Ambulance Manual Policy and Procedures

Written by michael paul maupin
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Ambulance Manual Policy and Procedures
A standard operating procedure manual for an ambulance service is critical for staff working in stressful environments. (book image by Anna Chelnokova from

A manual outlining the policies and procedures for an ambulance service is usually referred to as an SOP (standard operating procedures) manual. SOPs are vital to any emergency medical services organisation because ambulance personnel often work outside of the department manager's view. Ambulance service SOPs should be worded clearly and cut straight to the point, as time is always a concern in the EMS industry. Depending on the level of care of the service, the SOPs will vary.

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Chain of Command

A clearly outlined chain of command is needed as the first item of an SOP manual. Field technicians have to know who to contact and, additionally, why each person in the chain of command should be contacted. This is the first step to problem-solving in the field care setting.

Ambulance Manual Policy and Procedures
The official chain of command should be the first page of the SOP manual. (process flow image by Christopher Hall from

Job Descriptions

An elaborate job description is not as important as descriptions that are easy to read and fully explained. Each position in the service should have a unique job description. This allows for technicians to understand what is expected of them while also outlining what they can expect from other coworkers in different positions.

Everyone needs to know what ladder rang they occupy in their ambulance service position.
Everyone needs to know what ladder rang they occupy in their ambulance service position. (jobs image by Ewe Degiampietro from

Basic EMS Protocols

Since everyone on an ambulance will be educated to the least amount of information there is to know about their agency and state regulations governing pre-hospital care, a basics overview helps to reorient field staff when the call they respond on is overwhelming. This basic overview should include when to begin and when to discontinue CPR, basic oxygen flow rates for nasal cannulas, non-rebreathing and semi-rebreathing face masks, as well as dial-flow masks like a Venturi face mask.

Ambulance Manual Policy and Procedures
Knowledge of basic EMS protocols are one point each pre-hospital technician will have in common. (emergency vehicle image by Richard J Thompson from

Intermediate and Paramedic-Level Drug Protocols

In some states intermediate technicians are trained to administer simple medications such as baby aspirin without a paramedic partner. They might also be cleared to assist a patient in taking medications pre-prescribed by a physician. There should be a clear delineation in what each level of care is expected to practice when it comes to medication administration. This helps to reduce administration errors.

Ambulance Manual Policy and Procedures
Each pre-hospital provider who has been trained in pharmacology needs to know what their service will permit them to administer. (drug vial and syringe image by William Berry from

Protocols Pre-Authorized by a Medical Control Physician or Designate

Protocols that have been through a committee and preapproved for use in the field without first contacting a medical control designate helps to speed the ability for paramedics to treat various illnesses and injuries. Cardiac medications, current ACLS (advanced cardiac life support) protocols, RSI (rapid sequence intubation) algorithms, and dosage preparations for seldom-used field drugs that remain in the pharmacopoeia should be outlined in a kilogram-per-dose quick-check sheet to minimise medication errors.

There is not always time to call from the field to obtain medical direction.
There is not always time to call from the field to obtain medical direction. (phone. image by Alexander Lukyanov from

Mass Casualty Protocol

Every ambulance service should have a well designed mass casualty protocol plan. It should be a plan for dealing with more than five patients from a single event. This protocol should be reviewed every six months. It should also take into consideration the causal event and should have a plan of attack for each scenario. A plane crash would be treated differently than a chemical spill. Once size does not fit all when it comes to large-scale disaster protocols.

Ambulance Manual Policy and Procedures
During a mass casualty accident is the wrong time to be caught without a pre-existing protocol. (explosion image by Vely from

Non-Clinical Information

An SOP manual should contain phone numbers to area hospitals, police enforcement agencies, radio communication frequencies, contact information for ambulance service administrators, and any other information that might be needed quickly with little-to-no prior warning.

Ambulance Manual Policy and Procedures
What's the frequency, Kenneth? The SOP manual should tell you. (walkie talkie image by mangia from

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