The public often observes ambulances remaining at an incident for a significant period and may perceive this as an unnecessary delay. This time spent on the scene is not arbitrary, but rather a direct result of mandatory, life-saving medical procedures and critical logistical requirements that must be completed before transport can safely begin. Emergency medical services (EMS) personnel must transform an uncontrolled emergency environment into a stable one, involving systematic patient care and careful coordination with outside agencies. The moments spent on-scene are a calculated investment to maximize a patient’s chance of survival and ensure a smooth transition to hospital care.
Initial Patient Assessment and Stabilization Protocols
The most time-consuming yet necessary phase of a call involves the medical assessment and immediate stabilization of the patient before moving them to the ambulance. EMS providers adhere to a structured, systematic approach to rapidly identify and treat life-threatening conditions. This begins with the primary survey, often using the ABCDE mnemonic (Airway, Breathing, Circulation, Disability, and Exposure) in a prioritized sequence. Any life-threatening problems identified, such as a blocked airway or severe bleeding, must be treated immediately before proceeding, which consumes valuable minutes.
Once the primary survey is complete and immediate life threats are managed, a more detailed secondary survey begins, including gathering a patient history. This history collection often follows the SAMPLE mnemonic:
- Signs and Symptoms
- Allergies
- Medications
- Past Medical History
- Last oral intake
- Events leading up to the illness or injury
Obtaining this information from the patient, family, or bystanders is essential for making informed treatment decisions, but it is a process that cannot be rushed.
Stabilization protocols require performing advanced procedures on-scene that are too complex or unsafe to attempt in a moving ambulance. These procedures can include establishing intravenous (IV) access to administer fluids or medications, applying a cardiac monitor, or performing advanced airway management like intubation. For trauma patients, this time is used for immobilizing the spine or splinting fractures to prevent further injury during movement. The decision to stabilize a patient on-scene versus immediate transport is a complex medical judgment. Stabilization is often favored for medical emergencies, while rapid transport is sometimes preferred for time-sensitive trauma cases.
Required On-Scene Communication and Coordination
Time is dedicated to logistical and safety factors that surround the patient and the ambulance crew. Scene safety is a fundamental concern; EMS personnel must wait until hazards like fuel spills, downed power lines, or unstable structures are addressed by fire or police departments before they can safely enter or leave an area. This interagency coordination ensures that the environment is secure for both the patient and the providers.
Communication with the central dispatch center is continuous, involving updates on the patient’s condition and the estimated time of departure. This process ensures that appropriate resources, such as fire department personnel for extrication or police for traffic control, are allocated effectively.
The EMS crew must also communicate with the receiving hospital by giving a pre-arrival report. This report provides the hospital with a concise summary of the patient’s condition, the treatment already provided, and the estimated time of arrival. Giving this report allows hospital staff to prepare specialized equipment and personnel to meet the ambulance immediately upon arrival. Securing the appropriate hospital destination can also take time, as the crew may need to confirm that a facility has the necessary resources and bed availability to treat the patient’s specific condition.
Essential Documentation and Transfer Preparation
The final minutes on-scene are consumed by administrative and physical tasks required to legally and safely transfer the patient. Documentation is a legal and medical necessity, as the Patient Care Report (PCR) becomes a permanent part of the medical record. The PCR must detail the patient’s demographics, vital signs, assessment findings, every intervention performed, and the patient’s response to treatment.
While some documentation is performed during patient care, the final details must often be completed before transport to ensure accuracy and to provide the receiving hospital with an interim report. This is also the time to collect the patient’s personal belongings, such as medications or identification, which are necessary for the hospital admission process.
The physical act of preparing the patient for transport requires careful, deliberate movements to prevent worsening their injuries. The patient must be secured onto the stretcher, which is then loaded and locked into the ambulance. All medical equipment used during the stabilization phase, including monitors and IV pumps, must be secured so that care can continue safely while the vehicle is in motion.