To Kneel or not to Kneel

“Muungh… What the heck was that!?” I thought to myself as I looked around the darkened room. “Where am I? Why am I awake? What IS that awful noise?” I thought. Something had awoken me from a not-so-good sleep on a not-so-comfy sofa. Slowly, I realized where I was. “I must have fallen asleep in the day room at the station” I thought. “Why am I awake?”. I heard commotion outside and realized that it must have been the radio that woke me up. Somewhere in the dark subconscious recesses of my brain it came to me that the pager said “Person not breathing, CPR in progress”. I pulled on my shoes and thought the most important thought that any EMS provider can have when being jolted from a deep sleep at 0′ dark 30 to try and wake the dead: “I have to pee!”

 

 

Once the bathroom duty was completed I slid into the passenger seat of the ambulance and pulled up the address on the map program. My partner pointed the ambulance South while I clicked on the siren. Wailing into the night we went, lights flashing, adrenaline pumping, morning breath so bad I could slay a walrus. “Where did I put that mouthwash?” was my thought. So focused on the job were we.

Arriving at the address just behind the engine company from the first due station we hurried to gather up our gear for the battle ahead. Monitor? Check. Airway and drug bags? Check and Check. Backboard? Check that too. We hurry up to the front door and are met by a middle aged female saying “I couldn’t wake him up! He was fine when we went to bed!” We enter the bedroom and I see the middle aged male on the bed. His lifeless eyes were fixed and unseeing as we approached him. His mottled skin was cool to the touch. Long gone was any fighting chance at life. I knelt on the bed next to his torso to check a pulse and apply pads to get a strip and immediately know what is going to happen next.

“I’m freakin going to have freakin dead guy pee on my freakin knees for the rest of the freakin shift! Dang it! Dang it! Dang it!”

EMS people kneel a lot, and not just when we want a raise or need to get state-to-state reciprocity from an EMS office. At one of the departments I work at we did a big action photo spread of all of the EMTs and Medics in action. EVERY SHOT was me kneeling. Kneeling at a patient’s head working on the airway, kneeling at the patient’s chest starting an IV, kneeling next to a patient to assess them after an injury, I kneel so much that you’d think I have a promotion by now. We all do.

But you’d think that by now I’d know enough not to kneel in poo, pee, blood, vomit, or whatever vile substance is on the bed, floor, or surface that I have to kneel on. I mean come on. I’ve been doing this over a decade now. I have thousands of calls under my belt. I live, sleep, eat, breathe, blog, and study EMS as much as I can stand to (and that’s a lot) and I *still* am stupid enough to put my knees in poo on a somewhat regular basis?

Right now, I’m on the 2nd day of a 48hr shift a half hour away from my home. Last night, around late evening I knelt in a poo/pee mixture. I was really trying not to here, but the patient began to vomit after we got (the Pt) on the backboard in the cramped, carpeted bathroom (the Pt) was in. I couldn’t log roll (the Pt) without kneeling and the carpet was just saturated with a vile mixture of hours old poo/pee. My knees got soaked in it. And no, if you are asking, I ran out of the house late and didn’t think to bring an extra pair of pants and the pants that I had kept at the station had been taken home for laundering after another like incident.

For times like these, I recommend the “Ckemtp” method of knee disinfection. It applies for those times where call volumes don’t allow you to actually take your pants off to clean them:

  1. Put on gloves. No sense in contaminating your hands. Chances are your knees won’t have broken skin on them unless you’ve been trying to get that promotion (Enough with the “on your knees” jokes! – This is serious!)
  2. Take and put a towel or washcloth (a smaller wash cloth works better) in between your knees and your pants.
  3. Spray the ever-loving bejeebus out of your pants, saturating your knees with disinfectant spray. DO NOT use bleach-based spray. The milder the better. (see “Clean EMS” for advice on contact times)
  4. Press another towel on the outside of your pants, soaking up as much poo/pee laced disinfectant into the towels as you can. Rub them together a bit.
  5. Re spray with disinfectant and let it air dry.
  6. Remove the towels from your pants.
  7. Call your wife and beg her to drive you up a new pair. Beg. Hard.

Just for the record, my lovely wife was unable to drive me up some new pants. Awesome…..

  • Dani

    THANK YOU! I appreciated this post more than you would realize. Working in a hospital I have come to ‘kneel’ in a few vile things myself while helping patients, and during EMS training we have found MANY suprises!

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  • Ambulance_Driver

    I don't do much kneeling on calls, but I seem to notice a lot of the other EMTs doing it when I'm around.

    Or, more properly, they're genuflecting. ;)

  • Ambulance_Driver

    I don't do much kneeling on calls, but I seem to notice a lot of the other EMTs doing it when I'm around.

    Or, more properly, they're genuflecting. ;)

  • http://www.lifeunderthelights.com Ckemtp

    Hey man, I saw yer post about RP IV and saw the first comment from “nice emt”

    So yea, genuflecting ;)

  • emschick

    My only exposure so far *knock on wood* was from kneeling. We had a MVA on the interstate and I had to use my knees to hold c-spine while fighting with a suction unit. I realized that I was kneeling in blood but I didn't realize that the gravel I was kneeling on was also cutting up my knees. When I got to the ER I looked at my jeans and saw they were destroyed, then I realized they were cut up, too. I've been very careful about how and where I kneel ever since then.

  • emschick

    ok my last line is kind of dirty in a way…but I am married so…well nevermind I keep making it worse lol

  • emschick

    My only exposure so far *knock on wood* was from kneeling. We had a MVA on the interstate and I had to use my knees to hold c-spine while fighting with a suction unit. I realized that I was kneeling in blood but I didn't realize that the gravel I was kneeling on was also cutting up my knees. When I got to the ER I looked at my jeans and saw they were destroyed, then I realized they were cut up, too. I've been very careful about how and where I kneel ever since then.

  • emschick

    ok my last line is kind of dirty in a way…but I am married so…well nevermind I keep making it worse lol

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  • thejohnykat

    How else is the system supposed to properly shaft me if I'm not kneeling?

    But seriously, there is almost nothing worse then getting a leg soak in mystery goo. Except perhaps for putting an ungloved hand down to stabilize yourself.

  • Nick

    I do a lot of squatting in questionable situations. Once we had a person passed out drunk in their car. So the car wouldn't be towed, I was going to be nice and move it to the parking lot. Whoops…drunk people sometimes pee themselves and I just sat down in the drivers seat!

  • OffshoreEMT

    I once worked a suicide in a rural area. We got on scene and there were life signs so we started working. Got the PT out of the house on LSB and everthing and into the truck away from the family. After the call I was sitting in the day room about an hour or so after we had gotten back to the station. I looked down at my pants and right at the crease for the pocket on my thigh; was a small chuck of brain matter stuck to my pants. I dont remember exactly which point I could have gotten it on me but I can say I would much rather that than poop or pee on me. One more and I am done.

    My partner and I went to back up a unit on a CPR. We get there and start helping the other crew and we get loaded up, my partner rides with the other medic, the emt from that unit closes the door and busts out laughing. She tells me that her partner slid the patient off the bed and into the floor to get started and he lays down not looking with scope and tube in hand, down in a pile of crap. He joked about it more than we did. First time he ever seen screech marks on a shirt before.

  • TDH1104

    Went on a suicide one time, pt had life signs at the time so we started working and moved out to the truck to continue, and to wait on the chopper. Did our interventions, loaded the chopper across the street and left. I was at the station in the day room looked down and seen a small chunk of brain matter on the crease of my leg pocket. Probably had been there for over an hour before I noticed it. Still am not sure exactly where I picked it up cause there was to many places it could have happened. Thought I would share that one.

  • TDH1104

    Went on a suicide one time, pt had life signs at the time so we started working and moved out to the truck to continue, and to wait on the chopper. Did our interventions, loaded the chopper across the street and left. I was at the station in the day room looked down and seen a small chunk of brain matter on the crease of my leg pocket. Probably had been there for over an hour before I noticed it. Still am not sure exactly where I picked it up cause there was to many places it could have happened. Thought I would share that one.

  • Anna

    Uhg, kneeling in bodily humours-ick. Sounds crazy, but I carry a chucks pad folded up in my hip/theigh pocket. I can whip that thing out and place it anywhare so fast…..well, the jokes I put up with after the call for my abilities are far worth it, considering I'm the only one with clean knees! So say what you will, but it works. Another thing I've done is sew gortex patches (from an old parka) onto my knees. It's the same colour so it just looks like it part of the pant. What ever works. Great post.

  • http://www.lifeunderthelights.com Ckemtp

    Anna, you win the “Life Under The Lights” prize of the week!! I don't know what it is yet.. But look for an upcoming post. That idea for the chux pad is just amazing. Bravo.

  • Anna

    Uhg, kneeling in bodily humours-ick. Sounds crazy, but I carry a chucks pad folded up in my hip/theigh pocket. I can whip that thing out and place it anywhare so fast…..well, the jokes I put up with after the call for my abilities are far worth it, considering I'm the only one with clean knees! So say what you will, but it works. Another thing I've done is sew gortex patches (from an old parka) onto my knees. It's the same colour so it just looks like it part of the pant. What ever works. Great post.

  • http://www.lifeunderthelights.com Ckemtp

    Anna, you win the “Life Under The Lights” prize of the week!! I don't know what it is yet.. But look for an upcoming post. That idea for the chux pad is just amazing. Bravo.

  • http://grumpydispatcher.blogspot.com/ The Grumpy Dispatcher

    Clearly an experienced medic. Peeing and gargling before you go is imperative. Else your knee-pinching urine-hold posture will distract you from good patient care, or your breath will kill them anyway. You made the Right Call. :)

    I was going to suggest stowing an extra blanket on the cot or brought in with the board. It's already folded, and about the right size to throw down, and not a huge expense to “forget” to bring with you when you leave.

    We have an OB pouch in our 02 bags. Not many goo calls where the 02 bag isn't brought in, so we have easy access to copious amounts of gauze, too.

    That said, I like Anna's solution better.

  • http://www.msparamedic.com/ MsParamedic

    we use disposable sheets on the rig and the “cover sheet” is dark blue. guess what i keep several of on the back of the stretcher and in every bag? yup. the cover sheet. i won't kneel anywhere without it. except last night. and i was bloody for 2 hours before i could shower and change into a new uni. *head desk*

  • http://www.msparamedic.com/ MsParamedic

    we use disposable sheets on the rig and the “cover sheet” is dark blue. guess what i keep several of on the back of the stretcher and in every bag? yup. the cover sheet. i won't kneel anywhere without it. except last night. and i was bloody for 2 hours before i could shower and change into a new uni. *head desk*

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Chris Kaiser aka "Ckemtp"

I am a paramedic trying to advance the idea that the Emergency Medical Services can be made into the profession that we all want it, need it, and know it deserves to be.

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