Ambulance
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Ambulance |
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| Abbreviation: | KTW |
| Crew: | national regulations, usually a paramedic and a rescue worker |
| Commitment: | usually ambulance , repatriation service |
| Furnishing: | DIN EN 1789 Type A: Ambulance Cars |
An ambulance ( KTW ) is a transport vehicle in the rescue service and in the medical service for non-acute transport of injured or sick people under suitable transport conditions including support by qualified personnel. Other colloquial names are ambulance , ambulance and Sanka . These terms are also often used for ambulances (RTW) and related emergency vehicles, although this is not correct due to differences in their equipment and their purpose. Compared to the ambulance, both the medical equipment and the qualification of the staff are lower.
tasks
An ambulance is mainly used to carry out qualified patient transports . Common types of patient transport are:
- Transport to the hospital (briefing by a family doctor or as part of a medical service at major events)
- Transport to a specialist (ordination, medical center)
- Transport from the hospital or specialist back home (apartment, retirement home)
- Transfers between hospitals
- Ambulance trips, e.g. B. for dialysis or to change the catheter - the patient is brought for treatment and then driven back again
- Carrying out the transport of blood products when no other vehicles are available
- Compulsory admissions for mental illnesses (partly with police escort)
Since an ambulance usually does not carry out rescue operations, it seldom drives with a special signal (" blue light " and acoustic horn ), but is equipped with it in an emergency . The crew has been trained in rescue services and can provide first aid and emergency transport if necessary. In this case, the transport is billed to the patient or the health insurance company in the same way as an ambulance. As a rule, however, an ambulance or an emergency doctor's vehicle (NAW) is used for ground-based emergency rescue .
In the following exceptional cases, an ambulance can carry out emergency rescue missions , also using special rights and right of way :
- next vehicle on site, similar to on-site helpers
- no ambulance available as they are all already in use
- Sending an ambulance appears unjustified based on the emergency call information
- " Mass casualty " (MANV)
If it turns out in the course of an operation (transport) that the ambulance cannot guarantee sufficient care (for example in the event of a drastic deterioration in the patient's condition), the rescue service personnel will request an ambulance or an emergency doctor or transport depending on the location of the nearest hospital and the situation continue with special signals.
crew
During the ambulance transport, the patient must be lifted and carried and continuously looked after during the journey, which is why the crew always consists of at least two people.
In Germany, the required manning of an ambulance is regulated by the rescue service laws of the individual federal states. There are always at least two people, of whom the technically better trained must be a paramedic in most countries , in Schleswig-Holstein and Thuringia a paramedic , whereby in Thuringia the minimum requirement consists of two paramedics and in Lower Saxony "suitable and reliable" (§ 10 NRettDG). Often, federal volunteer service providers , FSJler or volunteers with training as rescue workers used as a driver.
In Austria, a KTW must be manned by at least two paramedics, but often better-trained emergency paramedics are also deployed on ambulances. A common crew in Austrian ambulance transport is a full-time or voluntary driver as well as a civil servant trained as a paramedic who looks after the patients. In some federal states, however, longer-serving civil servants are also used as drivers.
In contrast to the ambulance, the KTW is seldom manned by three people, since from the point of view of the organizations commissioned with the ambulance the low added value does not justify the higher personnel costs. Most often, teams of three occur when a new employee is admitted or the patient should require a special caregiver.
technology
Vehicle types
In an ambulance less equipment is carried than in an ambulance, it is not designed in and of itself to treat patients in it, therefore more compact and cheaper vehicles are used. The most widespread are small vans ( VW Transporter , Mercedes Sprinter , Fiat Ducato , Opel Vivaro as well as Ford Transit and especially Ford Transit Custom ), some with high roof construction. There are also ambulances based on a Mercedes-Benz E-Class in the high-long design.
Furnishing
The dimensions and equipment features of ambulances are standardized across Europe. Essentially, the specific minimum equipment consists of a stretcher , carrying chair , oxygen system, suction pump , portable emergency equipment and bandages. Additional medical equipment is a voluntary service provided by the rescue service provider or is available due to local regulations and therefore varies greatly.
Basically, four types of ambulances are defined by DIN EN 1789, whereby the minimum equipment increases from type to type:
- A1 - Patient Transport Ambulance (for one patient) → Ambulance
- A2 - Patient Transport Ambulance (for one or more patients) → ambulance
- B - Emergency Ambulance → emergency ambulance
- C - Mobile Intensive Care Unit → Ambulance / ambulance
In the German-speaking area, the A1 type is practically not used for qualified ambulance transport due to insufficient requirements for equipment. Vehicles of at least category A2, which are also equipped with important aids such as a defibrillator or a vacuum mattress , are contemporary today . According to standardization, two patients can be transported in these vehicles at the same time if necessary. The type C listed above for the sake of completeness no longer corresponds in terms of equipment to the usual ambulance, but to the related ambulance .
Coloring
The most common basic colors are white, red and ivory ( RAL 1014), as is the case with ambulances, while sulfur and euro yellow (RAL 1016) are now also used. Often the vehicles are supplemented with circumferential, contrasting colored stripes or foil stickers (e.g. in "daylight red" according to RAL 3024) made of fluorescent and / or reflective material . For better identification, the vehicles are also often stuck with the logos of the operator organizations, the designation rescue service or ambulance and their radio call name. Regional differences and legislation must be observed here.
communication
The ambulance is permanently connected to the control center via radio , in Germany in the public rescue service via the BOS radio . In Austria, work is currently being carried out on a nationwide uniform radio system for emergency organizations (see BOS radio system in Austria ). On the one hand, classic voice radio and, in some cases, special data radio ( e.g. POCSAG ) are available, via which the rescue control center can transmit transport information such as the location of the call, the place of delivery, the patient's name and the like. Rescue personnel can also use radio data transmission to provide simple information about the position and readiness for use (" status ") of their own vehicle. In some areas, the vehicles also have GPS location transmitters, so that all vehicle locations are transmitted to the control center in real time become. An alternative communication option that is often used are commercially available cell phones , which are used primarily in cases of overload or failure of the radio system.
Historically, communication and thus the entire handling of operations has improved enormously thanks to the new technical possibilities. In the middle of the 20th century most rescue services did not have a radio system for technical and financial reasons, and vehicles that had moved out had to rely on telephone systems in hospitals , police stations and local telephone booths for communication . Later, the use of simple voice radio systems similar to CB radio began . The next technical innovation was the gradual introduction of analog data radio at the end of the 1980s and the beginning of the 1990s , especially the radio reporting system . Since the turn of the millennium, GSM and GPS technology, which has become cheap, has found its way more and more into communication and coordination. The last technical advancement are tap-proof and powerful digital radio systems that can be used across all authorities in the event of a disaster . Nevertheless, there is still room for improvement, especially when it comes to data exchange between the emergency services and hospitals, which in many places is still carried out manually using their own transport tickets.
Special shapes
There are various ambulances that specialize in certain applications and are therefore a good addition to conventional vehicles. These include in particular the following vehicle types:
- 4-stretcher KTW (KTW-4) : A special form is the 4-stretcher ambulance with two stretchers one above the other on the left and right. This type of vehicle is used in disaster control and in rapid response groups as well as by the German Armed Forces (here under the name of ambulance vehicles (KrKw), often based on the Unimog 435 ) and has the purpose of transporting the injured from the damage site to treatment centers further away in extreme damage situations also to support the rescue service and to relieve it with its transport capacity. Adequate patient care is no longer possible in this vehicle when fully loaded, so that only slightly injured people should be transported. However, it is also possible to operate the vehicle with just one, two or three stretchers. The unneeded carrying tables can then be folded up against the wall to save space.
- 8-stretcher KTW (KTW-8) and large capacity ambulance (GKTW) : Used to transport eight patients. These designs are hardly suitable for transporting seriously injured patients, even in disaster control . A GKTW can also be used very well as a first seat and collection point for uninjured people (e.g. for residents of a burning house).
- Infection KTW : for patients with infectious diseases (such as MRSA or tuberculosis ; see article " Infection "). The interior is reduced to the bare essentials to facilitate subsequent disinfection . In some cases, the patient room is also designed in such a way that it can be cleaned easily (no grooves, smooth surfaces, etc.).
- Newborn KTW : a KTW with special equipment for the transport of newborns or infants, this includes e.g. B. an incubator , emergency baby equipment and appropriately experienced personnel such as e. B. Pediatric nurse or pediatrician . If no newborn KTW is available, many KTWs can also be converted for incubator transport by replacing the vehicle's own stretcher with an incubator with a suitable chassis.
- Medical vehicles (military) : Name for military ambulance or field ambulance , which are mainly used for the evacuation of injured persons from unsafe areas. These are mostly armored and robust military vehicles with all-wheel drive , which can be recognized by their olive-green coloring and a large red cross or red crescent moon . They therefore differ greatly from civil ambulances.
- Hochlang : Common name for ambulances with a special design. This design is based on large car chassis (almost exclusively Mercedes in Germany) with a longer and higher body. This design was very widespread in Germany from the late 1960s to the mid 1990s. Occasionally, high-length KTWs have also been built on chassis from Opel.
- Heavy-duty KTW : Describes an ambulance with which very obese (overweight) patients can be transported as gently as possible (for patient and staff). Heavy-duty ambulances are available (just like heavy-duty ambulances) in different technical designs. Some of them use special stretchers (which can hold up to more than 500 kg) or they can transport entire hospital beds .
Users
In Germany, ambulances are available from aid organizations (within the scope of the rescue service, disaster and civil protection ), private rescue service companies, the Federal Armed Forces and some large police forces (for police officers; e.g. Federal Police and Bavarian Police) as well as fire departments that are active in the rescue service, in use.
maintenance
The crew of an ambulance is responsible for the maintenance of the vehicle. Maintenance includes the following activities:
- Checking the operational readiness of the vehicle
- This activity is carried out before each start of work. It is of great importance as the crew cannot rely on finding the vehicle in the same condition as it was when the duty ended. The car may have been changed or the car was used on the night shift . It is necessary to check the road safety of the motor vehicle, including the special signal system , and check the medical equipment on board (devices and sufficient consumables for the entire shift). In contrast to the ambulance, a return to the base is usually only ordered by the control center at the end of duty when the order situation is high .
- Ongoing restoration of operational readiness
- After each transport, the crew ensures that the vehicle is reasonable for the next patient and restores operational readiness. In order to maintain hygiene , cleaning and disinfection work has to be carried out again and again . Unforeseen bottlenecks in important consumables such as oxygen are reported to the control center and rectified immediately by approaching the base.
- Cleaning the vehicle at the end of the day
- At the end of duty, the vehicle is subjected to an exterior wash, if necessary, and the interior is freed from weather-related dirt. The waste is also disposed of and, if necessary, consumables are added.
- Weekly scrub-wipe disinfection
- A so-called scrub-wipe disinfection with a specified concentration solution takes place every week. The exposure time and the change of agent must be taken into account in order to be able to counteract possible resistance formation. Also dependent on the concentration of the agent is the personnel required for this, which has either received special instruction from the head disinfector or consists directly of a disinfector. The measures are usually written down in a binding hygiene plan .
- Complete review
- Depending on local and internal organizational requirements, a complete check-up is sometimes carried out independently on a monthly basis in order to replace expired medication and sterile materials (e.g. bandage packs or intravenous cannulas).
It can also be ordered by the control center. This includes the holistic inventory and inspection of all items on board as well as the complete cleaning and disinfection of the vehicle and must be fully documented. Since a conscientious implementation takes several hours, intensive care is only ever assigned to individual vehicles at times when there is little order.
See also
Web links
Individual evidence
- ↑ Photos of ambulance type "Hochlang". on: rettungsdienst.net
- ↑ Emergency vehicle: Florian Opel Bochum 01 / 85-01 (aD). bos-vehicles.info
- ↑ http://drk-goe-nom.de/Rettungsdienst/Fahrzeuge-und-Personal/Spezial-KTW-fuer-Adipoese ( Memento from May 11, 2009 in the Internet Archive )
