Ch.38 Transport Operations
You’re first on scene to a major crash on a highway. Traffic is still moving, and debris is everywhere. Where do you park the ambulance and why?
You park the ambulance to create a protective barrier between traffic and the scene, leaving room for safe patient loading. Use vehicle as a shield.
Why should you never stand directly in front of a crashed car’s bumper?
Because shock-absorbing bumpers can pop out suddenly and injure you.
You arrive at a bus crash with several injured passengers. Some are walking, one is not breathing, and another is bleeding heavily.
What is the first thing you should do to start organizing patient care?
Begin START triage — tell everyone who can walk to move to a safe area (they’re green-tagged “minor”)
You arrive at a crowded subway station after a loud explosion. There’s smoke, debris, and several people with burns and penetrating injuries. What is your first priority, and what steps should you take before entering the scene?
First priority: Scene safety do not rush in.
Actions:
Assess for secondary devices or ongoing hazards.
Wait for law enforcement or bomb squad to declare scene safe.
Establish command and begin triage once safe.
Use PPE appropriate to the hazard.
Dispatch calls for an air evac due to a mountain crash. You’re assigned to secure the landing zone. How big should the landing zone be? How and when do you enter the helicopter?
Landing zone should be at least 100 ft x 100 ft and on level ground.
Only enter when the flight crew tells you too, do not approach from the rear (tail rotors = invisible blender)
What’s the difference between simple and complex access?
Simple access means getting to the patient without tools (like opening a door).
Complex access needs special tools or training (like cutting metal).
You’re the first EMT to arrive at a bus crash involving 25 passengers. Fire and police haven’t arrived yet.
What’s the first thing you should do to begin organizing the scene, and which command role do you take on initially?
Establish Incident Command and announce it over the radio
Begin a scene size-up and request additional resources.
As the first on scene, you act as the Incident Commander until relieved by higher authority.
A victim near the epicenter of an explosion has ruptured eardrums and lung injuries but no external trauma. Another has experienced debris hitting and impaling their chest, and a third was thrown into a wall. Identify the type of blast injury each victim sustained.
Ruptured eardrums & lung injury → Primary blast injury
Shrapnel wounds → Secondary blast injury
Thrown into wall → Tertiary blast injury
You approach a red light at a busy intersection with lights and sirens activated. You can see cross traffic but they don’t seem to see you.
What should you do before entering the intersection?
Come to a complete stop.
Make eye contact with other drivers.
Proceed slowly only when the intersection is fully clear.
Even in emergencies, you can’t assume right of way.
Explain what two of the colors on a hazardous material diamond represent.
blue shows health hazards.
red shows fire hazards.
yellow shows reactivity hazards.
white shows special hazards (like radiation or corrosives).
During a multi-vehicle pileup, one team is tracking ambulance fuel and supplies, another is keeping records of expenses, another is assigning triage and treatment teams, and a fourth is creating a plan for the next operational period.
Identify each Incident Management System section at work and their main responsibility. (command, finance, logistics, operations, planning, ect.)
Logistics Section – tracking supplies and support (fuel, food, water)
Finance Section – managing costs and documentation
Operations Section – managing tactical response and patient care teams
Planning Section – forecasting needs and developing the action plan
At a concert, multiple patients are found with pinpoint pupils, excessive drooling, vomiting, and difficulty breathing. What type of chemical agent is most likely involved?
Nerve agent (e.g., sarin, VX, soman, tabun)
You’ve just arrived at the hospital with a trauma patient. What’s the proper order of operations before you go back in service?
Notify dispatch and the hospital you’ve arrived.
Give your verbal report and hand off care.
Obtain signatures for transfer of care.
Restock, clean, and prep for the next call
What is the EMTs hazmat training level called? What are the top two priorities for EMTs at a hazmat scene?
First responder awareness level
1. Personal safety and 2. Patient care in the safe (cold) zone
In START triage system, what does the RPM method stand for?
R = Respirations:
Not breathing after airway opened → Black (Expectant)
Breathing after airway opened → Red (Immediate)
30 breaths/min → Red
P = Perfusion:
No radial pulse / cap refill >2 sec → Red
M = Mental Status:
Can’t follow commands → Red
Can follow commands → Yellow (Delayed)
Green: Minor (walking wounded)
Black: Dead or dying
After a suspected dirty bomb explosion, several people are covered in dust and ash. Some are vomiting and report dizziness. How should you protect yourself and others from radiation exposure?
Wear PPE
Move patients from the hot zone
Decontaminate (remove clothing, brush off dust, rinse exposed areas)
Provide supportive care for symptoms
Simply describe the three main types of ground ambulances
Type I: Truck chassis with a modular ambulance body
Type II: Standard van design
Type III: Specialty van with a square patient compartment mounted on the chassis
What do the hot zone, warm zone, and cold zone represent for hazardous materials?
Hot zone is the most dangerous place to be, closest to the hazardous materials. EMTs should never be in hot zone. The warm zone is for decontamination and only life-threatening care. The cold zone is safe for patient treatment and transport.
How does JumpSTART triage differ from adult START triage?
For children under 8 years old
If not breathing, open airway:
No pulse → Black (Expectant)
Pulse present → Give 5 rescue breaths
If breathing starts → Red (Immediate)
If no breathing → Black (Expectant)
Respiratory rate <15 or >45 → Red
No palpable pulse → Red
Mental status: inappropriate response or unresponsive → Red,
appropriate → Yellow
Over several days, patients across the city report fever, weakness, and respiratory distress that appear flu-like. Hospitals notice the same symptoms in dozens of unrelated people. What type of weapon of mass destruction does this indicate, and what should EMS providers focus on?
Type: Biological agent (disease-causing organism)
EMS focus:
Use PPE (gloves, mask, eye protection)
Isolate suspected cases
Notify public health authorities
Supportive care (airway, oxygen, fluids)
Prevent secondary contamination