Medical Equipment For Ambulances

A joint committee, made up of several US professional organizations in surgery, trauma, and emergency medicine, updated their recommendations for equipment in ambulances in 2009. Equipment recommendations may vary depending on the certification levels of the providers, population densities, geographic, and economic conditions of the region. They divide equipment into basic life support (BLS) and advanced life support (ALS). ALS ambulances must have all equipment on the BLS list in addition to the ALS requirements. BLS is subdivided into ventilation and airway equipment, monitoring and defibrillation, immobilization devices, bandages,
communication, obstetrical kit, miscellaneous, infection control, and injury prevention equipment. Required equipment for advanced life support includes airway and ventilation equipment, vascular access, cardiac and optional medications. Let’s go over these requirements in more detail!

There are a variety of different types of ventilation and airway equipment available for ambulances including: a portable and fixed suction apparatus with a regulator, a portable oxygen apparatus capable of metered flow with adequate tubing, a portable fixed oxygen supply equipment (with a variable flow regulator), oxygen administration equipment (adequate length tubing for adults and children), and a bag-valve mask (manual resuscitator). Airways (masks, nasal cannulas, etc…) should include nasopharyngeal (16F-34F; adult and child sizes) and oropharyngeal (sizes 0-5; adult, child, and infant sizes) sizes. Pulse oximeters with both pediatric and adult probes should be included.

All ambulances should be equipped with an automated external defibrillator (AED), unless staffed by advanced life support personnel who are carrying a monitor/defibrillator. The AED should have pediatric capabilities, including child sized pads and cables. The ambulance should carry cervical collars rigid for children 2 years and older and adult sizes (small, medium, and large). Backboards should be available for management of spinal injuries. Bandages and tourniquets are recommended for treatment of wounds and fractures. Obstetrical kits should include towels, 4 x 4 dressings, umbilical tape, sterile scissor, and thermal absorbent blanket. For infection control, stock should include eye protection, face protection, shoe covers, disinfectant solution for cleaning equipment, and standard sharps containers.

For more intensive management, ALS requirements include airway and ventilation equipment. This includes laryngoscope handles with extra batteries and bulbs. Laryngoscope blades should be stocked in two different categories: Miller blades (straight) in sizes 0-4 and MacIntosh blades (curved) in sizes 2-4. For vascular resuscitation, ambulances should make sure they carry crystalloid solutions, such as Ringer’s lactate or normal saline. Equipment needed to manage cardiac emergencies, includes a portable, battery-operated monitor/defibrillator and a transcutaneous cardiac pacemaker, with pediatric pads and cables. Medications used on advanced level ambulances should be compatible with current guidelines. Medications such as epinephrine (both 1:1,000 and 1:10,000 strengths), atropine, antidysrhythmics, calcium channel, blockers, beta-blockers, nitroglycerin, aspirin, vasopressors, furosemide, and albuterol should be stocked. It is advantageous to stock benzodiazepines, for example, lorazepam or diazepam for the treatment of seizures or alcohol withdrawal. Optional advanced equipment includes a respirator, blood sample tubes, automatic blood pressure devices, and a needle cricothyrotomy kit.

That summarizes the current guidelines for medical equipment in ambulances. For more information, the official guidelines can be found on the American College of Surgeons website, www.facs.org.