I'm almost afraid to ask... Blankets?

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Sullybird89

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I was wondering if anyone could give me any information on where the "Patient gets a blanket" rule comes from. I certainly don't disagree with it, but I never thought it to be a hard and fast protocol. I'm beginning to suspect it is, as many of my ALS techs are very consistent in kindly reminding me to put one on many of my patients that I haven't done so with already... and there was a pretty wordy/snarky post that I saw (yes... on facebook...) this morning that emphasized it. I'll probably post the thing below this.

Is the blanket rule an important, golden rule? And why is it? And where did you learn about it?

I'll be happy to know for sure. Thank you. :D
 
This is the post that my friend shared on facebook... which is interesting in it's own right - though it's that blanket thing that's really catching my eye right now. :)

It's our fault.

As I am wheeling in a patient through the bay doors of an urban ED, I pass a local crew coming out of the hospital with their empty stretcher. The provider is middle aged, morbidly obese & disheveled... his partner is young, thin and wearing a crooked baseball cap of some random sports team... they both have a cigarette already out ready to be lit. One of them is wearing jeans... the other blue pants with some resemblance to EMS pants, but not quite... one has tennis shoes on... the other a pair of aging boots. Both of their shirts are untucked.. both are covered in fast food grease... and both have been long divorced from their washing machine.

This is what a typical EMS crew looks like.... this is what I look like to the ED department... to the family to whom I respond... and to the rest of the world that sees me day in and day out. Because once you have seen an EMS crew looking like that... we all look like that. Yup... sad, but that is the way it is. My shirt is tucked in... it is clean... the only stains on my uniform are the blood/vomit crap that my pt managed to fling at me today. Yet... when I roll in and turn over my patient to the ED nurses & docs... guess what... that image of the previous EMS crew is seared in their minds... the damage is already done. It is irrelevant as to how professional I look... how much I have done for this patient... and how much I may or may not know. Period.

When I roll up on scene in the middle of the night, and the first responder EMS/fire crew rolls up behind me with their pants half way pulled up... uniform shirts not even on... the radio mic clipped to their ripped undershirt... my confidence in that crew is next to zero. You can't even tuck your damn shirt in... how do you expect me to trust you with bagging?

It is ironic... but having lived & breathed the dark side of EMS for the majority of my adult life... I now get to experience the other end of the equation. I get to sit in the seat where the turnover is now given over to me. And I promise you... when you roll in through the door... looking like absolute hell... if I confuse you with the local urban explorer that you have on your stretcher... if your a$$ is selling more crack than the city ghetto... if your patient from the pits of the projects looks cleaner, more put together than you... I am going to have a very hard time trusting anything that comes out of your mouth. You want me to sign for your IV??? I'm not even sure if you put the blanket on this patient right.......

And I have LIVED and BREATHED EMS for the majority of my life... I know how tough and sucky and sleep deprived and food famished you are.... been there, done that... and yet that is how I view you!!! Can you imagine how the rest of the world views you? Or views me when I roll in wearing my squad uniform.... and not my clean white doctor coat. The other docs... nurses... hospital staff... family... still call us ambulance drivers... they think we are all just a bunch of trauma junkees that scoop... run... and do a bunch of procedures we should have no business doing. Why is it that as a profession we receive so little recognition as compared to our fire & police comrades?

Now many of you may disagree with me as that is "not how my agency works"... good I am glad... that's how it should be... or "I don't know where you ride... but we don't have crews like that"... well that would be a pretty big fat lie that you are telling to yourself. I have seen up close & personal over a dozen high paced inner city (and probably twice as many rural) agencies bringing in patients all over the East coast... and guess what... we all look like that as a majority... sadly. Just look around...

So when the next time you complain to me... to your supervisor... to your partner... or just in general as to why our profession is undervalued... underpayed... and never mentioned... take a long hard look at yourself... and pull up your pants... tuck your shirt in... wash the french fry grease out of your uniform... shave... don't chain smoke in front of the ED entrance... cover your patient with a blanket... bring them in feet first... put the C-collar on the right way... small steps for an EMT/Paramedic... but giant leaps for the rest of us in EMS. -EMSDoc911​
 
If they're cold give them a blanket...if they aren't cold in the back but it's freezing outside offer them a blanket...if they are exposed either because it's a sexy college coed on a pub crawl or a multisystems trauma patient, preserve their dignity and give them a blanket and lets not forget BLS shock treatment...if they ask for a blanket, give them a blanket.

If it's 100* out, or their fever is through the roof, don't give them a blanket...a sheet sure, not a blanket.

Pretty much all our patients get a blanket if not two or three. With that said, it was -2* F last night...according to my car.
 
There is a proven psychological value to providing a patient with a blanket, or in warm weather a sheet. The comfort of being covered often is far more important than the warmth the blanket provides. This is especialy true in elderly patients. I try not to use the fancy red blankets we carry because we charge a ridiculous amount for them but I cover every patient with a hospital sheet/blanket unless they wont tolerate it or it interferes with care.

Also as pointed out it simply makes things seem more professional and less haphazard when you bring in a patient who is packaged comfortably.

Edit: just FYI some departments push the blanket thing to create billable charges, just like they push O2.
 
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Thanks!!

I've always kind of been using the common sense/weather-based model of blanketing, but I'm definitely all for the comfort factor as well.

Where did you learn that? As part of classes, or on the job?
 
bigbaldguy said:
Also as pointed out it simply makes things seem more professional and less haphazard when you bring in a patient who is packaged comfortably.
Click to expand...

Random and off topic, but it irks me to know end when crews bring in a patient who's slid down the gurney to the point that they're basically supine with their neck at a 90* angle against the head of the bed....take the extra two seconds to reposition them and make them comfortable dammit.
 
When it's cold and windy I use two blankets place one on the stretcher and wrap the pt. in and place the other on top.

I have a hard time understanding crews that cover the pt. with very little, but will use a bunch of blankets to take a nap with.
 
Seriously? A blanket protocol?

If its cold, give them a blanket, jesus
 
Sullybird89 said:
This is the post that my friend shared on facebook... which is interesting in it's own right - though it's that blanket thing that's really catching my eye right now. :)

It's our fault.

As I am wheeling in a patient through the bay doors of an urban ED, I pass a local crew coming out of the hospital with their empty stretcher. The provider is middle aged, morbidly obese & disheveled... his partner is young, thin and wearing a crooked baseball cap of some random sports team... they both have a cigarette already out ready to be lit. One of them is wearing jeans... the other blue pants with some resemblance to EMS pants, but not quite... one has tennis shoes on... the other a pair of aging boots. Both of their shirts are untucked.. both are covered in fast food grease... and both have been long divorced from their washing machine.

This is what a typical EMS crew looks like.... this is what I look like to the ED department... to the family to whom I respond... and to the rest of the world that sees me day in and day out. Because once you have seen an EMS crew looking like that... we all look like that. Yup... sad, but that is the way it is. My shirt is tucked in... it is clean... the only stains on my uniform are the blood/vomit crap that my pt managed to fling at me today. Yet... when I roll in and turn over my patient to the ED nurses & docs... guess what... that image of the previous EMS crew is seared in their minds... the damage is already done. It is irrelevant as to how professional I look... how much I have done for this patient... and how much I may or may not know. Period.

When I roll up on scene in the middle of the night, and the first responder EMS/fire crew rolls up behind me with their pants half way pulled up... uniform shirts not even on... the radio mic clipped to their ripped undershirt... my confidence in that crew is next to zero. You can't even tuck your damn shirt in... how do you expect me to trust you with bagging?

It is ironic... but having lived & breathed the dark side of EMS for the majority of my adult life... I now get to experience the other end of the equation. I get to sit in the seat where the turnover is now given over to me. And I promise you... when you roll in through the door... looking like absolute hell... if I confuse you with the local urban explorer that you have on your stretcher... if your a$$ is selling more crack than the city ghetto... if your patient from the pits of the projects looks cleaner, more put together than you... I am going to have a very hard time trusting anything that comes out of your mouth. You want me to sign for your IV??? I'm not even sure if you put the blanket on this patient right.......

And I have LIVED and BREATHED EMS for the majority of my life... I know how tough and sucky and sleep deprived and food famished you are.... been there, done that... and yet that is how I view you!!! Can you imagine how the rest of the world views you? Or views me when I roll in wearing my squad uniform.... and not my clean white doctor coat. The other docs... nurses... hospital staff... family... still call us ambulance drivers... they think we are all just a bunch of trauma junkees that scoop... run... and do a bunch of procedures we should have no business doing. Why is it that as a profession we receive so little recognition as compared to our fire & police comrades?

Now many of you may disagree with me as that is "not how my agency works"... good I am glad... that's how it should be... or "I don't know where you ride... but we don't have crews like that"... well that would be a pretty big fat lie that you are telling to yourself. I have seen up close & personal over a dozen high paced inner city (and probably twice as many rural) agencies bringing in patients all over the East coast... and guess what... we all look like that as a majority... sadly. Just look around...

So when the next time you complain to me... to your supervisor... to your partner... or just in general as to why our profession is undervalued... underpayed... and never mentioned... take a long hard look at yourself... and pull up your pants... tuck your shirt in... wash the french fry grease out of your uniform... shave... don't chain smoke in front of the ED entrance... cover your patient with a blanket... bring them in feet first... put the C-collar on the right way... small steps for an EMT/Paramedic... but giant leaps for the rest of us in EMS. -EMSDoc911​
Click to expand...

I swear to all that's holy it wasn't me. I don't write that well!
 
Rant over, a nice blankie looks good (not some moth-eaten thing), both for you/your service, and usually the pt is not dressed to the nines. Many pts are older, and they may have come from an apartment that is heated to 76 degrees.
It's respectful, don't let desensitization or laziness have you whipping pts out unless there's a mass casualty on ("on" not meaning "on Chicago Fire").
 
LOL.

Mr. Mycrofft your posts here and on other threads crack me up. I appreciate your feedback and agree that the blankie treatment looks professional.

I know I'd probably want one if I'm being wheeled into the loony bin they call the E.D....

In addition to not trusting getting close with the straps on ANYONE'S stretchers....
 
If its cold, they're cold, exposed, scared, anxious, raining, windy/unpleasant -> blanket.

IFT out of my local ED we make a brief stop at the blanket heater.

I am a firm believer in the medicinal properties of a blanket fresh out of the blanket oven. I've seen some VERY sick people smile when I put a warmed blanket on them. And a non-warmed one on top to hold in the heat.
 
And if they are really cold, take a second blanket and unfold it until it is narrow and full length (usually 1-2 unfolds). Have the patient sit up and wrap the blanket around their shoulders. This way you have access to the front for care reasons and have still taken their comfort in mind.

It it's super cold and they have no hat, a towel on the head is effective.
 
abckidsmom said:
And if they are really cold, take a second blanket and unfold it until it is narrow and full length (usually 1-2 unfolds). Have the patient sit up and wrap the blanket around their shoulders. This way you have access to the front for care reasons and have still taken their comfort in mind.

It it's super cold and they have no hat, a towel on the head is effective.
Click to expand...

roger that
 
My rule of thumb is: everyone gets at least one blanket. If its cold enough that I'm wearing a job shirt or jacket, they get at least 2.

Think about when you were a kid, and you were sick. What would happen? Mom would come and put an extra blanket on the bed. I think it's psychological. But it always seems to make people happier, especially when they get in the back of a cold ambulance.

Even after a couple blankets when patients are still cold, I make it a point to tell them as soon as we get to the ER I'll run and grab a blanket out of the warmer for them. And I'll usually grab one on the way by, heading to the room.

It's not all tubes, IVs and amiodarone… Sometimes people just need a warm blanket.

Along those same lines, I'm always yelling at the EMTs that pull-up on scene and leave the back door and the side door of the ambulance open when it's 12° outside. Turn the heat on and close the doors.
 
Giving good customer service covers many many patient care errors. Very few people will complain about that nice man who took such nice care of grandma, even if she had pneumonia, was bordering on sepsis, and he gave her 120 mg Lasix.

She'd be the same dead, but he would be looking ok still.
 
abckidsmom said:
Giving good customer service covers many many patient care errors. Very few people will complain about that nice man who took such nice care of grandma, even if she had pneumonia, was bordering on sepsis, and he gave her 120 mg Lasix.

She'd be the same dead, but he would be looking ok still.
Click to expand...

"You would never sue your friend, you would gladly sue your enemy, make every patient your friend."

Oustanding advice from an outstanding doctor.
 
What forum did I just step into...?

Really? Nothing about hypothermia in trauma and formation of the fibrin net, it's all "personal experience?" Where are my statisticians when this kind of thing happens? Nothing about creating a hypothermic patient, nothing about creating a hyperthermic patient? Have we really gotten to a place in EMS where we have to say "everybody gets a blanket?" In a couple of years, there will be some contraindication to this "everyone gets a blanket," and a decrease in post hospital outcomes secondary to inappropriate blanket usage.... I knew we were on a downhill slope, but Jesus!!! I guess as long as we can care appropriately for the patient and stop this cookbook monkey trick stuff, then maybe we'll all get through this, but really.... Rant Off...
 
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