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 ˙TricksÓ 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″ wideƒso 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 Âem at the receiving facilityƒwhich 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-softƒto 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 thingƒeven 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

Thom Dick has been involved in EMS for 38 years. 23 of them as a full-time EMT and paramedic in San Diego County. He’s currently the quality card coordinator of Platte Valley Ambulance, a hospital-based 9-1-1 systems in Brighton, Colo. Contact him at„[email protected].