Staff putting personal touches on the rigs...

paradoxicalmotion · Sep 17, 2014

The short question: Does anyone have any experience with staff at their agency re-arranging the ambulances how they feel they should be set up, despite how management has dictated they be stocked and arranged?

Background: I recently took a lead medic position with a service that up until the last couple years was a mix of volunteer/paid per call staff, but still very much run in the style of a rural volunteer service. The service area is fairly large, and previously it was set up so that each ambulance at a fixed base was managed independently. People from one base rarely worked at the others. Now staff work at any base they get scheduled at, and our ambulances stage as other trucks are on calls.

Since being taken over and turned into a full-time/career service, the staff is a mix of former volunteers grandfathered in, and staff with experience brought in from elsewhere. We are now at a point where the primary ambulances at each base are basically identical in layout, and were initially stocked identically. Since day one however, we have had issues with staff coming on duty and moving things based on where they feel it should be, or how it was set-up before. The other part of this is that people simply don't know where things belong in the truck (or how many of something there are supposed to be etc.) despite everything being very adequately labeled.

I'm just wondering if anyone has any experience with this happening in a similar situation, and what, if anything was done to correct things?

DesertMedic66 · Sep 17, 2014

We have several different layouts of our units because we have several different patient compartment layouts.

I have never heard of anyone moving anything around however I doubt it would last long. We have people called VSTs who go through the ambulances at the end of our shift and restock them to the correct levels (I have no clue how many NRB we carry).

If it kept being a problem or constant issue out management would work with the crews to find out if there is a better layout for the unit that everyone agrees on. If not then the crew would get warnings and eventually write ups if it was a major issue.

LACoGurneyjockey · Sep 17, 2014

DesertEMT66 said:
We have people called VSTs who go through the ambulances at the end of our shift and restock them to the correct levels (I have no clue how many NRB we carry).

6.
And I don't even know what that stands for, BUT I WANT ONE!

paradoxicalmotion · Sep 17, 2014

Vehicle Service Techs. I so wish that was an option.

Handsome Robb · Sep 17, 2014

I don't think it's appropriate. Sounds like a "we've always done this this way" attitude of old geezers that refuse to change.

I can jump in any of our 43 units and tell you exactly where everything is. I don't need to be searching around for equipment.

TransportJockey · Sep 17, 2014

We had some issues with an Intermediate doing that at our second station. It's no longer an issue after a couple writeups. Our three trucks are all different box layouts, but I can still jump in any of the other two trucks and be able to find anything without too much difficulty (airway at head, cardiac and IV stuff in the middle, splinting/trauma at the feet, drugs by the side door)

MrJones · Sep 17, 2014

Handsome Robb said:
I don't think it's appropriate. Sounds like a "we've always done this this way" attitude of old geezers that refuse to change.

I can jump in any of our 43 units and tell you exactly where everything is. I don't need to be searching around for equipment.

Old Geezers?!

Get off my lawn, kid.

LACoGurneyjockey · Sep 17, 2014

paradoxicalmotion said:
Vehicle Service Techs. I so wish that was an option.

I was so sure it was Very Special Tperson-who-does-my-job-for-me.

OnceAnEMT · Sep 17, 2014

I believe all rigs in a system should have the EXACT same layout and stocking scheme, especially when those rigs are operated by multiple crews. It is just ignorant not to.

I don't know how ATCEMS does it, but I know some folks who work for ATC come to the ED I'm at daily with a large UPS-style truck and stock a small EMS supply closet in our EMS bay. And I know at WilCo the stations have a rather large closet that has all supplies and medications, which leave the crews responsible to stock the truck, and the "stockers" to stock the closet. So I suppose ATC may do the same.

That said, especially when the trucks are stocked the same way and the same amount, I don't really care who stocks it, be it me or someone else, as long as it is done and done right.

TransportJockey · Sep 17, 2014

Grimes said:
I believe all rigs in a system should have the EXACT same layout and stocking scheme, especially when those rigs are operated by multiple crews. It is just ignorant not to.

I don't know how ATCEMS does it, but I know some folks who work for ATC come to the ED I'm at daily with a large UPS-style truck and stock a small EMS supply closet in our EMS bay. And I know at WilCo the stations have a rather large closet that has all supplies and medications, which leave the crews responsible to stock the truck, and the "stockers" to stock the closet. So I suppose ATC may do the same.

That said, especially when the trucks are stocked the same way and the same amount, I don't really care who stocks it, be it me or someone else, as long as it is done and done right.

The problem with same layout is the boxes do change from year to year based on who they ordered from. Replacing a whole fleet at once instead of staggered gets bloody expensive

OnceAnEMT · Sep 17, 2014

TransportJockey said:
The problem with same layout is the boxes do change from year to year based on who they ordered from. Replacing a whole fleet at once instead of staggered gets bloody expensive

I completely agree, but wasn't referring to being that specific. I emphasized more on if the truck was shared between crews, but not so much stations. As long as all personnel assigned to that truck know that truck's layout, I think it is fine for other rigs in the system to be different, barring that the crews of THOSE rigs know their own layout. Now, sure, preference would be for all rigs to be the exact same, but as you mentioned there comes a point where that is not reasonable.

TransportJockey · Sep 17, 2014

Grimes said:
I completely agree, but wasn't referring to being that specific. I emphasized more on if the truck was shared between crews, but not so much stations. As long as all personnel assigned to that truck know that truck's layout, I think it is fine for other rigs in the system to be different, barring that the crews of THOSE rigs know their own layout. Now, sure, preference would be for all rigs to be the exact same, but as you mentioned there comes a point where that is not reasonable.

Gotcha. Sorry my comprehension skills suck this morning lol

PotatoMedic · Sep 17, 2014

All our essential equipment is in the same location. I know that when I started on my unit I moved some stuff around to make equipment I needed more often more accessible. Over time how I had laid out the rig became standard across the company. In hind site I should have gone to management with my suggestion. Yes I do believe in a standard layout. But I also believe that the field crews should have some say in how things are done.

Ewok Jerky · Sep 17, 2014

how about labeled cabinets (ie. NRB(6) NC(6) OPA(2ea.) NPA(2ea) NS(8) LR(2)). maybe with those ez break zip ties?

People hate change, and they hate when someone else organizes their stuff. If it is a new policy you have to be firm that this is the way it is going to be. Be armed with logical reasoning for why you want the rigs stocked this way, and an avenue for suggestions of another way to stock.

Handsome Robb · Sep 17, 2014

MrJones said:
Old Geezers?!

Get off my lawn, kid.

Made me LOL.

No disrespect intended, just in my experience it's the older providers who refuse to change with the times whereas younger ones are being introduced into new systems and are more open to change.

MonkeyArrow · Sep 17, 2014

Is it really that hard to clean up after yourself? When you're doing the equipment check-off in the morning, arrange the ambulance whichever way you want, I really don't care. When you're done with your shift, please put everything back the way that you found it. No one even has to know of your little personal touches.

Jason · Sep 17, 2014

At our squad (and almost for the whole county, since there are 5 agency in the county), the equipment layout is very, very similar from unit to unit. Easy to learn and get use to. We also use a Bin System in each cabinet. Should you need more than what's in the bags, you break open the needed Bin for more supplies and restock the bags as you go. Next shift simply replaces each Bin as needed. Each Bin is labelled and sealed, containing a specific number of the supplies intended for that Bin. I think it makes checking out the unit and restocking a lot faster.
I agree with a previous statement, that it is inappropriate to move things around.

exodus · Sep 17, 2014

The only "personal" touches we have on our unit that the other shift sees is that we keep our adult long and peds BP cuff wrapped around the safety net at the end of the bench so they're easily accessible and we don't have to dig through cabinets to find the bag they're stored in. We also keep our glucometer in the back of our monitor pouch instead of in our everything bag so we can just bring one bag next to the patient for the entire assessment. That's irrelevant though as our bags go back to normal and get sealed with tags at the end of our every shift.

Handsome Robb · Sep 17, 2014

MonkeyArrow said:
Is it really that hard to clean up after yourself? When you're doing the equipment check-off in the morning, arrange the ambulance whichever way you want, I really don't care. When you're done with your shift, please put everything back the way that you found it. No one even has to know of your little personal touches.

I disagree.

We run with the same three FDs and they know how our rigs are laid out. We give them inservices so they can help more efficiently if we take them as a rider. They shouldn't have to deal with different layouts either.

DesertMedic66 · Sep 17, 2014

exodus said:
The only "personal" touches we have on our unit that the other shift sees is that we keep our adult long and peds BP cuff wrapped around the safety net at the end of the bench so they're easily accessible and we don't have to dig through cabinets to find the bag they're stored in. We also keep our glucometer in the back of our monitor pouch instead of in our everything bag so we can just bring one bag next to the patient for the entire assessment. That's irrelevant though as our bags go back to normal and get sealed with tags at the end of our every shift.

My unit yesterday had 4 glucometers in it. Blue bag, red bag, one in the gutter, and one in the monitor.

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