Preventing and Handling Your Own Emergencies

If your agency does a great job of maintaining your ambulance, count yourself lucky. There are organizations that respect neither the value of their people nor the consequences of sloppy fleet care. Ambulances are complex machines. Even with expert maintenance, they’re made of parts that wear and eventually fail—just like the human body. In this final installment of Ambulance A&P, we’re going to walk you through a good vehicle checklist—and a couple of risky emergency procedures you may need to handle when there’s no one to help you: jump-starting your engine and changing a tire.

Your Vehicle Checklist

Your first job in EMS isn’t to save people’s lives, and it has nothing to do with being a medical genius. It’s to come home safe to your family. That presupposes a realization on the part of you and your agency that you are not an expendable resource. You are valuable. Irreplaceable. Losing you would hurt us all.

But if you don’t thoroughly check your ambulance at the beginning of every shift, you’re goofy. All that scene safety stuff you practice at every skills station in every recert exam is garbage, because you have no assurance of ever reaching your next scene. These are strong words. But somebody needs to say them, because too many of us don’t bother to check our ambulances before we head for Starbucks. If your agency won’t build checkout time into its schedules, find another agency—or come in early and do it on your own time. Or do it at Starbucks. But do it. There, that’s out of the way.

There are two ways to check an ambulance, and you need to do them both in the same order every time. The static check looks at the things you can see without starting the engine. The dynamic check looks at things you can only see with the engine running.

Static Check

Always start a vehicle check the way you approach an unfamiliar scene: from a distance. Even your own ambulance may not be the same vehicle you worked in on your last shift. Look at the thing, and ask yourself if this is an ambulance that could end your life. Is it sitting level on level ground? Are there fluids under it? Is there new body damage?

Conduct a walk-around, which is a lot like a scene assessment. Examine the tires for abnormal or excessive wear. (Do they appear to be inflated normally?) Check your fuel. You should probably start your shift with full tanks. You have no idea what’s ahead of you, and refueling is so easy. (Incidentally, if you ever put gas in a diesel tank or diesel in a gasoline tank, avoid starting the engine and call your fleet staff immediately.)

Check your O2 levels, both in the portables and in the big tank. Do that specifically before you check your fluids, to keep the fluid residues away from your O2 systems. (The combination can cause fires.)

Pop the hood and check the motor oil before anyone starts the engine. (Put the keys in your pocket, so somebody doesn’t start the engine while your hands are under the hood.) When you check any fluid, check it for quality as well as quantity. Motor oil should be amber or brown (brown in a diesel). It should flow on a warm dipstick, and it should feel slippery between your fingertips. Take a good look around the engine compartment and at the visible components under it. Note anything that looks unfamiliar to you, and consider the possibility that someone has worked on the vehicle in your absence.

Most of us check tire pressures about as often as we take patient temperatures—almost never (dumb and dumber). A ton of tire failures are caused by under- and overinflation. Why would you want to risk your life over something so simple?

Dynamic Check

Next, start the engine.

An ambulance needs to be able to start, steer, stop and stay running. Those four S’s are like a patient’s ABCs. Anything you detect that would hamper one of those four functions should prompt you to put yourself out of service immediately. Incidentally, there was a time when the dashboard instrumentation in an ambulance was unreliable, but you can generally trust the modern stuff. Just like a patient, your ambulance has a way of telling you how it’s doing. Teach yourself to watch those gauges routinely, the way you taught yourself to watch a patient’s face.