Purpose

To establish guidelines for the operation and maintenance of the ambulance.

Policy

1. Employees will use the unit designated by the rotation schedule. If there is a problem with the assigned unit, employees will switch to the off line unit only with direct approval from management.
2. The ambulance’s mechanical function will be checked out by the crewmember according to the daily check off sheet with all discrepancies noted on the check off sheet.
3. Any minor repairs, which can safely be done by the crewmember, will be done during check out.
4. Repairs requiring special equipment or expertise will be recorded on “Vehicle Needs Attention or Out of Service” form (Green Form).
5. Communications must be notified prior to a vehicle being taken out of service.

Ambulance Operations

Only City Ambulance employees are authorized to operate or drive any equipment or vehicle owned by City Ambulance. Any unauthorized use must be reported to the supervisor immediately.
All employees will have in their possession a valid, properly classed drivers license and must be insurable to operate company vehicles.
No employee will operate any company vehicle with illegal drugs in his/her system or while impaired by alcohol, prescription drugs or over-the-counter medications.
No employee shall consume any alcoholic beverage, regardless of its alcohol content or be under the influence of an intoxicating beverage within 4 hours of reporting on duty.
Employees must verify safety belts are in proper working condition and must be worn while the vehicle is in motion.
The off-going crews will give a verbal report to the on-coming crew as to the status of the ambulance and station.
Headlights are to be on anytime the ambulance is in motion, regardless of the time of day.
While the ambulance is in motion, the passenger will be the primary person to operate the radios.
At no time will the AM/FM radio be set at a volume where the ability to hear the Med Net radio is compromised.
The Med Net radio will be set to the scan mode at all times.
Non-pertinent channels may be locked out, however all Med Net dispatch channels must remain unlocked.
Ambulances will be operated within the provisions of the law at all times. This includes but is not limited to obeying the posted speed limits and laws regarding controlled and uncontrolled intersections, with the exceptions of Code 3 Driving.
At no time will an ambulance be operated at a speed or in a way that is unsafe for road, weather or visibility conditions.
Smoking will not be permitted in or near the ambulance at any time.
EMT students and all non-employees must ride in the front passenger seat while transporting a patient. Exceptions to this are MICN’s, paramedic interns, law enforcement, firefighters or anyone approved by management.

Transporting Patients

While transporting patients, the driver will operate the vehicle smoothly and in such a manner that will permit the primary care provider to safely provide medical care to the patient.
The patient will be properly secured to the gurney with straps and all patients will be placed into and out of the ambulance by gurney, except when it is not reasonable to do so.
Transportation of anyone other than the patients is prohibited without supervisor approval. The following exceptions may be made
· Only the parent or guardian of a minor child
· An interpreter
· Minor with a parent being transported, if this would cause the minor to be left unattended.
Transportation of pets is prohibited in company vehicles with the exception of service pets.
Whenever possible, attendants, riders, interns and first responders will wear a safety belt while assisting with patient care.

Parking

1. The ambulance will be parked in a safe area, which protects the crew, patient and the unit. Prior to parking on scene, precautions for hazardous conditions will be observed, including but not limited to the following:
Parking a safe distance from any potential hazard
Parking clear of hazards such as power lines
Parking uphill from any spilled fluids
Parking upwind when there is potential of fire or airborne contaminants.
The parking brake will be set anytime the vehicle is not in motion.
When parked, always turn off the battery switch on the unit except when on a scene of a call.
Do not park in a way that has the potential to obstruct exit from the scene.
All parking laws will be obeyed.
The ambulance will be locked anytime it is unattended.
Emergency lights will be turned off while on scene unless the ambulance is creating a traffic hazard.
When on detail or code 7, the driver will attempt to park in a space where backing is not required either when parking or leaving. If such a space is not available, the operator will back into the space using a spotter so they can pull out forward in case of an emergency call.

D. Unattended Vehicles

1. When bringing a patient into a facility, the ambulance will be turned off upon arrival.
2. When the vehicle is left running on scene and will be unattended, the vehicle will be locked. To allow for this, each unit is provided with three complete sets of keys- one for the ignition and one for each crewmember.
3. While on scene, a police officer or firefighter should be asked to watch over the unit in your absence if available.

E. Backing

The ambulance will not be placed in reverse gear or backed up until all of the following have been done
· The unit has come to a complete stop.
· A spotter is in place 8-10 feet to the left rear of the vehicle.
· Eye contact has been made with the spotter through the left-hand side rear view mirror.
· Voice or hand communications have been established with the spotter.
· When a spotter is not available, the operator must park the unit, get out and walk around the unit to survey the backing area.
2. A spotter is not mandatory in the following locations:
Parking spaces provided at all stations.
Backing up to hospital emergency doors.
However, if any unfamiliar objects or vehicles are present or out of
place a spotter will be used.

F. Code 3 (Life Threatening Emergency) Driving

Code 3-ambulance operation is very dangerous and should only be used in life threatening circumstances or by request of the dispatcher.
When operating code 3, the driver will activate the headlight flashers, all emergency lights and have the siren in the ready mode.
When sirens are necessary the wail mode will be used.
The driver will maintain a four-second following distance.
The vehicle operator will use the left lane of traffic at all times with the exception of one-way streets where 3 or more lanes are available, at which time the center lane will be used.
The vehicle operator will make all passes to the left of traffic with the following exceptions.
If the traffic pulls to left and stops, the operator will slow to a safe speed, make his/her intentions clear and proceed to the right of traffic practicing, “Due Regard”.
If the traffic pulls to the left and stops at an intersection, the operator will come to a complete stop at the vehicles right rear, deactivate the siren and proceed to the right of traffic practicing due regard.
The maximum speed while operating code 3 shall be 10 miles per hour over the posted speed limit with the maximum speed being 70 miles per hour.
Proper use of signaling and warning equipment is not enough. Never travel at a speed that does not permit complete control of the vehicle.
The ambulance operator will come to a complete stop at all controlled intersections where they do not have the right-of-way.
150 feet before the intersection the operator will switch the siren to the yelp mode.
After assuring all cross traffic is stopped and eye contact has been made with all other drivers, the operator will proceed through the intersection while practicing ‘due regard’.
After clearing the intersection the operator will switch the siren back to the wail mode.
Emergency lights should be turned off on scene unless the ambulance is creating a traffic hazard.
Electronic air horns are not to be used at any time.
Vehicle operators must follow the direction of traffic control officers regardless of code 3 operations.
Code 3 operations must cease and you must stop when a school bus has it’s stop signs or flashing red lights displayed. This includes operation in the opposite lane and direction of travel. The exception will be when a barrier or median separates the lanes. Operation may only proceed only when the signs or lights are no longer displayed or the school bus driver motions the ambulance operator to continue.

G. Fueling

Ambulances will be fueled in the crews designated response area and will use a CFN card lock whenever possible.
If an alternate fueling site is used the receipt will be saved and given to a manager.
The odometer reading will be entered accurately.
When inputting the unit’s mileage the operator will not use tenths. On units with over one hundred thousand miles the operator will include the first digit of the mileage.
When fueling the unit the following safety practices will be observed:
The engine will be turned off prior to fueling.
Smoking will not be allowed in the vicinity of fueling operations.
Fuel tank caps will be replaced and secured before starting the engine.
Fuel tanks should be at no less than ¾ of a tank at any time.

H. Gurneys

a) Use of Stretchers When Loaded With a Patient

1. When a patient is being moved on a stretcher, both attendants must maintain a firm grip on their respective ends (foot and head).
2. The stretcher should be rolled on the long axis, feet first, and not sideways as it may tip if a wheel hits an obstruction.
3. At no time shall any objects be placed under the stretcher mattress that could cause the locking mechanism to fail. This includes blankets, pieces of cardboard, etc.
4. Whenever a patient is placed on the stretcher, all straps/belts will be securely fastened to prevent the patient from shifting or falling from the stretcher in the event of a sudden stop or impact.
5. CAE employees must be in control of both ends of the stretcher at all times. Additional assistance may be requested from first responders to safely lift heavy patients or when negotiating hazardous obstacles.

b) Inspection and Care of the Ambulance Stretchers

1. At the beginning of each shift, it shall be the responsibility of the driver to remove the stretcher from the ambulance and physically check it for overall tightness, working locking mechanisms and general overall condition.
2. If there is a problem or concern as to the reliability of the stretcher, it shall be immediately taken out of service and management should be contacted.
3. After each patient, the stretcher will be disinfected and wiped down as necessary and linens replaced.