Ambulances, Power and Gases

Transcription

1 Section Five Ambulances, Power and Gases The vehicle will have a tail lift to accommodate at least 350kg load capable of handling the neonatal trolley with equipment. The tail lift will be fitted with a visual and audible alarm to operate when the tail lift is being operated. It is the ambulance driver s responsibility to ensure that the trolley is loaded safely onto and off the vehicle. The brakes on the trolley will be applied prior to operating the tail lift. Other members of the team will assist in placing the trolley onto and off the vehicle The vehicle supplied to the Neonatal Transport Service will have the ability to take one Paraid trolley fitted against one side (the driver s side) of the ambulance, secured firmly to the floor using ferno locking devices. The dimensions of the paraid trolley and mounted equipment are 1.826metres long, 530 mm wide between wheel centres (596 mm between outside of wheels) and 1.4 metres high. There must be the ability to access the baby via the incubator door at the bottom left hand side of the incubator which will be positioned in proximity to the driver. Access must enable the clinicians to withdraw the incubator platform about 1 foot and give access for re intubation and face mask ventilation in an emergency. This means that optimally there must be 1.3 metres clearance. This can be provided in a stationary vehicle by unlocking the trolley and moving it towards the rear of the ambulance. This means that the length of the clinical area of the vehicle must be at least 3.2 metres. When the service starts the new paraid transport trolleys will not yet be commissioned. The trolley used in some units will need to be fixed into the ambulance using millennium clamps. All other equipment carried on the vehicle will be securely stowed away in lockable cupboards so that it cannot cause injury during acceleration or deceleration of the ambulance vehicle. Tiered response during ambulance transport As well as keeping the baby safe during the transfer, it is important to maintain the safety of all the team including the ambulance driver, doctor and nurse. For this reason the blue lights and sirens will rarely be used. The baby will be more stable during transfer if progress is smooth and deceleration and acceleration forces are kept to a minimum Green Response Condition of the baby does not warrant the use of blue lights and sirens eg stable non ventilated baby, non urgent surgical condition (high dependency transfer). Blue lights 1

2 and sirens would only be used if baby starts to deteriorate or if severe traffic congestion would put the baby at risk. Amber response Time is an important factor eg stable intensive care, CPCP transfers where gas supplies are time limited. Smooth steady progress is appropriate. Blue lights and sirens again not used except to get through heavy traffic Red response Blue lights and sirens will only be used when the baby requires immediate clinical intervention and the time element is critical eg to get to an extremely preterm and unstable infant on a level 1 unit. Once stabilised by the team the transfer to the receiving unit would no longer require a red response. The selected response should be a team decision considering the following Level of referring unit Condition of the baby Distance to the referring hospital Traffic or road conditions Note the use of blue lights and sirens constitutes a hazard to the team and should be avoided wherever possible. Communications Ambulance radio Ensure that take mobile phone which is fully charged. Recommended network coverage orange which has t mobile as back up Protocol for optimising power supply Charge the vehicle overnight Use the alternator/invertor to transport the baby Ensure the incubator is in standby mode when not in use 2

3 The power consumption of various pieces of equipment is as shown in the table Equipment Battery Life (hours) Power Voltage Weight Draeger Incubator Watts 12V or 240V 49 Kg Either Drager reanimator 2 60 watts 12V or 240V 18 kg Or Fabien Ventilator with CPAP watts 12V or 240V 9kg Alaris Asena Syringe Pumps Watts 240V 15 kg for 6 Times 6 Phillips MP30 monitor watts 240V 6 kg Printer Nox Box None 20 watts 12v or240v 2kg Viasys Infant flow system (CPAP) 4 hours 25 12v or 240 v 7 kg 3

4 F&P MR850 Humidifier None V 3.1kg Oxyliter Suction Unit Large 12 V battery lasts 80 mins 100watts 240V 6kg Fully loaded the system is less than 1500W power (1350w Singleton and Newport, 1140W UHW for ventilated baby, 1335 CPAP baby) Equipment weight less than 110kg without oxygen and air cylinders Trolley weight 35 kg approximately Protocol for charging of transport incubator Ensure the incubator is on charge at all times by means of the following guidelines When at base plug into mains power and leave on standby When travelling to the referring unit, charge via alternator/invertor as a first choice. This time the incubator should be on standby showing the AC charging light. In the event of the alternator/ invertor failing the incubator will alarm showing power failure. At this point switch to generator (bespoke vehicle) by 1) Turn off invertor 2) Open generator switch cupboard 3) Open left hand switch box and turn on to generator 4) Shut cupboard Incubator should now read AC If the generator fails the ambulance crew to report through the normal channelsin the event of both generator and invertor failure you can power the incubator by using the 12v vehicle supply by 1) Attach the round black 12v lead to socket on baby end of incubator by on/ off switch 2) Attach the opposite end of black lead to two pronged wall socket behind incubator 3) Attach copper coloured lead to rear of ventilator (Cardiff) or incubator (Swansea and Newport) 4

5 4) Attach other end of copper coloured lead to 12 volt socket also behind incubator 5) This will show DC on incubator Fabian ventilator will work off batteries (Swansea and Newport =2 hours) Drager reanimator = 2 hours. Pumps will work off batteries = 5 hours Monitor has spare batteries which can be changed to extend battery life When on the referring unit always plug the incubator and other equipment into the mains AC supply. When travelling back to base without a patient on board you may return using the invertor supply ensuring that the incubator is put on charge via the charging socket with the incubator turned off (standby). Gases Before transporting a baby, always undertake a calculation of the medical gases required. Multiply the answer by 2 and ensure that there is at least this amount of gas available for the journey. This will be a safety margin in case of unforeseen circumstances eg delays, breakdowns etc. For oxygen always ensure a good supply both to cover the need for ventilation and also to cover any possible need during resuscitation. For example - a baby on CPAP in 8 litres air per minute would require for a two hour journey 8 x60 x2 litres = 960 litres air We need to ensure that we have a supply of air available for at least twice this time to allow for unforeseen circumstances Thus we would need to ensure that we have approximately 2000 litres air available. In addition oxygen would need to be available in case of a change in clinical condition during the journey or need for resuscitation. Oxygen is carried in HX cylinders which contain 2300 litres when full. Air is carried in F cylinders which are about 1360 litres when full When setting out to do a back transfer, if a call for an acute retrieval is then received this call might take priority. The team could thus be redirected to the acute retrieval. It is important to ensure that the medical gases on board the vehicle are sufficient to allow for this flexibility. 5

6 Further example A baby in 50 % oxygen ventilated in 10 litres per minute of gas for a three hour journey would require approximately 5 x 60 x 3 = 900 litres of oxygen Plus 5 x 60 x 3 = 900 litres of air We need to double this amount to allow for unforeseen circumstances. We should aim to carry at least two full F cylinders of air and 2 full HO cylinders of oxygen for each journey. (In bad weather and long journeys we might increase this amount) So we would need to have on board 2 F size cylinders with the appropriate connections for this journey. It would be sensible to have one of these on the transport trolley and perhaps another two in the vehicle. If one is undertaking many back transfers of babies on CPAP in a shift, there would be the need to get new air cylinders at frequent intervals throughout the day. It would be advisable to do this after handing over a baby at the receiving unit and before picking up the next baby. 6