4 Patient Transport and Ambulance Operations

Transport as continued care

Patient transport is a continuation of care, not simply movement from a scene to a hospital. EMS clinicians must move patients safely, select an appropriate destination, communicate changes, and reduce risks to the patient, crew, and public. Follow current state and local protocols, medical direction, and applicable law because destination and transport rules vary among EMS systems.

Patient movement

Before moving a patient, assess both the patient’s condition and the route. Note hazards such as stairs, tight spaces, difficult surfaces, and obstacles. Decide what equipment and assistance are needed, assign clear roles, and agree on commands before lifting or transferring.

Use a suitable device, such as a powered cot, stair chair, or transfer sheet, when available and appropriate. Avoid unnecessary manual lifting because patient handling can injure both patients and EMS clinicians.

During movement, protect the patient from falls and avoid pulling on injured limbs, medical tubing, or monitoring cables. Coordinate movements and use sound body mechanics. Once the patient is on the cot, apply cot restraints as designed, check their fit, and secure the cot to the ambulance’s approved mount. Reassess the patient after movement because lifting, position changes, and transport may affect comfort or condition.

For example, in a narrow hallway, the crew can plan the route and position a stair chair before moving the patient. One clinician leads communication while the others follow agreed commands. At the ambulance, the crew transfers the patient to the cot, fastens the restraints, and secures the cot before departure.

Ambulance and occupant safety

Check the vehicle and required equipment before a shift and before transport according to agency policy. During movement, secure loose equipment and close storage compartments. The patient, driver, and crew should use available seat belts or restraints whenever possible. If patient care requires a clinician to unbuckle, minimize the time unrestrained and resume restraint as soon as feasible. Ambulance crashes can injure unrestrained occupants, and unsecured equipment can become a hazard.

Driving and warning devices

Use defensive driving: maintain a safe speed and following distance, avoid distractions, and respond to changing road and weather conditions. Emergency lights and sirens request right-of-way, but do not guarantee that other road users have seen or heard the ambulance. Never assume the path is clear.

Slow or stop at intersections as required by law and agency policy, confirm the path is clear, and proceed cautiously. Use lights and sirens only when justified by patient need and permitted by law and protocol. Weigh the potential benefit of time saved against the added crash risk.

Care and communication en route

En route, continue patient assessment and appropriate treatment, watch for changes, and communicate significant updates to the receiving facility. If the patient deteriorates, reassess priorities and follow protocol for treatment, notification, and any change in destination.

Choosing the destination

Choose a destination based on the patient’s condition and needs, nearby facility capabilities, travel time, and the regional EMS system. Consider patient preference when applicable, while following laws, medical direction, and destination protocols. The nearest hospital is not always the most appropriate destination, and a more distant specialty center is not automatically the right choice. Match patient needs to system resources while accounting for urgency, distance, facility capability, and protocol. Notify the receiving facility early when appropriate so it can prepare.

For injured patients, field triage uses injury patterns, mental status and vital signs, mechanism of injury, and EMS judgment to help identify those who may need trauma-center care. The 2021 national guideline recommends preferential transport of high-risk patients to the highest-level trauma center available within the regional system, subject to geographic constraints and local procedures. Patients in extremis may need initial stabilization at a closer hospital.

Ground and air transport

Ground transport is appropriate for most EMS calls. Helicopter air ambulance transport may be considered when it is expected to provide a meaningful clinical or access advantage, such as when geography or distance makes timely access to appropriate care difficult. Activation should follow local criteria and coordination procedures.

Consider the time needed to request and meet the aircraft, transfer the patient, and reach the destination; flying is not automatically faster or safer. Air operations also depend on aircraft availability, weather, and landing-site conditions. Safety culture, operational procedures, and weather-related requirements are important elements of helicopter air ambulance operations.

Helicopter coordination and handoff

Coordinate the landing zone (LZ) with the flight crew and ground team. Select a firm, level area with adequate space, free of people, vehicles, loose debris, and obstructions, including wires that may be difficult to see from the air. Report hazards, wind, and the landing-zone location to the crew.

Keep bystanders and vehicles back, secure loose items, and follow flight-crew directions. Never approach or depart an aircraft unless directed by its crew. The pilot may reject or change the landing plan if conditions are unsafe.

During air transport, follow the flight crew’s instructions for patient loading, restraints, equipment, and communication. Coordinate the handoff between ground and flight clinicians so relevant assessment findings, care provided, and changes in condition are relayed clearly.