I’ve written about my dad many times in JEMS. He wasn’t just a good care provider throughout his 40-plus years as an “ambulance man” with the Scranton (Pa.) Fire Department; he was also a great innovator and mentor to me and many others in “first aid” and EMS circles. He always seemed to think things through to resolution of the worst-case scenario and paid close attention to risk management, resource management and disaster preparedness long before it was fashionable to do so.
For example, he not only had all critically needed tools and devices positioned where they were easy to access, but he also had a professional sign painter outline the items so he could ensure they were returned and properly secured in their exact location and position after a call. This included non-traditional tools, such as Partner PryAxes, tin snips, Halligan bars, hacksaws, ring cutters, hammers and chisels, fire extinguishers, multi-purpose fencing pliers and other “unusual” (not on the ambulance essential equipment list) items (a jar of petroleum jelly) that he found useful in the field.
He had thousands of calls and field experiences under his belt. And he often remarked that some of the people authoring the essential equipment lists “never rode on an ambulance” or were what he called “windbags” who rode an ambulance for a year or two and then got promoted, moved on to medical school or off to some other administrative position, only to surface later on some high-powered committee where they could use their “extensive” EMS experience to change or influence the industry.
He pointed out that these self-proclaimed “experts” would never think to use petroleum jelly to grease up the ears of a child whose head was simply stuck between the rails of a fence to “extricate” them but would, instead, have a big rescue truck dispatched to do it. Boy did he have that one correct!
Another thing he ingrained in me was that, “If one is good, two are better.” It was a philosophy he carried over to his ambulances and storage areas.
I remember asking him one day, way back in 1970, why he insisted on the department’s ambulance carrying two OB kits, two fire extinguishers and liter flow regulators on every oxygen tank in the ambulance. That question got me a polite, but educational, 30-minute lecture that I never forgot:
He told me he had delivered multiple sets of twins in his career and realized after the first set that if it could happen once, it could happen many times. Thus came another famous quote, “Find a problem; fix a problem.”
He pointed out that, in his experience, just about the time a five-pound fire extinguisher achieved a 90% knockdown of a car fire it ran out, so it was best to carry two to “finish the job.”
Living in the coal region of Pennsylvania, and having provided emergency care to many families overcome by coal gas fumes and other sources of carbon monoxide (CO), he told me that it made no sense to carry just one oxygen (O2) tank equipped with a regulator and four spare O2 tanks. He called these “naked soldiers,” which was a reference to how useless a soldier would be in battle without his rifle. He noted how inadequate it would be if an ambulance arrived at the scene of a CO poisoning at a home, found a mother, father and two children lying out on the front lawn in need of oxygen, and EMS providers had just one complete portable O2 unit and four spare bottles. Once again, he said, if it happened to him once, he would never let it happen to him or his crews again.
My dad also carried two separate resuscitation devices (a bag-valve mask and a Robertshaw demand-valve system), as well as two separate suction systems and two separate, identically-equipped trauma bags. He did so to be able to care for two separate patients at the same scene and to ensure he had a “backup” in case one of the devices failed, or so he was never delayed from immediately doing a “turnaround” and responding to a critical trauma case.
His advice hit home for me recently when I heard a chief officer from Regional EMS Authority (REMSA) present lessons learned from their management of the victims injured at the Reno (Nev.) Air Races crash in 2012. Although each of the five ambulances stationed on site was equipped with one tourniquet, there were 15 amputated extremities at the scene. Crews were forced to improvise with men’s belts on several patients.
The REMSA official was quick to point out that almost immediately after the incident, his agency added multiple tourniquets to each REMSA unit so each unit was better prepared to manage multiple simultaneous amputations in the future. When I heard the fast action REMSA took to address this issue, I had to pass my dad’s “If one is good, two are better” advice on to you.