What equipment do you bring with you on calls?

[Bieber]

Okay, pretty sure no one else has made this topic before, but I'm just curious, what do you take in with you on calls? I know this is a broad question, so I've divided it into certain categories and answered for myself.

Unknown Medical - Monitor

Abdominal Pain - Monitor

Chest Pain/Cardiac Call - Monitor, medbox (contains bandages, IV supplies, all meds).

Difficulty Breathing - Monitor, medbox, O2 bag (if fire isn't already on scene, which they usually are).

Cardiac Arrest - Monitor, medbox, IO bag, O2 bag (if fire isn't on scene yet, which they usually are).

Diabetic Emergency - Medbox

Fall - Monitor, I'll send someone for the board/collar if needed.

OB - OB kit, medbox.

Minor Trauma- Medbox, or nothing if they're close to the truck.

Major Trauma/MVC - Nothing--I go to assess and then send someone for the board/collar or whatever else as needed.

Hospital Transfer/Nursing Home - Stretcher, other equipment per call info.

Psych - Medbox or nothing.

If it's a large complex and we'll be doing a lot of walking, I'll usually bring the cot with me, otherwise I tend to leave it in the truck until I know we'll need it.

Do you bring everything in on every call? Why or why not? Do you bring the stretcher in on every call? Have you ever been burned for not taking everything in or not taking a certain piece of equipment in? Did patient care actually suffer from not having a certain piece of equipment on scene immediately, or was it merely an inconvenience?

P.S. The list above is not all-inclusive, if anyone thinks of something I missed, let me know!

[Kiwiology]

It is really here because everything is kept in a big green backpack; IV, drugs, airway, general stuff, everything!

Ambulance in a bag, seriously

[Bieber]

Does it weigh as much as an ambulance too? =)

[Kiwiology]

Yes, its bloody heavy, probably twenty kilos, but so much of an improvement of what was used in the past

Inside the ambulance in the top lockers on the left are drawer sheets, blankets and pillow cases. On the right (above the stretcher) are oxygen supplies, an IV kit, first aid bits and pieces, glad wrap and one or two other things minor.

In the side locker is the scoop stretcher, traction splints, KED and stair chair

Oxygen is in the portable cylinder and so is entonox

Morphine, ketamine, midazolam and fentanyl are carried in a hip pouch, we do not have a safe.

Most jobs get the backpack, monitor and oxygen, sometimes on the stretcher e.g. cardiac arrest or a job at a nursing home, others you know you will need e.g. stair chair so that is taken

Edited June 6, 2012 by Kiwiology

[Bernhard]

Do you bring everything in on every call? Why or why not?

• Medical call: knapsack + oxygene, ECG/Defi
  
• Children: additional child box (replaces most of knapsack, but not all)
  
• Medical call with known respiratory problem, involvement of vomit or else like that (including suspected/anticipated CPR) - or if a hand is still free: additional electrical suction unit (for surprises: knapsack contains a manual suction unit).
  
• Trauma call in house (or garden, mostly all other than a traffic accident or trauma with different access): same as medical call
  
• Traffic accident: knapsack (contains cervical splint and pulse oxymeter)
  

The reduction of equipment in case of a traffic accident is reasoned by: 1. the more equipment you have, the more tends to get into the way - and for a sufficient first monitoring a pulse oxy is all you need in this case; 2. you usually can get the other stuff pretty easy if needed, since ambulance usually isn't far away;

Do you bring the stretcher in on every call?

No, actually very rarely. Usually only in nursery homes, when the emergency is known as "broken leg" or anything else not needing every second of speed (reliable dispatch message, radio report from medical first responder units).

Have you ever been burned for not taking everything in or not taking a certain piece of equipment in? Did patient care actually suffer from not having a certain piece of equipment on scene immediately, or was it merely an inconvenience?

No. On my local vollie unit we optimized the equipment after near-critical incidents (mostly occuring in training), where there may have been a significant efficiency loss. But most improvements there are driven by the fact, that we often respond alone (non-transporting first responder) and I like to have the stuff with me and my only two arms. So we have our knapsack packed with all things, we initially would need, including oxygene. Weighs 18kg in sum, but served well in various situations. Only ECG/Defi and electrical suction unit has to be carried additionally then, if needed - see above.

Packing your stuff and having the appropriate things at the patient at time with not too much hands needed is an essential thing in team resource management. A lot of optimzation possibilities there.

[WolfmanHarris]

Last year they took a few of our folks on modified duty and had them ride around with various crews to observe and record equipment use. They watched what bags were taken in on what calls, what was used most frequently, and other data points which were then collected and used to help design our new bag layout. Our new bag layout is really practical.

Monitor: LP15 has the defib supplies, monitoring cables, ETCO2 via nasal and also carries our basic drug bag in the back pouch.

Symptom Relief Bag (carried on monitor): ASA, NTG, Glucagon, Ventolin, epi, gravol, benadryl, glucose, glucometer.

We can get away with carrying just the monitor into a great deal of our calls while still having our meds handy if we misjudge.

Oxygen Bag: O2 in a sleeve on top with labeled pouches at the head of the tank for masks, nebs, etc. Main bag opens up into subdivided compartments with CPAP, manual BP cuffs (all sizes), BVM (adult and child), aerochamber and loops holding OPA's and NPA. Exterior compartments hold V-vac suction (back-up), sharps container and a small pouch with supplies for minor trauma (one roll kling, one ab pad, a couple of gauze pads) so we don't need the trauma bag for small wounds.

On most calls we bring the monitor and the oxygen bag.

Back-pack: Contains ACLS drugs, narcs (only if ACP on the truck), suction, King LT's and airway supplies, intubation kit, IV kit.

This bag is designed for high acuity calls and is left in the truck on most of our calls unless distance from the vehicle would make retrieving it impractical.

Trauma Bag: Top pouch holds gloves. Front pouch dressings. L-side pouch back board straps. R-side pouch triangulars. Main pouch hold two adult and two peds select all collars, two towel rolls, one litre bag, one disposable blanket, splints.

ACP Reserve bag: Rather than keep perishable stock in the vehicle drugs and the like are kept in a back-up bag to be restocked from. This helps ensure that when crews switch into or out of a spare vehicle that supplies aren't left to expire or inadvertently parked outside where they may freeze or overheat. It really doesn't come out of the truck though in a pinch it could fill much of the role of the main bag and back pack.

With our bag redesign the thinking was to only carry what was needed for one call into the call. There are essentially no spares in the bag but it makes for a fairly lean and light set-up.

[Kiwiology]

Sounds reasonably aweso

We just have one big backpack, oxygen and monitor, it really does work very well. I have seen a modified version which has drugs in a small zip up pouch rather than a large roll out.

With just three pieces of equipment it makes taking them into a job very easy but I think my arms are a big longer now ....

[emtdennis]

Depends on how much information we get about the patient and the location.

Definitely the "jump bag".

Possibly O2, Depending on the call, our ALS team is there before us if necessary.

We take the stretcher out of the rig, just in case we need it. 95% of the time we do.

As soon as I see a second floor on the house I grab the stair chair.

[Bieber]

Thanks for all the replies so far!

Dennis, what is in your "jump bag"? Also, slightly off topic, you said you need the stretcher 95% of the time, do you mean you transport 95% of all patients or that you have to move patients to the ambulance via stretcher 95% of the time? Do you have a policy that all patients should be moved to the ambulance via stretcher?

Harris, having those meds on your monitor is pretty ingenuous, do you also have IV supplies in it? Do you carry different sizes of BP cuffs on the monitor as well or did you have to sacrifice those for the drugs? With regards to the O2 bag, we have one of those too, but I rarely use it because fire is usually on scene before we are and they have their own O2 bag (plus we have a D cylinder on the foot of the cot), and because I very rarely place people on oxygen unless it's a difficulty breathing complaint.

Bern, could you describe what all you carry in your knapsack?

Kiwi, wow, that's a ton of weight to lug around. I'll refer you to my next question, which is for everyone...

To everyone who brings additional equipment beyond the monitor in on calls, how often do you find yourselves using equipment out of your medboxes/knapsacks/medbags/first in bags/O2 bags? Do you feel like you get a lot of use out of them or that it's mostly there "just in case"?

If you could design your own setup for your equipment, what would it be?

[emtdennis]

We have a policy that patients are "supposed" to be brought to the ambulance on a stretcher especially with an accident.

"jump bag" = tape, assorted bandages, water, opas, npas, scissors, non rebreather masks (adult & peds) nasal cannulas, bp/cuffs, stethoscope, ring cutter, flashlights, plus a bunch of other stuff I can't think of right now. I am writing this from my full time job which has nothing to do with EMT.

But I am not complaining!!!!