Operations, Patient Care

Wheel Patients to the Ambulance

Issue 9 and Volume 35.

One of my mentors taught me when I was just a pup that when somebody is sick enough to call for an ambulance, they should be carried—not walked—to the ambulance. He said you should use wheels to do the job, if possible. Get the ambulance as close as you can. Then, get the cot as close as you can. Finally, lift and carry them. Nobody walks. It was part of the service.

I idolized the man, so I lived by that rule for years. But he learned his craft early in the evolution of EMS, when “ambulance service” meant barely more than safe transportation to a hospital. That, and maybe oxygen. Most of us were in our early 20s and shooting for degrees, law enforcement or the fire service. There were two models of stair chairs, and neither of them spared you a carry. Nobody talked about EMTs sustaining cumulative injuries (or enjoying long, happy careers); and like most of my friends, I felt invincible.

These days, plenty of us are smarter than that. Most EMTs are still one scant back injury away from unalterable impairment of the quality of their lives and the certain end of their careers. But today’s field providers do a lot more than transport, and many of us use EMS as a gateway into other medical professions.

Today’s ambulance cots are more sophisticated, but they’re considered by many to be albatrosses. Four manufacturers offer self-lifting models that are so heavy, they’re used primarily as loading devices. Most of the folks who design and build them don’t use their own products, and I don’t believe they listen to enough people who do. You certainly can’t take one of those things into a cornfield, or even a home with three steps at the door. And they know their products are too heavy to be used in many prehospital situations. One manufacturer has even gone so far as to camouflage the weight of their cot by specifying it without a second battery, mattress or restraints. (Just try using one that way.)

I remember when the first inventor of a self-loading cot, Joe LeGasse, brought an early prototype to my agency. It was made of stainless steel and powered by an SCBA tank. Joe was just a little guy. He was an engineer, not an EMT, and he was truthful about the fact that he didn’t know much about ambulance cots. But he had read a series of three JEMS articles, published in December 1981 through February 1982, which analyzed the designs of ambulance cots (read them at www.jems.com/magazines/2010/september). In those days, there was one cot manufacturer, and the most popular model had to be lifted into and out of ambulances on every call. The final installment of that series proposed a design for “The JEMS Cot,” which eventually became the mechanical basis for the Ferno Model 35, and thereafter the concept for virtually all X-frame cots in use today (self-powered or not).

During Joe’s visit, one of his competitors called my cell phone (I have no idea where he got the number) and told me, “If anybody could have designed a self-lifting ambulance cot, we would have done it.” A second one called my boss at the time and asked if he could get a look at the prototype in my office over the coming weekend. That one is suing a third competitor as you read this—for patent infringement. A rep from the third one told me three years ago they were about to release a new self-lifter weighing less than 100 lbs. I haven’t seen it, have you? No wonder we’re not making progress here.

Because the self-loading cots are heavy, I think too many EMSers are playing doctor. Their thinking: “My office is the ambulance. You walk to my office, and I will help you.” I’ve heard ’em say it and seen ’em do it—routinely.

What do you think, Life-Saver? Think that would be good enough for your mom? It wouldn’t be for mine.

Just about everybody’s got a mom, and just about nobody would make their mom walk to an ambulance if she were having The Big One. Or skip part of her physical exam just out of laziness. Or, gamble on her C-spine if they couldn’t honestly clear it. Those kinds of shortcuts attract lightning strikes on fine summer days.

If you wouldn’t gamble on your mom by making her walk to the ambulance, don’t gamble on somebody else’s mom. That simple precaution has helped me be nice to more nasty people—and kept me out of trouble more times when I was really whupped than anything else I can think of.

Maybe it’ll help you, too. JEMS

This article originally appeared in September 2010 JEMS as “Playing Doctor: Are you walking too many patients?”

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