Minimum Equipment

[fiznat]

I assume we all check out our gear at the beginning of our shifts to make sure that everything is on-board, in order, and working. My question is about what you guys do when you find out something is missing or NOT in place. Do you have a list of minimum equipment before your unit is available to take calls? What items are important enough to refuse a call if you don't have it? Does your company back you up on this?

Lately at my service I've noticed that the supervisors and dispatch are trying to push us out onto the road to take calls before we're able to do a complete check of the ambulance/gear. Sometimes if we are missing something, the supervisor might say that we should "just take this one call" and come back to get the restock later when it is available. This situation makes me very nervous. In principle I would like to remain "off line" until I have done a complete check and made sure everything works, but in reality it is often hard to stand firm on this when dispatch is calling for you to sign on for a supposed critical call and you are the only unit "available."

Now, I know some types of gear are absolutely necessary while others maybe not so much, but it is a blurry line. I'm also pretty sure the responsibility would fall on me alone if I showed up to a call and found out that I was missing something really important, and I hadn't checked it or insisted on it's restock. I guess my question to you guys is: what equipment would you refuse to go to a call without, and does your service/supervisor/dispatch back you up if you make the decision to refuse a call for these reasons?

[crotchitymedic1986]

One of the best layouts that i saw was a service that had all of your softgoods sealed in plastic storage containers (everything in the interior cabinets --- This was a shoebox size rectangular bin with a lid on it). This allowed you to quickly check those cabinets; if all 20 something tubs were sealed, you were good. If not, you replaced the unsealed tub with a sealed one from the supply room (tubs were numbered, and were universal -- tub #2 had the same supplies in it in all trucks). This just left the exterior compartments, jump seat compartment, ALS equipment to check. You could check a truck in less than 10 minutes if everything was there.

Most states have a list of equipment that is required for an ambulance to get certified, and a critical list of what must be on it to roll out the door everyday. My philosophy was, is it nice to have, or NEED to have. I can run calls without tegaderms and INT caps. I cant run without oxygen, a working laryngoscope, a working cardiac monitor, etc...........

[Arizonaffcep]

I assume we all check out our gear at the beginning of our shifts to make sure that everything is on-board, in order, and working. My question is about what you guys do when you find out something is missing or NOT in place. Do you have a list of minimum equipment before your unit is available to take calls? What items are important enough to refuse a call if you don't have it? Does your company back you up on this?

Yes...the minimum equipment is: IV Pump, Monitor (with at least 2 spare batteries), Transport Vent, Drug Box, Complete Airway Kit, at least 1 LSB, Soft Breakdown, KED Board, Hare Traction, PPE. This is my personal list of things that MUST be intact before I go in-service. In looking over the other supplies, as long a I have enough to run a trauma code, I'm ok (not saying I won't restock, because I get everything to a minimum level before I ideally go in-service, but as long as we have a little bit of everything else, I can work).

Lately at my service I've noticed that the supervisors and dispatch are trying to push us out onto the road to take calls before we're able to do a complete check of the ambulance/gear. Sometimes if we are missing something, the supervisor might say that we should "just take this one call" and come back to get the restock later when it is available. This situation makes me very nervous. In principle I would like to remain "off line" until I have done a complete check and made sure everything works, but in reality it is often hard to stand firm on this when dispatch is calling for you to sign on for a supposed critical call and you are the only unit "available."

I've run into this same thing. I'm in a unique position, because I'm in the field as part time only...in hospital FT. So...as I only pick up shifts in the field for fun, I have no problem telling them to shove it if I feel its an inappropriate situation. Luckily, the majority of what I've come across is, they ask if we'd be willing to take XYZ call, if not it's ok, and put's the ball in my court. If it's a critical call, or 911 and I have at least what I'm comfortable with on the truck, I usually don't refuse, with the understanding we will take care of the rest afterwards. And yes, I'll ask the details of the call if it's critical and make the call myself...(dispatchers forgive me) but at least with the services I've worked for (private EMS), the dispatchers are all AMS, possibly from hypoxia from no fresh air.

Now, I know some types of gear are absolutely necessary while others maybe not so much, but it is a blurry line. I'm also pretty sure the responsibility would fall on me alone if I showed up to a call and found out that I was missing something really important, and I hadn't checked it or insisted on it's restock. I guess my question to you guys is: what equipment would you refuse to go to a call without, and does your service/supervisor/dispatch back you up if you make the decision to refuse a call for these reasons?

See my answer to the first question(s). As far as backing me up...I've told them before, they are more than welcome to dispatch me on the call...but I will NOT respond or leave the property until my minimums are filled.

[Eydawn]

Would hate to roll without swapping monitor batteries.... and I think most of the medics get nervous if we haven't had a chance to check the airway roll before we leave. We usually have a sense of what the car is like before getting in, however, because the off-going crew will usually tell us if they had a busy shift and if we're down on important things like O2, drugs, IV stuff, etc. So, even if a call drops, we can grab a few handfuls of stuff and chuck it on the bench seat before taking off. We also have some good redundancy as far as drugs go between the go-bag and what's in the ambulance... so if we don't have any albuterol or neb setups in the cabinet, chances are good we've still got one in the bag.

It's also not as much of an issue in my system because our supervisors roll in a fully stocked ambulance (which makes it easy for them to become another functional car- they grab whoever's on the psych van and can roll as a team when there's no transfers going on.) So if we happen to have to roll to a call the second we walk in the door and we're missing something, we can radio for a super and get more supplies on scene. For example, a papoose got left at one of the further out hospitals... so the next person heading out there was supposed to grab it. If that car had needed one in between that happening, the supervisor could have brought the one from his/her vehicle to wherever it was needed.

Actually, on a shift I had the other day (since I'm not cleared to work solo yet) we almost left without the other EMT! My FTO was going to take me to the scene and the supervisor was going to meet us there with the other crew-member after she showed up at the station. She walked in the door right as we were starting up and jumped in... sans radio, but she made it.

I think we go out of service if the monitor isn't working and if we drop below our minimum stock level of 2 for the heavy duty drugs... I'm not sure, however. I haven't seen it happen yet.

Wendy

CO EMT-B

[fiznat]

Okay, maybe it is better to list some of these "borderline" items specifically.

Would you respond to a 911 call with:

1. Expired (or missing) benzodiazepines?

2. No spare monitor batteries?

3. One D-tank of oxygen only?

4. No macrodrip (10 gtt) sets, only microdrip (60 gtt) sets?

5. 1-day expired antidysrhythmic drugs?

6. No rescue airway (meaning no combitube/LMA. Still have ETT/OPA+BVM/Crich stuff)

7. No portable radio (saftey issue)

8. Dim bulbs in the laryngoscope blades?

[JPINFV]

One of the best layouts that i saw was a service that had all of your softgoods sealed in plastic storage containers (everything in the interior cabinets --- This was a shoebox size rectangular bin with a lid on it). This allowed you to quickly check those cabinets; if all 20 something tubs were sealed, you were good. If not, you replaced the unsealed tub with a sealed one from the supply room (tubs were numbered, and were universal -- tub #2 had the same supplies in it in all trucks). This just left the exterior compartments, jump seat compartment, ALS equipment to check. You could check a truck in less than 10 minutes if everything was there.

The company I used to work for did something similar where they sealed the cabinets with the same sort of plastic lock found on hospital crash carts. The problem, though, was that the vehicle service techs were unreliable at best. After a few times of finding things like an open OB kit or an adult BVM with pediatric mask, I stopped trusting the seals to ensure that everything was there. While no patient care was harmed by the lapses, there's a big difference between hospital work and prehospital work. If something is missing in the hospital, there's a central supply area, pharmacy, and other floors where equipment can be obtained quickly if need be. If my BVM is missing from the sealed and checked cabinet, then I don't have a BVM and I lack the ability to rapidly quickly acquire one.

[Eydawn]

Responses below....

1. Expired (or missing) benzodiazepines?

I don't think so. Unless the supervisor is in the same general area and his truck has them, this wouldn't be the best idea. Unless the call I was going to was definitely not going to require them, and since I failed psychic 101....

2. No spare monitor batteries?

As long as I just checked the battery that's currently on the monitor and it's at full, I could see running one call without a spare. But only that one call.

3. One D-tank of oxygen only?

No onboard M tank? If I had one D tank on the cot and then the M tank in the truck, sure. That D tank only needs to last me until I get back inside the ambulance. If that D tank is all we've got period, then I'd be pretty leery of running a call with it.

4. No macrodrip (10 gtt) sets, only microdrip (60 gtt) sets?

None, anywhere? Not in your go bag? I would have to say I wouldn't want to run without this. You could put in a lock to do meds with, but if that patient needs any kind of fluid... I suppose one could use a blood-Y in a pinch, but still not ideal.

5. 1-day expired antidysrhythmic drugs?

This should never happen. We check our drugs for expiry on the last day of every month and replace them that day. But no, I wouldn't run with it because you can't give them even though they're only one day expired. That would be another one where the supervisor would have to meet us there to give us supplies.

6. No rescue airway (meaning no combitube/LMA. Still have ETT/OPA+BVM/Crich stuff)

I think we could make do without this for one call. As long as you've got NPA/OPA and ETT tubes, and your cric kit, you still have enough airway tools. Wouldn't want to do 2 calls in a row though, as Murphy is likely to bite us in the ass.

7. No portable radio (saftey issue)

Each person should have a radio, no doubt. Is it possible to roll without one? Sure... but it's not the best idea. As long as you can go get one after that first call, I'd say it's up to your discretion.

8. Dim bulbs in the laryngoscope blades?

Wouldn't want to run without this one. If you can't see to secure that airway... sucktastic.

Wendy

CO EMT-B

[Arizonaffcep]

Okay, maybe it is better to list some of these "borderline" items specifically.

Would you respond to a 911 call with:

1. Expired (or missing) benzodiazepines?

2. No spare monitor batteries?

3. One D-tank of oxygen only?

4. No macrodrip (10 gtt) sets, only microdrip (60 gtt) sets?

5. 1-day expired antidysrhythmic drugs?

6. No rescue airway (meaning no combitube/LMA. Still have ETT/OPA+BVM/Crich stuff)

7. No portable radio (saftey issue)

8. Dim bulbs in the laryngoscope blades?

1. My drug box MUST be complete and dates checked on EVERY shift before I think about rolling.

2. Will NOT run without spare monitor batteries...I once went through 4 different batteries (fully charged, crappy batteries but the FD wouldn't buy more, very $$) on a vf code...shocked for 25 minutes during transport-unresponsive to EVERYTHING we had. Eventually, batteries died and we could either get one more shock or continue to montior the patient...no joke, I immediately went out and bought a DC-AC converter. Then, I didn't worry too much about it, cause during transport we could run and charge the montior off the rig power.

3. I'd be ok with a D tank of O2, we can't carry any other gas. Must have a 1/4 full primary tank in the rig (very large tank) and one FULL portable.

4. If we have blood tubing, then I can live without 10gtts. If not, then no. Need one or the other. 60gtts' are not large enough for trauma codes.

5. Refer to #1. Although we switch/exchange drugs 30-60 days prior to expiring.

6. Must have all airway equipment.

7. Must have a radio. You said it...safety issue.

8. Again, refer to #6.

9. Soft goods, 4x4s, trauma pads, kling, etc. As long as I have a little of each, I can survive.

[stcommodore]

I've begin to realize that the stock and resupply system grows based around the system you work in. In a county system the trucks can live off resupplying IV's, fluids, drug box from the hospital from call to call. Basically when your only running 4-6 calls a day that system will work. Come to the city where you won't see the station for 14 hours and that won't work. You need a full cabinet of back up ALS supplies. The problem is that life in the city means sometimes the morphine shipment hasn't come in yet and everyones morphine is expired. Or you make shift change and 3 of your batteries are gone and all you have is one full battery to work with until you can steal new ones.

[crotchitymedic1986]

Referencing sealed cabinets versus sealed tubs: The company i was talking about started with sealed cabinets, and found the same issues you discussed, which is why they went to the smaller sealed tubs. It was easy to pick up the unsealed tub to see if you had 8 NRBS or 2 left. It was your truck, and your responsibility to keep it stocked. Obvioulsy the reserve trucks had to be checked more closely, as they would get raped while sitting at the station. But having an open and stocked supply room, cut down on the need to steal from other trucks.

As far as the list of equipment the poster put up : It seems that you are working for a service that is cutting corners. You really need to think about whether or not you want to stay with them. Where else are they cutting corners -- No workers comp, no vehicle insurance, no liability insurance or insufficient amount ? Will your paychecks cash next week ? Are they paying your taxes to the feds, or pocketing that money ? Are they commiting medicare fraud to maximize billing ? It is not uncommon with this type of company, to come in and find the doors deadbolted and chained by the feds.