Administration and Leadership, Columns

Elevate Your Care & Operations

Issue 5 and Volume 41.

If you were at the JEMS EMS Today Conference and Exposition in Baltimore, Md., this February, you were treated to an up-close look at the recently refurbished Heartmobile–a Cortez motorhome mobile ICU (MICU)-used in Columbus, Ohio, in the late ’60s and one of the first MICUs in the world.

What struck me as I lavished its beauty and design was how innovative and functional it was, with easy access to the patient on all sides and, more importantly, the ability to care for a patient at waist level.

Way back then, they’d bring a patient into the double doors on the side, place them onto a surgical platform retrofitted to hold a Ferno flat cot, and care for them like they would in an operating theater. The physician and three trained Columbus firefighters were able to easily access and treat the patient without having to bend down in awkward positions. What a novel, no-brainer idea. (See Photo 1 above.)

It reminded me of my training to become a paramedic in 1976 with Cathy Reid, an accomplished ED registered nurse with EMS field experience. She instructed her neophyte paramedic students that we, whenever possible, should treat patients on a couch, in bed or on an elevated stretcher because it was more efficient and conducive to care (rather than on the floor). She made us realize it was similar to what we were doing in the efficient, elevated ED bays, ICU areas and operating rooms. It made perfect sense.

Cathy’s husband, Art, who happened to be our paramedic program director, further illustrated the benefits of elevated care through drills that forced us to assess mock patients, cut off their clothing, start IVs and intubate them on the floor in dark, cramped bathrooms, inside wrecked vehicles or in the street.

He timed us to show the delays in care and things we failed to see, assess or accomplish because we were operating in awkward positions. Then, he made us move the same patients to elevated stretchers and repeat the procedures. It was an experience I’ve never forgotten and applied throughout my career.

I do a lot of mass casualty incident (MCI) training and am continually amazed at the great principles the crews utilize to initially triage and position dozens of patients into patient collection points (PCPs), marked by color-coded tarps. They assess and treat patients low to the ground because there aren’t enough stretchers (i.e., elevated treatment platforms) available. (See Photos 2 and 3, below.)

EMS triage and patient care at MCI

2. It can be awkward to treat patients lying flat on a treatment tarp.

EMS triage and patient care at MCI

3. Avoid bending and kneeling when assessing and caring for MCI victims.

The reality is, there are usually at least four stretchers and stairchairs available at every MCI. The first four ambulances on the scene are usually parked (“beached”) and not used for patient transport. Their crews are occupied elsewhere for important EMS command, triage, treatment, transport and staging roles.

The beached ambulances become important equipment sources. But many times, if you assess what equipment ends up being used, you’ll find that stretchers and stairchairs are often left behind.

These important resources can, and should, be used to make our jobs easier, and allow us to be more effective in both scene operations and patient care.

While triage is underway, initial EMS commanders can remove a stretcher from their ambulance and use it as a desk to perform the myriad tasks required of them more conveniently and efficiently. (See Photo 4.)

EMS triage and patient care at MCI

4. Stretcher used by EMS command officer as a desk.

Additional stetchers can be used to trolley patients to the PCPs, enabling just two people to perform the task versus 4-6 responders, depending on the weight of each patient.

One stretcher should be retrievied and positioned in the Red (Priority 1), Yellow (Priority 2) and Green (Priority 3) treatment areas to allow for “sub-triaged” patients. The patients in each area deemed next in need of priority assessment and care can be treated on an elevated platform and then moved through the transporatation process to awaiting ambulances. (See Photo 5.)

EMS triage and patient care at MCI

5. An IV is started on an elevated stretcher.

Available stairchairs and stretchers that often sit unused in equipment stockpile areas can be used to create practical and productive charting areas for personnel. (See Photo 6.) It’s awkward, inefficient and time-
consuming for transportation group personel to use clipboards and radios simultaneously
in a standing position. (See Photo 7.)

EMS triage and patient care at MCI

6. Use stairchairs, stretchers or tables for transport logging.

EMS triage and patient care at MCI

7. It’s awkward and inefficient to use clipboards and radios simultaneously.

Keep your personnel (and patients most/next in need of care) off the ground and elevated whenever possible. It will expedite your care, make you more effiecient and, more importantly, make your demanding job easier.