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On the road again...

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Bryan McEssy

on 23 October 2016

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Transcript of On the road again...

The Break Down
Catastrophic failure of the vehicle are one of the many situations that can leave a crew and patient exposed...

How do you procede? What are our priorities? How can you best get yourself, crew, and patients out of this situation?

Lets take a look at some examples...
Blowouts and Tread Separation
If you experience a blowout we're gona need you to do this...
No Brakes!!!
Generally speaking, vehicles with air brakes rarely suffer a true mechanical failure. Most often difficulty slowing is related to overheating of the brakes. Utilizing good techniques is key here. Scanning ahead and anticipating the change of lights, traffic ahead, etc. These vehicles slow themselves fairly well. By letting off the accelorator early, utilizing the engine brake, and not speeding, can make for hardly having to touch the breaks during most of our transports. If you truly get no response from the brakes, use the engine break, manually down shift the transmission, and find an escape route with the least amount of hazards in your path.
The MCCS involved accident
Policy 2.09

r) The EMT vehicle operator shall immediately report all accident and incidents involving the vehicle to the Officer in Charge (OIC). This includes physical damage and traffic violations. Drug testing will be performed as directed by WakeMed Health & Hospitals Human Resources Drug Free Workplace Policy.

s) Any motor vehicle accident involving MCCS regardless of fault shall be reported to the local law enforcement jurisdiction for investigation and to obtain an accident report. The EMT vehicle operator should request an accident report if the law enforcement officer does not initially complete one. Immediately after contacting the law enforcement jurisdiction, the EMT vehicle operator or crewmember should notify MedCom and request additional resources if needed (i.e. mutual aid for a patient on board). MedCom will immediately notify the OIC who will contact the Logistics Officer and MCCS Administration as needed. The OIC should notify Risk Management of all accidents. An online incident/occurrence report will also be completed. The EMT vehicle operator shall proceed to Occupational Health for a drug screening and shall not operate a WakeMed owned vehicle until Occupational Health has cleared the results. Drug testing will be performed as directed by the WakeMed Human Resources Drug Free Workplace Policy.
Marking our territory...
Letting others know
So something happened and you are forced to pull over on the side of the road....
Lets switch gears...
General truck safety
General inspection stuff...
- Condition/Tread, Pressure, Valve stems, Damage
- Cracks/Dents, Missing Lugs, Rust
- Wear, Vibration, Smell, Fluid level, Leak?
- New Damage, Lean, Battery Contacts, Chassis, Windsheid?
Under the Hood
- Belts, Fluids, Fan Blades, Leaks?
In the seat
- Adjustment, Mirrors, Steering Column,Seat.
Assisting at an MVC
Pulling up on an MVC can be a common occurance here at MCCS.
On the road again...Version2.1
Basic safety...
How do we keep ourselves safe when something goes wrong while away from home?
Tire blowouts and Tread Separation are two different events. In the event of either, a calm and collected operator should know what to do...

Stay off the brakes! Use the drag of the flat tire to slow the vehicle. If you feel the truck is "losing control", accelerate till the truck stabilizes and remove your foot from the accelerator. Friction will slow the vehicle. Keep the vehicle in a straight path, avoid sudden steering adjustments.
Same techniques, however, realize that the tire may still contain air and wont have the same friction to slow down your vehicle.
Out and Around the Vehicle
-So we all use a "backer" right?
-Making sure that the vehicle is off when doing any maintainance.
-Chocking the wheels...
-Letting others know if you're underneath it.
-How many of us stand on the tires to clean windshield? How many do it while the engine is running?
-How many people wear the safety vests, or ask the crew member to, when backing a vehicle?
-Are you getting out and looking for hazards when getting ready to back out of a situation?
Being Seen
So Heres some examples of the differences with our onesies, our new jackets, and a safety vest... These photos were snapped at night with scene light and emergency lights on... Thoughts?
Onesie Window Up
Onsie Window Down
Jacket Window Up
Jacket Window Down
Vest Window Up
Vest Window Down
Get to as safe a spot as possible. I know that ideally its not on the side of the road. Can you "limp" to a safer spot? Are you in a curve? Is there a straight shot with decent visibility behind you? How do you let others know you're stopped?
From the NC DOT
The "Obstructed View"
Be Seen
This is the trick. Giving plenty of warning so others may have enough time to correct their speed and direction, makes for a slightly safer place to sit. Turn on your lights. If there is any concern for the safety of you or your team, leave the vehicle and find a place you feel safe.
If you must stop on or by a one-way or divided
highway, place warning devices 10 feet, 100
feet, and 200 feet toward the approaching traffic.
If you stop on a two-lane road carrying traffic in
both directions or on an undivided highway,
place warning devices within 10 feet of the front
or rear corners to mark the location of the
vehicle and 100 feet behind and ahead of the
vehicle, on the shoulder or in the lane you
stopped in.
Is this safe?
No! That was not at all...
How do can this scene be improved?
The Blocker
Whats this button do?
Winter weather is around the corner...
Onspot Chains
The Onspot chains are a handy tool when were driving in winter weather. Things to know about them:
ONSPOTs should be engaged and disengaged with the vehicle moving. The system can be turned on with the vehicle going as fast as 25 mph. Your max speed is 35 mph while using ONSPOTs. As the chainwheel hits at the tire centerline and the chainwheel is driven by centrifugal force the system will provide traction in forward or reverse. ONSPOT is designed to effectively work on ice, packed snow, and up to 6 inches of snow.
Beast Mode- 4 Wheel drive
So a little on the new truck's 4x4 system
Do not use 4X4 mode on dry, hard surfaced roads. Doing so will produce excessive noise, increase tire wear and may damage drive components. 4X4 mode is only intended for consistently slippery or loose surfaces. 2H (2WD)-For general on-road driving. Sends power to the rear wheels only and should be used for street and highway driving. Provides optimal smoothness and fuel economy at high speeds.
4H (4X4 HIGH)-Used for extra traction such as in snow or icy roads or in off road situations. This mode is not intended for use on dry pavement.
4L (4X4 LOW)-Uses extra gearing to provide maximum power to all four wheels at reduced speeds. Intended only for off-road applications such as deep sand, steep grades, or pulling heavy objects. 4L (4x4 low) will not engage while the vehicle is moving above 5 km/h; this is normal and should be no reason for concern. Refer to Shifting to/from 4L (4x4 low) for proper operation.
Shifting between system modes
Note: Momentarily releasing the accelerator pedal while performing a shift will improve engagement/disengagement times.
Note: Do not perform this operation if the rear wheels are slipping.
Note: Some noise may be heard as the system shifts or engages; this is normal.
Note: 4X4 high mode is not intended for use on dry pavement.
You can move the control from 2H or 4H at a stop or while driving. The information display may display a message indicating a 4X4 shift is in progress. Once the shift is complete the message center will then display the system mode selected.
If SHIFT DELAYED PULL FORWARD is displayed in the information display during the mode shift, transfer case gear tooth blockage is present. To alleviate this condition, place the transmission in a forward gear and move the vehicle forward approximately 1.5 m to allow the transfer case to complete the mode shift.
Let's do a slight review from last year...
Routine – No lights or siren, run speed limit

Urgent – no stops for coffee etc, go directly to ED with run speed limit; ED makes this request not Med Com

Emergent – Lights & Siren, per the new policy speed at posted limit.

How we're getting there...
Entrance, Apex, Exit

3 Parts of Curve
Negotiating the curve
Outside, Inside, Outside
Left – White to yellow back to white
Right – Yellow to white back to yellow

Braking for a curve
Smooth, steady pressure
100 – 10%

Visual Attention
Hands follow the eyes!!
Normal perception time ¾ second
Normal reaction time ¾ second
Total 1.5 seconds before action
Look as far ahead as possible
Gives time to react
Visual Attention continued
Looking up slows things down

Looking down speeds up

Creates “Tunnel Vision”

Target fixation

Multi–tasking is a big distraction
Talking on the radio
Operating ambulance
Listening to radio response
Observe other traffic, searching for hazards
Checking mirrors
Not to mention cell phones.

Visual Attention continued
Look an avenue of escape

Not just in emergency response, but every day driving also

When stopping, be able to see tires touching pavement

Always leave an out!
Why are we doing this again?
Well look at these stats....
Test Time
1.What is the purpose of this course?

2.What’s the most important thing for an operator during a blowout or tread separation?

3.What’s the difference between a blowout and tread separation?

4.Difference between, Routine, Urgent, Emergent.

5.What distances should you place warning devices on a two lane road with traffic approaching in both directions?

6.What are 2 things a driver has control of?

7.What is something you can do to get more attention to your situation when on the side of the road
with your crew that could create a safer environment?

8.Should you use a backer when available for backing the truck?

9. Can ONSPOT chains be deployed while moving?

10.Should you run 4X4 mode on dry sunny day on the highway?

It is ok to change your response mode...
If you are dispatched emergently and get updated information that the patient does not require an emergent response, then down grade... It works both ways. Just make sure that MedCom know what your plan is so everyone is on the same page...
Full transcript