Ambulance

Measurements of hygiene

The ambulances are used with transport of patients and casualties. They are weakened people and who are thus likely to contract diseases more easily. The infection can come from the material or the ambulance men. In addition, the patients can contaminate the ambulance men to them-even. Or, the ambulance men or the material can transport the germs of a patient towards another patient. The problem is similar to the Infection nosocomiale, although being legally regarded as distinct, because one cannot control the environment in which one will seek the person.

The ambulance men must thus be formed with the Hygiène and follow protocols of cleaning and disinfection. It is recommended to use material of single use as much as possible.

Here as illustration some broad outlines of hygiene ambulancière.

; Between each transport

the ambulance men must wash carefully the hands with a Savon soft; if the hands are not dirty, one can use a gel or a Solution hydro-alcoholic;
to change cloths and pillowcases, to put them in a plastic bag closed to store them on standby cleaning;
sharp objects or prickles used (razors, needles…) are put in a special container;
biological waste and of care is conditioned for a destruction by a special die;
the material used (or accidentally contaminated) is thrown (single use), or is cleaned and disinfected, or conditioned to be disinfected by a specialized die; in particular: stretcher, seat of the guide, material of oxygen treatment, carry-perfusion;
the wash-hand basin and the handles of door of the cell postpones is cleaned and disinfected;
the material is recomplété by even sterile clean material.

; Each day

the cell before (driver's cab) is cleaned: the ground and the seats are aspired (the vacuum cleaner remaining outside), the seats, the ground, the orders (flying, levers, buttons, levers…) and handles of door are cleaned and disinfected;
the behaviors are changed and conditioned in plastic bags;
water reserve is emptied, rinsed and filled of clean water; the reserve of recovery is emptied, cleaned and disinfected;
the mouths of circulation of air are aspired, cleaned and disinfected;
the conditioned linens are sent to cleaning; this includes the cover (the cover is systematically wrapped of a cloth which is him changed between each patient)
the objects to be destroyed (biological waste and of care, material of single use) are sent in the die of destruction;
the ambulance men douchent themselves and ensure themselves to have short nails.

; Each week

water reserve is disinfected;
the receptacle for objects cutting and perforating is closed definitively and sent for elimination in a specific die;
surfaces of the cell postpones (ground, support of stretcher, walls, panes) is cleaned and disinfected;
all the material left, cleaned and disinfected; one uses for that two schemes of work, one receiving the material on the outlet side of the vehicle, the other where the material after disinfection is laid out;
the drawers (emptied) are cleaned and disinfected.

Cleaning is done with gloves of single use, or for certain acts with gloves and blouse of cleaning, the agnts of single use being fragile. The hands are washed after cleaning. The cleaning of surfaces is always done while progressing towards the exit, the top to the bottom, of clean towards the dirty one, without passing by again twice at the same place (one would be likely to bring back stains on a place already cleaned); one carries out for that of the movement in “S”. One uses two buckets, a bucket containing the disinfectant, and a bucket containing of clean water:

one soaks sponge or the floorcloth of disinfecting mixture, one it essort,
one cleans a portion of surface, then sponge is rinsed or the floorcloth with clear water, one essort,
one soaks again with the mixture disinfecting…

Specific measures can be taken if the patient is contaminated by a Bactérie multirésistante (BMR), a Virus particularly contaminant or Ectoparasite S of the type Gale.

Ambulances in Switzerland

In Swiss, from the Federalism, there exist a little different laws in each canton, but take the example of Geneva which is all the same quite representative of the services of medical emergency in Switzerland. In Geneva, there are two kinds of ambulances:

the emergency ambulances, engaged by the 144 (call number of Urgency S medical), those are made up of two graduate ambulance men CRS (Croix-Rouge Suisse). These ambulances form part either of a private company or of a public body (like the Fire protection organization and Help of the town of Geneva). The emergency ambulances can, if need be, being reinforced by SMUR, also called Cardiomobile.

ambulances of transfers or repatriations, which are partners of the hospitals for intra-hospital transfers or Rega amongst other things for repatriations of wounded or sick. These ambulances can be made up of MT (technicians ambulance men), medical teams and of to the maximum a person without specific training.

the medical section of SA professional Firemen of the International airport of Geneva, at summer finalized on April 1st, 2003. It is directly attached to the medical brigade cantonal gathering the cardiomobile (SMUR) and the helicopter of the HUG. It is composed of ten nine ambulance men IAS/CRS gathered in six groups of three, which take turns to ensure two ambulances of day and one of night, 24:00 /24 on the totality of the canton of Geneva and the Holy Land part of the canton of Vaud in 3rd level. Engagement by 144 GE and VD.

Ambulances in France

In France, the term “ambulance” is reserved for the vehicles having on their board at least a holder of the certificate of competence of ambulance man (CCA) and allowing lengthened transport. That includes/understands:

vehicles of the titular privately held companies of a medical approval of transport allowing lengthened transport; the vehicles of these companies allowing sitted transport are not light “ambulances” but “medical vehicles” (VSL);
vehicles of intervention of the Smur (emergency Mobile service and of reanimation), also called “hospital mobile units” (UMH);
the ambulances of help and care of urgencies (ESA) are the ambulances or the crew can hold upright in the medical cell.
“ambulances of reanimation” (AR) of the Brigade of firemen of Paris (BSPP).

In particular, the following vehicles are not ambulances with the lawful direction:

the “vehicles of help and assistance to the victims” (VSAV) and old “the vehicles of helps to asphyxiated and to wounded the” (VSAB) of the firemen;
vehicles “first aid raising” (PSR) and “first aid evacuation” (PSE) of the Brigade of firemen of Paris;
vehicles of first aid to people (VPSP) of associations (the Red Cross, civil protection…)
medical freight vehicles of the army (vehicles khaki with a Red Cross on white zone).

All these vehicles (ambulances, VSAB, VSAV, PSR and PSE, medical vehicles of the army) are gathered under the term “vehicles adapted to medical transport”.

Various types of ambulances

The standard NF IN 1789 of December 1999 relative to the “medical Freight vehicles and their equipment” (ICS: 11.160; 43.160) distinguishes four types of vehicles adapted to medical transport:

----

Type a: road ambulance conceived and equipped for medical transport with patients whose health condition does not let predict that they can become patients in distress.

A1 category: adapted to the transport of a single patient;
A2 category: adapted to the transport of one or more patients on one (of) stretcher (S) and/or chair (S) portoire (S);

Type b: Ambulance of emergency care (ESA), road ambulance designed and equipped for transport, first aid and the monitoring of patients.

Type C: Mobile unit of Intensive care (UMH), road ambulance designed and equipped for transport, the intensive care and the monitoring of patients.

The VSL (light medical Vehicle) do not form any more part of the same standard but the ambulances ----

These road vehicles must be in conformity with the homologation of the type for the vehicles of spéeciaux use in accordance with the last version amendéee applicable to the Directive 70/156/CEE

The private ambulances are “vehicles of general interest profiting from facilities of passage” (R311-1 article of the Highway code), and are thus equipped:

of blue fires with glare (flashes) (R313-27 article of the Highway code);
of a sound signalling Hooter with three let us tons (pine-pon-pine… pine-pon-pine…).

The UMH of the Smur and the AR of the BSPP the PSR, PSE and VSAV of the BSPP and the VSAV of the firemen in general are “priority vehicles of general interest”, and are thus equipped:

of blue fires turning (gyrophares) (R313-27 article of the Highway code);
of a sound signalling Hooter with two let us tons (pine-pon-pine-pon).

The VSL (light medical Vehicle) do not profit from any special provision of the highway code.

The case of the associative vehicles (associations of first aid known as “of civil security”) is more ambiguous. Until the law of modernization of the civil security (law n°2004-811 of August 13rd, 2004), these vehicles concerned the normal mode of medical transport: associations were to obtain a departmental approval and to have a titular ambulance man of CCA, the vehicles were thus “vehicles of general interest profiting from facilities of passage”. Associations of small the crowns Parisian (the French Red Cross, Civil protection of Paris, Cross-White, French Center of first aid and civil protection) dérogeaint with this principle, the Prefect of police having taken a permanent decree of requisition placing in fact these vehicles in the category of the “priority vehicles of general interest”; the legality of this device is not however assured. This should be given flat by the decree on enforcement of a law of the law of modernization.

Update concerning the private ambulances intervening on request of the SAMU, since the Decree n° 2007-786 of May 10th, 2007 relating to the vehicles of general interest published with the J.O n° 109 of May 11th, 2007 page 8543 text n° 53, these ambulances return from now on in the category of the " vehicles of general interest prioritaire" and either in the category of the vehicles " profiting from facility of passage". BUT ONLY with a specific request of the service of urgent medical assistance.

References

Article L. 51-1 and following of the Public health code
Stopped of February 22nd, 1988 fixing the conditions requested the vehicles and the physical plants assigned to terrestrial medical transport urgent Medical assistance
Circular DGS/SQ 2 n° 98-483 of the July 29th 1998 relating to the participation of the private medical conveyers in the urgent medical assistance
Stopped March 20th 1990 fixing the conditions required for the vehicles and the physical plants assigned to terrestrial medical transport * Decree of the February 7th 2005 modifying the decree of the March 20th 1990 fixing the conditions required for the vehicles and the physical plants assigned to terrestrial medical transport
Standard NF IN 1789 concerning the medical Freight vehicles and their equipment.

See too

Internal bonds

External bonds

Disinfection of the ambulances

Hygiene of the medical freight vehicles, CHU of Lyon (document pdf, 30p, 1,9 Mo)
Protocols of hygiene and disinfection of the VSAV of the Sdis - 54

Organization of the Medical Helps in France

www.appel-urgence.com

Gate of the ambulances in France

www.ambulance.fr

Gate of information of the ambulance men in French-speaking Switzerland

Ambulanciers.ch

Gate of information on the ambulances in the world

emsworldtour.com

Simple: Ambulance Zh-yue: 十字車

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