Lack of Oxygen...On the Unit

[exodus]

H-size in the rigs.

 

[mycrofft]

Marketing and discipline.

MARKETING; it is a common rookie trick to leave the O2 on to make it "quicker to use", or because they are fixated on "Miller Time" (afterglow of a good run) then forgot. Also, the concept of "The run is not over until you are fully ready for the next one" needs to be a mantra.

DISCIPLINE: where are the crew chiefs? If they can't do this, they can be suspended or demoted, or fired. They should use humor then sarcasm then counseling then disciplinary action. The "crewch" needs to be in the station first, and out of the vehicle last, and her/his butt hits the sofa last after a run because that unit is HERS/HIS.

Have an exercise, leave a low bottle for them to use, and if they spot the low bottle keep the pressure on, don't throw the flag, until the pt dies or they get it fixed. THEN "ream" the drill "crewch", throw some chairs, whatever it takes to impress them.

 

[White Fang]

I am still a student and by the 22nd of dec i take my finals for EMT-B, in my squad where I volunteer we shut off the valve when we offload, also the new crew on duty we check the rig, you need, must check before you take your shift, i come 15min before and check the rig

 

[medicdan]

Why not move towards positive reinforcement before punnishment. Although childish, try rewards for performing a proper skill check. One of the EMS magazines suggested a year or so ago, put a gift card in to the straps of a traction splint, so the first person to take it out, and actually inspect it finds it. Put candy in the O2 cabinet, whatever it takes.

If that doesn't work, put your foot down. Whatever your call volume, make sure once a week, the vehicle is checked top to bottom. Every 24 hours, the fluids (transmission, oil, etc) should be checked along with fuel, and the state of all expendables (O2 being a critical one). Make them write down the numbers, and hand them in. Track O2 levels and compare to use on calls, etc.

Good Luck!
Dan

 

[Sparky21]

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.

I agree completely!! Having worked as a volunteer and drawing a paycheck I always check off my truck as soon as i get to it. Its patient safety more than anything! not to mention its a CYA. I would hate to arrive on scene and not have what i need. Not only does it make me and my partner look like bad but the company i work for as well. Those are just my two cents...h34r:

 

[White Fang]

MARKETING; Also, the concept of "The run is not over until you are fully ready for the next one" needs to be a mantra.

DISCIPLINE: where are the crew chiefs? If they can't do this, they can be suspended or demoted, or fired. They should use humor then sarcasm then counseling then disciplinary action. The "crewch" needs to be in the station first, and out of the vehicle last, and her/his butt hits the sofa last after a run because that unit is HERS/HIS.

Amen to that too!!!!
you need to check before you come on-duty and replace what you used and should not be a discussion it should be done!! it is critical!!! and not only O2 with anything and everything!

 

[EMS_Junkie]

Im from a small town on a volunteer squad. What we do is after every call on our way back to the station, we go over okay this has to be done when we get back. We know when we run out of o2 and we change it right away when we get back. Its a simple thing to do that takes 5 minutes. But try going over the call and going over what needs to be check on your way back to the station after every call. It should help.

 

[EMSLaw]

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?

It depends on your rig. Ours have, and I think this is fairly standard, an M tank in the side compartment (just like in the picture DigitalSoCal posted) that links to the ball-float valves inside. You flip on the power to the O2, turn the flowmeter until the little ball is where you want it, and go to town.

We also carry a D cylinder in the jump bag, have a ready backup with a regulator already on, and have one or two spares without regulators. Jumbo D's are fatter, and therefore heavier. If you're taking an EMT class, this is all at least mentioned in the Ambulance Operations chapters, so you'll get an overview.

You fill the M tank from the big steel bottles back at the station. A full M tank contains plenty for all but the longest trips, unless the medics come aboard and decide to use CPAP. Then we'll be filling up soon.

 

[JPINFV]

You fill the M tank from the big steel bottles back at the station. A full M tank contains plenty for all but the longest trips, unless the medics come aboard and decide to use CPAP. Then we'll be filling up soon.

Just curious, services are cascading their M tanks instead of just exchanging them with their suppliers? I've cascaded D and E tanks, but the cascade at my original company used M tanks as a part of a 4 tank cascade.

 

[EMSLaw]

Just curious, services are cascading their M tanks instead of just exchanging them with their suppliers? I've cascaded D and E tanks, but the cascade at my original company used M tanks as a part of a 4 tank cascade.

We do. We have a 3-tank cascade that we fill everything from. I agree that it doesn't seem to make much sense. The only thing I can think of is that the ones in the rigs are newer and nicer than the ones we send back and forth to the supplier, but that shouldn't really make a difference.

 

[JPINFV]

See... what concerns me about cascading M tanks is that it isn't hard to screw up a cascade. I'll admit, I've accidently equalized the M tanks a few times. Given the size of tanks needed to cascade a M tank, it sounds like that would be a costly error that would happen from time to time.

 

[EMSLaw]

See... what concerns me about cascading M tanks is that it isn't hard to screw up a cascade. I'll admit, I've accidently equalized the M tanks a few times. Given the size of tanks needed to cascade a M tank, it sounds like that would be a costly error that would happen from time to time.

Yeah, I've done it too. "Oh, wait... I was supposed to close those other valves, wasn't I? No wonder the pressure dropped so much..."

 

[medicdan]

The only other reason I can think to cascade an M tank is so you don't have to take it off the truck, but that takes proper placement of the cascade system. Everywhere I work has, as well, used M tanks swapped out as mains, and Ms to fill the Ds.
I'm thinking that if you are cascade filling M tanks you are going to want more then three in the system...that's just too complicated.

 

[medicdan]

Double Post...

 

[Seaglass]

I'm not sure what size we use at the rural service, but our tanks are larger than Ms... offhand, I'd say around five feet tall and much wider than the average tank. Procedure for replacement apparently involves finding some firefighters who want to show off their muscle. In our bags, we carry Jumbo Ds. I think it's because we can sometimes have patients that take quite awhile to get back to the ambulance, and our third-choice hospital is pretty far away. So, if helicopters are unavailable and nearby hospitals are not receiving, it's conceivable that we could have it running for a long time. We also always have four or so replacement JDs stashed in the rig.

Everywhere else, it's standard Ds and Ms.

 

[lightsandsirens5]

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.

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.

Seconding the second here. My service uses a check off sheet like the one I will try to attach here. If there is a problem when you take a rig out, you note it isn the problems box.

As for the stadards thing, if you fail to meet them, you get hauled into the coodinators office. If it is a pt care issue in any way and you don't fix it(rapidly), you are gone.


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