Ideas from the Field

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.

  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.

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. 

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.