Ideas from the Field

On this blog, I get the chance to bring my ideas to the table every time I hit the “Publish Post” button. I have brought forth many ideas both big and small that I think will help improve our profession and I really enjoy taking the time to do it in the hopes that one day somebody actually might listen and do something about it.

However, we work in an “idea economy” and well, I’m not the only one with ideas here.

I want to hear your ideas, big and small. I want to hear what you think will improve the profession of paramedicine, EMS, and/or patient care in general and I’d like you to post them up here for the world to see. Whatever POSITIVE and CONSTRUCTIVE ideas you may have, please post them below this page in comment form.

I’ll take the best ones and write them into posts. Who knows which one of you out there will have the best idea going. Bring it forward. Everyone can help drag us along to a brighter future.

  • I work at 14,110 feet on the top of a mtn. I deal mostly with altitude sickness, hypothermia and trauma. I am fine with most “fluids” cept vomit. I just cant do it, mabe it is too many nights of taking care of kids, pre kids too many drunk nights or whatever. The sound and smell get me every time. Well unfortunately n/v is common at work. I ask ALL of my pts if they are nauseated, most are because of the altitude. Tell them you are a sympathetic puker. I tell them we both will be getting ill if they start vomiting, alcohol pad breathed in slowly thru the nose. (I learned that from an anest) helps.

  • Ya I tried the alcochol pad and it worked

  • Miller

      It was a routine motor vehicle collision.  One patient with complaints of neck and back pain who was ambulatory at the scene.  There was no significant damage to the vehicle and the detailed physical assessment was unremarkable.  We had  immobilized the patient and transported them to a local  Atlanta hospital, which happened to be a Level 1 Trauma Center.  As I handed the nurse the printed patient care report, she informed me that the physician had wanted to ask me about something pertaining to the care we had provided.  I approached the Resident Physician, “Excuse me, Doc…the nurse said you wanted to see me.”  “ Oh, Dr.______ wanted to ask you about something,” the Resident said as he pointed toward the Attending Physician.  “Thank you,” I replied.  I approached the Attending, who was attentively listening to another Resident give a patient report.  After the Resident finished her report, the Attending acknowledged me.  “ Did you bring in the patient in Trauma 2?” he asked.  “Yes sir,” I replied.  “ I wanted to ask you about something, have you got a minute?”  he asked. “Yes sir.”  I followed the Attending into Trauma 2.  “I used to be a medic myself,” he said.  “Out West…Dallas/Fort Worth…worked there as a medic for seven years before I decided to go on to medical school.”  He donned an exam glove and grabbed our backboard.  “Walk with me,” he said.  We walked out to the ambulance ramp, he turned around to face me,  and  continued, “ Prehospital care has changed a lot since I was a medic…some changes for the good and other changes for the bad.   One thing that I don’t think should ever change though, is pride in the job.”  His expression was stoic.  He stood the backboard up and spun it around.  “ Would you put your mother on this?”  The elliptical-shaped island of tarry adhesive located on the backboard where the patient’s head would be placed was evident.  “ No sir,” I answered ashamedly.  “  Look closely…” he continued, “… there appears to be hair, straw, and no telling what else embedded in this stuff…what is this stuff, anyway…tape?”  “ Well sir, you see our service uses a disposable cervical immobilization device.  It adheres to the backboard with a sticky adhesive.  After the patient is taken off of the backboard, we pull the device off and throw it away.  A sticky residue from the adhesive is left.  It builds up over time and creates this tarry mess.”  “ I see,” he said as he turned to survey the other backboards corralled against the wall of the ambulance ramp.  “This seems to be an epidemic,” he said, noticing that other services’ backboards were in the same condition.  “ Do you know the efforts that are being made in hospitals throughout the country to combat health-care acquired infections?” he asked.  “ These spine boards are probably harboring MRSA and VRE.”   “ I am really disappointed that this is acceptable to the EMS community,” he muttered as he walked back into the E.R.  After returning to the station, the arduous task of backboard decontamination began.  Thirty minutes and two steel wool pads later, most of the tarry adhesive had been removed.  Someone suggested that the use of Goo Gone TM may prove to be more effective than the previous method.  It was discovered at a later date that the use of Goo Gone TM did indeed prove to be more effective.  After generously spraying the affected area of the backboard with Goo Gone TM and waiting approximately 5 minutes, the tarry adhesive was easily wiped from the backboard.  This procedure was then followed by a thorough cleansing with 1:100 bleach/water solution as recommended by the Centers for Disease Control for medical equipment decontamination.

    Commercial head immobilization devices leave a tarry residue on backboards and unfortunately this residue is typically not removed. This results in the accumulation of this residue and the probability of bacterial colonization. This provides a challenge for infection control to EMS providers. Goo Gone or another residue-dissolving substance should be part of the EMS infection control arsenal.

    • Charlieb

      Baby oil or WD-40 will remove most adhesives and its a lot chepaer then goo-gone.

    • Larrydemt

      This is more than about the solution to remove the adhesive residue . This is about pride and be diligent about providing a safe and healthy environment both for patients and staff . I have seen many ems personnel remove their equipment straight from the e.d. storage area to only be placed either directly on a freshly sanitized stretcher or in the rig cabinet , ready to be used on the next patient . This is unfortunately repeated time and time again . I have more than once stripped a freshly made stretcher and held my partner accountable in this unsafe practice . The other excuse I’ve heard when others do not sanitize after every use is that their patient was not bleeding , but take note of the longboard that your’s was in contact with , most of the time they are contaminated  

  • Avi

    Check out My idea from the field is a stethoscope tape holder and comes in six colors. Ever find yourself scrounging around for a piece of tape to secure that iv to your diaphoretic pt, or to keep that ET tube in place? Check it out!

  • James_63

    Many EMTs carry tape with them. In your pocket the sides of the tape rolls get covered in lint and dirt. If you must keep a roll of tape with you, put it in a small container. I use an empty roll of plumber’s teflon tape. I roll enough 1/2″ tape onto it to last several calls. It has a cover that keeps the tape clean and dry. By putting only a few feet of tape on it, you can discard the tape and clean the container if it gets contaminated. 

  • I was listening to Craig Fugate talk at a meeting today and the topic of changing EMS protocols to accept more risk came up. This comes out of Boston where EMS was already on scene and treating patients before law enforcement declared the scene safe. There is discussion at high levels about changing the protocols regarding staging in order to better react to these fast moving incidents. Law enforcement agencies are changing their active shooter protocols from (paraphrasing here) “wait for the team” to “first one to arrive gets in there” because these things tend to be over in 10 minutes, far before a SWAT team or other trained team can arrive. Should it be the same for EMS? By the time a trained tactical EMS team can get there, things are over. So, what should EMS do? Should EMS agree to take on more risk by eschewing staging for a more aggressive response? Do you send EMS in when the shooter is still alive and shooting? Do you wait until the shooting stops but not wait for law enforcement to declare the all clear? I haven’t seen any conversation about this, though I’m sure it’s being had somewhere.

  • Barefoot in MN

    One service I was with had butterfly stickers on the ceiling of their rigs. Another stuck a (toy) stuffed hamster over the cot, between the grab bars & ceiling. It gives the patient something friendly to look at.

  • Eli

    Over the years of being on the Box I have consistently run into the same problem. Whenever a patient becomes combative due to (Confusion, Substance Related, Dementia etc.) the first thing they do is take their seat belts off.

    By doing this I often find myself fighting with the patient and unable to give patient care. My question to you is there something that can be done to restrain the patient in order to help prevent them from hurting themselves (and also allowing faster patient care) and to increase the safety of the Medic.

    Things can go 180 when your in the back of the box by yourself. Please let me know your thoughts and if this is something that you believe will increase the safety of the patient and the medic at the same time.