# Interesting interview question popped up today... Remove one piece of equipment



## Hockey (Jul 13, 2009)

If you could get rid of ONE piece of equipment in your ambulance, what would it be?


I froze because honestly, I don't know.  I mentally went through an entire truck.  I made an arse out of myself by saying Ked Board 


One item I could keep from my rig.  I made an arse out of myself again by saying BP cuff.  Seriously a BP cuff what the hell was I thinking?  They asked, even over O2?  I said well the radio too. 

Stupid questions.

Apparently this is the first time they did an oral board interview so I got to be the guinea pig or something


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## medic417 (Jul 13, 2009)

Actually great question.  Question allows us to see persons ability to reason and even if they understand the true medical value of equipment.


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## Hockey (Jul 13, 2009)

medic417 said:


> Actually great question.  Question allows us to see persons ability to reason and even if they understand the true medical value of equipment.




I first said nothing because I can't predict the next call for service is.  He told me I can't play that way.


I redid my answer for the what equipment could you not lose, and I said the radio because if not, we will be blind out there


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## Hockey (Jul 13, 2009)

So what would your one thing to save or getting rid of?  BLS truck (none of that ALS stuff..you have too many things you can chose from  )


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## WolfmanHarris (Jul 13, 2009)

My top 3 in no particular order"
- CPR Board. Ministry required, never used. (this one came to me almost instantly. Hate the bulky thing)

- Long spine board. When will we drop these piece of equipment and use vacuum matresses and clinical judgment? Besides, I much prefer the scoop.

- Squad bench in the back. I don't want my back to be the crumple zone in a minor side impact. Front/rear facing captain's chair that can be rotated if necessary for pt. care.


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## Onceamedic (Jul 13, 2009)

flippin' useless bite stick - DHS demands we carry one and it is the most useless thing ever...  every month we blow the dust off of it count it


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## WuLabsWuTecH (Jul 13, 2009)

I would get rid of the MAST pants.

I would keep my gloves.


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## usafmedic45 (Jul 13, 2009)

REMOVE:
-MAST
-CPR board
-Long spineboard
-Bite sticks/jaw screws
-Inflatable splints (as opposed to vacuum splints)
-Gas-powered manual resuscitators


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## Maya (Jul 13, 2009)

no pants.  hmmm...  interesting.


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## rescue99 (Jul 13, 2009)

The pulse-ox. There are other ways to evaluate and the SPO2 is not all that reliable.


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## PapaBear434 (Jul 14, 2009)

I went to MAST pants, but we don't carry them anyway.  So, out of the stuff we have...  I guess some of the redundancy.  We have a Broslow bag and a Peds kit.  We have a trauma jump bag and a box in the cabinet we can use when they get to the truck.  There is really no point of either of these redundancy measures when each bag and box has multiple of each tool.

If I had to choose something to get rid of, altogether?  The CORR and HEAR radios.  We never use them.  I have personally NEVER used them at all.  We use the 800mhz radio for pretty much anything and everything.  They just take up needless room.


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## usafmedic45 (Jul 14, 2009)

> The pulse-ox. There are other ways to evaluate and the SPO2 is not all that reliable.



I'll give you a chance to pull your foot out of your mouth.  OK, time's up. The problem with pulse oximetry is usually how it is applied and by whom it is being interpreted.  Most EMS providers have a very weak understanding of how to interpret and troubleshoot issues.  Do not throw the baby out with the bathwater simply because of a misplaced bias.  There's a really great joke about accuracy of lab results and how to address problems:

-Precise and accurate:  Give the technician a pay raise
-Precise but not accurate (you get a technically acceptable result but it's not correct): Calibrate the machine
-Accurate but not precise (you have problems getting the reading but it comes out correct once you do): retrain the technician
-Neither precise nor accurate: fire the technician and get rid of the machine

Most of the problems I hear EMS providers bring up about fall under the "accurate but not precise" criteria above.  Quite frankly, if you put even the best equipment in the hands of a poorly trained troglodyte, you're going to get crap for results.  

Short of a blood gas, there is no more reliable measure- in skilled hands- than a pulse oximeter and it has a vital role to play in the titration of oxygen therapy. Sure, you have to correlate it with what you are seeing with the patient but one could technically argue that we should throw away our BP cuffs because you can use other assessment findings to judge perfusion.  There have been studies done that show a very poor correlation between assessment findings and demonstrable hypoxia.  Contrary to the popular held belief, not all that is dyspneic is hypoxic.  Likewise, the old tendency in our field to blame the equipment is not the best approach.


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## rescue99 (Jul 14, 2009)

Excuse me? Pull my foot out of my mouth? Wow..not necessary! It happens to be a NR question.


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## usafmedic45 (Jul 14, 2009)

> It happens to be a NR question.


Oh, excuse me, I didn't realize that inclusion on the NR exams was the penultimate Level I evidence.  Just because it's on a test does not mean it's correct.  




> Wow..not necessary!



Sorry to come across as snide, but I don't like people making indefensible statements based on BS, spin and supposition.  Now if you care to point to something of _scientific value_ that indicates that pulse oximetry in the hands of properly trained providers is inaccurate we'll talk like adults and I'll depart from my current guess that your knowledge in this area is a little lacking and based largely on hearsay.  Got anything that says that it's inaccurate?  That it is unreliable?  That it's a bad idea to use it as a diagnostic tool?  For future reference, it's not a good idea to make definitive statements in a professional setting- and this forum counts since you're dealing with colleagues- without being prepared to back them up with more than just "it's a NR question."


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## rescue99 (Jul 14, 2009)

Who said it isn't a useful tool? There are other ways to assess and if I had to make a decision on what tool of the trade I could leave behind, it would be the SPO2. It is a good tool but, isn't an absolutely necessary tool and in many instances, not my most reliable tool.


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## WuLabsWuTecH (Jul 14, 2009)

It always surprises me how few people know that pulse oximeters need to be calibrated.

Its more or less a IR specroscopy machine or a UV-Vis spectoscopy machine.  Would you walk into a chem lab and not calibrate those?  We calibrate our "spec's" at least once an hour!  Why on earth would you never have to calibrate a pulseox?


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## daedalus (Jul 14, 2009)

usafmedic45 said:


> I'll give you a chance to pull your foot out of your mouth.  OK, time's up. The problem with pulse oximetry is usually how it is applied and by whom it is being interpreted.  Most EMS providers have a very weak understanding of how to interpret and troubleshoot issues.  Do not throw the baby out with the bathwater simply because of a misplaced bias.  There's a really great joke about accuracy of lab results and how to address problems:
> 
> -Precise and accurate:  Give the technician a pay raise
> -Precise but not accurate (you get a technically acceptable result but it's not correct): Calibrate the machine
> ...



I love this post! I have always fought the whole "Treat the patient, not the machine" because the phrase is overused and misunderstood. It is imperative that any medical provider have a mastery of physical assessment and a good PE can bring hidden truths to light. However, there is a reason why EKGs, ABGs, Pulse oximeters, glucometer, CT scanners, X ray, etc were developed. To augment and enhance the PE. Of course you are going to treat findings from diagnostic studies, as long as you are educated enough to know when they are precise and accurate and you are not being fooled by them. (Kudos to those who know the difference between precise, and accurate. If not, read up on it, and while you are at it, read up on specificity and  sensitivity)


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## usafmedic45 (Jul 14, 2009)

> There are other ways to assess



Ever heard of inter-rater reliability?  It's a way of examining the differences between a number of people who are looking at the same thing.  The problem with these "other ways" is that the inter-rater reliability is generally crappy mostly because of the fact that not everyone who looks hypoxic is hypoxic and some people have a better ability to separate the two.  The reliability of these "other ways" in other words, is marginal at best.   Since reliability seems to be a primary concern of yours, then I am surprised that you are not aware of this.  



> It is a good tool but, isn't an absolutely necessary tool and in many instances, not my most reliable tool.



It's either a good tool, or it's not reliable. Which is it?  It is either a good tool or you can't rely on it a lot of the time.  It sounds like you're basing this stance off of opinion and personal experience rather than anything valid or defensible.  

Just in case you're interested:
Aughey K, Hess D, Eitel D, Bleecher K, Cooley M, Ogden C, Sabulsky N: An evaluation of pulse oximetry in prehospital care.  Ann Emerg Med. 1991 Aug;20(8):887-91.

STUDY OBJECTIVES: We performed this study to evaluate the accuracy of pulse oximetry oxygen saturation (SpO2) against direct measurements of arterial oxygen saturation (SaO2) in the field. DESIGN: Prospective, cross-sectional, paired measurements of SpO2 against SaO2. SETTING: This evaluation was done in the prehospital setting. INTERVENTIONS: A pulse oximeter with digital probe was used to measure SpO2 in 30 patients. Arterial blood gases were drawn in the field while the pulse oximeter was in use, and oxygen saturation (HbO2) was measured by CO-oximetry. MAIN RESULTS: There was no significant difference between SpO2 (94.6 +/- 5.4%) and HbO2 (94.9 +/- 5.1%) (P = .495, beta less than .2). There was a strong correlation between SpO2 and HbO2 (r = .898). The bias between SpO2 and HbO2 was -0.3, with a precision of 2.4. When SpO2 was 88% or more, HbO2 was 90% or more in every case. Mean carboxyhemoglobin was 1.3 +/- 0.9%, and mean methemoglobin was 0.9 +/- 0.3%. There was no significant difference between the pulse oximeter heart rate and the ECG heart rate (P = .223, beta less than .2). CONCLUSION: *We conclude that pulse oximetry is sufficiently accurate to be useful in the field when SpO2 is more than 88%. It is potentially useful in patients with clinical signs of acute hypoxemia and in patients receiving interventions that may produce acute hypoxemia*. Further work is needed to evaluate the accuracy of pulse oximetry in the settings of elevated carboxyhemoglobin, methemoglobin, and very low saturations.

BTW, "very low sats" is really a moot point in the field.  If you have clinically correlatable reading that is less than 80% (most pulse oxs state not to rely upon a reading lower than 70-75%) you are not worry any further.  It is quite overt hypoxemia and should be treated as such.  



> It always surprises me how few people know that pulse oximeters need to be calibrated.



Wu, a lot of modern pulse oximeters have a built in calibration check that automatically maintains the validity of the results.  In fact, I believe it's effectively an industry standard nowadays.  This is per a conversation I had with an engineer from Masimo (one of the major manufacturers of pulse oxs) where I asked about exactly what you just brought up.


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## reaper (Jul 14, 2009)

To add to this, many states have SPO2 has a mandatory vital sign, just like Pulse,BP,and RR. So, it is not something that can be left behind.

To the OP, I would leave the portable stretcher off the truck. The kind that folds in half. We carry them as a requirement, but never use them, except in mountain rescue.


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## WolfmanHarris (Jul 14, 2009)

reaper said:


> To the OP, I would leave the portable stretcher off the truck. The kind that folds in half. We carry them as a requirement, but never use them, except in mountain rescue.



I was going to say that at first, but then flashed on a rural 5-car MVC I went to where I had to transport two minor, but boarded patients and had to use it. (The trucks have specifc brackets in the bench to secure a Ferno #9) It was February and this was a rural service. If we'd waited for enough trucks for one patient per it wouldn't have been a good use of resources. To me it's one of those pieces of equipment, that when you need it, you need it, however rare.


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## Mishka (Jul 14, 2009)

wow you guys have all that stuff on your buses...hehehe...  I guess short-boards on our side...most useless thing


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## WuLabsWuTecH (Jul 14, 2009)

daedalus said:


> I love this post! I have always fought the whole "Treat the patient, not the machine" because the phrase is overused and misunderstood. It is imperative that any medical provider have a mastery of physical assessment and a good PE can bring hidden truths to light. However, there is a reason why EKGs, ABGs, Pulse oximeters, glucometer, CT scanners, X ray, etc were developed. To augment and enhance the PE. Of course you are going to treat findings from diagnostic studies, as long as you are educated enough to know when they are precise and accurate and you are not being fooled by them. (Kudos to those who know the difference between precise, and accurate. If not, read up on it, and while you are at it, read up on specificity and  sensitivity)


Precision and accuracy is easy.  Precision is how close to the value that your sensor wants to read can get.  So if your sensor wants to read 97% when given finger A, willl it be able to read 97% 10/10 times?  Also, if your sensor wants to read that same finger A, can it read 97.23% (more precise) or just 97% (less precise)?

Accuracy is how close to the actual value it is.  If finger A is actually 85%, then a reading of 97% is less accurate than one of 90%.

Specificity and sensitivity has been awhile for me, but lemme take a stab at it.

Sensitivity recognizes the pathology.  So if a test is very sensitive, you recognize all people with the pathology as having the pathology.  Therefore, false negatives are rare and you use the test results looking to identify patients with a negative result as NOT having the pathology.

Specificity identifies individuals without the condition of interest.  So if a test is very specific, then it minimizes false positives and we use the test results looking to identify patients with a positive result as having the condition.

Theres a way to calculate using formulas too and a 2x2 square but I have long lost that!

@usaf, we need to upgrade then!

@ everyone.  Can anyone explain to me why we still carry MAST pants?


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## usafmedic45 (Jul 14, 2009)

> @usaf, we need to upgrade then!



Well, look at the precision level you guys are aiming for (in terms of decimal places) versus what you are looking at in a pulse ox (2 decimal places at most and often just one).  The QC/QA gets a lot harder to establish and maintain with the increased precision of the instrument.   I don't work with the same equipment you do in your lab, so I can't say if anyone has bothered to produce an automated model.  It's a lot cheaper and easier to simply hire an undergraduate to do it.   No offense of course....



> Can anyone explain to me why we still carry MAST pants?



I think it is mostly due to the fact that no one has the drive to rewrite the state minimum equipment lists.


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## Hal9000 (Jul 14, 2009)

*How specific do we get to be?*

I'd get rid of 2x2s.  We also have 3x3s/4x4s...though they're phasing out one for the other.  

I'd keep things that keep me safe, such as gloves, glasses, radios.  It's me, then you.


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## akflightmedic (Jul 14, 2009)

WuLabsWuTecH said:


> Can anyone explain to me why we still carry MAST pants?



We don't in Florida. State removed them years ago, somewhere around 2003 I think.


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## Hockey (Jul 14, 2009)

Why did my title get edited?


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## mycrofft (Jul 14, 2009)

*Check this thread:*

http://www.emtlife.com/showthread.php?t=8649

I love these exercises.
Toss the 2X2 gauze (you can use a bitestick as a door prop or finger splint).
As the unit burns, carry away your radio, definitely.
I would cheat that exercise and put stuff down my shirt. All's fair in fire and EMS.


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## Seaglass (Jul 14, 2009)

I'd get rid of: MAST, bite stick. 

If I was allowed to improvise, I'd also get rid of most of the specialized bandages, tourniquets, and some of the splints. I'd only say this if they were asking about an emergency jump bag, though.

I'd keep: radio, gloves, boots (I hate dropping stuff on my toes), sharpie.

I suspect we still have MAST pants because they're so rarely used that nobody even remembers we have them...


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## mycrofft (Jul 14, 2009)

*MAST is good for busted pelvis and as a flotation device.*

(Don't put them on to float, you will float head DOWN).


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## apagea99 (Jul 14, 2009)

mycrofft said:


> (Don't put them on to float, you will float head DOWN).



Haha! I was thinking something similar B)

I'd dump the PTL. When I first had to use it in class I thought it was simple and easy to use. After a few weeks I figured out how much I hate it. It's much too bulky and it's a pain to inflate the cuffs with the BVM (I wasn't about to inflate by mouth after everyone else in class had handled the thing). The combitube is a much better choice IMO.


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## WuLabsWuTecH (Jul 14, 2009)

mycrofft said:


> (Don't put them on to float, you will float head DOWN).


Well, duh!  But yuo can hold on to it.  At least I hope what the poster was referring to!

Also, what are these bite sticks everyone keeps referring to?  The OPAs?


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## TransportJockey (Jul 14, 2009)

WuLabsWuTecH said:


> Also, what are these bite sticks everyone keeps referring to?  The OPAs?



No, not OPAs. I'm not sure exactly what they are, since we don't carry them, but I do know they aren't OPAs


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## Rob123 (Jul 14, 2009)

WuLabsWuTecH said:


> Also, what are these bite sticks everyone keeps referring to?



As far as I know, "bite sticks" are also known as "seizure sticks".  They are plastic U shaped tongue depressors that provides an airway for seizure patients.  I have never actually seen one as they are not in the current NYS BLS protocols.


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## MRE (Jul 14, 2009)

I'm cheating, but I would drop the 30lb car jack from my rig.  We don't carry a spare tire, so its not much good, but according to the director, we are required to carry it.


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## usafmedic45 (Jul 14, 2009)

> tourniquets,



Care to explain why you would get rid of tourniquets?  They are a low use item but are extremely useful in some situations.


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## PapaBear434 (Jul 14, 2009)

W1IM said:


> I'm cheating, but I would drop the 30lb car jack from my rig.  We don't carry a spare tire, so its not much good, but according to the director, we are required to carry it.



You know, we have that too.  Little stupid scissor jack, that in no way would EVER lift an ambulance.  No spare tire, either.

I guess it might be useful if I ever needed to lift a car off someone, but in those cases we almost ALWAYS have an extrication team on hand.


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## usafmedic45 (Jul 14, 2009)

> we almost ALWAYS have an extrication team on hand.



Key word, "almost".  I'd rather have it around when I need it for those cases where we have a car fall on someone in a garage or something similar that doesn't get put through by dispatch.  I've walked into exactly that situation without the benefit of an extrication team.


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## WuLabsWuTecH (Jul 14, 2009)

Haha, that's funny.  Perhaps you guys ARE required to carry a spare tire?  I probably wouldn't feel comfortable changing a tire on the rig anyway...

And yeah i've never seen a bitestick either, but an OPA would do the same job?


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## WuLabsWuTecH (Jul 14, 2009)

usafmedic45 said:


> Key word, "almost".  I'd rather have it around when I need it for those cases where we have a car fall on someone in a garage or something similar that doesn't get put through by dispatch.  I've walked into exactly that situation without the benefit of an extrication team.


I don't have extrication training so I don't extricate people except from cars using a KED like we learned.  If we need extrication that's what the guys on the engine and rescues do!


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## usafmedic45 (Jul 14, 2009)

WuLabsWuTecH said:


> I don't have extrication training so I don't extricate people except from cars using a KED like we learned.  If we need extrication that's what the guys on the engine and rescues do!


Pulling someone from under a car that has fallen off it's jack while they were working on it is not that involved of an extrication.  We're not talking cutting someone out of a car or rolling an overturned car off of them.


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## PapaBear434 (Jul 14, 2009)

usafmedic45 said:


> Key word, "almost".  I'd rather have it around when I need it for those cases where we have a car fall on someone in a garage or something similar that doesn't get put through by dispatch.  I've walked into exactly that situation without the benefit of an extrication team.



Not hardly.  If it's a pin, we call them out and they take care of it.  We just stabilize as necessary.


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## usafmedic45 (Jul 14, 2009)

Two to four minutes to get them out versus 10 minutes to call for the rescue unit and then four or five for them to get the person out.  Which do you think is better for someone with a car sitting on their chest and/or abdomen?   We're not talking a "pin job" here.  This is a simple basic car fallen off it's jack call.  Let me put it another way:  Would you wait on the fire department to roll a refrigerator off of someone? 

BTW, I'm saying this as someone who oversaw EMS and rescue operations for a volunteer fire department so do not take this as being "anti-fire/rescue" like someone accused me of being in a PM I just received.


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## mycrofft (Jul 14, 2009)

*Bite stick, classic*

http://quickmedical.com/images/sku/9709.jpg






Classically never used because trismus would already have set in, and if it went in past the thickest part, it could slide down the airway. Also people would pad a wooden tongue depressor with gauze.


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## MRE (Jul 14, 2009)

WuLabsWuTecH said:


> Haha, that's funny.  Perhaps you guys ARE required to carry a spare tire?  I probably wouldn't feel comfortable changing a tire on the rig anyway...



Nope, they let us drop the spare tire because we don't do long interfacility transports, just local runs to the hospital.  The reasoning is that it would be faster and better for the patient to be transferred to a second ambulance than having the crew trying to change the tire and continuing on.

Lug wrench and jack are still on the required list though.


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## chadwick (Jul 14, 2009)

CPR masks are a little useless if you have a BVM


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## WuLabsWuTecH (Jul 14, 2009)

usafmedic45 said:


> Pulling someone from under a car that has fallen off it's jack while they were working on it is not that involved of an extrication.  We're not talking cutting someone out of a car or rolling an overturned car off of them.


Yes, but I have no idea how to do it safely and without it accidently falling on me too.  I would assume he'll need to be C-spined and I'd rather wait for the Rescue to move the car and secure it before I go under it to cspine.

Ditto to the fridge.  We run a 3 man sometimes 4 man crew so we might be able to get it, but if not, we'll call for manpower.


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## PapaBear434 (Jul 14, 2009)

chadwick said:


> CPR masks are a little useless if you have a BVM



Ah!  Another one!  Yeah, we carry at least one adult and one peds BVM in our bag and three adult, two peds, and two infant ones in the rig.  The mask is a little pointless.


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## mycrofft (Jul 14, 2009)

*CPR pocket mask can be a replacement BVM mask*

Fittings are compatible


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## Sasha (Jul 14, 2009)

The radio.. It keeps interrupting my naps.


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## Shishkabob (Jul 14, 2009)

Why the bite stick?  Takes up nill room, and can be used as a nifty finger split.


I say the crap load of SAM splints.  Love em, but there's only so many appendages you'll need to split before you arrive to the hospital.  We can fit a small TV back there!


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## MSDeltaFlt (Jul 14, 2009)

Yeah, the most useless item on the truck is the CPR board.  If you're doing CPR, you're going to need to be able to move the pt if it is decided to transport.  Then the CPR board is just in the way.


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## WuLabsWuTecH (Jul 15, 2009)

PapaBear434 said:


> Ah!  Another one!  Yeah, we carry at least one adult and one peds BVM in our bag and three adult, two peds, and two infant ones in the rig.  The mask is a little pointless.


I don't think we have pocket masks on our rigs.

But yes, the fittings are compatible.


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## EMT11KDL (Jul 15, 2009)

I just went through my rig and I would have to say the X-Small Gloves.  

our rig carries X-Small up to X-Large Gloves.  And the X-Small box has never been opened but it is still in the rig and we continue to buy them even tho we never have used any of them!


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## JPINFV (Jul 15, 2009)

Latex free kit when everything on the ambulance is already latex free.


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## usafmedic45 (Jul 15, 2009)

BTW, in reference to the earlier post about tourniquets needing to be removed, I refer anyone interested to this article: http://wjes.org/content/pdf/1749-7922-2-28.pdf


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## chadwick (Jul 15, 2009)

Anything latex that can be latex free. Too much risk for some people.


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## Pudge40 (Jul 15, 2009)

I would say activated charcoal as getting anybody to drink enough and keep it down is pretty much impossible anyway.


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## Momof7 (Jul 15, 2009)

rescue99 said:


> The pulse-ox. There are other ways to evaluate and the SPO2 is not all that reliable.



No kidding I agree. If their blue they need more O2. LOl


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## Momof7 (Jul 15, 2009)

Lemon sticks, yeah I would get rid of the lemon sticks. Not sure how long they have been in there. YUCK


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## Momof7 (Jul 15, 2009)

Oh I have one. Teddy bears and OB kits in our B rig. Thats the rig we use for the nursing home runs.^_^


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## usafmedic45 (Jul 15, 2009)

> No kidding I agree. If their blue they need more O2. LOl



Cyanosis is a poor indicator of existence of hypoxia.  To put it in scientific terms, the specificity is pretty high but the sensitivity leaves a lot to be desired.   Otherwise you're correct, although your approach would leave a lot of people with hypoxia untreated and people without hypoxia overtreated.


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## Momof7 (Jul 15, 2009)

I was joking.


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## JPINFV (Jul 15, 2009)

Momof7 said:


> Oh I have one. Teddy bears and OB kits in our B rig. Thats the rig we use for the nursing home runs.^_^



...and what happens when the unit is on the way back to base and gets flagged down for an OB call?


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## Momof7 (Jul 15, 2009)

Lol Ok OK well then, I would punt. If the babies coming it is coming with or without an OB kit.


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## usafmedic45 (Jul 15, 2009)

Ah, sorry....it's a real pain in the backside to judge humor on forums even with an LOL.  What you said is such a common misconception among EMS personnel that I saw a teaching point and ran with it.


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## EMT-G36C (Jul 15, 2009)

Discard:

Stretcher, workdays just got a whole lot easier!

All kidding aside, Powered suction unit. 

Weighs a bit, and not as useful as onboard or the manual portable.

Keep: 

Dash mounted computer with NOMAD.


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## usafmedic45 (Jul 15, 2009)

> Powered suction unit.
> 
> not as useful as onboard or the manual portable.


Just out of curiosity, how many calls have you had where you've actually had to suction someone? 

How do you figure it's not as useful?  The fact that it's a little bulky does not mean it's not worth it's weight in gold when you have a difficult airway.  I don't see how the manual portable is a big advantage over them in a patient with copious amounts of secretions or blood in the airway and I have a lot more experience with secretions than most people on this forum.  The _only_ manual suction devices I've ever seen that work even passingly well are bulb syringes and turkey basters.  All of the commercial designed manually powered units intended for EMS (such as the V-Vac, etc), seem to be lacking in power to deal with thick secretions or coagulated blood or are too tiring on the hands to be of much use.


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## EMT-G36C (Jul 15, 2009)

usafmedic45 said:


> Just out of curiosity, how many calls have you had where you've actually had to suction someone?
> 
> How do you figure it's not as useful?  The fact that it's a little bulky does not mean it's not worth it's weight in gold when you have a difficult airway.  I don't see how the manual portable is a big advantage over them in a patient with copious amounts of secretions or blood in the airway and I have a lot more experience with secretions than most people on this forum.  The _only_ manual suction devices I've ever seen that work even passingly well are bulb syringes and turkey basters.  All of the commercial designed manually powered units intended for EMS (such as the V-Vac, etc), seem to be lacking in power to deal with thick secretions or coagulated blood or are too tiring on the hands to be of much use.



10-20, probably on the lower end of that spectrum.

The way I see it though (working mostly IFT for a private) the hospitals or nursing homes have a good suction unit. My rig has a good unit.

The V-Vac will suffice in the short time between those two places. 

Anytime I have a pt. that needs to be suctioned, I do it before I leave, and will follow up en route as needed. 

Anyone with a trach, I ask if they feel like they need suctioning before we do anything else.

Airway is important after all.

Also, we have really $#!77* electric portable units.

We actually are in the process of getting rid of them lol.

I have one today, and was totally surprised.


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## usafmedic45 (Jul 15, 2009)

> The way I see it though (working mostly IFT for a private) the hospitals or nursing homes have a good suction unit. My rig has a good unit.



Ah....that explains it.  However, I've been surprised by walking into nursing homes and finding nothing useful so I would always rather have my own equipment at hand and not put my faith in institutions that may or may not have the patient's best interest at heart.  Also, I look at it from the perspective of what happens if you find yourself stumbling upon a critical accident where the patient is trapped and needs suctioning and you can't move them.  It's all too easy to overwhelm a V-Vac. 



> The V-Vac will suffice in the short time between those two places.



I would rather have a turkey baster.  Much more effective for much less work.  There's a reason why I carry one in the jump kit I still keep in my car.



> Anyone with a trach, I ask if they feel like they need suctioning before we do anything else.



Smart move.


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## djmedic913 (Jul 15, 2009)

I would get rid of the the *toilet paper*...yup NH Dept of Health makes toilet paper mandatory on an Ambulance.

I would also get rid of the seran wrap...LMAO...I tried to use it once on a someone who slit their own throat (training/protocol so I said why the hell not) and it was a mess...hysterical tho...LOL...

the 3 things I would absolutely keep (it is not exactly 3 but it is 3 categories anyway)
O2
appropriately stocked first in bag
backboard/collars/head blocks

I can work any call with these things...the other toys are nice and helpful and fun...I don't need a monitor to tell me an irregular rhythm or fast or slow or dead. (it helps to treat properly I know)...


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## reaper (Jul 15, 2009)

But, a portable power suction unit is the most needed thing on a truck. You will see this, when your truck unit stops working in the middle of a trauma intubation! The hand units are pretty much useless.


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## djmedic913 (Jul 15, 2009)

reaper said:


> But, a portable power suction unit is the most needed thing on a truck. You will see this, when your truck unit stops working in the middle of a trauma intubation! The hand units are pretty much useless.



those hand squeeze suction things...LMAO...those are great you can even flip a piece of plastic or something to make it suction for peds...

was my response dripping with sarcasm too much?


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## Sasha (Jul 15, 2009)

djmedic913 said:


> I would get rid of the the *toilet paper*...yup NH Dept of Health makes toilet paper mandatory on an Ambulance.



The company I used to work for required bedpans to be on the truck.. I never knew of anyone who _successfully_ placed a bed pan while driving down the road, and that's what their diaper or little paddy thing is for.


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## EMT-G36C (Jul 15, 2009)

Sasha said:


> The company I used to work for required bedpans to be on the truck.. I never knew of anyone who _successfully_ placed a bed pan while driving down the road, and that's what their diaper or little paddy thing is for.


:lol::lol::lol::lol:


Also, if I worked for a service where I had trauma and all that, I may change my answer.

Hopefully I'll let ya"ll know in a year or two.


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## djmedic913 (Jul 15, 2009)

Sasha said:


> The company I used to work for required bedpans to be on the truck.. I never knew of anyone who _successfully_ placed a bed pan while driving down the road, and that's what their diaper or little paddy thing is for.



we have those too. had that at my lst company as well over 500 miles from here...lol

it is not like I'm gonna wipe anyones butt on a call...lol...


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## Sasha (Jul 15, 2009)

I could see bedpans on longer trips, I know of a company here that will transport to any state within the contential US providing insurance clears but for run of the mill everyday trips? Nope! Hold it or use the diaper!


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## Seaglass (Jul 15, 2009)

usafmedic45 said:


> Care to explain why you would get rid of tourniquets?  They are a low use item but are extremely useful in some situations.



Because it's possible to improvise, I'd get rid of them if I were asked to pare a kit down to the bare minimum. In reality, though, I'd prefer a tourniquet made for that purpose.


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## Shishkabob (Jul 15, 2009)

Seaglass said:


> Because it's possible to improvise, I'd get rid of them if I were asked to pare a kit down to the bare minimum. In reality, though, I'd prefer a tourniquet made for that purpose.



TQ's take up minimal space and weight in a bag... and considering the NR just changed their testing to push TQs forward quicker, I highly doubt they are going anywhere soon.


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## JPINFV (Jul 15, 2009)

Sasha said:


> The company I used to work for required bedpans to be on the truck.. I never knew of anyone who _successfully_ placed a bed pan while driving down the road, and that's what their diaper or little paddy thing is for.



Bedpans were on the state required list in both OC, CA and Massachusetts. While I've never had the pleasure of using the bed pan, I have had to use a urinal a few times.


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## usafmedic45 (Jul 15, 2009)

> Because it's possible to improvise, I'd get rid of them if I were asked to pare a kit down to the bare minimum.



Improvisation of tourniquets (short of using your BP cuff as a pneumatic tourniquet which is less than ideal for at least a couple of reasons) is not a good idea.  It often fails to stop bleeding as has been cited again and again in the literature.  I recommend you read the article I posted. 

If anything, I would advocate for a purpose built tourniquet as a part of any standard "bare essentials" kit.  There is a reason why they are in the bare bones kit issued to US combat troops. 



> In reality, though, I'd prefer a tourniquet made for that purpose.



I would expect that to be a standard.  Trying to improvise a tourniquet- as outlined in the literature- in an emergency is a very bad idea.  Given the number of purpose built tourniquets available, I can't see why anyone would carry anything else.


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## Ridryder911 (Jul 15, 2009)

djmedic913 said:


> we have those too. had that at my lst company as well over 500 miles from here...lol
> 
> it is not like I'm gonna wipe anyones butt on a call...lol...



Obviously you have never transported many patients that was given Lasix or Kayexalate, or even Activated Charcoal with sorbital. So you have a transport time of 30 -45 minutes, you going to allow them to lie in it? 

Just remember, skin breakdown occurs fast and if there is any open lacs, lesions, abrasions, etc.. exposure is not a good thing. 

Personally, I don't feel I am too good to wipes any one's behind if they need it. Again, it's about the patient and not me... 

Is those in EMS really getting that selfish? 

R/r 911


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## EMT-G36C (Jul 15, 2009)

I've always liked you RR.

I totally agree!

I have wiped behinds, and changed diapers.

Some partners have told me that we dont have to do that, we arent CNAs.

I disagree. Pt. care (and IMO in IFTs this includes comfort) is number one.

You gotta do what you gotta do.


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## Sasha (Jul 15, 2009)

> Personally, I don't feel I am too good to wipes any one's behind if they need it. Again, it's about the patient and not me...



I don't feel that I am to good for it, as I often help nurses and CNAs change and clean up patients for transport. It just doesn't sound like a great idea to do in the back of an ambulance, it sounds messy. Perhaps it's my short arms, but I found it difficult to try and manuver a patient onto a bed pan solo while seat belted in. Then again, most of my transports rarely reach an hour and even more rarely exceed that.


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## Buzz (Jul 16, 2009)

Air splints. Reason being that I've used an air splint only once, partially because I had never used one and had a situation where I could, and partially because I didn't want to fight with the board splints in the over-stuffed bench seat cabinet.


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## WuLabsWuTecH (Jul 16, 2009)

Pudge40 said:


> I would say activated charcoal as getting anybody to drink enough and keep it down is pretty much impossible anyway.



Yeah that's in our protocol, but we don't carry it!


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## WuLabsWuTecH (Jul 16, 2009)

Ridryder911 said:


> Obviously you have never transported many patients that was given Lasix or Kayexalate, or even Activated Charcoal with sorbital. So you have a transport time of 30 -45 minutes, you going to allow them to lie in it?
> 
> Just remember, skin breakdown occurs fast and if there is any open lacs, lesions, abrasions, etc.. exposure is not a good thing.
> 
> ...



Agreed rid.  If a pt is feeling cold, and its 90 degrees out, I'll shut off the back AC and turn on the heat if he still really wants it.  I wasn't the one in the water for the past 20 minutes.  My partners think i'm nuts, but i don't mind sweating a bit for all of 5 minutes to the hospital.


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## Lone Star (Jul 16, 2009)

Personally, I'd leave the NIBP machines by the side of the road.  I prefer auscultation as opposed to a machine.  At least I can tell if my cuff is calibrated simply by looking at the gauge.  Can you tell if the NIBP is calibrated by looking at it, or if all the lights come on when you power on the device?


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## CAOX3 (Jul 17, 2009)

That list would be quite long.

Thank god we dont carry bed pans.


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## JPINFV (Jul 17, 2009)

CAOX3 said:


> Thank god we dont carry bed pans.



Why? I'd rather have and not need than need and not have.


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## Shishkabob (Jul 17, 2009)

JPINFV said:


> Why? I'd rather have and not need than need and not have.



Guess you could say that about everything we have which makes this whole thread moot, doesn't it?


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## JPINFV (Jul 17, 2009)

Linuss said:


> Guess you could say that about everything we have which makes this whole thread moot, doesn't it?



Not really. There are a handful of useless equipment on the ambulance. Things I considered useless that I've had include a latex free kit (no latex equipment on anyways), hazmat gear (no real training or QI. One training session we had it took the 2 people who volunteered to put it on 10 minutes), binoculars, saran wrap, aluminum foil, plastic bags in addition to the biohazard bags, and an extraction kit (no real training on extraction).

While a handful of those are about lack of training, you don't need training for a bed pan.


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## reaper (Jul 17, 2009)

JPINFV said:


> Not really. There are a handful of useless equipment on the ambulance. Things I considered useless that I've had include a latex free kit (no latex equipment on anyways), hazmat gear (no real training or QI. One training session we had it took the 2 people who volunteered to put it on 10 minutes), binoculars, saran wrap, aluminum foil, plastic bags in addition to the biohazard bags, and an extraction kit (no real training on extraction).
> 
> While a handful of those are about lack of training, you don't need training for a bed pan.



I can agree on most of that, except for the Binoculars and Saran wrap! They are needed on the truck!


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## Shishkabob (Jul 17, 2009)

JPINFV said:


> binoculars, saran wrap, aluminum foil,



Binocs-- Role up to a over-turned semi with a HAZMAT tag on the back... You stay far away and look at what is in side the trailer (which is why you also have the HAZMAT road guide)

Saran-rap-- impromptu occlusive dressing

Aluminum foil-- making popcorn on the engine.


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## djmedic913 (Jul 17, 2009)

we recently had pet O2 masks added to the trucks and added to the protocols...


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## WuLabsWuTecH (Jul 18, 2009)

Lone Star said:


> Personally, I'd leave the NIBP machines by the side of the road.  I prefer auscultation as opposed to a machine.  At least I can tell if my cuff is calibrated simply by looking at the gauge.  Can you tell if the NIBP is calibrated by looking at it, or if all the lights come on when you power on the device?


Yes, you can tell if they are calibrated correctly (at least some of them) as they will give a digital readout as they are inflating including when they are at 0.


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## WuLabsWuTecH (Jul 18, 2009)

JPINFV said:


> Not really. There are a handful of useless equipment on the ambulance. Things I considered useless that I've had include a latex free kit (no latex equipment on anyways), hazmat gear (no real training or QI. One training session we had it took the 2 people who volunteered to put it on 10 minutes), binoculars, saran wrap, aluminum foil, plastic bags in addition to the biohazard bags, and an extraction kit (no real training on extraction).
> 
> While a handful of those are about lack of training, you don't need training for a bed pan.


Binocs are good at the scene of a rollover truck.

And if you took away my saran wrap and aluminium foil, what am i to wrap my sandwich in when we get called out during lunch? :-D


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## mikeN (Jul 18, 2009)

I'd get rid of the axe and the ten pound hammer.  
We don't carry MAST pants, inflatable/vaccuum splints, pulse ox


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## djmedic913 (Jul 18, 2009)

mikeN said:


> I'd get rid of the axe and the ten pound hammer.



you must be Fire based. If an axe is standard on your stand alone EMS deptartment......................


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## PotatoMedic (Jul 18, 2009)

I can't remember where I heard this.  Must have been from a guy I was talking to when riding along, but his old EMS company he worked for carried chainsaws, wedges, and axes to clear the road of downed trees.  

Sorry I can't reference where.  It just clicked in my mind when I saw the axes.


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## medic417 (Jul 18, 2009)

Linuss said:


> Saran-rap-- impromptu occlusive dressing
> 
> Aluminum foil-- making popcorn on the engine.



Nope.  These both are used to retain heat in a newborn.  Thought that was still a basic skill.


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## Shishkabob (Jul 18, 2009)

medic417 said:


> Nope.  These both are used to retain heat in a newborn.  Thought that was still a basic skill.



Basics aren't allowed to touch anything younger then 16 and older then 35.  I thought this was paramedic knowledge?


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## Sasha (Jul 18, 2009)

medic417 said:


> Nope.  These both are used to retain heat in a newborn.  Thought that was still a basic skill.



It is, and its specially packaged as "foil baby bunting" Not "Reynolds Wrap"


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## medic417 (Jul 18, 2009)

Sasha said:


> It is, and its specially packaged as "foil baby bunting" Not "Reynolds Wrap"



Actually Reynolds wrap and Saran wrap work just fine.  No need for that expensive space blanket.


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## Sasha (Jul 18, 2009)

medic417 said:


> Actually Reynolds wrap and Saran wrap work just fine.  No need for that expensive space blanket.



What is the liability behind using non medical grade house hold items for medical care?


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## Shishkabob (Jul 18, 2009)

Gives a new meaning to "bun in the oven".  Get it?  A baby in cooking material?!




Awe, why do I even try?


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## medic417 (Jul 18, 2009)

Sasha said:


> What is the liability behind using non medical grade house hold items for medical care?



Actually they are mentioned in NRP courses so would be considered standard of care.  Of course they take up more space than than a space blanket.


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## WuLabsWuTecH (Jul 19, 2009)

is there something wrong with regular blankets for warming?

And also why do we not vacuum splints?  Besides the fact that they are expensive, they work great from what I hear and can be better than backboards.


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## reaper (Jul 19, 2009)

medic417 said:


> Actually Reynolds wrap and Saran wrap work just fine.  No need for that expensive space blanket.



Is that whole 99 cents, going to bankrupt us? Space blankets are one of the best and cheapest tools we have!


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## djmedic913 (Jul 19, 2009)

WuLabsWuTecH said:


> is there something wrong with regular blankets for warming?
> 
> And also why do we not vacuum splints?  Besides the fact that they are expensive, they work great from what I hear and can be better than backboards.



Vacuum splints don't work well in cold weather. Because during the winter in the northeast [only place I've worked] since you go to extreme temperatures. In side the houses, ambulance, and ER it is warm, while outside is sub-arctic. So if you inflate the splint in the cold, when it gets into a warmer temp it will expand and tighten cutting off circulation. If it is inflated in a warm temp area, when it goes into the cold it well deflate a little becoming too loose and no longer splinting properly.

I wonder if it works well in the warmer parts of the nation. [ie San Diego]


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## MrBrown (Jul 19, 2009)

I'd throw out the second stretcher (we carry a Ferno or a Stryker AND a York) and replace it with a proper bench seat.


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## Sasha (Jul 19, 2009)

> I wonder if it works well in the warmer parts of the nation.



Of course, we don't have this thing called "Winter"


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## djmedic913 (Jul 19, 2009)

Sasha said:


> Of course, we don't have this thing called "Winter"



Growing up and living in the North East, when I went to Florida in January, the days in Florida were still humid and hot. Which was of course coming from the sub-arctic of the NE. but at night the temp dropped to the 60's. While I was wearing a light jacket/sweatshirt others were bundled for the ice age. I thought it was kind of funny. But alas, digress, the reason I asked if it worked in the warmer parts, like FLA, was because almost every building has their air conditioning turned way up. 

so does that cause enough of a change to cause problems with the splints?


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## trevor1189 (Jul 19, 2009)

Get rid of, bite stick. I don't even think we are supposed to use them anymore, but we carry one.

Keep, gloves. I am not very fond of touching patients without gloves.

Add, Glucometer. I don't know why the hell we can't check BGL levels as that can be an important indicator for altered loc. In PA they describe EMT-Bs as non invasive life support, so I see why it wasn't in there. But now we can administer epi pens, so glucometer seems reasonable.


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## djmedic913 (Jul 19, 2009)

trevor1189 said:


> Get rid of, bite stick. I don't even think we are supposed to use them anymore, but we carry one.
> 
> Keep, gloves. I am not very fond of touching patients without gloves.
> 
> Add, Glucometer. I don't know why the hell we can't check BGL levels as that can be an important indicator for altered loc. In PA they describe EMT-Bs as non invasive life support, so I see why it wasn't in there. But now we can administer epi pens, so glucometer seems reasonable.



I am not going to start an argument of what should basics do or invasive or non-invasive.

But with altered mental status, glucose level is helpful. But since a Basic can only administer oral glucose only. oral glucose is not going to drastically change any BGL if it is already high. So if the Pt can swallow safely on their own, then give them the oral (except in a head injury). So if you know the BGL is low/high, how will/can that change your treatment. I am also assuming that if ALS was not dispatched with you for the "Altered Mental Status" call, then you would call for ALS and play "catch me if you can" with them.


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## Sasha (Jul 19, 2009)

A coworker of mine used a bite stick yesterday, she used it to apply oral glucose to the inside of the patients cheek in place of a tongue depressor.. don't know why they didn't use D50 or glucagon, but it turns out it did have a use.


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## trevor1189 (Jul 19, 2009)

True I think oral glucose has a very limited window of use,  but if you find an unresponsive person and can say hey bgl is 30. You have a pretty good idea why they are unresposive. So yeah they aren't really helpful in treatment at the basic level, but helpful in dx. But I don't want to get the thread off topic. So if there are a lot of comments about this post I'd be happy to open a dedicated thread for it so we don't derail the original topic.


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## Ridryder911 (Jul 19, 2009)

Part of my job is to interview candidates two to three times. Our process to be hired is a lengthy one (the minimum is one to two months, some has awaited as long as a year the The first interview is just an introduction, but still I pay attention and make notes of what was said, the second is during the FTO/Supv board interview then the final is with the Director and myself. 

The Director and I, ask some personal questions that we want to know about the person, not just so much about EMS. We are hiring a person; not just a medic. One of the questions that the director ask is .." _If you had a guaranteed financial securities (as in never have to work again); where and what would you be doing now_?....

It is pretty interesting to see the replies. There is no wrong or right answer; but you can find out a lot about a person in the replies. The other question I ask is; what is your favorite .. Trauma or Cardiac? ...Why? One can see the eagerness of adrenaline or the want of having an in-depth knowledge. Again, no right or wrong answer; but those questions can open questions about themselves and the character they may possess. 

R/r 911


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## reaper (Jul 19, 2009)

Ridryder911 said:


> Part of my job is to interview candidates two to three times. Our process to be hired is a lengthy one (the minimum is one to two months, some has awaited as long as a year the The first interview is just an introduction, but still I pay attention and make notes of what was said, the second is during the FTO/Supv board interview then the final is with the Director and myself.
> 
> The Director and I, ask some personal questions that we want to know about the person, not just so much about EMS. We are hiring a person; not just a medic. One of the questions that the director ask is *.." If you had a guaranteed financial securities (as in never have to work again); where and what would you be doing now?....*
> It is pretty interesting to see the replies. There is no wrong or right answer; but you can find out a lot about a person in the replies. The other question I ask is; what is your favorite .. Trauma or Cardiac? ...Why? One can see the eagerness of adrenaline or the want of having an in-depth knowledge. Again, no right or wrong answer; but those questions can open questions about themselves and the character they may possess.
> ...



I would be the sunblock lotion man on a nude beach somewhere!


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## Pudge40 (Jul 19, 2009)

trevor1189 said:


> Get rid of, bite stick. I don't even think we are supposed to use them anymore, but we carry one.
> 
> Keep, gloves. I am not very fond of touching patients without gloves.
> 
> Add, Glucometer. I don't know why the hell we can't check BGL levels as that can be an important indicator for altered loc. In PA they describe EMT-Bs as non invasive life support, so I see why it wasn't in there. But now we can administer epi pens, so glucometer seems reasonable.



No in PA we *can not* *administer* an epi pen, we can only assist the patient with the use of an epi pen. Just the same with nitro we can not give them the nitro we can only assit them in taking it only after checking the 5 rights.


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## WuLabsWuTecH (Jul 19, 2009)

djmedic913 said:


> Vacuum splints don't work well in cold weather. Because during the winter in the northeast [only place I've worked] since you go to extreme temperatures. In side the houses, ambulance, and ER it is warm, while outside is sub-arctic. So if you inflate the splint in the cold, when it gets into a warmer temp it will expand and tighten cutting off circulation. If it is inflated in a warm temp area, when it goes into the cold it well deflate a little becoming too loose and no longer splinting properly.
> 
> I wonder if it works well in the warmer parts of the nation. [ie San Diego]



Wait a sec...  When you use a vacuum splint, you are actually taking all of the air out, so there is very little air left in there to begin with.  Even so, with that little bit left, it will not significantly cause the vacuum splint to become less rigid and there is no way (at least that I can see) that it will cut off circulation.  Are you sure you've been deflating your vacuum splints ALL the way?



MrBrown said:


> I'd throw out the second stretcher (we carry a Ferno or a Stryker AND a York) and replace it with a proper bench seat.



Agreed!  I don't know why you would carry a second stretcher.  How often do you even use the bench seat for a patient?


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## medic417 (Jul 19, 2009)

WuLabsWuTecH said:


> How often do you even use the bench seat for a patient?



Several times a week.


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## reaper (Jul 19, 2009)

Several times a shift!


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## Sasha (Jul 19, 2009)

I use it a lot... for a patient named Sasha


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## WuLabsWuTecH (Jul 20, 2009)

Wow!  For our calls around here that are bigger (think chest pain, abdominal pain) we get 2 paramedics with a medic and an engine that has 2-4 paramedics on it.  For anything bigger (hit by car, shooting, stabbing) they'll send 2 medics with 2 paramedics each.

We've never needed the bench seat for a patient since there is always another medic avalaible.


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## trevor1189 (Jul 20, 2009)

Pudge40 said:


> No in PA we *can not* *administer* an epi pen, we can only assist the patient with the use of an epi pen. Just the same with nitro we can not give them the nitro we can only assit them in taking it only after checking the 5 rights.



Semantics.


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## Pudge40 (Jul 20, 2009)

trevor1189 said:


> Semantics.



I was accually mistaken when I said that. I did not know that in PA BLS can carry EPI auto injectors, as long as you have had the correct training. I did not know this so there are cases where in PA you can administer EPI.


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