Bringing ALL the EMS equipment in...

[Box9104]

Hello. I am an explorer with a large career fire department and one of the expectations that they expect of us it to grab the EMS equipment when we pull up on a call.

Our department does not have prioritized dispatch (as in EMS calls being designated as "Priority 1/2/3/4/etc"). In fact, when there is a run...the call is sent to the MDC. All that is on there is the incident type along with basic information (caller's location, phone number, etc).

We were dispatched on a "Breathing Difficulty". When we were at patient, we found that it was actually a CPR. Unfortunately, the only thing we had was our ALS bag and oxygen bag. The Lifepak 12 was still inside the Medic-Ambulance. The thing is...when we pulled up...I went ahead and grabbed the ALS bag, oxygen bag, AND the Lifepak. However, the medic said not to worry about the Lifepak and just to "leave it there".

This was an eye-opener for me as it has taught me that any call can turn out to be more serious/life-threatening than you think. Having to run back tot he Medic-Ambulance is just totally inappropriate.

So...with that in mind...

What should I bring when riding on the ambulance? We have a Lifepak 12, an oxygen bag, and an ALS bag.

Since there is no call information...the only thing we know is that it could be anything. I'm thinking about from now on just putting everything on the stretcher and just bringing it all in at once regardless of the call type.

I'd just throw the equipment on the stretcher and when we pulled up to a scene, take the stretcher out and just wheel it in with everything.

I did get stuck on whether to put a backboard on the stretcher, however. I mean...is it really necessary to bring a backboard on a breathing difficulty? Is it necessary to bring a backboard on a burn victim or choking?

With that in mind...what do you think of my idea of putting everything on the stretcher and hauling it in?

For the backboard part...I'm thinking of bringing it in on fall patient, unconscious person, injured person, and medical emergencies (no additional details...just..."medical emergency"...could be anything). Is that a reasonable idea?

Also...I do have to say that unfortunately, some of the medics around here are a little ****y and what not when it comes to having to actually help an explorer to bring the equipment in. They seem to have the mindset that it is 100% our responsibility. But the thing is...there's no way I can manuever a stretcher myself...somebody's gotta help.

I'm just afriad that if I do put everything on the stretcher and bring the stretcher out they might just tell me next time to "just bring the ALS bag"...or..."don't worry about the Lifepak". Would disobeying these type of orders actually be wrong? I can't see myself being disciplined for bringing in the AED on a breathing difficulty or whatever. How can you blame somebody for bringing all the equipment in? You have absolutely nothing to lose especially considering the fact that you have no call details.

What do you think?

Thanks!

[FiremanLyman]

http://www.firehouse.com/forums/showthread.php?t=116674

Did you not get your answer then?

[Box9104]

FiremanLyman,

I read through the posts there but I think now after witnessing the complication on one of the calls I rode on...I was just posting to see if bringing everything in (on the stretcher) would be a good idea. That last one was a little bit more geared towards when riding the engine. The post here is more directed toward riding the Medic-Ambulance.

They're similar in some ways though...I'll give you that much...lol.

[Bushwhacker]

Carry it all in, Everything.... On your Belt.

[nameless]

the crew should man up and carry the equipment in. If you have a 2 person and can't carry in the defib/monitor, ems bag with 02, and the drug box your equipment is poorly packed (requiring to many boxes/bags) or you are a mary.

[FyredUp]

Let's see, you are an explorer. Do what your told or go work at McDonald's. It is really that simple.

[LVFD301]

Amen. You are an explorer. You do not set policy. You do not make the rules.

DO WHAT YOU ARE TOLD or stay home.

[KanFireman]

I guess I'll bite... again. Are your medics lazy? An explorer shouldn't have any business making this type of decision. Also your problem with dispatch is nothing new, but your medics are either not asking your dispatch the right questions or they just aren't filling you in on the details. If I don't know what I need while heading to a scene, me or my partner are asking my dispatchers to get those answers for me. We also talk out the scenario based on what we know on our way there, which usually results in more questions for us to ask our dispatch/first responders.

That Lifepak won't be doing that patient any good unless they're unconscious, all it will accomplish is confirming what is already suspected which is that the patient needs to go to the hospital. The backboard can always be retrieved later if it's needed. I also find that first responders focus too much on getting the cot as close to the patient as possible. They don't realize there are other ways of moving the patient besides a cot or a spine board.

The answer to the stretcher thing is you just haven't figured out how to efficiently maneuver a cot by yourself yet. That will come with experience. When we drop a patient off at the ER whichever one of us drove, takes the cot back to the unit cleans the unit and cot then reloads the cot by themselves. This is a manually two-man Stryker cot. Stairways, self-closing doors and tall thresholds are the only places where I absolutely need assistance with maneuvering the cot; but then again you're an explorer so there shouldn't be too many scenarios where you should be unsupervised on a scene.

Personally I always bring in my med bag and my cot has a portable O2 cylinder mounted to it. The only time my Lifepak goes in with me is for Full arrest, unknown unconscious, chest pains, or any time electricity passes through the patients body. I bring a spineboard for Full arrests, unknown unconscious, falls (when grandma falls in the nursing home at 3am and needs a Sager Splint you've got to secure it to something), GSWs, and MVAs. I like using a scoop stretcher, but not all of my colleagues agree with me on this. When I do use one I use it for picking up hip fracture patients off of none solid surfaces like a grassy field. The other occasion where I use them is if I have a patient that isn't able to transfer themselves to the Hospital bed and are getting too large for a blanket, but too small for most bariatric transfer devices. It also avoids the discomfort associated with a spineboard. I am in no way saying a that if a patient needs spinal immobilization that you can reach for a scoop stretcher and be good, I'm strictly talking about the instances where a spineboard isn't required but chosen for rescuer convenience.

There is nothing inappropriate about returning to the ambulance for something that initially wasn't required. Since you're not psychic you had to guess what the patient needed until somebody made patient contact. As long as that patient didn't code right in front of your medic, then shocking them right away probably wouldn't have been very effective anyway. They would have benefited from a cycle of properly executed two-rescuer CPR before the first shock attempt, which should be more than enough time for someone to bring the AED and a Spineboard for the patient.

If there isn't any communication happening, that's an entirely different matter all together. The dispatcher should be maintaining contact with the reporting party until the first unit arrives on scene, whether it is Fire, EMS, or LEO doesn't matter. The dispatcher should be continually updating the responding units of changes in the patients condition and asking more in depth questions about the situation then they originally asked and relaying the pertinent information to the rescuers. If that first unit that arrives isn't the transporting unit, they should be advising the transporting unit(s) of the # and condition of the patient(s) within 60 seconds of making patient contact. Even if that unit is the transporting unit they still need to advise the other units and dispatch on the condition of the # of patients, giving each patient a triage code. They also need to advise the dispatch and other responding units of things like when they're initiating CPR, etc. My dispatchers suck no matter whether I'm working in my normal area or in the state capital. The first responders in both places are pretty decent and the Fire department's dispatchers in the Capital are some of the best I've ever seen. My Fire department is also in the same area as I normally work for the ambulance company. We also get to use the same bad dispatchers.

In closing, I get the impression that your department is taking advantage of you. Both the engine and the ambulance are assigning you the sole responsibility of bringing all of the equipment to the scene. Additionally you either aren't paying attention to the dispatch as it comes in or the crew isn't passing along the pertinent information for you to make an informed decision that you shouldn't even be making in the first place. The longest description that shows up on my MDT when I have one is Fall from Significant Height. That is also as descriptive as it gets too. However, my page has all the pertinent information in it including gender, age, number of patients and a more in depth description then what appears on the MDT.

[rescue1man]

KanFireman,

Amen!!! Could not have said it better myself. And as for everyone here who thinks the poor kid should shut up or go home, please.... Like you have never been there. Cut him some slack will you??? He is trying to get as much information as possible to make the best decision. And not for nothing, but if the people he is working with are not telling him what they expect on any particular call (CP, dyspnea, etc...) then shame on them. They are the people who should be mentoring the kid.

Box9104,

There will coma a time when you will make the correct decision without even really thinking about it, but that will come in time. For now, my advice is to bring what you think is necessary and if they dont like it and give you hell for it, ask them what they want. Just remember, move with a purpose on scene, but dont rush. If you rush, you will forget something you need. Just keep eyes open and your mind focused on scene.

[bradenframe]

If you don't know what to bring...

...then you shouldn't be making the decision.

And if you want to learn what to bring...learn with the stuff does...then you'll know.

We EMT's, FF's, Paramedics...we know what the stuff is for...and who needs it. When we don't have enough information on the patient or patients...we take what we know...assume the worst...add ten...and bring our stuff. And remember too...half the time (especially non medically certified) dispatcher info isn't correct, either because of dispatch or the caller.

Unless its not far to the truck and the dispatch info is pretty cut and dry...I bring the stretcher...the aid bad (its the one with the ALS/BLS meds and stuff), the airway bad (its got o2...BVM's...NRB's...etc) and the monitor...EVERY MOTHER F-ING TIME! And amazingly enough...all the stuff sits quite nicely on top of my stretcher...

Hey...you wanna be a firefighter...you want to be a hero? You want to pull some victim out of a building one day? Then you can carry three bags in to your calls. I mean really...if you're going to don 75lbs of gear...go on air...and drag a charged 1.75" line in to a house that is on fire...you can carry a blue, red, green, orange and god knows what other color bag in to your difficulty breathing call.

B Frame

[LFDmedic421]

I believe in keeping things simple. If a run comes in as a CPR then you bring it all otherwise, bring what the run calls for. Since AHA has changed ACLS to be pretty much compression based, if you're surprised by a CPR you can do compressions for 2 minutes while your partner gets the rest of the gear(this happened to me recently). My philosophy to EMS is that it is not my job to sit in someone's house wasting time getting a full set of vitals, ECG, IV, meds and so on. I can do that crap en route. It is my job to quickly assess a pt's condition, package, treat and transport ASAP. My job is to either reverse a condition or keep it from getting worse until they can get corrective care at the ER. Like I said, keep it simple, take in what the dispatch info tells you and go from there.

[big iron]

Always better to have too much, than not enuff, especially when it comes to saving someones life. But dont let the amount of equipment you carry interfere with your ability to provide quality patient care. It wasnt too long ago that an EMT could provide CPR to a patient in distress without having equipment other than maybe a mask.

If you are an explorer, you arent paid to make those decisions, so just do as you are told, and everything will be alright. When you get past that point, provide your input as requested. If you cant learn to take orders, then you wont have to worry about anything past explorers.

[tree68]

My philosophy to EMS is that it is not my job to sit in someone's house wasting time getting a full set of vitals, ECG, IV, meds and so on. I can do that crap en route. It is my job to quickly assess a pt's condition, package, treat and transport ASAP. My job is to either reverse a condition or keep it from getting worse until they can get corrective care at the ER.

My philosophy as well, but there are a lot of folks in EMS who disagree, feeling we should be delivering all sorts of treatments that go well beyond dealing with life-threatening issues. Get wheels under them and go.

Besides, I hear that Medi**** is starting to take a look at EMS and perhaps wondering if they really need to be paying us for some of this stuff.

EMD these days is getting pretty comprehensive. If the caller was able to provide sufficient information to the call-taker, their assessment should be enough to help you determine what you need.

As bradenframe points out - the basics aren't all that hard to bring with us, although sometimes getting them all back to the rig can be a challenge.

[ffscm72]

To be quite honest with you dude...just do as your told & what your station policy states. There are times I will want a backboard & others I prefer the reeves. Just wait to see what the medic wants. Each one of us does something different on scene. I usually don't give these types of answers but I'll have to agree w/ FyredUp on this one. You are an explorer, do as you're told & move on. If you don't like the running back & forth then maybe this isn't for you. You really don't have any decisions to make other than how fast you should be running....& that's even questionable.

[FFSKPII]

Exactly- do what they tell you. They say bring everything, bring everything. They say bring Windex, bring some Windex. Do I bring EVERYTHING on every call? No! I'm probably not going to need an OB kit when grandma falls. But one thing you should bring anytime you bring your "airway" bag would be suction- it's used a lot more than you might think (or at least I use it a ton, maybe it's just my luck to get those calls) and stuff to spinal patients- I spinal a ton of people