# Medical Equipment differences between EMS and Hospital



## biomedrepairs (Jul 19, 2013)

I am new to this forum but have been in the medical equipment repair business since 2005. I have been involved in all aspects of equipment repair and troubleshooting in hospital and clinic facilities but I understand that the scenarios are completely different when in an EMS situation. 

Do you mind elaborating the various differences you may experience while in EMS which you may not have in a clinical setting? From what I have read NIBP and SpO2 are somewhat harder to obtain due to the movements of patient and ambulance but would like to really understand the difficulties you experience with your medical equipment so I can obtain a better knowledge in the repair field.

Thanks in advance and have a great day!


----------



## biomedrepairs (Jul 20, 2013)

Nobody wanna talk to the new guy lol ?


----------



## Mariemt (Jul 20, 2013)

If it is bumpy, sometimes we have to hold the cord on the bp cuff from bouncing all over during a bp.

Never had a problem with spo2

Sometimes with 3 leads, 12 leads  and fast patches you can get artifact . But usually it is fine

Other than that, if scanning a forehead for a temp, try not to do it while on a very bumpy road,I am always afraid I'll bump the pt in the head.


----------



## NomadicMedic (Jul 20, 2013)

The only difference I've noted is, occasionally the temperature probe on the lifepak 15 differs a degree or two from the temperature probe on the Welch Allen thermometer in the hospital.  I chalk that up to the difference between the axilla and oral placement.


----------



## Tigger (Jul 20, 2013)

Many EMS services use reusable probes for SpO2 readings, this is not something I see done in hospitals in my areas. Not sure there's any difference in accuracy though.


----------



## biomedrepairs (Jul 20, 2013)

Thanks for all the responses. Disposable in hospital is more preventative for infection prevention. However it really depends on adhesion and placement to aquire good signals. I would imagine the same EOC (environment of care) standards would apply for EMS. 

 I have dealt a lot with nonin and nellcor but have heard Masimo has the best noise cancellation algorithm for spo2. 
Thermometer can be Interesting as well. It really depends on placement too. But welch allyn thermometer probes sucks! One bite and they are trash. $150.00 down the drain lol


----------



## Tigger (Jul 20, 2013)

biomedrepairs said:


> Thanks for all the responses. Disposable in hospital is more preventative for infection prevention. However it really depends on adhesion and placement to aquire good signals. I would imagine the same EOC (environment of care) standards would apply for EMS.
> 
> I have dealt a lot with nonin and nellcor but have heard Masimo has the best noise cancellation algorithm for spo2.
> Thermometer can be Interesting as well. It really depends on placement too. But welch allyn thermometer probes sucks! One bite and they are trash. $150.00 down the drain lol



We have Masimo 3 and 12 lead cables as well as SpO2 on our LifePak 12 monitor. I have found that the SpO2 has a much harder time getting a reading in transport than the stock Physio unit we have at my part time job.


----------



## biomedrepairs (Jul 20, 2013)

I don't deal alot with life packs but am trained on Philips Mrx and heart start. Do you use the auto shift check feature on the life pack? Wasn't the 12 part of a major recall with issues in the power supply? 

Could anyone suggest ways I could possibly market my services to our local ems units? I am hoping to get into the ems equipment pm  field mainly since I am in a rural area and if they are using an outside company then they are being charged a fortune for travel. This isn't good for an area already suffering due to massive coal layoffs.


----------



## NomadicMedic (Jul 20, 2013)

biomedrepairs said:


> I don't deal alot with life packs but am trained on Philips Mrx and heart start. Do you use the auto shift check feature on the life pack? Wasn't the 12 part of a major recall with issues in the power supply?
> 
> Could anyone suggest ways I could possibly market my services to our local ems units? I am hoping to get into the ems equipment pm  field mainly since I am in a rural area and if they are using an outside company then they are being charged a fortune for travel. This isn't good for an area already suffering due to massive coal layoffs.



My service runs the checks on the LP15 twice a day, defibbing into a test load once per shift. As for service, you may want to talk to each EMS agency in your area. We use a dedicated Physio rep to service our LifePaks and LUCAS device. Any other biomed gear (vents, CPAP) is sent out to the manufacturer or rep for service, PM and recalibration.


----------



## biomedrepairs (Jul 20, 2013)

Thanks. Oem pms are usually extremely inflated unless you have a full service contract even which an ISO can offer cheaper. I have contacted roughly 20 EMS services within a 30 mile range and keep getting the run around. I give the spill about meeting board regulations As well as mfg recommendations and still no no luck. I am going to try to join our chamber of commerce and see if that may help but not sure why the opposition or hesitation.


----------



## Mariemt (Jul 20, 2013)

I personally would be hesitant too. Not because you aren't qualified, but because the manufacturer will have record, record of certified techs who did it etc so if something goes wrong, All the correct steps have been taken, warranty work etc.

Saves a lot of headache. Plus if it is something that can't be fixed under warranty,  they will replace it without too much headache


----------



## biomedrepairs (Jul 20, 2013)

I do offer asset management for pm and repair tracking as well as replacement assistance if a unit is doa. Warranties are like insurance programs lol always good for the company selling them. But Ivan understand the hesitation. That's part of the reason for joining the chamber of commerce. To show I am not a fly by night company. I also have full liability insurance but I guess it's just a waitin game.


----------



## mycrofft (Jul 23, 2013)

biomedrepairs said:


> Nobody wanna talk to the new guy lol ?



Sorry, I wrote a long reply right after you started the thread and it didn't post.

BTW you are working my former/original dream retirement job.

1. Field-use equipment and handheld equipment: plug-in probes wires and electrodes are enemy number one. The wires get repetitive motion syndrome (snapped wires, broken shields, loosened connectors), the connectors break away from or simply crack the motherboard, people pick up machines by the leads sometimes (especially thermometers). Also, things get dropped. 

2. User ignorance and sloth. Workers don't get taught and indoctrinated about the machines. Electrodes are opened and the gel dries out. Dead batteries are left in place, or the replacement battery is substituted and the dead battery (etc) is stuffed back where the spare was. People think Lithiums are like NiCads and want to exhaust them before recharging. Paper is loaded wrong or is the wrong paper. Ask the users to show you the manuals and training records (they won't, but watch their faces). And many times nothing's wrong except they can't figure out the overcomplicated operating instructions, or are using a home quality machine on a professional rig.

3. Calibration/cleaning/software upgrades not done. No one is in charge and truly doing it. I took my clinic's eight Welch-Allyn Sure-Temp thermometers and ran them all against a lab thermometer in a 99 degree F cup of coffee. Many were as far as 1.5 to 2 degrees F off using the predictive algorithm, and nearly as far off on "monitor" mode.

I once found a WA vital sign monitor fried because someone had substituted another external power supply (the plug on the motherboard matched).

That help?


----------



## mycrofft (Jul 24, 2013)

On the business side:
1. Need INSURANCE. Bigtime. _Any_ machine you _ever_ worked on can drag you into a lawsuit. (Opinion, not legal advice).
2. Manufacturers want to do maintenance, because they can get money for it and first chance at a replacement sale.
3. EMSA and others may require certification, such as from a school or the originating company, who wants to do the repairs, etc....

Since most calls are either BS (user issues), minor trouble with leads/probes/batteries or the  machine is _muerto_, therer is a ray of sunlight, except to provide faster service than calling the company and getting the new probes etc via overnight mail you need to stock a buncha different models, styles of lots of types of expensive items.

How about allying your self as a local rep for a company? Or multiple companies? Get an idea of what's going on locally, might decide to go it on your own, or keep wearing their uniform, or drop it altogether.

 If a local customer needs a maintenance department/manager ( periodic maint, updating software, keeping records) you could offer that as a service like a pest guy or accountant.

Good luck.


----------



## AlphaButch (Jul 25, 2013)

mycrofft said:


> 1. Field-use equipment and handheld equipment: plug-in probes wires and electrodes are enemy number one. The wires get repetitive motion syndrome (snapped wires, broken shields, loosened connectors), the connectors break away from or simply crack the motherboard, people pick up machines by the leads sometimes (especially thermometers). Also, things get dropped.



Our biggest issue and most frequent repairs needed are due to wear and tear to the cables and probes. A lot of this can be attributed to design (lack of specific cable storage area, covers that kink cables, etc). We don't even keep automatic NIBP cuffs attached anymore (they're put away to be used for only long transports) because of repair costs.


----------



## medicdan (Jul 25, 2013)

^^ Agreed. The services I work for want a service contractor who can do a whole bunch of things, including: 


-- Not only maintaining the warranties of the equipment, but also having liability insurance if things go wrong (remember, it's all about passing the buck, because while the operations managers know lots about field use, they often don't understand the mechanics) 
--Quick turnaround when things break (i.e., we only own six vents, with five in service at a time). Part of this might be anticipating problems, and stocking parts, etc.
-- Avoiding unexpected costs (i'm not sure how you generally do this, whether service contracts, or identifying when things are about to fail...)
-- Lastly, full service, and able to manage all of different devices we carry and use (Stryker/Ferno stretchers and stair chairs, PhysioControl monitors and AEDs, Zoll AEDs, Phillips AEDs, Newport ventilators, IMED pumps, SSCOR suction, etc.) Other services are going to need you to service slightly different manufacturer's equipment. 
-- Are you scalable? Can you manage a service with five trucks? 50? 150? Can you do the service on-site? How long does equipment need to be OOS for PMI?

I applaud your interest in expanding your business, and for doing your research by coming here... and I encourage you to think about how EMS uses equipment differently than a hospital or clinic. We generally don't have replacement equipment immediately available on the ambulances, and limited replacements at the garage; we generally take a much more physical toll on equipment, so have more damage from water, falls, etc. There's a culture of "McGuyverism", where we try to fix things in the moment, rather than swapping equipment out, which sometimes results in more damage... 
Consider taking a look at some of the larger BME repair businesses around (at least me), http://www.emsar.com/products-serviced/ems-biomedical.aspx and http://www.progressivemed.com/biomed.html


----------



## mycrofft (Jul 25, 2013)

"Avoiding unexpected costs (i'm not sure how you generally do this, whether service contracts, or identifying when things are about to fail...)"

So, bring expectations of cost into reality. Use experienced honest people to assess likely costs and incorporate these into your budget. Keep records of repair and replacement costs in the past and track the service life of each device, including "cause of death" and service costs.

To reduce costs, do NOT have cursory introduction to new devices. Use your inservice assets to conduct the classes and document. Tell your folks if the budget is busted by broken and missing equipment, then they will have to go back to manual means. If things get really bad, had RFIDS installed and be able to scan for them at doorways, lockers, personal bags. Engrave and record ID numbers as well as serial and model numbers and mark the device on its face so it is visible in a listing photo for EBAY or such.

SOME*ONE* has to be in charge of these to prevent theft and damage, and keep them in working order.


----------



## biomedrepairs (Aug 2, 2013)

Thank you all so much for your information. I apologize for the slow response. I see the struggles daily for all medical professionals who work with equipment and figured that ems was no different besides the overall decrease budget compared to a hospital. 

I have called Zoll and physio control to find out their charge for pm services and was floored at their hourly rate. I am working on getting a general device charge setup depending on overall options etco2, spo2 and such. 

Would anybody be able to offer some examples what your currently being charged for a single device pm and what options you have. 

This may also benefit other ems services to see if there is an alternative source available to help cut costs which may help increase salaries lol

Also for those Bls crews who are only using AED, has anybody stressed the need for an actual outputs check vs the standard "device self test"? There has been an increase concern in a devices ability to function, even though the self test passes physio control had many units still unable to deliver life saving therapy!


----------

