Lack of Oxygen...On the Unit

[resq330]

So, among other issues, my vollie squad has an issue with people forgetting to turn the big tank off when they get off the truck and therefore having the O2 leak out. Or just forgetting to change out an empty tank when they get back to the station. This obviously causes problems when the next crew gets on to run a call and they are out of O2 in the big tank. I'm sure other squads have ran into this problem. I was just curious if anyone had suggestions on how to overcome this problem. This is not really directed to the paid folks, since its their job to always check trucks. But feel free to comment cause I'm sure it still happens

 

[fma08]

Make some sort of checklist that they are required to complete after the run? Like a rig check, except to be done after a call?

 

[resq330]

Make some sort of checklist that they are required to complete after the run? Like a rig check, except to be done after a call?

That's what we were thinking about. Having them document the amount left in the tank on the ppcr. But some can't and won't even do this.

 

[HuiNeng]

That's what we were thinking about. Having them document the amount left in the tank on the ppcr. But some can't and won't even do this.

Good way to get fired in the Real World™. An empty O2 tank is a clear and present danger to patients. Why are these people still employed?

 

[resq330]

Good way to get fired in the Real World™. An empty O2 tank is a clear and present danger to patients. Why are these people still employed?

Very true...As I was saying this is an all volunteer squad. Not paid.

 

[akflightmedic]

You can still "fire" a volunteer or certainly reprimand them.

It presents a serious danger to the very people they are volunteering to assist...if they do not see that part of the picture, then they do not belong in the role.

I have been affiliated with volunteer squads before and we still had check off sheets prior to the start of shift which we signed up for. If your department does not have sign up for shifts and it is a just show up from home and grab truck when call comes in...then you need to implement policy that directs them on what to do after a call.

If this does not work, see first two sentences above.

 

[resq330]

You can still "fire" a volunteer or certainly reprimand them.

It presents a serious danger to the very people they are volunteering to assist...if they do not see that part of the picture, then they do not belong in the role.

I have been affiliated with volunteer squads before and we still had check off sheets prior to the start of shift which we signed up for. If your department does not have sign up for shifts and it is a just show up from home and grab truck when call comes in...then you need to implement policy that directs them on what to do after a call.

If this does not work, see first two sentences above.

Thanks for your input. Makes perfect sense to me. And yes, we are as you described, show up and run the call.

 

[EMT.Hart]

I'm employed in a very rural area where getting the very large o2 tanks requires a 1.5 hour drive. What we do ( here comes the part that will help you ) is use portable o2 tank on the end of the stretcher , or place it between PTs legs , and make sure we always have at least 2 back ups. This is because the portables we get are much more available in our town.

Might work for you. The main o2 is our backup.
Hope this helps.

 

[resq330]

I'm employed in a very rural area where getting the very large o2 tanks requires a 1.5 hour drive. What we do ( here comes the part that will help you ) is use portable o2 tank on the end of the stretcher , or place it between PTs legs , and make sure we always have at least 2 back ups. This is because the portables we get are much more available in our town.

Might work for you. The main o2 is our backup.
Hope this helps.

Yes, we 'normally' always have a couple portable bottles on hand. But when you have a long transport time to the hospital and your running 15lts with a NRB, it doesn't last long.

 

[EMSLaw]

I'm employed in a very rural area where getting the very large o2 tanks requires a 1.5 hour drive. What we do ( here comes the part that will help you ) is use portable o2 tank on the end of the stretcher , or place it between PTs legs , and make sure we always have at least 2 back ups. This is because the portables we get are much more available in our town.

Might work for you. The main o2 is our backup.
Hope this helps.

While I understand doing what works for you, remember that the D-sized portable tanks are only good for about 20-30 minutes, often less. That can be a lot of tank-switching. And if you run out, what are you going to do when you get off the ambulance? You can use your D-tanks if your M-tank runs out, but the other way doesn't work so well.

 

[EMT.Hart]

Very true. Just a suggestion to help on those calls that don't require NRBs.

 

[resq330]

Very true. Just a suggestion to help on those calls that don't require NRBs.

Thank you for your input.

 

[JPINFV]

This is not really directed to the paid folks, since its their job to always check trucks.

Negative ghost rider. If you use something, you need to replace it regardless of if you draw a check or not. Similarly, it is the responding crew's responsibility to ensure that they have enough supplies to run the call. If that means that a response is delayed while more spare bottles and regulators are loaded because someone forgot to close the tank, then so be it.

 

[EMT.Hart]

Negative ghost rider. If you use something, you need to replace it regardless of if you draw a check or not. Similarly, it is the responding crew's responsibility to ensure that they have enough supplies to run the call. If that means that a response is delayed while more spare bottles and regulators are loaded because someone forgot to close the tank, then so be it.

Agreed. Big time. :excl:

 

[medicdan]

Based on your avatar, can I safely assume you ride with VTRescue? This is a part of a greater problem with college campus EMS with accountability, shifts and maturity. If your members don't value or spend the time to do a good rig check, you are not a valuable asset to the community you serve. Do you not do rig checks at shift change? CHeck them on a regular basis?

Would you consider adjusting/fixing your built in O2 system to leak (less)?
I have to say... I dont really think about turning the main O2 on and off, it has just become muscle memory for me. WHen I load a patient on O2, I just find myself in the cabinet, turning it on, when I offload, it always gets turned off before offloading or while cleaning the truck.

Do you maintain your mains at low pressure normally? I guess I have never seen a bottle hemorrhage O2, and unless its open for weeks on end, I cant see bottles getting sucked dry pretty often.

Good Luck!

 

[akflightmedic]

Yes, we 'normally' always have a couple portable bottles on hand. But when you have a long transport time to the hospital and your running 15lts with a NRB, it doesn't last long.

And this my friend would be one of the root causes of your "problem". How often are you running 15lpm via NRB for long transfers? Is it necessary, or is it simply what we do cause that is how we were taught?

Just asking...but if you do this for every patient, yeh I can see you having O2 issues.

 

[Seaglass]

It's hard to change habits in people who've been doing this awhile, but make sure that newbies learn to always treat the on-board O2 just like they would a portable tank, in terms of turning it on and off and using the regulator.

Also seconding the idea of checklists. If you can, you could even make them a mandatory part of every call, at least until people stop wasting your supplies.

Based on your avatar, can I safely assume you ride with VTRescue?

I can understand that you might not want to answer that question explicitly, since it casts your agency in a bad light. But if you do, as suggested by your location and avatar, be aware that you're held up as an example for other college EMS systems, especially ones just starting out. The "you're a role model" line really does work on some people.

I sometimes work with a volunteer agency, and we're held to very high standards for equipment replacement and care. If volunteers want to keep volunteering in the future, the standard of care, including equipment, needs to be equal to what paid services provide.

 

[HuiNeng]

sidebar -- regarding tanks

While I understand doing what works for you, remember that the D-sized portable tanks are only good for about 20-30 minutes, often less. That can be a lot of tank-switching. And if you run out, what are you going to do when you get off the ambulance? You can use your D-tanks if your M-tank runs out, but the other way doesn't work so well.

Never having ridden an ambulance while upright, I have some trivial questions.

I understand the various portable tanks, such as these:

What are the mains on a rig? A couple of Ms? Big green steel bottles? An integral, built-in tank?

 

[DigitalSoCal]

What are the mains on a rig? A couple of Ms? Big green steel bottles? An integral, built-in tank?

yep

 

[resq330]

Based on your avatar, can I safely assume you ride with VTRescue? This is a part of a greater problem with college campus EMS with accountability, shifts and maturity. If your members don't value or spend the time to do a good rig check, you are not a valuable asset to the community you serve. Do you not do rig checks at shift change? CHeck them on a regular basis?

No, I don't run for VT Rescue. Just a football fan. (Which will change to UNC Basketball soon ^_^)

We are all volunteer and don't have shifts or shift change. Some people check their units if they come out for run crew and some don't.

Would you consider adjusting/fixing your built in O2 system to leak (less)?
I have to say... I dont really think about turning the main O2 on and off, it has just become muscle memory for me. WHen I load a patient on O2, I just find myself in the cabinet, turning it on, when I offload, it always gets turned off before offloading or while cleaning the truck.

Fixing the leak could be an option, I guess. I may look into that.


Do you maintain your mains at low pressure normally? I guess I have never seen a bottle hemorrhage O2, and unless its open for weeks on end, I cant see bottles getting sucked dry pretty often.

Good Luck!

Not sure how to answer this one. Our call volume isn't super high. Anywhere from 60-100 calls a month. So a unit could sit a whole day or maybe even two and not be ran. And still may not use the O2 if it is ran.
Thanks for your input.

And this my friend would be one of the root causes of your "problem". How often are you running 15lpm via NRB for long transfers? Is it necessary, or is it simply what we do cause that is how we were taught?

Just asking...but if you do this for every patient, yeh I can see you having O2 issues.

I don't do this very often at all. When they get on the truck I switch them to the big tank. (If its not empty )

It's hard to change habits in people who've been doing this awhile, but make sure that newbies learn to always treat the on-board O2 just like they would a portable tank, in terms of turning it on and off and using the regulator.

Also seconding the idea of checklists. If you can, you could even make them a mandatory part of every call, at least until people stop wasting your supplies.

Yes, its VERY hard to change old habits in people that have been at it a while. I think we may get them to start writing it on the ppcr when they get the mileage off the truck to write down as well.

I can understand that you might not want to answer that question explicitly, since it casts your agency in a bad light. But if you do, as suggested by your location and avatar, be aware that you're held up as an example for other college EMS systems, especially ones just starting out. The "you're a role model" line really does work on some people.

I sometimes work with a volunteer agency, and we're held to very high standards for equipment replacement and care. If volunteers want to keep volunteering in the future, the standard of care, including equipment, needs to be equal to what paid services provide.

Never having ridden an ambulance while upright, I have some trivial questions.

I understand the various portable tanks, such as these:

What are the mains on a rig? A couple of Ms? Big green steel bottles? An integral, built-in tank?

Our units house the big green "M" size bottles. And we usually carry a couple of the "C" or "D" size as portables.