I may have mentioned recently that I started a new part-time job. I'm an EMS coordinator at a local hospital. I'm still keeping my full-time medic job, only I won't be working so much overtime. I haven't written yet about the new job -- I need to think more about the proper way to write about it. I obviously will have to keep the same confidentiality and fair play standards I have tried to keep when writing about EMS calls. In the meantime, the job affects this blog in that it I have less calls to chose from by only working the street 40 hours instead of 60-70, and I have less time to write. I hope to still post at least twice a week with at least one post being street material.
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Today, I'm going to resort to an old trick that served me well as far as material in the past. Instead of posting a comment on another blogger's site, I'm going to use his post to riff on my own.
Again I turn to one of my favorite bloggers, Baby Medic, who recently posted Points of View, a thoughtful account of doing a great job medically, getting a STEMI patient to the cath lab, only to return to his ambulance to receive a "ticket" from a supervisor for not using all five straps (leg, waist, chest with connection to right and left shoulder) to secure the patient on his stretcher.
In general, I sympathize with Baby Medic on this. He did an awesome job, helping save a patient's life only to be met with demerits for not using all the straps. On the other hand, (maybe it is my new position talking), if you have policies, and you are going to enforce those policies, you have to be even-handed about it. You can't ticket only medics you dislike or only medics who provide inferior care if you are going to let medics you like and medics who provide great care get away with violating the policy. And far as policies go, if 5-straps are the safety standard, then you have to encourage the application of that standard.
Again on one hand, I understand the need for patient safety. Heaven forbid, you have a rollover and your patient is not properly secured. On the other hand, had that supervisor witnessed nearly every patient I have brought in for however long back, he wouldn't have enough ticket books to write me up with. I am, you see, a chronic violator of the 5-strap rule.
In fact, in the middle of writing this post, in which I will finally come down on the side of needing to properly secure patients, I did a call (an OD), in which I only used two of the 5 straps. I try not to be a do as I say, not as I do guy, but sometimes, it is what it is.
When I started in EMS in 1989, we only had two straps. Sometime in the early 90's we got three. We went to five sometime back -- I don't know maybe five or six years ago. I had a hard time with that new third strap. I have a really hard time with the 5-straps. By hard, I mean hard time complying, not hard time understanding the need. (I do love the five straps on boarded patients -- keeps them from coming off the board on decelerations).
Here's why it is hard. I work in high volume systems where care is largely provided during transport. Not just rare lights and sirens transports, but routine no L&S emergency transports. I get the patient, I get them in the ambulance, we get on the way to the hospital and I do what I have to do. It is hard for me to properly assess a patient with the five straps on, sitting them up to listen to lung sounds, getting an accurate 12-lead, or keeping them in a comfortable position when they are having a hard time breathing or are nauseous. This isn't to say, it can't be done, it is just often difficult. The same goes with the seat belt around my waist, which I confess I don't wear much either.
Maybe I need to change my ways. Maybe I need to do as much care as possible in the driveway or at curbside, and then when all is done, strap everyone up and say to my partner. We're all set. I do this only on occasion when I have certain unnamed drivers who I deem to be lead-foot, herky-jerky, take-my-life-in-their-hands drivers.
If I do use all five straps, I'll get one of those few movie, or coffee and doughnut coupons I have heard they at times pass out to people who bring in their patients in with the proper straps as a reward incentive. While at the same time, I'll be arriving at the hospital five or ten minutes later than I might have otherwise. In most patients, that won't make a difference, but in a STEMI like Baby Medic's, it may in fact make a big difference.
Years ago I use to work in a hardware factory on an assembly line. They run assembly lines at a speed a little faster than comfortable, which is the most efficient speed. Just enough to keep you working at your peak. Too slow and it is unproductive, too fast and it falls completely apart. We had three bosses -- each of which had different agenda. The time keepers wanted things done the fastest, the quality control person wanted them done the best. And the line supervisor wanted the best done product in the shortest amount of time.
One of our many projects was assembling door knobs and screws on a large paper sheet (30 or so door knobs to a sheet) that was then heat-wrapped and chopped into 30 individual door knob units all ready for sale.
The conflict came when the time keeper was on me or my co-workers to be more efficient in our movements, which to satisfy him, invariably led to poorer quality (the knobs would be laid down slightly off-centered), which caused the line supervisor to get angry because we'd have to rerun the sheet.
Me, I'd just shrug when they yelled at me and say, "I'm doing the best I can." If pressed, I would freely admit I preferred to err on the side of quality. (F- the time keeper.)
We do -- in this job of taking care of people -- the best we can. We need to do our best to do what is best for their safety. In almost all cases that will involve using those troublesome straps. But if I have a STEMI right now and I need a good 12-lead or set of lung sounds or whatever, I can tell you I will likely unsnap those top straps and may not get around to resnapping them. But I will try. I make that resolution today.
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A question has been raised in the comments about how do we know the five point straps are actually safe. I admit I was taking that on faith alone. I have just looked up the web site of the noted ambulance safety expert Nadine Levick and found the following from one of her handouts:
"Firmly secure patients with over the shoulder harnesses. If medically feasible, have them sit as upright as possible for safety."
Here are two links:
Best Practices Interview
Objective Safety Home Page
Check Nadine Levick out, and if you ever get a chance to hear one of her lectures and watch some of her videos on ambulances classes, they will chill you to the bone.
Here's some comments of mine after attending her lecture in Baltimore last year:
Funk
