# First in bag



## emtjack02 (Jan 4, 2009)

Currently I run with a volunteer ALS ambulance that has about a 10min transport time to the hospital.  We currently have no drugs in our primary first in bag.  I'm looking to change this.  Does anyone else care first line drugs in their first in bag?


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## flhtci01 (Jan 4, 2009)

None of the services I work with, or have worked with, have drugs in the first in bag.


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## Jon (Jan 4, 2009)

are you really ALS? At the Paramedic level? (as volunteers?)

Do you carry drugs at all on the ambulance?


If you don't carry drugs in some form of ALS bag... how do you work a code?
I've seen many different companies kits... some have a big bag with EVERYTHING in it, and others have a very small bag with very basic interventions... including an IV set-up and a set of 1st-round drugs... including ASA/Nitro


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## JPINFV (Jan 4, 2009)

At the company I used to work with, there was a case on the transport monitor (what is now known as the Welch Allyn PIC brand monitor) that carried a set of first line cardiac drugs for the CCT transports.


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## flhtci01 (Jan 4, 2009)

We carry drugs, but they are in a separate box that does not go in on every call, so not considering it a first in bag. First in bag does contain NS and IV set-up. If it is a definite ALS call (code, etc), then drug box goes in. 

Normally patients are moving to the rig before the drug box is out of the rig due to long (up to an hour) transport times we don't normally 'stay and play'.


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## mcrs41 (Jan 4, 2009)

OK, I take offense at the remark below, even if *I* am not ALS, many of our volunteers *are!*

are you really ALS? At the Paramedic level? (as volunteers?)


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## emtjack02 (Jan 4, 2009)

Jon 
We are an ALS ambualnce all volunteer/paid on call. We only require one medic and one basic to be staffed.  We do have NTG, ASA, albuterol in our first in bag/airway bag.  I dont like to get caught with my pants down so if I dont bring the drug bag I've nothing for diabetics, seizure, cardiac (besides ntg asa).


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## KEVD18 (Jan 4, 2009)

heres a shocking suggestion for you. be prepared for this to rock your world:

bring all your gear on every call. first  in bag, airway, monitor and drugs. every time you get off the truck on a job, those things go with you. then you're able to be "caught without your pants down".

anything less is lazyness and asking for trouble.

but to answer your question, yes i have seen medics carry a round of code drugs in the monitor case. it isnt approved and would land them in hot water btu they did it anyway.


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## Jon (Jan 4, 2009)

I've seen transport medics that had a small soft-sided bag that had a set of code drugs so that they never got caught with their pants down... because how many times do you transport a patient on the monitor, but don't drag your drug box into the hospital, to the floor. (I vividly remember the look of panic on a partner's face when we were in the elevator with a patient who started with multiple short runs of V-tach - 10-20 beats at a time... Pt. stated he was feeling funny, but was conscious).


In my area, we have responder-car medics that meet with BLS ambulances. Some services run both chase cars and ALS ambulances, and the gear is standardized between them. It seems that the common ALS kit bag for our area is the Pacific Emergency Product's 300-series bag.





These are big bags, and really allow you to bring everything but the kitchen sink. Everyone has a seperate CPAP set-up, peds set-up, and trauma kits with spare fluid. Most keep additional spare supplies on the rig so that the medics can run several calls without needing to return to quarters to restock.

Some services have smaller bags, and some medics choose to not bring their gear into the house on every call... but that burns you occasionally.

I'm going to have to agree with Kev... if you are running an emergency call, you are walking into an unknown situation... no matter what they told 911, and you need to be ready to rock and roll.


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## emtjack02 (Jan 4, 2009)

Kev
I agree that it's lazy but my partners get irritated b/c our call aquity is actually pretty low.  Im interested in who approves or disapproves carrying drugs in the monitor case.


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## KEVD18 (Jan 4, 2009)

emtjack02 said:


> Kev
> I agree that it's lazy but my partners get irritated b/c our call aquity is actually pretty low. Im interested in who approves or disapproves carrying drugs in the monitor case.


 

there are two angle to consider here, the approved and the not approved but we'll do it anyway.

in ma, all als meds are required to be stored in a locked case, so putting a few meds in the monitor bag would be against the rules. Ive seen it done though. what we did when i was working at one company was we had a small nylon bag that was really just big enough to fit one epi, one atro and one lido box. that went into one of the monitor bag pockets during the shift and back into the drug box after.

another place Ive worked there was essentially two separate drug supplies. one had basically one of everything but the narcs and then there was the main drug box with all the duplicates and the narcs. the small bag went every where the monitor went. it was ket in the locked drug cabinet, but if you grabbed the monitor you grabbed the drug bag. ift, 911, didn't matter. this was above board because it was kept in the locked cabinet.

if your state only requires narcs to be locked, then there's no legal issue behind code drugs being unsecured. you just have to get past service rules.


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## JPINFV (Jan 4, 2009)

emtjack02 said:


> Kev
> I agree that it's lazy but my partners get irritated b/c our call aquity is actually pretty low.  Im interested in who approves or disapproves carrying drugs in the monitor case.




I think it depends on how the medications are carried. It's one thing if the monitor case has a built in storage area for medications (for example the large black box on top of the case for the PIC line of monitors. It's another issue if the medications are just loose in a bag.


Edit: Thanks for the clarification Kev...


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## daedalus (Jan 4, 2009)

If you are an EMT, why do you not let your paramedic partner decide what he wants in the the way of drugs for the first in bag?


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## artman17847 (Jan 4, 2009)

When I first started we had our drug boxes in a locked cabinet, with the narcs in another locked case. They were not part of our first in gear. 

Today our first in ALS bag has all our first line meds and narcs. The bag goes with on any ALS call.


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## Veneficus (Jan 4, 2009)

Maybe it is just my original fire service training, but I have always carried jump bag, airway bag, monitor, and drugs in on every call I ever went on.

Probably overkill, but pants were never down. (at the very least it was my daily weight training)


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## EMT-P633 (Jan 4, 2009)

Where I work, we carry a fully stocked jump bag with 2 rounds of cardiac meds.  Its a good idea we dont get caught so to speak, But our bags are a bit over stuffed with overkill.  Thats ok tho. My overeager EMT partner loves to carry it.  (by the way he is young and a volly FF)!!!!


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## emtjack02 (Jan 4, 2009)

So those that have taken the entire drug bag with them and just carried some first line in the jump bag, which do you prefer?


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## emtjack02 (Jan 4, 2009)

just to clarify it's my choice what goes in


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## KEVD18 (Jan 4, 2009)

emtjack02 said:


> So those that have taken the entire drug bag with them and just carried some first line in the jump bag, which do you prefer?


 

depends on the call. als ift call get the small bag. 911 class regardless of c/c per dispatch and everything comes in.


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## emtjack02 (Jan 4, 2009)

what is ift? All of our calls are through 911


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## JPINFV (Jan 4, 2009)

interfacility transport


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## firecoins (Jan 4, 2009)

Veneficus said:


> Probably overkill, but pants were never down. (at the very least it was my daily weight training)


I have a belt to solve that problem.

Most ALS services pring three bags in.  The first in bag, an ALS bag and the monitor for most calls. If they don't, there is something obviously indicating its overkill.


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## Kendall (Jan 4, 2009)

Typically, we bring the monitor and our "everything" bag. It has a d-tank and a few varieties of masks, BP cuff, pulse ox, steth, glucometer, IV n/s kit, basic airways, manual suction unit and some basic drugs (nitro, ASA, ventolin, atrovent, epi, D50W, oral glucose and glucagon). If there's reason to bring in the works, then it goes. The one who's attending makes the call, but since that is the extent of my scope that's all I bring. My service is combined ALS/BLS so it depends which truck I'm on.


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## EMTinNEPA (Jan 5, 2009)

First In Bag: Epi, atropine, lasix, sodium bicarb, D50, narcan, albuterol, nitro, aspirin, a BVM, ears, BP cuff, neb mask, neb pipe, IV start kit, glucometer, BLS bandages, saline, sharps container

Big Bag: D50, sodium bicarb, narcan, adenocard, lasix, lidocaine, epi, atropine, nitro, aspirin, albuterol, glucagon, zofran, mag sulfate, benadryl, versed, morphine, fentanyl, lorazepam, diazepam, BVM, IV start kit, glucometer, neb mask, neb pipe, BLS bandages, ET tubes, combitubes, chricothyrotomy kit, mac blades, miller blades, laryngoscopes, BP cuff, ears, sharps container, syringes

Monitor: Capnography, SPO2, NIBP, 4 lead and 12 lead EKG, pacing, defibrillation

O2 Bag: D cylinder, NRBs, nasal canullas, oral and nasal airways

Trauma bag: about 8 1000 bags of saline, trauma dressings, IV start kit

Peds Bag:  Same as first due bag, only everything is smaller and add a Broslow tape

I think that covers it, bag-wise.


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## Veneficus (Jan 5, 2009)

EMTinNEPA said:


> First In Bag: Epi, atropine, lasix, sodium bicarb, D50, narcan, albuterol, nitro, aspirin, a BVM, ears, BP cuff, neb mask, neb pipe, IV start kit, glucometer, BLS bandages, saline, sharps container
> 
> Big Bag: D50, sodium bicarb, narcan, adenocard, lasix, lidocaine, epi, atropine, nitro, aspirin, albuterol, glucagon, zofran, mag sulfate, benadryl, versed, morphine, fentanyl, lorazepam, diazepam, BVM, IV start kit, glucometer, neb mask, neb pipe, BLS bandages, ET tubes, combitubes, chricothyrotomy kit, mac blades, miller blades, laryngoscopes, BP cuff, ears, sharps container, syringes
> 
> ...



8  litres of NACL?!!! any left in the ocean? 

seriously what do you need to carry around that much water for that is more than the volume of circulating blood.


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## EMTinNEPA (Jan 5, 2009)

Veneficus said:


> 8  litres of NACL?!!! any left in the ocean?
> 
> seriously what do you need to carry around that much water for that is more than the volume of circulating blood.



Local protocol states that victims of significant trauma are to get two lines with saline running wide open.  If we have multiple victims, or LifeFlight won't fly due to weather conditions and we have an extended transport time, or there is significant bleeding, then we might need it.  Plus, there are days when we won't see the station for hours at a time and we may wind up dumping the truck.


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## boingo (Jan 5, 2009)

I thought the 2 large bore IV's and w/o fluids went out over a decade ago?

We carry a pelican box for our drugs, LP12, O2 bag and a jump kit, mine is set up for both adult and peds.


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## emtjack02 (Jan 5, 2009)

I thank everyone who has shared their thoughts. I am pitching the idea of combining stuff tonight at the meeting.


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## Veneficus (Jan 5, 2009)

boingo said:


> I thought the 2 large bore IV's and w/o fluids went out over a decade ago?



I wouldn't go so far as to say over a decade. Probably within the last 5 years. But I would suggest that protocol be looked at and possibly updated. I would also think it a good idea to have a trauma or critical care surgeon give their input on trauma protocols. The 8th edition ATLS is supposed to advocate permissive hypotension in specific patient groups, but the guidlines are not published yet, but I would expect this year or next.


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