllapplicable C.S.A. Hospitrl Stendar&!

- Components sclcctcd 1s 'ninirnize electrical logds.- R""dy accessibility through acccss panels.- Switcbes, indicators, rnd controls locat€d end instelled in e menner thet permits easy removel and

servicing.

Waruing ligbt panel loceted in the driver's compartment with indicetor lights showing ope,D entry dmr(s),and battery circuitry.

Back-up elarm - the vehicle rhsll be equipped with a solid state back-up elerm with s canc€l butlon locgtedon tbe drivcr's consolc. The alarm should be aa automatic rpsct tlpe whereby it is rcectivst€dautomatically each time the velicle is placed in reverse gesr.rl

Page 9Part Itr

6 .8

6.9

s-7.

7 . 1

7.2

7.3

08t92

Standards for Ambulance Services in Na'v Brurswick Fage f0Part Itr

a-7. Electrical Svstem and Comoonents (cont'd)

7.4 Alternator - heavy duty - "'ini6um 160 amps.

7.5 Eugine higb-idle speed control, eutomgtic lnless the chassis manufscturcr's recolnnended engine idle speedcan sustain the embulance's totel continuous electricel load, including mexinum heeting/eir conditioningoutput. An engine high-idle spccd control sbsll bc provided nfiich increases tbc eogine (RPM) spced. Thedevice shsll be prcsent so thet, when activated, it will operste the engine st the sppropriete RPM. Thedevicc sball opente only when srvitched !o the 'On' position end the trensmission is in 'neutnl' or 'park'.

The device shdl disengage wben the service brake pedal is depressed or tbe trensmission is placed in gear,and sutomaticelly re-cngege when tbe service breke is releascd or u&cn tbe trensmission is placed inneutrd or park.t'ltt

7.6 Battery system- Du8l, 12 volt heavy duty betteries with a rnini6u6 cold crankiag cspscity of 600-650 amps.- An autornatic battery isolating system with boosting capabilities from e second battery.

7.6.1 If tbe second battery csuot be installed under the hood, tbe battery shqil be housed in en outsidecompartnent in or under the body on a slide-out bsttery trsy or box and shall be securpd snd ventilatcdto ensurc that fumes do not cnter the ambulance.

7.7 Electrical receptacles & invertorr'

7.7.1 The patient compsrtment shall be furnished with a 12 volt DC, 20 ampere capacity, scpantely prot€ctedcircuit with I outlet receptacle.

7 .7.2 A I l0 volt external Fnwer supply to bc clearly Esrkd I l0 volt external.

7.7.3 lavertor- DC to AC invertor - 1000 wetts.- With 2 duplex receptecles in tbe petient compertnent to be clcarly rnsrked - ll0 volt AC invertor.- Loclted in an opcn erea.

7.8 Patient compertment controls, svitches & instruments- Panel mounted.- Located within normal rcech of tbe seated ambulance attJendant.- Clearly visible & identified.

08t92

Standards for Ambulance Senices in New Bnrnswick page 1lPart Itr

a-8. Driver Area

8.1 - Sufficient sizp to accomrno&te driver and other attcndent.- Designed and organized with specified and required equipment and accessories for ease of operation and

safety.

8.2 Driver Console - constructed of a moulded fibreglass or proveD equivalent- Accessible end visible to the driver.- Location not to excced 75 rr'n (2 inches) above the lowest portion of the top of tbe vehicle rl"qhboard.

8.3 The driver compartment shall be furnished witb at lesst the following equipment:- tuel gaugds);- oil prcssure gsuge;- engine tempera$re gauge;- tinted windshield;- wasbable type upholstery and flooring materids;- mnp reading light accessible to attendant in passenger seat;- cigarette lighter socket.

8.4 Mirrors

8.4.1 Regular nanufacturer supplied mirrors, minimum 15 x 20 cm (6 x 8 inches), located on eech side ofvehicle.

8.4.2 Convex mirrors approximately 12.5 cm (5 inches) in diameter, located on each side of the vehicle,attached to tbe mirror brecket:- made of a corrosive resist-nt metal or equivalent;- full convex nirrors not acceptablellt.

a-9. Driver snd Patient Aress

9.1 Partition bctweeir cab and paticnt comparthe,nt with a door et least 42 cm (17 inches) wide and ll5 cm(46 inches) high to provide an &isle bctween the compertments.

9.2 . Heater - maximum output with independent controls for esch compsrtment.

9.3 Air conditioning system(s) of srfficient capacity to lowcr the tcmperature in cach compartment tD 26"C(78'F) within 30 minures.

9.4 Fire extingrishers - minimum of 2 with valid inspection stickers, 2.3 kg (5 lb), ABC dry chemical, I ineacb compartment.

9.5 No smoking signs - international red-on-white signs at least l0 cm (4 inches) in size prominently displayedin both the patient and driver compartnents.

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Standards for Ambulance Services in Ne*'Brurrswick

a-I0. Patient Area

l0.l Sufficient in size !o tnnsport 2 stretcher patients with he8ds forwerd.

l0.l.l Stretcber fasteners - permsnent wall or floor mount strctcher fsstener rail instelled on the left side ofthe patient conpartment with a fixed or detachable floor mount 'antler' et the front.

10.2 Patient Compartment Interior DimensionsHeisht - shall provide 8t lesst 255 cm (51 inches) height over the prinary patient area, measured fromfloor to ceiling.Width - The width of the compertncnt after instsllation of storage cabinets shall provide et least 25 cm (10inches) of cleer risle welhvey benvccn thc primery stretchcr end the bgse of the sqrnd bench.I-ensth - The lengtb of the compertmcnt sball provide et least 37 cm (15 inches) of uaobstructed space etthe heed of tbe stretcher to the sttendsnt's scat. A minimum of 15 cm (6 inches) shdl be provided fiomthe end of the strctcber to tbe rear loading doors.

10.3 416qrtrnt Seating- I-ocsted at the hesd of the strercher equipped with a sest belt, seat belt retrecors, padded beck and head

fest.

10.4 Doors

10.4.1 2 patient compartme,nt door opcnings sbsll be providcd; I on tbe right forwerd side, wide cnough !oellow evscuation of e stretcher patient, aad other at the reer for lording end unlogding the primarystretcher.

10.4.2 Equipped witb interior hendles es well ss extemal door locks with key scc€ss from the outside for eachdoor opcniag.- Hardwsre or deviccs to pr"vcnt inedvcrtcnt opening or closing- 'Door Open' waraing device to signal (indicated in tbe cab) when doors are not closed

10.4.3 Reflective tape - rninimum of 5 cm (2.inches) wide applied on the entire interior width of eech door.

10.4.4 SteP 8t the back (loading door opcning) of the petient compartnent if the floor is nore thrn 44 cm (18inches) above the grouod.

10.5 Windows- Sbsll be tinted, shstterptoof gless end locsted only in the side and reer doors of tbe patient compartncst.

Becteriostatic cultains or blinds msy b used inside the windows.

10.6 Floor aad Floor Covcrings- Seamless, one piecc bonded to the subflmr witb waterproof adhesive.- Non-slip, non carP€t meterial sesled et the edges to prevent s€cp8ge into storage conpartnents.

Page 12FBn m

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Standards for Ambulance Senices in New Brunswick

a-10. Patient Area (cont'd)

10.7 lnsulation- Walls, roof and doors in the patient compartnent shall be completely insulated.- Non-toxic, vermin proof, mildew proof, firc retardant and non-settling.- Rigid spray foam acceptable.- Asbestos, products using rsbestos, or rigid styrofoan sball not be used.

10.8 lnterior Surfaces- Free of sharp projections.- Exposed edges and coruens sball be provided with a radius or chamfer.- All hinges or supports for equipment and devices mounted as flush as possible with the zurrounding

surface when not in use.- Padding placed at all head ares obstructious which rnay prove dangerous to persons moving about in tbe

patient compartment- Finish of the entire patient compartmeDt, including interior of storrge cabinets and squad bencb, shall

be fire retardant, mildew proof and impervious to 6oap, water, and disinfectans.

10.9 Storage Compartmeotslnterior shall provide enclosed storage cabinetry, compartnent space and shelf space conveniently locatedfor medical supplies, extrication equipment devices snd installed systeDls as applicable for the serviceintended.- Cabinets shall be securely anchored to the vehicle.- Plexiglass sliding doors must cottrply with current Trrnsport Cqmdr Regrrletions for motor vehicles.rtr- Storage cabinets shall be easily opened, but shdl not come open in transil or rs the result of e vehjcle

collision.

10.10 Sq'rad Bench, Seats, Backrest- Squad bench platform sball be long and wide enough to eccommodate e second stretcher including wheel

cups for model 107 strctcher or equivalent. (sc Appendix F)- Maximum height 42 cm (17 inches) including cushions.- Seat belts with rctractor:, rnini6s6 3 sets.- Rear and lateral padding at tbe hcad are8s.- Squd bench cover shall be fitted with a closcd latching device for safety and a 'hold open' device.

l0.ll Il lumination

10. I 1. I Minimum of 6 ceiling ligbts of dual intensity- Shell be not less than 15 foot candle intensity.- 3 lighs over the prirnary strctcher providing not less that 35 foot candle intensity and 3 lights over tbe

sguad bench.t- Recessed or near flush mounted, not protruding more tban 3.5 cm (lk inches).- Operated by e' 2 stage svitch (high/low) loceted on the atten.lant control panel, activated when side

or rear doors are opened.

l0.ll.2 A reading light shaU be provided at the attendent control panel.

Page f3Pert m

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Standards for Ambulance Services in New Brunswick

a-10. Patient Area (cont'd)

10.12 Heating

10. 12. I Separate heater witb thermostat control providing uniform distribution of heat, controls mouated in thesttegdsnt control panel. If used, floor heater must be mountcd near the rear door.

l1.l2.2 Heatcr hoses insulated to prcvent heat loss, with a control vdve under tbe hood.

lO. 13 Ventilation system in petient compartment desiped to provide g comFlete cbange of ambient eir every 4rninglg5 with tbe vehicle stetionary. Fresh air intakes chell f,g locstod in thc most practicsl, contsmin8nt-free eir sprce of tbe vehicle. The patient area sball be ventileted by the eir delivery system of theenviroumeotcl equipment (heater/air conditioner) or by sepante system(s), zuch es power intake, exheustventilatorls), atrd ststic roof vcnt(s).rrr

10.14 Overb""d gr"b rail - minimum 150 cm (60 inches) long, meximum l0 cm (4 inches) drpth, on the ceilingover lbe prinary pstient, p"ddd or curvcd up ends, and roundcd comers.D

10. 15 Intravenousholders-rninimumof2IVhookswithvelcrosecuringstrapsinstelledatthemidscctionofbothstretcher/cot locations. D

a-I1. Bodv - General Construction

- Shdl bc desiped and constnrcted to provide impact end paticnt compertmat penctntion rpsistance andsbsll be of sufficient streng$ to support tbe entirp weigbt of the fully loadd vehicle on is top or eide,without scparation of joints or pennsnently deforming roof bow or reinforceme,nts, body posts, doors,stringers, floor, inner linings, outer panels, rubrails, and other reinforcements. Wood or wood producsshell not be us€d for structunl framing.ttt'r

- All exposed cdges shall bc protected by 'T' moulding, cbemfer, or pedding. C;eution must be taken toensure thst screws do not penetrste the gas t8nk, fuel lines or wiring.

a-12. Communicstions

l2.l Public address system rnd electronic siren.

12.2 Antenna ceble sDd mounting propcrly grounded.

Page 14Pafl m

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Standards for Ambulance Services in Ne*'Brurswick Page 15Psrt m

b. Eouioment

b-1. Communication Eouipment - 2 way V.H.F. radio to be mounted on 8n epproved bracket with a remoteband set for the patient compartment and an approved portable radio.

All communication equipment shall be as approved by Ambulance Services Branch, DHCS which providestbe 2 way V.H.F. radio with renote hand set.

b.2. Accessorv Ambulance Eouipment

MinimumItem Number Snecifications

2.1 Chain or device I cspable of towin g2,700kg or 2.7 t (6,000 lb) with connectors(hooks) at each end - rninimum length 3 m (10 feet)

2.2 Rope I 30 m (100 feeD - 1.25 cm (% inch)

2.3 Hacksaw I with I spare blade

2.4 Wrecking bar I at least 68 cm (27 inchas)

2.5 Hamner I 900 g or .9 kg (2 lb)

2.6 Portable hand lights 2 one with a waming wand

2.7 Work gloves 2 pairs

2.8 Flares 3 in an approved csatainsl

2.9 Scrcwdrivers multiple bis

2.lO Pliers wire cutting capabilities

t"3. |g[ent Cerc Ee!t!p-E[er!

3 I 'inrsprrtntion Equiprnent

3.1.1 Stretchers - 2 strctchers, each having 2 safety restraining strsps. (see Appendix F):- I approved whceled desigu multi-level rdjustrble end fully contoured for head elevation, shdl meet

or exceed a Ferno \{rchington Model 30.- I strctcher doubling as e stsir chair meeting or exceeding e Ferno Washington Model 107-C or e steir

cbair meeting or cxcecding Femo Washington Model 42 accompanied by a Ferno Model 9 strptcheror equivalent.

Note: If incubators are transported, an adequate system for securing the incubator must be provided bythe Ambulance Service.

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Standards for Ambulance Ser-vices in Ner,v Brunswick Page 16PBrt m

b-3. Patient Care Equioment (cont'd)

MinimumItem Numbcr Soecificgtions

3.2 ImmobilizstionDevices

3.2.1 long spine boards 2 design approved by Ambulence Sendccs Branch, DHCS -smooth frnishd with sloe for a rninimum of 3 ssfetvrestraining straps each

3.2.2 short spine bosrds 2 or equivdcnt - with e mini6sp of 2 safety restnining strapsesch

3.2.3 head imnobilizers Z block qpe or equivdeot

3.2.4 ccrvical collars 6 rigid - verisblc sizcs from pediatric to tsll !o mectrequirements (sce Appcodix G)

3.2.5 extremity immobili- 4 rigid (inflatable/air splins not acceptable)zation devices

3.2.6 traction splint I Klippel, Herc or eguivalent

3.3 Oxygm Equipmmt

Note: An ambulance shell not rcspond on s call with less then the prescribed vol"me of oxygen. Aswell, en cxtra I hour supply sbell be provided as beck-up. (sce Appendix H)

A pulse oximcter is desirsble to eccuretcly monitor oxygco edministntion.te

3.3.1 oxygen cylinder I Main - CSA epproved hospial piped - designed & mounted towithstsnd high force collision - locgted in an gres tbat providesfor propcr bsl&ce and weight distribution -minimum cepecity3000 lilres with e mininum of 1200 litrcs evailgble whenresponding to e cell (chenge 8t 20o PSI for M cylinder) -duminum cylinden rccommended - controls sccessible -plessure geuge visible from eitber the etlen&nt's sert or thesqued-bcnch

I Porteble - ceprcity et lcast 300litr€s 'D' size (cbangc rt 500PSr)

3.3.2 regtlators, litre 2 one for cesh cylinderflow meter asscmbly

3.3.3 oxygen maslcs 8 transluccot disposable; edult (2), child (2), end infant (2)with obing sized Venturi; ed 100% ts6lpgthing (2)

3.3.4 nasal cannula, 2 disposable

3.3.5 pocket fgce rnssk 2 e4uipped with I way valve and 02 gdrninisg6tiea port, herdstrap ifappropriete

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Standards for Ambulance Serrices in New Brunswick

b-3. Patient Care Eouinment (cont'd)

MinimumItem Number Specifications

3.4 Bag Valve Mask 2 | adult & t pediatric size, portable, hand-openred bag valvenask (B.V.M.) system to Eeet requirements(see Appendix I)

3.5 Suction Apparatrs I vehicle mounted, electrical, prinery suction to meet C.S.A.hospital stsndards, a suction capacity such that the system hasc debit of 20 lJrnin rad creetcs sutic preszure of 300 'n- ofmercury in 4 secon&. Collection bottle with disposable liner,one-way valve to prevent back flow, I litre capacity.D

I Portgble - conteinsy with minimum capacity of 400 mls.

3.6 Suction Accessories

3.6.1 flexible suction catheters z disposable, graduated sizas

3.6.2 rigid suction cgtheters z disposable, tonsit wand tlpe

3.7 Oropharyngeal Airways 6 non-metallic, graduated sizes from pediatric to large adult

3.8 Portable First Aid Kit Ito indude:

3.8.1 bandagesgauze rolls 2 l0 cm (4 inchcs) Kling or cquivalenttriangular 4

3.8.2 steriledressingsgauze pads 12 l0 cm x 10.16 cm (4 inches x 4 inches) individuallyvrrappedabdominal parls 2pressurc dressings 2 witb sttsched bandagescye pads 4saline dressings 4 wet, slerile, individruly wnpped

3.8.3 adhesive repe Z rolls - 2.5 cm (l inch)

3'8.4 scissors I Psir - super sbeers 12.5 cm (5 incbes) or equivelent3.8.5 penlight I

3.8.6 blood pressure cuff I

3.8.7 stetboscope I

3.8.8 sugar packets 2 or equivalent

Page 17Part III

08t92

Standsrds for Ambulance Serrices in New Brunswick

b-3. Patient Care Eouipment (cont'd)

MinimumItem Number Soecifications

3.9 Vdride Supplies

3.9.1 bandagesgauze rolls 6 l0 cm (4 inches) Kling or equivalenttriaagular 6

3.9.2 steriledrcssingsgauze prds 24 l0 cm x l0 cm (4 inches x 4 inches)$dsminrl p6615 6cyc pads 6pressute dressings 4seliac dressings 6 wa, sbrile, individrully wrapped

3.9.3 adhesive tape 2 rclls 2.5 cm minimum (1 inch)

3.9.4 scissors I parr

3.9.5 penlight I

3.9.6 stethoscope I

3.9.7 blood prcssurc cuffs 2 I pediatric, I edult

3.9.8 saline intrevenous solution 2 1000 mls erch or cquivelcnt

3.9.9 intrsvenous infirsion sct 2 sten&rd

3.9.10 burn kit I dry stcrilc sheets end dressings only

3.9.11 duminum foil I roll

3.9.12 obstetricsl kit I stcrilizd prc,packaged Dpamcd or cquivdcnt

Page ltPsn m

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Standards for Ambulance Senices in Ner*' Brunswick Page f9Part m

b-3. Patient Care Eouioment (cont'd)

MinimumItem Number Soecifications

3.9.13 linenblankets 5 washable

2 heat-retsining, fluorcsccntsheets 4 cottonpillows 2 waterproof coveringbath towels 2pillow cases 4

3.9. !4 kjdney basins 2 or e4uivalent

3.9.15 latex disposable gloves l0 pair

3.9.16 sterile disposable gloves 2pair appropriate sizes

3.9.17 face shields/masks 2 | for esch "11gsrhnt

3.9.18 urinal I or equivalent

3.9.19 bedpan I

3.9.20 facial tissue I box

3.9.21 intravenous pole I for main strctcher

3.9.22 CPR boerd I or equivalent

3.9.23 sbarps container I puacnrre proof (C.D.C. approved)

3.9.24 triage tags 50

Note: AII equipment must be securcly fastc,ned.

c. l$

c-1. A maintenance and inspection progrem shall be established for all vehicles and r€ported on eprescribcdfonn that is computer adaptable. (see Appendix J)

c-2. Copies of the maintenancc record sball be made available to tbe lnspector on rpquest.

c-3. Copies of invoices for rcpairs should be accessible if requested by Inspcctor.

c-4. Each ambulence service shdl pcrform a consistent and regular inspection of equipment and shall replenishsupplies after each use.

c-5. Every ettendant shdl ensure that the vehicle supplies and equipment ere clean and serviceable et dl times.

c{. A minimum fuel level of 213 czprcity shall be maintained in the ambulance prior to eacb cgll.

oEp2

Standards for Ambulance Serrices in New Brurswick Frge 20Pan fV

Pan fV: Qrutity IVlanagenrent/Risk Management

a. Or.reliw Manepement

e-1. Eech snbulsnce service sbell bave a comprehcnsive prognm of qrrqli3l' Eaasgement sctivities designed tocDsurr thst escb pstient recives tbe bcst possible care. (sce Appendix K)

e-2. The ambulance scrvice sbdl be avail eble24 bours a day, with back-up from aeighbouring scrvices arrengedthrough mutusl eid agrecments.

e-3. A critical incident stress debriefing program should be evsilable 8s necesssry.

b. Risk Manasement

b-1. HazardousMaterials

Each attendant shall hrow how to recog'nize hezardous materiels, and procedures to be followed whendealing with a bazardous matcrial situation.6'B

b-2. Legal Issues (see Appendix L)

Each ambulance service shall have written policics end proccdures thgt 8re reviewed regutarly and reviscdas nocesssry, covering issues 'nrch rs cons€ots, BpE, child rbusc, polico crs€rs, Eodicslexaminers/coronerr' c8scs, pstient tre8tment r€fusats, medie rcletions, confidentielity, notifieble conditions,and do not resuscitale'.114

b3. Accideot Reporting

All molor vehicle rccidents involving an ambulsncc with &mages cxccoding $1,000 shlll be reportcd ona supplicd form !o tbe Ambulencc Serviccs Branch, DHCS.

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Sgndards for Ambulance Serrices in New Bnrrrsr'rick Page 2lPsrt V

Part V: Communication

a. Djslsb

a-I. Dispatcher:

l.l should be qualiflred in standsrd first aid and cardiopulmonary resuscitetion;

1.2 shall be knowledgeable of the geography of the sres;

1.3 shall be eble to hendle emergency calls and !o determine priorities. (see Appendix M)e

s-2. An smbulance shall be en route 8s soon as possible in l0 minutes or less from the time the elnergencyrequest is received by the disparcher.

b. Radio Communicstion

b-1. Atten.l2nts shall follow Department of Communicstions (DOC) Regulations for redio comnunications.e

b-2. Attendants shall be eble to provide the receiving hospital with the following informstion: age, gender,chief complaint, history of present illness - cxamination results, intervcntions, expcctcd time of arrival(ETA). (see Appendix N)

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Standards for Ambulance Serrices in New Bnrnsr*'ick

APPENDD( A: COMPONENTS OF AN EMERGENC}' I\IEDICALSERVICES (EM$ SYSTEIIT MODEL

Although not an inegral part of the standards, this Appendix is inchded as a usefal reference.

Emergcncy medical scrviccs in the United States bave developed since the 1960's from concepts that appropriatcprehospital tre8tment can reduce mortality and morbidity.s'6

Excerptcd from Emersencv Medicine Clinics of North America*

'Most EMS system models focus on functional componeuts. The Federal (USA) EMS Act identified 15 componentstbat grantees were required to addrcss. Other developers of EMS system standards dso adopted this approach,although using various listrngs oi system components. Tne rbderal oomponens were:!5

1. Manpower2. J6ining3. go6spnicstionS

4. Transportation5. Fecilities6. Criticel care units7. Pnblic safety agencies8. Consumer participation9. Access to csre10. Patient transferll. Coordinated patient recordkecping12, Public information and educationL3. Review and eveluation14. Dissster linkege15. Mutuel aid'

A-l

MI92

Standards for Ambulance Services in New Brunswick

Afuhough not an inegral pan of the $ardards, these program requirements are included as a useful reference.

Program requirements esteblished by tbe Consdisn Medical Association, reviscd 1991:!

Clinical Experieoce

A I-evel I program must include appropriate didsctic instruction and adequate clinical experience (hospitsl and

ambulance practicums) to ensure that students will acquire conpeteoce in Level I skills. The clinicsl prognm sball

bc bas€d on clearly defined objectives which are realisticelly echievable wirhin the time frames of the clinicel

rotations as specified by the prograrn.

The clinical program must include supervision appropriate to the student's level of compctence. Students Eust notperforur tasks beyond their level of training.

Assessment of Competencv

The clinical program must include an appropriate, documented evalu8tion Process to ensure tbat students beve

echieved the clinical objectives.

The ass€ssment of competency must be b8s€d on both acsdenic and clinical pcrforoancc, and the latter in both

simulated and real situations, wbenever possible.

Tbe end of the bospital pncticum end of the ambulance practicum are critical evalustion Poins; sNdents must be

carefully evaluatcd to ensurc ac4uisition of appropriate skills.

Proeram IJneth

The length of the verious components of a Irvel I program will depcnd on tbe objectives of the program. The

length of eech segment shall be sucb tbst rn 8versge student c8n meet the objectives within the specified time.

Tiry C.rideliles

The length of crrrrenily r.<,redited Level I prograrns in C8nsda vsries wirhin the following range:

Did.uctic segnent 180 - 260 hounHospital pncticum 24 - 72 hounAmbulance practicum 25 - 30 calls

B-l

0Et92

Standards for Ambulsnce Serric€s in New Brunswick

APPENDD( C: IMMIJMZATION OF HEALTH CARE WOR}GRS

Ahhough not an integral part of the Standards, this Appcilit is inclded as a usefil referene.

The following information excerpted from the Canadian Immunizatiou Guide?r is supported by tbe New BnrnswickDepartment of Health and Cornmunity Services @HCS).|o|

Hospital employees, laboretory workers, and otber healtb csre pcrsonnel are et risk of exposure to communicgblediscss€s becsuse of their contsct witb patients or material from patiens with infections, bo& diagnosed endgndiagnosed. It is thercforc most important thgt their basic immunizatiou be rmintained. In certein instqnces,depcnding on the n8ture of their employment, additional imrnunization msy trc indicatcd.

The immunization status of each worker should be assessed et the time of initisl employment. A full immunizgtionhistory should be elicited end efforts made to obtaia documentary evidence of tbe doses received and dates ofadministration.

Risk of infection varies with the worker's occupation and the type of facility; immunization policies should allowfor tbese differcnces.

Vaccines Recommended for All Health WorkersTt

Diphtheria and Tetanus Toxoid

lotsr"nization aggin5l diphtheria and tetanus is recommended for all aduls in Csnsds. The opportunity should betaken on entry into health carc employmcnt to ensurc tbat the appropriatc prirnary qourses and booster doscs asdescribed elsewhere in this Guide have been given. Bmster doscs of Td should be givcn toutinely every l0 yeers.

14eqsles Vaccine

Measles vaccine (given as MMR) should be givcn to health carc workers who were born gft€r 1956 and have nodocumented history of measles or of vaccinetion with live megsles veccine. Persons born bcfore 1957 hsve probablybecn infected naturally and mey be considered to be immune. It is not necesssry to initiste a serological testitrgprcgr8m to detect susceptibles.

Polio Vaccine

Prirnary immunizetion with inactiveted poliomyelitis vaccine (IPV) is indicsted for dl health care workers who hevenot had a primary coune of oral poliovinrs veccine (OPV) or IPV. (OPV is not recomme,nded for heelth cereworkers because they may stred the virus end inedvenently erpose immunocompromised patients to live virus).Persons wbo have previously bcen given less that a full primary oourse of OPV or IPV should have the seriescompleted with IPV regardless of the interval since tbe last dose.

c-r

0Et92

Standards for Ambulsnce Senices in New Brurswic} c-2

Rubella Vaccine

All femele employees wbo may become prcgnant should be immune to rubella. In addition, ell employees of eitbersex who may heve fsce-to-face contact with pregnant pstients should be immune to rubella to avoid trsnsnissiouof infection !o zuch paticnts. The immune stetus of new cmployees should be determined by review of immunizstionrccords or by scrological testing. Tbose who ere fouud to bc susc€ptible should be givcn rubells vrcciae unless itis contraindicsted. Adult fernales should be gdvised to evoid pregn8ncy for 3 months sftcr vscci!8tion.

Vsccines Recommended for Selective Use

Hepatitis B Vaccine

Hepatitis B vaccine is recornmended for thosc bealth carc workers who may be repeatedly exposed to blood or bloodproducts. Tne risk of exposure will differ according to locsl circumst.nces. E8ch institution or orgeni2ggisr shouldrcview its own experience with hcpatitis B aad develop its own priorities for immunizetion.

Influenza Vaccine

lnfluenza vscche is recommended for all hesltb csre personnel who heve extensive contsct with iadividuals in high-risk groups.

Typhoid Vsccine

Routine imruunization of health carc workers with typhoid veccine is not r€comm€oded.

08,t92

Standards for Ambulsnce Services in New Brun$r'ick

IPPENDD( D: PHILOSOPfTY OF MEDICAL CONTROL IN EI\TERGENC}' IT{EDICAL SYSTEI\I

Akhough not an integral part of the Standards, this Appendix is included as a useful rcference.

a. Medical Control

'Medical control is an essentiel concept in tbe development of a pre-bospital enrergency csre system. ln order to

have a medically sound, conpetent and credible system, including the necessery medical srrpcrvision strd control6ss!ani565, protocols and rcgulations, medical iaput must be obtained in tbe pln'ning, direction ead operation ofthe system. Medicsl authority gnd sccountsbility for pstient care Eust be provided for in pre-hospital end in-hospital emergency care. Medicsl supervision is essentiel to the provision of rdvanced life suPPort to petients stthe scene and during transpon.

Medical input is also essential in order to ensure the competence of ell pre-hospitel emergeocy care personnelthrough training, examination and continuing education progrsns, and rs part of the evdustion and auditing of thequality of csre provided. This may extend to the delegation of medical scts to energency medicsl gitesdqnts withadvanced emergency care training.d

Ambulance services deliver medicol csre to patients ouside hospitsl. Tbst carc is considered to be part of the hcsltbcBrc systeE, subject to medicel review and improvement.

Examples of Medical Control Onout)

D-l

l. Rlucstion

2. Designation of Fscilitie,s

3. Protocol development

4. Equipment standards

5. Quality management(see Appendix I)

6. Communications

7. Problem resolution

8. Advise / consultation on patient care issues

- essistence with continuing E€dicsl educstion of embulencepersonnel

- when eppropriete, sssistsnce with certificstion endreccrtificetion of embuhnce jitcadqnts at EMT l-evel I

- wher€ two possible sites exist for petieut to be 'delivered',

beve prior arruged protocols: traunra to one perticularhospital, cerdiac errest elways to tbe nesrest epproprialehospirrl

- for those issues not covered rmder training

- whcn appropriate, participale in rcview of individud cescs(risk rmnagement, audit, complaints, etc.) rnd in systcmimprovement (policies, procedures, progr8ms to 'c8re for tbecare givcrs' nrch as Criticlt lncidcnt Stress Debricfing)

- Iiaison role for medical 8sp€cts of ambulence services

- rssist'nce in relation to patient c,arp or tbe Emergency MedicalSysten (EMS) if not covered ebove

wt92

l .

2.

Standards for Ambulance Services in No*'Bnrnswick D-2

b. Roles of Medical Control Phvsicians

I-ocal Medicsl Control Physician (see Standards Part II, section f. p. 6)

Regional Ambulancc Coordinating Medic8l Consultant:- 8n emergency pbysician or physician with emergency medicine experience releting to ambulance scrvices

will advise the Regional Ambulance Coordinating Committep on Esttcrs relating to the practice ofmedicine in relstion to embulrncc services;

- will be a physician wbo precticcs medicine in thc region;- will bc familiar with embulancc serviccs in Ncw Brunsvick;- will bc knowledgeeble of medical control;- tcccpts responsibility for comrtr""ication with the medical community in the region, especielly re

changes in policy.

Consultent emergency physician to Ambulance Serices, Depertment of Heelth rnd Commrmity Sendces:- has primery role ss sn sdvoc8te for the csrc of the paticnt in Emergency Mcdical Systcms;- consrltrnt for medicel issues for Ambulance Services.

c. Phvsician Prcoantion

Department of Healtb gnd Comrnunity Services, Ambulance Services Brench will essist by providing educstionmaterials end coordinating mectings neoesssrJ for medicel conhol physicians to csrry out their men&te.

d. Advanced Life Procedures

Advenced Life Procedun3s !rc not the mandate of the Ambulrnce Services Act. Where performed by ambulencepersonnel, it is esscntid tbet they ere pcrformcd with propcr n€dicd ruthority. It is up to tbe physician. who aretransferring this function to ensur! thet the proccdure is propcrly teught, is certified and reccrtifiod approprietely,and tbat there ere eudits of pcrfomunoe. Tbe hospitals recciving the petic,ots from tbese rmbulanccs should 8pprcvethe transfer of function through reguler rdministntive cbanncls (Mdicsl Advisory Q6rrnmi116s, Hospital Board).Ambulance personnel who participate in Advrnced Ufe Procedures without tbe ebove critcrir do eo at their owurisk.

Advanced Life Support protocols sbell be registered with Ambulsnces Services Brrnch of the De,partment of Healthand Cornrnnnity Services as rcsogrce informstiOn.

Problems with AI.S procedures urd practice whicb cannot be resolvcd locelly or regionelly tnsy b referred to theDepartment's Consultant Emergency Physician.

3 .

0Et92

Standards for Ambulance Services in Neu' Bnrnsvick

APPENDTX E: POLICY ON USE OF EMERGENCY FLASHING LIGI{TS AND SIREN

Tbe followiag policy approved by DHCS is currently undcr review:

1. When en embulsrce is tnvelling !o an emergency call, end it is necesssry to exceed the qpe€d lirdts(bccause, for example, tbe circumstances of the accident sre not known to the driver), cmergcncy lightswith siren must be used in order to obtain the benefit of tbe exemptions provided for in Section 110 of theMotor Vehicle Act.t

2. Wben responding to 8n emergency csll with both the emergency lights and sircn being uscd, 8.n ambulancemey procced past a red or stop signal or stop sign, but only after slowiag donm gs m8y be necessary forsafe operation.

3. When an ambulance is:a) travelling to a catl and speed is not required, orb) csrrying a patient but hnste is unnecessary,emergency lights or sircn will not be used.

4. Wben an ambulance is carrying a patient to whose transportation there is some urgency, emergency lightswith siren will be uscd to clear an unirnpeded psssage.

5. The use of emergency or bazard lights simply es a safety devicc to show up the ambulsDc€, e.g. in bedweather, is not allowed. Headligbts should bc us€d in these circumstrnccs.

Pertinent Section of Motor Vehicle Actt

ll0(l) The driver of rn cutborized emergency vehicle, when responding to an emergency csll or wheu in thepursuit of an actuel or suspected violator of the law or when responding !o but not upon returning from a fire elarm,rnay exercise the privileges set forth in this s€ction, but subject to tbe conditions herein ststed.

I l0(2) Tbe driver of an authorized emergency vehicle may(a) park or srqnd, irresp€ctive of tbe provisions of this Act,(b) proceed past a red or stop signel or stop sign, but only after slowing down as Ety b necesssry for sgfeoperation,(c) exceed the speed limis so long as he does oo1 sgd-nger life or propcrty, rnd(d) disregard regulations govaning direction of movement or tuming in spccified direction.

E-t

0u92

Standards for Ambulance Services in Nen' Bnrnswick E-2

I l0(3) The cxemptions herein gruted to an authorized emergency vehicle apply only when tbe driver of eny suchvehicle while in motion sounds a bell, siren, or exhsust whistle, and when tbe vehicle is equipped with et leest onelighted lamp displaying r flashing red light visible under normel etmospheric conditions from e distance of onehundred fifty metrcs to the front of nrcb vchicle, exeept tbat en suthorizcd cmergency vehicle operated es e policcvchicle need not be "quippd with or display e rcd ligbt visible from in front of the vehicle ind the driver thereof,when following a sspected violgor of the lgw, necd not rcund eny audible sigosl.

110(4) This scction docs not relieve the driver of an euthorizcd emergcncy vehicle from the duty to drive with duercgard for tbe safety of ell persons and property.

225(3) Flashing or rcvolving lights ere prohibitcd on EotJor vehicles exccpt in the following crscs:

(s) en euthorized emergency vehicle,(b) 8 Departmcnt of Trensportstion vehicle,(c) a school bus,(d) s servicc vehicle,(e) any vehicle 8s a mesns of indicating a right or left orra, and(f) any vehicle equipped with an emergency flashing swilch pcrmitting the parking and teil ligha to flash onlywhen such vehicle is parked on the highway or 8ny portion thereof due to 8n en€rgency or under circunstencesbeyond tbe control of the driver.

0E,t92

Standards for Ambulance Services in Ne*'Bnrn-sr+'ick

APPENDIX F: AI\TBT]LANCE STRETC}IERS

Ahhough ,ot an intcgral part of thc Snndards, thb Appcndix b incldd as a useful reJerencc.

F-l

A - FAil Model30 CotThe Modcl 30 Cot edjusts to ssy of eightlevels for cesy tr:nsfer to or froE rny bcdor treatmcnt teble. For reasons of sefety,sttcn&nts must t$iun€ petient's weightprior to nising or lowering the cot. ThcModcl 30 Cot is well suited for usc bycither cnergcncy or invelid embulencescrviccs.

C - F il Modd 42 Stsir ChairDcsigncd for smsll storagc conpsrbcaB, thc Modcl42 SteirCbrir functions wcU in confincd rrces wcb rs Drrrowhellweys rnd nanow, multiple-lendiag steinnys. Vinyl-coetcd nylon cover is sain rtsist-'t end casy ts rn'ini'in. Irgstr8p ssyr/cs rs psticnt rcstnint rnd dso kecps steir cbrir infolded posilion during slorege. Inrcroationel Orenge. OrdcrModcl 38+A Febric Combiution Cerryingnildl Crsc.

0Et92

Standards for Ambulance Services in New Brun-swick F-2

D - F/W Model 107-C Combination Stretdrer/Chairlncludes ra edjrsable brckr*t scction, es wcll es tbe sten&rdfegnrr€s of other strcrchcr cbrirs. I-ording wbccls st be.dend, with wbccls end posts et fmt end. Folding cerryingbendles on both ends pcrmit eesy hrnl[fug of strercher evenwitb backrest elevatcd.

Ferno Model 9 Low-Fnofile StnetclerDcsigucd for usc in grtion wsgons or vehicles with limitodherd rmm. Heedad frec scction Glescopcs to shortca$rcrchcr. Brckrest is rdjusteblc 3o 8 englcs. Four-inchwhccls rt hcad cod with sutioorry posts 8t fmt eod. Folds inhelf for conprct stonge.

Soecifications

L€o8th, opco (strechcr)ninimum (stretcher)

Dcpth, foldcdwidrhHcight, opco (strercber)

foldcd (stongc)WcightLord ceprcity

fDcmO4X i*''s)f6lcal(64% irr"s)2OnQtA inchcs)$o(19% in'+q)16 cm (6 iachcs)%ca'(llk I'rdFc)

t kg (f7 pounds)l5etr CJsoFd)

0E,rvl

Stsndards for Ambulance Serrices in Ner'v BruNwick

APPENDTX G: REOIJIREITTENTS FOR CERI'ICAL COLLARS

l. Must srpport the weight of heed in normal flexion.

Z. Mrst provide -6 6sintqin traction on the neck and should pr€vent laterd, rotstional, rnd anteroposterior

EovemeDt of the head.

3. Should be comforuble, X-Ray translucent and compact enough to fit into the standerd psrsmedic equipment

box witbout undergoing deformity.

4. Should be eble to be applied reliably by a single trained technicien ard an ustrsired bystander.

5. Should be capable of sustaining rcpeated sanitation.

6. Should not itrterfere with psteDcy of the airway nor effect ccrcbral circulation.

7. Must be able to be applied in less thnn 60 secouds, in darkness, rain, cold witb or witbout manipulationof bead or neck.

8. Equal to or better than the Stiff Neck in immobilizing capacity.

: #1 - ? edapted from Clinical Procedurcs in Emergency Medicine, p.579.t2

G-r

08t92

Standards for Ambulance Senices in New Bnrnswick H-r

APPENDTX H: OXYGEN CYLINDER CONTENT

Although not an integral pan of the Standards, this Appedir is inclded as a useful reference.

Duration of flow for M cvlinder (in minutes) (capacity: 3,000 Liters)

Cslculated by Joe Noel to detcrmine en approxirnation of tbe total rcmainins oxvpen in an 'M' cylinder. (bascfactor of 1.57 is multiplied by the P.S.I.)rro

Litcr Flow Rete

PSI I 2 3 4 5 6 7 t 9 l0 l l t2

22W

20@

1800

1600

1400

1200

1000

800

600

500

2@

3015

2740

2465

2t90

1920

r645

1370

1095

820

685

275

1505

t370

r235

1100

960

820

685

550

410

340

135

lm5

915

820

730

640

550

455

365

275

230

90

755

685

615

550

480

410

345

275

205

175

70

603

550

495

40

385

330

275

220

165

140

55

500

455

410

365

320

275

230

180

135

1 1 5

45

430

390

350

315

2?5

?35

195

155

t20

95

40

375

345

310

275

240

205

170

135

105

8 5 '

35

335

305

275

245

2t5

180

150

t20

90

80

30

300

275

245

220

r90

165

135

110

80

70

275

250

2?5

200

175

150

t25

100

75

60

EO

230

205

180

160

135

l15

90

70

55

Mt92

Standards for Ambulsnce Senices in Ne$'Brunswick

APPENDD{ I: BAG.VALVE DEVICES

Bag-valve devices consist of a CSA approved self-inflating bag and s uon-rebreathing valve. They mey be us€dwith s Essk, an endotracheal tube, or an esophageal obturator airway. It is recomnended that these devices fulfilltbe following criteria:e' rj

l. A self-inflating bag that is easily cleaned and sterilized.

2, A non-jam vdve systcm st 15 L/min of oxygen inlet flow.

3. No pressure-rcleasc valve ('popoff velve'). If one is present, tbe vdve should be "t "uelly bypsssed topernit the higbcr pr€ssure needed to ventilete a petient with high airway resistsnce end low lungcompliaace.

4. Stan&rd 15 mml22 mrn (.6 inch/.86 inch) fittings.

5. A system for delivery of high concentrations of oxygen througb an ancillary oxygen inlet at the back ofthe bag or sn oxygen rescrvoir.

6. A true non-rebreathing valve.

7. Satisfactory pcrformance under extremes of environmental tcmperatures.

8. Suitability for manikin practice.

9. Should be available in adult and pcdiatric sizcs.

I-1

08t92

Standards for Ambulance Services in Ner+'Brunswick

APPENDTX I: \IEHICLE SERVICE AND MAIIIiTENANCE

Date: Vehicle No:

Mileage:

J-1

Dailv Serriee Check N/A c NC OK

l. Enpine oil level.

2. All liphts and sircn.

3. Visral inmection of tires.

4. Coolant level

5- \risr:e,l insnection of belts

6- Ooeretion of ell peuses.

7 - Trsnsmission level.

8. Radio check with P.M.C.C.

Repairs and Comments:

Everr 5-000 Km R-m0 miles) N/A c NC OIr

Chanse ensine oil end filter.

2. Clreck enpine coolant- hoses end clemns.

3. Check erhaust svstcm.

4. Check tire Dressurr end tircs.

5. Check transmission & differcntial oil levels.

6. HHlf"

stecring linkage snd all gr€8se

7. InsD€ct brake end fuel hoscs end lines.

Repairs and Corrrqents:

Even' 10-000l(rn (6-000 rnilesl N'A C Nf'

Insnect and adiust drive helrs

2. Check end clean air filter.

3 l-uhricale door hinoec rnd latehe<

4- I-uhricete nerkino hralce crhle nnd linlrnoa

5. Clean betterv terminels and insoect bstteries.

Repairs end Conments:

Mt92

Standsrds for Ambulance Serrices in New Bn t$wick J-2

Even 30.000 Ktn (lE.000miles) N/A c NC OK

Lubricate drive shaft Ujoiats-cgd slipsltaE-

2. Drain and refill transmisslQqllui.d,

3. Insoect front whcel beerings.

4. Insnect hmke lininps.

5. l-oad test b8tteries snd check charsins syslgls-

6. Check snrinss nnd shocks.

7. Front cnd dignment rnd belsnc€ wbecls ifnanlttnaal

8. Lubricste ball ioints.

Repeirs and Cornments:

Even 40.000I&n (2y',-000 miles) N/t c NC OK

Renlace soark oluss.

2- Reolece PCV filter.

3. Engine Cooletrt - flush rnd rcplece or st 36mrinths

4- Reolace eir filter.

5. Reolace fuel filter.

Repairs and Cornments:

l0-0m Km f48^lxl0 miles) NTA l,:NC rlIC

l - Ionition cetrle- distribulor elD end mtor-

), Rerrleee V tvne drive helts-

3. Replacc EGR vslve.

Repeirs and Comnents:

Completed by:

Motor Vehicle Inspection expiry drte:

I-esend:

N/A: Not appliceble, C: Completed, NC: Not Completcd0Et92

Standards for Ambulance Services in New Bnrnswick

APPENDTX K: SUGGESTED OUALITY MANAGEMENT ACTTVTTIES

Ahhough not an inegral pan of the &atdards, this Appendit b included as a useful reference.

Examples of pre-hospital emergeucy care quality sssurance ectivities:s.rr3

a. Promective Methods

- Initial training and continuing education prograns- Development of protocols and stgnding orders- Recertification- Collaborarion with the hospital energency department- Preventetive maintensnce progrsm for all vehicles- Vehicle and equipment checks

b. Concurrcnt Methods

- Direct communication between tbe etten&nt physicien end the embulrnce rttcnd"nt- Direct field observetion- Petient intervicws during cere

c. Retrosoective Methods

- Mdical debrieFrng- Auditf- Run report reviewss- Complaint review- Performence appraisals- Steff meetings - to identify problems strd solutions- Rendom mailing of questionnaires to pstieDts- Eveluation of response times - scene times

K-l

0t/92

Standards for Ambulance Serrices in New Bnrnswick I(-2

d. The following list of potcntial audis or analyses is excerpted from Pre-hospital Emergency Care ServicesGuidelines (p.17)."'

SUGGESTED ANALYS$ AND AIJDITS

Tlpc of csll end location of patient. (Catcgory)

Resource Requiremcnts Analysis: Time of &y, (anelysis should be based onone-hour intcrvds.) Day of wcck, (staffing, level of training, oquipmeat andvehicles).

Pcrformance Anelysis: (delays, r€sponsc timcs, timp Et sccae rnd trsvel times).

Demogrephic date.

Average trip distance/time (by time of day, &y of weck).

Presenting and suspected condition (morbidity, frequency distribution,observetional capability of EMA).

Trestments (outcomes, training and equipmcnt needs).

Others involvcd, gc,lrenl public, police, fire 8nd other egencics (rdeqrncy ofcoordingtion 8sd trsining, ctc.).

Equipment used (t1pe end effectiveness of cquipmcnt, invcotory control).

Follow-up intcgttd sudit Boedd for earlysis of system's cffectiveoess.

08,rn

Standards for Ambulance Services in New Brunswick

APPENDD( L: GI]IDELINES FOR POLICY DEVELOPI\TENT ON LEGAL ISSTIES(see Stsndards, Part fV, section b-2)

Although not an integral pan of the Standards, this Apperdix is includd as a useful reference.

l. Refusals Of Treatment

It bas bccome a basic accepted principle tbat 'every human being of adult yesrs and of sound mind hns fts

rigbt to determine wbat sball be done with his or her body'.t

The refusal of gn obviously injured or ill patient to conseDt to trcstEent is one of the lDost difficult

situatious in prehospital care. The critical stu&rd in dercrmining whether the refirsel should be accepted,

is whether tbe rcfirsing individual is a competent rnd conscious edult. A refusel of trestnent should notbe bonoured if the paticnt is a minor or apparcntly inpaired by elcohol, drugs, psychiatric disorder,rraums, or 8ny medical condition thet would affect the exercise of reasonable judgement.o

ln those instances wben treatment is reftrsed by a conscious, competent adult, ambulsnce Peronnel sbouldthoroughly document what transpired st tbe scene, instructions give,lr by supervisory personnel andcommunications with the patient and/or family members.E The patient should be esked to sigl a refus8lof service stetemeDt. This applies also when the ambulance is disparched uPon request of a third party,with zubsequent refusal of service by tbe patient.

Mentallv Disordered

In the Mental Health Act l(l), "menlsl disorder' means a substantisl disorder of thought, mood,perception, orientetion or rnemory that grossly inpairs a penon's(a) behaviour,(b) judgment,(c) capacity !o recogpize reality, or(d) ability to meet the ordinary demsnds of life,but does not include the disorder known as mental retardation;'s

Persons suffering from a mentel disorder ere entitled to anbulance services.

Under the Mentel Heelth Act, Pert II, 10, 'If e peece officer hes reesoneble grounds to beliwe thrt rperson(a) hrs threatened or 8ttenpted, or is thrcatcning or attempting, io ceuse harm to himself or herself,

O) brs behaved or is bebrving in a wey thrt ceuses or is likely !o cause rnotber person harm or is cnrsinganotber person to fear harm from the person(c) hes sbowu or is showing a lack of competence to care for himself or herself,and if tbe peace offrccr is of the opinion thst the pcrson is apparently suffering from e mentrl disorder ofa nature or degree that likely will rasult in barrr to the pcrson or berm to another person and tbet it wouldnot be reasonable to proceed in eccordance with scction 9 (an order for exemin8tion), the peace officer(d) nay take the person into custody and t8ke the person to a medicsl facility, physician's office orpsychiatric facility for examination, and(e) nay require any assistance the peace officer considers necessary from any other peace officcr or otherperson.'95

LI

2.

2 .1

2.3

08t92

Standards for Ambulance Services in New Brurrsvick L-2

2.4 Restraints:

2.4.1 Ambulance si6sdant5 shall only restrain patients st the direct request of a pbysician, police offrccr or intbe event that a patient becomes violent on route.

2,4.2 The cxleot of restraint shdl be 'the least restrictive and intnrsive' 'to protect Persons f1s6 rl'ngerous

beheviour caus€d by a mental disorder'.s

2.4.3 Where restraints are applied prior o departing tbe scene, en edditionel appropriate Person shnll gsssmPeny

the paticnt rnd the sttcndsnts in tbe paticot compartment of the ambulance.

2.4.4 Wbcn embulsnc€ sttendsnts rre involved in the rcstraint of e petient, they will gdvise dispatch or thereceiving facility rnd document:

- resson for restraint;- penson (pbysician/police officer or ambulance attcndant) ordering rcstraint;- metbod of restraint;- cons€quence of restrailt.

3. Pronouncement of Death

3.1 'An embulangs stlga.lant, policc officcr, fircman or ooroncr c&l prcnounce desth in cases where it isrrnmistakeoly clear that deeth has occurred, such es in crscs of decapitation, trenscction through the chestor ebdomen, incineration, or decomposition. In ell other ceses prcnounccment of deeth should be csrriedout by a physician. Where cven the Eost rcmote possibility cxise tbst &s visrim is still dive, one shoulderr on the side of caution and proceod rs if the patieat is Etill alive until a physician can make anappropriale rssessment.' Department of Hcalth and Cornmunity Servicrs policy stuenent, January 192.

In tbe cvent of an obvious death (see 3.1 ebovc):- police should be notificd immcdietcly;- the scene should bc lcft undisnrrbed in crses ofnrspccted foul pley end preserved for the police.

t.2 rrr rbrila cc scrvirci Should not trrnsport e dcad body.lsl

3.'i l"itb thc rdrmt of i'sue: srrch rs living wills rnd Do Not Rcsuscitei,e orders, it is cssartid tbet prchospitelpolicies be develoled to essist embuhnce pcrsonnel in these situations.'

0u92

Standards for Ambulance Services in New Bnrruwick M-1

APPENDD( M: BASIC DISPATCH INFORMATION

Ahhough not an integral part of the &ardards, this Appedit is inclded as a useful referene,

The disparcber is often the patient's first contect witb the Emergency Medicsl System. This individuel must poss€ss

special knowledge esd skills which dlow himAer to discenr the nerurc and urgency of the embulgnce call in order

to select the most appropriete response.e The dispatcher Eust be eble to assist those in nccd of Eodicsl

instructions, as well rs to obtein edditionel information which could be inveluable to the responding ambulance.x

Tbe following information should be obtained from the caller.

Adapted from: Medical Priority Dispatch System Case Entry Protocol.r

I-ocation:

Call Back Number:

Chief Complaint:(Wbat's lhe problcm?)

Age: - Ssx: -Male -Female

Conscious: - Yes

- N o

Breathing: - Yes

- N o

Name of Person Requesting tbe Ambulance:

wt92

Standards for Ambulance Services in New Bnrnsnick

APPENDTX N: SAMPLE PREHOSPITAL COI\|]\fIIMCATION RECORI)

Ahhough not an integral part of the Standards, this Appedix is included as a useful reference.

Date:

Narne:

t - o .

Code:

Gf rcqucrtcd by rccciving horpitd)D . O . B .

Doctor:

In ju ry :

B/P 1at

Pu1ge Rate:

Pulee Rhythm:

Reap. Rate:

Reep. Rhythm:

Temperature:

2nd

2nd

2nd

2nd

Skln Colour:

L .O .C . No rma l : Confuged:

Reaponde To Patn:

Pupils: Reactive

No.Respon3es

Non-reactive:

Normal r Di lated: Conatrieted:

Note: This sample prehospital comm"nication form is intended as a worksheet only and is not to replace tbeAsrbulance C.all Report form.

t{-l

08t92

Standards for Ambulance Serrices in New Brurrswick

APPENDTX O: SELECTED REFERENCES

1. Alberta Ministry of Health and the Alberta Association of Emergency Medicsl Services Physicians.Medical Control Guidelines. Edmonton, Alberta, January 1990.

2. Ambulance Services Act. Fredericton, New Bnrnsvick: Province of New Brunsvick, 1990.

3. Americen Associetion of Moor Vehicle Administrators, (AAII{VA), Manufacnrrcrs Guide for SafetvEouipment Services. Revised January 1990.

4. Anericstr Collegc of Emergency Physicians. 'Guidelines for Do Not Resuscitste Orders in the PrehospitelSetting.' Annsls of Emersencv Medicine. l7(October 1988): l106-1108.

5. American College of Emergency Physicians. -Principles of EMS Systems'. ACEPT Distribution Center,1989.

6. Americsn College of Emergency Physicians. 'Guidelines for Emergency Medical Systems.' Annals ofEmerpencv Medicine. t7(July 1988): 742-745

7. Americsn College of Orthopaedic Surgeons. Emersencv Csre 8nd Tr8nsportstion of the Sick & Iniured.Park Ridge, Illinois, 1992.

8. Americgn College of Surgeons, Comsrittee on Traumg. Essential Eouioment for Ambulances. RevisedMay 1986.

9. Anerican Heert Association. Textbook of Advanced Cardiac Life Suoport. Dellss, Texes, 1987,36-37.

10. American Heart Association. 'Stsndsrds snd Guidelines for Cerdiopulmonery Rcsuscitetion endEmergency Cardiac C8re'. Journal of the American Medicsl Association. 55(June 1986)z 2842-3W.

ll. ASTM (forurerly the American Society for Tcsting and Meterials) Designation F 123C89. StenderdSoecification for Minimum Performance Reouirements for Emersencv Medic8l Services (EMS) GroundVehjcles. July 31, 1989.

12. ASTM (forrrerly the Americen Sociery for Testing and Materiets) Designetion F 92G85. StandsrdSoecification for Minimum Perforrnance and Safetv Requircments for Rsuscitetors Interded for Use withHumans. June 5, 1985.

13. Bechman, John and McDonald, Gregory. 'A Study of Outof-Hospitals Crrdiec Arrests in NorthcastcrnMinnesou.' Journal of the Americen Medical Association. 2(September/October 1987): 3542.

o-l

0u92

14.

15.

Standards for Ambulance Services in New Brurswick o-2

Ballinger, Jeck. 'Secrets of Airway Management.' Emerpencv. December l9gg,47-49.

Baraes, Thomas and Stochvcll, Deborab. -Evaluation of Tcn Msnusl Resuscitators.' Respiratorv C-8rc.36(March l99l): 16l-173.

Barton, George. 'Tbe Wait for an Ambulance.' Journal of Emersepcv Medic8t Services. Decembert986,6749.

Beum, Scotr. 'Bssic Breathing: Use of Pocket end Bag Valve Masks.' Journal of Emerpcncv MedicslServices. July 1987, 57-58.

B8um, Scott. 'You Cen Breerhe Easy.' Journet of Emersencv Medicat Services. M"y 1989, 5962.

Baum, Scott. 'hllse Oximetry.' On Scene. October 1991, 4-S.

Boyd, Devid- 'Conccptuet Development of EMS Systcms in the United States.' Emerqencv MedicalServices. JanuarylFebnrary 1982, lg-26.

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61. Fitzpatrick, Stepben. 'Lost in tbe Legal Maze.' Emereencv Prehospital Medicine. 3(July L989):29-32.

62. Fitzpatrick, Stephen. 'Ambulance Senices & Tbe l-aw: Working in tbe Fast Lane.' EmerpencvPrehosoitsl Medicine. 4(JanuaryiFebruary l99O): 27'3 l.

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65. Golden, Joscph, Jr. 'safety & Healtb Compliance fs1 llamet - The'Hazwapcr' Stqndard.' Jounrel ofEmereencv Medicsl Servic€s. October 1991, 28-33.

66. Goldstein, Arnold. EMS end the l-aw. Robert Brady Co., Meryland, USA 1983.

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