Operations, Patient Care, Trauma

TP: Handy padding in a pinch

Issue 7 and Volume 33.

It’s been 28 years since you first turned to this column, Life-Saver, and read about the use of a stethoscope to tamponade the external neck veins to start an IV.

Writing “Tricks” for you has been nothing but fun since then, considering some of the stuff we’ve slid past those JEMS editors. Trust me, they’ve been lookin’ at us funny for years.

But this column is called Tricks of the Trade because it’s all about adapting simple stuff to address complex problems. I can’t even remember how many times we’ve talked about things you can do with sheets and blankets, or ordinary rolls of tape. So, until somebody starts putting trailer hitches on ambulances, tricks will have a place in our medicine.

I don’t know who conceived the notion of putting people on boards, but the dimensions of the earliest boards had nothing to do with the sizes of people. Instead, they were 15- 7/8″ wide—so you could get three of them out of a single sheet of plywood. Those boards didn’t accommodate anything else about people, either.

My first EMT class was in 1971. That’s when my peeps and I first heard about folks on the right coast putting people on boards instead of canvas stretchers (also called breakdowns). We thought they were goofy. People just weren’t going to lie still on a board.

Actually, patients were surprisingly tolerant. They put up with a lot worse from us, too. In turn, working with emergency department staffs, we’ve since learned to get patients off those hard surfaces a lot faster than we used to. And numerous manufacturers came up with ways for us to keep them just a little more comfortable in the meantime.

But there are some people whose bodies simply won’t lie on a board; little old people, with their kyphotic curves and other arthritic kinks, often don’t have their spaces in all the right places. Try forcing somebody like that to lie on a flat surface, and you just add to their troubles.

Unless, of course, you make some accommodations.

You can do that with towels, but, you’ll lose ‘em at the receiving facility—which may not be your home base. Fortunately, one of the most elegant tools of all happens to be available in most places where you find sick people.

It’s a plain old roll of toilet paper. There are different kinds of toilet paper. Most of it’s cheap and ordinary, you know. The fancier, more expensive stuff is quilted, embossed or even cushy-soft—to accommodate the needs of people who graduate from Yale, ignore speed limits and park their Bentleys in Brentwood. (See, they’re special.)

You’ve probably seen the dinnertime TV commercials with those idiotic bear cartoons and wondered what bears have to do with toilet paper. Truth is, human anatomy is human anatomy, and all toilet paper is eventually doomed to address the same basic challenge.

If you’ve read this column for even a short time, you know the best tools in the world are the ones that do more than just one thing—even things they were never designed for.

It turns out, toilet paper has that kind of versatility; it’s a great padding substance. You can squash a roll with your boot, then insert it beneath a patient’s head. It’s just about wide enough and firm enough to support the weight of the head, but it’s not too firm. And you can make it as thick or thin as you want it, just by unrolling some.

If you need to pad somebody’s knees, you can use two rolls (or a roll of paper towels, actually).

Need a bulky compress to control bleeding? Don’t have time to run out to the ambulance for compresses (which will need to be unwrapped before you can use them)?

Toilet paper is absorbent by design. It’s likely to be handy when and where you need it. And, once again, you can quickly size it to suit your needs.

If you find yourself in a public restroom, the toilet paper may not be removable. Instead, you might consider a stack of paper hand-towels, stowed in a wall dispenser, or, if the dispenser is empty, the patient’s shoes, stacked on top of one another. You’ll probably be examining their feet anyway, right? Tricky you. JEMS