911 versus IFT Service - Pillows ?

[mikeymedic1984]

I have noticed a trend over the years regarding pillows and ambulances ? Most 911 services never have a pillow on the cot, most IFT services have a pillow on their cot. When I have asked 911 medics about it, they are quite indignant about having a pillow on the cot, usually saying something like "this is not the Ritz Carlton, if you need a pillow you do not need 911". So to all you 911 medics, are you "burned out" or "less compassionate" if you are not concerned about patient comfort ? If you are one of the ardent ones that are against pillows, can you tell me why ?

And what if you work for one of those alphabet services that do both 911 and IFT, what do you do then ?

P.S. I said "most" not all, I realize that there will be services who fall on both sides of issues, regardless of which type you work for. I am just curious if there is a cultural difference between the types of services, or if it is between types of medics ?

[akflightmedic]

Of the two (IFT versus 911) which one typically has to continuously market, expand and offer a concierge type service? Which one typically has direct competition-a lot of it?

I do not think it is "cultural", I think it comes down to need versus want and budgetary reasons.

[Just Plain Ruff]

No, I think it's partially laziness on not grabbing a pillow. How hard is it to not grab a pillow.

Also, if someone who has not been a patient in the ambulance and has wanted a pillow where there has not been one available and has to either have held their head up for the entire ride or put their head down at a uncomfortable angle, they don't have any idea what the patient goes through and their discomfort.

I think that someone said "Walk a mile in my shoes" or something like that.

Edited April 23, 2012 by Captain Kickass

[CPhT]

I work for a service who provides IFT and rescue services at both the basic and advanced levels. I have noticed that most of our trucks have a pillow and a couple of blankets under the squad bench, as well as the one we typically exchange out on a one-for-one basis with every patient. To me, it's important to make sure a pt is comfortable, even if you're only going a mile, because the discomfort from our stretcher could cause false feedback from the patient. Your 60yo female pt with DIB and right arm pain is now complaining of back pain during the transport... is it because she's uncomfortable, or is she experiencing referred cardiac pain?

Now having said that, in a true life and death situation, I could care less if the patient is comfortable. If I'm doing CPR, I'm not going to stop to make sure that the pt has a pillow. I can see the attitude of "if they call 911, they don't need a pillow", and I can even agree with that sentiment. However, how often do you get calls where you are truly the difference between life and death, versus how many calls do you drop an IV just to KVO, take history, and run a slow priority 3? The minor calls, I'd call it laziness for not concerning themselves with pt comfort.

[mikeymedic1984]

Could someone make the argument that it is a germ thing (shared pillow) and not a laziness thing ?

[DFIB]

Why would patients share linen? Failure to change sheets, pillow cases and blankets after a call would pretty much constitute laziness.

[WolfmanHarris]

Pillows are a hot commodity in my area, not for EMS per se, but all the ED's. We exchange linen at the hospital and if there is no pillow on the bed we're offloading to then we won't have one unless we take it from the patient. Generally I use an extra blanket folded up for the head and keep our pillow under the bench. If we get a long transport, or need it for splinting, or have a patient who is particularly uncomfortable (kyphosis, chronic pain, etc) I will pull it out. Unfortunately due to logistical realities I can't have a pillow for every patient and I do pick and choose when to use it, knowing I'll likely lose it.

As far as hygiene goes, the pillow is vinyl. Remove the case, virox the pillow and put on a new case; problem solved.

[HERBIE1]

I think it depends on the service, the area you work in, AND the transport time. Most ER's around here do not have pillows. If someone needs one, a doubled up sheet roll, towel, or blanket works just fine- either in the ER or prehospital. Even if you had a pillow, the linen carts in the ER's do not have replacement pillowcases or pillows- those items are reserved for the in-patients up on the floors. It's not a sanitation thing, it's merely practicality and budget related. If a blanket or sheet get destroyed or stolen, they are cheaper- and easier- to replace than a pillow.

That said, by state law we are supposed to stock pillows as part of our inventory. The required supplies are standardized statewide and not specific to any one area. Our employer provides them for us, but they are essentially one use, throw away, foam rubber mini pillows so if they get soiled, we need to order replacements and may get them in a couple days. In other words, not a high priority item in a high volume system.

Most private providers here do have pillows, and most of them also have fancy linen- even quilted type sleeping bags for the winter. Then again, that is part of the service they provide, and they can exchange pillows, and pillow cases when they transport patients to and from the hospital floors. Also, unless you are talking about transporting for an IFT or contracted account, these providers charge well over 1K per patient, payable UP FRONT, so they better have nice linen and pillows for each patient. We may charge similar prices, but our bill comes in the mail, so the pain is delayed. LOL

[Grind_time_medic]

the ritz carlton bit you put up was pretty funny!

But to answer your question at the service that I work for we do both IFT and Emergency. There is one station that we have here, that is constantly in need of pillows or blankets while we have other stations that do not seem to have this problem of doing the 1 for 1 change out with the local hospital.

I have asked the same question you did about why people are having so many issues getting pillows and was told that it is a two fold problem. I don't remember the exact answer I was told and don't want to tell you wrong. But I do know that hospitals are getting tired of having to keep filling a tank (restocking the pillow supply) with a leak that shows no sign of stopping any time soon.

Personally i think the pillows hospitals provide is a nothing more then a vinyl/thick plastic pillow shape casing filled with Walmart bags or something along those lines they are not comfortable at all.

[zippyRN]

Could someone make the argument that it is a germ thing (shared pillow) and not a laziness thing ?

to suggest it;s an IPC issue is also laziness

there are various types of impermeable cover available for pillows to go betwee nthe pillow and the pillow case as well as those pillows designed for institutional use whose cover is impermeable

these are wipe clean, you should be wiping the stretcher down and changing linens between runs on an ambulance used as an ambulance - if you are doing event cover you can usually get away with 'elephant's loo roll' over the cot linen for most 'none dripping' casualties...