Unit 5: Operations
EMS Operations & Patient Transport
Safe ambulance operations involve much more than driving to an emergency and transporting a patient to the hospital. EMTs must prepare their equipment, operate emergency vehicles safely, move patients without causing additional injuries, and select appropriate transport destinations. This NREMT study guide lesson covers the phases of an ambulance call, emergency vehicle safety, patient transportation, and air medical operations. Five EMT practice questions with explanations will help you review these important responsibilities.
Emergency Medical Services (EMS) operations include responding to emergencies, providing safe patient transportation, and maintaining readiness for future calls.
EMTs must protect patients, coworkers, and the public while following agency procedures and applicable laws.
Phases of an Ambulance Call
An ambulance call is commonly divided into nine phases.
| Phase | Description |
| 1. Preparation | Check the ambulance, equipment, and supplies. |
| 2. Dispatch | Receive emergency information and call details. |
| 3. En Route | Travel safely to the emergency scene. |
| 4. Arrival at Scene | Perform a scene size-up and begin patient care. |
| 5. Patient Transfer | Move and secure the patient in the ambulance. |
| 6. Transport | Travel to the receiving medical facility while providing care. |
| 7. At the Hospital | Transfer patient care to hospital personnel. |
| 8. Return to Station | Return to the station or another assigned location. |
| 9. Post-Run | Clean, restock, document, and prepare for the next call. |
These phases help EMS crews remain organized throughout an emergency response.
Ambulance Preparation
Before responding to calls, EMTs must ensure the ambulance is ready for service.
Important preparation tasks include:
- Checking fuel, tires, lights, and other essential vehicle systems.
- Confirming that oxygen and suction equipment function properly.
- Inspecting the stretcher and securing mechanisms.
- Checking medical supplies, medications, and expiration dates.
- Testing communication equipment.
- Ensuring personal protective equipment is available.
Equipment problems should be reported and corrected according to agency procedures before the ambulance is placed into service.
Emergency Vehicle Safety
Ambulance operations create risks for EMS personnel, patients, and other motorists.
Important safety practices include:
- Wear a seat belt whenever the vehicle is moving.
- Adjust speed for traffic, road, and weather conditions.
- Maintain a safe following distance.
- Use warning lights and sirens only when appropriate.
- Exercise particular caution at intersections.
- Never assume other drivers see or hear the ambulance.
Warning lights and sirens do not guarantee the right-of-way.
At intersections, ambulance drivers must slow down, stop when necessary, and ensure that traffic has yielded before proceeding.
Unnecessary emergency driving increases risk and should be avoided.
Patient Moving and Lifting
Improper lifting techniques can injure both EMTs and patients.
Before moving a patient, consider their condition, weight, available personnel, and environmental obstacles.
Basic lifting principles include:
- Keep your back in a neutral position.
- Bend at the hips and knees.
- Keep the load close to your body.
- Avoid twisting while lifting.
- Communicate clearly with other rescuers.
- Request additional assistance when needed.
Common patient movement devices include:
| Device | Primary Use |
| Ambulance stretcher | Securing and transporting patients in an ambulance |
| Stair chair | Moving appropriate patients through stairs or confined spaces |
| Scoop stretcher | Lifting patients while limiting unnecessary movement |
| Long backboard | Extrication and selected patient movement situations |
The choice of device depends on the patient’s condition, available resources, and local protocols.
Never attempt to lift a patient when the task exceeds your team’s capabilities.
Emergency and Nonemergency Moves
Emergency moves are used when an immediate danger makes it unsafe to leave the patient in place.
Examples include:
- A vehicle that is catching fire.
- A structure at risk of collapse.
- Exposure to hazardous chemicals.
- A patient whose position prevents lifesaving treatment.
Nonemergency moves are performed when no immediate danger exists. EMTs should assess the patient and plan the safest method of movement before proceeding.
In either situation, use appropriate equipment and minimize unnecessary patient movement.
Securing Patients During Transport
Before the ambulance begins moving:
- Fasten the patient’s stretcher restraints.
- Lock the stretcher into the ambulance’s securing system.
- Secure oxygen cylinders and other equipment.
- Ensure EMS personnel are appropriately restrained.
- Recheck the patient’s condition and medical equipment.
Proper restraints and equipment securement reduce injuries during sudden stops, turns, or collisions.
Avoid standing or moving unnecessarily inside a moving ambulance.
Selecting a Transport Destination
The closest hospital is not always the most appropriate destination.
Transport decisions depend on the patient’s condition, available medical facilities, and local EMS protocols.
Examples include:
- Major trauma: A designated trauma center.
- Suspected stroke: A stroke-capable hospital.
- Serious cardiac emergencies: A facility with appropriate cardiac treatment capabilities.
- Obstetric emergencies: A hospital equipped for maternal and newborn care.
Continue treatment and reassessment during transport, and notify the receiving facility when indicated.
Air Medical Operations
Air medical transportation may be appropriate when a patient requires specialized care or when ground transportation would cause a significant delay.
Two types of air ambulances are:
- Rotary-wing aircraft: Helicopters, commonly used for scene responses and certain interfacility transfers.
- Fixed-wing aircraft: Airplanes, commonly used for longer-distance transfers.
Air transport is not automatically faster or better. Decisions should consider the patient’s condition, distance, weather, aircraft availability, and local protocols.
Helicopter Landing Zone Safety
A helicopter landing zone (LZ) must meet the requirements of the responding aircraft and flight crew.
An appropriate landing zone should be:
- Large enough for the aircraft.
- Relatively level, firm, and free of loose debris.
- Clear of power lines, trees, and other obstacles.
- Free of unnecessary personnel and vehicles.
Landing-zone dimensions vary by aircraft and operator. Follow the flight crew’s instructions rather than assuming one size is appropriate for every helicopter.
Securely weighted cones may be used when approved by the flight crew. Avoid flares, loose caution tape, and unsecured objects that could become dangerous in rotor wash.
Never approach a helicopter unless instructed by the flight crew. Be especially cautious around the tail rotor.
Post-Run Responsibilities
After transferring patient care, the EMS crew must prepare for the next call.
Important responsibilities include:
- Completing the patient care report.
- Cleaning and disinfecting equipment and surfaces.
- Replacing used supplies.
- Checking oxygen levels and equipment.
- Reporting equipment problems or exposure incidents.
- Notifying dispatch when the ambulance is available.
These procedures help ensure that the ambulance remains ready for emergency responses.
Key Tip
Patient and responder safety must remain a priority throughout every ambulance call. Use appropriate lifting techniques, secure patients and equipment before transport, drive cautiously even when using lights and sirens, and select transport destinations based on the patient’s needs and local protocols.