When you arrive at an EMS call, do you immediately unload and bring your gear in with you? Or do you wait and send at least one EMT inside to find out what you actually need and whether you will actually be transporting?
“I don’t know how it started,” says Martin Vigil, Assistant Chief of Santa Fe County (N.M.) Fire Department. “Somewhere along the line EMTs started getting out of their units without any equipment at all.” As a 25-year veteran in EMS, Vigil says he has never done that in his own practice and has always brought in at least his jump bag, with oxygen, first line drugs, suction, intubation and trauma supplies. “I was out of the field for a few years in the mid ’90s. When I came back full time in 2004 and reinstated as an EMS educator, it had changed. In the EMS classes I’ve taught, we always mandated that EMTs bring their equipment in when responding to a call.”
Is this a new trend in EMS practice and how widespread is it? If so, when and how did it change? Are EMS responders becoming complacent, or just plain too lazy to pick up their gear and carry it in?
Should We Screen Our Calls?
It’s clearly reasonable to tailor the equipment you bring in to the type of call it is. If dispatch hasn’t given you sufficient information, ask the dispatcher to get you some answers while you’re en route to the call. Dispatch should remain in contact with the calling party until your unit arrives and should attempt to obtain as much information as possible to guide you on what equipment will be needed.
Pre-arrival call screening can be extremely helpful to the crew when deciding what equipment needs to be brought in. However, experienced EMS personnel know that calling parties are often upset, confused or intoxicated, and despite their best efforts, dispatchers may not be able to obtain the information you’d like to have.
In general: If you’re going in on a confirmed trauma call, you know you’ll need lifting and immobilization devices, while a cardiac arrest call requires a defibrillator, drugs and airway supplies. It’s always a good plan to expect the worst and bring in the equipment you may need even though you may be taking it back out to the unit before long. But to arrive at a call without so much as an oxygen bottle may present a picture to the patient or their family that you aren’t prepared to do your job. “At a minimum, the basics of your trade should come in with you”, Vigil says.
Should We Always Lug in that Stretcher?
Whether to bring in a stretcher on the first trip is another practice worth examining. If you’re a transport unit, whether you bring in your stretcher right away may be a systems issue. Some services want the stretcher brought in on every call to demonstrate that the crew is ready and able to transport the patient, as well as to save time having the crew go back out to get the stretcher after you’ve made patient contact. If you’re a first response unit, you may not want to take the extra time to haul a stretcher inside a building. But you don’t want to be caught short without lifesaving oxygen and airway equipment on a medical call. You should also remember to inform the incoming transport unit of the patient’s condition so that they don’t haul in unnecessary gear. If you are a second tier transport unit and have good radio contact with the first arriving unit, you may or may not want to bring your stretcher or other gear based on the information the first-in unit has provided.
Another question arises as to how EMS has traditionally packed equipment at the various levels of practice. Is it time, as an industry, to re-evaluate how we’re packing and organizing our EMS gear? Are there lessons to be learned from our military medic counterparts coming home from war? There are now special operations medical bags that may make the way we have carried multiple medical kits obsolete because they consolidate bags into what really constitutes life saving gear and can save time when minutes matter.