I could hear the sirens coming to help my husband, John. I knew he wasn’t feeling well when he collapsed on the living room floor. He was a very stubborn man when it came to asking for help, even with his history of heart problems. The dispatcher tried to talk me through CPR, but when I discovered that he wasn’t breathing and had no pulse, all I could think about was getting him professional help as fast as possible.

I cried and prayed. What seemed like an eternity was just a few minutes. When the paramedics arrived, I just knew they could save him because they were the best trained and most experienced paramedics in the area. They advertised that they used the most advanced medical equipment available. I knew they’d save my husband of 25 years. Thankfully, they had arrived.

At first, I thought it was a terrible joke when the lead paramedic told his partner, “the cardiac monitor is dead” and needed fresh batteries from the ambulance. John’s heart had stopped and needed to be shocked immediately, but the life-saving machine was now nothing more than a box with a blank screen.

As additional help arrived, the crew carried in a special automated CPR machine and quickly maneuvered John onto it. “Hold on John,” I said under my breath as I cried. John lay motionless in the grasp of the CPR machine, which also failed after just a few short compressions. Its batteries died too, rendering the device useless. How could this have happened, and who’s responsible?

Accountability or Liability
It seems silly that something as simple as a battery can affect the proper delivery of patient care, cause grief and anger for a patient’s family, and become a liability for EMS agencies and manufactures of battery-powered EMS products. But it can.

Just stop and think about how many batteries we rely on every day in EMS to deliver patient care. The list is long and includes batteries for use in vehicles, radios, cardiac monitors, laryngoscopes, CPR machines, suction devices, cots, electronic patient care report (ePCR) laptops, glucometers, thermometers, pulse oximeters, carbon monoxide sensors and cell phones.

So who’s responsible when lifesaving medical equipment malfunctions because the batteries are dead? The Chicago Fire Department found out in 2009, when the city settled out of court with a patient’s family for $3.2 million after they tried to deploy a defibrillator with dead batteries.

Their 49-year-old patient had collapsed while clearing snow and, when the first
arriving unit diagnosed V-tach, the monitor’s batteries failed to hold a charge and deliver a lifesaving shock. A spare set of batteries were installed, but they too were lifeless. The CFD EMS providers regretfully discovered the value of charged batteries, as did the family of the patient who died.

Energizer Bunny
Batteries have become a common source of portable power for home and industrial use ever since they were invented by Alessandro Volta in 1800. The electric battery is a combination of electrochemical cells used to convert stored chemical energy into electrical energy.
The battery industry generates an estimated $50 billion in sales each year with an annual growth rate of 6% in 2006.1 The battery’s popularity has skyrocketed since becoming smaller, lighter and more powerful over the years.

Two types of batteries are used in EMS, primary and secondary batteries. Primary batteries are disposable and typically used in equipment, such as glucometers and laryngoscope handles. They have low current drain, are used only intermittently, are designed to be discarded when they’re exhausted and can’t be recharged. Common primary batteries include zinc-carbon, alkaline and nickel oxyhydroxide. These disposable batteries don’t fare well with constant use and high-drain applications, but are relatively inexpensive to replace.

Secondary batteries are designed to be recharged by applying electrical current from a charger to the battery cells, which reverses the chemical reaction that drains them. Secondary batteries are used in many EMS applications, from cardiac monitors and suction devices to ePCR laptops and communications equipment.

Standard technology for rechargeable batteries has been the nickel-cadmium (Ni-CD) battery. These batteries are prone to the “memory effect,” or voltage depletion which means that if the batteries are recharged before they’re completely exhausted or fully discharged, they “remember” the old charge, thereby shortening the battery’s energy and overall “life.”

A new standard for portable power is the lithium ion (Li-ion) battery. Li-ion batteries weigh
20–35% less and don’t experience significant memory effect. Manufacturers are now producing “smart” batteries that have internal circuit boards with computer chips that allow the battery to communicate with the device they’re in to monitor battery performance, voltage and temperature. Smart batteries generally run longer due to their increased efficiency.

Additional Battery Facts
New batteries usually come in a discharged state and require a full charge before use— usually 12–18 hours of continuous charging.

Spare secondary batteries, stored for a long period of time, should be kept in a discharged state and be fully charged at least once a year. Avoid storage areas with high humidity and high temperatures, which can deteriorate the battery and shorten its life.
There are a few hazards you should be aware of when handling batteries:

  • Battery explosions are rare, but they can occur. Misuse, such as charging a primary (non-rechargeable) battery, can cause an explosion;
  • The chemicals in most batteries are corrosive and/or poisonous if battery leakage occurs; and
  • Batteries can be harmful to equipment if they spontaneously rupture or are damaged.

Widespread battery use has createdenvironmental concerns due to the chemical components, and tons of batteries end up in landfills across the country each year. Most manufactures will recycle your dead batteries to help protect the environment.

Taking Care of Business
Manufacturers have a responsibility to train their customers on the proper operation and charging procedures for their battery systems. The user’s manual and in-service DVD should underscore the importance of proper battery maintenance and troubleshooting.

Simple instructions are usually available in various electronic formats with photos, diagrams, videos and Web links to highlight important information to users of all ages. Emergency service agencies should have their personnel review this information on each new piece of equipment and battery system placed into service. They should also post battery rotation diagrams near the charging support system to remind users of the necessary steps required to keep the equipment functioning to its specifications.

EMS system managers should anticipate battery problems and have an ample supply of spare batteries accessible at all times. It’s also a good idea to carry at least one spare battery in mobile units, so there’s limited “down” time in the event of a failure while on the road.

To improve accountability for batteries getting charged, rotated and conditioned, managers should implement a battery log to track deployment and station management of each battery. The log should track each unit by serial number, charging date, conditioning date, in-service days and should be signed off by the person completing the tasks. An equipment malfunction form should be used to track specific details of medical equipment that didn’t function to the manufacturer’s specifications. Equipment failures should be immediately reported to the manufacturer, medical director and risk manager.

The Buck Stops WITH YOU
I remember a senior captain in my fire department frequently saying, “after 0800 shift change, the only person responsible for your equipment is you.” Some believe battery problems are “just going to happen” in this crazy place we call EMS. However, with good communication, proper attention to detail and training, it shouldn’t.

Most EMS providers—the people running the calls—aren’t going to pick up a user’s manual and read it thoroughly enough to pull out critical battery care information. Battery charging instructions may be complicated, with specific rotations, charging sequences, deep cycling, on- and off-ambulance charging and battery shelf life. Your crews may not know their batteries may be losing 8–10% of their capacity every day, known as the “self-discharge rate,” and that, when batteries are unused or unattended to over time, problems can occur.

Saving lives comes with the responsibility of making sure your equipment is ready to roll. Managers should read and present this important information to their personnel. And first responders, EMTs and paramedics should constantly train and be retrained on lifesaving equipment and the battery system that provides their power.

The Power to Be All You Can Be
Some might argue that we’re only as good as our batteries. To some extent, this may be true. Although a battery system shouldn’t fail, it can. We practice medicine in tough places that are hard on equipment and batteries. Our patients expect us to render care when they need it, just as we expect our equipment to light up when we press the “on” button.

A patient’s worst day should never be defined by the Energizer Bunny dying in the middle of a critical call. Plan and train for failures and overcome unexpected breakdowns with redundant equipment, extra charged batteries and the ability to think on your feet. Explaining to a patient’s family that their loss was the result of a battery failure is the last thing any EMS chief wants to do. JEMS

1. Buchmann I. Battery Statistics. www.batteryuniversity.com/parttwo-55.htm

This article originally appeared in October 2010 JEMS as “Lead the Charge: Keep your batteries functioning optimally for best patient care.”

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