Many of you have seen or at least heard of the law enforcement body camera footage recently released in response to homicide charges against two EMS providers in Illinois. The providers are accused of causing the death of a patient by securing him to a stretcher prone during transport to a hospital. Viewers commented that the EMS provider appeared to have entered the home without any equipment to assess or treat the patient.
This, in turn, lead to conversations about the gear that we all carry in when responding to a call. It seems that there are some of us that take a healthy chunk of the ambulance in with us, while others have it scaled down to the bare minimum, opting to first move the patient to the ambulance before performing any in-depth assessment or care. My mind immediately sees Johnny and Roy from Squad 51 pulling a trauma box, a medication box, the bio-phone and an oxygen cylinder on a metal cart from the rig for each response.
What do you carry in? What goes into the decision and where do our selections land on a spectrum of being 100% prepared for any condition we may find to being quick, light and back pain free?
The decision about what gear EMS providers take with them to the side of a patient may involve several factors:
- Information provided by dispatch
- Familiarity with the patient or care facility
- Distance from the patient to the ambulance
- Stairs or other access barriers
- Weather
- Number of crew on scene available to help carry items
- Weight of monitor and packs
- Pressure from management to limit damage or loss of equipment
- Protocols or procedures
- Culture within the department
How were we trained?
It is likely that in your initial EMS courses, you practiced patient care scenarios by carrying a collection of bags and equipment from one room of your training facility to another, plopped it down next to the patient, proclaimed “scene safety, BSI” and then kneeled by the patient to begin an assessment.
In flipping through a number of EMS texts here in my office, I was unable to find any that reference moving the patient to the ambulance before beginning assessment or basic treatment. Certainly, the exception is unsafe or unstable scenes.
What is the reality?
We know that some of what we are taught in our initial courses is textbook, and when we get to the station, we will learn how it’s done in the streets, but reality needs to be a delicate balance of principles learned in school and best practice experienced in real life. The classroom version doesn’t always factor in the challenges of everyday response and the “streets” version can easily evolve from cutting corners, bad habits and misplaced motivation. Finding the middle is important.
Protocols and procedures
Certainly, your service protocols and procedures may dictate how you approach each call. For example, the Massachusetts state EMS protocols specifically instruct providers to “begin assessment and care at the side of the patient; avoid delay,” and to “bring all necessary equipment to the patient in order to function at your level of certification and up to the level of the ambulance service license.” Likewise, the Rhode Island version requires providers to “bring all necessary equipment to the patient.”
Other protocols lack clear language about providing care at the side of the patient or bringing equipment in, but all outline an assessment and initial care before discussing triage and transport decisions. This takes some amount of gear, right?
Of course, terms like “necessary” leave room for critical decision making which, in the EMS setting, seems reasonable. Use the information you already know about the patient’s condition, the scene setting, safety concerns and other logistical factors to identify which packs and monitors you will lug to the patient’s side and back.
What are your practices?
Let’s hear from you about how your service works as it relates to taking equipment into a scene. At the agency I occasionally pick up shifts at, some staff have started carrying their own small pack of essentials because the main trauma pack has gotten so heavy. We grab the multi-function monitor, a glucometer and our personal kit for calls that do not sound critical.
Do you have a similar practice? Do you have different bags for different call types? Or do you subscribe to the load-then-assess practice? Tell us why.
Stay safe out there.
Read more:
Poll call: Majority of responders answer non-critical calls loaded with gear
"Whatever you don’t bring is what you’re going to need," one commenter wrote
