The hospital, therefore, must ensure the following actions before loading the patient in the ambulance/dispatch of ambulance for the patient: 1. The ambulance vehicle is fully roadworthy and reliable as checked, as per the standard protocol, daily and before dispatch of the vehicle.

2. The vehicle has and complies with a standard laid down response time and without any undue delay. 3. There is a standard protocol, rigidly implemented, for checking of the availability and functioning of all the items (medical stores, instruments and equipment) every morning by sister in-charge emergency. 4.

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There should be a protocol for replenishment of all the consumable items used during the outing of the ambulance, by the nurse in-charge, immediately on return. A written report should be handed over to the nurse in-charge Emergency confirming that the inventory of drugs has been topped up and all the equipment in the ambulance is fully functional. In case, any equipment/instrument has been found to be missing or nonfunctional, the same should be included in the report for immediate replacement and sending the defective item for repairs. 5. The disease pathology and the exact latest condition of the patient are ascertained before dispatch of the vehicle to receive the patient. Any drugs/equipment required for the patient’s specific disease/condition may also be loaded.

6. Depending on the patient’s disease/pathology and the clinical condition, the type of ambulance (critical care ambulance equipped with advance life support or an ordinary ambulance with basic life support facility) is detailed and the same, along with the charges, is informed to the patient/relatives. 7. Depending upon the patient’s condition the escort staff is made available at the earliest. 8. The staff should be trained in conducting the emergency resuscitation procedures effectively in a moving vehicle. 9. The staff detailed should quickly check the drugs, instruments and equipment, as required, (as per the standard list) for availability and full functional status.

10. For safe loading/unloading and transfer of patients with fractured spine, ambulance should have a special stretcher (such as stretcher scoop) which allows lifting and transfer of patient without any further damage to the spinal cord. 11. For loading/unloading of patients on trolley, it is desirable that the ambulance is equipped with a folding type ambulance ramp. 12. The vehicle should have a reliable two way communication system.

13. Only after confirming all the above, should the staff load the patient on the ambulance (for outward movement) or leave for bringing the patient (inward movement). 14. For speed of movement, it is desirable that the driver should know the area/route well and the escort doctor should be aware of the hospitals located en route, for any assistance that may be required.

15. On long distance trips, it is recommended that the nurse should be accompanied by another female staff (nurse/aya). 16. Hospital should have a documented protocol for operating the ambulance service.

2. Safe Neonatal Critical Care Transport System:

For safe and speedy transportation of neonates in a critical condition, Neonatal Critical care Transport system should be available. In addition to the special equipment for resuscitation of neonates, it should have the arrangement for managing hypothermia which can be a serious problem in neonates. The staff should have age specific competence in managing critically sick neonates.

3. Safe Lifts/Escalators:

Lifts are the fastest, the most convenient and most commonly used mode of vertical transportation in hospitals, especially in case of patients while these lifts do save a lot of lives in critical moments, they can become a serious hazard if not well maintained. Instances of lifts getting stuck and causing panic among the patients/other passengers are not uncommon.

Instances of uncontrolled free fall of lifts injuring the passengers have also been reported. It is in view of these hazards that the Lifts and Escalators Act has been enacted in some states like Delhi, Maharashtra and Karnataka. The Act requires the hospital to ensure full safety of lifts being operated within the premises.

4. Safe Trolleys:

Trolleys are commonly used in all hospitals for internal transportation of all bed ridden patients from one department to another. If the staffs are not careful, patients many times do fall off the trolley.

Many times, accidents takes place when a fast moving trolley coming down the ramp hits the wall or the public causing injuries in the process. It is imperative that all such accidents are avoided because they can cause serious injuries to patients. The trolleys can be made safer by implementing following measures: 1. Provision of rails, strong enough, on both sides of the trolley. 2. Provision of straps to secure the patient on the trolley while on the move. 3.

Provision of brakes to slow down the speed, down the slope. 4. Ensuring that the trolleys used are sturdy enough to take the weight of the patient and have sturdy wheels. 5.

Ensuring that the trolley of a patient on IV fluids/other support is properly escorted, especially through the narrow passageways or crowded areas. 6. Trolleys are often not included in the maintenance schedule until there is a break down. They should be included in the maintenance schedule so that the oiling/serviceability of wheels are attended to.

5. Safe Wheel Chairs:

Wheel chairs are a common mode of transport for patients who are not sick enough to use a trolley. Many of them are well enough but are on the wheel chairs because of physical disability.

There are others who require a wheel chair because they are too weak to walk, but not too weak to be on the trolley. The first category generally come on their own wheel chairs and is trained and fit enough to drive and maneuver their wheel chair. They may, however, have a problem going up or coming down the ramp, if the gradient is too steep and if their chairs do not have the brake system. However, nonskid surface with landings at frequent intervals and rails on both sides of the ramp can help slow down the speed.

Patients in the second category are not used to be on the wheel chairs and are too sick to drive or maneuver them. They need to be escorted by someone who can push the wheel chair and maneuver it safely and speedily through the crowds as well as on the ramp, up and down, without any accidents. For safe and speedy movements, the wheel chairs need to be maintained through a regular preventive maintenance schedule.