Your lead off equipment on scene...

[stcommodore]

You arrive on scene for a dispatch, what equipment do you bring in?

Do you have calls (ex toe injury) where you or you have seen providers walk in without equipment?

Do you go by the "long and deep" rule where the patient is in a nursing home or high rise for example and you take everything with you (Moniter, 1st in bag/drugs, 02)?

Does your specific squad/department have a rule for this type of situation?

A paramedic I consider a mentor of mine has a phrase that goes something like "without your equipment your nothing but a trained observer" which you can figure obviously means he and I are for bringing anything and everything the dispatch/location calls for.

[JPINFV]

The company I worked for was BLS with an RN/RT CCT program. They were too cheap to provide the units with jump bags, but they had some for mass casualty responses [ambulance strike teams] and I believe the main 911 backup unit had one [it was the only unit with a KED as well]. O2 bag was attached to the frame of the cot with basic wound care supplies and a NRB and NC. "Patient fell, transport to ER for eval" calls sometimes had c-spine supplies taken in, but that was dependent on the crew. We brought in a steth and BP cuff for ER calls, but not for non-emergent transports [discharges, etc].

CCT calls required the approprate equipment [RT=vent and tubing, RN= monitor. The monitor was mounted to the gurney by means of a C-clamp, so there was no need to remove the monitor to transfer the patient to the gurney]. The monitor had first line drugs on a pouch on the top of it with additional supplies carried in the ambulance.

[akflightmedic]

Good thread.

When I worked stateside...

My O2 is always connected to the stretcher or I have an airway bag with everything in it.

The drug bag has BP cuff, steth, pulse ox, and few basic bandaging supplies and 2 IV start kits with 2 bags of fluid as well as the drugs.

The monitor ALWAYS goes.

The bag goes on the stretcher and the stretcher goes with me as close as possible to the patient. I have been burnt by not having the cot or other items with me when it is a "stubbed toe" that turns into a cardiac arrest.

Suction usually rides along too depending on nature of call. I always have a Vvac (hate them) in the airway bag, so occasionally I bring the big dog.

Early in my career, two medics were fired and two others reprimanded for not having suction on scene of a kid with a crushed larynx. No protocol for surg cric at the time and it would not have made a difference. However the county needed a scape goat due to pressure form the parents and they determined that the child's condition could have improved had suction been on scene. Never mind the fact he was hit by a baseball bat in the throat.

I do not allow my partners or students to ever go anywhere empty handed. I try to get them in that mindset before they venture out on their own. Whats the harm of having equipment there and not needing it? At the very minimum, we get a little exercise which benefits us all.

One of my pet peeves is when someone runs ahead of me empty handed.

But yes, everything goes on every call.

I forgot to address policy. We had county policy that at the very minimum, you had to enter with airway bag and monitor on every scene. If you needed something else, FD would fetch it, but usually to present a professional image, we had everything we needed to do our job right there.

[stcommodore]

Add to the equipment the phrase "everybody goes in together" if its just 2 on a crew, 3, 4 or whatever for simply safety does anybody else follow this?

[dahlio]

What about when it comes to carrying devices? No way you can bring a Reeves, Stair Chair, or backboard in to every call. Do you make the best decision you can at the time? Or do you wait to fetch it later?

[akflightmedic]

Those devices you fetch later unless you have knowledge of a patients location. For example a 2 story house and you know the pt is upstairs, you may want to go ahead and have the 3rd set of hands bring it in or your partner fetch it after you go in and make initial contact and determine severity,etc.

If I am responding to a confirmed cardiac arrest, the LSB (backboard) goes on the stretcher and the patient is rolled onto it almost immediately before airway or lines are placed. Less chance of something being yanked by accident.

[suzeg487]

Our situation is a little different. Depending on the call type (extremity pain; fall, etc.) and the town we're dispatched to, the first response is just the BLS squad. In the first-in bag we have bandaging supplies (including trauma) O2 with devices, oral and nasal airways, sterile water, pulse ox, glucose gel, CO monitor, BP cuff and defibrillator. If we need a backboard, splints or stairchair we run out and get it after the patient's been assessed.

The medic is in a different unit and carries all of his ALS supplies separately. We don't always get a medic dispatched and sometimes have to ask for one if the call isn't what was originally stated or turns into an ALS call. Some of the towns we serve have us duel-dispatched with the medic for every call.

Hope this helps.

[AnthonyM83]

FD always brings Airway Bag, Monitor, Drug Box.

If ambulance is first on-scene, we bring Jump Bag (O2 is on gurney), if it's anything where call-type is a cardiac symptom (or is similar...sick, dizzy, ALOC, Sz, arm pain) I'll take the AED.

Any unknown injury or unconscious, I bring backboard.

A good medic has the equipment he needs. I never see a medic going anywhere without his monitor. So, I try never to be found without the equipment I need. If we bring extra, then FD will (usually) carry it back for us.

Transport equipment like stair chair and or soft flat bed is up to the driver to automatically take if we're going up stairs or wait to see patient condition. You have more time to go back and get that stuff while FD does assessment.

[Dustdevil]

It is all dependent upon the scenario, but I generally subscribe to the Johnny & Roy system, which means all necessary equipment goes into the scene with me, and care is initiated where they lie. I've reamed out my share of lazy wankers who think that they're going to do all their care in the ambulance. If it's not acceptable to your agency for you to delay your response times by another five minutes, then it is not acceptable for you to delay your patient care for five minutes either.

Usually I won't take the cot in with me though. That's what firemonkeys are for.

[VeinTapperIam]

Being in Canada (Alberta) things are a little bit different here. We're a Municipal service under the guidance or an ambulance board (aka group of directors) who make the major decisions, but general policy is set by our Medical Director in conjunction with management & the policy committees. We don't have any specific policies that state what should, or shouldn't be brought into a call.

I like the "long & deep" rule, since we not only respond to nursing homes & apartment buildings, but rural homes, native reserves and our international airport as well! Any patient further than 30 seconds from the truck gets all 3 kits brought in. Of course if they need all 3 kits and they're closer than 30 secs, we bring all 3... ooooh you know what I mean! <lol> Even if I don't need the airway kit or monitor, I still need a set of vitals... and all of that eqpt is in my drug box. Like someone said, I'd rather have & not need, than need & not have!!

akflightmedic... I like the backboard idea... on the 9Echo calls (cardiac/resp arrest)... I've always just worked them on the floor and sent a fire guy out to get the board after... but putting them on it right off the bat makes sense.

Good ideas in here!!! [/font:93bf91a1be]