Using a map book..

[COmedic17]

I have seen several posts about people being concerned over navigation/driving.


Do they teach people how to use map books anymore? I feel like being able to use a map book is of extreme importance in this job......


Yes GPS are nice, but they are not fail proof.

 

[Chris07]

Map book use and reading is a required skill taught and drilled during field training time here. When you're out on your own you can do whatever you want so long as you make the times and of course arrive at the correct location.

Most of my co-workers, including myself, use map books when responding to 911 calls. It's usually more convenient since we are given the map page, grid number, and cross streets all on our MDT. So looking up an address in a map book is usually just as fast as using GPS.

At 3am on a 24 hour shift I usually just use a GPS since sleepy eyes + small text + poor lighting = too much effort for 3am. Of course before using a GPS I ensure the cross streets match. Nothing like going to 1234 E. Main St. vs 1234 W Main St, or worse, 1234 Main St in one city vs 1234 Main St in the next city over.

 

[DesertMedic66]

Same as Chris07. It's required during field training time. Once you are done with field training it's up to the person.

Everyone of our ambulances has a mapbook inside it. I use both the MDT and Google maps on my phone for every call, unless I know where the call is.

 

[Chris07]

Everyone of our ambulances has a mapbook inside it.

...they have map books...but it doesn't mean the map book has the pages you need. The most frequently used pages fall out first...and as luck would have it, those pages are the ones of your coverage area.

 

[COmedic17]

unless I know where the call is.

Don't you just love those calls where you know the address?..........And the patients name, medical history, and favorite brand of vodka.

 

[DesertMedic66]

...they have map books...but it doesn't mean the map book has the pages you need. The most frequently used pages fall out first...and as luck would have it, those pages are the ones of your coverage area.

Actually, all of our mapbooks were replaced with brand new ones not too long ago. Since not too many people use them anymore they are still brand new. Mine still has the front and back covers

 

[DesertMedic66]

Don't you just love those calls where you know the address?..........And the patients name, medical history, and favorite brand of vodka.

One of our frequents just passed away. Everyone in our division new his address by heart and all of his information.

 

[exodus]

...they have map books...but it doesn't mean the map book has the pages you need. The most frequently used pages fall out first...and as luck would have it, those pages are the ones of your coverage area.

Like desert said, they bought the durable water-resistant map books for us where you have to TRY to rip the pages out, they don't come out easy. And if they do rip, most people stick the page back in the book at the right location. And if a book gets too bad, we can let our ops supervisor know and he'll replace at after a little bit of cursing about the other crews.

 

[COmedic17]

One of our frequents just passed away. Everyone in our division new his address by heart and all of his information.

I have my favorites.
As weird as that sounds.

 

[Aprz]

I feel like I am about to make some very controversial statements, lol. I think map books are way overrated. The people who prefer them are the typical dinosaur EMT/paramedic who has his or her shirt untucked or wears a t-shirt, doesn't use a radio clip or mic, doesn't use a monitor to get their vital signs (or more commonly now just gets their first set of vitals and then use the monitor afterward), doesn't like to go into quarters (they sit in the ambulance the whole shift), etc.. You can spot those guys a mile away. That's not a bad thing, but I consider it to be a preference. It is just another tool in the toolbox, lol.

I've seen people mentioned the issue of the GPS failing. How common does that happen now a days? Probably about as often as the number of times you get dispatched to a call and the map book page is damaged or missing or not updated.

What about areas that are difficult to drive through that the GPS tells you to go to? Well... you can't always see that with a map book either.

I like the GPS. A lot of them will show you traffic and you are able to actively see nearby roads if you don't want to follow the recommended route the GPS is showing. Sometimes I use the GPS to help me see nearby roads or give me the names of the steet without typing the address/route. Street signs can be hard to see!

I do not like the idea of relying 100% on the GPS throughout the day. It is easy enough to take the map book with you. If the GPS fails, use the map book. If you want to have an idea of where you are going before leaving, use the map book. If you notice that something doesn't seem right with the GPS, use the map book. Use some common sense!

I do believe the map book is better for helping you learn the area.

Another major pro with the map book is knowing advance where you are going where it is more like a surprise with most GPS. Some GPS has options where you can see the whole route you are going, but then it is harder to see the details of the roads if the road is complicared/unique versus the common upclose view that I usually see on a GPS. I like it when the GPS has an option where it is easy to toggle the different view (kinda like MARVLIS).

At my company, the map books are kinda bad... They reorganized the pages so it is clumped up with each posting spot and they didn't mark it/label it to help you find the section with your area. For the people who work in the same county as me, page 770 is a great example of what I am talking about. Page 770 isn't after page 769 in our map books. :/

Also what if your dispatch doesn't give you the right grid or page? I am not 100% certain if I am making a mistake, if I was just given the wrong grid once, but there is a spot where we commonly respond to and they gave me the wrong grid. I kinda know basics to the area, but it is a little confusing so I went to look it up in the map book awhile ago and noticed the grid they gave me was one grid too south, lol. If somebody that knows where I work wants to look into it, it's the grid they give for the southern jail...

 

[exodus]

All of our units now have assigned MDT laptops in them as well with GPS and internet. The way I do it, is zoom into the side streets to get to the call, but use my area knowledge to get to the smaller area.

 

[Angel]

We have map books, they are rarely used anymore. Cells phones, GPS, mdt...people who just know the area.
It's not necessary.
Welcome to the 21st century

 

[COmedic17]

I've seen people mentioned the issue of the GPS failing. How common does that happen now a days? I work in the mountains. So every shift. Radio communication is limited as well as cell phone reception.


Also what if your dispatch doesn't give you the right grid or page? If you actually know how to use a map book, you only need to know the address. You don't need someone to look up the page number for you.

 

[COmedic17]

Welcome to the 21st century

You should inform the Rocky Mountains that the terrain is interfering with GPS/phone/radio reception aka "the 21st century"

I don't think they got the memo.

 

[COmedic17]

I feel like I am about to make some very controversial statements, lol. I think map books are way overrated. The people who prefer them are the typical dinosaur EMT/paramedic who has his or her shirt untucked or wears a t-shirt, doesn't use a radio clip or mic, doesn't use a monitor to get their vital signs (or more commonly now just gets their first set of vitals and then use the monitor afterward), doesn't like to go into quarters (they sit in the ambulance the whole shift), etc.. You can spot those guys a mile away. That's not a bad thing, but I consider it to be a preference. It is just another tool in the toolbox, lol.

.

I have a huge bone to pick with that statement.

So your AGAINST getting the first set of vitals manually? That's not only dangerous, that's poor patient care to only use the monitor to obtain a baseline set of vitals. Machines malfunction. I have taken a BP manually that was COMPLETELY different then the monitor reading and after arrival at ED guess which one was correct. The Manual one. Do you honestly think the monitor BP cuff is infallible? You really think it's getting a proper reading bouncing down the road? I will tell you, it's not.


God have mercy on you when you roll into the ER with a patient with a BP of 200 and you didn't catch it because you didn't bother with a manual BP. The doctor is going to tear you apart.

 

[chaz90]

^Not that this is wholly related to the thread, but I typically use automated NIBP readings for all of my vitals, including the first set. Sometimes BLS has a manual set before I arrive, sometimes they don't.

If my machine fails to obtain a BP or gives a clearly erroneous value (often way, way high when in error), then I move to manual checks. Most importantly, I trend the machine readings and ensure the NIBP cuff is sized properly. I very rarely have any problems with the automated BP functions on my LP15. I often have to use my spare disposable NIBP cuff if the attached one has burst, but I have a reliable set of monitor vitals going in to the ED 99% of the time.

When's the last time you saw a manual BP auscultated in the ED?

 

[DesertMedic66]

^Not that this is wholly related to the thread, but I typically use automated NIBP readings for all of my vitals, including the first set. Sometimes BLS has a manual set before I arrive, sometimes they don't.

If my machine fails to obtain a BP or gives a clearly erroneous value (often way, way high when in error), then I move to manual checks. Most importantly, I trend the machine readings and ensure the NIBP cuff is sized properly. I very rarely have any problems with the automated BP functions on my LP15. I often have to use my spare disposable NIBP cuff if the attached one has burst, but I have a reliable set of monitor vitals going in to the ED 99% of the time.

When's the last time you saw a manual BP auscultated in the ED?

This. If the vital signs my monitor is giving me seem appropriate with the patient condition then I have no issues and will trust it. If I get an abnormal value that doesn't add up then I will check manually.

The last time I saw a BP manually obtained in the ED is when I did it during my clinical rotations...

 

[COmedic17]

When's the last time you saw a manual BP auscultated in the ED?

everytime I bring in a patient with symptoms that might relate to an irregular BP ( MI, stroke, etc).

I have seen an automated BP be off on several occasions. Just as I have seen a pulse Ox say someone is at 60% with pink skin and completely alert. I will use a monitor for basic trending in a stable patient, but I will never set a patients baseline off of it.


Someone ( not myself) just got QA'd for bringing in a patient with a blood pressure of 190. They stated the patients BP was in the 140s for the duration of transport. After backing up the monitor- that was the automated readings... All the way until they were taken off the monitor in the ED and had their BP taken which showed it was actually 190. Whoops.


How many times have you ran a 12 lead and the monitor says it's an active infarct, when in reality it's a old LBBB.


It's pretty common for the monitor to be wrong.


Here's a study by the University of South Dakota- school of medicine on the accuracy of automated BP readings.
http://www.ncbi.nlm.nih.gov/m/pubmed/18755068/

 

[Angel]

You should inform the Rocky Mountains that the terrain is interfering with GPS/phone/radio reception aka "the 21st century"

I don't think they got the memo.

Well I'd never work there so...

And about the BP thing, manual BP=human error
If you're treating your patient not some numbers I fail to see the issue.
You seem to get very defensive when people don't agree with you.

 

[chaz90]

everytime I bring in a patient with symptoms that might relate to an irregular BP ( MI, stroke, etc).

I have seen an automated BP be off on several occasions. Just as I have seen a pulse Ox say someone is at 60% with pink skin and completely alert. I will use a monitor for basic trending in a stable patient, but I will never set a patients baseline off of it.


Someone ( not myself) just got QA'd for bringing in a patient with a blood pressure of 190. They stated the patients BP was in the 140s for the duration of transport. After backing up the monitor- that was the automated readings... All the way until they were taken off the monitor in the ED and had their BP taken which showed it was actually 190. Whoops.


How many times have you ran a 12 lead and the monitor says it's an active infarct, when in reality it's a old LBBB.


It's pretty common for the monitor to be wrong.


Here's a study by the University of South Dakota- school of medicine on the accuracy of automated BP readings.
http://www.ncbi.nlm.nih.gov/m/pubmed/18755068/

So you use the study's suggested "gold standard" of a mercury manometer? There can be inaccuracy in anything we use. I use pleth waveforms and assess the extremity and patient to assess the accuracy of my SpO2 readings, I trend automated NIBP readings to evaluate their accuracy and correlate them with my patient, and I pay very little attention to monitor algorithm interpretations (which is really an entirely unrelated issue).

Honestly, I have no problem in others choosing to grab a manual pressure first. I just choose not to and haven't ever had any issues with it. Different strokes and all that [emoji4]