You can judge a book by its cover

I recently had the opportunity to ride along with the crews of Los Angeles County Fire Department Squad 7 and Engine 7, based out of West Hollywood, Calif. My introductions occurred in the morning when the crews were all busy performing vehicle checks and cleaning their apparatus. I note the cleaning aspect because, when I ride with crews, I’m always interested in how clean and neat their apparatus and medical kits are.

My mom was right about stuff she taught me just about 100% of the time. She used to hit me with the old, “Wear clean underwear in case you end up in the ED.” (You can tell she spent her life surrounded by EMSers!) She also used to say, “You can tell a lot about a person by peeking into the interior of their car to see if it’s filthy or neat.” She was right about that one too because it works for just about all aspects of life, from the person you’re dating, to the plumber you hire to fix your bathroom pipes, to the EMS crews that come into your house to fix your tracheal pipes. If their car or truck is disorganized and unkempt, odds are they will be too. It’s one thing if your bathroom faucet leaks; it’s another if a contaminated endotracheal tube is introduced into your airway.

What impressed me about the L.A. County Station 7 crews was that they cleaned and organized everything, from the tubes in their medical kits to the rims of their wheels. You could eat off the floor of their station and, for that matter, off the rear step of the squad.

The first run of my shift was to a hotel where a caller reported a “sick male.” As we exited the squad, I offered to carry equipment inside but was politely reminded that each crew member had a specific equipment assignment and would each carry their own gear. It was a sign of things to come.

As usual, the call was more complicated than the dispatch information provided because the caller, after waking to find his friend unconscious from a drug overdose, exited the hotel rapidly, telling the front desk clerk to “call an ambulance” for his sick friend as he hurried out the front door.

We were met by another friend, who initially didn’t want us to enter the hotel room for fear that his buddy would be arrested for drug use. However, that became a moot point when the crew observed the patient lying prone on the floor and making snoring respirations. They entered the room en masse and attacked the patient’s condition in a methodical and organized manner, despite the limited space on the floor.

Because of my earlier introduction to the crews’ equipment cleaning regiment and attention to detail, I knew the care I witnessed would be organized and precise, and I wasn’t disappointed. In many systems, this patient would be intubated before other treatment was rendered. But the crews of Station 7 cleared his airway, applied oxygen and then prepped and inserted a “nasal bugle” in his right (“preferred”) nostril.

The lubricated nasopharyngeal airway did the trick, and the crews then bagged and supported his airway en route to the hospital. At Cedars-Sinai Medical Center, a team of residents and attending ED physicians intubated the patient in a cleaner, more sterile environment.

It was the coordinated care that I believe we need to see more of in EMS: more emphasis on good, quality basic airway care, followed by advance procedures–when and where it’s best for the patient.

Franklin Pratt, MD, L.A. County’s medical director, has been doing his job for a long time. His passion for EMS and emphasis on providing the basics of EMS care to every patient was reflected in the actions of the crews of Station 7.

My mom’s record intact, I left Station 7 at the end of my shift confident that if I rolled my car on my way home, I wouldn’t have to crawl out and peek in the arriving apparatus before letting their crews treat me. I felt confident that they’d all be as clean, organized and professional as the ones I’d just visited. JEMS

This article originally appeared in July 2010 JEMS as “Bugle Call: You can judge a book by its cover.”



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